Association of systemic anaplastic large cell lymphoma and active toxoplasmosis in a child

Introduction: Anaplastic large cell lymphoma is a subset of non-Hodgkin lymphoma and an unusual disease in children. Case Presentation: Herein we have reported a 7- year- old girl with a large necrotic skin ulcer on the chest caused by systemic form of anaplastic large-cell lymphoma and simultaneous active toxoplasmosis diagnosed by PCR on lymph node specimen. There were few reports showing a role for toxoplasma infection to cause some malignancies such as lymphoma in adults. Conclusions: Based to our knowledge, this has been the first report of simultaneous systemic anaplastic large cell lymphoma and active toxoplasmosis, documented by positive PCR on tissue biopsy in a child. This case report has suggested more attention to the accompanying Toxoplasma gondii infection as a probable cause of some types of lymphomas. © 2015, Iranian Journal of Cancer Prevention

On the Pathology of Hodgkin's Disease

In Part I an attempt was made to offer a brief and reasonably critical account of the inherent peculiarities of the structure and of the diseases of the reticulo---endothelial system. Particular emphasis was accorded to works which have served to integrate the concept of lymphoid tissue sarcoma. While it is doubtful whether knowledge is yet adequate enough to endorse this idea universally, it has the advantage of being a practical generalisation which simplifies the subject. The view that the morbid process, primary reticulosis, was covered by the generic lymphoid tissue sarcoma was also supported. In Part II some account was given of the lymphatics and lymphoid tissue. In this outline attention was drawn to the mysterious and bewildering problems inseparable from the system. The structure of lymph nodes was given with observations on their development, involution, and possible neogenesis in adult life. From these studies it emerged that the full complement of lymph nodes in the locus examined was probably attained in adolescence or early adult life, and that fat replacement was the usual mode of atrophy. Attention was also drawn to the rarity of fibrosis in physiological nodes, except where it was the result of blood vascular hyaline change. In Part III Hodgkin's disease was studied. In the introduction of this part of the work the historical aspect of the malady was recorded, with, it is hoped, advertisement of interesting and possibly less well-known facts about it. This was followed by a critical consideration on the nature of the disease and its morbid anatomy, the latter being /illustrated illustrated in part by analyses of the cases coming to necropsy at Glasgow Royal Infirmary over a period of fifty years. In this part also were the findings of a large series of biopsy specimens. Here endeavours were made to shew the microscopical variations in morphology in the lesion, and to demonstrate the affinities of other lymphoid tissue sarcomata with the disease. Within the resources available the generic lymphoid tissue sarcoma was established, and links between the better recognised variants were presented with a reasonable degree of conviction. In the necropsy series a detailed study of thirteen cases of Hodgkin's disease or reticulum cell sarcoma was offered. In these it was shewn that the favourite locus was lymphoid tissue, that complete systematisation was rare, and that metamorphosis to a more tumour-like lesion was common. In Part IV two components of the Hodgkin's disease complex were studied in relation to general pathology. The view that fibrosis, an essential and inherent peculiarity of the Hodgkin's disease lesion, was represented in certain other morbid states was submitted. This was illustrated by brief accounts of some diseases where quasi-neoplastic features are shewn by connective tissue. Eosinophilia in tumours was also made the subject of investigation and revealed that the phenomenon, while possibly not so rare as might be expected, was not nearly so common as in Hodgkin's disease. Some evidence was found for the cyto-metaplastic origin of eosinophiles in Hodgkin's disease, but possibly due to the restriction to histological as opposed to cytological methods, the results were not highly conclusive. In Part V an experimental attempt to reproduce the disease by /chronic chronic trypan blue poisoning of rats and mice proved unsuccessful, although interesting results followed. The main contention in this thesis has been that Hodgkin's disease is a neoplasm. Perhaps the following may influence the reader more convincingly than I have been able to do by so much work. The reasons for human beliefs depend chiefly upon Authority, Intuition, and Scientific Method. The last two have been exploited as far as I have been able; the foremost remains. As a junior student I saw a case of Hodgkin's disease first in the wards of the Late Professor Archibald Harrington, at Glasgow Royal Infirmary. I was chagrined at the doubt cast on its nature in the discussion which followed the demonstration; at twenty, one is very intolerant of obscure aetiology! On my return home I imprudently assailed my Father with the question at the dinner table, where even renal oedema was taboo. He was exceedingly angry. There was a dreadful silence, and then he relented - 'of course it is tumour, - but mind to whom you say that' Nothing more was said. I submit that this terse pronouncement has been my most precious axiom, with deepest respect and affection

Unusual Presentations of Adrenal Masses

With the advancement in imaging technology and pathological evaluation, several unusual adrenal gland lesions have been identified over the years. Presently, the literature consists of case reports or small case series without a comprehensive review on these uncommon adrenal pathologies. The current chapter discusses the epidemiology, pathogenesis, pathology, imaging features and management principles of uncommonly reported infectious and neoplastic adrenal masses

Classical Hodgkin's lymphoma with cutaneous involvement in an adolescent male: A case study

Background: Hodgkin's lymphoma (HL) with skin involvement is reasonably rare. It typically occurs late in the course and is associated with a poor prognosis; however, it may also be indolent in some cases. Case: We report a case of a 15-year-old previously healthy male with Hodgkin's lymphoma who presented with multiple lymphadenopathies of axilla and serpiginous ulcerative nodular lesions involving pectoral skin. A lymph node biopsy was performed following an initial diagnostic workup for a suspected active infectious disease, which revealed a neoplastic invasion from a mixed cellularity classical HL with skin involvement. A total of six cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy regimen was administered to the patient. Conclusion: In comparison to other studies, this case demonstrates that a good response is possible with standard ABVD chemotherapy

Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy

<p>Abstract</p> <p>Background</p> <p>For patients suffering of recurrent breast cancer within the irradiated breast, generally mastectomy is recommended. The normal tissue tolerance does not permit a second full-dose course of radiotherapy to the entire breast after a second breast-conserving surgery (BCS). A novel option is to treat these patients with partial breast irradiation (PBI). This approach is based on the hypothesis that re-irradiation of a limited volume will be effective and result in an acceptable frequency of side effects. The following report presents a single center experience with intraoperative radiotherapy (IORT) during excision of recurrent breast cancer in the previously irradiated breast.</p> <p>Methods</p> <p>Between 4/02 and 11/06, 15 patients were treated for in-breast recurrences at a median of 10 years (3–25) after previous EBRT (10 recurrences in the initial tumor bed, 3 elsewhere in-breast failures, 2 invasive recurrences after previous DCIS). Additional 2 patients were selected for IORT with new primary breast cancer after previous partial breast EBRT for treatment of Hodgkin's disease. IORT with a single dose of 14.7 – 20 Gy 50 kV X-rays at the applicator surface was delivered with the Intrabeam™-device (Carl Zeiss, Oberkochen, Germany).</p> <p>Results</p> <p>After a median follow-up of 26 months (1–60), no local recurrence occurred. 14 out of 17 patients are alive and free of disease progression. Two patients are alive with distant metastases. One patient died 26 months after BCS/IORT due to pulmonary metastases diagnosed 19 months after BCS/IORT. Acute toxicity after IORT was mild with no Grade 3/4 toxicities and cosmetic outcome showed excellent/good/fair results in 7/7/3 cases.</p> <p>Conclusion</p> <p>IORT for recurrent breast cancer using low energy X-rays is a valuable option for patients with recurrent breast cancer after previous radiotherapy.</p

Evaluation of strategies for reducing the burden of COPD in the UK using Bayesian methods

Chronic obstructive pulmonary disease (COPD) is responsible for 5.3% of all deaths and 1.7% of all hospital admissions in the UK. This thesis focuses on strategies to reduce COPD burden by targeting three aspects across the public healthcare system: prevention, emergency treatment, and long-term management. Analyses were performed in a Bayesian framework to exploit its flexibility in modelling uncertainty and the incorporation of prior knowledge. First, I assessed whether communication of personalised disease risk in primary care is an effective smoking cessation intervention, using cost-effectiveness and value of information analyses based on various data sources across the literature. The odds ratio for the effectiveness of communication of personalised disease risk was 1.48 (95%CrI:0.91-2.26). While I found a probability of cost-effectiveness of about 90%, further research up to a maximum of £27 million is justified to reduce the uncertainty around this estimate. Secondly, I assessed whether case ascertainment affects the detection of poorly performing hospital trusts in the treatment of acute exacerbation of COPD (AECOPD) in secondary care, using data from the National Asthma and COPD Audit Programme. Case ascertainment was associated with 30-day mortality (OR:1.74; 1.25-2.41) and adjusting for it impacted the findings, with 5 trusts becoming outliers and 2 trusts no longer classified as outliers. Finally, using general practice data from Clinical Practice Research Datalink, I assessed whether new guidelines suggesting triple therapy (long-acting beta-2 agonists, LABA + long-acting muscarinic antagonists, LAMA + inhaled corticosteroids, ICS) for the treatment of those with poorly-controlled COPD on LABA+LAMA dual therapy improves disease outcomes. Triple therapy was not associated with severe AECOPD (IRR:1.00; 0.93-1.07) or mortality (IRR:0.95; 0.86-1.06), but was associated with increased risk of pneumonia (IRR:1.19; 1.05-1.35). This thesis applied sophisticated Bayesian methods to increase understanding of how COPD burden could be reduced in different areas of the public healthcare system.Open Acces

Factors associated with hospitalisation and mortality among people with Parkinson's disease: Analysis of a large UK primary care database

Background: Parkinson’s disease (PD) is characterised by worsening motor symptoms, falls/fractures and infections with disease progression, leading to hospitalisation and in some instances, death. Quality data on hospitalisation and mortality in PD is lacking. Objective: To investigate hospitalisation, mortality and incidence of PD over time in UK primary care setting. Methods: Through a systematic review and meta-analysis, estimates of the pooled prevalence of common reasons for hospitalisation was calculated. Three cohort studies using data from The Health Improvement Network (THIN) were conducted in the period 2006-2016: [1] Incidence of PD; [2] Mortality and [3] Hospitalisation in PD. Findings: In the review, from the nine included eligible studies, the main reasons for hospitalisation and their pooled prevalence among PwPD were infections (22%,95%CI:16%-30%), worsening motor features(19%,95%CI:13%- 27%), falls/fractures(18%,95%CI:14%to21%), cardiovascular comorbidities (13%,95%CI:9%-18%), neuropsychiatric (8%,95%CI:4%-13%) and gastrointestinal complications(7%,95%CI:4%-11%). In my empirical studies, the incidence of recorded PD gradually decreased using the stricter case definitions but remained stable using the broadest case definition over time. For the strictest case definition (diagnostic Read code and at least two prescriptions of antiparkinsonian medication), the incidence of PD was 60.42 in 2006 and dropped to 42.24 cases per 100,000 person years at risk (PYAR) in 2016 and for the broadest case definition (diagnosis Read code or symptom Read code or at least one prescription of antiparkinsonian medication), the incidence of PD was 149.20 cases in 2006 and this reduced slightly to 143.70 cases per 100,000 PYAR in 2016. 10,104 incident PD cases were identified and matched with 55,664 people without PD. Overall, rates of hospitalisation (IRR:1.33, 95%CI:1.29-1.37) and mortality (IRR:1.14, 95%CI:1.09-1.20) were higher in PwPD than those without. Hospitalisation rates were higher among people with PD (PwPD) in the younger age-group than those without PD in the same age-group. Other sociodemographic factors had no impact on hospitalisation and mortality in PD. PwPD were more often admitted with falls/fractures, infections, gastrointestinal complications, dementia, psychosis/hallucinations, postural hypotension, electrolyte disturbances, stroke, and surgical procedures compared to those without PD. Further results showed a widening mortality gap between PwPD and the general population. Conclusions: PD is associated with increased hospitalisation and mortality. The complications of motor and non-motor features of PD are amongst the main reasons for admission, some of which could be managed pro-actively to avoid admissions and maybe prevent death. Future studies should be directed at exploring effectiveness of preventive strategies to reduce hospitalisations and maybe mortality among PwPD

Somatostatin and substance P analogues: applications in autoimmune and haematological diseases

Somatostatin has been extensively studied in relation to the endocrine and nervous systems. Many reports on the role of somatostatin receptor imaging and somatostatin treatment of neuroendocrine tumours have been published. The relation between somatostatin and other neuropeptides and the immune system is less explored. The aim of this study was to investigate the diagnostic applications of somatostatin and substance P analogues in autoimmune and haematological diseases. Both in vivo and in vitro studies were performed, using peptide receptor scintigraphy in patients and rats, peptide receptor autoradiography on tissue biopsies, ligand binding assays on cell homogenates, and polymerase chain reactions on lymphoid cell lines. Moreover, based on the results of these studies, speculations were made about the therapeutical applications of somatostatin and substance P analogues in autoimmune and haematological diseases