IntroductionBreast cancer is the most frequent type of tumor and the second leading cause of death in women. Metastases are present in nearly 60% of cases at the time of diagnosis with the lymph nodes, skeleton, lungs, brain and liver as the most frequent sites of metastases. Gastrointestinal involvement is rare, present in only 10% of all the cases. There is a very low risk of developing breast cancer in men.Case presentationA 68-year-old man, with a past history of ductal breast cancer, presented with duodenal obstruction. Medical treatment was attempted without success, so he underwent surgery with subtotal gastrectomy and resection of the first portion of the duodenum. Histological examination showed a duodenal metastasis originating from the previous carcinoma of the breast. Five months after surgery, the patient is alive and well.ConclusionGastrointestinal metastases should be considered in patients with a past history of breast cancer. Surgical treatment should be performed in patients who are symptomatic and in good general condition. To our knowledge this is the only case of a gastrointestinal metastasis from breast carcinoma in a man.
Neuroendocrine tumours (NETs) are a family of neoplasms that come from neuroendocrine cells and express neural markers, such as synaptophysin or chromogranin A.The current classifications of these tumours are presented by the WHO 2000 classification, based on histological parameters, and the WHO 2010 classification, based on the proliferative index, that divides the NETs into a neuroendocrine tumour of a low grade, neuroendocrine tumour of a intermediate grade and neuroendocrine carcinoma (NEC) of a high grade.We are reporting a very rare case of a G1 low-grade neuroendocrine tumour (NET) of the ileum with a peritoneal carcinomatosis.This case is challenging because the tumour expresses low proliferative index as G1 tumours, but it has an aggressive clinical behaviour such as node metastasis and peritoneal carcinomatosis.The peritoneal carcinomatosis is not actually considered by the current classifications of NETs, so it is difficult to predict the prognosis of this patient.
The vast majority of malignant neoplasm of the stomach is represented by epithelial tumors composed of tubular, acinar, or papillary structures or consisting of a complex mixture of isolated cells with variable morphologies in combination with glandular, trabecular, or solid nests. The most commonly used classification systems are the WHO and the Lauren systems. The diffuse type of gastric cancer is more aggressive, is located in the proximal part of the stomach, is more frequent in young patients, and frequently displays signet ring cell differentiation [1].Several other types of gastic carcinomas exist, which do not constitute an integral part of the above classifications. In particular, adenosquamous carcinoma, which probably comprises less than 0.5% of gastric carcinomas, is characterized by the coexistence of variable proportions of adenocarcinoma and squamous cell carcinoma within a tumor [2]. Other types of combination tumors are even rarer, such as combinations between adenocarcinoma and choriocarcinoma or embryonal carcinoma or carcinoma with hepatoid differentiation (hepatoid adenocarcinoma) [3]. As in the esophagus, carcinomas with a sarcomatous component (so-called carcinosarcomas) have been sporadically described in the stomach [4].Here we report a patient with primary epithelial gastric neoplasm and a concomitant sarcomatous component, in which the latter was represented by chondromatous differentiation. To the best of our knowledge, this is the first case to be described.
Case reportA 45-year-old man reported a history of recent-onset (1-month) epigastric pain associated with sporadic episodes of vomiting. Since in the last vomiting episode fresh blood was present, he was admitted to our surgical unit. Physical examination at admission was unremarkable, as well as blood chemistry; in particular, no anemia was present.An upper gastrointestinal endoscopy showed the presence of a large vegetating antral neoplasm, ulcerated, causing pyloric stenosis. Endoscopic biopsies were consistent with adenocarcinoma.After abdominal ultrasound and TC scans, not showing other neoplastic areas, the patient was operated, and a total gastrectomy with lymphadenectomy and cholecystectomy was carried out. The postoperative period was uneventful, except for a mild anemia requiring one transfusion of red blood Springer
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