BACKGROUND: Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy affecting the skin, for which timely diagnosis and aggressive treatment are essential. MCC has most often been reported in Caucasians, and case reports in Asians are rare. This study presents our experiences with the surgical treatment and radiotherapy of MCC in Asian patients. METHODS: We retrospectively reviewed the records of seven MCC patients between 2000 and 2018 from a single institution, and analyzed patient characteristics, tumor characteristics, surgical treatment, sentinel lymph node evaluation, reconstruction, adjuvant radiation therapy, and prognosis. RESULTS: Eight MCC lesions occurred in seven patients, most commonly in the head and neck region. All patients underwent surgical excision with reconstruction. The final surgical margin was 1.0 cm in most cases, and reconstruction was most commonly performed with a split-thickness skin graft. Five patients received adjuvant radiotherapy, and two patients received sentinel lymph node biopsy. During the follow-up period, three patients remained well, two died from other causes, one experienced recurrence, and one was lost to follow-up. CONCLUSIONS: We treated seven Asian MCC patients and our series confirmed that MCC is a very dangerous cancer in Asians as well. Based on our experiences, thorough surgical excision of MCC with histopathological clearance should be considered, with sentinel lymph node evaluation if necessary, followed by appropriate reconstruction and careful postoperative observation. Adjuvant radiation therapy is also recommended for all Asian MCC patients. The results of this case series may provide guidance for the treatment of Asian MCC patients in the future.
Asian Continental Ancestry Group ; Carcinoma, Merkel Cell ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Lost to Follow-Up ; Lymph Nodes ; Mohs Surgery ; Neck ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Skin ; Transplants

BACKGROUND: Leptomeningeal metastasis (LM) is an uncommon, but devastating complication of advanced cancer and has no standard treatment. Herein, we analyzed the clinical characteristics and outcomes of patients with solid tumors who were diagnosed with LM. METHODS: Between January 2007 and December 2017, we retrospectively analyzed the medical records of patients with solid tumors who were diagnosed with LM. RESULTS: A total of 58 patients were enrolled in this study. The median age of patients was 51 years (range, 27–72 years), and 62.1% had a poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) (>2). The common types of primary tumor were breast cancer (39.7%), gastric cancer (25.9%), and non-small cell lung cancer (20.7%). Forty-two patients (72.4%) were diagnosed with LM by MRI of the brain and/or spine and cerebrospinal fluid (CSF) analysis, 14 were diagnosed by CSF analysis alone, and 2 were diagnosed by MRI alone. Treatments for LM were performed in 53 patients (91.4%), and best supportive care was provided for 5 patients (8.6%). Intrathecal chemotherapy, radiotherapy, and systemic chemotherapy were administered in 43 (74.1%), 17 (29.3%), and 24 (41.4%) patients, respectively. The median overall survival of the entire cohort was 2.4 months (95% confidence interval, 1.0–3.7). In the analysis of prognostic factors for survival, a good ECOG PS (≤2), administration of systemic chemotherapy after LM diagnosis, and a prior history of brain radiation were associated with prolonged survival. CONCLUSION: Although the prognosis of LM in patients with solid tumors is poor, systemic chemotherapy might improve survival in selected patients with a good PS.
Brain ; Breast Neoplasms ; Carcinoma, Non-Small-Cell Lung ; Cerebrospinal Fluid ; Cohort Studies ; Diagnosis ; Drug Therapy ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Meningeal Carcinomatosis ; Neoplasm Metastasis* ; Prognosis ; Radiotherapy ; Retrospective Studies* ; Spine ; Stomach Neoplasms

Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2–1.2 mg/dL), AST 200 IU (normal 0–40 IU), ALT 390 IU (normal 0–40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0–60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0–37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.
Bile Duct Neoplasms ; Bile Ducts, Extrahepatic* ; Bilirubin ; Carcinoma, Neuroendocrine* ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Common Bile Duct ; Diagnosis ; Dilatation ; Drainage ; Drug Therapy ; Follow-Up Studies ; Hepatic Duct, Common ; Humans ; Jaundice ; Liver ; Middle Aged ; Neuroendocrine Tumors ; Radiotherapy ; Recurrence ; Synaptophysin ; Tomography, X-Ray Computed ; Transferases

Signet ring cell carcinoma is a rare form of gallbladder cancer and has a worse prognosis. Since few cases have been reported, information regarding the behavior and prognosis of the gallbladder carcinoma is limited. About twenty four cases of gallbladder signet ring cell carcinoma have been reported so far. We present a rare case of primary signet ring cell carcinoma of the gallbladder. A 58-year-old male presented with epigastric pain. Abdominal computed tomography showed diffuse gallbladder wall thickening with enhancement, gallstones, and choledocholithiasis. After endoscopic treatment of choledocholithiasis, laparoscopic cholecystectomy was performed. Pathologic examination of the resected gallbladder revealed adenocarcinoma of signet ring cell type in the epithelium. Immunohistochemical stain for cytokeratin 7 was positive for tumor cells. The final pathologic diagnosis was primary signet ring cell carcinoma of the gallbladder. Lymph node metastasis was detected and he received chemotherapy and radiotherapy. After one year of follow-up, bone metastasis in the lumbar spine and malignant ascites were found. The patient is being provided with palliative care.
Adenocarcinoma ; Ascites ; Carcinoma, Signet Ring Cell* ; Cholangitis ; Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Choledocholithiasis ; Diagnosis ; Drug Therapy ; Epithelium ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Keratin-7 ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Palliative Care ; Prognosis ; Radiotherapy ; Spine

OBJECTIVES: The aim of this study was to assess the change in oral health-related quality of life among patients with head & neck cancer who received radiotherapy. METHODS: A total of 40 patients who were diagnosed as having head and neck cancer and scheduled to have radiotherapy were enrolled in this study; however, only 25 patients were included in the final analysis. Prior to radiotherapy, a dentist performed an oral examination to check for the presence of decayed and missing teeth, plaque, and determine the gingival index. Oral health-related quality of life was assessed using the OHIP-14 questionnaire. Eight weeks after starting radiotherapy, oral health-related quality of life was re-evaluated using the same questionnaire. RESULTS: The mean age of the participants was 60.20 (±7.29) years, and 22 (88.8%) of them were men. The majority of the participants were diagnosed as having squamous cell carcinoma (68.0%). The total OHIP-14 score was significantly decreased from 56.20 (±13.50) at baseline to 45.72 (±10.98) eight weeks after radiotherapy. In addition, according to subjective oral health at baseline, the observed change in the OHIP-14 score was significantly different. CONCLUSIONS: Oral health-related quality of life was significantly lowered after radiotherapy in patients with head and neck cancer.
Carcinoma, Squamous Cell ; Dentists ; Diagnosis, Oral ; Head and Neck Neoplasms* ; Head* ; Humans ; Male ; Oral Health ; Periodontal Index ; Quality of Life* ; Radiotherapy* ; Tooth

PURPOSE: Previous studies reported an association between an increased risk of tongue cancer and radiation treatment for nasopharyngeal carcinoma (NPC). This study compared the clinicopathologic characteristics and outcomes of tongue squamous cell carcinoma (TSCC) in patients with and without a history of radiotherapy for NPC. MATERIALS AND METHODS: From 1965 to 2009, a total of 73 patients were diagnosed with TSCC with a history of radiotherapy for NPC. The patients were matched in a 1:3 ratio with patients with sporadic TSCC according to age, sex, and year of the TSCC diagnosis. The primary endpoint was the overall survival. RESULTS: The median interval from NPC to TSCC was 82 months. The NPC survivors were more likely to be diagnosed with a more advanced T classification, less likely to have lymph node involvement, and more likely to have the tumor located in the dorsum of the tongue than sporadic TSCC. Regarding the histologic characteristics, the NPC survivors were more likely to have a weak lymphocytic host response, low tumor budding, and low risk of a worse pattern of invasion. The sporadic TSCC patients had a better overall survival (hazard ratio, 0.690; p=0.033) than the NPC survivors. In competing risks analysis, the cumulative incidence functions for the competing event (documented non-tongue cancer death) were significantly higher in the NPC survivors (Gray's test, p=0.001). CONCLUSION: TSCC patients with a history of radiotherapy for NPC appear to have particular clinicopathologic features, a poorer survival, and are more likely to die from non-tongue cancer causes than those with sporadic TSCC.
Carcinoma, Squamous Cell* ; Case-Control Studies* ; Classification ; Diagnosis ; Epithelial Cells* ; Humans ; Incidence ; Lymph Nodes ; Neoplasms, Second Primary ; Prognosis* ; Radiotherapy ; Survivors ; Tongue Neoplasms ; Tongue*

BACKGROUND: A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula. METHODS: Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation. RESULTS: A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation. CONCLUSIONS: Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.
Carcinoma, Squamous Cell ; Carotid Arteries ; Constriction, Pathologic ; Cutaneous Fistula ; Diagnosis ; Fistula* ; Free Tissue Flaps ; Head ; Humans ; Hypopharynx* ; Incidence ; Myocutaneous Flap ; Neck ; Oropharynx* ; Postoperative Complications ; Radiotherapy ; Retrospective Studies ; Risk Factors* ; Rupture ; Serum Albumin

A synchronous incidence of breast cancer and follicular lymphoma (FL) is uncommon. The association between these two conditions could be explained by the antigenic stimulation of the adjacent carcinoma and common genetic background. This study aimed to review the literature, and discuss the etiology and management of synchronous breast cancer and FL. Herein, we presented a case of synchronous ductal carcinoma in situ (DCIS) of the breast and FL involving multiple lymph nodes, including those in both axilla. A 49-year-old woman presented with palpable lumps in both axilla. She underwent lumpectomy, radiotherapy, and hormonal therapy for DCIS, while adjuvant chemotherapy was recommended for the lymphoma. Diagnosis was based on histopathologic analysis, such as excision or biopsy.
Axilla ; Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Chemotherapy, Adjuvant ; Diagnosis ; Female ; Genetic Background ; Humans ; Incidence ; Lymph Nodes ; Lymphoma ; Lymphoma, Follicular* ; Mastectomy, Segmental ; Middle Aged ; Radiotherapy

Malignancy of the external auditory canal (EAC) is a rare tumor. Among the malignancies of EAC, squamous cell carcinoma (SCC) is the most common pathologic type. The causes of SCC of EAC may be exposure to ultraviolet rays, cholesteatoma, chronic otitis externa, and rarely radiotherapy. SCC of EAC has the diverse and non-specific clinical features including mass of tissue, otorrhea, otalgia, tinnitus, and facial palsy which make it difficult to distinguish between SCC and benign tumor. Recently, we experienced a case of SCC of EAC occurred in the left external auditory canal after radiotherapy for Kimura's disease, which was misdiagnosed as keratoacanthoma at first. The findings of this case suggest that when it is difficult to distinguish SCC from benign tumor of EAC, the excisional biopsy including enough resected margin and base of tumor is needed for an exact diagnosis.
Biopsy ; Carcinoma, Squamous Cell* ; Cholesteatoma ; Diagnosis ; Ear Canal* ; Earache ; Epithelial Cells* ; Facial Paralysis ; Keratoacanthoma* ; Otitis Externa ; Radiotherapy* ; Tinnitus ; Ultraviolet Rays

PURPOSE: Local recurrence is a major concern in patients who have undergone surgery for ductal carcinoma in situ (DCIS). The present study assessed whether the expression levels of hormone receptors, human epidermal growth factor receptor 2 (HER2), and Ki-67, as well as resection margin status, tumor grade, age at diagnosis, and adjuvant hormonal therapy and radiotherapy (RT) are associated with recurrence in women with DCIS. METHODS: In total, 111 patients with DCIS were included in the present study. The invasive and noninvasive recurrence events were recorded. The clinicopathological features; resection margins; administration of hormonal therapy and RT; expression statuses of estrogen receptor (ER), progesterone receptor (PR), and HER2; Ki-67 expression; and molecular subtypes were evaluated. Logistic regression analysis was performed to examine the risk factors for recurrence. RESULTS: Recurrence was noted in 27 of 111 cases (24.3%). Involvement of resection margins, low tumor grade, high Ki-67 expression, and RT were independently associated with an increase in the recurrence rate (p<0.05, Pearson chi-square test). The recurrence rate was not significantly associated with patient age; ER, PR, and HER2 statuses; molecular subtype; and hormonal therapy. CONCLUSION: The results of the present study suggested that the involvement of resection margins, low tumor grade, high Ki-67 index, and the absence of adjuvant RT were independently associated with increased recurrence in patients with DCIS. Future studies should be conducted in a larger cohort of patients to further improve the identification of patients at high-risk for DCIS recurrence.
Breast ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Cohort Studies ; Diagnosis ; Estrogens ; Female ; Humans ; Logistic Models ; Mastectomy, Segmental* ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Recurrence ; Risk Factors