Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis in an Immunocompetent Patient.

Peritoneal tuberculosis (TB) is a rare disease among the general population that can be seen in patients with associated immunocompromised conditions such as diabetes mellitus, human immunodeficiency virus (HIV)-positive patients, patients with liver cirrhosis, patients on peritoneal dialysis, and patients on treatment with anti-tumor necrosis factor (TNF) agents. Patients who already have active pulmonary TB and who are not treated promptly can develop disseminated disease within the lungs or can affect extrapulmonary organ systems such as the nervous system, gastrointestinal system, or urinary system. It is unusual to see an otherwise healthy person develop peritoneal TB as a first-time diagnosis, without any previous exposure to TB or any immunocompromising condition. The diagnosis of this condition can be tricky as the clinical and radiological manifestations of this disease strongly mimic that of malignancy, such as ovarian cancer or peritoneal carcinomatosis. In the majority of cases, the first impression of malignancy is made while examining the radiological images of the abdomen, and only after obtaining the biopsy results, an unexpected diagnosis of peritoneal TB is established. Hence, it is an interesting and uncommon diagnosis, which should always be kept in mind while managing patients with an apparent gynecological malignancy. Here, we report a case of a 65-year-old female patient who presented with a history of abdominal pain and weight loss. Initial investigation with abdominal ultrasonography revealed ascites with multiple sub-centimeter mesenteric lymphadenopathies. She also had an elevated cancer antigen 125 (CA-125), which further raised suspicion of gynecological malignancy. However, following the investigations, it was found that the actual diagnosis was an unexpected one.

Docetaxel and irinotecan as first-line chemotherapy in patients with advanced non-small-cell lung cancer: a pilot study.

AIMS: The aim of this study is to evaluate the activity and toxicity of the combination docetaxel and irinotecan as first-line therapy for advanced non-small-cell lung cancer (NSCLC). MATERIALS & METHODS: Twenty-two chemotherapy-naive patients with stage IIIB with pleural effusion or stage IV NSCLC received irinotecan 50 mg/m2 on days 1, 8, and 15, and docetaxel 50 mg/m2 on day 2, every 28 days until disease progression. RESULTS: Median follow-up was 10 months (range: 2-28 months). The overall response rate was 36.4% (8/22 patients; 95% confidence interval: 16.8-56.0), with no complete responses. Median time to disease progression was 5 months (range: 1-24 months) and median overall survival was 10 months (range: 2-28). Grade 3-4 diarrhea was observed in 2 patients (9.1%). Grade 3-4 neutropenia occurred in 2 patients (9.1%): 1 episode of febrile neutropenia in one patient, and 1 death due to neutropenic sepsis in another patient. One patient received transfusion for grade 4 anemia. CONCLUSIONS: Irinotecan showed a moderate response rate and overall survival of clinical interest. Diarrhea was the main toxicity. This regimen may be suitable for patients unable to tolerate cisplatin-based therapy, for elderly and/or for patients with poor performance status, and should be investigated in a larger trial.

Vascular endothelial growth factor family of ligands and receptors: review.

VEGF signaling often represents a critical rate-limiting step in physiological angiogenesis. The VEGF family comprises seven secreted glycoproteins that are designated VEGF-A, VEGF-B, VEGF-C, VEGF-D, VEGF-E, placental growth factor (PlGF) and VEGF-F. The VEGF family members bind their cognate receptors. The receptors identified so far are designated VEGFR-1, VEGFR-2, VEGFR-3 and the neuropilins (NP-1 and NP-2). We review in this article the biology of the VEGF ligands and the receptors.

Understanding the biology of angiogenesis: review of the most important molecular mechanisms.

Angiogenesis is an important process for forming new blood vessels. It is fundamental in many biological processes including development, reproduction and wound repair. Under these conditions, angiogenesis is a highly regulated process. Numerous inducers of angiogenesis have been identified, including the members of the vascular endothelial growth factor family, angiopoietins, transforming growth factors, platelet-derived growth factor, tumor necrosis factor-alpha, interleukins and members of the fibroblast growth factor family. Vascular endothelial growth factor-A is the most potent pro-angiogenic protein described to date. It induces proliferation, sprouting and tube formation of endothelial cells. Angiogenesis is therefore a putative target for therapy. The potential application of different angiogenesis inhibitors is currently under intense clinical investigation. A better understanding of the biology of angiogenesis may reveal new targets for treating many diseases that are associated with this complex process. In this review, we summarize the most important molecular mechanisms mediating angiogenesis.

Combined ovarian ablation and aromatase inhibition as first-line therapy for hormone receptor-positive metastatic breast cancer in premenopausal women: report of three cases.

Aromatase inhibitors have become well established for the treatment of postmenopausal women with hormone receptor-positive metastatic breast cancer and for adjuvant hormonal therapy for primary breast cancer. Benefit of aromatase inhibition has not yet been extended to premenopausal women. Ovarian ablation by oophorectomy, ovarian radiation or hormonal suppression is the initial recommended treatment for hormone receptor-positive metastatic breast cancer in premenopausal women. The addition of tamoxifen improves the benefit of ovarian ablation/ovarian suppression. Addition of aromatase inhibitors to luteinizing hormone-releasing hormone analogs has been reported to significantly decrease circulating estrogens and produce tumor responses in only a very small number of patients over the last 15 years. We treated three premenopausal patients with hormone receptor-positive metastatic breast cancer with combined oophorectomy or ovarian irradiation and anastrozole. One patient remained free of progression for 4 years, while the other two remained free of progression for more than 5 and 3 years, respectively. We also note that monthly zoledronic acid for 4 years produced sclerosis of vertebral body metastasis. We conclude that combined ovarian ablation and aromatase inhibition is a feasible treatment modality that deserves more attention and further investigation for hormone receptor-positive metastatic breast cancer in premenopausal women.