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A 68-year-old male was hospitalized because of headache, nausea, and disturbance of consciousness. Neurological examination on admission disclosed somnolence, disorientation, marked neck stiffness, papilledema, and quadriparesis. Computed tomography (CT) scanning demonstrated a round mass with marked contrast enhancement in the right sylvian fissure and small contrast-enhanced masses in the interpeduncular, quadrigeminal and ambient cisterns. CT also showed marked peritumoral edema, a midline shift, and hydrocephalus. The patient's consciousness level and respiration deteriorated 3 days after admission and a craniotomy was performed. The tumor, which was well demarcated, firmly attached to the sphenoidal ridge, and grossly appeared to be a meningioma, was totally removed. Histologically, the tumor had two well defined components, glioblastoma and fibrosarcoma. The patient underwent ventriculoperitoneal shunting, chemotherapy, and radiotherapy after surgery, but the primary tumor soon recurred, with scalp metastasis, and he died 5 months postoperatively. Autopsy revealed metastases to the liver, spleen, and spinal cord. The histogenesis of this mixed tumor and the mechanism of extracranial metastasis are discussed, and the literature is reviewed.
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Testicular tumors spread in a predictable manner to lymph nodes in the paraaortic chain and then to supradiaphragmatic nodes in the mediastinum and supraclavicular fossae. The most common sites of extranodal disease are the lungs and liver. In a series of 650 patients with testicular tumors who underwent CT examinations unusual sites of thoracoabdominal metastases were demonstrated in 20 patients (23 sites). The sites involved were kidney (six patients), adrenal glands (four patients), inferior vena cava (four patients), muscle (three patients), spleen (two patients), and stomach, pelvic cyst, seminal vesicles and prostate, and pericardium (one patient, each site). Renal metastases were either of soft-tissue density (four patients) or cystic (two patients). Cystic metastases were also identified in the spleen in two patients and in the adrenal gland in one patient. In three of the patients with inferior vena cava involvement, thrombus was seen to extend above the nodal mass over several centimeters. Metastases were demonstrated in the psoas, iliac, and middle gluteal muscles. These were separate from retroperitoneal nodal masses. The ability of CT to identify sites of metastases, which may remain undiagnosed by conventional staging procedures, is emphasized.
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We report here a 20-year-old man presenting with primary nasal NK/T-cell lymphoma which showed an aggressive clinical course spreading to the spleen and skin despite various treatments. Eight months after high dose chemotherapy followed by autologous peripheral blood stem cell transplantation, acute appendicitis with perforation occurred and the patient underwent appendectomy. The histopathological diagnosis was NK/T-cell lymphoma of the appendix. Lymphoma of the appendix is extremely rare and the majority of appendiceal lymphomas are of B-cell origin. This is the first report of involvement of appendix by nasal NK/T-cell lymphoma.
Fourteen dogs (11 females, three males) with extraskeletal osteosarcomas (EsOSAs) were identified. The median age was 11.5 years. The median body weight was 18 kg. The primary sites of the EsOSAs were the spleen (n=6), mammary gland (n=3), lung (n=2), and one each in the skin, axilla, and mesenteric root. The overall median survival time was 74 days. The only factor which was found to be prognostic for survival was the use of chemotherapy (p of 0.02). Cases which did not have chemotherapy were 3.62 times as likely to die a tumor-related death than cases which had chemotherapy.
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CONTEXT: Myeloid sarcoma is a neoplasm of myeloid cells that can arise before, concurrent with, or following acute myeloid leukemia. Rarely, it can also occur as an isolated mass. OBJECTIVE: To describe the clinicopathologic features of 6 patients with myeloid sarcoma involving the breast. DESIGN: Clinical information for all 6 patients was obtained from the medical record. Routine hematoxylin-eosin-stained slides; naphthol AS-D chloroacetate stain; and immunohistochemical stains for myeloid, B-cell, and T-cell antigens were prepared. RESULTS: There were 6 women with a median age of 52 years (range, 31-73 years). Two patients presented with isolated tumors of the breast, with no history or subsequent development of acute myeloid leukemia. In 3 patients, the breast tumors represented relapse of acute myeloid leukemia. One patient who presented initially with myeloid sarcoma involving the breast, skin, and spleen was lost to follow-up. Histologically, these tumors were classified as well differentiated (n = 3), poorly differentiated (n = 2), and blastic (n = 1). Naphthol AS-D chloroacetate esterase was positive in all 3 cases assessed. Immunohistochemistry showed that myeloperoxidase (n = 5) and CD43 (n = 3) were positive, and CD3 (n = 5) and CD20 (n = 5) were negative in all cases assessed. Lysozyme was positive in 4 (80%) of 5; CD117 was positive in 2 (67%) of 3; and single cases were positive for CD45 (1/3), TdT (1/2), CD79a, and the PAX5 gene product. CONCLUSIONS: Myeloid sarcoma involving the breast is uncommon. In the literature, as in this study, these tumors most often represent relapse or the initial presentation of acute myeloid leukemia. However, 2 of the cases we report presented with isolated masses, without a history or subsequent development of acute myeloid leukemia at last follow-up. Immunohistochemical studies are extremely helpful for recognizing isolated myeloid sarcoma.
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The sonographic findings in the abdomen in 42 patients with intra-abdominal metastases from malignant melanoma are described. Multiple metastatic sites were seen in 10 of the 42, with the liver being the organ most often involved. Liver metastases were predominantly of low echo amplitude, and fluid was visible within 30 per cent of all metastases, probably being an indicator of the frequency of hemorrhage into these lesions. Bulky disease, especially in the retroperitoneum, was unusual in the patients examined, which probably accounts for the absence of hydronephrosis as a complication.
Ultrasonographic findings in the liver, gallbladder, and spleen of 42 patients with metastatic melanoma of the skin are described in a retrospective study stressing sonomorphologic results. Liver metastases were detected in 27 (64%) of the patients. Clinically asymptomatic melanoma metastases were found in the gallbladder of three patients and in the spleen of three others. The liver metastases were still in the initial stages in 10 patients, whose survival times averaged 8.4 months. The significance of upper abdominal ultrasonography in assessing the spread of metastasizing malignant melanoma during follow-up is emphasized.
Eight cats with visceral or cutaneous hemangiosarcoma were evaluated, and unusual metastatic and clinicopathologic behavior was evident in each. Cutaneous hemangiosarcoma is generally believed to be locally aggressive and slow to metastasize. These 8 cats with cutaneous hemangiosarcoma, however, developed metastatic disease after initial surgical resection; only 1 had local regrowth of the tumor. All cats with visceral hemangiosarcoma had metastasis at the time of diagnosis, which is consistent with cats of other reports. Three of 8 cats had evidence of disseminated intravascular coagulation, including increased prothrombin time and partial thromboplastin time, decreased number of platelets, and anemia. These potential complications need to be considered when planning diagnostic and treatment protocols.
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