Unusual Site Of Metastasis Research Articles

Exploring the Uncommon: A Series on Dermatofibrosarcoma Protuberans with Rare Locations, Unusual Sites of Metastasis, and Their Close Mimics

Abstract Dermatofibrosarcoma protuberans (DFSP) is an uncommon, slowly growing soft-tissue tumor that involves the dermis, subcutaneous fat and very rarely involves, muscle and deep fascia. It is locally aggressive and an intermediate-grade fibroblastic neoplasm that rarely metastasizes. It is important to know about this entity as it is locally aggressive and has a higher rate of transformation into fibrosarcoma which has an aggressive growth pattern and frequently metastasizes. Apart from this, there are diagnostic challenges, especially in small biopsies, where they resemble other spindle cell neoplasms. This article reviews the clinical and histological features of DFSP as well as possible pitfalls in their diagnosis and how to resolve them. Diagnosed cases of DFSP were retrieved from pathology archives. Their locations and histopathological features along with Immunohistochemistry (IHC) features were reviewed. Our study identified 26 cases of DFSP for 5 years from January 2019 to January 2024 in a tertiary care hospital. The age of study subjects was in the range of 11–70 years. Male:female ratio was 1.30:1. The most common site was shoulder (n = 5). Immunohistochemistry (HC) was performed in cases with diagnostic dilemmas and cases of high-grade transformation. The aim of this study was to perform a retrospective analysis of histopathological features of DFSP to distinguish it from other mimics and emphasize its local aggressiveness, reoccurrence, and rare site of metastasis, especially in cases with fibrosarcomatous transformation. The careful histomorphological examination particularly in smaller biopsies can be challenging, especially in peripheral laboratories and in resource-limited settings.

Simultaneous Metastatic Involvement of Bilateral Testes and Left Spermatic Cord in Prostate Cancer Detected on 68Ga-PSMA-11 PET/CT.

Bilateral testicular involvement in prostate cancer is quite rare. It is often associated with widespread systemic disease and inadequate response to systemic therapy. We present a case of metastatic prostate cancer with bilateral testicular metastases and simultaneous involvement of the left spermatic cord detected on 68Ga-PSMA-11 PET/CT and confirmed on the histopathology of bilateral orchiectomy done for achieving the androgen deprivation status. Early detection of such unusual sites of metastases has poorer prognostic outcome and management implications.

Patterns and Clinicopathological Features of Histologically Proven Metastases in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary liver malignant neoplasm. Multiple risk factors have been identified for several decades for this overly aggressive tumor. HCC is an overly aggressive malignancy with frequent intrahepatic and extrahepatic metastasis. In our practice, we have observed that HCC has the propensity to metastasize to very unusual sites and can sometimes show variable patterns leading to diagnostic difficulty. In this study of 257 patients, we aim to discuss the unusual sites of HCC metastasis, the various patterns of metastasis, clinicopathological features, and the most common cause of HCC in our population. In the course of our research study, we systematically extracted a comprehensive dataset comprising 257 instances of metastatic HCCs from the hospital database spanning the period from 2016 to February 2022. The assessment of metastatic sites uncovered a wide range of locations, reflecting significant diversity. The most common location was bone, with 135 cases (52.5%). The vertebral column was the most common location among bony metastasis, with 63 cases (24.7%). Morphologically, the most common histological pattern observed was pure trabecular in 192 patients (74.7%). All cases were diagnosed with the help of immunohistochemical stains. Out of 257 cases, 29.18% were diagnosed using glypican-3 and HepPar1, while 26.1% relied solely on HepPar1 positivity. HepPar1 was performed in a total of 240 cases, and positivity was seen in 205 cases (85.5%). In summary, our study represents the most comprehensive investigation of clinicopathological characteristics in metastatic HCC conducted within the past 20 years. It helps understand the histological and immunohistochemical features useful for diagnosis at metastatic sites for tumors with an unknown primary.

Endometrial endometrioid adenocarcinoma with a malignant squamous component: is the unusual metastatic pattern unique of these tumors?

The FIGO scheme is currently applied for tumor grading of endometrioid adenocarcinoma. The current report presents a series of ten cases of endometrioid carcinomas that when applying the FIGO grading does not fully convey the true biological nature of the disease. The squamous component of these tumors is malignant; it constitutes the predominant invasive component, and it often metastasizes to unconventional sites. Half of the cohort developed distant disease recurrence within 2 years, even those with early-stage disease. Somatic mutations were analyzed, targeting 101 genes in all ten cases, and mutations in PTEN, MMR, PIK3CA, ATM, RB1, and TP53 genes were detected, often multiple mutations in the same case. None of the cases revealed unique molecular signatures or previously unreported gene mutations. Immunohistochemical staining for beta-catenin showed aberrant nuclear staining in eight of ten cases and remaining two showed cytoplasmic and membranous staining. Aggressive behavior and unusual sites of metastases are observed in this series even in low-grade tumor. The FIGO grading on smaller samples may be deceptive for these cases. Even if FIGO is applied, the pathology report should emphasize the malignant squamous component and its potential significance so that the gynecologic oncology team can formulate appropriate adjuvant treatment upfront. This case series argues that this histology should be regarded as a high-grade endometrioid carcinoma and can show unusual metastatic patterns. Further research is needed with more cases within this histologic subtype to guide recommendations on adjuvant therapies for this aggressive tumor type.

Unusual Metastasis of Signet-Ring Cell Gastric Cancer That Could Not Be Detected With 18 F-FDG PET But With 68 Ga-FAPI PET/CT.

A 70-year-old man who was scheduled for surgery because of the recurrence of gastric cancer was referred to our clinic preoperatively. The patient underwent a comprehensive evaluation through 18 F-FDG and 68 Ga-FAPI ( 68 Ga-labeled FAP inhibitors) PET/CT scans. The 68 Ga-FAPI PET/CT scan was particularly valuable in this case because of its ability to detect recurrent mass lesions and identify unusual metastatic sites compared with the 18 F-FDG PET/CT scan.

Clinical characteristics and outcomes of patients with metastatic colitis-associated cancer treated with EGFR inhibitors.

37 Background: Colitis-associated cancer (CAC) is a devastating complication of inflammatory bowel disease. CAC tumor biology differs from that of sporadic colorectal cancer (CRC). Patients (pts) with (w/) metastatic CAC (mCAC) treated w/ 1st line (1L) chemotherapy have worse outcomes than pts w/ sporadic metastatic CRC (mCRC). EGFR inhibitor (EGFRi) w/ chemotherapy is standard of care for mCRC that is left (L) sided, RAS wild type (WT), without BRAF V600E mutation (mut) or ERBB2 amplification (amp). There are no published data on efficacy of EGFRi in CAC. We report outcomes of mCAC pts treated w/ EGFRi. Methods: Cases were identified by querying a prospectively maintained database of CAC pts seen at Memorial Sloan Kettering Cancer Center from 1/2000-present. Among mCAC pts who received EGFRi (n = 16), outcomes of interest: best response, progression-free survival (PFS), and overall survival (OS). PFS was calculated from date of 1st treatment w/ EGFRi until progression or death. OS was calculated from date of 1st treatment w/ EGFRi until death or last follow-up. Survival analyses were performed using Kaplan-Meier method. Data were obtained through review of electronic medical records. Results: 84 pts w/ mCAC were identified (52 L sided, 24 right [R] sided, 8 small bowel). Genomics were consistent w/ our prior reports: 79% TP53 mut, 19% APC mut, 14% MYC amp/gain, 32% KRAS mut, 4% BRAF mut, 6% ERBB2 amp. Limiting to pts w/ tumors that were L sided, RAS WT, without BRAF V600E mut or ERBB2 amp, we identified 34 (40%) mCAC pts. 16 (47%) of these pts received EGFRi as 2L or 3L therapy. 3 pts (19%) received EGFRi alone, 13 pts (81%) received EGFRi w/ FOLFIRI or irinotecan. 8 pts (50%) had tumors that were high grade and/or w/ signet ring features. Metastatic sites at initiation of EGFRi: lymph node (69%), liver (50%), lung (50%), peritoneum (38%), bone (38%), soft tissue (38%). 2 pts (12.5%, 95% CI: 1.5-38.3%) had a response, 4 pts (25%) had stable disease (SD), and 10 pts (62.5%) had progressive disease (PD) as best response. Median PFS and OS: 3.0 months (95% CI: 1.8-8.7) and 11.5 months (95% CI: 8.8-17.4), respectively. 2 additional pts w/ R sided CAC received EGFRi w/ SD and PD as best responses. Conclusions: Pts w/ mCAC, who by established criteria are eligible for treatment w/ EGFRi, have rapid progression and low response rates to EGFRi. This suggests that unlike sporadic CRC, CAC may not be driven primarily by EGFR. Many had high grade histology and unusual sites of metastases (bone, soft tissue). Experiments are under way to elucidate mechanisms underlying resistance to EGFRi and will be reported. These include immunohistochemistry for EGFR and its ligands, transcriptomic analyses to classify consensus molecular subtypes, and assessment of EGF dependence and EGFRi sensitivity in CAC organoids.

Metastasis from renal cell carcinoma-unusual presentations

ABSTRACT Renal cell carcinoma is one of the most lethal tumors of the urologic system and has high metastatic potential. The usual sites of metastasis are lung, bone, liver adrenal, lymph node, and brain. Thumb and oral cavity metastasis are unusual sites of metastasis. This case report describes two cases reported with unusual thumb and oral cavity metastasis. Patients with acral and oral metastasis are often misdiagnosed as benign inflammatory disease and treatment initiation is often delayed. This case report helps in drawing the attention that such lesions can be metastatic also.

A Rare Case of Cutaneous Metastasis of Osteosarcoma

Abstract Osteosarcoma (OS) is a primary bone tumor, usually seen in childhood or adolescence. With an estimated incidence of 5 in every 100,000 new cases detected per year, OS is an aggressive malignant mesenchymal tumor. The most common sites for this tumor are the distal end of the femur and the proximal tibia. Metastases from OS are most commonly seen in the lung or other bones. Patients with skin and subcutaneous tissue metastases are a relatively rare subset. Here, we report a rare case of an 18-year-old girl who presented to the hospital with an unusual site of metastasis from OS.

Unusual metastases of breast cancer: a single-center retrospective study

Objectives: While clinical and radiological awareness of the usual, frequent metastatic sites of breast cancer is high, unexpected 'atypical' localisations may be more easily overlooked in the cancer management process. The aim of this article is to contribute to this awareness in order to facilitate and improve the diagnosis and follow-up of breast cancer. Methods: In this study, we retrospectively evaluated breast cancer patients who were diagnosed and followed up between 2017 and 2022 in our hospital, which is an important oncology center. Results: Of the 852 patients included in this study, 79 had an unusual metastasis localization. The most common unusual metastasis sites were mediastinal lymph nodes and brain. These sites were followed by atypical bone involvement, mesenteric lymph nodes, cervical lymph nodes, hilar lymph nodes and surrenal metastases. The most rare metastases were more common in the uterus and ovary, followed by pancreas, parotid gland, spleen, colon, pericardium-atrium, orbital soft tissues and lacrimal gland. . The unusual site of metastasis was mediastinal lymph nodes in 17.7% (n = 14), brain in 17.7% (n = 14), atypical bone sites in 12.6% (n = 10), mesenteric lymph nodes in 11.3% (n = 9), cervical lymph nodes in 11.3% (n = 9), hilar lymph nodes in 5% (n = 4) and surrenal in 6.3% (n = 5). Conclusions: Sharing knowledge and experience about unusual metastases of breast cancer will contribute to the diagnosis and treatment of metastatic diseases by increasing the awareness of this issue. For this, multicentre studies should be conducted to combine these experiences.

Metastasis to Ascending Colon from Squamous Cell Carcinoma Cervix: Unusual Presentation

Ascending colon is an unusual site of metastasis from primary carcinoma cervix. Unusual sites of metastasis from squamous cell carcinoma (SCC) cervix include bones, stomach, duodenum, colon, skin. Squamous cell carcinoma is a rare malignancy of gastrointestinal tract (GI). Metastasis of SCC of cervix to GI tract is uncommon and has been reported only in a handful of cases. It may present with intestinal obstruction requiring debulking surgery. Management is palliative and role of chemotherapy or radiation is unclear. In this report we discuss a 47 year old female with history of squamous cell carcinoma of cervix treated in 2014. She developed local recurrence in 2019 and received pelvic re radiation. She presented with intestinal obstruction and on evaluation diagnosed to have metastatic squamous cell carcinoma of ascending colon.

Cutaneous Malignant Melanoma with Testicular Metastases in a Wild Rabbit (Oryctolagus cuniculus).

Melanocytic skin tumours have been rarely described in pet rabbits, and exposure to UV light in sparsely haired areas has been hypothesised to play a cancerogenic role. Here, we describe a case of cutaneous malignant melanoma arising from the skin of the scrotum in an 8-year-old male wild rabbit, with testicular metastases as an unusual metastatic site for melanoma reported in humans to date. The tumour was nearly 5 cm in size, firm, and highly pigmented, with multifocal superficial ulcerations and large areas of intratumoural necrosis. The adjacent testis was 1.5 cm, multinodular, and black, obscuring tissue morphology. Histologically, the dermis was expanded by an infiltrative, densely cellular neoplasm composed of nests and sheets of polygonal to spindle neoplastic melanocytes, supported by scant fibrovascular stroma. Neoplastic cells showed intermediate N/C ratio, moderate basophilic cytoplasm, often obscured by abundant brownish granular pigment, and eccentric nuclei with prominent nucleoli. Cellular pleomorphism and nuclear atypia were severe, and high mitotic activity was observed. Diffuse dermal lymphovascular invasion was also observed. The testis was delimited by a thin tunica albuginea, and the parenchyma was largely obscured in its morphology by densely packed neoplastic cells. Seminiferous tubules, lined with a thin basement membrane and containing neoplastic and scattered spermatogenic cells, were occasionally observed. Neoplastic cells within the skin and the testis were positive for HMB-45, Melan-A, and S-100. The growing popularity of rabbits as pets allows for a greater ability to accumulate data on the spontaneous occurrence of tumours in these animals. Furthermore, descriptions of the biological aspects of spontaneously occurring tumours may serve to improve current knowledge in animal species and humans in which the same neoplasm may occur.

Collaborative Approach for Patient Management: Parapharyngeal Metastasis of Papillary Thyroid Carcinoma

A collaborative approach is important in the management of patients, in order to facilitate discussion, and allow cross-checking, in order to achieve the optimal outcome for patient care. Here we present a case, where a collaborative approach allowed the pre-operative identification of an unusual site of metastasis for recurrent papillary thyroid cancer, leading to the change of treatment plan.

Therapeutic Strategies and Oncological Outcome of Peritoneal Metastases from Lung Cancer: A Systematic Review and Pooled Analysis

The peritoneum is an unusual site of metastases from lung cancer, and optimal management at the moment remains unclear and mostly based on palliative strategies. Therefore, the aim of the study was to investigate demographic characteristics, management and overall survival of patients with peritoneal metastases from lung cancer (PCLC). A PRISMA-compliant systematic review and pooled analysis was performed searching all English studies published until December 2022. PROSPERO, CRD42022349362. Inclusion criteria were original articles including patients with peritoneal carcinomatosis from lung cancer, specifying at least one outcome of interest. Exclusion criteria were being unable to retrieve patient data from articles, and the same patient series included in different studies. Among 1746 studies imported for screening, twenty-one were included (2783 patients). Mean overall survival was between 0.5 and 5 months after peritoneal carcinomatosis diagnosis and 9 and 21 months from lung cancer diagnosis. In total, 27% of patients underwent first-line or palliative chemotherapy and 7% of them surgery. Management differs significantly among published studies. The literature on PCLC is scarce. Its incidence is low but appears to be substantially rising and is likely to be an underestimation. Prognosis is very poor and therapeutic strategies have been limited and used in a minority of patients. Subcategories of PCLC patients may have an improved prognosis and may benefit from an aggressive oncological approach, including cytoreductive surgery. Further investigation would be needed in this regard.

Melanoma Metastases Arising at Unexpected Sites: Gallbladder and Uterus

Although malignant melanoma (MM) most frequently tends to metastasize to the regional lymph nodes, liver, lung and brain, several unusual sites of metastasis have been described in the literature. Among these, the metastatic involvement of gallbladder or uterus represents an exceptional event, usually associated with diffuse metastatic disease or observed as an autopsy finding. In this paper, we present two unusual cases of isolated MM metastasis to these anatomic sites, arising in a 71-year-old man and a 54-year-old woman, for whom no information on previous malignancies was known at the time of the histological examination. The clinico-pathologic features are described, emphasizing that MM metastasis must be included in the differential diagnosis when dealing with patients with a previous diagnosis of MM and onset of a novel mass/lesion even at unusual sites.

Metastatic Renal Cell Carcinoma to Duodenum and Pancreas 10 Years After Nephrectomy: A Case Report

Renal cell carcinoma (RCC) accounts for 2-3% of the malignant tumors in adult patients. The most common sites of metastasis are the lung, bone, liver and brain respectively. Unusual metastatic sites require attention during follow-up of renal cell carcinoma. The duodenum and pancreas are uncommon sites for metastasis from renal cell carcinoma. We describe here a 62-year-old man with metastastic renal cell carcinoma to the duodenum and pancreas. The patient presented with melena and bowel obstruction, 10 years after nephrectomy for renal cell carcinoma, then with initial diagnosis of ampula vater adenocarcinoma undergo an exploratory laparotomy and a mass was found in duodenum, vater ampulla and pancreas, then pancreaticoduodenectomy was performed. histopathological examination of mass showed a metastatic renal cell carcinoma with sarcomatoid component. In conclusion, patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Gastrointestinal metastasis from Renal cell carcinoma should be considered in nephrectomized patients with gastrointestinal symptoms.

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.

Triple Malignancy: A Series of Three Cases

Occurrence of Multiple Primary Malignancies (MPM) in an individual is an uncommon phenomenon. It can occur synchronously or metachronously, and the incidence ranges from 1 to 16%. There has been a dramatic increase in the incidence of multiple primaries in patients in the last few years. The diagnosis and treatment of these malignancies pose a clinical challenge as there is no consensus on the optimal management of this condition. It is important to distinguish this condition from the metastasis of an existing malignancy as it can alter the treatment and prognosis of these patients. So far, there have been few case reports published in the literature on triple malignancies, and to the best of authors knowledge, no series have been published yet. Here, authors report a series of three patients (one male and two females) who developed three primary malignancies either synchronously or metachronously. The management of all the patients was decided in a multidisciplinary board based on the stage of each disease and patient tolerance. Two of these patients are alive and on regular follow-up, while one patient was lost to followup during treatment. These cases highlight the importance of evaluating and closely following up patients, as well as considering histopathological examination of lesions in unusual sites of metastasis.

Metastasis of a Primary Sinonasal Alveolar Rhabdomyosarcoma to the Testicle in an Adult Patient

Abstract Introduction/Objective Alveolar rhabdomyosarcoma is an aggressive tumor of skeletal muscle differentiation that predominantly affects adolescents and young adults, and is rare over 45 years of age. It has poor prognosis with metastasis, and most commonly spreads to the lymph nodes, bone marrow, and lungs. In this report, we describe a middle-aged patient with a primary sinonasal alveolar rhabdomyosarcoma which metastasized to the right testicle, an unusual metastatic site reported only a few times in literature. Methods/Case Report Our patient is a 53 year old male who presented in 2020 with recurrent epistaxis and bilateral cervical lymphadenopathy over a 2 month period. Maxillofacial CT/MRI imaging revealed a 4-cm sized mass within the left nasal cavity eroding into the ethmoid sinuses. The patient underwent endoscopic sinus surgery of the sinonasal mass, which on histology, appeared as poorly differentiated small round blue cells with numerous mitoses infiltrating as single cells and nests. These cells stained positive for vimentin, myogenin, desmin, and CD56, and negative for AE1/AE3, chromogranin, S-100, CD99, and CD45. The cells showed very high Ki67 proliferation index (70-80%) and tested positive for FOXO1 gene rearrangement, which supported the diagnosis of alveolar rhabdomyosarcoma. The patient completed chemoradiation therapy, and MRI scans over the next 2 years were negative for residual sinonasal tumor. However, the patient returned in 2022 after having undergone a right orchiectomy at an outside hospital for testicular pain, and abdominal CT showed diffuse retroperitoneal lymphadenopathy concerning for metastasis. On histology, the resected testicle showed seminiferous tubules infiltrated and destroyed by sheets of poorly differentiated small round blue cells with fibrous septae separating the nests of tumor cells into alveolar-like spaces with central loss of cohesion. The tumor cells showed the same immunohistochemical staining pattern as the primary sinonasal lesion, thus confirming it to be metastatic alveolar rhabdomyosarcoma. Results (if a Case Study enter NA) NA. Conclusion It is unusual for alveolar rhabdomyosarcomas to occur in adults over 45 years old, and is even rarer for these tumors to metastasize to the testicle. Metastases also only account for 1% of testicular tumors. Our report documents a very rare case of an alveolar rhabdomyosarcoma in a middle-aged adult which metastasized to the testicle after chemoradiation therapy.

MDCT Detection of Omental Metastases with Peritoneal Carcinomatosis and Ascites in Prostate Cancer: An unusual metastatic site

Prostate cancer is the second most common cause of cancer related death in males. The most common sites of prostate cancer metastases include bone and regional lymph nodes followed by lung, liver and brain. Peritoneal metastasis without skeletal involvement is extremely rare, with only a few cases reported in the literature. We present herein a patient of prostate cancer with omental metastases and peritoneal carcinomatosis accompanied by ascites but without bone metastases. The importance of this case report is to keep in mind that the lack of skeletal involvement does not exclude the possibility of distant metastases in prostate cancer. Prostate cancer can present with distant metastases in unexpected sites. The presence of ascites may indicate peritoneal involvement. KYAMC Journal Vol. 13, No. 02, July 2022: 124-126

Skeletal muscle metastasis from colorectal adenocarcinoma: A literature review.

BACKGROUNDColorectal adenocarcinoma is the third most common cancer worldwide. It accounts for almost 10% of all cancer-related deaths. Skeletal muscle is a very unusual site for metastasis from colorectal cancers and is associated with a poor prognosis and high mortality.AIMTo review the literature for cases of skeletal muscle metastasis (SMM) from colorectal adenocarcinoma.METHODSA systematic literature search using a validated search strategy was carried out to identify the incidence of SMM associated with colorectal adenocarcinoma. The studies identified were tabulated in a PRISMA, and data was extracted in a tabulated form.RESULTSTwenty-nine studies were included in this literature review. SMM was most commonly detected in the thigh muscles. Most of the tumours had originated from the rectum or the right colon. The histopathology of the primary tumour was generally advanced. The mean time interval between the primary tumour and onset of SMM was 22 mo. In 3 cases, asymptomatic SMM had been picked up by advanced imaging systems, like fluorodeoxyglucose-positron emission tomography scan.CONCLUSIONSMM from colorectal adenocarcinomas is a rare complication. However, it is possible that the low incidence could be due to under-reporting. Early use of advanced imaging techniques and a high index of clinical suspicion might increase the reporting of SMM from colorectal adenocarcinoma.