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Prostaglandin E2 promotes colon cancer cell growth through a Gs-axin-beta-catenin signaling axis. Science : — Gut 58 : — Cancer Res 63 : — Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst 81 : — Prognostic value of tumor infiltrating lymphocytes in the vertical growth phase of primary cutaneous melanoma.
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Crit Rev Oncol Hematol 46 : 33— De novo carcinogenesis promoted by chronic inflammation is B lymphocyte dependent. Cancer Cell 7 : — Cancer Immunol Immunother 52 : — Long-term survival for patients with non-small-cell lung cancer with intratumoral lymphoid structures. J Clin Oncol 26 : — Cancer immunoediting: from immunosurveillance to tumor escape. Nat Immunol 3 : — Interferons, immunity and cancer immunoediting. Nat Rev Immunol 6 : — The three Es of cancer immunoediting.
Annu Rev Immunol 22 : — CTLA new insights into its biological function and use in tumor immunotherapy. Increased regulatory T cells correlate with CD8 T-cell impairment and poor survival in hepatocellular carcinoma patients. Gastroenterology : — Generation of experimental allergic airways inflammation in the absence of draining lymph nodes. J Clin Invest : — Type, density, and location of immune cells within human colorectal tumors predict clinical outcome.
The adaptive immunologic microenvironment in colorectal cancer: a novel perspective. Cancer Res 67 : — The B lymphocyte in rheumatoid arthritis: analysis of rearranged V kappa genes from B cells infiltrating the synovial membrane. Eur J Immunol 25 : — Cancer Immunol Immunother 56 : — Bronchus-associated lymphoid tissue BALT in human fetal and infant lung. J Pathol : — Crohn's-like lymphoid reaction and colorectal carcinoma: a potential histologic prognosticator.
Mod Pathol 3 : — The localization and density of immune cells in primary tumors of human metastatic colorectal cancer shows an association with response to chemotherapy. Cancer Immun 9 : 1. Halvorsen TB, Seim E. Association between invasiveness, inflammatory reaction, desmoplasia and survival in colorectal cancer. J Clin Pathol 42 : — Hanahan D, Weinberg RA.
The hallmarks of cancer. Cell : 57— From Dukes through Jass: pathological prognostic indicators in rectal cancer. Hum Pathol 25 : — Herr HW, Morales A. History of bacillus Calmette—Guerin and bladder cancer: an immunotherapy success story.
J Urol : 53— Br J Cancer 94 : — Eur J Immunol 39 : — Hohenberger P, Gretschel S. Gastric cancer. Lancet : — Survival and the immune response in patients with carcinoma of the colorectum. Gut 20 : — Ectopic lymphoid structures support ongoing production of class-switched autoantibodies in rheumatoid synovium. PLoS Med 6 : e1. Prognostic significance of T helper 1 and 2 and T cytotoxic 1 and 2 cells in patients with non-small cell lung cancer.
Anticancer Res 25 : — Jass JR. Lymphocytic infiltration and survival in rectal cancer. J Clin Pathol 39 : — Tumour-infiltrating lymphocytes: a prognostic factor of PSA-free survival in patients with local prostate carcinoma treated by radical prostatectomy. Cancer : — Tumor-driven evolution of immunosuppressive networks during malignant progression.
Cancer Res 66 : — Immunoglobulin repertoire of B lymphocytes infiltrating breast medullary carcinoma. Hum Antibodies 12 : — Gut 57 : — Prognostic significance of tumor-infiltrating T-lymphocytes in primary and metastatic lesions of advanced stage ovarian cancer. Cancer Immunol Immunother 58 : — ASCO update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 24 : — Evidence for in situ amplification of cytotoxic T-lymphocytes with antitumor activity in a human regressive melanoma.
Cancer Res 53 : — Study of tumor infiltrating lymphocytes and transforming growth factor-beta as prognostic factors in breast carcinoma. Int J Cancer 74 : — Peri- and intratumoral T and B lymphocytic infiltration in breast cancer.
Eur J Gynaecol Oncol 29 : — High density of FOXP3-positive T cells infiltrating colorectal cancers with microsatellite instability. Br J Cancer 99 : — Persistence and responsiveness of immunologic memory in the absence of secondary lymphoid organs. Immunity 25 : — Role of inducible bronchus associated lymphoid tissue iBALT in respiratory immunity.
Cancer Res 58 : — Cancer Res 61 : — Independent prognostic value of eosinophil and mast cell infiltration in colorectal cancer tissue. Okazaki T, Honjo T. Trends Immunol 27 : — Effector memory T cells, early metastasis, and survival in colorectal cancer. N Engl J Med : — The essential role of the in situ immune reaction in human colorectal cancer. J Leukoc Biol 84 : — The in situ cytotoxic and memory T cells predict outcome in early-stage colorectal cancer patients. J Clin Oncol 27 e-pub ahead of print 26 October Systematic review of microsatellite instability and colorectal cancer prognosis.
Hum Pathol 35 : — Inducible bronchus-associated lymphoid tissue iBALT in patients with pulmonary complications of rheumatoid arthritis. The number of intratumoral dendritic cells and zeta-chain expression in T cells as prognostic and survival biomarkers in patients with oral carcinoma. Cancer 91 : — Histopathology 53 : 30— Prognostic value of tumour-infiltrating lymphocytes TILs in colorectal cancer. J Clin Oncol 27 : — CD8 tumor-infiltrating lymphocytes are predictive of survival in muscle-invasive urothelial carcinoma.
Clinical significance of poor CD3 response in head and neck cancer. Clin Cancer Res 8 : — A fresh look at tumor immunosurveillance and immunotherapy. Nat Immunol 2 : — Helicobacter and gastric MALT lymphoma. Lymphoid infiltration and prognosis in colorectal carcinoma. Br J Cancer 49 : — Immunocytochemical analysis of the cellular infiltrate in primary regressing and non-regressing malignant melanoma.
J Invest Dermatol 97 : — Immune-mediated dormancy: an equilibrium with cancer. Direct antigen presentation by a xenograft induces immunity independently of secondary lymphoid organs. J Immunol : — Immunogenic cancer cell death: a key-lock paradigm. Curr Opin Immunol 20 : — B cell survival in intragraft tertiary lymphoid organs after rituximab therapy.
Transplantation 85 : — Tschernig T, Pabst R. Bronchus-associated lymphoid tissue BALT is not present in the normal adult lung but in different diseases. Pathobiology 68 : 1—8. Haematologica 93 : — Histological grade, perineural infiltration, tumour-infiltrating lymphocytes and apoptosis as determinants of long-term prognosis in prostatic adenocarcinoma.
Eur J Cancer 30A : — TNM residual tumor classification revisited. Cancer 94 : — Intratumoral T cells, recurrence, and survival in epithelial ovarian cancer. Cancer despite immunosurveillance: immunoselection and immunosubversion. Zou W. Immunosuppressive networks in the tumour environment and their therapeutic relevance. Nat Rev Cancer 5 : — Download references. Correspondence to W-H Fridman. Reprints and Permissions. Immune infiltration in human tumors: a prognostic factor that should not be ignored.
Oncogene 29, — Download citation. Received : 23 June Revised : 14 October Accepted : 18 October Published : 30 November Issue Date : 25 February Advances in Nutrition Breast Disease European Archives of Oto-Rhino-Laryngology Free Radical Biology and Medicine Advanced search. Skip to main content Thank you for visiting nature. Download PDF. Introduction Although the presence of immune infiltrates of variable content in human solid tumors from different origins and different patients has long been established, the prognostic value of these components is still controversial.
Evidence for variable immune infiltrates in human cancers that predict clinical outcome Solid tumors are commonly infiltrated by immune cells for example, T and B lymphocytes, natural killer NK cells, NK-T cells, dendritic cells DCs , macrophages, neutrophils, eosinophils and mast cells. Table 1 Cancers associated with chronic inflammatory diseases Full size table. Table 2 Cancers in which T-cell infiltration is associated with favorable prognosis Full size table.
Correlation of high numbers of Th1 and cytotoxic memory T cells with the absence of metastatic invasion The clinical outcome of a cancer is highly dependent on the capability of tumor cells to extravase the tumor through blood, lymphatic vessels or along neural routes, circulate in the body and establish in a distant organ, forming a growing metastasis. Figure 1.
Full size image. Coordinated adaptive immune response as the strongest prognostic factor in colorectal cancer In addition to the total number of intratumoral T cells, the location of the lymphocytic infiltration within the tumor seems to be relevant in terms of prognosis. Immune scoring in early stage colorectal cancers in clinical practice As stated above, in early stage colorectal cancers in patients with no detectable lymph node or distant metastasis, surgery alone is the state of the art.
T regulatory cells and prognosis In a recent publication, Salama et al. Adjacent tertiary lymphoid structures as the site of tumor-initiated immune reaction As described above, the density of tumor-infiltrating T lymphocytes with cytotoxic and memory phenotypes is highly predictive of favorable clinical outcome.
Concluding remarks: from tumor immune infiltrates to tumor immune contexture Lymphocytic infiltration is a common feature of human cancers, including those that develop in immunoprivileged sites, such as the eye Touitou et al. Conflict of interest The authors declare no conflict of interest. Neck dissection was reserved for residual disease after definitive IMRT.
Overall survival, disease-free survival, and locoregional control were calculated using the Kaplan-Meier method. No occurrence of primary cancer was observed during the follow-up period. The reported rates of xerostomia reduced with the interval from the completion of treatment.
In our institution, IMRT for unknown primary cancer has provided good overall and disease-free survival in all the patients with an acceptable rate of complications. IMRT allowed us to address the bilateral neck and ipsilateral putative pharyngeal mucosa with minimal late salivary function toxicity.
The use of concurrent chemotherapy and IMRT for more advanced disease led to good clinical results with reasonable toxicities. Presents a brief history of the growth of counseling in primary care. Discusses the challenges for primary care counselors and counseling, as well as the need for coordination, regulation and management.
Also discusses the imperative for research support and the unique nature of counseling in primary care including challenges to its survival. Searching for ' Unknown Unknowns '. As part of this goal, methods are being investigated to enable the NESC to become proactive in identifying areas that may be precursors to future problems. The goal is to find unknown indicators of future problems, not to duplicate the program-specific trending efforts. The data that is critical for detecting these indicators exist in a plethora of dissimilar non-conformance and other databases without a common format or taxonomy.
In fact, much of the data is unstructured text. However, one common database is not required if the right standards and electronic tools are employed. Electronic data mining is a particularly promising tool for this effort into unsupervised learning of common factors. This work in progress began with a systematic evaluation of available data mining software packages, based on documented decision techniques using weighted criteria.
The four packages, which were perceived to have the most promise for NASA applications, are being benchmarked and evaluated by independent contractors. Preliminary recommendations for "best practices" in data mining and trending are provided. Final results and recommendations should be available in the Fall This critical first step in identifying " unknown unknowns " before they become problems is applicable to any set of engineering or programmatic data.
Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection. The impact of different prognostic factors such as age and N stage is not completely known, the optimal treatment is not yet established, and the reported survival rates vary. In the last decade, human papilloma virus HPV has been identified as a common cause of and important prognostic factor in oropharyngeal cancer, and there is now growing interest in the importance of HPV for HNCUP.
The aim of the present study on curatively treated HNCUP was to investigate the prognostic importance of different factors, including HPV status, treatment, and overall survival. The medical records were reviewed, and only patients with squamous cell carcinoma or undifferentiated carcinoma treated with curative intent were included.
The tumor specimens were retrospectively analyzed for HPV with p16 immunostaining. Sixty-eight patients were included. The majority were males, and had N2 tumors. Sixty-nine percent of the tumors were HPV positive using p16 staining. HPV infection was common.
Treatment with neck dissection and postoperative radiation or. Diagnostic value of 18F-fluordesoxyglucose positron emission tomography for patients with brain metastasis from unknown primary site. All observations were confirmed in the validation cohort. Therefore, randomised trials on patients with BM should standardise methods of staging, notably when stratifying for GPA.
Johnson, David Y. Objective To report the clinical, neuropsychological, linguistic, imaging, and neuropathological features of a unique case of sporadic Jakob-Creutzfeldt disease in which the patient presented with a logopenic variant of primary progressive aphasia. Design Case report. Setting Large referral center for atypical memory and aging disorders, particularly Jakob-Creutzfeldt disease. Patient Patient presenting with logopenic variant primary progressive aphasia initially thought to be due to Alzheimer disease.
Results Despite the long, slow 3. Conclusions These findings expand the differential of primary progressive aphasia to include prion disease. Human papillomavirus HPV is recognized as a risk factor for oropharyngeal squamous cell carcinomas SCC , especially tonsillar and base of tongue cancer. HPV has recently also been implicated in cancer of unknown primary CUP in the head and neck region, where a primary tumour is not found despite extensive workup. John G. Delinassios , All rights reserved.
The aim of this investigation is to study neurophysiologic mechanisms of processing of relevant words and unknown words. The main difference between known targets and unknown stimuli was revealed in the thetal and theta2 bands at the early stage after stimuli onset ms and in the delta band ms.
In the late time window at about ms thetal ERS in response to the target stimuli was smaller than to other stimuli, but theta2 and alpha ERD in response to the target stimuli was larger than to known nontarget words. Purpose: To determine how the addition of cisplatin-based concurrent chemotherapy to radiation therapy influences outcomes among a cohort of patients treated for head-and-neck cancer of unknown primary origin.
Methods and Materials: The medical records of 60 consecutive patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Exploratory analysis failed to identify any subset of patients who benefited from the addition of concurrent chemotherapy to radiation therapy.
Although selection bias cannot be ignored, prospective data are needed to further address this question. Radiation therapy in the management of head-and-neck cancer of unknown primary origin: how does the addition of concurrent chemotherapy affect the therapeutic ratio?
To determine how the addition of cisplatin-based concurrent chemotherapy to radiation therapy influences outcomes among a cohort of patients treated for head-and-neck cancer of unknown primary origin. The medical records of 60 consecutive patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed.
HPV status in patients with head and neck of carcinoma of unknown primary site: HPV, tobacco smoking, and outcome. Infection with human papillomavirus HPV is linked to oropharyngeal cancer. This analysis investigated possible associations between HPV status, smoking history and survival outcome in patients with neck metastasis and carcinoma of unknown primary CUP. Registries at the Universities of Hamburg and Kiel were searched for patients with CUP diagnosed from to who had formalin-fixed and paraffin-embedded metastatic lymph node samples available.
All patients underwent routine diagnostic procedures to establish the primary site and received radiotherapy 60Gy using conventional fractionation with or without concurrent cisplatin-based chemotherapy depending on disease extent. Genotyping was performed using polymerase chain reaction; p16 [INK4a] expression was assessed using immunohistochemistry. Overall survival appeared to be superior in patients with Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada.
Cancer of unknown primary origin CUP is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival OS.
Patient diagnostic information, including histology and survival data, was obtained from the OCR. OS was assessed using Cox regression models adjusting for histology and sites of metastases. We identified patients diagnosed with CUP. Three-year survival rates were 3. CUP patients in Ontario have a poor prognosis.
Some subgroups may have better survival rates, such as patients with metastases localised to lymph nodes and patients with squamous cell histology. Purpose: No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary HNCUP. Intensity-modulated radiotherapy IMRT is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. Of these patients, 22 had Stage N2 disease or greater.
All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy.
With a median follow-up of 2. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis. Next generation sequencing of carcinoma of unknown primary reveals novel combinatorial strategies in a heterogeneous mutational landscape. Subbiah, Ishwaria M. Background Advanced carcinoma of unknown primary CUP has limited effective therapeutic options given the phenotypic and genotypic diversity.
To identify future novel therapeutic strategies we conducted an exploratory analysis of next-generation sequencing NGS of relapsed, refractory CUP. Conclusion Every patient had a unique molecular profile with no two patients demonstrating an identical panel of mutations.
Head and neck squamous cell carcinoma of unknown primary : Outcomes of a pre-defined institutional treatment policy in a region with a high prevalence of skin cancer. To determine the rate of subsequent primary site failure in patients with head and neck squamous cell carcinoma of unknown primary UKP HNSCC in a region with a high prevalence of cutaneous squamous cell carcinoma, according to a pre-determined institutional policy. Secondary aims included regional and distant control, and overall survival.
Patients with presumed mucosal origin were treated with radiation therapy RT with or without chemotherapy, while patients with presumed cutaneous SCC were treated with surgery and post-operative RT with or without chemotherapy.
A total of 63 patients met the inclusion criteria. Median follow up duration was 3. There were no subsequent primary site failures. The rate of nodal failure among presumed mucosal patients was The rate of distant metastatic failure was Treatment according to our pre-defined institutional policy for UKP HNSCC in a region with a high prevalence of cutaneous SCC appears to be safe and effective with low rates of mucosal primary emergence and nodal failure.
Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report. Primary aortoduodenal fistula ADF is a rare cause of gastrointestinal GI bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm AAA. Diagnosis was made by CTA of aorta.
A timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.
African Primary Care Research: Quantitative analysis and presentation of results. The article describes types of continuous and categorical data, how to capture data in a spreadsheet, how to use descriptive and inferential statistics and, finally, gives advice on how to present the results in text, figures and tables. The article intends to help Master's level students with writing the data analysis section of their research proposal and presenting their results in their final research report.
Juvenile primary extranasopharyngeal angiofibroma, presenting as cheek swelling. Angiofibroma is a locally advancing immensely vascular tumor that essentially arises from the nasopharynx. The clinical characteristics of extranasopharyngeal angiofibroma ENA do not accord to that of nasopharyngeal angiofibroma and can present a diagnostic confront.
We describe a case of primary juvenile ENA in a year-old patient who presented with a rapidly enlarging mass of the cheek region. The case is unusual because of its anatomic location. The diagnostic and management particulars are sketched. Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary.
We aimed to investigate the cost-effectiveness of a gene-expression profiling GEP test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary CUP. We built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP.
The model was parameterized using follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. Field evaluations of the test are associated with a large societal benefit. Comprehensive analysis of cancers of unknown primary for the biomarkers of response to immune checkpoint blockade therapy.
Avoiding immune destruction is a major cancer characteristic and therapies aimed at immune checkpoint blockade are in use for several specific cancer types. A comprehensive survey of predictive biomarkers to immune checkpoint blockade in CUP were explored in this study. About cases of CUP were analysed for mutations in genes and 52 gene fusions using a massively parallel DNA sequencing platform next-generation sequencing [NGS].
High TML was seen in Published by Elsevier Ltd.. Primary human immunodeficiency virus infection presenting as elevated aminotransferases. Primary human immunodeficiency virus type 1 HIV-1 infection is often under-diagnosed because of its nonspecific presentations. Elevated aminotransferase levels is one of its clinical manifestations, but is infrequently reported in the literature.
The objective of this study was to investigate cases of elevated aminotransferases as a manifestation of primary HIV-1 infection. A retrospective chart review from October to May of HIV-1 infected patients in a registered database at a tertiary hospital was conducted to identify patients diagnosed with primary HIV-1 infection.
An elevated aminotransferase level was broadly defined as above-normal values of alanine or aspartate aminotransferases. Acute hepatitis markers were determined using stored serum samples. Twenty-three of the 2. The most common clinical manifestations were fever Elevated aminotransferases may be an initial manifestation of primary HIV infection and is more common than expected. Primary HIV-1 infection should be one of the differential diagnoses considered in young men presenting with unexplained, new-onset liver function impairment.
Published by Elsevier B. Purpose: To analyze survival, failure patterns, and toxicity in patients with head-and-neck carcinoma of unknown primary origin HNCUP treated with intensity-modulated radiotherapy IMRT. Nodal staging ranged from N1 to N3. The mean preoperative dose to gross or suspected disease, Waldeyer's ring, and uninvolved bilateral cervical nodes was Sixteen patients underwent neck dissection after radiation and 4 patients before radiation.
Eight patients with advanced nodal disease N2b-c, N3 or extracapsular extension received chemotherapy. When stratified by nonadvanced N1, N2a nodal disease without extracapsular spread vs. Three nodal recurrences were observed: in 1 patient with bulky N2b disease and 2 in patients with N3 disease.
No nodal failures occurred in patients with N1 or N2a disease who received only radiation and surgery. Conclusion: Definitive IMRT to Gy followed by neck dissection results in excellent nodal control and overall and disease-free survival, with acceptable toxicity for patients with T0N1 or nonbulky T0N2a disease without extracapsular spread. Patients with extracapsular spread, advanced N2 disease, or N3 disease may benefit from concurrent chemotherapy, targeted therapeutic agents, or.
Squamous cell carcinoma of cervical lymph nodes from an unknown primary site: The impact of neck dissection. To investigate the treatment strategies of squamous cell carcinoma of cervical lymph nodes from an unknown primary site SCCUP and the value of neck dissection ND. The study included patients referred to the Zhejiang Cancer Hospital from to , with males and 24 females.
Distribution of patients by N status was as follows: N1 - 14 cases; N2a - 21 cases; N2b - 78 cases; N2c - 7 cases; and N3 - 13 cases. The selection of surgical strategy was determined by the extent and location of disease. The data were analyzed with SPSS version The actual overall survival OS rates were calculated by the Kaplan-Meier method. Different factors affecting the OS were determined by the log-rank test on univariate analysis.
Cox regression was used to evaluate the multivariate analysis. The 5-year OS rate of the whole cohort was The locoregional failure rate of ND group and of the non-ND group were Primary peritoneal serous carcinoma presenting as inflammatory breast cancer. Metastasis to the breast from extramammary malignancies is rare. Nevertheless, its recognition is important because the prognosis and treatment differ from that of primary breast cancer. We report a unique case of primary peritoneal serous carcinoma that initially presented as inflammatory breast cancer.
The patient received neoadjuvant chemotherapy for breast cancer and subsequently underwent bilateral total mastectomy and bilateral sentinel lymph node biopsy. She was found to have extensive intralymphatic carcinoma in both breasts, with only focal minimal breast parenchymal involvement, and residual metastatic carcinoma in bilateral sentinel lymph nodes.
Further work-up revealed pelvic ascites and omental nodularities. The patient underwent laparoscopic bilateral salpingo-oophorectomy, which revealed high-grade serous carcinoma involving both ovaries and fallopian tubes.
Molecular testing of tumor from the ovary and axillary lymph node showed an identical pattern of allelic loss, confirming a common origin for both tumors. To our knowledge, this is the first reported case of an extramammary primary malignancy that not only presented as inflammatory breast cancer but also was diagnosed and initially treated as such. Primary tuberculosis clinically presenting as gingival enlargement: a case report. Tuberculosis is a chronic systemic granulomatous disease which rarely affects the oral cavity.
Oral lesions can be either primary or secondary to systemic tuberculosis, the former being rare. This is a never-before reported case of primary tuberculosis presenting as a localized diffuse gingival enlargement in an year-old Indian female patient. The diagnosis was reached through identification of positive histopathological features, Tuberculin test results, presence of anti-tubercular antibodies confirmed by a polymerase chain reaction.
In view of the recent increase in the incidence of tuberculosis and the prevalence of the same, it is reasonable to include tuberculosis in the differential diagnosis of gingival enlargements. This is essential to avoid any serious complications for both the clinician and patient due to a delay in the diagnosis of such a rare but plausible oral condition.
Primary jejunal adenocarcinoma constitutes a minute portion of small intestine adenocarcinomas. Clinically, this cancer presents at latter stages of its progression, mainly due to vague and non-specific symptoms, and the difficulty encountered in accessing the jejunum on upper endoscopy.
Diagnosis of jejunal adenocarcinoma is usually inconclusive with the use of computed tomography CT scan, small bowel series, or upper endoscopy. Laparoscopy followed by frozen section biopsy provides a definitive diagnosis. In the past decade, balloon-assisted enteroscopy BAE and capsule endoscopy have become popular as useful modalities for diagnosing small bowel diseases. Physicians are advised to suspect jejunal adenocarcinoma as a differential diagnosis in patients who present with non-specific symptoms of abdominal pain, nausea, vomiting, weight loss, anemia, gastrointestinal bleeding or signs of small bowel obstruction.
We present a rare case of a year-old woman with suspected bilateral ovarian masses, which was immunohistochemically confirmed as primary jejunal adenocarcinoma with bilateral ovarian metastasis. Diffuse large B-cell lymphoma is the commonest form of non-Hodgkin lymphoma. Gastro-intestinal tract and bone marrow are common extra-nodal sites of lymphomatous involvement. A year-old woman presented with acute onset epigastric pain.
On evaluation, raised serum amylase and radiological features of acute pancreatitis were detected. Gastroscopy revealed thickened folds in distal stomach, which on histopathology revealed large B-cell lymphoma. Subsequently, the patient developed extra-hepatic biliary obstruction due to peripancreatic lymph nodal mass that was relieved with plastic biliary stenting. Subsequent chemotherapy regime directed against lymphoma led to resolution of lymphoma. In this patient , pancreatitis was the initial presentation of primary gastric lymphoma, which has not been commonly reported and therefore should be considered in the etiological workup.
Malignant plasma cell proliferation can be presented as part of disseminated disease of multiple myeloma, as solitary plasmacytoma of bone, or in soft tissue as extramedullary plasmacytoma. In this paper, we report a rare case of primary cutaneous plasmacytoma involving the lip in a year-old male.
The patient presented with a nonhealing lower lip sore for the past 3 years. Upon further workup, there was no evidence of multiple myeloma or light chain disease. The patient was treated with radiation therapy and his last follow-up revealed no evidence of multiple myeloma or light chain disease.
To identify a molecular subgroup of prostate cancers with metastatic potential at presentation resulting in a high risk of recurrence following radical prostatectomy. Unsupervised hierarchical clustering was performed using gene expression data from 70 primary resections, 31 metastatic lymph nodes, and 25 normal prostate samples.
Independent assay validation was performed using radical prostatectomy samples from four sites with a mean follow-up of Molecular subgroups were identified using unsupervised hierarchical clustering. A partial least squares approach was used to generate a gene expression assay.
Relationships with outcome time to biochemical and metastatic recurrence were analysed using multivariable Cox regression and log-rank analysis. A molecular subgroup of primary prostate cancer with biology similar to metastatic disease was identified. A transcript signature metastatic assay was developed and independently validated in the radical prostatectomy samples. Metastatic assay positive patients had increased risk of biochemical recurrence multivariable hazard ratio [HR] 1.
The metastatic assay may improve the ability to detect patients at risk of metastatic recurrence following radical prostatectomy. The impact of adjuvant therapies should be assessed in. Non-Hodgkin lymphoblastic lymphomas are very uncommon tumors that rarely involve the heart; however, when they do, they typically cause cardiac symptoms. Herein, we describe the case of a young woman who presented with respiratory symptoms. These were caused by a high-grade lymphoblastic lymphoma, which originated in the left inferior pulmonary vein and extended into the left atrium.
The tumor was surgically debulked, but it recurred in 1 month, and the patient underwent chemotherapy. Six months later, she had recurrent respiratory symptoms, and echocardiography revealed a persistent mass in the left lower lobar vein. A modified chemotherapy regimen led to complete resolution of the tumor within 2 months. We are unaware of other reports of a primary cardiac non-Hodgkin lymphoblastic lymphoma with this unusual site of origin and rare manifestation of symptoms.
We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care.
We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action. Their diagnostic work up has largely changed in recent years. This review provides an update on diagnostic developments and their potential therapeutic impact. This is a systematic review of the literature.
In recent years, changes in epidemiology-based prognostic factors such as human papilloma virus HPV cancers, advances in imaging and minimally invasive surgery have been integrated in the management of cervical lymphadenopathies of unknown primary. In particular, systematic use of PET scanner and increasing practice of robotic or laser surgery have contributed to increasing detection rate of primary cancers. These allow more adapted and personalized treatments. The impact of changes in the eighth TNM staging system is discussed.
On the other hand, practice changes will have to be assessed. Purpose: Conventional therapy for cervical node squamous cell carcinoma metastases from an unknown primary can cause considerable toxicity owing to the volume of tissues to be irradiated. In the present study, hypothesizing that using intensity-modulated radiotherapy IMRT would provide effective treatment with minimal toxicity, we reviewed the outcomes and patterns of failure for head-and-neck unknown primary cancer at a single tertiary cancer center.
Anderson Cancer Center between and A total of 26 patients had undergone neck dissection, 13 before and 13 after IMRT; 14 patients had undergone excisional biopsy and presented for IMRT without evidence of disease. Finally, 14 patients had received systemic chemotherapy. All patients underwent IMRT to targets on both sides of the neck and pharyngeal axis.
The median follow-up time for the surviving patients was 3. Only 3 patients developed distant metastasis with locoregional control. Conclusion: The results of our study have shown that IMRT can produce excellent outcomes for patients who present with cervical node squamous cell carcinoma metastases from an unknown head-and-neck primary tumor. Severe late complications were uncommon.
Intensity-modulated radiotherapy for cervical node squamous cell carcinoma metastases from unknown head-and-neck primary site: M. Anderson Cancer Center outcomes and patterns of failure. Conventional therapy for cervical node squamous cell carcinoma metastases from an unknown primary can cause considerable toxicity owing to the volume of tissues to be irradiated. We retrospectively reviewed the records of 52 patients who had undergone IMRT for an unknown primary at M. The patient and treatment characteristics were extracted and the survival rates calculated using the Kaplan-Meier method.
The results of our study have shown that IMRT can produce excellent outcomes for patients who present with cervical node squamous cell carcinoma metastases from an unknown head-and-neck primary tumor. The visual system is confronted with rapidly changing stimuli in everyday life. It is not well understood how information in such a stream of input is updated within the brain. We performed voltage-sensitive dye imaging across the primary visual cortex V1 to capture responses to sequences of natural scene contours.
We presented vertically and horizontally filtered natural images, and their superpositions, at 10 or 33 Hz. At low frequency, the encoding was found to represent not the currently presented images, but differences in orientation between consecutive images. This was in sharp contrast to more rapid sequences for which we found an ongoing representation of current input, consistent with earlier studies. Our finding that for slower image sequences, V1 does no longer report actual features but represents their relative difference in time counteracts the view that the first cortical processing stage must always transfer complete information.
Instead, we show its capacities for change detection with a new emphasis on the role of automatic computation evolving in the ms range, inevitably affecting information transmission further downstream. Primary angioplasty: the past, the present and the future. Primary angioplasty PTCA in acute myocardial infarction has many theoretical advantages including better antegrade flow and reduced intracranial haemorrhage. However the improvement in the mortality and morbidity of primary angioplasty in the randomized trials from sophisticated centres has not been translated to the community setting.
Primary PTCA is a suitable alternative to thrombolytic therapy if performed in a timely fashion by persons skilled in the procedure in a suitable laboratory. It is also recommended in patients with cardiogenic shock and in those with contraindications to thrombolytic therapy. The images thus obtained were analyzed with visual and semi-quantitative methods.
The false positive rate was 8. Purpose: The management of patients with cervical lymph-node metastases from unknown primary site UPS remains a matter of discussion. This study aimed to analyze the results and prognostic factors in a series of patients treated with radiotherapy. Methods and Materials: Data from patients who presented with cervical lymph nodes metastases from UPS treated from to were reviewed. Eighty-seven patients Ninety-one patients were treated with curative and 22 with palliative intent.
Fifty-nine of patients Twenty-one patients Results: The 5-year overall survival rates were The occurrence of the occult primary was observed in 23 of patients At multivariate analysis, treatment with curative intent and extensive irradiation of bilateral neck and pharyngeal mucosa were favorable prognostic factors for the whole series, and treatment with curative intent, extensive irradiation of bilateral neck and pharyngeal mucosa, and absence of extracapsular spread were favorable prognostic factors for the SCC subgroup.
Conclusions: Patients with cervical lymph node metastases from UPS have a similar prognosis to those affected by other head and neck malignancies. Curative treatment strategies including neck dissection and extensive irradiation by three-dimensional conformal radiation therapy resulted in significantly better outcomes.
Primary breast lymphoma presenting as non-healing axillary abscess. A year-old woman with non-insulin dependent diabetes mellitus with a history consistent with a right axillary abscess, presented to her general practitioner GP. A diagnosis of folliculitis was made and the GP started a course of flucloxacillin. Despite antibiotics, the patient's symptoms worsened and the abscess increased in size. This prompted her GP to perform an incision and drainage procedure of the abscess.
The practice nurse subsequently oversaw the follow-up care of the wound. Two months after the incision and drainage, and after regular wound dressing, the patient was referred to the acute surgical team with a complicated, non-healing right axillary abscess cavity and associated generalised right breast cellulitis. There was no history of breast symptoms prior to the onset of the axillary abscess.
The patient underwent wound debridement, washout and application of negative pressure vacuum therapy. Biopsies revealed primary breast lymphoma B-cell. She underwent radical chemotherapy and is currently in remission. Spontaneous haemothorax: an unusual presentation of primary lung cancer. An unusual case of spontaneous haemothorax caused by a subpleural primary lung cancer is reported.
Tumour invasion of the pulmonary vessels and visceral pleura was the possible cause. A year-old man presented with fever of unknown origin and renal dysfunction. Laboratory examination revealed anemia, thrombocytopenia, hypoalbuminemia, proteinuria, and elevations of C-reactive protein, lactic dehydrogenase, creatinine and ferritin. Based on the imaging study, renal biopsy was performed and histological diagnosis of intravascular large B-cell lymphoma IVLBCL was made.
Explores the characteristics of social interaction during an English language based task in the primary classroom, and the role of the computer in structuring collaboration when compared to a non-computer mode. We describe fever of unknown origin FUO in a year-old woman with hepatosplenomegaly. The diagnostic workup was directed at diagnosing a lymphoma. Her history of travel and exposures to food and water did not make typhoid fever a likely diagnostic possibility.
Because she presented with prolonged fevers, fatigue, anorexia, weight loss, and night sweats with hepatosplenomegaly, lymphoma was likely. Initially, Epstein-Barr virus EBV was not considered because of her age, the absence of pharyngitis and cervical adenopathy, and the higher likelihood of another diagnosis, ie, lymphoma. All of her symptoms as well as her clinical and laboratory findings resolved spontaneously. Epidemiology of paediatric presentations with musculoskeletal problems in primary care.
Musculoskeletal disease is a common cause of morbidity, but there is a paucity of musculoskeletal research focusing on paediatric populations, particularly in primary care settings. In particular, there is limited information on population consultation frequency in paediatric populations, and frequency varies by age and sex.
Few studies have examined paediatric musculoskeletal consultation frequency for different body regions. The objective was to determine the annual consultation prevalence of regional musculoskeletal problems in children in primary care. Musculoskeletal codes within the Read morbidity Code system were identified and grouped into body regions. Consultations for children aged three to seventeen in containing these codes were extracted from recorded consultations at twelve general practices contributing to a general practice consultation database CiPCA.
Annual consultation prevalence per 10, registered persons for the year was determined, stratified by age and sex, for problems in individual body regions. Annual consultation prevalence for any musculoskeletal problem was significantly higher in males than females male: female prevalence ratio 1. Annual consultation prevalence increased with age and the most common body regions consulted for were the foot, knee and back all of which had over consultations , and respectively per 10, persons per year.
This study provides new and detailed information on patterns of paediatric musculoskeletal consultations in primary care. Musculoskeletal problems in children are varied and form a significant part of the paediatric primary care workload. The findings of this study may be used as a resource for planning future studies. Current strategies are based on retrospective studies, clinical experience, and institutional policies. Frequency distributions of responses for each question were calculated.
The data were also analyzed by type of practice. Statistically significant differences between universities and institutions and clinics and practices could be found with respect to positron emission tomography-computed tomography PET-CT utilization, indications for chemotherapy, radiotherapy volumes, and cumulative doses. Diplopia as the primary presentation of foodborne botulism. Foodborne botulism is a serious condition caused by Clostridium botulinum neurotoxin.
Clinically, botulism presents as bilateral cranial nerve neuropathy and descending paralysis. We report a unique presentation of botulism to remind clinicians of this potentially fatal condition. In this observational case report initial evaluation showed only esodeviation. This progressed to unilateral cranial nerve six CN VI paresis along with systemic signs. Clinical diagnosis was made based on in-depth history and concurrent symptoms in three other patients.
Foodborne botulism presenting as diplopia and unilateral motility deficits is rare and can represent a diagnostic and therapeutic challenge to the ophthalmologist. We report a year-old woman who presented to our facility in a hypertensive crisis. Computed tomography CT revealed a thoracic aortic tumor, and tissues obtained via endovascular biopsy revealed undifferentiated sarcoma. A final diagnosis of intimal sarcoma was made by intra-operative pathological examination.
Despite undergoing surgical resection followed by adjuvant chemotherapy, the patient died from progressive multiple metastasis and severe sepsis. Although aortic sarcoma is rarely diagnosed, it should be considered a possible etiology of hypertensive crisis.
Aortic tumor; Endovascular biopsy; Hypertension crisis; Intimal sarcoma. Patterns of care and survival after a cancer of unknown primary CUP diagnosis: A population-based nested cohort study in Australian Government Department of Veterans' Affairs clients.
Little is known about patterns of care after a cancer of unknown primary CUP diagnosis. We performed a retrospective cohort study to describe and compare the treatment, health service use and survival of patients with CUP and metastatic cancer of known primary among , Australian Government Department of Veterans' Affairs clients, We ascertained health services from the month of diagnosis up to 2 months post-diagnosis for consultations, hospitalizations and emergency department visits, and up to 1 year for treatment.
We compared cancer treatments using conditional logistic regression; consultation rates using negative binomial regression; and survival using stratified Cox regression. Patients with CUP receive less treatment but use more health services, which may reflect underlying patient and disease characteristics.
Patients received IMRT to the potential primary tumour sites and elective cervical nodes. Concomitant chemotherapy was used in patients who received primary radiotherapy or those with nodal extracapsular extension. Twenty-five patients Two year mucosal and local nodal control rates were One mucosal primary was detected 7.
At a median follow-up of Destination Unknown. Explores how, for college students, the events of September 11, , have changed everything; the new directions they have taken vary as much as they do. Presents profiles of several students with differing perspectives. Patient characteristics associated with self- presentation , treatment delay and survival following primary percutaneous coronary intervention. This was a retrospective observational study. STEMI patients included numbered ; Married patients OR 1.
Unmarried females waited longest to call for help OR vs. Married patients had a borderline association with lower mortality hazard ratio 0. Unmarried female patients had the longest treatment delays. Married patients and those living closer to an Emergency Room self- present more frequently.
Early and exclusive use of the ambulance service may reduce treatment delay and improve STEMI outcome. Unusual presentation of anaplastic large cell lymphoma with clinical course mimicking fever of unknown origin and sepsis: autopsy study of five cases. To describe a subset of cases with the unusual clinical and histomorphological presentation of anaplastic large cell lymphoma ALCL mimicking fever of unknown origin FUO and sepsis. Of those, five cases that did not have a correct premortem diagnosis were further analyzed to elucidate the reasons for delayed and incorrect pre-mortem diagnosis.
The analyzed data included clinical presentation , duration of symptoms, duration of hospital stay, premortem presumed cause of death, white blood cell count, platelet count, anion gap and blood pH, liver enzymes alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase , lactate, coagulation tests prothrombin time, partial thromboplastin time, fibrinogen, D-dimers , microbiology cultures, and radiology and surgical pathology reports.
Autopsy reports were reviewed for description of major gross findings, initial clinical diagnosis, and cause of death. Five fatal and pre-mortem unrecognized ALCL cases were characterized by rapid decline, with histologic findings showing predominantly extranodal involvement, intravascular lymphomatosis, and hemophagocytosis.
The cases were also characterized by unusual clinical manifestations including a FUO, sepsis, and disseminated intravascular coagulation-like picture, lactic acidosis, hepatosplenomegaly, and absence of significant peripheral adenopathy. There is a distinct group of ALCLs with unique and specific clinical, gross autopsy, and histopathologic findings. Recognition of this clinical variant may facilitate early detection and potentially timely diagnosis and therapy.
Patients with spinal metastasis from cancer of unknown primary origin have limited life expectancy and poor quality of life. Surgery and radiation therapy remain the main treatment options, but, to our knowledge, there are limited data concerning quality-of-life improvement after surgery and radiation therapy and even fewer data on whether surgical intervention would affect quality of life.
The quality of life of 2 patient groups one group that underwent surgery followed by postoperative radiation therapy and one group that underwent radiation therapy only was assessed by the Functional Assessment of Cancer Therapy-General FACT-G questionnaire during a 6-month period. A subgroup analysis of quality of life was performed to compare different surgical strategies in the surgical group. A total of patients, including patients in the group that underwent surgery and 96 patients in the group that underwent radiation therapy only, were enrolled in the prospective study; patients completed all 5 checkpoints and patients had died by the final checkpoint.
The surgery group had significantly higher adjusted quality-of-life scores than the radiation therapy group in each domain of the FACT-G questionnaire all p unknown primary origin in the 6-month assessment. In terms of surgical strategies, circumferential decompression seems better than laminectomy alone in quality-of-life improvement.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Background Neuroendocrine tumours NETs are rare, heterogeneous group of tumours which usually originate from small, occult primary sites and are characterized by over-expression of somatostatin receptors SSTRs.
Out of them, 68 patients 45 males, 23 females; mean age, Quantitative estimation of SSTR expression in the form of maximal standardized uptake value SUVmax of detected primary and metastatic sites was calculated. Follow-up data of individual patients was collected through careful survey of hospital medical records and telephonic interviews. Identified primary sites were: small intestine , rectum , pancreas , stomach , lung  and one each in rare sites in kidney and prostate.
In one patient, 2 primary sites were identified one each in stomach and duodenum. Mean SUVmax of the detected primary sites was. Combined p16 and p53 expression in cervical cancer of unknown primary and other prognostic parameters : A single-center analysis. Cervical cancer of unknown primary CUP represents an uncommon and heterogeneous subentity of head and neck cancer. However, both optimal diagnostics and therapy remain unclear.
An improved understanding of the underlying pathology is essential to enable future tailored therapies and optimized outcomes. All patients have received radiotherapy between and Preradiotherapy involved lymph node specimens were analyzed for p16 and p53 immunoreactivity. Median patient age was After a median follow up of The combined p and pexpression status in cervical metastases of CUP may represent a simple method for risk stratification. Further validation of these biomarkers in large prospective trials is essential to design rational trials for CUP treatment optimization.
Prevalence of urinary tract infection UTI in sequential acutely unwell children presenting in primary care: exploratory study. Due to the non-specific nature of symptoms of UTI in children and low levels of urine sampling, the prevalence of UTI amongst acutely ill children in primary care is unknown.
To undertake an exploratory study of acutely ill children consulting in primary care, determine the feasibility of obtaining urine samples, and describe presenting symptoms and signs, and the proportion with UTI. Exploratory, observational study. Four general practices in South Wales. A total of 99 sequential attendees with acute illness aged less than five years.
GPs indicated they would not normally have obtained urine samples in any of these three children. However, all had received antibiotics for suspected alternative infections. Urine sample collection is feasible from the majority of acutely ill children in primary care, including infants. Some cases of UTI may be missed if children thought to have an alternative site of infection are excluded from urine sampling. A larger study is needed to more accurately determine the prevalence of UTI in children consulting with acute illness in primary care, and to explore which symptoms and signs might help clinicians effectively target urine sampling.
Carcinoma of Unknown Primary—Patient Version. Carcinoma of unknown primary CUP occurs when cancer cells have spread in the body and formed metastatic tumors but the site of the primary cancer is not known. There are a number of reasons why the primary cancer may not be found. Start here to find treatment information for carcinoma of unknown primary.
Age-related variation in primary care-type presentations to emergency departments. A significant amount of attention has been paid to the increase in emergency department ED presentations in Australia. Questions have arisen regarding whether all of those presenting to the ED are actually in need of true emergency services. Under-standing the characteristics of those patients who may be cared for in non-emergency settings is important for future health system strategies.
The aim of this study was to identify age-related variation in primary care type emergency department ED presentations over time. A secondary analysis of data from the Victorian emergency minimum dataset VEMD between was conducted. The main outcomes were patterns of primary care type ED presentations for different ages groups over time, age-specific patterns of specific primary care type exclusion criteria and primary care type ED presentations by residents from aged care facilities.
The proportion of triage category 4 or 5 ED presentations that met the criteria for a primary care type visit was greatest in the year age group and tended to decrease as the age of the patient increased. The greater proportion of residential aged care facility patients who arrived by ambulance resulted in a much smaller proportion of primary care type visits.
There are marked differences by age in the proportion of triage category 4 or 5 ED presentations that met the criteria for primary care type visits. These results indicate it was primarily younger patients who presented to the ED with non-urgent conditions.
Most might be able to safely receive care in a primary care setting. Kottschade, Lisa A. A subset of patients with melanoma present in rare and unique clinical circumstances requiring specific considerations with respect to diagnostic and therapeutic interventions. Herein we present our review of patients with: 1 primary mucosal melanoma of the head and neck, gastrointestinal and genitourinary tracts; 2 primary melanoma of the eye; 3 desmoplastic melanoma; 4 subungual melanoma; 5 melanoma in special populations: children, non-Caucasians, as well as a discussion of familial melanoma.
Primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele: a case report. Introduction Primary pulmonary mucinous cystadenocarcinoma is a rare variety of lung cancer. It is characterized pathologically by copious mucin production predominantly in the extracellular space. This tumour has a remarkably favorable prognosis. Case presentation We present imaging and histopathological findings of primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele in a year-old Caucasian woman.
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