Colon cancer presenting with polymyositis-A case report

Introduction

Colorectal cancer most often presents with a change in bowel habit, weight loss or with bleeding per rectum. Much less commonly, colorectal cancer may present as part of a paraneoplastic syndrome. Polymyositis is a rare disease most often considered a complement-mediated idiopathic inflammatory myopathy manifested by proximal muscle weakness. However, polymyositis may also be part of a paraneoplastic syndrome associated with an underlying malignancy. The relationship between polymyositis and malignancy is well known, but it has been suggested that tumours of the large bowel are rarely complicated by myositis.

Presentation of case

The authors describe a case report of an 82-year-old gentleman with a presumed musculoskeletal or neurological deficit who was subsequently diagnosed with metastatic colon cancer in the setting of progressive fatigue and muscle weakness. Concurrently, we review the current literature looking at the relationship between cancer and polymyositis.

Discussion

Colorectal cancer rarely presents with symptoms such as muscle weakness, however it is important to be aware of the possibility of an underlying malignancy when seeing patients with symptoms which are suggestive of polymyositis.

Conclusion

The diagnosis of polymyositis in the elderly population should raise suspicion of an underlying malignancy.     

Exfoliative urine cytology in the treatment of bladder cancer

Urine cytology in addition to cystoscopy and transurethral resection is an integral part in diagnostic and follow-up of transitional carcinomas. The WHO-Classification of 2004 distinguishes between low grade and high grade tumours. Cytological diagnosis had to be adjusted to this new classification. Above all cytology has to detect high grade lesions in a reliable manner. The sensitivity for these lesions ranges between 85?C95%. Well differentiated transitional cell carcinomas show marginal nuclear alterations compared to normal urothelial cells. Therefore the cytological low grade diagnosis is needless. Well differentiated papillary tumours can be detected with conventional cystoscopy in nearly 100 percent of all cases. This subtype of urothelial carcinomas is characterized by a very low rate of tumour progression despite a relevant rate of tumour recurrence. A negative cytology result combined with a cystoscopically proven papillary bladder tumour implies low grade disease with low risk of tumour progression.     

Feasibility of laparoscopic gastrectomy for advanced gastric cancer with positive peritoneal cytology

Purpose

The role of gastrectomy for patients with positive peritoneal cytology, but a negative macroscopic peritoneal implant (P?/cy+), remains unclear. The aim of this study was to evaluate laparoscopic gastrectomy for P?/cy+ patients.

Methods

This study reviewed a prospectively maintained gastric cancer database of gastric-cancer patients those underwent surgical resection. P?/cy+ gastric cancer that had invaded the subserosa, or deeper layers, of the stomach wall without distant organ metastases was considered operable in this institution. P?/cy+ patients underwent either open or laparoscopic gastrectomy with D2 lymphadenectomy. The short-term results were examined to assess differences in outcome between the two groups.

Results

Eighteen P?/cy+ patients without distant organ metastases underwent surgery between 2000 and 2010. Laparoscopic gastrectomy was performed in nine patients and open gastrectomy in nine patients. The estimated blood loss was significantly smaller, the resumption of food intake earlier, and the length of postoperative hospital stay shorter in the patients that underwent laparoscopic gastrectomy than in the patients that underwent open gastrectomy. There were no significant differences in the 2-year survival rates between the groups.

Conclusion

Laparoscopic gastrectomy for P?/cy+ patients is a minimally invasive and safe oncologic procedure with good short-term results.     

A case of advanced prostatic cancer presenting as inguinal mass

A 71-year-old man visited our hospital complaining of a nodule in the left inguinal region. Pathological and immunohistochemical examination of the prostate and the mass and clinical examination revealed a case of prostatic cancer with lymph node metastasis, stage D. Chemoendocrine therapy (diethylstilbestrol diphosphate, cisplatin, adriamycin and carboquone) was performed and the patient responded well. This case indicated the presence of an unusual prostatic cancer in which large non-regional superficial lymph node metastasis occurred.     

Value of urine cytology versus bladder washing in bladder cancer.

A prospective study compared the diagnostic outcome of paired urine cytology and bladder washings in 26 patients as well as the diagnostic accuracy of cytologic reading of voided urine in 43 patients, all with documented bladder cancer. We demonstrate the superiority of bladder washing over voided urine cytology and recommend its routine use in spite of the additional cost and patient discomfort.     

Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Purpose  

To determine the independent risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (UUT-UC).     

In advanced gastric cancer:Prognosis and treatment of patients with positive peritoneal cytology

Positive peritoneal cytology in gastric cancer is classified as M1 disease by the 7thEdition of American Joint Committee on Cancer staging system.With the introduction of laparoscopy and peritoneal washing cytology in the staging of gastric cancer a new category of patients has been identified.These are patients with no macroscopic peritoneal metastases but with peritoneal cytology positive(P0C1).Prognosis and treatment of such patientsrepresent a controversial issue.We evaluate the state of the art of staging system in gastric cancer and discusss tandardisation in staging and treatment procedures.There is still a lack of uniformity in the use of laparoscopy with peritoneal cytology in clinical decision making and in the surgical treatment for gastric cancer.Survival of this patient subset remains poor.Multimodal therapies and new therapeutic strategies are required to improve the survival of these patients.     

A case of esophageal cancer metastatic to the kidney presenting as renal pelvic cancer

A 50-year-old man, who had undergone operation of esophageal carcinoma 2 years earlier, was admitted with the complaints of right flank pain and macroscopic hematuria. Intravenous urogram showed right unvisualized kidney. Right retrograde pyelography showed the dilatation of calices and irregularity of middle and lower calices. Computed tomography revealed severe hydronephrosis of the right kidney. Right nephrectomy was performed under the diagnosis of either renal pelvic cancer or esophageal cancer metastatic to the kidney. Pathological examination revealed metastatic squamous cell carcinoma from esophagus. The patient was treated by radiotherapy but died 4 months after the surgical treatment. Literature on eight case of metastatic renal cancer from esophagus is reviewed.     

The clinical significance of urine cytology after a radical cystectomy for urothelial cancer

Objectives: To evaluate the impact of urine cytology on the prediction of the upper urinary tract recurrence (UTR) of urothelial cancer after a radical cystectomy (RC) with urinary diversion. Methods: A total of 125 patients who underwent RC from 1987 to 2005 were retrospectively identified. The median follow‐up period was 64 months. The specimens for urine cytology were obtained from the urine voided or obtained through a catheter or a conduit. The relationship between a positive urine cytology result and UTR detection was determined. Results: UTR was diagnosed in eight patients (6.4%) at a median follow‐up of 63.3 months. The overall rate of a positive urine cytology result was 12.3% for the urine in an ileal conduit, 18.8% in a continental reservoir and 10.5% in an orthotopic neobladder. The overall sensitivity and specificity of the urine cytology for the detection of UTR were 75.0% and 90.6%, respectively. However, UTR could be diagnosed earlier by using urinary cytology, rather than by radiological examinations and/or related symptoms in only 5.9% (1/17 positive urine cytology) of cases. Eleven (64.7%) of 17 patients with positive urine cytology were false positive and eight (72.7%) of the 11 patients with no UTR had a positive urine cytology result only once. Conclusions: Urine cytology after RC was not a potent screening tool for the early detection of UTR because of the difficulty in distinguishing the cancer cells from degenerated intestinal epithelial cells in the urinary diversion urine.     

The dilemma of suspicious urine cytology in patients being followed for bladder cancer

BACKGROUND AND AIMS: Urine cytology is gold standard for clinical tests used in the diagnosis and follow-up of bladder cancer. Cytology, however, exhibits variable sensitivity depending on tumour grade and interpretation of urine specimens is highly dependent on the skill of the examiner. Furthermore, a "suspicious" cytology report (class III) makes clinicians uncomfortable. In these cases, a more objective test, such as the BTA stat Test, may be useful in providing clarification. The aim of this study was to evaluate the dilemma of suspicious routine urine cytology and to determine whether the BTA stat Test provides diagnostic aid in this rare but controversial category. MATERIAL AND METHODS: 506 consecutive patients who were being followed for bladder cancer were included in the study. A voided urine sample was obtained prior to routine follow-up cystoscopy and split for culture and testing with the BTA stat Test. Clinical status of the disease was evaluated in patients with suspicious urine cytology, and the diagnostic aid of the BTA stat Test in these patients was determined. RESULTS: A total of 57 patients (11.3%) had urine cytology classified as suspicious. The BTA stat Test was positive in 29 (50.9%) and negative in 28 (49.1%) patients. Nineteen (33.3%) patients had recurrence at routine cystoscopy. Of the remaining 38 patients, 10 were further investigated due to a positive BTA stat Test. Two additional recurrences were detected bringing the total number of recurrences to 21 (36.8%), 48.3% (14/29) of the patients with positive and 25.0% (7/28) of the patients with negative BTA stat Test had recurrence (p = 0.069). Overall, 65.5% (19/29) of the patients with a positive BTA stat Test were found to have recurrence either at routine cystoscopy, at further investigations, or at the next cystoscopy compared to that of 35.7% (19/28) in those with negative testing (p = 0.024). The overall sensitivity of the BTA stat Test was 66.7%, and the specificity was 58.3%. CONCLUSIONS: At least a third of the patients under follow-up for bladder cancer with suspicious cytology had a recurrence, indicating that these patients are a risk group for recurrence. More importantly, a BTA stat Test result seems to provide some help in distinguishing those patients with very high risk for recurrence, for whom invasive further investigations should be conducted and a close follow-up policy maintained.     

Intrapleural chemotherapy improves the survival of non-small cell lung cancer patients with positive pleural lavage cytology

Purpose

Information regarding the treatment of pleural lavage cytology (PLC)-positive patients is still limited. This study evaluated the efficacy of intrapleural chemotherapy (IPC) in PLC-positive patients.

Methods

Three hundred eighty-six of the 567 lung cancer patients who underwent surgery had undergone PLC after thoracotomy, following by a complete resection were evaluated. IPC was performed after surgery, and cisplatin or adriamycin was injected intrapleurally through the thoracic tube.

Results

The pathological diagnosis showed that 17 patients (4.4 %) were positive for (or suspected to have) malignancy in their PLC. The univariate and multivariate analysis showed that only pleural invasion was a significant predictor of a PLC-positive status. The 5-year overall survival in PLC-positive patients was 38 % and that in PLC-negative patients was 84 %. Both the univariate (p < 0.01) and multivariate (p = 0.045) analyses showed that the status of PLC was significantly associated with the overall survival. Eight of the 17 PLC-positive patients underwent IPC. The 2-year OS rate in the patients treated with IPC was 88 % and that of those without IPC was 44 (p = 0.04).

Conclusion

IPC improved the postoperative survival in PLC-positive NSCLC patients, and a further prospective evaluation regarding this therapy is warranted.     

A case of metastatic malignant melanoma presenting with hematuria

We report a case of metastatic malignant melanoma that presented with macroscopic hematuria and lower urinary tract symptoms. Effective palliation of urinary tract symptoms was achieved with transurethral resection of metastatic lesions in the bladder. However, the patient was lost due to widespread disease despite systemic therapy. Solitary or multiple dark blue-black nodular or vegetating lesions encountered during cystoscopy should raise the suspicion of metastasis of malignant melanoma and be investigated accordingly.