Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pulmonary blastoma (PB) is an uncommon primary lung malignancy. This neoplasm was first described by Barrett and Barnard in 1945. The tumor is composed of immature epithelial and mesenchymal tissues which may recapitulate early embryological lung development. Under the microscope, the globular component resembles immature bronchus and connective tissue as seen in embryonic lung. More than one hundred cases have been reported in the literature. PB is more frequent in older people and in males and tends to affect blacks at younger ages. Symptomatology varies from asymptomatic to symptoms of a non-specific pulmonary disease. Cough, hemoptysis, dyspnea, chest pain, respiratory distress, fever, anorexia and weight loss are the most common presenting features. The most common roentgenologic pattern is a well-demarcated peripheral lesion, encapsulated by compression or atelectatic lung tissue, although in some cases there is a tendency to lobulation and cavitation. The size of the mass varies from a small peripheral nodule to a mass occupying the entire lobe or hemithorax. The treatment of choice has been surgical excision, radiation and, in selected cases, a combination of chemotherapy with radiation. The prognosis of this malignancy is poor; overall five-year survival is approximately 16 percent. No correlation has been established between histopathologic criteria and survival. The factors that indicate poor prognosis are tumor recurrence, metastasis at initial presentation, tumor size over 5 cm and lymph node metastasis. Liver, central nervous system and bones are the most frequent location of distant metastases. A rare case is presented of a pulmonary blastoma with an upper lip metastasis occurring in a paraplegic male. Diagnosis was confirmed by autopsy findings.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulmonary blastoma presenting as a solitary lip metastasis: case report and review of the literature. 755 26

Sex chromosome status, ploidy, and proliferation rate were evaluated in archival material of 73 Barrett's esophagus patients (48 males and 25 females). Diagnosis in esophageal mucosa samples ranged from intestinal metaplasia with no dysplasia to invasive esophageal adenocarcinoma; also, four lymph node metastases were studied. Chromosomal and ploidy aberrations were determined by in situ hybridization with repetitive DNA probes specific for chromosomes Y, X, and 1. Proliferation index (Ki-67 protein expression) was assessed by immunohistochemistry. Proliferation rate was elevated in all stages of dysplasia and in the adenocarcinomas. Aneuploidy (hyperdiploidy) and loss of the Y chromosome correlated with the advancing stages toward neoplasia (P < 0.001) and reached high prevalences (70-100%) in high-grade dysplasia and adenocarcinoma. Abnormalities of the X chromosome were not seen. These data suggest that in Barrett's esophagus, genetic perturbations may be generated in relation to a high proliferation rate.
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PMID:Accumulation of genetic abnormalities during neoplastic progression in Barrett's esophagus. 772 67

Adenocarcinomas of the gastro-esophageal junction (GEJ) and those arising in Barrett's esophagus (BE) are increasing in the West and have a poorer prognosis than distal stomach cancers. This has been attributed mainly to anatomical location, but biological factors such as growth-regulatory molecules have been implicated. We have investigated the expression of one of these factors, TGF alpha, and its precursor prepro TGF alpha in 82 adenocarcinomas of GEJ (32 resected specimens and 50 biopsies) as well as in 48 BE biopsies without tumor, by immunohistochemistry and by Western-blot analysis. TGF alpha staining was shown in the cytoplasm and membrane of cells. Western blot confirmed that most immunoreactivity was against mature TGF alpha (5.6 kDa), but higher-molecular-weight bands were also identifiable, suggesting some reactivity with prepro protein. TGF alpha expression was more extense and intense in intestinal metaplasia and cancer. The tubular histological type of adenocarcinoma was more often positive than the signet-ring type. Primary tumors with lymph-node metastases also had increased TGF alpha expression. We conclude, therefore, that there is differential regulation of the expression of TGF alpha and its precursors during esophageal tumorigenesis.
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PMID:Association of transforming growth factor alpha (TGFA) and its precursors with malignant change in Barrett's epithelium: biological and clinical variables. 781 48

Reduced expression of E-cadherin, a Ca(2+)-dependent cell adhesion molecule present in normal epithelium, has been associated with invasive and metastatic cancer. Immunohistochemistry was used in examining the relationship between E-cadherin expression and stage in 59 oesophageal and 52 lung cancers. Advanced-stage oesophageal cancers were associated with both reduced and disorganised E-cadherin expression (P < 0.01). Advanced-stage lung adenocarcinomas generally exhibited disorganised or reduced E-cadherin expression, but no statistical association between expression pattern and stage was found (P > 0.05). No differences in stage were seen between tumours with reduced or disorganised E-cadherin expression. Altered E-cadherin expression was detected in dysplastic, non-invasive Barrett's oesophagus. Importantly, high-level E-cadherin expression was detected in 17 of 17 lymph nodes containing metastatic cancer. E-cadherin mRNA expression was decreased in tumours with reduced protein expression, but not in tumours with disorganised expression. Expression of alpha-catenin mRNA, an E-cadherin-associated protein, was detected in tissues with altered E-cadherin protein expression. Reduced and disorganised expression of E-cadherin appear to be related to transcriptional and post-translational events respectively, and both appear to represent altered cell adhesion associated with invasion and metastasis in thoracic neoplasms.
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PMID:E-cadherin expression in primary and metastatic thoracic neoplasms and in Barrett's oesophagus. 781 34

Numerous reviews of adenocarcinoma arising in Barrett's esophagus have been reported, but detailed pathologic findings or survival analysis have rarely been provided. This retrospective study analyzed 67 patients (mean age, 64 years; male-to-female ratio, 10:1) with an adenocarcinoma arising in Barrett's esophagus treated by surgical resection. Prevalence of smokers was 63%, alcohol users, 45%, and patients with hiatal hernia, 73%. Five patients had another synchronous cancer, and seven patients, previous esophageal surgery. Forty percent of the tumors were well differentiated, 31% moderately differentiated, 15% poorly differentiated, 7% mucinous, and 6% composed of signet-ring cells. Depth of invasion in the esophageal wall was limited to mucosa in 13% of cases and submucosa in 18%. Invasive adenocarcinomas extended to the muscular layer in 12% of cases, to adventitia in 33%, and to periesophageal tissue in 24%. Vascular and perineural neoplastic invasion was present in 67 and 38% of cases. Regional lymph node involvement and distant metastases were found in 51 and 9% of cases. Overall, 1-, 2-, and 5-year survival rates were 63, 41, and 32%, respectively. Five-year survival rate was significantly better for patients with superficial cancer limited to mucosa or submucosa (82 vs. 12%) or without regional lymph node involvement (59 vs. 10%). Tumor differentiation, vascular and perineural invasion, extranodal spread, distant metastases, and resection margins status also had a significant prognostic value on univariate analysis. In a multivariate Cox regression analysis for overall survival, depth of invasion in the esophageal wall and regional lymph node involvement were independent prognostic factors. Careful pathologic staging is of value in determining the prognosis of patients with adenocarcinoma arising in Barrett's esophagus.
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PMID:Surgical pathology of adenocarcinoma arising in Barrett's esophagus. Analysis of 67 cases. 783 78

To assess potential clinical applications for molecular genetic markers associated with human esophageal tumorigenesis, ten patients with primary esophageal adenocarcinomas were studied prospectively to evaluate expression of the p53 and H-ras genes. Total RNA was extracted from tumor, Barrett's epithelium, and histologically normal esophageal mucosa obtained at surgical resection, and gene expression investigated by Northern blot analysis. p53 was overexpressed, relative to normal tissue from the same patient, in seven tumor and six Barrett's specimens, whereas high levels of H-ras were found in only four tumor and one Barrett's specimen. Clinical correlative data were obtained for all patients, with a median follow-up of 14 months. Advanced pathologic stage was associated with poor survival. No association was found between gene expression and outcome. Three patients with low p53 and H-ras levels developed metastatic disease 7 to 12 months following resection. We conclude that both p53 and ras are implicated in the progression of Barrett's epithelium to invasive cancer, and that further clinical correlative studies are warranted to evaluate potential clinical application for such molecular markers.
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PMID:p53 and ras gene expression in human esophageal cancer and Barrett's epithelium: a prospective study. 807 80

The role of surgery in patients with Barrett's esophagus and high-grade dysplasia is controversial. The aims of this study were to determine the prevalence of unsuspected early cancer and to evaluate surgical outcome in a cohort of patients with high-grade dysplasia. Records of all 16 patients who underwent esophagectomy for high-grade dysplasia from 1986 to 1991 were reviewed. All had preoperative endoscopy with no gross evidence of carcinoma, and none had a preoperative diagnosis of intramucosal or invasive carcinoma. Intramucosal carcinoma was found in six (38%) resection specimens. There were no cases of invasive carcinoma or lymph node metastases. One patient (6%) died 3 months postoperatively. The remaining patients are alive without evidence of recurrent cancer (range of follow-up, 2-68 months). Early postoperative complications occurred in seven patients (44%). Late complications occurred in 11 patients (73%). Anastomotic strictures accounted for seven of the 11 (64%) late complications. Complications were successfully managed conservatively in all but two patients. One required laryngectomy for chronic aspiration and another required a gastrojejunostomy for gastric outlet obstruction. Intramucosal carcinoma that had been unsuspected is frequently found in patients with Barrett's esophagus and high-grade dysplasia. Mortality associated with esophagectomy is low, and perioperative complications can usually be managed conservatively. Esophageal resection is indicated in appropriately selected patients with Barrett's esophagus and high-grade dysplasia.
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PMID:Surgical management of high-grade dysplasia in Barrett's esophagus. 823 24

Oesophageal cancer is one of the most lethal carcinomas, with 5-year survival rates of less than 5%. This is due to a combination of factors including late presentation, associated cardiac and respiratory disease, and the technical difficulties of resectional surgery. The outcome for patients with oesophageal cancer has changed little in recent years, perpetuating a pervading attitude of pessimism in the surgical community. The epidemiology of oesophageal cancer is changing with the increasing incidence of adenocarcinoma. Most of these tumours arise in the setting of Barrett's oesophagus and chronic gastro-oesophageal reflux disease. Survival following surgery for oesophageal cancer is determined by several independent factors, most notably the pathological stage of the disease and the patients physiological status. However, in patients with limited disease, in particular patients with less than five lymph node metastases, the extent of the nodal dissection positively impacts survival. This article reviews the changing epidemiology of oesophageal cancer, focusing on the need for early diagnosis and the selection of patients for surgery. It places emphasis on the importance of integrating surgical therapy in a multidisciplinary team approach to the management of such patients.
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PMID:Carcinoma of the oesophagus: the time for a multidiciplinary approach? 906 63

Recent changes in the epidemiology of esophageal carcinoma now recognize adenocarcinoma as the predominant histologic cell type. Barrett's esophagus and dysplasia in this epithelium identify patients who are at risk of developing invasive adenocarcinoma. This neoplasm is not a single entity with a consistently poor prognosis, and disease stage is important for determining therapy. These findings offer the potential for further development of therapeutic regimens. Endoscopic esophageal ultrasound is an accurate and reproducible staging tool. It allows the physician to determine clinical stage and modify treatment. T2 N0 M0 or lesser stage tumors have acceptable surgical cure rates, and patients should undergo immediate resection. Patients with more advanced T3 or N1 tumors have a potential for cure but do poorly with surgery alone. These patients should be considered for multimodality therapy. Palliative therapy should be given to patients with hematogenous metastatic disease. Treatment stratification by stage proves that esophageal carcinoma is not a uniformly fatal disease without hope for cure.
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PMID:Advances in the treatment of esophageal carcinoma. 943 4

Between 1980 and 1997, 1194 patients with a malignant tumor of the lower esophagus have been observed and treated in our Institution. There were 555 patients (46.5%) presenting with squamous-cell carcinoma, 101 (8.5%), with Barrett's adenocarcinoma and 538 (45%) with cardia adenocarcinoma. Most patient underwent a transthoracic esophagectomy with esophagogastroplasty; transhiatal approach was mainly reserved to high-risk patients. Over the past two years sixty-three patients (42 with adenocarcinoma and 21 with squamous cell carcinoma) underwent enlarged mediastinal lymphadenectomy. Three patients (4.7%) died post-operatively: one sepsis, in pulmonary embolism and one myocardial infarction. Four patients (6.3%) developed pulmonary complications: no patient had recuriential palsy. Pathologic exam revealed 1342 nodes (807 thoracic and 827 abdominal). Twenty patients (31.7%) had mediastinal nodal metastases, of which 8 in the upper mediastinum. Median follow-up was 19 months (2-36 months). Seven of the sixteen patients with recurrent disease (12 systemic, 3 mediastinal and 1 anastomotic) died. The number of metastatic nodes increased with serial section and even more with immunohistochemical staining technique (from 11.7% to 13% to 15.5%, respectively). Two patients were up-staged from M0 to M1 because of peripancreatic nodal micrometastases. We conclude that enlarged mediastinal lymphadenectomy allowed to detect upper mediastinal lymph node metastases in 12.8% of patients without increasing post-operative complication rate. A longer follow-up is required to evaluate the impact on long term survival.
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PMID:[The value of extensive lymphadenectomy in cancer of the lower esophagus and cardia]. 977 74


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