GJO ISSUE NO. 25, SEP 2017
  Issue No. 25 - Sep 2017
6-10 Diet, Physical Activity, Marital Status and Risk of Cancer: A Case Control Study of Adults from Riyadh, Saudi Arabia
  Eyad Fawzi AlSaeed1,2, Mutahir A. Tunio3
1 Faculty of Medicine, King Saud University, 2 Consultant Radiation Oncology, King Khalid University Hospital, Riyadh, Saudi Arabia, 3 Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh-59046, Saudi Arabia.
    Objectives: We aimed to compare the dietary habits, engagement in various sports, smoking habits, marital status and other demographic characteristics, between cancer patients and healthy adults (control) at our institute, Riyadh, Saudi Arabia.

Patients and methods: A cross-sectional descriptive study was conducted on 500 participants (237 cancer patients and 263 healthy adults). A well-structured questionnaire was given to these participants regarding the life style, dietary habits, and marital status through interviews.

Results: Mean age of whole cohort was 39.3 years (range: 14-85). Among the cancer patients, breast cancer was predominant (45.6%). Compared to controls, higher percentage of married (72.6% vs. 55.5%) and divorced (10.2% vs.4.2%) was noticed in cancer patients (P = 0.002). In cancer patients, majority were unemployed (housewives = 49.3%; retired = 16.0%) as compared to controls (housewives = 14.1%; retired = 2.0%) P = 0.0001. Use of computer laptops/tablets and internet surfing was significantly higher in controls as compared to cancer patients (80.3% vs. 42.2%) P = 0.0001. Similarly, cancer patients started smoking at early age and were relatively heavy smokers with P = 0.03 and P = 0.001 respectively. Cancer patients consumed > 3 cups of coffee/day as compared to control (42.4% vs. 21.5%) P = 0.02. More cancer patients got married at early age between 11-20 years (58.7% vs. 37.7%) P = 0.01.

Conclusion: Unemployment, marital status, lack of nutritional knowledge through internet, heavy smoking, heavy coffee consumption and early age at marriage were associated with the risk of various cancers in both genders.
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2 11-14 Clinico-hematological Profile of 184 Patients with Non-Hodgkin’s Lymphoma: An Experience from Southern Pakistan
    Sadia Sultan1, Syed Mohammed Irfan1, Anila Rashid2, Saira Parveen1, Neesha Nawaz3
1 Department of Hematology & Blood bank, Liaquat National Hospital and Medical College, Karachi, Pakistan
2 Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
3 Liaquat National Medical College, Karachi, Pakistan
    Background: Non-Hodgkin lymphoma (NHL) is a diverse group of lymphoma comprises of divergent tumors with paradoxical clinical behaviors and potential difference in response to therapy. We conducted a data-base analysis on NHL patients to evaluate the clinico-epidemiological features and WHO spectrum of NHL in Pakistani patients.

Materials and Methods: This descriptive study was conducted over a period of 5 years from January 2011 to December 2015 at Hematology department of Liaquat National Hospital. All NHL cases were diagnosed by morphology on H&E sections and Immunohistochemical profile according to WHO classification of lymphoid neoplasms.

Results: 184 histopathologically confirmed cases of NHL were identified. There were 139 males and 45 females, with a male to female ratio of 3: 1. The mean age was 48.5±16.0 years with the median age of 50 years. B symptoms were present in 80.4% of patients. Lymph node enlargement was present in 71.1% of the cases. 168 patients ad B-cell lymphoma (91.3%) and 16 patients had T-cell (8.6%) lymphoma. Overall 158 (85.8%) patients had aggressive lymphoma. Histopathologically, Diffuse large B-cell lymphoma constituted major subtype in 67.9%, followed by follicular lymphoma in 7.6% patients. Marginal lymphoma in 3.8%patients, 3.2% patients had mantle cell, 2.7% patients of anaplastic large cell and 2.1% patients each for Burkitt’s lymphoma and T-cell rich lymphoma. In T cell neoplasm, peripheral T cell lymphoma and adult T cell lymphoma are the main variants accountable in 4.3% and 3.2% respectively.

Conclusions: B cell lymphoma is more frequent than T cell lymphoma with diffuse large B-cell lymphoma being the commonest NHL. Our analysis shows that clinicopathological features of NHL are comparable to published data. However, aggressive lymphoma and predominance of B symptoms are more frequently seen.
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3 15-19 Ambiguity of Whole Body PET CT Scans in Diagnosis of Co-existing Tuberculosis and Malignancy: Is Histopathological Confirmation Mandatory?

Prekshi Chaudhary1, Sweety Gupta4, Nitin Leekha2, Ravi S. Rajendra1, Shiv S. Mishra1, Vandana Arora3, Sudarsan De3, Sandeep Agarwal1
1 Department of Radiation Oncology, 2 Department of Surgical Oncology, 3 Department of Pathology, Max Super Specialty Hospital, Vaishali, India. 4 All India Institute of Medical Science, Rishikesh, India

    Introduction: Whole body PET CT is an important investigation tool in malignancy patients and helps in ascertaining the metabolic activity and exact stage of the disease. However, like any other investigation, false positive results do exist and certain diseases other than cancer may show increased uptake. Hence, a careful evaluation of PET CT and clinical correlation in malignancy patients is a must to accomplish the suitable treatment.

Methods: In this retrospective observational study, seven cases of cancer with concomitant tuberculosis were included. All the patients were proven malignancy patients with advanced or metastatic stage. On clinical suspicion, a tissue diagnosis was obtained which led to change in staging as well as management of the patients.

Results: Seven patients were having primary diagnosis of carcinoma breast, carcinoma esophagus, coepidermoid carcinoma of submandibular salivary gland, carcinoma tongue, squamous cell carcinoma skin, carcinoma cervix and carcinoma endometrium. They showed FDG uptake at distant sites leading to upstaging of disease. On histopathological examination, lymph nodal mass reported granulomatous lymphadenitis, leading to change of overall staging and management of the patients.

Discussion and Conclusions: Whole Body PET CT scan may produce false positive results and upstage the disease. It should be evaluated and interpreted with caution in cases of doubtful findings and any abnormal FDG accumulation in PET CT scan at unusual locations should be evaluated carefully and confirmed histopathologically.
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4 20-26 Epidemiology and Outcomes with Platinum-Based Chemotherapy in Recurrent or Metastatic Carcinoma Cervix in a Developing Country: Experience from a Tertiary Oncology Centre in Southern India
    K.C. Lakshmaiah, Aditi Harsh Thanky, D. Lokanatha, K. Govind Babu, Linu Jacob, Suresh Babu, A.H. Rudresha, K.N. Lokesh, L.K. Rajeev, Aparna Sridharmurthy
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
    Introduction: Carcinoma cervix is the leading cause of cancer in Indian women. Recurrent/metastatic cervix is the most aggressive form of the disease. There is paucity of data in this setting in Indian women regarding outcomes with palliative chemotherapy.

Methods: We retrospectively analyzed hospital registry data between January 2013 and December 2014 for recurrent/metastatic carcinoma cervix patients who were planned for palliative chemotherapy and assessed their demographic parameters, response and survival outcomes with chemotherapy.

Results: We identified 165 cases of recurrent/metastatic carcinoma cervix. Median age at presentation was 48 years. Most common symptoms at presentation were bleeding or white discharge per vagina and lower abdominal pain. Majority of the patients were multiparous. Histologically squamous cell carcinoma was found most commonly (93.3%) with adenocarcinoma and adenosquamous carcinoma being exceedingly uncommon (3.63% each). 38% of patients were upfront metastatic while rest were recurrent disease. Most common sites of metastasis were retroperitoneal lymph nodes (21.21%), liver (11.51%), lung (9.69%), supraclavicular lymph nodes (8.48%) and bone (7.27%). After a median of 6 cycles of paclitaxel and carboplatin based chemotherapy, overall response rate (ORR) was 26.7% with 10.5% complete remission (CR) and 16.4% partial remission (PR) rates. Median progression free survival (PFS) was 6 months while median overall survival (OS) was 11 months.

Conclusion: Recurrent/metastatic cervical carcinoma is an aggressive disease. Our patients showed an ORR of 26.7% to palliative chemotherapy with median PFS of 6 months and median OS of 11 months. Further research is required related to novel targeted agents and nonplatinum doublets.
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5 27-34 Disclosure of Adverse Cancer News: The Public’s Perspective in a Middle Eastern Country

Jamal Zekri 1, 2, Mohamed E. El Sayed 1,3, Youssef Nauf 4
1 Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah - Saudi Arabia;
2 Al-Faisal University, Saudi Arabia 3 Radiotherapy and Nuclear Medicine Department, National Cancer Institute, Cairo University, Cairo, Egypt; 4 Department of Family Medicine, King Faisal Specialist Hospital and Research Center, Jeddah-Saudi Arabia

    Objectives: The disclosure to patients of unfavorable news related to cancer remains a controversial issue in the Middle East. This study investigated the perspective of the public in Saudi Arabia regarding the disclosure of unfavorable cancer-related news.

Methods: A convenience sample of 103 adult noncancer patients attending a family medicine clinic were asked to respond to 9 closed-ended questions. These questions reflected possible adverse news from the time of diagnosis until the end of life. The primary endpoint was an affirmative response (AR) to =7 questions (AR=7) indicating a preference to be informed of the majority (=78%) of adverse situations.

Results: One hundred individuals completed the questionnaire. Of these, 56 (56%) were male, and 44 (44%) were female. The median age was 32 years (18–75 years). Different questions were answered affirmatively by 76–99% of the responders. An AR=7 was reported by 83% of the responders. There was no statistically significant correlation between an AR=7 and age, gender or employment status (Chi-squared P values: 0.731, 0.427, and 0.148, respectively). There was a trend towards an AR=7 among those with higher levels of education compared to those with a lower level of education (88% and 73%, respectively, P=0.055).

Conclusion: The results of this study suggest that the majority of Saudi Arabians prefer to be informed of most of the adverse health-related news if diagnosed with cancer. These results should encourage physicians to keep cancer patients informed of their health-related events unless the patient indicates otherwise.
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6 35-40 Second Primary Tumors associated with Breast Cancer: Kuwait Cancer Control Center Experience

Salah Fayaz, Gerges Attia Demian, Heba El-Sayed Eissa, and Sadeq Abuzalouf
Radiation Oncology Department, Kuwait Cancer Control Center, Kuwait

    Objectives: To review the clinico-epidemiologic characteristics of patients who presented with two or more primary cancers, one of which was breast cancer (BC) and to develop a follow-up program for the high risk patients.

Patients and Methods: Patients who were diagnosed with BC and one or more non breast cancer (NBC) were retrospectively reviewed. Medical files were retrieved and epidemiological as well as clinical data were analyzed.

Results: Sixty-two patients were retrieved. BC was the first primary in 26 patients while it was the second in 36 patients. Two were males and 60 were females. The median age was 48 years and the median follow-up was 11.5 years. The median interval between the 1st and 2nd primary was 6 years. The most commonly associated NBCs were colon and thyroid cancers, each accounts for 24% of cases followed by endometrial cancer, 18%; Hodgkin’s disease, 6.5%; renal and ovarian neoplasm and NHL, 5% each. Others included prostate, lung, cervical and gastric cancers, soft tissue sarcoma and osteosarcoma. Thyroid cancer was more common as first cancer while endometrial cancer was more as second cancer. All patients who developed BC following Hodgkin’s disease had received chest irradiation. Seven patients developed 3rd primary (4 lung cancers, 2 NHL, and 1 AML).

Conclusion: Patients who were diagnosed with BC should be screened for colon and endometrial cancer. Similarly, patients received chest irradiation at young age, and those diagnosed with thyroid or colon cancer should be screened for BC. Protocol of surveillance needs to be defined. Genetic counseling should be offered to individuals who have experienced multiple primary cancers particularly those with family history and young age of onset.
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7 41-45 Implications of Observer Variation in Gleason Scoring of Prostate Cancer on Clinical Management: A Collaborative Audit
    A. Harbias1, E. Salmo2, A. Crump3
1 Department of Urology, University Hospital South Manchester, U.K. 2 Department of Histopathology, Bolton NHS Foundation Trust, Bolton, U.K. 3 Department of Urology, Manchester Royal Infirmary, Oxford Road, Manchester, U.K.
    Background: Prostate cancer is the most frequently diagnosed cancer in men. Histological tumour grade is a strong predictor of outcome and helps determine what treatment options are offered. There are numerous studies on Inter-observer agreement/variability on prostate cancer grading. In this study, we were looking to establish if disconcordance between pathologists when grading prostate cancer, could affect treatment options offered to men.

Methods: In Greater Manchester West Cancer Sector, all prostate cancer biopsies undergo a central review by three pathologists with a special interest in urological pathology prior to referral for treatment at specialist centres. 96 prostate biopsies (from 48 patients) from a District General Hospital were reviewed during a 6-month period (March 2014-September 2014). The original Gleason Score assigned was compared with the uropathologists consensus diagnosis established at the central review meeting. Any changes in patient risk and treatment plans were subsequently reviewed.

Results: Of the 96 biopsies discussed at central review meeting, 24 (25%) biopsies from 19 patients underwent a change in Gleason grade and a subsequent change in risk for 13 (68%). Of the 19 patients, management plans could be affected for 9 patients (47%) and treatment options could potentially be affected for 5 (26%).

Conclusion: This study shows that where disconcordance between pathologists is present, there is the potential to affect patient management. A central review process can help to minimize the effect over or undergrading can have on the patient and should be considered a necessary step in the management of prostate cancer.
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8 46-50 Squamous Cell Carcinoma of the Buccal Mucosa: A Single Institute Retrospective Analysis of Nodal Involvement and Survival

Vivek Tiwari1, Rakesh Mahawar2
1 Department of Radiation Oncology, Gandhi Medical College, Bhopal, M.P. India.
Department of Radiation Oncology, J.N.C.H and R.C., Bhopal M.P. India

    Background: The magnitude of head and neck (H&N) cancers in the Indian subcontinent is very high. Neck nodal involvement is indicative of higher stage and subsequent adverse prognosis when compared with node negative disease. The frequency of such spread is greater than 20% for most H& N squamous cell carcinomas (SCC). The purpose of this study was to analyze the pattern of nodal metastasis in patients presenting with SCC of buccal mucosa (BM) and correlate it with survival.

Patients and methods: Ninety-nine cases of carcinoma BM who received post op radiotherapy were analyzed retrospectively. Medical records were reviewed and data collected from the hospital case files. Patients were analyzed for age and sex distribution, tumor staging, metastasis and overall survival.

Results: The majority of cases were T4 lesions (n=40, 40.40%), followed by T2 lesions (n=35, 35.35%). T3 lesions constituted for 19.19% cases (n=19) while there were five cases (5.05%) of T1 lesions. 62 patients (62.62%) had positive neck nodes, with/without adverse pathologic features mandating post-operative radiotherapy, while 37 patients (37.37%) did not have any neck nodal involvement. The mean overall survival of the node negative patients (n=37) was 14.51 months (range 02-61 months) and was significantly more (p=0.03) than that of the node positive patients [10.82 months (range 01-35 months)]. A statistically significant difference in survival was also seen between the node negative patients and patients with >3 positive neck nodes (p=0.04).

Conclusion: Neck nodal involvement in cases of carcinoma BM is an adverse prognostic indicator. The number of pathological positive neck nodes can be used as a predictor of treatment outcome.
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9 51-60 Clinical and Pathological Characteristics of Triple Positive Breast Cancer among Iraqi Patients
    Nada A.S. Alwan1, Faisal H. Mualla2, Munawar Al Naqash3, Saad Kathum4, Furat N. Tawfiq5, Sana Nadhir6
1 Director, National Cancer Research Center, Iraq; Professor, Baghdad University 2 Public Health, Queen Mary Hospital, UK 3 Lecturer of Oncology, Baghdad Medical College, Iraq 4 Lecturer of Statistics, College of Administration and Economics, Baghdad University, Iraq 5 Lecturer of Informatics, National Cancer Research Center, Iraq 6 Oncology Teaching Hospital, Iraq
    Background: Breast cancer is the most common malignancy affecting the Iraqi population and the leading cause of cancer related mortality among Iraqi women. It has been well documented that prognosis of patients depends largely upon the hormone receptor contents and HER-2 over expression of their neoplasm. Recent studies suggest that Triple Positive (TP) tumors, bearing the three markers, tend to exhibit a relatively favorable clinical behavior in which overtreatment is not recommended.

Aim: To document the different frequencies of ER/PR/HER2 breast cancer molecular subtypes focusing on the Triple Positive pattern; correlating those with the corresponding clinico-pathological characteristics among a sample of Iraqi patients diagnosed with the disease.

Patients and Methods: This retrospective study involved 570 female patients diagnosed with breast cancer who visited the Main Referral Center for Early Detection of Breast Cancer and the National Cancer Research Center. The requested data was mainly extracted from an established information system database, developed by the principal author over a 4-years period from 2012 to 2016. The registered information comprised data related to clinical presentation, diagnostic and pathologic findings. ER, PR and HER2 status were analyzed immunohistochemically and the detected profiles were correlated with the corresponding clinico-pathological characteristics.

Results: The rates of ER (+), PR (+) and HER-2 (+) tumors were 66.8%, 64% and 29.3% respectively. The tumor marker expression status was documented in eight subtypes; 83 cases (14.6%) of the examined breast carcinomas were categorized as ER+/PR+/HER2+ (Triple Positive/Luminal B), 89 cases (15.6%) were ER-/PR-/HER2- (Triple Negative), 241 (42.2%) were ER+/PR-/HER2- (Luminal A) while 67 (11.8%) showed ER-/PR-/HER2+ expression (HER-2 variant). No significant variations were noted when comparing age, menopausal status and tumor grade of Luminal B pattern to Luminal A and the rest of the studied subtypes. Although our data revealed a statistical difference with respect to the distribution of tumor types; where infiltrative ductal carcinoma constituted the major histology among patients with Triple Positive/Luminal B subtype (86.7% as compared to 67.6% in Luminal A), nevertheless, more than two third of those patients (67.4%) were diagnosed at earlier stages (I and II) compared to 55.2% of those in the remaining groups.

Conclusions and Recommendations: Our findings support the hypothesis that the Triple Positive subtype might be driven primarily by the hormone receptor status. Further comprehensive surveys are recommended to focus on the intrinsic interactions and tumor cell heterogeneity of that pattern to avoid overtreatment and predict accurate response to therapy.
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10 61-63 Pre-Treatment Nutritional Status and Radiotherapy Outcome in Patients with Locally Advanced Head and Neck Cancers
    Amit Bahl, Arun Elangovan, Satinder Kaur, Roshan Verma, Arun Singh Oinam, Sushmita Ghoshal, Naresh K Panda
Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
    Aim: Poor oral intake and associated nutritional depletion can affect treatment outcome in locally advanced head and neck cancers. The aim of this study was to evaluate the pre radiotherapy nutritional status as a predictor for response to radiotherapy treatment.

Patients and Methods: Fifty patients of locally advanced head and neck cancers undergoing radical chemoradiotherapy were evaluated in this prospective analysis. Patients were treated with definitive radiotherapy to a total dose of 60-70 Gy along with concurrent chemotherapy with injection Cisplatin 100mg/m2 delivered three weekly. The patients were evaluated for pre-treatment nutritional status using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire. The PG-SGA evaluation was completed just before starting radiotherapy treatment and scores correlated to treatment outcome.

Results: Forty-seven male and three female patients were evaluated in this analysis. The median PG-SGA score was 8 with a range from 2-14.Grade 3-4 mucositis was seen in seven patients (21.8%) with PGSGA <9 compared to 55.5% in those with PG-SGA score = 9 (p=0.01). At the time of evaluation a complete response was seen in 16 patients (32%) with a PG-SGA score < 9 compared to 4 patients (8%) with a PGSGA =9 (p=0.05). The median survival was 16±2.8months (Median ±S. Error) and 17±2.9 months in those with PG-SGA <9 and =9 respectively (p=0.49, log rank).

Conclusion: PG-SGA nutritional score <9 is associated with a better local control and acute toxicity profile in radically treated head and neck cancer patients
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11 64-69 Evaluation of BRCA1 Large Genomic Rearrangements in Group of Egyptian Female Breast Cancer Patients Using MLPA
    Ola M. Eid1, Eman A. El Ghoroury2, Maha M. Eid1, Rana M. Mahrous1, Mohamed I. Abdelhamid3, Zahra I. Aboafya2, Esmat A. Abdel Ghaffar2, Amany H. Abdelrahman2
1 Human Cytogenetics Department, National Research Centre, Egypt 2 Clinical Pathology Department, National Research Centre, Egypt 3 General Surgery Department, Zagzeg University, Egypt
    Introduction: Breast cancer is one of the most widespread cancers affecting women all over the world. In Egypt, it is considered to be the first cause of malignancies among female. BRCA1 Large Genomic Rearrangements (LGRs) have been reported in hereditary breast families and occurs in considerable proportion of cases in various populations.

Objective and methods: We investigated the incidence of BRCA1 LGRs in group of Egyptian females with breast cancer using Multiplex Ligation-dependent Probe Amplification (MLPA) assay.

Results: Thirty six female breast cancer patients were included in this study. There were no BRCA1 LGRs detected in the studied group of patients which does not coincide with other study that were done on a group of Egyptian female patients.

Discussion and Conclusion: This variance may be due to the small number of the investigated patients in both studies, which is considered as a limitation. So, screening for LGRs of BRCA1 gene as well as other genes that may be involved in breast cancer such as BRCA2 and CHEK2 genes of a larger number of patients is recommended to get the actual prevalence of these gene in the Egyptian population to deliver a cost-effective primary approach for these patients.
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12 70-72 Brain Metastasis from Colorectal Adenocarcinoma: A Case Report
    Jaroslav Nemec, Abdulsalam Alnajjar, Jasem Albarrak, Shaban A, Mariam al Otaibi, Asit Mohanty
Department Of Medical Oncology, Kuwait Cancer Control Center, Kuwait
    Colorectal cancer (CRC) is the third leading cause of cancer death in the Western world, accounting for approximately 140,000 new cases and more than 51,000 deaths in 2010 in the United States. In Kuwait, CRC is the first most-diagnosed neoplasm among males and overall, the second leading cause of death from cancer. The 5-year survival rate in 2002–2004 was 61% for men and 62% for women. Even after complete resection of the colorectal tumor, distant metastases have been noted to develop in 10%–15% of patients. Of all metastases, those to the liver were found in 20%–30% of cases, and to the lung, in 10%–20%; brain metastases are quite rare. The percentage of CRC patients developing brain metastases during the course of their disease is reported to range from 2% to 12%, but the effect of such metastases on the patient’s prognosis is significant. With the advent of new targeted therapies and the resulting improvements in outcome for CRC patients, the management policy for brain metastases has changed. Regardless of the therapy used to address brain metastases, reported median survival ranges from 2.8 months to 6 months. We report a case of brain metastasis in a patient of primary colorectal adenocarcinoma. He was evaluated for convulsion, CT findings showed brain metastasis.
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13 73-76 Leiomyosarcoma of Penis: An Aggressive and Exceptionally Rare Entity
  Vinita Trivedi, Muneer A, Rita Rani, Richa Chauhan, Usha Singh, Naveen Kuna
Department of Radiatin Oncology, Mahavir Cancer Sansthan, Patna, India
    Penile leiomyosarcoma is a very rare disease of penile mesenchymal tissue, most of them are of vascular origin and pathologically classified into the superficial and deep type. Because of the small number of cases reported so far, the conclusions about treatment and prognosis are equivocal. Here we report a case of 40-year old patient who presented with leiomyosracoma of penis; despite adequate surgery patient developed local recurrence and distant metastasis indicating aggressive nature of leiomyosarcoma entity of penis.
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14 77-84 Chemotherapy-Induced Febrile Neutropenia in Solid Tumours
    Ayman Rasmy1,2, Mohammed Al Mashiakhi1 and Amal Ameen3
1 Oncology Department, King Saud Medical City, Riyadh, Saudi Arabia 2 Medical Oncology, Zagazig University Hospitals, Zagazig, Egypt 3 Microbiology and Immunology Department, Faculty of Medicine, Fayoum University, Egypt
    Febrile neutropaenia (FN) is defined as an oral temperature of >38.3°C or two consecutive readings of >38.0°C for 2 hours and an absolute neutrophil count (ANC) of <0.5 × 109/l, or expected to fall below 0.5 × 109/l. Fever is one of the characteristic symptoms of FN and is usually associated with the presence of an infection caused by various microorganisms.

The incidence and epidemiology of FN are variable based on different factors: (type of cancer, the age/sex of the patient, chemotherapy type /number of cycles). FN remains one of the most common and risky complications of chemotherapy which occurred within 6–8 days with standard chemotherapy and it is occurred as about 7-8/1000 patients receiving treatment with chemotherapeutic agents. There is a clear relationship between the severity of neutropaenia (which directly influences the incidence of FN) and the intensity of chemotherapy. Currently, the different regimens are classified as producing a high risk (>20%), an intermediate risk (10%–20%) or a low risk (<10%) of FN.

The causative organisms including either bacteria, fungi or viruses. The bacteria Gram-positive (currently dominating) and Gram-negative (Dominant in the 1970s), are usually the main microorganisms responsible for FN and cause complicated infections.

Although the morbidity and mortality rates of FN have decreased over the years due to use of proper antibiotic treatment, preventive measures and use the standardrisk management plan as per guidelines but it is still one of oncological emergency. FN is responsible for considerable morbidity as 20%–30% of patient’s present complications that require in-hospital management, with an overall in-hospital mortality of ~10%.
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