Low Incidence Of Metastasis Research Articles

The Value of Restaging With Chest and Abdominal CT/MRI Scan After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer.

Little was known with regard to the value of preoperative systemic restaging for patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT). This study was designed to evaluate the role of chest and abdominal computed tomography (CT) scan or magnetic resonance imaging (MRI) on preoperative restaging in LARC after neoadjuvant CRT and to assess the impact on treatment strategy.Between January 2007 and April 2013, 386 newly diagnosed consecutive patients with LARC who underwent neoadjuvant CRT and received restaging with chest and abdominal CT/MRI scan were included. Imaging results before and after CRT were analyzed.Twelve patients (3.1%) (6 liver lesions, 2 peritoneal lesions, 2 distant lymph node lesions, 1 lung lesions, 1 liver and lung lesions) were diagnosed as suspicious metastases on the restaging scan after radiotherapy. Seven patients (1.8%) were confirmed as metastases by pathology or long-term follow-up. The treatment strategy was changed in 5 of the 12 patients as a result of restaging CT/MRI findings. Another 10 patients (2.6%) who present with normal restaging imaging findings were diagnosed as metastases intra-operatively. The sensitivity, specificity accuracy, negative predictive value, and positive predictive values of restaging CT/MRI was 41.4%, 98.6%, 58.3%, and 97.3%, respectively.The low incidence of metastases and minimal consequences for the treatment plan question the clinical value of routine restaging of chest and abdomen after neoadjuvant CRT. Based on this study, a routine restaging CT/MRI of chest and abdomen in patients with rectal cancer after neoadjuvant CRT is not advocated, carcino-embryonic antigen (CEA) -guided CT/MRI restaging might be an alternative.

Antithyroid peroxidase antibody positivity is associated with lower incidence of metastasis in breast cancer.

Thyroid extracts were first used to treat patients with metastatic breast cancer over a century ago. Since then, a number of studies have investigated the association between thyroid disorders and breast cancer. The presence of antibodies to thyroid peroxidase (TPOab) was recently reported to be associated with improved outcome in these patients. The aim of the present study was to evaluate the association between TPOab positivity and clinicopathological characteristics in breast cancer patients. The study included 318 newly diagnosed cases of breast cancer treated at Ondokuz Mayis University Hospital, Samsun, Turkey, between 2008 and 2012. Serum thyroid-stimulating hormone, free triiodothyronine and free thyroxine levels were measured at the time of diagnosis. Of the 318 patients, 253 were considered to be TPOab-negative (TPOab ≤34 IU/ml) and 65 TPOab-positive (TPOab >34 IU/ml). No cases with distant metastases were found in the TPOab-positive group. However, 20 (7.9%) of the 253 patients displayed distant metastases in the TPOab-negative group (P=0.01). Therefore, TPOab positivity was found to be associated with a lower incidence of metastasis in breast cancer patients.

Macrofollicular Variant of Papillary Thyroid Cancer: A Clinicopathologic and Molecular Review

Context: The macrofollicular variant of papillary thyroid carcinoma (MFVPTC) is a rare entity; this variant is a well-differentiated tumor with predominance of macrofollicles lined by cells showing the nuclear features of papillary thyroid carcinoma (PTC). It is claimed to be clinically nonaggressive with a low incidence of metastasis. It is very important to correctly recognize this entity, it might clinically represents a dangerous source of diagnostic error, since it can be easily misinterpreted as a benign disease such as goiter, macrofollicular adenoma, Grave's disease, or hyperplastic nodule. The objective of this article was to provide an update overview of the clinical, cytologic, histologic, and immunohistochemistry (IHC) as well as the molecular characteristics of MFVPTC. Evidence Acquisition: This rare subtype of papillary thyroid carcinoma was first described in 1991. We performed a comprehensive online literature review since its first description up to this date. Results: MFVPTC is a rare variant of papillary thyroid carcinoma that can be extremely difficult to diagnose preoperatively; however, IHC stains and molecular studies might help to differentiate this neoplasm from other thyroid entities. Conclusions: This review highlights the diagnostic difficulties that both clinicians and pathologists face when dealing with follicular variants of papillary thyroid carcinoma. While IHC and gene mutation studies are helpful in narrowing down the differential diagnosis, these techniques need further improvements in order to increase their diagnostic accuracy.

Buschke-Löwenstein tumor of the vulva in a patient with a history of squamous cell carcinoma of the cervix

Background Buschke-Lowenstein tumor (BLT) is a very rare sexually-transmitted disease associated with human papillomavirus (HPV) type 6 and 11, but rare cases of oncogenic HPV types including HPV 16 and HPV 18 were also reported. It is characterized by slow, locally invasive growth and clinically presents as exophytic masses with a cauliflower-like morphology. It usually occurs in uncircumcised men and location in sites other than the penis is very rare. It is a premalignant disorder with a low incidence of metastasis but with a considerable risk of malignant transformation to squamous cell carcinoma (SCC).

JS1-2 - Clinicopathologic Characteristics of Malignant Neoplasms in the Elderly

The occurrence of malignant neoplasms increases with advancing age. Although aging and carcinogenesis are basically different processes, there are phenomena common to each such as accumulation of DNA damage and abnormal proteins, telomere shortening, and dysfunction of immune and metabolic systems. Common cancers in the elderly are gastric, lung, colorectal and prostate cancers in men whereas colorectal, gastric, lung and biliary cancers in women. Compared with malignant neoplasm in the younger patients, there exist several characteristic features such as tumor location, histology, biological behavior and pathway of carcinogenesis in tumors occurring in the elderly. The representative tumors are as follows: solid-type poorly differentiated adenocarcinoma occurring in the gastric antrum, microsatellite-unstable medullary and mucinous colorectal carcinomas, proximal colon carcinomas, squamous cell carcinoma of the lung, apocrine and mucinous carcinoma of the breast, hepatocellular carcinoma without cirrhosis, acute myeloid leukemia arising from myelodysplastic syndrome, and intraductal papillary-mucinous neoplasm of the pancreas. These tumors may have different pathways of carcinogenesis in comparison with those in the younger patients. Multiple cancers also increase with aging. Although it is generally recognized that carcinoma in the elderly shows well differentiation, slow growth, low incidence of metastasis and favorable prognosis, the tumor does not always show such features. Regarding biological behavior of malignant tumor in the elderly, age-related alterations of the host such as stromal weakness and decreased immune response against cancer cell invasion should be considered as well as characteristics of tumor cell itself.

Canine testicular tumors: two types of seminomas can be differentiated by immunohistochemistry.

BackgroundTesticular tumors are the most common genital neoplasms in male dogs, with Leydig cell tumors (LCT), seminomas (SEM), and Sertoli cell tumors (SCT) the most common forms. Human SEM are classified as classical (CSEM) or spermatocytic (SSEM). Intratubular germ cell neoplasia of undifferentiated origin (IGCNU) is another form of human testicular tumor. The aim of this study was to verify that CSEM/SSEM classification is valid in dogs and confirm the existence of canine IGCNU.ResultsTesticular tumors were found in 46% of dogs at necropsy and accounted for 7% of tumors biopsied. The median age of dogs with tumors at necropsy was 10.16 years; median age at positive biopsy was 10.24 years. The most common tumors, in decreasing order, were LCT, mixed tumors, SEM and SCT at necropsy, and SEM, SCT, mixed tumors, LCT, peripheral nerve sheath tumor, and teratoma in the biopsy group. IGCNU was found in 3% of testicles at necropsy and in 3% of biopsy samples. Two dogs had testicular tumor metastasis. Expression of c-KIT was most common in SEM and seminomatous components of mixed tumors. PLAP was mostly expressed in IGCNU, SEM, teratoma, and some mixed tumors. Cytokeratin was mainly expressed in SCT. CD30 expression was low in both groups.ConclusionsThe high tumor incidence at necropsy can be attributed to older age. Tumor incidence in biopsy samples, dog age, and histological classification were consistent with previous studies. The higher incidence of SEM and SCT in the biopsy group probably resulted from the obvious clinical expression of these tumor types. The low incidence of metastasis confirmed the predominance of benign tumors. Low CD30 expression confirmed the low incidence of testicular embryonal carcinoma. Cytokeratin helps differentiate stromal tumors, especially SCT, from germ cell tumors. Histology and c-KIT and PLAP expression indicate that IGCNU exists in dogs. Expression of c-KIT and PLAP confirmed that CSEM and SSEM classification is valid in dogs.

Verrucous Carcinoma of the Lower Lip: A Case Report

Verrucous carcinoma is a relatively rare variant of well differentiated squamous cell carcinoma first described by Ackerman in 1948. It is distinct in its slow progression, exophytic cauliflower like growth, low grade malignancy and low incidence of metastasis. The oral cavity is one of the predilection sites for verrucous carcinoma. In the oral cavity, the gingiva and buccal mucosa are the common site. Verrucous carcinoma of the lip is clinically quite rare and only several cases of that were reported in the world. The aim of this study is to report an unusual case of verrucous carcinoma of the lower lip.

In search of a prognostic classification of endocrine pituitary tumors.

Pituitary tumors, the most frequent intracranial tumors, are historically considered benign. However, various pieces of clinical evidence and recent advances in pathological and molecular data suggest the need to consider that these tumors are more than an endocrinological disease despite the low incidence of metastasis. We present here a historical and critical review of the classifications of pituitary tumors, including a new prognostic clinicopathological classification based on tumor size, immunohistological subtype (prolactin (PRL), growth hormone (GH), follicle-stimulating hormone and luteinizing hormone (FSH-LH), adrenocorticotropic hormone (ACTH), and thyroid-stimulating hormone (TSH)), and five grades, which take into account invasion and proliferation of the tumors. We also present a brief review of the main markers of tumor behavior. We believe that a better classification of these tumors and the identification of prognostic markers will help the clinician to choose the appropriate therapeutic management.

MANAGEMENT OF ENDOCRINE DISEASE: Clinicopathological classification and molecular markers of pituitary tumours for personalized therapeutic strategies

Pituitary tumours, the most frequent intracranial tumour, are historically considered benign. However, various pieces of clinical evidence and recent advances in pathological and molecular analyses suggest the need to consider these tumours as more than an endocrinological disease, despite the low incidence of metastasis. Recently, we proposed a new prognostic clinicopathological classification of these pituitary tumours, according to the tumour size (micro, macro and giant), type (prolactin, GH, FSH/LH, ACTH and TSH) and grade (grade 1a, non-invasive; 1b, non-invasive and proliferative; 2a, invasive; 2b, invasive and proliferative and 3, metastatic). In addition to this classification, numerous molecular prognostic markers have been identified, allowing a better characterisation of tumour behaviour and prognosis. Moreover, clinical and preclinical studies have demonstrated that pituitary tumours could be treated by some chemotherapeutic drugs or new targeted therapies. Our improved classification of these tumours should now allow the identification of prognosis markers and help the clinician to propose personalised therapies to selected patients presenting tumours with a high risk of recurrence.

Carcinoma verrucoso plantar. A propósito de un caso poco frecuente

Background: Verrucous carcinomas rarely mentioned in the literature its location on the soles of feet, being a distinct variant of squamous cell carcinoma seen in mucosa and skin, including the feet. Objective: To describe the clinical, histopathological and laboratory and clinical results of an unusual case of a verrucous carcinoma on the sole.Methods: We present a rare case of a verrucous carcinoma in the left sole, at the first metatarsal, which was completely resected and remained without evidence of tumor recurrence or metastasis during follow-up over a period of four years. On this basis, we reviewed the published cases of verrucous carcinoma in the foot, to define the characteristics of this rare tumor and give diagnostic and therapeutic recommendations.Results: Verrucous carcinoma is characterized by a slow but inexorable clinical presentation similar in appearance to large plantar wart, histology is typical minimal local invasion with low incidence of metastases and good prognosis. For the correct diagnosis, both physical examination and must be comprehensive and complementary performed by surgical biopsy. Radical resection is the treatment of choice with histological confirmation of free resection margins of the tumor.Conclusions: The plantar verrucous carcinoma may present diagnostic difficulty, complete surgical resection of the lesion allows the diagnosis, prognosis and has good early healing.

Osteosarcoma of the maxilla: A case report and review of literature

Osteosarcoma (OS) is the most common primary bone tumor of the jaw. It is rare, and the biological behavior differs from other skeletal bone tumors. OS of jaw is characterized by lower incidence of metastasis and better prognosis than OS of long bones. Surgery with adjuvant radiotherapy is the mainstay of treatment. The complicated three-dimensional anatomy of the head and neck region makes it difficult to obtain wide resection margins, leading to higher chances of recurrence. Death is usually caused by the uncontrollable local spread. We present a case of 61-year-old man with diabetes mellitus, who presented with an upper jaw swelling, which was histologically confirmed as OS of the maxilla. He underwent surgery and adjuvant radiation for the same. 1 year later, patient developed recurrence at the base of the skull which was inoperable. He received palliative chemotherapy for the same and is now under follow-up.

Statin use and the development of bone metastasis in breast cancer patients.

40 Background: The Mevalonic Acid Pathway has been implicated in the promotion of a microenvironment suitable for establishment of bony metastasis from breast cancer. The statins, which act on this pathway, have been shown to have in vitro antineoplastic activity against breast cancer. This study was designed to evaluate the association of statin use and development of bony metastasis in breast cancer patients. Methods: Medical records of patients treated for stage II-III breast cancer from 1999 to 2010 were retrospectively reviewed. Statin use was defined as medication use for at least 3 months in patients with no evidence of disease after initial diagnosis and treatment. The primary outcome was development of metastasis to bone. Secondary outcomes were overall survival, disease free survival and other sites of distant metastasis. Results: A total of 841 patients were included in the study of which 223 used statins. Both unadjusted and multivariate analysis adjusted for age, race, grade, stage, BRCA status, showed that patients on statins had a significantly lower incidence of metastasis to bone (OR 0.49, 95% CI 0.25-0.96, p=0.04). Adjusted analysis for other sites showed a trend towards decreased incidence of metastasis for statin users, but was not statistically significant (95% CI 0.39-1.08, p=0.10). Overall survival was increased in statin users with mean survival of 66.45 +/- 2.48 months versus non-users 58.78 +/ - 1.41 months (p=0.05). Statin users had significantly longer disease free survival with a mean of 63.65 +/- 2.49 months versus 53.96 +/- 1.42 months in non statin users (p=0.00). Conclusions: The use of statin drugs in patients with breast cancer was significantly associated with decreased incidence of metastasis to bone, but not to other distant sites. The role of statins in chemoprevention of bone metastasis should be further explored.

Cutaneous metastases from colonic adenocarcinoma: case report

The presence of cutaneous metastases (CM) from a digestive tract cancer is infrequent, appearing in less than 5% of the cases. Given the low incidence of metastasis from colon adenocarcinoma, an unusual case that occurred in the Colorectal Surgery Department of Santa Casa de Sao Paulo is described in this report, and a brief review of literature is presented. A 78-year-old female patient who underwent right hemicolectomy, developed a tumor with approximately 8 cm in diameter in her gluteus eight months later, which was surgically resected, and the histological diagnosis was metastatic adenocarcinoma of the right colon. Although the literature estimated short survival in cases of CM, the patient developed no signs of tumor recurrence five months after the onset of metastasis in the gluteus, with significant improvement in her quality of life.

Statin use and the development of bone metastasis in breast cancer patients.

536 Background: The Mevalonic Acid Pathway has been implicated in the promotion of a microenvironment suitable for establishment of bony metastasis from breast cancer. The statins, which act on this pathway, have been shown to have in-vitro anti-neoplastic activity against breast cancer. This study was designed to evaluate the association of statin use and development of bony metastasis in breast cancer patients. Methods: Medical records of patients treated for stage II-III breast cancer from 1999 to 2010 were retrospectively reviewed. Statin use was defined as medication use for at least 3 months in patients with no evidence of disease after initial diagnosis and treatment. The primary outcome was development of metastasis to bone. Secondary outcomes were overall survival, disease free survival and other sites of distant metastasis. Results: A total of 841 patients were included in the study of which 223 used statins. Both unadjusted and multivariate analysis adjusted for age, race, grade, stage , BRCA status, showed that patients on statins had a significantly lower incidence of metastasis to bone (OR 0.49, 95% CI 0.25-0.96, p=0.04). Adjusted analysis for other sites showed a trend towards decreased incidence of metastasis for statin users, but was not statistically significant (95% CI 0.39-1.08, p=0.10). Overall survival was increased in statin users with mean survival of 66.45 +/- 2.48 months versus non-users 58.78 +/ - 1.41 months (p=0.05). Statin users had significantly longer disease free survival with a mean of 63.65 +/- 2.49 months versus 53.96 +/- 1.42 months in non statin users (p=0.00). Conclusions: The use of statin drugs in patients with breast cancer was significantly associated with decreased incidence of metastasis to bone, but not to other distant sites. The role of statins in chemoprevention of bone metastasis should be further explored.

Absence of Dickkopf (Dkk)-3 protein expression is correlated with longer disease-free survival and lower incidence of metastasis in head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma (HNSCC) is one of the most frequently occurring types of cancer worldwide. We focused on the fact that the aberrant function of Wnt/β-catenin signaling is a frequent event in malignancies. Dickkopf (Dkk)-3 is a major negative regulator of Wnt/β-catenin signaling, which is a known tumor suppressor and is down-regulated in various types of cancer. However, the expression profile of the Dkk-3 protein in HNSCC has not yet been reported. The present study was conducted to investigate Dkk-3 protein expression in 90 cases of HNSCC tissue samples and HNSCC-derived cell lines. In contrast to findings available on other types of cancer, the Western blot analysis revealed that HNSCC cell lines expressed the Dkk-3 protein. In immunohistochemistry, 76 cases (84.4%) out of 90 tissue samples were Dkk-3-positive, whereas only 14 cases (15.6%) were negative. Notably, survival analysis showed that the Dkk-3 (-) group exhibited significantly longer disease-free survival (p=0.038), metastasis-free survival (p=0.013) and longer overall survival (p=0.155). The results showed that the Dkk-3 protein was dominantly expressed and may be involved in carcinogenesis and metastasis in HNSCC. Moreover, the findings suggest that the function of Dkk-3 differs depending on the tissue of origin, and that it may exert an oncogenic function in HNSCC.

Clear Cell Adenocarcinoma of the Base of the Tongue: A Case Report and Review of the Literature

Clear cell adenocarcinoma is an extremely rare tumor of the head and neck region. We report a case of a 75-year-old Caucasian woman with a 10-day history of hemoptysis but with no pain or other significant symptoms. A head and neck computed tomography scan with contrast medium showed an irregular, soft-tissue-like, irregularly enhanced lesion of the base of the tongue extending to its posterolateral portion. The tumor reached the lateral wall of the oropharynx, which showed a nonhomogeneous aspect. The patient underwent resection of the tumor via a conservative transmandibular approach. A clear cell adenocarcinoma of the base of the tongue is rarely a primary malignant lesion; it is more frequently a secondary lesion from a metastatic renal tumor. Because of this neoplasm's relatively slow growth rate and low incidence of metastasis or local recurrence, the gold standard of treatment is complete excision of the tumor with a sufficient tumor-free margin.

Restoration of Transforming Growth Factor-β Receptor II Expression in Colon Cancer Cells with Microsatellite Instability Increases Metastatic Potential in Vivo

Microsatellite instability (MSI), which occurs in 15% of colorectal cancer, has been shown to have a lower incidence of metastasis and better patient survival rates compared with microsatellite stable colorectal cancer. However, a mechanistic understanding of the basis for this difference is very limited. Here, we show that restoration of TGFβ signaling by re-expression of TGFβ receptor II in MSI colon cancer cells increased PI3K/AKT activation, conferred resistance to growth factor deprivation stress-induced apoptosis, and promoted cell motility in vitro. Treatment with a potent PI3K inhibitor (LY294002) blocked the prosurvival and promotility effects of TGFβ, indicating that TGFβ-mediated promotion of cell survival and motility is dependent upon activation of the PI3K/AKT pathway. Analysis of apoptotic effectors that are affected by TGFβ signaling indicated that Bim is an effector of TGFβ-mediated survival. In addition, TGFβ-induced down-regulation of E-cadherin contributed to the prosurvival effect of TGFβ, and restoration of TGFβ signaling in MSI colon cancer cells increased liver metastasis in an orthotopic model in vivo. Taken together, our results demonstrate that restoration of TGFβ signaling promotes cell survival, motility, and metastatic progression in MSI colon cancer cells and indicate that TGFβ receptor II mutations contribute to the favorable outcomes in colon cancer patients with MSI.

Metastatic inflammatory myofibroblastic tumor identified by EUS‐FNA in mediastinal lymph nodes with ancillary FISH studies for ALK rearrangement

Inflammatory myofibroblastic tumor (IMT) is an exquisitely rare neoplasm with a low incidence of metastasis. Previously, cytologic diagnosis of this entity, by fine needle aspiration (FNA) or endoscopic ultrasound guided fine needle aspiration (EUS-FNA), was challenging, if not impossible. However, advancements in the field of molecular pathology, the applications of which have lagged in cytopathology relative to other disciplines, now makes diagnosis possible. Here we report a case of pulmonary inflammatory myofibroblastic tumor with mediastinal nodal metastasis in a 74-year-old man, definitively diagnosed by EUS-FNA utilizing morphologic, immunohistochemical, and molecular findings, including fluorescent in situ hybridization studies for ALK gene rearrangement. This case report demonstrates the value of ancillary molecular studies to assist in the diagnosis of rare neoplasms, including those at sites of metastasis.

587 BILATERAL TESTIS GERM CELL TUMORS: OBSERVATIONS FROM THE SEER DATABASE

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011587 BILATERAL TESTIS GERM CELL TUMORS: OBSERVATIONS FROM THE SEER DATABASE A. Ari Hakimi, Steve K. Williams, Reza Ghavamian, and Farhang Rabbani A. Ari HakimiA. Ari Hakimi Bronx, NY More articles by this author , Steve K. WilliamsSteve K. Williams Bronx, NY More articles by this author , Reza GhavamianReza Ghavamian Bronx, NY More articles by this author , and Farhang RabbaniFarhang Rabbani Bronx, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1419AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bilateral testis tumors are rare. We sought to use the population-based Surveillance, Epidemiology, and End Results (SEER) database to evaluate if there are differences between unilateral and bilateral tumors. METHODS From 1973–2006, 30330 men were identified in the SEER database as having a primary germ cell tumor of the testis, of which 29890 were unilateral, 163 bilateral synchronous and 277 bilateral metachronous. Median patient age was 33. Patient demographics and tumor characteristics were compared using the chi-squared test. RESULTS Patients with metachronous bilateral tumors were younger at the time of diagnosis of the first tumor (median age 28) vs. those with unilateral or bilateral synchronous tumors (median age 33 for each group). There was no statistically significant difference in laterality, histology, T stage, N stage, or incidence of AFP or LDH elevation at presentation. Patients with unilateral tumors had a higher incidence of metastases at presentation: 2897/26778 (10.8%) for unilateral, 11/229 (4.8%) for metachronous and 9/141 (6.4%) for synchronous tumors (p=0.0034). Patients with metachronous tumors had a higher incidence of BHCG elevation at diagnosis: 14/21 (67%) for metachronous, 3520/8523 (41%) for unilateral and 16/47 (34%) for synchronous tumors (p=0.037). The distribution of histology was similar in the three groups of patients with unilateral, synchronous and metachronous tumors: the histology was seminoma was in 17382, 94 and 163 cases, respectively; embryonal carcinoma/yolk sac tumor in 4271, 30 and 42 cases, respectively, teratoma/teratocarcinoma/mixed GCT in 7194, 35 and 66 cases, respectively; and choriocarcinoma in 1043, 4 and 6 cases, respectively (p=0.62). The correlation between the histology of the first and second tumor for those with metachronous tumors is shown in the table (p=0.030). Histology of Primary and Secondary Tumors Histology of Primary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Choriocarcinoma Embryonal/Yolk Sac Tumor Seminoma Teratoma/Teratocarcinoma/Mixed Total Choriocarcinoma 1 0 5 0 6 Embryonal/Yolk Sac Tumor 1 7 23 11 42 Seminoma 2 14 119 28 163 Teratoma/Teratocarcinoma/Mixed 5 10 38 13 66 Total 9 31 185 52 277 CONCLUSIONS Patients with metachronous tumors present at a younger age with a higher incidence of BHCG elevation. The lower incidence of metastases in these patients may be due to selection bias as these patients live to develop a second primary tumor. There is weak correlation between the histology of the first and second tumors in those with metachronous tumors. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e236-e237 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information A. Ari Hakimi Bronx, NY More articles by this author Steve K. Williams Bronx, NY More articles by this author Reza Ghavamian Bronx, NY More articles by this author Farhang Rabbani Bronx, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment of Verrucous Carcinoma of the Lower Lip with Topical Imiquimod (Aldara®) and Debulking Therapy

Verrucous carcinoma is an unusual, non-metastasizing, distinct variant of squamous cell carcinoma composed of four subtypes according to the site of occurrence: oral type, anogenital type, plantar type, and other cutaneous sites. Oral type verrucous carcinoma usually shows slow progression with a low incidence of metastases. Treatment of verrcous carcinoma is challenging; multiple medical and surgical therapies are often attempted, with limited success. We reported on 2 cases of verrucous carcinoma of the lip treated with topical imiquimod and debulking therapy.