Isolated prostatic metastasis from primary sigmoid colon carcinoma.

Metastasis to the prostate is extremely uncommon. We report a 38-year-old man with sigmoid colon carcinoma, treated with surgery and adjuvant chemotherapy, who developed isolated metastasis to the prostate four years after initial treatment. He was treated with chemoradiation and remains disease-free three years after detection of metastasis.     

非小细胞肺癌淋巴结转移时间对患者生存率影响分析

目的评价非小细胞肺癌患者淋巴结转移出现于初诊前或治疗中对患者生存率的影响。方法 80例未手术非小细胞肺癌（NSCLC）患者,卡氏评分≥70分,按初诊时有无淋巴结转移分为两组,初诊有淋巴结转移40例,归为同步淋巴结转移组,中位年龄50岁;治疗中或治疗后出现淋巴结转移40例,归为非同步淋巴结转移组,中位年龄55岁。两组患者皆行序贯放化疗,放疗范围包括病灶、纵隔及出现转移的颈部淋巴结区,总剂量Dt5000～6400cGy（中位剂量6000cGy）,常规分割,预防性照射病侧锁骨上淋巴结区,单侧锁骨上淋巴结区转移者预防性照射对侧锁骨上淋巴结区。化疗方案采用NP和（或）TP方案。放疗后均继续化疗直至完成至少4个周期的化疗。结果同步淋巴结转移组平均生存时间为13月,非同步组平均生存时间为16月（P=0.020）。非同步组出现淋巴结转移至死亡的平均时间为7月（P〈0.01）。结论对于未手术的NSCLC患者来说,发生淋巴结转移,从出现淋巴结转移至死亡的生存时间同步较非同步者长。     

Distal phalanx metastasis in operated bronchial carcinoma

A 54 years old man who admitted with thoracolomber pain and pain at left knee had history of left pneumonectomy four months ago for squamous cell lung carcinoma. At physical examination swelling and hotness at the left knee, swelling and redness of the distal phalanx of the right third finger were found. Distal phalanx was not observed at the X-ray which was taken for suspect of metastasis. Incision biopsy was performed from this lesion and microscopic findings of the material were evaluated as metastatic squamous cell carcinoma. Bone metastasis are seen frequently at bronchial carcinoma, but hand metastasis are seen in 0.2% of all cases. This case is represented because of the rare metastatic localisation of bronchial carcinoma.     

Endobronchial Metastases from Colon Cancer without Liver Metastases: Report of Eight Cases

Purpose The liver is the most common site of hematogenous spread from colon tumors. Pulmonary metastases from colon cancer result, in most of the cases, from hepatic metastases. Methods We describe eight cases of colorectal cancers in which endobronchial metastases have been developed without any evidence of liver involvement. Results Median age was 62 years old. In most of the patients, the primary cancer developed in the left side. The median time from colorectal presentation to pulmonary onset was four years. Dyspnea was the major symptom in all cases. Pulmonary involvement included endobronchial metastasis in all cases. CT scan of the chest showed bilateral, diffuse, large, nodular infiltrates without lymph nodes enlargement and without pleural effusion. Endobronchial therapy brought symptomatic relief in all cases; however, two-year follow-up showed only 50 percent survival rate. Conclusions Endobronchial metastasis should be suspected in patients with colon cancer with respiratory symptoms, even without known liver metastasis. To the best of our knowledge, such a case series has not been published yet.     

Central nervous system metastases in breast cancer

Summary Sixty-two breast cancer patients with central nervous system (CNS) metastases were reviewed. The CNS was the first site of metastatic involvement in 38 cases (61%). The median survival from the primary diagnosis was 3.0 years; from the diagnosis of the CNS metastasis, 6 months. The interval between primary diagnosis and CNS metastasis had a median value of 2.0 years; between the initial extra-cranial metastasis and CNS metastasis this was 0.9 years. Prognostic factors for the appearance of CNS metastasis could not be identified. Subsequent to CNS metastasis appearing, the well-known prognostic factors for the survival time and the metastasis-free interval lose their importance. Brain metastases occur, above all, in patients aged between 50 and 55 years, very often in the first 2.5 years after the first distant metastasis and not later than 10 years from the primary diagnosis.     

Three cases of gastrointestinal stromal tumor (GIST) with bone metastasis]

We report three cases of gastrointestinal stromal tumor (GIST) with delayed bone metastasis at least four years after initial surgery. One small intestinal and two rectal GISTs were all considered as high-risk according to the classification based on tumor size and mitotic count. GIST usually metastasizes to the liver and peritoneum, however bone metastasis should be considered in the patients with long prognosis.     

Solitary recurrence of hilar cholangiocarcinoma in a mediastinai lymph node two years after curative resection

We recently encountered an unusual case of hilar cholangiocarcinoma in which a solitary recurrence in a mediastinal lymph node occurred two years after curative resection of the primary tumor. A 64-year old woman was admitted to our hospital with a complaint of right hypochondrial discomfort. After imaging studies demonstrated a hilar cholangiocarcinoma in the left hepatic duct, a curative resection of the tumor was performed, consisting of a left hepatic lobectomy along with caudate lobectomy, regional lymph node dissection, and resection of the extrahepatic bile duct. No nodal metastasis was observed histologically. Two years after surgery, the patient was found to have a nodule in the posterior mediastinum, which was thoracoscopically resected. No other swollen lymph nodes, local recurrence, or distant metastasis were noted. Histologically, the nodule proved to be a metastatic lymph node, and adjuvant chemoradiation therapy was initiated. The patient remained well for the four years following her first operation and had no evidence of disease recurrence 28 mo after her second operation. To our knowledge, this case is the first report of solitary recurrence in a mediastinal lymph node after curative resection of hilar cholangiocarcinoma.     

Solitary recurrence of hilar cholangiocarcinoma in a mediastinal lymph node two years after curative resection

We recently encountered an unusual case of hilar cholangiocarcinoma in which a solitary recurrence in a mediastinal lymph node occurred two years after curative resection of the primary tumor. A 64-year old woman was admitted to our hospital with a complaint of right hypochondrial discomfort. After imaging studies demonstrated a hilar cholangiocarcinoma in the left hepatic duct, a curative resection of the tumor was performed, consisting of a left hepatic lobectomy along with caudate lobectomy, regional lymph node dissection, and resection of the extrahepatic bile duct. No nodal metastasis was observed histologically. Two years after surgery, the patient was found to have a nodule in the posterior mediastinum, which was thoracoscopically resected. No other swollen lymph nodes, local recurrence, or distant metastasis were noted. Histologically, the nodule proved to be a metastatic lymph node, and adjuvant chemoradiation therapy was initiated. The patient remained well for the four years following her first operation and had no evidence of disease recurrence 28 mo after her second operation. To our knowledge, this case is the first report of solitary recurrence in a mediastinal lymph node after curative resection of hilar cholangiocarcinoma.     

Indolent gastric carcinoma.

A 55 year old woman presenting with epigastric pain and dyspeptic symptoms was diagnosed to have gastric carcinoma on endoscopic biopsy independently on two occasions. She was subsequently asymptomatic without any specific therapy till she developed gastric outlet obstruction and weight loss four years later. Histology of the resected specimen revealed an adenocarcinoma infiltrating the serosa without any evidence of metastasis.     

Epidermoid carcinoma of the anal canal

Thirty consecutive patients with epidermoid carcinomas of the anal canal larger than 2 cm were treated with the concomitant application of radiation and two cycles of chemotherapy (5FU and mitomycin-C) between January 1982 and January 1988. Twenty-eight patients were treated with curative intention and two for palliation only. All patients were reexamined after a period of one to 2 months, under light general anesthesia, and any residual tumor or scar tissue was biopsied. Control biopsy was positive in eight patients. Three of six patients who had abdominoperineal excision died from locoregional recurrence; the remaining are alive and cancer free after 1 to 4 years. Two patients had local excision; one is alive and the other died of other cancer metastasis four years later. Seventeen patients who had negative biopsies are alive and free of disease after 1 to 5 years; two died of unrelated causes, two died with distant metastasis (present prior to treatment), and one died with locoregional recurrence. Locoregional failures occurred in four patients (13.3 percent) in the entire series. Individualization of each patient, adjustment of doses, and carefully executed radiation and chemotherapy are the most important points for the success of treatment. Read at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17, 1988.     

Lymph Nodes Metastasis is a Risk Factor for Bone Metastasis From Extrahepatic Cholangiocarcinoma

Background/Aims: The rate and site of bone metastasis from cholangiocarcinoma as well as the prognosis are unclear. Therefore, we intend to make a comparative review of the background to bone metastasis, examine a high-risk group for bone metastasis and use the data towards the improvement in quality of life. Methodology: We studied 200 cases of cholangiocarcinoma resected in our division from January 2003 to April 2010. Results: Bone metastasis was confirmed in four cases (2.0%). The survival period after the diagnosis of bone metastasis ranged from 2.9 months to 21.6 months and the average was 6.7 months. We studied histopathological findings of bone metastasis, lymph node metastasis, lymphatic invasion, blood vessel invasion and perineural invasion (ly, v and pn) and found that all of four bone metastasis cases were positive for lymph node metastasis which was a statistically significant factor affecting bone metastasis. Conclusions: Since the number of cases we studied is small, it is difficult to determine whether lymph node metastasis is a risk factor for bone metastasis; however, we think it is necessary to take the probability of bone metastasis into consideration when we provide medical care to patients positive for lymph node metastasis.     

Lung cancer with skin metastasis

Cutaneous metastasis from lung cancer is rare, but physicians should understand its significance. We treated eight such patients during a 30-month period at Wilkes-Barre (Pa) General Hospital. The seven men and one woman ranged in age from 46 to 72 years (mean, 59 years). In three, the skin lesion was the first manifestation of the underlying cancer and in another three, it was found coincident with the lung mass. Pathologic findings included small-cell undifferentiated carcinoma in four patients, squamous cell carcinoma in three patients, and large-cell undifferentiated carcinoma in one patient. Seven of the eight primary lung lesions were in the upper lobes. Six patients had clinically occult visceral metastases at the time of skin biopsy. Only one patient survived more than six months following skin metastasis. Biopsy specimens must be taken from all new skin lesions, particularly in patients who smoke or who already have a history of lung cancer.     

Adrenalectomy for Clinically Isolated Metastasis from Colorectal Carcinoma: Report of Eight Cases

Purpose  Metastasis to the adrenal glands is a relatively frequent finding at autopsy. Adrenal metastasis of colorectal carcinoma is rare (14 percent). Isolated adrenal metastasis is even rarer, and presents a therapeutic dilemma. Methods  Between 1997 and 2006, eight patients (5 men; mean age, 62 years) underwent adrenalectomy for metastasis of colorectal carcinoma. The tumors were Stage D in four cases, Stage B in two cases, and Stage C in the remaining two. Adjuvant chemotherapy was instituted. Results  All patients were asymptomatic, and adrenal metastasis was suspected from an elevated serum level of carcinoembryogenic antigen or discovered by computed tomography. Adrenal metastases were metachronous in seven patients, with median disease-free interval of 3.75 years. At the time of follow-up, one patient remained alive and free of disease 12 months after adrenalectomy, one patient was lost to follow-up after 22 months, and 6 patients have died from malignancy. The mean survival for the patients who died was 32 months. Conclusions  The rarity of isolated adrenal metastasis of colorectal carcinoma makes a randomized, prospective trial comparing surgery vs. nonsurgical management highly unlikely. Our results provide further support for surgical resection of solitary adrenal metastasis, which may translate into survival benefit. Presented in part in abstract form at European Society of ColoProctology (ESCP) meeting. Lisbon, Portugal, September 13–15, 2006. Reprints are not available.     

Unusual upper gastrointestinal bleeding due to late metastasis from renal cell carcinoma: a case report

A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63-year-old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow-up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life-long follow-up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease-free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.     

Early esophageal cancer with epidermization diagnosed and treated with endoscopic resection

The patient was a 57-year-old man who had undergone endoscopic submucosal dissection for early esophageal cancer (distance from incisor tooth, 30 cm) when he was 50 years of age. Pathological findings showed squamous cell carcinoma invading the lamina muscularis mucosae and mild lymphatic invasion. Considering the possibility of lymph node metastasis and distant metastasis, we administered radiation chemotherapy (CDDP+ 5-FU, total radiation 41.4 Gy) in the same year. Two years later, follow-up endoscopy revealed a white, flat, elevated lesion in the thoracic esophagus (distance from incisor tooth, 36 cm) that was not stained by Lugol’s iodine. A biopsy of this lesion was performed. Although esophageal epidermization was seen, there were no findings suggestive of malignancy. The lesion grew slightly during four and a half years of follow-up after identification. We performed a repeat biopsy of the lesion, and the tissue was diagnosed as atypical epithelium, so we performed endoscopic mucosal resection for diagnostic and therapeutic purposes. The postoperative pathological diagnosis was squamous cell carcinoma of T1a-LPM with epidermization due to its histological features. To the best of our knowledge, this is the first report of esophageal cancer accompanied by epidermization.     

Hepatic resection for intrahepatic cholangiocarcinoma: relation to gross tumor morphology

BACKGROUND/AIMS: The aim of this study was to investigate the clinicopathologic features and biological behaviors related to the gross appearance of intrahepatic cholangiocarcinoma. METHODOLOGY: Fourteen patients with intrahepatic cholangiocarcinoma who underwent hepatic resection between 1986 and 1998 were divided into four groups according to the gross appearance of the tumor: ID (intraductal growth) type (n = 1), PD (periductal-infiltrating) type (n = 4), MF (mass-forming) type (n = 5), MF-with-PD type (n = 4). RESULTS: Overall survival at 1, 5, and 10 years was 50.0%, 35.7%, and 35.7%, respectively. All three long-term survivors without recurrence had tumors unassociated with vascular invasion, intrahepatic metastasis, or lymph node metastasis. The MF and MF-with-PD tumors were more frequently associated with vascular invasion and/or lymph node metastasis than the ID or PD type. The Ki-67-positive grade of the cancer cells was clearly higher in the MF and MF-with-PD tumors than in the ID or PD type. All of the cases of MF-with-PD tumors were stage IV-A and had a poor outcome. CONCLUSIONS: Extended hepatic resection with a sufficient surgical margin yielded good results in intrahepatic cholangiocarcinoma patients without vascular invasion, intrahepatic metastasis, or lymph node metastasis. However, it is necessary to develop a new effective strategy for advanced intrahepatic cholangiocarcinomas, such as the MF-with-PD type.     

The repeated hepatectomy for frequent recurrence of hepatic metastasis from gastrointestinal stromal tumor of the stomach

Although in recent years hepatic resection has become a safe procedure, there are few data on repeat liver resection for hepatic metastases from gastrointestinal stromal tumor. A 60-year-old Japanese man underwent partial gastrectomy and extended right hepatectomy for gastrointestinal stromal tumor of the stomach with liver metastasis. However, liver metastasis recurred at the interval of less than 1 year. Therefore, the patient underwent a total of six liver resections. The liver resections comprised four R0, one R1 and one R2 resection. To our knowledge, six times for liver resection performed on one patient is a maximum. This patient survived 43 months after the first surgery. Despite frequent recurrence of hepatic metastasis from gastrointestinal stromal tumor, repeated hepatectomy provides a survival benefit if complete removal of all tumorous masses appears possible.     

Histopathological changes in invasive thymoma in patients with recurrence

In the last 20 years, we treated 123 cases of thymoma. In 2 patients histopathological features of the tumors changed during the long-term follow up. In one patient the tumor was resected along with the invaded tissues. Eleven years later, recurring tumor and the invaded organs were extirpated. Hepatic metastasis was detected by abdominal CT scanning 16 years after the first operation. Two years later she died in an accident. Histopathologically, the primary thymoma was lymphoepithelial type and the recurrent tumor was epithelial type. In the other patient, four years after the surgical treatment for thymoma with disseminated lesions, recurrent disseminations were removed. Eight years later, both the disseminated and a metastatic lesion were resected. This patient is currently well without tumor 14 years after initial detection of the disease. Both the primary and recurrent thymoma were lymphoepithelial type and the third tumor was epithelial type. Thus, slow-growing thymomas in patients with long-term survival possibly undergo histological change.     

A patient with hepatocellular carcinoma who underwent resection of the primary lesion 10 years ago and resection of a giant adrenal metastasis 8 and a half years later

A 56-year-old male consulted us because of a palpable mass and pain of the left flank 8 and a half years after resection of hepatocellular carcinoma of the left lobe about 3 cm in diameter. Ultrasound examination of the abdomen demonstrated a tumor about 10 cm in diameter showing a mosaic of hyperechoic and hypoechoic areas on the upper pole of the left kidney. By angiography, the tumor was found to be supplied mainly by the inferior adrenal artery. PIVKA-II was increased. Adrenal metastasis of hepatocellular carcinoma was suspected, and adrenalectomy was carried out. No intrahepatic metastasis was noted. The tumor was histopathologically identified as a pseudo-glandular type of moderately differentiated hepatocellular carcinoma with a trabecular pattern similar to the primary lesion. In this patient, a resectable giant metastasis was observed only in the left adrenal gland and no intrahepatic metastasis was demonstrated 8 and a half years after resection of hepatocellular carcinoma. The patient has survived 10 years after the first operation. This case is considered to be important for evaluation of the treatment for distant metastasis of hepatocellular carcinoma.     

Cerebellar metastasis as first metastasis from papillary thyroid carcinoma

Brain metastasis is an uncommon complication of differentiated thyroid carcinoma. Even more, cerebellar metastases from papillary thyroid carcinoma (PTC) are exceptional. We report a 69-year-old male patient with infiltrative PTC who developed high levels of thyroglobulin (Tg) and deteriorated neurological symptoms four years after the initial diagnosis. Computerized tomography (CT) of the brain demonstrated a cerebellar mass and the patient underwent surgery. Pathology revealed metastasis from PTC. Immunochemistry was positive for Tg. The patient had no other sites of distant metastases. Although PTC has generally a good prognosis, metastases to the cerebellum can occur, even as the first metastatic site, despite the fact that appropriate therapy (surgery, radioactive iodine therapy, TSH suppression therapy, chemotherapy and external radiotherapy) had been given for the primary tumour.