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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 30 and 70% of almost one million new cancer patients diagnosed each year will develop osseous metastases. Clinicians are faced with the difficult task of determining which patients require prophylactic stabilization to prevent pathologic fracture. The objective of this study was to test the ability of macroscopic finite element models to predict the fracture strength of the proximal femur with a lesion in the femoral neck. Drill hole defects in human cadaver femora were used to simulate lesions that penetrate one cortex of the femoral neck. Based on the first of two series of in vitro experiments, the fracture strength of a femur with a lesion that penetrates either the inferior-medial or superior-lateral cortex of the neck is approximately 45% less than the fracture strength of the paired intact femur; based on the second series, the fracture strength with the inferior-medial lesion is approximately 20% less than the fracture strength with the superior-lateral lesion. A series of three-dimensional finite element models were used to predict the fracture strength for anterior and posterior lesions, as well as the inferior-medial and posterior-lateral lesions tested in vitro. Based on a direct comparison of the strengths predicted by the finite element models to the measured in vitro fracture strengths, the finite element models performed poorly. In particular, the application of an anisotropic strength criterion to the stresses predicted by the models resulted in a considerable underestimation of the percentage reduction in the in vitro fracture strength. This may reflect a fundamental inability of a linear, macroscopic continuum-based analysis to predict accurately the fracture strength of a bone structure as complex as the proximal femur. However, despite this lack of agreement in absolute fracture strength, the general trends for gait and stair ascent loading for the inferior-medial and superior-lateral lesions were consistent with the in vitro data. The greatest reduction in strength was predicted for the inferior-medial lesion, followed by the anterior lesion and then the superior-lateral lesion, and the least reduction in strength was predicted for the posterior lesion. Most importantly, the predicted strength ratio varied considerably as a function of the applied loads. Any metastatic lesions of the femoral neck may be especially sensitive to some particular activity, making it difficult to determine precisely the risk of fracture.
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PMID:Evaluation of finite element analysis for prediction of the strength reduction due to metastatic lesions in the femoral neck. 846 38

The presence of pathologic fracture in osteosarcoma raises concerns of tumor dissemination by the fracture hematoma and has been considered a contraindication to limb salvage surgery. Because this is a theoretical concern, there are little clinical data available in the literature on which to base treatment of these patients. Eighteen patients with osteosarcoma who sustained a pathologic fracture and had a minimum of 24 months of followup were reviewed retrospectively. Surgical treatment included nonoperative therapy, amputation, and limb salvage groups. Patients who refused surgical intervention (2) had a uniformly poor outcome. Patients who underwent amputation (6) had no local recurrences and 33% developed metastases. Patients who underwent limb salvage (10) experienced 3 local recurrences and 6 distant recurrences. Although the distant recurrence rate for patients undergoing amputation was no different from the rate for those undergoing limb salvage, the difference in local tumor control approached statistical significance. All patients who developed local recurrence died. Surgical treatment needs to be individualized and based on factors such as fracture displacement, stability, radiographic and histologic response to chemotherapy, and the perceived ability to resect the fracture hematoma completely.
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PMID:The surgical treatment of patients with osteosarcoma who sustain a pathologic fracture. 859 61

During a 10-year period, 17 patients with segmentally destructive bone lesions of the humeral diaphysis in disseminated malignancies resulting in impending fracture (8 patients), pathologic fracture (6 patients), or failure of attempted internal fixation techniques (3 patients) were treated with resection of the involved diaphyseal segment and reconstruction with a cemented modular intercalary humeral spacer. Fourteen patients had metastatic cancer, 2 had multiple myeloma, and 1 had lymphoma. Breast and renal carcinoma were the most common pathologic diagnoses. The involved site was within the middle 1/3 in 8 patients, in the proximal-middle junction in 5, in the middle-distal junction in 2, and within the proximal and distal 1/3 in 1 patient each. Early pain relief was successful in 88% of patients. Early in the postoperative hospital course, patients generally were able to use the ipsilateral hand to assist feeding. Radiographic analysis revealed that the limited selection of stem lengths led to 76% of the distal stems and 47% of the proximal stems being shorter than the ideal length. The complication rate independent of disease progression was 29%. The most common complication was temporary radial nerve injury (3 patients). There were 3 implant failures, most commonly due to disengagement of the male-female junction. Two periprosthetic fractures occurred, 1 proximally (due to tumor progression) and 1 distally. Suggestions are given for modification of the implants to improve the major problems of limited versatility in intramedullary stem length and inadequate mating at the junction.
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PMID:Intercalary spacers in the treatment of segmentally destructive diaphyseal humeral lesions in disseminated malignancies. 859 62

Many patients diagnosed with breast cancer will develop metastases and these have diverse presentations. We have reviewed 100 consecutive patients who have died with metastatic breast cancer, to determine the frequency, sites and mode of presentation of recurrent disease. The commonest site of failure was loco-regional (n = 61), this usually presented with a mass, but a minority of patients also complained of pain. Bone metastases developed in 60 patients and produced bone pain, pathological fracture (n = 6) or cord compression (n = 5). Pulmonary metastases producing shortness of breath were diagnosed in 34 patients and were asymptomatic in a further 10. Intra-abdominal metastases were found at some time in 23 patients, most commonly in the liver (n = 20) and the majority complained of epigastric pain (n = 17). Brain metastases occurred in 23 patients and produced a wide range of symptoms including those of a space-occupying lesion (n = 10), cranial nerve palsy (n = 7), diabetes insipidus (n = 3), focal limb weakness (n = 2) and meningitis (n = 1). Three patients had choroid metastases producing reduced visual acuity. Recurrent breast carcinoma can present in a variety of ways, therefore any new symptom or sign should be considered to represent recurrence until proved otherwise.
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PMID:Patterns of clinical metastasis in breast cancer: an analysis of 100 patients. 863 4

In the period from 1988 to 1992, 23 patients (16 females and 7 males, average age at operation 57.3 years) with metastatic disease of the proximal femur were treated by resection of the lesion and insertion of a modular prosthesis (PGR). At latest review (at an average 3.2 years following the operation, range 1 to 5 years) twelve patients were still alive. Local recurrence of the neoplasia occurred at, respectively 6, 8, and 12 months after prosthesis insertion in the three patients in whom surgery was performed because of a pathological fracture. Pain relief was obtained in all cases after surgery and no patient developed any complication during or after surgery. Functional results (Enneking Function Evaluation system) were excellent in 2 patients, good in 13 and fair in 8. PGR modular prostheses appear to be a safe form of palliative treatment in a patient with proximal femoral metastases.
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PMID:Modular prostheses in metastatic bone disease of the proximal femur. 873 12

The high prevalence of bone metastases in breast cancer and the risk that spinal and femoral osteoporosis may add further morbidity provide a rationale for bisphosphonate therapy in patients with skeletal metastases from mammary carcinoma. We investigated the effects of oral clodronate given during 9 months, with a 24-month follow-up, on bone mineral density (BMD), on biochemical markers of bone remodeling, and on osseous complications in 67 women with documented relapsing breast cancer, aged 58.7 +/- 1.5 years (x +/- SEM). Patients with active cancer disease were randomly allocated to two groups, with or without clodronate treatment (1600 mg/day, orally). Twenty-six women considered in complete remission (52.4 +/- 2.4 years) were also studied. Expressed in deviation from gender- and age-matched normals (z score), base-line BMD at the levels of lumbar spine (LS), femoral neck (FN), and midfemoral shaft (FS) was +0.10 +/- 0.22 vs. -0.12 +/- 0.25, +0.03 +/- 0.19 vs. -0.54 +/- 0.24, and +0.08 +/- 0.14 vs. -0.02 +/- 0.22, in patients with active breast cancer and in subjects in remission, respectively. After 9 months of treatment, fasting urinary calcium to creatinine ratio was lower (0.26 +/- 0.04 vs. 0.40 +/- 0.04 mmol/mmol creatinine, p < 0.02) and serum osteocalcin was stabilized (-2.1 +/- 1.1 vs. +7.0 +/- 3.3 micrograms/L, as compared with pretreatment values, p < 0.02), in the clodronate-treated group. The rate of osseous complications (pathological fracture, hypercalcemic episode, scintigraphic or radiological evidence of metastasis development, chemo- or radiotherapy for bone disease progression) was 28.8 events per 100 patient-year in the clodronate-treated group vs. 39.0 in controls, and 31.5 vs. 40.5, after 9 and 15 months of follow-up, respectively. In 15 women without evident LS bone metastasis (7 clodronate-treated and 8 controls), LS BMD increased in the clodronate-treated group by +5.2 +/- 2.5% vs. -0.3 +/- 1.4%, and +8.1 +/- 4.7 vs. -0.9 +/- 1.7, after 10.3 +/- 0.4 and 17.3 +/- 1.2 months, respectively (p < 0.01), as compared with pretreatment values. These results indicate that clodronate treatment decreased bone turnover and attenuated cancer-related bone morbidity. In addition, clodronate increased LS BMD in apparently unaffected bone of women with relapsing breast cancer.
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PMID:Effects of oral clodronate on bone mineral density in patients with relapsing breast cancer. 880 93

In 12 patients with acetabular metastases, we reconstructed the hip with a support ring, cement, and Charnley prosthesis with a 22 mm head. There were no immediate postoperative deaths or cardiovascular complications. Dislocations occurred in 5 patients, 1 of whom required open reduction. At follow-up, 3 patients were alive 11, 15, and 18 months after surgery. 9 patients died after 8 (2-13) months. All patients obtained relief from pain, became ambulatory and were discharged to their homes. 1 patient had rapid disease progression with pathologic fracture and cranial dislocation of the support ring. Among the remaining 11 patients, the hip has not again caused pain or limited function. There were no signs of loosening, except in the patient with fracture of the hemipelvis. Remineralization was observed in 2 breast cancer patients after chemotherapy. Hip reconstruction can restore painless function until death in cancer patients with severe destruction of the acetabulum.
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PMID:Reconstruction in metastatic destruction of the acetabulum. Support rings and arthroplasty in 12 patients. 894 45

Metastatic cancer is among the most frequent causes of skeletal pain associated with a destructive bone lesion or pathologic fracture in adults. Patients with a known primary carcinoma should undergo systematic evaluation and monitoring to determine the extent of skeletal disease and risk of pathologic fracture. Patients without a known primary carcinoma who have symptoms consistent with metastatic disease of the skeleton present a diagnostic dilemma. Plain radiographs may not reveal a metastatic lesion until extensive marrow replacement has occurred. Bone scans are more sensitive than radiographs and provide a survey of the entire skeleton. However, increased uptake on a bone scan is not specific and some neoplasms are poorly detected by scintigraphy. Computed tomography can identify bone destruction or neoplastic bone formation that is not easily demonstrated by plain radiographs and can help the clinician assess the risk of pathologic fracture. Magnetic resonance imaging may be helpful in detecting and defining the extent and precise location of marrow lesions and soft tissue extension of neoplasms.
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PMID:Metastatic disease of the skeleton. 910 3

Adenocarcinoma of the gallbladder combined with a malignant peripheral nerve sheath tumor (MPNST) in the gallbladder in an 81-year-old woman is reported. The resected gallbladder showed two distinct tumor components, the epithelioid type of MPNST and adenocarcinoma with areas of mucin production. Although the immediate postoperative course was uneventful, a pathologic fracture of her right upper femur developed 4 months after the cholecystectomy. The pathology was determined to be a feature of metastatic MPNST rather than of adenocarcinoma. A whole body bone scan revealed multiple metastases, including the left parietal skull, left ninth rib, seventh thoracic vertebra, and right upper third of the femur. Despite cholecystectomy and postoperative irradiation therapy, she died 6 months after diagnosis of the tumor. Without an autopsy the primary site of the MPNST was unknown. We found that the prognosis was very poor in patients with distal metastatic MPNST, especially in older patients.
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PMID:Adenocarcinoma combined with malignant peripheral nerve sheath tumor of the gallbladder. 926 60

Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is a recently recognized malignant neoplasm of the thyroid gland. Two additional cases of this condition which occurred in a 70-year-old woman and a 69-year-old woman are presented. The case of the 70-year-old woman (patient 1) is the first report of distant metastasis, besides lymph node metastasis, for this type of tumor. The patient initially presented with a thyroid mass, and the thyroid gland with surrounding cervical lymph nodes was removed. Because of focal keratin "pearl" formation, the tumor was misinterpreted as a metastatic squamous cell carcinoma to the thyroid. Approximately 4 years later, the patient developed a left supraclavicular mass and lung densities. A pathological fracture of the right humeral head followed, and the left supraclavicular mass recurred along with newly developed subcutaneous nodules on the chest wall and arm. Open lung and bone biopsies revealed metastatic SMECE, which was morphologically identical to that of the thyroid mass. The 69-year-old woman (patient 2) had, in 1983, undergone thyroidectomy with left radical neck dissection; this had been diagnosed as follicular carcinoma of the thyroid with lymph node involvement. After multiple isolated lymph nodes metastases, the patient developed locally extensive, recurrent tumor that showed microscopic features of SMECE. Review of the previous thyroid tumor and lymph nodes revealed the same type of histology. To our knowledge, only a single report containing eight cases of this distinctive carcinoma of the thyroid has been published. Herein we describe characteristic morphological features of two additional cases of this rare malignancy, one with distant metastasis, and we review the related literature.
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PMID:Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: report of two patients, one with distant metastasis, and review of the literature. 930 35


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