Multiple nodules over the body.

Chief Complaint A 46 y/o female presents with multiple hard swellings on her body. Examination Physical examination shows 1-2 cm subcutaneous mobile, firm, nodules on her chest, back, axilla, abdomen, and thighs. Pelvic examination was unremarkable Investigations Punch biopsy was done which showed a poorly differentiated adenocarcinoma. A CT showed thickening of the cervix, thickening of sigmoid colonic wall. Colonoscopy showed a 3.5 cm, fungating, sigmoid mass. Treatment Now what is your opinion how should we go with the case?

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Poorly differentiated adenocarcinoma of sigmoid colon with multiple cutaneous metastasis Certainly, a rare presentation This patient will need systemic palliative chemotherapy, distant metastases makes it stage 4 disease

Secondary metastasis...to neurofibromatosis .. Consult Oncologist for management if metastasis is confirmed for Chemo or/and Radio therepy

? CUTANEOUS METASTASIS OF .. ADENOCARCINOMA.. NEED'S.. ONCOLOGISTS OPINION..

Tnx Dr Ashok Leel sir
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CUTANEOUS METASTASES of adenocarcinoma. Secondary metastasis Needs further investigation and evaluation to conclude and line of treatment. As per reports chemotherapy or RADIOTHERAPY.

Obviously C A sigmoid with metastasis Chemotherapy and radiotherapy

Thanx dr Aus A
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I think it is neurofibromatosis

PETCT assess spread. Total Colectomy followed by chemo radiotherapy.

NEUROFIBROMATOSIS WITH C A

Case of ? Metastasis See the primary cause of Metastasis N treat accordingly

Rule out FAP RESECTION+ CHEMOTHERAPY

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