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)

We report a case of carcinomatous meningitis from transitional cell carcinoma of the urinary bladder. A 70-year-old man with invasive bladder cancer and multiple pulmonary metastases received 3 courses of systemic M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy, after which the primary tumor and pulmonary metastases diminished in size and number. During the 4th course of chemotherapy, he complained of nausea, headache, diplopia, and neck stiffness. Computer tomographic (CT) scan of the brain showed no evidence of parenchymal metastases, cerebral hemorrhage, or infarction. Cerebrospinal fluid examination revealed an increase in cells along with elevated protein and depressed glucose concentrations, but no malignant cells were identified. He died two weeks after the onset of neurological symptoms. Autopsy revealed numerous tiny metastatic lesions in the leptomeninx, so called carcinomatous meningitis, without parenchymal metastases in the brain. Although metastases to the central nervous system from transitional cell carcinoma of the bladder, especially carcinomatous meningitis rarely have been reported, this unusual complication will be seen more frequently with the development of more effective systemic chemotherapy such as M-VAC.
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PMID:[A case of carcinomatous meningitis from transitional cell carcinoma of the urinary bladder]. 786 65

Neurologic complications of malignancy can result from paraneoplastic manifestations, cerebral metastases or leptomeningeal involvement. Radiologic evaluation by computerised tomography (CT) has proven to be an invaluable tool in cancer patients with neurologic symptoms. Myelography and CT myelography have been the main modalities for evaluating leptomeningeal metastases. The advent of magnetic resonance imaging (MRI) with contrast has provided an alternative modality for evaluation of leptomeningeal disease. MRI as compared to CT myelography is non-invasive and at least as sensitive. The findings in two patients with leptomeningeal involvement are reported to illustrate the value of MRI.
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PMID:Magnetic resonance imaging of leptomeningeal metastases to the spine. 826 85

Patients with gynecologic malignancies may develop metastases throughout the neuraxis. Cervix-related carcinomatous meningitis is a distinctly unusual clinical event with only two previous cases reported in the English medical literature. We review clinical, radiographic, and pathologic findings of a woman with advanced adenocarcinoma of the uterine cervix, whose course was complicated by leptomeningeal metastases. Carcinomatous meningitis occurs in the setting of rapidly advancing systemic disease and represents a terminal complication of cervical cancer.
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PMID:Carcinomatous meningitis complicating cervical cancer: a clinicopathologic study and literature review. 863 58

MR imaging with intravenous gadolinium has greatly enhanced our ability to detect and delineate intracranial metastases as well as to differentiate them from other disease processes. Techniques such as magnetization transfer and triple dose gadolinium imaging have further improved lesion detection. Consideration of these radiologic techniques, including the issues and controversies of screening and cost effectiveness, suggests a reasonable approach to imaging patients with possible intracranial metastases. Newer modalities such as echo planar imaging, spectroscopy, PET, and SPECT, may in the future, prove to be very useful in the evaluation of patients with intracranial metastases. Proper imaging is also critical to appropriate diagnosis and management of meningeal metastases, calvarial metastases, and paraneoplastic disease.
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PMID:Imaging of cerebral metastases. 882 71

Immunotoxins are extremely potent agents that recognize specific antigens located on metastatic tumor cells and cause cytotoxicity after cell entry by inhibiting protein synthesis. These agents have considerable in vitro efficacy against numerous metastatic tumor cell lines. In vivo studies have shown complete tumor regression in athymic animals bearing flank tumors or with leptomeningeal neoplasia. Phase I clinical trials have demonstrated therapeutic efficacy in patients with carcinomatous meningitis or with intraparenchymal brain metastases. These agents may be particularly appropriate for patients with widespread intracranial metastatic disease or with radioresistant tumor histology.
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PMID:Immunotoxin therapy. 882 81

Carcinomatous meningitis (CM) is an uncommon but devastating complication of malignancy. The management is controversial and clear recommendations cannot be made because: 1) Most series include patients with CM that has arisen from different primary malignancies which are associated with different median survival intervals. 2) There have been no prospective randomised investigations of treatment modalities in patients with CM from a particular tumour type. 3) The definition of response varies from one report to another so that some response rates refer to cytological changes in the CSF while others take clinical, cytological and biochemical parameters into account. 4) Reports include patients with and without parenchymal metastases and the natural history of carcinomatous meningitis in the two situations may differ. The median survival of solid tumour carcinomatous meningitis (excluding leukaemia and lymphoma) is approximately 2-3 months and patients with breast cancer have the longest survival (median 3 months). Currently patients are treated with radiotherapy to part or all of the neuraxis with either intrathecal or intravenous chemotherapy but the relative contribution of these modalities to survival or quality of life remains unknown. Approximately 50% of patients with carcinomatous meningitis die from other causes, including systemic disease. The two most important endpoints for the patient, neurological improvement and overall survival, are seldom used in isolation in the literature. Many reports have focused on surrogate markers of response, namely biochemical and cytological data points but the correlation between clinical status and these parameters is poor because of differences between lumbar and ventricular CSF and disturbances of CSF flow in CM. The current literature does not provide clear guidelines for the treatment of this condition. Multicentre, prospective, randomised trials should be conducted that address questions of most relevance to the patient, namely neurological status and overall survival.
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PMID:Carcinomatous meningitis in solid tumours. 892 90

Neoplastic meningitis (NM) occurs in approximately 8% of all cancer patients. To confirm a clinical impression that NM is relatively common in patients who undergo surgical resection of an isolated cerebellar metastasis (ICM), a retrospective study was performed. All patients who underwent a surgical resection of an isolated CNS metastasis at The Johns Hopkins Hospital between January 1991 and June 1993 were identified. Their charts, laboratory and pathologic data, radiologic studies, survival and cause of death were reviewed. A total of 66 patients were identified fifty-five patients underwent a surgical resection of a supratentorial metastasis while 11 patients (6 females and 5 males) underwent a surgical resection of an isolated cerebellar metastasis. The ages of patients with cerebellar metastases ranged from 23 to 74 years at the time of diagnosis with a median age of 49 years. All 11 patients had stable systemic disease and an excellent performance status. Five patients had tumors from lung, 2 from breast, and 4 from other sites. Each was expected to have a long survival. However, 4 of the 11 patients (36%) developed unequivocal NM at 1, 3, 6, and 7 months following surgical resection and all died within 1 month from the diagnosis of NM. Two patients had a positive CSF cytology and the other two had multiple enhancing leptomeningeal metastases on MRI. Two additional patients died of progressive neurological disease without evidence of local recurrence, yet were never formally evaluated for NM and two were lost to follow-up. Thus, the incidence of NM in this patient population is at least 36%. In the 55 patients who had resections of supratentorial metastases, only 1 patient (2%) developed NM. This study suggests that NM following surgical resection of an ICM may be common and may result in the premature demise of patients with excellent performance status, minimal systemic disease, and a reasonable life expectancy. Further studies are needed to determine if prophylactic intrathecal chemotherapy administered perioperatively could diminish the incidence of clinically apparent NM in this patient population.
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PMID:Neoplastic meningitis following surgical resection of isolated cerebellar metastasis: a potentially preventable complication. 904 83

Two patients, a woman aged 65 years and a man aged 56 years, with cancer, presented with pain in one leg as the first manifestation of metastases. The woman had tumour plexopathy of the lumbosacral plexus caused by an os sacrum metastasis of a thyroid carcinoma; she received radiotherapy but died a short time later. The man had lumbosacral epidural metastases of a colon carcinoma, compressing lumbosacral roots; with radiotherapy he survived the first year. Back pain with radiating pain is a frequent symptom in patients with cancer. Spinal epidural metastases, spinal and paraspinal metastases without epidural extension, tumour plexopathy and leptomeningeal metastases are the commonest causes. Early diagnosis (by MRI or spinal fluid examination) is important; with progressive weakness or sphincter disturbances the prognosis worsens.
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PMID:[Pain in one leg in patients with cancer]. 1009 55

Neurologic complications occur frequently in patients with cancer. After routine chemotherapy, these complications are the most common reason for hospitalization of these patients. Brain metastases are the most prevalent complication, affecting 20 to 40 percent of cancer patients and typically presenting as headache, altered mental status or focal weakness. Other common metastatic complications are epidural spinal cord compression and leptomeningeal metastases. Cord compression can be a medical emergency, and the rapid institution of high-dose corticosteroid therapy, radiation therapy or surgical decompression is often necessary to preserve neurologic function. Leptomeningeal metastases should be suspected when a patient presents with neurologic dysfunction in more than one site. Metabolic encephalopathy is the common nonmetastatic cause of altered mental status in cancer patients. Cerebrovascular complications such as stroke or hemorrhage can occur in a variety of tumor-related conditions, including direct invasion, coagulation disorders, chemotherapy side effects and nonbacterial thrombotic endocarditis. Radiation therapy is the most commonly employed palliative measure for metastases. Chemotherapy or surgical removal of tumors is used in selected patients.
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PMID:Neurologic complications of systemic cancer. 1006 11

This retrospective study concerning patients with a carcinomatous meningitis (CM) associated with solid tumour aimed at identifying risk markers of CM which could be used in the future in order to prevent from this neurological complication. From 1976 to 1996, the patients whose CSF sampling was positive cytologically, were registered recording baseline clinical data, tumour histology with grade, tumour dissemination, treatments and follow-up. Simultaneously to the recruitment of the patients the incidence of CM was derived at each 5-year period. The variables were analysed by uni- and multivariate statistics. Among the 41 cases, the first three sites of the primary were breast, lung, essentially small cell lung cancer, and urinary tumours. At their initial presentation, 22 patients revealed an M1 dissemination and 22 tumours were undifferentiated. Over the 20 years, the incidence of CM has significantly increased for urinary cancers, decreased for breast cancer while the administration of neoadjuvant chemotherapy was increasing, and remained unchanged for lung cancer. M1 and/or undifferentiated tumours shortened the time-to-CM whereas bone metastases, that were the most frequent site for secondary deposits, did not. Breast, lung and urinary cancers produced 80% of the CM in the series. Neoadjuvant chemotherapy possibly could save patients from the meningeal dissemination. M1 and undifferentiated tumours appeared to be independent risk factors, as well as osseous metastases. Other risk factors of CM should be identified in prospective trials.
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PMID:Carcinomatous meningitis and solid tumours. 1060 19


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