Oligometastatic deposits of prostate cancer found within the sigmoid pericolic fat that was resected for colonic adenocarcinoma: a case report

BACKGROUND

Prostate cancer may rarely metastasize to the colon and colonic lymph nodes, and local treatment of oligometastatic deposits may improve oncological outcomes. Immunohistochemical stains are used to determine the most likely source of metastatic deposits when they are seen within surgical specimens. The aim of this case report is to illustrate how such techniques were used to identify unexpected prostatic metastases within the pericolic fat of a sigmoid colon resection specimen following elective curative surgery for colorectal cancer. To our knowledge, this is the first report of complete excision of oligometastatic deposits of prostate cancer found incidentally within the specimen of another cancer.

CASE REPORT

An 89-year-old Caucasian man underwent sigmoid colectomy for an obstructing colorectal cancer in the sigmoid colon with some mesenteric lymphadenopathy. He had previously received radical radiotherapy for prostate cancer 10 years earlier. When the specimen was examined by the histopathologist, it was noted that the pericolic fat adjacent to the colorectal adenocarcinoma contained some metastatic deposits. Positive immunohistochemical staining for prostate-specific antigen and prostate-specific acid phosphatase with negative staining for CDX2 and CK20 revealed these to be prostatic metastases rather than colonic. Since these were completely excised, and there were no other metastases, this represented a serendipitous, curative excision of oligometastatic deposits of an additional cancer to the one that was being treated.

CONCLUSIONS

This case illustrates how immunohistochemical staining may be used to distinguish the source of metastatic deposits based on the likelihood of primary tumor from a careful and thorough patient history.

Sacral nerve stimulation for the treatment of faecal incontinence secondary to a pelvic war injury: a case report

Faecal incontinence can be physically and socially disabling and the level of unmet need in men appears to be high. We report a case of faecal incontinence in a 29-year-old, heterosexual serviceman who sustained a trans-pelvic gunshot injury (without perineal injury) while on active duty. Despite apparently successful surgical treatment, the patient presented to our colorectal department 7 years after injury with disabling faecal incontinence. Following assessment, sacral nerve stimulation (SNS) was initiated with excellent results. We report the successful use of SNS to treat faecal incontinence resulting from a combat gunshot injury. We recommend that surgeons carefully document the anatomical position of retained ballistic fragments after gunshot or blast fragment injury and that attention should be paid to the functional results in a patient's follow-up after intestinal surgery.