Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This case presents a patient with hypertrophic osteoarthropathy of the lower extremities that developed secondary to congenital cyanotic heart disease. The major clinical manifestation was severe bilateral leg pain. The pain that was debilitating in nature completely resolved following a single administration of 60 mg pamidronate. Hypertrophic osteoarthropathy (HOA) is an acquired, uncommon disorder of obscure etiology. It has been described mainly in association with chronic suppurative pulmonary diseases, bronchogenic carcinoma and lung metastases, cystic fibrosis, and cyanotic congenital malformations of the heart.
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PMID:Hypertrophic pulmonary osteoarthropathy: control of pain and symptoms with pamidronate. 1529 94

A 70-year-old female developed respiratory failure due to pharyngolaryngeal edema after posterior occipito-cervical fusion. She had a history of total thyroidectomy with bilateral neck dissection for advanced thyroid cancer associated with multiple lung metastases. However, her general condition was good, and she was not in cachexia. Her pulmonary function test revealed %VC of 54% and %FEV1.0 of 79%. This posterior occipito-cervical fusion was necessary for pain relief. Twenty-four hours after surgery she suddenly showed dyspnea, requiring tracheal intubation, and was supported by mechanical ventilation. The pharyngolaryngeal edema was recognized with bronchoscopy from the lower larynx with arytenoid region to nasal choana. In several days she recovered from pharyngolaryngeal edema and was extubated. She was discharged from ICU after close observation for 24 hours after extubation. She developed respiratory distress again due to difficulty in sputum expectoration, resulting in emergency tracheostomy an the floor at midnight. In this case, pharyngolaryngeal edema may have been caused by disturbance of lymphatic flow due to posterior occipito-cervical fusion in a patient with a past history of bilateral neck dissection. We also reviewed the literature in this report.
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PMID:[A case of pharyngolaryngeal edema after posterior occipito-cervical operation]. 1555 53

Malignant myoepithelioma of soft tissue is extremely rare. Presented herein is a case arising in a 17-year-old man. The tumor was initially noticed as a painless deep soft-tissue mass in the right forearm when the patient was aged 3 years. Thereafter, it grew without remarkable symptoms, such as pain or tenderness, until his visit to the hospital because of swelling of his forearm when he was 17 years old. An excisional biopsy specimen disclosed an invasive tumor exhibiting a lobular architecture. The tumor cells were arranged in a reticular and/or trabecular fashion with a myxoid background, and nuclear atypia was evident. Mitoses and tumor necrosis were also observed. Immunohistochemically, S-100 protein and epithelial markers were diffusely positive. Faint intercellular junctions and basal laminae were identified by electronmicroscopy. On the basis of these findings, the tumor was diagnosed as a malignant myoepithelioma of soft tissue. Six months later, multiple lung metastases were observed, and an open biopsy revealed a neoplasm displaying the same histological feature as the previously biopsied specimens. The patient died of his disease 18 months after the lung biopsy. Malignant myoepithelioma should be kept in mind in diagnosis of deep soft-tissue tumors with epithelioid features.
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PMID:Malignant myoepithelioma (myoepithelial carcinoma) of soft tissue. 1599 80

Hypertrophic osteoarthropathy (HOA) is one of the paraneoplastic syndromes most commonly associated with non-small-cell lung cancer. Although pulmonary metastasis is the second most common initial site of melanoma metastasis, HOA is rarely detected in patients with metastatic melanoma in the lung. We report a case of a 45-year-old woman with advanced melanoma who developed HOA after her disease had progressed through first-line systemic therapy. The patient's diagnosis of HOA was made on the basis of digital clubbing, arthralgia, pain, joint effusion and periosteal bone formation on X-ray with negative rheumatologic laboratory studies. Only six cases of HOA in metastatic melanoma have been reported previously. This diagnosis should be considered with lung metastases and the presentation of polyarthralgia with appropriate laboratory and imaging findings. Interestingly, the patient responded to bisphosphonates and second-line chemotherapy with carboplatin and paclitaxel, which is commonly used for lung cancer, not advanced melanoma. As with many paraneoplastic syndromes, successful treatment of the underlying disease was associated with a rapid resolution of the symptoms.
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PMID:Hypertrophic osteoarthropathy associated with metastatic melanoma. 1631 44

Only about 15% of patients diagnosed with lung carcinoma each year are surgical candidates, either due to advanced disease or comorbidities. The past decade has seen the emergence of minimally invasive therapies using thermal energy sources: radiofrequency, cryoablation, focused ultrasound, laser, and microwave; radiofrequency ablation (RFA) is the best developed of these. Radiofrequency ablation is safe and technically highly successful in terms of initial ablation. Long-term local control or complete necrosis rates drop considerably when tumors are larger than 3 cm, although repeat ablations can be performed. Patients with lung metastases tend to fare better with RF lung ablation than those with primary lung carcinoma in terms of local control, but it is unclear if this is related to smaller tumor size at time of treatment, lesion size uniformity, and sphericity with lung metastases, or to differences in patterns of pathologic spread of disease. The effects of RFA on quality of life, particularly dyspnea and pain, as well as long-term outcome studies are generally lacking. Even so, the results regarding RF lung ablation are comparable to other therapies currently available, particularlyfor the conventionally unresectable or high-risk lung cancer population. With refinements in technology, patient selection, clinical applications, and methods of follow-up, RFA will continue to flourish as a potentially viable stand-alone or complementary therapy for both primary and secondary lung malignancies in standard and high-risk populations.
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PMID:Radiofrequency ablation in lung cancer: promising results in safety and efficacy. 1636 74

Giant cell tumor of the bone (GCT) is a relatively uncommon tumor. It is characterized by the presence of multinucleated giant cells. GCT is a primary benign tumor but may evolve into a malignant tumor, usually after irradiation. We report a rare case of osteosarcoma arising ten years after the primary surgery for GCT without radiation. A 45-year-old woman presented with severe right knee pain after suffering contusion. Roentgenogram revealed a bone tumor in the lateral femoral condyle of the right knee. Histopathological examination demonstrated the features of GCT, and treatment consisted of curettage and bone grafting. Four months after the operation, multiple lung metastases of GCT occurred, which were treated by partial lobectomy. Ten years after the primary treatment, severe knee pain recurred. Roentgenogram and magnetic resonance imaging (MRI) demonstrated a destructive lesion in the lateral condyle of the right knee. Histopathological examination demonstrated a lacy pattern of osteoids and abnormal mitoses in the aggregated atypical mononuclear cells, indicating osteosarcoma. Despite above-knee amputation and chemotherapy, scapular and lung metastases developed and the patient died five months after above knee amputation. One may question whether the primary GCT contained some malignant cells. However, given the aggressiveness of the malignant tumor, this is unlikely. The recurrence of pain and aggravation of bone destruction many years after the primary treatment suggest malignant transformation of GCT.
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PMID:Osteosarcoma arising from giant cell tumor of bone ten years after primary surgery: a case report and review of the literature. 1643 39

The prevalence of thyroid metastases in colorectal cancer (CRC) patients is unknown. We retrieved the records of all patients with CRC and pathologically proved thyroid metastasis for the period 1993-2004. Among 5,862 consecutive patients with CRC, 6 (0.1%) were diagnosed with thyroid metastases, a median of 61 months after the diagnosis of primary tumour, and a median of 19 months after the last surgical resection or radiofrequency ablation of other metastases (which were present in all cases). Signs and symptoms, when present (n=3), consisted of cervical pain, cervical adenopathy, goitre, dysphagia, and/or dysphonia. In other cases, the diagnosis was made by positron emission tomography scanning. Thyroidectomy was performed in the 5 patients with isolated thyroid metastases, with cervical lymph node dissection being required in all cases. The only patient treated conservatively because of concomitant liver and lung metastases developed life-threatening dyspnoea, which required emergent tracheal stenting. Median overall survival was 77 months, 58 months, and 12 months after the diagnosis of primary CRC, initial metastases, and thyroid metastasis, respectively. It is concluded that thyroid metastases are rare and occur late in the course of CRC. Thyroidectomy (with cervical lymph node dissection) may result in prevention or improvement of life-threatening symptoms and prolonged survival.
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PMID:Thyroid metastases from colorectal cancer: the Institut Gustave Roussy experience. 1676 42

Low grade central osteosarcoma is a distinct, rare low grade malignant neoplasm characterized histologically by a spindle cell proliferation associated with trabecular bone formation. This tumor usually carries a good prognosis. However, it has the potential to recur, dedifferentiate, and metastasize subsequent to surgical treatment. In extremely rare occasions, LGCOS presents with areas of dedifferentiation upon initial patient evaluation. In this report we describe one such case affecting the fibula of a 39-year-old female, presenting with pain. Initial biopsy demonstrated a high-grade osteosarcoma. No areas of LGCOS were seen histologically. Following biopsy the patient received 3 months of chemotherapy at a different institution. However, the patient continued to exhibit symptoms. X-rays indicated a very aggressive tumor in the diaphysis of the proximal fibula, MRI revealed soft tissue involvement. The tumor and surrounding soft-tissues were excised en bloc at our institution. Microscopically, the lesion consisted of high-grade osteosarcoma as well as an underlying LGCOS that involved the cortex and medullary cavity of the fibula. The two histological components of the tumor were sharply delineated from one another. No chemotherapy effect was appreciated histologically or clinically. Eight months following the surgery, the patient died from lung metastases. This is the third documented case of dedifferentiated LGCOS at initial presentation. This case reveals that the low-grade component was also evident on preoperative radiographs.
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PMID:Dedifferentiated high-grade osteosarcoma originating from low-grade central osteosarcoma of the fibula. 1681 66

Hypertrophic osteoarthropathy (HOA) is a clinico-radiological syndrome characterized by digital clubbing, periosteal proliferation, bone pain, synovitis and arthralgia, all of these being commonly symmetrical. It is occasionally associated with nasopharyngeal lymphoepitheliomas and may develop before or after development of lung metastases in these patients. We report a case of a healthy 22-year-old female who presented to our institution with pain and swelling in the thighs and legs. She had a history of childhood nasopharyngeal lymphoepithelioma. Radiographs of the knees were negative. Magnetic resonance imaging (MRI) showed features suggestive of bilateral periostitis. Because of the propensity of the rare childhood nasopharyngeal lymphoepithelioma to present with HOA, this entity was included in the differential diagnosis. A subsequent chest radiograph and CT demonstrated a lung and mediastinal mass that were histologically confirmed to be metastatic. To the best of our knowledge, HOA and metastases from nasopharyngeal lymphoepithelioma occurring after such a long time interval have not been previously reported. Early demonstration and consideration of HOA on the basis of MRI, lead to expeditious and appropriate subsequent investigation.
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PMID:MRI diagnosis of hypertrophic osteoarthropathy from a remote childhood malignancy. 1695 48

Glomic tumours are perivascular tumours whose cells resemble modified smooth muscular cells of the glomic body. They are more frequent in the subungueal region and rare in the lung. The authors present a case of a 62 year old women with left thoracic pain and great enforces dyspnoea. She presented a solitary nodule in the external basal segment of the LLL, 1.9 cm diameter, circumscribed, firm and with nodular whitish rose cut surface. Glomic tumours are generally benign. They may origin in ectopic glomic cells or be differentiated from non glomic cells. They should be classified as glomic tumor, glomangioma and glomangiomioma according to the relative abundance of glomic cells and of the vascular and muscular components. Pulmonary metastasis of malignant glomic tumours have been described. In these cases an extra pulmonary primary origin must be excluded. The differential diagnosis of glomic tumours of the lung includes the carcinoid, hemangioperycitoma, smooth muscle tumours (epithelioid leyomioma) and the paraganglioma.
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PMID:[Glomic tumor: presentation of an infrequent case]. 1696 76


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