Bilateral choroidal metastasis of follicular thyroid carcinoma 7 years after total thyroidectomy: a case report

ABSTRACT Follicular thyroid cancers account for 15%-20% of all thyroid tumors. Choroidal metastases secondary to follicular thyroid cancer rarely occur. Herein, we report the case of an 85-year-old woman who presented choroidal metastasis from a follicular thyroid carcinoma in the right eye 7 years after total thyroidectomy and underwent enucleation. To confirm the diagnosis and primary tumor site, histopathological, and immunohistochemical examinations were performed. One year later, she presented metastasis in the contralateral eye. Few similar cases have been described in the literature.

Computed tomography aspects of thoracic metastases from osteosarcoma: pictorial essay / Aspectos tomográficos das metástases torácicas de osteossarcoma: ensaio iconográfico

Abstract Osteosarcoma is the most common primary bone tumor, with a higher incidence in the second decade of life, and it often leads to pulmonary metastases. The most common pattern seen on computed tomography is one of multiple well-defined nodules in the lung parenchyma, often with calcifications. Because of the variety of presentations of pulmonary metastases in osteosarcoma, including atypical forms, knowledge of the computed tomography aspects of these lesions is important for characterizing and evaluating the extent of the disease, as well as for distinguishing metastatic disease from other benign or malignant lung diseases. This essay discusses the main tomographic findings of pulmonary metastases from osteosarcoma.

Resumo O osteossarcoma é o tumor ósseo primário mais comum, com maior incidência na segunda década de vida, sendo as metástases pulmonares achado frequente. O padrão tomográfico mais comum das metástases pulmonares de osteossarcoma é o de múltiplos nódulos bem definidos no parênquima pulmonar, frequentemente com calcificações. Em razão da multiplicidade de apresentações das metástases pulmonares do osteossarcoma, inclusive com formas atípicas, o conhecimento dos aspectos dessas lesões na tomografia computadorizada do tórax é importante para a caracterização e avaliação da extensão da doença, além de permitir a diferenciação entre doença metastática e outras doenças pulmonares benignas ou malignas. Este ensaio discute os principais achados tomográficos das metástases pulmonares de osteossarcoma.

Acquired reactive perforating collagenosis in association with prostate adenocarcinoma, chronic lymphocytic leukemia, and Graves disease

Abstract Acquired reactive perforating collagenosis is a rare skin disorder characterized by the presence of umbilicated pruritic papules and nodules. Transepidermal elimination of altered and perforating bundles of basophilic collagen from the epidermis is a characteristic histologic feature of acquired reactive perforating collagenosis. Along with its well-known association with systemic diseases such as diabetes mellitus, chronic renal failure, and dermatomyositis, there are reports of acquired reactive perforating collagenosis being associated with malignancies. Herein, we present a case of acquired reactive perforating collagenosis associated with chronic lymphocytic leukemia, prostate adenocarcinoma, and Graves's disease. Clinicians are required to be more vigilant in evaluating patients with acquired reactive perforating collagenosis due to its unique association with malignancies and other systemic diseases.

Bilateral metastases to the extraocular muscles from small cell lung carcinoma / Metástases bilaterais aos músculos extraoculares de um carcinoma de pequenas células do pulmão

ABSTRACT Bilateral orbital metastases restricted to the extraocular muscles (EOMs) are exceedingly rare. We report a case of bilateral extraocular muscle metastases from a small cell lung carcinoma and provide a review of the relevant literature. A 56-year-old smoker presented with proptosis, motility changes, and a relative afferent pupillary defect of the left eye, with a previous history of a small cell lung carcinoma. An orbital computerized tomography scan revealed a mass restricted to the left medial rectus. An incisional biopsy confirmed metastasis. Visual acuity of the left eye decreased rapidly, and right globe proptosis became evident. Orbital magnetic resonance imaging at two months follow-up showed marked left orbital mass enlargement and a new right lateral rectus mass. The patient was maintained on palliative care and died from metastatic disease-related complications.

RESUMO As metástases orbitárias bilaterais restritas aos mús­culos extraoculares são extremamente raras. Os autores apresentam um caso de metástases bilaterais, localizadas aos musculares extraoculares com base num carcinoma de pequenas células do pulmão e revisão da literatura relevante. Um homem, fumador, de 56 anos recorreu ao serviço de urgência por proptose, alterações de motilidade ocular extrínseca e um defeito pupilar aferente relativo do olho esquerdo, com história pessoal de carcinoma de pequenas células do pulmão. A tomografia computadorizada orbitária revelou uma massa restrita ao reto medial esquerdo. Uma biópsia incisional confirmou o diagnóstico de metástase. A acuidade visual do olho esquerdo diminuiu rapidamente e surgiu uma proptose do globo ocular direito. A ressonância magnética orbitária aos dois meses de seguimento revelou um aumento da massa orbitária esquerda e uma nova massa no reto lateral direito. O paciente foi mantido em cuidados paliativos e faleceu devido a complicações relacionadas com doença metastática.

Metastatic choroidal melanoma to the contralateral eye: a rare case / Melanoma de coróide metátastico para o olho contralateral: caso raro

ABSTRACT Uveal melanoma is the most common adult primary intraocular cancer. Although liver metastasis is common to the natural history of the disease, metastasis to the fellow eye is extremely rare. Here we report the case of a 59-year-old man with choroidal melanoma in his right eye who underwent enucleation at a different center. The patient was referred to our service 21 months postoperatively, complaining of decreased vision. He was found to have a new pigmented choroidal tumor in his left eye associated with liver disease. Ocular ultrasonography and liver biopsy with histopathological and immunohistochemical analysis were performed and confirmed the diagnosis. Few similar cases have been described in the literature. The differential diagnosis included primary bilateral choroidal melanoma and metastatic choroidal tumor from a primary skin melanoma.

RESUMO O melanoma uveal é o câncer intraocular primário mais frequente em adultos. Embora a metástase hepática seja comum à história natural da doença, a metástase para o outro olho é extremamente rara. Aqui relatamos o caso de um homem de 59 anos com melanoma de coroide em seu olho direito que foi submetido à enucleação em um centro diferente. O paciente foi encaminhado ao nosso serviço 21 meses após a cirurgia, com queixa de diminuição da visão. Foi encontrado um novo tumor de coróide pigmentado em seu olho esquerdo associado com doença hepática. Ultrassonografia ocular e biópsia hepática com exame histopatológico e imuno-histoquímico foram realizadas e confirmaram o diagnóstico. Poucos casos semelhantes foram descritos na literatura. O diagnóstico diferencial incluiu melanoma de coróide bilateral orimário e tumor coroidal metastático de um melanoma primário da pele.

Melanoma brain metastases presenting as delirium: a case report

Abstract Background Metastatic tumours sometimes present with neuropsychiatric symptoms, however psychiatric symptoms as rarely the first clinical manifestation. Cutaneous melanoma is the third most common cause of brain metastasis, with known risk factors increasing the chance of such central nervous system metastization. Objectives We present a clinical report of delirium as the first clinical manifestation of melanoma brain metastases, illustrating the relevance of an adequate and early differential diagnosis. Methods In addition to describing the clinical case, searches were undertaken in PubMed and other databases using keywords such as “brain metastasis”, “melanoma”, “agitation”, “psychiatric” and “delirium”. Results We here report the case of a 52-year-old female patient evaluated by Liaison Psychiatry after sudden onset of delirium while admitted at the Gastroenterology Department to study a hypothesis of pancreatitis. A head CT scan identified brain metastases, and after further examination, including brain biopsy, melanoma brain metastization was confirmed. Discussion Some of the diagnostic challenges of psychiatric symptoms associated with secondary brain tumours are discussed, underlining the importance of an adequate differential diagnosis when working in Psychiatry Liaison.

A Case of Hepatocellular Carcinoma with Recurrent Peritoneal Metastasis after Hepatectomy Who Showed Complete Response by Surgical Resection

Recurrence of hepatocellular carcinoma (HCC) after hepatic resection is quite common. Peritoneal recurrence has been considered incurable status and related to poor prognosis. Although peritoneal metastasectomy is a therapeutic option for some selected patients with a few peritoneal metastasis, the indication and therapeutic effect has not been clear. We report a case of a 61-year-old man achieving complete remission of recurrent peritoneal metastasis after repeated surgical resection by a multidisciplinary approach. Peritoneal metastasectomy might be a therapeutic option for selected patients with localized oligonodular peritoneal metastasis.

Analysis of prognostic factors in patients with pancreatic ductal adenocarcinoma and synchronous liver metastases after palliativet reatment / 中华胰腺病杂志

Objectives To explore the prognostic factors of patients with pancreatic ductal adenocarcinoma and synchronous liver metastases ( PALM ) receiving palliative treatment .Methods The clinical characteristics , therapeutic approaches and survival outcomes of 108 consecutive patients with PALM who were pathologically diagnosed and received only palliative treatment at Tianjin Medical University Cancer Hospital from January 2001 to December 2015 .were retrospectively analyzed .Survival rates were calculated by Kaplan-Meier method, and factors influencing the survival were analyzed by univariate and multivariate Cox proportional hazard regression model .Results Of these patients, 68 were male and 40 were female, with an average age of 58 years old.Seventy-seven (71.3%) cases or their relatives refused to receive anticancer therapies.Palliative treatments included choledochojejunostomy and /or gastrojejunostomy after exploratory laparotomy for 5 (4.6%) cases, percutaneous transhepatic biliary drainage (n=22, 19.4%), drug analgesia (n=79, 73.1%), drug analgesia combined with percutaneous neurolytic coeliac plexus block (n=17, 15.7%).The median survival time (MS)was 94 days in all patients.Karnofsky performance score (KPS)<80, lymph node metastases, ascites, fasting blood glucose ≥6.1 mmol/L and lactate dehydrogenase ( LDH ) ≥250 U/L were independent risk factors influencing prognosis of PALM . Three groups were categorized according to the number of the above 5 risk factors for 0~1 in low risk group, 2~3 in middle risk group and 4~5 in high risk group, and the MS of 3 groups was 137, 95 and 48 days, respectively, with an extremely statistical significance (P<0.0001).Conclusions KPS, lymph node metastases, ascites, fasting blood glucose and LDH were the risk factors for prognosis of PALM .Patient stratification according to the above factors is more advantageous for judging individualized prognosis and can provide reference for making clinical decision .

Metástase óssea como forma de apresentação de carcinoma hepatocelular / Bone metastasis as the presenting symptom of hepatocellular carcinoma

O carcinoma hepatocelular (CHC) é o tumor maligno primário do fígado mais frequente, apresentando na maioria das vezes em doentes cirróticos. O espectro de apresentação é muito variado e as manifestações clínicas dependem da fase evolutiva da doença. A progressão local e sistémica do carcinoma hepatocelular é frequente e as metástases ósseas não são incomuns. Apesar de as metástases ósseas serem uma forma de apresentação rara de carcinoma hepatocelular, por vezes estas precedem as manifestações hepáticas pelo que o carcinoma hepatocelular deve ser incluído no diagnóstico diferencial de lesões ósseas osteolíticas. Os autores apresentam um caso clínico e uma breve revisão teórica, pela sua raridade e importância clínica, sublinhando a importância do diagnóstico diferencial de carcinoma hepatocelular um doente previamente assintomático, sem doença hepática conhecida anteriormente, com um fractura patológica...

Hepatocellular carcinoma (HCC) is the most frequent primary malignancy of the liver, presenting most often in cirrhotic patients. The spectrum of presentation is very varied and clinical manifestations depend on the phase of the disease. The local and systemic progression of hepatocellular carcinoma is frequent and bone metastases are not uncommon. Although bone metastases are a rare form of presentation of hepatocellular carcinoma, sometimes they precede hepatic manifestations and that's way hepatocellular carcinoma should be included in the differential diagnosis of osteolytic bone lesions. The authors present a case report and a brief literature review, due to its rarity and clinical importance, stressing the importance of the differential diagnosis of hepatocellular carcinoma in a previously healthy patient without previously known liver disease, with a pathological fracture...

A case report of bilateral choroidal metastases of epithelial carcinoma of pancreas / Um relato de caso de metástases de coroide bilaterais de carcinoma epitelial de pâncreas

A 49-year-old woman with acute loss of vision in her left eye was examined in our clinic. Two months before arriving at out clinic, she was diagnosed with pancreatic endothelial carcinoma. Her visual acuities were 20/20 for the right and 20/200 for the left eye. Fundus examination and fundus fluorescein angiography showed bilateral subretinal solitary mass. Multiple metastases to lung, pleura, liver, spleen, and abdominal lymph nodes were detected during the initial diagnosis. The patient underwent chemotherapy during the period when the visual symptoms were observed. No additional treatment was offered because of the extent of the disease and poor general health. Although pancreatic endothelial carcinoma usually spreads to the abdominal visceral organs and lungs, choroidal metastases are rarely observed.

Uma mulher de 49 anos de idade, com perda visual aguda de seu olho esquerdo, que teve diagnóstico de carcinoma endotelial de pâncreas há dois meses, foi examinada em nossa clínica. Suas acuidades visuais eram 20/20 no olho direito e 20/200 no olho esquerdo. O exame de fundo de olho e a angiofluoresceinografia mostraram massa solitária sub-retiniana bilateral. Múltiplas metástases do pulmão, pleura, fígado, baço e nódulos linfáticos abdominais foram detectados no diagnóstico inicial. A paciente foi submetida a quimioterapia durante o tempo que os sintomas visuais foram observados. Nenhum tratamento adicional foi oferecido por causa da extensão da doença e problemas de saúde em geral. Embora o carcinoma endotelial de pâncreas normalmente se espalhe para órgãos abdominais e pulmões, este pode ser uma causa rara de metástases de coroide.

Analysis of the risk factors for brain metastasis among patients with metastatic breast cancer / 中国医师杂志

Objective This study aimed at retrospective analysis of some metastatic breast cancer cases,investigated the recurrence of brain metastases of metastatic breast cancer in patients with risk factors,and provided a reference for the implementation of prevention strategies in the treatment plan and a reasonable choice.Methods A total of 796 breast cancer cases was visited,of whom 456 patients with recurrent metastatic breast cancer,in which 61 patients were with brain metastasis.The follow-up data were analyzed with SPSS13.0 software.x2 was used to test the age,estrogen receptor (ER),progesterone receptor (PR),cerbB-2 expression,lymph node metastasis,and brain metastasis.The COX proportional hazard model was used to analyze the recurrence and metastasis in patients with single-factor,multi-factor analysis,in order to obtain the independent prognostic factors.Results The x2 tests that group age ≤ 35 years,hormone receptor-negative,CerbB-2 (2 +)/(3 +) has a higher risk than another group (x2 =24.92,8.28,4.02,P ＜0.01 orP ＜0.05).COX univariate analysis showed that patient age,tumor size,ER and PR expression,CerbB-2 expression,lung metastases were looked.as the first metastatic site and hormone therapy.Those were significant factors whether the patient suffered from brain metastasis (P ＜ 0.05).COX multivariate analysis showed that age,ER and PR expression,CerbB-2 expression,and lung metastases were looked as the first metastatic site acted as an independent prognostic factor for brain metastasis (P ＜0.05).Conclusions Age,ER and PR expression,CerbB-2 expression,lung metastases as the first metastatic site are the independent prognostic factors for brain metastasis.

Secondary infiltration of the central nervous system in patients with diffuse large B-cell lymphoma

OBJECTIVE: To investigate the incidence and risk factors of infiltration of the central nervous system after the initial treatment of diffuse large B-cell lymphoma in patients treated at Santa Casa de Misericórdia de São Paulo. METHODS: A total of 133 patients treated for diffuse large B-cell lymphoma from January 2001 to April 2008 were retrospectively analyzed in respect to the incidence and risk factors of secondary central nervous system involvement of lymphoma. Intrathecal prophylaxis was not a standard procedure for patients considered to be at risk. This analysis includes patients whether they received rituximab as first-line treatment or not. RESULTS: Nine of 133 (6.7%) patients developed central nervous system disease after a mean observation time of 29 months. The median time to relapse or progression was 7.9 months after diagnosis and all but one patient died despite the treatment administered. Twenty-six (19.5%) patients of this cohort received rituximab as first-line treatment and nine (7.1%) received intrathecal chemoprophylaxis. Of the nine patients that relapsed, seven (77.7%) had parenchymal central nervous system involvement; seven (77.7%) had stage III or IV disease; one (11.1%) had bone marrow involvement; two (22.2%) had received intrathecal chemoprophylaxis; and 3 (33.3%) had taken rituximab. In a multivariate analysis, the risk factors for this infiltration were being male, previous use of intrathecal chemotherapy and patients that were refractory to initial treatment. ...

A Case of Triple Early Gastric Cancer with Bone Marrow Metastasis / 대한내과학회지

The clinical outcome of early gastric cancer (EGC) has gradually been improving, and the 5-year survival rate for patients with EGC has been reported to exceed 85% in most studies. However, in some rare cases, EGC is associated with distant metastasis. Bone metastases from stomach cancer are usually osteolytic lesions. Although there have been a few reports of EGC with bone marrow metastasis, cases of triple EGC with bone marrow metastasis are rare. We report a 50-year-old male patient who was diagnosed with triple EGC with bone marrow metastasis. This case can be considered to be rare because the patient had no spread of the disease to other organs.

Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center / Fatores prognósticos de sobrevida em pacientes com metástases hepáticas colorretais

CONTEXT: Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. OBJECTIVES: To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. METHOD: This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. RESULTS: During the period analyzed, 209 procedures were performed on 170 patients. Postope-rative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. CONCLUSION: Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients showed similar results to those pointed in international series. The occurrence of major postoperative complications appears to be able to compromise overall survival and further investigation in needed in this topic.

CONTEXTO: As metástases hepáticas são evento comum na evolução clínica de pacientes com câncer colorretal e são responsáveis por 2/3 dos óbitos por esta doença. Há grande controvérsia entre os dados publicados na literatura quanto a resultados de tratamento cirúrgico e seus fatores prognósticos e não há análise, em casuísticas maiores, destes aspectos em uma grande coorte de pacientes no Brasil. OBJETIVOS: Caracterizar os resultados do tratamento cirúrgico de pacientes com metástases hepáticas de tumores colorretais e estabelecer os fatores prognósticos de sobrevida em uma população. MÉTODO: Estudo retrospectivo de pacientes submetidos a ressecção hepática de metástases colorretais em hospital oncológico terciário, de 1998 a 2009. Foram analisadas variáveis epidemiológicas e dos tumores primários da doença metastática e seu tratamento, dos procedimentos cirúrgicos e do seguimento e os resultados de sobrevidas. Para as análises de sobrevida foram utilizadas as curvas de Kaplan-Meyer e o teste de log-rank foi aplicado para determinar a influência das variáveis estudadas nas sobrevidas global e livre de doença. Aquelas variáveis em que este teste apresentou P<0,20 em análise univariada, foram incluídas em análise multivariada pelo modelo de regressão de Cox. RESULTADOS: No período analisado, 209 procedimentos foram realizados em 170 pacientes. A mortalidade em 90 foi de 2,9%. A sobrevida global em 5 anos foi de 64,9%. Os fatores prognósticos independentes de sobrevida global foram a presença de doença extra-hepática no momento do diagnóstico das metástases hepáticas, de nódulos em ambos os lobos hepáticos e a ocorrência de complicações maiores após a cirurgia. A sobrevida livre de doença estimada em 5 anos foi de 39,1% e seus fatores prognósticos incluíram a ressecção R1, a presença de doença extra-hepática, doença bilobar, a presença de acometimento linfonodal no tumor primário e tumores primários localizados no reto. CONCLUSÃO: A ressecção de metástases hepáticas de câncer colorretal se demonstrou segura e eficaz em nosso meio, com resultados semelhantes aos apresentados por outras grandes séries internacionais. A ocorrência de complicações pós-operatórias parece poder comprometer os resultados de sobrevida global obtidos e investigação mais aprofundada se faz necessária neste sentido.

Comparative study of therapeutic efficacy of systemic therapy with FOLFOX-6 and hepatic arterial infusion for hepatic metastases from colorectal cancer / 中华肝胆外科杂志

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.

Factors analysis on liver metastasis from rectal cancer / 中国医师进修杂志

Objective To detect the clinical factors related with liver metastasis in young patients with rectal cancer.Methods Three hundred and fifty young patients with rectal cancer were collected to set up the database.Single and multi-factor Logistic regression was applied to indicate the independent factors relating to liver metastasis.The regression equation to predict probability of liver metastasis from rectal cancer was established.Results Liver metastasis was 120 cases (34.3%).Single-factor analysis revealed that patho-organization type,pathologytype,infiltration extent,blood vessel invasion (BVI),TNM stage,operation character,the preoperative level of carcino-embryonic antigen,histology grading were related with liver metastasis.Multi-factor analysis revealed that only BVI (P=0.001),TNM stage (P=0.001),pathoorganization type (P=0.005),the preoperative level of CEA (P=0.008) and operation character (P=0.032) were independent factors to predict probability of liver metastasis.Conclusions Rectal cancer of young patients who being with BVI,advanced phase,high preoperative level of CEA,radical operation or poor differentiation degree,are apt to develop liver metastasis.They should be given further individualized intensive adjuvant treatment.

Spontaneous Rupture of Adrenal Metastasis from Hepatocellular Carcinoma

Rupture of adrenal tumor from various primary origins is a rather rare event. We report here on a ruptured adrenal metastasis from hepatocellular carcinoma, and this ruptured metastasis was observed at the time of the initial diagnosis.

A Rare Metastatic Liver Cancer: Hemangiopericytoma

Hemangiopericytoma is a rare tumor, and especially when it arises in the peritoneal cavity. We present here the case of a 60-year-old woman with an isolated recurrent hemangiopericytoma in the liver. The patient presented to us for evaluation of palpable RUQ mass 7 years after she had undergone her first resection of a malignant hemangiopericytoma arising from the greater omentum. She has been lost to follow up 6 months after the first surgery. Various imaging studies showed a single large liver tumor that was hypervascular, well-capsulated and had central necrosis. She was negative for HBs-Ag and Anti-HCV. Under an impression of the recurrent malignant hemangiopericytoma, a right trisegmentectomy was performed for complete resection of the tumor. The pathological examination confirmed the diagnosis of recurrent hemangiopericytoma. Even though the incidence of hemangiopericytomas is low, malignant hemangiopericytomas have displayed frequent recurrences after long disease- free periods. A recurrent hemangiopericytoma is not easily detected early during follow-up until it is symptomatic because this tumor has no specific tumor marker and it has diverse sites of recurrence. We think that Positron Emission Tomogram (PET) can be a useful tool for detection of recurrent hemangiopericytoma. We describe herein the clinically relevant information about hemangiopericytomas, and we particulary focus on the features of this tumor after the surgical resection.

Metastatic Bone Tumors with Sunburst Periosteal Reaction

PURPOSE: The purpose of this study was to describe the clinical and imaging features of metastatic bone tumors with sunburst periosteal reaction and to define the characteristic findings which would be helpful for differentiating metastatic bone tumors from primary malignant bone tumors. MATERIALS AND METHODS: The authors retrospectively reviewed the cases of nine patients with pathologically confirmed metastatic bone tumors with sunburst periosteal reaction, for which imaging studies (plain radiographs [n=9], radioisotope [RI] scans [n=4], magnetic resonance [MR] images [n=6], and computed tomographic [CT] scans [n=4]) were performed. The imaging studies of each lesion were analyzed by two musculoskeletal radiologists focusing on the metastatic site, patterns of bone response, signal intensity characteristics and pattern of contrast enhancement on MR. The clinical records of the patients were reviewed with regard to the age and sex of the subjects, the clinical presentation, and the origin of the primary tumors. RESULTS: The cases consisted of six men and three women, whose mean age was 62 years (age range, 50-88 years). The primary tumors were adenocarcinoma of the stomach [n=4], adenocarcinoma of the lung [n=2], adenocarcinoma of the prostate [n=1], hepatocellular carcinoma of the liver [n=1], and adenocarcinoma of unknown origin [n=1]. The sites of metastatic involvement exhibiting sunburst periosteal reaction were the scapula [n=2], proximal humerus [n=2], rib [n=1], iliac bone [n=1], tibia [n=1], spine [n=1], and proximal phalanx [n=1]. In all patients, the imaging findings showed osteolytic [n=3] or osteoblastic [n=6] lesions with sunburst periosteal reaction. In six cases, the lesions were iso-intense on the T1-weighted images and heterogeneously hyperintense on the T2-weighted images. The gadolinium-enhanced T1-weighted images showed a nearly homogenous enhancement of the lesions without any central necrotic portion. CONCLUSION: Although metastatic bone tumor exhibiting sunburst periosteal reaction is rare, it should be included along with primary malignant bone tumors in the differential diagnosis of bone lesions with sunburst periosteal reaction, especially in older patients with or without a known primary malignancy.

The clinico-pathological analysis of choroidal metastatic carcinoma arising from lung carcinoma / 中华眼底病杂志

Objective To observe the clinical and pathological characteristics of choroidal metastatic carcinoma from lung carcinoma. Methods The clinical and pathological data of 6 patients with choroidal metastatic carcinoma from lung carcinima were analysed retrospectively. Results All the 6 patients had severe visual impairment, including 3 with severe ophthalmalgia. Flat neoplasm were seen in the posterior pole of the eyes in all the 6 patients and retinal detachment were found in 5 patients. Fundus fluorescein angiography (FFA) examination had been performed on 1 patient and blocked fluorescence and hyperfluorescence were seen in the lesion with pinpoint fluorescein leakage loop around it. CT examination had been performed on 3 patients and the shadow of flat homogenous tumor was seen. MRI examination had been performed on 1 patient and high signal intensities on T1W and low signal intensities on T2W were found. In all the 6 patients with primary lung carcinoma, 5 were diagnosed with adenocarcinoma and 1 with cellule carcinoma through pathological examination, and 5 patients were diagnosed with choroidal metastatic carcinoma from adenocarcinoma and 1 with choroidal metastatic carcinoma from cellule carcinoma through pathological examination. Conclusion Rapid visual acuity decrease, severe ophthalmalgia, flat neoplasm in ocular fundus and secondary retinal detachment are the main clinical characteristics of the choroidal metastatic carcinoma from lung carcinoma. Most histopathological manifestations of the metastatic carcinoma like that of the primary focus, and adenocarninoma is the most common histoclassification.