Primary Sites of Gastric Carcinoma with Metastatic Spread Detected by Transabdominal Hydrosonography: Experience of 76 Cases in Bangladesh

Background: Metastasis is frequently occurred among the gastric carcinoma patients. Objectives: The purpose of the present study was to detect the different primary sites of gastric carcinoma by ultrasonography with the metastatic spread. Methodology: This cross-sectional study was carried in the department of Radiology and Imaging of Dhaka Medical College, Dhaka from July 2009 to June 2011 for a period of two (2) years. Clinically suspected gastric carcinoma patients attended at indoor and outdoor Surgery department of Dhaka Medical College Hospital, Dhaka were selected as study population. All the patients were examined by ultrasonography of upper abdomen and or Ba-meal X-ray. Detailed clinical history and relevant points in clinical examination and investigations were noted. The sonographic findings were noted. The extent of tumour infiltration and metastasis was assessed in all patients with suspected gastric malignancy. All these patients were properly follow up and collect the endoscopic biopsy and/or surgical resection biopsy reports. In all patients who underwent operation the extent of tumour infiltration and metastasis was looked for and was noted. Results: A total number of 76 patients were included in this study. Among 76 patients, 3 unwilling to take part in the study, 4 patients refused to undergo endoscopy or surgery, 5 patients were unfit for the same and in 4 cases, and histopathological reports were not available. Ultimately 60 patients were evaluated finally. The commonest site of involvement of gastric carcinoma as determined by ultrasound was the antrum 13 out of 23 cases (56.52%). Among them metastatic para-aortic lymph nodes were seen in seven patients and hepatic metastases was detected in five patients’ ascites was seen in eleven patients. Conclusion: In conclusion, the most common site of gastric carcinoma is the antral part of stomach and majority are metastasized in peritoneum.

Metastatic clear cell renal cell carcinoma in isolated retroperitoneal lymph node without evidence of primary tumor in kidneys: A case report

BACKGROUND Retroperitoneal lymph node dissection(RPLND)plays a diagnostic,therapeutic,and prognostic role in myriad urologic malignancies,including testicular carcinoma,renal cell carcinoma(RCC),and upper urinary tract urothelial carcinoma.RCC represents 2%of all cancers with approximately 25%of patients presenting with advanced disease.Clear cell RCC(CCRCC)is the most common RCC,accounting for 75%-80%of all RCC.CASE SUMMARY A 71-year-old man presented with a history of benign prostatic hypertrophy.He was asymptomatic without any hematuria,pain,or other urinary symptoms.A computed tomography(CT)scan of the abdomen and pelvis showed a 1.8 cm left retroperitoneal lymph node.There was no evidence of renal pathology.A core biopsy was performed of the left para-aortic lymph node.Although the primary tumor site was unknown,the morphological and immunohistochemical features were most consistent with CCRCC.A RPLND was performed which revealed a single mass 5.5 cm in greatest dimension with extensive necrosis.The retroperitoneal lymph node was most compatible with CCRCC.A nephrectomy was not conducted as a renal mass had not been detected on any prior imaging studies.The patient did not receive any type of adjuvant therapy.The patient underwent surveillance with serial CT scans with contrast of the chest,abdomen,and pelvis for the next 5 years,all of which demonstrated no recurrent or metastatic disease and no evidence of retroperitoneal adenopathy.CONCLUSION Our unique case emphasizes the therapeutic role of metastasectomy in metastatic CCRCC even in the absence of primary tumor in the kidneys.

Metastatic inguinal lymph nodes with two different histological types in a case of carcinoma of unknown primary site

Cancer of unknown primary site is a group of uncommon cancers where patients present with metastatic disease and the primary site is not identifi ed,even after a complete workup to establish the diagnosis.Inguinal metastasis with unknown primary is even more uncommon,and histological type is the most important guiding factor to look for the primary.This report describes the rare situation of inguinal metastasis with an unknown primary site where a combination of squamous and transitional cell carcinoma was found on fi nal histopathology.It highlights the importance of multimodality approach including an aggressive surgical resection combined with adjuvant radiation therapy to achieve an optimal outcome.