Endobronchial metastases from extrapulmonary solid tumors

Malignancy detected during endobronchial biopsies is usually regarded as proof of lung cancer. It may, however, represent endobronchial metastases from extrapulmonary primary tumors. The literature was reviewed to describe how frequent extrapulmonary tumors have been reported to metastasize to the endobronchial epithelium. English language literature was searched from 1962 through 2002. Primary lung cancer and lymphomas were excluded. Endobronchial metastases were reported in 204 patients, originating from 20 different extrapulmonary primary tumors, usually cancers of the breast, kidney, colorectal, uterine cervix, sarcoma and skin. The mean time from diagnosis of primary tumor was 50 months (range 0-300 months) and mean survival time from diagnosis of endobronchial metastasis was 15.2 months (range 0-150 months). It is important to make a distinction between endobronchial metastases from primary lung cancer, as treatment possibilities may be different. The possibility of endobronchial metastasis should be considered if the patient has a history of malignancy in other organs.     

Primary peritoneal tumors: report on a series of eight cases and review of the literature

Primary peritoneal tumors are rare and yet not well-known malignancies. We report here the clinical cases of 8 patients who were referred to our institution with a primary peritoneal tumor, 4 serous carcinomas (PSC) and 4 malignant mesotheliomas (PMM). Diagnosis was available in all cases and reviewed by two pathologists. A battery of various immunomarkers contributed to confirm the morphological diagnosis. All patients underwent initial surgery with or without optimal debulking. All of them received a platinum-based systemic chemotherapy. Intraperitoneal treatment with cisplatin and hyperthermia was performed in two cases. Four patients are dead (3 PSC, 1 PMM), two are alive (one in partial remission (1 PSC) and one is having treatment (1 PMM)), one is in complete remission (1 PMM) and one is lost to follow up (1 MMP). PSC and PMM are difficult to distinguish since they share the embryonic cOElomic epithelium as a common origin. The clinical presentations are similar and usually include the detection of a pelvic mass and/or diffuse peritoneal carcinomatosis with or without malignant ascites. Therefore, the accuracy and reliability of the initial histological examination is of crucial importance. Further attempts will be required to better identify the most active therapeutic post-surgical combinations, especially for PMM.     

Massive hemoperitoneum secondary to spontaneous rupture of hepatic metastases: report of two cases and review of the literature

Two cases of massive hemoperitoneum secondary to spontaneous rupture of hepatic metastases are presented. This devastating complication of hepatic malignant disease is difficult to diagnose preoperatively. However, the diagnosis should be considered in patients with known malignant disease who present with unexplained blood loss, shock, or signs consistent with an acute surgical abdomen. The presence of fever and leukocytosis with these signs and symptoms may also be part of the clinical picture. Treatment by hepatic resection is never curative. Review of the literature indicates that local control of the bleeding site by suture ligature, packing with topical hemostatic agents, or hepatic artery ligation offers the best chances of obtaining hemorrhage control and some degree of palliation in these desperately ill patients.     

慢性粒细胞白血病合并恶性实体瘤八例并文献复习

目的 探讨慢性粒细胞白血病(CML)合并恶性实体瘤患者的临床特点,并复习相关文献.方法 回顾性分析2006年8月至2018年8月郑州大学附属肿瘤医院、南阳市中心医院、河南科技大学第一附属医院、新乡市中心医院收治的8例明确诊断为CML且合并恶性实体瘤患者的资料,并结合文献对患者临床特征、治疗及预后进行总结.结果 8例患者中,男性3例,女性5例,中位年龄50岁(40~76岁).发病初7例患者CML处于慢性期,1例处于加速期;除1例仅给予羟基脲治疗外,其余7例均服用酪氨酸激酶抑制剂(TKI)治疗.8例患者中,同时性多原发癌(SMPC)2例,异时性多原发癌(HMPC)6例;手术治疗2例,手术+化疗1例,化疗4例,同位素治疗1例.1例SMPC患者已死亡,1例治疗中;6例HMPC患者均在继续治疗中.结论 CML与恶性实体瘤之间的关系目前暂无定论,发病少但并不罕见,临床医生应该提高认识,避免误诊和漏诊,治疗上应遵循综合治疗及个体化治疗两条主线.     

皮肤转移癌5例报告并文献复习

目的:了解皮肤转移癌的特点,提高皮肤转移癌的诊治水平.方法:报道5例来源于不同恶性肿瘤的皮肤转移癌病例,并复习相关文献.结果:5例肿瘤的恶性程度较高,皮肤转移发生在术后6月到18月,其中4例合并重要脏器转移,临床症状与皮肤病症状类似,通过以化疗为主的综合治疗获得较好疗效.结论:皮肤转移癌的临床发生率较低,常合并其他重要脏器转移,预示肿瘤已进入晚期,其诊断依靠病史和结节活检.及时诊断、积极治疗对于减轻患者痛苦,延长生存期有重要意义.     

Extracranial metastases in childhood primary intracranial tumors. A report of 21 cases and review of the literature

A clinical and pathologic review of primary intracranial tumors (917 cases in a 62-year period) at The Hospital for Sick Children, Toronto, identified 21 cases with systemic metastases (2.3%). This included 15 cases of medulloblastoma and 1 case each of astrocytoma, meningeal sarcoma, malignant melanoma, ependymoblastoma, teratoma, and endodermal sinus tumor, adding to the pediatric literature of 94 previously reported cases (72 medulloblastoma and 22 cases of other brain tumors). Like adults, children with medulloblastoma tend to develop bone and bone marrow metastases, while those with other brain tumors frequently invade adjacent tissues, and then spread to regional lymph nodes and the lungs. The prognosis is almost uniformly fatal, although prolonged palliation could be achieved with radiation and/or chemotherapy. The pathogenesis of systemic metastases is related to breakage of the blood-brain barrier, whether at surgery, or with tumor invasion into vascular channels, and especially with preoperative systemic-cerebrospinal fluid shunting. Thirteen of 16 patients who developed systemic metastases, including 5 with peritoneal involvement, had ineffective or no millipore filters within their shunts, suggesting their possible prophylactic role against tumor dissemination. A greater understanding of the pathogenesis of systemic metastases may aid the design of future effective preventive measures.     

8例外周性原始神经外胚层肿瘤的病理、CT、MRI表现并文献复习

背景与目的:外周性原始神经外胚层肿瘤(primitive neuroectodermal tumor,pPNET)罕见。本研究目的是分析外周性PNET的影像学及病理学表现,以提高对本病的认识。方法:回顾性分析有完整影像学资料及经病理证实的8例PNET。结果:1例病灶位于上颌窦,1例位于鼻旁,1例位于肩颈部,2例位于胸腔,2例位于纵隔,1例位于骶尾部臀大肌。本组病例均表现为软组织肿块,CT显示病灶范围大、边界不清,密度不均匀且伴坏死囊变,部分病灶内有沙砾样钙化,增强后呈不均匀强化。软组织肿块侵蚀临近骨质时表现为溶骨性骨质破坏。在MRI SE T1WI上表现为等或低信号,T2WI上表现为不均匀高信号,部分病例可见假包膜或分隔样改变。病理形态上Homer-Wright菊形团为其特异性表现,免疫组织化学结果,肿瘤均表达CD99,3例检测NSE和VIM者结果均呈阳性,5例检测CK者结果均呈阴性,并且不表达白细胞共同抗原(LCA)等。结论:pPNETs的病理及免疫组化可提供诊断依据。pPNETs的CT与MRI缺乏特征性表现,但能较好的显示肿瘤的内部结构、明确肿瘤的范围,有助于指导制定治疗方案和评价治疗效果。     

Cushing's syndrome secondary to bronchopulmonary carcinoid tumor: report of two cases and literature review

Bronchopulmonary carcinoid tumors have been associated with a variety of endocrine disorders including Cushing's syndrome (CS), which is caused by ectopic adrenocorticotrophic hormone (ACTH) secretion. We report two cases of CS secondary to bronchopulmonary carcinoid tumors. The first patient, a 29-year-old woman, presented hypokalemia, high serum ACTH level and high free-urinary cortisol, raising suspicion of an ectopic ACTH syndrome. Chest computed tomography and Octreoscan showed a peripheral nodule in the left-superior lobe of the lung. After lobectomy, a typical bronchopulmonary carcinoid was diagnosed. The second patient, a 16-year-old boy, presented "moon face" and progressive asthenia, high serum ACTH level and high free-urinary cortisol, raising the same hypothesis. Chest computed tomography and Octreoscan showed a peripheral nodule in the middle lobe. After lobectomy, an atypical bronchopulmonary carcinoid was diagnosed. Both cases had IA stage (T1N0M0), positively immunostaining for chromogranin and ACTH. Neither of these patients had hypophysary microadenomas, adrenal adenomas or recurrence of CS after surgical treatment, demonstrating that CS was caused solely by the presence of the bronchopulmonary carcinoid tumors.     

Multiple extracranial metastases from secondary glioblastoma multiforme: a case report and review of the literature

Extracranial metastasis of glioblastoma multiforme (GBM) is very rare, in spite of very aggressive tumor behavior and being documented in only a few patients. In this article we present a 25-year-old man with secondary glioblastoma associated with extracranial progression and distant metastasis. He was diagnosed by magnetic resononce (MR) with an intracranial lesion in the right parietofrontal region, which was subsequently resected. Histology revealed a diffuse astrocytoma (grade II). The tumor recurred 1 year later and the patient received a second craniotomy. A diagnosis of GBM was made. After radiotherapy, he presented with right cervical lymph node metastases. The cytomorphological features supported a diagnosis of metastatic glioblastoma multiforme. The neck dissection was made and histology confirmed the fine needle aspiration diagnosis of glioblastoma multiforme. MR with diffusion-weighted imaging revealed right cervical lymph node metastases and multi-bone metastases (mainly pelvic bone) 3 weeks later.     

Brain metastases from endometrial carcinoma: report of three cases and review of the literature

AIMS AND BACKGROUND: Endometrial carcinoma is a rare cause of brain metastases, accounting for less than 1% of all metastatic lesions to the brain. This report aims to review our experience in the treatment of patients with brain metastases from endometrial carcinoma in order to establish the characteristics of these patients and evaluate the results and efficacy of whole-brain radiation therapy as a palliative measure. METHODS: Three cases of brain metastases from endometrial carcinoma treated with radiotherapy were identified in the files of the Division of Radiotherapy at the A. Businco Regional Oncological Hospital of Cagliari between 1999 and 2005. RESULTS: All patients had brain metastases as the only sign of systemic disease (a single lesion in 2 patients and 2 lesions in 1 patient). Two patients were classified as RTOG RPA class I and 1 patient as class III. Radiotherapy to the brain was delivered after surgical resection in the first 2 patients and as the only method of palliation in the third patient. The delivered radiation dose was 3000 cGy in 10 fractions over 2 weeks in the postoperative setting and 2000 cGy in 5 fractions over 1 week to the patient treated with irradiation alone. The 2 surgically treated patients are alive and well after 16 and 64 months, respectively. The patient treated with palliative intent died 2 months after irradiation. CONCLUSIONS: The combination of surgery and postoperative whole-brain irradiation in selected patients with solitary brain metastases from endometrial carcinoma is an effective method of palliation.     

Leptomeningeal carcinomatosis originating from gastric cancer: report of eight cases and review of the literature

Leptomeningeal carcinomatosis caused by metastatic gastric adenocarcinoma has been rarely reported in the United States. We present eight cases of patients with gastric cancer who subsequently developed meningeal carcinomatosis. On average, patients presented with symptoms of leptomeningeal disease (LMD) 12 months after the initial diagnosis. Distinguishing features include a predominance of poorly differentiated histology, typically associated with signet ring cells, a diffuse pattern of primary organ involvement, systemic dissemination in the form of peritoneal carcinomatosis, and development of LMD despite responsiveness to chemotherapy elsewhere in the body. The natural history of these patients, with or without treatment, was uniformly poor. Although previously thought to be an extremely rare event, LMD in the setting of gastric adenocarcinoma may be a problem on the rise, possibly due to the increasing survival times of patients. Physicians should have a high index of suspicion since no single test can reliably diagnose this entity in all cases. Furthermore, the striking clinical picture of patients with LMD raises interesting questions about the biology and metastatic behavior of certain subclasses of gastric cancer.     

Priapism secondary to penile metastasis: A report of two cases and a review of the literature

Malignancy metastasis to the penis is an uncommon clinicopathological entity. We present two cases of malignant priapism following penile metastasis, in which the diagnosis was established by core needle biopsy of the corpus cavernosum. Primary tumors were urothelial carcinoma of the urinary bladder in one case (the patient having concomitant high-grade prostatic adenocarcinoma) and prostatic adenocarcinoma in the other. The clinicopathological features of 51 previously reported cases of penile metastasis in the recent literature are reviewed. J. Surg. Oncol. 1998:68:51–59. © 1998 Wiley-Liss, Inc.     

Metastatic tumors of the umbilicus: report of two cases and review of the literature

An umbilical nodule may be an early or late sign of metastatic spread from an internal malignancy. Usually it appears when the internal malignancy is widely disseminated and has been previously diagnosed. More rarely, such a nodule is the first sign of disease and eventually results in the diagnosis of the primary tumor. We present two cases which document examples of both events, in order to focus on the most relevant aspects of this condition.     

B细胞非霍奇金淋巴瘤继发第二肿瘤3例报告并文献复习

 目的 通过报道3例B-NHL继发第二肿瘤复习多原发癌病因、治疗、预后。方法 分析我院近年3例B-NHL继发第二肿瘤患者临床资料,复习国内外相关文献。结果 3例B-NHL治疗后分别继发白血病、肝癌、食管癌。 结论 B-NHL治疗后要长期密切随访,做到早发现,早诊断,早治疗第二肿瘤。     

皮肤转移癌5例报告并文献复习

目的：了解皮肤转移癌的特点，提高皮肤转移癌的诊治水平。方法：报道5例来源于不同恶性肿瘤的皮肤转移癌病例，并复习相关文献。结果：5例肿瘤的恶性程度较高，皮肤转移发生在术后6月到18月，其中4例合并重要脏器转移，临床症状与皮肤病症状类似，通过以化疗为主的综合治疗获得较好疗效。结论：皮肤转移癌的临床发生率较低，常合并其他重要脏器转移，预示肿瘤已进入晚期，其诊断依靠病史和结节活检。及时诊断、积极治疗对于减轻患者痛苦，延长生存期有重要意义。     

输卵管交界性肿瘤五例并文献复习

目的探讨输卵管交界性肿瘤的临床病理学特征及诊治要点。方法回顾性分析5例输卵管交界性肿瘤患者及文献报道的21例患者的临床及病理学资料。结果 26例患者年龄3～75岁,平均36.1岁,主要临床表现为下腹痛（30.8%）和盆腔包块（84%）,超声检查可于附件区探及囊性包块内有中强乳头状回声,血清CAl25水平多正常（〈35 U/ml）或仅轻度升高（平均89.9 U/ml）;肿瘤多局限于一侧输卵管或系膜内（96.2%,25/26）,直径1.7～13 cm,平均5.8 cm,22例为囊性,其中73%内壁有乳头突起,3例为实性,组织学类型以浆液性肿瘤（69.2%,18/26）居多;手术方式2例不详,16例行保留生育功能的手术,其中3例采取全面分期/再分期手术,13例未分期,仅行肿瘤剔除（4例）、输卵管部分或全部切除（6例）或患侧附件切除（3例）,其余8例接受子宫及双附件切除术,其中2例行全面分期/再分期手术;术后随访6～84个月,均无复发。结论输卵管交界性肿瘤好发于年轻女性,临床表现缺乏特异性,术前诊断困难,确诊依靠手术探查及病理检查,诊断时多为早期,预后好,保留生育功能的保守性手术是安全可行的,全面分期手术的治疗意义有待观察,进一步的结论需积累更多病例加以明确。     

Subdural hematoma secondary to metastatic neoplasm: report of two cases and a review of the literature.

Subdural hematoma secondary to dural metastases is a rare event. Vascular obstruction due to invasion of dural vessels is an important etiological factor. When this is associated with a clotting defect, the subdural hematoma can cause significant clinical symptoms and death. Two cases are presented with a review of the literature.     

Metastatic tumors in the breast: a report of 5 cases and review of the literature

Breast cancer is the most common malignancy in women. However, metastases to the breast from nonmammary malignant neoplasms are rare and were detected at a rate of 0.28% in our series. Clinical and pathologic findings in 5 cases of metastatic tumors (malign mesenchymal tumor, squamous cell carcinoma of the tongue, non-Hodgkin lymphoma, and Sézary syndrome) in the breast are presented and discussed with respect to the literature. Detailed clinical history and a multidisciplinary approach are useful in establishing correct diagnosis and preventing unnecessary radical surgery.     

血管免疫母细胞性T细胞淋巴瘤继发急性髓系白血病三例并文献复习

目的 探讨血管免疫母细胞性T细胞淋巴瘤（AITL）继发急性髓系白血病（AML）的临床特征、发病机制、诊断、治疗及预后。方法 回顾性分析3例AITL继发AML患者的临床资料,包括免疫组织化学、流式细胞术结果,并进行文献复习。结果 3例均为老年男性患者,初诊为AITL,分别于治疗后的8、14及34个月继发AML。继发AML后,1例未治疗于10个月后死亡,1例积极治疗后于13个月后死亡,另1例失访。结论 AITL有继发AML的风险,其发病机制目前尚不清楚,预后较差。