Kissing pleural metastases from metastatic osteosarcoma of the lung.

Two patients with osteosarcoma lung metastases of which migrated to the parietal pleura due to contact are reported. The first patient was a 16-year-old male who had a pleural metastasis in the diaphragm within an area in contact with a single lung metastasis. Both of the tumors were resected, followed by systemic chemotherapy. Nine months after the resection of the first metastases, two other lung metastases were found which were resected after chemotherapy. The patient is alive without recurrence 84 months after the first resection of the metastases. The second patient was an 11-year-old female with a pleural metastasis of osteosarcoma which was within an area in contact with a single lung metastasis, which had been resected 4 months before. We concluded (1) that a lung metastasis of osteosarcoma occasionally metastasizes to the pleura due to contact; and (2) that because this kissing metastases of osteosarcoma could be cured by a complete resection, the intrathoracic cavity should be thoroughly observed.     

The neurosurgical management of brain metastasis from colorectal cancer: A report of three cases

We report herein three cases of brain metastasis from primary colorectal cancer in which the metastatic lesion was resected to effectively relieve neurological symptoms. Case 1 was a 61-year-old woman with a solitary brain metastasis from colorectal cancer and no other metastases; case 2 was a 59-year-old woman who died from liver metastasis 11 months after resection of the metastatic brain tumor; and case 3 was a 68-year-old woman with multiple metastases to the lungs and bones detected before the brain metastasis. According to 16 cases previously reported in the Japanese literature and our 3 cases, the interval between diagnosis of the primary cancer and discovery of brain metastasis was 23 months on average, while the median survival after the discovery of brain metastasis was 7 months. Brain metastases with liver and lung metastases were seen more frequently than brain metastases alone. In these three cases, chemotherapy appears to have been of no use in preventing recurrence. Thus, we believe neurosurgical management to be appropriate for a solitary lesion and that it should be actively pursued to prolong survival and improve quality of life.     

Operative therapy in disease progression and local recurrence of renal cell carcinoma

When local recurrence or distant metastasis occurs, the question arises as to which therapeutic concept should be applied. In contrast to the data on systemic immunotherapy, there are no systematic studies on surgical management of metastasis. Local recurrence (a rare condition) is frequently resected, whereby a prolongation of life can be achieved in individual cases. The complete surgical resection of pulmonary metastases has been shown, in a number of studies, to achieve a survival rate of 5 years in up to 44% of the cases. There are only few data regarding resection of osseous metastases; although in this respect some studies have reported an average survival rate of 34 months, the indication for this condition has, up to now, usually been seen as palliative. The prognosis of liver or brain metastasis is unfavorable; the survival rates achieved with the help of surgical procedures are scarcely higher than those resulting from the spontaneous progression of metastatic renal carcinoma (12 months). Thus, there is an urgent need for further studies in order to define the indication for the surgical management of metastasis. Copyright Copyright 1999 S. Karger AG, Basel     

Metastatic Tumors to the Nail Unit: Subungual Metastases

BACKGROUND: Cutaneous metastases are variable in location and morphology. Metastatic tumor can present as a subungual lesion in either an oncology patient or a previously cancer-free individual. However, the diagnosis of a subungual metastasis is often not initially considered since the symptoms and appearance of the subungual tumor frequently mimic those of other conditions. OBJECTIVE: To describe the clinical characteristics, radiographic changes, and pathologic findings of the subungual metastases in two women with metastatic carcinoma and to discuss the features of metastatic tumor lesions to the subungual area and distal digits previously reported in oncology patients. METHODS: The clinical presentation, radiologic studies, and pathologic examination of metastatic subungual tumor lesions were described in two oncology patients: a woman with breast cancer and a woman with renal cell carcinoma. The published reports of cancer patients with subungual metastases were reviewed and the following variables were evaluated: the primary origin of the cancer, the histology of the primary tumor, the temporal relationship between the onset of symptoms or the appearance of subungual metastasis and the diagnosis of the visceral malignancy, the symptoms and the morphology of the subungual metastases, the clinical differential diagnosis of subungual metastases, the relationship between the site of origin of the primary tumor and the incidence of metastases either to the fingers and the thumbs or to the toes, the distribution of subungual metastases, the incidence of radiologically confirmable bony involvement of the distal phalanx by metastatic tumor in the digit containing the subungual metastasis, and the prognosis of patients in whom the diagnosis of a subungual metastasis has been confirmed. RESULTS: Subungual metastases most frequently occur in patients with primary tumors of the lung (41%), genitourinary tract organs (17%, of which the kidney represents 11%), and breast (9%). The histology of the primary tumors that was most common included renal cell carcinoma and squamous cell carcinoma. The appearance of the subungual tumor was the first sign of a previously unsuspected primary malignancy in 44% of the patients with subungual metastases. Subungual metastases were frequently painful and most often presented as either an erythematous enlargement or swelling of the distal digit or a red to violacious nodule that distorted either the nail plate or the soft tissue of the distal digit, or both. The lesion was often initially mistaken as an acute infection. The lesion involved one or more digits of the hands in 92% of patients with subungual metastases; symmetrical subungual metastases and metastatic tumor restricted only to the great toes were less commonly observed. In patients with subungual metastases that involved the digits of their hands, the most frequent sites of primary tumor origin were the lung (35%) and the genitourinary tract organs (25%). Radiologic evidence of bony involvement of the respective distal digit was either initially present or subsequently developed in 92% of patients with subungual metastases. Patients with subungual metastases have a poor prognosis; their survival following the diagnosis of the subungual tumor is usually only a few months. CONCLUSION: The clinical differential diagnosis of a new periungual or subungual lesion (with or without an associated nail plate dystrophy) should include tumor metastasis to the nail unit not only in oncology patients, but also in previously cancer-free individuals.     

Successful limb salvage of pathological fracture of the distal tibia caused by cancer metastasis

Pathological fractures of the distal tibia as a result of cancer metastases are rare. In particular, the management of intraarticular fractures of the distal tibia has not been established. In this article, we present a case of pathological intraarticular fracture with an extensive bone defect of the distal tibia that was successfully treated by limb salvage with a locked intramedullary nail and pirarubicin-impregnated methylmethacrylate. A 52-year-old patient with duodenal cancer presented with a painful swelling in the left crus. The condition was diagnosed as an impending pathological fracture of the tibia because of cancer metastasis. During radiation therapy, an actual pathological fracture of the distal tibia occurred due to an accident. Limb-salvage surgery was performed by removing the metastatic lesion, followed by using a locked intramedullary nail. Three distal and seven proximal locking screws were inserted into the tarsal bones and the remaining tibia. About 10 cm of bone defect was reconstructed by pirarubicin-impregnated methylmethacrylate. Consequently, good stability was achieved. One month later the patient could walk without any aid. Postoperative functional score was 77% according to the Musculoskeletal Tumor Society criteria. There was no recurrence; however, the patient died of lung metastases 4 months after the limb-salvage surgery. Received: January 19, 2001 / Accepted: October 26, 2001     

双膦酸盐在骨转移瘤中的应用进展

骨转移瘤是肿瘤患者的严重并发症，与骨痛、病理性骨折、神经缺失和（或）高钙血症等紧密相关，因此，骨转移瘤的治疗是必要的。双膦酸盐是标准的治疗和预防骨相关事件的药物，可抑制破骨细胞介导的骨吸收，显示抗癌活性，是最有效的治疗骨转移瘤和预防骨转移并发症的药物，可降低患者骨相关事件的发生，提高患者生活质量。     

A metastatic gastric tumor originating from a pleomorphic rhabdomyosarcoma of the extremity: a case report and literature review

Pleomorphic rhabdomyosarcoma is a rare and aggressive variant of rhabdomyosarcoma that usually occurs only in adults aged 45 years or older. Gastric metastasis from a soft-tissue sarcoma of the extremity is likewise very rare, with only a few previously reported cases. Here, we describe the case of a 52-year-old man with gastric metastasis who underwent en bloc excision of the primary tumor and distal gastrectomy but died 6 months after surgery due to lung metastases. This is, to our knowledge, the first reported case of gastric metastasis from pleomorphic rhabdomyosarcoma of the extremity. In cases such as these, patients may have widespread disease, and thus, surgery may only have a limited role in its management.     

The solitary cutaneous metastasis of asymptomatic colon cancer to an operative scar

Although umbilical or cutaneous metastases from asymptomatic internal malignancies are occasionally documented, the literature contains no report of a solitary cutaneous metastasis to an old operative scar from an asymptomatic internal malignancy. A rare case of colonic cancer presenting as a solitary subcutaneous metastasis to a lower abdominal scar resulting from an open prostatectomy is described in this communication. It was impossible to distinguish this subcutaneous metastasis from a pyogenic granuloma caused by residual sutures without histological evidence. Thus, a granuloma that persists despite repeated treatment may be a possible sign of asymptomatic internal malignancy.     

Medical management of brain metastases

The main objective of treating brain metastases is to improve survival and to reduce symptom burden, preserve function, and enhance quality of life. As such, concurrent local control of existing brain metastases, prevention of future metastasis elsewhere in the brain, and control of the systemic cancer are required. The treatment modalities used to achieve these aims include surgery, radiation, and medical therapy. This article is devoted to the medical management of brain metastases, namely the role of medical treatments and chemotherapy. Radiation therapy and surgery are discussed in detail elsewhere; however, a brief discussion of all of these modalities is included for the sake of thoroughness.     

�ѳ�����ת���������

??Surgical management of hepatic metastases of ovarian carcinoma YANG Lian-yue??XU Jiang-feng. Department of Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Corresponding author??YANG Lian-yue??E-mail: lianyueyang@hotmail.com
Abstract Ovarian carcinoma is a common tumor of gynecologic malignancies, and many cases of liver metastases of ovarian carcinoma have been reported. By recent studies, a significantly better quality of life and longer survival in patients has been obtained for whom received hepatic resection of ovarian cancer with liver metastasis. Hepatic resection should be the first choice for ovarian cancer with liver metastasis with definite indications for operation. For those who are inable to receive hepatectomy, non-surgical treatment should be carried out.     

Radiation therapy for bone metastasis

Radiation therapy is an important palliative treatment in the management of patients with metastatic bone disease. Excellent results are obtained following radiation therapy to the involved area when generous margins are employed with appropriate megavoltage devices and time-dose-fractionation/protraction. Often an objective response to treatment occurs, as evident by roentgenograms and by pathologic evaluation. Whether the patient's expected life span is relatively short or relatively long, the approach to treatment of bone metastasis must be done within the context of a multidiscipline management. Close cooperation is necessary among radiation oncologists, medical oncologists, orthopedic surgeons, and physiatrists. Radiation therapy for local persistent symptoms relative to bone metastases is an effective technique for achieving long-term control of localized pain without the need for retreatment. Those patients who have a single metastasis with no other evidences of metastatic disease, and who are best treated aggressively, should be differentiated from those patients who have bone metastases as part of a general pattern of metastatic disease where more conservative radiation therapy techniques would be pursued.     

Monoarthritis secondary to joint metastasis. Two case reports and literature review

Synovial metastases from neoplasms are uncommon. We report two cases of knee monoarthritis due to joint metastasis. Joint fluid cytology established the diagnosis. In one patient, an epidermoid carcinoma of the ureter metastasized to the left knee. The other patient had chronic monoarthritis of the left knee unresponsive to conventional treatment and was found to have distal femoral metastases from a lung adenocarcinoma. Only 28 cases of synovial metastases from solid tumors have been reported in the literature. The knee is the most common target, the lung the most common site of the primary (12 cases), and adenocarcinoma the most common histological type (12 cases). Joint metastasis carries a poor prognosis with a mean survival of less than 5 months.     

The surgical results of pancreatoduodenectomy and total pancreatogastrectomy combined with autotransplantation of the distal half of the pancreas for the treatment of advanced gastric cancer located in the lower half of the stomach

In the last 16 years we employed pancreaticodudenectomy (PD) on 27 patients with cancers of the distal third of the stomach, associated with duodenal invasion, invasion to pancreatic head, or n3 metastasis. More recently, total gastrectomy and total pancreatectomy combined with heterotopic autotransplantation of the distal pancreas (TGTP) was performed in 7 patients with n4 metastases. These cases were compared with 56 patients who underwent subtotal gastrectomy (SG) in the same period. When the survival rates were compared, PD provided better long-term results than SG, especially on the patients with tumors infiltrating into the pancreas head. On the contrary, there was no significant survival advantage in patients with duodenal invasion or n3 metastasis between PD group and SG group. TGPT showed the longest survival for the patients with n4 metastasis. These results indicate that PD is a rational and safe method for the treatment of gastric cancer infiltrating into the pancreas head. In addition, TGTP may be the most radical procedure for the treatment of gastric cancer with n4 metastases.     

胃窦癌胃周淋巴结转移规律的探讨

目的 探讨胃窦(胃L区)癌的淋巴结转移规律与临床病理因素之间的关系及其临床意义.方法 对2006年6月至2007年12月期间于西安交通大学医学院第一附属医院进行胃窦癌根治性淋巴结清扫手术的129例患者的手术切除标本进行解剖,分组收集切除淋巴结,逐枚进行病理组织学检查,判断淋巴结是否转移并计算各组淋巴结转移率,分析其与肿瘤大小、肿瘤部位、浸润深度、组织学类型、Borrmann分型等方面的关系.结果 本组129例胃窦癌患者的淋巴结转移阳性80例(62%).共收获3295枚淋巴结,平均每例25.54枚,中位数24枚/例,转移淋巴结数889枚.胃窦癌患者No.1、No.3、No.4d、No.5、No.6、No.7、No.8a、No.9、No.11p、No.12a、No.14v各组淋巴结转移率分别为18.60%、48.84%、37.98%、38.76%、44.19%、31.01%、10.85%、14.73%、4.65%、1.55%及0.78%,其中以No3和No6组为最高.结论 在实施胃癌根治手术时,应综合考虑各临床病理因素,并结合胃窦区胃癌淋巴结分组、分站转移的特点,合理选择淋巴结清扫范围,以达到根治目的.     

Endometrial Carcinoma Metastasis to the Distal Phalanx of the Hallux: A Case Report

Endometrial carcinoma is the most common invasive cancer of the female genital tract and accounts for 7% of all invasive cancer in women. Bony metastasis is uncommon with endometrial carcinoma and distal metastasis is very rare. The purpose of this paper is to present a case of an 86 year-old female with endometrial carcinoma metastasis to the distal phalanx of the hallux. The patient had a known history of endometrial carcinoma with metastases (FIGO IIIC), and had been diagnosed with pulmonary and bony metastases 2 months prior to presentation. Her initial foot complaint was of a painful, infected ingrown toenail. The infection continued to progress following avulsion of the nail, and the patient was then diagnosed with osteomyelitis. Given her past history, the possibility of metastasis to the hallux was also considered. A hallux amputation was performed, and the pathology report revealed the diagnosis of endometrial carcinoma metastasis to the distal phalanx of the hallux. While the amputation site healed uneventfully, the patient refused further treatment measures for her carcinoma and eventually succumbed to the disease.     

Metastasis of Primary Colon Cancer to the Breast - Leave Well Alone

BACKGROUND: Metastasis to the breast is rare. Its management differs from that of primary breast cancer, as illustrated by this case of a colonic metastasis to the breast. CASE REPORT: A 78-year-old woman presented with a breast lump 16 months after a palliative colonic resection for an obstructing colon cancer (T4 N0 M1). Core biopsy of the breast lump revealed morphological features identical to the original bowel cancer. In view of her progressive metastatic disease, the breast lump was simply observed. She passed away 4 months later from advanced intra-abdominal carcinomatosis. DISCUSSION: There are 19 cases of colonic metastasis to the breast in the literature. In the literature, colonic metastases to the breast are usually excised. CONCLUSION: Excision of a colonic metastasis to the breast can be avoided if the patient's life expectancy is short.     

Small bowel metastases from head and neck cancers

AIM OF THE STUDY: Small bowel metastases represent less than 10% of malignant tumours of the small bowel. Among primitive cancers with small bowel metastases, head and neck cancers are exceptional. The aim of the study was to evaluate clinical and evolutive characteristics of patients with small bowel metastases from head and neck cancers. PATIENTS AND METHODS: Analyse of a reported case and bibliographic study by asking the Medline database and gathering anamnestic, clinical and evolutive data from observations of small bowel metastases from head and neck cancers. RESULTS: We report the case of a 63 years-old male patient with a small bowel metastasis from a head and neck cancer. Nine other observations have been published in the international literature. Analysis of this 10 patient-series shows that small bowel metastases of head and neck cancers occur rather in old male patients (mean age: 71 years). They are usually discovered after primitive cancer diagnosis, always because of occlusive, perforative or bleeding complications. Jejunal metastases are rather complicated by perforation whereas ileal ones rather induce occlusion or digestive bleeding. Discovering a small bowel metastasis in the context of head and neck cancer is highly indicative of a poor prognosis. In these 10 patients, deaths occurred within the 8 months following the diagnosis, because of postoperative complication or neoplastic evolution. CONCLUSIONS: Small bowel metastases from head and neck cancers usually occur as emergent complications. They are indicative of an advanced disease and the prognosis is extremely poor. The aim of the management is to afford the best quality of life as possible.     

Ependymoma of the Cauda Equina

Summary  Myxopapillary ependymomas are benign tumours which occasionally metastasize along cerebrospinal fluid pathways. Extraneural metastases of spinal ependymomas, however, are very rare, even more so when situated in the pleura.  We report the case of a 67 year old woman presenting with shortness of breath after recurrent myxopapillary ependymomas of the cauda equina. Chest X-ray showed multiple pleural lesions diagnosed as metastases of a myxopapillary ependymoma. The MIB-1 proliferation index was 3.1% for the initial spinal tumour, 14.2% for the first and 11.2% for the second recurrence while 12.0% for the pleural metastasis.     

Metachronous metastasis to the penis from carcinoma of the rectum

Metastases to the penis are a rare event with most arising from pelvic organs, but occasionally the kidneys. Furthermore, very few cases exist where primary rectal carcinoma metastasising to the penis has been reported. We report on such a case and discuss the general management of penile metastases.     

Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer

BACKGROUND: Lateral lymph node metastases occur in some patients with low rectal cancer and may cause local recurrence after total mesorectal excision. The aims of this study were to identify risk factors for lateral node metastases in patients with pathological tumour (pT) stage 3 or pT4 low rectal adenocarcinoma, and to evaluate the prognostic significance of lateral node metastases. METHODS: A retrospective analysis was performed of the outcome of 237 patients with pT3 or pT4 low rectal adenocarcinoma who underwent R0 resection with systematic lateral node dissection. RESULTS: Lateral lymph node metastases were found in 41 patients (17.3 per cent). Increased risk of lateral lymph node metastases was associated with a distal tumour margin close to the anal margin, histological type other than well or moderately differentiated adenocarcinoma, and the presence of mesenteric lymph node metastases. Patients with lateral node metastases had a significantly shorter postoperative survival (5-year survival rate 42 versus 71.6 per cent; P < 0.001) and an increased risk of local recurrence (44 versus 11.7 per cent; P < 0.001) compared with those without lateral node metastases. CONCLUSION: Tumour site, histological type and the presence of mesenteric lymph node metastasis are factors predicting the risk of lateral node metastasis. The poor prognosis of patients with lateral lymph node metastases after systematic lateral dissection suggests the need for adjuvant therapy.