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)

Gestational trophoblastic disease is a common gynaecological problem in Malaysia. The incidence of molar pregnancy is 2.8 per 1000 deliveries, being more common amongst the Chinese. The preferred method of evacuation is suction curettage; complete evacuation of the uterus was not achieved at the first attempt in 25 per cent of cases. Partial moles in our centre comprised 30 per cent of all moles. This is potentially malignant and needs follow-up for a complete mole. In the management of an invasive mole, chemotherapy should not be withheld in the presence of metastases and failure of regression of hCG. The role of prophylactic hysterectomy and prophylactic chemotherapy in the management of molar pregnancy is discussed "Selective preventive chemotherapy" in patients at "risk" appears appropriate. Chemotherapy remains the main modality of treatment for gestational trophoblastic tumours (GTT). We categorised our patients into low, medium and high-risk groups; survivals were 100, 98, and 61.7 percent respectively. These patients when categorised according to FIGO staging had survivals of 100, 80, 78.6 and 68.2 per cent respectively for stages 1, 2, 3 and 4 respectively. The reasons for the poor survival in the 'high-risk' group are discussed. Colour doppler blood flow studies are now being carried out; its role needs further evaluation. Surgery and radiotherapy have only a limited role in the management of these cases.
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PMID:The management of gestational trophoblastic disease in developing countries such as Malaysia. 983 22

Gestational trophoblastic diseases are a heterogenous group of conditions ranging from the benign hydatidiform mole to the malignant choriocarcinoma. Optimal therapy in this group of diseases rest in the correct diagnosis, assessing their risk for malignant behavior using prognostic scoring systems and administering appropriate treatment. Their rarity makes it imperative that these patients are treated in special centres by experts. Benign moles are treated surgically with evacuation of the uterus or hysterectomy. In malignant gestational trophoblastic disease, chemotherapy is the treatment of choice; single agent for non-metastatic and low-risk metastatic disease and combination chemotherapy for high-risk metastatic disease. Judicious use of surgery and radiotherapy in these cases will improve the survival rate. With appropriate treatment, the cure rates approach 100% in the low-risk group and 80% to 85% in the high risk group.
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PMID:Optimal treatment in gestational trophoblastic disease. 991 43

In the UK there are standardized surveillance procedures for gestational trophoblastic disease. However, there are differences in practice between the two treatment centres in terms of definition of persistent gestational trophoblastic disease, prognostic risk assessment and chemotherapeutic regimens. The role of prophylactic chemotherapy for cerebral micrometastatic disease in persistent gestational trophoblastic disease is unclear. We have analysed the outcome of 69 patients with lung metastases who elsewhere might have received prophylactic intrathecal chemotherapy. Of the 69 patients, 67 received intravenous chemotherapy only. The other two patients had cerebral metastases at presentation. One patient who received only intravenous chemotherapy subsequently developed a cerebral metastasis, but this patient's initial treatment was compromised by non-compliance. This experience supports our current policy of not treating patients with pulmonary metastases, without clinical evidence of central nervous system (CNS) involvement, with prophylactic intrathecal therapy.
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PMID:Gestational trophoblastic disease: does central nervous system chemoprophylaxis have a role? 1009 70

Placental site trophoblastic tumour (PSTT) is a rare form of gestational trophoblastic disease (GTD). We have conducted an analysis of all cases of PSTT managed at the Trophoblastic Disease Screening and Treatment Centre, Sheffield, from 1984 to 1996. During this time we received 4,988 registrations for GTD and managed seven cases of PSTT. A large range of interval between antecedent pregnancy and presentation was observed - the most common presenting symptoms being irregular vaginal bleeding with or without preceding amenorrhoea. Three out of seven patients had disease confined to the uterus at diagnosis and were successfully treated by hysterectomy alone. Two out of seven patients had pulmonary metastases in addition to uterine tumour and were treated with combination chemotherapy--both are alive and well. Of the remaining two patients one had distant and the other loco-regional metastases and both died despite numerous therapeutic interventions.
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PMID:Placental site trophoblastic tumour: a rare but potentially curable cancer. 1073 4

Gestational trophoblastic disease (GTD) is a spectrum of rare neoplastic conditions that are highly curable, even in the presence of widely metastatic disease. These diseases vary from partial hydatidiform mole, which rarely metastasizes and infrequently requires treatment with chemotherapy, to choriocarcinoma, for which multi-agent chemotherapy is the standard treatment. Much has been learned regarding the epidemiology of this disease, and our understanding of the genetics underlying GTD is rapidly expanding. As technology such as ultrasonography and sensitive tests for beta-human chorionic gonadotropin have evolved, the presentation of molar pregnancy has significantly changed, although the incidence of persistent GTD has not decreased. This review highlights these recent advancements in the epidemiology, genetics, diagnosis, and treatment of gestational trophoblastic disease.
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PMID:Gestational trophoblastic diseases: new standards for therapy. 1097 58

Trophoblastic disease occasionally presents with apparent metastases that turn out to be lesions not associated with the trophoblastic tumor. In this article, we present one case of a cerebellar hemangioma, two of lung and mediastinal teratoma, and one of pulmonary granuloma masquerading as metastases from trophoblastic disease. If an apparent metastasis associated with trophoblastic tumor does not accord with the clinical diagnosis, look for an independent cause.
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PMID:Phantom metastases in trophoblastic disease. 1124 Jun 62

This is a case report of a 31 year-old female with choriocarcinomatous metastasis in brain and lung. Her serum beta-HCG level rose six times following normalization during 61 months of diverse multiagent systemic chemotherapy. Pulmonary lobectomy was done in March 1997 (57 months after initial diagnosis) due to persistent pulmonary nodule and poor response to chemotherapy. Histologic examination disclosed metastatic choriocarcinoma. However, her serum beta-HCG level did not normalize. Meanwhile, repeated measurement of beta-HCG concentration in cerebrospinal fluid was normal and imaging studies did not indicate evidence of metastasis. Sixty-one months after initial diagnosis fulminant intracerebral hemorrhage made emergency craniotomy mandatory. Histologic examination revealed metastatic choriocarcinoma. Serum beta-HCG levels returned to normal immediately after craniotomy and she reached complete remission after whole brain irradiation in January 2000. She is free of disease 91 months from initial diagnosis. The role of surgery in the treatment of patients with metastatic choriocarcinoma has been diminished by the responsiveness to chemotherapy. However, local resection of metastases still seems to play a significant role in controlling complications of gestational trophoblastic neoplasia and even in curing the disease in a small subset of patients.
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PMID:Chemo-resistant choriocarcinoma cured by pulmonary lobectomy and craniotomy. 1124 Jun 69

Placental site trophoblastic tumor (PSTT) is very rare. It is an unusual variant of gestational trophoblastic neoplasia usually confined to the uterus, although 10% of patients have metastases. The clinical behaviour of PSTT varies and despite knowledge of its histology, diagnosis of this rare form of trophoblastic disease and prediction of its biological behaviour remains difficult due to only a few cases reported in literature.
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PMID:Metastatic placental site trophoblastic tumor: a case report. 1133 Jul 31

Placental site trophoblastic tumor (PSTT), a rare variant of gestational trophoblastic disease, was first described in 1976. PSTT is usually seen in young women, generally treated by hysterectomy, and is associated with a 20% fatality rate. The development of metastases secondary to PSTT is associated with an extremely poor prognosis. Metastatic PSTT has generally been resistant to chemotherapy although one complete and some partial responses have been noted previously. We report a case of a complete chemotherapeutic response in a patient with pulmonary metastases.
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PMID:Resolution of pulmonary metastases with chemotherapy in a patient with placental site trophoblastic tumor. 1157 78

Point mutations of c-K-ras in ovarian cancer were detected by replacement of GGT of codon 12 by GAT, AGT, TGT and GTT, polymerase chain reaction, agarose gel electrophoresis and Southern blot hybridization with a digoxigenin detection system. The incidence of four-typed point mutations of c-K-ras oncogene in 37 ovarian cancers was 35.1% (13/37) and the distributions were 32.4% (12/37), 2.7% (1/37), 0% and 0% of GGT to GAT, GGT to AGT, GGT to TGT, and GGT to GTT, respectively. The incidence of c-K-ras point mutations on codon 12 among 37 patients with ovarian cancer was 35.5% (8/22) in those with serous cystadenocarcinomas and 28.6% (2/7) in those with mucinous cystadenocarcinomas. c-K-ras point mutations on codon 12 were detected in 14.3% (1/7) of patients with stage I disease, 28.6% (2/7) with stage II disease, and in 43.5% (10/23) with stage III/IV disease, and there was a statistically significant increase in point mutations of c-K-ras oncogene with advancing clinical stage. The incidence of c-K-ras point mutations on codon 12 among 33 patients who had a pelvic lymph node dissection was 52.4% (11/21) in those with pelvic lymph node metastases and 16.7% (2/12) in those without pelvic lymph node metastases, a statistically significant difference. Furthermore, point mutation of c-K-ras gene was found most frequently in patients with advanced stage disease, and in those with pelvic lymph node metastases. Activation of c-K-ras oncogene seems to be a major factor in ovarian carcinogenesis and tumor progression.
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PMID:Detection of c-K-ras point mutation in ovarian cancer. 1157 63


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