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)

Primary intracranial yolk sac tumor (Endodermal sinus tumor, YST) is quite rare, and most usually involves the pineal gland. This report concerns a rare case of unknown origin of yolk sac tumor with intracranial and spinal metastases. The 6-year-old boy initially manifested symptoms of acute urinary retension and paraparesis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an intrathecal tumor spreading below the third lumbar segment, and tumors also appeared in the left temporal area and right cerebellar hemisphere. The pineal region was free of neoplastic involvement and the gonads were normal. The patients underwent operation to remove intracranial and spinal tumors, and postoperative radiotherapy was administered. The histological findings showed metastatic yolk sac tumor. Multiple intracranial and spinal seeding were noticed postoperatively. The patient died of recurrent YST and pneumonia three months after operation. The origin of secondary YST can always be found in specific midline sites. This is a rare case since the primary lesion is unknown.
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PMID:Yolk sac tumor of unknown origin with intracranial and spinal metastases. 749 Jul 97

We reviewed our experience in 23 patients with acquired immunodeficiency syndrome (AIDS) who had acute lumbosacral polyradiculopathy. The patients developed a distinctive syndrome of rapidly progressive flaccid paraparesis and areflexia that was frequently associated with sphincter disturbances. Persuasive laboratory evidence of a cytomegalovirus polyradiculopathy (polymorphonuclear pleocytosis or confirmatory cerebrospinal fluid culture) was found in 15 of the 23 patients. Treatment with ganciclovir in these patients led to clinical stabilization, although worsening during the first 2 weeks of treatment was common. Most patients with cytomegalovirus polyradiculopathy had severe residual deficits. Metastasis from systemic lymphoma accounted for the polyradiculopathy in 2 other patients. A more benign syndrome was identified in the remaining 6 patients. They generally had slower clinical progression and less severe neurological deficits at their nadir than did patients with cytomegalovirus polyradiculopathy. Unlike patients with cytomegalovirus infection, their cerebrospinal fluid showed a predominantly mononuclear pleocytosis. Moreover, spontaneous improvement without treatment was common. Our experience together with the published experience of others suggests that the acute lumbosacral polyradiculopathy in AIDS is a clinical syndrome with different etiologies and variable clinical outcome. Recognition of this heterogeneity is necessary for the management of individual patients, as well as the interpretation of treatment results.
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PMID:Acute lumbosacral polyradiculopathy in acquired immunodeficiency syndrome: experience in 23 patients. 828 93

We report a case where targeted radionuclide therapy using 153Sm-EDTMP gave substantial palliative effect. A 35-year-old male with a primary osteosarcoma located in the first lumbar vertebra relapsed with progressive back pain after conventional treatment modalities had failed. He became bedridden, and developed paraparesis and impaired bladder function. On a diagnostic bone-scan intense radioactivity was localized in the tumor. He therefore was given 153Sm-EDTMP treatment twice, 8 weeks apart, 35 and 32 MBq/kg body weight respectively. After a few days the pain was significantly relieved and by the second radionuclide treatment the pareses subsided. For six months he was able to be up and about without any neurological signs or detectable metastases. Eventually, however, he experienced increasing local pain, developed paraparesis, was re-operated but died 4 months later. The dramatic transient improvement observed in this case warrants further exploration using 153Sm-EDTMP as a boost technique, supplementary to conventional external radiotherapy.
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PMID:Targeted radiotherapy of osteosarcoma using 153 Sm-EDTMP. A new promising approach. 867 70

Spinal instrumentation currently allows gross-total resection and reconstruction in cases of malignancies at all levels of the spine. The authors analyzed the results in 110 patients who underwent surgery for primary and metastatic spinal tumors over a 5-year period (1989-1993) at a single institution. Major primary sites of tumor included breast (14 cases), chordoma (14 cases), lung (12 cases), kidney (11 cases), sarcoma (13 cases), plasmacytoma (10 cases), and others (36 cases). Prior to surgery, 55 patients (50%) had received prior treatment. Forty-eight patients (44%) were nonambulatory, and severe paraparesis was present in 20 patients. Fifty-three patients (48%) underwent combined anterior-posterior resection and instrumentation. 33 (30%) underwent anterior resection with instrumentation, 18 (16%) underwent anterior or posterior resection alone, and the remaining six patients (5%) underwent posterior resection and instrumentation. Major indications for anterior-posterior resection included three-column involvement, high-grade instability, involvement of contiguous vertebral bodies, and solitary metastases. Postoperatively, 90 patients improved neurologically. The overall median survival was 16 months, with 46% of patients surviving 2 years. Fifty-three patients (48%) suffered postoperative complications. Despite the high incidence of complications, the majority of patients reported improvement in their quality of life at follow-up review. Our findings suggest that half of all patients with spinal malignancies require combined anterior-posterior surgery for adequate tumor removal and stabilization.
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PMID:Indications and results of combined anterior-posterior approaches for spine tumor surgery. 875 30

We report a case of a patient with isolated central nervous system relapse of classical seminoma, refractory to intrathecal and systemic chemotherapy, but successfully salvaged with craniospinal axis irradiation. A 44-year-old man with bulky Stage II classic seminoma obtained complete remission with four cycles of cisplatin etoposide combination chemotherapy, but relapsed with lumbar vertebral metastases with epidural spinal cord compression 5 months after completion of primary treatment. He underwent laminectomy, local radiotherapy, and salvage chemotherapy. Two months later he developed cranial nerve palsies, and magnetic resonance imaging confirmed leptomeningeal disease. After brain radiotherapy, systemic and intrathecal chemotherapies were begun but tumor recurred around the cauda equina, producing paraparesis. The patient received salvage craniospinal irradiation, with resolution of paraparesis and cranial nerve palsies. Thirty months after completion of craniospinal radiotherapy, he remains in complete remission. We suggest consideration of craniospinal axis irradiation as salvage therapy in patients with isolated central nervous system relapse of seminoma.
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PMID:Seminoma with isolated central nervous system relapse, and salvage with craniospinal irradiation. 960 51

Metastatic spine disease is frequent in renal cell carcinoma and 50% of osseous metastases are already found at the time of primary diagnosis. Therefore patient mobility and quality of life are threatened early in the course of disease. Surgery is able to relieve pain and to regain or to preserve mobility. Indication and technique of surgery (anterior decompression, vertebral replacement and transpedicular fixation) are explained and treatment results of eleven cases are reported. All patients with paraparesis or cord compression preoperatively were mobile when leaving our hospital after surgery. There were no severe complications, especially no neurological deteriorations or deaths. Postoperative survival time was ten months approximately in cases with multiple osseous lesions and it was several years in cases with solitary metastases. Mobility was preserved for most of the survival time. In conclusion, restabilisation of the spine proved to be a worthwhile treatment option in well-selected cases suffering from malignant spinal involvement.
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PMID:Metastatic spine disease in renal cell carcinoma--indication and results of surgery. 1036 57

This 54-year-old patient with a breast carcinoma of one year's evolution presented a progressive paraparesis and sphincter disregulation of a week evolution; MRI image showed a tumor in the medullary conus. She improved after removal of the conus mass. The histologic diagnosis was metastasis of adenocarcinoma. Metastasis at this level is infrequent and represents less than 1% of all spinal metastases. When the patients' general condition is good, surgery can relieve the neurologic deficit produced by the medullary mass.
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PMID:Intramedullary spinal cord metastasis. A case report. 1110 39

Two cases of intramedullary metastasis were observed in our department within a short period of time that change the picture of uncommon locations of spinal metastases as described in literature. The patients presented primarily with rapidly progressing flaccid paraparesis of the lower extremities. Both additionally described diffusely located hypesthesia and pallhypesthesia of the limbs. One complained about sphincter disturbance. Both were treated by laminectomy and microsurgical extirpation of the tumor. In the first case reported here, an intramedullary metastasis of an epithelioid sarcoma in the conus medullaris region was ascertained which may be regarded as the first such reported case. In the second case report, histologic findings confirmed a thoracic intramedullary metastasis of a mastocarcinoma. At follow-up 6 and 8 months postoperatively, we observed full recovery of neurologic function in one patient and partial recovery in the other. Intramedullary metastases are extremely rare. Clinical presentation may show rapid onset and outcome is related to rapid resection and adjuvant therapy. In contrast to intracerebral metastases, this is a remarkable incidence of sarcomatous intramedullary metastatic disease.
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PMID:Spinal intramedullary metastases. Report of two cases and review of the literature. 1148 45

The members of four generations of a family with Von Hippel-Lindau syndrome (VHL) have been followed by one of us (I.P.) for 30 years. The disease was proved in four members of this family, in three of them associated with pheochromocytoma. The grandmother (I-1) died at the age of 16 years two months after her first birth. The cause of death was not established. Her daughter (II-1) had 9 births with 5 children alive. Paresthesia and difficulties in walking followed by paraparesis and paraplegia were the first signs of the disease at the age of 58 years. The surgical treatment was performed because of an expansive lesion at the level of Th 3-4. Pathohistological examination was not done. It seems that a haemangioblastoma might be the cause of her disease. Diagnosis of pheochromocytoma was documented in a female patient (III-2) in 1972. Two years later she was successfully operated on. Pathohistological examination proved clinical diagnosis. She had also diabetes mellitus, cholelithiasis and cardiomyopathy. She died at the age of 56 years. A right-sided pheochromocytoma was diagnosed in a next female patient (III-4) at the age of 22 years. Her surgical treatment was successful. Retinal haemangioblastomatosis was established 7 years later in this patient. She was blind at the end of her life. Haemangioblastomatosis cerebelli was diagnosed soon, and she died at the age of 51 years. A 12- year old boy (IV-3) presented severe hypertension (36/24 kPa). Left-sided pheochromocytoma was removed in this patient one year later. Right-sided pheochromocytoma was operated on in the same patient at the age of 24 years. An elevated level of urinary dopamine was documented four years after the second operation. A malignant right-sided pheochromocytoma was operated on in the same patient 15 years later. At the same time metastases were found in the lower part of the right lung lobe. A 131-I-MIBG therapy could not be realized. He died at the age of 41. Pathohistological examinations proved the clinical diagnosis in this patient after all of three surgical treatments. MEN 2 syndrome was excluded by proper genetical analyses on the RET-protooncogen. Genetical analyses are in the course to identify the possible mutations of VHL-tumour-suppressor gene through the living members of the family. Multidisciplinary approach is mandatory in diagnosis, follow up and treatment of this specific group of patients. A collaboration among specialists of different fields of medicine (internal medicine, ophthalmology, neurology, radiology, urology, neurosurgery, biochemistry, pathology and genetics) is suggested.
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PMID:[The von Hippel-Lindau syndrome with pheochromocytoma]. 1258 97

A 73-year old woman presented with mild paraparesis and hypesthesia of the legs. Furthermore, she complained dizziness, fainting and dyspnea. There was a history of peripheral artery disease, diabetes mellitus, arterial hypertension and chronic atrial fibrillation. Five years ago she had breast cancer with removal of the left mamma and additional radiation therapy. Cardiac catheterization at that time demonstrated no significant coronary stenoses. A contrast-enhanced CT-scan excluded lumbal spinal metastases. Instead, a subtotal occlusion of the abdominal aorta was noticed, but was initially interpreted as a chronic thrombosis because there were no typical symptoms and only moderate pain. About 24 hours later the patient developed an acute ischemic syndrome of the legs with progressive paraparesis, cold and pale legs in combination with acidosis and hyperventilation. Color-coded duplex ultrasound showed only a small turbulent flow in the ilial arteries, highly suspicious of a complete occlusion of the distal aorta. Angiography revealed an acute total occlusion of the infrarenal aorta without collaterals. During surgical intervention, complete obstruction of the abdominal aorta above the bifurcation was confirmed. Subsequent embolectomy was performed and an embolus consisting of several layers of different age was extracted. After successful surgical intervention with subsequent clinical improvement, the patient's clinical condition deteriorated a few day later. She died on day 9 after surgery from a complete ischemia of the small intestine and the colon ascendens.
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PMID:[Atypical Leriche syndrome]. 1265 74


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