Primary gastric yolk sac tumour

Primary gastric yolk tumours are extremely rare. We report a 52-year-old male who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 after having undergone a gastrectomy abroad due to a suspected poorly-differentiated adenocarcinoma. The patient subsequently returned to Oman to receive chemotherapy. However, while undergoing chemotherapy, an abdominal computed tomography scan revealed a lobulated mesenteric mass. Microscopic examination of the resected lesion confirmed a diagnosis of a yolk sac tumour. The mass was diffusely positive for á-fetoprotein [AFP] and a gastric carcinoma stain was negative. Gastrectomy slides from the patient's previous surgery were examined retrospectively. The morphology was typical for a yolk sac tumour and was negative for epithelial markers. An AFP stain showed diffuse immunoreactivity. Thus, the patient was deemed to have had a primary gastric yolk sac tumour which had later metastasised to the mesocolon. Germ cell tumour protocols were initiated and the patient responded well to treatment

Trends and outcomes of non-small-cell lung cancer in Omani patients - experience at a university hospital

Objectives: The incidence of lung cancer in Oman has shown a gradual but definitive increase since 2002. This study aimed to evaluate the demographic and epidemiological characteristics and survival outcomes of patients with non-small-cell lung cancer [NSCLC] at a university hospital in Oman

Methods: This study was conducted from January to June 2016. A retrospective analysis was performed of consecutive patients diagnosed with NSCLC presenting to the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman, between March 2000 and December 2015. Clinical features at presentation and prognostic and predictive markers were reviewed. Kaplan-Meir estimates were used to determine relapse-free survival, progression-free survival [PFS] and overall survival [OS]

Results: A total of 104 patients presented to SQUH during the study period. The median age at diagnosis was 64 years. Overall, 62 patients [59.6%] had adenocarcinomas. Only 12 patients [11.5%] presented in the early stages [I or II] of the disease and the majority of patients had an Eastern Cooperative Oncology Group performance status of 1 [27.9%] or 2 [26.0%]. The prevalence of epidermal growth factor receptor mutations was 27.9%. The median PFS for patients with advanced disease [stages III or IV] was five months and the median OS for all patients was seven months. After five years, 50.0%, 60.0%, 10.0% and 8.0% of patients with disease stages I, II, III and IV, respectively, were alive

Conclusion: Patients with NSCLC in Oman were found to present at an advanced stage. However, patient outcomes were similar to those reported in the USA

Psychosocial impact of breast cancer diagnosis among Omani women

The aim of this study was to explore different psychosocial impacts on Omani women diagnosed with breast cancer. Semi-structured individual interviews were conducted with 19 Omani women diagnosed with breast cancer to describe the impact of the disease on their personal and social life. Women were recruited from wards and out-patient clinics at the Sultan Qaboos University Hospital, Muscat. Four main themes emerged. These were: a] factors related to psychological distress of the disease and uncertainty [worry of death, interference with work and family responsibilities, searching for hope/cure, travelling overseas]; b] reactions of family members [shocked, saddened, unity, pressure to seek traditional treatments]; c] views of society [sympathy, isolation, reluctant to disclose information]; and d] worries and threats about the future [side effects of chemotherapy, spread of the disease, effect on offspring]. Breast cancer diagnosis has several devastating psychosocial impacts on women in Oman. Healthcare professionals working with women with breast cancer should be aware of the different psychosocial impacts of the disease on women's lives. Appropriate measures must be taken by the decision makers whenever needed, including enforcing positive views and support of Oman's society towards women with breast cancer

p53 mutation/deletion profile in a small cohort of the Omani population with diffuse large B-cell lymphoma

Mutations/deletions affecting the TP53 gene are considered an independent marker predicting a poor prognosis for patients with diffuse large B-cell lymphoma [DLBCL]. A cohort within a genetically isolated population was investigated for p53 mutation/deletion status. Deoxyribonucleic acid [DNA] samples were extracted from 23 paraffin-embedded blocks obtained from DLBCL patients, and subjected to polymerase chain reaction [PCR] amplification and sequencing of exons 4-9 of the p53 gene. While 35% of patients analysed displayed allelic deletions [P <0.01], immunohistochemical analysis revealed a mutation rate of 69.5%. It is noteworthy that the rate of p53 mutations/deletions in this small cohort was found to be higher than that previously reported in the literature. Interestingly, patients with p53 mutations displayed a better overall survival when compared to those without. The survival of patients treated with rituximab-containing combination chemotherapy was significantly better than those who did not receive rituximab [P <0.05]. Furthermore, a modelling analysis of the deleted form of p53 revealed a huge structural change affecting the DNA-binding domain. The TP53 mutation/deletion status plays a role in mechanism[s] ruling the pathogenesis of DLBCL and may be useful for stratifying patients into distinct prognostic subsets

Mucinous breast cancer with solitary metastasis to humeral head: a case report

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

Customised, individualised treatment of metastatic non-small-cell lung carcinoma [NSCLC]

A series of phase II and randomised phase III trials in Asia and Europe have confirmed recently that advanced stage non-small-cell lung carcinoma patients with adenocarcinoma subtypes harbouring specific mutations when subjected to targeted therapy experience equivalent survival outcomes as those treated with chemotherapy and are spared from its side effects. The concept of chemotherapy for all is fading, and therapy optimisation has emerged as a paradigm shift in treatment. This article briefly describes cellular mechanisms involved in lung carcinogenesis which provide a molecular basis for targeted therapy. Advances in molecular biology have improved our understanding of mechanisms involved in primary or secondary drug resistance. Evolving biomarkers of prognostic and predictive importance, and the impact of translational research on outcomes are also covered. A marker is considered prognostic if it predicts the outcome, regardless of the treatment, and predictive if it predicts the outcome of a specific therapy

Improving outcomes in advanced lung cancer. Maintenance therapy in non-small-cell lung carcinoma

Systemic chemotherapy has remained the traditional treatment for metastatic non-small-cell lung carcinoma [NSCLC], enhancing survival rate at 1 year to 29%. The median survival had plateaued at around 10 months until early 2008, and in an attempt to enhance survival in advanced disease, maintenance chemotherapy trials were initiated which had recently demonstrated prolongation of survival by an additional 2-3 months in patients who had performance status [PS] 0-1 and well-preserved organ functions. Suitable patients with any degree of clinical benefit are treated with 4-6 cycles, and then one of the active agents is continued until best response, or toxicity [continued maintenance], or changed to a cross non-resistant single agent [switch maintenance]. The article briefly reviews the evolution of systemic therapy and describes key randomised trials of maintenance therapy instituting chemotherapy and targeted agents in an attempt to improve outcomes in advanced metastatic NSCLC, based on certain clinical features, histology, and genetics

Synchronous bilateral endometrioid ovarian cancer and uterine adenocarcinoma in a young woman

Synchronous carcinomas involving both the ovary and uterine corpus are relatively uncommon. These tumours represent a diagnostic and therapeutic challenge, particularly if they have similar histology. Here we present the case of a 34-year-old woman with bilateral endometrioid cancers of both ovaries and adenocarcinoma of the uterus