Coincidence of dystrophia myotonica and pleomorphic adenoma of the parotid gland

Two patients with dystrophia myotonica and pleomorphic adenoma of the parotid gland are described. The probability that this coincidence could be due to chance is less than 1 to 1,000 (P less than or equal to 0.001). There are several reports in the literature of the association of myotonic dystrophy with neoplasia. The reason for their association is not understood.     

Intramedullary spinal cord metastasis from salivary ductal carcinoma of the parotid gland mimicking transverse myelitis in a patient with radiologically isolated syndrome

Intramedullary spinal cord metastases (ISCMs) are rare lesions but their presence should not be underestimated in a cancer patient with rapidly progressive neurological compromise. Due to similar timing of clinical progression and imaging characteristics, these lesions may be misdiagnosed as transverse myelitis, an inflammatory disorder of the spinal cord that may be idiopathic or secondary to other diseases including infections, connective tissue disorders, nutritional deficiencies, and demyelinating disorders. We present a case of a 44 year-old male with a history of parotid gland metastatic salivary ductal carcinoma (SDC) and incidental demyelinating white matter lesions on brain magnetic resonance imaging (MRI) diagnosed as radiologically isolated syndrome with a CSF that was positive for oligoclonal bands. The patient initially presented with mid-thoracic dermatomal numbness, bilateral lower extremity weakness, and neurogenic bladder. MRI spine demonstrated an enhancing T5–7 intramedullary lesion initially diagnosed as transverse myelitis. After progressing to complete motor and sensory loss below T6 despite high-dose intravenous steroids and plasmapheresis, surgical biopsy was undertaken. Intraoperative findings revealed an intramedullary tumor for which a subtotal resection was performed. Pathology was consistent with a metastatic deposit from the patient's primary parotid SDC. The patient underwent postoperative chemotherapy but expired due to systemic disease progression seven months following surgery without neurological improvement. This is the first reported case of ISCM from a primary SDC. The median survival is 6 months for patients with ISCMs treated surgically. The goals of surgery are spinal cord decompression, functional preservation, and tissue diagnosis.     

Cavernous sinus metastasis from thyroid papillary adenocarcinoma.

We report here an extremely rare case of cavernous sinus metastasis from thyroid papillary adenocarcinoma presenting long after initial diagnosis. A 41-year-old patient presented with a cavernous sinus tumor causing progressive diplopia 10 years after treatment for a papillary adenocarcinoma of the thyroid. After 5 years of close observation, subarachnoid hemorrhage developed from the cavernous sinus tumor extending to the cerebellopontine angle, at which point the patient underwent surgical removal of the tumor followed by gamma knife radiosurgery. The pathological diagnosis was papillary adenocarcinoma, indicating the distant metastasis from the thyroid. This case illustrates the unique event of a cavernous sinus metastasis long after initial treatment of the primary cancer.     

Dural metastasis of prostatic adenocarcinoma presenting as acute intracranial subdural hematoma: a case report

Intracranial malignant metastatic dissemination usually is seen as a unique nodular formation enhanced after intravenous injection of contrast medium. Forms mimicking meningioma or subdural hematoma have been described. We report a case of dural metastasis from an adenocarcinoma of the prostate in a 60-year-old man. The CT image suggested acute subdural hematoma.     

Solitary skull metastasis from mucoepidermoid mimicking a parotid tumour.

Metastatic parotid tumours in the skull are very rare. An interesting case of a mucoepidermoid parotid tumour metastasizing to the skull vault is described in a patient who had previously been operated for a pituitary adenoma 20 years back with no post operative radiotherapy; however, she required hormonal supplementation therapy. She underwent an operation for a parotid tumour 7 years ago and received postoperative radiotherapy for the parotid tumour away from the site of the skull metastases. No local recurrence of the parotid tumour was noted. The initial diagnosis was that of a solitary intradiploic meningioma. Interesting clinico-radiological findings are presented.     

Clinical features of brain metastasis from salivary gland tumors

Salivary gland tumors comprise a group of 24 tumor subtypes with a wide range of clinical behaviors and propensities for metastasis. Several prognostic factors have been identified that help predict the development of systemic metastases, most commonly to the lung, liver, or bone. Metastases to the brain are rare. To better understand the behavior of salivary gland tumors that metastasise to the brain, we performed a retrospective cohort analysis on a series of patients to highlight features of their medical and surgical management. From 2007 to 2011, a database of 4117 elective craniotomies were queried at a single institution to identify patients surgically treated for salivary gland metastases to the brain. Three patients were identified. Histologic subtypes included salivary duct carcinoma, poorly differentiated carcinoma, and papillary mucinous adenocarcinoma. They had all undergone previous treatment for their primary malignancy. The mean time to intracranial metastasis was 48 months from initial diagnosis (range, 14–91 months). Treatment for intracranial metastases included surgical resection, whole brain radiation, stereotactic radiosurgery, and chemotherapy. Intracranial metastases from salivary gland tumors are rare, present years after diagnosis of the primary tumor, and are treatable with multimodality therapy.     

Dural metastasis from prostatic adenocarcinoma mimicking chronic subdural hematoma

Dural metastasis is rare. In most reported cases, brain CT scan findings are mistaken for subdural hematoma or meningioma. We present here a 72-year-old male with a history of headache and progressive mental status changes. Brain CT scans suggested chronic subdural hematoma. However, the only surgical findings were diffuse thickening of the dura and sclerosis of the temporal bone. Histopathology revealed metastatic prostatic carcinoma. As the surgical approach and prognosis of chronic subdural hematoma and metastatic tumors are completely different, the differential diagnosis of these diseases is very important. A contrast-enhanced brain CT scan is recommended for patients who could possibly have dural metastases.     

Pancreatic adenocarcinoma metastatic to the pineal gland

Metastases to the pineal gland are rare and reported cases have consisted primarily of gastrointestinal and lung primary malignancies. Here we present the case of a 66-year-old female with autosomal dominant polycystic kidney and liver disease who was found at autopsy to have an unrecognized infiltrating ductal adenocarcinoma of the pancreas with metastases to the liver, lungs and pineal gland. As far as we are aware, this is the first report of a metastasis of infiltrating ductal adenocarcinoma of the pancreas to the pineal gland.     

胃肝样腺癌脑转移

目的介绍大脑实质转移性胃肝样腺癌的组织病理学特点和临床表现。方法对2006年4月20日收治的1例大脑实质转移性胃肝样腺癌患者的临床表现、影像学特点、既往史以及神经病理学结果等进行回顾性分析。结果临床表现为左侧颞顶部阵发性胀痛伴双眼视物不清，短暂性失语1月余；MRI检查显示左侧颞后叶肿物，拟诊为转移性脑肿瘤。3年前因胃贲门部、胃小弯侧溃疡型低分化腺癌行根治性全胃切除术：手术后8个月B超和CT检查发现肝内多发性转移癌，施行肝动脉血管栓塞术。对左侧颞叶转移灶和胃癌手术切除标本存档切片进行组织病理学观察．可见肿瘤呈实性结节状生长、多角形上皮样，有丰富的嗜酸性胞质，细胞核圆，核仁明显，结节间有血窦样裂隙似肝细胞癌；免疫组织化学染色甲胎蛋白阳性，肝细胞石蜡1单克隆抗体阴性，证实二者均为胃肝样腺癌。结论首次报告胃肝样腺癌大脑实质转移病例。提示，对于脑转移癌的组织病理学鉴别诊断需应用成组抗体．避免与肝细胞癌脑转移相混淆；尤其有淋巴结转移、淋巴血管侵袭或转移至其他脏器的患者，应密切注意监测脑转移的发生．     

Autonomic control of protein production by the parotid gland of the sheep

The role of adrenoceptors in the control of parotid salivary function has been investigated in anaesthetized sheep. The enhancement of parotid protein output that occurs when the parasympathetic and sympathetic innervations to the gland are stimulated simultaneously in bursts at a low frequency (20 Hz for 1 s at 10-s intervals) was effectively abolished by pretreatment with propranolol (> or = 1.0 mg kg(-1), i.v., P < 0.001), without a comparable reduction in the flow of saliva or in the output of sodium or potassium. Secretion of protein was similarly augmented by simultaneous stimulation of the sympathetic innervation and an intracarotid infusion of acetylcholine (0.4-0.6 microg min(-1) g gland(-1)). This effect was also abolished by pretreatment with propranolol. Pretreatment with phentolamine (>1.0 mg kg(-1), i.v.) had no effect on the output of protein that occurred during combined stimulation of the parasympathetic and sympathetic innervations but increased the flow of saliva and the output of electrolytes. Stimulation of the parasympathetic innervation to the parotid gland caused a substantial fall in vascular resistance, which was reduced by the administration of atropine (0.5 mg kg(-1)). Stimulation of the sympathetic innervation caused a substantial rise in parotid vascular resistance in atropinized sheep. This effect was greater during continuous stimulation than during intermittent stimulation and enhanced by pretreatment with propranolol. It was virtually eliminated by pretreatment with phentolamine. It is concluded that the enhancement of protein output from the ovine parotid gland, that occurs during combined stimulation of the parasympathetic and sympathetic innervations at relatively low frequencies, depends upon interaction between cholinergic muscarinic and beta-adrenergic receptors. The vasoconstriction that occurs during sympathetic stimulation alone can be accounted for by activation of alpha-adrenoceptors.     

Treatment of an intracranial germinoma spinal metastasis

A 20-year-old male with a solitary intradural extramedullary spinal metastasis from a pineal germinoma presented with progressive spinal cord compression. This was initially treated with radiotherapy and the patient showed rapid clinical improvement with complete resolution of his neurological symptoms and signs. Subsequent systemic chemotherapy resulted in complete radiological resolution of the lesion. This case is presented to demonstrate radiotherapy and chemotherapy as a treatment option for germinoma 'drop' metastasis causing spinal cord compression, along with a review of the literature.     

Mandibular ameloblastoma with intracranial extension and distant metastasis

A case of mandibular ameloblastoma which invaded intracranially through the skull base and developed distant metastasis to the femur is reported. The intracranial extension of the tumor was partially removed three times and the metastasis of the femur was curetted. The remaining tumor temporarily responded to chemotherapy, but the patient died of intracranial tumor regrowth. The period from the initial treatment of the mandibular tumor to death was 21 years.