Abstract
BackgroundCarcinoma of unknown primary site (CUP) is said to account for approximately 3 to 5% of all carcinomas. However, an isolated lesion in the abdominal cavity is rare, and there are no reports describing associated abscess formation.Case presentationA 76-year-old woman had consulted a previous physician complaining of fever and right lower quadrant abdominal pain. Enhanced computed tomography (CT) showed an abscess formation around the cecum. She was treated conservatively with antibiotics, but the symptoms relapsed and she consulted our hospital. Enhanced CT showed a persistent abscess, a tumorous lesion in the mesentery and right hydronephrosis. Because malignancy could not be ruled out, surgical treatment was selected. At laparotomy, encapsulated abscesses were found on the mesenteric side and outside of the ileocecal region. When we raised the ileocecal region, a tumor was found to be fixed to the right ureter, and there was leakage of white, solid tumor content. This tumor content was submitted to intraoperative frozen section diagnosis which revealed a carcinoma. Ileocecal resection with D3 lymph node dissection and retroperitoneal tumor resection was thus performed. There were no abnormal findings in the uterus and adnexa, nor any evidence of peritoneal dissemination. We regarded this case as an incomplete resection and chemotherapy with paclitaxel and carboplatin was administered. The patient has remained alive and disease-free for almost one year since the primary operation.ConclusionWe described a case with mesenteric CUP discovered during surgery for an intra-abdominal abscess. It is necessary to pay attention to treatment-resistant intraperitoneal abscesses as they may accompany a tumor.
Highlights
We described a case with mesenteric Carcinoma of unknown primary site (CUP) discovered during surgery for an intra-abdominal abscess
CUPs are a heterogeneous group of malignant neoplasms with different biological characteristics
An intra-abdominal abscess was diagnosed and the patient was treated conservatively with antibiotics, but her symptoms relapsed after discharge and she was referred to our hospital
Summary
Carcinoma of unknown primary site (CUP) is defined as the presence of metastatic cancer in the absence of an identifiable primary tumor site, even after thorough clinical examination and diagnostic studies. In CUP cases, finding an isolated lesion in the abdominal cavity is rare, and. Case presentation The patient was a 76-year-old woman who had a history of surgery for papillary thyroid cancer and cesarean section with uterus bicornis. She had consulted a previous physician complaining of fever and right lower quadrant abdominal pain. Enhanced CT was performed again and showed a persistent abscess, a tumorous lesion in the mesentery and right hydronephrosis (Figure 1). When we raised the ileocecal region, a tumor was found to be fixed to the right ureter and there was leakage of white, solid tumor content (Figure 2c) This tumor content was submitted to intraoperative frozen section diagnosis, which demonstrated a ‘carcinoma’. The patient has remained well and disease-free for almost one year, to date, since the primary operation
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