ABSTRACT
Background: Managing a brain tumor during pregnancy is a highly confusing and challenging situation, complicated by several technical, medical, ethical, and sociocultural concerns. The interests of the mother and child are often pitted against each other, for which legal opinion may occasionally be needed. Case Report?We present the report of a young lady with intracranial well-differentiated chondrosarcoma who was determined to be pregnant in the immediate postoperative period. We discuss the management of challenges and dilemmas in devising optimum therapy, and the modifications and care required at each step to help safeguard maternal and fetal health. Risks with therapeutic radiation and measures to assess and pre-empt fetal doses that may assist decision-making are also discussed. Conclusion?Radiation therapy during pregnancy is challenging and requires multidisciplinary involvement and psychosocial support for the patient and family.
ABSTRACT
Context: Gastric adenocarcinoma (GAC) is a common malignancy with high mortality-rate. Analysis of molecular markers could form a foundation for the future use of targeted therapies to reduce morbidity and mortality. Aims: To fi nd the prevalence and relation of epithelial cadherin (E-cadherin) and human epidermal growth factor receptor 2 (HER-2/neu) protein expression with histological type and grade of GAC using immunohistochemistry (IHC). Materials and Methods: A total of 100 cases of GAC diagnosed over a 2 year period were studied. Expression of E-cadherin and HER-2/neu was analyzed by IHC in relation to the histological type and grade. Results: Of the 100 cases of GAC studied, 11 revealed a loss of E-cadherin and over-expression of HER-2/neu was seen in 17 cases. Loss of E-cadherin was seen in 50% of signet ring-cell carcinomas but only in 8% of tubular and none of papillary and mucin-secreting GAC (P = 0.003). Of all the cases of tubular GAC with loss of E-cadherin expression, majority (71.4%) were Grade III (P = 0.04). Of all the tubular GAC cases with an over-expression of HER-2/neu, 20% and 67% were Grade I and II GAC respectively while only 13% were Grade III (P < 0.001). Conclusions: Although poorly-differentiated tumors show loss of E-cadherin, better-differentiated tumors over-express HER-2/neu protein. Signet ring-cell carcinoma is more likely to exhibit a loss of E-cadherin protein. Targeted therapy toward HER-2/neu in GAC should be considered. Novel therapy to block E-cadherin down-regulation is justified.
ABSTRACT
Acanthamoeba species are free-living amoebae that are the causative agents of chronic granulomatous meningoencephalitis, amoebic keratitis, pulmonary lesions, cutaneous lesions and sinusitis. Immunocompromised individuals are particularly susceptible to infections with Acanthamoeba, which can be disseminated at times. We herewith report the autopsy findings of disseminated Acanthamoeba infection in a 36-year-old female, a renal transplant recipient on immunosupressants for last four years. Central nervous system showed Acanthamoeba associated chronic granulomatous meningoencephalitis, with predominant perivascular infiltrate of amoebic cysts, trophozoites and inflammatory cells. Both lungs and pancreas also showed infiltration with Acanthamoeba.