Severe pulmonary hypertension reversed by antibiotics in a patient with Whipple's disease

The case is described of a 58 year old man with systemic Whipple's disease with pericardial and pleural effusions and severe pulmonary hypertension. After three months of antibiotic treatment there was a complete resolution, not only of the symptoms known to be associated with Whipple's disease (diarrhoea, arthralgia, pericardial and pleural effusions), but also of pulmonary hypertension.


     

Superior vena cava syndrome associated with Nocardia farcinica infection

A case is described of severe Nocardia farcinica infection which mimicked a pulmonary neoplasm with pneumonia, superior vena cava syndrome, pericarditis, and hypertrophic osteoarthropathy. Treatment with trimethoprim-sulphamethoxazole and surgery resulted in complete recovery.


     

Metastatic Pulmonary Adenocarcinoma Deposit Arising Within a Cutaneous Basal Cell Carcinoma: A Case Report

Skin metastases are rare complications of internal malignancies, and most commonly arise from primary lung carcinoma (Brownstein and Helwig in Arch Dermatol 105:82–68, 1972). Metastatic cutaneous lesions have not previously been documented to arise within other skin tumours. We report our experience of a solitary pulmonary adenocarcinoma metastasis that arose within a pre-existing basal cell carcinoma in a patient with undiagnosed lung cancer. Immunohistochemistry was invaluable in confirming both the metastatic nature of the secondary skin lesion and its site of origin.     

Metastatic appendiceal adenocarcinoma presenting late as epididymo-orchitis: a case report and review of literature

Background  

Whereas testicular metastases are in themselves a rare entity, testicular secondaries from an appendiceal carcinoma have not yet been described. The case also illustrates the diagnostic dilemma of a tumour presenting as epididymo-orchitis.     

Pancoast tumours: clinical assessment and long-term results of combined radiosurgical treatment

BACKGROUND: Many oncologists have now accepted a combined radiosurgical approach as the treatment of choice in patients with Pancoast tumour but most reports show an incorrect assessment of the disease. METHODS: Stage III lung cancer was classified as Pancoast tumour if the pulmonary extent was limited to the upper apical segment and if at least one of the features of Pancoast syndrome, indicating tumour spread to the para-apical structures, was present. Between 1984 and 1988 15 consecutive patients were treated with primary radiotherapy followed by surgery or with primary excision and subsequent radiotherapy in the absence of an initial histological diagnosis. RESULTS: The mortality of patients given the combined treatment was 6.6% (one death due to pulmonary embolism), and the five year survival rate was 26.6% for all patients and 57% for those who underwent complete resection without N2 disease. Long-term survival was 0% for those cases with incomplete resection, N2 disease, or malignant invasion of the first rib. CONCLUSIONS: Stage III lung cancer, classified as Pancoast tumour according to strict, consistent criteria, is best treated by primary radiotherapy; combined treatment should be used only for patients with potentially resectable cancer without N2 disease and/or malignant invasion of the first rib.


     

Listeria monocytogenes empyema in an HIV infected patient

Listeriosis in HIV infected patients is uncommon and usually presents as meningitis or bacteraemia. Pleural fluid infections caused by this organism are extremely rare. A case is described of empyema caused by Listeria monocytogenes in an HIV infected patient that was successfully treated with medical treatment only.




     

Pulmonary metastasis of a dermatofibrosarcoma]

Progressive and recurrent dermatofibrosarcoma, described by Darier and Ferrand in 1924, is a fibrous skin tumour with essentially local malignancy. The authors report a case with pulmonary metastasis, a rare event as only 13 cases of visceral metastases have been reported in the literature. The clinical course of this case was favourable (follow-up of 5 years), in contrast with the usually pejorative nature of metastatic disease (death after several months to one year following the discovery of the first metastasis).     

Giant condylomata acuminata of Buschke and Lowenstein: A peristomal variant

INTRODUCTION

Giant condylomata acuminata (GCA) is a rare, locally invasive tumour that may undergo malignant transformation. It was first described a HPV-induced penile tumour which clinically resembled both a squamous cell carcinoma and condyloma acuminatum, often arising from a pre-existing warty lesion. We describe a case of peri-stomal GCA transformation into invasive squamous cell carcinoma (SCC), which is, to our knowledge, the first report of this in the literature.

PRESENTATION OF CASE

A 74 year old gentleman developed an acuminate, papillomatous peristomal eruption around a fifty year old ileostomy, with biopsies of the eruption showing reactive changes. Two years later, he developed ulcerating plaques affecting the previously papillomatous areas and an erythematous nodular lesion involving the superior part of the ileostomy and adjacent skin. Histological examination of the ileostomy lesion showed focal small islands of atypical squamous epithelium, and moderately differentiated invasive squamous cell carcinoma was shown in the excised tissue subsequently. Human papillomavirus (HPV type 16), p16 and p53 tumour suppressors were positive in the peri-stomal skin sample.

DISCUSSION AND CONCLUSIONS

Recurring, changing papillomatous lesions in the peristomal area should be reviewed with a high index of suspicion in relation to GCA tumours as they can progress to invasive squamous cell carcinomas.Abbreviations: GCA, giant condylomata acuminata; SCC, squamous cell carcinoma; HPV, human papillomavirus; UC, ulcerative colitis     

Multiple skeletal metastases from a giant cell tumour of the distal fibula with fatal outcome

A giant cell tumour is a primary lesion of bone of intermediate severity. Its histogenesis is unclear. In a few cases pulmonary metastases have been described. Multiple skeletal metastases in the absence of sarcomatous change have been observed. We present a case report of a 25-year-old woman with a recurrent giant cell tumour of the distal fibula. After a second recurrence and six years after the initial diagnosis, she rapidly developed multiple bony metastases. The outcome was fatal.     

Pulmonary metastasectomy for gastric cancer: a 13-year single-institution experience

Purpose

Pulmonary metastases from gastric cancer are rare, and the role of surgery is unclear. The purpose of this study was to determine which patients with metachronous metastatic gastric cancer (MGC) might benefit from pulmonary resection.

Methods

Between 1998 and 2011, 12 patients underwent 14 pulmonary resections for MGC. We reviewed their clinical courses and evaluated their radiological findings.

Results

Solitary pulmonary lesions were identified for 11 metastases, and the remaining three showed multiple pulmonary lesions. Six patients received treatment for the metastases before pulmonary resection. Lobectomy was performed for five lesions and wedge resection was performed for the remaining nine lesions. At the median follow-up time of 23.0 months, four patients were alive without disease, and the median DFS following pulmonary resection was 6.6 months. The overall 5-year survival rate following pulmonary resection was 58.4 %. In a univariate analysis, the number of lesions and the tumor doubling time (TDT) were significant predictors of the DFS, although prior treatment was not a significant predictor of the DFS.

Conclusion

Pulmonary resection for MGC might be an effective therapeutic option when there is a solitary metastatic lesion that has a long TDT, even if the patient has been previously treated for metastases.     

Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited

The computed tomographic (CT) pulmonary angiogram appearancesof acute right ventricular dysfunction due to massive pulmonary embolusin a patient are described. Abnormal findings comprised rightventricular dilatation, interventricular septal shift, and compressionof the left ventricle. These changes resolved following thrombolysis.Use of CT pulmonary angiography to diagnose pulmonary emboli isincreasing. Secondary cardiac effects are established diagnosticfeatures shown by echocardiography. These have not been previouslydescribed but are important to recognise as they may carry importantprognostic and therapeutic implications.

     

Outcomes of pulmonary metastases in hepatoblastoma — is the prognosis always poor?

Background

Hepatoblastoma is a rare tumour accounting for approximately 1% of all paediatric malignancies. Hepatoblastoma complicated by pulmonary metastatic disease continues to cause management difficulties due to a lack of robust evidence and treatment guidelines.

Method

This series is the experience of a tertiary paediatric referral centre. Patients were prospectively enlisted, and their charts were retrospectively reviewed.

Results

Thirty-seven patients were treated for hepatoblastoma from 1995 to 2012 inclusive. The overall survival was 34/37(91.9%). Eight patients had lung metastases at diagnosis (LMD) and twenty-nine did not (NLMD). Two-year EFS was 62.5% in the LMD group and 89.3% in the NLMD group (p = 0.078). Overall survival in the LMD and NLMD groups was 100% and 89.7%, respectively (p = 0.389). Two patients in the LMD group required multiple thoracic resections to achieve cure. Within the NLMD group, two patients developed lung metastases whilst on treatment, and both of these patients died.

Conclusion

In this series, children presenting with lung metastases had a higher risk of relapse but excellent overall survival. However, children who developed pulmonary disease during treatment had a poor prognosis. We advocate aggressive surgical treatment of pulmonary hepatoblastoma to achieve cure.     

三步序贯法治疗四肢皮肤软组织缺损合并骨或肌腱外露创面

目的:探讨采用改良VSD技术、皮耐克覆盖、自体皮移植三步序贯法治疗拒绝皮瓣修复的四肢皮肤软组织缺损合并骨或肌腱外露创面的临床疗效。方法:2013年1月至2015年6月,采用三步序贯法治疗18例四肢创伤后皮肤软组织缺损合并骨或肌腱外露创面患者,其中男13例,女5例;年龄23～72岁,平均34.6岁;受伤至手术时间1.5～5.0 h,平均2.5 h。皮肤软组织缺损面积4.2 cm×3.1 cm～7.4 cm×5.2 cm。评估创面恢复情况及取皮创口恢复情况综合评价治疗效果。结果:术后18例患者获得随访,时间5～16个月,平均7.6个月。所有创面深部骨肌腱组织被有效覆盖,人工真皮成活,愈合创面质地韧、外形可;创面移植皮片成活,未见明显瘢痕组织生成,外观平整,皮肤颜色略深于正常皮肤,整体效果满意。结论:采用三步序贯法治疗拒绝皮瓣修复的四肢皮肤软组织缺损合并骨或肌腱外露创面疗效良好,具有操作简单、手术风险及创伤小等优点。     

An unusual case of multiple recurrence of a glomangioma.

Glomus tumour is a benign lesion arising from the glomus apparatus of the skin and subcutaneous tissue. Glomangioma is the angiomatous variant, which is uncommon. We report a very rare presentation of a glomangioma with multiple recurrences. We advocate preoperative angiography to delineate the extent of the lesion to facilitate complete excision.     

Skin metastasis from sigmoid colon cancer

Skin metastases from visceral cancers are rare and the reported incidence from all visceral cancers is 1.4% to 10%. Skin metastases from colorectal cancers account for only 5% of metastatic skin cancers, among which scalp metastases are very rare. We describe a 53-year-old man with scalp metastasis derived from sigmoid colon cancer that was diagnosed and surgically resected in 2005. Metastatic lung tumors that developed thereafter were surgically resected and then chemotherapy was administered. However, metastatic brain tumors occurred in 2008, and these were treated by gamma-knife radiosurgery. Around the same time, a raised lesion that appeared on the scalp was diagnosed as skin metastasis and treated with best supportive care. Thereafter, the brain metastases continued to spread, and the patient died in October 2008.     

Clinical and immunohistochemical characteristics of benign giant cell tumour of bone with pulmonary metastases: case series

PURPOSE: Giant cell tumour of bone with pulmonary metastases is rare. However, some patients die of pulmonary metastases, and histological examination cannot distinguish between benign tumour and malignant metastases. In this study, we present clinical and immunohistochemical findings associated with giant cell tumour of bone with pulmonary metastases. METHODS: Five patients with benign giant cell tumour of bone with pulmonary metastases (one man and 4 women) were studied. Patients' ages ranged between 20 and 23 years (mean age, 21.8 years). Tumours were in the distal femur in 2 cases, and in the proximal tibia, distal tibia, and lumbar spine in one case each. The tissue specimens from primary tumours, recurrent tumours, and pulmonary metastases were studied using immunohistochemical techniques. RESULTS: Three of the 5 primary tumours were of the spontaneous regression or growth cessation type, or the continuously slow-growing type, showing 4.2% to 6.2% of positive cells for Ki-67 after immunohistochemical staining. However, 2 patients with the rapid-growing type of disease died of pulmonary metastases; their primary, recurrent, and metastatic tumour specimens contained 9.0% to 11.5% of positive cells for Ki-67. CONCLUSION: Three of the 5 primary tumours had a benign clinical pattern and immunohistochemistry. Two of the 5 patients died of pulmonary metastases, which had an aggressive clinical pattern and a high prevalence of positive cells in Ki-67. Examination of Ki-67 should be carried out for aggressive type of giant cell tumour.     

Transcutaneous abdominal ultrasonography in the staging of lung cancer

BACKGROUND: There is limited information available regarding the relationship between clinical indicators of widespread disease in patients with lung cancer and the findings of transcutaneous ultrasonography. METHODS: A retrospective survey was made of 279 consecutive patients with lung cancer. By reviewing the patients' records the clinical findings were divided into symptoms, signs, and laboratory tests indicative of metastatic disease. All patients had been examined by abdominal ultrasonography. RESULTS: The patients included 19% with small cell carcinoma. The frequency of abdominal metastases by ultrasonography in those with small cell carcinoma was 40%, in the other patients it was 8%. Regardless of histological group, all the 40 patients with abdominal metastases by ultrasonography had at least one clinical category indicative of widespread disease and 38 (95%) had two or all three clinical categories positive. Fifty nine patients had no clinical indicators of metastases and none of these had abdominal metastases by ultrasonography. CONCLUSIONS: The results of this study indicate that abdominal metastases are found in lung cancer patients with clinical findings indicative of widespread disease. No abdominal metastases were found in patients with a negative clinical evaluation. The results indicate that transcutaneous ultrasonography of the abdomen is not necessary in the initial staging if the clinical evaluation is unremarkable.




     

Interstitial laser photocoagulation of normal lung parenchyma in rats

BACKGROUND—Managementof peripheral lung tumours may be risky in patients with poor lungfunction or in the elderly. A new possibility is interstitial laserphotocoagulation (ILP) in which tumours are gently coagulated usingthin laser fibres placed percutaneously under radiological guidance.This could have a useful palliative role in selected patients, but tobe safe the effects on normal lung parenchyma must first be understood.This paper describes the creation and healing of ILP lesions in thenormal rat lung.
METHODS—ILP wasperformed using single laser fibres placed percutaneously in the leftlung of normal rats under general anaesthetic with radiologicalguidance (laser power 1-3 W at 805 nm, treatment time 250-1000 s).The lesion size and healing were studied in rats killed at times fromthree days to six months after treatment, the bursting pressure wasmeasured, and any complications noted.
RESULTS—Zones ofnecrosis up to 12 mm in diameter were produced, the size depending onthe laser power and treatment time. Histological examination showedtypical thermal effects with complete healing with fibrosis by twomonths. The effect was very localised with remarkably little effect onthe structure and function of the rest of the lung. Adverse effects inthe lung parenchyma only occurred if the ILP lesion involved the hilarvessels or the oesophagus, causing pulmonary congestion andperforation, respectively. Pneumothorax was seen in 6% of cases.
CONCLUSIONS—ILP with asingle fibre can produce a localised zone of necrosis in normal lungparenchyma which heals safely and which has little effect on the restof the lung. Further study of this technique using multiple fibres in alarger animal model is warranted to see if it is feasible and safe toproduce a large enough volume of necrosis to be of value in thetreatment of small peripheral lung tumours in patients who areunsuitable for surgery or palliative radiotherapy.

     

Surgical treatment for pulmonary aspergilloma: a 28 year experience

BACKGROUND: Pulmonary aspergilloma has been treated surgically for many years but the mortality rates of larger surgical series, varying from 7% to 23%, is not considered acceptable by today's standards. The authors report their experience in the surgical treatment of pulmonary aspergilloma and present a review of the literature. METHODS: Sixty seven patients who underwent thoracotomy for pulmonary aspergilloma from 1968 to 1995 were studied retrospectively by reviewing their medical records. RESULTS: The most common clinical presentation of pulmonary aspergilloma was haemoptysis which occurred in 61 patients (91.0%). Tuberculosis was the most common pre-existing disease, occurring in 54 patients (80.6%). The plain chest radiograph showed the typical "air-crescent" sign in 36 patients (53.7%). Systemic antifungal therapy neither palliated the clinical symptoms nor eradicated the aspergilloma, and transarterial embolisation was also unsuccessful. Surgery offered the only chance of cure for both unilateral and bilateral disease. Procedures varied from segmentectomy to pneumonectomy with most (61.4%) undergoing lobectomy. There was one death following surgery from pneumonia and 15 postoperative complications occurred in 12 patients-empyema (7), massive bleeding (3), bronchopleural fistula (2), wound infection (2), and Horner's syndrome (1). Postoperatively, most of the patients were symptom-free. CONCLUSIONS: With appropriate preoperative evaluation and judicious surgical technique, surgery is the preferred treatment for pulmonary aspergilloma, both for eradicating the tumour and for curing the underlying disease.


     

Squamous cell carcinoma of the palm: a case report

Squamous cell carcinoma (SCC) arising from the palm skin is very rare, having a very aggressive course and poor outcome. A 74-year-old male patient presented with a painful and rapidly growing nodular lesion, 20 mm in size, in the distal part of the right palm. He received antibiotic treatment at another center with the thought of an infection, and then with oral corticosteroids with an estimation of a granuloma. The patient underwent a wide excision with an initial diagnosis of skin cancer, followed by full-thickness skin grafting. Histopathologic examination showed moderately differentiated SCC extending to the deep subcutaneous tissue and positivity in deep surgical margins. Subsequent surgery included ray amputation involving index and middle fingers. However, recurrent skin lesions appeared in the dorsum of the hand together with enlarged lymph nodes in the epitrochlear and medial axillary regions. Following a wide surgical removal of the lesions, metastases were detected in epitrochlear and axillary lymph nodes and in fatty subcutaneous tissue. A month later, new lesions developed in the dorsum of the hand, which required another surgical excision. However, new epitrochlear lymph nodes and multifocal lesions in the right axillary region emerged. This time, radical radiotherapy was administered. In a short time, cutaneous and subcutaneous metastases in the thoracic wall and widespread lung metastases were detected. The patient died from pulmonary complications 10 months after presentation.