Journal of Cancer and Allied Specialties
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INTRAOSSEOUS SARCOIDOSIS MIMICKING AS BONE METASTASES ON 18F- FDG PET/CT
Get PDFA 62-year-old male with known prostate cancer underwent 18F- uorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) scan for suspected osseous metastases after a magnetic resonance imaging of the pelvis, done for chronic low back pain and demonstrated a number of suspicious T1 hypointense/T2 hyperintense lesions in the sacrum, iliac bones and right proximal femur.18F-FDG PET/CT showed abnormal foci of increased tracer uptake in the sacrum, iliac bones and right proximal femur. Core biopsies from the sacrum were performed, showing intertrabecular non-caseating granulomata with surrounding small lymphocytes. Acid-fast bacilli and Gomori methenamine silver stains were negative, consistent with intraosseous sarcoidosis. Key words: 18F- uorodeoxyglucose positron emission tomography/computed tomography, non-caseating granulomata, sarcoidosis
MALIGNANT OVARIAN GERM CELL TUMOURS (MOGCT); SURVIVAL OUTCOMES FROM A SINGLE INSTITUTION IN PAKISTAN
No full textObjectives: Malignant ovarian germ cell tumours (MOGCTs) are rare, but aggressive tumours seen mostly in young women or adolescent girls. The aim of our study was to evaluate the survival outcomes of MOGCT patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Materials and Methods: One hundred and nine females were retrospectively identi ed through hospital information system with MOGCT from 2007 to 2013. Histology was based on the WHO classi cation. Tumours were staged according to the Federation of Gynaecology and Obstetrics staging system. Overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan–Meier method. All patients were included in the study. Patient who had been lost to follow-up was contacted through telephone. Results: Mean presenting age was 20 years (range 4–54). 38% of patients had Stage I, 7% had Stage II, 25% had Stage III and 30% of patients had Stage IV disease. Based on histology, 42% had dysgerminoma, 25% had mixed germ cell tumours, 18% had yolk sac tumour, 13% had teratoma and 2% had embryonal carcinoma. Median follow-up time was 41 months. All patients underwent initial surgery, of which 86 (79%) had fertility-preserving surgery. 91 (84%) patients received adjuvant chemotherapy and 18 (16%) were kept on surveillance. The chemotherapy regimen used was a combination of bleomycin, etoposide and cisplatin. 89 patients had a complete remission, 14 had partial response and one had progressive disease. Five patients had relapsed disease, four distant and one local. The 5 year OS was 91% and DFS was 88%. Conclusion: MOGCTs have a good prognosis. Fertility-sparing surgery was possible in the majority of cases. BEP regimen has excellent activity and acceptable toxicity in patients with MOGCT. Key words: Disease-free survival, malignant ovarian germ cell tumours, overall survival
CORRELATION OF P21 EXPRESSION IN HEAD AND NECK SQUAMOUS CELL CARCINOMA WITH CLINICOPATHOLOGIC AND PROGNOSTIC PARAMETERS
Get PDFPurpose: Head and neck tumours include tumours of nose, paranasal sinuses, oropharynx, larynx and mouth. Squamous cell carcinoma (SCC) is the most common head and neck malignant tumour which accounts for 90% of head and neck malignant tumours. p21 is an important immunohistochemical marker which has signi cant role in predicting prognosis of head and neck SCC (HNSCC). Increased p21 expression in HNSCC is associated with bad prognosis in terms of increased risk of nodal metastasis, increased rate of recurrence and decreased survival rate. The purpose of this study was to evaluate the expression of p21 in HNSCC with various clinicopathologic and prognostic parametres. Materials and Methods: A total of 110 patients (n = 110) of HNSCC (oral cavity n = 98 and laryngeal tumours n = 12) were included in the study which were diagnosed and treated between January 2008 and January 2011 at a tertiary care centre in Pakistan. Mean age was 51 years (age range 15–78). 65 (59%) were male and 45 (41%) were female. Tumours were classi ed as p21 positive when ≥10% tumour cells were immunoreactive for p21. p21 expression was noted and correlated with T-stage, nodal metastasis, perineural and depth of invasion, recurrence and 2-year survival rate. Results: Of 110 cases, p21-positive cases were 88 (80%) compared to 22 (20%) negative. T1–T2 tumours with p21 expression were 59 (67.04%) while 17 cases (77.27%) had negative for p21 (P = 0.44). Amongst T3–T4, 29 cases showed p21 expression (32.96%) while 5 cases (22.73%) were negative (P = 0.44). Nodal metastasis was seen in 51 cases (57.95%) with p21 positivity as compared to 4 cases (18.8%) with no p21 expression (P = 0.0015). Perineural invasion was seen in 15 carcinomas (17.04%) having p21 positivity and 1 case (4.54%) with p21 negativity (P = 0.18). 48 cases (54.54%) had depth of invasion >1 cm with positive p21 as compared to 4 cases (18.18%) without (P value = 0.0035). 39 cases (44.31%) showed recurrence along with p21 expression while 3 cases (13.63%) showed recurrence without (P = 0.0076). 2-year survival rate was 56.81% (n = 88) in p21 positive cases, whereas it was 90.90% (n = 20) those with negative p21 (P = 0.0026). Conclusion: Positive p21 expression in HNSCC correlates with intermediate grade, late stage, increased nodal metastasis, tumour recurrence and decreased survival. p21 should be considered as an important prognostic and predictive marker in HNSCC to detect tumours at early stage and to improve therapy and prognosis. Key words: Head and neck squamous cell carcinoma, lymph node metastasis, p21, recurrence, survival rate
ROLE OF INTEGRATED PET/CT IN DETECTING RECURRENT OVARIAN CANCER IN PATIENTS WITH RISING CA-125 LEVELS
No full textPurpose: The purpose of this study was to assess the sensitivity and diagnostic accuracy of integrated positron emission tomography/computed tomography (PET/CT) in detecting recurrent ovarian cancer in treated patients presenting with rising CA-125 levels during clinical follow-up and compare it with those of CT alone. Materials and Methods: This was a retrospective study. We evaluated 45 patients with pathologically proven ovarian carcinoma who underwent PET/CT during October 2010–November 2013 at our institution for suspected relapse; IRB deemed that approval for this retrospective study was not required. Of these, 35 patients who presented with rising CA-125 levels during clinical follow-up were included in this study. Remaining 10 patients were excluded as they had normal CA-125 levels. At least three previous consecutive CA-125 readings and initial conventional imaging before uorodeoxyglucose-PET/CT were noted. Sensitivity and diagnostic accuracy for tumour detection with PET/CT and CT alone were calculated; histological analysis after biopsy/second look surgery or clinical- radiologic follow-up/response to chemotherapy was taken as reference standard. K statistics (Cohen K) was used for statistical analysis. Results: Of 35 patients with suspected relapse, one patient was lost to follow up. 30 patients were documented to have relapsed, while in four patients, recurrence was not identi ed either on CT or PET-CT and they were proved to be disease free on 2-year follow-up. Amongst these relapsed patients, 10/30 cases were proven histologically, 3 with imaging-guided biopsy and 7 with second-look surgery, whereas 20/30 were con rmed on clinical/radiological follow-up (ranging from 3 to 6 months) or by response to chemotherapy on subsequent imaging. Of 30 patients with relapse, PET-CT highlighted recurrence in 27. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of integrated PET/CT were calculated to be 90%, 75%, 96%, 50%, and 88%, respectively. CT alone detected recurrence in 20 patients. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of CT were calculated to be 73.3%, 100%, 100%, 33%, and 76%, respectively. Conclusion: PET/CT is a highly sensitive and accurate post-therapy surveillance modality for the detection of recurrent ovarian cancer in patients with rising tumour markers as compared to CT alone. Key words: CA125, uorodeoxyglucose, ovarian cancer, positron emission tomography/computed tomography, recurrenc
