Small bowel intussusception caused by multiple intestinal metastases from a giant cell carcinoma of the lung: a case report.

Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

Small Bowel Intussusception Caused by Multiple Intestinal Metastases from a Giant Cell Carcinoma of the Lung: a Case Report.

Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

Jejunal intussusception caused by metastasis of a giant cell carcinoma of the lung.

A 55-year-old woman was admitted to our hospital reporting of nausea, vomiting and anorexia. One month before admission, she had been diagnosed with lung cancer with intestinal metastasis. A CT scan confirmed intussusception due to intestinal metastasis and she underwent emergency laparoscopic surgery followed by resection of the primary lung cancer. Histopathological findings of the intestinal specimen suggested the metastasis was from a giant cell carcinoma of the lung, which had extensive necrosis. She was still alive without recurrence 11 months after the first surgery. Giant cell carcinoma of the lung is a rare type of non-small cell carcinoma and intestinal metastasis is one of the unique features. This type of tumour has such aggressive characteristics that oncological prognosis is reported to be extremely poor. In our case, however, complete surgical resection of both primary and metastatic tumours might result in a better outcome than has been reported.

Characteristics and Prognostic Analysis of 69 Patients With Pulmonary Sarcomatoid Carcinoma.

BACKGROUND: Pulmonary sarcomatoid carcinoma (PSC) is a rare malignancy. METHODS: A total of 69 patients with PSC treated at a single institution in southern China with long-term follow-up were evaluated in this study. We analyzed the clinical characteristics, immunohistochemical profiles, epidermal growth factor receptor mutation status, K-RAS mutation status, treatments, and prognosis. RESULTS: PSC mainly occurred in young male patients with a history of smoking. Most patients received multimodality treatments and the majority had early-stage disease. The median survival time was 19.1 months, and the 5-year survival rate was 17.4%. The patients without distant metastasis, with normal or higher body mass index (≥18.5), with normal hemoglobin, with smaller tumor size (≤4 cm), and those who received complete resection had significantly better overall survival (P<0.05). The patients with pleomorphic carcinoma had much worse prognosis. In a Cox regression model, M stage, pathology, and having received a complete resection were independent prognostic factors (P<0.05). CONCLUSIONS: PSC is a unique lung malignancy with poor prognosis. Patients receiving complete resection had better prognosis, likely a reflection of early-stage disease. Neither neoadjuvant nor adjuvant chemotherapy improved patient survival for those with early-stage disease. The retrospective design and small sample size limited the generalizability. Future multicenter collaborations may be necessary to determine the optimal treatment.

Solitary muscle metastasis from lung carcinoma.

Recurrence after resection of non-small cell lung carcinoma is generally associated with a poor outcome. Limb muscle metastasis from lung cancer is extremely rare. We present a case of a 71-year-old man who presented with a solitary metastasis to his right lower limb two months after right upper lobectomy for lung cancer (stage: T2N0M0). Twenty-four months after surgical excision and chemotherapy he is alive without signs of neoplastic disease. We believe that a more aggressive approach might be considered for selected patients with solitary extracranial and extra-adrenal metastasis from lung cancer.

Study on the metastatic mechanisms of human giant-cell lung carcinoma comparison between the strains C and D.

The biologic characteristics of the two human giant-cell lung carcinoma strains with high (strain D) and low metastatic potential (strain C) were studied, including karyotype of chromosome, intracellular free calcium ([Ca2+]i), morphologic changes of cell surface and the expression of nm23-H1, p53, ras, c-myc, c-erbB2, bcl-2 genes and PCNA. The correlation between different biologic features and the metastatic potential of the two strains was analyzed. We found: 1) Both strains had the karyotypic abnormality of -13, -14, -15, +20, +21 with seven same marker chromosomes. Only strain D had the karyotypic abnormality of +7, -17, -18, +X, 7p+; 2) [Ca2+]i of the strain C (984.7 +/- 573.8) and D (517.6 +/- 216.6) was significantly different (p < 0.05). The amplitude of intracellular calcium oscillations of strain C was lower than the one of strain D; 3) strain C had more villous-like protrusions on the cell surface, whereas strain D had more bubble-like protrusions; 4) The expression of nm23-H1 and p53 protein of strain C was all higher than that of strain D. The expression of PCNA of strain C was lower than strain D; 5) nm23-H1 mRNA levels of strain C was lower than that of strain D. We consider that the karyotype of chromosomes, intracellular free calcium, the structure of cell membrane and the expression of nm23-H1 gene, p53 gene, PCNA could be closely related to the metastatic potential of human giant-cell lung carcinoma. They could be used as the sign for judging whether the tumor will metastasize in clinical practice as well as in judging the prognoses of patients.

[The expression of 67-KD laminin receptor (LN-R) gene in PG tumor cells with high metastatic potential].

The expression level of 67-KD LN-R mRNA was observed in high-metastatic PG tumor cells and low-metastatic PAa tumor cells based on the cDNA fragments of 67-KD LN-R amplified by PCR technique and the specific cDNA probe prepared by random primer labeling method. Results showed that the transcripts were homologous in size, about 1.7kb, in PG and PAa tumor cells. The 67-KD LN-R mRNA level was higher in PG than that in PAa tumor cells, and gene amplification was also more marked in PG tumor cells. After treated with 67-KD LN-R monoclonioal antibody (50, 100 and 400 micrograms/ml) for 48 hours, LN-R mRNA of PG tumor cells decreased significantly. It is suggested that 67-KD LN-R may play important roles in metastatic processes of PG tumor cells.

[Function of IL-18 in promoting metastasis of lung cancer].

OBJECTIVE: To study the function of IL-18 in promoting metastasis of lung cancer. METHODS: The differential expression of IL-18 protein or mRNA level between highly and poorly metastatic sublines of human lung giant cell carcinoma metastatic model was detected by Western blot, semi-quantitative RT-PCR and northern blot analysis. The poorly metastatic PLA801C subline or highly metastatic PLA801D subline was transfected with constructed IL-18 sense or IL-18 antisense expressed plasmid by lipofectamine stable transfection technique. The metastasis-related effect mediated by IL-18, the metastatic phenotype differences, cell motility and cell invasion potential in vitro determined by MICS system and the expression level of metastasis-associated biomarkers detected by Western blot analysis, were compared between IL-18 stably transfectants and mock control, i.e. between PLA801C/IL-18(S) and PLA801C/pcDNA3.1, or between PLA801D/IL-18(As) and PLA801D/pcDNA3. RESULTS: IL-18 was only present in highly metastatic PLA801D subline at either protein or mRNA level, which implied that IL-18 might play a role in promoting metastasis of lung cancer. After IL-18 sense expressed plasmid was transfected into poorly metastatic PLA801C subline, IL-18 fused protein with myc tag detected by Western blot analysis using either IL-18 or myc tag monoclonal antibody. In addition, cell motility ability in vitro was significantly increased about 3 times and E-cadherin protein was significantly down-regulated at about 50% in PLA801C/IL-18(S) transfectants compared with mock control. While IL-18 expressed plasmid was transfected into highly metastatic PLA801D subline, IL-18 protein and mRNA were simultaneously decreased by 30%. In addition, cell invasion ability in vitro was significantly decreased at about 75% and E-cadherin protein was significantly up-regulated in PLA801D/IL-18(As) transfectants compared with mock control. CONCLUSION: IL-18 might play a role in enhancing tumor metastasis of lung cancer by down-regulating E-cadherin protein expression.

[Differentially expressed genes in human giant-cell lung cancer lines with different metastatic potentials].

OBJECTIVE: To screen genes differentially expressed in two human giant-cell lung cancer lines of same origin but with different metastasis potentials. METHODS: Suppression subtractive hybridization (SSH) was done twice on two giant-cell lung cancer lines, PLA-801C and PLA-801D (hereafter abbreviated as C and D), of same origin but with low (C) and high (D) metastatic potentials. In the first round, SSH C was used as tester and D as driver, while in the second round, the tester and driver were interchanged. The sequences acquired from both rounds of SSH were spotted on glass slides respectively and screened by hybridizing with two-color fluorescence probes. Clones that had different expression levels on chips were also confirmed by RNA dot blot or Northern blot. RESULTS: There were 16 sequences with high expression in C as compared to those in D, and 79 sequences with high expression in D compared to those in C. After sequencing, most of them were found to be highly homologous to those encoding the following proteins: (1) cytokines and their receptors; (2) kinases and related proteins; (3) other proteins including enzymes, heat shock proteins, receptors, proteins of cell skeleton and mitochondria, products of oncogenes, etc; (4) some proteins deduced from gene sequences with yet unknown functions. CONCLUSION: The alterations in expression of some known genes, including HSP70, AXL receptor tyrosine kinase and 14-3-3zeta, might have impact on metastasis of giant-cell lung cancer. Whether some differentially expressed genes newly revealed are metastasis-related needs further study.

[A study on the correlation between the activity of 72,000 type IV collagenase and the metastatic potential of cancer cells].

OBJECTIVE: To evaluate the enzyme activity of 72,000 type IV collagenase and its relationship with the metastatic potential of cancer cells. METHODS: The levels of secreted 72,000 type IV collagenase in the conditioned media of five human cancer cell lines with different metastatic potential and a normal lung fibroblast strain treated with cancer cell culture media were examined by gelatin zymography and densitometric analysis. RESULTS: The levels of 72,000 type IV collagenase secreted by cancer cells with high metastatic potential (PG, WM451 and WM983a) were higher than those secreted by cancer cells with low metastatic potential (PAa and WM35). In the conditioned media of fibroblasts which were treated with the culture media of PG and WM451, enhanced levels of activation were observed. CONCLUSION: The secretion of 72,000 type IV collagenase is closely correlated to the metastatic potential of cancer cells. The cancer cells with high metastatic potential may possibly through certain soluble mediators stimulate normal fibroblasts to activate 72,000 type IV procollagenase.

[Effects of TIMP-2 gene transfection on biological behaviors of a metastatic human lung carcinoma cell line].

OBJECTIVES: To explore the suppressive effects of tissue inhibitor of metalloproteinase 2 (TIMP-2) on malignant phenotype of human carcinoma cells and to evaluate its potential application in cancer gene therapy. METHODS: A man malian expression vector containing TIMP-2 cDNA was constructed and transfected into a metastatic human lung carcinoma cell line PG. In vitro and in vivo tests such as Northern blotting, immunohistochemistry as well as x enografting in nude mice experiment were used to analyse expression levels of TIMPs and MMPs, in vitro and in vivo behaviors of the tumor cells before and after the gene transfection. RESULTS: After transfection, the TIMP-2 mRNA expression was upregulated significantly. Changes, in some malignant phenotypes of the transfectants were seen. For instance, the abilities of in vitro invasion through Matrigel, colony formation on soft agar, tumorigenecity as well as spontaneous metastasis in nude mice were remarkably decreased. Immunohistochemical staining and in situ hybrydization showed that MMP2, MMP9, TIMP-1 and TIMP-2 were expressed by both tumor cells and stromal cells, with stronger staining at the site of tumor invasion. CONCLUSION: Up-regulation of TIMP-2 in tumor cells could suppress their expression of malignant phenotype and could be used for cancer therapy.

[The suppressing effect of TIMP-3 gene transfection on the invasion and metastasis of human lung carcinoma cells line].

OBJECTIVE: The purpose of this study is to determine if increasing levels of tissue inhibitor of metalloproteinase 3 (TIMP-3) expression could suppress the malignant phenotype of human cancer cells. METHODS: The recombinant expression vector, which contains full length cDNA of human TIMP-3, was constructed and transfected into BE1 cell line by lipofectin technique. The invasive and spontaneous metastatic potential was examined. RESULTS: TIMP-3 mRNA expression in TIMP-3 gene transfected BE1 cells was upregulated as detected by Northern blot. The invasion of TIMP-3 gene-transfected cells across matrigel-coated filters was significantly decreased when compared with controls. Following subcutaneous injection into nude mice, the TIMP-3 transfected cells suppressed primary tumor growth, as characterized by reduced tumor incidence (9/12 vs 6/6), longer latency and reduced metastatic potential to the lungs (1/12 vs 5/6) and lymph nodes (5/12 vs 6/6). CONCLUSION: The results suggest that upregulation of TIMP-3 expression in BE1 cells resulted in suppression of the invasive potential of BE1 cells in vitro as well as tumorigenic and metastatic potential in nude mice.

[Zymographic analysis of MMPs in human carcinoma cell lines with different metastasis potential].

OBJECTIVE: To investigate the correlation between matrix metalloproteinases (MMPs) activities and metastatic potential of several groups of human carcinoma cells with different metastatic potential. METHODS: Several groups of human carcinoma cell lines (human lung carcinoma, human prostatic carcinoma and melanoma) with different metastatic potential were selected. By using cell culture, collection and concentration of conditioned media and zymographic analysis method the difference of MMPs production and activity among those cell lines were detected. RESULTS: The MMPs production capabilities of carcinoma cells rose following the increase of their invasive and metastatic potentials: that of PG is much higher than PAa's, and BE1 is higher also than CL3 and LH7. Advanced stage melanoma cell WM983a and WM451 product MMP-9, but primary stage cells don't. There are MMP-9 in the conditioned medium of prostatic carcinoma cell PC-3M, the metastatic clone of PC-3 which don't express MMP-9. CONCLUSION: The expression of MMPs especially MMP-9 of carcinoma cells is closely correlated to the metastatic and invasive potential.

[Differential expression and response of growth factors in metastatic variants of human pulmonary giant cell carcinoma cell line].

OBJECTIVE: To study the difference in expression and response of certain growth factors between the two metastatic variants PGbE1 and PGLH7 of human pulmonary giant cell carcinoma, and the action of these growth factors on the metastasis of tumor cells. METHODS: RT-PCT was conducted to detect the expression of TGF alpha, TGF beta 1, IL-6, IL-8, bFGF and ANG, and the expression of receptors EGFR, IL-6R and IL-8R; 3H-TdR incorporation assay was used to determine the effects of recombinant TGF alpha, TGF beta 1 and IL-6 on the proliferation of the two cells. RESULTS: TGF alpha, EGFR, IL-6 and IL-6R were expressed at a higher level in PGbE1 cells than in PGLH7 cells. No significant differences were found in the expression of TGF beta 1, bFGF, IL-8, IL-8R and ANG between the two cells. Recombinant TGF alpha and IL-6 stimulated the proliferation of both cells, while TGF beta 1 had dual effects. CONCLUSION: TGF alpha, TGF beta 1, bFGF, IL-6, IL-8 and ANG may be involved in the autocrine regulation of the growth and proliferation of pulmonary giant cell carcinoma, TGF alpha and IL-6 may play an important role in the metastasis of the tumor cells.

[Regulatory effects of cAMP analogs on growth and differentiation of metastatic human lung cancer cells].

OBJECTIVE: To study the effects of two cAMP analogs with different site-selectivity on growth and differentiation of metastatic human lung cancer cells. METHODS: The methods used include cell culture, in vitro invasion assay, soft agar colony formation assay, immunocytochemistry and electron microscopy. A metastatic human lung cancer cell line gwas treated with dibutyryl cAMP (db-cAMP, non-site-selective) or 8-chloro-cAMP (8-Cl-cAMP, site-selective for type II PKA). RESULTS: Treatment of PG cells with 1 mmol/L of db-cAMP for 7 days resulted in 48% growth inhibition, while treatment with 20 mumol/L of 8-Cl-cAMP gave 70% growth inhibition. The growth inhibitory effect of db-cAMP was shown to be reversible, while that of 8-Cl-cAMP was not. The ability of PG cells to penetrate matrigel-coated membrane and to form colonies in soft agar was also significantly inhibited by treatment with these two drugs. Microscopic observation showed that cells formed elongated cytoplasmic processes and increased expression of neuron-specific enolase as well as chromogranin after treatment. CONCLUSION: The objective to inhibit malignancy could be reached by activation of specific PKA with site-selective cAMP analogs.

[Histogenesis of the giant cells of the osteoclast type in anaplastic thyroid carcinoma]. / K voprosu o gistogeneze gigantskikh kletok tipa osteoklastov v anaplasticheskom rake shchitovidnoi zhelezy.

One case is reported of amphicrin thyroid carcinoma with signs of A- and C-cell differentiation. This tumor at its early stage had a follicular structure with massive deposits of amyloid in the stroma. In the course of progression the tumor transformed into C-cell anaplastic carcinoma with stromal amyloid deposits in the form of thin fibrils and production of polypeptide hormones and their precursors by tumor cells. The distinctive feature of the tumor metastases was the presence of many giant cells which, as was shown, were amyloid-clasts.

[Are lung choriocarcinoma and giant cell carcinoma producing chorionic gonadotropins just variants of the same neoplasm?]. / Czy kosmówczak pluca i olbrzymiokomórkowy rak pluca produkujacy gonadotropine kosmówkowa to tylko odmiany tego samego nowotworu?

An article presents two cases of choriocarcinoma lung metastases. One case revealed the primary mediastinal choriocarcinoma and the second one had unknown primary localisation of the tumor, which could be suggestive of a spontaneously regressed primary gonadal choriocarcinoma. Authors discuss the clinico-pathological aspects of extragonadal choriocarcinomas, theories of their histogenesis and the morphological similarities to anaplastic giant cell lung carcinoma.

Value of uroplakin III in distinguishing variants of primary bladder urothelial carcinoma from malignancy metastatic to the urinary bladder.

BACKGROUND: Urothelial carcinoma (UC) variants can be difficult to differentiate from carcinoma metastatic to the bladder. MATERIALS AND METHODS: We examined immunostaining for uroplakin III in 43 cases of primary bladder UC variants including micropapillary UC (n=19), nested variant of UC (n=2), pleomorphic giant-cell carcinoma (n=8), plasmacytoid UC (n=4), lymphoepithelioma-like carcinoma (n=2), large cell undifferentiated carcinoma (n=2), UC with abundant myxoid stroma (n=3) and lipid cell variant (n=3) and in 11 tumors from other organs metastatic to the bladder. These tumors included invasive ductal carcinoma of the breast (n=2), colorectal adenocarcinoma (n=4), endometrioid adenocarcinoma (n=1) and serous papillary carcinoma of the uterus (n=1) melanoma (n=1), embryonal carcinoma of the testis (n=1), and renal clear cell carcinoma (n=1). RESULTS: Out of the 43 UC variants, 35 (81%) were positive for uroplakin III, including micropapillary, lipid cell variant and UC with abundant myxoid stroma. Pleomorphic giant cell carcinoma, plasmacytoid UC and nested variant of UC were less commonly positive. Of the 11 metastatic tumors, six were found to be positive for uropIakin III: metastatic colorectal adenocarcinoma, clear cell carcinoma of the kidney and embryonal carcinoma of testis. CONCLUSION: UP III Positivity for uroplakin III is not found only in primary bladder UC variants, but in some tumors that have metastatized to the bladder. Staining for uroplakin III alone should not be taken as evidence of UC.

Polyomavirus (BK)-associated pleomorphic giant cell carcinoma of the urinary bladder: a case report.

This report describes the morphological features of a pleomorphic giant cell carcinoma with focal trophoblastic differentiation of the urinary bladder in a male, 12 years post living related donor renal transplant. The voided urine cytology demonstrated rare decoy cells admixed with markedly atypical urothelial cell clusters, papillae and giant cells. Cystoprostatectomy demonstrated a nodular mass involving the trigone and right lateral-posterior wall, adjacent to the ureteral orifice. Hematoxylin-eosin stained sections showed two synchronous malignancies: (a) pleomorphic giant cell carcinoma with focal trophoblastic differentiation of the urinary bladder, metastatic to the omentum and (b) prostatic adenocarcinoma, Gleason score 3+4=7, involving the right prostate lobe. Strong diffuse expression of polyomavirus large T antigen was demonstrated in the primary and metastatic pleomorphic giant cell carcinoma, supporting a possible role for polyomavirus (BK) in the oncogenetic pathway. The prostatic adenocarcinoma was negative for polyomavirus large T antigen. Our findings of p63, CK7 and CK903 expression in pleomorphic giant cell carcinoma suggest that the tumor is of urothelial derivation. This is the first report describing the morphological features of urinary bladder pleomorphic giant cell carcinoma with trophoblastic differentiation, positive for polyomavirus large T antigen, arising in the background of BKV reactivation.