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

Hepatocellular carcinoma (HCC) is likely to be detected as multiple intrahepatic metastases, and trans-arterial embolization (TAE) is the treatment of choice. However, other therapy is needed when TAE is not effective for a tumor. We performed partial liver resection with small skin incision in two such patients. One patient had two HCCs of segment 6 (S6) and S7, and TAE was performed twice. However, HCC of S7 was viable, and we partially resected the tumor of S7. In the other patient, HCC was multiple in segment 6 and 7. TAE was performed three times, and in segment 6 we detected a tumor which grew into the extrahepatic space and seemed uneffected by TAE. We performed a partial resection of liver segment 6. After 3 months, TAE was repeated in the latter. The operation time was about three hours, and no blood transfusion was performed. Two of the patients were discharged on the 13th postoperative day. We concluded that partial liver resection with small skin incision was useful for one case of multidisciplinary treatment for hepatocellular carcinoma.
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PMID:[Partial liver resection with small skin incision for multidisciplinary treatment of hepatocellular carcinoma]. 1056 Apr 19

BACKGROUND: Carcinoid tumors are the most frequently encountered endocrine tumors of the gastrointestinal tract. They are most often found in the appendix, although they can arise in any location of the gut. Carcinoid tumors may secrete a variety of bioactive substances, which can cause the complex of symptoms associated with the carcinoid syndrome. METHODS: The authors reviewed the pathology, clinical presentation, and management of carcinoid tumors with an emphasis on the surgical management. RESULTS: The primary treatment for a carcinoid tumor located anywhere in the gut is surgical. Those who have widely metastatic disease or who are anatomically unresectable may undergo cytoreductive surgical debulking and/or hepatic arterial embolization followed by palliation of symptoms with octreotide, the long-acting somatostatin analog. CONCLUSIONS: The prognosis for patients with carcinoid tumors that are fully resected is excellent. Those with hepatic metastases and the carcinoid syndrome have a less favorable prognosis.
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PMID:Carcinoid Tumors of the Gut. 1076 99

We report two cases of local recurrence of renal cell carcinoma, which invaded the gastrointestinal tract. The intervals to local recurrence after primary nephrectomies were 5 and 13 years. Both cases developed massive gastrointestinal bleeding. Blood transfusions and arterial embolization were performed; however, continuous melena prevented improvement in their general condition. Although distant metastases were observed in both cases, tumor resections combined with intestine invasion were performed. Although this surgical approach does not significantly improve the prognosis, even in patients who have remaining metastatic lesions, it may provide palliation and improve the quality of survival.
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PMID:Local recurrence of renal cell carcinoma causing massive gastrointestinal bleeding: a report of two patients who underwent surgical resection. 1085 4

A 45-year-old male received wedge resection for his small hepatocellular carcinoma in April 1989 and extended right lobectomy for tumor recurrence 8 months later. Unfortunately, recurrent hepatic tumor with lung metastases were found 18 months after the second operation. Both the hepatic and pulmonary recurrent tumors were resected and transcatheter arterial embolization was added for the residual hepatic tumors. He remained symptom free for another 18 months. However, mediastinal lymphadenopathy, superior vena cava thrombus with superior vena cava syndrome, cardiac and brain metastases developed subsequently. He died of increased intracranial pressure. It is rare for hepatocellular carcinoma to have mediastinal metastases, superior vena cava thrombus and superior vena cava syndrome.
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PMID:Recurrent hepatocellular carcinoma presenting with superior vena cava syndrome. 1102 Aug 92

In 30 patients with gastric cancer metastasizing to the liver over the past 15 years at our hospital the primary foci in the stomach could be resected in a curative manner. The authors report herein three long surviving patients in this series. [Case 1] A 49-year-old male. Distal gastrectomy was performed in November 1984. Metastasis to the liver occurred in June 1986. The right lobe of the liver was resected in November 1987 after transcatheter arterial embolization (TAE). Although hepatic arterial infusion chemotherapy was conducted, the cancer metastasized to the whole body, and the patient died in December 1991. [Case 2] A 65-year-old female. Distal gastrectomy was performed in July 1994. The left hepatic lobe and segment 5 in the right lobe were resected in June 1995. Although TAE was performed six times starting in December 1996, the patient died of hepatic failure in July 1999. [Case 3] A 73-year-old male. This patient simultaneously received distal gastrectomy and extended resection of the posterior hepatic segments in September 1997. Cancer recurred in the remaining liver in July 1998. Although microwave coagulation therapy (MCT) and TAE were performed, the patient died of hepatic failure in January 2000. In these patients who survived for a long period, the primary focus was well-differentiated adenocarcinoma under sufficient local control with metastasis limited to the nearest regional lymph nodes (group 1 lymph nodes). The patients could undergo interdisciplinary therapy, including hepatectomy, MCT, TAE, and hepatic arterial infusion chemotherapy.
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PMID:[Three long surviving patients with gastric cancer metastasizing to the liver under interdisciplinary therapy]. 1108 63

We describe a rare case of spontaneous rupture of a hepatic metastasis from renal cell carcinoma that was treated successfully by hepatic arterial embolization. A 65-year-old woman, who had been undergoing immunotherapy for inoperably disseminated renal carcinoma and lung metastases, presented with severe abdominal pain in a state of hypovolemic shock. Computed tomography revealed a highly attenuated mass lesion in the right lobe of the liver and massive intraperitoneal hemorrhage. Subsequent hepatic angiography showed extravasation from the feeding right hepatic artery. Transcatheter embolization of the right hepatic artery was subsequently performed, and the patient made an uneventful recovery. Although hepatic rupture due to metastatic cancer is extremely rare, transcatheter arterial embolization (TAE) is an appropriate and useful treatment for massive hemorrhage caused by spontaneous rupture of liver metastasis.
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PMID:Rupture of a hepatic metastasis from renal cell carcinoma. 1112 74

Islet cell tumors of the pancreas are rare, indolent, neuroendocrine tumors. Approximately 50% of the patients diagnosed with these tumors present with symptoms related to various biologically active hormones that are secreted by these neoplasms. Currently, the only curative treatment for islet cell tumors is complete surgical resection. Management of metastatic disease is conservative. Initial treatment of these tumors includes expectant observation and medical management of symptoms with clinical monitoring and serial CT scans to assess tumor growth. Patients with rapidly progressive disease, with local symptoms caused by tumor bulk, or with uncontrolled symptoms related to hormone secretion require more aggressive medical or surgical intervention. The somatostatin analogue octreotide may help control hormone secretion and stabilize tumor growth. Patients refractory to octreotide with tumor predominantly in the liver are potential candidates for mechanical ablative techniques, such as hepatic arterial embolization. Radiofrequency ablation and cryosurgical techniques may also be useful, although specific data are limited. Surgical resection of metastatic disease may offer palliative relief of symptoms related to hormone secretion in carefully selected patients. Chemotherapy may be used for palliation when ablative techniques have failed or when significant extrahepatic disease is present. Streptozicin-based combinations remain the first line standard, but major objective responses are less common than had been previously thought. Because of the overall modest success of current chemotherapeutic regimens, patients with advanced disease in need of treatment should be encouraged to enroll in clinical trials testing newer antineoplastic agents or newer treatment strategies.
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PMID:Islet cell tumors of the pancreas: the medical oncologist's perspective. 1145 69

In a phase I/II study, 37 patients with metastatic liver disease, predominantly from colorectal cancer (n = 33) were treated between 1986 and 1994 by intrahepatic arterial embolization of radioactive yttrium 90 (Y 90) glass microspheres. The calculated total liver dose increased in stages from 5,000 cGy to 15,000 cGy. Mean follow-up was 8 months (range, 1 to 49). No major procedural, hematologic, or pulmonary complications occurred. Late gastroduodenal ulceration occurred early in the study at 6 to 8 weeks in three patients with a history of chronic alcohol abuse and was treated successfully medically. Of 30 patients with either computed tomography (CT) or sonography follow-up for 4 months or longer, 15 had tumor involvement in the liver that was diffuse, irregular, or infiltrating with mixed or poor vascularity and thus definitive imaging changes could not be appreciated on follow-up. In 15 patients with identifiable marker lesions with developed hypervascularity, post-treatment beneficial effects were noted. In seven of these patients followed by CT, decreased tumor attenuation and sharper definition of tumor-liver interface were noted. Findings on sonography in eight patients were increased tumor sonolucency centrally, consistent with liquefaction necrosis, and rim hyperechogenicity, consistent with calcification. A 25% to 40% decrease in area of marker lesions occurred in five patients and one other patient had small 1.0- to 1.5-cm lesions disappear temporarily on sonography. In conclusion, this method provides a feasible single-session technique for treatment of hepatic metastases. Complications are low and if the tumor pattern is nodular with some hypervascularity, beneficial effects are observed clinically and on imaging studies.
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PMID:Radioembolization for hepatic metastases. 1195 Dec 13

The nonepithelial, nonlymphoid tumors of the gastrointestinal tract are heterogeneous in terms of clinical presentation, behavior, pathology, and genetic features. Concepts regarding these tumors have changed rapidly over the past decade as nomenclature has evolved. Many of these tumors have no muscle differentiation, and designations such as leiomyoma or leiomyosarcoma are inappropriate for many of these neoplasms. With an improved understanding of the biology of these tumors, gastrointestinal stromal tumor (GIST) is used as a specific term for tumors of the gastrointestinal tract that lack markers of myogenic differentiation, but stain positive for vimentin, and express CD34 and CD117, the product of the c-kit oncogene. Both benign and malignant types are recognized. In addition to myogenic tumors and GIST, gastrointestinal autonomic nerve tumors (GANT) are also recognized. Complete en bloc surgical resection, when possible, is the cornerstone of therapy. Metastasis tends to occur to the liver and within the peritoneal cavity, especially in patients whose tumors have ruptured spontaneously or been violated by the surgeon. Incomplete surgical resection and metastatic disease indicate a dismal prognosis in the majority of patients. Recurrent or metastatic disease is often resected, but this has an uncertain impact on outcome. Operation may palliate patients with intestinal obstruction or other symptoms. For patients with unresectable disease, the results with systemic chemotherapy have been dismal. Treatment with doxorubicin/ifosfamide combinations is of dubious value. Hepatic arterial embolization, with and without intra-arterial chemotherapy, results in regression of liver metastases in selected patients. Regression has also been seen using intrahepatic arterial infusion of doxorubicin without embolization. The impact of such treatment on outcome, however, is poorly studied. Aggressive surgical resection of peritoneal metastases with intraperitoneal chemotherapy has been advocated, but requires formal study in large trials.
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PMID:Gastrointestinal stromal tumors. 1205 70

Arterial tumor embolization is a rare complication of neoplasms. This report describes a 64-year-old female with metastatic melanoma and acute arterial embolization to the left lower extremity. With surgical embolectomy, a clot was retrieved that had an atypical bland solid lead point. Pathologic examination confirmed metastatic melanoma. Further echocardiography revealed an intracardiac mass consistent with metastatic disease. The patient was seen a month later with embolization to the right middle cerebral artery.
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PMID:Arterial tumor embolism caused by metastatic melanoma: case report and literature review. 1209 80


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