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)

Treatment of T4 bladder cancer patients remains a clinical challenge. Conservative management is often insufficient regarding local control, neoadjuvant chemotherapy delays definite treatment while leading to increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has also been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome, including therapy-related complications, in 20 T4 bladder cancer patients subjected to primary cystectomy. Twenty patients underwent radical cystectomy for T4 bladder cancer. At the time of surgery, 8 patients had regional lymph node metastases. The median postoperative follow-up was 13 months for the whole group. Mean duration of postoperative hospitalization was 19 days. Ten patients received no intra- or postoperative blood transfusions, whereas an average number of 3 blood units were administered in the remaining cases. Major therapy-associated complications were paresthesia affecting the lower extremities (n = 3) as well as insignificant pulmonary embolism, enterocutaneous fistulation and acute renal failure in one patient, respectively. At the time of data evaluation, 11 patients were still alive after a follow-up of 20 months. Four patients >or=70 years at the time of cystectomy were still alive after 11, 22 and 31 months following surgery, respectively. The current data demonstrate primary cystectomy for T4 bladder cancer as a technically feasible approach that is associated with a tolerable therapy-related morbidity. Additionally, satisfying clinical outcome is observed even in a substantial number of elderly patients.
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PMID:The rationale for radical cystectomy as primary therapy for T4 bladder cancer. 1752 49

The oral region is an uncommon site for metastatic tumour cell colonization and is usually evidence of a wide spread disease. In 25% of cases, oral metastases were found to be the first sign of the metastatic spread and in 23% it was the first indication of an undiscovered malignancy at a distant site. The jawbones, particularly the mandible, were more frequently affected than the oral soft tissues (2:1). In the oral soft tissues, the attached gingiva was the most commonly affected site (54%). The major primary sites presenting oral metastases were the lung, kidney, liver, and prostate for men, breast, female genital organs (FGO), kidney, and colo-rectum for women. The primary site differs according to oral site colonization, in men the lung was the most common primary site affecting both the jawbones and oral mucosa (22% and 31.3%, respectively) followed by the prostate gland in the jawbones (11%) and kidney in the oral soft tissues (14%). In women, the breast was the most common primary tumour affecting the jawbones and soft tissues (41% and 24.3%, respectively), followed by the adrenal and female genital organs (FGO) in the jawbones (7.7%) and FGO in the soft tissues (14.8%). The clinical presentation of the metastatic lesions differ between the various sites in the oral region. In the jawbones most patients complain of swelling, pain and paresthesia which developed in a relative short period. Early manifestation of the gingival metastases resembled a hyperplastic or reactive lesion, such as pyogenic granuloma, peripheral giant cell granuloma, or fibrous epulis. Because of its rarity, the diagnosis of a metastatic lesion in the oral region is challenging, both to the clinician and to the pathologist, in recognizing that a lesion is metastatic and in determining the site of origin. The clinical presentation of a metastatic lesion in the oral cavity can be deceiving leading to a misdiagnosis of a benign process, therefore, in any case where the clinical presentation is unusual especially in patients with a known malignant disease a biopsy is mandatory.
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PMID:Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases. 1806 27

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

Primary intraosseous salivary gland tumors of the mandible are rare, with mucopidermoid carcinoma being the most frequent, followed by adenoid cystic carcinoma (ACC). We present a case of a central ACC involving the mandible of a 46-year-old man. He presented an indurated swelling on the vestibular aspect of the left mandibular body and ipsilateral paraesthesia of the lower lip. A panoramic radiography revealed a large radiolucent area, with irregular margins, involving the body and ramus of the left mandible, and CT scan confirmed that the lesion was confined within the mandibular bone. The histopathological features were of an ACC. CT scan also revealed multiple nodular lesions in both lungs suggestive of metastases. The patient was surgically treated by hemi-mandibulectomy. The patient is well with no evidences of recurrences in the mandible. The present case shows that the clinical and immunohistochemical profile of primary intraosseous ACC is similar to what is found in ACC involving the salivary glands.
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PMID:Primary intraosseous adenoid cystic carcinoma of the mandible: histopathological and immunohistochemical analysis. 1938 75

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

Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although hepatitis C, one of the known risk factors for disease, is currently showing burgeoning growth in the country. Hence, it is possible that the incidence of HCC also will increase. Clinicians and pathologists in the United States are relatively unfamiliar with the patterns of metastatic spread for HCC. We report 2 US-native patients with cirrhosis and HCC who developed epidural space metastasis, a pattern of disease spread seen infrequently, even in endemic areas. Diagnostic testing was delayed in both patients because of the lowered suspicion for metastasis and the fact that neither patient had recognized metastatic spread to more common sites, such as lung or lymph nodes. New-onset neck or back pain-especially with symptoms of paresthesia, radiculopathy, or cord compression-in the setting of HCC warrants prompt investigation for metastases to the spine and epidural space.
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PMID:Hepatocellular carcinoma metastases to the epidural space. 2052 57

Small cell lung cancer (SCLC) has a very aggressive clinical progression with widespread metastases. We describe the case of a patient with SCLC treated with concurrent chemoradiotherapy. One month later, after finishing the scheduled treatment, the patient was admitted to the hospital again with symptoms of low back pain that radiated to bilateral lower legs with painful paresthesias, urinary incontinence, and constipation. After a series of examinations, including bone scan and magnetic resonance imaging, the patient received an L2-L3 laminectomy. The concluded diagnosis through histopathologic examination with immunohistochemistry was extramedullary-intradural spinal metastasis causing cauda equina syndrome. The metastatic tumour originated from the SCLC. To the best of our knowledge, this is the first reported case of SCLC metastasized to the cauda equina causing cauda equina syndrome.
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PMID:Extramedullary-intradural spinal metastasis of small cell lung cancer causing cauda equina syndrome. 2001 82

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

A 21-year-old woman was referred by the dental practitioner to an oral surgeon concerning a hard elastic swelling of the left cheek in combination with local paresthesia. Histopathologic and radiographic examination revealed an osteosarcoma in the left segment of the maxilla. Subsequently, the patient was referred to a medical centre for head and neck oncology. The treatment consisted of 3 courses neoadjuvant chemotherapy, followed by radical surgical resection of the tumor, and 3 courses adjuvant chemotherapy. One year after treatment, there was no sign of local tumor recurrence or metastases. An osteosarcoma is a malignant tumor of bone forming cells. About 10% of osteosarcomas are appearing in the head and neck region, primarily in the mandible and the maxilla. The treatment of choice is adequate surgical removal. Treatment with (neo)adjuvant chemotherapy seems to have additional benefit, but this needs further research.
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PMID:[Cheek paresthesia by an osteosarcoma]. 2044 50

Out of all skeletal metastases 30% are located in the spine as are 10% of primary bone tumors, whereby 52% of metastases occur in the lumbar region, 36% in the thoracic spine and 12% in the cervical spine. Patients suffer from local pain caused by irritation of the periosteum due to rapid growth of the tumor or subsequent pathologic fractures which may lead to compression and neurological impairment with paresthesia, paresis and paraplegia. If the diagnosis cannot be confirmed exactly by radiological imaging and laboratory tests, a biopsy should be performed. A precise diagnosis of the tumor entity as well as an estimation of the prognosis provides an important basis for further decision-making. The aim of therapy is pain relief and stabilization by operative and non-operative measures. Therapy is palliative with the aim of pain relief and preservation of mobility. In cases of solitary metastasis a curative operative treatment should be performed.
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PMID:[Diagnostics and therapy of spinal metastases]. 2127 38


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