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

Treatment of choriocarcinoma is mostly successful but there is still appreciable mortality from early respiratory failure. A series of 135 patients with choriocarcinoma presenting with dyspnea between 1960 and 1988 was studied to find prognostic factors for early respiratory death and to identify how mortality may be further reduced. Mortality with respect to early respiratory death (ERD) was 11% and was significantly associated with WHO prognostic score, chest X-ray appearance, central cyanosis, tachycardia, anemia, and clinical evidence of pulmonary hypertension. Indicators on chest X ray of high risk of ERD were the presence of more than 10 opacities, extensive opacification of lung fields, size of metastases, and hazy background obscuring the vascular pattern. Intensity of initial treatment was not correlated with this outcome. A set of criteria has been derived which will predict ERD with 100% sensitivity and 38% positive predictive value. These are opacification of lung fields on chest X ray of more than 50%, OR initial plasma hCG level greater than 10(5) when there is anemia and a history of chest pain. Patients presenting with choriocarcinoma and dyspnea who fulfill these criteria should be considered for extracorporeal perfusion techniques. As respiratory failure in this condition is characterized by hypoxemia and right-to-left shunting, extracorporeal perfusion should be effective. Ventilation should be avoided as no patient survived mechanical ventilation.
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PMID:Respiratory failure due to choriocarcinoma: a study of 103 dyspneic patients. 169 17

Echocardiography and Doppler ultrasound are useful in evaluating a variety of pathological conditions affecting the pericardium. Cardiac tamponade results in right atrial collapse and right ventricular diastolic collapse detectable by echocardiography. These echocardiographic signs have a high degree of sensitivity and specificity. False-negative echocardiographic studies may be seen in patients with pulmonary hypertension, and false-positive studies for cardiac tamponade may occur in severe hypovolemia. Although cardiac tamponade is usually caused by pericardial effusion, less commonly intrapericardial clot may result in hemodynamic compromise. Pericardial clot may be echogenic, and hence the diagnosis potentially can be missed. If the intrapericardial clot is localized, the classic echocardiographic signs of pericardial effusion may be absent, and a localized mass may be seen on the echocardiogram. Increased respiratory variation in transvalvular blood flow velocities detectable by Doppler ultrasound is found in cardiac tamponade. Doppler ultrasound studies may be particularly useful in those patients in whom the characteristic echocardiographic abnormalities are absent. Both M-mode and two-dimensional echocardiography may be useful in diagnosing pericardial thickening. Constrictive pericarditis results in a variety of echocardiographic abnormalities including pericardial thickening; biatrial enlargement with good left ventricular function; a diastolic septal bounce; and a dilated inferior vena cava without significant respiratory variation. Doppler echocardiographic abnormalities are commonly found in constrictive pericarditis. Echocardiography is also useful as a guide to performing pericardiocentesis and in the detection of pericardial adhesions and pericardial metastases.
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PMID:Echocardiography and Doppler ultrasound in the evaluation of pericardial disease. 188

Diffuse tumor microemboli to the lungs from prostatic carcinoma are extremely rare, with only six reported cases in the literature published in English. Here a seventh case is reported. The patient resembled the previously reported cases in the following ways: (1) There were minimal chest x-ray findings; (2) there was no other evidence of significant parenchymal or lymphangitic tumor involvement; and (3) pulmonary hypertension developed, but without signs of cor pulmonale. The case was even more unusual because of the presence of an apparent second neoplasm, ie, a malignant fibrous histiocytic sarcoma primary in the chest wall. There were wide-spread "collisional metastases" (metastases from each malignancy at the same site).
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PMID:Diffuse pulmonary tumor microemboli from prostatic carcinoma with an associated fibrous histiocytic sarcoma. 215 98

Progressive dyspnea developed in a 36-year-old woman. Physical examination and chest roentgenogram showed the signs of pulmonary hypertension. She died of respiratory failure in spite of treatment. Autopsy disclosed gastric carcinoma in the pylorus with metastases to the regional lymph nodes, left adrenal gland, and ovaries. There were no gross pulmonary emboli, but more than 50% of pulmonary microvasculature was occluded by tumor cell microemboli. No parenchymal metastases were found in the lung. This case was remarkable because cor pulmonale due to tumor cell microemboli to the lung was the initial and terminal manifestation of clinically occult, but pathologically advanced, gastric carcinoma.
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PMID:Cor pulmonale due to tumor cell microemboli. Report of a case with occult gastric carcinoma. 284 76

A case of primary liver cell carcinoma is presented in which tumor emboli to the pulmonary microvasculature resulted in pulmonary hypertension, documented by clinical, radiologic, electrocardiographic, and cardiac catheter studies. Emboli arose from tumor invading the portal vein and passed via a patent splenorenal shunt to the systemic venous and pulmonary arterial microvasculature. Despite a prolonged clinical course (20 mo) there was no radiologic evidence of pulmonary metastases and, histologically, tumor emboli were seen to undergo organization and recanalization.
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PMID:Pulmonary hypertension complicating hepatocellular carcinoma. 609 Feb 60

A case, unique in the literature, is reported in which a primary carcinoma of the liver presented a right-sided heart failure and pulmonary hypertension. The diagnosis of hepatocarcinoma was established by needle biopsy of the liver. Later, postmortem examination demonstrated that the pulmonary arterial tree was severely compromised by multiple tumor microemboli, despite the persistent lack of characteristic roentgenographic abnormality in our patient. In reviewing the literature, we found rare cases of occult renal cell carcinoma, choriocarcinoma and one of occult hepatocarcinoma, which presented as pulmonary embolism. These were diagnosed by pulmonary embolectomy, human chorionic gonadotrophin levels or autopsy, respectively. In another small group of reported cases of known carcinoma (gastric, breast, colonic) the patients had a clinical picture of "idiopathic" pulmonary hypertension or of pulmonary hypertension with pulmonary metastases. Pulmonary hypertension in these cases resulted from carcinomatous lymphangitis and/or tumor microembolization, as in our case. We report this case to emphasize the necessity of including occult carcinoma in the differential diagnosis of pulmonary hypertension and right ventricular failure.
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PMID:Pulmonary hypertension as a presentation of hepatocarcinoma. Report of a case and brief review of the literature. 624 34

We report the case of a 37 years old woman with a past history of a chondrosarcoma who was admitted to hospital for acute pulmonary hypertension which proved rapidly fatal; autopsy confirmed that the etiology was tumour microemboli rising from a single cardiac metastases from her chondrosarcoma. The originality of this case report lies in the origin of the microemboli and the way in which they presented as a recurrence of the cancer.
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PMID:[Pulmonary artery hypertension due to tumor micro-embolism]. 789 72

Between January 1980 and December 1990, 75 (57.3%) of 131 patients with metastatic gestational trophoblastic tumor had pulmonary metastases detected on plain chest roentgenography at the King Faisal Specialist Hospital and Research Centre. Pulmonary involvement was commonly extensive, with 32 (42.7%) patients having > 10 pulmonary metastases and 45 (60%) patients having a pulmonary lesion > 5 cm in diameter. Greater than 50% lung opacification, mediastinal involvement and pleural effusion were present in 25 (33.3%), 25 (33.3%) and 36 (48%) patients, respectively. Eight (10.7%) patients developed early respiratory failure requiring mechanical ventilation within one month of presentation. The development of early respiratory failure was significantly associated with the presence of dyspnea, anemia, clinical pulmonary hypertension, cyanosis, > 50% lung opacification, mediastinal involvement and bilateral pleural effusion. Because all patients requiring mechanical ventilation died, the use of extracorporeal perfusion should be considered in patients with early respiratory failure.
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PMID:Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure. 803 73

In a patient with diffuse pulmonary metastases of a renal cell carcinoma the development of severe pulmonary hypertension is described after reaching a complete remission during treatment with r-IFN-alpha 2c and rIFN-gamma. Rechallenge with interferon after the discovery of recurrent disease did not lead to deterioration of the cardiopulmonary condition. Possible causative mechanisms are discussed.
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PMID:Acute right ventricular heart failure in a patient with renal cell carcinoma after interferon therapy. 844 28

We report a 67-year-old man who developed pulmonary hypertension as an initial clinical manifestation of occult gallbladder adenocarcinoma. He had a 6-week history of persistent dry cough followed by progressive dyspnea on exertion. Physical examination and chest roentgenogram revealed signs of precapillary pulmonary hypertension. He died of shock 1 h after pulmonary angiography, which failed to show any intravascular filling defects. Autopsy disclosed a mucin-producing small adenocarcinoma (2 cm diameter) and a gallstone in the gallbladder with a few small metastases to peri-aortic, peri-bronchial and mediastinal lymph nodes. Macroscopically, there was no gross thrombotic pulmonary embolism or pulmonary metastases. However, microscopically, more than 60% of the small pulmonary arteries less than 1 mm in diameter were occluded with pulmonary tumor microemboli. This case emphasizes the need to include tumor pulmonary embolism in the differential diagnosis of pulmonary hypertension whether or not there is evidence of an underlying malignant tumor.
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PMID:Subacute pulmonary hypertension due to pulmonary tumor microembolism as a clinical manifestation of occult gallbladder adenocarcinoma. 907 Sep 64


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