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

Malignant primary adrenal tumors are rare forms of cancer with an estimated incidence of two to ten new cases per one million inhabitants per year. The 5-year survival rate for adrenocortical carcinoma is approximately 35%, whereas the 10-year survival rate of malignant pheochromocytoma reaches 40%. Clinical studies support repeated surgery as the mainstay of treatment, either with curative or palliative intention. For adrenocortical carcinoma, adjunctive treatment with oral mitotane leads to well-documented improvement of survival. Rare malignant pheochromocytomas with distant metastases are preferably treated by 131I-MIBG. Chemotherapy is reserved for unresectable tumors without sufficient response to mitotane or 131I-MIBG, respectively. Cisplatin and etoposide as single therapy, or in combination with doxorubicin or etoposide, appear to be effective in adrenocortical carcinoma. Malignant pheochromocytoma may be treated with vincristine, dacarbazine, and cyclophosphamide. Treatment with octreotide is currently being evaluated. Radiotherapy is indicated if unresectable tumor masses cause local symptoms. If symptoms of endocrine activity are not sufficiently controlled by measures aiming at tumor mass reduction, specific inhibitors of hormone synthesis or action are available. Ketoconazole is widely used for adrenocortical carcinoma, and phenoxybenzamine and metyrosine are available for malignant pheochromocytoma. This review provides guidelines for rational disease management based on still scanty clinical evidence.
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PMID:Clinical management of malignant adrenal tumors. 1126 Aug 59

Malignant endocrine disorders have been an enigma over the last few decades, from genetic, clinical, and imaging perspectives. The detection of the primary tumor and the identification of recurrent disease have been essentially based on various anatomic techniques, with localization procedures extensively developed for staging, follow-up, radio-guided surgery, and therapy. Frequently, the lesions are too small to cause anatomic alterations, or they are obscured by the changes in anatomic planes that occur after initial surgery. Small lesions, however, are the ones that can potentially be cured. Thus, every attempt should be made to localize these sites before further growth and dissemination occur beyond the scope of cure. Since the advent of iodine-131 for staging and follow-up of patients with differentiated thyroid carcinoma, the search has led to the use of radioiodinated metaiodobenzylguanidine (MIBG) for recurrent pheochromocytoma and neuroblastoma, to the development of antibodies to carcinoembryonic antigen for the staging and treatment of medullary thyroid carcinoma, and to the characterization of peptide receptors on neuroendocrine tumors. Additionally, there has been a breakthrough with the use of positron emitters in nuclear oncology, including F-18-fluorodeoxyglucose, for I-131-negative metastases of differentiated thyroid carcinoma, recurrent medullary thyroid carcinoma, malignant pheochromocytoma, and adrenocortical carcinoma. Undoubtedly, optimal care of the patient requires both the expertise of the treating endocrinologist and the use of various imaging techniques in the diagnosis, staging, and follow-up of these diseases.
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PMID:Nuclear endocrinology as a monitoring tool. 1143 May 30

Because of the rarity of adrenocortical carcinoma, survival rates and the prognosis for patients who have undergone operation are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors over an 18-year period. A trend study was associated to assess changes in the clinical and biochemical presentations as well as the surgical evolution. A total of 253 patients (158 women, 95 men) with a mean age of 47 years were included. Cushing syndrome was the main clinical presentation (30%), and hormonal studies revealed secreting tumors in 66% of the cases. Altogether, 72% (n = 182) of patients underwent resection for cure, and 41.5% (n = 105) of them had an extensive resection because of metastatic cancer. A lymphadenectomy was performed in 32.5% (n = 89) of the cases. The operative mortality was 5.5% (n = 14). Patients were given mitotane as adjuvant therapy in 53.8% of the cases (n = 135). The results of staging were stage I in 16 patients (6.3%), stage II (local disease) in 126 patients (49.8%), stage III (locoregional disease) in 57 patients (22.5%), and stage IV (metastases) in 54 patients (21.3%). Neither tumor staging nor the rate of curative surgery changed during the study period. More subcostal incisions were performed, and the use of mitotane increased significantly. The 5-year actuarial survival rates were 38% overall, 50% in the curative group, 66% for stage I, 58% for stage II, 24% for stage III, and 0% for stage IV. Multivariate analysis showed that mitotane benefited only the group of patients not operated on for cure. A better prognosis was found in patients operated on after 1988 (p = 0.04), in those with precursor-secreting tumors (p = 0.005), and in those at local stages of the disease (p = 0.0003). Thus mitotane benefited only patients not operated on for cure. Curative resection, precursor secretion, recent diagnosis, and local stage were favorably associated with survival.
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PMID:Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. 1157 30

Bilateral adrenal tumors were detected in a 72-year-old man who had a history of hepatic inflammatory pseudotumor. Computet tomography (CT)-guided fine needle aspiration cytology (FNAC) of the adrenal glands was performed. The cytologic findings were similar to the previous diagnosis of "inflammatory pseudotumor" in the liver. However, the origin of some aggregated large atypical cells observed in the adrenal FNAC specimens was not known. Immunocytochemically, these large atypical cells were positive for vimentin and negative for cytokeratin and chromogranin A. An electron-microscopic study showed that these large atypical cells contained mitochondria with tubulovesicular cristae and smooth endoplasmic reticulum arranged in whorled and laminated patterns, and these findings confirmed diagnosis of primary adrenal cortical carcinoma. The histopathological diagnosis of the resected bilateral adrenal tumor was adrenal cortical carcinoma. The patient died 7 months after surgery, with recurrence of the bilateral adrenal cortical carcinoma and extensive metastases. A diagnosis of primary adrenal cortical carcinoma with extensive metastases was finally demonstrated by autopsy. Retrospectively, the previous liver tumor was determined to be a metastatic lesion.
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PMID:Use of electron microscopic evaluation for the diagnosis of adrenal cortical carcinoma in fine needle aspiration cytology: a case report and review of the literature. 1179 96

We report a case of non-functioning adrenal cortical carcinoma (ACC) presenting with metastatic disease to the tongue, which is an extremely uncommon onset for this neoplasm. Histologically, the lesion had the appearance of an anaplastic neoplasm, and a panel of immunohistochemical markers including vimentin, MART-1, S100 protein, HMB-45, smooth muscle actin, common muscle actin, desmin, CD31, CD34, CD68, EMA and cytokeratins, was helpful in excluding melanoma, as well as other mesenchymal and epithelial neoplasms.
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PMID:Non-functioning adrenal cortical carcinoma presenting with metastasis to the tongue. 1258 89

A total of 15 adrenocortical carcinomas with myxoid differentiation from 15 ferrets were evaluated in this retrospective study. Six of these ferrets (40%) either were euthanatized or died due to invasive and/or metastatic disease. The myxoid component was a variable part (between 5% and 95%) of the adrenal cortical neoplasm and consisted of sheets and cords of small, polygonal neoplastic cells that formed lumenlike spaces. Such spaces contained a variable amount of alcian blue (pH 2.5)-positive mucinous product (i.e., acidic mucopolysaccharides). Neoplastic cells were negative for the argentaffin reaction, but immunohistochemically they were strongly positive for vimentin and alpha-inhibin and lightly positive for synaptophysin. Proliferating cell nuclear antigen (PCNA)-labeling indices (LI) of adrenal cortical neoplastic cells within the myxoid component of the neoplasm were significantly elevated (P < 0.05) compared with those of typical neoplastic adrenal cortical cells or the adjacent nonneoplastic zona reticularis. Ultrastructurally, cells in the myxoid component exhibited a typical adrenocortical phenotype characterized by cytoplasmic lipid vacuoles, prominent rough and smooth endoplasmic reticulum, and zonula adherens. This lesion was interpreted as an adrenal cortical carcinoma with myxoid differentiation and appeared to be highly malignant based on PCNA LI, rate of invasion into adjacent tissue, and metastasis (6/15). This report is the first description of this histologic variant in the ferret, which morphologically resembled the rare myxoid variant of adrenocortical carcinoma described in humans.
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PMID:Adrenal cortical carcinomas with myxoid differentiation in the domestic ferret (Mustela putorius furo). 1263 52

An adrenocortical carcinoma was found in an eight-year-old male donkey. The main clinical feature was severe depression and inappetence. The animal died 24 hours after hospitalization. Necropsy revealed a large tumor around the anterior pole of the left kidney and metastases to liver, heart and lung. Fibrous adhesions were seen between the tumor and the intestinal serosa. The abdominal cavity contained a large amount of red-brown fluid.
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PMID:Adrenocortical carcinoma in a donkey. 1275 61

Adrenocortical carcinoma is a rare but aggressive malignancy with metastases being present in 30-40% of cases at the time of diagnosis. A number of prognostic factors have been identified in patients with adrenocortical carcinoma, but criteria predicting survival are not uniform. We report the case of a 58-year-old man with a large, non-functioning and poorly-differentiated adrenocortical carcinoma who, according to current knowledge, was expected to have a short survival. On the contrary, the prompt diagnosis and curative resection of the primary tumour, together with two reoperations for local recurrences, allowed a 15-year survival and a good quality of life. A revision of both clinical and histological prognostic factors is therefore needed in patients with this type of malignancy.
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PMID:Adrenocortical carcinoma: a 15-year survival after complete resection and repeated resection. A retrospective study in a patient with an expected poor prognosis. 1292 37

Malignant tumor of adrenal cortex without early diagnosis and radical surgical treatment is fatal. The results of treatment of 216 patients with adrenocortical carcinoma treated in 1968-2002, which is 32.6% of all the patients with tumors of adrenal cortex treated in the clinic were analyzed. In majority of cases the disease was hormonally active. The best result was observed after primary radical surgery at early stage (without regional metastases). Re-operation in majority of cases ensures remission, however, it cannot be considered as radical method of treatment. Chloditane application permits to prolongs survival, however it has usually been used as additional treatment.
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PMID:[Treatment results in adrenal cortex malignant tumors ]. 1461 Jul 95

Workup of a patient with lung cancer involves adrenal imaging for evaluation of metastatic disease. When nodules are detected, biopsy is often attempted to differentiate a primary neoplasm from metastatic carcinoma or other lesions, such as granuloma. CT-guided biopsy of the deep seated adrenal glands is technically difficult and material is often scanty. We present a case and review histologic features enabling the diagnosis of adrenal cortical carcinoma.
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PMID:Synchronous adrenal cortical carcinoma in a patient with lung cancer. 1500 Feb 12


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