Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Multiple Hepatic and Osseous Focal Lesions without Splenomegaly and/or Lymph ...JohnJulie1
Hepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in diagnosis of hepatic focal lesions.
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...daranisaha
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely,
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...semualkaira
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...semualkaira
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...AnonIshanvi
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute
Multiple Hepatic and Osseous Focal Lesions without Splenomegaly and/or Lymph ...JohnJulie1
Hepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in diagnosis of hepatic focal lesions.
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...daranisaha
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely,
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...semualkaira
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...semualkaira
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...AnonIshanvi
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...NainaAnon
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
Primary Epithelioid Hemangioendothelioma of the Kidney Pelvissuppubs1pubs1
Epithelioid hemangioendothelioma is a rare type of angiogenic tumor composed of Epithelioid endothelial cells, which is characterized by potentially malignancy and metastasis potential. It is mainly seen in adults, while very rare in children. Tumor can be found in soft tissue or other parts,such as liver and lung, however it is rare in the kidneys
Primary Epithelioid Hemangioendothelioma of the Kidney Pelvissemualkaira
Epithelioid hemangioendothelioma is a rare type of angiogenic tumor composed of Epithelioid endothelial cells, which is characterized by potentially malignancy and metastasis potential. It is mainly seen in adults, while very rare in children. Tumor can be found in soft tissue or other parts,such as liver and lung, however it is rare in the kidneys. The very report is the first case of that tumor is found in the renal pelvis, which contains only 4 cases of EHE in the kidney. This paper reports one case of EHE in the kidney, and reviews the relevant literatures to discuss its clinical characteristics and differential diagnosis points to better understand the disease.
Primary Epithelioid Hemangioendothelioma of the Kidney Pelvissuppubs1pubs1
Epithelioid hemangioendothelioma is a rare type of angiogenic tumor composed of Epithelioid endothelial cells, which is characterized by potentially malignancy and metastasis potential. It is mainly seen in adults, while very rare in children. Tumor can be found in soft tissue or other parts,such as liver and lung, however it is rare in the kidneys.
Primary Epithelioid Hemangioendothelioma of the Kidney PelvisJohnJulie1
Epithelioid hemangioendothelioma is a rare type of angiogenic tumor composed of Epithelioid endothelial cells, which is characterized by potentially malignancy and metastasis potential. It is mainly seen in adults, while very rare in children. Tumor can be found in soft tissue or other parts,such as liver and lung, however it is rare in the kidneys. The very report is the first case of that tumor is found in the renal pelvis, which contains only 4 cases of EHE in the kidney. This paper reports one case of EHE in the kidney, and reviews the relevant literatures to discuss its clinical characteristics and differential diagnosis points to better understand the disease.
Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
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Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
Abnormal Sodium and Chlorine Level Is Associated With Prognosis of Lung Cance...JohnJulie1
The imbalance of sodium and chloride ions occurs frequently in patients with lung cancer. However, the correlation between ion concentration change and patients prognosis have not been studied thoroughly. Our research will fill the gap, especially for high ion concentration.
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Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
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The IRF family of proteins involves in the tumor progression. However, but the functions of IRF5 in the tumorigenesis are largely unknown. Here, IRF5 was found to be up-regulated in hepatocellular carcinoma (HCC). Interfering with IRF5 inhibited the growth and tumorigenic ability of HCC cells.
•
Fibrous
•
Fibro glandular
•
Adipose (Fatty)
What is Tomosynthesis?
•
Is a 3 dimensional projection
•
Reduces overlapping tissue seen with 2D only
•
15 projections are taken with each combo exposure (7.5) (-7.5)
•
With an average breast (18*24) 3D dose is 1.34, combo is 2.56 Milligrey. (3 Milligrey FDA) (2D is 1.2
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Gut microbiota has been implicated as a critical role in the development of colorectal cancer (CRC) and colorectal adenoma (CRA). However, few basic research has revealed the association between gut microbiota and the development of CRA and CRC. We aim to compare the diversity and composition of intestinal flora in CRA and CRC patients, to reveal the changes of intestinal microorganism in the evolution of normal intestinal mucosa-CRA-CRC axis, and to explore potential biomarkers.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...JohnJulie1
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...JohnJulie1
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Combined Analysis of Micro RNA and Proteomic Profiles and Interactions in Pat...JohnJulie1
Liquid Chromatography Tandem Mass Spectrometry
The Liquid Mass System(LMS) includes an Easy nLC1000 (Thermo Fisher) coupled ultra-high resolution mass spectrometer Orbitrap Fusion Lumos (Thermo Fisher) with a Thermo Fisher electrospray source. Each injection is sent to a preset column (Acclaim PepMap C18, 100 μm x 2 cm, Thermo Scientific) for adsorption at a flow rate of 3 L/min. The sample is then sent to the analyzer column (Acclaim PepMap C18, 75 μm x 15 cm, Thermo Scientific) for separation.
Skeletal muscle channelopathy are rare heterogeneous episodic disorders with marked genotypic and phenotypic variability resulting in periodic paralysis, and falls in young people which often misdiagnosed or undiagnosed due to its rarity, often the symptoms are miscommunicated to the treating phycision due to its episodic nature and not uncommonly physical examination by the time patient attend the clinic or hospital will be unremarkable apart from periodic muscle paralysis where patient will presented to ED with flaccid weakness,
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
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Epithelioid hemangioendothelioma is a rare type of angiogenic tumor composed of Epithelioid endothelial cells, which is characterized by potentially malignancy and metastasis potential. It is mainly seen in adults, while very rare in children. Tumor can be found in soft tissue or other parts,such as liver and lung, however it is rare in the kidneys.
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Epithelioid hemangioendothelioma is a rare type of angiogenic tumor composed of Epithelioid endothelial cells, which is characterized by potentially malignancy and metastasis potential. It is mainly seen in adults, while very rare in children. Tumor can be found in soft tissue or other parts,such as liver and lung, however it is rare in the kidneys. The very report is the first case of that tumor is found in the renal pelvis, which contains only 4 cases of EHE in the kidney. This paper reports one case of EHE in the kidney, and reviews the relevant literatures to discuss its clinical characteristics and differential diagnosis points to better understand the disease.
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Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
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Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
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Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Literature and a Case Presentation
1. Clinics of Oncology
ISSN: 2640-1037
Review Article
Critical Role of PET-Scan in Unravelling the Dual Pathology-
Review of Literature and a Case Presentation
Islam MS*
Department of Hematology, Consultant Hematologist, Guy’s Hospital and Queen Elizabeth Hospital, Stadium Road, London, UK
Volume 2 Issue 3- 2019
Received Date: 30 Nov 2019
Accepted Date: 16 Dec 2019
Published Date: 24 Dec 2019
2. Keywords:
Myeloma; Lymphoma; DLBCL;
PET/CT scan; Biopsy
1. Abstract
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare.
Adequate and optimal diagnostic steps including various imaging techniques and histopathological
biopsies are required unpin the exact diagnoses to be able to deliver the best management
strategies. Positron Emission Tomography/Computerised Tomography scan (PET/CT) can be
used to determine the sites of disease with the highest Standardized Uptake Value (SUV) and
hence, the preferred site of biopsy.
3. Introduction
The simultaneous occurrence of two lymphatic malignancies in
one patient is extremely rare with an incidence rate of 1.4–6.5
cases/1,000,000 individuals [8]. Co-existence of MM and other
lymphoid malignancies like Chronic Lymphocytic Leukemia (CLL)
[9], MM and Hodgkin’s Disease (HD) [10], MM and Lympho
Plasmacytic Lymphoma (LPL) [11] has been reported. However,
there are less than 5 reported cases in PubMed of simultaneous
presentation of DLBCL and MM [12].
Diffuse Large B-cell Lymphoma (DLBCL) is the most common
type of Non-Hodgkin Lymphoma (NHL), comprising about 24%
of new cases of NHL [1, 2]. DLBCL is an aggressive NHL which
usually present with rapidly enlarging lymph nodes. Positron
Emission Tomography/Computerised Tomography scan (PET/
CT) can be used to determine the sites of disease with the highest
Standardized Uptake Value (SUV) and hence, the preferred site of
biopsy.
Multiple Myeloma (MM), a plasma cell neoplasm involving
clonal proliferation of terminally differentiated plasma cells and
MM is the second most common hematologic cancer [3]. Unlike
other metastatic bone malignancies, multiple myeloma related
osteolyticbone lesions exhibit no new bone formation [4]. Myeloma
relatedbone disease is one of the main causes of morbidity and
this can be detected on skeletal radiographs, low-dose Whole
Body Computed Tomography (WB-CT), Magnetic Resonance
Imaging (MRI) or PET/CT [5,6]. About 1% to 2% of MM patients
presents with Extrame Dullary Disease (EMD) and an accurate
differentiation of this finding from nodal lymphoma is very crucial
as treatments are very different for these two haematological
cancers [7].
Positron Emission Tomography (PET) scan is a functional
imaging developed in the late 1950s. Radio-labelled glucose
analogue Fluorine-18 Fluorodeoxy-Glucose (F-18 FDG) is the
most frequently used PET tracer and it allows visualization of the
cellular uptake of glucose, which is often up regulated in malignant
neoplasms. FDG-PET has replaced Gallium-67 scintigraphy,
which was previously used to assess the extent and viability of
lymphoma [13, 14]. A major advantage of FDG-PET is the ability
to quantify the level of FDG uptake from PET images and resulting
in a Standardized Uptake Value (SUV). The combined PET and
CT isan important evolution of imaging technique and the CT
component of PET/CT provides anatomical information and PET
component provides tissue metabolic activity. Combined PET/CT
results in a reduced incidence of false-positive and false-negative
PET findings.
*Corresponding Author (s): Md Serajul Islam, Department of Hematology, Consultant He-
matologist, Guy’s Hospital and Queen Elizabeth Hospital, Stadium Road, London, UK, SE18
4QH, E-mail: serajul@doctors.org.uk
Citation: Islam MS Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of
Literature and a Case Presentation Clinics of Oncology. 2019; 2(3): 1-6
clinicsofoncology.com
3. for the coexisting malignancies but studiesusing immunoglobulin
light and heavy chain isotype analysis or genotypic studies
have demonstrated disparate clonal evolutions in concomitant
malignancies. The separate clonal origins indicate DLBCL and
MM evolve independently and not from transformation of a B-cell
clone [19].
Until the early 2000s, lymphoma staging was based mainly on CT
scan as the main imaging modality along with results from clinical
examination and bone marrow biopsy [20]. Since then studies
have shown that combined FDG-PET/CT is superior to FDG-
PET or contrast-enhanced CT as separate imaging procedures
in the staging of lymphoma [21-26]. The 2014 International
Myeloma Working Group (IMWG) criteria for the diagnosis of
MM highlighted the importance of new imaging techniques for
the management of MM in order to early detection of bone disease
as a symptomatic MM criterion requiring treatment even when
asymptomatic[27].Studiesconductedoverrecentyearshaveshown
better performance using low-dose whole-body CT and MRI scans
than standard skeletal radiographs [28, 29]. However PET/CT scan
may be better imaging technique as it can simultaneously show the
functionality of neoplastic cells as well as show their anatomical
position.
A more recent study suggests that PET/CT scan is a reliable
imaging for initial staging, therapeutic monitoring and relapse
workup in MM, especially because of its prognostic potential [30].
PET/CT scan is very useful in evaluating metabolic activity in
malignant tumor. For MM staging PET-FDG allows whole-body
exploration and has 90% sensitivity for the detection of medullary
disease and 70-100% specificity [31-33]. PET scans are shown to
have prognostic importance in myeloma patients as the presence
of at least 3 Focal Lesions (FL) and EMD predicted inferior Overall
Survival (OS) as well as Progression Free Survival (PFS) [34, 35].
The PET scan identifies the location of lymphoma uptake and
distinguishesitfromphysiologicuptakeorothercausesofincreased
FDG uptake i.e. infection, inflammation or any second malignancy
as in our case according to distribution and characteristics of FDG
uptake. PET/CT appears to be very sensitive and highly specific
for detecting NHL in nodal and extra-nodal siteshowever, the
reliability of detection lymphoma in bone marrow involvement is
no consistent [36-39].
However, PET scan findings are usually different between MM
and high grade lymphoma as the latter group shows more intense
FDG uptake than neoplastic cell of MM [40-45]. Moreover, MM
does not usually present with lymphadenopathy. Our patient
had lymphadenopathy as well as there was a differential FDG
uptake between para-spinal mass and the groin lymph nodes
which prompted further investigation in our patient. In this case,
the patient was found to have a second malignancy in the form
of DLBCL which is potentially curable versus myeloma which at
present time is an incurable malignancy. Therapeutic decision
making was complicated by the fact that for these two different
malignancies patients usually receive very different treatment
regimens. However, our patient was treated with a regimen based
on the ReMODL-B trial with excellent response for both MM and
Volume 2 Issue 3 -2019 Review Article
clinicsofoncology.com 3
Figure 1:
Figure: 2
4. NHL [46].
6. Conclusion
PET/CT is an invaluable diagnostic tool that should be
integrated in evaluating lymphoid malignancies, during initial
diagnosis and as subsequent response assessment. The specific
mechanisms underlying the simultaneous presentation of two
B-cell malignancies have yet to be established. Hence, there are
no consistent treatment guidelines. Due to the lack of specific
guidelines management of such should be based on available
evidence and the doctor’s experience, the characteristics of the
patient’s illness and the performance status.
7. Acknowledgement:
Talhah S Bin-Islam for helping with the typing and editing the
manuscript.
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