Issue No. 7 - Jan 2010

AIM OF THE WORK. To investigate whether a mixture of antioxidant supplementation can ameliorate damaging effects of ionizing radiation in cancer cervix patients during radiotherapy Accordingly apoptosis, lipid peroxides and Fas among cancer cervix patients undergoing postoperative radiotherapy (n=40) were measured before and after administration of a mixture of antioxidants including 60 mg vitamin C, 10 mg vitamin E, 1000 IU vitamin A and 50 mg Selenium. PATIENTS AND METHODS. Patients were divided into 2 groups each of 20 patients. Antioxidant mixture was administered to one group thrice per day during the duration of radiotherapy and one more week post cessation of radiotherapy. Twenty normal healthy women participated as controls. RESULTS. Results revealed that following the first and second sessions of radiotherapy, both the groups with and without antioxidant administration showed higher frequency of lipid peroxidation and the frequency of micronuclei compared to their level before radiotherapy as measured 24 hours and 48 hours post first session of radiotherapy. Patients undergoing radiotherapy showed a decrease in all parameters of the study after one-week, one-month post irradiation and one week post cessation of radiotherapy. However, the antioxidants group showed significantly lower levels of apoptosis and lipid peroxides and Fas compared to patients who did not receive antioxidant supplementation. CONCLUSION. The results of the present study reveals adaptation to radiation during radiotherapy and evaluate the prophylactic effect of a mixture of antioxidants during radiotherapy.

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A Matched Case-control Study of Triple Negative vs. HER-2 Positive (irrespective of hormonal status) Breast Cancer: Two Subtypes with High Risk Features and Poor Outcome

Abstract: Genetic profile studies of breast cancer identified a number of biologically different subtypes. These genetic subtypes are often surrogated by estrogen receptors (ER), progesterone receptors (PR) and HER2 status as measured by immunohistochemistry (IHC). Triple negative (TN) subtype is recognized to have high risk features and poor outcome. Over expression of the HER2 is also recognized as a poor outcome marker. The characteristics and outcome of HER2 positive tumours (irrespective of hormonal status) (HER2 HR±) identified by IHC have not addressed in the era of surrogate genetic subtyping. Therefore, we retrospectively compared the risk features and clinical outcome of patients with TN against these with HER2 HR± tumours.

Abstract: Head and neck cancer constitutes one of the commonest malignancies in Yemen. There may be a role for the use of Shamma and Zarda and Khat for the increase of HNC in Yemen. This study was conducted retrospectively with an overall aim to describe the pattern of head and neck cancers among Yemeni patients attending the Oncology Department of Al-Gamhouria Teaching Hospital, Aden, for the period from Jan. 2001 to Dec. 2004. The study included 183 patients with head and neck cancers (Lymphoma and thyroid were excluded), 134 were males (73.2%) and 49 were females (26.8%) , with male to female ratio of 2.7:1. The mean age was 51.3 ± 14.9 years (range: 3 – 82 years). Statistically, there is significant difference between the mean age of male (49.5 ± 15.1 years) and female (45.4 ± 16.3 years) patients with head and neck cancers [t= 2.1, p: 0.03]. The common types of head and neck cancers in this study are cancers of the oral cavity (31.7%), followed by pharyngeal (22.9%) and laryngeal (19.1%). In relation to sex, there is a significant statistical relationship between certain head and neck cancers and sex (p: 0.0000). In males, the common cancers are oral cavity cancers (22.7%), laryngeal (22.1%) and pharyngeal cancers (20.8%). The common histopathological type of head and neck cancers in this study is the well differentiated squamous cell carcinoma (70.5%). This study concluded that head and neck cancers are among the common health problems affecting Yemeni patients and recommended further wide national studies to determine the real incidence and the risk factors associated with such cancer.

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Castleman’s Disease: A Study Of A Rare Lymphoproliferative Disorder In A University Hospital

Abstract: Castleman’s disease (CD) is a group of rare lymphoproliferative disorders sharing characteristic clinical and histological features, and usually accompanied by a marked systemic inflammatory response. Two histological patterns of lymph nodes were described: the hyaline-vascular and plasma-cell types. The former is more common (80-90%) and tends to be localized. The plasma cell type is more aggressive and usually multicentric. It is interesting that the inflammatory manifestations seem to be related to a lymph node lesion, because the systemic symptoms and inflammatory activity can return to normal after surgical excision or successful medical treatment of the disease. We report here our 15-year experience with this rare disease in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, focusing on the clinical features, therapy, and patients’ outcome.

Abstract: Enteral feeding is the preferred method of nutritional support in malnourished patients with inadequate oral intake but with intact gastrointestinal tract. In cancer patients, adequate nutrition plays an important role in the success of the treatment and hence the overall prognosis. Percutaneous endoscopic gastrostomy proved to be an effective means for providing enteral nutrition with easy technique, less hospital stay and cost with less morbidity and mortality. Aim of work: It is a prospective study on 40 cancer patients with different indications for PEG which is done by pull technique under local anesthesia and sedation over a period of 12 months with a follow up period of 60 days. Results: The procedure was successful in 38 patients (95%), 22 patients (55%) with esophageal cancer, 16 cases (40%) with head and neck cancer, and 2cases (5%) for gastric decompression due to prepyloric gastric cancer. Mortality rate was 2.5% (1 case) due to leakage and peritonitis, and morbidity occurred in 6 cases (15%) due to port infection and minor leakage managed by dressing and systemic antibiotics. CONCLUSION: PEG is an easy procedure for providing enteral nutrition for cancer patients and associated with fewer rates of morbidity and mortality compared to gastrostomy procedures.

Abstract: Malignant Testicular Leydig Cell tumors (leydigomas) are extremely rare to occur and mostly carry a bad prognosis. Here we describe the disease course of a middle aged patient with recurrent / metastatic Leydig cell tumor of testes, who needed repeated oncosurgical intervention and chemotherapy. KEYWORDS: Testicular Interstitial tumor, Leydig cell tumor, Testicular cancer.

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Imaging findings in Idiopathic Lobular Granulomattous Mastitis, Case Report and review of literature

Abstract: Idiopathic lobular granulomatous mastititis is a rare inflammatory disease of the breast. Since the clinical manifestations simulate those of mammary malignancy, it is often misdiagnosed. We report a case in a 25 yrs old Egyptian woman who had presented with complaint of a painful mass in her right breast of 3 months duration. Clinical and radiological examinations were indeterminate of its nature and the diagnosis was established by histopathogical, microbiological and serological tests. Review of relevant literature mention the features of Idiopathic lobular granulomatous mastititis, which impose significant challenge on clinical, radiological and even histopathological diagnosis. These correlate well with our case scenario also. Complete resection of the lesions and/or administration of steroids are usually the recommended treatment, however about 38% patients may experience recurrence. Hence proper post treatment follow up is mandatory. Awareness among the clinicians, radiologists and pathologists about this disease entity is required and multi disciplinary approach is imperative to establish the diagnosis. We hope to convey these facts through this article with the review of relevant literature.

OBJECTIVE. To report a case of solitary intra-abdominal Castleman disease and highlight the importance of this entity to clinicians in the management of these patients. CASE PRESENTATION AND INTERVENTION. A 20 year old gentleman who presented with a recurrent intra-abdominal retroperitoneal mass. Previous biopsies obtained from a laparotomy showed Castleman disease- vascular hyaline type. Patient did not respond to chemotherapy and the mass was gradually increasing in size. Surgical intervention was the only option and the patient underwent complete resection of the retroperitoneal mass. Final histopathological examination confirmed the initial diagnosis of Castleman disease. CONCLUSION. Castleman’s disease is a fairly rare benign tumor of lymphoid origin. It should be included in the list of differential diagnosis of retroperitoneal masses. Unicentric Castleman disease should be treated surgically when feasible and carries better prognosis compared to multicentric disease.

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Intravenous leiomyomatosis of the uterus

Abstract: Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by nodular masses of histologically benign looking smooth muscle cells growing within uterine or extrauterine venous system.The exact etiology is unclear and benign histological appearance of neoplastic smooth muscles can be deceptive since IVL might behave in a malignant fashion. Total abdominal hysterectomy and excision of any extrauterine tumor if technically feasible is the cornerstone of treatment. We report clinical, histological, and immunohistochemical features of a uterine IVL in a 48 year old lady who presented with menorrhagia. We also elaborate etiopathogenesis and conclude that knowledge about IVL is essential as it must be differentiated from malignant tumors to prevent overtreatment. Long term follow up is recommended in such cases.

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Ibn Sina : A Tribute

Ibn Sina, popularly known in the west as Avicenna;(980-1037 A.D.) was one of the foremost physicians and Islamic philosophers of his time. His chief medical work, Al-Qanun fi’l-tibb (The Canon of Medicine), is considered to be the most comprehensive medical encyclopedia ever written by an Arab physician. The book served as the final authority on medical matters in Europe for several centuries. It described some of the most illuminating medical thoughts that are relevant to modern medicine. In this article, we pay tribute to this great medieval Arab physician by providing a brief overview of his life and works, with special reference to his contribution to the advancement of medical science.

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Focus on Breast and Prostate Cancer Prevention, Early Detection and New Trends in Management Highlights of the 1st National Conference on Cancer Control in Kuwait

Kuwait held its first National Conference on Cancer Control on the 9th and 10th of November 2009. It took place in Salwa Al Sabah Ballroom, Marina Hotel, Kuwait. The conference had the honour of being inaugurated by His Excellency Dr. Hilal Al Sayer, Minister of Health, Kuwait. The conference was efficiently organized by Dr. Medhat Oteifa, Head of Surgical Department, KCCC, Dr. Khaled Al Saleh, Head of Radiation Oncology Department, KCCC, and Dr. Abdulla Behbehani, Kuwait University. The conference was a great chance for multiple specialties interested in the field of early detection, programme.

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King Hussein Cancer Center, Leading Comprehensive Cancer Center of Excellence

Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by nodular masses of histologically benign looking smooth muscle cells growing within uterine or extrauterine venous system.The exact etiology is unclear and benign histological appearance of neoplastic smooth muscles can be deceptive since IVL might behave in a malignant fashion. Total abdominal hysterectomy and excision of any extrauterine tumor if technically feasible is the cornerstone of treatment. We report clinical, histological, and immunohistochemical features of a uterine IVL in a 48 year old lady who presented with menorrhagia. We also elaborate etiopathogenesis and conclude that knowledge about IVL is essential as it must be differentiated from malignant tumors to prevent overtreatment. Long term follow up is recommended in such cases. KEYWORDS: Intravenous, leiomyomatosis, uterus.