Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0153690 (bone metastases)
 6,382 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The CT and magnetic resonance (MR) findings in 13 patients with advanced Zollinger-Ellison syndrome are described. In eight patients (62%) one or more primary tumors were found with both methods. All patients with proven liver metastases (n = 7) were identified by MR. Computed tomography was positive in six of these patients. Three patients with lymph node metastases were identified on CT and MR and one patient had bone metastases. Computed tomography and MR were inferior to selective arteriography in the detection of multiple lesions of the pancreas in a patient with multiple endocrine neoplasia-I syndrome. On the T1-weighted MR images, the primary tumors demonstrated no consistency with regard to their signal intensity relative to the adjacent pancreatic parenchyma. All gastrinomas had an increased relative signal intensity on the T2-weighted images with the exception of a calcified tumor. Liver and lymph node metastases had a low signal intensity on the T1-weighted images and an increased signal intensity on the T2-weighted images. The signal intensity of primary tumors and metastases was independent of size. In conclusion, MR was able to detect abnormalities based on its outstanding lesion/normal tissue contrast, whereas CT diagnosis was based mostly on contour distortion. For the current technique, MR is considered at least equal to CT.
 ...
PMID:CT and MR imaging of advanced Zollinger-Ellison syndrome. 277 40

Six patients (4 women, 2 men) with malignant gastrinoma developed multiple bone metastases; osteolytic as well as osteoblastic lesions occurred. All lesions involved the central skeleton, most caused symptoms, and, in 2 cases, there was associated hypercalcemia with normal serum parathormone levels. Poor responses were observed after treatment with cytotoxic drugs, but good symptomatic responses occurred after radiotherapy in 2 of the 4 patients in whom it was used. The peptic ulcer component of the disease was well controlled in all patients by cimetidine with or without anticholinergic supplements or by ranitidine alone in doses of 300-600 mg daily. Five of the 6 patients died with a mean survival after diagnosis of Zollinger-Ellison syndrome of 3.3 yr (range 1.0-7.0 yr), suggesting that bone metastases are associated with a poor prognosis in metastatic gastrinoma.
 ...
PMID:Bone metastases in malignant gastrinoma. 375 10

Factors affecting natural history of gastrinoma (Zollinger-Ellison Syndrome) are not yet entirely understood, although much valid information has been gained in the last two decades. Prognostic factors are: a) adequate reduction of gastric acid overproduction insuring symptomatic control and healing of ulcerative lesions; b) inclusion in multiple endocrine neoplasia-1 syndrome rendering gastrinoma surgery rarely indicated and scarcely efficacious; c) size location and spread of the tumoural process(es) conditioning resectability and risk of metachronous liver and extra-abdominal metastases; d) hepatic and bone metastases, major determinants of death; e) development of paraneoplastic Cushing rapidly out of control and causing death within a short period of time; f) development of fundic EC-Lomas in Zollinger-Ellison Syndrome-multiple endocrine neoplasia-1 patients, generally undergoing benign course but possibly leading to lymph node and (exceptionally) to liver metastases and, sometimes, to total gastrectomy; g) experience of medical and surgical teams which are also most important in order to achieve no operative mortality and minimal post-operative complications.
 ...
PMID:Natural history of gastrinoma: lessons from the past. 1060 11

Recent studies report that the radiolabelled synthetic somatostatin analogue, [111In-DTPA-DPhe1]octreotide, is useful for imaging carcinoid tumours and pancreatic endocrine tumours. At present, it is unclear whether this method is superior to conventional imaging studies (computed tomography, magnetic resonance imaging, ultrasound, angiography) and what its role should be, if any, in the management of these patients. The aim of this paper is to review five recent studies performed at the National Institutes of Health in patients with Zollinger-Ellison syndrome to define the role of somatostatin receptor scintigraphy. Patients were from a tertiary referral centre, all had Zollinger-Ellison syndrome. In Study n. 1: the sensitivity of somatostatin receptor scintigraphy was assessed compared to conventional studies in 80 patients. Study n. 2: the effect of somatostatin receptor scintigraphy on management was determined in 122 patients. Study n. 3: ability of somatostatin receptor scintigraphy and other conventional methods to distinguish small hepatic metastases (< 2 cm) from hepatic haemangiomas was assessed in 29 patients. Study n. 4: somatostatin receptor scintigraphy, magnetic resonance imaging and bone scanning were compared in 115 consecutive patients to detect bone metastases. Study n. 5: ability of somatostatin receptor scintigraphy to detect gastrinomas found at surgery in 35 patients and its effect on cure rate and determinants of detection of gastrinomas by somatostatin receptor scintigraphy were analysed. Briefly, results showed: Study n. 1: somatostatin receptor scintigraphy is the most sensitive modality for detection of primary or metastatic gastrinomas; Study n. 2: somatostatin receptor scintigraphy changes management in 47% of cases; Study n. 3: somatostatin receptor scintigraphy is the only method to distinguish small liver metastases from small haemangiomas; Study n. 4: somatostatin receptor scintigraphy and magnetic resonance imaging have higher sensitivity and predictive values for bone metastases than bone scanning; Study n. 5: somatostatin receptor scintigraphy misses 33% of gastrinomas found at surgery, primarily small duodenal tumours. Size is the important factor. The use of somatostatin receptor scintigraphy does not increase cure rate. In conclusion, Somatostatin receptor scintigraphy is now the imaging method of choice in patients with Zollinger-Ellison syndrome for preoperative primary tumour localization, detection of bone or liver metastases, and to distinguish small liver metastases from small hepatic haemangiomas. Its specificity appears to be high but has been poorly studied as has the use of it in combination with endoscopic ultrasound. Studies by others suggest these recommendations will apply to carcinoid tumours and other pancreatic endocrine tumours except insulinomas.
 ...
PMID:Somatostatin receptor scintigraphy in gastrinomas. 1060 26