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Sánchez-López V, Marín-Romero S, Ferrer-Galván M, Elías-Hernández T, Lobo Beristain JL, Ballaz Quincoces A, Jara-Palomares L, Rodríguez Martorell FJ, Castro MJ, Marín Hinojosa C, López-Campos JL, Otero-Candelera R. Occult cancer in patients with unprovoked venous thromboembolism: A nested case-control study. Am J Clin Pathol 2024; 161:501-511. [PMID: 38340336 PMCID: PMC11063558 DOI: 10.1093/ajcp/aqad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Detecting occult cancer in patients with unprovoked venous thromboembolism (VTE) remains a significant challenge. Our objective was to investigate the potential predictive role of coagulation-related biomarkers in the diagnosis of occult malignancies. METHODS We conducted a nested case-control study with a 1-year prospective cohort of 214 patients with unprovoked VTE, with a focus on identifying occult cancer. At the time of VTE diagnosis, we measured various biomarkers, including soluble P-selectin (sP-selectin), dimerized plasmin fragment D (D-dimer), platelets, leukocytes, hemoglobin, total extracellular vesicles (EVs), EVs expressing tissue factor on their surface (TF+EVs), and EVs expressing P-selectin on their surface (Psel+EVs) in all participants. RESULTS We observed statistically significant increased levels of sP-selectin (P = .015) in patients with occult cancer. Despite an increase in Psel+EVs, TF+EVs, D-dimer, and platelets within this group, however, no significant differences were found. When sP-selectin exceeded 62 ng/mL and D-dimer surpassed 10,000 µg/L, the diagnosis of occult cancer demonstrated a specificity of up to 91% (95% CI, 79.9%-96.7%). CONCLUSIONS The combination of sP-selectin and D-dimer can be a valuable biomarker in detecting occult cancer in patients with unprovoked VTE. Further research is necessary to ascertain whether easily measurable biomarkers such as sP-selectin and D-dimer can effectively distinguish between patients who have VTE with and without hidden malignancies.
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Affiliation(s)
- Verónica Sánchez-López
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Samira Marín-Romero
- Medical Surgical Unit of Respiratory Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Marta Ferrer-Galván
- Medical Surgical Unit of Respiratory Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Teresa Elías-Hernández
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Medical Surgical Unit of Respiratory Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Luis Jara-Palomares
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Medical Surgical Unit of Respiratory Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - María José Castro
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
| | - Carmen Marín Hinojosa
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - José Luis López-Campos
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Medical Surgical Unit of Respiratory Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Remedios Otero-Candelera
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Medical Surgical Unit of Respiratory Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
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Kaira K, Amano H, Imai H, Okada H, Kagamu H. Membranous Nephropathy as a Paraneoplastic Syndrome in Cancer of Unknown Primary. In Vivo 2024; 38:1503-1508. [PMID: 38688636 PMCID: PMC11059915 DOI: 10.21873/invivo.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM Membranous nephropathy (MN) is a nephrotic syndrome with both idiopathic and secondary etiologies. The mechanism of cancer-associated MN is presumed to involve the immunological production of antibodies against a tumor antigen, although little is known about the detailed mechanism. Lung cancer is a major neoplasm associated with cancer-associated MN. However, the simultaneous occurrence of secondary MN in patients with cancer of unknown primary (CUP) remains unclear. CASE REPORT Here, we present a case of secondary MN in a 72-year-old female as a paraneoplastic syndrome in CUP. Thoracic radiotherapy up to a total of 60 Gy was initially performed on the right subclavian and mediastinal lymph nodes. Computed tomography revealed marked shrinking of these lymph nodes, and the secondary MN also improved without any symptoms. CONCLUSION The presence of proteinuria in patients with CUP suggests the possibility of secondary MN as a rare differential diagnosis.
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Affiliation(s)
- Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Hidaka, Japan;
| | - Hiroaki Amano
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Hidaka, Japan
| | - Hirokazu Okada
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Hidaka, Japan
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Monden Y, Une D, Torigoe H, Isoda T, Kamaguchi S, Yoshida K, Hirami Y, Nakai M. Surgical resection of an intraluminal tumor in the azygos vein with an unknown primary site causing superior vena cava syndrome. Thorac Cancer 2024; 15:578-581. [PMID: 38316628 PMCID: PMC10912538 DOI: 10.1111/1759-7714.15233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Intraluminal tumor in the azygos vein is a rare disease that can cause superior vena cava (SVC) syndrome. Radiotherapy and endovascular stenting with or without chemotherapy are reported to have a high clinical success rate for the management of SVC syndrome with malignancy, but a poor survival rate. Here, we report a 69-year-old man who presented with swelling of the face and upper extremities, who was diagnosed with SVC syndrome caused by an intraluminal tumor in the azygos vein. Enhanced chest computed tomography revealed an intraluminal mass with a filling defect from the azygos vein to the SVC, with no extravascular extension or dissemination of the primary tumor. Surgical resection of the mass en bloc with the azygos vein and SVC reconstruction was performed. A poorly differentiated carcinoma was diagnosed on postoperative pathological evaluation. Twelve months after resection, the patient was well with no signs of recurrent disease. This case highlights that surgical resection should be considered as a treatment of choice for the management of SVC syndrome caused by an intraluminal malignancy in the azygos vein.
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Affiliation(s)
- Yuki Monden
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Dai Une
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Hidejiro Torigoe
- Department of Thoracic SurgeryOkayama Medical CenterOkayamaJapan
| | - Tetsuya Isoda
- Department of PathologyOkayama Medical CenterOkayamaJapan
| | - Suzuka Kamaguchi
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Kenji Yoshida
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
| | - Yuji Hirami
- Department of Thoracic SurgeryOkayama Medical CenterOkayamaJapan
| | - Mikizo Nakai
- Department of Cardiovascular SurgeryOkayama Medical CenterOkayamaJapan
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4
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Manabe M, Inano N, Hagiwara Y, Sogabe N, Nanno S, Mazaki T, Koh K. Cancer-related thrombotic microangiopathy and disseminated intravascular coagulation in a patient with bone marrow carcinomatosis of unknown primary origin: A case report. Cancer Rep (Hoboken) 2024; 7:e2036. [PMID: 38517451 PMCID: PMC10959179 DOI: 10.1002/cnr2.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Cancer-related thrombotic microangiopathy (CR-TMA) is a rare type of Coombs-negative hemolytic anemia, which is caused by malignancy and has a poor prognosis. CASE A 76-year-old female was referred to our hospital due to Coombs-negative hemolytic anemia, which was causing fatigue and dyspnea on exertion, accompanied by schistocytosis. A bone marrow examination demonstrated bone marrow carcinomatosis, and the tumor cells were morphologically suspected to be signet-ring cell carcinoma cells. As we failed to find the primary tumor site before the patient died, she was diagnosed with CR-TMA due to bone marrow carcinomatosis of unknown primary origin. Thrombotic thrombocytopenic purpura (TTP) was rapidly ruled out based on her PLASMIC score. In addition, immunohistochemical staining of a clot section of the bone marrow and tumor marker data were useful for narrowing down the likely primary tumor site. CONCLUSION Although CR-TMA is an extremely rare phenomenon, clinicians who suspect CR-TMA should quickly rule out TTP and decide whether to provide appropriate chemotherapy or plan for palliative care.
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Affiliation(s)
- Masahiro Manabe
- Department of HematologyOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Naoyuki Inano
- Department of Clinical LaboratoryOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Yuuji Hagiwara
- Department of Clinical LaboratoryOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Nobuhiro Sogabe
- Department of HematologyOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Satoru Nanno
- Department of HematologyOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Takeshi Mazaki
- Department of PathologyOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Ki‐Ryang Koh
- Department of HematologyOsaka General Hospital of West Japan Railway CompanyOsakaJapan
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5
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Kalavacherla S, Li V, Voora R, Victor M, Faraji F, Guo T. Factors associated with unknown primary status in head and neck squamous cell carcinoma. Oral Oncol 2024; 148:106650. [PMID: 38039876 DOI: 10.1016/j.oraloncology.2023.106650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Head and neck cancer of unknown primary (CUP) poses significant therapeutic challenges. We compare CUP and oropharyngeal primary (OP) cases to identify factors associated with tumor detection. METHODS The 2004-2019 National Cancer Database was queried to identify CUP and OP cases based on clinical and pathologic TNM staging. Clinical and demographic characteristics were compared by primary detection and HPV status with descriptive statistics. Multivariable logistic regression models to characterize OP detection were constructed. Among HPV-positive and negative patients, respectively, OP and CUP patients were matched by clinical nodal disease. Cox proportional-hazards models were constructed using matched cohorts to characterize survival. RESULTS 81,053 CUP and OP cases were identified; 64.3 % were HPV-positive. OP detection increased over time in HPV-positive and negative disease. HPV-positive status had higher odds of OP detection (odds ratio (OR) = 1.77, p < 0.001), while females (OR = 0.95, p = 0.008), and black (OR = 0.82, p < 0.001) and Asian (OR = 0.7, p < 0.001) patients had lower odds compared to males and whites, respectively. In HPV-positive and negative disease, OP patients had higher 2 and 5-year survival rates than CUP (p < 0.001). Primary detection status conferred lower death risk in HPV-positive (hazard ratio (HR) = 0.85, p < 0.001) and negative disease (HR = 0.87, p < 0.001) when controlling for age, sex, race, comorbidities, insurance, treatment facility, and income. CONCLUSION In the largest cohort of CUP to date, we report a survival benefit in primary tumor detection regardless of HPV status. Groups with higher persistent CUP rates, including non-white, female, HPV-negative, and low income patients, may benefit from increased diagnostic workup to improve detection and treatment.
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Affiliation(s)
| | - Vivienne Li
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rohith Voora
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, CA, USA
| | - Mitchell Victor
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, CA, USA; Gleiberman Head & Neck Cancer Center, Moores Cancer Center, UC San Diego Health, La Jolla, CA, USA
| | - Farhoud Faraji
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, CA, USA; Gleiberman Head & Neck Cancer Center, Moores Cancer Center, UC San Diego Health, La Jolla, CA, USA
| | - Theresa Guo
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, CA, USA; Gleiberman Head & Neck Cancer Center, Moores Cancer Center, UC San Diego Health, La Jolla, CA, USA.
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Chen AM. Management of unknown primary head and neck cancer with radiation therapy in the era of human papillomavirus (HPV): No longer cutting down the tree to get an apple. Radiother Oncol 2023; 189:109952. [PMID: 37844736 DOI: 10.1016/j.radonc.2023.109952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Given the central role that radiation has in the management of head and neck squamous cell carcinoma of unknown primary origin, it is imperative to review how treatment paradigms have been refined and continue to evolve in the modern era. METHODS AND MATERIALS This study was designed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A literature search of peer-reviewed publications was undertaken to identify works pertaining to the use of radiation for squamous cell carcinoma of unknown primary origin presenting as cervical lymph node metastases. Articles published from January 2002 to January 2023 with full text available on PubMed and restricted to the English language and human subjects were included. The full bibliographies of identified articles were reviewed and irrelevant studies were removed. RESULTS While such breakthroughs as intensity-modulated radiotherapy, positron emission tomography, biomarker testing with immune-histochemistry, and minimally invasive surgical techniques such as transoral robotic surgery have fundamentally changed the approach to this disease in recent decades, controversies still exist with respect to the manner in which radiation is delivered. Although the incidence of head and neck unknown primary cancer is relatively low, questions regarding the necessity of comprehensive radiation using the age-old standard method of targeting the bilateral necks and entire pharyngeal axis to encompass all putative sites of mucosal disease persist. CONCLUSIONS Prospective evidence is lacking, and the available studies have been complicated by such factors as the relatively limited sample sizes, as well as the variability in work-up, treatment, inclusion criteria, and follow-up. Regardless, advances in science and technology have ushered in more precise approaches with a high degree of customization, particularly given the increased proportion of patients presenting with human papillomavirus-related disease.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA.
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7
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Yang S, Zhao J, Liu Q. Occult colon cancer with liver abscess and pancreatitis as the first manifestations: A case report. Medicine (Baltimore) 2023; 102:e32654. [PMID: 36701699 PMCID: PMC9857361 DOI: 10.1097/md.0000000000032654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Klebsiella pneumoniae-induced liver abscess (KP-PLA) is a common type of pyogenic liver abscess, severe acute pancreatitis (SAP) has high mortality, and poor prognosis in advanced colon cancer. There have been no report of SAP complicated with colon cancer after KP-PLA as so far. In this study, we reported a case of SAP secondary to KP-PLA with colon cancer for the first time, so as to provide reference for clinical diagnosis and treatment of these diseases. PATIENT CONCERNS AND DIAGNOSIS A 64-year-old woman with a history of diabetes visited our hospital with abdominal pain for 5 + days. He was diagnosed with KP-PLA a month ago, which had not healed when he was admitted. He was diagnosed with SAP, and histological examination of colonic biopsy confirmed the diagnosis of moderately differentiated adenocarcinoma. INTERVENTIONS AND OUTCOMES He was treated with intravenous antibiotics and underwent modified endoscopic mucosal resection under colonoscopy. We conducted a 2-month follow-up, and there was no recurrence of liver abscess and pancreatitis. CONCLUSION Screening for intestinal tumors is necessary in patients with cryptogenic liver abscess, especially KP-PLA with diabetes.
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Affiliation(s)
- Shan Yang
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Jin Zhao
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Qi Liu
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- * Correspondence: Qi Liu, Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, People’s Republic of China (e-mail: )
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Sevestre MA. [Screening for cancer in case of venous thromboembolism: when and how?]. Rev Prat 2022; 72:267-269. [PMID: 35638947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Screening for cancer in case of venous thromboembolism: when and how? Cancer associated thrombosis (cat) is an important challenge. When venous thromboembolism (vte) occurs without any identified risk factors, the risk of cat raises the question of a hidden cancer and the need for an extensive screening or not. Several series have shown a prevalence between 5% and 10% of cancer when non provoqued vte is diagnosed. Most of cancers occur during the following year of vte. If we consider diagnosing the cancer in early stage, we might improve the patient outcome and reduce cancer mortality. A simple screening, including clinical examina¬tion, personal and familial history of cancer, basic laboratory tests and recommended age and sex testing is mandatory. Other exams are considered as useless at present time. Whether a tep-scan, prescribed in patients older than 50, brings a clinical benefit, is still unresolved. Screening for cancer in case of venous thromboembolism: when and how? Cancer associated thrombosis (cat) is an important challenge. When venous thromboembolism (vte) occurs without any identified risk factors, the risk of cat raises the question of a hidden cancer and the need for an extensive screening or not. Several series have shown a prevalence between 5% and 10% of cancer when non provoqued vte is diagnosed. Most of cancers occur during the following year of vte. If we consider diagnosing the cancer in early stage, we might improve the patient outcome and reduce cancer mortality. A simple screening, including clinical examina¬tion, personal and familial history of cancer, basic laboratory tests and recommended age and sex testing is mandatory. Other exams are considered as useless at present time. Whether a tep-scan, prescribed in patients older than 50, brings a clinical benefit, is still unresolved.
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Bostan H, Duger H, Akhanli P, Calapkulu M, Turkmenoglu TT, Erdol AK, Duru SA, Sencar ME, Kizilgul M, Ucan B, Ozbek M, Cakal E. Cushing's syndrome due to adrenocorticotropic hormone-secreting metastatic neuroendocrine tumor of unknown primary origin: a case report and literature review. Hormones (Athens) 2022; 21:147-154. [PMID: 34478059 PMCID: PMC8414022 DOI: 10.1007/s42000-021-00316-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In this article, we present a case of neuroendocrine neoplasm of unknown primary origin (UPO NEN), which is a rare cause of ectopic Cushing's syndrome (ECS) presenting numerous challenges, together with a literature review. CASE REPORT A 43-year-old male patient presented with clinical features consistent with Cushing's syndrome (CS) and adrenocorticotropic hormone (ACTH)-dependent hypercortisolemia. Despite a suspicious lesion on pituitary MRI, the high-dose dexamethasone suppression test and bilateral inferior petrosal sinus sampling results were not compatible with Cushing's disease. Bilateral non-homogeneous opacities were observed in the thorax CT of the patient, who also had a history of COVID-19 infection, but no tumoral lesion was detected. When 68Ga-SSTR PET/CT and 18FDG-PET/CT were performed, multiple metastatic foci were detected in mediastinal and hilar lymph nodes and the axial skeleton. Paratracheal-subcarinal lymph nodes were excised mediastinoscopically, and the diagnosis of NEN was made. Histopathological findings indicated that the possible origin was an atypical pulmonary carcinoid with a low Ki-67 labeling index. After controlling hypercortisolemia, a regimen of somatostatin analogs and capecitabine plus temozolomide was decided upon as treatment by a multidisciplinary council. CONCLUSION This is a challenging case of UPO NEN presenting with ECS and confounding factors, such as previous infection and incidental lesions, during the diagnosis process. The case in question highlighted the fact that atypical pulmonary carcinoid with a low proliferation index may cause visible metastases even when radiologically undetectable.
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Affiliation(s)
- Hayri Bostan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey.
| | - Hakan Duger
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
| | - Pinar Akhanli
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
| | - Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
| | - Tugba Taskin Turkmenoglu
- Department of Pathology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ayse Kevser Erdol
- Department of Chest Diseases, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Serap Akcali Duru
- Department of Chest Diseases, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muhammed Erkam Sencar
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
| | - Bekir Ucan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv. No. 1, 6110, Ankara, Turkey
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10
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Castro Corredor D, Ramírez Huaranga MA, Rebollo Giménez AI, Arenal López R, Cuadra Díaz JL. Rheumatic syndromes and occult tumor: 10-year experience in a teaching hospital. Reumatol Clin (Engl Ed) 2020; 16:42-44. [PMID: 29456155 DOI: 10.1016/j.reuma.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/26/2017] [Accepted: 01/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the different clinical characteristics of patients admitted to the Rheumatology Department due to rheumatic manifestations as the first expression of an unknown malignant process. PATIENTS AND METHODS Retrospective and descriptive observational study involving the review of the medical records of those admitted to rheumatology in the University Hospital of Ciudad Real between January 2007 and August 2017 for initial rheumatic manifestations with a suspicion at discharge of an unknown tumor. RESULTS In all, 64 patients were identified from more than 500 admissions. The most common rheumatic manifestations were inflammatory low back pain, polyarthralgia, hip pain, thoracic spine pain, cervical pain, polyarthritis and polymyalgia rheumatica. Forty-four percent had low hemoglobin, 70% had elevation of acute-phase reactants, 62% had abnormal tumor markers, 76% had metastatic lesions. In 20% the primary tumor was of pulmonary origin and only 26.56% received palliative treatment; 64% died. DISCUSSION It is important to consider the possibility of an underlying malignant process in the differential diagnosis since its early identification can be determinant for prognosis.
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Affiliation(s)
- David Castro Corredor
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | | | | | - Rocío Arenal López
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - José Luis Cuadra Díaz
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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11
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C. Reuter T, Arndt S, F. Jakob T. A Rare Cause of Hearing Impairment. Dtsch Arztebl Int 2019; 116:486. [PMID: 31431238 PMCID: PMC6718895 DOI: 10.3238/arztebl.2019.0486a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Thea C. Reuter
- *Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg,
| | - Susan Arndt
- *Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg,
| | - Till F. Jakob
- *Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg,
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Nguyen ND, Simmons DB, Bersabe AR, Duginski TM, Sladky JH, Walton D, Will M, Renshaw JS. Lambert-Eaton myasthenic syndrome and merkel cell carcinoma. Cutis 2019; 103:E19-E23. [PMID: 31233589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lambert-Eaton myasthenic syndrome (LEMS) is an antibody-mediated disorder of the neuromuscular junction that is most commonly diagnosed in association with small cell lung carcinoma (SCLC). Small cell lung carcinoma is histologically similar to the aggressive cutaneous neuroendocrine malignancy Merkel cell carcinoma (MCC). We provide a full report and longitudinal clinical follow-up of a case of LEMS occurring with MCC. We also review the literature on paraneoplastic syndromes associated with MCC and other nonpulmonary small cell carcinomas.
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Affiliation(s)
- Nam D Nguyen
- Department of Internal Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Daniel B Simmons
- Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Adrian R Bersabe
- Department of Hematology and Oncology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Thomas M Duginski
- Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - John H Sladky
- Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Douglas Walton
- Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Micah Will
- Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - John S Renshaw
- Department of Hematology and Oncology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
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Frich L, Bjørkedal BT, Gagama R, Andersson H. A young woman with white fingers and dyspnoea. Tidsskr Nor Laegeforen 2019; 138:18-0247. [PMID: 30644670 DOI: 10.4045/tidsskr.18.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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14
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Iwata T, Ando K, Mizumatsu S. [A Case of Intractable Pain Caused by Retroperitoneal Primary Unknown Cancer Recurrence That Was Improved by Palliative Cyberknife Therapy]. Gan To Kagaku Ryoho 2018; 45:1967-1969. [PMID: 30692413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 79-year-old man was diagnosed with retroperitoneal primary unknown cancer recurrence who underwent open fenestration and drainage(because radical cure resection is difficult). Two years after the fenestration, the patient developed severe hip pain and numbness of the right lower limb. Abdominal CT revealed a cystic tumor recurrence extending from the lower abdomen to the right perineum. We selected a palliative cyberknife therapy for pain control. Fractionated radiation using a cyberknife was administered for 5 days(25 Gy in 5 fractions). The hip pain was relieved, and a CT scan showed a reduction in size of the perineal tumor after the cyberknife treatment. The cyberknife therapy may be an effective and promising palliative treatment for patients with pelvic recurrence.
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Carcaterra A, Serratrice J, Righini M, Robert-Ebadi H. [Unprovoked venous thromboembolism : should we look for occult cancer ?]. Rev Med Suisse 2018; 14:1840-1843. [PMID: 30329229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Idiopathic venous thromboembolic disease may be the first manifestation of a cancer yet undiagnosed. Early detection of neoplasia may allow a timely management and a reduction of mortality. However, the nature and extent of screening for hidden cancer is still debated. The purpose of this article is to review the usefulness of occult cancer screening in patients with idiopathic venous thromboembolism.
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Affiliation(s)
| | | | - Marc Righini
- Service d'angiologie et d'hémostase, HUG, 1211 Genève 14
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Chao CH, Wang HY, Kao CH. Occult cancer and thromboembolism: current epidemiology and its practical implications. Pol Arch Intern Med 2018; 128:539-544. [PMID: 30057385 DOI: 10.20452/pamw.4311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Venous thromboembolism (VTE) may be the first presentation of malignancy. Up to 10% of patients with unprovoked VTE are diagnosed with occult cancer within 1 year. Cancer patients with concomitant VTE have a worse outcome. While limited screening strategy (thorough medical history, physical examination, basic laboratory tests, and chest X‑ray) and extensive screening strategy (limited screening plus computed tomography scan of the abdomen/pelvis or 18F-fluorodeoxyglucose positron emission tomography-computed tomography) have a similar ability to detect early-stage cancer and improve morbidity and mortality of cancer patients with unprovoked VTE, the extensive screening strategy has been shown to diagnose occult cancer earlier. Among the risk factors for occult cancer in patients with unprovoked VTE, age is the most promising one. The risk of occult cancer detection increases with age. The newly developed RIETE score helps identify risk of occult cancer and might decrease unnecessary diagnostic procedures in lower-risk patients. Current guidelines suggest that patients with first unprovoked VTE undergo limited screening, with age- and sex-specific cancer screening, including colon, breast, cervical, and prostate cancers.
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Abstract
RATIONALE Paraneoplastic cerebellar degeneration (PCD) is an immune-mediated neurological deficit affecting the cerebellum. Anti-Yo antibody positive PCD is a rare occurrence most likely associated with gynecologic or breast malignancies. The identification of the underlying tumor is a diagnostic challenge in many of these patients. PATIENT CONCERNS We present a 68-year-old woman with acute symptoms of PCD as a first sign of underlying occult malignancy. Further investigation revealed a positive anti-Yo antibody. Although brain magnetic resonance imaging (MRI) was unremarkable, positron emission tomography (PET)/computed tomography (CT) revealed intense hypermetabolism of cerebellum and diffused hypometabolism in the rest of brain. On 1-year follow-up, despite the primary malignancy is still unknown, her symptoms improved significantly after immunotherapy. DIAGNOSES Paraneoplastic cerebellar degeneration. INTERVENTIONS The patient was given IV methylprednisolone 500 mg once a day for 5 consecutive days, followed by oral prednisone 60 mg once a day for 3 months. OUTCOMES The patient's symptoms were gradually improved during the hospitalization period. On one year follow up, she was able to walk independently and perform some simple tasks. LESSONS Cerebellar hypermetabolism in PCD suspected patients may help confirming the diagnosis in an earlier stage and may predict a better outcome after immunotherapy.
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de Cima Iglesias S, Viña Soria L, Martín Iglesias L, Astola Hidalgo I, López-Amor L, Escudero Augusto D. An unusual cause of acute liver failure: Tumour infiltration by neuroendocrine carcinoma. Gastroenterol Hepatol 2018; 41:320-323. [PMID: 28734480 DOI: 10.1016/j.gastrohep.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Sara de Cima Iglesias
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - Lucía Viña Soria
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Lorena Martín Iglesias
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Iván Astola Hidalgo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Lucía López-Amor
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Dolores Escudero Augusto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Beigi M, Häberle M, Gschwendtner A, Baum U, Weisshaar E. Generalized Chronic Itch as a First Sign of Malignancy Resembling Paraneoplastic Sensomotoric Neuropathy. Acta Derm Venereol 2018; 98:526-527. [PMID: 29437187 DOI: 10.2340/00015555-2910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
MESH Headings
- Aged
- Biopsy
- Carcinoma, Large Cell/complications
- Carcinoma, Large Cell/diagnosis
- Carcinoma, Large Cell/secondary
- Carcinoma, Large Cell/therapy
- Carcinoma, Neuroendocrine/complications
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/secondary
- Carcinoma, Neuroendocrine/therapy
- Chronic Disease
- Fatal Outcome
- Humans
- Immunohistochemistry
- Male
- Neoplasms, Unknown Primary/complications
- Neoplasms, Unknown Primary/diagnosis
- Neoplasms, Unknown Primary/therapy
- Paraneoplastic Polyneuropathy/diagnosis
- Paraneoplastic Polyneuropathy/etiology
- Pruritus/diagnosis
- Pruritus/etiology
- Tomography, X-Ray Computed
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Affiliation(s)
- Minaya Beigi
- Department of Clinical Social Medicine, Environmental and Occupational Dermatology, Ruprecht Karls University Heidelberg, Voßstr. 2, DE-69115 Heidelberg, Germany
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Abstract
We describe a case of spontaneous internal jugular vein thrombosis occurring as the first sign of occult lung cancer. The peculiarity of the case was the unusual site of thrombosis and the lack of risk factors for DVT (only a moderated reduction of protein S without inherited thrombophilia) as well as the absence of clinical signs of cancer. This report shows once again the strong association between idiopathic venous thromboembolism and cancer. Hypercoagulation tests confirmed the association between cancer and thrombophilia. Reduction of protein S has been discovered recently in patients with lung cancer but further data are required to confirm this finding. Combined treatment (chemotherapy and radiotherapy) associated with oral anticoagulation therapy was started in our patient at the moment of diagnosis.
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Affiliation(s)
- Pierpaolo Di Micco
- Department of Geriatric Medicine and Metabolic Disease, Fifth Division of Internal Medicine, Second University of Naples, Italy.
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21
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Jara-Palomares L, Otero R, Jimenez D, Praena-Fernandez JM, Font C, Falga C, Soler S, Riesco D, Verhamme P, Monreal M. Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism. PLoS One 2018; 13:e0194673. [PMID: 29558509 PMCID: PMC5860754 DOI: 10.1371/journal.pone.0194673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/07/2018] [Indexed: 01/07/2023] Open
Abstract
The usefulness of a diagnostic workup for occult cancer in patients with venous thromboembolism (VTE) is controversial. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to perform a nested case-control study to validate a prognostic score that identifies patients with unprovoked VTE at increased risk for cancer. We dichotomized patients as having low- (≤2 points) or high (≥3 points) risk for cancer, and tried to validate the score at 12 and 24 months. From January 2014 to October 2016, 11,695 VTE patients were recruited. Of these, 1,360 with unprovoked VTE (11.6%) were eligible for the study. At 12 months, 52 patients (3.8%; 95%CI: 2.9–5%) were diagnosed with cancer. Among 905 patients (67%) scoring ≤2 points, 22 (2.4%) had cancer. Among 455 scoring ≥3 points, 30 (6.6%) had cancer (hazard ratio 2.8; 95%CI 1.6–5; p<0.01). C-statistic was 0.63 (95%CI 0.55–0.71). At 24 months, 58 patients (4.3%; 95%CI: 3.3–5.5%) were diagnosed with cancer. Among 905 patients scoring ≤2 points, 26 (2.9%) had cancer. Among 455 patients scoring ≥3 points, 32 (7%) had cancer (hazard ratio 2.6; 95%CI 1.5–4.3; p<0.01). C-statistic was 0.61 (95%CI, 0.54–0.69). We validated our prognostic score at 12 and 24 months, although prospective cohort validation is needed. This may help to identify patients for whom more extensive screening workup may be required.
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Affiliation(s)
- Luis Jara-Palomares
- Department of Pneumonology, Medical Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Virgen del Rocío, Seville, Spain
- * E-mail:
| | - Remedios Otero
- Department of Pneumonology, Medical Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Virgen del Rocío, Seville, Spain
| | - David Jimenez
- Respiratory Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Carme Font
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Conxita Falga
- Department of Internal Medicine, Consorci Hospitalari de Mataró, Barcelona, Spain
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
| | - David Riesco
- Department of Internal Medicine, Hospital Sant Pau i Santa Tecla, Tarragona, Spain
| | - Peter Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Spain
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Payne-James JJ, de Gara CJ, Lovell D, Misiewicz JJ, Gow NM. Metastatic Carcinoid Tumour in Association with Small Bowel Ischaemia and Infarction. J R Soc Med 2018; 83:54. [PMID: 2304057 PMCID: PMC1292472 DOI: 10.1177/014107689008300124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Zusammenfassung. Eine unprovozierte venöse Thromboembolie (VTE) kann das erste Zeichen einer Neoplasie sein. Bei 5–10 % der Patienten wird in den nachfolgenden zwölf Monaten eine Krebserkrankung diagnostiziert. Bei allen Patienten nach einer unprovozierten VTE sollte deshalb eine gründliche Anamnese, eine sorgfältige klinische Untersuchung, eine Blutanalyse (Blutbild mit Blutausstrich, Leberenzyme, Kalzium), der Urinstatus und ein Thorax-Röntgen durchgeführt werden. Zusätzlich sollten ergänzend, je nach Alter und Geschlecht, die spezifischen Vorsorgeuntersuchungen (Darm, Zervix, Mamma und Prostata) vorgenommen werden. Alle auffälligen Befunde sollten weiter abgeklärt werden. Für eine noch aggressivere Tumorsuche konnte bislang kein Vorteil in Hinsicht auf die Tumordetektionsrate oder auf die Senkung der krebsbedingten Mortalität gezeigt werden.
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Affiliation(s)
- Svetlana Šarinayová
- 1 Medizinische Universitätsklinik, Zentrum für Onkologie, Hämatologie und Transfusionsmedizin, Kantonsspital Aarau
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Suzuki M, Hatanaka K, Hirata H, Suzuki K, Ono M, Kudo T, Yamamoto Y, Naruse H, Yokoyama N. [A Case of Unknown Primary Carcinoma with Dermatomyositis]. Gan To Kagaku Ryoho 2018; 45:273-276. [PMID: 29483419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 50-year-old woman was diagnosed with dermatomyositis at the department of neurology in our hospital; she then received steroid pulse therapy. A positron emission computed tomography(PET-CT)revealed swollen lymph nodes near the aorta and in the left inguinal region. She presented at our institution for examination to determine the cause of her lymphadenopathy, but the primary site of the carcinoma was unknown. A histopathological examination of the lymph node specimen obtained using endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)revealed a moderately to poorly differentiated adenocarcinoma. The patient underwent lymphadenectomy. After the surgery, a new lymph node metastasis appeared in the lower abdomen. We initiated a combination treatment with chemotherapy and radiotherapy. The patient died because of disease progression 31 months after her first visit.
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Affiliation(s)
- Marina Suzuki
- Dept. of Gastroenterology, Hakodate Municipal Hospital
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Atri D, Furfaro D, Dhaliwal G, Feingold KR, Manesh R. Going from A to Z. N Engl J Med 2018; 378:73-79. [PMID: 29298151 DOI: 10.1056/nejmcps1701264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Deepak Atri
- From the Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore (D.A., D.F., R.M.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D., K.R.F.)
| | - David Furfaro
- From the Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore (D.A., D.F., R.M.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D., K.R.F.)
| | - Gurpreet Dhaliwal
- From the Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore (D.A., D.F., R.M.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D., K.R.F.)
| | - Kenneth R Feingold
- From the Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore (D.A., D.F., R.M.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D., K.R.F.)
| | - Reza Manesh
- From the Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore (D.A., D.F., R.M.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.D., K.R.F.)
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Abstract
RATIONALE Intrathecal therapy, with a low complication rate, has become an alternative to standard pain management for treatment of neuropathic cancer pain. PATIENT CONCERNS Here, we reported a late-stage cancer patient with intractable neuropathic pain in his right neck, shoulder, and upper limb. DIAGNOSES The pain started 2 years ago when the patient was diagnosed as squamous cell carcinoma with metastasis to right supraclavicular lymph nodes. INTERVENTIONS Cervical intrathecal infusion of morphine and bupivacaine with patient control analgesia by external pump was performed. The intrathecal catheter was located at the level of C6 vertebra. The initial concentration of bupivacaine and morphine were both 1 mg/mL with infusion rate of 0.3 mL/h and bolus of 0.3 mL. Subsequently, the concentrations increased to 2 mg/mL (bupivacaine) and 1.33 mg/mL (morphine), with infusion rate to 0.6 mL/h and bolus to 0.5 ml. OUTCOMES The pain intensity decreased from numerical rating scale 6 to 7 to 2 to 3 at rest, and from 10 to 5 to 6 of breakthrough pain. LESSONS In conclusion, cervical intrathecal infusion requires low concentration but high doses of bupivacaine and morphine, which is safe and effective in cancer patients with refractory pain and short life expectancy.
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Affiliation(s)
- Yanxin Ju
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Shandong China
- Department of Anesthesiology, the 404th Hospital of PLA
| | - Demin Tian
- Department of Pain Management, Weihai Municipal Hospital, Weihai, Shandong China
| | - Yanqin Tan
- Department of Pain Management, Weihai Municipal Hospital, Weihai, Shandong China
| | - Zhijian Fu
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Shandong China
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Abstract
RATIONALE Occult breast cancer (OBC) is a rare type of breast cancer without any symptoms in the breast and is often presented with initial symptoms of axillary lymph node metastasis or other metastases. The low incidence rates of OBC make it a great challenge to diagnose and cure. PATIENT CONCERNS Our case was a 58-year-old female affected by dizziness and fatigue for nearly a month. Blood tests revealed anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed the metastatic carcinoma. DIAGNOSES It was diagnosed as an OBC based on the positive immunohistochemical staining of cytokeratin (CK) and gross cystic disease fluid protein-15 (GCDFP-15). INTERVENTIONS Doctor advised her to check whether the bone metastases existed in order to choose an appropriate treatment. It is highly regrettable that the patient gave up all treatments and left the hospital. OUTCOMES Recently, we conducted a telephone follow-up and received that the patient only took tramadol and other painkilling drugs to alleviate the pain caused by cancer. LESSONS The current case inferred that symptoms of anemia and thrombocytopenia should not be ignored for the diagnosis of OBC, and bone marrow biopsy is useful in reducing the rates of misdiagnosis and missed diagnosis of OBC.
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Affiliation(s)
- Lulu Liu
- Department of Central Laboratory
| | - Jingjing Zhang
- Department of Hematology, Affiliated Hospital of Jining Medical University, Jining, Shandong, P.R. China
| | | | - Saisai Ren
- Department of Hematology, Affiliated Hospital of Jining Medical University, Jining, Shandong, P.R. China
| | - Haihui Liu
- Department of Hematology, Affiliated Hospital of Jining Medical University, Jining, Shandong, P.R. China
| | - Hao Zhang
- Department of Hematology, Affiliated Hospital of Jining Medical University, Jining, Shandong, P.R. China
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Krishnamurthy A. Metastatic adenocarcinoma of unknown primary presenting with cervical lymphadenopathy: A diagnostic challenge. J Cancer Res Ther 2017; 13:599-601. [PMID: 28862237 DOI: 10.4103/0973-1482.183179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Garwood D, Renton BJ, Joekes E. Implementation of NICE recommendations on abdomino-pelvic CT, following unprovoked venous thromboembolism, in a UK teaching hospital: no additional detection of occult malignancy and high numbers of incidental findings. Acute Med 2016; 15:25-29. [PMID: 27116584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION NICE Clinical Guideline 144 recommends that patients with an unprovoked VTE, who do not have signs or symptoms of cancer on initial investigation, be considered for further investigation with an abdomino-pelvic CT to exclude occult malignancy. This study aimed to evaluate numbers of scans performed in a UK teaching hospital and outcomes, following this recommendation. METHODS Retrospective review of CT scans performed before and after publication of the NICE guidance in 2012. CT reports and case notes were analysed. Type and stage of malignancy, treatment and other relevant findings were documented. For the 2014 data set, all incidental radiological findings and follow-up recommendations were reviewed. RESULTS The annual number of CT scans requested for "unprovoked VTE", rose by 142% following publication of NICE Clinical Guideline 144. In the 2011 - 2012 data set, 21 patients were included, one of which was found to have a malignancy, which was clinically overt at the time of diagnosis i.e. not occult. Five patients (23.8%) had incidental findings requiring further investigation. In the 2014 - 2015 data set, 51 patients were included, five (9.8%) of which were found to have malignancy. In retrospect, all showed signs/symptoms of potential malignancy on initial investigation. No occult malignancies were detected in the patients correctly referred. Incidental findings warranting further investigation were reported in ten cases (19.6%). On review, follow-up advice was deemed incorrect in four of these. CONCLUSION Addition of an abdomino-pelvic CT scan in patients with a first unprovoked VTE and no signs or symptoms of cancer on initial investigation, significantly increased the number of scans and incidental findings, but did not pick up any additional occult malignancies.
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Affiliation(s)
- David Garwood
- Foundation Year 1 Doctor, Royal Liverpool University Hospital, UK
| | - Bryan J Renton
- Consultant in Acute Medicine, Royal Liverpool University Hospital, UK
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Turkoglu R, Gencer M, Aker FV, Meric K, Gokceer SY, Coban A, Tuzun E. Obturator mononeuropathy due to adenocarcinoma of unknown primary origin. EUR J GYNAECOL ONCOL 2016; 37:882-883. [PMID: 29943943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 35-year-old woman presented with a three-month history of left groin and thigh pain. Neurological examination and electromyography showed pathological features consistent with obturator nerve involvement. Imaging studies revealed a left retroperitoneal mass, which by pathological examination was shown to be metastatic adenocarcinoma of possible Mullerian origin. Primary tumor could not be detected in a follow-up period of three years. Obturator mononeuropathy can be the first manifestation of cancer. Cancer of unknown primary origin may occasionally be local, well-restricted and carry a good prognosis.
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Carrier M, Lazo-Langner A, Shivakumar S, Tagalakis V, Zarychanski R, Solymoss S, Routhier N, Douketis J, Danovitch K, Lee AY, Le Gal G, Wells PS, Corsi DJ, Ramsay T, Coyle D, Chagnon I, Kassam Z, Tao H, Rodger MA. Screening for Occult Cancer in Unprovoked Venous Thromboembolism. N Engl J Med 2015; 373:697-704. [PMID: 26095467 DOI: 10.1056/nejmoa1506623] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Venous thromboembolism may be the earliest sign of cancer. Currently, there is a great diversity in practices regarding screening for occult cancer in a person who has an unprovoked venous thromboembolism. We sought to assess the efficacy of a screening strategy for occult cancer that included comprehensive computed tomography (CT) of the abdomen and pelvis in patients who had a first unprovoked venous thromboembolism. METHODS We conducted a multicenter, open-label, randomized, controlled trial in Canada. Patients were randomly assigned to undergo limited occult-cancer screening (basic blood testing, chest radiography, and screening for breast, cervical, and prostate cancer) or limited occult-cancer screening in combination with CT. The primary outcome measure was confirmed cancer that was missed by the screening strategy and detected by the end of the 1-year follow-up period. RESULTS Of the 854 patients who underwent randomization, 33 (3.9%) had a new diagnosis of occult cancer between randomization and the 1-year follow-up: 14 of the 431 patients (3.2%) in the limited-screening group and 19 of the 423 patients (4.5%) in the limited-screening-plus-CT group (P=0.28). In the primary outcome analysis, 4 occult cancers (29%) were missed by the limited screening strategy, whereas 5 (26%) were missed by the strategy of limited screening plus CT (P=1.0). There was no significant difference between the two study groups in the mean time to a cancer diagnosis (4.2 months in the limited-screening group and 4.0 months in the limited-screening-plus-CT group, P=0.88) or in cancer-related mortality (1.4% and 0.9%, P=0.75). CONCLUSIONS The prevalence of occult cancer was low among patients with a first unprovoked venous thromboembolism. Routine screening with CT of the abdomen and pelvis did not provide a clinically significant benefit. (Funded by the Heart and Stroke Foundation of Canada; SOME ClinicalTrials.gov number, NCT00773448.).
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Affiliation(s)
- Marc Carrier
- From the Department of Medicine (M.C., K.D., G.L.G., P.S.W., M.A.R.) and the Clinical Epidemiology Program (D.J.C., T.R., D.C.), Ottawa Hospital Research Institute, and Department of Diagnostic Imaging (H.T.), University of Ottawa, Ottawa, Departments of Medicine (A.L.-L.), Oncology (A.L.-L.), Epidemiology and Biostatistics (A.L.-L.), and Medical Imaging (Z.K.), University of Western Ontario, London, Department of Medicine, Dalhousie University, Halifax, NS (S. Shivakumar), Department of Medicine, Jewish General Hospital (V.T.), and Department of Medicine, Montreal General Hospital (S. Solymoss), McGill University, and Department of Medicine, Sacre Coeur Hospital, Université de Montréal (N.R., I.C.), Montreal, Department of Medicine, University of Manitoba, Winnipeg (R.Z.), Department of Medicine, McMaster University, Hamilton, ON (J.D.), and the Department of Medicine, University of British Columbia, Vancouver (A.Y.L.) - all in Canada
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Ishikawa G, Nishimura N, Mochizuki S, Yamano Y, Kitamura A, Tomishima Y, Jinta T, Suzuki K, Chohnabayashi N. Long-term survival of a patient with extensive small cell carcinoma of unknown primary etiology complicated by nephrotic syndrome. Intern Med 2014; 53:159-62. [PMID: 24429459 DOI: 10.2169/internalmedicine.53.1323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We experienced a case of nephrotic syndrome (membranous nephropathy) complicated by extensive small cell carcinoma of unknown primary etiology that was diagnosed based on the findings of bilateral cervical and mediastinal lymphadenopathy. A complete cancer response and proteinuria remission following radical chemoradiation therapy were documented. The status of a complete response and nephrosis remission persisted for more than three years. This is the first report to demonstrate the long-term survival of a patient with extensive small cell carcinoma of unknown primary etiology complicated by paraneoplastic nephrotic syndrome.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Camptothecin/administration & dosage
- Camptothecin/analogs & derivatives
- Carboplatin/administration & dosage
- Carcinoma, Small Cell/complications
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/diagnostic imaging
- Carcinoma, Small Cell/drug therapy
- Carcinoma, Small Cell/secondary
- Combined Modality Therapy
- Cranial Irradiation
- Edema/etiology
- Etoposide/administration & dosage
- Glomerulonephritis, Membranous/drug therapy
- Glomerulonephritis, Membranous/etiology
- Glomerulonephritis, Membranous/radiotherapy
- Humans
- Irinotecan
- Lymphatic Metastasis
- Neoplasms, Unknown Primary/complications
- Neoplasms, Unknown Primary/diagnosis
- Neoplasms, Unknown Primary/drug therapy
- Nephrotic Syndrome/drug therapy
- Nephrotic Syndrome/etiology
- Nephrotic Syndrome/radiotherapy
- Paraneoplastic Syndromes/drug therapy
- Paraneoplastic Syndromes/etiology
- Pleural Effusion, Malignant/diagnostic imaging
- Pleural Effusion, Malignant/drug therapy
- Pleural Effusion, Malignant/etiology
- Proteinuria/etiology
- Radiotherapy, Adjuvant
- Remission Induction
- Tomography, X-Ray Computed
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Affiliation(s)
- Genta Ishikawa
- Division of Pulmonary Medicine, St. Luke's International Hospital, Japan
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Affiliation(s)
- A Aron
- Veterans Affairs Medical Center, 4101 S 4 street trafficway, Leavenworth, KS 66048, USA.
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Abstract
Low hemoglobin deferral occurs in about 10% of attempted whole blood donations and commonly is a consequence of iron deficiency anemia. Pre-menopausal women often have iron deficiency anemia caused by menstruation and pregnancy and have low hemoglobin deferral on their first donation attempt. Frequent donors also develop iron deficiency and iron deficiency anemia because blood donation removes a large amount of iron from the donor and the 56-day minimum inter-donation interval for donors in the United States is not sufficient for recovery of hemoglobin and iron stores. Other causes for low hemoglobin deferral range from a medically insignificant deferral of a woman with hemoglobin between 12.0 and 12.4 g/dL, which is within the normal reference range but below the 12.5 g/dL needed to donate blood, to anemia caused by an unrecognized malignancy in a "healthy" individual attempting to donate blood. The diverse causes of anemia in blood donors make it difficult to provide accurate information to donors about the cause of their low hemoglobin deferral and complicate implementation of programs to prevent them by blood collecting agencies. This article reviews how hemoglobin is measured and the demographics and causes of low hemoglobin deferral in blood donors. It provides recommendations for how blood collection agencies can provide donors with accurate information about the cause of their deferral and discusses programs that can be implemented to decrease these deferrals in regular donors.
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Affiliation(s)
- Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.
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35
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Castro-Castro J, Figueiredo-González O, Río-Gómez A, Carballo-Loureiro N, Castro-Bouzas D. [Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture]. ACTA ACUST UNITED AC 2013; 61:392-5. [PMID: 24041454 DOI: 10.1016/j.redar.2013.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/06/2013] [Accepted: 06/14/2013] [Indexed: 11/19/2022]
Abstract
A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy.
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Affiliation(s)
- J Castro-Castro
- Servicio de Neurocirugía, Complexo Hospitalario Universitario de Ourense, Ourense, España.
| | - O Figueiredo-González
- Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - A Río-Gómez
- Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - N Carballo-Loureiro
- Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - D Castro-Bouzas
- Servicio de Neurocirugía, Complexo Hospitalario Universitario de Ourense, Ourense, España
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36
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Miki H, Toyoda M, Senzaki H, Yanagimoto H, Kwon M, Tsubura A. [Asymptomatic longterm survival in a patient with sigmoid colon lymph node metastasis with cancerous ascites of unknown origin]. Gan To Kagaku Ryoho 2013; 40:1119-1122. [PMID: 23986064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 63-year-old man bearing a palpable tumor had a lymph node metastasis adjacent to the sigmoid colon that was detected by computed tomography and positron emission tomography. The sigmoid colon and enlarged lymph nodes were surgically resected, and cancerous ascites were present. Pathologically, the tumor in the lymph node was a poorly-differentiated adenocarcinoma that was positive for CA19-9 as well as CK7(-/+), CK20(+/-), VEGF(+), p 53(+)and MIB-1 (>10%). We treated this case as a pancreatic or bile duct carcinoma due to the patient's markedly elevated serum levels of CA19-9 and SPan-1. However, we could not make a conclusive diagnosis. Gemcitabine-based chemotherapy was administered, and the patient had no signs of recurrence for 24 months after the operation. Then, a recurrence was identified by imaging studies, and the chemotherapy was changed to paclitaxel and carboplatin. The patient had stable disease until tumor regrowth was identified 38 months after the operation, chemotherapy was then stopped. However, at 48 months after the operation, the patient remains well and has no symptoms. Our case suggests that surgery and the appropriate choice of anticancer drugs may contribute to the long-term survival of patients with cancer of an unknown primary origin.
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Affiliation(s)
- Hisanori Miki
- Division of Surgery, Osaka Saiseikai Nakatsu Hospital
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37
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Momeni M, Cantu J, Young AE. Placental abruption and fetal demise secondary to placental metastases from unknown primary: a case report. J Reprod Med 2013; 58:341-343. [PMID: 23947085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although maternal malignancy is relatively common, maternal metastases to the products of conception remains a rare event. There is no available literature that describes the incidence of placental metastases as a cause of abruption and fetal death. importanc CASE We present an unusual case of placental abruption and disseminated intravascular coagulation leading to fetal demise secondary to placental metastases of unknown origin. CONCLUSION In our case placental abruption likely resulted from metastases to the intervillous space.
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Affiliation(s)
- Mazdak Momeni
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
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38
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Bachmeyer C, Orsini D, Demay J, Dautheville S, Richard S, Steichen O. Fingertip necrosis and cervical lymphadenopathy. Neth J Med 2013; 71:319-323. [PMID: 23956317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- C Bachmeyer
- Department of Internal Medicine, Tenon Hospital, Paris, France.
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39
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Schattner A, Ben-Baruch N, Adi M. Facial swelling and somnolence in a patient with cancer. QJM 2013; 106:283-4. [PMID: 22223672 DOI: 10.1093/qjmed/hcr268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Schattner
- Department of Medicine, Kaplan Medical Centre, Rehovot, Israel.
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40
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Kondo M, Kuroda J, Ikai Y, Hayashi R, Uegaki S, Yoshida T, Yoshida A, Komatsu H, Kimura K. [Safe and effective administration of carboplatin-based chemotherapy in a patient undergoing hemodialysis with cancer of unknown primary by monitoring observed AUC of carboplatin-a case report]. Gan To Kagaku Ryoho 2012; 39:1749-1752. [PMID: 23152033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Here we report a case of successful treatment with combination chemotherapy of carboplatin(CBDCA)and paclitaxel for a patient undergoing hemodialysis(HD)with cancer of unknown primary, conducted by monitoring the observed AUC of ultrafilterable CBDCA. CBDCA was administered at a dose of 125 mg on day 1 in each course, an amount which had been calculated by the Calvert formula(GFR: 0, target AUC: 5). HD was started at a point in time one hour after the completion of each CBDCA administration, and performed for 5 hours in each course. Blood samples were collected during the first 3 courses of chemotherapy to measure the plasma concentration of free-platinum. The observed AUCs(o-AUC)of CBDCA in the first, second and third courses were 3. 03, 3. 44 and 3. 50mg·min/mL, respectively. The o-AUC in the first course was lower than that in the second course. The o-AUC in the second course was nearly equal to that in the third course, while each o-AUC was below the target AUC(t-AUC). Partial response was achieved after two courses of the CBDCA and paclitaxel combination chemotherapy, with adverse events of Grade 3 neutropenia and Grade 3 peripheral neuropathy observed in each course after the second course of chemotherapy. o-AUC of CBDCA administered to HD patients can not only be below t-AUC, as in this case, but also oppositely above t-AUC in cases with different doses of CBDCA or HD settings. Our results suggest that the monitoring of o-AUC of CBDCA is useful when practicing CBDCA-based chemotherapy safely and effectively in cancer patients undergoing HD.
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41
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Kleinjan A, van Doormaal FF, Prins MH, Büller HR, Otten JMMB. Limitations of screening for occult cancer in patients with idiopathic venous thromboembolism. Neth J Med 2012; 70:311-317. [PMID: 22961824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Idiopathic venous thrombosis (IVT) is associated with occult malignancy in 10% of patients. The Trousseau study investigated whether extensive screening using abdominal and chest computed tomography (CT) scans and mammography in women would decrease mortality, compared with limited screening. Here, the costs and test characteristics of these screening strategies are presented, including true- and false-positive findings, sensitivity and specificity. METHODS All investigations performed because of a suspicion of malignancy in the limited or extensive screening groups were collected. Costs were calculated using Dutch healthcare tariffs. RESULTS A total of 342 and 288 patients with IVT were included in the extensive and the limited screening group, respectively. The prevalences of malignancy and mortality were comparable between these two groups, as were the abnormal findings during routine screening. In 30% of the extensively screened patients, the CT scans or mammography showed abnormalities necessitating further diagnostic work-up; this yielded six malignancies and resulted in a positive predictive value of 6.6%, sensitivity of 33% and specificity of 70%. Mean costs per patient were €165.17 for the routine and €530.92 for the extensive screening. CONCLUSION Screening using CT scans and mammography results in extra costs due to the high percentage of false-positive findings for which a further diagnostic work-up is indicated.
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Affiliation(s)
- A Kleinjan
- Department of Vascular Medicine, Academic Medical Center in Amsterdam, Amsterdam, The Netherlands.
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42
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Dbouk MB, Nafissi S, Ghorbani A. Chronic inflammatory demyelinating polyneuropathy following malignant melanoma. Neurosciences (Riyadh) 2012; 17:167-170. [PMID: 22465895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Polyneuropathy has rarely been encountered in association with melanoma. Although this association may be a biologically plausible phenomenon considering the common embryonic origin of the melanocytes and Schwann cells with proven antibody cross reactivity, only few such cases have been reported so far. We report 2 new cases of chronic inflammatory demyelinating polyneuropathy in association with malignant melanoma, which we believe will add more evidence of this association. We also include a short review of the literature for similar cases.
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Affiliation(s)
- Mohamad B Dbouk
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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43
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Kayatani H, Matsuo K, Ueda Y, Matsushita M, Fujiwara K, Yonei T, Yamadori I, Shigematsu H, Andou A, Sato T. Pulmonary tumor thrombotic microangiopathy diagnosed antemortem and treated with combination chemotherapy. Intern Med 2012; 51:2767-70. [PMID: 23037471 DOI: 10.2169/internalmedicine.51.7682] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 29-year-old man developed a persistent dry cough. Chest high-resolution computed tomography (HRCT) revealed centrilobular ultrafine granular shadows scattered in all lung fields. A lung biopsy with video-assisted thoracoscopic surgery revealed findings compatible with pulmonary tumor thrombotic microangiopathy (PTTM). However, the primary tumor was not identified. Combination chemotherapy with S-1 and cisplatin decreased his cough and improved the chest HRCT findings. The illness, however, gradually became difficult to control. He eventually developed pulmonary hypertension and died. Typically, an antemortem diagnosis of PTTM cannot be made. In this case, the diagnosis of PTTM and combination chemotherapy improved the chest HRCT findings, respiratory symptoms, and prognosis.
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Affiliation(s)
- Hiroe Kayatani
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan.
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44
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Drosik A, Trzepióra B, Kozielski J. [Thromboembolic venous disease as a first sign of neoplastic disease--a case report]. Wiad Lek 2012; 65:15-18. [PMID: 22827111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Venous thromboembolism is a one of the most common complications of cancer, which contributes to mortality in cancer patients. The prognosis of cancer patients with thrombosis is significantly worse. Venous thromboembolism can be the first manifestation of occult cancer. Incidence of subsequent cancer diagnosis after thrombotic event reaches 25% and is highest within the first 6 months. Risk of cancer diagnosis is significantly higher in patients with idiopathic thrombosis compared with those with secondary thrombosis. We present case of 67-year-old man with recurrent vein thromboembolism and pulmonary embolism, who was subsequently diagnosed with disseminated adenocarcinoma, most likely of the lung.
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Affiliation(s)
- Anna Drosik
- Klinika Onkologii Klinicznej i Doświadczalnej, Centrum Onkologii-lnstytut im. Marii Sklodowskiej-Curie, Oddział w Gliwicach
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45
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Kato Y, Takeda H, Dembo T, Fukuoka T, Tanahashi N. Progressive multiple cranial nerve palsies as the presenting symptom of meningeal carcinomatosis from occult colon adenocarcinoma. Intern Med 2012; 51:795-7. [PMID: 22466842 DOI: 10.2169/internalmedicine.51.6682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein describe a rare case of meningeal carcinomatosis in a 77-year-old woman who had bilateral deafness as the initial symptom of a previously undetected colon cancer malignancy. Meningeal carcinomatosis should be considered in the differential diagnosis in cases of abrupt-onset sensorineural deafness. Both MRI scans and cerebrospinal fluid evaluation are necessary diagnostic tools, and should be used in conjunction as each of these procedures could have false-negative results. This should apply even when there is no known primary malignancy.
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Affiliation(s)
- Yuji Kato
- Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Japan.
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46
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Abstract
In paraneoplastic muscle disease, the malignancy may remotely affect neuromuscular transmission or incite muscle inflammation or necrosis. In several of these diseases, an autoimmune basis for the muscle disease has been established and has become a defining feature. These paraneoplastic muscle diseases may be the first manifestation of a malignancy, and their diagnosis thus demands a vigilant search for an underlying tumor. This article is focused on inflammatory and necrotizing myopathies and disorders of neuromuscular transmission that may arise in the setting of malignancy and are considered paraneoplastic phenomena.
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Affiliation(s)
- Alan N Baer
- Division of Rheumatology, Johns Hopkins University School of Medicine, Good Samaritan Hospital, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Room 413, Baltimore MD 21224, USA.
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47
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Schlittler LA, Dallagasperina VW, Schavinski C, Baggio AP, Lazaretti NS, Villaroel RU. Marantic endocarditis and adenocarcinoma of unknown primary site. Arq Bras Cardiol 2011; 96:e73-e75. [PMID: 21552651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a disease characterized by deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. This condition is more commonly seen in chronic inflammatory states, and is associated with higher incidence of thromboembolic events than infective endocarditis. We report the case of a 63-year old male patient with adenocarcinoma of unknown primary site and systemic embolism.
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48
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Lolis MS, Krishtul A, Vidal C, Shim-Chang H, Phelps R, Lebwohl M. Necrolytic migratory erythema associated with a metastatic neuroendocrine tumor. Cutis 2011; 87:78-80. [PMID: 21416773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Necrolytic migratory erythema (NME) is a skin condition historically associated with pancreatic glucagonomas. Rarely it occurs in the absence of a pancreatic tumor, which has been described as pseudoglucagonoma syndrome. We describe a woman with a metastatic neuroendocrine tumor who developed NME 6 years after diagnosis of the tumor. Her laboratory data revealed essential fatty acid deficiency and a high level of glucagon. Although the pathogenesis of NME is not completely understood, zinc, essential amino acid, and fatty acid deficiencies have all been postulated as possible causative factors.
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Affiliation(s)
- Margarita S Lolis
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York, USA.
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Ruiz-Tovar J, López-Hervas P. Right hepatectomy extended to segment I and pancreatoduodenectomy in the same surgical act for pancreatic neuroendocrine tumor with liver metastases. Am Surg 2010; 76:1439-1440. [PMID: 21265370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Miura K, Tsukikawa S, Nishio K, Katagiri H, Sakurai J, Shimamura T, Makizumi R, Otsubo T. [A case of unknown primary cancer responding to chemotherapy selected based on the results of an anticancer drug sensitivity test]. Gan To Kagaku Ryoho 2010; 37:1401-1404. [PMID: 20647737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CASE The patient was a 64-year-old man. In 1998, he underwent proximal gastrectomy for gastric cancer. In September 2007, follow-up CT revealed multiple tumors around the hilum of the spleen, and he was referred to our hospital. On the initial consultation, the marked retention of ascites was noted. The levels of tumor markers such as PIVKA-II and a-fetoprotein were markedly increased. Despite various examinations, the primary focus could not be determined. In November 2007, an exploratory laparotomy was performed, but the primary focus was unclear, so one of the nodules of the major omentum was excisionally biopsied. An anticancer drug sensitivity test showed that the specimen was sensitive to 5-FU and CDDP. Therefore, the combined chemotherapy with 5-FU and CDDP was performed. The patient responded to this therapy. Ascites and tumor markers remarkably decreased, and the performance status improved from 3 to 1. CONCLUSION These results suggest the usefulness of an anticancer drug sensitivity test in the treatment of cancer in which the primary focus is unclear.
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Affiliation(s)
- Kazuhiro Miura
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine
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