Review of inbound medical tourism and legal details of obtaining a visa for treatment of head and neck cancer.

BACKGROUND: We aim to provide a review of inbound medical tourism and the legal process of obtaining a visa for medical/surgical treatment for the patients with head and neck cancer. METHODS: We reviewed current statistics and the medical and legal literature regarding inbound medical tourism and the process of obtaining a visa for patients traveling to the United States for medical treatment. To illustrate this process, we present a case of an advanced-staged and disfiguring facial polymorphous high-grade adenocarcinoma in a previously healthy 29-year-old woman from Liberia. RESULTS: This report provides a synopsis of available statistical data on inbound medical tourism and the legal aspects of obtaining a visa for patients seeking medical care from abroad. CONCLUSIONS: Medical tourists traveling to the United States for treatment of head and neck pathologies face considerable barriers in obtaining prompt care, leading to a possible increased disease burden and difficulty in rendering oncologic treatment.

Metastatic Renal Cell Carcinoma to Jejunum: An Unusual Case Presentation.

The small intestine is a very uncommon and peculiar site for metastasis from renal cell carcinoma (RCC). We present a clinical presentation of insidious and unusual development of a jejunal metastasis while having stable disease in a remainder of metastatic sites, in a patient undergoing immunotherapy with nivolumab. Due to the extreme rarity of metastatic renal cell carcinoma to the lumen of the small bowel, it is easy to overlook and misdiagnose symptoms of this pathologic entity, particularly when the remainder of metastatic disease responds well to ongoing therapy.

The use of immunohistochemical expression of SF-1 and EMA in distinguishing adrenocortical tumors from renal neoplasms.

Steroidogenic factor -1 (SF-1) is an orphan member of the nuclear hormone receptor superfamily, and is considered to play an important role in the differentiation of steroidogenic tissues. In this study, we compared the immunohistochemical stains of SF-1 and epithelial membrane antigen (EMA) in non-neoplastic adrenal tissue, and adrenal and renal tumors using tissue microarrays (TMAs). The adrenal tissue array included 19 cases of normal adrenal cortex, 22 cases of adrenal adenoma, and 20 cases of adrenal cortical carcinoma. The renal tissue array included 20 cases of each of the following types of renal cell carcinoma: clear cell, papillary, and chromophobe. In addition, 20 cases of renal oncocytoma were also included in the study. SF-1 showed positive staining in all cases (100%) of normal adrenal cortex and adrenal cortical adenoma, and in 18 (90%) cases of adrenocortical carcinoma. In renal tumors, SF-1 showed negative stains in all of oncocytoma, papillary, and chromophobe renal cell carcinoma. Only 3 out of 20 cases of clear cell renal cell carcinoma showed weak positivity in approximately 10% of tumor cells. EMA stained positively in 85%, 95%, 100%, and 95% of clear cell, papillary, chromophobe renal cell carcinomas, and oncocytomas, respectively. EMA was completely negative in the adrenal TMAs. In conclusion, SF-1 and EMA may be helpful in the differentiation of adrenal tumors from renal tumors in difficult cases.

CDX2 expression in columnar cell variant of papillary thyroid carcinoma.

The columnar cell variant of papillary thyroid carcinoma (CCV-PTC) is a rare subtype of PTC that exhibits morphologic features often described as reminiscent of secretory endometrium or colonic adenomas/adenocarcinomas. CDX2, a nuclear transcription factor, is important for intestinal development. It is normally expressed in intestinal epithelium and is also detected in adenoma and adenocarcinomas of the gastrointestinal tract; however, it has also been reported in tumors of other sites with intestinal-type morphologic features. We evaluated CDX2 expression in CCV-PTC and in a thyroid tissue microarray composed of various benign and malignant thyroid lesions. CDX2 expression was identified in 6 (55%) of 11 cases of CCV-PTC, but not in any other benign and malignant thyroid lesions. We conclude that CDX2 is selectively expressed in CCV-PTC and can be used in distinguishing it from other variants of PTC with overlapping morphologic features.