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PubMed1988

Metastatic pattern in recurrent breast cancer. Special reference to intrathoracic recurrences.

The anatomical and temporal patterns of recurrence were studied in 401 patients with first recurrence of breast cancer. All patients underwent the same scheduled investigation program: history, physical examination, blood tests, bone scanning, bilateral iliac crest biopsy, radiologic bone survey, chest x-rays, and ultrasound scanning of the liver. The current article focuses on the diagnosis of intrathoracic (ITH) recurrence. Most patients recurred in a single site and 50% of the recurrences were diagnosed within the first 2 years from initial diagnosis. Chest x-ray revealed ITH recurrence in 27% (109 patients), and in 8% the lung, pleura, and/or mediastinum were the only signs of recurrence. Generally, the status of primary demographic, clinical, and pathoanatomical characteristics were not predictive as to the development of ITH recurrence, although patients with pleural recurrences often had centrally located primary tumors, locally advanced disease, and often received adjuvant radiotherapy. Clinical symptoms and signs of ITH recurrence were present in only one third of the patients, and the diagnostic specificity and sensitivity of serum lactate dehydrogenase were only 33% and 85%, respectively. Since ITH recurrences often are silent, and since recurrence in this site may have both prognostic and therapeutical implications, routine chest x-ray is indicated in all patients with first recurrence of breast cancer.

Breast Neoplasms↗
PubMed1983

Unusual metastatic pattern in testicular malignant teratoma.

A 25-year-old man presented with a malignant teratoma of the right testicle. After orchidectomy, the results of the surgical staging procedure were negative. Although pulmonary metastasis did not occur, massive bone marrow involvement with a bleeding tendency and hypercalcemic nephropathy developed. The response to chemotherapy was excellent, but after the attainment of a complete remission the patient developed carcinomatous leptomeningitis, which was confirmed at autopsy as cause of death.

Adult↗
PubMed1987

Metastatic patterns in squamous cell cancer of the head and neck.

This retrospective study on 832 head and neck cancer patients who died between 1961 and 1985 was carried out to determine the incidence and sites of distant metastases. All patients were staged prior to definitive treatment and were autopsied. The overall incidence of distant metastases was 47 percent. The hypopharynx had the highest incidence of distant metastases (60 percent), followed by the base of the tongue (53 percent) and the anterior tongue (50 percent). Of the 387 patients with distant metastases, 91 percent died with uncontrolled tumor either at the primary site or in the neck. The lung was the most common site of distant metastases (80 percent), followed by the mediastinal nodes (34 percent), the liver (31 percent), and bone (31 percent). Overall, 6 percent of the patients had stage I disease, 20 percent had stage II disease, 32 percent had stage III disease, and 43 percent had stage IV disease. The highest incidence of distant metastases was found in those patients with stage IV disease (193 of 350 patients, 55 percent). We believe that the initial stage of disease does appear to be related to the ultimate development of the distant metastases.

Carcinoma, Squamous Cell↗
PubMed1985

Metastatic patterns of squamous carcinoma in the parotid lymph nodes.

The clinical and pathological patterns of squamous carcinoma of the skin metastasising to the parotid lymph nodes have been analysed in 28 patients in whom such metastasis occurred over the period 1972 to 1981. Prognosis appears to be closely related to whether tumour has spread out with the nodes into the parenchyma of the parotid gland or is still confined within the nodes.

Carcinoma, Squamous Cell↗
PubMed2006

High positive sentinel node identification rate by EORTC melanoma group protocol. Prognostic indicators of metastatic patterns after sentinel node biopsy in melanoma.

Methods to work-up sentinel nodes (SN) vary considerably between institutes. This single institution study evaluated the positive SN-identification rate of the EORTC Melanoma Group (MG) protocol and investigated the prognostic value of the SN status regarding disease-free survival (DFS) and overall survival (OS) and evaluated the locoregional control after the SN procedure. Multivariate and univariate analyses using Cox's proportional hazard regression model was employed to assess the prognostic value of covariates regarding DFS and OS. The positive SN-identification rate was 29% at a median Breslow thickness of 2.00 mm and the false-negative rate was 9.4%. Breslow thickness and ulceration of the primary correlated with SN status. SN status, ulceration and site of the primary tumour correlated with DFS. SN status and ulceration of the primary correlated with OS. The in-transit metastasis rate correlated with SN-positivity, Breslow thickness and ulceration. Projected 3-year OS was 95% in SN-negative and 74% in SN-positive patients. Transhilar bivalving of the SN with step sections from the central planes is simple and had a high SN-positive detection rate of about 30%. The SN status is the most important predictive value for DFS and OS. In-transit metastasis rates correlated with SN-positivity, Breslow thickness and ulceration of the primary.

Adolescent↗
PubMed2005

Border between N1 and N2 stations in lung carcinoma: lessons from lymph node metastatic patterns of lower lobe tumors.

OBJECTIVE: Distinction of lymph node stations is one of the most crucial topics still not entirely resolved by many lung cancer surgeons. The nodes around the junction of the hilum and mediastinum are key points at issue. We examined the spread pattern of lymph node metastases, investigated the prognosis according to the level of the involved nodes, and conclusively analyzed the border between N1 and N2 stations. METHODS: We reviewed the records of 604 consecutive patients who underwent complete resection for non-small cell lung carcinoma of the lower lobe. RESULTS: There were 390 patients (64.6%) with N0 disease, 127 (21.0%) with N1, and 87 (14.4%) with N2. Whereas 11.3% of patients with right N2 disease had skip metastases limited to the subcarinal nodes, 32.6% of patients with left N2 disease had skip metastases, of which 64.2% had involvement of N2 station nodes, except the subcarinal ones. The overall 5-year survivals of patients with N0, N1, and N2 disease were 71.0%, 50.8%, and 16.7%, respectively (N0 vs N1 P = .0001, N1 vs N2, P < .0001). Although there were no significant differences in survival according to the side of the tumor among patients with N0 or N1 disease, patients with a left N2 tumor had a worse prognosis than those with a right N2 tumor (P = .0387). The overall 5-year survivals of patients with N0, intralobar N1, hilar N1, lower mediastinal N2, and upper mediastinal N2 disease were 71.0%, 60.1%, 38.8%, 24.8%, and 0%, respectively. Significant differences were observed between intralobar N1 and hilar N1 disease ( P = .0489), hilar N1 and lower mediastinal N2 disease (P = .0158), and lower and upper mediastinal N2 disease (P = .0446). Also, the 5-year survivals of patients with involvement up to station 11, up to station 10, and up to station 7 were 41.4%, 37.9% and 37.7%, respectively (difference not significant). CONCLUSIONS: N1 and N2 diseases appeared as a combination of subgroups: intralobar N1 disease, hilar N1 disease, lower mediastinal N2 disease, and upper mediastinal N2 disease. Interestingly, the survivals of patients with involvement up to interlobar nodes (station 11), main bronchus nodes (station 10), and subcarinal nodes (station 7) were identical. These data constitute the basis for a larger investigation to develop a lymph node map in lung cancer.

Adenocarcinoma↗
PubMed2003

Establishment of red fluorescent protein-tagged HeLa tumor metastasis models: determination of DsRed2 insertion effects and comparison of metastatic patterns after subcutaneous, intraperitoneal, or intravenous injection.

Metastasis is the leading cause of death in patients with cervical cancer. In this report, we establish novel fluorescent HeLa tumor metastasis models to determine whether HeLa transfected with the enhanced red fluorescent protein (DsRed2) gene in vitro and xenotransplanted through subcutaneous, intraperitoneal, or intravenous route into SCID mice would permit the detection of tumor micro-metastasis in vivo. Our results showed that DsRed2 insertions did not interfere the tumorigenic properties of HeLa cells. We also demonstrated that DsRed2-transduced HeLa cells maintained stable high-level DsRed2 expressions during their growth in vivo. DsRed2 fluorescence clearly demarcated the primary seeding place and readily allowed for the visualization of distant micro-metastasis and local invasion at the single-cell level. Lung metastasis, the major cause of cervical carcinoma related death, was found in all three models. However, intravenous injections of the HeLa-DsRed2 cells established tumor foci in the lung, while subcutaneous and intraperitoneal injections only established lung metastasis at single-cell levels. The DsRed2 tagged HeLa cancer model allowed detection and investigation of physiologically relevant patterns of cancer invasion and metastasis in vivo.

Animals↗
PubMed2001

Metastatic pattern of CC531 colon carcinoma cells in the abdominal cavity: an experimental model of peritoneal carcinomatosis in rats.

BACKGROUND: Peritoneal spread of tumour cells is a major source of morbidity and mortality in patients with colorectal cancer. In order to develop strategies to prevent intraperitoneal dissemination and to treat peritoneal carcinomatosis, the spread of tumour cells in the peritoneal cavity was studied. METHODS: Two million CC531 colon carcinoma cells were administered intraperitoneally in five groups of eight rats. The rats were killed after 1, 2, 4 and 8 hours and 3, 7, 14 and 21 days. After inspection of the abdominal cavity, samples of blood and ascites were taken. Liver, spleen, omentum, mesentery, diaphragm, parathymic lymph nodes and lungs were removed for histology and immunohistochemistry. RESULTS: No abnormalities were seen in the abdominal cavity until day 3. Subsequently the peritoneum and omentum became thickened and after 21 days all rats had haemorrhagic ascites and peritoneal carcinomatosis. The abdominal fluid contained tumour cells at all stages. The number of tumour cells decreased in the first 8 hours, and increased thereafter. At microscopy the peritoneum was completely covered by tumour cells after 3 days. Tumour cells concentrated in the milky spots (MS) of the omentum within 4 hours. The size of the MS increased as a result of an increase in number of tumour cells and macrophages. After 7--21 days the MS were completely replaced by tumour cells and new MS were formed. In the diaphragm tumour cells invaded the lymphatic lacunae after 8 h, and obliterated these after 3--7 days. Also invasion of the muscle fibres was seen after 3 days. Microscopically no tumour cells were found in blood, liver, spleen, parathymic nodes and lung. CONCLUSION: After intraperitoneal administration of CC531 colon carcinoma cells, tumour cells spread throughout the abdominal cavity, and concentrate in the milky spots of the greater omentum, the paracolic gutters, the subhepatic and subphrenic spaces and in the lymphatic lacunae of the diaphragm.

Animals↗
PubMed1980

Causes of death and metastatic patterns in patients with mammary cancer. Ten-year autopsy study.

As periodic evaluation of the causes of death in cancer patients may provide guidelines for further research on supportive care in cancer, the authors studied autopsy records of 144 mammary-cancer patients from the past ten years. The causes of death were analyzed and compared for the first and second five-year periods. During the first five-year period (65 cases), death was caused by the malignant process itself in 70.8% of the patients, by infection in 10.8% and by hemorrhage in 7.7%. During the second five-year period (79 cases), the malignant process itself was still the most frequent cause of death but in only 47.4% of the patients, and deaths due to infections (23.7%) and hemorrhages (9.2%) were relatively more frequent, without noticeable changes in the patients' survival times. These findings may be related to the more aggressive methods of treatment applied in recent years. The metastases to the organs tended to be massive, and except for the lymph nodes, the lung was the organ most frequently involved by tumors (60%), followed by bone (54%), liver (54%), adrenal gland (36%), pleura (36%) and brain (26%). As the chance of life-threatening infections is great in mammary cancer, the early detection and treatment of infections in mammary-cancer patients could become an important factor in prolonging the survival of these patients.

Autopsy↗
PubMed1978

An autopsy study of the metastatic patterns of human leukemias.

This paper analyses the distribution of metastases at every site of the human body in acute lymphoblastic, chronic lymphocytic, acute myeblastic and chronic myelocytic leukemias in patients that come to autopsy. It appeared that the 4 types of leukemia had a similar seeding frequency of the skin, breast, trachea, diaphragm and all other muscles. The highest incidence of metastases was found in the lymphatic system (i.e. all lymph-nodes and spleen). Acute lymphoblastic leukemia showed an excess of metastases in the major blood vessels, pleura, large intestines, extrahepatic biliary tract, ureters, prostate, cervix uteri, central nervous system, thymus, ovaries and pituitary. The excess of metastases at specific sites did not cluster either in topographical areas or in anatomical systems, with the exception of metastases in the central nervous and endocrine systems (acute lymphoblastic leukemia). Chronic lymphocytic leukemia showed an excess of metastases in all lymph nodes, kidney, adrenals and heart. A lymphatic route of dissemination, as opposed to a blood-borne spread of malignant cells, was hypothesised to account for the excess of metastases in the above mentioned organs in patients affected with chronic lymphocytic leukemia. Soil specificity with the degree of anaplasia of leukemic cells may account for the higher than expected occurrence of metastases in a given organ, for a specific leukemia. This remark holds true particularly for acute lymphoblastic leukemia.

Autopsy↗
PubMedDate not supplied

Pathology consultation. Metastatic patterns of salivary gland neoplasms.

Long-term follow-up of salivary gland carcinomas allows a better evaluation of their biologic malignancy than the traditional five-year period. Metastases (distant and local) are possible over the entire lifetime of a patient and are dependent upon histologic grade, persistence of neoplasm and clinical stage. Distant metastases to bone and lungs are manifested by nearly every carcinoma. Metastases to regional lymph nodes vary according to histologic type and it appears that the adenoid cystic carcinoma has the lowest incidence of that event.

Carcinoma↗