Species differences in carcinogenesis

The prognosis for carcinoma of the oesophagus is generally dismal especially when patients present late. Any clues to early diagnosis and management and identification of rapidly progressive variants are therefore helpful. Reports and review of the literature are presented with respect to four unusual cases of oesophageal carcinoma treated in the University of Ilorin Teaching Hospital in 1985 and 1986. Four men aged 59, 60, 55 and 60 years respectively presented with multiple polypoid carcinoma of the oesophagus, malignant oesophago-bronchial fistula at the level of the left main stem bronchus, achalasia co-existing with oesophago-gastric carcinoma and a small focus of carcinoma of the distal thoracic oesophagus presenting with widespread thoracic metastases and malignant pleural effusion mimicking advanced bronchogenic carcinoma. The unusual clinico-pathological features with the autopsy findings in the last case can influence diagnosis, management and prognosis of oesophageal cancer in general and of such cancer associated with pre-malignant conditions like achalasia and oesophageal polyps in particular.     

Squamous cell cancer: a practical approach

Cutaneous squamous cell carcinoma (SCC) is the second most common form of skin cancer and is treated frequently by dermatologists. For many years, the level of knowledge regarding treatment of SCC has taken a backseat to the treatment of basal cell carcinoma and malignant melanoma. As dermatologists become more surgically proficient and assume a leading role in the surgical care for cutaneous carcinoma, a thorough knowledge of the appropriate management of SCC is of paramount importance. In particular, it is essential to recognize that, unlike basal cell carcinoma, certain SCC have a significant metastatic potential and require more comprehensive care. This review targets the etiology, pathogenesis, clinical presentation, histopathology, and treatment of SCC. Particular attention is focused on providing appropriate care for SCC and recognizing and arranging appropriate management for high risk SCC.     

Metastatic renal cell carcinoma presenting as an aural polyp

Renal cell carcinoma may metastasize to the head and neck region at different stages of its evolution. We present a case of an undiagnosed renal cell carcinoma presenting as an ear polyp, and discuss the difficulties of the diagnosis and the management of these tumours.     

Ductal carcinoma in situ: the mammographer's perspective

Ductal carcinoma in situ represents a heterogeneous group of lesions now most commonly discovered by mammography. The biological behavior of ductal carcinoma in situ ranges from indolent, essentially benign lesions to obligate precursors of invasive carcinoma. This article reviews the natural history of this disorder, its mammographic and pathologic features, and current considerations in patient management, including the role of mammography. The results of recent clinical trials are summarized.     

Early stage carcinoma of the female breast and axillary lymph node dissection

Stage I carcinoma of the female breast can be treated effectively by total mastectomy and post-operative radiation therapy to the chest wall and regional lymph nodes. Identification of positive axillary lymph nodes for prognostic purposes or for definition of patients who might benefit by adjuvant chemotherapy is not a requisite to the successful management of early stage carcinoma of the breast.     

Frequency of homozygous deletion at p16/CDKN2 in primary human tumours

BACKGROUND: Carcinoma of the breast is characterized by a variable course with prognosis dependent on disease stage at presentation. Paradoxically, some patients with early malignancy demonstrate disease progression within a short time. The role of tumor markers in the management of carcinoma of the breast is controversial. While CA15-3 is the most widely used tumor marker in carcinoma of the breast, its role in the management of patients with early disease is controversial. STUDY DESIGN: Since 1986, all patients presenting to our unit with carcinoma of the breast have had serial CA15-3 levels measured. This study evaluates the role of serial CA15-3 levels in the management of a consecutive series of 168 patients with Stage I disease at presentation. RESULTS: The mean preoperative CA15-3 levels at presentation were significantly elevated in patients with Stage I disease compared with patients with benign disease. Sixteen patients had either locoregional (five patients) or metastatic recurrence (11 patients). CA15-3 levels were not elevated in patients with locoregional disease and were significantly elevated in patients with bony metastases and gave a mean lead time of 6.3 months over bone scintigraphy. CONCLUSIONS: Serial CA15-3 measurements are an efficient and cost-effective method of monitoring disease progression and have advantages over conventional investigations in patients with early carcinoma of the breast.     

Trousseau's syndrome in association with ovarian carcinoma

BACKGROUND: The association of neoplastic disease and thromboembolic disorders was first recognized by Trousseau in 1865. Abnormalities of blood coagulation tests have been reported in the majority of patients with cancer, including ovarian carcinoma. However, Trousseau's syndrome has rarely been reported in women with ovarian carcinoma. METHODS: A literature search for cases of Trousseau's syndrome in association with ovarian carcinoma was performed using the MEDLINE database. Case notes of patients with ovarian carcinoma treated at St. George's Hospital were reviewed and cases of Trousseau's syndrome identified. RESULTS: We report a series of 4 cases of Trousseau's syndrome in association with ovarian carcinoma occurring over a 3- to 4-year period, and highlight the particular difficulties associated with the management of these thromboembolic effects. CONCLUSIONS: Trousseau's syndrome can impair quality of life in patients with advanced ovarian carcinoma and enhanced anticoagulation regimens may be required for effective palliation.     

The role of surgery in the treatment of epidermoid cancer of the anal canal

Thirty patients underwent surgery for carcinoma of the anus, a surgical procedure having been planned as all or part of their management in only 18 of them. The other 12 patients required surgery after radiotherapy, either because of progression of their neoplasm, or because of irradiation-related complications. Any tendency to attribute a quasi-exclusive role to radiotherapy in the treatment of carcinoma of the anus should be avoided.     

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.     

Tracheal rupture after blunt chest trauma in a child

Metastatic carcinoma to the testis is very rare. Metastasis of prostate adenocarcinoma to testis was detected incidentally after bilateral orchiectomy for hormonal management of metastatic prostate carcinoma. The metastatic lesion was not identified in physical examination or in macroscopic dissection of the testis after surgery. Microscopy revealed an adenocarcinoma which, given the history of the patient and a positive immunohistochemical stain for PSA, was identified as metastatic prostatic adenocarcinoma.     

Cystoscopic staging of carcinoma uterine cervix, revisited

Of the 378 cases of stage 3 carcinoma uterine cervix, only 10 showed vesical invasion, while 19 of 24 cases of stage 4 disease had vesical invasion. Results of this procedure did not alter the management of the disease in any of these cases. From the whole series it was concluded that cysto-urethroscopy is an unnecessary, cost ineffective, invasive procedure which has no role in either diagnosis or in planning the definitive treatment of carcinoma uterine cervix.     

FDG PET evaluation of granular cell tumor of the breast

Granular cell tumor is a rare, usually benign neoplasm of neural origin that may arise in virtually any site and, when situated in the breast, can mimic breast carcinoma. We describe a case of granular cell tumor of the breast in a 57-yr-old woman. Clinical evaluation, mammography, sonography and MRI suggested a carcinoma with infiltration of skin and muscle. However, the tumor did not display increased glucose metabolism on PET. Clinical findings, imaging results, histological characteristics and surgical management are discussed.     

Is there a role for cryoablation of the prostate in the management of localized prostate carcinoma?

It is impossible to adequately answer the question of whether there is a role for CSAP in the management of localized prostate carcinoma without considering the relative advantages and limitations of using other therapies to manage this disease (radical prostatectomy, radiation therapy, hormonal therapy, brachytherapy, expectant observation, and so on). Obviously, this is beyond the scope of this article. It is probably fair to point out, however, that the management of localized prostate carcinoma in the United States is generally quite controversial at the present time, and that despite a considerable amount of data pertaining to these therapeutic alternatives, it is difficult to discern a standard approach that can be broadly applied for all men with this disease. Therefore, if an absence of consensus on the management of localized prostate carcinoma does exist, it seems evident that investigations into alternative therapies are justified, and the preliminary results and efforts investigating CSAP fall well into this paradigm. In this context, several points can be made based on the available information. Significant numbers of patients who undergo CSAP can sustain undetectable levels of PSA for durable periods of time (more than 24 months). Thus, on a clinical level it seems possible to ablate the entire prostate with percutaneous CSAP, although rates of achieving this may be lower than originally anticipated. The reasons for persistence of carcinoma post CSAP are likely technical and related to the difficulties in determining the effective probe placements, number of probes to be used, number of freeze-thaw-freeze cycles to be used, and so on. Previous radiation exposure appears to confer an increased risk of CSAP-related morbidity, with incontinence, tissue sloughing, and rectal injury most prominent. Among nonradiated patients, incontinence is rare, and the most prominent postoperative concern involves BOO/tissue sloughing in a minority of patients. The longest follow-up data available on CSAP suggests that for patients with nonmetastatic prostate carcinoma, CSAP is associated with persistence of carcinoma in only 25% of patients. This compares favorably with the available biopsy data following external beam radiotherapy, in which most reports document positive biopsy results ranging between 30% and 100%, with the majority in the 40% to 50% range. Notably, the positive biopsy rate among patients with stage T3 disease following CSAP at 2 years can be less than 30%, which compares very favorably with previously reported positive biopsy result for these patients following external beam radiation therapy, which ranged between 40% and 100%. The management of patients with persistent carcinoma following CSAP poses fewer concerns to physicians than for those with persistent carcinoma following radiation therapy. Given the number of patients with prostate carcinoma who currently undergo radiotherapy as primary management, these data indicate that CSAP can now be considered a very viable therapeutic alternative for selected patients. With standardizations of technique as well as improved modifications in equipment, these preliminary CSAP results may well improve steadily in the near future. In the absence of randomized, comparative trials, it is difficult to draw meaningful comparisons between CSAP and radical prostatectomy. Based on available information, CSAP appears to be associated with a much lower incidence of stress and total incontinence than is radical prostatectomy. The rates of impotence following CSAP are somewhat comparable to those seen after radical prostatectomy, with wide variation among individual series. For patients who would be ideal candidates for radical prostatectomy (for example, less than stage T2c disease, PSA less than 10 ng/mL, and Gleason score of 7 or less), several authors have noted that the positive biopsy rate between 6 and 12 months is less than 10%.     

Reactive heterotopic ossification. Its patterns on MRI

Using the combination of clinical diagnosis, mammography and fine-needle aspiration cytology (FNA) as a "triple diagnosis" to guide management of carcinoma of the breast, we retrospectively reviewed 46 patients with FNA diagnosis of carcinoma of the breast in Ramathibodi Hospital from 1993 to 1995. Pathological diagnosis was available in 36 cases and used as a gold standard. Clinical diagnosis alone was accurate in 28 of 36 cases. Mammography was available in 24 cases of which the diagnosis was accurate in 22 cases. Triple diagnosis was available in 19 cases and all were accurate. Using this approach and review of the literature, we suggest that triple diagnosis could replace an open biopsy in diagnosis of carcinoma of the breast.     

Indications for percutaneous radiotherapy in carcinoma of the thyroid gland. Freiburg consensus

At the University of Freiburg, a consensus was arrived at concerning the place of external radiotherapy in the management of thyroid cancer. External irradiation is always indicated in papillary and folliculary carcinoma in the pT4 stage of pTNM classification but not in those in pT1-3 pN0 stage. In the presence of lymph-node metastases and distant metastases, an individual treatment concept is recommended, which should be set up in an interdisciplinary conference regarding all risk factors, especially the age and sex of the patient, the histology and grading of the tumor and the completeness of tumor resection. Finally, radiotherapy is usually not indicated in medullary thyroid carcinoma, whereas it is always indicated in anaplastic carcinoma.     

Core needle biopsy of synchronous ipsilateral breast lesions: impact on treatment

OBJECTIVE: The purpose of this study was to evaluate the role of core biopsy in the diagnosis of multiple synchronous ipsilateral breast lesions and to determine the impact of this information on patients' management. MATERIALS AND METHODS: Of 371 patients who underwent core-needle breast biopsy under stereotaxic (n = 278) or sonographic (n = 93) guidance, 20 (5%) underwent core biopsy of two mammographically separate lesions in the ipsilateral breast on the same date. Fourteen of these 20 patients subsequently underwent surgery. We retrospectively reviewed the medical, radiographic, and histopathologic records in these 14 patients and in 91 patients with single mammographic lesions diagnosed as carcinoma by means of core biopsy during the same period. RESULTS: In 11 patients, core biopsy revealed two sites of carcinoma. Core biopsy findings in these 11 patients were two areas of infiltrating ductal carcinoma (n = 5), one infiltrating ductal carcinoma and one infiltrating lobular carcinoma (n = 2), one infiltrating ductal carcinoma and one ductal carcinoma in situ (n = 1), and two foci of ductal carcinoma in situ (n = 3). All 11 patients with two core biopsy-proven foci of carcinoma underwent mastectomy. Patients were significantly more likely to be treated with mastectomy if core biopsy revealed two rather than one site of carcinoma (100% versus 38%, p < .001). CONCLUSION: Core-needle biopsy is useful in diagnosing multiple synchronous ipsilateral breast lesions. By showing whether carcinoma is present in one or more sites in the breast, core biopsy can provide information of critical importance in making treatment decisions.     

Evaluation of the API 20C for identification of yeasts

Medroxyprogesterone acetate has been used to treat metastatic renal cell carcinoma largely because of its observed inhibitory effects on the growth of estrogen-induced tumors in male Syrian golden hamsters. The absence to date of any successful, established chemotherapeutic regimen in the management of metastatic renal cell carcinoma has led to the continued application of medroxyprogesterone acetate in the majority of patients with this disease because of the occasional regression witnessed (particularly in male patients) and the absence of untoward side effects. To examine the mechanism of action of medroxyprogesterone acetate renal cell carcinoma tumor cells from a patient who had responded to medroxyprogesterone acetate therapy were established in tissue culture. Cells were cultured in control medium, and in the presence of therapeutic and pharmacologic levels of medroxyprogesterone acetate. Tumor cell growth kinetics were determined by the incorporation of 3H thymidine. There was no growth inhibition effected by medroxyprogesterone acetate at therapeutic or pharmacologic levels. Therefore, the proposed salutary effect of medroxyprogesterone acetate in regression of metastatic renal cell carcinoma results from factors other than direct inhibition of renal cell carcinoma growth.     

Squamous cells in fine-needle aspiration biopsies of salivary gland lesions: potential pitfalls in cytologic diagnosis

A spectrum of neoplastic and non-neoplastic lesions of the salivary glands may contain squamous cells. These include chronic sialadenitis, lymphoepithelial cyst, pleomorphic adenoma, Warthin's tumor, mucoepidermoid carcinoma, and squamous cell carcinoma. The squamous cells may be a defining feature of the lesion, or an occasional and thus unexpected finding, with a consequent potential for misdiagnosis. Clinical management of these lesions differs significantly, and careful evaluation of the squamous elements, along with attention to other cellular and background components, facilitates accurate diagnosis.     

Fetal oxygen saturation and uterine contractions during labor

In the majority of cases, carcinoma of the thyroid presents as a cold nodule by radioiodine and Tc-99m sodium pertechnetate scintigraphy. Whereas the presence of a hot nodule usually implies a benign entity, it does not provide complete assurance against thyroid malignancy. Presented is a rare case of metastatic pure papillary thyroid carcinoma appearing as a hot nodule on Tc-99m sodium pertechnetate and I-123 sodium iodide scintigraphy. The implications of such a case, its management, and review of the pertinent literature are discussed.     

Acute suppurative cholangitis secondary to calcific pancreatitis

In the absence of calculi or carcinoma, the occurrence of acute suppurative cholangitis secondary to calcific pancreatitis is extremely rare. This report describes the successful management of acute suppurative cholangitis by surgical decompression and use of a new aminoglycoside, amikacin.