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Dr Yuan-chun Feng has completed her MD in 2010 year from Sichuan University(China). She is a deputy chief physician currently and she has worked in Peking University International Hospital for 4 years. She has compiled the chapter “ CT diagnosis of retroperitoneal tumor”in the book named “Retroperitoneal tumor-Clinical management”(Springer published) . She is one of the main MDT members in the Center of retroperitoneal tumor in international hospital for 4 years.
Abstract: Imaging manifestations of retroperitoneal tumors which come from different tissues lack specificity. Some of them have the same soft tissue composition, so they have the same attenuation. In addition, most of the tumor are huge when they are discovered on clinic. The correct diagnosis is very difficult before resection. How to locate them clearly, how to determine the extent of tumor invasion, how to make qualitative diagnosis, and how to judge the tissue source of tumor?
Abdominal non- and enhancement CT scan provide sufficient retroperitoneal anatomical information for surgeons before operation. The internal components of the tumor were identified according to the different attenuation shown on the image. The shape (round, oval, irregular, lobulated) and the size of the tumor, the relationship of the tumor and adjacent organs, and their interface (clear, fuzzy or halo sign) were observed on the images.
Abdominal CT examination can clearly locate whether the tumor is retroperitoneal or not, and show the special growth style and invasion behavior of the tumor. Preoperative diagnosis of benign or malignant lesions, and assistant to chose surgical pathway, postoperative follow-up of therapeutic effects and recurrence of lesions. Recently, we have attempted to explore the correlation between retroperitoneal tumors of different histological tissue origins and their common sites，retrospectively. The initial results are noteworthy. In the future, We will pay more attention to the CT localization function in the retroperitoneal tumors and try to find some common information which will help the diagnosis before operation. Therefore, MSCT is the first choice and main examination method for retroperitoneal tumors.
University of Medical Sciences, Iran
M. Valikhani has completed his MSc at the age of 27 years from Iran University of Medical Sciences. He has published some english and persian paper and books. Now, he has a research program on the agenda. Indeed, he has a holistic approach that he hopes to be practically performant to eradicate malignant cells in hematologic malignancies. Unfortunately, there are some sanctions against his country and he can't provide the needed materials. Therefore, he is starting to look through overseas' universities to find a fully funded scholarhip and he is glad to inform you that this is his first negotiation.
Objective and Background: The major contributing causes of hematologic malignancies as one of the highly convoluted types of cancers are chromosomal translocations and in the meantime for the most part, they are highly controllable. These translocations generally are the consequence of the aberrant DNA double strand break (DSB) repair. DSBs are exo- or endogenously originated and should be repaired by major pathways: non-homologous end joining (NHEJ), homologous recombination (HR), or the other minor routs: alternative end joining pathways (A-EJs). Henceforth, defective NHEJ, HR or A-EJs push the hematologic cells toward the malignancy. Methods: Current study has been conducted based on PRISMA checklist. To obtain corresponding English documentations, databases, SID, Medlib, Scopus, PubMed, Science direct, Cochrane, Web of Science, Springer, Online Library Wiley as well as search engine Google Scholar were searched with no time limit to February 2019. Searching, study selection, quality evaluation and data extraction have been done by two persons of researchers independently. Discussion: Components of non-homologous end joining (either classical or alternative) pathways are the guards of the genome. Reduction, inhibition, dysfunction or even increases of these components cause genomic instability and subsequently cancer development and disease progression in hematologic cell lines. On the other hand, removing or targeting these genome guards in cancer cells can sensitize them to radiation or chemotherapy agents. The targeting studies are being widely hired and accomplished but there is a series of biological pitfalls, clinical issues and occasionally underlain limitations. Conclusion: We conclude that a huge bulk of data is convergently in favor of targeting A-EJs especially in combination with irradiation, and other minor data are divergently concluded considering some pitfalls. Keywords: Double-strand break; Double-strand break repair; Non-homologous end-joining; Alternative end joining pathways; Hematologic malignancies; Treatment
Pavuluri krishna swathi has completed MBBS at the age of 23 from NRI medical college, AP, India and doing internal medicine in sri ramachandra medical college and hospital.
Catecholamine secreting tumours arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia are referred to as pheochromocytomas and catecholamine secreting paragangliomas respectively. Annual incidence of pheochromocytoma is approximately 0.8/100,000 person years. Although pheochromocytomas occur at any age,they are most common in 4-5th decades of life and about 10% of catecholamine secreting tumours are malignant. Classic triad of pheochromocytoma consists of episodic headache,sweating and tachycardia. Diagnosed biochemically with 24hr urine fractionated metanephrines or catecholamines and plasma fractionates metanephrines. Radiologically with CT/MRI,FDG-PET,68-Ga DOTATATE PET and iobenguane I-123 scans. Here iam presenting a case report-38 y/o male patient with no known co-morbids came with the complaints of pain in the right hypochondrium for one week.History of palpitations on and off associated with shortness of breath on exertion. No history of fever, vomitings, headache, chestpain, cough, giddiness and loose stools. On examination, patient is conscious and oriented and PR-87/min,BP-160/70mm hg and systemic examination was normal. Baseline investigations done showed HB 13.4g/dl, TC 12,100,Platelets 5.76,MCV 79.1,PT 13.1,INR 1.13,FBS 127,PPBS 190,S.Creatinine 1.0,S.potassium 3.0,s.sodium 137,s.chloride 98,s.bicarbonate 24,SGOT 36,SGPT 39,S.albumin 4.3,S.calcium 9.8,iPTH 91.6,ALP 202,S.phosphorous 2.6,TSH 1.82,25 hydroxy Vitamin D 9.5.Urine routine showed protein(trace) and RBC(nil).USG abdomen done showed right complex supra renal cystic lesion of size 7.4x7.2 cms and on doppler increased in the vascularity in the wall of the lesion. CECT whole abdomen done showed a well-defined thick walled lesion with intense peripheral enhancement on arterial phase measuring 7x8.2x7.6 cms seen replacing the right adrenal gland with mass effect on adjacent structures i.e IVC anteromedially, upper pole of right kidney inferiorly, liver superiorly and relatively well maintained fat planes.I-131 MIBG whole body scan showed abnormal tracer uptake in both supra renal regions with large cold area in the right suprarenal region in both 48 and 72 delayed static images( bilateral pheochromocytoma).24hr urine metanephrine 1.2,24 hr urine nor metanephrine 4890(<600), Normetanephrine creatinine ratio 4890(86-236).Through clinical symptoms,biochemical and radiological evidence diagnosis of "Bilateral pheochromocytoma" was made and to confirm whether its malignant or not, patient is planned for further surgical intervention and biopsy. Patient treated symptomatically with antihypertensives and arachitol. Malignant pheochromocytomas are histologically and biochemically the same as benign ones. The only clue to the presence of malignant pheochromocytoma is local invasion in to the surrounding tissues and organs or which may occur as long as 53 years after resection, so long term follow up is required.
St. Luke’s Medical Center Global City, Philippines
Paroxysmal nocturnal hemoglobinuria (PNH), a rare benign disorder of the hematopoietic stem cells, is often underdiagnosed. The incidence is about 5 cases per million inhabitants in a year. There are only 1610 patients reported in the International PNH Registry to date. In this report, we describe a case of PNH in the Philippines. Case Report. A 20-year-old Filipino female presented to the emergency department with abdominal pain. No other symptoms were noted. She was otherwise previously healthy. Family history was unremarkable. During physical exam, she was noted to be pale and have significant epigastric pain. Laboratory tests revealed macrocytic normochromic anemia with mild anisocytosis and increased reticulocytes suspicious for hemolytic anemia. The indirect Coomb’s test was negative, excluding an autoimmune hemolytic anemia. There was a note of indirect hyperbilirubinemia, elevated LDH while PT, PTT were within normal range. An abdominal ultrasound revealed no abnormalities. Eventually, she was referred to a hematologist. Flow cytometry was ordered which showed a PNH clone of 39.63% in RBC, 96.3% in granulocytes and 85.10% in monocytes using the reagent FLAER, CD45, CD55 and CD59. Thereafter, the diagnosis of PNH was made. She received blood transfusion and hematinics during admission. Conclusion. This report aims to raise awareness on the combination of unexplained abdominal pain, Coombs‐negative hemolytic anemia, indirect hemoglubinuria and elevated LDH levels to suspect a diagnosis of PNH.
Diana Colleen M. Dimayuga, MD is a medical resident at St Luke’s Medical Center-Global City, Philippines