Bone metastases from squamous-cell carcinoma of the larynx

Four patients are described with distant bone metastases from primary squamous-cell carcinoma of the larynx. In one case the metastases were osteosclerotic, a previously unreported occurrence. The metastases were osteolytic in the other three patients. Bone metastases from laryngeal carcinoma are rare and associated with locally extensive tumours and a poor prognosis.     

Methadone-related overdose deaths in South Australia, 1984-1994. How safe is methadone prescribing?

We report a patient in whom 11 years after the treatment of a breast tumour, bilateral ovarian metastases were disclosed. Surgical exploration confirmed unique ovarian metastases within a 'clean' abdomen and pelvis. The particularities of this case compared with the literature are the rather long interval of 11 years and the fact that no other metastases were present. The literature indeed reveals that most of the patient with ovarian metastases are premenopausal, have bilateral involvement; the ovarian metastases occur within a few years and are frequently accompanied by other metastases.     

Epidermo?d carcinoma of uterine cervix with bone metastases in lower limbs (author's transl)

Bone lesions are infrequent in the evolution of epidermo?d carcinoma of the uterine cervix. Direct bone invasion from the primary tumor, extension from lymph node metastases and distant metastases can be seen. The frequency of these lesions is about 3 to 4%. Hematogen bone metastases are very uncommon. They are often located in the lower limb. We report a case of a patient with a cervical carcinoma who developed isolated bone metastases in all the bones of a lower limb.     

Choroidal metastasis from primary mucinous cystadenocarcinoma of the ovary

Central nervous system metastases are uncommon in epithelial carcinoma of the ovary; and metastases to the eye are even more rare. This article describes what is believed to be only the third case reported of epithelial carcinoma of the ovary metastatic to the eye.     

Combined thoracoscopic lung resection and laser ablation for lung cancer with pulmonary emphysema: report of a case

The incidence of clinically detectable parenchymal liver metastases in patients with recurrent ovarian carcinoma has been infrequently reported, but autopsy findings indicate that they are the second most common site of distant metastases in patients with epithelial ovarian carcinoma. The case of a 58-year-old patient who developed parenchymal liver metastases as the first site of recurrent ovarian carcinoma is presented. The different spreading routes of this malignancy, as well as a review of the incidence of liver metastases are discussed.     

Ruptures of double-J ureteral catheter. Our experience and review of the literature

Follicular carcinoma, in association with other prognostic factors, identifies a class of "high-risk" patients in which a more aggressive treatment is indicated. In fact, in patients operated on for follicular carcinoma bone metastases, also many years after primary surgery, are reported. A case of skull metastases in a young women occurred 3 years after a near total lobectomy for follicular thyroid carcinoma is described. After six years the patient underwent total thyroidectomy, resection of skull metastases, radiometabolic therapy with I131 180 m Ci; now she is disease free at three years of follow-up. The biology of metastases in thyroid follicular carcinoma, risk factors and diagnostic and therapeutic controversies are analyzed. Good prognostic factors are considered age < 45 years, good degree of differentiation of primary tumor, small size of bone metastases and early appearance after primary diagnosis. The conclusions is drawn that bone metastases are the worst prognostic factors. In case of single lesion, surgical treatment allows good results.     

Tarsal metastases in a patient with rectal cancer

Bone metastases from colorectal cancer are uncommon and usually present late in the natural history of metastatic disease. This case report describes a 48-year-old man who developed an unusual distribution of bony metastases with multifocal osteolytic tarsal metastases 50 months after excision of a rectal carcinoma. An open biopsy was required to establish the diagnosis, exclude osteomyelitis and allow palliative radiotherapy to be given.     

An unusual presentation of oat cell carcinoma

A case is reported of oat cell carcinoma of the lung presenting with unusual sites of metastasis to the orofacial region. Distant metastases are common in oat cell carcinoma but a literature review did not reveal any reports of metastases either to the hard palate or to medial canthus of the eye.     

Late presentation of solitary jejunal metastasis from renal cell carcinoma

Haematogenous metastases to the small bowel are a rare occurrence, usually from malignant melanoma or bronchogenic carcinoma. There are occasional reports of other primary tumours presenting with small bowel involvement as the first evidence of metastases. We describe a case of intraluminal jejunal metastasis from a renal cell carcinoma, occurring 10 years after the original nephrectomy.     

Median sternotomy: the preferred incision for resection of lung metastases

OBJECTIVE: To describe our experience with median sternotomy for resection of lung metastases and to assess whether computer tomography (CT) accurately predicts the number and extent of lung metastases. DESIGN: Retrospective case record study. SETTING: University hospital/Cancer Centre, The Netherlands. SUBJECTS: 78 patients with pulmonary metastases from various histological types of tumours who were operated on through a median sternotomy during the 10-year period January 1985-January 1995. INTERVENTION: Median sternotomy for resection of lung metastases with the intention to cure. Extension of the incision in case of extended disease. MAIN OUTCOME MEASURES: Presence of unilateral or bilateral metastases in relation to preoperative CT. RESULTS: 78 patients underwent a total of 82 sternotomies. CT did not accurately diagnose the extent of disease in 38 patients (49%). In 72 cases metastases were excised. In 58 patients (81%) histological examination showed tumour-free margins microscopically. 36 patients had bilateral metastases. CT showed unilateral disease in 49 patients. 14 (29%) had bilateral involvement. 4 patients required lobectomy and in two patients anterolateral extension of the sternotomy was necessary. Eleven patients (15%) developed minor complications. There was no operative mortality. CONCLUSION: Bilateral staging and finding of occult metastases, complete surgical clearance in a one stage procedure, and lower morbidity are the reasons that we suggest that median sternotomy is the procedure of choice of resection of pulmonary metastases. For eligible patients the choice of surgical approach should not be made conditional on the results of CT alone.     

Chordoma with cutaneous metastasis

Chordoma is a neoplasm arising from the primitive notochord. Even though many chordomas follow a progressive course with multiple recurrences and metastases and eventual death due to tumor, reports of skin metastases from chordoma are rare. This report describes a case of chordoma with metastasis to the scalp in a 67-year-old man with a primary lesion of the sacrococcygeal region.     

Prognosis of visceral and osseous metastases of differentiated thyroid cancers. 24 cases

Twenty four cases of differentiated thyroid carcinoma with distant metastases are analysed. Prolonged survival periods are possible. The best prognosis in papillary forms is stressed. Metastases fixing I131 progress more slowly, as a result of treatment with radioactive iodine but apparently also by virtue of the higher degree of differentiation of such metastases. One case of apparent cure of pulmonary metastasis after treatment with radioactive iodine is described. Surgery and external radiotherapy retain a place of choice in the treatment of metastases. In our experience, chemotherapy has been disappointing.     

Massive lower gastrointestinal haemorrhage secondary to metastatic squamous cell carcinoma of the lung

Clinically significant symptoms due to gastrointestinal metastases from primary lung cancers is rare. A case of life-threatening lower gastrointestinal haemorrhage secondary to metastatic squamous cell carcinoma of the lung is reported. Previous reports of such metastases are reviewed, with reference to management and prognosis. After resection of colonic metastases from squamous cell lung cancer, survival is similar to that for primary disease. It is suggested that patients with known or suspected squamous cell lung cancer presenting with lower gastrointestinal symptoms be managed as aggressively as those with no previous history of disease.     

Effect of IL-4 deletion on cardiac allograft survival in the BALB/c to 129Sv x C57BL/6 strain combination

Calcified brain metastases are rare. They are unique or multiple. The primary site is lung, breast, gastro-intestinal tract, uterine cervix, bone or may be unidentified. It corresponds pathologically to an adenocarcinoma, a sarcoma or to a squamous cell carcinoma. We report a case of multiple calcified brain metastases discovered before primary tumour (bronchial adenocarcinoma), raising the problem of differential diagnosis resolved by stereotaxic brain biopsy.     

Prolactin-secreting pituitary carcinoma with implants in the cheek pouch and metastases to the ovaries. A case report and literature review

BACKGROUND: Prolactin-secreting pituitary carcinomas are uncommon, locally destructive neoplasms that rarely metastasize outside the central nervous system. The authors report a case of a prolactin-secreting tumor that initially presented as the empty sella syndrome. Two recurrences along transsphenoidal surgery tracts in cheek pouches were followed by distant metastases later in the abdomen and pelvis. Only 10 previous cases of either extracranial or intracranial metastases from prolactin-secreting pituitary carcinomas have been reported. No metastases below the diaphragm have been reported previously. METHODS: The patient's cheek pouch implants, lymph node metastases, ovarian metastases, and uterine metastases were studied with prolactin-specific immunohistochemistry. RESULTS: Long term treatment with bromocriptine, several debulking surgeries, extensive local radiation therapy (external beam and proton beam), and cytotoxic chemotherapy had little impact. Tamoxifen, however, may have slowed tumor growth. CONCLUSION: Tamoxifen may have efficacy in the treatment of prolactin-secreting pituitary carcinomas.     

Pseudocystic metastases of carcinoma of the uterine cervix mimicking polycystic liver disease

Pseudocystic liver metastases are rare and mainly described in neuroendocrine or ovarian tumors. We report the case of a 46-year-old woman who presented with multiple hepatic metastases mimicking polycystic liver disease. Carcinoma of the uterine cervix had been diagnosed 9 years earlier, and initially treated by radiumtherapy and surgery. Although histological post mortem examination of the pseudocystic liver metastases was not characteristic, they were related to the uterine cervix carcinoma for the following reasons: no other primary tumor was discovered, especially carcinoid or ovarian tumors: immunostains were positive for epithelial cells and negative for the neuroendocrine panel: the cystic cerebellum metastasis had a typical histologic aspect. Uterine cervical carcinoma must thus be included in the list of tumors which may form cystic hepatic metastases.     

Carcinosarcoma of the adult kidney

Carcinosarcoma of the adult kidney is a very rare tumour and there are only a few well documented cases in the literature. In this report such a tumour is described from a 50-year-old white male, which progressed very rapidly with widespread metastases. Histologically, the tumour consisted of renal cell carcinoma and fibrosarcomatous components. The interesting features in this case were that both the carcinomatous and sarcomatous elements of the tumour exhibited metastases separately to various organs.     

Complete spontaneous remission in a patient with metastatic non-small-cell lung cancer. Case report, review of the literature, and discussion of possible biological pathways involved

Spontaneous remission of cancer (SR) is defined as a complete or partial, temporary or permanent disappearance of all or at least some relevant parameters of a soundly diagnosed malignant disease without any medical treatment or with treatment that is considered inadequate to produce the resulting regression. We report the case of a 61-year-old man who presented with extensive metatastic disease five months after pneumonectomy for poorly differentiated large cell and polymorphic lung cancer. A vast metastatic tumour mass of the abdominal wall was confirmed histolologically and there was clinical and radiographic evidence of liver and lung metastases. Eight months later, the patient was operated on for a hernia, which had developed in the inguinal biopsy scar and the surgeon confirmed complete clinical SR of the abdominal wall metastases. Again five months later there was no longer any radiologic evidence of liver and lung metastases. Complete remission has persisted more than five years. Histology of the primary and of the abdominal metastases were reviewed by several independent pathologists. SR is an extremly rare event in lung cancer. This is the first documented case of clinically evident visceral metastases of a bronchiogenic adenocarcinoma developing after complete resection of the primary and then showing complete SR. The epidemiology of SR is reviewed and possible mechanisms involved in SR are discussed.     

Use of prostaglandin E1 for treatment of erectile dysfunction

Metastatic tumors to the head and neck are uncommon. We report a case of renal cell carcinoma that presented as an epidermal inclusion cyst on the forehead. The forehead is an exceedingly uncommon site for renal cell metastases. We review the biology of tumor metastases and explore the pathways by which infraclavicular tumors spread to the head and neck. We then discuss the clinical appearance and management of metastatic renal cell carcinoma.     

Computational site-directed mutagenesis of haloalkane dehalogenase in position 172

Laparoscopic cholecystectomy is considered as the new gold standard operation for removal of the gallbladder, and has several advantages over the traditional open cholecystectomy. However, in the last few years there is an increasing number of case reports of port site metastases following laparoscopic cholecystectomy for unsuspected carcinoma of the gallbladder. Two case reports of trocar site metastases are presented, and they further highlight the concern of the role of minimal invasive surgery in the presence of unsuspected carcinoma of the gallbladder. In this review we speculate on the mechanisms which may be responsible for metastatic deposits during laparoscopic cholecystectomy and suggest certain recommendations.