Isolated endobronchial metastasis of Wilms' tumor

Isolated endobronchial metastasis from extrapulmonary solid organ was rarely reported in previous literature. We report an isolated endobronchial metastasis of Wilms' tumor in a 4-year-old boy. He underwent right nephrectomy on account of Wilms' tumor at the age of 3 years. We performed a wedge resection of a metastasis to the right lower lobe of the lung a year later, followed by chemotherapy and irradiation of the involved lung over a period of 30 weeks. One and a half years later, he developed obstructive pneumonitis of the left lung. Fiberoptic bronchoscopy identified a tumor at the left main bronchus with near total bronchial obstruction, compatible with findings on a computed tomographic scan. Rigid bronchoscopy was performed to core out the obstructing tumor. It was reported as a metastatic Wilms' tumor. Successful reexpansion of the left upper lobe was achieved and he was discharged uneventfully, followed by adjuvant chemotherapy.     

脊柱原发部位不明的转移癌（附52例报告）

报道５２例脊柱原发部位不明的转移癌，其中手术治疗为主３２例，化疗为主１２例，（１５３）Ｓｍ－ＥＤＴＭＰ内放射为主６例，放疗为主２例。经综合治疗后，１０例不全瘫痪者中，２例完全恢复，４例部分恢复，３例无恢复；４例完全瘫痪者无改变。４４例随访１～５年，１年存活率为２９．５％（１３例），３年存活率为９．１％（４例），５年内全部死亡，平均生存期为８．４个月。文章详细讨论了脊柱原发部位不明的转移癌的诊断标准、发病率、来源判断及治疗等问题。     

True malignant mixed tumor of parotid

Carcinosarcoma is a rare malignant neoplasm of salivary glands that manifests both carcinomatous and sarcomatous components. Specimen of a recurrent parotid tumor of a 55-year-old male was received for histopathology. Diagnosis of a biphasic malignant neoplasm was made. Morphology and immunohistochemical profile were consistent with carcinosarcoma i.e. true malignant mixed tumor.     

Isolated skeletal metastasis to the patella

Metastases to the patella are rarely described in the literature. A 51-year-old man with stage IIIB adenocarcinoma presented to our clinic. One year after radiation and chemotherapy treatment, it was found that he had a metastasis in the right patella. Six months after incisional biopsy with curettage of the patellar lesion and placement of methylmethacrylate bone cement into the remaining patellar defect, he has no pain and is ambulatory. This case has been presented as a basis for palliative surgery in a patient with a rare metastatic tumor of the patella.     

Isolated nasopharyngeal metastasis from hepatocellular carcinoma

INTRODUCTION

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, the incidence of which parallels that of areas with high prevalence of chronic hepatitis. HCC commonly metastasizes to the lungs, lymph nodes, adrenals and bones with the overall prognosis of metastatic HCC being dismal.

PRESENTATION OF CASE

We herein with present a case of a 70-year-old male who was referred to our institution with history of nasal obstruction and nasal bleeding which on further evaluation was diagnosed to have an isolated metastasis to nasopharynx from liver primary.

DISCUSSION

Extrahepatic metastasis in HCC occurs in about 30–50% of patients, the commonest site being the lung. Rare sites of extrahepatic metastasis from HCC to the ovaries, kidneys, skeletal and cardiac musculature and brain have been reported. Unusual sites of metastasis in the head and neck area like the mandible have also been documented. With the changing trends in the treatment modalities, these patients are often treated using target therapy.

CONCLUSION

This article presents an unusual isolated metastasis to nasopharynx from HCC in the absence of disseminated disease. This case report illustrates the distinctive pathological features of metastatic HCC.     

Isolated calcaneal metastasis from prostate cancer

We report the first case of an isolated calcaneal metastasis from prostate cancer. This case highlights the importance of considering metastatic disease in patients with persistent bone pain in the presence of known cancer, however unusual the site.     

Cervical node metastasis of occult origin

This study reviewed a 12 year experience with 132 patients who were treated for metastatic carcinoma of the cervical lymph nodes with no apparent primary tumor. Using radical neck dissection as the main treatment modality, a 5 year survival of 50 percent was achieved in 79 patients with epidermoid carcinoma. Survival varied significantly depending on the extent of the tumor in the neck. It was 74 percent in those with stage N₁ disease compared with 41 percent in patients with N₂ or N₃ disease. Recurrence in the neck, the major reason for treatment failure, can probably be reduced by more aggressive use of adjunctive radiotherapy. Primary tumors were identified after therapy in only 15 percent of these patients, and this appeared to have relatively little impact on the outcome. Irradiation and chemotherapy were the preferred treatment modalities in 29 patients with metastatic adenocarcinoma of occult origin. All but one patient died within 29 months. A 53 percent 5 year survival was achieved in 13 patients with anaplastic or undifferentiated carcinoma. Radical neck dissection was employed in 11 patients with melanoma. No primary tumor was ever identified in this group and only one patient remained alive and well after 5 years.     

Thalamocapsular metastasis of muco-epidermoid adenocarcinoma of the parotid gland]

A 58 years woman with muco-epidermitis carcinoma of the left parotid gland treated by parotidectomy and external radiation developed seven years later a left hemianopsia and moria related to thalamo-capsulo-lenticular lesions. Three stereotactic biopsies were performed. Neuropathological examination confirmed a secondary lesion of carcinoma with the same histological features than primary lesion of the parotid. Due to the metastasis location treatment consisted in external radiotherapy guided by stereotactic coordinates.     

Hepatoblastoma of the adult with pericardial metastasis: A case report

BackgroundHepatoblastoma is the most frequent liver tumor in children, but very rare in the adult and associated with an unfavorable prognosis. The diagnosis is always postoperative or post mortem and biopsy is not useful. Surgery is the only accepted treatment.Case presentationOur patient underwent surgery in the suspect of liver metastasis from a previous gastric cancer. Surgery consisted in left lobectomy with partial diaphragm resection and partial pericardiectomy for a pericardial lesion, found after the opening of the thorax. The diaphragm defect was corrected with a biological mesh.ResultsThe histopathological examination indicated hepatoblastoma of the adult with pericardial metastases. The patient was asymptomatic and without recurrence after 21 months of follow up.ConclusionThe hepatoblastoma of the adult is related to a poor prognosis with median survival time less than 5 months. Surgery is the only curative treatment, but in many cases tumor resection requires complex operations. Vascular and thoracic expertise could be useful in the management of hepatoblastoma.     

Isolated colon cancer metastasis to the spleen

Splenic metastases from colon carcinoma are rare. If present they generally occur in concert with disseminated disease. Six cases have been previously reported. The patient presented here is a 51-year-old black man who presented with an enterocutaneous fistula as a complication from prior pelvic radiation. Workup included an abdominal CT and needle biopsy, which confirmed the splenic metastasis from a sigmoid colon cancer 6 years after the original diagnosis. The patient had an unevenful splenectomy. Although no long-term follow-up data are as yet available splenectomy including removal of hilar lymph nodes appears to be the treatment of choice. A case report and review of the literature are presented.     

未知来源骨转移癌病人的诊断

[目的] 通过对不明来源骨转移癌病例的原发瘤进行规范诊断,并对诊断策略进行评估,为寻找骨转移癌原发肿瘤提供合理方案.[方法] 2003年6月～2006年12月共收治无既往恶性肿瘤病史,来源不明的骨转移癌125例.初诊时骨转移部位主要包括,脊柱57例,骶骨24例,骨盆16例,股骨15例,肱骨7例.通过常规体检、实验室检查、胸部平片和(或)CT,腹部和盆腔B超和(或)CT,以及病理活检等方法对原发肿瘤进行诊断.[结果]在70.4%的病例中发现了原发肿瘤,来源分布肺脏40%、肾脏8%、前列腺5.6%、肝脏4.8%、乳腺4%、甲状腺和胃各2.4%,其他3.2%.各种检查方法中,体检仅发现96%的原发病灶,43.2%的病例存在肿瘤特异抗原异常.60%的病例经影像学检查发现原发肿瘤.病理检查结果中能够明确或提示诊断的占66.4%.发现原发肿瘤病例的1年生存率58.57%;未发现原发肿瘤病例的1年生存率22.93%.[结论]无明确恶性肿瘤病史的骨转移癌病例经规范检查后大部分可以诊断原发肿瘤,接受适当治疗后生存时间得到延长.     

Experimental model for metastasis of cecal origin

The pre-selected tumor cells injection in the cecal wall of rat, seems to be a intermediate model between spontaneous evolution of a colon tumor and intrasplenic or direct intraportal injections. From rhabdomyosarcoma cells (RMS S4-MH-) which present the advantage to prudce up lymphatic, pulmonary and hepatic metastases after subcutaneously injection, first subcutaneously (S.C.), intrasplenic (I.S.) and intracecal sites were compared: In the I.C. model, tumor was obtained in 80% of case and the survival was nearly similar to S.C. model's one. The lymphatic metastases were more and more distal as the evolution and the liver metastases were rarely observed. The I.S. model increased quickly and there were always liver metastases; In the two cases, pulmonary metastases were rarely observed (0 and 2/5). With adenocarcinoma colonic cells (Pro b) I.C. injection in the rat, tumor were obtained in 48% of cases without peritoneal dissemination; lymphatic nodes metastases were observed in 80% of cases; liver metastases was obtained in one animal from metastasis pulmonary selection cell lines. The I.C. model allows to estimate the liver and lymphatic nodes part; improved, it would be used to test adjuvant therapies and immunoscintigraphy.