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Floor-of-mouth metastasis in colorectal cancer.

Singh T, Amirtham U, Satheesh CT, Lakshmaiah KC, Suresh TM, Babu KG, Ramachandra C - Ann Saudi Med (2011 Jan-Feb)

Bottom Line: However, the incidence of recurrence, both local and distant, remains significant.Distant metastases occur most often in the liver and lung; however, metastases to bone, adrenals, lymph nodes, brain, skin and the oral region have been reported.The prognosis in such patients is usually very poor.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.

ABSTRACT
Colorectal cancers have potential for lymphatic and hematogenous metastases. Surgery is the definitive treatment, but the prognosis can be improved with the addition of chemotherapy, radiotherapy or both. However, the incidence of recurrence, both local and distant, remains significant. Distant metastases occur most often in the liver and lung; however, metastases to bone, adrenals, lymph nodes, brain, skin and the oral region have been reported. Metastases to the oral region are uncommon and may occur in the oral soft tissues or jaw bones. The prognosis in such patients is usually very poor. We report a case of colorectal carcinoma with metastasis to the floor of the mouth. This is probably the first reported case of metastasis to the floor of the mouth in a patient with colorectal cancer.

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Related in: MedlinePlus

Rectal biopsy. Neoplasm composed of pleomorphic epithelial cells arranged in glandular pattern (hematolxylin and eosin ×10)
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Figure 0001: Rectal biopsy. Neoplasm composed of pleomorphic epithelial cells arranged in glandular pattern (hematolxylin and eosin ×10)

Mentions: A 42-year-old woman was admitted in December 2003 with a 10-day history of blood and mucus in the stool. Rectal examination and endoscopic evaluation showed a circumferential lesion that began 4 cm above the anal verge and caused an obstruction. A CT scan of the abdomen demonstrated a mass of 4.5 cm in length with filling defect. A transanal incisional biopsy was performed. Histologic examination revealed an adenocarcinoma. The patient underwent anteroposterior resection with total mesorectal excision. Histological examination revealed a mucinous adenocarcinoma of the rectum extending through the whole muscular layer with invasion of the serosa (Figure 1). There was nodal involvement (two lymph nodes), and it was staged T3N1M0. Postoperatively, she received a course of radiotherapy (RT) consisting of 50 Gy in 25 fractions to the whole pelvis. Following RT, she received 6 cycles of 5-fluorouracil/leucovorin. She remained symptom free until January 2007. She was readmitted with persistent lower abdominal pain of 1-month duration. Clinical examination was noncontributory. CT scan of the abdomen revealed 3.8×3.0×3.2-cm hypodense lesion in the mid-presacral region. CT-guided fine-needle aspiration cytology of the lesion was suggestive of recurrence of adenocarcinoma. She was treated with 6 cycles of FOLFOX4 (oxaliplatin, folinic acid and 5-fluorouracil), and a CT scan of the abdomen subsequently revealed complete disappearance of the lesion. Within 2 months, she was readmitted with a growth in the floor of the mouth (Figure 2). A punch biopsy was performed. Histopathological examination revealed a well-differentiated adenocarcinoma (Figure 3), and the original primary and floor-of-mouth metastases were morphologically similar. She was treated with chemotherapy regimen consisting of FOLFOX4 with bevacizumab. Two cycles of chemotherapy elicited no response, and the growth was progressively increasing in size. Chemotherapy was stopped and she was treated with radiotherapy consisting of 64 Gy/32 Fr. She did not respond to radiotherapy either and succumbed to the disease after 20 days.


Floor-of-mouth metastasis in colorectal cancer.

Singh T, Amirtham U, Satheesh CT, Lakshmaiah KC, Suresh TM, Babu KG, Ramachandra C - Ann Saudi Med (2011 Jan-Feb)

Rectal biopsy. Neoplasm composed of pleomorphic epithelial cells arranged in glandular pattern (hematolxylin and eosin ×10)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3101733&req=5

Figure 0001: Rectal biopsy. Neoplasm composed of pleomorphic epithelial cells arranged in glandular pattern (hematolxylin and eosin ×10)
Mentions: A 42-year-old woman was admitted in December 2003 with a 10-day history of blood and mucus in the stool. Rectal examination and endoscopic evaluation showed a circumferential lesion that began 4 cm above the anal verge and caused an obstruction. A CT scan of the abdomen demonstrated a mass of 4.5 cm in length with filling defect. A transanal incisional biopsy was performed. Histologic examination revealed an adenocarcinoma. The patient underwent anteroposterior resection with total mesorectal excision. Histological examination revealed a mucinous adenocarcinoma of the rectum extending through the whole muscular layer with invasion of the serosa (Figure 1). There was nodal involvement (two lymph nodes), and it was staged T3N1M0. Postoperatively, she received a course of radiotherapy (RT) consisting of 50 Gy in 25 fractions to the whole pelvis. Following RT, she received 6 cycles of 5-fluorouracil/leucovorin. She remained symptom free until January 2007. She was readmitted with persistent lower abdominal pain of 1-month duration. Clinical examination was noncontributory. CT scan of the abdomen revealed 3.8×3.0×3.2-cm hypodense lesion in the mid-presacral region. CT-guided fine-needle aspiration cytology of the lesion was suggestive of recurrence of adenocarcinoma. She was treated with 6 cycles of FOLFOX4 (oxaliplatin, folinic acid and 5-fluorouracil), and a CT scan of the abdomen subsequently revealed complete disappearance of the lesion. Within 2 months, she was readmitted with a growth in the floor of the mouth (Figure 2). A punch biopsy was performed. Histopathological examination revealed a well-differentiated adenocarcinoma (Figure 3), and the original primary and floor-of-mouth metastases were morphologically similar. She was treated with chemotherapy regimen consisting of FOLFOX4 with bevacizumab. Two cycles of chemotherapy elicited no response, and the growth was progressively increasing in size. Chemotherapy was stopped and she was treated with radiotherapy consisting of 64 Gy/32 Fr. She did not respond to radiotherapy either and succumbed to the disease after 20 days.

Bottom Line: However, the incidence of recurrence, both local and distant, remains significant.Distant metastases occur most often in the liver and lung; however, metastases to bone, adrenals, lymph nodes, brain, skin and the oral region have been reported.The prognosis in such patients is usually very poor.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.

ABSTRACT
Colorectal cancers have potential for lymphatic and hematogenous metastases. Surgery is the definitive treatment, but the prognosis can be improved with the addition of chemotherapy, radiotherapy or both. However, the incidence of recurrence, both local and distant, remains significant. Distant metastases occur most often in the liver and lung; however, metastases to bone, adrenals, lymph nodes, brain, skin and the oral region have been reported. Metastases to the oral region are uncommon and may occur in the oral soft tissues or jaw bones. The prognosis in such patients is usually very poor. We report a case of colorectal carcinoma with metastasis to the floor of the mouth. This is probably the first reported case of metastasis to the floor of the mouth in a patient with colorectal cancer.

Show MeSH
Related in: MedlinePlus