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)

Central nervous system tumors are relatively common in the United States, with more than 40,000 cases annually. Although more than half of these tumors are benign, they can cause substantial morbidity. Malignant primary brain tumors are the leading cause of death from solid tumors in children and the third leading cause of death from cancer in adolescents and adults aged 15 to 34 years. Common presenting symptoms include headache, seizures, and altered mental status. Whereas magnetic resonance imaging helps define the anatomic extent of tumor, biopsy is often required to confirm the diagnosis. Treatment depends on the histologic diagnosis. Benign tumors are usually curable with surgical resection or radiation therapy including stereotactic radiation; however, most patients with malignant brain tumors benefit from chemotherapy either at the time of initial diagnosis or at tumor recurrence. Metastases to the brain remain a frequent and morbid complication of solid tumors but are frequently controlled with surgery or radiation therapy. Unfortunately, the mortality rate from malignant brain tumors remains high, despite initial disease control. This article provides an overview of current diagnostic and treatment approaches for patients with primary and metastatic brain tumors.
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PMID:Central nervous system tumors. 1790 33

Carcinomatous encephalitis is a rare entity, originally described by Madow and Alpers in 1951, which is characterized by tumoral spreading perivascular, without mass effect. Clinical manifestations such as hemiparesis, seizures, ataxia, speech difficulties, cerebrospinal fluid findings as well as computed tomography are nonspecific. This leads the physician to pursue more frequent diseases that could explain those manifestations--toxic, metabolic, and/or infectious encephalopathy. A magnetic resonance imaging (MRI) with gadolinium, the method of choice, presumes the diagnosis. Previous reports of this unusual form of metastatic disease have described patients with prior diagnosis of pulmonary adenocarcinoma. We present the case of carcinomatous encephalitis in a 76-year-old woman as the primary manifestation of occult pulmonary adenocarcinoma with its clinical, imaging, and anatomopathological findings.
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PMID:Carcinomatous encephalitis as clinical presentation of occult lung adenocarcinoma: case report. 1795 93

The primary intracranial giant cell type of malignant fibrous histiocytoma (GC-MFH) is rare, and the resemblance to meningioma causes diagnostic confusion. Discrimination from meningioma bears important therapeutic and prognostic implications. We report one such case in which an extracranial malignant neoplasm was seen after the initial diagnosis and treatment. A 62-year-old woman presented with history of seizure. MRI revealed a huge right frontotemporal, homogeneously enhanced extraaxial lesion with significant mass effect. The main vascular supply was the middle meningeal artery. Workup for lesions elsewhere was negative. Gross total resection including dural attachment was achieved. The histopathological features were consistent with the diagnosis of GC-MFH. Immunohistochemistry disclosed varied reactivity profiles in tumor component cells: the spindle-shaped cells possessed features of mesenchymal and hematopoietic lineage, the histiocytic cells those of mesenchymal and epithelial cells, and the osteoclast-like multinucleated giant cells those of monocyte/macrophage and epithelial cells. Proliferative activity was absent in giant cells. Local irradiation of 60 Gy (linac) was performed. The patient did well for 10 months, and follow-up MRI showed no evidence of tumor recurrence. Subsequently, she developed ascites and died 3 months later as a consequence of end-stage adenocarcinoma (ovary) with peritoneal dissemination. There is no established treatment protocol for primary intracranial MFH. Although gross total resection and local irradiation were effective in the short-term control of local relapse in the present case, occurrence of extracranial neoplasm was fatal. Close follow-up aimed at early detection of local recurrence and distant metastases, as well as extracranial malignancy, remains important.
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PMID:Giant cell type of primary intracranial malignant fibrous histiocytoma: a case report. 1809 21

We describe a man of 59 years old, a smoker (20 cigarettes per day), without any pathologic background, with epilepsia partialis continua, with a relatively sudden appearance in the last 6 weeks. We wanted to find the cause of these prolonged focal seizures. The initial diagnosis of emergency was that of right side hemiballismus. The initial diagnosis on admission was prolonged right brachial myoclonus. Initially I was thinking of primary tumor or secondary one but paraclinic examinations excluded this diagnosis. After 5 months I repeated cerebral MRI scan which revealed left neoplasm of cavum. After another 6 months head and neck MRI described left rhinopharyngeal neoplasm with laterocervical adenopathies, cerebral metastases secondary to bronchopulmonary cancer with mediastinal invasion. The epilepsia partialis continua preceded by one year the primary neoplastic process.
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PMID:[Paraneoplastic syndrome presenting as epilepsia partialis continua]. 1829 93

Cancer in the central nervous system can arise from a primary brain tumor and metastasize to the brain or to the leptomeninges, leading to leptomeningeal metastasis (LM). LM also is called leptomeningeal carcinomatosis and carcinomatous meningitis. When LM occurs, signs and symptoms include headache, nausea, vomiting, lumbar back pain, and stiff or painful neck; LM also may lead to mental disturbances and seizures. Nursing care of patients with LM requires an understanding of neurologic anatomy and physiology, along with associated treatments and complications. Treatment of LM may involve intrathecal or, more likely, intraventricular chemotherapy. Very little has been written about appropriate care of patients with LM. The purpose of this article is to review the literature, summarize clinical care recommendations, and construct evidence-based guidelines for the administration of intraventricular chemotherapy and the care and monitoring of patients with LM.
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PMID:Management of adult patients receiving intraventricular chemotherapy for the treatment of leptomeningeal metastasis. 1851 41

Primary malignant brain tumors account for 2 percent of all cancers in U.S. adults. The most common malignant brain tumor is glioblastoma multiforme, and patients with this type of tumor have a poor prognosis. Previous exposure to high-dose ionizing radiation is the only proven environmental risk factor for a brain tumor. Primary brain tumors are classified based on their cellular origin and histologic appearance. Typical symptoms include persistent headache, seizures, nausea, vomiting, neurocognitive symptoms, and personality changes. A tumor can be identified using brain imaging, and the diagnosis is confirmed with histopathology. Any patient with chronic, persistent headache in association with protracted nausea, vomiting, seizures, change in headache pattern, neurologic symptoms, or positional worsening should be evaluated for a brain tumor. Magnetic resonance imaging is the preferred initial imaging study. A comprehensive neurosurgical evaluation is necessary to obtain tissue for diagnosis and for possible resection of the tumor. Primary brain tumors rarely metastasize outside the central nervous system, and there is no standard staging method. Surgical resection of the tumor is the mainstay of therapy. Postoperative radiation and chemotherapy have improved survival in patients with high-grade brain tumors. Recent developments in targeted chemotherapy provide novel treatment options for patients with tumor recurrence. Primary care physicians play an important role in the perioperative and supportive treatment of patients with primary brain tumors, including palliative care and symptom control.
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PMID:Primary brain tumors in adults. 1853 76

Epilepsy is common in patients with brain tumors. Usually, an epileptic seizure is the presenting sign of the cerebral lesion but late seizures may also occur. The tumors type and their locations are determining factors that significantly influence seizure frequency. Brain tumors with a high risk for epilepsy are developmental tumors, slow-growing tumors (low-grade gliomas), hemorrhagic tumors and multiple metastases. Seizures associated with brain tumors are sometimes difficult to treat. This relative drug-resistance may be attributed to several factors: the tumor development, modifications of tumor and peritumor tissues, oncologic treatments. Genetic factors also play an important role and multidrug-resistance proteins associated with brain tumors can be a major cause of epilepsy refractoriness. The choice of the antiepileptic treatment is very important and must take into account individual factors but, in general, the first-line prescription of enzyme-inducing antiepileptic drugs, especially phenytoin, is not mandatory. Given the frequency of epilepsy in patients with brain tumors, a prophylactic antiepileptic treatment could be warranted; but, unfortunately, no study has proven the effect of antiepileptic drugs as prophylactic treatment and a consensus statement from the AAN recommends not using antiepileptic drugs routinely as prophylaxis in patients with brain tumors. Nevertheless, these recommendations are based on studies performed with conventional antiepileptic drugs. Further randomized large cohort studies seem thus required to assess the effectiveness of new antiepileptic drugs to prevent and cure epilepsy in patients with brain tumors.
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PMID:[Epilepsy and brain tumors]. 1856 49

Little is known about the long-term outcome of autoimmune pancreatitis (AIP), and whether AIP possesses malignant potential. We report herein a 68-year-old Japanese AIP patient who rapidly developed systemic malignant dissemination of unknown origin, resulting in death. The patient was diagnosed histopathologically as having AIP in 1999. After a 6-year history of 5 mg/day of prednisolone therapy, a sudden onset of abdominal pain and convulsive seizure occurred, and the patient died on the tenth hospital day owing to diffuse peritoneal disseminations and metastases in the bilateral lungs and brain. Autopsy disclosed that the primary site was renal cell carcinoma, detectable only by autopsy, originating in the left kidney. On microscopy, metastatic cells obtained from the brain, lung, and peritoneum were composed of pleomorphic malignant cells identical to those from the renal cell carcinoma. Unexpectedly, abundant IgG4-positive plasma cell infiltration, suggesting high activity of AIP in pancreatic parenchyma and around dilated bile ducts, was still observed.
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PMID:An autopsy case of autoimmune pancreatitis after a 6-year history of steroid therapy accompanied by malignant dissemination of unknown origin. 1879 9

The thyroid gland is a relatively uncommon site for a secondary malignancy; even less common is a case of malignant melanoma metastatic to the thyroid. We describe the case of a 68-year-old man who presented with a neck mass in the posterior triangle. Fine-needle aspiration biopsy (FNAB) identified the mass as a malignant melanoma. The patient had had no known primary skin melanoma. He underwent a left modified radical neck dissection, and the mass was discovered to be a positive lymph node. Postoperatively, he declined to undergo radio- and chemotherapy. Eighteen months later, he returned with a diffusely enlarged thyroid. FNAB again attributed the enlargement to malignant melanoma. Soon thereafter, the patient began experiencing seizures, and on magnetic resonance imaging, he was found to have metastatic disease to the brain. He developed ventilator-dependent respiratory failure and required a subtotal thyroidectomy for the placement of a tracheostomy tube. Patients who present with a thyroid nodule and who have a history of malignancy present a diagnostic dilemma: Is the nodule benign, a new primary, or a distant metastasis? The findings of this case and a review of the literature strengthen the argument that any patient with a thyroid mass and a history of malignancy should be considered to have a metastasis until proven otherwise.
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PMID:Malignant melanoma metastatic to the thyroid gland: a case report and review of the literature. 1917 60

Intracranial metastases from prostatic cancer are rare, but cranial vault metastases are not. Most patients who have vault metastases present with local symptoms such as pain. We describe a patient who presented with acute neurological symptoms as well as a midline shift, seizures and secondary intracranial effects as a result of the extensive cranial vault metastases from prostate cancer; the symptoms mimicked those of intracranial metastases.
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PMID:Midline shift, seizures and acute neurological deterioration due to cranial vault metastases from prostatic carcinoma. 1965 16


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