We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.
Abscess* ; Debridement ; Drainage ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Lung ; Lung Neoplasms ; Lymph Nodes* ; Male ; Mediastinum ; Middle Aged ; Needles* ; Neoplasm Staging ; Permeability ; Pleural Effusion ; Pleural Effusion, Malignant* ; Thoracic Surgery, Video-Assisted

OBJECTIVETo investigate the clinical pathological features of fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP).

METHODSThe clinical history, histopathological features and immunohistochemical characteristics were analyzed in twelve cases of FS-DFSP from January 1997 to February 2011, and related literature were reviewed.

RESULTSAge of the patients (2 females, 10 males) at diagnosis ranged from 41 to 70 years (mean 53 years). Among the 12 cases of FS-DFSP, 9 cases aroused in recurrent ordinary DFSP. Histologically, FS areas in FS-DFSP were characterized by a fascicular and highly cellular histology, frequently showing a characteristic herringbone pattern. FS-DFSP showed diminishment of CD34 staining in FS areas. The labeling index of Ki-67 was much higher in the FS areas (10%-40%) than that in the conventional DFSP areas (2%-5%). All the patients were treated by operation with local excision or wide excision. Postoperative radiotherapy and chemotherapy was administered in two cases respectively. Follow-up information in 9 of 12 patients (9 to 86 months) revealed local recurrence in 6 patients. Distant metastases were seen in two patients. One patient was died in the follow up period.

CONCLUSIONSFS-DFSP is a rare and unique subtype of DFSP and is associated with significant elevated risk of both local and distance metastasis, usually followed by poor outcome. Compared to ordinary DFSP as a borderline neoplasm, FS-DFSP should be considered as a malignant tumor.

Adult ; Aged ; Antigens, CD34 ; metabolism ; Chemotherapy, Adjuvant ; Dermatofibrosarcoma ; metabolism ; pathology ; therapy ; Diagnosis, Differential ; Female ; Fibroma ; pathology ; Fibrosarcoma ; metabolism ; pathology ; therapy ; Follow-Up Studies ; Histiocytoma, Benign Fibrous ; metabolism ; pathology ; Histiocytoma, Malignant Fibrous ; pathology ; Humans ; Ki-67 Antigen ; metabolism ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Radiotherapy, Adjuvant ; Retrospective Studies ; Skin Neoplasms ; metabolism ; pathology ; therapy

OBJECTIVETo investigate the clinicopathologic characteristics, differential diagnosis and biologic behaviors of pleomorphic rhabdomyosarcoma (PRMS).

METHODSThe clinical findings, pathological features and immunophenotypes were reviewed in 44 cases of PRMS (encountered during the period from 2005 to 2012). The clinical outcome was analyzed.

RESULTSThere were 33 males and 11 females with age ranging from 2 to 85 years (mean, 51 years; median, 55 years). Of 44 tumors, 22 occurred in the extremities (50.0%), 16 in the trunk (36.4%), 5 in the internal organs (11.4%), and 1 in the head and neck (2.2%). Histologically, 40 tumors showed features of pleomorphic sarcoma with striking resemblance to undifferentiated pleomorphic sarcoma (UPS)/malignant fibrous histiocytoma(MFH). However, variable amount of pleomorphic rhabdomyoblasts (PRMB) were identified in most cases. The remaining 4 tumors were composed predominantly of fascicles of spindle cells with interspersed PRMBs. Immunohistiochemically, tumor cells showed diffuse staining of desmin (41/41,100%), with variable expression of myogenin (18/32, 56.3%), MyoD1 (10/21, 47.6%) and MSA (21/29, 72.4%), whereas α-SMA was negative in most cases. Follow-up data (range, 2 to 51 months) available in 29 cases showed 12 patients were alive with unresectable or recurrent disease and 17 patients were alive with no evidence of disease. The median disease-free and overall survivals was 6.0 months (mean, 9.1 months) and 8.0 months (mean, 11.2 months) respectively. Thirteen patients (44.8%) exhibited progression of disease with recurrence in 4 cases and metastasis in 9 cases. The median interval to progression was 6.0 months (mean, 5.9 months).

CONCLUSIONSThe presence of pleomorphic cells with strong eosinphilic cytoplasm in a pleomorphic sarcoma is suggestive of a PRMS. Diffuse, strong expression of desmin and negative staining for α-SMA further facilitate the diagnosis of PRMS and its differential diagnosis from pleomorphic leiomyosarcoma. Although PRMS may affect children or adolescents, it should be cautious not to misdiagnose anaplastic rhabdomyosarcoma as PRMS. PRMS is a high-grade sarcoma with a poor prognosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Child ; Child, Preschool ; Desmin ; metabolism ; Diagnosis, Differential ; Extremities ; Female ; Follow-Up Studies ; Histiocytoma, Malignant Fibrous ; metabolism ; pathology ; Humans ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; MyoD Protein ; metabolism ; Myogenin ; metabolism ; Neoplasm Recurrence, Local ; Retrospective Studies ; Rhabdomyosarcoma ; metabolism ; pathology ; secondary ; surgery ; therapy ; Survival Rate ; Young Adult

OBJECTIVETo explore the mRNA expression of breast cancer susceptibility gene 1 (BRCA1) in tumor cells isolated from malignant pleural and peritoneal effusions, and the predictive role of BRCA1 related to the efficacy of cisplatin-based chemotherapy.

METHODSTumor cells were isolated from malignant pleural and peritoneal effusions of 31 cancer patients. The response of these tumor cells to cisplatin was determined by CCK8 assay. Real time quantitative RT-PCR was used to examine the BRCA1 mRNA level in the primary culture cancer cells.

RESULTSThe expression level of BRCA1 mRNA was 0.618 (0.014 - 18.063) in primary culture tumor cells. The IC(50) of DDP was 2.809 µg/ml in the primary culture tumor cells (0.118 - 19.439 µg/ml). Both BRCA1 mRNA expression and the tumor cells IC(50) of DDP were not significantly related with patient age, gender, the type of primary tumor, whether to accept the chemotherapy and effusion type (P > 0.05). The level of BRCA1 mRNA was negatively correlated with the chemosensitivity in terms of IC(50) of cisplatin (P < 0.001).

CONCLUSIONAssessment of expression level of BRCA1 mRNA may be useful in predicting the efficacy of cisplatin-based chemotherapy in patients with metastatic malignant effusions.

Antineoplastic Agents ; pharmacology ; Ascitic Fluid ; metabolism ; pathology ; BRCA1 Protein ; genetics ; metabolism ; Cisplatin ; pharmacology ; Drug Resistance, Neoplasm ; Female ; Humans ; Lung Neoplasms ; metabolism ; pathology ; Male ; Middle Aged ; Pleural Effusion, Malignant ; metabolism ; pathology ; RNA, Messenger ; metabolism ; Stomach Neoplasms ; metabolism ; pathology

PURPOSE: Carcinosarcomas are rare neoplasms in which both malignant epithelial and mesenchymal elements are identified. We have found only twenty one cases of primary cutaneous carcinosarcoma in the English language literature. Therefore it has been difficult to diagnosis because its unclear etiology and low frequency. METHODS: A 31-year-old young man with a protruding mass on his ankle dorsum was examined. The tumor was 7 x 6 x 3 cm sized and arose from a burn scar. The mass was wide excised and applied split thickness skin graft. Characteristic pathologic finding was a mixture of squamous cell carcinoma and malignant fibrous histiocytoma. RESULTS: Three months after the operation, the patient died of multiple metastasis to the liver, lung and finally of sepsis despite adjuvant chemotherapy and adjuvant radiotherapy. CONCLUSION: If a metastatic cutaneous carcinosarcoma is diagnosed, wide excision is required. There should be more aggressive management to minimize the risk of recurrence. Further research into the etiology and pathophysiology of the disease and a more careful differential diagnosis may allow improvement in treatment.
Adult ; Animals ; Ankle ; Burns ; Carcinoma, Squamous Cell ; Carcinosarcoma ; Chemotherapy, Adjuvant ; Cicatrix ; Diagnosis, Differential ; Histiocytoma, Malignant Fibrous ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Recurrence ; Sepsis ; Skin ; Transplants ; Ulcer

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma. It is regarded as an undifferentiated pleomorphic sarcoma with an unproven histogenesis. It most commonly occurs in the skeletal muscles of the extremities or the retroperitoneum of adults. It often metastasizes to the lungs, lymph nodes, bones and liver, but rarely to the skin. We report here a case of malignant fibrous histiocytoma that metastasized to the skin.
Adult ; Extremities ; Histiocytoma, Malignant Fibrous ; Humans ; Liver ; Lung ; Lymph Nodes ; Muscle, Skeletal ; Neoplasm Metastasis ; Sarcoma ; Skin

Shoyogan is a Kampo prescription described in the Jinkuiyaolue text, but there have been no case reports regarding this medicine. We report a patient with terminal stage lung cancer, whose appetite and general well-being was maintained following oral administration of this medicine.A 62-year old woman had her main tumor in the left pulmonary lobe, which invaded to the bilateral peritoneum and the mediastinum. Metastasis was recognized in the left femoral bone which had been broken, the ilium, chest and lumbar vertebral bones, and the liver. Her general condition was very poor in spite of the administration of corticosteroids and narcotic medicines, when she began to take shoyogan 5 months after the onset of her symptoms. Cytological examination of her pleural effusion revealed adenocarcinoma. Following the administration of shoyogan, her appetite recovered, nutrition improved, and she was able to survive while maintaining her quality of life for another 2 months.In this paper we discuss the efficacy of shoyogan in improving the general well-being of patients having the above-mentioned conditions, or jueyinbing in Kampo parlance. Although preparing shoyogan is laborious, we believe this medicine should be used more frequently.
Following ; Malignant neoplasm of lung ; Patients ; Medicine ; Administration, Oral

Malignant fibrous histiocytoma (MFH) has been considered to be the most common malignant soft tissue tumor of middle and late adulthood. This tumor is usually a skin-colored subcutaneous nodule. It metastasizes to the lung, lymph node, bone and liver. Metastasis to the skin is very rare. We present a case of a 69-year-old man who presented with an asymptomatic dome-shaped large nodule with central umbilical ulceration on his scalp that had grown abruptly over 3 months. The lesion clinically mimicked keratoacanthoma. Biopsy of the nodule was done to differentiate keratoacanthoma from MFH confirmed the latter. The result of biopsy was MFH. Diagnosis was MFH of unknown primary tumor origin. We report a case of metastatic MFH mimicking keratoacanthoma.
Aged ; Biopsy ; Histiocytoma, Malignant Fibrous ; Humans ; Keratoacanthoma ; Liver ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasms, Unknown Primary ; Scalp ; Skin ; Ulcer

OBJECTIVETo investigate the clinical value of pleural effusion lung ProGRP, neuron specific enolase (NSE), cytokeratin fragment 19 (CYFRA21-1), carcino-embryonic antigen (CEA), carbohydrate antigen 153 (CA153), carbohydrate antigen 19 - 9 (CA19-9) in differential diagnosis and histological typing of malignant pleural effusion caused by lung cancer.

METHODSAll the 171 patients with malignant hydrothorax caused by lung cancer were from coal-mine area of Kailuan. They were divided into the small cell lung cancer (SCLC) group (n = 39), the adenocarcinoma group (n = 99) and the squamous cell carcinoma group (n = 37). The patients with benign pleural effusion served as the controls (n = 30). The diagnostic value of pleural effusion ProGRP, NSE, CYFRA21-1, CEA, CA153 and CA19-9 was compared for each group.

RESULTSYouden index and the accurate rate of pleural effusion ProGRP + NSE (sequence test) were the highest in the diagnosis of malignant hydrothorax caused by SCLC. CEA + CA153 + CA19-9 (sequence test) was the highest in the diagnosis of malignant hydrothorax caused by adenocarcinoma. CYFRA21-1 + CEA + CA153 (on parallel test) were the highest in the diagnosis of malignant hydrothorax caused by squamous cell carcinoma. The Yonden index and the accurate rate were the highest by the single detection of CYFRA21 (0.5514 and 0.6878), and by the combined detection of ProGRP + CYFRA21-1 + CEA (on parallel test) (0.7029 and 0.8878).

CONCLUSIONThe first pleural effusion tumor markers of malignant hydrothorax caused by the SCLC, adenocarcinoma of lung, and lung squamous cell carcinoma are ProGRP, CEA and CYFRA21-1, respectively. The best combinations of pleural effusion tumor marker in diagnosis of malignant hydrothorax caused by the SCLC, adenocarcinoma of lung, lung squamous cell carcinoma and lung cancer are the combined detection of ProGRP + NSE (sequence test), combined detection of CEA + CA153 + CA19-9 (sequence test), the combined detection of CYFRA21-1 + CEA + CA153 (on parallel test) and ProGRP + CYFRA21-1 + CEA (on parallel test), respectively.

Adult ; Aged ; Aged, 80 and over ; Antigens, Neoplasm ; analysis ; Biomarkers, Tumor ; analysis ; CA-19-9 Antigen ; analysis ; Diagnosis, Differential ; Female ; Humans ; Keratin-19 ; analysis ; Lung Neoplasms ; complications ; diagnosis ; Male ; Middle Aged ; Peptide Fragments ; analysis ; Pleural Effusion, Malignant ; diagnosis ; etiology ; Recombinant Proteins ; analysis

We report a case of malignant fibrous histiocytoma (MFH) of the right buttock with multiple metastases to the lung, bone, and small intestine. He received resection and end-to-end anastomosis of the jejunum for the jejunal metastatic tumor, and mass excision of the metastatic tumor of the left femur followed by closed reduction and internal fixation and palliative radiotherapy. In addition, he received palliative radiotherapy to the metastatic pulmonary tumor with suspicious invasion into the thoracic aorta. However, one month after the completion of the aggressive local treatments, metastatic tumors recurred in the abdominal cavity, an extremely unusual site, resulting in peritoneal dissemination. He died of progressive disease 5 months after the initial diagnosis.
Abdominal Cavity ; Aorta, Thoracic ; Buttocks ; Femur ; Histiocytoma, Malignant Fibrous ; Intestine, Small ; Jejunum ; Lung ; Neoplasm Metastasis ; Neoplasm Seeding ; Peritoneal Cavity