In silico design of a novel multi-epitope vaccine against HCV infection through immunoinformatics approaches.

Infection with the hepatitis C virus (HCV) is one of the causes of liver cancer, which is the world's sixth most prevalent and third most lethal cancer. The current treatments do not prevent reinfection; because they are expensive, their usage is limited to developed nations. Therefore, a prophylactic vaccine is essential to control this virus. Hence, in this study, an immunoinformatics method was applied to design a multi-epitope vaccine against HCV. The best B- and T-cell epitopes from conserved regions of the E2 protein of seven HCV genotypes were joined with the appropriate linkers to design a multi-epitope vaccine. In addition, cholera enterotoxin subunit B (CtxB) was included as an adjuvant in the vaccine construct. This study is the first to present this epitopes-adjuvant combination. The vaccine had acceptable physicochemical characteristics. The vaccine's 3D structure was predicted and validated. The vaccine's binding stability with Toll-like receptor 2 (TLR2) and TLR4 was confirmed using molecular docking and molecular dynamics (MD) simulation. The immune simulation revealed the vaccine's efficacy by increasing the population of B and T cells in response to vaccination. In silico expression in Escherichia coli (E. coli) was also successful.

Network-base approaches to identify therapeutic biomarkers in hepatocellular carcinoma and search for drug hunting utilizing molecular dynamics simulations.

The presence of conditions like Alpha-1 antitrypsin deficiency, hemochromatosis, non-alcoholic fatty liver diseases and metabolic syndrome can elevate the susceptibility to hepatic cellular carcinoma (HCC). Utilizing network-based gene expression profiling via network analyst tools, presents a novel approach for drug target discovery. The significance level (p-score) obtained through Cytoscape in the intended center gene survival assessment confirms the identification of all target center genes, which play a fundamental role in disease formation and progression in HCC. A total of 1064 deferential expression genes were found. These include MCM2 with the highest degree, followed by 4917 MCM6 and MCM4 with a 3944-degree score. We investigated the regulatory kinases involved in establishing the protein-protein interactions network using X2K web tool. The docking approach yields a favorable binding affinity of -8.7 kcal/mol against the target MCM2 using Auto-Dock Vina. Interestingly after simulating the complex system via AMBER16 package, results showed that the root mean square deviation values remained within 4.74 Å for a protein and remains stable throughout the time intervals. Additionally, the ligand's fit to the protein exhibited fluctuations at some intervals but remains stable. Finally, Gibbs free energy was found to be at its lowest at 1 kcal/mol which presents the real time interactive binding of the atomic residues among inhibitor and protein. The displacement of the ligand was measured showing stable movement and displacement along the active site. These findings increased our understanding for potential biomarkers in hepatocellular carcinoma and an experimental approach will further enhance our outcomes in future.Communicated by Ramaswamy H. Sarma.

Clinicopathological Features and Treatment Outcomes of Male Breast Cancer in Pakistani Population: A 10-Year Retrospective Cross-Sectional Study.

Background: Male breast cancer (MBC) accounts for 1% of global breast cancer cases. On account of its rarity, very few prospective clinical trials have been carried out on MBC. Pakistan has the highest incidence of breast cancer in Asia, but very limited data are available on MBC. Objectives: The objective is to determine the clinicopathological characteristics and treatment patterns of MBC in Pakistani population. Design: This is a retrospective cross-sectional study. Methods: A retrospective cross-sectional study carried out using the cancer database of Shaukat Khanum Memorial Cancer Hospital & Research Center. Men with a histologically proven breast cancer, stage 0 to III disease and requiring surgical intervention were included. The Kaplan-Meier curve and log-rank test were used for survival analysis. Results: Sixty-eight patients with MBC were included with a median age at diagnosis of 55 years. Most patients were stage II (47.1%). Invasive ductal carcinoma (IDC) was the commonest type (89.7%). Estrogen receptor (ER), progesterone receptor (PR), and Her-2 receptor positivity were 92.6%, 86.8%, and 32.4%, respectively. Mastectomy was performed in 95.6% of the cases. Neoadjuvant and adjuvant chemotherapy was administered in 25 (36.8%) and 26 (38.2%) patients, respectively. Fifty-five (80.9%) patients received adjuvant radiotherapy. Most of the patients (89.7%) received tamoxifen. The 5-year overall and disease-free survival was 88.2% and 80.9%, respectively. Patients receiving neoadjuvant chemotherapy had a better overall and disease-free survival (P = .025). Conclusions: Male breast cancer occurs at a relatively earlier age in Pakistani population as compared with Western men. Mastectomy is the preferred surgical option for MBC on account of the advanced disease and delayed presentation. Neoadjuvant chemotherapy has a statistically significant effect on overall and disease-free survival, but in spite of these benefits, it remains underutilized.

Impact of SSO-ASTRO Margin Guidelines on Re-excision Rate in Breast-conserving Surgery: A Single-center Experience.

Introduction: Breast-conserving surgery (BCS) has been historically linked with a high rate of re-excision. To address this issue, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines in 2014 to standardize practices and improve clinical outcomes for BCS patients. In our tertiary cancer care hospital, we assessed the impact of these guidelines on the re-excision rate following BCS. Materials and Methods: We conducted a retrospective study on breast cancer patients who underwent BCS at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan. The study compared the re-excision rate before the implementation of the SSO-ASTRO consensus guidelines (November 2015-July 2017) and after the implementation (January 2018-August 2019). Margins were considered positive if "ink on tumor" was present and negative if "no ink on tumor" was present. Fisher's exact test or Chi-square test was used to compare the re-excision rates between the pre- and post-guideline periods. Results: A total of 919 patients were identified, with 533 from the pre-guideline period and 386 from the post-guideline period. Of the 919 patients, 31 with ductal carcinoma in situ (DCIS) were excluded from the re-excision analysis because the guidelines were not implemented on the DCIS. Furthermore, the overall rate of re-excision in our data was 4.3%. The re-excision rate decreased from 71.1% to 28.9% (P ≤ 0.05) following the adoption of the guidelines. We observed a statistically significant decrease in the re-excision rate after implementing the SSO-ASTRO guidelines. Conclusion: Implementation of the SSO-ASTRO margin guidelines led to a notable decrease in the overall re-excision rate in our data set. These findings suggest that continued adherence to the guidelines may lead to a further reduction in the re-excision rate in the future.

Integrative approach for women with fibromyalgia in a Veterans Affairs Medical Center: An observational study.

Fibromyalgia, a complex condition characterized by widespread musculoskeletal pain, presents a significant burden on individuals and healthcare systems. This observational study aims to explore the potential of an outpatient integrative care model for the management of fibromyalgia in women, focusing on personalized goals, patient education, non-pharmaceutical treatments, and lifestyle modifications. The primary objective is to assess patient satisfaction and its correlation with pain, quality of life, depression, and post-traumatic stress disorder (PTSD) symptoms. This pilot study seeks to determine the effectiveness of this model in the alleviation of fibromyalgia-related pain and the improvement of overall well-being. Twenty-five women diagnosed with fibromyalgia participated in a 14-week outpatient treatment program at a Veterans Affairs Medical Center, involving weekly patient-directed, integrative group visits and health coaching. Pre- and post-evaluation questionnaires were administered to assess patient satisfaction, patients' subjective sense of empowerment in the management of fibromyalgia, and symptom improvement (i.e., pain, quality of life, depression, and PTSD). In addition, the study evaluated the correlation of patient empowerment with symptom improvement. The integrative care model received high patient satisfaction, with a mean score of 8.04 out of 10. Significant pain reduction was observed based on the Numeric Rating Scale (n = 22, P < .001). Quality of life showed significant improvement according to the Fibromyalgia Impact Questionnaire (n = 24, P = .01). Furthermore, depression symptoms improved significantly, as assessed by Patient Health Questionnaire (n = 24, P = .04). However, there was no statistically significant change in PTSD scores (n = 22, P = .3). Patient empowerment was strongly correlated with pain reduction (n = 25, r = .78, P < .001), quality of life (n = 25, r = .57, P < .001), and improvement in depression symptoms (n = 22, r = .50, P = .004). Pairwise deletion was used for each outcome. This integrative care model demonstrated promising results in effectively managing fibromyalgia-related pain and enhancing quality of life and depression symptoms in women. This model presents a feasible and potentially effective treatment approach for fibromyalgia. Further research with larger sample sizes and control groups is warranted to validate these findings and encourage broader implementation.

A novel therapeutic approach to prevent Helicobacter pylori induced gastric cancer using networking biology, molecular docking, and simulation approaches.

Helicobacter pylori infects 50% of the world population and in 80% of cases, the infection progresses to the point where an ulcer develops leading to gastric cancer (GC). This study aimed to prevent GC by predicting Hub genes that are inducing GC. Furthermore, the study objective was to screen inhibitory molecules that block the function of predicted genes through several biophysical approaches. These proteins, such as Mucin 4 (MUC4) and Baculoviral IAP repeat containing 3 (BIRC3), had LogFC values of 2.28 and 3.39, respectively, and were found to be substantially expressed in those who had H. pylori infection. The MUC4 and BIRC3 inhibit apoptosis of infected cells and promote cancerous cell survival. The proteins were examined for their Physico-chemical characteristics, 3D structure and secondary structure analysis, solvent assessable surface area (SASA), active site identification, and network analysis. The MUC4 and BIRC3 expression was inhibited by docking eighty different compounds collected from the ZINC database. Fifty-seven compounds were successfully docked into the active site resulting in the lowest binding energy scores. The ZINC585267910 and ZINC585268691 compounds showed the lowest binding energy of -8.5 kcal/mol for MUC4 and -7.1 kcal/mol for BIRC3, respectively, and were considered best-docked solutions for molecular dynamics simulations. The mean root mean square deviation (RMSD) value for the ZINC585267910-MUC4 complex was 0.86 Å and the ZINC585268691-BIRC3 complex was 1.01 Å. The net MM/GBSA energy value of the ZINC585267910-MUC4 complex estimated was -46.84 kcal/mol and that of the ZINC585268691-BIRC3 complex was -44.84 kcal/mol. In a nutshell, the compounds might be investigated further as an inhibitor of the said proteins to stop the progress of GC induced by H. pylori.Communicated by Ramaswamy H. Sarma.

MRI Features of Synchronous Masses in Known Breast Cancer Patients in Predicting Benign Versus Malignant Lesions: A Case Based Review at Tertiary Care Cancer Hospital.

Sara RehmanObjectives The purpose of this study was to determine the diagnostic accuracy of breast magnetic resonance imaging (MRI) in classifying incidental satellite masses in biopsy-proven breast cancer patients as benign or malignant masses and assessing its impact on surgical management of these patients. We also analyzed the incidence of MRI-detected lesions, which were thereafter assessed with second look ultrasound (US). Materials and Methods A retrospective study was performed on breast cancer patients presenting from August 01, 2016 to July 31, 2019, with satellite masses seen on base line MRI. Satellite masses were classified as benign and malignant based on MRI features of shape, margin, T2-weighted imaging signals, internal enhancement pattern, enhancement kinetic curves, and diffusion restriction. This was compared with results of histopathological examination. The number of MRI-detected lesions, location of the satellite mass, and type of surgery were also documented. Results Out of 400 breast cancer patients undergoing MRI breast, 115 patients had multiple masses. Histopathological diagnosis was available for 73 patients; and a total of 93 satellite masses were evaluated. There was evidence of additional masses on second look ultrasound in 21 patients. Of 72 masses classified as malignant on MRI, 58 showed malignant pathological outcome; while out of 21 masses characterized as benign on MRI, 18 turned out to be benign on histopathology. A statistically significant association was found between MRI features and pathological outcome of satellite masses ( p = 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy were 95%, 56%, 80.56%, 85.7% and 81.7%, respectively. Based on these findings, modified radical mastectomy (MRM)/mastectomy was done for 42 patients, 5 patients underwent lumpectomy limited to a single tumor, extended resection done for 14 patients, 5 underwent bilateral breast conservation surgery (BCS), BCS for contralateral breast done for 4 patients undergoing ipsilateral MRM/mastectomy, and bilateral MRM/mastectomies were performed for 2 patients. One patient was lost to follow up. Conclusion Breast MRI is the most sensitive modality for the assessment of breast cancer and plays an essential role in the detection of additional tumor foci. These findings can modify the surgical approach in these patients. However, considering the low specificity, biopsy of satellite masses is imperative to determine the most appropriate surgical plan.

Is complete pathological response truly a complete response in breast cancer?

OBJECTIVE: To check if complete pathological response in breast cancer is a good prognostic factor. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2012 to December 2015 of all patients who received neo-adjuvant chemotherapy and had no distant metastasis at diagnosis. Mastectomy patients were excluded. Complete pathological response was defined as no detectable tumour cell in breast and axilla on pathological examination of the resected specimen. Tumour characteristics and 5-year disease free survival and overall survival were recorded. Data was analysed using SPSS 20. RESULTS: Of the 353 patients whose data was evaluated, 91(25.8%) had complete pathological response. Mean age at diagnosis was 43±10 years. Among them, 62(68%) patients had grade III tumour, 39(42.9%) were negative for oestrogen receptor, 58(63.7%) were negative for progesterone receptor, 25(27.5%) were positive for human epidermal growth factor receptor 2, and 26(28.6%) patients were triple negative. Overall, 28((30.7%) patients had recurrence; 20(71.4%) had distant metastasis, 6(21.4%) had local recurrence, and 2(7.14%) had contralateral cancer. The 5-year disease-free survival and overall survival rates (Kaplan-Meier Survial curve) were 70% (28 patients-recurrence) and 87% (15 patients-deaths), respectively. Conclusion: Despite complete disappearance of tumour, a significant number of patients developed recurrences.

Papillary Carcinoma of Breast: Clinicopathological Characteristics, Management, and Survival.

Objective: To study clinicopathological features, treatment strategies, and prognosis of papillary carcinoma of breast. Material and Methods. Data from 58 patients were retrospectively reviewed from January 2010 to December 2016. Four types of papillary carcinoma (on final resected specimen) were included, i.e., invasive papillary carcinoma (IPC), intracystic (encapsulated) papillary carcinoma (EPC), solid papillary carcinoma (SPC), and papillary DCIS (ductal carcinoma in situ). Various features of the four types were observed and compared. Results: Of the 58 patients, 8 were males (13.7%). The mean age at presentation was 61 years; the mean tumor size was 33 mm. The frequency of each histological type was as follows: IPC (n = 22/38%), EPC (n = 22/38%), SPC (n = 12/20.6%), and papillary DCIS (n = 2/3.4%). Only two patients were ER negative (both IPC). HER-2 Neu was positive in 3 patients only, out of which 2 died of progressive disease (one EPC and one IPC). LN metastasis was present in 3 (5%) patients (one in each of 1st three types) and only one died of bone metastasis that was also Her-2Neu positive. All patients underwent upfront surgery except two patients who had synchronous IDC on the contralateral side. Breast conservation surgery (BCS) was performed in 34 (58.6%) and mastectomy in 22 (37.9%) patients. 13 patients did not undergo invasive axillary staging; the rest of 43 (74%) patients did (32 sentinel biopsy and 11 axillary dissection). Chemotherapy was given to 18 patients (31%), mostly to IPC (n = 12). Only 2 patients had bone metastasis (one was IPC and one EPC). Cancer-related death was observed in 3 patients. For all groups combined, 5-year OS was 98% and DFS was 92%. Conclusion: Overall, papillary carcinoma of the breast has an excellent prognosis, even though less intense treatment modalities were used. It is still difficult to define the optimum management and avoid overtreatment, given the limited data in the literature.

Correlation of Breast Density Grade on Mammogram With Diagnosed Breast Cancer: A Retrospective Cross-Sectional Study.

Objective The objective of this study is to determine any association between mammographic density (MD) and breast cancer in Pakistani population. The study will also investigate relationship between mammographic breast density, clinical characteristics, and molecular tumor markers of the disease. Methods A retrospective review of data was carried out from January 2020 to December 2020 with stage 0-3 patients with histologically proven breast cancer included in the study. Mammograms were reviewed and density grade was recorded in accordance with "Breast Imaging Reporting and Data System (BIRADS)" guidelines. Patient age, tumor, and receptor characteristics were studied and their association with mammographic density was investigated by using chi-square test. P-value ≤0.05 was considered statistically significant. Results A total of 361 patients were included with a mean age of 46 years. The frequencies of BIRAD categories were as follows: category A: 8.9%, category B: 43.2%, category C: 33.5%, and category D: 14.4%. Cumulative frequency of categories B and C was 76.7%. There is a statistically significant p-value ≤0.05 association observed between age, estrogen receptors (ER) status, and T-stage versus MD. Also, majority of our patients were in T-stage category 2 or 3, which can easily be picked on mammogram. Conclusion Most of the breast cancer patients in our population had a mammographic density of B or C, indicating that breast cancer is more common in dense breasts. Strong significant association of mammographic density with age, ER status, and tumor stage was found in our population. Future studies need to address and confirm MD and its association with subtypes and aggressiveness of breast cancer.

ACC deaminase-producing endophytic fungal consortia promotes drought stress tolerance in M.oleifera by mitigating ethylene and H2O2.

Introduction: Drought has become more prevalent due to dramatic climate change worldwide. Consequently, the most compatible fungal communities collaborate to boost plant development and ecophysiological responses under environmental constraints. However, little is known about the specific interactions between non-host plants and endophytic fungal symbionts that produce growth-promoting and stress-alleviating hormones during water deficits. Methods: The current research was rationalized and aimed at exploring the influence of the newly isolated, drought-resistant, ACC deaminase enzyme-producing endophytic fungi Trichoderma gamsii (TP), Fusarium proliferatum (TR), and its consortium (TP+TR) from a xerophytic plant Carthamus oxycantha L. on Moringa oleifera L. grown under water deficit induced by PEG-8000 (8% osmoticum solution). Results: The current findings revealed that the co-inoculation promoted a significant enhancement in growth traits such as dry weight (217%), fresh weight (123%), root length (65%), shoot length (53%), carotenoids (87%), and chlorophyll content (76%) in comparison to control plants under water deficit. Total soluble sugars (0.56%), proteins (132%), lipids (43%), flavonoids (52%), phenols (34%), proline (55%), GA3 (86%), IAA (35%), AsA (170%), SA (87%), were also induced, while H2O2 (-45%), ABA (-60%) and ACC level (-77%) was decreased by co-inoculation of TP and TR in M. oleifera plants, compared with the non-inoculated plants under water deficit. The co-inoculum (TP+TR) also induced the antioxidant potential and enzyme activities POX (325%), CAT activity (166%), and AsA (21%), along with a lesser decrease (-2%) in water potential in M. oleifera plants with co-inoculation under water deficit compared with non-inoculated control. The molecular analysis for gene expression unraveled the reduced expression of ethylene biosynthesis and signaling-related genes up to an optimal level, with an induction of antioxidant enzymatic genes by endophytic co-inoculation in M. oleifera plants under water deficit, suggesting their role in drought stress tolerance as an essential regulatory function. Conclusion: The finding may alert scientists to consider the impacts of optimal reduction of ethylene and induction of antioxidant potential on drought stress tolerance in M. oleifera. Hence, the present study supports the use of compatible endophytic fungi to build a bipartite mutualistic symbiosis in M. oleifera non-host plants to mitigate the negative impacts of water scarcity in arid regions throughout the world.

Sonographic Evaluation of Incidental Synchronous Masses in Patients with Breast Cancer: Clinical Significance and Diagnostic Workup.

OBJECTIVE: This study aimed to evaluate the diagnostic accuracy of breast ultrasonography in classifying incidental satellite masses as benign or malignant in patients with breast cancer and to assess its effect on their surgical management. MATERIALS AND METHODS: Ultrasound-guided fine needle aspiration/biopsy was performed in 288 satellite masses of 225 patients with breast cancer. Two radiologists retrospectively reviewed the sonograms of these masses and classified them as benign or malignant and compared this feature with the results of the histopathological examination. The location of the satellite mass and type of surgery were also documented. RESULTS: Of the 288 satellite masses, 139 were located in the same quadrant, 95 in different quadrants, while 54 were in the contralateral breast. Of the 123 sonographically benign masses, 106 showed benign pathological outcome, and from 165 sonographically malignant masses, 127 were found malignant on histopathology/cytology. McNemar's chi-square was 7.27 (p-value=0.007), showing statistically significant association between sonographic features and pathological outcome of satellite masses. The sensitivity, specificity, positive and negative predictive values, and accuracy were 88.2%, 73.6%, 77%, 86.1%, and 80.9% respectively. Based on these findings, 61 patients underwent lumpectomy limited to a single tumor, 52 underwent extended resection, 78 underwent mastectomy, four underwent lumpectomy for the contralateral breast, and bilateral mastectomies were performed in another four patients. Surgery was not performed in 26 patients. CONCLUSION: Although ultrasound is an effective tool for the detection and characterization of incidental satellite masses in patients with breast cancer, biopsy is imperative to ascertain the pathological diagnosis and, therefore, select the most appropriate surgical plan.

Breast conservation surgery (BCS) for breast cancer in a resource limited country - Are we upto the challenge!

OBJECTIVE: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. RESULTS: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). CONCLUSION: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome.

Peritoneal encapsulation presenting as small bowel obstruction in a 16 year old girl.

Peritoneal encapsulation is a rare congenital anomaly characterized by a thin membrane of peritoneum encasing the small bowel to form an accessory peritoneal sac. Cases usually present with small bowel obstruction or can be an incidental finding during laparotomy. We report a case of peritoneal encapsulation presenting as a small bowel obstruction in a 16 year old girl. The sac was easily excised and surgery was otherwise uneventful. A discussion of the case and review of literature is presented.

Mucocele of the appendix: an unusual cause of disturbed bowel habits.

There are many causes of disturbed bowel habits. In this rare case of mucocele of appendix, patient presented with disturbed bowel habits of increased frequency, urgency and semisolid stool. Ultrasound of abdomen revealed fusiform cyst just below umbilicus. Differential diagnoses included mesenteric cyst, duplication cyst and mucocele of appendix. Coronal and saggital reformats of CT abdomen confirmed its origin from ceacum. Its tip was in contact with sigmoid colon. Surgical resection was carried out and histopathology revealed mucinous cyst adenoma.

Accuracy of multiphase helical tomography in detection and characterisation of suspected renal masses using histopathological findings as gold standard.

BACKGROUND: The introduction of multiphase helical computed tomography has created many important advances in the detection and characterisation of renal masses. Renal cell carcinoma (RCC) is the seventh most common cancer and makes up 80-85% of all primary renal cancer in adults. If it is found and treated early, the chances of survival from kidney cancer are high. This cross-sectional comparative was carried out at department of CMH/MH Rawalpindi from 1st February 2007 to 25 March 2008 to evaluate accuracy of multiphase helical tomography in detection and characterisation of suspected renal masses using histopathological findings as gold standard. METHODS: Thirty patients with suspicion of having renal masses were scanned with multiphase CT scanning and 5 mm thick contiguous section were obtained from kidneys before and after injection of intravenous contrast material. The corticomedullary phase images were obtained after a delay of 25 seconds and nephrographic phase images, after a delay of 120 seconds after initiation of contrast medium injection. The numbers of lesions detected in all three phases were determined. The mass was then characterised by evaluation of its features and by its degree of contrast enhancement. Results of CT scan were compared with histopathology. RESULTS: At review of unenhanced, corticomedullary and nephrographic phase images, 26, 29 and 30 lesions, respectively, were identified. One malignant lesion was not identified and 3 malignant lesions falsely appeared benign in the corticomedullary phase. All lesions were detected in the nephrographic phase and only 1 malignant lesion falsely appeared benign. The corticomedullary phase had a sensitivity of 86.2% and nephrographic phase 96.6% in malignant lesion detection. CONCLUSION: Enhancement of renal neoplasm is time dependent and is better in nephrographic phase. Small, hypovascular tumours and those placed in medulla may be missed or inadequately characterised if nephrographic phase scanning is not done.