Cervical cancer is the second most common cancer among women worldwide and metastasis to the spleen is a rare entity, with only few cases being reported. The present case of a 55-year-old patient diagnosed with a splenic lesion 3 years following completion of chemotherapy combined with radiotherapy for advanced cervical cancer. The patient underwent diagnostic laparoscopy with splenectomy. The histopathological studies confirmed the presence of a metastatic squamous cell carcinoma (in a known case of treated cervical cancer). At one-year follow-up after splenectomy, the patient was free of any recurrent disease. Owing to its rarity and scant data available, detailed workup should be done whenever a solitary lesion in the spleen is detected on follow-up since splenectomy is the apt management which is instrumental in preventing further complications and improves the survival rates.

/pdf/solitary-splenic-metastasis-in-a-case-of-treated-cervical-4dxhwf943t.pdf

Solitary splenic metastasis in a case of treated cervical cancer: a case report

An elderly woman was admitted to the hospital with generalised abdominal pain and bowel obstruction symptoms in a background of renal cell carcinoma and cervical cancer. Investigations showed a degree of gastric outlet obstruction with mild distension of the small bowel loops with no lead point seen and a raised alkaline phosphatase (ALP). Oesophago-gastroduodenoscopy (OGD) showed a stricture at D1/D2; therefore, an enteric stent was inserted. Biopsies showed metastatic cervical cancer. A few cases of metastatic cervical cancer to the duodenum have been reported. Obstructive bowel symptoms in the background of cervical cancer should raise the possibility of metastases in future practice.

Metastatic Cervical Cancer to the Duodenum: A Learning Point.

Malignant tumors of the small bowel (SB) represent 1-2% of the neoplasms of the digestive system, and 30 to 50% are adenocarcinomas, more frequently located in the duodenum [1,2]. Other primary tumors of the SB are lymphoma (15-20%), carcinoid tumors (5-24%) and sarcoma. The four mentioned tumors account for 95% of the malignant SB lesions [3]. Kanthan et al. [2] conclude that malignant and benign lesions of the duodenum are rare, and there could be coexistence of those types of tumors, stressing the importance of early diagnosis of malignant lesions for an adequate patient management [2].

https://crimsonpublishers.com/gmr/pdf/GMR.000529.pdf

Duodenal Metastasis of a Cervical Squamous Cells Carcinoma: Case Report

A 32-year-old G2P1L1 (5 months pregnant) woman presented with a 3-month history of a slow-growing cystic lesion on her scalp vertex. Similar lesions in the exact location were excised twice in the past with a diagnosis of trichilemmal carcinoma (TC). A biopsy of the scalp lesion showed morphology and immunoprofile consistent with previously diagnosed TC. Staging PET/CT demonstrated a 4.7 cm right upper lobe lung, and a subsequent lung biopsy showed a small, round blue-cell tumor with necrosis, morphologically identical to the prior biopsies from the scalp. Considering the unusual clinical course of TC, a lung biopsy was sent for next-generation sequencing that showed EWSR1-FLI1 (type1) fusion. Additionally, CD99 immunostaining revealed uniform cytoplasmic and membranous staining in the tumor cells. The previous scalp excision specimen was also sent for mutation analysis, which showed EWSR1-FLI1 fusion. In conjunction with clinical history and histological and molecular findings, a definitive diagnosis of primary cutaneous Ewing sarcoma (PCES) with local recurrence and metastasis to the lung was made. We present a case of PCES, which was previously misdiagnosed and treated as TC. This case emphasizes the importance of CD99 in the initial screening of cutaneous small round blue-cell tumors to avoid misdiagnosis from other morphological overlaps. Also, despite its rarity, PCES should be included in the differential diagnosis of small, round, blue cell tumors at cutaneous sites. Our case also exemplifies common biases in medical decision-making, including premature closure and anchoring bias which can result in misdiagnosis or diagnostic delay and associated delay in appropriate management. 

Primary Cutaneous Ewing Sarcoma of the Scalp With Metastasis to the Lung: An Unusual Manifestation During Pregnancy

The small bowel is an uncommon site for cancer metastasis. Despite this, cases have reported the duodenum as a metastatic site from local organs. However, duodenal involvement from more distant organs, such as the ovaries, has rarely been reported. Herein, we present a case of a 68-year-old female who developed duodenal metastatic disease from a primary ovarian serous adenocarcinoma. The goal of this report is to encourage clinicians to keep a broad differential in patients complaining of abdominal pain, especially in those with a history of primary ovarian malignancy.

/pdf/an-unlikely-route-metastatic-ovarian-malignancy-within-the-3ib86kb50y.pdf

An Unlikely Route: Metastatic Ovarian Malignancy within the Duodenum

Carcinoma cervix is the most common malignancy in Indian women. Squamous cell carcinoma (SCC) of cervix with metastasis to duodenum is a rare occurrence. Until now, we could find only six cases in the literature. We found such rare case and hence report here a case of a 67-year-old female patient with carcinoma cervix with duodenal metastasis diagnosed after 4 years of cervical carcinoma. On gastroduodenoscopy thickened mucosal folds were seen in the second and third part of the duodenum. Histopathology confirmed it as metastatic SCC. She was started on palliative chemotherapy but succumbed to the disease. This case is being reported due to its rare occurrence.

Duodenal metastasis from carcinoma cervix: An unusual presentation and review of literature

Ewing's sarcoma (ES) is a primitive neuroectodermal tumor. It is usually a primary bone tumor but rarely occurs in the skin and subcutaneous tissues (primary cutaneous ES [PCES]). It usually involves the deep subcutaneous tissue or muscles and rarely occurs as primary skin cancer. Most patients are white, women, and in the second decade of life. The diagnosis is made by aspiration cytology, histochemical stains, immunohistochemistry, electron microscopy, cytogenetics, and molecular genetics of translocations. Due to their rarity and morphological similarity to other cutaneous tumors, ESs are subject to being clinically and pathologically underdiagnosed. Cutaneous ES has a better prognosis than primary bone or soft-tissue ES, with a survival rate of 91% in 10 years and the presence of metastasis being rare. At present, no specific treatment guidelines inform the management of cutaneous Ewing tumor. The treatment modalities are extrapolated based on the management of bone ES while includes neoadjuvant chemotherapy, surgery, adjuvant chemotherapy (±radiotherapy), and autologous bone marrow transplantation in high-risk patients. Standard first-line treatment for patients with these tumors includes chemotherapy with a five-drug regimen of vincristine, doxorubicin (Adriamycin®), and cyclophosphamide, alternating with ifosfamide and etoposide. We report a rare case in a 60-year-old female diagnosed as PCES with lung metastases, treated by palliative chemotherapy.

Cutaneous Ewing's sarcoma of scalp with lung metastases in an elderly female: A rare case report

Cholangiocarcinoma refers to malignant neoplasms arising from epithelium of bile ducts, which may be intrahepatic, perihilar, or extrahepatic. Extrahepatic cholangiocarcinoma accounts for the majority, while intrahepatic cholangiocarcinoma comprises 8–10% of all types of cholangiocarcinoma [1]. Intrahepatic cholangiocarcinomas have distinct clinical course and epidemiology from perihilar and extrahepatic cholangiocarcinomas [1]. It usually occurs between fifth and seventh decades [2] and affects both men and women equally [3]. Ultrasound-guided needle biopsy is gold standard for diagnosis. Most of the intrahepatic cholangiocarcinoma are adenocarcinoma arranged in cord-like, tubular, or papillary pattern. Thyroid-like intrahepatic cholangiocarcinoma is a very rare variant and poses immense difficulty to practising pathologists. Moreover, it is till now not included in the World Health Organization (WHO) classification of intrahepatic cholangiocarcinoma because of limited data availability. Only 3 case reports have been published in English literature [4–6]. The purpose of this case report is to describe this unusual variant, which is to the best of our knowledge, a first case report from India.

Thyroid Follicle-Like Cholangiocarcinoma in Liver: a Novel Variant and What We Know So Far?

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Duodenal metastasis from carcinoma cervix: An unusual presentation and review of literature

Cutaneous Ewing's sarcoma of scalp with lung metastases in an elderly female: A rare case report

Thyroid Follicle-Like Cholangiocarcinoma in Liver: a Novel Variant and What We Know So Far?