Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

In disseminated nonseminomatous testicular cancer, chemotherapy is the first choice because this treatment can be curative. To illustrate the particular indications for surgical excision of pulmonary metastases from primary nonseminomatous testicular cancer three patients are presented who were operated on during the past two years. Surgery is recommended to ascertain the histologic nature of remaining metastases after chemotherapy, when there is no further response to chemotherapy or a partial response only. Histologic findings range from necrotic pulmonary lesions to benign transformation or viable tumor. These results should guide further therapy, particularly to decide whether chemotherapy should be continued or changed.
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PMID:Surgical excision of pulmonary metastases from primary testicular cancer--case reports. 280 Aug 50

To determine the predictive values of using different sizes on CT as criteria for the detection of retroperitoneal lymph-node metastases in patients with early-stage (nodes 5 cm or less in diameter) primary nonseminomatous testicular cancer, we performed a retrospective analysis of 51 patients. Measurements of lymph-node transaxial diameters on CT were correlated with histologic findings at lymph-node dissection or with response to initial chemotherapy. All patients had normal serum markers (alpha-fetoprotein, human chorionic gonadotropin) after orchiectomy. The frequency of lymph-node metastases in this population was 51%. When a CT criterion of 5 mm was used, the negative predictive value was 79%; the positive predictive value, 62%; the specificity, 44%; and the sensitivity, 88%. With a criterion of 15 mm, the negative predictive value was 63%; the positive predictive value, 71%; the specificity, 76%; and the sensitivity, 58%. Metastases in retroperitoneal lymph nodes that appeared within normal limits (i.e., had normal transaxial diameters) on CT were the limiting factor in the ability of CT to exclude the presence of metastases. We conclude that using smaller sizes on CT scans as the criteria for detection of lymph-node metastases cannot replace dissection of nodes in patients who have normal-sized nodes but may be helpful in identifying a subgroup of patients who are at lower risk of harboring metastases when treatment by orchiectomy alone is considered.
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PMID:Detection of retroperitoneal metastases in early-stage nonseminomatous testicular cancer: analysis of different CT criteria. 282 94

Twenty-six of approximately 1300 patients (1.9%) with unilateral testicular cancer developed a second primary germ cell cancer (seminoma 18; non-seminoma 8). Patients with previous seminoma had a significantly higher risk of developing a new seminoma than those with a previous non-seminoma. The diagnosis of second primary was made within 3 years of the first diagnosis in only 50% of the patients. In patients with a history of undescended and/or atrophic testes the interval significantly decreased between the diagnosis of the two testicular cancers. The prognosis of bilateral testicular cancer is generally good. Patients in whom the second testicular cancer is at clinical stage I (no metastases) at diagnosis can safely be observed without further treatment after orchiectomy. A patient with unilateral testicular cancer should be informed of the increased risk of developing a second primary germ cell tumour and should be encouraged to perform regular examination of the remaining testis. The need for life-long follow-up visits for patients with testicular cancer is questionable.
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PMID:Bilateral malignant testicular germ cell cancer. 286 70

About 130 Norwegian men (15-45 years old) develop testicular cancer each year. Men with a history of undescended testes, atrophic testes and/or fertility problems probably represent a high risk group. Typical symptoms are tumour, harder consistency and discomfort in the testes, low back pain and gynecomastia. Testicular ultrasonography often helps to establish the correct diagnosis. Seminoma is separated from non-seminoma histologically. Adjuvant radiotherapy to the retroperitoneal lymph nodes is the most frequent treatment in seminoma patients with early disease and is combined with chemotherapy in patients with advanced disease. Chemotherapy and surgery are the main therapeutic modalities in non-seminoma patients. In clinical trials a "wait and see" policy is applicable in selected patients with non-seminoma without metastases, provided that frequent follow-up examinations are feasible. Gastrointestinal side effects, alopecia, peripheral neuropathy and azoospermia are the most frequent acute and reversible side effects of treatment of testicular cancer. Post-treatment paternity can be achieved by at least half of the patients who wish to father a child after treatment. The 5-years' survival rate for young patients with testicular cancer is 95%. Young men should perform testicular self-examination regularly. Medical officers in the Armed Forces and doctors at schools and universities and in occupational health should be aware of testicular cancer in young adults with suspicious clinical findings.
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PMID:[Testicular cancer. A challenge to the health services taking care of young males]. 291 18

Forty patients with retroperitoneal metastasis from nonseminomatous testicular cancer treated with chemotherapy were retrospectively studied to (1) evaluate the predictive value of mass size as detected by computerized tomography (CT) as an indicator for postchemotherapy surgery and (2) determine the factors that influence relapse. Patients received two further courses of chemotherapy after their serum biomarkers became normal and computed tomography indicated a complete response or presence of a residual but stable mass. We found that patients with initial metastases less than 2 cm had a low frequency (14%) of residual masses after chemotherapy, vs. 59% for those with masses of 2-5 cm and 75% for those with masses of greater than 5 cm (P = 0.03). Of 22 patients with primary embryonal carcinoma, three of seven (43%) with residual masses after chemotherapy had mature teratoma at surgery. Six patients had small (1-2 cm) residual abnormalities that were not removed, and three of these patients relapsed. In conclusion, increasing size of retroperitoneal metastasis by CT scan predicts for increased likelihood of a residual mass after chemotherapy; patients who have a residual mass greater than or equal to 1 cm require retroperitoneal lymphadenectomy after chemotherapy, whether the tumor histology is embryonal carcinoma or teratoma. The role of surgery for patients who have residual retroperitoneal masses less than 1 cm after chemotherapy could not be determined from our study.
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PMID:Clinical and radiological correlation of retroperitoneal metastasis from nonseminomatous testicular cancer treated with chemotherapy. 292 Jul 67

A monoclonal antibody (H17E2) was used in a solid-phase localisation of enzyme activity (ILEA) assay to evaluate placental-like alkaline phosphatase (PLAP) as a serum marker of testicular germ cell tumours. Single or repeated assays were performed on 213 normal blood donor and a smaller number of term pregnancy and testicular cancer sera. The detection limit of PLAP by this system was 0.14 O.D. units equivalent to 0.04iul-1. Of 50 patients with established metastatic disease tested before treatment, 88% of 16 with seminoma, 54% of 13 with mixed seminoma and malignant teratoma and 33% of 21 with malignant teratoma had serum PLAP greater than 0.2 O.D. units. This compared to an incidence of 2% in non-smokers and of 29% in smokers who had been free of disease for more than 12 months. In 15 of 22 successfully treated patients, pre-treatment serum PLAP exceeded 0.2 O.D. units (mean 0.69 O.D.) and varying (53-97%) reductions in the initial levels occurred with treatment. These results with monoclonal antibody ILEA assay suggest that measurement of PLAP levels will be useful in the management of patients with germ cell tumours, particularly seminoma.
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PMID:Serum marker potential of placental alkaline phosphatase-like activity in testicular germ cell tumours evaluated by H17E2 monoclonal antibody assay. 298 64

Bilateral retroperitoneal lymphadenectomy is mainly a staging procedure in patients with stage I nonseminomatous testis cancer, and it causes permanent loss of antegrade ejaculation in approximately two-thirds of the cases. Between May 1978 and August 1981, 61 consecutive patients with no intraoperative evidence of lymph node involvement underwent unilateral retroperitoneal lymph-adenectomy for nonseminomatous germinal testis tumors. Microscopic metastases were found in 1 to 4 retroperitoneal nodes in 6 cases (9.8 per cent). Antegrade ejaculation was absent postoperatively in 11 patients (18 per cent), with no significant difference between patients who underwent lymph node dissection on the left or right side. Ejaculation returned spontaneously in 3 patients, 1 of whom fathered a child. The disease recurred in 10 patients 3 to 35 months after lymphadenectomy (median 6 months). Disease recurred in 8 of 55 patients (14.5 per cent) with negative nodes and 2 of 6 (33.3 per cent) with positive histological findings. No patient suffered retroperitoneal recurrence. The more than 3-year survival rates free of disease were 96.4 and 83.3 per cent in patients with pathological stages I and II disease, respectively. Unilateral retroperitoneal lymphadenectomy in patients with intraoperative stage I nonseminomatous germinal testis cancer preserves antegrade ejaculation in more than 80 per cent of the cases without apparently compromising the long-term survival.
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PMID:Unilateral lymphadenectomy in intraoperative stage I nonseminomatous germinal testis cancer. 299 72

Carcinomas derived from teratomatous epithelium occur rarely in the metastases of patients with testicular cancer. These carcinomas of teratomatous origin (CTO) are easily confused with residual embryonal carcinoma (EC). For that reason, we compared the light and electron microscopic appearances of 6 CTOs with those of 12 ECs. As seen by light microscopy, the CTOs formed glands and more frequently had well-defined cytoplasmic borders, eosinophilic cytoplasm, and nonoverlapping, regular nuclei with small or absent nucleoli and little chromatin clumping and clearing, compared with the ECs. Mucin was present in the cells or glandular lumina of three CTOs but was absent in all the ECs. The demonstration of cytoplasmic glycogen was of no differential aid. The most useful differentiating ultrastructural features were long tight junctions and telolysosomes, which occurred in all of the EC but which were absent in the six cases of CTO. Desmosomes with inserting tonofilaments were present in three cases of CTO but were much less developed in EC. Two cases of CTO had microvilli with anchoring rootlets; such anchoring rootlets were not observed among EC. The distinction of CTO from residual EC is important, because CTO will likely need to be treated in a different manner.
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PMID:The differentiation of carcinomas of teratomatous origin from embryonal carcinoma. A light and electron microscopic study. 300 79

Thirty-six consecutive patients underwent retroperitoneal lymphadenectomy for clinical stage I nonseminomatous germinal testis cancer from January 1980 to August 1981. Retroperitoneal lymphnode metastases were pathologically documented in 8 cases (22.2%). No patient received adjuvant therapy following surgery. The disease relapsed in 4 patients (11.1%) always in the lung, from 5 to 7 months after lymphadenectomy. The pulmonary disease was minimal in 3 cases and bulky (1 lung nodule greater than 2 cm) in 1 patient. All the relapsed patients entered continuous complete remission with cisplatin, vinblastine and bleomycin (plus surgery in one case). All the 36 patients in this series are alive and disease-free after a follow-up period of 40-60 months from lymphadenectomy. Antegrade ejaculation was lost by 10 out of 13 cases who had undergone the bilateral lymphadenectomy (77%) and by 2 of the 21 adult patients who had had the unilateral dissection (9.5%). Unilateral retroperitoneal lymphadenectomy is recommended in patients with negative intra-operative findings who undergo surgery for clinical stage I nonseminomatous testis cancer.
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PMID:Retroperitoneal lymphadenectomy in clinical stage I nonseminomatous germinal testis cancer. 300 18

A prospective clinicopathologic study of 60 patients with clinical Stage I nonseminomatous testicular cancer (NSTC) has been reported. Of 60 patients with clinical Stage I NSTC who underwent retroperitoneal lymphadenectomy (RPLA), 6 proved to be Stage II, a staging error of 10 per cent. In 4 patients of the remaining 54, metastases developed in the lungs. In 1 patient metastases developed both in the lung and in retroperitoneal lymph nodes. There was no death in these groups of patients. These 10 patients with staging error and/or recurrence after RPLA have been analyzed for the causes of treatment failure utilizing a set of prognostic criteria (tumor cell type, vascular or lymphatic invasion in the primary tumor, extension to the spermatic cord, and size of the primary tumors). It has been concluded that embryonal carcinoma (P less than 0.001), vascular invasion (P less than 0.001), and extension of the tumor to the spermatic cord (P less than 0.001) are significant predictors of metastases and/or recurrence after RPLA in Stage I NSTC. A plan of management is suggested based on these criteria.
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PMID:Predictors of recurrent clinical stage I nonseminomatous testicular cancer. A prospective clinicopathologic study. 301 47


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