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)

The study comprised 97 patients treated by the Scandinavian Sarcoma Group for high-grade, extremity-localized osteosarcoma. Chemotherapy was according to the T-10 protocol, with four courses of high-dose methotrexate (HDMTX) given preoperatively at weekly intervals. Seventeen percent of the patients obtained a good (grade III or IV) histologic response, 62% a moderate (grade II) response and 21% a poor (grade I) response. Grade II-IV responders had significantly higher serum MTX levels than grade I responders. Good responders had significantly better survival than moderate/poor responders, and had a trend towards both lower recurrence rate and longer time to recurrence. Five-year overall and relapse-free survival for all patients was 63% and 53%, respectively. Within a group of patients with similar primary tumour response, there was a trend for better survival with increasing serum MTX levels, indicating that individualization of MTX doses according to renal excretion rates may be indicated. The present results underline the importance of introducing effective chemotherapy from the start of osteosarcoma treatment, and that HDMTX alone seems to be insufficient preoperative therapy. The toxicity of HDMTX is generally mild, but we have by cerebral MRI found signal changes in white matter in 14/22 patients; changes that may represent subclinical MTX CNS toxicity. In the subsequent SSG osteosarcoma protocol, cisplatin and doxorubicin has been added to HDMTX from the start of treatment. Our data also suggest that an aggressive approach involving second-line chemotherapy and surgery is indicated for metastatic disease and that such an approach may lead to long-term survival in up to 30% of patients.
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PMID:The treatment of osteosarcoma: present trends. The Scandinavian Sarcoma Group experience. 162 72

In a rare case of teratocarcinoma of the pineal gland, MRI accurately depicted the primary tumor and diffuse enhancing drop metastases along the surface of the brain stem and the spinal cord.
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PMID:Pineal teratocarcinoma with drop metastases: MR features. 163 Jun 17

Cartilaginous lesions of the larynx are uncommon, approximately 250 cases being documented in the literature. In general, these tumours grow slowly, exhibiting only local aggressiveness. Distant metastases are rare. Up until now CT has been the best diagnostic tool for the evaluation of these tumours because it demonstrates intratumoral calcification so well. To the best of our knowledge there are no reports of the use of MRI for these lesions. Three cases of cartilaginous laryngeal tumours are presented, emphasizing the MRI features.
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PMID:MRI of cartilaginous tumours of the larynx. 164 77

Differentiation between liver metastases and local fat deposition may be difficult when using CT; the value of MRI was therefore investigated in 18 patients with metastases and ten patients with fat deposits. CT shows both lesions as similar hypodense areas. MRI, however, produces different appearances: T1- and 2-weighted images show marked differences in the signal arising from metastases, whereas local fat collections in both sequences differ little in their signal from normal liver. Quantitative MRI signal intensity of the two types of lesion were also different. Where the differentiation by CT may be difficult, it may be made with certainty by means of MRI.
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PMID:[The differential diagnosis of liver metastasis and regional fatty liver: a comparison of CT and MRT]. 164 66

A rare case of metastatic renal tumor originating from a malignant mixed tumor of the submandibular gland is reported. The patient was a 45-year-old woman with hard masses palpated in the right upper arm and the right upper gluteal region. She had a history of surgical resection of a right submandibular tumor followed by radiotherapy in 1977. Biopsy findings of the gluteal mass suggested a malignant clear cell tumor. A chest X-ray, excretory urogram, CT scan, MRI and renal angiogram were highly suggestive of a right renal cell carcinoma with metastases to the right lung (S1 & S10), the left 4th and 5th ribs, the right upper arm muscle and the right upper gluteal muscle. Right nephrectomy and resection of the right upper arm and right upper gluteal tumors were performed. Microscopic examination showed that all tumors were malignant mixed tumors. When compared to the previous surgical specimen, the tumors were believed to be identical. The tumors of the lung and ribs subsequently resected were malignant mixed tumors. The patient is well with no objective or subjective evidence of recurrent neoplastic disease 7 months post-operatively. To our knowledge only one report of metastatic renal tumor originating from a malignant mixed tumor of the salivary gland has been published in Japan. But metastatic renal tumor originating from the same tumor of the submandibular gland has not been reported previously in Japan.
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PMID:[A case of metastatic renal tumor originating from a malignant mixed tumor of the submandibular gland]. 166 13

To summarize the imaging work-up of gastric carcinoma, the patient should be initially evaluated with a double-contrast UGI series and correlated with endoscopy. Some authors feel that the primary role of UGI is to provide a guide to the endoscopist. The area in question should be biopsied. The role of CT is controversial due to limitations in staging. Some feel that it is an ancillary procedure, as are ultrasound, MRI, and angiography. Exploratory laparotomy is recommended as the diagnostic and therapeutic evaluation of choice. However, CT may prevent surgery in the nonsymptomatic patient with diffuse metastatic disease.
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PMID:Recent developments in diagnostic radiology of primary and recurrent gastric cancer. 168 52

We report a case of an extragonadal germ cell tumor in the retrovesical region. The patient complained of a perineal and micturition pain. Urethrography, CT and MRI showed a retrovesical tumor protruding into the bladder. Alfa-fetoprotein was increased to 12,170 ng/ml. Bilateral testes did not contain any palpable mass by careful palpation. No tumor was detected by ultrasonography, either. Clinically, he was diagnosed as having a retrovesical extragonadal germ cell tumor associated with paraaortic lymph-nodes and bilateral pulmonary metastases. Although he was treated by combination chemotherapy (PVB and VAB-6 regimen) and irradiation, he died of carcinomatosis about 6 months after the admission. There was no evidence of tumor in bilateral testes on autopsy. This case was a second case of extragonadal germ cell tumor originating from the retrovesical lesion in the literature.
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PMID:[A case of retrovesical embryonal cell carcinoma]. 171 80

Extra-adrenal pheochromocytomas may arise in any portion of the paraganglion system, although they most commonly occur below the diaphragm. The most common site of occurrence of extra-adrenal pheochromocytoma is the superior para-aortic region between the diaphragm and lower renal poles. Although the traditional teaching has been that 10% of all pheochromocytomas are at extra-adrenal sites, this may be an underestimation. Extra-adrenal pheochromocytomas probably represent at least 15% of adult and 30% of childhood pheochromocytomas. They may be malignant in up to 40% of the cases, although conflicting data add to the uncertainty of this point. Patients with tumors arising at extra-adrenal sites commonly present with headache, palpitations, sweating and hypertension. The diagnosis is most often confirmed by demonstrating increased catecholamine production, usually by measurement of urinary catecholamines and/or their metabolites. CT scanning is presently the imaging procedure of choice for localization. The roles of MRI and 131I-MIBG scintigraphy in the localization process are still being determined. Thorough preoperative pharmacological preparation, attentive intraoperative monitoring and aggressive surgical therapy all have an important role in achieving the safest and most successful outcome. Complete surgical excision is the treatment of choice for primary extra-adrenal pheochromocytoma as well as recurrent or metastatic disease. When residual tumor cannot be resected, medical therapy for symptomatic relief is preferred, since radiotherapy and chemotherapy have limited effectiveness. Extra-adrenal pheochromocytomas are more likely to recur and to metastasize than their adrenal counterparts, making lifelong followup with annual determinations of catecholamine production essential.
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PMID:Extra-adrenal pheochromocytoma. 172 90

In the immunocompromised patient, even mild forms of any combination of headache, meningismus, altered mental status, or focal neurologic signs should initiate an evaluation for possible CNS infection. The limited signs and symptoms of acute CNS infection are not due to specific organisms but to pathologic changes at the neuroanatomic site of infection. The initial clinical history, examination, laboratory, and neuroradiographic data will narrow the problem to one of several groups of agents, although it may not be possible to specify a single causative agent. It should be remembered that several concurrent infections (i.e., CMV and toxoplasmosis, aspergillosis, and bacterial sepsis) may be present. Thus, the clinician should rely on broad antibiotic coverage appropriate to the suspected causative agent or agents at the site of infection. It may be necessary to offer broad-spectrum antibiotic coverage for a CSF presentation that is subsequently found to result from a viral illness or from a noninfectious cause. However, one should avoid undertreating those infections for which specific therapy can be offered, and broad-spectrum treatment usually will not be regretted. Uncertainty in diagnosis following noninvasive procedures should lead to a brain biopsy. Although many of the infections discussed in this article have a poor prognosis, some of the most common pathogens, such as Cryptococcus, Listeria, and Toxoplasma, have effective specific therapies to which the patient should have access as rapidly as possible. The clinician who has successfully treated a patient with CNS infection should remain vigilant for late sequelae or recurrence of infection. Chronic treatment of some infections, such as toxoplasmosis or aspergillosis, may be necessary. The reintroduction of steroids for the treatment of an underlying cancer may reactivate previously treated disease, such as cryptococcosis, and periodic CSF surveillance is appropriate under these circumstances. Recurrence of the symptoms should raise the suspicion of recurrent or new infection, and the patient also should be evaluated with CT or MRI for the development of hydrocephalus or for new metastatic disease. In patients who have had varicella-zoster infection, postherpetic neuralgia and delayed arteritis may develop. Seizures, hearing loss, and neuropsychologic sequelae may follow any meningoencephalitis. The patient should always be reevaluated for the possibility of infection with a different opportunistic organism. CNS infections remain a major cause of morbidity and mortality in immunosuppressed patients with malignancies. In one series, 60% of such patients died as a result of their CNS infection, many at a time when the underlying disease had an otherwise good prognosis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Central nervous system infections in cancer patients. 175 29

In an open prospective study the tolerance and diagnostic value of the new hepatobiliary contrast agent Mn-DPDP in MR imaging was evaluated in 20 patients suspected of having focal liver lesions. T1- and T2-weighted spin-echo sequences and T1-weighted gradient-echo sequences were obtained before and after intravenous application of Mn-DPDP. In all patients the signal to noise (S/N) values of normal liver tissue increased significantly after application of Mn-DPDP. All focal lesions could be better localized and differentiated due to increased contrast to noise ratios of lesion to liver. Pathological examination revealed in 14 patients malignant and in 5 patients benign liver lesions; one patient had no pathological findings. In metastatic disease of the liver 25-120% more lesions could be detected in MRI after Mn-DPDP-application, compared with the unenhanced images. In 5 patients the lesions showed significant enhancement of Mn-DPDP (2 cirrhotic nodules, 2 hepatocellular carcinomas, 1 focal nodular hyperplasia). Our preliminary results indicate that Mn-DPDP is a well-tolerated contrast agent useful for the detection and differentiation of liver lesions in MR imaging.
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PMID:[The clinical value of Mn-DPDP: a new paramagnetic hepatobiliary contrast medium for magnetic resonance tomography of the liver]. 176 99


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