Metastasis to gluteal muscle from high grade transitional cell carcinoma of bladder. Report of a case and review of literature

High grade bladder malignancies have tendency to local and distant invasion. The most commonly involved sites are lymph nodes, lungs, bone and liver. Muscle metastases are generally rare and have been described in few cases of Genito-Urinary cancer. In this work we describe a rare case of high grade transitional cell carcinoma from bladder metastatising to the left gluteal muscle together with the review of the pertinent literature.

Isolated pulmonary IgG4-related disease mimicking lung malignancy

Immunoglobulin G4 (IgG4)-related disease is a relatively rare and only recently recognized immune-mediated fibro-inflammatory condition that is commonly associated with autoimmune pancreatitis. Reports have further been characterized in almost all other organ systems, with several lung-related IgG4 disease reports emerging over the past decade. IgG4-related disease affects more than one organ in 60–90% of patients. To this date, there have been few published cases of pathologically proven isolated IgG4-related lung disease (IgG4-RLD), where no other organ is affected. We report an isolated pulmonary case of IgG4-RLD in a 65-year-old female with clinical and radiological manifestations suggestive of primary lung malignancy. CT revealed multiple sub-solid ground glass opacities, several of which were part-solid, others were pure ground glass. Histological analysis revealed IgG4 disease with no evidence of neoplasia. Serum IgG4 levels were elevated (206 mg dl^–1). Malignancy was ruled out and the patient was treated with corticosteroids, though there was no change in CT appearance over 16 months. The CT imaging pattern in our case is atypical from previous literature characterisation.

Clinical presentations of schistosoma hematobium: three case reports and review

Urinary schistosomiasis is a prevalent parasitic infection in certain areas of Africa and the Middle East. It could present with common as well as unusual urological symptoms, which poses a considerable diagnostic challenge in countries where there is relative low incidence of the disease. We describe three unusual cases of urinary schistosomiasis identified in patients presenting to a London hospital. One patient was found to have schistosomiasis in the seminal vesicles following surgery for prostatic adenocarcinoma. Another was found to have schistosoma-related granulomatous inflammation within a urachal cyst. Thirdly a patient was found to have simultaneous occurrence of transitional cell carcinoma and schistosomiasis of the bladder. We review the literature on the presentations of the parasite and its association with malignancy. In conclusion, awareness of the disease prevalence, clinical and histopathological features will help to avoid missing the diagnosis.

Expression of sialyl-Tn predicts the effect of adjuvant chemotherapy in node-positive breast cancer

Sialyl-Tn (STn) is a carcinoma-associated carbohydrate determinant expressed on cancer-associated mucins and has the structure NANA alpha(2-6)alpha GalNAc. Expression of STn in colon and ovarian cancer is associated with a poor prognosis independent of tumour grade, stage or histological type. We have examined 237 cases of primary breast cancer for expression of this antigen using the antibody HB-STn (Dako). The frequency of STn expression was 31% in the whole group, 36% in the node-negative and 28% in the node-positive group. Survival was lower, but not significantly so, in the STn-positive group (P = 0.07), but this effect was highly significant for patients with node-positive disease (P < 0.002), the curves for node-negative disease being coincident (P = 0.31). In node-positive disease the effect was limited to those receiving adjuvant chemotherapy (P = 0.001). In a multivariate (Cox) analysis on the whole group STn staining, combined with adjuvant chemotherapy, showed a highly significant correlation with survival. In STn-negative cases, adjuvant chemotherapy improved survival (relative risk 2.3, 95% confidence intervals 1.4-3.9), whereas adjuvant chemotherapy did not influence survival in patients which expressed STn (relative risk 1.1, 95% confidence intervals 0.6-2.2). Thus, by either direct or indirect mechanisms, STn positivity appears to be a marker of resistance to adjuvant chemotherapy.