1/4. Multiple basal cell carcinomas arising in a port-wine stain with a remote history of therapeutic irradiation.The coexistence of a basal cell carcinoma and a port-wine stain is a very rare condition that may be associated with previous treatments. We present a case of multiple basal cell carcinomas developing within the boundaries of a port-wine stain, which had been treated with a tholium X and argon laser. Our case suggests that port-wine stains which were previously treated with irradiation or argon laser should be examined carefully and regularly by both physician and patient, because they may hide basal cell carcinomas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Malignant transformation of posterior fossa epidermoid cyst.The authors report the case of a 45-year-old man who presented with a short duration of a painful ophthalmoparesis. Initial magnetic resonance imaging revealed an extraaxial petroclival mass characteristic of an epidermoid cyst, with the exception of a contiguous contrast-enhancing lobule. A subtotal resection was performed with the histopathological diagnosis revealing malignant transformation of an epidermoid cyst. Despite aggressive postoperative adjuvant therapy, the patient developed leptomeningeal metastasis and died shortly thereafter. The presence of contrast enhancement at the site of an epidermoid cyst combined with an acute, progressive neurological deficit should alert the treating physician to the possibility of a malignant transformation. When transformation does occur, the clinical and radiological course is quite aggressive as compared with the indolent growth of epidermoid cysts. Treatment options include surgery with adjuvant chemotherapy or radiotherapy. We review the pertinent features of this case along with the relevant literature regarding primary intracranial squamous cell carcinomas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Benign giant cell tumor of bone with osteosarcomatous transformation ("dedifferentiated" primary malignant GCT): report of two cases.It is not uncommon for sarcomatous transformation of giant cell tumor (GCT) of bone to occur after radiation, but rarely does malignant transformation occur spontaneously, with less than 15 cases reported up to 1995. Only four of these cases have been documented in detail. We report two additional cases of GCT of bone spontaneously transforming or "dedifferentiating" into osteosarcoma without radiation therapy. The first case is absolutely unique and most interesting in that the dedifferentiation process occurred in one of multiple GCT lung metastases 6 years after successful eradication of a primary tibial tumor. The right lung was resected due to development of a large tumor, and at pathologic examination, demonstrated several small nodules of conventional GCT and a much larger, 14-cm mass composed of a mixture of GCT and high-grade osteosarcoma. The second case involved a physician, who had a large tumor in the sacrum with vague symptoms for 8 years. Open biopsy revealed conventional, benign GCT of bone with a secondary aneurysmal bone cyst. Complete curettage 2 weeks later revealed, in addition to areas of conventional, benign GCT a second component of very high grade osteosarcoma. Both patients died less than 1.5 years from diagnosis. This report of osteosarcomatous transformation of a conventional GCT of bone strengthens the theory that there is a mesenchymal cell line in GCT that may spontaneously transform to sarcoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Rapid progression of Barrett's esophagus to metastatic esophageal carcinoma in a patient with chronic lymphocytic leukemia.Barrett's esophagus is a common premalignant condition that predisposes to the development of adenocarcinoma of the esophagus through a process of transformation from metaplasia to dysplasia and then carcinoma. Periodic endoscopic surveillance with multiple biopsies is adopted by most physicians to detect dysplasia or early carcinoma. We report a case of an 80-year-old white man with chronic lymphocytic leukemia (CLL) who had periodic endoscopic surveillance without any evidence of dysplasia or cancer, and who died of metastatic carcinoma of the esophagus only 18 months after his last upper endoscopic examination. We suspect that the relative immunosuppressed state resulting from his CLL was the major contributor to the rapid progression of the Barrett's esophagus to cancer. patients with CLL have higher risk of second cancers, and several cases of aggressive carcinomas have been reported in association with CLL. This is the first case report of metastatic esophageal cancer arising in Barrett's esophagus in a patient with CLL. This case suggests that we might need a more aggressive surveillance strategy for Barrett's esophagus in patients with CLL or other immunocompromised conditions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |