Unusual Site Of Metastasis Research Articles

An Unusual Case of Cardiac and Thyroid Metastasis From Lung Cancer

SESSION TITLE: Non-Small Cell Lung Cancer SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Lung cancer is the leading cause of cancer related death worldwide. It is metastatic in a significant percentage of patients at diagnosis. Common sites of metastasis include adrenals, brain, bone and liver. Uncommon sites include intestine, skin, heart and thyroid. We present a rare case of lung cancer with metastasis to heart and thyroid. CASE PRESENTATION: A 67 year old female presented with cough and hemoptysis for 3 weeks. Computerized tomography (CT) scan of the chest showed right sided lung mass with mediastinal lymphadenopathy. Positron emission tomography (PET-CT) scan showed increased uptake in these lesions, with no other activity outside the chest. Endobronchial ultrasound and biopsy confirmed the diagnosis of squamous cell lung cancer-stage IIIB (T2bN3M0), and she was started on chemotherapy. PET-CT done 2 months after treatment showed improvement in size of lung lesion and mediastinal lymph nodes, but new lesions were identified in the thoracic spine and ribs. Palliative radiotherapy was started in additional to chemotherapy. A PET-CT repeated after 3 months showed progression of disease with enlarging spine lesions and new lesion in the right lobe of thyroid. Thyroid lesion was biopsied and the histological findings were similar to the prior lung biopsy sample. Patient started having hemoptysis again and presented to emergency room. CT chest revealed multiple metastatic lesions in liver, large pericardial effusion and a mass involving the left ventricular lateral wall measuring up to 4.3 cm. Echocardiogram confirmed large pericardial effusion and a large extra-cardiac mass attached to the lateral wall of left ventricle. Given her prognosis and poor response to treatment, she opted for hospice care. DISCUSSION: More than one thirds of patients with lung cancer have spread at the time of diagnosis. Common sites of metastasis from lung cancer include adrenals, brain, bone and liver. Rarely lung cancer can metastasize to intestines, skin, heart and thyroid. Very few cases of cardiac metastasis from lung cancer are reported. Most cases are diagnosed on autopsy. About two thirds of all cardiac metastases involve the pericardium, one third the epicardium or myocardium and rarely the endocardium. Of all the cardiac metastasis, it is adenocarcinoma in 26%, squamous cell carcinoma in 23.4%, undifferentiated in 21.2%, and bronchoalveolar carcinoma in 17.4% of cases(1). Thyroid metastasis from primary lung cancer is an even rarer thing. Common cancers which metastasize to thyroid include colon and kidneys. On extensive literature review, we could find very few cases of lung metastases to thyroid. Our patient had unfortunately two unusual metastatic sites of lung cancer. CONCLUSIONS: Lung cancer can rarely metastasize to locations like heart and thyroid, and we report the only case in literature with combined cardiac and thyroid metastasis. Reference #1: Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol 2007;60:27-34. DISCLOSURE: The following authors have nothing to disclose: Jay Patel, Shejuti Guha, Vishesh Paul No Product/Research Disclosure Information

Soft Palate Metastasis A Rare Site Of Metastasis In TCC Of Urinary Bladder

Majority of the urinary bladder cancers are transitional cell carcinomas (TCC). Transitional cell carcinoma (TCC) of the bladder typically metastasizes to the pelvic lymph nodes and to visceral sites including the lungs, liver, and bones. Other sites include the brain, especially after systemic chemotherapy. To our knowledge, we report the first case of TCC metastatic to the soft tissue of the hard palate and discuss common and unusual sites of metastasis in TCC. JMS 2017;20(1):47-48.

Delineating Extramammary Findings at Breast MR Imaging.

Breast magnetic resonance (MR) imaging is the only breast imaging modality that consistently encompasses extramammary structures in the thorax and upper abdomen. Incidental extramammary findings on breast MR images of patients with a history of breast cancer or other malignancies are significantly more likely to be malignant and may affect staging and treatment. An understanding of the frequency, distribution, and context of extramammary findings on breast MR images and a familiarity with common and uncommon sites of breast cancer metastasis inform the differential diagnosis and prompt the appropriate diagnostic next step, to differentiate benign from malignant findings. High-yield organ systems on breast MR images, as reflected by a high positive predictive value for malignancy, are correlated with known distant sites of breast cancer metastasis in the bone, lung, liver, and lymph nodes. Staging is considered when disease involves the skin and chest wall. Unusual sites of breast cancer metastasis from invasive lobular carcinoma are discussed, including the gastrointestinal tract, peritoneum, and adrenal glands. Nonmalignant clinically important findings involving the cardiovascular and gastrointestinal systems are reviewed, and potential pitfalls in diagnosis and interpretation are highlighted. A consistently systematic diagnostic approach is emphasized for identifying extramammary abnormalities on breast MR images. All things considered, the radiologist should be able to improve diagnostic sensitivity and specificity while interpreting extramammary findings on breast MR images. ©RSNA, 2017.

Long time response with chemotherapy in ROS1 NSCLC patient with unusual metastatic site

ABSTRACTDuring the last decade the therapeutic landscape of Non Small Cell Lung Cancer (NSCLC) has profoundly changed with the identification of actionable genetic alterations that defined molecularly selected subgroups of patients with specific clinic-pathological characteristics and increased sensitivity to specific targeted agents. The presence of ROS1 rearrangements defines a small subgroup of lung adenocarcinomas (∼1–2%) with peculiar clinic-pathological characteristics and increased sensitivity to Crizotinib. It has been reported that ROS1-tranlslocated NSCLCs may also respond well to Pemetrexed-based chemotherapy. Moreover, patients with oncogene-addicted NSCLC may present peculiar pattern of metastatization and, in some instances, are associated with unusual site of metastases. Herein, we present a case of a young woman with bilateral ovarian metastases from a ROS1-positive adenocarcinoma of the lung with a lengthy progression-free survival on Pemetrexed-containing chemotherapy.

Metastatic Renal Cell Carcinoma to the Pancreas: A Review.

The pancreas is an unusual site for tumor metastasis, accounting for only 2% to 5% of all malignancies affecting the pancreas. The more common metastases affecting the pancreas include renal cell carcinomas, melanomas, colorectal carcinomas, breast carcinomas, and sarcomas. Although pancreatic involvement by nonrenal malignancies indicates widespread systemic disease, metastatic renal cell carcinoma to the pancreas often represents an isolated event and is thus amenable to surgical resection, which is associated with long-term survival. As such, it is important to accurately diagnose pancreatic involvement by metastatic renal cell carcinoma on histology, especially given that renal cell carcinoma metastasis may manifest more than a decade after its initial presentation and diagnosis. In this review, we discuss the clinicopathologic findings of isolated renal cell carcinoma metastases of the pancreas, with special emphasis on separating metastatic renal cell carcinoma and its various differential diagnoses in the pancreas.

Clinical pathology of metastatic gastric carcinoma to the breast: A report of two cases and a review of literature.

The breast is an unusual site for metastasis from a gastric carcinoma. The present study reports two cases of metastatic gastric carcinoma to the breast. The first patient, a 37-year-old woman, initially presented with gastric adenocarcinoma, prior to developing metastatic cancer to the breast 4 years later. The second female patient presented with a breast mass, and a modified radical mastectomy was performed; however, the subsequent pathological examination revealed the mass to be a metastatic signet ring cell carcinoma. An abdominal computed tomography scan revealed a diffuse gastric wall thickening that was consistent with gastric cancer. The findings suggest that immunohistochemistry is a useful tool to differentiate between primary breast tumors and gastrointestinal carcinomas that have metastasized to the breast. Additional studies are required in order to define the optimal treatment.

Skeletal Muscle Metastases to the Flexor Digitorum Superficialis and Profundus from Urothelial Cell Carcinoma and Review of the Literature.

Urothelial cell carcinoma (UCC) metastases to skeletal muscle are extremely rare and usually found in patients with advanced stage cancer. The most common sites of bladder cancer metastases are lymph nodes, lung, liver, and bones. Muscle is an unusual site of metastases from a distant primary cancer, due to several protective factors. We present a rare case of 76-year-old patient with metastases in the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) muscles, 2 years after a radical cystectomy for invasive UCC of the bladder. This case is the first description of a forearm lesion, with an extensive infiltration of the volar compartments of the forearm, and the first one with a clear functional impairment.

A Rare Cause of Nasal Obstruction: Metastatic Renal Cell Carcinoma.

Introduction. Renal cell carcinoma can present with several interesting symptoms, paraneoplastic syndromes, and unusual metastatic sites. Head and neck region is one of the rare locations for renal cell carcinoma metastasis. Case Report. A 50-year-old man was admitted to the hospital with nasal congestion and snoring. Physical examination revealed nasal serous secretion. First taken biopsy was misinterpreted. The symptoms of the patient were not revealed and he was readmitted to the hospital. On radiologic examination, a vascular rich mass in maxillary sinus extending to the nasal cavity was observed. Biopsy was diagnosed as renal cell carcinoma metastasis. Herein, we present a patient with renal cell carcinoma presenting nasal obstruction and snoring as first and recurrent symptom.

Pancreas is an Unusual Initial Metastatic Site of Intracranial Hemangiopericytoma

Pancreas is an Unusual Initial Metastatic Site of Intracranial Hemangiopericytoma

Unusual Thyroid Carcinoma Metastases: a Case Series and Literature Review.

The most common sites of metastatic differentiated thyroid cancer are the neck lymph nodes, while distant metastases typically involve the lungs, the bones, and less frequently the brain. Uncommon metastatic sites include the liver, adrenal gland, kidney, pancreas, and skin. The epidemiological aspects of thyroid metastases in rare sites are largely unknown and their identification could have a significant impact on patients management. A mini-series of unusual metastatic sites of thyroid carcinoma is proposed as a contribution to current knowledge on anatomopathological characteristics and clinical outcome. Of the six cases that were assessed, the metastases were the following: skin metastases (2), skin and pancreas metastases (1), renal metastasis (1), adrenal metastasis (1), and liver metastasis (1). In our experience, metastases in rare sites do not always represent a negative prognostic factor for disease outcome. In fact they can occur as single distant lesion and if surgically resectable, their treatment can also lead to local disease remission.

Metastasis of myxoid liposarcoma to fat-bearing areas: A case report of unusual metastatic sites and a hypothesis.

Sarcoma is a rare disease that always metastasizes to the lungs and bones. Myxoid liposarcoma (MLPS), in comparison with other sarcomas, has a distinct biological characteristic. Recent studies have suggested that MLPS expresses high levels of adipophilin and chemokine (C-X-C motif) receptor 4 (CXCR4), which are correlated with adipogenesis and metastasis. In addition, the Ewing sarcoma breakpoint region 1-DNA damage-inducible transcript 3 (EWSR1-DDIT3) fusion transcript, recently identified in MLPS, was shown to selectively repress the osteoblastic transcription in multipotent mesenchymal cells. The present study reported a rare case of MLPS with metastasis in fat-bearing areas, including the bones, epidural region, orbits and abdominal cavity, while the lungs were not involved. Bone metastasis was diagnosed by magnetic resonance imaging and proven by histology. However, bone scanning lacked sufficient sensitivity to detect the bone metastasis. Based on these findings, we hypothesized that molecular adipophilin and molecular CXCR4 may contribute to the fat-bearing area metastasis pattern. Furthermore, the EWSR1-DDIT3 fusion transcript may repress the osteoblastic activity in the bone metastases, ultimately resulting in a low detection rate by bone scans.

2091143 Refractory Papillary Thyroid Cancer: Usual And Unusual Presentations on Ultrasound And Correlation to Other Imaging Modalities

The aim is to review the cervical anatomy, routes of lymphatic drainage, usual and unusual sites of metastases from the refractory papillary thyroid cancer (PTC). The initial imaging diagnosis and management of short and long outcomes is focused on ultrasound and other imaging modalities. A pictorial review of patients with PTC, emphasizing the use of ultrasound before and after treatment. Different imaging methods also illustrate local recurrence, metastases, or incidental findings. Ultrasound plays an important role in the initial diagnosis and management of PTC, mainly on the neck node recurrence. Additional imaging methods may be useful to confirm local recurrence or to detect distant metastases. The indolent course of PTC may induce radiologists and clinicians to underestimate the possibility of recurrent and metastatic lesions. The radiologist must be familiar with the cervical anatomy, routes of lymphatic drainage, sites of metatastases and their imaging findings.

Tonsillar Metastasis of Small Cell Lung Cancer in a Patient With Idiopathic Pulmonary Fibrosis

Small cell lung cancer (SCLC) metastasizes widely, but palatine tonsil is an extremely unusual site for metastasis. Idiopathic pulmonary fibrosis (IPF) is associated with increased risk of lung cancer. However, the most common histological findings among patients of lung cancer with IPF are known as non-SCLC such as adenocarcinoma and squamous cell carcinoma. In addition, the majority of them are located in IPF-associated fibrotic peripheral lesions.A 77-year-old man visited for 1-month persistent cough and dyspnea, with inspiratory dry crackles on both lower lung fields and a large oval mass in his throat. Chest computed tomography revealed 2 masses in the left lower lobe, 1 mass in the right upper lobe, and multiple enlarged mediastinal lymph nodes of the lung accompanying with IPF, which were diagnosed as SCLC pathologically. Very interestingly, the tonsillar mass was also confirmed as the metastatic lesion of SCLC. Chemotherapy for SCLC and medical treatment for IPF were applied. However, in following-up, he expired due to respiratory failure by an acute exacerbation of IPF 3 months after the diagnosis.In this current report, we describe, for the first time, a case of tonsillar metastasis of SCLC with IPF detected simultaneously in a 77-year-old man.

Psoas abscess: a rare metastatic presentation of asymptomatic carcinoma of the cervix

Isolated metastasis to the iliopsoas muscle is rare and is often misdiagnosed as psoas abcess, especially when it is the only presenting feature in the absence of a known primary tumour. A 52-year-old woman presented to us with a clinicoradiological diagnosis of psoas abscess. Initially, the patient was managed as a case of tubercular psoas abscess. However, later on, when the disease had not responded to antitubercular therapy, a cytological examination of aspirated material was performed, which confirmed it as being malignant in origin. While searching for primary malignancy, a small growth on the cervix was noticed. A biopsy and histopathological examination confirmed the diagnosis of squamous cell carcinoma of the cervix. A final diagnosis of squamous cell carcinoma of the cervix with isolated iliopsoas muscle metastasis was proposed. This case highlights an unusual site of metastasis in an asymptomatic primary tumour which was diagnosed retrospectively.

Gastrointestinal stromal tumour with unusual sites of metastasis: Accurate staging with 18F-FDG PET/CT

Gastrointestinal stromal tumour with unusual sites of metastasis: Accurate staging with 18F-FDG PET/CT

Metachronous metastasis of renal cell carcinoma to bilateral testis

Unusual site metastasis as a presenting complaint of renal cell carcinoma (RCC) has been reported previously in the literature. RCC is a tumor with notoriously unpredictable behavior. The authors report an unusual case of metachronous bilateral testicular metastasis in a patient who operated for RCC. The case highlights the unique behavior of RCC with an unusual site of metastasis. A 72-year-old patient presented with bilateral scrotal swelling of 1-month duration. There was a history of left radical nephrectomy for RCC 4 years prior. He underwent a bilateral high inguinal orchidectomy and diagnosis of chromophobe RCC was made on histopathological examination.

Omentum: An unusual site for distant metastasis for post-surgery radiotherapy treated squamous cell carcinoma larynx

Squamous cell carcinoma of the larynx is the most common histologic type, accounting for up to 90% of cancers with more predilections to spread locoregionally to the cervical lymph nodes. Distant metastasis, usually to lungs, bone, and liver is seen much less frequently, with an overall incidence of 6.5–7.3%. A case of 55-year-old male with the previous history of surgery and radiotherapy treated squamous cell carcinoma of the larynx, presenting with a chief complaint of pain abdomen is hereby reported for its unusual diagnosis of metastatic deposits of squamous cell carcinoma in the omentum. Though there are reference available for peritoneum as the distant metastatic site for hypopharyngeal carcinoma, reference for laryngeal carcinoma metastasizing to omentum were not found even with an extensive search of literature. Awareness of unusual sites of distant metastasis such as omentum must be kept in mind for treated laryngeal carcinoma patients presenting with non-specific symptoms like pain abdomen. And also, chances of involvement of unusual site of the distant metastasis increases with advanced tumor-node-metastasis stage and nodal status.

Late Solitary Acrometastasis of the Hands as Unusual Metastatic Site of Renal Cell Carcinoma: A Case Report and Literature Review

Skeletal metastases from renal cell carcinoma (RCC) are common, but its metastasis to the digital extremities is rare. The lesion presents diagnostic and therapeutic challenges because of the mimicry of other benign skeletal diseases resulting in difficulties in prompt recognition of diagnosis. We here report a 62 year-old male patient with RCC metastatic to a metacarpal bone presenting with pain and swelling of left hand after 8 years’ follow-up at stable disease without any recurrences. The pathological cytology from the swelling site revealed findings consistent with metastatic clear cell carcinoma.

Seminal vesicle metastasis from carcinoma lung: A very unusual metastatic site detected with (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography.

Seminal vesicle metastasis from carcinoma lung: A very unusual metastatic site detected with (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography.

Case Report: Mammary and rectal metastases from an ovarian cancer: report of two cases and review of literature.

In this paper we report two interesting cases of metastatic ovarian cancer. The first case is a patient who developed rectal and breast metastases mimicking an inflammatory breast cancer. In the second case, subclinical breast and axillary lymph node metastases were revealed by PET/CT. Metastases in the breast originating from solid tumors are extremely rare. The ovarian primitive is the fourth most common origin. The occurrence of breast metastasis is associated with an advanced disease and a poor prognosis. Their incidence is increasing since they are found more often due to better imaging techniques and to better treatment that, accordingly, improve patients' survival. Thus, unusual sites of metastases are more and more reported. Indeed, some authors reported the occurrence of colorectal metastases from ovarian cancer. However, they remain much less frequent.