Metastatic carcinoma of the distal ulna from an occult pancreatic carcinoma

A case of pancreatic carcinoma presenting as a pathologic fracture of the distal ulna is reported. To the best of our knowledge, metastatic pancreatic carcinoma distal to the elbow has never been reported. An attempt to stabilize the fracture with intramedullary fixation and methacrylate augmentation was unsuccessful. Because of the dismal prognosis of pancreatic carcinoma, therapy should be directed toward pain control and maintenance of function in these patients.     

Metastatic squamous cell carcinoma of the parotid: a case of an occult primary

Metastatic squamous cell carcinoma involving an intraparotid lymph node, although uncommon, remains of practical consideration in the differential diagnosis of a parotid mass. This is of particular importance when the primary skin lesion is not readily identifiable, or has been inadequately managed in the past. A representative case is presented, and a review of the literature follows with special emphasis on the anatomy of the parotid lymphatics and the implications for appropriate treatment.     

Intrathoracic papillary thyroid carcinoma from occult primary disease

A 42-year-old woman undertook a chest radiograph for a routine evaluation prior to surgery for pelvic endometrioma, which revealed a right paratracheal mass slightly displacing the trachea to the left. CT of the thorax disclosed a well demarcated, heterogeneous, lobular, right paratracheal mass, bearing punctate, coarse, and curvilinear calcifications. MRI further revealed two components within the lesion: a larger, cystic, exhibiting thin septations, and a solid component at the lower part exhibiting strong enhancement. No continuity of the mass with the thyroid gland was demonstrated, which had normal size and no focal lesion. Histological examination of the resected mass disclosed lymph node tissue infiltrated by papillary thyroid carcinoma; subsequent total thyroidectomy revealed small foci of papillary carcinoma within both lobes of the thyroid gland. Ablative dose I-131 was administered and the patient was put on daily thyroid supplements.     

Metastatic bone disease of the humerus

Metastatic bone disease is the most common cause of destructive bone lesions in adults, and involvement of the humerus is common. Patients with destructive lesions involving <50% of the cortex are treated nonsurgically with external beam irradiation. Patients with diaphyseal lesions involving > or =50% of the cortex or those with pain after irradiation can be treated with intramedullary nailing to achieve rigid fixation. Although closed intramedullary nailing is used most often, open nailing with methylmethacrylate is appropriate for destructive lesions in which rigid fixation cannot be achieved with closed nailing. Plate fixation is acceptable when adequate proximal and distal cortical bone is present for screw purchase, although proximal humeral lesions usually are treated with prosthetic arthroplasty. Postoperative external beam irradiation can help prevent disease progression and subsequent loss of fixation. However, when disease progression persists or rigid internal fixation is not feasible because of extensive bone destruction, wide resection and reconstruction with a custom prosthesis can be done.     

Metastatic bone disease: the requirement for improvement in a multidisciplinary approach

The purpose of this study was to assess the referral system, clinical notes and radiographs of patients presenting with metastatic disease of long bones. The study demonstrated that 93% of oncologists did not use a reliable scoring system to assess risk of pathological fracture, and 60% felt an improvement in communication was required. Notes and radiographs were reviewed for 37 patients presenting with femoral metastatic lesions. Sixteen patients had a Mirels’ score of greater than 8. Four patients were referred for an orthopaedic opinion. Twelve patients with a score of greater than 8 were not referred; seven of these patients suffered a pathological fracture. Sixteen patients had a Mirels’ score of less than 8; none of these patients were referred for an orthopaedic opinion. No pathological fractures occurred. In conclusion, the majority of patients who score above 8 in the Mirels’ scoring system are at risk of fracture and do require prophylactic surgery. In keeping with the British Orthopaedic Association (BOA) guidelines, “Metastatic Bone Disease: A Guide to Good Practice”, we would recommend a multidisciplinary approach and the use of a recognised scoring system.

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Résumé  Le but de cette étude est d’évaluer et de mettre en place un système de référence clinique et radiographique concernant les patients présentant des métastases des os longs. 93% des oncologistes n’utilisaient pas de scores fiables permettant d’évaluer le risque de fracture pathologique, néanmoins, 60% souhaitent avoir des informations plus importantes sur ce problème. Les observations cliniques et radiographiques de 37 patients présentant des métastases fémorales ont été revues pour cela. 16 patients avaient un score de Mirels supérieur à 8, 4 nécessitaient un avis orthopédique. 12 patients avaient un score supérieur à 8 et n’ont pas été évalués sur le plan orthopédique mais 7 sur 8 présentaient une fracture pathologique. 7 patients avaient un score de Mirels inférieur à 8 aucun de ces patients n’a nécessité un avis orthopédique et n’a présenté de fracture pathologique. En conclusion: la majorité des patients qui ont un score supérieur à 8 ont un risque de fractures et nécessitent une chirurgie prophylactique. En se reportant au référentiel de la BOA sur les métastases osseuses, un guide de bonnes pratiques doit être recommandé avec une approche multi disciplinaire et l’utilisation d’un système de classification reconnu.

     

直肠腺癌合并转移性巨大卵巢癌一例报告

病例：女，30岁。因下腹胀痛伴腹泻、便血1月余入院。入院查体：腹隆，腹正中可及巨大包块，质硬无压痛。肛指检查：截石位于直肠前壁9—12点距肛门约8cm处可触及一菜花状肿块，质硬，触之出血。实验室检查：血红蛋白83g／L，大便隐血（＋＋＋＋）；     

Metastatic bone disease from breast cancer: a review of minimally invasive techniques for diagnosis and treatment

Skeletal-related events in patients with metastatic bone disease include intractable severe pain, pathologic fracture, spinal cord and nerve compression, hypercalcemia and bone marrow aplasia. In patients with breast cancer, the skeleton is the most frequent site for metastases. Treatment options for metastatic bone disease in these patients include bisphosphonates, chemotherapeutic agents, opioids, hormonal therapy, minimally invasive/interventional and surgical techniques. Interventional oncology techniques for breast cancer patients with bone metastases include diagnostic (biopsy) and therapeutic (palliative and curative) approaches. In the latter, percutaneous ablation, augmentation and stabilization are included. The purpose of this article is to describe the basic concepts of biopsy, ablation, embolization and peripheral skeleton augmentation techniques in patients with metastatic bone disease from breast carcinoma. The necessity for a tailored approach applying different techniques for different cases and locations will be addressed.     

Metastatic bone disease: pathogenesis and new strategies for treatment

Bone is the third leading site of metastatic disease, after the lung and liver. Pain, pathological fractures, neurological deficits, and forced immobilization significantly decrease the quality of life of patients with bone metastasis. The development of metastasis, from the migration of malignant cells from the primary tumor to their proliferation at a distant site, involves a series of sequential steps: angiogenesis, matrix degradation, cell motility, cell attachment, and cellular pro-liferation. A better understanding of the pathogenesis of metastasis may be expected to lead to the development of new treatment modalities for bone metastasis. Currently, antiangiogenic agents, matrix metalloproteinase (MMP) inhibitors, and hyperthermia are some of the newer therapeutic modalities that seem to hold promise for the treatment of metastatic bone disease.Presented at the 36th Annual Musculoskeletal Tumor Meeting of the Japanese Orthopaedic Association, Kobe, Japan, July 11, 2003.     

Metastatic renal tumor originating from esophageal carcinoma: a case report

A 46-year-old woman with a past history of esophageal carcinoma was hospitalized with the chief complaint of right abdominal pain. Enhanced computed tomography (CT) and selective renal angiography suggested a metastatic renal tumor. Right nephrectomy was performed. Histological examination revealed a renal tumor originated from esophageal squamous cell carcinoma. Metastatic renal tumors are frequently observed at autopsy, but clinically they are extremely uncommon. Thirty-four clinical cases of metastatic renal tumors reported in the Japanese literature during these 20 years are discussed including the present case.     

Metastatic renal cell carcinoma to the temporal bone: case report

We report an extremely rare case of metastasic renal cell carcinoma to the temporal bone which presented initially as a jugulotympanic paraganglioma. The clinical and radiological appearances were misleading.Investigations of concomitant high blood pressure revealed a tumour of the right kidney. Biopsy of the mastoid mass was histologically compatible with a metastasis from a clear cell renal carcinoma. The patient underwent a radical nephrectomy and local external radiotherapy to the head. He also received adjuvant treatment with interferon-_ and interleukin 2. The clinical presentation, the radiological and histological features, the patterns of spread, the treatment options and the prognosis of these tumours are discussed. A review of the literature confirms the extremely unusual occurrence of this localisation.     

Metastatic bladder tumor from gastric carcinoma: a case report]

A 63-year-old man with a two-month history of nocturia and dysuria consulted his family doctor. As renal dysfunction and bilateral hydronephrosis were indicated, he was admitted to our hospital on November 28, 1988. Cystoscopy revealed a non-papillary and flat tumor from the ureteral orifice to the back wall of the bladder. A biopsy of the bladder wall revealed signet-ring cell carcinoma. A metastatic bladder tumor was suspected and laboratory tests of tumor markers showed a carcinoembryonic antigen value (CEA) of 1,000 ng/ml and CA19-9 of 12,210 U/ml. Upper gastrointestinal examination revealed carcinomatosis involving the stomach. A biopsy specimen of the stomach revealed the same pathological finding as the bladder wall. A metastatic bladder tumor was confirmed. The patient died of pulmonary emboli on December 11, 1988.     

Metastatic renal tumor originating from esophageal carcinoma: a case report

A 61-year-old male, who had undergone operation of esophageal carcinoma 11 months earlier, was admitted for left flank pain and high fever. Intravenous pyelography showed a space occupying lesion in the upper half of the left kidney. Computed tomographic scan showed an irregular low density area in the upper half of the left kidney. Angiograms revealed a hypovascular mass with encasement vessels in the same site. Left nephrectomy and paraaortic lymph node biopsy was performed. Pathological examination revealed a metastatic squamous carcinoma from the esophageal carcinoma. Chemotherapy was conducted, but he died 2 months later. Autopsy revealed recurrence in the retroperitoneum, and no metastasis in the right kidney. The literature on secondary renal tumor is reviewed.     

Metastatic carcinoma of breast simulating Crohn's disease

A 52-year-old female had radical surgery on both breasts in 1971 and 1973 for infiltrating lobular carcinoma of the breast. One year later, multiple metastases simulating Crohn's disease were found radiologically and intraoperatively in the colon and small bowel. The pathological examination revealed multiple areas of linitis plastica type carcinoma in the colon and small bowel. Review of the breast slides showed that the original breast carcinoma was morphologically identical to the metastatic lesions. The literature is reviewed and arguments are presented to attest that signet-ring-cell carcinoma of the breast is a distinct entity, which not too infrequently metastasizes to the gastrointestinal tract.     

Metastatic renal tumor from esophageal carcinoma

A 65-year-old woman, who had undergone total esophagectomy for cancer one year prior to admission, noted asymptomatic gross hematuria. Therefore, she was referred to our department in July, 1983. Physical examination revealed a hard, irregular and nontender mass in the left upper abdomen. Excretory urography revealed a space-occupying lesion in the lower pole of the left kidney. Selective renal angiography revealed a hypovascular mass and encasement of the renal artery. Percutaneous renal artery embolization was performed two weeks prior to nephrectomy. At surgery, the left kidney was adhered to the surrounding tissue and it was hard to dissect. Paraaortic lymph nodes were swollen and a couple of them were biopsied. The histopathological report of the tumor was squamous cell carcinoma. The patient was treated with systemic chemotherapy, but the postoperative course was poor and the patient emaciated gradually. She did ten weeks after operation and autopsy was refused. Metastases of malignant tumor to the kidney are rarely encountered in clinical cases and, to our knowledge, this case seems to be the forth metastatic renal tumor from esophageal cancer in the Japanese literature.     

Monoclonal antibodies detect occult breast carcinoma metastases in the bone marrow of patients with early stage disease

Thirty-five to 40% of patients with operable breast carcinoma develop metastases after primary therapy. There is a need for more specific prognostic parameters to identify patients who are most likely to benefit from adjuvant therapy. The success of such treatment stems from its ability to eradicate preclinical microscopic metastases. The bone marrow is an accessible and frequent site of breast carcinoma metastases. Following studies of Redding et al. (16), we used monoclonal antibodies that recognize membrane and cytoskeletal antigens expressed by epithelial cells (C26, T16, AE-1) in an immunohistochemical assay to find cancer cells in bone marrow aspirates. The assay can detect one cancer cell among 50,000-100,000 hematopoietic cells. None of the 44 control bone marrows (from normal individuals and patients with leukemias and lymphomas) contained antigen-positive (extrinsic) cells. We found extrinsic cells in the bone marrow of 35% (18 of 51) of patients with operable breast carcinoma; no extrinsic cells were identified by routine bone marrow cytology in these patients. Twenty-seven percent (six of 22) of patients with negative lymph nodes had antigen-positive cells, while 41% (12 of 29) of patients with lymph node metastases had such cells. Similarly, 23% (three of 13) of patients with TNM stage I disease, 38% (13 of 34) of patients with stage II disease, and 50% (two of four) of patients with stage III disease had extrinsic cells. In those cases where extrinsic cells were identified, stage II patients with negative lymph nodes and patients with stage I disease were found to have fewer such cells in their marrow than patients with lymph node metastases and patients with stage II disease. These trends did not reach the level of statistical significance in this small number of patients. The presence of extrinsic cells did not correlate with tumor size of lymphatic invasion around the tumor. We conclude that the epithelial cells detected in the bone marrow of the patients with breast carcinoma were carcinoma cells based on the following criteria: (a) they expressed both membrane and cytoplasmic epithelia-specific antigens, (b) they possessed the cytologic characteristics of malignant epithelial cells, and (c) these cells were not detected in the bone marrow from normal individuals or patients with nonepithelial neoplasms involving the bone marrow. We have shown that the technique described here can detect occult metastases in bone marrow and that the presence of extrinsic cells correlates with some established predictors of prognosis. Long-term clinical correlative follow-up studies are now underway.