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 sternum is known as a common site of bone metastasis in a variety of neoplasms. Sternal metastasis is usually visualized as hot spot on bone scintigraphy. However, photon deficiency in the sternum on bone scintigraphy is reported in few cases with malignancy. We undertook a retrospective analysis to clarify the clinical significance of photon deficiency in the sternum in 12 patients with malignancy. Twelve patients (five breast cancer, two multiple myeloma, one lung cancer, one renal cell cancer, one hepatocellular carcinoma, one malignant lymphoma, and one thyroid cancer) showing cold sternal metastasis on bone scintigraphy were identified among 9,430 patients in whom bone scintigraphy was performed. Except for two cases with pathologically confirmed sternal metastasis, all patients showed lytic change in the sternum on tomography or CT scan. Six cases of solitary sternal metastasis showed partial effect of systemic therapy (chemotherapy, humoral therapy, and radiation therapy) and surgical treatment. It is necessary to keep in mind that this type of lesion may occur as a manifestation of metastatic disease.
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PMID:Photon-deficient finding in sternum on bone scintigraphy in patients with malignant disease. 207 33

Hypercalcemia is one of the most serious metabolic disorders associated with cancer. The incidence and clinical circumstances associated with hypercalcemia vary in different types of cancer. Hypercalcemia is the most frequent metabolic complication of breast cancer and is usually related to widespread osteolytic metastases; however, local and systemic humoral factors mediating bone resorption have been described. In some patients with breast cancer, hypercalcemia results from treatment with estrogens, antiestrogens, androgens, or progestins. Coexisting primary hyperparathyroidism rarely confounds the diagnosis. In patients with lung cancer, the incidence of hypercalcemia varies with histology and is often unrelated to bone metastases. Hypercalcemia may occur either late or early in the disease but is seldom a presenting symptom. In patients with cancers of the head and neck region, hypercalcemia is most often associated with advanced recurrent and terminal disease, presumably humorally mediated. In renal cell carcinoma, hypercalcemia is also an adverse prognostic indicator, commonly mediated by humoral factors. On the other hand, almost all patients with multiple myeloma have extensive osteolytic bone destruction and hypercalcemia is frequently a presenting symptom. Hypercalcemia is uncommon in most lymphomas; however, it is usually a prominent feature of adult T-cell lymphomas and also occurs in some large cell, diffuse B-cell lymphomas. Awareness of the setting in which hypercalcemia of malignancy occurs will lead to its prompt diagnosis and institution of appropriate therapy.
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PMID:Overview of cancer-related hypercalcemia: epidemiology and etiology. 218 51

The present review is concerned with the value of bone scanning in the follow-up of patients with malignant tumors. The scintigraphic sensitivity depends on the type of bone metastases. Osteoplastic metastases (e.g., from prostatic cancer) can be detected much more easily than purely osteolytic foci (e.g., of multiple myeloma). One controversial point is the role of bone scans in the follow-up of patients with breast carcinoma. This particular malignancy is used as an example to point out irrationalities in the recommendations on the selection of imaging modalities in routine follow-up. Such recommendations are based on the present knowledge of the tumor growth kinetics, which is still inadequate. In view of this, follow-up strategies should not be based solely on statistical and epidemiological considerations and cost-benefit ratios.
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PMID:[The importance of bone scintigraphy in the aftercare of patients with malignancies]. 225 52

The authors related two cases of multiple myeloma BJX and GX combined with hypernephroid cancer. In both cases, the diagnosis of myeloma was supported by morphological examination of the bone marrow and immunochemical identification of monoclonal immunoglobulin. In female patient C, adenocarcinoma developed in the presence of polycystosis in the left kidney operated before. The diagnosis of hypernephroma was established simultaneously with the diagnosis of multiple myeloma BJX, stage III B. The patient was operated on 15 months after institution of polychemotherapy in the presence of myeloma reduction and recovery of nitrogen secretory renal function. The patient survived for 2.5 years after the operation, retaining work fitness for 2 years. She died from terminal exacerbation of myeloma. On autopsy no cancer metastases were detected. In male patient Ch. with myeloma GX, stage II A, hypernephroid cancer of the right kidney was diagnosed 7 months after the diagnosis of myeloma was established. Radical operation resulted in complete somatic and hematological compensation of the patient. The residual mass of myeloma does not manifest itself clinically after 9 courses of polychemotherapy carried out in the preoperative period. It is only detectable by the laboratory tests. The follow-up of the patient is continued.
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PMID:[The successful surgical treatment of hypernephroid cancer in 2 patients with multiple myeloma]. 228 96

The mechanisms of paraneoplastic hypercalcemic syndromes are heterogeneous. Neoplastic hypercalcemia without bone metastatic disease is caused by parathyroid hormone related protein, whose action is comparable to parathyroid hormone. Growth transforming factors, platelet derived growth factor, tumor necrosis factors and interleukin 1 are also involved in humoral hypercalcemia of malignancy. In addition to these substances, hypercalcemia in bone metastatic disease may be related to PGE. Tumor necrosis factors and interleukin 1 play a major role in multiple myeloma as well as in Adult T cell Leukemia/Lymphoma where overproduction of vit D3 by lymphomatous cells can also be significant.
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PMID:[Hypercalcemia and neoplasms: recent advances in pathogenesis]. 229 Oct 7

We evaluated the serum osteocalcin and alkaline phosphatase levels and the urinary hydroxyproline excretion in patients with blastic, lithic or mixed metastases, humoral malignant hypercalcemia (HMH) and myeloma. In patients with metastasis of any type osteocalcin did not reach a significant increase although in blastic metastases an increase approaching signification was observed. However, the sensitivities of alkaline phosphatase or hydroxyproline were much higher. In HMH hydroxyproline increased to levels similar to those found in primary hyperparathyroidism. By contrast, although osteocalcin had a significant increase, its values were much lower than in parathyroid disease. The changes in alkaline phosphatase were nonevaluable. In myeloma none of the three markers changed. The major conclusion of the present study is that osteocalcin has little practical usefulness for the investigation of neoplastic patients.
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PMID:[Bone turnover markers in tumor pathology with bone involvement]. 235 62

Current methods for the study of bone marrow to evaluate possible primary or metastatic cancers are reviewed. Bone marrow biopsy, radionuclide scan, computed tomography and magnetic resonance imaging (MRI) are analyzed with regard to their clinical usefulness at the time of diagnosis and during the course of the disease. Bone marrow biopsy is still the examination of choice not only in hematologic malignancies but also for tumors that metastasize into the marrow. Radionuclide scans are indicated for screening for skeletal metastases, except for those from thyroid carcinoma and multiple myeloma. Computed tomography is useful for cortical bone evaluation. MRI shows a high sensitivity in finding occult sites of disease in the marrow but its use has been restricted by high cost and limited availability. However, the future of MRI in bone marrow evaluation seems assured. MRI is already the method of choice for diagnosis of multiple myeloma, when radiography is negative, and for quantitative evaluation of lymphoma when a crucial therapeutic decision (i.e. bone marrow transplantation) must be made. Finally, methods are being developed that will enhance the sensitivity and specificity of MRI studies of bone marrow.
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PMID:Detection of bone marrow involvement in patients with cancer. 274 Dec 29

Forty patients with known primary tumor and progressive back pain, suspected of having spinal metastatic disease, underwent magnetic resonance (MR) examinations of the thoracic and lumbosacral spine. Conventional radiographs and CT scans of the spine were all normal. The radionuclide bone scans were equivocal. In 21 patients focal or diffuse vertebral MR abnormalities were detected. In nine patients the lesions were hypointense on T1 sequence, and the same lesions were demonstrated poorly or not at all on T2 and proton density sequences. In eight other patients the bone marrow metastases presented with strong signal intensity on T2 and were poorly or not at all demonstrated on T1 and proton density sequences. In three patients with multiple myeloma, the signal intensity pattern of the vertebrae was diffusely heterogeneous, with alternating small foci of strong and weak signals (a mosaic-like pattern). Following the MR studies, needle biopsy confirmed the malignancy in the 21 patients who had shown abnormalities. No correlation between the type of primary tumor and the signal intensity of the vertebral metastases was shown. Possibly the mosaic pattern shown in three of the multiple myeloma patients represents a special case.
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PMID:Early MR demonstration of spinal metastases in patients with normal radiographs and CT and radionuclide bone scans. 274 77

The search into the way in which skeletal metastases develops has not only shown that there are several mechanisms for the progressive bone destruction and bone formation that occur simultaneously in the majority of skeletal metastases, but also that an understanding of these basic mechanisms has significant therapeutic implications. Our results have shown that there are two main mechanisms for the bone formation: stromal bone formation and reactive bone formation. The former occurs in tumours which tend to be acellular, with a large fibrous stroma, whereas the latter occurs in virtually all metastases. There is no difference in the basic pathological process of sclerotic or lytic metastases, the radiographic appearance purely indicating the net balance between the different types of bone formation and the simultaneous progressive bone destruction. An understanding of the pathophysiological response to skeletal metastases explains why skeletal scintigraphy can be used to diagnose these lesions and the different mechanisms underlying the 'three-phase scintigram'. The first phase indicates the vascularity of the lesion; the second phase or 'blood-pool' image indicates the concentration in the extracellular fluid and the third phase or 'skeletal or delayed image' indicates the uptake in the reactive new bone. The secretion of an osteoblast inhibiting factor by myeloma indicates why there is no reactive bone produced by the majority of lesions in the absence of a fracture, and why scintigraphy is less reliable than plain radiographs for the detection of the lesions. There are two main mechanisms for the bone destruction, the most important being mediated via osteoclasts. An understanding of the humoral mechanisms stimulating the osteoclast proliferation may lead to more effective treatment of malignant hypercalcaemia and lytic metastases. Early results of use of APD are encouraging, and our results also suggest that clinical trials should be established to evaluate the effect of combination therapy with APD or prostaglandin inhibitor combined with the agents normally used in the management of patients with disseminated mammary carcinoma. The development of treatments to inhibit tumour-induced osteolysis will minimise the complications of pathological fracture, spinal instability, etc., and even if these treatments do not affect the primary tumour, its ability to metastasize, or the patient's survival, such treatment will be a major advance in the management of patients with carcinoma, because of the significant morbidity currently associated with the development of skeletal metastases and their complications.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The development of skeletal metastases. 279 40

In adults pathological fractures of the femur are mostly caused by skeletal metastases. In our own collective of femoral fractures 58 were caused by skeletal metastases and five by multiple myeloma. Average age was 59.8 years, women prevailed. In most of the metastatic fractures breast cancer was found to be the primary tumour. In all cases fracture stabilization as a palliative measure was the only possible therapy. Two patients could not be operated on because of other vital problems. In femoral neck fractures resection and endoprosthesis was the operative measure of choice. The pertrochanteric and subtrochanteric fractures were mostly treated by composites of cement and the 95 degrees condylar-plate. Also in shaft fractures cement-implant composites were performed with straight plates. Rarely, intramedullary nailing was done. Exercising stability could always be achieved, weight-bearing stability in most of the cases. The mean survival time was 7.2 months regarding 43 patients with well documented course. Six patients are controlled regularly, the operative treatment was done on an average 16 months before.
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PMID:[Managing pathologic femoral fractures in malignant bone tumors and skeletal metastases]. 281 48


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