We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: To describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumors. MATERIALS AND METHODS: Twenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined. RESULTS: The most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out. CONCLUSION: Although CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.
Adenocarcinoma/pathology/radiography/secondary ; Adult ; Aged ; Carcinoma, Hepatocellular/pathology/radiography/secondary ; Carcinoma, Renal Cell/pathology/radiography/secondary ; Carcinoma, Squamous Cell/pathology/radiography/secondary ; Diagnosis, Differential ; Female ; Gallbladder Neoplasms/pathology/*radiography/*secondary ; Humans ; Kidney Neoplasms/pathology ; Liver Neoplasms/pathology ; Male ; Melanoma/pathology/radiography/secondary ; Middle Aged ; Neoplasm Invasiveness/radiography ; Retrospective Studies ; Stomach Neoplasms/pathology ; *Tomography, X-Ray Computed

We report herein a case of hepatoid adenocarcinoma of the stomach with liver metastasis. Gastric carcinoma generally presents as adenocarcinoma and rarely shows a hepatoid pattern, which can produce alpha-fetoprotein (AFP). The stomach is one of the common sites at which hepatoid adenocarcinoma has been detected. A 75-year-old female patient was admitted to the hospital with a symptom of epigastric discomfort. Gastrofibroscopy revealed a large tumor occupying the greater curvature of the stomach body. The level of serum AFP was markedly increased. Abdominal computed tomography revealed multiple liver masses. Biopsy samples of the gastric lesion and liver masses finally confirmed her case as hepatoid adenocarcinoma in the stomach with liver metastasis. The AFP-producing gastric carcinoma needs special attention because it often presents with early liver metastasis and has a poor prognosis.
Adenocarcinoma/*diagnosis/pathology/radiography ; Aged ; Female ; Gastroscopy ; Humans ; Liver Neoplasms/*diagnosis/secondary/ultrasonography ; Lymphatic Metastasis ; Stomach Neoplasms/*diagnosis/pathology/radiography ; Tomography, X-Ray Computed ; alpha-Fetoproteins/metabolism

Metastasis to the primary thyroid carcinoma is extremely rare. We report here a case of colonic adenocarcinoma metastasis to medullary thyroid carcinoma in a 53-yr old man with a history of colon cancer. He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery. Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC). The patient underwent a total thyroidectomy. Using several specific immunohistochemical stains, the patient was diagnosed with colonic adenocarcinoma metastasis to MTC. To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC. Although tumor-tumor metastasis to primary thyroid carcinoma is very rare, we still should consider metastasis to the thyroid gland, when a patient with a history of other malignancy presents with a new thyroid finding.
Adenocarcinoma/pathology/surgery ; Biopsy, Fine-Needle ; Carcinoma, Medullary/diagnosis/radiography/*secondary ; Colonic Neoplasms/*pathology/surgery ; Humans ; Male ; Middle Aged ; Neoplasms, Second Primary/*diagnosis ; Thyroid Gland/pathology ; Thyroid Neoplasms/diagnosis/radiography/*secondary ; Thyroid Nodule/diagnosis

Adenocarcinoma ; diagnosis ; secondary ; surgery ; Aged ; Biopsy ; Cystoscopy ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; surgery ; Radiography ; Transurethral Resection of Prostate ; methods ; Ureteral Neoplasms ; diagnosis ; secondary ; surgery ; Ureteroscopy ; Urethral Neoplasms ; diagnosis ; secondary ; surgery ; Urothelium ; pathology

We report an extremely rare case of metastatic common bile duct cancer from pulmonary adenocarcinoma presenting as obstructive jaundice. The patient was a 76-year-old male, who presented with generalized weakness and right upper quadrant pain. Plain chest X-ray noted multiple small nodules in both lung fields. Abdominal computed tomography scan showed a stricture of the mid common bile duct along with ductal wall enhancement. Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct suggestive of primary bile duct cancer. However, pathology comfirmed metastatic common bile duct cancer arising from pulmonary adenocarcinoma with immunohistochemical study with thyroid transcriptional factor-1 (TTF-1).
Adenocarcinoma/*diagnosis/pathology/radiography ; Aged ; Brain Neoplasms/radiography/secondary ; Bronchoscopy ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/*diagnosis/secondary ; DNA-Binding Proteins/metabolism ; Humans ; Immunohistochemistry ; Jaundice, Obstructive/*etiology ; Lung Neoplasms/*diagnosis/pathology/radiography ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

No abstract available.
Adenocarcinoma/*diagnosis/pathology ; Aged ; Carcinoma, Hepatocellular/diagnosis ; Humans ; Immunohistochemistry ; Liver Neoplasms/*radiography/secondary/ultrasonography ; Magnetic Resonance Imaging ; Male ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

No abstract available.
Adenocarcinoma/*diagnosis/radiography/secondary ; Adult ; Antineoplastic Agents/therapeutic use ; Breast Neoplasms/*diagnosis/drug therapy/pathology ; Carrier Proteins/metabolism ; Doxorubicin/therapeutic use ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Female ; Glycoproteins/metabolism ; Humans ; Mastectomy, Modified Radical ; Positron-Emission Tomography and Computed Tomography ; Stomach Neoplasms/*diagnosis/radiography/secondary ; Taxoids/therapeutic use ; Tomography, X-Ray Computed

OBJECTIVE: To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery. MATERIALS AND METHODS: From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image. RESULTS: During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%. CONCLUSION: Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.
Adenocarcinoma/*diagnosis/radiography/*secondary/surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen/blood ; Digestive System Surgical Procedures ; False Negative Reactions ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/*diagnosis/radiography/*secondary/surgery ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Predictive Value of Tests ; Rectal Neoplasms/*pathology ; Retrospective Studies ; Survival Analysis ; *Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Markers, Biological/blood