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)

In patients with anti-Yo associated paraneoplastic cerebellar degeneration (PCD) neurological symptoms precede the diagnosis of the underlying cancer in about 60%. Ovarian carcinoma, breast cancer and other gynaecological malignancies are most frequently found as causative malignancies. Antitumour treatment should be applied in an early stage of disease. The identification of the tumour is a diagnostic challenge in many of these patients. In the first of two patients reported here a pelvic tumour was suggested after detection of a pathological lymph node and elevated tumour markers. The intraoperative findings appeared macroscopically normal during ovariectomy with adnexectomy. Not until microscopic examination of the resected tissue was performed was a tubal adenocarcinoma found. If intrapelvic gynaecological tumours are suspected a deliberate surgical exploration seems to be justified, but only after an intensive diagnostic investigation. To search for the underlying cancer in patients with paraneoplastic neurological disorders successive CT and [18F]-FDG-PET are widely recommended. Instead of this in the second reported patient whole-body dual-modality PET/CT was performed revealing enhanced uptake in three regions of the left thorax. By combining function and anatomy PET/CT was able to localise the lesions and characterise them as lymph node metastases of breast cancer. Diagnosis could be confirmed by subsequently executed needle biopsy. PET/CT seems to be highly applicable in the investigation of paraneoplastic disorders with unknown primary cancer. It may help in guidance of needle biopsy or to optimise the results of deliberate surgery and it provides whole-body tumour staging in a single session with higher diagnostic accuracy than PET alone.
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PMID:Strategies in detection of the primary tumour in anti-Yo associated paraneoplastic cerebellar degeneration. 1572 26

Multiple tumors in a patient have the possibility to interact with each other, through the competition for new blood supply which is required for growth and progression (angiogenesis). The multiple tumors can be independent, multiple primary cancers. Alternatively, they can be metastases which originate from one primary tumor. This paper uses mathematical models to investigate such dynamical interactions between multiple cancers. We start with a model which describes the growth of a single angiogenic tumor, and then generalize this model to include multiple tumors which compete for circulating endothelial progenitor cells in order to build new blood vessels. We explore under which conditions multiple tumors can coexist, and when one tumor can exclude other tumors from growing. Based on this framework, we discuss the circumstances under which independent multiple primary tumors can arise. We further discuss the inefficiency of metastatic cells to grow successfully, and suggest an explanation for the occurrence of multiple metastases with an unknown primary cancer.
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PMID:Dynamical interactions between multiple cancers. 1591 65

Lobular carcinoma of the breast is known to metastasize to unusual sites such as the gastrointestinal tract, peritoneum, and gynecologic organs. We report a patient with intraperitoneal metastases from lobular carcinoma who was originally treated for an unknown primary cancer. Ten years later, a tumor was found in her left breast and the diagnosis was changed to peritoneal metastases from invasive lobular carcinoma. Immunohistochemistry revealed that the metastases were high molecular weight cytokeratin (CK34betaE12) and estrogen receptor-positive, but were E-cadherin-negative. These results assisted in diagnosis. Surgeons should be aware of the characteristics of metastasis lobular carcinoma.
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PMID:A case of metastatic lobular breast carcinoma with detection of the primary tumor after ten years. 1769 May 15

The pathologic approach to metastases of unknown primary cancer (UPC) is stepwise and uses the clinical context, morphology, and, where necessary, immunohistochemistry (IHC). This review covers the initial approach to a UPC biopsy; the diagnosis of malignancy and broad tumor typing into carcinoma, melanoma, lymphoma, or sarcoma; and further subtyping of carcinoma into germ cell (broadly included), squamous, neuroendocrine, and solid organ including liver and renal, and adenocarcinomas. Finally, for adenocarcinoma, the prediction of primary tumor site, including lung, pancreas, stomach, colon, ovary, prostate, and breast, is discussed. For each tumor type, the morphologic features are presented alongside established useful IHC markers, with a description of their staining patterns and common diagnostic dilemmas. Optimal tissue handling and IHC interpretation, quality assurance, and limitations also are discussed. The target readership is oncologists, but other clinicians and trainee pathologists also may find the content of use.
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PMID:Pathologic evaluation of unknown primary cancer. 1917 85

Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3-5% of all malignant neoplasms. CUP represents a heterogeneous group of metastatic tumors for which no primary site can be detected following a thorough medical history, careful clinical examination, and extensive diagnostic work-up. Several authors have reported poor prognosis of this malignancy, because there is no consensus on diagnostic guidelines and optimal therapy. Historically, chemotherapy has been the cornerstone of treatment for patients with CUP. We experienced a case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of the cervix. We report this case with a brief review of the literatures.
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PMID:A case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of cervix. 1947 57

Cancer of unknown primary site is a common metastatic cancer, diagnosed in about 50 000 patients per year in the US. The diagnosis, classification, and management of patients with carcinoma of unknown primary site has been difficult and frustrating. The therapy has usually been empiric for the majority of patients, and their prognosis has been poor. Molecular classification of metastatic cancers with known primary sites has been accurate (76-89%), as reported from several studies. Molecular profiling of initial biopsy specimens has tremendous potential as a test to diagnose the site of tumor origin in patients with unknown primary cancer. Several retrospective studies of molecular profiling assays have provided indirect validation of the accuracy of primary site prediction, based on correlations with clinicopathologic features. One additional study of initial diagnostic biopsies in unknown primary cancer patients, where primary tumor sites were identified months to years later, has provided more direct validation of the accuracy of molecular classification (the primary tumor sites of 15 of 20 patients were correctly predicted). The ability to diagnose and classify unknown primary cancer more precisely would allow for more site-specific or targeted therapy, and likely improve patient outcomes. Several clinical studies are in progress or planned to test this concept.
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PMID:Molecular classification of cancers of unknown primary site. 1992 34

Multiple expression signatures for the prediction of the site of origin of metastatic cancer of unknown primary origin (CUP) have been developed. Owing to their limited coverage of tumor types and suboptimal prediction accuracy on distinct tumors, there is still room for alternative CUP gene expression signatures. Whereas in past studies, CUP classifiers were trained solely on data from tumor samples, we now use expression patterns from normal tissues for classifier training. This approach potentially avoids pitfalls related to the representation of genetically heterogeneous tumor subtypes during classifier training. Two expression data sets of normal human tissues have been reanalyzed to derive an expression signature for liver, prostate, kidney, ovarian and lung tissues. In reciprocal validation, classifiers trained on either data set achieved overall accuracies greater than 97%. Classifiers trained on combined expression data from both normal tissue data sets were able to predict the site of origin in a cohort of 652 primary tumors with approximately 90% accuracy. Prediction accuracies of primary cancer-based classifiers were in the same range, as determined by cross-validation on this cohort. For individual tumor types, normal tissue-based classifiers achieved sensitivities in the range of 64-99% and specificities in the range of 92-100%. Primary origins for 12 of 20 metastases were predicted correctly, with false predictions highlighting the need for accurate sample preparation to avoid contaminations by metastases-surrounding tissue. We conclude that gene expression patterns of normal tissues harbor phenotypic information that is retained in tumors and can be sufficient to recover the type of primary tumor from expression patterns alone.
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PMID:Predicting the site of origin of tumors by a gene expression signature derived from normal tissues. 2051 16

We report a case of primary diffuse leptomeningeal gliomatosis (PDLG) in a 76-year-old male presenting with confusion, dysarthria, diplopia, lumbal pain and headaches of recent onset. Neurological examination revealed nuchal rigidity and bilateral sixth cranial nerve palsy. The cerebrospinal fluid showed a marked hyperproteinorachia (4711 mg/L) and mild cytorachia (5-10 leucocytes/mm3) with a few atypical lymphoid cells. On admission, brain CT scan and MRI demonstrated diffuse and nodular leptomeningeal contrast enhancement predominant at the skull base and several osteolytic lesions in the right parietal bone. Extensive serological studies for infectious, autoimmune or neoplastic diseases were negative. The work-up diagnosis was neurosarcoidosis or multiple meningeal and osseous metastases of an unknown primary cancer. Surgical biopsy of the right parietal bone lesion showed only fibrous tissue with no evidence of tumour or inflammation. The patient was treated with high dose corticosteroids but its neurological status progressively worsened and he died of aspiration pneumonia 35 days after admission. Post-mortem examination revealed a PDLG, a rare fatal tumour with about 60 cases reported. PDGL is characterized by the diffusion of neoplastic glial cells throughout the leptomeninges without evidence of a primary intra-parenchymal lesion. Recognition of this rare brain tumour is important as recent reports suggest that radiotherapy and chemotherapy can improve patient survival.
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PMID:Primary diffuse leptomeningeal gliomatosis: an autopsy case and review of the literature. 2130 63

The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors.
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PMID:Unknown primary cancer of the head and neck: a multidisciplinary approach. 2132 96

Neuroendocrine tumors of the small intestine have been diagnosed with increasing frequency over the past 35 years and presently account for approximately 2% of all gastrointestinal neoplasms. While most of these tumors are discovered incidentally during emergency laparotomy or in the clinical setting of unknown primary cancer with hepatic metastases, the growing awareness of this rare entity and improved diagnostic methods promote earlier diagnosis. The classical carcinoid syndrome with flush, diarrhea and cardiac strain is observed only in 20-30% of patients. The clinical symptoms necessitate a special preoperative preparation of the patient including evaluation of cardiac function.Prospective studies assessing the efficacy of surgical treatment strategies for neuroendocrine neoplasms of the small intestine do not exist. However, retrospective studies have demonstrated that curative as well as palliative resection of the primary tumor improves the prognosis and the quality of life of patients. Besides limited resection of the small bowel in order to avoid postoperative short bowel syndrome an effective clearance of the regional lymph nodes is essential. A primary tumor site in the terminal ileum requires dissection of the lymph nodes on the right side of the ileocolic artery which usually implies an additional resection of the right colon. In cases of a primary tumor site located in the lower ileum up to the distal jejunum, a cone-shaped resection of the mesenterium of the small bowel with extension of lymphadenectomy into adjacent segments with preservation of vascularization is performed.
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PMID:[Extent of resection for neuroendocrine tumors of the small intestine]. 2167 5


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