History Of Local Recurrence Research Articles

Metastatic non-muscle invasive transitional cell carcinoma of urinary bladder: a case report

BackgroundAxillary lymphadenopathy is a common clinical presentation of variety of benign and malignant diseases. However, majority of patients with unilateral axillary lymph node enlargement have an underlying malignancy in which association with breast carcinoma being the commonest one. In most of these patients there will be a discernible primary tumor, either clinically or radiologically. However, in axillary lymphadenopathy with negative mammogram is not very common, and in this case other malignant causes should also be considered in addition to occult breast cancer and these can be metastases from other primary tumors for, e.g., lung, genitourinary tract, gastrointestinal, ovarian, thyroid carcinomas and malignant melanoma.Axillary node is an uncommon site of metastases from Transitional cell carcinoma (TCC) of urinary bladder even from its muscle invasive form, and distant metastasis from low grade superficial tumors without muscle invasion or regional metastasis is a very rare occurrence. Here we present a case of axillary nodal metastases from non-muscle invasive (superficial) bladder cancer without history of local recurrence and regional metastases.Case presentationWe present a case of female patient who complaint of hard swelling in right axilla and right breast enlargement. Patient had past history of non-muscle invasive transitional cell carcinoma of urinary bladder (pTa, grade II A) which had been treated accordingly. No recurrence of bladder growth had been observed on serial check cystoscopies. On clinical examination of breast and axilla, right breast appears enlarged and there were palpable hard fixed axillary lymph nodes. Ultrasound showed enlarged malignant looking lymph nodes. Occult breast carcinoma with metastatic axillary lymph nodes was our initial impression; however, subsequent biopsy of axillary lymph nodes showed Transitional cell carcinoma.ConclusionsThis patient’s case emphasizes the importance of having sound knowledge of natural behavior of primary tumor and common and uncommon sites of distant metastases. The causes of unilateral axillary lymphadenopathy include both benign and malignant disease.

Surgical outcomes of pulmonary metastasectomy for head and neck cancer in the current era of advances in chemotherapy and immunotherapy.

The innovation of novel systemic chemo/immunotherapy for metastatic head and neck cancer might contribute to prognostic improvement. We aimed to clarify the recent characteristics and outcomes of pulmonary metastasectomy for head and neck cancer. Twenty-five patients who underwent pulmonary metastasectomy from January 2011 to December 2016 were included. The clinicopathological factors and survival were assessed by retrospective chart reviews. The median follow-up period was 39months (range, 7-94months). The median age was 66years (range, 20-89years), and 23 males were included. The primary tumor locations were as follows: pharynx (n = 12), nasal/paranasal cavity (n = 5), larynx (n = 4), and others (n = 4). The 5-year overall survival rate was 49%. In the univariate analysis, a history of local recurrence before pulmonary metastasis was an independent predictor of a poor prognosis. In 90% of patients with recurrence after pulmonary metastasectomy, the site of recurrence was the lung. Eight patients achieved long-term survival without any evidence of recurrence (median: 45months). Molecular targeting chemotherapy and immune-checkpoint inhibitors were used in five patients with systemic recurrence after pulmonary metastasectomy, leading to preferable survival. In the current era of advances in systemic chemotherapy and immunotherapy, surgical indication has not changed for resectable pulmonary metastases and selected patients can still benefit from pulmonary metastasectomy. Further investigation is needed to clarify the significance of systemic therapy in patients with pulmonary metastasis of head and neck cancer.

Pulmonary metastasis of giant cell tumour: a retrospective study of three hundred and ten cases.

Giant cell tumour (GCT) is an invasive benign bone tumour, andthe incidence of pulmonary metastasis is rare. We are aiming to analyze risk factors of pulmonary metastasis and clinical prognosis for giant cell tumour patients with pulmonary metastasis. We performed a retrospective study of 310 patients with GCT between December 2004 and December 2016. Risk factors of pulmonary metastasis were analyzed by univariate and multivariate logistic regression analysis. Then, the influence of risk factors of overall LR (local recurrence), recurrent tumor at presentation, LR after our therapy, and with soft tissue mass on the pulmonary metastasis-free survival rates was analyzed. The mean follow-up of the present cohort was 45.6 ± 35.3months (median, 36.6months; range, 6.1-193.4months). Eighteen (5.8%) of 310 patients developed pulmonary metastasis. The average interval from surgery of primary tumour to detection of pulmonary metastasis was 15months. Multivariate logistic regression analysis showed overall local recurrence was the independent risk factor of developing pulmonary metastasis. Among 18 patients with pulmonary metastasis, sixteen cases had history of local recurrence (88.9%, 16/18), including eleven (68.8%, 11/16) with local recurrence at presentation before receiving our therapy and seven (43.8%, 7/16) with local recurrence after receiving treatment in our hospital. Time to local recurrence had obvious difference between patients with and without pulmonary metastasis. Patients with pulmonary metastasis were prone to recur earlier. Furthermore, overall local recurrence, local recurrence after our therapy, recurrent tumor at presentation, and tumour witha soft tissue mass showed statistical differences in the pulmonary metastasis-free survival rates. Giant cell tumour patients with soft tissue mass and overall local recurrence are prone to develop pulmonary metastasis. Although giant cell tumour is a benign tumor, more attention should be paid to the problem of pulmonary metastatic lesions, and chest CT scan should be recommended during follow-up.

Permanent colostomy wound: Aeromedical disposal

Background: A 41-year-old test pilot from the fighter stream presented to the Institute of Aerospace Medicine (IAM) with carcinoma lower one-third of rectum (opted) and a history of 2 years of follow-up post-surgery. He was physically fit with a healthy stoma in the left iliac fossa region. There was no history of local recurrence or distance metastases of colorectal cancer (CRC). During his evaluation at IAM, the officer had completed the OPTRAM profile with a stomal guard in place and could do AGSM effectively. Considering the overall prognosis, which was found to be favorable, the pilot was recommended an upgradation to a restricted flying category in the type, subject to a 1 time waiver from Director General Medical Services (air). Discussion: According to the Indian Council of Medical Research consensus document for the management of CRC 2014, the annual incidence rate of colon cancer and rectal cancer in Indian male population is 4.4 and 4.1/100,000, respectively. Surgery is the primary treatment for such cancers and they are mostly curative. Multimodal therapy with neoadjuvant chemotherapy and radiotherapy is done to improve the survival rates. Latest reports published by the National Comprehensive Cancer Network for Rectal Cancer, Version 2.2018, Clinical Practice Guidelines in Oncology indicate that the peak mortality rates are currently down by 50% due to better treatment modalities. Depending on the site of primary tumor, the surgery might leave the patient with either a temporary or a permanent colostomy wound. Conclusion: There was no available record/published case report of any pilot being returned to the cockpit in military flying with a permanent stoma. This case was a first of its kind with respect to aeromedical decisionmaking. With mortality rates decreasing due to effective treatment for cancer, aeromedical decision in more such cases may be required in the future. This case will serve as a precedence in effectively returning trained aviators to the cockpit.

Head and neck amyloidosis – a report on five cases

BACKGROUND: Amyloidosis is a group of diseases caused by extracellular accumulation of insoluble fibers referred to as amyloid fibers in tissues and organs. Amyloid fibers have a secondary beta-sheet structure which makes them resistant to proteolysis. In histological examination, amyloid deposits stain with Congo red and show apple-green birefringence in polarized light. Amyloid deposits disturb the function of organs and cause clinical symptoms. Their formation or accumulation within the system may be acquired or inherited. Due to the location of amyloid deposits, one may distinguish systemic and localized amyloidosis with the formation of tumors (usually composed of immunoglobulin light chains). CASE REPORTS: Five cases of amyloidosis in the head and neck region are presented in this paper. Locations of the amyloid deposits were as follows: larynx, nasopharynx, sublingual and submandibular gland and the tongue. The initial clinical presentation correlated with the location of amyloid tumour in our patients. Two patients had a history of local recurrence of the disease. Surgical resection and histopathological examination were performed. Sections stained with Congo red confirmed the diagnosis of amyloidosis. Three patients had potential conditions that predisposed them to amyloidosis, including previous radiotherapy, chronic inflammation due to hepatitis C virus infection and graft versus host disease. CONCLUSION: Amyloidosis should be considered as a possible cause of pathological symptoms in the head and neck region. The diagnosis requires a histopathological examination. The systemic form of the disease must be ruled out in all patients with head and neck amyloidosis. In localized amyloidosis, surgical resection of lesions is the procedure of choice; however, maintenance of organ's functionality should be taken into account.

Pulmonary and pleural metastasis of intracranial anaplastic meningioma in a 3-year-old boy: A case report

In adults, meningiomas occasionally display aggressive behavior and may occasionally metastasize. By contrast, pediatric meningiomas are rare, and there is limited information regarding their clinical characteristics, treatment and prognosis. We herein report the case of a 3-year-old boy with anaplastic meningioma with a history of local recurrence and late pulmonary metastasis. At diagnosis, a 70-mm mass lesion in was identified in the right frontal lobe, with intratumoral hemorrhage. The tumor was attached to the falx cerebri and was completely resected. The histological diagnosis was anaplastic meningioma, World Health Organization grade III. Two months after the surgery, the meningioma recurred at the same site. Although the patient received radiotherapy after a second operation, the tumor metastasized to the lung and pleura 8 months after the initial operation. The metastasis was resistant to treatment, even after gross total resection, and the effectiveness of further radiotherapy was limited. The patient succumbed to the disease 1 year and 4 months after the initial diagnosis. The findings of the present case and a review of the relevant literature suggest that recurrence and metastasis of meningiomas are difficult to predict. Therefore, such patients should be carefully monitored throughout the follow-up period.

Primary Ewing Family of Tumors of the Jaw Has a Better Prognosis Compared to Tumors of Extragnathic Sites

Primary Ewing sarcoma of the jaw is rare. The aim of this study was to describe new cases of primary Ewing sarcoma of the jaw and investigate reported prognostic factors of Ewing sarcoma in this series and treatment outcome. Six patients with primary Ewing sarcoma of the jaw were treated at the Memorial Sloan Kettering Cancer Center (MSKCC) from 1992 through 2013. Clinical data, pathology reports, treatment prescribed, treatment regimens, outcome, and follow-up information were reviewed. Five of 6 patients were female and 5 cases were in the mandible. No patient presented with metastatic disease at diagnosis. All cases were positive for CD99, and 3 patients with genetic confirmation were positive for EWS-FLI1 fusion or EWSR1 gene rearrangement. All patients received induction multiagent chemotherapy and surgical resection and 2 patients received adjuvant radiotherapy. Total (grade IV) or nearly total (grade III) tumor necrosis in 3 of 5 patients (60%) assessed for histologic response to chemotherapy indicated intense sensitivity. All patients were alive and free of disease, with no history of local recurrence, at a median follow-up period of 6.5years. Patients with primary Ewing sarcoma of the jaw have a good prognosis and metastasis is an uncommon occurrence at initial presentation.

Multiple Cutaneous Granular Cell Tumors: Case Report of a 19-Year-Old African American Female

This is a somewhat rare case of a 19-year-old African American female with multiple cutaneous granular cell tumors. Granular cell tumors are of neural origin, except in rare cases, and are considered benign, with a low incidence of malignancy. The clinical presentation varies greatly, but these tumors are most commonly painful and slow growing, with two-thirds occurring on the head and neck. Patients are most commonly in their second to fourth decades of life, two-thirds are black, and two-thirds are women. Granular cell tumors are diagnosed by the characteristic pathologic findings of polygonal cells with eosinophilic granular cytoplasm. These tumors are most commonly singular but can be multiple in 10 to 15% of patients. Older patient age, rapid growth or enlargement, and a history of local recurrence should raise concern for malignant behavior. The distribution and family history in this case are suggestive of possible mosaicism.