Malignant fibrous histiocytoma developing in bone 44 years after shrapnel trauma

Article Abstract:

In laboratory animals, particularly rodents, experimental tumors are easily induced by the presence of foreign objects. However, the induction of tumors by foreign objects in humans seems to be extremely rare. The recent of case of a 65-year-old man illustrates that such cases do occur, but often result only after decades of the presence of foreign material. In this case report, the patient complained of pain in the left arm near the shoulder at the site of a shrapnel wound received 44 years earlier at the battle of Smolensk in Russia. Histologic examination revealed a poorly differentiated tumor of unknown origin that was given a working diagnosis of possible adenocarcinoma. The final review determined that the lesion was a malignant fibrous histiocytoma. The tumor was surgically resected, but the patient experienced both local recurrence and metastatic spread to the lung 19 months later. Thirty-one months after the diagnosis, and 47 years after the shrapnel wound, the patient died of progressive disease. Isolated reports of tumors developing in response to metal in the body share similarities with the present case. It is not unusual for tumor development to occur decades after the initial exposure to metal. In another case, angiosarcoma developed in a body site containing shrapnel from a grenade 65 years after the original wound. Little is known about the mechanisms by which the presence of metal might contribute to the development of a tumor, particularly since there seem to be fundamental differences between the response of humans and that of laboratory animals. However, it is clear that the inflammatory response to foreign material with a porous surface is different from reactions induced by nonporous materials. A porous material tends to incite a more extensive cellular reaction, with little fibrosis, while a nonporous material like metal produces pronounced fibrosis, but macrophages remain relatively dormant. It is the latter type of reaction that is believed to favor the events which lead to tumor formation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Wounds and injuries, Injuries, Dermatofibroma, War wounds

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Malignant fibrous histiocytoma of the fallopian tube

Article Abstract:

A 54-year-old postmenopausal woman developed pain in the right groin, vaginal discharge, painful urination and bleeding after sexual intercourse. Examination revealed a tender lower abdomen with a mass on the right side. The erythrocyte sedimentation rate (ESR), which is elevated in the presence of internal swelling, was high. All other blood tests were normal. A laparoscope, a small tube affixed with a magnifying lens, was inserted into the abdomen and revealed a pus-filled area near the ovary. The ovaries and fallopian tubes appeared otherwise normal. The patient was treated with antibiotics (ampicillin and metronidazole) and planned to have surgery to remove the uterus and both ovaries six weeks later. After four weeks, the patient developed severe back pain, increased ESR, and weight loss, and a tumor was visualized in the right fallopian tube. The tumor was not well defined. In surgery, the entire uterus, fallopian tubes and both ovaries were removed. Since the tumor appeared cancerous, lymph nodes were sampled to determine if the cancer had spread. The nodes appeared clear of cancer. The patient began chemotherapy five weeks after surgery and an examination at that time revealed that the tumor had returned. Chemotherapy was not effective and radiotherapy was initiated. After 20 treatments, more abdominal masses including tumors near the kidneys, liver and spleen confirmed that the disease had spread. The patient died 21 weeks after the initial examination. A review of her case reveals that she was misdiagnosed initially with an ovarian infection. However, there is no evidence that early surgery would have benefited this patient, because the tumor was of a very aggressive nature. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Uterine cancer

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Raised serum CA 125 preceding the diagnosis of carcinoma of the fallopian tube: two case reports

Article Abstract:

CA 125 (cancer antigen 125) is a protein that is normally found in the fallopian tubes (the tubes that carry eggs from the ovaries to the uterus), endometrium (the inner lining of the uterus), and cervix, but not in the ovaries and breasts. Even though CA 125 is not normally found in the ovaries, it has been found in ovarian tumors. The amount of this protein that is present in the blood is higher than normal in patients with cancer of the ovaries, cervix or fallopian tubes, as well as in patients with endometriosis or pelvic inflammatory disease. The amount of CA 125 in the blood has been used as a marker for cancer, and has been shown to be related to the size of the tumor (the larger the tumor, the more CA 125 in the blood). Therefore, the clinical course of the disease can be followed by making frequent measurements of CA 125 in the blood. This article describes the case reports of two women, over 50 years of age, with cancer of the fallopian tubes. This type of cancer is rare; it is characterized by symptoms of abdominal pain and watery vaginal discharge. Both of these women participated in a voluntary screening program for ovarian cancer. The women had higher than normal blood levels of CA 125 before they had any symptoms of fallopian tube cancer (for 3 months in one case, and 11 months in the other case). It is concluded that fallopian tube cancer should be considered as a possible diagnosis in women with high blood levels of CA 125. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, Tumor antigens, Genital cancer, Urogenital cancer

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