Cutaneous Metastasis of Sigmoid Adenocarcinoma to Face and Scalp at Initial Diagnosis: Case Report.

Cutaneous metastases from colorectal cancer are very rare. They appear in less than 0.5% of colorectal metastatic cases at time of initial diagnosis. They indicate disseminated disease and poor prognosis. We describe a case of 54 years old patient who presented with scalp, face and upper back cutaneous metastatic lesions derived from sigmoid cancer, 9 months prior to his initial diagnosis. Final diagnosis of cutaneous metastasis of sigmoid carcinoma was made based on fine needle aspiration cytology. An index of suspicion should be maintained with a low threshold for biopsy for any cutaneous nodule in patient with malignancy.

Brain Metastasis from Colorectal Adenocarcinoma: A Case Report.

Colorectal cancer (CRC) is the third leading cause of cancer death in the Western world, accounting for approximately 140,000 new cases and more than 51,000 deaths in 2010 in the United States. In Kuwait, CRC is the first most-diagnosed neoplasm among males and overall, the second leading cause of death from cancer. The 5-year survival rate in 2002-2004 was 61% for men and 62% for women. Even after complete resection of the colorectal tumor, distant metastases have been noted to develop in 10%-15% of patients. Of all metastases, those to the liver were found in 20%-30% of cases, and to the lung, in 10%-20%; brain metastases are quite rare. The percentage of CRC patients developing brain metastases during the course of their disease is reported to range from 2% to 12%, but the effect of such metastases on the patient's prognosis is significant. With the advent of new targeted therapies and the resulting improvements in outcome for CRC patients, the management policy for brain metastases has changed. Regardless of the therapy used to address brain metastases, reported median survival ranges from 2.8 months to 6 months. We report a case of brain metastasis in a patient of primary colorectal adenocarcinoma. He was evaluated for convulsion, CT findings showed brain metastasis.

Acute transient cerebral toxicity associated with administration of high-dose methotrexate.

OBJECTIVE: To report the first case of transient central nervous system toxicity after administration of high-dose methotrexate (HDMTX) in the Middle East. CLINICAL PRESENTATION: A 10-year-old boy was diagnosed with osteosarcoma of the proximal end of the left tibia. He underwent primary amputation and was started on adjuvant chemotherapy, which included administration of HDMTX. He developed acute cerebral toxicity after the 5th dose of HDMTX in the form of diplopia, seizures and disorientation. He recovered completely without any complication or neurological sequelae. CONCLUSION: The acute cerebral toxicity associated with HDMTX was completely reversible and without any sequelae.

High survival rate in childhood non-Hodgkin lymphoma without CNS involvement: results of BFM 95 study in Kuwait.

Non-Hodgkin lymphomas (NHL) in children are the second most common malignant tumors in Kuwait. Until 1995 the patients (pts) received institutional protocols. From October 1995 to September 2000 21 children with NHL were treated. Five children were treated by NHL BFM 90 protocol, 7 pts received NHL BFM 95 scheme, and 9 children underwent therapy abroad or according to different types of protocols. The results of a retrospective analysis of NHL BFM 95 protocol in Kuwait are reported. Seven patients diagnosed with NHL--group B: 3 children with Burkitt lymphoma (B-cell NHL) and group A: 4 children with lymphoblastic lymphoma (T-cell NHL)--were treated from October 1995 to September 2000 in the Kuwait Cancer Control Centre according to NHL BFM 95 protocol. Group B consisted of 2 girls and 1 boy; median age at diagnosis was 4 years 8 months, 2 pts classified as stage II and 1 pt as stage III. All patients were assigned to risk group R2. Median follow-up is 2 years 8 months. Group A included 1 girl and 3 boys; median age at diagnosis was 5 years 8 months, 1 pt classified as stage III and 3 pts as stage IV. All patients were assigned to IR group. Median follow-up is 3 years 6 months. In group B all 3 pts are in 1st CR; in group A 3 pts are in 1st CR and 1 pt having Li-Fraumani syndrome died after the 3rd relapse of disease during therapy. In both groups there was no toxic death, myelotoxicity WHO grade III-IV, hepatotoxicity WHO grade II-III. Treatment results of NHL BFM 95 study in our small group of patients are very optimistic. Six patients are in 1st CR and one died due to progression of disease. Despite the small group of patients, the results suggest that NHL BFM 95 protocol is highly effective and safe with regular supportive care.