Accuracy of preoperative imaging in predicting optic nerve invasion in retinoblastoma: A retrospective study

Purpose: Optic nerve invasion is an important cause of mortality in retinoblastoma. We aimed correlate preoperative imaging and surgical histopathology findings in enucleated eyes with retinoblastoma to determine the efficacy of preoperative imaging in predicting optic nerve invasion in retinoblastoma. Methods: A retrospective review of records of all patients undergoing primary enucleation for retinoblastoma at a tertiary eyecare system between March 2013 and December 2017 with all patients having undergone preoperative imaging, either CT scan or MRI. Data was analyzed statistically to determine the correlation between preoperative CT scan/MRI and histopathology. Results: Totally, 97 eyes of 97 patients were included in the study who underwent primary enucleation for unilateral retinoblastoma. The average age at presentation was 27.8 months with the chief complaint being leukocoria in all the cases. 14 patients (14.43%) had evidence of optic nerve involvement in preoperative imaging. 30 patients had optic nerve invasion on histopathology (laminar and retrolaminar). Spearman's rank correlation test revealed a significant correlation between MRI findings and HP and an insignficant correlation between CT findings and HP. The CT scan had a sensitivity of 20%, specificity of 88.89%, 50% positive predictive value and 66.67% negative predictive value. MRI had a sensitivity of 40%, specificity of 93.55%, positive predictive value of 66.67% and a negative predictive value of 82.86%. Conclusion: MRI showed significant moderate correlation with surgical histopathology for predicting optic nerve invasion in retinoblastoma whereas CT shows insignificant correlation with HPE. Therefore, we recommend MRI for predicting optic nerve invasion in cases of retinoblastoma.

Breaking Survival Barriers In Breast Cancer- A Case Of Cns Metastasis

One in every eight women worldwide will be diagnosed to be suffering with breast cancer in their lifetime. It is vital not only to diagnose the disease early but also to refer it to a tertiary care center for the most appropriate or standard anti-cancer treatment without delay. The outcomes of such therapy can be a game changer for the patient. Screening mammography is only having a small reduction in mortality of breast cancer. Here, we present a clinical report of one patient who had Her2 Neu positive disease with early central nervous system (CNS) metastasis and responded extremely well to anti her2 Neu therapy with chemotherapy and has survived over six years now on treatment

Valproate-induced hyperammonemic encephalopathy with normal liver function.

Hyperammonemic encephalopathy with normal liver function is an uncommon serious adverse effect of valproate therapy. We retrospectively analyzed the case records of 5 patients of epilepsy on valproate with hyperammonemic encephalopathy. Of the 5 patients, 3 were on monotherapy. The mean valproate dose was 1250 mg/day and the duration of therapy ranged between 4 and 90 days. Alteration in the sensorium was the presenting clinical feature. The risk factors included high initial dose (2), long-term valproate therapy (1), and long-term valproate therapy with concomitant topiramate (1). There was good correlation between the fall in serum ammonia levels and clinical improvement. Hyperammonemic encephalopathy should be suspected in patients on valproate with altered sensorium. Response to treatment is rewarding.

Coexisting carcinoma and tuberculosis of stomach.

We report a rare association of carcinoma and tuberculosis of the stomach. It is difficult to explain the simultaneous occurrence or a causal relationship of the two diseases.