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)

A case of malignant somatostatinoma is reported in a patient with long-standing dermatitis herpetiformis and coeliac disease. The patient had non-specific abdominal pain of several years duration and came to attention because of weight loss despite strict adherence to a gluten-free diet. Plasma somatostatin levels were raised, and laparotomy showed a pancreatic tumour with metastases, which on histology, electron microscopy and immunohistochemistry proved to be a somatostatinoma. After a promising initial response to streptozotocin, she died 30 months later. This is the first reported occurrence of a somatostatinoma in a patient with coeliac disease, adding to the growing list of neoplastic complications in this condition.
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PMID:Malignant pancreatic somatostatinoma in a patient with dermatitis herpetiformis and coeliac disease. 289 27

Overall, hepatic resection appears to be an important means of curing patients with metastatic colorectal cancer isolated to the liver. The only absolute contraindication to surgery was the impossibility of a radical removal of tumor: if residual disease will remain after the hepatic resection, this operation is not indicated. A possible second contraindication to surgery is the presence of tumor in the hepatic or celiac lymph nodes. Such metastases from liver metastases signal a biologic grade of tumor that is almost sure to spread to other sites. However, one patient of the 25 in this group did survive long term when positive lymph node groups were dissected. Further clinical experience with this form of the disease along with trials of regional adjuvant therapies such as intraperitoneal chemotherapy may be needed. The presence of extrahepatic metastases at the time of liver resection should be considered a relative contraindication to this surgery, but if the patient can be made clinically disease free, long-term disease-free survival may result. It seems imperative that all patients with hepatic metastases be evaluated by an experienced hepatic surgeon for a curative resection. If the patient has between one and four metastases, a 25 per cent long-term disease-free survival rate can be expected. Patients who have a radical resection of more than four metastases should be considered to be in an experimental group in whom more data are needed. In our current state of knowledge, making such patients clinically disease free is their only chance for long-term survival. Other factors besides the number of metastases that will affect the prognosis of the patient include the disease-free interval between colorectal resection and liver resection, the pathologic margin of resection on the liver specimen, and the presence or absence of mesenteric lymph node metastases from the primary cancer. These factors should be considered when determining the prognosis in a given patient and should be used as stratification variables in prospective trials. However, from our analysis of available data, these factors should not be considered contraindications to hepatic resection.
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PMID:Surgery for colorectal cancer metastatic to the liver. Optimizing the results of treatment. 292 2

Based upon our clinical results indications of intraoperative radiotherapy (IORT) for gastric cancer were summarized as follows: (a) The primary tumor must be surgically removed. (b) There must be no metastases to the liver or peritoneum. (c) Serosal invasion must be limited to the posterior wall of the stomach. IORT is not adaptable to patients in whom there is direct invasion of the peritoneum beyond the anterior wall because of the ease of peritoneal dissemination. (d) All unresectable lesions must be encompassed by a single radiation field. (e) No significant difference between cumulative survival of patients with Stage I gastric cancer who were treated by IORT or surgery alone was found. Therefore IORT may be of no benefit to the prognosis of patients with Stage I gastric cancer. As for the IORT dose, it is recommended that for clinically undetectable lesions a single dose of 28 Gy be delivered. For macroscopic remnants 30-35 Gy should be delivered depending upon the residual tumor size. The electron energy is selected so that the entire lesion is included by the 90% isodose line. When IORT is applied to a curative operation, the radiation field is positioned toward the lymph node groups around the celiac axis, which are hard to eliminate by a surgical procedure.
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PMID:Japan gastric trials in intraoperative radiation therapy. 319 40

Clinicopathological factors such as depth of cancer invasion, size, gross type, frequency of metastases to regional lymph nodes, and distant prognosis were evaluated in last consecutive 339 cases with solitary early gastric cancer. The conservative surgery, that is, subtotal gastrectomy with complete dissection of lymph nodes of group 1 and selective celiac group and partial bursectomy, would be indicated for early gastric cancers located in antrum or corpus. But if the metastasis to the group 2 lymph nodes is suspected during the surgery, it is necessary to dissect lymph nodes en bloc more than group 2. The results, concerning the type of early gastric cancer without lymph node metastasis and the indication of endoscopic treatment, were as follows; 1. Intramucosal cancer of elevated type less than 2 cm in diameter. 2. Intramucosal cancer of depressed type less than 1cm in diameter, without peptic ulcer within the lesion, and a differentiated tubular adenocarcinoma histologically. 3. Intramucosal cancer of flat type less than 2 cm in diameter. But it is difficult to detect the depth of cancer invasion and lymph node metastasis preoperatively. We would emphasize that endoscopic treatment should be indicated in the case for which surgical treatment is not indicated.
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PMID:[Clinicopathological study of early gastric cancer--indication of conservative surgery and radical endoscopic treatment of early gastric cancer]. 320 47

The resection of hepatic metastases in patients with extrahepatic disease is of no proven benefit. Preoperative identification of extrahepatic disease may prevent unnecessary laparotomy. Preoperative evaluation including physical examination, computed tomography of the abdomen, full lung tomography or chest-computed tomography, and radionuclide bone scanning identified extrahepatic metastases, most commonly in the lung, in 25 of 132 patients with purported isolated liver metastases. Of 107 patients with negative staging evaluations, intra-abdominal extrahepatic metastases were found in 26 percent (28 of 107) at laparotomy, most commonly in portal and celiac lymph nodes. The presence of extrahepatic disease correlated with greater than 25 percent hepatic replacement by tumor, presence of symptoms, and Dukes' C primary lesions; however, none was predictive. We were unable to develop a model to preoperatively predict the presence of intra-abdominal extrahepatic disease. The authors recommend a preoperative evaluation including physical examination, and computed tomographic scans of the abdomen and chest. A bone scan is required only in patients with symptoms referable to bone. Despite a negative preoperative evaluation, however, a considerable proportion of patients with colorectal hepatic metastases will have extrahepatic disease at the time of abdominal exploration.
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PMID:Intra-abdominal extrahepatic disease in patients with colorectal hepatic metastases. 333 39

Extraluminal cancer spreadings such as peritoneal dissemination, liver metastases, lymph node metastases and infiltration to surrounding organs were examined in 236 patients with gastric cancer by ultrasound (US). Peritoneal dissemination was found in 36 of 236 cases. Ascites, nodules in the cul-de-sac and thickened wall of the transverse colon could be detected by US in 24 of 36 cases (sensitivity of 67%). Liver metastases were detected in 18 out of 23 cases (78%). Infiltration to the surrounding organs, mainly to the pancreas, was impossible to demonstrate by US. Sensitivity was 44% (17/39). Lymph node metastases in the region around the celiac axis were indicated in 30 of 40 cases (75%) by US. Para-aortic nodal metastases were also detected in 27 of 34 cases (79%). Ultrasonic images of para-aortic lymph node metastases were classified into four figures: plate type, sandwich type, unilateral multiple type, unilateral solitary type. These types were not necessarily the same in indication of laparotomy, selection of combined or adjuvant therapy, significance of nodal dissection and also prognosis. Solitary involved para-aortic node near the left renal vein should be removed in a case free from peritoneal dissemination or liver metastases. Ultrasound could be very useful in screening patients with gastric cancer for peritoneal dissemination, liver metastases and lymph node metastases.
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PMID:[Pre-operative staging in advanced gastric cancer by ultrasound; with special reference to para-aortic lymph node metastases]. 354 75

The purpose of the present study was to clarify the anatomy of the lymphatic system of the para-aortic region with special reference to lymphatic pathways from the pancreas, and the incidence and extent of lymphatic metastases of pancreatic cancer to para-aortic lymph nodes. Lymph nodes were found mostly on the bilateral and anterior sides of the aorta, and rarely on its posterior side. Lymphatic vessels from the pancreas (peripancreatic nodes) were closely related to the para-aortic lymph nodes on the bilateral and anterior surfaces of the aorta ranging from the root of the celiac artery and that of the inferior mesenteric artery. Out of 10 autopsy cases of relatively small pancreatic cancer, 4 cases were found to have microscopic metastases in a few para-aortic lymph nodes. The localization of involved para-aortic nodes was compatible with that of anatomically related para-aortic lymph nodes. Lymph node dissection of the para-aortic region, if carried out in a patient with a possibility of radical resection of the primary pancreatic cancer, should be an en bloc resection of lymph nodes and surrounding soft tissues in the area ranging between the root of the celiac artery and that of the inferior mesenteric artery.
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PMID:[An anatomical and pathological study of autopsy material on the metastasis of pancreatic cancer to para-aortic lymph nodes]. 360 May 84

The celiac axis could be visualized with ultrasound in 140 out of 166 cases (84%). Failure to identify the celiac axis was associated with extensive metastases to the celiac lymph nodes in 73% (19/26) of these cases. The location of lymph nodes in this region could be determined using the celiac axis and its branches as land marks. Celiac lymph nodes can be roughly classified into three types: Type 1--unclear margins and relatively uniform diffuse internal echoes, Type 2--clear margins and weak internal echoes, and Type 3--clear margins and scattered, large internal echoes, frequently seen with notchings. Metastases in celiac lymph nodes were found in 53 of 166 cases, based on histological examination of surgically removed nodes. A preoperative ultrasonic examination indicated lymph node metastases in 39 out of the 53 cases (sensitivity of 74%) and no lymph node metastases in 108 of the remaining 113 cases (specificity of 96%). Most lymph nodes with metastases were of Types 2 or 3. The longer the diameter of the lymph node or the larger the ratio of metastatic area to node cross-sectional area, the higher the detection rate tended to be. These results indicate that ultrasound can be very useful in screening patients for celiac lymph node metastases.
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PMID:Ultrasonic detection of lymph node metastases in the region around the celiac axis in esophageal and gastric cancer. 392 Feb 76

"Blunt" transhiatal esophagectomy was performed in 23 selected patients. Nineteen had squamous carcinoma of the esophagus (upper third, 1; middle third, 12; distal third, 6), and 2 had adenocarcinoma of the distal esophagus. The other 2 patients had severe lye strictures. Resection with reconstruction was performed in one stage. Esophagogastric continuity was restored using the stomach in the posterior mediastinal position in 20 patients and in the substernal position in 2. The colon in the posterior mediastinal position was used in 1 patient with a lye stricture. Transmural tumor extension or cervical or celiac nodal metastases or both were present in 18 of 21 patients with carcinoma. There was 1 hospital death due to pericardial tamponade. Morbidity included a transient cervical anastomotic leak in 3 patients, one temporary and three permanent unilateral recurrent laryngeal nerve palsies, one intraoperative splenic injury, and severe hemorrhage requiring sternotomy for control in 1 patient. Pulmonary complications occurred in 4 patients: aspiration pneumonia (1) and moderate atelectasis (3). Three patients have died (11, 12, and 17 months postoperatively) in the group with cancer, with follow-up time of 3 to 30 months (mean, 15 months). Transhiatal blunt esophagectomy is a safe and effective procedure in many patients with either esophageal cancer or extensive, benign esophageal strictures.
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PMID:Transhiatal (blunt) esophagectomy for malignant and benign esophageal disease: clinical experience and technique. 405 15

To determine the computed tomographic (CT) characteristics of nonfunctioning islet cell carcinoma of the pancreas, the CT scans of 27 patients with that disease were reviewed. The pancreatic tumor was identified as a mass in 26 patients (96%). Demonstrated masses were 3-24 cm in diameter. Eight of the tumors (31%) were larger than 10 cm. Six tumors (22%) contained calcification. Of the 25 tumors evaluated with contrast enhancement, 20 became partially or diffusely hyperdense relative to nearby normal pancreatic tissue. Hepatic metastases were identified in 15 patients (56%), regional lymphadenopathy in 10 (37%), atrophy of the gland proximal to the tumor in six (22%), dilatation of the biliary ducts in five (19%), and dilatation of the pancreatic duct in four (15%). The CT appearances of the nonfunctioning islet cell tumors were compared with those of 100 ordinary (ductal) pancreatic adenocarcinomas. Although the two types of tumors were sometimes indistinguishable, features found to be more characteristic of islet cell carcinoma included a pancreatic mass of unusually large size, calcification within the tumor, and contrast enhancement of either the primary tumor or hepatic metastases. Involvement of the celiac axis or proximal superior mesenteric artery was limited to ductal carcinoma.
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PMID:CT features of nonfunctioning islet cell carcinoma. 609 32


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