Calvarial Metastasis of a Renal Cell Carcinoma, Mimicking a Primary Alveolar Soft Part Sarcoma, in a Young Girl—a Rare Case Report

Renal cell carcinoma (RCC) is characterized by an unpredictable clinical behavior. It has a tendency for early metastasis, which, at times is the initial presentation and therein poses a diagnostic challenge. We present a rare case of a disseminated RCC in a 15-year-old girl, who primarily presented with an occipital soft tissue mass. Computed tomography (CT) of the head revealed a soft tissue mass in the scalp, eroding the occipital bone and extending intracranially. Biopsy examination showed overlapping features of an alveolar soft part sarcoma (ASPS) and a RCC. Immunohistochemistry (IHC) showed diffuse positivity for CD10 and focal positivity for vimentin. Cytokeratin (CK) and epithelial membrane antigen (EMA) were negative. The patient was recommended a clinical ‘work-up’ to rule out a possible primary in the kidneys. Her CT scan abdomen unraveled a large, lobulated, heterogeneous cystic mass, involving the middle and upper pole of the left kidney. Diagnosis of a metastatic RCC was ascertained. The present case represents a rare manifestation of a RCC metastasizing at an unusual location i.e. calvarium in the youngest patient known, so far and masquerading a primary ASPS. It also highlights the value of clinico-patho-radiological correlation, including CD10 as a useful IHC marker in diagnosing a RCC in young patients, especially when histopathological features overlap with ASPS.     

Gallbladder cancer, a vanishing disease?

Objective

Gallbladder cancer (GBC) is a rare gastrointestinal malignancy. A retrospective population-based study was conducted to evaluate trends in incidence, treatment, and outcome of GBC in the latter three decades in the south of the Netherlands.

Methods

All patients diagnosed with GBC diagnosed in the Dutch Eindhoven Cancer Registry area between 1975 and 2008 were included (n?=?659). Trend analyses were conducted for treatment and survival.

Results

During this time period, standardized incidence in females and males plummeted from 4.5 to 0.7 and from 2.0 to 0.4 per 100,000 inhabitants, respectively. Resection rates decreased from 74.3 to 53.4?%. Chemotherapy and radiotherapy rates did not change and were used sparingly. Five-year survival remained stable (10?%) over time.

Conclusion

The age-standardized incidence of GBC declined drastically over the last three decades. An increasing number of early cholecystectomies for gallstones may play a role. Parallel to the decreasing incidence of stomach cancer, the effective treatment of Helicobacter pylori may also have resulted in a lowered incidence of GBC.     

Does lapatinib,a small-molecule tyrosine kinase inhibitor,constitute a breakthrough in the treatment of breast cancer?

ErbB/HER receptor or its signal transduction pathway is an attractive therapeutic target for breast cancer. Lapatinib, an orally administered dual inhibitor of ErbB1 (EGFR) and ErbB2 (HER2) receptor tyrosine kinases has shown promising results for metastatic breast cancer (MBC). Lapatinib exhibited activity against trastuzumab-refractory MBC and showed an acceptable adverse event profile such as transient mild rash, diarrhea and nausea. The addition of lapatinib to capecitabine resulted in significantly prolonged time to progression. Large randomized trials using lapatinib following chemotherapy and surgery are ongoing for early stage HER2-overexpressing breast cancer. Various combinations with agents such as paclitaxel, aromatase inhibitors, or other molecular targeted agents are currently being investigated in clinical trials. If these approaches overcome the limitations of trastuzumab, lapatinib will become an effective treatment option for breast cancer in the near future.     

Cancer, a defect of the psyche?

Patients and families often put forward psychosocial determinants to explain occurring or progression of cancer disease. The idea of a psychogenesis in cancer is widely spread by the surrounding culture. Nevertheless, the scientific research in this field brought very contradictory results, and often rests on debatable methods. Some authors hypothesize that a type C personality predisposes to cancer. But so far, most of prospective studies analysing the association between C traits and this disease have been negative. Results of semi-prospective studies, in which patients are enlisted before a diagnostic investigation, are difficult to interpret, because the starting features can partly result from the stress of this investigation. The same problem interferes with most studies about the association between alexithymia and cancer. The reliable works analysing the impact of depression most often conclude in favour of a non-existent or a weak risk, and do not allow defining it as a well established risk factor. Most of prospective studies about the link between stress and cancer are negative. Moreover, they index stressful life events occurred for a few years before the diagnosis, that is to say during a too short delay to be allowed to incriminate them in the supervening of the disease. The question of the possible impact of coping styles with cancer on its evolution also remains debated. Some studies for instance plead in favour of a beneficial effect of fighting spirit or denial, but they are contradicted by other studies. All this forces us to be very careful when discussing the possible links between psyche and cancer. It is important to underline the hypothetical nature of these relationships. Psychosomatic explanations risk to be used to fill in gaps of knowledge, and to give us the illusion that we can avoid or control a disease which escapes us. They especially risk to make the patients guilty of their cancer or its evolution, through an inadequate point of view which does not take the complexity in stake into account.     

Bladder cancer,a two phased disease?

The processes of intraepithelial migration, intraluminal seeding, and field cancerization as models for initiation, spread, and recurrences of urothelial cell carcinoma (UCC) are reviewed in light of recent molecular investigations. The accumulated molecular data on synchronous and metachronous tumors indicate that the majority of recurrent and multiple tumors are monoclonal. Molecular data has also shown the presence of chromosomal and genetic changes in precursor lesions as well as in normal urothelial cells. Genetic-histological mapping of cystectomized bladders has shown that overt tumors occur as local events in areas of genetically altered urothelium. A model is put forward in which the tumor process is initiated by genetically altered but histologically normal cells that produce fields of altered cells by intraepithelial displacement. By the accumulation of further genetic changes the fields of altered urothelium reaches a state of criticality, which locally may produce frank tumors.     

Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective,population-based study

Background:

A healthy lifestyle following a cancer diagnosis may improve long-term outcomes. No studies have examined health behaviour change among UK cancer survivors, or tracked behaviours over time in survivors and controls. We assessed smoking, alcohol and physical activity at three times (0–2 years before a cancer diagnosis, 0–2 years post-diagnosis and 2–4 years post-diagnosis) and at matched times in a comparison group.

Methods:

Data were from waves 1–5 of the English Longitudinal Study of Ageing; a cohort of older adults in England. Behavioural measures were taken at each wave. Generalised estimating equations were used to examine differences by group and time, and group-by-time interactions.

Results:

Of the 5146 adults included in the analyses, 433 (8.4%) were diagnosed with cancer. Those with a cancer diagnosis were less likely to be physically active (P<0.01) and more likely to be sedentary (P<0.001). There were no group differences in alcohol or smoking. Smoking, alcohol and activity reduced over time in the whole group. Group-by-time interactions were not significant for smoking (P=0.17), alcohol (P=0.20), activity (P=0.17) or sedentary behaviour (P=0.86), although there were trends towards a transient improvement from pre-diagnosis to immediately post-diagnosis.

Conclusion:

We found little evidence that a cancer diagnosis motivates health-protective changes. Given the importance of healthy lifestyles, strategies for effective support for behaviour change in cancer survivors need to be identified.     

Revealing a cancer diagnosis to patients: attitudes of patients,families, friends,nurses, and physicians in Lebanon—results of a cross-sectional study

Background

Disclosure of a cancer diagnosis to patients is a major problem for physicians in Lebanon. Our survey aimed to identify the attitudes of patients, families and friends, nurses, and physicians regarding disclosure of a cancer diagnosis.

Methods

Study participants included 343 physicians, nurses, cancer patients, families, and friends from clinics in two major hospitals in Lebanon. All completed a 29-item questionnaire that assessed, by demographic group, the information provided about cancer, opinions about the disclosure of the diagnosis to cancer patients, perceived consequences to patients, and the roles of family, friends, and religion.

Results

Overall, 7.8% of the patients were convinced that cancer is incurable. Nearly 82% preferred to be informed about their diagnosis. Similarly, 83% of physicians were in favour of disclosing a cancer diagnosis to their patients. However, only 14% of the physicians said that they revealed the truth to the patients themselves, with only 9% doing so immediately after confirmation of the diagnosis. Disclosure of a cancer diagnosis was preferred before the start of the treatment by 59% of the patients and immediately after confirmation of the diagnosis by 72% of the physicians. Overall, 86% of physicians, 51% of nurses, and 69% of patients and their families believed that religion helped with the acceptance of a cancer diagnosis. A role for family in accepting the diagnosis was reported by 74% of the patients, 56% of the nurses, and 88% of the physicians. All participants considered that fear was the most difficult feeling (63%) experienced by cancer patients, followed by pain (29%), pity (8%), and death (1%), with no statistically significant difference between the answers given by the participant groups.

Conclusions

The social background in Lebanese society is the main obstacle to revealing the truth to cancer patients. Lebanese patients seem to prefer direct communication of the truth, but families take the opposite approach. Physicians also prefer to communicate the reality of the disease at the time of diagnosis, but in actuality, they instead disclose it progressively during treatment. Faith is helpful for acceptance of the diagnosis, and families play a key role in the support of the patients. An open discussion involving all members of society is necessary to attain a better understanding of this issue and to promote timely disclosure of a cancer diagnosis.     

Environmental tobacco smoke, carcinogenesis, and angiogenesis: a double whammy?

In this issue of Cancer Cell, Zhu and coworkers demonstrate that environmental tobacco smoke (ETS) results in tumor angiogenesis, and provide evidence that the responsible factor in ETS is nicotine. While a weak carcinogen, nicotine promotes carcinogenesis by a number of different mechanisms. The authors' findings provide further evidence of the harmful effects of ETS and indicate the desirability of reducing exposure to it.     

Belonging to a network—microRNAs,extracellular vesicles,and the glioblastoma microenvironment

The complexity of glioblastoma multiforme (GBM) and its distinct pathophysiology belong to a unique brain microenvironment and its cellular interactions. Despite extensive evidence of a role for microRNAs in GBM cells, little is known about microRNA-dependent communication between different cellular compartments of the microenvironment that may contribute to the tumor phenotype. While the majority of microRNAs are found intracellularly, a significant number of microRNAs have been observed outside of cells, often encapsulated in secreted extracellular vesicles (EVs). The function of these circulating/secreted microRNAs has not been explored in the context of the brain tumor microenvironment. Establishing how microRNAs are involved in the regulation of oncogenic signaling networks between tumor cells and stroma is likely to add a needed additional layer of complexity to the tumor network, consisting of intercellular communication. More importantly, microRNA/EV signaling may provide an additional therapeutic target for this deadly disease.     

Mitomycin C-induced renal toxicity,a dose-dependent side effect?

Mitomycin C (MMC) has been known to be nephrotoxic since 1971. Whether this side effect was dose-dependent is unknown, while data on incidence are scanty. The presently-reported prospective study was initiated with the objective to obtain more data on these subjects. Forty-four patients treated with MMC entered the study, 37 were evaluable. All patients were subjected to extensive serial laboratory tests to study renal function and to detect hemolysis or coagulation disorders. The results were evaluated per cumulative dose level. One patient developed a lethal hemolytic uremic syndrome after 40 mg/m² MMC. None of the laboratory tests predicted this side effect. None of the other patients developed renal toxicity, while all laboratory tests remained within normal ranges. All available literature on this subject was also reviewed. Based on the results of the present study, as well as on the literature review, it is concluded that MMC-related renal toxicity is a dose-dependent side effect, occurring at cumulative dose levels of 30 mg/m² or more. The incidence is likely to be less than 10%. Predictive laboratory test could not be indicated.