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Ohta R, Nishikura N, Suyama S, Sano C. Differentiation Between Disseminated Carcinomatosis of the Bone Marrow From Urothelial Cancer and Intravascular Large B-cell Lymphoma: A Case Report. Cureus 2024; 16:e57221. [PMID: 38686250 PMCID: PMC11056314 DOI: 10.7759/cureus.57221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
This case report describes a rare case of intravascular large B-cell lymphoma (IVLBCL), initially presenting with nonspecific symptoms of fever and fatigue, and tentatively diagnosed as disseminated carcinomatosis of the bone marrow originating from urothelial cancer in an 80-year-old woman. The patient's journey began with symptoms treated as common ailments and progressed through multiple differential diagnoses, including giant cell arteritis, TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) syndrome, and disseminated carcinomatosis of the bone marrow originating from urothelial cancer due to the presence of systemic inflammation, anasarca, and elevated soluble interleukin 2 receptor levels, indicative of an intense immunological response. Despite initial treatments, her condition deteriorated, leading to further investigations that ultimately revealed the presence of malignant cells in the urine and bone marrow, confirming the diagnosis of IVLBCL. This case underscores the diagnostic challenges faced when elderly patients present with systemic inflammation and the critical need for thorough investigation beyond initial impressions. It highlights the importance of considering differentiation between disseminated carcinomatosis of the bone marrow and IVLBCL in the differential diagnosis of persistent inflammation, especially in cases where common causes have been excluded and the primary malignancy is not immediately apparent.
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Affiliation(s)
| | | | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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2
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Suzuki D, Meguro S, Furusawa S, Hashimoto N, Kawasaki H, Kosugi I, Enomoto Y, Fujihiro M, Tsukui H, Iwashita T. An autopsy case of disseminated carcinomatosis of the bone marrow from esophageal adenocarcinoma. Clin Case Rep 2023; 11:e7877. [PMID: 37744630 PMCID: PMC10511695 DOI: 10.1002/ccr3.7877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Key Clinical Message Disseminated carcinomatosis of the bone marrow is rare. We present such a case, which is useful for raising awareness about the importance of early diagnosis and treatment of carcinomas complicated by disseminated carcinomatosis of the bone marrow. Abstract This is the first autopsy report of disseminated carcinomatosis of the bone marrow (DCBM) in esophageal adenocarcinoma. Advanced poorly differentiated adenocarcinoma with signet ring cell carcinoma arising in Barrett's esophagus caused disseminated intravascular coagulation (DIC) with extensive bone marrow metastasis, resulting in death from cerebral hemorrhage. Although DCBM due to malignancy is rare with poor prognosis, it should be considered in malignancies associated with DIC, and prompt initiation of chemotherapy is the only way to improve the patient's prognosis.
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Affiliation(s)
- Daisuke Suzuki
- Department of Diagnostic PathologyChutoen General Medical CenterShizuokaJapan
| | - Shiori Meguro
- Department of Regenerative and Infectious PathologyHamamatsu University School of MedicineShizuokaJapan
| | - Shin Furusawa
- Department of NephrologyChutoen General Medical CenterShizuokaJapan
| | - Nanako Hashimoto
- Department of RadiologyChutoen General Medical CenterShizuokaJapan
| | - Hideya Kawasaki
- Institute for NanoSuit Research, Preeminent Medical Photonics Education & Research CenterHamamatsu University School of MedicineShizuokaJapan
| | - Isao Kosugi
- Department of Regenerative and Infectious PathologyHamamatsu University School of MedicineShizuokaJapan
| | - Yasunori Enomoto
- Department of Regenerative and Infectious PathologyHamamatsu University School of MedicineShizuokaJapan
| | - Mayu Fujihiro
- Department of Diagnostic PathologyHamamatsu University School of MedicineShizuokaJapan
| | - Hiroe Tsukui
- Department of Diagnostic PathologyHamamatsu University School of MedicineShizuokaJapan
| | - Toshihide Iwashita
- Department of Regenerative and Infectious PathologyHamamatsu University School of MedicineShizuokaJapan
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3
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Chan WK, Lin NS, Tay KV, Teo LT. Systematic review of isolated disseminated carcinomatosis of bone marrow from colorectal cancer. ANZ J Surg 2023; 93:1169-1175. [PMID: 36772885 DOI: 10.1111/ans.18324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) metastasis commonly occurs in the liver and lungs with bone metastasis rarely occurring in isolation. Disseminated carcinomatosis of bone marrow (DCBM) is extremely rare in CRC. We conducted a systematic review to provide more information on the diagnosis, treatment options, and prognosis of the condition. METHODS Studies were identified by performing searches on MEDLINE and EMBASE electronic databases according to the PRISMA statement standards. We included a single patient whom we treated for metastatic CRC presenting with DCBM in our study. Statistical analysis was performed using SPSS software version 23.0. RESULTS A search through 5502 unique studies yielded 14 studies that were eventually included. There was a total of 17 cases of DCBM in CRC with back pain and constitutional symptoms as the most common presenting complaints. DCBM in CRC was associated with markedly elevated CEA of 275.57 (95% CI 17.13-534.00). There was no predilection for site of primary tumour. Overall median survival was 120 days (95% CI 64.43-175.58). The median survival for patients who received chemotherapy was 240 days (95% CI 71.11-408.89), as compared to 9 days (95% CI 1.80-16.20) for patients who received best supportive treatment. CONCLUSION DCBM from CRC is extremely rare. Bone marrow examination remains the gold standard for diagnosis. Colonic stenting or surgical diversion may be more appropriate than primary resection in obstructed CRC in view of the poor prognosis. Systemic chemotherapy shows promise in increasing median survival.
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Affiliation(s)
- Wai Kiu Chan
- Trauma Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Norman Sihan Lin
- Trauma Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Kon Voi Tay
- Trauma Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li-Tserng Teo
- Trauma Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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4
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Immunohistochemical analysis of the distribution of RANKL: a case of disseminated carcinomatosis of bone marrow as the first presentation of relapse in curatively resected colorectal cancer. Med Mol Morphol 2022; 56:138-143. [PMID: 36478259 DOI: 10.1007/s00795-022-00342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
Poorly differentiated adenocarcinoma of colorectal carcinoma (CRC) is a rare condition with poor prognosis. In this report, we describe a case of a 69-year-old man who underwent laparoscopic low anterior resection after being diagnosed with stage IIIB CRC. At 10 months post-operation, he developed fever and loss of appetite. Laboratory examination revealed > 120.0 μg/dL fibrin degradation products and > 60.0 μg/dL D-dimer. Bone marrow (BM) examination showed malignant epithelioid infiltrate with CK20 and CDX2 expression, leading to diagnosis of disseminated carcinomatosis of BM, which is rare in CRC and indicative of widespread disease throughout the body. Furthermore, immunohistochemistry revealed high expression of receptor activator of nuclear factor κB ligand (RANKL) in tumor cells, including budding cells of CRC and BM tissues. Thus, RANKL expression, which is known to indicate metastatic behavior of cancer cells, may play a critical role in promoting osteoclast formation, which has been associated with the pathogenesis of BM lesions.
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5
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Wang HJ, Zhou CJ. Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report. World J Clin Cases 2022; 10:2967-2973. [DOI: 10.12998/wjcc.v10.i9.2967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bone marrow metastasis is common in liver and lung cancer, but there are few reports on bone marrow metastasis in colon cancer. To date, there are no such reports from mainland China, and reports of bone marrow metastasis with septic shock as the main manifestation are even rarer.
CASE SUMMARY A 71-year-old woman with sepsis as the first symptom presented with high fever, low blood pressure and high inflammation indicators. Computed tomography (CT) examination revealed mild inflammation of the lungs and no obvious abnormalities in the abdomen. Blood culture suggested Escherichia coli, Aeromonas hydrophila and Aeromonas caviae infection. Antibiotic treatment significantly improved the patient’s sepsis symptoms; however, her thrombocytopenia (TCP) could not be corrected despite repeated platelet transfusions. Many malignant cells were ultimately found following a bone marrow puncture smear, and further positron emission tomography/CT (PET/CT) examination confirmed that the malignant tumor in the ascending colon was accompanied by multiple metastases, including the liver and bones. Colon adenocarcinoma was confirmed by autopsy.
CONCLUSION Patients with advanced colon cancer may not have typical clinical symptoms, and sepsis may be the first symptom. When patients have severe TCP that cannot be explained by sepsis of intestinal origin, it is necessary to be aware of the possibility of bone marrow metastasis of intestinal tumors. As such patients often cannot tolerate endoscopy, bone marrow biopsy smears or biopsy tests for specialized cells can help obtain a diagnosis, especially in less developed countries where PET/CT is scarce.
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Affiliation(s)
- Hua-Jun Wang
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
| | - Chen-Jie Zhou
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
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6
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Wang HJ, Zhou CJ. Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report. World J Clin Cases 2022; 10:2969-2975. [PMID: 35434087 PMCID: PMC8968824 DOI: 10.12998/wjcc.v10.i9.2969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/04/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bone marrow metastasis is common in liver and lung cancer, but there are few reports on bone marrow metastasis in colon cancer. To date, there are no such reports from mainland China, and reports of bone marrow metastasis with septic shock as the main manifestation are even rarer.
CASE SUMMARY A 71-year-old woman with sepsis as the first symptom presented with high fever, low blood pressure and high inflammation indicators. Computed tomography (CT) examination revealed mild inflammation of the lungs and no obvious abnormalities in the abdomen. Blood culture suggested Escherichia coli, Aeromonas hydrophila and Aeromonas caviae infection. Antibiotic treatment significantly improved the patient’s sepsis symptoms; however, her thrombocytopenia (TCP) could not be corrected despite repeated platelet transfusions. Many malignant cells were ultimately found following a bone marrow puncture smear, and further positron emission tomography/CT (PET/CT) examination confirmed that the malignant tumor in the ascending colon was accompanied by multiple metastases, including the liver and bones. Colon adenocarcinoma was confirmed by autopsy.
CONCLUSION Patients with advanced colon cancer may not have typical clinical symptoms, and sepsis may be the first symptom. When patients have severe TCP that cannot be explained by sepsis of intestinal origin, it is necessary to be aware of the possibility of bone marrow metastasis of intestinal tumors. As such patients often cannot tolerate endoscopy, bone marrow biopsy smears or biopsy tests for specialized cells can help obtain a diagnosis, especially in less developed countries where PET/CT is scarce.
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Affiliation(s)
- Hua-Jun Wang
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
| | - Chen-Jie Zhou
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
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7
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Okumura T, Mitsui K, Daikuhara S, Tatai T, Itagaki H, Miyabayashi H, Gibo Y. Disseminated Carcinomatosis of Bone Marrow as the Initial Presentation of Intrahepatic Cholangiocarcinoma without Jaundice: An Autopsy Case Report. Intern Med 2022; 61:657-662. [PMID: 34483207 PMCID: PMC8943367 DOI: 10.2169/internalmedicine.7688-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Disseminated carcinomatosis of the bone marrow (DCBM) is often accompanied by disseminated intravascular coagulation (DIC) and has a poor prognosis. DCBM develops most frequently in gastric cancer and is rarely associated with intrahepatic cholangiocarcinoma. A 41-year-old man was incidentally found to have DIC on his regular visit for ulcerative colitis and was diagnosed with DCBM with intrahepatic cholangiocarcinoma. He received intensive care, including chemotherapy, but died suddenly from hyperkalemia, possibly due to tumor lysis syndrome (TLS). The autopsy showed the periductal infiltrating type of intrahepatic cholangiocarcinoma and tumor necrosis, possibly due to chemotherapy, indicating the effectiveness of chemotherapy for DCBM with intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Taiki Okumura
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Kenta Mitsui
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Seiichi Daikuhara
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Toshiharu Tatai
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Hiroko Itagaki
- Department of Pathology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Hideharu Miyabayashi
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
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8
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Deng XH, Li J, Chen SJ, Xie YJ, Zhang J, Cen GY, Song YT, Liang ZJ. Clinical features of intracerebral hemorrhage in patients with colorectal cancer and its underlying pathogenesis. World J Gastrointest Oncol 2021; 13:2180-2189. [PMID: 35070050 PMCID: PMC8713314 DOI: 10.4251/wjgo.v13.i12.2180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of both cancer and intracerebral hemorrhage (ICH) in the same patient is not uncommon, but the clinical features and pathogenesis of patients with colorectal cancer (CRC) and ICH are still not well known.
AIM To investigate the clinical features and underlying pathogenesis of ICH in patients with CRC.
METHODS A retrospective review of CRC patients complicated with ICH from three centers between January 2014 and December 2020 was performed. Clinical data such as laboratory examinations, imaging features, prognosis, and underlying pathogenesis were analyzed.
RESULTS Of 16673 identified CRC patients, 20 (0.12%) suffered from ICH. There were 13 males and 7 females, with an average age (mean ± SD) of 68.45 ± 10.66 years. Fourteen patients (70%) had distant metastases and most patients (85%) showed an elevation of one or more cancer biomarkers. The hemorrhagic lesions in 13 patients (65%) were in the intracerebral lobe. Four patients were completely dependent and 4 died within 30 days after hemorrhage. Intratumoral hemorrhage (50%) and coagulopathy (50%) accounted for the majority of hemorrhages.
CONCLUSION Patients with ICH and CRC often have clinical features with lobar hemorrhage, distant metastases and poor prognosis. Intratumoral hemorrhage and coagulopathy are the main causes of ICH in patients with CRC.
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Affiliation(s)
- Xu-Hui Deng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Department of Neurology, The Affiliated Yuebei People’s Hospital of Shantou University Medical College, Shaoguan 512025, Guangdong Province, China
| | - Jing Li
- Department of General Medicine, The Affiliated Cancer Center of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shi-Jian Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi-Ju Xie
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Geng-Yu Cen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi-Ting Song
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Jian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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9
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Brahmer JR, Abu-Sbeih H, Ascierto PA, Brufsky J, Cappelli LC, Cortazar FB, Gerber DE, Hamad L, Hansen E, Johnson DB, Lacouture ME, Masters GA, Naidoo J, Nanni M, Perales MA, Puzanov I, Santomasso BD, Shanbhag SP, Sharma R, Skondra D, Sosman JA, Turner M, Ernstoff MS. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2021; 9:e002435. [PMID: 34172516 PMCID: PMC8237720 DOI: 10.1136/jitc-2021-002435] [Citation(s) in RCA: 435] [Impact Index Per Article: 108.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.
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Affiliation(s)
- Julie R Brahmer
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Hamzah Abu-Sbeih
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Paolo Antonio Ascierto
- Unit of Melanoma Cancer Immunotherapy and Innovative Therapy, National Tumour Institute IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - Jill Brufsky
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura C Cappelli
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frank B Cortazar
- Massachusetts General Hospital, Boston, Massachusetts, USA
- New York Nephrology Vasculitis and Glomerular Center, Albany, New York, USA
| | - David E Gerber
- Department of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lamya Hamad
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Eric Hansen
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory A Masters
- Department of Medicine, Helen F. Graham Cancer Center, Newark, Delaware, USA
| | - Jarushka Naidoo
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
- Department of Oncology, Beaumont Hospital Dublin, The Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Michele Nanni
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Bianca D Santomasso
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Satish P Shanbhag
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Cancer Specialist of North Florida, Fleming Island, Florida, USA
| | - Rajeev Sharma
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Michelle Turner
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Marc S Ernstoff
- Division of Cancer Treatment & Diagnosis, National Cancer Institute, Rockville, Maryland, USA
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10
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Desikan SP, Mclaughlin N, McClain C, Desikan R. Recurrent Colon Cancer: Presentation With Disseminated Intravascular Coagulation From Disseminated Carcinomatosis of the Bone Marrow. J Investig Med High Impact Case Rep 2021; 9:23247096211012224. [PMID: 33966469 PMCID: PMC8114248 DOI: 10.1177/23247096211012224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diffuse carcinomatosis of the bone marrow (DCBM) is a rare clinical condition characterized by diffuse bone marrow involvement with hematological changes. This case study concerns a patient who presented with DCBM secondary to colon cancer with diffuse intravascular coagulation. This is a rare presentation of DCBM in colon cancer. The case study also elaborates on clinical features, pathogenesis, and therapy of this unique presentation.
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11
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Alghandour R, Saleh GA, Shokeir FA, Zuhdy M. Metastatic colorectal carcinoma initially diagnosed by bone marrow biopsy: a case report and literature review. J Egypt Natl Canc Inst 2020; 32:30. [PMID: 32676803 DOI: 10.1186/s43046-020-00040-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Colorectal carcinoma still represents a global health burden despite the advances in its management. The most common sites of distant metastasis from colorectal carcinoma are hepatic and pulmonary metastases while metastases are rarely reported to affect the bone marrow. CASE PRESENTATION We report a 33-year-old female patient who presented with fever of unknown origin, bone aches limited to the lower back and pelvis, and pancytopenia. She was diagnosed by a bone marrow biopsy as a case of metastatic rectosigmoid carcinoma. Serum tumor markers were within normal ranges; CT, MRI, and colonoscopy confirmed the presence of malignant rectosigmoid mass with bone and ovarian metastases. CONCLUSION Though being rare, bone marrow metastasis should be suspected in colorectal carcinoma cases with abnormalities in peripheral blood count.
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Affiliation(s)
- Reham Alghandour
- Medical Oncology Department, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- Diagnostic Radiology Department, Mansoura University Hospitals, Mansoura, Egypt
| | | | - Mohammad Zuhdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, 35516, Egypt.
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12
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Chuwa H, Kassam NM, Wambura C, Sherman OA, Surani S. Disseminated Carcinomatosis of Bone Marrow in an African Man with Metastatic Descending Colon Carcinoma. Cureus 2020; 12:e7593. [PMID: 32399327 PMCID: PMC7212736 DOI: 10.7759/cureus.7593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Colorectal cancer (CRC) is ranked third worldwide and seventh in Tanzania. The liver and lungs are the most commonly involved sites. Disseminated carcinomatosis of the bone marrow (DCBM) from colorectal carcinoma is rare and typically indicates widespread disease and poor prognosis. We report a case of a 40-year-old African male, who presented to us with abdominal distension, weight loss, fever and change in bowel habit over the past month. He underwent colonoscopy which revealed a necrotic mass in the descending colon. Biopsies were taken, and histopathology confirmed the presence of poorly differentiated mucin-producing adenocarcinoma. The patient suffered a colonic perforation after the fifth cycle of chemotherapy, requiring surgical interventions. Patient's course was complicated by pancytopenia and bone marrow biopsy revealed infiltration by non-hematopoietic malignant cells and bone marrow necrosis. Disseminated carcinomatosis of the bone marrow is a rare and fatal condition; hence high level of clinical suspicion may help in detecting this rare manifestation of colorectal cancer.
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Affiliation(s)
| | - Nadeem M Kassam
- Internal Medicine, Aga Khan University Medical College, Dar es salaam, TZA
| | - Casmir Wambura
- Internal Medicine/Gastroenterology, Aga Khan University, Dar es Salaam, TZA.,Internal Medicine/Gastroenterology, Aga Khan Hospital, Dar es Salaam, TZA
| | | | - Salim Surani
- Internal Medicine, Texas A&M Health Science Center, Bryan, USA.,Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
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13
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Ehara T, Kitazawa M, Hondo N, Takahata S, Yamamoto Y, Koyama M, Okumura M, Nakamura S, Tokumaru S, Muranaka F, Miyagawa Y, Soejima Y. Treatment of Rectal Cancer-Induced Disseminated Carcinomatosis of the Bone Marrow with FOLFOX plus Cetuximab and Panitumumab. Case Rep Oncol 2020; 13:145-152. [PMID: 32231536 DOI: 10.1159/000505323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Abstract
Disseminated carcinomatosis of the bone marrow (DCBM) in colorectal cancer is an extremely rare complication with a poor prognosis. Here, we report a case of DCBM due to rectal cancer successfully treated with a combination of FOLFOX and an anti-epidermal growth factor receptor (EGFR) agent. The patient was a 38-year-old man diagnosed with rectal cancer with multiple bone and para-aortic lymph node metastases complicated by disseminated intravascular coagulation (DIC). He first recovered from DIC following cotreatment with FOLOX plus cetuximab; subsequently, the second attack was successfully treated with FOLFOX plus panitumumab. His initial condition was extremely poor, but he survived with two FOLFOX plus anti-EGFR regimens and died 333 days after introduction of chemotherapy.
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Affiliation(s)
- Takehito Ehara
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masato Kitazawa
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nao Hondo
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shugo Takahata
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Yamamoto
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Koyama
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Motohiro Okumura
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Nakamura
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeo Tokumaru
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Futoshi Muranaka
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyagawa
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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14
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Suyama T, Yokoyama M, Nishimura T, Kobayashi K, Katagiri K. Sweat gland carcinoma of the left axilla with disseminated carcinomatosis of the bone marrow. Int J Dermatol 2020; 59:e281-e284. [PMID: 32202308 DOI: 10.1111/ijd.14854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Takayuki Suyama
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Megumi Yokoyama
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tokihiro Nishimura
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Keisuke Kobayashi
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Kazumoto Katagiri
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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15
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Vitale FV, Longo-Sorbello GS, Rotondo S, Ferrau F. Understanding and treating solid tumor-related disseminated intravascular coagulation in the "era" of targeted cancer therapies. SAGE Open Med 2017; 5:2050312117749133. [PMID: 29318012 PMCID: PMC5753895 DOI: 10.1177/2050312117749133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/28/2017] [Indexed: 01/07/2023] Open
Abstract
A systemic activation of blood coagulation is usually present in many clinical conditions including the infectious or inflammatory ones and malignant disease as well. Depending upon circumstances, patients suffering from acute decompensated disseminated intravascular coagulation may be managed by a medical oncologist and either an internist or a physician working in an emergency and/or intensive care unit. In some cases, for example, the indolent ones, the activation of coagulation might not be easily detected by routine laboratory tests and not lead to clinical manifestations. Such a chronically activated intravascular coagulation can progress toward an overt decompensated disseminated intravascular coagulation. Traditional therapy of decompensated disseminated intravascular coagulation is based on reversing the underlying triggering disease and providing patients with adequate supportive treatment. The dilemma for the oncologist is whether or not the trigger cause can be treated and amended with a specific antineoplastic treatment, without worsening the consumption of platelets and the risk of bleeding. In light of the availability of new targeted therapies, the main criteria that should drive the strategy against solid cancer-related disseminated intravascular coagulation will be discussed.
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Affiliation(s)
| | | | - Stefano Rotondo
- Ambulatorio Diagnostica Vascolare, Angiologia e Medicina Interna, IRCCS Piemonte-Bonino Pulejo, Messina, Italy
| | - Francesco Ferrau
- Divisione di Oncologia Medica, Ospedale San Vincenzo, Messina, Italy
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