Cancer metastasis of an unknown primary location into a postoperative kelody scar after a mine blast wound of the neck

Authors

DOI:

https://doi.org/10.14739/2310-1237.2024.2.301356

Keywords:

metastasis, adenocarcinoma, scar, keloid, military trauma

Abstract

The connection between military trauma and cancer is not sufficiently studied. We present a clinical observation of metastasis of cancer of unknown primary localization into a keloid scar of the neck, which occurred after surgical treatment of a wound due to a previously suffered mine-explosive injury. There are no similar descriptions in the literature.

The aim of this article is analysis of a clinical case of adenocarcinoma metastases in keloid scar tissue, which occurred after gunshot wounds to the body.

Clinical observation. A young man, a military serviceman, developed a keloid scar after a landmine-explosive wound and primary surgical treatment of a neck wound, in which 2 years after excision, a metastasis of intestinal-type adenocarcinoma was detected (Cytokeratin-20+, Cytokeratin-7-, CDX-2+ and SATB 2+). With the help of clinical, endoscopic and radiological methods (computed tomography and positron emission tomography / computed tomography), the primary tumor and additional metastases in the neck, chest, abdominal cavity and pelvis could not be detected. The article analyzes the possible mechanisms of the rare case of metastasis of adenocarcinoma in the tissue of an uninfected keloid scar and discusses the concept of the formation of a premetastatic niche in the early stages of carcinogenesis of a preclinical tumor.

Conclusions. This observation raises new questions for fundamental and translational studies of the process of hematogenous metastasis during the parallel progression of the primary tumor and its metastases.

Author Biographies

O. O. Kovalyov, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Oncology and Oncosurgery

S. M. Zavhorodnii, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of General Surgery and Postgraduate Surgical Education

O. P. Tolok, Medical Oncology Center “Yulis”, Zaporizhzhia, Ukraine

MD, Head of the Pathology Department

M. A. Kubrak, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, Associate Professor of the Department of General Surgery and Postgraduate Surgical Education, Educational and Scientific Institute of Postgraduate Education

K. O. Kovalov, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, Assistant of the Department of General Surgery and Postgraduate Surgical Education, Educational and Scientific Institute of Postgraduate Education

References

Eistert B, Glanz H, Kleinsasser O. Zwei Fälle von Krebs nach Schussverletzungen des Kehlkopfes [2 cases of cancer following gunshot injuries of the larynx]. HNO. 1989;37(5):220-3. German.

Lambert WC, Kasznica J, Chung HR, Moore D. Metastasizing basal cell carcinoma developing in a gunshot wound in a black man. J Surg Oncol. 1984;27(2):97-105. doi: https://doi.org/https://doi.org/10.1002/jso.2930270209

Pusey RJ. Squamous cell carcinoma following gunshot wounds: a rare late complication. Injury. 1981;12(6):499-500. doi: https://doi.org/https://doi.org/10.1016/0020-1383(81)90173-x

Djabali EJ, Dziegielewski PT. A lucky bullet in the neck: Incidental carcinoma of unknown primary found during a gunshot wound repair. Otolaryngol Case Rep. 2020;16(100185):100185. https://doi.org/10.1016/j.xocr.2020.100185

Paget S. The distribution of secondary growths in cancer of the breast. 1889. Cancer Metastasis Rev. 1989;8(2):98-101.

Fidler IJ. The pathogenesis of cancer metastasis: the 'seed and soil' hypothesis revisited. Nat Rev Cancer. 2003;3(6):453-8. doi: https://doi.org/https://doi.org/10.1038/nrc1098

Fidler IJ, Kripke ML. Metastasis results from preexisting variant cells within a malignant tumor. Science. 1977;197(4306):893-5. doi: https://doi.org/https://doi.org/10.1126/science.887927

Geetha R, Janardhanan M, Thankappan KK, Iyer S. Premetastatic Niche: A Novel Area for Research in Metastasis with a Potential as Therapeutic Targeting in Oral Cancer. J Pharm Bioallied Sci. 2023;15(Suppl 1):S36-S39. doi: https://doi.org/https://doi.org/10.4103/jpbs.jpbs_49_23

Dong Q, Liu X, Cheng K, Sheng J, Kong J, Liu T. Pre-metastatic Niche Formation in Different Organs Induced by Tumor Extracellular Vesicles. Front Cell Dev Biol. 2021;9:733627. doi: https://doi.org/https://doi.org/10.3389/fcell.2021.733627

Leyrat B, Bernadach M, Ginzac A, Lusho S, Durando X. Sister Mary Joseph Nodules: A Case Report about a Rare Location of Skin Metastasis. Case Rep Oncol. 2021;14(1):664-70. doi: https://doi.org/https://doi.org/10.1159/000515298

Gómez González AM, Mantilla Rey D, Ortiz Zableh AM, de Valencia C, Villareal Trujillo N. Laparoscopic port-site metastasis as the manifestation of neuroendocrine prostate cancer: Case report and literature review. Urol Case Rep. 2019;24:100845. doi: https://doi.org/https://doi.org/10.1016/j.eucr.2019.100845

Siriwardena A, Samarji WN. Cutaneous tumor seeding from a previously undiagnosed pancreatic carcinoma after laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1993;75(3):199-200.

Rieger N, McIntosh N. Port site metastasis from synchronous primaries of the colon and ovary following laparoscopic cholecystectomy. Eur J Surg Oncol. 1998;24(2):144-5. doi: https://doi.org/https://doi.org/10.1016/s0748-7983(98)91641-9

Saladzinskas Z, Tamelis A, Paskauskas S, Pranys D, Pavalkis D. Facial skin metastasis of colorectal cancer: a case report. Cases J. 2010;3:28. doi: https://doi.org/https://doi.org/10.1186/1757-1626-3-28

Schwartz RA. Cutaneous metastatic disease. J Am Acad Dermatol. 1995;33(2 Pt 1):161-82; quiz 183-6. doi: https://doi.org/https://doi.org/10.1016/0190-9622(95)90231-7

Cangkrama M, Wietecha M, Werner S. Wound Repair, Scar Formation, and Cancer: Converging on Activin. Trends Mol Med. 2020;26(12):1107-17. doi: https://doi.org/https://doi.org/10.1016/j.molmed.2020.07.009

Fernández-Guarino M, Hernández-Bule ML, Bacci S. Cellular and Molecular Processes in Wound Healing. Biomedicines. 2023;11(9):2526. doi: https://doi.org/https://doi.org/10.3390/biomedicines11092526

Hassanshahi A, Moradzad M, Ghalamkari S, Fadaei M, Cowin AJ, Hassanshahi M. Macrophage-Mediated Inflammation in Skin Wound Healing. Cells. 2022;11(19):2953. doi: https://doi.org/https://doi.org/10.3390/cells11192953

Güç E, Pollard JW. Redefining macrophage and neutrophil biology in the metastatic cascade. Immunity. 2021;54(5):885-902. doi: https://doi.org/https://doi.org/10.1016/j.immuni.2021.03.022

Wu L, Saxena S, Awaji M, Singh RK. Tumor-Associated Neutrophils in Cancer: Going Pro. Cancers (Basel). 2019;11(4):564. doi: https://doi.org/https://doi.org/10.3390/cancers11040564

Martin-Perez M, Urdiroz-Urricelqui U, Bigas C, Benitah SA. The role of lipids in cancer progression and metastasis. Cell Metab. 2022;34(11):1675-99. doi: https://doi.org/https://doi.org/10.1016/j.cmet.2022.09.023

Yang D, Liu J, Qian H, Zhuang Q. Cancer-associated fibroblasts: from basic science to anticancer therapy. Exp Mol Med. 2023;55(7):1322-32. doi: https://doi.org/https://doi.org/10.1038/s12276-023-01013-0

Maia A, Wiemann S. Cancer-Associated Fibroblasts: Implications for Cancer Therapy. Cancers (Basel). 2021;13(14):3526. doi: https://doi.org/https://doi.org/10.3390/cancers13143526

Bent EH, Millán-Barea LR, Zhuang I, Goulet DR, Fröse J, Hemann MT. Microenvironmental IL-6 inhibits anti-cancer immune responses generated by cytotoxic chemotherapy. Nat Commun. 2021;12(1):6218. doi: https://doi.org/https://doi.org/10.1038/s41467-021-26407-4

Nangole FW, Agak GW. Keloid pathophysiology: fibroblast or inflammatory disorders? JPRAS Open. 2019;22:44-54. doi: https://doi.org/https://doi.org/10.1016/j.jpra.2019.09.004

Tan S, Khumalo N, Bayat A. Understanding Keloid Pathobiology From a Quasi-Neoplastic Perspective: Less of a Scar and More of a Chronic Inflammatory Disease With Cancer-Like Tendencies. Front Immunol. 2019;10:1810. doi: https://doi.org/https://doi.org/10.3389/fimmu.2019.01810

Su Z, Jiao H, Fan J, Liu L, Tian J, Gan C, et al. Warburg effect in keloids: A unique feature different from other types of scars. Burns. 2022;48(1):176-83. doi: https://doi.org/https://doi.org/10.1016/j.burns.2021.03.003

Wang ZC, Zhao WY, Cao Y, Liu YQ, Sun Q, Shi P, et al. The Roles of Inflammation in Keloid and Hypertrophic Scars. Front Immunol. 2020;11:603187. doi: https://doi.org/https://doi.org/10.3389/fimmu.2020.603187

Lim KH, Itinteang T, Davis PF, Tan ST. Stem Cells in Keloid Lesions: A Review. Plast Reconstr Surg Glob Open. 2019;7(5):e2228. doi: https://doi.org/https://doi.org/10.1097/GOX.0000000000002228

Lu YY, Tu HP, Wu CH, Hong CH, Yang KC, Yang HJ, et al. Risk of cancer development in patients with keloids. Sci Rep. 2021;11(1):9390. doi: https://doi.org/https://doi.org/10.1038/s41598-021-88789-1

Qaseem A, Usman N, Jayaraj JS, Janapala RN, Kashif T. Cancer of Unknown Primary: A Review on Clinical Guidelines in the Development and Targeted Management of Patients with the Unknown Primary Site. Cureus. 2019;11(9):e5552. doi: https://doi.org/https://doi.org/10.7759/cureus.5552

Krämer A, Bochtler T, Pauli C, Baciarello G, Delorme S, Hemminki K, et al. Cancer of unknown primary: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023;34(3):228-46. doi: https://doi.org/https://doi.org/10.1016/j.annonc.2022.11.013

Pouyiourou M, Regnery S, Bochtler T, Herfarth K, Krämer A. Cancer of unknown primary (CUP) – lokal begrenzt, oligometastatisch und im Kopf-Hals-Bereich [Cancer of unknown primary (CUP)-single-site, oligometastatic, and in the head and neck region]. Radiologie (Heidelb). 2023;63(5):358-65. German. doi: https://doi.org/https://doi.org/10.1007/s00117-023-01133-8

Christ SM, Heesen P, Muehlematter UJ, Pohl K, William Thiel G, Willmann J, et al. Recognition of and treatment recommendations for oligometastatic disease in multidisciplinary tumor boards. Clin Transl Radiat Oncol. 2022;38:123-9. doi: https://doi.org/https://doi.org/10.1016/j.ctro.2022.11.008

Klein CA. Parallel progression of primary tumors and metastases. Nat Rev Cancer. 2009;9(4):302-12. doi: https://doi.org/https://doi.org/10.1038/nrc2627

Downloads

Additional Files

Published

2024-08-30

How to Cite

1.
Kovalyov OO, Zavhorodnii SM, Tolok OP, Kubrak MA, Kovalov KO. Cancer metastasis of an unknown primary location into a postoperative kelody scar after a mine blast wound of the neck. Pathologia [Internet]. 2024Aug.30 [cited 2024Nov.2];21(2):177-82. Available from: http://pat.zsmu.edu.ua/article/view/301356

Issue

Section

Case Reports