Intravascular Metastases Research Articles

Value of 18F-FDG PET/CT Combined with Lung HRCT in Diagnosis of Solitary Pulmonary Intravascular Metastasis.

Background Solitary pulmonary intravascular metastasis is a rare complication of malignant tumors, and accurate diagnosis can improve clinical decision-making, but diagnosing it effectively using conventional techniques is difficult. Purpose To explore the value of 18F-FDG PET/CT combined with lung high-resolution computed tomography (HRCT) in the diagnosis of solitary pulmonary intravascular metastasis. Methods 18F-FDG PET/CT, lung HRCT, and follow-up data of 18,143 cancer patients were retrospectively analyzed to select patients with pulmonary vessel involvement besides the primary tumor only. The histopathological or imaging follow-up results were used as the diagnostic criteria for pulmonary intravascular metastasis. Results A total of 13 patients with 17 pulmonary intravascular metastases were found, of which 9 patients had a single lesion and 4 had double. The SUVmax was 1.1–5.4 (average, 2.4 ± 1.4), and the length of hypermetabolic metastasis was 5.1–24.1 mm (average, 10.7 ± 6.5 mm). All the intravascular metastases were located in the terminal pulmonary vessels. Strip or branched pulmonary vessels enlargement with increased metabolism was the main imaging manifestation (15/17, 88.2%), while the other 2 cases only showed strip metabolic enhancement without abnormalities in pulmonary vessels (2/17, 11.8%). Four pulmonary intravascular metastases were confirmed by pathology, and the other 13 cases were diagnosed by imaging follow-up. Conclusion 18F-FDG PET/CT combined with lung HRCT is an effective technique for the diagnosis of solitary pulmonary intravascular metastasis. High-strip or branched FDG uptake in the distal pulmonary vessel accompanied by corresponding morphological changes in patients with malignant tumors can be used as a specific diagnostic indicator.

A case of spontaneous systemic immunity to melanoma associated with cure after amputation for extensive regional recurrence

Survival after amputation for melanoma is short; however, rare long-term survivors are reported. The mechanism for durable systemic tumor control in patients with regional failure is not known. To explore whether systemic tumor immunity may be implicated, tumor and circulating immune responses were examined in a patient who survived disease-free 14 years after hip disarticulation. A 71-year-old female with extensive regional metastases of melanoma in the left lower extremity underwent amputation for palliative reasons. Tumor was collected at surgery, and blood was collected during follow-up. Tumor sections were evaluated for lymphocytic infiltration and NY-ESO-1 expression by immunohistochemistry. Cellular immune responses to defined tumor antigens were evaluated by ELISPOT assay, and antibody responses to a panel of tumor antigens were assayed by ELISA. The patient's tumor had minimal lymphocytic infiltrate (immunotype A). NY-ESO-1 was strongly expressed by the melanoma cells. Circulating T-cell responses to NY-ESO-1 peptides were observed 6 and 12 years postoperatively, and antibodies to NY-ESO-1 were detected 2-6 years after surgery. The patient described in this report experienced relentless regional tumor progression, with intravascular metastases, and then 14-year systemic disease-free survival after palliative resection, without evidence of melanoma recurrence before death from other causes. Her immune response to NY-ESO-1 likely failed to control established regional metastases because T cells were unable to infiltrate them. It is possible, however, that among other factors, the host immune response may have contributed to systemic protection.

Adult with red-brown nodules and plaques

of developing squamous cell carcinoma after radiotherapy is increased if the individual is prone to sunburns. Radiotherapy can also further increase the risk of lymphedema, which can develop in patients after lymph node dissection. Chronic lymphedema can lead to recurrent infections, fibrosis, and verrucous hyperkeratosis of the skin, and angiosarcoma, which presents as ‘‘bruise’’-like patches on the skin that become violaceous and nodular and can bleed easily. It can very rarely lead to other cancers, including squamous cell carcinoma, Kaposi sarcoma, B-cell lymphoma, and malignant fibrous histiocytoma. Lastly, patients with a history of radiotherapy can develop radiation recall after recent administration of a cytotoxic agent. They present with erythema or vesiculation confined to the area of the previous radiation exposure, which can occur months or years after irradiation. In summary, parotid gland tumors rarely metastasize to the skin. Together with other salivary gland tumors, they make up only a small proportion of cutaneous metastases. The patient presented herein had distant metastases to a rare site presenting with discrete white papules that resemble milia or molluscum contagiosum. In a review of the literature, there have been case reports of radiation induced milia or comedo formation in previously irradiated fields. However, we were unable to find any cases of milia-like metastases presenting in previously irradiated skin. Although telangiectatic metastatic breast carcinoma is described more as lymphangioma circumscriptumelike papulovesicles, our case appears to represent a very similar process of intravascular metastases. Metastases should always be considered in a patient with a history of parotid gland carcinoma, even in lesions that appear benign. For the series, the recommended choices are: 6, d; 7, b; 8, d; 9, c; 10, d; 11, a.

Tree-in-bud Pattern on Thoracic CT due to Pulmonary Intravascular Metastases From Pancreatic Adenocarcinoma

We report a case of pulmonary intravascular metastases from pancreatic adenocarcinoma manifesting as tree-in-bud pattern on thoracic computed tomography. Although infectious bronchiolitis is the most common cause of tree-in-bud pattern, this case emphasizes that the differential diagnoses include pulmonary intravascular metastases, particularly in patients with extrapulmonary adenocarcinomas.

Giant atypical carcinoid of the liver with vascular metastases and local sinusoidal invasion: a case report

We present the case of a 46 year old woman with a giant, 23-centimeter, atypical carcinoid of the liver. A primary site for this neoplasm could not be identified despite multiple radiographic imaging studies, including a somatostatin scan, and a thorough inspection of the bowel during surgical resection of the lesion. Histologically, the tumor displayed mild cytologic atypia, abundant necrosis, and intravascular metastases, the last feature of which was identified by immunohistochemical markers for chromogranin and synaptophysin. Also described is the unusual sinusoidal infiltration, or "spillage," of tumor cells into the surrounding liver parenchyma, a feature that has not been described as far as we are aware but may suggest an aggressive clinical course. Even though an exact definition of atypia for these lesions apparently does not exist at this point, the multiple atypical features in this case strongly suggest the diagnosis of atypical carcinoid of the liver, thus far an altogether rare and vaguely reported entity. As more cases arise in the medical literature, it may be worthwhile to establish a set of guidelines to define atypical hepatic carcinoids and other gastrointestinal carcinoids, although survivorship data thus far indicates no significant difference in the prognosis between typical versus atypical variants.

Metastatic periosteal osteosarcoma causing cardiac and renal failure

The case of a 25-year-old man who had periosteal osteogenic sarcoma with intravascular metastases in unusual locations is reported. The patient presented with acute renal failure, unilateral pulmonary edema, functional mitral stenosis, and low cardiac output. After successful surgical removal of a left atrial metastasis with subsequent improvement in cardiac output, renal function improved only transiently and urinary output varied markedly. At autopsy, metastatic osteogenic sarcoma was discovered within the lumen of the abdominal aorta obstructing both renal arteries. The case is the first report of a neoplasm metastatic to the aorta causing intermittent bilateral renal arterial obstruction; it illustrates the diagnostic difficulties presented by intravascular metastatic disease.