Unusual Site Of Metastasis Research Articles

Skeletal Muscle Metastases from Breast Cancer: Two Case Reports

The skeletal muscle is an unusual site for metastasis from breast cancer. We present two cases of breast cancer that relapsed as skeletal muscle metastasis without other distant organ metastasis. We performed the core needle biopsy of metastatic sites and confirmed discordance in estrogen receptor, progesterone receptors, and human epidermal growth factor receptor 2 expression between primary breast cancer and skeletal muscle metastases. In the second case, we found the skeletal muscle metastasis through F-18 fluorodeoxyglucose positron emission tomography/computed tomography scans (PET/CT). Intramuscular hot spots on PET/CT scans should be considered as a sign of metastasis even in the absence of abnormalities on computed tomography scans. Our patients received systemic chemotherapy, and showed a partial response. Further studies are needed to determine the prognosis and proper management of isolated skeletal muscle metastasis in breast cancer.

Bladder metastasis from primary breast cancer: a case report and literature review.

Breast cancer is the most common malignancy in woman. The urinary bladder is an unusual site for metastasis from primary tumors of the breast, especially when it is the only organ involved. We present the case of a female patient with known breast cancer stage T2N3M0 who developed isolated bladder metastasis five years after the primary diagnosis. We reviewed the literature for similar cases and discussed the clinical presentation, pathophysiology, and prognosis of this entity.

Breast metastasis from carcinoma of gall bladder

Carcinoma of gall bladder has early lymphatic and haematogenous spread. Most common extra abdominal site of metastasis is the lung. Metastasis to breast from carcinoma of breast is very rare. Our case describes an interesting case of carcinoma of gall bladder metastising to breast. A 50-year-old female presented to our outpatient department with a small nodule on upper outer quadrant of left breast. Patient had a history of cholecystectomy done for symptomatic gall stones 2 years back. Histopathological examination of the gall bladder specimen showed adenocarcinoma of the gall bladder with invasion to lamina propria. No additional treatment was offered to the patient. The breast nodule was excised and sent for histopathological examination. Histopathological examination revealed metastising adenocarcinoma. Patient was subjected to palliative chemotherapy (Gamcitabine and carboplatin). However, patient died of hepatic encephalopathy after 5 months. Our case reports an unusual site of metastasis from carcinoma of gall bladder which is very rare.

Second Primary Malignant Neoplasms: A Clinicopathological Analysis from a Cancer Centre in India

Patients diagnosed with a cancer have a life time risk of developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Of late the detection of new primary has increased mainly due to refinement in both diagnostic and treatment modalities. Cancer victims are surviving longer and thus are more likely to develop a new metachronous malignancy. To report our observed trend of increase in prevalence of both synchronous and metachronous second malignant neoplasms among cancer victims and to review the relevant literature. A hospital based retrospective collection of prospective data of patients diagnosed with second denovo malignancy. The study was conducted over a 5 year period from July 2008 to June 2012. All patients diagnosed with a histologically proven second malignancy as per Warren Gate's criteria were included. Various details regarding sex, age at presentation, synchronous or metachronous, treatment and outcome were recorded. The occurrence of multiple primary malignancies is not rare. Awareness of the possibility alerts the clinician in evaluation of patients with a known malignancy presenting with unusual sites of metastasis. Individualizing the treatment according to the stages of the primaries will result in durable cancer control particularly in synchronous double malignancy.

Colon Adenocarcinoma Metastatic to the Distal Extremity

Cutaneous metastases from colorectal carcinomas are rare manifestations of widespread metastatic disease with poor prognosis. Unusual sites of cutaneous metastasis have been reported in the literature [1–13]. To the authors’ knowledge, this case will be the second case of skin metastasis to the distal leg in colon cancer in the literature. In our case, making the correct diagnosis was challenging because the metastatic soft tissue was superinfected. It is important to recognize suspicious skin lesions in cancer patients as a possible metastatic disease to the skin. Biopsy is very important because the gross appearance of these skin lesions is not distinctive.

Metastatic hepatocellular carcinoma presenting as gynecomastia in male: A diagnostic dilema in fine needle aspiration cytology

Metastatic hepatocellular carcinoma presenting as gynecomastia in male: A diagnostic dilema in fine needle aspiration cytology

Vulvar Metastasis From Bilateral Lobular Breast Carcinoma

INTRODUCTION: The invasive lobular carcinoma is the second most frequent pathological type of breast cancer, accounting for about 5-10% of breast carcinomas. Recent studies suggest an increase in incidence in relation to invasive ductal carcinoma, especially in women over age 50. The CLI has characteristic patterns of metastasis, showing the most commonly bilateral and metastases to peritoneum, gastrointestinal tract, gynecological organs, bone marrow and leptomeninges. The case reported below refers to a patient treated at the Hospital Aristides Maltez - BA, in 2002. REPORT: C. L. S. , 77 years old woman, sent to Mastology department by the Gynecology’s sector from the Hospital Aristides Maltez on 03/09/2010, whose main complaint was a lump in the vulva for 03 years. The patient had noted a small lump in the vulva for about 03 years, with faster growth in the last 06 months. Vulvar examination showed bulging of the right labia majora with almost complete erasure of the small ipsilateral lip. Hard and irregular mass of about 2.5 x2, 0cm in the right labium, which bulged the vaginal opening. We performed an incisional biopsy of that lesion which was consistent with invasive carcinoma with standard immunohistochemistry resembling ductal carcinoma of the breast. Under evaluation by mastologist there were no founds to inspection, there was a palpable dense area of about 02cm in upper outer quadrant (UOQ) right breast as well as in the union of the upper quadrants (UUQ) in the left breast, another nodule in the left breast measuring 01 cm fibroelastic consistency in UOQ. In the left axilla there was a lymph node measuring 01 cm with fibroelastic consistency. There was no nipple discharge. Mammography showed focal asymmetry in right breast union of lower quadrants (ULQ), Bi-Rads 0. Left breast presenting benign vascular calcifications, Bi-Rads 2. Ultrasound showed a heterogeneous hypoechoic poorly delimited area, measuring about 13. 3 x 6, 7mm, which may correspond to solid nodule in the right breast. The left breast showed a hypoechoic heterogeneous area in UUQ, measuring 10. 3 x7, 5mm. We performed core needle biopsy of palpable areas, the result was compatible with invasive lobular carcinoma in both breasts. The staging tests were normal, except for the chest x-ray showed diffuse interstitial infiltrate predominating in lung bases. The patient died before starting treatment due to respiratory complications. DISCUSSION: This case is relevant to show an unusual site for metastasis from infiltrating lobular carcinoma. It also shows the importance of inclusion of mammary carcinoma in the differential diagnosis of vulvar diseases.

Metastatic signet ring cell adenocarcinoma of the bladder: responsive to treatment?

Signet ring cell variant of mucinous adenocarcinoma of the urinary bladder is an exceptionally rare urologic malignancy, generally felt to be resistant to chemotherapy and radiotherapy. We describe a case of this malignancy with unusual sites of metastasis and an unexpectedly good response to treatment.

Colonic metastasis from carcinoma cervix: an unusual cause of intestinal obstruction

Intestinal obstruction is a rare complication after pelvic radiotherapy for carcinoma cervix. Metastasis from carcinoma of the uterine cervix to the gastrointestinal tract is uncommon. We report a case of a 36-year-old woman who was treated by concurrent chemo-radiation for stage II B carcinoma of the uterine cervix. Five years later, she presented with acute intestinal obstruction. A laparotomy revealed a metastatic growth in the transverse colon, which was resected. The colon is an unusual site for metastasis from carcinoma cervix, and it has to be differentiated from a primary squamous cell carcinoma of the colon. Resection of the metastatic lesion may help palliate acute intestinal obstruction, and possibly prevent a perforation, which can rapidly become fatal.

Metastasis of Colorectal Adenocarcinoma to the Thyroid: A Case Report and Review of the Literature

Purpose. We present a rare case of colorectal metastasis to the thyroid five years following primary colonic resection. This case highlights the need to be cognisant of unusual sites of metastasis from colorectal neoplasms. Case Report. An 82-year-old male patient had a panproctocolectomy for synchronous colorectal tumours. Five years later he was found to have lung and thyroid metastases found incidentally on imaging for an acute presentation with small bowel obstruction. Conclusion. Metastases to the thyroid should be considered in the differential diagnosis of the thyroid lesion with any history of malignancy, particularly with increasing patient age and when renal cell carcinoma or lung, colon, or breast primaries are involved.

Unusual Sites of Extrapulmonary Metastases of Osteosarcoma After Several Lines of Treatment

The authors report a case of peritoneal and chest wall metastases in a 17-year-old boy previously diagnosed of femur osteosarcoma with metastases in the lung and bones. Although the patient achieved complete remission after initial treatment, he presented with lung metastasis 15 months after initial diagnosis. They were resected 3 times and he received second-line chemotherapy with gemcitabine and docetaxel. However, 31 months after initial diagnosis he presented with abdominal and chest wall masses. In this report the authors discuss clinical outcomes and how unusual sites of metastasis are being increasingly reported after the use of new treatments.

Site métastatique atypique d’un adénocarcinome bronchique

The case concerns a 40 years old smoker male, treated for an adenocarcinoma of the left upper lobe, metastatic in muscle extended to the right femur cortex. The patient had first a surgical excision of the mass of the thigh, an intramedullary femoral nailing, and six courses of chemotherapy (cisplatin-vinorelbine) with concurrent thoracic radiotherapy. This treatment led to disease stability. One year later, hematuria revealed a bladder tumor. Cystoscopy with biopsy concluded to an adenocarcinoma pulmonary origin. The PET-scanner showed an uptake of the bladder mass, a hypermetabolic right adrenal gland and subcutaneous left shoulder nodule. The patient had a partial cystectomy associated with enterocystoplasty and left ureteral reimplantation, plus excision of the subcutaneous nodule located in the left shoulder and a right adrenalectomy during the same time. All of the sites were metastasis from adenocarcinoma of pulmonary origin. A salvage chemotherapy was initiated. In the vast majority of cases, bladder metastasis as primary bladder tumours is revealed by hematuria, cystitis or sometimes vague pelvic pain. Our case is a very unusual bladder metastatic site from lung cancer. We will discuss the different procedures and the therapeutic strategies on the basis of the published data.

Unusual Features of Gastrointestinal Stromal Tumor on PET/CT and CT Imaging

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. It can be benign or malignant in behavior. Stomach, being the most common site (70%) for GISTs, is followed by the small intestine (20%). Anorectal, colonic, and esophageal GISTs are uncommon, whereas extraintestinal GISTs are extremely rare. The presenting symptoms are highly dependent on tumor size and location, although a large number of GISTs are asymptomatic. The purpose of this article is to highlight the unusual characteristics of GISTs illustrated by PET/CT and CT imaging. These characteristics are organized into (1) unusual tumor location, (2) unusual clinical presentation, and (3) unusual sites of metastasis. Knowing the uncommon features of GISTs is important, as they are more often seen nowadays with the increasingly important role of PET/CT and CT in GIST management; and these tumors are associated with a poorer prognosis and unwanted delay in diagnosis is avoidable. With the availability of effective treatment by imatinib mesylate, a prompt and early diagnosis is essential for disease control. All GISTs illustrated in this article are pathologically proven.

Nasal metastases from renal cell carcinoma are associated with Memorial Sloan-Kettering Cancer Center poor-prognosis classification

Unusual sites of metastases are recognized in patients with renal cell carcinoma (RCC). However, the prognostic implications of these sites are not well understood. We used the Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification for metastatic RCC to evaluate 912 consecutive patients with RCC managed at the Singapore General Hospital between 1990 and 2009. Among these patients, 301 had metastases either at diagnosis or during the course of illness. Nasal metastases, all arising from clear cell RCC, were identified histologically in 4 patients (1.3% of those with metastasis). All 4 patients were classified as MSKCC poor prognosis by current risk criteria. Nasal metastases were significantly associated with lung and bone metastases. The frequency of nasal metastases in patients with metastatic RCC is about 1 %, occurring predominantly in patients with clear cell RCC. Nasal metastases are associated with poor prognosis as estimated by the MSKCC risk classification, with attendant implications for selection of targeted therapy, and are usually associated with multi -organ dissemination, including concurrent lung and bone involvement.

FDG PET–CT in detection of diaphragmatic metastasis of dedifferentiated liposarcoma: A case report

Dedifferentiated liposarcoma is an aggressive soft tissue disease, with a prognosis critically depending on a timely detection of the primary and metastatic lesions. We present here a rare case of diaphragmatic metastasis from a recurrent liposarcoma of the colon, demonstrating the important contribution of FDG PET and CT imaging to disease management: FDG PET/CT imaging allowed the identification of this unusual metastatic site and a complete clinical remission by the surgical excision of the lesion. These data support the systematic inclusion of FDG PET/CT scans in the follow-up of high-grade soft tissue tumors.

Lung carcinoma metastasis presenting as a pineal region tumor

The pineal region is an unusual site for brain metastasis and most metastatic pineal lesions are asymptomatic. A 53 year-old man presented with severe headache, limitation of upward gaze and diplopia. The patient's neurological examination was unremarkable. Magnetic resonance imaging (MRI) scans of the brain demonstrated a 1.5 x 2 cm well demarcated solitary mass in the pineal region with hydrocephalus. Surgery was performed and adenocarcinoma was diagnosed. A systemic investigation revealed adenocarcinoma of the lung as primary lesion. Although rare, metastatic tumor should be considered in the differential diagnosis of pineal region tumors.

Zygomatic Metastasis From Breast Cancer

Breast cancer continues to be the second most common cancer among women, after nonmelanoma skin cancer; in the United States, there is an average lifetime risk of 11% for developing a breast malignancy. Metastatic tumors from distant primary foci to the maxillofacial (MF) region are reported to account for only 1% of all MF malignancies, usually with grave prognosis. In the MF region, the bones more frequently involved in metastasis are the mandible, maxilla, temporal bone, frontal bone, and malar bone; the soft tissues more affected are gingiva, parotid gland, tongue, submandibular gland, and cheek. We describe a unique case of a solitary mass found in the body of the right zygoma, revealing a metastasis from breast cancer. According to the literature, the zygomatic complex is a very unusual site for metastasis; we found only 4 cases of metastatic localization from lung, rectum, liver, and uterine cancer. In MF region, oral and nasal cavity has been described as atypical sites of metastasis from breast cancer; this is to our knowledge the first recorded instance of malar metastasis from breast cancer.

Variation of Safety for Tracheal Regeneration with iPS Cells

METHOD: In this retrospective case series performed at a tertiary care center, four patients treated for papillary thyroid cancer between September 2009 and February 2010 were found to have unusual sites of metastases. We report on this series and perform a review of the current literature regarding typical sites of spread. RESULTS: Metastatic papillary thyroid cancer was found in the following locations: 1) within the sternocleidomastoid muscle, 2) occipital skin, skull, dura, and within the internal jugular vein, 3) retropharynx, and 4) in the right atrium. Review of current literature demonstrated the most common locations of regional metastases are level VI (77%), followed by level III (69%), level IV (66%), and level II (46%) of the deep cervical chain. CONCLUSION: Our patients novel sites of metastatic disease have not been depicted in previous reports. In our series all patients with unusual metastatic disease had a more aggressive course, more aggressive histology, less iodine avidity, and had worse outcomes. Although this disease most often spreads to the deep cervical chain, atypical sites of distant metastases should always be considered in patients presenting with a new mass who have known history of papillary thyroid cancer.

Metastatic Breast Cancer to the Bladder – case report and review of literature

The main cause of mortality among patients with breast cancer is the metastatic spread of the primary tumour. The urinary bladder is considered as an unusual site for breast cancer metastasis. A patient has presented with right breast tumour and qualified for surgical treatment. After removal of the mass, an intra-operative and final pathology evaluation indicated breast invasive lobular carcinoma. Adjuvant chemotherapy was given. Years later, an increase of serum CA15-3 tumour marker level was noted and physical examination revealed a lump at the mastectomy scar. A follow-up abdominal ultrasound scan demonstrated thickening of the urinary bladder wall segment, confirmed later by CT scan. A transurethral resection of bladder was performed, reaffirming a neoplastic mass, with histological assessment revealing invasive breast carcinoma. Palliative chemotherapy was given and another follow-up ultrasound scans were unremarkable. The patient is alive today.

Metachronous contralateral testicular and bilateral adrenal metastasis of chromophobe renal cell carcinoma: a case report and review of the literature

Chromophobe renal cell carcinoma (ChRCC) metastatic to the testis has not, to the best of our knowledge, been reported in the literature. Nor have there been reports of delayed bilateral adrenal metastasis of ChRCC. Here we report a case of metachronous contralateral testicular and bilateral adrenal metastasis of ChRCC in a 70-year-old man who underwent right radical nephrectomy for RCC six years ago. He was admitted to the hospital because of left intrascrotal enlargement of two-month duration. Ultrasonography revealed a mass in the upper pole of the left testis. Computed tomography (CT) showed irregular masses in the bilateral adrenal area. Left radical orchiectomy and laparoscopic bilateral adrenalectomy were performed. The pathologic examination showed metastatic ChRCC in the left testis and bilateral adrenal gland. Postoperative follow-up showed that the patient had survived for at least 56 months without recurrence. The case highlights the unique behavior of RCC with an unusual site of metastasis and favorable survival after multiple metastasectomy.