Metastatic tumor of squamous cell carcinoma from uterine cervix to heart: ante-mortem diagnosis

Sixty-three-year-old woman with a past medical history of uterine cancer and complaint of fatigue and dyspnea on mild exertion. Physical examination revealed hypertension and rales at lung bases. A transthoracic echocardiogram showed a mass with reduced mobility in the right ventricle. The patient was taken to surgery during which a mass involving the anterior wall of the pulmonary artery, tricuspid valve, right atrium, and posterior wall of the right ventricle was found. The pulmonary artery and the right ventricle were reconstructed with a bovine pericardium patch and the tricuspid valve was replaced by a number-31 biological prosthesis. The pathological examination revealed metastasis of squamous cells with well-differentiated infiltrative areas. The patient was discharged one month after surgery. Four months later, however, she was readmitted to hospital in terminal stage, confirming the guarded prognosis of the disease at this stage.     

Metastatic squamous cell carcinoma in a bone marrow transplant recipient

We report a case of 53 year old female with history of acute myelogenous leukemia, for which she underwent allogeneic peripheral blood stem cell transplant; her course was complicated by chronic graft versus host disease. Seven years later she presents with squamous cell carcinoma of the skin which metastasize to her heart. Here, in this case we tend to highlight the aggressive nature of the squamous cell carcinoma in an immunocompromised individual.     

Metastatic germ cell tumor to the heart presenting with syncope.

Malignant nonseminomatous germ cell tumors (NSGCT) rarely metastasize to the heart. The first such case presenting with syncope is described. Eight previously described cases of NSGCT with intracaval metastasis to the heart are reviewed and the literature to date is discussed. Transesophageal echocardiography is the diagnostic study of choice and treatment consists primarily of platinum-based chemotherapy followed by surgical resection of residual deposits.     

Outcomes of anus squamous cell carcinoma. Management of anus squamous cell carcinoma and recurrences

BackgroundLittle is known about the management of squamous cell carcinoma of the anal canal and its recurrence at a population level. The aim of this study was to draw a picture of management, recurrence and survival in squamous cell carcinoma of the anal canal.Material and methodsThe 5-year probability of recurrences was estimated using the cumulative incidence function to consider competing risks of death. Net survival was estimated and a multivariate survival analysis was performed. The study was conducted using data of the Burgundy Digestive Cancer Registry. Overall, 273 squamous cell carcinomas of the anal canal registered between 1998 and 2014 were considered.ResultsOverall, 80% of patients were treated with curative intent. Of these, 61% received chemoradiotherapy, 35% received radiotherapy and 4% received abdominoperineal resection alone. After these treatments, for cure the 5-year cumulative recurrence rate was 27% overall; it was 20% after chemoradiotherapy and 38% after radiotherapy. Five-year net survival was 71% overall; it was 81% after chemoradiotherapy and 55% after radiotherapy.Conclusions and relevanceChemoradiotherapy was highly effective in routine practice. We confirm that it is difficult to distinguish between persistent active disease and local inflammation due to radiotherapy. Squamous cell carcinoma of the anal canal recurrences remains a substantial problem, highlighting the interest of prolonged surveillance. Aggressive management of recurrences may be beneficial.     

Metastatic squamous cell carcinoma of hilar lymph node with unknown primary site]

An abnormal shadow was observed on chest X-ray films of a 63-year-old man presenting with cough and sputum. Chest computed tomographic scans disclosed enlargement of the right hilar lymph nodes, but no obvious primary lesion was found in the lung field. Bronchoscopic examination revealed a slightly widened second carina, but no malignant cells were detected by transbronchial aspiration cytology. At surgery, a tumor was found between the truncus superior and the truncus intermedius. The pathologic diagnosis was a metastatic lymph node of poorly differentiated squamous cell carcinoma. Because the tumor severely adhered to the bronchus and pulmonary arteries, we performed a right pneumonectomy with mediastinal node dissection. Pre- and postoperative examinations did not detect the primary lesion, and no recurrence had been observed 76 months after surgery. This was thought to be a very rare case of T0 N1 M0 lung cancer. In general, the prognosis is poor for patients with metastatic carcinoma of unknown primary site. However, patients with T 0 lung cancer, as in this case, might enjoy a better prognosis if complete resection and dissection of metastatic lymph nodes are performed.     

Metastatic renal cell carcinoma to the pituitary gland presenting with hypopituitarism.

A 57-year-old man with pituitary metastasis from renal cell carcinoma is reported. He underwent right nephrectomy and total pancreatectomy for renal cell carcinoma and its pancreatic metastasis, respectively. Imaging studies showed an intrasellar mass lesion. The examination revealed panhypopituitarism, diabetes insipidus and bitemporal hemianospia. Metastatic renal cell carcinoma was diagnosed by the biopsy of the pituitary tumor. Metastatic renal cell carcinoma to the pituitary gland, which is extremely rare, appears to have unique features of presenting with hypopituitarism and visual disturbance more frequently than other metastatic pituitary tumors.     

Pulmonary venous infarction secondary to squamous cell carcinoma.

This type of pulmonary venous infarction has not been previously reported, namely: pulmonary vein obstruction from squamous cell carcinoma. Furthermore, this case is unique in that the characteristic pathologic vascular changes observed with pulmonary venous infarction were contrasted with a noninfarcted upper lobe that was removed from the same patient one year later.     

Appreciation of precordial cardiac murmur on examination relative to knowledge of valvular heart disease

Skills associated with physical examination have continued to decline as practitioners have become increasingly reliant on advanced imaging modalities. Our study sought to determine if documentation of valvular heart disease on echocardiography resulted in an increased appreciation and documentation of precordial murmur.     

Metastatic squamous cell carcinoma of the skin in chronic myeloid leukaemia: complication of hydroxyurea therapy

Hydroxyurea is a ribonucleotide diphosphate reductase inhibitor used in the treatment of patients with myeloproliferative disorders. Hydroxyurea has some dermatological side-effects. It has recently been recognized that hydroxyurea can induce squamous cell and basal cell carcinomas of skin. We present the case of an elderly man with chronic myeloid leukaemia who was treated with hydroxyurea for 4 years, with good control of his disease. However, in addition to the appearance of various skin lesions and cutaneous squamous cell carcinoma after 3 years of therapy, he was found to have a metastatic squamous cell carcinoma after 4 years. Hydroxyurea was discontinued, and he underwent surgery and radiotherapy. The patient subsequently died of ventricular fibrillation. We present this case to draw attention to the association between hydroxyurea and secondary skin cancers and to emphasize the need for dermatological examination before and during the course of hydroxyurea therapy.     

Unusual cause of desynchronization in a cardiac resynchronization device

This report describes a new cause of desynchronization encountered in a cardiac resynchronization device functioning in the VVIR mode. Left ventricular stimulation was inhibited when the sensor-driven rate exceeded the programmed left ventricular (LV) maximum trigger rate. With these devices, it is important to program the LV maximum trigger interval (essentially equivalent to a LV upper interval) to a value equal or faster than the sensor-driven upper rate.     

Clinicopathologic study of esophageal squamous cell carcinoma confined to the mucosa.

The authors studied patients with esophageal squamous cell carcinoma confined to the mucosa (ESCM) with respect to various clinicopathologic factors to investigate the course of invasion of very early-stage esophageal cancers. A total of 74 patients with ESCM were studied. Fifty of these patients had tumor invasion of the basement membrane confined to the lamina propria mucosae (m2 cancer), and 24 patients had tumor invasion of the muscularis mucosa (m3 cancer). All lesions were investigated with regard to clinicopathologic factors such as tumor differentiation, pattern of invasion, endoscopic morphology, and inflammatory response. The patients were divided into groups of 8 patients with positive lymphatic invasion, lymph node involvement, or both (Inv[+] group), and a group of 66 patients with no lymphatic invasion or lymph node involvement (Inv[-] group). The inflammatory response was evaluated on the basis of lymphocyte infiltration at the tumor invasion front and lymphocytic follicles beneath the tumor invasion front. Mean lesion size was significantly greater in the Inv(+) group than in the Inv(-) group (p < 0.05). However, there was no significant difference in the mean area of invasion of the lamina propria mucosae or deeper between the Inv(+) group and Inv(-) group. Patients with m2 cancer had a significantly higher rate of high-degree lymphocytic follicles than those with m3 cancer (p < 0.01). In patients with m2 cancer, the mean area of invasion of the lamina propria mucosae in patients with high-degree lymphocytic follicles was significantly greater than that in patients with low-degree lymphocytic follicles (p < 0.05), whereas there was no significant difference in mean lesion size between patients with high-degree and low-degree lymphocytic follicles. In patients with ESCM, lesion size was an important risk factor for lymphatic invasion and nodal involvement, lymphocytic follicles were prominent beneath the front of relatively broad cancer invasion, and lymphocytic follicles were less common with deeper cancer invasion.     

Early cardiac metastasis from squamous cell carcinoma of the tongue in 2 patients

Cardiac metastasis from primary tumors is rare. Cardiac metastasis from squamous cell carcinoma of the tongue is rare; in the English-language medical literature, we read of only 4 patients with this condition. Here, we discuss the cases of 2 such patients who presented at our institution only a few months apart. In both, with the use of 2-dimensional echocardiography, we incidentally found cardiac metastasis from squamous cell carcinoma of the tongue. Resection of the cardiac masses was precluded. These cases illustrate the usefulness of early cardiac evaluation with 2-dimensional echocardiography in patients with head and neck cancer and known metastatic disease.