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PubMed2004

Importance of adrenal incidentaloma in patients with a history of malignancy.

BACKGROUND: Adrenal incidentaloma presents a frequent finding in patients with a history of malignancy. This study was carried out to determine whether imaging techniques can discriminate between a malignant and a benign adrenal tumor and subsequently select candidates for adrenal surgery. METHODS: Beginning in July 1995, oncologic patients with adrenal incidentaloma underwent abdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and [ 18 ]fluoro-2-deoxy-D-glucose positron emission tomography (18-FDG-PET). Consecutively in all patients adrenalectomy was performed. Histologic findings were compared with the imaging results. RESULTS: In 42 patients, 33 to 79 years old (mean age, 58 years), 44 adrenal lesions were detectable. Two patients presented with bilateral adrenal masses. At operation, 43 adrenal resections and 3 biopsies were performed. Histologic examination revealed 31 metastases (71%) and 13 adrenal adenomas (29%). In metastases the sensitivity of ultrasonography, CT, MRI, and 18-FDG-PET was 66%, 81%, 100%, and 100%, respectively. For adrenal adenoma, the sensitivity of ultrasonography, CT, MRI, and 18-FDG-PET was 46%, 39%, 100%, and 54%, respectively. CONCLUSIONS: In oncologic patients with indeterminate adrenal tumors MRI and 18-FDG-PET provide accurate differentiation between metastases and benign adenomas. Positive results of these 2 imaging modalities are highly suggestive for metastatic disease. In cases of negative MRI and 18-FDG-PET results the adrenal lesion corresponds to a benign adenoma that needs no surgical intervention.

Adenoma↗
PubMed2004

Comparative study on the prevalence of clinically detectable prostate cancer in patients with and without bladder cancer.

OBJECTIVES: To investigate the prevalence of prostate cancer in patients with a past or present history of bladder cancer compared with age-matched control subjects in population-based screening for prostate cancer. METHODS: Between 1998 and 2000, 106 patients who were followed up in the outpatient clinic for bladder cancer (case cohort) and 1060 age-matched men who participated in screening for prostate cancer (control cohort) were enrolled in this study. Serum prostate-specific antigen (PSA) levels were measured for all participants, and all participants underwent digital rectal examination (DRE). The PSA distribution and prevalence rate of prostate cancer were compared between these two cohorts. RESULTS: The serum PSA levels were significantly greater in the case cohort than in the control cohort. The detection rate of prostate cancer was 12.3% (13 of 106) and 1.5% (16 of 1060) in the case and control cohorts, respectively. The biopsy compliance for those with abnormal PSA and/or DRE findings was significantly lower (31%) in the control cohort than in the case cohort (84%). If all those in the control cohort with abnormal PSA and/or DRE findings had undergone prostate biopsies, another 26 cases of prostate cancer might have been detected. The expected detection rate of prostate cancer in the control cohort was high at 4.0% (42 of 1060); however, this was still significantly lower than that in the case cohort. CONCLUSIONS: Patients with a present or past history of bladder cancer could be a high-risk group for developing or having prostate cancer. Additional studies should be conducted to confirm this.

Adenocarcinoma↗
PubMed2004

Histopathologic confirmation of complete cancer-cell kill in excised specimens after renal cryotherapy.

We present the first case of complete documentation of total cancer ablation in a previously cryoablated human renal tumor. A 61-year-old patient with metachronous bilateral renal cell carcinoma was treated with open partial nephrectomy and subsequently laparoscopic cryoablation. His renal function deteriorated, prompting bilateral radical nephrectomy before renal transplantation. Detailed histopathologic examination of the specimen did not reveal any evidence of malignancy in two cryoablated sites 36 months (left kidney) and 19 months (right kidney) after the respective cryoablations.

Adenocarcinoma, Clear Cell↗
PubMed1999

Colorectal adenoma and cancer divergence. Evidence of multilineage progression.

Colorectal cancer progression involves changes in phenotype and genotype. Although usually illustrated as a linear process, more complex underlying pathways have not been excluded. The object of this paper is to apply modern quantitative principles of molecular evolution to multistep tumor progression. To reconstruct progression lineages, the genotypes of two adjacent adenoma-cancer pairs were determined by serial dilution and polymerase chain reaction at 28-30 microsatellite (MS) loci and then traced back to their most recent common ancestor. The tumors were mismatch repair deficient, and therefore relatively large numbers of MS mutations should accumulate during progression. As expected, the MS genotypes were similar (correlation coefficients >0.9) between different parts of the same adenoma or cancer, but very different (correlation coefficients <0. 2) between unrelated metachronous adenoma-cancer pairs. Unexpectedly, the genotypes of the adjacent adenoma-cancer pairs were also very different (correlation coefficients of 0.30 and 0.36), consistent with early adenoma-cancer divergence rather than direct linear progression. More than 60% of the divisions occurred after this early adenoma-cancer divergence. Therefore, the tumor phylogenies were not consistent with sequential stepwise selection along a single most "fit" and frequent lineage from adenoma to cancer. Instead, one effective early progression strategy creates and maintains multiple evolving candidate lineages, which are subsequently selected for terminal clonal expansion.

Adenoma↗
PubMed2001

[Esophagectomy for squamous cell carcinoma of the esophagus isolated or associated with head and neck cancer: long-term survival].

STUDY AIM: Esophageal squamous cell carcinomas are frequently associated with head and neck cancers. This retrospective study was conducted to compare the long-term outcome of the patients with a double cancer and of the patients with a solitary esophageal cancer after curative management. PATIENTS AND METHODS: From 1989 to 1999, 114 patients with an esophageal carcinoma were included in the study. Among them, 52 had an associated head and neck cancer (metachronous: n = 17 and synchronous: n = 35). Curative treatment was achieved in all patients. The patients were divided in "solitary" and "associated" group. RESULTS: Age, sex distribution, tumor location and histological findings were similar in the two groups. The esophageal resection was an esopharyngolaryngectomy (n = 13), a subtotal esophagectomy with cervical anastomosis (n = 92) and a Lewis-Santy esophagectomy with thoracic anastomosis (n = 9). Operative mortality (8 versus 7.7%), anastomotic leaks rate (14.5 versus 21%) and pneumonia rate (21 versus 9.6%) were not significantly different in the two groups. The mean hospital stay was 27 days. The mean follow-up was 85 +/- 50 months. Five-year survival rates were not significantly different in the two groups (p = 0.6411). In univariate survival analysis the only significant predictive factors were the depth of esophageal tumor invasion (p = 0.0002) and node involvement (p = 0.0373). The presence of head and neck cancer did not affect survival after esophagectomy. CONCLUSION: With an aggressive therapeutic plan, the survival of patients with an esophageal cancer associated to head and neck cancer was similar to the survival of patients with an isolated esophageal carcinoma. Long term esophageal survey seems to be useful to detect more superficial esophageal carcinomas in patients with head and neck cancer.

Aged↗
PubMed2004

Metachronous and synchronous lung tumors: five malignant lung pathologies in 1 patient during 7 years.

We present the case of a 70-year-old man who previously had a left upper lobectomy for nonsmall cell lung carcinoma that subsequently developed into small cell carcinoma, which was successfully treated, and finally he had a right upper lobectomy that revealed three synchronous lung malignancies. We were unable to find a previous case report with a total of five separate lung malignancies with a combination of metachronous and synchronous tumors. This case demonstrates the importance of screening after the diagnosis and treatment of lung carcinoma.

Adenocarcinoma↗
PubMed1988

Bilateral granular cell tumors of the posterior mediastinum.

Granular cell tumors are uncommon and generally benign lesions that are commonly accepted to be of Schwann cell origin. These tumors occur most frequently in the skin and oral cavity and are generally asymptomatic. However, when signs and symptoms occur, they are relative to the organ or site involved. The histological features are distinct. Surgical resection is curative in almost all cases, with only rare local recurrences. We report a case of symptomatic bilateral granular cell tumors arising in the posterior mediastinum.

Adult↗
PubMed1999

Bilateral breast carcinomas: do they have similar mammographic features?

AIMS: This study compared the mammographic appearance, site and histological features of synchronous and metachronous bilateral breast carcinomas. METHODS: Site, type of abnormality and background pattern seen on the diagnostic mammograms of 63 women with bilateral breast carcinoma were compared. The histological type and grade of all the carcinomas were verified by histological review. RESULTS: There was a tendency for the contralateral tumour to have similar mammographic features to those of the initial tumour. In patients in whom the first carcinoma was visible purely as a mass, the contralateral carcinoma had a similar appearance in 82% (P < 0.001). When the original tumour showed mammographic calcification the contralateral tumour did so in 65% (P< 0.001). Normal mammography or calcification alone were seen almost exclusively in women with a dense background pattern (100% and 92% respectively) while masses and calcification with masses were seen in women with dense and fatty patterns (58% and 35% dense respectively). When the mammographic site of the contralateral tumour was compared with that of the first tumour no significant correlation could be demonstrated. There was a significant trend for contralateral carcinomas to be of the same histological grade (P < 0.005) but not histological type. CONCLUSIONS: Contralateral carcinomas often have a similar mammographic appearance to the first tumours. Two factors may be responsible: (i) the tendency for contralateral carcinomas to be of the same histological grade and (ii) the influence of mammographic background pattern on the radiological appearance of breast carcinoma. This knowledge may assist in the interpretation of follow-up mammography in patients with a previous breast carcinoma.

Adult↗
PubMed1999

Site specificity of colorectal neoplasms in families without an inherited syndrome.

BACKGROUND: Relatives of patients with bowel neoplasia have an increased risk of bowel neoplasia. If there were concordance in location of neoplasia between relatives, then location-specific screening could be used. Such concordance might also assist in the understanding of the etiology of neoplasia within individual families. METHODS: We have investigated the concordance in anatomic location of colonic neoplasia between first-degree relatives using a new statistical technique for paired data called alternating logistic regression. RESULTS: A total of 146 families were ascertained, none of which had clinical evidence of a hereditary predisposition to edon neoplasia. Among those with neoplasia, there was an increased risk for right-sided disease with older age (40% for less than age 60 vs. 58% for at least 70 years of age, p = 0.008). As assessed by the odds ratio, we found no significant concordance within families for location of neoplasia (odds ratio = 1.2: CI [0.7, 2.2]), although there was a suggestion that location in family members of the same generation was more strongly associated (odds ratio 1.87: CI [0.82, 4.25]). CONCLUSIONS: The lack of concordance within families for location argues against considering family-specific bowel screening protocols and indicates that the most important causes of bowel neoplasia are not sufficiently focused on one anatomic site to facilitate etiologic research.

Adenoma↗
PubMed1984

Second malignant lesions after therapy for Hodgkin's disease.

Among 169 adult pathologically staged patients with Hodgkin's disease who were treated at the Mayo Clinic between 1974 and 1978, we identified four cases of second malignant lesions that developed. The median duration of follow-up after diagnosis for the entire population was 4.1 years. Of the 169 patients, 73 received irradiation only, 19 received chemotherapy only, and 77 received both chemotherapy and radiation therapy. In all four patients with second malignant lesions, Hodgkin's disease was in apparent remission at the time of diagnosis of the second tumor. These four patients had received either total nodal irradiation or six or more cycles of chemotherapy as initial treatment (and one of them had received both treatment modalities). Thus, intensive therapy might be hypothesized to have played a role in the development of the second malignant tumor. To our knowledge, the development of non-Hodgkin's lymphoma within a previously irradiated field after treatment of Hodgkin's disease with radiation therapy only has not been reported previously. Although further studies with longer follow-up should be conducted, our analysis supports a definite risk for development of a second malignant lesion not only after combined-modality treatment or chemotherapy for Hodgkin's disease but also after irradiation only.

Adult↗
PubMed1995

Arguments against routine contralateral mastectomy or undirected biopsy for invasive lobular breast cancer.

BACKGROUND: Management of the contralateral normal-appearing breast in a patient with ipsilateral invasive lobular carcinoma (ILC) is controversial. METHODS: The case histories of patients with histologically proven ILC who underwent definitive surgery at our institution from 1978 to 1991 were retrospectively reviewed. RESULTS: Of the 419 women with ILC, 36 (8.6%) had bilateral cancer, with a cumulative risk of 10% at 10 years. Twenty-five (69%) of these cancers were suspected before operation. From 105 contralateral prophylactic surgical procedures, seven (64%) in-situ and four (36%) invasive cancers were detected. The age at presentation and multifocality of the index cancer were significantly different between patients with unilateral and those with bilateral cancers. No survival difference was noted between patients whose contralateral cancers were suspected clinically and those whose cancers were detected prophylactically. Survival rates between patients with unilateral versus bilateral cancers were also not different. However, patients with contralateral prophylactic surgery had a better prognosis than those with unilateral tumors and no prophylaxis. CONCLUSIONS: Ten percent of patients with ILC experienced bilateral cancers during a period of 10 years. Survival was not influenced by the development of a second cancer, but it improved with surgical prophylaxis.

Adult↗
PubMed1971

Other tumors.

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Bile Duct Neoplasms↗
PubMed1999

Identical clonal origin of synchronous and metachronous low-grade, noninvasive papillary transitional cell carcinomas of the urinary tract.

One of the most important biological features of papillary transitional cell carcinoma (pTCC) of the urinary tract is its multicentricity and its tendency for recurrences. Two possible mechanisms, field effect and intramucosal seeding/spreading, have been proposed. The former theory hypothesizes that carcinogenic agents cause synchronous or metachronous malignant transformation of multiple urothelial cells (independent clonal origin), and the latter speculates that synchronous and metachronous tumors are derived from implantation or direct spreading of tumor cells (identical clonal origin). We tested these hypotheses by analyzing the methylation patterns of the androgen receptor gene (HUMARA) located at the X-chromosome. Thirty-five metachronous and synchronous, low-grade (grade 1 or 2), noninvasive pTCCs of the urinary tract from 10 heterozygous female patients were successfully analyzed using formalin-fixed, paraffin-embedded tissue. These included 16 recurrent bladder tumors from 4 patients, 10 metachronous bladder and ureter/renal pelvis tumors from 4 patients, and 9 multifocal tumors from 2 patients. All tumors are monoclonal as indicated by unbalanced methylation of HUMARA. Furthermore, same methylated allele was detected in multiple recurrent or multifocal tumors from any given patient, indicating their identical clonal origin. We conclude that low-grade, noninvasive pTCCs are monoclonal in nature. Synchronous or metachronous pTCCs have an identical clonal origin, strongly supporting the intramucosal seeding/spreading hypothesis.

Carcinoma, Papillary↗
PubMed2002

Cancer-related thrombotic microangiopathy secondary to Von Willebrand factor-cleaving protease deficiency.

Cancer-related thrombotic microangiopathy (TM) is a serious complication with a short-term life-threatening prognosis. This complication shares certain similarities with thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, both characterized by circulating platelet aggregates containing ultralarge multimers of Von Willebrand factor (VWF). We report a case of cancer-related thrombotic microangiopathy secondary to disseminated metastatic cancer with undetectable serum Von Willebrand factor-cleaving protease activity and no evidence of serum inhibitory antibody. A concomitant decrease of Ca 19-9 level and hemolysis was observed during chemotherapy, in parallel with normalization of Von Willebrand factor-cleaving protease activity. The role of ultralarge multimers of Von Willebrand factor in platelet aggregation in the context of metastatic disease is discussed with respect to our findings in this case of cancer-related thrombotic microangiopathy.

ADAM Proteins↗
PubMed1999

Radiographic incidence of multicentric malignant gliomas.

BACKGROUND: Multicentric malignant gliomas are interesting yet uncommon clinical entities with an unknown rate of occurrence. METHODS: We reviewed the computed tomography (CT) and magnetic resonance (MR) images of 100 consecutive patients with malignant gliomas to determine the incidence of multicentricity in malignant glial neoplasms. RESULTS: Five patients had multiple lesions on their initial radiographic study (synchronous lesions) and in four patients multiplicity developed after initial diagnosis (metachronous lesions). MR imaging demonstrated one lesion not seen on CT. CONCLUSIONS: Because synchronous or metachronous multicentricity was found in 9% of patients with malignant gliomas, treatment delivery should not be based on radiographic imaging without attempting to obtain an accurate diagnosis of the ongoing intracranial process.

Adult↗