Thoracic Metastases Research Articles

Inflammatory mammary carcinoma in dogs: 33 cases (1995-1999).

To determine epidemiologic, clinical, and pathologic characteristics of inflammatory mammary carcinoma (IC) in dogs. Retrospective study. 33 dogs with IC and 153 dogs with malignant mammary tumors other than IC. Medical records were reviewed, and signalment, history, physical examination findings, and results of thoracic radiography and necropsy were obtained. 33 of 436 (7.6%) dogs examined at a veterinary teaching hospital because of dysplasia or tumors of the mammary glands and 33 of 186 (17.7%) dogs with at least 1 malignant tumor had IC. Thirty-two of the 33 dogs were sexually intact. Dogs with IC were significantly older than were dogs with other malignant mammary tumors, and in dogs with IC, the tumor was initially noticed a mean of 52 days after the beginning of the last observed estrus, whereas in dogs with other mammary tumors, the tumor was initially noticed a mean of 137 days after the beginning of the last observed estrus. Dogs with IC were more likely to be anorectic and to have generalized weakness, weight loss, and thoracic metastases. Dogs with IC survived a mean of 25 days with palliative treatment. Histologically, involvement of dermal lymphatic vessels was identified in 14 of 19 (74%) dogs with IC. Two clinical forms of IC (primary and secondary) were identified. Dogs with primary IC had a worse clinical condition. Results suggest that IC is an uncommon but distinct entity in dogs. A histologic finding of dermal lymphatic involvement should be considered a hallmark for the pathologic diagnosis of IC in dogs.

Indium-III octreotide scintigraphy of Merkel cell carcinomas and their metastases

Somatostatin receptor scintigraphy (SRS) may be of interest for staging Merkel Cell Carcinoma (MCC). This study was undertaken to evaluate the sensitivity and specificity of SRS and to determine its role compared to conventional investigations. From 1993 to December 2000, 20 patients (10 females and 10 males, aged from 38 to 88, mean 66 years) were included prospectively. At the time of SRS: 12 patients had been diagnosed as having stage I disease, 6 stage II and 4 stage III. Two patients had two SRS studies during the course of their disease. SRS was performed with Indium-111 pentetreotide (Octreoscan), a radiolabelled somatostatin analogue. Patients were treated according to the clinical stage. A regular follow-up was scheduled every three months. SRS depicted stage I and II MCC tumour sites with an overall sensitivity of 78% (95% confidence interval (CI): 40%-97%) and a specificity of 96% (81%-100%). The histopathological diagnosis was used as the gold standard. Sites visualised by SRS were compared to those detected with conventional modalities and to follow-up data for all stages: SRS visualised four out of five primary tumour sites, six out of eight lymph node sites, no skin metastases (14 sites in 2 patients), two out of three thoracic metastases and zero out of two hepatic metastases. SRS did not influence treatment decision-making in any of the cases. Although SRS seems highly specific in MCC and could be of help in difficult cases, it cannot be recommended for routine evaluation.

Controversy: endoscopic approaches to metastatic thoracic disease

Traditional approaches to thoracic metastases and spinal cord compression have been well worked out and validated in the literature. Anterior decompression is clearly superior to laminectomy; vertebrectomy and reconstruction are indicated for sagittal collapse, instability, and pain; and surgical decompression is necessary in cases of bony impingement. The role of endoscopic and minimally invasive techniques in treatment of metastatic disease is evolving. Dr. Lieberman advocates the use of thoracoscopic anterior approaches as the principal application in these patients, whereas Dr. McLain has found that endoscopic assistance has vastly improved his results with posterolateral decompression. The two authors weigh the relative advantages and disadvantages of these approaches for the selected patient with metastatic thoracic disease.

Exploratory Thoracotomy for Nonresectable Lung Cancer

We sought to evaluate the effect of new diagnostic modalities on patients explored surgically for inoperable lung cancer. From July 1983 to February 1992, 335 patients underwent thoracotomy for lung cancer. Thirty-three of the 35 patients with nonresectable disease had sufficient data for analysis and underwent chest radiography (CXR), CT scan, and bronchoscopy. The study was terminated when video-assisted thoracoscopy (VAT) was introduced at the institution. Causes of nonresectability included significant N2 disease not diagnosed preoperatively (n = 11), tumor invasion of contiguous mediastinal structures (n = 8), and insufficient pulmonary function (n = 4). Four patients were left with unresected disease because of thoracic metastasis. Two patients had technically unresectable disease; three patients were explored surgically because diagnoses could be obtained by no other means. One patient was found to have small cell cancer. Data analysis demonstrated that 19 of 33 thoracotomies could potentially have been avoided or resulted in resection with current techniques. Refinement of imaging criteria, a judicious surgical approach to N2 disease, and VAT may significantly reduce thoracotomies for nonresectable lung cancer.

Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients

The symptoms in metastatic compression of the spinal cord or cauda equine are described after a systematic recording of the sequence of symptoms in 153 patients. Radicular pain was predominant in patients with metastases located in the lumbar area, while the severity of motor symptoms was positively correlated with thoracic metastases. The most common initial symptom was radicular poin, followed, with decreasing frequency, by motor weakness, sensory complaints and bladder dysfunction. The progression of motor weakness influenced the probability of establishing the diagnosis of spinal cord compression by stepwise marked increased probability when patients lost gait function or progressed into total paralysis.

Pleural involvement in the carcinoid syndrome

Tissue fibrosis is a recognized complication of the carcinoid syndrome but pleural changes have not been described. Prompted by the finding of severe pleural thickening in two patients with the metastatic carcinoid syndrome but no thoracic metastases or previous pleural disease we reviewed the chest radiographs and CT scans in 50 patients with the carcinoid syndrome investigated from 1981 to 1990. Pleural abnormality was noted in 14 of the 50 patients (28%), five of whom had other possible causes for pleural disease. However, nine (18%) patients had 'idiopathic' pleural thickening. Pleural disease had developed within 2 years of the diagnosis in all cases, and seven of the nine patients had fibrosis elsewhere (heart valves, skin or mesentery). There were no features to suggest a more rapid disease progression in the patients with pleural disease. We suggest that the pleural abnormality is a complication of metastatic carcinoid disease.

Primary cardiac angiosarcoma: A clinicopathologic study of six cases

Autopsy or surgical specimens from six patients with primary cardiac angiosarcoma seen at the Mayo Clinic (all in men) between 1939 and 1988 were studied (patients' ages, 31 to 80 years; mean 50 years). The symptoms were nonspecific and included dyspnea and thoracoabdominal pain in six; anorexia in five; fatigue, hemoptysis, or orthopnea in four; nausea and vomiting, fever, or weight loss in three; and night sweats in two. Cardiomegaly was present in five, and a pericardial effusion or density, a mass adjacent to the heart, or nonspecific ST-T wave changes were present in three. All six neoplasms arose from the right atrium and exhibited epicardial or endocardial extension; three produced obstructive intracavitary right atrial masses. Pulmonary metastatic lesions were noted in five patients. The cardiac neoplasm was diagnosed by computed tomography or magnetic resonance imaging in the three most recent patients, and surgical resection was performed in two of them. Mean survival was 6 months after presentation. Causes of death were pulmonary hemorrhage in three, thoracic metastasis in two, and hemopericardium in one. The diagnosis of primary cardiac angiosarcoma was established at operation in two patients and at autopsy in four. Despite diagnosis by noninvasive imaging procedures and aggressive early surgical intervention, survival was less than 6 months. Thus optimal therapy is unclear.

An aortic body carcinoma with multifocal thoracic metastases in a cat

A necropsy performed on an aged cat with respiratory signs revealed a large white firm mass cranioventrally to the heart, and multiple similar masses scattered throughout the lungs, diaphragm, pericardial sac and intercostal muscles. The histological examination of the primary site and the metastases are consistent with a well-differentiated aortic body carcinoma.

Primary and secondary chest wall tumors from the pathologist's viewpoint

Fibrous dysplasia (20%), metastases (16%) and chondrosarcoma (11%) are the most common bone tumors of the chest wall. Except lipoma, primary lesions of the soft tissue of the chest occur rarely as well. The Askin- and Abrikosoff tumor, elastofibroma dorsi and desmoid can be seen as typical exceptions. With respect to the histogenetic classification of undifferentiated sarcomas and thoracic metastases (f.e. prostatic carcinomas or mesotheliomas) an intimate cooperation of surgeons and pathologists as well as modern immunohistochemical investigations are required.

Radiologic investigation of thoracic metastases from unknown primary sites.

When a patient presents with thoracic metastases from a tumor whose site of origin is not apparent from the initial history, physical examination, and routine laboratory studies, there is a considerable likelihood that the individual will be subjected to an extensive and frequently unrewarding series of radiologic examinations. An analysis of the "behavior" of so-called tumors of unknown origin suggests that these tumors metastasize to distant sites with a frequency that is different from the more common tumors, that is to say, those whose primary site is readily apparent. While compulsive testing should unquestionably be eschewed, certain radiologic tests are still appropriate. These studies should be supplemented, when necessary, by newer pathologic studies, primarily those that involve the rapidly developing field of immunocytochemistry.

Surgery of Pulmonary Metastases

From 1954 to 1985, 150 metastases were removed in 80 patients (55 males, 25 females) with an age range from 8 to 82 years. The role of pulmonary resection for metastatic lesions of the period 1954 to 1975 (group I) was compared to the period 1976 to 1985 (group II). In group I, 48 metastases were resected in 35 patients and in group II, 102 metastases in 45 patients. The surgical mortality in the total population was 1%. The average interval from diagnosis of the primary neoplasm to diagnosis of thoracic metastases was 4 years in both groups. Primary neoplasm localization did not differ in the 2 groups. In both groups approximately 50% of the patients were without symptoms. Wedge resection and lobectomy were the most frequent procedures followed by segmentectomy and pneumonectomy. The median post thoracotomy survival was 21 months in group I and 36 months in group II. Although the tumor-free interval, presenting symptoms and surgery did not differ in the 2 groups, the actuarial 5-year survival in group I was 31%, and 53% for group II. Neither sex, age nor the lung resection type significantly affected the therapeutic results. Good prognostic factors were a non-seminomatous testicular tumor as the primary tumor, a tumor-free interval longer than 60 months and a tumor-doubling time longer than 136 days. Poorer results were obtained in the presence of N2 metastases, and of a large tumor volume. It seems that with the increased effectiveness of chemotherapy, especially in non-seminomatous testicular tumor, the role of surgery is changing. Surgery is now also indicated to resect metastases unresponsive to chemotherapy and to obtain histology of stabilized lesions after chemotherapy.

Breast cancer and thoracic metastases: review of 119 patients.

Review of the case notes of 660 patients with a diagnosis of breast cancer during a five-year period showed that in 119 cases there had been thoracic metastases. These were recorded as pleural or extrapleural metastases (79 patients), mediastinal tumour (46 patients), lymphangitic carcinoma (41 patients), pulmonary nodules (34 patients), and solitary pulmonary nodule (nine patients). Endobronchial metastases were present in seven patients and multiple pulmonary tumour emboli in two. The thorax was often the initial site of tumour recurrence. Most of these recurrences were present in several locations (intrathoracic or both intrathoracic and extrathoracic) simultaneously, facilitating the clinical diagnosis of metastatic breast cancer. Histopathological confirmation of metastasis was mandatory for the 10 patients who had a solitary intrathoracic abnormality without evidence of disease elsewhere. The median survival after diagnosis and treatment of a solitary thoracic metastasis was 42+ months and three of 10 patients are currently in remission (at 44, 87, and 121 months). The small tumour burden and early diagnosis giving lead time may explain the long survival in this group of patients.

Thoracic metastases.

One hundred and four patients are reviewed who were found to have thoracic metastases arising from distant primaries. Ninety lesions were intrapulmonary and the remainder involved other thoracic structures, such as chest wall and pleura. The tissue diagnosis was established in all but eight patients. Cases were included only if review of the histology revealed that both primary and secondary tumours were identical. The chest lesion was the presenting feature of the disease in 21 patients. In the remainder, the interval between treatment of the primary and appearance of the thoracic metastasis varied from a few months to 25 years. Twelve patients had metastatic sarcoma. The remainder had metastases from the gastrointestinal tract (29), from the genitourinary tract (32), from breast primaries (18), and a miscellaneous group (13) which included five instances of malignant melanoma and metastases from adrenal, laryngeal, and thyroid primaries. The metastases were treated surgically in 47 patients. In the light of cell type, availability of nonsurgical methods of treatment, site of metastasis, and survival, an attempt is made to evaluate the place of surgery in the management of thoracic metastatic disease.

Behavior of tumors produced by transplantation of human mammary cell lines in athymic nude mice

The behavior of malignant tumors produced by subcutaneous injections of 4 human mammary cell lines (BT 20, MCF- 7, CaMa 15, MaNo 4) in athymic nude mice was studied over several serial passages. BT 20 and MCF- 7 tumors became manifest after latency periods of variable length. They displayed a slow infiltrative growth, had metastatic rates of 9% and 15% respectively, and seldom recurred after surgical excision. Active growth of CaMa 15 and MaNo 4 tumors began a few hours after grafting; they were very aggressive undifferentiated carcinomas which recurred frequently ( 69% and 70%) and metastasized in 50% and 37% of the cases respectively. The commonest sites of metastases were the regional lymph nodes, lungs and mediastinum. Thoracic metastases were more frequent in CaMa 15 and in MaNo 4 tumors than in the 2 other groups. Whether and to what extent these tumors were influenced by uncontrolled host factors was not determined. Therefore, their behavior should be evaluated on the basis of the present experimental conditions rather than as fixed characteristics particular to each cell population.

Thoracic metastases from cervical carcinoma: current status.

Thoracic metastases from squamous carcinoma and adenocarcinoma of the cervix were studied by reviewing 245 consecutive cases to describe comparative incidence, natural history, and radiographic patterns. The incidence of chest metastases was higher for adenocarcinoma (20%) than for squamous carcinoma (4%). Few patients diagnosed in the early stages of squamous carcinoma developed metastases; for adenocarcinoma, chest metastases occurred regardless of the stage at diagnosis. For both histologies, parenchymal (often cavitary) nodules only were seen; lymphangitic pattern was not observed. Both adenopathy and malignant effusion are common (44% of metastases) in thoracic metastasis from squamous carcinoma. Adenopathy but not effusion was common in adenocarcinoma.

Cancer reductive surgery.Report on the simultaneous excision of abdominal and thoracic metastases from widespread testicular tumors

Cancer reductive surgery.Report on the simultaneous excision of abdominal and thoracic metastases from widespread testicular tumors

Thoracic Metastasis in Malignant Melanoma: A Radiographic Survey of 65 Patients

Sixty-five patients with malignant melanoma metastatic to the thorax were evaluated retrospectively. Chest x-ray films showed abnormalities in 63 patients and provided the first evidence of dissemination in 42 of the 62 with widespread metastasis. Frequent radiographic follow-up evaluations of patients with primary melanoma is necessary to detect metastasis at an early stage. Pulmonary metastasis was seen radiographically in almost 90 percent of the patients. Snowstorm metastasis denotes a poorer prognosis than other patterns of pulmonary involvement. Enlargement of mediastinal lymph nodes, bronchial obstruction with atelectasis, pleural effusion, bone metastasis with an extrapleural mass, and cardiomegally were also seen. Follow-up chest x-ray films are of limited value in evaluating patients once they are found to have thoracic metastasis. The rate of growth of metastatic lesions or the regression of the metastasis does not correlate with survival.