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Thyroid metastasis from rectal adenocarcinoma.

ABSTRACT: The thyroid is a rare site for metastasis, occurring in 0.1% of colorectal cases. A 46-year-old man with rectal adenocarcinoma developed an enlarging anterior neck mass and increasing carcinoembryonic antigen 2?years after curative intent treatment. Imaging showed aggressive features with invasion of the larynx, trachea and oesophagus, suspicious for anaplastic thyroid carcinoma. The patient underwent tumour debulking with neck dissection and tracheostomy. Final histopathological review revealed metastatic adenocarcinoma from a colorectal primary. Despite chemotherapy, the patient eventually succumbed to disease progression and complications of his illness. This case demonstrates that recognising rare sites of metastasis may help clinicians effectively institute earlier intervention.

SUBMITTER: Amante MA

PROVIDER: S-EPMC6101333 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Thyroid metastasis from rectal adenocarcinoma.

Amante Madelaine Amurao MA Real Irisyl Orolfo IO Bermudez Gherald G

BMJ case reports 20180814

The thyroid is a rare site for metastasis, occurring in 0.1% of colorectal cases. A 46-year-old man with rectal adenocarcinoma developed an enlarging anterior neck mass and increasing carcinoembryonic antigen 2 years after curative intent treatment. Imaging showed aggressive features with invasion of the larynx, trachea and oesophagus, suspicious for anaplastic thyroid carcinoma. The patient underwent tumour debulking with neck dissection and tracheostomy. Final histopathological review revealed ...[more]

PMID: 30108119

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Project description:Overall declines in incidence of rectal cancer (RC) in patients older than 50 years have been mostly attributed to improvement in treatment modalities and introduction of age-based screening. Recent studies, however, have shown a rise in the incidence of RC in patients younger than 50 years. The etiology of early-onset (EO) RC is not well understood. The aim of this study is to elucidate the molecular features of (EO) RC and show its uniqueness compared to late-onset (LO) disease.Two cohorts of patients with sporadic RC were identified. Tumors and matching non-involved tissues from six (EO) RC patients (< 50 years) and six (LO) RC patients (>65 years) were obtained from Pathology archives. Deparaffinized tissues were macro-dissected from FFPE sections, RNA isolated and used for expression profiling of 770 cancer related genes representing 13 canonical pathways. Statistical analysis was performed using the Gene Expression R-script module within the nCounter software v2.6. A gene was considered to be above background if the average count for the target gene was greater than the average counts for the eight negative control genes and if the P value of the t-test was less than 0.05.When we compared rectal tumors to non-involved rectal tissues, changes in expression levels of 171 genes were statistically significant in early-onset group and 151 genes in late-onset group. Further comparative gene expression analysis between early- and late-onset rectal tumors normalized to their matching non-involved tissues revealed that changes in expression of 65 genes were unique to early-onset rectal tumors with 16 genes being up- and 49 genes down-regulated using the cutoff criteria of expression levels difference >2 fold and p-value <0.01. At the pathway level, MAPK signaling was the most deregulated pathway in early-onset rectal tumors compared to PI3K-AKT signaling pathway being the most deregulated in late-onset rectal tumors.Results of this study suggest that sporadic early-onset rectal cancer is characterized by distinct molecular events compared to late-onset disease.

Project description:Background and Objectives: To evaluate the predictive factor for and patterns of distant metastasis in patients with rectal adenocarcinoma receiving total mesorectal excision (TME). Methods: We enrolled 217 consecutive patients who had histologically confirmed rectal adenocarcinoma and underwent surgery at Taipei Medical University- Wanfang Hospital between January 2000 and December 2014. TME was performed in all patients undergoing a sphincter-sparing procedure or abdominal perineal resection of rectal cancer. We performed univariate and multivariate Cox regression analyses of the distant metastasis rate in all patients to evaluate predictive factors. Overall survival (OS) rates were calculated using the Kaplan-Meier method, and Kaplan-Meier survival curves were compared using the log-rank test. Results: A multivariate Cox regression analysis of the distant metastasis rate in patients with rectal adenocarcinoma identified tumor locations and American Joint Committee on Cancer (AJCC) stages as prognostic risk factors. The adjusted hazard ratios (aHRs) of distant metastasis for the upper-third, middle-third, and AJCC stage I-II cancers were 0.08 (95% CI, 0.01-0.69; p = 0.021), 0.41 (95% CI, 0.15-0.99; p = 0.047), and 0.20 (95% CI, 0.10-0.66; p = 0.008), respectively. The 5-year lung metastasis rates among patients with upper-, middle-, and lower-third rectal cancers were 0%, 3.37%, and 13.33%, respectively (log-rank, p = 0.001), and the 5-year liver metastasis rates among patients with upper-, middle-, and lower-third rectal cancers were 2.12%, 9.10%, and 11.76%, respectively (log-rank, p = 0.096). The 5-year OS rates also differed with different rectal adenocarcinoma locations. The 5-year OS rates for upper, middle, and lower rectal cancers were 96%, 86%, and 64%, respectively (log-rank, p < 0.001). Conclusion: A poor OS rate and high lung or liver metastasis rate were observed in distal rectal adenocarcinoma. Longer intensive surveillance of the chest, abdomen, and pelvis after TME in distal rectal adenocarcinoma could be necessary.

Dataset Information

Thyroid metastasis from rectal adenocarcinoma.

Publications

Thyroid metastasis from rectal adenocarcinoma.

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