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)

To ascertain the range of neurological problems in patients with systemic cancer, we prospectively evaluated neurological symptoms, neurological diagnoses, and primary tumors in all patients with a history of systemic cancer examined by the Department of Neurology at the Memorial Sloan-Kettering Cancer Center, from Jul 1, 1990, to Dec 31, 1990. Of the 815 patients seen for neurological symptoms, less than half (45.2%) had metastatic involvement of the nervous system. The three most common symptoms were back pain (18.2%), altered mental status (17.1%), and headache (15.4%). The most common neurological diagnosis was brain metastasis (15.9%), followed by metabolic encephalopathy (10.2%), pain associated with bone metastases only (9.9%), and epidural extension or metastasis of tumor (8.4%). Of 133 patients with undiagnosed back or neck pain, 44 (33%) had epidural extension or metastases from tumor and 40 (30%) had pain associated with vertebral metastases only. In 15 (11%) the cause for the back pain was unrelated to metastatic disease. Of 132 patients seen on initial consultation for altered mental status, metabolic encephalopathy was the major neurological diagnosis (80; 61%); 20 (15%) had intracranial metastases. Of 97 patients with undiagnosed headache, 59 (61%) had a nonstructural cause. Fifty-three of these patients had either migraine, tension headache, or headache related to systemic illness (e.g., fever, sepsis). These results indicate that even in patients with systemic cancer, a group particularly prone to developing neurological disease that can be diagnosed radiologically, the role of clinicians remains important in helping distinguish noncancer-related and nonmetastatic neurological problems.
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PMID:The spectrum of neurological disease in patients with systemic cancer. 163 35

A 79-year-old male was admitted for macroscopic hematuria and right back pain. A mass shadow in the right lower lung fields had been present for three years previously with unconfirmed diagnosis. Excretory urogram, ultrasonogram and computed tomographic scan revealed bilateral renal tumors. Selective right renal arteriogram demonstrated a slightly hypervascular mass in the upper pole of the right kidney. Chemotherapy was not effective. Slow but definite malignant progression developed and the patient died two and a half years later. Autopsy finally revealed the adenoid cystic carcinoma of the right lung with bilateral renal metastases. The renal metastasis of this tumor is the first case in Japan to our knowledge.
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PMID:[Bilateral renal metastases of lung adenoid cystic carcinoma]. 166 61

Twenty patients with known malignancies, back pain, abnormal roentgenograms of the spine, and normal neurological examinations were evaluated by outpatient computed tomographic (CT) myelography to determine the presence and extent of epidural tumor. Spinal CT following the intrathecal administration of low doses of water soluble contrast agents provided high quality diagnostic information. Three patients experienced adverse effects from this procedure which were mild and easily managed in the outpatient setting. Epidural tumor was identified in 15 of 20 (75%) patients. Patients were followed for 9-27 months following myelography. The 14 patients with epidural tumor treated with local radiation experienced pain relief and only one of these patients developed signs or symptoms of recurrent epidural tumor in the treated site. This study documents the high incidence of epidural tumor in selected patients without neurological deficits and the excellent palliative results of non-emergent, carefully planned radiation therapy. It also demonstrates that high resolution CT myelography can be performed safely in an outpatient setting in patients at high risk for epidural tumor. Outpatient myelography facilitates the early diagnosis of epidural tumor and provides needed information on the extent of the tumor for radiation treatment planning while conserving health care resources. For these reasons, outpatient CT myelography should be considered in selected patients with cancer who are at high risk for epidural metastases.
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PMID:Early diagnosis of spinal epidural metastases using out-patient computed tomographic myelography. 169 89

Because it is important to assess relevant prognostic factors when deciding which patients will profit from pancreatic resection and which will not, 484 patients with ductal pancreatic carcinoma who were operated on between 1 January 1978 and 31 December 1987 in the Department of General and Abdominal Surgery of Mainz Medical School were studied retrospectively. Prognostically favourable factors were: a history of 8 weeks or less, the presence of jaundice, the absence of back pain, a well to moderately differentiated carcinoma, a tumour less than 3 cm in diameter, a preoperative CA19-19 value of less than 400 U/ml, and no sign of lymph node metastases or other metastatic spread. Only 19 patients (3.9%) satisfied these criteria. Our objective is to now check these results in a prospective study with a larger number of patients and, in addition, to compare the quality of life of patients who were treated by resection with that of those who received palliative treatment.
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PMID:Relevant factors in the prognosis of ductal pancreatic carcinoma. 170 25

The case of a 7-year-old boy with a spinal epidural extraosseous Ewing's sarcoma (EES) is presented. He is in complete remission without neurologic deficit 40 months after diagnosis. Another 15 cases were found in the literature and are discussed together with this patient. Twelve of them were male patients. The mean age of the patients was 17.5 years (range, 4 to 47). Symptoms included back pain and/or radicular pain (100%), paresis of one or both legs (83%), sensory disturbances, and bladder and bowel dysfunction. The mean diagnostic delay was 5.8 months. Each patient underwent laminectomy; complete resection of the tumor was impossible in more than 50% of the cases. Most patients received radiation therapy and/or chemotherapy. Four patients suffered from local recurrence, eight from metastases. Ten (63%) patients died, 1 to 48 months (mean, 16) after diagnosis. The differential diagnosis is discussed, including disk herniation and several benign and malignant tumors.
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PMID:Primary spinal epidural extraosseous Ewing's sarcoma. 206 87

We reviewed 63 cases of cytologically confirmed leptomeningeal metastases (LM). 31 (49%) had solid tumors 17 (27%) had leukemia and 15 (24%) had lymphoma. The most common presenting symptom was pain (76%) with radicular discomfort (58%), headache (32%), neck or back pain (17%). The predominant neurological signs were mental status abnormalities (49%), weakness (47%), seizures (14%). The mode of presentation varied with tumor type. Patients with leukemia (18%) and lymphoma (13%) tended to present frequently with LM without systemic involvement, or during periods of apparent remission (leukemia 35%, lymphoma 27%), while patients with solid tumors had established systemic metastases (90%) at time of presentation. Laboratory studies did not vary among the groups. 71% had positive cytology on the first lumbar puncture (LP) and only 8% required more than 2 LPs. The cell count was a poor predictor of positive cytology as 29% of LP's with positive cytology and 36% of all LP's had less than 4 cells/mm. We conclude that 1) LM presents with pain and seizures more frequently than has been previously recognized; 2) LM is frequently the mode of presentation in patients with leukemia and lymphoma and; 3) cytology is positive frequently in CSF specimens with normal cell counts and chemistries.
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PMID:Leptomeningeal metastases: comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias. 208 37

Metastatic disease of the lumbar spine is a relatively common, but catastrophic cause of low back pain. Because of an increasing role as primary care providers for back pain patients, it is essential that chiropractors keep this possibility in mind. Careful consideration of the patient's history, physical and laboratory findings, and the use of imaging procedures are helpful in establishing a correct diagnosis in those cases where metastasis is suspected.
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PMID:The use of imaging procedures in the diagnosis of metastatic disease of the lumbar spine. 214 Jan 24

Epidural metastases are a common complication of malignancy and are usually considered an oncologic emergency requiring hospitalization and urgent diagnostic and therapeutic interventions. However, patients at high risk for epidural cord compressions can be identified, evaluated, and treated electively before they develop serious neurological deficits. Often this can be accomplished entirely in the outpatient setting. The early diagnosis and treatment of epidural metastases is crucial in preserving ambulation and bowel and bladder function. The possibility of such metastases should be suspected in any cancer patient with back pain.
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PMID:Diagnosis and treatment of epidural metastases. 214 29

Primary sarcomas of the kidney in adults are rare. In the handful of published reports of all soft tissue sarcomas, DNA ploidy has correlated with histologic grade and outcome. This report presents the clinicopathologic and flow cytometric features of 17 cases of primary renal sarcoma (seven men and ten women, ages 28-69 years). Presenting symptoms included abdominal and back pain and hematuria. Stages at diagnosis were I, in three patients; II, five patients; III, two patients; and IV, two patients. Eight tumors were leiomyosarcoma, two malignant fibrous histiocytoma, one hemangiopericytoma, one fibrosarcoma, and five unclassified. Tumors measured 5.5 to 23 cm, seven contained marked nuclear pleomorphism, seven were extensively necrotic, and mitotic rate was 1 to 33 per 10 high-power fields. Seven tumors showed aneuploidy and five were diploid. Thirteen patients were dead of disease after a mean of 23 months and two were alive with known metastases at 29 and 33 months, respectively. Ploidy pattern and outcome or time to death were not correlated, but aneuploidy correlated with histologic grade, marked nuclear pleomorphism (P less than 0.05), extensive necrosis (p less than 0.01), and high mitotic rate (0.05 less than P less than 0.10). The authors conclude that although DNA ploidy does correlate with histologic grade, for primary renal sarcomas, whose prognosis in this series was extremely poor, it does not correlate with outcome.
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PMID:Primary sarcomas of the kidney. A clinicopathologic and DNA flow cytometric study of 17 cases. 215 1

Back pain is a common complaint in patients with cancer. The standard diagnostic approach includes plain roentgenograms and radionuclide scans. We report two patients who presented with back pain and had unremarkable or equivocal roentgenograms and radionuclide scans. Their MRI scans demonstrated metastatic disease to the bone and spinal cord compression. The role is discussed of MRI scanning in patients with solid tumors and persistent back pain.
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PMID:Detection of occult bone metastasis by MRI scan. 177 63


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