Metaplastic breast carcinoma with osteogenic component

Metaplastic breast carcinomas [MBC] are rare primary breast malignancies characterized by the co-existence of carcinoma with non-epithelial cellular elements. They can be classified as monophasic spindle cell [sarcomatoid] carcinoma, biphasic carcinosarcoma, adenocarcinoma with divergent stromal differentiation [osseous, chondroid and rarely rhabdoid] as well as adenosquamous and pure squamous cell carcinomas. Nearly all reports portrait women in their forties or older, yet younger affected females in their twenties have been reported. The usual presentation included firm painless breast mass ranging between 1.4 and 14 cm in diameter, with no evidence of loco-regional or distal metastasis. Mammary osteosarcomas are aggressive tumors with a propensity for blood-borne rather than lymphatic spread. Metastatic disease expected to develop at a mean of 10.5 and 14.5 months from the initial diagnosis and demise followed within 20 months of the onset of metastasis. MBC remains a rare entity with poor response to both chemo-radiotherapy, histological diagnosis is challenging yet it is the main stay in outlining the management. The surgical option remains the only successful current treatment in the form of simple Mastectomy to achieve negative margins sparing the patients axillary node dissection

Transport characteristics of patients on automated peritoneal dialysis may not affect their lipid profile

Introduction: End-stage renal disease patients undergoing peritoneal dialysis usually have significant hyperlipidemia. The peritoneal membrane permeability and residual renal function [RRF] may affect lipid profile in these patients

Objective: To study the correlation of lipid profile with peritoneal membrane transport characteristic and RRF as well as cancer antigen [CA]-125 in patients on automated peritoneal dialysis [APD]

Materials and Methods: The present study is a retrospective analysis of forty end-stage renal disease patients on APD. Lipid profile [total cholesterol, serum triglyceride, low-density lipoprotein and high-density lipoprotein], serum albumin and CA-125 were correlated with various peritoneal membrane transporters, assessed by peritoneal equilibration test [PET]. Lipid profile was also correlated with residual renal function and KT/V

Results: The study included 21 female and 19 male patients on APD. The duration of peritoneal dialysis was 18-70 months. There was no significant difference in lipid profile at baseline and at one year in patients with different peritoneal transporter status. There was no correlation between lipid profile and residual renal function as well as CA-125

Conclusion: The findings suggest that there is no relation of lipid profile with peritoneal membrane transporter status and residual renal function in patients maintained on automated peritoneal dialysis

Cellular and molecular responses of Saudi chronic myeloid leukaemia patients to imatinib (sti-571): ten year experience

The cyto-genetic hallmark of chronic myeloid leukaemia [CML], the Philadelphia chromosome [Ph], is the first consistent chromosomal abnormality that has been associated to a certain cancer type. In CML, Philadelphia chromosome is present leading to resistance to cell death and rapid proliferation. The aim of this study is to evaluate the different responses, toxicity and survival of Saudi CML patients to imatinib mesylate. All newly diagnosed CML patients who were treated with imatinib were included in this study. We investigated haematological, and molecular and cytogenetic responses by CBC, FISH and RT-PCR respectively. Cell proliferation and apoptosis were assayed using AUC and TUNEL respectively. Of the 12 cases, 9 [75%] were males and 3 [25%] were female. Four [33%] of the cases were diagnosed incidentally and 8 cases [67%] presented mainly with fatigue [75%], fever [58%], and splenomegaly [83%]. Signs of bleeding and rashes were rare at presentation. The majority of patients had low risk [8, 67%], and 33% had intermediate risk; but none of them had high risk CML. At the last follow up, 11 [92%] were in remissions. One patient [8%] was in remission after 3 years, 4 [33%] were in remission after 6 years, one was in remission after 7 years and 5 [42%] were in remission after 10 years. Only one patient had incomplete major molecular response [MMR] to imatinib after 12 years. The majority of the patients [10, 83%] were in MMR after 6 years and 42% of them were in MMR after 10 years of therapy. Adverse effects of imatinib were not reported by the patients. Imatinib treatment resulted in the reduction of proliferation and induction of apoptosis of CML CFU-GM cells. Imatinib mesylate is capable of treating Philadelphia chromosome-positive CP-CML without any adverse effects.

Castleman disease

Castleman and Towne described a disease presenting as a mediastinal mass resembling thymoma. It is also known as "giant lymph node hyperplasia", "lymph node hamartoma", "angiofollicular mediastinal lymph node hyperplasia", and "angiomatous lymphoid hyperplasia". The pathogenesis is unknown, but the bulk of evidence points toward faulty immune regulation, resulting in excessive B-lymphocyte and plasma-cell proliferation in lymphatic tissue. In addition to the mediastinal presentation, extrathoracic involvement in the neck, axilla, mesentery, pelvis, pancreas, adrenal gland, and retroperitoneum also have been described. There are 2 major pathologic variations of Castleman disease: (1) hyaline-vascular variant, the most frequent, characterized by small hyaline-vascular follicles and capillary proliferation; and (2) the plasma-cell variant, in which large lymphoid follicles are separated by sheets of plasma cells. The hyaline-vascular cases usually are largely asymptomatic, whereas the less common plasma-cell variant may present with fever, anemia, weight loss, and night sweats, along with polyclonal hypergamma-globulinemia. Castleman disease is a rare lymphoproliferative disorders. Few cases have been described world widely. In this article we reviewed the classification, pathogenesis, pathology, radiological features and up to date treatment with special emphasis on the role of viral stimulation, recent therapeutic modalities and the HIV-associated disease.

Attitudes of Saudi medical students toward the disclosure of information on cancer in eastern Saudi Arabia

To assess the attitude of future physicians regarding the disclosure of diagnosis, prognosis, benefits, and adverse effects of therapeutic intervention if they happen to have cancer. It also examined the differences if any between regions or gender. A total of 332 medical students from University of Dammam, in the Eastern Province of the Kingdom of Saudi Arabia were surveyed using a self-administered questionnaire. The questionnaire consisted of nine questions on the attitudes to disclosure of information on cancer. This self-administered questionnaire was completed by the students in the presence of an investigator. The vast majority of Saudi medical students stated that they would like to know about diagnosis of cancer [92.8%] and only 7.2% wanted information withheld from them. Further, 67% of the males and 74.1% of the females wanted family members to know [P = 0.01], but one-third [33%] did not want their family to know. Only 24.1% of the male and 21.1% of female students wanted their friends to know. In addition, -97% of the males and 98.8% of the females wanted to know the diagnosis, and 97% and 95.8% of females and males, respectively, would like to know the side effects of the therapy. Almost 95% of male and 93.4% of female students wanted to know the prognosis. Also, 98% of medical students from the Eastern Region would want the diagnosis of cancer to be disclosed compared to 73.6% of those from other regions [P = 0.01]. There is no difference between the genders in attitudes toward the disclosure of the diagnosis, 94.6% and 92.2% [P = 0.38]. There was a consensus among Saudi medical students on the knowledge of the benefits of treatment, adverse effects of therapy, and prognosis. Female students significantly more than males would like their families to be informed. Significantly more medical students from the Eastern Region than those from other regions would like the diagnosis of cancer to be disclosed

Long-term survival of gastric adenocarcinoma without therapy: case report

Planning for treatment of gastric adenocarcinoma in a patient previously treated with partial gastrectomy for primary gastric lymphoma is difficult. Long term survival of advanced gastric adenocarcinoma is poor with therapy and even worse without treatment. The only potentially curative treatment for gastric adenocarcinoma is surgical resection with adequate margins. Palliative surgery ameliorate symptoms in about 50% of patients Chemotherapy may play a lesser role. This report presents a case of gastric adenocarcinoma in a patient who had primary gastric lymphoma treated with partial gastrectomy. The patient is still alive 6 years after diagnosis with no signs of progression despite the fact that no active treatment was given

Prevention of breast cancer

The best therapy for cancer is prevention. Primary prevention involves health promotion and risk reduction in the general population so that invasive cancers do not develop. These primary preventive measures include the cessation of smoking, lifestyle and diet modification, vitamins and micronutrients supplementation. Identification of genetic risk, understanding of carcinogenesis, development of effective screening tools, avoiding risk factors and effective chemoprevention can lead to decreased morbidity and mortality of cancers in general and more importantly breast cancer. Secondary prevention is the identification and treatment of premalignant or subclinical cancers. Screening by means of mammography is a typical example of secondary prevention. Tertiary prevention is defined as symptoms control and rehabilitation. These definitions may become less useful in the future as they do not account for the new incoming data such as molecular data