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Chemotherapy-induced small bowel perforation in a patient with extrapulmonary small-cell carcinoma of the small bowel.

Owen S, Chasen M - Curr Oncol (2008)

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, McGill University Health Centre, McGill University, Montreal, QC.

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Current knowledge of epsmcc is reviewed, and clinical correlates on the approach to perforation of high-grade intestinal malignancies are explored... Overall, epsmcc represents 0.1%–1% of git malignancies... One month earlier, he had presented to another institution with a 1-month history of fatigue and dyspnea... On that occasion, he was found to be anemic (hemoglobin: 76 g/L), for which an endoscopy and colonoscopy were performed... Those tests failed to reveal any cause for the anemia... The patient was sent for urgent ct-guided abdominal drainage, which removed more than 4 L purulent material, and intravenous antibiotics were administered... Symptoms improved immediately with drainage... Like its counterpart in the lung, epsmcc has an aggressive clinical presentation and high-grade pathologic features... It is frequently metastatic at presentation, and prognosis for these tumours is poor, particularly for epsmcc of the git... Perforation is a common complication in this group of diseases, frequently seen at disease presentation and portending a poor prognosis,... No surgical benefit is observed for gastric lymphomas, but failure-free survival is significantly correlated with resection of intestinal lymphomas... However, the benefit in failure-free survival in the aforementioned study did not result from prevention of perforation, because only 1 case of bowel perforation occurred... Given the lack of feasibility of prospective trials for this rare entity, large retrospective analyses are needed to better characterize the risk factors for perforation among patients with epsmcc of the git and to help guide future clinical management.

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Extrapulmonary small-cell carcinoma involving the small bowel. (A) Large anterior abdominal tumour seen at initial presentation. (B) After initiation of chemotherapy, gas bubbles (arrows) indicate sites of tumour necrosis. (C) A large abscess develops from perforation of the small bowel. (D) Reduction of tumour size after 2 cycles of chemotherapy and drainage of the abscess.
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f1-co15-6-298: Extrapulmonary small-cell carcinoma involving the small bowel. (A) Large anterior abdominal tumour seen at initial presentation. (B) After initiation of chemotherapy, gas bubbles (arrows) indicate sites of tumour necrosis. (C) A large abscess develops from perforation of the small bowel. (D) Reduction of tumour size after 2 cycles of chemotherapy and drainage of the abscess.

Mentions: Imaging of the abdomen by ct showed a large heterogeneous mass appearing to arise from the small bowel mesentery, measuring 15.7 × 26.3 × 22 cm, and partly encasing loops of small bowel [Figure 1(A)]. No adenopathy or other significant intra-abdominal pathology was observed. Imaging of the chest by ct demonstrated a single 2.2 × 2.1-cm subpleural lesion in the left lower lobe of the lung, abutting the inner aspect of the thoracic wall, appearing to arise from the abdomen, with no intrathoracic adenopathy. A ct-guided biopsy of the abdominal mass demonstrated a poorly differentiated neuroendocrine carcinoma with features of a small-cell carcinomaa. A bone marrow biopsy revealed no malignant cells. A bone scan and imaging of the head by ct were negative for bone and brain metastases respectively. A diagnosis of epsmcc was made, and after prompt placement of a peripherally inserted central catheter, treatment with etoposide (100 mg/m2, days 1 to 3) and cisplatin (80 mg/m2, day 1) began, with planned cycles of 21 days.


Chemotherapy-induced small bowel perforation in a patient with extrapulmonary small-cell carcinoma of the small bowel.

Owen S, Chasen M - Curr Oncol (2008)

Extrapulmonary small-cell carcinoma involving the small bowel. (A) Large anterior abdominal tumour seen at initial presentation. (B) After initiation of chemotherapy, gas bubbles (arrows) indicate sites of tumour necrosis. (C) A large abscess develops from perforation of the small bowel. (D) Reduction of tumour size after 2 cycles of chemotherapy and drainage of the abscess.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2601019&req=5

f1-co15-6-298: Extrapulmonary small-cell carcinoma involving the small bowel. (A) Large anterior abdominal tumour seen at initial presentation. (B) After initiation of chemotherapy, gas bubbles (arrows) indicate sites of tumour necrosis. (C) A large abscess develops from perforation of the small bowel. (D) Reduction of tumour size after 2 cycles of chemotherapy and drainage of the abscess.
Mentions: Imaging of the abdomen by ct showed a large heterogeneous mass appearing to arise from the small bowel mesentery, measuring 15.7 × 26.3 × 22 cm, and partly encasing loops of small bowel [Figure 1(A)]. No adenopathy or other significant intra-abdominal pathology was observed. Imaging of the chest by ct demonstrated a single 2.2 × 2.1-cm subpleural lesion in the left lower lobe of the lung, abutting the inner aspect of the thoracic wall, appearing to arise from the abdomen, with no intrathoracic adenopathy. A ct-guided biopsy of the abdominal mass demonstrated a poorly differentiated neuroendocrine carcinoma with features of a small-cell carcinomaa. A bone marrow biopsy revealed no malignant cells. A bone scan and imaging of the head by ct were negative for bone and brain metastases respectively. A diagnosis of epsmcc was made, and after prompt placement of a peripherally inserted central catheter, treatment with etoposide (100 mg/m2, days 1 to 3) and cisplatin (80 mg/m2, day 1) began, with planned cycles of 21 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, McGill University Health Centre, McGill University, Montreal, QC.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Current knowledge of epsmcc is reviewed, and clinical correlates on the approach to perforation of high-grade intestinal malignancies are explored... Overall, epsmcc represents 0.1%–1% of git malignancies... One month earlier, he had presented to another institution with a 1-month history of fatigue and dyspnea... On that occasion, he was found to be anemic (hemoglobin: 76 g/L), for which an endoscopy and colonoscopy were performed... Those tests failed to reveal any cause for the anemia... The patient was sent for urgent ct-guided abdominal drainage, which removed more than 4 L purulent material, and intravenous antibiotics were administered... Symptoms improved immediately with drainage... Like its counterpart in the lung, epsmcc has an aggressive clinical presentation and high-grade pathologic features... It is frequently metastatic at presentation, and prognosis for these tumours is poor, particularly for epsmcc of the git... Perforation is a common complication in this group of diseases, frequently seen at disease presentation and portending a poor prognosis,... No surgical benefit is observed for gastric lymphomas, but failure-free survival is significantly correlated with resection of intestinal lymphomas... However, the benefit in failure-free survival in the aforementioned study did not result from prevention of perforation, because only 1 case of bowel perforation occurred... Given the lack of feasibility of prospective trials for this rare entity, large retrospective analyses are needed to better characterize the risk factors for perforation among patients with epsmcc of the git and to help guide future clinical management.

No MeSH data available.


Related in: MedlinePlus