EGFR mutation testing in non-small cell lung cancer [NSCLC]

Lung carcinoma is subdivided into small cell carcinoma and non-small cell carcinoma [NSCLC]. NSCLC is heterogeneous group of carcinomas and accounts for 70-80% of lung cancer. NSCLC is further divided into adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Activating somatic mutations of the tyrosine kinase domain of epidermal growth factor receptor [EGFR] have recently been characterized in a subset of patients with non-small cell lung cancer [NSCLC]. These mutations involve exons 18, 19, 20 and 21. Patients harboring these mutations in their tumors show good response to EGFR tyrosine kinase inhibitors [EGFR-TKIs]. The aim of this manuscript is to provide an overview of EGFR mutations in NSCLC as well as to briefly discuss sample requirements and testing guidelines for EGFR mutation.

Bronchiolitis obliterans organizing pneumonia: experience at three hospitals in Riyadh

Because reports of bronchiolitis obliterans organizing pneumonia [BOOP] are lacking from the Middle East, we conducted a retrospective review of all histopathologically proven cases of BOOP over a 10-year period at three tertiary care hospitals in Riyadh and describe the clinical features and outcome. Charts at the three hospitals were searched using a specific code for BOOP or cryptogenic organizing pneumonia [COP]. Lung specimens had to show histological proof of BOOP with a compatible clinical picture. Chest radiographs and high-resolution CT scans were reviewed. Twenty cases of biopsy-proven BOOP had well-documented clinical and radiographic data. There were 11 males and 9 females [mean age, 58 years; range, 42-78]. The clinical presentation of BOOP was acute or subacute pneumonia-like illness with cough [85%], fever [70%] dyspnea, [85%] and crackles [80%]. The most frequent radiological pattern was a bilateral alveolar infiltrate. The most common abnormality on pulmonary function testing [n=14] was a restrictive pattern [11 patients]. Most patients [70%] had no underlying cause [idiopathic BOOP]. Other associations included thyroid cancer, rheumatoid arthritis, syphilis and Wegner's granulomatosis. Ten patients [50%] had a complete response to steroids, 6 [30%] had a partial response and 3 [15.8%] with secondary BOOP had rapid progressive respiratory failure and died. The clinical presentation of BOOP in our patients is similar to other reported series. A favorable outcome occurs in the majority of cases. However, BOOP may occasionally be associated with a poor prognosis, particularly when associated with an underlying disease

Grading of follicular lymphoma using flow cytometry

The treatment and prognosis of follicular lymphoma [FL] is dependant on the grade of the disease. In the World Health Organization classification of lymphoma, grading of FL into low grade [1 and 2] and high grade [3] is recommended. Grading of FL is possible in excision biopsy; histological grading is subjective and inconsistent Grading is extremely difficult in needle core biopsies and fine needle aspirates. We attempted to grade FL using flow cytometry [FCM] and CD 19/forward scatter. Cases of FL seen in our institution and submitted for FCM were evaluated for the percentage of cells detected beyond the 500-channel mark [on a 1024 scale] on a CD19/forward scatter dot plot. We hypothesized that these cells most likely represent centroblasts and their percentage would reflect the grade of the disease. Histological grading of the lymphoma on the open biopsies constituted the reference for FL grade. Thirty-six cases of FL, including 22 males and 14 females, ranging in age from 19 to 92 years [median, 42 years], were studied. There were 17 cases of low grade [grade 1; n=10 and grade 2; n=7] and 19 cases of high grade [grade 3] FL The percentage of cells identified beyond the 500-channel mark on CD19/forward scatter dot plot ranged from 0.12% to 12.55% [median, 4.9%] in low grade [grade 1 and 2] whereas the percentage of those cells in high grade FL ranged from 6.22% to 51.95% [median, 21%; p=0.00001]. Our findings suggest that using a CD19/forward scatter dot plot can help identify centroblasts in FL making grading possible on FCM, especially in small biopsies and fine needle aspirates

case of vitamin D deficiency masquerading as occult malignancy

At present, the diagnosis of a [brown tumor] is a clinical curiosity. It is considered to be a complication of severe and rapidly progressive hyperparathyroidism [HPT]. Indeed, such a presentation is typical of a patient harboring a parathyroid carcinoma. The incidence of brown tumors is 3% in the benign form of primary hyperparathyroidism [1]. In secondary HPT, the incidence of brown tumors is under 2% and is caused by chronic renal failure.[1] Brown tumors are locally destructive lesions consisting of fluid-filled cysts that are rich in highly vascularized fibrous tissue containing hemorrhagic spots. Blood pigment [hemosiderin] will accumulate, which imparts a reddish-brown hue and hence the name [brown tumor].[1] Brown tumors are demonstrated radiologically as lesions of osteitis fibrosa cystica [1]. We describe a young lady who was erroneously diagnosed elsewhere as a case of metastatic bone disease. Our evaluation documented this as a case of vitamin D deficiency [VDD] causing secondary hyperparathyroidism [SHPT] with diffuse distribution of brown tumors in her skeleton. Following vitamin D and calcium treatment, the patient improved