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)

Among 37 patients with hepatocellular carcinoma given systemic chemotherapy, 12 (32 percent) lived 14 to 37 months from initiation of treatment whereas the remainder died within five months. Individual factors associated with improved survival included fully ambulatory performance status, lack of jaundice, response to chemotherapy, the fibrolamellar carcinoma pathologic variant, absence of cirrhosis, and normal serum alpha-fetoprotein levels. Patients living longer than 12 months fell into two groups. Seven patients with fibrolamellar carcinoma lacked evidence of hepatitis B serum markers or cirrhosis and had normal alpha-fetoprotein levels and surprisingly frequent extrahepatic metastases. All but one were Caucasians aged 25 years or less. The other five "long-term" survivors were all fully ambulatory without jaundice, and the majority were older non-Caucasians with tumor confined to the liver at the time of diagnosis and with hepatitis B markers, elevated alpha-fetoprotein levels, or cirrhosis. All patients without fibrolamellar carcinoma who were less than fully ambulatory or who had jaundice died quickly. Patients with fibrolamellar carcinoma have homogeneous clinical features, and their disease follows a relatively indolent course. In other patients with hepatocellular carcinoma, assessment of ambulatory status and serum bilirubin determination can identify those with some prospect of prolonged survival.
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PMID:Prognostic factors in patients with hepatocellular carcinoma receiving systemic chemotherapy. Identification of two groups of patients with prospects for prolonged survival. 257 51

A liver transplant was performed on a 4-year-old female in liver failure caused by hereditary tyrosinaemia, with hepatocellular carcinoma following a negative evaluation for metastases. However, serum alpha-fetoprotein levels never returned to normal after the surgery. Urinary succinylacetone (SA) was detected in her urine prior to transplantation despite strict adherence to a low-tyrosine diet. Other patients with severe liver disease awaiting liver transplantation do not excrete SA in the urine. She continued to excrete SA during the postoperative period despite normal liver functions. Oral tyrosine loading resulted in significant elevation of SA excretion. Possible explanations for this observation and clinical and therapeutic relevance are discussed.
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PMID:Persistent succinylacetone excretion after liver transplantation in a patient with hereditary tyrosinaemia type I. 258 Oct 63

A study of post-orchiectomy surveillance without radiation therapy was done in patients with histologically pure seminoma apparently confined to the testicle. Criteria for study entry included a negative physical examination, chest x-ray, bipedal lymphogram, excretory urogram, abdomino-pelvic computerized tomography scan and serum alpha-fetoprotein. Followup consisted of frequent clinical examination, repeat lymphograms, abdominal computerized tomography scans, chest x-rays and serum markers. The purpose of this study was to determine the percentage of patients cured by orchiectomy alone, percentage who ultimately required therapy for occult metastases beyond the testicle, sites of relapse, factors predictive of relapse, and over-all cure rate and treatment morbidity. Of 81 patients followed for 3 to 43 months (median 19 months) only 3 had relapse at 3, 5 and 18 months after orchiectomy with nonbulky retroperitoneal disease: 1 patient had disease 17 months after salvage infradiaphragmatic radiation therapy, 1 had an increase in beta-human chorionic gonadotropin 11 months after radiation therapy, presumably due to occult nonseminoma, and he is receiving chemotherapy, and 1 has not yet completed treatment. Further followup is necessary to determine ultimate survival, since a risk for later relapse exists. However, to date it does not appear as if the outcome has been compromised when surveillance was applied in place of routine adjuvant radiotherapy.
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PMID:A study of post-orchiectomy surveillance in stage I testicular seminoma. 274 49

Between August 1981 and December 1984, 85 consecutive patients with clinical stage I nonseminomatous germ cell tumors of the testis who were suitable for close observation entered a surveillance study after orchiectomy alone. All patients had unequivocally negative chest x-ray, bipedal lymph-angiography, and computerized tomography of the abdomen and pelvis, and normal levels of alpha-fetoprotein and human chorionic gonadotropin before entering the study. Patients were followed closely for 24 to 64 months (median 42 months) with regular chest x-rays, plain films of the abdomen for lymphangiography control, and serum determinations of alpha-fetoprotein and human chorionic gonadotropin but it was difficult to obtain computerized tomography scans of the abdomen at scheduled intervals for such a long period. Followup was closed December 31, 1986. At that date 62 patients (73 per cent) were continuously free of disease after orchiectomy alone and 23 (27 per cent) suffered relapse. The over-all occurrence rate of retroperitoneal relapses was 16.5 per cent and they usually were detected late, 4 to 36 months (median 10 months) after orchiectomy. Lung metastases were detected much earlier, 2 to 10 months (median 3 months) after orchiectomy. Alpha-fetoprotein and human chorionic gonadotropin elevations preceded the radiographic demonstration of metastases in 8 patients only (35 per cent) and in 1 they were the only sign of relapse. All but 1 patient with relapse were cured with chemotherapy and/or surgery, with an over-all survival rate free of disease of 98.8 per cent. Invasion of the epididymis, rete testis and spermatic cord, primary scrotal surgery, peritumor vascular invasion and embryonal carcinoma were associated with a higher risk for relapse but it was impossible to find clear-cut indications to select patients for adjuvant chemotherapy, retroperitoneal lymphadenectomy or no treatment. Furthermore, the followup of retroperitoneal nodes proved to be much more difficult than expected. Unilateral or modified retroperitoneal lymphadenectomy facilitates management of clinical stage I nonseminomatous germ cell tumors of the testis: only the chest and markers must be followed, the status of the retroperitoneal nodes is known immediately and antegrade ejaculation is preserved in the majority of cases.
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PMID:Difficulties of a surveillance study omitting retroperitoneal lymphadenectomy in clinical stage I nonseminomatous germ cell tumors of the testis. 282 62

To determine the predictive values of using different sizes on CT as criteria for the detection of retroperitoneal lymph-node metastases in patients with early-stage (nodes 5 cm or less in diameter) primary nonseminomatous testicular cancer, we performed a retrospective analysis of 51 patients. Measurements of lymph-node transaxial diameters on CT were correlated with histologic findings at lymph-node dissection or with response to initial chemotherapy. All patients had normal serum markers (alpha-fetoprotein, human chorionic gonadotropin) after orchiectomy. The frequency of lymph-node metastases in this population was 51%. When a CT criterion of 5 mm was used, the negative predictive value was 79%; the positive predictive value, 62%; the specificity, 44%; and the sensitivity, 88%. With a criterion of 15 mm, the negative predictive value was 63%; the positive predictive value, 71%; the specificity, 76%; and the sensitivity, 58%. Metastases in retroperitoneal lymph nodes that appeared within normal limits (i.e., had normal transaxial diameters) on CT were the limiting factor in the ability of CT to exclude the presence of metastases. We conclude that using smaller sizes on CT scans as the criteria for detection of lymph-node metastases cannot replace dissection of nodes in patients who have normal-sized nodes but may be helpful in identifying a subgroup of patients who are at lower risk of harboring metastases when treatment by orchiectomy alone is considered.
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PMID:Detection of retroperitoneal metastases in early-stage nonseminomatous testicular cancer: analysis of different CT criteria. 282 94

The proportion of patients with metastatic germ cell tumors achieving complete remission increased, and the total survival improved between 1975 and 1982. Several analyses were undertaken to evaluate the influence of stage migration on treatment outcome in patients with germ cell tumors. (a) A logistic regression analysis showed that a formulation of time was an independent statistically significant variable (P = 0.025) in addition to the total number of sites of metastasis (P less than 0.001) and pretreatment values of human chorionic gonadotropin (P less than 0.001) and lactate dehydrogenase (P = 0.002). (b) The proportion of patients with lung metastases and elevated levels of human chorionic gonadotropin and alpha-fetoprotein decreased, and the number of patients with retroperitoneal metastases and without prior radiation therapy increased significantly. (c) The number of patients with a high likelihood of complete response increased significantly over time (P less than 0.001). Computerized tomography of the abdomen permits detection of large but asymptomatic retroperitoneal disease, and such patients are now being treated with chemotherapy rather than surgery and are included in advanced disease treatment results. Stage migration has played a role in the increasing proportion of complete responders in clinical trials of patients with germ cell tumors.
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PMID:Stage migration and the increasing proportion of complete responders in patients with advanced germ cell tumors. 283 58

Hepatocellular carcinoma (HCC), a common malignancy in the United States with poor prognosis, must be differentiated from hemangioma, focal fat, metastases, and regenerating nodules. Serum alpha-fetoprotein (AFP) levels are not a sensitive method for detection of HCC. High resolution ultrasound has been highly effective in detecting HCC in Japan and Taiwan. Doppler ultrasound can be used to increase the specificity. We review the roles of angiography, computed tomography (CT), and magnetic resonance, to conclude that the Japanese experience has demonstrated the efficacy of screening for HCC in the population at risk using serum AFP and ultrasound with the addition of dynamic CT and angiography where indicated. The continuing poor prognosis of patients with HCC in the United States suggests a failure to apply these methods for the early detection of HCC.
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PMID:Diagnostic imaging of hepatocellular carcinoma: progress in noninvasive tissue characterization. 284 92

Seven cases of hepatocellular carcinoma (hepatoma) (HCC) presenting as primary extrahepatic masses on CT are reported. All cases were diagnosed at the time of percutaneous biopsy, surgical resection, or autopsy. In none of the cases was the final diagnosis of HCC prospectively suspected on the basis of clinical and radiologic findings. Although three of the patients were at higher risk for development of HCC because of their medical histories, the absence of an elevated serum alpha-fetoprotein level and the extrahepatic location of the masses by CT suggested other disease. This variable pattern of radiologic presentation of HCC should be kept in mind during the evaluation of patients with suspected HCC, or when the findings on abdominal/pelvic CT of mass and presumed hepatic metastases are at variance with the clinical presentation.
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PMID:Hepatocellular carcinoma presenting as primary extrahepatic mass on CT. 300 40

The patient, a 76-year-old woman, was found to have a tumor in the epigastrium in April 1983 and was admitted to our hospital. She was diagnosed as having hepatocellular carcinoma in the left lobe of the liver with intrahepatic metastases in the right lobe. The patient also had autoimmune hemolytic anemia. Because of this condition and the metastases, we decided that the tumor was not resectable. Transcatheter arterial embolization was unsuccessful, and therefore, beginning on June 28, 1983, the patient was treated three times using balloon-occluded arterial infusion of 10 mg of mitomycin C and 30 mg of adriamycin into the proper hepatic artery. After these treatments, the serum alpha-fetoprotein level returned to normal levels. CT scans and hepatic angiography showed that the main tumor and the metastases had become smaller. The patient presently shows no evidence of disease, three years after treatment.
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PMID:[Chemotherapy of balloon-occluded arterial infusion in a patient with unresectable hepatocellular carcinoma and autoimmune hemolytic anemia]. 302 83

A 10-year-old girl had a primary choriocarcinoma of the posterior third ventricle. Craniotomy a few hours before death did not yield any tumor tissue. At autopsy, an extensively hemorrhagic tumor abutted the pineal gland. Immunostains were positive for beta-human chorionic gonadotropin (beta-HCG) but were negative for alpha-fetoprotein and carcinoembryonic antigen. The presence of beta-HCG in serum or cerebrospinal fluid may be used as a diagnostic marker and monitor of therapy. HCG is, however, not a unique marker for trophoblastic neoplasms, as a significant number of intracranial germinomas contain cells that are beta-HCG positive. Because of the rarity of primary extragenital choriocarcinomas and the much more common occurrence of metastases of genital choriocarcinomas, it is doubtful whether any investigation less than detailed autopsy can prove the extragenital origin of the tumor.
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PMID:Primary intracranial choriocarcinoma: a case report. 302 84


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