Carcinoma buccal mucosa with left axillary lymph node metastasis: First reported case and review of the literature

Head-and-neck squamous cell carcinomas are tumors with propensity mostly for locoregional spread. The most frequent sites of metastasis include lung, bone, liver, adrenal, heart, and kidney. Distant metastasis to axillary lymph nodes from buccal mucosa cancer is extremely rare. To the authors' knowledge, this is the first case reported where a gentleman who was treated for carcinoma right buccal mucosa developed left axillary lymph node metastasis at 6th year of follow-up.

Living donor liver transplantation for hepatocellular carcinoma: a single centre experience.

BACKGROUND: The indications of liver transplantation in hepatocellular carcinoma (HCC) are evolving. With the advent of living donor liver transplantation (LDLT), there is a renewed interest in this procedure for tumors beyond the standard Milan criteria. METHODS: We retrospectively analyzed the outcome of 28 patients who underwent LDLT for HCC in one institution. Survival analysis was done using the Kaplan-Meier method. RESULTS: Of the 28 patients, 9, 12 and 7 had Child's A, B and C cirrhosis respectively; 26 (93%) had underlying hepatitis B or C. Nineteen patients (68%) had tumors exceeding the Milan criteria. Postoperative (within 90 days) mortality and morbidity rates were 2/28 (7%) and 7/28 (25%) respectively. The actuarial overall 1-year, 2-year and 3-year survival rates were 76%, 76% and 51%, respectively. The actuarial 1-year, 2-year and 3-year recurrence free survival rates (computed by censoring the data of patients who died of causes other than HCC recurrence) were 88%, 82% and 70%, respectively. Although the survival rates were better for tumors within the Milan criteria than those exceeding them, the difference was not significant. CONCLUSIONS: LDLT is an effective modality in the treatment of HCC in patients with liver cirrhosis. It may also provide an opportunity for potential cure to patients with tumors beyond Milan criteria.

Pre-transplant optimization by Molecular Adsorbent Recirculating System in patients with severely decompensated chronic liver disease.

BACKGROUND: The outcome of liver transplantation (LT) is influenced by the recipient's clinical condition. In a retrospective observational study, we evaluated the role of pre-LT Molecular Adsorbent Recirculating System (MARS) treatment in improving the clinical status and thereby the outcome of patients with chronic liver disease and severe hepatic decompensation. METHODS: Between March 2002 and September 2006, 70 patients with end-stage chronic liver disease underwent living-donor LT (LDLT). Of these, 9 (13%) patients with severely decompensated liver function (serum bilirubin> 350 micromol/L [20 mg/dL] and/or hepatic encephalopathy > or = grade 2) received pre-LT MARS treatment. RESULTS: The median MELD score was 33 (range, 26-47). A median of 2 (range, 1-6) sessions (8 hour/session) of MARS dialysis was performed per patient. MARS treatment was associated with reduction in serum bilirubin, creatinine and ammonia levels and no procedure-related complications. CONCLUSION: Pre-LT MARS is well tolerated and results in reduction of jaundice and improvement in renal function and may be useful in the management of patients with severe hepatic decompensation.

Metachronous gastric diffuse large B-cell lymphoma and adenocarcinoma.

The development of gastric carcinoma in a patient with gastric lymphoma is rare. Helicobacter pylori is a common etiologic agent for both these conditions. We report a 38-year-old lady who was initially diagnosed to have gastric lymphoma and developed early gastric carcinoma on follow up. She was operated on for the carcinoma and is in complete remission since.

Isolated gall bladder metastasis from renal cell carcinoma.

Gall bladder metastasis from renal cell carcinoma is rare. We report a 46-year-old man with isolated gall bladder metastasis from renal cell carcinoma 11 months after radical nephrectomy. He underwent cholecystectomy and frozen section revealed the metastatic tumor. Sixteen months later, the patient is free of disease.

Impact of intra-operative ultrasonography in liver surgery.

BACKGROUND/OBJECTIVE: Intra-operative ultra-sonography (IOUS) during surgery for primary and metastatic hepatic tumors identifies additional lesions and helps in determining the most optimal surgical strategy. We assessed the impact of IOUS in liver surgery at our hospital, a tertiary-care cancer center. METHODS: Patients with potentially resectable hepatic tumors underwent surgical exploration. The relationship of the tumor with regard to the intrahepatic vasculature was determined by IOUS. A search was also made for additional lesions not detected by pre-operative imaging modalities. In appropriate cases, IOUS was also used to assist resection and radiofrequency ablation/ethanol injection. RESULTS: Between January 2003 and January 2005, 52 patients underwent surgery for primary or secondary hepatic tumors. IOUS was performed in 48 of these patients. It detected additional hepatic lesions in 14 patients (29.2%). IOUS contributed to changing the operative plan in 21 patients (43.8%). It was directly responsible for avoiding resection or ablation in 7 patients (14.6%), 5 of whom had multiple bilobar lesions, 1 had IOUS-guided biopsy that revealed caseating granuloma on frozen section, and 1 patient had no lesion on IOUS. Three patients had extent of resection changed based on IOUS findings. IOUS also guided radiofrequency ablation in 8 patients and ethanol injection in one patient. CONCLUSION: IOUS is an essential tool in surgery for hepatic tumors. In addition to accurate staging, it also aids in safe resection and radiofrequency ablation in appropriate cases.

Pelvic exenteration: a perspective from a regional cancer center in India.

BACKGROUND: Pelvic exenteration is an extensive surgical procedure performed for locally advanced cancers in the pelvis. AIMS: The twenty-year experience with this procedure at the Cancer Institute has been analyzed for morbidity, failure pattern and survival. SETTINGS AND DESIGN: The case records of all the patients who had undergone pelvic exenteration between 1981 and 2000 at Cancer Institute (WIA), Chennai were retrieved from Tumor Registry and were analyzed. METHODS AND MATERIAL: Forty-eight patients underwent Pelvic Exenteration from 1981 to 2000 at the institute. Twenty-nine of them had rectal cancer, 15 had cervical cancer, 3 had bladder cancer, and 1 had ovarian cancer. There were 43 women and 5 men with a median age of 45 years. STATISTICAL ANALYSIS: The survival rates were calculated by Kaplan-Meier method using EGRET statistical software package. RESULTS: The operative mortality and postoperative morbidity were 10.42% and 62.50% respectively. The 5-year overall survival for the patients with Ca rectum and Ca cervix were 54.2% and 77.6% respectively. All 4 patients with Ca bladder or Ca ovary survived for more than 5 years. On multivariate analysis, nodal involvement and number of positive nodes emerged as significant prognostic factors for patients with Ca rectum. Although no factor reached statistical significance for patients with Ca cervix, those with adjacent organ invasion had a trend towards poorer survival. CONCLUSIONS: For carefully selected locally advanced cancer in the pelvis, pelvic exenteration may provide the opportunity of long-term survival.