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Head and neck extra nodal NHL (HNENL) - Treatment Outcome and Pattern of failure - A Single Institution Experience

  • Giridhar, Prashanth;Mallick, Supriya;Bhasker, Suman;Pathy, Sushmita;Mohanti, Bidhu Kalyan;Biswas, Ahitagni;Sharma, Atul
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.15
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    • pp.6267-6272
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    • 2015
  • Background: Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum. Materials and Methods: We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma. Results: We retrieved data of 75consecutive patients HNENL. Median age was 47years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI- 68.6- 95.35) and 88% (95%CI- 60.82 - 92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid. Conclusions: Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.

Prognostic Significance of TP53 Mutations and Single Nucleotide Polymorphisms in Acute Myeloid Leukemia: A case Series and Literature Review

  • Zeichner, Simon Blechman;Alghamdi, Sarah;Elhammady, Gina;Poppiti, Robert John;Castellano-Sanchez, Amilcar
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.4
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    • pp.1603-1609
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    • 2014
  • Background: The response to treatment and overall survival (OS) of patients with acute myeloid leukemia (AML) is variable, with a median ranging from 6 months to 11.5 years. TP53 is associated with old age, chemotherapy resistance, and worse OS. Using genetic sequencing, we set out to look at our own experience with AML, and hypothesized that both TP53 mutations and SNPs at codon 72 would mimic the literature by occurring in a minority of patients, and conferring a worse OS. Materials and Methods: We performed a pilot study of randomly selected, newly diagnosed AML patients at Mount Sinai Medical Center, diagnosed from 2005-2008 (n=10). TP53 PCR sequencing was performed using DNA from bone marrow smears. Analysis was accomplished using Mutation Surveyor software with confirmation of the variants using the COSMIC and dbSNP databases. Results: Fewer than half of the patients harbored TP53 mutations (40%). There was no significant difference in OS based on gender, AML history, risk-stratified karyotype, or TP53 mutation. There were possible trends toward improved survival among patients less than 60 (11 vs 4 months, p=0.09), Hispanics (8 vs 1 months, p=0.11), and those not harboring SNP P72R (8 vs 2 months, p=0.10). There was a significant improvement in survival among patients with better performance status (28 vs 4 months, p=0.01) and those who did not have a complex karyotype (8 vs 1 months, p=0.03). The most commonly observed TP53 mutation was a missense N310K (40%) and the most commonly observed SNP was P72R (100.0%). Conclusions: Our study confirms previous reports that poor PS and the presence of a complex karyotype are associated with a decreased OS. In our cohort, TP53 mutations were relatively common, occurring more frequently in male patients with an adverse karyotype. Although there was no significant difference in survival between TP53 mutated and un-mutated patients, there was a possible trend toward worse OS among patients with SNP P72R. Larger studies are needed to validate these findings.

Reports and Statistics on Korean Spicy Fish Soup Cooking in Busan (부산지역 생선횟집을 중심으로 생선 매운탕 조리실태 조사)

  • Kim, Jung-Sun;Jo, Young-Je;Lee, Nahm-Gull
    • Journal of Fisheries and Marine Sciences Education
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    • v.18 no.2
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    • pp.164-171
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    • 2006
  • kochukaru (chili powder) and various vegetables. As its main ingredient, fresh or sea-water fish is cut into several pieces and boiled with ground beef and green vegetables such as watercress as well as garland chrysanthemum. In addition, onion, radish, chilies, crown daisy, garlic and some times, pumpkin and bean curds are added to the mixture to absorb the kochujang which is the base flavor of this dish. It is then seasoned with kochukaru, garlic, soy sauce and if needed, more kochujang to suit everyone's taste buds. Restaurants that offer this dish often allow you to select your fish from a tank. Many specialty seafood restaurants have several tanks from which you may choose a fish. Popular fish for this dish may include Korean rockfish, flounder, yellow corvina, codfish, croakers, pollacks, and even fresh water fish like carp and trout. In addition, other shell fish such as crabs, clams and oysters can be also added to this soup to compliment and enhance its spicy but refreshing flavor. This soup is one of Korean's most popular dishes while drinking soju. If you order sushi or sashimi, the soup is made from the left-over parts of the fish. The objective of this study is to determine a standardized recipe of Maeun-Tang and to investigate consumption so as to increase its intake opportunities for consumers through its development. Fish species used in Maeuen-Tang's recipes were flounder, Korean rockfish and other fish. Onion, radish, chilies, crown daisy, garlic and some times, pumpkin and bean curds were added to the mixture to absorb the kochujang which is the base flavor of this dish. Most of the stock used in Maeuen-Tang's recipes is pure water, fish stock and vegetable stock, 1.0-1.5 Korean rock fishes and 0.5-1.0 flounders, with its head and bone, which were used in 3-4 portions of Maeun-Tang. Most of the seafood restaurants used seasoning which didn't age and was made by the restaurant. The cooking equipment used in the Maeuen-Tang's recipes were a cook-port and earthen bowl.

Arthroscopic Rotator Cuff Repair: Serial comparison of outcomes between full-thickness rotator cuff tear and partial-thickness rotator cuff tear

  • Park, Jin-Young;Chung, Kyung-Tae;Yoo, Moon-Jib
    • Clinics in Shoulder and Elbow
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    • v.6 no.1
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    • pp.72-79
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    • 2003
  • Purpose: To compare the results of arthroscopic rotator cuff repair and subacromial decompression in partial thickness rotator cuff tear (PTRCT) with those in full thickness rotator cuff tear (FTRCT). Subjects and method: Of the 46 patients who were rested of the rotator cuff tear based on the operational findings, 42 patients who were able to receive a serial follow-up for 2 years were selected as the study subjects. The average age of the patients at the time of the operation was 55 years, and the mean duration of the follow-up was 34 months. The subjects included 22 cases of PTRCT and 20 cases of FTRCT. In terms of rotator cuff repair, the average number of tendon to tendon repair (TTR) was 1 in both PTRCT and FTRCT, and that of tendon to bone repair (TBR) was 1 and 3 in PTRCT and FTRCT, respectively. The average number of use of suture anchor was 1 and 2 in PTRCT and FTRCT, respectively. The level of shoulder pain and function of the subjects were measured using shoulder functional evaluation score of American shoulder and elbow society (ASES score) at before and 2 years following the operation. Results: At the final follow-up following the operation, PTRCT group showed changes in scores from 7.2 to 0.9 on average pain score and 34 to 91 on ASES score, whereas FTRCT group showed changes in scores from 7.6 to 1.2 on pain score and 29 to 88 on ASES score. There were no significant differences between the two groups (P > 0.05). The average range of motion of shoulder significantly increased in both groups at the final follow-up in comparison with the pre-operative time point. The evaluation at the final follow-up showed that 93% of the total subjects showed good or excellent results, and 95% showed satisfactory results from the procedure with regard to pain reduction and functional outcomes. Two cases of the 3 fair results were caused by acromioclavicular arthritis. Conclusion: It may be anticipated that arthroscopic rotator cuff repair and subacromial decompression may bring satisfactory post-operative outcomes in both PTRCT and FTRCT on pain relief and functional recovery. However, careful preoperative examination of the acromioclavicular joint is critical to avoid failures of these procedures.

Infiltrating Intramuscular Lipoma (침윤성 근육내 지방종)

  • Suh, Jeung-Tak;Kim, Jeung-Il;Cheon, Sang-Jin;Lee, Choon-Key;Ku, Ja-Gyung;Kim, Young-Goun
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.40-45
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    • 2005
  • Purpose: To suggest an accurate diagnosis and treatment of infiltrating intramuscular lipoma by analysis of the clinical, biological, radiological and pathological features. Materials & Methods: 20 patients who treated at our hospital for infiltrating intramuscular lipoma from 1998. to 2001 were selected for this study. Mean age was 45.8 years old. Four were male and eight female. All cases were checked preoperative radiographs, MRI and diagnosed by biopsy. The methods of surgical treatment included excision of tumor and peripheral tissue. We assessed the recurrence by follow up. Results: Tumors located in upper limbs 5 cases, lower limbs 3 cases, abdomen 3 cases, gluteal region 1 case. In preoperative radiographs, infiltrating intramuscular type were 7 cases. In 11 cases, tumors were completely excied with peripheral tissue. 1 cases was incompletely excised because it was very huge mass and infiltrated lung. Encapsulated tumors were 3cases and uncapsulated tumors 9 cases. There were no recurrence excepts 1 case that was infiltrated lung. Conclusion: Infiltrating intramuscular lipoma was wrongly diagnosed as well differentiated liposarcoma. To increase the rate of correct diagnosis, preoperative radiographs, MRI and pathologic diagnosis were performed. Careful wide excision is necessary to prevent the recurrence.

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Diagnostic Efficacy of PET in Soft Tissue Tumors: Comparative Study with Conventional Methods (연부 조직 종양에서 PET의 유용성: 기존의 진단법과의 비교 연구)

  • Seo, Sung-Wook;Park, Sang-Min;Cho, Hwan-Seong
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.32-39
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    • 2005
  • Introduction: Currently, F-18 fluorodeoxyglucose positron emission tomography scans (FDG-PET) has been investigated in soft tissue tumor especially for tumor detection and noninvasive grading. However, the validity and the efficacy of FDG-PET are still unclear in clinical evaluation. The purpose of this study is to determine the efficacy of FDG-PET in compared to conventional diagnostic imaging studies currently used in the soft tissue tumor. Methods: Between March 2001 and March 2002, 29 patients (sixteen males, thirteen females, mean age, 47 years; a range from 4 to 73) diagnosed with soft tissue tumor were evaluated by both conventional diagnostic imaging and FDG-PET. Valid reference test of the local lesion was the histopathologic diagnosis, which was measured in all patients. The suspecting metastasis in the imaging studies was validated by pathology or follow up imaging for at least 6 months. Each imaging diagnosis was made independently. The accuracy of each diagnostic method was evaluated. The incremental cost accuracy ratio was determined in each diagnostic method. Results: For detection of local lesion, sensitivity, specificity, and accuracy for MRI and FDGPET scans were 91%, 57%, 83% and 95%, 43%, 83% respectively. For detection of distant lesion, sensitivity, specificity, accuracy for conventional diagnostic methods and FDG-PET scans were 77%, 89%, 87% and 92%, 94%, 93% respectively. The incremental cost accuracy ratio (ICAR) of FDG-PET for detection of distant lesion was 145,000won/%. According to ICAR for each tumor grade, PET strategy is most cost-effective at high grade tumors. Conclusions: For detection of local lesion such as recurrence or remnant tumor, FDG-PET scan was not more accurate than MRI. However, It was more accurate for detection of metastatic lesion than conventional methods. For detection of high grade tumor, PET was most costeffective than for detection of lower grade tumor.

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Inflammatory Myofibroblastic Tumor of Extremities (사지에 발생한 염증성 근섬유모세포성 종양)

  • Kong, Chang-Bae;Lee, Jeong-Dong;Lee, Jung Uk;Song, Won-Seok;Cho, Wan-Hyeong;Koh, Jae-Soo;Jeon, Dae-Geun
    • The Journal of the Korean bone and joint tumor society
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    • v.19 no.1
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    • pp.14-19
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    • 2013
  • Purpose: We analyzed the oncologic characteristics and outcome of patients with inflammatory myofibroblastic tumor of extremities. Materials and Methods: Among the soft tissue tumor patients who were treated between 1999 and 2012, 5 patients who were pathologically confirmed as the inflammatory myofibroblastic tumor of extremities were analyzed retrospectively. Results: There were 1 man and 4 women with mean age of 44 years (37-55 years). The average follow up was 34.6 months (8-87 months). All patients underwent surgical treatment. Only 1 patient had wide resection margin and remaining 4 had marginal (3) or intralesional (1) resection margin. All of 4 patients without wide resection margin developed local recurrence at 10.3 months (8-19 months). Malignant transformation to fibrosarcoma was occurred in 2 patients who developed local recurrence, and 1 patient developed multiple metastases to lung, liver and lymph nodes and expired at 37 months. Three of 5 patients had tumor location abutted to or invasion to major arteries and 1 patient had tumor invading sciatic nerve. Conclusion: It is observed that inflammatory myofibroblastic tumor of extremities is usually located near the major neurovascular structure. Wide resection should be considered as the initial surgical treatment because this tumor showed a high local recurrence rate and possibility of malignant transformation.

Serum 25-hydroxy Vitamin D Status is Not Related to Osteopenia/Osteoporosis Risk in Colorectal Cancer Survivors

  • Akinci, Muhammed Bulent;Sendur, Mehmet Ali Nahit;Aksoy, Sercan;Yazici, Ozan;Ozdemir, Nuriye Yildirim;Kos, Tugba;Yaman, Sebnem;Altundag, Kadri;Zengin, Nurullah
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.8
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    • pp.3377-3381
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    • 2014
  • Background: The incidence of colorectal cancer increases with vitamin D deficiency as shown in recently published studies. In addition, prospective investigations have indicated that low vitamin D levels may be associated with increased mortality of colorectal cancer, especially in stage III and IV cases. However, the exact incidence of vitamin D deficiency and the relation between vitamin D deficiency and osteopenia/osteporosis is still not known. The aim of this study is to identify severity of vitamin D deficiency and absolute risk factors of osteopenia/osteoporosis in colorectal cancer survivors. Materials and Methods: A total of 113 colorectal cancer survivors treated with surgery and/or chemotherapy ${\pm}$ radiotherapy were recruited from medical oncology outpatient clinics during routine follow-up visits in 2012-2013. Bone mineral densitometry (BMD) was performed, and serum 25-OH vitamin D levels were also checked on the same day of the questionnaire. The patients was divided into 2 groups, group A with normal BMD and group B with osteopenia/osteoporosis. Results: The median age of the study population was 58 (40-76). Thirty (30.0%) were female, whereas 79 (70.0%) were male. The median follow-up was 48 months (14-120 months). Vitamin D deficiency was found in 109 (96.5%); mild deficiency (20-30 ng/ml) in 19 (16.8%), moderate deficiency (10-20 ng/ml) in 54 (47.8%) and severe deficiency (<10 ng/ml) in 36 (31.9%). Osteopenia was evident in 58 (51.4%) patients whereas osteoporosis was noted in 17 (15.0%). Normal BMD was observed in 38 (33.6%). No apparent effects of type of surgery, presence of stoma, chemotherapy, radiotherapy and TNM stage were found regarding the risk of osteopenia and osteoporosis. Also, the severity of the vitamin D deficiency had no effect in the risk of osteopenia and osteporosis (p=0.93). In female patients, osteopenia/osteoporosis were observed in 79.5% patients as compared to 60.7% of male patients (p=0.04). Conclusions: In our study, vitamin D deficiency and osteopenia/osteoporosis was observed in 96.5% and 66.4% of colorectal cancer survivors, respectively. There is no defined absolute risk factor of osteopenia and osteoporosis in colorectal cancer survivors. To our knowledge, in the literature, our study is the first to evaluateall the risk factors of osteopenia and osteoporosis in colorectal cancer survivors.

Age-related Changes in Plasma Leptin from Early Growing to Late Finishing Stages of Castrated Holstein Steers: Utilizing Multi-species Leptin RIA

  • Vega, R.A.;Lee, H.G.;Kuwayama, H.;Matsunaga, N.;Hidari, H.
    • Asian-Australasian Journal of Animal Sciences
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    • v.15 no.5
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    • pp.725-731
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    • 2002
  • This experiment was performed to understand the changes in plasma leptin in association with plasma IGF-1, body weight and ADG from early growing to late finishing stages of Holstein steers. Blood collection was performed by arterial vein puncture at selected monthly ages of 1 (54 kg), 2.6 (103 kg), 7.2 (205 kg), 13.5 (314 kg), 16.9 (414 kg), 22.2 (550 kg), 24.9 (626 kg) and 27.4 months (695 kg). The blood was analyzed for leptin using the multi-species leptin RIA with recombinant bovine leptin (rbleptin) as standard, plasma IGF-1 was also measured using RIA. Against the standard rbleptin, the multi-species Leptin RIA system's sensitivity, cross reactivity, slope and recovery of 41.0 ng/ml rbleptin in plasma were 4.9 ng/ml, 11.22%, -1.396 and 97.8%, respectively. Plasma leptin measured were more than 5.0 ng/ml, which enable multi-species RIA system to investigate plasma leptin in normal growing steers. Body weight resulted to a highly significant second-degree polynomial relationship with plasma leptin (q=0.54, p<0.0001) and plasma IGF-1 (q=0.44, p<0.0001) from 1 to 27.4 monthly ages. However, the second-degree polynomial curve of plasma leptin and IGF-1 differs showing a concave and convex curvilinear relationship, respectively. ADG was not significantly associated to plasma leptin (r=0.06, p>0.05) and plasma IGF=1 (r=0.06, p>0.05) from 1 to 27.4 monthly ages. Low coefficient, but significant associated increase of plasma leptin and IGF-1 (r=0.12, p<0.008) from 1 to 27.4 months was observed. The uncoordinated increases of plasma IGF-1 at growing and plasma leptin at fattening period, may indicate (1) indirect involvement of endogenous IGF-1 on leptin secretion, and (2) IGF-1 level may signify lean and bone accretion while plasma leptin may mirror body fatness across the monthly ages of Holstein steers.

Maternal Low-protein Diet Alters Ovarian Expression of Folliculogenic and Steroidogenic Genes and Their Regulatory MicroRNAs in Neonatal Piglets

  • Sui, Shiyan;Jia, Yimin;He, Bin;Li, Runsheng;Li, Xian;Cai, Demin;Song, Haogang;Zhang, Rongkui;Zhao, Ruqian
    • Asian-Australasian Journal of Animal Sciences
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    • v.27 no.12
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    • pp.1695-1704
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    • 2014
  • Maternal malnutrition during pregnancy may give rise to female offspring with disrupted ovary functions in adult age. Neonatal ovary development predisposes adult ovary function, yet the effect of maternal nutrition on the neonatal ovary has not been described. Therefore, here we show the impact of maternal protein restriction on the expression of folliculogenic and steroidogenic genes, their regulatory microRNAs and promoter DNA methylation in the ovary of neonatal piglets. Sows were fed either standard-protein (SP, 15% crude protein) or low-protein (LP, 7.5% crude protein) diets throughout gestation. Female piglets born to LP sows showed significantly decreased ovary weight relative to body weight (p<0.05) at birth, which was accompanied with an increased serum estradiol level (p<0.05). The LP piglets demonstrated higher ratio of bcl-2 associated X protein/B cell lymphoma/leukemia-2 mRNA (p<0.01), which was associated with up-regulated mRNA expression of bone morphogenic protein 4 (BMP4) (p<0.05) and proliferating cell nuclear antigen (PCNA) (p<0.05). The steroidogenic gene, cytochrome P450 aromatase (CYP19A1) was significantly down-regulated (p<0.05) in LP piglets. The alterations in ovarian gene expression were associated with a significant down-regulation of follicle-stimulating hormone receptor mRNA expression (p<0.05) in LP piglets. Moreover, three microRNAs, including miR-423-5p targeting both CYP19A1 and PCNA, miR-378 targeting CYP19A1 and miR-210 targeting BMP4, were significantly down-regulated (p<0.05) in the ovary of LP piglets. These results suggest that microRNAs are involved in mediating the effect of maternal protein restriction on ovarian function through regulating the expression of folliculogenic and steroidogenic genes in newborn piglets.