Synchronous primary adenocarcinoma of the appendix and colon: Case report and literature review.

INTRODUCTION: Primary adenocarcinoma of the appendix (PAA) is rare with fewer than 300 cases reported from 1882 Up to 2004. Synchronous occurrence of PAA with a second primary colonic carcinoma is even more unusual. Literature review shows a total of 40 reported synchronous cases in the English literature from the first case reported in1947 up to 2017. Hereby, an additional case is presented, which is the first case reported in Jordan. PRESENTATION OF CASE: A 39-year-old woman presented in October 2016 with persistent right lower quadrant abdominal pain diagnosed clinically as acute appendicitis. Abdominal computed tomography showed an oval shaped 3 × 3.4 cm mass at the sub-hepatic region, associated with increased attenuation of surrounding mesenteric fat and multiple enlarged lymph nodes. Three days later, a right hemicolectomy was carried out. A diagnosis of invasive primary adenocarcinoma of the ascending colon with an incidental, microscopic primary adenocarcinoma of the distal part of the appendix was reported. DISCUSSION: Primary appendiceal adenocarcinoma is rare pathology with an incidence ranges from 0.01% to 0.3% that is characterized by presence of adenocarcinomatous cells originating in the appendix that are in direct continuity with the normal appendiceal mucosa. Even it is less common, synchronous primary adenocarcinoma of the appendix and the colon has been reported in literature, with less than 37 cases being reported in literature so far. PAA are seldom suspected in preoperative phase or even intraoperatively, and it is diagnosed based on histopathologic examination of the resected appendix. Once PAA is diagnosed, a lifelong surveillance with colonoscopy is mandatory to detect synchronous or metachronous colonic malignancies. CONCLUSIONS: Once a diagnosis of primary appendiceal adenocarcinoma is proved histologically, it is it is warranted to perform surveillance for synchronous or metachronous tumors because of the increased risk of a second primary malignancy in the gastrointestinal tract.

Humidification mitigates acute mucosal toxicity during radiotherapy when factoring volumetric parameters. Trans Tasman Radiation Oncology Group (TROG) RadioHUM 07.03 substudy.

PURPOSE/OBJECTIVE(S): To model in a subset of patients from TROG 07.03 managed at a single site the association between domiciliary based humidification use and mucositis symptom burden during radiotherapy (RT) for head and neck cancer (HNC) when factoring in volumetric radiotherapy parameters derived from tumour and normal tissue regions of interest. MATERIALS/METHODS: From June 2008 through June 2011, 210 patients with HNC receiving RT were randomised to either a control arm or humidification using the Fisher & Paykel Healthcare MR880 humidifier. This subset analysis involves patients recruited from Auckland City Hospital treated with a prescribed dose of ≥70 Gy. Regression models included control variables for Planning Target Volume 70 GY (PTV70Gy); Equivalent Uniform Dose (EUD) MOIST and TSV (surrogates of total mucosal and total swallowing volumes respectively). RESULTS: The analysis included 39 patients (humidification 20, control 19). There was a significant odds reduction in CTCAE v3.0 functional mucositis score of 0.29 associated with the use of humidification (p<.001). Within the parameters of the model therefore, the risk of a humidification patient being scored as experiencing a one-step increase in functional mucositis was 3.45 times lower (1/0.29) than for control patients. A control patient was 4.17 times more likely to receive an unfavourable nutritional mode score (p<.001). The risk of being admitted to hospital decreased by a factor of 11.11 for humidification patients (p=.013). CONCLUSION: The results support the hypothesis that humidification can help mitigate mucositis symptom burden. Radiotherapy dosimetric parameters assist in the evaluation of toxicity interventions.

A Golgi study of the camel cuneate nucleus.

Neurons in the cuneate nucleus of the camel brain stem were studied by Golgi method. Six types of neurons were identified based on soma size and shape, density of dendritic trees, morphology and distribution of spines, and appendages. Type I neurons had large spherical somata with somatic appendages. Dendritic appendages were predominant on proximal dendrites with terminal flower-like appendages. Type II neurons had medium to large soma. Appendages and spines were found for the soma as well as along dendrites of different orders. Axons with local branches were seen for these neurons. Type III neurons were small to medium spheroidal or triangulated with large number of spines and appendages on all parts of neurons including soma, dendrites, and initial axonal segments. Axons of these neurons branch profusely and formed rich local axonal arborizations. Type IV medium-size neurons have bipolar, round, or fusiform soma with somatic spines. Their dendrites were sparsely branching with spines and terminal side branches. Type V neurons were spheroid or triangular with small soma with somatic appendages. Their dendrites were sparsely branching and terminate as thin spiny side branches. Type VI neurons were small-size unipolar, round, or fusiform with some dendritic spines and protrusions. These findings shed some light on the structure of the cuneate nucleus of one of the largest animals (the camel).