Breast cancer, in women, and lung cancer, in men, are the most common origins of cutaneous metastasis. Lung cancer can metastasize to any organ but mostly to the contralateral lung, liver, adrenal gland, bones, and brain. Over 1-12% of patients with lung cancer can develop skin metastasis. Non-small cell lung cancer includes 87% of lung cancer cases. Adenocarcinomas subtype accounts for approximately 40% of all lung cancers and is the most common histology in women. A woman's lifetime risk of developing lung cancer is 1 in 16 women but lower than that of a man (1 in 13 men). The survival rates of women with lung cancer are usually higher than those of men. Herein, we report the case of a 66-year-old female who presented with painless multiple skin nodules over the chest back and axilla for three months. On evaluation, biopsy and immunohistochemistry were done from skin nodules suggestive of adenocarcinoma. CT thorax showed lung mass and was diagnosed as a case of metastatic adenocarcinoma, primary being from the lung. Our case demonstrated that skin metastasis could be the first sign of internal malignancy. Metastasis to the skin is often a preterminal event that heralds a poor prognosis.
Paragangliomas (PGLs) are extra-adrenal neuroendocrine tumors. PGL of the urinary bladder are very rare and commonly present with features of hypertensive crisis, headache, syncope, and other symptoms of sympathetic excess. A few of these tumors are silent at the presentation. Here, we report a case of a urinary bladder PGL, presenting with lower abdominal pain.
Objective Lymphedema of the upper limb is the most common complication in patients with breast cancer, who require axillary lymph node (LN) dissection. Proposition of identifying upper limb draining LN and preserving it, during axillary dissection can reduce significant postoperative morbidity, but it has the risk of inadequate oncological resection. This study was planned to find out metastatic rate in axillary reverse mapping (ARM) nodes in our population.
Materials and Methods Lymphoscintigraphy (LSG) was performed using intradermal injection of 99mTc Sulfur Colloid into ipsilateral second and third interdigital web spaces of hand in patients with breast cancer. Planar, single-photon emission computed tomography-computed tomography images were acquired followed by intraoperative localization of arm draining LNs using Gamma Probe. All identified ARM nodes were dissected and sent for histopathological examination to confirm metastatic involvement.
Results Twenty eligible patients were prospectively analyzed. The identification rate of arm draining LN with LSG was 90% (18/20). Among 14 eligible patients included in the study, ARM node metastasis was seen in two patients. A total of 64 ARM nodes were dissected from 14 patients, 4/64 nodes (2 patients) were positive for metastases (6.25%). Of the six patients excluded from the study, in 1 patient ARM node could not be identified on Gamma Probe, in two cases, it could not be retrieved surgically, in next two cases ARM could not be identified on LSG and remaining one case was removed because of previous surgical intervention.
Conclusion In the current study, LSG showed the identification rate of 90% for ARM nodes in patients with carcinoma breast and metastatic involvement was seen in 6.25% (4/64) of these nodes in 2/14 (14.2%) patients, which is in agreement with previously published data. Oncological safety of preserving ARM nodes needs to be evaluated in the larger population.
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