Propionibacterium acnes is the most common bacterium commensal in peripheral lung tissue and mediastinal lymph nodes from subjects without sarcoidosis

BACKGROUND: In studies of the unknown etiology of sarcoidosis, Propionibacterium acnes (a possible agent) was found in the lungs and lymph nodes of many sarcoidosis patients and some control subjects. P. acnes might be commensal not only to the skin, conjunctivae, and intestine, but also to the lungs and lymph nodes of individuals without sarcoidosis. METHODS: We cultured peripheral lung tissue and various lymph nodes obtained from patients with diseases other than sarcoidosis. DNA of 45 isolates of P. acnes from these patients, 67 isolates from normal skin, conjunctiva, and intestine, and 39 isolates from sarcoid lymph nodes were compared by random amplified polymorphic DNA analysis. RESULTS: P. acnes was isolated from half of 43 lungs and 8 of 11 mediastinal lymph nodes, mostly in pure culture. P. acnes was isolated from half of 20 gastric and 3 of 12 intestinal lymph nodes; intestinal bacteria were also numerous. In general, fewer than 500 colony-forming units of P. acnes per gram tissue were isolated, but 4 lung tissue specimens, 2 of which had a few granulomas, had many more. P. acnes strains from a particular site (lung, lymph node, skin or conjunctivae, and intestine) were genetically similar, more than isolates obtained from different sites. Lymph-node isolates from subjects with and without sarcoidosis differed little. CONCLUSION: These results suggest that P. acnes normally resides in peripheral lung tissue and mediastinal lymph nodes and that the strains of P. acnes isolated from sarcoid lymph nodes were not specific to sarcoidosis.     

Metastasis of colorectal carcinoma to the testes: clinical presentation and possible pathways

Distant metastasis from colorectal carcinoma most often occurs in the liver and lungs. Metastasis to bones, adrenals, lymph nodes, brain, and skin has also been reported. Metastatic colorectal carcinoma to the testes is very uncommon. Even more uncommon is testicular metastasis from rectal carcinoma. Researchers throughout the last few decades have not acquired a clear understanding of the lymphatic pathways involved in reported cases of testicular metastasis from primary colorectal carcinoma. These cases may present with testicular complaints after or even before the diagnosis of colorectal cancer; this is why it is crucial to differentiate between primary testicular tumor and a secondary one from a colorectal primary. We searched the English medical literature using the MEDLINE/PUBMED database from 1950 through January 2010. Our search yielded 33 cases of testicular metastasis from rectal or colonic carcinoma. These cases are reviewed and summarized. This paper reviews the literature for all cases of testicular metastasis from colonic and rectal adenocarcinomas shedding light on the possible pathways of metastasis. We recommend that physicians be aware of the risk of metastasis from the colorectal region to the testis in their evaluation of patients with testicular symptoms in the setting of colorectal carcinoma.     

Endometrial Cancer with Sarcoidosis in Regional Lymph Nodes: A Case Report

Sarcoidosis is a chronic, multisystemic disease commonly affecting the lungs and lymphatic system and is characterized by the formation of noncaseating granulomas. Although several reports are available on cases developing both sarcoidosis and cancer metachronously, cases of simultaneous diagnosis of these diseases have rarely been reported. A 67-year-old woman diagnosed with endometrial cancer had developed systemic lymph node swelling, including bilateral hilar, paraaortic, and a few pelvic lymph nodes, as observed on preoperative imaging. During surgery, frozen sections of a paraaortic lymph node were examined, revealing noncaseating granulomas compatible with sarcoidosis. Next, modified radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed. Postoperative pathological analysis revealed endometrioid adenocarcinoma of the uterus, and no metastasis but noncaseating granulomas were detected in the resected lymph nodes. Postoperatively, we identified cutaneous sarcoidosis and uveitis in the presence of a tuberculin-negative test. On the basis of these findings, we diagnosed the patients with endometrial cancer complicated by sarcoidosis. She underwent adjuvant chemotherapy, and at the 1-year follow-up, the lymph node swelling due to sarcoidosis was stable, and no recurrence of the cancer was observed. This turned out to be a case of early endometrial cancer mimicking advanced cancer by sarcoidosis. Histological confirmation and additional examination for sarcoidosis are necessary in cancer patients suspected of sarcoidosis.Key Words: Endometrial cancer, Sarcoidosis, Noncaseating granulomas     

Sarcoid-like hilar and mediastinal lymphadenopathy in a patient with metastatic testicular cancer

Previous reports indicate that enlarged hilar and mediastinal lymph nodes due to sarcoid-like reactions may develop after curative resection of testicular cancer, and their presence does not necessarily denote neoplastic recurrence. Reports further suggest that coexisting pulmonary nodules in this setting may be related to nodular sarcoidosis. A patient developed progressive hilar and mediastinal adenopathy associated with multiple pulmonary nodules after apparent curative resection of a testicular embryonal cell cancer. Biopsy specimens from the mediastinal lymph nodes demonstrated granulomas, suggesting the diagnosis of nodular sarcoidosis. Needle aspiration of the pulmonary nodules, however, revealed metastatic testis cancer. Sarcoid-like mediastinal reactions occur after resection of testis cancer, but biopsies should be performed on coexisting pulmonary nodules to exclude pulmonary metastases.     

A case of esophageal squamous cell carcinoma metastatic to the breast

Metastasis to the breast from extramammary malignancies is rare. There are especially few reports of metastasis from esophageal cancer. We report the pathological and autopsy findings of a 44-year-old man with advanced esophageal cancer and a left breast tumor. Squamous cell carcinoma invading the mammary glands was demonstrated histologically. Immunostains for ER, PgR, and ErbB-2 were negative. At autopsy, metastatic lesions were found in lung, liver, diaphragm, peritoneum, spine, and mediastinal lymph nodes, with no evidence of metastasis to the skin. While metastatic breast tumors are rarely the initial sign of malignancy, it is important to distinguish a metastasis from primary breast cancer to avoid unnecessary conflicting treatments.     

Study of papillary carcinoma of thyroid with uncommon sites of metastasis

Papillary carcinoma of thyroid (PCT) is the most common type of thyroid malignancy and metastasis to cervical lymph nodes is very common [1]. Blood borne metastases from PCT are less frequent than with the other thyroid carcinomas [2]. Uncommon sites include lungs, bone, atrium, cerebrum, kidney, skin [3]. We report four cases of papillary carcinoma with uncommon sites of metastasis. One showed tumor emboli of 2.5 cm in internal jugular vein, one had tumor deposit in metacarpal bone and lung, one had a subcutaneous tumor deposit and one was a micropapillary carcinoma with metastasis axillary nodes. All these four cases were classical PCT.     

Sarcoid-like lymphadenopathy mimicking metastatic testicular cancer

A case of nonseminomatous testicular cancer and enlarged mediastinal lymph nodes, which were interpreted as metastases, is reported. When there was no change after two courses of chemotherapy, a mediastinoscopy was performed and the results showed sarcoidosis.     

Multicentric Breast Cancer of the Axillary and Pectoral Breasts: A Case Report and Literature Review

Multicentric cancer of the pectoral and ectopic breasts is extremely rare, and diagnosing this malignancy remains challenging because axillary breast cancer is easily misdiagnosed as lymph node metastasis. Moreover, there are no established treatment guidelines for this disease. We present our experience with a multicentric breast cancer patient who showed different responses to neoadjuvant chemotherapy (NAC) and underwent surgical treatments that differed from those in previous studies. In our case, the preoperative imaging of both lesions and subsequent core needle biopsy of each lesion were crucial, as these procedures confirm the diagnosis and help decide the chemotherapy regimen based on the subtype. After NAC, the patient underwent right breast-conserving surgery, sentinel lymph node biopsy (SLNB), and excision of accessory breast tissue in the right axilla. SLNB should be the initial step in staging multicentric breast cancer, unless imaging scan shows evidence of lymph node metastasis.     

Testicular Metastasis in a Case of Squamous Cell Carcinoma of the Lung

Testicular metastases are a rare finding. Typically, a testicular metastasis will present as a complication of progressive disease or as a primary sign of malignancy. Excluding lymphoma and leukemia, prostate cancer is the most common primary site that metastasizes to the testes. Testicular metastases resulting from squamous cell carcinoma of the lung have rarely been reported in previous literature. Here, we report a case of stage IV squamous cell carcinoma of the lung with metastases to the brain and multiple bilateral lung lesions. Following palliative systemic chemotherapy, this patient was found to have a right testicular mass. Pathology reports confirmed that this was a testicular metastasis of squamous cell lung carcinoma origin.Key Words: Testicular cancer, Testicular metastasis, Blood-testis barrier, Squamous cell, Lung cancer, Sanctuary site     

PET and PLAP in suspected testicular cancer relapse: Beware sarcoidosis

A 31-year-old man previously treated with chemotherapy for metastatictesticular cancer presented with new mediastinal lymphadenopathy andperipheral lung opacities. Serum tumour markers were not elevated and aPET (positron emission tomography) scan revealed increased FDG(fluoro-deoxyglucose) uptake in the lungs and mediastinum consistentwith testis cancer relapse. A biopsy of a mediastinal lymph node wasperformed and the pathology was that of sarcoidosis.Immunohistochemistry however was positive for PLAP (placental alkalinephosphatase) and negative for EMA (epithelial membrane antigen). Thisimmunohistochemical profile raised concerns that the observed pathologyrepresented a sarcoid reaction to micro-metastatic testicular cancerrelapse. We performed immunohistochemical pathology analysis on fourknown cases of sarcoidosis and found the sameimmunohistochemical-staining pattern. This case highlights the problemof specificity when interpreting the significance of PET scans andimmunohistochemical analysis in this situation. Sarcoidosis,a condition that has been associated with testicular cancer, shouldalways be considered in the differential diagnosis.     

Management of accidentally found pathological lymph nodes on routine screening mammography

Normal lymph nodes in the anterior part of the axilla are readily seen on routine mammography. It is important, however,to recognize pathological lymph nodes, characterized by increased attenuation, high density, a round or irregular shape and lack of fat in the hilus, as they often indicate significant diseases. We examined the final diagnosis in 22 patients referred for clinical examination from a mammographic screening programme because of pathological lymph nodes without concomitant breast malignancy. Ten of them were found to have a malignant lesion, and one had sarcoidosis. None of the malignancies had been diagnosed before screening. Among women with abnormal but impalpable nodes, only one malignancy was found (in a woman with previous breast cancer), whereas nine of 13 women with palpable nodes had malignancies. Seven malignant lymphomas were discovered, but among all 60 women of the age group in question with newly diagnosed lymphomas in the region, only 13 had pathological axillary nodes. Mammography cannot therefore be used as a screening method for lymphoma. We conclude that mammographically pathological lymph nodes in the axilla should be examined clinically and propose a simple programme for patient management.     

食管癌右喉返神经旁淋巴结转移的相关因素研究

目的 探讨食管癌右侧喉返神经旁淋巴结转移的相关因素.方法 回顾性分析280例行右侧喉返神经旁淋巴结清扫的食管癌患者的临床病理学资料.应用χ2检验进行单因素分析,应用Logistic回归分析进行多因素分析.结果 280例食管癌患者中,右侧喉返神经旁淋巴结转移76例,转移率为27.1%.右侧喉返神经旁淋巴结清扫979枚,转移118枚,转移度为12.1%.Logistic回归分析结果显示,肿瘤分级、淋巴结转移数、脉管瘤栓、胸部淋巴结转移数、腹部淋巴结转移数、隆突下淋巴结转移以及食管周围淋巴结转移是影响右侧喉返神经旁淋巴结转移的独立因素.结论 右侧喉返神经旁淋巴结清扫应该参照淋巴结转移的影响因素,合理地进行清扫.     

头颈部癌前哨淋巴结的临床研究

目的 探讨头颈部肿瘤前哨淋巴结的检测及其对淋巴结转移的预测价值。方法 用手术中注射蓝染料的方法,对51例未经治疗的头颈部癌颈淋巴结NO的患者进行了手术中前哨淋巴结的临床研究。手术中取前哨淋巴结作快速冰冻病理,并与手术后常规石蜡切片病理对照,观察冰冻病理前哨淋巴结转移和常规病理颈淋巴结转移的相关性及其对颈淋巴结转移 癌的预测值。结果 51例中48例成功的显示了前哨淋巴结,成功率94．1％,前哨淋巴结平均每例每侧2．5枚。11例前哨啉巴结阳性,其中2例有前哨淋巴结以外的颈淋巴结转移,2例为假阴性。前哨淋巴结对颈淋巴结转移的总阳性预测值为85％。结论 前哨淋巴结检测对头颈部癌的淋巴结转移有重要的预测价值。     

A case of breast cancer diagnosed by inguinal lymph node metastasis

We describe a case of a 58-year-old woman with right inguinal lymph node swelling and a T1 tumor in the right breast. She was referred with an 18-month history of the former complaint and a six-month history of the latter. Excisional biopsy of the inguinal lymph node revealed breast cancer metastasis. Radiographical examination showed no metastases to the lungs, liver or bone. Modified radical mastectomy was performed. Histological examination revealed solid tubular carcinoma, PT2, PM (axillary lymph node metastases 4/16), stage IV. Estrogen and progesterone receptors were negative. Three cycles of postoperative cyclophosphamide, adriamycin and 5-fluorouracil (CAF) chemotherapy were given, and the right inguinal area was irradiated with 40 Gy. The patient complained of swelling in both legs three years after surgery. Computed tomography revealed marked lymph node swellings in the pelvic cavity. She died six months later. Inguinal lymph node metastasis from breast cancer is very rare, although distant lymph node metastasis in the cervix occurs frequently. This case should help clarify how breast cancer metastasizes to distant lymph nodes.     

骨肉瘤区域淋巴结检查的临床意义

目的通过本研究了解在骨肉瘤患者中区域淋巴结转移的发病率、淋巴结肿大原因及与预后的关系。方法对1963年至2004年受治的946例骨肉瘤病人进行临床回顾，对76例行术前淋巴结活检的患者进行病理回顾。结果病理证实有4例患者出现了淋巴结转移，这些患者初诊时未发现有其他血行转移。所有淋巴结转移的患者均于术后两年内死亡。绝大多数淋巴结增大者病理学表现为窦增生。结论骨肉瘤患者中淋巴结转移少见，如出现转移则预后极差，预后与出现血行转移者一样。淋巴结有免疫作用，淋巴结肿大多为非特异性反应。     

Supraclavicular node biopsy in staging of testicular carcinoma

The supraclavicular lymph nodes are known as a potential site for metastatic disease of the gastrointestinal and genitourinary cancers. The values of supraclavicular node biopsy in patients undergoing staging for testicular cancer were studied prospectively. Of 108 patients with testicular cancer undergoing therapy, 26 had supraclavicular node biopsy as part of their staging procedure. Evidence of metastatic disease to the supraclavicular nodes was found in 36% (10/26) of the patients. Ten of these patients had abnormal examinations of the supraclavicular fossa and nine of them (90%) had histologic evidence of metastatic disease. However, of the 16 patients with normal examination of the supraclavicular fossa, only one patient (6.3%) presented with clinically inapparent metastatic disease. The low yield for detection of clinically inapparent metastatic disease mitigates against indiscriminate supraclavicular node biopsy in the staging of testicular carcinoma.     

Adenocarcinoma of the stomach following radical radiotherapy for testicular cancer

Two male patients who underwent curative surgery and adjuvant radiotherapy (with further chemotherapy in one) for testicular cancer developed adenocarcinoma of the stomach 5 and 19 years after treatment. The stomach is included in the field of radiotherapy used to treat the para-aortic lymph nodes and this may lead to dysplastic changes in the stomach mucosa which can lead to frank malignancy. Early endoscopy should be offered to patients with dyspeptic symptoms after adjuvant radiotherapy for testicular cancer.     

多层螺旋 CT双期增强扫描对乳腺癌及早期淋巴结转移患者的诊断价值

目的：探讨多层螺旋CT在乳腺癌及早期淋巴结转移中的诊断价值。方法对37例乳腺肿瘤患者采用多层螺旋CT机平扫和增强扫描检查是否发生淋巴结转移，并与病理结果进行对照，并观察乳腺癌淋巴结大小与转移及其内部结构关系。结果清扫淋巴结总数为61枚，其中转移性淋巴结33枚，非转移性淋巴结28枚。 MSCT与病理学检查结果相一致，但是MSCT扫描淋巴结大小无法单独作为评估是否发生转移指标。淋巴结门结构与是否发生转移相关，淋巴结门结构厚度不均可作为预测是否发生转移的独立指标。结论多层螺旋CT扫描速度快，分辨率高，能获得精确的乳腺癌患者扫描图像，有利于淋巴结转移的检出，为临床治疗乳腺癌患者有着重要意义。     

Unknown primary carcinoma, diagnosed as inflammatory breast cancer,and successfully treated with trastuzumab and vinorelbine

Occult breast cancer presenting with axillary lymph node metastases is uncommon, and inflammatory breast cancer (IBC), as a subtype, is quite rare. Here we describe a case of IBC, which arose as an unknown primary carcinoma; the patient presented with axillary lymph node metastasis, and was successfully treated with trastuzumab and vinorelbine. Specifically, a 55-year-old woman presented with right axillary lymphadenopathy. Although she underwent various examinations, the primary site of the disease was not revealed. Axillary lymph node dissection was performed, and the lesion was diagnosed as a poorly differentiated adenocarcinoma. The patient chose to be treated by alternative medicine. About 6 months later, she was referred to our hospital, due to marked bilateral neck and axillary lymph node swelling. She presented withdiffuse right breast enlargement, redness, and peau d’orange. Computed tomography (CT) of the breast showed skin thickening and swelling of the right breast.F-18 Fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG uptake in the right breast. The patient was clinically diagnosed with IBC. Because overexpression of the human epidermal growth factor receptor 2 (HER2) was found in the specimen from her right axillary lymph node, she was treated with trastuzumab and vinorelbine. Two months after the start of chemotherapy, CT revealed a complete response in the lymph nodes, and the skin thickening and parenchymal edema of the right breast had improved. FDG-PET was also performed at this time, and revealed no FDG uptake in either the right breast or the lymph nodes.     

Invasion and metastasis following orthotopic transplantation of human pancreatic cancer in the nude mouse

A good experimental model for metastasis of human pancreatic cancer would be a valuable tool for the study of this process, which contributes significantly to morbidity and mortality. Models of experimental metastasis using injection of tumor cells into the portal or systemic circulation bypass some important steps of the metastatic process. We describe invasion and metastasis following orthotopic transplantation of human pancreatic carcinoma into nude mice. Tumor pieces were used as xenografts in this study, and metastases were observed in the regional lymph nodes, liver, lungs, and distant lymph nodes of the animals. Peritoneal implants and ascites were not observed in this study. Orthotopic transplantation of human pancreatic cancer in the nude mouse appears to be a promising model of spontaneous metastasis relevant to clinical reality.