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A Typical Metastasis of Colorectal Cancer: A Case Report and Literature Review

In the world: CCR ranks 4th (breast, prostate, lung). In Europe, colorectal cancer is the second most common cancer. In Morocco, at the National Institute of Oncology in Rabat, CCR occupies 5th place (breast, cervix, lymphoma, lung), 2nd digestive after stomach. Brain metastases occur in 1 to 4% of colorectal cancer patients and its unique in 0.5% of patients. Due to its rarity, brain imaging is not recommended in the systematic monitoring of these patients.
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0% found this document useful (0 votes)
52 views8 pages

A Typical Metastasis of Colorectal Cancer: A Case Report and Literature Review

In the world: CCR ranks 4th (breast, prostate, lung). In Europe, colorectal cancer is the second most common cancer. In Morocco, at the National Institute of Oncology in Rabat, CCR occupies 5th place (breast, cervix, lymphoma, lung), 2nd digestive after stomach. Brain metastases occur in 1 to 4% of colorectal cancer patients and its unique in 0.5% of patients. Due to its rarity, brain imaging is not recommended in the systematic monitoring of these patients.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG045

A Typical Metastasis of Colorectal


Cancer: A Case Report and Literature Review
Intissar Belrhali1,2 ; Oumaima Lamsyah 1,2 ; Stephane Ruck3 ; François RUSCH4 ; Guillaume GAUCHOTTE5 ;
Hind EL YACOUBI1,2 ; Sarah NACIRI1,2 ; Hassan Errihani1,2
National Institute of Oncology Rabat, Morocco1
Faculty of Medicine and Pharmacy of Rabat, Morocco2
Medical Oncology Department, EMILE DURKHIEM Hospital Center Épinal, France3
Radiology Department, EMILE DURKHIEM Hospital Center Épinal, France4
Department of Bacteriology Anatomy and Pathological Cytology, CHRU of Nancy-Institut de Oncérologie de Lorraine5
Nancy Faculty of Medicine, University of Lorraine5

Abstract:- In the world: CCR ranks 4th (breast, prostate, II. CASE PRESENTATION
lung). In Europe, colorectal cancer is the second most
common cancer. In Morocco, at the National Institute of A 59-year-old woman, with a history of active smoking
Oncology in Rabat, CCR occupies 5th place (breast, at 25PA not stopped, treated at the Émile Durkheim Hospital
cervix, lymphoma, lung), 2nd digestive after stomach. in Épinal, France, was diagnosed in April 2021 with
Brain metastases occur in 1 to 4% of colorectal cancer Liberkühnian adenocarcinoma of the cecum with secondary
patients and its unique in 0.5% of patients. Due to its hepatic, peritoneal and lymph node involvement, classified
rarity, brain imaging is not recommended in the T4 N1 M1, MSS and mutated RAS. His baseline CEA level
systematic monitoring of these patients. According to the was 99.8 µg/dl. The initial diagnosis was an occlusive
literature review by Esmaeilzadeh et al, the prognosis for syndrome associated with a cecal tumour with invasion of
brain metastases from colorectal cancer is poor, with a liver segment V, lesion of segment IV and peritoneal
median survival of 5.2 months. In this paper, we report carcinomatosis. The patient received chemotherapy with
the case of a 59-year-old patient who was admitted for Folfox for a curative strategy, including 12 cycles from May
treatment of brain metastases from colorectal cancer. to October 2021, with a partial response. In February 2022,
she underwent right ileocolectomy, hepatic metastasectomy
 Categories: of segments IV and VI, omentectomy, bilateral adnexectomy,
Digestive Oncology, Neurosurgery, Radiotherapy, followed by hyperthermic intraperitoneal chemotherapy with
Oncology mitomycin. In March 2022, during surveillance, progression
of a right lower lobar pulmonary nodule was detected and
Keywords:- Colorectal Cancer - Brain Metastasis, treated by stereotactic radiotherapy at the Lorraine Cancer
Neurosurgery, Radiotherapy, Chemotherapy. Institute in Nancy. The patient was well controlled until 15
November 2022, when she presented with disorientation and
I. INTRODUCTION behavioural disturbances. CT and MRI of the brain showed a
single lesion measuring 6 cm in diameter at the frontal level
In Europe, colorectal cancer (CRC) is the second most (Figures 1-6), with necrotic changes and perilesional oedema
common cancer (1). At diagnosis, 20% of people have (Figures 1,2). No other distant lesions were found. The patient
metastases (2), mainly in the liver and also in the lungs, rarely underwent a large but partial surgical excision of the brain
in the brain. MCs are typically derived from bronchial lesion on 5 December 2022 (vascular wound of the right
carcinoma cells, breast, periodontal or melanoma cells (3). In anterior cerebral artery). Pathological analysis revealed an
CRC, a solitary brain stem metastasis is even more adenocarcinoma compatible with a primary colorectal origin
phenomenal. In fact, previous research studies have reported (diffuse expression of CDX2 and SATB2) (Figure 7-9). She
the occurrence of brain metastases in CRC to vary from 1% was then treated with brain radiotherapy, which was
to 3% (4). Survival rates for people with lethal CRC (mCRC) completed in February 2023 and resulted in a marked
have been improving progressively with advances in improvement in her general condition, with no major
treatment. Typical survival for patients with mCRC is cognitive impairment or evidence of intracranial
currently around 21-24 months (5). As an outcome of long- hypertension. An abdominopelvic CT performed after
term survival with metastatic disease, the occurrence of brain completion of radiotherapy showed bilobar multifocal
metastases can be expected to improve patient survival". In hepatic progression, but no pulmonary progression. In the
the recommendations, radiological assessment of the brain to absence of a possible surgical indication, second-line
look for metastases is only recommended if there is a warning chemotherapy with FOLFIRI +/- AVASTIN was started from
sign (38). In the literature, brain metastases secondary to May to October 2023. On assessment, the ACE rate was high
colorectal cancer are rare; there are only case reports or case (3215 U/ml) and there was a 20-30% radiological liver
series (38). progression. Resumption of oral chemotherapy with
STIVARGA or LONSURF was considered, but given the

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG045

lack of improvement in the patient's general condition, this


option is not possible. The patient is currently on palliative
care only for jaundice associated with liver progression, with
no additional therapeutic resources. The lack of dilatation of
the bile ducts makes any drainage impossible and exposes the
patient to poor short-term risk.

3 weeks later, the clinical situation deteriorated again


with very marked asthenia, without pruritus or fever, cutaneo-
mucosal jaundice +++, early encephalopathy.

The last biological evaluation on 18 January 2002


confirmed the worsening of the cholestasis with a bilirubin
rate that today reaches 204 mg/l of conjugated bilirubin, as
well as a cytolysis more than three times normal. Fig 1: Scanner with Injection

We discussed at length with the patient the need to


remain in hospital, given the risk of rapid clinical
deterioration and the binding vital prognosis.

Despite our explanations, she did not want to follow our


suggestion and wanted to go home as soon as possible.
home as soon as possible.
- She died at home.

Fig 2 : Scanner without Injection

Fig 3: Scan Without Injection with Bone Reconstruction: No Lysis Bone

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ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG045

Fig 5: Invasion of Cortex


Fig 4: 3 D Flair

Fig 6: Extra Axial Implantation Base with Images Interposition of Perilesional Cerebrospinal Fluid.
Invasion of the Fronto-Basal Cortex

Fig 7: Adenocarcinoma, Hematoxylin Eosin and Saffron, x200

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ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG045

Fig 8: Positive Staining for SATB2, Immunohistochemistry, x200

Fig 9: Adenocarcinoma, Hematoxylin Eosin and Saffron, x400

III. DISCUSSION therapy of main tumour as well as systemic illness, which


have actually brought about a boost in survival.
Brain metastases represent one of the most regular nerve
problems of systemic cancer cells and are a crucial source of The majority of individuals who create brain metastases
morbidity along with death. Mind metastases are the most have a fairly brief survival, despite the reality that preliminary
common intracranial growths, surpassing key mind lumps therapy is generally efficient, as in our patient's case. The
(5). The regularity of mind metastases has actually increased short survival could be the result of either a modern systemic
with time, most likely as a result of developments in disease (more than fifty per cent of clients) or an intractable
neuroimaging procedures as well as improvements in the neurological disease. Treatment of brain metastases includes
corticosteroids, surgery and radiotherapy.

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Brain metastases occur in 20-40 per cent of people with data. One third of these tumours are mutated for the KRAS
cancer, are symptomatic throughout life in 60-75 per cent of gene, the others are called "non-mutated". No abnormality of
people with cancer, or are discovered incidentally on CT/MRI the NRAS gene was observed. There was no significant
or at death (6). difference in their distribution as single or multiple based on
their molecular results. The majority of brain metastases of
Anatomical-clinical data of brain metastases treated in colorectal origin are single, whether mutated (70.6%) or not
Clermont-Ferrand from 2007 to 2017 (Table 1): In the series, (62.5%).
we observe 25 Lieberkühn adenocarcinomas with molecular

Table 1: Comparative Overview of 10 Cases of Brain Metastasis

The professional discussion of brain metastases is people have focal neurological deficits, and seizures occur in
similar to the discussion of any type of intracranial mass about 15 to 20 per cent of people. Altered brain function or
lesion. Headache is a presenting sign and symptom in 40% to impaired cognition is regularly seen, especially in individuals
50% of patients with multiple metastases or with posterior with multiple metastases and/or increased intracranial
fossa tumours, and may be mild. Papilledema is the cause of pressure, in some cases resembling metabolic encephalopathy
headache in only 15-25% of individuals. Forty per cent of (39).

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG045

Contrast-enhanced MRI is more sensitive than enhanced but the long-term effects of WBRT are of greater concern, as
CT (including double-dose delayed contrast) or unenhanced WBRT has been shown to significantly impair learning and
MRI in detecting brain metastases, especially posterior fossa memory function.
lesions or multiple punctate metastases(7, 8).Although T2-
weighted images are difficult to detect vasogenic oedema as As a result, it appears that WBRT can be withheld in
sites of increased signal intensity, not all metastatic brain has high-risk patients with stable systemic disease and a limited
enough oedema to be detected. In fact, some studies have number of brain metastases (one to three metastases) who are
reported that triple gadolinium doses are significantly better initially treated with either radiosurgery or surgery, if serial
than single doses(9,10). Metastases of 1 centimetre or more imaging is performed for follow-up. (28).
were easily seen with the reference doses and usually also
produce a T2 signal abnormality; triple-dose gadolinium was IV. CONCLUSION
slightly better at detecting 5-10 mm metastases and was three
times more difficult to detect lesions smaller than 5 mm (10). Brain metastases are rare and their treatment is a real
MRI is particularly indicated for people with a single challenge. Due to their location, they can quickly become
metastasis on CT who are candidates for stereotactic life-threatening. Dysphagia in a cancer patient cannot be
radiotherapy or surgical resection. (10). ignored and must be integrated with other symptoms and
signs to assess the need for brain imaging. With a precise and
Dexamethasone is the corticosteroid of choice, largely careful approach, neurosurgery followed by adjuvant SBRT
because of its minimal mineralocorticoid effect. Up to 75% radiotherapy can help control metastases, at least the
of patients with brain metastases show marked clinical symptoms associated with them, as demonstrated in this
improvement within 24 to 72 hours of starting clinical case, aggressive multidisciplinary treatment can offer
dexamethasone. (11). improvement in quality of life and potentially survival.

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