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American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
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American Journal of Infectious Diseases and Microbiology
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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Disseminated Carcinomatosis of Bone Marrow Due to Sigmoid Colon Cancer

Christos Konstantinidis*, Panagiotis Varsos, Sotirios Kympouris*

Surgical Department, Hippocratio General Hospital of Athens, 114 Vasilissis Sofias str, Athens, Region of Attica, GreeceSurgical Department, Hippocratio General Hospital of Athens, 114 Vasilissis Sofias str, Athens, Region of Attica, Greece

Abstract: Introduction: Disseminated carcinomatosis of the bone marrow (DCBM) caused by colorectal cancer is rarely seen. DCBM is often accompanied with diffuse intravascular coagulation (DIC). Presentation Of Case: A 72-year-old male patient with a history of right nephrectomy three decades ago for referred benign disease, underwent sigmoid colon resection for cancer causing bowel obstruction. The preoperative evaluation revealed elevated values of CA 19-9 and PSA, with no metastatic lesions in abdominal CT. On eighth postoperative day, the patient developed fever with anemia and thrombocytopenia. Bone marrow examination revealed disseminated carcinomatosis caused by colon cancer. The patient deceased on the twenty seventh postoperative day due to the rapid progression of the accompanied disseminated intravascular coagulation. Discussion: Prognosis for patients with cancer who develop disseminated carcinomatosis of bone marrow (DCBM) is poor. Conclusion: In our case, the rapid deterioration of the patient gave us no option for adjuvant chemotherapy. The outcome was fatal. A 72-year-old male patient with a history of right nephrectomy for benign disease underwent sigmoid colon resection for bowel obstruction due to cancer. Tumor markers CA 19-9 and PSA were elevated, with no metastatic lesions in abdominal CT of admission. On eighth postoperative day, the patient developed severe anemia and thrombocytopenia. Bone marrow examination revealed disseminated carcinomatosis caused by colon cancer. The patient deceased on the twenty seventh postoperative day due to the rapid progression of the accompanied disseminated intravascular coagulation.

Keywords: sigmoid colon, cancer, obstruction, disseminated carcinomatosis, disseminated intravascular coagulation

Received February 08, 2015; Revised February 24, 2015; Accepted March 03, 2015

Citation: Christos Konstantinidis, Panagiotis Varsos, Sotirios Kympouris, Disseminated Carcinomatosis of Bone Marrow Due to Sigmoid Colon Cancer. American Journal of Medical Case Reports, 3 (4). 102-104. January 2015. doi:10.12691/ajmcr-3-4-4

1. Introduction

Disseminated carcinomatosis of the bone marrow (DCBM) caused by colorectal cancer is rarely seen. In most cases, DCBM is derived from gastric cancer. The prognosis of the disease is poor, especially when it is complicated with disseminated intravascular coagulation (DIC).We report a fatal case of early and rapid manifestation of DCBM accompanied by DIC, which was developed after surgically treatment of sigmoid colon cancer causing bowel obstruction.

2. Case Report

A 72-year-old male patient was admitted to our hospital complaining for abdominal discomfort and constipation. He had a medical history of right nephrectomy for cystic lesions. Physical examination showed moderate abdominal distension. Hematological and blood biochemical examinations were normal, while tumor markers CEA, CA19-9 and PSA had elevated values (13.04 ng/ml, 623.37 U/ml and 28.71 ng/ml respectively) (Table 1). Abdominal CT revealed a mass from the wall of the sigmoid colon which was causing obstruction of the lumen (Figure 1, Figure 2). The patient underwent nine days after his admission a scheduled resection of the sigmoid colon, after the placement of a stent at the left ureter, with primary end-to-end anastomosis. The histopathological examination of the specimen revealed middle grade adenocarcinoma (Figure 3), without penetration of the wall of the colon but with extensive lymphatic invasions (positive 10 of 10 lymph nodes and other more lymphatic blocks) (Figure 4). The postoperative period was uneventful until the fifth postoperative day, when the complete blood cell account revealed mild thrombocytopenia (~100,000/uL), which worsened rapidly the following days. On eighth postoperative day, the patient developed fever with anemia and severe thrombocytopenia. The total amount of platelets dropped to levels less than 20,000/uL. Despite blood infusions the amount of platelets remained at extremely low levels. Additional abdominal CT revealed lesions at the body of lumbar vertebra while chest CT demonstrated diffuse peripheral pulmonary emboli (Figure 5), laboratory test for HITTS were negative for pathological findings. A subsequent bone marrow examination revealed diffuse neoplastic infiltration caused by moderate differentiated adenocarcinoma (CK20+, CK7-, CD10-), indicative of disseminated carcinomatosis of the bone marrow from colon cancer (Figure 6, Figure 7). Due to patient’s rapid deterioration, treatment with chemotherapy wasn’t an option. The patient deceased twenty seven days after initial surgical operation.

Table 1. Laboratory Data on Admission

3. Discussion

Patients with disseminated carcinomatosis of the bone marrow complain for back pain and bleeding tendencies, as was with our patient, presented as purpura. The peripheral blood examination reveals severe anemia with thrombocytopenia, elevated alkaline phosphatase and lactase dehydrogenase. Bone marrow examination demonstrates a diffusely infiltration rather than a nodular pattern.

A review of the literature shows that most studies related to disseminated carcinomatosis of the bone marrow (DCBM) were conducted in Japan. In these studies, the origin of DCBM is advanced gastric cancer, in up to 90% of cases. In the contrary, colorectal cancer remains a rare cause of DCBM, with rectal cancer slightly more frequent. In one study, only 27 cases of colorectal cancer are reported, as an origin of DCBM, between 1984 and 2013 in Japan [1].

Prognosis of disseminated carcinomatosis of bone marrow (DCBM) accompanied with diffuse intravascular coagulation (DIC) in patients with cancer is poor. Standard anticoagulant therapy is considered to be ineffective for DIC caused by malignancies [2]. Other treatment options are administration of fresh frozen plasma and platelet replacement, with or without anticoagulation therapy, which also has little impact in patientssurvival, who usually die within 1–3 weeks [3].

Targeting towards the underlying cancer would offer better survival rates. Various chemotherapy regimens are used for this purpose with different outcomes [4-12]. Although survival is improved in most cases, patients with colorectal cancer and DCBM do not survive more than 100 days [1]. Yoshida et al [13] report the early start of chemotherapy after surgery in patients with colorectal cancer and synchronous metastases, aiming at preventing tumor growth. The effect and safety of such an approach needs further confirmation with prospective studies.

Unfortunately in our case, the rapid deterioration of the patient gave us no option for adjuvant chemotherapy with a better outcome. His general condition was severe on the fourteenth postoperative day and thereafter, making any administration of chemotherapy prohibitive. The general condition of the patient didn’t improve and he, finally, deceased on the twenty seventh postoperative day.

Figure 1. Abdominal CT scans in series indicating the sigmoid colon cancer, obstructing the lumen of the bowel (red arrows).

Figure 2. Abdominal CT scans in series indicating the sigmoid colon cancer, obstructing the lumen of the bowel (red arrows).

Figure 3. Histopathological specimen examination of the sigmoid colon cancer (H&E X 25)

Figure 4. Histopathological examination of infiltrated lymph node from the sigmoid colon cancer ( H&E X 25)

Figure 5. Chest CT scan indicating diffuse peripheral pulmonary emboli.

Figure 6. Bone marrow examination of the ilium that reveals a cluster of abnormal cells (stain X 100)

Figure 7. A different imagination of the same bone marrow examination of the ilium that reveals abnormal cells accompanied by mucous (stain X 400)

Conflict of Interest

The authors declare that there is no conflict of interest.

References

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