Tumor clinical presentation

Diffuse Large-Cell Lymphoma (DLCL). These clinically aggressive tumors may present in lymph nodes or in extranodal sites (Hll). They can occur in patients of all ages (Al, A14). Most cases arise de novo however, some may represent transformation from a low-grade lymphoma. 

Rebbeck TR, Jaffe JM, Walker AH, et al. Modification of clinical presentation of prostate tumors by a novel genetic variant in CYP3A4. J Natl Cancer Inst 1998 90 1225-1229. 

The clinical presentation of the patient is also important to consider when interpreting patterns of biochemical results. Patients with tumors that produce large amounts of epinephrine (and also metanephrine) may present with hyperglycemia, dyspnea, and pulmonary edema, signs and... 

Localized infections. Localized infections develop in 5% to 10% patients with bacteremia. Extraluminal infection or abscess formation or both can occur at any site. They may follow any of the other syndromes, or they may be the primary presentation. Metastatic infections involve bone, cysts, heart, kidney, liver, lungs, pericardium, spleen, and tumors. The clinical presentation usually is determined by the organ systems involved. Polymorphonuclear leukocyte counts often are elevated. 

Patients with lung cancer frequently have numerous concurrent medical problems. Such problems may be related to invasion of the primary tumor and its metastases, paraneoplastic syndromes (see clinical presentation, above), chemotherapy and radiotherapy toxicity, or concomitant disease states (e.g., cardiac disease, renal dysfunction, chronic obstructive pulmonary disease, asthma, or diabetes). Depression is also common and sometimes persistent in patients with SCLC and NSCLC and should be treated. Identification, diagnosis, and treatment of the patient as a whole may improve the patient s overall quality of life and tolerance to cancer treatments. 

Renal carcinoma continues to be a major cause of morbidity and mortality worldwide (Table 16.12). Last year, approximately 54,000 new renal tumor patients were diagnosed and 13,000 deaths were ascribed to renal cancer in the United States. Renal cell carcinoma (RCC) is the seventh most common neoplasm in American males and the ninth most common neoplasm in females. There is a twofold to threefold male predominance of RCC incidence but no obvious racial predilection. Recognized risk factors include tobacco smoking, obesity (body mass index >29 may double the risk of RCC) and acquired or hereditary polycystic diseases. The classic clinical presentation symptom triad of flank pain, hematuria, and palpable mass is no longer the... 

Russell H, Hicks J, Okcu F, et al. (2004) CXCR4 expression in neuroblastoma primary tumors is associated with clinical presentation of bone and bone marrow metastases. J Pediat Surg 39 1503-1511... 

Atrial myxoma is a rare atrial tumor that causes multiple emboli of either thrombus or myxomatous tissue. When myxomatous material is embolized from the left atrium into the brain arteries, they may cause the formation of multiple distal cerebral aneurysms with risk of hemorrhage [46]. Papillary fibroelastomas are rare benign cardiac tumors usually involving a heart valve. They are small vascular growths with marked papillary projections. They usually grow on the aortic or mitral valves. The tumor consists of fibrous tissue surrounded by an elastic membrane, which in turn is covered by endothelium. One of the most conunon clinical presentations is of transient ischemic attack or stroke [47,48]. 

The clinical presentation of patients with endocrine pancreatic tumors will vary according to the type of hormone released. Hyperinsulinism manifested with diarrhea, abdominal pain, and low levels of glucose will be found in the majority of patients. Nesidioblastosis is a primitive pancreatic B cells hyperplasia. Approximately 5% of patients with hyperinsulinism may have this type of tumor. Hunger, jitteriness, lethargy, apnea, and seizures are common manifestations in newborns with nesidioblastosis, while older children may show diaphoresis, confusion, or unusual behavior. Zollinger-Elli-son syndrome will present with intractable peptic ulcers. Patients with vipomas will have watery diarrhea, hypokalemia, and achlorhydria, while multiple endocrine neoplasias have been reported with multiple endocrine neoplasia type 1 (MEN 1). 

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