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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with gastric adenocarcinoma typically present with symptoms that include anorexia, early satiety, and weight loss. Although the disease may already be far advanced at presentation, signs and symptoms from involvement of skeletal muscle are extremely uncommon. In fact, metastatic cancer of any type to the skeletal muscles is rare, and most of these metastases are discovered at autopsy. We report here the case of a 65-yr-old man who presented with complaints of weight loss, early satiety, bloating, and swelling and tenderness in his upper thighs. Endoscopy with biopsy revealed invasive, poorly differentiated gastric adenocarcinoma. Biopsy of one of the thigh masses displayed the same findings. The patient initially responded well to an investigational protocol with high-dose 5-fluorouracil, with regression of the thigh masses and palliation of his pain.
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PMID:Gastric adenocarcinoma presenting with soft tissue masses. 229 68

Endoscopic surveillance is recommended for patients with Barrett's esophagus to detect high-grade dysplasia (HGD) or cancer. We studied the outcome of esophagectomy in a cohort of patients who developed HGD or cancer between 1995 and 2003 while under surveillance for Barrett's. Outcomes were measured by analysis of clinical records, symptom questionnaire, and SF-36 (version 2). In 34 patients, mean surveillance time was 48 months (range, 4-132); the mean number of endoscopies was 10 (range, 3-30). Preoperative diagnosis was HGD in 9 patients (26.5%), carcinoma in situ in 16 (47%), and adenocarcinoma in 9 (26.5%). There was no esophagectomy-related mortality; 10 patients (29%) had complications. At mean follow-up of 46 months (range, 13-108), SF-36 (version 2) results showed quality of life scores equal to or better than those of healthy individuals. Incidence and severity scores (VAS 1-10) for postoperative symptoms were reflux, 59% (2.8); dysphagia, 28% (3.7); bloating, 45% (2.6); nausea, 28% (2.1); and diarrhea, 55% (2.5). Twenty-nine patients (85%) have no clinical, radiographic, or endoscopic evidence of recurrent esophageal cancer or metastasis. One patient has metastatic disease. Endoscopic surveillance in Barrett's patients yields malignant lesions at an early, generally curable, stage. Esophagectomy is curative in the great majority and can be accomplished with minimal mortality and excellent quality of life.
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PMID:Long-term outcome of esophagectomy for high-grade dysplasia or cancer found during surveillance for Barrett's esophagus. 1650 78

Small cell carcinoma (SCC) of the female genital tract is rare, constituting less than 2% of all gynecologic malignancies. It occurs most frequently in the cervix but can also occur in the endometrium, ovary, fallopian tube, vagina, and vulva. SCC of the genital tract is microscopically indistinguishable from that of the lung. Neuroendocrine differentiation is often manifested by a histologic growth pattern, argyrophilia, ultrastructural demonstration of secretory granules, and expression of neuroendocrine markers. Patients with SCC of the female genital tract may be asymptomatic but usually present with localized pain, vaginal bleeding, abdominal bloating or a mass, or symptoms of metastasis disease to the liver, bone, lung, or regional lymph nodes. Ectopic Cushing's syndrome has been reported in SCC of the vagina, and hypercalcemia and inappropriate secretion of antidiuretic hormone have been noted with SCC of the ovary. In general, these tumors have an aggressive clinical course with a propensity for extensive local invasion and distant metastases. Therapy has included surgery, radiation, and chemotherapy akin to those regimens used for SCC of the lung. Although there are no randomized clinical trials, it appears that multimodality therapy is associated with the best results and is the treatment of choice for most patients. Despite aggressive therapy, however, the prognosis for SCC of the female genital tract is poor, with only a minority of patients enjoying a prolonged survival. Indeed, the majority of patients have an early demise with extensive distant disease. We review the clinical features, evaluation, and management of SCC of the female genital tract based on a comprehensive review of the literature.
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PMID:Small cell carcinoma of the female genital tract. 1727 Jun 67

A case of synchronous adrenocortical carcinoma (ACC) and renal cell carcinoma (RCC) has not yet been described in the English medical literature, to our knowledge. We report a first such case of adrenocortical and renal cell carcinomas occurring simultaneously in a 53-year-old male. He presented with history of vague abdominal pain. Ultrasound followed by a computed tomography (CT) scan and a magnetic resonance imaging (MRI) examination revealed a 6.4 cm left adrenal mass and a 3.5 cm right renal mass. The patient had complaints of gastroparesis manifesting with constant nausea as well as intermittent abdominal bloating and abdominal pain. He also had history of profuse intermittent sweating. There was no history of palpitations or fluctuations in blood pressure. The patient's urinary vanillylmandelic acid (VMA) levels and serum cortisol levels were normal. His 24-hour urine metanephrine levels were slightly elevated. Left adrenalectomy and right partial nephrectomy were performed. In this case, it is important to determine whether these tumors represent metastases or two synchronous tumors, as this has implications on the patient's management and prognosis. Clinical and pathological clues that led to the diagnosis are discussed in detail.
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PMID:Synchronous renal cell carcinoma and adrenocortical carcinoma: a rare case report and clinicopathologic approach. 1840 53

Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Family physicians can manage many nonmalignant adnexal masses; however, prepubescent girls and postmenopausal women with an adnexal mass should be referred to a gynecologist or gynecologic oncologist for further treatment. All women, regardless of menopausal status, should be referred if they have evidence of metastatic disease, ascites, a complex mass, an adnexal mass greater than 10 cm, or any mass that persists longer than 12 weeks.
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PMID:Diagnosis and management of adnexal masses. 1983 43

A 53-year-old man was evaluated for a chief complaint of abdominal bloating. Physical examination revealed an abdominal distention and ascites, and CT showed multiple large retroperitoneal masses. The patient was diagnosed with retroperitoneal liposarcoma. Surgery was performed including the tumor, small bowel, and sigmoid resection, and an artificial anus was constructed. Multiple tumors in the peritoneum were noted. Large dark red tumors that were hemorrhagic were resected, but the yellowish tumors were unresectable. On histopathology, the dark red lesions showed dedifferentiated liposarcoma, and the yellowish lesions showed well-differentiated liposarcoma. One month postoperatively, peritoneal dissemination increased including nodular infiltration of the artificial anus and multiple hepatic metastases. Despite VAC chemotherapy (VCR 1.5 mg, ACD 0.5 mg, CPA 900 mg), progressive disease (PD) was noted. As second-line chemotherapy, weekly IFM (2 g)+CDDP (30 mg) was given. Shrinkage of the tumor infiltrates in the artificial anus, decreased abdominal bloating, and improved QOL were observed. A partial response (PR) against peritoneal dissemination was achieved. However, hepatic metastases increased, and the patient died 6 months after surgery. This case suggests that IFM+CDDP may be useful in dedifferentiated liposarcoma.
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PMID:[A case of retroperitoneal dedifferentiated liposarcoma successfully treated with IFM and CDDP]. 2003 41

We report a case of advanced rectal cancer with bladder carcinoma. The patient was a 81-year-old man who complained of abdominal bloating. A colonoscopy showed that he had advanced lower rectal cancer. CT scan revealed many lymph node metastases around the tumor, and also a bladder tumor. He experienced myocardial infarction during the operation but was relieved by PCI. During the operation, sigmoid colostomy was performed. The curative operation was declined and chemotherapy was selected. Capecitabine(2, 000mg/m / 2, biweekly)plus oxaliplatin(130mg/m2, day 1)was selected. At first, he complained of peripheral vein pain. The speed of oxaliplatin infusion was slowed and the pain was relieved. He had Grade 3 platelet decrease, but the number improved after 3 weeks. The tumor marker decreased after 3 courses, 6 courses after CT scan revealed that the tumor and lymph node metastases had evidently decreased. Capecitabine plus oxaliplatin(XELOX)was considered to be a useful chemotherapy against advanced rectal cancer, even for older patients or high risk groups.
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PMID:[A case of advanced rectal cancer with bladder carcinoma salvaged from myocardial infarction during operation, showing tumor regression by XELOX treatment, good quality of life]. 2330 31

Cancer Antigen 125 (CA125) and Human Epididymis Protein 4 (HE4) are the most studied ovarian tumor markers. Their diagnostic performance for identification of ovarian cancer are superior to CA19-9, CA72-4, and carcinoembryonic antigen, which are no more recommended for the diagnosis of presumed benign ovarian tumor. HE4 (>140 pmol/L) is superior to CA125 (>30 U/mL) in terms of specificity and positive likelihood ratio. CA125 and HE4 can be combined into an algorithm ROMA, or associated to clinical information (composite index), biological data (OVA1) or imaging (Risk for Malignancy Index (RMI), LR2). ROMA algorithm is an exponential equation combining plasmatic concentrations of HE4 and CA125. ROMA is more sensitive and less specific than HE4 in predicting epithelial ovarian cancer. ROMA is more accurate in post-menopausal women. The performance of ROMA is lower than the ultrasound model LR2 in differentiating malignant from benign ovarian tumors, whatever the hormonal status. The composite index combining CA125 with a symptoms index (pain, abdominal distension, bloating, difficulty eating) has a good sensitivity in a screening program, but because of a 12% false positive rate, ultrasound is required before management. The RMI algorithm is based on serum CA125, ultrasound findings (septation, solid zones, metastases, ascite, bilaterality) and menopausal status. RMI is less sensitive, but more specific than ROMA or OVA1 for the classification of ovarian masses. The addition of HE4 to RMI seems to be the most accurate. The subjective evaluation of ovarian cysts by sonography and color Doppler is better than ROMA and RMI algorithms, and not affected by the hormonal status.
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PMID:[Ovarian tumor markers of presumed benign ovarian tumors]. 2421 Feb 43

A 72-year-old woman was admitted for investigation of lower abdominal bloating and melena. She was diagnosed with rectal cancer with ascites, multiple liver metastases, and large bilateral ovarian metastases. The patient underwent bilateral oophorectomy for the ovarian tumors and a Hartmann procedure for rectal cancer. The ovarian lesions were diagnosed as ovarian metastasis of colorectal cancer by histological analysis. Ascites and lower abdominal bloating resolved after the intervention. At 11 months after surgery, the patient is alive and well. Ovarian metastasis from colorectal cancer is relatively rare and associated with poor prognosis. Radical intervention is generally not possible in the presence of metastases, but in the present case, the ovarian tumors were large. It is often difficult to determine the optimal type of invasive surgery, although excision of the lesion may provide palliative relief. In this case, the patient's quality of life improved following palliative resection of the primary colon cancer and ovarian metastases.
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PMID:[A case of palliative resection resulting in improvement in quality of life in a patient with colon cancer and simultaneous ovarian metastasis]. 2573 38

A 55-year-old male presented with upper abdominal bloating followed by modest hematemesis that led to the diagnosis of an ulcerated poorly differentiated (with signet ring cells) adenocarcinoma in the angularis of the stomach. A contrast-enhanced positron emission tomography (PET) with computed tomography (CT) scan showed higher-than-normal physiologic avidity (standardized uptake value, 4.3) in the proximal stomach but not in the lower stomach, and the CT scan vaguely suggested a polypoid lesion in the distal stomach. Nodes were normal in size, and there were no metastases. He underwent esophagoduodenoscopy with ultrasonography (EUS) that showed a 3- x 2-cm flat nodular mass with an 8-mm ulcer in the angularis. The tumor mass was demarcated well on narrow-band imaging, and with a 20-MHz EUS probe, it was designated eusT1bN0. His case was presented to our weekly Multidisciplinary Gastric Adenocarcinoma Conference, and the consensus was to offer surgery as primary therapy. He underwent a subtotal gastrectomy with Roux-en-Y gastrojejunostomy along with D2 nodal dissection. The surgical pathology showed a poorly differentiated adenocarcinoma with signet ring cells; the primary tumor measured 2.8 x 2.2 cm in diameter with infiltration through the muscularis propria and into the subserosal fat. Seven of 53 examined lymph nodes were malignant; therefore, his cancer was staged pT3N3M0 (a higher stage than designated clinically). He recovered well without complications, and the postoperative CT scans showed no metastases. His case was represented at the tumor board meeting, and adjuvant chemotherapy with oxaliplatin and capecitabine was recommended.
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PMID:Surgical Resection First for Localized Gastric Adenocarcinoma: Are There Adjuvant Options? 2632 61


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