Metastatic Adenocarcinoma of Parotid Gland Originating from the Ampulla of Vater: Case Report and Review of the Literature

Aim

To report a rare case of metastasis from an adenocarcinoma of the ampulla of Vater to the parotid gland.

Patients and Methods

In February 2004, a 61-year-old male underwent Whipple surgery due to a grade II adenocarcinoma of the ampulla of Vater (stage IB:pT₂N₀M₀). Post surgery, the patient did not receive any adjuvant treatment, but was followed up regularly. Two years post surgery, an abdominal computed tomography (CT) revealed metastatic hepatic lesions. The patient subsequently underwent three lines of chemotherapy without significant response. Two months after chemotherapy (April 2007), the patient complained of a painless lump in the parotid region that was progressing fast. Not long after presentation, the mass caused severe local pain that was hardly managed with opioid analgesics. A head and neck CT depicted a 5?×?4?×?3 cm solid mass that was infiltrating the masseter and pterygoid muscles, the mandible, and parotid gland. Fine needle aspiration showed that the infiltrating mass was due to an adenocarcinoma of the ampulla of Vater. The patient subsequently received palliative radiotherapy (50.4 Gy), achieving a considerable therapeutic response.

Conclusions

Metastasis of adenocarcinoma of the ampulla of Vater to the parotid gland has not to our knowledge been previously reported. Radiotherapy offers an excellent means of palliation with minimal morbidity.     

Metastatic Mantle Cell Lymphoma to the Pituitary Gland: Case Report and Literature Review

We present an unusual case of a metastatic mantle cell lymphoma (MCL) to the pituitary gland. The patient had a known history of MCL for which she previously received chemotherapy. She presented with new-onset diplopia and confusion, and reported a history of progressive vision blurriness associated with headache, nausea, and vomiting. MRI of the brain showed an enhancing lesion within the sella turcica involving the cavernous sinuses bilaterally, extending into Meckel''s cave on the left, and abutting the optic nerves bilaterally. Following surgical excision, histopathology revealed the tumor to be a MCL. Metastatic pituitary tumors are rare and have been estimated to make up 1% of tumors discovered in the sellar region. The two most common secondary metastatic lesions to the sella are breast and lung carcinoma followed by prostate, renal cell, and gastrointestinal carcinoma. Metastatic lymphoma to the pituitary gland is especially rare and is estimated to constitute 0.5% of all metastatic tumors to the sella turcica. To our knowledge, this is the first reported case of MCL metastasizing to the pituitary gland.Key Words: Mantle cell lymphoma, Metastasis, Pituitary gland, Sella turcica     

Breast Adenocarcinoma Metastatic to Epidural Cervical Spine Meningioma: Case Report and Review of the Literature

Summary While several cases of cancer metastatic to cranial meningiomas have been reported, metastasis to spinal meningioma has been reported only once, and a mechanism for such metastases has not been investigated. We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summarize the literature on metastases to central nervous system meningiomas, and suggest a possible mechanism. Our patient, a 55-year-old woman, presented with difficulty walking, back pain, and quadriparesis. Magnetic resonance imaging revealed an enhancing C3-4 epidural lesion and an L4 compression fracture. Because of concern that the fracture and epidural lesion might represent metastases, we performed a metastatic work-up, which revealed a right breast mass. The patient underwent C3-C4 laminectomies and an epidural lesion was encountered. Intraoperative frozen section revealed mixed meningioma and breast adenocarcinoma. A gross total resection was achieved and the patient subsequently received spinal irradiation and hormonal therapy. Whereas a literature review revealed numerous reports of metastases to cranial meningiomas, this represents only the second reported case of such pathology in the spine. Mechanisms of this unusual process likely include meningiomas’ vascularity, meningiomas’ slow growth providing nutrient availability, and perhaps, as suggested by our analysis, E-cadherin expression by both meningiomas and breast cancer. Metastasis to meningioma must be considered in an epidural spinal lesion in all patients with a known malignancy, with surgical aggressiveness tailored to the intraoperative pathologic diagnosis.     

Primary Synovial Sarcoma of the Thyroid Gland: Case Report and Review of the Literature

Synovial sarcoma (SVS) of the thyroid gland is exceedingly rare. We report the case of a 55-year-old man with a rapidly growing 7-cm neck mass. Because of suspicion of anaplastic thyroid carcinoma, a total thyroidectomy was planned, without preoperative cytology. During surgery, the tumor ruptured, leading to fragmented and incomplete resection. The morphological and immunohistochemical aspects suggested thyroid SVS, which was confirmed by fluorescent in situ hybridization (SYT gene rearrangement). The patient experienced immediate local relapse in close contact with large vessels and the thyroid cartilage and was referred to our institution. Doxorubicin-ifosfamide chemotherapy led to a minor response that authorized secondary conservative surgery. Because of microscopically incomplete resection, adjuvant radiotherapy was chosen and is ongoing 10 months after initial surgery. The prognosis of thyroid SVS is associated with a high risk for local and metastatic relapses. Pretreatment diagnosis is fundamental and may benefit from molecular analysis. Margin-free monobloc surgical excision is the best chance for cure, but adjuvant chemotherapy and radiotherapy deserve to be discussed.Key words: Primary synovial sarcoma, Thyroid gland, Chemotherapy, Prognosis     

Subcutaneous Metastatic Adenocarcinoma: An Unusual Presentation of Colon Cancer - Case Report and Literature Review

Subcutaneous metastasis from a visceral malignancy is rare with an incidence of 5.3%. Skin involvement as the presenting sign of a silent internal malignancy is an even rarer event occurring in approximately 0.8%. We report a case of a patient who presented to her dermatologist complaining of rapidly developing subcutaneous nodules which subsequently proved to be metastatic colon cancer, and we provide a review of the literature.     

Thyroid Hemiagenesis: Report of a Case and Review of Literature

Our objective was to report an incidental finding of thyroid hemiagenesis in a patient who presented with a left neck mass, present a review of literature, and to discuss management of this diagnosis. Case report and review of literature. An internet-based literature search was performed via Pubmed with key words, “hemithyroid agenesis, thyroid hemiagenesis, absent thyroid gland”. Clinical, pathological, radiologic data and follow up information is reported. A 55 year old woman with a left neck mass presented to our service. A diagnostic CT scan of the head and neck revealed an unrelated finding of an absent left thyroid lobe. A review of the CT imaging did not reveal ectopic thyroid tissue. A complete physical examination including a flexible laryngoscopy was unremarkable. The neck mass was pathologically a granulomatous lesion on surgical pathology. Thyroid function tests were within normal limits. In follow-up, patient remains asymptomatic. Hemithyroid agenesis is most commonly associated with hyperthyroidism, although, hypothyroidism has been reported. Pathology that can be associated in the remnant thyroid lobe includes adenocarcinoma, adenoma, multinodular goiter, and chronic thyroiditis. In counseling patients, it is important to educate them regarding these associated conditions and offer appropriate work up if indicated. Incidental thyroid agenesis with a negative work up can then be observed.     

Primary Duodenal Adenocarcinoma without Stenosis: A Case Report with a Brief Literature Review

This article focuses on the symptomatic and diagnostic problems of primary duodenal adenocarcinoma (PDA) by way of two case reports and a literature review. An 85-year-old woman with an adenocarcinoma in the 1st duodenal portion was offered palliative care. A 90-year-old woman with an adenocarcinoma in the 3rd duodenal portion was also offered palliative care. A unique finding in the two cases reported herein is that PDA did not cause stenosis and occlusion of the lumen. As no reports of PDA without stenosis have been published so far, these cases may add to our knowledge of PDA. The diagnosis of PDA is often delayed because its symptoms may be absent until the tumor has progressed, thus leading to a delay of several months. Patients typically present with a long history of variable and vague symptoms, and many are diagnosed with advanced disease. As regards clinical manifestations, abdominal pain is the most frequent symptom. The majority of these tumors are found to have infiltrated the duodenal wall at presentation, with many being unresectable due to local and distal invasion. Esophagogastroduodenoscopy and gastrointestinal barium radiography are the main diagnostic tests for PDA, detecting 88.6 and 83.3% of tumors, respectively. In some cases, ultrasonography or computed tomography are useful for detecting PDA and determining vascular invasion.Key words: Primary duodenal adenocarcinoma, without stenosis; Primary duodenal adenocarcinoma, first portion; Primary duodenal adenocarcinoma, third portion; Best supportive care; Symptoms; Clinical manifestations     

结肠腺癌转移至牙龈1例报道及文献复习

0?引言 结肠癌是我国常见的消化道肿瘤之一,而口腔转移癌临床罕见,约占所有口腔恶性肿瘤的1％[1],可能发生在口腔软组织或颌骨.其中颌骨,尤其是下颌骨,比口腔软组织更易受累(2:1),在口腔软组织中,最常见的病变部位是牙龈(54％)[2].已有报道称牙龈癌转移来自肺、前列腺、直肠癌、肾上腺癌和乳腺等,结肠癌的牙龈转移报...     

Nasopharyngeal Carcinoma Metastasis to the Pituitary Gland: A Case Report and Literature Review

While nasopharyngeal carcinoma (NPC) commonly invades the skull base, true central nervous system metastasis is a rare phenomenon. We report a case of NPC metastasis to the pituitary gland and review the literature for similar events. Eight months after his definitive radiation therapy, our patient presented with symptoms of optic chiasm compression and panhypopituitarism. Medical imaging revealed a pituitary mass but demonstrated no evidence of skull base erosion or direct intracranial extension. Subsequent biopsy of the pituitary lesion was confirmed as NPC in origin with Epstein-Barr virus-encoded RNA in-situ hybridization studies. The patient was treated with high dose chemotherapy followed by autologous stem cell transplant, which produced short-term symptomatic relief and at least a 7 month survival.     

Metastatic Renal Oncocytoma: A Case Report and Review of the Literature

Oncocytic renal tumour is an uncommon tumour and considered by many to be benign. Metastases are extremely rare. A case of renal oncocytoma with extensive skeletal metastases is described and the relevant literature reviewed     

Tracheal Adenocarcinoma Treated with Adjuvant Radiation: A Case Report and Literature Review

Primary adenocarcinoma of the trachea is extremely rare and a standard treatment does not exist due to nonavailability of evidence-based randomized control studies. This paper reports the case of a 60-year-old male, who presented with cough and occasional respiratory distress. Bronchoscopic examination and a computed tomography scan revealed a soft tissue mass in the trachea arising from the posterior tracheal wall. Cytological examination and immunochemistry confirmed primary adenocarcinoma of the trachea. Excision of the tumor followed by three-dimensional conformal radiation therapy was performed, and a dose of 56 Gy was delivered to the primary site. Two and a half years after treatment, the patient has no clinical or radiological evidence of the disease, and no late complication has occurred.Key Words: Tracheal neoplasm, Adenocarcinoma, Adjuvant radiation     

Recurrent Metastatic Chordoma to the Liver: A Case Report and Review of the Literature

Chordoma is a rare malignant neoplasm derived from notochordal tissue that primarily affects the axial skeleton. Almost 40% of patients have non-cranial chordoma metastases. The most common metastatic sites are the lungs, bones, lymph nodes, and subcutaneous tissue. We present a 52-year female with a history of sacral chordoma presenting with abdominal fullness, early satiety, and a palpable abdominal mass. Abdominal magnetic resonance imaging (MRI) revealed an isolated, highly vascularized, and multilobed liver mass in the left lateral segment. The mass was surgically removed using a clean surgical margin. A histological examination and immunohistochemical staining were consistent with a metastatic chordoma. Two years later, follow-up imaging studies showed a 6.5 × 4.0 × 2.0 cm right liver lesion with multiple lungs, chest wall, pleural, and diaphragmatic lesions. Microscopic- and immunohistochemical staining revealed a recurrent metastatic chordoma. Herein, we present a unique case of metastatic recurrent chordoma in the liver with the involvement of other sites. To the best of our knowledge, no other case of recurrent liver metastasis has been reported.     

肺高分化胎儿型腺癌1例报告并14例文献复习

肺高分化胎儿型腺癌(wel l-di f ferent iated feta l adenocarcinoma of lung, WDFA)是一种罕见的肺的低 度恶性肿瘤,文献[1]报告其发病率为所有肺部肿瘤的 0.25%-0.5%.我们报告1例肺高分化胎儿型腺癌,结合文 献复习探讨其临床特征、流行病学资料、治疗及预后, 提高医务人员对WDFA的认识.     

Oncocytoma of the Parotid Gland: A Case Report and Review of the Literature

We report the case of a patient who presented to the ENT service with left facial swelling of 5 months duration. Imaging studies revealed a dense expansive mass confined to the inside of the left deep parotid lobule and moderate enhancement following contrast media injection. Subsequently, a biopsy confirmed the presence of an oncocytoma. The patient was treated with total parotidectomy, complete tumor resection and sparing facial nerve surgery. Today, the patient is disease free and has no complications.Key words: Computed tomography, Magnetic resonance imaging, Parotid gland, Tumor, Oncocytoma     

直肠腺癌伴肛周Paget病1例

患者男性,68岁。因反复便血十余天,伴乏力、四肢酸软而入院。患者无发热,无腹痛、腹部包块,无恶心呕吐。体检:肛门及肛管触及乳头状隆起肿块,表面结节状,指套染血。污血涂片细胞学检查找到高度可疑癌细胞。结肠造影示直肠近肛门处可见黏膜部分中断,呈双边改变,并见充盈缺损影,管腔略变窄。肝胆B超见左肝内囊肿,胆囊结石,后腹膜及盆腔未见明显异常团块回声。实验室检查血常规,中性粒细胞升高,血AFP、CEA、CA199、CA125正常范围。病理检查结果:送检直肠癌Miles术标本,直肠长29cm,直肠近齿状线处见隆起型肿块,大小3.5cm×3.5cm×1cm,菜花…