Results of chemical pleurodesis with mitoxantrone in malignant pleural effusion from breast cancer

BACKGROUND: Carcinoma of the breast is the second leading cause of malignant pleural effusions. This study reports on the efficacy of mitoxantrone as a sclerosing agent in patients with breast cancer who had a pleural effusion as a direct consequence of metastatic disease. PATIENTS AND METHODS: Over a 5-year period, 114 patients with a known breast malignancy and having recurrent symptomatic pleural effusion referred for chest tube drainage and sclerotherapy were considered eligible. They had received no prior intrapleural therapy and had a predicted survival of >1 month. All of them underwent pleural drainage and chemical pleurodesis with mitoxantrone. Survival, complications and response to pleurodesis according to clinical and radiographic criteria were recorded. The data are expressed as the mean ± standard error of the mean (SEM) and the median. The χ(2 )test was used for statistical analysis. To assess the prognostic value of Karnofsky's performance status score a Cox proportional hazards model was used. RESULTS: The mean age of the patients was 53.5 ± 2.1 years. Effusion occurred after 38.2 ± 6.2 months (range: 1–229 months) after the diagnosis. Ipsilateral effusion was seen in 73%, contralateral in 20% and bilateral in 7%. Forty patients (35%) had pleural effusion as the first evidence of recurrence. The mean volume of effusion drained was 1020 ± 125 ml and the chest tube was removed within 5 days in 82% of patients. Side effects of chemical pleurodesis included mainly fever, chest pain, nausea and vomiting. At 30 days 64 patients (56.3%) had a complete response (CR) and 30 patients (26.3%) partial response (PR) to pleurodesis (overall response: 82.6%). At 60 days the overall response was 78.5% (CR:53.5%, PR: 25%). The mean survival was 15.6 ± 2 months. Karnofsky's performance status score was found to be a statistically significant predictor. Patients with Karnofsky's performance status score >70 had a median survival of 513 days, as opposed to a median survival of only 63 days for patients with a Karnofsky's performance status score <30. CONCLUSIONS: Mitoxantrone is effective in the treatment of malignant pleural effusion due to breast carcinoma with relatively low local or systemic toxicity. Karnofsky's performance status score at the time of pleurodesis is predictive of survival

Cardiac Tamponade Secondary to Metastasis from Adenocarcinoma of the Parotid Gland

BACKGROUND: Metastatic involvement of pericardium producing cardiac tamponade is rare. When occurs it is mainly from the lung, breast and the neoplasms of the lymphoreticular system. Hematogenous spread of parotid adenocarcinoma to heart is extremely rare and only two cases have been reported in literature so far. CASE PRESENTATION: We report an unusual case of a patient with adenocarcinoma of the parotid gland, which presented with cardiac tamponade and was treated urgently with pericardial drainage and intrapericardial injection of cisplatin. CONCLUSIONS: Our case demonstrates the possibility of metastatic pericardial involvement and cardiac tamponade in patients with parotid adenocarcinoma. The patient was successfully treated with pericardial drainage and intrapericardial injection of chemotherapeutic agent to control recurrent pericardial effusion

Cutaneous metastasis to the face from colon adenocarcinoma. Case report

BACKGROUND: Facial skin metastases from colorectal cancer are extremely rare and appear several years after resection of the primary tumour. They are an important finding, often being the first sign of metastasis from a previously treated colon cancer. CASE PRESENTATION: We describe a case of a 69 year old patient with cutaneous metastasis to the chin from a previously treated adenocarcinoma of the colon. The patient presented with dyspnoea, pleuritic pain and loss of weight. A chest x-ray revealed a right upper lobe mass of the lung which on subsequent surgical exploration proved to be metastatic from colorectal adenocarcinoma resected three years ago. During the postoperative course, a nodule was noted on the chin and excision biopsy revealed it was also a metastasis from the initial colorectal cancer. Palliative chemoradiotherapy was administered and the patient survived 8 months. CONCLUSION: High index of suspicion is necessary for the early detection of facial cutaneous metastases from colorectal cancer. The aim is to start treatment as soon as possible before widespread visceral metastases occur. Cutaneous metastases from colorectal cancer carry a better prognosis in comparison to those of other epithelial tumours

Renal Artery Thrombosis following Lobectomy for Lung Cancer

Acute renal arterial thrombosis is a rare but very urgent situation demanding immediate treatment. It is characterized by unspecific symptomatology which often misleads the clinicians. As a result, precious time can be lost until the correct diagnosis is reached. The case of a 53-year-old female who underwent a left upper lobectomy for lung cancer is presented. On the third postoperative day, the patient began to complain of a flank pain located at the lower side of the left hemithorax and the nearby lumbar area. A renal arterial thrombosis was finally diagnosed and subcutaneous low molecular weight heparin was started immediately. The patient was discharged two weeks later and anticoagulation therapy with warfarin was given. Six months later, renal function remains satisfying and the patient is free of any symptoms. This is probably the first case in English literature of renal arterial thrombosis following lobectomy for lung cancer

Paraneoplastic pemphigus regression after thymoma resection

<p>Abstract</p> <p>Background</p> <p>Among human neoplasms thymomas are associated with highest frequency with paraneoplastic autoimmune diseases.</p> <p>Case presentation</p> <p>A case of a 42-year-old woman with paraneoplastic pemphigus as the first manifestation of thymoma is reported. Transsternal complete thymoma resection achieved pemphigus regression. The clinical correlations between pemphigus and thymoma are presented.</p> <p>Conclusion</p> <p>Our case report provides further evidence for the important role of autoantibodies in the pathogenesis of paraneoplastic skin diseases in thymoma patients. It also documents the improvement of the associated pemphigus after radical treatment of the thymoma.</p

Facial skin metastasis due to small-cell lung cancer: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer. They are an important finding and are not often the first sign leading to diagnosis.</p> <p>Case presentation</p> <p>We describe the case of a 64-year-old male patient who presented with dyspnea, pleuritic pain, loss of weight and a nodule on his left cheek. A chest X-ray revealed a left upper lobe mass with mediastinal lymphadenopathy. Excision biopsy of the facial nodule revealed small-cell lung carcinoma. Palliative chemo-radiotherapy was administered and the patient survived for 12 months.</p> <p>Conclusion</p> <p>A high index of suspicion is necessary for the early detection of facial cutaneous metastases. Appropriate treatment may prolong patient survival.</p

Intraoperative tracheal reconstruction with bovine pericardial patch following iatrogenic rupture

<p>Abstract</p> <p>Introduction</p> <p>Iatrogenic injuries of the membranous trachea have become increasingly common and may trigger a cascade of immediate life-threatening complications.</p> <p>Case presentation</p> <p>A case of a 48-year-old man with an iatrogenic membranous tracheal wall rupture after double-lumen intubation during Ivor Lewis esophagogastrectomy is presented. Tracheal injury was successfully managed surgically with the use of bovine pericardial patch and reinforcement with the gastric conduit which was moved toward the posterior wall of the membranous trachea sealing the wall laceration.</p> <p>Conclusion</p> <p>Our technique was proved to be safe, effective and not technically demanding. Early recognition with prompt surgery is the gold standard of managing such cases, although small tears can be managed conservatively.</p

Primary mediastinal liposarcoma: a case report

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Cutaneous skull metastasis from uterine leiomyosarcoma: a case report

<p>Abstract</p> <p>Background</p> <p>Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer.</p> <p>Case presentation</p> <p>A 52-year-old woman who admitted with a lung and a skull skin nodule is presented. She had a known diagnosis of uterine leiomyosarcoma following an extended total hysterectomy two years ago. Excision biopsy of both nodules revealed metastatic disease.</p> <p>Conclusion</p> <p>The appearance of a cutaneous nodule in a patient with a history of uterine leiomyosarcoma might indicate a metastatic tumor lesion. Biopsy and immunohistochemistry are essential for correct diagnosis.</p

Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases

<p>Abstract</p> <p>Background</p> <p>Malignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months) and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage.</p> <p>Materials and methods</p> <p>From September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS) for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival.</p> <p>Results</p> <p>The median duration of follow up was 40 months (range 4-61 months). All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma.</p> <p>Conclusions</p> <p>Video-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.</p