Metastasis to the penis in a patient with adenocarcinoma of lung, case report and literature review

Metastasis of lung cancer to the penis is very rare; it causes various clinical symptoms seriously affecting the quality of life. Early recognition and appropriate management will likely enhance survival in these patients. Here, we report a case of penile metastasis secondary to pulmonary carcinoma along with a review of the literature. One case of penile metastasis secondary to pulmonary carcinoma was detected in a 51-year-old patient who was admitted to the First Affiliated Hospital of Sun Yat-Sen University with persistent cough along with swelling of the perineum and penis. The clinical features, diagnosis, and treatment of this disease along with a relevant literature are reviewed and discussed. A MEDLINE search was performed to identify similar reports in the literature. CT scan revealed lung mass, and a glans penis ulcer and enlargement of inguinal lymph nodes was discovered upon physical examination. CT-guided percutaneous puncture of the lung mass revealed adenocarcinoma of lung, and biopsies of the glans penis ulcer and inguinal lymph nodes confirmed metastatic adenocarcinoma. The patients received chemotherapy and died of acute pulmonary embolism in less than 2 months. Metastasis of lung cancer to the penis is extremely rare. It presents an advanced form of lung cancer, and thus survival is extremely short. Although treatment of penile metastasis is almost always palliative, early recognition may enhance survival for these patients.     

Extrapulmonary small cell: a novel case of small cell carcinoma of the thyroid gland

Neuroendocrine tumors comprise a large group of malignancies which share unique morphological features and are characterized by the presence of neuroendocrine markers such as synaptophysin, chromogranin-A, and CD56 (N-CAM), ranging from indolent tumors, such as carcinoid tumors, to aggressive tumors, such as small cell carcinoma. The lung is the most common site for primary neuroendocrine tumors. Extrapulmonary primary sites of small cell carcinoma are rare but have been documented arising from various sites including esophagus, stomach, colon and rectum, gallbladder, thymus, salivary gland, ovary, cervix, bladder, prostate, and skin. We present a case of small cell carcinoma arising from the thyroid gland, a site not previously described in the literature. A 59-year-old woman presented with a thyroid mass, which, after resection, showed small cell morphology and positive immunostains for TTF-1, synaptophysin, chromogranin-A, CD56, etc. Five months after diagnosis, she had widely metastatic disease. After a near-complete response to the first chemo-treatment, her disease progressed. Following local radiation and more rounds of chemotherapy, she succumbed to the disease, 15?months after diagnosis. Our patient had no pulmonary lesions at the time of diagnosis to suggest metastasis from the lung. Much like its pulmonary counterparts, this small cell carcinoma of primary thyroid origin displayed an aggressive clinical course and poor outcome. Although it shows early sensitivity to chemotherapy, small cell carcinoma remains a difficult-to-treat cancer with a poor prognosis and can rarely be seen originating in organs outside of the lung.     

Unusual metastasis in colorectal cancer

Metastasis from colorectal carcinoma occurs by either lymphatic or hematogenous spread. The most common sites of colorectal metastasis are the liver and lung. Involvement of the skin, muscles and bones are quite rare. The prognosis in such patients is usually poor. Herewith, we are reporting a case of colonic carcinoma who had cutaneous metastasis, muscular involvement and diffuse skeletal metastasis. At the end, she had brain metastasis, but liver and lung involvement was not observed till the end.     

Adenoid cystic carcinoma of the larynx

Adenoid cystic carcinoma of the larynx is rare. Only 7 cases have been treated in our hospital from 1959 to 1986, which comprised 0.7% of all laryngeal malignancies in the same period. Of the 7 cases, there were 5 males and 2 females with the average age of 47. The symptoms at the time of diagnosis varied according to the size and location of the tumor. Three lesions were considered as supraglottic and one as subglottic. Six cases were treated by surgery and one by radiotherapy alone. The most common site of distant metastasis was the lung. The average survival was long even in those with pulmonary metastasis.     

A complicated case of lung cancer and pulmonary tuberculosis initially presented with painful scapular metastasis in other side

We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography (CT). Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor. Same side lung biopsy and histopathological study characterized tuberculosis but biopsy of the left lung lesion identified adenocarcinoma of the lung. The final diagnosis was right scapular metastatic lesion from left lung adenocarcinoma. Musculoskeletal symptoms are commonly encountered in lung malignancies due to paraneoplastic syndrome or hematogenous metastasis but scapular metastasis on the other side as the presentation of lung cancer is extremely rare.     

Asymptomatic Pelvic Metastasis from Thymic Carcinoma: A Case Report

Thymic epithelial tumors are rare and often occur somewhere local. Metastatic sites of thymic carcinomas (Masaoka-Koga stage IVb) are mostly seen in the lung, liver and brain. We report a 64-year-old female with an initial diagnosis of thymoma B3 who first showed thoracic recurrences and then an asymptomatic isolated pelvic metastasis from her thymic carcinoma.Key words: Thymic carcinoma, Thymoma, Extrathoracic metastasis, Pelvic metastasis, Positron emission tomography     

Hemodynamic considerations in organ and tissue patterning of B16 melanoma systemic metastasis and colonization.

Several populations of the mouse B16 melanoma that are highly metastatic from subcutaneous transplants but differ in growth characteristics were compared with regard to systemic site patterning of visible metastasis, as well as colonization effected by intracardiac injection of tumor cells. In all cases, metastasis proceeded in two stages, initially to the lungs and secondarily from lung metastases to systemic sites. The relative ranking of systemic site involvement by secondary-stage metastasis was basically similar for all tumor cell populations; the overall hierarchy was: kidneys greater than brain greater than adrenals and ovaries greater than pancreas greater than mesentery. Colonization patterns resulting from intracardiac injection were also generally comparable but differed from metastasis patterning in that the kidneys and brain were poorly colonized while the bones were frequent sites of colonization. Enumeration of fluoresceinated tumor cells or microbeads trapped in various sites following intracardiac injection revealed a ranking of initial involvement that differed markedly from colony formation. These results indicate that the hemodynamics of blood flow is not a critical determinant of colonization patterning. Based on the colonizing behavior of microbead-bound tumor cells, the frequent metastatic involvement of the kidneys and brain appears to result from selective trapping of large multicell tumor emboli within arteries in those organs. The occurrence of metastasis in other systemic sites is, like colonization, not readily explained by hemodynamics.     

肺癌合并眼部转移:单中心回顾性研究并文献综述

背景与目的 眼部转移(ocular metastasis)是肺癌少见转移之一,影响患者生活质量.本研究旨在探讨肺癌合并眼转移患者的临床特征及预后.方法 回顾性分析肺癌合并眼部转移9例患者的临床资料,回顾近10年文献报道共42例患者的临床特点.结果 9例患者的中位年龄为51岁(范围:41岁-61岁),其中7例诊断为非小细胞肺癌(包括腺癌6例);1例为小细胞肺癌;1例病理不详.眼转移部位方面,脉络膜8例,虹膜1例.文献回顾中,小细胞肺癌占21.4%(n=9),腺癌占47.6%(n=20),脉络膜是最常见的眼转移部位(66.7%,n=28).肺癌合并眼转移患者,系统化疗的疾病控制率仅为28%,联合眼部局部治疗可有效控制眼部症状.结论 肺癌合并眼部转移以肺腺癌多见,脉络膜转移是肺癌眼部转移的最常见转移部位.眼部局部治疗可控制局部症状,但系统性化疗疗效差.     

Primary Tuberculosis of Upper Airway: Case Report of 3 Rare Presentation

Tuberculosis of the upper airway is usually seen in conjunction with primary pulmonary tuberculosis. Primary tuberculosis of this area without involvement of the lung is very rare and often mistaken for malignancies. We report here three patients (2 male & 1 female) who presented with different symptoms and on investigations revealed to be suffering from tuberculosis of the upper airway (nasopharynx, tonsil & epiglottis). Further investigations revealed that no other area was involved. All the patients were started on standard anti tubercular therapy and showed complete cure on completion of therapy.     

肺癌眼脉络膜转移的临床分析

目的探讨肺癌眼脉络膜转移的临床特点、诊断和治疗。方法采用回顾性研究的方法,对收治的21例肺癌眼脉络膜转移的临床资料进行总结、分析。结果 21例中,以肺部为首发症状的7例,以眼部为首发症状的14例;肺部病变位于左肺12例,右肺9例;中心型8例,周围型13例。眼部病变位于单眼20例,双眼1例,共22只眼受累,左眼13例,右眼9例;病变位置在后极14例,近视乳头5例,脉络膜周边3例。病理类型:肺腺癌13例,小细胞肺癌4例,鳞癌3例,大细胞肺癌1例。18例并发眼以外器官的转移。随访19例,中位生存期12.0月,1年生存率44.7%,2年生存率6.5%。结论肺癌眼脉络膜转移应对其重视及完善检查,使其尽早确诊。恰当的治疗可延长患者的生存期、缓解症状及提高生活质量。     

Classic biphasic pulmonary blastoma: a case report and review of the literature

Pulmonary blastomas are rare malignant tumors, comprising only 0.25-0.5% of all malignant lung neoplasms. Pulmonary blastomas are subdivided in three categories: well-differentiated fetal adenocarcinoma (WDFA), classic biphasic pulmonary blastoma (CBPB) and pleuropulmonary blastoma (PPB), which is currently regarded as a separate entity. The majority of patients with CBPB and WDFA are adults with an average age of 43 years. Tobacco use is identified as a causative agent. Symptomatology varies from asymptomatic (40%) to symptoms of a non-specific pulmonary disease. The most common roentgenologic pattern is a large peripheral nodule. The treatment of choice is surgical excision. The efficacy of adjuvant chemotherapy and radiotherapy is not yet established. The prognosis of pulmonary blastoma is very poor; overall five-year survival is 16%. WDFA appears to have a better prognosis. Adverse prognostic factors are biphasic type, tumor recurrence, metastasis at initial presentation, gross size of the tumor (>5 cm) and lymph node metastasis. On the basis of the available literature, an initial aggressive treatment that includes surgery and, wherever possible, postoperative chemotherapy and radiotherapy could be useful to prolong survival in patients with this rare lung neoplasm. We present a case of classic biphasic pulmonary blastoma in a 77-year old male and review the literature.     

Two cases of early squamous cell carcinoma of the hilar region of the lung cured by bronchofiberscopic excision

We experienced two patients with early squamous cell carcinoma at the hilar region of the lung. The carcinoma were completely eliminated by tumor biopsy using a bronchofiberscope. In both cases, there was either pulmonary tuberculosis or a second primary lung cancer (bronchiolo-alveolar carcinoma) on the contralateral side. After bronchoscopic excision of the tumor, the patients were closely observed using by repeat bronchoscopy at 5 to 6 week intervals. One patient is free of recurrence at 4.5 years after treatment and is deemed to be cured. The other patient died of recurrence and metastasis from a second primary bronchioloalveolar carcinoma at 1 year and 5 months after treatment, however he had no recurrence of the squamous cell carcinoma.     

经支气管镜支架植入联合化疗及阿帕替尼成功救治直肠癌支气管转移患者1例

肺是肺外恶性肿瘤转移最常见的部位,而气道内转移少见.气道内转移最常见的肿瘤是肾癌、乳腺癌和结直肠癌.直肠癌晚期会出现肺转移,但气道内转移而无肺转移的少见,易误诊.我们报道1例直肠癌术后出现支气管内、胸膜腔、心包腔内转移,给予经支气管镜支架植入、化疗、靶向药物等综合治疗而获缓解的病例.诊治过程较为复杂,故有一定临床参考价值.     

Study of papillary carcinoma of thyroid with uncommon sites of metastasis

Papillary carcinoma of thyroid (PCT) is the most common type of thyroid malignancy and metastasis to cervical lymph nodes is very common [1]. Blood borne metastases from PCT are less frequent than with the other thyroid carcinomas [2]. Uncommon sites include lungs, bone, atrium, cerebrum, kidney, skin [3]. We report four cases of papillary carcinoma with uncommon sites of metastasis. One showed tumor emboli of 2.5 cm in internal jugular vein, one had tumor deposit in metacarpal bone and lung, one had a subcutaneous tumor deposit and one was a micropapillary carcinoma with metastasis axillary nodes. All these four cases were classical PCT.     

Complete cerebral response with sunitinib for metastatic renal cell carcinoma.

Renal cell carcinoma (RCC) is a relatively rare cancer, representing2–3% of the neoplasms in the adult population. Metastasisis in 30% of cases synchronous to the diagnosis of RCC. Themost frequent common sites of metastasis include lung, liver,bone, brain and adrenal gland [1]. Brain metastasis from RCCis responsible for significant mortality [2]. RCC is characterized by the inactivation of the von Hippel–Lindautumour-suppressor gene, which results in the deregulation ofhypoxia response genes, including an overproduction of     

肺结核合并肺癌的影像和临床特点及误诊原因分析

目的：总结肺结核合并肺癌的临床和影像学特点，以提高诊断水平，减少误诊。方法：回顾2001年1月-2008年1月期间确诊为肺结核合并肺癌以及初诊分别为肺结核和肺癌而进一步确诊为肺癌和肺结核病的临床和影像资料。结果：在收治的15660例肺结核病人中，肺结核合并肺癌182例（1．16%），其中肺癌病灶发生在肺结核所在肺叶或肺段63例；临床诊断为肺癌而行剖胸探查的2588例病人术后病理确诊为肺结核合并肺癌22例（0．85％）。主要症状为刺激性咳嗽、发热、盗汗等。肺部影像表现为偏心空洞、肿块周围毛刺状、肺不张以及胸腔积液等，同时也具有各型肺结核的影像特点。结论：肺结核合并肺癌以及肺结核与肺癌的临床鉴别诊断在临床上较为困难，应认真进行相关辅助检查以防止误诊、漏诊。     

Malignant meningitis secondary to ovarian carcinoma: an unusual occurrence

We report the case history of a patient with Stage IV ovarian carcinoma with leptomeningeal involvement. Although metastasis to other sites is relatively common, this scenario is rare.     

Tuberculous Otitis Media and Lupus Vulgaris of Face: An Unusual Association

Tuberculous otitis media is a rare extra-pulmonary presentation of tuberculosis. Tuberculous otitis media is usually associated with pulmonary tuberculosis or tuberculosis involving nasopharynx and oropharynx. Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. The disease often affects the face and may be associated with nasal or nasopharyngeal tuberculosis. Lupus vulgaris associated with tuberculous otitis media is not reported in English literature. We report a case of 40 year old female patient who presented with symptoms of chronic suppurative otitis media and non-healing skin lesion of face. The biopsy of skin lesion showed granulomatous pathology and helped us to reach a diagnosis of tuberculous otitis media.     

Multiple pulmonary infarctions associated with lung cancer

We present a case of right lung adenosquamous cell carcinoma that had obstructed the main pulmonary artery and superior pulmonary vein, causing multiple pulmonary infarctions in the right upper and middle lobes. Multiple peripheral pulmonary nodules showed clinical features that are characteristic of pulmonary infarction: rapid appearance and gradual reduction in size, pleural-based parenchymal density with a truncated apex and a round nodular shadow with a blurred margin and a centrally directed linear shadow. The nodules were more intense than the primary tumor in both T1- and T2-weighted magnetic resonance imaging (MRI). We conclude that pulmonary infarction can look like a nodule when lung cancer invades both the pulmonary artery and vein and that such cases can be distinguished from pulmonary metastasis by MRI, computed tomography and a series of radiological examinations.     

Association of rare alleles of the Harvey ras protooncogene locus with lung cancer

The hypothesis that rare variable nucleotide tandem repeat alleles of the Ha-ras-1 polymorphism are an inherited predisposing factor in human lung carcinogenesis has been evaluated in an age, race, and smoking matched case-control study. Twenty-three different alleles were identified by their restriction fragment length in DNA isolated from peripheral blood lymphocytes and were categorized into three groups: common; intermediate; and rare. The frequencies of rare alleles in blacks with either squamous cell carcinoma, large cell carcinoma, or small cell carcinoma were found to be significantly higher than those among groups of control subjects that were comprised of chronic obstructive pulmonary disease patients and patients with cancer at sites other than the lung. A similar trend which did not reach statistical significance was observed in whites. These data are consistent with the hypothesis that inheritance of Ha-ras-1 rare restriction fragment length alleles represents a genetic risk factor for some human lung cancers. The biological basis of this observation remains to be clarified, and it is possible that ethnic variations in rare allele frequencies are responsible for the differences noted. However, the data suggest that further evaluation of the Ha-ras-1 polymorphism as a marker of individual lung cancer susceptibility is warranted.