Abstract
BackgroundColonic neuroendocrine neoplasms (NENs) are relatively rare tumors with an incidence rate of 0.11–0.21/100,000. NENs account for approximately 0.4% of colorectal neoplasms. Cutaneous metastases of colonic neuroendocrine carcinomas (NECs) are very infrequent, while cases of scalp metastasis are even fewer. Cutaneous metastases are more rare than visceral metastases and usually develop later; therefore, cutaneous metastases as initial distant metastases can be easily overlooked. This is the second case report of a colonic NEC with scalp metastasis. Compared with the previous case, in this instance scalp metastasis developed before visceral metastasis, and the cutaneous lesions were confined to the scalp alone.Case presentationA 62-year-old Chinese man, who had undergone radical surgery for a “locoregional” colonic NEC one and half months before, came to our hospital for adjuvant chemotherapy. We found multiple scalp nodules during physical examination. Moreover, these nodules had occurred and had not been detected prior to the patient undergoing radical surgery. The scalp nodules proved to be metastases from colonic NEC as determined using pathological and immunohistochemical examinations following lumpectomy. After one and half months, visceral metastases were detected in this patient. Ultimately, the patient died two months later.ConclusionsIn this report an unusual case of a colonic NEC with initial distant metastasis confined to the scalp is presented. This case is unusual because of the development of cutaneous metastasis before visceral metastasis. The scalp metastasis were initially overlooked, leading to inaccurate staging and radical surgery that was not curative. This demonstrates that distant metastasis can occur during the early phase of tumor growth in these aggressive lesions. Thus, the possibility of distant metastases should be assessed in the initial work up to avoid mistaken clinical staging especially when distant metastases occur only in skin.
Highlights
Colonic neuroendocrine neoplasms (NENs) are relatively rare tumors with an incidence rate of 0.11–0.21/100,000
In this report an unusual case of a colonic neuroendocrine carcinomas (NECs) with initial distant metastasis confined to the scalp is presented
Functional neuroendocrine tumor (NET) is often accompanied by corresponding neuroendocrine symptoms
Summary
The gastrointestinal tract constitutes the most common site of origin of extra-pulmonary NECs, which can originate anywhere in the gastrointestinal tract [7]. At the time of initial diagnosis, extensive metastases usually do not appear in colonic adenocarcinoma, but distant metastasis often developed in NECs because of its invasive nature When this case was first diagnosed from the CT scan, this patient was considered to have regional disease and underwent radical surgery with curative intent. Hematoxylin-eosin staining showed that in this case the scalp metastasis consisted of small to medium-sized tumor cells arranged in nesting patterns, which were in line with the features of an NEC. Blood levels of platelets and lactate dehydrogenase were strong predictors of survival as well [12] The tumor of this patient, derived from the colon, was extensive with a high Ki-67 index, indicative of a poor prognosis.
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