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)

A 53-year-old woman presented with symptoms of weight loss, diarrhea, and melena. A barium enema with endoscopy revealed multiple colonic polyps which were shown histologically to be metastatic deposits of poorly differentiated adenocarcinoma. The primary tumor, a poorly differentiated gastric adenocarcinoma, had been resected 11 years earlier. This appears to be only the second published report of polypoid colonic metastases from gastric adenocarcinoma.
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PMID:Metastases from gastric adenocarcinoma presenting as multiple colonic polyps: report of a case. 751 12

This study was aimed at evaluating CT diagnostic capabilities in detecting carcinoid tumors of the small bowel and comparing CT results with conventional radiographic findings. The CT diagnosis of carcinoid tumor was made in 6 cases based on CT findings. All patients had undergone conventional radiographs (transit or double-contrast studies of the small intestine) and 2 patients had undergone double-contrast barium enema of the colon. 500 ml of oral contrast medium were administered 2 hours, 1 hour and 15 minutes before CT scans, respectively. A hypotonic agent was injected i.v. immediately before the examination. Primary lesion extent, mesenteric involvement, extramesenteric lymph nodes and hepatic metastases were the investigated CT patterns. The first two variables were also assessed on plain radiographs. In all patients the diagnosis of enteric carcinoid tumor was confirmed at surgery or liver biopsy. CT proved to be useful in demonstrating the primary tumor in 5 cases, mesenteric involvement in all patients, liver metastases in 3, lymphadenopathy in none. CT yielded very accurate findings and thus allowed the diagnosis of carcinoid tumor to be made in all the 6 patients, while plain films resulted normal in 2 cases and aspecific in 4. In conclusion, CT, if adequately performed, proved the best technique to detect carcinoid tumors of the small bowel. Of course, further evidence is required.
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PMID:[Computed tomography diagnosis of small intestine carcinoid]. 824 84

During a seven year period 18 benign small intestinal tumors were histologically documented in patients referred to us for a small bowel study, using a barium infusion technique. These included seven leiomyomas, five adenomatous polyps, two Peutz-Jeghers hamartomas, one myoepithelial hamartoma, one lipoma, one Brunner's gland adenoma and one neurilemmoma. Ten of the patients were women and eight were men, with their ages ranging from 20 to 75 years (mean age 45 years). Presenting symptoms were gastrointestinal bleeding in 12, anemia in 9, abdominal pain in 4, partial intestinal obstruction in 3 and bloody diarrhea in one. The time elapsed from onset of symptoms to radiological diagnosis ranged between one month and seven years (mean time 16 months). Multiple lesions were encountered in four cases and solitary in fourteen. The site of involvement was the duodenum in 3 patients, the jejunum in 8 and the ileum in 7 of them. Main radiological appearances included solitary or multiple intraluminal filling defects, mass effect on neighbouring loops and dilation of intestinal loops proximally to the lesion. The primary tumor, in the form of a mass or other abnormality of the small intestine was identified in all study cases. Correlation with surgical or endoscopic findings showed that radiology depicted all single lesions, whereas multiple lesions were underestimated in one case. The individual morphological changes shown on examination of the resected specimens resembled the appearances on the barium study in all cases. However, enteroclysis missed four out of seven ulcers and a stalk in one of the five pedunculated lesions. A specific tumor-type diagnosis was reached preoperatively in eleven patients, it was suggestive in five and mistaken in two of them. Our experience indicates that enteroclysis is an effective means in evaluating patients with suspected benign small bowel tumors, preoperatively.
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PMID:Benign tumors of the small intestine: preoperative evaluation with a barium infusion technique. 846 75

Knowledge of the extent of primary colorectal carcinoma at initial diagnosis is critical for proper management of disease. Currently, CT does not have a role in screening for colorectal carcinoma, though promising work on virtual colonoscopy is on the horizon. In patients with proven colorectal carcinoma, accurate prospective noninvasive assessment can identify those who may benefit from preoperative local radiotherapy, hepatic resection or cryoablation, or intra-arterial chemotherapy. CT should be considered complementary to the clinical assessment of colorectal carcinoma and to other modalities, such as barium enema, endorectal ultrasonography, MRI, and immunoscintigraphy. Although limited in evaluation of the primary tumor and local spread, CT has proven useful in assessing patients thought to harbor extensive local or metastatic disease. CT is generally the modality of choice for imaging the postoperative patient. The cross-sectional display of CT clearly depicts the operative bed, particularly after abdominoperineal resection. Baseline examinations should be obtained 2 to 4 months after surgery, with follow-up examinations every 6 to 9 months for 2 years, and yearly studies thereafter. CT-guided biopsies should be performed when findings suggest recurrent carcinoma.
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PMID:Computed tomography evaluation of colorectal carcinoma. 884 30

Three active antitumor agents, i.e. 5-fluorouracil (5-FU), oxaliplatin and CPT-11, are available for the treatment of advanced colorectal cancer (CRC) patients and have been successfully combined in two-drug regimens. Hence, CRC has become a chemosensitive disease, but the optimal combination of these agents in first-line treatment remains to be determined. We report the first case of the combination of CPT-11 with oxaliplatin, 5-FU and folinic acid (FA) as first-line chemotherapy for a patient with a pre-occlusive sigmoid adenocarcinoma and synchronous bulky liver metastases. CPT-11 was given at 125 mg/m2, prior to the start of a chronomodulated 4-day infusion of oxaliplatin 25 mg/m2/day, 5-FU 800 mg/m2/day and FA 300 mg/m2/day repeated every 2 weeks. The doses could be escalated to 150 mg/m2 for CPT-11 and 900 mg/m2/day for 5-FU. After six cycles of chemotherapy 70% reduction in tumor size was documented in the liver. The primary tumor was no longer detectable by barium enema. The toxicity included three episodes of grade 4 neutropenic fever, and two episodes of severe diarrhea and vomiting with dehydration. A cumulative grade 2 neurosensory toxicity was observed after six cycles. Following surgery of the primary tumor, because of the major hepatic tumor response and of the absence of extra-hepatic metastases, the patient might be registered for a liver transplantation program. This first report of combining the three active agents in CRC every 2 weeks led to a high dose intensity of each agent and was associated with a dramatic tumor response of a very advanced disease in a patient with already altered performance status. The antitumor activity in this patient suggests that a three-drug intensified regimen might be feasible and active. A prospective study appears warranted to further examine the efficacy and toxicity of this therapeutic approach, and to determine whether it may increase the fraction of advanced CRC patients becoming resectable. This aggressive chemotherapy program may contribute to a re-examination of the usefulness of liver transplantation in patients with metastatic CRC confined to the liver.
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PMID:Dramatic tumor response of bulky liver metastases following treatment with CPT-11 and a chronomodulated 4-day infusion of 5-fluorouracil, folinic acid and oxaliplatin every 2 weeks in a colorectal cancer patient. 1089 41

An 81-year-old man who had been aware of a right anterior abdominal mass for 1 week was admitted to our hospital on July 3, 1999, after the mass had perforated and was secreting mucinous purulent material. Computed tomography clearly showed an anterior abdominal wall abscess and a large intraabdominal tumor that contained a fistula-like structure. Barium enema revealed an apple-core sign at the transverse colon, with a fistula that connected the colon to the abscess cavity. Transverse colonic cancer complicated by an anterior abdominal wall abscess was diagnosed, and an extended right hemicolectomy was performed. We did not perform en bloc excision of the full thickness of the anterior abdominal wall, including the abscess, because the defect was determined to be too large to repair. Thus, when curative resection is not feasible, as in our patient, resection of the primary tumor with en bloc partial resection of the adherent parietal wall should be performed if possible, as this procedure has the potential to improve the postoperative quality of life of the patient.
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PMID:Transverse colonic cancer presenting as an anterior abdominal wall abscess: report of a case. 1129 14

Acquired TEF is a rare complication that can occur from a variety of causes. The most common etiology of nonmalignant TEF is as a complication of intubation with cuff-related tracheal injury. Most patients present with increased secretions, pneumonia, and evidence of aspiration of gastric contents while the patient is on mechanical ventilation. When diagnosed after extubation, the most frequent sign of TEF is coughing after swallowing. A high index of suspicion is required in patients at risk for developing a TEF. The diagnostic evaluation is by bronchoscopy and esophagoscopy. When the diagnosis has been made, the immediate goal should be to minimize tracheobronchial soilage by placing the cuff of a tracheostomy tube distal to the fistula. Reflux of gastric contents is diminished by placement of a gastrostomy tube, and adequate nutrition is facilitated by inserting a jejunostomy tube. Surgical correction is required because spontaneous closure is rare, but surgery should be postponed until the patient is weaned from mechanical ventilation because positive pressure ventilation after tracheal repair carries an increased risk of anastomotic dehiscence and restenosis. An anterior cervical collar incision can be used for most cases of post-intubation TEFs. The esophagus should be closed in two layers over a nasogastric tube and buttressed with a pedicled strap muscle flap. If the tracheal defect is small, primary repair can be employed. In most cases, however, the best results can be achieved with tracheal resection and reconstruction. The patient should be extubated at the completion of the case, if possible. With this strategy, as first described by Grillo and colleagues [27], single-stage repair can be performed safely and with a high success rate. Malignant TEFs cannot be cured because of the underlying incurable disease process. As with nonmalignant TEFs, the principal complications are tracheo-bronchial contamination and poor nutrition. Without prompt palliation, death occurs rapidly, with a mean survival time of between 1 and 6 weeks in patients who are treated with supportive care alone. The most common primary tumor causing malignant TEF is esophageal carcinoma. The other frequent cause is lung cancer. Patients present with signs and symptoms typical of TEF, including coughing after swallowing. Diagnosis is made by barium esophagography, and the location and size of the fistula is determined by bronchoscopy and esophagoscopy. Treatment must correct the two problems of airway contamination and poor nutrition. The most effective treatments are esophageal bypass and esophageal stenting. Bypass is demonstrated to resolve respiratory soilage and allow fairly normal swallowing, but it should be reserved for patients who can tolerate a major operation. Stenting can be offered to nearly all patients regardless of their physiologic condition. Stenting also limits aspiration and allows swallowing. Esophageal exclusion is rarely indicated in the current era of familiarity with stenting techniques. Direct fistula closure and fistula resection do not yield satisfactory results. Radiation therapy and chemotherapy combined might offer a survival benefit compared with supportive care alone. The complication of TEF secondary to malignancy is a devastating problem that carries a bleak prognosis, but when it is performed promptly after the diagnosis of a malignant TEF, esophageal bypass or stenting improves survival and quality of life for these unfortunate patients.
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PMID:Tracheoesophageal fistula. 1275 13

A 59-year-old male patient with rectal cancer 2 cm in diameter (T2) at the peritoneal reflection with suspicious left lateral node metastasis was treated with 400 mg of preoperative oral uracil and tegaful (UFT) for 5 weeks, 5 days a week in combination with concomitant radiotherapy of 45 Gy per 25 fractions for 5 weeks. After resting for another 5 weeks, colon fiberscopy, barium enema, and computed tomography revealed a trace of the primary tumor and a 40% shrinkage of the lateral metastasis. The serum CEA level decreased to the normal range during treatment. The adverse effects were nausea, bloody stool and elevation of transaminase, all at grade 1. Low anterior resection with a left hemi-lateral lymphadenectomy was performed through a suprapubic, one hand-size incision without laparoscopy. The preoperative treatment did not affect any operative procedures, and no postoperative complications occurred. The surgical specimen showed that the rectal tumor had been remarkably shrunk by the preoperative treatment, to the level of a superficial type tumor. Histological analysis indicated moderately differentiated adenocarcinoma cells that were present at only 2 mm in diameter in the mucosal layer, 6 mm in the submucosal layer, and 1 mm or less in the muscular layer with scar formation. No metastasis was detected in the 16 lymph nodes dissected, but an organizing tumor thrombus, which had preoperatively been diagnosed as lateral node metastasis, was detected. These results suggest that preoperative oral UFT plus concomitant radiotherapy may be a feasible, tolerable and effective treatment for patients with rectal cancer.
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PMID:Neoadjuvant therapy of rectal cancer using oral tegaful-uracil (UFT) plus concomitant radiotherapy--a case report. 1618 Jul 2

A 54-year-old woman with advanced gastric cancer was referred to our hospital. Because it was the yearend, we selected neoadjuvant TS-1 combined with CDDP therapy. TS-1 (60 mg bid) was administered orally for 21 consecutive days, and CDDP (60 mg/m(2)) was infused intravenously on day 8. One course was completed without serious toxicities. The primary tumor revealed partial response (PR) with no lymph node metastasis judged from barium meal study and upper GI endoscopic findings. After 3 weeks, a simple total gastrectomy with lymph node dissection was performed. The pathological diagnosis proved that there were no cancer cells in the primary lesion or regional lymph nodes, suggesting a complete response (CR) to chemotherapy. The postoperative course was uneventful, and she has been fine as an outpatient.
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PMID:[Advanced gastric cancer responding to pathological CR after neoadjuvant TS-1 combined with CDDP therapy--report of a case]. 1677 Jan 2

A 56-year-old man, who had been complaining of diarrhea for several months, was admitted for further examination of a hepatic tumor. A needle biopsy of the hepatic tumor suggested metastatic carcinoid tumor. The primary tumor was found in the ileum by extracorporeal sonographic examination and a barium meal study. We performed a partial excision of the ileum, lymph node resection, wedge biopsy of the liver, and catheterization from the right iliac artery to the hepatic artery for intraarterial chemotherapy. The pathological diagnosis was endocrine cell carcinoma of the ileum and local lymph nodes and hepatic metastasis. After surgery, the patient has been treated with continuous intraarterial infusion of CDDP and 5FU. The liver tumors almost disappeared. As of 20 months after the surgery, the patient is well and is being followed in the outpatient clinic.
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PMID:[A case of endocrine cell carcinoma of the ileum: sonographic findings and clinical outcome]. 1702 56


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