ABSTRACT
A 68-year-old man underwent surgery for renal cell carcinoma half a year ago, and developed low back and hip pain. The pain did not respond to antibiotics. Collagen disease, in particular ankylosing spondylitis, was suspected and steroids were administered, resulting in the improvement of the symptoms. polymyalgia rheumatica (PMR) was diagnosed.As all symptoms improved following resection of the metastatic lymph nodes, he was diagnosed with paraneoplastic syndrome. A biological preparation (pazopanib) was administered for renal cell carcinoma, but colon cancer was diagnosed, followed by extirpation of the colon tumor. Although the patient had recurrent thigh pain, he was able to leave the hospital temporarily with walking aids.This is the first report of PMR as paraneoplastic syndrome after surgery for renal cell carcinoma in a patient with colon cancer.
ABSTRACT
Multiple cancers in the extrahepatic biliary tree are relatively rare. Many such cases are a double cancer of the common bile duct and the gallbladder. We report a case of a double primary cancer that occurred synchronously at the hilum of the extrahepatic duct and the ampulla of Vater with a review of the relevant literature. A 57-year-old man was admitted to our institution after a 15 day of painless jaundice and a urine color change. Ultrasonography showed a dilation of both intrahepatic ducts. Upper endoscopy revealed a protruding ulcerative mass at the ampulla of Vater and endoscopic retrograde cholangiography showed a dilated common bile duct and a mildly dilatated pancreatic duct, but both intrahepatic bile ducts were not visualized. An upper abdominal CT scan showed a dilation of both intrahepatic bile ducts and an infiltrating mass at the bifurcation area. Magnetic resonance cholangiopanreatography showed narrowing bile duct lumen that was obstructed by the tumor at the hepatic duct bifurcation, which dilated both intrahepatic ducts. A histological examination of the ampulla of Vater revealed a well differentiated adenocarcinoma of the ampulla of Vater. The final diagnosis was a synchronous double cancer of Klatskin's tumor and an adenocarcinoma of the ampulla of Vater.
Subject(s)
Humans , Middle Aged , Adenocarcinoma , Ampulla of Vater , Bile Ducts , Bile Ducts, Intrahepatic , Biliary Tract , Cholangiography , Common Bile Duct , Diagnosis , Endoscopy , Gallbladder , Hepatic Duct, Common , Jaundice , Klatskin Tumor , Pancreatic Ducts , Tomography, X-Ray Computed , Ulcer , UltrasonographyABSTRACT
Combined hepatocellular carcinoma and cholangiocarcinoma is found at a frequency of 1.0~6.3% in resected primary hepatic tumors. However, the case of double cancers of hepatocellular carcinoma and cholangiocarcinoma that are discovered synchronously in different lobes of a liver is very rare. We experienced a case of a 74-year-old man who was found to have hepatocellular carcinoma and cholangiocarcinoma in different lobes of the liver, which were accompanied by early gastric cancer. To our knowledge, this is the first case report of double primary hepatic cancers accompanied with early gastric cancer. The pathogenesis and previous related reports of these lesions are discussed.
Subject(s)
Aged , Humans , Male , Adenocarcinoma/diagnosis , Bile Duct Neoplasms/diagnosis , Bile Ducts, Intrahepatic/pathology , Carcinoma, Hepatocellular/diagnosis , Cholangiocarcinoma/diagnosis , Liver Neoplasms/diagnosis , Neoplasms, Multiple Primary/diagnosis , Stomach Neoplasms/diagnosisABSTRACT
Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) is sometimes found in resected livers, however, cases with double cancer of HCC and CC are very rare. As well, the rarity of CC arising in von Meyenburg complexes (VMCs) is appreciated. We report the case of a 74-year-old man found to have intrahepatic double cancer composed of well-differentiated HCC and CC which exhibited a histologic progression from VMCs to adenomatous lesions and CC. To our knowledge, this is the first case report published in the literature of a double HCC and CC associated with multiple VMCs. The pathogenesis and previous associated reports of these lesions are discussed.
Subject(s)
Aged , Male , Bile Ducts, Intrahepatic/abnormalities , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/etiology , Cholangiocarcinoma/pathology , Cholangiocarcinoma/etiology , /pathology , Liver Neoplasms/etiology , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/etiologyABSTRACT
We have surgically experienced a case with primary double cancer which metachronously occurred in the gall bladder and the distal portion of common bile duct. This 61-year-old male underwent cholecystectomy with en bloc wedge resection of liver due to the malignant tumor in the gall bladder about 30 months ago. The histopathological examination revealed that the lesion was adenocarcinoma, moderately to poorly differentiated, with partly neuroendocrine differentiation, in the neck portion of the gall bladder (Figure 1). The malignant potential invaded to the subserosal layer, and the resected margin of the cystic duct was free from the malignant invasion. During the post-operative period, he has periodically or sporadically visited the out-patient Department of Surgery and Internal Medicine at Taejeon St. Mary's Hospital for follow-up studies. He was admitted again because of the insiduous onset of painless jaundice along with generalized itching sensations. The studies, using the ultrasonogram and the CAT scan, showed that the intra- and extra-hepatic biliary trees were moderately dilated due to a mass effect at the distal portion of the common bile duct (Figure 2). The ERCP revealed the lesion was malignant(Figure 3), and histologically confirmed adenocarcinima, well differentiated. He underwent Whipple's pancreaticoduodenectomy with regional lymph node dissection(Figure 4). The histopathological examination revealed that the lesion was adenocarcinoma, moderately differentiated, with lymphatic and perineural invasion, in the distal portion of the common bile duct (Figure 5). The malignancy extended toward the submucosal layer of duodenum and the pancreatic parenchyme. The resected margin of common bile duct was free from malignant invasion. He recovered uneventfully from the second surgical intervention. He periodically visits the out-patient Department of Surgery nowadays.
Subject(s)
Animals , Cats , Humans , Male , Middle Aged , Adenocarcinoma , Biliary Tract , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy , Common Bile Duct , Cystic Duct , Duodenum , Follow-Up Studies , Internal Medicine , Jaundice , Liver , Lymph Nodes , Neck , Outpatients , Pancreaticoduodenectomy , Pruritus , Sensation , Ultrasonography , Urinary BladderABSTRACT
The occurrence of double primary cancer of the esopbagus and duodenum is considered very rare. Moreover, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. We report a case of double primary cancer, which we have synchronously confirmed esophageal squamous cell carcinoma and duodenal adenocarcinoma with gastrofiberscopic biopsy, and then treated them by gastrojejunostomy and systemic chemotherapy.
Subject(s)
Adenocarcinoma , Biopsy , Carcinoma, Squamous Cell , Drug Therapy , Duodenum , Esophageal Neoplasms , Gastric Bypass , Neoplasm MetastasisABSTRACT
Double primary cancer of the stomach and esophagus has been revealed a very low incidence in the world except Japan and reported only 6 cases in Korea. Furthermore, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. This paper is concerned with a case of double primary cancer, which we have synchroniously confi~rmed esophageal squamous cell carcinoma and gastric adenocarcinoma with gastrofiberscopic biopsy, and then treated them by radical resec tion and systemic chemotherapy.