Synchronous presentation of muscle-invasive urothelial carcinoma of bladder and peritoneal malign mesothelioma

ABSTRACT Introduction Cancer is one of the most important leading cause of death in man and woman in the world. The occurrence of new cancer has become more frequent in recent years due to strict screening protocols and occupational and environmental exposure to carcinogens. The incidence of secondary malignancies has also increased due to close medical follow-up and advanced age. Herein, we report a case and its management diagnosed as synchronous peritoneal malignant mesothelioma and muscle-invasive urothelial carcinoma. Case Description A 71-year-old male presented with macroscopic hematuria and abdominal distension increasing gradually. A contrast enhanced computerized tomography demonstrated bladder mass and diffuse ascites with nodular peritoneal thickening and umbilical mass. He was treated with the multidisciplinary team working including urologist, medical oncologist and general surgeon. Conclusions To our knowledge, this is the first case of peritoneal malign mesothelioma with synchronous muscle-invasive urothelial carcinoma. Because of the rarity of this condition, there is still no consensus on the definitive treatment protocols, yet. Individualized treatment with multidisciplinary close follow-up might improve the survival outcomes.

Cáncer sincrónico detectado con PET/ CT-Tomografía Computada contrastada (PET/CTc) en 210 pacientes con cáncer colorrectal recientemente diagnosticado / Synchronous tumors detected with contrast-enhanced F18-FDG positron emission tomography/computed tomography (PET/CTc) in colorectal cancer

Background: Colorectal cancer (CRC) is the third most prevalent cancer in the world and is the second cause of cancer death. Positron emission tomography/computed tomography (PET/CT) using 18F-FDG is used for its staging and follow up. Aim: To assess the occurrence of synchronous colonic and extracolonic tumors detected with contrast-enhanced F18-FDG PET/CT (PET/CTc) in patients with a recently diagnosed CRC. Material and Methods: PET/CTc of 210patients aged 16-91, years (63% men) with a recently diagnosed CRC were reviewed. PET/CTc with incidental findings, not expected to be due to CRC, were followed (laboratory, imaging and pathology) searching for synchronous tumors. Results: Ten patients (4,7%) had a second synchronous CRC. Only 70% of synchronous CRC were accessible to colonoscopy, due mainly to incomplete procedures for stenotic tumors. Extracolonic synchronous neoplasms were detected in 12 patients (5,7%), namely lung cancer in three, renal cell carcinoma in two, non-Hodgkin lymphoma in two, pancreatic cancer in one, breast cancer in one, hepatocellular carcinoma in one, bladder cancer in one and thyroid cancer in one. Conclusions: Ten percent of patients with a recently diagnosed CRC had a synchronic neoplasm detected at staging using PET/CTc.

Cáncer sincrónico y metacrónico detectado con PET/CT en población oncológica / Multiple primary malignant neoplasms detected by PET/CT in cancer patients

Background Imaging with F18-fluorodeoxyglucose PET/CT is used to determine sites of abnormal glucose metabolism and can be used to characterize and localize many types of tumors. Aim To assess the prevalence of multiple primary malignant neoplasms (MPMN) detected by PET/CT in cancer patients. Material and Methods F18-fluorodeoxyglucose PET/CT scans performed to 800 patients with a newly diagnosed cancer or with already treated tumors were retrospectively reviewed. In patients whose examination described incidental findings not related to the primary tumor, a research was done about further laboratory, imaging or pathological studies. Results In 188 PET/CT scans (23%) an incidental finding was found. Of these, 66 (35%) were considered as MPMN, 12 as atypical metastases of a known primary tumor, 14 as false positive images (inflammatory or physiologic uptake) and 29 as benign or low grade tumors. In 67 cases (36% of all incidental tumors), the finding was not confirmed. Seven percent of patients with a newly diagnosed tumor had a synchronic MPMN detected by PET/CT. Nine percent of patients with treated tumors developed a metachronous MPMN during their follow up. The most common incidental tumors were thyroid cancer in 15 cases, kidney cancer in 13, lung cancer in 10, colorectal carcinoma in 9, breast cancer in 6, prostate cancer in 4, non-Hodgkin lymphoma in 3 and pancreatic cancer in 2. Conclusions A MPMN is detected by PET/CT in a significant number of cancer patients.

Synchronous conjunctival melanoma and lentigo maligna melanoma

Abstract: Lentigo maligna has an extensive and neoplastic character. It typically progresses slowly and may eventually develop into an invasive melanoma, which is called lentigo maligna melanoma. Ocular melanoma is the second most common type of melanoma. The uvea is the most common site of origin of ocular melanomas, while conjunctival melanoma accounts for about 1-5% of cases. In this article, we describe a rare case of synchronic conjunctival melanoma and lentigo maligna on the face.

Synchronous gynecologic cancer and the use of imaging for diagnosis / Câncer ginecológico sincrônico e o uso da imagem para seu diagnóstico

Summary Endometrial and cervical cancers are the most prevalent gynecologic neoplasms. While endometrial cancer occurs in older women, cervical cancer is more prevalente in young subjects. The most common clinical manifestation in these two gynecological cancers is vaginal bleeding. In the first case, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). The authors present a case of synchronous gynecological cancer of the endometrium and cervix diagnosed during staging on MRI and confirmed by histological analysis of the surgical specimen.

Resumo Os cânceres de endométrio e cervical são as neoplasias ginecológicas mais prevalentes. Enquanto o primeiro ocorre em mulheres mais velhas, o segundo é mais prevalente em mulheres jovens. A manifestação clínica mais comum nestas duas neoplasias ginecológicas é o sangramento vaginal. O diagnóstico do câncer de endométrio é feito a partir da avaliação histológica do endométrio e da avaliação por imagem, enquanto o câncer cervical é diagnosticado clinicamente, de acordo com a Federação Internacional de Ginecologia e Obstetrícia (FIGO). Apresentamos um caso de câncer ginecológico sincrônico de endométrio e cervical diagnosticado durante estadiamento por ressonância magnética e confirmado pela análise histológica da peça cirúrgica.

Synchronous second primary cancers in patients with squamous esophageal cancer: clinical features and survival outcome

BACKGROUND/AIMS: Unexpected diagnosis of synchronous second primary cancers (SPC) complicates physicians' decision-making because clinical details of squamous esophageal cancer (EC) patients with SPC have been limited. We evaluated clinical features and treatment outcomes of patients with synchronous SPC detected during the initial staging of squamous EC. METHODS: We identified a total of 317 consecutive patients diagnosed with squamous EC. Relevant clinical and cancer-specific information were reviewed retrospectively. RESULTS: EC patients with synchronous SPC were identified in 21 patients (6.6%). There were significant differences in median age (70 years vs. 63 years, p = 0.01), serum albumin level (3.3 g/dL vs. 3.9 g/dL, p < 0.01) and body mass index (20.4 kg/m2 vs. 22.8 kg/m2, p = 0.01) between EC patients with and without SPC. Head and neck, lung and gastric cancers accounted for 18.2%, 22.7%, and 18.2% of SPC, respectively. Positron emission tomography-computed tomography (PET-CT) detected four cases (18.2%) of SPC that were missed on CT. Management plans were altered in 13 of 21 patients (61.9%) with detected SPC. Curative esophagectomy was attempted in 28.6% of EC patients with SPC (vs. 59.1% of patients without SPC; p = 0.006). EC patients with SPC had significantly lower 5-year survival than patients without SPC (10.6% vs. 36.7%, p = 0.008). CONCLUSIONS: Synchronous SPC were found in 6.6% of squamous EC patients, and PET-CT contributed substantially to the detection of synchronous SPC. EC patients with SPC had poor survival due to challenges of providing stage-appropriate treatment.

Positron emission tomography detection of synchronous colon cancer in a patient with chronic lymphocytic leukemia

No abstract available.

Tumor híbrido parotídeo / Parotid hybrid tumor

Los tumores de glándulas salivales representan el 3%-10% de las neoplasias de cabeza y cuello. La localización más común es en la glándula parótida, representando el 50%-85% de los casos, siendo 20%-30% de ellos malignos. Los siguientes son indicadores de malignidad: Crecimiento acelerado, masa dolorosa, parálisis facial asociada y linfoadenopatía. La mayoría de las neoplasias de parótida derivan de un único tipo histológico, pero eventualmente puede ocurrir el desarrollo de más de un tipo en la misma glándula. Este trabajo presenta un caso de una neoplasia en parótida con dos tipos histológicos diferentes, con una presentación clínica atípica. El paciente se presentó inicialmente con otalgia y otorrea, al examen destacaba un tumor en el canal auditorio externo. El estudio complementario evidenció una neoplasia de parótida y se realizó resección total de la glándula. La biopsia informó un carcinoma adenoideo-quístico con áreas basaloideas diferenciadas. Se administró radioquimioterapia adyuvante, y el control imagenológico con PET-TC mostró la ausencia de recurrencias o diseminación del tumor.

Tumors of the salivary glands represent 33%-10% of head and neck neoplasms. The most common location is the parotid gland, accounting for 50%-85% of the cases, with 20%-30% of them being malignant. The following are known to be indicative of a malignant tumor: fast growing, painless mass, associated facial paralysis and lymphadenopathy. Most parotid neoplasm derive from a single histological type but eventually the development of more than one type on the same gland can occur. This paper presents a case of a parotid neoplasm with two different histological tumors, with uncharacteristic clinical presentation. The patient presented initially with ear pain and otorrhoea, in the clinical examination highlighted an external auditory canal tumor. The complementary study revealed a parotid neoplasm and a total resection of the gland was performed. The biopsy revealed an adenoid-cystic carcinoma with differentiated basaloid areas. Adjuvant radio-chemotherapy was administered, and the imaging control with PET-CT showed no evidence of recurrence or dissemination of the tumor.

Neoplasias insospechadas detectadas en pacientes que se realizaron PET/CT de cuerpo entero / Clinically unexpected malignant disease detected by whole-body PET/CT

La técnica híbrida PET/CT ha sido utilizada en el estudio inicial y seguimiento de neoplasia malignas, con óptima relación costo/beneficio.El objetivo de este trabajo fue evaluar la aparición de neoplasias no sospechadas en pacientes que se realizaron un PET/CT de cuerpo entero en nuestro Servicio.Método: Se revisaron 354 PET/CT realizados entre enero de 2009 y enero de 2010, registrándose aquellos exámenes de cuerpo entero que detectaron una neoplasia no sospechada, que no tenía relación con la indicación del examen.Resultados: Se pesquisaron 11 neoplasias no sospechadas en 11 pacientes que fueron derivados para estudio de otra patología, 9 de ellos con otro cáncer en etapificación o seguimiento.Los tumores pesquisados fueron Ca pulmonar (2), Ca tiroides (2), meningioma (2), Ca páncreas (1), Ca colon (1), TMPI Páncreas (1), Ca endometrio (1), y Ca mama (1).La ocurrencia de neoplasia detectada incidentalmente en la población total fue de 4,4 por ciento (11/252 excluyendo PET/CT por control de tratamiento), y en la población oncológica de4,2 por ciento (9/216 excluyendo pacientes no oncológicos y PET/CT controles).En conclusión, el PET/CT es de gran utilidad en el estudio inicial y seguimiento de pacientes oncológicos, permitiendo además pesquisar un segundo tumor primario

PET/CT has been in the initial study follow-up of malignant tumors, shown optimal cost/benefit relation. The purpose of this study was to evaluate the occurrence of unexpected malignancies in patients who realize a PET/CT whole-body scan. Methodology: A total of 354 PET/CT scans were done from January 2009 to January 2010. The scans in which an unexpected malignancy was detected, that unrelated to the primary indication of exam, were recorded. Results: Eleven unexpected neoplasm were discovered in 11 patients, 9 of them with a known cancer in initial staging or follow-up. Tumors encountered were lung cancer (2), thyroid cancer (2), meningioma (2), pancreatic cancer (1), colon cancer (1), IPTM of the pancreas (1), endometrial cancer (1), and breast cancer (1).The occurrence of incidentally neoplasm in total group was 4,4 percent (11/252 excluding follow­up PET/CT scans 4,2 percent in oncologic population (9/216 excluding non oncologic patients and follow-up scans). In conclusion, PET/CT is a very helpful imaging procedure in the initial study and follow up of oncologic patients, allowing to detect a second primary malignancy

Combined hepatocellular and cholangiocarcinoma: CT findings with emphasis on multiphasic helical CT.

OBJECTIVE: To describe CT findings of patients with combined hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) in correlation with clinical data and histopathological results. MATERIAL AND METHOD: Ten from 31 cases whose CT study was available were reviewed retrospectively in the aspect of imaging findings, clinical data, and pathological results. RESULTS: Most of the tumors were hypodense solitary mass with gradually enhanced after contrast administration. Bile duct dilatation was observed in two cases. The overall CT findings were more similar to CC rather than HCC despite the pathological result showing predominant HCC component. Serum alpha-fetoprotein level was normal or mildly elevated while an elevated concentration of carbohydrate antigen 19-9 was observed. Hepatitis profiles showed positive to hepatitis B virus infection in four cases and hepatitis C virus infection in one case. CONCLUSION: The diagnosis of combined HCC-CC should be considered if the tumor has similar findings to CC without bile duct dilatation on cirrhotic liver and the patient has normal or low rising of the AFP level with or without elevated CA 19-9 level. In non-cirrhotic liver, the finding is non-specific.

Diffuse hepatic hemangiomatosis in an adult

Diffuse hepatic hemangiomatosis without extrahepatic lesions is extremely rare in adults. A case of diffuse hepatic hemangiomatosis involving right lobe in a 50-year-old woman was presented. The hemangiomatosis was demonstrated by ultrasonography, computerized tomography (CT) and magnetic resonance image (MRI), and was confirmed histopathologically. Although diffuse hepatic hemangiomatosis is a rare disease in adults, its diagnosis should be considered in patients with diffuse tumor growth in one or both hepatic lobes and distinguished from malignant tumors. The present case is the first documented case of diffuse hepatic hemangiomatosis in an adult in Korea.

Diffuse hepatic hemangiomatosis in an adult

Diffuse hepatic hemangiomatosis without extrahepatic lesions is extremely rare in adults. A case of diffuse hepatic hemangiomatosis involving right lobe in a 50-year-old woman was presented. The hemangiomatosis was demonstrated by ultrasonography, computerized tomography (CT) and magnetic resonance image (MRI), and was confirmed histopathologically. Although diffuse hepatic hemangiomatosis is a rare disease in adults, its diagnosis should be considered in patients with diffuse tumor growth in one or both hepatic lobes and distinguished from malignant tumors. The present case is the first documented case of diffuse hepatic hemangiomatosis in an adult in Korea.