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PubMed2005

Epithelioid angiosarcoma involving the lungs.

Diffuse lung involvement by metastatic tumor from an unknown primary site often constitutes a diagnostic dilemma. Although cytologic features and pattern of metastatic spread can guide in narrowing the list of possible primary neoplasms, immunohistochemistry remains pivotal in determining the phenotype of metastatic disease. We report a case with extensive involvement of lung parenchyma by a metastatic epithelioid neoplasm exhibiting a variety of distinctive patterns with a predominance of intra-arterial and lymphangitic spread. Immunohistochemical studies showed no evidence of epithelial, melanocytic, or lymphoid differentiation. The neoplastic cells were strongly positive for vimentin and CD31 but negative for CD34 and factor VIIIR:Ag. Electron microscopy of formalin-fixed tissue revealed multiple Weibel-Palade bodies and pinocytosis, supporting the diagnosis of epithelioid angiosarcoma. Doppler studies performed after pathologic diagnosis was rendered demonstrated 2 discrete hypoechoic masses within the medial aspect of the left proximal calf musculature, suggestive of solid soft tissue neoplasm-a possible source of pulmonary metastatic disease.

Aged↗

PubMed2004

Secondary mucinous carcinoma of the skin: metastatic breast cancer.

BACKGROUND: Breast cancer is the most common cancer in women. Its involvement of skin is the most frequent of visceral cancers in women. In cutaneous metastatic disease, including breast cancer, the clinical and histologic pattern may be specific or nonspecific. Specific clinical patterns of cutaneous metastatic disease are linked with breast cancer but occur less often with other cancers metastatic to skin. Likewise, specific histologic patterns of cutaneous metastatic disease are linked with breast cancer but occur less often with other cancers metastatic to skin. OBJECTIVE: To present a case of a mucinous breast cancer metastatic to skin where the histologic pattern is similar to the primary tumor. METHODS: This is a case report and a literature review. RESULTS: Metastatic breast cancer may rarely resemble primary skin cancer, in this case primary mucinous carcinoma of the skin. We describe a 60-year-old woman with breast cancer with the incidental finding of a nonspecific, soft, solitary nodule on her back. It was found to contain mucinous material and on close examination was found to be a metastatic mucinous carcinoma of the skin from a primary adenocarcinoma of the breast. CONCLUSION: One usually considers that hard, firm nodules are more suggestive of cutaneous metastatic disease than soft, nondescript ones, but one should be careful to consider secondary mucinous carcinoma of the skin and a histologically similar solitary cutaneous metastasis.

Adenocarcinoma, Mucinous↗

PubMed1986

[Relation between the metastatic spread of stomach cancer and the factors characterizing the primary tumor].

The paper deals with the analysis of patterns of metastatic spread in 738 gastric cancer patients versus site, size, gross appearance and histologic pattern of tumor at presentation. The likelihood of organ involvement through dissemination or invasion by gastric tumor was determined by assessing unknown probabilities by Bayes' theorem. The probability of correct preoperative evaluation of dissemination pattern ranged 0-0.935.

Adenocarcinoma↗

PubMed1993

Metastatic disease of the ureter: patterns of tumoral spread and radiologic findings.

The radiographic and sectional imaging features (ultrasound [US], computed tomography [CT], and magnetic resonance imaging [MRI]) of ureteral obstruction due to metastatic disease are reviewed. The radiologic findings depend on the pattern of the tumoral spread: hematogenous submucosal/mucosal metastasis, hematogenous adventitia metastases spreading along periureteral vessels, scirrhous metastatic spread along periureteral vessels, or metastatic spread into lymph nodes with perinodal desmoplastic reaction. Solitary or multiple extraluminal obstructions without substantial displacement of the ureter are characteristic. CT is the examination of choice for morphological analysis. Together with the patient's history and clinical data, a presumptive diagnosis of ureteral obstruction caused by metastatic disease can be made.

Adult↗

PubMed1999

A novel orthotopic model of breast cancer metastasis to bone.

Breast cancer affects approximately one woman in twelve and kills more women than any other cancer. If detected early, patients have a five year survival rate of 66%, but once metastatic disease has developed, there is no effective treatment. About 70% of patients with metastatic disease have bone involvement, while lungs and liver are the other common targets. Bone metastases cause severe pain, pathological fractures and hypercalcaemia and thus are a significant clinical problem. The development of new therapies for metastatic breast carcinoma depends on a better understanding of the mechanism of homing of the tumour cells to bone, liver and lungs and the factors required for their growth in these organs. Research on mechanisms of breast cancer metastasis, particularly to bone, has relied on in vitro studies or on tumour models in which the inoculation route is designed to promote delivery of tumour cells to a specific organ. Metastases in bone are achieved by inoculation into the right ventricle of the heart. To our knowledge there has been no report of a model of metastatic spread from the mammary gland to distant sites which reliably includes bone. In this paper, we describe our recent development of a novel murine model of metastatic breast carcinoma. The new model is unique in that the pattern of metastatic spread closely resembles that observed in human breast cancer. In particular, these murine breast tumours metastasise to bone from the primary breast site and cause hypercalcaemia, characteristics not normally found in murine tumours, but common in human disease. Furthermore, in a preliminary characterisation of this model, we show that secretion of parathyroid hormone-related protein, a role for which has been implicated in breast cancer spread to bone, correlates with metastasis to bone. This model therefore provides an excellent experimental system in which to investigate the factors that control metastatic spread of breast cancer to specific sites, particularly bone. The special advantage of this system is that it involves the whole metastasis process, beginning from the primary site. Existing models consider mechanisms that pertain to growth of tumour once the site has been reached. An understanding of the regulation of these factors by potential therapeutic agents could lead to improvement in therapies designed to combat metastatic disease. For the first time, this development will allow exploration of the molecular basis of site-specific metastasis of breast cancer to bone in a clinically relevant model.

Animals↗

PubMed1998

Imaging characteristics of metastatic disease to the chest.

The radiographic appearance of metastatic disease is classic, but nonspecific. The differentiating characteristics of radiographic patterns of metastatic disease are discussed in this article, as well as the relative advantages of different imaging modalities. Recommendations for radiologic evaluation are also presented.

Blood↗

PubMed1999

Subtypes of renal cell carcinoma. Different onset and sites of metastatic disease.

Different subtypes of renal cell carcinoma have different genetic features and prognoses. Whether the patterns of metastatic spread of different subtypes of renal cell carcinoma are different is unknown. To assess this, we reviewed the time course and sites of all pathologically confirmed metastatic disease in patients who underwent resection of the primary tumor at Brigham and Women's Hospital, Boston, MA, between 1973 and 1997. In 82 patients, 119 metastatic lesions were identified. Compared with clear cell tumors, papillary tumors were more likely to be Fuhrman grade 3 or 4, to have metastases present at the time of resection, and to involve lymph nodes but not lung. Metastases associated with chromophobe tumors developed in 3 patients, all of whom had Fuhrman grade 2 tumors, and were found only in the liver. We conclude that different subtypes of renal cell carcinoma develop pathologically confirmed metastases at different times and sites. The value of Fuhrman grading may depend on the subtype of renal cell carcinoma.

Aged↗

PubMed1994

The relationship between tumour volume and the extent of spread in colorectal carcinoma.

115 colorectal carcinomas were measured in three dimensions. To compare the tumour volume, greatest linear dimension and the maximum thickness of colorectal carcinomas with the extent of spread. A formula was devised for estimating tumour volume based on the oval shape of most carcinomas. Dukes staging was performed after xylene/alcohol fat clearance. The mean tumour volume of Dukes B tumours was greater than A tumours. The mean volume of C tumours was greater than that of A tumours. The mean volume of Dukes B tumours was greater than that of C tumours. The greatest linear dimension and the tumour thickness measurements also showed differences but were not as discriminating as the tumour volume. Using the Astler and Coller modification of Dukes staging, the mean tumour volume of C2 tumours was significantly greater than that of C1 tumours. Both C1 and C2 tumour volumes when considered separately were smaller than those of the B tumours. There was a significant positive correlation coefficient between tumour volume and the greatest linear dimension and also between tumour volume and the tumour thickness. There was no significant correlation within the C tumours between tumour volume and the number of lymph nodes with metastatic deposits. Colorectal carcinomas differ from other solid tumours in their growth pattern and metastatic behaviour. There is no direct relationship between increasing tumour size and progression in the Dukes staging. Some tumours appear to metastasize to lymph nodes while still small (C1 tumours); other tumours appear not to metastasize to lymph nodes regardless of size (B tumours).(ABSTRACT TRUNCATED AT 250 WORDS)

Colorectal Neoplasms↗

PubMed2003

Metastatic carcinoma of the gallbladder after a renal cell carcinoma.

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor. We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease. Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour. If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.

Carcinoma, Renal Cell↗

PubMed2005

Variation in gene expression patterns in effusions and primary tumors from serous ovarian cancer patients.

BACKGROUND: While numerous studies have characterized primary ovarian tumors, little information is available regarding expression patterns of metastatic sites of this cancer. To define sets of genes that distinguish primary and metastatic ovarian tumors, we used cDNA microarrays to characterize global gene expression patterns in 38 effusions (28 peritoneal, 10 pleural) and 8 corresponding primary ovarian tumors, and searched for associations between expression patterns and clinical parameters. RESULTS: We observed multidimensional variation in expression patterns among the cancers. Coordinate variation in expression of genes from two chromosomal regions, 8q and 19q, was seen in subsets of the cancers indicating possible amplifications in these regions. A set of 112 unique genes of known function was differentially expressed between primary tumors and effusions using supervised analysis. Relatively few differences were seen between effusions isolated from the pleural and peritoneal cavities or between effusions from patients diagnosed with stage III and stage IV cancers. A set of 84 unique genes was identified that distinguished high from lower grade ovarian cancers. The results were corroborated using immunocytochemistry, mRNA in situ hybridization, and immunoblotting. CONCLUSION: The extensive variation in expression patterns observed underscores the molecular heterogeneity of ovarian cancer, but suggests a similar molecular profile for ovarian carcinoma cells in serosal cavities.

Adult↗

PubMed2001

[Diagnosis and treatment of tumor metastases].

More than half the patients with malignat tumours have at the time of diagnosis already remote metastases or they develop remote dissemination after different intervals following termination of local treatment. Organ complications in case of metastatic dissemination are for the majority of patients the most life threatening condition. In therapeutic decisions the approach to some solid tumours is the same as in systemic diseases. The possibility to achieve a long-term therapeutic effect during conventional systemic therapy are limited in metastatizing solid tumours of adult age. Assessment of the extent of the disease incl. detection of metastatic dissemination is of decisive importance for the selection of therapeutic strategy. Imaging methods such as computed tomography, ultrasonography and nuclear magnetic resonance provide basic structural anatomic information. The limitating factor is obtaining functional information on tumor tissues and the possibility to differentiate the residual disease from non-viable or necrotic tumor masses. These data can be provided by radiopharmacological imaging methods such as positron emission tomography. Introduction of new imaging methods is becoming increasingly important when new therapeutic methods are used where the effect of the therapeutic result does not mean necessarily reduction of the tumour volume. Research of the metastatic process involved revolutionary changese lucidating individual stages linked in a cascade pattern. The metastatic potential of human tumours correlates with the expression of a number of genes regulating tumour growth (EGF - epidermal growth factor, IGF - insulin like growth factor) motility of tumour cells (AMF - autocrine motility factor) the process of angiogenesis (VEGF vascular endothelial growth factor, bFGF - basal fibroblastic growth factor, interleukin-8) and the invasiveness (genes for the matrix of metalloproteinase MMP-2/MMP-9). Expression of the surface glycoporotein E-cadherin which influences the cohesiveness of cells is in an inverse relationship with the invasiveness and metastatic potential. Identification of the appropriate genes in a heterogeneous tumour population calls for multiparametric, multivariation analysis of gene expression. Understanding of this complex problem opened new possibilities of therapeutic action and improved curability of neoplastic diseases in all stages of the disease. Gradual more detailed understanding of individual stages of a multigrade process of metastatizing helped to reveal new potential target structures for treatment. In the process of angiogenesis these are metalloproteinases, angiogenic growth factors, endothelial cells and vascular structures of tumours. Practical use for therapeutic purposes will develop on the basis of results of clinical studies which are underway.

Humans↗

PubMed1996

Anatomic distribution of metastases in the vertebral body and modes of hematogenous spread.

STUDY DESIGN: A retrospective review of the magnetic resonance spine examinations of 49 patients with metastatic bone disease to the spine was performed. OBJECTIVES: To determine whether the pattern of metastatic distribution in the spine correlates with the type of primary tumor and theoretical mode of hematogenous spread by arterial or venous routes. SUMMARY OF BACKGROUND DATA: In 1940, Batson theorized a venous plexus route by which tumors spread to the spine from pelvic tumors such as prostatic carcinoma. It this theory is true, the venous vascular anatomy of the spine would result in metastases being deposited in the central or posterior vertebral body, whereas arterial deposits would occur near the end-plates. METHODS: Each vertebral body was divided into 27 equal cells in the magnetic resonance images; the central and posterior cells in the midsagittal view were defined as central, and the other cells were defined as peripheral. The primary tumor was assigned to either the arterial or venous group based on Batson's proposed mode of spread. The average number of lesions per involved vertebral body in the central and peripheral regions was calculated. RESULTS: There was no statistically significant correlation between tumors with proposed arterial/venous routes of metastasis and central/peripheral location of metastatic deposits. CONCLUSION: The mechanism by which tumors spread to the vertebral body may not be via a pure arterial or venous route. Other mechanisms such as tissue specificity, cascade system, and closed loop circulation system may be involved.

Adolescent↗

PubMed2006

Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck.

BACKGROUND: Among patients with cutaneous squamous cell carcinoma (SCC) of the head and neck, recent studies have shown that those with involvement of the parotid gland also have a high incidence of neck node involvement. Treatment of the neck by either surgery or radiotherapy is therefore recommended among patients with parotid SCC, even if clinical examination is negative. The aim of this study was first to analyze patterns of metastatic spread in the parotid and cervical lymph nodes and then to correlate the pattern of involved nodes with the primary cutaneous site in order to guide the appropriate extent of surgery, should neck dissection be used to treat the neck in patients with parotid SCC. METHODS: A cohort of 209 patients with cutaneous SCC of the head and neck and clinically evident regional metastatic disease was reviewed retrospectively from 3 Australian institutions. The distribution of involved nodes was obtained from pathology reports; the anatomic sites of primary cutaneous cancers were then correlated with these findings. RESULTS: Among 209 patients, 171 (82%) had clinical parotid involvement. Of these, 28 had clinical neck disease, whereas 143 had parotid disease alone. Thirty-eight (18%) patients had neck disease only. A total of 199 patients were treated surgically, whereas 10 received radiotherapy alone. Surgery included 172 parotidectomies and 151 neck dissections (93 of which were elective). Primary sites were cheek (21.7%), pinna (20.4%), temple (15.8%), forehead (15.8%), postauricular region (5.9%), neck (5.3%), anterior scalp (5.3%), posterior scalp (3.3%), periorbital (3.3%), nose (2.6%), and chin (0.6%). Among pathologically positive necks, level II was most frequently involved (79%). Level IV (13%) and level V (17%) were only involved in extensive lymph node disease, the exception being for isolated level V metastases from the posterior scalp. CONCLUSIONS: Primary sites were mainly localized to the lateral aspect of the head. Among patients with cutaneous SCC involving the parotid and neck, level II was the most commonly involved neck level. The distribution of involved nodes suggests that in a patient with parotid involvement and a clinically negative neck with an anterolateral primary, a supraomohyoid neck dissection, always including the external jugular lymph node(s) would be appropriate. In the case of a posterior primary, level V should be dissected as well. In patients with parotid SCC and a clinically positive neck, a comprehensive neck dissection is recommended.

Adult↗

PubMed1990

The pattern of vertebral involvement in metastatic vertebral breast cancer.

The spine is a common site of bony metastasis. To date, studies have not identified the initial site and pattern of vertebral metastasis in a homogeneous group of patients. Twenty-seven magnetic resonance imaging studies performed on 25 patients with metastatic vertebral breast cancer were reviewed retrospectively. The location and extent of metastatic vertebral involvement were determined. The vertebral body is the most frequent initial site of metastatic seeding. Although radiographically an absent pedicle is often the first sign of metastatic disease, involvement of the pedicle is by direct extension from either the vertebral body or the posterior elements and is therefore a late occurrence in the disease process.

Breast Neoplasms↗

PubMed2006

[Clinicopathologic characteristics of metastatic carcinomas to spleen].

OBJECTIVE: To study the clinicopathologic characteristics of metastatic carcinomas to the spleen. METHODS: Sixteen cases of metastatic carcinoma to the spleen were retrieved from archival clinical, surgical pathology and autopsy records. The demographic data (including sex and age of patients), clinical symptoms, primary sites, tumor histologic types, gross appearance of spleen and growth patterns within the spleen were analyzed. RESULTS: Among the 16 patients studied, 12 were males and 4 were females. The male predilection was obvious. The age ranged from 48 to 90 years, the median age 66.5 years. Major clinical symptoms included discomfort in the left upper quadrant, pain, emaciation and loss of appetite. Splenomegaly was noted in some patients and computerized tomography could show space-occupying lesions in the spleen. In general, lung was the most common primary site for splenic metastasis and accounted for 43.8% of all cases (7/16). In male patients, primary lung tumor was found in 50.0% cases (6/12). On the other hand, primary ovarian tumor was commonly seen in females (2/4). Histologically, undifferentiated carcinoma of lung was frequently encountered (25.0%, 4/16), including 3 cases of small cell undifferentiated carcinoma and 1 case of large cell undifferentiated carcinoma. Other histologic tumor types included bronchioloalveolar carcinoma (2 cases), colonic adenocarcinoma (2 cases), ovarian serous papillary adenocarcinoma (2 cases), and prostatic adenocarcinoma (2 cases). The commonest histologic tumor type found in male patients was pulmonary undifferentiated carcinoma. The growth patterns of metastatic carcinoma in spleen included nodular, diffuse and multinodular. Most cases presented as a single splenic nodule. Sometimes, tumors with high metastatic potential (5/16) showed diffuse and multinodular growth patterns. Examples of these tumors included small cell undifferentiated carcinoma (3 cases), pulmonary adenocarcinoma (1 case) and prostatic adenocarcinoma (1 case). CONCLUSIONS: Metastatic carcinoma to the spleen is rare. Understanding of the clinicopathologic characteristics is helpful in guiding clinical management and pathologic diagnosis.

Adenocarcinoma↗

PubMed1990

Serous carcinoma of the ovary: value of computed tomography in detection of calcified pleural and pulmonary metastatic implants.

Reported are three cases of serous papillary cystoadenocarcinoma of the ovary with pleural and pulmonary calcified metastatic implants detected by computed tomography (CT), but not by chest X-ray. CT patterns of metastatic calcifications were considered because of the unexpected frequency of this finding (15.7%) and in view of a possible clinical use of CT in monitoring extraabdominal disease.

Adult↗

PubMed2002

The role of (111)In Capromab Pendetide (Prosta-ScintR) immunoscintigraphy in the management of prostate cancer.

(111)In Capromab Pendetide (ProstaScintR) is a whole murine antibody that is reactive with prostate specific membrane antigen (PSMA), a glycoprotein on the surface of normal and abnormal prostate epithelium. It has proven to be of great value in assisting management decisions in prostate cancer patients who initially present with high risk for metastatic spread, or who develop a picture of recurrent disease after surgery or radiation therapy. Patterns of metastatic lymphatic spread have correlated well with autopsy reports in the literature. Unfortunately, other imaging study and/or histologic confirmation of scintigraphic findings has been difficult to obtain. Prostascint's role in predicting durable complete response (DCR) in postoperative patients having salvage radiotherapy to their prostate fossa is very promising. Further investigative work in larger patient populations is needed to confirm these early results.

Antibodies, Monoclonal↗

PubMedDate not supplied

CT of renal metastatic disease. A pictorial essay.

The routine use of computed tomography (CT) for the staging and follow-up of malignant neoplasm has improved the detection of secondary spread to the kidneys. This essay illustrates the gamut of the CT aspects of such secondary lesions. Seven main patterns of metastatic features are identified. Some of these patterns appear to reproduce the same radiological features seen in the corresponding primary lesions. Where feasible, differential diagnostic criteria are offered.

Adult↗