Isolated splenic metastasis from clear cell renal carcinoma – A case report

Back groundMetastatic deposits in spleen are rare owing to its physiological functions and sharp angle of splenic artery with coelic axis.Case reportWe report a case of a 53 year old male with clear cell carcinoma of left kidney. Isolated splenic metastasis was detected on a follow up PET CT scan 2 months post radical nephrectomy. Splenectomy was performed; histopathology confirmed multiple metastatic lesions within the spleenConclusionTimely treatment of isolated metastasis in case of renal cell carcinoma carries good prognosis.     

Gallbladder metastasis from hepatocellular carcinoma: Report of a case and review of literature

INTRODUCTIONThe incidence of metastasis of hepatocellular carcinoma (HCC) to the gallbladder is low. Here, we report a case of HCC with metastasis to the gallbladder and discuss the pattern of spread and the treatment.PRESENTATION OF CASEA 74-year-old man was diagnosed with advanced hepatocellular carcinoma. Computed tomography and magnetic resonance imaging demonstrated a tumor in the right lobe of the liver with a thrombus in the bifurcation of the portal vein. Because intraoperative ultrasonography showed portal vein tumor thrombosis from the main tumor reaching the umbilical portion, we performed only a cholecystectomy for the elimination of postoperative cholecystitis. Pathological examination showed gallbladder vein tumor thrombosis from poorly differentiated hepatocellular carcinoma.DISCUSSIONA preoperative diagnosis of metastatic HCC to the gallbladder is difficult because there are no specific findings in the imaging tests. Cancer cells in the liver were thought to migrate to the gallbladder via the connection between the portal system and the cholecystic veins, and grow in the lumen of the veins in our case. The survival rate, in all reported cases including the present case, was increased in patients who underwent radical resection, compared to patients who underwent palliative surgery.CONCLUSIONThe resection of metastatic HCC to the gallbladder might appear to prolong survival.     

Rare tumors of the gallbladder: Clear cell carcinoma

IntroductionGallbladder cancer is a rare tumor in the gastrointestinal tract has poor prognosis, low survival and is difficult to diagnose. The most common type of gallbladder cancer is adenocarcinoma, and the incidence of clear cell carcinoma is low. Mostly, it is difficult to determine whether the isolated tumor is a primary tumor in the gallbladder or a metastatic tumor from another region. Before accepting a clear cell carcinoma as a primary gallbladder tumor, the kidneys and other possible secondary focuses are clinically considered in terms of metastases.Presentation of caseHere, we present a rarely seen case of gallbladder clear cell carcinoma, which was diagnosed by pathological examination after the surgery.DiscussionPrior to establishing that clear cell carcinoma is a primary gallbladder cancer, it is appropriate to clinically investigate possible secondary focuses, in particular the kidneys in terms of metastasis.ConclusionOur goal in presenting this case was to emphasize the importance of taking an accurate medical history in patients with clear cell carcinoma, a rarely seen gallbladder cancer.     

Adenosquamous carcinoma of the gallbladder with tumor thrombus in left portal trunk

We report a surgically resected case of adenosquamous carcinoma of the gallbladder accompanied by portal tumor thrombosis, which is regarded as a rare complication. A 73-year-old man was admitted to our hospital because of epigastralgia. Preoperative examinations led to a diagnosis of advanced gallbladder carcinoma with liver metastasis, and operation was performed. Since intraoperative ultrasonography showed a tumor thrombus in the left main portal trunk originating from the metastatic lesion in the left medial segment of the liver, extended left lobectomy with extrahepatic bile duct resection and lymph node dissection was performed, instead of right trisegmentectomy, as proposed preoperatively. Histological examination revealed adenosquamous carcinoma of the gallbladder with medullary growth that was similar to the hepatocellular carcinoma, most notably in the metastatic lesion of the liver and in the portal tumor thrombus. We discuss the relation between portal tumor thrombosis and medullary tumors, and note the atypical operative method employed.     

Colorectal carcinoma and brain metastasis: Distribution,treatment, and survival

Background: Brain metastasis from colorectal cancer is rare. The present study reports the nature of this disease and analyzes factors correlated with survival in patients harboring such disease. Patients and Methods: One hundred patients diagnosed between 1980 and 1994 with metastatic brain tumors secondary to colorectal adenocarcinoma were retrospectively reviewed. Of these patients, 36 underwent surgery, 57 underwent radiotherapy alone, and the remaining seven received steroids. Results: The most common primary sites were the sigmoid colon and rectum (65%). Brain metastases with concomitant liver and/or lung metastases were seen more frequently than brain metastases alone. The median interval between the diagnosis of primary cancer and the diagnosis of brain metastasis was 26 months (95% confidence interval =22–30). The median survival time after the diagnosis of brain metastasis was 1 month for patients who received only steroids, 3 months for those who received radiotherapy (p=0.1), and 9 months for those who underwent surgery (p<0.0001). The extent of noncerebral systemic disease was not correlated with survival (p>0.05), but early onset of brain metastasis was significantly associated with poor prognosis (p=0.04). Conclusion: Surgical removal of colorectal metastatic brain lesions results in significantly increased survival time, regardless of the status of the noncerebral systemic disease.     

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目的　总结原发性胆囊鳞癌、腺鳞癌的诊治经验。方法　回顾性分析了浙江大学医学院附属第二医院 1994～ 2 0 0 3年收治的少见胆囊癌 9例 (鳞癌 1例 ,腺鳞癌 8例 )。结果　行根治性手术 4例 ,姑息性手术 5例。9例中有 8例得到随访 ,均在术后半年内死亡 ,术后中位生存期 5 1d。结论　胆囊鳞癌腺鳞癌恶性程度较高 ,但淋巴结转移相对较晚。对于合适病例应尽可能行根治性胆囊切除 ,必要时行扩大根治性切除 ,术后放疗可能是一个较好的治疗方式。     

Adenosquamous carcinoma of the remnant stomach: Report of a case

We report herein the case of a 59-year-old man found to have adenosquamous carcinoma of the remnant stomach which demonstrated rapid progression. The patient was admitted to our hospital to undergo surgery for a papillary tumor of the remnant stomach. Total resection of the remnant stomach with lymph node dissection was performed, and pathological examination confirmed a diagnosis of adenosquamous carcinoma with invasion into the muscularis propria and lymph node metastasis around the perigastric areas. Multiple liver metastases were found 6 months after the operation, for which a right hepatectomy was performed with curative intent; however, he died 2 months later due to lymphangitis carcinomatosa of the lung. Received: March 15, 1999 / Accepted: January 7, 2000     

Gallbladder’s clear cell renal carcinoma metastasis: A case report

IntroductionClear cell renal cell carcinoma (ccRCC) is well known for its propensity to metastasize to unusual sites, even after 10 years. Gallbladder metastases are extremely rare, being found in approximately 0.6% of cases, at autopsy.Case presentationA 51-year-old man with a history of right ccRCC underwent total nephrectomy with extended lymphadenectomy, in another Hospital. Three years later, he was hospitalized at our Hospital, with gallbladder metastasis detected during a follow-up CT scan. At clinical examination, the patient did not present any symptoms or signs of gallbladder disease. Several imaging tests were performed to better characterize the lesion. A successful cholecystectomy and hepatic resection of 4b segment were performed, obtaining a R0 resection. The clinical course was uneventful, without any complications. After a 7-month follow-up, the patient is free from disease.DiscussionA typical metastases are those located in a site other than thoracic, skeletal, hepatic, adrenal or encephalic tissue. Cholecystectomy with R0 resection has demonstrated to be the only factor increasing survival, mainly in isolated cases of metastasis, providing an overall 35–60% survival rate at 5 years.ConclusionIn the follow-up of patients with a positive history of renal cell carcinoma specially clear cell subtype, all new finding should be taken into account as possible metastases. We ought to consider US and CT-scan behavior of gallbladder metastatic disease in order to orientate our diagnosis. Surgery for metastatic gallbladder disease of renal origin seems to be a feasible therapy which is capable of increasing patients’ overall survival.     

Cardiac metastasis from gallbladder carcinoma

INTRODUCTIONPrimary gallbladder carcinoma is a rare aggressive neoplasm of elderly with poor prognosis. The tumour is often unresectable at the time of diagnosis. Metastasis to heart is rare and only 6 cases have been reported in the indexed literature. We herein report a case of gallbladder carcinoma metastasizing to heart.PRESENTATION OF CASEA 54 year old female presented with dyspnoea and chest pain with past history of radical cholecystectomy and palliative chemotherapy for adenocarcinoma of gallbladder. Chest X-ray showed cardiomegaly and 2-D ECHO revealed features of tumour deposits on the surface of myocardium and malignant pericardial effusion. Mini-thoracotomy and pericardial window procedure was done to relieve distressing symptoms and biopsy of pericardial tissue revealed metastatic adenocarcinoma. In spite of intensive care, patient succumbed to disease in the post-operative period.DISCUSSIONPrimary adenocarcinoma of gallbladder is the most common malignancy of biliary tract and fifth most common malignancy of gastro-intestinal system with dismal prognosis. It most commonly spreads to liver and regional lymph nodes, very rarely distant metastasis occurs to kidney, adrenal, thyroid and bones as reported in the literature. Metastasis to heart presents with symptoms of cardiac failure due to pericardial effusion. Even with intensive care patients will invariably succumb to the disease.CONCLUSIONMetastatic spread to heart from carcinoma of gallbladder is very rare. Should a patient be suspected of or an operated case of gallbladder carcinoma present with symptoms of congestive heart failure and massive pericardial effusion, cardiac metastasis should be considered.     

Adenosquamous carcinoma of the liver: case report

We report a case of adenosquamous carcinoma of the liver arising from the left intrahepatic bile duct. A 65-year-old man was referred to our hospital with epigastric discomfort of 2 weeks duration. The results of laboratory and clinical investigations suggested the presence of a cholangiocarcinoma; consequently, left hepatectomy with caudate lobectomy were performed. The histopathological examination revealed adenocarcinoma, squamous carcinoma, and transitional cancer cells in the resected specimen. Multiple liver metastases developed 12 months after surgery, leading to hepatic insufficiency 3 months later. Twenty-five cases of adenosquamous carcinoma of the liver reported in the world literature, including the present case, were reviewed as to the clinicopathological features.     

Liver Transplantation for Progressive Unresectable Colorectal Liver Metastases: Case Report and Review of the Literature

BackgroundPrevious dismal clinical studies have stated that colorectal cancer with unresectable liver metastases is an absolute contraindication for liver transplantation (LT). During recent decades, it has been shown that patients with colorectal cancer with liver metastasis benefited from LT, but 100% recurrence was inevitable in progressive colorectal cancer with liver metastasis.Case presentationA 61-year-old man was found at the first visit to be suffering from unresectable liver metastases of colorectal cancer. This patient underwent colorectal radical surgery and palliative treatment after the operation. During a 2-year follow-up, we found that CEA and CA199 rebounded sharply to high levels, and liver metastasis lesions increased significantly, so we made the decision to perform LT 2 years after the first surgery. Chemotherapy and sirolimus were given post-LT. Slow-growing pulmonary metastases after transplantation were found 4 months post-LT. This patient survived the next 4 months tumor-free and by now has survived 34 months free of liver tumors. Here, we review the literature on LT for progressive liver metastasis of colorectal cancer and summarize our experience from this successful case.ConclusionThis case provides vital evidence that LT is an option and can provide curative therapy for patients with advanced unresectable liver metastasis. Careful selection of patients, postoperative comprehensive treatments, and rational application of immunosuppressive agents are vital factors for favorable prognosis.     

Metastatic Carcinoma of the Gallbladder after a Renal Cell Carcinoma

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor.

We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease.

Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour.

If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.     

胆囊鳞癌和腺鳞癌12例临床分析

目的总结原发性胆囊鳞癌和腺鳞癌的诊治经验。方法回顾性分析了解放军总医院肝胆外科1994-2004年收治的胆囊癌12例(鳞癌4例,腺鳞癌8例),男女各6例。结果行根治性手术9例,姑息性手术3例。12例中有11例得到随访,其中2例在1年后死亡,1例在半年后死亡,其余均在半年内死亡。术后中位生存期108d。结论胆囊鳞癌和腺鳞癌恶性程度高,但远处转移较少,有利于手术切除。术后放疗有可能是一个有效的方法。     

胆囊鳞癌和腺鳞癌12例临床分析

目的总结原发性胆囊鳞癌和腺鳞癌的诊治经验。方法回顾性分析了解放军总医院肝胆外科1994—2004年收治的胆囊癌12例（鳞癌4例，腺鳞癌8例），男女各6例。结果行根治性手术9例，姑息性手术3例。12例中有11例得到随访，其中2例在1年后死亡，1例在半年后死亡，其余均在半年内死亡。术后中位生存期108d。结论胆囊鳞癌和腺鳞癌恶性程度高，但远处转移较少，有利于手术切除。术后放疗有可能是一个有效的方法。     

Synchronous nephrectomy and right hepatectomy for metastatic chromophobe renal cell carcinoma: report of a case and review of the literature

The prognosis of metastatic renal cell carcinoma is poor, since non-operative modalities for advanced renal carcinoma have failed to yield effective results. In fact, there is no indication for radiotherapy, except for palliative treatment of symptomatic bone metastases, and systemic chemotherapy is not effective. Despite the promising early results with immunotherapy, a complete response occurs in less than 15% of patients and is rarely lasting. Surgery, when indicated, seems to be the only therapeutic option possible. Liver metastases occur in 20% of cases and are often multiple. Experience with hepatectomy for metastatic renal tumours has rarely been reported. Not only does a small group of patients have isolated liver metastases that may be treated with radical surgery, but also extrahepatic metastases ordinarily coexist at the time of diagnosis. We report a case of a 55-year-old man with a chromophobe renal cell carcinoma with a single synchronous hepatic metastasis that were treated simultaneously with radical nephrectomy and right hepatectomy. To the best of our knowledge this is the first case of a single metastasis of a chromophobe renal cell carcinoma treated with synchronous kidney and hepatic resection.     

Pancreatic resection for renal cell carcinoma metastasis: An exceptionally rare coexistence

IntroductionPancreatic metastases are uncommon and only found in a minority of patients with widespread metastatic disease at autopsy. The most common primary cancer site resulting in pancreatic metastases is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma.Presentation of caseHerein, we report a 63-year-old male patient who presented −3.5 years after radical nephrectomy performed for renal cell carcinoma (RCC)-with a well-defined lobular, round mass at the body of the pancreas demonstrated by abdominal Magnetic Resonance Imaging (MRI). The patient underwent distal pancreatectomy combined with splenectomy and cholecystectomy. Histopathological examination revealed clusters of epithelial clear cells, immunohistochemically positive for RCC marker, and negative for CD10 and CA19-9. A final diagnosis of clear RCC metastasizing to pancreas was obtained in view of the past history of RCC, microscopy and the immunoprofile. This was the second metachronous disease recurrence after a previous metastatic involvement of the liver, developed 19 months from the initial diagnosis. The patient has remained well at a 6 month follow up post-resection.DiscussionSolitary pancreatic metastases may be misdiagnosed as primary pancreatic cancer. However, imaging including computed tomography (CT) and MRI, may discriminate between them. Surgical procedures could differentiate solitary metastasis from neuroendocrine neoplasms. The optimal resection strategy involves adequate resection margins and maximal tissue preservation of the pancreas.ConclusionRecently, an increasing number of surgical resections have been performed in selected patients with limited metastatic disease to the pancreas. In addition, a rigid follow-up scheme, including endoscopic ultrasound (EUS) and CT is essential give patients a chance for a prolonged life.     

Microscopic Liver Metastasis: Prognostic Factor for Patients with pT2 Gallbladder Carcinoma

Hepatic metastasis is the most frequent mode of recurrence of advanced gallbladder cancer after radical resection. The aims of this study were to clarify the clinical significance of microscopic liver metastasis from pT2 gallbladder cancer and to clarify whether partial hepatectomy can prevent hepatic recurrence in patients with microscopic liver metastasis. The subjects included 20 patients with pT2 tumors who underwent radical surgery and partial hepatectomy with lymph node dissection. Microscopic liver metastasis was defined as a distant metastatic nodule including cancer cell nests in the lumen of the portal vein and discrete nodular lesions in the liver, all less than 5 mm in diameter. Coxs proportional hazard regression was used to analyze factors that contributed to outcomes. Microscopic metastases were detected in the resected livers from 5 of 20 patients. There were more metastatic lesions within 1 cm of the gallbladder bed than were located 1 to 2 cm away from it. Microscopic liver metastases showed a strong correlation with the extent of blood vessel invasion around the primary tumor and were frequently detected in patients with a primary tumor localized on the hepatic side and with more than 3 cm of subserosal invasion. In four of five patients with microscopic liver metastases, recurrence was found in the remnant liver, which led to death within 15 months after the initial operation. Microscopic liver metastasis, operative curability, and lymph node metastasis were assessed as independent prognostic factors. A large proportion of patients with microscopic liver metastasis suffered from hepatic recurrence. Our results suggest that partial hepatectomy alone cannot prevent hepatic recurrence in patients with microscopic liver metastasis.     

Solitary metastatic gallbladder malignant melanoma originated from the nasal cavity: A case report

INTRODUCTIONSolitary gallbladder metastasis of malignant melanoma is rare and generally originates from skin melanoma. We report a case of gallbladder metastasis from a malignant melanoma of the nasal mucosa that was surgically treated.PRESENTATION OF CASEA 77-year-old Japanese woman diagnosed with malignant melanoma of the left sinonasal cavity three years ago underwent follow-up PET–CT and FDG uptake was detected only at the gallbladder. The nasal melanoma had been stable for the last 1.5 years after chemoradiation and her general condition was good. Cholecystectomy was performed with partial liver resection. Lymphadenectomy of the hepatoduodenal ligament was also performed. The tumor was soft and whitish, and was microscopically diagnosed as a poorly differentiated malignant melanoma that was not similar to the nasal cavity melanoma. No further metastasis is observed for more than 13 months after surgery.DISCUSSIONIn the literature, cutaneous melanoma is described as the origin of most metastatic gallbladder melanomas; however, no skin lesion was evident in this case. We believe that the poorly differentiated compartment of the nasal melanoma had metastasized to the gallbladder.CONCLUSIONFor patients with melanomas and gallbladder tumors, the possibility that metastasis could occur should be considered when selecting optimal treatment. Even when original melanoma is present, surgical treatment for gallbladder metastasis may be useful depending on the patient's conditions.     

Treatment outcomes of breast cancer liver metastasis treated with stereotactic body radiotherapy

BackgroundTo assess the outcomes of breast cancer liver metastasis (BCLM) treated with stereotactic body radiotherapy (SBRT) and systemic treatment.Materials and methodsPatients with oligometastasis at the time of liver metastasis (LM) or who became oligometastatic (≤5 metastases) after systemic treatment were assessed. Twenty-nine liver metastatic lesions were treated with a total of 54 Gy delivered in 3 fractions. The local control (LC), overall survival (OS), and progression-free survival (PFS) rates were calculated using Kaplan-Meier analyses.ResultsA total of 22 patients with 29 liver metastatic lesions treated with liver SBRT between April 2013 and September 2017 were retrospectively analyzed. After a median follow-up time of 16.0 months (range 4.4–59.4 months), 18 patients (82%) had disease recurrence, median of 7.4 months (range 1.0–27.9 months) after completion of liver SBRT. The 1- and 2-year OS rates were 85% and 57%, and the 1- and 2-year PFS rates were 38% and 8%, respectively. The 1- and 2-year LC rates were 100% and 88%, respectively. No significant prognostic factors, including disease extension, size of metastasis, number of liver metastasis and timing of liver metastasis, hormonal status affecting OS, PFS and LC were found. No patients experienced Grade 4 or 5 toxicity; furthermore, only one patient experienced rib fracture 6 months after completion of treatment, and one patient had a duodenal ulcer.ConclusionThis study is the first to evaluate the feasibility of SBRT to BCLM patients. Liver SBRT is a conservative approach with excellent LC and limited toxicities.     

积极开展中晚期胆囊癌的外科治疗：附32例报告

目的　多数外科医生对中晚期胆囊癌的外科治疗持消极悲观态度,作者探讨积极采取外科治疗的价值。方法　对３２ 例中晚期胆囊癌患者进行积极的外科治疗,除胆囊切除外,另行肝段切除术７ 例、半肝切除１ 例、肝门部胆管切除高位胆肠吻合４ 例、肝段切除并肝门部胆管切除高位胆肠吻合６例、肝部分及胰头十二指肠切除１４ 例。其中２６ 例行肝十二指肠韧带骨骼化清扫。结果　手术均顺利完成,１７ 例１２ 个月前手术者,１０ 例仍存活,其中２ 例已超过３０ 个月,最长达４０ 个月;１５ 例１２ 个月内手术者１４ 例存活。结论　对中晚期胆囊癌积极进行根治性手术,能改善其生活质量,延长生存期。