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

A case of nonseminomatous testicular cancer and enlarged mediastinal lymph nodes, which were interpreted as metastases, is reported. When there was no change after two courses of chemotherapy, a mediastinoscopy was performed and the results showed sarcoidosis.
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PMID:Sarcoid-like lymphadenopathy mimicking metastatic testicular cancer. 191 31

Forty-nine young males with advanced testicular cancer treated between March 1982 and June 1989 comprised a 49/588 (8%) subgroup with distant metastases to the retroperitoneum, mediastinum and lungs, and required mandatory surgery on basis of the risk for reactivation of "slumbering" malignant components in tumor tissue temporarily inactivated by chemotherapy and/or radiotherapy. Preoperative CAT-scan was carried out with the intention of mapping regional pathology related to the size, number, burden of the tumor tissue, and the occasional and prognostic ominous invasion of the great vessels. Regarding radical surgery, the positive predictive value of CAT-scan was found to be 33/34 (97%). The negative predictive value was 5/15 (33%) and was interpreted as an expression of the radiologist's cautious assessment. 14/49 (29%) died before March 1990. Poor prognosis was related to invasion of major vessels and was found in 14 patients of whom eight died. It seems established that CAT-scan presents an extremely valuable preoperative investigation when it comes to planning of surgical strategy in a patient population with testicular cancer metastases with difficult access.
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PMID:[Residual metastases from testicular cancer. CT as a diagnostic and strategic adjuvant]. 192 1

A retrospective study of bipedal lymphography (BL), computed tomography (CT) and ultrasonography (US) of retroperitoneal lymph nodes has been carried out in 95 patients with newly diagnosed testicular cancer. Twenty-one patients had abnormal lymph nodes at the time of staging. The diagnostic accuracies of CT and US were almost identical with a sensitivity of 80% and 76% respectively and a specificity for both of 100%. BL was performed in 84 patients and was in accordance with US and CT in 66 cases. In 2 cases only BL was positive, while 16 had equivocal results of lymphography, of whom 5 had metastases. Nine patients relapsed to the retroperitoneal lymph nodes during observation, reducing CT/US sensitivity for macroscopic and microscopic disease to 63%. US-guided biopsy was performed in a total of 28 patients at the time of staging or during follow-up. Twenty-three patients had malignant findings and 5 verified benign lesions. US represents a cheap and accurate alternative to CT in the detection of metastatic retroperitoneal lymph nodes. US and US-guided biopsy is indicated supplementary to CT in cases with borderline enlarged nodes on CT. Furthermore, US-guided biopsy should always be performed to verify or exclude relapse, when follow-up examinations reveal abnormal abdominal findings.
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PMID:Ultrasound and ultrasound guided biopsy, CT and lymphography in the diagnosis of retroperitoneal metastases in testicular cancer. 194 35

Two groups of patients between 1977-1986 and 1987-1989 underwent surgery for pulmonary metastases. The most frequent primary sites were the kidney and the colon-rectum. While metastases from testicular cancer have become rare indications, metastases from breast cancer are increasing. Our results show that more metastatic lesions are usually found at operation than indicated by CT scan. The discrepancy amounts to 18% in presumably solitary metastases and increases to 50% if three or more lesions were identified preoperatively. Therefore, bilateral exploration is advocated. Lesions of the posterior lower lobes are more satisfactorily approached by a bilateral transverse incision and sternotomy. The mortality was 1% in the former and 0% in the more recent group of patients.
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PMID:[Developments in surgery of pulmonary metastases]. 198 60

Controversy exists concerning the role of adjunctive chemotherapy in patients with regional nodal involvement. A randomized study reported a 48% relapse rate for patients with positive nodes (stage B1 or stage B2), all of whom were salvaged by full-dose platinum-based chemotherapy. In a series of patients with positive nodes who received two cycles of adjunctive chemotherapy postoperatively, the relapse rate was only 2%. In order to evaluate the effect of retroperitoneal lymph node dissection on relapse rates in patients with stage B1 testicular cancer, a retrospective review of a series of 39 patients was performed. Criteria for inclusion included pathologic stage B1 (less than six positive nodes, located in the primary landing site, with no node greater than 2 cm in diameter and no extracapsular lymph node extension). Patients who fulfilled the criteria along with normalization of tumor markers were followed-up expectantly after retroperitoneal lymph node dissection. Thirty-nine patients were followed from 1 to 10 years with the median duration of follow-up of 3.5 years. Ten of the 39 patients had modified retroperitoneal lymph node dissections with preservation of antegrade ejaculation. The other 29 had full retroperitoneal lymph node dissections. Three relapses were seen, one patient with retrocrural and pulmonary metastases and two patients with pulmonary metastases only for a relapse rate of 8% (three of 39). Patients with stage B2 disease received adjunctive chemotherapy with two or three cycles of platinum-based chemotherapy. We conclude that retroperitoneal lymph node dissection alone is adequate treatment for the majority of patients with pathologic stage B1 testicular cancer. In that subset of patients, adjunctive chemotherapy should be reserved for relapse.
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PMID:Is adjuvant chemotherapy necessary for patients with stage B1 testicular cancer? 207 43

From January 1976 to December 1988, 338 patients with pulmonary metastases underwent 376 resections. For 26 patients with recurrent disease a second or repeated thoracotomy was necessary. The operative mortality was for isolated lesions under 1%, for multiple bilateral nodules 3.8%. A parenchymal saving resection was performed, except for metastases from colorectal carcinoma, who often involved the bronchopulmonary lymphatic nodules. In these cases (30%) a segmentectomy or lobectomy was indicated. The five-year survival rates was significantly favorable for patients with isolated lesions, specially for late uterine metastases (57%), late mammary metastases (45%) and head and neck metastases (60%). The adjuvant hormones substitution and chemotherapy for multiple uterine and mammary metastases leaded to favorable results (prolonged median survival of 18 months). The indication for resection of multiple ipsilateral or bilateral lesions from testicular cancer, soft tissue and osteogenic sarcomas were recommended only when there was no response or partial response to the chemotherapy. The five-year survival was 46%, 27% and 17% approximately. The disease-free interval, location of the pulmonary lesions and the stage of primary cancer had not influenced on post-thoracotomy survival. The metastatic route of primary cancer, caval or portal route, size and number of metastases and the tumor doubling time was significantly associated with postoperative survival.
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PMID:[Interdisciplinary concepts and long-term results after surgery of pulmonary metastases]. 207 88

In 16 patients with metastatic testicular cancer and 10 age matched male control subjects growth hormone (GH) responses to growth hormone releasing hormone (GHRH; 1 microgram/kg body weight iv.) and thyrotropin releasing hormone (TRH; 200 micrograms iv.) were measured. Basal GH levels and GH levels following stimulation with GHRH or TRH were significantly increased in cancer patients compared to control subjects. 9 patients with testicular cancer were studied both in the stage of metastatic disease and after they had reached a complete remission. In complete remission GH responses to GHRH tended to decrease but the differences did not reach statistical significance. Our data suggest an alteration of hypothalamic and/or pituitary regulation of GH secretion in patients with metastatic testicular cancer.
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PMID:Increased growth hormone responses to growth hormone releasing hormone and thyrotropin releasing hormone in patients with metastatic testicular cancer. 210 20

118 Patients with non-seminomatous testicular cancer (NSTC) in clinical stage I (CSI = no metastases by clinical, radiological and biochemical evaluation) underwent retroperitoneal lymph node dissection (RLND). The operation was done unilaterally (95 patients) in peroperatively tumor-free patients or in those with limited metastatic growth. In 23 patients with more extensive metastases, bilateral RLND was performed. Metastatic lymph nodes were found in 36 patients, and these patients received 3-4 cycles of a cisplatin-based combination chemotherapy. If no metastases were detected the patients had no further treatment. The 5-year disease-free survival rate was 100%. 8 of 82 patients without detected metastases in the operation specimen relapsed (all outside the retroperitoneal space), but were cured by salvage chemotherapy. Solitary metastases were found in 11 patients, whereas 25 patients had more than 1 metastatic lymph node. The size of the largest metastasis ranged from 0.3 to 40 mm. Metastases from right-sided tumors were detected at all levels of the lumbar region, predominantly to the right of the inferior vena cava and/or within the interaortocaval space. Left-sided tumors metastasized to the upper two thirds of the lumbar space, only rarely crossing the midline. This anatomical distribution of metastatic lymph nodes indicates that the presacral sympathetic nerve plexus and the sympathetic nerve fibers around the aortic bifurcation can be spared from extensive resection in the majority of patients with NSTC in CSI. Unilateral RLND or other nerve-sparing techniques are thus possible, preserving antegrade ejaculation in greater than 80% of the patients. This RLND represents a reasonable alternative to the 'surveillance' policy in NSTC.
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PMID:Distribution of retroperitoneal lymph node metastases in patients with non-seminomatous testicular cancer in clinical stage I. 215 89

We present two patients with testicular cancer and extragonadal germ cell tumor respectively in whom neurological symptoms due to metastases preceded the correct diagnosis. Testicular cancer and extragonadal germ cell tumor are today curable malignancies even when distant metastases are present at diagnosis. The diagnosis of germ cell tumor should be considered whenever a young man presents with metastases of uncertain origin, and all histological specimens should be revised with the diagnosis of germ cell tumor in mind.
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PMID:Metastatic testicular cancer and extragonadal germ cell tumor presenting with neurological symptoms. 216 14

Improvements in operative technique and perioperative management have expanded the application of hepatic resection for metastatic cancer. Although a policy of aggressive surgical resection of residual pulmonary and retroperitoneal disease following chemotherapy and normalization of serum tumor markers has been adopted for disseminated germ cell carcinoma, resection of residual hepatic disease in these cases has not been addressed. This report concerns a series of prospectively randomized patients who received systemic cisplatin-based chemotherapy for testis cancer during the past 13 years. Twenty-eight patients underwent resection of residual hepatic disease after serologic remission. Most (23 of 28 patients) of these procedures were performed concomitantly with other cytoreductive procedures. There were no operative deaths, although 28% of the patients developed complications. The 2-year survival rate was 54%, with an average follow-up of 34 months. Patients were stratified into three groups based on the most aggressive histology noted in the resected specimen. Survival is predicted by this histologic classification system. Hepatic resection can be performed safely and is an important component in the treatment of disseminated testicular carcinoma.
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PMID:Hepatic resection for disseminated germ cell carcinoma. 216 94


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