Uncommon Site Of Metastasis Research Articles

Primary perianal alveolar rhabdomyosarcoma with uncommon metastatic sites: a case report and follow-up using 18F-FDG PET/CT

BackgroundRhabdomyosarcoma (RMS), a rare pediatric soft tissue neoplasm, predominantly develops in late childhood and adolescence with no discernible gender bias. Alveolar rhabdomyosarcoma (ARMS) stems from mesenchymal cells and may develop most frequently in the trunk, extremities, and head/neck areas, while occurrences in the pelvic cavity are less frequent. The manifestation is typically characterized by a high rate of aggressive metastasis and a poor overall survival prognosis.Case reportWe present the case of an 11-year-old girl with ARMS initially presenting with a perianal mass. The diagnostic workup included MRI and PET/CT, which highlighted the tumor’s aggressive nature and metastatic potential. Subsequent metastases to the pleura, lymph nodes, and, less frequently, to the bone were detected using 2-deoxy-2-[fluorine-18]-fluoro-D-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) imaging. The patient underwent a multi-regimen chemotherapy protocol but showed an incomplete response, indicating a poor prognosis.ConclusionThis report presents a rare case of ARMS primarily located in the perianal region with multiple metastases, including the uncommon occurrence of bone metastasis, which illustrates the challenges in diagnosing and treating ARMS, emphasizing the need for accurate and early diagnosis, advanced imaging for disease assessment, and more effective treatment strategies. 18F-FDG PET/CT imaging highlights its preeminence in detecting multiple rare metastatic lesions. However, the persistent disease activity despite treatment highlights the need for further research into the biology of ARMS and the development of novel therapeutics to improve patient outcomes.

Histology-Proven Gastrointestinal Metastasis from Nongastrointestinal Malignancies: Experience of This Rare Occurrence in a Single Center

Introduction Lymph nodes, lung, liver, bone, and brain are the commonest metastatic sites for malignancies arising in various body sites. Gastrointestinal (GI) tract is a very uncommon metastatic site and the present study describes the single-center experience of GI metastases from non-GI malignancies. Aims and Objectives To study the spectrum of metastatic tumors to GI tract and elucidate their clinicopathological characteristics. Materials and Methods This was a retrospective study done on cases diagnosed from 2015 to 2023 at our institute. All cases of non-GI malignancies metastatic to hollow GI tract were included. Cases with GI primary, hematological malignancies, cases with exclusive serosal deposits, and direct invasion of a GI organ from an adjacent primary tumor were excluded. Apart from hematoxylin & eosin (H&E)-stained slides, immunohistochemistry findings of these were reviewed. Results Thirty-six patients were histologically proven GI metastases from non-GI malignancies diagnosed during the study period. Most cases were seen in 5th to 7th decade with a significant female preponderance (M:F of 1:8). The commonest metastatic GI sites were small bowel (n = 11), sigmoid colon (n = 9), and rectum (n = 7), followed by stomach (n = 3), appendix (n = 3), gall bladder (n = 2), and ampulla (n = 1). Stricture, perforation, and nodular mucosa were the most common endoscopic findings. The most common primary malignancies in females were ovarian serous carcinoma (n =21) followed by squamous cell carcinoma (SCC) of cervix (n = 8). In males, there was no site preference, and the primary sites included prostate, lung, kidney, and oral mucosa. Conclusion The study highlights the rare occurrence of GI metastases from non-GI malignancies. Females are at greater risk of such metastases primarily from ovarian serous carcinoma and cervical SCCs.

Abstract PO4-16-07: Cyclin-dependent kinase inhibitor plus endocrine therapy in HR+/HER2- invasive breast cancer with bone marrow and pancytopenia: a new standard of care? Collaborative multicentric Argentinean real-world study (SUMA-02)

Abstract Introduction Bone marrow involvement is a rare occurrence in patients with advanced breast cancer (ABC), and the prognosis in this context is generally poor. Prompt initiation of treatment to improve the patient's hematological status is crucial. However, this condition is often excluded from clinical trials, making it challenging to determine the effectiveness of new drugs. Limited data and evidence are available to guide treatment decisions, but guidelines recommend starting with chemotherapy for the need of a rapid response. This study aims to analyze the real-world efficacy of cyclin-dependent kinase inhibitors (CDKis) in HR+/HER2- ABC with bone marrow infiltration. Methods Retrospective multicenter cohort study including HR+/HER2- ABC patients from public and private facilities in Argentina. Patients with confirmed bone marrow involvement (blood smear or histological biopsy analysis) and treated with CDKi were eligible. Bone marrow response was defined as an increase in at least one of the previously abnormal blood series to Hb >10.0, platelets >100,000, and leukocytes >4,000. Results A total of 22 patients from different medical centers in Argentina were included. The median age was 55.5 (IQR 46.25-65). Histological confirmation of bone marrow involvement was reported in 81.8% (18) of patients. Among them, 54.5% (12) had initial diagnosis at an early stage, and 13.6% (3) experienced relapse during or within 1 year of completing adjuvant hormonal treatment. Bone-only metastasis was observed in 50% (11) of patients, while the remaining 50% (11) had both visceral and bone disease. Anemia, thrombocytopenia, and leukopenia were present in 95.5% (21), 90.9% (20), and 40.9% (9) of patients, respectively. In 68.2% (15) of patients, bone marrow involvement was detected at the first-line treatment setting. The selected CDKis were palbociclib in 40.9% (9) of patients, ribociclib in 31.8% (7), and abemaciclib in 27.3% (6). The bone marrow response rate was 68.2% (15), with a median of 2 cycles (range 1-5) required for a response. Dose reduction was necessary in 31.8% (7) of patients. Discussion Managing patients with uncommon sites of metastasis, such as bone marrow, poses significant challenges for oncologists. Bone marrow infiltration leads to hematopoietic alterations that adversely affect the quality of life, resulting in increased risk of infections, bleeding, and other comorbidities with fatal consequences. While chemotherapy is the standard treatment in such cases, our study demonstrates that CDKis are a safe and effective option for managing these complications. Conclusion The findings of this study support the evaluation of CDKis as a standard treatment for HR+/HER2- ABC patients. Our results are in line with the recently published phase 2 clinical trial RIGHT CHOICE, which showed a prolonged progression free survival in patients treated with ribociclib and HT with HR+/HE2- ABC and visceral crisis. Citation Format: Alexis Ostinelli, Pablo Mandó, Carolina Almada, Melina Winocur, M. Agustina Ipiña, Viviana Paez, Silvia Aparicio, Sergio Rivero, Federico Waisberg, Laura Sabina Lapuchesky, Cristian Micheri, M. Belen Montenegro, Cristina Rusz Maidana, Carolina Reinhardt, Evelina Rovera, Gonzalo Gómez Abuin, Santiago Bella, Florencia Perazzo, Adrian Nervo, Andrea Aguilar, Matías Chacón, Victoria Costanzo, Valeria Caceres, Jorge Nadal. Cyclin-dependent kinase inhibitor plus endocrine therapy in HR+/HER2- invasive breast cancer with bone marrow and pancytopenia: a new standard of care? Collaborative multicentric Argentinean real-world study (SUMA-02) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-16-07.

Sister Mary Joseph Nodule: A Dermatological Insight into Metastatic Pancreatic Cancer

The Sister Mary Joseph (SMJ) nodule is a metastatic umbilical growth observed in primary tumors originating from the gastrointestinal or genitourinary tract. Commonly, SMJ nodules are associated with gastrointestinal cancers, particularly those affecting the stomach and colon. While the pancreas is an uncommon primary site for umbilical metastasis, pancreatic adenocarcinoma that spreads to the umbilicus typically originates from the body or tail of the pancreas. The presence of an SMJ nodule often indicates a poor prognosis, serving as a straightforward physical indicator of advanced intra-abdominal malignancy. Although pancreatic cancer is a rare cause, it should be considered among the primary sites in such cases. This report details a case of an SMJ nodule unveiling pancreatic adenocarcinoma in a 61-year-old patient. The case underscores the significance of examining the umbilicus, an area frequently overlooked but crucial for diagnosis. Vigilant clinical follow-up and histological evaluation are imperative in such cases, highlighting the importance of not underestimating this infrequently assessed region.

Skin metastases of endometrial cancer

About 400 thousand of new cases of endometrial cancer is registered in the world every year. Previously uncommon (for this type of malignancy) metastatic sites, such as brain or skin, have been observed over the past 15 years. Skin metastases of endometrial cancer are extremely rare and occur in less than 1 % of cases. We present a clinical case of atypical metastasis of endometrial cancer to the skin of the pubic region in a patient who underwent combined treatment.

Cutaneous, Subcutaneous, and Bilateral Adrenal Gland Metastases in Progressive Prostate Carcinoma: Theranostic Potential of 68 Ga-PSMA-11 PET/CT Imaging and 177 Lu-PSMA-617 Therapy.

Prostate carcinoma (PC) is the second most common malignant tumor in males globally. The metastatic spread of PC usually involves the pelvic and abdominal lymph nodes and the skeletal system. Cutaneous metastases are exceedingly uncommon and typically manifest themselves late in the disease course, considered as ominous sign with limited treatment options and a poor prognosis. We describe a patient wherein 68 Ga-PSMA-11 PET/CT detected multiple uncommon metastatic sites in the cutaneous region of the scrotum, penis, and thigh, as well as in the subcutaneous region of anterior abdominal wall, and in bilateral adrenal glands. These findings served as a theranostic tool for selecting 177 Lu-PSMA-617 treatment for these extremely rare metastatic sites.

Thyroid metastasis from nasopharyngeal cancer: a case report

Background. Nasopharyngeal cancer is a rare head and neck cancer with a relatively high risk of locoregional recurrence and distant metastases. The most common sites of metastases are bones (70–80 %) followed by liver (30 %), lung (18 %), and lymph node (axillary, mediastinal, pelvic, and inguinal). Thyroid gland is an uncommon site of metastasis with an incidence ranging from 0.5% to 24 %. Thyroid metastasis from nasopharyngeal cancer has been reported in only 9 cases in the world literature and no one in Russia. Case report. We report a case of thyroid metastasis from nasopharyngeal cancer found incidentally in a 53-year-old female patient. Conclusion. Metastases to the thyroid gland are rare, and patients with metastatic thyroid disease rarely present with organ-specifc symptoms, thus raising diagnostic diffculties for both clinicians and the pathologists. This clinical report demonstrates the diffculties of differential diagnosis,as well as the importance of a thorough collection of complaints, anamnesis, and clinical examination.

Perirenal Fascia - an Uncommon Site of Metastases in Prostate Cancer Detected on 68Ga-PSMA-11 PET/CT.

Prostate-specific membrane antigen (PSMA) PET/CT is being increasingly utilized as a hybrid imaging modality for the evaluation of prostate cancer (PCa). We report a case of a 50-year-old man with biopsy-proven high-risk PCa in which multiple tracer avid perirenal fascia deposits were identified on 68Ga-PSMA-11 PET/CT, in addition to multi-focal prostatic primary, extensive nodal, and skeletal metastases. This case highlights that perirenal fascia is an uncommon metastatic site in PCa.

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.

Hormone Positive HER2 Negative Breast Cancer Metastatic to the Rectum: A Case Report

Background: The rectum is an uncommon site for metastases from Invasive Ductal Carcinoma (IDC) of the breast, and it poses risks such as perforation and obstruction.
 Case Report: A 50-year-old non-diabetic, non-alcoholic, and nonsmoker premenopausal female patient diagnosed with rectal metastasis primarily originating from breast cancer.
 In 2009, the patient was diagnosed with stage IV hormone positive, Her-2 (+2) negative, FISH positive right breast cancer with cervical (C6) vertebrae metastasis seen on PET scan. As she had oligo metastasis with a single bony focus, she was treated with intent to cure. For this purpose, she received radiation therapy to the cervical vertebrae, resulting in a complete response. This was followed by pseudo-neoadjuvant chemotherapy with six cycles of Docetaxel and trastuzumab. The patient then underwent a right-modified radical mastectomy. The pathology showed no complete response with residual 2.5 cm invasive carcinoma (PT2), and 4 out of 25 Axillary lymph nodes were positive for metastases (PN2). She was given (pseudo) adjuvant radiotherapy to the chest wall and lymphatics and was started on (pseudo) adjuvant tamoxifen. Trastuzumab was completed for one year as a (pseudo) adjuvant setting.
 Her disease seemed to be cleared up as no new cancer signs were reported by follow-up full body scans (CT/PET). After seven years, in May 2016, her PET-CT scan showed multiple new hypermetabolic osseous lesions, in keeping with metastasis involving the right shoulder, mid-thoracic spine, left aspect of L5, right sacrum, and the greater trochanteric region of the left femur and left ischium. She also presented a new hypermetabolic retroperitoneal paracaval lymph node, in keeping with metastasis. The new ill-defined hypodensity in the left hepatic lobe was associated with increased FDG uptake, which is suspicious for early metastasis. She also presented a tiny right lung peri-fissural nodularity that was too small to be characterized by PET.
 She was treated with Zoladex 3.6 mg injection monthly, Femara 2.5 mg daily, Palbociclib 125 mg PO daily for 21 days over a 28-day cycle, and Denosumab 120 mg monthly. The treatment was initiated in Singapore. As previously stated, Her-2 testing was reported as negative. The patient went into complete remission for more than six years, as documented by the PET scan conducted on January 19, 2022. Later, in June 2022, the patient developed signs and symptoms of intestinal obstruction (abdominal pain, nausea, and vomiting) and was diagnosed with rectal cancer metastases of breast origin.
 Conclusion: As the patient first developed breast cancer with oligo-bony metastasis, which was successfully treated with chemotherapy and radiotherapy, but later relapsed in the lung, liver, lymph nodes, and multiple bony sites. She was treated successfully via hormonal and targeted therapy. Finally, she relapsed in the form of rectal metastasis.

S1920 A Rare Case of Small Cell Lung Cancer With Pancreatic Metastasis Presenting as Obstructive Jaundice

Introduction: Small cell lung cancer (SCLC) is an aggressive high grade neuroendocrine carcinoma that accounts for 15% of all lung cancers & usually presents with early distant metastatic spread typically to liver, bone, brain & lung on diagnosis. Pancreas is a very uncommon site of metastasis. We present a rare case of SCLC metastasis to the pancreas presenting as obstructive jaundice upon initial presentation. Case Description/Methods: A 62-year-old male with a past medical history of recurrent pancreatitis presented to the emergency department with abdominal pain, nausea, vomiting, & jaundice. Routine blood work on admission were notable for elevated total bilirubin of 16.4 mg/dL along with elevation in alkaline phosphatase at 547 IU/L & elevation in AST & ALT to 120 U/L & 144 U/L, respectively. Imaging with CT followed by MRI abdomen showed focal enlargement of the pancreatic head with dilatation of the common bile duct & the main pancreatic duct along with innumerable rim-enhancing lesions within the liver consistent with metastasis. CT Chest was also done that showed a large right suprahilar mass with mass effect on the right main bronchus. CT guided biopsy of liver lesion was performed which confirmed small cell carcinoma on pathology. Worsening jaundice prompted ERCP with EUS which showed a large mass at the major papilla site. Pancreatic duct was cannulated & sphincterotomy was performed; However, biliary cannulation could not be completed due to the size of the mass & prior history of chronic pancreatitis cannulation. Patient subsequently underwent IR guided PTC drain placement with appropriate decrease in bilirubin. Chemotherapy was initiated with carboplatin/ etoposide for metastatic small cell cancer with spread to the pancreas & liver (Figure). Discussion: SCLC metastasis to pancreas is rare & majority of patients with pancreatic metastasis are asymptomatic upon incidental diagnosis by abdominal CT. Pancreatitis & obstructive jaundice are seldom found on initial presentation, as seen in our patient. Jaundice can result from biliary ductal obstruction if SCLC spreads to lymph nodes in the porta hepatis or the pancreatic head. Endoscopic ultrasound (EUS) is more sensitive than CT or MRI in the diagnosis of pancreatic malignancy. Metastasis to pancreas typically indicates advanced disease & clinicians should consider palliative treatment with surgical biliary bypass & chemotherapy in select patient groups which has shown to lead to clinically significant increased mean survival time.Figure 1.: MRI Abdomen with contrast transverse image showing rim-enhancing lesions within the liver and focal enlargement of the pancreatic head with dilatation of the common bile duct and the main pancreatic duct (A). Endoscopic imaging showing a large fungating mass was found at the major papilla (B).

The pancreas as a target organ for metastases: Multi-center study in Argentina

Background: The pancreas is an uncommon site for metastases, accounting for 0.25% to 5% of pancreatic tumors, so that solitary pancreatic metastases are rare. The most frequent primary tumor capable of metastasizing in the pancreas is clear cell renal carcinoma (CCRC). Surgical resection remains the best therapeutic alternative to achieve long-term survival. Our aim is to present the long-term results of a multi-center study in Argentina of pancreatic resection due to pancreatic metastases. Methods: Multi-center, retrospective report of adult patients operated for pancreatic metastases from July 2010 to December 2019, in 7 high volume Argentinian HPB surgery centers. Results: 1557 pancreatic surgeries were performed, 48 (3.1%) due to pancreatic metastases. Median age was 62±11 years, 25 (52%) male. Twenty-six distal pancreatectomies, 12 pancreatoduodenectomies, 5 total pancreatectomies, 1 central pancreatectomy and 4 tumor enucleations were performed. The most frequent primary tumor was CCRC (N=35) followed by colorectal cancer (N=4). Mean number of pancreatic lesions was 1.6±3. Twenty-two (45%) patients had complications and 5 (10%) patients required reoperation; the 90-day mortality rate was 4.2%. Mean follow-up was 80 months. The mean disease-free interval was 5.3±6 years. The disease-free and overall survival was better in patients with pancreatic metastases of clear cell renal carcinoma compared with other type of cancer. Conclusion: Despite its rarity, pancreatic metastases must be considered as a possible diagnosis in patients with a prior oncological history; surgical resection remains as the main therapeutic option.

Rectal linitis plastica as the first presentation of metastatic lobular breast cancer: an endoscopic ultrasound diagnosis

Gastrointestinal tract is an uncommon site of breast cancer metastasis. Rectal linitis plastica (RLP) is a rare presentation of rectal neoplasia, both primary and secondary, and refers to a diffuse infiltration of the wall by an infiltrating carcinoma. Diagnostic assessment of RLP may be challenging since cross-sectional imaging and endoscopic findings may be nonspecific, and endoscopic biopsies are frequently non-diagnostic due to the submucosal disease localization. Endoscopic ultrasound (EUS) with fine needle biopsy (FNB) is widely used for the diagnostic assessment of sub-epithelial lesions of upper and lower gastrointestinal tract. However, data about the use of EUS in case of rectal linitis plastica are very poor. We present a case of rectal metastasis as the first presentation of lobular breast cancer, presenting as rectal linitis plastica and diagnosed with EUS-FNB.

A Case Report of Isolated Bone Marrow Metastasis from Neuroendocrine Tumor of Occult Primary: A Pathologist's Perspective on this Unusual Presentation - A Case Report

Introduction: Neuroendocrine tumors (NETs) are poorly understood neoplasms that, although slow growing compared with epithelial malignancies, can behave aggressively. Bone marrow (BM) is an uncommon site of metastasis by neuroendocrine tumors (NETs), occurring in approximately 5% of the cases. Despite advanced diagnostic techniques, primary site cannot be deciphered in few patients. Case: A 46-year-old male with a recent history of myocardial infarction, rapidly worsening back pain from past two months. He was referred to us with a suspicion of multiple myeloma with multiple lytic lesions of bone. The patient underwent a BM examination, which revealed extensive infiltration of the marrow with tumor cells positive for immunohistochemical (IHC) markers of NET with high proliferation index. Thus, a diagnosis of “metastatic NET” was rendered. Conclusion: In an occult primary, a panel of IHC biomarkers are of key importance to confirm the nature and grade of the tumor. Site-specific markers may be lost in high-grade tumors. Thus, in an era of theradiagnostics, immunohistochemistry remains a tool of paramount vitality, to accurately classify these tumors, and may aide in finding the primary site of neoplasm.

Incidence and comparative prognosis of cancers with metastasis to noncommon sites: A population-based study.

Primary tumors have common sites of metastasis such as lymph nodes, bones, liver, lungs, and brain; however, they can also metastasize to other uncommon sites such as adrenals, bone marrow, and skin among others. Our study aimed to investigate the relationship between uncommon sites of metastasis at the time of diagnosis and median survival in a number of primary tumors using the Surveillance, Epidemiology, and End Results (SEER) database.This retrospective cohort study conducted between September–October 2021 included patient-level SEER data for 2016–2018 using SEER Research Data, 9 Registries, Nov 2020 Sub (1975–2018). Descriptive analysis for complete cohort and median survival for each primary within the cohort was performed using R software.A total of 25,345 patients (females, 51.4%) were diagnosed with primary tumors with metastasis to uncommon sites at the time of diagnosis; the mean age at diagnosis was 68 years. Lung and bronchus primaries constituted the largest proportion of cohort (41.9%) that metastasized to uncommon sites, followed by nonHodgkin lymphoma-nodal (7.4%), pancreas (6.6%), stomach (3.7%), and ovarian (3.4%). The incidence of metastasis to uncommon sites was most common in respiratory cancers in ages 61–80 years (25%) and least in breast primaries in ages 18–40 years (0.1%), and was higher in Whites compared to other races. Regarding median survival, liver cancer with metastasis to uncommon sites had the worst prognosis (1 month), whereas small intestine tumors were associated with a better prognosis, median survival of 13 months.In this cohort study, the lung and bronchus cancers were the most common primaries metastasized to uncommon sites at diagnosis. The liver tumor had the worst survival compared to other tumors. These findings will help redirect the available screening tools to improve survival in patients with primary tumors with metastasis at diagnosis and may also play an essential role in future research and achieve a better prognosis for cancer patients.

The incidence and comparative prognosis of primary cancers with metastasis to non-common sites: A SEER database analysis of 2016-2018.

e22506 Background: Primary tumors can present late with metastasis to uncommon sites (such as adrenals, bone marrow, pleura, malignant pleural effusion, peritoneum, and skin, among others) as well as common sites (such as liver, bone, lung, and distal lymph nodes). Our study aimed to investigate the characteristics and comparative survival for metastasis to uncommon sites at the time of diagnosis using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We extracted the data from the SEER database for the years 2016-2018 to include all patients presenting with metastasis to uncommon sites at diagnosis without restrictions on age, race, year of diagnosis, or histological type. Uncommon sites of metastasis were coded as other sites in the SEER database and did not involve liver, bone, brain, lung, and distal lymph nodes. We used R software to perform the descriptive analysis for uncommon sites according to the primary sites and co-metastasis along with their survival. Results: A total of 25,345 patients were included with metastasis to uncommon sites with a female predominance of 13,033 (51.4 %); the mean age at diagnosis was 68 ± 17 years. Lung and bronchus primaries represented the largest proportion with metastasized to uncommon sites 10,612 (41.9%), followed by non-Hodgkin's lymphoma-nodal 1,871 (7.4%), pancreas 1,690 (6.6%), stomach 940 (3.7%), and ovarian 885 (3.4%). The incidence was most common in respiratory cancers in ages 61-80 years (25%) and least in breast primaries in ages 18-40 years (0.1%). Whites compared to other races had a higher incidence. Liver cancer had the worst prognosis with a median survival of 1 month, whereas small intestine tumors were associated with a better prognosis with a median survival of 13 months. Further survival data is mentioned in the table. Conclusions: Our study concluded that the lung and bronchus cancers were the most common primaries metastasized to uncommon sites at diagnosis while the liver had the worst survival. These findings will help redirect the available screening tools to improve survival in patients with primary tumors with metastasis at diagnosis and may also play an essential role in future research and achieve a better prognosis for cancer patients.[Table: see text]

Carcinoma En Cuirasse as an Initial Manifestation of Gastric Cancer: New Case Report

Carcinoma en Cuirasse (CEC) is an extremely rare and dramatic form of cutaneous metastases (CM); characterized by a scleroderma-like clinical appearance. The skin is an uncommon site for distant metastasis; when it is present the most origin are breast, lung and colon. We report a rare case of CEC pattern of CM secondary to gastric malignancy in a 45-year-old male patient; the interesting part being that skin Metastasis was the first-presenting sign. which on further histopathological and immunohistochemical evaluation led to the diagnosis of serious hidden gastric carcinoma.

Rare presentation of cardiac tamponade secondary to myocardial metastasis from breast cancer

Cardiac tamponade is a rare presentation of metastatic disease. The estimated incidence of pericardial effusions in patients with breast cancer is about 2.1%. Myocardial metastasis an uncommon site of cardiac metastasis, (29–32%) after pericardial and epicardial involvement respectively. The increasing incidence of cardiac metastasis likely corresponds to an increase in life expectancy from modern oncologic treatment.

Hepatocellular carcinoma with uncommon sites of metastasis: a rare case report

BackgroundHepatocellular carcinoma (HCC) is a highly malignant tumor, causing both intrahepatic and extrahepatic metastases. The extrahepatic metastasis occurs in one-third of patients with HCC and it is associated with a poor prognosis. The most common sites of extrahepatic metastasis are lung, regional lymph nodes, bone, adrenal glands, and peritoneum/omentum. Detection of such extrahepatic metastasis plays a vital role in the staging and treatment planning of HCC.Case presentationA 60-year-old man was presented to our centre with loss of apetite, generalised weakness, and weight loss. Abdominal examination revealed a firm lump in the right hypochondrium. CT findings revealed a large well-defined hypodense mass in almost entire right lobe of the liver. A well-defined oval, heterogeneously enhancing soft tissue mass lesions were also noted in both adrenal glands and psoas muscles. For histopathological diagnosis, percutaneous ultrasound-guided truecut biopsy was done from right lobe liver mass confirming well differentiated HCC.ConclusionsIn the present case report, we present an extremely rare and unique case of HCC with disseminated skeletal muscle metastasis with concomitant bilateral axillary lymph node metastasis. It is crucial for radiologists to detect such extrahepatic sites of metastasis initially at the time of diagnosis for accurate staging and treatment planning for a better prognosis.

Abstract 2846: Stereotypic patterns and genomic correlates of organotropism in metastatic melanoma

Abstract Despite the major role that metastasis plays in the morbidity and mortality of melanoma, stereotyped patterns of metastasis and drivers of its organotropism in melanoma are still not well characterized, limited by a dearth of sequencing data in well-annotated clinical melanoma samples. To address these open questions, we performed an integrative analysis of clinical and genomic features from 243 patients with metastatic melanoma treated at Dana Farber Cancer Institute (DFCI). Tumor biopsies were sequenced with OncoPanel, a next-generation sequencing panel that identifies mutations in 331 cancer genes. Presence of site metastases was evaluated radiographically pre-treatment for each patient; sites include lymph node (64% of cohort), soft tissue (59%), lung (57%), liver (32%), brain (24%), bone (22%), mesentery (12%), adrenal gland (9%), spleen (7%), and other metastatic sites (13%). Metastases showed significant co-occurrences (e.g. bone and lung, OR 2.8, 95% CI = [2.3, 3.3], p < 0.01; adrenal and mesentery, OR 4.4, 95% CI = [3.8, 5.0], p < 0.01) and exclusions (lymph node and brain, OR 0.5, 95% CI = [0.2, 0.8], p = 0.02). We performed unsupervised hierarchical clustering of patients with cutaneous melanoma (n = 203) by metastatic site pattern using a Euclidean distance metric weighted to favor uncommon metastatic sites, yielding five stereotypic patterns of metastasis, characterized by: (1) co-occurrence of adrenal, mesenteric, and abdominal metastases (n=19); (2) liver metastases (n=33); (3) low metastatic burden (n=80); (4) co-occurrence of lung, brain, and mesentery metastases (n=42); and (5) co-occurrence of bone and lung metastases (n=29). Clustering is stable, with highly concordant cluster assignments in repeated subsampling of the data. Patients with cutaneous melanoma (n=203) exhibited both site-specific and pattern-specific genomic correlates of metastatic organotropism that persist after correction for mutational burden. Tumors from patients with liver metastases showed significantly higher prevalence (p < 0.05) of mutation compared to patients without liver metastases in KMT2D (56% vs 18%), BCL6 (22% vs 0%), TMPRSS2 (22% vs 0%), ARID1B (33% vs 4%), MET (33% vs 4%), and AXL (44% vs 11%), with similar enrichment in the liver met-predominant metastatic cluster, implicating dysregulation of histone and protein deacetylation pathways in liver metastatic organotropism (p < 0.01). Numerous additional mutational correlates were found for the remaining nine metastatic sites and all five metastatic patterns, and validation in an orthogonal dataset is ongoing. We present robust stereotypic patterns of metastasis and both site- and pattern-specific genomic correlates of organotropism in metastatic melanoma. By leveraging a valuable clinical/genomic data set, we nominate genetic correlates of organotropism for functional validation and potential therapeutic targets. Citation Format: William H. Ge, Giuseppe Tarantino, Emily Robitschek, Michael P. Manos, Lauren Eastman, Olivia Ouyang, Patrick Ott, Ann W. Silk, Osama E. Rahma, Alexander Gusev, Rizwan Haq, Elizabeth I. Buchbinder, Megan L. Insco, Stephen Hodi, Eliezer Van Allen, David Liu. Stereotypic patterns and genomic correlates of organotropism in metastatic melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2846.