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At least 433 records · Page 24Linked to original sources
PubMed1997

Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression. Evaluation by low-field MR imaging in cancer patients.

PURPOSE: The aim of the study was to estimate, in an acute care service, the frequency of multiple-level lesion involvement in patients with clinically suspected spinal cord compression or spinal blockage. MATERIAL AND METHODS: Over a period of 17 months, 240 patients with symptoms of acute spinal cord compression underwent acute MR examination of the spine in a 0.1 T MR unit. The cervical spine was only added to the examination if there was clinical suspicion of cord compression above Th1. RESULTS: In 65 (27%) of the 240 patients, involvement of at least one level was found. Of these patients, 32 (49%) showed involvement of more than one level. This high rate was surprising, since only 14 (44%) of the 32 multiple lesions had been clinically suspected. There was no correlation to age or original type of cancer. CONCLUSION: MR accurately demonstrates the anatomy of the spine and spinal cord, showing the level and complexity of spinal lesions. Multiple lesions may be underestimated when the combination of myelography/radiculography and CT is used.

Acute Disease↗
PubMed2005

Chordomas of the base of the skull and upper cervical spine. One hundred patients irradiated by a 3D conformal technique combining photon and proton beams.

To define the prognostic factors for local control and overall survival among 100 consecutive patients with chordoma of the base of skull or upper cervical spine treated by fractionated irradiation combining proton and photon beams. Between December 1993 and August 2002, 100 patients (median age: 53 years [8 - 85], M/F sex ratio: 3/2) were treated by a combination of high-energy photons and protons. The proton component was delivered at the Centre de Protonthérapie d'Orsay (CPO) by a 201 MeV beam. The median total dose delivered to the tumor volume was 67 GyECo. With a median follow-up of 31 months [range: 0 - 87], 25 tumours relapsed locally. The 2- and 4-year local control rates were 86.3% (+/-3.9%) and 53.8% (+/-7.5%), respectively. According to multivariate analysis, at least 95% of the tumor volume encompassed by the 95% isodose (p = 0.048; RR: 3.4 95%CI [1.01 - 11.8]) and a minimal dose delivered into the tumor volume <56 GyECo (p = 0.042; RR: 2.3 95%CI [1.03 - 5.2]) were independent prognostic factors of local control. Ten patients died. The 2- and 5-year overall survival rates were 94.3% (+/-2.5%) and 80.5% (+/-7.2%), respectively. According to multivariate analysis, local tumor control (p = 0.005; RR: 21 95%CI [2.2 - 200]) was a prognostic factor of overall survival. For chordomas of the base of the skull and upper cervical spine treated by surgery and irradiation combining photons and protons, the quality of irradiation, reflected by homogeneity of the dose into the tumor volume, is a major factor of local control. Close attention must be paid to minimize the underdosed areas close to critical organs. The role of surgical resection remains paramount, and a trial of dose escalation would have to consider an increase in the dose to critical organs, especially as current results indicate the low toxicity of this treatment.

Adolescent↗
PubMed1999

The beginnings of radioiodine therapy of metastatic thyroid carcinoma: a memoir of Samuel M. Seidlin, M. D. (1895-1955) and his celebrated patient.

Emerging from a stimulating encounter over fifty years ago between Dr. S. M. Seidlin and a celebrated patient at Montefiore Hospital in New York City are a number of findings that bear significantly on the contemporary practice of medicine relating to targeted radioisotope therapy. In 1943, Seidlin administered radioiodine to this patient, who was hyperthyroid although previously thyroidectomized, but who had several metastases from adenocarcinoma of the thyroid which localized the radioisotope. Seidlin recognized early that some thyroid metastases would take up radioiodine (i.e., function), but only after the normal thyroid gland was ablated, an essential preliminary procedure before radioiodine therapy should be administered, the clinical practice followed to this day. He held that removing the normal thyroid increased TSH production and eliminated the gland's competition for radioiodine, inducing the metastases to function. From 1942 until his death in 1955, Seidlin and his group followed many patients having metastatic thyroid carcinoma, conducting fruitful investigations concerned with the induction of function, dosimetry, and the occurrence of leukemia in some massively treated patients.

Adenocarcinoma, Follicular↗
PubMed1994

Chondroid chordoma--a variant of chordoma. A morphologic and immunohistochemical study.

In 1973, Heffelfinger and coworkers described a variant of chordoma that contained cartilaginous areas indistinguishable from hyaline type chondrosarcoma. They designated these tumors chondroid chordomas and found that they had a better prognosis than classic (nonchondroid) chordomas. Since that time, there has been an ongoing debate over whether chondroid chordoma is best considered a distinct clinicopathologic entity separable from chondrosarcoma or a misdiagnosed chondrosarcoma whose concept developed from the erroneous interpretation of morphology. In an attempt to clarify the issue, the authors used light microscopy and immunohistochemistry to study 12 chondroid chordomas, 38 classic chordomas, and 28 chondrosarcomas that arose in the base of the skull or spine. As a reference, they also analyzed the immunohistochemical profile of fetal notochord, ecchordosis physaliphora, and fetal hyaline cartilage. They found that all chondroid and nonchondroid chordomas were positive for cytokeratin, and the majority were also positive for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA). In contrast, none of the chondrosarcomas stained for cytokeratin, EMA or CEA. Vimentin and S-100 were positive in more than 95% of both classic and chondroid chordomas and chondrosarcomas. The immunohistochemical profile of these tumors was similar to the pattern of immunoreactivity of their nonneoplastic counterparts. The authors conclude that chondroid chordomas is a variant of chordoma and should not be confused with chondrosarcoma. Because chondroid chordomas have been reported to have a better prognosis, they felt that this nosologic term should be preserved and that chondroid chordoma should continue to be a focus of clinical and pathologic study.

Adolescent↗
PubMed1975

Symptomatic vertebral haemangiomas.

Eight cases of vertebral haemangioma causing spinal cord or nerve root compression are described, together with one other which was not causing organic signs or symptoms. The compression was due to extradural tumour in 5 cases, bony expansion encroaching on the neural canal in 2 cases, and a combination of bony expansion and extradural tumour in one case. When present the classical radiological appearance of accentuated vertical striation or honeycomb pattern is easily recognized, but atypical features, such as apparent pedicular erosion, paravertebral soft tissue mass and bony expansion, may occur, making diagnosis more diffcult. In 2 cases the correct diagnosis was not made before surgery. In one of these there were no plain film changes and in the other a metastasis was considered the more likely diagnosis. In the asymptomatic case the absence of extra-osseous extension was an important factor in excluding any possible clinical significance of the haemangioma. The great importance of pre-operative spinal angiography is stressed.

Adult↗
PubMed1979

Microsurgical approach to the anterior cervical spine and spinal cord.

When the cervical spine is affected by disease that is predominantly anterior, we prefer to take an anterior operative approach. Whether or not fusion is indicated depends largely upon the case. In general, we do not fuse the spine unless it is unstable. Widening of the spinal canal and the neural foramina can be done effectively by the anterior route, with or without anterior fusion. When the spine is unstable from disease affecting the vertebral bodies, we routinely fuse with bone graft or provide mechanical stability with a vertebral body prosthesis if life expectancy is short.

Bone Transplantation↗
PubMed1995

Cutaneous metastasis of chordoma.

A chordoma metastatic to the skin of the nose is reported. The patient (a 40-year-old man) had undergone excision of a sacral chordoma 16 months previously. In patients whose clinical histories are unknown, cutaneous metastases of chordoma can be confused with mixed tumors of sweat glands. Cytological features, including the presence of physaliphorous cells, and immunohistochemical coexpression of low molecular weight keratins and S-100 protein are helpful features that lead to a correct diagnosis.

Adult↗
PubMed1996

Radiotherapy without steroids in selected metastatic spinal cord compression patients. A phase II trial.

A phase II trial was planned to investigate the feasibility of radiotherapy (RT) without steroids in 20 consecutive patients with metastatic spinal cord compression (MSCC), no neurologic deficits, or only radiculopathy, and no massive invasion of the spine at magnetic resonance imaging (MRI) or computed tomography (CT). Aiming at an early diagnosis, MRI or CT was prescribed for all cancer patients with back pain and osteolysis, even when there were no signs of neurologic spinal compression. All patients were given 30 Gy in 10 fractions over 2 weeks with no steroids. Back pain and motor capacity were the parameters adopted to verify response to RT. Sixteen of 20 patients (80%) were able to walk without support, and 14 (70%) had no radiculopathy. Seventeen of 20 cases (85%) achieved relief from back pain. Regarding motor function, all patients (100%) responded to RT because the 16 patients able to walk without support at diagnosis did not deteriorate and the other 4, who needed support, became ambulatory without motor impairment. Median survival time was 14 months. Eight of 20 (40%) treated patients are still alive (14 to 36 months after end of RT), fully ambulatory, and free from relapse in the treated spine. Acute side effects were documented in only 2 patients (10%) and were managed without steroids. The results of this study suggest that RT without steroids is a feasible regimen for MSCC patients with good motor function. Elimination of steroids from the standard treatment for MSCC avoids cortisone side effects above all in those patients with diabetes, hypertension, peptic ulcer, and other steroid-sensitive medical problems.

Adult↗
PubMed2003

Parathyroid hormone-related protein and hypercalcemia in patients with metastatic melanoma: case report and review.

Hypercalcemia associated with malignancy has been attributed to osteolytic processes secondary to bony metastases and to humoral factors causing increased bone resorption and decreased renal excretion of calcium. Parathyroid hormone-related protein (PTH-rP) is a humoral factor that has been associated with hypercalcemia in renal cell carcinoma, squamous cell carcinoma, and bladder carcinoma. Hypercalcemia does occur in patients with melanoma; however, few studies have reported on hypercalcemia in these patients, and even fewer have described a direct connection to PTH-rP. We here report a patient with stage IV malignant melanoma presenting with severe hypercalcemia associated with elevated PTH-rP levels. Immunohistochemistry showed strong expression of PTH-rP in biopsy of the patient's subcutaneous masses. In addition, we found a 4.9% incidence of hypercalcemia in 1,146 consecutive patients treated for metastatic melanoma at the Surgery Branch of the National Cancer Institute between January 1, 1988 and March 31, 2000. Thus, PTH-rP may play a significant role in severe hypercalcemia in patients with metastatic melanoma. The discovery of PTH-rP and relevant literature will also be reviewed.

Adult↗
PubMed1992

Chondroid chordomas and low-grade chondrosarcomas of the craniospinal axis. An immunohistochemical analysis of 17 cases.

The classification of cartilaginous neoplasms of the craniospinal axis is controversial. Indeed, the very existence of chondroid chordomas has recently been questioned. In an effort to clarify the direction of differentiation of cartilaginous neoplasms of this region, 17 neoplasms obtained from 17 patients with cartilaginous tumors of the craniospinal axis were examined by immunohistochemistry with a panel of antibodies. The panel included antibodies to cytokeratin (CK), epithelial membrane antigen (EMA), vimentin (VIM), S-100 protein, carcinoembryonic antigen (CEA), and type II collagen. Areas with cartilaginous differentiation were present in all 17 neoplasms. These areas were characterized by a matrix of amorphous blue ground substance with lacunae that contained enlarged and slightly atypical cells. This cartilaginous matrix stained strongly for type II collagen. Thirteen of the 17 neoplasms had a biphasic growth pattern in which areas with conventional chordoma were admixed with areas with cartilaginous differentiation. The cells within the cartilaginous components of these 13 neoplasms stained for CK (10 of 12 cases), EMA (10 of 13 cases), VIM (12 of 12 cases), S-100 protein (seven of 12 cases), and CEA (two of nine cases). Similarly, the conventional chordoma components of these same 13 neoplasms stained for CK (12 of 12 cases), EMA (13 of 13 cases), VIM (12 of 12 cases), S-100 protein (nine of 12 cases), and CEA (two of nine cases). The hyaline-appearing areas between the cords and sheets of cells of the conventional chordoma components of these 13 tumors also stained with type II collagen. These 13 tumors with both neoplastic cartilage and conventional chordoma were classified as chondroid chordomas. One of the 17 cases was composed entirely of neoplastic cartilage; however, the cells within the matrix of the cartilage of this neoplasm stained with the epithelial markers (CK and EMA). Based on the presence of epithelial differentiation within this otherwise cartilaginous neoplasm, it was also classified as a chondroid chordoma. In contrast, the remaining three cases without histologic evidence of chordoma differentiation did not stain for CK or EMA, but they did stain for S-100 protein (three of three cases) and VIM (three of three cases). These three tumors were therefore classified as chondrosarcomas. For purposes of comparison, 19 conventional chordomas without cartilage and 29 peripheral chondrosarcomas were also stained. The 19 conventional chordomas stained in a pattern similar to the conventional chordoma components of the chondroid chordomas, whereas the 29 peripheral chondrosarcomas stained in a pattern similar to the three chondrosarcomas of the craniospinal axis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Metastatic basal cell carcinoma: review of the literature and report of three cases.

Basal cell carcinoma is the most common type of malignant cutaneous neoplasm found in man. Rarely, however, is it life-threatening or does it metastasize. A review of the literature revealed 138 cases of metastatic basal cell carcinoma. We describe 3 additional patients with metastatic basal cell carcinoma who were treated at the Mayo Clinic during the past ten years. Patients with metatypical carcinoma (basosquamous) were excluded. All metastatic lesions were to regional lymph nodes, and two patients died of their disease. It is important to recognize this rare but lethal condition.

Aged↗
PubMed2001

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

Low back pain affects a minority of individuals over 65 years of age. Four years after the onset of sciatica, the number of individuals working is independent of their workers' compensation status. A complex interaction of metalloproteinases, cytokines, chondrocytes, and macrophages are necessary for the resorption of herniated intervertebral discs. Positional magnetic resonance imaging in the seated extended posture identifies foraminal narrowing that is not visualized with conventional magnetic resonance studies. Compression associated with cauda equina syndrome must be reversed within 48 hours to preserve neurologic function. The gene for transforming growth factor can be transferred to intervertebral discs, resulting in increased proteogylcan production in a rabbit animal model. An aerobic exercise program is as effective as more expensive exercise programs in the treatment of chronic low back pain. Complementary therapies, willow bark and magnets, have marginal benefit for low back pain. Surgical intervention results in improved function for spinal stenosis patients.

Animals↗
PubMed1994

Intracanalicular osteochondroma producing spinal cord compression in hereditary multiple exostoses.

Spinal cord compression is an unusual but potentially catastrophic manifestation of hereditary multiple exostoses (HMEs). Isolated, osteochondromas are usually of little significance. However, if they are located near neurologic structures, they may cause irritation due to mechanical compression. In patients with HMEs who present with neck or back pain, and particularly in those who have neurologic symptoms in the upper or lower extremities, a diagnosis of intracanalicular osteochondroma should be presumed until proven otherwise. Prompt diagnosis and surgical excision affords the best prognosis for these patients who have spinal cord compression secondary to intracanalicular osteochondroma.

Adolescent↗
PubMed1996

Improved detection of disseminated pheochromocytoma using post therapy I-131 MIBG scanning.

A 50-year-old man had metastatic pheochromocytoma to the left frontal bone. The primary adrenal tumor was removed 12 years previously. Bone scanning and diagnostic I-131 and I-123 MIBG imaging showed metastatic lesions in the right femur and midthoracic spine. However, post-therapy I-131 MIBG scanning showed extensive and widespread metastatic disease. Post-therapeutic I-131 MIBG whole-body scanning was necessary to more fully assess the extent of metastatic pheochromocytoma.

3-Iodobenzylguanidine↗
PubMed1971

Osteosarcoma.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

Intervertebral disc abnormalities associated with vertebral metastasis: observations in patients and cadavers with prostatic cancer.

Abnormalities of intervertebral discs associated with vertebral metastasis from prostatic carcinoma are described in an investigation utilizing patient and cadaveric material. Radiographic and pathologic findings indicate that discal abnormality in this situation relates to three potential processes: intervertebral disc degeneration (intervertebral osteochondrosis); cartilaginous (Schmorl's) nodes; discal invasion by tumor. In most patients with vertebral metastasis, the adjacent intervertebral disc appears normal, a useful radiographic finding suggesting the presence of tumor rather than infection. Occasional patients with vertebral metastasis demonstrate roentgen abnormalities of the adjacent intervertebral disc indicating the occurrence of one or more of the above processes.

Humans↗