The impact of surgical resection and adjuvant therapy on survival in paediatric patients with Atypical Teratoid Rhabdoid Tumour: Systematic review and pooled survival analysis

Background Atypical teratoid/rhabdoid tumours (AT/RT) is a rare malignant neoplasm in the paediatric population. AT/RT is characterised by rhabdoid cells combined with the loss of either the INI1 or BRG1 protein. Objective To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with AT/RT confirmed by alterations in INI1 or BRG1. This systematic review is the first only to include paediatric cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods MEDLINE was searched using the terms "atypical teratoid/rhabdoid tumour" AND "paediatric/pediatric". Cases were included if confirmed by loss of INI1 or BRG1. The extracted dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results A total of 38 articles were included in this study. The average age at diagnosis was three years. The most common locations reported are the supratentorial region and cerebral hemispheres. Ninety-three patients were reported to show evidence of dissemination. The average overall survival was 29 months. A significant difference in survival was noted between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001). Extent of resection and adjuvant therapy were significant for survival (Chi-square = 10.107, p = 0.018) and (Chi-square = 20.38, p = < 0.0001), respectively. Conclusion AT/RT of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. Future studies should be directed to find a standardised treatment protocol

Epithelioid Variant of Pleomorphic Liposarcoma: A Rare Challenging Diagnosis Causing Severe Medial Thigh Pain

We present the case of pleiomorphic liposarcoma in the medial compartment of the thigh of a 59-year-old female patient. The lump was noticed eight months prior to presentation and had gradually increased in size, leading to pressure symptoms in her thigh. Although painless initially, the lump eventually became tender prompting her to seek surgical attention. At the plastic surgery clinic, she was advised to get an MRI, which revealed an irregular but well-defined mass lesion measuring 8.2 x 6.6 x 4.3 cm. The mass did not have any manifestations in the surrounding structures. A wide excisional biopsy was then performed, and multiple sections were processed for histopathological analysis, confirming a diagnosis of epithelioid variant of pleomorphic liposarcoma

The Potential Applicability of Melatonin as an Immunosuppressive Agent for COVID-19: Review

COVID-19 is an emerging pathogen that has recently caused a global pandemic. It is an RNA virus that causes a respiratory tract infection. The pathogenesis of this virus involves an over aggressive immune reaction leading to inflammation and in certain cases acute respiratory distress syndrome (ARDS) and various neurological manifestations. Melatonin, a mitochondrially targeted antioxidant with anti-inflammatory properties, is being tested in trials as a potential adjuvant therapeutic agent that can help reduce oxidative stress damage caused by viral infections as well as optimizing the innate immune response. In addition, melatonin is an extremely safe drug and reports show its usefulness in treating other respiratory viral infections. The role of melatonin as an adjuvant in managing COVID-19 cases as well as the delirious states that are often encountered in these patients is being discussed

The impact of surgical resection and adjuvant therapy on survival in paediatric patients with Atypical Teratoid Rhabdoid Tumour: a systematic review and pooled survival analysis

Background: Atypical teratoid/rhabdoid tumours is a relatively rare malignant neoplasm in the paediatric population. It is characterized by the presence of rhabdoid cells in combination with loss of either the INI1 or BRG1 protein from the tumour cells. Aim: To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with Atypical Teratoid/Rhabdoid Tumour (AT/RT) confirmed by alterations in INI1 or BRG1. This is the first systematic review to only include cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods: A systematic review was conducted using MEDLINE using the terms “atypical teratoid rhabdoid tumour” AND “paediatric”. Cases were included if the pathology was confirmed by loss of INI1 or BRG1. The dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results: A total of 38 articles were included in this study. The average age at diagnosis was 3 years. The most common locations reported is the supratentorial region and cerebral hemispheres. 93 patients were reported to show evidence of dissemination. The average overall survival was 29 months. There was a significant difference in survival between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001), but not statistically significant differences in adjuvant therapy groups (p = 0.581) and the extent of surgical resection groups (p= 0.262). Conclusion: Atypical teratoid rhabdoid tumour of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. The treatment and clinical course are highly variable, and it remains unclear which factors impact prognosis