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1/14. Synchronous anal and penile cancers.

    Malignancies of the anogenital region have similar etiology, including viral infections, sexual habits, social and educational factors. condylomata acuminata represent precancerous lesions. In the available literature, we found no cases of synchronous cancers of anus and penis reported. We report a case of synchronous cancer of the penile foreskin and cancer of the anus in a 36 year-old man. The microscopic diagnosis of the anal lesion was squamous cell cancer, basaloid type. The penile lesion was squamous cell cancer, keratinizing type. Both cancers presented with the in situ component. Immunohistochemical staining (MIB-1) and histological features (koilocytosis, acanthosis and dyskeratosis) indirectly confirmed the past viral infection. Numerous etiological similarities in anogenital cancers entail careful clinical inspection in patients with a malignant lesion in this region and suggest searching for possible other concomitant cancers or precancerous lesions.
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2/14. High-grade pancreatic intraepithelial neoplasia in a patient with familial adenomatous polyposis.

    Familial adenomatous polyposis (FAP) is caused by mutation of the adenomatous polyposis coli (APC) gene and is characterized by multiple colorectal adenomas and tumors of other organs and sites. A 58-year-old woman with FAP syndrome and previous total colectomy presented for routine follow-up examination. Abdominal ultrasound and subsequent endoscopic evaluation revealed ampullary and duodenal polyps, as well as inhomogeneity of the pancreatic head. A pancreaticoduodenectomy confirmed multiple duodenal adenomas. In addition, high-grade pancreatic intraepithelial neoplasia (PanIN-3) was found in the smaller pancreatic ducts. Pancreatic precancerous lesions have only rarely been described in FAP, including 2 pancreatic duct adenomas and 2 intraductal papillary mucinous neoplasms. A review of the world English literature revealed no reports of PanIN-3 in association with FAP. Further studies are required to determine if patients with FAP are at increased risk for pancreatic premalignant lesions.
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3/14. Double primary carcinoma of the lips.

    The case of a 40-year-old man who was a moderate smoker with two squamous-cell carcinomas on the lips has been presented. The importance of follow-up in such cases has been stressed. When oral cancer develops, all mucous membrane surfaces must be considered to be highly susceptible to future malignant change. Exfoliative cytology, biopsies, and histologic studies should be employed for the early detection of precancerous conditions and, if possible, to prevent the development of subsequent oral carcinomas. It is necessary to insist on frequent and regular follow-up examinations, so that any second primary lesion may be detected and treated in its early stages. It is also necessary to initiate appropriate prophylactic measures to eliminate any possible sources of carcinogenic irritation.
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keywords = precancerous
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4/14. Juvenile papillomatosis and breast carcinoma.

    Juvenile papillomatosis (JP) is a breast tumor of young women featuring atypical papillary duct hyperplasia and numerous cysts, first described as a clinicopathologic entity in 1980. The disease is of interest because of the youth of these patients and the fact that the pathologic elements resemble those considered to be precancerous in older women. This report summarizes the findings in 180 patients enrolled in the Juvenile Papillomatosis Registry. The mean age at diagnosis was 23 years (range, 12-48 years; median, 21 years; mode, 18 years). No relationship was found with parity, age of menarche, or use of birth control pills. Fifty patients (28%) reported that one or more relatives had had breast cancer. Twelve (7%) patients reported a first degree relative (mother, 10; sister, 2), whereas in 38 (21%) breast cancer was limited to one or more secondary relatives, most often maternal (23/39 or 59%). Persistent (or recurrent) JP was found in 25 patients who had a subsequent biopsy, and 8 patients had bilateral JP. Pathologic analysis revealed focal epithelial necrosis, a feature often associated with carcinoma, in 30 (17%) cases predominantly in those with the most severe cytologic atypia of hyperplastic duct lesions (77%). Positive family history was reported by 33% (10/30) of women with epithelial necrosis and 27% (40/150) without this finding. Seven patients (4%) had breast carcinoma diagnosed concurrent with JP (ipsilateral, 5 cases; contralateral, 2 cases). A previously unreported finding is the diagnosis of carcinoma subsequent to JP in two cases (contralateral intraductal and ipsilateral microinvasive duct, respectively) with intervals of 8 and 9 years, respectively. The nine patients with carcinoma and JP tended to be slightly older at the time JP was diagnosed (mean, 27 years) and had a higher frequency of positive family history (56%) than those without breast cancer (mean age, 23 years; positive family history, 26%). These findings confirm earlier evidence that JP is a marker for families at risk and now indicate that the patient with JP may herself be in jeopardy of developing breast cancer coincidentally or at a later date. Wide local excision is adequate to control the lesion in most cases. Careful clinical surveillance is indicated for any woman who has juvenile papillomatosis and for her female relatives. The early age of onset of this unusually florid proliferative disease, and family history association, suggest there may be an underlying hormonal disturbance or genetic abnormality.
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5/14. Inverted papillomas of the urinary tract. A case of multiple, recurring inverted papillomas of the renal pelvis, ureter and bladder associated with malignant change.

    A case of multiple, recurring urothelial inverted papillomas is reported with localization in the bladder, ureter and renal pelvis. association of several of these with areas of transitional cell tumours and final occurrence of pure transitional cell tumour of papillary and non-papillary type grade II, causes us to question the original concept of inverted papillomas as benign tumours and lean to the more recent concept of inverted papillomas representing precancerous lesions.
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keywords = precancerous
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6/14. peutz-jeghers syndrome with intestinal carcinoma: report of the association in one family.

    The peutz-jeghers syndrome is a rare, genectically inherited disorder. There are insufficient data to establish this syndrome as a precancerous condition, but documented cases of gastrointestinal cancer arising in this syndrome have been reported with an incidence of 2--3%. Since the syndrome is transmitted as an autosomal dominant and is associated with cancer, family members so afflicted may show an increased cancer risk. This is the first reported case of a father and son with both peutz-jeghers syndrome and colonic carcinoma.
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keywords = precancerous
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7/14. Chronic neutrophilic leukemia and myeloma. Report on long survival.

    A case of chronic neutrophilic leukemia associated with multiple myeloma is described. The patient appears to be the longest surviving case reported in the literature. Since myeloma developed several years after leukemia, the possible precancerous role of myeloproliferative syndromes is proposed.
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8/14. Squamous cell carcinoma presenting 10 years after cystectomy for leukoplakia.

    leukoplakia of the bladder is widely accepted as a precancerous lesion. We describe a patient in whom squamous cell carcinoma presented as an enterourethral fistula 10 years after cystectomy for leukoplakia of the bladder. During cystectomy we left most of the prostate and posterior urethra intact to preserve potency. In view of this case we recommend that in patients with bladder leukoplakia in whom ablative surgery is being contemplated a complete cystoprostatectomy be performed and a urethrectomy be considered seriously.
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9/14. colonic polyps and adenocarcinoma complicating ureterosigmoidostomy: report of a case.

    A case of bilateral juvenile polyps and unilateral adenocarcinoma at the ureterocolic junctions occurring 40 years after ureterosigmoidostomy for exstrophy of the bladder is reported. Although adenocarcinoma of colon at the anastomotic site represents an uncommon late complication of ureterosigmoidostomy, patients undergoing this form of urinary diversion have a risk of developing colonic carcinoma that is 100 to 550 times greater than the normal population. Moreover this complication is being reported with increasing frequency in the literature. Different pathogenetic factors may play a role in carcinogenesis, but none has been satisfactorily proven. We suggest the possibility that polyps developing at the site of a ureterocolic junction may represent precancerous lesions.
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10/14. Malignant melanoma of the conjunctiva and the iris in a case of primary acquired melanosis of the conjunctiva.

    A case of primary acquired melanosis of the conjunctiva is reported. During the 18 years of observation the patient developed a malignant melanoma in the iris, and seven years later a malignant melanoma appeared in the lower lid. The iris melanoma may be an extension from the precancerous melanosis, but the most likely explanation is that the condition represents two independent diseases.
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keywords = precancerous
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