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)

The purpose of this study was to evaluate the efficacy of somatostatin receptor scintigraphy (SRS) in imaging metastases in patients with advanced breast cancer (BC), and assess the relationship between exposure to chemotherapy and hormonotherapy with overexpression of somatostatin receptor (SS-R) on the breast cancer cell surface. Twelve patients with metastatic breast cancer were intravenously (i.v.) injected with In-111 pentatreotide (120 MBq). Early and later images were obtained with a double-head gamma camera equipped with medium-energy collimators. SPECT was performed when needed. Imaging results were compared with computed tomography and bone scan. Uptake levels were evaluated by site-specific visual analysis. Metastatic breast cancer can be visualized with SRS. Global sensitivity of imaging was 80% and specificity for correct prediction of tumor absence was 100%. Sensitivity was significantly higher for bone and lung metastases. SRS results related to the expression of SS-R on metastatic cell surfaces did not evidence a relationship with the biologic characteristics of the primary BC and drug exposure. In our series, SRS quantitative analysis demonstrated that tumor metastases differ greatly in uptake levels. Fifteen percent of metastatic sites in our series showed strong uptake. Our data support the important specificity of SRS in identifying BC metastases, mostly in cases of bone and lung disease, as well as the role of SRS in predicting responsiveness of metastatic BC cells to treatment with somatostatin analogues (SS), when SS-Rs are overexpressed on cell surfaces. If our results are confirmed in large scale studies, SRS shows the potential to treat selected patients with overexpressed SS-R on their tumoral cells with designed target therapies with SS analogue.
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PMID:Somatostatin receptor scintigraphy in metastatic breast cancer patients. 1558 98

We studied 58 patients with distant metastases of differentiated thyroid carcinoma diagnosed after initial therapy. Lymph node metastases were observed in 65% of the patients on initial presentation. All lymph node metastases, ninety percent of the lung metastases and only 25% of the bone metastases were asymptomatic. Radiography revealed lytic metastases in cases of bone involvement, was normal in 39.6% of the patients, and showed micrometastases in 34.5% and macrometastases in 25.8% of the patients with lung disease. Thyroglobulin (Tg) under thyroxine use was detectable in all patients without antibodies at a cut-off > 1 ng/ml, in 90% at > 5 ng/ml and in 80% at > 10 ng/ml, and after thyroxine withdrawal in 100% at a cut-off > 5 ng/ml and in 94% at > 10 ng/ml. In the case of patients with antibodies (13.8%), Tg was undetectable in half of them. Diagnostic scanning was positive in 83 and 77.6% of the patients with bone and lung metastases, respectively. After ablative therapy, the sensitivity was 100 and 93%, respectively. Eighty-five percent of patients with a negative diagnostic scan had lung metastases visible on radiographs. The determination of serum Tg is the best method in the follow-up of patients with differentiated thyroid cancer. Elevated Tg levels suggest the presence of metastases, indicating the need for ablative therapy with posttreatment scanning, which might reveal non-apparent metastases.
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PMID:[Clinical manifestations and diagnosis of distant metastases of differentiated thyroid carcinoma after initial therapy]. 1576 61

Metastatic leiomyosarcoma to the thyroid gland has rarely been described. We report a 54-year-old postmenopausal woman with uterine leiomyosarcoma, who presented with a single "cold" nodule in the right thyroid lobe 3 months after hysterectomy. The lesion was identified as a papillary thyroid carcinoma. In a separate area of the thyroid, a 1.2-mm area of a malignant mesenchymal neoplasm with morphologic and immunohistochemical features of leiomyosarcoma existed. Seven months after thyroidectomy the patient developed micronodular lung disease visible on successive chest computed tomography scans, consistent with metastatic disease from the primary uterine leiomyosarcoma that showed very good and prolonged response to chemotherapy. The thyroid papillary carcinoma was likely the recipient of an early and possibly the first metastasis of the patient's uterine leiomyosarcoma. This is the first report of metastatic leiomyosarcoma coexisting with a primary thyroid carcinoma and supports the possibility of a common pathway connecting thyroid gland neoplasms and sarcomas.
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PMID:Metastatic uterine leiomyosarcoma coexisting with papillary carcinoma of the thyroid gland. 1644 75

The studies evaluating the efficacy and safety of recombinant TSH in the ablative therapy and follow-up of patients with differentiated thyroid carcinoma by serum thyroglobulin (Tg) measurement and iodine scanning were reviewed in this article. Recombinant TSH is comparable to hypothyroidism in the generation of Tg and in the execution of iodine-131 whole-body scanning, with the advantage of sparing patients from the symptoms of hypothyroidism and from impaired quality of life induced by levothyroxine withdrawal, in addition to a reduced exposure to elevated TSH and shorter absence from work, with recombinant TSH being the preparation indicated for the diagnosis of metastases in both low risk (Tg after recombinant TSH) and moderate or high risk patients (Tg and iodine-131 scanning after recombinant TSH). In the case of ablative therapy, the results are promising when using a dose of 100 mCi for remnant ablation, but hypothyroidism is still preferred, except for patients in whom the desired TSH elevation after levothyroxine withdrawal is not achieved, patients with base diseases that are aggravated by acute and severe hypothyroidism (severe heart and lung disease, coronary disease, compromised renal function, history of psychosis due to myxedema), patients debilitated by advanced disease, and elderly individuals. The studies also show that the administration of recombinant TSH is safe, with few mild or moderate adverse effects.
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PMID:[Recombinant TSH in ablative therapy and follow-up of patients with differentiated thyroid carcinoma]. 1654 88

The objective of this study was to evaluate the utility of micro-computed tomography (micro-CT) for the detection and monitoring of experimental lung and bone metastases in nude mice. Whole body micro-CT scans were performed in lung or bone metastasis-bearing nude mice under deep anesthesia. The volumes of individual lung metastases were estimated by micro-CT, and compared to direct measurements on excised tumors. The two data sets were highly correlated (p<0.0001). The smallest lung tumor detected was 0.85 mm in diameter. The progression of metastatic lung disease, including tumor growth and the development of pleural effusion, was visualized by serial micro-CT scans in live mice. In addition, multiple bony metastases, with both osteolytic and osteoblastic features, were successfully detected by micro-CT. Bone lesions identified by micro-CT were confirmed as metastases by histopathological examination. Micro-CT may be used as an accurate, noninvasive tool to detect and monitor experimental bone and lung metastases in intact live nude mice.
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PMID:Visualization of experimental lung and bone metastases in live nude mice by X-ray micro-computed tomography. 1655 Nov 34

Angiosarcoma is a highly malignant neoplasm, which most often develops on the scalp or face of elderly people. Common distant metastatic sites include the lung, liver, lymph nodes, and skin. We report a case of angiosarcoma manifesting as simultaneous bilateral spontaneous pneumothorax secondary to pulmonary metastases in an 86-year-old man. The pneumothorax preceded the diagnosis of angiosarcoma. Chest computed tomography showed multiple thin-walled cavitary metastatic pulmonary lesions, which increased in size as new lesions appeared over the clinical course of several months. This case suggests that a finding of simultaneous bilateral spontaneous pneumothorax may indicate a serious parenchymal lung disorder.
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PMID:Simultaneous bilateral spontaneous pneumothorax secondary to metastatic angiosarcoma of the scalp: report of a case. 1699 87

Three-view thoracic radiography is often used to evaluate patients for pulmonary metastatic disease. Although use of three views has been reported to be more sensitive than two views for focal lung disease, it also requires increased time, effort, and radiographic exposure of patients and personnel. This study was performed to evaluate the conspicuity of lesions on two-view vs. three-view radiographic procedures to determine the proportion of diagnoses that would change. One hundred three-view radiographic studies of the canine thorax were randomized, and four protocols were reviewed for each study: right lateral and ventrodorsal views, left lateral and ventrodorsal views, both lateral views, and all three views. Radiographs were interpreted as either positive or negative for structured interstitial pulmonary disease, and the certainty of the reading was recorded using a visual analog scale. There was 85-88% agreement between each two-view group and the three-view group, with the kapp statistic ranging from 0.698 to 0.758. There were no differences in certainty of diagnosis among the groups, though within each group there was more certainty for positive diagnoses than negative diagnoses. These findings indicate that three-view studies should be continued when evaluating for possible structured interstitial pulmonary disease, including metastatic disease, as eliminating one view from a three-view study would change the diagnosis in 12-15% of patients.
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PMID:Comparison of two- vs. three-view thoracic radiographic studies on conspicuity of structured interstitial patterns in dogs. 1715 62

Although pulmonary metastases from colorectal carcinoma (CRC) often represent systemic and uncontrolled tumour growth, in a number of patients lung disease is limited and the patient remains well. When the metastases can be removed, long term survival is a possibility, with 5- and 10-year survivals in the order of 44% and 25%. Chemotherapy, the only alternative treatment only very rarely leads to survival beyond 24 months. Pulmonary metastases which are suitable for resection are usually detected on chest radiography, especially when carried out during monitoring of patients. They are rarely a cause of symptoms and the majority of patients have otherwise healthy lungs. CT scans supplemented by PET scans usually confirm the diagnosis, but percutaneous biopsy is sometimes necessary to exclude a primary lung cancer. The criteria for resecting CRC pulmonary metastases are (1) the primary tumour is controlled or is controllable; (2) complete resection is possible; and (3) the patient has adequate pulmonary reserve to tolerate the planned resection. Surgical approaches include posterolateral thoracotomy, staged bilateral thoracotomies, median sternotomy, clamshell incision, and video-assisted thoracic surgery. Each has its advantages and disadvantages. The majority of patients having resection of pulmonary metastases from CRC recover well with very few post-operative complications. Following resection favourable prognostic factors include a long disease-free interval, small number and small size of metastases, a normal carcinoembryonic antigen level, and an absence of concomitant liver metastases and mediastinal lymph node spread. Surgery for pulmonary metastases of CRC remains the best means of local control and the best way to render the patient disease-free. Patients with complete resection of pulmonary metastases have an improved long-term survival when compared to patients with unresected metastases.
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PMID:Resection of pulmonary metastases from colorectal carcinoma. 1802 32

Diffuse pulmonary ossification most commonly occurs in men in their fifth and sixth decades of life and is usually associated with diffuse and chronic lung disease, cardiac disease, or other systemic disorders. In this report, we describe a case of dendriform pulmonary ossification with a past history of giant cell tumor in the femur that occurred 8 years before. The nodules mimicked calcified pulmonary metastases. The patient was young (30 y old) and had no chronic lung or cardiac diseases. We speculate that the pulmonary ossification might have been due to dissemination of bone cells into the pulmonary circulation during bone curettage.
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PMID:Dendriform pulmonary ossification in a patient with a past history of giant cell tumor in femur. 1834 21

Hospice is available for any patient who is terminally ill and chooses a palliative care approach. Because of the close relationship that primary care physicians often have with their patients, they are in a unique position to provide end-of-life care, which includes recognizing the need for and recommending hospice care when appropriate. The hospice benefit covers all expenses related to the terminal illness, including medication, nursing care, and equipment. Hospice should be considered when a patient has New York Heart Association class IV heart failure, severe dementia, activity-limiting lung disease, or metastatic cancer. Timely referrals are beneficial to both patient and hospice because of the cost related to initiating services and the time required to form a therapeutic relationship. Once the decision to refer to hospice is made, the family physician typically continues to be the patient's primary attending physician. The attending physician is expected to remain in charge of the patient's care, write orders, see the patient for office visits, and complete and sign the death certificate. Hospice, in turn, is a valuable physician resource when it comes to medication dosages, symptom management, and communication with patients and their families.
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PMID:The role of the family physician in the referral and management of hospice patients. 1838 96


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