1/95. pituitary apoplexy following metastasis of bronchogenic adenocarcinoma to a prolactinoma.A 42-year-old house wife presented with worsening headaches over 6 months in the absence of visual symptoms or symptoms suggestive of focal neurology. She was a life-long smoker. Systems review was unremarkable apart from secondary amenorrhoea and galactorrhoea of 6 months duration. Her serum prolactin was found to be 620 mU/l (60-400), FT4 12.6 nmol/l (9.8-23.1), TSH 1.38 mU/l (0.35-5.5), oestradiol < 73 pmol/l, LH and FSH of 4.4 and 12.6 mIU/l, respectively. She was on bromocriptine. A presumptive diagnosis of pneumonia, based on pyrexia and CXR findings, was made and she was started on IV antibiotics. Two days later she developed meningism and deterioration of conscious level. (Lumbar puncture results: no organisms, 312 neutrophils and 164 lymphocytes). CT scan revealed a 2.5-cm pituitary adenoma, with suprasellar extension. A repeat hormonal profile revealed FSH 1.4, LH < 0.3 mU/l, oestradiol < 73 pmol/l, prolactin 488 mU/l (60-400), and low random cortisol at 29 nmol/l. T1-weighted MRI revealed a large pituitary mass with evidence of haemorrhage. The patient subsequently underwent a transsphenoidal exploration with resection of the pituitary lesion. Whilst awaiting the histopathology results, CT of chest revealed a 1. 5-cm diameter rounded well defined density in the right lower lobe associated with hilar, pre- and right para-tracheal lymphadenopathy. The histopathology of the pituitary lesion, obtained piecemeal, revealed fragments of fibrous tissue infiltrated by sheets of acidophilic prolactin-positive cells, in keeping with a prolactinoma. In addition, other fragments with blood clot included highly atypical epithelial cells with mitotic figures. These were negative for prolactin but showed HMFG-and CEA-positivity, excluding them from a pituitary lineage. Transbronchial biopsy revealed moderately differentiated adenocarcinoma, with evidence of lymphatic spread. The overall conclusion was of bronchogenic adenocarcinoma, metastasizing to a prolactinoma and complicated by apoplexy.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
2/95. Pulmonary lymphangioleiomyomatosis. A study of 69 patients. Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P).Pulmonary lymphangioleiomyomatosis (LAM) is a rare disorder of unknown cause characterized by peribronchial, perivascular, and perilymphatic proliferation of abnormal smooth muscle cells leading to cystic lesions. The hypothesis of hormonal dependence and the effectiveness of hormonal therapy have not yet been demonstrated conclusively, and the prevalence of extrathoracic manifestations and the survival of patients with LAM are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features, the diagnostic procedures, the associated lesions, and, above all, the management and course of LAM in a large homogeneous series of 69 stringently selected patients, with a majority of cases diagnosed since 1990. The aim of the study, based on a review of the literature, also was to provide a comprehensive view of this uncommon disease. The clinical features were in keeping with previous studies, but we found that exertional dyspnea and pneumothorax were the most common features, and chylous involvement was less frequent. LAM was diagnosed after menopause in about 10% of cases. The onset of LAM occurred during pregnancy in 20% of cases, and a clear exacerbation of LAM was observed in 14% of cases during pregnancy. Pulmonary LAM was diagnosed on lung histopathology in 83% of cases, but renal angiomyolipoma, observed in 32% of our patients, may be a useful diagnostic criterion when associated with typical multiple cysts on chest CT scan or with chylous effusion. Chest CT scan was more informative than chest X-ray (normal in 9% of cases), and may be indicated in spontaneous pneumothorax or renal angiomyolipoma in women of childbearing age. About 40% of the patients had a normal initial spirometry, while an obstructive ventilatory defect (44%), a restrictive ventilatory defect (23%), was observed in other patients. Initial diffusing capacity for carbon monoxide was frequently decreased (82%). Hormonal therapy was administered in 57 patients, but a clear > or = 15% improvement of FEV1 was observed in only 4 evaluable patients, treated with tamoxifen and progestogens (n = 2), progestogen (n = 1), and oophorectomy (n = 1). Probably 1 of the most urgent needs for clinical research in LAM is to test the currently available hormonal treatments in the context of international multicenter prospective controlled studies. pleurodesis was performed in 40 patients. lung transplantation was performed in 13 patients, 7.8 /- 5.2 years after onset of LAM, in whom the mean FEV1 was 0.57 /- 0.15 L. After a follow-up of 2.3 /- 2.2 years, 9 patients were alive. Mean follow-up from onset of disease to either death or closing date was 8.2 /- 6.3 years. overall survival was better than usually reported in LAM, and Kaplan-Meier plot showed survival probabilities of 91% after 5 years, 79% after 10 years, and 71% after 15 years of disease duration.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
3/95. Metastatic chondrosarcoma to the maxilla: review of the literature and report of case.Metastatic tumors to the jaw are relatively uncommon. When they occur, the primary tumor is most likely to be an adenocarcinoma from the breast, lung, or kidney. Metastatic tumors most frequently involve the mandible rather than the maxilla. The route of metastasis is considered hematogenous, although spread via lymphatic channels or the vertebral venous plexus may occur. An unusual instance of primary chondrosarcoma of the scapula metastasizing to the maxilla and to various soft tissue sites from tumor emboli, probably arising from an extensive metastatic lesion of the left atrium of the heart, has been presented.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
4/95. Late pelvic recurrence of nonseminomatous testicular carcinoma after negative retroperitoneal lymph node dissection.We report a case of pathologic Stage I teratoma recurring in the pelvis as embryonal carcinoma 12 years after radical orchiectomy and bilateral retroperitoneal lymph node dissection (RPLND). The patient received three cycles of chemotherapy (cisplatin, etoposide, bleomycin) followed by complete surgical excision of the pelvic mass. Successful treatment of these rare late recurrences usually requires chemotherapy and complete surgical excision. Pelvic relapse may potentially result from incomplete iliac node resection at the time of RPLND, altered lymphatic drainage from an incompletely resected spermatic cord, or a second primary extragonadal tumor focus. Our case emphasizes the importance of meticulous surgical technique during RPLND and the necessity for follow-up beyond 5 years in patients with testicular cancer.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
5/95. lung transplantation for advanced bronchioloalveolar carcinoma confined to the lungs.BACKGROUND: Bronchioloalveolar carcinoma (BAC) is a well-differentiated lung adenocarcinoma that has a tendency to spread chiefly within the confines of the lung by aerogenous and lymphatic routes and may therefore be amenable to local therapy. However, a high rate of local recurrence after lung transplantation was recently reported. We describe two patients with unresectable and recurrent extensive BAC limited to the lung parenchyma who underwent lung transplantation with curative intent. methods: patients were chosen to receive lung transplants for BAC if they met the following criteria: (1) recurrent or unresectable BAC limited to the lung parenchyma without nodal involvement and (2) suitable candidate for lung transplantation. RESULTS: The first patient relapsed in the lungs at 9 months after transplantation. The pattern of disease suggested contamination of the new lungs at the time of implantation. Repeat lung transplantation was performed, with cardiopulmonary bypass and irrigation of the remaining upper airway. This patient has had no evidence of local or systemic tumor recurrence at more than 4 years since the second transplantation. The second patient underwent transplantation using the modified technique and expired 16 months after transplantation of other causes. An autopsy showed no evidence of recurrent BAC in the lungs or of metastatic lesions at any site. CONCLUSIONS: lung transplantation may be an option for unresectable or recurrent BAC confined to the lungs. Isolation of the diseased lungs and the use of cardiopulmonary bypass during surgery may be important in this disease and should be studied further.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
6/95. Pulmonary lymphangitic carcinomatosis from an oropharyngeal squamous cell carcinoma: a case report.Pulmonary lymphangitic carcinomatosis (PLC), a form of lymphatic spread of cancer cells, from head and neck cancers is extremely rare. We report here a case of PLC from an oropharyngeal squamous cell carcinoma in a 68-year-old man. The patient underwent inductive chemoradioimmunotherapy which resulted in complete tumor remission. The tumor, however, recurred 6 months later and was resected. Late metastasis occurred in the ipsilateral cervical lymph nodes 13 months post surgery and these lymph nodes were dissected. Three months later, the patient suffered from a fever, cough and dyspnea and a chest radiograph revealed an interstitial linear pattern from the right hilum to the right upper lung field. Without diagnosis of the pulmonary lesion, swelling of the bilateral lymph nodes followed after a few months and dyspnea worsened with spread of the reticular shadow and appearance of Kerley's B line on the roentgenogram, suggesting PLC. The patient gradually became more distressed and finally died 6 months after the onset of dyspnea. The microscopy of the autopsied pulmonary tissue revealed tumor cell nests in the lymph vessels in the septa and the pulmonary lesion was histopathologically diagnosed as PLC. The present case indicates that we should consider PLC when cough and dyspnea with reticular shadows and Kerley's B line are observed in patients with head and neck carcinoma.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
7/95. A 7 mm lung adenocarcinoma with mediastinal involvement and lymphangiosis carcinomatosa: a case report.We report a case of a 46-year-old man with a 7 mm lung adenocarcinoma with mediastinal nodal involvement and lymphangiosis carcinomatosa. The resected right middle lobe contained a 7 mm well-differentiated papillary adenocarcinoma and lymphatic vessels towards the hilum were severely involved. The disease was pathologically diagnosed as T1N2M0. Six months after the operation, malignant pleural effusion and multiple bone metastases developed and he died 21 months after the operation. This case indicates that even a very small-sized lung cancer, 1 cm or smaller, could be biologically highly malignant.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
8/95. Solitary pulmonary lymphangioma.lymphangioma is an abnormal collection of lymphatics that are developmentally isolated from the normal lymphatic system. lymphangioma rarely presents as a solitary pulmonary lesion. We present a case of solitary pulmonary lymphangioma and review the literature on its pathogenesis, clinical features, and radiographic findings.- - - - - - - - - - ranking = 2keywords = lymphatic (Clic here for more details about this article) |
9/95. A case of adenocarcinoma with mixed subtypes displaying ground-glass opacity on high-resolution CT.We report a case of adenocarcinoma with mixed subtypes with pleural dissemination and lymphatic permeation, although the CT results showed ground-glass opacity that led to the diagnosis of bronchioloalveolar carcinoma without foci of active fibroblastic proliferation.- - - - - - - - - - ranking = 1keywords = lymphatic (Clic here for more details about this article) |
10/95. Synchronous multifocal osteosarcoma with lymphatic spread in the lung: an autopsy case report.Synchronous multifocal/multicentric osteosarcoma (MOS) is a rare variant of osteosarcoma. We report here an autopsy case of a 15-year-old boy with MOS. Radiological examinations showed multiple sclerotic lesions in the left distal femur and in the ipsilateral proximal tibia without pulmonary metastasis at the first examination. Histological examination showed osteoblastic-type osteosarcoma. Despite high-dose chemotherapy the patient died of multiple bone and lung involvements 6 months after the initial diagnosis. autopsy examination revealed prominent invasion of the tumor cells into lymphatic vessels and pleural dissemination without the formation of bulky, nodular metastasis in the lungs. Metastases in pulmonary hilar lymph nodes were noted without metastasis in other organs. immunohistochemistry revealed that p53 protein was positive in most of the tumor cells. In summary, the present case was characterized by multiple bone involvement and prominent lymphatic spread of sarcoma cells in the lungs.- - - - - - - - - - ranking = 6keywords = lymphatic (Clic here for more details about this article) |
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