Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare intracranial tumor that arises from pericytes surrounding the blood vessels. Solitary fibrous tumor/hemangiopericytoma accounts for less than 1% of primary brain tumors and is classified as grades I, II, or III based on mitotic count. These tumors often masquerade as meningiomas. Histologically, SFT/HPC is vascular with high cellularity and often surrounded by connective tissue. Immunohistochemistry is positive for stat 6, vimentin, and CD34. Although aggressive surgical resection is the mainstay of treatment, close long-term follow-up is necessary as recurrence or extra cranial metastasis can present several years after resection.

Colorectal adenocarcinoma (CRC) most commonly metastasizes to the peritoneum, liver, lung, and bone. Metastasis to the oral cavity is uncommon. Here, we report the case of a 74-year-old man who presented with a few months of chewing and swallowing difficulty, shoulder pain, and weight loss of 30 pounds. On oral exam, he was noted to have a 5 cm fixed hard palate mass. Primary hard palate malignancy was initially suspected. Biopsy of the mass confirmed adenocarcinoma with an immunohistochemical pattern suggestive of colorectal origin. He was later found to have extensive skeletal metastasis. Palliative radiotherapy to the hard palate region was initiated, followed by palliative systemic chemotherapy. We have found only three other published cases of rectal adenocarcinoma with hard palate metastasis.

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Extramedullary myeloma (EMM) is an infrequent but well-established manifestation of multiple myeloma (MM), defined as a soft tissue plasma cell neoplasm without bone marrow involvement. Gallbladder involvement in EMM, however, is a very rare occurrence, with only 8 cases found in the English medical literature. Here, we present a case of an older adult male with a gallbladder mass in the presence of increasing serum kappa light chains after a normal bone marrow biopsy confirmed the complete remission of a previous MM diagnosis. Histopathologic evaluation of a biopsied sample confirmed the mass as an atypical plasma cell neoplasm. Later in his treatment, he developed several firm, smooth, violaceous skin nodules on the torso, which histopathology confirmed as also being atypical plasma cell neoplasms. We aim to contribute to the medical literature by expanding the pool of information regarding EMM of the gallbladder to support future diagnostic and treatment recommendations.

Introduction: Patients with esophageal cancer often need a Percutaneous Endoscopic Gastrostomy (PEG) tube to provide nutrition. However, metastasis of the original tumor to the gastrostomy site may occur as a rare, but noteworthy complication. Case Description/Methods: A 64-year-old male had a PEG tube placed after he was diagnosed with Stage 2 esophageal adenocarcinoma with extension into the proximal stomach in Sep 2018. Following this, he received chemo and radiation therapy and did well. A follow up EGD demonstrated no evidence of malignancy, but a non-malignant duodenal narrowing / stenosis was noted. Subsequently, the patient suffered persistent leakage around his PEG tube; due to this and duodenal stenosis, his gastrostomy tube (G-tube) was removed and a jejunostomy tube (J-tube) was placed with surgical closure of the gastrostomy site (Figure). A few months later, when the patient was admitted with melena and severe anemia, an upper endoscopy performed revealed a hard, 3-4 cm malignant appearing mass with recent evidence of bleeding noted on the greater curvature of the stomach at the previous PEG tube site. Biopsies from this area showed invasive moderately differentiated adenocarcinoma with histological features similar to the previous adenocarcinoma. Though re-initiation of chemotherapy and radiation did result in improvement of the patient's stomach neoplasm, his wound healing complications at the J-tube site persisted, resulting in delay of his treatment. In October 2021, there was recurrence of his stomach cancer. Due to persistent difficulties with wound healing and recurrent illnesses, the patient elected to forgo further treatment in favor of comfort care. He subsequently passed away peacefully. Discussion: Our experience with this case and review of the literature indicate that, in patients with esophageal cancer, usage of the "pull-string" technique as well as length of time of PEG tube placement are associated with a significantly higher risk of metastatic implantation. To avoid this rare complication, potential alternative techniques such as the "push" technique for PEG tube placement or radiologically / surgically placed G-tubes or J-tubes should be considered in patients with oropharyngeal or esophageal cancer for nutrition.[2346] Figure 1. Endoscopic image revealing a malignant-appearing mass on the greater curvature of the stomach at initial PEG tube site.