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Recurrence pattern of metastatic testicular cancers after chemotherapy.

Recurrence pattern of metastatic testicular cancer after the initial treatment was investigated. Seventy-seven patients with metastatic testicular cancer were treated by cisplatin-based chemotherapy. Patients with residual masses after chemotherapy and whose tumor markers were normalized underwent surgical resections. Of the 77 patients, 61 achieved cancer free status and 4 who did not need the study criteria excluded. Recurrences were detected in 12 (21.1%) patients, 2 (7.1%) patients among 28 stage II patients; 10 (34.5%) patients among 29 stage III patients; none (0%) patients among 14 seminoma patients and 12 (27.9%) patients among 43 non-seminoma patients. All recurrences were detected within 17 months (median, 3) after the initial treatment. Of the 12 patients experiencing recurrence, 4 died of cancer. The recurrence rate of the patients in stage III was significantly higher than that in stage II. No recurrence was detected in patients with seminoma. Follow-up studies after treatment should include serum tumor markers and computed tomographic scanning of lung, abdomen and pelvis at defined intervals. Intensive follow-up will be needed especially for the patients in stage III and with non-seminoma. Follow-up within the first two years is especially important in detecting recurrence after chemotherapy.

Antineoplastic Agents↗

Patterns of metastatic breast carcinoma: influence of tumour histological grade.

AIM: To assess if the pattern of metastatic spread of carcinoma of the breast varies according to tumour histological grade. MATERIALS AND METHODS: The clinical details, histological features of the primary tumour, and imaging findings at presentation of patients with metastatic breast cancer have been recorded prospectively since 1997. The pattern of metastatic spread, age at metastasis, metastasis-free interval (MFI), and length of survival with metastases were analysed by tumour grade. RESULTS: There was a significant association between histological high-grade tumours and high frequency of intra-pulmonary metastases (p=0.013); liver metastases (p=0.039); para-aortic lymphadenopathy (p=0.022) and metastatic presentation under 50 years of age (p=0.003). A significant correlation was also demonstrated between histological low-grade tumours and increased frequency of pleural disease (p=0.020); increased frequency of bone metastases (p=0.004); prolonged MFI (MFI>5 years; p<0.0001); and increased length of survival (p<0.0001). CONCLUSION: There is a correlation between patterns of metastatic spread and tumour histological grade. This partly explains the negative prognostic value of high tumour grade, as metastases from grade 3 tumours more commonly occur at sites associated with a worse prognosis. This finding may also prove useful in interpreting imaging in patients who have a history of breast cancer and undergo subsequent imaging because of new symptoms.

Age Factors↗

[A histopathological investigation of metastatic liver tumors--the classification of their histological patterns and metastatic pathways taking into account the microscopic metastatic foci].

A histopathological study of metastatic liver cancers has been performed on 433 autopsied cases at the Shikoku Cancer Center Hospital. With respect to the intrahepatic spread of the metastatic liver carcinomas, their invasion through the portal vein and the sinusoid were separately examined. The histological patterns of the prevalence of the liver metastasis were classified by taking into account both the factors and the prevalence of the nodules. A liver metastasis which was not detected by the naked eye but by microscopy was considered to be an early stage metastasis. All histological characteristics as well as the metastatic pathways also were considered.

Aged↗

[Flow cytometric analysis of DNA content of urinary bladder cancers--study on primary tumors and metastasized lymph nodes].

PURPOSE: This study was designed to evaluate DNA ploidy patterns and metastatic patterns between primary tumors and metastatic lymph nodes in bladder tumor patients with lymph node metastases. METHODS: Flow cytometry (FCM) was used to study the DNA ploidy. The DNA ploidy patterns in 16 lymph node metastases in relation to the degree of ploidy in the primary bladder tumor were evaluated in 63 patients who underwent total cystectomy. RESULTS: The primary tumor that had metastasized was G3 tumor in grade and over pT2 in stage in many cases. Thirty-nine diploid tumors had given raise to lymph node metastases in only 5 cases (13%), whereas 11 cases (46%) of aneuploid tumors had metastasized (p < 0.01). With regard to ploidy patterns between primary tumors and the corresponding lymph node metastases, four patterns were noted, namely D-->D (5 cases), D + A-->D (4), A-->A (5) and A-->D (2) (D: DNA diploid, A: DNA aneuploid). The DNA index between the primary tumors and the corresponding lymph node metastases was the same in all but 2 cases (14/16.88%). In cases with lymph node metastases, the prognosis was very poor whether or not the DNA ploidy of the primary tumors or the metastatic tumors was DNA aneuploid. CONCLUSION: These data suggest that a malignant cell on the primary tumor metastasized to the lymph node in many cases.

Aged↗

Distribution pattern of metastatic bone disease. A need for total body skeletal image.

Distribution patterns of metastatic bone disease in 62 patients with soft-tissue cancers showed that 60% of bone lesions were located in the axial and 40% in the appendicular skeleton. Thirteen percent of the lesions were in appendicular regions not usually included in routine imaging studies. The majority of the metastatic skeletal lesions were clinically asymptomatic. The serum alkaline phosphatase level is a poor indicator of early bone metastases.

Adult↗

The pivotal role of CXCL12 (SDF-1)/CXCR4 axis in bone metastasis.

Tumor cells are known to adapt to and utilize existing physiological mechanisms to promote survival and metastasis. The role of the microenvironment in the establishment of a metastatic lesion has become increasingly important as several factors secreted by stromal cells regulate metastatic pattern in a variety of tumor types. Tumor cells interact with osteoblasts, osteoclasts and bone matrix to form a vicious cycle that is essential for successful metastases. Here we review the current concepts regarding the role of an important chemokine/chemokine receptor (SDF-1 or CXCL12/CXCR4) pathway in tumor development and metastasis. CXCL12 secretion by stromal cells is known to attract cancer cells via stimulation of the CXCR4 receptor that is up regulated by tumor cells. CXCL12/CXCR4 activation regulates the pattern of metastatic spread with organs expressing high levels of CXCL12 developing secondary tumors (i.e., the bone marrow compartment). CXCL12 has a wide range of effects in regards to tumor development but the primary role of CXCL12 appears to be the mobilization of hematopoietic stem cells and the establishment of the cancer stem-like cell niche where high levels of CXCL12 recruit a highly tumorigenic population of tumor cells and promotes cell survival, proliferation, angiogenesis, and metastasis.

Animals↗

Metastatic transcriptional pattern revealed by gene expression profiling in primary colorectal carcinoma.

Metastatic spread to the liver is the major contributor to mortality in patients with colorectal carcinoma (CRC). In order to seek for gene expression patterns associated with metastatic potential in primary CRC, we compared the transcriptional profiles of 10 radically resected primary CRCs from patients who did not develop distant metastases within a 5-year follow-up period with those of 10 primary/metastatic tumor pairs from patients with synchronous liver metastases. To focus selectively on neoplastic cells, the study was conducted on laser-microdissected bioptic tissues. Arrays of 7,864 human cDNAs were utilized. While a striking transcriptional similarity was observed between the primary tumors and their distant metastases, the nonmetastasizing primary tumors were clearly distinct from the primary/metastatic tumor pairs. Of 37 gene expression differences found between the 2 groups of primary tumors, 29 also distinguished nonmetastasizing tumors from metastases. The gene encoding for mannosyl (alpha-1,3-)-glycoprotein beta-1,4-N-acetyl-glucosaminyl-transferase (GnT-IV) became significantly upregulated in primary/metastatic tumor pairs (p < 0.001). GnT-IV upregulation was confirmed by RT-PCR. These data support the existence of a specific transcriptional signature distinguishing primary colon adenocarcinomas with different metastatic potential, the further pursuit of which may lead to relevant clinical and therapeutic applications.

Adenocarcinoma↗

Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread.

PURPOSE: To investigate and describe the anatomic distribution, imaging features, and pattern of metastatic spread of malignant gastrointestinal stromal tumors (GISTs). MATERIALS AND METHODS: The medical records of all patients at our institution with a histologic diagnosis of GIST were reviewed. Two radiologists with knowledge of the diagnosis reviewed the radiologic findings by means of consensus. Sixty-seven patients underwent computed tomography, and scans of the primary tumor were available in 38 patients. RESULTS: One hundred sixteen patients with malignant GISTs were identified (76 men and 40 women; mean age, 54.6 years +/- 13.5 [SD]). The primary tumor locations in descending order of frequency were the small bowel (n = 49), stomach (n = 43), colon (n = 7), rectum (n = 6), other (n = 3), and not specified (n = 8). Mean primary tumor size was 13 cm +/- 6. Tumors were typically well defined (31 of 36 [86%]), with a heterogeneous rim of soft tissue with lower signal intensity than that of the contrast material-enhanced liver. Central fluid attenuation was seen in 24 of 36 (67%) patients. Metastases were seen in 23 of 38 (61%) patients at presentation and in 53 of 61 (87%) patients during follow-up. Spread was usually to the liver or peritoneum. Visceral obstruction rarely occurred, even in the presence of extensive peritoneal metastatic disease. Ascites was an unusual finding. CONCLUSION: Malignant GISTs are typically large, well-circumscribed, heterogeneous, centrally necrotic tumors that arise in the wall of the small bowel or stomach. They rarely obstruct viscera, despite their large size and propensity to metastasize to the liver and peritoneum.

Adult↗

Correlation between secretion pattern and metastatic potential from drug-treated 3LL tumor cell line.

In the present study, we described the effects of three different drugs, A23187 calcium ionophore (A23187), indomethacin (IND) and phorbol myristate acetate (PMA), on the secretion pattern and the metastatic potential in the low metastatic 3LL tumor cell line. The results evidence that a low molecular weight protein fraction is always secreted in an higher amount in drug treated cells than in untreated cells independently of the drug used. In addition to their effects on secretion pattern, the three drugs assayed enhance noticeably the metastatic rate in vivo of the 3LL cells. The data confirm our earlier observations showing that our high performance gel permeation chromatography (HPGPC) method is suitable for discriminating even between cells with a different degree (low and high) of metastatic potential by its chromatographic secretion pattern and that alterations in the secretion pattern from treated cells are related with changes in the degree of metastatic potential of these cells.

Animals↗

Association of DNA pattern of metastatic lymph node with disease free survival in patients with intraoral squamous cell carcinoma.

BACKGROUND AND OBJECTIVE: Intraoral squamous cell carcinoma (OSCC) is one of the common tobacco related cancers affecting Indian population. These tumours are slow growing, endophytic and are mostly well differentiated. Cervical lymph node is the common site of metastasis of these tumours. In most of the patients cervical lymph node metastasis rather than the primary tumour, affects prognosis. However, no reports are available on the DNA pattern of the metastatic lymph nodes in patients with intraoral squamous cell carcinoma. Therefore, the present study was undertaken to observe DNA pattern of primary tumours and their corresponding metastatic lymph nodes and its association with the clinicopathological parameters and prognosis. METHODS: DNA flow cytometry was successfully carried out on 68 paraffin embedded specimens of the primary tumours and their 22 corresponding metastatic cervical lymph nodes. The findings were evaluated for their possible association with clinicopathological features of the tumour and disease free survival of patients with intraoral carcinoma. RESULTS: Analysis of nuclear DNA patterns revealed 32 (47.0%) diploidy and 36 (52.9%) aneuploidy in primary tumours whereas metastatic lymph nodes showed 7 (31.8%) diploidy and 15 (68.1%) aneuploidy. The aneuploidy group in metastatic lymph node had significantly higher S phase fraction (SPF) (P<0.01) and poor histological grade (P<0.002) as compared to their counterparts with diploidy. DNA pattern of metastatic lymph node further showed a significant association with disease free survival in the log rank test. Aneuploidy and high SPF in metastatic lymph node was found to be associated with early recurrence while DNA pattern of the primary tumour did not show significant association with the disease free survival. INTERPRETATION AND CONCLUSION: It may be concluded that aneuploidy and high SPF in metastatic lymph node might be considered as an important discriminatory risk factor in patients with similarly staged intraoral squamous cell carcinoma.

Adult↗

Steroid hormone receptor activity of primary human breast cancer and pattern of first metastasis. The Breast Cancer Study Group.

A series of 258 breast cancer patients with known estrogen receptor (ER) status of the primary tumour who subsequently developed metastases were reviewed for site of first metastasis. In 188 cases progesterone receptor (PgR) data were also available. Univariate analysis showed metastatic patterns to differ statistically significantly related to ER status and (less pronounced) PgR status of the primary tumour. Patients with ER-positive tumours had bone metastases three times more often than patients with ER-negative tumours. With respect to PgR-positive and PgR-negative tumours this frequency differed by a factor of two. With regard to visceral metastases ER and PgR status were equally potent prognosticators, patients with receptor negative tumours having a 50% higher frequency of visceral metastasis than patients with receptor positive tumours. Assessment of metastatic patterns in relation to combined receptor status did not substantially enhance the discriminatory value of ER and PgR when assessed separately. Multivariate analysis showed that the observed differences in metastatic patterns were all attributable to differences in the ER status of the primary tumour, and were not influenced by age, menopausal status, axillary lymph node involvement, duration of disease-free interval (DFI), mode of postoperative treatment, or the PgR status of the primary tumour.

Abdominal Neoplasms↗

Age and sex differences in bone metastasis of hepatocellular carcinoma in Japanese autopsy cases.

Metastatic patterns of hepatocellular carcinoma (HCC) in 6997 autopsy cases recorded in the Annual of the Pathological Autopsy Cases in Japan from 1981 to 1984 were analyzed by using a computer. Significant association of the metastatic pattern of hepatocellular carcinoma with age and sex was shown after separating patients into different age groups in pack years. It was especially worthy of notice that bone metastasis decreased in an age-dependent manner only in men within the widest age range (P less than 0.001) and was significantly prevalent in men in their forties and fifties (P = 0.012). In addition, in 350 cases of hepatocellular carcinoma autopsied at Tokyo University Hospital during 15 years from 1971 to 1985, it was suggested that bone metastasis might be prevalent in male patients with liver cirrhosis although significant relationship between bone metastasis and hepatitis B virus infection or alcohol abuse was not shown. These results might indicate possible effects of sex differences on the metastatic pattern of hepatocellular carcinoma, particularly bone metastasis, as well as on the incidence of the cancer.

Adult↗

[The value of pinhole collimator imaging in the scintigraphic analysis of vertebral diseases].

Recent findings suggested a possible role for pinhole collimator scintigraphy to differentiate between metastases, infection and fractures of the vertebrae. The aim of this study was to verify these findings and to ascertain whether we could identify any other specific scintigraphic patterns. The study group consisted of 58 patients. A metastatic pattern was obtained in 18 patients, while 16 showed the compression fracture pattern, 3 the tuberculosis pattern and 1 the pyogenic infection pattern. The study was considered normal in 4 patients and showed a nonspecific pattern in 4. Sensitivity was 85% for the metastatic pattern and 83% for the compression fracture pattern. Specificity was 94% for both patterns. Unique new patterns were identified in Paget's disease and in degenerative disease of the vertebrae (12 patients). Pinhole scintigraphy of the vertebrae is a valuable aid for detecting specific diseases of the vertebrae. Our findings suggest a valuable new role for skeletal scintigraphy, improving the specificity and obviating, in most cases of vertebral disease, the need for additional investigations.

Evaluation Studies as Topic↗

Comparison of the pattern of metastatic spread of squamous cell cancer and adenocarcinoma of the uterine cervix.

Retrospective review of medical records and autopsy findings in patients dying of squamous cell cancer or adenocarcinoma of the uterine cervix was undertaken to evaluate for possible differences in biologic behavior between these tumor types. Twenty-one patients with each tumor type were evaluated. Patients with adenocarcinoma were found to have a higher incidence of tumor involvement of the paraaortic lymph nodes (13/21 vs 6/20, P less than 0.05), uterine corpus (17/17 vs 12/20, P less than 0.05), and adrenal gland (7/21 vs 0/21, P less than 0.005). Presence of ascites (9/21 vs 2/21, P less than 0.05) and hydrothorax (9/21 vs 3/21, P less than 0.05) was also significantly more frequent in patients with adenocarcinoma. These findings suggest that this tumor may behave differently in regard to pattern of metastatic spread or response to therapy. The therapeutic implications of these findings deserve further study.

Abdominal Neoplasms↗

Cytologic patterns of metastatic thymoma: diagnosis by fine-needle aspiration biopsy.

Thymomas are the most frequent primary tumors of the anterior mediastinum. These lesions are slow growing and can be locally invasive, but extrathoracic metastases are rare, occurring in less than 2% of cases. Fine-needle aspiration biopsy (FNAB) may be helpful in making the diagnosis of metastatic thymoma, with or without a clinical history of primary mediastinal thymoma. We report three cases of metastatic thymoma diagnosed by FNAB. Each case illustrates a distinctive cytologic pattern. While two of the patients had a history of histologically confirmed thymoma 11 and 13 years previously, a third patient presented with an enlarged supraclavicular lymph node and pulmonary nodules, and no prior diagnosis of thymoma. These cases demonstrate that based on distinctive cytologic patterns and features, a diagnosis of metastatic thymoma can be made with FNAB. Ancillary studies will often confirm the diagnosis.

Aged↗

The pattern of metastatic disease in patients with pleural effusions secondary to breast cancer.

The pattern of pleural metastases in women with effusions secondary to breast cancer was evaluated by thoracoscopy in a series of 46 patients with previously untreated effusions. Metastases involving the visceral pleural were seen in 59 per cent of patients whereas parietal deposits were found in only 15 per cent. No tumour deposits were seen in 26 per cent of cases. No patients had both visceral and parietal tumour secondaries. Patients within each of these groups showed differences in rates of positive effusion cytology, chest wall recurrence and previous evidence of recurrent breast cancer.

Breast Neoplasms↗

Postoperative chemoradiotherapy in Wilms tumor with concurrent lung and lymph node metastasis.

BACKGROUND: An effective treatment strategy is essential for metastatic Wilms tumor (WT) management. To improve prognostic accuracy, this study examined metastatic patterns and key prognostic factors. METHODS: Children diagnosed with WT from 2010 to 2021 were identified from the SEER database. All patients underwent chemotherapy and surgical resection. Metastatic patterns, metastasis-related predictors, and prognostic factors were evaluated. RESULTS: Of the 1040 patients analyzed, 226 (21.7%) experienced lung metastasis, 31 (3.0%) liver metastasis, 6 (0.6%) bone metastasis, and 220 (21.2%) regional lymph node metastasis. Distant metastasis was associated with a higher incidence of lymph node metastasis (OR = 1.506, 95% CI 1.346-1.685, p < 0.001). Age 3-17 years (OR = 1.933, 95% CI 1.406-2.680, p < 0.001), left-sided (OR = 1.383, 95% CI 1.016-1.890, p = 0.040), bilateral (OR = 2.303, 95% CI 1.215-4.243, p = 0.009), and tumor size &#x2265;135 mm (OR = 2.020, 95% CI 1.481-2.749, p < 0.001) were identified as predictors of metastasis. Both lymph node (p < 0.001) and lung metastasis (p < 0.001) were high-risk factors for WT. Radiotherapy provided long-term survival benefits for the metastatic population (p = 0.027), while postoperative chemotherapy showed better outcomes than preoperative or other strategies (p < 0.001). Further analysis demonstrated that the concurrent lung and lymph node metastasis group benefited more from postoperative chemoradiotherapy, with HRs of 0.226 (p = 0.028) for overall survival and 0.255 (p = 0.048) for cancer-specific survival. CONCLUSION: WT with concurrent lung and lymph node metastasis represents a distinct and aggressive metastatic phenotype associated with a significantly poor prognosis. Postoperative chemoradiotherapy may provide superior survival benefits for this high-risk population.

Humans↗

Histologic growth patterns of metastatic carcinomas of the liver.

One hundred autopsied livers containing metastatic cancers were studied pathologically. Macroscopically, the cancers were of the multinodular type in 65.0% of cases, massive type in 17.0% and portal tract type in 8.0%. Among liver metastases from colon and lung cancers, most cases showed predominantly intraparenchymal growth (92.3% and 87.5%, respectively). In contrast, among liver metastases from gallbladder/bile duct cancer, intraparenchymal growth was less frequent (35.7%). With regard to the histologic growth pattern at the boundary of the liver metastases, in micrometastases less than 1 mm in diameter a replacement growth pattern was predominant among metastases from lung, colon and pancreas cancers (69.7%, 79.3% and 66.7%, respectively), whereas a sinusoidal growth pattern was predominant in those from gastric and gallbladder/bile duct cancers (48.5% and 66.7%). Among macrometastases of the liver over 20 mm in diameter, an expansive growth pattern was predominant, irrespective of the cancer primary site. Thus metastatic liver cancers showed changes in growth patterns according to the size of the metastatic tumors.

Aged↗