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Metastases
Kinds of Metastases Selected AbstractsCMR2009: 3.03: Oral manganese-based contrast agent CMC-001 for liver MR imaging in patients with hepatic metastases: initial experience of a phase II trialCONTRAST MEDIA & MOLECULAR IMAGING, Issue 6 2009M. Rief No abstract is available for this article. [source] Imaging of the lymphatic system: new horizons,CONTRAST MEDIA & MOLECULAR IMAGING, Issue 6 2006Tristan Barrett Abstract The lymphatic system is a complex network of lymph vessels, lymphatic organs and lymph nodes. Traditionally, imaging of the lymphatic system has been based on conventional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI), whereby enlargement of lymph nodes is considered the primary diagnostic criterion for disease. This is particularly true in oncology, where nodal enlargement can be indicative of nodal metastases or lymphoma. CT and MRI on their own are, however, anatomical imaging methods. Newer imaging methods such as positron emission tomography (PET), dynamic contrast-enhanced MRI (DCE-MRI) and color Doppler ultrasound (CDUS) provide a functional assessment of node status. None of these techniques is capable of detecting flow within the lymphatics and, thus, several intra-lymphatic imaging methods have been developed. Direct lymphangiography is an all-but-extinct method of visualizing the lymphatic drainage from an extremity using oil-based iodine contrast agents. More recently, interstitially injected intra-lymphatic imaging, such as lymphoscintigraphy, has been used for lymphedema assessment and sentinel node detection. Nevertheless, radionuclide-based imaging has the disadvantage of poor resolution. This has lead to the development of novel systemic and interstitial imaging techniques which are minimally invasive and have the potential to provide both structural and functional information; this is a particular advantage for cancer imaging, where anatomical depiction alone often provides insufficient information. At present the respective role each modality plays remains to be determined. Indeed, multi-modal imaging may be more appropriate for certain lymphatic disorders. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve diagnostic accuracy. Published in 2006 by John Wiley & Sons, Ltd. [source] Kinetic analysis of hyaluronidase activity using a bioactive MRI contrast agentCONTRAST MEDIA & MOLECULAR IMAGING, Issue 3 2006Liora Shiftan Abstract One of the attractions of molecular imaging using ,smart' bioactive contrast agents is the ability to provide non-invasive data on the spatial and temporal changes in the distribution and expression patterns of specific enzymes. The tools developed for that aim could potentially also be developed for functional imaging of enzyme activity itself, through quantitative analysis of the rapid dynamics of enzymatic conversion of these contrast agents. High molecular weight hyaluronan, the natural substrate of hyaluronidase, is a major antiangiogenic constituent of the extracellular matrix. Degradation by hyaluronidase yields low molecular weight fragments, which are proangiogenic. A novel contrast material, HA-GdDTPA-beads, was designed to provide a substrate analog of hyaluronidase in which relaxivity changes are induced by enzymatic degradation. We show here a first-order kinetic analysis of the time-dependent increase in R2 as a result of hyaluronidase activity. The changes in R2 and the measured relaxivity of intact HA-GdDTPA-beads (r2B) and HA-GdDTPA fragments (r2D) were utilized for derivation of the temporal drop in concentration of GdDTPA in HA-GdDTPA-beads as the consequence of the release of HA-GdDTPA fragments. The rate of dissociation of HA-GdDTPA from the beads showed typical bell-shaped temperature dependence between 7 and 36 °C with peak activity at 25 °C. The tools developed here for quantitative dynamic analysis of hyaluronidase activity by MRI would allow the use of activation of HA-GdDTPA-beads for the determination of the role of hyaluronidase in altering the angiogenic microenvironment of tumor micro metastases. Copyright © 2006 John Wiley & Sons, Ltd. [source] Fine needle aspiration cytology in the diagnosis of bone lesionsCYTOPATHOLOGY, Issue 2 2005U. Handa Objective:, Fine needle aspiration cytology (FNAC) in combination with radiological examination has recently gained clinical recognition for evaluating skeletal lesions. We evaluated our experience with the use of FNA in diagnosing bone lesions with emphasis on areas of difficulty and limitations. Materials and Methods:, Over a period of 5 years FNA was performed in 66 cases of bone lesions. Aspirations were done by cytopathologists using 22-gauge needle. Out of 66 cases unsatisfactory aspirate was obtained in 12 cases. Cytohistological correlation was available in 19 cases. Results:, Adequate aspirates were categorized into neoplastic (27 cases) and non-neoplastic (27 cases) lesions. Of the 27neoplastic aspirates, 20 were malignant (12 primary, 8 metastatic deposits) and 7 were benign. In the malignant group osteosarcoma was correctly diagnosed in 3 cases while other 3 were labeled as sarcoma NOS because of lack of osteoid. Metastatic deposits were sub-typed in 6 cases; from renal cell carcinoma (3 cases), proststic adenocarcinoma, follicular carcinoma thyroid, and squamous cell carcinoma. Neoplastic group comprised of 6 cases of cysts and 21 cases of chronic osteomyelitis. Thirteen cases were diagnosed as tuberculous osteomyelitis. Conclusions:, FNA is a frequent indication in metastases in the bone where distinct cytologic features can even identify an unknown primary. However, diagnosis of primary tumours of the bone is limited by precise subtyping of the tumours. FNA has emerged as a cost effective tool for initial diagnosis of both neoplastic and non-neoplastic lesions of the bone. [source] Stereotactic biopsy and cytological diagnosis of solid and cystic intracranial lesionsCYTOPATHOLOGY, Issue 3 2003L. M. Collaço Cytological smears from 115 consecutive cases of stereotactic biopsies of intracranial lesions were reviewed. Ninety-five lesions were solid and 20 cystic. Material from 90 solid and 13 cystic lesions was sent both for cytological and histological examination. In 66 of the solid lesions, the cytological diagnosis was confirmed by histology (five were benign lesions and 61 malignant tumours: 56 primary brain tumours, three metastases and two lymphomas). In 24 cases with discrepant cytology and histology, the histology was inconclusive or insufficient in 14 cases, while cytology established the diagnosis of astrocytoma grade II (seven cases), metastases (two cases), gliosis (one case) and benign (four cases). Necrosis of tumour type was observed cytologically in six patients representing glioblastoma (two cases), anaplastic astrocytoma (one case), lymphoma (one case) and normal brain (two cases) histologically. Three cases reported cytologically as benign were primary brain tumour (two cases) and gliosis (one case). One smear of a glioblastoma was insufficient for cytological diagnosis. Cystic lesions were cytologically benign in 17 cases and malignant in three cases. Histology from the cyst wall confirmed the malignant diagnosis in three cases and showed tumour in six more cases, a benign process (two cases), changes induced by radiotherapy for arteriovenous malformation (one case) and insufficient material (one case). In conclusion, cytology from solid brain lesion allows an accurate diagnosis and subtyping of tumours in a majority of cases, and can thus be used to choose type of therapy. In cystic brain tumours, however, examination of the cystic fluid, is often inconclusive and a biopsy from the cyst wall should be performed if there is clinical or radiological suspicion of tumour. [source] Sentinel Lymph Node Excision and PET-CT in the Initial Stage of Malignant Melanoma: A Retrospective Analysis of 61 Patients with Malignant Melanoma in American Joint Committee on Cancer Stages I and IIDERMATOLOGIC SURGERY, Issue 4 2010JOACHIM KLODE MD BACKGROUND AND OBJECTIVES Sentinel lymph node excision (SLNE) for the detection of regional nodal metastases and staging of malignant melanoma has resulted in some controversies in international discussions. Positron emission tomography with computerized tomography (PET-CT), a noninvasive imaging procedure for the detection of regional nodal metastases, has increasingly become of interest. Our study is a direct comparison of SLNE and PET-CT in patients with early-stage malignant melanoma. MATERIALS AND METHODS We retrospectively analyzed data from 61 patients with primary malignant melanoma with a Breslow index greater than 1.0 mm. RESULTS Metastatic SLNs were found in 14 patients (23%); 17 metastatic lymph nodes were detected overall, only one of which was identified preoperatively using PET-CT. Thus, PET-CT showed a sensitivity of 5.9% and a negative predictive value of 78%. CONCLUSION SLNE is much more sensitive than PET-CT in discovering small lymph node metastases. We consider PET-CT unsuitable for the evaluation of early regional lymphatic tumor dissemination in this patient population and recommend that it be limited to malignant melanomas of American Joint Committee on Cancer stages III and IV. We therefore recommend the routine use of SLNE for tumor staging and stratification for adjuvant therapy of patients with stage I and II malignant melanoma. The authors have indicated no significant interest with commercial supporters. [source] High-Risk Cutaneous Squamous Cell Carcinoma without Palpable Lymphadenopathy: Is There a Therapeutic Role for Elective Neck Dissection?DERMATOLOGIC SURGERY, Issue 4 2007JUAN-CARLOS MARTINEZ MD PURPOSE The beneficial role of elective neck dissection (END) in the management of high-risk cutaneous squamous cell carcinoma (CSCC) of the head and neck remains unproven. Some surgical specialists suggest that END may be beneficial for patients with clinically node-negative (N0) high-risk CSCC, but there are few data to support this claim. We reviewed the available literature regarding the use of END in the management of both CSCC and head and neck SCC (HNSCC). METHODOLOGY The available medical literature pertaining to END in both CSCC and HNSCC was reviewed using PubMed and Ovid Medline searches. RESULTS Many surgical specialists recommend that END be routinely performed in patients with N0 HNSCC when the risk of occult metastases is estimated to exceed 20%; however, patients who undergo END have no proven survival benefit over those who are initially staged as N0 and undergo therapeutic neck dissection (TND) after the development of apparent regional disease. There is a lack of data regarding the proper management of regional nodal basins in patients with N0 CSCC. In the absence of evidence-based data, the cutaneous surgeon must rely on clinical judgment to guide the management of patients with N0 high-risk CSCC of the head and neck. CONCLUSIONS Appropriate work-up for occult nodal disease may occasionally be warranted in patients with high-risk CSCC. END may play a role in only a very limited number of patients with high-risk CSCC. [source] Subungual Metastasis from a Rectal Primary: Case Report and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 4 2006BARRY GALLAGHER MD BACKGROUND Subungual metastases from colorectal cancer are unusual and have mainly been reported in patients with lung, genitourinary, and breast cancer. OBJECTIVE We present the case of a 72-year-old man with rectal adenocarcinoma and a subungual metastasis to the left thumb 5 years later. METHODS A case report and a brief review of the literature of subungual metastases are given. RESULTS The thumb was amputated and the patient died 6 months later with extensive metastatic disease. CONCLUSION Metastatic carcinoma should be considered in the differential diagnosis of persistent subungual masses, particularly in patients with a history of cancer. The prognosis with such lesions is generally poor. [source] Evaluation of the American Joint Committee on Cancer Staging System for Cutaneous Squamous Cell Carcinoma and Proposal of a New Staging SystemDERMATOLOGIC SURGERY, Issue 11 2005Scott M. Dinehart MD Purpose. To identify and propose corrections for deficiencies in the American Joint Committee on Cancer (AJCC) system for staging cutaneous squamous cell carcinoma (CSCC). Materials and Methods. Prognostic factors for CSCC were identified by retrospective analysis of the published literature. Limitations and deficiencies in the current AJCC staging system for CSCC were then determined using these prognostic factors. Results. Size, histologic differentiation, location, previous treatment, depth of invasion, tumor thickness, histologic subtype, perineural spread, and scar etiology are the most powerful tumor prognostic indicators in patients with localized disease. The most important prognostic factors for patients with nodal metastases are the location, number, and size of the positive lymph nodes. Proposed changes for the T classification include increased stratification of tumor size, identification of patients with perineural invasion, and the addition of tumor thickness or depth of invasion. The N classification has been expanded to include the number and size of nodal metastases. Conclusion. The current AJCC staging system for carcinoma of the skin has deficiencies that limit its use for CSCC. The proposed TMN staging system for CSCC more accurately reflects the prognosis and natural history of CSCC. SCOTT M. DINEHART, MD, AND STEVEN PETERSON, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Single-Institution Experience in the Management of Patients with Clinical Stage I and II Cutaneous Melanoma: Results of Sentinel Lymph Node Biopsy in 240 CasesDERMATOLOGIC SURGERY, Issue 11 2005Jordi Rex MD Background. Lymphatic mapping and sentinel lymph node biopsy (SLNB) has been developed as a minimally invasive technique to determine the pathologic status of regional lymph nodes in patients without clinically palpable disease and incorporated in the latest version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma. Objective. To analyze the results of SLNB and the prognostic value of the micrometastases and the pattern of early recurrences in patients according to sentinel lymph node (SLN) status. Method. Patients with cutaneous melanoma in stages I and II (AJCC 2002) who underwent lymphatic mapping and SLNB from 1997 to 2003 were included in a prospective database for analysis. Results. The rate of identification of the SLN was 100%. Micrometastases to SLN were found in 20.8% of patients. The rate of SLN micrometastases increased according to Breslow thickness and clinical stage. Breslow thickness of 0.99 mm was the optimal cutpoint for predicting the SLNB result. Twenty-four patients (12.3%) developed a locoregional or distant recurrence at a median follow-up of 31 months. Recurrences were more frequent in patients with a positive SLN. Among patients who had a recurrence, those with a positive SLN were more likely to have distant metastases than those with negative SLN. Nodal recurrences were more frequent in patients with a negative SLN compared with those with a positive SLN. Conclusions. The status of the SLN provides accurate staging for identifying patients who may benefit from further therapy and is the most important prognostic factor of relapse-free survival. THIS WORK WAS SUPPORTED BY GRANTS FROM FONDO DE INVESTIGACIONES SANITARIAS (98/0449), BECA DE FORMACIÓ DE PERSONAL INVESTIGADOR (2001/FI0757), AND THE RED ESPÑOLA DE CENTROS DE GENÓMICA DEL CÁNCER (C03/10). [source] Microcystic Adnexal Carcinoma Involving a Large Portion of the Face: When Is Surgery Not Reasonable?DERMATOLOGIC SURGERY, Issue 11 2005Daniel Brian Eisen MD Background. We report a case of microcystic adnexal carcinoma (MAC) involving a large portion of the face, one of the largest of any MAC reported thus far in this area, and review the literature regarding the nature of the tumor and available treatments. We also review all of the reported cases of metastases and the possible role of radiation in the etiopathogenesis of this tumor. Objective. To review the literature about what is known about therapy for MAC and what options are available to patients who have this disease. Materials and Methods. Case report and review of the literature. Results. Of the 274 cases of MAC thus far reported, there are 6 cases of metastases, only 1 of which resulted in death. Conclusion. Mohs surgery should be the treatment of choice for this tumor; however, when extirpation entails sufficiently large morbidity, given the low rate of metastases and mortality, observation is a reasonable alternative. DANIEL BRIAN EISEN, MD, AND DAVID ZLOTY, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Late Inguinal Metastasis of a Well-Differentiated Subungual Squamous Cell Carcinoma after Radical Toe AmputationDERMATOLOGIC SURGERY, Issue 7 2005Kuo-Chin Huang MD Background Although squamous cell carcinoma (SCC) is commonly found on sun-exposed skin, this malignancy in nail beds is rare. There is a very low rate of metastases, especially for well-differentiated lesions without bony involvement. Objective To present a case of late inguinal metastasis after radical toe amputation 3 years previously for subungual SCC. Materials and Methods Case report. Results The patient received modified inguinal lymphadenectomy and adjuvant radiation therapy. No recurrence or metastases were observed for 12 months. Conclusion For patients with subungual SCC postsurgery, it is important to regularly evaluate for a minimum of 3 years, despite the very low rate of metastases. [source] Ocular Melanoma Metastatic to Skin: The Value of HMB-45 StainingDERMATOLOGIC SURGERY, Issue 6 2004Robert A. Schwartz MD Background: Cutaneous metastatic disease is an important finding that may represent the first sign of systemic cancer, or, if already known, that may change tumor staging and thus dramatically altered therapeutic plans. Although cutaneous metastases are relatively frequent in patients with cutaneous melanoma, they are less so from ocular melanoma. Objective: To demonstrate the value of HMB-45, staining in the detection of ocular melanoma metastatic to skin. Methods: The immunohistochemical stain HMB-45 a monoclonal antibody directed against intact human melanoma cells, was employed on a skin biopsy specimen from a cutaneous tumor. Results: HMB-45 staining was positive in the atypical hyperchromatic cells of the deep dermis. Conclusion: HMB-45 may be of value in the detection of ocular melanoma metastatic to skin. Cutaneous metastatic disease is a somewhat common and extremely important diagnosis. Although cutaneous metastases from cutaneous melanoma are relatively frequent, those from ocular melanomas are less so. Use of histochemical staining, especially the HMB-45 stain, allows confirmation of the diagnosis. [source] In-Transit Metastasis From Primary Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients and Nonimmunosuppressed Patients: Clinical Characteristics, Management, and Outcome in a Series of 21 PatientsDERMATOLOGIC SURGERY, Issue 4p2 2004John A. Carucci MD Background. In-transit metastases from cutaneous squamous cell carcinoma (SCC) may occur in organ transplant recipients and may indicate aggressive disease and poor prognosis. Objective. The objective of this study was to describe in-transit metastases from cutaneous SCC and to identify factors associated with this phenomenon in a series of 21 patients. We also attempted to evaluate outcome with respect to status as an organ transplant recipient or nonorgan transplant recipient. Methods. A multicenter case series of patients was reviewed; factors included clinical presentation, management, and outcome. Results. Twenty-one patients, 15 organ transplant recipients, and 6 nontransplant recipients with in-transit metastases were reviewed. In-transit metastases presented most commonly as discrete, dermal papules distinct from but in the vicinity of the primary tumor site. Histologic differentiation was variable. At a mean follow up of 24 months, 33% the transplant patients had no evidence of disease compared with 80% of nontransplant patients. Thirty-three percent were dead from disease and 33% were alive with nodal or distant metastases. In contrast, 80% of nonimmunosuppressed patients had no evidence of disease and none had died at mean follow-up of 24 months. Conclusion. In-transit metastasis from cutaneous SCC is a unique presentation of metastatic SCC, more commonly described in organ transplant recipients, and is associated with poor prognosis in that group. This description represents the largest experience with in-transit metastases from cutaneous SCC in the literature. [source] Carcinoma En Cuirasse Presenting as Keloids of the ChestDERMATOLOGIC SURGERY, Issue 2 2004Kimberly Mullinax Background. Carcinoma en cuirasse is a form of metastatic cutaneous breast malignancy occurring most commonly on the chest as a recurrence of breast cancer, but it can be the primary presentation. Objective. To discuss the clinical features of carcinoma en cuirasse that distinguish it from hypertrophic scars and keloids of the chest. Method. We report a 63-year-old woman with primary cutaneous breast carcinoma presenting as keloid nodules on the chest that failed treatments for keloids. Biopsy revealed a pattern of breast carcinoma in the skin. Results. After further workup, no tumor was found in the deep breast tissue, but metastases were found in her axillary lymph nodes. Conclusions. Unusual keloid-like nodules or scars on the chest that fail to respond to therapy may be primary or metastatic malignancies, and adequate histologic verification should be obtained to avoid delay in the proper treatment. [source] Aggressive Squamous Cell Carcinoma Originating as a Marjolin's UlcerDERMATOLOGIC SURGERY, Issue 2 2004Shawn R. Sabin MD Background. Marjolin's ulcer is an epidermoid carcinoma arising in a scar or chronic wound and can have an aggressive course. Objective. To present a case of squamous cell carcinoma arising in a burn scar with resulting metastases and to discuss Marjolin's ulcer. Results. The patient continued to have further metastatic disease despite aggressive surgical treatment. Conclusion. In following patients with chronic ulcers and wounds, it is important to evaluate any changes immediately with biopsies and further imaging studies if indicated in order to treat effectively. Even aggressive surgical intervention will sometimes be inadequate in treating these tumors. [source] Locoregional Cutaneous Metastases of Malignant Melanoma and their ManagementDERMATOLOGIC SURGERY, Issue 2004Ingrid H. Wolf MD The correct classification of locoregional metastases of malignant melanoma to skin is central to the planning of treatment. Local recurrence means persistence of neoplastic cells at the local site by virtue of incomplete excision of the primary melanoma. Standard treatment is excisional surgery. In contrast, locoregional metastases of malignant melanoma (satellites, in-transit metastases) are metastases around a primary melanoma or between a primary melanoma and regional lymph nodes. They represent intralymphatic or hematogenous spread of neoplastic cells. We present a variety of available treatment options and discuss especially topical imiquimod as a novel approach for the palliative treatment of locoregional cutaneous melanoma metastases in selected patients. [source] Extraorbital Sebaceous Carcinoma With Rapidly Developing Visceral MetastasesDERMATOLOGIC SURGERY, Issue 9 2003Deniz Güney Duman MD Background. Extraorbital sebaceous carcinoma (SC) is a rare carcinoma of the skin but is known to have a good prognosis in terms of metastasis and survival. Objective. To discuss and emphasize through the clinical and histopathologic findings and the aggressive potential of extraorbital SC and to review the corresponding literature. Methods. We present an unusual form of extraorbital SC that has followed an aggressive course and that has metastasized rapidly. Results. Local excision of the primary cutaneous tumor with negative margins did not prevent the rapid and fatal internal organ metastases. The patient did not benefit from the docetaxel chemotherapy regimen applied after the distant metastases were developed. Conclusion. Extraorbital SC may show a poor prognosis. Both the dermatologic surgeon and the dermatologist should be cautious of the risk of local recurrence and distant metastasis when dealing with extraorbital SC. [source] Squamous Cell Carcinoma of the Anal Margin with Pruritus Ani of Long DurationDERMATOLOGIC SURGERY, Issue 1 2003Yoshihiro Handa MD BACKGROUND. Anal margin is an unusual location for squamous cell carcinoma (SCC). On rare occasions, anal margin carcinoma is the cause of pruritus ani. OBJECTIVE. To describe a case of SCC of the anal margin with pruritus ani of long duration. RESULTS. A 52-year-old man had been aware of perianal itching for over 10 years. Examination of the perianal area revealed a reddish, eroded, hard nodule that was 2.0×1.5 ×0.3 cm in size located in the 3 o'clock position. The histopathologic diagnosis was well-differentiated SCC. The nodule was totally excised with a 1-cm margin. No recurrence or metastases were observed for 7 months. CONCLUSION. When pruritus ani does not respond to conservative therapy and when symptoms have existed for a long time, we should suspect the presence of malignancy. [source] Mucoepidermoid/Adenosquamous Carcinoma of the Skin: Presentation of Two CasesDERMATOLOGIC SURGERY, Issue 12 2001Darlene S. Johnson MD Background. Mucoepidermoid carcinoma is a relatively common neoplasm of the major and minor salivary glands comprising 10,30% of primary carcinomas. They may involve the skin through direct extension, metastases, and rarely, as a primary focus (adenosquamous carcinoma). Objective. To discuss through case reports, the nomenclature, histology, clinical course, and treatment of mucoepidermoid/adenosquamous carcinoma. Methods. We present a case of mucoepidermoid carcinoma primary to an upper eyelid accessory lacrimal gland with direct cutaneous extension and a case of primary cutaneous adenosquamous carcinoma of the scalp. Results. An eyelid neoplasm of lacrimal origin was initially treated with Mohs micrographic surgery (MMS), requiring an orbital exenteration to achieve a tumorfree plane. In the second case, a primary scalp lesion was cleared with MMS. Neither patient has had local recurrence or metastases. Conclusion. Correct diagnosis is crucial to pursuing adequate treatment for this aggressive neoplasm. We support the use of MMS to achieve local control. [source] Malignant Eccrine Spiradenoma: A Case Report and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 1 2001Masashi Ishikawa MD Background. Eccrine spiradenoma is a well-differentiated benign tumor of the sweat glands. Malignant change arising within eccrine spiradenoma is rare. Objective. We describe a patient with malignant eccrine spiradenoma exhibiting both carcinomatous and sarcomatous differentiation. Methods. Case report and literature review. Results. A 37-year-old woman noted enlargement of a left axillary tumor that had been present for 20 years. The tumor was resected and the specimen, measuring 3.0 cm × 1.5 cm, revealed an encapsulated benign eccrine spiradenoma as well as an undifferentiated carcinoma possessing both carcinomatous and sarcomatous components. A transition zone was evident between the benign eccrine spiradenoma and the undifferentiated carcinoma, suggesting that the latter had arisen from the benign tumor. The malignant areas consisted principally of undifferentiated carcinoma (70%), although squamous cell carcinoma (10%), adenocarcinoma (10%), and chondrosarcomatous (10%) components were also present. Numerous mitotic figures were noted within the areas of malignant change, suggesting that the tumor was aggressive in nature. The patient died of systemic metastases 7 months after diagnosis. Conclusion. Although eccrine spiradenomas are usually benign, they can, on rare occasions, undergo malignant transformation. This case report describes one such occurrence of malignant transformation of a benign eccrine spiradenoma that unfortunately resulted in the patient's death from systemic metastases 7 months after diagnosis. [source] Neurological complications in two children with Lemierre syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2010BASHEER PEER MOHAMED Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the ,clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this ,forgotten disease'. [source] Fine-needle aspiration diagnosis of a metastatic adult sclerosing rhabdomyosarcoma in a lymph nodeDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2010Richard L. Cantley M.D. Abstract Adult sclerosing rhabdomyosarcoma (ASRMS) is a rare variant of rhabdomyosarcoma with a characteristic histological appearance of small, round cells in a dense, hyalinized stroma. Although nodal metastases of soft-tissue sarcomas are considered uncommon, up to 5% overall are associated with lymph node metastases. Nonetheless, there is little literature on the cytologic characteristics of metastatic soft-tissue sarcomas in lymph nodes, and to our knowledge, there are no reports of nodal metastasis of ASRMS diagnosed by fine-needle aspiration (FNA) cytology. We report here a 55-year-old woman who presented with a right thigh mass and associated ipsilateral inguinal lymphadenopathy. Biopsy of the mass revealed a uniform population of small, round cells in a dense, sclerotic background. A diagnosis of ASRMS was rendered. Subsequently, the patient underwent FNA of an enlarged inguinal lymph node, which revealed an identical population of small, round cells in a dense, myxoid background. This case highlights the cytologic features of a rare form of rhabdomyosarcoma, and emphasizes the utility of FNA in the assessment of lymphadenopathy in the setting of a soft-tissue sarcoma. Diagn. Cytopathol. 2010;38:761,764. © 2010 Wiley-Liss, Inc. [source] Fine needle aspiration of metastatic prostate carcinoma simulating a primary adrenal cortical neoplasm: A case report and review of the literatureDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2010Andrea P. Subhawong M.D. Abstract Adrenal metastases usually occur in prostate cancer patients with widespread bone and visceral disease. Autopsy studies have shown that adrenal metastases may be found in up to 23% of these patients. However, the finding of an isolated adrenal metastasis without the involvement of other organs in a patient with prostate cancer is exceedingly rare. Thus, it may cause a diagnostic dilemma on FNA cytology. We report a patient with a history of prostate cancer, status post radiation, and hormonal therapy 4 years before, who presented with a new, single adrenal mass on abdominal imaging studies. The ultrasound-guided FNA cytology of the adrenal mass revealed cytomorphological features that were suggestive of a primary adrenal cortical neoplasm, but overlapped with those of a prostate metastasis. To our knowledge, FNA findings of metastatic prostate cancer simulating an adrenal cortical neoplasm have not been previously reported in the English literature. The purpose of our study is to discuss the differential diagnosis of these entities. The accurate diagnosis is important because of different prognosis and treatment implications for the various diseases. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Epithelioid angiosarcoma: A neoplasm with potential diagnostic challengesDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2010Christine F. Lin B.S. (Student) Abstract Epithelioid angiosarcomas are extremely rare tumors associated with poor prognosis and early metastases. Its epithelioid cytomorphology and limited vasoformation make it difficult to distinguish from more common malignancies, such as, carcinoma. This can be a potential diagnostic pitfall for the cytopathologist. In this report, the patient is a 24-year-old man presenting with testicular pain, a pelvic mass, and innumerable liver nodules. Immediate interpretation of the needle core biopsies of the pelvic mass and liver lesions initially favored a poorly differentiated adenocarcinoma. Unusual positive immunohistochemical stains for CD30 and CK7 ultimately led the investigation toward a tumor of mesenchymal origin. Further, immunohistochemical evaluation demonstrated positive CD31 and Factor VIII staining and established the final diagnosis of epithelioid angiosarcoma. The tumor cells were negative for CD34, CK20, alpha-fetoprotein, placental-like alkaline phosphatase, hepatocyte paraffin 1, polyclonal carcinoembryonic antigen, CD10, CA-125, prostate-specific antigen, and prostatic acid phosphatase. This case is reported to illustrate the importance of considering the diagnosis of epithelioid angiosarcoma when encountering an "epithelioid" neoplasm particularly with unusual immunoreactivity for CK7 and CD30. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Role of fine-needle aspiration cytology in evaluation of cutaneous metastasesDIAGNOSTIC CYTOPATHOLOGY, Issue 12 2009Sonal Sharma M.D. Abstract Skin is an uncommon site for metastasis. This study was done to evaluate the role of FNAC as an important tool for investigating cutaneous and subcutaneous nodules in patients with known malignancy or as a primary manifestation of an unknown malignancy. All the FNAC done from January 2003 to August 2008 were reviewed (n = 55,556). Ninty-five patients (49 males and 46 females with age range of 4,96 years) with cutaneous/subcutaneous nodules which were diagnosed as metastasis were analyzed. Primary tumors of skin/subcutis were excluded from the study. In our study, 63 out of 95 cases had a known primary malignancy. Of these, five had underlying hematological malignancy and 58 patients had solid organ tumors. Lung carcinoma was seen to metastasize most commonly to skin in males and breast carcinoma in females. The most common site for a cutaneous/subcutaneous metastasis was chest wall [40 followed by abdominal wall (14) and scalp (9)]. Multiple site involvement was also observed (8). In 32 cases primary site was not known. They were most commonly diagnosed as poorly differentiated carcinoma followed by adenocarcinoma. FNAC can diagnose a variety of tumors in the skin and support the diagnosis of a metastasis in case of a known primary and offer a clue to underlying malignancy in case of an occult primary. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Diagnosis of metastatic pancreatic mesenchymal tumors by endoscopic ultrasound-guided fine-needle aspiration,DIAGNOSTIC CYTOPATHOLOGY, Issue 11 2009Linda Varghese M.D. Abstract Involvement of the pancreas by metastatic sarcoma is rare, and can prove challenging to differentiate from sarcomatoid carcinomas which occur more commonly. The endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) technique has been successfully used for the diagnosis of pancreatic carcinomas whether primary or metastatic, and is now considered the most effective noninvasive method for the identification of pancreatic metastases. However, to date very few reports detail the diagnosis of mesenchymal neoplasms by EUS-FNA. Herein, we report a series of four patients who underwent EUS-FNA of the pancreas, where the diagnosis of metastatic sarcoma was made based on morphology and ancillary studies. The cases include metastases of leiomyosarcoma, liposarcoma, alveolar rhabdomyosarcoma, and solitary fibrous tumor. The history of a primary sarcoma of the chest wall, mediastinum, and respectively lower extremity was known for the first three of these patients while in the case of the solitary fibrous tumor a remote history of a paraspinal "hemangiopericytoma" was only elicited after the EUS-FNA diagnosis was made. We conclude that EUS-FNA is efficient and accurate in providing a diagnosis of sarcoma, even in patients without a known primary sarcoma, thus allowing institution of therapy without additional biopsies. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Aspiration biopsy cytomorphology of primary pulmonary germ cell tumor metastatic to the brainDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2009Haitham Arabi M.D. Abstract Extragonadal germ cell tumors are uncommon and such tumors originating from the lung parenchyma are extremely rare. This is a case of 68-year-old female who was admitted with complaints of right-sided weakness, inability to maintain her balance, right-sided headache, and bloody sputum. Her workup revealed two enhancing brain lesions and large lung mass involving the left lower lobe. Fine-needle aspiration (FNA) of the lung followed by craniotomy was performed and the patient was initially diagnosed with lung adenocarcinoma metastatic to the brain based on the cytomorphology of the lung FNA and histology of the brain mass. However, retrospective investigation revealed markedly elevated alpha fetoprotein (AFP) of which the cytopathologist was unaware at the time of diagnosis. A review of the cytology and surgical specimen slides, as well as immunohistochemistry (IHC) on the brain tumor and FNA cell block were preformed. On the basis of the slides review, clinical findings, and immunostaining results, a diagnosis of primary pulmonary mixed germ cell tumor, containing choriocarcinoma and yolk sac elements, with brain metastases, was retrospectively made. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Cytological features of signet-ring cell carcinoma of the lung: Comparison with the goblet-cell-type adenocarcinoma of the lungDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2009Koji Tsuta M.D. Abstract Signet-ring cell carcinoma (SRCC) and goblet-cell-type adenocarcinoma (GCA) are mucin-producing lung adenocarcinomas. Primary SRCC shows an aggressive clinical course, whereas GCA shows infrequent distant metastasis, but more frequent intrapulmonary metastases resembling lobar pneumonia. To distinguish SRCC from GCA, this study investigated the respective cytological features of these lesions. We selected 10 cases each of SRCC and GCA from the archival imprint smears. We assessed them for the following 10 cytological features. Necrosis/debris was observed in 60% of the SRCC and 90% of the GCA. A mucinous background was observed in 10% of the SRCC and 90% of the GCA. Significant inflammation was observed in none of the SRCC and 80% of the GCA. Stromal cluster was observed in 30% of the SRCC and 70% of the GCA. Nuclear overlapping was observed in 50% of the SRCC and in all of the GCA. Single tumor cells were observed in 80% of the SRCC and 10% of the GCA. Honeycomb-like cluster was observed in none of the SRCC and 80% of the GCA. Prominent nucleolus was observed in 50% of the SRCC and 40% of the GCA. Nuclear membrane irregularity was observed in 70% of SRCC and 60% of the GCA. Nuclear pleomorphism was observed in all of the SRCC and none of the GCA. The cytological features of SRCC were the presence of single tumor cells and nuclear pleomorphism, whereas that of GCA were the presence of abundant mucin and significant inflammation in the background, and a honeycomb-like cluster. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Primary small cell carcinoma of the lung initially presenting as a breast mass: A fine-needle aspiration diagnosisDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2009Wei Liu M.D. Abstract The incidence of metastases to the breast from extramammary sites is relatively low compared with the incidence of primary breast carcinoma. Primary sites which have a predilection for metastases to the breast include, in the order of decreasing frequency, malignant melanoma, lymphoma, lung carcinoma, ovarian carcinoma, and soft tissue sarcoma, followed by gastrointestinal and genitourinary primaries. Most lung primaries metastasizing to breast represent adenocarcinoma. Other types of lung carcinoma, including small cell carcinoma, are relatively rare. We report a case of lung small cell carcinoma metastasizing to the breast and initially presenting with a breast mass in a 50-year-old female. The tumor was first diagnosed on a fine-needle aspiration biopsy specimen (FNAB) from the breast lesion and subsequently supported by core biopsy. A discussion of the differential diagnoses to consider on FNAB follows. Because of the difference in treatment for primary small cell carcinoma of breast versus primary small cell carcinoma of the lung, as well as the difference in prognosis for both malignancies, determining the site of primary malignancy is crucial to adequate patient care. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||||||||||||||