Adrenocortical cancer (ACC) is a rare malignancy (estimated annual incidence 0.7 to 2.0 cases per million individuals worldwide) with a poor prognosis. In contrast, Lynch Syndrome (LS) is a much more commonly encountered hereditary syndrome that predisposes individuals to colon cancer and multiple other malignancies.
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
Functional genomics has led to an improvement of our understanding of CVD and can be translated to clinical utility. Gene-based pre-symptomatic prediction of illness, finer diagnostic sub-classifications and improved risk assessment tools will permit earlier and more targeted intervention. Pharmacogenetics will guide our therapeutic decisions and monitor response to therapy. Personalised medicine requires the integration of clinical information, stable and dynamic genomics and molecular phenotyping.
It is now possible to systematically search the entire human genome for common variants that are associated with a particular phenotype. (HGP, HAP MAP)
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
Functional genomics has led to an improvement of our understanding of CVD and can be translated to clinical utility. Gene-based pre-symptomatic prediction of illness, finer diagnostic sub-classifications and improved risk assessment tools will permit earlier and more targeted intervention. Pharmacogenetics will guide our therapeutic decisions and monitor response to therapy. Personalised medicine requires the integration of clinical information, stable and dynamic genomics and molecular phenotyping.
It is now possible to systematically search the entire human genome for common variants that are associated with a particular phenotype. (HGP, HAP MAP)
Abstract
A 53 year old man with a background of castrate-sensitive prostate cancer on intermittent androgen deprivation therapy (ADT) presented with right sixth nerve palsy secondary to a solitary right petroclival lesion involving adjacent dura and bone. The clinical and imaging characteristics of the lesion were consistent with a number of differential diagnoses (including metastatic prostate cancer, meningioma and chondrosarcoma). The patient initially declined biopsy and ADT was recommenced but the lesion continued to enlarge despite an excellent biochemical response. A subsequent biopsy of the petroclival mass demonstrated a WHO grade I meningioma and the patient proceeded to have definitive stereotactic radiotherapy. This case illustrates an unusual solitary skull base lesion in a man with prostate cancer. Whilst bony metastases, usually multiple, in the skeleton are common, solitary skull or brain lesions should be investigated as alternate diagnoses are likely in such circumstance.
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A 40-year-old woman with a past medical history of myomatosis and dysmenorrhea, who presented to her primary care physician with various complaints such as shortness of breath and fatigue, was found to have a large left renal mass. In April, 2014, she underwent a total left nephrectomy with removal of 13 lymph nodes, and pathology confirmed papillary renal cell carcinoma. One year later, she had recurrence of her disease in the subligamentary space attached to T12, which was also surgically removed in November, 2015. Although she showed all three classic symptoms of hereditary leiomyomatosis and renal cell cancer (HLRCC), which include cutaneous and uterine leiomyomas and papillary renal cell cancer, she remained undiagnosed for 20 months after her initial renal cancer diagnosis. Genetic testing, including next generation sequencing, was performed on the tumor, and the results were consistent with HLRCC. After starting treatment with bevacizumab and erlotinib in December, 2015, she has remained free of disease.
A 49-year-old asymptomatic man presents for a vasectomy
evaluation. His past medical history is noncontributory, and his
family history is remarkable for prostate cancer in his father. On
genitourinary examination, his left testicle is notably larger than
his right testicle, with concern for a firm, nontender upper pole
mass palpated on the left side.
A 3′-untranslated region KRAS variant and triple-negative breast cancer: a ca...UCLA
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breast cancer.
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Abstract
A 53 year old man with a background of castrate-sensitive prostate cancer on intermittent androgen deprivation therapy (ADT) presented with right sixth nerve palsy secondary to a solitary right petroclival lesion involving adjacent dura and bone. The clinical and imaging characteristics of the lesion were consistent with a number of differential diagnoses (including metastatic prostate cancer, meningioma and chondrosarcoma). The patient initially declined biopsy and ADT was recommenced but the lesion continued to enlarge despite an excellent biochemical response. A subsequent biopsy of the petroclival mass demonstrated a WHO grade I meningioma and the patient proceeded to have definitive stereotactic radiotherapy. This case illustrates an unusual solitary skull base lesion in a man with prostate cancer. Whilst bony metastases, usually multiple, in the skeleton are common, solitary skull or brain lesions should be investigated as alternate diagnoses are likely in such circumstance.
Next Generation Sequencing in Diagnosis of Reed’s Syndrome, or Hereditary Lei...CrimsonpublishersCancer
A 40-year-old woman with a past medical history of myomatosis and dysmenorrhea, who presented to her primary care physician with various complaints such as shortness of breath and fatigue, was found to have a large left renal mass. In April, 2014, she underwent a total left nephrectomy with removal of 13 lymph nodes, and pathology confirmed papillary renal cell carcinoma. One year later, she had recurrence of her disease in the subligamentary space attached to T12, which was also surgically removed in November, 2015. Although she showed all three classic symptoms of hereditary leiomyomatosis and renal cell cancer (HLRCC), which include cutaneous and uterine leiomyomas and papillary renal cell cancer, she remained undiagnosed for 20 months after her initial renal cancer diagnosis. Genetic testing, including next generation sequencing, was performed on the tumor, and the results were consistent with HLRCC. After starting treatment with bevacizumab and erlotinib in December, 2015, she has remained free of disease.
A 49-year-old asymptomatic man presents for a vasectomy
evaluation. His past medical history is noncontributory, and his
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A 3′-untranslated region KRAS variant and triple-negative breast cancer: a ca...UCLA
The KRAS-variant might be a genetic marker for development of triple negative breast cancer in premenopausal women, and altered gene and miRNA expression signatures should enable molecular and biological stratification of patients with this subgroup of
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Acute promyelocytic leukemia(APL),a specific characteristic of t(15;17) chromosomal translocation,molecular gene analyses are conclusive in vivo evidence that oncogenic pml/RARa fusion plays a crucial role in APL leukemogenesis [1-3]. Since the introduction of initial 13-cis retinoic acid(13-cis RA)[4],and currently all-trans RA(ATRA) [5] and tamibarotene [6],RA plus chemotherapy or RA plus As2O3 regimen is currently the standard of care [7]...
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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1. ISSN: 2640-1037
Clinics of Oncology
Case Report
An Adrenal Mass in a Patient with Lynch Syndrome
Sarah B Fisher, Jeffrey E Lee, Paul H Graham
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
Volume 2 Issue 1- 2019
Received Date: 03 May 2019
Accepted Date: 26 May 2019
Published Date: 02 Jun 2019
1. Abstract
Adrenocortical cancer (ACC) is a rare malignancy (estimated annual incidence 0.7 to 2.0 cases
per million individuals worldwide) with a poor prognosis. In contrast, Lynch Syndrome (LS) is
a much more commonly encountered hereditary syndrome that predisposes individuals to colon
cancer and multiple other malignancies. Recently ACC has been described as a LS associated
malignancy. Identifying associations between LS and other malignancies such as ACC is
impor-tant as it promotes identification of individuals not already diagnosed with LS, may
influence decisions to screen families, and may impact screening or evaluation of otherwise
nonsuspicious findings (i.e. an adrenal nodule) in patients at risk.
2. Introduction
Lynch syndrome (LS) describes a subset of patients with germ-
line mutations in DNA mismatch repair (MMR) genes (most
commonly MLH1, MSH2, MSH6, and PMS2) that account for
2-4% of all colorectal cancers [1, 2] with varying phenotypes
de-pending on specific mutation. Patients with LS have an
estimated lifetime risk of 80% for developing colorectal cancer
and an in-creased risk for other extracolonic malignancies,
including endo-metrial, gastric, ovarian, pancreas, ureter and
renal pelvis, biliary tract, brain, and small intestinal cancers.2
Recently adrenocor-tical cancer (ACC), a rare and aggressive
malignancy, has been associated with LS [3-7], although the
low prevalence of ACC makes it difficult to attribute causality.
3. Case
A male in his 30s with a family history of colon cancer in mul-tiple
first degree relatives underwent colonoscopy for evaluation of
persistent diarrhea and was found to have a moderately dif-
ferentiated adenocarcinoma of the distal transverse colon. Pre-
operative staging did not demonstrate evidence of metastatic
disease. He underwent a laparoscopic-assisted partial colectomy,
with resection of a T2N1, stage IIIb moderately differentiated ad-
enocarcinoma with loss of expression of MSH2 and MSH6. Con-
firmatory genetic testing demonstrated a deletion of the MSH2
gene, consistent with Lynch Syndrome. Six weeks after surgery, a
staging PET-CT demonstrated a metabolically active left ad-
renal nodule (1.3 x 1.0 cm, SUV 8.6) without evidence of addi-
tional disease. High resolution CT imaging identified enhance-
ment and washout characteristics incompatible with a benign
adenoma (Figure 1A and B). Biochemical evaluation excluded a
hormonally functional adrenal tumor. Image-guided fine needle
aspiration biopsy of the nodule demonstrated adrenal tissue with
atypical cells, but failed to render a conclusive diagnosis. Immu-
nostaining on the biopsy specimen was positive for calretinin,
weakly positive for inhibin, and negative for CDX-2 and CK20;
estimates of the Ki-67 proliferation index were high (32%). The
patient was started on adjuvant FOLFOX therapy for treatment of
his colorectal cancer and later referred for surgical evaluation of
the adrenal mass. Following completion of therapy, repeat im-
aging demonstrated an increase in the size of the adrenal mass to
1.7 x 1.2 cm.
The patient underwent an uncomplicated open left adrenalec-
tomy for a clinical suspicion of a primary adrenal malignancy.
Pathologic examination showed adrenocortical carcinoma
(ACC) with oncocytic features, measuring 1.5 x 1.4 x 1.2 cm,
confined to the adrenal gland with surgical margins free of tu-
mor. The mitotic rate was 10 per 50 high power fields with
severe nuclear atypia and a ki-67 index of 32%, supporting the
malig-nant diagnosis. Immunostaining for MSH2 and MSH6
demon-strated loss of protein expression consistent with the
pattern ob-served in the patient’s initial colorectal cancer.
*Corresponding Author (s): Paul H Graham, Department of Surgical Oncology, The
University of Texas MD Anderson Cancer Center, 400 Pressler St. Unit 1484, Houston,
USA, Tel: 936-446-5246; Fax: 936-446-5266 E-mail: PHGraham@mdanderson.org
clinicsofoncology.com
Citation: Sarah B Fisher, Jeffrey E Lee, Paul H Graham, An Adrenal Mass in a Patient with Lynch Syn-
drome. Clinics of Oncology. 2019; 1(8): 1-3.
3. Volume 2 Issue 1 -2019 Case Report
3018.
8. Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW.
Clini-cal review: Prevalence and incidence of endocrine and metabolic
dis-orders in the United States: a comprehensive review. J Clin
Endocrinol Metab. 2009; 94(6): 1853-78.
9. Bisceglia M, Ludovico O, Di Mattia A. Adrenocortical oncocytic tu-
mors: report of 10 cases and review of the literature. Int J Surg Pathol.
2004; 12(3):231-43.
10. Wong DD, Spagnolo DV, Bisceglia M, Havlat M, McCallum D,
Plat-ten MA. Oncocytic adrenocortical neoplasms--a clinicopathologic
study of 13 new cases emphasizing the importance of their recognition.
Hum Pathol. 2011; 42(4):489-99.
clinicsofoncology.com 3