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

The very rapidly expanding knowledge and technologies of molecular biology are reviewed with special reference to problems in the clinical management of lung cancer. Genetic events, tumor-associated antigens, production of murine and human monoclonal antibodies, culture of cell lines, intratumoral phenotypic diversity and squamous-lung-cancer-associated antigens are discussed and related to possible therapeutical approaches. A monoclonal antibody with high specificity for squamous cell lung cancer reacted positively in blood samples and tissue extracts in about 80%. Its use as a marker during follow-up after surgical treatment is demonstrated by examples. It is concluded that there will be limiting factors in the therapeutic use of monoclonal antibodies, such as intratumoral phenotypic diversity. Genetic analysis might be a method for selecting a high risk group of individuals in whom exposure to carcinogenic factors, such as cigarette smoking, would be fatal. Murine monoclonal antibodies can be used in vitro for screening, for histological examination and for prognostic studies. Human monoclonal antibodies should be used for in vivo purposes as well as for the screening of primary tumor and metastases for the therapy. To achieve usable results, the monoclonal antibodies should be raised against the cell membranes that, in particular, are expressed on the stem cells of the neoplastic cell population.
Thorac Cardiovasc Surg 1986 Dec
PMID:On the advent and necessity of molecular biology in the clinical management of lung cancer. 243 92

A tumor embolism with occlusion of the left pulmonary artery was the first manifestation of a hypernephroma. After angiographic diagnosis, embolectomy was performed successfully using the heart-lung-machine. Four days later, nephrectomy followed. In the meantime, the patient has experienced a period of 3 years free of symptoms and metastases.
Thorac Cardiovasc Surg 1987 Feb
PMID:Successful treatment of tumor embolism of a hypernephroma with complete occlusion of the left pulmonary artery. 243 49

In cases of malignant disease of the chest wall, such as primary tumors or extensive metastases, a particularly large resection is necessary. This leads to great problems in restoring an adequately functional chest wall. In addition to the cosmetic effect one must pay particular consideration to the dynamic parameters of pulmonary function. In a 54 years old male suffering from recurrent malignant schwannoma we performed an extensive chest wall resection. It included the ribs 3-8 on the right. The extension of the defect was 15 X 22 cm. We reconstructed the pleura with Vicryl-mesh. The covering was done with musculus pectoralis major, musculus rectus abdominis and a musculocutaneous obliquus externus abdominis flap. Three months after operation a small restriction of vital capacity is observed. In a 29 years old male partial resection of the right chest wall had to be done for a local extended chondro-sarcoma. The tumor included the ribs 4-9: chest wall defect after resection amounted to 15 X 18 cm. We performed a primary reconstruction using Vicryl-mesh as substitute for the pleura. We covered the pleura with a musculocutaneous latissimus dorsi flap. Three months after successful reconstruction the parameters of pulmonary function reached normal values again. In these and further cases the combination of Vicryl-mesh as a resorbable substitute for the pleura and musculocutaneous flaps for the chest wall has been successful in restoring a good pulmonary function.
Thorac Cardiovasc Surg 1987 Apr
PMID:[Reconstruction of the chest wall]. 244 Jan 33

The value of computed tomography (CT) in predicting direct mediastinal infiltration of stage T4N0-1 lung carcinoma was evaluated prospectively in 11 patients with surgical and histological proof. Furthermore, its role in twelve non-operated patients was assessed retrospectively. The radiologic signs detected independently by two radiologists correlated in 90%. Mediastinal infiltration was verified in 7 of 11 patients (63%). Only in 3 out of the 12 patients treated non-surgically was CT the only criterium for inoperability. In all other patients additional findings, such as scintigraphy, radiologic or bioptic proof of distant metastases, supported inoperability. The limited specificity of CT (63%) demands aggressive staging procedures before any patient is excluded from surgery, the only potentially curative treatment.
Thorac Cardiovasc Surg 1987 Dec
PMID:Mediastinal infiltration of lung carcinoma (T4N0-1): the positive predictive value of computed tomography. 244 5

Palliative therapy for obstructing esophageal carcinoma is more often necessary than curative surgery. The neodymium:yttrium-aluminum-garnet laser was used for vaporization of obstructing esophageal carcinoma in 18 patients requiring 24 treatments. Three women and 15 men (age range 42 to 87 years) had esophageal carcinoma (seven squamous cell and nine adenocarcinoma). Twelve tumors were at the esophagogastric junction, four at the midesophagus, and two in the cervical esophagus. Lengths varied from 3 to 7 cm. Inoperability was due to diffuse metastases in eight patients, local invasion in five, poor operative risk in one patient, and patient refusal for operative treatment in four patients. Energy use was 1000 to 22,600 J per session (mean 6120 J). Good results were achieved in 16 patients (88.9%): Seven returned to full diet, five to soft diet, and four to full fluids without dysphagia. Four patients required retreatment 1 to 3 months later because of recurrent dysphagia. One patient was not benefited by the treatment and died of carcinomatosis 1 week later. No intraoperative complications occurred. Postoperatively, one patient had laryngeal edema and another had a bronchoesophageal fistula 3 weeks later. The mean survival time is 3 1/2 months. Neodymium:yttrium-aluminum-garnet laser vaporization for obstructing esophageal carcinoma is effective palliation regardless of histologic tumor type. It can be performed under direct vision with a low frequency of postoperative complications.
J Thorac Cardiovasc Surg 1989 Jul
PMID:Neodymium:yttrium-aluminum-garnet laser vaporization for palliation of obstructing esophageal carcinoma. 247 31

Nine patients with renal cell carcinoma and severe hematuria were palliatively treated with a new type of angioocclusion: the concept of capillary embolization. The so-called occlusion gel Ethibloc was used as embolizing agent. Each patient was followed up until death or for at least 4 years. All patients had a stage T3 or T4 tumor, 3 patients had metastases to multiple organs, 3 had lung metastases, and 3 were free of metastatic disease. In all cases, very high volumes (14-40 ml) of the embolizing agent were necessary to achieve total occlusion of the entire arterial compartment. Patients without metastatic disease had a mean survival time of 6 years and 4 months, all of them without signs of malignant disease. Patients with metastases had a mean survival time of 3 years. Compared with the natural history of renal cell carcinoma treated otherwise, this represents a substantial prolongation of survival time. Contrary to other angioocclusive treatment modalities, the concept of capillary occlusion with Ethibloc seems to achieve total tumor destruction.
Cardiovasc Intervent Radiol
PMID:Prolonged survival following palliative renal tumor embolization by capillary occlusion. 249 23

Mesenteric ischemia associated with carcinoid tumors often presents with nonspecific abdominal pain and is usually due to mesenteric branch artery occlusion caused by elastic vascular sclerosis. Mesenteric ischemia was defined by the operative findings of cyanosis or infarction. Eleven patients with intraabdominal metastatic carcinoid tumor were evaluated by angiography. Angiographic narrowing and occlusion of multiple peripheral jejunal and ileal intramesenteric branch arteries was present in 3 patients with mesenteric ischemia, but also occurred in 5 of 8 patients without mesenteric ischemia. Other angiographic abnormalities included staining of the primary tumor (5) or metastases (6), tenting of small mesenteric vessels (5), and occlusion of draining mesenteric veins (2). We conclude that in patients with midgut carcinoid tumors, angiographic narrowing and occlusion of peripheral mesenteric arteries most likely represents elastic vascular sclerosis, is indicative of mesenteric invasion of tumor, but correlates poorly with the presence of ischemia in the subtended bowel. Alternatively, a normal selective arteriogram should exclude mesenteric ischemia as the cause of abnormal pain.
Cardiovasc Intervent Radiol
PMID:Limitations of angiography for mesenteric ischemia caused by midgut carcinoid tumors. 250 47

One hundred forty-six cases of pulmonary neuroendocrine tumors are assessed according to the classification of Gould and associates and are evaluated for their clinical presentation and subsequent clinical course. Bronchial carcinoids are characteristically found to be central tumors often occurring in comparatively young patients; surgical resection with minimal but clear margins is usually curative. The long-term prognosis is excellent in the majority of patients, although rarely regional nodal and distant metastases develop. Well-differentiated neuroendocrine carcinomas are most frequently peripheral tumors. In stage I and II disease, surgical resection alone is curative and patients with locally advanced tumors may have a prolonged disease-free interval. The overall prognosis is less favorable than that of bronchial carcinoids but considerably better than that of small cell neuroendocrine carcinomas, with which they are still at times confused. Intermediate-sized cell neuroendocrine carcinomas are often wrongly categorized as large cell undifferentiated carcinoma. They have a distinctly aggressive clinical course comparable with that of small cell neuroendocrine carcinoma and should be treated similarly. Small cell neuroendocrine carcinomas are aggressive, rapidly disseminating neoplasms. Even in clinical stage I tumors, patients must be considered to have disseminated metastases. The role of surgical therapy in these two latter tumor types is adjuvant to aggressive systemic chemotherapy.
J Thorac Cardiovasc Surg 1989 Sep
PMID:Neuroendocrine neoplasms of the lung. A clinicopathologic update. 217 Jul 73

Eighty-one primary pulmonary neuroendocrine neoplasms were assessed by the classification of Gould and associates. The neuroendocrine features of these tumors were studied by a combination of conventional light microscopy, electron microscopy, and immunohistochemical staining for hormonal substances and neuron-specific enolase. In each case, clinical follow-up was obtained to test the prognostic value of this new pathological classification. This study indicated that bronchial carcinoids are very low-grade neuroendocrine neoplasms that are locally invasive and only occasionally metastasize late in their course. Well-differentiated neuroendocrine carcinomas are relatively low-grade carcinomas that either present with or subsequently develop nodal or distant metastases in 73% of patients. Intermediate cell neuroendocrine carcinomas are highly aggressive tumors often mistakenly called "large cell undifferentiated carcinoma." Their clinical course is comparable to that of small cell neuroendocrine carcinomas, which has a mean survival of 9 months. The different clinical courses of these tumors demonstrate the predictive value of the proposed classification. It appears particularly valuable to identify well-differentiated neuroendocrine carcinoma as a low-grade carcinoma, distinct from true bronchial carcinoids. This classification may resolve some discrepancies regarding the therapy for and prognosis of "carcinoids" and their presumed variants.
J Thorac Cardiovasc Surg 1985 Jun
PMID:Neuroendocrine neoplasms of the bronchopulmonary tract. A classification of the spectrum of carcinoid to small cell carcinoma and intervening variants. 258 9

A case report on a 27 year old woman with an inoperable angiosarcoma of the right atrium is presented. The tumor localization was established by echocardiography, computed tomography and cinecardiography. There was no evidence of distant metastases at diagnosis. After exploratory thoracotomy with surgical biopsy a radiotherapy was started covering the whole heart and the mediastinum. Superior Vena Cava Syndrome was improved quickly and reducing the target volume to the right atrium after 40 Gy radiotherapy was continued up to a total dose of 60 Gy. A complete remission was documented by echocardiography and computed tomography. Chemotherapy ("VAPAC") for distant metastases led to partial remission. The patient died 15 months after diagnosis from brain metastases. Autopsy revealed no macroscopic evidence of tumor in the right atrium. A combined modality approach with surgical tumor mass reduction followed by high dose locoregional radiotherapy (60 Gy) and combination chemotherapy (e.g. "VAPAC") is suggested.
Thorac Cardiovasc Surg 1989 Dec
PMID:Primary angiosarcoma of the heart. 261 5


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