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)

Twenty-nine young men (mean age 29 years) had primitive neuroectodermal tumors (PNETs) arising in germ cell tumors (GCTs). Nine patients had PNETs confined to the testis, eight patients had PNETs in the testis and at metastatic sites, and 12 patients had PNETs identified only at extratesticular sites. Immunohistochemistry was of use in the further classification of these PNETs as neuroblastoma, medulloepithelioma, peripheral neuroepithelioma, or ependymoblastoma. The histologic pattern of PNETs in the testis (neuroblastoma or medulloepithelioma) did not predict which tumors metastasized. PNETs localized to the testis did not affect prognosis. Eight patients with no PNETs outside the testis were free of disease 1 month to 10 years after diagnosis. PNETs in extratesticular sites were an adverse prognostic factor. Nineteen patients with extratesticular PNETs had adequate clinical follow-up. Thirteen are dead of disease from 4 months to 5 1/2 years (mean 26 months) after diagnosis, four are alive with disease 6 months to 2 years after diagnosis, and two have no evidence of disease with short follow-up (6 and 17 months). Mean survival was longer (34 months) for patients whose extratesticular PNET was neuroblastoma than for those with other types of PNETs (13 months). Chemotherapy directed against GCTs was not effective in patients who developed metastatic PNETs of GCT origin. We conclude that extratesticular PNETs in patients with testicular GCTs are usually fatal, but patients with neuroblastomatous metastases may have a more prolonged course.
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PMID:Primitive neuroectodermal tumors arising in testicular germ cell neoplasms. 1007 29

Between 1982 and 1991, 24 patients with advanced testicular germ cell tumor were treated by combination chemotherapy with cisplatin, vinblastine and bleomycin (PVB). Based on short-term efficacy of the PVB regimen and long-term prognosis in our patients, we evaluated 4 risk criteria proposed by Indiana University, National Cancer Institute (NCI), Memorial Sloan-Kettering Cancer Center (MSKCC) and European Organization for Research and Treatment of Cancer (EORTC). Clinical staging were IIA in 8 patients, IIB in 8, IIIA in 1, IIIB in 5 and IIIC in 2. Metastases included retroperitoneal lymph node in 20 cases (> 5 cm in 10), lung in 6, bone and liver in each 1. Complete response (CR) was obtained in 12 (50%) patients and partial response (PR) in 9 (38%). According to the stage and metastatic site, CR was achieved in 75%, 38% and 38%of the stage IIA, IIB and III tumors, respectively, and in 60% and 50% of retroperitoneal and pulmonary metastases, respectively. However, neither CR nor PR was recognized for live and bone metastases. Prognosis was assessed with a mean followup period of 88.5 months. Although all 12 patients with CR were alive, 4 of the 9 with PR and all patients on whom the drug was ineffective died of cancer. Accuracy in predicting prognosis was 82%, 75%, 74%, and 63% using the MSKCC, Indiana, NCI and EORTC risk criteria, respectively.
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PMID:[Clinical results of combination chemotherapy with cisplatin, vinblastine and bleomycin (pvb) for advanced testicular cancer: evaluation of risk criteria]. 931 Jul 78

We report a case of a sonographically-detected impalpable embryonal cell carcinoma with bulky retroperitoneal metastases. A 34-year-old man, who presented with left flank pain, was presumed to have an extragonadal retroperitoneal germ cell tumor. Scrotal sonography revealed a hypoechoic lesion, 7 mm in diameter, which was histologically diagnosed as a primary embryonal cell carcinoma. Evidence suggested that the primary tumor had grown slowly, as the tumor was well encapsulated. This case suggests that some extragonadal germ cell tumors arise from a primary testicular cancers, and that successful treatment of these tumors should include consideration that they may have arisen as a primary testicular mass.
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PMID:Sonographically-detected impalpable testicular cancer with retroperitoneal bulky metastases: a case report. 935 63

Pure teratomas are considered to be less aggressive and less likely to metastasize than other nonseminomatous germ cell tumors. Therefore, patients with mature teratomas are considered to be candidates for surveillance protocols. We report on the clinical history and treatment of 44 patients with a primary pure testicular teratoma. In all, 35 patients (79.5%) presented with clinically low-stage disease [n = 26, clinical stage I (59.1%); n = 9, clinical stage IIA/B (20.4%)] and underwent radical orchiectomy followed by retroperitoneal lymphadenectomy (RPLND); nine patients (20.5%) presented with clinically advanced disease (clinical stage IIC to stage IV). Archival tumor blocks were available for pathological reevaluation and serial sections were obtained in all cases. The frequency of lymph node metastases in patients with clinical stage I disease was 19.2%; in patients with clinical stage IIA/B the risk was 66%. Pathohistological diagnosis of mature teratoma was confirmed in all cases; however, 17/20 patients demonstrated scars or calcifications in the adjacent parenchyma, indicating a burned-out tumor and 3/20 demonstrated microfocal germ cell tumor elements. None of the clinical stage I patients relapsed during follow-up; relapse rate among patients with stage IIA/B disease was 33%. Our data demonstrate the malignant potential of pure testicular mature teratoma. Based on our results, metastases in testicular mature teratoma seem to result from metastazising non-germ-cell components undergoing early regression as demonstrated by the high frequency of burnedout tumors. We recommend serial sections of the orchiectomy specimen in all cases of pure mature teratoma for deciding on adequate management: RPLND in cases with associated scars, calcifications or microfocal malignant germ cell components, and surveillance in cases with pure mature teratomas.
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PMID:[Clinical stage I mature teratoma of the testis--retroperitoneal lymphadenectomy or surveillance?]. 942 96

GCT is considered a curable tumor with a greater than 90% overall long-term survival. Pulmonary metastasis is common in patients with disseminated disease. First-line therapy in the management of patients with pulmonary metastases from germ cell tumors is cisplatin-based chemotherapy. Pulmonary metastasectomy has an important adjuvant role in a subset of patients who have residual radiographic abnormalities or progression of disease despite optimal chemotherapy. Surgical resection of residual pulmonary and mediastinal disease provides an accurate response assessment and consolidates the chemotherapy by removal of any viable GCT. Therefore, surgical resection of all residual masses is indicated in patients with NSGCT and normalized serum value of tumor markers after definitive systemic chemotherapy. Surgical resection or biopsy is a reasonable alternative in residual seminoma > or = 3 cm in diameter.
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PMID:Medical and surgical management of pulmonary metastases from germ cell tumors. 951 78

The presentation of nonseminomatous germ cell tumor confined clinically to the testicle (clinical stage I) is associated with a 30% incidence of occult retroperitoneal metastases. For decades, the standard of care in these patients has been a retroperitoneal lymph node dissection (RPLND), both for staging purposes, and, in the pre-modern chemotherapy era, it was performed with curative intent. The improvements in combination chemotherapy during the past 20 years have resulted in the cure of most individuals with small volume recurrent disease, calling into question the continued need for RPLND. The strategy of surveillance and chemotherapy for the 30% who relapse has gained acceptance, and, with meticulous follow-up, can result in the same excellent cure rates seen in patients treated with the surgical option. Although primary chemotherapy has also been suggested as a treatment option, the majority of patients will receive that chemotherapy unnecessarily, and cure rates with this strategy will not surpass those for surveillance or RPLND. Prognostic factors have been developed that can successfully identify a group of patients who are at an extremely low risk of relapse, thus potentially sparing these individuals any additional therapy. However, attempts to define a very high risk population have been unsuccessful to date, and we await the development of newer biologic markers able to predict which patients are most likely to have occult retroperitoneal disease and therefore most likely to benefit from additional "adjuvant" therapy post-orchiectomy.
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PMID:Clinical stage I nonseminoma: surgery versus surveillance. 956 47

Yolk sac tumor is the most frequent germ cell tumor of testis in children. For stage I yolk sac tumor of testis in children younger than 2 years, high inguinal orchiectomy alone has been the standard treatment, with a cure rate of at least 75%. Here, we compare the treatment results of receiving chemotherapy or no chemotherapy after orchiectomy, to analyze the role of chemotherapy. From February 1987 to January 1997, 22 children younger than 2 years, with stage I yolk sac tumor of testis, were included in the study. All patients had high inguinal orchiectomy without retroperitoneal lymphadenectomy. Initial diagnostic imaging studies included computed tomographic scan of abdomen, chest radiography, and long bone survey. Clinical stage I was defined as a tumor completely resected with no evidence of local regional lymph node involvement or distant metastases. Serum alpha-fetoprotein (AFP) was assessed at diagnosis. After orchiectomy, diagnosis, and staging, patients were stratified into two treatment groups, with or without chemotherapy, according to the decision of the parents. Ten children received chemotherapy consisting of cisplatin, vinblastine, and bleomycin (PVB, modified "Einhorn regimen") for 12 weeks. The remaining 12 patients were followed up according to a "wait and see" policy. Determination of AFP was performed monthly during the first postoperative year, every other month during the second year, every 3 months during the third year, every 6 months during the fourth year, and yearly until the fifth postoperative year at least. The duration of follow-up ranged from 3 months to 119 months (median, 53 months). The Kaplan-Meier plot estimated an overall survival rate of 91.6% at 7 years after diagnosis. Among the 12 patients without chemotherapy, 2 children had relapses at 4 and 6 months after diagnosis, respectively. One was cured with PVB chemotherapy. The other patient died with refractory lung metastasis, in spite of intensive multimodality salvage therapy. The Kaplan-Meier plot showed a survival rate of 80% at 7 years and a relapse-free survival rate of 81.8% at 5 years after diagnosis. All children receiving chemotherapy were alive and free from relapse. There was no significant treatment-related toxicity. Our results may suggest that PVB chemotherapy after orchiectomy is an affective and safe regimen for stage I yolk sac tumor of testis in children younger than 2 years. Instead of four courses of PVB as used here, two or three courses could be enough. To elucidate the necessity for chemotherapy and to determine the number of courses of PVB needed (if chemotherapy is given), a randomized study of more cases is warranted.
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PMID:The stage I yolk sac tumor of testis in children younger than 2 years, chemotherapy or not? 961 19

Germ cell tumors (GCT) remain the model for solid tumor therapy. Until 1997, GCT staging was based on individual institution systems, which limited comparison of data and collaboration between GCT groups. GCT staging is based on four basic criteria: disease site of origin, histology, secretion of serum tumor markers (STM), and bulk of disease. Within most staging systems developed by investigators, clinical stage I disease is confined to the testis based on radiographic imaging and STM or pathological stage I based on lack of histological disease at retroperitoneal lymphadenectomy. Stages II and III are considered to be disease outside the testis categorized by lymphatic spread to the retroperitoneal lymph nodes or hematological spread to lungs and visceral organs, respectively. The major staging systems previously used include the Indiana University Staging System; Modified Samuels' Classification (M.D. Anderson Cancer Center); Memorial Sloan Kettering Cancer Center Mathematical Model; and the Tumor, Nodal, Metastases (TNM) Staging System (American Joint Committee on Cancer). The most recent evolution in staging systems is the 1997 International Germ Cell Consensus Classification, which is based on prognosis and outcomes. This system allows for comparison of data and collaboration between Germ Cell Tumor Groups.
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PMID:Germ cell tumors: staging, prognosis, and outcome. 964 31

The point mutations occurring in codons 12 and 13 of Ki-ras in 78 patients with colorectal carcinoma (31 Dukes' A and B, 21 Dukes' C, and 26 Dukes' D) have been determined by allele-specific oligonucleotide hybridization and sequencing. Duplicate samples of invasive primary carcinoma, adjacent normal tissue, and available lymph node and liver metastases from the same patients were microdissected from paraffin sections. There were no differences in the mutation rate between primary carcinomas and secondary deposits: 26 of 78 (33 per cent) primary carcinomas, 10 of 32 (31 per cent) lymph node metastases, and 10 of 26 (38 per cent) liver metastases. Multiple sampling revealed frequent heterogeneity within carcinomas: 9 of 26 primaries with Ki-ras mutations also contained areas of carcinoma with only the wild-type gene, implying that Ki-ras mutation, even when present in a colonic carcinoma, may not have been necessary for establishing the malignant phenotype. Also, 2 of 26 (8 per cent) Dukes' D patients had a mutation in their primary carcinoma but none in liver metastases and 6 of 47 (13 per cent) Dukes' C and D patients had mutations in liver or lymph node metastases but none in the primary carcinoma. Such heterogeneity may modify the effectiveness of novel therapies targeting mutant Ki-ras function, such as farnesyltransferase inhibition. Mutation of codon 12 from GGT (glycine) to GTT (valine) was more prevalent in primary and metastatic deposits of Dukes' C/D carcinomas (P = 0.01) than in primary carcinomas from Dukes' A/B patients. Mutations of codon 12 to GAT, AGT, GCT and codon 13 GGC to GAC were also found, but no correlation with carcinoma aggressiveness was apparent. Follow-up of 71/78 patients (up to 12 years) revealed decreased overall survival (P = 0.001) in patients with the GGT to GTT transversion in codon 12, even when the analysis was restricted to Dukes' D cases, supporting the suggestion that this mutation may confer a more aggressive phenotype in colorectal carcinoma.
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PMID:Heterogeneity of mutant versus wild-type Ki-ras in primary and metastatic colorectal carcinomas, and association of codon-12 valine with early mortality. 971 38

Germinoma is the most frequent type of intracranial germ-cell tumor initial presentation is usually acute intracranial hypertension. MRI investigations are non-specific. Most of the time, only stereotactic surgery is performed before treatment. Metastases are rare but germ cells can disseminate both by infiltration and via ventricular and subarachnoid pathways. Abdominal and pelvic metastases occur in 10 p. 100 of patients who have received ventriculosomatic shunting. Since germinoma is well known to be a very radiosensitive tumor, patients are usually given radiation therapy. Chemotherapy seems to be an interesting alternative treatment.
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PMID:[Germinal tumor metastases. Case report]. 977 50


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