Journal of cancer & allied specialties最新文献

Introduction: Chromophobe renal cell carcinoma (CHRCC) is the third most common RCC subtype, typically with a favorable prognosis, though some cases show aggressive behavior. The prognostic utility of tumor grading in CHRCC remains controversial, particularly regarding the Fuhrman grading system due to inherent nuclear atypia. The Paner et al. three-tiered chromophobe tumor grading (CTG) system addresses these limitations by incorporating nuclear crowding and anaplasia. This study evaluates CTG's prognostic value versus Fuhrman grading and other factors like pT stage, sarcomatoid differentiation, and tumor necrosis.

Materials and methods: This retrospective study analyzed 51 patients who underwent radical nephrectomy for chromophobe renal cell carcinoma (CHRCC) at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, between 2014 and 2019. Tumors were graded using the Fuhrman and Paner CTG systems. Prognostic factors assessed included pT stage, sarcomatoid differentiation, and tumor necrosis. Statistical analysis used Chi-square and independent sample T-tests. Survival analysis was performed using Kaplan-Meier curves to determine overall survival (OS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS).

Results: Most cases (68.6%) were CTG grade 1-2, and 31.4% were grade 3. All adverse events occurred in grade 3 tumors (DMFS 75%, RFS 93.8%, CSS 87.5%). Grades 1-2 had 100% survival. Fuhrman grading showed less prognostic relevance due to inconsistent results. Tumor necrosis and advanced pT stage correlated with poor outcomes. Sarcomatoid differentiation appeared in one of four progressing cases.

Conclusion: The Paner CTG system effectively stratifies CHRCC patients by prognostic risk. It outperforms Fuhrman grading in predicting adverse outcomes. Higher tumor grade, necrosis, and advanced pT stage all significantly correlated with poor prognosis. These findings support adopting the Paner grading system for CHRCC to improve risk stratification and clinical decisions. Larger studies are warranted to validate these results.

Background: Duodenojejunal intussusception (DJI) is an uncommon clinical entity in adults, most often secondary to an underlying structural lesion. Its nonspecific gastrointestinal symptoms and rarity frequently delay diagnosis and complicate management.

Case description: We present the case of a 30-year-old woman with an 18-month history of right hypochondrial pain, intermittent non-bilious vomiting, and significant weight loss. Imaging and endoscopic biopsy revealed duodenojejunal intussusception secondary to a large periampullary tubulovillous adenoma. Although a transduodenal ampullectomy was initially planned, the procedure was converted to a pancreaticoduodenectomy due to the lesion's size and morphology. The postoperative course was uneventful, and the patient has remained asymptomatic and in good health for more than fifteen months after surgery.

Practical implications: DJI secondary to periampullary adenoma is rare but clinically significant. While endoscopic or limited surgical resection may be appropriate in select cases, pancreaticoduodenectomy offers a definitive treatment option when ampullectomy is not feasible.

Introduction: Metastatic colorectal cancer (mCRC) poses significant challenges in low- and middle-income countries (LMICs) due to limited access to comprehensive care. This study aims to analyze the clinical characteristics, treatment patterns, and outcomes of patients with metastatic colorectal cancer (mCRC) at a single tertiary care center in Pakistan.

Materials and methods: A retrospective cross-sectional study was conducted on 141 patients diagnosed with mCRC at the Aga Khan University Hospital (AKUH) between January 2020 and December 2022. Data on demographics, tumor characteristics, metastasis patterns, treatment modalities, and outcomes were extracted from electronic medical records. Descriptive statistics and survival analysis were performed.

Results: The mean age of the cohort was 51 years (SD ± 17.43), with 56.7% male patients. The study included patients from all over Pakistan, with the majority residing in Sindh (71.1%). Additionally, 8.5% of patients were from outside Pakistan. Rectum (27.5%) and sigmoid colon (20.4%) were the predominant tumor locations. Adenocarcinoma was the most common histological type (90.1%). Liver-only metastases were observed in 27.5% of patients, with 48.2% presenting multisite metastases. Chemotherapy was administered to 74.6% of patients, with FOLFOX being the most common regimen (38.3%). Primary tumor resection was performed in 43.7% of cases, and metastatic lesion resection in 7.7%. Fragmented care was observed, with 21.4% of patients receiving diagnostic or therapeutic interventions outside AKUH as well. The median time from diagnosis of metastasis to death was 4.9 months (IQR: 1.1-9.3).

Conclusion: mCRC patients in Pakistan present with a younger age, higher prevalence of multisite metastases, and limited access to advanced multimodal treatments compared to HICs. These findings underscore the need for tailored public health initiatives, including age-specific screening programs, improved diagnostic and treatment infrastructure, and enhanced access to advanced therapies to improve outcomes in LMICs.

Introduction: Minimal invasive surgery for abdominopelvic solid organ tumors in paediatric patients is a growing field. Technical challenges persist despite potential benefits, such as reduced postoperative pain and shorter recovery times.

Materials and methods: This was a retrospective review of all paediatric patients who underwent laparoscopic excision for abdominopelvic tumors. Parameters such as demographics, tumor histology, tumor location and size, blood loss, operation duration, and early outcomes were analyzed.

Results: Thirty-five patients underwent laparoscopy. The median age was 13 years. Females constituted the majority (29). Tumor sites included the pelvis (n=29), right kidney (n=2), retroperitoneal (n=3), and colon (n=1). The average tumor size was 11 cm. Successful laparoscopic excision was achieved in 32 cases, without postoperative complications, with a mean hospital stay of two days.

Conclusions: Laparoscopic excision is technically feasible for paediatric abdominopelvic solid organ tumors, offering minimal complications. However, further studies are needed to define long-term outcomes.

Introduction: Hamartomas are benign masses seen in different organs including breasts. These are well-defined masses with a pseudocapsule and variable tissues from the surrounding organ.It is an uncommonly reported benign breast lesion, the cause and pathogenesis of its development is still not fully understood. The tumour exhibits a female predominance with a mean age of 45.

Case description: We present two cases of breast hamartoma in 51 and 61 years old female who presented to us through screening and symptomatic clinics.Both cases had imaging findings typical for diagnosis of hamartoma however there was a distortion within the hamartoma which raised possibility of malignancy and prompted a core biopsy and MDT discussion.

Practical implication: Many hamartomas have typical benign imaging appearances and require no further investigation. Biopsy is needed in atypical looking hamartomas to exclude a breast carcinoma, which although rare may develop within a hamartoma. Multidisciplinary team discussion is crucial in the management of atypical cases to ensure radiological-pathological concordance.

Introduction: Between 2020 and 2022, Pakistan's population reached 235.7 million, with an average of 120.6 million men and 115.1 million women each year. Balochistan is in the southwest of Pakistan and is the fourth most populous region in the country, with an average annual population estimated at 13.9 m. There were 6.8 m (48.7%) children, 1.4 m (10.3%) adolescents, and 5.7 m (40.9%) adults over 2020-2022. The male population (7.4 m (52.6%)) was higher than the female population (6.6 m (47.4%)).

Materials and methods: We conducted a study from 2020 to 2022, retrospectively evaluating the distribution of cancer in Balochistan on data reported by the collaborating centers, namely, the Pakistan Atomic Energy Commission, Shaukat Khanum Memorial Cancer Hospital and Research Center, and Chughtai Lab. We computed the proportional distributions of the commonly diagnosed cancers by age category.

Results: We recorded 6,492 malignancies from Balochistan over three years from 2020 to 2022. In children (n=214 (3.3%)), 20.1% were Hodgkin lymphomas; in adolescents (n=214 (3.3%)), 19.6% were non-Hodgkin lymphomas (NHL); and in adults (n=6,064 (93.4%)), 17.5% were tumors of the breast.

Conclusion: This is the first report on regional cancer registration in the country's neglected province of Balochistan. It shows that cancer counts were low from 2020 to 2022. However, we can use the information recorded as the foundation to evaluate the statistics over time to see if any changes are recorded. We also need to increase awareness among the stakeholders about the impact of cancer surveillance in the region.

Introduction: Acute Myeloid Leukemia (AML) has a peak incidence in elderly patients with the median age of onset being 68 years. Owing to the advanced age and multiple comorbidities, such patients are not candidates for the standard chemotherapeutic protocols. Here we discuss the treatment strategies employed for newly diagnosed elderly patients with AML at our institution and their associated outcomes.

Materials and methods: We conducted a single institutional retrospective review of cases which included elderly patients aged ≥ 50 years diagnosed with AML and treated with venetolcax in combination with azacitidine. Data relating to patients' characteristics, cytogenetics, molecular aberrations and vital status were extracted. We evaluated the overall survival (OS) as our primary outcome of interest.

Results: This study involved 58 patients with confirmed AML, with a median age of 61.5 years. The majority of patients were male (77.6%). Most patients (75.9%) died, while 15.5% were still under treatment at the end of the study period. The median OS was 7.0 months. There was no significant difference in survival based on comorbid conditions (p = 0.586). However, survival differed by gender, with a median OS of 6 months for males and 16 months for females (p = 0.021). The number of chemotherapy cycles significantly impacted survival, with increased cycles associated with a reduced hazard of death (HR = 0.74, p < 0.01).

Conclusion: Our findings contribute to the growing evidence that venetoclax combined with azacitidine is an effective treatment option for elderly patients with AML who are not eligible for intensive treatment.

Background: EAU guidelines advise patients with intermediate risk Gleason 4+3=7 prostate cancer undergo cross-sectional abdominopelvic imaging and bone scan for metastatic screening. We hypothesised detection rate of extra-prostatic disease in this cohort is low using conventional CT/bone scans and could potentially be avoided.

Materials and methods: Patients with overall Gleason 4+3 histology were identified over 69 months at East Kent University Hospitals NHS Trust. Patients were excluded if PSA >20ng/mL and/or MRI prostate >T3b stage. Primary outcomes were: (a) detection rates of metastatic disease using conventional CT and bone scan and b) the proportion of fully-staged patients with positive lymph nodes at dissection or biochemical recurrence following robotic-assisted laparoscopic prostatectomy (RALP).

Results: A total of 134 patients were identified. Median age was 72 (range 45-83), PSA 7.8ng/mL (range 1.8-19.3) and prostate volume 40cc (range 10-129). 130/134(97%) had MRI scans prior to staging. 124/134(93%) had bone scans and 83/134(62%) had CT scans, of which 77/134(57%) had both. 0/124(0%) bone scans identified metastatic disease and only 2/83(2%) CT scans identified nodal disease not detected by MRI. 0/134(0%) had management changes from staging. 57/134(43%) patients negatively-staged proceeded to RALP. 19/57(32%) had lymph node dissections. 6(11%) had missed metastatic disease at 19 months median follow-up.

Conclusion: Detection of metastatic disease by conventional CT and bone scan was poor in this cohort, despite their presence, and their recommendation by EAU seems unwarranted. Patients could safely avoid these scans and proceed directly to radical treatment, due to the theoretical benefit of treating despite oligometastatic disease.

Introduction: Breast cancer is a major global health concern among all malignancies, with HER2-positive breast cancer representing a particularly aggressive subtype. It affects approximately 20% of patients and is associated with a high risk of relapse. The management of HER2-positive breast cancer has been significantly improved by targeted therapies, though challenges remain, especially in resource-limited settings. Invasive fungal infections are also common and can manifest as metastatic lesions in immunocompromised cancer patients undergoing intensive treatments making the diagnosis challenging for the oncologists.

Case description: We report a case of a 39-year-old premenopausal female with relapsed HER2-positive breast cancer complicated by an invasive fungal infection. The patient initially presented with a 5 × 5 cm right breast lump, which was diagnosed as invasive ductal carcinoma, HER2-positive estrogen and progesterone receptor negative. Despite receiving chemotherapy with doxorubicin, cyclophosphamide, paclitaxel in the neoadjuvant setting and breast conservation surgery, the patient experienced disease recurrence. She was then treated with modified radical mastectomy followed by adjuvant chemotherapy TCH (trastuzumab, carboplatin, and docetaxel) six cycles. After three cycles, she developed high-grade fevers, renal impairment, and altered mental status. Imaging initially suggested ongoing infective vs metastatic process in bilateral renal and CNS parenchyma, so biopsy was performed from brain that revealed Aspergillus flavus infection. Treatment was adjusted to include antifungal therapy with voriconazole, and the patient's condition improved.

Practical implications: This case underscores the critical need for biopsy of new or evolving lesions in cancer patients, particularly when imaging is not convincing enough for a relapse. Accurate diagnosis is essential to differentiate between disease progression and complications such as opportunistic infections. The occurrence of a fungal brain abscess in this patient highlights the importance of considering such invasive opportunistic infections in immunocompromised individuals, especially those undergoing intensive chemotherapy. Furthermore, the challenges faced due to the unavailability of targeted therapies in resource-limited settings emphasize the need for better access to advanced treatments and comprehensive management strategies. This case also calls for heightened vigilance and prompt diagnostic evaluation to address both cancer progression and potential opportunistic infections effectively.

Introduction: Cancer treatment can impose a significant financial burden on patients, impacting their quality of life. The COST-FACIT tool is commonly used to assess financial toxicity (FT) in cancer patients. This study aimed to translate and validate an Urdu version of the COST-FACIT tool in Pakistan.

Materials and methods: A cross-sectional validation study was conducted at four tertiary care hospitals in Karachi, Pakistan, from October to December 2023. We translated and back-translated the 12-item COST-FACIT tool and validated it in accordance with FACIT guidelines. The study included 10 native Urdu-speaking cancer patients as recommended in the guidelines. The analysis included descriptive statistics, content validity indices, and assessment of internal consistency using Cronbach's alpha, analyzed with Stata MP v.14 software.

Results: The study population included 6 females (60%) and 4 males (40%), with most participants aged between 40 and 60 years (4 patients, 40%). The mean FACIT COST score was 16.3 (SD = 11.255, range 4-40), with 6 (60%) patients experiencing moderate (Grade 2) financial toxicity. Internal consistency was good, with a Cronbach's alpha of 0.90, and content validity indices indicated items were relevant and clear (average expert CVI = 0.82 for relevance, 0.90 for clarity).

Conclusion: We have translated and validated an Urdu version of the COST-FACIT tool. It is a valid and reliable instrument to assess financial toxicity experienced by cancer patients in Pakistan.