title: A case of rectal carcinoma with skin and bone marrow metastasis with concurrent extensive visceral involvement; unusual and dismal co-incidence.
abstract: Novel systemic therapies and modern surgical and ablative approaches have improved the survival rates for the patients with metastatic colorectal cancer. However, there are still patients with poor prognosis and underlying mechanisms that could not be defined clearly. Metastatic colorectal cancer patients with skin metastasis have a poor prognosis. A 45-year-old man, who presented with large bowel obstruction, was diagnosed with metastatic rectal adenocarcinoma. Unresectable liver metastases were found at diagnosis. FOLFOX plus bevacizumab treatment was started, but the patient developed bowel obstruction after the third cycle. Therefore, ileostomy was performed. Multiple skin, lung, liver and bone metastases appeared during that time. Bone marrow biopsy demonstrated diffuse infiltration by adenocarcinoma cells. Even though partial remission was achieved after 4 cycles of FOLFIRI-cetuximab, the disease progressed after the 8th cycle. The patient lost his life due to disease progression 8 months after the diagnosis. Bone marrow and skin are unusual sites of metastasis for colorectal carcinoma. Metastases in bone marrow and skin develop at later stages of metastatic disease. This patient lived only 4 months after the development of skin and bone marrow metastases. Skin and bone marrow metastases may be the harbingers of short survival. Biopsy of metastatic sites is crucial for diagnosis and detailed molecular analysis. Molecular pathway alterations underlying worse disease course may be found, and hence probable targets for drug improvement may be indicated.
authors.affiliation: Department of Medical Oncology, Izmir University Hospital, 35520 Izmir, Turkey.
authors.forename: Cagatay
authors.initials: C
authors.lastname: Arslan
authors.forename: Cenk Ahmet
authors.initials: CA
authors.lastname: Sen
authors.forename: Ragip
authors.initials: R
authors.lastname: Ortac
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D019046:Bone Marrow Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D018450:Disease Progression; D057915:Drug Substitution; D017809:Fatal Outcome; D006801:Humans; D007081:Ileostomy; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy; D012307:Risk Factors; D012878:Skin Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: bone marrow; rectal carcinoma; skin metastasis