Journal of Cancer and Allied Specialties
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RADIONUCLIDE IMAGING AND THERAPY OF NEUROENDOCRINE TUMOURS
Get PDFThe incidence and prevalence of neuroendocrine tumours (NETs) are on the rise. Although NETs are a heterogeneous group of tumours, they have some similar properties, for example, that they can concentrate neuroamines and tend to have a high degree of somatostatin receptor (SSR) expression. These mechanisms can be exploited and this article discusses the important role of radionculide imaging and radionculide therapy in the management of NETs based on these mechanisms. This article reviews the current literature and discusses the role of radionuclide imaging in NETs both in terms of SSR imaging and neuroamine (metaiodobenzylguanidine [MIBG]) imaging. We discuss state-of- the-art 68Ga-radiopeptide imaging and indications for it use. We also discuss the role of 18F-FDG and other tracers in the management of NETs. The second half of the article focuses on radiotargeted treatment of NETs, discussing I-131 MIBG therapy and focussing on the emergence of peptide receptor radionuclide therapy. We discuss the clinical results, toxicities and patient selection for PRRT. Key words: DOTA octreotide, DOTATATE, Ga-68, Lu-177, metaiodobenzylguanidine, neuroendocrine tumours, peptide receptor radionuclide therapy, Y-90
BALLOON TRAWL; A SAFE AND EFFECTVE WAY OF REMOVING COMMON BILE DUCT (CBD) EMBEDDED STENTS
Get PDFBiliary stenting has been used since the 1970s to relieve biliary obstruction for a variety of causes including benign and malignant biliary strictures. Migration of stents proximally into the biliary tree or distally into the intestinal tract is relatively uncommon. We report a case of a 64-year-old female with a peri-ampullary tumour, who had symptomatic obstructive jaundice following endoscopic retrograde cholangiopancreatography and plastic stent insertion. Follow-up imaging showed proximal migration of the plastic stent and blockage of the distal common bile duct (CBD) secondary to the periampullary tumour. The biliary stent was safely removed endoscopically using balloon trawl. This case highlights that, while biliary stenting for strictures is generally safe and effective, stent migration to proximal CBD can occur. Balloon trawl is safe and effective way of removing such stents. Key words: Biliary stricture, common bile duct, endoscopic retrograde cholangiopancreatography, periampullary tumour, stents
CORRELATION BETWEEN STANDARDIZED UPTAKE VALUE AND HISTOPATHOLOGY OF OESOPHAGEAL CARCINOMA: A SINGLE CENTER ANALYSIS
Get PDFAim: This study aims to evaluate the correlation between oesophageal cancer histopathology and the standardised uptake value (SUV) of the primary lesion on positron emission tomography/computed tomography (PET/CT) scan.Methods: We reviewed clinical data of consecutive newly diagnosed oesophageal cancer patients who underwent positron emission tomography with 2-deoxy-2-[ uorine-18] uoro-D glucose integrated with CT (18F-FDG PET/CT) between September 2009 and July 2014. Results: A total of 289 baseline scans were performed in this 55-month period. Of these, 171 (59%) were male. The mean age was 52.6 years (standard deviation ± 12.4 years). On histological review, 214 were squamous cell carcinomas (SCCa) and 75 were adenocarcinomas. Of the SCCa, 15.9% were poorly differentiated, 70.6% were moderately differentiated and 13.5% were well differentiated. Of the adenocarcinomas, 20% were poorly differentiated, 45% were moderately differentiated, 28% were well differentiated and signet ring cell was 7%. Mean maximum SUV (SUVmax) for SCCa was 12.6 ± 5.14 and 10.5 ± 6.2 for adenocarcinomas. In bivariate analysis, being a female was associated with a higher SUV in the primary lesion by 1.66 units (P = 0.011) compared to males. Adenocarcinomas were associated with a lower SUV by 2.14 units (P = 0.004) compared to SCCa. In bivariate analysis, no signi cant correlation was found between the T-stage of the tumour and the SUVmax of the primary tumour (P = 0.339). Multivariate analyses showed no association of the SUV of the primary oesophageal tumour with the degree of differentiation of either SCCa or adenocarcinoma. There was no correlation between the SUVmax of the primary lesion and the presence or activity level of a metastatic focus, whether visceral or nodal. Conclusion: At our centre, three-fourths of patients with oesophageal carcinoma had squamous cell carcinoma on histology. Adenocarcinoma is associated with a lower SUV compared to SCCa. There is no association between the SUVmax and degree of differentiation of the primary oesophageal cancer. Key words: Fluorodeoxyglucose, oesophageal adenocarcinoma, oesophageal squamous cell carcinoma, positron emission tomography/computed tomography, standardised uptake value
BORDERLINE PHYLLODES TUMOUR
Get PDFWe report a case of 40-year-old woman with a painful lump in the left breast. Mammography revealed a suspicious mass ACR BI-RADS category 4a. Excision biopsy revealed borderline phyllodes tumour. Our case highlights the signi cance of multidisciplinary approach in managing benign breast masses such as phyllodes tumours which have malignant potential and a high rate of recurrence. Key words: Breast ultrasound, mammography, phyllodes breast tumour
IS ACROMEGALY A HYPERCOAGULABLE CONDITION? CASE REPORTS AND REVIEW OF THE LITERATURE
Get PDFIntroduction: Cardiovascular complications are a major cause of morbidity and mortality in patients with uncontrolled acromegaly. However, there are no published reports of an increased risk of venous thromboembolism (VTE) in such patients. We report three patients with uncontrolled acromegaly who presented with VTE. Clinical Cases: A 52-year-old male with uncontrolled acromegaly despite transsphenoidal (TSP) surgery and medical therapy presented in 2012 with acute chest pain and shortness of breath that was later con rmed as secondary to pulmonary embolism. A 44-year-old male immigrant, previously treated for acromegaly with radiation therapy alone, in 1992, in his native country, was referred to our centre in 2006 for acromegaly which remained uncontrolled despite medical therapy until 2009 when he achieved remission through TSP surgery. He had several episodes of VTE between 2008 and 2010. A 69-year-old male with uncontrolled acromegaly for 28 years despite two surgical resections and radiation therapy in 1986 and 1992, as well as continuous medical therapy, presented with VTE of the right axillary vein and bilateral pulmonary emboli in 2011. A thrombophilia screen in case 1 showed mild protein S de ciency, case 2 was homozygous for factor V Leiden (FVL) mutation and case 3 was heterozygous for FVL. Extensive investigations revealed no evidence of malignancy and echocardiography showed preserved ejection fraction in all three patients. Conclusion: Patients with uncontrolled acromegaly may be at increased risk of VTE. However, larger studies are required to further assess this association and determine the underlying cause. Key words: Acromegaly, pituitary tumours, thromboembolism
IMAGING TECHNIQUES USED IN MULTIPLE MYELOMA
Get PDFMultiple myeloma (MM) is a plasma cell disorder, characterised by bone marrow infiltration with clonal plasma cells; production of monoclonal immunoglobulin (paraprotein); end-organ damage; lytic lesions in the bones; renal impairment; hypercalcaemia and anaemia. Skeleton evaluation in MM is necessary not only for staging purposes but also to detect serious complications such as fractures. Skeletal survey is an established rst-line investigation for this purpose. However, in recent years, new imaging techniques such as whole-body magnetic resonance imaging and 2- uoro-2-deoxy-D-glucose positron emission tomography computed tomography have been used widely. In this article, we review different imaging techniques used in MM and their impact on patient management. Key words: Imaging techniques, magnetic resonance imaging, multiple myeloma, osteolytic lesions, positron emission tomography/computed tomography, skeletal survey
CLINICAL IMPACT OF 18F FDG PET-CT ON MANAGEMENT OF GERM CELL TUMORS
No full textPurpose: The purpose of this study was to review the impact of 18F- fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET-CT) scans on the management of patients with germ cell tumours (GCT) at our centre. Methods: A descriptive, cross-sectional, retrospective review of a total of 29 FDG PET-CT scans acquired in 20 patients with GCT between December 2009 and May 2013. Results: Sixteen males and four females with the average age of 34.4 years (+18SD) were identi ed who underwent FDG PET-CT scans for treatment response/outcome evaluation on an average period of 3 months after completion of therapy. Hypermetabolic residual disease (PET-CT positive) was identi ed in 8 (40%). 6 (30%) had non-FDG-avid residual morphologic disease (PET negative and CT positive) and 6 (30%) were disease free (PET-CT negative). FDG PET-CT led to change in the management plan of 12 (60%) of cases as compared to the CT alone ndings. Follow-up was available for a median of 2.9 years (±1.5 SD). The overall 5-year disease-free survival was found to be PET-CT positive patients = 62%, PET-negative and CT-positive patients = 80% and PET-CT-negative patients = 100%. Conclusion: FDG PET-CT scanning has a potential role in the evaluation of response to treatment and can predict the survival outcome. Key words: 18F- uorodeoxyglucose positron emission tomography computed tomography, disease-free survival, germ cell tumour, standardised uptake value
EMBOLIZATION OF RENAL ANGIOMYOLIPOMA: CASE SERIES
Get PDFRenal angiomyolipomas (AML) are benign lesions usually left alone. However, lesions larger than 4 cm carry the risk of spontaneous haemorrhage and need treatment. Angiography and embolisation are the current standard of care particularly in patients with high operative risks. Angio-embolisation is a safe, minimally invasive procedure preserving maximum renal parenchyma, with the added advantage of preventing peri-procedural morbidity. Two cases of AML are presented in this case series. Key words: Angiomyolipoma, embolisation, renal