RESUMEN
BACKGROUND AND PURPOSE: External beam radiation therapy (XRT) for head and neck cancer is known to induce hypothyroidism and cause morphologic changes in the thyroid gland. This retrospective study investigates change in the size of the thyroid gland detectable by CT after XRT for laryngeal cancer. MATERIALS AND METHODS: The measured width of the thyroid lobes in 61 patients treated nonsurgically with XRT for laryngeal cancer between 2000 and 2003 on posttherapy CT was compared with that on pretherapy CT. Absolute and percentage changes in measured thyroid width following XRT were analyzed according to chemotherapy administration and posttherapy thyroid function. RESULTS: Eighty-five percent (52/61) of patients had a decrease in the width of the thyroid gland. The average change in width measuring -4.7 mm and -13.8% (SD, 5.7 mm and 19.9%) occurred at an average of 758 days following completion of XRT (mean, 402-1534 days) and was significant (P = .002). Average change in width between hypothyroid patients (n = 19, -6.1 mm and -20.0% change) and euthyroid patients (n = 42, -4.1 mm and -11.1% change) was not significant (P = .20 absolute change and P = .11 percentage change). The average change in width between patients receiving chemotherapy (n = 31, -5.5 mm and -16.1% change) and patients not receiving chemotherapy (n = 30, -3.9 mm and -11.5% change) was not significant (P = .26 absolute change and P = .37 for percentage change). CONCLUSIONS: Most nonsurgical patients receiving XRT for laryngeal cancer have a significant decrease in the width of their thyroid glands detected on CT. The average change in the size of the thyroid gland does not differ when development of hypothyroidism or chemotherapy administration are considered.
Asunto(s)
Carcinoma de Células Escamosas/radioterapia , Hipotiroidismo/etiología , Neoplasias Laríngeas/radioterapia , Radioterapia/efectos adversos , Glándula Tiroides/patología , Glándula Tiroides/efectos de la radiación , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Tumor Carcinoide/tratamiento farmacológico , Tumor Carcinoide/radioterapia , Carcinoma de Células Escamosas/tratamiento farmacológico , Terapia Combinada , Estudios de Seguimiento , Humanos , Hipotiroidismo/diagnóstico por imagen , Hipotiroidismo/patología , Neoplasias Laríngeas/tratamiento farmacológico , Persona de Mediana Edad , Tamaño de los Órganos/efectos de la radiación , Estudios Retrospectivos , Rabdomiosarcoma/tratamiento farmacológico , Rabdomiosarcoma/radioterapia , Glándula Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: Adrenal abnormalities are often identified on imaging studies performed during the staging of patients presenting with a new malignancy or restaging of patients with a history of a malignancy. METHODS: We reviewed the records of patients who underwent surgical resection of an adrenal mass identified in the setting of previously or newly diagnosed extra-adrenal malignancy. RESULTS: Eighty-one patients with an adrenal mass and recently diagnosed malignancy (n = 24) or history of a malignancy (n = 57) underwent adrenalectomy. In 42 patients (52%) the adrenal mass was a metastasis. In 39 patients (48%) the adrenal mass was an additional primary adrenal tumor process: 19 pheochromocytomas, (14 syndrome-associated, 5 sporadic), 13 cortical adenomas, 3 adrenocortical carcinomas, 2 ganglioneuromas, and 2 cases of nodular hyperplasia. CONCLUSIONS: In this series nearly half of the patients with cancer and an adrenal mass had adrenal pathologic condition independent of their primary malignancy. Despite the presence of a newly diagnosed malignancy or history of malignancy, all patients with an adrenal mass should undergo a standard hormone evaluation to confirm that the mass is not a functional neoplasm. An assumption that the adrenal mass is metastatic disease will be wrong in up to 50% of such patients.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Adulto , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Synchronous appearance of 2 different malignancies in one patient is a rare phenomenon. We describe our experience of 2 patients with synchronous malignancies of the testis and thyroid gland, and of a third patient who developed a thyroid neoplasm unrelated to recent treatment for a germ cell tumor. The medical records of 3 male patients treated for both a germ cell tumor and a thyroid cancer between 1989 and 1994 were reviewed. Two patients with nonseminomatous germ cell tumor received postoperative chemotherapy after orchiectomy and developed a papillary carcinoma of the thyroid during treatment. A third patient, who received radiation therapy for a clinical stage 1 seminoma, recurred with biopsy proven seminoma in the neck in association with a thyroid nodule 2 years later. All 3 patients had their thyroid cancer treated by surgical resection, and one received adjuvant radioactive iodine. Two of the patients are currently alive and disease-free. One patient died of pulmonary complications that stemmed from bleomycin toxicity. Synchronous appearance of germ cell tumor and papillary carcinoma of the thyroid has not been previously described. Genetic predisposition may play a role in the development of such simultaneous neoplasms.
Asunto(s)
Carcinoma Papilar/patología , Neoplasias Primarias Múltiples/patología , Seminoma/patología , Neoplasias Testiculares/patología , Neoplasias de la Tiroides/patología , Adulto , Carcinoma Papilar/terapia , Humanos , Masculino , Neoplasias Primarias Múltiples/terapia , Seminoma/terapia , Neoplasias Testiculares/terapia , Neoplasias de la Tiroides/terapiaRESUMEN
The prevalence of breast cancer (a hormonally driven neoplasm) in the United States, the potential health benefits of estrogen replacement therapy for postmenopausal women, and the burgeoning research focusing on selective estrogen receptor modulators (SERMs) have resulted in additional complexity in managing breast cancer. In an attempt to clarify existing data, the Society of Surgical Oncology sponsored a symposium entitled "Estrogens and Antiestrogens in Managing the Patient with Breast Cancer" at its 52nd Annual Cancer Symposium. This conference was held in March 1999 and was chaired by Dr. S. Eva Singletary, Professor of Surgery and Chief of the Surgical Breast Section at The University of Texas M. D. Anderson Cancer Center in Houston, Texas. The following is a review of the material presented by the symposium participants.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/etiología , Moduladores de los Receptores de Estrógeno/uso terapéutico , Terapia de Reemplazo de Estrógeno/efectos adversos , Factores de Edad , Antineoplásicos Hormonales/uso terapéutico , Inhibidores de la Aromatasa , Neoplasias de la Mama/prevención & control , Femenino , Humanos , Osteoporosis Posmenopáusica/prevención & control , Posmenopausia , Factores de Riesgo , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Tamoxifeno/uso terapéuticoRESUMEN
OBJECTIVE: To evaluate surgical complications, patterns of lymph node metastases, and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent medullary thyroid carcinoma (MTC). SUMMARY BACKGROUND DATA: The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies. These data have provided the rationale for surgeons to perform a more extensive lymphadenectomy at the time of initial thyroidectomy and to consider reoperative cervical lymphadenectomy in patients with persistently elevated calcitonin levels after thyroidectomy. METHODS: Forty patients underwent surgery for MTC from 1991 to 1997 (23 sporadic cases, 17 familial cases). Patients were divided into three groups based on whether they had undergone previous thyroidectomy and on the results of standardized staging studies performed after referral to the authors' institution. Group 1 (11 patients) had received no previous surgery; group 2 (13) underwent thyroidectomy before referral and had an elevated calcitonin level without radiologic evidence of local regional or distant metastases; and group 3 (16) underwent thyroidectomy before referral and had an elevated calcitonin level with radiologic evidence of local-regional recurrence. The central neck compartment was dissected in all patients; preoperative staging and the extent of previous surgery dictated the need for lateral (modified radical) neck dissection. After primary or reoperative surgery, calcitonin levels were assessed. RESULTS: All patients had major reductions in postoperative calcitonin levels. Seven (29%) of 24 patients in groups 1 and 2 achieved normal calcitonin values compared with only 1 (6%) of 16 in group 3. Postoperative complications included seven cases (17%) of permanent hypoparathyroidism; five (71%) of these occurred in group 3. There were no iatrogenic recurrent laryngeal nerve injuries; one patient required recurrent nerve resection to achieve complete tumor extirpation. At a median follow up of 35 months, local recurrence was documented in 5 (13%) of 40 patients. CONCLUSIONS: Compartment-oriented lymphadenectomy performed early in the course of MTC is safe and may return calcitonin levels to normal in up to 25% of carefully selected patients. However, reoperation for bulky cervical disease (group 3) rarely results in normal calcitonin levels and is associated with a high incidence of permanent hypoparathyroidism.
Asunto(s)
Carcinoma Medular/cirugía , Proteínas de Unión al ADN , Escisión del Ganglio Linfático/métodos , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adolescente , Adulto , Anciano , Calcitonina/sangre , Carcinoma Medular/sangre , Carcinoma Medular/genética , Carcinoma Medular/secundario , Niño , Análisis Mutacional de ADN , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/cirugía , Proteínas Nucleares/genética , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/patologíaRESUMEN
PURPOSE: To investigate the frequency, presentation, clinical management, and prognosis of appendiceal carcinoid tumors in children. METHOD: A review of our institution's experience over 50 years. RESULTS: Twenty-two patients below the age of 20 presented with appendiceal carcinoid tumor. The mean age at presentation was 14.6 years. Twelve patients presented with symptoms of appendicitis. No tumor was > 2.0 cm in size. Only 2 patients underwent resection beyond appendectomy. No patient had recurrent or metastatic carcinoid tumor, and all but 1 patient (who died of ovarian choriocarcinoma) are alive without evidence of carcinoid tumors 1.5 to 30 years after diagnosis. CONCLUSIONS: Appendiceal carcinoid tumors in children are rarely life-threatening and the incidence of large tumors (> 2.0 cm) is very low. The role of right hemicolectomy in large (> 2.0 cm) tumors is questionable in this age group.
Asunto(s)
Neoplasias del Apéndice , Tumor Carcinoide , Adolescente , Adulto , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/cirugía , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Niño , Femenino , Humanos , MasculinoRESUMEN
Parathyroid cysts are uncommon. They can be divided into functional and nonfunctional cysts depending on whether or not they are associated with hypercalcemia. Functioning cysts are very rare, with fewer than twenty reported cases. We report a case of functioning parathyroid cyst associated with hypocalciuric hypercalcemia. We have been unable to find a similar case previously reported in the literature.
Asunto(s)
Calcio/orina , Quistes/complicaciones , Quistes/patología , Hipercalcemia/complicaciones , Glándulas Paratiroides/patología , Adulto , Quistes/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Glándulas Paratiroides/cirugíaRESUMEN
Approximately 25% of breast cancers occur in premenopausal women. In addition to local therapy, surgery or surgery plus irradiation, systemic chemotherapy administration has become the standard of care for all node-positive and many node-negative patients. Systemic adjuvant chemotherapy can result in ovarian dysfunction or failure. This renders many women prematurely estrogen deficient. The consequences of menopause, genitourinary atrophy, bone loss, and increased risk of cardiovascular disease, have not been routinely assessed in clinical trials. The risks of estrogen deficiency have not been assessed in comparison to improved disease-free and overall survival benefits of adjuvantly treated premenopausal breast cancer patients. Estrogen-replacement therapy in postmenopausal women has been shown to prevent osteoporosis and reduce fracture risk. The majority of studies also show a marked reduction in cardiovascular disease and mortality. Estrogen-replacement therapy has been considered a disease-prevention strategy rather than a therapeutic intervention. The risks and benefits of estrogen-replacement therapy in women with primary breast cancer are unknown. It is unknown how the well-known benefits accrued from reduction in skeletal and cardiovascular morbidity/mortality compare with the potential risks of increased breast cancer morbidity/mortality. Carefully designed prospective clinical trials with well-defined objectives and endpoints are required to learn if more harm than good is done by the withholding of estrogen therapy in breast cancer patients.
Asunto(s)
Neoplasias de la Mama , Terapia de Reemplazo de Estrógeno , Insuficiencia Ovárica Primaria/terapia , Adulto , Antineoplásicos/efectos adversos , Neoplasias de la Mama/inducido químicamente , Neoplasias de la Mama/terapia , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Estudios de Casos y Controles , Quimioterapia Adyuvante , Terapia Combinada , Neoplasias Endometriales/inducido químicamente , Terapia de Reemplazo de Estrógeno/efectos adversos , Femenino , Rubor/epidemiología , Rubor/etiología , Rubor/prevención & control , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Trastornos Mentales/prevención & control , Persona de Mediana Edad , Neoplasias Hormono-Dependientes/inducido químicamente , Neoplasias Hormono-Dependientes/terapia , Osteoporosis Posmenopáusica/epidemiología , Osteoporosis Posmenopáusica/prevención & control , Embarazo , Premenopausia , Insuficiencia Ovárica Primaria/inducido químicamente , SobrevivientesRESUMEN
BACKGROUND: Nonfunctioning islet cell carcinoma of the pancreas has a variable and often indolent natural history, which has resulted in a wide range of treatment recommendations. To more clearly define the natural history and appropriate treatment of this disease, we reviewed our institutional experience over the last 39 years. METHODS: The records of all patients confirmed to have a nonfunctioning islet cell carcinoma of the pancreas were retrospectively reviewed. Kaplan-Meier life tables were constructed and log-rank comparisons were performed. RESULTS: The 73 patients studied had an overall 5-year actuarial survival rate of 50%. Patients with localized disease at presentation (n = 39) had a significantly higher survival rate (p = 0.03) compared with patients with metastatic disease (n = 34). The 19 patients who underwent a potentially curative resection of the primary tumor had a significantly higher survival rate (p = 0.03) compared with the 20 patients with locally advanced, unresectable, nonmetastatic disease. Nine of these 20 patients died of complications of the primary tumor. In contrast, only 2 of 22 cancer-related deaths in the 34 patients with metastatic disease at diagnosis were due to the primary tumor. CONCLUSIONS: (1) Surgical resection should be performed in patients with resectable nonmetastatic disease. (2) Resection of the primary tumor in the presence of metastatic disease is rarely indicated. (3) Innovative treatment strategies are needed for patients with locally advanced, unresectable, nonmetastatic tumors of the pancreatic head.
Asunto(s)
Carcinoma de Células de los Islotes Pancreáticos/cirugía , Neoplasias Pancreáticas/cirugía , Adolescente , Adulto , Anciano , Carcinoma de Células de los Islotes Pancreáticos/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Pancreatectomía , Neoplasias Pancreáticas/mortalidad , Pancreaticoduodenectomía , Complicaciones Posoperatorias , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Unstimulated and stimulated salivary flow rates, Streptococcus mutans samples, and dental caries data were obtained from 50 patients with thyroid cancer who had received radioactive iodine, I131, from 0.3 to 20 years earlier. The salivary flow rates were compared with a healthy control group, and the S. mutans counts were compared to a group of patients with head and neck cancer who were sampled before radiotherapy. Flow rates were found to be significantly lower in the patients with thyroid cancer, and S. mutans levels were slightly but not significantly higher than the controls. Longitudinal flow rate data taken on four patients, who served as their own controls before and after I131 therapy, indicated a trend in saliva reduction.
Asunto(s)
Glándulas Salivales/efectos de la radiación , Salivación/efectos de la radiación , Neoplasias de la Tiroides/radioterapia , Adulto , Anciano , Recuento de Colonia Microbiana , Caries Dental/etiología , Femenino , Humanos , Radioisótopos de Yodo/efectos adversos , Masculino , Persona de Mediana Edad , Boca/microbiología , Radioterapia/efectos adversos , Glándulas Salivales/fisiopatología , Tasa de Secreción/efectos de la radiación , Streptococcus mutans/aislamiento & purificación , Neoplasias de la Tiroides/fisiopatología , Xerostomía/complicaciones , Xerostomía/etiologíaRESUMEN
Parathyroid cysts are uncommon. They can be divided into functional and nonfunctional cysts depending on whether or not they are associated with hypercalcemia. Functioning cysts are very rare with less than twenty reported cases. We report a case of functioning parathyroid cyst associated with hypocalciuric hypercalcemia. We have been unable to find a similar case previously reported in the literature.
Asunto(s)
Quistes/cirugía , Hipercalcemia/complicaciones , Glándulas Paratiroides/cirugía , Adulto , Análisis Químico de la Sangre , Calcio/efectos adversos , Calcio/sangre , Calcio/orina , Quistes/diagnóstico , Quistes/etiología , Citometría de Flujo , Humanos , Hipercalcemia/sangre , Hipercalcemia/orina , Cálculos Renales/cirugía , Litotricia , Masculino , Orina/químicaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Glucagonoma/tratamiento farmacológico , Neoplasias Pancreáticas/tratamiento farmacológico , Fluorouracilo/administración & dosificación , Glucagonoma/secundario , Humanos , Interferón alfa-2 , Interferón-alfa/administración & dosificación , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Proteínas Recombinantes , Resultado del TratamientoRESUMEN
It is common practice to forego the prescribing of estrogen replacement therapy (ERT) for patients with a history of breast cancer. The consequences of estrogen deprivation particularly cardiovascular morbidity and osteoporosis are reviewed in the context of the potential risks of ERT in patients with prior breast cancer. The published data regarding breast cancer risks with oral contraceptive use and ERT in healthy women is reviewed. The rationale for a clinical trial of ERT in breast cancer patients, the proposed appropriate patient group and positive end points for assessing benefit of ERT in the population are presented. Lack of reliable clinical data makes ERT in breast cancer patients an unresolved clinical dilemma.
Asunto(s)
Neoplasias de la Mama/patología , Terapia de Reemplazo de Estrógeno , Menopausia/fisiología , Neoplasias Hormono-Dependientes/patología , Adolescente , Adulto , Neoplasias de la Mama/mortalidad , Contraindicaciones , Terapia de Reemplazo de Estrógeno/efectos adversos , Femenino , Humanos , Neoplasias Hormono-Dependientes/mortalidad , Factores de RiesgoRESUMEN
A total of 117 patients under 20 years of age with papillary and/or follicular thyroid cancer presented to the M. D. Anderson Cancer Center between 1949 and 1987. The most common presenting symptom was a cervical mass. Twenty percent of the patients had a history of prior irradiation. Sixty percent initially had palpable lymph nodes, while 26% who had clinically negative examinations had pathologically positive lymph nodes. Recurrence was highest in regional lymph nodes at 24%, with only a 4% recurrence rate at the primary site and a 3% recurrence rate at distant sites. There were no deaths due to the thyroid cancer. To maintain a low rate of recurrence, near-total thyroidectomy with neck dissection followed by iodine 131 treatment should be considered in these young patients.
Asunto(s)
Adenocarcinoma/patología , Metástasis Linfática , Neoplasias de la Tiroides/patología , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Adolescente , Adulto , Carcinoma Papilar/patología , Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirugía , Niño , Preescolar , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática/patología , Masculino , Mediastino , Cuello , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugíaAsunto(s)
Glucagón/uso terapéutico , Hipoglucemia/tratamiento farmacológico , Neoplasias Meníngeas/complicaciones , Neurofibroma/complicaciones , Adulto , Glucagón/administración & dosificación , Hormona del Crecimiento/administración & dosificación , Hormona del Crecimiento/uso terapéutico , Humanos , Hipoglucemia/etiología , Infusiones Intravenosas , MasculinoRESUMEN
The clinical features of 20 patients from five families with multiple endocrine neoplasia syndrome type I (MEN-I) were studied. Nineteen patients (95%) had hyperparathyroidism. Five patients who had a diagnosis during surgery of adenoma and who had fewer than 3.5 glands removed had recurrence of hypercalcemia after surgery. Fourteen patients (70%) had pancreatic islet cell tumors. All had one or more elevated serum polypeptide hormones, and six had symptoms related to the hormones produced. Multiple pancreatic tumors were identified in the nine patients who underwent surgery. Three patients who died had a mean survival of 6.3 +/- 2.9 years. Eight patients had pituitary tumors; seven had macroadenomas. Of the eight patients with pituitary tumors, seven had high serum prolactin and responded to bromocriptine therapy, whereas the eighth patient had acromegaly treated with radiotherapy. It was concluded that hypercalcemia due to hyperparathyroidism in MEN-I syndrome patients should be managed by a resection of four glands and transplantation of one half gland into the forearm because none of the patients has shown evidence of a recurrence, and serum calcium levels have been normal. Pancreatic tumors, which are usually multiple, may be asymptomatic. Patients with these tumors usually have long survival rates, even with distant metastasis. Total pancreatectomy may be the method of choice, especially in patients with gastrinoma caused by the diffuse nature of the disease. Long-term follow-up is needed, however, with more patients. Pituitary tumors are primarily prolactin-producing tumors, and medical treatment is the method of choice.
Asunto(s)
Neoplasia Endocrina Múltiple/genética , Adenoma de Células de los Islotes Pancreáticos/epidemiología , Adenoma de Células de los Islotes Pancreáticos/secundario , Adolescente , Adulto , Femenino , Humanos , Hiperparatiroidismo/epidemiología , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasia Endocrina Múltiple/patología , Neoplasia Endocrina Múltiple/terapia , Neoplasias Pancreáticas/epidemiología , Linaje , Neoplasias Hipofisarias/epidemiologíaRESUMEN
The records of 110 patients (58 females and 52 males) with histologically proven adrenal cortical carcinoma were studied. Fifty-six of 110 (50.9%) patients had abdominal symptoms and 33 (30.0%) had a palpable abdominal mass. Surgery for localized and regional disease was associated with a disease-free survival time of at least 2 years in 28 of the 50 (56%) patients. Abdominal radiotherapy, systemic chemotherapy, and 1,1 dichloro-2 (O-chlorophenyl)-2 (P-chlorophenyl) ethane (OPDDD) were effective in three of 19 (15.8%) patients, three of 31 (9.7%) patients, and 21 of 72 (29.2%) patients, respectively. Combined radiotherapy and OPDDD did not confer any additional benefit over OPDDD alone. Six of seven patients who received OPDDD as adjuvant treatment are still alive at 1 to 4 years. Distant metastases occurred most commonly in the lungs, liver, peritoneum, lymph nodes, and bones. Only 23% of the patients survived 5 years or more. We conclude that early diagnosis and complete surgical excision offer the best prospects for long-term survival and that the efficacy of adjuvant OPDDD needs to be evaluated further.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/terapia , Carcinoma/terapia , Adolescente , Neoplasias de la Corteza Suprarrenal/diagnóstico , Neoplasias de la Corteza Suprarrenal/mortalidad , Adulto , Anciano , Carcinoma/diagnóstico , Carcinoma/mortalidad , Carcinoma/secundario , Niño , Preescolar , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias MúltiplesAsunto(s)
Adenoma de Células de los Islotes Pancreáticos/complicaciones , Dermatitis/etiología , Neoplasias Pancreáticas/complicaciones , Polipéptido Pancreático/metabolismo , Síndromes Paraneoplásicos , Adenoma de Células de los Islotes Pancreáticos/metabolismo , Adenoma de Células de los Islotes Pancreáticos/terapia , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/terapiaRESUMEN
Seventy-seven patients with histologically proven adrenal cortical carcinoma seen at the University of Texas M. D. Anderson Hospital (1950-1981) were studied. Thirty-nine were women (mean age at diagnosis, 36.6 years), and 38 were men (mean age at diagnosis, 48.3 years). On presentation, 41 of 74 had abdominal symptoms (55.4%) and 25 of 74 had an abdominal mass (33.8%). Twenty-six patients (33.8%) were found to have clinically functional disease (18 women, 8 men). At diagnosis, 26 (33.8%) had clinical or radiologic signs of distant metastases. Preoperative radiologic studies yielded an abnormal intravenous pyelogram in 42 of 51 (82%), an abnormal abdominal ultrasound in eight of nine (88.9%), abnormal computerized tomography in 10 of 10 (100%), and abnormal arteriogram in 18 of 19 (94.7%). Surgery for localized or regional disease was associated with a disease-free interval of at least 2 years in 16 of 34 patients (47%). The use of op'DDD, abdominal radiotherapy, and systemic chemotherapy produced demonstrable effects in nine of 47 (19.1%), two of nine (22.2%), and three of 26 (11.5%), respectively. Distant metastases occurred in 60 patients, commonly in lung, liver, peritoneal and pleural surfaces, lymph nodes, and bone. Analysis of survival data showed a 5-year survival of approximately 30%. The authors concluded that early diagnosis and radical surgery offer the only prospects of long-term survival and the possibility of cure.