Prostatic carcinoma presenting as an abdominal mass: a case report]

Prostatic carcinoma presenting as an abdominal mass is a very rare disorder. A 64-year-old man was referred to our hospital with the chief complaint of a right lower abdominal mass on March 6, 1984. Physical examination revealed a firm, smooth, fixed, non-tender, pulseless fist size mass in the right lower abdomen. Rectal examination revealed an apple size, smooth and elastic firm prostate which had an induration. Needle biopsy of the prostate showed well-differentiated adenocarcinoma. At first we regarded the abdominal mass as retroperitoneal tumor unassociated with prostatic carcinoma. After preoperative irradiation (20 Gy) to the pelvis, the abdominal mass was resected and bilateral orchiectomy was performed on April 11, 1984. The mass was histologically diagnosed as a metastatic lesion from prostatic carcinoma. On the basis of these findings, we considered the mass to be due to pelvic lymph node metastasis from prostatic carcinoma. His postoperative course was uneventful. In April 1991, he is still alive without evidence of recurrence or bone metastasis.     

Spinal metastasis of submandibular gland adenoid cystic carcinoma: a case report

BACKGROUND: Adenoid cystic carcinoma is a rare malignant tumor of the salivary glands, with pulmonary metastasis being the most common site of distant metastasis. CASE DESCRIPTION: The author reports an unusual case of intradural adenoid cystic carcinoma metastasis of the lumbar spine in a patient with recent prostate carcinoma suffering from progressive back pain. The primary submandibular tumor was resected 7 years before the appearance of the spine metastasis, and a prostatic carcinoma had been detected 1 year before. The patient died of systemically advanced disease a few months after surgical decompression. CONCLUSION: Late submandibular gland adenoid cystic carcinoma recurrence may present as an intradural lumbar spine metastasis. The case further displays difficulty in diagnosis and differentiation of metastasis in case of metachronous tumors.     

Intracranial leptomeningeal metastasis from thymic carcinoma: case report and review

BACKGROUND: Thymic carcinoma is an uncommon malignant tumor of the anterior mediastinum. Meningeal metastasis from this type of neoplasm is extraordinarily rare and the prognosis is abysmal. CASE DESCRIPTION: This article presents the case of a 45-year-old man with known metastatic thymic carcinoma who presented with intractable headaches. An MRI scan was highly suggestive of a meningioma, and it was initially suspected that this patient had 2 primary tumors. Surgical resection of the mass both demonstrated a metastatic thymic lesion and ameliorated the patient's quality of life. CONCLUSION: The authors report a case of intracranial meningeal metastasis from a lymphoepithelioma-like poorly differentiated metastatic thymic carcinoma, which was treated by resection and WBRT. A review of the current literature revealed no other cases of this uncommon alhistologic subtype of thymic carcinoma metastatic to the cranium. The incidence, histologic classification of subtypes, and treatment are discussed. This case also illustrates the importance of maintaining a high degree of suspicion for a metastasis in patients with known primary malignancy who present with an MRI highly suspicious for meningioma.     

A case of prostatic carcinoma presenting as a metastatic orbital tumor]

A 66-year-old man presented with progressive proptosis of the left eye associated with ocular pain. A computed tomographic scan showed a high density mass in the posterolateral portion of the left orbit. The patient underwent surgical removal of the tumor and histopathological examination revealed adenocarcinoma of unknown origin. To find out the primary focus of the tumor the patient was referred to our department, where biopsy of the prostate revealed adenocarcinoma. Further, immunohistochemical examination of the orbital tumor was performed and prostatic acid phosphatase was identified. Finally, we made a diagnosis of orbital metastasis from prostatic carcinoma. This paper presents a rare case of prostatic carcinoma with orbital metastasis and reviews the literature of the subject.     

Carcinoma of prostate metastatic to breast

Clinically diagnosed breast metastasis from prostatic carcinoma is rare. Primary breast carcinoma in patients with prostatic primary is also uncommon. Four patients who presented with breast malignancies in the course of their prostatic carcinoma are described. All but one of them had diffuse metastatic disease. Three of them were on estrogens at the time breast malignancy was diagnosed. Difficulties always arise in differentiating primary lesions from metastasis clinically and histopathologically. The development of histochemical methods for acid phosphatase, and the newest indirect immunofluorescent antibody technique, used in one of our patients, helped in making the differentiation between primary lesion and metastatic disease. Diagnosis of prostatic carcinoma metastatic to breast carries a poor prognosis, and may be an indication for aggressive therapy.     

Clinical study of six thymic carcinomas including long-term survivors]

Six cases of thymic carcinoma (mean age 48.5 years old, one male and 5 females) were treated in our hospital from September 1990 to September 1998. The histological subtypes of thymic carcinoma were squamous cell in 4, undifferentiated in one, and small cell in one. All cases underwent midsternal thoracotomy, 4 had total resection of the tumor and 2 had exploratory thoracotomy due to tumor invasion of the aorta and the main pulmonary artery. Within 2 years after operation, 2 cases without radiation therapy were died of the carcinoma and one case was died of asthma. However, two cases of squamous cell carcinoma have been alive and disease free for 3 and 5 years since the operation followed by mediastinal irradiation. We think that radiation therapy is very effective to control the disease because one of them underwent only exploratory operation prior to irradiation. Another one case who survives 5 years after total resection of the tumor following irradiation revealed swelling of numerous mediastinal lymph nodes, pathologically consisted of non-caseating epithelioid cell granulomas without metastasis of carcinoma, at the time of operation. These lymph nodes were diagnosed as "sarcoid-like reaction" because there was no clinical evidence of generalized sarcoidosis. The "sarcoid-like reaction" may contribute to the 5-year survival of the patient because it is thought to be a local immune response against the cancer cells. A remaining patient, alive 6 months after total resection of the thymic small cell carcinoma following irradiation, received preoperatively three cycles of the intra-arterial administration using CBDCA via bilateral internal mammary arteries. This induction chemotherapy had no response of the tumor size, but it was considered to have a possibility of reducing the size of thymic carcinoma by the use of other agents (CDDP, VDS etc.) because the tumor was fed mainly by the highly developed internal mammary arteries.     

Thymic squamous cell carcinoma

In the case described, a 43-year-old man had an asymptomatic mass involving the right hilar and superior mediastinum. At surgery, the tumor was found to have invaded the right middle lobe of the lung and the pericardium. The mass was found to be a thymic squamous cell carcinoma, a rare tumor. Two serum tumor markers--lipid-associated sialic acid and squamous cell carcinoma antigen--were elevated. The patient underwent postoperative radiation therapy and has responded favorably to treatment. He had no clinical evidence of metastasis or recurrence as of 43 months postoperatively.     

An autopsy case of prostatic neuroendocrine cell carcinoma and adenocarcinoma initially found by brain and abdominal wall metastasis

A 62 year-old man had been suffered from headache and left shoulder pain since March 1997. In November 1997, he visited our hospital complaining of work incapability, slow-moving and somnolence. Multiple nodular lesions were found in his brain and abdominal wall. Biopsy of the abdominal wall mass revealed small cell carcinoma/neuroendocrine cell carcinoma. Radiation therapy on brain and abdominal wall was done and these tumor nodules became decreased. However, recurrence and metastasis occurred later and died at March 1998. The autopsy revealed the origin of these tumors was the prostate. The prostatic tumors revealed neuroendocrine cell carcinoma mainly, combining a portion of adenocarcinoma. Most parts of the metastatic tumors were neuroendocrine cell carcinoma. Only the seventh thoracic vertebral metastasis was bone-sclerosing metastasis of adenocarcinoma.     

Predicting the probability of bone metastasis through histological grading of prostate carcinoma: a retrospective correlative analysis of 81 autopsy cases with antemortem transurethral resection specimen

In a retrospective correlative analysis of postmortem findings and antemortem transurethral resection specimens from 81 patients with prostatic carcinoma a simple and reliable prediction index was found. This index was derived from the transurethral resection specimen in regard to the probability of ultimate bone metastasis by tumor and was obtained by dividing the number of prostatic tissue chips involved with tumor by the total number of prostatic tissue chips examined microscopically. We found that when 75 per cent or more of the transurethral resection chips were involved with tumor, regardless of the degree of tumor differentiation, the probability of bone metastasis was more than 9.0 (greater than 90 per cent), whereas the probability was 0.58 for 50 to 75 per cent involvement, 0.38 for 30 to 50 per cent involvement, 0.27 for 20 to 30 per cent involvement, 0.10 for 10 to 20 per cent involvement and 0.06 for less than 10 per cent involvement. Other tumor grading systems, such as the Gleason system, also were compared. A good correlation was obtained by the Gleason grading system in the prediction of bone metastasis but the system is not as simple or as reproducible as the tumor involvement index described herein. Other parameters, such as prostatic acid phosphatase and prostatic specific antigen as determined by the immunoperoxidase method, had no specific or significant value in the prediction of bone metastasis. Our findings reaffirm the relatively old concept that the extensiveness of tumor involvement in the transurethral resection specimen is the single most important factor in the prediction of the clinical behavior of the prostatic carcinoma.     

Thymic carcinoma presenting as cranial metastasis with intradural and extracranial extension: case report

OBJECTIVE AND IMPORTANCE: Thymic carcinoma is an uncommon malignant tumor that is different from thymoma. Cranial and brain metastases from this tumor are extremely rare. We report a thymic carcinoma with cranial metastasis and discuss the behavior of this tumor. CLINICAL PRESENTATION: A 50-year-old man presented with headache and a palpable scalp tumor. Computed tomographic scans and magnetic resonance images revealed an osteolytic tumor with intradural and extracranial extension in the right occipital bone. INTERVENTION: After gross total resection and histological diagnosis, further investigation revealed a primary thymic tumor in the anterior upper mediastinum and liver metastases. The patient received multiple-cycle chemotherapy (cisplatin and gemcitabine) for primary and metastatic lesions. CONCLUSION: Thymic carcinoma has a poor prognosis because of a high degree of malignancy, early metastasis, and delayed diagnosis. Thus, treatment of a patient with this tumor calls for prompt diagnosis, surgical treatment, and optimal adjuvant therapy.     

Lymphogenous and hematogenous metastasis of thymic epithelial tumors

BACKGROUND: A TNM classification has been established for various tumors. However, the TNM classification of thymic epithelial tumor has not been established yet. METHODS: We received replies to a questionnaire on thymic epithelial tumors from 115 institutes. We compiled a database of 1,320 patients with thymic epithelial tumor (1,093 thymomas, 186 thymic carcinomas, and 41 thymic carcinoids) who were treated between 1990 and 1994. We used a tentative TNM classification of thymoma presented by Yamakawa and associates in 1991. The regional lymph nodes of the thymus were classified into three groups: anterior mediastinal lymph nodes (N1), intrathoracic lymph nodes (N2), and extrathoracic lymph nodes (N3). RESULTS: The rate of lymphogenous metastasis in thymoma, thymic carcinoma, and thymic carcinoid was 1.8%, 27%, and 28%, respectively. Most tumors with lymph node metastasis metastasized to N1 (thymoma, 90%; thymic carcinoma, 69%; thymic carcinoid, 91%). The 5-year survival rates of N0, N1, and N2 thymoma were 96%, 62%, and 20%, respectively. The 5-year survival rates of N0, N1(,) N2, and N3 thymic carcinoma were 56%, 42%, 29%, and 19%, respectively. The 5-year survival rates of M0 and M1 thymoma were 95% and 57%. The 5-year survival rates of M0 and M1 thymic carcinoma were 51% and 35%. Multivariate analysis demonstrated that survival of patients with thymoma was dependent on the clinical stage of Masaoka and complete resection. In thymic carcinoma, survival was dependent on lymph node metastasis and complete resection. CONCLUSIONS: The N factor was one of the predictors of survival in thymoma and thymic carcinoma. However, M factor showed less influence on survival than T or N factors.     

Clinicopathologic assessment of primary thymic carcinoma based on seven cases

In order to study clinicopathologic characteristics of thymic carcinomas, seven patients experienced in our department were reviewed in this paper; 6 patients underwent thoracotomy and one did not receive surgical treatment. Among 6 who received operation, the tumor was resected totally in 3, subtotally in one, partially in one. One patient underwent exploratory thoracotomy. There have been no distinctive clinical features including clinical symptoms and radiographical findings from invasive thymomas in 7 primary thymic carcinomas, however, in these malignant tumors there have been no tumor-associated disorders not infrequently observed in thymomas. Postoperatively, distant metastasis was common in patients with thymic carcinomas, even though the primary tumor was resected totally in the operation. However, one patient with squamous cell carcinoma of the thymus who underwent subtotal tumor resection followed by radiotherapy and chemotherapy are surviving over 6 years postoperatively. Intensive treatment including pre- and postoperative radiation, tumor resection and postoperative chemotherapy is absolutely necessary for thymic carcinoma. Histologically, there were 4 squamous cell carcinomas and 3 large cell carcinomas. One of 3 large cell carcinomas showed squamous cell differentiation histologically. Two of 4 squamous cell carcinomas demonstrated concomitant entity of residual thymus tissue as well as thymoma in one specimen. However, further studies are necessary to determine precise etiology and tumor characteristics of thymic carcinoma.     

Prostatic carcinoma with metastasis to the testicle: a case report

A 63-year-old man was admitted with the complaints of macrohematuria, sense of residual urine and urinary frequency. Physical examination revealed an enlarged hard prostate and left scrotal mass. The pathological diagnosis of the needle biopsy specimen of the prostate showed undifferentiated adenocarcinoma. The patient underwent bilateral orchiectomy for hormone therapy of prostatic carcinoma and treatment of suspected left testicular tumor. The histology of testicular tumor revealed metastasis from carcinoma of the prostate. Metastasis of the testis from prostatic carcinoma is rare in spite of the high incidence of the primary tumor. Clinical findings on testicular metastasis from carcinoma of the prostate obtained in 62 cases reported in available literature are reviewed and discussed in detail.     

Thymic carcinoma with myasthenia gravis: Two case reports

IntroductionMyasthenia gravis (MG) has been reported to correlate with earlier-stage thymoma, and theoretically does not accompany thymic carcinoma. However, we encountered two cases of thymic carcinoma with MG.Presentation of casesCase 1 involved a 54-year-old man who had been diagnosed with MG based on symptoms and detection of anti-acetylcholine receptor antibody (ARAB). Computed tomography (CT) revealed an anterior mediastinal tumor 30 mm in diameter. Prednisolone (PSL) and tacrolimus were administered without surgery at that time. Six years after diagnosis of MG, he was admitted to our hospital and underwent extended thymectomy. Pathological examination revealed type B2-B3 thymoma according to World Health Organization criteria, comprising 80% of the tumor with small cell carcinoma as 20%. Case 2 involved a 51-year-old woman. She had been diagnosed with MG based on eyelid ptosis and detection of ARAB. Ten years after diagnosis of MG, diaphragm elevation was detected on chest X-ray. CT revealed an anterior mediastinal tumor, 47 mm in diameter. We suspected tumor invasion to the right phrenic nerve, right atrium, and superior vena cava. We therefore performed extended thymectomy after preoperative radiotherapy (40 Gy). Pathological examination revealed squamous cell carcinoma.DiscussionMost cases of thymic carcinomas appear to arise de novo, but appearance in thymomas has been described. In both our cases, MG was treated with pharmacotherapy alone without extended thymectomy, and thymic carcinoma was considered to have developed from the thymoma during long-term follow-up.ConclusionThymic carcinoma can accompany MG.     

A prostatic duct carcinoma difficult to distinguish from transitional cell carcinoma: a case report

A 77-year-old male with a complaint of dysuria and gross hematuria for 3 months visited our hospital. Abdominal ultrasonography, computed tomographic scan and magnetic resonance imaging revealed a prominent tumor from the bladder neck. Serum prostate specific antigen (PSA) level was high (1,130 ng/ml) suggesting prostate cancer, but transitional cell carcinoma (TCC) was detected by transurethral biopsy. Bone scintigraphy revealed multiple bone metastasis. Since gross hematuria requiring bladder tamponade continued, simple cystoprostatectomy and cutaneous ureterostomy were performed. Pathological findings showed prostatic acinar carcinoma and prostatic duct carcinoma mimicking TCC, and PSA immunohistochemically weak positive. The final diagnosis was prostate cancer consisting of acinar and ductal component. Adjuvant hormonal therapy was performed, but was ineffective. The patient died 2.5 months after operation. We reviewed and discussed 66 cases of prostatic duct carcinoma, including our case, in the Japanese literature.     

Unusual radiologic features of metastatic prostatic carcinoma confirmed by immunohistochemical study

The clinical application of an immunohistochemical technique for prostatic acid phosphatase allowed the accurate diagnosis of metastatic prostatic carcinoma in 17 patients whose condition was not recognized by either clinical or histologic observations. The cardinal manifestations in these 17 patients included supraclavicular lymphadenopathy in 7, hilar lymphadenopathy in 1, pulmonary infiltration in 2, simulating carcinoma of the rectum in 4, fracture of femur in 1, orbital tumor in 1, and brain tumor in 1. A retrospective analysis of the radiologic features of these patients showed that the unusual manifestations were due to the route of metastasis, that is, direct invasion, lymphatic, and hematogenous. Radiologic studies, even in these unusual cases, are both useful in establishing the diagnosis and helpful in delineating the mode of metastasis of prostatic carcinoma.     

Well-differentiated thymic carcinoma. An organotypical low-grade carcinoma with relationship to cortical thymoma.

Based on a study of 26 cases, the well-differentiated thymic carcinoma is described as a distinct organotypical carcinoma of the thymus with low-grade malignancy. It is characterized by a predominance of epithelial cells with usually low mitotic rate, an epidermoid differentiation with slight to moderate cytological atypia, the constant presence of interepithelial immature cortical thymocytes, lobular growth, and formation of epithelial palisades around perivascular spaces. The tumor occurs at age 14 to 76 years in both sexes. An association with myasthenia gravis is found in 77% of the patients, and 83% of the tumors show invasion of adjacent organs or endothoracic metastasis at primary operation. This rate is higher than in cortical thymomas (47%) but lower than in other thymic carcinomas (92%). Two of 18 patients with follow-up died of tumor recurrence and pleural metastasis. Well-differentiated thymic carcinoma can be related to cortical thymoma by common morphological features and a similar immunophenotype of epithelial cells. It must be differentiated from the lymphocyte-depleted cortical thymomas after corticosteroid treatment and from the benign epithelial-rich medullary thymomas.     

Thymic carcinoid tumor--report of 3 operative cases]

Three cases of thymic carcinoid were surgically treated in our hospital. All 3 cases belonged to stage IVb (Masaoka's classification) because of anterior lymph nodes metastasis. A 44-year-old male patient died of multiple metastasis of bone and liver in 94 months after the operation. A 45-year-old female patient who had undergone operation 4 years ago, was re-operated on for recurrent carcinoid tumor but complete resection of the tumor could not be performed because of the tumorous invasion to superior vena cava, pericardium and costal bone. After the operation she has been treated by radiotherapy and any re-growth of the tumor has never been detected for 1 year. Another 50-year-old male patient who had been operated and treated by chemo-radiotherapy for thymic carcinoid before 50 months was diagnosed as recurrent tumor at left interpectoral lymph node. Radiotherapy is now preparing for this patient. 160 cases of thymic carcinoid reports in Japan were reviewed. 37 cases were stage IVb and 36 cases had supraclavicular or mediastinal lymph nodes metastasis. Those cases which had been underwent complete resection followed by radiotherapy seemed to have better prognosis. We conclude that patients of thymic carcinoid should be treated with complete resection including supraclavicular and mediastinal lymph nodes dissection, followed by radiotherapy.     

Spontaneous metastasis of PC-3 cells in athymic mice after implantation in orthotopic or ectopic microenvironments

The ability of subcutaneous, prostatic, and nonprostatic intraabdominal organ microenvironments to influence local tumor growth and metastasis of PC-3 human prostate carcinoma cells in athymic mice was determined. Tumorigenesis and metastasis of PC-3 were evaluated 60 days after subcutaneous and intraprostatic (orthotopic) implantation of 5 × 10⁵ PC-3 cells in 6-week-old, male athymic mice. Intraprostatic implantation of PC-3 cells resulted in paraaortic lymph node metastases in 10 of 10 (100%) mice with prostatic tumors, whereas metastases were present in only 2 of 9 (22%) mice after subcutaneous implantation. Next, we determined whether the urinary bladder (nonprostatic, urogenital microenvironment) or stomach (nonurogenital, intraabdominal microenvironment) would facilitate the metastasis of PC-3 cells in athymic mice. Tumorigenesis and metastasis were 100% after subserosal implantation of PC-3 cells within the wall of the urinary bladder (n = 6 mice). Subserosal implantation of PC-3 cells into the stomach wall (n = 7 mice) also resulted in tumor formation and metastasis to regional lymph nodes in 100% of mice. In all experiments, regional lymph nodes were the most frequent site of metastasis, regardless of implantation site. We conclude that tumor microenvironment factors responsible for the metastasis of PC-3 cells in athymic mice may not be organ-specific, since nonprostatic visceral microenvironments are sufficient for predictable metastasis. Use of these models may further our understanding of how tumor microenvironment modulates expression of the metastatic phenotype by human prostate carcinoma cells.     

Thymic basaloid carcinoma with hepatic metastasis

A thymic basaloid carcinoma is rare, as is an unusual case with extra-thoracic metastasis. We report on a 41-year-old woman who had a thymic basaloid carcinoma with liver metastases. The patient underwent resection of the thymic basaloid carcinoma followed by curative partial hepatectomy. At 1 year later, another metastatic lesion developed in the residual liver, which was also curatively resected. The postoperative course was uneventful, and the patient is surviving without recurrence for 12 months, to date.