Metastatic carcinoma of the thyroid gland:as report of 35 cases

Objective To study the clinical characteristics,diagnosis,treatment and prognosis of cancer metastasis to the thyroid gland. Methods A restropective review was performed on 35 patients with cancer metastasis to the thyroid gland in our hospital from 1958 to 2010l.     

Case report and literature review: Metastatic lobular carcinoma of the breast an unusual presentation

Introduction

Invasive lobular carcinoma is the second most common type of invasive breast carcinoma (between 5% and 15%). The incidence of invasive lobular carcinoma has been increasing while the incidence of invasive duct carcinoma has not changed in the last two decades. This increase is postulated to be secondary to an increased use of combined replacement hormonal therapy. Patients with invasive lobular carcinoma tend to be slightly older than those with non-lobular invasive carcinoma with a reported mean age of 57 years compared to 64 years. On mammography, architectural distortion is more common and microcalcifications less common with invasive lobular carcinoma than invasive ductal carcinoma. The incidence of extrahepatic gastrointestinal (GI) tract metastases observed in autopsy studies varies in the literature from 6% to 18% with the most commonly affected organ being the stomach, followed by colon and rectum. Gastric lesions seem to be slightly more frequent, compared to colorectal lesions (6–18% compared to 8–12%, respectively).

Presentation of case

We present the case of a 70-year-old woman who was referred to our institution with a concurrent gastric and rectal cancer that on further evaluation was diagnosed as metastatic invasive lobular carcinoma of the breast. She has a stage IV clinical T3N1M1 left breast invasive lobular carcinoma (ER positive at 250, PR negative, HER-2/neu 1+ negative) with biopsy proven metastases to left axillary lymph nodes, gastric mucosa, peritoneum, rectal mass, and bone who presented with a partial large bowel obstruction. She is currently being treated with weekly intravenous paclitaxel, bevacizumab that was added after her third cycle, and she is also receiving monthly zoledronic acid. She is currently undergoing her 12-month of treatment and is tolerating it well.Discussion Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women aged 20–59 years. It accounts for 26% of all newly diagnosed cancers in females and is responsible for 15% of the cancer-related deaths in women.⁹ Breast cancer is one of the most common malignancies that metastasize to the GI tract, along with melanoma, ovarian and bladder cancer.

Conclusion

We present one of the first reports of metastatic lobular breast cancer presenting as a synchronous rectal and gastric tumors. Metastatic lobular carcinoma of the breast is a rare entity with a wide range of clinical presentations. A high level of suspicion, repetition of endoscopic procedures, and a detailed pathological analysis is necessary for early diagnosis, which might help to avoid surgical treatment due to incorrect diagnosis. Patients with a history of breast cancer who present with new gastrointestinal lesions should have these lesions evaluated for evidence of metastasis through histopathologic evaluation and immunohistochemical analysis. Differentiating between a primary GI lesion and metastatic breast cancer will allow initiation of appropriate treatment and help prevent unnecessary operations.     

Sialadenoma papilliferum of the parotid gland: Case report and review of literature

Sialadenoma papilliferum is a rare benign salivary gland tumor. We present an unusual case of sialadenoma papilliferum of the parotid gland, discuss clinical presentation, diagnostic challenges, and review of the literature. A 65‐year‐old male smoker presented with a large, exophytic, fungating, painless mass in the tail parotid for 8 years. The tumor developed an exophytic component 2 years before presentation. The patient subsequently underwent superficial parotidectomy with facial nerve preservation. Initial pathological analysis suggested a variant of Warthin's tumor. The pathology underwent extensive internal and external review. Final diagnosis was consistent with sialadenoma papilliferum. We present the fourth reported case of sialadenoma papilliferum within the parotid gland and only the second that has presented with breach of the overlying skin. The clinical presentation may mimic an advanced parotid malignancy. However, facial nerve preservation and good surgical outcomes can be obtained. © 2011 Wiley Periodicals, Inc. Head Neck, 2013     

Acinic cell carcinoma of the parotid gland: Auckland experience and literature review

Acinic cell carcinoma is an uncommon malignancy of the salivary glands and as such it has been difficult to accurately delineate its natural history. The aim of this study is to assess the behaviour of acinic cell salivary cancer of the parotid gland presenting to a single head and neck surgical unit in Auckland. The study is a structured review of cases of acinic cell carcinoma of the parotid gland presenting from 2000 to 2006 to the Head and Neck Unit at Auckland Hospital, those identified from the pathology database and the Otobase head and neck database. Case records and pathology reports were reviewed. Fifteen patients were identified, 9 men and 6 women. The mean age was 67.2 years, with range 50-85 years. The mean follow up was 4.4 years and range 1.1-7 years. There was one case of local recurrence during study period and no deaths. Five of 15 patients received postoperative radiotherapy. Postoperative complications consisted of one wound haematoma and two cases of marginal mandibular weakness (one transient and one permanent). Current management strategies are obtaining appropriate rates of recurrence and postoperative complications within the Auckland population.     

Myoepithelioma of the parotid gland in a child: a case report

Myoepitheliomas of the parotid glands are very rare in the pediatric population. Only a few cases of myoepitheliomas of the salivary glands have been reported in children. They have some similar features with pleomorphic adenoma. However, they may be malignant and infiltrate locally. Hence, histopathologic examination should be considered to differentiate these tumors. The treatment of myoepitheliomas is complete removal of the tumor. We report a child with myoepithelioma of the parotid gland and review the related literature.     

Carcinoma of the parotid gland

BACKGROUND: The low incidence and heterogeneity of histiotypes of primary parotid carcinomas makes these tumors histologically and epidemiologically difficult to evaluate. The present study reviews a single institution's experience in the treatment of primary parotid carcinomas during the last 10 years. METHODS: The charts of 98 consecutive patients who had a primary parotid carcinoma and who received primary curative treatment were analyzed retrospectively. The tumors were grouped into high-grade and low-grade malignancies. The effect of treatment modalities on locoregional control, the incidence of locoregional recurrences and distant metastases, and survival rates are evaluated and compared between high- and low-grade malignancies. RESULTS: High- and low-grade malignant tumors were observed in 50 and 48 cases, respectively. Lymph node metastases were detected in 25 of 98 (25%) patients, of whom 8 of 22 (22%) clinically NO staged patients underwent elective neck dissection. In 24 of 26 resected facial nerves, a histologic tumor infiltration was confirmed, in 14 high-grade and 10 low-grade tumors. Local recurrence developed in 13 patients and was associated in 7 with high-grade and in 6 with low-grade tumors. All but 1 of the low-grade malignancies with local recurrence did not receive postoperative irradiation. Regional recurrence developed in 11 patients and distant metastases developed in 10, 3 in combination with a neck recurrence and 1 with a local recurrence. The survival rate at 5 years for low- and high-grade carcinomas was 87% and 56% and the disease-free survival rate 72% and 48%, respectively. CONCLUSIONS: The incidence of occult metastases in clinically N0-elective neck dissection was 22%. A routine elective neck dissection in all N0 parotid carcinomas is suggested. There is no statistically significant difference between low- and high-grade tumors as for the rate of local recurrence and, as all except one of the low-grade malignancies with local recurrence did not receive postoperative irradiation, postoperative irradiation is not only suggested for high-grade carcinomas but also for T2 to T4 low-grade carcinomas.     

Branchial cyst of the parotid gland

Summary Cystic lesions in parotid glands are rare, and on clinical examination alone, accurate diagnosis is impossible. A case of a 27-year-old male patient with such a cystic lesion is presented. The cyst was removed surgically by superficial parotidectomy and pathological examination revealed a branchial cyst of the parotid gland.     

Hepatocellular carcinoma with chondrosarcomatous variation: Case report with immunohistochemical findings, and review of the literature

Hepatocellular carcinoma with chondrosarcomatous variation is very rare. We report a case with the results of pathology examination, and review the literature. The patient, a 72-year-old may had a very large tumor in the liver revealed during follow-up for diabetes mellitus. The liver mass, which was 14 cm in diameter, was diagnosed as hepatocellular carcinoma by abdominal ultrasonography. Anterior segmentectomy and partial liver resection were performed. Histopathology examination revealed that the tumor consisted of two different components: the major one was hepatocellular carcinoma (HCC), which occupied most of the tumor; and a sarcomatous component, which occupied a smaller area, and included spindle-shaped cells with chondroscarcomatous variation. Intrahepatic metastases and tumor thrombi of HCC were also found in portal and hepatic veins. Investigations of the immunohistochemical localization of keratin (KRT), vimentin (VMT), and S-100 protein (S 100) were performed by the avidin-biotin complex method. Some of the spindle cells were immunohistochemically positive for both KRT and VMT, and the chondrosarcomatous cells were positive for S 100. These results strongly suggested that the sarcomatous lesion resulted from a sarcomatous change of HCC. Received for publication on Aug. 18, 1997; accepted on Dec. 12, 1997     

Metastatic basal cell carcinoma to the lungs diagnosed by means of fine needle aspiration

Summary The case of a 50-year-old patient is presented, suffering from multiple penetrating basal cell carcinomas of the forehead, left orbit, auricle and scalp. He was first irradiated 25 years ago and since which time the patient has undergone repeated excisions. The orbital lesion which has penetrated deeply has caused blindness of the left eye, necessitating exenteration. Two years ago the patient developed metastases to the hilus of both lungs, which were diagnosed by means of fine needle aspiration. These lesions are spreading notwithstanding radiotherapy.     

Infantile congenital parotid lipomatosis: a rare case report

A case of congenital parotid lipomatosis in an infant is reported and literature is reviewed. This rare condition in children presents as gradually increasing parotid swelling, which is difficult to diagnose preoperatively as this condition is not considered in the differential diagnosis of a parotid mass. Complete excision with superficial or total parotidectomy with preservation of facial nerve is the treatment of choice.     

胆管内生长型肝细胞癌1例

正患者男,62岁,无明显诱因间歇性上腹钝痛2月余,伴尿黄;乙型肝炎病史20年。查体:巩膜稍黄染,上腹部稍压痛,无反跳痛,墨菲征阳性。实验室检查:直接胆红素25.6U/L,甲胎蛋白(alpha-fetoprotein,AFP)1 544.4U/L。腹部超声示肝外胆管内实性低回声填充(图1A),边界不清,未见明显血流信号;肝内胆管扩张,呈"蝴蝶征";CEUS动脉相病灶呈不均匀稍低增强,门静脉相及延迟相增强程度减弱。CT平扫见肝门部胆总管上段软组织密度结节,位于门静脉及肝动脉分叉上方,     

Lipoma of the adrenal gland. Case report and review of the literature

Summary Adrenal lipomas are extremely rarely occuring benign tumors being hormonally inactive. The patient described in this report underwent surgical excision of an adrenal lipoma because of the associated hypertension. The blood pressure decreased postoperatively to normal levels. This case report and the review of the literature consider diagnosis and therapy of the adrenal lipomas.      

Squamous cell carcinoma of the parotid gland

BACKGROUND: Our objective was to evaluate the outcome of patients treated for squamous cell carcinoma (SCC) of the parotid gland. METHODS: We conducted a retrospective chart review of the tumor registry from 1982 through 2003 at a tertiary referral medical center. Patients with SCC of the parotid gland were identified and followed for a minimum of 2 years after therapy. RESULTS: SCC involving the parotid was identified in 66 patients. The tumor was a metastasis from a known primary site in 41 patients (62%). In 16 patients (24%), no other primary site was identified, and the tumor may have originated in the parotid gland. Nine patients (14%) were undetermined. Therapy frequently included surgery. The integrity of the facial nerve was preserved in 92% of surgical patients. Only eight patients initially had clinical evidence of cervical metastasis; however, cervical metastasis was identified in 25 patients (44%), changing the course of therapy. CONCLUSION: SCC of the parotid gland was metastatic from a known primary tumor in more than half of the patients. The most common site of the primary tumor was a cutaneous malignancy of the head and neck. The high incidence of cervical lymph node involvement underscores the diagnostic and therapeutic importance of neck dissection with parotidectomy.     

Cutaneous metastatic squamous cell carcinoma to the parotid gland: analysis and outcome

BACKGROUND: Our aim was to review the presentation, treatment, and outcome of patients with metastatic cutaneous squamous cell carcinoma involving the parotid gland at a tertiary referral center. METHODS: We performed a retrospective chart review of the cancer registry at the Princess Margaret Hospital, Toronto, from 1970 to 2001. All patients had a previously untreated metastatic cutaneous head and neck squamous cell carcinoma involving the parotid gland. A minimal follow-up of 1 year was mandatory for inclusion in the study. RESULTS: Fifty-six white patients (43 men and 13 women), with a median age of 76 years (range, 49-97 years), were eligible for inclusion. The disease in all patients was retrospectively staged according to a new system. Twenty patients had P1 disease, 14 had P2, and 22 had P3. Therapy included surgery and adjuvant external beam radiation in 37 patients, single-modality external beam radiation in 12, and surgery alone in seven patients. The overall recurrence rate was 29%. The disease-specific survival was significantly worse in patients treated with external beam radiation alone (p <.05). Tumor size >6 cm (p <.01) and the presence of facial nerve involvement (p <.01) were poor prognostic factors. CONCLUSIONS: Metastatic cutaneous squamous cell carcinoma to the parotid gland is an aggressive neoplasm that requires combination therapy. The presence of a lesion in excess of 6 cm or with facial nerve involvement is associated with a poor prognosis.     

肝癌射频消融术中病灶内碘油外漏1例

正患者男,79岁,因"发现原发性肝癌2月余"入院;既往慢性乙型肝炎病史50余年,3年前开始接受规律抗病毒治疗至今。2019年8月腹部增强CT提示肝右叶占位,结合病史、影像学表现及实验室检查,考虑为肝细胞肝癌(hepatocellular carcinoma,HCC)(图1A)。2019年9月行TACE,术中以盐酸吡柔比星30mg及碘化油混合乳剂10ml予以栓塞,并以适量