Issue No. 6 - July 2009

PET/CT is a new imaging technology that has already found a number of clinical applications in oncologic imaging. Widespread introduction into clinical practice started approximately 5 years ago. It can already be stated that the synthesis of structural and metabolic information improves the accuracy of primary staging and the detection of recurrent disease and has the realistic potential to change patient management in up to 30% of cases. PET/CT imaging of Colorectal Malignancies has shown that this new modality has higher specificity and sensitivity than PET alone and in certain settings even when compared to PET and CT viewed side by side.

Ongoing and future studies will refine its exact place in the diagnostic work-up of colorectal cancer patients and address how often PET/CT can eliminate the need for other imaging studies that are currently performed for the staging or detection of recurrence in these patients. PET/CT fusion images can directly guide biopsies or surgical interventions. This manuscript highlights on potential clinical applications for PET/CT in colorectal tumors.

Conclusion
Great advancements are underway with IMRT and use of Particle therapies. We
cannot have conservative approach to changing trends in treatment, no doubt, safety and efficacy of treatment is prime concern. Progress in technology is rapid and fundamental and this review will provide an update on what is happening in the changing field and how it affects our clinical practice.

Conclusion
Our findings confirm low levels of cervical cancer screening among Sudanese women. Culturally and linguistically appropriate Pap testing intervention programs for less acculturated Sudanese women should be developed, implemented, and evaluated.

Conclusion
The current setup for irradiating head and neck cancer patients using IMRT in our department is accurate. The 4 mm CTV-PTV margin is enough.

Naturally trephine biopsies have definitive advantages over aspirates in case of dry tap bone marrow aspirates as a result of fibrosis or densely packed bone marrow by tumour cells and may be informative independent of cytology especially in bone marrow involvement by lymphomas and carcinomas. In this prospective descriptive study we aimed to compare between the bone marrow trephine biopsy (BMTB) and bone marrow aspirates (BMAs) regarding the detection rate of solid tumours, lymphoma and myeloma involvement of the bone marrow. The study was carried out in the department of pathology and Haematology-Oncology of Al-Gamhouria Teaching Hospital/Aden during the period between Jan 2005 to Dec 2005. A total of 32 patients with suspected or confirmed malignancy undergone both BMTB and BMA from the posterior superior iliac crest and both results were compared. We divided them into three groups: those with solid tumours (21) patients, lymphoma (7) patients and with MM (4) patients. Our results showed that BMA had a 47.6% sensitivity, 100.0% specificity, with positive predictive value (100%), and negative predictive value (50.0%). In solid tumours alone it had a sensitivity of (40.0%), 100% specificity, with positive predictive value (100%,  and negative predictive value (64.7%). This gives the BMA a lower sensitivity in detecting solid tumour metastasis and lymphoma involvement in comparison to BMTB. In conclusion, any patient with suspected or confirmed cancer should undergo BMTB because of its high sensitivity compared to BMA.

Neuroblastoma is the most common extracranial solid tumor of childhood and the third most common paediatric malignancy after leukemia and central nervous system(CNS) tumors. It constitutes 10% of all paediatric malignancies and 75% of them present in children below 4 years of age.

Seventy five percent of neuroblastoma arise in the abdomen and pelvis, 20% in the thorax and 5% in the neck. The median age at diagnosis is 22 months. Up to 95% of cases are diagnosed by the age of ten years. Neuroblastomas have been diagnosed in utero as early as 19 weeks of gestational age.

They can arise anywhere along the sympathetic chain. They occur most commonly in the adrenal medulla (35%). Neuroblastomas also occur as primary tumors in the extra-adrenal retroperitoneum in 30% of cases, in the posterior mediastinum in 20% of cases , in the neck up to 5% of cases and in the pelvis in 5% of cases. Approximately 50% of patients will have metastasis at presentation.

We report a rare case of multicentric Castleman disease diagnosed in Kuwait. A 56-year-old man presented with fever of unknown origin and generalized lymphadenopathy. Laboratory investigations revealed mild anemia and polyclonal gammopathy. Bone marrow biopsy demonstrated 15% increase in plasma cells. Viral screenings including HIV were negative. Lymph node biopsy showed follicular hyperplasia with inter-follicular plasma cells infiltrate with a typical morphology of plasma cell variant of Castleman disease. The patient was treated with methyl-prednisone pulse therapy and showed good response.

Conclusion
Multicentric Castleman is a rare disease and clinicians and pathologists should be aware of it and should be considered in the differential diagnosis of fever of unknown origin and generelized lymphadenopathy.

Dense lymphoplasmacytic infiltrate in tissues pose diagnostic challenge to pathologists. Presence of intracytoplasmic crystalline inclusions in plasma cells has been strongly linked with B- cell lymphoproliferative disorders, although isolated reactive cases are also reported. We reviewed the literature and present clinical, morphological and immunohistochemical findings in a polyp of the cervix. The polyp showed extensive plasma cell infiltrate with needle shaped and elongated intracytoplasmic inclusions in many of them. These cells were positive for CD 79α, CD 138, kappa and lambda light chain ( equal proportions) and IgG. They were negative for cytokeratin, desmin, CD 20, CD 68, and IgA. Immunoprofile, laboratory data and clinical follow up were consistent with reactive nature of the lesion. This case highlights the fact that the presence of intracytoplasmic crystalline inclusions should not be considered pathognomonic of B-cell lymphoproliferative disorder.

Primary “xanthoma” of bone is a rare lesion of unsettled histogenesis that may pose a diagnostic challenge owing to its wide range of differential diagnosis. Herein, we present a case of primary xanthoma of the right acromion in a middle aged woman who had no aberrant lipid metabolism or evidence of other pre-existing bone lesions. To our knowledge, this is the second reported case of a primary xanthoma involving the acromion in an adult.

The Third Gulf Nuclear Medicine Conference took place in the state of Kuwait at Salwa Al Sabah hall, Safir marina hotel in salmiya. The event extended from March 29th to April 1st 2009. The assembly was a great chance for all nuclear medicine, i.e. physicians, technologists and researchers in the field to meet and exchange experience and knowledge. The number of participators registered for this conference was beyond expectations; total registrants of 611 attended the event and actively end it. The participants in the conference included international, regional and local. There were 23 speakers, including 13 invited guest speakers, who came from different parts of the world including USA, Canada, Europe and Gulf region. In addition to the lectures and oral presentations, there were 30 poster presentations. The latest updates in the field together with most recent findings in the participants’ own research were presented. The lectures and posters covered different basic and clinical categories of nuclear medicine. This article summarizes the highlights of the major topics discussed with some recommendations when applicable. Proceedings of the conference can be found in the World Journal of Nuclear Medicine of April, 2009.