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Akhtar S, Khan Q, Rehman A, Khalid MW, Siddique K. A Rare Case of Cutaneous Metastasis of Unresectable Rectal Adenocarcinoma. Cureus 2024; 16:e51550. [PMID: 38313923 PMCID: PMC10835020 DOI: 10.7759/cureus.51550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common malignancy. Common metastatic sites for colorectal carcinoma are the lung and liver while cutaneous metastases are extremely rare. Skin metastasis may be an early manifestation of metastatic disease and represents a poor prognosis. Here we present a case of metachronous skin metastasis during chemoradiation treatment in a patient with locally advanced rectal cancer. A young boy aged 19 years presented to our hospital with radiological TNM staging of T3c N1 M0 with circumferential resection margin (CRM) involved. The treatment plan was defunctioning colostomy with neoadjuvant chemotherapy and radiotherapy with a later plan for surgery. Seven months later, there is a focal skin nodule in the nape of the neck. A core biopsy of this cutaneous nodule was done and proved metastatic. Surgery for the primary tumor and oligometastatic site was planned but due to extensive primary tumor, surgery was terminated and continues with chemotherapy and reassessment.
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Affiliation(s)
- Sana Akhtar
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Quratulain Khan
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Anis Rehman
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Muhammad W Khalid
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Kashif Siddique
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
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2
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van Dam KAM, Tweed TTT, de Vries B, Belgers HJ. Peristomal adenocarcinoma 16 years after colorectal adenocarcinoma resection with curative intent. J Surg Case Rep 2023; 2023:rjad419. [PMID: 37485497 PMCID: PMC10359180 DOI: 10.1093/jscr/rjad419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
Metachronous colorectal cancer is relatively rare, occurring in 0.7-3.6% of patients diagnosed with colorectal adenocarcinoma. Cutaneous metastases are similarly a rare presentation, occurring in <6% of metastatic colorectal cancer patients. Even more rare are the cutaneous recurrences at the peristomal site. Clinically, it is difficult to distinguish between metachronous cancer and cutaneous metastases. This paper reports a case of an elderly woman presenting with a slowly progressing peristomal cutaneous lesion 16 years after surgical resection for colorectal cancer. Core punch biopsy revealed a cutaneous localization of an intestinal type of adenocarcinoma. A surgical resection of the peristomal area was carried out whereby a new colostomy was created on the contralateral side. Definite histopathological examination showed a superficially located intestinal type adenocarcinoma with extensive pagetoid spread in the epidermal surface. In conclusion, it is important to remain alert and strive for early detection for cutaneous abnormalities following colorectal cancer.
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Affiliation(s)
- Kayleigh A M van Dam
- Correspondence address. Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands. Tel. +31 (0) 618705361; Fax: 088-4597975; E-mail:
| | - Thaís T T Tweed
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Bart de Vries
- Department of Pathology, Zuyderland Medical Center, Sittard-Geleen and Heerlen, the Netherlands
| | - Henricus J Belgers
- Department of Surgery, Division of Gastro-intestinal Surgery, Zuyderland Medical Center, Sittard-Geleen and Heerlen, the Netherlands
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3
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An unusual case of irregular mass around the anus. Asian J Surg 2022; 45:2291-2292. [PMID: 35599130 DOI: 10.1016/j.asjsur.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
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4
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Fong SH, Narasimha N, Thakkar R, Misra S, Thakkar D. A rare isolated cutaneous metastatic mass after colon cancer resection. J Surg Case Rep 2021; 2021:rjab571. [PMID: 34992768 PMCID: PMC8718370 DOI: 10.1093/jscr/rjab571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
Metastatic cutaneous lesions from colorectal in origin are extremely rare, and especially without any visceral metastasis. Due to its poor response to chemotherapy, it is a poor prognostic indicator with a 1–6 month(s) death rate. Routine screening colonoscopy should be highly encouraged. This case is about a patient with obstructing, bleeding right colon mass and metastatic cutaneous soft tissue mass postcolonic mass resection. The biology and the mechanism of these metastatic lesions are not well understood, and they can be mistaken with any other primary soft tissue malignancy.
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Affiliation(s)
- Suysen Hung Fong
- Brandon Regional Hospital, HCA Healthcare/USF Morsani College of Medicine GME, Brandon, FL 33511, USA
| | - Neethi Narasimha
- Brandon Regional Hospital, HCA Healthcare/USF Morsani College of Medicine GME, Brandon, FL 33511, USA
| | - Rishabh Thakkar
- Brandon Regional Hospital, HCA Healthcare/USF Morsani College of Medicine GME, Brandon, FL 33511, USA
| | - Subhasis Misra
- Brandon Regional Hospital, HCA Healthcare/USF Morsani College of Medicine GME, Brandon, FL 33511, USA
| | - Darshan Thakkar
- Brandon Regional Hospital, HCA Healthcare/USF Morsani College of Medicine GME, Brandon, FL 33511, USA
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AlSubait NA, BinJadeed HF, AlSaleh MR, AlFaifi FS, AlSaif FM, Arafah MA. Dermoscopy of scalp cutaneous metastasis of sigmoid adenocarcinoma. JAAD Case Rep 2021; 14:116-119. [PMID: 34337122 PMCID: PMC8318904 DOI: 10.1016/j.jdcr.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Norah A. AlSubait
- Department of Dermatology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Hessah F. BinJadeed
- Department of Dermatology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Muneera R. AlSaleh
- Department of Dermatology, King Khalid University Hospital, Riyadh, Saudi Arabia
- Correspondence to: Muneera R. AlSaleh, MD, Department of Dermatology, College of Medicine, King Saud University, King Abdullah Street, Riyadh 12372, Saudi Arabia; and King Khalid University Hospital, Riyadh 12372, Saudi Arabia.
| | - Fawziyah S. AlFaifi
- Department of Dermatology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Fahad M. AlSaif
- Department of Dermatology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Mariah A. Arafah
- Department of Pathology, King Khalid University Hospital, Riyadh, Saudi Arabia
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Faye PM, Cagniet A, Abousarhan F, Jolidon C. Atypical localization of colorectal cancer metastasis one case and literature review. Int J Surg Case Rep 2020; 77:18-21. [PMID: 33137665 PMCID: PMC7610026 DOI: 10.1016/j.ijscr.2020.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/17/2020] [Accepted: 10/17/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION colorectal cancer is a public health challenge in France. Cutaneous metastases are rare but they give evidence of poor prognosis. PRESENTATION OF CASE 88 years old female patient, with a previous history of hysterectomy, venous thrombosis outcomes of ankle fracture and stable multiple sclerosis without treatment. She came to emergency with peritonitis. CT scan showed a pneumoperitoneum, and a transverse colonic mass. A laparotomy was performed. This revealed a perforation of caecum, and an obstructive tumor of transverse colon. An extended right semi-colectomy was performed to remove both the perforate caecum and the tumor. The patient was discharged on the 7th post-operative day. Examination confirm an adenocarcinoma pT3N0Mx. At follow up, a nodule was found on her forehead. The biopsy showed a metastasis of colon adenocarcinoma. A surgical resection was performed. To date the patient is well with no evidence of recurrent disease. CONCLUSION Cutaneous metastases are rare and there are no recommendations for their treatment. Surgical resection is the best choice, but radiotherapy may be an alternative.
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Cutaneous Metastasis in the Setting of Both Colon and Breast Primary Malignancies. Case Rep Gastrointest Med 2020; 2020:8852459. [PMID: 33062353 PMCID: PMC7542512 DOI: 10.1155/2020/8852459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in the United States, and many patients unfortunately have metastases at the time of their diagnosis. Cutaneous metastases of CRC have been reported in few journals and primarily as case reports due to their rarity. Here, we present the case of an 83-year-old woman with recently resected colon cancer, T4aN1bMx stage IIIB. She presented to our clinic for evaluation of a right midback mass, and a punch biopsy revealed dermal involvement by invasive, poorly differentiated carcinoma with epidermoid features. The mass was excised, and we ordered a PET scan in search of the primary tumor, which at that time was suspected to be of skin cancer origin. Surprisingly, this revealed a second malignancy triple-negative invasive ductal carcinoma of the left breast. The back mass stained positive for CK20, which was compatible with a metastasis from a colonic primary. After initially declining adjuvant therapy, the patient completed one cycle of capecitabine and oxaliplatin, which she tolerated poorly. She continued to further decline, developed widespread cutaneous metastases, and went home on hospice. Cutaneous lesions are an exceedingly rare site of metastasis for colon adenocarcinoma, and their clinical presentation can vary widely. It is important for providers to investigate any new skin lesion in a patient with a recent or remote history of malignancy, even if there were no sites of distant metastasis at initial diagnosis.
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Yang Y, Chen R, Zhang R. Cutaneous metastasis of a colon adenocarcinoma presenting as an unusual manifestation: a report of one case. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1897-1901. [PMID: 32782720 PMCID: PMC7414491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
Colorectal cancer has a low probability of metastasizing to the skin, usually < 6%, and the common sites of metastasis are the liver and lungs. Skin metastases usually occur within 2 years of the discovery of the primary tumor. Here we report a case in which the skin lesions were mainly characterized by unilateral scattered papules and "fake blisters". The patient was initially misdiagnosed with lymphoma and was ultimately diagnosed with metastatic colorectal cancer through pathology.
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Affiliation(s)
- Yuhua Yang
- Department of Dermatology, The Third Affiliated Hospital of Soochow University Changzhou, China
| | - Renhe Chen
- Department of Dermatology, The Third Affiliated Hospital of Soochow University Changzhou, China
| | - Ruzhi Zhang
- Department of Dermatology, The Third Affiliated Hospital of Soochow University Changzhou, China
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Liao L, Cheng Q, Zhu G, Pei F, Ye S. Cutaneous metastasis of ascending colon cancer harboring a BRAF V600E mutation: A rare case report. Medicine (Baltimore) 2020; 99:e20026. [PMID: 32481270 PMCID: PMC7249915 DOI: 10.1097/md.0000000000020026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Cutaneous metastases from colorectal cancer are extremely rare and generally appear several years after diagnosis or resection of the primary colorectal tumor. Although cutaneous metastasis is unusual, it often indicates a poor prognosis. PATIENT CONCERNS We treated a 62-year-old woman with multiple cutaneous metastatic nodules on the chest, back, and armpit 7 months after resection of ascending colon cancer. DIAGNOSES The patient was diagnosed with cutaneous metastasis of ascending colon cancer with BRAF V600E mutation. INTERVENTIONS After 6 cycles of fluorouracil, leucovorin, oxaliplatin, cetuximab, and emurafenib, most of the metastatic lesions had begun to shrink, and no new metastases were observed. Serum tests showed that the levels of several tumor markers were decreased. OUTCOMES The patient responded well to treatment and survived for 6.5 months after presentation with skin metastasis. LESSONS Cutaneous metastasis of colorectal cancer with BRAF V600E mutation is a rare but important phenomenon that should not be ignored. Cutaneous metastasis of colorectal cancer frequently indicates advanced disease and poor prognosis. The SWOG 1406 program is one of the treatment options, but this needs further exploration.
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Affiliation(s)
- Lianggong Liao
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology, Huazhong
- Colorectal Cancer Clinical Research Center of Wuhan
- Colorectal Cancer Clinical Research Center of Hubei Province, 116 Zuodaoquan South Road, Wuhan, Hubei, China
| | - Qian Cheng
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology, Huazhong
- Colorectal Cancer Clinical Research Center of Wuhan
- Colorectal Cancer Clinical Research Center of Hubei Province, 116 Zuodaoquan South Road, Wuhan, Hubei, China
| | - Guangsheng Zhu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology, Huazhong
- Colorectal Cancer Clinical Research Center of Wuhan
- Colorectal Cancer Clinical Research Center of Hubei Province, 116 Zuodaoquan South Road, Wuhan, Hubei, China
| | - Feng Pei
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology, Huazhong
- Colorectal Cancer Clinical Research Center of Wuhan
- Colorectal Cancer Clinical Research Center of Hubei Province, 116 Zuodaoquan South Road, Wuhan, Hubei, China
| | - Shengwei Ye
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology, Huazhong
- Colorectal Cancer Clinical Research Center of Wuhan
- Colorectal Cancer Clinical Research Center of Hubei Province, 116 Zuodaoquan South Road, Wuhan, Hubei, China
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Hakami R, Alali MN, Alshammari T, AlShammari S, Alyahya Z, Ayesh M, AlSaad K, Abduljabbar A. A cutaneous metastasis of unresectable rectal adenocarcinoma: A case report and literature review. Int J Surg Case Rep 2020; 71:95-101. [PMID: 32446230 PMCID: PMC7243000 DOI: 10.1016/j.ijscr.2020.04.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022] Open
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer death in the world. Approximately, 0.8% of patients will present with skin lesion as the first sign of a silent internal malignancy as skin metastasis without visceral metastasis is rare in CRC. A comprehensive literature review (including clinical features of patients, management, and outcome) covering all reported cases of cutaneous metastasis secondary to rectal cancer was included for better understanding of the disease.
Background Colorectal cancer is ranked third among the most commonly diagnosed malignancies and fourth among the leading causes of cancer death in the world. However, only a few case reports are found in the literature regarding skin metastasis originating from rectal cancer, which usually shows widespread disease and poor prognosis. Approximately, 0.8% of the patients will have skin lesion as the first indication of a silent internal malignancy, which is rare. Case report We report a complicated case of a 45-year-old male patient who referred to our highly specialized governmental hospital for diversion loop colostomy as well as biopsies of rectal and inguinal skin areas followed by palliative radiation therapy to the pelvis. Histopathological exam of rectal biopsies revealed moderately differentiated rectal adenocarcinoma, while the skin of the right inguinal area showed metastatic cutaneous rectal adenocarcinoma. Unfortunately, palliative radiation therapy was not started as the patient passed away secondary to respiratory failure which ended by cardiopulmonary arrest. Conclusion A patient who is having new or evolving skin lesions with an oncology history should be well investigated as cutaneous metastasis is a strong possibility.
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Affiliation(s)
- Riyadh Hakami
- Department of Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Mohammed N Alali
- Department of Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Turki Alshammari
- Department of Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Sulaiman AlShammari
- Department of Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Zyad Alyahya
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Mohammed Ayesh
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Khaled AlSaad
- Department of Radiology and Medical Imaging, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Alaa Abduljabbar
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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