11/842. Primary eyelid mucinous adenocarcinoma of eccrine origin. To report a case of mucinous adenocarcinoma of the eyelid. A 70-year-old man presented with a lesion of his lower left eyelid, which had been growing over the past few years. An excisional biopsy was performed. The lesion was incompletely excised and recurrence at the excision site was observed at a 3-month follow-up visit. A histopathological examination of the excised specimen showed it to be a mucinous adenocarcinoma of eccrine origin. Primary mucinous adenocarcinoma of the eye lid is a rare malignant sweat gland tumor with a high incidence of local recurrence. It has to be differentiated from other adenocarcinomas which may rarely metastasize to the skin. ( info) |
12/842. Colorectal cancer recurrence during pregnancy--unique and poorly understood clinical entity: report of a case. The detection of primary or recurrent colorectal cancer during pregnancy is a rare event. early diagnosis is difficult, because symptoms are often attributed to pregnancy. Here we describe a case of recurrent adenocarcinoma of the colon in a 23-year-old pregnant patient. The relationship between various hormonal and immunological changes of pregnancy and colorectal cancer is discussed. ( info) |
13/842. Intrasellar adenoid cystic carcinoma and papillary mucinous adenocarcinoma: two previously undescribed primary neoplasms at this site. Most carcinomas involving the sella turcica are metastases. We report two previously undescribed carcinomas that appear to be primary at this site. The first occurred in a 44-year-old woman who presented with hemianopsia. A mass was noted by computed tomography to occupy the sella turcica, from which it appeared to originate. Transphenoidal biopsy showed the tumor to be an adenoid cystic carcinoma with a typical cribriform pattern. The patient died shortly after a subsequent attempt at tumor resection. The second tumor arose in a 55-year-old man who presented with diplopia. Computed tomography showed a mass in the sella turcica that was presumed to be a pituitary adenoma. However, transphenoidal resection revealed a mucinous adenocarcinoma composed of small papillae and glands lined by columnar epithelium. The tumor cells exhibited varying degrees of stratification with prominent interspersed mucin vacuoles. Focal solid areas showed a component of signet ring-type cells. In contrast to the apparent aggressive behavior of the adenoid cystic carcinoma, the papillary mucinous adenocarcinoma appeared much less aggressive, as the second patient was alive and without evidence of disease 5 years later. Both tumors may be derived from epithelial rests within the pituitary gland, either minor salivary gland rests or Rathke's cleft remnants. ( info) |
14/842. bone marrow relapse in primary mucinous carcinoma of skin. Primary mucinous carcinoma of skin is a rare adnexal tumor arising from the eccrine sweat gland. The tumors grow slowly and have low rates of local recurrence and rare chances of distant metastasis. The authors report a 70-year-old man with primary mucinous skin carcinoma who had a relapse in bone marrow 19 months after initial treatment. ( info) |
| Cystic neoplasms of the pancreas are an uncommon entity comprising fewer than 1 per cent of all pancreatic neoplasms. The guidelines for management of these tumors, specifically, the extent of resection, are unclear. Formerly, a distal pancreatectomy including the spleen was performed for tumors in the tail of the pancreas. The importance of preserving the spleen has been well documented; however, there are few reports of spleen-preserving pancreatectomy for cystic neoplasms of the distal pancreas. We report two patients who underwent spleen-preserving pancreatectomy for mucinous cystic neoplasms in the tail of the pancreas. Both patients were female, ages 39 and 65 years. Preoperative preparation included administration of vaccinations and subcutaneous somatostatin. Operative technique emphasized division of the splenic artery and vein beyond the tip of the distal pancreas without mobilization of the spleen. The pancreas was transected with a vascular stapler. fibrin glue was applied to the margin of the pancreas. The operative blood loss, duration of operation, and postoperative hospital stay were 150 and 250 mL, 150 and 180 minutes, and 7 and 9 days, respectively. The pathology revealed both lesions to be mucinous cystic neoplasms. The patients recovered and at 6-month follow-up were without complaints and in good health. spleen-preserving pancreatectomy is rapid and associated with minimal morbidity. This procedure should be considered in the surgical management of cystic neoplasms in the tail of the pancreas. ( info) |
16/842. Gastric cancer with sarcoid reactions in the regional lymph nodes, the stomach wall, and the splenic parenchyma: report of a case. A 66-year-old man was referred to our institute for investigation of heartburn and epigastralgia. Endoscopic examination demonstrated a type 4' gastric cancer which occupied the whole stomach. At laparotomy, multiple small nodules were found in the spleen which were diagnosed as metastases of the gastric cancer. Thus, total gastrectomy with distal pancreatectomy, splenectomy, cholecystectomy, and left adrenalectomy, combined with D4 lymph node dissection, was performed. Microscopic examination of the tumor revealed tubular and mucinous adenocarcinoma which invaded the muscularis propria. Sarcoid reactions were observed in the submucosa adjacent to the carcinoma tissue. Only one lymph node from station no. 8a demonstrated tumor metastasis, while those from station nos. 1, 2, 7, 8, 9, 10, 11, 13, and 16 revealed sarcoid reactions without tumor metastases. Subsequently, the multiple small nodules that had been presumed to be splenic metastases at laparotomy were found to be sarcoid reactions similar to those seen in the submucosa and regional lymph nodes. Since no skin or ocular lesions indicative of systemic sarcoidosis were seen in this patient, a diagnosis of advanced gastric cancer associated with sarcoid reactions was established. To our knowledge, there have been no previous reports regarding an association between sarcoid reactions in the spleen and gastric cancer. ( info) |
17/842. Well-differentiated mucinous carcinoma of the ovary and a coexisting brenner tumor both exhibit amplification of 12q14-21 by comparative genomic hybridization. Although the coexistence of mucinous ovarian neoplasms and Brenner tumors is well established, the histogenesis and developmental relationship between the two remain unknown. We used comparative genomic hybridization to analyze two such tumors occurring simultaneously, one in each ovary, in a patient. Amplification of 12q14-21 sequences was found in both tumors; in addition, both tumors also had other, different changes, four identified in the brenner tumor and six in the mucinous carcinoma. The occurrence of the same genetic alteration in both tumors in this woman suggests that the mucinous carcinoma and brenner tumor may be clonally related, i.e., one arose from the other by means of metastatic spreading of transformed cells from one ovary to the other. An alternative explanation is that some unknown, putative tumorigenic agent induced similar and synchronous pathogenetic changes in the epithelium of both ovaries. The phenotypic differences between the tumors are presumably attributable to the other unique genetic abnormalities identified in both tumor types. ( info) |
| BACKGROUND: Computerized tomography (CT) of metastatic adenocarcinoma to the brain usually shows low-to-moderate attenuation. However, mucinous adenomas may appear with high attenuation, mimicking hemorrhage. CASE DESCRIPTION: A 68-year-old man with a history of metastatic esophageal adenocarcinoma presented to the emergency room complaining of a chronic, progressive right occipital headache. A head CT demonstrated a moderate-to-high attenuation, homogenous mass in the right cerebellar hemisphere consistent with an intracerebral hemorrhage. There was no frank calcification in the mass by CT criteria. An emergent posterior fossa craniectomy revealed nonhemorrhagic metastatic mucinous adenocarcinoma. CONCLUSION: Moderate-to-high attenuation, noncalcified brain masses should raise the possibility of mucin-containing neoplasm. ( info) |
19/842. Successful thrombolysis for massive pulmonary embolism after pulmonary resection. We report the successful use of thrombolysis for acute massive pulmonary embolism 2 days after right lower lobectomy for bronchial adenocarcinoma. Pulmonary angiography revealed extensive clot unsuitable for surgical embolectomy. A bolus infusion of recombinant tissue plasminogen activator produced an immediate improvement in the patient's hemodynamic state. There was substantial blood loss requiring the transfusion of 21 units of blood over the postoperative period. The patient made a successful recovery and remained well at 1 year. ( info) |
20/842. Intraductal papillary-mucinous tumor of the pancreas: presentation in a young adult. Intraductal papillary-mucinous tumor (IPMT) of the pancreas is a premalignant lesion that can result in the hypersecretion of mucous and subsequent pancreatitis. In this report, one of the youngest cases of IPMT is described. Initial pancreaticogram was normal. Pathognomonic changes of the pancreatic duct were found only years later; otherwise, the recurrent pancreatitis seen in this patient might have been repeatedly misdiagnosed as idiopathic. Pre- and perioperative evaluation resulted in pancreaticoduodenectomy for what was felt to be a curative resection. However, the patient suffered an aggressive metastatic course. More extensive surgery may be needed in IPMT, such as total pancreatectomy, especially in cases of diffuse ductal dilation of the pancreas. ( info) |