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)

The region of the foramen magnum (FM) presents an especially difficult area for therapeutic intervention. Indeed, this location is challenging to access surgically, particularly in the case of intramedullary and anterior lesions. Therefore, the potential for morbidity associated with therapy to the foramen magnum, most frequently in the form of lower cranial nerve deficits, has encouraged the search for methods that can effectively treat lesions of this region while sparing the important neighboring structures. We report our experience in the use of Cyberknife radiosurgery as a treatment option for these lesions. Thirty-five patients (17 men, 18 women; mean age, 51 yr; range, 18-83) with 35 lesions either spanning or approximating the foramen magnum were treated with the CyberKnife radiosurgical system. Histologies were determined either by prior surgery or radiographic criteria and included 25 benign tumors (nine meningiomas, five schwannomas, four neurofibromas, three hemangioblastomas, two ependymomas, one chordomas, and one pilocytic astrocytoma) along with 10 malignant growths (nine metastases and one chondrosarcoma). Twenty-seven (77%) patients presented with at least one sign and/or symptom, while eight (23%) patients were completely asymptomatic. The most common symptoms were headache, limb numbness, and limb/truncal ataxia, all of which were reported by ten (29%) patients. Among cranial neuropathies, CN XII dysfunction was evident in four (11%) patients. The specific fractionation schedule (mean of 1.8 sessions; range, 1-5) was based on the size of the treated lesion. The mean dose utilized was 19 Gy. Radiographic follow-up was obtained for twenty-three (66%) patients. Nine of the twenty-three (39%) were stable in size, ten lesions decreased in size (43%), and four lesions increased in size (17%). In terms of symptom relief, follow-up was collected for twenty-four (69%) patients. Eleven (46%) of these patients experienced no change in their signs or symptoms, while seven (29%) patients experienced improvement. Six (25%) patients witnessed deterioration in their signs and symptoms. Overall, eighteen (75%) patients had their signs and symptoms either stabilize or improve. There were eleven (31%) deaths in our series, eight of which were related to the disease (though not directly related to CyberKnife treatment) and three of which were from unrelated causes. Complications directly related to CyberKnife radiosurgery were noted in four (11%) of the thirty-five patients. These included one case of temporary emesis immediately following treatment, one case of cystic enlargement two months out, and two cases of radiation necrosis (occurring 1.5 yrs and 2.5 yrs out from treatment). Cyberknife radiosurgery can be an effective treatment for many foramen magnum lesions.
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PMID:CyberKnife radiosurgery for lesions of the foramen magnum. 1766 41

Cranial metastasis has been reported as infrequent during colon cancers and usually occurs in the late stages with liver and/or lung metastasis. Metastasis to cavernous sinus is even rarer and only reported as case reports in the literature. In patients with cavernous sinus metastasis, the most common primary sites are the breast, lung, and genitourinary carcinomas, if head and neck tumors are excluded. A 34-year-old man underwent a right hemicolectomy for a mucinous adenocarcinoma of the right colon 14 months before presentation. Because metastatic implants on the omentum were detected during the operation, combination chemotherapy was begun. After 5 months of the last cycle of the chemotherapy, his left eyelid began to droop, left eye movements became limited, and he began experiencing numbness of his right forehead and cheek. Clinical and radiologic findings were discussed. Despite antiedematous treatment and radiation therapy, he did not experience marked improvement of his symptoms. He could not be given chemotherapy and died 2.5 months after the first symptom of cavernous sinus metastasis. Primary colon adenocarcinoma with cavernous sinus metastasis is very rare. It was hypothesized that the paravertebral plexus of Batson could permit the spread of tumor cells from pelvis toward the cranium. This could explain the metastases from pelvis to the cavernous sinus, such as in our case. Prognosis for the patients with cavernous sinus metastasis seems to be poor, and this might be the harbinger of rapid progression with widespread disease.
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PMID:Cavernous sinus syndrome caused by metastatic colon carcinoma. 1768 Nov 7

We report the rare case of a 74-year-old man who was admitted to our hospital with rapid progression of tetraparesis, which was most apparent in the lower right limb, sensory disturbances from C3 to S1 on the left side and recent onset of constipation and urinary retention. There was no known history of cancer. As MRI of the neck disclosed a cervical intramedullary mass lesion at C 4/5 level suspicious for a primary glial tumour, the patient underwent surgery. After microsurgical excision the histological analysis of the lesion unexpectedly revealed an intramedullary spinal cord metastasis (ISCM) of a poorly differentiated carcinoma, immunohistochemically consistent with a bronchial carcinoma. As intramedullary spinal cord metastases are generally associated with poor survival, a palliative irradiation of the levels C1-6 was additionally performed. Unfortunately tetraparesis and numbness remained. The very rare occurrence of intramedullary spinal cord metastasis and the absence of pathognomonic symptoms often lead to a delay until an underlying malignancy is discovered. Although rare, intramedullary spinal cord metastasis should be considered as a differential diagnosis of a spinal intramedullary lesion. Surgery and radiation are both options in the controversially discussed treatment of ISCM.
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PMID:Intramedullary spinal cord metastasis as initial presentation of systemic cancer--report of a rare case. 1796 82

Primary intracranial squamous cell carcinoma is extremely rare, with most cases arising from a preexisting benign epidermoid cyst. We report a rare case of primary intracranial squamous cell carcinoma in the brain stem with a cerebellopontine angle (CPA) epidermoid cyst. A 72-year-old female suffered from progressive left hemiparesis, difficulty in swallowing, and right hemifacial numbness. Diffusion-weighted magnetic resonance imaging revealed a high signal intensity (SI) lesion in the CPA region and an intra-axially ring-enhanced cystic mass in the right brain stem with low SI. Whole-body positron emission tomography showed no evidence of metastatic disease. The histological findings revealed a typical epidermoid cyst in the CPA region and a squamous cell carcinoma in the brain stem. We speculate that the squamous cell carcinoma may have been developed due to a chronic inflammatory response by the adjacent epidermoid cyst. The patient underwent a surgical resection and radiotherapy. After 12 months, she had no evidence of recurrence.
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PMID:Primary intracranial squamous cell carcinoma in the brain stem with a cerebellopontine angle epidermoid cyst. 1913 89

Numb chin syndrome (NCS) is a sensory neuropathy presenting with numbness of the chin in the distribution of the mental nerve and the branches of the mandibular division of the trigeminal nerve. Though it can be caused by a benign process, NCS should be regarded as being due to malignancy until proven otherwise. Among the malignancies that cause NCS the most common are breast cancer, prostate cancer, and lymphoreticular malignancy. In squamous cell carcinoma (SCC) of the esophagus, spread to the mandible is a rare and often late event. An often overlooked clinical sign in mandibular metastases is hypoesthesia or paresthesia over the peripheral distribution of the inferior alveolar nerve/mental nerve; this sign has been referred to in the literature as NCS or numb lip syndrome or mental nerve neuropathy. Rarely, this may be the first presentation of a disseminated malignancy. Prognosis is usually poor. The discovery of this symptom should alert the clinician to the possibility of disseminated disease. In this article we report a rare case of metastatic SCC of the esophagus in a 40-year-old male patient who presented with NCS. We also review the mechanism, causes, and evaluation of NCS.
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PMID:Numb chin syndrome as a manifestation of metastatic squamous cell carcinoma of esophagus. 1929 91

The numb chin syndrome (NCS) is characterized by facial numbness along the distribution of the mental branch of the trigeminal nerve. Most cases of this syndrome that are not dental in origin have been associated with malignant tumors or diffuse metastatic disease, particularly with underlying lymphoproliferative diseases and breast cancer. NCS can appear together with other signs of neoplastic dissemination or constitute the presenting symptom of the disease. The appearance of this mental nerve neuropathy should be considered as a significant symptom for clinicians, and investigations to detect a possible cancer should be mandatory. We report 12 patients with the NCS as the presenting and isolated symptom of a generalized malignancy.
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PMID:Chin numbness: a symptom that should not be underestimated: a review of 12 cases. 1935 84

We report the case of a patient with metastatic hormone refractory prostate cancer in whom "indirect" cauda equina syndrome developed concurrent with multilevel spinal cord compression (SCC). Three months after his first positive bone scan, a 65-year-old otherwise healthy man presented with severe back pain, bilateral lower extremity paresthesias, leg weakness and urinary retention. Magnetic resonance imaging (MRI) showed a dural-based mass causing SCC at the T9, T10 and T11 vertebrae, with a normal cauda equina. He received corticosteroids and palliative external beam radiotherapy, resulting in good pain control and gradual improvement in his neurological symptoms. He did well for 8 months, at which time his residual bilateral leg weakness abruptly worsened and he experienced numbness, paresthesias, urinary incontinence and constipation. Repeat MRI showed progression of epidural metastatic disease compressing the spinal cord or thecal sac at 7 thoracic vertebral levels. The cauda equina was also distorted and flattened without evidence of direct solid tumour impingement. We hypothesized that the etiology was increased intrathecal pressure due to disrupted cerebrospinal fluid flow resulting from multiple levels of upstream thecal sac compression. It is essential to image the entire spinal cord and cauda equina when patients with metastatic bone disease present with neurological symptoms to institute correct treatment and preserve function and mobility.
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PMID:A case of indirect cauda equina syndrome from metastatic prostate cancer. 1967 34

We describe our experience with a patient who had unresectable anal signet-ring cell carcinoma with extensive metastases to the lymph nodes, lungs, and bones. The patient was treated with bevacizumab (Bev)+mFOLFOX6 and achieved complete response (CR). He was a man in his fifties, who visited a local doctor with the chief complaints of swelling in the axillary and inguinal regions. Signet-ring cell carcinoma was diagnosed by examination of a biopsy specimen from the inguinal lymph nodes. A search for the primary tumor was performed, and anal canal carcinoma with pagetoid spread was detected in the perianal region. Positron emission tomography-computed tomography (PET-CT) showed an accumulation in lymph nodes throughout the body, as well as in the lungs and the bones. Bev+mFOLFOX6 therapy was initiated. After completion of 4 courses, the lymph nodes were no longer palpable. PET-CT scanning showed no accumulation. During the 8th course, tumor markers decreased to the normal range, and CR was diagnosed. When 13 courses had been completed, the patient experienced grade 3 numbness of the hands and feet, so his treatment was changed to Bev+FOLFIRI therapy. In conclusion, Bev+mFOLFOX6 therapy achieved 6 months of CR in our patient who had anal signet-ring cell carcinoma with systemic metastases, which seemed likely to have a very poor prognosis.
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PMID:[A case of anal canal carcinoma with systemic lymph node metastases successfully treated by bevacizumab+mFOLFOX6 therapy]. 2003 79

Axillary lymph node dissection (ALND) is associated with significant morbidity, whilst sentinel node biopsy (SNB) has the potential to minimize complications in the management of breast cancer. The aim of this study was to systematically appraise the outcome of SNB when compared to ALND. A comprehensive search for published trials examining outcomes after SNB for breast cancer was performed using medline and cross-referencing available data. Each study was reviewed and data extracted. Primary outcomes were nodal positivity and surgery-related morbidity. A total of 9,608 patients were identified from trials comparing ALND and SNB. The overall rate of axillary lymph node positivity for those with no clinically palpable nodes was 28.8% for ALND and 27.6% for SNB (OR = 1.00, 95% CI = 0.86-1.17, P = 0.956), though there was a trend for superior detection of metastatic disease with SNB when this was compared with ALND alone (OR = 1.22, 95% CI = 0.95-1.57, P = 0.122). Patients who undergo SNB are significantly less likely to suffer post-operative morbidity relative to ALND: risk of infection (OR = 0.58, 95% CI = 0.42-0.80, P = 0.0011), seroma (OR = 0.40, 95% CI = 0.31-0.51, P = 0.0071), arm swelling (OR = 0.30, 95% CI = 0.14-0.66, P = 0.0028) and numbness (OR = 0.25, 95% CI = 0.1-0.59, P = 0.0018). SNB is at least equivalent to ALND in detecting metastatic disease in the axilla. SNB is the optimum approach in terms of morbidity for the assessment of axillary metastasis in clinically node negative breast cancer.
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PMID:Outcome of axillary staging in early breast cancer: a meta-analysis. 2006 21

Numb chin syndrome (NCS) is a rare but important clinical symptom and sign. It describes a condition presenting as anaesthesia or paraesthesia over the chin, which is usually unilateral. The condition manifests spontaneously with no history of trauma, infection or obvious odontogenic cause. NCS is a clinically important finding as it may be the primary manifestation of Multiple Sclerosis (MS) or sign of systemic malignancy. We present a case of a 58-year-old gentleman who was referred to a regional oral and maxillofacial unit with a three-month history of sudden onset unilateral numbness of the chin. No odontogenic cause could be found and subsequent CT/PET scan from the cerebellum to the upper thighs revealed evidence of widespread metastatic disease. The patient died five weeks after his initial presentation. We discuss the importance of this clinical symptom, the likely mechanism of disease and offer differential diagnoses. Additionally, we recommend that patients presenting to their general dental practitioner with a numb chin be urgently investigated for a potentially undiagnosed malignancy or MS and be referred to their local oral and maxillofacial unit as an urgent 'target' referral.
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PMID:Numb chin syndrome: an ominous clinical sign. 2037 42


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