Duodenal choriocarcinoma, either primary or metastatic, is very rare. Early diagnosis and prompt initiation of chemotherapy improve the prognosis of this neoplasm. We herein present, together with the referred literatures, a case of a 47-year-old female patient who visited to our hospital with upper intestinal bleeding. She was diagnosed as duodenal choriocarcinoma by operation. Brain metastasis was found soon after the operation and combination chemotherapy was done.
Brain Neoplasms/*secondary ; Choriocarcinoma/*diagnosis/secondary ; Duodenal Neoplasms/*diagnosis/pathology ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Middle Aged

OBJECTIVETo study the clinical characteristics and MR imaging features of intracranial metastasis from malignant tumors.

METHODS1271 patients who had history of primary tumor and suspected of cranial metastasis had MRI on Philips Gyroscan T5-NT MR scanner. The sequences included pre-contrast T(1)WI, FLAIR, and postcontrast transversal, sagittal, and coronal T(1)WI. All of the clinical data and MRI features of the patients were recorded and analyzed.

RESULTSOf 547 patients with intracranial metastasis, 393 came from lung cancer (71.9%), 10% of 547 patients were found to have the presenting symptoms of cranial metastasis. 526 had parenchymal cerebral metastasis, and 21 only meningeal metastasis. Of these 526 patients found to have brain metastasis, 164 had single metastasis (31.2%), and 362 multiple (68.8%). Most of the cerebral metastatic lesions showed uniform or ring enhancement after intravenous injection of contrast medium, dura-arachnoid metastasis showed continuous and thick-curve enhancement at the cerebral convex, but not extending to the sulcus, while pia-dura metastasis displayed as thin and linear or nodular enhancement extending to the adjacent sulci.

CONCLUSIONThe most common primary lesion with metastasis to the brain were lung cancers, followed by breast and gastrointestinal cancers. By using gadolinium-DTPA enhanced MR imaging, many single and small cerebral metastasis could be found earlier.

Adult ; Aged ; Brain Neoplasms ; diagnosis ; secondary ; Breast Neoplasms ; pathology ; Female ; Gastrointestinal Neoplasms ; pathology ; Humans ; Lung Neoplasms ; pathology ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms ; diagnosis ; secondary ; Middle Aged

No abstract available.
Aged ; Female ; Gastrointestinal Neoplasms/*diagnosis/pathology/*secondary ; Humans ; Liver Neoplasms/*diagnosis/radiography/*secondary ; Melanoma/*pathology ; Skin Neoplasms/*pathology ; Tomography, X-Ray Computed

No abstract available.
Adenocarcinoma/*diagnosis/pathology/*secondary ; Female ; Gastrointestinal Hemorrhage ; Humans ; Jejunal Neoplasms/pathology/*secondary ; Lung Neoplasms/*diagnosis/pathology ; Middle Aged ; Tomography, X-Ray Computed

Hepatocellular carcinoma (HCC) rarely invades the gastrointestinal (GI) tract. It occurs in 0.7% to 2% of clinical HCC cases. Moreover, gastric invasion with GI hemorrhage via peritoneal seeding is very rare. We report the case of 67-year-old woman who had a history of HCC rupture and was admitted due to left upper quadrant abdominal pain. The patient was diagnosed with three omental metastatic masses and underwent hepatic segmentectomy and omental tumorectomy. Two months later, the patient had massive melena, and an esophagogastroduodenoscopy showed very large ulcerated friable mass on the gastric body. The histology was consistent with the diagnosis of metastatic HCC. The patient died from persistent GI hemorrhage 93 days after the admission. This case illustrates the very rare event of peritoneal seeding of a ruptured HCC causing direct invasion of the stomach, followed by GI hemorrhage.
Aged ; Carcinoma, Hepatocellular/*diagnosis/radiography/secondary ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/radiography ; Gastroscopy ; Humans ; Liver Neoplasms/*diagnosis/pathology/radiography ; *Neoplasm Seeding ; Peritoneal Neoplasms/*diagnosis/radiography/secondary ; Stomach Neoplasms/*diagnosis/radiography/secondary ; Tomography, X-Ray Computed

OBJECTIVETo summarive the experience in diagnosis and treatment of primary small intestinal neoplasm.

METHODSThe data of 305 patients with pathologically confirmed primary small intestinal tumor collected from 6 hospitals around the Songhua River during the past 33 years were analyzed retrospectively.

RESULTSThere were 42 benign and 263 malignant tumors in this series with a ratio of 1: 6.26. The 263 malignant tumors in this series consisted of 135 adenocarcinomas, 57 malignant stromal tumors, 37 malignant lymphomas, 20 carcinoids, and etc. Chronic occult bleeding, gradual of body weight loss and mild abdominal pain (three obscurities) were the common clinical features and alerting massage of intestinal tumor. Correct preoperative diagnostic rate was only 57.0% (174/305) due to difficulty in early diagnosis, which was 67.2% (92/137) in the duodenal tumors, and 51.9% (82/168) in the jejunoileal tumors. All of the 42 benign tumors were resected completely. For the 263 patients with malignant tumors, radical dissection was performed in 153, palliative resection in 34, and gut by-pass or biopsy in 76. The median survival of the patients who underwent radical resection of their malignant tumors was 92 months, which was significantly higher than that of the other groups.

CONCLUSIONEarly diagnosis of primary small intestinal tumors is difficult and with a preoperative misdiagnosis rate of 43.0%. Total intestinal barium swallowing, endoscopy and superior mesenteric arteriography are three critical examinations for diagnosis and location. Early surgical resection is crucial in improving the prognosis. The primary small intestinal tumor should be resected as early as possible if no distant metastasis is detected.

Adenocarcinoma ; diagnosis ; secondary ; surgery ; Adenoma ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoid Tumor ; diagnosis ; secondary ; surgery ; Diagnostic Errors ; Digestive System Surgical Procedures ; methods ; Duodenal Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; secondary ; surgery ; Humans ; Ileal Neoplasms ; diagnosis ; pathology ; surgery ; Jejunal Neoplasms ; diagnosis ; pathology ; surgery ; Liver Neoplasms ; secondary ; surgery ; Lymphatic Metastasis ; Lymphoma ; diagnosis ; pathology ; surgery ; Male ; Middle Aged ; Young Adult

Approximately 5-30% of the ovarian cancers are metastatic malignancies. The prevalence of metastatic ovarian tumors varies with the incidence rates and spread patterns of primary malignancies. We evaluated the prevalence, pre- and postoperative characteristics of metastatic ovarian cancer in Korean women. We reviewed the records for 821 ovarian malignancies with pathological consultation from 1996- 2006 and recorded patient demographical, radiological, histopathological, and survival data. The study included 112 cases of histologically confirmed metastatic ovarian cancer. Metastatic ovarian cancer accounted for 13.6% of all ovarian malignancy, primarily arising from the gastrointestinal tract. The preoperative detection rate with imaging was 75%, and none of the radiological or serological features were useful for differential diagnosis. In multivariate analysis for prognostic variables, the only significant factor was the primary tumor site (p=0.004). Furthermore, extensive resection increased survival for some patients. The differential diagnosis of metastatic ovarian cancer can be problematic, so multiple diagnostic approaches are necessary. The extent of cytoreductive surgery for this type of tumor must be decided on a case-by-case basis.
Adenocarcinoma/*diagnosis/*secondary/surgery ; Adult ; CA-125 Antigen/blood ; Data Interpretation, Statistical ; Diagnosis, Differential ; Female ; Gastrointestinal Neoplasms/diagnosis/pathology ; Humans ; Medical Records ; Middle Aged ; Ovarian Neoplasms/*diagnosis/*secondary/surgery ; Ovariectomy ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Analysis

Symptomatic gastro-intestinal metastasis in lung cancer is extremely rare and only a few case reports have been published. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain, nausea and vomiting due to duodenum, jejunum, and colon obstruction by the gastro-intestinal metastasis. The patient underwent colonoscopy and the pathologic report was adenocarcinoma. When there are similar histologic findings in both colon and pulmonary lesion, the question is whether both lesions are primary cancer or the colon lesions are metastases from lung cancer. Microscopic examination of a conventional pathologic section was not sufficient to make this determination. Immunohistochemistry was positive for thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20) and caudal-related homeobox transcription factor-2 (CDX-2) on colon mucosa specimen. Accordingly, we used immunohistochemical marker for differential diagnosis of primary adenocarcinoma of the lung with gastro-intestinal metastasis.
*Abdominal Pain ; Adenocarcinoma/*diagnosis/pathology ; Colonoscopy ; Diagnosis, Differential ; Gastrointestinal Neoplasms/*pathology/secondary ; Homeodomain Proteins/metabolism ; Humans ; Immunohistochemistry ; Keratin-20/metabolism ; Keratin-7/metabolism ; Lung Neoplasms/*diagnosis/pathology ; Male ; Middle Aged ; Nuclear Proteins/metabolism ; Tomography, X-Ray Computed ; Transcription Factors/metabolism

The identification of primary location of a metastatic tumor is a difficult diagnostic problem and sometimes can be facilitated by the use of immunohistochemical markers. Thyroid transcription factor-1 (TTF-1) is a 38-kDa nuclear homeodomain transcription factor that is expressed specifically in lung or thyroid neoplasms. Cytokeratin 20 (CK20) is a 46-kDa low-molecular-weight cytokeratin that shows restricted expression in adenocarcinomas of the gastrointestinal tract (GIT) and transitional cell carcinomas of the urinary tract. We studied the immunohistochemical expression of TTF-1 and CK20 in 68 metastatic carcinomas in cervical lymph nodes. The primary sites were the lung in 29 cases, stomach in 13, colorectum in 3, and other sites in 23. TTF-1 expression was detected in 69.0% of metastatic lung carcinomas and none in metastatic GIT carcinomas, whereas CK20 expression was detected in 68.8% of metastatic GIT carcinomas and none of metastatic lung carcinomas. TTF-1 had a specificity of 0.95 and a sensitivity of 0.69 for metastatic lung carcinoma, whereas CK20 had a specificity of 1.00 and a sensitivity of 0.69 for metastatic GIT carcinoma. These results indicate that TTF-1 and CK20 should be the first choice as a component of antibody panel to prove or to exclude the lung and GIT origin, respectively, especially in patients presenting with metastatic carcinomas of unknown primary site.
Adenocarcinoma/chemistry/pathology/secondary ; Carcinoma/chemistry/pathology/*secondary ; Gastrointestinal Neoplasms/chemistry/pathology ; Homeodomain Proteins/analysis ; Humans ; Intermediate Filament Proteins/*analysis/immunology ; Keratin-20 ; Lung Neoplasms/chemistry/pathology ; Lymph Nodes/chemistry/pathology ; Lymphatic Metastasis/*diagnosis/pathology ; Neck ; Neoplasms, Unknown Primary/chemistry/pathology ; Nuclear Proteins/*analysis/immunology ; Sensitivity and Specificity ; Transcription Factors/*analysis/immunology ; Tumor Markers, Biological/analysis

BACKGROUND: The incidence of bone marrow (BM) metastasis might be related with the occurrence of malignant tumors in ethnic groups. So, we investigated the type and the frequency of metastatic tumors of BM and analyzed the clinicopathologic variables of BM metastasis. METHODS: This study included 932 cases of primary malignant tumor which were requested for BM study from January 1995 to June 2006 in Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Peripheral blood smears (PBS); aspirates, touch prints, and trephine biopsies of BM; and medical records including other laboratory test results were reviewed. RESULTS: Overall frequency of BM metastasis was 11.9% (111/932). Primary tumors with BM involvement in children comprised neuroblastoma (74.1%), rhabdomyosarcoma (7.4%), and malignant lymphoma (7.4%). For adult patients, they consisted of malignant lymphoma (56.0%), gastrointestinal cancer (20.2%), and lung cancer (6.0%). In the case of malignant lymphoma, diffuse large cell lymphoma was the most frequent one. Laboratory findings of patients with BM metastasis commonly showed anemia and thrombocytopenia; in addition, serum LD, ALP, AST and ALT were elevated in 81.5% (75/92), 63.4% (59/93), 63.5% (61/96) and 33.3% (32/96), respectively. Leukoerythroblastosis was observed only in 19.8% (22/111) on PBS examination. CONCLUSIONS: The most common non-hematopoietic metastatic tumor was neuroblastoma in children and gastrointestinal tumors in adults. Leukoerythroblastosis, anemia, and the elevation of serum LD, ALP, and AST were useful markers for the prediction of BM metastasis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Marrow Examination ; Bone Marrow Neoplasms/diagnosis/pathology/*secondary ; Child ; Child, Preschool ; Female ; Gastrointestinal Neoplasms/pathology ; Hematologic Tests ; Humans ; Infant ; Male ; Middle Aged ; Neuroblastoma/pathology