Delayed Hematogenous Metastasis Versus Second Primary Squamous Cell Carcinoma of the Neck in a Patient With Previous Cancer of the Cervix.

Squamous cell carcinoma (SCC) of the uterine cervix commonly spreads through direct infiltration and disseminates by lymphatic or hematogenous pathways. The most frequent locations for metastasis are lungs, liver, and bone. Other distant metastatic sites are rare, with only 1 reported case of neck metastasis. We present here a 73-year-old female with a prior human papillomavirus (HPV) + SCC of the cervix that had metastasized to her peri-aortic lymph nodes. Eight years after diagnosis and treatment, she returned with a hypermetabolic supraclavicular lymph node and new left-sided neck mass. Biopsy of the neck mass revealed invasive SCC positive for high-risk HPV genotype. The presence of high-risk HPV genotypes in both the cervix and supraclavicular lymph node, without evidence of second primary tumor, implies that the neck mass is a delayed metastasis of the patient's previous cervical cancer. This marks the second recorded case of neck metastasis from a SCC of the cervix.

Fever as the only manifestation of hypersensitivity reactions associated with oxaliplatin in a patient with colorectal cancer Oxaliplatin-induced hypersensitivity reaction.

Hypersensitivity reactions (HSR) to oxaliplatin in patients with colorectal cancer include facial flushing, erythema, pruritus, fever, tachycardia, dyspnea, tongue swelling, rash/hives, headache, chills, weakness, vomiting, burning sensations, dizziness, and edema. We report a patient with fever as the sole manifestation of initial HSR, review the literature and discuss the management of HSR. A 57-year-old female with T3N2M0 rectal adenocarcinoma received modified FOLFOX-6. She tolerated the first 8 cycles without any toxicities except grade 1 peripheral neuropathy and nausea. During 9th and 10th infusions, she developed fever to a maximum of 38.3 centigrade with stable hemodynamic status despite medications. During 11th infusion, she developed grade 3 HSR consisting of symptomatic bronchospasm, hypotension, nausea, vomiting, cough, and fever. On examination, she was pale, cyanotic, with a temperature of 38.8 centigrade, BP dropped to 95/43 mm Hg, pulse of 116/min and O(2) saturation of 88%-91%. She was hospitalized for management and recovered in 24 h. Fever alone is not a usual symptom of oxaliplatin HSR. It may be indicative that the patient may develop serious reactions subsequently, as did our patient who developed hypotension with the third challenge. Treatment and prevention consists of slowing the infusion rate, use of steroids and antagonists of Type 1 and 2 histamine receptor antagonists, whereas desensitization could help to provide the small number of patients who experience severe HSR with the ability to further receive an effective therapy for their colorectal cancer.

Locally recurrent and metastatic apocrine-gland carcinoma in an elderly man.

BACKGROUND: A 78-year-old man with a history of untreated hypertension and dementia presented with a rapidly growing, painful mass in the left axilla. He was a nonsmoker and did not consume alcohol. There was no family history of malignancy. The patient had not experienced any constitutional symptoms, such as fever, weight loss, night sweats, or loss of appetite. INVESTIGATIONS: Physical examination, blood tests, excisional biopsy, studies of tumor morphology and immunohistochemistry, CT of the chest and abdomen, and PET scan. DIAGNOSIS: Carcinoma of the axillary apocrine gland. MANAGEMENT: Surgical excision, and radiation therapy.