Cases reported "Neoplasm Metastasis"

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1/17. Intraoperative cytodiagnosis of metastatic brain tumors confused clinically with brain abscess. A report of three cases.

    BACKGROUND: Cystic lesions of the brain may have diverse etiologies, ranging from true cysts to malignant tumors with cystic degeneration. Preoperative determination of the exact nature of them as well as intraoperative diagnosis may be sometimes difficult or even impossible. sensitivity and specificity of diagnosis will be improved by introducing new methods or combining traditional procedures. CASES: Three metastatic brain carcinomas with primary sites of breast, pancreas and prostate presented as cystic lesions and were confused clinically with abscess. Intraoperative frozen section was not revealing. Cytologic study of sediments of aspirated fluid uncovered malignant cells. CONCLUSION: When combined with frozen section, intraoperative cytologic studies in the form of crush preparation, fine needle aspiration or evaluation of aspirated fluid in cystic lesions (as in our cases) can improve diagnostic accuracy by detecting important diagnostic features that otherwise may be missed.
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2/17. Tumor-specific immunity in sarcoma patients.

    Stimulatory responses of 40 patients with bone [33] and soft tissue [7] sarcomas to autologous tumor cells were correlated with clinical data and prognosis. Although conclusive judgments for individual patients cannot be made, some genral features emerge: patients with stimulation indices greater than 1.5 have a 50 percent relapse-free interval after surgery of 22 months, patients with indices, below 1.5 have a 50 percent relapse-free interval of 5 months. 7 out of 10 responder patients are tumor-free 1 year after surgery as compared to 5 out of 19 (26 percent of non-responder pateints (p less than 0.05). Removal of the tumor is followed by an increase in the stimulatory response and by the dissappearance of blocking serum factors in patients with favourable prognosis. Responses return to baseline levels in tumor free patients 9-12 months after surgery. The results suggest that tumor-associated immune responses play a role in the development of human sarcomas. In addition, 47 lymphocyte samples of 25 patients were tested for stimulation by autologous tumor cells and for cell-mediated cytotoxicity against allogeneic sarcoma cell lines. Similar results were obtained in both test systems when pre-therapy lymphocytes were used. Discordant results were frequently seen at times after surgery. Both test systems may complement each other and may help clarify the tumor-specificity of certain lymphocytotoxic activities.
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3/17. FDG-PET uptake in occult acute pelvic fracture.

    The role of FDG-PET in the diagnosis of bone metastases remains unsettled, although it is hoped that PET scans will add specificity to or replace bone scintigraphy. We report a case in which an acute traumatic fracture presented with a level of uptake generally considered indicative of neoplasm. It is important to recognize that increased FDG-PET activity in bone should not be accepted as definitive evidence of metastatic disease.
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4/17. Criteria of complete remission from trophoblastic neoplasia with the use of human chorionic gonadotropin (HCG) excretion pattern as a parameter.

    The excretion pattern of human chorionic gonadotropin (hCG) or luteinizing hormone (LH) was observed in the urine of 77 patients with trophoblastic neoplasia, 109 with complete remission from trophoblastic neoplasia, and 94 with no trophoblastic neoplasia, when the anti-beta-subunit hCG system radioimmunoassay (anti-beta-subunit RIA), which specifically measured hCG was used. The sensitivity of anti-beta-subunit RIA was limited to urinary hCG 16 mIL/ml from the specificity of the anti-beta-subunit serum. luteinizing hormone in the urine of patients with complete remission and in normal menstrual, postmenopausal, and castrated women was less than 16 mIU/ml in most cases. The excretion pattern of urinary hCG in the patients undergoing treatment for trophoblastic neoplasia was more clearly comprehended with the anti-beta-subunit RIA as compared with the anti-hCH RIA. The criteria for judgment of complete remission were that the hCG value dropped to less than 16 mIU/ml and that cellular response was not observed at least in the last two courses.
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5/17. Evaluation of CA M26, CA M29, CA 15-3 and CEA as circulating tumor markers in breast cancer patients.

    The clinical utility of CA M26 and CA M29 was studied in 116 breast cancer patients and compared with results for CA 15-3 and carcinoembryonic antigen (CEA). The highest sensitivities for breast cancer detection were achieved with CA 15-3 (0.60) and CEA (0.56), but this was compromised by a relative lack of specificity (0.87 and 0.88 for CA 15-3 and CEA, respectively). Sensitivities attained with CA M26 (0.47) and CA M29 (0.53) were lower, but there was an excellent specificity (1.00) for each assay in this series of benign patients. Tumor marker elevations were appreciable with advanced disease such that 82 of 91 patients (90%) with active metastatic breast cancer exhibited at least one abnormal test value. longitudinal studies demonstrated that CA M26, CA M29, CA 15-3 and CEA complement each other and combinations of these markers reflect disease status better than individual tests.
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6/17. Expression of human prostatic acid phosphatase in a pancreatic islet cell carcinoma.

    The immunologic specificity of human prostatic acidphosphatase has been established by several previous investigations as well as in this study. An apparent exception to this specificity was observed--a case of pancreatic islet cell carcinoma metastasized to the liver produced acid phosphatase that was immunologically indistinguishable from the prostatic acid phosphatase. In this case, the possibility of prostatic involvement was convincingly ruled out by clinical follow-ups and by postmortem pathologic studies. Highly purified prostatic acid phosphatase and this tumor acid phosphatase exhibited very similar Km values and identical molecular weights. Immunochemical analysis of the two enzymes using antiprostatic acid phosphatase sera showed that enzymes are antigenically identical. The implications of our observation are discussed in relation to clinical application of immunoassays for prostatic phosphatase in the future and to the molecular basis of human acid phosphatase polymorphism.
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7/17. Computerized tomography in metastatic evaluation.

    A case is presented in which a radionuclide liver-spleen scan suggested multiple space-occupying lesions compatible with multiple metastases. Computed axial tomography, however, demonstrated more generalized hypodensity without focal defects, and liver biopsy confirmed the presence of fatty infiltration and cirrhosis. The sensitivity and specificity of liver spleen scans and computed axial tomography scans compared to liver biopsy are reviewed. In the evaluation of hepatic metastases, computed axial tomography scanning should be the diagnostic imaging procedure of choice.
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8/17. Cytologic diagnosis of pineal germinoma in cerebrospinal fluid and sputum.

    The cytologic findings in an unusual case of primary germinoma of the pineal region which metastasized to the lungs are presented and compared with those in a case of typical testicular seminoma metastatic to the central nervous system (CNS). Tumor cells in Papanicolaou- or Wright's-stained cytocentrifuge preparations and Papanicolaou-stained sputum smears could all be readily compared to biopsies of the primary tumors. Large round nuclei with dispersed chromatin and multiple, prominent nucleoli were important identifying features. The cytoplasm was usually scanty and often vacuolated. Human chorionic gonadotropin (HCG) (8 ng/ml of the beta subunit) appeared in the cerebrospinal fluid (CSF) of the patient with pineal germinoma, indicating that trophoblasts were present in the tumor even though none were seen in the biopsy or cytologic preparations. CSF polyamine levels, a test with 81% sensitivity and 66% specificity for brain tumors, were normal in the same patient. A comparison of tumor cells from both cases illustrates the similarity of germinoma cells from pineal primary tumors and testicular tumors metastic to the CNS. Although the identification of malignant germ cells in body fluids remains a grave prognostic sign, treatment with vincristine, bleomycin and cis-platinum is now inducing progressively longer remissions. Cytology should play an increasingly greater role in monitoring disease activity in patients receiving long-term treatment for malignant germ cell tumors in all locations.
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9/17. Immunologic staging of prostatic carcinoma: three years of experience.

    The immunological specificity of prostatic acid phosphatase has been demonstrated previously in the laboratory and used in a small number of patients. Our findings in 96 patients using gel immunodiffusion with an acid phosphatase antiserum in the study of bone marrow aspirates and lymph nodes are reported.
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10/17. Tumor antigen of human cervical squamous cell carcinoma: correlation of circulating levels with disease progress.

    A double-antibody radioimmunoassay method was used for serial determinations of a tumor-antigen (TA-4) of cervical squamous cell carcinoma, and the correlation of serum antigen levels with the disease progess was investigated in 23 patients with cervical squamous cell carcinoma. Ten cases with widespread metastases received radiotherapy and/or chemotherapy. Nine of these cases who showed progression of the disease had a corresponding increase in serum antigen levels, while one case who had regression of the disease showed a corresponding decrease in serum antigen levels. Thirteen patients received radical surgery, and in all of these, high pretreatment antigen levels declined to undetectable levels 1 or 2 weeks after surgery. A panel of coded sera from the NCI-Mayo Clinic serum Bank was also studied for evaluating the specificity of the assay. Thirteen of 25 patients (52%) with cervical squamous cell carcinoma showed positive serum antigen levels, while only one of 58 control cases (1.7%) showed false-positive result. These results suggest that serial TA-4 determinations may provide a useful method for evaluating regression or progression of the disease.
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