Conjunctival melanoma is a rare but life-threatening malignancy that arises from melanocytes in the basal layer of the conjunctival membrane.It only accounts for 2% of ocular melanomas.Its genetic makeup is distinct from uveal melanoma.It has more similarities to cutaneous melanoma in both patterns of spread and genetics.It predominantly affects Caucasians and the elderly.It arises most commonly from primary acquired melanosis but can also arise from a pre-existing conjunctival naevus or de novo.This review aims to outline the predisposing conditions, epidemiology, survival, histology, genetics, and current therapy for practising pathologists who may have limited experience with this tumour type.
Objective: In this study, we evaluated treatment volume determination with PET-CT fusion for small cell lung cancer. Materials and methods: Primary goal of this study has been to evaluate treatment volume determination for fused PET-CT in patients with small cell lung cancer. We have carried out a comparative analysis of treatment volume determination by CT simulation images only or by integration of PET. While we primarily focused on evaluation of incorporated multimodality imaging for treatment volume determination, we also assessed critical organ contouring along with interobserver and intraobserver variations. Ground truth target volume has been utilized for comparative analysis, and it was determined by board certified radiation oncologists after detailed evaluation of all imaging and relevant data with thorough colleague peer review and consensus.
Surgical resection of hypervascular meningiomas is often complex and may be accompanied by blood loss, followed by incomplete resection and tumor recurrence. We present a case of successful combined endovascular and surgical treatment for a large, complex, transcalvarial meningioma that is successfully resected. A 52-year-old male is admitted to our hospital with large left fronto-parietal tumefaction. Magnetic resonance imaging revealed extra-axial, transcalvarial fronto-temporal-parietal space occupying lesion with vivid contrast enhancement. Preoperative embolization was done using microspheres and coils. Surgical resection of tumor was done and pathohistology report showed Grade III meningioma. The patient recovers completely after the surgery and at first clinical follow-up 30 days later mRS was 0. Preoperative embolization of grade III meningioma reduces the surgery time, intraoperative blood loss and allows better resection without significant increase of perioperative complications. Reports on the association between embolization and tumor recurrence are insubstantial and require more research in future.
Objective: In this study, we evaluated treatment volume determination for parametrial boosting in patients with locally advanced cervical cancer. Materials and Methods: Primary goal of this study has been to evaluate treatment volume determination for parametrial boosting based on CT only or fused CT-MRI in patients with locally advanced cervical cancer. We have carried out a comparative analysis of treatment volume determination by CT simulation images only or by integration of MRI. While we primarily focused on evaluation of incorporated multimodality imaging for treatment volüme determination, we also assessed critical organ contouring along with interobserver and intraobserver variations. Ground truth target volume has been utilized for comparative analysis, and it was determined by board certified radiation oncologists after detailed evaluation of all imaging and relevant data with thorough colleague peer review and consensus.
Objective: In this study, we assessed tumor size changes after neoadjuvant systemic treatment in patients with advanced oropharyngeal squamous cell carcinoma (OSCC).Materials and methods: Primary objective of this study was to assess tumor size changes after neoadjuvant systemic treatment in patients with advanced OSCC.For this purpose, advanced OSCC patients with available imaging data as part of initial workup were studied.All included patients received upfront neoadjuvant systemic treatment and then were referred for radiation therapy (RT) at Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences.We have performed a comparative analysis for tumor sizes at diagnostic CT scan of the patients and at CT-simulation for radiation treatment planning after neoadjuvant systemic treatment.CTsimulations of the patients have been performed at CT-simulator (GE Lightspeed RT, GE Healthcare, Chalfont St. Giles, UK) available at our institution.Tumor size changes after neoadjuvant systemic treatment was documented for comparative evaluation.Results: As the main result of our study, we found a mean decrease of 35% in tumor size after neoadjuvant systemic treatment for patients with advanced OSCC.Conclusion: Our results may have implications for implementation of adaptive RT strategies despite the need for further supporting evidence.
Objective: Hodgkin lymphoma is a critical malignancy which may be seen during childhood and adolescence. Since it may be observed in younger patients, treatment strategies should be considered thoroughly to achieve optimal results in terms of local control and treatment related adverse effects. Systemic therapy plays a critical role in treatment of Hodgkin lymphoma. In this study, we evaluated changes in tumor volume following chemotherapy for nodular sclerosing Hodgkin lymphoma (NSHL).
One of the most common issues caused by antineoplastic agents is chemotherapy-induced peripheral neuropathy (CIPN). In patients, CIPN is a sensory neuropathy accompanied by various motor and autonomic changes. With a high prevalence of cancer patients, CIPN is becoming a major problem for both cancer patients and for their health care providers. Nonetheless, there are lacking effective interventions preventing CIPN and treating the CIPN symptoms. Several current studies have demonstrated the cellular and molecular signaling pathways leading to CIPN using experimental models and the beneficial effects of some interventions on the CIPN symptoms related to those potential mechanisms. This review summarizes results obtained from recent human and animal studies, which include the abnormalities in mechanical and temperature sensory responses following chemotherapeutic agents such as representative bortezomib, oxaliplatin and paclitaxel. The underlying mechanisms of CIPN at cellular and molecular levels are also discussed for additional in-depth studies needed to be better explored. A better understanding of the risk factors and fundamental mechanisms of CIPN is needed to design effective preventive drugs and therapeutic strategies. Overall, this paper reviews the basic picture of CIPN and the signaling mechanisms of the most common antineoplastic agents and potential approaches to be considered to alleviate neuropathic pain observed during chemotherapy.
Mastocytosis is an uncommon hematologic malignancy characterized by accumulation of abnormal mast cells in various organs or tissues. A somatic point mutation in the KIT gene at codon 816 is detected in more than 90% of patients with systemic Masto cytosis (SM). The 2022 WHO classification continues to recognize three disease types: systemic mastocytosis, cutaneous mastocytosis and mast cell sarcoma. Bone marrow mastocytosis is a new separate subtype of SM. The classification also recognizes well-differentiated systemic mastocytosis, a morphologic pattern that can occur in any SM subtype. Diagnostic criteria for SM have been modified. The expression of CD30 and the presence of any KIT mutation causing ligand-independent activation have been accepted as minor diagnostic criteria. Classical B-findings and C-findings have undergone minor refinements. Most notably, variant allele frequency of D816V mutation ≥ 10% in bone marrow cells or peripheral blood leukocytes is qualified as a B-finding.
Central nervous system pathologies can be detected by employing various imaging modalities. Among others, the computerized tomography scanning, or CT scanning is an important imaging modality to detect various intracranial lesions including brain tumors. Given its availability in basic clinical settings which is more than advanced neuroimaging modalities, CT scanning can be a useful and easy to access imaging technique to detect central nervous system pathologies. Although it has some limitations but still CT scanning is a useful modality to detect central nervous system pathologies including brain tumors. Considering this, it is important for the clinicians to have knowledge to interpret the results of the CT scanning of the central nervous system, so that they can detect abnormalities and pathologies with more precision. This brief review tries to point to some important notes in the interpretation of the results of cranial computerized tomography scanning in detection of various central nervous system pathologies including brain tumors.
Background: Aromatase enzyme activity is a key step in the biosynthesis of estrogens.Aromatase is a monooxygenase coded by gene CYP19A1 which catalysis myriad biological reactions associated with the biosynthesis of steroids.Over expression of aromatase is routinely observed in estrogen-responsive breast cancer cells of postmenopausal women.Aromatase inhibitors such as anastrozole, exemestane and letrozole are predominantly utilized to treat these hormone dependent breast cancers.However, drug resistance and side effects are commonly associated in such treatments.Objective: The present study investigates the inhibitory activity of isorottlerin (a novel Mallotus philippinensis derived flavanone) compared against known aromatase kinase inhibitors, namely anastrozole, exemestane and letrozole.Methods: Anastrozole, exemestane and letrozole together with isorottlerin were docked on human placenta aromatase.The 3D structure of aromatase (PDB id: 3s7s) employed for docking studies using Autodock vina, MGL tools as well as molecular dynamic studies utilizing the iMOD server.Results: Computational studies revealed isorottlerin as a competitive aromatase kinase inhibitor compared against FDA approved drugs, specifically anastrozole, exemestane and letrozole.In addition, docking studies results suggested that similar interactions in the binding site of aromatase.The binding energies of docked anastrozole, exemestane, letrozole and isorottlerin complexes with aromatase kinase were -7.8, -10.7, -8.4 and -11.0 kcal/mol, respectively.The docking results were supported through molecular simulation studies using the iMOD server. Conclusion:The in silico docking simulations of anastrozole, exemestane, letrozole and isorottlerin suggested that isorottlerin is a competitive inhibitor of aromatase kinase.
VEXAS syndrome is a recently described hemato inflammatory disease. It is an acronym from the syndrome’s key characteristics: vacuoles in bone marrow biopsies, low levels of ubiquitin activating enzyme (E1 enzyme), X-linked, autoinflammatory, somatic. It results from a somatically acquired mutation affecting methionine 41 of the E1-ubiquitin ligase UBA1, leading to the expression of a catalytically impaired isoform that drives inflammation. As this gene is located on the X chromosome, only men appear to be affected by this syndrome. Patients have severe inflammatory symptoms that affect multiple organs. Clinical features bridge rheumatological, dermatological, ophthalmological, respiratory, and hematological conditions. There is an association between severe autoinflammatory manifestations and myeloid dysplasia.
The prognosis of patients with initially metastatic ES is very poor. Significant risk factors for death include affectation at combined local and distant sites and soft tissue involvement. For the diagnosis, an initial radiographic and/or computed tomography (CT) is performed. Both techniques are outstanding in evaluating the affected bones. However, when primary Ewing´s tumor or its metastases involves soft tissues, these might be misdiagnosed if magnetic resonance imaging (MRI) is not applied. The purpose of the present case is to expose the role of MRI in the assessment of a rare and aggressive ES with metastases affecting bones and soft tissue of the head.
Introduction: Conventional fractionation in post-operative adjuvant radiotherapy (usually 60 Gy in 2 Gy per fraction delivered over six weeks) remains the standard in carcinoma oral cavity.Post-operative hypofractionated radiotherapy is less explored especially in post-operative oral cavity cancers.The aim of this study is to evaluate postoperative moderate hypofractionation as the adjuvant treatment in post-operative oral cavity cancer.Method: Patients of oral cavity cancers meriting adjuvant postoperative irradiation were inducted in the study.Hypofractionation consisted of a total dose of 52 Gy in 20 fractions over 4 weeks with concurrent chemotherapy.The primary endpoint was acute toxicity and late toxicity according to CTCAE V4.03 classification.The secondary endpoints included progression free survival at 1 year.Acute toxicity within 3 months of treatment and late toxicity at 1year follow up.Result: Thirty patients were recruited over 18 months.All patients completed a minimum of 1 year of follow-up.Twenty-Nine patients completed planned radiotherapy doses within a median treatment time of 30 days (27)(28)(29)(30)(31)(32)(33).Grade 2, 3and 4 skin reactions were seen in 86.2%, 10.34%, and 3.4% respectively.Grade 2,3,4 mucositis was seen in 55.17%, 41.3%, 3.4% patients respectively during treatment (acute toxicity).Recurrence was seen in 17% of patients at 3 months.Progression free survival at 1 year was 51%.Overall survival in 1 year was 79%. Conclusion:The schedule of 52 Gy in 20 fractions with concomitant chemotherapy is tolerable in patients with better compliance and equivalent PFS to conventional fractionation postoperative radiotherapy.Phase 3 trial is required for further validation of results.
Thyroid cancer is the most common malignancy of the endocrine system, representing 3.8% of all new cancer cases in the United States and is the ninth most common cancer overall. The American Cancer Society estimates that 62,450 people in the United States will be diagnosed with thyroid cancer in 2015, and 1950 deaths will result from the disease.
Objective: Anaplastic thyroid carcinoma (ATC) is a rare type of head and neck cancer with a relatively poor prognosis. Local recurrence may be encountered during the course of disease. Management of patients should be performed on an individual basis by use of a collaborative approah. Surgery serves as the main modality of management, however, radiation therapy (RT) may also be used for treatment. RT may play a crucial role as the supplementary or definitive therapy, and recurrent disease may also benefit from RT. Treatment of ATC may be challenging, however, RT has been used for ATC management. In this original research article, we explored treatment volume determination for ATC.
Giant cell tumor (GCT) of bone, a benign but locally aggressive invasive tumor. It commonly affects long bones, has a low incidence in pelvis (1.5-6.1%). It is most commonly treated with a surgical approach. However, here we present a rare case of GCT of pubic bone, which was rendered unresectable due to its location and extensive nature. Thereby, treated with radical radiation therapy and injection denosumab.
