- Email: [email protected]
A Rare Cause of Duodenal Obstruction: Metastatic Parotid Mucoepidermoid Carcinoma
Accepted Manuscript A Rare Cause of Duodenal Obstruction: Metastatic Parotid Mucoepidermoid Carcinoma Dominique Kasindi, Rajeev Jain
PII: DOI: Reference:
S1542-3565(17)30380-4 10.1016/j.cgh.2017.03.027 YJCGH 55171
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 22 March 2017 Please cite this article as: Kasindi D, Jain R, A Rare Cause of Duodenal Obstruction: Metastatic Parotid Mucoepidermoid Carcinoma, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/ j.cgh.2017.03.027. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
A Rare Cause of Duodenal Obstruction: Metastatic Parotid Mucoepidermoid Carcinoma
1
RI PT
Dominique Kasindi1 and Rajeev Jain1,2 Department of Medicine, Texas Health Dallas, Dallas, Texas and 2Texas Digestive Disease
SC
Consultants, Dallas, Texas
Rajeev Jain, M.D., A.G.A.F. Texas Digestive Disease Consultants
214-345-7398
AC C
[email protected]
EP
Dallas, TX 75231
TE D
8230 Walnut Hill Lane, Suite 610
M AN U
Corresponding Author:
Each author was equally involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.
Conflict of Interest Statement
ACCEPTED MANUSCRIPT
Rajeev Jain Governance: Private Practice Councilor, American Gastroenterological Association Governing
RI PT
Board; Member, ABIM Board of Directors. To protect the integrity of Board Certification, ABIM strictly enforces the confidentiality and its ownership of ABIM exam content, and Dr. Jain has agreed to keep ABIM exam questions confidential. No ABIM questions are shared in
SC
this article. Research: Abbvie, Celgene, Gilead, Janssen, Roche, and Salix.
M AN U
Dominique Kasindi None
TE D
A 76 year-old-man with a prior history of a parotid mucoepidermoid carcinoma presented with a 3 week history of post-prandial nausea and vomiting with a 10 pound unintentional weight loss. Two years earlier, he presented with a left parotid mass with biopsy demonstrating a carcinoma.
EP
He underwent a left total parotidectomy and left neck dissection. On surgical pathology, he had a high grade, poorly differentiated mucoepidermoid carcinoma with 9 of 49 lymph nodes involved
AC C
by tumor. He was treated with adjuvant chemoradiation with no evidence of recurrence by subsequent PET scan. On physical examination at current presentation, he had normal vital signs with evidence of the prior head and neck surgery. The abdomen was soft, nontender and nondistended. Laboratory analysis revealed normal complete blood cell count and comprehensive metabolic profile. A computed tomography of the abdomen demonstrated mild dilation of the proximal duodenum without associated wall thickening, inflammation or mass. (Figure A, arrow).
ACCEPTED MANUSCRIPT
Upper endoscopy was performed with the findings of an ulcerated, obstructing lesion in the second part of duodenum (Figure B), with biopsies demonstrating nests of infiltrating carcinoma that were morphologically similar to his previous parotid mucoepidermoid tumor (Figure C). The
confirming mucoepidermoid metastasis to the duodenum.
RI PT
patient underwent surgical resection of the duodenum and proximal jejunum with pathology
Small bowel neoplasms, either primary or secondary, are uncommon despite the small intestine
SC
representing approximately 75% of the total length of the gastrointestinal tract and more than
M AN U
90% of the gastrointestinal mucosal surface. The most common primary tumor of the duodenum is adenocarcinoma. Secondary tumors or metastasis to the duodenum may occur by hematogenous spread, direct invasion or intraperitoneal seeding.1 Between 1988 and 2005, 36 cases of small bowel obstruction from isolated metastases were reviewed with the most common
TE D
primary tumors being breast, melanoma and non-small cell lung cancer.2
Malignant salivary gland tumors are a rare cause of head and neck cancers. Our patient had a parotid mucoepidermoid carcinoma, which is the most common histologic subtype of parotid
EP
tumors. In a series of 2400 patients with high-grade mucoepidermoid cancer, only 3% of patients had distant metastases.3 One case report describes an upper gastrointestinal hemorrhage from
AC C
gastric metastases from a high-grade mucoepidermoid cancer.4 In 20 patients who developed distant metastases from mucoepidermoid cancer, 16 occurred in the lung, 3 in the bone and 1 in the liver.5 To our knowledge, this case presentation is the first description of a parotid mucoepidermoid cancer presenting with a late, distant metastasis causing a duodenal obstruction.
References
ACCEPTED MANUSCRIPT
Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol 2001;33:267-82.
2.
Idelevich E, Kashtan H, Mavor E, et al. Small bowel obstruction caused by secondary tumors.
RI PT
1.
Surg Oncol 2006;15:29-32. 3.
Chen MM, Roman SA, Sosa JA, et al. Histologic grade as prognostic indicator for
mucoepidermoid carcinoma: a population-level analysis of 2400 patients. Head Neck
4.
SC
2014;36:158-63.
To EW, Tsang WM, Pang PC, et al. A case of parotid mucoepidermoid carcinoma complicated by
Chen AM, Lau VH, Farwell DG, et al. Mucoepidermoid carcinoma of the parotid gland treated by surgery and postoperative radiation therapy: clinicopathologic correlates of outcome.
EP
TE D
Laryngoscope 2013;123:3049-55.
AC C
5.
M AN U
fatal gastrointestinal bleeding. Ear Nose Throat J 2001;80:671-3.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
PII: DOI: Reference:
S1542-3565(17)30380-4 10.1016/j.cgh.2017.03.027 YJCGH 55171
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 22 March 2017 Please cite this article as: Kasindi D, Jain R, A Rare Cause of Duodenal Obstruction: Metastatic Parotid Mucoepidermoid Carcinoma, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/ j.cgh.2017.03.027. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
A Rare Cause of Duodenal Obstruction: Metastatic Parotid Mucoepidermoid Carcinoma
1
RI PT
Dominique Kasindi1 and Rajeev Jain1,2 Department of Medicine, Texas Health Dallas, Dallas, Texas and 2Texas Digestive Disease
SC
Consultants, Dallas, Texas
Rajeev Jain, M.D., A.G.A.F. Texas Digestive Disease Consultants
214-345-7398
AC C
[email protected]
EP
Dallas, TX 75231
TE D
8230 Walnut Hill Lane, Suite 610
M AN U
Corresponding Author:
Each author was equally involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.
Conflict of Interest Statement
ACCEPTED MANUSCRIPT
Rajeev Jain Governance: Private Practice Councilor, American Gastroenterological Association Governing
RI PT
Board; Member, ABIM Board of Directors. To protect the integrity of Board Certification, ABIM strictly enforces the confidentiality and its ownership of ABIM exam content, and Dr. Jain has agreed to keep ABIM exam questions confidential. No ABIM questions are shared in
SC
this article. Research: Abbvie, Celgene, Gilead, Janssen, Roche, and Salix.
M AN U
Dominique Kasindi None
TE D
A 76 year-old-man with a prior history of a parotid mucoepidermoid carcinoma presented with a 3 week history of post-prandial nausea and vomiting with a 10 pound unintentional weight loss. Two years earlier, he presented with a left parotid mass with biopsy demonstrating a carcinoma.
EP
He underwent a left total parotidectomy and left neck dissection. On surgical pathology, he had a high grade, poorly differentiated mucoepidermoid carcinoma with 9 of 49 lymph nodes involved
AC C
by tumor. He was treated with adjuvant chemoradiation with no evidence of recurrence by subsequent PET scan. On physical examination at current presentation, he had normal vital signs with evidence of the prior head and neck surgery. The abdomen was soft, nontender and nondistended. Laboratory analysis revealed normal complete blood cell count and comprehensive metabolic profile. A computed tomography of the abdomen demonstrated mild dilation of the proximal duodenum without associated wall thickening, inflammation or mass. (Figure A, arrow).
ACCEPTED MANUSCRIPT
Upper endoscopy was performed with the findings of an ulcerated, obstructing lesion in the second part of duodenum (Figure B), with biopsies demonstrating nests of infiltrating carcinoma that were morphologically similar to his previous parotid mucoepidermoid tumor (Figure C). The
confirming mucoepidermoid metastasis to the duodenum.
RI PT
patient underwent surgical resection of the duodenum and proximal jejunum with pathology
Small bowel neoplasms, either primary or secondary, are uncommon despite the small intestine
SC
representing approximately 75% of the total length of the gastrointestinal tract and more than
M AN U
90% of the gastrointestinal mucosal surface. The most common primary tumor of the duodenum is adenocarcinoma. Secondary tumors or metastasis to the duodenum may occur by hematogenous spread, direct invasion or intraperitoneal seeding.1 Between 1988 and 2005, 36 cases of small bowel obstruction from isolated metastases were reviewed with the most common
TE D
primary tumors being breast, melanoma and non-small cell lung cancer.2
Malignant salivary gland tumors are a rare cause of head and neck cancers. Our patient had a parotid mucoepidermoid carcinoma, which is the most common histologic subtype of parotid
EP
tumors. In a series of 2400 patients with high-grade mucoepidermoid cancer, only 3% of patients had distant metastases.3 One case report describes an upper gastrointestinal hemorrhage from
AC C
gastric metastases from a high-grade mucoepidermoid cancer.4 In 20 patients who developed distant metastases from mucoepidermoid cancer, 16 occurred in the lung, 3 in the bone and 1 in the liver.5 To our knowledge, this case presentation is the first description of a parotid mucoepidermoid cancer presenting with a late, distant metastasis causing a duodenal obstruction.
References
ACCEPTED MANUSCRIPT
Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol 2001;33:267-82.
2.
Idelevich E, Kashtan H, Mavor E, et al. Small bowel obstruction caused by secondary tumors.
RI PT
1.
Surg Oncol 2006;15:29-32. 3.
Chen MM, Roman SA, Sosa JA, et al. Histologic grade as prognostic indicator for
mucoepidermoid carcinoma: a population-level analysis of 2400 patients. Head Neck
4.
SC
2014;36:158-63.
To EW, Tsang WM, Pang PC, et al. A case of parotid mucoepidermoid carcinoma complicated by
Chen AM, Lau VH, Farwell DG, et al. Mucoepidermoid carcinoma of the parotid gland treated by surgery and postoperative radiation therapy: clinicopathologic correlates of outcome.
EP
TE D
Laryngoscope 2013;123:3049-55.
AC C
5.
M AN U
fatal gastrointestinal bleeding. Ear Nose Throat J 2001;80:671-3.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT