Raye Angeli B. Abella
Corazon Locsin Montelibano Memorial Regional Hospital, Philippines
Title: ISOLATED CUTANEOUS METASTASIS AS AN INITIAL PRESENTATION OF COLONIC ADENOCARCINOMA IN A 45 YEAR-OLD MALE: A CASE REPORT
Biography
Biography: Raye Angeli B. Abella
Abstract
SYNOPSIS: Colonic adenocarcinoma frequently metastasizes to the liver, lungs, and bones. Cutaneous metastasis is a rare initial manifestation of colonic adenocarcinoma. This is a case of a 45-year old male diagnosed with Colonic Adenocarcinoma, initially presenting with cutaneous metastasis.
CLINICAL SCENARIO: We report a case of a 45-year old male who came in due to the presence of a mass at the left gluteal area, noted six months prior to admission, which progressively increased in size. Pallor and weight loss were likewise present.
PHYSICAL FINDINGS: Pertinent physical examination findings revealed presence of a gray to dark brown fungating mass, approximately 10cm x 20 cm in size, at the left gluteal area extending up to the medial 3rd of the right gluteal region, with presence of bloody discharge.
COURSE IN THE WARDS: We report a case of a 45 year-old male who presented with a gluteal mass. Initial incision biopsy done revealed findings of Papillary Eccrine Adenocarcinoma vs. Metastatic Adenocarcinoma. On further work-up, no significant findings was seen on chest radiography. Computed tomography (CT) of the abdomen showed presence of left gluteal and ischiorectal masses, retroperitoneal and mesenteric lymphadenopathies, suggestive of malignancy. Colonoscopy done revealed no significant findings. Patient underwent excision of gluteal mass with creation of gluteus maximus rotational flap. Frozen section biopsy of the mass showed a malignant neoplasm, consistent that of Adenocarcinoma, moderately-differentiated. Immunohistochemistry studies of the neoplasm show positive (+) cytoplasmic membrane staining for CK20 and negative (-) cytoplasmic membrane staining for CK7. The following immunohistochemistry are consistent with adenocarcinoma of colonic origin. The patient was then advised for chemotherapy, however, was lost to follow-up.
CONCLUSION: Cutaneous metastasis is a very rare initial manifestation of colonic adenocarcinoma. Cutaneous metastases are thought to be associated with poor average survival because of underlying widespread disease, thus physicians should be more aggressive in terms of management.
Keywords: Colonic adenocarcinoma, Metastatic adenocarcinoma, Cutaneous metastasis