Metastases to the stomach wall presenting as simple polyps

Endoscopic and pathologic findings associated with clinical outcomes of melanoma in the upper gastrointestinal tract

BACKGROUND

Melanoma that involves the upper gastrointestinal (GI) tract is rare and studies relating to endoscopic and pathologic findings with clinical outcomes are lacking. We reviewed the gross and microscopic patterns of the upper GI tract in primary and metastatic melanoma, and examined their association with clinical outcomes.

METHODS

Twenty-nine cases of primary esophageal (n = 19) and metastatic gastric and/or duodenal melanoma (n = 10) that were detected during upper GI endoscopy between 1995 and 2011 were retrospectively analyzed.

RESULTS

Three types of gross patterns were recognized-nodular pattern in 7 cases, mass-forming pattern in 18 cases, and flat pigmented pattern in 4 cases. In primary esophageal melanoma, 13 patients (68.4 %) underwent surgery and 9 received palliative therapy. Of all cases, 22 patients (75.9 %) died of disease progression; the median overall survival period was 12 months (interquartile range [IQR] 4.5-24.5 months), and from recognition of upper GI tract melanoma the median overall survival period was 9 months (IQR 3.5-17.0 months). In primary esophageal cases, skin melanoma stage better discriminated the patients with good prognosis than the esophageal cancer stage. The flat pigmented gross pattern proved to be a good prognostic factor in primary and metastatic GI tract melanomas (p = 0.016 and p = 0.046, respectively).

CONCLUSIONS

Melanoma of the GI tract is a highly aggressive disease with a poor prognosis, both in primary and metastatic cases. However, in primary esophageal melanoma, careful inspection of the mucosa during endoscopic examination followed by surgical resection may result in extended survival.

Prostate cancer metastasizing to the small bowel

Although prostate cancer is one of the most commonly encountered malignancies in clinical practice, it is very unusual for prostate cancer to metastasize to the small bowel. Our search of the literature found no such cases published from 1966 to the present. We report the case of a 69-year-old man who presented for evaluation of anasarca and anorexia. He had a history of prostate cancer diagnosed 9 years before and had undergone a radical prostatectomy with subsequent radiotherapy for positive tumor margins. He developed anasarca 2 years before presentation to us. His serum albumin ranged between 1.5 and 2.5 g/dL. Upper endoscopy was performed for possible protein-losing enteropathy and the appearance of gastric and duodenal mucosa was found to be normal. Random small bowel biopsies revealed submucosal infiltrating adenocarcinoma with positive prostate-specific antigen stains consistent with the diagnosis of prostate cancer metastatic to the small bowel. This is a rare presentation of metastatic prostate cancer. Even though prostate cancer is the most commonly diagnosed cancer in American men, antemortem diagnosis of small bowel metastasis has not been reported. In patients with unexplained anasarca, especially with a history of malignancy, an upper endoscopy with small bowel biopsy may be useful in establishing the diagnosis.

Gastric metastases from retroperitoneal leiomyosarcoma

Computed tomographic (CT) appearance of two cases of gastric metastases from retroperitoneal leiomyosarcoma are reported. In both cases tumors infiltrated the gastric wall with endoluminal growth. The use of water-filling technique in opacifying the lumen and distending the gastric wall is also emphasized.

Giant cell carcinoma of the lung

BACKGROUND

Giant cell carcinoma of the lung has been described as an aggressive tumor characterized by extensive local and distant disease and extremely short survival. In 1981, the World Health Organization defined giant cell carcinoma as a variant of large cell carcinoma. Before then giant cell lung cancer was a descriptive term, but it was not considered a separate entity.

METHODS

The authors retrospectively studied 16 cases of giant cell carcinoma of the lung.

RESULTS

These cases had a prognosis that was not appreciably different from that for lung cancer of other non-small cell histologic types. Of those patients with pathologic Stage I or II at resection, five of nine are alive and disease-free from 20 to 116 months and one has died without evidence of disease at 15 months.

CONCLUSIONS

Based on this series and a review of the literature, there appears to be an increased incidence of both clinical and subclinical gastrointestinal tract involvement in patients with this histology, compared with patients with other non-small cell histologic types. The authors conclude that patients with giant cell carcinoma of the lung have a prognosis similar to that of patients with other non-small cell histologic types, and that clinicians should be aware of the increased incidence of gastrointestinal tract involvement in this disease.

A case of pulmonary adenocarcinoma with sarcomatous elements initially manifested as a submucosal tumor of the stomach

A case of pulmonary adenocarcinoma, which was initially manifested as a gastric submucosal tumor, is presented. Endoscopy showed a submucosal tumor in the fundic region in a 79-year-old Japanese woman. Initial biopsy specimens of the stomach revealed atypical spindle cell proliferation, suggesting primary leiomyosarcoma of the stomach. However, biopsy specimens obtained one year later were diagnosed as malignant lymphoma or malignant histiocytosis of the stomach. Autopsy revealed a large necrotic lesion in the right S8 region with metastases in multiple organs. Microscopy demonstrated well to moderately differentiated adenocarcinoma containing spindle or pleomorphic sarcomatous elements. Metastatic nodules including the gastric tumors all showed sarcomatous elements with no epithelial component. Immunohistochemistry showed positive reactions for keratin, epithelial membrane antigen, and carcinoembryonic antigen in areas of carcinoma, whereas most of the sarcomatous elements revealed no positivity for any of the antibodies used, except for focal keratin and EMA positivity in the primary site. This is a rare case of pulmonary adenocarcinoma with sarcomatous elements discovered as a gastric tumor at initial diagnosis, resulting from metastasis of the sarcomatous element in the submucosa.

Hematogenous metastases to the stomach. A review of 67 cases

Metastatic tumors to the mucosa of the stomach are unusual occurrences that can cause clinical and pathologic problems in diagnosis. The authors report 67 cases from the files of the Veterans Administration Center at Houston. Ten cases were found on endoscopic biopsy and 57 at necropsy. Each patient endoscopically evaluated presented with upper gastrointestinal tract symptoms, including bleeding, abdominal pain, anorexia, and vomiting. At endoscopic examination, characteristic "volcano-like" ulcers were noted. Clinical gastrointestinal symptoms were present in 30 of the necropsy cases, and in four cases the gastric metastases led to the patients' deaths. Tumors primary in the lung accounted for most of the metastases (55%), followed by other gastrointestinal malignancies. A correct diagnosis is important to direct therapy and is facilitated by the characteristic clinical, endoscopic, and histologic findings.

Hematogenous metastases to the stomach. A review of 67 cases

Metastatic tumors to the mucosa of the stomach are unusual occurrences that can cause clinical and pathologic problems in diagnosis. The authors report 67 cases from the files of the Veterans Administration Center at Houston. Ten cases were found on endoscopic biopsy and 57 at necropsy. Each patient endoscopically evaluated presented with upper gastrointestinal tract symptoms, including bleeding, abdominal pain, anorexia, and vomiting. At endoscopic examination, characteristic "volcano-like" ulcers were noted. Clinical gastrointestinal symptoms were present in 30 of the necropsy cases, and in four cases the gastric metastases led to the patients' deaths. Tumors primary in the lung accounted for most of the metastases (55%), followed by other gastrointestinal malignancies. A correct diagnosis is important to direct therapy and is facilitated by the characteristic clinical, endoscopic, and histologic findings.

Symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma

Gastrointestinal metastases secondary to bronchogenic carcinoma are relatively uncommon and most are found incidentally at autopsy examination in patients with advanced or widely disseminated lung cancer. Occasionally gastrointestinal metastases occurr relatively early in the course of the disease and give rise to a variety of clinical symptoms and radiological abnormalities. Recognition of these abnormalities is important in order that appropriate palliative therapy may be undertaken. The clinical. radiological and pathological findings in 12 patients with symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma were reviewed. Clinical symptoms varied according to the site of metastatic involvement and included dysphagia, epigastric pain, nausea, vomiting, gastrointestinal bleeding, anaemia and signs of intestinal obstruction or perforation. The sites of metastatic involvement were: oesphagogastric junction (2 cases); stomach (2 cases); duodenum (1 case): jejunum (3 cases); ileum (2 cases), colon (2 cases). The radiological findings are discussed and illustrated.

Metastatic disease involving the stomach

Metastatic disease involving the stomach is an unusual and difficult clinical problem. A review of 1010 autopsies of patients with cancer disclosed 17 cases of gastric metastases (an incidence of 1.7%), with breast cancer, lung cancer, and melanoma being the most frequent primaries. The clinical manifestations of epigastric pain, melena, and anemia are nonspecific, necessitating radiographic examination of the gastrointestinal tract. The radiographic findings are usually sufficient to suggest the diagnosis.