Tongue metastasis as an initial manifestation of distant metastasis in oesophageal adenocarcinoma

Metastasis to the head and neck region from primary is rarest manifestation. Lung and breast carcinomas are the commonest malignancies to metastasize to the head and neck region. Oesophageal adenocarcinoma with metastasis to the oral cavity is a rarest presentation and is associated with dismal prognosis. Only few related case reports have been published so far. Her-in we report a case of 55 years old male who underwent radical oesophagectomy for adenocarcinoma of lower oesophagus twelve months back, now presented with hard mass in the right margin of tongue which was suspected as primary tongue carcinoma; subsequently was confirmed as metastatic oesophageal adenocarcinoma following excision. Two months after tongue excision, patient died of progressive metastatic disease

Follicular dendritic cell sarcoma of the neck with pulmonary metastases

We present a case of follicular dendritic cell sarcoma in a 48 years old Saudi female who reported with slowly progressive right sided extranodal neck mass associated with pulmonary metastasis. Clinical examination, histopathologic features including distinct immunostains combine together to make the rare diagnosis of follicular dendritic cell sarcoma. This entity is often misdiagnosed due to non-consideration in differential diagnosis of sarcoma. It carries a significant potential for regional as well as distant spread and hence categorized as intermediate risk malignancy. Clinical, histopathological and immunohistochemical aspects and therapeutic options of this unusual case are discussed

Role of neo-adjuvant chemoradiation in locally advanced rectal cancers

To determine the radiologic downstaging and histological response after neo-adjuvant concurrent chemoradiation in locally advanced rectal cancers. Case series. Radiation Oncology department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from December 2004 to November 2005. Thirty patients with histopathologically confirmed locally advanced carcinoma rectum who had not received any treatment [chemotherapy, radiotherapy or surgery] prior to presentation were enrolled. Radiation therapy was delivered with a three-field technique to a dose of 50.4 Gy over 5 weeks at the rate of 1.8 Gy/day. Two cycles of chemotherapy were given synchronously, which comprised of 5-fluorouracil 350 mg/m[2] and folinic acid 20 mg/m[2] continuous intravenous infusion over first five days and last five days of radiotherapy. Surgery was planned 4-6 weeks later to chemoradiation after radiologic post therapy staging. Viable specimens were identified and toxicity was observed. All patients completed treatment without modification. Radiologic downstaging was found in 56.7%, stable disease was seen in 30.0% and progressive disease was present in 13.3% of the patients. Radiologically complete resolution of tumour was not observed. Pathological complete resolution of tumour was achieved in 3.3% and near complete resolution was observed in 13.3% of the patients. In 86.6% cases, a total gross tumour resection with no macroscopic residual disease was possible. All the patients tolerated the treatment well. Neo-adjuvant chemoradiation for locally advanced rectal cancers is associated with high resectability rate and is relatively safe with acceptable morbidity which favours its use in future