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Small bowel hemangioma is a rare benign tumor in the pediatric population. The usual presentation of these tumors is melena, anemia, or hematochezia. Our case demonstrates the usefulness of Meckel's/Tc-99m pertechnetate scan with single-photon emission computerized tomography/computerized tomography in diagnosing a vascular lesion in the small bowel in a child presenting with melena, unresponsive to medical management. We present a case of incidentally detected jejunal hemangioma during Tc-99m pertechnetate scintigraphy which would help the nuclear medicine physician and surgeon, to be cognizant of this atypical presentation in their clinical practice.
RESUMO
BACKGROUND: The incidence of cancer is increasing throughout the world. One of the prime aims of its management is early diagnosis and therapeutic intervention. Factors causing delay to either of these goals should be identified and rectified. AIM: To identify the factors causing delayed initial diagnosis and subsequent management in patients presenting to the Oncology department. MATERIALS AND METHODS: Three hundred proven cancer patients were prospectively evaluated for the pattern of presentation to the outpatient Department of Radiation Oncology of a Government Medical College (MC) in Central India. RESULTS: The mean age of presentation was 51.05 years (range 7 months-77 years). The number of male patients was 168 while females were 132. The duration of symptoms ranged from 20 days to 3 years. The number of patients with little/no education presented mainly in advanced stages as compared to their educated counterpart and this difference was statistically significant (p<0.001). The number of patients presenting directly to the department was 108, those diagnosed outside and referred to us was 84 while those diagnosed and received some form of oncologic treatment outside and referred thereafter was 108. The difference in the primary delay between patients presenting directly to the MC versus those diagnosed outside was significant (p=0.0126). The mean duration of starting definitive treatment after presentation to the outpatient was 4.68 days (range 0-22 days) and was very significantly (p< 0.001) less than the secondary delays caused to the other two subsets of patients. CONCLUSION: Factors causing delayed presentation are both patient and system related. It is imperative to educate the common people regarding the early signs and symptoms of cancer. At the same time, the system needs to overhaul its efficiency to avoid secondary delays that adversely affect the treatment outcome. An upgradation of the existing oncology facilities in the public sector can achieve this target efficiently.
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Occurrence of second tumors has been seen in patients with papillary and follicular thyroid cancer. We studied the occurrence of meningioma as a second neoplasm in patients with differentiated thyroid cancer treated with radioiodine at our institution.