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The most common site of distant primary tumor metastasis to the jaw bones is the breast. The clinical signs and symptoms, and radiographic appearance of these lesions can be extremely variable. Histologic examination, however, will usually resemble the tissue from the primary tumor. In the case presented, the biopsy specimen was consistent with adenocarcinoma of the breast.
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Vascular occlusion is described using microemboli of a predetermined size for the treatment of neoplastic conditions with a "capillary barrier." Particulated microemboli of either 40--60 micron Gelfoam powder or 200--1,000 micron polyvinyl alcohol foam (PVA) are best. Fluid embolic agents such as silicone fluid are used in lesions without a capillary barrier. The radiographic, pathologic, and clinical results in three patients are described in detail. Microembolization is useful in the treatment of neoplastic conditions for it produces tumor necrosis in addition to hemostasis.
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A 68-year-old white man presented to the inpatient service at Columbia-Presbyterian Hospital with a chief complaint of a progressively enlarging tumor of the right infraorbital region for many years and multiple, pink papulonodules on his head, neck, and trunk. A biopsy specimen of the right infraorbital and back lesions demonstrated an infiltrating adenocarcinoma with prominent signet ring cells, and small lumen formation. Results of an extensive work-up revealed bone marrow metastases and no evidence of a primary malignancy. We present a case of primary sweat gland carcinoma with metastases to the skin based upon history, clinical presentation, results of physical examination, histopathologic examination, immunohistochemical studies, and response to 5-fluorouracil chemotherapy. Due to the rarity of the tumor, the diagnosis is usually not made until the tumor(s) is invasive. An excellent response to systemic chemotherapy with 5-fluorouracil in metastatic sweat gland carcinoma was noted in this case.
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Patients with neurofibromatosis type 1 (NF-1) have an increased incidence of optic glioma. Although spinal dural ectasia or meningocele is well represented in the NF-1 literature, radiologists are not as familiar with dural ectasia of the optic nerve sheath as spinal dural ectasia. This is a report of a pediatric patient with NF-1 with dural ectasia of the optic nerve sheath. This is the second reported case of dural ectasia of the optic nerve sheath demonstrated by magnetic resonance imaging.
Metastasis of the oral and maxillofacial region frequently causes serious morbidity. Despite the importance of the clinical problem, little is known about the pathophysiological mechanisms of this metastatic process. Therefore, we examined whether the intracardiac injection of human breast cancer cells reproductively leads to jaw metastases developing an adequate experimental model. Human breast cancer MDA-MB-231 (MDA-231) cells (1 x 10(5)) were injected into the left heart ventricle of 4-week-old, female nude mice. Jaw metastases were examined radiographically and histologically 4 weeks after the cancer cell inoculation. At this time, the nude mice showed a marked body weight loss and cachexia. Osteolytic bone metastases were commonly observed in limbs, vertebral bone, pelvis and scapulae. In maxillofacial bones, breast cancer cells metastasized in 11 of 12 nude mice (91.7%). The lesions were radiographically determined at the mandible (11/12), maxilla (8/12) and zygomatic arch (2/12). Metastasis frequently occurred at the molar and angle regions of the mandible and at the palatal suture as well as around the root of the incisal teeth of the maxilla respectively. Histological examination revealed that numerous osteoclasts were present along the trabecular bone surfaces with aggressive bone resorption. This experimental model may be useful not only for the investigation of the mechanism of jaw metastasis formation but also for the screening of potential therapeutic agents for osteolytic bone metastasis.
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