JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

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Year : 2021 Month : June Volume : 8 Issue : 23 Page : 1998-2000.

Malignant Bowel Obstruction due to Metastatic Carcinoma of Buccal Mucosa - A Case Report

Vikas Katiar1, Kumar Vineet2, Amit Yadav3, Ankita Kamthan4, Shubham Singh5

1, 2, 3, 5 Department of General Surgery, GSVM Medical College, Kanpur, Uttar Pradesh, India.
4 Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India.

CORRESPONDING AUTHOR

Dr. Kumar Vineet, Department of General Surgery, LLR Hospital, Kanpur, Uttar Pradesh, India.
Email : likho2vineet@gmail.com

ABSTRACT

INTRODUCTION

Cancers of the oral cavity are one of the most common malignancies encountered among cancer patients in India.1 There are different histological variants of oral cavity cancers, and squamous cell carcinoma (SCC) is most common among them. The main etiological factors implicated for development of oral cavity cancers are tobacco chewing and alcohol use.2 In India, carcinoma of buccal mucosa has the highest incidence among all the oral cavity cancers.3 The mean age of presentation is 50 years.4 Incidence among males is three times that of females.5 Most of the patients present in advanced stage (Stage III & IV) with majority in stage IV.6 Metastasis from oral cavity cancer takes place by detachment, invasion, proliferation and evasion through lymphatic system and blood vessels. It is regulated at various levels in the body.7 Most common sites of distant metastasis from oral cavity cancers are lungs and liver. Sometimes vertebral bone metastasis is also seen among patients. Metastasis to omentum and intra peritoneal organs other than liver is very rare.

PRESENTATION OF CASE

A 45-year-old female patient presented to us as a case of acute obstruction. Patient had history of mild pain in abdomen for 1 month which was gradually increasing in intensity. She also had complaint of multiple episodes of vomiting for last 1 week. Vomitus was greenish to yellowish green in color. On enquiring, patient gave history of squamous cell carcinoma of buccal mucosa for last 1 year. She was undergoing radiation therapy for SCC. On per abdominal examination, it was distended and tender. On percussion, dull notes were present all over abdomen. Per rectal examination did not show any nodularity. Before presenting to our side, patient already had ultrasonography and computed tomography scan of abdomen. Ultrasonography of abdomen reports mild hepatomegaly with fatty changes and distended central bowel loops with minimal ascites. CT scan of patient stated subacute intestinal obstruction. On routine blood investigations, there was no dyselectrolemia and total leukocyte count had increased. X-ray abdomen had no gas under right dome of diaphragm but jejunal loops were dilated. After due diligence, patient was operated and exploratory laparotomy was done.

DISCUSSION OF MANAGEMENT

On exploratory laparotomy, Omentum was thickened. [Fig. 1] Omentum was adhered to small bowel loops. There was also mild ascites with small bowel loops adhered to each other. Bowel loops were dilated and edematous. On inspection of liver, there was absence of any lesion with central umbilication. Mesenteric lymphnodes were not enlarged. Peritoneum was normal on inspection with absence of any nodularity. Peritoneal lavage was done and omental biopsy was taken. Adhesiolysis of small bowel loops was tried and at last exteriorization of distal ileum was performed.

 

PATHOLOGICAL DISCUSSION

 

On gross examination, an 8 x 6 x 1.7 cm omental flap with yellowish to grayish cut surface was present. On microscopic examination, tissue section shows sheets, nests and cords of malignant epithelial cells showing high N : C ration nuclear hyperchromasia with coarse and clumped chromatin, focal keratin whorls and intraepithelial keratinization. Malignant foci were embedded within desmoplastic and inflamed stroma with intervening foci of peritoneal adipose tissue. All these features were suggestive of poorly differentiated metastatic squamous cell carcionoma with lymphovascular and perineural invasion. [Fig. 2, 3]

CONCLUSIONS

Carcinoma of buccal mucosa usually presents in locally advanced stage. It metastasizes to lungs and liver. In this patient, metastasis was present in omentum which lead to adhesion of omentum to bowel wall. This adhesion was presented as a case of malignant bowel obstruction. Intraabdominal adhesions are a leading cause of small bowel obstruction. It is found in about 75 % of small bowel obstruction.8 In most cases, metastasis to omentum is of adenocarcinoma variety because of adenocarcinoma primaries in gastrointestinal tract.9 This case is peculiar in sense that omental metastasis was squamous cell in nature and primary tumor was squamous cell carcinoma of buccal mucosa.

 

Financial or other competing interests: None.

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REFERENCES

  1. Jemal A, Bray F, Center MM, et al. Global Cancer Statistics. CA Cancer J Clin 2011;61(2):69-90.
  2. Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48(11):3282-3287.
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  5. Tandon A, Bordoloi B, Jaiswal R, et al. Demographic and clinicopathological profile of oral squamous cell carcinoma patients of North India: a retrospective Institutional study. SRM J Res Dent Sci 2018;9(3):114-118.
  6. Singh MP, Misra S, Rathanaswamy SP, et al. Clinical profile and epidemiological factors of oral cancer patients from North India. Natl J Maxillofac Surg 2015;6(1):21-24.
  7. Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, et al. Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases. Oral Oncol 2008;44(8):743-752.
  8. Attard JA, MacLean AR. Adhesive small bowel obstruction: epidemiology, biology and prevention. Can J Surg 2007;50(4):291-300.
  9. Mura G, Verdelli B. The features of peritoneal metastases from gastric cancer. J Cancer Metastasis Treatment 2016;2:365-374.

DISCLOSURE AND FUNDING

Disclosure forms provided by the authors are available with the full text of this article at jebmh.com

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Financial or other competing interests: None.

CORRESPONDENCE

How to cite this article

Katiar V, Vineet K, Yadav A, et al. Malignant bowel obstruction due to metastatic carcinoma of buccal mucosa - a case report. J Evid Based Med Healthc 2021;8(23):1998-2000. DOI: 10.18410/jebmh/2021/375