Calvarial metastasis from adenocarcinoma of lung: An uncommon initial presentation diagnosed by cytology

Bone metastasis from lung primary is not uncommon and about one-third of bone metastases originate from lung. However, skull bone metastasis is uncommon from lung carcinoma. Metastasis to skull bone and scalp as an initial presentation of lung carcinoma is a very rare phenomenon. We have diagnosed a case of calvarial metastasis with scalp swelling as an initial presentation of adenocarcinoma of lung by fine-needle aspiration cytology in an aged female. Radiologically, it was suggested as tuberculous lesion but cytology gave the correct diagnosis. Here, we present a rare case of calvarial metastasis as a presentation of adenocarcinoma of lung in an elderly female

Subtle Dysphagia as an Initial Presentation of Hidden Malignancy: A Report of 2 Cases / 대한연하장애학회지

Subtle dysfphagia, which is increased post-swallowing remnants, is a frequent finding in the elderly with various etiologies. These changes in swallowing are frequently overlooked by physicians. On the other hand, subtle changes evident on a videofluoroscopic swallowing study (VFSS) may suggest hidden disease. Therefore, clinicians should evaluate incidental dysphagia. Case 1: A 65-year-old man with no relevant medical history, presented with dysphagia and residual sensation during meals. VFSS showed moderate post-swallowing remnants in the vallecular fossa and pyriformis sinus. Further examination revealed prostate cancer with multiple bone metastases including the skull. Case 2: A 60-year-old man complained of residual sensation after swallowing, which started 2 months ago. He had a history of lung cancer. Pharyngeal residue was observed on VFSS. A brain metastasis was observed on MRI. Post-swallowing residue is often neglected or overlooked by clinicians who regard them as the features of aging. The present cases show that mild dysphagia with increased post-swallowing remnants may be an initial presentation of a hidden malignancy with metastasis. Physicians should consider unexplained dysphagia or tongue atrophy as possible initial presentations of hidden malignancies.

Minimally differentiated acute myelogenous leukemia presented with multiple cervical lymphadenopathy

Lymphadenopathy is a relatively uncommon finding of minimally differentiated acute myelogenous leukemia (AML-MO). We experienced a case of AML-MO in a 57-year-old man initially presented with multiple cervical lymphadenopathy. Bone marrow aspiration revealed myeloblasts, which were negative for myeloperoxidase, Sudan black B, Periodic acid-Schiff, non-specific esterase and double esterase reaction. In cell surface marker studies, CD13, CD14, CD33, CD34, CD45 and HLA-DR were present. CT scan of neck demonstrated multiple lymphadenopathy at both internal jugular chains, spinal accessory chains and submandibular area. He died about two weeks after diagnosis without specific treatment.

A case of rectal cancer with sternal metastasis as initial presentation

Colorectal cancer with bone metastasis as initial manifestation is a very rare event. We have reported a case of rectal cancer presenting with sternal metastasis. A 30 year-old man was evaluated due to pain in the sternal area with a bulging mass. History and physical examination did not suggest any specific disease. A radionuclide bone scan revealed increased uptake in the sternal area, right 6th rib, and sacrum. Microscopic examination of a biopsy specimen from the sternum showed metastatic adenocarcinoma. A barium enema and CT scan of the pelvis suggested carcinoma of the upper rectum. Adenocarcinoma of the rectosigmoid junction area was demonstrated by colonoscopic examination with biopsy. He received palliative transverse colostomy for obstruction without further treatment.