Subcutaneous gluteal metastasis from gastric cancer: case report and clinicopathologic analysis of 50 Japanese patients

Skin metastasis from gastric cancer is rare. We report a case of gluteal skin metastasis from gastric cancer. A 74-year-old woman underwent curative gastrectomy for advanced gastric cancer. Thirty-six months after surgery, follow-up abdominal computed tomography showed a subcutaneous gluteal tumor, and surgical extirpation was performed. Histopathologic examination of the resected tumor revealed poorly differentiated adenocarcinoma, coinciding with the histopathologic diagnosis of the resected gastric cancer. Further systemic evaluation revealed a lung metastasis and left supraclavicular lymph node metastasis. The patient was treated with chemotherapeutic reagents. However, she died of the disease 9 months after the diagnosis of skin metastasis. We reviewed the cases of 50 Japanese patients with skin metastasis from gastric cancer and analyzed the clinicopathologic features.     

外科治疗胃癌肝转移疗效分析

目的探讨外科治疗胃癌肝转移的方法与疗效。方法1996年1月至2003年12月间行外科治疗的胃癌肝转移患者25例，17例为同时性肝转移，8例为术后发现的异时性肝转移。其中单转移灶15例，多转移灶10例。行不规则肝切除16例，左外叶切除4例，左叶切除3例，右叶切除2例，术后行肝动脉灌注化疗9例，肝动脉化疗栓塞16例。结果1例同时性肝切除患者术后死于肺部感染、成人呼吸窘迫综合征，余24例均获随访，中位时间25(7—60)个月。胃癌肝转移灶切除后1、3年生存率为68．5％和29．8％，原发癌浸润表浅、淋巴结转移少、单转移灶、异时性转移及转移灶有包膜是影响生存率的有利因素。结论同时及异时性胃癌肝转移可经外科手术切除肝转移灶，但应注意手术指征的把握。     

Duodenal metastasis from large cell carcinoma of the lung: Report of a case

Duodenal metastasis from primary lung cancer is extremely rare. It rarely shows any symptoms, and the prognosis for this condition is poor. We herein describe the case of a 46-year-old woman with primary lung cancer who underwent a left upper lobectomy. Severe anemia was observed about 20 days after lobectomy. Gastroduodenoscopy showed duodenal metastasis. Simultaneously, brain metastasis was also detected using magnetic resonance imaging. The patient underwent a local resection of the duodenum and a tumor resection of the brain. Postoperative irradiation of the brain metastases and systemic chemotherapy of the lung metastases were performed, and complete remission occurred. However, abdominal lymph node metastasis recurred, and the patient died 1 year after the lobectomy.     

Gastrointestinal metastasis from primary lung cancer

Aim: Although gastrointestinal metastasis from primary lung cancer is uncommon, the incidence may increase due to widespread application of chemotherapy and positron emission tomography scan. The aim of the present study was to determine the incidence and characteristics of patients with gastrointestinal metastasis from primary lung cancer. Methods: All patients with curative pulmonary resection for primary lung cancer from January 1994 to December 2006 were reviewed. A total of 10 patients (0.3%) who had gastrointestinal metastases from primary lung cancer were included. Results: Eight patients had small bowel metastases and two had gastric metastases. All eight patients who had small bowel metastases underwent emergency laparotomy. Two gastric metastases were diagnosed via endoscopy. None of them survived more than 3 months after diagnosis. Conclusion: Gastrointestinal metastasis from primary lung cancer is uncommon and its prognosis is poor. Extensive bowel resection and reconstruction are not recommended.     

Gingival metastasis of pulmonary pleomorphic carcinoma; report of a case

A 71-year-old male was admitted to the hospital complaining of cough. The chest X-ray and computed tomography (CT) revealed a large tumor in the right lower lung, which was diagnosed as poorly differentiated adenocarcinoma. As the tumor grew rapidly and caused obstructive pneumonia, right middle and lower lobectomy was performed even if right gingival tumor was suspected as metastasis from lung tumor. The patient complicated with aspiration pneumonia after operation and died on the 20th postoperative day. The prognosis of lung cancer with gingival metastasis is very poor. Early detection and appropriate therapy is necessary.     

Solitary Splenic Metastasis of Lung Cancer Presenting as Benign Cystic Disease

Solitary splenic metastasis from primary lung cancer is extremely rare. Here, we demonstrated a solitary splenic metastasis of primary lung cancer that was difficult to distinguish from benign cystic disease. A 69-year-old-female was diagnosed as middle lobe lung cancer. Although preoperative abdominal computed tomography (CT) demonstrated a low-density splenic nodule, fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed no fluorodeoxyglucose uptake in the splenic nodule. Therefore, the nodule was diagnosed as benign cystic disease and middle lobe lobectomy was performed. Postoperative pathologic examination demonstrated papillary-predominant adenocarcinoma with mucin, and the tumor was diagnosed as primary lung cancer. However, the splenic nodule continued to increase postoperatively. Splenectomy was undergone 30 months after the pulmonary resection and the splenic tumor was diagnosed as the splenic metastasis of lung cancer. In the 24 months since the splenectomy, no recurrence has been observed in the absence of treatment. Splenectomy was an effective treatment for solitary splenic metastasis of lung cancer in this case. FDG uptake in the splenic tumor was not evident due to marked mucus production.     

Resection for pulmonary metastasis of gastrointestinal stromal tumor of the stomach at 10 years after gastrectomy; report of a case

A 70-years-old male, who had received gastrectomy for leiomyosarcoma of the stomach 10 years ago, was found to have a left lung tumor on chest X-ray and computed tomography (CT). The tumor was diagnosed to be a pulmonary metastasis of gastric leiomyosarcoma. On admission, another tumor was detected at left occipital region by brain CT and was thought to be meningioma. Left lower lobectomy and brain tumor resection were performed serially. The histologic and immunohistochemical findings showed that both tumors were metastases of gastrointestinal stromal tumor (GIST) of the stomach after long disease-free interval. Compared with the primary tumor, cellular density, mitotic figures, bizarre nuclei, and necrotic foci were prominent in the metastatic tumors. This case suggest that GIST may recurrent as pulmonary metastasis after long disease-free interval and should be follow up longer after resection. Patient prognosis with pulmonary metastases is considered to be reflected more exactly in biological malignant potential of metastatic tumor rather than that of primary tumor.     

Curative Effects of Different Sequences of Vessel Interruption During the Completely Thoracoscopic Lobectomy on Early Stage Non-Small Cell Lung Cancer

Objective: To study the correlation between prognosis and different sequences of pulmonary artery and vein interruption during completely thoracoscopic lobectomy for early stage non-small cell lung cancer.Methods: Retrospective analysis of 334 cases underwent completely thoracoscopic lobectomy, which were identified as stage I~II non-small cell lung cancer by pathology. They were divided into three groups according to the order of vessel interruption: pulmonary vein first (Group V, n = 174), pulmonary artery first (Group A, n = 93), and artery-vein-artery group (Group M, n = 67). Their preoperative and operative conditions, and the postoperative survival, recurrence were compared.Results: Group A had less cases with history of smoking but more with history of pulmonary infection. The average bleeding amount during the operation in Group A is significantly less Group V, and Group M fell in between them. The duration of operation and postoperative complications were similar among the three groups. The types of tumor recurrence were also similar, which were mostly distant metastasis. There was no statistically significant difference in tumor-free survival and overall survival among the three groups.Conclusions: For the treatment of stage I~II non-small cell lung cancer using completely thoracoscopic lobectomy, pulmonary artery interruption first can reduce the bleeding amount without affecting the operative difficulty and postoperative complications. The sequence of vessel interruption during lobectomy by thoracoscopic surgery would not affect tumor recurrence, metastasis and survival.     

Phyllodes tumor metastasis to the tonsil with synchronous undifferentiated carcinoma

INTRODUCTION

Breast tumor metastasis to the tonsil is extremely rare.

PRESENTATION OF CASE

A 54-year-old woman underwent resection of a breast malignant phyllodes tumor and later presented with metastasis to the lung and the left tonsil. She underwent left lower lobectomy and resection of the left tonsillar tumor. She subsequently developed undifferentiated carcinoma of the right tonsil. She underwent resection of the right tonsillar tumor and chemotherapy was started. The central venous catheter became infected with methicillin-resistant Staphylococcus aureus. Finally, she died.

DISCUSSION

To the best of our knowledge, this is the first reported case of a phyllodes tumor metastasizing to the tonsil. Furthermore, morphological and immunohistochemical study revealed that the right tonsillar tumor was irrelevant to the phyllodes tumors.

CONCLUSION

We report a case of phyllodes tumor metastasis to the left tonsil which developed undifferentiated carcinoma in the other side of tonsil later. Breast tumor metastasis to the tonsil is rare but it should be considered as a possible diagnosis.     

Hepatoblastoma of the adult with pericardial metastasis: A case report

BackgroundHepatoblastoma is the most frequent liver tumor in children, but very rare in the adult and associated with an unfavorable prognosis. The diagnosis is always postoperative or post mortem and biopsy is not useful. Surgery is the only accepted treatment.Case presentationOur patient underwent surgery in the suspect of liver metastasis from a previous gastric cancer. Surgery consisted in left lobectomy with partial diaphragm resection and partial pericardiectomy for a pericardial lesion, found after the opening of the thorax. The diaphragm defect was corrected with a biological mesh.ResultsThe histopathological examination indicated hepatoblastoma of the adult with pericardial metastases. The patient was asymptomatic and without recurrence after 21 months of follow up.ConclusionThe hepatoblastoma of the adult is related to a poor prognosis with median survival time less than 5 months. Surgery is the only curative treatment, but in many cases tumor resection requires complex operations. Vascular and thoracic expertise could be useful in the management of hepatoblastoma.     

胃癌卵巢转移的研究进展

胃癌卵巢转移又被称为Krukenberg瘤,好发于绝经前女性,属于晚期癌症,预后很差。胃癌卵巢转移的发病机制尚未明确,且诊治方法尚有争议。了解胃癌卵巢转移的临床表现及其预后因素,有利于其早发现、早诊断、早治疗,从而提高患者的生存率。本文对胃癌卵巢转移近年来在发病机制和诊疗方法上的研究进展进行综述。     

Extended sleeve lobectomy for interlobar lymph node metastasis invading the bronchus from peripheral lung cancer

Although extended sleeve lobectomy has been used as an alternative to pneumonectomy for the treatment of centrally located lung cancer, the validity of this surgical procedure is unclear in patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus. We herein report four patients with peripheral lung cancer in the left lower lobe who underwent extended sleeve lobectomy consequent to interlobar lymph node metastasis. The tumor and metastasized lymph node was extirpated en bloc with division of the main bronchus and upper division bronchus, and those bronchi were anastomosed using the telescope method. All patients were doing well without recurrence. Extended sleeve lobectomy may be applicable to patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus to avoid pneumonectomy.     

Surgical resection for sternal metastasis from gastric cancer; report of a case

A 72-year-old woman underwent a distal gastrectomy for gastric cancer 8 years ago. Histopathological examination showed poor differentiated adenocarcinoma. She had no symptom but chest computed tomography (CT) revealed tumor at sternum. A percutaneous needle biopsy under CT was performed and showed poor differentiated adenocarcinoma. Therefore, extirpation was performed. The tumor was located in sternum and left 2nd rib and thought to invade greater pectoral muscle and left lung. The tumor was resected at sufficient margin with surrounding tissues. Compared with tissue of gastric cancer for histopathological examination, sternal tumor had homeomorphous formation and was diagnosed sternal metastasis from gastric cancer. Sternal metastasis from gastric cancer is a rare disease and standard therapy is controversial. In this case, no findings of reccurrence have been found for 8 months after the operation.     

A long survival case of small cell lung cancer synchronized with renal cancer]

A long survival case of small cell lung cancer synchronized with renal cancer was reported. The patient was a 73-year-old male, complaining of cough and fever up. The chest roentgenogram showed a tumor mass in the right lower lung field. The specimen obtained from transbronchial lung biopsy of right S8b was diagnosed as small cell carcinoma of lung. In the check of the metastasis to other organs, abdominal CT scanning and the echogram demonstrated a solitary mass in the left kidney. We supposed a possibility of primary renal cancer rather than the metastasis from the lung because of being solitary mass, no existence of the metastasis except the kidney, and from the finding of the renal angiography. The patient underwent left nephrectomy for the renal cancer, and also underwent right lower lobectomy for the lung cancer after neo-adjuvant chemotherapy using cisplatinum and carboquone. Pathologically, the renal lesion was diagnosed as typical clear cell carcinoma of the kidney. He has survived for more than 4 years.     

Primary squamous cell carcinoma in the gastric remnant

A 67-year-old male developed primary gastric squamous cell carcinoma (SCC) 13 years after undergoing distal gastrectomy for gastric cancer. Gastroscopy revealed a type 2 gastric remnant tumor and tumor biopsies revealed poorly differentiated carcinoma. The patient underwent remnant gastrectomy with lateral segment hepatectomy, splenectomy, partial resection of diaphragm, and distal partial esophagectomy. The histological findings revealed SCC without an adenocarcinoma component in the gastric remnant tumor. The patient died 13 months after surgery due to multiple-organ metastasis of gastric SCC. The post-operative prognosis of gastric SCC cases tends to poorer than that of gastric adenocarcinoma. Early diagnosis is important to improve the prognosis of primary gastric SCC and pathogenetic analysis of gastric SCC may contribute to improving the diagnosis and treatment of carcinogenesis and the prognosis of gastric SCC.     

Long-term survival of Askin tumor for 10 years with 2 relapses.

An abnormal shadow was noted on a chest X-ray of a 32-year-old female in a medical check-up in March 1995, 3 months after she had given birth. Thoracic CT detected a tumor in contact with the left thoracic wall, and tumorectomy was performed in May 1995. The tumor was diagnosed as a primitive neuroectodermal tumor (PNET). After surgery, the thoracic wall to which the tumor adhered was treated with irradiation at 50 Gy. Chemotherapy was considered, but the patient did not wish to undergo this treatment. Lung metastasis occurred 5 years after the first surgery, and the left lower lobe of the lung was partially resected. Four years later, lobectomy of the left lower lobe of the lung was performed, due to further lung metastasis. The patient remains healthy as of April 2005.     

Lung cancer with p53 expression and a solitary metastasis to the stomach: a case report.

Lung cancer with a solitary metastasis to the stomach occurred in a 65-year-old man, surgically treated for gastric metastasis was followed by pulmonary resection. The gastric metastasis accompanied by upper gastrointestinal hemorrhage. After total gastrectomy to control this hemorrhage, a left lower lobectomy with a partial resection of the lingular segment and combined resection of the chest wall were done. Histopathological features of both the primary tumor in the left lower lobe and the gastric tumor were poorly differentiated adenocarcinoma, and showed the same immunoreactivities of p53 protein, carcinoembryonic antigen and keratin. These results indicate that the gastric tumor was a metastasis originated from the lung cancer.     

胸腔镜手术在孤立性肺结节诊断和治疗中的应用

目的探讨胸腔镜手术在孤立性肺结节诊断和治疗中的价值。方法1994年5月～2009年11月,经胸片、胸部CT发现的周围型孤立性肺结节(直径≤3cm)115例,术前均无明确病理诊断,经胸腔镜手术局部切除,术中送快速冰冻病理检查,根据病理结果和病人情况决定手术方式。原发性肺癌行全胸腔镜或胸腔镜辅助小切口肺叶切除、淋巴结清扫40例;行肺楔形切除75例,其中良性肿瘤59例、转移癌11例、不适合肺叶切除的原发性肺癌5例。结果所有病人均明确病理诊断,确诊率100%。术中、术后并发症10例(8.7%,10/115):全胸腔镜肺叶切除术中肺动脉分支出血1例,转小切口开胸止血;胸引管拔除超过1周3例,呼吸功能不全3例,肺不张、胸腔积液、切口感染各1例,经对症治疗治愈。无严重手术并发症,无手术死亡。良性肿瘤59例随访2～176个月,平均44.5月,无复发。原发性肺癌行全胸腔镜肺叶切除、淋巴结清扫18例,随访3～24个月,平均11个月,1例24个月复发仍存活,其余无复发。结论胸腔镜手术在明确孤立性肺结节病理诊断方面有不可取代的重要作用。良性孤立性肺结节得到治愈,原发肺癌可以得到明确诊断,及时有效的治疗,微创效果显著。     

A surgical case of methotrexate-associated lymphomatoid granuloma

We reported a surgical case of methotrexate-associated lymphomatoid granuloma. A 69-year-old female had been treated with methotrexate for rheumatoid arthritis for 35 months. The patient underwent partial resection of the right upper pulmonary lobe for lung cancer when she was 67 years old. A nodule was detected in the left lung field on a chest radiograph performed during the postoperative follow-up period. Computed tomography revealed a 28-mm nodule in the lower left pulmonary lobe. A transbronchial biopsy examination did not lead to a diagnosis. The pulmonary nodule subsequently increased in size. We suspected a malignant tumor and performed lower left lobectomy. A pathological examination revealed lymphomatoid granuloma. Finally, the patient was diagnosed with methotrexate-associated lymphomatoid granuloma based on her history of oral methotrexate treatment.