Hepatocellular carcinoma with a complete remission of bone metastasis achieved by arterial chemotherapy

Reported is the case of a hepatocellular carcinoma with a complete remission of the bone metastasis by arterial chemotherapy. The patient was 60 year old male, with the chief complaint being a tumor at the right side of the chest. The diagnosis was a hepatocellular carcinoma with a bone metastasis at the right 10th rib. The bone tumor showed no decrease in size after an intra-arterial injection of adriamycin, and radiation and or hyperthermia. Therefore, intra-arterial injections of mitomycin C mixed with lipiodol were instituted through the intercostal artery, and no bone tumor was noted after start of this therapy. Although the patient subsequently died, microscopic examination of a specimen obtained at autopsy revealed no malignant cells at the right 10th rib. Intra-arterial injections of anticancer agents mixed with lipiodol therefore are thought to be useful for the treatment of a bone metastasis.     

Post-menopausal bleeding: a rare presentation of metastatic uveal melanoma

Uveal melanoma differs from cutaneous melanoma in many ways, including its pattern of metastasis, and exhibits latency with clinical evidence of metastasis sometimes appearing many years after primary diagnosis. Most patients develop metastasis within the liver, but some may present with metastasis to other sites. We report a case of uveal melanoma that presented with post-menopausal bleeding due to metastasis. Further investigation revealed widespread metastatic disease and the patient was not fit for chemotherapy. She died two months after presentation: autopsy revealed metastases in many sites, including the uterus, right ovarian fibroma, kidney, mesentery, liver, lung, thyroid, bone marrow and skin. The immediate cause of death was cardiac tamponade due to a malignant effusion secondary to cardiac metastasis. This case illustrates the widespread metastatic potential of uveal melanoma and highlights the potential for unusual presentation of metastatic disease from this eye tumor.(Pathology Oncology Research Vol 12, No 3, 184–187)     

Solitary rib metastasis of nasopharyngeal carcinoma

We report a case of a 49-year-old man who developed solitary rib metastasis of nasopharyngeal cancer. Patient had been treated for primary carcinoma with radiation therapy and concomitant chemotherapy. The bone metastasis presented as bulky, solid, painful mass in the posterior arch of 10th rib, within nine months the end of treatment. Biopsy of the solitary lesion presented the same histological characteristics as those of primary lesion. Although there are reported in literature series of nasopharyngeal cancer metastasizing to bone, we did not find previously pubfished report of a nasopharyngeal carcinoma metastasizing only to a rib.     

同时性多原发癌伴肝转移1例并文献复习

目的 探讨同时性多发性骨髓瘤和结肠癌的病因、诊断及治疗方法。方法 对1例同时诊断为多发性骨髓瘤和结肠癌并继发肝转移患者的临床资料及相关文献进行回顾性分析。结果 患者以贫血为首发症状,骨髓穿刺术提示多发性骨髓瘤,荧光原位杂交检测示14q32 IgH基因重排阳性,肠镜及病理活检明确诊断结肠癌,数月后继发肝占位。给予VTD方案减轻骨髓负荷后行结肠癌切除术,术后采用VTD与XELOX联合方案化疗,肝占位行局部肝病损射频消融术,患者可耐受,肝转移灶较前明显缩小。 结论 同时性多发性骨髓瘤和结肠癌并伴肝转移罕见,需组织病理检查鉴别诊断原发癌与转移癌,治疗上尚无统一标准,需多学科评估制定治疗方案。     

Influence of metastatic site as an additional predictor for response and outcome in advanced colorectal carcinoma

Every year, 31,230 men and women are diagnosed with colorectal carcinoma, and up to 60% of these will ultimately develop advanced disease. However, there is little information to identify which patients are most likely to benefit from palliative chemotherapy. This analysis is unique in evaluating how the site of metastasis influences response and survival. A database of 497 patients treated within randomized clinical trials using 5-Fluorouracil (5FU)-based chemotherapy at the Royal Marsden Hospital was analysed. The potential for site of metastasis as a predictive variable for response to chemotherapy and survival was examined, in addition to other clinical parameters. The presence of liver metastases was a better predictor for overall response than either performance status or number of metastatic sites on presentation. Probability of response was significantly decreased by a raised serum carcinoembryonic antigen (CEA) and presence of peritoneal metastases. In liver metastases, a normal serum albumin was as significant a predictor for response as good performance status. The most important predictor for survival was initial performance status. The number of metastatic sites on presentation had no influence on survival. Site of metastasis can predict for response to 5FU-based chemotherapy and patients should be stratified according to the involved site of metastasis in the future.     

Intracranial hemorrage due to brain metastases in an Italian HCV patient with hepatocellular carcinoma

Brain metastases from hepatocarcinoma are exceptional and only a few cases have been reported in the literature, mainly from Far-Eastern countries. Clinical diagnosis in asymptomatic patients with preserved liver function is difficult and usually late. In some cases, cerebral metastasis is the initial manifestation of HCC and patients may develop intracerebral hemorrage and have a stroke-like presentation. We report on the first Italian case of cerebral metastases from multifocal hepatocellular carcinoma in an asymptomatic HbsAg negative patient with unknown HCV related chronic hepatitis and no evidence of liver cirrhosis. For many years he had a mild liver enzyme elevation and the presence of multiple misinterpreted hypoechogenic hepatic lesions. The hepatic tumor spread to the lungs and the brain and the patient developed two major episodes of intracranial hemorrage. He had two nodular lesions in the brain and alpha-fetoprotein levels were more than 10,000 ng/ml. He died from neurologic causes, without major signs of liver failure.     

A case of esophageal small cell carcinoma with multiple liver metastases responding to chemotherapy with irinotecan plus cisplatin

We report a case of small cell esophageal carcinoma (SCEC) with multiple liver metastases treated with some success by chemotherapy with irinotecan (CPT-11) plus cisplatin (CDDP). Radiologic and endoscopic examination of a 75-year-old man with multiple liver tumors disclosed a 4.0-cm type 2 tumor in the middle third of the esophagus. An endoscopically obtained biopsy specimen was diagnosed as undifferentiated small cell carcinoma. Multiple liver metastases were confirmed but lymph node metastases and distant metastases other than those in the liver were not detected. After six courses of chemotherapy with CPT-11 plus CDDP, the primary lesion showed complete response and liver metastases showed partial response. However, because all lesions almost immediately relapsed or progressed, arterial infusion chemotherapy for liver metastases and radiation for the primary lesion were given as second-line treatment. The primary lesion showed complete response with radiation. Arterial infusion chemotherapy prevented the progression of liver metastases once, but the patient died of liver failure at last. No distant lesions including metastatic lymph nodes were confirmed over the course of his illness, and the patient survived for a year after first diagnosis. Although the prognosis of SCEC is quite unfavorable due to highly aggressive behavior, a better prognosis is possible with effective chemotherapy and second-line treatment is important in improving prognosis.     

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.     

A case report of synchronous small cell lung cancer and gastric cancer successfully treated with carboplatin

A 53-year-old man complained of anorexia and abdominal distention of one month's duration. The chest X-ray demonstrated a mass in the left lung with hilar and mediastinal adenopathy and a lytic lesion in the right fourth rib. A transbronchoscopic biopsy of the mass revealed oat cell carcinoma (WHO classification). The endoscopic evaluation also revealed a gastric lesion (IIc type). Biopsy of this lesion indicated signet ring cell gastric cancer. An abdominal CT scan demonstrated multiple liver metastases. Based on these findings, the patient was diagnosed as having synchronous lung and gastric primaries, with liver and bone metastasis from lung cancer. Carboplatin (CBDCA) was administered by intravenous drip infusion of 450 mg/m2. After a second treatment with CBDCA about 3 weeks later, the patient achieved a partial response at the primary site of lung cancer as well as at the liver and bone metastases. In addition, repeat endoscopy of the stomach demonstrated a complete regression. A biopsy specimen taken by gastroscopy was negative for cancer cells. Subsequent chemotherapy for small cell lung cancer was administered with cyclophosphamide, adriamycin, and vincristine, and to date there is no evidence of recurrence. Further studies on CBDCA treatment of small cell lung cancer and gastric cancer are needed to establish the efficacy of this drug against these two histologically different cancers.     

Bone metastasis in hepatocellular carcinoma

Bone metastasis was observed in 16.1% or in 14 of 87 male autopsy cases of hepatocellular carcinoma. The primary tumor within the liver was located in the right lobe in all but one case. There were six patients who first presented with signs attributable to bone metastasis, and lung metastasis subsequently became evident in five of them. These 6 patients lived significantly longer as compared with 8 other patients with bone metastases and 73 patients without. The possible route by which hepatocellular carcinoma cells were carried to the bone is discussed.     

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.     

Active chemotherapy for bone metastasis in sarcomatoid renal cell carcinoma

 Sarcomatoid renal cell carcinoma (SRCC) is associated with an aggressive course, high incidence of bone metastasis, and an extremely poor prognosis. There are a few case reports concerning the effectiveness of chemotherapy on metastasis in SRCC. To our knowledge, however, there are no reports describing its effectiveness on bone metastasis. We report a 22-year-old woman with an 8-cm × 7-cm left renal mass. Left nephrectomy was done. The pathological diagnosis was SRCC, INF-β, pT3aN2. Although, she received continuous infusion of interferon α-2a (INFα-2a) and interleukin-2 (IL-2) as adjuvant therapy, liver metastasis appeared 2 months later. Resection of the liver metastasis was done. After resection of the metastasis, multiple bone metastases appeared, in both humeri, the left chest wall, the left fourth rib, and the left iliac bone. The patient was treated with gemcitabine, 1000 mg/m² (days 1, 8), docetaxel 80 mg/m² (day 1), and carboplatin 300 mg/m² (day 1). A computed tomography (CT) scan after the first cycle revealed that the multiple osteolytic bone tumors had significantly decreased in size. Her ability of daily life (ADL) improved and this continued for almost 2 months. A second course of chemotherapy, with gemcitabine and IL-2 was given, but it was ineffective, and the patient died approximately 16 months after the initial diagnosis of SRCC. Combination chemotherapy with gemcitabine, docetaxel, and carboplatin was effective for the bone metastasis of SRCC. Received: August 21, 2002 / Accepted: December 10, 2002 Correspondence to:S. Hoshi     

An atypical extrahepatic metastasis of the distal phalanx from hepatocellular carcinoma

A 49-year-old woman presented with severe swelling and pain of the left little finger, which had exacerbated rapidly, in October 2006. The patient had a history of hepatocellular carcinoma and metastatic lung cancer. She had undergone partial hepatectomy for the hepatocellular carcinoma in September 2001 and pulmonary resection for metastatic lung cancer in November 2005. Roentgenogram of the hand on admission showed complete destruction of the distal phalanx of the left little finger. The final pathological result of the tissue obtained by disarticulation was an extrahepatic metastasis of hepatocellular carcinoma. Extrahepatic metastasis from primary hepatocellular carcinoma to the hand is very rare and only four cases have been reported in the literature. All the patients with extrahepatic metastases from the primary hepatocellular carcinoma to the hand had poor prognoses, but the patient presented in this article exhibited an unusual clinical course. The patient is still alive 1 year after the diagnosis of extrahepatic bone metastasis of the distal phalanx.     

Multidisciplinary management of intrahepatic cholangiocarcinoma: Current approaches

Intrahepatic cholangiocarcinoma (ICC) is a common primary hepatic tumor. However, its outcomes are usually worse than those of hepatocellular carcinoma owing to its non-specific presentation and detection at an advanced stage. The most widely used serum marker, carbohydrate antigen 19-9, is non-specific. Furthermore, imaging studies rarely identify any pathognomonic features. Surgery is the only treatment option that offers a chance of long-term survival. However, the resectability rate is low owing to the high frequencies of intrahepatic metastases, peritoneal carcinomatosis, or extrahepatic metastases. Surgical treatment should be tailored according to the macroscopic classification of ICC (e.g. mass-forming, periductal infiltrating, and intraductal growth types) because it reflects the tumor's dissemination pattern. Although lymph node metastasis is a negative prognostic factor, the importance and extent of lymph node dissection is still controversial. To improve patient survival, liver transplantation is considered in some patients with unresectable ICC, especially in those with an insufficient remnant liver volume. Minimally invasive procedures, including laparoscopic and robotic liver resection, have been tested and achieved comparable outcomes to conventional surgery in preliminary studies. No randomized trials have confirmed the efficacy of adjuvant chemotherapy in ICC, and several trials have evaluated molecular-targeted agents as monotherapy or in combination with cytotoxic chemotherapy. Multidisciplinary approaches are necessary to improve the outcomes of ICC.     

Primary Hepatocellular Carcinoma and Hepatoid Adenocarcinoma of the Stomach with Liver Metastasis: An Unusual Association

Alpha-fetoprotein (AFP)-producing hepatoid adenocarcinoma ofthe stomach is a rare and recently discovered entity. We reportan unusual combination of hepatocellular carcinoma and hepatoidadenocarcinoma of the stomach with multiple liver metastases.The patient, a 62-year-old Japanese man, was clinically diagnosedas having hepatocellular carcinoma because of the presence ofliver tumors, a markedly elevated serum AFP level, and a positivehepatitis C virus (HCV) antibody titer. Autopsy revealed multipletumors in the liver; one was a primary hepatocellular carcinomawithout metastasis, and the others were metastases from latenthepatoid adenocarcinoma of the stomach. In the hepatocellularcarcinoma, bile production was observed although the tumor wasimmunohistochemically negative for AFP. On the other hand, boththe primary gastric and metastatic liver hepatoid adenocarcinomaswere positive for AFP. Therefore, hepatoid adenocarcinoma ofthe stomach was responsible for the excessive production ofAFP and was the cause of death.     

Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC

Brain metastases from hepatocellular carcinoma are extremely rare. The objectives of the current study were to assess the natural history, outcome, and possible prognostic factors in patients with brain metastases from hepatocellular carcinoma. Between 1995 and 2006, 6,919 patients with hepatocellular carcinoma were treated at Yonsei University Health System. Of those, 62 (0.9%) had a diagnosis of brain metastasis. We carried out a retrospective review of these 62 patients and performed a statistical analysis. The median age at the time patients were diagnosed with brain metastasis was 54 years. Forty-seven patients (76%) were male, and 53 patients had hepatitis B. Median time from diagnosis of hepatocellular carcinoma to brain metastasis was 18.2 months, and 5 patients had brain involvement as their initial presentation. Intracranial hemorrhage was frequently associated (54.8%) with brain metastasis. The most common presenting symptoms were motor weakness, mental change, and headache. Metastases were treated with whole-brain radiation therapy (WBRT) alone in 17 patients and gamma knife surgery alone in 10 patients. Six patients underwent surgical resection and 5 patients were treated with surgical resection followed by WBRT. Twenty-four patients (39%) received steroids only. Median survival after diagnosis of brain metastasis was 6.8 weeks (95% confidence interval: 3.8–9.8 weeks). Univariate analysis showed that treatment modality, number of brain lesions, α-fetoprotein, ECOG performance score, recursive partitioning analysis (RPA) class, and Child-Pugh classification had a statistically significant impact on survival. In multivariate analysis, treatment modality, number of brain lesions, and Child-Pugh classification were statistically significant prognostic factors for survival. The overall prognosis of patients with brain metastases from hepatocellular carcinoma is extremely poor. Nevertheless, some subsets of patients manifested the most favorable survival criteria (single brain metastasis and good liver function); thus, for at least these patients, treatment may result in an improved survival time.     

Skull metastasis from hepatocellular carcinoma with chronic hepatitis B

A 56-year-old male visited our hospital for evaluation of an occipital mass. Contrast computed tomography showed hypervascular enhancement with osteolytic change in the skull and a huge enhanced mass in the liver. Magnetic resonance imaging showed bone metastasis in the thoracic vertebrae. Assays for hepatitis B surface antigen and hepatitis B core antibody were positive and his liver condition was Child-Pugh grade A. Our diagnosis was hepatocellular carcinoma (HCC) with skull and vertebrae metastases on chronic hepatitis B. He was treated with radiation therapy for bone metastases and transcatheter arterial chemoembolization for HCC. But he developed acute respiratory failure because of aspiration pneumonia, congestion and oedema with haemorrhage of the lungs and died. Dissection showed HCC with multiple bone metastases. The liver tumor was categorized as well-differentiated HCC, Edmondson classification I, trabecular type and pseudoglandular type. In the liver mild infiltration of lymphocytes was seen in Glisson's capsules which were significantly enlarged with well preserved limiting plates. Piecemeal necrosis was not obvious. No fibrosis was noted. An 8 cm × 7 cm × 3 cm metastatic lesion had formed in the left occipitotemporal part of the cranial bone. The lesion was osteolytic and showed invasion into the dura mater. Neither the subdural cavity nor the brain showed involvement from the metastatic tumor. However, skull metastasis from HCC is very rare and it affects the patient's prognosis and the quality of life. Therefore, it is very important to make an early diagnosis and carry out proper management of skull metastasis from HCC.     

Clinicopathological features of gastric metastasis from breast cancer in three cases

The common sites for metastases from breast cancer are lymph nodes, bone, lung, liver, and brain. Gastrointestinal (GI) metastasis is rarely found or diagnosed in patients with breast cancer. This report presents three cases of gastric metastasis from breast cancer. Case 1 was a 42-year-old female diagnosed with gastric metastasis after mastectomy with axillary lymph node dissection for invasive lobular carcinoma of the left breast. Case 2 was a 54-year-old female who was diagnosed to have invasive lobular carcinoma of the left breast with systemic bone and gastric metastasis. Case 3 was a 54-year-old female who was diagnosed to have bilateral invasive ductal carcinoma of the breast with simultaneous bone and gastric metastasis. The immunohistochemical statuses for estrogen receptor, progesterone receptor, mammaglobin, and gross cystic disease fluid protein-15 (GCDFP-15) between the primary and gastric metastatic lesions were all well matched. All three cases were treated with systemic chemotherapy, hormone therapy or both, without surgical intervention for gastric lesions. Two patients with disseminated disease died 27 and 58 months after diagnosis of gastric metastasis, while one patient without organ metastasis is still alive at 56 months after diagnosis. It is important to make a correct diagnosis by distinguishing gastric metastasis from breast cancer in order to select the optimal initial treatment for systemic disease of breast cancer.     

结直肠癌骨转移的临床特点及治疗(附104例)

目的:探讨结直肠癌骨转移的临床特点,提高结直肠癌骨转移诊疗水平.方法:通过对中国医科大学附属盛京医院2012年1月1日至2015年1月1日收治的104例结直肠癌骨转移患者资料进行回顾性分析,分析其临床特征,绘制生存曲线,总结诊疗规律.结果:2012年1月1日至2015年1月1日期间我院共收治结直肠癌骨转移患者104例,占同期结直肠癌患者的10.0%(104/1 038),其中结肠癌骨转移38例,直肠癌骨转移66例.多发骨转移60例(57.7%),单发骨转移44例(42.3%),常见转移部位依次为腰椎(38.5%)、骶骨(32.7%)、胸椎(30.8%)、肋骨(26.9%)、四肢骨(19.2%)、肩胛骨(3.8%)、颌面骨(1.9%).共有74例患者合并有远处脏器转移(71.2%),≥2处者46例,肺脏42例,肝脏40例,腹膜后淋巴结14例,腹股沟淋巴结6例,肾上腺4例,脑2例.确诊骨转移的中位时间为(26.1±3.3)个月.从确诊骨转移之日算起,中位生存期为(22.5±4.0)个月.结论:结直肠癌骨转移患者多合并远处脏器转移;直肠癌比结肠癌更易发生骨转移.     

Liver metastases from gastric carcinoma: A Case report and review of the literature

Gastric carcinoma (GC) is the fifth most common malignancy worldwide but the third leading cause of cancer death, and surgery remains the only curative treatment option. Prognosis of patients with liver metastases from gastric carcinoma (LMGC) is poor, and the optimal treatment of metastatic gastric cancer remains a matter of debate. In 2002, a 53-year-old male patient with GC and synchronous oligometastatic lesion in liver VIII segment underwent a total gastrectomy combined with metastasectomy. The pathologic diagnosis was stage IV gastric adenocarcinoma (pT3N2M1), which was treated with adjuvant chemotherapy (cisplatin, epirubicin, leucovorin, and 5-fluorouracil). In 2012, abdominal ultrasound and percutaneous liver biopsy revealed recurrence of the metastasis in the right liver lobe. Progression of the disease was observed after palliative chemotherapy (epirubicin, oxaliplatin, and capecitabine). Nevertheless, an extended right hemihepatectomy, with excision of segments 1, 4A, 5, 6, 7, and 8, was still performed. Pathologic examination confirmed large KRAS- and HER2-negative LMGC. The patient is alive and free of disease 47 months after the repeated hepatectomy and 13 years after removal of the primary GC and synchronous liver metastasis. Based on review of 27 articles, 5-year overall survival rate following gastrectomy and liver metastasectomy may reach 60%, with median survival time up to 74 months. Although the combination of aggressive surgical approach with systemic therapy for LMGC is controversial, it may allow favorable outcome. Careful selection of patients based on evaluable predictive factors for R0 surgical resection of both primary tumor and liver metastases can lead to cure, as shown in our case presentation, where a 10-year relapse-free survival was observed, followed by successful repeated hepatectomy due to liver metastases.