Cutaneous metastases in patients with rectal cancer: a report of six cases

Cutaneous metastases from rectal cancer are rare manifestations of disseminated disease and uniformly represent dismal survival. A retrospective review of six patients with rectal cancer metastatic to the dermis was performed. The diagnosis of rectal cancer was made concurrently with the diagnosis of the dermal metastases in all six patients. A 100 per cent histopathologic concordance existed between the tissue of the dermal metastases and primary rectal tumor. The progression of systemic metastatic disease was the cause of death in 83.3 per cent of patients (5/6). No patient survived more than 7 months from the time of diagnosis. Recognition of suspicious skin lesions as possible harbingers of undiagnosed visceral malignancy is important in managing patients both with and without a history of previous cancer.     

Endoscopic endonasal management of invasive skull base mucocele: report of two cases.

Two cases of massive erosive skull base sphenoid mucocele are reported. Even if intra-sphenoid mucoceles are an ENT pathology, when extensive they become of neurosurgical interest. An endoscopic minimally invasive procedure was performed in both cases with an excellent outcome. Patient 1 presented with several years of retro-orbital bilateral pain and several months of purulent pharyngeal leak. CT scan and MRI imaging showed an extensive erosive intra-sphenoid mass, with peripheral contrast enhancement. Patient 2 was referred because of several months of frontal headache and decreased left visual acuity. A wide intra-sphenoid mass was evident at CT scan and MRI. This mass included an anterior compartment, hyperintense on both T (1)- and T (2)-weighted images, and a posterior part, hypointense on T (1)- and hyperintense on T (2)-weighted images. A pure endoscopic endonasal one nostril pure procedure was performed in both cases. Endoscopic technique has been shown to be an easy and minimally invasive procedure. It should be the treatment of choice in case of invasive skull base mucocele in order to avoid blind damage of vasculo-nervous structures which are not protected by the bone, extensively eroded by the lesion.     

Anterior skull base surgery for secondary malignancies in retinoblastoma survivors: report of two cases

With the improved survival rate of patients with retinoblastoma, the incidence of second malignancies has become substantial. We had two retinoblastoma survivors with secondary malignancies in the naso-ethmoidal complex, one a 21-year-old man with anaplastic carcinoma and the other a 16-year-old girl with malignant fibrous histiocytoma. They underwent repeated craniofacial surgery. Secondary malignancies arising at the nose and ethmoidal cells often invade the anterior skull base. The introduction of skull base surgery has provided wider surgical margins and increased the resultant likelihood of cure. Both patients have so far shown no evidence of recurrence.     

Primary ovarian cancer presenting with axillary lymph node metastases: a report of two cases

BACKGROUND: Axillary lymph node metastasis of primary ovarian cancer is rare. CASE I: A 74-year-old woman presented with a 2 x 2 cm hard, mobile mass in the right axilla. She had a history of stage IIIA epithelial ovarian cancer which was diagnosed and treated four years previously. A right lateral wall involvement of the rectum was detected in abdominal tomography. A right axillary lymph node dissection and low anterior resection of the rectum were performed. Histopathologic examination showed ovarian epithelial serous papillary adenocarcinoma metastases to axillary lymph node and the rectum. CASE 2: A 38-year-old woman presented with a 3 x 2 cm hard, mobile mass in the right axilla. She was treated surgically and by systemic chemotherapy with a diagnosis of stage IIIA epithelial ovarian cancer two years previously. A trucut biopsy was taken from the enlarged axillary lymph node, and histopathological examination revealed metastases of primary ovarian cancer. Complete axillary lymph node dissection was performed and metastases of ovarian papillary adenocarcinoma were found in 11 of the 30 lymph nodes. CONCLUSION: Supradiaphragmatic lymph node involvement of primary ovarian cancer is very rare. We report here two cases presenting with axillary metastases of ovarian cancer.     

Cranial nerve dysfunction in metastatic cancer of the prostate

We report 11 patients with cranial nerve dysfunction due to bone metastases from advanced prostatic cancer. Diplopia, speech disturbances, tongue deviation and headache were the typical clinical symptoms. X-ray and/or computed tomography of the base of the skull demonstrated bone destruction (and the surrounding soft tissue tumour) in 8 cases. In 1 patient the bone destruction was visualised only by bone scan. In 2 cases no bone destruction could be demonstrated in spite of the clinical findings. In 9 of the 10 evaluable patients the clinical symptoms improved after high voltage radiotherapy and high dose corticosteroid treatment. Cranial nerve dysfunction is a late complication of hormone-resistant prostatic cancer. The symptoms are usually due to bone destruction at the base of the skull. Radiotherapy combined with corticosteroid treatment is an excellent palliative measure if started immediately after the onset of symptoms.     

Multiple cranial nerve palsies due to a hyperextension injury to the cervical spine. Case report

The case of a patient with multiple bilateral cranial nerve palsies and spinal cord sparing secondary to a stable hyperextension injury to C-1 is presented.     

Pericardial effusion due to metastatic prostate cancer: a case report

We describe a patient whose complaints were related to pericardial effusion due to prostatic carcinoma. An 80-year-old man was admitted to our hospital because of chest discomfort and dyspnea. The chest radiograph revealed cardiomegaly and computed tomographic scan showed a large pericardial effusion. Pericardiocentesis revealed sanguinous exudates. Cytologic study suggested metastatic adenocarcinoma or malignant mesothelioma. He died suddenly because of ventricular tachycardia. At autopsy, the major finding was poorly differentiated adenocarcinoma of the prostate with metastases to the mediastinum.     

Intraosseous lipoma of the skull: a report of two cases

Case histories of a 12-year-old boy and a 20-year-old woman with hyperostosis of the frontoparietal bones are presented. Microscopical examination of the lesions showed intraosseous lipoma with hyperostosis of diplo?. In both cases, only the prominent part of the tumor was removed for cosmetic reasons. The results were satisfactory, and there was no evidence of recurrence over a period of six years.     

Bilateral traumatic abducens nerve palsy associated with skull base fracture--case report

A 29-year-old man presented with skull base fractures involving the bilateral petrous bones and clivus to the posterior clinoid process manifesting as bilateral abducens nerves palsy. Conservative treatment resulted in residual bilateral abducens nerves palsy. Posterolateral impact probably resulted in strain-stress in the neighborhood of the foramen lacerum, resulting in a clivus fracture of the posterior clinoid process and bilateral petrous bone fractures. Chalasia of Gruber's ligament then exerted mechanical pressure on the bilateral abducens nerves.     

Cranial nerve involvement with carcinoma of prostate

Eleven patients with known prostate cancer presented with cranial nerve deficits and skull metastases during the course of their disease. All were treated with radiation therapy to the base of skull. Of the 11 patients, 10 (91%) responded to therapy. Four of the patients in the responder group had complete resolution of the cranial nerve deficits. This response lasted until their death. One patient had a complete response but later relapsed and is still alive. He is the only survivor of the 11 patients. Partial responses were achieved in 5 patients. These patients had either improvement but not resolution of the cranial nerve deficit or, in cases of multiple nerve involvement, there was response of some of the involved nerves. Four of the partial responders retained the response until their death. One patient achieved partial response but later relapsed with additional nerve deficits. The development of this problem represented a grave prognostic factor as 10 patients died within a median of five months (range 1-16 months) after presentation. One patient is alive nineteen months later but in poor condition with disease progression. Only 1 patient (9%) did not achieve any response to therapy. His treatment was not completed due to deterioration of his general health. The seventh cranial nerve was the most frequently involved either alone or in combination with other nerves. The most commonly used treatment schedule was 3,000 rad in 10 treatments (7 cases). We conclude that effective palliation is achieved though short survival is possible.     

Peroneal nerve palsy due to rare reasons: a report of three cases

Peroneal nerve entrapment was diagnosed in three patients (2 males, 1 female) by clinical and electrophysiological studies. Of these, one patient had postural bilateral involvement due to prolonged squatting, while two patients had mechanically-induced entrapment. Initially, all the patients were treated conservatively with a drop-foot splint and vitamin B. One patient responded to treatment; in one patient with bilateral involvement, right-sided peroneal nerve palsy improved. Upon detection of no clinical and electrophysiological improvement after three months of conservative treatment, surgical decompression was performed in two patients, which resulted in a successful outcome in the patient with bilateral palsy. Incomplete recovery was obtained in the other patient with diabetic polyneuropathy.     

Intravesical instillation of Maalox for the treatment of bladder hemorrhage due to prostate cancer invasion: report of two cases]

Two cases treated by intravesical instillation of Maalox for bladder hemorrhage are reported. A 79-year-old man and an 81-year-old man were admitted because of macroscopic hematuria and bladder tamponade. In both cases, bladder hemorrhage caused by bladder invasion of prostate cancer had not improved after bladder lavage, intravenous drip infusion and medication of hemostatics. In the first case, bladder hemorrhage had decreased 4 days after the intravesical instillation of 50-100 ml Maalox for an hour per day. In the second case, irrigation of Maalox was performed because of the difficulty of intravesical instillation of Maalox due to irritable bladder. The bladder hemorrhage had not completely disappeared but improved 5 days after the bladder irrigation of 100 ml of Maalox with 100 ml of 0.9% NaCl for an hour per day. This method is easy and can be performed without complications. This method might be useful as first-line therapy in the case of severe bladder hemorrhage.     

Rare abdominal metastases from occult lobular breast cancer: report of two cases

Intra-abdominal metastases from breast carcinomas are rarely reported in the literature. Least are those originating from occult breast primary. We report, one case of pancreatic metastasis and one case of metastatic infiltration of the colonic wall, both by occult lobular breast carcinoma. The first patient underwent pancreaticoduodenectomy for obstructive jaundice, with unexpected histological finding of infiltration of distal bile duct, pancreatic gland, portal vein and retroperitoneal soft tissue by lobular carcinoma of the breast. The second patient complained of diffuse abdominal pain associated with constipation and rectal bleeding and underwent endoscopic biopsy of three intestinal strictures, revealing metastatic lobular carcinoma with signet-ring cell morphology. In both cases, a subsequent complete diagnostic work-up demonstrated asymptomatic multiple breast nodules, diagnosed as lobular carcinoma by fine needle aspiration cytology.     

Primary tuberculous osteomyelitis of skull: report of two cases

Two cases of primary tuberculous osteomyelitis of skull confirmed by appropriate laboratory investigations are described here. Primary tuberculous osteomyelitis of skull is rare. Only two cases of chronic granulomatous osteomyelitis have been described so far in the literature.     

恶性肿瘤患者维持性血液透析期间使用卡瑞利珠单抗导致严重皮疹伴瘙痒2例

恶性肿瘤合并肾衰竭的患者在透析中常需抗肿瘤治疗.在抗肿瘤药物中,程序性细胞死亡蛋白-1 (programmed death-1,PD-1)抑制剂能有效恢复T细胞对肿瘤杀伤功能,目前已成为晚期恶性肿瘤主要的治疗方式.由于PD-1抑制剂临床使用时间不长,对其不良反应存在认识不足,尤其是在血液透析这类特殊人群中,目前文献未见...     

Spontaneous haemoperitoneum due to a ruptured intra-abdominal varix with cirrhosis: report of two cases

Spontaneous haemoperitoneum due to ruptured intra abdominal varices with cirrhosis is rare and the diagnosis is generally difficult. Two cases of spontaneous intraperitoneal bleeding due to ruptures varices with cirrhosis are reported. One case is a ruptured portal cavernome and the other one is a ruptured varix of the gastrosplenic ligament. The combination of hypovolemic shock with increasing abdominal girth should impose the diagnosis. This is a surgical emergency and the mortality rate is high.