Journal of Cancer and Allied Specialties
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Imaging Characteristics of Breast Lymphoma; a Case Series
Full text linkIntroduction: Breast involvement by lymphoma is rare. It can occur as a primary breast tumour or as an extranodal manifestation of the systemic disease. The imaging features of breast lymphoma (BL) arenot characteristic. Biopsy is necessary for diagnosis due to non-specific imaging features. Materials and Methods: A retrospective electronic medical chart review was conducted of patients diagnosed with lymphomaof breast that underwent diagnostic radiological procedures (including mammography, ultrasound breast, computed tomography (CT) scan and positron emission tomography (PET/CT) scan from 1 July 2018 to 31 March 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. Results: Four patients were identified. On mammogram, the most common finding consisted of the presence of high-density masses with circumscribed or indistinct margins. On ultrasound, hypoechoic masses and indistinct diffuse infiltrative patterns were observed. PET/CT and CT were helpful in detecting extramammary sites of disease and for classifying the disease into primary or secondary BL. Conclusion: The early diagnosis of the BL is important. The radiologists should include lymphoma in the differential diagnosis when there is the absence of microcalcifications or spiculated margins on mammography and ultrasound
Recent Changes to the Editorial Policies
Full text linkAn overview of the recent editorial and structural changes that have taken place in the Journal of Cancer & Allied Specialties
High Grade B-Cell Non-Hodgkin’s Lymphoma Masquerading as Thyroid Carcinoma; a Case Report
Full text linkIntroduction: High grade B-cell lymphoma and diffuse large B cell exhibiting myelocytoma (MYC) translocation with B-cell lymphoma 2 (BCL2) and/or B-cell lymphoma 6 (BCL6) re-arrangements, also known as double and triple hit lymphomas, are aggressive entities. World Health Organization update 2017 includes this cytogenetically defined category of “High grade B cell lymphoma with myelocytoma MYC and BCL2 and/or BCL6 rearrangements” as a distinct entity on their own. We present an interesting case of an obese patient presenting with a neck mass, suspected to be an aggressive thyroid carcinoma, which eventually turned out to be a high grade B-cell lymphoma. Case description: A 64 years-old male presented with complaints of neck pain for 10 weeks and a huge swelling in front of neck for 4 weeks. Respiratory system evaluation revealed cough, pleuritic pain and expectoration. Rest of the systemic review was unremarkable. Baseline reports showed hypothyroid status. Ultrasonography (USG) thyroid showed right upper pole Thyroid Imaging Reporting and Data Systems - 4 (TIRADS-4) nodule with bilateral cervical lymphadenopathy for which correlation with fine needle aspiration cytology (FNAC) was advised. Magnetic resonance imaging (MRI) films were submitted for review which showed overall features of locally invasive primary thyroid malignancy. Case was discussed in a multi-disciplinary team (MDT) meeting and suspicion arose of non-thyroidal origin of tumor. Patient underwent Positron emission tomography/computed tomography (PET/CT) as per MDT recommendations. PET/CT findings were highly suggestive of lymphomatous disease as opposed to thyroidal malignancy suspicion early on, which was confirmed on histopathology of cervical nodes. Practical implications: High grade B-cell lymphoma is an aggressive entity and can be very deceptive in its presentation, as evident from this case report. Functional imaging modalities such as Fluorodeoxyglucose (F-18 FDG) PET/CT can provide crucial assistance in unmasking a deceptive disease entity masquerading as some other, thus changing the management plan completely
Late Morbidity Among Survivors of Childhood Cancers; Experience at Tertiary Care Cancer Hospital
Full text linkBackground: Long-term survivors of childhood malignancies are at increased risk of experiencing treatment-related morbidities. Survival into late adulthood in these children provides ample time for the acquisition of long-term sequelae. This study aimed to determine late adverse effects among long-term survivors of childhood cancer from a low-income country perspective. Methods: Data were retrospectively collected from review of charts of patients aged under 18 years at the time of their primary diagnosis between January 1, 1995, to December 31, 2008, and who survived for at least 5 years after completion of their treatment. Analyzed data included demographics, cancer type, treatment modality, types of chemotherapy agents administered and specific late morbidities including frequency of azoospermia, oligospermia, endocrine abnormalities, hearing and pulmonary function impairment, and cardiac dysfunction among the long-term survivors of cancer. Results: The total number of patients was 300 with a mean age of 18 ± 2 years. The male to female ratio was 2.7:1. Median follow up duration was 18 years (range: 5-25 years). Seventy-seven percent of patients were from Punjab, 20% were from Khyber Pakhtunkhwa and 3% were from other provinces. Fifty percent had a diagnosis of Hodgkin Lymphoma, 17% Acute Lymphoblastic Leukemia, 13% Non-Hodgkin Lymphoma, 10% Germ cell tumors and 10% had other tumors. Fifty-seven percent received chemotherapy, 23% chemotherapy and radiotherapy, 15% chemotherapy and surgery, 3% chemotherapy, surgery and radiotherapy and 2% had only surgery. Notable long-term documented sequelae were; azoospermia/oligospermia in 64%, endocrine abnormalities in 25% with hypothyroidism in 13.5% and follicle-stimulating hormone and luteinizing hormone abnormalities in 11.5%, ototoxicity in 6.5%, impaired pulmonary function tests in 4.6%, cardiotoxicity in 2.4% and second malignancies (acute myeloid Leukemia and myelodysplastic syndrome) in 1%. Conclusion: Childhood cancer survivors are at increased risk of adverse treatment-related sequelae and a long-term follow-up plan should be in place in centers where they receive treatment for their primary disease
Intracranial Extra-axial Undifferentiated Pleomorphic Sarcoma; a Case Report
Full text linkIntroduction: Head and neck sarcomas result in high mortality rates. A lot of new cases of sarcomas are diagnosed every year constituting about 1 % of all head and neck malignancies. Undifferentiated pleomorphic sarcomas (UPS) are high grade soft tissue malignant tumors which occur primarily in limbs and retroperitoneal cavities. These tumors can often metastasize to the central nervous system. However, in rare instances, soft tissue sarcomas may develop as a primary lesion within the intracranial compartments. Case description: A young male presented to the clinic with occipital headache and blurring of vision. Initial workup included brain contrast enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). The CECT suggested that there was an extra-axial mass present which was pressing against the adjacent left frontal lobe. Overlying frontal bone of the left side showed remodeling effect and associated mild periosteal reaction. MRI scan showed intracranial extra-axial lobulated mass with T1 intermediate to low signal intensity and intermediate to high signals on T2 sequences. Heterogeneous enhancement on post-contrast sequences was also seen. The lesion had a broad-based attachment with dura mater and was closely applied to the orbital roof without orbital invasion. Staging Positron emission tomography–computed tomography (PET/CT) scan showed a solitary site of disease in an intracranial location. Final diagnosis was confirmed by histopathology following excision of mass as undifferentiated pleomorphic sarcoma. Post-surgery MRI brain showed satisfactory postoperative appearance without any residual disease. Patient remained asymptomatic for 2 years and 6 months following the resection of the tumor. Practical implications: Most of the extra-axial intracranial soft tissue tumors arise from the meninges with meningiomas making the substantial bulk; however, possibility of other relatively rare tumors of meningeal origin must not be ignored. Intracranial soft tissue sarcomas mostly arise from meninges thus require a good understanding of clinical presentation as well as acquaintance with morphological features on radiological imaging to differentiate from other tumors. These can be treated with excision and radiotherapy along with sequential follow-ups to look for recurrence. Tissue sampling is mandatory followed by complete staging scan in case of sarcomas to rule out possible primary or secondary disease
Reasons for Admission and Outcome to an Acute Palliative Care Unit in Patients with Advanced Malignancy in a Cancer Hospital
Full text linkIntroduction: The alleviation of suffering is a primary goal of palliative care team for patients with terminal cancer. In some cases, patients experience symptoms requiring inpatient care. The purpose of this investigation was to assess the clinical presentation and outcomes of hospitalization in patients that were admitted to the acute palliative care service. Materials and Methods: This is a retrospective descriptive study looking at admissions to an acute palliative care unit in a single center over a 24-month period. Medical records of all patients, admitted in palliative care unit from 1st January 2013 till 31st December 2014, were reviewed for reason of admission and outcome. Results: A total of 226 patients were identified and included in the present investigation. Among these 55.5 % (125) were females. The median age of the cohort was 48 (15 - 86) years. The most common reasons for admission were alteration in consciousness (19.5 %), respiratory tract infection (18 %), diarrhea and/or vomiting (14.2 %) and respiratory distress (not related to infection) (13.4 %). The median duration of hospital stay was 4 (0-27) days. Majority of the patients were discharged home (65.1 %). However, a significant portion (33.1 %) of the patients did not survive the hospitalization. Following discharge from the hospital, at 4-weeks follow-up the survival rate was 38.7 %. This dropped to 21.7 % at 8-weeks. Conclusion: Patients with advanced disease have a multitude of reasons to seek acute inpatient care. Majority of the patients were discharged following care. However, the survival rate of patients following discharge was low
EVALUATION OF CLUSTERED MICROCALCIFICATIONS, INITIALLY GRADED AS LIKELY MALIGNANT ON BASELINE MAMMOGRAPHY, WITH STEREOTACTIC BIOPSY: A RAD-PATH CORRELATION
Full text linkBackground: Stereotactic-guided breast biopsy is an invincible tool to sample abnormalities visible only on mammography with subtle or occult ultrasound findings. Common mammographic abnormalities which require stereotactic core biopsy include calcifications, architectural distortion and satellite lesions. With advancement in techniques for adequate localisation of lesions, the use of stereotactic needle breast biopsy is exponentially increasing. A study was performed to look for frequency of benignancy or malignancy of microcalcifications and architectural distortions in patients initially falling in malignant category of Breast Imaging-Reporting and Data System of American College of Radiology (BI-RADS®) Assessment Categories.Materials and Methods: Patient presenting in outpatient (OPD) clinic who underwent stereotactic biopsies for labelled malignant on mammograms from May 2015 to May 2018 was included in retrospective study. Age, technique used, baseline mammogram and histopathology were reviewed.Results: A total of 91 patients underwent stereotactic biopsy. Age range varied between 28 and 81 years. Stereotacticguided biopsies were taken using a standard 14-gauge core needle with long throw of 22 mm excursion. None of the biopsy was inconclusive. In comparison with baseline mammograms and histopathology, 40% of the clusters of microcalcification which were initially labelled as malignant turned out to be malignant on histopathology as well, whereas 60% were reported as benign breast parenchyma.Conclusion: Agreement between the diagnostic accuracy of microcalcifications on mammogram and histopathology of same lesions after stereotactic biopsy was comparable to international figures with probability of being benign surpassing malignant on routine screening.Key words: Breast cancer, mammography, microcalcifications, stereotactic biops
Pre-operative Occurrence of First Bite Syndrome in Two Cases of Parotid Gland Tumour
Full text linkIntroduction: First bite syndrome (FBS) is a gustatory-evoked painful condition that is characterized by the onset of severe electric-shock like pain in the periauricular region. In the majority of patients, FBS develops post-operatively. However, in rare instances it may present in a preoperative setting. Case description: Two cases of FBS developing preoperatively secondary to parotid gland tumour are presented. The patients, 54 and 30 years old, presented with complaints of electric-shock like pain localized over the periauricular region. In each case the pain was triggered following first bite of the meal. In both cases, pain lasted for a few seconds and with subsequent bites subsided only to return at the beginning of next meal. Practical implications: Preoperative occurrence of FBS in the absence of a history of trauma or surgery should necessitate a thorough investigation and follow up for an underlying salivary gland tumour
THE PREVALENCE OF DYSPLASIA IN COLORECTAL SERRATED/HYPERPLASTIC POLYPS IN OMANI POPULATION
Full text linkPurpose: Serrated/hyperplastic polyps (SPs) are characterised histologically by sawtooth architecture. Historically, these polyps were considered benign, without malignant potential and thus clinically unimportant. At present, the WHO defines serrated/hyperplastic lesions as heterogeneous group, which include hyperplastic polyps (HP), sessile serrated adenoma (SSA)/polyp and traditional serrated adenoma (TSA). These can have malignant potential. The aim of this study was to evaluate the prevalence of dysplastic changes in SP of colon and rectum of Omani population reported at a tertiary care centre.Methods: The study was conducted in the pathology department of a tertiary care centre including endoscopic polypectomies from colon and rectum of Omani patients presenting to gastroenterology clinic reported between 2014 and 2016, and these were analysed retrospectively for dysplastic changes and their association with different clinical parameters.Results: Dysplasia was seen in 32 of 146 cases (21.9%) and 114 (78.1%) were without dysplasia. Of these dysplastic, biopsies’ only two cases (1.4%) showed high-grade dysplasia and rest 30 (20.5%) low-grade dysplasia. According to the type of polyp, dysplasia was found in TSA 8/21 cases (46.7%) and SSA 9/17 cases (53.3%). Association of dysplasia was more common in the age group of > 50 (15.07%) and male patients (62.5%).Conclusion: SPs are now common findings that a gastroenterologist faces in their daily practice. In our study of Omani population, the prevalence of dysplasia is associated with older age group, male gender, SSA/polyp and traditional serrated adenoma.Key words: Dysplasia. colorectal, polyp
SOLITARY FIBROUS TUMOR OF BREAST
Full text linkSolitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the pleura but are now being reported in other anatomic sites as well. SFT is generally characterised as a radiologically confined neoplasm composed of a proliferated spindle cells arranged in patternless manner. Intervening tissue shows prominent haemangiopericytoma-like vessels. Stroma is usually fibrous. Tumour is positive for CD34. SFT has a specific translocation representing fusion NAB2 with STAT6 genes. This translocation can be highlighted with very good specificity and sensitivity using STAT6 immunohistochemical stain. Some cases of SFTs have also been described in the breast. Rarely, SFT can show aggressive behaviour. SFT enters the differential diagnoses of benign and malignant spindle cell tumours of breast and it is, therefore, important that its clinical, radiological and pathological features are known to clinicians and diagnosticians. Key words: CD34, myofibroblastoma, NAB2-STAT6, solitary fibrous tumou