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Two patients are reported who experienced multiple pilomatricomas beginning in childhood. Although one patient had no evidence of associated diseases, the second patient was diagnosed with myotonic dystrophy subsequent to the onset of the pilomatricomas. Previous reports of multiple pilomatricomas and the association with myotonic dystrophy are reviewed.
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We evaluated the effectiveness of arterial infusion chemotherapy for liver metastasis from gastric cancer. Nineteen patients (9 synchronous cases, 10 metachronous cases) were treated with hepatic arterial infusion chemotherapy (HAIC). The response rate was 26% (CR 3, PR 2, PD 14), and the median survival time was 357 days after the diagnosis of liver metastasis. The treatment was discontinued in 8 patients because of treatment associated complications and disease progression. Absence of extrahepatic lesion, response of HAIC, and hepatectomy did not improve the prognosis. The combination of systemic chemotherapy with HAIC tended to improve the prognosis. It may be necessary to reevaluate HAIC as a treatment modality for liver metastasis from gastric cancer.
Male breast cancer represents about only 1% of all breast cancers. We have analysed a retrospective, multicentric series of 404 patients, initially non-metastatic, with mean age of 63 years. The 5 and 10-year overall survival rates were 65 and 36% respectively. Sixty-eight patients developed secondary cancer. From ten patients who already presented with cancer (2.5%) 3 cases corresponded to prostatic cancer treated by estrogen. Four had synchronous cancer (1%). Three and eight patients respectively had a synchronous and metachronous contralateral breast cancer (2.7% of bilateral cancer). Forty-three other patients (10.6%) developed metachronous cancer. The main tumor types were: prostate (9), lung (6), colon and rectum (6), esophagus (4). Four patients developed various hematologic malignancies and 14 patients, various types of solid tumors. From these 43 patients, 27 died; 19 as a result of secondary cancer. This represents 9% of all deaths among the 404 patients. While the bilateral cancer rate is similar to women, the second cancer rate appears to be higher in men. From hematological malignancies, chemotherapy and radiotherapy do not seem to contribute to this high incidence of second cancer.
Little is known about epidemiology of adults soft tissue and visceral sarcomas (ASTS). The frequency of previous cancers and associated genetic diseases has been analyzed out of 493 ASTS, treated between 1997 and 2002 at Oscar Lambret Cancer Center. Median age is 51, sex ratio is close to 1. Liposarcomas and malignant fibrous histiocytofibromas are the two main types (respectively 104 and 86 cases). Upper and lower limbs are the two main locations (respectively 176 and 75 cases). Fifteen patients had associated genetic disease, including 12 cases of Recklinghausen diseases. 7 out of those 15 patients have neurosarcoma. 30 patients have previous cancers, including 7 breast cancers, 3 lymphomas and 3 chronic lymphocytic leukemias. Four out of those 30 patients have two different previous cancers. 13 patients have radiation-induced sarcomas, after an average 10-year-period, and an average dose of 53 Gy. Undifferenciated sarcomas are the main histologic type (8/13), followed by angiosarcomas (2/13). Radiation-induced sarcomas are located in the chest wall (7/13), in pelvis (2/13) and head and neck (2/13). Those sarcomas are high grade (10 grade III tumours). ASTS epidemiology is complex with different risk factors depending on histologic type.
While Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) have long been regarded as distinct disease entities, recent observations suggest a closer association. The analysis of cases in which these diagnoses are made in the same anatomic site (composite lymphomas) or in separate sites (simultaneous or sequential HD and NHL) indicates that this phenomenon occurs more frequently than would be expected by chance alone. The most common form of composite lymphoma is coexistent nodular lymphocyte-predominant Hodgkin's disease (NLPHD) and large cell lymphoma (LCL) of B cell phenotype. This finding is consistent with a B cell origin for the abnormal cells in NLPHD, suggesting that LCL represents a form of histologic progression, with the existence of a clonal relationship between the two components. The association of other forms of HD (nodular sclerosis or mixed-cellularity) and NHL is less common, but still significant. As with NLPHD and LCL, one may observe composite lymphomas, or the diagnosis of HD may precede or follow the diagnosis of NHL. The vast majority of NHLs associated with HD are of B cell origin, most commonly follicular lymphomas. An association between HD and B cell chronic lymphocytic leukemia (CLL) is also observed. In selected cases, Reed-Sternberg (RS) cells are seen in a background of otherwise typical CLL, and some of these patients have progressed to disseminated HD. These findings suggest that, at least in some cases, HD may be clonally related to an underlying B cell malignancy, and that the RS cell may be an altered B lymphocyte.(ABSTRACT TRUNCATED AT 250 WORDS)
Patients with epithelial cancer of the upper aerodigestive tract are at increased risk of a new epithelial cancer developing in the same upper aerodigestive tract, in the oesophagus, or in the lung. We studied the cases seen at our Hospital in the last seven years. The clinical characteristics, the diagnosis and the treatment of 38 patients with synchronic epithelial cancer of the upper aerodigestive tract, oesophagus and lung, were reviewed.
BACKGROUND/AIMS: Detection and removal of adenomatous polyps with colonoscopy is known to be the best preventive method for the colon cancer. With removal of synchronous colon polyps, the risk of metachronous cancer seems to be decreased effectively. However, the preoperative evaluation of entire colon is frequently impossible due to luminal obstructive lesion. Therefore, it is important to evaluate entire colon in postoperative period as earlier as possible. The aim of current study is to analyze the characteristics and risk factors of synchronous as well as metachronous polyps. METHODS: From Jan. 1998 to Dec. 2001, among the patients who received operative treatment for colon cancer in Yonsei University, Severance Hospital, 972 patients, who had underwent preoperative endoscopic evaluation and surveillance above one year after operation, were enrolled. RESULTS: In 617 patients who had completed total colonic evaluation within one year after operation, 45.93% of cases had synchronous polyps, 17.0% advanced polyps, and 5.8% synchronous cancer. The incidence of synchronous and advanced synchronous polyps was high in elderly (>or=60 year), male patients (p<0.05). In 166 patients who had underwent postoperative colonoscopy after one year, 25.3% had metachronous polyps, 3.0% advanced polyps, and 0.6% metachronous cancer. The presence of synchronous polyps was associated with the risk of metachronous polyps (p<0.05). CONCLUSIONS: Complete colonic evaluation during perioperative period should be recommended to identify precancerous lesions, which can contribute to reduce the development of colon cancer.
BACKGROUND/AIMS: Synchronous and metachronous multiple colorectal cancers are not rare occurrences. Since features of colorectal cancer depend on tumor location, we focused attention on the tumor distribution of synchronous and meta-chronous lesions in colorectal cancer. METHODOLOGY: The records of 1812 patients with colorectal malignancies (either invasive colorectal cancer or high grade dysplasia) were clinicopathologically analyzed. RESULTS: In one hundred and twenty patients with colorectal malignancies there were synchronous or metachronous lesions. The distribution of synchronous malignancies showed a significant shift from the proximal to the distal site, while in metachronous malignancies, the distribution of second tumors showed a significant shift from the distal to the proximal site. CONCLUSIONS: Our findings suggest that different types of cancer lesions do exist, hence careful and meticulous examinations are important.
Germ-cell tumors of the testis are rare tumors of the young adult. Half of them are seminoma. The majority of patients have disease limited to the testis. Radiotherapy still remains the standard treatment of these patients. Almost all patients are cured by orchidectomy and radiotherapy on the lomboaortic area extended to homolateral iliac area. The dose is 24 to 30 Gy in a standard fractionation. Different studies are ongoing to reduce the irradiation field (omission of the pelvic irradiation), to decrease irradiation dose (to 20 Gy). Other treatment options are strict surveillance and adjuvant carboplatin based chemotherapy. None of these options are standard treatments. A strict attention must be directed on controlateral germ-cell tumors and second cancers.
A case is presented of a 38-year-old female patient who developed bifocal metachronous cerebral glioma with the same histological appearance (glioblastoma multiforme). Two separate tumors were operated on within six months: the first one was localized in the left parieto-occipital area, and the other in the right temporal lobe. The tumor cells dissemination occurred probably via the CSF pathways: during the first operation the posterior horn of the left lateral ventricle was opened, and the second neoplastic lesion was situated also in the direct vicinity of CSF spaces (the Sylvian cistern). For all practical purposes, the case presented testifies to the necessity of intraoperative protection of the CSF spaces by separating any open CSF cisterns from the removed tumor mass with cotton pads. In case of diagnosing cerebral glioma, a possibility of the presence of multiple foci should be taken into account. It is especially important for the differentiation of multiple lesions occurring synchronically, where similarity of radiological features is seen in metastases, cerebral abscesses and demyelinating lesions.
There is significant recent progress in the surgical and oncological treatment of colorectal liver metastases. In our review we try to explain the variability and the multidisciplinarity approach we use to treat our patients more successful after the year of 2000. Beside the old rule: "Resect if possible"--thanks to the improvement of chemotherapy and new surgical instruments- there are new trends: "Make it resectable" or "resect it as many times as possible" thanks to the loco-regional and systemic neoadjuvant chemotherapy and/or the repeated interventions in metastasis surgery. The most important prognostic factors influencing the overall survival rate are free surgical margins, synchronous or metachronous metastasis and the need for repeated interventions. The view about extra hepatic metastases of CRC is changed in the last decade as the resection of these metastases is also suggested. After the year 2000 colorectal liver metastases should be treated "a-la-carte", based on multidisciplinary planning and treatment in specialised centres providing the long survival rates.
Pacinian neuroma is an extremely rare benign tumor which has only occasionally been reported in the literature. To date, this lesion has usually been observed in the hand and foot; only one had intra-abdominal localization. Local trauma is reported in the most of these cases. We describe the first case of retroperitoneal pacinian neuroma. The lesion was observed as an incidental finding in a 75-year-old man who underwent laparotomy for aortic aneurysm. Here are discussed the differential diagnosis and a complete literature review on the topic.
BACKGROUND/AIMS: After colorectal cancer surgery, colonoscopic surveillance should be done for prevention and early detection of secondary cancer. This study aimed to identify the group with high risk of developing colorectal adenoma after curative surgery of colorectal cancer. METHODS: We retrospectively investigated the medical records of the subjects of 130 patients who had been examined using colonoscopy before and after the curative surgery. RESULTS: The average age was 59.4 years. Synchronous adenomas were in 42 patients (32.3%). The occurrence rate was significantly high in men (38.8%) than women (22.0%). After the operation, the mean interval of examining colonoscopy was 11.6 months (3-24 months) and metachronous adenomas were detected in 26 patients (20.0%). The patients who have both metachronous and synchronous adenomas were observed in 13/42 (30.9%) and the patients of metachronous adenomas without synchronous adenomas were observed in 13/88 (14.8%). The occurrence rate of metachronous adenomas with synchronous adenomas was significantly high. The frequency of synchronous adenomas didn't increase with age. However, the frequency of metachronous adenomas increased with age: 0/9 (0%) under 40 years, 7/49 (14.3%) in 41-61 years and 19/72 (26.4%) over 61 years. The occurrence rate was higher in men (26.3%) than women (10.0%). CONCLUSIONS: The occurrence rate of metachronous adenomas after colorectal cancer surgery was higher in the patients with synchronous adenomas, male gender and old aged patients.
We report a case of a simultaneous occurrence of medullary and papillary carcinomas of the thyroid gland with metastases of a papillary carcinoma to the cervical lymph nodes and a concurrent small B-cell lymphocytic lymphoma revealed in the lymph nodes examined in a 71-year-old woman. The diagnosis was based on microscopic examination of surgical specimens and supported by immunohistochemistry. Additionally, P53 and RET mutation analysis was performed. In this case, the coincidence of medullary and papillary carcinomas of the thyroid gland may account for a true composite tumor. The coexistence of a small B-cell lymphoma in our patient may be explained by irradiation treatment undergone during the adolescence.
Our knowledge of Gastrointestinal Stromal Tumours (GIST) has been broadened in the last few years by the discovery of the key function of c-kit tyrosine kinase mutation in their pathogenesis. A single institution database is presented and a hypothesis is examined regarding probable connection between GIST and other gastrointestinal malignancies. Between 2000 and 2004 20 patients were admitted to our department with GIS tumour. With the addition of three cases detected between 1991 and 2000, and proved to be GIST retrospectively, 23 cases are followed. Mean age was 64.52 years, male to female ratio 11:12. Ten tumours originated from the stomach, ten from small bowel, one from rectum and two from mesenterium. All patients underwent surgery, 16 operations were completed with R0 radicality, one R1 and four R2 resections were performed. Follow-up ranged from 1 to 157 months. Five out of 23 patients died (21.7%), six patients live with metastatic disease, twelve are disease free. Amongst patient-, tumour- and treatment-related factors the prognostic significance of Fletcher's risk and radicality of resection was demonstrated (p<0.05). Significantly more synchronous or metachronous gastrointestinal malignancies were found is this population of GIST patients, when compared to the prevalence of malignancies in normal Hungarian population (p<0.001).