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    • In patients with ovary lesions surgical intervention play an

    2019-04-26

    In patients with ovary lesions, surgical intervention play an important role to establish correct diagnosis. First of all, obtaining histologic confirmation of disease by laparotomy is critical in differentiating primary ovarian cancer between metastatic lesions such as gastric cancer to the ovary (krukenberg tumor). Second, surgical intervention can provide a way to determine the detail disease burden and whether postoperative treatment will be required once primary ovary cancer is impressed during operation. Although our patient presented with poor performance status initially, there is a difficulty to differentiate metastatic or primary ovary cancer based on these current biopsy results (massive necrosis) and no positive findings of first time endoscopy. In this time, surgical intervention is an important diagnostic procedure to obtain adequate tissue to establish correct diagnosis for further therapeutic plan.
    Sources of funding
    Conflict of interest
    Introduction Nasopharyngeal carcinoma (NPC) is a non-lymphomatous squamous-cell carcinoma which occurs in the nasopharynx epithelial lining. Nasopharyngeal carcinoma is a common in Southeast Asia with an incidence around 20–30 per 100,000 in South-east Asia. NPC had the characteristic of easy dissemination. The most common type in Asia is non-keratinizing, thought with sensitive to both chemotherapy and radiotherapy. This type has characters of higher incidence of distance metastasis, compared to other two type. Liver is one of the most common site of mibefradil from NPC; liver metastasis usually multifocal and had the poorest prognosis compared with metastasis to lung and bone. Hepatectomy for solitary colorectal liver metastasis has been well-recognized as major part of its standard treatment. The role of partial hepatectomy for NPC with liver metastasis has not well documented. In this paper, two NPC cases who received initial chemotherapy had disease progressed to liver metastasis and underwent partial hepatectomy plus post operative chemotherapy showed prolong survival time.
    Case report
    Discussion The subtype of NPC in the WHO classification including three types, type 1: squamous cell carcinoma; type 2: non-keratinizing carcinoma and type 3: undifferentiated carcinoma. The incidence of the three type around, 25% in type I, 12% in typ2 II and 60% in type III. The 5-year-survival in type I around 10% and in 50% in type II and III. But type II and III with long-term risk of recurrence. It has been reported that 30%–60% patients with local advanced NPC will developed distance metastasis within 5 years, and 5–8% with distance metastasis at the time of diagnosis. The most common site of distance metastasis is bone, followed by lungs, liver and distance lymph node. Overall survival in bone metastasis is 6–24 months. For lungs metastasis the median overall survival around 3.9 months. And for patients with liver metastasis, the median overall survival decreased to 3–5 months. The incidence of NPC with liver metastasis is around 29.3%–36%. Current standard treatment regimen for NPC with liver metastasis is combined chemotherapy. The most common regimen is cisplatin and 5-Fu with a response rate around 66–76%. In this case report, we explored 2 patients with nasopharyngeal carcinoma under treatment with disease progress to liver metastasis, two of the case had accepted partial hepatectomy with prolong survival and with normal liver function. Hepatectomy for liver metastasis from nasopharyngeal carcinoma is not a standard treatment. Due to had successful treatment experience with hepatectomy in colorectal cancer with liver metastasis, partial hepatectomy had been tried in nasopharyngeal carcinoma. In Hung study, they had suggested no obvious capsule was found in liver metastasis and the lesions had displayed an infiltrating growth pattern with a deficiency of blood supply and lack of a capsule. It may explain why tumor resection is a possibility of distance metastasis control. Multimodality therapy for NPC with metastasis still needs further elevation for establishing standard treatment. From the 2 cases, we explored the possibility of prolong survival for NPC with liver metastasis treated with hepatectomy.