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Multiple scalp metastases from colonic neuroendocrine carcinoma: case report and literature review.

Wang SM, Ye M, Ni SM - BMC Cancer (2014)

Bottom Line: NENs account for approximately 0.4% of colorectal neoplasms.We found multiple scalp nodules during physical examination.Moreover, these nodules had occurred and had not been detected prior to the patient undergoing radical surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Oncology, Affiliated Hospital, School of Medicine, Ningbo University, No, 247 Renmin Road, Ningbo 315020, Zhejiang Province, China. 29091740@qq.com.

ABSTRACT

Background: Colonic neuroendocrine neoplasms (NENs) are relatively rare tumors with an incidence rate of 0.11-0.21/100,000. NENs account for approximately 0.4% of colorectal neoplasms. Cutaneous metastases of colonic neuroendocrine carcinomas (NECs) are very infrequent, while cases of scalp metastasis are even fewer. Cutaneous metastases are more rare than visceral metastases and usually develop later; therefore, cutaneous metastases as initial distant metastases can be easily overlooked. This is the second case report of a colonic NEC with scalp metastasis. Compared with the previous case, in this instance scalp metastasis developed before visceral metastasis, and the cutaneous lesions were confined to the scalp alone.

Case presentation: A 62-year-old Chinese man, who had undergone radical surgery for a "locoregional" colonic NEC one and half months before, came to our hospital for adjuvant chemotherapy. We found multiple scalp nodules during physical examination. Moreover, these nodules had occurred and had not been detected prior to the patient undergoing radical surgery. The scalp nodules proved to be metastases from colonic NEC as determined using pathological and immunohistochemical examinations following lumpectomy. After one and half months, visceral metastases were detected in this patient. Ultimately, the patient died two months later.

Conclusions: In this report an unusual case of a colonic NEC with initial distant metastasis confined to the scalp is presented. This case is unusual because of the development of cutaneous metastasis before visceral metastasis. The scalp metastasis were initially overlooked, leading to inaccurate staging and radical surgery that was not curative. This demonstrates that distant metastasis can occur during the early phase of tumor growth in these aggressive lesions. Thus, the possibility of distant metastases should be assessed in the initial work up to avoid mistaken clinical staging especially when distant metastases occur only in skin.

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Multiple reddish nodules in the subcutis of the scalp.
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Figure 1: Multiple reddish nodules in the subcutis of the scalp.

Mentions: The patient came to our hospital for adjuvant chemotherapy on March 28th, 2013. Multiple nodules in the scalp were found using physical examination (>3) (Figure 1) and no cutaneous nodules were palpated at other sites. The patient recalled that he had some reddish papules on his scalp before surgery, but he did not mention them to the surgeon. These papules became gradually larger and formed multiple nodules. Laboratory tests done on admission showed that carbohydrate antigen 19-9 was 51.27 U/mL (normal, <37 U/mL), carbohydrate antigen 125 was 95.09 U/mL (normal, <35 U/mL) and neuron-specific enolase (NSE) was 123.9 μg/L (normal, <17 μg/L). Magnetic resonance of the head showed multiple space-occupying lesions with a rich blood supply in the soft tissue of his scalp (Figure 2). Our patient received one cycle of systemic chemotherapy with a regimen of etoposide 100 mg/m2 IV on days 1-3 and cisplatin 25 mg/m2 IV on days 1-3.


Multiple scalp metastases from colonic neuroendocrine carcinoma: case report and literature review.

Wang SM, Ye M, Ni SM - BMC Cancer (2014)

Multiple reddish nodules in the subcutis of the scalp.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4012716&req=5

Figure 1: Multiple reddish nodules in the subcutis of the scalp.
Mentions: The patient came to our hospital for adjuvant chemotherapy on March 28th, 2013. Multiple nodules in the scalp were found using physical examination (>3) (Figure 1) and no cutaneous nodules were palpated at other sites. The patient recalled that he had some reddish papules on his scalp before surgery, but he did not mention them to the surgeon. These papules became gradually larger and formed multiple nodules. Laboratory tests done on admission showed that carbohydrate antigen 19-9 was 51.27 U/mL (normal, <37 U/mL), carbohydrate antigen 125 was 95.09 U/mL (normal, <35 U/mL) and neuron-specific enolase (NSE) was 123.9 μg/L (normal, <17 μg/L). Magnetic resonance of the head showed multiple space-occupying lesions with a rich blood supply in the soft tissue of his scalp (Figure 2). Our patient received one cycle of systemic chemotherapy with a regimen of etoposide 100 mg/m2 IV on days 1-3 and cisplatin 25 mg/m2 IV on days 1-3.

Bottom Line: NENs account for approximately 0.4% of colorectal neoplasms.We found multiple scalp nodules during physical examination.Moreover, these nodules had occurred and had not been detected prior to the patient undergoing radical surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Oncology, Affiliated Hospital, School of Medicine, Ningbo University, No, 247 Renmin Road, Ningbo 315020, Zhejiang Province, China. 29091740@qq.com.

ABSTRACT

Background: Colonic neuroendocrine neoplasms (NENs) are relatively rare tumors with an incidence rate of 0.11-0.21/100,000. NENs account for approximately 0.4% of colorectal neoplasms. Cutaneous metastases of colonic neuroendocrine carcinomas (NECs) are very infrequent, while cases of scalp metastasis are even fewer. Cutaneous metastases are more rare than visceral metastases and usually develop later; therefore, cutaneous metastases as initial distant metastases can be easily overlooked. This is the second case report of a colonic NEC with scalp metastasis. Compared with the previous case, in this instance scalp metastasis developed before visceral metastasis, and the cutaneous lesions were confined to the scalp alone.

Case presentation: A 62-year-old Chinese man, who had undergone radical surgery for a "locoregional" colonic NEC one and half months before, came to our hospital for adjuvant chemotherapy. We found multiple scalp nodules during physical examination. Moreover, these nodules had occurred and had not been detected prior to the patient undergoing radical surgery. The scalp nodules proved to be metastases from colonic NEC as determined using pathological and immunohistochemical examinations following lumpectomy. After one and half months, visceral metastases were detected in this patient. Ultimately, the patient died two months later.

Conclusions: In this report an unusual case of a colonic NEC with initial distant metastasis confined to the scalp is presented. This case is unusual because of the development of cutaneous metastasis before visceral metastasis. The scalp metastasis were initially overlooked, leading to inaccurate staging and radical surgery that was not curative. This demonstrates that distant metastasis can occur during the early phase of tumor growth in these aggressive lesions. Thus, the possibility of distant metastases should be assessed in the initial work up to avoid mistaken clinical staging especially when distant metastases occur only in skin.

Show MeSH
Related in: MedlinePlus