WCIM 2014 SEOUL KOREA 195
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0575 Oncology
Biphosphonate Induced Osteonecrosis of the Jaw in the Context of Prostate Cancer – Case Report
Joao Gomes PEREIRA1, Rita Azenha CARDOSO2
C. Hosp. Lisboa Norte - Hospital De Santa Maria, Portugal1, Instituto Português de Oncologia Francisco Gentil, Portugal2
Biphosphonates are potent drugs that inibit bone resorption, and are widely used in the treatment of many diseases, such as osteoporosis, Paget disease, and many cancer situations with bone metastases. Osteonecrosis of the jaw (ONJ) can occur as a com- plication of this therapy and there are known risk factors such as bad dental hygiene, history of dental extraction, chemotherapy, corticosteroids and radiation therapy of the head and neck. The authors describe a case of ONJ in a 75 year old patient with Prostate cancer and bone metastatic disease who started therapy with Zoledronic Acid in 2007. In 2014 he developed pain and numbness in the mandible region with subsequent diagnosis of ONJ. The patient was submitted to segmentar mandibulecto- my in July of 2014 and is presently assintomatic. Physicians should be aware of this potential complication of biphosphonate therapy. ONJ can affect the quality of life in cancer patients and an early diagnosis may reduce or avoid the consequences of such disease.
PS 0576 Oncology
Diversity Creates Confusion: Carcinosarcoma in the Anterior Abdominal Wall of a Young Adult Male
Gelinemae MALAZA1, Felycette Gay LAPUS1 Davao Doctors Hospital, Philippines1
Objective: To present a case of anterior abdominal wall mass in a young adult male with histopathologic diagnosis of carcinosarcoma.
Design: Case Report
Setting: Tertiary Hospital in Davao City, Philippines
This is a case of a 22-year-old male who presented with progressive knee pain and an incidental fi nding of anterior abdominal wall mass with spinal cord compression symptoms. He underwent posterior decompression and screw fi xation of vertebra, and excision of anterior abdominal wall mass. Microscopic fi ndings of tissue speci- mens revealed malignant small round cell tumor. Immunohistochemical stain done on abdominal wall mass was strongly positive for cytokeratin and vimentin, negative for leukocyte common antigen (LCA), non-specifi c esterase (NSE), desmin, and chromog- ranin A. The stained cells were distinctive and separated but admixed which was more compatible with carcinosarcoma. The patient however succumbed to sepsis prior to further management. This paper serves to report a highly aggressive tumor in a previ- ously-well young man whose histopathologic diagnosis with basic microscopy yielded diverse differentials. Further workup with immunohistochemistry came up with a fi nal diagnosis of carcinosarcoma in the anterior abdominal wall metastatic to bone, spine, and soft tissue in the head.
PS 0577 Oncology
18 Year Old Girl with Rapid Growing Cervical Tumor and Loss of Muscular Function of the Lower Extremi- ties
Friederika FLUCK1, Luiz MENEZES FALCAO2, Raquel PAIXAO3, Isabel PINHEIRO4 University Hospital of Lisbon, Portugal1, University Hospital of Lisbon, Portugal2, University Hospital of Lisbon, Portugal3, University Hospital of Lisbon, Portugal4
Background: Ewing’s sarcoma is usually identifi ed as a primary malignancy of the bone affecting children and young adults. It is associated with soft tissue extension in 90% of cases. Primarily extraskeletal Ewing’s sarcoma is a rare subtype, and very few data are available concerning optimal treatment modalities.
Case Presentation: We report a case of an 18 year-old female from Cabo Verde in her 34th week of pregnancy presenting with a rapid growing cervical tumor. It had initially started as an indolent swelling at the left cervico-postero-lateral region. CT had shown involvement of both superfi cial and deep cervical fascia. At time of pres- entation, the histologic diagnosis of a peripheral Primitive Neuroectodermal Tumor type T extraskeletal Ewing’s sarcoma had already been provided. To reduce risk of fetal metastasis, the child was delivered by caesarean section. A chest CT of the patient revealed pulmonary metastasis and compressive atelectasis of the left lung caused by the tumor. Three weeks post partum, she presented with loss of muscular function of the extremities as well as parestesia and bladder dysfunction. A repeat CT confi rmed medullar compression at the level of C5-C6, C6-C7 and C7-D1 by the tumor without signs of bone metastasis. Five sessions of palliative radiotherapy were performed that led to parcial recovery of muscular function of the upper right extremity. Palliative chemotherapy was refused, so that the patient was released from hospital. No metas- tasis had been detected in the child so far.
Conclusion: Extraskeletal Ewing’s sarcoma can manifest as a rapidly growing localized mass causing local compression symptoms. Palliative radiotherapy can achieve local tumor-reduction and symptom relief. Risk of fetal metastasis should be minimized by early delivery. The newborn should be followed for early detection of metastasis.
PS 0578 Oncology
Recurred Maxillary Sinus Cancer with only Adrenal Metastasis
Ha Yeon LEE1, Wan Kyu EO1, Hye Jung CHANG1 Kyung Hee University Hospital at Gangdong, Korea1
Maxillary sinus cancers are rare tumors. Patients with maxillary sinus cancers tend- ed to be asymptomatic until they invade adjacent structures, and then they often presented with locally advanced disease. Within a year since treatment completion, tumor recurrences were commonly occurred with locoregional failure. Relatively fewer patients presented a distant metastasis and the most commonly involved metastatic sites were lung and bone. Here, we report a rare case of recurred maxillary sinus can- cer with only adrenal gland metastasis. A 64-year-old man had been treated for the odontogenic sinusitis through the dental caries on palatal root of #26. We extracted his tooth #26 and prescribed oral antibiotics for the past 3 weeks. Although he had took antibiotics, he was still complained about painful swelling in the left subman- dibular area and it extended to the left maxillary sinus. Upon intraoral examination, we found a granulation tissue was protruded at the tooth #26 extraction site and we performed a biopsy at that site. Histological examination revealed a poorly differenti- ated squamous cell carcinoma. Computerized tomography (CT) and positron emission tomography (PET)/CT were performed for tumor staging. We concluded he had a max- illary sinus squamous cell carcinoma stage IVA (cT3N2) by American Joint Committee on Cancer (AJCC 7th ed.). The patient had received left partial maxillectomy and left radical neck dissection followed by postoperative chemoradiotherapy (CCRT). One month later since completion of CCRT, we assessed primary tumor status by Neck CT.
There was no oral and neck lesions. We took Neck CT and Chest CT 2 months later.
There was still no locoregional recurrence but presented a newly developed left ad- renal mass. He had received a laparoscopic left adrenalectomy and histological result showed a poorly differentiated squamous cell carcinoma. Then we delivered him a palliative chemotherapy.
