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Query: UMLS:C0677930 (primary tumor)
 20,210 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

All the consultants agree that, given this patient's history, a common skin tumor like squamous cell or basal cell carcinoma is unlikely. Melanoma or Merkel cell carcinoma belong in the differential. Interestingly, the consultants all suggest a biopsy of the lesion prior to other testing, and because this tumor is so accessible, a biopsy should not interfere with further testing or treatment. Drs. Weymuller and Marks would then proceed with a CT scan; Dr. Ridge favors an MRI scan. While a chest-ray is in order to rule out metastases, Dr. Weymuller also suggests immunocytochemistry. All the experts agree that the primary tumor should be excised. Dr. Weymuller would perform a total parotidectomy with facial nerve preservation, while Drs. Marks and Ridge suggest a superficial parotidectomy with facial nerve preservation. Drs. Weymuller and Ridge would also perform a modified radical neck dissection. In the absence of cervical disease, Dr. Marks would treat the neck primarily with radiotherapy. Only Dr. Weymuller favors immediate reconstruction and would use a lower trapezius island flap or a large rotational flap. Drs. Marks and Ridge prefer primary closure or skin graft. Drs. Weymuller and Ridge would treat this patient with combined therapy, giving radiotherapy to the primary area and the neck postoperatively at a dose of 55-60 Gy. However, Dr. Marks would treat the primary site postoperatively and the neck primarily with radiotherapy. He would treat the primary site with 59.40 Gy and the neck with 50.40 Gy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Merkel cell carcinoma of the ear. 198 33

CT and MRI are both useful for assessing deep tissue extensions of squamous cell carcinomas of the extracranial head and neck region that are stage T2 or greater. Diagnostic imaging information, in combination with clinical findings, will establish the stage of a primary tumor and the status of regional nodes and will allow a rational treatment plan to be made. Once treatment is completed, a baseline scan 3 to 6 months following treatment is recommended in patients who are at risk for a later recurrence. For most primary tumor sites, MRI will give the most information concerning recurrent disease. Occult primary tumors with regional node metastases present a special set of circumstances. CT or MRI scans are recommended prior to performing random biopsies to search for elusive primary tumors in the upper aerodigestive tract.
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PMID:The impact of radiologic imaging on staging of cancer of the head and neck. 201 3

A retrospective, nonblinded review of ten nerve sheath tumors (four malignant) selected for pathologic proof and complete magnetic resonance (MR) evaluation was performed to assess the primary tumor location, signal pattern, and extent of reactive zone. A modification of visual fuzzy cluster analysis (VFCA) that emphasized the number of visual fuzzy clusters in each mass was developed to assess the neural tumors. The MR findings were correlated with the findings at surgery and histopathology. There were six men and four women, aged 19 to 62 years (mean, 43). Nine tumors involved the lower extremity. In all tumors, MRI correctly identified the nerve trunk of origin. Tumor dimensions were generally overestimated by MRI. Three internal signal patterns were observed: homogeneous (1/1 benign), finitely inhomogeneous (5/5 benign), and hectically inhomogeneous (4/4 malignant). The number of visual fuzzy clusters (VFCRs) for each sequence did not allow reliable separation of benign and malignant entities, but when considered in aggregate, benign and malignant lesions segregated in different clusters. This implies that the likelihood of malignancy increases as the number of MR-identifiable tissue types per lesion increase. Three types of reaction (edema) were observed best on long repetition time/echo time (TR/TE) sequences, confined to immediate peritumoral region, intracompartmental, and extracompartmental. The first two patterns correlated well with clinicopathologic findings; however, the third pattern did not. Separation of indolent (benign) cellular masses from aggressive (malignant) ones by MR characteristics is difficult but VFCA shows promise for aiding this differentiation and deserves further investigation in larger study populations.
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PMID:Magnetic resonance imaging of peripheral nerve sheath tumors. Assessment by numerical visual fuzzy cluster analysis. 212 35

Whether to accept the report of the referring physician is often a stumbling block for many otolaryngologist-head and neck surgeons, especially when management of the case is changing hands. Thus, it is no surprise that all the consultants would repeat the examination of the upper aerodigestive tract under anesthesia. Drs. Robbins and Fried objected to the term "blind" biopsies and preferred "random-guided" and "directed" biopsies is that order. Yet, all 3 specialists agree that multiple biopsies of Waldeyer's ring should be obtained. They emphasize that palpation is an integral part of the endoscopy and may guide the surgeon in deciding where to biopsy. The surgeons agree that the base of tongue has the highest yield in cases like this one. Dr. Robbins stands alone in his use of ipsilateral tonsillectomy as a screening biopsy technique. Dr. Robbins believes imaging studies have a role prior to the initial panendoscopy and prefers an MRI of the head and neck. Drs. Gluckman and Fried use imaging studies if the primary tumor is in a clinically difficult area to evaluate. Faced with a normal repeat endoscopy and no other cervical adenopathy, Drs. Fried and Robbins would treat Waldeyer's ring and both sides of the neck with radiotherapy; Dr. Fried suggests 60 to 65 Gy over 6 weeks and Dr. Robbins suggests 65 to 70 Gy over 6 to 7 weeks to Waldeyer's ring and the upper neck but would treat the remaining nodal areas of the neck with 50 Gy over 5 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cervical metastatic squamous carcinoma of unknown or occult primary source. 179 Nov 50

From March 1985 to September 1988, 38 out-patients with nasopharyngeal carcinoma (NPC), proven by pathology and examined by CT scan or MRI with involvement of deep upper cervical lymph nodes larger than 2 cm, were treated. The invasion of the poststyloid space is probably caused by metastases of the lymph nodes deep-seated in the neck and not by direct infiltration of the primary tumor. In TNM staging, it should be considered as N1, but not T3. As to the design of radiotherapy for these cases, the upper margin of the cervical field should be moved up to the level of the external auditory meatus in order to encompass the base of the skull. If lymph nodes in the mastoid cells on the same side are involved, beta-beams with energy not lower than 15 Mev should be used to ensure enough dose in the target volume.
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PMID:[Invasion of poststyloid space and metastasis of deep upper cervical lymph node in nasopharyngeal carcinoma]. 240 Nov 73

Over the past 10 years there has been significant progress made in the recognition and treatment of soft tissue sarcomas. With the advent of CAT scans and MRI, preoperative delineation of soft tissue tumors has become readily available. The diagnostic use of these modalities in patients presenting with an ill-defined asymptomatic mass has been extremely helpful in terms of screening patients to decide whether or not a biopsy is indicated. These techniques have also provided a much clearer delineation of the anatomic extent of the primary tumor, which has been of great assistance both in radiation therapy treatment calculations as well as in preoperative surgical planning. The recognition that tumor grade is the dominant prognostic variable has resulted in the more common use of a grading system, and a more uniform reporting and stratification of end results. Recent studies with immunohistochemical staining have proven of value in determining the histogenesis of many tumors that in the past were difficult to classify accurately. Most recently the use of flow cytometry suggests that this will also be a valuable adjunct in determining tumor grade and thereby prognosis. The most recent investigations of molecular biologic evaluation of genetic DNA and RNA sequences, as well as of oncogenes are extremely interesting from a diagnostic standpoint and in demonstrating the potential of molecular biologic evaluation for understanding the origin of these tumors. Multimodality therapy with surgery, radiation, chemotherapy, or all three has resulted in a marked improvement in local tumor control for patients with soft tissue sarcomas. The combination of modalities has allowed smaller surgical excisions of the tumor and thereby preservation of the extremity and much of its function. There are currently several different methods of multimodality therapy used including neoadjuvant therapy and postoperative therapy, both of which have been proven efficacious. Chemotherapy is now playing an increased role in clinical investigation and treatment. The availability of Adriamycin, DTIC, cisplatin, and most recently ifosfamide has added several chemotherapeutic agents for use by the clinician. Combination chemotherapy and radiation is of value in the neoadjuvant setting, and several studies are now underway to determine whether postoperative adjuvant chemotherapy is of similar value in reducing systemic spread of disease. Finally, surgical resection of pulmonary metastases has been proven of value in 20% to 25% of patients who subsequently develop metastatic disease. As a result of these advances in several different treatment disciplines, the overall survival rate and quality of life of patients with soft tissue sarcoma have improved markedly over the past 10 years.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Progress in the recognition and treatment of soft tissue sarcomas. 240 92

Cross-sectional imaging techniques have dramatically improved the diagnosis of adrenal disease. In most patients with endocrine-active adrenal disease, CT is the only imaging test needed to establish the correct diagnosis. Adrenal venography with blood sampling may provide important additional information in patients with Conn adenoma. Magnetic resonance imaging and (IMBG) scintigraphy appear to be the best imaging tests for the localization of multiple or extra-adrenal pheochromocytomas. Inactive adrenal tumors detected incidentally are a problem as for as diagnosis is concerned, since inactive adrenal adenomas have to be differentiated from carcinomas and metastases. MRI is rarely helpful in these cases. For patients with a known primary tumor, the authors recommend CT-guided biopsy. In all other cases a follow-up study often reveals that the adrenal tumor detected is benign.
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PMID:[Current developments in the radiologic diagnosis of the adrenal glands]. 264 16

Preservation of anorectal function makes chemoradiotherapy attractive as the primary treatment in patients with squamous cell carcinoma of the anal region. Despite variations in techniques of chemoradiotherapy administration, the accumulated experience of a number of institutions indicates substantial improvement over previous approaches, which included surgery or radiation therapy individually. Although no longer providing the definitive therapeutic role in this disease, the surgeon is frequently asked to evaluate lesions suspected of being anal malignancies. In addition, it is the surgeon who most often performs the diagnostic biopsy, consults on local complications of chemoradiotherapy, and manages complications of local recurrence. In this context, optimal care includes early organization of the medical oncologist, radiation therapist, and surgeon to participate in the initial diagnostic evaluations, examinations with the patient under anesthesia, and follow-up during therapy. A complete response is often not evident until 2 to 3 months after treatment. We recommend a follow-up schedule of monthly visits for the first 6 months, examinations every 3 months for the next 2 years, and assessment every 6 months thereafter. Evaluation during early routine visits includes manual and proctoscopic examination of the perineum and rectum and review of the hemogram and liver enzyme levels in the serum. CT, MRI, or lower endoscopy procedures are performed only if clinical examination or studies suggest the possibility of recurrence or a second primary tumor. Patients with an incomplete response to therapy after 3 months often undergo examination under anesthesia with biopsy of suspect areas. Chronic inflammatory changes in the area of previous carcinoma may be interpreted as persistent disease. Thus histologic proof of recurrent malignancy must be obtained before considering surgical or chemoradiotherapy salvage treatment.
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PMID:Carcinoma of the anal region. 268 Feb 90

47 patients with histologic/cytologic confirmed bronchogenic carcinoma were examined with CT and MRI. Negative and contrast enhanced CT examinations were performed, MR images were obtained with ECG gated T1- and T2-weighted SE sequences in axial and coronal planes. Both methods were evaluated with respect to tumor imaging and delineating of tumor extensions. CT and MRI were generally in agreement for primary tumor and lymph node staging. 7 out of 10 patients with malignant pericardial involvement and 3 out of 27 patients with mediastinal subcarinal lymph node metastases were identified only in MR images. MRI was superior to CT in demonstration of aortic involvement, poststenotic syndrome and extension of chest wall invasion. Additionally MRI gave functional informations about blood flow in case of superior vena cava obstruction.
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PMID:[MRI of bronchogenic carcinoma]. 272 6

54% cases of malignant gliomas followed more than 2 years were studied about prognostic factors focusing on neuroradiologic image analysis in the two groups classified survival cases over 2 years and dead cases within 2 years after surgical treatment. 21% cases of malignant gliomas having tumor infiltration or edema to contralateral hemisphere on CT and MRI before treatment were dead within 2 years. 80% of recurrent malignant gliomas had abnormal shadow on CT due to tumor recurrence in primary tumor site or ventricular wall and/or contralateral hemisphere continuing with there. Remote metastasis discontinuing with primary site was demonstrated in only 20% of them. Over 90% of glioblastoma multiforme showing irregular tumor stain with arteriovenous fistula on angiogram were dead within 2 years, whereas in the cases without tumor stain the alive cases more than 2 years increased comparing with those having tumor stain.
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PMID:[Neuroradiological image analysis and prognostic factors of malignant gliomas in the cerebral hemisphere of adults]. 281 Jul 74


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