RESUMO
Osseous metastases to the hand are very rare. Only a single case of osseous metastasis of hepatocellular carcinoma to the hand has been reported in the literature to date. We report a case of osteolytic metastasis of the right first metacarpal as first manifestation of unresectable, alpha-fetoprotein-negative hepatocellular carcinoma (pT3, Nx, M1, UICC stage IVB, Okuda's stage I). The therapy consisted of R0-resection and hormonal therapy with tamoxifen 2 x 10 mg/d orally. Generally patients with metastatic cancer to the bones of the hand have a very poor prognosis.
Assuntos
Neoplasias Ósseas/secundário , Carcinoma Hepatocelular/secundário , Neoplasias Hepáticas/diagnóstico , Metacarpo , Osteólise/diagnóstico , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Metacarpo/patologia , Metacarpo/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Osteólise/patologia , Osteólise/cirurgiaAssuntos
Neoplasias Ósseas/secundário , Carcinoma Hepatocelular/secundário , Neoplasias Hepáticas/patologia , Polegar , Neoplasias Ósseas/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteólise , Tomografia Computadorizada por Raios XRESUMO
In a 52-year-old female patient and a 50-year-old patient with a malign tumor of the right distal femur (stage IIIb) respectively the left distal tibia (stage Ia according to Enneking), the extremely rare primary leiomyosarcoma of the bone was diagnosed. The mortality of the primary leiomyosarcoma of the bone is 50%, the mean survival time after diagnosis is 3.4 years. Diagnosis of a primary leiomyosarcoma of the bone is only possible after a secondary leiomyosarcoma has been excluded as well as by histopathological including immunohistochemical examination. The operative procedure is the therapy of choice. A neoadjuvant and/or adjuvant radio- or chemotherapy can be useful.
Assuntos
Neoplasias Ósseas/diagnóstico , Leiomiossarcoma/diagnóstico , Angiografia , Artrografia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
In a 50-year-old patient with a malignant tumor of the left distal tibia (stage la, according to Enneking) undermining the cartilage of the ankle joint, an extremely rare primary leiomyosarcoma of bone was diagnosed. The diagnosis of a primary leiomyosarcoma of bone is possible only after a secondary (metastatic) leiomyosarcoma has been excluded. Furthermore, typical histopathological features, including immunohistochemical staining results, are required for the diagnosis. Surgery is the therapy of choice. An R0 resection should always be attempted.
Assuntos
Articulação do Tornozelo/patologia , Neoplasias Ósseas/patologia , Leiomiossarcoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Criança , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Pessoa de Meia-IdadeRESUMO
For several weeks a 15-year-old girl had complained of increasing abdominal pain with vomiting. On admission to hospital the bloated abdomen was diffusely sensitive to pressure and the bowel sounds were high pitched and loud. Erythrocyte sedimentation rate was increased to 23/40 mm and the white cell count to 12,000/microliters. Ultrasound examination revealed an echo-dense area with dorsal echo loss at the gastric side of the pylorus. X-ray films of the stomach showed fluid levels and a soft-tissue mass in the left upper abdomen. At laparotomy a large (12 x 6 cm) trichobezoar was found in the middle of the small intestine and two smaller ones at the pylorus. Subsequently the patient admitted to trichophagia but refused any psychological treatment.