Solid neuroendocrine carcinoma of the breast

Primary neuroendocrine carcinoma of the breast is a rare disease that accounts for less than 5% of all cancers arising from the breast. The tumour cells stain positively for chromogranin and synaptophysin. This report describes the occurrence of infiltrating ductal carcinoma of breast with neuroendocrine differentiated tumour in 37 year old female. Early small cell neuroendocrine cancer of the breast that is treated with surgery and adjuvant chemotherapy shows an increased disease-free survival. She is planned for anthracycline/cyclophosphamide based chemotherapy followed by etoposide/platinum based chemotherapy. As her tumour showed ER/PR positivity, she will be given hormonal therapy subsequently, however, more extensive review is required to define a standard treatment protocol for this rare neoplasm.

Diagnosis and treatment of Hodgkin's lymphoma: at times a challenge

Hodgkin's lymphoma has been traditionally defined as a hematopoietic neoplasm composed of diagnostic Reed-Sternberg cells. More than 70% of the cases involve cervical or supraclavicular lymph nodes. Isolated sub-diaphragmatic lymphadenopathy or organ involvement is rare. We present the case of Hodgkin's lymphoma in a 51 years old female, who presented with obstructive jaundice and lymphadenopathy, empirically treated previously as a case of tuberculosis. Chemotherapy with modified ABVD protocol was given with dose modification according to LFT's. Her liver functions returned to normal levels after the first cycle. The main purpose of reporting the case is to stress definitive diagnosis of the disease before initiating treatment and the modified chemotherapy regimen used in this infrequent presentation of the disease

Gated MIBI myocardial spect showing balanced ischemia and global hypokinesia in patient having thrombus in basal segment of dominant circumflex system blocking both left anterior descending and circumflex artery

Myocardial perfusion imaging [MPI] is a powerful diagnostic and prognostic tool for evaluating coronary artery disease [CAD]. Gating myocardial perfusion gives important diagnostic and prognostic information. This 43 years old patient was referred for cardiac scan. Exercise stress test showed > 2mm horizontal ST segment depression. Cardiac scan was normal except for left ventricular cavity dilatation on stress images. Gated images showed global hypokinesia and increased end-diastolic volume. Patient was suspected to have balanced ischemia and was referred for Angiography. Angiography showed total occlusion with no flow in proximal Left Anterior Descending Artery and distal circumflex artery. It is very important to evaluate symptomatic patients and patients with risk factors carefully with normal myocardial perfusion scan

Dual phase MIBI scintigraphy in diagnosis of parathyroid adenoma followed by ultrasound guided percutaneous alcoholic ablation

Primary Hyperparathyroidism [HPT] is an inappropriate hyper secretion of parathyroid hormone [PTH]. Primary HPT is caused by parathyroid adenoma in 80-85% of patients. Clinical manifestations are kidney stones, abdominal groans, painful bones, psychic moans, and fatigue overtones. Ultrasonography is widely used in suspected cases for localization of parathyroid adenoma. There is considerable intra-observer variation and it is difficult for ultrasound alone to differentiate parathyroid lesion form that of thyroid. Dual phase Tc-99m MIBI scinitigraphy for detection of parathyroid adenomas has sensitivity and specificity values ranging from 82% to 100% and from 89% to 100%, respectively. Percutaneous ethanol injection for parathyroid glands can be applied effectively in selected cases when surgery is unadvisable either for technical reasons e.g., recurrence of hyperplastic glands in the neck after subtotal surgery or intrathyroideal parathyroid tumors or the poor clinical state of the patient

Bone stress injuries in the army cadets of Pakistan Military Academy

Bone stress injuries are common among army cadets during training period and these injuries give rise to morbidity and loss of training hours. Some cadets with stress fractures re-join their duties while some are kept out of services resulting in attrition and economic loss. A retrospective analysis of bone stress injuries of one hundred and twenty cadets between June 2006 and Dec 2007 was conducted from the case documents available at Institute of Nuclear Medicine, Oncology and Radiotherapy [INOR] Abbottabad. The occurrence of stress fractures among cadets at Pakistan Military Academy, presenting with exercise induced pain was 68.3% amongst these cadets. Seventy fours percent f the fractures were labelled grade-I. High grade fractures were confined to tibia. Tibia was the commonest site of stress fractures in both sexes, accounting for about 73% of all stress fractures. Fifty percent of these patients were labelled as having shin splints and 3% as thigh splints. Most of the stress injuries were confined to the tibia. The referral was considered early as most of the stress injuries were of low grade