A very rare autopsy case of metastatic brain tumor originating from ureteral cancer

We report here a very rare case of metastatic brain tumor originating from ureteral cancer which was verified at autopsy. An 88-year-old elderly woman was admitted to our department because of recurrent convulsions which started in March, 1987. Following this episode, right hemiparesis and speech disturbance appeared on June 6, 1987. Neurological examinations at admission on August 12, 1987 showed slightly disturbed consciousness, motor dominant aphasia, and dysphasia. Enhanced CT scan demonstrated a large tumor in the left frontal lobe with perifocal edema, and a small mass in the right frontal lobe (Fig. 1). Left carotid angiogram showed downward displacement of the middle cerebral artery complex at the Sylvian portion. After admission, she developed marked distention of the abdomen, with occurrence of hematuria followed by aggravation of respiration and consciousness. She died on September 2, 1987. Removal of metastatic brain tumor had not been performed due to the poor general condition of the patient. An autopsy was permitted. A coronal section of the cerebrum clearly demonstrated a large tumor in the left frontal lobe with small mass in the right frontal lobe (Fig. 2). Kidney and the ureter at the right side showed hydronephrosis and hydroureter because of the presence of ipsilateral ureteral tumor at the distal end (Fig. 3). Microscopical findings verified that the metastatic brain tumor was a transitional cell carcinoma, which was, histologically, completely the same as the ureteral tumor (Fig. 4, 5). No case of metastatic brain tumor originating from ureteral cancer has yet been reported, as far as the authors know.(ABSTRACT TRUNCATED AT 250 WORDS)     

Metastatic renal tumor originating from thyroid cancer: a case report

A 82-year-old female was referred to our department for close examination and treatment of a right renal tumor incidentally found by computed tomography. Her past history included partial thyroidectomy for follicular thyroid carcinoma 20 years earlier. Enhanced computed tomography showed a hypervascular mass with a diameter of 3 cm at the lower pole of the right kidney. We carried out radical nephrectomy for diagnosis of renal cell carcinoma. Pathological findings revealed a metastatic renal tumor of follicular thyroid carcinoma. It is rare to find metastatic renal tumors arising from thyroid carcinoma in clinical practice. Thirty cases have been reported in the Japanese literature.     

Metastatic renal tumor originating from esophageal carcinoma: a case report

A 46-year-old woman with a past history of esophageal carcinoma was hospitalized with the chief complaint of right abdominal pain. Enhanced computed tomography (CT) and selective renal angiography suggested a metastatic renal tumor. Right nephrectomy was performed. Histological examination revealed a renal tumor originated from esophageal squamous cell carcinoma. Metastatic renal tumors are frequently observed at autopsy, but clinically they are extremely uncommon. Thirty-four clinical cases of metastatic renal tumors reported in the Japanese literature during these 20 years are discussed including the present case.     

Metastatic renal tumor originating from esophageal carcinoma: a case report

A 61-year-old male, who had undergone operation of esophageal carcinoma 11 months earlier, was admitted for left flank pain and high fever. Intravenous pyelography showed a space occupying lesion in the upper half of the left kidney. Computed tomographic scan showed an irregular low density area in the upper half of the left kidney. Angiograms revealed a hypovascular mass with encasement vessels in the same site. Left nephrectomy and paraaortic lymph node biopsy was performed. Pathological examination revealed a metastatic squamous carcinoma from the esophageal carcinoma. Chemotherapy was conducted, but he died 2 months later. Autopsy revealed recurrence in the retroperitoneum, and no metastasis in the right kidney. The literature on secondary renal tumor is reviewed.     

A case of malignant peripheral nerve sheath tumor originating from the cervical vagus nerve

A 45-year-old female presented a peripheral nerve sheath tumor (MPNST), which had progressed to malignancy from a neurofibroma arising in the left cervical vagus nerve. Neuroimaging showed that a tumor grew in the left neck area of the patient, involving the internal carotid and vertebral arteries, and invading the intracranium through the left jugular foramen. The tumor was extensively removed using a combination of the lateral suboccipital approach and the neck incision, and the frontotemporal approach accompanied with EC-IC highflow bypass and EC-MCA anastomosis. Postoperatively, pathological features demonstrated a MPNST arising from the cervical vagus nerve. Here, we discuss the clinical behavior of MPNST by quoting previous reports, and conclude by emphasizing 2 points in the treatment of MPNST; 1) that prognosis of patients with MPNST is greatly affected by the time between presenting symptoms and diagnosis, and 2) that it is very important to carefully observe neurofibroma patients, because there is a possibility of progression to malignant MPNST.     

A metastatic gastric tumor originating from a pleomorphic rhabdomyosarcoma of the extremity: a case report and literature review

Pleomorphic rhabdomyosarcoma is a rare and aggressive variant of rhabdomyosarcoma that usually occurs only in adults aged 45 years or older. Gastric metastasis from a soft-tissue sarcoma of the extremity is likewise very rare, with only a few previously reported cases. Here, we describe the case of a 52-year-old man with gastric metastasis who underwent en bloc excision of the primary tumor and distal gastrectomy but died 6 months after surgery due to lung metastases. This is, to our knowledge, the first reported case of gastric metastasis from pleomorphic rhabdomyosarcoma of the extremity. In cases such as these, patients may have widespread disease, and thus, surgery may only have a limited role in its management.     

A case of metastatic intracerebral malignant schwannoma]

A 53 year old male complaining of headache and left hemiparesis was referred to our hospital on November 11, '89. He had no evidence of von Recklinghausen's disease. He had been operated on because of a well circumscribed tumor in the left paravertebral muscle on July 11, '87, and metastasis in the lower lobe of the left lung on April 20, '88. The pathological diagnosis of both the primary and the metastatic lung tumor was malignant peripheral nerve sheath tumor showing peripheral cell differentiation (malignant schwannoma). Contrast enhanced CT demonstrated an irregularly enhanced mass in the right parietal lobe just before admission. On the night of admission November 12, '89, he suddenly had severe headache and this progressed to hemiparesis. Repeat CT examination was done immediately and revealed intratumoral hemorrhage. On November 19, '89, the tumor was totally removed. His symptoms disappeared postoperatively. The pathological findings of the tumor were the same as those made previously. The patient received radiotherapy to the brain (local 50 Gy and whole brain 30 Gy) and chemotherapy with nitrosourea (MCNU 150mg). He was discharged without neurological deficits. However he had two operations to remove metastatic tumors in the soft tissue of the hip on January 12, and August 17, '90. A very rare case of metastatic intracerebral malignant schwannoma is reported, and the literature on this point is reviewed.     

A case of carcinosarcoma originating from the renal pelvis

The first case of carcinosarcoma originating from the renal pelvis in Japan is reported. A fifty-five year old woman was admitted to the hospital on July 13, 1987, complaining of a one-year history of lumbago. On physical examination, a mass of child's head size was palpable in the right loin. There were other palpable masses in the posterior head (8 x 8 cm), left anterior chest (3 x 3 cm) and sacral region (3 x 3 cm). A chest X-ray showed multiple pulmonary metastases and an excretory urogram revealed a non-visualizing right kidney. Computed tomogram and renal angiogram suggested right renal tumor. Right renal arterial embolization with ethanol sclerosing was performed. She had previously undergone biopsy of the sacral lesion at another hospital, histological examinations of which pointed to suspected carcinosarcoma. She was treated by a combination chemotherapy with vincristine, adriamycin and cyclophosphamide. Despite one course of chemotherapy, her general condition deteriorated with progression of metastatic lesions in the regions other than the lungs. She died of the disease on december 9, 1987. Autopsy was performed. Sections of the right kidney showed a transitional cell carcinoma in-situ with squamous and glandular differentiation in addition to the chondrosarcoma. The metastases were found in the liver, lung and bone, all of which consisted of chondrosarcoma. On the other hand skin metastases consisted of both carcinomatous and sarcomatous elements. The pathological specimens were reviewed at the Armed Forces Institute of Pathology, Washington, D.C.     

A case of malignant lymphoma originating from paraureteral tissue

A 53-year-old man was admitted with epigastric discomfort. Excretory pyelography demonstrated left non visualizing kidney. Computed tomography showed the dilatation of left renal pelvis and a mass along with a left lower ureter. Retrograde pyelography showed the stenosis of left lower ureter. Urine cytologies from both voided and upper urinary tract showed class I. Ureteroscopy revealed the normal ureteral mucosa, suggesting extrinsic obstruction of the ureter. The operation was performed under the diagnosis of retropelvic tumor. The tumor could be easily resected from the left ureter. The pathological diagnosis was follicular lymphoma. There was no prolificative accumulation on Gallium scintigraphy after the operation. The tumor was considered to have originated from paraureteral tissue.     

A case of metastatic urinary bladder tumor from gastric carcinoma]

We report a case of metastatic bladder tumor from gastric carcinoma. A 55-year old male patient was referred to our urological clinic with a complaint of frequent urination and voiding pain. He had undergone total gastrectomy for poorly differentiated adenocarcinoma, signet-ring cell type, 9 months earlier. Computed tomographic scan revealed a thick bladder and rectum wall all around. Punch biopsies from vesical and rectal wall revealed metastatic adenocarcinoma, signet-ring cell type. There were no other metastatic sites. Systemic chemotherapy was done with a combination of mitomycin-C, 5-fluorouracil and cytosine arabinoside. This chemotherapy was effective and complete remission was obtained at bladder and rectum. Six months after chemotherapy, peritoneal recurrence developed and he died 9 months after chemotherapy. However no recurrence of bladder tumor was detected. This was a quite rare case of metastatic bladder tumor characterized by good response to systemic chemotherapy.     

A case of metastatic tumor of spermatic cord from renal cell carcinoma

A 51-year-old man was admitted with the complaint of left scrotal swelling (11 x 5 x 5 cm). He had undergone left nephrectomy and removal of tumor thrombus in inferior vena cava due to renal cell carcinoma. Nine months after the nephrectomy, left scrotal enlargement was noticed. Left high orchiectomy was performed on January 20, 1988. A clear cell carcinoma was present in spermatic cord and pampiniform plexus histologically but testis and epididymis were intact. Renal cell carcinoma seemed to disseminate retrograde through the spermatic vein to spermatic cord. The metastatic tumor of spermatic cord from renal cell carcinoma is very rare and this case is the fifth case in the Japanese literature.     

A case of metastatic tumor of the pituitary gland presenting as a subarachnoid hemorrhage

We reported the case of a 55-year-old man with metastatic tumor of the pituitary gland who suffered from symptomatic pituitary apoplexy with subarachnoid hemorrhage. The patient, who had sigmoid colon carcinoma and left parietal metastatic brain tumor, developed severe headache and decrease of right visual acuity. CT showed a pituitary mass with subarachnoid hemorrhage. Transsphenoidal surgery was performed after replacement therapy with corticosteroids. Histological examination revealed metastasis of adenocarcinoma. Pituitary apoplexy is an unusual manifestation of metastatic pituitary tumor. The case of metastatic tumor of the pituitary gland presenting as subarachnoid hemorrhage such as this case is especial rare.     

A case of giant cell tumor originating from the rib

We have experienced a case of giant cell tumor originating from the rib. A 45-year-old male was admitted to our hospital because of a mass in the left chest wall. A tumor shadow was observed in the left side of chest X ray. Chest CT, bone scintigram showed tumor originating from the left 4th rib. The tumor was suspected giant cell tumor of bone by needle biopsy examination. The tumor was completely resected with chest wall surrounding the tumor. The defect of chest wall was reconstructed with Marlex mesh and the Latissimus dorsi muscle flap. The pathological diagnosis was a giant cell tumor of bone. The patient has been well for two years and one month since surgery, with no signs of recurrence.     

Extragenital malignant mixed mesodermal tumor: A case report

IntroductionPrimary malignant mixed mesodermal tumor (MMMt, also called malignant mixed Mullerian tumor and designated in the WHO classification of female genital tract neoplasms as carcinosarcoma) is an infrequent tumor that develops usually in the uterus and more rarely in the ovary. Extragenital tumor, including primary peritoneal MMMt, is an extremely rare and aggressive neoplasm with only few case reported in the literature.Presentation of caseWe report a case of a 70-year’s old female who presented with nausea and abdominal discomfort for 6 months. Workup revealed an abdominal mass. Patient was treated with surgical removal in a general hospital.DiscussionMost peritoneal carcinosarcomas originate in the pelvic peritoneum, followed by decreasing frequency in the serosal surface of the colon, retroperitoneum, anterolateral abdominal peritoneum, and omentum. Surgical excision is the most effective treatment in carcinosarcomas. A complete cytoreduction, with resection of cancer to a status of no evidence of disease by the surgeon’s unaided eye should be attempted.ConclusionOwing to the rarity of the disease, limited data regarding the management of peritoneal MMMT exists. Recommendations for the treatment of MMMT are based on individual cases only. In our case, the patient is alive with a follow-up of 15 months and she did not receive any cycle of chemotherapy.     

Giant submandibular gland tumor: mucoepidermoid carcinoma within the pleomorphic adenoma (mixed tumor)

Pleomorphic adenoma (mixed tumor) is the most common type of salivary gland tumors, most often involving the parotid glands. The study presented a case of a giant pleomorphic adenoma of the submandibular gland in a 78-year old woman. Due to the initially slow and progressive growth (during a period of 25 years) without treatment, the tumor attained a size of 25×19×16 cm and a weight of 4 kg. The patient underwent surgery. The histopathological examination showed that the tumor was subject to malignant transformation: within the pleomorphic adenoma one observed mucoepidermoid carcinoma lesions of high-degree malignancy. In spite of the good postoperative esthetic and functional effect the patient was diagnosed with distant metastases to the lungs.     

A case of tracheal benign mixed tumor]

A 44-year-old male was admitted because of dyspnea. Bronchoscopy revealed a tumor obstructing 85% of the tracheal lumen, at the site of the membranous portion, 3 cm below the vocal cords. The tumor was removed by sleeve tracheal resection with end to end anastomosis. Histological findings showed benign mixed tumor (pleomorphic adenoma) arising from the tracheal wall. Postoperative course was uneventful. Only 5 tracheal mixed tumors have been found in the Japanese literatures. Therapeutic approach to this tracheal tumor is discussed in this paper.     

Three cases of metastatic renal tumor]

Since solitary metastatic renal tumors are not commonly diagnosed before death, the conclusive treatment of the metastatic renal tumor has not been established. We report three cases of metastatic renal tumors and discuss the indication of surgical therapy for metastatic renal tumors. The first case was in a 64-year-old male who underwent esophagectomy for squamous cell carcinoma. Seven months after the operation, a right renal tumor was found. The second case was in a 63-year-old male who underwent right upper pneumonectomy for adenocarcinoma with a right renal tumor, which seemed to be a solitary metastasis. The third case was in a 69-year-old male who underwent right pneumonectomy for adenocarcinoma. One month after the initial operation, a left renal cystic tumor was found. Since, in all cases, the tumors seemed to be solitary metastatic renal tumors without any other metastatic lesions, nephrectomy was performed. Unfortunately, however, the nephrectomy did not improve prognosis and all three patients did within 10 months after the nephrectomy. Nephrectomy may not be recommended in cases of metastatic renal tumors even if no other metastatic lesions can be found by various image examinations.     

A case of benign mixed tumor of the trachea]

A very rare case of benign mixed tumor of the trachea was reported. A 52-year-old male was admitted to our hospital because of hemoptysis, slight dyspnea and stridor. Bronchoscopic examination revealed a polypoid tumor which arose from the anterior wall of the upper trachea, obstructing about 70% of the tracheal lumen. For the purpose of getting pathological specimen and securing the air way in anesthesia, endoscopic polypectomy (2/3 of the tumor) was done by using GIF-XP 20. Circumferential resection of the trachea (4 rings) with end-to-end anastomosis was performed one month after polypectomy. To our knowledge, this was the 7th reported case in Japan. Clinical studies and operative procedures of this disease were briefly discussed.