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

Of 36 cases of choriocarcinoma treated at the University Hospital Kuala Lumpur during 1980-84 inclusive, 6 patients were found to have cerebral metastases. Intrathecal methotrexate and combination chemotherapy were started in all cases, with monitoring of tumor growth by serial beta-HCG assays and CT scanning of brain and lung. Chemotherapy was reduced because of severe toxicity in 2 patients, one of whom received radiotherapy to the brain. Four patients (66%) have now been in remission for 2.5-6 years. Two did not respond to therapy and died. The factors involved in therapy and response are discussed.
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PMID:Cerebral metastases from choriocarcinoma. Results of chemotherapy. 342 44

Although none of the known tumor markers, including the relatively new ones characterized by monoclonal antibodies, are sufficiently sensitive or specific as to be useful in the primary diagnosis of incipient malignancies, many of them turned out, nevertheless, to be of great clinical importance: their main field of interest lies in the surveillance of the already diagnosed patient in the post-operative phase. More recently some of them, e.g. tumor proteins like CEA and AFP, hormones (HCG), some enzymes, and monoclonal antibody-characterized membrane components, are used also as target antigens for the radioimmuno-detection (RAID) of carcinomas and their metastases. Most of the tumor marker antigens were already successfully used as targets for tumor imaging with radiolabelled antibodies; however, many immunological and technical problems still remain to be resolved.
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PMID:Tumor markers as target substances in the radioimmunologic detection of malignancies. 353 36

Radioimmunoscintigraphy was performed in 52 patients with a variety of malignant tumors (colorectal, melanoma, lung, testicular, ovarian, bladder, carcinoid). Respective antibodies or their F(ab')2 fragments against CEA (n = 23), melanoma antigen 225.28 S (n = 18), TPA (n = 4), beta HCG (n = 5) and HMFG2 (n = 2) were selected by immunohistochemistry of the primary tumor. Most patients were suspected of recurrence or of hitherto unknown distant or local metastases. Overall accuracy was 61% (32/52). False negatives amounted to 33% (17/52). Useful additional clinical information-not available by CT, ultrasonics or serum levels of tumor markers-was obtained in 17 out of 52 patients (= 33%). From these results it seems obvious that antibodies used for radioimmunoscintigraphy should be selected on the basis of immunohistochemistry.
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PMID:Clinical results of immunoscintigraphy in a variety of malignant tumors with special reference to immunohistochemistry. 354 Aug 57

Between February 1983 and July 1985, 52 patients with Clinical Stage I seminoma were observed after orchiectomy without lymph node irradiation. Seven patients (13%) have relapsed, six in retroperitoneal lymph nodes and one with abdominal node and pulmonary metastases. Relapses were diagnosed 6 to 23 months after orchiectomy, four occurring in the first year and three in the second year. Of eight patients with raised serum concentrations of HCG prior to orchiectomy none has relapsed, whereas of 14 patients with normal HCG levels one has relapsed. The significance of these observations for future management policy is discussed.
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PMID:Surveillance after orchiectomy for stage I seminoma of the testis. 358 Jul 75

Two hundred and eighty-six patients presenting with metastatic adenocarcinoma or undifferentiated carcinoma whose primary site was not identified by clinical history, physical examination and chest radiograph have been studied. Median survival from presentation was 22 weeks. Factors independently predicting improved survival were lymph node presentations, good performance status and body weight loss of less than 10 per cent. In 88 (31 per cent) patients the primary tumour site was subsequently identified, in 58 (20 per cent) during life. Lung cancer was the most frequently identified primary tumour, and in only 32 (11 per cent) of the patients was a 'treatable' primary tumour (i.e. germ cell, breast, ovarian, prostate, thyroid cancer or lymphoma) identified. Among the treatable primary tumours were those in eight out of 16 female patients presenting with axillary metastases who were subsequently shown to have primary breast cancer and four of 13 females presenting with ascites who were found to have primary ovarian cancer. Prostatic cancer was confirmed in five out of 13 men with raised serum acid phosphatase. Of 22 patients with elevated serum alphafoetoprotein (AFP) or beta-human chorionic gonadotrophin levels (beta HCG) 18 had some features of the 'atypical teratoma syndrome'. Of the total of 32 patients with treatable tumour types, 29 (90 per cent) were identified during life. Median survival for patients with treatable tumour types identified during life was 104 weeks, compared with 22 weeks for the group as a whole. Retrospective immunocytochemical staining of the original biopsy showed that prostatic specific antigen and antibodies to beta HCG and AFP were diagnostically useful, but a series of organ site non-specific markers of histogenesis or cellular differentiation (carcinoembryonic antigen, secretory component for IgA, peanut lectin binding, epithelial membrane antigen and keratin) showed no significant correlations with identified primary sites, responsiveness to empirical chemotherapy or survival. Metastatic undifferentiated carcinoma or adenocarcinoma from an unknown primary site represents 6.5 per cent of all referrals to the medical oncology unit, Royal Prince Alfred Hospital, Sydney. We offer guidelines for the rapid identification of the limited number of primary sites for which effective and specific forms of systemic treatment are available.
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PMID:Metastatic adeno or undifferentiated carcinoma from an unknown primary site--natural history and guidelines for identification of treatable subsets. 365 56

A case of adenocarcinoma of the colon is reported, whose metastases exhibited a syncytiotrophoblastic differentiation that gradually increased with advancing distance from the primary. Immunohistochemically, syncytiotrophoblastic giant cells with strong positivity for beta-HCG could be demonstrated within the metastatic tissue. Also, there was beta-HCG positivity in a fraction of the atypical epithelial elements of the primary. The case is discussed with respect to the differential diagnosis, and the cause of the syncytiotrophoblastic differentiation is attributed to the phenomenon of genetic instability. The case shows that by virtue of genetic instability totally new differentiations may be elaborated, so that the phenotypical appearance of a given tumor does not necessarily allow conclusions as to its tissue of origin. Thus, observations such as the one presented here clearly indicate that the histogenetic principle of tumor classifications by far does not apply to all cancers and that, therefore, its value and validity are considerably limited.
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PMID:Adenocarcinoma of the colon with syncytiotrophoblastic differentiation: differential diagnosis and implications. 403 56

The author resumes the basic progress achieved in the classification, staging and treatment of testicular cancer in the last 10 years. It is already possible to evaluate with precision the extent of non-seminomatous tumours of the testicles by using serum and intra-cellular tumoral markers (immunoperoxydase and anti-peroxydase peroxydase technique), ultrasonography and CT scan. It should be possible to selective scan the metastases with anti-alpha-foeto protein and anti HCG antibodies. Greater precision is necessary in the staging of tumors than is generally admitted. Local invasion of blood vessels and lymphatics. Invasion of the cord. The number of invaded retro-peritoneal lymphnodes (greater than or less than 5). The size of the lymphnodes (2 cm). For stage I tumours: A. Good prognosis. Wait and see without lymphnode dissection or chemiotherapy. Year 1--monthly check-ups. Year 2--quarterly check-ups. Then annual check-ups. B. Poor prognosis. Limited biopsic retroperitoneal lymphnode dissection subsequently extended following the result of the frozen section histology. For stage II tumours (with histologic proof of lymphnode invasion) the author recommends radical lymphnode dissection, except in the case of very large tumours. Subsequently: Where the excision is complete and the prognosis good (number and size of lymphnodes) no immediate chemotherapy. The author prefers to save it should the patient suffer a relapse (same follow-up as for stage 1A). Where the excision is incomplete or where it is complete but the lymphnodes are numerous (greater than 5) or large (greater than 2 cm) chemiotherapy is recommended. Where the lymphnodes are bulky. The author recommends chemiotherapy initially to be followed by retroperitoneal radical dissection. The presence of persisting tumoral tissue would imply additional chemiotherapy. In advanced tumours, a bone-marrow sampling would precede very aggressive chemiotherapy followed by surgery for residual tumoral tissue, reinjection of the bone marrow and an additional course of chemiotherapy.
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PMID:A decade of progress, current problems and future perspectives in testicular cancer. 407 52

The most important aspects of the clinical findings, endocrinology and course of the disease in 14 patients with the histological diagnosis of pure seminoma of the testis and positive serum beta-HCG levels are presented. In addition to routine investigations, immunohistochemical examination of the formalin-fixed specimen by the immunoperoxidase technique was also carried out. Serum alpha-feto-protein levels remained normal in all 14 patients. There was no correlation between serum beta-HCG level and tumour stage. The longest period of observation was 76 months and the shortest 8 months. Patients with no evidence of metastatic disease (5 patients, N0M0) or patients with low-stage disease (5 patients, N1 or N2M0) respond very well to radiotherapy. 4 patients (N3-N4M0) with large retroperitoneal metastases or distant lymph node metastases underwent different combinations of treatment.
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PMID:[Clinical, endocrinological and pathohistologic aspects of beta-HCG positive seminoma]. 608 74

Prognostic factors in carcinoma of the testis were studied in 1058 adult patients treated in Denmark from 1976 to 1980. Separate analyses of the prognostic factors were carried out within the subgroups formed by a classification of the patients according to main histologic type (seminoma, non-seminoma) and the clinicoradiologic stage (I, II and III). The prognosis was measured by relapse-free survival (stage I and II), and survival (stage II and III). The prognostic value of 19 clinical and histologic parameters was evaluated using logrank tests and multiple regression analyses. An elevated HCG level and the size of retroperitoneal metastases were associated with a significantly adverse prognosis for seminoma in stage II. For non-seminomas the following parameters had a significant influence on the prognosis. Stage I: postoperative HCG level, local invasion and number of mitoses. Stage II: size of retroperitoneal metastases, postoperative HCG level, tumour size and local invasion. Stage III: presence of liver or lung metastases, postoperative HCG level, presence of choriocarcinoma or endodermal sinus tumour, and age.
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PMID:Prognostic factors in testicular germ cell tumours. Experiences from 1058 consecutive cases. 609 42

Sixty two patients with gestational trophoblastic disease were investigated and treated between January 1977-December 1983. The value of pelvic arteriography was examined. The cases included: 45 moles with a simple outcome. 14 cases of invasive trophoblastic neoplasia after evacuation of the mole. 3 choriocarcinomas after full term pregnancy. Pelvic arteriography was performed in 14 patients. 9 of the 14 patients presented with persistent HCG secretion 6 to 8 weeks after evacuation of the mole. Before chemotherapy was begun, we looked for unfavourable prognostic features such as extra-pelvic metastases, multiple pulmonary metastases, high HCG secretion, delay between the initial event and starting chemotherapy of more than six months. The Ishizuka score was calculated. Six arteriography type I readings suggested choriocarcinoma with an Ishizuka score above five. Double chemotherapy (oncovin-methotrexate) was started successfully (with a one year follow up). Only two patients had unfavourable factors. Two arteriography type III suggested persistent moles, with an Ishizuka score below five. Chemotherapy (only methotrexate) was successful). It was not possible to classify the last arteriography, so the patient was treated successfully with double chemotherapy. Three patients failed to recover with chemotherapy. Arteriography was indicated to determine the site of HCG secretion. Three hysterectomies were performed. Tissue choriocarcinoma was found. Two diagnoses of choriocarcinoma were confirmed by arteriography: In one case an unexplained pleurisy appeared six months after full term. HCG was then positive. In the other case, extrauterine pregnancy was first suspected, but the woman had not had intercourse for six months. Arteriography demonstrated tubal choriocarcinoma. So pelvic arteriography is useful for managing complicated gestational trophoblastic disease.
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PMID:[Importance of arteriography in complicated trophoblastic disease]. 609 10


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