Solitary pleural metastasis from renal cell carcinoma: a case of successful resection.

While renal cell carcinoma frequently metastasizes to the lung, solitary pleural metastasis without lung involvement is extremely rare. A 69-year-old man was admitted to our hospital with a solitary pleural metastasis 6 years after surgery for renal cell carcinoma. Needle biopsy was performed, and the tumor was diagnosed as a metastasis of renal cell carcinoma. The pleural tumor was surgically resected. The patient received interferon-α as postoperative therapy. He has been alive for 9 years without recurrence. Only 11 cases of solitary pleural metastasis have been reported thus far, and of these, 7 involved a large amount of pleural effusion resulting in a poor prognosis. This is the first reported case of solitary pleural metastasis from renal cell carcinoma, which was curatively resected, as indicated by long-term survival.

[A case of pulmonary actinomycosis in which differentiation of primary and metastatic lung cancers was difficult].

The patient was a 72-year-old woman who had undergone low anterior resection for T2N1M0 stage IIIA colorectal cancer. A chest X-ray examination was performed 10 months later for persistent cough, and a solid nodule was found in S5 on the mediastinal side of the middle lobe. There were no malignant findings on bronchoscopy, but FDG-PET was performed because primary or metastatic lung cancers could not be ruled out. High FDG accumulation was detected with an SUV value of 13.7, and thus surgical resection was performed for diagnosis and treatment. The postoperative diagnosis was pulmonary actinomycosis. Bronchoscopic diagnosis of pulmonary actinomycosis has been found to be difficult in many reported cases. False positivity of other inflammatory diseases on FDG-PET is common, but there are few reports of false positive pulmonary FDG-PET findings in actinomycosis. Therefore, pulmonary actinomycosis should be kept in mind for the differential diagnosis of cases that are positive in FDG-PET.

Sudden death from metastatic esophageal cancer to the ventricular septum.

A 67-year-old man was admitted to our hospital due to esophageal cancer. Cancer existed at the lower esophagus and subtotal esophagectomy and lymphadenectomy was performed. The postoperative course was uneventful. Pathological findings revealed moderately differentiated squamous cell carcinoma that metastasized to the abdominal lymph nodes which include the paraaortic lymph nodes. He complained of anorexia three months after the operation and was found to have multiple liver and mediastinal lymph node metastases. He was admitted for chemotherapy. Before starting chemotherapy, he suddenly died without any sign of hemorrhage or respiratory disorder. Autopsy showed metastatic lesions to the heart and mediastinal lymph nodes, liver, thoracic vertebrae, kidney, adrenal gland and heart. Metastatic nodules in the heart were on the ventricular septum where the conducting system exists. No direct invasion from the pericardium was observed. Blockade of the conducting system of the heart was considered to have caused the severe arrhythmia and sudden cardiac arrest.