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)

Two cases of occlusion of the inferior vena cava by leiomyosarcoma are reported. This localisation is extremely rare for mesenchymal tumors. The neoplasm originated from the wall of the vena cava, expanded forward into the lumen of the vessel, in one case up to the right atrium. Collateral circulation, anasarca edema and varices develop by this occlusionsyndrome. The fatal outcome of the disease is usually determined by right heart failure and not by metastases directly. In most cases diagnosis is made by autopsy. In cavography the differential diagnosis of thrombosis might include the rare possibility of leiomyosarcoma of the caval vein. Only early diagnosis makes succesful surgical therapy possible.
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PMID:[Vena cava occlusion-syndrom by leiomyosarcoma. Two case reports (author's transl)]. 89 50

Histiocytosis X describes a disease characterized by histiocytic infiltration of the reticuloendothelial system, skin, bones, and pituitary gland. The disseminated form frequently occurs in infants and children. Chemotherapy has significantly improved the prognosis in this disorder. Sixty-three per cent of survivors, however, have some residual disability related to fibrosis of tissues previously infiltrated by histiocytes. In instances of liver involvement, healing by fibrosis may result in cirrhosis with portal hypertension and bleeding esophageal varices. Clinical findings include hepatosplenomegaly, jaundice, ascites, hypoalbuminemia, prolonged prothrombin time, and Bromsulphalein retention. Histologic examination of the liver shows a characteristic dense "macronodular" periportal cirrhotic pattern. Three children with portal hypertension and bleeding varices due to healed histiocytosis X were sucessfully managed by portosystemic shunt procedures. Portacaval, mesocaval, and central splenorenal shunts were equally effective in relieving poral hypertension. These children had neither recurrence of bleeding nor evidence of encephalopathy. Two children remain well whereas in one patient a primary hepatoma developed fourteen years posthung and he died of pulmonary metastases. Portosystemic shunt procedures effectively relieve the threat of potentially fatal variceal hemorrhage and improve the opportunity for long-term survival in children with cirrhosis and portal hypertension due to healed histiocytosis X.
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PMID:Portal hypertension in infants and children with histiocytosis X. 108 50

Varices of the colostomy are a rare complication of colostomy performed in patients with portal hypertension. This work is based on 14 cases. The colic stomy is the terminal operation in surgery for cancer in twelve cases, and a bypass stomy in two cases. Portal hypertension is due to cirrhosis in 10 cases and to metastases to the liver in 4 cases. All 14 colostomy varices were expressed by bleeding. In 7 cases, oesophageal varices were detected with fiberendoscopy. Only one of these patients had an upper digestive hemorrhage. Colostomy hemorrhages are the revealing complication and the main sign of the disease. The emergent treatment of bleeding of the colostomy must combine several methods, most often consecutively: local compression, ligation, sclerotherapy. Once bleeding is controlled, the radical treatment must be primarily medical (hygienic and dietary habits, beta-adrenergic blocking agents), but complementary surgery may prove to be necessary, most often to redo the colostomy with additional deconnection. The prognosis mainly depends on the function of the liver, the deterioration of which is accelerated by the successive hemorrhagic accidents. Hepatorenal failure is the main cause of death.
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PMID:[Colostomy-induced varices in portal hypertension]. 133 37

Endoscopic ultrasound is a new technology that improves the local staging of esophageal, gastric, and rectal carcinomas. In addition, EUS may provide useful information which will affect management in individual patients with subepithelial masses (e.g., varices, leiomyomas) and pancreatic diseases. Other imaging studies such as transcutaneous ultrasonography and CT are still necessary to detect distant metastatic disease. At present, EUS may be best reserved for use by individuals who have sufficient patient materials to provide broad experience with the technique. Physicians at centers where large numbers of patients with gastrointestinal cancer are evaluated may find this technology most useful. Even in patients with malignancy, however, studies are needed to show that the improved local staging by EUS will translate into changes in patient management and improved outcome.
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PMID:Status evaluation: endoscopic ultrasonography. American Society for Gastroenterology Endoscopy. Technology Assessment Committee. 147 98

Gastrointestinal hemorrhage from left-sided portal hypertension and gastric varices is an unusual presentation for islet cell carcinoma of the pancreas. Islet cell tumors of the pancreas themselves are rare. They present in a variety of ways. Those that elaborate functional hormones cause specific neuroendocrine syndromes. Nonfunctional tumors characteristically present later with symptoms of metastatic disease or as a result of local enlargement. We present a case of islet cell carcinoma of the pancreas presenting with recurrent gastrointestinal bleeding from gastric varices and review the literature for this rare presentation. We emphasize the importance of a careful initial diagnostic work-up that may enable curative surgery.
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PMID:Islet cell carcinoma of the pancreas presenting as bleeding from isolated gastric varices. Report of a case and review of the literature. 184 33

Spindle cell haemangioendothelioma is an uncommon vascular lesion, of which 35 cases have been previously reported. A further 20 cases are reported herein. These lesions affected a wide age range in both sexes, and showed a predilection for the extremities. Twelve patients had multiple lesions and, in these cases, local progression over many years but no true recurrence was typical. None of the 20 patients developed metastases, but one later developed an angiosarcoma. Individual cases were associated with congenital lymphoedema. Klippel-Trenaunay syndrome and early-onset varicose veins. Histologically, in addition to the admixture of cavernous spaces and solid spindle cell/epithelioid cell areas, the presence both of irregularly distributed and perivascular smooth muscle cells and of malformed variably-sized vessels at the periphery of almost every lesion was noted in each case. Reticulin staining, immunohistochemistry and electronmicroscopy revealed the presence of primitive vessel formation and partial endothelial differentiation in the solid spindle cell areas. Combining these data with those from previously published series, it is suggested that spindle cell haemangioendothelioma is a non-neoplastic lesion (rather than a borderline malignancy as it is currently regarded) and that its development correlates with histological and/or clinical evidence of a malformed vasculature at the affected site.
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PMID:Spindle cell haemangioendothelioma: a clinicopathological and immunohistochemical study indicative of a non-neoplastic lesion. 849 66

Clinical, laboratory, and ultrasonographic features of 75 patients of primary hepatocellular carcinoma (PHC) living in the Gizan Area of Saudi Arabia and their follow-up, during a 2-year period, were characterized. Eighty-nine percent of the cases were defined histologically, whereas in the rest, ultrasonographic (US) evidence along with an alphafetoprotein (AFP) level exceeding 480 ng/ml were taken as the positive evidence for PHC. Eighty percent of the cases were male patients, with the peak incidence during the seventh decade. The most common clinical presentations were hepatic enlargement (91%), abdominal pain (76%), splenic enlargement (33%), and acites (33%), followed by bruit, fever, metastases, and varices. Alteration in a liver function test was manifest in 97% of the cases, AFP values greater than 480 ng/ml in 57%, and a hepatitis B virus surface antigen (HBsAg) positivity in 65% of the cases. There was no intersex variation in positivity for HBsAg, antibody to HBsAg (anti-HBs), antibody to hepatitis B virus core antigen (anti-HBc) among the 30 PHC cases studied. Positivity for HBsAg or the overall hepatitis B virus exposure in PHC cases was higher than the normal controls (P less than 0.001). In addition to histologic confirmation of PHC in 67 cases, there was histologic evidence of cirrhosis in 25%, or chronic active hepatitis in 19% of the cases. At the time of diagnosis, the average duration of the presenting illness was less than 2 months, while the mortality in the ensuing 2-month period was 73%. The average span of total illness in the vast majority of cases was 4 to 6 months. Two female patients (one with fibrolamellar carcinoma) however, survived for 2 years. Immunization against hepatitis B virus should be considered for all newborns in such hyperendemic communities. A continuous program should be started in such communities to screen and immunize all those yet unexposed to hepatitis B virus. The established HBsAg carriers should be periodically examined ultrasonographically along with an AFP estimation for initiating the chemotherapeutic and other measures against PHC in fairly early stages of malignancy.
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PMID:A profile of primary hepatocellular carcinoma patients in the Gizan Area of Saudi Arabia. 242 66

CT has become an important tool in the diagnosis and management of diseases that affect the stomach and duodenum. By depicting the bowel lumen, wall, and extramural structures, CT can provide unique information that complements standard air contrast radiography and endoscopy. Proper scanning methods and knowledge of normal anatomy are necessary for optimal results. We utilize the gas contrast technique for organ-specific examination in patients with known or suspected gastroduodenal disease. Gastric adenocarcinoma is an important indication for CT evaluation. Unfortunately, early hopes that CT could accurately stage gastric cancer have not been realized. CT is not as accurate as laparotomy in staging early gastric cancer, primarily owing to its inability to detect small peritoneal implants, diagnose metastases in normal-sized lymph perigastric nodes, and predict pancreatic invasion. Nevertheless, CT retains an important role in depicting gross metastatic disease and guiding percutaneous biopsy, particularly in patients who are deemed poor surgical candidates or have undergone prior gastric resection. A variety of conditions other than primary gastric adenocarcinoma produce recognizable abnormalities on CT. Gastric lipoma, leiomyosarcoma, and varices have a distinctive appearance. Others, including gastritis and uncomplicated peptic ulcer, produce nonspecific gastric wall thickening. Endoscopic correlation and biopsy are required for specific diagnosis in these cases. The duodenum, by virtue of its location in the anterior pararenal compartment of the retroperitoneum, may be involved by numerous benign and malignant conditions. In blunt trauma, complicated pancreatitis, and peptic ulcer disease, as well as primary and metastatic malignancy, CT can provide data that may alter patient management.
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PMID:CT of the stomach and duodenum. 265 48

Twenty-six stage II/III malignant melanoma patients with 321 measurable metastatic lesions were imaged using Fab fragments of an IgG murine monoclonal antibody labeled specifically with 10-30 mCi Tc-99m with a bi-functional chelating method (NeoRx, Seattle, WA). There were no side effects or adverse reactions. Immunoscintigraphy demonstrated 66.6% of lesions larger than 1 cm and 92.5% of lesions larger than 3 cm. Most frequently detected metastases were in lymph nodes, subcutaneous areas, and bone. Of lesions less than 1 cm, 23.6% were detected if superficial cutaneous lesions were excluded. The smallest detectable lesion was 4 mm. Twenty-one additional clinically unsuspected sites were visualized in 12 of the 26 patients studied. Of these, 56% were confirmed as metastasis by other tests. There were apparent nonspecific localizations owing to other causes, including fracture, varicosities, skin abscess and pneumonitis. Increased experience in image analysis facilitates correct interpretation of these localizations. This study demonstrates that imaging with Tc-99m labeled antibody fragments detects melanoma lesions in organs routinely surveyed and in other areas not routinely assessed by other imaging techniques. The procedure is readily performed and safe. The principal advantage of the test is its ability to survey the entire body and all organs with a single test. Its principal limitation, in common with other diagnostic imaging procedures, is its poor sensitivity for detecting lesions less than 1 cm.
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PMID:Technetium-99m labeled monoclonal antibodies in the detection of metastatic melanoma. 280 39

Histological examination of the wall of the stomach and esophagus in patients with hepatocellular carcinoma associated with cirrhosis demonstrated intravariceal tumor thrombi in 13 (23.6%) of 55 cases studied. There were distant hematogenous metastases in 31 of them, of whom 12 (38.7%) had variceal tumor thrombi. Tumor thrombi were of varying sizes, and tumor cells appeared either intact, degenerated or necrotic. In seven cases, there was a firm adhesion of thrombi onto the vascular wall suggesting possible mural infiltration, but no extravascular metastases were noted grossly. These findings suggest a possibility of metastasis of hepatocellular carcinoma to the stomach and esophagus via the portal vein. It is also suggested that the degree of varices is not increased by tumor thrombus formation per se, and that both varices and tumor thrombi are due to extensive hepatofugal collateral circulation. Considering that 12 of 13 cases of intravariceal tumor thrombi had lung metastases, a portal vein-varices-lung route is possible for lung metastasis beside the established route through the hepatic vein in hepatocellular carcinoma.
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PMID:Frequency and significance of tumor thrombi in esophageal varices in hepatocellular carcinoma associated with cirrhosis. 301 30


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