Cases reported "Neoplasms, Second Primary"

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1/13. Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report.

    Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.
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keywords = carcinogenesis
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2/13. osteosarcoma following retinoblastoma: age at onset and latency period.

    In order to assess the role of genetic predisposition in the induction of radiation-induced tumors, we performed statistical analysis on data from the literature and from our own Institute with regard to the age at onset and the latency period of osteosarcoma as the second primary tumor for retinoblastoma with or without subsequent radiotherapy. In retinoblastoma survivors who subsequently developed osteosarcoma, the age at onset of retinoblastoma was young (average of 12 months) in both unilateral and bilateral forms. This suggests that all or almost all of the patients were genetically predisposed by a mutation of one allele of the RB1 gene. For retinoblastoma patients, osteosarcomas occurred 1.2 years earlier inside than outside the radiation field. The latency period between radiotherapy and osteosarcoma onset was 1.3 years shorter inside than outside the radiation field. Interestingly, a bimodal distribution of latency periods was observed for osteosarcomas arising inside, but not outside the radiation field: 40% occurred after a short latency, while the latency of the remaining 60% was comparable to that of osteosarcoma occurring outside the radiation field. This suggests that different mechanisms may be involved in radiocarcinogenesis. A radiation-induced mutation of the second RB1 allele may be the cause of osteosarcomas occurring after a short delay, while other genes may be affected in those occurring after a longer delay.
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keywords = carcinogenesis
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3/13. A repeated pancreatectomy in the remnant pancreas 22 months after pylorus-preserving pancreatoduodenectomy for pancreatic adenocarcinoma.

    We report a case of a repeated curative pancreatic resection in the remnant distal pancreas 22 months after pylorus-preserving pancreatoduodenectomy (PpPD). The patient was a 52-year-old woman with a past history of PpPD for adenocarcinoma of the head of the pancreas 22 months prior to the present operation. The original tumor was histopathologically diagnosed as a papillary adenocarcinoma with clear surgical margin at the surgical cut end of the pancreas (R0, International Union Against Cancer [UICC] classification). Twenty months after the PpPD, a follow-up computed tomography (CT) scan showed multiple low-density lesions in the body and tail of the pancreas without any other distant metastasis. A second operation, curative resection of the remnant pancreas, with splenectomy and distal gastrectomy, was performed. The second tumor was a papillary adenocarcinoma, the same diagnosis as that of the first tumor, and it also showed similar histopathological findings, including immunohistochemical staining of Ki-67 and p53 protein, and the same pattern of K-ras point mutation. The patient is considered to have shown a rare, unique pancreatic cancer with metachronous carcinogenesis in the remnant pancreas.
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keywords = carcinogenesis
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4/13. The nature of tamoxifen action in the control of female breast cancer.

    tamoxifen, now in use in the breast cancer clinic worldwide, was a study subject of controversy showing an estrogenic property on one occasion and an anti-estrogenic property on another occasion. The outcomes of 4 case-control studies of tamoxifen use were disclosed through 4 publications in 1998. The contents of these reports were intriguing, not only to surgeons of breast cancer clinics, but also to researchers of oncological science in general. The results of 4 research groups, being compatible with each other, were summarized in succession as follows: a) long-term use of tamoxifen reduced the occurrence of estrogen receptor (ER)-positive tumors by 69%, but no difference in the occurrence of ER(-) tumors was seen; b) the incidence of endometrial cancer was increased in the tamoxifen group; c) in women who did not have breast cancer and who had had a hysterectomy, there was no difference of breast cancer occurrence between the placebo- and tamoxifen-arms. Nevertheless, there was a statistically significant reduction of breast cancer among women receiving tamoxifen who also used hormone-replacement therapy during the trial; d) there was also no case-control difference of breast cancer occurrence between tamoxifen- and placebo-groups, when tested in a healthy population with a strong family history; e) the beneficial effect of long term use of tamoxifen in patients with early breast cancer, as assessed in terms of recurrence reduction, survival improvement and suppression of a contralateral tumor growth, was restricted to ER( ) patients; f) there was a positive correlation between the duration of tamoxifen use and the occurrence of endometrial cancer. All these observations provide strong support to the concept of the steroid criminal theory of human carcinogenesis in general. On the basis of both tamoxifen data and other information surrounding the hormonal aspect of human carcinogenesis of multiple tumors including breast cancer, we propose that the steroid generating system, as linked to the ever changing environment, plays a cardinal role as the transmitter of steroidal signals that can be taken as a "go" sign by the local oncogene-tumor suppressor gene complex of one target tissue and as a "stop" sign by that of another target tissue. The fitness of the tamoxifen data to the steroid carcinogenesis concept was discussed in the light of experimental pathology of chemical carcinogens, including the mammocarcinogen 7,12-dimethyl-benz(a)anthracene.
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ranking = 3
keywords = carcinogenesis
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5/13. Metachronous multiple carcinoma of lip after surgery for gingival carcinoma: a case report.

    A case of multiple carcinoma of the lower lip probably induced by repeated bite trauma due to lack of sensation is reported. A reduction in immunocompetence by carboplatin (CBDCA) might be an additional condition for the carcinogenesis. This case suggests that the reconstruction of the sensory nerve is important after resection of a malignant tumor of the head and neck region.
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keywords = carcinogenesis
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6/13. urinary bladder cancer following cyclophosphamide therapy for Hodgkin's disease.

    urinary bladder cancers following prolonged cyclophosphamide therapy are being increasingly reported. We report a case of transitional cell carcinoma of the urinary bladder occurring 12 years after pulse intravenous therapy with cyclophosphamide for Hodgkin's disease. The mechanism of bladder carcinogenesis and the possible role of the uroprotector mesna in preventing cyclophosphamide induced bladder cancer are discussed.
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keywords = carcinogenesis
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7/13. osteosarcoma as a second tumor after treatment for primary non-Hodgkin's lymphoma in a child with ataxia-telangiectasia: presentation of a case and review of possible pathogenetic mechanisms.

    patients with ataxia-telangiectasia (A-T) and cancer are exposed to additional toxicity due to their underlying inability to repair chemotherapy-induced dna damage. The authors report the development of osteosarcoma as a second neoplasia in a child with A-T who was treated, without being irradiated, for non-Hodgkin's lymphoma as a primary malignancy. This is the first report of osteosarcoma associated with A-T. The authors postulate that the mechanisms of carcinogenesis are common and independent of the different histopathology categories of these two neoplasias, and the underlying "canvas" of the A-T mutated gene was further triggered by chemotherapy, leading to the development of a second malignancy.
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keywords = carcinogenesis
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8/13. Metachronous breast carcinoma (second malignancy), following "cure" from colorectal carcinoma.

    Metachronous or synchronous breast carcinoma following or co-existing with colorectal carcinoma are well recognised clinicopathological entities, and the risk of developing both possibly underlines the similarities in carcinogenesis pathways for these carcinomas. We present a 60-year-old housewife with a history of a treated primary colon carcinoma (Duke's C) 15 years previously. Six months ago, during the follow-up care a small sub-areolar lesion was determined in a mammogram. A lumpectomy was performed under local anaesthesia, which revealed an infiltrating ductal carcinoma (6 mm in greatest diameter). Immuno-histochemical assays for oestrogen and progesterone receptors and c-erb B2 ongoprotein were performed. Axillary lymphadenectomy showed 1/11 positive node. She received adjuvant radiotherapy and hormone manipulation. To date, seven months later she is disease free. The aim of this report is to emphasise the risk of metachronous second malignancy of breast or colorectal carcinoma following colorectal carcinomas. A second primary colonic malignancy following breast primary carcinoma is more frequent than inverse clinical form.
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keywords = carcinogenesis
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9/13. Epstein-barr virus-related gastric adenocarcinoma: an early secondary cancer post hemopoietic stem cell transplantation.

    BACKGROUND & AIMS: Epstein-Barr virus (EBV) infection has been associated with some cases of gastric cancer. methods: We studied a case of early onset gastric adenocarcinoma after nonmyeloablative hematopoietic stem cell transplantation for myeloma in a 56-year-old man. RESULTS: The development of gastric adenocarcinoma was preceded by severe graft-versus-host disease (GVHD) necessitating strong immunosuppression, which resulted in an intense reactivation of EBV infection. Three sequential gastric biopsy examinations performed at 100, 130, and 150 days after hematopoietic stem cell transplantation showed gastritis, dysplasia, and adenocarcinoma, respectively. There was no evidence of helicobacter pylori infection. Quantitative polymerase chain reaction for circulating EBV showed a surge of EBV DNA peaking at the time of gastritis, followed by a gradual decrease afterward with adequate control of GVHD and tailing of immunosuppression. in situ hybridization for EBV-encoded early small rna showed absence of EBV in the gastritis specimen, but the presence of EBV in the dysplastic and carcinoma specimens. Aberrant promoter methylation of E-cadherin was observed only in the carcinoma specimens, showing that infection with EBV preceded E-cadherin methylation. CONCLUSIONS: Mucosal damage caused by GVHD, immunosuppression, and EBV reactivation combined to lead to EBV infection of the gastric cells and initiation of carcinogenesis, suggesting this case to be a genuine EBV-related opportunistic malignancy post-transplantation. An interesting proposition is that this case also might reflect a compacted timeline of events in EBV-related gastric cancers developing in immunocompetent patients.
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ranking = 1
keywords = carcinogenesis
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10/13. Multiple metachronous skin squamous cell carcinomas and epidermodysplasia verruciformis in the head region: a human papilloma virus-associated disease.

    Data from a young adult man with epidermodysplasia verruciformis (EV) and multiple metachronous spinaliomas in the head and neck region are presented. diagnosis of this rare, human papilloma virus (HPV)-associated disease was based on: (1) Typical skin lesions, including viral warts, verruca plana-type lesions and pityriasis versicilor; (2) typical histological features, including "foamy giant keratinocytes"; (3) evidence of HPV 5, 8 and 20 in pityriasis versicilor-like lesions; (4) a cellular immunodeficiency due to a relative T-helper-cell deficit. No specific treatment of EV is known, so that therapy concentrates on early removal of spinaliomas and treatment of intercurrent infections. Since EV patients have numerous benign skin lesions and frequently develop metastatic and non-metastatic carcinomas, molecular changes of HPV during carcinogenesis can be studied.
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ranking = 1
keywords = carcinogenesis
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