A Case of Adenomyoepithelioma of the Breast Showing Strong Uptake of 18F‐Fluorodeoxyglucose on a Positron Emission Tomography

An adenomyoepithelioma of the breast is a rare tumor characterized by biphasic proliferation of both epithelial and myoepithelial cells. This tumor is generally considered as a benign neoplasm, and there are few reports describing the imaging features of this tumor through ¹⁸F‐fluorodeoxyglucose positron emission tomography (FDG‐PET). Here, we report a case of an adenomyoepithelioma that showed strong uptake of FDG on PET similar to that observed with a malignant tumor. A 73‐year‐old woman presented to our hospital with a 3.5‐cm, mobile, and elastic hard tumor in the upper area of the left breast. Although the findings of mammography, ultrasonography, and contrast‐enhanced magnetic resonance imaging suggested that the tumor was malignant, it was diagnosed as an adenomyoepithelioma by core needle biopsy. An invasive ductal carcinoma, 0.5‐cm in size, was detected in the medial upper area of the ipsilateral breast during an examination. Although FDG‐PET demonstrated no lymph node or distant metastases from the invasive ductal carcinoma, strong uptake of FDG was detected in the adenomyoepithelioma. Breast conserving surgery and sentinel lymph node biopsy for the invasive ductal carcinoma together with resection of the adenomyoepithelioma was performed. A diagnosis of adenomyoepithelioma was confirmed through histologic examination of the resected specimen. This case indicates that some adenomyoepitheliomas may show a strong uptake of FDG on PET, which resembles a malignant tumor.     

甲状腺乳头状癌远处转移16例临床病理特征分析

目的探讨甲状腺乳头状癌合并远处转移患者的临床病理特点及预后。 方法收集2003年1月至2017年12月在中山大学附属第一医院住院诊治病例资料完整的16例甲状腺乳头状癌合并远处转移患者,回顾性分析其临床和病理特点及预后。 结果同步转移13例,其中2例老年患者死亡,中位数年龄为35岁。肿瘤的平均直径为（2.9±1.89）cm,转移部位多为肺转移,11例存在颈部淋巴结转移,占总数的68.75%。转移淋巴结的数量中位数达到9.75枚。转移淋巴结的平均最大直径为（2.5±1.50）cm。10例患者超声显示病灶为血供丰富。8例甲状腺球蛋白（TG）定量明显升高。 结论甲状腺乳头状癌远处转移可能是致命的。对于原发肿瘤直径较大并且较多肿大淋巴结、血供丰富、TG升高的患者要注意远处转移特别是肺转移的发生。     

Adenomyoepithelioma of the breast. A spectrum of biologic behavior.

Adenomyoepitheliomas of the breast have been considered to have limited metastatic potential; axillary node metastasis has been reported, but there has been no report of distant metastasis. We report six cases, including two malignant adenomyoepitheliomas, one of which metastasized to the lung and brain. Patient age ranged from 26 to 63 years (mean 46). Primary tumors were solitary and measured 0.9-3.5 cm (mean 1.7). Five of six tumors presented as palpable masses. Two patients treated by local resection have no evidence of disease at 5 and 18 months' follow-up. Two patients treated by local resection had recurrences, one at 48 the other at 60 months. The fifth patient had a spindle-cell type adenomyoepithelioma diagnosed as malignant because of high mitotic rate and cytologic atypicality of the myoepithelial component. This patient was treated by mastectomy and has no evidence of disease at 18 months. The sixth patient, initially treated by local excision, had six local recurrences over 52 months treated by reexcisions, mastectomies, and radiation. A lung metastasis was resected at 54 months and brain metastases were identified at 60 months with death occurring at 64 months. Both malignant adenomyoepitheliomas had high mitotic rates [11-14/10 high-power fields (HPF)] diffusely throughout the tumors and foci of cytologically malignant cells. The malignant adenomyoepithelioma that metastasized had an infiltrative growth pattern that increased with successive local recurrences. The four other tumors had only isolated areas of mitotic activity (maximum 1-9/10 HPF) and minimal cytologic atypia. Immunohistochemistry performed on five of six cases confirmed dual epithelial/myoepithelial cell populations in all tumors examined, including the metastasis. Electron microscopic examination of the malignant adenomyoepithelioma that metastasized also confirmed dual epithelial/myoepithelial cell populations in a local recurrence and the lung metastasis. We conclude that there is a spectrum of behavior for breast adenomyoepitheliomas with potential for local recurrence and, rarely, distant metastasis.     

Surgery as palliative treatment for distant metastases of melanoma.

Sixty-five patients with distant metastatic melanoma amenable to surgical treatment had excision of 94 metastatic lesions from the brain, lung, abdomen, distant subcutaneous sites, and distant lymph nodes. Relief of symptoms, if present, was obtained after excision of 77% of brain metastases, 100% of lung metastases, 88% of distant lymph node and subcutaneous metastases, and 100% of abdominal metastases. Median survival after excision of brain metastases was 8 months, lung metastases 9 months, abdominal metastases 8 months, and distant subcutaneous and lymph node metastases 15 months. Sixteen per cent of patients lived for 2 years of longer. These results demonstrated that surgery can achieve an effective local disease control in selected patients with distant melanoma metastases and that a few have a relatively long-term survival.     

Phyllodes tumors of the breast: A clinicopathological study of 118 cases

The clinical and pathological features of phyllodes tumors of the breast were evaluated through a study of 118 cases: 110 benign tumors, four borderline tumors, and four malignant tumors. Local excision was utilized in 105 patients (88%) and radical mastectomy was performed in 10 patients (8%) as the initial treatment. Estrogen receptor (ER) status was positive in seven (50%) of 14 cases and progesterone receptor (PgR) status was positive in nine (75%) of 12 cases. Local recurrence developed in eight patients, six of those having benign tumors, and two having malignant tumors, all of whom were treated by local excision. Of the four patients with malignant tumors, one died of lung and liver metastases 47 months after her first operation. We believe that excision with sufficient free margin may be the treatment of choice for most benign or borderline phyllodes tumors, whereas an Auchincloss modified radical mastectomy or a total glandectomy with lymph node dissection is recommended for patients with malignant tumors. However, a number of problems regarding the treatment of patients with distant metastasis remain yet to be addressed.     

Simultaneous Bilateral Spontaneous Pneumothorax Secondary to Metastatic Angiosarcoma of the Scalp: Report of a Case

Angiosarcoma is a highly malignant neoplasm, which most often develops on the scalp or face of elderly people. Common distant metastatic sites include the lung, liver, lymph nodes, and skin. We report a case of angiosarcoma manifesting as simultaneous bilateral spontaneous pneumothorax secondary to pulmonary metastases in an 86-year-old man. The pneumothorax preceded the diagnosis of angiosarcoma. Chest computed tomography showed multiple thin-walled cavitary metastatic pulmonary lesions, which increased in size as new lesions appeared over the clinical course of several months. This case suggests that a finding of simultaneous bilateral spontaneous pneumothorax may indicate a serious parenchymal lung disorder.     

99例周围型小肺癌的TNM分期分析及临床意义探讨

目的 通过对周围型小肺癌的TNM分期进行分析,以提高临床医师对恶性肺小结节的重视,并探讨小肺癌系统性淋巴结清扫的必要性.方法 回顾性分析2005年1月至2013年6月99例行肺叶切除术＋系统性淋巴结清扫术的周围型小肺癌患者的临床资料,肿瘤及所有淋巴结均获得病理证实,然后进行TNM分期,分析各组淋巴结的转移情况,肿瘤T分期、淋巴结大小与淋巴结转移的关系.结果 病理T分期：T1a期71例（71.72%）,T2a期28例（28.28%）.22例患者有淋巴结转移（22.22%）,其中N1 12例（12.12%）、N2 10例（10.10%）.TNM分期：Ia期58例（58.59%）,Ib期18例（18.18%）,≥Ⅱa期者23例（23.23%）.共清扫胸内淋巴结1226枚,平均每例12.38枚,126枚淋巴结存在癌转移（10.28%）.T2a期淋巴结转移率明显高于T1a期（P＜0.05）.淋巴结直径0.5～1.0cm的转移率高于直径＜0.5cm者,但差异无统计学意义（P＞0.05）.结论 周围型小肺癌并不完全是早期肺癌,约1/4患者为≥Ⅱ期的中、晚期肺癌.对小肺癌患者进行系统性淋巴结清除术非常必要,不能以术中未触及肿大淋巴结而排除淋巴结的清扫.     

乳腺癌患者术后远处转移及其不良结局的危险因素

目的探讨乳腺癌患者术后发生远处转移及其不良结局的危险因素。 方法回顾分析2012年1月至2015年10月期间行手术治疗后发生术后远处转移67例和未发生远处转移130例的女性乳腺癌患者病例资料,随访时间截止2020年10月。采用SPSS 22.0统计软件包分析数据,单因素生存分析采用K-M法,行Log-rank检验;Cox回归模型分析乳腺癌术后转移的多因素分析。 结果脉管状态、组织学分级、肿瘤大小、淋巴结阳性数及化疗方案和靶向治疗是影响乳腺癌术后远处转移的独立危险因素（P<0.05）。67例远处转移患者死亡48例,存活19例,中位生存时间为39个月。多因素分析显示,脉管状态、肿瘤大小、临床分期、组织学分级、转移数目、Her-2状态及化疗方案和靶向治疗是影响远处转移患者预后不良的独立危险因素（P<0.05）。 结论发生脉管癌栓、肿瘤直径越大、临床分期和组织学分级越高、多部位转移、Her-2阳性是影响远处转移患者预后的独立危险因素,术后蒽环类联合紫杉类化疗可以降低远处转移率,提高患者预后。     

Feasibility of Breast Preservation in the Treatment of Occult Primary Carcinoma Presenting With Axillary Metastases

Background: The objective of the study was to compare the treatment outcomes in patients with occult primary carcinoma with axillary lymph node metastasis who were treated with mastectomy or with intent to preserve the breast.Methods: From 1951 to 1998, 479 female patients were registered with axillary lymph node metastasis from an unknown primary. After clinical workup, including mammography, 45 patients retained this diagnosis and received treatment for T0 N1–2 M0 carcinoma of the breast. Clinical and pathological data were collected retrospectively, and survival was calculated from the date of initial diagnosis using the Kaplan-Meier method. Median follow-up time was 7 years.Results: Median age was 54 years (range, 32–79). Clinical nodal status was N1 in 71% and N2 in 29% of the patients. Surgical treatment was mastectomy in 29% and an intent to preserve the breast in 71% of the patients. Locoregional radiotherapy was used in 71% and systemic chemoendocrine therapy was used in 73% of the patients. Of the 13 mastectomy patients, only one had a primary tumor discovered in the specimen. Two patients (4%) were ultimately diagnosed with lung cancer and neuroendocrine tumor. No significant difference was detected between mastectomy and breast preservation in locoregional recurrence (15% versus 13%), distant metastases (31% versus 22%), or 5-year survival (75% vs. 79%). Regardless of surgical therapy, the most important determinant of survival was the number of positive nodes. Five-year overall survival was 87% with 1–3 positive nodes compared with 42% with 4 positive nodes (P < .0001).Conclusions: Occult primary carcinoma with axillary metastases can be treated with preservation of the breast without a negative impact on local control or survival.     

The Impact of Lymph Node Metastases on Survival in Extremity Soft Tissue Sarcomas

Background The impact of lymph node metastases on survival in extremity soft tissue sarcomas has been studied for a long time with controversial results. The purpose of this study was to compare survival of patients with initial lymph node metastases with those having lymph node or distant metastases or both after initial curative surgery. Methods Patients treated between 1995 and 2000 for extremity soft tissue sarcoma were retrospectively studied in four groups: those with metastatic regional lymph nodes at the time of diagnosis, those with only regional lymph node recurrences, those with only distant metastatic relapses, and those with both regional lymph node recurrences and distant metastatic relapses, all of the last three groups after initial curative surgery. The impact of timing of lymph node metastases on disease-free and overall survival was evaluated. Results A total of 110 patients (73 men) with a median age of 45 years were eligible for the study. Three-year disease-free survival was significantly longer in patients with initial regional lymph node metastases than in patients with only lymph node recurrences after curative surgery (p = 0.04) and patients with initial (p = 0.0002) and recurrent (p = 0.0004) regional lymph node metastases had longer disease-free survival than patients with distant metastases. Overall survival difference between patients with initial regional lymph node metastases and patients with only lymph node recurrences after curative surgery was significant at 5 years (p = 0.01). Conclusions It is logical to separate patients with initial lymph node metastases from those with distant metastases in staging and to treat patients with initial lymph node metastases with radical surgical interventions if complete tumor resection seems feasible.     

Basal cell carcinoma with lung metastasis

A forty-seven year-old man had a small ulceration on his left cheek. The ulcer had a repeated crust formation following removal, for ten years. The patient found a hard tumor in the deep site of the ulcer and the tumor was resected. The pathological diagnosis was basal cell carcinoma. The metastases to the regional lymph nodes developed one year later and these lymph nodes were resected. The histological picture was the same as seen in the primary tumor. Lung metastasis occurred three years later. The tumor was resected and the pathological diagnosis was basal cell carcinoma. Multiple lung metastases developed one year later and massive hemoptysis led to a sudden death two years after the thoracotomy. Thirty-seven cases of basal cell carcinoma with lung metastases were reported in the literature. This case is the thirty-eighth case and the third occurrence in a Japanese.     

Rupture of liver metastasis of malignant melanoma —A case of hepatic resection—

A case is reported in which resection of the left lateral segment of the liver was performed for rupture of a metastatic malignant melanoma in an attempt to control hemorrhaging. The primary lesion was located in the skin of the head, and there were multiple metastases to the lung, liver and distant nodes. The patient, a 47-year-old woman, had been undergoing systemic chemotherapy for the disseminated disease, but she presented with intraabdominal bleeding from a metastatic nodule in the left lateral segment of the liver. An emergency operation was performed, and the immediate postoperative course was uneventful. She was discharged 10 days after the operation. The patient died, however, of hemorrhagic shock due to renewed intraabdominal bleeding on the 39th postoperative day. It is concluded from the above case that hepatic resection for a bleeding metastasis of malignant melanoma is a viable option even in patients with disseminated disease.     

Metachronous common iliac lymph node metastasis after rectosigmoid colon cancer resection: A case report

Introduction and importanceMetastases to common iliac lymph nodes from cancer of the rectosigmoid are extremely rare. We report a patient with a right common iliac lymph node metastasis after rectosigmoid cancer resection.Case presentationThe patient is a 57-year-old woman diagnosed with rectosigmoid cancer (Stage IIIc) who underwent laparoscopic resection followed by 8 courses of adjuvant chemotherapy with capecitabine. Sixteen months after resection, an intra-abdominal mass and a left lung nodule were found on computed tomography scans, which were suspected to be recurrences. Exploratory laparoscopy showed that the abdominal lesion was an enlarged common iliac lymph node, which was completely excised. No other intraabdominal recurrences were found. Subsequently, a left upper lobe lung metastasis was resected thoracoscopically. However, multiple lung metastases developed four months after the lung resection, and systemic therapy was begun.Clinical discussionA lower incidence of lateral lymph node metastases from cancer in the rectosigmoid has been reported. Direct lymphatic pathways from the sigmoid colon or rectosigmoid to lateral lymph nodes have been suspected, which may be associated with the poor prognosis in this patient.ConclusionA metachronous metastasis to a common iliac lymph node from primary rectosigmoid cancer is reported. Common iliac lymph node metastases from rectosigmoid cancer might have more malignant potential, and should be treated in the same manner as peri-aortic lymph node metastases.     

Fluorescent labeled anti-EGFR antibody for identification of regional and distant metastasis in a preclinical xenograft model

BACKGROUND: Detection of regional and distant metastatic disease has significant implications for patient management. Fluorescent imaging may be a useful technique for metastasis detection and removal. METHODS: Anti-epidermal growth factor receptor antibody (cetuximab) and isotype-matched control antibody (immunoglobulin G [IgG]) were labeled with a near-infrared fluorophore (Cy5.5), then systemically administered to mice with tumors resulting from either intraoral or intravenous injections of head and neck squamous cell carcinoma. Mice were sacrificed before undergoing fluorescent stereomicroscopy to assess pulmonary or cervical lymph node metastasis. Fluorescent areas were serially excised until wound bed demonstrated negative fluorescence. RESULTS: Mice bearing pulmonary metastases displayed diffuse background after IgG-Cy5.5 injection, but demonstrated a speckled fluorescent pattern across lung surface following cetuximab-Cy5.5 injection. Mice bearing cervical metastases demonstrated clear fluorescence of primary tongue tumor and bilateral cervical nodes. Fluorescence correlated with histopathology. CONCLUSION: These data suggest that cetuximab-Cy5.5 may have clinical utility in the detection and guided the removal of regional and distant micrometastasis.     

Invasive micropapillary carcinoma of the ascending colon--a report of a case

Micropapillary carcinoma (MC) has been recently recognized to be a rare but distinctive variant of adenocarcinoma. At present, only a limited number of colorectal MC cases have been reported. We present a case of MC of the ascending colon with distant metastasis. A 61-year-old female patient was hospitalized with a complaint of abdominal pain. A diagnostic work-up revealed cancer of the ascending colon with multiple lung metastases. The patient underwent a right hemicolectomy with lymph node dissection. A peritoneal nodule was observed in the abdominal cavity during surgery, and this nodule was also resected. The pathologic findings of the colon tumor revealed components of conventional tubular adenocarcinoma and micropapillary carcinoma. Lymph nodes and a peritoneal nodule revealed tubular adenocarcinoma. MC is a rare disease but has high malignant potential. In the present case the tumor was small in size, but the patient had a peritoneal and multiple lung metastases.     

A rare and unusual case of bilateral, axillary, metachronous apocrine carcinoma

Apocrine carcinoma is a rare sweat gland neoplasm with very few cases reported in the published literature. We report a case of primary axillary apocrine carcinoma with later recurrences in both axillae. A 55-year-old man was clinically diagnosed with hydradenitis suppurativa in the right axilla, and after excision of lesion, histology showed metastatic adenocarcinoma of probable breast origin. However, no primary focus was found after extensive work-up except for metastatic lymph nodes in the ipsilateral axilla treated with axillary clearance. After 4 years, the patient developed metastatic lymph nodes in the contralateral axilla and had surgery. He had a further recurrence in the right axilla and was treated with surgery and radiotherapy. He continues to do well at this time, with no evidence of local or distant metastases.     

Mediastinal lymph node involvement as the initial manifestation of occult thyroid cancer in the surgical treatment of lung cancer: Report of a case

A 63-year-old man was referred to our institute for the treatment of squamous cell carcinoma of the upper lobe of his right lung. A right upper lobectomy of the lung was performed with a mediastinal lymph node dissection. The postoperative pathological examination of the dissected specimens revealed one of the superior mediastinal lymph nodes to be morbid with micrometastasis of occult thyroid cancer, while no node involvement was seen due to lung cancer. A right lobectomy of the thyroid gland with a modified radical neck dissection was done 4 years later after the confirmation of the absence of any recurrent sign of lung cancer. In the resected specimen, papillary thyroid microcarcinoma was observed with several intraglandular metastases and right regional lymph node involvement. Eight months later, a new primary lung cancer developed in the left lung, and a left upper lobectomy of the lung with a mediastinal lymph node dissection was performed. At that time, the absence of mediastinal lymph node metastasis from lung cancer or thyroid cancer was confirmed. Mediastinal lymph node involvement as the initial manifestation of occult thyroid cancer in surgical treatment for lung cancer is rare, but it is important to be aware of the possibility of incidentally detecting occult thyroid cancer in surgical dissections in this area for lung cancer. The appropriate surgical treatment should be determined while carefully considering the prognosis of the lung cancer as well as that of any coexisting malignancy.     

Re-evaluation of Axillary Skip Metastases in the Era of Sentinel Lymph Node Biopsy in Breast Cancer

Purpose To investigate whether skip axillary metastases are really skip metastases or a continuation of level I micrometastases in invasive breast cancer, and to determine whether there are any factors predisposing to skip metastases. Methods We reviewed 568 consecutive patients with breast cancer who underwent complete axillary lymph node dissections (ALND) between January 1998 and December 2004. For patients with skip axillary lymph node metastases, resectioning and immunohistochemical staining of the remaining part of paraffin blocks from level I lymph nodes were done to determine whether there were any micrometastases in this group of lymph nodes. Results Skip axillary metastases were found in 27 (10%) of 268 patients with axillary lymph node metastases. Re-evaluation of the level I lymph nodes, both with thin sectioning and immunohistochemical staining, in the patients with axillary skip metastases revealed no micrometastases. No significant correlation was found between the demographic and histopathological variables of the patients with skip metastases and those with regular axillary metastases. Conclusions These results suggest that skip axillary metastases are actual skip metastases, not a continuation of undetected level I micrometastases. Moreover, none of the clinical and histopathological measures of primary tumors are predictors of the presence of skip metastases.     

125例鼻咽癌患者治疗后发生远处转移的临床多因素分析

目的:探讨鼻咽癌患者治疗后发生远处转移的特点和临床影响因素,建立远处转移预测模型,为临床提供参考.方法:2001年5月-2006年5月收治鼻咽癌治疗后0.5年出现远处转移的患者125例,采用Cox回归模型分析远处转移的影响因素,并建立远处转移危险指数(HI)公式,并根据HI值将全部患者分为不同的危险组进行比较.结果:125例中骨转移60例(48.0%),肝转移43例(34.4%),肺转移42例(33.6%),多脏器、多部位转移28例(22.4%),0.5～2年发生远处转移89例(71.2%).单因素分析显示T分期、N分期、临床分期、颈淋巴结转移影响治疗后远处转移(P＜0.01).多因素分析显示N分期、临床分期、有无化疗是鼻咽癌治疗后远处转移的重要影响因素,不同危险组发生远处转移的危险差异有显著性(P＜0.01).结论:大部分鼻咽癌患者发生远处转移在治疗后2年内,常见转移部位是骨、肝、肺.HI值能较好地反映远处转移的危险性.