Abdominal Wall Metastasis Research Articles

General principles for the prevention and treatment of complications of percutaneous endoscopic gastrostomy (review of literature)

We considered the views of researchers presented in the modern literature on both the problem as a whole and discussion questions regarding the causes of development, preventive measures, and methods of treating percutaneous endoscopic gastrostomy complications, such as clogging of the gastrostomy tube, peristomal wound infections, necrotic fasciitis, pneumoperitoneum, buried bumper syndrome, growth of granulations in the gastrostomy zone, postoperative bleeding and intraparietal hematoma of the gastric wall, traumatic dislocation of the gastrostomy tube, peritonitis after percutaneous endoscopic gastrostomy, peristomal leakage, сolonic fistula, liver injury and abdominal wall metastasis at the percutaneous endoscopic gastrostomy site.

Abdominal Wall Metastases from Ovarian Cancer: Should It Be Considered an Advanced Stage?

Background: Patients (pts) with abdominal wall metastasis(AWM) as metastatic lesion outside of the abdominal cavity are classified as tumor stage FIGO IVB.

1615 Rare Case of Abdominal Wall Metastasis Secondary to Colon Cancer

INTRODUCTION: Colorectal cancer(CRC) with direct abdominal wall and skin invasion is an extremely rare finding. We present a unique case of CRC with an oligometastatic lesion in the abdominal wall. CASE DESCRIPTION/METHODS: Patient is a 56-year-old male who presented to the gastroenterology clinic with 2 months of constipation and hematochezia, in the absence of melena,weight loss, anorexia and abdominal pain. A screening colonoscopy revealed severe stenosis in the descending colon(50 cm proximal to the anus) with inability to further advance the scope. This area was biopsied and tattooed; pathological diagnosis was confirmed to be moderately differentiated adenocarcinoma.Tumor markers were negative and CT of the abdomen/pelvis was done which showed lymphadenopathy around the descending colon with no evidence of metastasis. 2 weeks later he underwent a robotic-assisted left colon resection with intracorporeal anastomosis, with no immediate postoperative complications.The histopathology of the resected mass was consistent with the initial biopsy findings and lymph nodes were negative for malignancy. Patient underwent adjuvant chemotherapy with capecitabine and oxaliplatin for 4 cycles which was well tolerated.A year later he developed a slowly progressive asymptomatic mass in the right abdominal wall.CT of the abdomen revealed a focal soft tissue mass measuring 3 × 3cm, involving the right lower anterolateral abdominal wall and rectus abdominis muscle.CT guided biopsy revealed metastatic adenocarcinoma consistent with primary CRC. PET scan was devoid of any metastatic or recurrent disease in other locations. Hence proceeded with resection of the mass and mesh placement for the abdominal wall defect. Patient tolerated the procedure well. The follow up scans have shown no evidence of recurrence or metastatic disease, and patient is symptom free. DISCUSSION: CRC often metastasizes to regional lymph nodes,liver, lung or bone via lymphatic and hematogenous routes. Abdominal wall metastasis is very rare and can be caused by direct invasion, lymphatic or hematogenous routes, and direct cancer cell implantation during prior surgical intervention which is the probable source in our patient. Laparoscopic resection is a feasible treatment option for solitary abdominal wall metastasis along with the advantage of assessing the abdomen for other metastases; especially in patients with advanced CRC who are at higher risk of developing fatal complications like peritoneal dissemination that may affect management.

Metastasectomy for visceral and skeletal oligorecurrent prostate cancer.

Metastasis direct therapy (MDT) is a common practice in different fields of oncology. However, there is a lack of data on surgical MDT in visceral/skeletal oligometastatic prostate cancer (PCa). We aimed to assess the role of surgical excision of visceral and skeletal PCa recurrence. Seventeen PCa patients experienced metachronous visceral or skeletal oligometastatic recurrence following maximal local treatment. Oligometastatic recurrence was defined as 1-3 lesions, detected with the best imaging technique available at the time of diagnosis. All patients underwent metastasectomy and were followed for a median of 43months. Postoperative complications were graded using the Clavien-Dindo classification of surgical complications. Kaplan-Meier plots were used to assess overall survival. Fourteen patients (82%) had visceral lesions, two had bone lesions (12%), and one had an abdominal wall metastasis (6%). Four patients (24%) were under active ADT at the time of metastasectomy. PSA decreased after metastasectomy in 16 (94%) patients. Ten (77%) of the 13 ADT-naïve patients had a PSA decrease of ≥ 50%. Following metastasectomy, 16 (94.1%) patients developed metastatic recurrence of which 11 (64.7%) were again oligometastatic, amenable for repeated MDT. The median time to metastatic recurrence was 14months (range 6.4-40). We observed 8% Clavien-Dindo grade 3-4 complications in 21 procedures. In this report, we analyzed the outcomes of surgical excision of visceral and skeletal PCa recurrence following primary treatment. We found that removing metastasis to the bone and viscera can be associated with long-term disease-free periods at a low rate of serious complications. These exploratory results should be confirmed in prospective studies.

Ultrasound-Guided 125I Seed Implantation in Treatment of Abdominal Wall Metastases

Background: The treatment of abdominal wall metastasis presents a challenge, because resection can be followed by poor healing and external radiotherapy is associated with serious adverse events. This study aimed to evaluate the efficacy and safety of interstitial 125I seed implantation under ultrasound (US) guidance for treating abdominal wall metastasis. Materials and Methods: The cases of 21 patients with 28 abdominal wall metastases who received brachytherapy with 125I seeds at the department from August 2010 to March 2015 were retrospectively reviewed. 125I seeds were implanted in the abdominal wall lesions under US guidance and with the help of a treatment planning system. Follow-up was performed using computed tomography at 1 d and at 3, 6, and 12 months after implantation. The lymphocyte count before the surgery was compared with the 3-month postoperative count. The main indicators observed were changes in tumor size, side effects, and complications. Results: All 21 patients were successfully treated with 125I seed implantation under US guidance. The median follow-up since 125I seed implantation was 15 months (range 6-23 months). The response rates and local tumor control after 3, 6, and 12 months were 78.6% and 89.3%, 64.3% and 85.7%, and 52.4% and 71.4%, respectively. The mean preoperative lymphocyte count was 0.262 ± 0.117 × 109/L, which did not differ significantly from the postoperative count, which was 0.259 ± 0.094 × 109/L (p = 0.122). Procedure-related complications included fever, bleeding, and pain, but all these were Grade 1-2. No severe side effects or complications were noted. Conclusions: Percutaneous interstitial implantation of 125I seeds under US guidance is safe and feasible for abdominal wall metastases. However, its long-term efficacy requires further investigation.

Metachronous metastasis to inguinal lymph nodes from sigmoid colon adenocarcinoma with abdominal wall metastasis: a case report

BackgroundInguinal lymph node metastasis from rectum is uncommon but well-known occurrence, whereas that from colon adenocarcinoma is extremely rare. Inguinal lymph node metastasis from colon adenocarcinoma has only been reported in previous cases involving primary tumor invasion of the abdominal wall, or in those involving colon cancer metastasis to external iliac lymph nodes. We describe a case of inguinal lymph node metastasis from colon cancer without primary tumor invasion to the abdominal wall.Case presentationA 42-year-old female, who had undergone twice cesarean sections before, underwent open sigmoidectomy for sigmoid colon adenocarcinoma and received 12 cycles of FOLFOX regimen as adjuvant chemotherapy. Two years after sigmoidectomy, a follow-up CT scan revealed enlarged inguinal lymph nodes as well as growth of enhanced mass lesions on the abdominal wall at site of the cesarean section scar. Biopsy of both lesions revealed well-differentiated adenocarcinoma, and immunohistochemistry demonstrated positive expression of CDX2, substantiating its gastrointestinal origin. We therefore performed dissection of left inguinal lymph nodes and mass lesion of the abdominal wall. The patient died 51 months after lymph node dissection.ConclusionsThis is the first reported case of inguinal lymph node metastasis from colon cancer without invasion of the primary tumor to the abdominal wall or without involvement of the external iliac lymph nodes, suggesting that the pathway of inguinal metastasis originated from the abdominal wall metastasis. When inguinal lymph node metastasis from colon cancer is suspected, if an R0 resection was possible, inguinal lymph node dissection may be a potentially effective treatment.

Exsanguinating Hemorrhage from an Anterior Abdominal Wall Metastasis of an Asymptomatic Renal Cell Carcinoma.

Renal cell carcinoma is the most frequently encountered urological malignancy and accounts for 3% of all adult malignancies. The classically described triad of hematuria, palpable mass, and flank pain is rarely encountered, and most patients are diagnosed by screening done for other reasons. It is notorious for unusual sites of metastatic spread. We present a case of an asymptomatic renal cell carcinoma that presented as an anterior abdominal wall swelling and its neglect led to ulceration, and torrential and exsanguinating hemorrhage to which the patient succumbed.

Tumor Seeding after Open Nephroureterectomy for Ureteral Transitional Cell Carcinoma

Skeletal muscle metastases following cancer surgery are rare. Few cases of abdominal wall metastasis have been reported in the literature and attributed to tumor seeding after laparoscopic surgery or percutaneous nephrostomy. We report a case of abdominal tumor seeding after open nephroureterectomy managed by means of a surgical and medical approach.

Abdominal Wall Metastasis as the First Clinical Manifestation of Pancreatic Adenocarcinoma: A Case Report

Introduction: Pancreatic cancer has been described in the literature to metastasis to wide verity of organs, but we were unable to find a case reported metastasis to the abdominal wall pre-operatively. Therefore, we present the first case of abdominal wall metastasis as the first clinical presentation in a virgin abdomen to our knowledge. Case Presentation: A 55 years old gentleman presented to our hospital for evaluation of a para-umbilical mass. The mass was measuring 6 × 4 cm in the right upper side of the umbilicus, hard in consistency with distinct edges, and mildly tender. The histopathology findings of ultrasound guided biopsy of the abdominal wall mass were consistent with metastatic poorly differentiated adenocarcinoma of pancreaticobiliary origin. Conclusion: Abdominal wall mass could be the presenting symptom of metastatic pancreatic cancer.

Risk of tumor implantation in percutaneous endoscopic gastrostomy in the upper aerodigestive tumors.

Percutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive head, neck and esophageal tumors. Tumor cell implantation is a rare complication in patients with aerodigestive cancers, who have undergone PEG tube placement. The objective of this review is to determine the incidence and contributing risk factors leading to the implantation of metastases into the abdominal wall following PEG placement. A comprehensive review of the literature in PUBMED (2008-2018) was performed. The literature search revealed reports of more than 50 cases of abdominal wall metastases after PEG placement. As most of these studies were case reports, the exact rate of metastasis remains unknown. Generally pharyngoesophageal location of primary cancer (100%), squamous cell histology (98%), poorly differentiated tumor cells (92%), advanced pathological stage (97%), and large primary cancer size were identified as strong risk factors for the development of stomal metastasis. Abdominal wall metastases following PEG placement are a rare but serious complication in patients with head and neck malignancy. (www.actabiomedica.it)

Prostate Cancer with Cutaneous Abdominal Wall Metastasis: A Case Report

Prostate Cancer with Cutaneous Abdominal Wall Metastasis: A Case Report

Is Transvaginal Core Needle Biopsy A Safe Method in Diagnosis of Ovarian Cancer?

Background: The optimal management of highly invasive ovarian cancer has changed from adjuvant chemotherapy after surgery to neoadjuvant chemotherapy followed by interval debulking surgery. Generally, tissue specimen for definitive diagnosis of ovarian malignancy is necessary. However, abdominal wall metastasis is a complication, known as transabdominal ascites aspiration or percutaneous core needle biopsy. When neoadjuvant chemotherapy is indicated, transvaginal core needle biopsy under sonographic guidance provided enough tissue specimens. In addition, resection of most of upper vaginal wall during surgery prevents needle site metastasis. The aim of this study is to evaluate transvaginal core needle biopsy as a safe method for diagnosis of ovarian cancer. Methods: This clinical trial study was performed on patients who were candidate for neoadjuvant chemotherapy and were referred to gynecology oncology department of Ghaem Hospital, Mashhad University of Medical Sciences during 2014 to 2015. Results: Twelve women with a presumptive diagnosis of stage III c or IV ovarian cancer were selected. Adequate sample was obtained by transvaginal core needle biopsy, and cancer diagnosis was confirmed in all cases. This procedure resulted in optimal debulking surgery in 2 /3 of cases. Conclusions: Transvaginal core needle biopsy is a safe diagnostic method of ovarian cancer.

Gastric Metastasis of an Ovarian Granulosa Cell Tumor (GCT) Diagnosed in a Patient Presenting With Worsening Reflux

GCT is a rare sex cord-stromal tumor and constitutes approximately 2-3% of all ovarian malignancies. Adult GCT accounts for 95% of all GCTs. Distant metastases from GCT are rare and to the best of our knowledge this is the first reported case of gastric metastasis from GCT presenting as multiple gastric polyps. 60-year-old female with history of reflux, hypertension, inferior vena cava thrombus on lovenox, granulosa cell tumor diagnosed 2 years ago s/p Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy, omental biopsy showing T1a NX M0 adult granulosa cell tumor presented to GI clinic with worsening reflux symptoms and loss of appetite for 3 weeks. Computed tomography (CT) chest was concerning for esophageal mass. EGD showed multiple gastric polyps, most of them had white colored tops with patches of necrotic appearing mucosa, no esophageal mass (Figure 1). Biopsy of gastric polyps showed ulcer with associated atypical epithelioid and spindle cell proliferation, favor metastasis from known granulosa cell tumor. CT chest, abdomen and pelvis showed bilateral metastatic pulmonary nodules, enlarged paraesophageal and periaortic lymph node. Brain metastasis was noted on MRI. Patient was deemed poor surgical candidate. She was started on systemic chemotherapy. She subsequently presented with worsening nausea, vomiting and abdominal pain. Repeat imaging showed worsening metastases. Radiation oncology was consulted for possible radiation of brain and paraesophageal mass. However patient decided to go forward with hospice. GCT have low malignant potential and late relapse. They are associated with a favorable prognosis, especially when they are detected in the early stages. The recurrence rates ranges between 9 and 35% and is associated with a poor prognosis. Although most recurrences are within 10 years after the initial diagnosis, there are reports of recurrence after 10 years. So, patients should be kept on a long-term follow-up protocol even if the primary tumor is occult. Spread is largely within the pelvis and the lower abdomen. Distant metastases are rare with few reported cases of lung, liver, brain, bone, diaphragm, abdominal wall, adrenal gland and supraclavicular lymph node metastasis from ovarian tumors. Patients with advanced metastatic GCTs, are typically treated with aggressive surgical resection followed by postoperative systemic chemotherapy. Radiation therapy may have some effect in cases with minimal residual disease.Figure: EGD showed multiple gastric polyps with patches of necrotic appearing mucosa.

Abdominal wall metastasis (recurrence) in uterine cervix carcinoma: Report of 2 cases

Abdominal wall metastasis (recurrence) in uterine cervix carcinoma: Report of 2 cases

A Case of Parastomal Hernia with Isolated Abdominal Wall Metastasis of Colorectal Cancer

A Case of Parastomal Hernia with Isolated Abdominal Wall Metastasis of Colorectal Cancer

Port Site Metastasis Following Laparascopic Right Hemicolectomy

Case Presentation: A 67 year old patient underwent laprascopic right hemicolectomy for carcinoma caecum in the month of January 2014; he had a good postoperative recovery. Histopathology showed well- differentiated carcinoma caecum T3N1M0 and patient received 4 cycles of adjuvant chemotherapy and was on regular follow up. In 2015 October, in view of elevation of CEA from 2.3 to 9, PET scan was done that showed evidence of abdominal wall metastasis (Figure 1) with incisional hernia at specimen extraction site with no other evidence of recurrence. The patient underwent excision of abdominal wall metastasis along with incisional hernia repair. On follow up, patient is doing well with CEA below (Figures 2-4). Conclusion: Port site metastasis in laprascopic colorectal surgery is still a possibility; hence appropriate measure needs to be taken to prevent contact of tumour to the skin during its extraction.

Incidence of abdominal wall metastases following percutaneous endoscopic gastrostomy placement in patients with head and neck cancer.

Percutaneous endoscopic gastrostomy (PEG) tubes are an effective modality for enteral nutrition in patients with head and neck cancer; however, there have been documented case reports of "seeding" of the abdominal wall by the theoretic risk of dragging the tube along the tumor during PEG placement. The objective of this study is to determine the incidence and contributing risk factors leading to metastasis to the abdominal wall following PEG placement in patients with head and neck cancer. A retrospective chart review was performed on patients diagnosed with head and neck malignancy who underwent PEG placement between 1/5/2009 and 12/22/2014. Variables collected included development of abdominal wall metastases, type of malignancy and tumor characteristics, smoking history, PEG placement technique, and survival following recurrence. Data were then analyzed for overall trends. Out of 777 patients analyzed, a total of five patients with head and neck malignancy were identified with abdominal wall metastasis following PEG tube placement with an overall incidence of 0.64% over an average follow-up of 27.55months. All of these patients underwent PEG tube insertion via a Pull technique. One patient was found to have a clinically evident and symptomatic stomal metastasis, while the other four patients had radiologically detected metastases either on CT or PET scan. All of the identified patients were found to have stage IV oral cancer at time of initial diagnosis of their head and neck malignancy, followed by widespread distant metastatic disease at time of presentation with their PEG site stomal metastasis. Abdominal wall metastases following PEG placement are a rare but serious complication in patients with head and neck malignancy.

Impact of Abdominal Wall Metastases on Prognosis in Epithelial Ovarian Cancer.

Epithelial ovarian cancer (EOC) patients with the presence of abdominal wall metastasis (AWM) are categorized as stage International Federation of Gynecology and Obstetrics (FIGO) IVB, irrespective of other biologic factors or preceding invasive intervention before final surgery. We evaluated the impact of AWM on patients' overall survival (OS). In this exploratory study, 634 consecutive patients with advanced EOC treated in our center from 2000 to 2014 were included. Patients were categorized into FIGO IIIC (n = 308), FIGO IVB AWM only (n = 86), and FIGO IV others (metastases other than AWM, n = 240). Clinicopathological parameters and survival data were extracted from our prospectively maintained tumor registry. Survival analyses were calculated using Kaplan-Meier method and Cox regression models. In 75 (87.2%) of 86 cases, AWM was seen after a preceding intervention, and only in 12.7%, the deposits were spontaneously established. The median OS in patients with stage FIGO IIIC, FIGO IVB AWM only, and FIGO IV others was 37, 58, and 25 months (P < 0.001), respectively. Patients with FIGO IVB AWM only had a significantly better OS than patients with FIGO IV others (P < 0.001). The numeric longer OS of patients with FIGO IVB AWM only compared with patients with FIGO IIIC was not statistically significant (P = 0.151). In multivariate analysis considering all confounding factors including residual disease, OS of patients with FIGO IIIC did not differ from patients with FIGO AWM only (hazard ratio, 0.84; 95% confidence interval, 0.56-12.26; P = 0.398). Most AWM are acquired after preceding intervention (puncture or laparoscopy). Prognosis of patients with AWM as the only site of distant metastasis is superior compared with other stage FIGO IV patients. Therefore, up-staging of patients only because of AWM to FIGO IVB may be questioned. A revision/clarification of the FIGO classification system should be considered to avoid unnecessary stigmatization of patients and to classify these patients more appropriately according to prognosis.

Impact of abdominal wall metastases on prognosis in FIGO IV epithelial ovarian cancer

Impact of abdominal wall metastases on prognosis in FIGO IV epithelial ovarian cancer

Abdominal wall metastasis of carcinoma breast : a case report

Abdominal wall metastasis from breast carcinoma is an uncommon occurrence compared to local invasion into muscle from direct tumor spread. A 30 years old lady was referred to our hospital from a medical college hospital for adjuvant treatment after being done the left sided modified radical mastectomy. Pathological examination revealed poorly differentiated infiltrative duct cell carcinoma, metastatic deposits in axillary lymph node with histological grade 3. She underwent adjuvant chemotherapy and radiotherapy with regular schedule and follow up. Her adjuvant treatment and follow up period were uneventful upto 13 months. Thereafter she reported a painless lump in the right upper abdomen which was rapidly growing in size. Cytopathology report confirmed that the cells of the parietal lump were compatible with metastatic duct cell carcinoma. So, though the primary pathology was in the left side but the parietal lump was found in the right side. Skeletal muscle metastasis is uncommon and pain is the commonest symptom. But here the lump is painless and this is another rare presentation. Treatment principle is only palliation.Bangladesh Med J. 2015 Sep; 44 (3): 172-174