ABSTRACT
BACKGROUND: Perianal Paget's disease (PPD) is a rare malignancy, often associated with an underlying adenocarcinoma and a poor prognosis. CASE PRESENTATION: A 69-year-old female was presented with a history of perianal pruritus for 6 months and enlarged inguinal lymph nodes in the left side. Paget cells were confirmed by pathology after a wide excision of perianal skin. Radiotherapy was performed covering the bilateral inguinal lymphatic drainage area. Hepatic metastasis was found 8 months after surgery. Hepatic artery embolization (HAE) and high-intensity focused ultrasound therapy (HIFU) were performed successively. However, hepatic metastasis happened again 3 months later. Ultrasound-guided percutaneous radiofrequency ablation (PRFA) was carried out and various means of inspection could not identify the primary tumor. In the case of rapid progression of the tumor, we gave the patient chemotherapy regimens of XELOX. After 4 cycles of chemotherapy, the tumor marker went down continuously and the hepatic metastasis stayed stable. CONCLUSIONS: Hepatic metastasis from perianal Paget's disease without identified underlying carcinoma may benefit from XELOX on the basis of adenocarcinoma.
Subject(s)
Anus Neoplasms , Liver Neoplasms , Paget Disease, Extramammary , Aged , Anal Canal , Anus Neoplasms/therapy , Female , Humans , Liver Neoplasms/therapy , Paget Disease, Extramammary/surgery , PrognosisABSTRACT
BACKGROUND: Hepatocellular carcinoma (HCC) is a malignant tumor with frequent intrahepatic metastases; extrahepatic metastases are not rare but less frequent compared to intrahepatic ones. The most frequent sites of extrahepatic metastases are the lungs, followed by the lymph nodes, bones, and adrenal glands. Case report covering gastrointestinal (GI) tract involvement from HCC is limited. CASE PRESENTATION: A 60-year-old man was referred to us in May 2019 with a diagnosis of sigmoid colon tumor. The patient had a history of HCC and had received two stages of open resections for the primary and the abdominal metastasis successively and many times of transcatheter arterial chemoembolization (TACE). The sigmoid colon tumor received Hartmann procedure after abdominal enhanced computerized tomography (CT) scan and colonoscopy, while postoperative pathology and immunohistochemistry identified it as extrahepatic colonic metastasis from HCC. CONCLUSIONS: The ratio of extrahepatic metastasis to the digestive tract was very low, and the majority was upper gastrointestinal involvement because of direct invasion or intraperitoneal implantation. TACE may be the risk factor of retrograde hematogenous metastasis to the downstream colon.
Subject(s)
Carcinoma, Hepatocellular , Chemoembolization, Therapeutic , Liver Neoplasms , Carcinoma, Hepatocellular/therapy , Colon , Humans , Liver Neoplasms/therapy , Male , Middle Aged , PrognosisABSTRACT
RATIONALE: Pyoderma gangrenosum (PG) is a rare postoperative complication of enterostomy, mostly developing from dermatitis, which may have serious consequence. PATIENT CONCERNS: A patient with lower rectal cancer receiving low anterior resection (LAR) and protective ileostomy was initially diagnosed with dermatitis, which very quickly developed to PG, though no medical or familial history was found. DIAGNOSIS: We diagnosed the patient with peristoaml dermatitis starting from a tiny skin ulceration, but corrected the diagnosis to PG because of the rapid development and severe consequences. INTERVENTIONS: Routine stoma care did not improve the condition, so we performed 2 terms of debridement, the closure of the stoma and autologous skin transplantation before finally solving the problem. OUTCOMES: The patient was discharged 60 days after the first surgery and 5 days after the last one. After 18 months of follow-up, the patient kept in a stable condition. LESSONS: Medical staff should not neglect peristoaml dermatitis because of its common occurrence. Once the situation develops beyond the doctors' expectation, more efforts should be made to treat it, even expand debridement if possible.
Subject(s)
Debridement/methods , Ileostomy/adverse effects , Pyoderma Gangrenosum/therapy , Skin Transplantation/methods , Anti-Bacterial Agents/therapeutic use , Humans , Male , Mezlocillin/therapeutic use , Middle Aged , Transplantation, Autologous , Zinc Oxide/administration & dosage , Zinc Oxide/therapeutic useABSTRACT
Electroacupuncture at the head acupoints Baihui (GV20) and Shuigou (GV26) improves recovery of neurological function following ischemic cerebrovascular events, but its mechanism remains incompletely understood. We hypothesized that the action of electroacupuncture at these acupoints is associated with elevated serum levels of transforming growth factor beta 1 (TGF-ß1). To test this, we established a rat model of cerebral ischemia by middle cerebral artery occlusion. Electroacupuncture was performed at Baihui and Shuigou with a "disperse-dense" wave at an alternating frequency of 2 and 150 Hz, and at a constant intensity of 3 mA. Each electroacupuncture session lasted 30 minutes and was performed every 12 hours for 3 days. Neurological severity scores were lower in injured rats after acupuncture than in those not subjected to treatment. Furthermore, serum level of TGF-ß1 was greater after electroacupuncture than after no treatment. Our results indicate that electroacupuncture at Baihui and Shuigou increases the serum level of TGF-ß1 in rats with acute cerebral ischemia/reperfusion injury, and exerts neuroprotective effects.
