Colon cancer with isolated metastasis to the kidney at the time of initial diagnosis

Blood-borne metastases to the kidneys from solid tumors have received little attention in the medical literature because they usually occur in a setting of advanced systemic disease, and renal involvement is a elatively minor cause of symptoms. Although the frequency of metastases to the kidney in cancer patients is 7–13% in large autopsy series, incidental discovery of a renal metastasis as the first manifestation of a primary tumor is a very rare event. The most common primary malignancy to involve the kidney is bronchogenic carcinoma, followed by breast and gastrointestinal cancers. In this article, we report a patient with left colon cancer and isolated metastasis to the right kidney at the time of initial diagnosis. Left hemicolectomy and right nephrectomy were performed. Adjuvant systemic chemotherapy consisting of 5-fluorouracil (5-FU) and folinic acid (FA) was given. 5-FU and FA were stopped after four cycles because metastases to the lung and liver occurred about 3 mo after the surgery during adjuvant chemotherapy. Capecitabine was started. The patient died 9 mo after the discovery of the isolated renal metastasis. Nephrectomy is more for diagnostic clarification in the setting of synchronous primary because it has no effect on survival and its effect on quality of life is minimal; as seen in our case, the other organ metastases rapidly occur and the survival is limited. Nephrectomy may also compromise the choice of chemotherapy agents that require renal clearance, thus a careful evaluation of renal functions is necessary if a nephrectomy is performed. In the matter of a decreased renal clearance, the doses of these drugs should be decreased or the choice should be reevaluated.     

Incidence of brain metastasis at initial presentation of lung cancer

Background

No reliable estimates are available on the incidence of brain metastasis (BM) in cancer patients. This information is valuable for planning patient care and developing measures that may prevent or decrease the likelihood of metastatic brain disease.

Methods

We report the first population-based analysis on BM incidence at cancer diagnosis using the Kentucky Cancer Registry (KCR) and Alberta Cancer Registry (ACR). All cancer cases with BM were identified from KCR and ACR, with subsequent focus on metastases from lung primaries; the annual number of BMs at initial presentation was derived. Comparisons were made between Kentucky and Alberta for the stage and site of organ involvement of lung cancer.

Results

Low incidence of BM was observed in the United States until mandatory reporting began in 2010. Both the KCR and ACR recorded the highest incidence of BM from lung cancer, with total BM cases at initial presentation occurring at 88% and 77%, respectively. For lung cancer, stage IV was the most common stage at presentation for both registries and ranged from 45.9% to 57.2%. When BM from lung was identified, the most common synchronous organ site of metastasis was osseous, occurring at 28.4%.

Conclusion

Our analysis from the Kentucky and Alberta cancer registries similarly demonstrated the aggressive nature of lung cancer and its propensity for BM at initial presentation. Besides widespread organ involvement, no synchronous organ site predicted BM in lung cancer. BM is a common and important clinical outcome, and use of registry data is becoming more available.     

Lymphoscanning potentials in the diagnosis of lung cancer metastasis

Clinical estimation is given of indirect isotope lymphoscanning, performed by intrapulmonary administration of Au-198, for diagnosing lung cancer metastases. The method enables obtaining scannographs of intrathoracic lymphnodes and also, based on the changes in scannograms, judging the presence of lymphogenic metastases. Lymphoscanning is a technically feasible and safe method, it provides comparatively large information for diagnostic purposes and may occupy an important place among other diagnostic technics for ascertaining the extent of lung cancer proliferation.     

PET-CT对肺癌骨转移诊断的研究进展

 正电子发射型计算机断层扫描仪 (PET)-CT对诊断肺癌骨转移有重要的作用,它可以反映肺癌骨转移病灶的病理生理变化及形态结构变化。PET-CT全身显像对肺癌骨转移诊断的敏感性、特异性及准确性均高于X线片、CT、磁共振成像（MRI）和单光子发射计算机断层（SPECT）等传统的肺癌骨转移临床诊断方法。     

肿瘤标志物诊断肺癌转移的临床价值

目的:检测肿瘤标志物在肺癌与肺癌并转移患者中的水平差异,并分析其鉴别诊断价值。方法:纳入388例肺癌患者及67例肺癌并转移患者,采集血液样本,采用凝集素亲和方法检测肿瘤异常蛋白（TAP）,采用化学发光免疫分析法检测糖类抗原125（CA125）、癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）、糖类抗原50（CA50）、铁蛋白(FRT)、神经元特异性烯醇化酶（NSE）、鳞状细胞癌抗原（SCC）。比较上述肿瘤标志物在肺癌与肺癌并转移患者中的水平差异,利用受试者工作特征曲线（ROC）,分析肿瘤标志物对两组患者的鉴别诊断价值。利用Logistic回归分析鉴定肺癌转移的风险因素。Spearman相关性分析患者肿瘤标志物之间的相关性。结果:CEA、CYFRA21-1及NSE在肺癌并转移患者中的水平明显高于肺癌患者（P＜0.05）,而其他肿瘤标志物在两组患者之间无明显差异（P＞0.05）。与各自的参考区间相比,TAP在肺癌及肺癌并转移患者中的阳性率最高（>98%）,SCC阳性率最低（<10%）,其他指标的阳性率介于10%~65%。肺癌并转移患者CEA阳性率明显高于肺癌患者（62.69% vs 43.8%,P＜0.05）。ROC分析结果显示,CEA对两组患者的鉴别效能最优（特异性:82%、敏感性:42%）。联合指标分析显示,与其他指标联合并不能明显提升CEA的鉴别诊断价值（P＞0.05）。Logistic回归分析显示,CEA是肺癌转移的风险因素。相关性分析显示,在肺癌与肺癌并转移患者中,各肿瘤标志物之间的相关性不一致。结论:与肺癌患者组相比,肺癌并转移患者中的CEA阳性率及水平均明显升高,对肺癌转移的诊断具有一定的临床意义。     

建立初诊肺癌患者骨转移风险评估模型

目的:建立一个列线图来预测肺癌患者骨转移的风险。方法:收集2012年1月至2019年12月未经任何治疗(包括手术、放疗和化疗)的肺癌患者的临床资料,包括骨转移情况、性别、年龄、病理类型、血清钙浓度、碱性磷酸酶(alkaline phosphatase,ALP)、癌胚抗原(carcinoembryonic antigen,CEA)、T分期、N分期。分析骨转移的危险因素,通过Logistic回归分析建立列线图。结果:在分析的306例患者中,有137例(44.78%)肺癌患者在初次诊断时已经发生骨转移。其中ALP、CEA、病理类型和N分期是新诊肺癌患者骨转移的危险因素,列线图模型曲线下面积(area under curve,AUC)值为 0.867。结论:当临床上出现初诊 ALP 值高、CEA＞7.285 ng/ml、N分期高、腺癌和小细胞癌的患者时,有必要及时对患者进行相关骨转移检查。     

Radiographic diagnosis of lung cancer and lymph nodal metastasis of the mediastinum

Primary lung cancer is divided into two types: peripheral type and hilar or central type. Peripheral lung cancer appears as a solitary mass or patchy shadow and is typically lobulated or irregular in shape. Any regular or scattered calcification within or around the lesion on routine radiographs indicates that it is benign. Hilar or central lung cancer may accompany hilar and mediastinal lymphadenopathy, lobar collapse and consolidation, and pneumonitis distal to a mass in a large bronchus. In addition, it is very important that the metastases of the hilar and mediastinal lymph nodes are detected preoperatively or prior to conservative therapy. On 44 cases of lung cancer pathologically proved, the diagnostic accuracy of the metastases of the hilar or mediastinal lymph nodes is 42.4% preoperatively on routine radiographs.     

Results of recent therapy for non-small-cell lung cancer with brain metastasis as the initial relapse

The results of radiosurgery for treatment of patients with non-small-cell lung cancer with brain metastasis as the initial relapse were evaluated. Twenty-three patients were included in the study. The dominant pathologic type was adenocarcinoma (56.5%). In the mean interval of 13.7 months (range, 3-52 months) between the lung operation and treatment of brain metastasis, a solitary lesion developed in 9 patients and multiple lesions developed in 14 patients. The modalities used for brain metastasis were gamma-knife radiation therapy (GKS) in nine patients, GKS plus operation in six, GKS plus whole brain radiation therapy (WBR) in two, operation plus WBR in two, operation only in one, WBR only in two, and no treatment in one. The 1- and 3-year survival rates after treatment of brain were 47.3% and 7.4%, respectively. The prognostic impact of stage and number of brain metastases was not clear. Primary tumor size and adjuvant chemotherapy after the lung operation significantly affected survival after the management of brain metastasis. The low invasive radiosurgery is beneficial in terms of improving the quality of life of patients.     

住院初诊肺癌患者信息需求现状及相关因素研究

目的探讨住院初诊肺癌患者信息需求现状,为后续更好满足患者信息需求提供依据。方法选取2014年12月至2016年3月间江苏省肿瘤医院收治的193例住院初诊肺癌患者,采用自行设计的问卷进行信息需求问卷调查。结果信息需求率不低于85.0%的信息条目共11个,其中8个属于疾病与治疗信息,需求率低于70.0%的条目共10个,5个属于家庭照护维度。结论普及吸烟与二手烟易罹患肺癌的科学知识,根据各维度信息需求程度,制定和实施有针对性、实用性的健康教育和护理干预措施,可提高初诊肺癌患者应对疾病各阶段的能力,提高生活质量,降低病死率。     

Outcomes of surveillance for contralateral breast cancer in patients less than age 60 at the time of initial diagnosis

Background

After an initial diagnosis of breast cancer, the risk of contralateral breast cancer is approximately 0.5% per year. Annual mammography is recommended to identify local recurrences and contralateral new primaries. Because the sensitivity of mammography tends to be lower in younger women, we conducted a retrospective review of the method of detection and pathologic stage of metachronous contralateral primary breast cancers according to age at diagnosis in a cohort of breast cancer patients.

Methods

The Henrietta Banting Database contains information on cases of breast cancer diagnosed at Women’s College Hospital from 1987 to 2004. From among 1992 women in the database, 71 patients were identified who were initially diagnosed before age 60 and who subsequently developed a contralateral breast cancer. Medical records were obtained for 53 of the 71 patients.

Results

Of the 53 contralateral cancers, 33 (62%) were detected by mammography, including 4 in 16 patients (25%) diagnosed before age 50 and 29 in 37 patients (78%) diagnosed at age 50 or older (p ≤ 0.001).

Conclusions

Mammography has poor sensitivity for the surveillance of contralateral breast cancer in early-onset breast cancer patients. Other imaging modalities should be evaluated in this setting.     

Detection of brain metastasis at diagnosis of small cell carcinoma of the lung

Summary As a part of the initial evaluation of previously untreated patients with small cell carcinoma of the lung, radionuclide and/or computerized tomographic (CT) scanning of the brain was performed. Evidence of metastatic brain disease was documented in 10 (9%) patients (9 by CT and 1 by radionuclide scanning). CT was abnormal in 2 patients who had no evidence of brain metastasis by radionuclide scan. The detection of brain metastasis resulted in upstaging of 6 neurologically asymptomatic patients who had no other extrathoracic disease. Evaluation of the brain with CT is recommended as part of the initial staging of patients with small cell carcinoma of the lung.     

以单纯指骨转移为首发症状的肺癌2例并文献复习

目的探讨原发性肺癌以单纯指骨转移为首发症状的临床特点以及肺癌发生指骨转移的机理。方法对1991年至2007年间，见诸于有关文献报道的以单纯指骨转移为首发症状的原发性肺癌病人的文献资料进行综合性分析。结果在文献报道的以单纯指骨转移为首发症状的17例原发性肺癌的病人中，其转移病灶位于左手指骨者7例，右手指骨者9例，双手指骨者1例，指骨转移病灶的数量在两手之间的分布大致相等，除3例病人其转移病灶位于近节指骨外，其余病人的转移病灶均位于其末节指骨；有6例病人的患病手指既往曾有外伤史。结论传统的机械一解剖学说和种子一土壤学说的观点均不能解释原发性肺癌发生指骨转移的机理，故临床上如遇久治不愈的手指软组织炎症时，应想到是否有肿瘤细胞转移至此的可能性。     

High miR-96 levels in colorectal adenocarcinoma predict poor prognosis,particularly in patients without distant metastasis at the time of initial diagnosis

Tumor Biology - MicroRNA-96 (miR-96) is an oncomiR that facilitates the development of malignant tumors by promoting growth, proliferation, and survival of cancer cells. Previous studies using...     

Splenic metastasis of lung cancer

Splenic metastasis from a lung cancer is infrequently noted, however, the pattern of the metastasis has not been studied, thus we conducted a retrospective study. Twelve of the consecutive 997 patients with lung cancer, who were admitted to our division, developed splenic metastasis. The pattern of splenic metastasis involved solitary nodule in 7 patients (58.3%); multiple nodules in 4, and microscopic metastasis in 1. All of the 12 patients had other abdominal organ metastasis. Splenic mass accompanying metastasis to other abdominal organs in a patient with a known lung cancer should be regarded as a metastasis.     

非小细胞肺癌脑膜转移的诊疗进展

脑膜转移是非小细胞肺癌的严重并发症,其临床表现不特异,主要包括脑实质受累、颅神经及脊髓、脊神经根刺激症状。诊断主要依据肿瘤病史、临床表现、影像学及脑脊液检测。EGFR-TKIs等靶向治疗药物应用于选择人群可能存在生存获益,但目前其总体治疗效果仍不满意,预后差。本文就非小细胞肺癌脑膜转移的流行病学、病理生理、临床表现、诊断方法及治疗疗效的研究进展进行综述。     

Muscle metastasis as initial manifestation of epidermoid carcinoma of the lung

Typical sites of squamous cell carcinoma of lung metastases include liver, brain, bones, pulmonary and adrenal glands. In advanced dissemination it can rarely involve the skeletal muscle. The patient in this case report was a 46-year-old man, with no significant medical history. He was admitted to hospital because of a large swelling on his left thigh. Investigations resulted in a diagnosis of primary squamous cell carcinoma of the lung. Biopsy of the left great adductor muscle produced similar pathology to that of the lung primary. This case report describes a skeletal muscle metastasis as the first sign of metastatic disease.     

肺癌血清CA125测定的诊断价值

目的探索血清CA125在肺癌诊断中的价值.方法检测69例肺癌、38例良性肺疾病和25例健康人的血清CA125.随访40例肺癌患者治疗后血清CA125的变化.结果肺癌组血清CA125(124.9±175.9 u/ml)高于良性疾病组和健康人组(28.1±21.7 u/ml,18.2±7.1 u/ml).以CA125>35u/ml为阳性界值,则正常健康人均为阴性.对诊断肺癌的敏感性为53.6%(37/69).Ⅰ、Ⅱ期肺癌血清CA125阳性率(20%,28%)与良性疾病组(15.8%)无显著差异,Ⅲ、Ⅳ期肺癌CA125阳性率分别为61.0%、72.7%显著高于良性疾病组.血清CA125增高的40例肺癌患者经治疗后,CA125浓度降至正常范围内者38例.结论血清CA125对晚期肺癌有诊断价值.可作为判断预后的参考指标.     

转移灶穿刺活检在肺癌诊断中的应用

目的:探讨肺部病灶活检难度大或者肺部活检组织较少等情况下,转移灶穿刺活检的意义。方法:回顾性分析了自2013年10月至2016年12月于南京大学医学院附属鼓楼医院肿瘤中心接受淋巴结、骨、肝脏等转移灶穿刺活检的20例肺癌患者。对转移灶活检的必要性、转移灶活检的手段、准确性、标本质量、病理诊断及相关副作用进行分析。结果:从2013年10月至2016年12月,共20例患者于肿瘤中心行转移灶穿刺,其中行肾上腺转移灶穿刺1例、骨转移灶穿刺3例、肝脏穿刺4例、皮下包块穿刺5例、淋巴结穿刺7例,结合临床及免疫组化均考虑肺来源（其中肺腺癌13例、肺鳞癌2例、肺小细胞癌4例、1例最终只能确定为肺低分化癌）。对非小细胞肺癌患者行分子检测,其中3例患者因穿刺组织较少难以行分子检测,余12例患者分子检测结果显示EGFR敏感突变阳性率75%（9/12）、ALK融合基因阳性率16.7%（2/12）。所有转移灶穿刺患者均未见严重出血、感染或针道种植转移等并发症。结论:对临床高度怀疑肺癌并且伴有远处转移的患者,在肺部病灶活检难度大或活检组织取材不能满足分子检测时,转移灶穿刺活检可作为重要补充手段,达到较好的诊断效能。     

结直肠癌肺转移的多学科综合诊疗现状

近年来,中国结直肠癌发病人数和死亡人数呈增长趋势,术后复发及转移是导致患者死亡的主要原因,肺是除肝以外结直肠癌转移最常见的好发部位。结直肠癌肺转移患者的治疗手段包括手术治疗、化疗、放疗、射频消融等多种方式。随着多学科诊疗的逐步发展和深入,结直肠癌肺转移患者的生存得到显著提高。