Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vascular invasion is not a prominent feature of cholangiocarcinoma (CCC), in contrast to hepatocellular carcinoma (HCC), which frequently shows extensive vascular tumor thrombi. We report an autopsy case of CCC with extensive portal tumor thrombi and portal hypertension. A 57-yr-old man presented with abdominal pain. Liver imaging revealed no tumors, but showed intrahepatic portal venous obstruction. HCC with portal tumor thrombi was suspected clinically. His clinical course was rapid; he died of hepatic failure 50 days after admission. At autopsy, the liver (2,700 g) was studded with diffuse whitish yellow granular areas with flecks of coalescent granules. Intrahepatic portal veins were diffusely occluded by tumor thrombi. Microscopically, the tumor was poorly differentiated adenocarcinoma with mucin; tumor cells were immunohistochemically positive for carcinoembryonic antigen, CA 19-9, DU-PAN-2, and biliary type cytokeratins, but negative for alpha-fetoprotein. Tumor cells were diffuse in the liver, and there were numerous tumor thrombi in the small portal veins. Hepatic veins and small arteries were occasionally occluded by tumor thrombi. There was ascites, splenomegaly and tumor thrombi in the gastric and esophageal veins, suggesting that portal hypertension had been present. This tumor seemed to have marked affinity to invade portal veins. It must be stressed that there are CCCs with extensive portal tumor thrombi and resultant portal hypertension.
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PMID:Extensive portal tumor thrombi with portal hypertension in an autopsy case of intrahepatic cholangiocarcinoma. 132 98

Thirty patients with adenomyomatosis of the gallbladder (AMG) were operated on between January 1983 and June 1990. They were made up 3.3% of patients who underwent cholecystectomy during the same interval. Of the 30 patients, ages ranged from 22 to 77 years (mean 52.3 years) and the male-to-female ratio was 8:7. Among the macroscopic types, 10 cases of generalized, 12 of segmental (S) and 8 of fundal (F) were noted, and the size of the affected portion in type S (0.8 +/- 0.2 cm, mean +/- SD) was significantly thinner than in other two types (p less than 0.05). Although the main symptom was abdominal pain, the majority of patients with type F had no complaints. Twenty patients (27%) were accompanied by gallstones including cholesterol stones in 60% of cases, and all six cases showing microbes in the bile had gallstones. Only six patients were diagnosed as AMG by preoperative imaging techniques. Other diagnoses comprised 15 of chronic cholecystitis and 3 of suspected gallbladder carcinoma. To identify the expanded Rokitansky-Aschoff sinuses, endoscopic retrograde cholangiography and/or ultrasonography of the abdomen were most useful. No preponderant coexistent lesion other than gallstones was noted. Levels of carcinoembryonic antigen in gallbladder bile in cases of AMG (2.5 +/- 1.5 ng/ml, mean +/- SD) were significantly lower than in gallbladder carcinoma (p less than 0.01). All the patients were easily treated with cholecystectomy, and 24 patients who have been followed up after surgery are doing well.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Adenomyomatosis of the gallbladder: a clinical survey of 30 surgically treated patients. 153 Mar 87

The distinction of metastatic ovarian carcinoma from a primary malignant ovarian neoplasm is crucial to its subsequent management. The most common metastatic carcinoma that mimics primary ovarian carcinoma is that of large bowel origin. The clinical and pathologic features of 25 cases of intestinal adenocarcinoma metastatic to the ovaries were analyzed. The patients ranged in age from 47 to 80 years (average age, 60 years). Most patients had abdominal pain and a pelvic mass. In 56%, the ovarian tumors and the large bowel carcinomas were discovered synchronously; 44% were metachronous. Seventy-five percent of the tumors were unilateral. Gross examination revealed that all the ovarian tumors were solid and cystic with smooth outer surfaces. Most of the tumors showed hemorrhage and necrosis. Histologic examination showed that 13 cases had a predominantly endometrioid-like pattern, four cases were predominantly mucinous, and the rest demonstrated a mixed pattern. The presence of a garland pattern with cribriform areas and "dirty" necrosis were the most distinctive features that were helpful in correctly differentiating these tumors from primary endometrioid ovarian carcinoma, with which they are often confused. Immunohistochemical stains for carcinoembryonic antigen showed strong intracytoplasmic positive staining in all the cases of intestinal adenocarcinoma metastatic to the ovaries, in contrast to primary ovarian endometrioid carcinoma, which stain negatively for carcinoembryonic antigen or show only intraluminal or apical positivity. As expected, intestinal adenocarcinoma metastatic to the ovaries had a very poor prognosis. Seventy percent of the patients died within a period of 1 to 19 months (average, 8.2 months). Its distinction from primary ovarian carcinoma is crucial because the management and prognosis of metastatic ovarian carcinoma of large intestine origin is different.
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PMID:Metastatic ovarian carcinoma of large intestinal origin simulating primary ovarian carcinoma. A clinicopathologic study of 25 cases. 159 93

Serous surface carcinoma (SSC) of the peritoneum is defined as a primary tumor histologically indistinguishable from serous carcinoma of the ovary, diffusely involving the peritoneal surface but sparing or only superficially invading the ovaries. In this study of 22 cases of SSC, it was found that the main clinical manifestations of SSC were abdominal pain and enlargement. In most cases, SSC evenly involved the entire mesothelial surface but rarely was predominant in or even limited to the pelvis. It frequently invaded the submesothelium, but deep invasion into abdominal and pelvic organs or local metastasis was rare, and distant metastasis was not seen at presentation. Microscopically, SSC was a high-grade tumor frequently showing high mitotic rate, psammomas bodies, and necrosis. The tumor was usually contiguous with hyperplastic mesothelium on either ovarian surface or other locations. Tumor cells in all cases except one showed cytoplasmic or surface neutral or acidic mucin or both. Tumor cells stained positive for keratin (100% of cases), epithelial membrane antigen (100%), Leu-M1 (45%), B72.3 (85%), vimentin (35%), and carcinoembryonic antigen (25%). Electron microscopic studies of six cases showed epithelial differentiation in each. Seven patients (32%) were alive with no clinical disease at 3 to 31 months, one patient (4%) was alive with extensive local disease at 24 months, 11 patients (50%) died almost exclusively of local recurrence at 1 to 70 months, and three patients (14%) died of operative complications. It is concluded that SSC arises from peritoneal mesothelium but has epithelial phenotype. It can be morphologically differentiated from other conditions with similar laparotomy findings, such as malignant mesothelioma, benign papillary mesothelioma, cystic mesothelioma, and benign or borderline peritoneal serous tumors. The prognosis of SSC is poor, and most patients die of uncontrollable local disease.
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PMID:Serous surface carcinoma of the peritoneum: a clinicopathologic study of 22 cases. 168 45

We report a case of extramammary Paget's disease in ovarian mature cystic teratoma. The patient was a 70-year-old Japanese woman who complained of lower abdominal pain. Examination showed elevation of carcinoembryonic antigen and CA 19-9. Ultrasonography and computer tomography revealed a cystic tumor of the left ovary. The gross appearance of the resected ovary was typical for mature cystic teratoma. Microscopic observation revealed a lesion of Paget's disease within the squamous epithelium. The tumor cells had intracytoplasmic mucin and positive immunoreactivity for carcinoembryonic antigen, epithelial membrane antigen, and cytokeratin; but they were negative for S-100 protein and vimentin. On multiple and serial sections, underlying adenocarcinomas were not found either in the ovary or other primary sites. From these pathological findings, we concluded that the disease was an intraepithelial adenocarcinoma, possibly derived from multipotential cells in squamous epithelium of ovarian mature cystic teratoma. This is the first reported case, to our knowledge, of extramammary Paget's disease arising in mature cystic teratoma of the ovary.
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PMID:Extramammary Paget's disease arising in mature cystic teratoma of the ovary. 171 75

A 57-year-old man with malaise, ascites, and abdominal pain was found to have a peritoneum studied with numerous, small nodular tumor masses. Light microscopy revealed an anaplastic malignant tumor of uncertain differentiation. Mucin stains were negative. Electron microscopy revealed pleomorphic tumor cells with diffusely distributed cytoplasmic tonofilaments and well-developed true desmosomes. No long, thin, branching microvilli were present, yet tumor cells were strongly positive for both callus keratin (polyclonal) and monoclonal cytokeratin (AE1/3) in a diffuse cytoplasmic distribution (a pattern corresponding to the diffuse cytoplasmic tonofilaments). Tumor cells were negative for Leu-M1 and carcinoembryonic antigen. The findings were most consistent with malignant mesothelioma, and additional questioning, after tissue diagnosis, revealed a work history of asbestos exposure.
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PMID:Malignant mesothelioma of peritoneum. 172 49

In this study, we determined the sensitivity and specificity of the new serum assay CA19-9 in detecting adenocarcinoma of the pancreas and compared the results with those of the serum assay to carcinoembryonic antigen (CEA). Thirty-seven patients with biopsy-proven adenocarcinoma (14 patients with resectable disease and 23 patients with unresectable disease) were compared with 157 controls (48 patients with benign pancreatic disease, 34 patients with nonpancreatic sources of abdominal pain, 58 patients with benign jaundice, 7 patients with nonpancreatic malabsorption, and 10 patients with renal failure on dialysis). It was determined that a cutoff of 75 U/ml enhanced the diagnostic efficiency (sensitivity + specificity) of CA19-9 over the manufacturer's recommended cutoff of 37 U/ml. The sensitivity of CA19-9 (greater than 75 U/ml) in detecting cancer was greater than that of CEA (greater than 5 ng/ml) (86.5% vs. 48.4%) (p less than 0.01, McNemar test). The sensitivity of CA19-9 was 78.6% in resectable and 91.3% in unresectable disease. The specificity of CA19-9 was also greater than CEA (92.5% vs. 87.3%), although this difference was not statistically significant. The higher the CA19-9 or CEA level, the greater the specificity of either assay; at CA19-9 levels greater than 600 U/ml and CEA levels greater than 20 ng/ml the specificity is approximately 99%. The combination of an elevated CA19-9 level (greater than 75 U/ml) and an elevated CEA level (greater than 5 ng/ml) also enhanced specificity to 99%. It is concluded that CA19-9 used alone is superior to CEA used alone in detecting cancer of the pancreas and that the combination of mild elevations of both assays improves their specificity. Although the CA19-9 marker can be elevated with other intraabdominal adenocarcinomas (e.g., gastric, biliary, or colonic), CA19-9, together with CEA, will be useful to the clinician in differentiating benign from malignant pancreatic processes and in alerting the clinician to the possible presence of an intraabdominal neoplasm in the proper clinical setting.
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PMID:Comparison of the sensitivity and specificity of the CA19-9 and carcinoembryonic antigen assays in detecting cancer of the pancreas. 241 28

A case of adenocarcinoma arising in Meckel's diverticulum in a 55 year old man is reported, and a brief review of the literature is presented. The patient developed low abdominal pain and showed elevation of serum carcinoembryonic antigen (CEA) level. The tumour was located in the apical portion of the diverticulum and extended into the mesenterium. Histologically, the tumour was a well-differentiated adenocarcinoma arising in the Meckel's diverticulum. Immunohistochemical study showed that malignant cells were positive for CEA. The noteworthy feature of this case is the pre-operative elevation of serum CEA level and the immunohistochemical demonstration of CEA in the cancer cells.
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PMID:Adenocarcinoma in Meckel's diverticulum: case report and literature review. 268 22

We reviewed 18 cases of mucinous adenocarcinoma of the endometrium seen at this hospital during 1969-1985. Tumor histology was studied in curettage and hysterectomy material; the Hospital Tumor Registry provided follow-up data. All women were postmenopausal, 47-89 years of age, and presented with vaginal bleeding; few had abdominal pain; four of the 18 were nulliparous. Eight patients had been receiving estrogen therapy. The disease was in Stage IA in 15 patients and Stage IB in three patients. All patients had total hysterectomy and salpingo-oophorectomy; six had preoperative radium implants, and four had postoperative radium plus progesterone treatment. Histologically the tumor was grade 1 in 13 (72%) women, only five being grade 2 or 3 (28%). All tumors were positive for mucicarmine and carcinoembryonic antigen (CEA). Only two cases showed adjacent benign endometrial mucinous metaplasia. Myometrial invasion varied from 5-60% and was absent in three cases. The degree of invasion did not appear to affect the rate of recurrence. The tumor recurred 54 weeks after treatment in one of 13 patients with grade 1, in none in grade 2 and in two of two patients with grade 3 within 10 months of diagnosis. In summary, mucinous endometrial carcinoma is a rare tumor (1% of endometrial carcinomas in our hospital) of postmenopausal women; it tends to be well differentiated and has a relatively good prognosis.
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PMID:Mucinous adenocarcinoma of the endometrium: a clinico-pathological review of 18 cases. 282 54

The clinical and pathological features of eight ovarian yolk sac tumors with glandular patterns resembling those of endometrioid adenocarcinoma are described. The patients ranged in age from 11 to 34 years (mean, 22 years) and presented with abdominal pain or swelling. The serum alpha-fetoprotein (AFP) level was elevated at the time of presentation or later in all seven patients in whom it was measured. Seven tumors were unilateral, one was bilateral, and three had spread beyond the ovary. There was a contralateral streak gonad in two cases. The tumors were 6-35 cm in diameter; seven were solid and cystic, and one was a unilocular cyst with a small solid nodule in the wall. Microscopic examination revealed a prominent, and in two cases, pure endometrioid-like glandular pattern that often simulated that of an early secretory endometrium. Reticular, polyvesicular-vitelline, and hepatoid patterns of yolk sac tumor were also present in five tumors; minor teratomatous foci (squamous epithelium and cartilage) were present in one. Immunohistochemical staining revealed AFP, alpha-1-anti-trypsin (AAT), and carcinoembryonic antigen within the glandular epithelium; AFP and AAT were also present in areas showing the other patterns. Three patients died of recurrent or metastatic tumor 19-60 months postoperatively; in the remaining cases, there was a tumor-free follow-up of short duration. The endometrioid-like pattern reflects an unusual form of endodermal differentiation within yolk sac tumors that should be distinguished from endometrioid carcinoma.
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PMID:Endometrioid-like variant of ovarian yolk sac tumor. A clinicopathological analysis of eight cases. 366 22


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