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

Leiomyosarcomas are uncommon tumors. They have a predilection for deep soft tissues, with a rare group arising in medium-sized or large veins, far less frequently in arteries. We report a case of a 63-year-old man, with an enlarging mass located in the left pulmonary hilar region which was discovered on a routine chest radiograph. Cytology of the sputum and bronchoscopic biopsies did not reveal any malignant cells. Over 5 months observation, there was a clear progression of the mass, and the patient finally underwent a left pneumonectomy which allowed the diagnosis of an intravascular leiomyosarcoma partially destroying major arteries and veins in the hilar region. A review of the literature reveals 67 cases of leiomyosarcoma involving the pulmonary artery. None of these cases had an associated venous pathology. The disease is found mainly in adult women. Clinical diagnosis is very difficult because most of the cases have no specific clinical signs; the major differential diagnosis is that of pulmonary thrombo-embolism. Prognosis depends on histological degree of the tumor and extent of the disease, metastases occur mainly in the liver, lung, and brain and less frequently in regional lymph nodes. Treatment is always surgical, chemotherapy is ineffective and the effectiveness of radiotherapy depends on the total dose of irradiation. Sarcomas of hilar blood vessels have a very poor prognosis with a one year survival estimated, from the onset of symptoms, at 20%.
Thorac Cardiovasc Surg 1992 Feb
PMID:Leiomyosarcoma of the pulmonary hilar vessels. 163 67

Thirty-three bronchial carcinoid tumours operated on in a 22-year period are reviewed. They were histologically verified as typical carcinoids with Grimelius' argryophilic staining (25 cases), electron microscopy (6) and immunostaining for synaptophysin (4). Nineteen were endobronchial and 14 peripheral, intraparenchymal tumours. Lymph-node metastases were present at operation in two patients. Two tumours, in patients with Cushing's syndrome, were hormonally active (one secreting ACTH and the other ACTH and calcitonin). There was one case of multiple endocrine neoplasia syndrome, but none of carcinoid syndrome. During follow-up for 5-18 (mean 8.2) years five patients died of unrelated causes. Only one patient showed distant metastasis (after 15 years in salivary gland and a year later in mediastinal fat). Extensive clinical re-examination was performed on 20 patients, and six others were interviewed. All were well but one, who died of uterine cancer 8 weeks later. Typical bronchial carcinoid is concluded to be of low-grade malignancy and suitable for limited pulmonary resection.
Scand J Thorac Cardiovasc Surg 1991
PMID:Bronchial carcinoid: a clinical follow-up study of 33 cases. 166 42

Thoracic computed tomography (CT) is an essential component in the preoperative staging of bronchial carcinomas as is mediastinoscopy (MSC) in cases of mediastinal lymphoma. It is known that endoscopic ultrasonography (EUS), as a new diagnostic procedure, can predict lymph-node involvement in cases of tumors in the upper gastrointestinal tract with an 80% probability. In a prospective study, we examined whether EUS could be used to ascertain the presence of mediastinal lymph nodes in cases of bronchial carcinoma. Since 1990, therefore, 32 patients with operable non-small-cell bronchial carcinoma have been examined with an Olympus-Aloka EU-M2 or EU-M3 (frequency 7.5 and 12 MHz) in addition to routine diagnostics. The graded cross-sections of lymph-node dissections obtained during subsequent surgery served as evidence as to the true or false prognosis of the lymph-node status. Endoscopic ultrasonography identifies the presence and estimates the size of subcarinal, tracheobronchial, paraortal and paraesophageal lymph nodes better than computed tomography. Lymph nodes lying behind organs containing air (pretracheal lymph nodes) cannot be identified by ultrasonography. Lymph-node involvement was correctly identified by EUS in 72% of the cases, and the specificity was 86%. The poor sensitivity, at 67%, is explained by the high proportion (37%) of patients with anthracosilicosis, as the latter produces the same echo pattern as malignant infiltration. In 47% of all the cases, CT showed enlarged mediastinal lymph nodes which were not actually infiltrated in 67%. Of these lymph nodes, 33% could be classified as definitely free of metastases on the strength of their echo pattern, the rest were inflamed or really infiltrated by metastases.(ABSTRACT TRUNCATED AT 250 WORDS)
Thorac Cardiovasc Surg 1991 Oct
PMID:Endoscopic ultrasonography of the mediastinum in the diagnosis of bronchial carcinoma. 166 46

Hepatic arterial embolization has been shown to be a safe and effective method for the palliation of symptoms in patients with metastatic disease, particularly those with secondary deposits from endocrine tumors. This review examines the indications for the procedure, discusses some aspects of technique, and assesses the potential benefits and complications of the method.
Cardiovasc Intervent Radiol
PMID:Arterial embolization in the management of liver metastases. 169 61

Tumor involvement of the carotid artery with head and neck cancers may be present either simultaneously with the primary lesion or more often appears at a later date following resection of the primary tumor. Management of the secondary tumor consists of its resection together with the involved carotid artery with or without carotid artery reconstruction. The Authors are convinced that the best chance for cure of patients with advanced head and neck squamous cell cancers involving the carotid artery is radical extirpation with ablative surgery in the form of en block resection of the primary lesion, the secondary tumor, and the involved carotid artery followed by immediate revascularization. This bold approach was carried out in two male patients, 48 and 61 years of age, followed by chemotherapy and radiation therapy in one and radiation therapy alone in the other, with excellent results. Dermal grafts were placed over the entire length of the arterialized veins to protect them from radiation injury. Based on this limited experience and excellent results, we recommend this one-stage surgical ablative procedure in well selected patients. However, cooperation between the ENT and vascular surgeons, strict adherence to the principles and techniques of vascular surgery, and coverage of the arterialized vein with a dermal graft is absolutely essential.
J Cardiovasc Surg (Torino)
PMID:Carotid artery resection and replacement in patients with head and neck malignant tumors. 170 93

One of the rare cases in which metastases of a carcinoid tumor infiltrate the aortic wall is reported. Cross-clamping the descending aorta and en-bloc resection of the tumor and the descending aorta were possible. The postoperative course was uneventful.
Thorac Cardiovasc Surg 1991 Oct
PMID:Carcinoid tumor invading the thoracic aorta: en-bloc resection. 178 20

From 1976 to 1989, 166 patients were operated on for primary adenocarcinoma of the lung. For better comparison, all the tumors were categorized retrospectively according to the TNM system of the UICC 4th edition of 1987. One hundred and thirty-eight patients could be potentially curatively operated. The average survival time following incomplete resection was 5 months and after potentially curative resection it was 65 months for stage I, 22 months for stage II and 6.5 months for stage IIIa. The 5-year survival rate was 53.7% for stage I, 18.5% for II and 0% for IIIa. The differences between the tumor stages are statistically significant. At the time of writing a large number of the patients have already died due to either recurrence of the tumor or, as in most cases, secondary metastases distant from the primary growth CI: 32%, II: 66%, IIIa: 79%). Comparison of the results of potentially curative operations in patients with adenocarcinoma and those with squamous cell carcinoma show a better prognosis in the equivalent stages for cases of squamous cell carcinoma. In seven cases there was the situation of ipsilateral pulmonary metastasis which could be subjected to potentially curative resection together with the primary tumor (5 bronchioloalveolar, 2 other adenocarcinomas). The prognosis of these patients was just as good, following resection, as for cases of T2N0 tumors without such metastases.
Thorac Cardiovasc Surg 1991 Dec
PMID:Adenocarcinoma of the lung: a contribution on prognosis after potentially curative resection. 178 43

A series of 61 consecutive procedures of chest wall resection and reconstruction in 58 patients during the period between August, 1986 and December, 1990 is reported. The ages ranged between 6-77 years. The chest wall resection was indicated for malignant affections in 54 cases. Among these, there were 24 patients with bronchial carcinoma invading the chest wall, 17 patients with primary or metastatic sarcoma, 11 patients with recurrent breast cancer and 3 with cancer metastases of varying origin. Pulmonary resection included pneumonectomy in 8 cases, lobectomy in 19, segmental and wedge resections in 26. In the majority of resections, the reconstruction was accomplished without implants. In cases with full thickness removal of the chest wall, the plane of the rib cage and/or the sternum was reconstructed using Vicryl mesh (n = 7), PTFE soft tissue patch (n = 11), marlex-mesh (n = 1), or methyl-methacrylate (n = 3). There was one case of hospital mortality, 6 weeks postoperatively, due to neurological failure from an independent preoperatively undiagnosed brain tumor. There were 4 reoperations: one early and one late (4 months) infection, one case of limited superficial necrosis of a flap and one with chronic lymphous drainage from a large myocutaneous flap. In no instance was primary postoperative ventilation therapy necessary. Mechanical ventilation was instituted only on day 8 in the patient who accounts for the mortality in this series. In the presence of primary infection, the greater omentum was used for the restoration of the integument.
Thorac Cardiovasc Surg 1991 Dec
PMID:Reconstruction of chest wall defects. 180 37

Combined modality treatment with chemotherapy and radiation produces tumor regression in most patients with small-cell lung cancer, but the impact on survival has been small, and less than 20% of patients with limited disease survive 2 years. Survival time is extremely short after failure to respond or relapse after treatment. Local control remains a problem, with one third of patients having recurrence only at the primary site. In an attempt to prolong survival and perhaps achieve cure, we undertook surgical resection in 28 patients with limited small-cell lung cancer who did not have complete remission with standard treatment or who had only local recurrence after treatment. There were 28 patients, 22 male and six female, median age 61 years (range 41 to 76). All patients had been treated with chemotherapy and 13 had received preoperative radiotherapy to the primary site and mediastinum. Eight patients underwent an operation for relapse after complete remission. Five patients had had no response to treatment, three had had a slight response followed by progression during chemotherapy, and 12 had achieved partial response but had greater than 3 cm residual masses. Twelve patients required pneumonectomy, 15 lobectomy, one patient had unresectable disease, and two had bulky residual masses after the operation. Three others had microscopic residual disease. Pathologic examination showed only small-cell lung cancer in 18 patients, mixed small-cell and non-small-cell in four, and only non-small-cell lung cancer in six. There were only four patients with stage I disease, 10 with stage II, and 14 with stage III. The median survival from the date of diagnosis for the entire group is 105 weeks and from the date of operation, 74 weeks. The projected 5-year survival rate is 23%. The two patients with residual masses died with local progression, and distant metastatic disease developed in 17 others. One patient died at 6 years without recurrent disease. Eight patients are alive 2 to 5 years after diagnosis. Seven of these patients required only a lobectomy, four had stage I disease, two had stage II, and two had stage III disease. Five had pure small-cell lung cancer and three had mixed small-cell and non-small-cell tumors. All of the patients with pathologic stage I disease remain alive compared with one of 10 with stage II disease and two of 14 with stage III. In summary, relapse or failure to respond to chemotherapy may be due to non-small-cell lung cancer or a mixed tumor.(ABSTRACT TRUNCATED AT 400 WORDS)
J Thorac Cardiovasc Surg 1991 Feb
PMID:Is there ever a role for salvage operations in limited small-cell lung cancer? 131 31

Eighty-three patients underwent pulmonary metastatectomy as part of a combined modality approach between 1. 1. 1972 and 31. 12. 1988 and 80 were followed up until 1. 1. 1990 or until death, with an average follow-up of 110 months. The estimated 5-, 10-, and 15-year survival rate was 38%, 32%, and 22% respectively. Recurrent pulmonary metastases were observed in 60% of the patients during follow-up with an estimated 24 months relapse-free survival rate of 50%. An additional 20% of the patients developed extrapulmonary recurrent tumor manifestation without evidence of pulmonary disease. One of five patients remained tumor free up to 207 months (an average of 87 months) after the initial pulmonary metastatectomy. A multivariate analysis identified completeness of tumor removal, the type of primary tumor, and a difference in histology between primary and metastatic neoplasm as three independent prognostic factors with significant impact on overall survival, the completeness of tumor removal being the most important one. Disease-free long-term survival for patients with pulmonary metastases treated by surgery and chemotherapy is related to completeness of tumor removal and the type of primary tumor.
Thorac Cardiovasc Surg 1991 Aug
PMID:Surgery and chemotherapy for pulmonary metastases: long-term results from a combined modality approach. 194 72


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