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)

A 54-year-old woman with obstructive jaundice was found to have a 4-cm ulcerated, elevated tumor, located at the papilla of Vater by endoscopy and radiographic investigation. Based on a clinical diagnosis of carcinoma of the ampulla of Vater, a pylorus-preserving pancreaticoduodenectomy was performed. The histologic appearance of the lesion was identical to extrapulmonary small cell carcinoma, with diffuse proliferation of small, spindle-shaped, atypical tumor cells with numerous mitoses. Neuroendocrine differentiation was demonstrated by immunoreactivity with neuron-specific enolase (NSE) and Leu-7, and by the presence of dense core granules ultrastructurally. The tumor was composed mainly of small cell neuroendocrine carcinoma, and partially of an area of squamous differentiation, showing transition from one to the other. Histopathologic investigation disclosed direct invasion deep to the lamina propria, and infiltration of the pancreatic parenchyma, duodenum, and bile duct. Lymph node metastases were present in the superior pancreaticoduodenal chain. The patient died of liver metastases 8 months later. As in previously reported cases of small cell neuroendocrine carcinoma of the ampullary region, the present case showed extremely aggressive clinical behavior with early metastases resulting in fatal outcome.
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PMID:Small cell neuroendocrine carcinoma of the ampulla of Vater with foci of squamous differentiation: a case report. 1574 32

Though the high incidence of pancreatic metastasis of lung cancer has been reported in autopsy series, symptomatic cases with jaundice due to that is very rare. Dominant histological type with pancreatic metastases is small cell carcinoma and prognosis is poor. Hereby, we report a case initially presenting with gastroenterologic symptoms as jaundice, nausea, vomiting, weight loss and abdominal pain and then diagnosed as primary small cell carcinoma of the lung with metastasis to pancreas. He underwent a palliative surgery due to obstructive jaundice. This presented case is a rare one with its priority of gastroenterologic symptoms rather than pulmonary complaints.
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PMID:A case of a small cell lung carcinoma presenting with jaundice due to pancreatic metastasis. 1661 26

We present herein a rare case of a long-term survivor after major hepatectomy performed for a metastatic liver tumor from carcinoma of the papilla of Vater. A 74-year-old man had undergone a pancreaticoduodenectomy for carcinoma of the papilla of Vater with obstructive jaundice, in April 1995. Histologically, an exposed mass-forming type of tumor, measuring 40 x 30 mm, was composed of mucinous and papillary adenocarcinoma, invading into the muscularis propria of the duodenum, without lymph node metastases. The patient did not receive any type of chemotherapy. In September 1999, a solitary hepatic tumor, 3.5 cm in diameter, was detected in segment VIII of the liver by computed tomography. In November 1999, right hepatic lobectomy was carried out. The anterior and posterior portal pedicles were ligated and dissected in the hepatic parenchyma so as not to compromise the hepaticojejunostomy. After the hepatectomy, the patient was treated with low-dose tegafur/uracil/cisplatin therapy for approximately 2 years. He has been doing well, without recurrence, for 5 years after the hepatectomy. Hepatectomy for hepatic metastases from carcinoma of the papilla of Vater is thought to be a useful surgical treatment in selected patients.
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PMID:Long-term survival after hepatectomy for hepatic recurrence of carcinoma of the papilla of Vater. 1613 1

Adenocarcinoma of the pancreas (pancreatic cancer) is the most frequent tumor entity in the pancreas. While the results of surgical therapy of pancreatic cancer were disappointing in the past due to high perioperative mortality rates, resection of pancreatic cancer nowadays represents the standard treatment for non-metastatic cancer with a mortality rate below 5%. This decrease in perioperative mortality of the Whipple operation is inversely correlated to the case load of the hospital and the responsible surgeon, and is mainly related to improvements in the intensive care management, the surgical technique and patient selection. In particular, the perioperative use of octreotide resulted in a significant decrease in the rate of pancreatic fistula. Furthermore, modern staging examinations such as diagnostic laparoscopy, PET, or endoscopic ultrasound resulted in improved patient selection. In addition, the long-term results of the surgical treatment of pancreatic cancer has been improved by adjuvant and neoadjuvant chemotherapy in the past 10 years. Similar progress has been made in the palliative treatment of metastatic or locally advanced cancer. Nowadays, endoscopic procedures can replace surgical palliation of obstructive jaundice in most cases and sometimes even gastric outlet obstruction. Moreover, systemic chemotherapy using gemcitabine-based protocols has resulted in a significant prolongation of survival. However, further progress in the treatment of pancreatic cancer can only be achieved by an interdisciplinary management of this disease.
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PMID:[Current diagnosis and treatment of pancreatic cancer]. 1613 69

TS-1/CPT-11 combination therapy was carried out in a case of advanced gastric cancer with liver and lymph node metastases and obstructive jaundice after percutaneous transhepatic cholangio drainage (PTCD). Regression of the primary carcinoma and reduction in size of metastases were observed. Grade 1 fatigue and grade 2 neutropenia were noted as adverse reactions to the treatment. TS-1/CPT-11 combination therapy was useful in this case of advanced gastric cancer with liver and lymph node metastases.
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PMID:[A case of advanced gastric cancer with obstructive jaundice that responded to TS-1/CPT-11 combination therapy after percutaneous transhepatic cholangio drainage]. 1622 50

The surgical treatment of gastric adenocarcinoma foresees, toghether with the gastric resection, the lymph nodes resection as indicated by the Japanese Research Society for Gastric Cancer. Obstructive jaundice, as a consequence of lymph nodes metastases, is one of the most debilitating pattern of recurrence. In the present paper three cases of jaundice, observed during the follow-up, after D2-D3 gastric adenocarcinoma resection, with no evidence of lymph nodes recurrence either at the restaging or at the intraoperative esploration are reported. We believe that the jaundice etiology, in the present series, could be due to neoplastic lymphangites of the biliar wall.
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PMID:[Jaundice from neoplastic lymphangitis in patients undergoing D2/3 lymphadenectomy for gastric neoplasms. Our experience]. 1643 12

Although not a typical site, the pancreas does occasionally harbor metastatic disease. Management of these metastases differs from the management of conventional primary cancers. Our case is one of an 85-year-old female presenting with obstructive jaundice and whose workup revealed a pancreatic mass. Her past medical history included a mastectomy 14 years previous for invasive lobular carcinoma. She underwent celiotomy, and an intraoperative diagnosis of metastatic lobular carcinoma of the breast was made based on frozen section. Due to pulmonary metastasis and vascular infiltration, which precluded pancreatoduodenectomy, the patient underwent palliative bypass and fared well postoperatively. With more aggressive management of primary breast cancers in the past decade, isolated metastatic disease is of increasing concern and raises questions about surgical strategies to be implemented with these patients. For instance, should palliative treatment be considered or should a radical intention to cure procedure be performed despite the metastatic disease? Factors favoring radical procedures include prolonged lag phase between the primary and the recurrence; presence of well-differentiated tumors; and isolated metastatic disease. Primary lung and renal cancers metastasize more frequently than breast cancers do to the pancreas. Hence, existing literature has not clearly defined indications for radical treatment of metastatic breast cancers to the pancreas. Based on experiences with metastatic renal and lung cancers, one can reasonably infer that radical procedures performed on selected cases could possibly achieve a cure or prolonged disease-free survival. The key factor in determining whether the patient undergoes palliative versus radical treatment is a slow growth pattern of the tumor, characterized by a prolonged lag phase between the primary and the metastatic disease.
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PMID:Pancreatic mass of unusual etiology: case report of metastatic disease after a prolonged lag phase. 1644 87

A 74-year-old man was suffering from Borrmann type 2 advanced gastric cancer with abdominal lymph node metastases and multiple lung metastases. He started to undergo outpatient treatment with oral administration of TS-1. But pyloric stenosis was found after 6 courses of TS-1 chemotherapy, so he underwent palliative distal gastrectomy. TS-1 chemotherapy was continued afterwards, however obstructive jaundice was found. So combination chemotherapy of CPT-11 60 mg/m(2)and CDDP 30 mg/m(2)biweekly was selected as a second-line therapy after PTCD. As no side effects were found, he could be treated on an outpatient basis by CPT-11 60 mg/body and CDDP 30 mg/body biweekly. Four months has passed since the palliative operation, and the PTCD tube was successfully removed. The abdominal lymph nodes had decreased in size and the patient has maintained good QOL. Thus, combination CPT-11 and CDDP therapy could well be a new candidate for a second-line chemotherapy in outpatients.
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PMID:[A case of gastric cancer presenting with obstructive jaundice and responding to biweekly CPT-11 and CDDP combination administration]. 1668 67

Obstructive jaundice is uncommon in patients with hepatocellular carcinoma. It can be due to compression of the common bile duct by the liver tumor or by enlarged lymph node metastases in the porta hepatis. Obstructive jaundice can also be due to direct extension of hepatocellular carcinoma into the bile ducts with or without a detectable primary hepatic tumor. These particular hepatocellular carcinoma have been termed "icteric type hepatoma" by Lin et al. in 1975, who emphasized their poor prognosis. We report a similar case of endobiliary hepatoma without a detectable intraparenchymal hepatic tumor in a seventy year-old man. This case is unusual because of its positive evolution and late recurrence.
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PMID:[Delayed recurrence of an endobiliary hepatocellular carcinoma without detectable intra-parenchymatous tumor]. 1680 6

Pancreatic cancer, which is responsible for >90% of exocrine pancreatic tumours, is typically a disease of the elderly (> or =70 years of age). However, older patients are less likely to be staged than younger patients despite having a worse overall 5-year survival rate than their younger counterparts. Various radiological, ultrasonographic and endoscopic investigations are used not only as diagnostic tools but also to accurately stage the cancer for possible surgery. Many patients with pancreatic cancer have mutations of the K-ras oncogene, and various tumour suppressor genes are also inactivated. Pancreas resection can be performed in elderly resectable patients without excess mortality, even in those >80 years of age. However, treatment for locally advanced, unresectable and metastatic pancreatic cancer is palliative. Fluorouracil-based chemoradiation for locally advanced or unresectable cancer, and gemcitabine for patients with metastatic disease, can result in clinical benefits. Placement of a stent in the biliary tract has been shown to improve symptoms of obstructive jaundice or ascites, as well as quality of life. As molecular targets are identified, interventions with targeted specific agents may improve tumour control. However, further studies will be needed to demonstrate whether or not various agents targeting signal transduction pathways or nuclear transcription factors are useful for elderly patients with advanced pancreatic cancer.
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PMID:Current treatment strategies for pancreatic cancer in the elderly. 1682 93


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