Cystic Metastases Research Articles

側頸嚢胞および嚢胞状転移性リンパ節の内容液アミラーゼ・サイログロブリン測定による鑑別診断

側頸嚢胞および嚢胞状転移性リンパ節の内容液アミラーゼ・サイログロブリン測定による鑑別診断

Un cas de dégénérescence maligne de kyste amygdaloïde

An amygdaloid cyst is a rare high laterocervical cystic tumor arising from the second branchial cleft. It accounts for 2% of laterocervical tumors and up to 85% of second branchial cleft abnormalities [1]. The incidence of intracystic squamous cell carcinoma ranges from 4 to 22% [2]. The diagnosis of primary carcinoma or intracystic metastasis is a controversial issue. We report a rare case of degenerate amygdaloid cyst meeting the diagnostic criteria for intracystic squamous cell carcinoma determined by Martin and Khafif. A 73-year-old female patient consulted for a left cervical swelling in 2010; the diagnosis was an amygdaloid cyst. She had a history of squamous cell carcinoma of the hard palate (T1NoMo) surgery and radiation therapy in 2009, without recurrence. Three years later, the swelling increased to a large size without any cervical node involvement. An exploratory cervicotomy with histological study revealed intracystic squamous cell degeneration. Primary squamous cell carcinoma location in the wall of an amygdaloid cyst is extremely rare and a highly controversial issue. The challenge is to be able to discriminate between a cystic metastasis of squamous cell carcinoma of the aerodigestive tract and a primary squamous cell carcinoma located in the wall of an amygdaloid cyst. Martin and Khafif defined specific criteria to confirm the diagnosis of primary branchiogenic carcinoma.

Stage IV Squamous Cell Carcinoma of Esophagus With Multi-Loculated Cystic Metastasis to Pancreas: A Rare Presentation

Introduction: A 60-year-old male with no significant medical history presented to the gastroenterology clinic with dysphagia. Patient did not have any odynophagia, weight loss, hematemesis, malena or abdominal pain. He did not have any family history of malignancy. He had history of tobacco and alcohol abuse. Physical examination was unremarkable. EGD was performed which showed a hemi circumferential thickening between 29-34 cm in the esophagus and another nodularity at 37cm. Biopsies from the lesions revealed a moderately differentiated invasive squamous cell carcinoma. CT chest revealed a circumferential thickening of the mid esophageal wall corresponding to the EGD findings. CT abdomen revealed multiple cysts in the pancreas, the largest measuring 5.3 x 4 cm. It was multi-loculated with macrocysts in the tail of the pancreas with thickened septum and a central calcification. The pancreatic lesion was found to be mixed solid and cystic in nature on endoscopic ultrasound. Two enlarged peritumoral nodes were also identified. USG guided aspiration of the pancreatic cyst revealed that the fluid had a CEA level of 41.1 ng/ml and an amylase level of 13 U/L. Fluid cytology revealed malignant cells consistent with metastatic squamous cell carcinoma. As per the TNM staging system, the patient was found to be in stage T3N1M1 and was started on chemotherapy with carboplatin and paclitaxel. Primary squamous cell carcinoma in pancreas is extremely rare of all pancreatic malignancies as the pancreas does not have squamous epithelium. Pancreatic metastasis occurs in 0.12% of all primary esophageal carcinomas. Only 4 cases of squamous metastasis to pancreas from esophagus have been reported in literature. Of them 2 patients had synchronous metastasis and 2 patients had metachronous metastasis. Our patient had the pancreatic metastasis at the time of presentation. Esfehani et al reported a case of pancreatic squamous metastasis that presented 4 years after the removal of esophageal primary. The pancreatic lesion was noted to be cystic on a CT abdomen but gross examination after surgery revealed a hard mass. All the other reported cases had solid metastases. Our patient is unique as he had a mixed solid and cystic metastasis.

Predictors of treatment response of cystic brain metastasis to gamma knife radiosurgery

Predictors of treatment response of cystic brain metastasis to gamma knife radiosurgery

Abstract 131: C-kit induces epithelial-mesenchymal transition and contributes to salivary adenoid cystic cancer progression

Abstract Epithelial-mesenchymal transition (EMT) is associated with salivary adenoid cystic cancer (ACC) progression and metastasis. Here, we report that ectopic overexpression of c-kit in ACC cell lines is sufficient for acquisition of mesenchymal traits, enhanced cell invasion, along with stem cell properties defined by the presence of a CD133+/CD44+ cell subpopulation. c-kit positively regulated expression of known EMT inducers, also activating TGF-βto contribute to EMT. c-kit itself was induced by TGF-βin ACC cell lines and required for TGF-β-induced EMT. Xenograft experiments showed that c-kit cooperated with oncogenic Ras to promote tumorigenesis in vivo. Finally, in human specimens of ACC, we found that c-kit was abnormally overexpressed and correlated with the prognosis of ACC. Our findings define an important function for c-kit in ACC progression by orchestrating EMT, and they implicate this gene product as a marker of poor prognosis in this disease. Citation Format: Xinhua Liang, Ya-ling Tang, Jian Jiang, Yun-long Fan. C-kit induces epithelial-mesenchymal transition and contributes to salivary adenoid cystic cancer progression. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 131. doi:10.1158/1538-7445.AM2014-131

Chronic pancreatitis of the pancreatic remnant is an independent risk factor for pancreatic fistula after distal pancreatectomy.

BackgroundThere is an ongoing debate about the best closure technique after distal pancreatectomy (DP). The aim of the closure is to prevent the formation of a clinically relevant post-operative pancreatic fistula (POPF). Stapler technique seems to be equal compared with hand-sewn closure of the remnant. For both techniques, a fistula rate of approximately 30% has been reported.MethodsWe retrospectively analyzed our DPs between 01/2000 and 12/2010. In all cases, the pancreatic duct was over sewn with a separately stitched ligation of the pancreatic duct (5*0 PDS) followed by a single-stitched hand-sewn closure of the residual pancreatic gland. The POPF was classified according to the criteria of the International Study Group for Pancreatic Fistula (ISGPF). Univariate and multivariate analyses of potential risk factors for the formation of POPF were performed. Indications for operations included cystic tumors (n = 53), neuroendocrine tumors (n = 27), adenocarcinoma (n = 22), chronic pancreatitis (n = 9), metastasis (n = 6), and others (n = 7).ResultsDuring the period, we performed 124 DPs (♀ = 74, ♂ = 50). The mean age was 57.5 years (18–82). The POPF rates according to the ISGPF criteria were: no fistula, 54.8% (n = 68); grade A, 24.2% (n = 30); grade B, 19.3% (n = 24); and grade C, 1.7% (n = 2). Therefore, in 21.0% (n = 26) of the cases, a clinically relevant pancreatic fistula occurred. The mean postoperative stay was significantly higher after grade B/C fistula (26.3 days) compared with no fistula/grade A fistula (13.7 days) (p < 0.05). The uni- and multivariate analyses showed chronic pancreatitis of the pancreatic remnant to be an independent risk factor for the development of POPF (p = 0.004 OR 7.09).ConclusionBy using a standardized hand-sewn closure technique of the pancreatic remnant after DP with separately stitched ligation of the pancreatic duct, a comparably low fistula rate can be achieved. Signs of chronic pancreatitis of the pancreatic remnant may represent a risk factor for the development of a pancreatic fistula after DP and therefore an anastomosis of the remnant to the intestine should be considered.

The role of GPC5 in lung metastasis of salivary adenoid cystic carcinoma

ObjectiveProteoglycans play a crucial role in salivary adenoid cystic carcinoma (SACC) tumorigenesis, neurotropic growth and lung metastasis. In this study, we investigated the role of GPC5 in the lung metastasis of SACC. DesignThe expression of heparan sulfate proteoglycans (HSPGs) was detected in SACC-M (high lung-metastatic cell line), SACC-2 (low lung-metastatic cell line) and SACC-83 (low lung-metastatic cell line) cells by relative quantitative Real-Time PCR. The expression of GPC5 was detected by immunofluorescence and Western blot analysis in SACC-M, SACC-2 and SACC-83 cells, and by immunohistochemical analysis in primary tumours from 16 cases of SACC patients with or without lung metastasis. GPC5 expression was silenced in SACC-M cells, cell proliferation and tumour growth was evaluated by MTT assay and nude mice model, respectively. ResultsExpression of most HSPGs was decreased in SACC-M cells, but GPC5 expression increased 3.24-fold and 815.69-fold (more than 3-fold) in SACC-M compared with SACC-2 and SACC-83 cells, respectively. Immunohistochemical analysis showed higher expression of GPC5 in SACC with lung metastasis compared to SACC without lung metastasis. The lung metastasis of SACC-M cells in nude mice was obviously decreased after GPC5 silencing (P<0.05), although GPC5 silencing had no significant effect on SACC-M cell proliferation. ConclusionGPC5 may contribute to lung metastasis of SACC.

Clinical Features of Human Papilloma Virus-Related Head and Neck Squamous Cell Carcinoma of an Unknown Primary Site

Purpose: Head and neck squamous cell carcinoma of an unknown primary site (HNSCCUP) is a heterogeneous group of tumors that includes the human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma. To investigate the relationship between HNSCCUP and HPV, we reviewed p16 overexpression and HPV DNA in lymph node metastases and examined their correlation with the primary site and clinical features. Materials and Methods: Thirty-three patients with HNSCCUP were retrospectively studied. Dissected neck metastases were analyzed for p16 overexpression by immunohistochemistry, and the presence of HPV DNA was investigated by in situ hybridization. Results: Of the 33 patients, 8 (24%) exhibited p16 overexpression. p16-positive lymph node metastases contained significantly more HPV DNA and were most frequently associated with occult primary lesions in the oropharynx and a favorable prognosis. Patients with a lower alcohol consumption, only level II/III metastasis, and cystic lymph node metastasis tended to have p16 overexpression. Conclusions: This is the first report on the relationship of HNSCCUP with p16 and HPV DNA status in Asian patients. In total, 24% of the HNSCCUP patients were p16 positive. p16 overexpression in neck metastasis was predictive of both an occult primary lesion in the oropharynx and an association with HPV infection. Alcohol consumption, location, and features of neck metastasis were correlated with p16 expression.

Human papillomavirus and cystic node metastasis in oropharyngeal cancer and cancer of unknown primary origin.

The clinical significance of human papillomavirus (HPV) in neck node metastasis from cancer of unknown primary (CUP) is not well established. We aimed to address the relationship of HPV status between node metastasis and the primary tumor, and also the relevance of HPV status regarding radiographically detected cystic node metastasis in head and neck squamous cell carcinoma (HNSCC) and CUP. HPV DNA was examined in 68 matched pairs of node metastasis and primary tumor, and in node metastasis from 27 CUPs. In surgically treated CUPs, p16 was examined immunohistochemically. When tonsillectomy proved occult tonsillar cancer in CUP, HPV DNA and p16 were also examined in the occult primary. Cystic node metastasis on contrast-enhanced computed tomography scans was correlated with the primary site and HPV status in another series of 255 HNSCCs and CUPs with known HPV status. Node metastasis was HPV-positive in 19/37 (51%) oropharyngeal SCCs (OPSCCs) and 10/27 (37%) CUPs, but not in non-OPSCCs. Fluid was collected from cystic node metastasis using fine needle aspiration in two OPSCCs and one CUP, and all fluid collections were HPV-positive. HPV status, including the presence of HPV DNA, genotype, and physical status, as well as the expression pattern of p16 were consistent between node metastasis and primary or occult primary tumor. Occult tonsillar cancer was found more frequently in p16-positive CUP than in p16-negative CUP (odds ratio (OR), 39.0; 95% confidence interval (CI), 1.4–377.8; P = 0.02). Radiographically, cystic node metastasis was specific to OPSCC and CUP, and was associated with HPV positivity relative to necrotic or solid node metastasis (OR, 6.2; 95% CI, 1.2–45.7; P = 0.03). In conclusion, HPV status remains unchanged after metastasis. The occult primary of HPV-positive CUP is most probably localized in the oropharynx. HPV status determined from fine needle aspirates facilitates the diagnosis of cystic node metastasis.

Intracranial extension of adenoid cystic carcinoma: potential involvement of EphA2 expression and epithelial-mesenchymal transition in tumor metastasis: a case report

BackgroundAdenoid cystic carcinoma is a malignant epithelial tumor derived from salivary glands and tends to invade the surrounding structures including nervous system. We present a case of adenoid cystic carcinoma with intracranial extension and propose a novel molecular mechanism of adenoid cystic carcinoma metastasis.Case presentationA 29-year-old Japanese male presented with left trigeminal nerve disturbance. Neuroimaging revealed a tumor located at the right middle cranial and infratemporal fossa. The tumor was removed via a subtemporal extradural and infratemporal fossa approach and histologically diagnosed as adenoid cystic carcinoma. Radiological and operative findings confirmed a perineural spread of the tumor along the mandibular nerve. Immunohistochemical analyses of molecular consequences in this case were performed for better understanding of the biological processes associated with adenoid cystic carcinoma metastasis. First, the neoplastic cells were not immunoreactive for E-cadherin, an epithelial marker, but for vimentin, a mesenchymal marker, suggesting changes in cell phenotype from epithelial to mesenchymal states. Correspondingly, immunoreactivity of transcriptional factors, such as Slug, Twist, matrix metalloproteinase-2 and -9, which are involved in epithelial–mesenchymal transition, were observed. Second, elevated expression of EphA2 receptor, not ephrin-A1, was notable in the neoplastic cells, suggesting morphological changes reminiscent of epithelial–mesenchymal transition and ligand-independent promotion of tumor cell migration and invasion.ConclusionsWe report a case of adenoid cystic carcinoma with perineural spread and provide the first published evidence that EphA2 expression without ephrin-A1 and epithelial–mesenchymal transition might play important roles in adenoid cystic carcinoma progression.

Cystic Brain Metastasis in Non–Small-Cell Lung Cancer With ALK Rearrangement

Cystic Brain Metastasis in Non–Small-Cell Lung Cancer With <i>ALK</i> Rearrangement

PET/CT in head and neck oncology: State‐of‐the‐art 2013

Combined positron emission tomography with simultaneous computed tomography (PET/CT performed using 18F-fluorodeoxyglucose [FDG] as a radiopharmaceutical) results in improvement in anatomic localization of tumor. This review explores the contemporary application of PET/CT to pretreatment assessment, posttreatment monitoring, and subsequent treatment planning for patients with squamous carcinoma of the head and neck. Contemporary publications on the use of PET/CT in head and neck oncology are reviewed and synthesized. This review presents selected literature interpreted by expert opinion. PET/CT is highly sensitive in staging of patients with squamous cancer of the head and neck. The sensitivity is limited by tumor size, and PET/CT cannot currently replace the information obtained from elective neck dissection in the assessment of cervical metastases. In the setting of posttreatment monitoring, PET/CT allows for identification of persistent carcinoma prior to clinical observation in approximately two-thirds of cases. However, contemporary reports do not allow assessment of cost effectiveness, and they do not allow determination if the application of PET/CT in this setting results in improved treatment outcomes. PET/CT is insensitive to evaluation of patients with glandular tumors, and those with low volume tumors and cystic metastases. PET/CT requires further evaluation before recommendations can be made regarding comparative effectiveness when compared to CT or MRI for posttreatment monitoring. The improved sensitivity and specificity of PET/CT during treatment planning justifies its use in this setting for patients with advanced stage squamous cancer of the head and neck.

Contrast-Enhanced PET/MR Imaging Versus Contrast-Enhanced PET/CT in Head and Neck Cancer: How Much MR Information Is Needed?

Considering PET/MR imaging as a whole-body staging tool, scan time restrictions in a single body area are mandatory for the cost-effective clinical operation of an integrated multimodality scanner setting. It has to be considered that (18)F-FDG already acts as a contrast agent and that under certain circumstances MR contrast may not yield additional clinically relevant information. The concept of the present study was to understand which portions of the imaging information enhance the sensitivity and specificity of the hybrid examination and which portions are redundant. One hundred fifty consecutive patients referred for primary staging or restaging of head and neck cancer underwent sequential whole-body (18)F-FDG PET with CT-based attenuation correction, contrast-enhanced (ce) CT, and conventional diagnostic MR imaging of the head and neck in a trimodality PET/CT-MR system. Assessed were image quality, lesion conspicuity, diagnostic confidence, and the benefit of additional coronal and sagittal imaging planes in cePET/CT, PET/MR imaging with only T2-weighted fat-suppressed images (T2w PET/MR imaging), and cePET/MR imaging. In 85 patients with at least 1 PET-positive lesion, 162 lesions were evaluated. Similar robustness was found for CT and MR image quality. T2w PET/MR imaging performed similarly to (metastatic lymph nodes) or better than (primary tumors) cePET/CT in the morphologic characterization of PET-positive lesions and permitted the diagnosis of necrotic or cystic lymph node metastasis without application of intravenous contrast medium. CePET/MR imaging yielded a higher diagnostic confidence for accurate lesion conspicuity (especially in the nasopharynx and in the larynx), infiltration of adjacent structures, and perineural spread. The results of the present study provide evidence that PET/MR imaging can serve as a legitimate alternative to PET/CT in the clinical workup of patients with head and neck cancers. Intravenous MR contrast medium may be applied only if the exact tumor extent or infiltration of crucial structures is of concern (i.e., preoperatively) or if perineural spread is anticipated. In early assessment of the response to therapy, in follow-up examinations, or in a whole-body protocol for non-head and neck tumors, T2w PET/MR imaging may be sufficient for coverage of the head and neck. The additional MR scanning time may instead be used for advanced MR techniques to increase the specificity of the hybrid imaging examination.

59-jähriger Patient mit rezidivierendem Erröten bei blander Leberzyste

A 59-year-old patient was admitted to hospital with recurrent flush symptoms and pathologically elevated 5-hydroxyindoleacetic acid (5-HIAA) levels in urine. A known cystic lesion of the liver which had been followed for years by ultrasound examinations and was regarded as a bland hepatic cyst was identified as a metastasis of a neuroendocrine neoplasm of the ileum. In two sequential surgical interventions the primary tumor with mesenteric lymph node metastases as well as the cystic liver metastasis could be resected. After surgical treatment an R1 situation at the mesenteric site and suspicious para-aortic lymph nodes remained. The long established treatment of factor-V Leiden mutation by anticoagulation with phenprocoumon was supplemented by deep subcutaneous injection of lanreotide autogel every 4weeks. Currently, there is no evidence for progressive disease and the patient is without clinical signs of a carcinoid syndrome.

C-kit induces epithelial-mesenchymal transition and contributes to salivary adenoid cystic cancer progression.

Epithelial-mesenchymal transition (EMT) is associated with salivary adenoid cystic cancer (ACC) progression and metastasis. Here, we report that ectopic overexpression of c-kit in ACC cell lines is sufficient for acquisition of mesenchymal traits, enhanced cell invasion, along with stem cell properties defined by the presence of a CD133+/CD44+ cell subpopulation. c-kit positively regulated expression of known EMT inducers, also activating TGF-β to contribute to EMT. c-kit itself was induced by TGF-β in ACC cell lines and required for TGF-β-induced EMT. Xenograft experiments showed that c-kit cooperated with oncogenic Ras to promote tumorigenesis in vivo. Finally, in human specimens of ACC, we found that c-kit was abnormally overexpressed and correlated with the prognosis of ACC. Our findings define an important function for c-kit in ACC progression by orchestrating EMT, and they implicate this gene product as a marker of poor prognosis in this disease.

Thyroglobulin measurements in fine-needle aspiration cytology of lymph nodes for the detection of metastatic differentiated thyroid carcinoma

Ultrasound-guided fine needle aspiration biopsy (US-FNAB) is a routinely used technique in the examination of suspicious lymph nodes in patients treated for differentiated thyroid carcinoma (DTC). The measurement of thyroglobulin levels in needle washout fluids (FNAB-Tg) has been reported to increase the diagnostic accuracy of FNAB. US-FNAB and FNAB-Tg measurements of suspected lymph nodes were performed in 116 patients who underwent surgery because of DTC. Results of FNAB and corresponding FNAB-Tg values were compared to the histology of removed lymph nodes and to clinical follow-up. All patients with positive cytology (n = 23) and two with elevated FNAB-Tg and negative cytology underwent surgery. Two patients with elevated FNAB-Tg and negative cytology were treated with J131 and one patient was not treated but only observed. In five patients with positive cytology, FNAB-Tg levels were not elevated. Three of these patients presented with cervical lymphadenopathy shortly after thyroidectomy and two had metastases from other malignancies.US-FNAB is not sensitive enough to detect all metastatic lymph nodes. FNAB-Tg measurement increases diagnostic accuracy of the US-FNAB of suspicious neck lymph nodes in the follow-up of patients with DTC, and is particularly useful in detecting small and cystic metastases and in cases of indeterminate cytology.

MRI Findings of Brain Metastases in Lung Cancers

Brain metastasis is a serious clinical problem in patients with lung cancers and a particular factor affecting the mortality and morbidity. The presence of brain metastasis and the number of the metastatic focusi are important for the treatment decision. In this study we aimed to analyze the brain metastases due to lung cancers retrospectively. The study involved 103 patients who had brain metastases. The patients were evaluated in terms of localizations of the brain metastases, histopathologic types, lesion characteristics and solidarity or multiplicity. In all of the cases, the most frequent metastases were to frontal lobe (38,5%). In SCLC and NSCLC, frontal lobe was the most frequent metastatic localization. In all the metastatic focusi, 46.6% of multiple and 53.4% of solid brain metastases were present. The multiple metastasis rate detected in SCLC’s was 82.3% and was the greatest in all the cases. The squamous cell cancers had 67.5% solid metastasis and this rate was the highest among all the types. Also, our study showed that brain metastasis of lung cancer cases had solid characteristics of 59.3%, the 38.3% included cystic component and 6.1% had hemorrhagic characteristics. In epidermoid carcinomas, cystic metastases were the most to be detected and the rate was 69.7%. In the hemorrhagic metastatic types, adenocarcinomas had the highest rate with 10.7%. In conclusion, we suppose that in lung cancers, the properties of the brain metastases will offer a positive prediction for the method prior to the treatment. However, since the metastases from the epidermoid lung cancers are frequently located in frontal lobe and mostly as single lesions, we predict that these would benefit more from the treatment.

Faisability of a Fine Needle Aspiration and Cytology for Cystic Lesions of the Pancreas During Echo-Endoscopy

Background: Cystic pancreatic lesions (LCP) include inflammatory pseudocysts or mesenchymal and epithelial cystic neoplasms in 80-90% and 10-15% of cases, respectively. Other pancreatic cystic lesions include cysts alone, pancreatic policistose (von Hippel-Lindau syndrome), cystic hydatid cyst and metastasis. The prevalence of LCP is about 3.5%. Objective: Was to investigate the clinical application of Biopsy guided by endoscopic ultrasound in patients with pancreatic cystic lesion, considering demographic, endoscopic and cytological data. Methods: We retrospectively studied 24 patients with pancreatic cystic lesion, regardless of sex and race, from the region of Sao Jose do Rio Preto, SP, underwent biopsy puncture guided by endoscopic ultrasound. The ecoguide of the punctures were performed using only 22G needle, and the collection and processing of medical liability endoscopist material.

術後22年目に再発し多発性肝嚢胞と診断された腎癌嚢胞性肝転移の1例

症例は85歳，男性．糖尿病治療中，スクリーニングで施行された腹部CT検査において多発性肝嚢胞と診断された．内科で経過観察されていたが，嚢胞の増大と腹痛を認めたため，手術目的に外科転科となった．腹腔鏡下に肝嚢胞開窓術が施行されたが，嚢胞壁の病理組織検査で腎細胞癌の肝転移と診断された．患者は22年前に腎癌で右腎摘出手術を受けており，病理組織学的検査においてこの腎癌の再発と考えられた．腎細胞癌は晩期再発をきたしやすい腫瘍であるが，術後20年以上を経て再発することは稀であり，また，嚢胞状肝転移も稀な転移様式であるため，文献的考察を含め報告する．

嚢胞状リンパ節転移をきたした肺腺癌の1切除例

嚢胞状リンパ節転移をきたした肺腺癌の1切除例