Metastatic squamous cell carcinoma from hand skin causing small bowel obstruction: an unusual case presentation
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Metastatic squamous cell carcinoma from hand skin causing small bowel obstruction: an unusual case presentation Ruixin Li, Zihua Chen, Qiaocheng Wen and Zhikang Chen*
Abstract The small bowel rarely suffers from metastatic tumors from outside the abdomen. Small bowel obstructions caused by the metastatic spread of squamous cell carcinoma (SCC) of the hand to the intestines are even rarer. A 71-year-old man with intermittent abdominal distension and pain for 4 months was diagnosed with partial bowel obstruction. The patient underwent a video capsule endoscopic examination; however, the patient was unable to pass the capsule, which worsened the abdominal distension. He was transferred to our department for acute intestinal obstruction, and an emergency exploratory laparotomy was performed. Intraoperatively, a tumoral stricture of the intestine at a distance of 150 cm from the ileo-cecum and dilation of the proximal bowel was found. The involved segment was resected, and ileo-ileal anastomosis was performed. The pathological sections confirmed the lesion to be a moderately differentiated SCC with whole bowel layer infiltration. Immunohistochemical staining showed positive expression of cytokeratin 5/6 and p63. The patient had an uneventful recovery. However, 6 months later, he was hospitalized again with intestinal obstruction. Reoperation was performed and revealed multiple metastases in the small bowel. He died 4 months later. In this unusual case, metastasizing SCC of the hand skin led to intestinal obstruction and poor prognosis. Therefore, follow-up procedures regarding intestinal spread should be performed in patients with SCC who present with abdominal symptoms. Keywords: Metastasis, Intestinal obstruction, Squamous cell carcinoma
Background Symptomatic intestinal or other intra-abdominal metastases from hand skin squamous cell carcinoma (SCC) are very rare. The majority of these metastatic lesions originate from the lung and esophagus [1-4]. Katz and colleagues reported a case of a renal transplant recipient who developed a small bowel obstruction caused by multiple organ metastases of skin SCC [5]. However, in our unusual and rare case, metastatic SCC of the hand skin metastasized to the small bowel and caused intestinal obstruction. Although the small bowel obstruction was successfully managed by laparotomy, the patient died 4 months later. Case presentation A 71-year-old man presented to a local hospital with a 4-month history of intermittent abdominal distension * Correspondence: [email protected] Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
and periumbilical pain. The patient had bloating and loose stools but no nausea or vomiting. Eating aggravated the symptoms, whereas defecation relieved them. At the local hospital, capsule endoscopy was performed, and partial intestinal obstruction was diagnosed. The patient was transferred to our department becaus
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