Based on the large celloidin‐embedded section method, human mandibles from 62 autopsied carcinoma cases were examined histologically to determine the pathological characteristics of any mandibular metaslases. Metastasis was confirmed histologically in 10 (16%) of the 62 cases and was comparatively frequent with gastric and pulmonary carcinomas. The hemopoietic areas in the mandibular marrow seemed to favor the early deposition of tumor cells. These micrometastatic foci seemed to increase in size, spreading to all parts, including the periodontal tissue or anterior part of the mandibular body. Increased hemopoietic activity following lodgement, seemed to play an important role for further metastases. Roentogenographic examination did not seem to be the best method of detecting metastasis.
Objective: To establish a treatment strategy for pulmonary metastases, we clinically investigated the characteristics of distant metastases from head and neck carcinomas. Methods: In 636 head and neck carcinomas, the pathophysiology of distant metastases was investigated by charts, roentgenographies, computed tomographies and scintigraphies. Results: Of the squamous cell carcinomas, oropharyngeal tumors were most highly metastatic, followed by lower gingiva, floor of the mouth, maxillary sinus, and tongue. In distant metastases, 30 (4.7%), 5 (0.8%), and 7 (1.1%) metastasized to the lungs only, lungs and other organs, and organs excluding the lungs, respectively. In pulmonary metastases, the right, left and both lungs were involved in 18, 5, and 8 patients, respectively, although details were not obtained for 4 patients. Pulmonary metastases consisted of 1, 2, and 3 or more tumors in 18, 4, and 6 patients, respectively. Diffuse cancer cell infiltration was observed in 3 patients. Of the 42 patients with distant metastases, 12 patients died of progressive pulmonary metastases, and 5 of these patients manifested only 1 pulmonary lesion throughout life. However, the metastatic pulmonary tumors were controlled surgically or conservatively in 3 patients. Conclusion: These results indicate that distant metastases from head and neck carcinomas involve the lungs most frequently and that chemoimmunotherapy and surgical removal of the metastatic tumors are recommended when indicated.
patients are reported to have died from distant metastases of ACC of the prostate [1]. A good prognosis has been described for ACC of the salivary gland, but ACC in other organs, e.g. the uterine cervix, has a poor prognosis and aggressive course [2,3]. ACC of Cowper's gland is extremely rare; only two cases have been reported [4,5]. The first survived 13 years after local resection and adjuvant radiotherapy, and pelvic exenteration with CASE REPORTA 52-year-old man was referred to our hospital for further examination of a rectal mass. He had first noticed the mass 3 years earlier but had had perineal pain for 8 years. A DRE showed a firm, tender mass underneath but separate from the prostate. His serum PSA level was 0.4 ng/mL; TRUS (Fig. 1A) and MRI (Fig. 1B) showed a mass extending inferiorly from the prostatic apex. Histology of a biopsy obtained under TRUS guidance showed basaloid cell nests with peripheral palisading surrounded by basophilic myxoid matrix. Basaloid tumour cells showed a cribriform arrangement surrounded by basophilic secretion, features consistent with adenoid cystic carcinoma (ACC) (Fig. 2). Immunohistochemically, the tumour cells did not stain for PSA, prostatic acid phosphatase, carcinoembryonic antigen, S-100 protein or smooth muscle actin, but were positive for high molecular-weight cytokeratin. A plain Xray and CT of the chest revealed several lung metastases, but bone scintigraphy and abdominal CT were negative. The patient received radiotherapy followed by two courses of chemotherapy (cisplatin and epirubicin), which resulted in a reduction of primary tumour size and amelioration of symptoms. However, the number and size of lung metastases did not change. Although the patient subsequently received several courses of cisplatin-based chemotherapy, the metastatic lung disease deteriorated gradually and the patient died 5 years after diagnosis; there was no autopsy. COMMENTCowper's glands are paired, pea-sized structures located within the urogenital diaphragm, which drain into the floor of the bulbous urethra. ACC is a relatively rare tumour and usually arises in salivary glands, and rarely in the nasopharynx, oral cavity, trachea, breast and prostate. Nineteen cases of ACC of the prostate have been reported and all were treated by surgical resection. Adjuvant radiotherapy, chemotherapy and hormone therapy have been used, although their effectiveness is controversial. Only two FIG. 1. a, Sagittal TRUS view, showing a mass (arrow) extending inferiorly from the prostatic apex. There is a hyperechoic mass compared with the prostate (arrow head), characterized by the presence of numerous tiny anechoic areas. b, The T2-weighted coronal image (TR = 3000, TE = 105) showed a mass (arrow) extending inferiorly from the prostatic apex. The high signal intensity area indicated a cystic component of the tumour (arrow head). a b
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