Primary liver tumor in a young man: a brief review of diagnostic strategies and treatment options.
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Biomedical subjects
Publications and source records attributed to R J Steckel.
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A single iv dose of 15 ml/kg fluosol DA (20%), a perfluorochemical oxygen carrier, caused hepatomegaly and splenomegaly which persisted for at least 3 weeks after drug injection. The peak increase in weight was at 3 days in the spleen (1.7x) and at 14 days in the liver (1.5x). Lung and kidney weights were not altered 1-21 days after administration of fluosol DA. The slopes of the single-dose radiation survival curves for intestinal epithelial cells and spermatogenic stem cells in mice breathing air or oxygen were not significantly altered by the administration of fluosol DA 10 min before irradiation, and the doses to achieve an isoeffect were altered by 1.03 or less. When mice were challenged with iv injected FSa tumor cells 24 h after treatment with fluosol DA, no increase in the number of artificial pulmonary metastases was observed.
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In summary, when photon-deficient lesions are demonstrated on bone scans of patients in the cancer age group, metastatic disease should be the first consideration. This is especially true in the presence of a lytic bone lesion. Bronchogenic and breast carcinomas are the most common primaries. A negative physical examination and normal CEA levels do not exclude the possibility of metastatic breast cancer.
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Following initial diagnostic work-up and histological confirmation of a metastatic lesion, an extensive search may fail to locate a primary cancer site. Two case reports are presented. A retrospective analysis was done of 255 patients with metastases of unknown origin; 231 patients (over 90%) have since died. Of 34 patients with autopsy information, no primary lesion was found in 20. In the remaining 14 cases, prior knowledge of the primary site would not have influenced either therapy or proganosis. A plea is made for judicious restraint in the use of diagnostic imaging procedures to search exhaustively for a primary cancer site.
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Pulmonary nodule detection was evaluated in full lung linear tomography at 1 and 2 cm intervals. Three radiologists independently reviewed 1 and 2 tomograms on 26 patients with 39 pulmonary nodules. Decisions made in each case included: (1) no nodule; (2) definite nodule(s); and (3) suspect nodule(s). The presence of nodules was determined by surgery, radiographic follow-up, or observer consensus. A significantly greater number of nodules was detected by all reviewers on the 1 cm tomograms. Of the 39 nodules, 72%-97% were detected as definite and 82%-100% were identified as definite or suspect. Factors relating to nodule detectability and observer performance are discussed. It is recommended that full lung linear tomography be performed at 1 cm intervals.
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In an initial pilot study technetium-99m-labelled human serum albumin was perfused directly into bipedal lymphatic cannulae prior to a standard lymphangiogram, in order to assess rapidly normal and abnormal lymph flow patterns in the lower extremity, pelvic and para-aortic lymph chains. A continuing study of these patients has lent further support to the hypothesis that the radionuclide perfusion study, when negative, may prove more accurate in some patients than the standard lymphangiogram in predicting the clinical course and/or the results of histopathological lymph node examination. The radionuclide technique also seems to meet, in this preliminary evaluation, the requirements for a pre-lymphangiogram screening study, particularly for use in high-risk patients.
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