Plastic surgery for giant metastatic endometrioid adenocarcinoma in the abdominal wall:A case report and review of literature

BACKGROUND Endometrial cancer(EC)is a common gynecological malignancy,but metastasis to the abdominal wall is extremely rare.Therefore,an appropriate treatment approach for large metastatic lesions with infection remains a great challenge.CASE SUMMARY We report the case of a 65-year-old woman who developed abdominal metastasis of endometrioid adenocarcinoma,as defined by International Obstetrics and Gynecology stage II,in which the lesion was complicated by infection.A right hemicolectomy was performed for colon metastasis in relation to her initial gynecological cancer 3 years ago.When admitted to our department,a complete resection of the giant abdominal wall lesion was performed,and a Bard composite mesh was used to reconstruct the abdominal wall.A local flap was used to close the resultant large defect in the external covering of the abdomen.The patient underwent chemotherapy following cytoreductive surgery.Pathology revealed metastasis of EC,and molecular subtyping showed copy number high of TP53 mutation,implying a poor prognosis.CONCLUSION When EC patients develop giant abdominal wall metastasis,a plastic surgeon should be included before contemplating resection of tumors.

Abdominal metastases of primary extremity soft tissue sarcoma: A systematic review

BACKGROUND Despite the fact that about one third of patients with primary localized extremity soft tissue sarcoma(e STS)will develop metastatic disease,abdominal metastases(AM)and retroperitoneal metastases(RM)constitute rare events.There is no clear consensus on how to achieve follow-up on patients with primary localized e STS following curative resection,especially regarding the surveillance of potential AM/RM.AIM To systematically analyse incidence,diagnosis,treatment and outcome of AM/RM in e STS patients.METHODS In this systematic review,899 studies available in Pub Med and published between 2000 and 2018 were screened,identifying 17 original articles focused on AM or RM in e STS.Article selection was based on the PRISMA guidelines,using the search terms(abdominal metastasis AND soft tissue sarcoma)and(soft tissue sarcoma metastasis abdomen).All studies published between January 1,2000 and December 31,2018 were screened.Further articles were identified by crosssearching article references,with the final search date being February 18,2019.Due to limited data and the different reporting techniques used,the present review focused on descriptive analysis of the included studies.RESULTS Of the 17 studies included,six original articles reported on incidence±diagnosis,therapy and outcome in AM and RM,whilst three original and eight case reports focused on diagnostic pathway,therapeutic procedures or outcomes without allowing conclusions regarding incidence of AM and RM.According to the former six studies,incidence of AM ranged from 0.9%-5.6%in patients with miscellaneous histological subtypes,and up to 12.1%in patients with myxoid liposarcoma.The most common histological subtypes that developed AM or RM were(myxoid)liposarcoma and leiomyosarcoma,but also rare subtypes such asepithelioid sarcoma,myxofibrosarcoma,synovial sarcoma,and malignant peripheral nerve sheath tumour had been reported to develop AM/RM.Surgery for AM/RM was performed in five of eight case-reports(62.5%)and in 20.8%-100.0%of original articles.In particular,patients with hepatic metastases undergoing metastasectomy had a survival benefit compared to patients treated with chemotherapy or best supportive care(>3 years vs<6 mo).CONCLUSION Patients with e STS should undergo surveillance with abdominal ultrasonography/computed tomography,or even whole-body-magnetic resonance imaging to detect AM/RM at an early stage.

Asynchronous abdominal wall and sigmoid metastases in clear cell renal cell carcinoma: A case report and literature review

Sigmoid metastasis of renal cell carcinoma(RCC)is very rare.Herein we report a case of pathologically proven asynchronous abdominal wall and sigmoid metastases after a right nephrectomy.An 84-year-old man underwent right radical nephrectomy for clear cell renal cell carcinoma(ccRCC)13 years ago.Solitary contralateral abdominal wall metastasis was found for left abdominal mass 9 years after nephrectomy.The man experienced melena underwent resection of sigmoid colon tumor in February,2016.The postoperative pathological examinations revealed that the tumors were metastases of ccRCC.Recurrence more than 5 years after nephrectomy has been accepted as late recurrence by the majority of urologists now.Late recurrence is one of the specific biological behaviors of RCC.Asynchronous late recurrence of abdominal wall and sigmoid metastases in ccRCC has not been reported before.When patients have sigmoid mass after nephrectomy for RCC,doctors may consider the possibility of late recurrence.