Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Richard S. Finn, MD, Anthony El-Khoueiry, MD, and Josep M. Llovet, MD, PhD, prepared useful practice aids pertaining to hepatocellular carcinoma for this CME activity titled "Breaking the Paradox: Expanding Options and New Questions in HCC Management: Mapping the Pathways to Better Patient Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HU6L5K. CME credit will be available until February 14, 2020.
Clinical outcome, proteome kinetics and angiogenic factors in serum after the...Enrique Moreno Gonzalez
Thermoablation is used to treat patients with unresectable colorectal liver metastases (CRLM). We analyze clinical outcome, proteome kinetics and angiogenic markers in patients treated by cryosurgical ablation (CSA) or radiofrequency ablation (RFA).
Richard S. Finn, MD, Anthony El-Khoueiry, MD, and Josep M. Llovet, MD, PhD, prepared useful practice aids pertaining to hepatocellular carcinoma for this CME activity titled "Breaking the Paradox: Expanding Options and New Questions in HCC Management: Mapping the Pathways to Better Patient Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HU6L5K. CME credit will be available until February 14, 2020.
Clinical outcome, proteome kinetics and angiogenic factors in serum after the...Enrique Moreno Gonzalez
Thermoablation is used to treat patients with unresectable colorectal liver metastases (CRLM). We analyze clinical outcome, proteome kinetics and angiogenic markers in patients treated by cryosurgical ablation (CSA) or radiofrequency ablation (RFA).
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
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.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Adjuvant therapy protocols for liver cancer in patients undergoing liver tran...hr77
Many patients undergo liver transplantation for a liver cancer in a setting of liver cirrhosis. When is it possible to consider chemotherapy in such patients? Is it even possible? Is there a role?
Reperfusion strategy in patients with ST-Segment Elevation Myocardial Infarct...Premier Publishers
Reperfusion therapy is the cornerstone in management of STEMI. This study was designed to evaluate both In-hospital and 30 days outcome in patients with STEMI treated with primary percutaneous coronary intervention (PPCI) versus fibrinolysis. This prospective, controlled, study included 140 patients with STEMI who were eligible for reperfusion therapy. In hospital and 30 days major adverse cardiovascular events (MACE) were reported and head to head comparison was done between PPCI versus fibrinolysis. All-cause mortality was reported in 5% of patients (10% versus 0% in fibrinolysis and PPCI respectively, p=0.07), recurrence of ischemic symptoms was reported in 18% of patients (30% versus 7% in fibrinolysis and PPCI respectively, P =0.02), heart failure was evident in 22% of patients (33% versus 10% in fibrinolysis and PPCI respectively, P =0.02). PPCI is safe and effective treatment option for patients with STEMI
Nowadays the problem of surgical treatment of Colorectal
Cancer (CRC) is becoming very important due to the high speed of increasing morbidity and mortality, which is registered almost in all economically developed countries in the world [1,2]. In 2012, more than one million new cases of CRC were detected on our planet and about half a million people died from this disease [1]. On the territory of Russia, a primary diagnosis of colorectal cancer is annually established in 6000 people, with the highest incidence rates in the North-West region (St. Petersburg and Leningrad region), where in the general structure of oncopathology, colorectal cancer is in the second
Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases.Dr./ Ihab Samy
Amr H. Sleema MD; Ihab S. Fayeka MD; Hany F. Habashyb MD;Amany Saberc MD;Alfred E. Namourd MD;Nevine F. Habashye MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University – Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University – Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University – Egypt.
Kasr el-aini journal of surgery Volume 15, No.2, May 2014
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013
Suboccipital lymphadenectomy for patients with occipital squamous cell carcin...Dr./ Ihab Samy
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013.
Impact of dead space closure and lymph vessel ligation during MRM on Post-ope...Dr./ Ihab Samy
Hany F. Habashy MD.a , Ihab S. Fayek MD b , Mohamed I.Abd el aziz MD a
a:Department of Surgery-Fayoum University Hospital-El Fayoum , Egypt.
b:Department of Surgical Oncology –National Cancer Institute – Cairo University ,Egypt.
Kasr el-aini journal of surgery Volume 14, No.2, May 2013
Poster Presentation at the 6th Breast-Gynecological international cancer conference (BGICC) at Fairmont Towers Hotel, Cairo-Egypt on the 9th-10th of January 2014
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Treatment and early outcome of 11 children with hepatoblastoma.
1. 1
Treatment and outcome of 11 children
with hepatoblastoma
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt
Abstract:
Aim : This study was designed to retrospectively review our experience National Cancer
Institute,Cairo University with the multimodality management of hepatoblastomas (HB) and to
assess the outcome of childhood hepatoblastoma after a combination therapy of resection and
chemotherapy. Materials and Methods: eleven patients were treated for HB between 2006 and
2010. The clinical presentations, chemotherapy tolerance and response and surgical procedure
undertaken were analysed. Results: Median age of the population was 15 months (6-37
months), mean age was 16.7 months; with a male-to-female ratio of 4.5:1. Nine patients were
treated with neoadjuvant chemotherapy incorporating cisplatin and adriamycin. Primary surgery
was done in two patients. Extent of hepatic resection in the operated patients varied. Mixed
type was the predominant histopathological diagnosis. Adjuvant chemotherapy was well
tolerated with no morbidity or mortality. All the nine patients who could complete
multimodality treatment are alive with no evidence of disease or complications with median
follow-up of 13 months (7-19 months), mean follow up was 12.2 months. Overall Survival of all
11 patients is 91%. Conclusion: Treatment of HB with multidisciplinary approach was well
tolerated. Overall Survival of patients were comparable with published studies.
Keywords: hepatic resections, Chemotherapy , hepatoblastoma, multimodality treatment,
neoadjuvant treatment.
Introduction:
Hepatoblastomas (HB) are rare pediatric
neoplasms, with incidence of 1.5 per
million, and comprising 1% of pediatric
malignancies (1). Till 1970s, surgery was
the primary modality of treatment of HB.
Unfortunately, up to 60% of the patients
present in an unresectable stage(1,2).
Later, the chemo-responsiveness of the
tumor was demonstrated which led to the
incorporation of adjuvant chemotherapy
with cisplatinum and doxorubicin in the
treatment of HB (3,4,5). International
Society of Pediatric Oncology (SIOP)
pioneered the concept of neoadjuvant
chemotherapy in the management of HB
(6,7). Surgical resection of the tumors were
made easier by reducing the size and
vascularity of the tumor, and the chances
for obtaining negative margins of resection
were more (7,8). A partial response (PR)
status could be achieved in 82% of the
cases in SIOPEL-1 study. Surgical resection
2. 2
after neoadjuvant chemotherapy could be
done in 87% of the cases whereas
historically only 30% of the cases were
operable upfront. Surgical morbidity was
also less if resection was performed after
neoadjuvant chemotherapy. Extended
surgical resections of HB have been safely
performed in the pediatric age group (8).
Orthotopic Liver transplant (OLT) is an
effective treatment for unresectable HB
with survival rates of 82% if done as a
primary treatment (1). Combined modality
treatment is now the standard of care in
HB. Management of HB over 4 years is
reviewed in this article.
Materials and Methods:
This study included patients diagnosed to
have HB and treated between January 2006
and December 2010 at National Cancer
Institute,Cairo University. Patient
demographics, mode of presentation,
method of diagnosis, extent of tumor at
diagnosis, surgical procedures performed,
complications of treatment and outcome
were recorded. Based on imaging using a
computerized tomography (CT) scan (fig. 1)
and/or magnetic resonance imaging (MRI),
all patients were assigned a PRETEXT (Pre-
treatment extent of disease) stage and four
groups of patients were identified as
PRETEXT I-IV.
Nine patients received neoadjuvant
chemotherapy followed by surgical
resection. The standard of care,
cisplatinum and adriamycin as in the PLADO
(PLA, Platinum; DO, Doxorubicin) regimen
was administered to the nine patients every
21 days. PLADO chemotherapy consisted of
PLA on day 1 at a dose of 80 mg/m2,
administered in a continuous 24-h infusion
and DO at a dose of 30 mg/m2 per day,
administered as a continuous 24-h
intravenous (IV) infusion on days 2 and 3.
Both drugs were administered via a central
venous catheter.
Patients were routinely reassessed after
three cycles for surgical resection. If the
tumor was found to be inoperable, patient
was given one more cycle of chemotherapy.
The decision regarding timing of surgery
was taken by the surgical oncology team.
Postoperatively, two to three cycles of
chemotherapy were given to a total of six
cycles. The patients were followed up after
treatment with serial AFP levels and
imaging. Follow-up was complete for all
treated patients. Resection is typically
performed through a bilateral subcostal
incision . Intraoperative ultrasonography
has been applied to determine the exact
location of the tumor relative to the vessels.
Unresectability is usually determined by
involvement of hilar structures or all
hepatic veins, invasion of inferior vena cava
(IVC) or portal vein. Centrally located
tumors are, by definition, more likely
unresectable. Once deemed resectable, the
resection is marked out and various tools
may then be used to perform the resection;
electrocautery, bipolar devices such as
LigaSure for hemostasis have been used
(fig. 2,3,4,5).
3. 3
Results: (Tables 1 & 2)
Eleven patients were diagnosed and treated
for HB. All the patients had elevated AFP
levels and pathological confirmation was
done in all feasible cases. There were nine
males and two were females in the group
(M:F, 4.5:1). The median age was 15
months (range, 6-37 months). None of the
patients had any cardiac anomalies. The
commonest presenting feature was that of
an abdominal mass (in 10 out of 11
patients). One patient was diagnosed while
being evaluated for fever. None of the
patients had jaundice or was seropositive
for Hepatitis B or C. All the patients had
palpable hepatomegaly. AFP was elevated
in all the cases with a median level of
20,000 ng/ml (range, 620-1,42,000 ng/ml).
CT scan was done for 6 patients and MRI for
5. PRETEXT staging distribution was as
follows; PRETEXT Stage 9.1% (n = 1), Stage II
54.5% (n = 6), Stage III 36.4% (n = 4), and
Stage IV 0% (n = 0). Patients who
underwent straight surgery did not have
preoperative biopsy. Eight of the remaining
nine patients had pretreatment fine needle
aspiration (FNA) or Trucut biopsy.
Surgical procedures performed included
right hepatectomy in five patients,
extended right hepatectomy in three
patients, and left hepatectomy in
three.Neoadjuvant chemotherapy was
given to 9 of 11 patients. The remaining two
had initial surgery (Table 1). An 18-month-
child with PRETEXT 2 disease who
underwent upfront surgery died 8 months
later from extensive lung metastases which
led to pulmonary insufficiency and failure.
Of the neoadjuvant group, three patients
completed four cycles and another six
completed three cycles of chemotherapy
before surgery. All nine patients received
adjuvant chemotherapy also for a total of
six cycles. The two patients who had
primary surgery received adjuvant
chemotherapy also.
The median duration of surgery was 180
min (range, 120-260 min). The median
blood loss was 250 ml (100-400 ml). The
median length of postoperative hospital
stay was 10 days (range, 6-17 days). The
only postoperative complication was
intestinal obstruction in one patient which
was managed conservatively. There was no
postoperative mortality.
Histopathology and margins
The histological types encountered were as
follows: embryonal and mixed
embryonal/foetal subtype in four patients
and mixed epithelial and mesenchymal in
seven. Pathological complete remission was
noted in one patient after neoadjuvant
chemotherapy, others having residual
tumor. Among the eleven patients eight
had tumor-free margin of at least 5 mm,
three had close margins (<5 mm).
4. 4
Patient
No.
Age AFP Preop Liver segments involved PRETEXT Staging Initial ttt.
1 11 2,000 5,6,7 2 CHEMO
2 7 35,618 2,3,4 2 CHEMO
3 16 5,692 5,6,7 2 CHEMO
4 6 620 2,3 1 Surgery
5 8 131,861 5,6,7,8,4 3 CHEMO
6 12 960 4,8 3 CHEMO
7 32 142,000 4,5,6,7,8 3 CHEMO
8 18 121,150 5,6,8 2 Surgery
9 22 20,000 4,7,8 3 CHEMO
10 37 130,605 5,6,7 2 CHEMO
11 15 730 5,6,8 2 CHEMO
Table 1: Preoperative Evaluation and treatment
Patient
No.
Extent of liver
resection
Operative
time (min.)
Blood
loss (ml.)
PO hosp.
stay (days)
FU Current
Status
1 Rt. hepatectomy 210 190 10 14 CR
2 Left hepatectomy 160 150 7 9 CR
3 Rt. hepatectomy 170 250 10 7 CR
4 Left hepatectomy 120 100 6 11 CR
5 Extended RT
trisegmentectomy
230 300 17 13 CR
6 Left hepatectomy 130 150 8 18 CR
7 Extended RT
trisegmentectomy
260 400 14 13 CR
8 Rt. hepatectomy 210 250 7 8 dead
9 Extended RT.
trisegmentectomy
260 350 11 19 CR
10 Rt. hepatectomy 160 250 10 8 CR
11 Rt. hepatectomy 180 190 11 14 CR
Table 2: Operative and Postoperative details
Discussion
Hepatoblastomas are the most common
pediatric primary liver malignancy
accounting for more than 90% of the liver
tumors in less than 5 years of age (1). Most
of the cases are asymptomatic and present
in an advanced stage. The exact etiology is
unknown. The association with preterm
births and genetic conditions like Beckwith-
Wiedemann syndrome is well documented
in the literature (9,10). Surgical resection is
the cornerstone for successful management
of HB. Management of HB has evolved from
extensive surgical resections through the
incorporation of adjuvant chemotherapy to
the current standard of care of neoadjuvant
chemotherapy followed by surgery. The
5. 5
survival in 1970s with surgical resection
alone was a meagre 10-20% (11). However
with the arrival of chemotherapeutic
regimens such as PLADO, the surgical
outcomes improved tremendously.
Neoadjuvant chemotherapy pioneered by
SIOP has reduced the surgical
complications, facilitated more complete
resections and improved the cure rates (7).
Presently, survival is between 75% and 90%
(12,13,14). Multi-institutional trials have
confirmed the feasibility of this approach in
limited resource settings also (15,16). An
initial surgical approach may be acceptable
for resectable disease, but a neoadjuvant
approach may be preferable in advanced
stages (13).
The patients in our study had a lower
median age of presentation (15 months)
and male predominance compared to some
of the previous reports. PRETEXT stage II
predominated in our series (54.5%). All
patients in our series had a mixed type of
HB comprising foetal, embryonal, and
epithelial elements. Chemotherapy-related
long-term toxicities were absent in our
study. Most importantly all the nine
patients who completed multimodality
treatment are long-term survivors (up to 19
months). Relapse of the disease was not
observed in any of the survivors. Only one
patient died from extensive lung
metastases which led to pulmonary
insufficiency and failure.
Excellent results have been reported from
tertiary care centers in HB, thus reaffirming
the role of expertise in the management of
this rare neoplasm. Bajpai et al. reported
excellent outcome in 10 patients with HB.
Three patients recurred in their study. Fetal
subtype was the most common histology
(16). Ang et al. analysed outcome of 30
patients with HB treated at Royal Children's
Hospital Australia, from 1984 to 2004. The
5-year EFS was 75.7% (14).
From a malignancy with dismal outcome,
HB has come a long way through mainly
because of the combined modality
treatment with improved
chemotherapeutic regimes and surgical
techniques. HB is one cancer where the
coordinated effort of multiple specialities
has given a leap in the cure rates.
Conclusion:
Treatment of HB with multidisciplinary approach was well tolerated, safe with promising long
term survivors.
6. Figure 1: CT post chemotherapy
Figure 3: Exploration of the vena cava and the hilum
References:
1.Mueller Bu, Terrada DL, Finegold MJ.
Hepatoblastoma. 5 th
ed. Principles and
practice of pediatric oncology. In: Pizzo PA,
Poplack DG, editors. Houston: Lippincott
6
CT post chemotherapy Figure 2: Marking of the resection
Exploration of the vena cava and the hilum Figutr 4: Tumor after resection
Figure 5: Cut surface of the liver
gold MJ.
ed. Principles and
practice of pediatric oncology. In: Pizzo PA,
Poplack DG, editors. Houston: Lippincott-
Williams Wilkins Publishers; 2006. p. 887.
Marking of the resection
Tumor after resection
Williams Wilkins Publishers; 2006. p. 887.
7. 7
2.Exelby PR, Filler RM, Grosfeld JL. Liver
tumours in children in particular reference
to hepatoblastoma and hepatocellular
carcinoma: American Academy of Pediatrics
Surgical Section Survey - 1974. J Pediatr
Surg 1975;10:329-37.
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