Background: A female patient with a history of stage IIB invasive lobular breast cancer presented with
symptoms of partial small bowel obstruction and workup led to a presumptive diagnosis of Crohn’s disease.
However, at the time of surgical intervention, she was found to have metastatic lobular breast cancer with
carcinomatosis and metastases to the small and large intestines.
Summary: Our patient presented at age 55 with intermittent nausea and vomiting, dyspepsia, altered bowel
habits, and weight loss. She had a history of invasive lobular carcinoma of the right breast treated with right
modified radical mastectomy followed by adjuvant chemoradiation and hormonal therapy 5 years earlier.
She was thought to be in remission. Initial workup of her GI complaints was notable for thickening of the
sigmoid colon and hepatic flexure on CT scan and stricturing and colitis in these areas on colonoscopy.
Mucosal biopsies showed nonspecific active colitis. The patient was treated for a presumptive diagnosis of
Crohn’s disease without significant improvement. She was eventually taken for surgery after presenting
with a high-grade small bowel obstruction. On exploration, numerous additional small and large bowel
strictures, some associated with intraluminal masses, were found and a small bowel resection and ileostomy
performed. Pathology revealed metastatic invasive lobular breast carcinoma. Although isolated metastases
to the bowel wall are rare, they have been reported secondary to a wide range of malignancies. Breast cancer,
especially lobular carcinoma, is one of the most common tumors to metastasize to the GI tract and can
present years after the primary cancer diagnosis. Therefore, the differential diagnosis for a patient with signs
and symptoms of bowel obstruction and a history of lobular breast cancer should include metastatic disease.
Conclusion: Metastatic cancer to the GI tract can mimic Crohn’s disease and should be on the differential
in older patients with abdominal complaints, particularly those with a history of breast cancer.
Patient: Male, 73-year-old
Final Diagnosis: Intramuscular myxoma
Symptoms: Shoulder pain
Medication:—
Clinical Procedure: —
Specialty: General and Internal Medicine • Orthopedics and Traumatology
Objective:
Rare disease
Background:
Intramuscular myxomas are rare and benign soft-tissue tumors of uncertain differentiation. Predisposing or precipitating factors have not yet been reported. Activating mutation in GNAS (exons 8 and 9) is detected in >90% of sporadic cases. The role of chronic myopathy, tendinopathy, or trauma to muscles in the etiology of these neoplasms is not known. We report an unusual case of a deltoid mass found following longstanding rotator cuff tendinopathy and a recent fall, later confirmed to be an intramuscular myxoma on biopsy.
Case Report:
A 73-year-old man with a 5-year history of left shoulder pain and rotator cuff tear presented with intractable pain in his left shoulder after a recent fall at home. Physical examination was suggestive of a rotator cuff injury and magnetic resonance imaging (MRI) of the left shoulder revealed a 2.7×2.5×3.7cm T1 hypo- and T2 hyperin-tense oblong mass-like signal abnormality with heterogeneous, predominantly peripheral enhancement within the deltoid muscle concerning for a malignant mass. Surgical resection was carried out along with left reverse total shoulder replacement, and histopathology revealed findings consistent with an intramuscular myxoma.
Conclusions:
Intramuscular myxomas are rare, benign tumors. This case report presents one such myxoma incidentally found in a patient with longstanding rotator cuff tendinopathy and a recent fall. Although this co-occurrence is likely incidental, further research and case series review of similar presentations may influence postulations of the pathophysiology of myxomas.
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