Small Bowel Metastasis Research Articles

Carcinoma esophagus with small bowel metastasis: a case report with review of literature.

Small intestinal metastasis is extremely rare and only 13 cases have been reported till date and almost all such patients have presented with intestinal obstruction. The 5-year overall survival for metastatic esophageal cancer is as low as 5% while the patients with small intestinal metastasis have a median survival of only 3months (range 1-12months) despite undergoing radical resection of the small bowel. We present a case of a male in his 50's who presented with difficulty in swallowing for 4months. On evaluation, he was found to have squamous cell carcinoma in the mid thoracic esophagus. He underwent radical chemo-radiation up to 60Gy in 25 fractions over 5weeks. One week after completion of treatment he presented with ileal obstruction and omental nodules and surgical resection and evaluation of the respective ileal segment and omental biopsy revealed a metastatic squamous cell carcinoma. The patient expired 3months post-surgery. Carcinoma esophagus with small bowel metastasis has a very grave prognosis that patients rarely survive beyond 1year despite undergoing resection. Hence it is imperative to consider a small bowel metastasis when such patients present with clinical features of intestinal obstruction for early diagnosis and aggressive management.

The clinical characteristics of metastatic tumors in small intestine

To investigate the clinical characteristics of metastatic tumors in small intestine. The clinical manifestations, imaging and endoscopic findings, treatment methods and follow-up of patients with small bowel metastatic tumors admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2022 were retrospectively analyzed. A total of 10 patients were included, including 7 males and 3 females, aged 33-77 (56.4±12.6) years. The main clinical manifestations were intestinal obstruction (8 cases), such as abdominal pain, abdominal distension, nausea, vomiting, and reduced defecation. Some patients had intussusception (abdominal pain, vomiting, black stool and other symptoms, 1 case) or gastrointestinal bleeding (1 case) with early symptoms imperceptible. The primary tumors include gastric cancer (3 cases), malignant melanoma (2 cases), ovarian cancer (2 cases), colon cancer (1 case), rectal cancer (1 case), and lung cancer (1 case). Most of the primary tumors were poorly differentiated (6 cases) or moderately to poorly differentiated (2 cases). The median time from primary tumor surgery to detection of small bowel metastasis [M (Q1, Q3)] was 22 (18, 28) months.The metastatic lesions were single (6 cases) or multiple (4 cases), in both jejunum and ileum. Positron emission tomography-computed tomography (PET-CT, 3 cases) and endoscopy (2 cases) were helpful for detection of small intestinal metastases. The main treatment methods were surgical resection (9 cases), supplemented by radiotherapy, targeted drugs, immunotherapy, etc. Postoperative recurrence and metastasis occurred in some patients (5 cases). Most patients died within 4 to 29 months after diagnosis. Metastatic tumors in small intestine are rare in clinical practice with atypical early symptoms. The patients often present with complications such as intestinal obstruction, which is prone to delayed diagnosis and poor prognosis.

Potential for Metastasis and Recurrence in Colorectal Carcinoma In Situ: A Retrospective Analysis of 1069 Patients

BackgroundColorectal carcinoma in situ, characterized by cancer limited to the intramucosal layer or known as intraepithelial carcinoma, has conventionally considered to be without any risk of regional lymph node metastasis. However, isolated cases of regional lymph node metastasis, local recurrence, and distant metastasis challenge this assumption. This study aimed to assess the occurrence of regional lymph node metastasis and recurrence of colorectal carcinoma in situ. MethodsA retrospective analysis was conducted in 1069 patients who underwent full-thickness local excision or radical surgery for colorectal carcinoma in situ between January 1994 and December 2020. Histopathological features were assessed by 2 experienced pathologists. In cases of suspected recurrence, evaluation involved abdomen-pelvis and chest computed tomography, or PET-CT. ResultsThe recurrence rate of colorectal carcinoma in situ patients was 0.46%. Among the patients, 9 were diagnosed with regional lymph node metastasis or cancer recurrence. Of these, 4 patients were diagnosed with lymph node metastasis during primary surgery; 2 exhibited regional lymph node metastasis, and 2 presented with both regional and distant lymph node metastases. Regional lymph node metastasis occurred in additional 2 patients after radical surgery for the primary tumor. Distant metastasis was observed in 3 patients: hepatic metastasis in 1, hepatic and pulmonary metastases in another, and small bowel metastasis in the third patient. Among the 5 patients experiencing cancer recurrence, 1 expired due to cancer progression. ConclusionContrary to previous assumptions, colorectal carcinoma in situ can potentially metastasize to lymph nodes and recur. Therefore, careful assessment at the time of diagnosis is crucial, recognizing the possibility of lymph node metastasis or recurrence. This approach is essential for accurately identifying instances of cancer recurrence and ensuring optimal oncological outcomes.

Metastatic melanoma to small bowel: metastasectomy is supported in the era of immunotherapy and checkpoint inhibitors

BackgroundMetastatic melanoma to the small bowel is an aggressive disease often accompanied by obstruction, abdominal pain, and gastrointestinal bleeding. With advancements in melanoma treatment, the role for metastasectomy continues to evolve. Inclusion of novel immunotherapeutic agents, such as checkpoint inhibitors, into standard treatment regimens presents potential survival benefits for patients receiving metastasectomy.Case PresentationWe report an institutional experience of 15 patients (12 male, 3 female) between 2014-2022 that underwent small bowel metastasectomy for metastatic melanoma and received perioperative systemic treatment. Median age of patients was 64 years (range: 35-83 years). No patients died within 30 days of their surgery, and the median hospital length of stay was 5 days. Median overall survival in these patients was 30.1 months (range: 2-115 months). Five patients died from disease (67 days, 252 days, 426 days, 572 days, 692 days postoperatively), one patient died of non-disease related causes (1312 days postoperatively), six patients are alive with disease, and three remain disease free.ConclusionsThis case series presents an updated perspective of the utility of metastasectomy for small bowel metastasis in the age of novel immunotherapeutic agents as standard systemic treatment. Small bowel metastasectomy for advanced melanoma performed in conjunction with perioperative systemic therapy is safe and appears to promote long-term survival and enhanced quality of life.

A Rare Case of Osteosarcoma Metastasis to the Small Bowel Causing Intussusception in a Pediatric Patient: A Case Report and Review of Literature

Osteosarcoma, a type of bone cancer, predominantly metastasizes to the lung and bone. However, rare instances of metastasis to the small bowel have been documented. Cases involving metastasis to atypical sites such as the small bowel are associated with poor prognosis, as the majority also present with concurrent lung metastasis. Intussusception, a condition in which a segment of the intestine folds into another, has been reported in a limited number of cases involving small bowel metastasis, with only four documented cases in pediatric patients, including the current case. While intussusception is primarily idiopathic in pediatric patients, those with oncological diseases represent a unique subgroup. Medical professionals should maintain a high level of suspicion for the presence of metastasis as a leading point in such cases and conduct timely, thorough evaluations to confirm or rule out this possibility.

Intussusception caused by small bowel metastasis from hepatocellular carcinoma.

Intussusception caused by small bowel metastasis from hepatocellular carcinoma.

S3073 Small Bowel Metastasis of Melanoma Presenting as Overt Gastrointestinal Bleeding

S3073 Small Bowel Metastasis of Melanoma Presenting as Overt Gastrointestinal Bleeding

Small Bowel Metastases From Malignant Phyllodes Breast Tumor Detected by 18 F-FDG PET/CT.

The most common sites of distant metastases are lung, bone, pleura, and mediastinum in malignant phyllodes breast tumors. However, small bowel metastasis from malignant phyllodes breast tumors is rare. We reported that using CT and FDG PET/CT imaging we identified a case with small bowel metastasis from breast cancer. PET/CT scan showed that high 18 F-FDG uptake occurred in the duodenum and jejunum. Histopathology and immunohistochemistry analyses further confirmed that malignant phyllodes tumors are derived from the breast.

585 Surgical Excision of Isolated Gastrointestinal Metastasis from Malignant Melanoma – a 10-Year Survey

Abstract Aim Patients with malignant melanoma (MM) can develop isolated metastasis years after treatment of the primary. The spleen and small bowel are the recognised intra-abdominal sites of isolated metastasis. Excision of these metastases is recommended as several international case series have shown good prognoses after excision. Method This is a 10-year retrospective study of patients with MM diagnoses who underwent excision of isolated metastasis at our Trust. Splenectomy and small bowel resection unrelated to MM and patients with disseminated metastasis were excluded. The surgical management, postoperative outcome and overall survival of the patients were assessed. Results In these 10 years, 2160 patients diagnosed with MM were treated in our Trust. Of these, 4 patients developed isolated splenic metastasis, and one had an additional small bowel metastasis. The primary MM location was the trunk in 2 patients, the posterior auricular region, and the left forearm in the other 2 patients. The patients developed metastasis an average of 47 months after treatment of their primary MM (range 11 - 96 months). The first patient underwent laparoscopic excision; the subsequent 2 patients underwent robotic-assisted excision. The patient with 2 isolated metastases underwent an open procedure. All four patients had no postoperative complications. The mean length of stay was 6 days with a zero-readmission rate. The mean survival time was 28 months (range: 3-60 months). Conclusions Isolated metastasis from MM is very uncommon. Surgical excision should be offered to all suitable patients. The feasibility of minimally invasive surgical excision should be considered in each patient.

Small bowel metastases with necrotizing enterocolitis like picture in high-grade osteogenic sarcoma: A pictorial report of a rare presentation

Small bowel metastases with necrotizing enterocolitis like picture in high-grade osteogenic sarcoma: A pictorial report of a rare presentation

Different Presentation and Appearance of Small-Bowel Metastasis of Malignant Melanoma: Two Cases and Review of the Literature

Different Presentation and Appearance of Small-Bowel Metastasis of Malignant Melanoma: Two Cases and Review of the Literature

S3371 A Rare Case of Iron Deficiency Anemia Due to Lung Cancer Metastasis to Small Bowel

Introduction: Lung cancer remains the leading cause of cancer related death in the United States, likely due to its high malignant potential. While the brain, bone, liver, and adrenal glands are common sites of metastasis for lung cancer, metastasis to the GI tract remains rare. Here we present a rare case of primary lung cancer with symptomatic metastasis to the small bowel. Case Description/Methods: A 48 year old M was referred to the Gastroenterology clinic for iron deficiency anemia and abdominal pain. A year prior, he was diagnosed with CK7 positive poorly differentiated Adenocarcinoma of the lung after a biopsy from a right upper lobe pleural mass. He underwent local radiation and chemotherapy with Carboplatin and Pemetrexed, followed by immunotherapy with Durvalumab. Follow up imaging in the interim showed excellent response to therapy. A month prior to presenting to the GI clinic, he developed recurrent mid abdominal pain associated with food intake. Labs revealed iron deficiency anemia with Hemoglobin 5.2 g/dL, MCV 64.5 um 3, Iron 9 mcg/dL. He denied overt GI bleeding. EGD and colonoscopy were negative for malignancy, however video capsule endoscopy showed areas of mucosal ulceration throughout the middle of the exam. Small bowel enteroscopy redemonstrated mucosal changes in the jejunum. Pathology from jejunal biopsies identified CK7 positive carcinoma, consistent with lung metastases to the small bowel. Follow up PET scan disclosed diffusely metastatic disease. Unfortunately, no treatment options remained, and patient died shortly thereafter. Discussion: Symptomatic disease spread to the small bowel in lung cancer has been estimated to be 1.8%,1 however autopsy studies have indicated rates of up to 11.9%2. This discrepancy is likely due to minimal symptom burden associated with small bowel metastases. In addition, small bowel metastasis is often an extremely late presentation of disease, as nearly all patients with small bowel metastasis are found to have additional sites of metastasis3, thus lending to an extremely poor prognosis. This case was particularly interesting in that this patient’s only indications for metastatic disease were iron deficiency anemia abdominal pain due to small bowel metastasis. A high index of suspicion is needed for patients with a history of lung cancer who develop abdominal pain or iron deficiency anemia for the detection of metastasis.

S3538 An Atypical Case of Suspected Small Bowel Metastasis From a Gastric Primary Site

S3538 An Atypical Case of Suspected Small Bowel Metastasis From a Gastric Primary Site

To Identify Small Bowel Metastasis From Lobular Breast Cancer on 18 F-Fluoroestradiol PET/CT : Necessary to Adjust the Background Uptake Level.

A 61-year-old woman was incidentally found to have small bowel metastasis from an undiagnosed lobular breast cancer in a workup for her acute presentation of small bowel obstruction. However, outside-hospital mammogram and breast ultrasound failed to reveal primary breast cancer. At 3.5 months postsurgery, the patient transferred her care to our hospital and received initial staging 18 F-fluoroestradiol (FES) PET/CT. The occult primary right breast cancer and previously biopsied right axilla lymph node were visualized on FES PET/CT. The intense small bowel uptake of FES was initially considered as physiological; however, after readjusting the background FES level on PET, an intense focus at small bowel anastomosis site became obvious.

Clinicopathological Features and Surgical Outcomes of Small Bowel Metastasis from Renal Cell Carcinoma.

Small bowel metastasis from renal cell carcinoma (RCC) is rare, and its clinicopathological characteristics are unclear; thus, we revisited the concept of this tumor and reviewed its diagnostic and treatment modalities. We filtered MEDLINE searches of articles published in English between 1950 and 2019, and identified 100 patients who had undergone treatment, including 1 patient from our clinic. We extracted patient characteristics, treatment, and prognostic data, resulting in clinicopathological data on 100 patients (83 men, 17 women). Mean age was 63 years (range, 16-86 years). Tumor sites were duodenum, jejunum, ileum, and multiple sites in 30, 37, 25, and 7 patients, respectively. The 1-, 3-, and 5-year overall survival rates after diagnosis were 53.0%, 36.0%, and 36.0%. Curative resection patients showed 62.1% 5-year survival after surgery, vs. 27.5% in noncurative surgical management cases. Good prognoses can be expected if these tumors are identified early for complete removal. Surgery is the only curative option. To determine the best management strategy and improve prognostic accuracy, we continue to collect and analyze epidemiological and pathological data. Although this condition is rare, surgery should be considered if curative resection is expected. Prognosis after curative resection is not poor, but recurrence is not unlikely.

Countless Small Bowel Metastases From Lung Adenocarcinoma.

Countless Small Bowel Metastases From Lung Adenocarcinoma.

Primary Small Bowel Melanoma or Small Bowel Metastasis with Vanishing Primary Cutaneous Lesion

The small bowel represents one of the main sites for cutaneous melanoma metastasis; however, numerous cases of primary intestinal melanoma have recently been described. In view of this, we present the case of a 39-year-old woman admitted for nausea, heartburn, abdominal pain, change in bowel habits and weight loss. Contrast-enhanced CT revealed a small bowel mass. Surgical resection of a 6 cm ileal tumour with regional mesenteric lymphadenectomy and end-to-end anastomosis was performed. Histopathological findings indicated the presence of an ileal melanoma metastasis. Subsequent dermatological examination identified a cutaneous lesion on the right forearm, however no malignant cells were found at the histopathological exam. Whole body PET CT with FDG identified multiple frontal and parietal lesions. Genetic testing was positive for BRAF gene V600 E mutation. The patient underwent multiple neurosurgical procedures for the resection of cerebral metastases. Palliative external radiation and chemotherapy was also attempted. After approximately 2 years after the diagnosis, the patient died following multiple episodes of intracranial hypertension.

A Case of Small Intestinal Perforation due to Small Bowel Metastasis of Cervical Cancer

症例は70歳，女性．腹痛を主訴に救急搬送された．腹部CTにて腹腔内遊離ガスと腹水貯留を認め，消化管穿孔による腹膜炎と診断し，緊急試験開腹術を施行した．既往歴として8カ月前に子宮頸癌cStage II B期の扁平上皮癌と診断されていたが，強皮症・肺高血圧症・慢性閉塞性肺疾患の併存疾患のため手術や化学療法は適応なく，姑息的放射線治療のみ施行されていた．手術所見ではTreitz靱帯より約80cm肛門側の小腸に腫瘍穿孔を認めたため，同部位を中心に約15cmの小腸を切除して吻合した．切除標本の肉眼的所見では白色調の腫瘤を穿孔部に認め，粘膜面には周囲に肥厚を認め，粘膜下腫瘍と考えられた．病理組織学的所見にて扁平上皮癌を認め，子宮頸癌の小腸転移と診断した．子宮頸癌の小腸転移は稀で本邦での臨床報告は5例のみであった．子宮頸癌の既往がある患者の急性腹症では子宮頸癌小腸転移も鑑別診断に挙げる必要があると考えられた．

Rare cause of acute abdomen: Small bowel metastasis from lung cancer

Rare cause of acute abdomen: Small bowel metastasis from lung cancer

S3001 Testicular Seminoma With Small Bowel Metastasis as a Presentation

S3001 Testicular Seminoma With Small Bowel Metastasis as a Presentation