Metastatic carcinoma of the gallbladder after a renal cell carcinoma

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor. We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease. Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour. If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.     

Metastatic Carcinoma of the Gallbladder after a Renal Cell Carcinoma

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor.

We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease.

Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour.

If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.     

Basal cell carcinoma of the prostate: a case report

A 69-year-old man presented with gross hematuria and irritative urinary symptoms. He underwent transurethral resection of his prostate. The prostate chips revealed 70% poorly differentiated carcinoma with neuroendocrine features, initially read as small cell carcinoma, later as basal cell carcinoma. PSA at this time was 0.3. He received 4 cycles of etoposide and cisplatin. After which, rebiopsy of the prostate showed tumor consistent with poorly differentiated basal cell carcinoma. Given progression on chemotherapy, decision was made to proceed with radical prostatectomy. Metastatic workup was negative. Gross extraprostatic invasion was noted but lymph nodes were free of metastatic disease.     

局部皮瓣在头皮恶性肿瘤切除后创面修复中的应用

目的：探讨旋转皮瓣修复头皮肿瘤切除后创面缺损的效果。方法：对24例头皮恶性肿瘤患者（鳞癌7例、基底细胞癌15例、黑色素瘤2例）实施肿瘤扩大切除术。切除后创面面积3cm×4cm～9cm×11cm,肿瘤切除后创面用旋转皮瓣修复,供瓣区直接缝合或中厚植皮修复。结果：24例患者皮瓣血运正常,所有患者供瓣区愈合良好或植皮全部存活,16例随访6个月～2年,未见肿瘤复发。结论：利用旋转皮瓣转移修复恶性肿瘤切除后创面疗效满意。     

Scalp metastases of a renal cell carcinoma

An 80-year-old man presented with a localized tumor of the right occipital scalp. The tumor was a 1-cm, bright red-purple, ulcerated, and crusted exophytic nodule on a smooth base (Figure 1). The lesion had grown asymptomatically over 18 months except for profuse bleeding induced by minimal trauma. It was extirpated with the clinical diagnosis of pyogenic granuloma vs. renal metastasis to the scalp. The patient's medical history included a transurethral prostatic resection 3 years earlier and, 1 year later, a right nephrectomy for a 2-kg kidney tumor verbally reported as "benign." The patient also had a 2-year history of untreated high blood pressure. Histopathologically, the excised tissue was an exo-endophytic nodule of a solid form composed of pleomorphic neoplastic cells with abundant clear cytoplasm, surrounded by fibrous collagen septae, blood vessel proliferation, and areas of hemorrhage (Figures 2 and 3). The histopathologic diagnosis of metastatic renal cell carcinoma was supported by immunohistochemistry with positive epithelial membrane antigen staining (Figure 4). Cytokeratins 7 and 20 were nonreactive. Laboratory studies revealed hematuria and elevated creatinine and urea nitrogen levels, but no malignant cells were observed in five urinary cytologies. Renal ultrasound showed the presence of two simple cysts in the left kidney and data compatible with chronic inflammatory disease.     

Sentinel lymph node dissection for merkel cell carcinoma

Merkel cell carcinoma is an aggressive neuroendocrine skin tumor whose treatment modality is still controversial. It resembles malignant melanoma in its cutaneous presentation, unpredictable biologic behavior, early regional lymph node involvement, early distant metastases, and high recurrence rate. Regarding these common features, we used sentinel node biopsy (a well-described technique for the treatment of malignant melanoma) in a 50-year-old man with Merkel cell carcinoma of the left arm. Only one sentinel lymph node was identified and it was revealed to be disease-free on histology. No further axillary dissection was performed. This case report shows that sentinel node biopsy is applicable to Merkel cell carcinoma.     

Pancreatic metastasis from renal cell carcinoma 25 years after radical nephrectomy

We report a case of pancreatic metastasis from renal cell carcinoma detected 25 years after radical nephrectomy. A 74-year-old man, who had undergone radical nephrectomy for renal cell carcinoma at age 49, was found by computed tomography to have a strongly enhanced mass on the pancreatic head. The patient underwent pancreaticoduodenectomy and the pathological diagnosis was metastatic renal cell carcinoma. This was evidently a slow growing tumor because the metastatic pancreas tumor was well demarcated and the metastasis was found 25 years after the primary operation. Aggressive surgical treatment of isolated metastatic lesions offers a chance of long-term survival. Patients with a history of RCC should undergo a long-term follow-up to detect and evaluate metastasis to pancreas as well as other organs.     

A malignant proliferating trichilemmal tumor simulating a squamous cell carcinoma

An 84-year-old man with a 3x3 cm tumor of the nasal dorsum is described. The tumor was surgically removed, reconstruction was with a forehead flap. Histologically the tumor was a malignant proliferating trichilemmal tumor (MPTT). There has been no recurrence or distant spread two years after surgery. MPTT is a rare tumor occurring mainly on the scalp and face in elderly men. It can be difficult to differentiate from a squamous cell carcinoma (SCC), both clinically and histologically. It has a tendency to metastasize and recur more frequently than SCC. When a malignant tumor occurs on the scalp or face, the diagnosis of MPTT should be considered by both surgeon and pathologist.     

Primary intracranial T cell type malignant lymphoma: a case report

Primary intracranial T cell type malignant lymphoma is extremely rare. Only 8 cases are reported in the literature so far. In this paper, a case with this type of malignant lymphoma is reported. A 41-year-old man was admitted because of abnormal behavior. Enhanced CT scan demonstrated high density mass and perifocal low-density area in the right frontal lobe, the right basal ganglia and the periventricular region. Specimen biopsied from right frontal lobe was submitted for histological examination. An immunohistochemical technique using monoclonal surface markers confirmed reactivity for LCA, MT-1, OKT-4 and OKT-8, while there was no reactivity for MB-1 and OKB-2. Pathological diagnosis was diffuse medium T cell type malignant lymphoma. Postoperatively, after 60 Gy irradiation, the tumor disappeared. There is no difference on CT findings between B cell type and T cell type malignant lymphoma.     

Diagnosis and management of atypical fibroxanthoma

A 90-year-old Caucasian man with a history of basal cell carcinoma and squamous cell carcinoma presented with a friable erythematous nodule on his scalp that had been present for several months. The lesion measured 1.4 x 1.8 cm. What is your diagnosis? How would you proceed?     

Malignant melanoma metastatic to the cavernous sinus and skull with an unknown primary origin: report of a case]

A rare case of malignant melanoma metastatic to the cavernous sinus and skull, with an unknown primary origin, is reported. A 46-year-old man noticed diplopia, lt. ptosis and swelling in the parietal and maxillary regions. The parietal skull tumor and the maxillary lymph node were excised and histological examination revealed malignant melanoma. Because of its roentogenological characteristics, the lesion of the cavernous sinus was also thought to be the site of metastasis of malignant melanoma. This case is rare because the initial symptom was cavernous sinus syndrome, and no involvement of brain parenchyma was observed.     

Poorly differentiated neuroendocrine carcinoma of the seminal vesicle

We describe an extremely rare case of poorly differentiated neuroendocrine carcinoma arising from the seminal vesicle. A 67-year-old man presented with a left humeral bone tumor resulting in a pathological fracture. Positron emission tomography scan disclosed a large pelvic tumor mimicking prostatic cancer invading into the seminal vesicle. Laboratory data showed an elevation of neuron-specific enolase, despite the normal prostate-specific antigen. Transrectal needle biopsy showed a poorly differentiated carcinoma of the right seminal vesicle and the metastasis of the pelvic lymph node. Immunohistochemical results were compatible with the features of neuroendocrine carcinoma; synaptophysin, chromogranin A and CD 56 were positive. The previously biopsied bone tumor was finally diagnosed as a metastasis. A systemic chemotherapy using etoposide and cisplatin failed. The patient died of cancer one-and-a-half years later.     

Primary malignant melanoma of the lung with rapid progression

This report presents a case of primary malignant melanoma of the lung with rapid progression in a 68-year-old man. During a regular checkup, a chest roentgenogram revealed an abnormal shadow in the left lower lung field. Computed tomography (CT) of the chest revealed an ill-defined tumor shadow measuring 4 × 3 cm in the left upper lobe. A CT-guided lung biopsy suggested a large-cell carcinoma, and left upper lobectomy was performed. Histopathologically, the tumor was comprised of malignant epithelial tumor cells with large amounts of acidophilic cytoplasm and prominent nuclei. A dark brown pigment was observed in the tumor cells. Immunohistochemical staining was positive for S-100 protein and HMB45; staining for cytokeratin, CAM5.2, and chromogranin was negative. The final diagnosis was malignant melanoma of the lung. Two months later, multiple brain metastases developed, and he died of the disease 6 months after the surgery.     

Signet ring cell carcinoma of the testis: clinicopathologic and molecular evidence for germ cell tumor origin--a case report

Development of a somatic-type malignancy from a mixed germ cell tumor is a rare but recognized event and typically represented by sarcoma or, less commonly, by carcinoma. This phenomenon is generally believed to result from progression of a teratomatous component. In many cases, because of intermingling of other germ cell tumor components, the diagnosis is apparent; however, in rare cases, metastatic carcinoma to the testis or a novel primary tumor may be a diagnostic consideration. In this study, we report the clinicopathologic, immunohistochemical, and molecular features of a 53-year-old man, whose testicular tumor was composed entirely of signet ring cells, mimicking metastatic carcinoma. Subsequent retroperitoneal lymph node dissection revealed metastatic deposits composed of teratoma and yolk sac tumor, in addition to signet ring cell carcinoma. Fluorescence in situ hybridization for abnormalities of chromosome 12p revealed the presence of i(12p) in both the teratoma and signet ring cell carcinoma in the metastasis and in signet ring cells in the testis, supporting a common germ cell origin. Our report indicates that signet ring carcinoma cells in an orchiectomy specimen, although usually strongly suggestive of metastatic adenocarcinoma from a primary tumor in another organ, may be a primary testicular neoplasm of germ cell tumor origin. This is the first report of testicular signet ring cell carcinoma of germ cell tumor derivation.     

Thymic carcinoma presenting as cranial metastasis with intradural and extracranial extension: case report

OBJECTIVE AND IMPORTANCE: Thymic carcinoma is an uncommon malignant tumor that is different from thymoma. Cranial and brain metastases from this tumor are extremely rare. We report a thymic carcinoma with cranial metastasis and discuss the behavior of this tumor. CLINICAL PRESENTATION: A 50-year-old man presented with headache and a palpable scalp tumor. Computed tomographic scans and magnetic resonance images revealed an osteolytic tumor with intradural and extracranial extension in the right occipital bone. INTERVENTION: After gross total resection and histological diagnosis, further investigation revealed a primary thymic tumor in the anterior upper mediastinum and liver metastases. The patient received multiple-cycle chemotherapy (cisplatin and gemcitabine) for primary and metastatic lesions. CONCLUSION: Thymic carcinoma has a poor prognosis because of a high degree of malignancy, early metastasis, and delayed diagnosis. Thus, treatment of a patient with this tumor calls for prompt diagnosis, surgical treatment, and optimal adjuvant therapy.     

Malignant priapism associated with metastatic urethral carcinoma

We present a 40-year-old man with malignant priapism secondary to urethral squamous cell carcinoma. Magnetic resonance imaging revealed the tumor originating from the bulbous urethra, extending into the penile urethra and corpora spongiosa and cavernosa. A penile biopsy confirmed poorly differentiated squamous cell carcinoma of the urethra. Despite administration of systemic chemotherapy, the prognosis of the patient has worsened due to the extensive metastatic disease.     

Metastatic melanoma of the pituitary gland. Case report

The authors report on the clinical features and imaging studies in a case of metastatic melanoma of the pituitary gland. Cerebral metastatic melanoma and pituitary metastasis from any source are commonly associated with systemic metastasis, whereas pituitary metastatic melanoma without widespread disease dissemination is distinctly rare. This 46-year-old man presented with diabetes insipidus and anterior pituitary dysfunction 5 years after he underwent resection of a cutaneous malignant melanoma of the neck. Magnetic resonance imaging demonstrated the presence of melanin within a sellar tumor mass. Transsphenoidal resection was performed and histopathological examination of tumor material confirmed metastatic melanoma. Postoperative [18F]fluorodeoxyglucose-positron emission tomography revealed no other focus of hypermetabolism in the patient's body.     

Renal cell carcinoma metastatic to the tongue: a case report

We report a case of renal cell carcinoma (RCC) metastatic to the tongue in a 58-year-old female. The patient had undergone radical nephrectomy for renal cell carcinoma 5 years previously, and experienced multiple metastatic disease in lung, bone, and contralateral kidney, before she noticed yellowish tumor on the left border of the tongue. Microscopic appearances of the biopsied lingual tumor were almost identical to those of the primary kidney tumor, thus the diagnosis of lingual metastasis from renal cell carcinoma was established. This case represents the tenth case of RCC metastatic to the tongue.