Colonic Adenocarcinoma Metastatic to the Thyroid: Report of a Case

We report herein the case of a 67-year-old man who was admitted to our hospital with a 3-month history of hoarseness, a cervical mass, and weak muscles of the extremities 6 years after undergoing a right colectomy for carcinoma. Physical and imaging examinations disclosed a nodule in the thyroid with swollen cervical lymph nodes, multiple pulmonary lesions with pleural effusion, and a cerebral mass. Fine-needle aspiration cytology of the thyroid nodule and brush cytology of the lung mass revealed adenocarcinoma, which was consistent with a diagnosis of metastases from the primary colon adenocarcinoma to the thyroid, brain, and lung. The patient eventually died from the malignancy, although he survived for 4 months after the disclosure of the metastases. The rarity, diagnosis, and prognosis of thyroid metastasis from colon carcinoma are discussed. Received: February 22, 2001 / Accepted: July 17, 2001     

Spermatic Cord Metastasis as an Initial Manifestation of Sigmoid Colon Carcinoma: Report of a Case

We report herein the unusual case of a 63-year-old man in whom adenocarcinoma of the sigmoid colon manifested as metastasis to the left spermatic cord, the capsule of the left testis, and the wall of an associated testicular hydrocele. Received: March 22, 2001 / Accepted: September 11, 2001     

Urethral metastasis: an uncommon presentation of a colonic adenocarcinoma

Introduction Metastases to the urethra are a rare clinical entity. To our knowledge there are less than ten case reports described in the literature. In this report, however we describe a case of urethral metastases from a colonic cancer origin where the urethral lesion was the presenting symptom. Case Report A 69-year-old woman presented with a swelling at the urethral opening. Per vaginal examination revealed a hard tender lesion situated at the external urethral meatus with contact bleeding. Excision biopsy revealed adenocarcinoma. Immunohistochemical staining demonstrated that the tumour cells were strongly suggestive of a metastatic lesion from the colon. Subsequent investigations revealed that the patient did indeed have a sigmoid adenocarcinoma and underwent chemotherapy with a view to anterior resection and pelvic exenteration. Discussion Metastases to the urethra are rare. Treatment options have to be individualised to the extent of the disease and the symptoms of the patient. Immunohistochemical staining can help to a certain extent to point the direction towards the possible primary lesion. Atypical presentations of urethral lesions should be viewed with suspicion. A biopsy of the lesion is the only way of confirming diagnosis.     

Gingival Swelling as the Initial Manifestation of Granulomatosis with Polyangiitis

We describe a case of granulomatosis with polyangiitis (GPA; formerly named Wegener granulomatosis) that presented initially as florid areas of gingival swelling. The patient also had upper respiratory symptoms that included sinus congestion and cough of recent onset. Clinical-pathologic correlation aided the interpretation of non-specific biopsy findings and immediate referral to an appropriate medical specialist. Treatment was rendered at an early stage of disease with a good response to date. Review of the literature indicates that gingival swelling, often with the characteristic appearance of “strawberry gingivitis” may represent the initial sign of disease in 2% of patients with GPA. Biopsy of gingival lesions often shows a non-specific histologic appearance that should be interpreted in the context of the clinical appearance and pertinent medical history. The clinical investigations that lead to definitive diagnosis and treatment are presented to facilitate the management of this uncommon but potentially fatal condition.     

Metastatic Pulmonary Adenocarcinoma Deposit Arising Within a Cutaneous Basal Cell Carcinoma: A Case Report

Skin metastases are rare complications of internal malignancies, and most commonly arise from primary lung carcinoma (Brownstein and Helwig in Arch Dermatol 105:82–68, 1972). Metastatic cutaneous lesions have not previously been documented to arise within other skin tumours. We report our experience of a solitary pulmonary adenocarcinoma metastasis that arose within a pre-existing basal cell carcinoma in a patient with undiagnosed lung cancer. Immunohistochemistry was invaluable in confirming both the metastatic nature of the secondary skin lesion and its site of origin.     

Delayed Metastasis to the Mandible of Esophageal Adenocarcinoma

Around 1 % of oral cancers are metastases from distant sites. Tumor metastases to the jaw bones are uncommon and are most likely to arise from primary lung, breast, prostate or kidney tumors. Jaw bone metastases from a primary esophageal adenocarcinoma are especially rare, with only 7 reports published in the literature. Here, we describe a case of a 69 year-old male patient where 7 years elapsed between the diagnosis and successful treatment of a poorly differentiated, stage pT2N0 primary esophageal adenocarcinoma and re-presentation with jaw pain due to a metastatic mandibular deposit. The morphological appearance of the metastasis and immunohistochemical positivity with CK20, CK7 and CDX2 strongly supported an adenocarcinoma of upper gastrointestinal tract origin. This case is of particular interest as there is an unusually long time between the detection of the primary esophageal adenocarcinoma and diagnosis of metastatic disease. The longest period of time we have found for this in the literature is 9 months, although it is also reported that some oral metastases may appear more than 10 years following the primary tumor diagnosis.     

甲状腺乳头状癌颈淋巴结转移途径的探讨

探讨甲状腺乳头状腺癌颈淋巴结转移途径的规律及其临床意义。方法:1991年1月～2002年5月,为97例甲状腺乳头状腺癌颈淋巴结转移的病人作了108次功能性颈淋巴结清扫术。参照美国耳鼻咽喉头颈外科基金协会颈淋巴结分区法,分析淋巴结转移的规律。结果:Ⅵ、Ⅳ、Ⅲ区淋巴结转移最为常见,转移率分别为78.5%、70.3%、68.5%;尤其在转移早期的Ⅳ和Ⅲ区转移中,转淋巴结多位于颈内静脉后方,单靠触诊不易发现;Ⅰ区较少淋巴结转移;Ⅱ、Ⅴ区淋巴结转移率居中。结论:本研究的发现有助于甲状腺乳头状腺癌手术时前哨淋巴结活检的设计,并恰当地选择清扫区域和范围。     

Metastatic colon cancer from intrahepatic cholangiocarcinoma

A 62-year-old man had been followed because of an elevated serum level of carcinoembryonic antigen without the detection of any cancer lesions. However, there was a sudden increase in the serum level of carcinoembryonic antigen, and abdominal imagings showed a hepatic tumor with peripheral intrahepatic bile duct dilatation, and a submucosal tumor at the sigmoid colon with intact mucosa. Histopathological findings showed that the hepatic tumor had perineural invasion, suggesting an intrahepatic cholangiocarcinoma, and that the colon tumor infiltrated the submucosa, while its mucosa was intact. Both tumors showed similar pathological features and were positive for cytokeratin 20 and 7. These findings suggested intrahepatic cholangiocarcinoma with metastatic sigmoid colon cancer.     

Lymph Node Size and Metastatic Infiltration in Colon Cancer

Background: Detection of metastatic lymph nodes in colon cancer is essential for determining stage and adjuvant treatment modalities. Lymph node size has been used as one possible criterion for nodal metastasis. Although enlarged regional lymph nodes are generally interpreted as metastases, few data are available that correlate lymph node size with metastatic infiltration in colon cancer.Methods: In a prospective morphometric study, the regional lymph nodes from 30 colon specimens from consecutive patients with primary colon cancer were analyzed. The lymph nodes were counted and the largest diameter of each lymph node was measured and analyzed for metastatic involvement by histological examination.Results: A total of 698 lymph nodes were present in the 30 specimens examined for this study. A mean number of 23 (range, 19–39) lymph nodes was found in each specimen. Of these nodes, 566 (81%) were tumor-free and 132 (19%) contained metastases. The mean diameter of the lymph nodes free of metastases was 3.9 mm, whereas those infiltrated by metastases averaged 5.9 mm in diameter (P< 0.0001). Of the tumor-free lymph nodes, 528 (93%) measured < 5 mm in diameter, whereas 70 (53%) lymph nodes containing metastases measured < 5 mm in diameter.Conclusions: Lymph node size is not a reliable indicator for lymph node metastasis in colon cancer. A careful histological search for small lymph node metastasis in the specimen should be undertaken to avoid false-negative node staging.     

Prognostic Significance of Metastatic Lymph Node Ratio in Node-Positive Colon Carcinoma

Background The aim of this study was to evaluate the prognostic significance of the lymph node ratio between metastatic and examined lymph nodes (LNR) in patients with stage III colon cancer. Methods A review was made of 201 patients (106 men) with stage III colon cancer of R0 resection. Lymph node (LN) disease was stratified both by the American Joint Committee on Cancer and the International Union Against Cancer nodal staging system (pN) and by quartiles of the LNR. Survival curves were made by Kaplan-Meier analysis and assessed by the log rank test. Multivariate analysis was performed by the Cox proportional hazard model. Patients ranged in age from 22 to 82 (median, 59) years with median follow-up of 52 (range, 13–96) months. Results The LNR increased as a function of the number metastatic LNs (P < .0001; 95% confidence interval [95% CI], .7155–.8265). Cutoff points of LNR quartiles to be the best separating patients with regard to 5-year disease-free survival (DFS) were between quartile 1 and 2, and between 3 and 4 (pNr1, 2, and 3); the 5-year DFS according to such stratification was 83.6%, 61.1%, and 20% in pNr1, pNr2, and pNr3, respectively (P < .0001). The Cox model identified the pNr as the most statistically significant covariate: pNr2 was three times (95% CI, 1.407–6.280) and pNr3 eight times more risky than pNr1 (95% CI, 3.739–18.704). Conclusions Ratio-based LN staging, which reflects the number of LNs examined and the quality of LN dissection, is a potent modality for prognostic stratification in patients with LN-positive colon cancer.     

Manifestation of Bilateral Huge Ovarian Metastases from Colon Cancer Immediately After the Initial Operation: Report of a Case

This report describes the case of a 34-year-old premenopausal woman in whom bilateral huge ovarian metastases were found immediately after initial surgery for sigmoid colon cancer. Both ovaries had been intact at the time of sigmoidectomy, but 2 months later, she complained of persistent vaginal bleeding, and large bilateral metastases were detected in both ovaries. Oophorectomy with intraperitoneal chemotherapy proved ineffective and the patient died 3 months later, after a second operation, from peritoneal dissemination. This case report serves to demonstrate the importance of searching for synchronous or nonsynchronous metastases to the ovaries after surgery for colon cancer in young women. Consideration should also be given to the feasibility of performing prophylactic oophorectomy or administering intensive chemotherapy in association with colon resections for carcinoma for premenopausal women because of the ineffectiveness of these modalities as treatment for metastatic disease. Received: February 6, 2001 / Accepted: September 11, 2001     

Maxillary Verrucous Carcinoma Coincident With Cervical Lymph Node Metastasis of Colon Adenocarcinoma

Cervical lymph node metastasis is an extremely rare event in oral verrucous carcinoma. Isolated cervical lymph node metastasis of colon cancer is also rare. This article describes a case of maxillary verrucous carcinoma accompanied by colon adenocarcinoma that metastasized to a cervical lymph node in a 69-year-old Japanese woman. During preoperative evaluation for maxillary verrucous carcinoma, enlarged cervical lymph nodes and colon cancer were suspected by positron emission tomography. Colonoscopy with biopsies confirmed primary colon adenocarcinoma. Left radical neck dissection, partial maxillectomy, and full-thickness skin graft to the mucosa of the upper lip were performed before treatment of colon adenocarcinoma. Cervical lymph nodes showed metastasis from colon adenocarcinoma, and right hemicolectomy was performed. This is the first case report of synchronous oral verrucous carcinoma and colon adenocarcinoma with cervical lymph node metastasis.     

Gingival Fibroma: An Emerging Distinct Gingival Lesion with Well-Defined Histopathology

Gingival growths, barring a few are mostly reactive and seldom exhibit significant true neoplastic potential. The common etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth. Such lesions are easily distinguishable and categorized into diagnoses such as pyogenic granuloma, peripheral ossifying fibroma, etc. We present a previously undescribed, but commonly encountered, reactive gingival growth with unique histologic features and suggest the diagnostic term “gingival fibroma.” An IRB approved retrospective review of the University of Florida Oral Pathology Biopsy Service encompassing years 2010–2019, was performed to select cases. Demographics, clinical data, and microscopic diagnoses were recorded and analyzed. Four board-certified oral and maxillofacial pathologists agreed upon and established the diagnostic criteria. These are: a prominent fibromyxoid stroma, variable cellularity, a whorled or storiform pattern of arrangement of the cellular elements, lack of significant inflammation or vascularity, and complete absence of calcification, and/or odontogenic islands. A total of 60 cases met all criteria and were included in the study. Age range in years was 14–87 with the mean at 45.11 years. A striking female predilection (90%) was noted. Approximately 62% of cases were reported on the maxillary gingiva, followed by 38.3% in the mandibular gingiva. Majority, 66.7% were in the anterior incisor region followed by 11.7% in the canine/first premolar areas. All lesions were submitted as excisional biopsy, and 4 cases recurred within 2–3 years of excision. In all cases, lesional tissue appeared to extend to the surgical base of the specimen. We present 60 cases of a histologically unique entity occurring exclusively on the gingiva and introduce the diagnostic term “Gingival Fibroma” for these lesions. Further studies with adequate clinical follow-up may help understand the exact clinical behavior of these lesions.     

Prognostic Factors in Patients with Synchronous Peritoneal Carcinomatosis (PC) Caused by a Primary Cancer of the Colon

Background  Peritoneal carcinomatosis (PC) is seen in about 10% of patients with colon cancer during the initial operation and has been considered a preterminal condition. The actual outcome can vary extensively depending on the presence/absence of metastases other than PC. Methods  A total of 975 consecutive patients with colon cancer who underwent resection were included. The extent of PC was determined at laparotomy. Metastases restricted to the adjacent peritoneum or a few metastases to the distant peritoneum were classified as “limited,” whereas numerous metastases to the distant peritoneum were as “extensive” regardless of the sizes of the disseminated nodules. Results  PC group consisted of 75 patients (7.7%). The median survival time (MST) in the PC group was 6.8 months. Survival was significantly better in cases with limited PC (MST, 12.4 months), without lymph node involvement (20.8 months), with preoperative performance status of 0 or 1 (8.5 months), and who received chemotherapy more than 3 months (8.8 months). A multivariate analysis revealed that these four factors were significant predictors of better outcome. Conclusions  The extent of PC and lymph node involvement, even if the distribution is confined around the primary lesion, are more accurate prognostic factors than distant metastasis in patients with colon cancer and synchronous PC.     

Colon sarcoma in the newborn.

Two newborns with similar lesions were treated at two children's hospitals. Each newborn presented with an abdominal emergency that required immediate surgery. In each instance, small bowel obstruction was clinically and radiologically suspected; barium enema examination showed an irreducible colonic intussusception in the first baby and a colonic perforation in the second. Both these findings required immediate operation. The baby with the intussusception had a colon resection and a primary anastomosis, while the newborn with the perforation had a resection and temporary colostomy. Subsequent to the initial surgery, neither baby has received any further treatment for the tumor. The two patients are now well at 13 yr and 6 yr of age.     

Carcinosarcoma of the Rectosigmoid Colon: Report of a Case

We report an unusual case of carcinosarcoma of the colon. An 80-year-old woman was admitted to our hospital with lower abdominal pain. Computed tomography showed a large pelvic mass, 18 cm in maximal diameter, and barium enema and colonoscopy both showed a type-2 tumor in the sigmoid colon. We performed Hartmann's procedure with resection of the ileocolic segment. Immunohistochemical stains of the resected specimen revealed that most of the tumor consisted of spindle cell sarcoma with neural and muscle differentiation, while only the superficial area of an ulcerated lesion contained adenocarcinoma positive for carcinoembryonic antigen. The patient died of a fast-growing recurrent pelvic tumor 6 months postoperatively. Our experience of this case and our review of eight other cases in the English literature indicate that wide resection provides the best chance of cure, but careful postoperative follow-up is essential. Received: April 3, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: H. Ishida     

牙龈清洁术联合康复新液治疗口腔正畸患儿慢性牙龈炎的临床效果

分析牙龈清洁术联合康复新液在口腔正畸患儿慢性牙龈炎治疗中的应用效果。方法 选取2020年8月-2023年8月于廊坊市人民医院口腔科行口腔正畸的90例慢性牙龈炎患儿为研究对象,随机分为对照组和研究组,各45例。对照组实施牙龈清洁术治疗,研究组实施牙龈清洁术联合康复新液治疗,比较两组临床疗效、牙龈肿胀情况、口腔卫生情况及疼痛程度。结果 研究组治疗总有效率为93.33%,高于对照组的77.78%（P ＜0.05）;两组治疗后Ⅰ级牙龈肿胀占比高于对照组,Ⅲ级牙龈肿胀低于对照组（P ＜0.05）;两组Ⅱ级牙龈肿胀情况比较,差异无统计学意义（P ＞0.05）;研究组治疗后GI、CI、PLI、SBI均低于对照组（P ＜0.05）;研究组治疗后VAS评分低于对照组（P ＜0.05）。结论 牙龈清洁术联合康复新液治疗口腔正畸患儿慢性牙龈炎的临床效果良好,可有效减轻患儿的牙龈肿胀及疼痛症状,改善口腔卫生情况,有利于提升治疗效果。