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)

Carcinoma metastatic to the spleen is found at autopsy in 6% to 13% of patients who die of cancer, yet clinical symptoms referable to splenic metastases are unusual. Two cases of breast carcinoma metastatic to the spleen discovered incidentally at therapeutic splenectomy for idiopathic thrombocytopenic purpura are described. On gross examination, the spleens were mildly enlarged with a homogeneous congested cut surface; rare 0.2-cm white nodules were present in one case. Microscopic examination revealed large, poorly cohesive cells that diffusely involved both the red and white pulp. Histochemical, immunohistochemical, and ultrastructural analyses confirmed the epithelial nature of the cellular infiltrate. These cases show that idiopathic thrombocytopenic purpura may herald the presence of diffuse splenic metastases when metastatic disease is not otherwise clinically suspected. The lack of a discrete tumor mass in the spleen in such cases may make the diagnosis of metastatic carcinoma a challenge both clinically and pathologically. Immunohistochemical and electron microscopic examinations are useful to establish the appropriate diagnosis in such cases.
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PMID:Breast carcinoma diffusely metastatic to the spleen. A report of two cases presenting as idiopathic thrombocytopenic purpura. 155 12

MR imaging was used to investigate normal and abnormal meningeal enhancement, with an emphasis on meningeal carcinomatosis. Three groups of patients were studied on a 1.5-T system. In group 1, the normal meninges were examined in 20 patients and were found to show fine linear enhancement in short segments, especially in a parasagittal distribution. In group 2, all gadolinium-enhanced head scans were reviewed retrospectively. Abnormal meningeal enhancement was detected in 52 patients. In some of these, the enhancement was associated with pathologic conditions of the meninges, including leptomeningeal tumor and meningeal infections and other inflammatory conditions; in others the enhancement was adjacent to subdural hematomas, subacute infarcts, and skull lesions, such as metastases or postoperative defects. In group 3, 30 cases of meningeal carcinomatosis were studied prospectively. Enhancement was seen in approximately two-thirds of cases and usually was quite diffuse and applied to the inner table of the skull. Frank nodules were seen less often. Contrast-enhanced CT was equal to MR in the detection of nodules but was nearly always unable to show diffuse meningeal enhancement against the inner table of the skull. Contrast-enhanced MR was more sensitive than contrast-enhanced CT in the examination of normal and abnormal meninges. Abnormal findings, such as meningeal carcinomatosis, were demonstrated more often by MR than by CT.
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PMID:MR imaging of the cranial meninges with emphasis on contrast enhancement and meningeal carcinomatosis. 250 42

MR imaging was used to investigate normal and abnormal meningeal enhancement, with an emphasis on meningeal carcinomatosis. Three groups of patients were studied on a 1.5-T system. In group 1, the normal meninges were examined in 20 patients and were found to show fine linear enhancement in short segments, especially in a parasagittal distribution. In group 2, all gadolinium-enhanced head scans were reviewed retrospectively. Abnormal meningeal enhancement was detected in 52 patients. In some of these, the enhancement was associated with pathologic conditions of the meninges, including leptomeningeal tumor and meningeal infections and other inflammatory conditions; in others the enhancement was adjacent to subdural hematomas, subacute infarcts, and skull lesions, such as metastases or postoperative defects. In group 3, 30 cases of meningeal carcinomatosis were studied prospectively. Enhancement was seen in approximately two-thirds of cases and usually was quite diffuse and applied to the inner table of the skull. Frank nodules were seen less often. Contrast-enhanced CT was equal to MR in the detection of nodules but was nearly always unable to show diffuse meningeal enhancement against the inner table of the skull. Contrast-enhanced MR was more sensitive than contrast-enhanced CT in the examination of normal and abnormal meninges. Abnormal findings, such as meningeal carcinomatosis, were demonstrated more often by MR than by CT.
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PMID:MR imaging of the cranial meninges with emphasis on contrast enhancement and meningeal carcinomatosis. 280 23

A series of 146 women underwent 150 preoperative localizations of mammographically suspicious but nonpalpable breast lesions. The lesions were localized using the hook-wire method of Frank in 133 of these patients. Carcinoma was discovered in 24 (16%) of the women; 18 (75%) of these women had invasive and six women (25%) had noninvasive carcinomas. Sixty-seven patients demonstrated calcification, and of these, 16 patients (24%) turned out to have malignancies. Eighty percent of the cancers were less than 1 cm in diameter, and 38% met the criteria of minimal carcinoma as described by Gallagher and Martin in 1969. Fourteen percent of the patients with carcinoma had lymph node metastases. We conclude that this is a safe, rapid, and accurate method for localizing small, potentially highly curable breast cancers with minimal sacrifice of breast tissue.
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PMID:Needle localization of nonpalpable breast masses. 398 97

The vast majority of neuroendocrine neoplasms of the appendix are carcinoid tumors. Most are of enterochromaffin (EC) cell type, although rare examples are of L cell type. EC cell carcinoids of the appendix differ from those encountered elsewhere in the gastrointestinal system. For example, they are remarkably common given the small size of the appendix, are usually benign, occur in younger patients, and typically contain sustentacular cells that express S-100. Origin from subepithelial neuroendocrine cells could explain these characteristics. It has also been suggested that most appendiceal carcinoids are hyperplastic rather than neoplastic, although this hypothesis requires further study. Nevertheless, truly neoplastic EC cell carcinoids of the appendix undoubtedly occur, and those greater than 2 cm in diameter have a significant risk of producing distant metastases. Carcinoid syndrome is a very rare presentation. Tubular carcinoids are unusual benign neoplasms; it has been proposed that they represent L cell carcinoids with a predominant tubular pattern of growth. Goblet cell carcinoids tend not to produce a grossly visible tumor mass but diffusely infiltrate the wall. They typically exhibit tight clusters of goblet cells, usually with scattered neuroendocrine cells and sometimes with Paneth cells, sometimes surrounding a small lumen. They may behave as a low-grade malignancy. The distinction between goblet cell carcinoid and other types of tumor is of great importance because of the implications for treatment and prognosis. Frank adenocarcinoma can arise from goblet cell carcinoids, and tumors with both components are classified as mixed goblet cell carcinoid-adenocarcinoma. The carcinoma component of the latter determines their prognosis, which would be worse than for a goblet cell carcinoid alone.
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PMID:Neuroendocrine tumors of the appendix. 1580 71

The most significant discovery of the last quarter of the XXth century in the field of prostate cancer is probably the observation that the human prostate synthesizes locally an amount of androgens from the inactive steroid precursors dehydroepiandrosterone (DHEA) and its sulfate DHEA-S that is approximately equivalent to the androgens made in the testis. Based upon this observation, two important discoveries also made by our group are applied worlwide, namely the use of GnRH (gonadotropin -releasing hormone) agonists that completely block testicular androgen secretion, while, simultaneously, the androgens made locally in the prostate from DHEA are blocked in their access to the androgen receptor by a pure antiandrogen (flutamide, bicalutamide or nilutamide). This treatment, called combined androgen blockade, has been the first treatment demonstrated to prolong life in prostate cancer in prospective and randomized studies. While the first studies were performed in patients with advanced and metastatic disease, our recent data indicate a much higher efficacy of the same treatment applied to localized prostate cancer, thus leading to an at least 90 % possibility of cure. In fact, the lifesaving benefits of androgen blockade in prostate cancer have been largely underestimated. When compared to other cancer therapies, the results obtained are quite remarkable. A recent metaanalysis of all clinical trial data mostly gives the credit to follow-up hormone therapy. "Hormonal treatment as a whole works ridiculously well", as reported by Arnst. In fact, while death rates decreased by 1.1 % per year from 1993 to 2001 for all cancers combined, prostate cancer showed a larger decrease at 3.6 %. Although improvements in surgery and radiotherapy are likely to play a role, a study by Frank R. Lichtenberg using National Cancer Institute data obtained from 2.1 million cancer patients, has concluded that "cancer-fighting drugs improved survival rates, especially for cancer of the prostate, where drug innovations have been the greatest". The knowledge about the absence of development of resistance to androgen blockade in localized prostate cancer is extremely important. In fact, it is often erroneously believed that androgen blockade should not be administered early because resistance to treatment will develop and one might as well wait to use androgen blockade at a later stage of the disease. In fact, deferring treatment implies that, very often, it will then be too late, because after the cancer has migrated to the bones, resistance to treatment can no more be avoided. It should be realized that when prostate cancer is first detected, even by screening, the cancer is not small since its diameter is of the order of 1 cm or more. This is the most appropriate time to treat with the strong hope of a cure. With the presently available techniques, screening can diagnose prostate cancer at a clinically localized stage in 99 % of cases. Such an early diagnosis permits immediate treatment with a curative intent, combined androgen blockade (CAB) being a truly efficient alternative especially in older patients. Most importantly, CAB must be used immediately in patients who fail radical prostatectomy, radiotherapy of brachytherapy. When androgen blockade is used, it should always be combined androgen blockade. Using this strategy, based upon today's available diagnostic and therapeutic approaches, death from prostate cancer can be an exception, confirming that victory against prostate cancer is achieved.
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PMID:[Keyrole of endocrinology in the victory against prostate cancer]. 1698 Feb 38

This study examines the perioperative outcome of laparoscopic splenectomy in a minimal resources setting in the Caribbean. Seventeen consecutive patients who underwent elective laparoscopic splenectomies by a single surgeon from August 2003 to December 2008 were studied. Data collected included patients' demographics, indications for surgery, operative time, complications, and outcome. 88% were females, the median age being 33.3 years. Idiopathic thrombocytopenic purpura was the most common indication (82%) in majority of the cases. Other indications included hereditary spherocytosis, hypersplenism, and metastatic disease. The mean operative time was 88.8 minutes and the mean hospital length of stay was 3.3 days. One case was converted to open splenectomy. Five patients experienced postoperative complications. There was no mortality. Despite limited blood banking facilities and hematology support, laparoscopic splenectomy may be safe in minimal resources setting, if cases are selected carefully and performed by an experienced surgeon with short operative times.
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PMID:Laparoscopic splenectomy in a minimal resource setting: a case series from the Caribbean. 2055 92

A 64-year-old female with idiopathic thrombocytopenic purpura(ITP)was admitted to our hospital under the diagnosis of rectal cancer. Intersphincteric resection and splenectomy were performed after high-dose gamma globulin therapy. Thirteen months after the surgery, she suffered from a local recurrence and groin and pelvic lymph node metastases. Radiotherapy was planned before curative resection. During radiation, she complained of severe back pain and high fever with severe thrombocytopenia, and was admitted to our hospital. The examinations revealed disseminated intravascular coagulopathy(DIC), probably induced by multiple bone and hepatic metastases. Although anti-DIC therapy and chemotherapy with FOLFIRI were performed, thrombocytopenia did not improve, and she died of cancer progression about 2 months after admission. We report a case ofDIC induced by cancer progression with ITP. Since thrombocytopenia may be induced by either DIC or ITP, selecting a treatment for such a patient is difficult. We report the present case in detail and discuss findings from the literature.
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PMID:[A case of recurrent rectal cancer with idiopathic thrombocytopenic purpura showing rapid progression, suggesting disseminated intravascular coagulopathy]. 2224 70

Not all feasible care is desirable care. At the end of life, aggressive interventions may not only be futile but also inappropriate because they may impair the quality of the remaining life for both the patient and the caregiver. Although it is challenging to identify patients with a poor prognosis, certain terminal conditions among the elderly, such as end-stage dementia, heart failure, and metastatic cancer, demand a more measured use of aggressive care. Frank discussions with patients and family about their desires in the context of the prognosis, as well as symptom support, can yield both economic savings and better quality of life.
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PMID:Economics at the end of life: hospital and ICU perspectives. 2287 82

A 74-year-old man diagnosed with idiopathic thrombocytopenic purpura (ITP) nine years ago, was referred to our hospital because of cecal cancer. After the infusion of a high dose of gamma globulin preoperatively, iliocecal resection and splenectomy were performed. His blood platelet count did not increase much postoperatively, therefore, adjuvant chemotherapy was not performed. After one year, metastases of the liver, lung, and lymph node of the para aorta were revealed by CT. Since high-dose steroid therapy was effective temporarily, we decided to perform mFOLFOX chemotherapy. After that, his blood platelet count increased gradually to the normal range, and steroid therapy was no longer required. His blood platelet count remained in the normal range after changing the mFOLFOX chemotherapy to FOLFIRI and XELOX chemotherapy. Some studies reported the effect of chemotherapy on refractory ITP, but no one has reported the effect of chemotherapy for colon cancer refractory to ITP. We concluded that chemotherapy for colon cancer can be indicated for refractory ITP.
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PMID:[A case of colon cancer with idiopathic thrombocytopenic purpura (ITP) which achieved complete remission by chemotherapy]. 2299 83


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