Intra-abdominal metastases from primary carcinoma of the lung

The case of a 56-year old male with an intra-abdominal metastasis from a primary lung cancer is presented. He was admitted for abdominal obstruction, toxic syndrome and paraumbilical pain. He had a previous history of squamous cell carcinoma of the right lung, for which he had undergone a right upper lobectomy in 1995, four years prior to the development of the abdominal obstruction. A debulking operation and bowel resection for the intestinal metastasis was performed. Eleven months after this operation the patient developed a recurrence: he underwent another debulking operation with resection of the sigmoid colon, jejunal segment and a small part of the bladder. The patient is alive and well 13 months after the initial operation. Intra-abdominal metastases of bronchial carcinoma may be observed with greater frequency, because of the improved survival of the patients with lung cancer. Metastatic small bowel carcinomas are rare and should be considered in the differential diagnosis of acute abdominal syndromes of patients with known history of the lung cancer. Bowel resection and debulking of the metastatic tumour mass give the best palliation and improve short-term survival.     

Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tube placement is a safe and widely accepted alternate route for enteral alimentation in the head and neck cancer patient population. Cancer metastatic to a PEG tube exit site is a rare but serious complication of this procedure. We sought to determine the route of spread responsible for PEG site metastases such that we may prevent further occurrences of this highly morbid condition. We also report a case of PEG site metastasis at our institution. METHODS: We performed a MEDLINE search for the years 1962 to 2002 and conducted a review of the literature. In the case at our institution, a 63-year-old man was referred to our institution with recurrent squamous cell carcinoma of the right base of tongue; he also had a 1.5-cm left apical lung nodule. He underwent PEG tube placement at the time of staging panendoscopy. Six months after the original tube placement, he had an ulcerated mass develop at the PEG site; biopsy of the mass revealed squamous cell carcinoma histologically identical to the base of tongue tumor. He also had recurrent lung cancer and four hepatic lesions develop. RESULTS: In our MEDLINE search, of the five patients diagnosed with PEG site disease >10 months after PEG placement, all five (100%) had synchronous distant metastatic disease. In the group of patients diagnosed with PEG site metastases < or =10 months after PEG placement, only four (24%) of 17 had synchronous distant metastatic disease. All patients underwent PEG placement by means of the "pull" technique. Direct implantation with a variable-sized initial tumor burden can explain all cases of PEG site metastasis. The presence of distant metastases is representative of the natural history of advanced head and neck malignancies. Smaller initial tumor implants present later than would larger initial tumor burdens, when the patient is more likely to have distant metastatic disease. In the case at our institution, the patient did not respond to treatment for his hepatic and PEG site metastases and his lung cancer, and he died 4 months after detection of the PEG site metastasis. CONCLUSIONS: PEG site metastases are iatrogenic complications of PEG tube placement in patients with squamous cell carcinoma of the upper aerodigestive tract. The use of laparoscopic, open, or the "push" technique of PEG tube placement in patients with head and neck cancer may prevent direct implantation of malignant cells into an enteral access site.     

Secondary penile tumors: report of two cases

Two cases of secondary penile tumor are reported. The first was a 69-year-old man with the complaint of continuous painful penile erection. He had been diagnosed to have left lung cancer, squamous cell carcinoma, and was treated with chemotherapy as well as irradiation 10 months previously. He underwent amputation of penis and histopathologically diagnosed to have penile metastasis from the lung cancer. The second was a 60-year-old man who had been treated by Miles' operation due to rectal cancer, adenocarcinoma, 24 months previously. Autopsy demonstrated continuous invasion in a corpus cavernosum of rectal cancer which had locally recurred. We reviewed and discussed briefly 74 cases with secondary penile tumor collected from the Japanese literature.     

Thymic squamous cell carcinoma

In the case described, a 43-year-old man had an asymptomatic mass involving the right hilar and superior mediastinum. At surgery, the tumor was found to have invaded the right middle lobe of the lung and the pericardium. The mass was found to be a thymic squamous cell carcinoma, a rare tumor. Two serum tumor markers--lipid-associated sialic acid and squamous cell carcinoma antigen--were elevated. The patient underwent postoperative radiation therapy and has responded favorably to treatment. He had no clinical evidence of metastasis or recurrence as of 43 months postoperatively.     

Laparoscopic adrenalectomy for solitary metachronous adrenal metastasis from lung cancer: Report of a case

We report herein the case of a 69-year-old man who underwent laparoscopic adrenalectomy for a solitary adrenal metastasis 10 months after a left lower lobectomy for T2N1M0 lung cancer. A 30×20 mm tumor was found in the left adrenal gland, and dissected using an ultrasonically activated scalpel. Histological examination revealed metastatic squamous cell carcinoma. The patient recovered uneventfully and his condition is now stable 18 months after the second operation, with no evidence of local recurrence or metastatic disease. Although laparoscopic resection for malignant adrenal tumors is still controversial, we consider that laparoscopic adrenalectomy may be an optional treatment for metastatic adrenal tumors, provided the tumor is solitary, small in size, and well-localized. To our knowledge, only 14 cases of laparoscopic adrenalectomy for malignant tumors have been reported to date; however, this is the first case of successful laparoscopic adrenalectomy for a metastasis from lung cancer.     

Testicular metastasis from squamous cell carcinoma of the lung

We present a case of squamous cell carcinoma of the testis that metastasized from lung cancer. The patient, who had received left pneumonectomy 2 years earlier for squamous cell carcinoma (SCC) of the lung, developed pulmonary metastasis, which was treated with chemotherapy. Although the recurrence regressed after treatment, the testicular tumor progressed gradually. Left radical orchiectomy was performed. Pathological examination revealed metastatic SCC. Testicular metastasis from lung cancer is a very rare disease.     

Successful resection of endotracheal metastatic lung cancer using percutaneous cardiopulmonary support system: a case report

We experienced a rare case of endotracheal metastasis derived from squamous cell lung cancer. The patient was 56 year-old male whose primary lung cancer of the left upper lobe was completely resected. Pathological diagnosis indicated stage IIB and he underwent two cycles of chemotherapy with CDDP + VDS. He had been asymptomatic thereafter, however, two years postoperative chest CT revealed a nodular lesion of the anterior carinal wall. Bronchofiberoptic examination showed same as CT finding and its brushing cytology confirmed squamous cell carcinoma. WE successfully resected his endotracheal metastatic lesion and reconstructed by direct sutures assisted by PCPS (Percutaneous Cardiopulmonary Support System). His postoperative course was uneventful. Majority of the reported cases of endotracheal metastases were treated conservatively as radiation, laser and/or chemotherapy. We conclude that PCPS is useful device for surgical management for selected cases.     

Small cell carcinoma of the urinary bladder with synchronous esophageal cancer and incidental lung cancer: a case report]

We present a case of triple primary cancers occurring synchronously in the urinary bladder, esophagus, and incidentally in the lung. A 65-year-old man with a chief complaint of gross hematuria was admitted to our hospital. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a non-papillary broad-based bladder tumor. Histological diagnosis was transitional cell carcinoma of the urinary bladder and he underwent one course of neoadjuvant chemotherapy (M-VAC) with the preoperative diagnosis of T3bN0M0. After one course of chemotherapy, chest CT, lymph node biopsy and esophagoscopy revealed squamous cell carcinoma of the esophagus. He first underwent radiochemotherapy (total 70 Gy, CDDP 5 mg x 41, 5-FU 250 mg x 24) for esophageal cancer and achieved complete remission. Then, he underwent radiotherapy for a total of 60 Gy for bladder cancer. However, his general condition gradually became worse and he died from metastatic cancer. The autopsy proved that he died from multiple metastases of small cell carcinoma of the urinary bladder and incidentally squamous cell carcinoma of the lung was identified.     

Solitary skin metastasis after lung cancer resection

A 75-year-old woman admitted for an abnormal chest X-ray shadow was found in transbronchial lung biopsy to have malignant cells. After right lower lobectomy with mediastinal lymph node dissection, pathological examination showed primary pulmonary squamous cell carcinoma (pT2N1M0, stage IIB). After discharge, we followed her up as an outpatient, with oral administration of uracil and futrafur (300 mg/day). Five months postoperatively, a subcutaneous mass detected on her back and surgically removed was found histologically to be metastatic squamous cell carcinoma of subcutaneous tissue from lung cancer. No other metastases were found. The patient has survived 3 years and 3 months since primary surgery and remained cancer-free 2 years and 11 months since resection for skin metastasis. Given that skin metastasis is detected when most patients are in an advanced stage of disease, our case was a rare one of solitary skin metastasis after resection for lung cancer.     

Acute pulmonary embolism performed embolectomy under percutaneous cardiopulmonary support successfully after lung cancer operation

We have experienced a case of acute pulmonary embolism after lung cancer operation. The case was a 74-year-old male. He underwent left upper lobectomy due to squamous cell carcinoma. He fell into shock state suddenly on the 6th day postoperatively. We diagnosted acute pulmonary embolism, performed urgent embolectomy under percutaneous cardiopulmonary support (PCPS). Postoperative course was smooth, and he has returned to normal daily life. Urgent diagnosis and management are indispensable for acute pulmonary embolism after lung cancer operation from the aspect of residual among of pulmonary vascular bed.     

A case of lung squamous cell carcinoma with metastases to the duodenum and small intestine

Gastrointestinal metastasis of lung cancer is fairly rare, and metastasis to the duodenum is very uncommon. We report a case of duodenum and small intestine metastases of lung squamous cell carcinoma. The patient was a 66-year-old man. He was diagnosed with lung squamous cell carcinoma (T4N3M1 [mediastinum, cervical lymph node, and duodenum metastases], stage IV). He noted a sense of abdominal fullness on the evening of the day chemoradiotherapy was given, and emergency surgery was performed for suspected perforation of the digestive tract. Intraoperative findings included a tumor in the small intestine with a perforation at the tumor site; partial resection of the small intestine, including the tumor, was performed. Small intestine metastasis of lung cancer was diagnosed following histopathologic examination. When lung cancer patients complain of abdominal symptoms, it is important to consider gastrointestinal metastases in diagnosis and treatment.     

Metastatic soft tissue squamous cell carcinoma

Metastatic squamous cell carcinoma of the soft tissue is extremely rare. We report two patients with soft tissue metastasis from squamous cell carcinoma of the cervix in one and scalp in another. Case 1: A 63-year-old black woman with a history of cervical cancer presented with a painful mass over the right scapula. An incisional biopsy revealed squamous cell carcinoma. She underwent radiation treatment followed by wide local excision with en bloc resection and a myocutaneous flap closure. Case 2: A 46-year-old white man with a history of squamous cell carcinoma of the scalp and two kidney transplantations requiring long-term immunosuppression presented with a 2-month history of a left proximal arm mass. Magnetic resonance imaging revealed that the mass was within the triceps muscle and fixed to the humerus. Biopsy revealed squamous cell carcinoma. He underwent a shoulder disarticulation for tumor invasion into the adjacent humerus and neurovascular bundles. The patients remain disease-free at 12 and 8 months, respectively. To our knowledge there are no reports of soft tissue squamous cell carcinoma metastatic from the cervix and only rare cases from the lung, head, and neck. The optimal mode of treatment and prognosis is undefined in these patients because of its rare incidence. Surgery and radiation with curative intent were used.     

Squamous cell bronchogenic carcinoma with syndrome of inappropriate secretion of antidiuretic hormone

Non-small cell lung cancer with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is rare. A case of squamous bronchogenic carcinoma with SIADH is reported. A 64-year-old man was admitted with 2 cm nodule of the left lung on chest radiography. Transbronchial lung biopsy revealed the squamous cell carcinoma. His past history included hypertension and hemiparesis due to brain infarction. Serum sodium level was low (122 mEq/l) and serum osmolarity was low (271 mOsm/kgH2O). However, urine sodium level was high (82 mEg/l) and urine osmolarity was high (461 mOsm/kgH2O). Renal and adrenal function was normal. He was diagnosed with cT1N0M0 squamous bronchogenic carcinoma accompanied by SIADH. He underwent left upper lobectomy with lymph node dissection. Five months after the operation, serum sodium level returned to normal. He remains well 20 months after the operation.     

Diffusely infiltrative squamous cell carcinoma of the esophagus presenting diagnostic difficulty: report of a case

We report a rare case of diffusely infiltrative squamous cell carcinoma of the esophagus. The patient, a 68-year-old man, was admitted to our hospital for investigation of dysphagia. Esophagography and upper gastrointestinal endoscopy revealed esophageal stenosis and gastric cancer. As a biopsy from the esophagus revealed no sign of malignancy, he underwent only distal gastrectomy. After 3 months, the stenosis became worse. Again, biopsy from a gastrointestinal endoscopy showed no malignancy, but endobronchial ultrasound-guided transbronchial needle aspiration revealed squamous cell carcinoma of the esophagus. Despite various treatments, the patient died of disease progression 20 months after its onset. Autopsy revealed diffusely infiltrative squamous cell carcinoma of the esophagus, which is a rare malignancy with few case reports documented.     

A long survival case of small cell lung cancer synchronized with renal cancer]

A long survival case of small cell lung cancer synchronized with renal cancer was reported. The patient was a 73-year-old male, complaining of cough and fever up. The chest roentgenogram showed a tumor mass in the right lower lung field. The specimen obtained from transbronchial lung biopsy of right S8b was diagnosed as small cell carcinoma of lung. In the check of the metastasis to other organs, abdominal CT scanning and the echogram demonstrated a solitary mass in the left kidney. We supposed a possibility of primary renal cancer rather than the metastasis from the lung because of being solitary mass, no existence of the metastasis except the kidney, and from the finding of the renal angiography. The patient underwent left nephrectomy for the renal cancer, and also underwent right lower lobectomy for the lung cancer after neo-adjuvant chemotherapy using cisplatinum and carboquone. Pathologically, the renal lesion was diagnosed as typical clear cell carcinoma of the kidney. He has survived for more than 4 years.     

Combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis

We report here a case of combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. A 61-year-old female presented with right flank discomfort, microhematuria and progressive renal dysfunction. Following diagnosis of right renal pelvic carcinoma, radical nephroureterectomy with lymph node dissection was performed through a midline incision. The tumor was pathologically diagnosed to be combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. The patient had no evidence of recurrence or metastasis, 16 months postoperatively. Small cell carcinoma or sarcomatoid squamous cell carcinoma of the renal pelvis is very rare. We believe this is the first such case to be reported in the world.     

Surgical treatment for small bowel metastasis of pleomorphic carcinoma 6 months after pulmonary resection

The prognosis of patients with distant metastases of pulmonary pleomorphic carcinoma is poor. We report a case of pulmonary pleomorphic carcinoma patient who underwent surgical resection of small bowel metastasis. A 69-year-old man developed anemia secondary to melena 6 months after right upper lobectomy for pulmonary pleomorphic carcinoma and small bowel metastasis was detected endoscopically. He underwent laparoscopic ileocecal resection and has survived for 2 years after lung cancer resection without any other recurrence or metastasis.     

Bladder carcinoma associated with hypercalcemia: report of 3 cases

Three cases of bladder carcinomas associated with hypercalcemia were presented. Case 1: A 43-year-old male was diagnosed as having bladder carcinoma 2 years ago and treated in another hospital by partial cystectomy with uretero-vesiconeostomy of the left side. On March 6, 1985, in our clinic, he received a total cystectomy with an ileal conduit for urinary bladder carcinoma. A 5-month post-operative clinical examination showed recurrence of the carcinoma with elevated serum Ca level (15.6 mg/dl). He was treated with eel-calcitonin, predonine, indomethacin, and furosemide, but died on August 23, 1985. Autopsy disclosed carcinoma of the urinary bladder (transitional cell cancer much greater than squamous cell cancer). Case 2: A 51-year-old male was diagnosed as having transitional carcinoma of the urinary bladder and was treated in our clinic by total cystectomy with cutaneous ureterostomy. Three months after the operation, he was readmitted with complaints of anorexia and disturbances of consciousness. His serum Ca level was elevated (17 mg/dl), and clinical examination showed recurrence of the carcinoma; bone scan revealed no metastasis. He was treated by radiotherapy with eel-calcitonin, predonine, indomethacin, and furosemide, but died on October 22, 1985. Autopsy disclosed carcinoma of the urinary bladder (squamous cell cancer). Case 3: A 72-year-old male was diagnosed as having a large urinary bladder tumor. An IVP showed a left non-functioning kidney. On admission, he complained of anorexia and confusion. His serum Ca level was elevated (13.8 mg/dl); bone scan revealed no metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of metastasis of lung cancer to renal cell carcinoma]

A 62-year-old male was admitted with abnormal shadow in chest X-P. CT and other examinations were done, and he was diagnosed left renal cell carcinoma with metastatic lung cancer. He rejected operation and was discharged. We gave him alpha-interferon injection every day. About 5 months later, he complained of fever and dyspnea, and was admitted. On the 10th day after admission, he died suddenly with massive hemoptysis. This hemoptysis was from the pulmonary artery, which was surrounded by tumors and ruptured into the trachea. Pathological diagnosis was double cancer, such a case is very rare with a primary lung cancer (oat cell carcinoma) which has metastasized into a renal cell carcinoma (common type, clear cell subtype).     

肺癌淋巴结转移特点的研究

目的：探讨肺癌淋巴结转移频度、分布及特点，为淋巴结清除术提供依据。方法：按Naruke肺癌淋巴结分布图对348例肺癌病人施行根治性手术及系统性淋巴结清除，分析其淋巴结转移特点。结果：3689组淋巴结N1转移率23．4％，N2转移率16．5％。Tis期肺癌无淋巴结转移；T1期以后各期肺癌N1、N2均可见转移；T1期、T2期鳞癌和腺癌N2转移率相比差异有显著性；淋巴结转移频度与T分期直线相关。肺下叶癌较肺上叶癌更容易转移至纵隔。肺上叶癌较肺下叶癌更容易发生跳跃式纵隔转移。结论：淋巴结转移腺癌比鳞癌活跃，小细胞肺癌最活跃，且随着T分期增加而增加；肺癌可跨区域纵隔转移；除T1期鳞癌不进行系统性淋巴结清除亦有可能达到根治目的外，其余类型肺癌均应进行系统性淋巴结清除。