Repeated resections for originally unresectable liver metastasis from colorectal cancer after multiagent chemotherapy

We describe the case of a 74-year-old man with liver resection for originally unresectable liver metastasis from colorectal cancer after multiagent chemotherapy. Eleven bilobar liver metastases appeared four months after curative resection for double cancer of sigmoid colon and upper rectum. After 6 courses of multiagent chemotherapy (mFOLFOX 6 with bevacizumab), the number of liver metastasis decreased from 11 to 5. The patient underwent curative resection for liver metastasis. A new lesion of 7 mm in the segment 6 appeared 8 months after an initial liver resection. After 3 months' observation, two more liver metastases appeared. All liver metastases were resected. Solitary lung metastasis appeared 10 months after the second liver resection. The lung metastasis was also resected. The patient was alive with no evidence of disease in 33 months after the initial liver resection. We experienced the case with repeated liver resections after multiagent chemotherapy for originally unresectable bilobar liver metastasis. The therapeutic strategy which combines surgical resection with cytotoxic chemotherapy will be important more than ever.     

Surgical resection of a cerebral metastasis from cervical cancer: case report and review of the literature

AIMS AND BACKGROUND: Central nervous system metastasis from cervical carcinoma is uncommon. CASE REPORT: We report the case of a 51-year-old woman who developed a solitary cerebral metastasis 29 months after radical hysterectomy with pelvic lymphadenectomy for a stage IB, grade III cervical cancer. The patient suddenly complained of headache, confusion and dizziness; she was submitted to emergency surgical resection of a 2 x 3 cm metastasis in the right frontal lobe. The postoperative course was uneventful and she completely recovered from her neurological deficit. Following surgery the patient underwent careful restaging. Massive bilateral involvement of the pelvic wall was diagnosed, and the patient received three courses of cisplatin-based chemotherapy. She developed liver and lung metastases and died 10 months later of progressive disseminated disease, without, however, any sign of recurrent or persistent cerebral involvement. CONCLUSION: Neurosurgical resection should be considered in cervical cancer patients with solitary brain metastasis in the absence of systemic disease.     

Central nervous system metastasis from nasopharyngeal carcinoma: a report of two patients and a review of the literature

BACKGROUND: Central nervous system (CNS) metastasis from nasopharyngeal carcinoma (NPC) is an extremely rare occurrence, although direct intracranial invasion is not infrequent in patients with NPC at a locally advanced stage. Only five other patients have been reported in detail in the English literature. METHODS: The clinical records of two such patients with NPC who were diagnosed with metastasis to the spinal cord (intradural) and to the occipital lobe, respectively, were reviewed. The literature was searched for a review of similar incidents. RESULTS: Both patients had locally advanced disease at the time of presentation and were treated with neoadjuvant chemotherapy and radical radiotherapy. The CNS metastases in both patients were accompanied by disease recurrences in multiple sites after a prolonged period of clinical remission. Spread through cerebral spinal fluid was postulated for the patient with spinal cord metastasis, and hematogenous spread was postulated for the patient with brain metastasis. Aggressive surgical resection with or without postoperative radiotherapy conferred reasonable survival and symptom control. The patient with brain metastasis died 6 months later of lung metastasis, whereas the other patient is still alive 40 months from the diagnosis of spinal metastasis. CONCLUSIONS: Good symptom control and disease control can be achieved for patients with CNS metastasis after surgery with or without radiotherapy. After aggressive therapy, the ultimate survival depends on control of extracranial disease.     

Glioblastoma multiforme with metastasis to lung,bone,and chest wall:a case report

Glioblastoma multiforme(GBM)is a common brain tumor that rarely metastasizes extra-cranially.We present the case of a 40-year-old male with left temporal GBM who underwent craniotomy followed by radiotherapy and chemotherapy.Postoperative MRI scans at different time intervals demonstrated a good response.Eleven months after the initial diagnosis,there were no clinical or radiological signs suggesting recurrence.However,the tumor showed metastasis simultaneously to the chest wall,lungs,and bone,despite 2 cycles of chemotherapy.The patient developed paraplegia 14 months after the initial diagnosis and died due to systemic failure 19 months after diagnosis.Extracranial metastasis of GBM is extremely rare.We present the unusual case of a patient with GBM who showed simultaneous metastasis to the lungs,bone,and chest wall.The prognosis of patients with extracranial metastasis of glioblastomas is very poor,regardless of chemoradiotherapy.Newer approaches,such as immunotherapy and anti-angiogenic therapy,need to be further studied.     

肾上腺皮质癌1例报道并文献回顾

目的:探讨肾上腺皮质癌的临床表现、诊断及治疗方法。方法:报道我科近期收治的1例肾上腺皮质癌患者的临床资料,并检索中国知网、PubMed等数据库,进行文献回顾,对该病的临床特征及诊断要点、治疗方法及最新的研究进展进行归纳总结。结果:本例患者以腹痛为首发临床表现,影像学提示肾上腺肿瘤,行腹腔镜切除,术后20天查PET/CT提示多发转移,给予依托泊苷+顺铂化疗4周期后进展,遂应用吉西他滨联合卡培他滨化疗1周期,出现脑转移后行放疗。结论:肾上腺皮质癌是一种罕见的泌尿系恶性肿瘤,且预后差。诊断应结合临床表现、肾上腺皮质激素水平、影像学检查及病理结果。治疗方面首推多学科会诊（MDT）,早期患者首选手术,术后需根据疾病分期、分级选择辅助治疗,复发转移的患者可给予化疗、放疗、米托坦、免疫治疗等。     

A case of gastric cancer with umbilical metastasis that responded to TS-1 with low-dose cis-platinum

An umbilical metastasis of gastric cancer is known as Sister Mary Joseph's nodule. It ordinarily indicates a poor prognosis because umbilical metastasis often develops with peritoneal dissemination. Herein, we report a case of umbilical metastasis of gastric cancer that showed good response to chemotherapy, including the oral anticancer agent TS-1. The patient was a 55-year-old man in which gastric cancer was found by upper gastrointestinal series. Physical examination revealed an umbilical nodule that had an irregular surface and a hard consistency. Ultrasonography showed a 15 x 10 mm hypoechoic mass under the umbilicus. Core needle biopsy of the umbilical mass revealed adenocarcinoma. Peritoneal dissemination was proved by diagnostic laparoscopy. Oral anticancer agent TS-1 was administered with low-dose cis-platinum. The gastric lesion and umbilical nodule showed marked response to the chemotherapy and the response continued for 20 months. The patient died of disease progression 31 months after the initiation of the treatment.     

A case of esophageal carcinoma with the lung and liver metastases surviving more than 3 years

A case of advanced esophageal carcinoma with liver and lung metastases who survived more than 3 years by combination chemotherapy consisting of Cisplatin and continuous 120 hours infusion of 5-Fluorouracil was reported. The primary lesion and liver metastases achieved complete response (CR) but the lung metastases attained only partial response. CR was, however, achieved by another regimen of chemotherapy. Forty months after the initiation of treatment, brain metastasis was recognized, which was controlled by radiotherapy. The patient is still alive three years after the onset of disease but with lung metastases. Quality of life in these 3 years was considered to be relatively good.     

Solitary brain metastasis from classic biphasic pulmonary blastoma: a case report and review of the literature

BACKGROUND: Classic biphasic pulmonary blastoma (CBPB) is a rare and aggressive primary malignancy, brain metastases of this type of tumor are even rarer. CASE REPORT: A 51-year-old male patient with a solitary cerebral metastasis, diagnosed ten months after left pneumonectomy for a CBPB, was treated by surgery and accelerated hypofractionated radiotherapy. RESULTS: The patient died 15 months after partial removal of the brain metastasis. Literature review revealed only 4 cases of solitary brain metastases from this type of malignancy. The present case is the second one reported with a combined treatment of surgery and radiotherapy resulting in the longest survival. CONCLUSION: The best treatment for CBPB is difficult to determine because of the small number of cases, however, the combination of surgery with radiotherapy seems to be effective. The effectiveness of chemotherapy has not been ascertained.     

Post-menopausal bleeding: a rare presentation of metastatic uveal melanoma

Uveal melanoma differs from cutaneous melanoma in many ways, including its pattern of metastasis, and exhibits latency with clinical evidence of metastasis sometimes appearing many years after primary diagnosis. Most patients develop metastasis within the liver, but some may present with metastasis to other sites. We report a case of uveal melanoma that presented with post-menopausal bleeding due to metastasis. Further investigation revealed widespread metastatic disease and the patient was not fit for chemotherapy. She died two months after presentation: autopsy revealed metastases in many sites, including the uterus, right ovarian fibroma, kidney, mesentery, liver, lung, thyroid, bone marrow and skin. The immediate cause of death was cardiac tamponade due to a malignant effusion secondary to cardiac metastasis. This case illustrates the widespread metastatic potential of uveal melanoma and highlights the potential for unusual presentation of metastatic disease from this eye tumor.(Pathology Oncology Research Vol 12, No 3, 184–187)     

Solitary brain metastasis 13 years after removal of renal adenocarcinoma

Summary We report a case of a patient who developed a single brain metastasis to the cerebellum 13 years after removal of a renal adenocarcinoma. The cerebellar metastasis was removed twice due to local recurrence one year after the first operation. The patient is alive and doing well 18 months after the second neurosurgical procedure. The metastasis was not associated with any other evidence of disease. Brain metastasis may present many years after removal of kidney adenocarcinoma and when not associated with other evidence of disease their operative treatment may carry a good prognosis.     

Brain metastasis as the first manifestation of small cell lung cancer in a female adolescent

Small cell lung cancer is commonly regarded as an old age related disease. Although the brain is a common site of metastasis for this type of lung cancer, the first manifestation is rarely shown from the metastasis site. In this paper, we report a rare case of 19-year-old female patient with small cell lung cancer whose initial presentation was a solitary brain metastasis. The patient was admitted to our hospital for the recurrence of brain tumor, and the histological diagnosis after operation showed small cell lung cancer. Three months later, she suffered from dry cough and was diagnosed as small cell lung cancer by trans-bronchial biopsy. Due to the identical cell types and immunohistochemical phenotypes, the brain tumor was retrospectively diagnosed as metastasis of small lung cancer by two neurological pathologists. She is the youngest female with brain metastasis as the first manifestation of small cell lung cancer reported so far internationally as to our knowledge. Second-hand smoking was possibly one of the risk factors.     

A case of advanced gastric cancer successfully treated with chemoradiotherapy targeting for recurrent lymph node metastasis

The patient was a 75-year-old male, who was diagnosed with type 3 advanced gastric cancer and bulky lymph node metastasis. Two courses of neoadjuvant chemotherapy (S-1, CDDP) which showed a partial remission and distal gastrectomy were performed. Although he received S-1 medication as adjuvant chemotherapy, lymph node recurrence appeared 6 months after the operation. Radiation therapy at a total dose of 65 Gy (10MV X ray, 2.5 Gy/day × 26 Fr) selectively targeting for recurrent lymph node metastasis with S-1 medication were applied. There were no adverse effects during chemoradiation therapy and the metastatic node showed regression (30 mm to 15 mm). Sixteen months passed from chemoradiation, and the patient remains alive with no signs of relapse without any treatment after the chemoradiation. Therefore, our case suggests that chemoradiation therapy could be an effective treatment for recurrent lymph nodes metastasis in gastric cancer.     

Small cell lung cancer with a brain metastasis controlled for 5 years: a case report

We report a case of small cell lung cancer whose initial presentation was a solitary brain metastasis. On chest radiography the primary tumor was unclear and only detected by bronchofiberscopy. A small single pulmonary metastasis was noted in the right lower lobe. Subtotal resection and external irradiation were applied to the brain tumor and external irradiation was applied to the lung. Concurrently one course of systemic chemotherapy was administered. The tumors in the brain and lung had disappeared by the end of the treatment. The patient has been alive and well for 5 years without recurrence.     

Small cell carcinoma of the esophagus: a case report

This article reports a case of primary undifferentiated small cell carcinoma of the esophagus with lymph node metastasis which invaded the stomach wall. The patient was treated with chemotherapy alone, consisting of CDDP and VP-16. The patient had a complete response to chemotherapy, with no evidence of disease for nine months, after six courses of the regimen. Small cell carcinoma of the esophagus is an aggressive tumor with an extremely poor prognosis. Because its characteristics are similar to small cell carcinoma of the lung, small cell carcinoma of the esophagus should be treated by multi-drug chemotherapy including CDDP, with or without radiation as the first line treatment. This chemotherapy regimen may achieve a long disease-free survival time.      

Brain metastases in soft tissue sarcomas: case report and literature review

Background and purpose: Brain metastasis is a relatively uncommon event in the natural history of soft tissue sarcomas. The increasing use of chemotherapy may have caused a reduction in local relapses as well as distant failures leading to an improvement in survival, thereby allowing metachronous seeding of the brain, a sanctuary site. The purpose of this report is to increase awareness amongst clinicians regarding such a possibility.Patients and methods: A review of the departmental sarcoma database following the presentation of this index case in the clinic.Results and discussion: An adolescent male who had previously been treated with surgery and radiotherapy for a spindle cell sarcoma of the left thigh developed a space-occupying lesion in the brain within 6 months of treatment of the primary tumor. He subsequently underwent resection of the presumed solitary brain metastasis followed by whole brain radiotherapy. On radiation he was detected to have pulmonary metastases too, for which he was offered palliative chemotherapy. The patient died of brain metastasis within 4 months. A review of the departmental sarcoma database, restricted to soft tissue sarcomas purely, maintained prospectively from 2000 till date, could not identify any other such case.Conclusion: Brain metastases from soft tissue sarcomas are rare. Patients with neurological symptoms, however, should be appropriately investigated. Surgical resection of brain metastasis could be considered for solitary brain metastasis in non-eloquent areas. Palliative radiotherapy is appropriate for patients with multiple brain metastases or co-existing extra-cranial disease.     

Prolonged survival in a nasopharyngeal carcinoma patient with multiple metastases: a case report and review of the literature

Nasopharyngeal carcinoma is a common cancer in South East Asia. In the early stages, radiotherapy alone may achieve sustained control, but once metastasis occurs, it becomes an incurable disease with limited survival time. We report a case of nasopharyngeal carcinoma, initial stage T4N0M0, diagnosed in 1985 in a patient aged 36 years who received 70 Gy radiotherapy to the head and neck region. In 1988, relapse occurred with multiple lung metastases. The patient received many chemotherapy regimens with a very good response, including near complete remission with the first treatment regimen of cisplatin, 5-fluorouracil and leucovorin for lung metastases, and with the fifth chemotherapy regimen of ifosfamide as a single agent. After ifosfamide treatment, there was residual fibrotic change in the lung and complete disappearance, lasting for almost a year, of the liver and bone lesions. The patient eventually died in July 1995 due to progressive disease. Prolonged survival after mainly thoracic metastasis is possible in patients with nasopharyngeal carcinoma, especially if the tumor is chemo-responsive.      

Cutaneous matastasis from sino-nasal malignant melanoma — a rare case report

To report a case of disseminated cutaneous metastasis from malignant melanoma of sino-nasal region. A 53-year-old man from rural parts of West Bengal presented with progressive nasal obstruction. CT scanning was done to know the extent of the mass and punch biopsy from the mass was performed. Malignant melanoma of sino-nasal region was diagnosed and chemotherapy was started. The patient developed cutaneous deposits after two cycles of chemotherapy. The patient developed cutaneous deposits during the course of chemotherapy. Excision biopsy from cutaneous deposits revealed malignant melanoma. A rare case of diffuse cutaneous metastasis of malignant melanoma is presented here along with review of literature.     

The development of numerous radiation-induced cavernous malformations in a germ cell tumor patient: A case report

Radiation-induced cavernous malformations (RICMs) are most commonly reported in young patients who have previously received radiotherapy. Here, we report a case of a patient with a germ cell tumor who was treated with whole brain radiotherapy (WBRT) and then incidentally found to have numerous RICMs. A 31-year-old male visited the hospital for a testicular mass. On examination, he was diagnosed with a mixed germ cell tumor with lung/brain metastases. The patient underwent a left orchiectomy and received 4 cycles of chemotherapy. He was then treated with WBRT for residual lesions in the brain and a wedge resection for the lung metastasis. Four years later, approximately 250-300 RICMs were incidentally observed in a follow-up brain image. Because the patient had not noticed any symptoms and the RICMs were small in size, he was not treated. To our knowledge, this is the first reported case of numerous (approximately 250-300) RICMs in a germ cell tumor patient after WBRT. Herein, we report details of this case and discuss the typical clinical features of RICM.     

Osteoblastic metastatic disease as a therapeutic response to adjuvant chemotherapy in breast cancer

Included in this study were 43 breast cancer patients treated with adjuvant chemotherapy who presented metastasis only in bone. Forty-two percent had metastasis during chemotherapy, and 58% had metastasis after the completion of chemotherapy. In 66% of the patients, the lesions were osteolytic. Twenty-nine percent had osteoblastic lesions, and 5% had mixed lesions. Of the patients with osteoblastic metastatic disease, five showed asymptomatic, osteoblastic disease; this response was considered to be a healing response to chemotherapy. These five patients were continued on the same therapy. The median duration of this response to the adjuvant chemotherapy was 29 months (range 6 to 62+). In one patient, osteoblastic disease gradually faded, and skeletal radiographs reverted to normal.     

Cutaneous metastasis at a surgical drain site after gastric cancer resection

Cutaneous metastasis from intra-abdominal malignant solid tumours such as gastric adenocarcinoma is very rare. Here, we report the case of a 76-year-old male patient with a T4N2M0, poorly differentiated, signet-ring cell gastric carcinoma, who underwent potentially curative resection of the tumour and developed cutaneous metastasis at the site of the surgical drain 4 months after the operation while he was on chemotherapy. The lesion involved the skin and the subcutaneous fat only. A CT scan revealed local recurrence at the resection bed but no distant metastases. The patient died 1 month later. It is concluded that the development of cutaneous metastasis after gastric carcinoma resection indicates tumour recurrence or disseminated disease and is associated with poor prognosis.