Malignant Neoplasms of the Colon
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
The prognosis of metastatic carcinoma is grave. Kuo et al. (591) collected data from 74 patients with stage IV colorectal carcinoma to identify prognostic factors for predicting selection criteria for operative treatment in patients with metastatic disease. Overall survival time was 16.1 months. Survival in the curative resection group was significantly longer than in the noncurative groups (31.9 months vs. 12.7 months). The operative mortality and morbidity rates were 5.6% and 21%, respectively. The two most common complications were leakage at the site of anastomosis and urinary tract infection. Based on these results, they concluded that patients older than 65 years with metastases at multiple sites, intestinal obstruction, preoperative carcinoembryonic antigen level ≥500 ng/mL, lactate dehydrogenase ≥350 units/L, hemoglobin < 10 mg/dL, or hepatic parenchymal replacement by metastatic disease > 25% have poor prognosis for operative intervention. They noted the more aggressively they performed radical resection and metastasectomy in selected patients the more survival benefits the patients obtained.
Cysts and Tumours of the Bony Facial Skeleton
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Metastatic carcinoma to the jaws may be from a known or as yet undiagnosed primary carcinoma.48, 106, 142 Elderly men and women are mainly affected and haemopoietic marrow within the posterior mandible is the most commonly involved site. It is not known whether healing extraction sockets and/or subclinical chronic inflammation which result in foci of increased vascularity encourage deposition of metastatic tumour at other sites within the jaws. Clinical presentation varies from asymptomatic to mobile/drifting teeth, pain, swelling and pathological fracture. Radiography typically reveals an ill-defined or mottled radiolucency. For men, the most common origins of the primary carcinoma are lung, prostate and adrenal glands; and for women, breast, adrenal glands, colon and rectum, genital tract and thyroid.
Cancer
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Breast cancers most commonly develop from epithelial tumors. Carcinoma in situ is diagnosed when there is cancer cell proliferation in the ducts or lobules. The majority of breast cancers are ductal carcinomas. A small or wide breast area may be affected. If the area is wide, microscopic invasive foci may eventually develop. Metastatic carcinoma is usually adenocarcinoma. The mucinous subtype usually develops in older women, and grows slowly with a much better prognosis. Inflammatory breast cancer grows quickly and is often fatal. Breast cancer may spread via the regional lymph nodes, bloodstream, or both. Metastatic breast cancer may spread to the lungs, bones, brain, liver, or skin. The pathophysiological link between diabetes and breast cancer is a bit complicated. When there is increased abdominal fat, there is decreased production of adiponectin and increased production of estrogen – all of which lead to increased insulin levels. Increased insulin also increases estrogen and increases the blood supply to cancer cells. Increased estrogen decreases sex hormone binding globulin, further increasing estrogen, and the increased estrogen contributes to breast cancer cell growth.
A perianal subcutaneous metastasis as the presenting sign for lung cancer
Published in Baylor University Medical Center Proceedings, 2021
Aaminah Azhar, Elizabeth Wilder
A 77-year-old white man presented with a 9-day history of a rapidly growing and painful mass on his left buttock. He reported a 60 pack-year smoking history, previously worked in the US Navy, and had exposure to asbestos. Present in his left medial buttock, in the gluteal cleft, was a 2.2 cm subcutaneous mass (Figure 1a) with an overlying punch biopsy wound. Initial pathology reports from the punch biopsy showed a dermal carcinoma compatible with poorly differentiated SCC. Given the deep dermal location of the neoplasm and the complete lack of epidermal involvement, a metastatic carcinoma could not be excluded. The lesional cells were positive for cytokeratin AE1/AE3 and negative for Mart-1. This immunohistochemical profile along with the histomorphology confirmed the diagnosis of a poorly differentiated SCC. Wide local excision of the mass (Figure 1b) and full-body positron emission tomography (PET)–computed tomography imaging were carried out.
Renal cell carcinoma with metastases to the rectum and gastric body
Published in Baylor University Medical Center Proceedings, 2020
Michelle Bernshteyn, Umair Masood, Alexandria Smith-Hannah, Divey Manocha
A 68-year-old man with stage IV renal cell carcinoma (RCC) to the skin and lung, treated by right total nephrectomy and right upper lobe wedge resection, presented to the hospital with a 1-month history of dyspnea and 10 to 15 episodes of melena per day. His heart rate was 121 beats per minute and his blood pressure quickly dropped from 130/80 mm Hg to 110/60 mm Hg. His abdomen was tender. He was cachectic. His hemoglobin was 6.7 g/dL and his serum sodium level was 128 mmol/L. The hepatic panel and coagulation parameters were within normal limits. Hemoccult testing was positive. He was subsequently started on intravenous fluids, a pantoprazole infusion, and blood transfusions (2 units). A computed tomography scan of the abdomen demonstrated a metastatic lesion in the distal sigmoid colon. Endoscopy revealed a nodule in the duodenum, and a mass was visualized on the greater curvature of the gastric body (Figure 1a). Colonoscopy revealed a single 10-mm polyp in the rectum, which was treated with bipolar cauterization. Pathological reports demonstrated metastatic carcinoma consistent with a renal primary source (Figure 1b).
Radical cystoprostatectomy to treat urachal carcinoma
Published in Baylor University Medical Center Proceedings, 2019
Ahmed Ebrahim, Nitin Kondapalli, W. Scott Webster
The umbilicus, urachus, bladder, prostate, distal segments of the distal ureters, and 34 lymph nodes were collected by pathology. Gross examination of the bladder demonstrated a palpable mass involving the fibrofatty tissue of the urachus, which extended inferiorly to involve the bladder dome. Opening the bladder revealed a 2.5-cm area of mucosal ulceration overlying the mass. Upon microscopic examination, the tumor was found to be an adenocarcinoma with enteric and mucinous features (Figures 1b, 1c). A detached segment of urothelium at the ulcer showed in situ urothelial carcinoma. No invasive high-grade urothelial carcinoma or diffuse cystitis cystica/glandularis was noted in the adjacent urothelium. All lymph nodes and ureter segments were found to be negative for metastatic carcinoma. In accordance with the Sheldon classification for urachal adenocarcinomas (Table 1),7 the current tumor was staged IIIa. Incidentally, an acinar adenocarcinoma was detected on examination of the prostate (Figure 1d). Perineural invasion was present, although surgical margins were found to be negative and no extraprostatic extension was identified. The Gleason score was 6 (3 + 3) and the grade group was 1.
Related Knowledge Centers
- Carcinoma
- Lymph
- Metastasis
- Neoplasm
- Cancer
- Bloodstream Infections
- Skin Condition