Gemcitabine is a deoxycytidine analog with broad antitumor activity. Its main toxicities include myelosuppression, flu-like symptoms, bronchospasms and mild skin rash. We report three cases, in which the patients developed time- and dose-limiting erysipeloid skin reactions confined to areas of impaired lymphatic drainage after application of gemcitabine. Three patients with metastatic tumors (breast cancer, endometrial cancer and non-small cell lung cancer) received weekly infusions of gemcitabine (1000 mg/m2). All patients suffered from lymphedema of different origin and developed an erysipeloid erythema 40-48 h after chemotherapy within their preexisting lymphedema. Genuine erysipela was ruled out by laboratory tests and clinical observation. The skin reaction was repeatedly observed and faded after 14 days without specific treatment. Although the pathogenesis of the observed reaction is unclear, it is suspected that the skin symptoms were caused by gemcitabine or its metabolites. Gemcitabine is usually metabolized fast and excreted renally. In areas with impaired lymphatic drainage pharmakocinetics might be altered: inactivation happens slower and the drug might accumulate in the s.c. and cutaneous tissue, thus increasing local toxicity. Clinical judgement and biochemical parameters can help to tell apart genuine erysipela and the erysipeloid reaction.

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Single-agent bendamustine is an active treatment in patients with MBC independent of the previous treatment. The low toxicity profile favors its use as a single agent.

Although prostate cancer is the most common cancer in male patients, it is only the second leading cause of cancer death in men because of the often slow course of the disease (1). Some environmental and genetic promoting factors have been described, including older age, increased duration of androgen exposition, black race and a high-fat low-ber diet (2). Prostate speci c antigen (PSA) levels and histopathological grading are currently used as prognostic factors, with a proven correlation between PSA level and tumor volume and stage (3). Tumor size, ploidy and amount of angiogenesis can also be prognostically important (4).A rare case is reported of a patient with locally advanced hormone refractory metastatic adenocarcinoma of the prostate who had normal PSA but excessive serum levels of CEA and CA 19-9 along with unusual sites of metastases and who responded very well to chemotherapy with mitomycin C.Case report. The patient, a 58-year-old, had a short history of pelvic pain when diagnosed with carcinoma of the prostate by ultrasound-guided biopsy in spring of 1998. Histology revealed an undifferentiated adenocarcinoma of the prostate (Gleason score 9, clinical stage T3b). Additional immunostaining of the biopsy was positive for PSA and prostatic acid phosphatase in several tumor cells. CEA and CA 19-9 immunostains, which were done retrospectively, remained negative. Serum PSA was not elevated at the time of diagnosis. (value: 0.29 mg l).Hormone ablative therapy with utamide and an LHRH-analogue was started. After 3 months, CT and MRI scans were performed for restaging revealing massive progression of the disease with in ltration of the bladder, right seminal vesicle and rectum. In addition, extensive liver metastases with the beginning of compression of the portal vein were diagnosed ( Fig. 1 -left). A bone scan revealed metastatic lesions in the vertebral bone and hips. The patient was referred to our department for radiotherapy, complaining of progressive bowel obstruction symptoms, weight loss and pelvic pain, as well as abdominal tension and pain in the right upper quadrant.Baseline laboratory tests again revealed a normal PSA level (2.1 m g l ( -normal range: B 4 mg l)) but surprisingly elevated levels of CA 19.9 (80 kU l; ( -normal range B37 kU l)) and CEA (204 m g l; ( -normal range B5 m g l)). As the patient presented with rectal obstruction and showed elevated tumor markers for colorectal cancer with hepatic metastases, we suspected a second malignancy and thus decided to re-evaluate the diagnosis.A rectosigmoidoscopy and endoscopy of the colon descendens was performed, showing an intact rectal mucosa compressed by external tumor. An abdominal CT scan gave no evidence of another primary site (e.g. pancreatic cancer). A liver biopsy was arranged and revealed in ltration of a solid carcinoma (e.g. undifferentiated adenocarcinoma), expressing pancytokeratin, and prostate acid phosphatase.PSA was negative in this specimen. Because of an identical histology of the prostatic and liver tumor cells and the e...

BackgroundRare sites of metastases, atypical symptoms and paraneoplastic syndromes are often neglected or misinterpreted, especially when they represent early symptoms of an underlying malignant disease. Hence, an interdisciplinary approach to these patients is essential to avoid tumor progression and metastatic spread in order to provide curative treatment options to the patients. We here report the case of a young woman presenting with visual loss which led to diagnosis of a thymic carcinoma.Case presentationA 28-year old white woman presented with subacute loss of vision in the last trimester of her first pregnancy which was first interpreted as an exacerbation of a pre-existing dermatomyositis and treated with steroids. After failure of steroid therapy choroidal metastases from an undifferentiated thymic carcinoma were diagnosed. This also shed a new light on the dermatomyositis the patient had been suffering from for seven years possibly representing a paraneoplastic syndrome from the tumor. Despite aggressive chemotherapy, the patient died from progressive disease eight years after first onset of dermatomyositis and 14 months after initial diagnosis of the thymic carcinoma.ConclusionsChoroidal metastases from a thymic carcinoma have never been reported before but should be included into the differential diagnosis of choroidal masses.