Evolution of colorectal cancer in schistosomiasis

Aim: To define the clinico-pathologic character of schistosomiasis mansoni associated colorectal cancer [S.CRC] and the possible carcinogenic relation of Schistosoma mansoni [S.M]

Methods: This study included 176 patients with colorectal cancer associated with S.M. Their clinical database and surgical pathology sheets were documented with the detection of S.M on stool analysis, serologic tests, pathologic associated lesions and tumor P53 protein expression using immuno-cytochemical assay

Results: Sixty eight patients [40%] with S.CRC were below 40 years with male predominance [1.8 - 1], distal CRC predominance in 109 patients [62%], mucinous type in 58 patients [33%], higher grades II, III in patients [79%], with significant angio-invasion in 50 patients [30%], lymph vessels invasion in 50 patients [35%] and perineural invasion in 17 patients [10%], associates with poor immune response in 8 patients [5%], preceded with schistosomal lesions especially in patients with schistosomal colitis >/= 10 years, associates with TP53 in 114 cases [65%] and presented at advanced stages in 99 cases [56%] with only hepatic metastasis in 28 cases [90%]

Conclusion: S.CRC is a special clinical entity that has all pathologic pattern, bad biologic behavior and the SM is implicated in SCRC progression

Can mobilized unprocessed whole blood replace leukapheresis product for autologous peripheral blood stem cell transplantation in patients with lymphoma? implementation of pre-apheresis CD34 analysis

High dose chemotherapy [HDC] with peripheral blood stem cell transplantation [PBSCT] is increasingly used therapeutic option for patients with hematological malignancies. This requires leukaphresis and cryopreservation of at least 1-2 x 10 [6]/kg CD34+ cells. As the leukapheresis procedures is expensive, time-consuming, and involve several technical and psychological problems for the patients. The aim of this study was to develop a simplified, safe, and cost effective peripheral blood stem protocol for collection of at least 1-2 x 10 [6]/kg CD34+ stem cells with liquid preservation at 4°C which may be suitable for patients refusing leukapheresis or in areas lacking cryopreservation facilities. Patients and Twelve patients with relapsed lymphomas underwent stem cell mobilization with rhG-CSF subcutaneous 10 ug/kg/day for 5 days. At the day of stem cell harvest white blood cells [WBCs], mononuclear cells [MNCs] and CD34+ cell count were estimated from peripheral blood. According to absolute count of CD34+ cells in the peripheral blood, CD34+ cells in 1000 ml blood and/patient kg were calculated. Patients with CD34+ cells < 1 x 10 [6]/kg, leukapheresis was performed, while extraction of 1000 ml mobilized whole blood by 2 phlebotomies was performed for patients with calculated CD34+ cells > 1 x 10 [6]/kg. Six patients were candidate for whole blood collection by phlebotomy with liquid preservation while leukapheresis and cryopreservation were necessary to reach the target stem cell dose for another 6 patients. Hematological recovery after high dose chemotherapy was compared between both groups. Pre-apheresis MNCs, and CD34+ cells count were higher in six patients candidate for leukapheresis than patients candidate for unprocessed mobilized whole blood collection [27.7 +/- 3.4 x 10 [9]/L, and 26.6 +/- 6.9 x 10 [6]/L] versus [39.5 +/- 5.7 x 10[9]/L, 89.8 +/- 21.9 x 10 [6]/L] respectively and this difference was statistically significant [p < 0.01 and 0.001] respectively. The apheresis product and collected mobilized unprocessed whole blood both exceed the minimum target cell dose for auto transplantation. The patients with leukapheresis received product contained more MNCs and CD34+ cells [2.9 +/- 0.3 x 10 [8]/kg and 2.15 +/- 0.5 x 10 [6]/kg] higher than patients received collected mobilized whole blood [2.6 +/- 0.4 x 10 [8]/kg and 1.28 +/- 0.3 x 10 [6]/kg] respectively and this difference was statistically significant for CD34 [p < 0.01]. There was non significant difference between patients who received apheresis products for neutrophil and platelets recovery [p > 0.07 and 0.057], where the days to reach ANC >/= 0.5 x10 [9]/L was 10.3 +/- 1.5 [8-12] days and for platelet >/= 20 x10 [9]/L was 11.3 +/- 3.01 [7-15] while patients received whole blood the ANC was 12.3 +/- 1.9 [9-16] and for platelets was 16.0 +/- 4.3 [8- 20] days but this was statistically non significant. In some patients with CD34+ cell count more than 65/uL measured in peripheral blood at the day of stem cell collection and if the total CD34+ cell/kg count in one liter blood exceed target stem cell dose of 1 x 10 [6]/kg, mobilized unprocessed whole blood collected by phlebotomy with liquid preservation can replace leukaphresis product for stem cell autotransplantation. The mobilized unprocessed whole blood with liquid preservation was able to reconstitute bone marrow after HDC like cryopreserved mobilized PBSC with lower cost and effort

Evaluation of different treatment modalities in dukes B and C rectal adenocarcinoma

A retrospective analysis of 291 eligible patients with carcinoma of rectum and rectosigmoid was undertaken. The patients were assigned to one of four treatment groups: Preoperative chemoradiotherapy [CRT], followed by postoperative chemotherapy [POCT], postoperative radiotherapy [PORT], postoperative chemotherapy [POCT] and postoperative CRT. The results showed that with a median follow up of 57.2 months, the 5-year overall survival was 47.8%, the 5-year DFS was 42.4%. The 5-year OS was 48.3% in the preoperative CRT group, 42.4% in PORT group, 34.3% for POCT group and 55% in the POCRT group. The 5-year DFS was 44.8%, 39.4%, 31.5% and 50% in the four treatment groups, respectively. Local failure [LF] occurred in 14.1% of the patients and distant metastasis [DM] was observed in 28.9%

strategy of wide local excision followed by postoperative radiotherapy in adult rhabdomyosarcoma: is it worthwhile?

This study was done on 20 patients with adult rhabdomyosarcoma of lower extremities. They were subjected to careful history taking, general and local examination. Investigations were done to confirm the diagnosis and to be sure that there was no distant metastasis. They included biopsy [Tru-Cut, incision and excision], plain X-ray chest, computed tomography [CT] chest, bone scan and magnetic resonance imaging [MRI] on the tumor area. The preoperative investigations included complete blood picture, liver functions, serum creatinine, blood sugar and ECG. Operation was done in the form of wide local excision [conservative surgery or limb salvage technique]. Radiotherapy was applied at the tumor area after surgery in the form of 6000 rad divided on six doses over six weeks. A long-term follow up for two years was done regarding local recurrence, distant metastasis and other complications

Skeletal metastasis in hepatocellular carcinoma

During the period from 1979 to 1989 inclusive, 128 patients with hepato-cellular carcinoma were treated at Mansoura University Hospital. The most common site for metastasis was the lung 26.6% [34/ 128]. Bon metastasis was present in 10.9% [14 / 128] of these patients. 80% of patients with bone metasis survived not more than 6 months. Bone metastasis was mainly in vertebra 79% [11 / 14], followed by rib metastasis in 43% [4 / 14]. The radiologic features were mostly lytic, destructive with cortical erosion and frequent expansion into the soft tissues. Two patients with bone metastasis showed also long metastasis. The infrequency of bony metastasis in hepatocellular carcinoma and the possible route of spread will be discussed

Study of different palliative fractionation schedules for relief of pain due to ossus metastases from cancer breast

This work studied the correlation between pain relief and other factors, such as type of metastases, schedules, for 91 patients with cancer breast and having bone metastases. It was found that the single massive dose causes immediate pain relief than short or protracted fractionated dose, but it causes severe morbidity and rapid pain recurrence, while the late results in the cases treated by fractionated doses are better. The choice of the optimal radiation does not depend on single factor, but on many associated factors, which are intimately related to each other such as suspected life span of the patient, number of metastases and site of metastases

Study of the patterns of recurrence in cancer breast after treatment

199 cases with breast cancer were analyzed from the year 1987 to 1982 inclusive. 122 out of total cases demonstrated recurrence after surgery +/- postoperative radiotherapy, +/- chemotherapy. The recurrent cases were frequently seen in middle and older age groups and in postmenopausal class of patients [75.86%]. Most of cases with recurrence were noticed in patients with primary 5 cm [56.56%]. Most of cases with recurrence were noticed in patients with primary 5 cm [56.56%]. Moreover, most of the recurrences were associated with advanced clinical stage [65.76%], cases with infiltrating duct carcinoma [81.15%], and cases with high incidence of positive axillary node involvement [90.09%]. The most common site involved by recurrence was the chest wall. It was concluded that, early detection and treatment of cancer breast are m and atory to improve the results and increase curability of this serious disease