Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0677930 (primary tumor)
 20,210 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Reported are three cases of a spinal leptomeningeal dissemination from supratentorial malignant gliomas, in which the recurrence of the primary tumors of the intracranial leptomeningeal involvement was not observed clinicopathologically. All cases complained of spinal cord symptoms such as paraplegia or a sensory disturbance from time to time after the initial operation for their intracranial primary tumors. The duration between the first operation and the appearance of the spinal cord symptoms ranged from 11 to 17 months. In all cases, a computerized tomography scan demonstrated no recurrence of the primary tumor and no findings indicating intracranial leptomeningeal gliomatosis, such as a diffuse contrast enhancement of the ventricular wall or the subarachnoidal space, or hydrocephalus. Myelography showed a block or an irregular filling defect in two cases given immediate operations for spinal mass lesions. In one of these cases, a well-defined extramedullary tumor was removed at the level of the 7th-8th thoracic vertebrae. The pathological diagnosis was a glioblastoma multiforme, which was similar to the primary tumor. The patient survived for 18 months after total removal of the spinal tumor followed by postoperative spinal irradiation. All patients died of recurrent tumors from 3 to 18 months (mean: 8 months) after the appearance of the spinal cord symptoms. In the other case, an intramedullary tumor was found by a laminectomy. These two cases were autopsied. In one, an intramedullary tumor was found to extend from the lower medulla oblongata to the cervical cord, whereas the recurrence of the primary tumor was not seen and there was no intracranial leptomeningeal invasion nor any spinal subarachnoid seeding. The pathological diagnosis of this intramedullary tumor was a glioblastoma. In the other, there was a diffuse leptomeningeal dissemination of glioblastoma multiforme throughout the spinal cord, with an intramedullary invasion to almost all parts. A partial intracranial subarachnoid seeding of a malignant lower grade tumor than seen in the spinal lesion was found, though there was no recurrence of the primary tumor.
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PMID:[A clinicopathological study of the spinal leptomeningeal dissemination from cerebral malignant gliomas without a recurrence of the primary lesions]. 215 48

The diagnosis of intramedullary spinal cord metastasis (ISM) is difficult, and treatment is usually ineffective. We review our own experience with ISM as well as the pertinent medical literature, and suggest a practical diagnostic and therapeutic approach. The problem of the diagnosis of ISM is essentially that of the differential diagnosis of a noncompressive myelopathy in a patient with systemic cancer. Most such patients prove to have ISM, meningeal carcinomatosis, radiation myelopathy, or paraneoplastic necrotizing myelopathy. Neurologic features of value in this differential diagnosis are pain, the tempo and mode of progression of symptoms, and tumor cells in the spinal fluid. Oncologic features of value are the location of the primary tumor, the past exposure to therapeutic radiation, cerebral metastases, and the extent of systemic metastatic disease. The myelogram in ISM is either normal or nonspecifically abnormal; therefore, the diagnosis must be made on clinical grounds. Although no single finding is diagnostic of ISM, a careful clinical analysis will lead to the correct diagnosis in most cases. Radiation therapy is effective treatment for ISM, but only if it is administered early, before paraplegia supervenes. Thus, the diagnosis should be made and treatment begun as soon as possible. Intramedullary spinal cord metastasis is often multifocal rather than solitary; therefore, whole-cord rather than local spinal radiation should be given, if possible. If local radiotherapy is chosen, the construction of the portal can be based on the myelogram or, in the event of a normal study, on the clinical localization of the tumor.
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PMID:Intramedullary spinal cord metastasis. Diagnostic and therapeutic considerations. 357 64

The epidural compression secondary to genitourinary malignancies is relatively uncommon. Of 2118 patients who were diagnosed as having a genitourinary malignancy at the Columbia-Presbyterian Medical Center from 1970-1979, 21 are known to have developed an epidural cord compression by June 30, 1985 (16 from prostate, 1 from urinary bladder, and 4 from renal origin). The following items were reviewed in these 21 patients: age of the patient at diagnosis of the primary tumor; primary site of the genitourinary primary; time in months from the date of diagnosis of the genitourinary primary to the data of diagnosis of the spinal cord compression; methods of diagnosis; presenting symptoms and signs; treatment methods; and survival following the date of diagnosis of the compression. The distribution of location of the epidural metastasis in the current series is as follows: cervical-thoracic, 7%; thoracic, 73%; and lumbosacral, 20%. Skip metastases to the epidural space was the initial sign of malignancy in six patients (31.5%). Five patients (26%) with epidural cord compression survived at least 24 months following the date of diagnosis of their compression. Only two patients in this series with paraplegia (secondary to their compression) had improvement in ambulation following treatment of their compression: of these two patients, one had a prostate primary and the other a renal primary. The indications and techniques for surgery and radiotherapy are briefly described and early diagnosis and treatment are stressed.
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PMID:Epidural cord compression in association with genitourinary neoplasms. 371 59

Ten (23%) patients out of 43 with malignant glioma developed meningeal gliomatosis during the follow up period of at least one year. The duration between the first surgery and diagnosis of meningeal gliomatosis ranged from one to 78 weeks (median 45 weeks). In younger age group less than 20 years old, 5 (56%) out of 9 patients had meningeal gliomatosis, and on the contrary the incidence was lower in older age group above 20 years old (5 of 34, 15%). Seven (22%) out of 32 male and 3 (27%) out of 11 female patients developed meningeal gliomatosis. The primary tumor location were frontal lobe in 4 cases (including one bifrontal tumor), temporal in 2, parieto-occipital in 1, thalamus in 1, midbrain in 1, and cerebellar hemisphere in 1, respectively. Histologically, 7 tumors were anaplastic astrocytoma, and 3 were glioblastoma. The characteristic neurological findings observed during the course of meningeal gliomatosis were abnormal mental status (80%), cranial nerve palsies (50%), paraplegia (60%), stiff neck (80%), seizure (50%), and respiratory disturbance (80%), CSF cytology was positive in all 9 patients tested. CT scan demonstrated hydrocephalus (70%), and diffuse contrast enhancement of ventricular wall (60%) and basal cistern (10%). In 2 cases, block and irregular filling defect were seen by myelography. Six patients were treated by irradiation to the whole brain and/or spine, and 5, by intrathecal chemotherapy with methotrexate, cytosine arabinoside and bleomycin. However, all patients died of the tumor one to 46 weeks (median 18 weeks) after the diagnosis of meningeal gliomatosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical studies of meningeal gliomatosis]. 649 23

The majority of spinal neoplasms are metastatic lesions. This paper reports results of combination therapy of ninety-one cases of spinal metastasis verified by pathology. Most of them were metastases from breast, lung, thyroid and gastrointestinal cancers. Multiple metastatic lesions were mainly treated by chemotherapy. Radiotherapy was for radio-sensitive solitary lesions. Indication for operation included: (1) isolated spinal focus with unknown site of primary tumor; (2) recurrence or aggravation of tumor after chemotherapy or radiotherapy; (3) isolated radioresistant focus; and (4) the patients having paraplegia or an instable spine. Thirty cases were mainly treated by chemotherapy, 10 by radiotherapy, and 51 by operation. After the combination therapy, 13 cases were completely free of symptoms, 44 alleviated and 11 invalid. Of the 39 cases having paraplegia, 3 had complete recovery, 15 partial recovery and 21 no improvement. Of 85 cases having been followed up for 1-4 years, 51 cases (59.3%) survived for 3-11 months, 25 (29.1%) for 1-2 years and 10 (11.6%) for 2-3 years. The average survival time was 10.5 months. Analyzing the clinical and radiographic manifestations of the tumors and their treatment and prognosis, we consider that early diagnosis and combination therapy are the major factors influencing the therapeutic effect of spinal metastatic tumors.
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PMID:[Combination therapy of 91 cases of spinal metastases]. 817 68

Multiple myeloma, a multicentric hematological malignancy, is the most common primary tumor of the spine. As epidural myeloma causing spinal cord compression is a rare condition, its therapeutic approach and clinical results have been reported to be diverse, and no clear guidelines for therapeutic decision have been established. Three patients presented with progressive paraplegia and sensory disturbance. Image and serological studies revealed multiple myeloma and spinal cord compression caused by epidural myeloma. Emergency radiotherapy and steroid therapy were performed in all three cases. However, their clinical courses and results were distinctly different. Following review of our cases and the related literature, we suggest a systematic therapeutic approach for these patients to achieve better clinical results.
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PMID:Multiple Myeloma and Epidural Spinal Cord Compression : Case Presentation and a Spine Surgeon's Perspective. 2417 35

Anesthesia for a patient with pheochromocytoma is challenging; irrespective of whether it is a diagnosed case for planned surgery or an occult case, it can be a nightmare. The patient may be given anesthesia for removal of the primary tumor or for surgery other than for the removal of the primary tumor. Hemodynamic derangements like hypertension and arrhythmia can be catastrophic. Monitored anesthesia care, though used for many cases, is unusual for a patient with diagnosed pheochromocytoma, with vertebral metastasis leading to paraplegia and atrial myxoma. In the case described below, the patient was operated for closed reduction, internal fixation with interlock nail femur, for pathological fracture. Surgery was done under monitored anesthesia care as there was no need for regional, spinal, or general anesthesia because of coexisting paraplegia. Surgery was uneventful and the postoperative period was smooth. This case is presented for its uniqueness of multiple diseases and uneventful recovery without any complications of anesthesia. The nightmare of pheochromocytoma eased without any morbidity for the patient, but this may not always be the case.
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PMID:Monitored anesthesia care in a case of pheochromocytoma and atrial myxoma. 2588 32

A 48-year old male patient developed numbness in the lower half of the body 5 months after the curative operation of left renal cell carcinoma. Neurological examinations revealed the sensory disturbance below the T10 dermatome. A sagittal T2WI of the spinal MRI demonstrated a longitudinally extensive spinal cord lesion (LESCL) ranging from the C7 to L1 vertebral level. The neurological deficits rapidly deteriorated to paraplegia with bladder bowel disturbance. The high dose steroid pulse therapy showed temporary effect. The Gd enhanced T1WI of the spinal MRI taken on the 24th hospital day demonstrated a solitary intramedullary mass in the T8-9 level with ring enhancement, and a subsequent total resection of the tumor was performed. The histopathological studies of the tumor lead to the diagnosis of intramedullary spinal cord metastasis of the renal cell carcinoma. The post-operative T2WI of the spinal MRI revealed disappearance of the longitudinally extensive lesion. On the 112 hospital day, he was discharged with ambulatory aid. While solitary intramedullary spinal cord metastasis of renal cell carcinoma is quite rare, it should be suspected when the LESCL is revealed on a spinal MRI, even after the curative operation of the primary tumor.
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PMID:Metastatic renal cell carcinoma initially presented with a longitudinally extensive spinal cord lesion on MRI. 2709 2

Prostate cancer is the second common etiology of cord compression after lung cancer. Its slow natural history justifies an aggressive treatment. The fact that the metastatic lesion precedes the primary tumor remains rare. We report the case of a 86 year-old man who was admitted for heaviness of both lower limbs responsible for gait disorder. He had flaccid paraplegia. Spinal MRI showed an epidural lesion. Histology after surgery was compatible for a metastasis of prostatic adenocarcinoma. Spinal cord compression due to prostate cancer is correlated with poor prognosis. The fact that the metastatic lesion precedes the primary tumor remains rare.
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PMID:Isolated metastatic dorsal spinal cord compression revealing prostatic adenocarcinoma. 3121 Oct 73