Resistant retinoblastoma in a 23-year-old patient

Retinoblastoma is a very rare disease in adults. We are reporting a rare case of resistant retinoblastoma in 23-year-old patient. A 23-year-old male patient presented with loss of vision in the right eye over one-month duration. Examination showed an epiretinal membrane in the right macula in addition to a white mass located inferiorly and associated with vitreous seeds. The diagnosis of retinoblastoma was established. In order to save the patients life and to preserve the eye and vision, he was treated with chemotherapy, focaltherapy, and radioactive Iodine [125] plaque therapy The tumor was resistant for treatment and recurred two years after plaque therapy, and enucleation showed well-differentiated retinoblastoma. Retinoblastoma may present in adults, and it was resistant to both chemotherapy and plaque radiation therapy in our case

Pigmented renal cell carcinoma: a case with unusual findings and review of the literature

A few cases of pigmented renal cell carcinoma have been reported in the literature so far. It has been described in both conventional and chromophobe subtypes of renal cell carcinoma. The nature of these pigmentations is consistent with melanin, neuromelanin, and lipochrome granules. We report a rare case of pigmented renal carcinoma due to the accumulation of abnormal phagolysosomal bodies, with histochemical features consistent with neuromelanin. A review of cases of pigmented conventional renal cell carcinoma in literature is also presented. Awareness of pigmentation in primary renal cell carcinoma is important in differentiating it from primary and metastatic malignant melanoma and other malignancies that can show pigmentation. Whether the presence and nature of the pigmentation has any clinical importance has yet to be established

Choroidal metastasis as the sole initial presentation of metastatic lung cancer

Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy [EBRT] is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. We present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adeno-carcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. Choroidal metastasis as an initial presentation of metastatic lung cancer is exceedingly rare, as only 30 cases have been reported. EBRT and systemic chemotherapy are effective therapeutic modalities. This case report could prove helpful to clinicians faced with a similar exceedingly rare scenario

challenges of managing glioblastoma multiforme in developing countries: a between cost and quality of care

The management of glioblastoma multiforme [GBM] in developing countries is hindered by the paucity of clear protocols due in part to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes for patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide. Retrospective case series. Charts of consecutive patients with a pathologic diagnosis of high-grade glioma diagnosed between January 2003 and December 2008 were retrospectively reviewed. We identified 146 adult patients, including 105 males and 41 females between 19 and 81 years of age [median age, 51 years], with histologically confirmed high-grade glioma. All patients underwent craniotomy. Eighty-two patients were treated with radiotherapy and temozolomide, of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide; 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months [median, 9.4 months]. The median survival for the whole cohort was 10.2 months. The median survival for the radiotherapy-alone group was 5.3 months and for combined radiotherapy/temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months compared with standard therapeutic modalities. The results compare favorably to those reported in developed nations. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients

Carcinoid tumor of the common bile duct case report and review of literature

Primary carcinoid tumor of the extrahepatic bile ducts [EHBD] is a rare tumor. A 31 year old male presented with vague right upper abdominal pain associated with jaundice and pruritus of 8 weeks duration. Abdominal ultrasonography revealed dilated biliary ducts and gall bladder, but no definite mass was identified. At operation, a mass was palpated in the proximal common bile duct [CBD] adjacent to the cystic duct junction. Microscopic examination proved the mass to be carcinoid tumor with prominent lymphovascular and perineural invasion. Immunostains were positive for chromogranin A and synaptophysin. Electron microscopy revealed electron dense granules in the cytoplasm of the cells. Metastasis in one hilar lymph node was seen. Postoperative course was uneventful. Six months later, the patient is free of the disease. Carcinoid tumor at the EHBD is described along with review of literature