Non surgical treatment of sacral osteosarcoma

Osteosarcoma may rarely originate from the axial bones such as pelvis or vertebrae. In some pelvic and most vertebral primary tumors, resection often is not possible completely. In general, these tumors cannot be resected with negative margins so they need additional radiotherapy and chemotherapy, but results are unfavourable because of poor local control and high incidence of distant metastases. This is a case report of sacral osteosarcoma which was treated successfully with chemotherapy and radiation therapy. The patient is a 14-year-old boy with a large osteosarcoma tumor in the first sacral vertebral body, with extra skeletal extension. The patient took radiotherapy [6000 centigray] plus chemotherapy regimen consisting of doxorubicin and cisplatin. In the last follow up 48 months later, the patient was completely asymptomatic with normal performance and there was not any evidence of local progression or distant metastasis

[ rare case of primary orbital yolk sac tumour [YST]]

The endodermal sinus tumor [EST] or yolk sac tumor [YST] is a malignant germ cell neoplasm that usually arises in gonads, but on rare occasion occurs in extragonadal sites such as mediastinum, retoperitoneum and intra cranium. Orbit is an extremely rare location for this tumor. In this report a primary yolk sac tumor in the orbit of a 17 months old child is presented. Patient had a rapidly progressive proptosis and high level of serum alpha fetoprotein [12500 IU/ml]. After surgical biopsy and histopathological diagnosis, the patient treated with 4 courses of a 3 drugs chemotherapeutic regimen. A period of 6 months follow up did not reveal any sign of recurrence. Although yolk sac tumor is very rare in orbit, a rapid and correct histopathological diagnosis in conjuction with immunohistochemical and other paraclinical evaluation and at last, effective chemotherapeutic regimens can provide a good prognosis and even cure for the patient

[Comparing the prevalence of mast cells out the stroma of basal cell carcinoma and control group]

Basal cell carcinoma is the most frequently observed neoplasm of human skin. Many genetic and environmental factors contribute to pathogenesis of skin. It is shown that mast cell-derived histamine is an important mediator of systemic immunomodulation caused by UVB. The aim of this study was to compare the prevalence of dermal mast cells in BCC patients and control subjects with not inflammatory lesions in sunlight exposure site. Biopsy samples from sun-exposed skin were obtained from 40 BCC patients and 10 control subjects. Histological sections were prepared using H and E and Giemsa stains. Mast cells were counted in the whole specimen and mean number of mast cells per high power field [x40] was determined. We found a significant increase in the number of peritumoral mast cells comparing those in control group. [p< 0.001, student t-test] No significant association was found between the frequency of mast cells and age or gender. The association between high dermal mast cell prevalence and BCC development support for the concept that mast cells may be important to UVB-induced systemic immunosuppression in human. The results can be used as the baseline for future studies and development of new methods for medical treatment leading to prevention, suppressing the development and invasion, or eventually elimination of the tumor

[Epithelial mesothelioma with desiduoid features a case report]

Deciduoid mesothelioma is an unusual morphologic variant of epithelial mesothelioma that closely simulate peritoneal decidusis, florid mesothelial hyperplasia and peritoneal metastatic carcinoma. We reported a rare case of epithelial mesothelioma with deciduoid features in a 12 years old girl with abdominal tightness and swelling and weight loss without history of asbestos exposure. CT scan and Sonography showed severe ascitis and multiple masses in peritoneal cavity. In the time of surgery very much fluid was evacuated and a multicystic huge mass occupying the pelvis was resected. In histopathologic examination malignant desiduoid epithelial neoplasm with psammoma bodies was seen which cells were positive for Vimentin, Cytokeratin, EMA, Calretinin

Chronic meningitis in acute promyelocytic leukemia [a case report]

The occurrence of extramedullary disease [EMD] at presentation or at relapse has long been considered a rare event in Acute Promyelocytic Leukemia [APL]. Our purpose from recent reports of EMD at presenting in APL have raised increasing concern about one of causes of chronic meningitis. This study describe a case of acute promyelocytic leukemia [APL] in 25 years old female patient admitted in Emam Reza hospital, presenting with severe headache and vomiting and showed signs of meningeal irritation as well as papilledema. Cytocentrifuge examination of CSF showed an excess of promylocytes, but peripheral blood didn't show any abnormal cell or blasts where as BMA showed increase of promyelocyte with multiple auer rod. After 2 weeks of aleukemic phase, this patient developed hematologic picture of APL diagnosed myeloid origin cells with myelopperoxidase stain. She was diagnosed as having leukemic meningitis and after 3 weeks in spite of chemotherapy, she dead Leukemic relapse or first presentation of leukemia may be the etiology of aseptic meningitis. Rarely central nervous. system leukemia and leukemic meningitis are associated with normal bone marrow and sometimes patients at Aleukemic phase present with meningitis. therefore we suggested that in patients with aseptic meningitis cerebrospinal fluid cytospine smear should be evaluated for neoplasic and leukemic cells

Frequency of macroprolactinemia in hyperprolactinemic patients with simple polyethylene glycol precipitation test

Hyperprolactinemia is seen not only in pregnancy but also in several pathological conditions, However, some patients with hyperprolactinemia are diagnosed as idiopathic, because the causes are unknown. They are subjected to repeated radiological examinations to find a microadenoma, to a long term treatment with bromocriptine, and even to a surgical intervention. There is evidence that macroprolactinemia, in which most circulating PRL form large protein complexes [>150 KDa], is a major cause of idiopathic hyperprolactinemia. Macroprolactinemic patients are clinically characterized by lack of or less hyperprolactinemia - related symptoms. The objective of this study was to assess the prevalence of macroprolactinemia in hyperprolactinemic patients. Prolactin was measured before and after precipitation of macroprolactin by polyethylene glycole in 113 hyperprolactinemic [PRL>28 micro g/L patients. In 23% of the patients, macroprolactinemia was found. Considering the high prevalence of macroprolactinemia and to avoid diagnostic and therapeutic pitfalls, the screening for macroprolactinemia in all hyperprolactinemic patients is recommended

[ role of HbA1c in the diagnosis of gestational diabetes mellitus]

Gestational Diabetes Mellitus GDM is the most common metabolic disorder during the pregnancy with numerous fetal an maternal complications.It seems that the frequency of GDM is increasing so it necissitates a greater attention and more study in this field. The aim of this research is to find an alternative or at least an adjuvant method for diagnosis of GDM which is traditionally made by the time consuming and cumbersome 3 hour oral glucose tolerance test. This research is a prospectively designed study on pregnant women who were in the 24[th] to 32[nd] week of gestation. The main purpose of this study is to defining the role of HbAlc [HPLC method] in the diagnosis of GDM in comparison with the 3 hour Glucose Tolerance Test [GTT], according to carpenter- coustan criteria. 105 cases with a mean age of 29 years and an age range of 18 to 50 years were in the following groups:43 persons normal,15 had impaired glucose tolerance [IGT] and 47 were in GDM group, range of HbAlc [mean +2SD] in these three groups were:%3.66%5.8,%2.81-%7.45 and%2.79-%8.91 respectively. There was a significant difference [p-value<0.05] between the means of HbAlc in normal, IGT, and GDM groups but due to the wide range of variations in persons with GDM, it wasn't possible to determine a suitable lower cutoff and only the upper cutoff of%5.85 for discriminating patients with GDM from other groups especially normal persons was achieved. This cutoff was able to diagnose%38 of GDM without any normal one [no false positive result]. The most correlation exists between HbAlc with GTT3hour [r = 0.55] and fasting blood glucose [r = 0.504]. Using the upper cutoff of%5.85 for HbAlc is able to discriminate persons with GDM who have higher than this value from normal ones, but due to the wide range of variations in lower values in person with GDM and overlapping of it with the normal values,there is not a suitable lower cutoff [with high specificity and sensitivity]