Unusual collision tumor with infiltrating ductal carcinoma and breast skin squamous cell carcinoma: A case report and literature review.

INTRODUCTION: Breast cancer is the most common diagnosed cancer among women worldwide. Invasive ductal carcinoma (IDC) is the most common type, on the other hand, squamous cell carcinoma of the skin (SCC) overlying the breast is a rare tumor. The co-presence of two tumor types in one organ is even a rarer entity, termed as collision tumor. Only 3 known cases of collision tumor with breast invasive ductal and skin squamous carcinoma were reported in the literature. CASE PRESENTATION: An otherwise medically free 91-year-old, postmenopausal, female presented with left breast fungating mass for four months. Pre-operative core tissue biopsy and incisional skin biopsy revealed two distinct tumor subtypes of invasive ductal carcinoma, positive for progesterone, estrogen receptors and negative for human epidermal growth factor receptor 2, as well as skin squamous cell carcinoma, and axillary lymph node metastasis. Patient underwent left breast modified radical mastectomy and split skin grafting for wound closure. The final histopathology was consistent with grade 2 IDC. The nipple and areola complex were involved by moderately differentiated squamous cell carcinoma. Currently patient on adjuvant hormonal treatment. Follow up showed no local recurrence or distal metastasis. CONCLUSION: Collision tumors of the breast with IDC and SCC of the overlying skin is very rare. The surgeon has to be aware of of such entity as the proper peri-operative management should be tailored to target the most aggressive histologic subtype.

Familial Idiopathic Pan-Colonic Varices Found Incidentally in a Young Patient with a Hepatic Flexure Tumor.

BACKGROUND Colonic varices are rare entity that often results from portal vein hypertension and hepatic cirrhosis. In the absence of underlying pathology, they are termed "idiopathic colonic varices". They are usually an incidental finding; however, they can present with varying degrees of lower gastrointestinal bleeding. There is only one reported case in the literature of colonic varices with a concomitant colonic tumor; our patient is the second one with such a presentation. We report a case of this rare combination with the outcomes of the elected surgical management and review the literature. CASE REPORT A 24-year-old male was referred to our hospital with a 1-month history of colicky abdominal pain. His family history is remarkable of 2 relatives with colonic varices. A computed tomography scan of the abdomen and pelvis showed a hepatic flexure colonic mass. Colonoscopy revealed pancolonic varices. Biopsy from the lesion revealed adenocarcinoma. Options were discussed with the patient to undergo only a right hemicolectomy for his cancer or a total colectomy to include the colonic segment involved with varices, and he elected the first option, with no complications upon 1 year follow up. CONCLUSIONS Idiopathic pan-colonic varices are rare pathology. Their presence with colonic tumor presents a dilemma as to whether a subtotal/total colectomy is needed on the premise that a limited resection may carry the risk of subsequent bleeding. In the literature, the only similar case to ours had brisk postoperative bleeding, while ours did not experience such a complication.

A rare cause of small bowel perforation: A metastatic lesion from squamous cell carcinoma of the tongue.

BACKGROUND: Metastatic lesions from head and neck tumours to the small bowel are extremely rare, and metastasis from tongue squamous cell carcinoma in particular has been reported only twice in the English literature. CASE PRESENTATION: A 76 year-old lady diagnosed with a loco-regionally advanced tongue squamous cell carcinoma but deferred surgical resection. Seven months later after her diagnosis, she presented with generalized abdominal pain, due to image-proven viscous perforation, thus taken for emergent exploratory laparotomy, where the perforation was found at the distal ileum, which was resected, and a primary side to side anastomosis was done. The histopathological examination of the resected segment revealed squamous cell carcinoma originating from the tongue. The patient was deteriorating clinically and vitally during her stay, and passed away on day 16 post operation due to multi-organ dysfunction syndrome. CONCLUSION: Metastatic lesions from tongue carcinoma found in the vicinity of the small bowel represent a terminal stage with a dismal prognosis, and when these lesions present clinically with a complicated course, the survival rate is decreased significantly.