Background
Anaplastic thyroid carcinoma is a highly aggressive form of thyroid cancer associated with a very poor prognosis. Anaplastic transformation most commonly occurs in the thyroid itself or ...within regional lymph nodes. Here we report the case of a patient with papillary thyroid cancer, presenting with colon perforation as a result of anaplastic transformation of metastases in the mesentery tissue. There have been no previous reports of this form of anaplastic transformation.
Case presentation
A 74-year-old man was admitted to our hospital, presenting with abdominal pain that he had been experiencing for 1 week prior to admission. The patient had a history of papillary thyroid carcinoma, for which he underwent a total thyroidectomy and mediastinal lymph node dissection 6 years earlier, and subsequently received radioactive iodine therapy for postoperative recurrence in the lung 2 years later. During the present reported admission, a computed tomography scan revealed a large intra-abdominal mass infiltrating into the colon and retroperitoneum and also highlighted the pneumoperitoneum. The patient was diagnosed with generalized peritonitis as a result of colon perforation, as such, we conducted an emergency laparotomy. Intraoperative findings showed a mass affecting the ascending colon and kidney, following which, an ileostomy and biopsy were completed. Poorly differentiated spindle cells were identified in the biopsy specimens, and histopathological and immunohistochemical findings revealed the absence of thyroid carcinoma cells. The tumor was therefore believed to be a primary sarcoma. Following surgery, the patient recovered from sepsis that had arisen as a result of colon perforation, however, rapidly developed systemic metastases and died 1 month post-operation. An autopsy was performed, and the patient was diagnosed with anaplastic papillary thyroid cancer at the mesentery site of metastasis. This conclusion was reached owing to the presence of the squamous differentiation of lymph node cells, and because tumor cells were positive results for paired-box gene 8 expressions.
Conclusions
Anaplastic transformation of papillary thyroid carcinoma should be considered in the diagnosis of a large mesentery mass in patients with a history of papillary carcinoma. An appropriate biopsy and paired-box gene 8 immunostaining can be useful in confirming such a diagnosis.
Advanced hepatocellular carcinoma (HCC) with macrovascular invasion has an extremely dismal prognosis. We report a rare case of multiple HCC with tumor thrombosis in the portal vein and inferior vena ...cava that was initially treated with hepatic arterial infusion chemotherapy (HAIC); later resection revealed pathological complete response.
A 75-year-old man presented with HCC in his right liver, with tumor thrombosis growing to the right portal vein and the inferior vena cava, and bilateral intrahepatic liver metastases. He underwent HAIC (5-fluorouracil 170 mg/m
+ cisplatin 7 mg/m
) via an indwelling port. Although the tumor shrank and tumor marker levels decreased rapidly, we abandoned HAIC after one cycle because of cytopenia. We resumed HAIC 18 months later because of tumor progression, using biweekly 5-fluorouracil only 1000 mg due to renal dysfunction. However, after 54 months, the HAIC indwelling port was occluded. The patient therefore underwent a right hepatectomy to resect the residual lesion. Histopathological findings showed complete necrosis with no viable tumor cells. The patient has been doing well without postoperative adjuvant therapy for more than 10 years after initially introducing HAIC and 6 years after the resection, without evidence of tumor recurrence.
HAIC can be an effective alternative treatment for advanced HCC with macrovascular invasion.
We conducted a multicenter prospective study to clarify the efficacy and safety of surgery and imatinib for liver oligometastasis of gastrointestinal stromal tumors. Eligible gastrointestinal stromal ...tumor patients were enrolled in the surgery trial or the imatinib trial. Primary endpoints were recurrence-free survival and progression-free survival, respectively. The trials were prematurely terminated due to amendment of guidelines for adjuvant imatinib therapy and low patient accrual. In the surgery trial, all the six patients showed hepatic recurrence: median recurrence-free survival was 145 days (range: 62-1366 days). Of the five patients receiving salvage imatinib therapy, two showed progressive disease although no death was observed. Of the five patients enrolled in the imatinib trial, one died of pneumonia after progressive disease, and four had not shown progressive disease as of last visit. The results suggest that liver oligometastasis of gastrointestinal stromal tumor may not be controllable by surgery alone and require concomitant imatinib therapy.
A 64-year-old woman who had been treated in a hospital with the diagnosis of cholelithiasis with acute cholecystitis was seen at our hospital after the treatment for the purpose of cholecystectomy. ...Abdominal contrast-enhanced CT scan and MRI performed before surgery disclosed a gallstone which had impacted in the head of the gallbladder to compress the posterior segmental branch. Since blood examinations revealed elevations of hepatobiliary enzymes, Mirizzi syndrome was diagnosed. Endoscopic retrograde cholangiopancreatography (ERCP) for close exploration revealed fistula formation at the gallbladder and the posterior segmental branch. Preoperative placement of an ENBD tube enabled us to see the fistula directly and to perform surgery safely. The fistula was closed by suture using a part of the gallbladder wall. No postoperative infectious signs occurred and her postoperative course was uneventful. Cholangiography is essential before surgery for Mirizzi syndrome. So far no reports on fistula formation at the gallbladder and the posterior segmental branch have been presented in the web Japan Medical Abstracts Society as far as we could review. In this case our device in that the fistula is closed with sutures by using the gallbladder wall was necessary.
We encountered a case of late recurrence of breast cancer that required differentiation from small bowel metastasis of lung cancer. The patient was a 69-year-old woman who underwent surgery for left ...breast cancer 24 years ago and postoperative endocrine therapy was performed. Follow-up was completed ; however, she was diagnosed with stage IV left lung adenocarcinoma a year previously and was treated with chemoradiotherapy. Recently, the patient visited our hospital with a chief complaint of lower abdominal pain. She was diagnosed with small bowel intussusception associated with small bowel tumor based on computed tomography. Laparoscopic-assisted partial resection of the small bowel was performed. Comparing the histopathological findings of the resected small bowel tumor with that of the breast cancer resected 24 years ago revealed strong similarities ; thus, she was diagnosed with a late recurrence of breast cancer. In the case of metastatic small bowel cancer with a history of breast cancer surgery, late recurrence of breast cancer should also be considered as a differential diagnosis.
A 20-year-old man was admitted to our hospital with upper abdominal pain. Abdominal computed tomography (CT) showed a whirl-like pattern around the superior mesenteric artery and a fist-sized ...multilocular cystic lesion in the pelvis. CT- colonography showed the ascending colon to be located on the left side of the abdomen. Abdominal magnetic resonance imaging showed a high intensity mass on the T2-weighted image with septal structure. The upper gastrointestinal contrast imaging showed an abnormally positioned duodenojejunal junction, so we diagnosed intestinal malrotation complicated by midgut volvulus and mesenteric cyst. Laparoscopic repair of the volvulus and a Ladd operation was performed, and an appendectomy and cystectomy resecting about 20cm of the jejunum were performed outside the lower small incision. Histological findings showed a multiple cystic tumor with lymphatic dilatation and with invasion in the muscularis propria of the jejunum. Histological examination confirmed the diagnosis of mesenteric lymphangioma. The laparoscopic Ladd procedure is a safe and useful technique for midgut volvulus and mesenteric lymphangioma without ischemic change of the small intestine.
A 76-year-old woman was referred to our department after an abnormality was identified on a computed tomography (CT) scan performed during investigation for anemia. Blood tests showed an elevated ...human chorionic gonadotropin level of 194,000 mIU/ml, and abdominal contrast-enhanced CT showed a large mass in the ascending colon with invasion of the duodenum, as well as irregularly shaped masses in the liver. Examination of a biopsy specimen from the lesion in the ascending colon identified it as choriocarcinoma, and since there were no abnormalities of the gynecological organs, primary colorectal choriocarcinoma was diagnosed. The tumor could not be removed because the superior mesenteric artery was involved, and only gastrojejunostomy and ileo-transverse colostomy were performed, because gastrointestinal stenosis was evident. Postoperatively, the patient was treated with chemotherapy for chorionic carcinoma, methotrexate, etoposide, and actinomycin D, but the cancer progressed, and her general condition deteriorated rapidly to the point that it was decided to switch to palliative care approximately 6 months after surgery. Primary colorectal choriocarcinoma is extremely rare, with only 22 cases reported worldwide to date. There is no established method of treatment, and most patients already have distant metastasis at presentation, making its prognosis extremely poor.
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