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)

Prostaglandins and serotonin are vasoactive compounds with profound effects on the gastrointestinal tract. Both cause inhibition of gastric acid secretion (although serotonin stimulates gastric pepsin secretion), stimulation of intestinal motility, and conversion of small intestinal mucosa from absorption to secretion of water and electrolytes. Their effects on pancreatic and biliary function are still not clear. Although prostaglandins appear to elicit their effects primarily by a paracrine mode of action, and serotonin is primarily a neurotransmitter (neurocrine), it is clear that even under normal conditions both can function as humoral agents. For example, we have shown that serotonin plays a physiologic role as a humoral inhibitor of gastric acid secretion. However, the effects of these agents become more pronounced in patients with humorally mediated diarrheogenic syndromes. Serotonin (and related indoles, particularly 5-hydroxytryptophan) has been firmly implicated as a cause of diarrhea in patients with carcinoid syndrome; our recent studies suggest that the diagnosis can be more effectively made by measuring circulating immunoreactive serotonin concentrations than urinary excretion of 5-HIAA; that some circulating serotonin escapes hepatic inactivation and, thus, large intestinal tumors can cause carcinoid syndrome in the absence of hepatic metastases; and that large amounts of serotonin are produced by some noncarcinoid diarrheogenic tumors, including medullary carcinomas of the thyroid and tumors associated with the WDHA syndrome. A large number of tumors of probable neural crest origin, including medullary thyroid carcinoma, carcinoids, and tumors associated with the WDHA syndrome, secrete large amounts of prostaglandins, particularly PGE2. The clinical response of at least some of the patients harboring these tumors to inhibitors of prostaglandin synthesis (particularly indomethacin) suggests that prostaglandins play a role in the etiology of these diarrheogenic syndromes.
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PMID:Prostaglandins and serotonin: nonpeptide diarrheogenic hormones. 39 Aug 99

A 48-year-old woman with severe carcinoid syndrome caused by multiple liver metastases was treated by hepatic dearterialization. After the operation, urinary 5-HIAA excretion fell transiently to normal levels and the patient was symptom-free for six months. After one year the symptoms of carcinoid syndrome had recurred and a re-dearterialization was performed. A favourable clinical effect was again achieved, but the relief of symptoms lasted only six months. The changes in urinary 5-HIAA excretion and SGOT, SGPT, bilirubin, alkaline phosphatase, cholesterol, PP activity as well as serum protein levels were uniform after both operations to an astonishing degree. Histological specimens taken at reoperation showed that the carcinoid metastases in the anterior parts of the liver were largely necrotic. The necrotic areas has peculiar features, e.g. the necrosis was partly incomplete and ghost like carcinoid structures could be seen.
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PMID:The effect of hepatic dearterialization and re-dearterialization on carcinoid liver metastases. 96 86

A patient with hepatic metastasis of an intestinal cancer tumor is presented. Six years previously the patient had been diagnosed of HTA secondary to pheochromocytoma of the left adrenal gland and surgery. The clinical findings are described and the results of scintigraphy with 123I-MIBG used for tumor detection are analyzed. The literature was revised and this unique presentation confirmed following the study and exclusion of a possible association with pluriglandular adenomatosis. Finally, following the poor results obtained with different therapeutic procedures in metastatic cancer tumors, the systematic, periodic determination of 5-HIAA, among other investigations, is suggested as a useful alternative in the early diagnosis and potential surgical treatment patients diagnosed of pheochromocytoma.
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PMID:[Adrenal pheochromocytoma and metastatic intestinal carcinoid tumor in the liver. A purely accidental association?]. 156 Jun 89

A 39 year old male patient was treated with daily 5 X 10(6) IU interferon alpha 2b s.c. for 22 months because of advanced carcinoid tumor. Objective response was achieved with greater than 50% reduction of 5-HIAA-excretion. Multiple metastases (liver, lung, bones, thyroid gland) were not progressing in size. An unintentional omission of treatment resulted in a rapid biochemical and morphological tumor progression. Reversibility was achieved with reinstitution of effective interferon therapy. Thus, interferon therapy of advanced carcinoid tumor is able to induce a long-term objective response. It seems to be superior to conventional chemotherapy.
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PMID:[2 year interferon therapy of metastatic carcinoid tumor]. 210 57

The increased knowledge of the pathobiology of gastrointestinal carcinoid (neuroendocrine) tumours and the improved therapeutic possibilities have brought a demand for more precise diagnosis. Although the carcinoid tumours can often be tentatively recognized in routinely processed microscopic slides, their more accurate identification requires additional diagnostic procedures. General neuroendocrine markers such as the argyrophil reaction of Grimelius and immunohistochemistry with application of antibodies against chromogranin A and of neuron-specific enolase are discriminatory staining methods which are used to reveal the neuroendocrine origin of almost all highly differentiated carcinoid tumours of the gastrointestinal tract. Mid-gut carcinoids, which predominate among these tumours almost unexceptionally contain serotonin. This biogenic amine can be demonstrated by the argentaffin reaction of Masson, serotonin immunoreactively or by formalin-induced fluorescence. The characteristic staining pattern of mid-gut carcinoids is almost invariably preserved in the metastatic deposits and consequently the staining methods for identifying serotonin can also be used on metastases to reveal a primary mid-gut carcinoid. The enterochromaffin-like (ECL) cell carcinoids of the body and fundic area of the stomach often seen in association with pernicious anaemia are argyrophil with the Sevier-Munger silver stain. Other neuroendocrine tumours, viz. antral, duodenal and rectal carcinoids should be studied by a battery of relevant peptide hormone antisera for adequate diagnosis. During the last decade new peptide hormones have been found in circulation in patients with carcinoid tumours, but serotonin and urinary 5-HIAA are still the most important markers for carcinoids of the mid-gut origin. Other clinically useful tumour markers are chromogranin A + B, pancreatic polypeptide, human chorionic gonadotropin alpha and beta subunits. For localizing procedures, angiography is the most reliable investigative method for primary tumours in the gut, whereas CT-scan and ultrasound investigations are good for detection of liver metastases. During the last five years, the therapy for malignant carcinoid tumours has been considerably improved. Chemotherapy has only revealed objective response rates in about 10-30% of the patients giving median survivals from start of therapy of about 10 months. Recently treatment with alpha interferons and the new somatostatin analogue octreotide have given objective responses in 50-75% of patients with malignant mid-gut carcinoid tumours. These patients have now a median survival from start of therapy of 70 months when treated with alpha interferons. In the future new therapies will come into use such as monoclonal antibodies and perhaps also agents blocking different growth factors.
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PMID:Gastrointestinal carcinoid tumours. Histogenetic, histochemical, immunohistochemical, clinical and therapeutic aspects. 266 60

A case of a 69 year old man in whom hypertrophic gastritis was associated with the carcinoid syndrome is reported. Concentrations of prostaglandin E2 were increased in plasma, gastric juice, gastric mucosa and urine. He had marked hypochlorhydria in response to pentagastrin stimulation (Peak acid output (PAO) pg:0.2 mmol/h). After successful hepatic arterial embolisation of the metastases (as indicated by an 85% decrease in 24 h urinary 5-HIAA) the concentrations of prostaglandin E2 decreased in the plasma, gastric juice and gastric mucosa. The gastric mucosal hypertrophy regressed and secretion of acid in response to pentagastrin returned (PAO pg:9.0 mmol/h). These findings suggest that the carcinoid tumour was producing a substance which stimulated increased local synthesis of prostaglandin E2 in the gastric mucosa, with concomitant gastric mucosal hypertrophy and inhibition of gastric acid secretion.
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PMID:Hypertrophic gastritis associated with increased gastric mucosal prostaglandin E2 concentrations in a patient with the carcinoid syndrome. 319 4

The simultaneous occurrence of carcinoma and carcinoid in the stomach is rare. Only 5 cases have been reported in the literature so far. Our patient developed double primary neoplasms adjoining the gastric antrum. One was an early ulcerated adenocarcinoma limited to the submucosa, the other a minute carcinoid also within the submucosa. A large amount of 5-HIAA, but a normal amount of histamine, was excreted in the urine. The carcinoid syndrome, however, was absent through clinical course. The patient died of liver metastasis 3.5 months after gastrectomy. Microscopic examination after autopsy disclosed that the metastases consisted of only carcinoid cells.
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PMID:[Adenocarcinoma adjoining to the gastric antrum and minute carcinoid--a case report]. 663 17

An autopsy case of a 67-year-old Japanese male is presented. He had been suffering from carcinoid syndrome for 5 years and showed a typical picture of carcinoid heart disease. In Japan, carcinoid heart disease is rare and we can find only four reported cases (33% of reported carcinoid syndrome). The patient had high urinary secretion of 5-HIAA and high serum serotonin, and finally he died of heart failure and bronchopneumonia. The primary site of this carcinoid tumor was of the bronchus of the right B10c , and it had large hepatic metastases. Electronmicroscopically, the tumor cells had secretory granules measuring 1500-3500 A in diameter. Immunohistochemically, the tumor cells were markedly positive for human chorionic gonadotropin (hCG) and antidiuretic hormone (ADH) and positive for serotonin, in both the primary site and hepatic metastases. Characteristic fibrous plaques were detected in the right atrium, tricuspid valve, right ventricle, and left atrium. Electron-microscopically, the fibrous plaques consisted of smooth muscle cells and myofibroblasts surrounded by basement membrane-like material. The abundant matrix of the fibrous plaques contained acid mucopolysaccharide, microfibrils and collagen fibers. The same fibrous plaques were also found in hepatic veins. Furthermore, retroperitoneal fibrosis was present, which showed proliferation of myofibroblasts, fibroblasts and immature mesenchymal cells.
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PMID:Cardiovascular lesion of carcinoid syndrome. An autopsy case of bronchial carcinoid. 673 Sep 65

Although patients with bronchial and ovarian carcinoid tumors can develop the carcinoid syndrome (diarrhea and/or flushing) in the absence of hepatic metastasis, it is believed that development of the carcinoid syndrome in patients with carcinoid tumors of gastrointestinal origin occurs only after the patient has hepatic metastasis. This is explained by hepatic inactivation of most of the serotonin in the portal circulation or by the fact that hepatic metastases are larger than the primary tumor in the gastrointestinal tract. Three patients with ileal and jejunal carcinoid tumors who developed the carcinoid syndrome without obvious hepatic metastasis are described. Two of the patients had intra-abdominal, but extrahepatic, metastasis that probably drained directly into the systemic circulation. The third patient had an ileal carcinoid with clinical involvement limited to adjacent mesenteric lymph nodes. Following resection of her tumor, her urinary 5-HIAA excretion and platelet serotonin level returned to normal, and her attacks of carcinoid flushing virtually ceased. She has occasional spells of "blushing" that are thought to be benign; however, further close follow-up study will be needed to be certain that she is free of disease. It is suggested that each patient with the carcinoid syndrome be evaluated with CT and technetium-99 pertechnetate liver scans. If there is no liver involvement detected with these studies, one should consider hepatic arteriogram or laparotomy to determine if the patient's tumor might be totally resectable.
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PMID:Carcinoid syndrome from gastrointestinal carcinoids without liver metastasis. 709 50

CT was performed on 80 patients referred for staging and treatment of histologically verified midgut carcinoid tumours. In 17 cases (21%) CT was normal in spite of biochemical signs of tumour (increased U-5-HIAA). The most common finding was liver metastases in 54/80 (68%) of patients. Mesenteric metastases, usually as a soft tissue mass at the mesenteric root, were found in 17/80 (21%). Retroperitoneal adenopathy was found in 19/80 (24%). During a follow-up time of 3 months to 10 years (median 3 years) 445 additional CT examinations were performed on 77 patients. In 39 of these, progressive disease (new lesions) was found after a median time of 15 months (range 3 months-6.5 years). CT is poor in detecting primary carcinoid tumours but helpful in evaluating the extent of tumour spread before surgical exploration and during follow-up once the diagnosis has been established.
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PMID:Midgut carcinoid tumours. CT appearance. 761 13


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