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

Lymphoscintigraphy is used to identify ambiguous drainage patterns in cutaneous melanoma of the head, neck and trunk. This study evaluated the efficacy and reliability of lymphoscintigraphy to identify the drainage nodes in 51 patients undergoing both elective and therapeutic lymphadenectomy over a seven-year period. All 13 patients who had lymph node metastases during this follow-up period had the metastatic disease in the very lymph node basins identified by lymphoscintigraphy. Most significantly, none of the 51 patients had metastatic disease in lymphatic basins that were not previously identified by lymphoscintigraphy.
Conn Med 1999 Jul
PMID:The predictive value of lymphoscintigraphy for nodal metastases of cutaneous melanoma. 1046 6

A clinical syndrome combining hypertension and hypokalemic alkalosis led to the diagnosis of primary hyperaldosteronism, caused by a right-sided, 2 cm large, apparently benign aldosterone-producing adenoma. The adrenal tumor was completely resected by laparoscopic adrenalectomy. Six months after surgery, the patient exhibited a severe relapse of hyperaldosteronism. Extensive peritoneal metastases of a mixed aldosterone- and cortisol-secreting adrenocortical carcinoma were found at abdominal laparotomy. In the light of this case report, we discuss the possibility that laparoscopic resection of adrenocortical tumors might contribute to their subsequent peritoneal dissemination.
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PMID:Peritoneal carcinomatosis following laparoscopic resection of an adrenocortical tumor causing primary hyperaldosteronism. 1068 40

A 32-year-old recent Russian immigrant, mother of a 20-month-old son, presented with right hip pain. She had a history of peptic ulcer disease and a positive Helicobacter pylori serology. Her pain was not relieved by analgesics. Spine and pelvic films were unremarkable. A bone scan was consistent with metastatic disease. She underwent several diagnostic tests including computed tomography of the chest and abdomen, magnetic resonance imaging of the spine, mammogram, and breast ultrasound. A bone marrow biopsy revealed adenocarcinoma, primary site unknown. An upper endoscopy performed eight weeks after her initial presentation showed an ulcerating gastric carcinoma. She was treated with chemotherapy but died two months after diagnosis. Our patient had an uncommon presentation of a common disease. Recognizing her country of origin, and other risk factors, may have facilitated an earlier diagnosis.
Conn Med 2000 Mar
PMID:An uncommon presentation of a common disease: the importance of the history in medicine. 1075 Mar 5

Carcinomas of the skin appendices are rare neoplasms but for prognostic reasons it is important to differentiate them from the indolent squamous and basal cell carcinomas, as their behavior is more aggressive. We report on a case of eccrine sweat gland carcinoma that displayed all the typical features of those neoplasms. The patient sought medical attention after a lesion in his foot, already present for four years, began to enlarge and developed satellite lesions. The pathological diagnosis was made only after the lesion was initially misdiagnosed as basal cell carcinoma of the skin. Multiple chemotherapeutic regimens and radiation therapy were administered with only temporary benefit. The patient developed distant metastatic disease but survived with metastases for three years. He died nine years after the initial lesion developed in his foot and five years after the diagnosis. The diagnosis of sweat gland carcinomas can be facilitated by histochemical stains. In contrast to squamous and basal cell carcinomas of the skin, these are generally positive for the carcinoembryonic antigen (CEA). Once metastatic, these neoplasms are only infrequently, and usually briefly, responsive to either chemotherapy or radiotherapy and new treatments are urgently needed. Early recognition of the entity may allow more timely treatment.
Conn Med 2000 May
PMID:Eccrine sweat gland carcinoma: a case report and review of diagnosis and treatment. 1086 Feb 32

Laparoscopic adrenalectomy has proved to be the technique of choice for the treatment of benign pathologies of the adrenals and also for the treatment of isolated adrenal metastases, especially arising from lung tumor, but it shouldn't be performed for primitive adrenal carcinoma. The harmonic scalpel is very useful for laparoscopic adrenalectomy showing a significant reduction in operative time. The Authors retrospectively investigated 78 laparoscopic adrenalectomies performed from April 1995 to April 2000 using a transperitoneal approach with the patient on a lateral position as suggested by Gagner. Special care was taken to improve the surgical approach to the adrenals also by means of new technological devices as the Harmonic scalpel. The 78 laparoscopic adrenalectomies were performed in 70 cases for benign neoplasms: incidentalomas 24, Cushing's disease 16, Conn's disease 20, pheochromocytomas 9, myelolipoma 1. In the remaining 8 patients laparoscopic adrenalectomy was performed in 7 cases for isolated adrenal masses (5 metastases, 2 adenomas) in neoplastic patients, and in 1 patient for a preoperatively diagnosed adrenal carcinoma. Patients operated for functioning neoplasms had all remission or improvement of symptoms and humoral parameters; patients operated for isolated adrenal metastases showed this survival: 3 patients 3 years asymptomatic and disease free, 1 patient 18 months, and 3 patients are still alive and healthy after 6-12-15 months. A fast onset of local recurrence was seen in a patient operated for a preoperatively diagnosed adrenal carcinoma. We analyzed the operating time dividing the patients in three groups: a) 14 patients operated in the first semester of 1998 when we completed the training curve (average operative time 120.7 minutes); b) 14 patients operated from 1998-1999 (average operative time 118 minutes); c) the last 14 patients (operated from December 1999 to April 2000) where surgery was performed using the Harmonic scalpel (HS) (average operative time 94 minutes). The analysis of the average operative time comparing groups B and C using T-Student Test showed a significant reduction (p = 0.004). The morbility rate was 2.6%, mortality 1.3%, and a conversion rate of 2.6%. Laparoscopic approach results to be an extremely reliable procedure also for the treatment of incidentalomas up to 4-5 cm in which the incidence of adrenal carcinoma is about 13%. Doubts may yet result for the treatment of adrenal carcinomas preoperatively diagnosed. When laparoscopic adrenalectomy in performed using HS the operative time is significantly reduced and surgery is easier.
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PMID:Laparoscopic adrenalectomy. Personal experience in 78 patients. 1144 44

There were a total of 9788 newly-diagnosed cancers in Connecticut residents in 1969, an increase of 475 (5.1%) over 1968. 4620 were in males and 5168 in females. Tumors of the digestive organs were the most frequent, 2680 cases (27.4%). There were 1895 tumors of the genital organs (19.4%), 1421 of the breast (14.5%), and 1285 of the respiratory system (13.1%). The age-adjusted incidence rates for all tumors were 297.3 per 100,000 for males, an increase of 1% over 1968, and 295.1 for females, an increase of 5.4%. Among females the increased numbers of tumors were mostly breast, digestive organs, and lymphatic and hematopoietic tissues. For males cancer of the respiratory system showed the most increase. Female respiratory cancer declined slightly. Breast cancers in females increased 13.9%, the largest yearly increase ever recorded in Connecticut. The older age group (75-79 years) showed the most marked increase, from 311 to 403.1 per 100,000. Of the breast cancers 50.4% were localized, 37.2% had regional spread, and 7.8% remote metastases. In the others the stage was not recorded. Earlier diagnoses are obviously needed. In males cancer of the respiratory system increased from 63.7 per 100,000 in 1968 to 67.3 in 1969. Men over age 85 showed an increase of 156%. The rates in males for tongue and prostate cancer decreased. For children leukemia was the most frequent cancer, for girls 15-19 and boys 19-24 Hodgkin's disease was more frequent. In women aged 20-39 cancer of the cervix was most often diagnosed; after age 40, cancer of the breast; after age, 80, tumors of the large intestine. In men aged 25-34 cancer of the testes predominated; from 40-74, cancers of the lung and bronchus; and over 75, cancer of the prostate. During 1969 there were a total of 5073 cancer deaths, exclusive of nonmelanotic skin and myelofibrosis, 2759 males and 2314 females. 301.% of the deaths among males were digestive organ cancers, 27.8% were respiratory organ disease. Among females 29.4% of deaths were tumors of the digestive organs and 23.7% were breast cancers. Age-adjusted mortality rates were 176.6 per 100,000 for males and 122.4 for females, a slight decrease from 1968.
Conn Health Bull 1972 Apr
PMID:Cancer in Connecticut, 1969. 1233 71

Hepatocellular carcinoma is the seventh most common cancer in men and ninth in women. The authors describe a case of an 83-year old man with a history of cryptogenic cirrhosis and a remote history of tuberculosis who presented with sudden onset of dyspnea. Screening ultrasound of the abdomen and alpha-fetoprotein levels three months before this acute presentation were not suggestive of hepatocellular carcinoma. Chest roentgenogram showed a miliary pattern of pulmonary nodules and the patient was admitted with the diagnosis of miliary tuberculosis. Biopsy established the diagnosis of hepatocellular carcinoma with pulmonary metastases.
Conn Med 2002 Aug
PMID:Unusual presentation of hepatocellular carcinoma: a case report. 1240 55

The incidental finding of an unsuspected adrenal mass ranges from 0.5% to 5% in abdominal CT series. The optimal diagnostic approach to such masses is to diagnose malignant or secretory tumors requiring excision and to otherwise avoid unnecessary surgery. Physical examination generally contributes little. A standard biochemical evaluation should include the measurement of 24 hour urinary catecholamines and metanephrine, urinary free cortisol and plasma cortisol levels at 8 a.m. and 8 p.m. combined with an overnight low-dose dexamethasone suppression test, serum potassium assay, and determination of upright plasma aldosterone to plasma renin activity. These tests will serve to screen for pheochromocytoma, subclinical Cushing's syndrome, and primary hyperaldosteronism respectively. Imaging characteristics suggestive of malignancy include: size greater than 4 cm., heterogeneous lesion and/or density greater than 20 Hounsfield Units on CT scan, slow enhancement with delayed washout after intravenous contrast injection on CT scan, and slightly decreased signal intensity in out of phase (fat suppressed) MR acquisition. Fine-needle aspiration biopsy should be performed only if metastatic disease is suspected. Adrenal scintigraphy with iodocholesterol may be useful where adenoma with subclinical Cushing's syndrome or solid tumor is suspected. In summary, the following strategy is recommended for the management of adrenal incidentalomas : mass lesions larger than 4 cm. and hormone-secreting tumors should be removed. All non-secreting adrenal incidentalomas smaller than 4 cm. in diameter should be followed by serial imaging at regular intervals (6, 12, and 36 months) and by endocrine reevaluation at one year.
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PMID:[Diagnostic and therapeutic strategy for an incidental finding of an adrenal mass]. 1241 Jan 36

Aldosterone-producing adrenocortical carcinoma (APAC) is a rare cause of hypertension often diagnosed late because of paucity of information. Thus, we delineated its clinical course and survival rates based on two cases referred to us that featured diverging clinical courses, and on a scrutiny of the literature since 1955 when the first case of APAC was identified. Data on demography, imaging results, hormonal assessment, histology, and clinical course were extracted independently by the investigators. We included in our database 58 cases, most presenting with Conn's syndrome. Plasma aldosterone levels were on average increased 14-fold; plasma renin activity was suppressed in 55% of cases. The tumor showed extremely variable size and weight, and no gender or side preference. Metastases were present in 10% of all cases at initial diagnosis and in an additional 48% of cases at follow-up. Median survival was 546 days (95% confidence interval (CI): 240-851); median time to either recurrence or death was 212 days (95% CI: 29-395). No clinical or histological signs predicted survival with Cox regression analysis. We concluded that, although an ominous course with a poor survival rate is common, no sign accurately predicts the course of APAC. Thus, molecular studies to identify diagnostic markers of survival are mandatory.
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PMID:Aldosterone-producing adrenocortical carcinoma: an unusual cause of Conn's syndrome with an ominous clinical course. 1578 46

In this study we have analyzed 84 patients (58 women, 26 men, mean age 57 +/- 1.1 year) hospitalized in the Department of Nephrology, Endocrinology and Metabolic Diseases of the Medical University of Silesia in Katowice from 01.01.1999 to 30.04.2003 because of incidentally discovered adrenal tumors (incidentaloma). The diameter of the tumors ranged from 8 to 86 mm (mean size 35.4 +/- 1.8 mm). Unilateral tumors were found in 74 patients and bilateral ones in 10 patients. In all patients circadian rhythm of plasma cortisol concentration and urinary cortisol excretion were measured. In 73 patients with a history of hypertension plasma renin activity was estimated in basal conditions and after stimulation by sodium restriction and upright position. Aldosteronemia and urinary metoxycatecholamines excretion were also determined. 45 patients with tumors >4 cm and/or with suspicion of malignancy or hormonal hypersecretion were qualified for surgical treatment. Thirty two patients out of the selected 45 have been operated so far. In two patients histopathological examination confirmed malignancy (adrenocortical carcinoma in one patient and metastatic cancer in the other one). The remaining 30 patients were operated because of size of the adrenal mass (16 patients) or biochemical suspicion of pheochromocytoma (12 patients, 5 of them with the mass size >4 cm) or primary aldosteronism (2 patients). The histological examination confirmed Conn syndrome in two patients and pheochromocytoma in one patient.
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PMID:[Clinical, biochemical and hormonal characteristics of 84 patients with incidentally found adrenal tumor (incidentaloma)]. 1596 10


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