Recurrent Wilms tumour presenting as bilateral pneumothoraces.

We report the case of a 14-year-old girl who presented with bilateral pneumothoraces secondary to recurrent Wilms' tumour, 10 years following the initial treatment of her tumour. Recurrent Wilms' tumour presenting as bilateral pneumothorax so long after the original diagnosis has not previously been reported.     

Occult primary breast carcinoma presenting as axillary lymphadenopathy

BACKGROUND: The objective of this study was to review the need for radiotherapy or not in patients with occult primary breast cancer presenting with axillary metastases treated with breast conservation usually with no surgery to the breast. METHODS: From 1975 to 2001, 58 patients were treated with axillary lymphadenopathy from a cryptic primary breast carcinoma. After clinical and radiological assessment, 29 patients retained a diagnosis of occult primary breast carcinoma. Clinical and pathological data were collected retrospectively on the 29 patients and survival was calculated from the date of initial diagnosis using the Kaplan-Meier method. The median follow-up was 44 months. RESULTS: Median age at diagnosis was 57 years (range 28-81 years). Sixteen patients had radiotherapy to the ipsilateral breast. Eleven patients received no local therapy to the ipsilateral breast and two patients had quadrantectomies which were negative for malignancy. Locoregional relapse occurred in 12.5% of patients who had received radiotherapy and 69% of those who had not received any radiotherapy (P=0.02). Fifty-seven per cent of patients having a local relapse were salvaged with further surgery. The eventual breast conservation rate was 93%. Patients who received radiotherapy to the breast had significantly improved relapse-free survival (HR=0.31; P=0.04) and local relapse-free survival (HR=0.09; P=0.004). There were no significant differences in overall survival between those patients who had breast irradiation and those who did not (HR 0.91; 95% CI 0.18-4.5). CONCLUSION: Occult primary carcinoma with axillary metastases can be treated successfully with breast preservation but radiotherapy to the breast is necessary to minimize the risk of locoregional recurrence.     

Metastatic malignant melanoma presenting as bilateral incidentalomas

Incidentally discovered adrenal masses often pose a diagnostic challenge in the asymptomatic patient. The majority represent functional adrenal adenomas but primary or secondary malignancy must be considered. Bilateral incidentalomas are rare, and a case of asymptomatic bilateral adrenal melanoma metastases is presented. The diagnostic and treatment strategies relevant to this clinical problem are presented and discussed.     

Eosinophilic ureteritis presenting as bilateral upper ureteric strictures

During evaluation for loin pain a 54-year-old man was found to have bilateral upper ureteric strictures with hydroureteronephrosis on imaging. Renal function tests were normal. There was no peripheral eosinophilia but an excision biopsy of the stricture revealed eosinophilic ureteritis. As the patient had a previous history of cellulitis with epididymitis and came from an endemic area, filariasis should be considered as a possible triggering etiology.     

Multiple myeloma presenting as bilateral renal complex stones

Hypercalcaemia is a frequent complication of multiple myeloma. A mild degree of nephrocalcinosis has been noted in occasional patients and renal calculi are also sometimes present. We report herein a case of multiple myeloma that was revealed by the presence of bilateral calcium renal staghorn calculi. Medical treatment of myeloma, surgical management of this complex lithiasis and the course of multiple myeloma are discussed.     

Prostate adenocarcinoma presenting with inguinal lymphadenopathy

The lymphatic spread of prostate adenocarcinoma most often involves the iliac, obturator, and hypogastric nodes. Inguinal lymphadenopathy is very rare during the early stages of this disease, especially in the absence of pelvic lymphadenopathy or other metastases. We present a case of prostate adenocarcinoma with inguinal node involvement during the initial presentation, emphasizing the importance of a complete physical examination and the consideration of other concurrent diseases.     

Renal hilar extramedullary hematopoiesis presenting as incidental unilateral renal hilar mass in adolescent male: a case report

Extramedullary hematopoiesis (EMH) is a response to erythropoiesis failure in bone marrow, and is mostly encountered in the liver and spleen. Renal involvement is rare and the radiological literature on renal EMH is scant. We report the computed tomography (CT) and magnetic resonance imaging (MRI) findings of one such rare case of renal EMH in a young boy, appearing as a unilateral renal hilar mass.     

Serous carcinoma of the ovary, fallopian tube, or peritoneum presenting as lymphadenopathy

The clinicopathologic features of 35 cases of serous carcinoma of the ovary, fallopian tube, or peritoneum presenting as lymphadenopathy are described. The cases were retrieved from the files of the Department of Pathology at the University of Texas M. D. Anderson Cancer Center from a 20-year period (1982-2002). The following parameters were evaluated: patient age at diagnosis, lymph node involved, primary tumor site, tumor histology, peritoneal disease status, and survival. The patients ranged in age from 30 to 85 years (mean, 59 years). The lymph nodes involved were inguinal, 20 cases; supraclavicular, 11 cases; axillary, 2 cases; cervical, 1 case; and retroperitoneal, 1 case. Primary tumor sites included 20 ovarian, 10 peritoneal, and 2 fallopian tube. In 2 patients, total abdominal hysterectomy/bilateral salpingo-oophorectomy and complete staging showed no additional tumor, and in 1 patient with a previous history of total abdominal hysterectomy/bilateral salpingo-oophorectomy for a benign condition, imaging studies did not identify a primary site. The carcinoma was high grade in 30 cases and low grade in 4 cases. In one case, the diagnosis was made on cytology material and the tumor could not be graded. Peritoneal disease status was known in 33 patients and was as follows: omentum with gross disease, 16 cases; and omentum without gross disease, 17 cases. Follow-up was available in 33 patients and ranged from 4 to 204 months, with a median survival of 36 months for stage III patients and 29 months for stage IV patients. Patients with adenopathy and minimal peritoneal disease (grossly negative omentum) had a median survival of 120 months compared with 24 months for those with bulky peritoneal disease (grossly positive omentum). Serous carcinoma of the ovary, fallopian tube, or peritoneum presenting as a lymph node metastasis is uncommon. In rare cases, a primary site may not be found. The median survival of the patients for stage is not appreciably different from those patients presenting in the usual fashion, suggesting that this atypical presentation does not adversely affect survival. Patients with minimal peritoneal disease and extra-abdominal lymph node metastases survive longer than those with bulky peritoneal disease