Cutaneous metastasis of gallbladder adenocarcinoma in a patient with chronic lymphocytic leukemia: a case report and review of the literature

Skin metastasis of primary gallbladder tumors is extremely rare with a reported incidence of 0.7~9% and it usually involves the thorax, abdomen, the extremities, neck, head region, and scalp. Cutaneous metastasis may occur synchronously or metatochronously. In the present case, the patient had chronic lymphocytic leukemia, which was being treated with an alkylating agent (chlorambucil) when the patient developed skin metastasis from gallbladder adenocarcinoma during post- cholecystectomy follow-up. Given the fact that secondary malignancies occur in chronic lymphocytic leukemia; this clinical setting warrants attention. We aimed to discuss secondary malignancy in chronic lymphocytic leukemia patients and gallbladder adenocarcinoma with skin metastasis, based on a review of the literature and the presented case.

Acupuncture-related rapid dermal spread of breast cancer: a rare case

Many ethnic Chinese patients seek second or adjuvant alternative therapies after breast cancer is diagnosed. Chinese herbs and acupuncture are the most popular methods in East Asia. We present a case of acupuncture manipulation-related cutaneous spread that no literature reported before. Post-acupuncture cutaneous spread was noted in a 54-year-old woman with left neck lymph node recurrence after complete surgery, chemotherapy and radiotherapy treatment. The results of chest computed tomography and skin biopsy showed the metastatic breast cancer in the dermis. Six courses of paclitaxel and gemcitabine followed by trastuzumab were given as therapeutic chemotherapy. The neck mass and cutaneous lesions subsided after 2 courses of chemotherapy. Direct puncture of a metastatic lymph node might increase the incidence of tumor spread on the skin. Therefore, despite the efficacy of complementary and alternative medicine, its safety and possible side effects should be more emphasized.

Effect of remedies for enhancing resistance and relieving blood stasis on metastasis in postoperative gastric cancer and ornithine decarboxylase levels

AIM: To study the action of remedies for enhancing resistance and relieving blood stasis on metastasis in postoperative gastric cancer and its influence on ornithine decarboxylase (ODC).

METHODS: Sixty-three postoperative patients with gastric cancer were randomly divided into two groups. Thirty-one patients were treated with western medicine consisting of the FAP (5-fluorouracil, adriamycin, cisplatin) and CODP regimens (cyclophosphamide, vincristine, daunorubicin, prednisone), whereas 32 patients were treated with the FAP regimen and traditional Chinese medicine. Correlations were made between the ODC levels detected before and after treatment and other factors such as tumor diameter, infiltration depth, histological type, and lymph node metastasis.

RESULTS: The ODC levels in the gastric cancer tissue and adjacent normal gastric mucosal tissue were significantly higher in the patients than in the controls. There was an obvious correlation between increased ODC and tumor size, infiltration depth, degree of differentiation, and lymph node metastasis. Six months later, there were no significant changes in the ODC levels of the group using only Western medicine, while the ODC levels decreased markedly in the group using combined Western and traditional Chinese medicine (P < 0.01).

CONCLUSION: The effects of traditional Chinese medicine remedies on metastases in postoperative gastric cancer are related to the reduction of ODC activity.

Expression of metastasis suppressor gene nm23 in human hepatocellular carcinoma

AIM: To investigate the relationship between the expression of nm23-Hi mRNA and the metastatic potential of hepatocellular carcinoma (HCC).

METHODS: The expression of nm23-H1 mRNA was detected in 24 cases of HCC by in situ hybridization using digoxigenin-labeled nm23-H1 antisense cRNA probe. Twenty-four HCC specimens were divided into two groups according to the following criteria: (1) metastasis in portal lymph nodes; (2) the number of tumors in the liver; (3) cancerous emboli in the portal vein; and (4) the existence of satellite lesions. We named those meeting criteria (1) or (2) and (3), or (3) and (4) high metastatic potential (n = 6); and the others formed the low metastatic potential group (n = 18).

RESULTS: Positive results of in situ hybridization showed granules or masses in the cytoplasm. In the low metastatic potential group strong staining was obtained in ten specimens, while in the high metastatic potential group there was none. Three negative results were found in the high metastatic potential group, and one in the low metastatic potential group (P < 0.05). The expression of nm23-H1 mRNA was not correlated with some clinical factors, such as tumor size or the background liver disease.

CONCLUSION: The expression of nm23-H1 mRNA is inversely correlated with HCC metastatic potential, and can be considered as an index which indicates the metastatic potential of HCC.