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)

Between 1965 and 1987, 190 patients with nonmetastatic and 134 patients with metastatic gestational trophoblastic disease (GTD) underwent initial metastatic survey at the Southeastern Regional Trophoblastic Disease Center (Durham, NC). These patients were evaluated for characteristics which might predict the presence of high-risk metastases before a full radiographic survey was obtained. Minimal staging evaluation of all patients included history and examination, quantitative HCG level by beta-subunit radioimmunoassay, chest radiograph, and evaluation for brain and liver metastases with radionuclide or computed tomography (CT) scans. Seventeen patients had high-risk sites of metastases (i.e., those outside lungs, vagina, or pelvis). Characteristics were identified which might predict high-risk metastases: (1) all had metastases in lungs or vagina; (2) 13 of 17 (76%) had at least one other high risk factor (i.e., beta-HCG titer greater than 40,000 mIU/ml, greater than 4 months since onset of symptoms or antecedent term pregnancy; and (3) 15 of 17 (88%) had obvious symptoms or signs related to high-risk metastasis. The authors then evaluated these criteria to identify high-risk metastasis: (1) asymptomatic patients with GTD are screened for therapy with history and physical examination, HCG level, and chest radiograph or CT of the lungs; and (2) further radiographic imaging is used only for patients with signs or symptoms of high-risk metastases, identifiable lung or pelvic metastases, or other high-risk clinical factors. Using this criteria, patients with high-risk metastases were identified with sensitivity of 100% and specificity of 63%. Approximately 60% of patients did not require further radiographic evaluation.
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PMID:Efficacy of the metastatic survey in the staging of gestational trophoblastic disease. 215 2

The term "unknown carcinoma" may be referred to any tumour that is not revealed by clinical examination or by routine diagnostic measures; the same term can indicate metastases whose source remains unknown until revealed by autopsy. The definition of the tumour histotype is mandatory for a correct choice of curative or a palliative treatment; therefore, a recognition of primary tumour should be cunningly aimed at. With regard to imaging diagnostics, some highly paramagnetic molecules for RM will shortly be available; with regard to nuclear medicine, some gamma-releasing immuno-specific markers reacting with tumour-associated antigens are also made available. Laboratory advances nowadays afford a better definition of biopsy samples, namely monoclonal antibodies versus cytospecific antigens and/or tumour-associated antigens; immuno-histochemical markers, such as anti-AFP and anti-HCG monoclonals, that detect the testicular source (germinal tumours) of a highly undifferentiated retroperitoneal mass; etc. It seems therefore possible the foresee a reduction in the incidence of "unknown" carcinomas.
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PMID:[Occult carcinoma in urology. Nosography and diagnosis]. 220 66

We present 8 years' experience of primary retroperitoneal lymph node dissection (RLND) in 190 patients with low stage non-seminoma; 154 patients had clinical stage I (CSI) and 36 had clinical stage IIa (CSIIa) disease. Of the 154 patients with CSI tumours, 33 had increased serum AFP and/or HCG before RLND (CSIM+) and 121 had normal tumour markers (CSIM-). Retroperitoneal lymph node metastases (pathological stage II) (PSII) were found in 38 of 121 patients with CSIM-, in 19 of 33 patients with CSIIM+ and in 26 of 36 patients with CSIIa. In a multivariate analysis, the presence of small vessel infiltration (demonstrated in histological sections of the primary tumour) and a prolonged tumour marker half-life were predictive factors for PSII. These 2 factors enabled a group of non-seminoma patients with CSI disease to be identified who had a 15% risk of retroperitoneal tumour growth (low risk group) as compared with a high risk group where 60 to 70% of patients had retroperitoneal lymph node metastases. Relapses occurred in 7 of 107 patients with PSI and in 6 of 83 patients with PSII disease; in the latter group, 5 relapses developed before the start of routine adjuvant chemotherapy; 6% of patients developed major post-operative complications. In addition, "dry ejaculation" was the principal side effect following RLND (unilateral RLND: 20/132 patients; bilateral RLND: 50/54 patients). The comparative cost to the health service during the first year of follow-up was estimated for low risk non-seminoma patients with CSI subjected to RLND and for those in whom a surveillance policy was adopted. The latter approach was preferable. It was concluded that a surveillance policy should be followed in low risk non-seminoma CSI patients provided that frequent follow-up is possible. A more active policy is recommended in high risk patients (e.g. adjuvant chemotherapy without RLND). Nerve-sparing RLND may be considered in patients with CSIIa disease and negative tumour markers.
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PMID:Is routine primary retroperitoneal lymph node dissection still justified in patients with low stage non-seminomatous testicular cancer? 234 Mar 72

A 38-year-old man was admitted to Nara Medical University Hospital on Feb.7,1983, because of swelling of the scrotal contents on the right side and elevated serum AFP, beta-HCG and LDH suggestive of testicular tumor. Right orchiectomy was carried out and a pathological diagnosis of embryonal cell carcinoma of the right testis (pT3N0M1) was made. The patient, upon evidence of multiple pulmonary metastases, was treated with a combination chemotherapy of cis-Diamminedichloroplatinum, vincristine and peplomycin. After three courses of combination chemotherapy, pulmonary metastases were decreased, but their foci persisted. The patient was then treated with Etoposide 62 mg/m2 daily for 5 days every three weeks, and after this course, complete remission of pulmonary metastases was obtained. The patient recieved 3 courses of Etoposide and retroperitoneal lymph node dissection, and has since shown no evidence of disease for 2 years and 4 months after surgery.
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PMID:[Complete remission obtained in advanced testicular cancer treated by etoposide (NK-171)]. 242 Feb 82

Between 1977 and 1985, 149 male patients with anaplastic germ cell tumours (AGCT) completed chemotherapy with POMB/ACE (platinum, vincristine (oncovine), methotrexate, bleomycin, actinomycin D, cyclophosphamide and etoposide). By increasing the number of courses of POMB in 1979, we have been able to compensate for adverse prognostic factors. Since then each patient has received at least three courses of POMB and 118 patients have completed therapy. The overall survival rate since 1979 is 89% and for the 100 patients who had not received prior radiotherapy it is 92%. We established that an initial serum concentration of human chorionic gonadotrophin (HCG greater than 50,000 iu/l) and/or alphafetoprotein (AFP greater than 500 ku/l) indicated a poor prognosis. Between 1977 and 1979 the survival rate in 12 patients in this category was only 45%. After increasing the number of courses of POMB, the survival rate rose to 89% in 31 patients. However, patients who had received prior radiotherapy and who presented with high tumour markers (HCG greater than 50,000 iu/l and/or AFP greater than 500 ku/l) continue to have a poor survival rate (20% in five patients). With this chemotherapy, 14 of 16 patients (88%) presenting with liver metastases and 6 of 7 patients (86%) presenting with brain metastases are in complete remission. Neither the stage at presentation nor the volume of metastatic disease was a major adverse prognostic variable. We believe that POMB/ACE chemotherapy, followed by surgery in selected cases, is currently the best treatment for patients with AGCT.
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PMID:Current optimum management of anaplastic germ cell tumours of the testis and other sites. 242 38

69 patients with different tumors (colorectal, melanoma, testicle, ovary, bladder, carcinoid, lungs) were investigated by radioimmunoscintigraphy. The corresponding antibodies or their F(ab')2 fragments against CEA (n = 30), melanoma antigen (n = 25), TPA (n = 6), beta-HCG (n = 5), HMFG-2 (n = 2) and CEA/CA 19-9 (n = 1) were selected on the basis of immunohistochemical investigations of the primary tumors. The precision was 62%, and the number of false-negative findings was 32%. Additional clinical information (detection or exclusion of a suspected recurrence) could be obtained in 22 patients. From these results, it can be concluded that the corresponding tumor antibodies should be selected on the basis of immunohistochemical investigations of the primary tumor before performing radioimmunoscintigraphy to screen for recurrences or metastases.
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PMID:[Scintigraphic detection of malignancies with radioactively labelled tumor antibodies. Clinical results based on immunohistochemical research]. 243 96

This report is based on the observation of 109 patients with testicular cancer over a period of 6 years. At the time of orchiectomy metastases were present in 54 patients. In 13 patients with an initially nonmetastatic disease, secondaries occurred later. The aim of this study was to evaluate the role of serum levels of human chorionic gonadotropin (beta-HCG) and alpha-fetoprotein (AFP) in the prognosis for achieving a complete remission. The importance of serial serum AFP and beta-HCG determinations for the early detection of tumor metastases was also evaluated. Remission rates were lowered significantly in patients with serum AFP levels above 500 micrograms/liter (8%, P less than 0.0005) and serum beta-HCG concentrations exceeding 5,000 U/liter (27%, P less than 0.05). For an early detection of metastases the best results (efficiency 0.92) were achieved with the combination of beta-HCG with AFP and X-ray examination of the chest.
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PMID:Prognostic value of tumor marker determinations in testicular cancer patients. 243 82

We report on two unusual adenocarcinomas of the lung. The primary of the first case could be classified as a "solid adenocarcinoma" of the lung, whereas the metastases were undifferentiated and contained syncytiotrophoblast-like tumor cells. The primary of the second case consisted of diversely differentiated cells including adenocarcinomatous and syncytiotrophoblast-like cells, while the metastases were either adenocarcinomatous or syncytiotrophoblastic-like differentiated. Immunohistochemically, both primaries showed abundant CEA and little beta-HCG, while the metastases exhibited little CEA and abundant beta-HCG. The implications of such differences between the primaries and their metastases for tumor-cell heterogeneity and tumor classification are discussed.
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PMID:[Bronchial cancers with morphologic and immunohistochemically diversely differentiated metastases]. 243 62

In order to establish the extent of neuroendocrine differentiation and the occurrence of neurohormonal peptides in the neoplastic cells of prostatic carcinomas, silver-staining and immunocytochemical techniques were used. All gave satisfactory results. The incidence of the neuroendocrine cells seemed to be higher in the fresh "Bouin-fixed" biopsy specimens than in the conventionally "formalin-fixed" specimens from archival paraffin blocks. All carcinomas demonstrated argyrophil cells as an integral element of the tumour. In highly differentiated carcinomas (grade I) these cells were scattered focally, intermingled with non-argyrophil cells in typical adenocarcinomas; their incidence was estimated to be about the same as in benign prostatic hyperplasia. Most of them were immunoreactive with antisera raised against serotonin and/or TSH (thyroid stimulating hormone). In moderately and poorly differentiated (grades II-III) carcinomas, however, the argyrophil cells were more numerous and showed greater variation in growth pattern; only occasionally they displayed a typical carcinoid-like structure. Moderately and poorly differentiated carcinomas also showed a greater variation in the number and kinds of peptide immunoreactivities than the highly differentiated carcinomas. In addition to serotonin- and TSH-immunoreactive cells as the most prevalent type, now also human chorionic gonadotrophin (HCG-alpha), adrenocorticotropic hormone (ACTH), leu-enkephalin, beta-endorphin, somatostatin, glucagon and calcitonin immunoreactive cells could be found within certain tumour areas and often with a distinctly patchy distribution. In two cases, where the tumour cells in the metastases were also investigated, they were found to be both argyrophil and immunoreactive with the same antisera as those of the primary tumour. Our findings emphasise the fact that prostatic carcinomas are more complex and heterogenous than previously thought, exhibiting endocrine differentiation as an integral element of virtually all prostatic adenocarcinomas.
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PMID:Peptide-hormone- and serotonin-immunoreactive tumour cells in carcinoma of the prostate. 244 32

A multiple regression analysis was performed of factors affecting the prognosis of 93 patients with metastatic malignant teratoma treated at the Royal Marsden Hospital between 1979 and 1981. In a subgroup of 53 patients, where exact tumour bulk could be calculated from sequential CT scan slices, a correlation was seen between tumour marker level and volume of metastatic disease. On analysis of the risk of relapse after initial chemotherapy, the independent adverse influence was detected of serum AFP greater than 500 micrograms/l and of bulky disease defined by clinical staging. An adverse influence of high serum HCG levels was not seen, probably due to the small number of patients in this series with this presenting feature.
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PMID:Prognosis following chemotherapy for metastatic malignant teratoma. 244 91


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