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Query: UMLS:C0242379 (lung cancer)
 71,905 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of metastatic brain tumors is increasing because of the recent progress in the detection and management of primary cancer. However, metastatic skull tumors from cancers associated with giant subcutaneous mass lesions are rare. We present four patients with metastatic skull tumors: two from hepatic cancer, one from lung cancer, and one from mamma cancer. In these patients, plain skull X-ray and bone CT showed osteolytic lesions. Angiograms revealed a tumor stain fed by abnormal vessels from the external carotid artery. MRI demonstrated masses with marked homogeneous enhancement with the "dural tail sign" in the dura adjacent to the tumors in three skull tumors from hepatic and mamma cancers, and a mass with slightly enhancement without the "dural tail sign" in a skull tumor from lung cancer. At surgery, hemorrhagic well-demarcated tumors were totally removed. The histological diagnosis was skull metastases from cancers in all cases. In cases with the "dural tail sign" on MRI, no tumor cells were seen in the inner layer of the dura and the dura adjacent to the tumors. It is possible that the "dural tail" is due to increased vascular permeability of the dural vessels. The recurrence of these skull tumors was not observed during the follow-up period. Surgical treatment for the metastatic skull tumors from cancers may be indicated to prevent deteriorating neurological symptoms affecting the quality of life.
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PMID:[Metastatic skull tumors from cancers associated with subcutaneous mass lesions]. 1036 72

The authors describe a case of lung cancer in a 55-year-old man who complained of back pain. Initial isotopic bone scanning showed no abnormality, however, magnetic resonance (MRI) imaging revealed bone metastasis in thoracic vertebral bone. Even when there is no typical findings of metastasis in bone scintigraphy, MRI imaging would be useful if vertebral bone metastasis is suspected. MRI imaging is an important modality to evaluate extraosseous extension and marrow invasion of metastatic tumors.
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PMID:Atypical presentation of vertebral bone metastasis from lung cancer. 1037 56

The value of FDG-PET in oncology is currently investigated in clinical studies. There is only limited information on the usefulness of FDG-PET in the evaluation of distant metastases of lung cancer. The purpose of the present prospective investigation was to determine the diagnostic accuracy of FDG-PET in the detection of brain metastases of lung cancer. After intravenous injection of 220 +/- 50 MBq F-18-deoxyglucose PET acquisition was carried out using an ECAT ART scanner (CTI Siemens). Images were reconstructed using a filtered backprojection with a Hanning filter. PET data were analyzed by visual interpretation of coronal, sagittal and transversal slices. PET scans were interpreted by two experienced nuclear medicine physicians without prior knowledge of the results of other imaging studies or clinical data. Between March 1997 and July 1998 whole-body PET was performed in 417 patients with suspected lung cancer. 402 patients were used for statistical analysis. Based on conventional brain imaging with CT (occasionally MRI), brain metastases were suspected in 17 patients (prevalence 4.2%). For FDG-PET alone, sensitivity was 82% (14/17) and specificity 38% (14/37). Therefore, diagnostic accuracy of FDG-PET in detection of brain metastases was 93.5%. The low specificity of FDG-PET can be explained by reduced tracer uptake mainly due to brain infarction or vascular encephalopathy in this group of elderly patients. Our results indicate that due to its low specificity FDG-PET is not useful for the evaluation of brain metastases in the primary staging of patients with lung cancer.
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PMID:[Brain metastases of lung cancer: diagnostic accuracy of positron emission tomography with fluorodeoxyglucose (FDG-PET)]. 1037 59

The incidence of elderly patients with small cell lung cancer is increasing in Japan. Because of the variation in their physical function and increasing co-morbid disease, elderly patients are usually excluded from clinical trials. Questionnaires were sent to 40 institutes of the "West Japan Thoracic Oncology Group", and answers from 33 (83%) institutes were obtained. Eighty-five percent of replies recognized the need of trials for limited disease (LD) and 70% for extensive disease (ED). We investigated the methods of staging procedures, and management of 351 small cell lung cancer patients aged 70 years or older diagnosed from 1994 to 1996 in 28 institutes. There were 173 patients aged 70-74, 120 aged 75-80, and 58 aged 80 years or older. Staging procedures including chest CT, abdominal CT, abdominal CT or Echo. Brain CT or MRI and bone scinti scan were performed in 333 (95%) patients. One hundred fifty-nine of 178 patients with LD and 143 of 168 patients with ED received anticancer therapy. Although 48% of PS 0-1 patients received 4 courses or more of chemotherapy, among the patients with ED 24% of patients with PS 2 and 19% of PS 3 patients received adequate chemotherapy. The response rate was 79% for LD and 69% for ED. Many elderly patients received insufficient courses and/or doses of chemotherapy but achieved a good response. Median survival for patients with LD and ED was 12 and 6 months, respectively. To determine suitable regimens for elderly patients with lung cancer, more clinical trials are definitely needed.
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PMID:[How should we treat elderly patients with small cell lung cancer?--information gathered by questionnaires and analysis of 351 patients aged 70 or over. West Japan Thoracic Oncology Group]. 1041 Jan 49

Pathologic results of 543 lymph nodes removed during 164 radical surgery for lung cancer is compared with the expected findings based on preoperative MRI imaging. Specificity of T2 weighted MRI images were 95.5% for individual lymph nodes and 88.1% for TNM staging, respectively. Sensitivity was found to be 89.4% for lymph nodes and 94.6% for TNM staging of the patient. The accuracy of the MRI imaging was 84.7%. Properly chose MRI imaging and interpretation sounds to be no inferior to more invasive methods as collar mediastinoscopy, Chamberlain procedure or VATS exploration.
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PMID:Predictive value of MRI in lung cancer. 1043 6

The results of MRI in 81 patients with morphologically verified lung cancer, mainly Stages IIIA and IIIB, were analyzed. They were compared with CT data in 37 cases and surgical findings in 28. MRI was performed by using Magnaview 0.04 T and Vectra 0.5 T apparatus in the T1- and T2-weighted SE and PC sequences as well in the fat-suppression mode. Thoracic metastases were evaluated from the direct signs tumor spread into the adjacent tissue and vessels. The criteria for the involvement of lymph nodes were their over 1-cm enlargement and characteristic changes in the intensity of signals from them. CT was found to yield less information on pleural, pericardial, and vascular invasion (66-75% sensitivity). MRI detected this type of cancer spread (88-94% sensitivity). Both techniques have nearly equal sensitivities in revealing intrathoracic lymphadenopathy. The interpretation of MRI data did not depend on the voltage of a magnetic field. It is recommended that MRI should be made after CT when there is a need for assessing large vessels or for making clear the data that remain open to question following CT.
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PMID:[Magnetic resonance tomography in the diagnosis of lung metastases in the mediastinum and thorax]. 1071 24

The necessity for a compulsive attitude toward preoperative assessment of lung cancer is to be emphasized, since rational treatment and prognosis depend largely on the stage of disease at the time of diagnosis. In the preoperative setting, the techniques used should be sequential, logical, and help to identify patients suitable for treatment with curative intent. With regard to the primary tumor (T status), the accuracy of CT or MRI to predict the need for extended resections is limited. Similarly, all noninvasive methods to determine the nodal status (N) are valuable, but mediastinoscopy has a greater sensitivity and specificity than either CT or MRI. The role of routine organ screening for the detection of distant occult metastasis in the asymptomatic patient is still controversial. Ultimately, the prognosis of the resected patient with lung cancer is based on complete intraoperative staging, which can be done by either systematic node sampling or complete lymphadenectomy. At present, neither of these techniques has been shown to improve the quality of staging or survival.
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PMID:Clinical and surgical staging of non-small cell lung cancer. 1077 62

One of the most important recent advances in imaging technology for the diagnosis of lung cancer is CT consisting of high-resolution and helical volumetric techniques. CT has made a detailed morphological analysis correlated with histopathology as well as the detection of small peripheral lung cancers possible. MRI still remains as a complementary role to CT, but MR angiography using fast gradient-echo technique has achieved a great progress. FDG-PET is the most encouraging development in nuclear medicine and is vigorously evaluated for its cost-effective clinical value in differentiating benign and malignant nodules as well as in staging of lung cancer. In chest radiography, the development of computer-aided diagnosis is underway and seems promising.
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PMID:[Diagnosis--radiologic imaging]. 1082 48

Paraneoplastic limbic encephalitis (PLE) is a rare disorder characterized by personality changes, irritability, depression, seizures, memory loss and sometimes dementia. The diagnosis is difficult because clinical markers are often lacking, and symptoms usually precede the diagnosis of cancer or mimic other complications. The frequency of antineuronal antibodies in patients with PLE has not been investigated. We examined the neurological symptoms and the causal tumours in 50 patients with PLE to determine the utility of paraneoplastic antibodies and other tests. The diagnosis of PLE required neuropathological examination or the presence of the four following criteria: (i) a compatible clinical picture; (ii) an interval of <4 years between the development of neurological symptoms and tumour diagnosis; (iii) exclusion of other neuro-oncological complications; and (iv) at least one of the following: CSF with inflammatory changes but negative cytology; MRI demonstrating temporal lobe abnormalities; EEG showing epileptic activity in the temporal lobes. Of 1047 patients with neurological symptoms, whose sera or CSF were examined for paraneoplastic antibodies, 79 had the presumptive diagnosis of limbic encephalitis, dementia, cognitive dysfunction, or confusion. Fifty of these patients fulfilled our criteria for PLE. Pathological confirmation was obtained in 12 patients. The commonly associated neoplasms were of the lung (50%), testis (20%) and breast (8%). Neurological symptoms preceded the cancer diagnosis in 60% of patients (by a median of 3.5 months). Twenty-five of 44 (57%) patients with MRI studies had signal abnormalities in the limbic system. Thirty (60%) patients had antineuronal antibodies (18 anti-Hu, 10 anti-Ta, 2 anti-Ma), and 20 were antibody-negative or had uncharacterized antibodies (n = 4). The combination of symptoms, MRI findings and paraneoplastic antibodies established the diagnosis of PLE in 78% of the patients. Patients with anti-Hu antibodies usually had small-cell lung cancer (94%), multifocal neurological symptoms (78%) and a poor neurological outcome. Patients with anti-Ta (also called anti-Ma2) antibodies were young men with testicular tumours (100%), frequent hypothalamic involvement (70%) and a poor neurological outcome. In the group of patients without anti-Hu or anti-Ta antibodies, the tumour distribution was diverse, with cancer of the lung the most common (36%); 57% had positive MRI. Fifteen of 34 (44%) patients with a median follow-up of 8 months showed neurological improvement. Treatment of the tumour appeared to have more effect on the neurological outcome than the use of immune modulation. Improvement was observed in 38% of anti-Hu patients, 30% of anti-Ta patients and 64% of patients without these antibodies.
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PMID:Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. 1086 59

We report a 67-year-old man with progressive disturbance of gait. He was well until the spring of 1993 (62 years of the age), when he noted an onset of unsteady gait. He also noted that he started to have a difficulty in playing tennis, in which he became unable to hit the ball with his racket. He also noted parkinsonian features such as bradykinesia and loss of hand dexterity. He was treated with levodopa, which did not improve his symptoms. His MRI revealed marked atrophy of the cerebellum and the pons. The criss-cross high signal lesion was seen in the center of the pons. The third ventricle was dilated. The putamen was unremarkable. His subsequent course was complicated by easy to fall, difficulty in swallowing with episodes of aspiration pneumonia. He also developed nocturnal apneustic episodes. He was admitted to our hospital on November 15, 1998, when he was 67 years of the age. He had low grade fever and low blood pressure (98/70). He was anemic but not icteric. Tumors were palpated in his jaw, anterior chest, and in the left arm. He was alert but unable to convey his desire because of dyspnea and tracheostomy. His gaze was slightly restricted in the horizontal direction and markedly so in the vertical direction. Motor functions were difficult to evaluate. His clinical course was complicated by atelectasis of the right lung and pleural effusion. He developed marked edema and oliguria. He developed sudden bradycardia and expired on December 26, 1998. He was discussed in a neurological CPC and the chief discussant arrived at the conclusion that the patient had multiple system atrophy. Majority of the audience agreed with this diagnosis. Post-mortem examination revealed a lung cancer in the right lung (undifferentiated adenocarcinoma) with metastases to the liver, kidneys, lymph nodes, pericardium, pleura, skin, bone marrow, and the brain. Neuropathologic examination revealed marked atrophy of the pons and the cerebellum. The putamen showed brownish discoloration and atrophic changes. The substantia nigra showed marked neuronal loss and gliosis. Oligodendrocytic inclusion bodies (alpha-synuclein positive) were seen in the putamen, globus pallidus, substantia nigra, pontine nucleus, cerebellar white matter, internal capsule, cerebral peduncle, and the spinal cord. These findings are consistent with the pathologic diagnosis of multiple system atrophy. What was interesting to us was the presence of neurofibrillary tangles in the substantia nigra, nucleus ruber, globus pallidus, and subthalamic nucleus. Tuft-shaped astrocytes were also seen. This patient appears to be a rare example of combination of MSA and PSP.
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PMID:[A 67-year-old man with progressive disturbance of gait]. 1093 28


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