Long-term survivors of small cell carcinoma of the lung

Small cell carcinoma of the lung has been shown to be exquisitely responsive to chemotherapy. Unfortunately, these responses are often short in duration and long-term disease-free survival is infrequent. This review of the records of all patients with small cell carcinoma of the lung treated on protocol at The Johns Hopkins Oncology Center from 1973 to 1982 showed that 25 of 225 (11.1 percent) survived two years or longer. Patients with limited disease (20 of 94) and patients with a complete response (15 of 72) had greater two-year survival than those with extensive disease (five of 131) or partial remission (eight of 104). However, 18 of the 25 long-term survivors eventually had relapses, and relapse occurred as late as eight years after diagnosis. This study further emphasizes the impressive discrepancy between the rate and magnitude of the initial response and ultimate survival in patients with small cell carcinoma of the lung.     

A case of pulmonary tuberculosis in a long-term survivor with small cell carcinoma of the lung

A 64-year-old woman complained of chest pain, back pain and dry cough. Chest X-ray film showed marked left hilar enlargement and left pleural effusion. Biopsy of the bronchial mucosa and demonstrated small cell carcinoma of the lung. Treatment with cisplatin, adriamycin and etoposide led to regression of symptoms and chest X-ray findings within 3 months. She received maintenance chemotherapies at the outpatient clinic for 2 years after the first therapy. Thirty-months after the first admission, chest X-ray film showed multiple small nodules in the left upper lobe. Chest tomography and high-resolution computed tomography showed acinar or lobular nodules disseminated in the left upper lobe. Mycobacterium tuberculosis was obtained from bronchoalveolar lavage fluid of the left upper lobe. Pulmonary tuberculosis in a long-term survivor of small cell carcinoma of the lung is very rare.     

Long-term survivors after the resection of limited esophageal small cell carcinoma

Patients with small cell carcinoma of the esophagus have a poor prognosis and have generally been treated by chemotherapy. However, all reported cases were at advanced stages. We need to establish an adequate treatment for patients with small cell carcinoma of the esophagus with invasion limited to the submucosal layer. In this paper, five cases of small cell carcinomas, which accounted for 2.8% of 180 surgically treated esophageal carcinomas, were reviewed for pathological findings, treatment, and outcome. Among three patients who had a small cell carcinoma of the esophagus with invasion limited to the submucosal layer, two patients survived for 7 and 9 years after surgery with no evidence of the disease. One of them was treated using surgery alone. Consequently, surgery may be considered as a possible choice of treatment for small cell carcinoma of the esophagus with invasion limited to the submucosa.     

A case of gastric metastasis from small cell lung carcinoma]

Gastric metastasis of lung carcinoma is a rare entity which is detected mostly at autopsy. Patients diagnosed as having those on lifetime are extremely rare. In addition to our case, 54 cases of lung carcinoma metastasis to the gastro-intestinal tract have been reported in the literature since 1961. We report a case of gastric metastasis originated from small cell lung carcinoma. The patient was a 87-year-old man. He refused lung biopsy and further treatment and died 2 months after the diagnosis. This is the case of gastric metastasis originated from lung carcinoma, which was confirmed by immunohistochemical staining.     

An autopsy case of primary small cell gastric carcinoma and adenocarcinoma

A 62-year-old man was emergently admitted to our hospital because of disturbance of consciousness. Computed tomography of the chest and abdomen showed pleural effusion, ascites, and generalized lymphadenopathy. Upper gastrointestinal endoscopy revealed bleeding from an irregular ulcerative lesion in the lesser curvature of the middle portion of the gastric body, and exhibited the morphology of Borrman type 4 gastric cancer. The patient died on the seventh hospital day. At autopsy, a diagnosis of primary small cell gastric carcinoma associated with adenocarcinoma was made. Primary small cell gastric carcinoma and its coexistence with adenocarcinoma, as in this case, is rare.     

Long-term survivor without recurrence after resection of simultaneous solitary pancreatic metastasis from thyroid medullary carcinoma

A 43-year-old Japanese man had an increasing level of serum CEA pointed out by annual physical check-ups. No abnormal findings were detected in the lungs or gastrointestinal tract. The only pathological lesions were a 1.5-cm-sized nodule in the pancreatic tail and a 5-cm-sized thyroid tumor. The thyroid tumor was shown to be medullary carcinoma by aspiration cytology. He underwent total thyroidectomy with extensive lymph node dissection. After thyroid surgery, the patient received distal pancreatectomy 2 weeks later. Pathological examination revealed the pancreatic tumor to be a metastasis of thyroid medullary carcinoma. The patient is alive and well without recurrence 5 years after thyroidectomy and pancreatectomy. The serum levels of CEA and calcitonin remain within normal limits. Thus, the patient seems to have had a solitary metastatic tumor from thyroid medullary cancer.     

Primary advanced gastric small cell carcinoma: a case report and review of the literature

We report a 73-yr-old man with primary advanced gastric small cell carcinoma, pure type. A large, Borrman type I tumor was located from the cardia to the entire gastric fundus and upper body. Atypical cells showed a round nucleus, small nucleolus, dense to granular chromatin, and scant cytoplasm. The histological findings indicates an advanced stage and exposure to the gastric serosa. Mitotic figures were observed. There was a proliferation of a sheet-like, solid pattern, but no rosette-like, sqamoid, or glandular patterns. The neoplastic cells were positive for Leu-7 (CD57) and 123C3 (CD56, neural cell adhesion molecule, NCAM) on the surface membrane. We diagnosed this case as primary advanced gastric small cell carcinoma, pure type, and report that Leu-7 and 123C3 monoclonal antibodies are useful markers for gastric small cell carcinoma. The 32 previously reported cases of gastric small cell carcinoma are also reviewed.     

A case of primary gastric small cell carcinoma with a rare pattern of lymph node metastasis

We report a very rare case of primary gastric small cell carcinoma (GSCC) that was accompanied with gastric tubular adenocarcinoma. A male in his 60s had an elevated tumor with a central ulceration in the middle stomach. The patient underwent a distal gastrectomy with lymph node dissection. The pathological examination showed two separated lesions of the stomach, which contained the components of primary GSCC and primary gastric tubular adenocarcinoma. Immunohistochemical (IHC) examination demonstrated that the tumor cells in the small cell carcinoma stained positive for synaptophysin, chromogranin A, and neural cell adhesion molecule (NCAM). GSCC cells and adenocarcinoma cells independently metastasized to each regional lymph node. Further studies on the biological behavior of individual tumors may allow the development of new treatment strategies for GSCC.     

Long-term survivor of anorectal melanoma: report of a case

Anorectal melanoma is a rare malignant tumor with approximately 500 cases reported in the literature and has dismal long-term survival prospects. Its poor prognosis is attributable to a delay in diagnosis and its inherent biologic aggressiveness, with many patients presenting with metastatic disease. Endoluminal ultrasound is an established mode of evaluation. The mainstay of treatment is usually surgical with curative or palliative intent. The choice of abdominoperineal resection wide local excision of the tumor is controversial. This is an interesting report of a 76-year-old female who presented with an anal mass, eventually underwent a wide local excision of the lesion, which pathologically proved to be malignant melanoma, and was doing well without any evidence of disease ten years after surgery. This is the only known case in the literature of a lesion of this thickness to be "cured" by wide local excision.     

Tonsillar metastasis of small cell lung carcinoma

Metastasis to palatine tonsils are rare, accounting from only 0.8% of all tonsillar tumors, so far only 100 cases reported in the English literature. Only a few cases have been reported for small cell and non‐small cell lung cancer as a primary site. With a diagnosis of small cell lung cancer, a 68‐year‐old male patient relapsed after six cycles of chemotherapy in tonsilla palatina and cervical lymph nodes. Patients died 26 months after being diagnosed with lung cancer and 2 months after detection of tonsil metastasis. We present the current case report because of the rarity of metastasis to tonsil in lung cancer.     

Primary small cell carcinoma of the ureter

Primary small cell carcinoma of the ureter is a rare clinico-pathological entity. We present a report of primary ureteric small cell carcinoma and pathological correlates.     

Primary small cell carcinoma of the stomach

We report on an 80-year-old man with primary gastric small cell carcinoma (SmCC). He was admitted to hospital with hematemesis. An upper gastrointestinal examination revealed an irregularly ulcerated tumor, 60 mm in diameter, on the lesser curvature of the stomach body extending to the cardia. An endoscopic biopsy revealed a solid proliferation of intermediate-sized tumor cells with hyperchromatic nuclei and scanty cytoplasm. Immunohistochemically, the neoplastic cells were positive for neuron-specific enolase and chromogranin A, but negative for carcinoembryonic antigen. No tumor was detected on examination of the chest. Therefore, primary gastric SmCC was diagnosed preoperatively. To date, only 38 cases of primary gastric SmCC, including our case, have been reported. By using endoscopic biopsy, approximately two-thirds of cases have been diagnosed incorrectly. In the reported cases of gastric SmCC, the endoscopic findings frequently indicated a submucosal tumor. Gastric SmCC is clinically aggressive and has an extremely poor prognosis, even when discovered at an early stage. Most patients with gastric SmCC die within 1 year of diagnosis. Although a standard treatment for gastric SmCC has not been established, intensive chemotherapy should be considered to promote long-term survival. We believe that careful examination, including immunohistochemical investigation, is necessary for determining the therapeutic strategy whenever gastric SmCC is suspected during endoscopy.     

Calcified small cell carcinoma of the lung

Calcification within pulmonary lesions usually signifies a benign entity, but depending on the specific pattern of calcification it can also represent malignancy. The authors report a case of calcified small cell lung cancer in a patient with end-stage renal disease. The calcification was unrelated to renal failure and not the result of metastatic calcification, and the pattern of calcification and tissue pathology excluded other causes of calcification within this mediastinal mass.     

A case of endocrine cell carcinoma (small cell carcinoma) of duodenum]

Extra-ampullary duodenal endocrine cell carcinoma is extremely rare. A 65-year-old woman visited our hospital, complaining of epigastralgia, anorexia and vomiting. She was admitted for suspected duodenal or pancreas head tumor by abdominal CT. Fiberscopic examination revealed a circumferential tumor in the extra-ampullary duodenal second portion. Histopathological findings of biopsy specimen showed a small cell carcinoma, and positive immunohistochemical staining for synaptophysin revealed this tumor to be endocrine cell carcinoma. Pylorus-preserving pancreaticoduodenectomy with partial transversocolectomy was performed, and intraoperative washing cytology detected tumor cells in the peritoneal cavity. Although she discharged from hospital uneventfully, she died 11 months later of multiple liver metastases and peritoneal dissemination. This case showed the high malignant potential of this tumor.     

Gastric metastasis by lung small cell carcinoma

Metastatic tumors of the gastrointestinal tract are rare. We describe a case of gastric metastasis due to primary lung cancer, revealed by an upper gastrointestinal endoscopy (UGIE). Haematogenous metastases to the stomach are a rare event. To our knowledge, only 55 cases have been described in the international literature. In these patients, the prognosis is very poor. We report herein a case of gastric metastasis by lung small cell carcinoma, with a review of the literature about this rare entity.     

Telomerase activity in small cell esophageal carcinoma

Small cell carcinoma of the esophagus is a rare and aggressive malignant tumor. Telomerase activation is common in human cancers. There is a lack of data on telomerase activity in esophageal small cell cancers. The present report studied the role of telomerase activity in esophageal small cell carcinoma. The clinicopathologic data of five patients with small cell carcinoma of the esophagus who underwent primary surgical treatment between 1991 and 2000 were studied. Telomeric repeat amplification protocol assays were used to investigate telomerase activity in these tumors. The proliferative activity (MIB-1) and p53 expression of these tumors were also studied using immunohistochemistry and correlated with the telomerase activity. All five small cell carcinomas showed detectable telomerase activity in the primary tumor. Two out of the five morphologically normal esophageal mucosae adjacent to the primary tumor had detectable telomerase activity. There was no correlation between the p53 expression, tumor stage, survival of patients, and the presence of telomerase activity. High MIB-1 expression in esophageal small cell carcinomas was associated with high telomerase activity. Telomerase activation is common in small cell carcinoma of the esophagus. This fact may find application in anti-telomerase treatment for this aggressive tumor.     

Hemophagocytosis by small cell lung carcinoma.

A 60-year-old woman with disseminated small cell carcinoma of the lung and hemophagocytosis by the metastatic cells in the bone marrow is presented. It is the first clinicopathologic report on phagocytosis of erythrocytes by lung tumor cells in concordance with a recently described evidence of a macrophage origin of small cell carcinoma of the lung.