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Other Malignancies (other + malignancy)
Selected AbstractsUtility of CD26 in flow cytometric immunophenotyping of T-cell lymphomas in tissue and body fluid specimens,CYTOMETRY, Issue 6 2008Diane M. Pierson Abstract Background CD26 is expressed by most CD4+ T cells in normal peripheral blood specimens. Neoplastic T cells are frequently CD26, in mycosis fungoides/Sezary syndrome involving the peripheral blood. However, CD26 expression by reactive and neoplastic T cells in solid tissues and body fluids has not been fully characterized by flow cytometry (FC). Methods Solid tissue and body fluid specimens were assayed for CD26 expression using four-color FC immunophenotyping, by qualitative assessment of population clusters, and by quantitation with comparison with isotype controls. Benign T cells were studied in reactive tissues and in the background of other malignancies. Results Many T-cell lymphomas were dim or negative for CD26, whereas a few were brightly positive. In the majority of T-cell lymphomas, CD26 expression could potentially help identify aberrant population clusters. T cells in reactive tissue specimens and tumor-infiltrating T cells were commonly dim to negative for CD26. Conclusions Both T-cell lymphomas and reactive T cells in tissue and body fluid specimens often show low levels of CD26 expression. Therefore, quantitative methods may not reliably distinguish benign from neoplastic T cells in these specimens. However, CD26, in combination with other T-cell markers, can be helpful for identifying aberrant population clusters in T-cell lymphomas. © 2008 Clinical Cytometry Society [source] Axillary Basal Cell CarcinomaDERMATOLOGIC SURGERY, Issue 11 2003Benjamin W. LeSueur MD Background. Basal cell carcinoma (BCC) rarely occurs in the axilla. Only 18 cases have been reported in the world literature. Objectives. To report our institution's 11-year experience with axillary BCC. Methods. A review of patient charts and biopsy specimens is given. Results. We report 14 patients with 15 axillary BCCs. The average patient age was 65.6. The average lesion size was 10.8 mm. Nine patients had a personal history of skin cancer at sun-exposed sites. One patient had basal cell nevus syndrome. A history of ionizing radiation and severe sunburn involving the axilla was each seen in separate patients. No other predisposing factors for developing BCC were identified, such as immune suppression or a history of other malignancies. Histologic subtypes of all tumors were considered less aggressive, and only one tumor recurred. Conclusions. Axillary BCC is rare. Factors other than ultraviolet radiation likely contribute to the development of BCC, especially at sun-protected sites. Performing a periodic and complete cutaneous examination that includes sun-protected sites is important, especially in patients who have a history of skin cancer. [source] A rare case of multiple myeloma initially presenting with pseudoachalasiaDISEASES OF THE ESOPHAGUS, Issue 6 2009Georgia Lazaraki SUMMARY Pseudoachalasia is a rare clinical entity with clinical, radiographic, and manometric features often indistinguishable from achalasia. Primary adenocarcinomas arising at the gastroesophageal junction or a tumor of the distal esophagus are the most frequent causes of pseudoachalasia. Rarely, processes other than esophagogastric cancers including chronic idiopathic intestinal pseudo-obstruction, amyloidosis, sarcoidosis, Chagas' disease, vagotomy, antireflux surgery, pancreatic pseudocysts, von Recklinghausen's neuroinomatosis, gastrointestinal stromal tumor, and other malignancies and rare genetic syndromes, may lead to the development of pseudoachalasia. Secondary achalasia is extremely rare, with less than 100 cases reported in the literature so far. Gastrointestinal manifestations in primary or secondary amyloidosis include abdominal pain, diarrhea, constipation, malabsorption, obstruction, motility disturbance, intestinal infarction, perforation, and hemorrhage; however, gastrointestinal tract involvement is asymptomatic in most instances. We present here a rare case of multiple myeloma initially presenting with dysphagia because of esophageal amyloidosis and manometric findings typical of achalasia. [source] Patients' health beliefs and coping prior to autologous peripheral stem cell transplantationEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2007E. FRICK md The aim of this study was to determine the associations between health locus of control (LoC), causal attributions and coping in tumour patients prior to autologous peripheral blood stem cell transplantation. Patients completed the Questionnaire of Health Related Control Expectancies, the Questionnaire of Personal Illness Causes (QPIC), and the Freiburg Questionnaire of Coping with Illness. A total of 126 patients (45% women; 54% suffering from a multiple myeloma, 29% from non-Hodgkin lymphomas, and 17% from other malignancies) participated in the study. Cluster analysis yielded four LoC clusters: ,fatalistic external', ,powerful others', ,yeah-sayer' and ,double external'. Self-blaming QPIC items were positively correlated with depressive coping, and ,fate or destiny' attributions with religious coping (P < 0.001). The highest scores were found for ,active coping' in the LoC clusters ,powerful others' and ,yeah-sayer'. External LoC and an active coping style prevail before undergoing autologous peripheral blood stem cell transplantation, whereas the depressive coping is less frequent, associated with self-blaming causal attributions. Health beliefs include causal and control attributions, which can improve or impair the patient's adjustment. A mixture between internal and external attributions seems to be most adaptive. [source] Delayed complete remission in a patient with multiple myelomaEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2008R. Ria Abstract We report a strikingly positive, late response to bortezomib in conjunction with pegylated liposomal doxorubicin in a 79-year old woman with multiple myeloma (MM). The patient obtained a partial remission after eight courses of therapy and a complete remission about 10 months after the end of therapy. This delayed complete remission may be similar to the spontaneous regression reported for other malignancies such as melanoma or lymphoma. We postulate that the immune response and a persistent anti-angiogenic effect of bortezomib could well explain the delayed complete remission in our patient. [source] Mechanisms of resistance to EGFR inhibitors in head and neck cancer,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2009Jonathan B. Cooper BS Abstract Epidermal growth factor receptor (EGFR), a receptor tyrosine kinase that activates multiple signaling pathways, including phosphatidylinositol-3-kinase/v-AKT murine thymoma viral oncogene homolog protein (Akt), has long been a target of novel therapies. Despite universal EGFR expression in head and neck squamous cell carcinoma (HNSCC), the majority of patients do not respond to EGFR inhibitors. This review focuses on mechanisms of resistance to these agents in HNSCC, and how these may be unique when compared with other malignancies such as non-small cell lung and colorectal cancers. Published studies and abstracts reveal that there are likely several mechanisms underlying resistance, suggesting that different strategies will be required to improve efficacy of EGFR inhibitors in HNSCC. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Current management of mucosal melanoma of the head and neckJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003Jesus E. Medina MD Abstract While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies. J. Surg. Oncol. 2003;83:116,122. © 2003 Wiley-Liss, Inc. [source] Liver tumors: Pediatric population,LIVER TRANSPLANTATION, Issue 11 2008Milton J. Finegold Liver tumors in childhood are rare and are typically not detected clinically until they reach a large size and often spread within the organ or metastasize. This can make surgical resection problematic, and almost all of them require extirpation for cure. With very effective chemotherapy for hepatoblastoma and to some extent for sarcomas, many cancers can be shrunk to permit partial hepatectomy, but for most hepatocarcinomas, some of the other malignancies, and even some benign proliferations, their location at the hilum and multiplicity of masses in multiple lobes make transplantation the treatment of choice. Major advances in diagnostic imaging, especially enhanced computed tomography and magnetic resonance imaging, permit a preoperative choice of resection versus transplantation to be achieved in almost all instances, and for the remainder, intraoperative ultrasonography can further help to determine the most desirable approach. The outcome is very much better in the case of hepatoblastoma when transplantation is a primary modality rather than following unsuccessful attempts at resection. In this review, transplantation for liver tumors in children is considered from all aspects, including the importance of screening for tumors whenever possible to avoid the need for transplantation. Liver Transpl 14:1545,1556, 2008. © 2008 AASLD. [source] Anaphylaxis to patent blue V: a case series and proposed diagnostic protocolALLERGY, Issue 3 2010R. A. Haque To cite this article: Haque RA, Wagner A, Whisken JA, Nasser SM, Ewan PW. Anaphylaxis to patent blue V: a case series and proposed diagnostic protocol. Allergy 2010; 65: 396,400. Abstract Patent blue V is widely used in the identification of sentinel lymph nodes in patients with breast cancer and other malignancies. Individual case reports of allergy to patent blue V have been described in the medical literature since the 1960s. However, there is little data on clinical features and little experience of which allergy tests are appropriate or useful. We gathered all cases of patent blue V allergy that had been seen and diagnosed in the Department of Allergy, Addenbrooke's Hospital over a 3-year period. We collected clinical details of each case including skin test results. For comparison we recruited 12 healthy control subjects who then underwent skin testing to patent blue V. Six cases of patent blue V allergy were identified, all occurring during sentinel lymph node identification for breast carcinoma. All 6 had positive skin prick tests to neat patent blue V (25 mg/ml). Skin prick testing with a 1 : 10 dilution (2.5 mg/ml) produced positive results in 3 of 4 patients tested, and intradermal testing at a 1 : 100 dilution was (0.25 mg/ml) was positive in all patients tested. Of 12 control subjects, 11 had negative skin prick tests to both neat and 1 : 10 patent blue V with one subject showing a positive reaction to the higher concentration only. On the basis of our experience of patent blue V allergy, we propose a diagnostic protocol that can be safely and reliably utilised in centres equipped for allergy testing. [source] Pleomorphic xanthoastrocytoma with anaplastic features presenting without GFAP immunoreactivity: Implications for differential diagnosisNEUROPATHOLOGY, Issue 3 2005Ellen Gelpi Pleomorphic xanthoastrocytoma (PXA) is an uncommon, usually low-grade, astrocytic tumor. Characteristic histological features include tumor cell pleomorphism and lipidization of tumor cells. Albeit prognosis in PXA is generally good, cases with histological signs of anaplasia have been observed. In these cases, the differential diagnosis needs to exclude other malignancies, for example, glioblastoma or malignant fibrous histiocytoma. Immunocytochemical detection of GFAP may support exclusion of non-glial neoplasms resembling PXA. However, GFAP expression in PXA may be faint or focal, although complete lack of GFAP has not been described. A 43-year-old woman was operated on for a left occipital parasagital tumor attached to the dura. Histopathology showed a pleomorphic tumor with moderate mitotic activity and necrosis, lack of GFAP immunoreactivity and ultrastructural detection of premelanosome-like structures. These features led to the tentative diagnosis of amelanotic melanoma, and the patient was irradiated. Three years later she had local tumor recurrence and underwent another operation. The recurrent tumor showed similar plain histology as the first specimen. In contrast, anti-GFAP immunoreactivity was now detectable in pleomorphic tumor cells. Anti-GFAP staining of the first biopsy was repeated using monoclonal and polyclonal antibodies in combination with prolonged tissue pretreatment. Focal GFAP staining of tumor cells was now achieved. We conclude that non-standard GFAP staining protocols may enhance sensitivity and thus lead to detection of a low level of GFAP expression in tumor specimens, in which PXA is considered in the differential diagnosis. This may avoid misleading diagnostic considerations that impact on postoperative patient management. [source] Expanding spectrum of the association between Type 1 Gaucher disease and cancers: A series of patients with up to 3 sequential cancers of multiple types,Correlation with genotype and phenotype,AMERICAN JOURNAL OF HEMATOLOGY, Issue 5 2010Sarah M. Lo In Gaucher disease (GD), inherited deficiency of lysosomal glucocerebrosidase due to mutations in GBA1 gene results in accumulation of glucosylceramide in tissue macrophages, systemic macrophage activation, and a complex multisystemic phenotype. We and others have reported an increased risk of multiple myeloma and other malignancies in non-neuronopathic Type 1 GD (GD1). Here, we describe a subset of GD1 patients with multiple malignancies. In our cohort of 403 patients with GD1, nine patients (2.2%) developed two or three different types of cancers either consecutively or simultaneously. Patients were characterized by age at diagnosis of GD1, GBA1 genotype, disease severity, age at cancer diagnosis, enzyme replacement therapy (ERT) status, and splenectomy status. Of the nine patients, six developed two types of malignancies and three had three cancers each. Overall, the hematologic malignancies comprised lymphoma/leukemia (4) and multiple myeloma (4). Nonhematologic malignancies included colon (2), lung (2), thyroid (2), and prostate cancer (1). Of the seven patients who received ERT, the first cancer was diagnosed before initiation of ERT in all but one. Asplenic patients were more likely to have single or multiple cancers compared with patients with intact spleens (P < 0.0072 and P < 0.0203, respectively). Our data strengthen the association of GD1 and cancer and suggest that patients may be at risk of developing multiple malignancies. We found an association between splenectomy and multiple cancers in GD1. It will be of interest to determine whether timely ERT and declining rates of splenectomy will translate into declining rates of multiple and single cancers. Am. J. Hematol. 2010. © 2010 Wiley-Liss, Inc. [source] Post-transplant lymphoproliferative disorder following pediatric heart transplantationPEDIATRIC TRANSPLANTATION, Issue 1 2006Fernando Mendoza Abstract:, Immunosuppression after heart transplantation is implicated in development of post-transplant lymphoproliferative disorder (PTLD). Despite a higher prevalence of PTLD in children, there is scarce knowledge about incidence, pathophysiologic mechanisms and risk factors for PTLD in pediatric recipients of cardiac allografts. We examined retrospectively the medical records of all 143 pediatric patients (mean age 9.2 ± 6.1 yr) who received donor allografts between 1984 and 2002 and survived over 30 days. Five children (3.5%) developed PTLD over a mean follow-up period of 41.1 ± 46.0 months. Time from transplant to diagnosis of PTLD ranged from 3.9 to 112 months (mean 48.0 ± 41.9 months). Excluding PTLD, no other malignancies were found in this population. Actuarial freedom from PTLD was 99.2%, 99.2% and 96.2% at 1, 2, and 5 yr, respectively. Children who developed PTLD were more likely (by univariate analysis) to have been Rh negative (p = 0.01), Rh mismatched (p = 0.003), Epstein,Barr virus (EBV) seronegative (p = 0.001) and transplanted for congenital heart disease (p < 0.02). PTLD was associated with significant morbidity and mortality with a mean survival following diagnosis of 21.2 months. PTLD is a serious complicating outcome of cardiac transplantation that occurs in approximately 3.5% of children. Aside of immunosuppression, risk factors in this series for developing PTLD include EBV seronegativity and Rh negative status and mismatch. Non-hematogenous malignancies are rare in light of short allograft half-life. [source] Myeloprotective effect of short-course high-dose methylprednisolone treatment before consolidation therapy in children with acute myeloblastic leukemiaAMERICAN JOURNAL OF HEMATOLOGY, Issue 1 2005Selin Aytaç Elmas Abstract In our previous studies, short-course high-dose methylprednisolone (HDMP) has been shown to shorten the chemotherapy-induced neutropenic period by stimulating the CD34+ hematopoietic progenitor cells in children with acute leukemia. In this study, we investigate the role of short-course HDMP on induction of a myeloprotective effect when administered before consolidation therapy consisting of high-dose cytosine arabinoside and daunorubicin. Thirty-four consecutive newly diagnosed children with acute myeloblastic leukemia (AML) who received 64 courses of consolidation regimen were entered into the study. The patients received HDMP (group A) at a daily dose of 30 mg/kg methylprednisolone starting 4 days before the initiation of consolidation therapy. The control group did not receive HDMP (group B). There were no differences in the white blood cell (WBC) and absolute neutrophil counts (ANC) between group A (at day ,4) and group B (at day 0) at the beginning of the study (medians: 3 × 109/L vs. 3.2 × 109/L and 1.5 × 109/L vs. 1.7 × 109/L, respectively). The WBC count increased significantly from 3 × 109/L to 6.4 × 109/L, and ANC increased from 1.5 × 109/L to 3.9 × 109/L after 4 days of HDMP treatment in group A (P < 0.01). Following high-dose chemotherapy, the median values of WBC and ANC also remained higher than the control values during the 16 days of the follow-up period. The neutropenic period was significantly shorter in the HDMP group than in the control group (9 ± 5.2 days vs. 22 ± 4.7 days) (P < 0.05). The duration of hospitalization and the interval between two chemotherapy cycles were significantly decreased in group A when compared group B (9 ± 2.7 vs. 14 ± 2.7 days; 22 ± 4.7 vs. 26 ± 4.2 days, respectively) (P < 0.05). Moreover, following consolidation therapy, the number of patients with ANC values below 0.5 × 109/L was lower in group A when compared the group B. In conclusion, the administration of short-course (4 days) HDMP before high-dose chemotherapy has been found to be beneficial for reducing the duration and severity of neutropenia. Further studies with short-course HDMP are required to evaluate its myeloprotective effects in patients with other malignancies. Am. J. Hematol. 80:1,5, 2005. © 2005 Wiley-Liss, Inc. [source] Cadherin switching dictates the biology of transitional cell carcinoma of the bladder: ex vivo and in vitro studies,THE JOURNAL OF PATHOLOGY, Issue 2 2008RT Bryan Abstract Bladder cancer is the fifth most common malignancy in the UK. Clinically, the most important process in determining prognosis is the development of invasion, initially of the lamina propria and then beyond as these transitional cell carcinomas (TCCs) progress from stage pT1 to stages T2+. Cadherins and catenins are the main mediators of cell,cell interactions in epithelial tissues, and loss of membranous E-cadherin immunoreactivity is strongly correlated with high grade, advanced stage and poor prognosis in bladder cancer and other malignancies. However, the role of P-cadherin is yet to be fully elucidated in bladder TCC. The objectives of this study were to establish how the expression of cadherins and catenins determines clinical and in vitro behaviour in bladder TCC. Utilizing immunohistochemistry, immunofluorescence and western blotting, we demonstrated a significant reduction in the expression of E-cadherin and ,-catenin as grade and stage of bladder TCC progress, accompanied by a significant increase in P-cadherin expression (all p < 0.05, Pearson's ,2 test). Increased P-cadherin expression was also associated with a significantly worse bladder cancer-specific survival (log rank p = 0.008), with Cox regression showing P-cadherin to be an independent prognostic factor. Utilizing a variety of tissue culture models in a range of functional studies, we demonstrated that P-cadherin mediates defective cell,cell adhesion and enhances anchorage-independent growth. The results provide evidence that increased P-cadherin expression promotes a more malignant and invasive phenotype of bladder cancer, and appears to have a novel role late in the disease. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Ongoing activation of p53 pathway responses is a long-term consequence of radiation exposure in vivo and associates with altered macrophage activities,THE JOURNAL OF PATHOLOGY, Issue 5 2008PJ Coates Abstract The major adverse consequences of radiation exposure, including the initiation of leukaemia and other malignancies, are generally attributed to effects in the cell nucleus at the time of irradiation. However, genomic damage as a longer term consequence of radiation exposure has more recently been demonstrated due to untargeted radiation effects including delayed chromosomal instability and bystander effects. These processes, mainly studied in vitro, are characterized by un-irradiated cells demonstrating effects as though they themselves had been irradiated and have been associated with altered oxidative processes. To investigate the potential for these untargeted effects of radiation to produce delayed damaging events in vivo, we studied a well-characterized model of radiation-induced acute myeloid leukaemia in CBA/Ca mice. Haemopoietic tissues of irradiated CBA/Ca mice exhibit enhanced levels of p53 stabilization, increased levels of p21waf1, and increased amounts of apoptosis, as expected, in the first few hours post-irradiation, but also at much later times: weeks and months after the initial exposure. Because these responses are seen in cells that were not themselves directly irradiated but are the descendants of irradiated cells, the data are consistent with an initial radiation exposure leading to persistently increased levels of ongoing DNA damage, analogous to radiation-induced chromosomal instability. To investigate the potential source of ongoing oxidative processes, we show increased levels of 3-nitrotyrosine, a marker of damaging nitrogen/oxygen species in macrophages. Not all animals show increased oxidative activity or p53 responses as long-term consequences of irradiation, but increased levels of p53, p21, and apoptosis are directly correlated with increased 3-nitrotyrosine in individual mice post-irradiation. The data implicate persistent activation of inflammatory-type responses in irradiated tissues as a contributory bystander mechanism for causing delayed DNA damage. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Prevention of malignant seeding at drain sites by hypofractionated radiotherapy in patients with pleural mesotheliomaASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Pinar KARA Abstract Aim: Unlike most other malignancies, malignant pleural mesothelioma (MPM) has a tendency to recur along tracks of chest wall instrumentation. We investigated the efficiency of hypofractionated radiotherapy for prevention of malignant seeding. Methods: Twenty-one (six female, 15 male) patients diagnosed with pleural mesothelioma who had chest wall instrumentation and were treated with prophylactic radiotherapy were investigated retrospectively. All patients underwent surgery or thoracoscopy and/or talc pleurodesis, for diagnosis, staging procedures or as a treatment. All were treated with electron (12 MeV) external beam radiation therapy (21 Gy in three fractions over 3 days), directed to the instrumentation pathway after the invasive procedure. After completion of radiotherapy, four of 21 patients had also undergone chemotherapy. Results: Nineteen of 21 patients were followed-up for a median period of 13 months (1,24 months) and two patients were lost just after the first month of the follow-up period. None of the followed patients had tumor progression in the treated area. Radiotherapy was well tolerated. The most common side-effect was grade 1 erythema (Radiation Therapy Oncology Group [RTOG] scale), noted in 13 treated patients. Conclusion: Our experience showed that prophylactic radiotherapy to prevent malignant seeding in malignant mesothelioma at invasive procedure sites was effective and well tolerated in preventing malignant seeding, painful metastases after surgery or instrumentation in patients with pleural mesothelioma. Larger multicenter prospective trials are still needed to validate this treatment approach utility for it to be recommended routinely. [source] Non-metastatic cholestatic paraneoplastic syndrome associated with soft tissue sarcomaASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 2 2009Amanjit BAL Paraneoplastic syndromes have been described in association with variety of malignant neoplasms. The non-metastatic cholestatic paraneoplastic syndrome first described as Stauffer's syndrome in association with renal cell carcinomas is also associated with other malignancies. We describe the autopsy findings of a patient with recurrent and metastatic leiomyosarcomas presenting with cholestatic liver dysfunction. The diagnosis requires the exclusion of all other possible causes of hepatitis and, where possible, resolution after the effective treatment of the underlying malignancy. [source] Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancerBJU INTERNATIONAL, Issue 6 2007Jochen Walz OBJECTIVE To test the accuracy of predicting life-expectancy (LE) among 19 raters, as the accurate prediction of LE in candidates for definitive therapy for localized prostate cancer is crucial, and little is known of the ability of clinicians to predict LE. SUBJECTS AND METHODS We randomly selected the case-vignettes of 50 patients treated with either radical prostatectomy (RP, 25) or external beam radiotherapy (EBRT, 25) for prostate cancer, and who either survived for >,10 years or died earlier with no evidence of disease relapse. The median age at treatment was 67 years and the median Charlson Comorbidity Index (CCI) was 2. The raters consisted of urology staff (six), urology residents (10) and medical students (three). The case-vignettes included patient age, comorbidities and CCI score, and raters were asked to predict the survival at 10 years (yes vs no), assuming no disease relapse. RESULTS Of the 50 cases, 20 (40%) did not survive for >,10 years; clinicians estimated a mean (range) of 23 (10,35) deaths before 10 years. The mean (95% confidence interval) overall predictive accuracy (0.5 = chance, 1.0 = perfect prediction) of LE predictions was 0.68 (0.64,0.71). Individual accuracy ranged from 0.52 (staff) to 0.78 (staff). There were no important differences among the rater groups (residents 0.69 vs staff 0.67 vs medical students 0.67). CONCLUSIONS Clinicians are relatively poor at predicting LE; tools to predict LE might be able to improve clinicians' performance in this important part of decision-making about prostate cancer treatment. It remains to be determined whether this limitation exclusively applies to prostate cancer or also to other malignancies. [source] A population-based study of skin cancer incidence and prevalence in renal transplant recipientsBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2006F.J. Moloney Summary Background, Cancers occurring following solid organ transplantation are a rapidly growing public health concern. Defining the extent of the problem has been limited by surveillance systems with incomplete registration of cases and the paucity of reliable national incidence data. Objectives, To determine the incidence of all cancers following renal transplantation and to make a detailed examination of trends and patterns associated with postrenal transplant skin cancers. Methods, Integration of data from the national renal transplant database and the national cancer registry in Ireland enabled accurate determination of the number of renal transplant recipients (RTRs) with skin cancers and other malignancies in the time period 1 January 1994 to 31 December 2001. Results, We demonstrated a biphasic increase in skin cancer incidence following renal transplantation, determined by the age at transplantation. There was a steady increase in risk for older RTRs (age 50+ years) from year 2 post-transplant, whereas the increased risk in younger RTRs (age <,50 years) occurred later but much more significantly, reaching 200 times the risk for an age-matched nontransplanted population by year 6 post-transplant. The number of nonmelanoma skin cancers (NMSCs) registered in RTRs accounted for 1% of all NMSCs registered nationally over the study period. The standardized incidence rates for invasive NMSC (33-fold increase) and in situ carcinoma of the skin (65-fold increase) were significantly increased (P < 0·05). The risk for invasive squamous cell carcinoma (SCC) was increased 82-fold compared with the nontransplanted population. Male RTRs were at particular risk of invasive SCC at sun-exposed sites such as the scalp and the external ear. Risk of malignant melanoma and Kaposi sarcoma were also increased relative to the nontransplanted population. Conclusions, This comprehensive national study illustrates how rates of skin cancer in Irish RTRs have influenced the national incidence of skin cancer. The high incidence of SCC, basal cell carcinoma and Bowen's disease in the early post-transplant period for older patients and the cumulative risk in younger patients with increased duration of transplantation highlight the importance of implementing early and continued cancer surveillance regimens post-transplant. [source] Cardiac monitoring of patients receiving arsenic trioxide therapyBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2004Dilip Unnikrishnan Summary Arsenic trioxide (ATO) is approved for the treatment of acute promyelocytic leukaemia and is under investigation for other malignancies. We report the cardiac findings in 18 patients with haematologic malignancies treated with ATO and assess the role of cardiac factors in fluid retention syndrome observed during ATO therapy. Based on initial observations in 10 patients treated with ATO, cardiac functions in the subsequent eight patients were evaluated prospectively. Evaluation included pre- and during-treatment electrocardiograms, Holter monitoring, echocardiograms, multigated acquisition scan and cardiac stress tests if indicated. All eight patients developed fluid retention during ATO, evidenced by pulmonary congestion, oedema and pleural/pericardial effusions. No cardiac factors were identified that contributed to fluid retention. Six patients had prolonged corrected QT (QTc) compared with baseline, three developed ventricular tachycardia. Sinus tachycardia, ventricular premature contractions, and non-sustained ventricular/supraventricular tachycardia were seen during ATO treatment. Fluid retention and cardiac events did not correlate with the dose or total amount of ATO or prior anthracycline therapy. In summary, fluid overload during ATO therapy does not appear to be cardiac in origin but appears to be drug-related, and may reflect cytokine-induced capillary leak. QTc prolongation, transient arrhythmias and clinically significant arrhythmias were seen with therapeutic doses of ATO. [source] Therapy-related acute lymphoblastic leukaemia with MLL rearrangements following DNA topoisomerase II inhibitors, an increasing problem: report on two new cases and review of the literature since 1992BRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2001Mette Klarskov Andersen A highly increased risk of myelodysplasia (MDS) and acute myeloid leukaemia (AML) is well established in patients previously treated for other malignancies with alkylating agents or topoisomerase II inhibitors. More recently, single cases of acute lymphoblastic leukaemia (ALL), often presenting balanced translocations involving chromosome band 11q23, have been observed. We present two such cases with t(4;11)(q21;q23), one of whom had previously received only single-agent chemotherapy with 4-epi-doxorubicin. A review of the literature since 1992 including these two patients reveals a total of 23 cases of ALL or lymphoblastic lymphoma after chemotherapy presenting balanced translocations to 11q23. All 23 patients had previously received at least one topoisomerase II inhibitor, and in two patients 4-epi-doxorubicin had been administered as single-agent chemotherapy for breast cancer. The latency period to development of t-ALL was 24 months or less in 20 out of 22 cases. The MLL gene was found to be rearranged in 14 out of 14 cases, and in three out of six cases the breakpoint was at the telomeric part of the gene, as observed in most cases of AML following therapy with topoisomerase II inhibitors. These results indicate that patients with ALL and balanced translocations to chromosome band 11q23 following chemotherapy with topoisomerase II inhibitors in the future should be included with cases of MDS or AML in calculations of risk of leukaemia. [source] Familial association of specific histologic types of ovarian malignancy with other malignancies,CANCER, Issue 7 2004Justo Lorenzo Bermejo Ph.D. Abstract BACKGROUND Population-based data on the familial association of specific histologic types of ovarian malignancy with other malignancies are limited. Such data may help to elucidate etiologic differences among histologic types of ovarian malignancy. METHODS The nationwide Swedish Family-Cancer Database, which includes 10.3 million individuals and 20,974 ovarian carcinomas, was used to calculate standardized incidence ratios and 95% confidence intervals for age- and histology-specific ovarian malignancies in women whose parents or siblings were affected with malignancies at the most common disease sites. RESULTS Ovarian malignancy was found to be associated with ovarian, laryngeal, breast, endometrial, liver, and colon carcinoma, as well as myeloma; epithelial ovarian malignancy was found to be associated with ovarian, endometrial, and skin malignancies and with melanoma and myeloma; papillary serous cystadenocarcinoma was found to be associated with ovarian and skin malignancies and with myeloma; and endometrioid carcinoma was found to be associated with endometrial, ovarian, and prostate malignancies and with melanoma. For younger women (ages 40,45 years) whose mothers were affected with endometrial malignancies, the risk of developing endometrioid carcinoma was slightly greater than the risk of developing papillary serous cystadenocarcinoma. CONCLUSIONS Specific types of ovarian malignancy may be associated with specific familial disease sites, with such associations depending on age at diagnosis; the strength of the observed associations varied according to histology. Associations were found between endometrioid carcinoma and endometrial malignancy and between serous carcinoma and Hodgkin disease. Cancer 2004;100:1507,14. © 2004 American Cancer Society. [source] Nevoid basal cell carcinoma syndrome: Relation with desmoplastic medulloblastoma in infancyCANCER, Issue 3 2003A population-based study, review of the literature Abstract BACKGROUND Patients with nevoid basal cell carcinoma syndrome (NBCCS) are believed to be predisposed to develop early-onset neoplasms including medulloblastomas (MB). The desmoplastic subtype of MB is associated most commonly with NBCCS. The goals of this study were to demonstrate the relation between desmoplastic MB and NBCCS and to evaluate the concomitant diagnosis of NBCCS and MB. METHODS The medical records of 76 consecutive children who received surgical treatment for MB between 1970 and 2000 were studied. A review of the literature was performed based on the National Library of Medicine database and bibliographies of selected articles were scanned. RESULTS The authors reported three patients with NBCCS who received surgical treatment for an MB during infancy. The literature review identified 33 patients with NBCCS who were treated for MB at a mean age of 28 months. The desmoplastic subtype was the only histopathologic subtype of MB reported in the NBCCS population. Although patients with NBCCS are predisposed to develop multiple basal cell carcinomas and intracranial tumors in the field of irradiation, the prognosis for syndromic MBs was much better compared with the prognosis for sporadic MBs. CONCLUSIONS Patients with NBCCS have an increased risk for other malignancies, especially radiation-induced neoplasms. Early diagnosis of this syndrome is important for the selection of appropriate adjuvant treatment and family genetic counseling. The authors did not advocate the use of radiotherapy as an adjuvant treatment in desmoplastic MB diagnosed in children younger than 5 years of age. They suggested that the desmoplastic subtype of MB in children younger than 2 years of age is a major diagnostic criterion for the diagnosis of NBCCS. Cancer 2003;98:618,24. © 2003 American Cancer Society. DOI 10.1002/cncr.11537 [source] Lymphatic mapping and sentinel lymph node biopsy in the detection of early metastasis from sweat gland carcinoma,CANCER, Issue 9 2003Paul N. Bogner M.D. Abstract BACKGROUND Several subtypes of sweat gland carcinoma have been found to demonstrate a propensity to metastasize systemically and to regional lymph nodes. The predictive value and benefit of sentinel lymph node (SLN) biopsy have been established in numerous other malignancies, but to the authors' knowledge there is little literature published to date regarding the use of SLN biopsy in patients with sweat gland carcinoma. In the current study, the authors demonstrated the utility of SLN biopsy in detecting subclinical metastases of sweat gland carcinoma, which may result in early treatment. METHODS The authors identified five patients with malignant eccrine tumors in whom SLN biopsy was performed at the study institution. Clinical and histopathologic data were reviewed. RESULTS The five study cases included two cases of aggressive digital papillary adenocarcinoma (both occurring on upper extremity digits), two cases of hidradenocarcinoma (occurring on the knee and foot, respectively), and an eccrine carcinoma (occurring on the scalp). In each biopsy-established case, there was no clinical evidence of metastatic disease, and a wide local excision or amputation was performed with concurrent SLN biopsy. Four of 18 SLNs in 3 of the 5 patients (60%) were found to be positive for metastatic carcinoma, as identified in hematoxylin and eosin stains and/or cytokeratin immunohistochemical stains. All three lymph node-positive patients subsequently underwent regional lymphadenectomy and were found to have no evidence of additional metastases. CONCLUSIONS The results of the current study demonstrate that SLN biopsy detects subclinical metastases from sweat gland carcinomas to regional lymph nodes. SLN mapping and biopsy at the time of resection can provide useful information with which to guide early treatment. Further studies are necessary to determine whether this procedure results in a survival benefit in patients with sweat gland carcinomas. Cancer 2003;97:2285,9. © 2003 American Cancer Society. DOI 10.1002/cncr.11328 [source] Sequential development of bilateral primary choroidal melanomaACTA OPHTHALMOLOGICA, Issue 4 2000Hayyam Kiratli ABSTRACT. Purpose: A case of a woman who had bilateral choroidal melanoma diagnosed sequentially 20 months apart and managed conservatively is described. Methods: The first eye having a juxtapapillary melanoma was treated with a notched episcleral radioactive plaque. The second eye, initially containing a small nevus with unequivocal rapid growth, was managed with diode laser transpupillary thermotherapy. Results: Both tumors regressed considerably following treatment and the patient retained good visual acuity in both eyes. No other malignancies or metastasis were detected during the follow-up period. Conclusions: A small choroidal nevus rapidly grew after treating a choroidal melanoma in the fellow eye. Close follow-up of such patients is mandatory. Also, conservative treatment should be opted whenever possible given the unpredictable course of the opposite melanocytic lesion. [source] De novo germline mutation in the serine,threonine kinase STK11/LKB1 gene associated with Peutz,Jeghers syndromeCLINICAL GENETICS, Issue 1 2004I Hernan Peutz,Jeghers syndrome (PJS) is an autosomal dominant disease, characterized phenotypically by mucocutaneous pigmentation and hamartomatous polyposis. Affected patients are at an increased risk of developing gastrointestinal and other malignancies. Mutations in the STK11/LKB1 (LKB1) gene, which encodes for a serine,threonine kinase, have been identified as a genetic cause of PJS. Molecular analysis of the LKB1 gene in a simplex case of PJS revealed a substitution of cytosine (C) for guanine (G) at codon 246 in exon 6, resulting in the Tyr246X mutation. The nucleotide substitution leads to a premature stop codon at the 246 residue, predicting a truncated protein and presumed loss of kinase activity. Analysis of DNA from both parents of the PJS patient did not show this mutation, which is therefore a de novo mutation. We isolated DNA from microdissected gastrointestinal hamartomatous polyps in the PJS patient and investigated the loss of heterozygosity (LOH) at the LKB1 locus by real-time fluorescence polymerase chain reaction genotyping using a fluorescent resonance energy transfer technique. The results suggest a different mechanism from LOH in the formation of hamartomatous polyps. [source] Effect of comorbidity on urinary neopterin in patients with breast carcinomaEUROPEAN JOURNAL OF CANCER CARE, Issue 3 2010K. MELICHAROVÁ md K. MELICHAROVÁ, H. KALÁBOVÁ, L. KR,MOVÁ, L. URBÁNEK, D. SOLICHOVÁ, B. MELICHAR (2010) European Journal of Cancer Care19, 340,345 Effect of comorbidity on urinary neopterin in patients with breast carcinoma Urinary neopterin is increased in less than 20% of patients with breast carcinoma. Moderately increased neopterin concentrations are also known to accompany comorbid conditions commonly observed in patients with breast carcinoma, for example, diabetes mellitus or complications of atherosclerosis. In the present study, we evaluated the effect of the presence of comorbid conditions on urinary neopterin. A trend for higher neopterin concentrations was observed in patients with most of the comorbid conditions, but significantly higher neopterin was observed only in patients aged 70 years or older and in a heterogeneous group of patients with comorbidity other than diabetes mellitus, thyroid disorder, hyperlipidaemia, cardiac disorder or other malignancy. Significantly higher neopterin levels were noted in patients with two or more comorbid conditions. In conclusion, present data demonstrate an association between systemic immune activation reflected in increased urinary neopterin concentrations and age or presence of comorbid diseases in patients with breast carcinoma. A cumulative effect was observed with the presence of two or more comorbid conditions resulting in significantly increased urinary neopterin. These observations should be taken into account when interpreting the changes of parameters of systemic immune and inflammatory response in patients with breast carcinoma. [source] The current status of targeted therapy for non-small cell lung cancerINTERNAL MEDICINE JOURNAL, Issue 9 2010H. Francis Abstract Lung cancer accounts for more cancer-related deaths than any other malignancy in Australia and worldwide. Non-small cell lung cancer (NSCLC) accounts for about 85% of lung cancers and is associated with a 5-year survival of only 15%. Treatment with platinum-based doublets in the first-line setting and single agent chemotherapy in the second-line setting has improved survival and quality of life in patients with NSCLC. However, the benefits associated with chemotherapy are modest and serve to stress the need for novel therapeutic approaches. In the last decade a range of targeted therapies has been evaluated in NSCLC. Dramatic and often durable responses were seen in patients treated with the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) gefitinib and erlotinib particularly in females, non-smokers, patients of East Asian ethnicity and those with adenocarcinomas , a group subsequently found to be enriched for tumours with activating EGFR mutations. Large randomized phase III trials have since established a role for EGFR TKI in the second- and third-line setting as well as a potential role for the monoclonal antibodies bevacizumab and cetuximab, directed at vascular endothelial growth factor and EGFR, respectively, in the combination with chemotherapy in the first-line setting. Recently it has been shown that patients with EGFR mutations may benefit from gefitinib in the first-line setting. Other promising agents under evaluation are inhibitors of the insulin-like growth factor-1 receptor and inhibitors of recently described ALK gene rearrangements. [source] Pancreatic cystic lesions: clinical predictors of malignancy in patients undergoing surgeryALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010E. S. HUANG Summary Background, Despite advances in cross-sectional imaging and the use of molecular markers, distinguishing between benign and malignant cysts remains a clinical challenge. Aims, To identify both preoperative clinical and cyst characteristics at the time of EUS that predict malignancy. Methods, A retrospective analysis was performed on consecutive patients with pancreatic cysts who underwent endoscopic ultrasound (EUS) and surgical resection from May 1996 to December 2007 at a tertiary centre. Clinical history, EUS characteristics, cytology, tumour markers and surgical histology were collected. Predictors of malignancy were determined by univariate and multivariate analysis using logistic regression. Results, A total of 153 patients underwent a EUS and subsequent surgical intervention. Of the 153 patients, 57 (37%) had a histological diagnosis of malignancy. On univariate analysis, older age (P < 0.001), male gender (P = 0.010), jaundice (P = 0.039), history of other malignancy (P = 0.036), associated mass in cyst (P = 0.004) and malignant cytology (P < 0.001) were found to be associated with malignancy. History of pancreatitis (P = 0.008) and endoscopist impression of pseudocyst (P = 0.001) were found to be associated with benign cysts. Multivariate analysis found that only older age [Odds ratio (OR), 1.04; 95% confidence interval (CI), 1.01,1.08], male gender (OR, 2.26; 95% CI, 1.08,4.73) and malignant cytology (OR, 6.60; 95% CI, 2.02,21.58) were independent predictors of malignancy. Conclusions, Older age, male gender and malignant cytology from EUS predict malignancy at surgical resection. These characteristics may be used to estimate the probability of malignancy in a cyst and aid in management. Aliment Pharmacol Ther,31, 285,294 [source] Severity of health conditions identified in a pediatric cancer survivor program,PEDIATRIC BLOOD & CANCER, Issue 7 2010Karen Wasilewski-Masker MD Abstract Background The Common Terminology Criteria for Adverse Events v3.0 (CTCAE) was designed for reporting acute and late effects of cancer treatment. To date, no study of pediatric-aged cancer survivors has graded health conditions using CTCAE, for patients in active follow-up in a cancer survivor program. Procedure Medical records were reviewed on 519 survivors of non-central nervous system childhood malignancies seen in the Cancer Survivor Program between January 1, 2001 and December 15, 2005. Health problems identified through histories, physicals, and recommended evaluation using the Children's Oncology Group (COG) Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancer were graded using the CTCAE. Results Overall, 1,625 adverse health conditions were reported or detected in 519 pediatric-age cancer survivors (mean age at diagnosis 4.8 years; mean age at first survivor visit 12.1 years). The majority of conditions were mild (47.4% Grade 1) or moderate (35.2% Grade 2); however, 17.4% of conditions were severe (Grade 3) or life-threatening/disabling (Grade 4). Only 12.1% of survivors had no adverse condition, and 36.2% of survivors had a Grade 3 or 4 condition. In a Cox multivariate analysis risk factors for a Grade 3 or 4 condition included minority race, diagnosis of other malignancy, older age, and a history of a hematopoietic stem cell transplant. Conclusions The majority of adverse health conditions in pediatric-aged cancer survivors are mild; however, a significant percentage will have a serious condition. Long-term follow-up with a multidisciplinary approach is essential to detect and intervene in health problems early. Pediatr Blood Cancer 2010;54:976,982 © 2010 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||