Primary squamous cell carcinoma of the thyroid associated with papillary thyroid carcinoma and Hashimoto's thyroiditis.

INTRODUCTION: We report the first case of squamous cell carcinoma (SCC) of the thyroid gland coexisting with papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis and discuss various theories concerning the histogenesis of SCC of the thyroid gland and the optimal treatment strategy. CASE REPORT: A 54-year-old woman presented with an anterior neck mass measuring 4cm on clinical examination. Imaging showed a suspicious thyroid nodule invading the trachea. Total thyroidectomy with bilateral central lymph node resection was performed. Histological examination revealed tall cell variant of papillary thyroid carcinoma associated with SCC of the right lobe of the thyroid and Hashimoto's thyroiditis. Immunohistochemistry of the SCC showed positive staining for p53 and Ki67 and negative staining for thyroglobulin. The patient underwent adjuvant radioactive iodine therapy and radiotherapy. With postoperative follow-up of 24 months, the patient was in good health. DISCUSSION: In conclusion, the most probable origin of SCC in this case was malignant transformation from Hashimoto's thyroiditis following a phase of metaplasia. This immunohistological profile is associated with a better prognosis. Optimal treatment consists of extensive surgical resection of tumour tissuefollowed by radiotherapy.

Clinical management of squamous cell carcinoma associated with sinonasal inverted papilloma.

OBJECTIVE: The aim of this study was to investigate the clinical features and prognosis of patients with squamous cell carcinoma (SCC) associated with sinonasal inverted papilloma (IP). METHODS: The medical records of 95 patients who were diagnosed with IP or SCC associated with IP were retrospectively reviewed. Out of 95 patients, 15 were diagnosed with SCC associated with IP. The clinical characteristics, treatment modalities, and survival outcomes of the patients were analyzed. RESULTS: The incidence of SCC associated with IP was 15.8%. Although differential diagnosis between IP and SCC associated with IP is difficult, epistaxis may be the specific symptom in SCC associated with IP cases. The 3-year disease-specific survival rate was higher in cases with T1, 2 and 3 than in cases with T4. There was no significant difference in survival rate between maxillary sinus and other primary sites. On the other hand, there was a significant difference in survival rate between the microscopic SCC with IP cases and the other cases. In addition, the patients with <70 years old better than those with >70 years old with a 3-year disease free survival of 80% versus 0%. CONCLUSIONS: Some T4 patients were found to have a highly aggressive disease. Therefore, complete surgical resection followed by chemo-radiation therapy is the recommended treatment for patients with T4 disease to control of the primary tumor site.

Sorafenib combined with radiofrequency ablation in the treatment of a patient with renal cell carcinoma plus primary hepatocellular carcinoma.

The combination of renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) is extremely rare, and the prognosis for patients with these two cancers is poor. In the past decade, molecular targeted therapy and radiofrequency ablation (RFA) have emerged and these treatments are now playing an increasingly important role in the management of patients with advanced primary RCC and HCC. In this case report, a 72-year-old male patient diagnosed as having RCC invading the renal vein and grade I-II HCC was treated with RFA and sorafenib (400 mg twice daily). After 3 months of this combination treatment, an evaluation of his target lesions showed stable disease (SD), and progression-free survival (PFS) times were 28 months weeks for RCC and 16 months weeks for HCC. Overall survival (OS) was 40 weeks.

[A case of multifocal colon carcinoma and cholecystolithiasis in an elderly patient].

An 83-year-old woman was admitted to our hospital because of general fatigue and symptoms of anemia. For 20 years, she had experienced right hypochondrial pain several times a year. Colonoscopic examination revealed a type 2 tumor at the ascending colon. The biopsy specimen was a Group 5 and type 0-IIa polyp at the transverse colon. The endoscopic mucosal resection (EMR) specimen was a well-differentiated adenocarcinoma(Stage pSM [2mm], ly0, v0). An apple core lesion in the cecum was detected by enema. Abdominal computed tomography demonstrated cholecystolithiasis and no metastasis or distant metastases. Therefore, a diagnosis of multifocal colon carcinoma and cholecystolithiasis was made. Expanding right hemicolectomy with cholecystectomy was performed. The patient was discharged without any complications. Subsequently, she underwent adjuvant chemotherapy for 6 months. At present, 1 year after surgery, the patient is still alive and has shown no signs of recurrence.

Specifics of diagnosis and treatment in synchronous colorectal cancers (SCC).

INTRODUCTION: SCC have an incidence of 1,8% up to 12,4% and could have more simultaneous localizations. MATERIAL AND METHOD: Between January 2004 and January 2011, 214 patients with CRC have been operated on in our ward; from those, eight patients had multiple colorectal neoplasms. RESULTS: The majority of SCC (six cases) was hospitalized under emergency status, with incomplete or complete bowel obstruction through colonic obstructive tumour. The favourite localizations were on the sigmoid (six tumours) and the transverse colon (four tumours). The diagnosis was preoperatively assessed in three cases by colonoscopy and barium enema, intraoperative in four cases, postoperative in one case. Curative operations were performed in five cases and palliative operations in three. Immediate postsurgical evolution was good, long time evolution was marked by the complications of the primary disease. Out of five patients that were long term monitored, three have a five year survival, one has survived for three years and one deceased within a nine month period after surgery, with multiple metastases. CONCLUSIONS: Preoperative diagnosis of synchronous lesions can be difficult (emergency hospitalized patient, incomplete bowel preparation, bowel obstruction or intestinal bleeding) and the colonoscopy exam can be incomplete. Rigorous intraoperative colonic examination is necessary in order to diagnose synchronous lesions and avoid surgical reintervention.

Long term survival in anti-Hu associated adult neuroblastoma.

We report on a young lady suffering from adult neuroblastoma and anti-Hu associated paraneoplastic encephalomyelitis (PEM) with a tumour free survival of nine years up to now. Treatment included tumour surgery, radiation, high dose chemotherapy, and stem cell transplantation. Serological testing demonstrated a marked decline in anti-Hu antibody titres under therapy, and subsequent disappearance of the antibody 31 months after second tumour resection.

An unusual pathological finding of chronic lymphocitic leukemia and adenocarcinoma of the prostate after transurethral resection for complete urinary retention: case report.

BACKGROUND: We describe a patient who underwent transurethral resection of the prostate for urinary obstructive symptoms and had histological findings of adenocarcinoma of the prostate with prostatic localization of chronic lymphocitic leukemia (CLL). The contemporary presence of CLL, adenocarcinoma of the prostate and residual prostatic gland after transurethral resection has never been reported before and the authors illustrate how they managed this unusual patient. CASE PRESENTATION: A 79-years-old white man, presented with acute urinary retention, had a peripheral blood count with an elevated lymphocytosis (21.250/mL) with a differential of 65.3% lymphocytes and the prostate-specific antigen (PSA) value was 3.38 ng/mL with a percent free PSA of 8.28%. The transrectal ultrasound (TRUS) indicated an isoechonic and homogenic enlarged prostate of 42 cm3 and the abdomen ultrasound found a modest splenomegaly and no peripheral lymphadenophaty. The patient underwent transurethral resection of the prostate and had a pathological finding of adenocarcinoma in the prostate with a Gleason Score 4 (2+2) of less than 5% of the material (clinical stage T1a), associated with a diffused infiltration of chronic lymphocitic leukemia elements. CONCLUSIONS: The incidental finding of a prostatic localization of a low-grade non-Hodgkin's lymphoma does not modify eventually further treatments for neither prostate cancer nor lymphoma. The presence of a low-grade and low-stage lymphoma, confirmed by a hematological evaluation, and the simultaneous evidence of an adenocarcinoma after transurethral resection of the prostate for acute urinary retention do not require any immediate treatment due to its long-term survival rate and the follow-up remains based on periodical PSA evaluation and complete blood count.

[Familial adenomatous polyposis coli--case report]. / A familiaris adenomatosus polyposisról egy eset kapcsán.

The authors report the case of a young 35 year-old male patient, investigated due to thrombocytosis for three years. First the diagnosis of chronic myeloproliferative disease was made. The diagnosis of familial adenomatous polyposis was only evident in advanced stage of the disease. Upper abdominal US, abdominal CT, double-contrast barium enema examination and colonoscopy proved advanced synchronous colorectal cancers (sigmoid and descending colon) with liver metastases along with polyposis throughout the whole large bowel. Days after the diagnosis was made the patients condition deteriorated rapidly and he died with septic symptoms suggesting bowel perforation and pneumonia. Beside the case report the authors try to give a short overview of the current literature of relatively rare but potentially fatal hereditary colon cancer syndromes to awake the attention of the clinicians to investigate more cautiously the background of unexplained clinical-laboratory signs in young adults.

Risk of lymphedema after regional nodal irradiation with breast conservation therapy.

PURPOSE: To evaluate the risk factors for lymphedema in patients receiving breast conservation therapy for early-stage breast cancer. METHODS AND MATERIALS: Between 1982 and 1995, 727 Stage I-II breast cancer patients were treated with breast conservation therapy at Massachusetts General Hospital. A retrospective analysis of the development of persistent arm edema was performed. Lymphedema was defined as a >2-cm difference in forearm circumference compared with the untreated side. The median follow-up was 72 months. Breast and regional nodal irradiation (BRNI) was administered in 32% of the cases and breast irradiation alone in 68%. RESULTS: Persistent arm lymphedema was documented in 21 patients. The 10-year actuarial incidence was 4.1%. The median time to edema was 39 months. The only significant risk factor for lymphedema was BRNI. The 10-year risk was 1.8% for breast irradiation alone vs. 8.9% for BRNI (p = 0.001). The extent of axillary dissection did not predict for lymphedema even within the subgroups of patients defined by the extent of irradiation. Most patients underwent Level I or II dissection. In this subgroup, the lymphedema risk at 10 years was 10.7% for BRNI vs. 1.0% for breast irradiation alone (p = 0.0003). CONCLUSION: Nodal irradiation was the only significant risk factor for arm lymphedema in patients receiving breast conservation therapy for early-stage breast cancer. Our data suggest that this risk is low with Level I/II dissection and breast irradiation. However, even after the addition of radiotherapy to the axilla and supraclavicular fossa, the development of lymphedema was only 1 in 10, lower than generally recognized.

Appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ: report of a case.

Appendiceal intussusception is an uncommon pathologic condition; however, villous adenoma of the appendix is a distinctly rare entity. We report herein a case of appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ. A 67-year-old man was admitted to our hospital with a 1-year history of lower abdominal pain for investigation. Barium enema showed a filling defect with an irregular surface in the cecum, and colonoscopy revealed a cecal tumor with a granular surface. Pathological examination of biopsy samples revealed tubulovillous adenoma with well-differentiated adenocarcinoma, and a diagnosis of cecal cancer in tubulovillous adenoma was made. Surgery was performed and the resected specimen was found to contain a tumor arising from the appendix. The tumor was 5.5 x 4.5 cm in size in the cecal cavity, and the appendix had invaginated into the cecum at its base. The cut surface of the appendix showed the villous tumor filling the appendiceal lumen and projecting into the cecal cavity. Microscopic examination revealed well-differentiated adenocarcinoma in tubulovillous adenoma. To the best of our knowledge, this is the first report of appendiceal intussusception caused by tubulovillous adenoma with carcinoma of the appendix.

Blue rubber bleb nevus syndrome.

A 26-yr-old man was admitted with malaise and melena. During the physical examination, six hemangiomas were spotted on the skin, and laboratory evaluations proved the existence of severe iron deficiency anemia (Hb 2.9 g/dl). Upper endoscopy and small bowel follow-through revealed no pathology. Colonoscopy documented the presence of a blue-red cavernous hemangioma, 1 cm in diameter, at the splenic flexura. The skin and colonic lesions were typical; thus, blue-rubber-bleb-nevus syndrome was diagnosed. The patient was given blood transfusions followed by oral iron supplementation. He refused further evaluation or surgery and is still fine after a follow-up period of 6 months. Here, we present a discussion of this case, together with a detailed review of the literature.

Obstructive jejunal adenocarcinoma in the Muir-Torre syndrome.

A young male patient was referred for endoscopic resection of a recto-sigmoid polyp and abdominal complaints. His medical history revealed a sebaceous adenoma resection from his back and a tubular adenoma excision from his right upper eyelid. After disclosure of a jejunal tumour on a small bowel enema and given the remarkable family history characterized by the frequent occurrence of bowel cancer, the diagnosis of Muir-Torre syndrome was established. This syndrome pertains to the combination of sebaceous gland tumours/adenomas in combination with gastrointestinal or genitourinary tract tumours. Inheritance takes place in an autosomal dominant manner. It usually occurs in males at an early age. Given its low malignancy potential, early detection of the syndrome renders a favourable prognosis. Careful examination and follow-up also involving the small intestine are mandatory for patients and relatives.

Multiple colorectal neoplasms in a young adult with hypogammaglobulinemia. Report of a case.

We report on a 22-year-old man with congenital hypogammaglobulinemia who developed multiple colorectal neoplasms. An immunodeficiency had been diagnosed in the patient since two years of age, and this time many tumors of the sigmoid colon and rectum were detected by barium enema and fiberscopy. Abdominoperineal resection was performed, and the resected specimen revealed 29 polyps, including 9 adenocarcinomas and 20 adenomas. The carcinomas, measuring 0.8 to 11.0 cm in size, showed various depths of invasion, and the adenomas, measuring 0.2 to 1.5 cm in size, showed various degrees of epithelial atypia. DNA analysis demonstrated that the tumors were heterogeneous, showing different DNA index and ploidy patterns. The pathogenetic relation between malignancy and immunodeficiency is also reviewed.

[Connective tissue nevus in disseminated tumors (of Graciansky and Leclercq)]. / Nevus conjuntivo en tumores diseminados (de Graciansky y Leclercq).

We describe three cases of Connective tissue nevi in disseminated tumors, similar to those referred by de Graciansky and Leclercq . Although clinically similar, their different dermopathological pictures stand out, as does the fact that one showed osteopoikilid . We review the clinical and dermopathological features, nosology, associations, differential diagnosis and therapeutic procedures.

Malignant melanoma and dermatofibrosarcoma in a 60-year-old patient with lifelong acrodermatitis enteropathica.

The life course of acrodermatitis enteropathica is recorded in a 62-year-old white man. Initially saved in infancy by breast-feeding and good medical care, later in his twenties he responded well to diiodohydroxyquinoline (Diodoquin) therapy, his only residua being dermatitis, hoarseness, and short stature. Subsequently untreated, this patient years later developed not only a dermatofibrosarcoma but also a large amelanotic malignant melanoma. Both were successfully excised. Subsequently, oral zinc therapy initiated for the first time cleared his acrodermatitis, which had been present for 60 years. It is suggested that this patient's malignancies developed as a result of an immune deficiency state typically found in acrodermatitis enteropathica. On this basis, acrodermatitis enteropathica may be viewed as having a malignant potential over the long term. The zinc-dependent nature of the immune deficit, however, suggests that lifelong daily zinc supplementation is an appropriate prophylactic measure.