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1/52. coronary vasospasm associated with uncontrolled carcinoid tumour.

    We report on a 74-year-old carcinoid patient who, following acute myocardial infarction (MI) and percutaneous transluminal coronary angioplasty, suffered recurrent episodes of chest pain and ST-segment elevation on ECG. This was accompanied by elevation of urinary 5-hydroxy-indole acetic acid. A review of the patient's file revealed that during the 3 weeks prior to the MI, she had been treated inadvertently with a fivefold lower dosage of octreotide. Following the correction of octreotide dosage, episodes of chest pain resolved immediately. We therefore suggest that this patient suffered from recurrent coronary vasospasm due to uncontrolled carcinoid tumour.
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ranking = 1
keywords = chest
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2/52. A spindle cell tumor of unknown origin and diffuse bone marrow involvement in a patient with hypercalcemia.

    BACKGROUND: Metastasis of unknown origin in bone marrow is infrequent, although, when it occurs, adenocarcinoma is the most common histologic type. Involvement of bone marrow by a spindle cell tumor and presentation with hypercalcemia are very rare. METHOD: This report describes a 21-year-old man with diffuse bone marrow involvement from a spindle cell tumor. RESULTS: The patient presented with low back pain, anemia, thrombocytopenia, azotemia, and hypercalcemia. bone marrow biopsy revealed a spindle cell tumor that was positive for vimentin staining but whose primary site could not be identified. A bone marrow scan revealed absence of uptake, which suggested systemic disease. We treated this case as a type of sarcoma by giving combined chemotherapy consisting of vincristine, actinomycin-D and cyclophosphamide. The patient showed a clinical response for seven months, but the disease progressed despite chemotherapy and he died one year after diagnosis. CONCLUSIONS: We have documented a rare case of spindle cell tumor involving bone marrow without evidence of the tumor's primary site.
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ranking = 2.1884195094487
keywords = back pain, back
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3/52. Basaloid squamous carcinoma in the liver.

    This report concerns a 46-year-old female who presented with 3 months of abdominal pain and underwent a right hemi-hepatectomy for a 27 x 25 x 15 cm, centrally necrotic tumor that showed histological, immunohistochemical and ultrastructural features typical of a basaloid squamous carcinoma (BSC). A primary tumor at another site was not diagnosed and she died of disease 2 years later after several intra-abdominal recurrences. The entity of BSC was first described in 1986 and is a rare, poorly differentiated variant of squamous cell carcinoma occurring in various sites including the upper aerodigestive tract, esophagus, lung, anus, cervix and thymus. It has never been reported arising in the liver. It has characteristic histological, immunohistochemical and ultrastructural features and is associated with a poor prognosis. Whilst no other primary tumor was diagnosed, it is not possible to substantiate that this is a primary hepatic tumor in the absence of an autopsy examination to exclude an occult malignancy in another site.
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ranking = 0.28458028216387
keywords = abdominal pain, upper
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4/52. Detection of occult thymoma during exercise thallium 201, technetium 99m tetrofosmin imaging for coronary artery disease.

    thallium (Tl) 201 and technetium (Tc) 99m tetrofosmin single-photon emission CT are routinely used in the evaluation of coronary artery disease. Mediastinal tumors demonstrate Tl 201 and Tc 99m tetrofosmin uptake. We report a 56-year-old man who developed chest pain after a previously successful angioplasty and stent of the left anterior descending coronary artery. He underwent a Tl 201, Tc 99m tetrofosmin exercise study. Abnormal mediastinal activity was visualized in both the Tl 201 and Tc 99m tetrofosmin images. Subsequently, the patient underwent resection of a stage II thymoma. Unanticipated focal extracardiac accumulation during myocardial scintiscanning should lead to further investigation to exclude mediastinal tumor.
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ranking = 0.5
keywords = chest
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5/52. Ischemic colitis associated with paclitaxel.

    Systemic chemotherapy can be complicated by colonic toxicity, which usually determines the onset of pseudomembranous colitis and, rarely, of ischemic colitis in patients with cancer. This report describes the case of a 49-year-old woman with liver metastases from a neuroendocrine tumor of unknown origin who developed mild ischemic colitis after chemotherapy with carboplatin and paclitaxel. The patient developed symptoms of gastrointestinal toxicity with abdominal pain and bloody diarrhea, which resolved in about 10 days. She had a normal white blood cell count throughout her illness; the assay of stool specimens for clostridium difficile toxins and the stool cultures were both negative. A sigmoidoscopy showed a mild, transient ischemic colitis, which was confirmed by pathologic examination of the biopsy specimens. Although carboplatin is not related to severe colonic cytotoxicity, it has been previously reported that paclitaxel induces necrosis of the gastrointestinal mucosa and inhibits angiogenesis. Pseudomembranous colitis is the most frequent complication in patients with cancer who undergo paclitaxel-based chemotherapy and develop gastrointestinal toxicity. Once C. difficile infection has been excluded, a diagnosis of ischemic colitis should be considered, especially in patients with cancer who have normal white blood cell counts.
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ranking = 0.16627589761963
keywords = abdominal pain
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6/52. Malignant tumor with chest wall pain mimicking tietze's syndrome.

    chest pain is commonly caused by musculoskeletal chest wall disorders. tietze's syndrome is a relatively rare cause of chest wall pain characterised by non-suppurative, painful swelling of the upper costal cartilages. The diagnosis should be based on these classic clinical features after excluding other potential causes of pain. A patient who was diagnosed with tietze's syndrome but was found to have squamous cell carcinoma of the mediastinum with unknown primary site invading the sternum and anterior chest wall is presented for discussion.
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ranking = 3.6183043845442
keywords = chest, upper
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7/52. Signet-ring cell carcinoma of unknown primary location. Metastatic to lower back musculature - remission following FU/FA chemotherapy.

    The detection of gastrointestinal signet-ring cell carcinoma by endoscopy can be a diagnostic challenge. The main clinical features include atypical metastasis and a poor prognosis.We present a case of a metastasizing signet-ring cell carcinoma with unknown primary location arising in 71-year-old female. Following 6 cycles of a routine intravenous FU/FA chemotherapy, an almost complete remission could be observed. After 2 years of follow up, metastatic recurrence was detected to the lower back musculature. This case report emphasizes the difficulties in diagnosing signet-ring cell carcinoma by endoscopy and demonstrates an unusual clinical course.
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ranking = 1.0602930585057
keywords = back
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8/52. Metastatic cancer to the floor of mouth: the lingual lymph nodes.

    BACKGROUND: The upper level of a cervical lymphadenectomy is anatomically defined at its anterior extent by the lower border of the mandible and, in surgical practice, by the lingual nerve. A neck dissection completed below this level is generally considered adequate for removal of lymph nodes at risk for metastases from oral cavity cancer. Traditional discontinuous neck dissections do not provide for removal of floor of mouth tissue along with the primary and neck specimens. methods: A case report presenting biopsies from a T2N2bM0 squamous cell carcinoma of the mobile tongue and adjacent floor of the mouth in a 73-year-old man. RESULTS: Deep biopsy of a ventral tongue and floor of mouth squamous cell carcinoma revealed occult metastatic cancer to lymph nodes located in the superficial floor of mouth associated with the sublingual gland above the lingual nerve. This report identifies floor of mouth lymph nodes that can be involved with cancer and missed through the standard practice of discontinuous neck dissection.Conclusions. This finding offers evidence that, in certain cases, a traditional discontinuous neck dissection may not address all lymph nodes at risk in the treatment of oral cavity cancer. Further investigation into lymph node distribution within the oral cavity is warranted to reappraise the upper limits of cervical lymphadenectomy.
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ranking = 0.23660876908847
keywords = upper
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9/52. Twenty-two years' survival of metastatic gastrinoma evidenced recently by somatostatin-receptor-specific scintigraphy.

    An 18-year-old male presented in 1979 with a gastrinoma of unknown primary origin. Massive upper-digestive haemorrhage led to total gastrectomy, at which histology evidenced liver metastases, confirmed 9 months later at reoperation for an intestinal occlusion. Postoperative morphological evidence of liver metastases was repeatedly negative using abdominal ultrasound and computerized tomography (CT) scans and magnetic resonance imaging (MRI), but a recent somatostatin-receptor-specific scintigraphy (Octreoscan) was positive only in the liver area. Twenty-two years after diagnosis, the primary tumour has not been identified, the patient leads a normal life, and his circulating gastrin levels, although still elevated at 317-550 pg/ml (normal < 127 pg/ml), have fallen over recent years from > 1000 pg/ml. We discuss the relevance of the described prognostic factors.
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ranking = 0.11830438454423
keywords = upper
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10/52. Intra-uterine death resulting from placental metastases in adenocarcinoma of unknown primary.

    A thirty-five year old woman presented with bilateral neck, chest wall and back masses. She was 16 weeks pregnant. lymph node excision revealed metastatic poorly differentiated adenocarcinoma of unknown primary. Abdominal ultrasound showed a mildly enlarged spleen and a 2-3 cm porta hepatis node. All other investigations were negative. The lymph node and cutaneous metastases progressed rapidly so it was decided to initiate systemic chemotherapy with a view to delivery at 28 weeks gestation by Caesarean section. Shortly after the second 3-weekly cycle of cisplatinum chemotherapy the patient suffered severe lower back and hip pain with MRI scan showing multiple bony metastases in the pelvic girdle. Ultrasound revealed the fetus to have been dead for at least 10 days. The products of conception were delivered following medical induction of labour. Two days later the patient suffered a cardiac arrest from which she could not be resuscitated. Placental histology revealed extensive metastases. With the exception of melanoma this has rarely been reported in solid adult malignancy. As a cause of fetal death, placental metastases are extremely rare.
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ranking = 0.92411722340227
keywords = chest, back
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