Neuroendocrine carcinomas of the bladder (small cell, large cell, typical and atypical carcinoids) are rare and usually co exist with urothelial carcinoma. As in small cell carcinoma of the lung, various paraneoplastic neurologic disorders can occur although they are even less frequent. Here we report the case of a 63 year old man with small cell carcinoma of the urinary bladder and with a paraneoplastic neurologic disorder.
Myoepithelial carcinoma (MC) of head and neck is extremely rare. The relevant literature consists only of case reports, and consequently many of its clinical characteristics and optimal treatment strategies remain unknown.
We retrospectively analyzed 23 patients diagnosed with MC of the head and neck between 1991 and 2005. Most patients were treated with surgery and postoperative radiotherapy or adjuvant chemotherapy. The recurrence, survival and local control rates were evaluated.
Thirteen (56.5%) patients were male and 10 were female with a median age of 52 years (range: 15–77 years). The parotid was the most frequently involved site (39.1%). Eighteen patients underwent surgery as their initial treatment and nine of these received postoperative radiotherapy. The 3-year and 5-year overall survival rates were 59% and 31.8%, respectively. The local relapse rate was 30.4% (6/23); eight patients had a distal metastasis, and the lung was the most common site. There was no difference in the local control and survival rates between patients who received surgery alone and those with additional postoperative radiotherapy (p=0.059). Two patients had partial response after chemotherapy with dacarbazine.
The detailed clinical data presented here reveal several new characteristics of MC of the head and neck. Postoperative radiotherapy did not improve the prognosis. Chemotherapeutic regimens that include dacarbazine might be useful.
Phyllodes tumors are extremely uncommon neoplasms that are usually benign. Patients with phyllodes tumors typically present with a well-circumscribed, painless, firm, and mobile mass or nodule characterized by rapid growth in a short period of time. It is recommended that these tumors be excised even though it may look as a fibroademoma. Our patient presented with a left nipple mass with rapid growth. The patient had been previously diagnosed with malignant phyllodes tumor, which was excised with adequate margins, later presenting with an exophytic mass extending from the nipple along with bloody discharge. The patient underwent a complete mastectomy of the left breast without a lymph node dissection, and pathology revealed an additional focus of intramammary myoepithelioma. The aim of this case report is increase awareness of these tumors and their potentially unusual presentations to allow clinicians the ability to recognize these neoplasms earlier as well as recognizing the need for better adjuvant therapy.
We report a case of a 59-year-old woman with brain metastases from an EGFR mutated adenocarcinoma of the lung. She was initially treated with erlotinib and two times whole brain radiation therapy. After a second relapse within the CNS the therapy was switched to gefitinib and a partial remission of the brain metastases could be achieved. Our case demonstrates that patients can respond to a switch of the EGFR TKI also within the CNS despite heavy pre-treatment. The article reviews the literature regarding the efficacy of tyrosine kinase inhibitors in brain metastases from lung cancers.
Combined small cell lung cancer is relatively rare. We report a case of combined small cell lung carcinoma that was suspected to originate from a small pure ground-glass nodule; the tumor was detected during a computed tomography (CT) health screening and observed periodically over 4 years. Surgical resection was performed; histology showed features of both adenocarcinoma and small cell carcinoma. The tumor histogenesis was interesting. Our result suggested that if a solid component appeared as a pure ground-glass nodule, clinicians should pay attention to both the CT -value and the doubling time. Not miss the timing of surgical resection considering of possibility of combined small cell lung carcinoma.
To examine patient perspectives on their personal and contextual factors relevant to TDM. The second aim was to describe physician perspectives on the TDM in older adults (≥60 y.o.) diagnosed with symptomatic MM.
Descriptive, cross-sectional.
A semi-structured interview schedule was administered. Directed content analysis procedures were used to develop major themes from the patient and physician participant interviews.
Themes related to treatment decision making among patient participants include various decisional role preferences; several sources of information related to myeloma; contextual and patient-specific factors influence treatment decisions; negative perceptions related to the treatment decision-making process exist; strong desire to be in remission and to live a longer life; For physician participants, top themes related to decision making were: QOL or survival considerations or simultaneously considerations of treatment effectiveness, QOL and survival; screening patients for eligibility for autologous HSCT; time is a barrier to effective TDM; Various methods were used to assess patient decisional role preferences.
Treatment decision making in older adults newly diagnosed with symptomatic myeloma is influenced by personal, social and contextual factors. Patients must be given the opportunity to choose the best possible treatment within the limits of the patient’s personal, social and medical contexts.
We report the first case of epidermal-growth-factor-receptor (EGFR) mutation-positive lung adenocarcinoma with acrometastasis in a 51-year-old woman who presented with a swelling on her right hand. Magnetic resonance imaging revealed an expansile lesion at the base of the 5th metacarpal bone of her right hand with cortical erosion and patchy enhancement suggestive of a malignant transformation of a giant-cell tumor. A core needle biopsy of this lesion showed a metastatic adenocarcinoma on histopathological examination which was immunoreactive to cytokeratin (CK) 7 and thyroid transcription factor (TTF)-1 but not to CK20 suggesting a lung primary. A chest radiograph and computed tomography (CT) scan revealed a right upper lobe lung mass. Fluoro-deoxyglucose hypermetabolism was noted in the lung mass and the right 5th metacarpal bone lesion but not elsewhere on positron-emission-tomography/CT scan. Needle biopsy of the lung mass showed adenocarcinoma with histopathological and immunohistochemical features similar to that of the right 5th metacarpal bone lesion. Both the primary lung adenocarcinoma and the acrometastatic lesion were tested positive for EGFR mutation in exon 21 (L858R substitution). She underwent R0 resection of her right upper and middle lobes with systematic mediastinal lymph nodes resection and wide excision of the metacarpal metastasis followed by cytotoxic chemotherapy. A curative approach with complete resection of the primary tumor and oligometastastic site in Stage IV non-small cell lung carcinoma (NSCLC) followed by additive cytotoxic chemotherapy has not been reported to date and as such there is still no data on disease-free survival with this approach.
To report a rare case of cervical malignancy necessitating complex treatment.
A sixty-five year old woman was admitted to the hospital with a diagnosed tumor arising from the upper lip of the cervix. Patient underwent the amputation of the cervix with the curettage of the cervical channel. Because of the diagnosis of malignant mixed Mullerian tumor (MMMT) a radical hysterectomy with pelvic lymphadenectomy was performed afterwards. The composition of the tumor concerning basaloid carcinoma combined with homologous sarcoma was published only in five cases in the known literature.
Because of rarity of MMMT there are no consensus guidelines regarding treatment. We present the case with successful management and 4-year disease free survival.
Lobectomy or pneumonectomy represents the treatment of choice for resectable early stage non-small cell lung cancer (NSCLC). The location of heart and great vessels, liver and spleen changes considerably following pneumonectomy as a consequence of mediastinal shift and elevation of the hemidiaphragm.
A 70 years old gentleman developed acute shortness of breath two months after undergoing a left pneumonectomy for a pT2pN1M0 NSCLC, squamous cell carcinoma. His dyspnea and oxygen saturation worsened when sitting upright and immediately improved when he assumed the supine position, consistent with platypnea-orthodeoxia syndrome, and suggesting a potential inter-atrial right-to-left shunt. The presence of a patent foramen ovale (PFO) was documented by transoesophageal echocardiography. The patient underwent percutaneous closure of the PFO which markedly reduced the shunt, and led to resolution of symptoms.
PFO is a common anomaly, found in approximately 25% of adults. Its presence is associated with increased risk of stroke from paradoxical emboli. Inter-atrial shunting after major thoracic surgery is a rare but clinically significant event. The case here reported was diagnosed following left pneumonectomy and to our knowledge, only two other single cases of PFO after left pneumonectomy have been reported in the literature so far.
A PFO should always be considered in the differentials for patients presenting with platypnea-orthodeoxia syndrome after lung surgery. Given the high risk of embolic stroke and high success rate of transcatheter percutaneous closure, these patients should be promptly referred for cardiac investigations and appropriate management.
Primary chest wall tumors are uncommon. Common soft tissue neoplasms and non-neoplastic chest wall masses include peripheral nerve tumors, lipomas, liposarcomas, lymphoma, haemangiomas, elastofibromas, metastases from distant tumors, desmoids tumors, infectious mass lesions, and malignant fibrous histiocytoma. Lymphoma comprises 2% of primary chest wall tumors. Treatment of these tumors is unclear. We are presenting a case of 65 years old male who presented to us with primary chest wall lymphoma on right lateral chest wall. Resection followed by adjuvant chemotherapy provided optimal disease control in our case.
Isolated chest wall lymphoma is a rare entity, treatment is also uncertain. Resection followed by adjuvant chemotherapy may be the appropriate management.
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