Issue No. 6, Jul 2009
  Issue No. 6 - Jul 2009
8-16 PET and PET/CT in the Clinical Management of Colorectal Cancer
T. El-Maghraby
Nuclear Medicine Section, Saad Specialist Hospital, Al-Khobar, Saudi Arabia

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.

Keywords: PET/CT, colorectal, cancer, diagnosis, staging and treatment.

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2 17-27 Conformal Radiation Therapy in Prostate Cancer - A Review
    A. Varghese, A. Juzer
Department of Radiation Oncology, Kuwait Cancer Control Centre

Purpose Radiotherapy has progressed considerably over a century. It is mainly because of understanding of physical and biological principles. How to improve therapeutic ratio is major concern. Excellent dose conformality and homogeneity is possible due to recent advances in treatment techniques. But there are many areas of challenges in achieving increased tumor control and normal tissue effects. The aim of this review is to provide a brief update of the rapidly changing field of external radiotherapy and how it affects the clinical practice of treatment of prostate cancer.

Methods and Materials A literature Search has been undertaken ,only relevant articles in the management of prostatic cancer that had appeared in peer viewed journals were considered. We have tried to discuss the levels of evidence available for various treatment techniques with photons and particles. American Society for Therapeutic Radiology and Oncology web site ( provided a large menu for this article. New brochures of information materials provided by various International medical companies also forms immense source of information. Materials from review articles and abstracts from world literature were also included.

Results The advances in imaging and computer visualization contribute greatly to radiotherapy planning by improving accuracy of treatment. It is possible to deposit a high conformal radiation dose within the tumor using highly targeted beam. Conformal radiation improved biochemical failures without an increased incidence of severe toxicity. Carefully conducted randomized studies are appropriate method for evaluating new treatment techniques and strategies. Proton therapy is an area of great therapeutic possibilities in the 21st century.

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.

Keywords: Prostate Cancer , 3D-CRT, IMRT, IGRT, Protons.

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3 28-34 Cervical Cancer Screening among Sudanese Women

F. M. Hassan, M. KhirElseed
Sudan University of Science and technology, College of Medical Laboratory Science, Khartoum, Sudan


Worldwide, cervical cancer is one of the three most common female cancers and accounts for over 370,000 new cases each year ( nearly 10% of all cancers). In Sudan, invasive cervical cancers is a leading cause of cancer death among women.

Methods: We conducted a community-based survey of Sudanese women living in Khartoum , from 2003 to 2008. Indicators of cervical cancer screening participation were examined : at least one previous Pap smear and Pap testing in the last 1 year. In Khartoum more than 30% of the ethnic Sudanese women live in the central and northern parts of the city.

Results: The overall estimated response rate was 32%, and the cooperation rate was 42% . Our study sample for this analysis included 256 women. Nearly One half (35%) of the respondents had never had a Pap test, and only 65% been screened recently. Factors independently associated with cervical cancer screening use included marital status, housing type, and age.

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.

Keywords: Cervical cancer, Screening

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4 35-40 Assessment of Three-Dimensional Set-up Errors in Head and Neck Cancer Patients Treated by Intensity Modulated Radiotherapy using Electronic Portal Imaging Device
    Y. Bayoumi, A. Al-Amro, R. A. Moniem, I. Sohaibani, O. Al-hanafy, A. S. Alawadi, M. Asiri
Radiation Oncology Department, Prince Sultan Haematology Oncology Center, King Fahad Medical City, Riyadh, Saudi Arabia

Set-up errors are an inherent part of radiation treatment process. Coverage of target volume is a direct function of set-up margins, which should be optimized to prevent inadvertent irradiation of adjacent normal tissues. The aim of this study is to evaluate set-up errors and propose optimum margins for target volume coverage in head and neck radiotherapy.

Methods: Twenty six head and neck cancer patients received intensity modulated radiation therapy (IMRT) included in the study. The weekly portal images taken after correction of the systematic error -if any- were evaluated. The systematic error tested and corrected by taking portal images in the 1st 3 days of treatment by using the VARIS offline review system. Three hundred sixty four portal images matched anatomically with anterior and lateral digitally reconstructed radiographs (DRRs). Five hundred forty six points used to evaluate isocenter displacement in antero-posterior direction (AP), supero-inferior direction (SI) and right-left direction (RL).

Results: The mean isocenter displacement in AP, RL, and SI directions were 1.5 ± 1.6 mm, 1.3 ±1.4 mm and 2.13 ± 1.6 mm. Ninety six percent of the isocenter deviations were within 4 mm in all three directions. The displacement more than 4 mm (negative or positive) was 4% in the vertical direction, 7% in the longitudinal direction and 1.6% in the lateral direction. There is insignificant increase of the isocenter shift in the last weeks of radiotherapy especially in the vertical and longitudinal directions.

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.

Keywords: Portal images, set up errors, CTV-PTV margin.

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5 41-44 Comparison of Bone Marrow Aspiration and Bone Marrow Biopsy in Neoplastic Diseases

G. A. Hamid1 and N. Hanbala2
1 Hematology/Oncology, 2 Pathology Department, Al-Gamhouria Teaching Hospital, Aden, Yemen.


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.

Keywords: Bone marrow aspiration, Biopsy, Solid tumors, Multiple myeloma, Lymphoma.

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6 45-47 Cervical Neonatal Neuroblastoma with Recurrent SVT

N. F. Al-Shammari, E. Redha, M. H. Al Hajeri
Paediatric Department, Mubarak Al- Kabeer hospital, Kuwait


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.

Keywords: Neuroblastoma, Stridor, Supraventricular Tachycardia, Neonate.

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7 48-50 Multicentric Castleman Disease: Report of Rare Disease in Kuwait
    B. A. Mohammad¹, N. Al-Brahim², S. Kunjhibava¹, M. Ahmad²
¹Department of Medicine, ²Department of Pathology, Al-Farwaniya Hospital, Kuwait

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.

Keywords: Castleman disease, lymphadenopathy, plasma cell disorders

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8 51-55 Significance of Intracytoplasmic Crystalline Inclusions in Plasma Cells – A Review with Case Discussion

R. Arora, A. A. El-Hameed, T. Al Ajrawi
Department of Pathology, Farwaniya Hospital, Kuwait


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.

Keywords: Crystals, plasma cell, cervix.

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9 56-59 Primary Xanthoma of The Acromion: A Case Report and Review of the Literature
    H. S. Alsaif1, K. M.Moghazy1, M. M. Asiri1, M. A. El-Shawarby2
Departments of 1 Radiology, and 2 Pathology college of Medicine, King Faisal University, Dammam, King Fahad Hospital of the University, Al-khobar, Saudi Arabia

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.

Keywords: Xanthoma, acromion, bone tumor

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