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

Pancreatic or gastric metastases from other primary malignancies are rare, especially from leiomyosarcoma. We report a case of leiomyosarcoma in the left lower leg with metastases to the pancreas and stomach. A 61-year-old man had liver cirrhosis caused by hepatitis C virus infection and was followed up by his primary physician. Two years before presentation at our hospital, he had undergone surgical resection of leiomyosarcoma in the left lower leg and systemic chemotherapy for multiple metastatic tumors in the lung. On admission, endoscopic examination and computed tomography were performed for a routine checkup to exclude esophageal varices and liver tumor. Although the patient had no specific symptoms, multiple gastric and pancreatic metastases were identified by endoscopy and computed tomography, respectively. In general, metastases to the pancreas and stomach are rare. We discuss the clinical and diagnostic findings of pancreatic and gastric metastases by reviewing previously reported cases.
 ...
PMID:Pancreatic and gastric metastases of leiomyosarcoma arising in the left leg. 1624 62

Hepatocellular carcinoma (HCC) is a disease on the rise in the United States, due to the epidemic of hepatitis C-induced liver disease. Better chemotherapy options, aggressive surgery, and liver transplantation have led to improved patient survival and an increase in late-appearing, distant metastases from HCC. Brain metastases, although formerly thought of as rare manifestations of HCC, may be more likely to come to clinical and pathological attention than extrahepatic metastases in other sites since they often produce clinical symptoms that necessitate neurosurgical intervention and metastasis removal. In addition, brain metastases from HCC are frequently associated with mass-producing hemorrhage, further requiring evacuation. Hence, pathologists are relatively more likely to encounter brain metastases from HCC as surgical specimens than metastases from HCC to some other common sites of spread, such as bone, lymph nodes, or adrenal. Brain metastases from HCC are being increasingly documented in areas of the world with high endemic rates such as Asia, but thus far have only very rarely been reported in patients native to the United States. We describe our institution's experience with three Caucasian US males, two with hepatitis C as risk factors, who developed metastatic HCC to the brain. We expect clinicians and pathologists will encounter more patients with HCC and extrahepatic metastases, particularly those to brain, in the near future.
 ...
PMID:Brain metastases from hepatocellular carcinoma in US patients. 1640 79

Primary liver lymphoma is a very rare disease and is frequently overlooked as a possible diagnosis. We report the case of an asymptomatic middle-aged man with chronic hepatitis C who developed primary liver lymphoma (PLL). A large solitary tumor in the left lobe of the liver was incidentally detected on routine ultrasound examination. Imaging studies showed mixed iso- and hypoechogenicity with hypoechoic rim, hypodense in the pre-contrast phase and thick wall enhancement in the post-contrast phase on computed tomographic study, hypointensity on T1WI, and hyperintensity of the central portion and slightly higher intensity in the peripheral wall on T2WI. These pictures were different from focal nodular hyperplasia, hepatocellular carcinoma, cholangiocarcinoma or metastases. Atypical hepatectomy was performed and the pathology of the hepatic tumor revealed non-Hodgkin's lymphoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, so PLL was diagnosed. There was no tumor recurrence more than 4 years after operation and chemotherapy. PLL should be included in the differential diagnosis of solitary hepatic tumor in patients who are hepatitis C virus-positive, and who have atypical imaging and no known malignancy or elevated tumor marker levels.
 ...
PMID:Primary liver lymphoma in a patient with chronic hepatitis C. 1652 Aug 42

We report a case documenting fluorodeoxyglucose (FDG) accumulation in upper abdominal lymph nodes resulting from acute hepatitis C infection. A 42-year-old African-American female with a history of metastatic breast carcinoma was found to have hypermetabolic porta hepatic, peripancreatic, and paraaortic lymphadenopathy and hypermetabolism in the spleen on a surveillance FDG positron emission tomography/computed tomography (PET/CT) scan. Concurrently, she was diagnosed with acute hepatitis C infection. Antiviral therapy was not recommended secondary to the low level of detectable virus at the time of diagnosis. Her breast cancer therapy regimen was continued unaltered. FDG PET/CT scan was repeated 2 months later as a result of concern that the hypermetabolic lymph nodes represented metastatic disease; however, the scan revealed complete resolution of the previously abnormal findings. The resolution of the lymphadenopathy and the patient's clinical course led to the conclusion that the most likely explanation for the FDG PET/CT findings was inflammation secondary to acute hepatitis C infection and not metastatic breast carcinoma. Inflammatory and infectious processes accumulate FDG, occasionally resulting in false-positives for malignancy. Infected macrophages in the lymph nodes draining the liver in this case and stimulation of a cellular immune response by the hepatitis C virus, with resultant cytokine production by cytotoxic and T-helper cells, offer possible explanations for the findings seen on FDG PET/CT in this case. This case highlights the importance of clinical history and laboratory correlation for the proper interpretation of FDG PET scans.
 ...
PMID:Lymphadenopathy resulting from acute hepatitis C infection mimicking metastatic breast carcinoma on FDG PET/CT. 1678 2

Oral metastases from hepatocellular carcinoma are very rare. We encountered a case of hepatocellular carcinoma with a solitary metastasis to the mandible as an initial manifestation. The patient was a 76-year-old man who was admitted for left mandibular swelling. A biopsy specimen of mandible was suspected to be a metastatic tumor. The histological findings, abdominal computed tomography, bone scintigraphy, and F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed it to be a solitary metastasis from hepatocellular carcinoma. As a result, he was diagnosed to have liver cirrhosis due to a hepatitis C virus infection and hepatocellular carcinoma with a solitary metastasis to the mandible. The primary lesion was treated with transcatheter arterial embolization (TAE), and the metastasis to the mandible was surgically resected. The patient survived for 9 months after treatment without recurrence.
 ...
PMID:Solitary mandibular metastasis as an initial manifestation of hepatocellular carcinoma. 1694 63

Within the spectrum of diagnostic procedures in hepatology, the procurement of a liver specimen plays an important role. Although diagnostic tests that employ seroimmunological, biochemical, molecular biologic, functional, as well as imaging techniques are capable of establishing the etiology of a chronic or acute liver disease, in most instances the gold standard for the assessment of stage as a common end point of progressive liver diseases is the histological evaluation of a liver sample. Since the first documented biopsy by Paul Ehrlich in 1883 by aspiration, the method has been diversified to encompass not only different needle types for cutting and aspiration but also different routes proceeding transvenously or transcutaneously, and in the combination with imaging modalities such as ultrasound, computed tomography, and laparoscopy. Standard liver biopsies can be rapidly performed and have an accepted mortality rate between 0.1% and 0.01%. The decision between different techniques is based upon the risk profile of the patient who very often has advanced liver failure with coagulopathy and ascites on the one hand and the underlying disease on the other hand. Although standard liver biopsy in hepatitis C infection or suspected rejection in a transplant patient is often sufficient, a laparoscopically guided biopsy can be of value in diseases such as primary sclerosing cholangitis or suspected metastatic disease, which are characterized by a zonal affection of the liver and possibly the peritoneum. Coagulopathy may lead to transjugular or plugged biopsies, and the workup of undetermined hepatic masses may favor ultrasound-guided aspiration cytology. Among the most feared complications of liver biopsies are hemorrhage, seeding of cancer cells, infections, and injury to the viscera. In view of these complications, a careful assessment of the clinical question, the appropriate invasive approach, and an expected management consequence are necessary. This requires a detailed consideration of the differences of biopsy techniques currently available to the clinical hepatologist.
 ...
PMID:Approaches to liver biopsy techniques--revisited. 1705 46

Tumor recurrence after resection of hepatocellular carcinoma (HCC) can occur early (<2 years) or late (>2 years) as metastases or de novo tumors. Interferon (IFN) has the potential for chemoprevention against hepatitis C virus (HCV)-related cirrhosis. A predetermined group of 150 HCV RNA-positive patients undergoing resection of early- to intermediate-stage HCC was stratified into 80 HCV-pure (hepatitis B anticore antibody [anti-HBc]-negative) and 70 mixed HCV+hepatitis B virus (HBV) (anti-HBc-positive) groups, then randomized to IFN-alpha (3 million units 3 times every week for 48 weeks [n = 76]) versus control (n = 74). The primary end point was recurrence-free survival (RFS); secondary end points were disease-specific and overall survival. Intention-to-treat and subgroup analysis on adherent patients were conducted. Treatment effects on early/late recurrences were assessed using multiple Cox regression analysis. No patient experienced life-threatening adverse events. There were 28 adherent patients (37%). After 45 months of median follow-up, overall survival was 58.5%, and no significant difference in RFS was detectable between the two study arms (24.3% vs. 5.8%; P = .49). HCC recurred in 100 patients (48 IFN-treated, 52 controls), with a 50% reduction in late recurrence rate in the treatment arm. HCC multiplicity and vascular invasion were significantly related to recurrence (P = .01 and .0003). After viral status stratification, while no treatment effect was apparent in the mixed HCV+HBV population and on early recurrences (72 events), there was a significant benefit on late recurrences (28 events) in HCV-pure patients adherent to treatment (HR: 0.3; 95% CI: 0.09-0.9; P = .04). In conclusion, IFN does not affect overall prevention of HCC recurrence after resection, but it may reduce late recurrence in HCV-pure patients receiving effective treatment.
 ...
PMID:Prevention of hepatocellular carcinoma recurrence with alpha-interferon after liver resection in HCV cirrhosis. 1713 92

The prognosis for patients with hepatocellular carcinoma (HCC) with progressive liver cirrhosis or extrahepatic metastases remains dismal. We report a case of HCC with liver cirrhosis and lung metastases who had been treated successfully by combination chemotherapy of 5-fluorouracil (5-FU) and interferon-alpha (IFN-alpha). A 67-year-old male with a history of hepatitis C, liver cirrhosis and HCC was hospitalized because of cough and dyspnea. Computed tomography (CT) of chest revealed multiple lung metastases. Systemic combination chemotherapy with 5-FU and IFN-alpha was begun, and lung metastases disappeared after one course of treatment. He died of liver failure one year later, but no recurrence of lung metastases was seen. Although systemic combination chemotherapy of 5-FU and IFN-alpha induced the bone marrow suppression, it was effective for lung metastases and palliates symptoms and signs in our case of HCC.
 ...
PMID:[A case of advanced hepatocellular carcinoma with lung metastases and cirrhosis that responded to combination chemotherapy with interferon-alpha and 5-fluorouracil]. 1719 59

The purpose of this study was to evaluate the impact of tumor-positive hilar lymph nodes (LN) on tumor recurrence and survival in patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT). A computer search of the Medline database was carried out. The outcome of patients with positive hilar LN (study group) was compared with that of patients with negative LN (reference group). Five clinical studies evaluating tumor recurrence after LT for HCC according to hilar LN status were identified. Five further clinical studies evaluated patients' survival in reference to LN metastases. The test of heterogeneity for each comparison revealed no significant differences (exact P=0.4638). A significant correlation between tumor-positive LN and tumor recurrence was shown (exact estimation of common odds ratio by 10.44, 95% confidence interval of 3.431-38.59). Furthermore, data analyses using the Fisher-combination test regarding patient survival in the two groups showed a statistical difference (P<0.0001). The negative prognostic value of hilar LN metastasis for both tumor recurrence and survival was confirmed by this analysis. Given the ever-present diagnostic dilemma associated with enlarged hilar LN, especially in hepatitis C-positive patients, hilar LN sampling during LT for HCC could better define patients at risk.
 ...
PMID:Hilar lymph nodes sampling at the time of liver transplantation for hepatocellular carcinoma: to do or not to do? Meta-analysis to determine the impact of hilar lymph nodes metastases on tumor recurrence and survival in patients with hepatocellular carcinoma undergoing liver transplantation. 1723 22

To analyze the clinical features of hepatocellular carcinoma (HCC) in patients with signs and symptoms of nervous system involvement as the initial presentation. Over a period of 11 years (January 1993 to December 2003), 15,008 HCC patients were identified at the Chang Gung Memorial Hospital in Kaohsiung, Taiwan. Amongst them, 42 cases had nervous system involvement, of which six had nervous system involvement as their initial presentation. These six cases were enrolled in this study and their clinical and laboratory data were analyzed. The clinical features of the other 36 HCC cases with nervous system involvement were also analyzed for comparison. The six cases were all males, aged 36-68 years old. The involved parts of the nervous system were the cerebellar hemisphere (one), the frontal lobe (one), the sphenoid sinus, sellar turcica, and cavernous sinus (one), the cervical spine (one), and the thoracic spine (two). Their corresponding neurologic presentations were back pain, headache, consciousness disturbance, visual disturbance, and limb weakness. Whilst three out of six patients presenting with nervous system manifestations were found to have concurrent systemic metastases in other expected sites (lung, bone), three had isolated nervous system involvement even after extensive work up. The associated medical conditions of the six cases included hepatitis B (three), hepatitis C (one), liver cirrhosis (two), portal vein thrombosis (three), and diabetes mellitus (two). All the six died within 9 months after the detection of nervous system involvement. The prevalence of nervous system involvement in HCC patients is 0.28% (42/15,088), with 0.04% (6/15,088) having this as their initial presentation. The prognosis of HCC with nervous system involvement is grave. Their clinical and laboratory data are not unique but the diagnosis could only be confirmed by hepatic and nervous system imaging studies, histopathologic examination, and serum alpha-fetoprotein detection. This consideration should be emphasized especially in areas that are hyperendemic for HCC and if the original focus of metastatic lesion is obscure.
 ...
PMID:Hepatocellular carcinoma presenting as nervous system involvement. 1738 89


<< Previous 1 2 3 4 5 6 7 Next >>