Aged ; Carcinoma, Renal Cell ; secondary ; surgery ; Female ; Humans ; Kidney Neoplasms ; pathology ; surgery ; Nephrectomy ; Parietal Bone ; Skull Neoplasms ; secondary ; surgery

Aged ; Carcinoma, Papillary ; complications ; diagnosis ; Humans ; Male ; Neoplasm Metastasis ; Skull Base Neoplasms ; secondary ; Thyroid Neoplasms ; complications ; diagnosis

We describe herein histologic, immunohistochemical, and molecular findings and clinical manifestations of a rare case of an extremely well differentiated papillary thyroid carcinoma (EWD-PTC). Similarly, it is also difficult to diagnose follicular variant papillary thyroid carcinoma (FVPTC), whose diagnosis is still met with controversy. A recently reported entity of well-differentiated tumor of uncertain malignant potential (WDT-UMP) is added to the diagnostic spectrum harboring EWD-PTC and FVPTC. We report this case, because EWD-PTC is different from FVPTC in its papillary architecture, and also from WDT-UMP in its recurrence and metastatic pattern. These morphologically deceptive entities harbored diagnostic difficulties in the past because the diagnosis depended solely on histology. However, they are now diagnosed with more certainty by virtue of immunohistochemical and molecular studies. We experienced a case of EWD-PTC, which had been diagnosed as adenomatous hyperplasia 20 years ago and manifested recurrence with lymph node (LN) metastasis 7 years later. After another 7 years of follow-up, a new thyroid lesion had developed, diagnosed as FVPTC, with LN metastasis of EWD-PTC. One year later, the patient developed metastatic FVPTC in the skull. Immunohistochemically, the EWD-PTC was focally positive for CK19, negative for galectin-3, and focally negative for CD56. Molecular studies revealed BRAF-positivity and K-RAS negativity. The FVPTC in the left thyroid showed both BRAF and K-RAS negativity. In conclusion, EWD-PTC and FVPTC share similar histologic features, but they are different tumors with different molecular biologic and clinical manifestations. A large cohort of EWD-PTC should be included in further study.
Adenocarcinoma, Follicular/pathology/secondary ; Adult ; Carcinoma, Papillary, Follicular/pathology/*secondary ; Female ; Galectin 3/analysis ; Humans ; Hyperplasia/pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Skull Neoplasms/*secondary ; Thyroid Neoplasms/*pathology

Unusual sites of metastases are recognized in patients with renal cell carcinoma (RCC). However, the prognostic implications of these sites are not well understood. We used the Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification for metastatic RCC to evaluate 912 consecutive patients with RCC managed at the Singapore General Hospital between 1990 and 2009. Among these patients, 301 had metastases either at diagnosis or during the course of illness. Nasal metastases, all arising from clear cell RCC, were identified histologically in 4 patients (1.3% of those with metastasis). All 4 patients were classified as MSKCC poor prognosis by current risk criteria. Nasal metastases were significantly associated with lung and bone metastases. The frequency of nasal metastases in patients with metastatic RCC is about 1%, occurring predominantly in patients with clear cell RCC. Nasal metastases are associated with poor prognosis as estimated by the MSKCC risk classification, with attendant implications for selection of targeted therapy, and are usually associated with multi-organ dissemination, including concurrent lung and bone involvement.
Antineoplastic Agents ; therapeutic use ; Bone Neoplasms ; secondary ; Carcinoma, Renal Cell ; diagnostic imaging ; secondary ; therapy ; Female ; Humans ; Indoles ; therapeutic use ; Kidney Neoplasms ; diagnostic imaging ; pathology ; therapy ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Nephrectomy ; Nose Neoplasms ; pathology ; secondary ; therapy ; Pyrroles ; therapeutic use ; Skull Neoplasms ; diagnostic imaging ; secondary ; Tomography, X-Ray Computed

Although intracranial dural metastasis of Ewing's sarcoma is a very rare finding, its imaging characteristics are similar to those of its primary form in the central nervous system. Thus, this tumor must be considered in the differential diagnosis of extra-axial dural masses.
Adult ; Dura Mater/*pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Sarcoma, Ewing's/diagnosis/*pathology/surgery ; Skull Neoplasms/diagnosis/*secondary/surgery ; Spinal Neoplasms/diagnosis/pathology/surgery ; Tomography, X-Ray Computed

The cavernous sinus of skull base is a extremely rare metastastatic site for hepatocellular carcinoma (HCC). A 51-year-old man was diagnosed with HCC by liver biopsy and palliative radiotherapy on HCC including main portal vein was performed. One month later, he was admitted due to sudden onset ptosis. Neurologic findings were normal except for abnormal movement of right eye, and it raised the possibility of abnormality in the right occulomotor, trochlear and the abducens nerves. Contrast-enhanced CT scan of brain showed a mass with homogeneous enhancement involving the right cavernous sinus. T2-weighted axial MR images demonstrated a homogeneous mass with intermediate signal intensity, and contrast-enhanced axial T1-weighted MR images demonstrated a mass with homogeneous enhancement in the right cavernous sinus. We describe a case of HCC metastasis to the cavernous sinus with symptoms of ptosis and disturbance of right eyeball movement.
Blepharoptosis/*etiology/pathology ; Carcinoma, Hepatocellular/complications/*diagnosis/*secondary ; Cavernous Sinus/*pathology ; Humans ; Liver Neoplasms/complications/*pathology ; Male ; Middle Aged ; Ophthalmoplegia/pathology ; Skull Base Neoplasms/diagnosis/*secondary ; Tomography, X-Ray Computed

OBJECTIVETo investigate the value of the additional skull lateral static imaging in whole-body bone imaging (WBI) vs CT for evaluation of skull base invasion in patients with nasopharyngeal carcinoma.

METHODSA total of 405 patients with pathologically confirmed NPC underwent WBI with additional static imaging of the left and right skull as well as CT examination of the nasopharynx and skull base within one week before the radiotherapy.

RESULTSThe concordance rates between WBI and CT for positive and negative diagnosis were 29.48% and 76.05% in these cases, respectively, with the total concordance rate of 81.23%. The concordance rates between skull lateral static imaging with visual judgment and CT examination for positive and negative diagnosis were 67.95% and 74.07%, respectively, showing a total concordance rate of 87.16%. Skull lateral static imaging with semi-quantitative analysis and CT examination showed concordance rates for positive and negative diagnosis of 75.64% and 74.07%, respectively, with a total rate of 88.64%. In 27 patients with negative diagnosis by CT but a positive one in skull lateral static imaging with semi-quantitative analysis, 9 had a positive diagnosis by magnetic resonance imaging.

CONCLUSIONSSkull lateral static imaging can be of value in the diagnosis of skull base invasion in NPC patients and may serve as an effective means for screening skull base invasion in NPC.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnostic imaging ; pathology ; Neoplasm Invasiveness ; Radionuclide Imaging ; Skull ; diagnostic imaging ; pathology ; Skull Neoplasms ; diagnostic imaging ; secondary ; Technetium Tc 99m Medronate ; Tomography, X-Ray Computed ; Whole Body Imaging ; Young Adult

Metastatic tumors in the sellar and parasellar regions are uncommon and rarely detected in clinical practice. We present four cases of sellar and parasellar metastatic tumors, which metastasized from distant organ in one case and extended directly from adjacent structures in three. Common presenting symptoms were cranial neuropathies, headache and facial pain. Invasion into the cavernous sinus was noted in all cases. We report rare cases of sellar and parasellar metastases. Also, we should consider the possibility of metastasis in these regions for patients who showed the above clinical presentations in systemic cancer patients. In extensive diseases, transient symptomatic relief could be obtained by direct surgical management, even in restricted degree.
Adenocarcinoma/therapy ; Adenocarcinoma/radiography ; Adenocarcinoma/pathology* ; Adult ; Breast Neoplasms/radiography ; Breast Neoplasms/pathology* ; Carcinoma, Infiltrating Duct/therapy ; Carcinoma, Infiltrating Duct/radiography ; Carcinoma, Infiltrating Duct/pathology* ; Case Report ; Female ; Human ; Magnetic Resonance Imaging/methods ; Male ; Middle Age ; Nasopharyngeal Neoplasms/therapy ; Nasopharyngeal Neoplasms/radiography ; Nasopharyngeal Neoplasms/pathology* ; Palatal Neoplasms/therapy ; Palatal Neoplasms/radiography ; Palatal Neoplasms/pathology* ; Sella Turcica* ; Skull Neoplasms/therapy ; Skull Neoplasms/secondary* ; Skull Neoplasms/physiopathology

OBJECTIVE: This study was designed to determine whether diffusion-weighted imaging (DWI) with sensitivity encoding (SENSE) could detect bone marrow involvement in patients with cranial bone marrow (CBM) metastases. DWI results obtained were compared with T1-weighted imaging (T1WI) findings. MATERIALS AND METHODS: DWI with sensitivity encoding (SENSE; b value = 1,000) was performed consecutively in 13 patients with CBM metastases diagnosed pathologically and radiologically. CBM lesions were dichotomized according to the involved site, i.e., skull base or calvarium. Two radiologists qualitatively evaluated the relative conspicuousness of CBM lesions and image qualities in B0 and in isotropic DWI and in T1WI. According to region of interest analysis of normal and pathologic marrow for these three sequences, absolute signal difference percentages (SD%) were calculated to quantitatively analyze lesion contrast. RESULTS: All 20 lesions in 13 patients with CBM metastases revealed abnormal DWI signals in areas corresponding to T1WI abnormalities. Both skull base and calvarial lesions provided better lesion conspicuousness than T1WI and B0 images. Although the image quality of DWI was less satisfactory than that of T1WI, relatively good image qualities were obtained. Quantitatively, B0 images (SD%, 82.1+/-7.9%) showed better lesion contrast than isotropic DWI (SD%, 71.4+/-13.7%) and T1WI (SD%, 65.7+/-9.3%) images. CONCLUSION: For scan times of less than 30 seconds, DWI with SENSE was able to detect bone marrow involvement, and was superior to T1WI in terms of lesion conspicuity. DWI with SENSE may be helpful for the detection of cranial bone/bone marrow metastases when used in conjunction with conventional MR sequences.
Adult ; Aged ; Bone Marrow Neoplasms/*pathology/*secondary ; Brain/pathology ; Contrast Media ; *Diffusion Magnetic Resonance Imaging ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Skull/*pathology

Facial nerve palsy due to temporal bone metastasis of hepatocellular carcinoma (HCC) has rarely been reported. We experienced a rare case of temporal bone metastasis of HCC that initially presented as facial nerve palsy and was diagnosed by surgical biopsy. This patient also discovered for the first time that he had chronic hepatitis B and C infections due to this facial nerve palsy. Radiation therapy greatly relieved the facial pain and facial nerve palsy. This report suggests that hepatologists should consider metastatic HCC as a rare but possible cause of new-onset cranial neuropathy in patients with chronic viral hepatitis.
Carcinoma, Hepatocellular/complications/*pathology ; Facial Nerve Diseases/diagnosis/etiology ; Facial Pain/etiology ; Facial Paralysis/diagnosis/etiology ; Hepatitis B, Chronic/diagnosis ; Hepatitis C, Chronic/diagnosis ; Humans ; Immunohistochemistry ; Liver Neoplasms/complications/*pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Skull Neoplasms/*diagnosis/pathology/secondary ; Tomography, X-Ray Computed