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

The results of pulmonary metastasectomy by a median sternotomy approach were retrospectively studied in 38 patients. This approach enabled the exploration of both thoracic cavities and, subsequently, the detection of other metastases. Such occult metastases were present in 11 of the 38 patients, four patients had unsuspected metastases at the contralateral side. There was no postoperative mortality, the morbidity associated with the median sternotomy and bilateral exploration was low. Pneumothorax occurred in three patients, pulmonary infection in four patients and a superficial wound infection in one patient. Hospital stay ranged from 4-25 days (mean 10 days). The five-year actuarial survival rate was 15 per cent. Resectability did not correlate significantly with long-term survival, neither did primary histology, disease-free interval or the presence of bilateral disease. The number of metastases was a highly significant predictor of survival (p = 0.0004).
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PMID:Pulmonary metastasectomy by median sternotomy. 194 90

Between 1968 and 1988, 207 children with congenital, inflammatory, and neoplastic diseases of the lung, pleura, and mediastinum underwent thoracotomy. In 34 patients indication for operation was a therapy-resistent recurrent spontaneous pneumothorax, in 25 benign and malignant mediastinal tumors, in 26 pulmonary metastases of extrathoracic primary tumors, in 42 bronchiectasis and post-pneumonic empyema with callosity, in 21 bronchogenic and enterogenous cysts. 22 children had benign tumors of the trachea, bronchi, and lung, 5 malignant tumors of the lung and chest wall. In a smaller number of children congenital defects, parasitic cysts, and aspergillomas as well as foreign bodies, were present. The surgical procedure included anatomical and atypical resections, bronchoplastic interventions, exstirpation of tumors and cysts, decortications and partial resections of the parietal pleura. There was no perioperative mortality.
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PMID:[Indications for surgery and results of 207 thoracotomies in children with diseases of the lung, pleura and mediastinum]. 198 68

To determine the presence of chest wall and mediastinal invasion by lung cancer and to establish the origin of chest tumors, we studied 12 patients with intrathoracic tumors by using chest CT combined with artificial pneumothorax. Six patients had primary lung cancer, two had metastases, and one each had neurofibroma, pericardial cyst, chondroma of the rib, and malignant mesothelioma. All 12 tumors abutted the chest wall or mediastinum and could not be separated by conventional CT. Between 400 and 800 ml of air was injected into the pleural space before a second CT scan was obtained. No invasion was found at surgery in cancers that were separated from chest wall or mediastinum on CT scans. Surgery revealed chest wall invasion in three patients in whom the CT scans showed that the tumor was not separated from the chest wall. Only one patient with a tumor that was not separated from the mediastinum on CT did not have mediastinal invasion: in this case, only adhesions were found at surgery. Thus, in the eight patients with primary lung cancer and metastasis, sensitivity, specificity, and accuracy were 100%, 80%, and 88%, respectively. In four patients with mediastinal or pleural tumor, CT combined with pneumothorax was useful for establishing the origin of tumors. In all, 11 of the 12 patients were correctly evaluated by using this method. No complications occurred, except for mild chest discomfort in one patient. This study suggests that chest CT combined with artificial pneumothorax is useful for the evaluation of the extension of lung cancer into the chest wall and mediastinum and for the diagnosis of the site of origin of intrathoracic tumors.
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PMID:Chest CT combined with artificial pneumothorax: value in determining origin and extent of tumor. 200 29

Neoplastic cavitary lesions are an unusual type of pulmonary metastases. The authors report two cases of cystic metastatic sarcoma of the lungs that illustrate the clinical, radiologic, and pathologic difficulties encountered in the diagnosis of these lesions. In one patient, multiple small, thin-walled cystic metastases from a lower leg leiomyosarcoma were the only manifestation of metastatic disease. The cystic lesions did not change over an 8-month period and a diagnosis of malignancy was not established until spontaneous pneumothorax, presumably due to rupture of the malignant blebs, prompted a thoracotomy. In the second patient, three thin-walled bullae developed after treatment of noncystic pulmonary metastases from a lower-leg synovial sarcoma. In both patients, the cystic lesions were not evident on chest radiographs, but were well visualized with computed tomography (CT), where they mimicked benign bullous disease. However, additional small cavitary lesions not seen with CT were present in resected pulmonary wedge specimens from both patients. A great degree of variability in the cellular composition of the cyst wall lining in both cases, and a lack of any solid neoplastic tissue masses in one case, led to histopathologic difficulties that required immunohistochemical studies for definitive diagnosis of the metastatic disease. These cases show that pulmonary bullae, even though thin-walled and benign-appearing on CT, may be a manifestation of pulmonary metastases. These lesions must therefore be surgically removed from patients in whom a curative resection of pulmonary metastases is warranted.
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PMID:Cystic pulmonary metastatic sarcoma. 215 5

The case of a 34-year-old female patient is presented. The patient was admitted because of bilateral pneumothorax caused by the metastasis of a malignant histiocytoma originating in the left gluteus. Bilateral chest-suction was made and the patient received complex chemotherapy. The chest X-ray taken 4 months later showed considerable regression of the lymph node metastases. Neither the time of development of pneumothorax nor its mechanism is known. There are only assumptions about it. Authors have considered their case worthy of publication because the lymph node metastasis of bilateral simultaneous pneumothorax due to histiocytoma has not so far been known in the literature.
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PMID:Bilateral spontaneous pneumothorax associated with metastasis of a malignant fibrohistiocytoma. 217 12

Malignant thymomas are extremely rare in children, with only 27 cases reported thus far in the pediatric surgical literature. We report four additional cases diagnosed at this institution over the past 20 years (ages 3 to 14 years). Clinical presentations included superior vena cava syndrome, cough, dyspnea, cyanosis, enlarging mediastinal mass, spontaneous pneumothorax, and pleuropericardial effusion. Three patients underwent incomplete resection of the mass or biopsy because of "unresectability" and were treated with radiotherapy and adjunctive chemotherapy. One patient underwent near complete macroscopic resection as well as radiotherapy and chemotherapy. All patients died at intervals ranging from 6 months to 2 1/2 years after diagnosis. Three patients were found to have metastatic disease prior to death or at autopsy. In one case, the initial pathological diagnosis was lymphocytic thymoma. After ultrastructural studies were performed, the diagnosis was changed to thymic T-cell lymphoma. This patient subsequently developed acute lymphoblastic leukemia 3 months after surgical resection followed by radiotherapy. Malignant thymomas are highly aggressive tumors in children. A radical surgical approach with complete excision of the tumor and contiguous structures in continuity, with adjunctive radiotherapy and chemotherapy remains the only hope for survival in children with these rare lesions.
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PMID:Malignant thymoma in children: a 20-year review. 227 28

A case is presented of a woman with bilateral spontaneous pneumothorax and pulmonary metastases originating from an ovarian granulosa cell tumor. It is the first known case report of an association between these two entities described in the English literature.
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PMID:Bilateral spontaneous pneumothoraces caused by metastatic ovarian granulosa cell tumor. 237 91

We invented a new surgical approach to the kidney through the flank to perform a radical nephrectomy for renal cell carcinoma. With the patient in usual lateral decubitus position keeping the dorsum vertical to the operating table, a skin incision is made over the XII rib from the posterior axillary line to the lateral edge of the rectus muscle. After the tip of XII rib is resected by about 5 cm, the retroperitoneal space is entered. Blunt dissection of the posterior aspect of Gerota's fascia from fasciae of the quadratus lumborum and psoas muscle is easily carried out with a liver retractor or intestinal spatula. The pulsating renal artery can be identified through Gerota's fascia when the renal hilus is exposed. Following ligation and division of the artery, renal vein is exposed. On the left side, adrenal, gonadal and occasionally lumbar veins are also ligated and severed in addition to the renal vein. Then, the kidney in Gerota's fascia is removed en bloc with perinephric adipose tissue and adrenal gland. Of 21 patients with renal cell carcinoma seen during 1 year and 3 months from June 1987, 11 underwent this operation, and other 10 patients transperitoneal radical nephrectomy because of the possible tumor extension into the renal vein, inferior vena cava or adjacent organ, the severe spinal deformity or metastases and the necessity of additional surgical procedures for concomitant benign intraperitoneal diseases. The blood loss was smaller and operating time was shorter significantly in the translumbar group than the evaluable transperitoneal group. None of those in the translumbar group received blood transfusion. As complications, pneumothorax due to pleural injury during operation and postoperative incisional hernia occurred each in one patient, but no other serious one was found. From the above results, this approach seems to be one of choices for the surgical treatment of renal cell carcinoma, as long as the tumor is not likely to extend to adjacent organs, ipsilateral nodes or the inferior vena cava.
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PMID:[Translumbar radical nephrectomy of renal cell carcinoma]. 258 20

Fourteen patients undergoing primary cytoreductive surgery for stage III ovarian malignancies had diaphragmatic peritoneum, muscle, or both resected in an attempt to remove all metastatic disease greater than 0.5 cm in diameter. Resection was completed in 13 of 14 patients (93%), all obtaining optimal cytoreduction. Size of resected specimens varied from 12 x 7 to 17 x 11 cm. The mediastinum was entered in two patients. Four patients had resection of diaphragmatic muscle. All defects were closed primarily and a thoracostomy tube was placed. One patient who did not have muscle resection had a 30% pneumothorax that spontaneously resolved. No subdiaphragmatic hematomas or abscesses occurred. Time (mean 65 min, range 40-150 min) and blood loss (mean 175 ml, range 100-1500 ml) for the surgery depended upon extent of disease. One procedure was terminated due to bleeding from a lacerated liver capsule. We conclude that diaphragmatic peritoneum/muscle resection can be completed successfully with acceptable morbidity.
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PMID:Resection of diaphragmatic peritoneum and muscle: role in cytoreductive surgery for ovarian cancer. 259 68

We reviewed 13 cases of biliary endoprosthetic insertion for malignant obstructive jaundice from August 1983 to May 1987, and recorded (1) location and etiology of the obstruction, (2) length of time the endoprosthesis remained functional, and (3) complications related to the endoprosthesis, its insertion, or its long-term function. Of the 13 patients, 3 had pancreatic carcinoma, 3 had cholangiocarcinoma, and 3 had metastatic disease to the porta hepatis. The underlying malignancy was not histologically proved in four patients despite evidence of neoplasm by percutaneous cholangiography and computerized tomography. These four patients were not considered good surgical risks and were referred for percutaneous therapy. The longest endoprosthetic patency was 3.5 years. Three patients experienced obstruction of the endoprosthesis at 3, 4, and 9 months after insertion, respectively. Two of the endoprostheses were subsequently removed endoscopically, while the third was extracted through a new percutaneous tract with use of a balloon angioplasty catheter. Complications related to endoprosthetic insertion included bilous hydro pneumothorax (1 patient), subcutaneous and subcapsular liver abscess (1 patient), postinsertion cholangitis (4 patients), and reflex ileus (1 patient).
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PMID:Endoprosthetic insertion for malignant obstructive jaundice: a retrospective review. 262 Nov 20


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