Solitary splenic metastasis of endometrial carcinoma ten years after hysterectomy. Case report and review of the literature

Solitary carcinomatous metastases to the spleen are rare. The reports of such cases in the literature usually concern late stages of the disease, with generalized carcinomatosis and metastatic foci in several other organs. Primary tumors that most often metastasize to the spleen are carcinomata of the breast, lung and ovaries, as well as malignant melanomata. Less often, carcinomata of the stomach, large bowel and kidneys are reported to implicate the organ with metastatic disease. The presence of solitary splenic metastasis of endometrial origin however, is extremely rare. We present a case of a 53-year-old female patient who ten years after hysterectomy due to the presence of endometrial carcinoma developed a metastatic focus to the spleen. This focus was diagnosed on the grounds of histology and immunohistochemistry, after splenic excision, to be of endometrial origin. Together with this case presentation, several aspects of the disease and its differential diagnosis are discussed, in correlation with the current literature.     

Malignant melanoma metastatic to the endometrium

A case of malignant melanoma metastatic to the endometrium is presented along with a review of the literature on metastatic melanoma, showing its rarity. Malignant melanoma metastasizes to many sites, including the lung, bone, liver, skin, and pancreas. Four cases of melanoma metastatic to the endometrium have been reported. The purpose of the present report is to describe the clinical picture of another patient with malignant melanoma metastatic to the endometrium as well as the general histologic and prognostic features of the disease.     

Ovarian melanoma. An interesting case

A rare case of metastatic melanoma of the ovary and extension to the omentum is reported. The tumor was discovered 25 years following enucleation of one eye for malignant melanoma of the choroid.     

Immature teratoma of the ovary--an unusual case.

A 30-year-old female was found to have a malignant immature teratoma of the ovary 14 years ago. This was treated with surgery followed by chemotherapy. Two years later, hepatic metastasis was discovered and treated with different multiple-agent chemotherapy, resulting in transformation or evolution into a mature teratoma form of disease. Twelve years later, this disease underwent malignant degeneration and transformed into a metastatic adenocarcinoma. This case report illustrates that malignant ovarian immature teratoma, teratocarcinoma, like its testicular counterpart, can evolve or differentiate into an apparently benign form of disease, but ultimately leads to death due to subsequent malignant transformation into new forms of malignancy arising from any of the three primordial germ cell layers.     

Malignant melanoma metastatic to the ovary. A case report

The diagnosis of malignant melanoma metastatic to the ovary is rare. The primary lesion can be followed by metastasis site after few years. We describe the case of a 31 year-old woman who presented an acute pelvic pain in relation with a right ovarian cyst. This patient presented many metastatic melanoma few years ago. The ovarian metastatic diagnosis is strongly suspected by the use of preoperative magnetic resonance imaging. The operating piece immunohistochemical studies demonstrated the positivity for S-100 protein, HMB-45 and negativity for keratin in cytoplasm cells. The surgical treatment (right salpingo-oophorectomy) would be followed by chemotherapy. The patient had a good postoperative recovery. She is in good health at six months.     

Ovarian malignant melanoma: unusual presentation of a solitary metastasis

BACKGROUND: Malignant melanomas of the ovary are rare with unpredictable clinical and biological behavior. We present this case report of a metastatic ovarian malignant melanoma, where the ovary was the first site of relapse after 10 years of remission. CASE: A 58-year-old postmenopausal woman was incidentally found to have an abdominal mass, 10 years after removal of a cutaneous malignant melanoma lesion. Ultrasound and CT scan revealed an adnexal mass, which was found to be a solitary ovarian tumor at laparotomy. Histology confirmed malignant melanoma metastasis. CONCLUSION: Relapse after a prolonged period of remission, presenting, as an isolated ovarian metastasis is an unusual presentation of malignant melanoma. As illustrated by this case report, a differential diagnosis of a metastatic malignant melanoma must be considered.     

Lung cancer during pregnancy involving the products of conception and a review of the literature

Approximately 1 per 1,000-1,500 pregnancies is complicated by maternal malignancies. Metastatic involvement of the products of conception is a rare event. There have been 62 cases of placental and/or fetal metastatic involvement originating from maternal cancer reported since 1866. Only 14 cases of lung cancer associated with pregnancy have been documented. We report on an additional case involving the products of conception, and the management of lung cancer in pregnancy is discussed based on an extensive review of the literature. The case of a 29-year-old woman presenting during the 31(st) week of gestation with metastatic non small-cell lung cancer to the placenta, liver and bone is described. The mother was delivered by caesarean section of a healthy baby girl during her 32(nd) week of gestation. The mother's postpartum course was complicated by disseminated pulmonary and bony metastases and malignant pericardial and pleural effusions causing the patient's death within 1 month after lung cancer was diagnosed. Malignancies spreading to the products of conception are melanoma (32%), leukemia and lymphomas (15%), breast cancer (13%), lung cancer (11%), sarcoma (8%), gastric cancer (3%) and gynecologic cancers (3%), reflecting malignancies with a high incidence in women of reproductive age. All lung cancers were diagnosed with widely disseminated, inoperable neoplastic disease, including distant metastases in 46%. The mean age was 35.1 years (range, 30-45 years) and 60% of patients had a history of tobacco use. The mean survival was 7.5 months (range: 1-42 months). Placenta involvement was present in 7 out of 15 cases. Fetal involvement was reported in only one case. Because there is no evidence of a direct adverse effect of pregnancy on the course of lung cancer, we recommend delivery at a time when enough fetal maturity can be assumed and the subsequent treatment of the mother.     

Complete Remission of Gestational Choriocarcinoma with Choroidal Metastasis Treated with Systemic Chemotherapy Alone: Case Report and Review of Literature

BACKGROUND: Gestational choriocarcinoma is a malignant tumor that frequently metastasizes to the highly vascularized organs such as the lung, brain, and liver via hematogenous spread. However, this tumor rarely metastasizes to the eye and only a few cases of metastasis to the choroid have been reported. CASE: A 17-year-old woman presented with visual field defects, decreased vision, and increasing pain in her left eye. She had undergone evacuation of a complete hydatidiform mole 32 months prior to the presentation. Ophthalmologic evaluation revealed a metastatic choroidal tumor, and a CT scan showed a metastatic tumor in the left lung. The serum hCG level was elevated at 7780 mIU/ml. A clinical diagnosis of metastatic gestational choriocarcinoma involving the choroid and lung was made. The patient received 13 courses of combination chemotherapy, resulting in complete remission. Radiotherapy and surgical treatment were unnecessary. CONCLUSION: This is a very rare case of the successful treatment of gestational choriocarcinoma metastatic to the choroid using systemic chemotherapy alone.     

Uterine tumor resembling an ovarian sex cord tumor associated with metastasis.

Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare, usually benign uterine tumors, and are probably derived from uterine mesenchymal stem cells. In this case report, a unique case of a malignant UTROSCT is described. Four years after a diagnosis of UTROSCT of the uterine corpus, the patient developed obstructive ileus due to a large infiltrating tumor within the small bowel with the same morphology and expression pattern as the previously diagnosed UTROSCT. In addition, 2 benign gastrointestinal stromal tumors were detected in the same patient. This case indicates that although the majority of UTROSCT are benign tumors, some of them might undergo malignant transformation and have a metastatic potency.     

Solitary cerebellar metastases: analysis of 11 cases.

Solitary cerebellar metastatic tumors are rarely reported in the literature. We reviewed 240 posterior fossa tumors treated in the past eight years. There were 11 cases of solitary metastases in the cerebellum. The primary tumor was lung cancer in five cases and breast carcinoma in two cases; the remaining three cases had colon cancer, nasopharyngeal carcinoma (NPC) and Ewing's sarcoma, respectively. All patients underwent craniectomy and gross total excision of the tumor. Seven patients survived less than one year, two cases died in the second year, and one case of NPC survived for more than two years. The only survival is a case of Ewing's sarcoma who underwent surgery 14 months ago. The symptoms and signs of all patients improved satisfactorily after surgery. Four patients received postoperative irradiation to the posterior fossa and two cases of lung cancer had a thoracotomy for the primary lung lesion; however, the survival period was not prolonged. We suggest that a cancer patient or a patient in the fifth to seventh decades of life presenting headache, gait disturbance and vomiting should promptly undergo a computed tomography (CT) scan of the head. In selected cases, surgical intervention for solitary metastatic tumors in the tiny posterior fossa may be the best initial treatment. Adjuvant therapies should then be added according to the type of tumor.     

Primary malignant melanoma in ovarian cystic teratoma

BACKGROUND: Malignant degeneration of benign cystic teratoma of the ovary is rare. Occurrence of melanoma in an ovarian cystic primary teratoma in the absence of a demonstrable extraovarian primary is even rarer. We describe here one such case. CASE: A 42-year-old nulliparous woman underwent laparotomy for a cyst in the right ovary. Histopathological examination of the specimen revealed malignant cystic teratoma with the presence of a melanoma component. There was no evidence of extraovarian primary melanoma on clinical examination. Two years later, she presented with lung metastasis and underwent left pneumonectomy. Histopathology confirmed metastatic melanoma. Postoperatively, she received combination chemotherapy using cisplatin and dacarbazine. She is on regular follow-up and continues to be disease-free, 18 months after treatment. CONCLUSION: Primary malignant melanoma in cystic teratoma of the ovary is extremely rare. We could find only 19 such cases on review of the literature. Clinical presentation is similar to that of primary epithelial ovarian cancer. Surgery remains the mainstay of treatment. Use of cisplatin and dacarbazine may be considered in a patient with metastatic disease.     

Angiosarcoma with pulmonary metastasis presenting with spontaneous bilateral pneumothorax in an elderly man.

Cutaneous angiosarcoma is a rare and invasive endothelial-derived sarcoma that occurs most frequently in the scalp and facial skin of elderly men. It is frequently accompanied by thin-walled cavitary pulmonary metastasis, and is often obscure on chest radiograph. We report a case of angiosarcoma of the scalp with cystic metastasis to the lung in a 63-year-old man, presenting as recurrent bilateral spontaneous pneumothorax. Lung metastasis was missed at the first episode of pneumothorax because the lung-expanded chest radiograph showed no significant abnormality. Two months later, bilateral pneumothorax recurred, and high-resolution computed tomography revealed multiple cystic, cavitary and nodular lesions. Pulmonary metastasis was confirmed by video-assisted thoracoscopic surgery, and pleurodesis was performed. After the operation, the patient received chemotherapy; no recurrence of pneumothorax was found during 6 months of follow-up. Pneumothorax in the elderly should be differentiated from malignant metastatic lung tumors.     

Early-stage ovarian carcinoma combined with pulmonary tuberculosis mimicking advanced ovarian cancer: a case report

In patients of ovarian cancer combined with multiple pulmonary nodules, the diagnosis of metastatic ovarian cancer is always considered. However, benign pulmonary conditions can be discovered instead. An 80-year-old female presented with a rapidly growing ovarian mass, elevated serum CA-125, and multiple pulmonary varying-sized nodular lesions. The pretreatment workup of her lung lesions failed to show a malignant cell, and it also failed to show any evidence of tuberculosis or other infectious diseases. After surgery, her disease was allotted to 'stage IV' epithelial ovarian cancer and adjuvant cytotoxic chemotherapy was then used. However, her sputum culture showed positive growth of Mycobacterium tuberculosis 4 weeks later. For fear of reactivation of pulmonary tuberculosis, the anticancer cytotoxic chemotherapy was postponed and the antituberculous treatment was given instead. After 6-month course of antituberculous therapy, no active lung lesion was detectable. In conclusion, infectious or inflammatory conditions can mimic metastatic disease and therefore add to the difficulty of stage determination. We recommend that there must be positive cytologic or pathologic results of lung lesions to allot a case of ovarian cancer to stage IV. Furthermore, whenever pulmonary lesions are seen on imaging, the possibility of diagnoses other than metastatic ovarian cancer should always be considered.     

Endobronchial metastasis of glioblastoma multiforme diagnosed by fiberoptic bronchoscopic biopsy.

We report a case of extraneural metastasis of an intracranial glioblastoma multiforme (GBM) to the left upper lung, in which fiberoptic bronchoscopy played a key role in the diagnosis. The patient, a 20-year-old woman, presented with dry cough and hoarseness 2 years after total excision of the brain tumor and postoperative radiotherapy. Tissue samples obtained during fiberoptic bronchoscopic biopsy had the same morphologic appearance as the primary intracranial tumor, which was consistent with GBM. In cases of pulmonary metastasis of GBM, antemortem diagnosis is rare. Our experience from this case suggests that fiberoptic bronchoscopy may be a valuable diagnostic tool for metastatic GBM.     

Successful treatment of malignant placental site trophoblastic tumor with combined cytostatic-surgical approach: case report and review of literature.

OBJECTIVE: Although rare among gestational trophoblastic diseases, the clinical relevance of malignant placental site trophoblastic tumor (PSTT) derives from its potential malignancy associated with early systemic tumor cell dissemination and manifestation of fatal metastases. Because of the low number of cases reported so far worldwide, several treatment strategies have been under consideration, which will be debated following this case report. METHOD: We present the case of a 33-year-old female with PSTT and metastases to the vagina and lung. A 9-month delay in accurate diagnosis was caused by a misinterpretation of her symptoms as signs of a spontaneous abortion. Specialized pathological examination finally led to the diagnosis of PSTT. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by multiple resections of recurrent vaginal disease. After the completion of six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy, hCG titers stayed within the normal range. The patient is without evidence of disease 39 months after primary diagnosis. RESULT: This is the third case of documented long-term remission (>1 year) in metastatic PSTT after combined cryostatic-surgical treatment. CONCLUSION: Since the few previously reported cases with prolonged remission have been treated with the described combined cytostatic-surgical approach consisting of cytoreductive surgery and adjuvant chemotherapy, this approach may be recommended for metastatic PSTT.     

Lung cancer metastatic to a cervical polyp

BACKGROUND: We describe an unusual finding of a lung cancer metastatic to a cervical polyp. CASE: A 69-year-old female with metastatic lung cancer was referred for evaluation of an asymptomatic cervical polyp. The polyp was removed and pathologic examination revealed a focus of invasive adenocarcinoma with signet ring features within a polypoid fragment of squamous mucosa. All studies suggest a primary pulmonary origin. CONCLUSION: Cervical polyps occur in up to 5% of women and 1.7% contain carcinomatous changes. Most malignant polyps result from the progression of localized dysplasia, but distant metastases have been reported. We were unable to find any prior report of a primary lung cancer metastatic to a cervical polyp. Although removal or biopsy of asymptomatic polyps is reasonable, further studies need to be done.     

Epithelioid angiosarcoma of the mons after chemoradiation for vulvar cancer.

Angiosarcomas are rare malignant tumors of endothelial origin with morphological properties similar to the vascular and lymphatic endothelium. Associated risk factors include chronic lymph edema and previously irradiated areas. Our patient is the first case report of an angiosarcoma of the mons pubis after chemoradiation and the second reported angiosarcoma of the mons. She was a 74-year-old woman who initially presented with stage II keratinizing squamous cell carcinoma of the vulva that underwent neoadjuvant chemoradiation followed by a radical vulvectomy with bilateral inguinal-femoral lymphadenectomy. She presented 4 years later with a lesion on her mons, consistent with an angiosarcoma. Angiosarcomas are rare malignant tumors of endothelial origin with morphological properties similar to the vascular and lymphatic endothelium. Our patient is the first case report of an angiosarcoma of the mons pubis after chemoradiation for vulvar cancer and the second reported angiosarcoma of the mons. Time to presentation was approximately 4 years from the time of completion of chemoradiation. She recurred within 6 months of surgical resection and required a reexcision. She currently is undergoing systemic chemotherapy after being diagnosed with a metastatic pelvic lymph node. As the treatment of vulvar cancer evolves, and more radiation therapy is given, the incidence of angiosarcomas will rise, requiring better diagnostic and treatment protocols.     

Robotic-assisted laparoscopic cytoreductive surgery for lobular carcinoma of the breast metastatic to the ovaries

The first case of robotic-assisted laparoscopic cytoreductive surgery for a metastatic malignant ovarian tumor is described. A 65-year-old woman who was treated for breast cancer 13 years earlier presented with a deep venous thrombosis in the right leg and a pelvic mass. Imaging tests showed bilateral solid ovarian tumors and an enlarged lymph node at the level of the right common iliac vessels but no evidence of any other tumor metastases. The patient was offered and accepted to undergo a da Vinci robotic-assisted bilateral adnexectomy with hysterectomy and pelvic lymph node sampling. The surgery took 200 minutes, and the patient was discharged uneventfully on the third postoperative day. Histologic examination showed strongly estrogen receptor-positive metastatic lobular carcinoma of the breast in both ovaries and fallopian tubes. She was further treated with adjuvant exemestane and is currently doing well. It is possible to treat selected patients with malignant ovarian tumors by robotic-assisted laparoscopy.     

外阴转移性肿瘤78例临床报告

目的 了解外阴转移性肿瘤的临床特点,探讨其诊断及治疗方法,方法 回顾性分析１９５８～１９９５年收治的７８例外阴转移性肿瘤患者,其中宫颈癌转移６１例（７８．２％）尿癌转移５例,阴道癌转移４例子宫内膜癌转移３例,乳腺癌转移２例,卵巢癌,直肠癌,恶性淋巴转移各１例,结果 患者中位年龄５５岁,７５．６％（５９／７８）转移瘤在原发肿瘤诊断之后的１５天至１８年发现,中位间隔时间为２．５年,６１．５％（４８／７