Carcinoid tumor metastatic to the tarsal conjunctivae.

A 64-year-old woman who had been diagnosed with carcinoid tumor of the large intestine over a decade earlier presented with an acute right periorbital inflammatory reaction. On examination, 2 disc-shaped, gelatinous masses were noted on the right upper and lower tarsal conjunctivae. Excisional biopsies of these masses revealed metastatic carcinoid tumor. Her total burden of metastatic carcinoid tumor continued to increase during 2 years of follow-up, with new metastatic foci in the right choroid, in the left upper and lower eyelids, and subcutaneously in the neck and chest. Despite a comprehensive treatment approach including radionuclide therapy with the somatostatin peptide analog, Y-DOTATOC, the patient succumbed to the disease and died. The authors report an unusual case of a gastrointestinal carcinoid tumor metastatic to the tarsal conjunctivae, eyelids, choroid, and orbit.

Chemotherapy in metastatic malignant triton tumor: report on two cases.

Malignant triton tumor (MTT) is a rare, highly malignant nerve sheath tumor with rhabdomyoblastic differentiation. Initial debulking surgery followed by adjuvant therapy is the current treatment of choice, but has very limited efficacy when optimal cytoreduction is not achieved by surgical procedure. Neoadjuvant therapy for MTT, to potentially facilitate subsequent surgery, eradicate micrometastatic lesions and, therefore, improve the therapeutical outcome, has never before been presented in literature. Here, we report on the multimodal management of two cases of advanced and metastatic MTT. Treatment modalities involved neoadjuvant and adjuvant chemotherapy, surgical resection, and radiation. In both cases, integrated Positron Emission Tomography/Computed Tomography (PET/CT) emerged as an important diagnostic tool for the reliable assessment of MTT response and metabolic remission.

[Protective silicone prosthesis prior to radiotherapy of recurrent colonic cancer]. / Skjermende silikonprotese ved bestråling for residiv av coloncancer.

Radiation therapy for abdominal recurrence of colon cancer is rarely an option due to subsequent bowel injury. Our case is a woman who underwent resection for a large retroperitoneal recurrence of caecal cancer. Tumour deposits encasing the iliac vessels had to be left behind. A silicone breast prosthesis for displacement of the abdominal content was implanted, allowing postoperative irradiation with 50 Gy. The prosthesis was removed once radiotherapy was accomplished; tumour regression was then complete. Complications are described, so are indications for surgical management of local recurrences of colonic origin as well as technical aspects of abdominal implantation of displacing prostheses. At follow-up after eighteen months the patient has no signs of enteropathy, she enjoys a good quality of life, and she is free of disease. Still, her prognosis is considered uncertain.

Postoperative radiation therapy for adenocarcinoma of the cecum using two fractions per day.

Twenty-one patients with adenocarcinoma of the cecum received post-operative local and regional radiation therapy, using two fractions per day. Six lesions were too extensive for any attempt at removal, and none of these was controlled by the irradiation. However, there have been no local recurrences among the 15 who had all or most of the local tumor excised. This local control rate is significantly better than that reported for definitive surgery alone.

Regional adjuvant irradiation for adenocarcinoma of the cecum.

Forty patients with adenocarcinoma of the cecum who underwent right hemicolectomy received regional irradiation for 40-45 Gy/4-5 weeks and weekly 5-Fluorouracil (5-FU). Thirty-four patients received this adjuvant therapy: 12, 10, 5, 4 with Stage B2, B3, C2, C3, respectively, and 3 with abdominal metastasis. Another six patients were similarly treated for palliation because of tumor bed recurrences. Patients were followed for a median of 4 years, 21/31 patients in the adjuvant group with Stage B and C were free of disease with a median survival of 48 months (63% 5-year actuarial disease-free survival). The total local failure rate among the adjuvant group for Stage B and C was 4/31 (13%) with local failure alone occurring in 1 of 4 patients (3%). In the patients treated at our Hospital, there was significant improvement in the 5-year actuarial survival (p = 0.001) for patients with lymph node metastases who received adjuvant irradiation compared to surgery-alone. Acute radiation enteritis occurred in seven out of 40 patients (17.5%) and was severe in 2 (5%). There were no delayed complications. We conclude that adjuvant therapy markedly lowered regional recurrence and seems to improve survival in patients with lymph node metastasis when compared to a group of patients treated by surgery alone in the same institution.

Postoperative adjuvant chemotherapy and radiotherapy for cancer of the large bowel and rectum.

Forty patients with invasive regional-stage adenocarcinoma of the large bowel and rectum received adjuvant postoperative chemotherapy combined with doses of radiation below the maximal tissue tolerance level. This treatment was reserved for patients with stage B2, C1, and C2 lesions, with only two exceptions. The treatment was well tolerated. It appeared to result in a longer disease-free interval when compared with population-based results for patients with sigmoid cancer who had surgery alone. Our results paralleled those of the Gastrointestinal Tumor Study Group (GITSG) for combined adjuvant therapy of rectal cancer, who also indicated an advantage for long-term survival. Patients who received additional extended chemotherapy had at least the same percentage of favorable outcomes. Tumors above the peritoneal reflection also appeared to share the same improved results. We believe a multicenter randomized study should be performed to evaluate this group of patients.

[Therapeutic management of primary digestive lymphomas at Yaoundé: analysis of a series of 46 cases]. / Prise en charge thérapeutique des lymphomes digestifs primitifs à Yaoundé: analyse d'une série de 46 cas.

The aim of this study was to identify the principal deficiencies and difficulties associated with the treatment of primary digestive lymphomas at Yaounde. We analyzed the medical records of 46 patients treated at Yaounde General Hospital over a period of 7 years (January 1989 to December 1996). The study population consisted of 24 men (52%) and 22 women (48%), giving a sex ratio of 1.08. The mean age of the patients was 49 years (range: 18 to 80 years). The treatment of these patients was not always optimal, due largely to socioeconomic and technical factors. We observed cases of very late diagnosis in which the histological data were imprecise or incomplete, in the absence of modern histological techniques. Assessment of the expansion of tumors was frequently inadequate, due to the absence of scanners or the inability to pay for their use. These problems, and the high cost of chemotherapy and radiotherapy, have severely limited the efficacy of treatment, resulting in poorer responses to treatment than reported elsewhere. In conclusion, national solidarity and cooperation at the regional and international levels seem to be necessary in these clinical conditions, to overcome these obstacles and to improve the quality of treatment for patients in general, and for those with primary digestive lymphomas in particular.

Right gluteal abscess: an unusual presentation of perforated caecal adenocarcinoma.

INTRODUCTION: Colonic cancer presenting as a remote abscess in the gluteal region, abdominal wall, retroperitoneal region, groin or thigh is rare. CASE REPORT: We report a case of advanced carcinoma of the caecum in an elderly lady without bowel symptoms presenting as right gluteal abscess. DISCUSSION: In the differential diagnosis of gluteal/ upper thigh abscess the rare possibility of colonic cancer perforation as a cause should be considered.

Postoperative adjuvant irradiation and 5-fluorouracil for adenocarcinoma of the cecum. A pilot study.

Twenty-one patients with adenocarcinoma of the cecum were treated in a pilot study between October, 1972 and June, 1982 by right hemicolectomy and received adjuvant postoperative irradiation (40-45 Gy/4-5 weeks) and 5-Fluorouracil (5-FU). There were 15, 4, and 2 patients with Stages (Astler-Coller) B2, C2, and D, respectively. There was no major morbidity nor mortality attributable to the adjuvant therapy. Patients were followed for a minimum of 15 months. Fifteen patients are alive and disease-free, with a median survival of 34 months (range, 17-79). There were no significant differences in the median survival or incidence of distant metastases when the adjuvant therapy group was matched by sex, age, and stage of disease with a group of patients treated by right hemicolectomy alone. There was a lower local failure rate in the adjuvant group compared with the surgery-alone group (5% versus 19%) (P less than 0.2). These data suggest that adjuvant therapy for cecal carcinoma is feasible, safe, and may reduce local failures and possibly improve survival in high-risk patients. It deserves further investigation so that a definite conclusion may be drawn.

Adenocarcinoma of the cecum. Analysis of 106 cases.

The natural history of surgically treated adenocarcinoma of the cecum has not been well defined. This report is a retrospective study of 106 patients followed for a median time of 25 months after hemicolectomy. The overall median survival rate was 73 months and the median disease-free survival rate was 37 months; 22 of 106 patients failed locally (21%). In addition, 7 of these 22 patients had distal failure. Thus, there appears to exist a group of patients likely to benefit from adjuvant radiotherapy. Whether total abdominal irradiation or locoregional radiotherapy is the method of choice needs to be further defined.