Virilising adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is a rare malignancy, with an estimated annual incidence of 0.7–2 cases per million and a median overall survival of 3–4 years. Hormone-secreting ACCs represent most cases; of these, only a small minority presents with virilisation alone. Early diagnosis is key to increase the chances of a better outcome. Here, we report a case of a 41-year-old woman who presented with menstrual irregularities, hirsutism and virilising symptoms, associated with abdominal discomfort and constitutional symptoms. On physical examination, there was a palpable mass in the right upper quadrant. Laboratory workup revealed elevated serum androgens. The imaging study showed a 163×110×122 cm right adrenal mass with features consistent with ACC and suggested potential hepatic invasion. Our patient underwent surgical resection, and the histopathological findings confirmed the diagnosis. She was referred to a specialised centre for follow-up and adjuvant therapy.

Effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma with radical resection

Purposes: This study was designed to evaluate the long-term prognostic value of preoperative jaundice and explore which clinicopathological factor significantly influencing the long-term prognosis of gallbladder carcinoma (GBC) after radical resection (R0). Methods: A total of 267 GBC patients who underwent R0 resection between January 2004 and December 2014 were enrolled, including 54 patients with preoperative jaundice and 213 patients without jaundice. The clinicopathological parameters between the two groups were compared, and the correlation between preoperative jaundice and the long-term prognosis was furtherly analyzed. Results: Unilateral and multivariate analyses of 267 GBC patients showed that the depth of tumor invasion (pT stage), lymphatic metastasis, and hepatic invasion were independent prognostic factors. In terms of the 54 GBC patients with preoperative jaundice, univariate and multivariate analysis showed that only pT stage was an independent factor for prognosis. Furthermore, the intraoperative blood transfusion and pT stage were significant different between long-term survival (survival for more than 3 years) and those who died within 3 years (P<0.05). Conclusion: Preoperative jaundice was not the independent factor affecting the poor long-term prognosis of gallbladder carcinoma after R0 resection. The pT stage was the only long-term prognostic factor in all GBC patients with and without preoperative jaundice.

Long-term outcome and prognostic factors of combined hepatocellular carcinoma and cholangiocarcinoma after curative resection

Background Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is a rare subtype of primary liver cancers. Its prognostic factors remain unclear. The study aimed to evaluate its long-term outcome and prognostic factors by retrospectively reviewing the series of cHCC-CC after curative resection from our institute. Methods A total of 55 pathologically confirmed cHCC-CC patients undergoing curative resections between January 2003 and January 2018 at the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) were included. The clinicopathological and follow-up data were retrieved. Overall survival (OS) and recurrence-free survivals (RFS) were analysed by Kaplan–Meier curve. The independent prognostic factors were determined by using univariate and multivariate Cox analyses. Results There were 41 males and 14 females, with a median age of 51.0 (interquartile range, 44.0–60.0) years. The 1-, 3-, and 5-year OS and RFS rates in cHCC-CC were 80.0%, 25.5%, and 16.4%, respectively, and 52.7%, 21.8%, and 10.9%, respectively. The median OS and RFS were 24.9 and 14.5 months, respectively. Univariate and multivariate analyses revealed that elevated alpha-fetal protein (AFP) and/or CA19-9, vascular invasion, local extra-hepatic invasion, and lymph-node metastasis (LNM) were independent unfavorable prognostic factors for OS and RFS (all P &lt; 0.005). Furthermore, elevated AFP and/or CA19-9 were independent unfavorable prognostic factors in various subgroups of cHCC-CC, including patients aged &lt;60 years, positive hepatitis B surface antigen, cirrhosis, single tumor, tumor size ≥5 cm, no vascular invasion, no LNM, and no local extra-hepatic invasion (all P &lt; 0.05). Conclusions Elevated AFP and/or CA19-9, vascular invasion, local extra-hepatic invasion, and LNM were independent unfavorable prognostic factors for long-term survival of cHCC-CC undergoing curative resections. Patients with normal levels of AFP and CA19-9 had better prognosis.

Effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma with radical resection

Purposes This study was designed to evaluate the long-term prognostic value of preoperative jaundice and explore which clinicopathological factor significantly influencing the long-term prognosis of gallbladder carcinoma (GBC) after radical resection (R0). Methods A total of 267 GBC patients who underwent R0 resection between January 2004 and December 2014 were enrolled, including 54 patients with preoperative jaundice and 213 patients without jaundice. The clinicopathological parameters between the two groups were compared, and the correlation between preoperative jaundice and the long-term prognosis was furtherly analyzed. Results Unilateral and multivariate analyses of 267 GBC patients showed that the depth of tumor invasion (pT stage), lymphatic metastasis, and hepatic invasion were independent prognostic factors. In terms of the 54 GBC patients with preoperative jaundice, univariate and multivariate analysis showed that only pT stage was an independent factor for prognosis. Furthermore, the intraoperative blood transfusion and pT stage were significant different between long-term survival (survival for more than 3 years) and those who died within 3 years (P<0.05). Conclusion Preoperative jaundice was not the independent factor affecting the poor long-term prognosis of gallbladder carcinoma after R0 resection. The pT stage was the only long-term prognostic factor in all GBC patients with and without preoperative jaundice.

Rare Case of Metastatic Colorectal Cancer to Uretral Meatus with Rapid Progression and Fatal Outcomes

Urethral metastases are extremely rare. A few cases of uretral metastasis in the literature have been found to arise from the colon. Because of the rarity of uretral metastasis and its similarity to primary uretral neoplasms, diagnosis is rarely evoqued. We report here a case of a 46-yearold female admitted to our hospital with complaints of rectal bleeding, bowel distension and urinary symptoms. Clinical examination revealed rectal mass associated with meatus urethral tumor. A biopsy yielded a diagnosis of rectal adenocarcinoma with metastasis to urethral meatus, and tumor cells were strongly and uniformly positive for CK20 and CDX2 at immunohistochemical analysis. A general examination has shown a sigmoid tumor with hepatic metastatic lesion. One month after diagnosis, the tumor grew rapidly, with hepatic invasion and therefore the patient was treated only by palliative care. She died from liver failure one month later. Although urethral metastasis originating from colon is rare, this entity is increasingly described. The synchronous character and the location of the metastasis in the uretral meatus, are two remarkable characteristics described in this case report. The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis when urethral mass is identified.

Hepatocellular Carcinoma Masquerading as a Large Renal Mass with Hepatic Invasion

Large masses are evaluated with imaging to assess primary origin and tumor spread. We present the unusual case of a 53-year-old male with a 17-cm right upper quadrant mass suspected to be renal or adrenal in origin based on radiographic findings. After surgical excision, the mass was subsequently discovered to be primary hepatocellular carcinoma with direct extension to the kidney and adrenal gland. A diagnosis of chronic hepatitis B was made postoperatively. Primary hepatocellular carcinoma with direct renal extension is an exceedingly rare occurrence based on our experience and review of the published literature.