ISSUE NO. 19 - SEP 2015
Pages Title / Authors / Abstract


111In-pentetreotide scintigraphy and 18F FDG PET-CT in differentiated thyroid carcinoma metastases with negative whole body radioiodine scan


S. Usmani, A. Esmail, F. Marafi, S.Al Deen, F. Abu Huda, F. Al Kandari

Hussain Makki Al Jumma Centre for Specialized Surgery (HMJCSS), Kuwait



Metastases of differentiated thyroid cancer (DTC) can lose affinity to radioiodine with the passage of time, with resultant difficulty in management. Thyroid tumors are known to express somatostatin receptors and therefore 111In-pentetreotide, somatostatin analogue, can visualize tumors with high concentration of somatostatin receptors. We report a case of I-131 whole body scan (WBS) negative recurrent metastatic papillary thyroid carcinoma with positive 18F FDG PET-CT and 111In-pentetreotide scan. Somatostatin receptor scintigraphy (SRS) with 111In-pentetreotide may be useful both in the staging and monitoring of patients with non-iodine avid carcinoma of the thyroid. 111In-pentetreotide scan positive patients are potential candidates for somatostatin receptor-targeted therapy.  

Keywords: Differentiated thyroid cancer, 111In-pentetreotide scintigraphy, somatostatin receptor-targeted therapy

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Incidental splenic littoral cell angioma complicating a case of colon cancer: A case Report 

S.A. George1, Al Bader2
1Dept. of Histopathology, 2Dept. of Surgery,
Mubarak Al Kabir Hospital, Kuwait


Littoral cell angioma (LCA) is a recently described rare generally benign primary vascular neoplasm of the spleen originating from the lining cells of the splenic red pulp sinuses that is usually discovered incidentally. LCA may be associated with epithelial malignancies and may itself also have malignant potential. We report the case of a 71-year-old woman who presented with intraoperative bleeding from the spleen during sigmoidectomy for colonic adenocarcinoma. Histopathological examination of the removed spleen revealed multiple haemorrhagic lesions diagnosed as littoral cell angioma. This case has been reported due to its rarity and to highlight how its accidental detection, unique and unexpected presentation complicated a case of colonic carcinoma. Individuals diagnosed with this tumour must be carefully evaluated to exclude primary, secondary and synchronous malignancies.

Keywords: Incidental, splenic, littoral cell angioma, colon, cancer

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A 65- year old female with synchronous HIV and Extramedullary Plasmacytoma of Maxillary sinus 

H. Sabir1, S. Kumbhare2, A. Parate2, S. Gupta3, Ravi Tale4
1Raj Multispeciality Dental Clinic, Indore (M.P).
Government Dental College & Hospital, Nagpur (M.S), India.
3College of Dentistry, Indore (M.P), India
4Dr Hedgewar Smruti Rugna Seva Mandal’s Dental College & Hospital, Hingoli (M.S), India


Extramedullary plasmacytoma in the head and neck region is a rare malignant neoplasm comprising approximately 3% of all the plasma cell neoplasms and less than 1% of head and neck tumors. This extraskeletal lesion is a unifocal, monoclonal, neoplastic proliferation of plasma cells. Some investigators believe that this lesion represents the least aggressive part of the spectrum of plasma cell neoplasms which extends to multiple myeloma. Therefore, plasmacytoma is believed to have clinical importance. We report a case of extramedullary plasmacytoma in the right maxillary sinus of a 65-year-old HIV positive female as a clinical rarity with review of the relevant literature.

Keywords: Plasma cell neoplasms; extramedullary plasmacytoma; maxillary sinus

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Spinal metastasis of breast cancer presenting after 25 years: An extremely rare presentation


V. Tiwari1, SC Pande2, K. Verma2, S. Goel2
1Department of Radiation Oncology, Gandhi Medical College, Bhopal, India.
2Department of Radiation Oncology, Artemis Health Institute, Gurgaon, India


Breast cancer is the most frequently diagnosed cancer in females of the developed world and is gradually becoming the leading cause in the developing world as well. The innate biology of breast cancer is marked by varied presentations, characteristics, response, recurrence and metastatic phenomenon. Even an early stage breast cancer has the potential to recur and/or metastasize after extremely long duration and this possibility should be borne in the clinician’s mind.

Keywords: Breast cancer, Delayed metastases, Radiotherapy

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Solid tumors after chronic lymphocytic leukemia patients: Report of six cases and review of the literature


H. Chaabouni1, K Kacem2, S Zriba1, R. Mansouri2, H. Ghédira1, R.B. Lakhal2, M. Zarrouk2, Y.B. Abdennebi2, H.B. Neji2, L. Aïssaoui2, Z.B. Ali2, H.B. Abid2, F.M. Sadek1, B. Meddeb2
1Clinical hematology department, Military Hospital of Tunis
2Clinical hematology department, Aziza Othama Hospital, Tunis


Malignancies have been reported to occur with increased frequency in chronic lymphocytic Leukemia (CLL) patients. The aim of this study was to describe which second malignancies occur in patients with CLL, whether these malignancies are related to CLL, its treatment, or both. We also attempt to study factors predicting the development of other malignancies.

Patients and methods: Between 1995 and 2009, six cases of CLL associated with solid tumor were diagnosed in Hematology Department of Military Hospital of Tunis. The diagnosis of CLL was made by immunophenotyping of peripheral blood circulating B cells, and the diagnosis of solid tumors was made by biopsy with anatomopathological exam and immunohistochemical study.

Results: The mean age of patients was 71 years. Five patients were male. The CLL was classified Stage A in one case, Stage B in three cases and Stage C in two cases. Two patients had abnormal karyotype. Three patients have not received specific treatment for their CLL. Solid tumors were represented by skin cancer in three cases, lung cancer in two cases and breast cancer in one case. The median time between diagnosis of CLL and that of solid tumor was 53 months.

Conclusion: Patients with CLL have an increased risk of developing a second cancer. Awareness of risk factors could permit early detection.

Keywords: tumor, lymphocytic, leukemia, association

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Bevacizumab in clinical practice

N. Majid, I. Ghissassi, H. Mrabti, H. Errihani
Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco


The development of targeted therapies and especially angiogenesis inhibitor drugs is undoubtedly a major advancement in the treatment of cancer in the 21st century. Bevacizumab is a recombinant humanized monoclonal antibody directed against vascular endothelial growth factor that was approved for the treatment of multiple solid tumors, we have reviewed the side effects cited in clinical trials of bevacizumab and the guidelines for their management and we can conclude that bevacizumab, is generally well tolerated but is associated with increase in some adverse side effects for which monitoring is required particularly vascular and renal side effects including hypertension, proteinuria, thromboembolic events and hemorrhage. The better understanding of bevacizumab toxicity profile and the guidelines for their optimal management as well as the education of patients may allow prolonged therapy and thus improved clinical outcomes.

Keywords: Angiogenesis, bevacizumab, hypertension, proteinuria, safety, toxicity

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Targeted therapies in the management of breast cancer

G.O. Abdulrahman Jnr.
Institute of Medical Education, Cardiff University School of Medicine, Cardiff, UK


The incidence of cancer is increasing in the United Kingdom. Breast cancer is the most commonly diagnosed cancer among women in the UK with an age standardised rate of 124 per 100,000 women. It accounts for almost one-third of all female cases of cancer in the UK and it is the most common form of cancer among women in both developing and developed countries. There are many management options for cancer such as surgery, chemotherapy and radiotherapy. Surgery has been the main treatment option for many solid tumours for several decades. However, research has shown that attacking specific targets within tumours such as receptors, intracellular proteins and genes could result in better clinical outcome. Promising therapeutic targets that have been identified include Raf kinase, Src, HER2, epidermal growth factor receptor and vascular endothelial growth factor receptor. After several decades of intensive research, it appears that we are finally hitting cancer where it hurts. It is very likely that in the near future, more targets for potential therapies would be identified and ultimately, there would be significant reduction in morbidity and mortality from cancers, including breast cancer.

Keywords: Breast cancer, HER2, BRCA genes, Raf kinase, antimicrotubule, targeted therapies

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Primary Surgery in Treatment of Stages II & III Wilms’ Tumour: A Developing Countries' Experience


O.M. Zakaria1,2, E.N. Hokkam2, K. Al Sayem2, M.Y.I Daoud1, H.M. Zakaria3, H.A. Al Wadaani1
1Department of Surgery, college of Medicine, King Faisal University, KSA,
2Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt,
3Department of Surgery, College of Medicine, Dammam University, KSA


Background: Treatment options for Wilms’ tumour (WT) are costly and it affects the country’s health budget and resources if adopted and implemented at the national level especially in developing countries with low or resource-challenged settings.

Aim: The objective of this study is to evaluate the role and effectiveness of primary surgery in the treatment of stage II and III pediatric WT following the schedule indicated in the National Wilms’ Tumor Study (NWTS-4) in the institutes of two developing countries.

Patients and Methods: The study enrolled 40 children who were primarily diagnosed as stage II and III WT. They were divided into 2 equal groups. Group I (n = 20) included those children who have undergone neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy, while group II (n = 20) included those children who have undergone primary surgery as an initial management followed by chemotherapy. After a mean postoperative follow-up period of 20±5 months, clinical and radiological evaluation was performed for all patients.

Results: In group I, 15 patients were preoperatively diagnosed as stage II and 5 patients as stage III while in group II, 16 patients were proved to be stage II and 4 patients were stage III. After a follow up period, clinical and radiological evaluation using CT was performed on all patients. In patients with stage II, evidence of recurrence was noted in 4 patients of group I whereas no patient showed any evidence of recurrence in group II. In patients with stage III, rebound increase in size was seen in 2 patients in group I and only one patient in group II.

Conclusion: Primary surgery with appropriate adjuvant therapy improves the treatment results compared to the neoadjuvant chemotherapy and delayed surgery for children primarily diagnosed as stage II and III WT. It may be used as a safe and effective tool in treating WT patients with relatively no changes from the long administration schedules. This will have a highly positive impact in lowering treatment cost in developing countries.

Keywords: Wilms’ tumour, children, chemotherapy and surgery, cost-effectiveness, resource challenge settings

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Utility of fine needle aspiration cytology in evaluation of lymphadenopathy – An audit from a Cancer Centre in South India


K. R Anila1, N. Nayak1, P.S. George2, K. Jayasree1
1Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.
2Department of Epidemiology and Statistics, Regional Cancer Centre,Thiruvananthapuram, Kerala, India


Background Cytological evaluation and diagnosis of lymphadenopathy plays an important role in distinction between reactive hyperplasia and malignancy.Being a tertiary cancer care centre, lymph node enlargement clinically suspected to be due to malignancy constitute the commonest indication for fine needle aspiration cytology (FNAC) at our centre. The aim of this study was to determine the utility of FNAC in evaluating enlarged lymph nodes and to categorizethe causes of lymphadenopathy diagnosed by FNAC at our centre.

Material and Methods: Data was collected from the records of department of Pathology over a period of three months from January to March 2014. The data was analyzed and various parameters studied.

Results: There were 2000 aspirates over a period of three months of which 270 (13.5%) were from lymph nodes. Of these, 130cases (48.2%) have metastatic deposits.We also came across 16 cases (5.9%) of lymphoma, 5 cases(1.9%) of granulomatous lymphadenitis, 2 cases(0.7%) of suppurative lesion and 99 cases (36.7%) of reactive hyperplasia during this period. In 3 cases (1.1%), the lesion turned out to be of salivary gland origin. Aspirates were suboptimal for diagnosis in 15 cases (5.5%). Aspirates were more in males (181) as compared to females (89). The most common site of aspiration was the cervical lymph node(64.5%),followed by supraclavicular=81(30%), inguinal=33(12.22%), axillary=19(7.04%) sub mental=1(0.37%) and others=7(2.59%). Apart from metastatic carcinomas other metastatic malignancies we came across were malignant melanoma, neuroblastoma, germ cell tumor and synovial sarcoma.

Conclusion: FNAC of lymph nodes helps in rapid diagnosis of lymphadenopathy. Categorizing the cause of lymph node enlargement as metastatic malignancy,lymphoma, reactive change, inflammatory cause,suppuration etc. can be done by FNAC.In patients with known histologically proven malignancy in whom a subsequent enlargement of lymph node occurs,a cytological diagnosis of metastasis helps in avoiding unwanted surgery for confirming metastasis.In patients without a previous diagnosis of malignancy, FNAC not only confirm metastatic deposit but in most conditions give a clue regarding site of primary. The use of immunocytochemistry and cell block preparations have increased the scope of FNAC

Keywords: Fine needle aspiration cytology, lymph node, malignancy

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Level of awareness of lung cancer risk factors, signs, symptoms and safe practices among college teachers of different states in India: Do awareness programmes have an impact on adoption of safe practices?


A. Shankar¹, S. Roy², R. Bhandari¹, A. Malik¹, GK Rath¹, PK Julka¹, K. Barnwal³, S.
Upadhyaya³, R. Singh³, V. Srivastava³
¹Department of Radiation Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
²Department of Paediatrics, VMMC and Safdarjung Hospital, Delhi, India
³Pink Chain Campaign, Punarjeevan, Bihar, India


Lung cancer is the one of the most common cause of cancer mortality among men in India where incidence rates are increasing although they are largely preventable diseases. In India, late presentation is generally responsible for high mortality and morbidity rates and early detection is one of the best ways to control it. The purpose of this study is to measure the level of awareness on lung cancer among women represented by a sample of college teachers in India and the impact of awareness programs in changing or adopting safer practices and the prevention and early detection of the disease.

Material and methods: The assessment was conducted during a Pink Chain Campaign on cancer awareness in 2011 in various women colleges in India. Pre-test related to lung cancer was followed by awareness programs. Posttest using the same questionnaire was conducted at the end of interactive session, at 1 year and 6 months.

Results A total of 156 out of 182 teachers participated in the study (overall response rate was 85.7%). Mean age of the study population was 42.4 years (range- 28-59 yrs). There was a significant increase in level of knowledge regarding lung cancer at 6 months and this was sustained at 1 year. Magazines and newspapers were the primary source for information regarding risk factors, signs and symptoms of lung cancer in more than 60% of teachers whereas more than 30% teachers were educated by doctors. At post-awareness after 1 year and 6 months, there was a significant change in alcohol and smoking habits. The main reasons for not undergoing screening tests are: ignorance (50%), lethargic attitude (44.8 %) and lack of time (34.6 %).

Conclusion Knowledge about lung cancer was very low among teachers. Overall awareness of risk factors, signs and symptoms, and screening modalities of lung cancer have improved after 1 year along with practices related to smoking and alcohol consumption. There was a significant improvement in people undergoing regular check-up’s. Improved means of communication, access to information and effective warnings about cigarette smoking are necessary to increase public awareness. To ensure the adoption of safe practices in the lifestyle of people who smoke and consume alcohol, awareness programmes such as the pink chain campaign should be conducted regularly, frequently and more widely in various areas of India.

Key words: Lung cancer, Awareness campaign, College teachers, Safe practices

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Characteristics and outcomes of acute kidney injury resulting in hospital admission in patients with solid tumor: Experience of a single center

N. Al-Faqeer1, M. Hajir2, L. Nazer1
1Department of Pharmacy, 2Department of Medicine,
King Hussein Cancer Center; Amman, Jordan


Aim: To describe the characteristics and outcomes of acute kidney injury (AKI) resulting in hospital admission in cancer patients managed at a comprehensive cancer center.

Methods: This was a prospective observational study conducted between December 2011 and July 2012. Patients admitted to the solid tumor service were screened to identify those who met the criteria of AKI upon admission. The identified cases were reviewed by two clinicians to determine the cause of AKI and to determine if AKI was the major cause for admission. Patient demographics, past medical and medication history were recorded. In addition, we evaluated patients for resolution of AKI.

Results: During the study period, 103 cases were identified, 57.3% were males, mean age was 64 years±11.2 (SD), 24 patients (23.3%) have diabetes, and 55 patients (53.4%) have hypertension. The most common causes of AKI were dehydration, medications, and tumor-related, reported in 40 (38.8%), 34 (33%), and 23 (22.3%) of these cases respectively. The most common medications associated with AKI were chemotherapy (n=13, 42%), mainly cisplatin (76.9%), followed by non-steroidal anti-inflammatory drugs (n=12, 38.7%). Eleven patients (10.7%) progressed to chronic renal failure and three patients required hemodialysis. In the remaining cases, AKI resolved after a mean of 6.39 days±3.73(SD). Transfer to the intensive care unit was required for 4 patients and death was reported in 3 patients.

Conclusion: AKI in cancer patients was mostly due to dehydration, medications, and the tumor. Measures to reduce the incidence of AKI are necessary to prevent unnecessary admission and the potential for further complications.

Keywords: Acute kidney injury, admission, causes, drug induced, outcomes

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Outcome of HER2 positive luminal operable breast cancer in comparison with outcome of other operable luminal breast cancer patients: Long follow-up of single center randomized study


R. Abo El Hassan1, M. Moneer2
1Nasser Institute Oncology Center, Adult Oncology Unit, Egypt,
2National Cancer Institute, Department of Biostatistics and Human Epidemiology, Egypt


Introduction: In clinical practice, there is increasing recognition that HER2-positive breast cancer patients are not a homogeneous group. Especially patients with luminal B breast cancers which are now subdivided to more than two groups.

Aim of the study: The aim of this study is to know the effect of HER2 positivity on luminal breast cancer patients by comparing disease free survival DFS luminal of HER2 positive breast cancer patients with other luminal cases with HER2 negative disease. Also we explored the effect of HER2 positivity on different risk factors for breast cancer.

Patients and methods: We compared the outcome of 25 HER2 positive luminal breast cancer patients with a control group of other luminal operable breast cancer at the same period of time with the same eligibility and exclusive criteria.

Results: Total of 59 operable luminal breast cancer patients were eligible for the study, 25 of them were luminal HER2 positive and the 34 were control group of luminal HER2 negative. We found that HER2 positive luminal breast cancer patients were having more unfavorable risk factors and have more incidence of relapse mainly after 48 months follow-up than other luminal patients: after 24 months follow-up period HER2 positive luminal patients have cumulative DFS of 91% compared with 93% in luminal HER2 negative patients but after 48 months follow-up the difference between the two groups became more obvious as it was 66% for luminal HER2 positive group and 90 % for the control group. High risk patients for luminal HER2 positive breast cancer patients have higher risk of relapse (60% compared with 86%), and this appeared also in other subgroups.

Conclusion: HER2 positive luminal breast cancer patients have a higher incidence of relapse compared with other luminal breast cancer, and this difference appear mainly after 48 months of follow-up. High risk patients for luminal HER2 positive breast cancer have higher risk of relapse than high risk patients of other luminal patients.

Keywords: HER2 positive, luminal breast cancer, DFS 48 months, breast cancer risk factors

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