Huge Bilateral Mature Cystic Teratoma in Adolescence: A Case Report and Review of Literature

A 13 years old, single female, presented to our emergency room complaining of generalized abdominal pain for two weeks. It was colicky in nature, progressive in intensity over time, with no history of fever, nausea, vomiting, or changes in bowel habits. She did not notice any abdominal distension or changes in weight, but, complained of dysuria for two weeks. 

Her menarche was two years ago and regular menstruation for the past elven months. The vital signs were within normal. A palpable pelvic-abdominal mass reaching up to the umbilicus,non-tender, mobile with no skin changes was found on abdominal examination. Ultrasound of the abdomen and pelvis revealed a normal, retroverted uterus, three multiple, right sided ovarian cyst, largest measuring 6.3 × 7.3 cm and 5.6 × 6.3 cm, and Left hyper-echogenic ovarian cyst measuring 12.5 × 7.8 cm with some projections inside the cavity. 

The Challenge of pN3 Stage in Breast Cancer

Since 1959 the American Joint Committee on Cancer (AJCC) TNM system has been used to stage breast cancer. Since then, the TNM has helped clinicians in deciding the better treatment for each patient.

Periodically revisions have been made to this classification with the aim of keeping a relationship between the disease extent and the prognosis. However, when we talk about breast cancer, the TNM is not always enough.Several publications in the last years report that there are other predictive factors that influence the prognosis, measured by the overall survival or the DFS (disease-free survival), as much as the TNM stage does.

Some authors claim that important factors as primary tumor histologic grade and biologic tumor markers should be included in the AJCC system.

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Cervical cancer screening strategies

Starting from May 1, 2017 in Australia the National Cervical Screening Program will shift from cervical cytology every two years, to HPV DNA testing as the sole primary screening test every five years in women aged 25 to 74 years, together with the implementation of an active HPV vaccination program.

Conversely in Japan cervical screening using cytology every two years is still being recommended for population-based and opportunistic screening. While Canadian guidelines also recommend cervical screening with cytology every 3 years, in Europe cervical cytology is recommended for women under 30-35 years, and HPV testing as the sole primary screening test every 5-10 years for women above 30-35 years.

Actually, guidelines do not represent the real situation in each European country. In the Netherlands, screening is well organised and relies on primary HPV testing every 5 years until 40 years of age and every 10 years for women aged 40 and beyond: no screening is provided for women under 30, nor over 60 years of age.

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Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Peritoneal metastases (PM) documented in a patient with primary colon or rectal cancer places the patient at extreme risk for local recurrence or progressive PM diagnosed in follow-up.

In the past, peritoneal seeding diagnosed with the surgical exploration did not result in any major changes in the surgical approach to the disease process. Rather, conventional surgery was performed and then the patient was referred for palliative systemic chemotherapy. At this point in time potentially curative treatments for PM have evolved and become an important part of the standard of care of colorectal malignancy.

In order to optimize the management of peritoneal metastases, a new approach to the primary cancer presenting with PM is required. The goal of manuscript is to describe a clinical pathway so that patients with PM diagnosed at the time of primary colorectal cancer resection receive treatment with curative intent.

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Taking Action against Anti-Healthcare Violence in China

Medical doctors and nurses are the key endpoints of delivery for our service of medicine and therapy. However, similar to gun violence in the US, the virulent anti-healthcare violence (AHcV) has rampaged like a type of "virus" in China for a while and is a public healthcare problem worldwide as well.

Fortunately, although we lagged behind other countries during the last century, China would now like to catch up with their counterparts in innovation and leadership in many aspects. On August 20, 2016 President Xi, Jin-Ping initiated an action against AHcV in the State Council Congress of China Central Government in that the AHcV is contrary to the health of the people.

Like or even better than the US in some aspects, we stand with our relatives, friends, colleagues and patients, and we also learn from the resilience of our community, which has demonstrated the power of a fast-responding and well-organized humanitarian movement to transform our society, our laws and our culture.

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CHECK THIS SIMPLE AND EFFECTIVE TREATMENT FOR LYMPHANGIOLEIOMYOMATOSIS

Lymphangioleiomyomatosis (LAM) is a rare disease caused by proliferation of abnormal smooth muscle-like cells (LAM cells), which can result in cystic destruction of lungs, formation of renal angiomyolipomas, lymphadenopathy, cystic lymphangiomas, abdominal lymphangioleiomyomas, chylothorax, and chyloperitoneum.

It is a low-grade metastasizing neoplasm spreading through lymphatic routs and belongs to the group of the PEComas (perivascular epithelioid cell tumours). This disease affects mainly women in childbearing age and occurs in two forms: As a sporadic lymphangioleiomyomatosis (sLAM) or associated with tuberous sclerosis complex (TSC-LAM).

The incidence of sLAM is about 3.4/ million to 7.5/million women, and it was assessed that approximately 0.3 million to 0.4 million of women with tuberous sclerosis (TSC) have a LAM.

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Hyaline-Vascular Variant Castleman Disease

A 48 year old male without any previous medical history had abdominal discomfort. On ultrasonography (US) and contrast enhanced computed tomography (CT), intra-abdominal mass located in between liver and stomach was founded.

Tumour markers including AFP, CEA, CA 19-9, CA 125, and NSE were within normal range. To figure out regional relationship between mass and adjacent structures, endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) were performed.

EUS revealed a mass separated from serosa of stomach, suspicious for gastrointestinal stromal tumour (GIST). MRI revealed a lobulated contour calcification containing solid mass, suspicious for carcinoid, hemangioma, or GIST.

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Chloroma- Myelosarcoma or Leukemic Nerve Tumor?

Following our review on leukemia and the nervous system we would like to draw your attention to a rare manifestation of leukemia termed historically chloroma (CH) or myelosarcoma, which can rarely affect the cranial nerves and the peripheral nerves.

These rare associations of leukemia and the peripheral nervous system, can occur in all stages of leukemia, as the first manifestation, as recurrence and post bone marrow transplant. Most frequently CH are seen in AML, less frequent CML, but also in OMF. They can also appear isolated, and leave room for speculations why leukemia can covert from a liquid into a solid tumor, and why the presentation can be in peripheral nerves.

Chloromas, myelosarcomas or leukemic tumors are rare and present at many sites of the body. Compared to lymphomas focal nerve lesion in leukemia are rare.

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Quality of Life and Sexual Activity after Stereotactic Hypofractionated Radiotherapy of Prostate Cancer Patients

Prostate cancer is the most prevalent solid tumor diagnosed in men in developed countries. The standard treatment for early stage prostate cancer is surgery (prostatectomy) or radiotherapy. To improve local control, the radiation dose should be escalated. Threedimensional conformal radiation treatment (3DCRT) increases local control rates while decreasing toxicity rates.

Recent data suggest that, to achieve high local control of prostate cancer with acceptable toxicity, hypofractionated radiotherapy (HRT) could be used. Short-duration HRT is an attractive option compared with a 7-to-8-week course of standard radiotherapy in terms of logistics the patient’s job, daily activities, and emotions; the availability of accelerators, and the cost of prolonged treatment.

Quality of life (QoL) has become one of the most significant issues in treatment decisions in prostate cancer. In the case of QoL measurement after radical prostatectomy, brachytherapy, or external beam radiotherapy, all types of prostate cancer treatment were shown to be associated with changes in the QoL domains related to urinary, bowel, and sexual functions.

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Carcinoma Associated Fibroblast: a Paradoxical Role in Pancreatic Cancer Microenvironment and a Promising Target for Therapy

Pancreatic cancer is a grave malignancy showing an upward trend in morbidity and mortality during the recent decades. For reasons of late diagnosis, chemo-resistance, low potential resect able rate and high post-operative recurrence rate, it has been the 6th most common cause of cancer death in China.

As one of the most aggressive malignancies and the most common type of pancreatic cancer, pancreatic ductal adenocarcinoma (PDAC) represents a significant therapeutic challenge. Conventional chemotherapeutic cytotoxic agents are proved to be with a poor survival benefit.

Though the current first-line therapy FOLFIRINOX increased the median survival time compared with gemcitabine, it has been still unsatisfactory. Another direction enlighten by the treatment experience in other tumours is targeting certain molecules that participate in specific signalling pathways mediating cancer cell proliferating, angiogenesis, chemo-resistance or metastasis.

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Preferential Localization of Iron in The Chromatin of Fe-Enriched Cells Is Linked to DNA Cleavage Sites and Control of Carcinogenesis

Iron uptake in mammalian cells has been extensively investigated and has revealed a post-transcriptional control mechanism regulating the transferrin receptor and ferritin synthesis. Cytosolic iron is strictly controlled, with most of the spare iron being stored as ferritin in a non-reactive form.

However, the distribution of cellular iron is still unresolved. In particular, little is known about iron localization in the nucleus. This is an important question, given the fact that the process of DNA oxidation by oxy-radicals is catalyzed by nuclear iron, which can produces DNA strand breaks even in the presence of physiological concentrations of hydrogen peroxide.

Nuclear iron has been found in several forms, either associated with ferritin as a heme complex that regulates gene expression, or in the nucleus in the form of iron-sulfur clusters associated with DNA repair enzymes and transcription factors.

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Eradicating Health Care Disparities in the Surgical Management of Prostate Cancer

Racial disparities in prostate cancer epidemiology and survival outcomes generally have been well documented, with assorted facts and figures indicating that African-American men are disadvantaged with regard to disease control and therapeutic gains associated with this disease relative to their Caucasian-American counterparts.

Prostate cancer is a daunting disease state for all Americans: it represents the most commonly diagnosed malignancy and the second most common cause of cancer-related deaths in the United States. However, for African-American men, the public health implications of this disease are all the more sobering: the disease incidence is 1.62-fold greater for African-American men than for Caucasian-American men and the mortality rate-ratio is 2.45-fold greater, respectively.

In blunt absolute terms, 1 in 3 African-American men will be at risk for developing clinically significant prostate cancer and as much as 1 in 5 African-American men >50 years of age will die of this disease.

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Nestin: A Biomarker of Aggressive Uterine Cancers

Cancers of the uterine corpus are the most common gynecologic cancers in the United States with incidence and mortality increasing both in the United States of America and globally. Most uterine cancers have a favorable prognosis and are cured by surgery alone.

Identifying patients at risk of recurrence, particularly those misclassified as low risk by current clinicopathologic standards is of paramount importance. Physicians need better risk stratification tools to identify when and which adjuvant therapy will decrease recurrence. Validated biomarkers with prognostic, predictive, and/or theragnostic value will likely play a vital role in advancing assessments of risk and guiding clinical management decision making.

Nestin is a class VI intermediate filament protein that was first described as a neural stem marker and regulates the TGFβ (transforming growth factor beta) pathway. It plays a critical role in cancer cell migration, invasion, angiogenesis, and metastasis both in vitro and in vivo.

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Imatinib in the Treatment of Chronic Myeloid Leukemia in Children and Adolescents is Effective and well-tolerated.

Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm typically diagnosed in adult population and relatively rare in children with incidence of 0.6-1.2/ million per year. CML is a clonal disorder of hematopoietic progenitor cells resulting from the balanced translocation called Philadelphia chromosome (Ph) at molecular level resulting in formation of a fusion gene BCR-ABL .

The BCR-ABL protein encoded by the fusion gene has an activity of tyrosine kinase and promotes uncontrolled proliferation of pluripotent stem cells in Bone Marrow (BM). CML has a three-phase course: Chronic phase (CML-CP), accelerated phase (CML-AP) and blast crisis phase.

CML is most commonly diagnosed in the CML-CP and only in about 10% of cases in advanced phases: CML-AP or CML-BC.Before the implementation of imatinib, hydroxyurea +/- interferon alpha remained the first line treatment of CML, followed by HSCT after achievement of hematologic remission. The identification of Tyrosine Kinase Inhibitors (TKI) with BCR-ABL blocking ability revolutionized the CML therapy due to pharmacological control of leukemic clone.

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Eradicating Health Care Disparities in the Surgical Management of Prostate Cancer

Racial disparities in prostate cancer epidemiology and survival outcomes generally have been well documented, with assorted facts and figures indicating that African-American men are disadvantaged with regard to disease control and therapeutic gains associated with this disease relative to their Caucasian-American counterparts.

Prostate cancer is a daunting disease state for all Americans it represents the most commonly diagnosed malignancy and the second most common cause of cancer-related deaths in the United States. However, for African-American men, the public health implications of this disease are all the more sobering: the disease incidence is 1.62-fold greater for African-American men than for Caucasian-American men and the mortality rate-ratio is 2.45-fold greater, respectively.

In blunt absolute terms, 1 in 3 African-American men will be at risk for developing clinically significant prostate cancer and as much as 1 in 5 African-American men >50 years of age will die of this disease.

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Review of Leakage from a Linear Accelerator and Its Side Effects on Cancer Patients

Cancer is becoming one of the main burdens of human being all over the world. The number of cancer patients is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development.

GLOBOCAN estimated about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. From the most recent reported statistics, cancer is becoming a major public health problem in the United States and many other parts of the world.

It is currently the second leading cause of death in the United States, and is expected to surpass heart diseases as the leading cause of death in the next few years. Radiation therapy is playing an important role for effective treatment of all kinds of tumors.

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The Utility and Applicability of Chronic Myeloid Leukemia Scoring Systems for Predicting the Prognosis of Egyptian Patients on Imatinib

Chronic myeloid leukemia (CML) is myeloproliferative clonal neoplasm with pluripotent hematopoietic stem cell origin. BCR-ABL fusion gene results from a balanced reciprocal translocation between BCR (Breakpoint cluster region) and ABL (Abelson) genes is the main finding in CML.

Transposition of ABL proto-oncogene from chromosome 9 to BCR on chromosome 22 is either at chromosome level [Philadelphia (Ph) chromosome t(9;22)(q34;q11)] or cryptic at gene level. BCR-ABL encodes an unregulated, cytoplasm-targeted tyrosine kinase, leading to uninhibited cell proliferation.

CML is a triphasic disease, chronic-phase (CP), accelerated-phase (AP), and blast-phase (BP). Most patients are asymptomatic and diagnosed in CP; most patients will progress to rapidly fatal BP within 3–5 years if untreated.

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