Neuroendocrine small cell rectal cancer metastasizing to the liver: a unique treatment strategy, case report, and review
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Neuroendocrine small cell rectal cancer metastasizing to the liver: a unique treatment strategy, case report, and review of the literature Bilal O Al-Jiffry1,2* and Owaid Al-Malki1
Abstract We describe the treatment of a 46-year-old Saudi man with advanced stage liver metastatic neuroendocrine rectal cancer. The patient presented with a large liver lesion and rectal bleeding. He was cachectic, with a firm tender mass 20 mm above the anal verge. Computed tomography (CT) showed a mass 9.5 × 13 cm in size in the right hemi-liver, abutting the middle hepatic vein. The patient refused treatment, and consulted another hospital. After 3 months, he presented with the same symptoms in addition to delirium. Colonoscopy showed an ulcerating anorectal mass, from which a biopsy was taken. Repeat CT showed an increase in the size of the liver lesion to 17 cm and no change in the pelvis. The final histopathology report identified anaplastic small cell carcinoma. The patient underwent extended right liver resection followed by abdominoperineal resection, then 13 cycles of chemotherapy and monthly somatostatin injections. At the most recent follow-up, the patient had been disease-free for 48 months. Surgical resection (R0) of the primary and secondary tumor, followed by platinum-based chemotherapy can result in good survival in cases of small cell carcinoma with large liver metastasis, irrespective of whether the primary or secondary tumor is resected first. Keywords: Extrapulmonary small cell cancer, Rectal cancer, Neuroendocrine liver metastasis, Large liver metastasis, Extended liver resection, Abdomino-perineal resection
Background Neuroendocrine tumors include a wide spectrum of lesions including microcarcinoid, carcinoid, and mixed endocrine/exocrine tumors, and small cell carcinoma (SCC). SCC most commonly originates in the lungs, but it can originate anywhere in the body, including the esophagus [1], large bowel [2] or urinary bladder [3], and is then referred to as extrapulmonary SCC. Gastrointestinal (GI) SCC is a type of extrapulmonary carcinoma, and the GI tract is known to have the largest population of neuroendocrine cells [4]. Approximately 650 cases of SCC of the GI tract have been reported in the literature [5]. Colorectal SCC was reported to comprise 25% of all reported SCC cases of the GI tract [5],
* Correspondence: [email protected] 1 Department of Surgery, College of Medicine and Medical Sciences, Taif University, P.O. Box 888, Taif 21947, Kingdom of Saudi Arabia 2 Department of Surgery, Al-Hada Military Hospital, P.O. Box 1347, Taif, Kingdom of Saudi Arabia
and the incidence of this carcinoma is less than 0.2% of all types of colorectal cancers [6]. Staging [7] and management [5] of GI tract SCC have been proposed and implemented in case reports and a few retrospective studies. The staging system was introduced by the Veteran’s Administrating Lung Study Group (VALSG) for primary SCC of the lung [8]. According to this system, SCC can be di
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