Despite the fact, that lung cancer is more common among older smoking men, however it may also develop among young women without a smoking anamnesis. We report here a history of a non-smoking woman, 40 years old, with a diagnosis of lung adenocarcinoma at IV stage. Despite the fact, the woman received three lines of palliative chemotherapy, the disease progressed. After the sample of the tumor was tested by genetic approach, ROS1 mutation was detected, and the patient was treated with a ROS1 inhibitor, Crizotinib. Sharp improvement was observed already after the first week of treatment. After one-month adenocarcinoma shrink, and specific supraclavicular lymph nodes disappeared. Unfortunately, due to problems with financing the treatment was stopped, after what the disease began to progress rapidly, and the patient died after a month due to brain metastasis. This case is noteworthy also because the patient was first diagnosed a thrombophilia with thrombi present in deep calf veins, left heart ventricle and lungs Adenocarcinoma was discovered occasionally when during video-assisted thoracoscopic surgery biopsy specimen was taken from suspicious mass in the lower lobe of the right lung. This story reminds us that lung carcinoma may start with a paraneoplastic syndrome, like thrombophilia as in this case and finding of adenocarcinoma of the lung in young, non-smoking persons is indicative for possible ROS1 gene mutation. In such cases early treatment with ROS1 protein-tyrosine kinase inhibitors should be started as soon as possible.
Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC) with particularly aggressive behaviour. We present a case of a 71-year-old female patient with a relevant personal history of multiple SCC and basal cell carcinoma (BCC) excision and chronic venous insufficiency showing for about three years a ulcerated lesion located on the anteromedial distal third of the left leg non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology revealed a G2 SCC in all biopsy samples. After the staging, a left inguino-femoral lymphadenectomy and the excision were done. The treatment of bone exposure with a soleus muscle flap in the upper half of the defect and skin graft for all the defect and a specific oncologic treatment were proposed as possible curative solutions. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.
Background: Colorectal cancer progresses without any symptoms early on, or those clinical symptoms are very discrete and so are undetected for long periods of time. The case reported is an unusual presentation of colorectal cancer.
Case Report: A 60 year old man presented with right sided abdominal swelling. On examination, a well-defined, firm, tender swelling was noted. Computed tomography confirmed the presence of a mass arising from the right colon with infiltration of the right lateral abdominal wall and adjacent collection. An exploratory laparotomy with drainage of the subcutaneous abscess, resection of ascending colon, and ileotransverse colon anastomosis was performed.
Conclusion: A differential diagnosis of carcinoma colon should be considered when an elderly patient presents with abdominal wall abscess accompanied by altered bowel habits or per rectal bleeding, even if there are no other significant clinical symptoms and a thorough investigative work up is required to confirm the diagnosis, to avoid untimely delay in treatment, and reduce mortality.
Aim: Percutaneous core needle biopsy (CNB) is considered the gold standard technique for initial histological diagnosis of suspicious breast lesions seen on screening mammogram, but it is less reliable for diagnosing atypical ductal hyperplasia (ADH) due to significant rates of diagnosis upstaging to malignant disease after excision biopsy. The purpose of this study was to identify factors that predict diagnosis upstage to carcinoma in patients diagnosed with ADH on core biopsy.
Methods: A retrospective database search identified 52 consecutive CNB of suspicious breast lesions revealing pure ADH. Inclusion criteria included asymptomatic women presenting for screening mammogram, who subsequently underwent surgical excision. Logistic regression analysis evaluated clinical, radiological, and histological factors.
Results: A total of 52 patients with ADH on CNB were identified who met our criteria. Twenty-six of 52 patients (50%) were upstaged to ductal carcinoma in situ or invasive carcinoma, based on histological interpretation of the surgically excised specimen. Lesion size was showed to be a statistically significant predictor on univariable logistic regression analysis. Multivariate logistic regression analysis revealed Asian ethnicity and lesion size as independent predictors of malignancy (p = 0.050 and 0.011, respectively). Conversely, women of Middle Eastern and European origin and lesions < 15 mm on mammography were negative predictors of malignancy.
Conclusion: Lesion size ≥ 15 mm on mammography and Asian ethnicity are independent risk factors for breast carcinoma in asymptomatic patients diagnosed with ADH on CNB.
Xanthogranulomatous cholecystitis is a rare benign inflammatory disease of gallbladder that may be misdiagnosed as carcinoma of the gallbladder intraoperative or in pre-operative imaging. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation can be very severe and can spill over to the neighboring structures like liver, bowel and stomach resulting in dense adhesions, abscess formation, perforation, and fistulous communication with adjacent bowel [1-3]. Cholecysto-colic fistula is a rare and late complication of gallstones roughly found 1 in every 1,000 cholecystectomies.
Clinical featuresThe clinical features are variable and non-specific. Patients with cholecysto-colonic fistula often present with symptoms of acute cholecystitis and preoperative diagnostic tools often fail to show the fistula. Hence most cases it is an on table diagnosis.
ManagementTreatment involves closing the fistula and performing an open or laparoscopic cholecystectomy.
In this manuscript it has been described a novel synthesis of mercury doped hydroxyapatite (Hap) and its application on human liver carcinoma cell line (Hep G2) and human lung fibroblast carcinoma cell line (MRC 5). Nano-sized hydroxyapatite doped with Hg2+ was synthesized by a solution based chemical method along with mercury ion. The surface of nanoparticle of mercury doped hydroxyapatite (MHAp) was functionalized by using phosphonomethyl iminodiacetic acid (PMIDA) for making it stable as dispersed phase with negative zeta potential. Surface functionalization was confirmed by FTIR measurements. Crystalline nature, morphology and surface topology were studied by powder XRD, FESEM and AFM measurements. Particle size of the well dispersed sample was obtained by HRTEM image. The studies on cell viability of Hep G2 and MRC 5 cell in presence of mercury doped HAp nanoparticle (MHAp) were determined through WST assay. It was observed that nanocomposite exhibited a site specific action towards MRC 5 cell lines along with reduction of toxicity toward normal cells.
Actinic keratosis (AK) are scaly lesions caused by chronic ultraviolet-induced damage to the epidermis which are a proxy for excessive sun-exposure [1] that may evolve into squamous cell carcinoma [2-7]. Therefore, there is a need or continuous surveillance of such patients along with adapted information for an effective photo-protection, practical couselling on photoprotection towards the defined population, i.e. elderly with actinic keratosis. Thus, patient observance and adhesion to the dermatologist recommendations become a real public health issue. In this context, we aimed to evaluate through a non-interventional, real-life observational study, the impact of photoprotection counseling by the dermatologist on patients attitude towards sun exposure
Non-alcoholic fatty liver disease (NAFLD) is a condition that is associated with cirrhosis and hepatocellular carcinoma, and is increasing in prevalence worldwide. Sleep disruptions are commonly seen in NAFLD, and the disease process is associated with sleep disorders, including obstructive sleep apnea, circadian rhythm disorders, and insufficient sleep. The intermittent hypoxia seen in obstructive sleep apnea may contribute to fibrotic changes in the liver.A major component of this linkage may be related to gut microbiome changes. One notable change is increase in Bacteroidetes/Firmicutes ratio, and decrease in flora that ferment fiber into anti-inflammatory short-chain fatty acids. Several therapeutic options exist for NAFLD that target both sleep and NAFLD, including non-pharmacological factors, such as lifestyle modification (mainly diet and exercise). Pharmacological options include melatonin, Vitamin E, thiazolidinediones, and fecal microbiota transplantation.Core tipThe pathogenesis of non-alcoholic fatty liver disease is closely tied to sleep and circadian rhythm abnormalities, through shared inflammatory pathways and altered metabolism. This review explores the pathogenesis of NAFLD in the context of sleep and circadian abnormalities. The associated inflammatory response is linked to changes in gut-microbiome interactions that contribute to the disease process. Understanding of this linkage has implications for various therapies for disease mitigation.
The involvement of bile duct in lymphoma is considered to be very rare and is usually a sequela of a disseminated disease [1]. In contrast to secondary involvement, primary non-Hodgkin’s lymphoma arising from the bile duct is extremely rare and presents with obstructive jaundice [2,3]. Non-Hodgkin’s lymphoma (NHL) accounts for 1% - 2% of all cases of malignant biliary obstruction [4]. Hepatobiliary involvement by malignant lymphoma is usually a secondary manifestation of systemic lymphoma. The first case of Non-Hodgkin lymphoma arising from bile duct was described by Nguyen in 1982 [5]. Most common extra nodal involvement of NHL is abdomen. Although, involvement of the stomach, pancreas or common bile duct is not common [6]. We present to you a case of 31year old male who presented to us with obstructive jaundice and was later diagnosed as Diffuse Large B-Cell lymphoma.
Oral lichen planus (OLP) is an autoimmune chronic inflammatory disease. The potential risk of malignant transformation in OLP remains controversial. The aim of the present study was to review original clinical studies published in indexed databases, which assessed the potential risk cofactors which were implicated in the malignant transformation of oral lichen planus. We focused our search to include most of the studies that reported malignant transformation of oral lichen planus using different combinations of the following key indexing terms: oral lichen planus, malignant transformation, smoking, alcohol, chronic inflammation, candida, human papillomavirus (HPV), hepatitis C virus (HCV) and immunosuppression. The animal studies were excluded from our study. Despite a dearth of studies on this topic we have identified consumption of tobacco and/or alcohol, the presence of erosive and/or atrophic areas, infection with candida, HCV, HPV, and immunosuppression as significant cofactors. Patients with OLP with these risk co-factors are at risk of malignant transformation should, therefore be followed up for an extensive period or even for life.
Retrorectal cystic hamartomas (HCR) (“tailgut cyst” in English-language literature) are congenital cystic tumors derived from vestiges of the hindgut. Its incidence is low, being more frequent in adult women. They are variable in size, uni or multiloculated. They can be lined with several types of epithelia (squamous, transitional, mucinous,...) in a same cyst and can contain mucus. Lesions usually present during adulthood due to pain, discomfort, rectal bleeding, infection, or malignant transformation. The incidence of malignancy is low, being adenocarcinoma and neuroendocrine the most frequent tumors associated to HCR. We present a case of HCR associated with squamous cell carcinoma and discuss aspects of the treatment.
Background: Cervical choriocarcinoma is a malignant trophoblastic neoplasm that arises from pluripotent gonadal germ cells. Various manifestations are expected including vaginal bleeding and symptoms related to metastasis. Here, we report a case of primary choriocarcinoma in a post-menopausal woman. Case presentation: A 67-year-old woman presented with vaginal bleeding and lower abdominal pain. Ultrasound and laboratory results were normal except for a β-hCG titer of 14850 IU/L. Hysteroscopy revealed a polyp in the posterior wall of the cervix. hysterectomy and bilateral salpingo-oophorectomy were performed due to suspected choriocarcinoma. The β-hCG titer decreased immediately after surgery. However, the β-hCG titer increased again one month after surgery and treatment was continued with weekly methotrexate administration. Conclusion: Manifestations such as vaginal bleeding is very important in post-menopausal women. Although there are no specific guidelines for the treatment of choriocarcinoma in these patients, hysterectomy following chemotherapy based on response to treatment and β-hCG titration is favorable.
A case of post-operative agranulocytosis which occurred in a 66-year-old woman following surgery for endometrial carcinoma is reported. The agranulocytosis had a rapid onset, being detected on the first post-operative day. The causative agent, cefazolin was given to the patient intraoperatively. The agranulocytosis persisted until the 22nd postoperative day. A bone marrow biopsy performed on post-operative day four showed a left-shifted myeloid maturation pattern but not a maturation arrest. The pathogenesis of drug-induced neutropenia/agranulocytosis is discussed. It is postulated that reversible binding of cefazolin to albumin accounts for the prolonged duration of agranulocytosis.
Objective: To report our experience in the management of gastric cancers at the Kara University Hospital (Togo).Materials and methods: This was a retrospective and prospective study which was conducted from January 1, 2018, to July 31, 2021, in the general surgery and hepato-gastroenterology department of the Kara University Hospital (Togo). This study involved all patients treated for gastric cancer during the study period at CHU Kara (Togo).Results: We recorded 32 gastric cancers out of the 218 cases of cancer diagnosed during the study period. We had 20 men and 12 women with a sex ratio (M/F = 1.7). The average age was 58 years with the extremes ranging from 17 to 85 years. The pattern of the consultation was dominated by epigastralgia (100%) and deterioration in general condition (100%). Upper digestive endoscopy with biopsies was performed in all our patients. The antral localization was the most found in 62.5% of cases. The most common macroscopic appearance was ulcers-budding (90.6%) and the dominant histological type was moderately differentiated adenocarcinoma (87.5%). The extension assessment found liver metastasis in 10 cases, multiple regional lymphadenopathies of the hepatic pedicle and celiac trunk in 26 cases, ascites related to peritoneal carcinomatosis in 26 cases. Therapeutically, a 4/5 gastrectomy with D1 dissection was performed in 6 cases; gastrojejunal anastomosis in one case and palliative treatment in 25 cases. Survival at 1 year is 50% (3 patients) among operated patients. All the other patients (78.1%) who received palliative treatment all died within 3 months.Conclusion: Improving the prognosis of stomach cancer like other cancers requires early diagnosis to perform a gastrectomy, the only guarantee of long survival.
Background: Ovarian cancer (OC) is the fifth cause of cancer mortality in females. There were an estimated 300,000 new cases of OC diagnosed worldwide in 2018, corresponding to 3.4% of all cancer cases among women. The high mortality rate of OC attributed to asymptomatic growth of the tumor leads to its diagnosis at advanced stages. About 85% - 90% of OC are epithelial including serous, endometrioid, clear cell, and mucinous carcinoma. Aim: To study the immunohistochemical (IHC) expression of FOXA1 and p53 in epithelial OC and its association with prognostic indicators such as age, tumor size, stage, grade, and histological type.Materials and methods: The study included 52 cases with EOC from the pathology department, faculty of medicine, Aswan, and Sohag Universities, in the period from January 2017 to December 2019. This study involved 52 patients with OC and a median age of 53 years. Different histological types were included as 37 serous, 12 mucinous, 1 case endometroid 2 cases clear cell OC. The study cases were classified into 22 Grade I, 16 Grade II, and 20 Grade III. About 22 cases were at stage I, 9 at stage II, 11 at stage III, and 10 at stage IV. Tissue sections were stained using the IHC technique with FOX A1 at a dilution of 1:100 and p53 at 1:100. Results: A statistically significant correlation was found between FOX A1 expression and advanced patient's age, high grade, advanced stage, ruptured capsule, and ascites, regardless of tumor laterality. No significant association was found between p53 immunoexpression and the same clinic-pathological parameters although p53 was associated with serious type. Conclusion: FOXA1 immunoexpression in EOC is considered a poor prognostic factor in EOC. FOXA1 could be a potential therapeutic target and prognostic marker in EOC.
Hajra Idrees, MBBS*, Raza Zarrar, MBBS, Bilal Mujtaba and MD
Published on: 8th November, 2022
Introduction: In recent years the increased utilization of imaging modalities has led to an accelerated diagnosis of renal masses. Initial diagnoses and staging are commonly done with the abdominal Computed Tomography (CT). This study evaluates the various aspects to consider when utilizing CT scan for the diagnosis of renal masses.Discussion: CT scan is the most important imaging modality to evaluate renal neoplasms. Postcontrast acquisitions can be tailored according to the indication for the study. This alongside various techniques, imaging modalities and classification systems may help differentiate the malignant Renal Cell Carcinoma, from benign or metastatic lesions, lymphomas or renal pseudotumor. Finally CT can also be utilized alongside other tools for staging the tumor. Conclusion: Certain CT imaging features are pertinent to evaluate the malignancy potential of renal lesions. However the CT alone may be inconclusive in diagnosing the majority of renal neoplasms, excluding AML with macroscopic fat. Hence it is recommended that the CT aid additional imaging modalities and tools to reach an accurate diagnosis.
Abdul Mohammed*, Prabhat Kumar, Neethi Paranji, Nithya Sritharan and Nisheet Waghray
Published on: 24th November, 2022
Malignancy of the small bowel is exceedingly rare, accounting for 3% - 5% of all gastrointestinal malignancies [1-3]. However, in recent years because of improved diagnostic accuracy, the incidence of small bowel cancer is rising. It is estimated that 10, 470 new cases of primary SI cancer will be diagnosed in the US with 1450 cancer-related deaths [4]. The most frequent histologic types of small bowel malignant tumors include adenocarcinomas, carcinoids, lymphomas, and sarcomas. Adenocarcinoma of the small intestine is the second most common histologic type of SI cancer. The most frequent location of SI adenocarcinoma is the duodenum (57%), followed by the jejunum (29%) and ileum (13%) [5]. SI cancers are more common in men than women [6]. They occur more commonly in the African-American population and after 60 years of age [7].
Nida Mishraz Siddiqui*, Kapila Hari, Bilal Bobat, Dinen Parbhoo, Vikash Lala and Adam Mahomed
Published on: 31st December, 2022
Background: Liver Transplantation (LT) is the definitive treatment for Autoimmune Hepatitis (AIH) in patients with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Outcomes of LT in AIH among black-Africans are not well-defined. We performed a single-center retrospective-review of adult LT patients. The study period was from 1st August 2004-31st August 2019. The primary aim was to document 1- & 5- year patient and graft survival. A secondary aim was to compare the survival of black-Africans to Caucasians. Data was analyzed using survival-analysis. Results: A total of 56 LT were performed for AIH. Sixty-seven percent (n = 38/56) had confirmed AIH on explant histology. Of these, the majority i.e., 79% (30/38) were female and 21% (8/38) were male. There were equal numbers of black-African 42% (n = 16/38) and Caucasian 42% (n = 16/38) patients. Rejection was four-times higher in black-Africans as compared to Caucasians. Forty-four percent (n = 17/38) had an acute rejection episode and 13% (5/38) had chronic rejection. Recurrence was found in four black-African females. Post-LT patient survival at 1- and 5- years was 86.5% and 80.7%, and graft survival was 94% and 70.8% respectively. The 5- year patient survival was insignificantly lower for black-Africans (73.9%) as compared to Caucasians (83.7%) (p - value 0.26, CI 6.3 - 12.2). Five-year graft survival was significantly lower among black-Africans (55%) as compared to Caucasians (84.8%) (p - value 0.003 CI 3.8 - 8.1)Conclusion: Black-Africans had a four-fold higher rate of rejection compared to Caucasians. Recurrent AIH was only found in patients of black ethnicity. Similar 1- & 5- year patient survival rates were observed between the two ethnicities. The 5-year graft survival among black-Africans was significantly lower than Caucasians.
Kundana Rayamajhi*, Richa Bansal and Bharat Aggarwal
Published on: 14th February, 2023
Aim: To determine the correlation between mammographic features of breast cancer with molecular subtypes and to calculate the predictive value of these features. Materials and method: This is a retrospective study of breast cancer patients presenting between January 2017 and December 2021, who underwent mammography of the breast followed by true cut biopsy and immunohistochemical staining of the tissue sample. Breast carcinoma patients without preoperative mammograms, those unable to undergo histopathological and IHC examinations and h/o prior cancer treatment were excluded. On mammography, size, shape, margins, density, the presence or absence of suspicious calcifications and associated features were noted. Results: Irregular-shaped tumors with spiculated margins were likely to be luminal A/B subtypes of breast cancer. Tumors with a round or oval shape with circumscribed margins were highly suggestive of Triple negative breast cancer. Tumors with suspicious calcifications were likely to be HER2 enriched. Conclusion: Mammographic features such as irregular or round shape, circumscribed or noncircumscribed margins and suspicious calcifications are strongly correlated in predicting the molecular subtypes of breast cancer and thus may further expand the role of conventional breast imaging.
Natalie Shammas*, Rosa Avila, Christopher Khatchadourian, Erland Laurence Spencer-Smith, Lisa Stern and Steven Vasilev
Published on: 28th April, 2023
The gold standard for advanced-stage ovarian cancer surgery entails exploration via a midline vertical laparotomy. Studies have shown that minimally invasive surgery (MIS) can be a safe and effective method for the surgical management of early ovarian cancer. In some cases, MIS can also be selectively used for cytoreductive surgery in cases with advanced-stage ovarian cancer. The robotic platform has the potential to provide similar outcomes to the laparotomy-based standard of care in advanced complex surgery while accelerating recovery, minimizing morbidity, and reducing perioperative complications. The primary objective of this study was to evaluate surgical and perioperative outcomes in patients with advanced ovarian carcinoma who underwent robotic-assisted cytoreduction. A chart review of a nonselected consecutive series of all patients undergoing surgical management of advanced ovarian cancer between 7/1/2017 and 12/31/2021 was conducted. All patients that were diagnosed with Stage III to IV ovarian cancer between the timeframe underwent robotic-assisted cytoreductive surgery at two urban community teaching hospitals in Los Angeles. Twenty-five patients were identified and included in this study. All surgeries were performed by a single surgeon. Optimal or complete CRS was achieved in 96% of the patients (24 of 25 cases). Seven (28%) underwent primary cytoreduction (PCRS) and 18 (72%) underwent interval cytoreduction (ICRS). The estimated median blood loss was 100 mL (25-500 mL), the median operative time was 5.9 hours (3.1-10.5 hours), and the conversion rate to open laparotomy was 0%. There were no intraoperative complications and the readmission rate within 30 days was 4% (1 patient) for ileus, which was managed conservatively. Currently, 64% of the patients in the case series remain alive. The median survival has not been reached. The median follow-up is 4.08 years. Results presented from this nonselected, consecutive case series illustrate how a minimally invasive robotic approach can be safely used in place of the standard exploratory laparotomy for ovarian cytoreduction.
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