Metastasizing basal cell carcinoma of the skin with myelophthisic anemia

A case report of a metastasizing basal cell carcinoma is presented, primary in the leg with regional inguinal lymph node metastasis, followed by extensive metastasis to skin and bone marrow with myelophthisic anemia and terminal splenohepatic and unilateral adrenal metastasis.     

Pseudo-chondrosarcoma: solitary osseous metastases from atypical bronchogenic carcinoma.

A patient with bronchogenic carcinoma with a solitary metastases to the femur in whom the clinical, radiologic, and pathologic setting suggested that the primary tumor was the bone lesion (chondrosarcoma) and the pulmonary lesion was a solitary metastasis is presented. This case is added to the limited literature indicating that mucin-secreting tumors metastatic to bone may simulate primary bone tumors radiographically.     

Isolated Skull Base Metastasis as the First Manifestation of Hepatocellular Carcinoma—A Rare Case Report with Review of Literature

Introduction

Hepatocellular carcinoma rarely metastasizes to skull base.

Case Report

We report an extremely rare case of solitary skull base metastasis without metastasis to any other site, with right third, fourth, and sixth cranial nerve palsy as the initial manifestation of the disease.

Discussion

The biopsy specimen of skull base lytic lesion suggested metastatic hepatocellular carcinoma. Subsequent examination revealed a large mass involving superior segment of right lobe of liver, which was confirmed as hepatocellular carcinoma on histopathological examination.

Conclusion

Until now, there have been only 24 cases of hepatocellular carcinoma metastasizing to skull base cited in literature. We report here an unusual case of solitary skull base metastasis from hepatocellular carcinoma prior to the diagnosis of primary tumor.     

Clinical evaluation of intra-arterial infusion of hyperthermo-chemotherapy in gastric cancer]

We performed intra-arterial infusion hyperthermochemotherapy by retaining an intra-arterial reservoir in 17 lesions of 12 patients with non-resectable, metastatic or recurrent gastric cancers. The 12 patients consisted of one with a primary gastric cancer lesion, 6 with a solitary gastric cancer lesion metastasizing to the liver, 4 with gastric cancer accompanied by hepatic metastasis, lymph node metastasis or local recurrence, and one with a gastric cancer lesion metastasizing to Douglas' pouch. A catheter was retained in the hepatic artery of all 6 patients with a solitary gastric cancer lesion metastasizing to the liver, and a catheter was retained in the aorta of the patient with a primary lesion, 3 of the 4 patients with two or more metastatic lesions, and the patient with a lesion metastasizing to Douglas' pouch. The duration of each hyperthermia session was 50 minutes, and one or two sessions were performed within a week. One course consisting of 5 or 6 sessions was repeated. Antineoplastic drugs such as MMC, 5-FU, ADR, epi-ADR, CDDP and VP-16 were injected in bolus form or administered serially through the reservoir. Nine of the 12 patients had polypharmacy. One to 3 courses or 4 to 20 sessions at maximum (average 9.8 sessions) were given. The rate of efficacy of intra-arterial infusion hyperthermochemotherapy was 44% for hepatic metastasis and 25% for lymph node metastasis. The local recurrent lesions, the lesion metastasizing to Douglas' pouch and the primary lesion did not respond to therapy.     

Three-time resection of the rib metastasis from hepatocellular carcinoma after two hepatic resections--a case report

A 40s woman, who had undergone hepatic resection twice for hepatocellular carcinoma (HCC), was admitted to our hospital because of a tumor with pain on the right 9th rib. From the findings of chest computed tomography (CT), abdominal CT and bone scintigraphy, we diagnosed the rib metastasis of HCC without any other recurrences. Local resection of the right 9th rib was performed in July 2008. Histologically, the tumor of the rib was diagnosed as the metastasis of HCC. The patient's pain on the right rib was disappeared after the operation. After the rib resection, the recurrence of the remnant of the right 9th rib occurred in June 2009. Local resection of the rib was performed in July 2009. Afterward, the recurrence of the remnant of the right 9th rib occurred again in April 2010. Local resection of the tumor of the same rib was performed in May 2010. The patient is still alive five years after the first hepatectomy. For HCC patients whose intrahepatic lesion or other metastatic lesions are controllable and the metastatic bone lesion is solitary and easily resectable, a resection for bone metastasis from HCC is thus locally effective in patient's pain control.     

Langerhans Cell Histiocytosis of the Rib in an Adult: A Case Report

Single-site, single-system Langerhans cell histiocytosis (LCH) of the rib is one of the rarest causes of bone tumor in adults. Herein, we report a case of a healthy 35-year-old male who presented with upper back pain that was attributed to a solitary osteolytic lesion at the posterolateral aspect of his sixth rib. For diagnostic confirmation and treatment, partial resection of the sixth rib was performed and pathologic finding was consistent with LCH. At the final follow-up after 2 years, no local recurrence or metastasis was observed.Key Words: Langerhans cell histiocytosis, Rib, Adult     

Hepatocellular carcinoma presenting with bone metastasis

Bone metastasis is an unusual complication of hepatocellular carcinoma. We report here 2 cases of patients with bone metastases of hepatocellular carcinoma at presentation. Patient No. 1 with liver cirrhosis and hepatocellular carcinoma was admitted with a bone metastasis in the rib. The patient was treated with hepatic arterial chemotherapy and rib resection. Patient No.2 was known to have an asymptomatic liver mass of uncertain histology for a year when he presented with back pain. Because of signs of spinal compression, laminectomy was performed, and the diagnosis of metastatic hepatocellular carcinoma was established. The presence of bone metastases in hepatocellular carcinoma at presentation is extremely rare. More frequently, bone lesions are observed after successful treatment of the primary liver tumor. Both surgery and radiotherapy are used as palliative treatment in bone metastases of hepatocellular carcinoma. The treatment of hepatocellular carcinoma presenting with bone metastasis by bone resection and intraarterial chemotherapy seems to be of limited impact on patient survival because of dissemination of micrometastases in other organs and the frequent presence of other comorbid conditions. However, effective palliation using this multimodality approach is feasible. Hepatocellular carcinoma should be considered in the differential diagnosis of bone metastases.     

Nasopharyngeal presentation of renal cell carcinoma

In this case report, we present a 50-year- old woman, who presented with severe headache as her only presenting clinical symptom due to nasopharyngeal mass. Histo-pathological evaluation of the biopsy from nasopharyngeal mass revealed clear cell carcinoma. On further evaluation, an asymptomatic mass was detected in the left kidney. The metastatic lesion was treated with palliative radiotherapy. A search of the literature revealed no reports of such unusual metastasis in the nasopharynx from a primary carcinoma of the renal origin.     

Neuroendocrine tumor metastasis to the thyroid gland

It has been reported that the thyroid is relatively immune to malignant metastasis. Therefore, in a practical setting, it is difficult to diagnose whether synchronous nodules in both lung and thyroid are independent or have metastasized from one to the other. In the present study, we report a treatment approach in a patient with such nodules, using a molecular technique. A 68-year-old woman presented with synchronous solitary thyroid mass and a nodular lesion in the right lung. Both tumors, which were surgically resected, morphologically showed neuroendocrine differentiation, which was confirmed by immunohistochemical analysis. These features required differential diagnosis from possible (1) medullary thyroid carcinoma (MTC) with metastasis to the lung, (2) pulmonary neuroendocrine carcinoma with metastasis to the thyroid, and (3) independent MTC and pulmonary neuroendocrine carcinoma. Identical mutations of the p53 gene were detected in both the thyroid and lung tumors, indicating the same origin for both tumors. In addition, these mutations and a lack of calcitonin expression suggested a pulmonary origin of the tumors. Metastatic thyroid cancers are well known to cause miliary lesions in the lung, while lung cancers can metastasize to various tissues. Furthermore, pulmonary neuroendocrine carcinoma has been reported as having a tendency of metastasizing to the thyroid. Head and neck surgeons should be aware that a particular subset of lung cancers may develop a metastatic solitary nodule in the thyroid, as presented. An effective therapeutic strategy is largely dependent on the differential diagnosis.     

Primary lymphoepthelial carcinoma of the parotid gland,pictorial review of a rare entity

Lymphoepithelial carcinoma (LEC) is a rare malignancy of the salivary gland arising from the parotid in 80% of cases. LEC is indistinguishable histologically from more common non‐keratinising undifferentiated nasopharyngeal carcinoma (NPC). Up to 40% of patients with primary LEC present with a cervical metastasis and histological assessment of the primary lesion or nodal metastasis may be reported as NPC. The absence of a nasopharyngeal lesion on imaging and endoscopic assessment together with a parotid mass strengthens the case for a LEC. A retrospective review of three cases of primary parotid LEC presenting to a tertiary head and neck clinic was performed. Clinical information, imaging and histopathology findings are presented in the form of a pictorial review. Two female and one male patient with an average age of 42 years presented with a neck lump. Initial pathology results were poorly differentiated carcinoma (2/3) and possible NPC (1/3). MR neck revealed unilateral parotid masses with ipsilateral cervical lymphadenopathy and assessment of the nasopharynx was negative (3/3). Resection occurred in all patients and consensus was metastatic LEC with parotid primary in all cases (3/3). 2 patients are disease free, and 1 patient is deceased (as a result of disease) at the time of this report. Lymphoepithelial carcinoma is identical histologically to NPC, this pictorial review highlights the need for clinical and radiological correlation to establish the diagnosis.     

Nasopharyngeal carcinoma with brain metastasis: A case report

Summary We report a case of nasopharyngeal carcinoma with brain metastasis of a 69-year-old man. The patient presented with blindness and a huge mass over right upper neck. The magnetic resonance imaging (MRI) showed right nasopharyngeal tumor and metastatic lesion in bilateral occiptal regions. The bony x-ray showed diffuse osteoblastic metastases. The brain lesion was pathology-proven through the computed-tomographic guidance sterotatic biopsy.     

Breast metastasis from nasopharyngeal carcinoma

The first two cases of breast metastases from anaplastic carcinoma of the nasopharynx are presented. In both cases the breast metastasis was solitary, but there was no delay in confirming their metastatic nature since both lesions manifested after the documentation of disseminated disease. The difference in histology, since 99% of our nasopharyngeal carcinoma patients have anaplastic carcinoma of poorly differentiated carcinoma subtype, makes it easy to differentiate them from primary breast cancer by cytology or histology.     

Isolated pancreatic metastasis of hepatocellular carcinoma after curative resection

Hepatocellular carcinoma (HCC) is a highly malignant tumor and extrahepatic metastasis is not rare. The most common organ of HCC metastasis is lung, followed by bone and adrenal gland. To the best of our knowledge, isolated pancreatic metastasis of HCC that developed after curative resection has not been described previously. We report a case of solitary pancreatic metastasis of HCC, which was found 28 mo after left hemihepatectomy for HCC. The lesion was successfully resected with the pancreas, and no other metastatic lesions have been found in follow-up.     

Intrathoracic Endotracheal Metastasis from Nasopharyngeal Carcinoma: A First Case Report and Review of the Literature

Intrathoracic endotracheal metastasis from a very distant site is extremely rare. We report the first case of such a disease in a 68-year-old man with nasopharyngeal carcinoma who presented with a cough and hemoptysis 34 months after finishing radiotherapy. Prior to tracheal metastasis, he developed a solitary metastasis in the lung and underwent chemotherapy followed by radiotherapy. Computed tomography showed the presence of an enlarged lymph node in the para-aortic arch. Fiberoptic bronchoscopy revealed an endotracheal tumor 1 cm above the carina. Histological and immunohistochemical analyses confirmed its nasopharyngeal origin. He was treated with conventional radiotherapy and three-dimensional conformal radiotherapy; complete tumor remission was achieved. He died of nonmalignant disease with no signs of tumor recurrence 2 years after treatment completion. Radiotherapy may be an appropriate management approach to achieve long-term tumor control for this disease.Key Words: Metastatic disease, Endotracheal malignancy, Nasopharyngeal carcinoma, Radiotherapy     

Risk factors of rib metastases in nasopharyngeal carcinoma patients with rib 99mTc- MDP foci on whole-body bone scansCSCD

Objective To investigate the correlation of rib 99mTc-MDP foci on whole-body bone scan with clinical variables and rib metastases in nasopharyngeal carcinoma(NPC) patients, and to screen the risk factors of rib metastases. Methods We retrospectively reviewed 312 NPC patients with rib 99mTc-MDP foci on wholebody bone scan. Chi-square test and logistic regression were performed to evaluate the correlation between clinical variables and rib metastases. Results In all 312 NPC patients, rib metastases were associated with T stage, skull base bone invasion, other bone metastasis, number of rib foci, lateral localization on rib and foci type (P<0.01), and the risk factors of rib metastasis included skull base bone invasion, other bone metastases, lateral localization on rib and foci type (P<0.05). In 176 patients with pure rib foci, rib metastases were closely related to T stage, skull base bone invasion, other bone metastasis, number of rib foci and lateral localization on rib (P<0.05), while only lobar distribution (P=0.029) was the effective risk factor. In 198 patients with single rib focus, rib metastases were affected by skull base bone invasion and foci type (P<0.01), while only foci type (P=0.000) was the effective risk factor. In all 566 rib foci, uptake level and localization on rib were the effective risk factors of rib metastases(P<0.01). Conclusion In NPC patients with rib foci on whole body bone scan, the effective risk factors of rib metastases include skull base bone invasion, other bone metastases, lateral localization on rib, foci type, uptake level and anterior and posterior localization on rib. Follow up should be the main way for the pure rib foci on unilateral ribs. For multiples rib foci on bilateral ribs or single rib focus combined with other bones foci, additional image modalities should be required to exclude bone metastasis. © 2020, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

Lace‐like enhancement pattern of osteosarcoma of rib and liver metastasis in CT scans

The rib is an uncommon site of osteosarcoma. With the use of adjuvant chemotherapy and aggressive surgical resection of the metastatic pulmonary lesions, extrapulmonary metastases are becoming more clinically evident. Primary rib osteosarcoma with extrapulmonary metastasis is exceedingly rare. A case is reported, showing that the pattern of metastasis of rib osteosarcoma is similar to that of primary bone osteosarcoma. The liver metastasis occurred after resection of the metastatic pulmonary lesions. A CT scan of the primary rib lesion and liver metastasis both showed a lace‐like enhancement pattern, its histological appearance corresponding with neoplastic osteoid. With the increasing use of CT abdomen for localization of extrapulmonary metastases, lace‐like enhancement may be seen more readily in the future.     

Solitary metastases from renal cell carcinoma: a review.

Nineteen patients with solitary metastatic lesions from renal cell carcinoma, 5 synchronous and 14 metachronous, were seen at the Tata Memorial Hospital over a 7 year period between 1981 and 1987. The mean metastatic interval for the metachronous lesions was 31.2 months. The commonest sites of metastases were bone, lung, and liver. The solitary nature of the metastasis was confirmed by appropriate investigations. All patients underwent nephrectomy for the primary kidney lesion. The metastatic lesions were treated with intent of cure. Only 1 patient with synchronous metastasis survived for 2 years and none survived 5 years while in the metachronous metastasis group, the estimated overall survival was 50% at 2 years and 25% at 5 years. The patients with a long metastasis-free interval were found to have a better survival. The patients with liver metastasis did poorly as compared to those with metastases at other sites. The stage of the disease also had a bearing on the survival.     

Isolated gastric metastasis from renal cell carcinoma 19 years after radical nephrectomy

Metastatic tumors in the stomach are rare. We report a case of solitary gastric metastasis from renal cell carcinoma (RCC) 19 years after radical excision of the primary tumor. During evaluation for anemia with melena, a small elevated tumor with ulceration was detected in the gastric fundus of this patient. The tumor was diagnosed as RCC based on endoscopic biopsy findings. There was no evidence of any other metastatic lesion, and a wedge resection of the stomach was performed. No additional metastasis or recurrence has been detected in the patient 12 months after discharge. This case confirms the existence of a very slow growing type of RCC with the potential for late solitary metastases and describes the surgical resectability.     

Preoperatively undetected solitary bile duct hamartoma (von Meyenburg complex) associated with esophageal carcinoma

Bile duct hamartomas, also known as von Meyenburg complexes, are benign neoplasms consisting of cystic dilatation of the bile duct surrounded by fibrous stroma. We report a rare case in a 60-year-old man who presented with coexistent von Meyenburg complex and esophageal carcinoma. Preoperative computed tomography did not reveal any liver tumors. Intraoperatively, a small lesion was discovered in segment III of the liver; the lesion was suspected to be a solitary liver metastasis from the esophageal carcinoma. Partial resection of the liver was performed, and pathological findings revealed bile duct hamartoma (von Meyenburg complex). As von Meyenburg complexes are small cystic lesions located throughout the liver, and as they do not present characteristic imaging findings, their preoperative morphological diagnosis and differential diagnosis from liver metastasis is extremely difficult. In conclusion, von Meyenburg complex should be considered in the differential diagnosis of intrahepatic cystic neoplasms.     

PCNA和PTEN的表达水平在鼻咽癌预后判断中的意义

目的:探讨鼻咽癌组织中PCNA、PTEN的表达水平与预后的关系。方法:采用免疫组织化学S-P法测定56例鼻咽癌组织中PCNA、PTEN的表达,分析其与原发灶范围、放疗后局部肿瘤残留、颈淋巴结有无转移及生存期的关系。结果:PCNA、PTEN的表达与原发灶范围、放疗后肿瘤残留无关(P>0·05),与颈淋巴结转移有关(P<0·05)。单因素分析PC-NA、PTEN蛋白表达与鼻咽癌的生存亦无相关性(P>0·05)。结论:PCNA和PTEN的免疫组化检测对鼻咽癌的预后无重要的预测价值。