Trousseau's Syndrome Caused by Intrahepatic Cholangiocarcinoma: An Autopsy Case Report and Literature Review

An autopsy case report of Trousseau''s syndrome caused by intrahepatic cholangiocarcinoma is presented, and seven previously reported cases are reviewed. A 73-year-old woman experiencing light-headedness and dementia of unknown cause for 6 months developed severe hypotonia. A hypointense lesion compatible with acute cerebral infarction was detected by magnetic resonance imaging. Abdominal computed tomography revealed an ill-defined large liver mass in the right lobe. The mass was not further investigated because of the patient''s poor condition. She died of multiple organ failure, and an autopsy was conducted. Postmortem examination revealed intrahepatic cholangiocarcinoma, fibrous vegetations on the mitral valves and multiple thromboemboli in the cerebrum, spleen and rectum. Trousseau''s syndrome is defined as an idiopathic thromboembolism in patients with undiagnosed or concomitantly diagnosed malignancy. This syndrome is encountered frequently in patients with mucin-producing carcinomas, while the incidence in patients with intrahepatic cholangiocarcinoma is uncommon. We found that tissue factor and mucin tumor marker (CA19-9, CA15-3 and CA-125) expression in cancer cells may be involved in the pathogenesis of thromboembolism. A patient with unexplained thromboembolism may have occult visceral malignancy; thus, mucin tumor markers may indicate the origin of a mucin-producing carcinoma, and postmortem examination may play an important role in revealing the hidden malignancy.Key words: Cholangiocarcinoma, Trousseau''s syndrome, Tissue factor, CA19-9, CA15-3, CA-125     

原发性肺癌胃肠道转移2例报道并文献复习

原发性肺癌最常见的远处转移部位包括肺、肝、脑、骨、肾上腺等,胃肠道转移鲜有报道。北京大学肿瘤学院胸部肿瘤内科近期先后收治了经病理证实为原发性肺癌发生胃肠道转移的2例患者,本文将就其诊治及随访情况进行报告,并回顾国内外相关文献,以加深对肺癌少见部位转移的认识,避免漏诊和误诊。     

Multiple Bulky Lymph Nodal Metastasis in Microinvasive Cervical Cancer: A Case Report and Literature Review

Microinvasive squamous cell cervival carcinoma is characterized by an exceptional incidence of lymph nodal metastasis. We report the case of a 45-year-old woman affected by IA1 squamous cell carcinoma, found to have massive pelvic lymph nodal metastasis. After a systematic pelvic and aortic selective lymphadenectomy, at 16 months of follow-up, she is still disease-free. Patients suitable for conservative therapy should be carefully counselled about the established risks and benefits of nondestructive treatment options.Key Words: Cervical cancer, Microinvasive carcinoma, Lymph nodal spread, Bulky     

大细胞肺癌小肠转移1例病例报告和文献复习

大细胞肺癌占肺癌的10%-15%,是非小细胞肺癌的相对少见病理类型,其组织分化差,易发生转移,小肠转移在临床很少见,其诊断多在出现梗阻或穿孔时,现报道1例大连医科大学第一附属医院肿瘤内科收治的大细胞肺癌小肠转移病例.     

结肠腺癌转移至牙龈1例报道及文献复习

0?引言 结肠癌是我国常见的消化道肿瘤之一,而口腔转移癌临床罕见,约占所有口腔恶性肿瘤的1％[1],可能发生在口腔软组织或颌骨.其中颌骨,尤其是下颌骨,比口腔软组织更易受累(2:1),在口腔软组织中,最常见的病变部位是牙龈(54％)[2].已有报道称牙龈癌转移来自肺、前列腺、直肠癌、肾上腺癌和乳腺等,结肠癌的牙龈转移报...     

Epididymis Metastasis from Colon Carcinoma: A Case Report and a Review of the Japanese Literature

A 56-year-old Japanese man in whom a descending colon carcinomahad been resected underwent a high orchitectomy for metastaticepididymis from the colon. Metastatic carcinoma from the digestiveorgans to the spermatic cord (SC) and/or the intrascrotal contents(ISC) is rare. Fifty-four Japanese patients with metastasisfrom the digestive organs to the SC and/or the ISC were analyzed.The most frequent primary site was the stomach and the mostfrequent metastatic site was the spermatic cord. Our patientwas the first to exhibit metastasis from the colon to the epididymis.A primary site was identified in 24 patients subsequent to themetastatic tumor. Twenty patients had other organ metastatis.The prognosis for SC and/or ISC metastasis patients is poor.Our patients has survived for 18 months following his orchitectomywith no other organ metastasis (31 months after the primaryoperation). In our patient, monoclonal estrogen receptor stainingwas negative; however, further study must be undertaken.     

Intrathoracic Endotracheal Metastasis from Nasopharyngeal Carcinoma: A First Case Report and Review of the Literature

Intrathoracic endotracheal metastasis from a very distant site is extremely rare. We report the first case of such a disease in a 68-year-old man with nasopharyngeal carcinoma who presented with a cough and hemoptysis 34 months after finishing radiotherapy. Prior to tracheal metastasis, he developed a solitary metastasis in the lung and underwent chemotherapy followed by radiotherapy. Computed tomography showed the presence of an enlarged lymph node in the para-aortic arch. Fiberoptic bronchoscopy revealed an endotracheal tumor 1 cm above the carina. Histological and immunohistochemical analyses confirmed its nasopharyngeal origin. He was treated with conventional radiotherapy and three-dimensional conformal radiotherapy; complete tumor remission was achieved. He died of nonmalignant disease with no signs of tumor recurrence 2 years after treatment completion. Radiotherapy may be an appropriate management approach to achieve long-term tumor control for this disease.Key Words: Metastatic disease, Endotracheal malignancy, Nasopharyngeal carcinoma, Radiotherapy     

A Pleomorphic Rhabdomyosarcoma Mimicking an Inguinal Hernia: A Case Report and Review of the Literature

A 59-year-old male presented with a painful right inguinal swelling and deep vein thrombosis at the ipsilateral leg. An inguinal hernia was initially diagnosed, but during surgery a large mass was found anteriorly to the peritoneal sheaths. Histology revealed a high-grade pleomorphic rhabdomyosarcoma. The mass advanced rapidly, occupying the whole right iliac fossa and metastasizing to the lung. Despite first- and second-line chemotherapy, the patient deteriorated rapidly and died. Rhabdomyosarcomas should be managed in specialized centres as they have prognostic factors and histologic features still controversial and poorly clarified.Key words: Rhabdomyosarcoma, Inguinal tumour, Chemotherapy     

Endometrial Carcinoma with Cerebellar Metastasis: A Case Report and Review of the Literature

Background: Endometrial cancer is the most common malignancy involving the female genital tract in the United States. There is a paucity of reports of brain metastases in this disease, and most of these reports emphasize that this pattern of dissemination is rare. Case: We present a case of a 63-year-old woman who had high-grade endometrial carcinoma treated with surgery and radiotherapy. She had three separate episodes of relapse in the lungs, the first two relapses being treated surgically. Chemotherapy was also administered following surgery for the first relapse. The third pulmonary recurrence was treated with chemotherapy and then consolidated with thoracic radiation. Four years from the date of diagnosis, and a few weeks after completion of thoracic radiotherapy, she had evidence of a solitary cerebellar metastasis. This was treated surgically and followed by whole brain irradiation. She died 6 months after this central nervous system diagnosis with systemic dissemination of her cancer. Conclusion: The existing literature on brain metastases from endometrial cancer is reviewed together with the patterns of spread of endometrial cancer. We call attention to the unusually long course of this patient. Partially successful treatment for metastatic disease may have predisposed eventual development of brain metastases. This occurrence reinforces reports emphasizing their increasing incidence in association with endometrial cancer.     

Nasopharyngeal Carcinoma Metastasis to the Pituitary Gland: A Case Report and Literature Review

While nasopharyngeal carcinoma (NPC) commonly invades the skull base, true central nervous system metastasis is a rare phenomenon. We report a case of NPC metastasis to the pituitary gland and review the literature for similar events. Eight months after his definitive radiation therapy, our patient presented with symptoms of optic chiasm compression and panhypopituitarism. Medical imaging revealed a pituitary mass but demonstrated no evidence of skull base erosion or direct intracranial extension. Subsequent biopsy of the pituitary lesion was confirmed as NPC in origin with Epstein-Barr virus-encoded RNA in-situ hybridization studies. The patient was treated with high dose chemotherapy followed by autologous stem cell transplant, which produced short-term symptomatic relief and at least a 7 month survival.     

Complex Differential Diagnosis between Primary Breast Cancer and Breast Metastasis from EGFR-Mutated Lung Adenocarcinoma: Case Report and Literature Review

We present a case of a woman with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma who received gefitinib for 2 years and obtained a partial response. The patient then developed liver metastasis and a breast lesion, displaying high estrogen receptor (ER) expression and harboring the same EGFR mutation. From the radiological studies, it was not possible to make a differential diagnosis between primary breast cancer and breast metastasis from lung cancer. After the removal of the breast nodule, thanks to the clinical history, radiology, and above all, molecular and immunohistochemical investigations, a diagnosis of breast metastasis from lung adenocarcinoma was made. This case emphasizes the importance of a comprehensive clinical, pathological, and molecular analysis in the differential diagnosis between primary breast cancer and metastases from extramammary tumor to guide adequate treatment decision making.     

Huge Bilateral Pulmonary and Pleural Metastasis from Intracranial Meningioma: A Case Report and Review of the Literature

Summary A case of recurrent meningioma with atypical features and extracranial metastases is reported. A 34-year-old female was operated in 1996, 2000, and 2002, and frontal parasagital meningioma was extirpated. Histological diagnoses of all the resected tumors were meningotheliomatous meningioma, WHO Grade I. However, 2 years later, the tumor recurred in the frontal scalp and was removed again totally. Histological diagnosis was reported as an atypical meningioma; meningotheliomatous type; WHO Grade II. She received radiation therapy. But the tumor had metastasized to the lung and pleura. Transthoracic tru-cut biopsy was performed from large mass of the left lung. Cytopathology was consistent with malignant meningioma, metastasis from the patient’s known intracranial meningioma. Ki-67 staining index at the primary and metastatic sites of the present cases were 7 and 5%, respectively. We reviewed and discussed the histopathological features and mechanisms of metastasizing meningioma.     

腰大肌旁多形性脂肪肉瘤复发伴纵隔转移1例及文献回顾

纵隔内转移性多形性脂肪肉瘤为纵隔内肿瘤的罕见病种,目前总体治疗效果欠佳.本文介绍腰大肌旁多形性脂肪肉瘤复发伴纵隔转移1例,探讨多形性脂肪肉瘤的临床特点和治疗策略.回顾性分析我院收治的1例转移性多形性脂肪肉瘤患者,基于影像学诊断与手术病理诊断,对患者进行针对性的多学科综合治疗.一名41岁女性患者,诊断腰大肌旁多形性脂肪肉瘤伴纵隔转移.经手术、靶向及化疗等多学科治疗,随访至今已65个月.对于多形性脂肪肉瘤治疗策略,应以外科完整切除为首选,术后辅助相关内科治疗,多学科综合治疗以延缓患者病情进展及复发.     

Brain Metastasis of Cardiac Myxoma: Case Report and Review of the Literature

Summary Cardiac myxoma is the most common benign heart tumor. Cardiac myxoma can be a sporadic lesion (93% of cases) and usually occurs in women over 30 years. Complete surgical removal of the myxoma and its cardiac attachment is usually curative. The frequency of recurrences in cardiac myxomas varies between 3% for sporadic cases and 22% for cases of Carney complex. Recurrence has been related to incomplete excision, multifocality, and embolism of tumor fragments. We report a case with multiple brain metastases presumably due to tumor embolization from previously operated cardiac myxoma.