Jejunal perforation: an unusual presentation of metastatic cutaneous squamous cell carcinoma (SCC) in an immunosuppressed patient

Abstract

We report the rare occurrence of a small bowel perforation secondary to a metastatic cutaneous squamous cell carcinoma (cSCC). A 70-year-old woman, who had previously undergone renal transplantation, presented with severe, sudden-onset abdominal pain. She was peritonitic on initial examination, with evidence of free intra-abdominal air on radiographic imaging. During an exploratory laparotomy, she was found to have a perforated jejunum secondary to disseminated metastases seen throughout her peritoneum. Following histopathological analysis, as well as further imaging studies, the primary malignancy was eventually identified as a cSCC on her upper back. Palliative care was started and the patient died 8 weeks following her initial presentation.

Small intestinal perforation secondary to metastasis from skin squamous cell carcinoma: A case report and literature review

“…Squamous cell carcinoma (SCC) of the small bowel, either primary or metastatic, is rare. Interestingly, only four case reports have documented skin as the primary site of secondary tumors of the small intestine [ [3] , [4] , [5] , [6] ]. They are summarized in Table 1 .…”

“…Although the majority of patients with cSCC present an excellent prognosis after adequate surgical resection, a subset of patients carry an increased risk of lymph node metastasis, local recurrence, and disease-specific death [ 7 , 9 , 14 ]. High-risk features include tumor diameter ≥ 2 cm, tumor thickness ≥ 2 mm, anatomic tumor site (face, ear, pre/post auricular area, genitalia, hands, and feet), poor histological differentiation, certain histological subtypes, evidence of perineural invasion, immunosuppression, and the presence of parotid metastases [ 3 , 7 , 16 ].…”

“…There are only four case reports in the literature concerning secondary cutaneous SCC of the small bowel [ [3] , [4] , [5] , [6] ]. Known as a disease of late adulthood, with the exception of appearance at a younger age in immunocompromised patients, in these four case reports, the youngest patient was 53 years old and the oldest was 71 years old.…”

“…Fewer than 30 cases of primary SCC of the small intestine have been reported in the literature. Although there are few references of SCC metastasis in the small intestine, only in four case reports, the skin is the primary site [ [3] , [4] , [5] , [6] ].…”