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Alvarez Moreno JC, Pagacz M, Mejia O, Oh KS, Medina AM. Rhabdoid collecting duct carcinoma with lymphangitic carcinomatosis causing acute lethal chylopericardium. Respir Med Case Rep 2020; 31:101240. [PMID: 33072511 PMCID: PMC7548980 DOI: 10.1016/j.rmcr.2020.101240] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022] Open
Abstract
Collecting duct carcinoma is a rare neoplasm of the kidney, accounting for only 1–2% of renal tumors. These tumors arise from the principal cells of the renal collecting ducts of Bellini. The majority of patients have lymph node involvement and metastases to lungs, liver, bone, adrenal glands, and brain. We present a case of a 48 year old woman who came to the hospital with a clinical presentation suspicious for pneumonia. One week later her symptoms aggravated. A CT chest and abdominal imaging showed bilateral pulmonary infiltrates, retroperitoneal lymphadenopathy, and left hydroureteronephrosis. She expired after developing acute respiratory failure. An autopsy was performed which revealed chylopericadium of 150 cc; bilateral reticular pattern on the surfaces of the lungs; neck, mediastinal and retroperitoneal lymphadenopathy, and a 5.1 cm left kidney mass located in the mid portion medulla. The kidney tumor was a rhabdoid collecting duct carcinoma. The lungs showed diffuse subpleural lymphangitic spread of the carcinoma. We report a rare case of chylopericardium due to lymphangitic carcinomatosis from a 5.1 cm rhabdoid collecting duct carcinoma not suspected clinically or radiologically. This case highlights the importance of performing autopsies in an era when clinicians heavily rely on high-tech imaging diagnostic modalities.
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Affiliation(s)
| | | | - Odille Mejia
- Mount Sinai Medical Center, Miami Beach, 33140, FL, USA
| | - Kei-Shing Oh
- Mount Sinai Medical Center, Miami Beach, 33140, FL, USA
| | - Ana Maria Medina
- Mount Sinai Medical Center, Miami Beach, 33140, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, 33199, FL, USA
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Viljoen N, Hendricks M, Panieri E, Aldera AP. Papillary thyroid carcinoma presenting as miliary nodules on chest roentgenogram in the paediatric setting: A case report. Int J Surg Case Rep 2020; 72:322-325. [PMID: 32563095 PMCID: PMC7305368 DOI: 10.1016/j.ijscr.2020.06.058] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Papillary thyroid carcinoma (PTC) is the most common carcinoma to occur in childhood with a peak incidence between 11-17 years, and typically presents with advanced locoregional disease. Pulmonary metastases are seen in up to 46% of cases and should enter the differential diagnosis of miliary nodules seen on chest roentgenogram, even in regions where tuberculosis is endemic. PRESENTATION OF CASE An 11-year-old male presented with a short history of cough, shortness of breath and constitutional symptoms. Examination revealed cervical lymphadenopathy and diffuse bilateral nodular infiltrates on the chest roentgenogram. Investigation for Mycobacterium tuberculosis was negative and this initiated biopsy of a cervical lymph node. Histopathological examination revealed metastatic PTC. Ultrasonography and magnetic resonance imaging (MRI) were performed for preoperative staging. The patient subsequently underwent total thyroidectomy with selective neck dissection. DISCUSSION There are several potential causes when dealing with miliary nodules on chest roentgenogram. Thorough interrogation of the clinical, radiological, pathological and microbiological data is required to arrive at the correct diagnosis. Postoperative adjuvant therapy with radioactive iodine is recommended in children with metastatic disease, but this should be restricted preferably to a single dose to avoid the complication of pulmonary fibrosis. CONCLUSION This case highlights the differential diagnostic considerations of a patient presenting with constitutional symptoms and a miliary pattern on chest roentgenogram. Carcinomas are uncommon in children but should not be forgotten.
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Affiliation(s)
- Nandi Viljoen
- Division of Anatomical Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service - Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marc Hendricks
- Haematology-Oncology Service, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Eugenio Panieri
- Oncology and Endocrine Surgery Unit, Division of General Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alessandro Pietro Aldera
- Division of Anatomical Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service - Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
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Berger I, Cengel KA, Simone CB, Alley EW, Roshkovan L, Haas AR, Patel AM, Khalid U, Culligan MJ, McNulty S, Singhal S, Friedberg JS, Katz SI. Lymphangitic carcinomatosis: A common radiographic manifestation of local failure following extended pleurectomy/decortication in patients with malignant pleural mesothelioma. Lung Cancer 2019; 132:94-98. [PMID: 31097101 DOI: 10.1016/j.lungcan.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The lymphangitic carcinomatosis (LC) pattern of metastatic malignancy is associated with a poor prognosis but is currently not well defined in malignant pleural mesothelioma (MPM). Here, we report the incidence and prognostic significance of the radiographic development of LC in MPM following extended pleurectomy/decortication (EPD). METHODS Consecutive patients with biopsy-proven MPM undergoing EPD with intraoperative photodynamic therapy (PDT) at our institution from 2008 to 2014 were included in this retrospective study. Patients without available post-surgical clinical or imaging data for direct review were excluded. CT images were reviewed by an experienced, board-certified thoracic radiologist and confirmed by consensus review. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan Meier methodology. Hazard ratios were compared with a cox proportional hazard model. RESULTS 44 patients underwent EPD with PDT during the study period and had available clinical and imaging data. During the follow-up period (median 34 months), 17 patients (39%) developed LC at a median of 10 months after surgery (IQR 5-21 months). 16 of the 17 patients who developed LC (94%) died during the follow-up period, compared to 17 of the 27 who did not develop LC (63%). OS for the LC versus non-LC group was 53% versus 93% at 1 year and 18% versus 67% at 3 years. LC was significantly associated with a lower OS (HR 4.07; 95% confidence interval 1.44-11.48; p = 0.008). PFS for the LC group versus non-LC group was 8 months (IQR 5-9 months) compared to 17 months (IQR 11-24 months) (p < 0.001). CONCLUSION LC is a common form of failure in MPM following EPD and is associated with a poor prognosis. Thus, further studies are warranted to determine if any evidence of preoperative LC should be an absolute contraindication to EPD and may warrant an EPP or no surgery at all.
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Affiliation(s)
- Ian Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Keith A Cengel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Charles B Simone
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Evan W Alley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Leonid Roshkovan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Andrew R Haas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Akash M Patel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Urooj Khalid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | | | - Sally McNulty
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sunil Singhal
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | | | - Sharyn I Katz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
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Fumet JD, Wickre M, Jacquot JP, Bizollon MH, Melis A, Vanoli A, Viel E. Successfully treatment by eribulin in visceral crisis: a case of lymphangitic carcinomatosis from metastatic breast cancer. BMC Cancer 2018; 18:839. [PMID: 30126360 PMCID: PMC6102904 DOI: 10.1186/s12885-018-4725-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Metastatic breast cancer (MBC) rest an incurably disease associated with bad prognosis and a median overall survival of 23-31 months. There are several treatment options including chemotherapy and sometimes endocrine therapy. Currently, there is no standard treatment for patients with MBC who have already benefited from anthracyclines and taxanes therapy. Many drugs like capecitabine, eribulin, gemcitabine, vinorelbin and liposomal doxorubicin are conventionally used as monotherapy. One important complication from MBC is life threating visceral crisis that needs a fast-effective treatment. CASE PRESENTATION We report here a case of an evolution of metastatic breast cancer with lymphangitic carcinomatosis after taxane based chemotherapy and endocrine therapy. This 37-year-old woman was referred to our hospital with complaints of dyspnea and dry cough. There was clinical concern for visceral crisis and a chemotherapy with eribulin was initiated. Pulmonary lymphangitic carcinomatosis disappeared and the patient achieved a good partial response. CONCLUSION We reported a case of rapid, positive treatment response using eribulin on metastatic breast cancer with visceral crisis and we could quoted others. Therefore, eribulin may be an appropriate chemotherapeutic option in instances requiring rapid symptom control.
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Affiliation(s)
- Jean-David Fumet
- Department of Oncology, Centre Georges François Leclerc, 1 rue Professeur Marion, 21000, Dijon, France.
| | - Mark Wickre
- Department of Radiology, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Jean-Philippe Jacquot
- Department of Pathology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
| | - Marie-Helene Bizollon
- Department of Pathology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
| | - Adrien Melis
- Department of Oncology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
- Department of Oncology, Chalon-sur-Saône and Institut de Cancérologie de Bourgogne, 4 allées St Jean des Vignes, 71100, Chalon sur Saône, France
| | - André Vanoli
- Department of Oncology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
- Department of Oncology, Chalon-sur-Saône and Institut de Cancérologie de Bourgogne, 4 allées St Jean des Vignes, 71100, Chalon sur Saône, France
| | - Erika Viel
- Department of Oncology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
- Department of Oncology, Chalon-sur-Saône and Institut de Cancérologie de Bourgogne, 4 allées St Jean des Vignes, 71100, Chalon sur Saône, France
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Sandberg JK, Mullen EA, Cajaiba MM, Smith EA, Servaes S, Perlman EJ, Geller JI, Ehrlich PF, Cost NG, Dome JS, Fernandez CV, Khanna G. Imaging of renal medullary carcinoma in children and young adults: a report from the Children's Oncology Group. Pediatr Radiol 2017; 47:1615-1621. [PMID: 28689245 PMCID: PMC5768308 DOI: 10.1007/s00247-017-3926-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/25/2017] [Accepted: 06/09/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Renal medullary carcinoma is a rare renal malignancy of childhood. There are no large series describing the imaging appearance of renal medullary carcinoma in children. OBJECTIVE To characterize the clinical and imaging features of pediatric renal medullary carcinoma at initial presentation. MATERIALS AND METHODS We retrospectively analyzed images of 25 pediatric patients with renal medullary carcinoma enrolled in the Children's Oncology Group renal tumors classification, biology and banking study (AREN03B2) from March 2006 to August 2016. Imaging findings of the primary mass, and patterns of locoregional and distant spread were evaluated in correlation with pathological and surgical findings. RESULTS Median age at presentation was 13 years (range: 6-21 years), with a male predominance (3.2:1). The overall stage of disease at initial presentation was stage 1 in 1, stage 2 in 2 and stage 4 in 22. Maximum diameter of the primary renal mass ranged from 1.6 to 10.3 cm (mean: 6.6 cm) with a slight right side predilection (1.5:1). Enlarged (>1 cm short axis) retroperitoneal lymph nodes were identified at initial staging in 20/25 (80%) cases, 10 of which were histologically confirmed while the others did not undergo surgical sampling. Enlarged lymph nodes were also identified in the mediastinum (14/25; 56%) and supraclavicular regions (4/25; 16%). Metastatic disease was present in the lungs in 19/25 (76%) and liver in 6/25 (24%). The pattern of lung metastases was pulmonary lymphangitic carcinomatosis: 10 cases (9 bilateral, 1 unilateral), pulmonary nodules with indistinct margins: 6 cases, pulmonary nodules with distinct margins: 2 cases, while 1 case had pulmonary nodules with both indistinct and distinct margins. Pulmonary lymphangitic carcinomatosis was pathologically confirmed in 4/10 cases. All cases with pulmonary lymphangitic carcinomatosis had associated enlarged mediastinal lymph nodes. CONCLUSION Renal medullary carcinoma in children and young adults presents at an advanced local and distant stage in the majority of patients. The diagnosis of renal medullary carcinoma should be considered when a child or young adult presents with a poorly defined/infiltrative, centrally located renal mass, especially in the setting of known sickle cell hemoglobinopathy. Distant metastases are common at initial presentation in the lungs, distant lymph nodes and liver and often involve multiple sites simultaneously. Pulmonary lymphangitic carcinomatosis, a distinctive and uncommon form of lung metastasis in children, is common in this patient population.
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Affiliation(s)
- Jesse K. Sandberg
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Elizabeth A. Mullen
- Department of Pediatric Oncology, Children’s Hospital Boston/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mariana M. Cajaiba
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ethan A. Smith
- Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI
| | - Sabah Servaes
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth J. Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James I. Geller
- Division of Pediatric Oncology, Cincinnati, Children’s Hospital Medical Center, University of Cincinnati, Ohio
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, Department of Surgery, CS Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Nicholas G. Cost
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeffrey S. Dome
- Division of Pediatric Oncology, Children’s National Medical Center, Washington, DC
| | | | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8131, St. Louis, MO, 63110, USA.
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Jinnur PK, Pannu BS, Boland JM, Iyer VN. Occult pulmonary lymphangitic carcinomatosis presenting as 'chronic cough' with a normal HRCT chest. Ann Med Surg (Lond) 2016; 6:77-80. [PMID: 26958342 PMCID: PMC4764654 DOI: 10.1016/j.amsu.2016.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/07/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022] Open
Abstract
A diagnosis of ‘chronic cough’ (CC) requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT) 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of ‘chronic cough’ and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported. Asthma, GERD and postnasal drip are the 3 most common causes of chronic cough. Constitutional symptoms (weight loss etc.) never occur in chronic cough. Pulmonary lymphangitic carcinomatosis can rarely present with chronic cough.
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Affiliation(s)
- Praveen K Jinnur
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bibek S Pannu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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