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)

Thirteen patients with hepatic tumors, from the Boston Center for Liver Transplantation, have been transplanted among a total of 169 recipients. Ten were transplanted primarily for tumor, while three other patients harbored incidental tumors. Two perioperative deaths occurred (15%). Eight patients had hepatocellular carcinoma, one hepatoblastoma and four bile duct (Klatskin) tumors. Two of the bile duct cancers recurred with patient deaths at 9 and 10 months. The remaining nine patients are alive from between 1 month and 36 months postoperatively. A selected review of the literature allowed analysis of follow-up on 185 patients transplanted for tumor. Overall, the proportion of patients transplanted for tumor was 16%. Fifty-two percent of patients had hepatocellular carcinomas (HCC), 24% cholangiocarcinomas, 10% other primary liver tumors, and 14% metastatic hepatic tumors. Median survival for HCC was 1 year; 90-day mortality was 30%. Actuarial survival for 1, 2 and 3 years was 49%, 37% and 30% respectively. Fibrolamellar HCC and incidental HCC had significantly better results than other HCC. Tumor recurrence was present in 72% of autopsies after 90 days. Transplantation for HCC has satisfactory results in selected patients and may be improved by adjuvant chemotherapy. The median survival with cholangiocarcinomas was 8 months; 90-day mortality was 40%. Actuarial survival for 1 year was 36%. Recurrence was present in 100% of autopsies after 90 days. Survival after transplantation for this tumor was similar to that observed in patients not undergoing surgical treatment. Median survival for 18 other primary hepatic tumors was 16 months. Transplantation in carefully selected patients with these other primary tumors appears warranted. Although experience overall with transplantation for metastatic disease has been relatively unfavorable, each histological type must be considered independently.
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PMID:Experience with transplantation in the treatment of liver cancer. 253 55

The sonograms of 14 patients with pathologically proven Klatskin tumors presenting between 1974 and 1985 were reviewed. All 14 patients demonstrated dilated intrahepatic bile ducts with a normal-sized extrahepatic biliary tree. In seven patients this was the only finding. The other seven patients demonstrated one or more additional abnormalities. These included an apparent intraductal mass at the confluence of the right and left intrahepatic ducts (four patients), enlarged portal lymph nodes (two patients), and hepatic metastases (one patient). With one exception, these additional findings were seen only in patients scanned after 1980, that is, using real-time sonography and up-to-date scanners. The presence of dilated intrahepatic ducts in a patient with a normal extrahepatic biliary tree should raise the possibility of Klatskin tumor. With high-resolution real-time sonography, further evidence suggestive of malignancy can be demonstrated in at least 50% of patients.
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PMID:Sonographic diagnosis of Klatskin tumors. 301 75

Cytologic preparations and histologic specimens from 404 liver biopsies were reviewed. The cytologic specimens were prepared from the saline rinsings of the Klatskin biopsy needle. Malignant neoplasms were detected by both methods in 50 cases. In seven cases, neoplasms were diagnosed by cytologic techniques alone; in nine cases neoplasms were present in the biopsy only. No false-positive cytologic diagnoses of malignancy occurred. The results of this study show that cytologic examination of the rinsings of the biopsy needle is a sensitive and highly specific adjunct to biopsy in the detection of hepatic metastases.
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PMID:Cytologic detection of hepatic metastases. 693 45

In most patients with a pancreatic head carcinoma or a cholangiocarcinoma of the liver (Klatskin tumour) US is the first imaging modality. Tumour detection using US can exceed that of CT. For small tumours, endosonography or ERCP is recommended. Enlarged lymph nodes are not a major diagnostic parameter, because a reliable differentiation between reactive and malignant lymph nodes is generally not possible. Very tiny liver and peritoneal metastases are missed by the current imaging modalities including US and only detectable by laparoscopy and/or laparoscopic US. Tumour involvement of the portal venous system is an important determinant for irresectability which can often be assessed by duplex Doppler US obviating invasive or expensive imaging modalities. In pancreatic head carcinoma an abnormal pulsed Doppler signal is highly suspicious for involvement of the portal venous system. However, a normal pulsed Doppler signal does not exclude involvement at all. In Klatskin tumour, Doppler US had an accuracy of 91% compared with surgical findings in predicting portal venous involvement. In most cases of pancreatic head carcinoma or Klatskin tumour, US can assess irresectability. However, assessment of curative resectability in these tumours remains a problem.
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PMID:Current applicability of duplex Doppler ultrasonography in pancreatic head and biliary malignancies. 777 12

Proximal bile duct carcinoma (Klatskin tumour) is infrequent and difficult to treat. In principle, surgery is indicated. The usefulness of irradiation after resection is controversial in the literature. This article describes the experiences gained in the Academic Medical Centre of Amsterdam with pre- and postoperative irradiation of resectable Klatskin tumours. Preoperative irradiation (10.5 Gy) is administered to devitalize detached tumour cells in the bile, to prevent implantation metastases after resection. Postoperative irradiation has been administered since 1986 according to protocol. An analysis of 71 patients, of whom 48 had been irradiated after resection while 23 had not, showed a statistically significant prolongation of survival in the group irradiated postoperatively. Radiotherapy was administered externally (55 Gy) or in combination with internal radiotherapy (45 Gy external, 10 Gy internal). For internal irradiation, the source of radiation (Iridium-192) was introduced along the bile duct anastomoses via the soma formed by the blind end of the Roux-Y jejunal loop used for bile duct reconstruction. Since internal irradiation in combination with external irradiation caused more complications, while there was no difference of survival from patients only irradiated externally, the complete postoperative irradiation is currently being given from the outside. Pre- and postoperative irradiation may contribute to the success of the treatment of the resectable Klatskin tumour.
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PMID:[Pre- and postoperative irradiation in the treatment of resectable Klatskin tumours]. 938 Jan 86

Hilar tumors are extremely difficult to manage with a considerably lower resection rate. We performed endoscopic biliary drainage for 288 patients with hilar tumors (Klatskin tumor 184, gallbladder carcinoma 23, HCC 47 and other metastases 34) in the past 3 years. 162 patients underwent endoscopic nasobiliary drainage, 80 plastic biliary stenting, and 46 expandable metal stent implantation. 4 patients were given double stents insertion simultaneously, 43.1% of patients received good drainage with the total effective rate of 67.0%, but postprocedure cholangitis took place in 13.8% of patients within one month and 3 died of cholangitis and sepsis. In the long-term follow-up patients without surgical treatment, the median sruvival was 5.3 months. The outcome was closely related to Bismuth types, and jaundice could be relieved if more than about 40% of the liver was drained. The double stents for the left and right intrahepatic duct in the meantime could enlarge drainage area and improve the theraputic effectiveness. To get highest benefit, the 3 endoscopic biliary drainage methods should be choosen properly and exchanged flexibly. We conclude that endoscopic biliary drainage is a safe and useful management for the hilar tumor and should be the treatment of choice for palliating jaundice in the inoperable patients.
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PMID:[The evaluation of endoscopic biliary drainage for 288 patients with malignant hilar obstruction]. 1037 80

Most patients with a pancreatic head carcinoma, periampullary carcinoma or a cholangiocarcinoma of the liver hilum (Klatskin tumor) present with obstructive jaundice and therefore ultrasound often is the first imaging modality. Visualization is sufficient in more than 90% of cases for adequate diagnosis and staging. Even most small papillary tumors can be diagnosed with conventional abdominal ultrasound. In pancreatic head and periampullary carcinoma vascular involvement is the most important determinant for local irresectability and can often be assessed by color Doppler US. An abnormal pulsed Doppler signal obtained from the portal venous system due to severe narrowing or occlusion is highly suspicious for major involvement and irresectability of the tumor. However, a normal pulsed Doppler signal does not exclude involvement, if the tumor has continuity with the vessel with interruption of the hyperechoic tumor vessel interface. Enlarged lymph nodes are not a major diagnostic parameter, because a reliable differentiation between reactive and malignant lymph nodes is generally not possible. Very tiny liver and peritoneal metastases are missed by abdominal US and only detectable by laparoscopy and/or laparascopic US. In cholangiocarcinoma of the liver hilum extensive biliary and vascular involvement are considered the most important factors for determining irresectability. Portal venous involvement can be assessed by color Doppler US with a high accuracy (91%). Although cholangiography (ERCP and PTC) is considered the best imaging modality in detecting proximal extension of the tumor into the biliary system US can provide useful additional information. If dilated ducts are seen without clear communication among each other within a liver lobe, extension of the tumor into the segmental bile ducts can be concluded. We consider color Doppler US, a valuable tool for preoperative imaging and staging of biliopancreatic malignancy.
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PMID:Imaging and staging of biliopancreatic malignancy: role of ultrasound. 1043 78

Biliopancreatic tumors that are potentially amenable to local resection include proximal bile duct tumors (Klatskin tumors), mid-choledochal duct tumors and tumors arising from the papilla of Vater. This paper reviews our experience in the AMC, with local resection of these conditions. From 1983-1997, 112 patients underwent surgical resection of a carcinoma of the hepatic duct confluence (Klatskin tumor). Local resection was undertaken in 80 patients (52 patients with type I and II tumors, and 28 patients with type III tumors) whereas in 32 patients with type III tumors, hilar resection was performed with liver resection. Negative surgical margins were achieved in 10 patients after local resection of type I and II tumors (19.2%), in 1 patient after local resection of a type III tumor (3.6%), and in 5 patients after hilar resection and liver resection (15.6%). Middle-third carcinomas of the extra-hepatic biliary tract are less common than proximal or distal bile duct tumors. From 1993-1998, 12 patients underwent resection of a mid-choledochal duct carcinoma. In 8 patients, local resection was performed and in 4 patients, subtotal pancreatoduodenectomy (PPPD) because of the close relationship of the tumor and the pancreas. Four patients had negative surgical margins, 2 after local resection (25%) and 2 after PPPD (50%). Although accepted for villous adenomas located in the ampulla, local resection for ampullary carcinoma is controversial. Nine patients underwent local resection of a presumed adenoma that proved to be an ampullary carcinoma. In 4 patients with T1 tumors, resection of the carcinoma was locally complete (44%). Additional PPPD was performed in 6 patients, including the 4 patients with complete local resections, showing no residual tumor at the previous site of excision, but, lymphnode metastases in two resection specimens (both of patients with presumed T1 tumors). Hence, local resection of a T1 ampullary carcinoma might result in tumor free margins, but does not deal with (usually retropancreatic) lymphnode metastases. In conclusion, local resection is applicable to Klatskin type I and II tumors. Local resection may be considered in the proximally located, mid-choledochal duct carcinomas but, when located closer to the pancreas, PPPD is the preferred treatment. For ampullary adenomas, local resection is feasible unless frozen section examination raises suspicion on a malignancy. Local resection of even limited ampullary carcinomas is not advisable because of lymphatic dissemination of the tumor and consequently, inadequate clearance.
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PMID:Local resection of biliopancreatic cancer. 1043 32

Malignant tumors of the hepatobiliopancreatic system are not curable in > 60%. For this reason, palliation plays an important therapeutic role. Indications are mainly obstructive jaundice, duodenal obstruction and pain. Assessment of the tumor's morphology and resectability is often possible only by surgical exploration. If necessary and feasible, non-curable malignancies are treated synchronously during this operation. In preoperatively proven distant metastases or local non-resectability, interventional procedures are preferred. They are efficient, at least primarily, and mostly correlated with little patient discomfort. A surgical biliary bypass obviously leads to improved long-term palliation. Especially in Klatskin tumors, palliative resection may be useful. Generally the patients benefit from palliation depends on minor therapeutic discomfort and long-lasting control of symptoms.
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PMID:[Palliative measures in the hepatobiliary-pancreatic system]. 1063 94

Resectional surgery offers a curative intent and a survival benefit for patients with hilar cholangiocarcinoma, but is associated with high morbidity. Since morphological imaging cannot solve differential diagnosis preoperatively, in order to exclude patients inappropriate to this aggressive surgery, we evaluated the impact of functional imaging using fluorodeoxyglucose positron emission tomography (FDG PET) in the detection of cholangiocarcinoma and its usefulness in the differentiation from benign Klatskin tumour-mimicking lesions. Fifteen consecutive patients aged 47-78 years underwent standardized whole-body FDG PET with attenuation correction before potentially curative surgery using a conventional full-ring PET scanner with an axial field-of-view of 16.2 cm. FDG PET was evaluated visually and semiquantitatively using tumour-to-background ratios (T/B) ratios. All lesions were evaluated histopathologically. FDG PET presumed to be indicative for carcinoma was positive in 12 of 15 patients, true positive in 10 (T/B ratio, 3.2+/-1.9) and false positive in two of them (T/B ratios, 2.1 and 2.8) with Klatskin tumour-mimicking lesions. While all true positive PET results were seen in the tubular type of cholangiocarcinoma with a high amount of tumour cells and only low production of mucus, a false negative FDG PET in three patients was observed in mucinous adenocarcinoma. Additionally, FDG PET detected locoregional lymph nodes in two patients and distant metastases in a further three patients. Due to false positive results FDG PET does not allow the differentiation of benign from malignant lesions, and FDG PET should be avoided in patients with mucinous cholangiocarcinoma. However, FDG PET may have significant influence on the treatment strategy in as much as 20% of the patients, since it may detect distant metastases.
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PMID:FDG PET in the diagnosis of hilar cholangiocarcinoma. 1171 97


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