Cases reported "Lymphatic Metastasis"

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1/15. Duodenal somatostatinoma: a case report and review of 31 cases with special reference to the relationship between tumor size and metastasis.

    Somatostatinomas are rare functioning neoplasms usually arising in the pancreas and duodenum. We report a case of somatostatinoma in a 42-year-old male with neither neurofibromatosis nor somatostatinoma syndrome. A large tumor in the descending duodenum had given rise to multiple lymph node metastases. An additional 31 duodenal somatostatinoma cases were also reviewed. Most originated in the descending part of the duodenum, with the ampulla and peri-ampullary area as the most common sites (60%). Frequent manifestations were abdominal pain (25%), jaundice (25%), or cholelithiasis (19%), the latter two reflecting obstruction of the bile duct by tumors. Only two cases showed a possible somatostatinoma syndrome (6%). The tumors with metastases, lymph nodes (10) and liver (2), were significantly larger than average than those without (2.91 /- 1.49 cm vs 1.36 /- 0.71 cm, P < 0.05). With a cut-off point of 2.0 cm, diagnostic accuracy for metastasis was 77.78% with 87.50% specificity and 63.64% sensitivity. The smallest tumor with metastases was 0.8 cm and the largest without metastases was 3.0 cm. These results indicate that duodenal somatostatinomas are malignant by nature and the risk of metastasis significantly increases with tumors larger than 2.0 cm.
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keywords = specificity
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2/15. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography.

    The aim of this study was to compare MR imaging and endoscopic ultrasonography (EUS) for the local staging of rectal tumours. Forty-nine patients were examined on a 1.5-T MR unit using either a pelvic phased-array coil (n = 37) alone or combined with an endorectal coil (n = 12). Sagittal and axial sequences with T2-weighted fast spin-echo and axial T1-weighted spin-echo techniques were employed. The EUS technique was performed using a flexible endosonoscope. The results were compared with findings at histopathological sectioning of the specimen. The T-stage on MR correlated with histopathology in 32 of 49 patients and on EUS in 29 of 49 patients. The N-stage on MR correlated with histopathology in 22 of 49 patients and on EUS in 26 of 49 patients. Tumour penetration of the rectal wall was predicted by MR with 86 % sensitivity and 65 % specificity, and by EUS with 89% sensitivity and 33% specificity. Preoperative radiotherapy was administered to 40 of the patients after the examinations which may explain some of the overstaging by MR and EUS. Three patients with surgically and histopathologically confirmed invasion of neighbouring organs in the pelvis were detected preoperatively on MR but none on EUS. Tumour penetration of the rectal wall and local lymph node metastases cannot accurately be predicted with MR or EUS. Magnetic resonance, however, seems to be more useful for preoperative identification of clinically occult advanced disease.
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keywords = specificity
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3/15. Merkel cell carcinoma: two case reports focusing on the role of fluorodeoxyglucose positron emission tomography imaging in staging and surveillance.

    BACKGROUND: Merkel cell carcinoma (MCC) is a rare skin neuroendocrine carcinoma frequently occurring in the head and neck area. It is known for being a locally aggressive disease with a high incidence of regional and distant metastases. Accurate initial staging and close surveillance are critical in the management of the disease. methods AND RESULTS: Two cases of MCC are reported in which fluorine-18-fluorodeoxyglucose positron emission tomography (FDG PET) imaging has been beneficial in directing management and predicting clinical course. Pretreatment FDG PET scans detected metastatic disease in subcentimeter lymph nodes that were not appreciated in initial computed tomography images. Posttreatment FDG PET scans predicted response to therapy with the level of FDG uptake correlating in both areas of complete response to treatment and areas of residual diseases. Finally, FDG PET imaging also detected the progression of the disease after initial treatment. CONCLUSION: FDG PET imaging is a very sensitive modality in staging, assessment of treatment response, and surveillance of MCC. Because of the rarity of MCC, multicenter study is warranted to accumulate enough cases to determine the sensitivity and specificity of FDG PET in staging and surveillance of MCC, and the impact on the management and treatment outcome.
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keywords = specificity
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4/15. 201Tl SPECT in the detection of mediastinal lymph node metastases from lung cancer.

    201Tl SPECT was performed to detect mediastinal involvement in 80 patients with lung cancer who underwent surgery within a week after the SPECT study. Out of 29 patients with mediastinal involvement 16 (55%) were positive on the 201Tl early scan at 15 min postinjection and 22 (76%) were positive on the delayed scan at 3 h. These metastatic lymph nodes tended to be visualized much better on the delayed scan. In all patients with true positive results on the delayed scan, the mediastinal lymph nodes were plural, with a lesion of more than 14 mm in size. Seven false negative cases were found to have metastatic lesions less than 12 mm in size. Both the early and delayed scans showed false positive accumulation in six of 51 patients without mediastinal involvement (specificity 88%). Thus the overall accuracy for the delayed scan was 84%. The 201Tl delayed SPECT is thought to be a good noninvasive method for assessing mediastinal lymph node metastases from lung cancer.
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keywords = specificity
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5/15. The relationship between fistulas in Crohn's disease and associated carcinoma. Report of four cases and review of the literature.

    patients with carcinoma involving chronic fistulizing Crohn's disease may have developed the malignancy due to chronic epithelial irritation at either end of the fistula tract. Alternatively, the carcinoma may be the cause of the fistula. Examples of each type of relationship are presented in the reports of four patients from our institution and supported by a review of the literature. The diagnoses of such carcinomas are often delayed due to lack of specificity of symptoms and signs. A high index of suspicion and regular surveillance of high-risk patients are recommended.
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keywords = specificity
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6/15. radionuclide angiography for the diagnosis of thyroid cancer.

    The conventional static thyroid scan is sensitive but nonspecific in detecting thyroid tumors. radionuclide angiography is a noninvasive and simple technique that can improve the specificity of the conventional scan significantly, since it can demonstrate hypervascularity of tumors. Our case reports demonstrated hypervascularity of the primary tumor and metastatic cervical lymph nodes.
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ranking = 1
keywords = specificity
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7/15. Distinctive immunofluorescent labeling of epithelial and mesenchymal elements of carcinosarcoma with antibodies specific for different intermediate filaments.

    A carcinosarcoma of the lung, as well as the paratracheal lymph nodes from the same patient, were subjected to immunofluorescent labeling with antibodies to tissue-specific intermediate-filament subunits, including desmin, vimentin, and prekeratin. Within the tumor mass two distinct populations of malignant cells were found: prekeratin-positive cells, corresponding to the carcinomatous component of the tumor, and vimentin-positive cells, corresponding to the sarcomatous elements. Tumor cells were also detected in lymph node metastases in which only the prekeratin-containing carcinoma cells were found. In view of the strict specificity of antivimentin and anti-prekeratin for cells of mesenchymal or epithelial origin, respectively, it is proposed that the two components of the carcinosarcoma are derived from distinct cell types and are not morphologic variants of the same tumor.
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ranking = 1
keywords = specificity
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8/15. An occult primary malignant melanoma in a black. Initial diagnosis by aspiration biopsy cytology of a metastasis.

    Aspiration of tissue through a fine needle is a feasible way of obtaining material for diagnosis. The value, readability, and specificity of aspiration biopsy cytology is illustrated by a case in which nonpigmented neoplastic cells from an axillary mass were interpretable as metastatic malignant melanoma. That interpretation was later confirmed by conventional and electron microscopy of tissue. A search for the primary lesion led to recognition and excision of a malignant neoplasm with Schwannian features that probably arose in a congenital nevus.
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ranking = 1
keywords = specificity
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9/15. Tomographic gallium-67 citrate scanning. Useful new surveillance for metastatic melanoma.

    Conventional gallium scans are not useful to evaluate patients with metastatic melanoma. We evaluated a new method of tomographic gallium imaging. One hundred fourteen tomographic scans were obtained in a prospective surveillance study of 67 patients over a 3-year period. Scans were evaluated and compared to findings of independent clinical evaluations. Sensitivity of gallium identification of tumor involving peripheral lymph nodes and soft tissues, abdomen, mediastinum, and osseous sites was 68% to 100%; overall sensitivity of this technique is 82% with specificity of 99% in 570 organ system assessments. Analysis of discordant findings when a site was clinically occult but gallium-positive showed gallium uptake to be true-positive in six of seven lymphatic sites, three of three lung and mediastinal sites, six of six abdominal sites, but in no brain or bone sites. gallium lesions identified by computed tomographic scans proved to be false-positive at one lymphatic and one bone site, and false-negative at four otherwise clinically evident lymph node and soft tissue sites, seven pulmonary sites, and four brain sites. gallium tomographic scanning provides a composite assessment of melanoma and may eliminate the need for other studies.
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ranking = 1
keywords = specificity
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10/15. Metastatic axillary adenopathy. Use of estrogen receptor protein as an aid in diagnosis.

    In a patient with nonpalpable carcinoma of the breast, the diagnosis from a metastalic axillary node was made by measuring estrogen receptor protein (ERP). The specificity of the technique makes it useful as a diagnostic aid in a patient with mammogram negative for tumor.
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ranking = 1
keywords = specificity
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