Multiple subcutaneous nodules leading to diagnosis of colon cancer

Skin metastases from colorectal carcinoma are rare and signal advanced disease. Skin metastasis refers to growth of cancer cells in the skin originating from an internal cancer. In most cases, cutaneous metastasis develops after the initial diagnosis of the primary internal malignancy and late in the course of the disease. In very rare cases, skin metastasis may occur at the same time or before the primary cancer has been discovered and may be the prompt for further thorough investigation. The incidence of skin metastasis varies but is somewhere between 3-10% in patients with a primary malignant tumor. Most common ones are melanoma [45%], breast cancer [30%], nasal sinus cancers [20%], cancer of the larynx and cancer of the oral cavity [12%] cases. Here we present a case of 39-year-old man presented to us with multiple subcutaneous lesions over the chest and forehead. Fine needle aspiration cytology of skin nodules revealed metastatic adenocarcinoma features. Further imaging of the abdomen with computed tomography [CT] revealed circumferential narrowing of caecum and ascending colon. The patient was managed with palliative right hemicolectomy in view of constipation and palliative chemotherapy as systemic treatment. An extensive review of the English literature did not reveal extensive data on metastatic subcutaneous nodules leading to diagnosis of colon cancer

Right cervical lymphadenopathy: a rare presentation of metastatic hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is the most common, malignant tumor of the liver. Hepatocellular carcinoma [HCC] commonly metastasizes to the lungs, abdominal lymph nodes, adrenal glands, or bones. Distant lymph node metastases are rare in hepatocellular carcinoma. A 49-year-old male patient presented with right sided neck mass. On examination there was right cervical lymphadenopathy and hepatomegaly. Excisional cervical lymph node biopsy showed metastatic carcinoma. However, further examination of the biopsy specimen for immuno-histochemistry markers, shows positivity for HepPar-1 and CD-10 suggestive of hepatocellular carcinoma. Considering the high incidence of HCC in Asia, a special attention should be given to such unusual site of presentation and metastasis of HCC; therefore, not to miss the diagnosis

Primary esophageal Burkitt's lymphoma: a rare case report and review of literature

Esophageal lymphoma is a rare condition, accounting for less than 1% of all gastrointestinal lymphomas. Primary extra nodal esophageal lymphoma constitutes less than 0.2% cases of the total esophageal lymphomas. The definition of primary GI lymphoma has differed among authors. The etiology of the disease is unknown, with the role of Epstein-Barr virus being controversial. The common symptoms of patients with esophageal lymphoma include dysphasia, odynophagia, weight loss, chest pain or present as a result of complications. Burkitt's lymphoma is one of the fastest growing human malignancies, with a 100% replication rate. Endemic, sporadic [non-endemic] and immunodeficient variants have been recognized. The diagnosis of Burkitt's lymphoma relies on morphologic findings, immunophenotyping results, and cytogenetic features. Burkitt's lymphoma is usually treated with LMB-96 protocol depending on the risk stratification. We present a case of primary esophageal Burkitt's lymphoma, which has been successfully treated with LMB-96 protocol. An extensive review of literature did not reveal a single case of esophageal Burkitt's lymphoma. To the best of our knowledge this is the first case report in the world literature with diagnosis of primary esophageal Burkitt's lymphoma