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

Following a normal delivery, a 22-year-old primigravida experienced fever resistant to antibiotic therapy. On the tenth post partum day, thoracic pain and chest X-ray were in favour of acute pneumonitis of left inferior lobe. Considering the extension to the right lung and a normal bronchic fibrescopy, a computed tomography (CT) was performed which showed a right ovarian vein thrombophlebitis, right minor subpleural opacities and left pneumopathy. The final diagnosis was post partum ovarian vein suppurated thrombophlebitis with pulmonary septic metastases from haematogenic diffusion. Post partum thrombophlebitis is a rare event with an incidence of 1 per 2,000 deliveries. Pulmonary inaugurating symptoms result rather from pulmonary embolism than from septic metastases. Post partum persisting and unexplained fever should be explored with abdominal CT-scan.
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PMID:[Post-partum suppurating thrombophlebitis of the ovarian vein presenting with pleuropulmonary manifestations]. 1048 32

Penile malignancies are infrequent but represent a diagnostic and therapeutic challenge as patients tend to disregard early asymptomatic lesions of the disease. Due to the lack of studies involving large patient numbers, the therapeutic concepts for different stages of the disease could not be defined by prospective studies. Long-term results are rare. We present the therapeutic concepts and the 10-year results of our experience with 42 cases of penile carcinoma treated at our institution between 1973 and 1986. Therapy included radical circumcision in 10 cases, local excision of the tumor in 4, partial or total glandular resection in 6 patients, partial penectomy in 20, and total penectomy in 2 cases. Inguinal lymphadenectomy was performed initially in 14 cases with positive histology in 7 patients (50%). Complications included meatal stenosis in 8 cases (19%), urethral stricture in 1 case, death due to fulminant pulmonary embolism in 1 case and local infections in 2 cases. Follow-up of patients with initially nonmetastatic disease showed a progression to death in 4 of 35 patients (11.6%) with a mean survival of 30 (range 11.5-56) months, in patients with initial lymph node metastases progression to death occurred in 5 of 7 patients (71.4%) with a mean survival of 9.76 months (range 9 days to 24 months). Stage-related disease-specific 10-year survival rates are 100% for stages 0 and 1, 90.9% for stage 2, and 20% for stage 3, while no patient in stage 4 survived for 5 years. From our data we conclude that the single most important prognostic factor in the treatment of carcinoma of the penis is lymph node involvement. Therefore increased attention has to be paid to the recognition of early stages of this potentially curable disease.
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PMID:Results and 10-year follow-up in patients with squamous cell carcinoma of the penis. 1056 92

We report a nationwide study based on a cohort of patients with a thromboembolic event (TE) defined as deep venous thrombosis and/or pulmonary embolism identified from the Danish National Registry of Patients from 1977 to 1993. Cancer occurrence in the cohort was determined by linkage to the Danish Cancer Registry. Expected number of cancer cases was estimated from age, sex and site-specific incidence rates. A total of 26,653 TE-cases were identified. We observed 1737 cases of cancer versus 1371 expected (SIR 1.3; 95% CI, 1.21 to 1.33). The risk was particularly high during the first months of follow-up, but declined rapidly hereafter to a constant level slightly above 1.0 one year after the TE. Forty percent of patients diagnosed with cancer within one year from the hospitalization for TE had distant metastases at the time of cancer diagnosis. The observed risk pattern provides evidence that most often a preclinical cancer gives rise to a subsequent TE. An aggressive search for hidden cancer in patients with TE is not warranted.
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PMID:[Incidence of cancer after primary deep venous thrombosis or pulmonary embolism]. 1082 55

We report a middle-aged woman who died 2 days after presenting with dyspnea and severe pulmonary hypertension of unknown etiology. Her symptoms were highly suggestive of pulmonary embolism, but clinical evaluations for that disease yielded negative results. Autopsy revealed a Krukenberg tumor of the left ovary, representing metastatic gastric carcinoma from an occult primary lesion. Although the lungs exhibited no gross evidence of pulmonary emboli or neoplasia, microscopic examination revealed diffuse microscopic metastases in the pulmonary arterial vasculature. The pulmonary arteries exhibited fibrocellular intimal proliferation with smooth muscle colonization of the luminal neoplastic lesions and associated microthrombi. This disease entity, known as tumor-related thrombotic pulmonary microangiopathy, results in generalized microvascular obliteration and subsequent pulmonary hypertension. It is a rare condition that is distinct from ordinary pulmonary thromboembolism and primary pulmonary hypertension. Tumor-related thrombotic pulmonary microangiopathy should be considered diagnostically by the autopsy pathologist in cases of rapidly evolving pulmonary hypertension in a middle-aged or elderly individual, or respiratory failure of unknown cause, especially if there is a history of a visceral malignancy.
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PMID:Tumor-related thrombotic pulmonary microangiopathy: review of pathologic findings and pathophysiologic mechanisms. 1091 85

A 30-year-old HBsAg-positive woman was admitted to the hospital because of 6 days of progressive shortness of breath. She was in severe respiratory distress with circulatory collapse. She had an enlarged liver but no stigmata of chronic liver disease or signs of cirrhosis. She had rapidly developed respiratory arrest and was transferred to intensive care unit. Heart ultrasonography and Doppler scan showed right heart straining and high pulmonary artery pressure. Despite cardiovascular and respiratory support she died a few hours after admission. Autopsy revealed combined hepatocellular-cholangiocarcinoma infiltrating the entire liver, metastatic invasion of lung blood vessels and absence of right ventricular hypertrophy. The incidence of hepatocellular-cholangiocarcinoma, a variant of hepatocellular carcinoma, is roughly 2-3% and the presenting symptoms are abdominal pain, weight loss, jaundice, fever or decompensation of liver disease. Associated HBsAg positivity and cirrhosis are reported in 20-30% and 60% of patients, respectively. Metastases to lungs are relatively frequent but this is the first report of hepatocellular-cholangiocarcinoma presented with acute respiratory distress due to massive pulmonary embolism.
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PMID:Combined hepatocellular-cholangiocarcinoma presented with massive pulmonary embolism. 1102 Aug 95

A 57-year-old female patient with known cardiac disease developed a 4 to 6 week history of diarrhea, followed by onset of orthopnea and subsequent right-sided cardiac failure. On hospital admission she was found to have pure tricuspid regurgitation, without evidence of cardiac ischemia, pulmonary embolism, bacterial endocarditis or pericardial disease. A 24-hour urine collection for 5-HIAA was elevated, and a subsequent octreotide scan documented abnormal uptake in the pelvic cul-de-sac. Bilateral ovarian masses were found at laparotomy, which on pathological examination were found to be a benign left ovarian cystic teratoma, and a right carcinoid tumor of the ovary. This patient presented with systemic complaints of diarrhea, and orthopnea and right sided heart failure that on evaluation were ultimately found to be due to a unilateral primary carcinoid tumor of the ovary, which accounts for less than 0.1% of all ovarian carcinomas, and only 5% of all carcinoids. Treatment of this malignant carcinoid syndrome presentation consisted of debulking of the tumor and continuation of her diuretics and digoxin. Diarrhea and orthopnea ceased within 2 weeks after her oophorectomy. On evaluation 6 weeks and 6 months postoperatively, her cardiac function was stable, though unchanged. 5-HIAA levels were within normal limits, demonstrating the curative function of surgery in patients with unilateral ovarian carcinoid without evidence of metastases, as well as preserved cardiac function in otherwise stable patients.
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PMID:A case of diarrhea and orthopnea in a 57-year-old female. 1106 Oct 23

Cancer patients show an increased susceptibility to develop thromboembolic diseases, suggesting that disorders of coagulation are very common in this pathology. Tumor cells possess the capacity to interact with the hemostatic system, activating the coagulation cascade and stimulating the prothrombotic properties of other blood cell components; the same events while inducing a hypercoagulable state, also contribute to the processes of tumor growth, neoangiogenesis and metastatic formation. Multiple risk factors associated with malignant disease contribute to the hypercoagulability state: stasis induced by prolonged bed rest, vascular invasion by the tumor and iatrogenic complications including the use of central vein catheters and chemotherapy. Several tests have been developed to assess the hypercoagulable state, however their clinical significance still needs to be defined, especially in terms of their predictive value for thrombosis. Clinical manifestations vary from localized deep venous thrombosis (DVT) or pulmonary embolism, more generally associated with solid tumors, to disseminated intravascular coagulation, frequent in hematologic malignancies and metastatic cancer. Diagnosis of idiopathic DVT, in the absence of other risk factors, could indicate the presence of occult cancer, but the usefulness of an extensive work-up to detect malignancy in terms of cost to benefit ratio still has to be demonstrated. Patients with cancer and thromboembolism must be treated with anticoagulant therapy; a large number of studies have shown that either low molecular weight heparins or standard unfractionated heparin for the treatment of acute deep vein thrombosis in hospitalized patients are equally safe and effective; however, the first treatment has been reported to be associated with a lower mortality. After an episode of thrombosis the patients should be protected by a long term course of oral anticoagulation, remaining high the risk of recurrence for as long as the cancer is active.
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PMID:[Blood coagulation changes and neoplastic pathology]. 1107 43

Purpose: To assess the cost of implementing 18F-Fluorodeoxyglucose (18FDG) PET scan in the presurgical evaluation of patients with hepatic metastases from colorectal cancer (CRC) detected by Computed Tomography with arterial portography (CTAP).Methods: We performed a cost analysis of two diagnostic pathways based on a population of CRC patients with metastatic disease limited to the liver by (CTAP). The payers' perspective was utilized. The algorithms compared 18FDG-PET with Computed Tomography (CT) versus CT alone. Patients found to have extrahepatic disease by 18FDG-PET or CT were assigned to palliative care. Patients found to be negative for extrahepatic extension were assumed to be surgically resectable. The prevalence of extrahepatic disease, true and false positives and negatives for CT and 18FDG-PET were extracted from published reports (Medline, 1991 to 1999). Three possible outcomes for surgery were considered: uncomplicated, complicated, and death. Surgical complications considered were: urinary tract infection, wound sepsis, intra-abdominal abscess, septicemia, pneumonia, deep venous thrombosis, pulmonary embolism, anemia requiring transfusion, and myocardial infarction. Complication rates, costs for CT, CTAP, 18FDG-PET, surgery and post-surgical complications were obtained from HCFA published data (1997-2000). Palliative care costs were assumed to be identical in both branches.Results: Average expected cost per patient with 18FDG-PET was $16,921, compared to $21,693 for a patient without PET scan. This represents net savings of $4,772 if PET is included in the diagnostic work up.Conclusion: Integration of 18FDG-PET in the presurgical evaluation of patients with liver metastases from CRC by CTP would substantially reduce overall costs.
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PMID:10. Positron Emission Tomography in the Presurgical Evaluation of Patients with Resectable Liver Metastases from Colorectal Carcinoma Detected by Computed Tomography with Arterial Portography. A Cost Analysis. 1115 Jul 67

This report describes a patient admitted with shortness of breath due to cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed only after right heart pressures failed to decrease after successful pericardiocentesis. The patient was found to have widely metastatic adenocarcinoma of colon (with metastases to pericardium) and a paraneoplastic syndrome of deep vein thrombosis.
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PMID:Cardiac tamponade masking pulmonary embolism. 1140 12

We present a rare case of pulmonary embolism in a patient with disseminated hypernephroma. Necropsy showed a large tumor thrombus in the right ventricle. Modern chemotherapy treatments, whilst improving patient's life expectancy to a certain degree don't hinder the spread of metastases which appear then in areas not previously known of. Providing there are no obvious signs of peripheral thrombi and to exclude intracardiac metastases, we recommend echocardiography for all cancer patients with pulmonary emboli.
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PMID:[Atypical pulmonary embolism in a patient with renal cell carcinoma]. 1155 Jun 21


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