Sarcomatoid Carcinoma of the Prostate Presenting in a 44 Year Old

We present the case of a 44-year-old man diagnosed with metastatic sarcomatoid carcinoma of the prostate. The pathogenesis and optimal treatment of this rare and aggressive subtype of prostate cancer are not fully clear. The patient was managed using a multimodality approach of chemotherapy, hormonal blockade and radiation therapy, with palliative intent.

Synchronous diffuse large B cell lymphomas of the endometrium and breast: a staging dilemma.

BACKGROUND: A 66 years old presented with abnormal postmenopausal vaginal bleeding and was diagnosed with an endometrial lymphoma (diffuse large B cell type, DLBCL). A left breast lesion was found on PET CT which was subsequently biopsy-proven as a separate stage IE DLBCL, but she had no lymph node, bone marrow or spleen involvement. AIMS: This study aimed to review the available literature and discuss the management and staging of synchronous extra-nodal DLBCL's. RESULTS: Our patient was staged as having synchronous stage IE DLBCL's of the endometrium and breast. Subsequent molecular analysis (IgH gene rearrangement analysis) on both lesions, confirmed the two lesions to be clonally unrelated. CONCLUSIONS: Staging of synchronous extra-nodal lymphomas, particularly when they arise in rare sites such as the endometrium and breast, is difficult and previously unreported. We present our rationale for defining our patient's disease as synchronous stage IE DLBCL's.

Epithelioid Angiomyolipoma - a case report and review of the literature.

Herein we present the case of a 43-year-old female in whom a left renal mass was identified incidentally on imaging performed for staging of a newly diagnosed breast carcinoma. The mass was resected and histologic examination and immunohistochemistry confirmed a diagnosis of epithelioid angiomyolipoma.

Accrual to Cancer Clinical Trial.

Accrual to cancer clinical trials (CCT) is imperative to safeguard continued improvement in cancer outcomes. A retrospective chart review was performed of patients (n=140) starting a new anti-cancer agent in a north Dublin cancer centre. This review was performed over a four-month period, beginning in November 2015. Only 29% (n=41) had a CCT option. The overall accrual rate to CCT was 5% (n=7), which is comparable to internationally reported figures. The main reasons for failure to recruit to CCT included the lack of a CCT option for cancer type (n=30, 23%), stage (n=25, 19%), and line of treatment (n=23, 17%). Over the last decade, the rate of accrual to CCTs has in fact doubled and the number of trials open to recruitment has tripled. Ongoing governmental and philanthropic support is necessary to continue this trend to further expand CCT patient options with a target accrual rate of 10%.

Get the GIST? An overview of gastrointestinal stromal tumours.

GISTs are the most common mesenchymal neoplasms of the gastrointestinal tract. The last 20 years have been revolutionary in the understanding of these tumours and began with the discovery of c-KIT, a proto oncogene that when mutated forms the molecular basis for the growth and development of these malignancies. Surgery was previously considered to be the only treatment modality in both local and advanced disease, however, the introduction of immunotherapy agents such as tyrosine kinase inhibitors has had profound effects on how we now approach and manage these tumours. These novel agents have significantly reduced the frequency of disease recurrence and dramatically improved survival, and serve as a model for the study of targeted therapies in other solid tumors. We present a review of gastrointestinal stromal tumours and consider the current evidence based detection and management of these unique tumors.

Plain water consumption in relation to energy intake and diet quality among US adults, 2005-2012.

OBJECTIVE: The present study examined plain water consumption in relation to energy intake and diet quality among US adults. METHODS: A nationally representative sample of 18 311 adults aged ≥18 years, from the National Health and Nutrition Examination Survey 2005-2012, was analysed. The first-difference estimator approach addressed confounding bias from time-invariant unobservables (e.g. eating habits, taste preferences) by using within-individual variations in diet and plain water consumption between two nonconsecutive 24-h dietary recalls. RESULTS: One percentage point increase in the proportion of daily plain water in total dietary water consumption was associated with a reduction in mean (95% confidence interval) daily total energy intake of 8.58 (7.87-9.29) kcal, energy intake from sugar-sweetened beverages of 1.43 (1.27-1.59) kcal, energy intake from discretionary foods of 0.88 (0.44-1.32) kcal, total fat intake of 0.21 (0.17-0.25) g, saturated fat intake of 0.07 (0.06-0.09) g, sugar intake of 0.74 (0.67-0.82) g, sodium intake of 9.80 (8.20-11.39) mg and cholesterol intake of 0.88 (0.64-1.13) g. The effects of plain water intake on diet were similar across race/ethnicity, education attainment, income level and body weight status, whereas they were larger among males and young/middle-aged adults than among females and older adults, respectively. Daily overall diet quality measured by the Healthy Eating Index-2010 was not found to be associated with the proportion of daily plain water in total dietary water consumption. CONCLUSIONS: Promoting plain water intake could be a useful public health strategy for reducing energy and targeted nutrient consumption in US adults, which warrants confirmation in future controlled interventions.

Development of TMTP-1 targeted designer biopolymers for gene delivery to prostate cancer.

Designer biopolymers (DBPs) represent state of the art genetically engineered biomacromolecules designed to condense plasmid DNA, and overcome intra- and extra- cellular barriers to gene delivery. Three DBPs were synthesized, each with the tumor molecular targeting peptide-1 (TMTP-1) motif to specifically target metastases. Each DBP was complexed with a pEGFP-N1 reporter plasmid to permit physiochemical and biological assay analysis. Results indicated that two of the biopolymers (RMHT and RM3GT) effectively condensed pEGFP-N1 into cationic nanoparticles <100 nm and were capable of transfecting PC-3 metastatic prostate cancer cells. Conversely the anionic RMGT DBP nanoparticles could not transfect PC-3 cells. RMHT and RM3GT nanoparticles were stable in the presence of serum and protected the cargo from degradation. Additionally it was concluded that cell viability could recover post-transfection with these DBPs, which were less toxic than the commercially available transfection reagent Lipofectamine(®) 2000. With both DBPs, a higher transfection efficacy was observed in PC-3 cells than in the moderately metastatic, DU145, and normal, PNT2-C2, cell lines. Blocking of the TMTP-1 receptors inhibited gene transfer indicating internalization via this receptor. In conclusion RMHT and RM3GT are fully functional DBPs that address major obstacles to gene delivery and target metastatic cells expressing the TMTP-1 receptor.

Breast cancer detection among Irish BRCA1 & BRCA2 mutation carriers: a population-based study.

BACKGROUND: High-risk breast cancer screening for BRCA1/2 mutation carriers with clinical breast exam, mammography and MRI has reported sensitivity of 100 %, but BRCA1/2 mutation carriers still present with interval cancers. AIMS: We investigated the presentation and screening patterns of an Irish cohort of BRCA1/2 mutation carriers with breast cancer. MATERIALS AND METHODS: BRCA1/2 mutation carriers with breast cancer were identified in this retrospective cohort study. Records were reviewed for BRCA1/2 mutation status, demographics, screening regimen, screening modality, stage and histology at diagnosis. RESULTS: Fifty-three cases of breast cancer were diagnosed between 1968 and 2010 among 60 Irish hereditary breast ovarian cancer (HBOC) families. In 50 of 53 women, the diagnosis of breast cancer predated the identification of BRCA1/2 mutations. Breast cancer detection method was identified in 47 % of patients (n = 25): 80 % (n = 20) by clinical breast exam (CBE), 12 % by mammography (n = 3), 8 % by MRI (n = 2). Fourteen women (26 %) developed a second breast cancer. Ten of these patients (71 %) were involved in regular screening; 50 % were detected by screening mammography, 20 % by MRI and 30 % by CBE alone. Six patients (43 %) had a change in morphology from first to second breast cancers. There was no change in hormone receptor status between first and second breast cancers. CONCLUSION: In this cohort of Irish BRCA1/2 mutation carriers, compliance with screening was inconsistent. There was a 30 % incidence of interval cancers occurring in women in high-risk screening. Preventive surgery may be a more effective risk reduction strategy for certain high-risk women.

Radiation shielding materials and radiation scatter effects for interventional radiology (IR) physicians.

PURPOSE: To measure the attenuation effectiveness and minimize the weight of new non-Pb radiation shielding materials used for radiation protection by interventional radiology (IR) physicians, to compare the accuracy of the different standard measurement geometries of these materials, and to determine x-ray qualities that correspond to the scattered radiation that IR physicians typically encounter. METHODS: Radiation attenuation capabilities of non-Pb materials were investigated. Typically, most studies of non-Pb materials have focused on the attenuating properties of metal powders. In this study, layers of materials incorporating non-Pb powdered compounds such as Bi(2)O(3), Gd(2)O(3), and BaSO(4) were measured individually, as bilayers, and as a Bi(2)O(3)-loaded hand cream. Attenuation measurements were performed in narrow-beam (fluorescence excluded) and broad beam (fluorescence included) geometries, demonstrating that these different geometries provided significantly different results. The Monte Carlo (MC) program EGSnrc was used to calculate the resulting spectra after attenuation by radiation shielding materials, and scattered x-ray spectra after 90° scattering of eight ASTM Standard primary x-ray beams. Surrogate x-ray qualities that corresponded to these scattered spectra were tabulated. RESULTS: Radiation shielding materials incorporating Bi(2)O(3) were found to provide equivalent or superior attenuation compared with commercial Pb-based and non-Pb materials across the 60-130 kVp energy range. Measurements were made for single layers of the Bi(2)O(3) compound and for bilayers where the ordering was low atomic number (Z) layer closest to x-ray source∕high Z (Bi(2)O(3)) layer farthest from the x-ray source. Narrow-beam Standard test methods which do not include the contribution from fluorescence overestimated the attenuating capabilities of Pb and non-Pb materials. Measurements of a newly developed, quick-drying, and easily removable Bi(2)O(3)-loaded hand cream demonstrated better attenuation capabilities than commercial Bi(2)O(3)-loaded gloves. Scattered radiation measurements and MC simulations illustrated that the spectra resulting from 90° scattering of primary x-ray beam qualities can be approximated by surrogate x-ray qualities which are more representative of the radiation actually encountered by IR physicians. A table of surrogate qualities of the eight ASTM F2547-06 Standard qualities was compiled. CONCLUSIONS: New non-Pb compound materials, particularly single layers or bilayers incorporating Bi(2)O(3), can reduce the weight of radiation protection materials while providing equivalent or better protection compared to Pb-based materials. Attenuation measurements in geometries that exclude the contribution from fluorescence substantially underestimate the quantity of transmitted radiation. A new Bi(2)O(3)-loaded hand cream demonstrated a novel and effective approach for hand protection. Standard testing protocols for radiation protection materials used by IR physicians specify a wider kVp range than is necessary. A more realistic range would acknowledge the lower kVp resulting from scatter and allow IR physicians to confidently utilize lighter-weight materials while still receiving adequate protection. Standards protocols incorporating the adjustments described in this work would maintain the safety of IR personnel and lessen the physical repercussions of long hours wearing unnecessarily heavy radiation protection garments.

Frequency and outcome of neoplastic brachial plexopathy: single institution experience.

Symptomatic neoplastic brachial plexopathy (NBP) is estimated to occur in about 0.4% of all patients with cancer. The aim of this review was to determine the incidence of NBP occurring in patients referred for magnetic resonance imaging (MRI). A retrospective review over a 5 year period revealed that a total of sixty-six MRls of brachial plexus were performed. Twenty-nine were performed for assessment of suspected traumatic injuries. Eighteen MRIs were performed in patients with a known cancer diagnosis, one was performed in a patient with a benign thymoma, one with a neurofibroma and the remaining seventeen MRIs were ordered for other conditions. In total, thirteen MRls were positive for brachial plexopathy (seven traumatic, five due to cancer, one neurofibroma). Of the twenty MRIs performed in patients with neoplasms, six (30%) confirmed a diagnosis of NBRP. Twenty seven point eight per cent (5/18) of patients with a diagnosis of cancer had NBP.

Symptomatic intra-cardiac metastasis complicating non-small cell lung cancer: imaging findings and clinical course.

We describe a man who was diagnosed with non-small cell lung cancer following previous treatment for small cell lung cancer. He developed dyspnoea, paroxysmal nocturnal dyspnoea and orthopnoea. Trans-thoracic echocardiogram revealed a large mass within the right atrium. The patient proceeded to thoracotomy at which time unresectable metastatic tumour was found in the right atrium infiltrating into the pericardium. Metastatic involvement of the heart by tumour is rare and is found at autopsy in 1-3% of unselected cases in various series. This translates into a finding of cardiac metastases in approximately 10% of autopsies where malignancy is diagnosed. Most cases are clinically silent and are undiagnosed in vivo. Echocardiography, CT and MRI are complementary investigations, and are all used in the evaluation of cardiac lesions. When metastatic disease is in question, MR and CT imaging offer advantages over echocardiography, chiefly a wider imaging field which allows evaluation of distant disease.

Risk factors for exercise-induced pulmonary haemorrhage in Thoroughbred racehorses.

REASONS FOR PERFORMING STUDY: Risk factors for occult exercise-induced pulmonary haemorrhage (EIPH) are poorly defined or quantified. OBJECTIVES: To investigate the importance of putative risk factors for EIPH amongst Thoroughbred racehorses in Australia. METHODS: Tracheobronchoscopy was used to determine EIPH status of 744 Thoroughbred racehorses after flat racing in Melbourne, Australia. Horses were identified for study before racing, and over 50% of horses racing during the study period were examined. Statistical analysis included use of bivariate and multivariate logistic regression analysis to account for simultaneous effects of a large number of variables. RESULTS: The only risk factor identified as associated with both EIPH ≥ 1 or ≥ 2 was ambient temperature, with horses racing at temperatures <20 °C being at ∼ 2 times risk of occult EIPH. There was no association of EIPH with age, sex, weight carried, track hardness, speed of racing, or air quality. CONCLUSIONS: There do not appear to be individual risk factors, amongst those examined in this study, that are strongly associated with EIPH. POTENTIAL RELEVANCE: The risk of developing EIPH cannot be readily determined from a combination of age, race speed, race distance, track hardness or air quality. This study does not provide support for the hypotheses that racing on hard surfaces or in polluted air contributes to the development of EIPH.

Quantitative determination of residual active pharmaceutical ingredients and intermediates on equipment surfaces by ion mobility spectrometry.

Ion mobility spectrometry (IMS) is an analytical technique that separates ions based on their gas phase mobility at atmospheric pressure. Since gas phase ion mobility is a function of the shape and structure of the ion, this technique has the potential to provide unique specificity and selectivity. Furthermore, IMS is very sensitive (subnanogram detection limits for many small molecules), and a single analysis is typically completed within 1 min. In principle, these features of IMS should make it an ideal choice for use in cleaning verification analysis of pharmaceutical manufacturing equipment. This report describes the successful development and validation of three different equipment cleaning verification methods using IMS. The methods were developed for a specific intermediate (Compound A) in the synthetic route for a drug substance as well as for final drug substances (active pharmaceutical ingredients Compounds B and C). The cleaning verification methods were validated with respect to specificity, linearity, precision, accuracy, stability, and limit-of-quantitation. In all cases, the limits-of-quantitation were determined to be at the nanogram or sub-nanogram level. Both swab and rinse samples collected from the equipment surfaces were successfully analyzed and manufacturing equipment down-time was significantly minimized due to the reduction in cleaning verification analysis time (for example, the total analysis time for more than 30 samples using IMS was reduced to less than 2h).

Multisystem langerhans cell histiocytosis with advanced orbital involvement: case report.

Langerhans cell histiocytosis (LCH) is a rare disease occurring most frequently in infancy or early childhood. The aetiology is still not completely understood, although some form of immunologic dysfunction has been implicated. Clinically, the disease may either be localised or present with multisystem involvement. Here we discuss the case of a seven year old boy presenting with advanced proptosis. To the best of our knowledge, proptosis of this extent has not been reported previously in association with LCH.

Clinic based transfer of the N(D,W)(60Co) calibration coefficient using a linear accelerator.

Ionization chambers used for reference dosimetry require a local secondary standard ionization chamber with a 60Co absorbed dose to water calibration coefficient N(D,W)(60Co) traceable to a national primary standards dosimetry laboratory or an accredited secondary dosimetry calibration laboratory. Clinic based (in-house) transfer of this coefficient to tertiary reference ionization chambers has traditionally been accomplished with chamber cross calibration in water using a 60Co beam; however, access to 60Co teletherapy machines has become increasingly limited for clinic based physicists. In this work, the accuracy of alternative methods of transferring the N(D,W)(60Co) calibration coefficient using 6 and 18 MV photon beams from a linear accelerator in lieu of 60Co has been investigated for five different setups and four commonly used chamber types.

Optimizing non-Pb radiation shielding materials using bilayers.

PURPOSE: The objective of this study was to demonstrate that the weight of non-Pb radiation shielding materials can be minimized by structuring the material as a bilayer composed of different metal-powder-embedded elastomer layers. METHODS: Measurements and Monte Carlo (MC) calculations were performed to study the attenuation properties of several non-Pb metal bilayers over the x-ray energy range 30-150 keV. Metals for the layers were chosen on the basis of low cost, nontoxicity, and complementary photoelectric absorption characteristics. The EGSnrc user code cavity.cpp was used to calculate the resultant x-ray fluence spectra after attenuation by these metal layers. Air kerma attenuation was measured using commercially manufactured metal/elastomer test layers. These layers were irradiated using the primary standard calibration beams at the Institute for National Measurement Standards in Ottawa, Canada utilizing the six x-ray beam qualities recommended in the German Standard DIN 6857. Both the measurements and the calculations were designed to approximate surface irradiation as well as penetrating radiation at 10 mm depth in soft tissue. The MC modeling point and the position of the measurement detector for surface irradiation were both directly against the downstream face of the attenuating material, as recommended in DIN 6857. RESULTS: The low-Z upstream/high-Z downstream ordering of the metal bilayers provided substantially more attenuation than the reverse order. Optimal percentages of each metal in each bilayer were determined for each x-ray radiation beam quality. CONCLUSIONS: Depending on the x-ray quality, appropriate choices of two complementary metal-embedded elastomer layers can decrease the weight of radiation shielding garments by up to 25% compared to Pb-based elastomer garments while providing equivalent attenuation.

Dose rate dependency of electronic personal dosemeters measuring X- and gamma-ray radiation.

Three models of electronic personal dosemeters (EPDs)-Siemens Mk 2.3, Rados RAD-60S and Vertec Bleeper Sv-were irradiated with seven photon beam qualities: 60Co, 137Cs and the ISO narrow spectrum series X-ray qualities N-250, N-200, N-150, N-60 and N-20. The personal dose equivalent rates delivered to the devices varied between 0.002 and 0.25 mSv s(-1). Measurements were made with the EPDs mounted free-in-air as well as against Lucite and water phantoms. Results for all models of EPDs showed differences in personal dose equivalent energy response for different energies covered by this range of radiation qualities, with different models showing variations from 15 to 65%. In some cases, the personal dose equivalent rate response of these devices varied by a factor of 3 between irradiations at typical calibration dose rates and those normally encountered by nuclear energy workers.

Wilms' tumour in adults: a case report and review of the literature.

BACKGROUND: Wilms' tumour is a very rare adult malignancy representing 1% of adult renal tumours. It is however the most common renal tumour of childhood, and adult patients are treated in accordance with paediatric protocols. AIM: To review modern day management of adult Wilms' tumour. METHODS: We report a case of adult Wilms' tumour and discuss the management including the use of newer treatment modalities. RESULTS: Following diagnostic nephrectomy, our patient was treated with chemotherapy in accordance with North American paediatric protocols and PET scanning was used to diagnose early relapse. CONCLUSION: In the absence of randomised controlled data, central reporting of cases of adult Wilms' Tumour may help improve management. The incorporation of newer chemotherapeutic agents, high-dose therapy and PET scanning into treatment protocols should improve outcome for these patients.