2451/3084. Secondary pancreatic involvement of mycosis fungoides detected by a clinically palpable mass. A patient with a 4-year history of mycosis fungoides, who presented a pancreatic spreading of the disease, detected by a clinically palpable mass, is reported and discussed with a review of the literature. mycosis fungoides (MF) is a T cell lymphoma primarily localized to the skin. Laparoscopic staging and autopsy studies, however, have shown that lymph node involvement or visceral spreading is common in the course of the disease [1-3]. Among visceral manifestations of MF, pancreas infiltration is found in 20-40% of autopsied cases [1, 2, 4]. Occurrence of a palpable pancreatic mass has never been described. We report a patient with a long-standing MF, and a secondary pancreatic extension detected by a palpable mass. ( info) |
2452/3084. Case report: poorly differentiated carcinoma of unknown primary presenting as Trousseau's syndrome. Two patients without clinical evidence of malignancy had idiopathic migratory thrombophlebitis. A clinical state consistent with Trousseau's syndrome prompted a work-up of each patient for occult cancer. In both individuals, computed tomography of the chest revealed a solitary mediastinal lymph node that, though inconspicuous, was evaluated further because of the clinical picture. mediastinoscopy with biopsy revealed poorly differentiated carcinoma. Treatment was begun for carcinoma of unknown primary with variable response to therapy. The clinical presentation and pathophysiology of Trousseau's syndrome, as well as its use in leading to an antemortem diagnosis of occult cancer in these and other patients, are delineated. ( info) |
2453/3084. Linac radiosurgery for locally recurrent nasopharyngeal carcinoma: rationale and technique. BACKGROUND. patients with locally recurrent nasopharyngeal carcinoma benefit from reirradiation. A main barrier to successful palliation or cure is dose limitation secondary to normal tissue tolerance. There are many strategies to increase the tolerated dose to the recurrent lesions. Stereotactic radiosurgery for the treatment of these lesions has rarely been reported. methods. Three patients with recurrent nasopharyngeal carcinoma were treated with linac-based stereotactic radiosurgery. RESULTS. One patient remained disease-free 1 year after radiosurgery; the second patient had neurologic deterioration of uncertain etiology (complication vs recurrence) 6 months after radiosurgery; and the third patient had local recurrence 6 months after radiosurgery. CONCLUSION. Stereotactic radiosurgery can be used to deliver a boost dose of radiation to recurrent nasopharyngeal carcinomas. The technique is increasingly available and may offer some advantages compared with other techniques. Treatment recommendations are presented. ( info) |
| Malignant lymphoma of the thyroid gland is a rare entity; only 200 cases have been reported to date since 1960. Four patients with this disease presented at the Kingston clinic of the ontario Cancer Treatment and research Foundation. Those with localized malignant lymphoma, particularly the histiocytic types, responded favourably to resection of as much of the tumour as possible and subsequent local radiation with cobalt-60 telecurietherapy (3000 to 4000 rads in 3 to 4 weeks). The results of local radiation alone after a biopsy in patients with inoperable localized diseases are encouraging; it is possible, but not yet established, that some of these patients are cured. It has been suggested that the tumour is dependent on thyroid-stimulating hormone but conclusive evidence is not yet available. ( info) |
2455/3084. Extranodal presentation of non-Hodgkin's lymphomas in the testis. The clinical and pathologic features of six patients, each of whom exhibited a testicular mass as the first sign of a lymphoma, are discussed. All underwent extensive staging procedures. Retroperitoneal lymph nodes and bone were frequent sites of extratesticular involvement early in the disease. Later widespread dissemination to multiple organs occurred in five of six patients. CNS involvement was a prominent feature of advancing disease. One patient was apparently cured by orchiectomy alone. Although the others exhibited partial responses to chemotherapy and radiation, the disease was fatal to all of them within a year of orchiectomy. Early, aggressive systemic treatment of these patients appears necessary. ( info) |
| leiomyosarcoma of the colon is a rare tumor, with fewer than 45 cases being reported by 1980. Wide resection, 10 cm margin, and adjacent mesentery will decrease chances of locoregional relapse. We recently encountered two leiomyosarcomas in the colon in the past two years. One is a 63-year-old female who was seen with rectal bleeding, pain, and was found to have a large intraluminal leiomyosarcoma in the descending colon. biopsy revealed leiomyosarcoma, grade III. She underwent a wide subtotal colectomy with ileosigmoid anastomosis, with metastases to three of the nodes in the mesentery, and remains well. The second is a 69-year-old female with general weakness who had previously undergone a hysterectomy and cholecystectomy. On examination she was found to have an abdominal mass. This proved to be a large leiomyosarcoma arising in the proximal portion of the transverse colon. There were no metastatic areas to the liver, chest, or any other areas. She has undergone extended right colectomy and remains well. Because of the rarity of this type of cancer, there is no established protocol concerning its treatment. ( info) |
2457/3084. An immunohistochemical study of glucagonoma conducted on the metastatic lymph nodes from a patient with recurrent metastatic glucagonoma: report of a case. In this report, we briefly present the case of a 67-year-old woman who developed recurrent glucagonoma with lymph node metastasis. An immunohistochemical study of the metastatic tumor revealed immunoreactivity of glucagon and protein kinase c (PKC)-alpha, -beta, and -gamma in the tumor cells, two types of which were seen by electron microscopy. One type had abundant secretory granules and mitochondria, while the other had few granules and mitochondria. Some granules were similar to typical A cell granules and others were atypical. An immunoelectron microscopic demonstration revealed PKC-alpha, -beta, and -gamma immunostaining in the cytoplasm of all the tumor cells, while some secretory granules had PKC immunostaining, and others had no immunostaining. Thus, it appears that metastatic glucagonoma and its associated granules are composed of two types of mature and immature cells or granules. As immunoreactivity of PKC-alpha and -gamma was found in the tumor cells, but not in the normal A cells of the islets of langerhans, the PKC subspecies alpha and gamma, which are not present in normal pancreatic A cells, may exist in human glucagonoma cells. ( info) |
2458/3084. Tc-99m MIBI scintigraphic detection of metastatic insular thyroid carcinoma. thallium-201 and, recently, Tc-99m MIBI have been used in conjunction with I-131 scintigraphy for follow-up of patients with well-differentiated thyroid cancer. Insular carcinoma of the thyroid is a fairly aggressive thyroid neoplasm that is believed to arise from follicular cells and usually concentrates I-131. The authors report a patient with recurrent insular thyroid carcinoma in whom bilateral adrenal and lung metastatic lesions developed 3 years after ablative I-131 therapy for cervical lymph node and skeletal metastases. Tc-99m MIBI planar and SPECT images demonstrated these new lesions better than pretherapy I-131 scintigraphy and affords an imaging technique for post-I-131 therapy follow-up that does not require withholding thyroid hormone suppression. ( info) |
2459/3084. Basal cell carcinoma of the vulva with lymph node and skin metastasis--report of a case and review of 20 Japanese cases. A 79-year-old Japanese woman who had basal cell carcinoma presenting as a large ulcer on her vulva with lymph node and skin metastasis is described. Histological examination revealed that tumor nests with peripheral palisading invaded deeply into the subcutaneous tissue and were accompanied by marked mucinous changes and fibrous reaction. Vascular invasion was also observed. There were inguinal lymph node metastases and two papular skin metastases on her right thigh. The primary tumor and the metastases were excised. The defect was repaired by bilateral gracilis musculo cutaneous flaps and a skin graft. We surveyed the literature and found 20 cases of metastasizing basal cell carcinoma in japan. ( info) |
| Two patients presented to their clinicians with bowel complaints thought to be suggestive of Crohn's disease. The patients were sent for radiological studies to confirm that diagnosis. The radiologic findings in both patients were thought to be consistent with Crohn's disease, although not classical. No further diagnostic studies were initially undertaken. Each patient suffered small bowel obstruction and at surgery each was found to have a mucinous adenocarcinoma of the ileocecal valve. No evidence of Crohn's disease was found. At pathologic examination some interesting characteristics of the tumors were observed, which perhaps accounted for the misdiagnosis of Crohn's disease. It also was evident that the clinical information supplied to the radiologist may have influenced the radiologic interpretations. These cases stress the importance of obtaining tissue diagnoses in situations where radiographic findings are consistent but atypical with the clinical diagnosis of Crohn's disease. ( info) |