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)

To evaluate the impact of non-small cell lung cancer (NSCLC) histological subtypes on survival, we performed a retrospective multivariate analysis of survival in 361 patients with a NSCLC diagnosed in 1987 and 1988 at the University Hospital in Strasbourg, France. There were 262 (73%) squamous cell carcinomas (SQ), 59 (16%) adenocarcinomas other than bronchioloalveolar carcinoma (ADOBAC), 24 (7%) bronchioloalveolar carcinoma (BAC) and 16 (4%) large cell carcinomas (LC). The proportion of metastatic disease was significantly higher in the ADOBAC group than in the SQ group (30% vs. 15%, P < 0.001). In operated patients, only extent of disease and age were independent prognostic factors. In patients with unresectable NSCLC, extent of disease had also the heaviest impact on survival. However, in these unresected patients, ADOBAC had a pejorative impact on survival, in contrast to BAC which was of better prognosis. If these results are confirmed by prospective studies, this will support stratification according to histological subtypes in clinical trials involving inoperable NSCLC patients.
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PMID:Prognostic value of histology in patients with non-small cell lung cancer. 919 32

The differential diagnosis of mesothelioma, primary adenocarcinomas and pleural metastases frequently causes problems. We have used the comparative genomic hybridization (CGH) technique on 34 malignant mesotheliomas and 30 primary lung carcinomas (adenocarcinoma, including bronchoalveolar carcinoma and large-cell anaplastic carcinoma) to compare their copy number changes and to evaluate the use of CGH to distinguish between these two types of tumour. In mesothelioma, gains of genetic material occurred as frequently as losses, whereas gains predominated over losses in carcinoma. In mesothelioma, the most frequent changes were losses in 4q, 6q and 14q and gains in 15q and 7p, whereas gains in 8q, 1q, 7p, 5p and 6p were the most common changes in carcinoma. Amplification of KRAS2 was detected in two adenocarcinomas by Southern blot analysis. CGH showed gains in 12p in the same tumours. Statistically significant differences between the two types of tumour were detected in chromosomes X, 1, 2p, 4, 8q, 10q, 12p, 14q, 15q and 18q. When comparing the frequency of gains and losses between mesothelioma and lung carcinoma using discriminant analysis, the sensitivity of CGH to differentiate mesotheliomas from lung carcinomas was 81% and the specificity 77%. The differences in DNA copy number changes between the two types of tumour suggest that they are genetically different tumour entities. Although CGH cannot be used as a definitive discriminatory method, we were able to distinguish between mesothelioma and lung carcinoma in a large proportion of the abnormal cases.
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PMID:Comparison of DNA copy number changes in malignant mesothelioma, adenocarcinoma and large-cell anaplastic carcinoma of the lung. 946 Sep 97

Peripheral pulmonary adenocarcinomas (PPAs) often demonstrate a bronchioloalveolar component, with or without glandular differentiation. PPAs can be nondescript, mucinous, or show features of Type II pneumocytes. Particularly, mucinous lung carcinomas can resemble gastrointestinal metastases. Previous reports suggested that patterns of keratins 7 (K7) and 20 (K20) differ in pulmonary tumors versus enteric metastases. These studies, however, often failed to specify the precise morphotypes of PPA. Thus, we undertook this evaluation of PPAs with different histologic images. Thirty-nine cases were retrieved from institutional files; all were confirmed as primary tumors by clinicopathologic and radiographic review. Cases were classified as Type I (mucinous) bronchioloalveolar carcinoma (BAC1); Type II (nonmucinous) bronchioloalveolar carcinoma (BAC2); conventional PPA with BAC1-like areas (PPA1); or conventional PPA with BAC2-like foci (PPA2). Immunostains were performed for K7, K20, carcinoembryonic antigen, CA19-9, tumor-associated glycoprotein-72, surfactant apoprotein-A, and the c-erbB-2 peptide. BAC1 and PPA1 failed to express surfactant apoprotein-A, and BAC2 also consistently lacked K20, whereas 28% of PPA2 lesions were labeled for K20. All of the other determinants, however, were seen in variable proportions in each subgroup of PPA. Primary BAC1 and PPA1 resembled enteric adenocarcinomas immunophenotypically; on the other hand, BAC2 demonstrated a pattern of protein expression similar to that of Type II pneumocytes. PPA2s are a diverse group of neoplasms, and a subset of PPA2 does show K20 reactivity, as would be expected in metastatic enteric carcinomas. Thus, immunohistochemical data on PPAs must be interpreted carefully and only in clinicopathologic context. With respect specifically to primary pulmonary mucinous tumors, there still seems to be no uniformly reliably marker that will always allow the exclusion of metastatic enteric tumors.
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PMID:Peripheral pulmonary adenocarcinomas with bronchioloalveolar features: immunophenotypes correlate with histologic patterns. 964 95

A 67-year-old female was admitted to our hospital because of pneumonia-like shadow on chest roentgenogram with persistent cough and sputum of 4 months duration. Diagnosis as lung cancer was delayed more than 4 months. She showed fever and inflammatory reactions. Antibiotics were effective to inflammatory reactions, but not effective to pneumonia-like shadow. Transbronchial lung biopsy was useful for the diagnosis. Right lower lobectomy was performed. In this case, tumor extents were limited within one lobe. Tumor cells did not invade blood and lymphatic vessels, and extrathoracic metastases were not detected. The prognosis of bronchiolo-alveolar cell carcinoma was determined by intra-pulmonary tumor extent. Based on a comparison with the outcome of unresected cases, bronchiolo-alveolar cell carcinoma limited within one lobe should be surgically resected.
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PMID:[A resected case of a bronchiolo-alveolar cell carcinoma of the lung accompanying pneumonia-like shadow on chest roentgenogram]. 975 49

Bronchioloalveolar carcinoma (BAC) has features distinct from those of conventional pulmonary adenocarcinoma (CPA) in terms of its characteristic growth pattern along alveolar walls and intrapulmonary metastasis via the aerogenous route. We speculated, therefore, that BAC might differ from CPA in its capacity for cell-to-cell or cell-to-basement membrane adhesion. E-cadherin (E-CD), one of the most important elements of epithelial integrity molecules, is related to tumor metastasis in various organs. Differences of E-CD and associated catenin expressions between BAC and CPA, however, have not been elucidated. We examined the expression of E-CD and alpha-, beta- and gamma-catenin immunohistochemically in 18 BACs (9 mucinous, 7 nonmucinous, and 2 sclerosing) in comparison with CPAs, all of which were well-differentiated adenocarcinomas. In addition, we analyzed the correlation between the expression of these cell adhesion molecules and the presence of intrapulmonary metastasis, histologic subtypes, and cell proliferation activity. Clinicopathologically, we observed intrapulmonary metastases in 4 of the 18 BACs and none of the CPAs. In 14 of the 18 BACs, more than one-half of the tumor cells expressed E-CD, and the E-CD expression level was significantly higher in the BACs than in the CPAs. In addition, all of the BACs exhibited preserved membranous staining for E-CD, whereas in 5 of the 14 CPAs, the expression pattern was disorganized cytoplasmic staining; the difference was statistically significant. The Ki-67 labeling index was significantly lower in the BACs than in the CPAs. There were no appreciable differences in E-CD expression among the BAC subtypes. E-CD expression was significantly lower in the BACs with intrapulmonary metastasis than in the BACs without intrapulmonary metastasis. These findings indicated to us that BAC was distinct from CPA in terms of proliferation activity and expression of certain adhesion molecules and that E-CD downregulation was associated with a tendency toward intrapulmonary metastasis.
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PMID:Expression of E-cadherin, alpha-catenin, beta-catenin, and gamma-catenin in bronchioloalveolar carcinoma and conventional pulmonary adenocarcinoma: an immunohistochemical study. 983 Nov 99

An unusual case of metastatic bronchioloalveolar carcinoma of the lung presented as a pituitary tumour in a young adult Chinese female, who subsequently died after having undergone trans-sphenoidal resection. Metastatic cancers of the pituitary are uncommon even in necropsy series and rarely give rise to clinical symptoms. This case draws attention to the fact that, although uncommon, pituitary metastases have been noted with increasing frequency and their distinction from primary pituitary tumours is often difficult. A metastatic pituitary tumour may be the initial presentation of an unknown primary malignancy, wherein the metastatic deposits may also be limited to the pituitary gland. Clinicians and pathologists alike should consider a metastatic lesion in the differential diagnosis of a non-functioning pituitary tumour.
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PMID:Bronchioloalveolar carcinoma with metastasis to the pituitary gland: a case report. 1007 Mar 37

Radiographically, there have been new advances in spiral computed tomography (CT) scanning are currently being studied as a screening tools. As a result, many cases of small-sized lung cancer have been discovered. Some are noninvasive or minimally invasive bronchioloalveolar carcinoma, which is characterized by a the unique sign of ground-glass opacity (GGO) on high-resolution CT (HRCT) scanning. In such cases, lymph node metastases are extremely rare. However, there is currently no definitive surgical modality for such lesions. To clarify the indications of limited resection (segmentectomy or wedge resection), preoperative tumor diameter, location, and, GGO area on HRCT were estimated in patients with clinical T1N0 disease. In patients whose tumor included > or = 50% GGO area and was 15 mm or less in diameter, or patients with pure GGO regardless of tumor size, wedge resection without lymph node dissection should be considered as an acceptable treatment. Video-assisted thoracic surgery is a useful approach for selected patients. On the other hand, in patients with tumors < 50% GGO area in the range of 10-15 mm in diameter, segmentectomy with systematic lymph node dissection or diligent lymph node sampling should be considered.
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PMID:[Indications for intentionally limited resection for non-small-cell lung cancer]. 1062 42

The combination of carboplatin and paclitaxel is an active regimen in non-small cell lung cancer (NSCLC). Historically, patients with stage III disease have manifested higher response rates than patients with metastatic disease, and patients achieving a pathologic complete response to induction chemoradiation therapy prior to surgery have shown better long-term outcome. Based upon our pilot data using high-dose carboplatin and paclitaxel, we designed a phase II trial in patients with marginally resectable stage IIIA NSCLC. Ten patients, with bulky nodal stage IIIA disease, initially received etoposide (2 g/m2) and granulocyte colony-stimulating factor (G-CSF) to mobilize peripheral blood stem cells (PBSC). Two cycles, 28 days apart, of carboplatin (AUC 12 in seven patients; AUC 16 in three patients) and paclitaxel (250 mg/m2) were administered with filgrastim (5 microg/kg) and PBSC support. After re-evaluation, patients underwent a thoracotomy followed by radiotherapy (44-60 Gy) if deemed resectable, or radiotherapy alone (60 Gy) if not resectable. The median age was 58.5 years (48-66) with a median ECOG performance status of 0 (0-1). Histology was adenocarcinoma in seven patients; the remainder had either squamous cell, large cell or bronchoalveolar carcinoma. Based on CT radiography, the overall response rate was 40%. Eight of ten patients underwent resection with four right pneumonectomies, three right upper lobectomies and one wedge resection of the right upper lobe. Six patients had a complete resection. Of eight patients resected, four were downstaged by induction therapy, three remained unchanged and one was found to have more extensive disease. The remaining two patients developed metastatic disease while receiving chemotherapy. The median dose of postoperative radiotherapy was 54 Gy (35-66 Gy). Actual median follow-up for all patients was 89 weeks (25 to 136+). The actuarial median overall survival was 124 weeks (25 to 136+) and time to progression was 57 weeks (17 to 136+). The median dose of carboplatin delivered expressed as mg/m2 was 779 (615-1540). Neutropenic fever occurred in two patients during the initial mobilization cycle only. The median number of units of RBC and/or platelets transfused was 0 (0-2 and 0-6, respectively). There were no significant non-hematologic toxicities. High-dose induction chemotherapy with stem cell rescue is feasible and safe with an acceptable response rate. Thoracotomy, including pneumonectomy and postoperative radiotherapy, were well tolerated by patients after undergoing high-dose induction chemotherapy with no apparent increase in peri-operative morbidity. The pathologic complete response rate was low--one out of ten patients. These results indicate that dose escalation of induction chemotherapy does not improve response rates even in this highly selected patient population. Accordingly, the complexity and potential toxicity of high-dose chemotherapy, as delivered in this trial as neoadjuvant treatment of non-small cell lung cancer, is not warranted.
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PMID:Phase II trial of induction high-dose chemotherapy followed by surgical resection and radiation therapy for patients with marginally resectable non-small cell carcinoma of the lung. 1067 82

The purpose of this study was to document the accuracy of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) with sodium iodide detectors in characterizing indeterminate lung nodules or masses and in identifying additional extra-lesional findings. 50 consecutive patients without a confident diagnosis of malignancy on CT underwent (18)FDG PET with and without attenuation correction. The diagnosis of malignancy was made using visual diagnostic criteria, and tumour-to-blood pool ratios were calculated. The final diagnosis was established by surgery, biopsy or long-term follow-up. Any additional findings made at PET were recorded and similarly verified. Using blinded visual diagnostic criteria for the differentiation of malignant from benign nodules, sodium iodide PET achieved a sensitivity of 91% (30 of 33 cases), a specificity of 88% (15 of 17 cases), a positive predictive value for malignancy of 94% (30 of 32 cases) and a negative predictive value of 83% (15 of 18 cases). False positives occurred with active tuberculosis and sarcoidosis. False negatives were a 3 cm bronchoalveolar carcinoma, a 1.3 cm sarcoma metastasis and a 1 cm carcinoma. Use of tumour-to-blood pool ratios did not improve performance. PET suggested the presence of nodal or distant metastases in 13 of 33 patients with a malignant pulmonary lesion. These PET findings were confirmed in 11 patients. These results indicate that sodium iodide PET is an accurate tool for the characterization of indeterminate pulmonary masses or nodules and simultaneously provides non-invasive staging information that can alter patient management in up to one-third of such patients. Performance of sodium iodide PET is comparable with reported results for PET scanners using other detector materials.
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PMID:Performance of sodium iodide based (18)F-fluorodeoxyglucose positron emission tomography in the characterization of indeterminate pulmonary nodules or masses. 1189 34

The utility of the preoperative staging of T1 lung cancer is controversial. This is due to a lower prevalence of N2 metastases in tumors of small diameter. To assess the prevalence of N2 metastases in such tumors and the sensitivity and specificity of computed tomography in mediastinal sadiation, the authors reviewed CT scans and pathology reports of 56 patients who had undergone surgical resection of a T1 lung cancer so distributed: Adenocarcinoma 20 cases, adenosquamous carcinoma 14, Bronchioloalveolar carcinoma 7, Undifferentiated 7, Carcinoid 5, Small cells carcinoma 3. Mediastinal nodal metastases were present in 11 patients: 6 of them were correctly detected by CT scan. Some differences in terms of N2 prevalence and sensitivity were noted when the T1 were divided in two groups of diameter greater or smaller of 2 cm. Important considerations derived after dividing our patients according to the histological type. The prevalence of N2 metastases was greater in adenocarcinoma than in adenosquamous carcinoma but CT sensitivity was lower in adenocarcinoma (40% Vs 100%). The authors conclude that the prevalence of N2 metastases is high enough to request a preoperative sadiation, but the utility of CT in this purpose is limited by a low sensitivity.
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PMID:[Role of CT assessment of mediastinal lymph nodes in the preoperative staging of T1 pulmonary carcinoma]. 1199 37


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