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)

To assess the biological significance of human chorionic gonadotropin (HCG) detection in large bowel carcinomas, we have studied immunohistochemically 50 colorectal carcinomas, 20 adenomas, 8 ulcerative colitis, and 10 normal colonic mucosae. The HCG-immunoreactive cells were found in 26 carcinomas (52%). Positivity was not detected in any normal mucosa or benign lesions. Cells containing HCG predominated in mucinous (80%) and poorly differentiated carcinomas (92%). No trophoblastic differentiation could be demonstrated in any tumor. Human chorionic gonadotropin was detected more frequently in carcinomas invading the entire bowel wall (67%) than in those confined to the submucosa or muscularis propria (30%). Fifteen of 19 cases (79%) with lymph node and/or hepatic metastases had HCG in the primary tumor, whereas only 9 of 23 cases (32%) without metastases showed HCG immunoreactivity. The eight patients with hepatic metastases had HCG in the primary tumor. Thus, the immunohistochemical detection of HCG in colorectal carcinomas may be a biological marker of prognostic significance.
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PMID:Human chorionic gonadotropin in colorectal carcinoma. An immunohistochemical study. 354 43

An autopsy case of primary gastric choriocarcinoma in a 55-year-old male is presented. The tumor was diagnosed as choriocarcinoma of the stomach from a histological examination of biopsy specimens. The level of human chorionic gonadotropin (HCG) was significantly increased in the serum and urine. A histological examination of autopsy specimens showed the tumor of the stomach to be a pure choriocarcinoma composed of syncytiotrophoblasts and cytotrophoblasts with a mixture of eosinophilic necrotic tissues, but with no elements of adenocarcinoma. The tumor showed metastases and/or invasions to the liver, lungs, pancreas, omentum, pleura, peritoneum and lymph nodes. Positive immuno-histochemical staining for the beta-subunit of HCG (HCG-beta) in the gastric tumor was demonstrated in the form of granular diffuse deposits in the cytoplasm of trophoblasts and predominated in syncytiotrophoblasts over transitional cells. Under electron microscopic observation, positive immunostaining for HCG-beta was observed in the perinuclear space, cisternae of the rough endoplasmic reticulum (RER) and secretory vesicles of syncytiotrophoblasts and transitional cells.
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PMID:An autopsy case of primary gastric choriocarcinoma. 366 67

Between 1963 and 1980 we have had experience of 54 patients with gestational choriocarcinoma and 29 are alive, a survival rate of 53.7%. The disease had metastasized to the central nervous system in 15 of these 54 patients, an occurrence rate of cerebral metastases of 27.8%. 13 of these 15 patients have died and 2 are now in a state of remission. Autopsy was performed in 8 cases. The following points are emphasized: cases with the pulmonary disease risk intracranial spread; the serum/cerebrospinal fluid ratio of human chorionic gonadotropin concentrations and computerized tomography are recommended as useful investigations in the diagnosis of CNS disease; decompression surgery in patients with increased intracranial pressure is indispensable; radiotherapy is temporarily effective for brain deposits; powerful systemic chemotherapy using multiple anticancer drugs is suggested to be helpful both in preventing and in treating CNS disease.
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PMID:Clinical analysis of intracranial metastases in gestational choriocarcinoma: a series of 15 cases. 386 1

Excluding patients with bulky stages II or III disease, 73 patients with nonseminomatous germ cell testicular tumors were evaluated between September 1979 and April 1983 for a protocol omitting retroperitoneal lymph node dissection. Patient eligibility required clinical stage I (T1 category) disease based upon normal post-orchiectomy serum tumor markers (alpha-fetoprotein, human chorionic gonadotropin and lactic dehydrogenase), chest x-ray, ipsilateral lymphangiography, and a computerized tomography scan of the abdomen and pelvis. Of the 73 patients 10 (14 per cent) were entered and followed for more than 2 years (3 had relapse within 7 months but were salvaged with retroperitoneal lymph node dissection and chemotherapy). Analysis of failures showed embryonal carcinoma in all 3 patients, with vascular invasion in the primary tumor in 1 and undetected spermatic cord involvement in 1, while 1 had a slower than expected decrease to normal of an elevated human chorionic gonadotropin level after orchiectomy. There were 63 patients (86 per cent) excluded from the protocol for various reasons: 2 (3 per cent) refused treatment, 16 (25 per cent) had suspicious or positive lymphangiography, 22 (40 per cent) had a positive CT scan, 6 (9 per cent) had elevated tumor markers, 3 (5 per cent) were less than 15 or more than 15 or more than 40 years old, 8 (13 per cent) had had a prior orchiopexy or scrotal violation, 4 (6 per cent) had extension to the spermatic cord and 2 (3 per cent) were unavailable for monthly followup. These 63 patients underwent retroperitoneal lymph node dissection, and 36 (57 per cent) had negative and 27 (43 per cent) had positive nodes (8 had stage N1, 10 stage N2A, 6 stage N2B and 3 stage N3 disease). Average interval from orchiectomy to final staging was 6 weeks. The results suggest that assessment of local tumor extent and potential sites of metastases via all available means are necessary in an effort to reduce the risk of tumor recurrence in patients who are followed expectantly.
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PMID:Selection of testicular tumor patients for omission of retroperitoneal lymph node dissection. 394 94

A regimen of multiple intermittent intensive doses of chemotherapy (chiefly 5-fluorouracil) was used in a series of 806 women with choriocarcinoma and malignant mole. The rate of complete remission of choriocarcinoma was 78.6%, and approximately 85% of the patients survived for more than 5 years. From 1962 through 1982, pulmonary metastatic choriocarcinoma was found to be resistant to chemotherapeutic agents in 43 of these patients; they subsequently underwent lung resection. There were no postoperative deaths, and the 5-year survival was 50%. These are relatively good results for patients with long-standing and widely disseminated choriocarcinoma. Human chorionic gonadotropin titer in urine and blood and variations of lung shadows are important criteria in selecting candidates for lung resection. For preservation of lung function, simple lobectomy is the first choice. Better long-term survival was obtained in patients who had a solitary lung lesion on admission without other major organ metastases and in those in whom the lung lesion was well encapsulated and became necrotic after chemotherapy.
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PMID:Resection of pulmonary metastatic choriocarcinoma in 43 drug-resistant patients. 403 69

A brief discussion of the definition, etiology, epidemiology, classification, and prognosis of the gestational trophoblastic tumor (GTT) is presented. Current therapeutic options are summarized. GTTs arise from fetal tissues and can be divided into three histologic categories, hydatidiform mole, chorioadenoma destruens, and choriocarcinoma. Clinically, it is classified as nonmetastatic, metastatic-low risk, or metastatic-high risk. Diagnosis is based on clinical signs and symptoms, ultrasound and X-ray examinations, and the presence of elevated serum levels of the B-subunit of human chorionic gonadotropin (hCG). Primary therapy for hydatidiform mole is evacuation of the uterine contents. Prophylaxis for metastases with actinomycin D sometimes is performed, but generally is not recommended. For persistent disease that is classified as nonmetastatic or low-risk metastatic, a methotrexate-leucovorin rescue protocol is preferred, with actinomycin D used in patients who show resistance to the regimen. Standard therapy for high-risk metastatic disease involves triple agent therapy with methotrexate, actinomycin D, and chlorambucil, but toxicity is significant. Other alternatives include the modified Bagshawe protocol, a VBC (vinblastine, bleomycin, cisplatin) regimen, cisplatin in combination with vincristine and high-dose methotrexate, and VP16-213 (etoposide) in combination with other agents. Other treatment modalities include radiation and surgery. Use of the most appropriate therapies can maximize the survival of a patient with gestational trophoblastic disease.
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PMID:Treatment of gestational trophoblastic tumors. 608 60

53 patients with clinical stage I non-seminomatous germ-cell testicular tumours were entered into a prospective study to receive no treatment other than orchidectomy until unequivocal clinical evidence of metastases was established. Of this group, 9 men (17%) have relapsed, 8 within six months of orchidectomy. All 9 are alive and disease-free after chemotherapy. The relapse rate was higher in patients with malignant teratoma undifferentiated (embryonal carcinoma) primary tumours than in those with malignant teratoma intermediate (teratocarcinoma); 42.8 and 3.4%, respectively. The results were compared with those from 157 men treated by orchidectomy and radiotherapy for stage I disease. In this group, 49 patients (25.8%) relapsed and 85% of relapses occurred within one year of orchidectomy. The tempo relapse was identical for embryonal carcinoma and teratocarcinoma. Of 32 patients in whom serum markers were measured before orchidectomy, 24 (75%) had raised levels of alphafetoprotein and/or beta human chorionic gonadotropin. These preliminary results imply that routine lymphadenectomy or lymph node irradiation in clinical state I testicular non-seminoma may be unjustifiable.
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PMID:Orchidectomy alone in testicular stage I non-seminomatous germ-cell tumours. 612 25

Surgical removal of bulky metastases of non-seminomatous germ-cell testicular cancer has been advocated as an adjuvant to chemotherapy in patients whose disease probably is too extensive to be cured by chemotherapy or surgery alone. However, in 8 of our patients, cytoreductive surgery was followed by a sudden and dramatic exacerbation of the disease. In some cases, a marked rise in the serum levels of alpha-fetoprotein and human chorionic gonadotropin was the only evidence. The cause and prevalence of such exacerbations are unknown. Cytoreductive surgery in patients with advanced testicular tumor is accepted treatment and should be advocated, but it appears that in some cases such surgery may adversely alter the course of the malignancy. This must be considered in planning treatment for patients with advanced disease.
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PMID:Acclerated growth of testicular cancer after cytoreductive surgery. 615 70

Radioimmunoassay determinations of the biochemical tumor markers, alpha-fetoprotein or human chorionic gonadotropin, revealed elevated serum levels in 94 per cent of the patients with advanced disease. No falsely positive values have been observed. The markers are useful in monitoring the response to therapy and, when persistently elevated after therapy, indicate the presence of residual malignant tumor, usually embryonal carcinoma. However, they have a more limited role in the management and followup of the great majority of new patients with non-seminomatous germ cell tumors of the testis (stages A and B) owing to a falsely negative incidence of 38 per cent in patients found to have retroperitoneal metastases at lymphadenectomy. Furthermore, marker levels obtained during chemotherapy, even in the presence of residual tumor, frequently are normal. Thus, they have a limited role in the early detection of residual disease in patients treated systematically with prophylactic chemotherapy. A meticulous retroperitoneal lymphadenectomy remains the single most important factor in dictating the use of adjuvant chemotherapy, the specific agent and the combination and duration of therapy. The prophylactic use of actinomycin D in stage A and the early aggressive use of vinblastine sulfate and bleomycin in stage B2 have reduced the incidence of recurrence substantially. A prospective plan of management used in 95 consecutive patients since 1974 has resulted in survival free of tumor of 100 per cent for patients with stage A disease, 91 per cent for stage B and 61 per cent for stage C.
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PMID:Relevance of biochemical tumor markers and lymphadenectomy in management of non-seminomatous testis tumors: current perspective. 615 25

Radioimmunoassays of human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP) made in 49 patients with nonseminomatous testicular tumors have shown that these investigations make the diagnosis more precise, permit to follow up the dynamics of the course of the disease and the effectiveness of treatment and may help to reveal the presence of otherwise undetectable tumorous metastases. The significance of the these assays is enhanced if the two tumorous proteins are investigated in parallel. The results proved rightly positive in 43 (87.8%) and falsely negative in 6 (12.2%) of the patients. The absence of HCG and AFP production in some of the patients with an active disorder has not as yet been elucidated.
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PMID:Significance of radioimmunoassay of human chorionic gonadotropin and alpha fetoprotein in nonseminomatous germ cell tumors of the testis. 616 14


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