Rare Site Of Metastasis Research Articles

Recurrence of Poorly Differenciated Cervical Cancer by Single Splenic Metastasis: Case Report and Literature Review

Background: The incidence of cervical cancer in Belgium is 11.1 per 100,000. With the introduction of cervical cytology screening and more recently anti-HPV vaccination, this rate has been decreasing for almost 20 years. Despite this, some patients are missed by the screening and prevention system and cervical cancer is still diagnosed at an advanced stage. Recurrences by splenic metastases are rare and are most often found at autopsy. Case Study: We describe the case of a 41-year-old caucasian patient with a single splenic recurrence after radiotherapy, chemotherapy, brachytherapy, and surgery for a poorly differentiated adenocarcinoma of the cervix grade 3 at an initial stage IIB according to FIGO. This recurrence happens 3 years after the initial treatment. After monitoring this asymptomatic lesion, the size increase results in laparoscopic splenectomy. Histology demonstrates a splenic metastasis recurrence of adenocarcinoma of endocervical origin. Conclusion: The spleen is a rare metastatic site in cervical cancer. Splenectomy followed by chemotherapy is the therapy most often found in the literature, which is however poor in this regard.

Non-Small Cell Lung Cancer Presenting as Anterior Nasal Mass and Epistaxis.

Lung malignancy presentation with an uncommon metastatic site is a diagnostic challenge and often associated with poor prognosis. Nasal cavity is a rare metastatic site for any type of lung cancer. We report an unusual case of poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis presenting as a right vestibular nasal mass with epistaxis. A 76-year-old male patient with chronic obstructive pulmonary disease and 80 pack-year smoking history presented with spontaneous epistaxis. He reported a new rapidly growing right-sided nasal vestibular mass first noticed 2 weeks prior. Physical examination showed fleshy mass with crusting in right nasal vestibule along with a left nasal domus mass. Imaging revealed an ovoid mass in the right anterior nostril and a large mass in the right upper lobe of the lung (RULL) along with thoracic vertebral sclerotic metastasis and large left frontal lobe hemorrhagic lesion with severe vasogenic edema. Positron emission tomography scan showed large right upper lobe mass and suspected to be the primary malignancy along with widespread metastasis. Biopsy of the nasal lesion revealed poorly differentiated non-small cell carcinoma with squamous and glandular features. The diagnosis of very poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis was made. In conclusion, unusual metastatic sites with unknown primary lesions require a thorough diagnostic workup involving biopsy and extensive imaging. Lung cancer with unusual metastatic sites is inherently aggressive and associated with poor prognosis. Multidisciplinary treatment modalities should be employed keeping in view the functional status and comorbidities of the patient.

Non-Small Cell Lung Cancer Metastases to Breast, Colon and Skin: A Case Report

Bronchogenic carcinoma is a leading cause of cancer mortality worldwide. Of lung cancer cases overall, 50% have metastasis at presentation, mostly to the brain, bone, liver, the adrenal glands ,thoracic cavity and non-regional lymph nodes .This case report presents a female patient with three rare sites of lung cancer metastasis: breast, colon, and skin. Her initial presentation was a several-month history of a mass in the left breast and in the upper abdominal wall, dyspepsia, weight loss, and intermittent per rectal bleeding. Diagnosis of this case was difficult because of the challenge to differentiate between primary breast cancer and metastasis. However, the diagnosis was made by the interpretation of images and immunohistochemistry.

864 ISOLATED CARDIAC METASTASIS FROM CARCINOMA OF THE CERVIX: RARE CASE OF ACS-NSTE. CASE REPORT

Abstract Introduction The heart is a rare site of tumor metastasis. Although rarely, cardiac metastases may be secondary to a primary intra-abdominal tumor. Aim we report the case of a 60-years-old woman, ante-mortem finding of an isolated cardiac metastasis from cervical carcinoma presented as ACS-NSTE, who was evaluated in our Division of Cardiology. Materials and methods electrocardiogram, transthoracic echocardiography, angioTC, cardiac surgery and histopathologic analysis were performed. Results electrocardiogram showed incomplete right branch block with diffuse negative T waves. On the echocardiogram evidence of a voluminous hypo-isoechoic formation almost completely occupying the cavity of the right ventricule (RV) which appeared dilated and dysfunctional; D-shape aspect of the left ventricule as from the overload of the right sections and with moderate pericardial effusion, mildly reduced ejection fraction (EF50%Q). An urgent Angio-CT was performed and revealed a voluminous solid neoformation with inhomogeneous content and progressive contrast enhancement in the right ventricule. Following admission, the patient's haemodynamic status gradually worsened. Therefore, urgent cardiac surgery was performed. After drainage of abundant serum/haematic effusion, probably neoplastic infiltration of RV was seen. Therefore, given the extension it was decided to perform only multiple biopsies. Histopathological examination revealed moderately differentiated squamous cell carcinoma, as from metastasis from K. cervix. Conclusions there is no standardized therapy for the treatment of cardiac metastases, it is necessary to evaluate on a case-by-case basis. The most important prognostic factors are the obstructive effect of the intracardiac mass and the extent of any pericardial effusion. In fact, they can adversely affect hemodynamic stability.

Rare sites of metastases in patients with differentiated thyroid carcinoma and added value of SPECT/CT over planar whole body radioactive iodine scan

BackgroundBeing aware of the unusual or rare location of thyroid metastases helps in early diagnosis and proper patient management. Rare metastases (RM) can be missed resulting in diagnostic pitfalls and delayed treatment. The use of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging in the follow-up of differentiated thyroid cancer (DTC) patients provides precise anatomical localization and characterization of RM that may be missed or misinterpreted in planar whole body iodine-131 (WBI) scan. There is a lack of knowledge about dealing with such patients, the treatment they should receive, and therapy response due to the rarity of such cases. In this work, we reported these rare cases increasing awareness about them and their methods of treatment with response to therapy and evaluated the added value of SPECT/CT imaging in changing patients’ management.Materials and methodsIn this study we reviewed all patients with DTC referred to our unit either for initial radioactive iodine-131 therapy (RAIT) or under follow-up from January 2019 to January 2022. When a suspected lesion was detected in a conventional planar WBI scan whether follow-up scan or post-therapeutic scan, SPECT/CT was acquired immediately in the same session for that region. Additional imaging modalities were performed for confirmation. Response to the given treatment either disease progression (DP) or favorable response which include complete response (CR), partial regression (PR) and stable disease (SD) recorded for each patient.ResultsTwo hundred and forty patients with DTC referred to our unit over a three-year period (from January 2019 to January 2022) were reviewed. Forty patients developed lung and bone distant metastases. Twenty-one patients were thought to have metastases at unusual sites. Due to incomplete data (no SPECT/CT pictures or confirmatory imaging), 6/21 patients were eliminated. We studied 15 patients with RM (9 females, 6 males) with a median age of 52 years (range 27–79). All patients received the initial RAIT after thyroidectomy in addition to other therapeutic modalities, e.g., radiotherapy (RTH), chemotherapy (CTH) or surgical tumor excision after detection of RM. Ten out of 15 patients (66.67%) showed favorable response to therapy (2 patients had CR, 6 patients had PR and 2 patients had SD), whereas only 5 patients had DP. Additional SPECT/CT changed management in 10/15 patients (66, 67%) of patients.ConclusionRM identification is mandatory to avoid misdiagnosis and delayed therapy. Increasing the awareness about such rare cases allows for better management. SPECT/CT could significantly impact patients' management through its precise anatomic localization and lesion characterization.

PSMA-PET Detection of Unusual Metastases in Castrate-Sensitive Prostate Carcinoma.

Prostate cancer (PCa) is a multifaceted, heterogeneous disease (with 7 molecular subtypes), which can metastasize to common sites, such as bone, lymph nodes, liver, and lungs. However, with PSMA PET imaging, rare sites of metastasis are increasingly discovered. We report 5 cases of unusual metastases in patients with castrate-sensitive PCa: solitary right inguinal nodal metastasis, solitary abdominal wall metastasis, penile shaft metastases, solitary perineum metastasis, and pleural metastases. These cases further support the use of PSMA-PET imaging in PCa monitoring, with the ability to detect solitary, small volume, and rare sites of metastases, which may not be apparent on conventional imaging.

S3551 Gastric Metastasis of Merkel Cell Carcinoma: A Rare Cancer

Introduction: Merkel Cell Carcinoma (MCC) is a rare aggressive cutaneous neuroendocrine carcinoma. MCC is localized in 65% of cases, 26% cases spread to lymph nodes and metastasis is seen in 8% of cases. Stomach metastasis is rare site of metastasis, seen in 0.2 to 0.7% of cases on autopsy. CK 20 is a sensitive and specific marker of MCC. We present a case of a 63-year-old man who presented with chronic anemia and was found to have gastric metastasis of his cutaneous Merkel Cell Carcinoma. Case Description/Methods: A 63-year Caucasian man with pertinent history for hypertension, chronic anemia on iron therapy and stage IV neuroendocrine cutaneous tumor of left thigh with distant metastasis on treatment presented with melena, worsening fatigue, and shortness of breath for 2 weeks. Two months prior to this hospitalization, the patient was admitted for symptomatic anemia where patient had undergone Upper Gastrointestinal (UGI) Endoscopy. It had revealed non-bleeding gastric ulcers with pigmented material and biopsy was negative for malignancy (Figure a). On presentation his labs were significant for hemoglobin/hematocrit of 5.2/14.7% (g/dL/%). Computed Tomography Angiogram of abdomen and pelvis revealed a GI bleeding source within the proximal stomach. UGI endoscopy was performed after adequate resuscitation which revealed a large, fungating, infiltrative and ulcerated masses in the body of the stomach (Figure b). Biopsies showed malignant cells with immunohistochemical staining positive for chromogranin, synaptophysin, CK7, and CK20. It was reported that the immunomorphological features of initial biopsy of left posterior thigh were like this gastric biopsy. It was concluded that the patient's gastric mass was metastatic MCC. Discussion: MCC is a rare extremely aggressive carcinoma. Its spread to stomach is rare but should be considered in patients with cutaneous neuroendocrine tumor who present with iron deficiency anemia/GI bleeding. In addition, gastric metastasis is exponentially aggressive. Our patient’s gastric ulcer with negative biopsy grew into a fungating mass with proven MCC in two months. Thus, we would also like to highlight the importance of re-biopsy when the index of suspicion is high. Our patient’s initial biopsies were negative for malignancy while subsequent biopsies showed MCC. A combination surgical excision and loco-regional radiotherapy is used for treatment of aggressive primary MCC without distant metastasis. Radiotherapy, or combination with chemotherapy can be used for unresectable MCC.Figure 1.: (a) Initial UGI endoscopy done 2 months before the presentation. Shown above is gastric ulcer with pigmentation in Gastric body and Fundus (b) A large, fungating, infiltrative and ulcerated mass with no bleeding at gastric body. Biopsy of this mass showed MCC.

Metastatic Lobular Carcinoma of the Breast Masquerading as Gallstone Disease – A Case Report

The gallbladder is a rare site of breast cancer metastasis. We report the patient case of a 60-year-old woman with isolated metastasis to the gallbladder, which was surgically removed for symptomatic cholelithiasis, with a subsequent new diagnosis of infiltrating lobular carcinoma (ILC) of the breast. ILC tends to metastasize to unusual sites such as the gastrointestinal and genitourinary tracts, but these usually occur concurrently with other more common sites of distant metastasis such as the bone, lungs, and liver. Our case underscores the need for routine histologic examination of gallbladder after cholecystectomy.

S3710 A Case Series of Gastric Adenocarcinoma Presenting as Cardiac Tamponade

Introduction: Gastric cancer is the fourth most common type of cancer worldwide and frequently presents at an advanced stage. As such, the presenting symptoms of gastric cancer may be related to sites of metastasis rather than the primary tumor. We describe two cases that presented to the same hospital within a six-month period who were found to have pericardial tamponade secondary to gastric adenocarcinoma metastasis. Case Description/Methods: Case 1 describes a case of a 91-year-old male who presented with progressively worsening dyspnea. A bedside echocardiogram revealed large pericardial effusion with evidence of cardiac tamponade. Pericardiocentesis and formation of a pericardial window was emergently performed. Cytology revealed metastatic signet ring adenocarcinoma with gastric as the most likely origin. Case 2 describes a case of a 68-year-old female with a history of breast cancer who presented to the hospital with epigastric pain, nausea and dyspnea on exertion accompanied by chest pain upon presentation to the ED. An echocardiogram revealed a large pericardial effusion with evidence of tamponade and a pericardiocentesis was urgently performed. A CT scan noted multiple hepatic lesions that were highly suspicious for metastatic disease. She underwent interventional radiology (IR) guided biopsy of a liver lesion and the pathology was consistent with adenocarcinoma. A follow-up esophagogastroduodenoscopy (EGD) with biopsies revealed moderately to poorly differentiated gastric adenocarcinoma as the primary tumor. Discussion: The pericardium is a rare site of metastasis for gastric adenocarcinoma and may present atypically. Subacute presentation of tamponade may mimic heart failure; thus physicians should have a lower threshold for ordering echocardiography.

Diagnostic and prognostic nomograms for newly diagnosed intrahepatic cholangiocarcinoma with brain metastasis: A population-based analysis.

Brain metastasis (BM) is one of the rare metastatic sites of intrahepatic cholangiocarcinoma (ICC). ICC with BM can seriously affect the quality of life of patients and lead to a poor prognosis. The aim of this study was to establish two nomograms to estimate the risk of BM in ICC patients and the prognosis of ICC patients with BM. Data on 19,166 individuals diagnosed with ICC were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database. Independent risk factors and prognostic factors were identified by the logistic and the Cox regression, respectively. Next, two nomograms were developed, and their discrimination was estimated by concordance index (C-index) and calibration plots, while the clinical benefits of the prognostic nomogram were evaluated using the receiver operating characteristic (ROC) curves, the decision curve analysis (DCA), and the Kaplan-Meier analyses. The independent risk factors for BM were T stage, N stage, surgery, alpha-fetoprotein (AFP) level, and tumor size. T stage, surgery, radiotherapy, and bone metastasis were prognostic factors for overall survival (OS). For the prognostic nomogram, the C-index was 0.759 (95% confidence interval (CI) = 0.745-0.773) and 0.764 (95% CI = 0.747-0.781) in the training and the validation cohort, respectively. The calibration curves revealed a robust agreement between predictions and actual observations probability. The area under curves (AUCs) for the 3-, 6-, and 9-month OS were 0.721, 0.727, and 0.790 in the training cohort and 0.702, 0.777, and 0.853 in the validation cohort, respectively. The DCA curves yielded remarkable positive net benefits over a wide range of threshold probabilities. The Kaplan-Meier analysis illustrated that the nomogram could significantly distinguish the population with different survival risks. We successfully established the two nomograms for predicting the incidence of BM and the prognosis of ICC patients with BM, which may assist clinicians in choosing more effective treatment strategies.

Rare Metastasis of Esophago-Gastric Cancers: Case series with review of literature

Purpose: in this case series we aim to highlight rare metastasis of gastric and esophageal cancers metastasizing to unusual locations causing a diagnostic challenge on presentation. We also review pertinent literature of rare locations of metastasis of gastro-esophageal cancer (GEC). Materials and methods: this is a retrospective analysis of four patients managed at our institution with one year follow up between 2020-2021. We include baseline patient characteristics, presenting symptoms, diagnostic work up and management of each individual case. Results: Out of the 4 cases with GEC; two had gastric adenocarcinoma, one esophageal adenocarcinoma and one gastroesophageal junction adenocarcinoma which metastasized to various locations throughout the body. Among the rarest locations of metastasis of gastric cancer is skeletal muscles. The locations of metastases were: ovaries and peritoneum from gastric adenocarcinoma, brain and liver from gastric adenocarcinoma, skeletal muscles from esophageal adenocarcinoma, and skeletal muscles and breast from GEC adenocarcinoma. The main diagnostic tool to identify these rare sites metastasis was Positron emission tomography scan (PET/CT). Conclusion: Studies have shown that not all gastroesophageal malignancies present with these alarm symptoms and up to 40% of patient can present without alarming symptoms. In our study; we shed the light on the possible rare metastatic sites that could have been missed with the regular presentation. Some of the rarest location of metastasis is to the skeletal muscles, which was present in two of our patients with an origin of gastric and esophageal cancer, which was identified with PET/CT. This study clarifies the importance of including whole body PET/CT scan in the staging process for patients with esophageal and gastric cancers to identify such rare sites metastasis that will alter the stage and clinical management of GEC patients.

Ocular metastasis of primary gynecological malignancies, a rare but not insignificant entity: A systematic review.

The genital system remains one of the most common sites of carcinogenesis in women. Advances in surgery, radiation treatment, and chemotherapy have increased their efficacy and many patients survive for many years after their initial diagnosis. The eye is a rare site of metastasis from gynecological cancer due to its distant location from the genitalia. In this systematic review, we retrieved all case reports of patients with ocular metastasis from gynecological neoplasms. The demographic, clinical, and treatment characteristics were retrieved and analyzed. A total of 70 case reports were included. Forty-eight of these reports concerned patients with a known malignancy that recurred in the eye and in 22 patients' ocular symptomatology accompanied the initial diagnosis of the gynecologic malignancy. 73.9% of these patients exhibited concomitant metastasis to other organs. The mean disease-free interval was found at 25.7 months and mean survival time after the eye metastasis was 13.5 months. Refractory disease was identified as the most important risk factor associated with mortality. Because eye metastasis has such a dismal prognosis, all gynecologists who treat oncological patients should be highly suspicious for reported eye complaints.

Renal cell carcinoma with gallbladder metastasis: a case report

Renal cell carcinoma (RCC) is the most frequent renal neoplasm, with a high rate of metastasis, especially in the lungs and bones. The gallbladder is one of the rare metastatic sites. We report an 80-year-old woman who presented with chronic right flank pain for the last six months. A computer tomography scan revealed a heterogeneous right renal mass measuring 86 ×76× 68 mm and multi lithiasis in the gallbladder. A right radical nephrectomy, lymphadenectomy, and cholecystectomy were performed. The postoperative clinical course was uneventful, without any complications. The histological results showed a clear RCC with metastasis to the gallbladder. After 12-months follow-up, the patient is free from disease. In conclusion, even though the coexistence of metastatic gallbladder from clear RCC is rare, the possibility of concurrence should be considered if suspected findings in the gallbladder are identified intraoperatively.

TRAPPED LUNG AS A COMPLICATION OF PLEURAL METASTASES FROM SQUAMOUS CELL CARCINOMA OF BUCCAL MUCOSA

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Trapped lung is an uncommon complication of malignant pleural effusion (MPE). It presents as post-thoracentesis hydropneumothorax (known as pneumothorax ex vacuo, PEV) or pleural effusion that cannot be completely drained due to development of chest pain [1]. It is important to recognize PEV, as although it may appear alarming, it is an asymptomatic process that is not amenable to chest tube placement. CASE PRESENTATION: 60 year old male with squamous cell carcinoma (SCC) of buccal mucosa for which he underwent surgery with radiotherapy 2 years ago, presented with 1 week of dyspnea. Chest X-ray showed a large right-sided pleural effusion with ipsilateral displacement of mediastinum [Figure 1]. He underwent thoracentesis but procedure was terminated prematurely due to development of chest pain. Post-thoracentesis CT chest [Figure 2] to evaluate for underlying lung pathology showed pleural thickening. Fluid cytology was positive for malignant squamous cells. He subsequently underwent thoracoscopy showing extensive involvement of visceral and parietal pleural surfaces with malignant appearing lesions. Pleural biopsies, done to obtain more tissue for next generation sequencing, were consistent with malignant squamous cells. An indwelling pleural catheter was placed at the end of the procedure for long term management of his malignant pleural effusion. Post-procedure chest X-ray showed a partially expanded right lung with a large PEV [Figure 3]. The patient was asymptomatic at this point with good oxygenation on room air. Pleural manometry was performed using a digital pleural manometer showing a negative pleural pressure. DISCUSSION: Pleura is a relatively rare site of metastases from head and neck SCC [2]. Trapped lung can develop due to pleural adhesions or involvement of visceral pleura with malignant lesions [3]. Diagnosis should be suspected when chest x-ray shows large pleural effusion with ipsilateral shift of mediastinum as was seen in our patient. The patients may also have chest pain with drainage of pleural effusion. Effective management of trapped lung and PEV in MPEs remains challenging. Various treatment modalities exist, including minimally invasive procedures such as thoracocentesis or indwelling pleural catheters, as well as invasive procedures such as pleuroperitoneal shunt, thoracotomy, and decortication. The optimal treatment approach should balance therapeutic benefit versus required period of convalescence for a disease with poor life expectancy [4]. CONCLUSIONS: We present a rare complication (PEV from trapped lung) in a relatively rare disease process (pleural metastases in head and neck cancer). In cases of pneumothorax after pleural drainage, it is important to consider PEV due to trapped lung as it will direct treatment approaches. REFERENCE #1: Huggins JT, Doelken P, Sahn SA. The unexpandable lung. F1000 Med Rep. 2010;2:77. Published 2010 Oct 21. doi:10.3410/M2-77 REFERENCE #2: Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec. 2001 Jul-Aug;63(4):202-7. doi: 10.1159/000055740. PMID: 11408812 REFERENCE #3: Petrov, D., Mihalova, T., Valchev, D.. Malignant pleural effusions and trapped lung. AME Medical Journal, North America, 5, mar. 2020. Available at: <https://amj.amegroups.com/article/view/5466> DISCLOSURES: No relevant relationships by Sudeepthi Bandikatla, source=Web Response No relevant relationships by James Bradley, source=Web Response No relevant relationships by Apaar dadlani, source=Web Response No relevant relationships by Umair Gauhar, source=Web Response No relevant relationships by Vatsala Katiyar, source=Web Response No relevant relationships by Adam Rojan, source=Web Response

Recurrent Gastric Cancer Metastasizing to the Bone Marrow Detected on 18F-Fluorodeoxyglucose Positron Emission Tomography/Contrast-Enhanced Computed Tomography Scan.

Gastric cancer is one of the important causes of cancer-related mortality worldwide, with significantly low median survival in metastatic gastric cancer. Thus, when planning treatment for gastric cancer, it becomes important to determine whether or not there is metastasis. Bone marrow is a rare region for metastasis in cases of gastric carcinoma, as suggested by the literature. We are herewith presenting the case of a 56-year-old patient of recurrent gastric carcinoma who showed a rare site of metastasis involving marrow on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan.

Neuroblastoma with ovarian and pancreatic metastasis

Neuroblastoma metastasis to the pancreas and ovaries is rare. We report a 12-year-old girl diagnosed with primary left adrenal neuroblastoma and metastases to the local lymph nodes, left orbit, left ovary, and multiple bones. After 4 courses of chemotherapy, the orbital and bone metastases disappeared; the ovarian tumor remained and the lymph node metastases were shown to be pancreatic metastases. Left adrenal tumor resection with spleen-preserving partial pancreas resection and left ovariectomy was performed. Pathological examination of surgical specimens showed viable tumor cells in the ovary but none in the pancreas. Additional chemotherapy, autologous bone marrow transplantation, I 131 -MIBG radiotherapy, and radiation therapy were performed after surgery. This case was a case where it was possible to resect a rare metastatic site, and it is thought that there are many points to discuss about the metastatic pathway, evaluation about reactivity of chemotherapy, and indication about excision of metastatic lesions.

Metastatic Carcinoid Tumor to the Heart, A Dreadful Complication of Neuroendocrine Tumors Yet Under Estimated: About an Observation

Cardiac metastases are uncommon in neuroendocrine tumors (NET). Features of patients with metastatic carcinoid tumor involving the heart have not been well described. Although carcinoid tumors have been described in almost every organ, few reported cases of confirmed cardiac involvement. The overall incidence of myocardial carcinoid metastases among patients with metastatic carcinoid disease is about 4%. There is limited knowledge on the prevalence, clinical presentation, and management of heart metastasis. The availability and increasing use of modern imaging techniques leads to more frequent discovery of rare metastatic sites. Our aim is to further clarify the clinical manifestations of heart metastasis, to increase the knowledge of rare localizations of NET metastasis and insist on the systematic screening of metastatic carcinoid heart disease as an integral part of the echocardiographic evaluation in patients with carcinoid syndrome. We report the case of a 67-year-old male with history of a low differentiated neuroendocrine tumor, presenting with palpitations and dyspnea and which investigations have led to diagnose myocardial metastasis signing the progression of the NETs.

Colon metastasis from recurrent gallbladder cancer: a case report

Gallbladder cancer (GBC) is associated with a poor prognosis. Colonic metastases representing approximately 1% of total colorectal cancers, are very rarely reported. According to more recent data in the literature, cases of colon metastases from GBC have not been reported. We report the case of a 78-year-old woman who underwent a cholecystectomy in 2017, for a diffuse carcinoma in situ and an infiltrating adenocarcinoma pT2a G2; she completed six months of adjuvant gemcitabine chemotherapy and started a regular follow up in our institution. Three years later she came to our observation after having developed severe anemia and she was diagnosed synchronous liver and colonic metastases from GBC immunohistologically confirmed. The case was collegially evaluated by a multidisciplinary team. In consideration of the progressive deterioration of the clinical conditions, the extension of the primary GBC and the patient's age, it was decided to start in July 2020 a first-line mono-chemotherapy treatment with gemcitabine. This is probably the first reported case of colonic metastasis in a patient with a recurrent GBC with synchronous liver involvement. We conclude that though colon is a rare metastatic site of GBC, one should keep vigilance for colon metastases to prevent and detect their occurrence in symptomatic cases in order to improve the survival.

Endometrial Carcinoma Presenting with an Isolated Osseous Metastasis: A Case Report

Patients with advanced endometrial cancer had generally a poor prognostic with a median survival often less than one year. Isolated bone metastases as the first sign of the disease of endometrial cancer was a very exceptional situation rarely described in the literature. The goal of this report is to describe the management of this rare site of metastases and to reviewed Clinic pathological features and prognosis of isolated bone metastases. We present a case of a 56-year-old woman treated for endometrial cancer with isolated ribs bone metastases. She was complaining about progressive right rib pain as a first sign of the disease of endometrial cancer. She had a biopsy of the lesion in the last right thoracic rib. This has proved a metastatic adenocarcinoma compatible with an endometrial primary cancer. An endometrial biopsy showed moderately differentiated endometrioid adenocarcinoma. Imagery did not reveal any other sites of metastatic disease. The patient underwent bilateral salpingo-oophorectomy and hysterectomy, peritoneal washing, omentectomy, bilateral pelvic and par aortic lymphadenectomy. In addition, a right thoracotomy was carried out and complete surgical excision of the rib mass was successfully performed. Adjuvant chemotherapy was administrated. The patient is clinically free of disease 10 months following diagnosis. Single-bone extrauterine metastatic site and local disease limited to the uterus had better survival outcomes than Stage IVb endometrial cancer with multiple metastatic sites. Therefore, the patient treated with surgery with a clear margin continued to behave as early-stage endometrial cancer.

Malignant Phyllodes Breast Tumor: A Rare Case of Metastasis in Skeletal Muscle Detected on 18-Fluorodeoxyglucose Positron Emission Tomography

Rapidly growing cystosarcoma phyllodes tumor (PT) of the breast are rarely encountered. Distant metastases are not uncommon in malignant PTs; however, rare sites of metastases are sometimes observed. Here, we present the case of a rapidly metastasizing malignant PT in which skeletal muscle metastasis was identified on 18F-fluorodeoxyglucose-based positron emission tomography-computed tomography reflecting its aggressive course and poor prognosis.