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Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction
Kamran Ahmed, Robiol Hoque, Sherif El-Tawil, Mohammad S Khan, Mark L George
World Journal of Surgical Oncology , 2008, DOI: 10.1186/1477-7819-6-23
Abstract: We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.The appendix is an uncommon site of gastrointestinal malignancy. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix.There are other clinical presentations and here we report a case of appendicular signet ring cell adenocarcinoma found unexpectedly in a patient who presented to the urologists with urinary symptoms.A 43 years old male presented to the emergency department with a two week history of right lower quadrant pain radiating to the right testis. Baseline blood tests were normal apart from creatinine of 227 (umol/l) and blood in the urine. An intravenous urogram showed bilateral ureteric obstruction with a standing column of contrast in the ureters extending up to the lower one third of the ureters. The patient was transferred to a specialist unit. Re-examination revealed a right iliac fossa mass and a clinically frozen pelvis on digital rectal examination. Cystoscopy and uret
Mucinous adenocarcinoma presenting as an isolated sternal metastasis
Elizabeth Ball, Gareth Morris-Stiff, Mari Coxon, Michael H Lewis
World Journal of Surgical Oncology , 2007, DOI: 10.1186/1477-7819-5-105
Abstract: We report a case of a 68 year old male who was referred to the surgical outpatient clinic with a six month history of sternal pain. The patient was known to have essential thrombocythaemia, which had recently transformed into acute myeloid leukaemia but a sternal biospy showed mucinous adenocarcinoma. He had not localising symptoms and full evaluation failed to localise the primary tumour.Solitary sternal metastases are rare and when found an underlying neoplasm is usually identified allowing targeted treatment. If however, there is no symptomatic tumour, the metastasis should simply be treated symptomatically.As a result of improvements in radiological imaging including cross-sectional and radiopharmaceutical studies, together with refinements in histological assessment of biopsy specimens such as the use of immunostaining, the primary site of a malignancy is usually identified and thus cancer of unknown origin now has an incidence of only 0.5–0.9% amongst all patients presenting with a malignancy [1].Bone is the commonest site for secondary spread of cancer, with 80% of metastases arising from breast, lung and prostatic primary tumours [2]. The metastases are predominantly located in the axial skeleton within the spine, pelvis and ribs. Sternal metastases are rare; no series has been published recording the incidence.A 68 year old male was referred to the surgical outpatient clinic with a six month history of sternal pain. The pain was an intense, continuous burning pain that disrupted his sleep. The patient was known to have essential thrombocythaemia, which had recently transformed into acute myeloid leukaemia. This had been confirmed by a previous marrow biopsy taken from the iliac crest just before the onset of his sternal pain.The patient had lost two stones in weight despite no loss of appetite. There had been no change in his bowel habit. He reported a single episode of rectal bleeding two months prior to his presentation that had been attributed to aspirin
Colonic adenocarcinoma presenting as a cutaneous metastasis in an old operative scar.  [cached]
Wright P,Jha M,Barrett P,Bain I
Journal of Postgraduate Medicine , 2003,
Abstract: Cutaneous metastasis from colon cancer is an uncommon event that usually occurs after identification of the primary tumour and generally indicates diffuse disease. Incisional metastasis occasionally occurs following laparoscopic or open colon cancer resection. However, to the authors′ knowledge only one previous case of colon cancer presenting as a cutaneous metastasis in an old operative scar has been reported. We describe a case of colon cancer presenting as a cutaneous metastasis in an old cholecystectomy scar and discuss possible pathophysiological mechanisms.
Lung adenocarcinoma presenting as a solitary gingival metastasis: a case report
Armando Orlandi, Michele Basso, Mariantonietta Di Salvatore, Francesco Federico, Alessandra Cassano, Carlo Barone
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-202
Abstract: We report the case of a 74-year-old asymptomatic Caucasian woman affected by a rapidly growing, painless gingival swelling. Histopathologic examination of the excisional biopsy showed metastasis of poorly differentiated thyroid transcription factor 1-positive adenocarcinoma. A total-body computed tomographic scan revealed a tumor of the right lung lower lobe with ipsilateral, mediastinal lymph node swelling. Moreover, bone scintigraphy revealed no bone metastases. No other metastases were found, so we planned a multi-modal therapeutic approach with a curative intent. However, the tumor proved to be intrinsically resistant and highly aggressive.The presentation of solitary gingival metastasis is exceptional. In view of its rapid clinical evolution, our case confirms that gingival metastasis is an important prognostic factor. This behavior raises the question whether the poor prognosis for patients with tumors with oral metastases depends on its diffuse spread or on its highly malignant nature.Oral metastatic tumors are rare, comprising approximately 1% of all oral tumors [1]. The jawbones are affected in 90% of the cases, whereas metastases to the soft tissues of the oral cavity occur very rarely and mostly involve the gingiva (54% of soft tissue metastases), followed by the alveolar mucosa or the tongue [2,3]. Metastases may reach the oral cavity hematogenously, mainly through inversion of the venous flow in the cervical Batson's plexus [4]. Alternatively, exfoliating cancer cells might be implanted in the oral mucosa by retrograde spreading along the respiratory tract or by cough [5]. The hyper-vascularization in inflamed periodontal tissues may be a causative factor [6]. In 30% of cases, oral metastasis is the first manifestation of cancer, but it is often a sign of advanced disease with multi-metastatic involvement [7]. In fact, survival after recognition of gingival metastasis ranges from a few weeks to less than six months, with five-year survival lower than 5%
Pulmonary adenocarcinoma presenting with penile metastasis: a case report  [cached]
Karanikas Christos,Ptohis Nikolaos,Mainta Evgenia,Baltas Christos S
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-252
Abstract: Introduction Penile metastases are an extremely rare occurrence, and most primary malignancies are located in the urinary bladder, prostate, rectum, and rectosigmoid. Although very few cases of penile metastases have been reported, those of lung cancer as the primary tumor are very rare. Among the latter, squamous cell carcinomas constitute the majority, whereas adenocarcinomas are almost exceptions. To the best of our knowledge, only two cases have been reported. Case presentation We report the case of a 59-year-old Greek man who presented with persistent cough and chest pain that had started one month prior to a medical appointment. A physical examination, complete laboratory work-up, computed tomography scanning (of the chest, brain, and abdomen), pelvic magnetic resonance imaging, penile ultrasonography, bone scanning, and histological analyses were conducted. Afterward, a lung adenocarcinoma metastatic to the bones, brain, adrenals, lymph nodes, and penis was diagnosed. The primary lesion was a mass of 4cm in diameter in the apical segment of the lower lobe of the right lung. The patient was treated with bone and brain radiotherapy and various cycles of first- and second-line chemotherapy, and partial response was achieved five months after the initial appointment. Conclusions Although these metastatic sites are well known to occur from a primary pulmonary malignancy, penile metastasis is extremely rare. Its identification requires prompt awareness by the physician despite the dismal prognosis. Furthermore, since the penis usually is omitted from the physical examination and lung cancer is the leading cause of cancer-related deaths, more penile metastases may be detected in the future, making early detection and appropriate management of great importance.
Sphenoid Sinus Metastasis as the Presenting Manifestation of a Prostatic Adenocarcinoma: Case Report and Overview of the Literature  [PDF]
I. Puche-Sanz,F. Vázquez-Alonso,J. F. Flores-Martín,H. Almonte-Fernández,J. M. Cózar-Olmo
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/819809
Abstract: Although a metastatic presentation of an occult prostatic adenocarcinoma is not uncommon, the majority of these patients present with bone metastasis affecting the axial skeleton. Cranial metastases to the paranasal sinuses are extremely rare. A 56-year-old man presented with loss of vision and numbness of the right side of the face. Computed tomography (CT) scan and cranial magnetic resonance imaging (MRI) revealed a mass invading the sphenoid sinus. The patient underwent surgery to remove the lesion, and the histopathological examination suggested metastasis of an adenocarcinoma, with positive staining to prostatic specific antigen (PSA). However, serum PSA was 4?ng/mL, and the patient did not report any lower urinary tract symptoms or bone pain. Transrectal ultrasound-guided biopsy revealed prostatic adenocarcinomas with a Gleason score of 8 [4 + 4]. The subsequent treatment consisted of radiotherapy and androgen deprivation, followed by first- and second-line chemotherapy (docetaxel and cabazitaxel) when the disease progressed. The patient achieved a good response with the last cycle of cabazitaxel and after a 5-year followup is currently alive. Cranial metastases of prostate adenocarcinoma are rare, and there is currently no standard treatment for these patients. Whenever possible, surgery combined with radiotherapy and hormonotherapy is the recommended option. 1. Introduction Metastatic tumors to the paranasal sinuses are rare. Kidney (renal cell carcinoma), lung, breast, testis (seminoma), gastrointestinal tract, and thyroid gland are, in order of frequency, the most common locations of the primary tumors that give origin to these metastases [1–3]. The sphenoid sinus is the most frequently involved, followed by the maxillary. In spite of the fact that a metastatic presentation of an occult prostatic carcinoma is not uncommon, the vast majority of these patients present with bone metastasis affecting the axial skeleton. Metastasis to the sphenoid sinus is an extremely rare event with less than 10 documented cases reported in the English literature [4]. We present an uncommon case of prostatic adenocarcinoma presenting with an extensive sphenoid sinus metastasis that, unlike the previous cases reported so far, has responded well to treatment and has achieved a long survival. 2. Case Report A 56-year-old male with no previous medical history of interest presented with a chief complaint of gradual right vision loss and numbness of the right side of the face. Computed tomography (CT) scan and cranial magnetic resonance imaging (MRI) revealed a 4.5 ×
Case Report: Uterine Adenocarcinoma Metastasis to the Skull Base and Cervical Spine Presenting with Pathological Fracture and Myelopathy  [PDF]
Paul E. Kaloostian, Han Chen, Martina Stippler
Open Journal of Modern Neurosurgery (OJMN) , 2013, DOI: 10.4236/ojmn.2013.33007
Abstract:

Objective: The authors report a rare case of uterine adenocarcinoma metastasis to both the skull base and cervical spine presenting with pathological fracture and myelopathy. Methods: We report the case of a 43-year-old Asian female with widely metastatic uterine adenocarcinoma who over the course of 3 years was diagnosed with a large clival mass and more recently a cervical spine pathological fracture presenting with myelopathy. Results: This patient underwent multiple procedures over a three-year period, including total hysterectomy with tumor debulking, endonasal biopsy of clival mass and most recently cervical corpectomy and fusion. She has received chemotherapy and radiation therapy for treatment of the unresectable clival mass and has done quite well despite having this pathology. Conclusion: This is the first documented case of clival involvement of endometrial adenocarcinoma. Additionally, this is a unique case of spinal metastatic endometrial adenocarcinoma presenting with pathological fracture and myelopathy.

Adenocarcinoma of the Appendix  [PDF]
Moussa Sylla, Pierlesky Elion Ossibi, Somuah Tenkorang, Ismael Dandakoye, KarimIbn Majdoub, Imane Toughrai, Said Ait Laalim, Khalid Mazaz
Surgical Science (SS) , 2018, DOI: 10.4236/ss.2018.93012
Abstract: Objective: To report the experience of our department on adenocarcinoma of the appendix through a series of six (6) cases. Materials and Methods: This is a retrospective study carried out from January 2010 to June 2015 collating all cases of adenocarcinoma of the appendix diagnosed at the department of visceral surgery B in Hassan II University Hospital in Fez. Results: Six cases of adenocarcinoma of the appendix were recorded during the determined period of study. The mean age was 54.67 ± 16.99 years with the extreme ages ranging from 28 to 78 years. There was a female predominance with a sex ratio of 2. All patients had no specific medical history. The revealing symptoms were the following: appendicitis syndrome (1 case), bowel obstruction (1 case), psoas abscess (1 case) and fortuitous discovery during laparotomy for another problem (3 cases). The following histological types found were: colloid adenocarcinoma (3 cases), mucinous adenocarcinoma (2 case), mucinous cystadenocarcinoma associated with a moderately differentiated adenocarcinoma of the appendix (1 case). The surgical procedure consisted of a right hemicolectomy in 3 patients. Appendectomy followed by a right hemicolectomy and drainage of psoas abscess was performed in two patients. Palliative ileocecal resection and Bouilly-Volkmann ileocolostomy was performed in one patent who had carcinosis. All patients received adjuvant chemotherapy. The following occurred during follow-up: carcinosis (2 patients), a locoregional recurrence (2 patients). Two patients never returned for follow-up. Conclusion: Tumor of the appendix is a rare and exceptional pathology. These tumors are generally discovered fortuitously or during histology of appendectomy specimens. The treatment is usually surgical.
Sphenoid Sinus Metastasis as the Presenting Manifestation of a Prostatic Adenocarcinoma: Case Report and Overview of the Literature
I. Puche-Sanz,F. Vázquez-Alonso,J. F. Flores-Martín,H. Almonte-Fernández,J. M. Cózar-Olmo
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/819809
Abstract: Although a metastatic presentation of an occult prostatic adenocarcinoma is not uncommon, the majority of these patients present with bone metastasis affecting the axial skeleton. Cranial metastases to the paranasal sinuses are extremely rare. A 56-year-old man presented with loss of vision and numbness of the right side of the face. Computed tomography (CT) scan and cranial magnetic resonance imaging (MRI) revealed a mass invading the sphenoid sinus. The patient underwent surgery to remove the lesion, and the histopathological examination suggested metastasis of an adenocarcinoma, with positive staining to prostatic specific antigen (PSA). However, serum PSA was 4 ng/mL, and the patient did not report any lower urinary tract symptoms or bone pain. Transrectal ultrasound-guided biopsy revealed prostatic adenocarcinomas with a Gleason score of 8 [4
A Case of Gastric Adenocarcinoma with Rectal Metastasis in the Form of Linitis Plastica Presenting as Primary Rectum Carcinoma
Sernaz Uzunoglu,Irfan Cincin,Hakan Karagol,Ozgur Tanriverdi
Trakya Universitesi Tip Fakultesi Dergisi , 2008,
Abstract: It is often reported that metastases in the form of linitis plastica developed in the gastrointestinal system are rare cases and frequently the primary tumor is located in the stomach. We presented a case of gastric adenocarcinoma developing a metastasis in the rectum in the form of linitis plastica, which appeared as a primary local advanced rectum cancer. We discussed the clinical, radiological, and pathological characteristics of the intestinal metastases of gastric adenocarcinomas.
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