ABSTRACT
Renal cell carcinoma is often characterized by the presence of metachronous metastases in unusual sites. The presence of isolated metastases is treated with surgical excision with good anticipated results. On the other hand, systemic chemotherapy is administered in the context of metastatic spread, usually sunitib or sorafenib. In such cases, however, the presence of symptomatic foci calls for minimal intervention.We present a case of a 77-year-old patient who presented with obstructive jaundice due to an ampullary mass. Endoscopic excision and biopsy set the diagnosis of metastatic renal cell carcinoma. Consequently, imaging studies revealed the presence of multiple foci in the lungs and bone. Therefore, pancreatoduodenectomy was excluded and the patient underwent endoscopic ampullectomy and was set to oral sunitinib. Interestingly, despite generalized spread, local control was achieved until the patient succumbed to carcinomatosis.Painless obstructive jaundice in a patient with history of renal cancer and negative computed tomography scanning for pancreatic or other causes of obstruction should alert for prompt investigation for an ampullary metastasis.
Subject(s)
Ampulla of Vater/pathology , Carcinoma, Renal Cell/secondary , Common Bile Duct Neoplasms/secondary , Jaundice, Obstructive/etiology , Kidney Neoplasms/pathology , Aged , Humans , Jaundice, Obstructive/pathology , Male , PrognosisABSTRACT
Myoepithelial tumors of the vulva are extremely rare, with only 8 cases reported in the literature to date. We report the first case of a high-grade myoepithelial vulvar carcinoma diagnosed in a 35-year-old woman during the 27th week of her pregnancy. The patient initially underwent a wide local excision of the lesion but noted rapid regrowth of the vulvar mass during the next 2 months before her delivery. Shortly thereafter, she underwent a classic radical Taussig-Basset total radical vulvectomy, bilateral superficial and deep inguinal groin node dissection, partial vaginectomy, and reconstruction of the vulva. However, the patient rapidly developed both locoregional and distant mestatatic disease, despite aggressive chemoradiotherapy, and she eventually succumbed to disseminated disease almost 20 months after her initial diagnosis.
Subject(s)
Abscess/pathology , Bartholin's Glands/pathology , Myoepithelioma/pathology , Pregnancy Complications/pathology , Vulvar Neoplasms/pathology , Adult , Antineoplastic Agents/therapeutic use , Combined Modality Therapy , Diagnosis, Differential , Fatal Outcome , Female , Gynecologic Surgical Procedures , Humans , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/surgery , Pregnancy , RadiotherapyABSTRACT
A 38-year-old woman with a history of pelvic endometriosis was referred to our surgical department for the treatment of a cystic lesion most probably originating from the liver. At the laparotomy a solitary cyst was found in the retroperitoneum, connected to the inferior surface of the liver, and was resected. Histopathological examination of the resected specimen revealed that it was an endometriotic cyst. The occurrence of endometriotic cyst in the upper abdomen is very rare: there are no published reports of an endometriotic cyst in that anatomic location. The literature on this subject is reviewed.
Subject(s)
Endometriosis/pathology , Liver Diseases/pathology , Retroperitoneal Space/pathology , Adult , Female , Humans , Pelvic Pain/diagnosisABSTRACT
BACKGROUND: Rectal squamous cell carcinoma (SCC) is a rare tumor. The incidence of this malignancy has been reported to be 0.25 to 1 per 1000 colorectal carcinomas. From a review of the English literature 55 cases of SCC of the rectum have been published. In this study we report a rectal metastatic SCC to the liver, discussing the efficacy of aggressive adjuvant and neo-adjuvant therapies on survival and prognosis. CASE PRESENTATION: A 39-year-old female patient with a pure SCC of the rectum diagnosed endoscopically is presented. The patient underwent initially neoadjuvant chemo-radiotherapy and then abdominoperineal resection with concomitant bilateral oophorectomy and hysterectomy, followed by adjuvant chemo-radiotherapy. Five months after the initial operation liver metastasis was demonstrated and a liver resection was carried out, followed by adjuvant chemotherapy. Eighteen months after the initial operation the patient is alive. CONCLUSION: Although prognosis of rectal SCC is worse than that of adenocarcinoma, an aggressive therapeutic approach with surgery as the primary treatment, followed by combined neo- and adjuvant chemo-radiotherapy, may be necessary in order to improve survival and prognosis.
Subject(s)
Carcinoma, Hepatocellular/diagnosis , Hepatomegaly/diagnosis , Liver Neoplasms/diagnosis , Adult , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Cell Nucleus/pathology , Diagnosis, Differential , Female , Focal Nodular Hyperplasia/diagnosis , Hepatectomy , Hepatomegaly/etiology , Hepatomegaly/surgery , Humans , Liver/diagnostic imaging , Liver Neoplasms/complications , Liver Neoplasms/surgery , Treatment Outcome , UltrasonographyABSTRACT
Pure undifferentiated carcinoma with osteoclast-like giant cells of the pancreas is very rare. Its prognosis is grim. The clinicopathologic findings of a case of this unusual tumor are presented. Following resection, the patient at 9 mo follow-up developed local recurrence.
