A 69-year-old man presented with painful swelling of several finger tips over a period of 2 months that interfered with activities of daily life and had not responded to topical or oral antibiotics prescribed by his primary care physician. The patient was diagnosed with locoregionally advanced laryngeal squamous cell carcinoma 18 months before this presentation, which was initially treated with total laryngectomy and postoperative concurrent chemoradiotherapy but had recurred with lung metastases. On examination, the patient had hard, erythematous, and tender swelling of several finger pulps in both hands (Fig 1A, arrows), most pronounced in the third finger of both hands. There was no fluctuation or warmth. A 3-cm erythematous mass was also present in the left thigh (Fig 1B). Cytologic examination from a fine-needle aspiration of an involved digit confirmed metastatic squamous cell carcinoma (Fig 2A, diff quick stain; Fig 2B, papanicolaou stain).The patient expired as a result of myocardial infarction before initiation of palliative chemotherapy.
DiscussionSquamous cell carcinoma of the head and neck has a predilection for cervical lymph node metastasis, and hematogenous spread is less frequent. With improvements in locoregional disease control associated with modern therapies, however, the reported rate of distant recurrence appears to have risen. 1 Although the lung is the most common site for distant recurrence, metastases to un-usual sites including intracardiac, kidney, small intestines, and muscles have also been reported. [2][3][4][5] There is a single report of laryngeal cancer metastasis to the thumb used for digital occlusion during tracheoesophageal speech in a laryngectomized patient with lung metastases. 6 The authors attributed the metastasis to direct implantation from contact with contaminated pulmonary secretions via the tracheostomy. In our case, hematologic metastasis is suspected as several fingers of both hands were involved, in addition to the lesion on the thigh. This clinical observation was associated with rapid patient demise.
Breast cancer is the first in the incidence of malignancies among women. The documented frequency of osseous metastasis from breast cancer is about 12.8 %. Although breast cancer cells have been documented in the bone marrow in autopsy, haematological manifestations due to metastatic disease to the marrow is rare. The prognosis of these cases is dismal and improper management worsen the condition further. IHC for ER, PR & Her 2/neu status plays a vital role in ascertaining the treatment protocol both in primary tumors as well as metastatic or recurrent tumors. Receptor conversion has been documented in metastatic and recurrent cases. We report a case of 65 year female with a history of ER, PR positive and Her 2/neu negative carcinoma breast 3½ years back, presented with anemia and low back ache diagnosed as metastatic breast carcinoma to bone marrow with receptor conversion.
418 Background: Accurate and fast screening of mutations is essential for designing individualized therapy necessary and critical for efficient disease management and better patient outcome in mCRC. Detection of hotspots by gold standard direct sequencing (DS) is time consuming and cost ineffective. Pyrosequencing (PS) technique is rapid and precisely committed towards SNP detection. Recent introduction of high throughput multiplex PCR based extension on microarray (Sequenom, SEQ) offers a robust platform capable of detecting multiple SNPs simultaneously in a rapid and cost effective manner. The current study analyzes the concordance and efficacy of the cutting edge SEQ technique to the well established DS and PS methods. Methods: DNA isolated from 122 specimens from 76 mCRC patients were sequenced by all three methods. DS and PS were performed on 4 genes at 10 hotspots. SEQ multiplexing was performed on 31 hotspots in 19 genes by 4 multiplex reactions. Results: We were able to make "calls" for all samples by DS and PS. With the multiplex system, the “calls” rate was 97.8% of successful reactions. Using PS data as our standard in the assay we calculated the percent concordance of DS and SEQ. Futhermore SEQ offered a more accurate identification of the substituted nucleotide in Kras codon 12 as compared to PS. Conclusions: The multiplexing of PCR reactions offers an excellent advantage of high throughput with strong feasibility of analyzing several samples for multiple SNPs simultaneously. The concordance rate of > 90% when compared to PS along with the ability to analyze multiple samples/ hotspots plexed together in a time effective rapid mode provided a trifold advantage of the sequenom technology. It is therefore the next generation technology for rapid genetic evaluation of cancer patients. [Table: see text]
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.