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

Although metastatic melanoma is renowned for its propensity to spread to a wide range of sites, symptomatic metastases within the biliary tree are very rare. A patient with a past history of melanoma who presented with obstructive jaundice and in whom computerized tomography (CT) scanning revealed a spherical filling defect 1 cm in diameter at the lower end of the common bile duct is reported. The obstructing lesion was thought likely to be a gallstone. However, on surgical exploration it was found to be a polypoid melanoma metastasis, freely mobile within the lumen of the lower duct but attached to its wall by a thin stalk. There was no evidence of metastatic melanoma elsewhere in the abdomen. The tumour was removed without difficulty, completely relieving the obstructive jaundice. The patient remains well 14 months later, with no evidence of recurrent visceral melanoma.
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PMID:Common bile duct obstruction due to intraluminal metastatic melanoma. 849 25

Carcinoids of the stomach, duodenum, and pancreas are represented by a variety of tumors with variable histologic and clinical features. Multicentric gastric carcinoids and concomitant nonantral argyrophilic hyperplasia are common in chronic atrophic gastritis, more rarely due to a multiple endocrine neoplasia (MEN)-related Zollinger-Ellison syndrome (ZES). These tumors are infrequently associated with metastases and may generally be dealt with by repeated endoscopic fulguration. Sporadic carcinoids tend to be larger, invasive, and more often metastatic, especially in the presence of atypical histology. Small tumors may be removed by endoscopy, but larger lesions need to be surgically excised. In association with metastases a histamine-related atypical carcinoid syndrome may evolve and require treatment with a somatostatin analog. Poorly differentiated neuroendocrine carcinomas of the stomach constitute markedly aggressive tumors that rarely are suitable for radical surgery. Gastrinomas are the most prevalent duodenal carcinoids and a common cause of ZES especially in MEN-I. Despite a marked tendency for regional lymph node dissemination, liver metastases occur late and duodenal gastrinomas are often excisable, thereby offering favorable odds for cure in ZES. Unusual somatostatin-rich carcinoids in the ampulla of Vater relate to von Recklinghausen's disease and may be the cause of obstructive jaundice; depending on their size, these tumors may be removed by local excision or pancreaticoduodenectomy. Gangliocytic paragangliomas are unusual, generally benign lesions of the duodenum. Rare pancreatic tumors with serotonin immunoreactivity may be classified as carcinoids and constitute an unusual cause of the carcinoid syndrome.
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PMID:Management of carcinoid tumors of the stomach, duodenum, and pancreas. 866 14

We describe a 69-year-old woman with basal cell carcinoma, and chronic lymphocytic leukemia who developed Merkel cell tumor. This latter malignancy first appeared as enlarged lymph nodes in the axilla and elbow regions and responded initially to radiotherapy. Later, the patient developed obstructive jaundice which was due to pancreatic metastases of the Merkel cell tumor, documented by post-mortem examination. To our knowledge, this is the first description of a Merkel cell tumor causing obstructive jaundice, in a patient with chronic lymphocytic leukemia.
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PMID:Merkel cell tumor in a woman with chronic lymphocytic leukemia. 883 12

The usefulness of percutaneous transhepatic biliary drainage (PTBD) in the treatment of obstructive jaundice caused by metastases from nonbiliary and nonpancreatic cancers was evaluated. Eighteen patients underwent PTBD during a 3-year period. The primary cancers were located in the stomach (nine cases), colon (four), lung (three), uterus (one), and breast (one). The causes of obstructive jaundice and bile duct strictures were investigated using both abdominal computed tomography and abdominal ultrasonography. The causes of obstructive jaundice, the usefulness of PTBD in terms of the relief of symptoms and laboratory data, survival after PTBD, and the relationship between patient characteristics and survival were evaluated. Obstructive jaundice was most often attributable to metastases to the lymph nodes (17 of 18 cases). One case was attributed to metastasis to the liver. PTBD decreased the jaundice and relieved the symptoms caused by biliary tract obstruction. Median survival after PTBD was 59 days. Patients whose performance status was 2 or less survived longer than those with a performance status of 3 or more (P=0.018). Furthermore, patients aged less than 60 years tended to survive longer than those aged 60 or over (P=0.057). Our results suggest that PTBD is useful for relief of symptoms caused by obstructive jaundice in patients with nonbiliary and nonpancreatic cancers.
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PMID:Percutaneous transhepatic biliary drainage for the treatment of obstructive jaundice caused by metastases from nonbiliary and nonpancreatic cancers. 900 53

The use of intraoperative ultrasonography (IOUS) to evaluate liver, bile ducts and pancreatic disease, as compared to the results of preoperative ultrasonography and CT, is discussed. Forty-two patients who underwent abdominal surgery for suspected hepatobiliary and/or pancreatic diseases were studied. The intraoperative study was carried out with a portable apparatus (Aloka 500, Japan), using 5.0 MHz and 7.5 MHz linear sterile transducers. The main indications for IOUS were the search for and/or evaluation of primary hepatic masses, hepatic abscesses or metastases, obstructive jaundice, or neuroendocrine tumors. In 5 cases (38.5 percent) from the hepatobiliary group and in 7 cases (58.3 percent) from the pancreatic group, a difference between preoperative and intraoperative findings was observed. The main difference was observed in relation to the number and size of hepatic and pancreatic lesions. The relationship between the lesions and the vascular structures was evaluated through IOUS. The method was also used to guide surgical procedures such as biopsies, the alcoholization of nodules, and the drainage of abscesses. IOUS plays an important role in detecting small hepatic and pancreatic nodules. In the assessment of anatomical relationships between the lesions and the vascular structures, and in the performance of interventionist procedures.
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PMID:Intraoperative ultrasonography of liver, bile ducts and pancreas. 919 35

Primary malignant melanoma of the biliary tract is an obscure entity, with only four previously reported cases. We report two cases involving the common bile duct. A 43-year-old male who underwent a right hepatectomy and excision of the extrahepatic biliary tree for a lesion at the bifurcation of the common bile duct. He remains alive and well 11 months after resection. The second patient is a 45 year old male with obstructive jaundice due to an ampullary lesion. Pancreaticoduodenectomy was performed with no signs of metastatic disease. He is 6 years following resection without evidence of disease. This is an unusual cause of obstructive jaundice and a definitive search for a possible extra-biliary primary should be pursued. In appropriately selected patients without evidence of metastatic disease, resection can potentially afford long-term survival if these lesions are true primary lesions and not metastatic from an undefined primary. However, given the high metastatic potential of melanoma it is unclear whether resection of these lesions results in cure or just effective long-term palliation.
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PMID:Primary malignant melanoma of the biliary tract. 934 49

26 consecutive cases of obstructive jaundice due to a carcinoma of the head of the pancreas were studied prospectively with ultrasound (US), computerized tomography (CT), endoscopic ultrasonography (EUS) and laparoscopic ultrasound (LUS). Sensitivity of US, CT were comparable, although CT seems better to evaluate the size of the tumor and for lymph node detection. 50 percent of patients had a criterion for noncurative resection. EUS (16 cases) had the best sensitivity (100 percent) for the staging of small tumors (less than 20 mm), detection of adjacent nodes and the relation between tumors- and mesenteric and portal vein. EUS was not able to detect peritoneal and/or liver micro-metastases. The criterion for noncurative resection was 57.6%. LUS exactly assessed all tumors larger than 2 cm. The accuracy compared with EUS was not as good for small tumors, but better concerning micro-peritoneal or hepatic metastasis. The criterion for noncurative resection was 80.7 percent. These results suggest to use of US and CT as first-line procedures in the preoperative staging and assessment of resectability of pancreatic cancers. When the patient does not appear to have disseminated lesions, EUS gives a good estimation of the size of the tumor, node assessment and vascular relations. LUS could be the first step for a curative surgical treatment. LUS revelated to discover 15 to 30 percent of unknown micro-metastases and avoided useless laparotomy in these patients.
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PMID:The use of laparoscopic ultrasound in the assessment of pancreatic cancer. 938 46

Combination chemotherapy with 5-FU and CDDP was given to two patients with obstructive jaundice due to intra-abdominal lymph-node metastases of advanced and recurrent gastric cancer. One patient was a primary case associated with lymph-node metastases of portal fissure and periaorta, and the other was a recurrent case associated with lymph-node metastases of hepatoduodenal ligament and periaorta. The regimen consisted of 5-FU 1,000 mg/ m2 (day 1-5, continuous infusion) and CDDP 100 mg/m2 (day 3, 1 hr drip infusion). The interval was from the 6th to 21st day. The response to chemotherapy showed shrinking of intra-abdominal lymph-nodes and reopening of the biliary tract. The patients could be discharged from the hospital without PTBD tube and enjoyed a better quality of life (QOL). This therapy is thought to be effective against obstructive jaundice due to intra-abdominal lymph-node metastases of advanced and recurrent gastric cancer.
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PMID:[Two patients with obstructive jaundice due to intra-abdominal lymph-node metastases of gastric cancer responding to combination chemotherapy with 5-FU and CDDP]. 953 Mar 69

Carcinoma of the pancreas is the fourth leading cause of cancer related death in Western Countries. The 5-year survival for resectable tumors is 15-25%, while patients with unresectable neoplasms survive a median of 7 months. Only 30% of carcinomas of the head of pancreas and 10% of the body and tail are resectable for cure. Therefore, palliation of symptoms, namely obstructive jaundice, duodenal obstruction and pain, involve 80-90% of cases. Jaundice is frequent in tumors of the head. Palliative biliary decompression can be achieved by non surgical methods-endoscopically placed endoprostheses or percutaneous biliary drainage- or surgically. The former are indicated in patients with metastatic disease, high operative risk and short life expectancy. Surgical palliation which includes choledocho-duodenostomy, cholecystoduodenostomy, cholecystojejunostomy, hepato or choledocho-jejunostomy offers the advantage of providing a simple procedure that can treat or prevent all of the major symptoms: jaundice, duodenal obstruction and pain. Mechanical obstruction of the duodenum occurs in about 30% of cases in association with jaundice at the time of presentation and in 13-21% of patients previously subjected to biliary bypass after 8 months. Actual obstruction can be relieved by gastro-jejunostomy. Significant controversy remains concerning the role of prophylactic gastro-jejunostomy in patients requiring biliary diversion without signs of duodenal obstruction. Pain, which sooner or later affects the majority of patients, can be relieved by splanchnicectomy, either surgically or percutaneously.
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PMID:[Palliative treatment of pancreatic adenocarcinoma]. 957 40

We report two cases of carcinoma of the pancreas with anomalous junction of the pancreaticobiliary tracts. A 71-year-old Japanese woman had obstructive jaundice. Ultrasonography showed a hypoechoic mass in the pancreatic head and computed tomography demonstrated a low-density nodule in the pancreatic head. Endoscopic retrograde cholangiopancreatography displayed a double duct sign and an anomalous junction of the pancreaticobiliary tracts. The patient underwent a pancreatoduodenectomy. The histopathologic diagnosis of the resected specimen was adenocarcinoma of the pancreatic head. A 56-year-old Japanese man also developed obstructive jaundice. Ultrasonography and computed tomography showed a huge mass almost replacing the whole pancreas and involving the superior mesenteric artery, splenic artery, splenic vein, and portal vein. Multiple hepatic metastases and peritoneal dissemination were present. Endoscopic retrograde cholangiopancreatography demonstrated an anomalous junction of the pancreaticobiliary tracts. The patient died of hemorrhage from esophageal varices. We discuss the relationship between the anomalous junction of the pancreaticobiliary tracts and pancreatic carcinoma.
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PMID:Carcinoma of the pancreas associated with anomalous junction of pancreaticobiliary tracts: report of two cases and review of the literature. 968 64


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