Hepatic metastasis of anal squamous cell carcinoma

A 50-year-old woman was diagnosed with anal squamous cell carcinoma following a colonoscopy performed for positive test from the National Bowel Screening Programme. During the staging imaging, it was discovered to have a liver lesion that was atypical for metastasis. She underwent a segmental liver resection, and histopathology showed the liver lesion as a metastatic squamous cell carcinoma. We aim to discuss the incidence, presentation and management strategies for this rare hepatic metastasis of anal squamous cell carcinoma.</jats:p

Triple synchronous malignancies of the stomach, bladder and thyroid in a previously treated prostate cancer patient: A Case Report

Cancers that develop within six months of the first primary cancer are referred to as synchronous malignancies. These malignancies are difficult to diagnose and treat, with treatment primarily based on case reports. We report here the case of a 51-year-old male with prior history of prostate cancer who presented with haematuria to the general practice. A CT pyelogram showed left bladder wall lesion that was further investigated with cystoscopy and biopsy confirmed as muscle-invasive urothelial carcinoma. Incidentally, two perigastric nodes and hepatic lesions were noted on CT. FDG-PET revealed high-grade uptake in the right lobe of thyroid gland and cervical nodes that was biopsy proven as papillary thyroid carcinoma. Subsequently, gastroscopy and a biopsy of the gastric lesion confirmed a gastric neuroendocrine tumour. The patient underwent chemoradiotherapy, total thyroidectomy, and commenced somatostatin analogue for treatment of urothelial carcinoma, papillary thyroid carcinoma, and neuroendocrine tumour, respectively. The diagnosis and treatment of synchronous malignancies is complex. A multidisciplinary team approach is required to improve treatment outcomes

Locally invasive cholangiocarcinoma causing gastric outlet obstruction in heterotaxy syndrome: A case report and review of literature

Heterotaxy syndrome is a disease of embryo development resulting in abnormal distribution of thoracic and abdominal organs across the left-right axis. In this case, A 77-year-old gentleman was admitted with gastric outlet obstruction secondary to cholangiocarcinoma. This is on a background of heterotaxy syndrome, specifically situs ambiguus. The patient's anatomical variations included a right-sided stomach, midline liver, and asplenia. Due to variant anatomy and risk of aspiration; endoscopy was abandoned in favor of surgical bypass via a gastrojejunostomy. Although technically challenging, complex upper abdominal surgery in heterotaxy syndrome has been described in the literature. Variations in anatomy observed in heterotaxy syndrome may render patients ineligible for resection of cholangiocarcinoma and increase the risk of complications. Careful preoperative planning with imaging and meticulous intraoperative dissection is required

Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus

INTRODUCTION: This meta-analysis aimed to compare perioperative and survival outcomes in patients who underwent hepatectomy with and without Bile Duct Tumour Thrombus (BDTT). METHODS: A comprehensive search of Cochrane Library, PubMed, MEDLINE and EMBASE was performed to identify relevant articles. The perioperative, postoperative and long term outcomes were compared. RESULTS: Eleven studies including 6051 patients met the inclusion criteria. The perioperative outcomes were comparable between the 2 groups. The BDTT group had higher proportion poorly differentiated tumours (OR = 1.87, X(2) = 10.00, df = 6, p = 0.002, I(2) = 40%), Lymphovascular invasion (LVI) (OR = 4.85, X(2) = 28.21, df = 9, p = <0.001, I(2) = 68%) and Macrovascular invasion (MVI) (OR = 5.41, X(2) = 8.73, df = 9, p = <0.001, I(2) = 0%). There was no difference in 1 and 3 year survival, however 5-yr survival was poorer in the BDTT group (OR = 0.37, X(2) = 37.04, df = 7, p = <0.001, I(2) = 81%). The mean difference (MD) in overall survival in the BDTT group was −20 months [−32.31, −7.06], p = 0.002, I(2) = 95%. CONCLUSION: Patients with HCC with BDTT had more advanced stage HCC with adverse histological features including higher rates of MVI, LVI and poor differentiation. Hepatectomy in this group of patients offers similar survival at 3 years but inferior long-term survival and should be considered when feasible