Renal cell carcinoma (RCC) is the third most frequently seen primary source of metastatic lesions of the oral cavity. Still oral cavity metastasis is a rarely seen clinical manifestation during the course of RCC. In a patient with a known history of RCC, in the presence of newly emerged oral and maxillofacial lesion(s), possibility of metastasis should be always thought of and pathological investigation should be performed as soon as possible. In RCC, metastatic involvement of oral cavity is generally accompanied by involvement of other organs with resultant lower chance of cure and poor prognosis. Especially in conditions which adversely affect functions of chewing and swallowing consequently nutrition and quality of life, surgery is contraindicated and local interventional methods transarterial chemoembolization, microwave ablation and radiofrequency ablation can be good palliative treatment alternatives. In advanced stages of the diseases with systemic involvement application of local interventional methods either solely or in combination with radiotherapy and surgery increases compliance to the systemic treatment and can contribute markedly to the prolongation of survival. Herein we aimed to present a case with unusual histopathological characteristics and presentation in whom we achieved a longer period of disease-free survival using a different local treatment method.
Malignant pleural mesothelioma (MPM) is an uncommon, aggressive malignant neoplasm derived from the mesothelial cells of pleura or peritoneum characterized by poor outcome. Mesothelioma is thought to metastasize locally only via direct invasion and not have distant spread. Distant metastases are discovered mostly on post-mortem examination. However, recent post-mortem studies have identified metastases to the central nervous system (CNS) in about 3% of cases. A 55 year old patient presented with agressive multiple brain metastases after 4 years from the initial diagnosis. Palliative cranial radiotherapy was given because of unresectability of the lesions. The patient died 3 months after completion of radiotherapy. Distant metastase patern is not predictable in this disease, thus attention should be paid on the high-risk factors at initial presentation to prevent systemic relapses. Multimodality therapies have been produced longer survival times in this disease; clinicians should perform careful screening for brain metastasis in MPM, especially in patients with risk factors including younger age, advanced stage and non-epithelioid features. Keywords: pleural mesothelioma, brain metastasis, brain radiotherapy.
ÖZETMalign plevral mezotelyoma (MPM) nadir görülen plevra ya da peritondaki mezotelyal hücrelerden köken alan, kötü prognozlu, nadir ve agresif bir malign neoplazidir. Mezotelyomanın sadece lokal direkt invazyon yolu ile lokal olarak metastaz yaptığı; uzak yayılım yapmadığı düşünülmektedir. Uzak metastazlar post mortem incelemeler sonucu ortaya çıkmaya başlamıştır. Son zamanlarda yapılan post mortem çalışmalarda %3 vakada santral sinir sistemi metastazları bildirilmiştir. 55 yaşında hasta ilk tanısından 4 yıl sonra çoklu agresif beyin metastazları ile başvurdu. Rezeksiyona uygun olmayan lezyonlar nedeniyle palyatif kraniyal radyoterapi verildi. Radyoterapinin tamamlanmasından 3 ay sonra hasta kaybedildi. Bu hastalıkta uzak metastaz paterni öngörülebilir olmadığı için, sistemik relapsları önlemede ilk tanı esnasında yüksek risk faktörlerine dikkat edilmelidir. Multimodal tedaviler bu hastalıkta daha uzun sağkalım sağlayabilmektedir. Klinisyenler MPM'de özellikle erken yaş, ileri evre ve epiteloid dışı özellikleri bulunan hastalarda beyin metastazı için dikkatli tarama yapmalıdırlar. Anahtar sözcükler: plevral mezotelyoma, beyin metastazı, beyin radyoterapisi
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