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 46-year-old man had a 7-year history of severe rash, which was then diagnosed as necrolytic migratory erythema. He had a weight loss of 6 kg, abnormal glucose tolerance test findings, anemia, glossitis, hair loss, and hypoproteinemia. Plasma amino acids levels were significantly decreased, and the fasting plasma glucagon (IRG) level was high at 5000 to 8000 pg/ml. Circulating IRG significantly increased after oral glucose loading, meal ingestion, and arginine infusion, and decreased with somatostatin infusion and insulin-induced hypoglycemia. No other gut or pancreatic hormone levels in plasma were elevated. Plasma IRG was eluted by gel-filtration, mainly in the position of true glucagon (MW 3500) by antiserum 30K. The rash was markedly improved after infusion of amino acids. Computerized tomography (CT) scan and celiac angiography revealed a large pancreatic tumor with multiple liver and lymph node metastases. The pancreatic tumor was totally resected, and was identified as glucagonoma by immunohistochemical technique. Since the plasma IRG levels remained high after surgery, the patient received dimethyltriazenoimidazole carboxamide therapy. After several courses of this treatment, plasma IRG levels decreased to 1000 to 2000 pg/ml, and the hepatic metastases were remarkably diminished in size.
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PMID:A functional study of a case of glucagonoma exhibiting typical glucagonoma syndrome. 286 23

SMS 201-995 (Sandostatin) was studied using low doses (50 to 100 micrograms) administered subcutaneously every 12 hours. A single 50-micrograms dose of SMS 201-995 effectively controlled gastric acid and blood gastrin levels for 12 hours in three patients with benign gastrinomas and was useful in their perioperative management. Higher doses of the agent (500 to 800 micrograms per day) had no effect on metastases in one of two patients with metastatic gastrinoma. In the other patient, one tumor shrank but the other continued to grow after three months of treatment while serum gastrin levels did not change. Cultured metastatic tumor tissue from this patient released different forms of gastrin; growth rates varied, independent of uptake of SMS 201-995, and gastrin release increased. A neonate with nesidioblastosis maintained normal blood glucose levels while receiving SMS 201-995 therapy following a 95 percent pancreatic resection. In two elderly patients with organic hypoglycemia--one with a single benign adenoma and one with multiple adenomatosis--the somatostatin analogue did not prolong the hypoglycemia-free interval. In nine patients with carcinoid syndrome, flushing was uniformly controlled with 50 micrograms of SMS 201-995 administered every eight to 12 hours. One of the nine required exocrine pancreatic replacement. After six months of treatment, three of the nine had no change in tumor size and one had remission of symptoms and stopped treatment. In two patients with vipoma, SMS 201-995 controlled diarrhea and reduced levels of vasoactive intestinal peptide; tumor necrosis occurred in one patient. In a patient with diabetic diarrhea unresponsive to all treatments, SMS 201-995 therapy controlled the diarrhea but did not interfere with control of the diabetes.
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PMID:Somatostatin analogue (SMS 201-995) in the management of gastroenteropancreatic tumors and diarrhea syndromes. 287 47

In some instances, tumors can produce signs and symptoms at a distance from the tumor or its metastases. These are defined as paraneoplastic syndrome or humoral syndrome associated with neoplasms. Paraneoplastic syndromes can arise from circulating substances secreted by tumors. The most well-recognized and frequent concomitant of neoplasms is the production of hormones by nonendocrine tumors. These are usually called ectopic hormone-producing tumors and bring about clinically endocrinologic manifestations secondary to hormone excess in patients with nonendocrine tumors. Paraneoplastic endocrine syndromes frequently observed are Cushing's syndrome due to ectopic production of ACTH, SIADH due to ectopic production of ADH, hyper-calcemia, hypoglycemia and so on. In order to establish a paraneoplastic etiology for alteration in hormone production, evidence that the hormone is produced by the tumor must be proved. Paraneoplastic endocrine syndromes should be distinguished from hormone production by benign cells, hormone production by a malignancy of an endocrine organ or alterations in hormone production being due to infiltration into the endocrine organ by a primary tumor. The treatment of ectopic endocrine syndromes should be directed primarily at the tumor. Because the course of this type of syndrome usually runs parallel to the course of the underlying tumor, the ectopically produced hormone can be a useful monitoring marker of the disease.
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PMID:[Paraneoplastic endocrine syndromes]. 301 95

The case of a 35-year-old woman with malignant fibrous histiocytoma of the right lung is reported. In spite of the considerable size of the tumour, no metastases have been found in the autopsy. The dominant type was a fibroblastlike cell. Owing to its infiltration of the spinal column, the tumour had paralyzed the lower part of body. Moreover, hypoglycemia was terminally observed. On the basis of these findings and reports in the literature we discuss the clinical and morphological problems, the therapy and prognosis of malignant fibrous histiocytoma of the lung. Besides the possible connection of tumour to hypoglycemia (Doege-Potter-Syndrome) is also discussed.
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PMID:[Malignant fibrous histiocytoma of the lung]. 609 52

We reviewed our personal experience with insulin-secreting carcinoma of the pancreas to determine the clinical course and the role of surgery in this disease. Seventeen patients with high-grade metastatic carcinoma were treated at our institution between 1957 and 1982. To this series we have added 45 cases of metastatic carcinoma reported in the literature. All patients had symptoms with manifestations of hypoglycemia. Patients with metastatic insulin-secreting carcinoma had an average age of 48.5 years, with male predominance. The average duration of symptoms at presentation was 2.0 years. The tumors were usually single and averaged 6.2 cm. All tumors had metastases, most commonly to the liver and/or lymph nodes. The median disease-free survival after curative resection was 5 years. The recurrence rate was 63%, with the median interval to recurrence 2.8 years, and the median survival with recurrent tumor was 19 months. Palliative resection was associated with a median survival of 4 years, and biopsy only, 11.0 months. Insulin-secreting carcinomas are slow-growing tumors with significant metastatic potential. Surgical resection of primary and metastatic tumors represents the treatment of choice when possible. Long-term follow-up is required.
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PMID:Metastatic insulin-secreting carcinoma of the pancreas: clinical course and the role of surgery. 609 77

The authors review briefly the contributions to the "insulin story" made by Canadian doctors. A.G. Nichols from the department of pathology, McGill University, first described an adenoma arising from the islets of Langerhans. The authors also review the background to the first successful excision of a functioning tumour of the pancreas by R.R. Graham in 1929; in the preceding 2 years W. J. Mayo had found a malignant islet cell tumour with hepatic metastases and J.M.T. Finney had operated on a patient suffering from functional hypoglycemia. Graham found and successfully excised what was probably a solitary benign islet cell adenoma. The authors believe the patient was cured.
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PMID:Canadian contributions towards the comprehension of hyperinsulinism: the first successful excision of an insulinoma. 625 57

Periampullary tumors, especially carcinoma of the ampulla of Vater and, to a lesser degree, carcinoma of the distal common bile duct and duodenum, are potentially and theoretically curable, even in the presence of regional lymph node metastases. Adenocarcinoma of the anatomic head of the pancreas or of the uncinate process, regardless of the status of the local lymph nodes, may be an incurable tumor because of its late clinical presentation. The treatment of choice for selected, curable carcinomas of the periampullary region is radical pancreatoduodenectomy. Carcinoma of the head of the pancreas should be resected when careful dissection does not reveal regional or distant lymph node involvement. Other presumed curable malignancies presenting as a mass in the pancreatic head, such as cystadenocarcinoma, islet cell carcinoma, and rare connective tissue sarcomas, also should be treated by the Whipple operation. If the remaining, distal pancreatic duct is unsuitable for anastomosis, total pancreatectomy should be completed. The so-called "regional pancreatectomy," as well as resection of portal and superior mesenteric veins, can be performed, but the value of these procedures has not been proved. Palliative bypass procedures should be performed for all malignant masses in the head of the pancreas if distant spread of disease is evident. The only exception is an islet cell carcinoma; this tumor can be resected with satisfactory palliation of symptoms of hypoglycemia despite the presence of advanced disease. Biliary enteric bypass also should be employed when diseased regional lymph nodes are associated with carcinoma of the head of the pancreas or large carcinomas of the periampullary duodenum. A side-to-side choledochojejunostomy is the preferred method of decompression. Gastrojejunostomy is a frequent companion procedure.
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PMID:Mass in the head of the pancreas: a practical approach. 738 71

Meningiomas rarely give rise to metastases despite frequent dural invasion. A rare case of symptomatic hypoglycaemia due to extensive liver metastases from an angioblastic meningioma is described along with the use of hepatic arterial chemo-embolization to effect palliation by reduction in tumour bulk.
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PMID:Intracranial meningioma with hepatic metastases and hypoglycaemia treated by selective hepatic arterial chemo-embolization. 753 50

We report herein a rare case of malignant insulinoma which recurred as multiple liver metastasis 8 years after the initial resection. The patient was a 51-year-old Japanese man who originally presented in 1985 at the age of 43 years suffering from general malaise and syncope. The initial surgery in 1985 involved complete enucleation of a 15 x 13 mm insulinoma located in the uncus of the pancreas. Histopathologically, the tumor was diagnosed as a benign adenoma (insulinoma) which was immunohistochemically stained with only the anti-insulin monoclonal antibody. Macroscopically, there were no signs of either invasion or metastasis. During the subsequent 7 years, he did not show any symptoms or significant abnormality in laboratory data. However, in 1993, the patient again experienced syncope with hypoglycemia and hyperinsulinemia. Ultrasonography revealed multiple echogenic lesions in the liver and a second laparotomy confirmed multiple hepatic metastases from insulinoma, the histopathological findings of which were similar to those of the primary tumor from 8 years before. The patient is currently being treated with streptozotocin and 5-fluorouracil via a catheter in the hepatic artery.
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PMID:Malignant insulinoma causing liver metastasis 8 years after the initial surgery: report of a case. 754 77

The development of renal cell neoplasms ranging from adenoma to metastatic carcinoma is the most serious complication of acquired cystic kidney disease (ACKD). A comprehensive review of the pertinent literature shows that there is up to 50-fold increased risk of renal cell carcinoma in ACKD compared to the general population. The ACKD-associated renal cell carcinoma is seen predominantly in males, occurs approximately 20 years earlier than in the general population, and is frequently bilateral (9%) and multicentric (50%). Acquired cystic kidney disease-associated renal cell carcinoma is frequently asymptomatic (86%), but may be associated with bleeding, abrupt changes in hematocrit, fever, and flank pain or rarely with hypoglycemia, hypercalcemia, or metastases at presentation. Computed tomography seems to provide a better diagnostic yield than sonography or magnetic resonance imaging; nevertheless, large (up to 8 cm) tumors not visualized by any imaging techniques have been reported. It is generally agreed that there is a need for regular screening of symptomatic ACKD patients for early detection of renal cell carcinoma; however, whether screening is needed for asymptomatic patients remains controversial. Nephrectomy is indicated for tumors larger than 3 cm. Management for tumors smaller than 3 cm with persistent symptoms, such as back pain or hematuria, remains controversial, but nephrectomy may be recommended since many of these tumors turn out to be unequivocal renal cell carcinoma. Asymptomatic tumors smaller than 3 cm should be serially screened, and tumor enlargement may be an indication for nephrectomy. Acquired cystic kidney disease-associated renal cell carcinoma accounts for approximately 2% of deaths in renal transplant patients. A median length of survival of approximately 14 months and a 5-year survival rate of 35% are comparable to the same data for renal cell carcinoma in the general population. Successful renal transplant probably decreases the risk of renal cell carcinoma in ACKD patients, but this preliminary observation needs confirmation. The development of ACKD-associated renal carcinoma is a continuous process with evolving phenotypic expression, including damaged renal tubule, simple cyst, cyst with atypical lining, adenoma, and, finally, carcinoma. The pathogenesis of this continuous process is not entirely known, but growth factor-induced compensatory growth of tubular epithelium initiated by the changes of end-stage kidney disease, and probably perpetuated by activation of proto-oncogenes, seems to be the most significant factor.
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PMID:Renal neoplasm in acquired cystic kidney disease. 761 Dec 40


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