This study documents a high incidence of lymph node micrometastases as detected by sentinel node biopsy in patients with high-risk DCIS and DCISM. Although the biological significance of breast cancer micrometastases remains unclear at this time, these findings suggest that sentinel node biopsy should be considered in patients with high-risk DCIS and DCISM.

These data demonstrate that intradermal injection of radioactive tracer is an effective method of localizing the SLN in cases involving small breast cancers. Further investigation is warranted before this technique is adopted for use in larger breast cancers. Intraoperative examination and biopsy of any suspicious nonsentinel nodes are critical.

Metastasis from colorectal carcinoma occurs by either lymphatic or hematogenous spread. The pattern of metastasis in patients with colorectal malignancy has been characterized by numerous clinical, surgical, and autopsy studies. The most common sites of colorectal metastasis are the liver and lung. Only two previous instances of colorectal carcinoma metastatic to skeletal muscle have been reported. The present report documents the third case of colorectal cancer metastatic to skeletal muscle and reviews the typical pattern of distant metastasis from colorectal carcinoma.

A 44-year-old white male with pseudomyxoma peritonei and intractable malignant ascites is described. This patient underwent three peritoneovenous shunt procedures utilizing first the LeVeen shunt and finally the Denver shunt in a surgical attempt at palliative decompression of his malignant ascites. The peritoneovenous shunts resulted in massive tumor embolization to the pulmonary vasculature, clinically asymptomatic disseminated intravascular coagulation, and partial thrombosis of the superior vena cava. The pulmonary tumor embolization was manifest clinically as moderate pulmonary hypertension with increased pulmonary vascular resistance and persistent hypoxia.

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