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A recommendation for the management of lesions of unknown malignancy in multiple primary malignant neoplasm patients: A case report.

Xia X, Cui K - Oncol Lett (2014)

Bottom Line: The patient more recently presented with hepatocellular carcinoma, which developed from an unexplained mass in the liver.The management of masses of unknown malignancy is also discussed.The current case provides useful insight for future research in this field.

View Article: PubMed Central - PubMed

Affiliation: Cancer Center, West China Hospital, West China Medical School, Chengdu, Sichuan 610041, P.R. China.

ABSTRACT
In numerous patients with multiple primary malignant neoplasms, it is difficult to determine whether the mass is benign or malignant, and the method to treat these lesions is controversial. For patients with a history of cancer, a point of high-risk for the development of a second primary tumor occurs following a 10-year gap. To the best of our knowledge, to date, there has been no large clinical trial to observe the appropriate method to manage the lesions in patients with multiple primary malignant neoplasms. The present study reports the case of a patient who was initially diagnosed with rectal cancer, treated with Dixon's rectectomy and post-operative chemotherapy. The patient's disease was evaluated as complete response following these treatments. However, the patient then presented with bladder cancer and underwent transurethral resection of the bladder tumor, again achieving a complete response. The patient more recently presented with hepatocellular carcinoma, which developed from an unexplained mass in the liver. The patient underwent partial liver resection and to date, has achieved a complete response. The management of masses of unknown malignancy is also discussed. The current case provides useful insight for future research in this field.

No MeSH data available.


Related in: MedlinePlus

(A) The 0.9-cm tissue mass of unknown malignancy: A contrast computed tomography scan on December 3, 2010, showed a mildly-enhanced lesion in the right lobe of the liver when it was discovered for the first time. (B) The mass of 3 cm in diameter was confirmed as hepatic carcinoma by computed tomography on December 20, 2011.
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f1-ol-08-06-2744: (A) The 0.9-cm tissue mass of unknown malignancy: A contrast computed tomography scan on December 3, 2010, showed a mildly-enhanced lesion in the right lobe of the liver when it was discovered for the first time. (B) The mass of 3 cm in diameter was confirmed as hepatic carcinoma by computed tomography on December 20, 2011.

Mentions: A 62-year-old male presented to the West China Hospital of Sichuan University (Chengdu, China) due to blood in the feces and weight loss that had been occurring for approximately one month. A proctoscopy indicated a rectal adenoma. At day seven post-admission, the patient underwent Dixon’s rectectomy. During the surgery, a 5×4-cm neoplasm was observed in the rectum and diagnosed as hepatic cirrhosis. Following the surgery, the microscopic examination confirmed the neoplasm to be a rectal adenoma. The patient received four cycles of post-operative chemotherapy composed of a 5-Fu infusion (250 mg/day from days one to three). However, due to intolera- ble rashes, the treatment was changed to 200 mg tegafur (three times per day on days four to 10) for the first cycle, while for the following three cycles the tegafur was administered at the same dose and frequency but for 10 days. The patient also received 41 doses of T-cell therapy (20 ml infusion ever two or three days). There were no complications in the procedure. Additionally, a hepatitis B virus (HBV) test showed that the patient was positive for the HB surface, envelope and core antigens. The HBV DNA content was 2.85×106/ml. The patient received glutathione (1,200 mg/day during hospitalization) and bifendate (15 mg, three times per day until the HBV-DNA levels had ret- urned to normal) as liver treatment. The patient achieved a complete response following these treatments. Approximately seven months later, the patient required hospitalization due to the chief complaint of painless gross hematuria persisting for 1 week. Ultrasonography showed a mass in the urinary bladder, which did not move with the change of body position. At day four post-admission, the patient received a transurethral resection of the bladder tumor. Following the surgery, bladder instillation was performed for treatment with doxorubicin. The post-operative biopsy of the neoplasm, with hematoxylin and eosin staining revealed that the pathological type was a bladder transitional cell carcinoma, following assessment by a pathologist from the West China Hospital. Eight years after the second surgery, a mass of 0.9 cm in diameter was discovered in the liver by contrast computed tomography (Fig. 1A). Approximately one year later, this mass developed into hepatic cancer in the right posterior lobe of the upper section of the liver (Fig. 1B). Subsequently, the patient received a partial liver resection, the hepatic mass was stained with hematoxylin and eosin and was confirmed as hepatocellular carcinoma by pathological analysis, by a pathologist from the West China Hospital. After this last surgery, the patient recovered well and was disease-free with an Eastern Cooperative Oncology Group score of 1.


A recommendation for the management of lesions of unknown malignancy in multiple primary malignant neoplasm patients: A case report.

Xia X, Cui K - Oncol Lett (2014)

(A) The 0.9-cm tissue mass of unknown malignancy: A contrast computed tomography scan on December 3, 2010, showed a mildly-enhanced lesion in the right lobe of the liver when it was discovered for the first time. (B) The mass of 3 cm in diameter was confirmed as hepatic carcinoma by computed tomography on December 20, 2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214459&req=5

f1-ol-08-06-2744: (A) The 0.9-cm tissue mass of unknown malignancy: A contrast computed tomography scan on December 3, 2010, showed a mildly-enhanced lesion in the right lobe of the liver when it was discovered for the first time. (B) The mass of 3 cm in diameter was confirmed as hepatic carcinoma by computed tomography on December 20, 2011.
Mentions: A 62-year-old male presented to the West China Hospital of Sichuan University (Chengdu, China) due to blood in the feces and weight loss that had been occurring for approximately one month. A proctoscopy indicated a rectal adenoma. At day seven post-admission, the patient underwent Dixon’s rectectomy. During the surgery, a 5×4-cm neoplasm was observed in the rectum and diagnosed as hepatic cirrhosis. Following the surgery, the microscopic examination confirmed the neoplasm to be a rectal adenoma. The patient received four cycles of post-operative chemotherapy composed of a 5-Fu infusion (250 mg/day from days one to three). However, due to intolera- ble rashes, the treatment was changed to 200 mg tegafur (three times per day on days four to 10) for the first cycle, while for the following three cycles the tegafur was administered at the same dose and frequency but for 10 days. The patient also received 41 doses of T-cell therapy (20 ml infusion ever two or three days). There were no complications in the procedure. Additionally, a hepatitis B virus (HBV) test showed that the patient was positive for the HB surface, envelope and core antigens. The HBV DNA content was 2.85×106/ml. The patient received glutathione (1,200 mg/day during hospitalization) and bifendate (15 mg, three times per day until the HBV-DNA levels had ret- urned to normal) as liver treatment. The patient achieved a complete response following these treatments. Approximately seven months later, the patient required hospitalization due to the chief complaint of painless gross hematuria persisting for 1 week. Ultrasonography showed a mass in the urinary bladder, which did not move with the change of body position. At day four post-admission, the patient received a transurethral resection of the bladder tumor. Following the surgery, bladder instillation was performed for treatment with doxorubicin. The post-operative biopsy of the neoplasm, with hematoxylin and eosin staining revealed that the pathological type was a bladder transitional cell carcinoma, following assessment by a pathologist from the West China Hospital. Eight years after the second surgery, a mass of 0.9 cm in diameter was discovered in the liver by contrast computed tomography (Fig. 1A). Approximately one year later, this mass developed into hepatic cancer in the right posterior lobe of the upper section of the liver (Fig. 1B). Subsequently, the patient received a partial liver resection, the hepatic mass was stained with hematoxylin and eosin and was confirmed as hepatocellular carcinoma by pathological analysis, by a pathologist from the West China Hospital. After this last surgery, the patient recovered well and was disease-free with an Eastern Cooperative Oncology Group score of 1.

Bottom Line: The patient more recently presented with hepatocellular carcinoma, which developed from an unexplained mass in the liver.The management of masses of unknown malignancy is also discussed.The current case provides useful insight for future research in this field.

View Article: PubMed Central - PubMed

Affiliation: Cancer Center, West China Hospital, West China Medical School, Chengdu, Sichuan 610041, P.R. China.

ABSTRACT
In numerous patients with multiple primary malignant neoplasms, it is difficult to determine whether the mass is benign or malignant, and the method to treat these lesions is controversial. For patients with a history of cancer, a point of high-risk for the development of a second primary tumor occurs following a 10-year gap. To the best of our knowledge, to date, there has been no large clinical trial to observe the appropriate method to manage the lesions in patients with multiple primary malignant neoplasms. The present study reports the case of a patient who was initially diagnosed with rectal cancer, treated with Dixon's rectectomy and post-operative chemotherapy. The patient's disease was evaluated as complete response following these treatments. However, the patient then presented with bladder cancer and underwent transurethral resection of the bladder tumor, again achieving a complete response. The patient more recently presented with hepatocellular carcinoma, which developed from an unexplained mass in the liver. The patient underwent partial liver resection and to date, has achieved a complete response. The management of masses of unknown malignancy is also discussed. The current case provides useful insight for future research in this field.

No MeSH data available.


Related in: MedlinePlus