Introduction: In patients with colorectal cancer a combined 18-Fluoro-deoxy-glucose positron emission tomography with computed tomography (CT) may be useful in advanced or recurrent disease to assess distant metastases. In the interpretation several pitfalls must be considered. Case Report: A 37-year-old woman presented with metachronous liver metastases three years after the first diagnosis of rectal cancer. A second-line chemotherapy and stereotactic radiofrequency ablation was performed. Six months after the intervention, the follow-up magnetic resonance imaging revealed new liver lesions with indefinite diffusion impairment and pathologic contrast enhancement in portal venous and hepatobiliary phase. Further investigation with combined 18-Fluoro-deoxy-glucose positron emission tomography with CT showed for malignancy suspicious glucose-uptake in the respective liver lesions and additional in unilateral enlarged inguinal lymph nodes. Because of the uncommon findings, histologic specimen was obtained. Histology revealed no malignancy, but granulomatous hepatitis and lymphadenitis consistent with sarcoid-like reaction. Furthermore, deposition of tattoo pigment was found in the enlarged lymph nodes, most likely deriving from a large tattoo located on the right lower extremity. Conclusion: We describe a case of a rectal cancer patient with misleading imaging findings on combined 18-Fluoro-deoxy-glucose positron emission tomography with CT. Awareness of rare conditions such as granulomatous inflammation and false-positive findings is key in the presence of uncommon findings, like in this case, suggested spread outside the metastatic pathway.
Purpose Patients with colon cancer are usually included in an intensive 5-year surveillance protocol after curative resection, independent of the tumor stage, though early stages have a considerably lower risk of recurrence. The aim of this study was to analyze the adherence to an intensive follow-up and the risk of recurrence in patients with colon cancer in UICC stages I and II. Methods In this retrospective study, we assessed patients who underwent resection for colon cancer in UICC stages I and II between 2007 and 2016. Data were collected on demographics, tumor stages, therapy, surveillance, recurrent disease, and oncological outcome. Results Of the 232 included patients, 43.5% (n = 101) reached the 5-year follow-up disease-free. Seven (7.5%) patients in stage UICC I and sixteen (11.5%) in UICC II had a recurrence, with the highest risk in patients with pT4 (26.3%). A metachronous colon cancer was detected in four patients (1.7%). The therapy of recurrence was intended to be curative in 57.1% (n = 4) of UICC stage I and in 43.8% (n = 7) of UICC stage II, but only in one of seven patients over 80 years. 44.8% (n = 104) of the patients were lost to follow-up. Conclusion A postoperative surveillance in patients with colon cancer is important and recommended as a recurrent disease can be treated successfully in many patients. However, we suggest that a less intensive surveillance protocol is reasonable for patients with colon cancer in early tumor stages, especially in UICC stage I, as the risk of recurrent disease is low. With elderly and/or frail patients in a reduced general condition, who will not endure further specific therapy in case of a recurrence, the performance of the surveillance should be discussed: we recommend a significant reduction or even renunciation.
BackgroundNeurocrine neoplasms (NEN) of the small bowel (SBNEN) are a rare entity and mostly asymptomatic. The aim of this study was to explore trends in the clinical presentation, diagnostic workup, surgical approach and oncological outcome in patients with SBNEN at our surgical department.Materials and methodsAll patients who underwent surgical resection for SBNEN from 2004 to 2020 at our department were enrolled in this single center retrospective study.ResultsA total of 32 patients were included in this study. In most cases, the diagnosis was based on incidental findings during endoscopy or radiographic imaging (n = 23; 72%). Twenty cases had a G1 tumor and 12 cases a G2 tumor. The 1-, 3- and 5-year overall survival (OS) were 96%, 86% and 81%, respectively. Patients with a tumor more than 30 mm had a significantly lower OS (p = 0.01). For G1 tumors, the estimated disease-free survival (DFS) was 109 months. Again, the DFS was significantly lower when the tumor had more than 30 mm in diameter (p = 0.013).ConclusionDue to the mostly asymptomatic presentation, the diagnostic workup can be difficult. An aggressive approach and a strict follow-up seem to be important for the oncological outcome.
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