Metastatic osteosarcoma causing intussusception.

Osteosarcoma is the most common malignant bone neoplasm. It has a very high metastatic potential, and lungs are the most common site of metastasis followed by bones. Multiagent chemotherapy has been reported to alter the biological behavior of the disease so that the tumor metastasizes to more rare sites such as brain, bowel, and soft tissues. The authors report a case of jejuno-jejunal intussusception caused by metastases from osteosarcoma.

Metastatic osteosarcoma presenting as a small-bowel polyp. A case report and review of the literature.

Gastrointestinal metastases of osteosarcoma are an extraordinarily rare event and, as far as we can determine, have been reported previously only 5 times; these cases represent an unusual pattern of progression. We describe a 21-year-old man with an osteosarcoma of the right tibia that was removed 4 years previously. Two years later, the patient showed lung metastases. At his most recent presentation, he complained of abdominal pain, nausea, vomiting, and anorexia. Radiologic examination revealed an abdominal mass close to the jejunum and 3 nodules in the liver. One metastasis was an ulcerated and pedunculated polypoid mass located in the mucosa of the bowel, and the other involved the entire thickness of the jejunum. This unusual phenomenon represents an alteration in the natural history of osteosarcoma as a result of increased long-term survival.

Hepatocarcinoma con metástasis intestinales polipoides: hallazgo en un caso de necropsia / Hepatocarcinoma with polypoid intestinal metastasis. Autopsy findings

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Hepatocellular carcinoma with unusual metastasis to the small intestine.

An autopsy case of a hepatocellular carcinoma (HCC) with unusual metastasis to the mucosa of the small intestine is reported. The patient was a 73 year old female. At autopsy, the liver weighed 970 g, and an ovoid and necrotic 6 x 5 cm sized tumor was found in the right posterior lobe with many daughter tumors within the cirrhotic liver. The tumor embolus in the portal vein was not found. Extrahepatically the tumor metastasized to the lungs, sacral bone and hepatohillar and para-aortic lymph nodes. Additionally, many sessile and pedunculated polyps up to 2 cm in diameter were found sporadically in the small intestine. These seemed to be primary adenomatous polyps but histologically they were HCC metastasis. To the best of the authors' knowledge, many polypoid involvements of the small intestine by a hepatocellular carcinoma have not been reported until now.

Stimulation of chemically induced rectal carcinogenesis by chronic ethanol ingestion.

The effect of chronic ethanol administration on 1, 2-dimethylhydrazine-induced rectal carcinogenesis was investigated in 32 paired male Sprague-Dawley rats fed a nutritionally-adequate liquid diet containing 36% of the total calories as either ethanol or isocaloric carbohydrates. Chronic ethanol ingestion increased the total number of rectal tumors significantly (17 vs 6; P less than 0.02), whereas no cocarcinogenic effect of ethanol was observed in other parts of the intestine. Alcohol did not influence tumor size or histopathology. A 47% increase in the activity of mucosal alcohol dehydrogenase in the distal colorectal region was found between chronically-ethanol-fed rats and pair-fed controls (0.241 +/- 0.019 vs 0.164 +/- 0.020 mumol/mg of protein/hr; P less than 0.01). This could in part explain the cocarcinogenic effect of alcohol in this tissue. Faecal bile acids, however, do not play a role as promotors of rectal carcinogenesis under the present experimental conditions. The results give experimental support to the epidemiologic findings of an increased incidence of rectal cancer in the alcoholic.

Breast carcinoma metastatic to a solitary adenomatous polyp in the colon.

A 70-year-old woman with known metastatic breast cancer was found at autopsy to have widely disseminated, poorly differentiated adenocarcinoma. An incidental adenomatous polyp of the colon also contained metastatic breast carcinoma. This is the first report, to our knowledge, of a metastasis to an adenomatous polyp of the colon.

Surgical pathology of endoscopically removed malignant polyps of the colon and rectum.

Fifty-six endoscopically removed malignant polyps of the colon and rectum were studied to assess criteria for adequacy of therapeutic polypectomy. Features examined were: 1) tumor grade; 2) lymphatic invasion; 3) tumor extent (head, stalk, margin); 4) sessile versus pedunculated; 5) size; and 6) type of background adenoma. Thirty-four patients underwent colon resection while the remaining 22 malignant polyps were followed for a mean of 4.5 years. Five (8.9%) malignant polyps metastasized to lymph nodes while three cases showed metachronous liver metastases. Pathologically, malignant polyps were grouped into 28 long stalk (LS), 21 short stalk (SS), and seven sessile types, with a lymph node metastatic rate of 0%, 19%, and 14%, respectively. Only one of six malignant polyps with lymphatic invasion had any lymph node metastases (16.5), while 66% of grade III cancers had lymph node metastases. In those 24 cases with tumor at or near the resection margin (17 SS and seven sessile cases), the incidence of lymph node metastases or local recurrence was 25%. The incidence of lymph node metastases or local recurrence was 0% among the 28 LS polyps and the four SS polyps with tumor limited to the head. Two of seven polypoid carcinomas (28.5%) metastasized; however, both had positive resection margins. There was no difference in size between metastasizing and nonmetastasizing malignant polyps. Of the 36 cases where histological criteria indicated polypectomy inadequate, the incidence of lymph node metastases or local recurrence was 17%. There were no metastases or recurrences where polypectomy was considered histologically adequate. LS polyps may be treated by polypectomy alone, except in those cases with grade III cancer, lymphatic invasion, or tumor at the resection margin. SS polyps with cancer limited to the head may be treated similarly to LS polyps, while all other SS polyps and sessile polyps should undergo resection postpolypectomy.