Non-Hodgkin's lymphoma presenting with spiral cord compression

To describe clinical features staging, histology, treatment, functional outcome and survival of 70 patients with histologically confirmed diagnosis of Non Hodgkin's Lymphoma of Epidural Space presenting with spinal cord compression at the outset. Design: A retrospective study of 70 patients of Non Hodgkin's Lymphoma presenting with spinal cord compression seen between March, 1983 and March 1994. Setting: Dept. of Neuro-surgery, Radiotherapy Oncology and Internal medicine of Nishtar Medical College/Hospital Multan. Subjects: Seventy patients out of 825 with biopsy proven diagnosis of Non-Hodgkin's Lymphoma and presenting with spinal cord compression and having stage 1e at initial presentation and treated with chemotherapy [CT] and radiotherapy [RT] after initial decompressive surgery. There were 70 patients with a median age of 35 years. Chronic backache in all the patients and leg weakness [Paraplegia or Severe Paraparesis] in 62 patients were the commonest complaints at the time of initial presentation. 42 patients were non ambulatory. Intermediate grade type was the commonest histology [90% of cases]. Postoperative treatment included Radiotherapy alone in 11 patients, C.T. alone in 22 patients and combination of both Chemotherapy + Radiotherapy [CT + RT] in 37 patients. Out of 70 patients only 23 patients were evaluable for long term follow up and functional results. 13 patients [56%] out of 23 who had combined modality treatment C.T. + R.T. had relapse free median survival of 5 years [0.5-8years] 10 patients out of 23 who either had C.T. alone and RT alone relapsed after a median survival of 2 years [range 0.5-3years]. Functional outcome was better in 13 patients who received combined Chemotherapy + Radiotherapy [CT +RT]. Conclusions: oSpinal Epidural Non-Hodgkin's Lymphoma [S.E.L.] had younger median age i.e. 35 years. This is a significant divergence from reports in the literature. oThere is poor follow-up of patients. oCombined modality treatment i.e. with CT and RT after initial decompressive surgery appears to have improved local control and survival. oLymphoma with involvement of spinal cord should be suspected in cases of spinal cord compression and appropriate neuroimaging be performed to exclude secondary involvement

Risk factors associated with breast cancer in Pakistan

Pathologically confirmed breast cancer patients were seen between November 1982 to November 1989. The risk factors in the breast cancer population were compared with age-matched control group in our Institute and an attempt was made to compare our results with already published data. We found that Age of onset was one decade earlier than western Countries [43.5 years]; 93% married before the age of 25 years; 90% had full term pregnancy before the age of 20 years; 70% had more than 3 children; 90% had H/O breast feeding; 05% women were smokers while 25% husbands were smokers. There was no difference in the histology but breast cancer was detected one decade earlier than that found in western countries and risk factors associated with breast cancer in the western world were not playing any role in our study population

Male breast cancer in Southern Punjab

In this first report from southern region of Punjab, we present a retrospective analysis of 33 men with biopsy proven diagnosis of carcinoma of breast, who were seen and treated between January, 1981 to December, 1991. We observed that out of 922 breast cancer patients treated during study period, 33 were males showing a relative frequency of 3.6% of male breast cancer, which is significantly higher than that reported in the currently available western literature [1%]. Majority of the patients were in the older age group [Median 60 years]. Locoregional control was possible in 60% of the cases with combined modality approach using surgery, radiotherapy, chemotherapy and hormone therapy. There is significantly high relative frequency of male breast cancer in southern region of Punjab. The reasons are not yet known. Further studies are required to evaluate the problem

Non-Hodgkin's lymphoma in South Punjab [retrospective analysis of 148 patients]

In this first report from south of Punjab, retrospective analysis of 148 patients with Non-Hodgkin's lymphoma, who were seen and treated between January 1983 and December, 1987 is presented. The aim of this study was to review .the mode of presentation, clinical features and histopathology of Non Hodgkin's lymphoma in a major teaching] hospital. There was a significant divergence from currently available information from western and regional countries. Our data a illustrates that 1] there is a relatively high frequency [6.4%] of Non-Hodgkin's lymphoma as compared to western countries [2.3%]. 2] there is higher male to female ratio [4:1] in our study. 3] there is a lower median age of onset of disease [40 years]. 4] intermediate and high grade histopathological types constitute great majority of lymphomas [90.5%], while nodular lymphomas are rare [1.4%]. 5] higher frequency of extranodal lymphomas [36%]. 6] among extra nodal lymphomas intestinal lymphoma is more prevalent than gastric lymphomas - a pattern resembling that Middle East and mediterranean countries. 7] there is a high frequency [11%] of CNS lymphoma, Spinal Epidural Lymphoma [SEL] as compared to regional and western countries. 8] there is low curative potential, which may be due to bulky disease at presentation, high frequency of poor prognostic histological types, poor patient compliance to treatment due to high cost and non-avialability of drugs and poor follow-up