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

An analysis of the clinico-pathological findings in 49 patients with adenocarcinoma of unknown primary origin indicates a short survival time. No factors were identified that influenced survival. Thromboembolic episodes and second primary tumors commonly complicate the clinical course. Metastases in widespread organs are common autopsy findings. Immunological mechanisms may explain these findings.
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PMID:Adenocarcinoma of unknown primary site: a clinico-pathological study. 48 22

Metastatic involvement of the temporal bone by malignant tumors is considered to be rare. The actual incidence of metastatic temporal bone tumors, however, is probably much higher than suggested by reports in the literature. The reason for this is that histologic studies are rarely performed on temporal bones in routine postmortem examinations of patients with possible metastatic disease. Also, in patients with multiple metastatic lesions, otologic complaints and signs may often be overshadowed by other more disabling symptoms. Twelve temporal bones were histopathologically examined from 6 patients who had metastatic temporal bone disease from various primaries and the results obtained in our present series of 6 cases were: 3 cases of hematogenous dissemination from a distant primary (a hepatic cell carcinoma, a bronchogenic squamous cell carcinoma, and an adenocarcinoma of unknown primary); 2 cases of direct invasion from adjacent head and neck tumors (squamous cell carcinomas of the eyelid and hypopharynx); and one case of diffuse metastatic leptomeningeal carcinomatosis (a transitional cell carcinoma of the renal pelvis). Among these, to our knowledge either hepatic cell carcinoma or renal pelvis carcinoma metastatic to the temporal bone has not been reported previously in the world literature. We reviewed the previously published reports of metastatic temporal bone tumors and found that there were 212 reported cases cited in the literature and that the most common sites of origin in order of frequency were breast, lung, pharynx, kidney, and prostate. Our temporal bone study and literature survey reveal that there are three distinct routes of tumor spread from the primaries to the temporal bone: 1) hematogenous dissemination from a distant primary, 2) direct neoplastic extension from adjacent areas, and 3) diffuse metastatic leptomeningeal carcinomatosis (DMLC). Our study also indicates that in most cases temporal bone symptoms appeared late in the course of disease, but in some cases the otologic symptoms were an initial sign of tumor, which was particularly conspicuous in the cases of DMLC. In the cases of hematogenous dissemination, the metastatic lesion tends to be overlooked or undiagnosed because occult metastases are relatively common or, when symptomatic, the otologic symptoms often resemble the features characterized by a severe form of mastoiditis. In the cases of direct neoplastic invasion, on the other hand, recognition of temporal bone involvement is usually simple since the primary disease is quite evident. Although metastatic temporal bone malignancies are rare, otologist should always be aware of existence of this disease entity in clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Secondary malignant tumors of the temporal bone. A histopathologic study and review of the world literature]. 191 60

We report a retrospective review of 223 patients who presented to the Department of Head and Neck Surgery from 1970 through 1987 with a diagnosis of metastatic adenocarcinoma of unknown primary origin. Multivariate analysis was performed using the following parameters: age, sex, initial side and site of nodal involvement, involvement of other body sites, degree of differentiation, treatment modality, outcome, and survival. Follow-up was obtained in all patients, with a minimum of 2 years for survivors. Average age was 55 years, with an approximately equal male:female ratio. The most common site of presentation was the supraclavicular fossa (76%). The initial side of presentation was the left neck in 53% of patients, right neck in 33%, and bilateral in 14%. Metastatic disease to other body sites was present in 86% of patients, with the most common sites being mediastinum (35%), lung (21%), and bones (19%). Increased survival was associated with unilateral neck involvement (p = 0.001) and disease limited to nodes above the cricoid cartilage (p = 0.007). Mean survival was 17 months, with a median of 8 months. Death was due to the index cancer in all but four patients; three of these four patients died of treatment-related causes. Survival was 20% at 2 years and 9% at 5 years. Length of survival was not affected by age, sex, initial side of neck disease, location of other metastatic sites, histologic appearance, or treatment modality. Our current algorithm for the work-up and treatment of this lethal disease is explained.
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PMID:Metastatic adenocarcinoma to the neck from an unknown primary source. 195 79

As part of a Phase II chemotherapy trial using mitomycin-C, adriamycin, and vindesine, 57 patients with adenocarcinoma of unknown primary site were assessed for prognostic variables predictive of response and survival. They were also evaluated for response and toxicity, usefulness of screening techniques, and eventual definition of primary site and pattern of progression. Only gender predicted response, with women being more likely to respond than men. Visceral metastases below the diaphragm, or the presence of liver metastases, predicted poor survival. Responding patients were highly likely to relapse first at sites of initial disease. Hemolytic-uremic syndrome was the most severe toxicity; other side effects were moderate. The response rate was 30% (three complete responders), which is similar to other current regimens. This study suggests that patients with better prognosis characteristics of single site of disease and without intraabdominal tumor may benefit from a policy of expectant observation after local control has been established. Patients with multiple sites of disease and/or intraabdominal tumor are appropriate candidates for investigational chemotherapy.
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PMID:Metastatic adenocarcinomas of unknown primary site. Prognostic variables and treatment results. 210 57

Cervical lymph node metastases as the only site of disease is a rare presentation of an adenocarcinoma of unknown primary origin. This retrospective analysis examines the records of ten consecutive patients at the Middlesex Hospital with this diagnosis between 1954 and 1986. The diagnostic protocol employed and the results of radical treatment are evaluated. Nine patients received radiation therapy with intent to cure, and one patient had a radical neck dissection. Overall actuarial survival for all patients (10) at 2 years was 23% and at 5 years 0%. Only two of the 10 patients subsequently revealed a primary tumour--both below the clavicles. Disease control above the clavicles was not achieved in a single patient despite radical treatment.
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PMID:Metastatic adenocarcinoma in the cervical lymph nodes from an occult primary. 248 68

Forty-two patients with adenocarcinoma of unknown primary (ACUP) presented to the Prince of Wales Hospital in Hong Kong from 1984 to 1985. They were studied for the site of symptomatic metastases at presentation, survival, and response to treatment. Bony (21) and lymph nodal (14) metastases were common. Survival was short with a median duration of 32 weeks and was not affected by sex, site of metastases at presentation, and development of new metastases. Response to combination chemotherapy with cisplatinum, adriamycin and cyclophosphamide (CAP) occurred in 4/31 (12.9%) patients with two complete responses and two partial responses and the responders survived significantly longer than non-responders with a median survival of 51 and 29 weeks respectively (P less than 0.05). Twenty out of 36 (55.6%) treated with radiotherapy had a positive response including five complete responses and fifteen partial responses but there was no demonstrable improvement in survival for the responders.
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PMID:A clinical study of adenocarcinoma of unknown primary site in Hong Kong. 263 4

A retrospective review of 108 patients with adenocarcinoma of unknown primary site (ACUPS) seen at Charleston Area Medical Center from 1979 to 1987 was performed. The liver and bones were the most common presenting sites of metastases. Only three patients had their primary site found after extensive radiologic and endoscopic workup. The pancreas and biliary tract were the most frequent laparotomy or autopsy-proven primary sites. Four of the 27 patients treated with chemotherapy responded (14.8 per cent). Eleven of 12 patients who survived for longer than 12 months had predominantly localized disease which permitted local therapy (i.e. surgery and/or radiotherapy). The median survival of the entire cohort was four months. The search for the primary site should include investigation of the patients' signs and symptoms, and limited screening tests.
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PMID:Adenocarcinoma of unknown primary site. 291 15

By using a recently developed flow cytometric method we have analyzed cellular DNA content of paraffin-embedded histological material from cancer patients. This method allows the retrospective study of tumors from patients whose clinical outcome is already known, and we have applied it to ovarian cancers, stage II breast cancers, and to metastatic adenocarcinoma of unknown primary site. In addition to knowledge of patient survival, comprehensive information was available about other prognostic determinants and treatment received, and we have used multivariate analysis in an attempt to determine the prognostic significance of cellular DNA content. In ovarian cancer, it is a major prognostic variable except in stage IV disease, whereas in metastatic adenocarcinoma of unknown primary site cellular DNA content has no influence on survival. For stage II breast cancer the situation is more complex and requires larger numbers to be studied. However, aneuploid tumors tend to have more extensive involvement of axillary lymph nodes and a poorer overall disease-free survival. This influence of DNA content on disease-free survival appears to be confined to premenopausal patients, and has no effect on patient survival following disease recurrence. Although we need to study more patients and more tumor types, taken together the results so far show a generally more favorable prognosis for patients with diploid tumors, except in the presence of recurrent or metastatic disease. The better prognosis associated with diploid tumors could be due to the fact that they are more commonly found in earlier clinical stages rather than to their being inherently less aggressive than aneuploid tumors.
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PMID:Application of DNA flow cytometry to paraffin-embedded archival material for the study of aneuploidy and its clinical significance. 401 99

Computed tomographic scans in 23 patients who had undergone total laryngectomy were analyzed retrospectively to determine normal postoperative appearance and to evaluate the role of CT in assessing recurrent neoplasm. Nine patients without clinical evidence of recurrence illustrated the normal postoperative changes: a round or ovoid neopharynx connecting the base of the tongue with the cervical esophagus and intact fat planes surrounding the neopharynx, neurovascular bundles, and sternocleidomastoid muscles. In the 12 patients with recurrent neoplasm, the CT manifestations included masses involving the internal jugular lymph node chain (adjacent to the neopharynx, neurovascular bundles, or sternocleidomastoid muscles), tracheostomy site, or paratracheal region. Recurrence was mimicked on CT in two patients, one with an abscess and one with metastases from an adenocarcinoma of unknown primary site. In eight patients, a distended neopharyngeal lumen correlated with benign or malignant stricture. CT supplemented physical examination and indirect mirror examination, providing data regarding presence and extent of recurrent tumor and aiding in planning the mode and scope of therapy.
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PMID:The neck after total laryngectomy: CT study. 649 67

Abdominal computed tomography (CT) and other studies were evaluated retrospectively in 46 patients with metastatic adenocarcinoma or undifferentiated carcinoma in whom the primary tumor site was not evident from the history, physical examination, or chest radiograph. The primary site was ultimately located in 21 patients (45.7%). CT of the abdomen in particular detected it in 16 patients (34.8%) and demonstrated additional and often unsuspected metastatic disease in 65%. CT proved superior to sonography in both diagnosis and assessment of the extent of disease and had a significantly higher diagnostic yield than contrast studies of the urinary and gastrointestinal tracts. abdominal CT is recommended as the initial modality in patients with metastatic adenocarcinoma of unknown primary origin. If the abdominal scan is negative, it should be followed by pelvic sonography or CT, particularly in women. Contrast studies should be limited to patients with specific organic dysfunction.
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PMID:Computed tomography in the evaluation of metastatic adenocarcinoma from an unknown primary site. A retrospective study. 706 18


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