2471/3084. Polymorphous sweat gland carcinoma. We describe nine cases of a distinctive cutaneous neoplasm showing features of eccrine adnexal differentiation that were characterized by their variegated histological appearance and low-grade malignant behaviour. The term polymorphous sweat gland carcinoma is proposed to designate these lesions. The tumours presented as large, long-standing, slow growing, dermal nodules showing a marked predilection for the extremities. Six patients were women. The patients were aged 42-70 years (mean, 59.8 years). Histologically, the lesions were characterized by a highly cellular proliferation displaying a variety of growth patterns, including solid, trabecular, tubular, pseudopapillary and cylindromatous, with prominent stromal changes including haemorrhage, hyalinization and cystic change, and displaying moderate cytological atypia and mitoses. Focal areas showing features associated with eccrine differentiation (i.e. tubular structures, small glandular lumina) could be identified in all cases. Clinical follow-up in six cases showed that two of the lesions recurred locally over a period of 3-6 years, and one tumour metastasized to regional lymph nodes 3 years after excision. Polymorphous sweat gland carcinoma should be considered in the differential diagnosis of neoplastic epithelial dermal proliferations; complete but conservative surgical excision appears to be the treatment of choice for these lesions. ( info) |
2472/3084. pleural effusion in patients with differentiated papillary thyroid cancer. Among 1,772 patients who registered at the MD Anderson Cancer Center between 1944 and 1991 with papillary thyroid cancer, 10 had malignant pleural effusion that developed during the course of the disease. At primary surgery, all 10 were found to have metastases to cervical lymph nodes. Seven of these patients also had invasion into adjacent soft tissues, 4 had lung metastases, and 1 had pleural effusion. All patients had radiologically apparent lung metastases at the time pleural effusion was found. Malignant effusion appeared 0 to 60 months after abnormal chest radiographs in 9 patients and 61 to 132 months after the initial diagnosis of thyroid cancer in 4 patients. Pleural effusions were treated with local radioisotopes or sclerosing agents, systemic radioiodine or chemotherapy, or both. All 10 patients died of thyroid cancer; overall survival time was 7 to 170 months (median, 27 months); however, appearance of pleural effusion preceded death by 1 to 20 months (median, 11 months). Malignant pleural effusion complicates the clinical course in 0.6% of adult patients with papillary thyroid cancer. It may develop many years after the initial diagnosis but is associated with greatly shortened survival time in all cases. ( info) |
2473/3084. Management of distant solitary recurrence in the patient with renal cancer. Contralateral kidney and other sites. About 25% to 57% of patients with RCC exhibit overt evidence of metastatic disease at the time of initial presentation. These patients have an average survival of about 4 months, and only 10% of them survive 1 year. Metachronous metastatic disease may develop in approximately 50% of patients who have undergone a presumably curative radical nephrectomy. Seventy percent of these patients relapse within the first year and manifest a median survival of about 11 months. The incidence of solitary metastatic lesions in patients with RCC ranges from 1.6% to 3.6%. In reality, the vast majority of these patients have evidence of subclinical, multifocal, micrometastatic disease and ultimately succumb to metastatic RCC. However, a 5-year survival rate of 35% to 50% can be achieved in properly selected patients using aggressive surgical treatment as a major component of therapy. In large part, insightful patient selection is predicated upon an understanding of the unique biologic and clinical issues relevant to each organ site of involvement. ( info) |
2474/3084. Management of recurrent penile cancer following partial or total penectomy. The initial management of localized penile carcinoma determines the probability of recurrence. Although potentially disfiguring, the management of recurrent carcinoma of the penis requires aggressive surgical resection of both the primary lesion and nodal sites to effect the best chance for long-term survival. ( info) |
2475/3084. Casual discovery of Tc-99m MDP uptake for melanoma metastasis in soft tissue. The authors report the casual discovery in 1991 of a metastasis during Tc-99m MDP imaging of a 57-year-old woman who underwent surgery in 1983 for cutaneous melanoma on the right calf. The scan did not show bone alterations but did reveal an area of hyperactive uptake in the soft tissue of the medial surface of the thigh, where slightly altered pigmentation was also apparent. A subsequent immunoscan with Tc-99m-F(ab')2 225.28S confirmed increased uptake at this site. The lesion was removed and was histologically diagnosed as a skin metastasis from melanoma. Inguinal adenopathy appeared 6 months later. The uptake of Tc-99m MDP by both primary and metastases tumors has been described, although this may be the first report concerning melanoma. The uptake mechanism is not known. ( info) |
2476/3084. Management of thyroid papillary carcinoma with radioiodine in a patient with end stage renal disease on hemodialysis. Metastatic papillary carcinoma was diagnosed in a 42-year-old woman. The cancer had invaded out of the gland and was present in many lymph nodes. After her surgical procedure, she was advised to have radioiodine. However, the patient had total renal failure and was on dialysis. Studies were carried out using a tracer dose of 2 mCi of radioiodine, demonstrating that approximately 60% of the radioactivity in the body was removed with each dialysis. Calculations indicated that a meaningful dose of radiation could be delivered to residual thyroid and metastases with 100 mCi of radioiodine and the total body radiation would be < 100 rad delivered over several days. Based on these analyses, she received 100 mCi of I-131 on two separate occasions and on follow-up scan, clinical evaluation and thyroglobulin measurement is free of disease. ( info) |
2477/3084. Aneuploid islet cell tumor with late metastasis. An unusual case of insulin producing islet cell tumor is reported which recurred after a 16 yr interval. In most instances malignancy of islet cell tumors is impossible to assess morphologically or functionally but depends on the recognition of metastases. Nuclear dna analysis provides significant prognostic and biological information in a number of solid human tumors. Retrospective computerized nuclear image analysis of the primary tumor in the present case showed an aneuploid dna profile similar to that seen in the metastasis. It appears that ploidy studies may be useful in predicting malignant potential of islet cell tumors. ( info) |
2478/3084. Metaplastic carcinoma of the breast in a renal transplant recipient. Initial diagnosis by fine needle aspiration cytology and immunocytochemistry. A 46-year-old woman presented with a mass in the left breast and left axillary lymphadenopathy. Five years earlier she had received a renal transplant from an unrelated donor because of end-stage renal failure secondary to adult polycystic kidney disease. She was on immunosuppression therapy in the form of cyclosporine, azathioprine and prednisolone. Fine needle aspiration cytology of the breast mass showed a metaplastic (sarcomatoid) carcinoma, whereas the axillary lymph node aspirate suggested carcinosarcoma. Immunocytochemical studies revealed dense positivity for vimentin in the sarcomatous component and positivity for epithelial membrane antigen in the epithelial component. Rare cells were positive for cytokeratin. The cytodiagnosis was confirmed by excision biopsy of axillary lymph nodes. The patient died on the fourth postoperative day following left mastectomy and axillary clearance. The histopathology report of the breast tumor showed sarcomatoid carcinoma. ( info) |
2479/3084. The use of dna typing to clarify the origin of metastatic carcinoma after renal transplantation. A clinical and medico-legal problem. We present an unusual diagnostic problem in a transplant patient whose failed renal transplant was found to contain undifferentiated carcinoma. When the patient later developed metastatic renal carcinoma, he began legal proceedings against the hospital for the transmission of a tumour with his renal transplant. He subsequently died of carcinomatosis. Post-mortem examination revealed acquired renal cystic disease in his native kidneys with a 1-cm adenocarcinoma arising from the wall of one of the cysts. We used dna typing to determine the origin of the metastatic tumour and resolve the medico-legal problem. ( info) |
2480/3084. Metastatic myxopapillary ependymoma: report of a case with fine-needle aspiration findings. A case of recurrent and metastasizing myxopapillary ependymoma of the sacral region in a 35-yr-old man is reported. Fifteen years after the original diagnosis, he presented with an abdominal mass, subcutaneous nodules in the previous surgical excision line, and bilateral inguinal lymph node enlargement. FNA cytology of the inguinal lymph nodes showed a poorly cohesive, highly cellular smear pattern exhibiting papillary formations and rosette-like structures composed of slim columnar cells having cytoplasmic processes without evidence of atypia. Histologic and ultrastructural findings confirmed the diagnosis. Chromosomal analysis was also done. ( info) |