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)

A 29 year old white man presented to the emergency room with new onset pleuritic chest pain and shortness of breath. He was initially diagnosed as having viral pericarditis and was treated with non-steroidal anti-inflammatory drugs. A few weeks later he developed recurrent chest pain with cough and haemoptysis. Chest radiography, cardiac examination, transthoracic and transoesophageal echocardiography pointed to a mass that arose from the posterior wall of the right atrium, not attached to the interatrial septum, which protruded into the lumen of the right atrium causing intermittent obstruction of inflow across the tricuspid valve. Contrast computed tomography of the chest showed a right atrial mass extending to the anterior chest wall. The lung fields were studded with numerous pulmonary nodules suggestive of metastases. A fine needle aspiration of the pulmonary nodule revealed histopathology consistent with spindle cell sarcoma thought to originate in the right atrium. Immunohistochemical stains confirmed that this was an angiosarcoma. There was no evidence of extracardiac origin of the tumour. The patient was treated with chemotherapy and radiation. This case highlights the clinical presentation, rapid and aggressive course of cardiac angiosarcomas, and the diagnostic modalities available for accurate diagnosis.
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PMID:Primary right atrial angiosarcoma mimicking acute pericarditis, pulmonary embolism, and tricuspid stenosis. 1021 78

A 49-year-old woman was diagnosed with local recurrence and cervical lymph node and bone metastases 55 months after surgery for breast cancer. She was treated with goserelin acetate and tamoxifen but the disease was assessed as progressive after 8 months. Five courses of CMF therapy were performed but lung, pleural and mediastinal lymph node metastases were detected. Then, five courses of CAF therapy were carried out, but a contralateral breast metastasis was detected and the patient complained of shortness of breath. The CAF therapy was assessed as PD. We attempted administration of doxifluridine (5'-DFUR) and mitomycin C (MMC) on an outpatient basis. After 6 months, no progressive disease was detected and she was relieved of her shortness of breath. The combination therapy was assessed as long NC. Combination therapy with 5'-DFUR and MMC is thus a useful treatment for adriamycin- and methotrexate-resistant breast cancer, especially in terms of quality of life.
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PMID:[A case of adriamycin and methotrexate-resistant recurrent breast cancer treated with doxifluridine and mitomycin C]. 1047 88

Myxopapillary ependymomas are benign tumours which occasionally metastasize along cerebrospinal fluid pathways. Extraneural metastases of spinal ependymomas, however, are very rare, even more so when situated in the pleura. We report the case of a 67 year old woman presenting with shortness of breath after recurrent myxopapillary ependymomas of the cauda equina. Chest X-ray showed multiple pleural lesions diagnosed as metastases of a myxopapillary ependymoma. The MIB-1 proliferation index was 3.1% for the initial spinal tumour, 14.2% for the first and 11.2% for the second recurrence while 12.0% for the pleural metastasis.
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PMID:Ependymoma of the cauda equina. 1048 92

With the FDA approval of Rituximab in 1998 for the treatment of lymphoma, and Trastuzumab in 1999 for the treatment of breast cancer, monoclonal antibodies were officially added to the therapeutic armamentarium against malignancy. Most of the side effects associated with these agents are due to antigen-antibody interactions on specific cells and tissues. One of the most predictable side effects of these products is a constellation of various systemic effects including flu-like symptoms such as headache, fever, sweats, skin rash, shortness of breath, hypotension, nausea, and asthenia that occurs with the first infusion of such products. Rarely severe hypotension, bronchospasm, and hypoxia and even death have occurred. The pathophysiology of these reactions appears to be secondary to the release of cytokines as the antibodies bind do circulating antigen-expressing cells that are then removed in the reticuloendothelial system of the lungs, spleen and liver. In patients with large numbers of antigen-dense cells that have a high mitotic index, such as prolymphocytic leukemia, mantle cell lymphoma, or lymphosarcoma cell leukemia, there is a risk of true tumor lysis syndrome. One should be particularly cautious when treating patients with high numbers of circulating antigen-expressing cells in the setting of underlying cardiovascular or respiratory disease.
Cancer Metastasis Rev 1999
PMID:Infusion reactions associated with the therapeutic use of monoclonal antibodies in the treatment of malignancy. 1085 89

A 30-year-old HBsAg-positive woman was admitted to the hospital because of 6 days of progressive shortness of breath. She was in severe respiratory distress with circulatory collapse. She had an enlarged liver but no stigmata of chronic liver disease or signs of cirrhosis. She had rapidly developed respiratory arrest and was transferred to intensive care unit. Heart ultrasonography and Doppler scan showed right heart straining and high pulmonary artery pressure. Despite cardiovascular and respiratory support she died a few hours after admission. Autopsy revealed combined hepatocellular-cholangiocarcinoma infiltrating the entire liver, metastatic invasion of lung blood vessels and absence of right ventricular hypertrophy. The incidence of hepatocellular-cholangiocarcinoma, a variant of hepatocellular carcinoma, is roughly 2-3% and the presenting symptoms are abdominal pain, weight loss, jaundice, fever or decompensation of liver disease. Associated HBsAg positivity and cirrhosis are reported in 20-30% and 60% of patients, respectively. Metastases to lungs are relatively frequent but this is the first report of hepatocellular-cholangiocarcinoma presented with acute respiratory distress due to massive pulmonary embolism.
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PMID:Combined hepatocellular-cholangiocarcinoma presented with massive pulmonary embolism. 1102 Aug 95

Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma. Tumor may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. Impairment of cardiac function occurs in approximately 30% of patients and is usually attributable to pericardial effusion. The clinical presentation includes shortness of breath, which may be out of proportion to radiographic findings in patients with pericardial effusion or may be the result of associated pleural effusion. Patients may also present with cough, anterior thoracic pain, pleuritic chest pain, or peripheral edema. The differential diagnosis of pericardial effusion in a patient with known malignancy includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis. Any disease process that causes thickening or nodularity of the pericardium or myocardium or masses within the cardiac chambers can mimic metastatic disease.
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PMID:Metastatic involvement of the heart and pericardium: CT and MR imaging. 1125 6

This report describes a patient admitted with shortness of breath due to cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed only after right heart pressures failed to decrease after successful pericardiocentesis. The patient was found to have widely metastatic adenocarcinoma of colon (with metastases to pericardium) and a paraneoplastic syndrome of deep vein thrombosis.
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PMID:Cardiac tamponade masking pulmonary embolism. 1140 12

This prospective study represents our experiences in using fibreoptic bronchoscopy (FOB) in the evaluation of different thoracic lesions. Over a 20-month period, 203 patients (151 males and 52 females) (age range: 15-100 years) underwent bronchoscopies. The patients had a wide range of symptoms and/or radiographic abnormalities. The majority had cough and shortness of breath; haemoptysis was a common symptom. In all, 148 patients had neoplasms and 55 had non-neoplastic lesions. The most common malignancy was bronchogenic carcinoma (91 confirmed, 33 suspected). Other neoplasms included pulmonary metastases and mediastinal tumours. The non-neoplastic chest lesions included pulmonary tuberculosis, pulmonary hydatid cyst, lung abscess and resolving chest infection and chronic bronchitis. FOB was most useful in the diagnosis of bronchogenic carcinoma (positive diagnostic yield of 73%). It was least useful in diagnosing mediastinal tumours.
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PMID:Flexible fibreoptic bronchoscopy in Basra, Iraq: a 20-month experience. 1155 6

A request for euthanasia (RFE) in the terminally ill raises concerns that physical and/or mental suffering remain unaddressed and thus mandates a critical appraisal of the physical and psychosocial aspects of the individual concerned. An alert datasheet (AD) is completed at the weekly Palliative Care Service (PCS) meeting as a measure of self-audit and deals with issues considered to be of importance in ensuring high-quality patient care, one of which is a RFE. The ADs for the year 2000 were examined, and where a RFE was made, the contributing factors as documented on the forms together with demographic data, the case synopsis and patient-rated main three problems/issues were appraised. Among 490 patients referred to the service, there were 6 RFE (1.6%) recorded. These were made by 1 female (age 44) and 5 male (age range 58-78 years) patients. Four of these patients had a cancer diagnosis (all had metastatic disease). Median survival from first contact with the PCS was 13 days (range 4-29). The contributing factors identified were: uncontrolled symptoms (2/6 - severe constipation in both), depression (1/6), issues of burden/dependency (6/6), lack of autonomy/control (4/6), sense of hopelessness (3/6) and social isolation (4/6). The patient-rated main three problems were: (i) physical symptoms (5/6), specifically pain (2/6), shortness of breath (2/6), fatigue (1/6) and nausea (1/6), and (ii) psychosocial issues (4/6). A RFE was seen to be a multifactorial entity (issues of burden/dependency being universal) and merits a focused appraisal in order to adequately address potentially unrecognised issues that contribute to suffering. The short median survival from the time of referral to the service suggests that (i) RFEs are made late in the trajectory of the illness and (ii) these patients are being referred late in the course of their illness - thus limiting the window in which these issues can be addressed.
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PMID:Requests for euthanasia made to a tertiary referral teaching hospital in Sydney, Australia in the year 2000. 1202 30

The case of a 28-year-old male patient with a locally aggressive lesion of the distal tibia is presented. Following the diagnosis of giant cell tumor of bone (GCT) on biopsy and curettage, a rapid malignant course was observed with recurrence 2.5 months later. Multiple metastases appeared 6 months after initial presentation. Following initial chemotherapy according to the COSS protocol and later with carboplatin and VP-16, therapy was changed to Adriamycin and later gemcitabine due to progressive disease. Good palliation was achieved, and the patient felt well with less shortness of breath on exertion and was ambulatory with walking aids. The malignant nature of the tumor was not detected in the initial pathologic examinations. Review of the pathologic material provided histologic clues permitting the diagnosis of a primary malignant GCT with a fibrohistiocytic/fibrosarcomatous component. Malignancy in a giant cell tumor is a much debated diagnostic dilemma when a frank sarcomatous component is lacking. Cytologic atypias and flame-like tufts of infiltration of soft tissue are important clues. Surgical treatment should be commensurate. Monotherapy with Adriamycin or gemcitabine can be considered in order to inhibit the disease progression.
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PMID:[Giant cell tumor of bone with rapid malignant course]. 1500 59


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