Unilateral Metastasis Research Articles

Classification and regression tree analysis for prediction of recurrence risk in patients with surgically resected lymph node-positive penile cancer

Objective: To assess the risk of recurrence in patients with surgically resected lymph node-positive penile cancer by classification and regression tree (CART) analysis. Methods: The medical records and follow-up data of sixty patients with surgically resected lymph node-positive penile cancer between 1990 and 2008 were retrospectively analyzed. The node-related prognostic factors were collected, such as the number of positive lymph nodes, unilateral or bilateral lymph node metastasis, pelvic nodal involvement and extranodal involvement. The CART analysis was used to generate a regression tree model for identifying recurrence risk of surgically resected lymph node-positive penile cancer, and the tree was validated in this study population. Results: The regression tree model for predicting different recurrence risk of patients with surgically resected lymph node-positive penile cancer was generated by CART. The positive lymph-node number and the extranodal involvement were both important prognostic factors. The patients with node-positive penile cancer were divided into four groups according to recurrence risk classified by CART. The survival curves showed the distinct difference in recurrence-free survival among these four gourps (P＜0.05). Conclusion: A regression tree model generated by CART can accurately identify and classify the recurrence risk of patients with surgically resected lymph node-positive penile cancer, and this regression tree may aid individualized decision-making in clinical practice. DOI:10.3781/j.issn.1000-7431.2011.07.014

A national population-based study provides insight in the origin of malignancies metastatic to the ovary.

A significant proportion of ovarian malignancies consists of metastatic tumors, with a wide variety in site of origin. Differentiating between a primary and metastatic malignancy of the ovaries can be difficult and misdiagnosis might have considerable impact on both treatment and prognosis. To further examine the origin of malignancies metastatic to the ovary, we performed a large-scale, nationwide search for ovarian metastases in the Dutch Pathology Registry (PALGA). All pathology reports concerning malignancies metastatic to the ovary and associated primary tumors in the Netherlands between 2000 and 2010 were collected. Age, year of diagnosis, tumor type, location of the primary tumor, and side of the ovarian tumor were extracted from the database. We identified 2312 patients fulfilling our selection criteria. The most common primary malignancy sites were colon (33.2 %), endometrium (17.1 %), breast (14.3 %), appendix (7.3 %), and stomach (4.5 %). The metastases were most frequently bilateral (46.3 %) followed by unilateral metastases in the right (26.7 %) and left ovary (19.8 %), while side was unknown in 7.2 % of cases. Of colorectal carcinomas, only 40.2 % metastasized bilaterally, compared to 63.9 % of breast, 62.9 % of gastric, and 58.9 % of appendix carcinomas. Left-sided colorectal carcinomas most often metastasized to the left ovary (p < 0.0001). We found colon carcinomas to be most frequently responsible for metastases to the ovaries, followed by endometrial and breast carcinomas. Metastases from breast, stomach, and appendix carcinomas were mostly bilateral, whereas metastases from colorectal carcinomas were mostly unilateral. The mechanisms underlying preferred sites for metastasis or side remain unclear.

Prostatic carcinoma presenting as unilateral proptosis - a rare case report

Adenocarcinoma of prostate typically involves axial skeleton and has been infrequently reported in unusual sites like orbit. It is noteworthy that upto 1989, only 28 cases of occulo-orbital metastases of prostate cancer (PC) had been reported in the literature [1] . PC is mostly known to metastasize to the bony skeleton [2] . The lack of skeletal metastasis does not exclude the possibility of visceral/ distant metastasis, and serum PSA levels usually do not correlate with the extent of metastatic disease [3] . Here in, we report a rare case of unilateral orbital metastasis from PC.

Unilateral breast metastasis from alveolar rhabdomyosarcoma in adult detected by 18F-FDG PET/CT

Unilateral breast metastasis from alveolar rhabdomyosarcoma in adult detected by 18F-FDG PET/CT

Results of surgical treatment of colorectal cancer liver metastases in Latvia oncology center.

485 Background: Colorectal cancer (CRC) is the third leading cause of cancer death. At the time of diagnosis 25% of patients present with stage IV disease and out of all CRC patients 50% develop liver metastases. About 15% of them have initially resectable disease. Surgical resection is the best treatment option as it is associated with longer survival. Latvia Oncology center (LOC) provide expertise in managment of all cancers, including metastatic CRC. Methods: Data about CRC patients with surgicaly treated liver metastases was colected and analysed from Latvia Oncology center in period 2011-2014. This data is also included in LiverMetSurvey international registry of patients operated for CRC liver metastases. 66 patients underwent hepatectomies, 10 patients had 2 or more surgeries due to a reccurent disease. Results: 77 surgeries were performed, 31 were hemihepatectomies and 46 were limited resections. Sinchronous surgery for liver metastases and primary tumor were performed in 19 cases: 11 for left colon cancer, 6 for rigt colon cancer and 2 for rectal cancer. Initially resectable liver disease was found in 70 cases. Unilateral metastases were diagnosed in 61 cases while there were 17 cases of bilateral disease. Postoperative complications developed in 18 patients, 5 of those after sinchronous surgeries for primary tumor. In 10 cases complications developed after major anatomical right sided hemihepatectomy and in 8 cases after atypical resections. Most frequent hepatic complications were infected collection in hepatic loge (n=9), non infected collection (n=3) and biliary leak (n=3); all of those were successfully treated with percutaneous dreinage. 1 patient died due to a postoperative liver insufficiency after right sided hemihepatectomy for recurrent disease. Conclusions: Overall 77 hepatectomies were performed, mostly limited non anatomical resections. In majority of patients 1 or 2 metastases were diagnosed. Initally resectable were 89% of cases. Mass of postoperative complications developed after major hepatectomies, were liver related and successfully treated with minimally invasive procedures. Complication rate (16%) in LOC is comperable to other Europian centers.

The value of preoperative 18F-FDG PET/CT for the assessing contralateral neck in head and neck cancer patients with unilateral node metastasis (N1-3).

The purpose of this study was to determine whether preoperative (18) F-FDG PET/CT is useful in assessing contralateral lymph node metastasis in the neck. A retrospective review of medical records was performed. Patients treated at a single institute. One hundred and fifty-seven patients whose pathology results were positive for unilateral node metastasis (N1-3) involvement and underwent preoperative (18) F-FDG PET/CT for head and neck squamous cell carcinoma (HNSCC) were reviewed. Prognostic factors and nodal SUVmax were studied to identify the risk of contralateral disease. Thirty-six (22.9%) patients had contralateral cervical lymph node metastases. The (18) F-FDG PET/CT had a sensitivity of 80% and a specificity of 96% in identifying the contralateral cervical lymph node metastases on a level-by-level basis. The median SUVmax values of the ipsilateral and contralateral lymph nodes were 3.99±3.36 (range, 0-20.4) and 2.94±2.04 (range, 0-8.7), respectively (P=0.001). There was a significant difference in the median SUVmax of contralateral nodes between the benign and malignant cervical lymph nodes (2.31±0.62 versus 3.28±2.43, P=0.014). The cut-off value of contralateral median SUVmax in the context of contralateral cervical metastasis was 2.5 with the sensitivity of 75% and the specificity of 94%. A median contralateral lymph node SUVmax ≥2.5 was associated with 5-year disease-specific survival (P=0.038). (18) F-FDG PET/CT median SUVmax cut-off values of contralateral lymph nodes ≥2.5 were associated with contralateral cervical lymph node metastases and 5-year disease-specific survival in HNSCC patients with unilateral metastases.

Prognostic significance of the number of positive lymph nodes, number of involved regions and metastatic lymph node ratio in hypopharyngeal cancer

To explore the relationship between positive lymph node number, involved region, positive lymph node ratio and the prognosis of patients with hypopharyngeal cancer. Clinicopatological data of 81 patients with hypopharyngeal squamous cell carcinoma who underwent hypopharyngectomy and cervical lymph node dissection from January 2000 to December 2005 in our hospital were analyzed retrospectively. The relationship between positive lymph node number, involved region, positive lymph node ratio and the prognosis was analyzed. The rate of lymph node metastasis was 79.0% (64/81) in the 81 patients with hypopharyngeal cancer. Of which, the rates of unilateral metastasis and bilateral metastasis were 82.9% (53/64) and 17.1% (11/64), respectively. The rate of lymph node metastasis was increasing with advancing tumor stage. The median survival times were 81, 51 and 26 months in the patients with 0, 1-3 and ≥ 4 positive lymph nodes, respectively (P < 0.001), 84, 45 and 23 months in patients with 0, 1-2 and ≥ 3 involved regions, respectively (P < 0.001), and 84, 51 and 17 months in patients with positive lymph node ratio of 0, <10% and ≥ 10%, respectively (P < 0.001). Multivariable analysis showed that positive lymph node ratio, extracapsular infiltration, T classification and treatment modality were independent prognostic factors (P = 0.002). Positive lymph node ratio is an independent prognostic factor for hypopharyngeal cancer.

Metastatic Esophageal Squamous Cell Carcinoma in the Kidney

Metastases from esophageal cancers represent only 4.8 per cent of secondary renal tumors. The kidney is known to be the 4th or 5th most common visceral metastasis site of esophageal carcinomas. More than 50% of renal metastases typically show bilateral involvement. Solitary, unilateral renal metastasis is extremely rare. Therefore, the diagnosis of renal metastases is very difficult. We report a case of solitary unilateral renal metastases in an esophageal squamous cell carcinoma in a 66 year old man’s autopsy.

Unilateral metastases in the lower limb as a first presentation of prostatic carcinoma

Like most other solid malignancies, prostate cancer can metastasize to distant organs, it has an unusually high propensity for metastasizing to the bone. It prefers the axial skeleton and takes a significant toll on the male population in both morbidity and mortality. In some rare cases presentation of prostate cancer can differ.

Unilateral Adrenal Metastasis From Non–Small-Cell Lung Cancer Demonstrating Very High FDG Uptake With a Standardized Uptake Value in Excess of Sixty

We report the case of a 52-year-old man who presented with a 2-week history of dyspnea and wheeze. CT scan of the chest showed a large soft-tissue lesion in the right main bronchus extending into the trachea. Pathologic examination of endoscopic tracheal biopsies showed features consistent with a non–small-cell lung carcinoma. 18F-FDG PET/CT showed very high uptake of FDG in the bronchial tumor (high standardized uptake values: 25.1) and unexpected very intense uptake in the left adrenal gland (high standardized uptake values: 62.5). Laparoscopic adrenalectomy was performed, and subsequent histopathological examination confirmed metastatic non–small-cell carcinoma in the adrenal gland. Although adrenal malignancies are generally metabolically active, such high uptake of FDG within a metastatic lesion has not been reported previously.

Hand-Assisted Thoracoscopic Surgery for Bilateral Lung Metastasectomy Through Sternocostal Triangle Access

Complete resection of pulmonary metastases remains the standard of care for selected patients. An open approach causes criticism because of aggressiveness. Without manual palpation the video-assisted thoracic surgery procedure has the high probability of missing occult metastases. Transxiphoid bilateral lung metastasectomy surgery has not been widely adopted. We developed a hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through natural sternocostal triangle access in 2001 to solve the problems mentioned previously. We retrospectively evaluated 55 consecutive patients between 2001 and 2009 who underwent hand-assisted thoracoscopic surgery through sternocostal triangle access for pulmonary metastasis. Complications after operation, operative time, operative bleeding, air leak days, length of stay, preoperation imaging examination, and survival rate were evaluated. Fifty-five patients had lung metastases. Bilateral explorations were performed in a total of 51 patients, with a total of 201 minimal resections and one lobectomy. Nearly half of the patients with bilateral metastases were misdiagnosed as unilateral metastases by imaging examination. Intraoperative cardiac arrhythmia was experienced in 5.2% of the right and 10.5% of the left approaches. Postoperative complication rate was 3.6%. Three-year and five-year overall survival rates for metastatic disease were 59.8% and 47.2%, respectively. This new surgical procedure, with an assisted hand, could complete bilateral pleural exploration in a single operation through the natural sternocostal triangle. It is easy to perform and may help the patients gain a faster rehabilitation. Furthermore, it may lead to a better survival.

Unilateral ovarian metastasis in a case of squamous cervical carcinoma IA1

Ovarian metastasis from early-stage squamous cervical cancer is rare. We report a case of unilateral ovarian metastasis from squamous cervical cancer IA1. Although ovarian metastasis from early-stage squamous cervical cancer is rare, gynecological oncologists should not overlook its possibility.

Bilateral ophthalmoplegia due to symmetric cavernous sinus metastasis from gastric adenocarcinoma

We report a patient with rapidly progressive bilateral total ophthalmoplegia due to bilateral cavernous sinus metastasis from gastric adenocarcinoma. Among a variety of differential diagnoses, etiology of oculomotoric disorders and ophthalmoplegia includes the affection of the cranial nerves III, IV, and VI in the cavernous sinus. Unilateral metastasis in the cavernous sinus occurs quite frequently, however, a bilateral tumor infiltration of both cavernous sinus is extremely rare. Our patient impressively demonstrates the relevance of this differential diagnosis of bilateral ophthalmoplegia. Repeated CCTs and cMRIs were required to find the diagnosis and finally start a therapy, demonstrating that even with advanced neuroradiological techniques, repetition of imaging within short intervals can be necessary to detect rapidly developing metastatic infiltrations as early as possible.

Prognostic factors and long-term results of pulmonary metastasectomy for pediatric histologies☆

Pulmonary resection in metastatic pediatric solid tumors is an accepted method of treatment. The purpose of this study was to determine the clinical course, outcome and prognostic factors after surgery. A retrospective analysis from 1985 to 2006 of 52 patients less than 17 years old at the time of tumor diagnosis and submitted to thoracotomy for pulmonary metastatic disease was performed. Three had nodules excised which proved to be benign at histology and were excluded from further analysis. There were 28 males and 21 females with median age of 13.2 years [2-36] at the time of metastasectomy. The primaries were osteosarcoma (25), Ewing's sarcoma (6), Wilms' tumors (4), hepatoblastoma (3) and miscellaneous (11). Pulmonary metastases were encountered either at the time of initial diagnosis (18%) or occurring within 1 month to 22 years. Disease free interval (DFI) was equal or less than 2 years in 31 (63%) patients and more than 2 years in 18 (37%). Patients had one (24), two (16), three (2), four or more (7) metastasectomies resulting in a total of 95 thoracotomies. Wedges (75%) were performed more frequently than anatomic resections (25%). The number of resected metastatic nodules ranged from 1 to 45, median 3. There were no perioperative deaths. There were six complications: pneumothoraces requiring chest tube drainage in two cases. Resection was incomplete in four cases. The mean drainage time and hospital length of stay were 2.7 and 5 days, respectively. Using the date of pulmonary resection as the starting point, 5-year survival rate was 25%. By univariate analysis, we found that a significantly longer survival was observed for patients with a complete resection (p=0.004), with two or less metastases (p=0.0004), with unilateral metastases (p=0.001) or when the DFI was more than 2 years (p=0.003). By multivariate analysis, we showed that the number of pulmonary metastases was an independent predictor of survival. We conclude that resection of pulmonary metastases of pediatric solid tumors is a safe and effective treatment that offers improved survival benefit in carefully selected patients within a multidisciplinary approach for pediatric cancer. Prognosis related criteria that support patient selection for surgery are identified.

Localización del ganglio centinela en el carcinoma escamoso de pene. Experiencia inicial

ObjectiveTo assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma Material and methodsFifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months. ResultsIn the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group. ConclusionsRadioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma.

Localization of sentinel node in squamous cell carcinoma of the penis. Initial experience

Objective To assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma. Material and methods Fifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months. Results In the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group. Conclusions Radioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma.

Trudności diagnostyczne w przebiegu mięsaka polimorficznego krtani

Malignant fibrous histiocytomas (MFH) of the upper respiratory tract are rare, aggressive mesenchymal neoplasms. Ultrastructurally MFH consisted of five different types of cells. It occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. There have been sporadic laryngeal cases reported in the literature. We report a case of a glottic malignant fibrous histiocytoma on a 45 year old man. There was difficulty to find finally diagnosis. Pathologic and immunohistochemical evaluation revealed tumor a few months after first symptoms. There was unilateral metastases into the neck lymph nodes. Immunohistochemical staining was positive for F13a, CD68 and negative for desmin and cytokeratin. Wide, aggressive excision of the tumour with total larygectomy to be the treatment of choice because it was difficult to prove clinically and pathologically that it was MFH. Unilateral neck dissection was done due to metastases into the neck lymph nodes. Radiation have been used after surgery. About two years after total laryngectomy the patient is well and free of disease.

Abomasal and Uterine Adenocarcinomas with Ovarian Metastasis in a Captive elk (Cervus Elaphus Nelsoni)

A captive, 20-year-old female elk (Cervus elaphus nelsoni) euthanized due to progressive lameness and weight loss was presented to Colorado State University Veterinary Diagnostic Laboratory for postmortem examination. Within the uterus there was a poorly demarcated, multilobulated mass measuring 10 cm in diameter. Histologically the tumor was an adenocarcinoma. Histologic examination of the ovaries revealed unilateral metastasis. A focal, 1-cm diameter adenocarcinoma was identified within the abomasum; this tumor was histologically distinct from the neoplasm found in the uterus and ovary. Although this elk had a history of experimental reproductive treatments, including leuprolide, gonadotropin-releasing hormone vaccine, and Brucella abortus vaccination, it was most likely that both tumors represent spontaneous, independent neoplastic transformations and were unrelated.

Breast metastasis of ilial carcinoid tumor: Case report and literature review

BackgroundMetastatic breast carcinoids are rare neoplasms. They can be mistaken for primary breast carcinoma both clinically and radiologically, even with known history of carcinoid tumor elsewhere in the body.Case presentationWe report a case of unilateral breast metastasis from carcinoid tumor of the small intestine in a 52-year-old woman who was successfully treated by lumpectomy and radiation therapy. An extensive review of the literature reveals only a few cases of metastatic carcinoid to the breast from small intestinal primaries.ConclusionClinical suspicion for metastasis should be high in a patient with breast mass and history of known carcinoid elsewhere in the body. Lumpectomy alone may be effective in these patients. Mastectomy and especially axillary dissection could be avoided. Their histological appearance may mimic ductal adenocarcinoma of the breast. However, the distinction is important due to differences in management and prognosis.

Toxicity and Efficacy of Isolated Lung Perfusion with Gemcitabine in a Rat Model of Pulmonary Metastases

Long-term toxicity and efficacy of isolated left lung perfusion (ILuP) with gemcitabine (GCB) were studied in a rat model of metastatic pulmonary adenocarcinoma. Forty rats were randomized into six groups and administered 160 or 320 mg/kg GCB or buffered starch, received either via intravenous injection (i.v.) or via ILuP. Efficacy experiment: Rats with unilateral metastases had ILuP with 320 mg/kg GCB (maximally tolerated dose administered by ILuP), while rats with bilateral metastases had an i.v. injection of 160 mg/kg GCB (maximally tolerated dose given by i.v.). TOXICITY experiment: After i.v. treatments, all rats receiving 320 mg/kg GCB died within one week, while rats who had received 160 mg/kg GCB had a survival rate of 60%. After ILuP with 160 mg/kg GCB and 320 mg/kg GCB, survival rates were 83% in both groups. A significant increase in collagen deposits was observed for ILuP with 320 mg/kg GCB compared to rats treated i.v. with 160 mg/kg GCB. Efficacy experiment: Median survival of ILuP rats treated with 320 mg/kg (38 +/- 4 days) was significantly longer compared to i.v. rats treated with 160 mg/kg (27 +/- 2 days; p = 0.02). ILuP with GCB prolongs survival in experimental metastatic adenocarcinoma while no major acute or long term toxicity is observed.