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)

Pancreatoblastoma is a rare pancreatic tumor with a distinctive histologic appearance that generally affects infants and young children. We have studied 14 cases of pancreatoblastoma and reviewed 41 previously reported examples. Nine of our cases occurred in children (from newborn to 4 years old; mean, 2.4), and five affected adults (from 19 to 56 years old; mean, 40). There were 8 male cases and 6 female cases. Most patients presented with incidental abdominal masses, although pain, weight loss, and obstructive jaundice were present, but rarely. The tumors were very cellular microscopically, with cytologically uniform epithelial cells arranged in sheets and nests. Well-formed acinar structures were a consistent feature, and several cases contained ectatic ductular formations, rarely exhibiting intracellular mucin. Consistently present were squamoid corpuscles: circumscribed, whorled nests of plump spindle cells with a squamous appearance and occasional keratinization. The stroma was moderate to abundant and frequently quite cellular (especially in the pediatric cases). By immunohistochemistry, the tumors exhibited acinar, endocrine, and ductal differentiation, with positivity for pancreatic enzymes (100%), endocrine markers (82%), and carcinoembryonic antigen (85%). Ultrastructural examination most commonly revealed acinar differentiation, although mucigen granules and neurosecretory granules were also occasionally found. The behavior was variable: 36% of patients developed metastases, especially to the liver. The adult patients did poorly: three of five died of tumor (mean survival, 18 months), and two were alive at 5 and 15 months, respectively. In contrast, five of the six evaluable pediatric patients were alive from 22 months to 22 years after diagnosis, and only one died of tumor after 16 months. Good responses to chemotherapy were noted in the pediatric group.
 ...
PMID:Pancreatoblastoma. A clinicopathologic study and review of the literature. 750 60

Adenocarcinoma of the pancreas is becoming an increasingly common disease. The differential diagnosis of pancreatic adenocarcinoma is that of obstructive jaundice. Suspicious findings on history and physical examination can be confirmed with appropriate laboratory and radiologic testing. Approximately 20% of patients with small lesions and no metastatic disease may be cured with resection. The operative mortality and morbidity for major pancreatic resections is now sufficiently low to warrant a more aggressive approach to these patients.
 ...
PMID:Pancreatic adenocarcinoma: a review for primary care physicians. 750 97

Cholestatic jaundice is the result of a malignancy of the bile duct itself, of the gallbladder, of the ampulla or (as in most cases) of the pancreas. Patients without evidence of metastases or other signs of advanced cancer (e.g. ascites) are candidates for explorative laparotomy. In the vast majority of cases resection of a tumor is not feasible and the surgeon is faced with the objective of providing palliation. To date there exists not only one palliative procedure, and the surgeon has to take into account the following: In patients with pancreatic cancer palliation can be given with biliary bypass with or without gastroenterostomy. This carries an operative mortality of almost 20% and means a survival of only 5-6 months. Nonsurgical procedures as transpapillary stenting play an increasing role in the management of patients with obstructive jaundice due to pancreatic cancer. In some cases however resectable tumors perhaps will be overlooked. The results of controlled studies comparing endoscopic stenting and surgical bypass are encouraging for stenting techniques (lower morbidity and mortality (< 10%), technical success rates exceeding 90%). The availability of different palliative treatment modalities for carcinoma of the bile ducts suggests that no approach is definitely superior. Operative biliary-enteric anastomosis gives a tolerable operative mortality rate in younger patients, less morbidity, than external biliary drainage by better quality of life of the patients. In retrograde placement of prosthetic stents, in patients with high bile duct obstruction difficulties are frequently. In such cases the percutaneous drainage should be reserved for endoscopic failures, in cases the endoscopic and percutaneous approaches can be combined in the 'rendezvous' procedure. In recent years several reports have advocated extensive surgery for biliary neoplasms. Preoperative staging of these patients remains an issue as none of the commonly modalities are accurate in predicting resectability.
 ...
PMID:[Palliative surgical and endoscopic therapy of malignant bile duct occlusion]. 752 70

The decision to perform surgical versus nonoperative palliation for unresectable pancreatic cancer is influenced by a number of factors. In most cases, patient symptoms clearly dictate the management. In patients with symptoms of duodenal obstruction at the time of presentation, surgery is the only option. In patients with obstructive jaundice alone, the options for management must be weighed against factors such as overall health status, projected survival, and procedure-related morbidity and mortality. A prospective multicenter trial recently analyzed factors influencing perioperative morbidity and mortality following both curative and palliative surgery for pancreatic cancer. This analysis demonstrated that preoperative diabetes, low Kanofsky's index, and liver metastases are significant risk factors in predicting perioperative morbidity and mortality in patients undergoing palliative procedures for pancreatic cancer. Another analysis focusing on tumor characteristics suggested that for patients with Stage I and Stage II disease (i.e., with no evidence of systemic metastases), survival and the potential for late duodenal obstruction favor surgical management. In summary, although patient management must be individualized, most patients with pancreatic cancer in good medical health and with no evidence of systemic disease are most appropriately managed with surgical palliation. This option affords patients the best chance of avoiding the late complications of recurrent jaundice, duodenal obstruction, and disabling pain. Surgical palliation can generally be completed with an acceptable perioperative morbidity and mortality and a hospital stay of approximately 2 weeks. Finally, only surgical exploration can offer full opportunity for resection for cure.
 ...
PMID:Surgical palliation of unresectable pancreatic carcinoma. 754 19

Our experience of inserting 90 self-expanding metal endoprostheses in 77 patients with obstructive jaundice is described. All were inserted percutaneously. The longest metal endoprosthesis available was inserted where possible. For local economic reasons most patients had a normal serum albumin, and no evidence of metastases at presentation. Dilatation of biliary occlusions and strictures was not performed. Six re-interventions have been necessary because of tumour ingrowth or overgrowth. Serum bilirubin levels fell to normal in 98.7% of patients within 7 days of insertion. Self-expandable metal endoprostheses offer technical, psychological, physiological and anatomical advantages compared to other forms of palliation in biliary obstructions thought to be unsuitable for surgery. Furthermore, where stents have to be placed percutaneously because endoscopy is not possible, self-expanding metal endoprostheses should be used.
 ...
PMID:Palliation of inoperable biliary obstruction with self-expanding metal endoprostheses: a review of 77 patients. 768 32

Experience is reported of palliative treatment for malignant obstructive jaundice by plastic drain positioned in the biliary tract during endoscopic retrograde cholangiopancreatography (ERCP). In the period January 1989 to December 1991, 35 plastic drains (10-12 French) were implanted in 22 patients of mean age 70 (range 51-88) years because of obstruction due to biliary tract carcinoma (n = 10), metastases (n = 5), pancreatic carcinoma (n = 4) and papillary carcinoma (n = 3). Endoscopic positioning was successful in 86% of cases. The early complication rate was 4.5% (cholangitis) and the 30-day mortality 14%. In 89% of cases drainage was effective and the obstructive jaundice subsided within 3 months. Late complications occurred in 36% of patients, involving cholangitis due to drain obstruction (n = 5) and drain displacement (n = 2). In 27% of patients the drain had to be changed 1-3 times, on the first occasion after an average of 146 (range 14-421) days. The patients' median survival was 5 months.
 ...
PMID:[Endoscopically inserted plastic endoprosthesis in the palliative treatment of malignant obstructive jaundice]. 768 37

The diagnostic value of percutaneous intraluminal ultrasound examination of the biliary tract (PIBUS) for the staging of malignancies that had obstructed the biliary tract was assessed in a prospective study. Intrabiliary sonography was performed 25 times in 22 patients (seven women, 15 men; mean age 66.4 +/- 16 years) with obstructive jaundice in whom percutaneous transhepatic drainage of the biliary tract had been undertaken. The obstruction involved the hepatic duct bifurcation in 15 patients, the distal portion of the choledochal duct in five and its central portion as well as hepaticojejunostomy in one patient each. Ultrasound examination made it possible to assess tumour infiltration into the lumen of the biliary tract, its wall or its surrounding structures. Correct T-staging was successful in all 12 patients with carcinoma of the biliary tract (T1: n = 4; T2: n = 2; T3: n = 6), judged against the "gold standard" of exploratory laparotomy in nine. Infiltration of the portal vein was demonstrated in three patients, lymph node metastases in the region of the hepatoduodenal ligament in seven. This experience indicates that PIBUS makes it possible correctly to T-stage carcinoma of the biliary tract, but because of its limited depth penetration it has to be combined with conventional imaging procedures for precise definition of the N and M stages.
 ...
PMID:[Percutaneous intraluminal ultrasound studies of the biliary tract in the diagnosis of malignant biliary obstruction]. 771 42

The patient was a 64-year-old woman. At hospitalization she had gastric remnant carcinoma with Virchow's and paraaortic lymph node metastases, extensive local infiltration and obstructive jaundice. The lesions were considered nonresectable, and the patient was placed on neoadjuvant chemotherapy consisting of low-dose CDDP and 5-FU, which resulted in the disappearance of Virchow's and paraaortic lymph node metastases. She was considered to have a partial response (PR) and underwent lower esophageal resection, total remnant gastrectomy and splenectomy. Eight months after surgery, however, she died of disseminated carcinomatosis of bone marrow. Since this therapy was associated with only slightly adverse events (< or = Grade 1), this treatment modality appears to be safe. However, further studies will be necessary to identify what type of recurrence is responsive to this therapy and to evaluate its effect on patient survival.
 ...
PMID:[A case of advanced gastric remnant carcinoma with Virchow's metastasis treated with neoadjuvant chemotherapy (low dose CDDP + 5-FU) followed by surgical resection]. 785 4

The authors report the second case to date of metastatic carcinoma of the common bile-duct from renal cell cancer presenting as an intraluminal polypoid mass. Obstructive jaundice developed in a 55-year old woman 14 years after nephrectomy for renal cell carcinoma. The diagnosis of polypoid tumor of the common bile-duct was established by sonography, endoscopic retrograde cholangiopancreatography and CT-scan. Palliative resection was performed. Postoperative histological examination revealed the resected tumor to be identical to the clear cell type of renal cell carcinoma. The postoperative course was marked by the development of distant metastases 6 months later. Diagnosis and therapeutic features of metastatic malignant biliary obstruction are discussed.
 ...
PMID:[Intraluminal polyp of the common bile duct corresponding to a metastasis of cancer of the kidney]. 819 15

From January 1990 through July 1992 we attempted to treat 42 patients (21 men, 21 women; mean age 69 +/- 2 years) with obstructive jaundice due to inoperable malignant biliary obstructions with insertion of metal stents. 67% of the patients had stenoses of the distal common bile duct, 5% of the proximal common bile duct, and 28% had hilar lesions. Obstructions were due to pancreatic cancer (47%), gallbladder cancer (13%), cholangiocarcinoma (20%), and lymphoma of metastatic cancer (20%). We inserted a total of 51 Wallstents and 17 Strecker Stents with a technical success of 100%. The functional success was 95%. The mean bilirubin level decreased from 18.2 +/- 1.7 mg/dl before to 1.5 +/- 0.2 after stent insertion. In the first 30 days one patient (2%) with hilar malignancy developed an early reobstruction due to tumor bleeding and debris. The 30-day mortality rate was 2%. 2 (5%) patients developed recurrent jaundice within the 3-month follow-up period; 1 had tumor overgrowth of the metal stent, 1 had tumor ingrowth through the mesh. Metal biliary endoprotheses offer sufficient initial relief of malignant obstructive jaundice with reduced morbidity and mortality compared to the placement of conventional plastic stents. However, the long-term results are impaired by stent occlusion due to tumor ingrowth or overgrowth.
 ...
PMID:Relief of malignant obstructive jaundice by endoscopic or percutaneous insertion of metal stents. 835 16


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>