Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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 23-year-old man was admitted with progressively disturbed vision and easy fatigability. CT scans demonstrated an enhanced mass in the sellar region. Physical and endocrinological examinations revealed atrophy of both optic nerves, temporal field cuts in both eyes, and panhypopituitarism. Concentrations of human chorionic gonadotropin (HCG) in the serum and cerebrospinal fluid were 12 and 33IU/L, respectively. On November 11, 1987, the tumor was partially removed using the transsphenoidal approach. The histological diagnosis was germinoma with syncytiotrophoblastic giant cells. Following postoperative craniospinal irradiation (whole brain, 30Gy; local, 18Gy; spinal canal 28Gy), CT scans showed no residual tumor and the HCG levels decreased until they were undetectable. Eighteen months later, the patient complained of abdominal pain. His serum HCG level had increased to 2,554 IU/L. CT scans of the abdomen revealed multiple low density areas in the liver. Chest X-ray was negative. A Ga scintigram disclosed only liver metastasis. Administration of a chemotherapy was started on June 26, 1989. Cisplatin and etoposide in doses of 20mg and 40mg respectively were given for 5 consecutive days in one course. Following four courses of the combined chemotherapy, the tumor entirely disappeared on CT scans and the HCG level returned to normal. The patient is now able to work well without evidence of recurrence. Multiple liver metastases of an intracranial germ cell tumor had been fatal in previous reports. This may be the first case with liver metastases in which the victim is still alive. The present case indicates that combined chemotherapy with cisplatin and etoposide is effective for extraneural metastases of an intracranial germ cell tumor.
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PMID:[Multiple liver metastases of a suprasellar germ cell tumor treated with combined chemotherapy of cisplatin and etoposide]. 189 Oct 59

Between 1968 and 1985, 28 patients with recurrent gestational trophoblastic disease (GTD) were treated at the Southeastern Regional Trophoblastic Disease Center. Sixteen patients received primary therapy at this center and had recurrence diagnosed by re-elevation of human chorionic gonadotropin (hCG) levels after three consecutive negative levels: five (2.5%) of 204 patients with nonmetastatic GTD, three (3.7%) of 81 with good prognosis metastatic disease, and eight (13%) of 61 with poor prognosis disease. The remaining 12 patients were referred for therapy after receiving primary therapy elsewhere. All episodes of recurrence were observed within 36 months of remission with 50% and 85% before 3 and 18 months, respectively. Fourteen (56%) of 25 patients who achieved secondary remission developed a second recurrence and five (45%) of 11 surviving a second recurrence developed one or more further episodes of recurrent GTD. Nineteen patients (68%) have sustained remission 18 months following therapy for recurrent GTD. Factors relating to development and survival of recurrent disease include: poor prognosis metastatic disease, inadequate initial staging and therapy, lack of adequate maintenance chemotherapy beyond the first negative hCG level, and prolonged intervals between cycles of chemotherapy. Recent regimens introduced have contributed to an increasing salvage rate: 15 of 18 patients treated since 1978 are without evidence of disease whereas only four of ten treated prior to 1978 are currently in remission (P = 0.03).
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PMID:Recurrent gestational trophoblastic disease. Experience of the Southeastern Regional Trophoblastic Disease Center. 216 50

Two cases of human chorionic gonadotropin (HCG)-producing lung carcinoma are reported. Both were male, aged 66 and 65, respectively histological examination of percutaneous lung biopsy revealed large cell carcinoma. The patients both developed bilateral gynecomastia during their clinical course. Endocrine function tests demonstrated high levels of HCG, HCG-beta, luteinizing hormone, estrone, estradiol, progesterone in the blood. They were given only anticancer chemotherapy with no effect and died. Autopsy revealed extensive metastases of lung cancer and the presence of HCG in tumor cells was demonstrated by immunohistochemical technique in both cases.
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PMID:[Two cases of human chorionic gonadotropin-producing large cell carcinoma of the lung accompanied with gynecomastia]. 217 Jul 32

Between 1961 and 1989 twenty testicular tumours were treated at the Basel University Children's Hospital. Ten were non germ cell tumours (50%) and a further 10 (50%) were germ cell tumours. Of the germ cell tumours six were benign teratomas, two yolk sac tumours and a further two were teratocarcinomas. In the non germ cell group eight tumours originated from paratesticular structures, one of which was a malignant rhabdomyosarcoma. The remaining two neoplasms originated from the supporting testicular tissues. The clinical presentation, the protocol of treatment and the long-term outcome are discussed. We advocate local tumour excision in benign cases (proven by instant frozen section) if normal testicular tissue can be preserved. In malignant germ cell tumours primary orchiectomy and high spermatic cord ligation is the treatment of choice. Secondary chemotherapy and/or retroperitoneal lymph node dissection is only added if the tumour markers alpha-fetoprotein and beta-human chorionic gonadotropin remain present in high serum levels postoperatively. Rhabdomyosarcomas are treated by surgical excision, primary chemotherapy and radiotherapy. All of the five patients (25%) suffering from malignant testicular tumours survived. A long-term follow-up (mean 12 years) did not show any evidence of recurrent local or metastatic disease.
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PMID:Testicular tumours in infancy and childhood--a review of 10 germ cell tumours and 10 non germ cell tumours. 217 92

Gestational trophoblastic tumor is a term applied to invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. The overall cure rate in the treatment of these gestational trophoblastic tumors now exceeds 90%. This high success rate is the result of (1) inherent sensitivity of trophoblastic tumors to chemotherapy, (2) ability to monitor therapy effectively with the use of human chorionic gonadotropin as a tumor marker, and (3) identification of prognostic factors which allows categorization of patients into high- and low-risk groups for selection of treatment. Virtually all patients with nonmetastatic and low-risk metastatic disease can be cured using single-agent methotrexate or Actinomycin-D chemotherapy. Intensive therapy with combination chemotherapy including etoposide, high-dose methotrexate and Actinomycin D and, where indicated, adjuvant radiotherapy and surgery has resulted in cure rates of 80-90% in patients with high-risk metastatic disease. The factors which are most important in determining response to treatment are: (1) clinicopathologic diagnosis of choriocarcinoma, (2) metastases to sites other than the lung or vagina, (3) number of metastases, (4) previous failed chemotherapy, and (5) WHO score greater than or equal to 8.
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PMID:Gestational trophoblastic tumors. 217 31

Biopsies from 64 patients with transitional cell carcinoma of the bladder (World Health Organization grade 3 and undifferentiated) were studied with deoxyribonucleic acid flow cytometry of fresh tissue and immunohistochemical staining on the histopathological slides for the presence of neuron specific enolase and human chorionic gonadotropin. No correlation was found among the presence of neuron specific enolase or human chorionic gonadotropin and T category, deoxyribonucleic acid ploidy, percentage of cells in the S phase, presence of metastatic disease or response to therapy. The prognosis for patients with muscle invasive disease and tumors positive for neuron specific enolase or human chorionic gonadotropin was similar to that for patients with tumors negative for these substances. When a possible new marker or prognostic factor is evaluated, it is important to investigate whether the new marker adds information on prognosis to what already is known by established standard methods. Further studies are needed to evaluate the clinical importance of human chorionic gonadotropin (and neuron specific enolase) as a marker in urothelial cancer with regard to prognosis and response to therapy.
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PMID:Human chorionic gonadotropin, neuron specific enolase and deoxyribonucleic acid flow cytometry in patients with high grade bladder carcinoma. 231 95

Forty consecutive patients with far-advanced germinal testis tumors (lymph node metastases greater than 10 cm, pulmonary nodules greater than 5 cm, extrapulmonary spread, alpha-fetoprotein greater than 1000 ng/ml, human chorionic gonadotropin greater than 50,000 mIU/ml) were treated with five courses of cisplatin, etoposide, and bleomycin (PEB). Twenty-five patients underwent surgery for the removal of residual masses after the first three inductions. Fibrotic-necrotic tissue was resected in 11 cases, 12 had mature teratoma, and residual cancer was found in 2. After the combined-modality treatment, 37 patients (82.5%) entered complete remission (CR): 25 (62.5%) with PEB and 12 (30%) with PEB and complete removal of the residual tumor. One patient progressed on therapy, and two others had incomplete resection of the residual disease. Hematologic toxicity was moderate and gastrointestinal toxicity was very mild. After a median follow-up period of 24 months (range, 13-40), 33 patients (82.5%) remain continuously disease-free, and 4 experienced relapse. Only one of these was salvaged with further surgery and chemotherapy. First-line PEB therapy combined with early resection of residual tumor induced a very high continuous CR rate in patients with far-advanced germinal testis cancer, and toxicity was moderate.
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PMID:Cisplatin, etoposide, bleomycin first-line therapy and early resection of residual tumor in far-advanced germinal testis cancer. 241 83

Forty-five nonseminomatous germ cell carcinomas of the testis were evaluated retrospectively to define the biologic features associated with the occurrence of metastatic disease. A statistical analysis of several pertinent clinical and pathologic factors was performed. The factors evaluated included: duration of symptoms before diagnosis, serum level of alpha-fetoprotein, serum or urinary level of human chorionic gonadotropin, testicular weight, extent of local tumor (pathologic T stage), and vascular invasion at the primary site. In each case, metastases were documented by a retroperitoneal node dissection, other biopsies, or by chest films. In 29 tumors with vascular invasion, 25 patients were seen with metastatic disease. In 16 tumors without vascular invasion, 3 patients demonstrated metastasis. The presence or absence of vascular invasion was strongly correlated with concomitant lymph node involvement or subsequent appearance of other metastatic disease (chi-square = 17.19). Additionally, vascular invasion in bifactoral++ analysis with tumor size and pathologic T stage proved a significant prognosticator even in low-staged (chi-square = 8.48) and small tumors (chi-square = 8.13). The implications of these findings, both as an adjunct to the staging of nonseminomatous germ cell tumors and in the management of clinical Stage I lesions, are discussed.
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PMID:Vascular invasion as a prognosticator of metastatic disease in nonseminomatous germ cell tumors of the testis. Importance in "surveillance only" protocols. 241 88

Cisplatin, vinblastine and bleomycin (PVB) is very effective therapy in disseminated testicular cancer, but toxicity is severe. A further reduction of vinblastine might reduce the acute toxicity of PVB without compromising the response rate in good-risk patients. Starting in March 1982, 42 consecutive patients with minimal or intermediate advanced disease (lymph node metastases less than 10 cm, lung nodules less than 5 cm) began a 0.2-mg/kg vinblastine PVB regimen, provided that serum alpha-fetoprotein (AFP) levels were not greater than 1000 ng/ml and human chorionic gonadotropin (HCG) values were not greater than 50,000 mIU/ml. Only 9 patients (21.4%) had leukocyte counts less than 1000/mm3, 6 (14%) had infections, but none had documented sepsis. Gastrointestinal and neuromuscular toxicities were mild. Of the 42 patients, 41 (97.6%) entered complete remission (CR), 8 with surgery. After a median follow-up period of 26 months (range, 19-40 months), 35 patients (83.3%) are continuously disease-free. Of the 6 patients with AFP levels greater than 400 ng/ml and/or HCG values greater than 1000 mIU/ml, only 2 (33.3%) entered continuous CR, versus 33 (91.6%) of the 36 patients with normal or less elevated markers (P less than 0.01). PVB with a 0.2-mg/kg vinblastine dosage is very effective and well-tolerated therapy in selected good-risk patients with disseminated germinal testis cancer.
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PMID:Successful treatment of good-risk disseminated testicular cancer with cisplatin, bleomycin, and reduced-dose vinblastine. 242 65

A case is reported of primary gastric choriocarcinoma occurring in a 73-year-old man, associated with a high serum level of beta hCG. Both primary and lymph node metastases contained exclusively cyto and syncytiotrophoblastic elements. Immunohistochemical localization of chorionic gonadotropin (hCG), placental lactogen (hPL) and pregnancy-specific glycoprotein (SP 1) is described in relation to cytotrophoblastic differentiation. An intramucosal focus of adenocarcinoma supports the hypothesis of the origin of choriocarcinoma from usual gastric cancer.
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PMID:Gastric choriocarcinoma; an immunohistochemical study. 242 92


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