Lester Freedman

Colonic Metastases from Pleomorphic Carcinoma of the Lung Presenting as an Ileocecal Intussusception

Pleomorphic carcinoma is a rare aggressive type of lung cancer that uncommonly metastasizes to the bowel, leading to bleeding, perforation, obstruction, and rarely intussusception. Serving as a lead point, metastatic lesions in the bowel may precipitate intussusception and require immediate surgical intervention. We present a rare case of colonic metastases from a primary lung malignancy, causing ileocecal intussusception in a 57-year old male.

Cutaneous Inflammatory Malignant Fibrous Histiocytoma Presenting with a Leukemoid Reaction: A Case Report and Review of the Literature

Malignant fibrous histiocytoma (MFH) is the most common sarcoma found in adults. We discuss a case of inflammatory MFH of dermal/epidermal origin presenting with a severe leukemoid reaction (LR). A 60 years old white male presented to hematology/oncology clinic complaining of mild shortness of breath on exertion. Past medical history was remarkable for removal of a left upper extremity necrotic mass 4.4 × 3 × 3 cm. Microscopy of the specimen showed clear surgical margin, and tumor cells restricted to the dermis without lymphovascular invasion. Immunohistochemestry was positive for CD 68 and CD 99. Chest x-ray was negative for metastatic disease. White blood cell count was 109.4 k/mm3 with 24 k/mm3 band neutrophils, and absolute neutrophil count of 69 k/mm3. CT scan of the thorax revealed numerous bilateral pulmonary nodules suspicious for metastasis. Based on these findings patient was diagnosed with metastatic cutaneous IMFH associated with a LR. Following review of medical literature, this appears to be the first reported case of inflammatory cutaneous MFH associated with LR. This histological variant is rare, and carries a poor prognosis. Thus, we would like to emphasize the need for investigating alternative therapies capable of improving the survival of these patients.

A Case of Gastrointestinal Bleeding due to Duodenal Metastasis from a Testicular Choriocarcinoma

Testicular cancers are the most common malignant neoplasm in men aged 15–35, but only constitute 1 % of cancers in males overall with an incidence of 2.1 cases per 100,000 males and four times greater incidence in white males than in black males [1–3]. Testicular tumors usually present as a nodule or painless swelling of one testicle, which may be noted incidentally by the patient or by his sexual partner [4]. Typically, the patients chief complaint includes acute testicular pain or heaviness in the lower abdomen. Signs or symptoms of metastatic disease are the initial implication of testicular cancer in approximately 10 % of patients. The most common sites of extragonadal disease are the retroperitoneum, lungs, and liver [5–8]. Only rarely (5 % of cases) are metastases found in the gastrointestinal tract [9]. We report a case of testicular mixed germ cell tumor with metastasis of pure choriocarcinoma involving the small intestine.

Synchronous Small Cell Neuroendocrine Carcinoma and Adenocarcinoma of the Colon: A Link for Common Stem Cell Origin?

Synchronous carcinomas have been recognized for over a century, with synchronous primary adenocarcinoma of the colon reported to range from 2–11% of cases involving this type of malignancy. Small cell carcinomas occur frequently with colorectal adenomas; however, despite these reports and a known adenoma-to-carcinoma sequence, scarce literature exists on synchronous colorectal adenocarcinoma and small cell carcinomas. We present a rare cancer of synchronous small cell neuroendocrine carcinomas and discuss a possible link between these two cancers.

Germ cell cancer presenting as gastrointestinal bleeding and developing brain metastases: case report and review of the literature

This paper describes a rare case of germ cell cancer with duodenum, brain and lung metastases. The patient presented with melena and left testicle enlargement. Orchiectomy revealed mixed germ cell cancer, enteroscopy revealed duodenal choriocarcinoma, and chest x-ray and computed tomography (CT) showed bilateral lung metastases. The patient received and tolerated cisplatinum-based chemotherapy, and responded well. However, he developed seizures 3 months later. MRI showed brain metastases and he was treated with whole-brain radiation. One month later, he developed progressive dyspnea. Chest CT showed worsening lung metastases. He received second-line chemotherapy, but died due to multiorgan failure. Germ cell cancer with nonpulmonary metastases has poor prognosis and the management of these patients requires a multimodal approach. Head CT should be considered as routine screening for all germ cell cancer patients on initial diagnosis and brain MRI should be considered for high-risk patients (with an embryo- or choriocarcinoma histology, dramatically elevated β-human chorionic gonadotropin and lung involvement).

Pathologic Rupture of the Spleen in Mantle-Cell-Type Non-Hodgkin’s Lymphoma

Mantle cell lymphoma (MCL) accounts for less than 10 percent of all non-Hodgkins lymphoma (NHL). Pathologic or spontaneous rupture of the spleen has been reported in patients with lymphoma; however only 5 cases have been reported in patients with MCL. Although splenomegaly occurs frequently in patients with MCL, spontaneous splenic rupture is rare. We present a case of a 51-year-old female with MCL, who presented to the medical emergency room with splenic rupture. This case illustrates that clinicians should be aware of the incidence and presentation of patients with MCL and spontaneous splenic rupture, as early detection and heightened suspicion may prevent potentially fatal outcomes.

Mucinous adenocarcinoma of the appendix presenting as intussusception in 27 year old female

While intussusception is commonly reported in children, it is quite unusual in adults almost always reported secondary to a definable lesion (1). Incidence secondary to adult intussusception has been estimated to range from 0.003% to 0.02% (2). Rarely, as in our case, the appendix may be the lead point for intussusception (3). Appendiceal intussusception may occur secondary to a number of etiologies including: villous adenoma, mucinous cystadenoma, endometriosis, and adenocarcinoma of the appendix (4-6). The incidence of epithelial malignancies of the appendix has been estimated to be 0.12 per 1 million persons per year (7). 5% of the total cases of intussusception (adults and children) have been reported in adults. Intussusception is reported as the underlying cause of 1-5% of adult cases of bowel obstruction (8). We will discuss our case, a 27 year female presenting with abdominal pain and a palpable abdominal mass, as well as briefly review the topic of appendiceal carcinoma.

A solid organising cryptogenic liver abscess and its association with a colonic tubullovillous adenoma

Cryptogenic liver abscess (CLA) is a well-known disease entity that has puzzled clinicians for centuries. With the advancement of diagnostic modalities, comes the decreasing incidence of liver abscess labelled as ‘cryptogenic’ in nature. Colonic diseases have been identified as a possible underlying condition found in patients with liver abscesses. Although rare, tubullovillous adenomas have been implicated as one of the colonic causes of a CLA. We present a case of a CLA in a 53-year-old man with a potentially associated tubullovillous adenoma found via colonoscopy.

Colonic intussusception induced by massive tubular adenoma in a patient post-radiofrequency ablation.

While intussusception is commonly reported in children, it is quite rare in adults and almost always secondary to a definable lesion. Incidence of adult intussusception has been estimated to range from 0.003 to 0.02 % [1]. We present a case of a 63-year-old male who presented to the emergency room with severe abdominal pain and later was found to have an ascending colonic intussusception. Case Presentation

Unusual finding of Trichuris trichiura on colonoscopy in a patient with a recent change in bowel habits.

pleomorphism and low mitotic activity. Adjacent colonic mucosa showed no dysplasia. There was endometriosis around the tumor (Fig. 2b). In immunohistochemical staining, there was diffuse expression of cytokeratin 7 (CK7) in the tumor but no staining for CK20, and vice versa in the adjacent normal rectal mucosa. The endometriosis was positive for estrogen receptor (Fig. 2c) and CD10 (Fig. 2d) in immunostaining. The final diagnosis was clear cell adenocarcinoma associated with endometriosis.After the diagnosis, the patient underwent additional total hysterectomy, bilateral salpingooophorectomy, and omentectomy, which were unremarkable except for endometriosis in the right ovary. Clear cell adenocarcinoma arising from rectal endometriosis is extremely rare. We describe clear cell adenocarcinoma arising from rectal endometriosis. Consequently, considering that different treatments may be applied for typical colonic adenocarcinoma, awareness of primary clear cell adenocarcinoma that can arise from endometriosis in the colorectum is important.