Liquid biopsy: A potential and promising diagnostic tool for advanced stage non-small cell lung cancer patients.

More than 50% of non-small cell lung cancer (NSCLC) cases harbor an actionable mutation, and molecular testing at different intervals can help in personalized and targeted treatment. Core tissue biopsy and needle biopsy done at the time of diagnosis/disease progression are interventional, time-consuming and can affect the patients adversely. Noninterventional biomarker testing by liquid biopsy promises to revolutionize advanced stage cancer screening. The present report was formulated based on an expert panel meeting of renowned oncologists who gave their opinions for minimally invasive liquid biopsy to detect targetable molecular biomarkers in advanced NSCLC cases. An exhaustive literature search was done to support their recommendations. Clinical utility of minimally invasive liquid biopsy, for detection of molecular biomarkers in advanced stage NSCLC patients, was broadly discussed by the key opinion leaders.

Highly elevated serum CA 125 in a lady with ascites and retroperitoneal mass--a diagnostic dilemma.

BACKGROUND: Cancer antigen 125 (CA 125), a widely used tumor marker for monitoring epithelial ovarian cancer, is also found to be raised in non-gynecological tumors and non malignant disease involving peritoneum. We report a case of non-Hodgkin's lymphoma who presented with peritoneal and pleural effusions with a very high level of serum CA 125. CASE: Fifty four years female presented with gross ascitis, bilateral moderate pleural effusions, right retroperitoneal mass and a very high serum CA 125 level (4462.60 u/ml). She was initially evaluated to rule out ovarian malignancy but her biopsy from retroperitoneal mass came out to be diffuse large B cell non-Hodgkin's lymphoma. CONCLUSION: In a female patient with ascitis with high serum CA 125 level, a differential diagnosis of lymphoma should not be overlooked unless cytology comes positive for epithelial carcinoma cells.

Febrile neutropenia in cancer patients in Kuwait: microbial spectrum and outcome.

A sample of 100 consecutive febrile neutropenic episodes in cancer patients in Kuwait was studied. Acute leukaemias (44%) and lymphomas (29%) were the most frequent underlying cancers; 21 bacteraemis (gram-positive 10, gram-negative 9, polymicrobial 2) were encountered. Staphylococcous epidermidis and Escherichia coli were the commonest organisms. Urinary tract infection occurred in 30% of the microbiologically documented cases. A total of 84 episodes responded to therapy and 9 of the 14 deaths were secondary to infection.

Human immunodeficiency virus (HIV) infection associated with acute myeloblastic leukemia in a low HIV prevalence area.

PIP: The association of acute myeloblastic leukemia (AML) and HIV infection is rare. Only eight cases had been reported of coexistence until 1990, and the association may be due to chance. HIV infection is associated with T cell immunodeficiency, however, and may contribute to the development of AML in such patients either due to defective T cell regulation of hemopoiesis and/or due to failure of immune surveillance. Previous reports have been from relatively high HIV prevalence areas. The authors report two cases of coexistent HIV infection and AML from a low HIV prevalence area found in routine screening for HIV. An 18-year-old male presented December 1991 with fever and fatigue, and a 70-year-old male presented February 1993 with cough and expectoration. Experience is limited in managing AML with coexistent HIV infection. Complete remissions have, however, been documented after low-dose cytosine arabinoside and intensive combination chemotherapy. The younger of the two patients received chemotherapy and tolerated it like HIV-negative AML patients, but succumbed to possible fungal pneumonia and intracerebral infection while in remission. The authors stress in closing that coexistent HIV infection in patients with AML may be overlooked especially in low HIV prevalence areas. Routine HIV screening of AML patients should be considered.^ieng

Gonadal function in prepubertal boys following treatment for Hodgkin's disease.

PURPOSE: Gonadal functions were evaluated in 26 male patients with Hodgkin's disease (HD), who were in continuous unmaintained remission following combination chemotherapy consisting of COPP/MOPP. MATERIALS AND METHODS: These patients had received chemotherapy during the prepubertal phase. The median duration after termination of chemotherapy was 72 months. RESULTS: Semen analysis of 18 patients showed azoospermia. Hormonal analysis showed elevated mean levels follicle-stimulating hormone (FSH) and inhibin as compared to age-matched controls, whereas luteinizing hormone levels were only marginally elevated. CONCLUSIONS: These results suggest that COPP/MOPP causes severe damage to germinal epithelium even when given during prepubertal age. Sertoli cells, which are responsible for secretion of inhibin, are resistant to these cytotoxic agents. Our data emphasize the lack of gross dysfunction of Leydig cells. It is possible that an alternative chemotherapy protocol (ABVD) may be used in young patients to minimize the gonadal damage.

High incidence of meningeal leukemia in lymphoid blast crisis of chronic myelogenous leukemia.

Fifteen patients with lymphoid blast crisis of chronic myelogenous leukemia (LyBC-CML) and five patients with acute lymphoblastic leukemia converting to Philadelphia-positive (Ph+) chronic myeloid leukemia (ALL Ph + CML) were followed. Seven of 15 (46.7%) LyBC-CML patients developed meningeal leukemia within a median period of 6 months (range 2-11 months), while there was no medullary relapse. Five of these responded well to triple intrathecal therapy. In the ALL Ph + CML patients, in spite of central nervous system (CNS) prophylaxis with IT MTX and 18 Gy cranial radiation, two of five patients (40%) experienced meningeal leukemia, one isolated and the other with medullary relapse. The data confirm that LyBC-CML patients experience a high incidence of meningeal leukemia. The role of CNS prophylaxis is not very clear, but its use may delay development and reduce morbidity due to CNS disease.

Splenic lymphoma with villous lymphocytes. Report of first 2 cases from the Middle East.

Two cases of splenic lymphoma with villous lymphocytes (SLVL) were diagnosed on the basis of marked splenomegaly, circulating villous lymphocytes, serum IgM monoclonal paraprotein and bone marrow infiltration. Immunological studies confirmed the B cell phenotype (CD19+, CD20+, CD22+ and CD5- and CD25-). Ultrastructural studies revealed characteristic uneven villi with polar predisposition. Interferon-alpha therapy in 1 patient did not result in any clinical or hematological improvement. This is the first report of SLVL from the Middle East.

Long-term right atrial catheters in patients with malignancies: an Indian experience.

Ninety-eight single lumen and two double lumen silicone right atrial Hickman/Broviac catheters inserted in 91 patients with various malignancies over a period of 36 months were prospectively studied. The average duration of use for all Hickman/Broviac catheters was 7,460 days with an average of 74.6 days. A total of 41 episodes of catheter-related infections were documented in all patients (0.5 per 100 access days). Catheter related bacteremia was the most frequent type of infection (31 out of 41, 75%). Majority of the bacteremias could be controlled with routine antimicrobial therapy. Exit site infections were seen in 5 Hickman/Broviac catheters. Two catheters had to be removed because of catheter tunnel infections. Gram negative bacteremic infections were the most common, with Pseudomonas aeruginosa being the major pathogen. Silicone rubber Hickman/Broviac catheters proved to be convenient, reliable, and easily manageable devices in our experience.

Primary lymphoma of breast--report of six cases and review of literature.

Six patients of primary lymphoma of breast are presented. All our patients were female with median age of 46 years. Combination chemotherapy was the mainstay of treatment in all the patients. Five patients achieved complete remission of which two relapsed, one had a distant relapse and the other was local. Patient with distant relapse expired after a follow-up of 224 months whereas the one with local recurrence was well controlled with radiotherapy only. The role of combination chemotherapy to decrease the distant relapse and thereby mortality is discussed.

Pure red cell aplasia and non-Hodgkin's lymphoma: a case report and brief literature review.

Pure red cell aplasia associated with lymphoproliferative malignancies other than thymoma is an uncommon occurrence. In the present paper we report a rare case of nodular non-Hodgkin's lymphoma with pure red cell aplasia who presented with symptoms related to anemia rather than the lymphoma and responded well to combination chemotherapy.

Primary endodermal sinus tumor of the penis: a case report.

We report a case of primary extragonadal germ cell tumor of the penis in a 2-year-old child with elevated serum alpha-fetoprotein. The patient responded well to a combination of bleomycin, etoposide and cisplatin, achieving a complete response within 3 cycles. He was alive and disease-free 8 months after diagnosis. To our knowledge this is the first case of an endodermal sinus tumor of the penis reported in the literature. The possible histogenesis of this tumor at such a rare site is discussed.

Ifosfamide in plasma cell leukemia: a report of two cases and review of the literature.

We report two patients with primary plasma cell leukemia (PLC) treated with a single agent, ifosfamide. One patient had a total disappearance of plasma cells (PC) from the peripheral blood and the bone marrow and disappearance of the myeloma protein, is disease free 8 months after completion of treatment, and alive 14 months after diagnosis. The second patient had a partial response with persistence of plasma cells in the bone marrow lasting 7 months, after which she had a frank relapse of the disease. We suggest that ifosfamide may be an active agent in plasma cell malignancies and needs further evaluation in multiple myeloma.

Pneumocystis carinii pneumonia in untreated acute non-lymphoblastic leukaemia.

Mixed opportunistic infection with Pneumocystis carinii and Candida prior to cytotoxic therapy in a young male diagnosed as having acute non-lymphoblastic leukaemia resulted in early catastrophe. The role of awareness of this complication and its prompt management is discussed.