Malignant mesothelioma presenting as stroke--a case report

A case of a 64-year-old man with metastatic malignant mesothelioma is described in detail. When he presented to us he gave a history suggestive of transient ischaemic attack (TIA) 2 weeks before and 3 days after admission he developed weakness of the left upper limb. Computed tomographic scan of the brain revealed a solitary metastasis in the right cerebrum. A few days later, he developed subcutaneous metastasis in the chin. Malignant mesothelioma is considered to metastasize rarely and to spread locally. We suggest that distant metastasis in malignant mesothelioma is not uncommon and may be considered to behave like other forms of lung cancer. Treatment modalities should be studied in such patients.     

A case of adrenal metastasis of lung cancer treated by carboplatin and docetaxel]

A 42-year-old male was referred to our hospital in October 1998, suffering from severe cough accompanied by repeated hemosputa. Serum NSE slightly increased and cytology of sputum indicated class V. Chest X-P and CT revealed a large tumor in the right upper lobe and hilar lymphadenopathy. Abdominal CT revealed bilateral adrenal tumors. For continuous bloody sputum, a right upper lobectomy and lymphadenectomy were performed and the pathologic diagnosis was large cell carcinoma. After surgery, we chose radiation and chemotherapy. The new chemotherapeutic agent docetaxel (60 mg/m2 in combination with carboplatin (CBDCA: AUC 6,800 mg/m2) was administered, resulting in the remarkable reduction in the size of adrenal metastasis by 50% after 3 courses of chemotherapy. Furthermore, 12 months later, the right adrenal metastasis was remarkably reduced (5 x 3 cm-> 0.5 x 1.0 cm), and the left adrenal metastasis had disappeared on abdominal CT. These findings may suggest the efficacy of newly developed docetaxel in cases of non-small cell lung cancer.     

Association of breast cancer with meningioma: report of a case and review of the literature.

We report a case of meningioma subsequently developed in a patient with primary breast carcinoma. A 53-year-old woman received a left modified radical mastectomy because of stage IIA breast carcinoma. Histologically, the tumor was a predominantly intraductal carcinoma with negative lymph node metastasis. Estrogen receptor (ER) was negative but progesterone receptor (PR) of the left tumor was positive by immunohistochemistry. Four years later, cranial bone and/or brain metastasis was suspected from a routine follow-up bone scintigram. The patient showed no symptoms or signs at that time. Magnetic resonance imaging (MRI) and angiography revealed that the right parasagittal mass was suspicious of meningioma. A complete tumor removal was performed. On histological examination, this brain tumor was a transitional-type meningioma (meningotheliomatous and fibrous type) without malignant findings. ER was negative but PR was positive also in this tumor. She is currently well 6 years after the initial surgery. A review of the literature is presented with emphasis on the association between breast cancer and meningioma, which indicates a possible hormonal relationship. The knowledge of this association is important in the differential diagnosis of patients with breast cancer who develop central nervous manifestations.     

Asymptomatic cerebellopontine angle and lateral ventricle metastases from renal cell carcinoma: case report and literature review

Tumors rarely metastasize to the cerebellopontine angle. We report the first instance of simultaneous metastasis of renal cell carcinoma to the cerebellopontine angle and the lateral ventricle. A 51-year-old man presented with anemia and fatigue owing to stomach metastases from renal cell carcinoma 8 years after undergoing partial left nephrectomy for grade II clear cell renal carcinoma and radical right nephrectomy for grade III clear cell renal carcinoma. He also suffered metastases to the lung, both adrenal glands, the L-3 vertebra, and the brain (asymptomatic, but revealed by magnetic resonance imaging): a 1-cm (maximum diameter) mass in the left medullary cistern and a 2-cm (maximum diameter) mass in the right lateral ventricle trigone. Both brain lesions were treated with stereotactic radiosurgery, followed by gross-total resection of the right trigonal mass 7 months later. Both tumors shrank significantly, but the patient died from progressive systemic cancer 1 year after diagnosis of brain metastasis.     

Two cases with long-term disease-free survival after resection and radiotherapy for solitary brain metastasis from breast cancer with extensive nodal metastases

Two rare cases, each with a solitary brain metastasis from breast cancer with extensive nodal metastases as the first site of distant metastasis, were locally treated with surgery and irradiation. The outcome of the two treated cases indicated an excellent and non-recurrent post-therapeutic survival period of more than 3 and 8 years, respectively. In a 50-year-old woman (Case 1), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with doxorubicin and tegafur-uracil (UFT) and hormonal therapy with tamoxifen for left breast cancer. The brain metastasis was treated twice surgically followed by radiotherapy. One year and 6 months later, local recurrence of the brain metastasis appeared and was treated surgically again. No other treatment was done thereafter. Since then, no other distant or lymph node metastasis occurred, and to date her outcome has been non-eventful for 8 years and 5 months. In a 63-year-old woman (Case 2), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with cyclophosphamide, epirubicin and fluorouracil (CEF) for right breast cancer. The brain metastasis was treated locally with surgery and irradiation of 50 Gy. She thereafter received no further treatments. Since then neither distant metastases nor local recurrence have developed, and to date the post-treatment outcome has been uneventful for 37 months. Our findings suggest that patients who developed a solitary brain metastasis as the first site of distant metastasis from breast cancer have a chance of achieving long-term disease-free survival when treated with aggressive local therapy, even in the presence of extensive lymph node metastases at the primary surgery site for breast cancer.     

Clinical benefit of bronchial arterial infusion chemotherapy to pulmonary metastasis from colorectal cancer--report of two cases

Case 1: A 60-year-old woman with sigmoid colon cancer and multiple lung metastases developed dyspnea 34 months after sigmoidectomy and following systemic chemotherapy. Chest X-ray revealed left atelectasis and obstruction of the left main bronchus by lung metastasis, and stenosis of the right main bronchus was also suspected. Bronchial arterial infusion of CDDP, 5-FU and MMC relieved the atelectasis and dyspnea. The left bronchus remained patent for 12 months. Case 2: A 70-year-old man who had a pulmonary recurrence of rectal cancer suffered from hemoptysis and dyspnea, which had improved with systemic chemotherapy but then become exacerbated again. Bronchoscopic examination revealed intraluminal bleeding from a metastatic tumor. The symptoms were relieved after bronchial arterial infusion of CDDP, 5-FU and MMC. The diameter of the treated tumor was reduced by 15%. Hemoptysis was negligible until he died 8 months later. Bronchial arterial infusion chemotherapy for pulmonary metastasis from colorectal cancer is clinically beneficial, especially for patients with life-threatening respiratory symptoms like airway obstruction or intraluminal bleeding.     

A resected case of thoracic esophageal cancer in which pCR was obtained using low-dose of nedaplatin (CDGP)/5-FU and radiotherapy

This is a report of a case with esophageal cancer in which pathological CR was obtained by neoadjvant chemoradiotherapy using a low-dose of nedaplatin (CDGP)/5-FU. The patient was a male aged 76. A protuberant lesion diagnosed as esophageal cancer was found in the middle thoracic esophagus by esophagography. Since another lesion in the upper thoracic esophagus was revealed by endoscopy, metastasis to the cervical lymph nodes was diagnosed by ultrasonography, and preoperative chemoradiotherapy combining a low dose of CDGP/5-FU with radiotherapy was performed. As side effects of this treatment, grade 2 stomatitis and granulocytopenia were observed. The main lesion of the esophagus was found to have significantly diminished through endoscopy after completion of the treatment, and with no malignant cells obtained by biopsy. No cervical lymph nodes were found. It was diagnosed as partial response (PR) through imaging diagnosis. Radical resection of esophageal cancer under right thoracotomy and laparotomy was performed. Operative findings were Ch x R-T3N0M0 Stage II R0 D2 Cur A. Pathological examination of resected specimens revealed no viable cancer cells in the esophagus or metastasis to the dissected lymph nodes. Neoadjuvant chemoradiotherapy using a low-dose of CDGP/5-FU is an effective treatment for esophageal cancer.     

A case of superficial esophageal cancer with metastasis to the gastric wall

A 65-year-old man with superficial esophageal cancer associated with gastric wall metastasis is presented. He had suffered from epigastralgia and dysphagia for two months. X-Ray and endoscopic examination revealed esophageal erosion at the right wall of the lower esophagus and a large gastric submucosal tumor at the lesser curvature of the upper and middle stomach. Resection of the lower esophagus and total gastrectomy were performed. Histologically, the erosion of the lower esophagus was moderately differentiated squamous cell carcinoma invading as deep as the submucosal tissue and the tumor of the stomach was metastasis of the esophageal cancer. Intramural metastasis of esophageal cancer was discussed.     

Esophageal cancer developing 13 years after radiotherapy of lung cancer

This paper reports on an autopsied case manifesting an esophageal cancer that had developed 13 years after radiotherapy for lung cancer. The patient was a 61-year-old man. He was found to have a squamous cell carcinoma of the right lower bronchus with a swelling of the mediastinal and left supraclavicular lymph nodes in July of 1973. He received 60 Gy of irradiation in the right lung, the mediastinum, and the left supraclavicular region. Later, after doing well until August of 1986, a squamous cell carcinoma of the esophagus was found at the upper intrathoracic site. Thus, he also received additional radiotherapy but died of pneumonia after this local recurrence 7 months later. At autopsy, no local recurrence of the primary lung cancer was found. The site of esophageal cancer was far from that of the primary lung cancer though it was included in the previous treatment ports. This suggests the possibility that the primary esophageal cancer had been induced by therapeutic irradiation. So far as we know, this is the first report of esophageal cancer that may have developed after irradiation for lung cancer.     

Surgical resection of a cerebral metastasis from cervical cancer: case report and review of the literature

AIMS AND BACKGROUND: Central nervous system metastasis from cervical carcinoma is uncommon. CASE REPORT: We report the case of a 51-year-old woman who developed a solitary cerebral metastasis 29 months after radical hysterectomy with pelvic lymphadenectomy for a stage IB, grade III cervical cancer. The patient suddenly complained of headache, confusion and dizziness; she was submitted to emergency surgical resection of a 2 x 3 cm metastasis in the right frontal lobe. The postoperative course was uneventful and she completely recovered from her neurological deficit. Following surgery the patient underwent careful restaging. Massive bilateral involvement of the pelvic wall was diagnosed, and the patient received three courses of cisplatin-based chemotherapy. She developed liver and lung metastases and died 10 months later of progressive disseminated disease, without, however, any sign of recurrent or persistent cerebral involvement. CONCLUSION: Neurosurgical resection should be considered in cervical cancer patients with solitary brain metastasis in the absence of systemic disease.     

Metastasis to the iris in squamous cell lung cancer

A 72-year-old Japanese woman, suffering from squamous cell lung cancer with brain metastasis, underwent 2 courses of combination chemotherapy, consisting of cisplatin and vindesine. Although both the primary tumor and the brain metastasis regressed markedly, she developed left ocular pain with blurred vision. An abnormal mass was found in the left iris, and cytologic examination of the aqueous aspirate revealed a few malignant cells, which, when examined by electron microscopy, were considered to be derived from squamous cell carcinoma of the lung.     

胸中段食管癌胸腹二野淋巴结清扫及其转移规律的临床研究

目的:探讨胸中段食管癌胸腹二野淋巴结转移规律及其清扫方法,指导临床淋巴结清扫的范围。方法:对95例胸中段食管癌采用右胸及上腹正中两切口术式为基础进行胸腹二野淋巴结清扫,并对淋巴结转移规律进行分析。结果:95例胸中段食管患者淋巴结转移度为20.4% ,肿瘤浸润深度和分化程度对淋巴结转移率的影响具有统计学意义。胸中段食管癌既有向上到右颈气管旁、双侧喉返神经链旁、食管旁、癌肿旁、隆突下淋巴结转移,也有向下至贲门旁、胃左动脉旁、胃小弯网膜等处淋巴结转移,呈现双向转移趋势。结论:胸中段食管癌患者淋巴结转移与肿瘤浸润深度及分化程度明显相关。具有胸腹二野淋巴结转移的倾向,右颈气管旁及双侧喉返神经链是淋巴结转移重要区域,右胸及上腹两切口术式更方便胸中段食管癌切除和胸腹二野淋巴结的清扫,并且以此为基础经右胸顶对右颈气管旁及双侧喉返神经链淋巴结清扫也是安全可行的。      

Testicular Metastasis of Prostate Cancer: A Case Report

The incidence of secondary neoplasms of the testis during autopsies is approximately 2.5%. Although most secondary testicular metastases are due to prostate cancer, only a few patients with prostate cancer have clinically manifested testicular metastasis. We report the case of a prostate cancer patient with testicular metastasis who was diagnosed after the presence of a palpable mass in the right testis. A 56-year-old Japanese male presented to our hospital with an elevated serum prostate-specific antigen (PSA) level of 137 ng/ml. He was diagnosed with stage IV (T3N1M1b) prostate cancer and received androgen deprivation therapy, followed by various hormonal manipulations. His serum PSA level was undetectable for 1 year. No distant metastases were detected during imaging examinations. He received radiation therapy; however, his serum PSA level increased gradually. Four months later, he presented with right testicular swelling. Computed tomography revealed a heterogenous mass in the right testis and a right high inguinal orchiectomy was performed. Histopathological analysis showed that the right testis was infiltrated with metastatic adenocarcinoma with a Gleason score of 8. This is a rare case of right testicular metastasis in a patient with prostate cancer. Testicular metastasis of prostate cancer can be aggressive and metastasize.Key Words: Prostate cancer, Testicular metastasis, Orchiectomy     

Heart metastasis of gallbladder cancer--a case report

A 42-year-old man with gall bladder cancer was given a pancreatoduodenectomy. Chest-roentgenograms revealed a prominence of the left cardiac silhouette 6 months after operation. Two months later, the patient developed exertional dyspnea and chest pain. A diagnosis of heart metastasis of gall bladder cancer was established by aspiration cytology. Intravenous administration of 5-FU and cis-DDDP proved ineffective in controlling the disease. The patient died 14 months after operation. An autopsy revealed metastasis to the left ventricle of the heart. This is the 6th such case of gallbladder cancer in the literature.     

Local therapy for stage IV advanced breast cancer with brain metastasis]

A 55-year-old female patient was diagnosed with right breast cancer with brain metastasis of 3 cm in size. Neurological examination revealed paralysis in the left upper and lower extremities. Chemotherapy and hormone therapy were performed. Brachytherapy by Cyberknife was performed for the brain metastatic lesion. As a result, the brain metastatic lesion decreased in size to 1 cm on the CT-scan after 2 months. The paralysis disappeared and the patient's QOL improved. Cyberknife therapy was useful for a brain metastatic lesion that harmed the patient's QOL.     

A case of complete remission of lymph nodes metastasis from esophageal cancer with combination treatment of UFT and radiation]

A 65 year old female patient, who had developed left atelectasis because of mediastinal lymph nodes metastasis after esophageal resection for esophageal cancer, underwent the combination treatment with UFT (300 mg/day) and radiation (1.5 Gy/day, total dosage: 70.2 Gy). The symptoms soon subsided, and mediastinal CT and bronchoscopy revealed a complete disappearance of metastatic lymph nodes after one month. During one year of CR she enjoyed her daily life, however the relapse occurred. It is suggested that the combination treatment is an effective and safe way even in a patient who went through a lot of invasive surgeries.     

Gastric cancer recognized by metastasis to the ureter

Although ureteral obstruction is rarely noted in patients with gastric cancer at an advanced stage or at autopsy, the condition caused by authentic ureteral metastasis of gastric cancer is extremely rare. We experienced a case of gastric cancer in a 51-year-old woman who showed bilateral ureteral metastasis. The patient initially complained of right flank pain, caused by right ureteral obstruction, and was referred to our hospital, where she underwent a right nephroureterectomy, with suspicion of primary ureteral neoplasm. Histopathological examination of the resected specimen showed that metastatic growth of adenocarcinoma in the ureteral wall had caused the obstruction, and the subsequent extensive search for the primary lesion revealed asymptomatic gastric cancer. Soon after the nephroureterectomy, the patient developed left hydronephrosis, possibly caused by left ureteral metastasis, and a left percutaneous nephrostomy was performed. She then received chemotherapeutic reagents. However, she finally developed peritoneal carcinomatosis, and died of the disease about 1 year after the onset of the disease. In this report, we also review true ureteral metastasis from the stomach, and discuss the clinicopathologic features. Received: March 28, 2000 / Accepted: May 19, 2000     

Pathologic complete response of thoracic esophageal cancer developing after gastrectomy to neoadjuvant low-dose nedaplatin (CDGP), 5-fluorouracil and radiotherapy

We treated a 69-year-old man who had developed esophageal cancer following gastrectomy. Pathologic complete response (pCR) was obtained by neoadjvant chemoradiotherapy using low-dose nedaplatin (CDGP) and 5-fluorouracil. The cancer located in the middle of the thoracic esophagus, had invaded the trachea and metastasized to cervical lymph nodes according to computed tomography. Preoperative chemoradiotherapy combining a low-dose of CDGP with 5-FU was administered together with radiotherapy. Adverse effects included grade 2 stomatitis and leukocytopenia. The esophageal cancer was found by endoscopy to have diminished significantly after completion of neoadjuvant therapy, An endoscopic biopsy specimen was found to contain no malignant cells. The tumor also was smaller by CT, where cervical lymph nodes no longer showed involvement. Partial response was diagnosed based on imaging, and radical resection of the esophageal cancer was performed via right thoracotomy and laparotomy. Operative staging findings indicated Ch x R-T 3 N 0 M 0, Stage II R 0 D 2 Cur A. Pedicled jejunum was used to reconstruct the esophagus through a mediastinal route. Pathologic examination of resected specimens disclosed no viable cancer cells in the esophagus or metastasis to dissected lymph nodes. Neoadjuvant chemoradiotherapy using low-dose CDGP/5-FU is an effective treatment for esophageal cancer.     

Brain metastasis of a papillary renal cell carcinoma, identified as type 2

Papillary renal cell carcinomas (PRCCs) tend to metastasize to lymph nodes, while metastasis to the brain is extremely rare. We report the case of a man who had a brain metastasis of PRCC type 2. He was brought to our hospital due to the sudden onset of convulsions. Diagnostic imaging studies showed a metastatic brain tumor in the left parietal lobe, and a primary renal tumor in the right kidney, with paraaortal lymph node metastases. An excision of brain tumor was performed. The brain tumor had a papillary structure with eosinophilic cytoplasm. Five weeks later nephrectomy was carried out. Histological analysis of the nephrectomy specimen revealed the same papillary structure, which was compatible with PRCC type 2.     

Unusual sites of colorectal cancer metastasis

We present 2 separate cases of adenocarcinoma of the colon with metastasis to the chin and the bladder, both of which are unusual sites of colorectal cancer metastasis. Patient 1 is a 77-year-old man who was diagnosed with adenocarcinoma of the colon, American Joint Committee on Cancer (AJCC) T4 N0 M0 (stage II), and underwent a right hemicolectomy. Fourteen months later he developed a firm 2.5-cm mass involving the chin. Excisional biopsy revealed moderately differentiated adenocarcinoma, consistent with the known colon primary tumor. Patient 2 is a 75-year-old man who was diagnosed with AJCC T3 N1 M0 (stage III) adenocarcinoma of the colon and underwent sigmoid colectomy. Ten years later, he was found to have transitional cell carcinoma involving retroperitoneal nodes with no identifiable bladder or ureteral primary, for which he received chemotherapy. Eighteen months following this diagnosis, he developed hematuria and was found to have metastatic colon adenocarcinoma involving the bladder. Details of both patient cases are presented here.