Metastasis To Other Organs Research Articles

Mucinous tubular and spindle cell carcinoma of the kidney: Five case reports and review of the literature.

Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney is a rare and polymorphic tumor, which has been previously considered to be a low-grade malignancy, predominantly occurring in women. To the best of our knowledge, MTSCC with bladder metastasis has never been reported. The current study presents five adult cases of MTSCC that included three male and two female patients. Among the male cases, two were of advanced stage, one with MTSCC and renal chromophobe cell carcinoma with bladder metastasis and the other with MTSCC with invasion of the renal vein. The other three cases with small masses were at an early stage. All five cases had a good prognosis and were without recurrence after several years of follow-up. A 70-year-old male with intermittent gross hematuria, intermittent renal colic, and groin radiation pain for a year (case 1), was incidentally detected to have a left renal density mass by total abdominal enhanced computed tomography scans. In the other four cases, renal masses were found by B-ultrasound. The patient in case 1 underwent a retroperitoneal laparoscopic radical nephroureterectomy with bladder cuff resection and transurethral resection of the bladder tumor, and received gemcitabine hydrochloride via intravesical instillation therapy plus cisplatin chemotherapy every 3 months. The patient in case 2 underwent an open left radical nephrectomy and renal pedicle lymph node dissection. The other three patients underwent a laparoscopic radical nephrectomy. All five patients had no recurrence or new metastasis in other organs after follow-up. In conclusion, the incidence of MTSCC in men and women is not as disparate as reported in previous publications. The characteristics of the images of the five adult cases in the present study showed a considerable consistency, with only minor differences. The malignancy and prognosis of MTSCC are still controversial, and thus inclusion and review of more cases is required to reach a definite final conclusion. Sunitinib and gemcitabine chemotherapy in combination with cisplatin may be effective for the therapy of MTSCC patients with metastasis, but a larger range of treatments needs to be identified.

Diagnosis and treatment of melanoma bone metastasis: A multidisciplinary approach.

Bone is the fourth most common site of melanoma metastasis after lung, liver, and brain. Melanoma bone metastases typically occur in patients who already have widespread metastases in other organs. Current available approaches for bone metastases from melanoma include chemotherapy, radiotherapy, biological therapy, combination therapy, and surgery. In this narrative review, we describe the management of patients affected by melanoma bone metastases, discussing the diagnostic and treatment approaches as well as their impact on survival and quality of life. Despite the fact that clinical and surgical trials will be required to determine the most appropriate treatment, we do expect a newer and more important role of multidisciplinary approach in the management of melanoma patients with bone metastases in the next future.

Surgical treatment of melanoma metastases to the small bowel: A single cancer referral center real-life experience

IntroductionTreatment of metastatic melanoma has rapidly changed during the last years, and patients often require a multidisciplinary approach to achieve effective results. We aimed to assess the survival benefit achieved through surgical approach to patients with small bowel (SB) metastases from cutaneous melanoma, to emphasize the potential role of surgery in association with novel therapies. MethodsNinety consecutive patients with cutaneous melanoma diagnosed as having resectable SB metastases from 1995 to 2015 were retrospectively investigated. ResultsMedian age at surgery of melanoma metastases was 53.4 years. Among 30 patients who had a curative-intent resection, the 5- and 10-year survival rates were 61% and 54%, respectively, while among 60 patients treated with a palliative surgery the corresponding rates were both 4%. Among 29 patients, for whom the interval time between the occurrence of SB metastases and the previous surgical event on GI tract was ≥36 months, the 5-year overall survival rate was 42%; for 56 patients who had an interval time <36 months the corresponding survival rate was 14%. Within the whole series, an absence of any residual disease after surgery (R0) was a factor affecting better survival, regardless of the evidence of metastases in other organs. ConclusionOur observational data showed that surgical treatment for patients with SB metastases from melanoma might increase survival, but further studies are needed to confirm this finding. In the age of novel available therapies, the increase in survival time given by surgery may offer important chances for patients to benefit from systemic therapies.

The importance of uninterrupted albendazole treatment in patients with unresectable alveolar echinococcosis undergoing liver transplantation.

This study focused on the monitoring of patients who had undergone liver transplantation (LT) because of unresectable alveolar echinococcosis (AE). The role of long-term administration of albendazole (ABZ) in patients with residual/recurrent AE lesions and without AE lesions was evaluated. Albendazole therapy was prescribed to patients diagnosed with AE 4-6weeks after LT on the background of continuous suppressive therapy while following the protocol for managing patients after LT. Clinical data (general condition, blood counts, and level of hepatic transaminases), ultrasound scans (USs), magnetic resonance imaging (MRI) or multispiral computed tomography (MSCT), and serological data were collected from four patients with residual/recurrent AE lesions and without AE lesions. The results of the USs, MRI, and MSCT examinations at diagnosis and at the end of follow-up were retrospectively reviewed for all patients. Observation of patients over a long period (up to 10years) showed that the continuous (without interruption) use of ABZ restrained the development of metacestodes. Interruptions in taking the drug, associated with the manifestation of hepatotoxicity in some patients, led to the development of lesions in other organs in which the parasite had not previously been detected. No new foci were found in the transplanted livers of the patients. Liver transplantation, together with continuous anti-relapse chemotherapy, prolongs the patient's life, both in the absence and in the presence of metastases in other organs.

Surgical management and prognostic factors in liver metastases from kidney cancer

Aim. To evaluate short- and long-term results of surgical treatment of the liver metastases from kidney cancer, to identify prognostic factors.Materials and methods. The retrospective study included 67 patients who underwent surgical treatment for liver metastases from kidney cancer from 1990 to 2019. A total of 71 operations on the liver were performed (53 economical resections, 15 extensive resections, 3 radiofrequency thermoablation). Four of them were repeated for the development of metastases in the liver remant.Results. Postoperative morbidity was 30%. There was one (1,5%) intraoperative death. Within 90 days after surgery, all patients were alive. The 5-year overall survival was 64%, median was 73 months. Univariate analysis revealed factors that significantly worsened overall survival: stage III and IV kidney cancer at the time of nephrectomy; nonclear cell histological type of metastases; synchronous liver metastases; intraoperative blood loss more than 2000 ml. Gender, age (≥ 65 years) at the time of surgery, number of metastases, maximum diameter of the metastases, presence of extrahepatic disease and major liver resection did not have a statistically significant impact on overall survival.Conclusions. Surgical treatment allows to achieve long-term overall survival of patients with liver metastases from kidney cancer. Higher indicators of overall survival were noted in the clear-cell variant of kidney cancer, stage I–II, and the metachronic nature of hepatic metastases. Patients with large (≥4 cm) and multiple resectable liver metastases, having solitary and single metastases in other organs, provided that they are radically removed, can also be considered as candidates for surgical treatment.

Hemophagocytic Histiocytic Sarcoma in Dog

Background: Histiocytic sarcoma can present in a localized or disseminated form, being a malignant neoplasm derived from interstitial dendritic cells. Another form of the disease is called hemophagocytic histiocystic sarcoma (HHS), which originates from macrophages located in the splenic red pulp and bone marrow. HHS is a rare neoplasm with unknown etiology and rapid development. It mainly affects middle-aged to elderly animals. It primarily affects the spleen and bone marrow, with occurence of metastases in other organs. Some canine breeds are considered more predisposed to this neoplasia, among them the Rottweiler. The aim of this study was to report a case of HHS in a Rottweiler dog.Case: An 8-year-old Rottweiler suffering from hyporexia and progressive weight loss for a month was attended at the Veterinary Hospital of State University of Maringá. On physical examination, he only presented mild discomfort on abdominal palpation. Blood count was performed, which revealed mild thrombocytopenia (145,000/µL, reference value for the species 150,000-500,000/µL). The Polymerase Chain Reaction (PCR) exam was requested for babesiosis and ehrlichiosis, due to a history of ectoparasites. The animal was released with the prescription of Doxycycline at a dose of 10 mg/kg orally for 28 days. After 5 days, the condition worsened and the animal returned with emesis, apathy and hyporexia, being hospitalized. Abdominal ultrasound, blood count, urinalysis, serum urea and creatinine tests were requested. Among the hematological changes, thrombocytopenia (116,000/µL) and the appearing of regenerative anemia and atypical round cells with ample and slightly basophilic cytoplasm in the smear, similar to histiocytes, stood out. On ultrasound examination, splenomegaly was observed with hypoechogenic areas. Ultrasound-guided fine-needle aspiration cytology (FNAC) of the spleen was performed, which revealed the presence of abundant cellularity consisting of round cells arranged individually and in small groups, with variable nucleus / cytoplasm ratio, slightly basophilic cytoplasm and, sometimes, vacuolized. Eccentric nucleus with chromatin ranging from loose to dense, with evident and often multiple nucleus. In addition, a large number of multinucleated giant cells, mitosis figures (sometimes atypical) and intense anisocytosis and anisocariosis were observed. Furthermore, it was possible to observe erythrophagocytic activity, alterations compatible with histiocytic sarcoma (HS). After 10 days of the first visit, the animal died. At necropsy, samples from altered areas of the spleen, lungs and lymph nodes were collected and sent for histopathological and immunohistochemical examination, in which the diagnosis of hemophagic histiocytic sarcoma was confirmed, in addition to lungs and lymph node metastasis.Discussion: The prognosis of HHS is the worst among histiocytic disorders, as it is associated with coagulopathies and severe anemia due to erythrophagocytic activity, as occurred in the case presented, with a maximum survival time between one to two months. The described animal died ten days after showing the first clinical signs. The immunohistochemistry technique using HLA-DR, CD18, CD163, and CD11d markers was essential to confirm the cell line. Positivity for CD11d marker was found, which allowed to classify the neoplasm as hemophagocytic HS. This report exposes the importance of cytological examination for screening and histopathological and immunohistochemical tests to confirm the diagnosis of this extremely aggressive neoplasm.

The clinical and histopathological features of patients with both uveal and cutaneous melanoma

Introduction: It is unusual to have uveal and cutaneous melanoma in the same patient. It is challenging to differentiate between primary uveal melanoma (UM) and melanoma metastatic to the uvea. Objective: The aim of this study is to evaluate the characteristics of patients who presented with concurrent melanomas (primary or metastatic) of the skin and uveal tract. Materials and Methods: Eleven patients with both uveal and cutaneous melanomas were obtained from the McGill University Ocular Pathology Laboratory database. The characteristics included cell type, number of mitotic figures, presence of necrosis, the time interval between primary and secondary melanoma and the presence of metastasis in other organs. Results: Five patients presented with both primary uveal and primary cutaneous melanoma, three patients with UM metastatic to the skin, and three patients with cutaneous melanoma metastatic to the uvea. In all of our cases, there was a time difference between the appearance of cutaneous and UM in the same patient. Conclusion: Patients with two primary melanomas presented with spindle-cell type (uveal tumor), a Breslow index 7 years between tumors. Systemic disease was negative. Patients with metastasis from cutaneous melanoma to the eye and from ocular to the skin showed epithelioid cell type, a Breslow index >1.5 mm, <5 years between tumors and positive systemic disease.

Survival in patients with surgically treated spinal metastases.

Background:Despite the various treatment protocols available, survival evaluation is a fundamental criterion for the definition of surgical management; there are still many inconsistencies in the literature on this topic, especially in terms of the value of surgery and its morbidity in patients with very short survival.Objective:The objective was to analyze the association of clinical, oncological, and surgical factors in the survival of patients undergoing spinal surgery for spinal metastases (SM).Materials and Methods:A retrospective cohort of forty patients who were surgically treated at our institution for SM between 2010 and 2018 were included in the study. We applied the prognostic scales of Tomita and Tokuhashi in each patient and evaluated the systemic status using Karnofsky Performance Scale (KPS) and Eastern Cooperative Oncology Group Performance Scale. Survival rate in months was estimated using the Kaplan–Meier curve, with death considered as primary outcome and, for the evaluation of the association between the variables, the Chi-square test, Fisher’s exact test, or Fisher–Freeman–Halton test was applied for better survival. The level of statistical significance was considered as 5% (P ≤ 0.05).Results:The mean survival was 8.4 months. Patients with KPS <70 had a mean survival of 6.36 months, while those with KPS >70 had a mean survival of 14.48 months (P = 0.04). The mean survival of patients classified as ECOG 2 was 7.05 months (95% confidence interval [CI]: 3.4–10.7), and that of patients classified as ECOG 3 and 4 was 1.24 months (95% CI: 0.8–1.59). The mean survival rate among the patients with unresectable metastases in other organs was 6.3 months (95% CI: 3.9–8.9), while the survival rate of those who did not have metastases was 13.8 months (95% CI: 10.0–17.68; P = 0.022).Conclusion:Survival was associated with the preoperative functional status defined by the KPS and ECOG scales and with the presence of nonresectable visceral metastases.

Patterns of bone metastases from head and neck squamous cell carcinoma

ObjectiveTo report clinical features of bone metastases (BM) from head and neck squamous cell carcinoma (HNSCC). MethodsAmong 772 patients with HNSCC diagnosed at our hospital over 9 years, 30 patients (3.9%) had clinical evidence of BM (24 men and 6 women; mean age: 63 years). We assessed the time interval from the primary diagnosis to BM development, symptoms attributable to BM, presence of distant metastases to other organs, number of BM, sites of BM, morphologic changes on computed tomography (CT) images, treatment for BM, and overall survival (OS). ResultsBM at the initial stage were found in 9 patients with HNSCC (30%), and in 21 patients (70%) with HNSCC during the course of the disease. In the later patients, the median time interval from the primary diagnosis was 11.5 months. Nineteen patients (63%) did not have BM-related symptoms, 6 (20%) had pain, 3 (10%) had neurologic symptoms resulting from vertebral or skull metastases, and 2 (7%) had hypercalcemia. Seventeen patients (57%) showed bone-exclusive metastases, and 13 (43%) had distant metastases in other organs. Eleven patients (37%) had monostotic metastases (solitary BM), and 19 patients (63%) had polyostotic metastases (multiple BM). When combined, 9 patients (30%) showed bone-exclusive and monostotic metastases. The most commonly affected site was the thoracolumbar spine, accounting for 34% of total BM, followed by the pelvis (24%), shoulder and thorax (21%), and the extremities (17%). Notably, metastases to bones above the clavicle (craniofacial bones and cervical spine) accounted for only 3% of all bone lesions. CT images showed variable morphologic patterns with osteolytic type in 17 patients (57%), intertrabecular in 7 (23%), osteoblastic in 4 (13%), and mixed in 2 (7%). Systematic chemotherapy for BM was performed in 19 patients and radiotherapy in 18. The median survival time for patients with bone-exclusive and monostotic metastases was significantly longer than that for patients with multi-organ metastases or polyostotic metastases at 18.2 months vs. 5.7 months (p=0.02). Neither chemotherapy nor radiotherapy extended OS. ConclusionThirty percent of BM cases from HNSCC showed bone-exclusive and monostotic metastases. These patients tended to show a more favorable prognosis than patients with multi-organ metastases or polyostotic metastases.

Long-term survival after adrenal metastasectomy from colorectal cancer: a report of two cases

BackgroundSolitary adrenal metastasis from colorectal cancer is rare. Adrenal metastasis is usually detected with synchronous multiple metastases in other organs and is, therefore, considered to be unsuitable for surgical resection. The long-term outcomes of patients with solitary adrenal metastasectomy from colorectal cancer have been reported; however, the survival advantage has not been established. We herein report two cases of curative adrenal resection in patients with solitary adrenal metastasis from colorectal cancer who achieved long-term survival of > 9 years without recurrence after surgical resection.Case presentationThe first case involved a 71-year-old man who underwent abdominoperineal rectal resection for rectal cancer. Preoperative CT revealed a mass in the right adrenal, which was growing after surgery. After chemotherapy the adrenal mass decreased in size, and adrenalectomy was performed at 8 months after the first surgery. A pathological examination confirmed metastasis from rectal cancer. The patient received adjuvant chemotherapy and is currently alive without recurrence at 9 years after the adrenalectomy. The second case involved a 53-year-old man who underwent sigmoidectomy for sigmoid colon cancer. Four years later, lobectomy was performed for isolated lung metastasis. Twenty months later, PET-CT revealed solitary metastasis in the left adrenal gland and adrenalectomy was performed. A histopathological examination revealed metastatic adenocarcinoma of sigmoid cancer. Postoperative chemotherapy was administered after adrenalectomy and the patient is currently alive and apparently disease-free at more than 9 years after undergoing adrenal metastasectomy.ConclusionCurative resection for solitary adrenal metastasis from colorectal cancer may be beneficial for survival.

An Unusual Presentation of Metastatic Breast Carcinoma.

Cutaneous metastasis from a carcinoma is a relatively uncommon phenomenon. Prompt diagnosis is crucial, as it will have future implications, particularly regarding prognosis and treatment. Skin metastases can be suspected and recognized earlier through physical examination than metastases in other organs or systems. However, they can be a diagnostic challenge due to the variable clinical presentation. This case highlights the importance of having a high index of suspicion for cutaneous metastases, especially in patients with a previous history of cancer.LEARNING POINTSCutaneous metastases occur in approximately 0.7–10% of patients with invasive carcinomas and, when present, usually indicate an unfavourable outcome.Clinically, cutaneous metastasis can pose a diagnostic challenge and a high index of suspicion is mandatory for a prompt diagnosis.Skin biopsy of such lesions is important to confirm the diagnosis and, in the right clinical scenario, they can provide information on the primary origin of the tumour.

Anti-angiogenesis therapy for the treatment ovarian cancer

The process of angiogenesis is regulated by several growth factors, the most important factor is VEGF which is an important mediator because it facilitates the growth of blood vessels and the remodeling processes. In addition, angiogenesis is significantly involved in tumor progression giving the tumor the necessary supplies for its survival and thus causing metastases in other organs by providing a site of entry to the circulation of vessels blood. The objective of this review is to reflect the fundamental role that angiogenesis has in the development and spread of cancer through vascular endothelial growth factor, its receptors, and its signaling pathways. On the other hand, antiangiogenics strategies (angiogenesis inhibitors) are proposed to fight cancer and clinical trials are presented to verify the survival range of patients who have been treated with anti-angiogenic therapy.

Validation of whole-body radiographs for examining uterine disorders in sexually intact female rabbits.

The present study evaluated whole-body radiographs of female rabbits regarding uterine disorders. Based on radiographs of 143 rabbits, visibility, size, shape and density of the uterus, nutritional status of the animal and possible metastasis in other organs were examined. A suspected diagnosis was deduced. The radiological findings were compared with the results of the histopathological examination. Especially the nutritional status was important regarding the visibility of the genital tract. In 99 of the 130 visible uteri (76.2 %), a pathological alteration was detected. Thereof, endometrial hyperplasia was most frequently seen (63.6 %), followed by neoplasia (altogether 42.4 %, 39.4 % of these with adenocarcinoma), endometritis (35.4 %) and other diseases (18.2 %). Forty-six rabbits showed only one disease, 42 rabbits had two, 10 rabbits three and one rabbit four different diseases. Among 13 of the 143 uteri that were not visible in the radiograph four were altered pathologically. In 31 of the 130 rabbits with a visible uterine region (21.7 %) the uterus was unaltered. Visualising the uterus proved impossible in two of four skinny rabbits (2.8 %), whereas in all 39 obese rabbits the uterus was visible. Only in one of the four skinny rabbits was the uterus without pathological findings and six of the 39 obese rabbits showed no pathological alteration, visibility notwithstanding. Calcification indicated a tumourous occurrence in 23 of 53 cases. Except for one rabbit, the mineralised neoplasia was an adenocarcinoma (n = 22). Five animals with calcification in the uterine region showed no abnormalities. Of these, the calcification of four animals was no longer existent in the radiograph after ovariohysterectomy. Neoplastic changes in the uterus did not always show calcification. In 20 of the 44 patients with uterine neoplasia no calcification was seen. Changes in uterine size occurred in 118 of the 143 rabbits (82.5 %) and alteration of the uterine shape in 109 of the 143 rabbits (67.1 %). Thus, the above presented parameters - especially size, shape and mineralisation - are very important regarding uterine diseases.

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

Background/Aims: Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up. Methods: We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods. Results: The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases. Conclusions: Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.

Serum microRNA-139-5p is downregulated in lung cancer patients with lytic bone metastasis.

Bone remodeling can be interrupted by tumor cells which leads to an inappropriate balance of osteoblasts and osteoclasts. As the progenitors of osteoblasts, mesenchymal stem cells (MSCs) have been reported to exhibit an abnormal osteogenic differentiation potential in some cancer‑related bone lesions. However, the evidence is very limited in terms of the biological alterations of MSCs in the bone metastasis of non‑small cell lung cancers (NSCLC). We investigated the expression and function of miR‑139‑5p in MSC osteogenic differentiation invitro in normal and NSCLC-exposed condition. Then, we compared the serum miR‑139‑5p in stageIV lung adenocarcinoma cancer patients with and without lytic bone metastasis. We found that MSCs exhibited a significant increase in miR‑139‑5p expression after exposure to osteogenic differentiation induction medium. However, Notch1, which was confirmed as a target of miR‑139‑5p by luciferase and western blot assays, showed a marked downregulated expression together with its pathway downstream factors during MSC osteogenesis. miR‑139‑5p positively regulated MSC osteogenic differentiation but this effect was abrogated significantly by Notch1 knockdown. After exposure to conditions of lung cancer cells A549 and L9981, MSCs exhibited significant downregulation of miR‑139‑5p expression and early osteogenic marker ALP activity. Furthermore, we demonstrated that the expression of serum miR‑139‑5p from lung adenocarcinoma patients with lytic bone metastasis was significantly lower compared to that in patients with metastases in other organs. The potential roles of miR‑139‑5p as a biomarker and treatment target in monitoring and controlling bone metastasis in lung cancer patients are worthy of being further explored.

In vivo imaging of T cell lymphoma infiltration process at the colon

The infiltration and proliferation of cancer cells in the secondary organs are of great interest, since they contribute to cancer metastasis. However, cancer cell dynamics in the secondary organs have not been elucidated at single-cell resolution. In the present study, we established an in vivo model using two-photon microscopy to observe how infiltrating cancer cells form assemblages from single T-cell lymphomas, EL4 cells, in the secondary organs. Using this model, after inoculation of EL4 cells in mice, we discovered that single EL4 cells infiltrated into the colon. In the early stage, sporadic elongated EL4 cells became lodged in small blood vessels. Real-time imaging revealed that, whereas more than 70% of EL4 cells did not move during a 1-hour observation, other EL4 cells irregularly moved even in small vessels and dynamically changed shape upon interacting with other cells. In the late stages, EL4 cells formed small nodules composed of several EL4 cells in blood vessels as well as crypts, suggesting the existence of diverse mechanisms of nodule formation. The present in vivo imaging system is instrumental to dissect cancer cell dynamics during metastasis in other organs at the single-cell level.

Isolated pancreatic metastases from renal cell carcinoma: an outcome of a special metastatic pathway or of specific tumor cell selection?

Isolated pancreatic metastases (isPM) are a rare metastasizing pattern in the natural history of renal cell cancer. Their clinical hallmark is that they are confined to a single organ, the pancreas, while all other organs are unaffected for a long time. Almost all workers in the field suggested that mechanical tumor cell propagation to the pancreas may be the mechanism underlying this metastasizing pattern. In 2006 our group, by contrast, proposed an alternative mechanism, i.e. a special affinity of the tumor cells for the pancreas. In the present study an attempt was made to shed more light on the settlement of isPM by reviewing recent literature data. 666 observations of isPM reported in the literature were reviewed. The analyses showed that local lymphatic spread does not play a major role because the lymphatic system is, in general, rarely involved in isPM. This also applies to a local venous spread, because the site of pancreatic metastases is independent of the side affected by the primary renal cancer. But the results are compatible with a systemic metastatic pathway. That metastases in other organs, which would be expected given a systemic spread, are absent can plausibly be explained by a seed and soil mechanism: only the pancreas offers the tumor cell emboli an environment which is conducive to the growth of clinically manifest metastases, while settlement of metastatic tumor cells is prevented in all other organs.

Determinants of prolonged survival for breast cancer patient groups with leptomeningeal metastasis (LM).

The study aimed to assess factors affecting survival of breast cancer patients suffering leptomeningeal metastasis (LM) and to compare survivals in patients with LM as the first and only site of metastases at presentation to patients with LM and metastases in other organs, along with selecting a patient group which had the best survival outcomes. Subject groups consisted of 187 patients consecutively referred during 1999-2015. A Cox proportional hazards model was used to identify factors associated with prolonged survival from LM. The Cox prognostic index was created to identify the group of patients with the most favorable prognosis. Median survival for all patients and for those with LM as the first site of metastases at presentation was 17 weeks and 1 year-survival was 15 and 16%, respectively. Factors beneficially affecting survival were: KPS ≥ 70, older age, biological subtype ER/PR+HER2-, systemic treatment, intrathecal treatment and radiation therapy. Based on these factors, 4 prognostic groups were found, with the most favorable group being 24 LM patients with median survival of 9.6months. In this group, all patients were treated systemically and all were irradiated, 88% had KPS ≥ 70, about 80% had luminal breast cancer, 75% were treated intrathecally and 58% were more than 53years old. Out of 4 prognostic groups of patients with LM, the most favorable group was selected. The median survival of breast cancer patients with the leptomeninges as the only site of metastases was comparable to those who had metastases in the leptomeninges and in other organs.

Urachal adenocarcinoma - case report and literature review

Introduction. Urachal adenocarcinoma is extremely rare and comprises from 0.35% to 0.7% of all bladder tumors. The most common histologic subtype of urachal tumors is adenocarcinoma which can be associated with intestinal metaplasia and mucin production. Case report. We report a case of a 53-year-old patient who attented a urologist because of an intermittent haematuria lasting for three months. The ultrasound examination detected infiltration of the bladder at the fundus, 24 ? 29 mm in diameter. By the same wall, next to the tumor, there was an oval hypoechoic lesion about 40 mm in diameter. Computed tomography scan showed a solid, echogenic, strictly limited tumor at the fundus of the bladder, anteriorly, 32 ? 35 ? 22 mm in diameter which was positive after contrast application. The patient underwent partial cystectomy with complete excision of the tumor lesion 1.5 cm in healthy tissue. Histopathological analysis showed diagnosis of Adenocarcinoma mucinosum vesicae urinariae infiltrans. Patohistological findings detected a part of the urachal wall with a thin layer of fibromuscular tissue, chronic inflammation, microcalcifications in the lumen, flattened and desquamated epithelium. One year after the surgery, there were no signs of primary disease or metastases in other organs. Conclusion. Urachal adenocarcinoma is extremely rare. Long term survival could be achieved by surgical treatment in the early stage of the disease which consists of complete resection of urachal carcinoma and partial or total cystectomy.

Metastasectomy in pediatric patients: indications, technical tips and outcomes.

Pulmonary metastasectomy has become a standard procedure for pediatric patients with certain types of solid tumors. Surgeons, expert pediatric oncologists and radiation oncologists contribute with their different skills to the management of pulmonary metastases. Patients are usually scheduled for surgery in case of primary tumor control, in absence of metastases in other organs and when a complete resection is achievable. Nodules are removed through precision resections using electrocautery or laser methods in order to ensure radical surgery with adequate margins. With these techniques, it is possible to preserve the surrounding parenchyma and cause a limited volumetric distortion as compared with staplers. Anatomical resections (segmentectomy, lobectomy or pneumonectomy) should be reserved for selected cases, since major lung resection can only be justified if it leads to a real oncological advantage. Repeated thoracotomies are possible, since there is no theoretical limit to reinterventions. Surgery of lung metastases has a therapeutic and curative role for some histology with acceptable rate of complications but it finds its role only in an aggressive multimodality approach. Indications can be discussed case by case and exceptions can be evaluated also in presence of different evidences. Children affected by metastatic tumors need to be managed by expert multidisciplinary oncological team in referral center with large experience.