Journal of cancer & allied specialties最新文献

Introduction: Asian developing countries share the burden of colorectal cancer (CRC) with rising mortality rates. This prospective study aims to apprehend the clinical relevance of age, gender, lifestyle choices (dietary habits and addiction) and body mass index (BMI) to the occurrence and progression of colon cancer (CC).

Methods: A cohort of non-cancer (NC) and CC patients of South-Central Asian origin registered for screening colonoscopy or surgery at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC), Lahore, Pakistan, from 2015 to 2020 was identified. BMI (Kg/m²) was classified according to the World Health Organization criteria as underweight (<18.5 Kg/m²), normal weight (18.5-24.9 Kg/m²) and overweight (≥25 Kg/m²).

Results: Among 236 participants, 99 (41.9%) belonged to the NC group, and 137 (58.1 %) participants had CC Overall, participants included 74 women and 162 men aged 20-85 years (mean ± SD; 49.9 ± 14.9). Notably, 46.0% of cancer patients had a family history of cancer. There was a direct relationship between CC with abnormal BMI (underweight and overweight), positive smoking history and positive family history of cancer.

Conclusion: Being underweight or overweight is a potential risk factor for CC patients. The overall survival in patients with CC is clinically associated with lifestyle choices before CC diagnosis. A balanced diet, walking and other forms of exercise should be strongly recommended to the community and those undergoing screening colonoscopy.

Introduction: Primary lymphomas of the prostate are globally rare, representing <0.1% of all prostatic neoplasms. Their rarity and non-specific symptomatology at presentation usually prompt a clinical diagnosis of benign prostatic hyperplasia or chronic prostatitis, leading to significant delay in diagnosis.

Case description: A 32-year-old man presented to our clinic with complaints of difficult urination and perineal pain. An enlarged, hard and nodular prostate was palpable on digital rectal examination. Needle biopsy of the prostate was performed, which revealed diffuse large B-cell non-Hodgkin's lymphoma by immunohistochemical studies. Computed tomography (CT) scan showed a large pelvic mass arising from prostate encasing ureters with bilateral hydronephroureter. No abnormal finding was seen on abdominal CT scan and bone marrow biopsy. Therefore, the disease was classified into the clinical stage IAXE according to the Ann Arbor's criteria. The patient achieved complete response to six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy with the central nervous system prophylaxis. He remained disease free, until 36 months after the end of chemotherapy.

Practical implications: According to the literature, the treatment and prognosis of primary lymphoma of the prostate are the same as that of other nodal lymphomas. The rituximab-based regimen should be considered in the management of prostatic diffuse large B-cell lymphoma.

Introduction: Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive disease carrying an increased risk of cancers (paediatric tumours of central nervous system, haematolymphoid malignancies along with gastrointestinal (GI) cancer(s), which are usually seen in the second and third decades), leading to syndromic presentation. Causal mutations are detected in DNA mismatch repair (MMR) genes, including MLH1, PMS2, MSH2 and MSH6 that are also known for their established role in Lynch syndrome. We describe a case of CMMRD with an earlier (first decade of life) presentation of mediastinal acute lymphoblastic lymphoma and colorectal malignancy.

Case presentation: A 5-year-old boy presented with respiratory complaints, bilateral cervical lymphadenopathy, multiple café-au-lait macules (CALMs) on the lower back and history of parental consanguinity with the death of three sisters due to brain tumour within 6 months of diagnosis. Computerised tomographic scan chest revealed a huge mediastinal mass. The patient underwent a trucut biopsy of the mass. The results were significant for a pre-T-cell acute lymphoblastic lymphoma. Suspicion of CMMRD was raised based on a combination of factors described above. A panel of MMR proteins was applied on the biopsy tissue that revealed loss of nuclear expression of MLH1 and PMS2 immunostaining in tumour cells with positive external controls. While on maintenance therapy for lymphoma, about a year later, the patient developed subacute intestinal obstruction due to a stenosing polypoidal circumferential tumour in the mid-sigmoid colon found on flexible sigmoidoscopy that was followed by endoscopic biopsies and insertion of a fully covered self-expanding metallic adult biliary stent with a diameter of 10 mm and length of 6 cm leading to immediate relief of obstruction. Biopsies revealed adenocarcinoma with neuroendocrine differentiation. Metastatic tumour deposits were seen in the omentum, anterior abdominal wall and the left peritoneal wall.

Practical implications: Earlier (first decade) presentation of GI malignancy warrants that an earlier screening through radiological scans for any possible tumours and MMR protein expression analysis (loss in tumour plus normal non-tumour cells) are essential in patients having CALMs and family history of paediatric tumours.

Introduction: Breast lymphoma (BL) is a rare breast tumour and accounts for <1% of all breast malignancies. It is further categorised into primary BL and secondary BL. This manuscript presents a case report of a patient diagnosed with secondary BL.

Case description: A 51-year-old female presented in the one-stop breast clinic with 6-month history of having a static and painless left breast lump. Mass was firm, non-tender and 2 cm in size. It was not adherent to skin or muscle and it was present in the upper outer quadrant of the left breast. Mammo-sonography revealed a circumscribed mass of 17 mm in the outer quadrant of the left breast. There were enlarged ipsilateral lymph nodes. Core biopsy suggested atypical lymphoid infiltrates. She underwent wide local excision of breast and axillary nodal mass. The definitive histological diagnosis revealed non-Hodgkin's follicular lymphoma grade 2/3. Staging computed tomography scan features were suggestive of cervical lymphadenopathy. Hence, staging workup proved this to be a case of secondary BL.

Practical implication: The early diagnosis of BL is highly relevant. Its diagnosis is challenging due to non-specific clinical presentation and imaging features. Commonly FL is diagnosed on excisional biopsy or after wide local breast mass excision. Primary and secondary lymphomas, though rare, should be considered in the differential diagnosis of breast malignancies.

Introduction: An abdominal binder is an elastic or non-elastic belt applied to the abdomen in post-operative patients with abdominal surgery. These provide support and splintage to the operative wound, reducing incision site pain. The present work aims to investigate the institutional practices regarding the use of abdominal binders, gain insight into the expected benefits that these practices are targeted to achieve, and determine if current practices are in accordance with the available evidence.

Materials and methods: It is a survey-based questionnaire study conducted at the Department of Surgical Oncology at Shaukat Khanum Memorial Cancer Hospital and Research Centre. Respondents were inquired about designation, frequency of binder usage, reasons for prescribing/not prescribing binders, duration of the prescription, clinical factors that influence the decision to use binders and the estimated cost of the device.

Results: The questionnaire was emailed to 85 surgeons working in the department of surgical oncology. Out of these, 34 responded, resulting in an overall response rate of 40%. Twenty-two (64.7%) of the respondents used abdominal binders regularly in post-operative patients. Eight (22.5%) reported using it occasionally, while 4 (11.7%) did not use abdominal binders in their clinical practice. About 67.8% and 50% of the respondents believed that it helped early mobilisation and better pain control, respectively. About 60.7% of the respondents believed that binders prevent incisional hernia formation, while 46.4% were of the view that these prevented wound dehiscence. Up to 60% of the respondents reported using an abdominal binder for 1 week-1 month after discharge, whereas 23.3% preferred using it only till discharge.

Conclusion: This survey demonstrates a gap between the evidence and actual practice. These gaps are often overlooked because of busy clinical practice. Equally important is the issue of surgical conservatism and the intrinsic desire to resist change by continuing old practices.

Introduction: The esophageal squamous papilloma (ESP) is a rare cause of dysphagia and hematemesis. The malignant potential of this lesion is uncertain; however, the malignant transformation and concurrent malignancies have been reported in the literature.

Case description: We report a case of esophageal squamous papilloma in a 43 years old female who had a background diagnosis of metastatic breast cancer and liposarcoma of the left knee. She presented with dysphagia. Upper gastrointestinal (GI) endoscopy showed a polypoid growth, and its biopsy confirmed the diagnosis. Meanwhile, she presented again with hematemesis. A repeat endoscopy showed that the previously seen lesion had likely broken off, leaving behind a residual stalk. This was snared and removed. The patient remained asymptomatic, and a follow-up upper GI endoscopy at six months did not show any recurrence.

Practical implications: To the best of our knowledge, this is the first case of ESP in a patient with two concurrent malignancies. Moreover, the diagnosis of ESP should also be considered when presenting with dysphagia or hematemesis.

Introduction: The impact of age on the prognosis of patients with gastric cancer is controversial. This study aimed to investigate the clinicopathologic features and prognosis of elderly advanced gastric cancer patients without serosal invasion compared to their younger counterparts.

Materials and methods: We retrospectively evaluated 43 elderly patients with advanced gastric cancer without serosal invasion. The clinicopathologic findings were compared between the elderly (age >70 years) and young (age <36 years) patients.

Results: Significantly higher numbers of elderly patients had tumours with differentiated histology, whereas more young patients had tumours with undifferentiated histology (P < 0.01). Curability (risk ratio, 3.122; confidence interval, 1.242-4.779; P < 0.001) was an independent prognostic factor of survival. The 5-year survival rates were not significantly different between the elderly and the young patients according to the absence of serosal invasion (80.0% vs. 77.9%; P = 0.654) and undergoing curative resection (82.0% vs. 78.9%; P = 0.312). Meanwhile, among the elderly patients, those who underwent curative resection had a better survival rate than those with non-curative resection (82.0% vs. 67.8%; P < 0.001).

Conclusion: Elderly patients with advanced gastric cancer without serosal invasion do not have a worse prognosis than their younger counterparts, indicating that age does not impact the prognosis of advanced gastric cancer. The important prognostic factor was whether the patients underwent curative resection.

Introduction: Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children, with a male predominance. Paediatric ALL is usually of B-cell lineage; T-cell leukaemia is uncommon and extremely rare under 1 year of age. Mixed-lineage leukaemia gene rearrangement is the best-known hallmark of infantile leukaemia and is a poor prognostic indicator. While multiagent high-dose chemotherapy remains the first line of treatment for paediatric T-cell lineage ALL (T-ALL), there are numerous side effects of these regimens, and most patients undergo relapse. Due to the rarity of the disease, treatment protocols for infantile T-ALL have not been established to date.

Clinical description: We present a case of a 7-month-old Pakistani male that presented with fever and cough and was subsequently diagnosed with T-cell ALL. T-ALL was diagnosed on flow cytometry. Due to poor prognosis, the patient was assigned palliative care.

Practical implications: Management of infantile leukaemia has yet to be studied in-depth. With a lack of clear treatment guidelines, the approach toward these patients remains challenging. Further research and clinical trials in this area of study are paramount to improving clinical outcomes for these young patients.

Introduction: Colon cancer is one of the leading malignancies globally and continues to be one of the most typical causes of cancer-related mortality. The clinical outcome of the disease depends on the primary tumour stage, regional nodal involvement and distant disease dissemination. It often presents with haematogenous spread to the liver at the time of diagnosis. Another factor for increased mortality is the presence of extramural venous invasion. This is exceedingly important as it has significant prognostic significance and helps predict survival.

Case description: A middle-aged female with a recent history of caesarean delivery presented with abdominal pain and occasional constipation, which led to a series of investigations. Initial computed tomography scan showed proximal to mid-transverse colonic tumoural thickening with locoregional lymphadenopathy and solitary distant metastasis in the left hepatic lobe. This was followed by extended right hemicolectomy and hepatic metastasectomy. The patient remained on follow-up and later presented with thrombus formation in the splenoportal circulation. Initially, this was considered a bland thrombus, and the patient was advised a close follow-up. However, the patient was lost to follow and later presented with extensive thrombosis of the portal and splenic veins.

Practical implications: Confident differentiation of the bland versus malignant thrombosis is crucial to ascertain disease stage and appropriate management. Invasive tissue sampling gives a confident diagnosis of benign versus malignant thrombus. However, using a non-invasive imaging modality, we can still distinguish between the two with reasonable certainty.