Gall Bladder Carcinoma: Clinical Presentations and Different Modalities of Treatment

Gallbladder cancer (GBC) is the most common cancer of the biliary tract and has a particularly high incidence in Chile, Japan and northern India. The clinical presentation of GBC is often vague or delayed relative to pathologic progression, contributing to advanced staging and dismal prognosis at the time of diagnosis. In the diagnosis of GBC, differential diagnosis and determination of the local extension of tumor are important. For these purposes, imaging modalities such as endoscopic ultrasonography (EUS), CT, MRI and magnetic resonance cholangiopancreatography (MRCP) are useful. The treatment of localized GBC is based on surgery. Chemotherapy has been used extensively in advanced GBC, and we have gained some experience with gemcitabine-based combination (with cisplatin and oxaliplatin or with capecitabine) regimens

Primary central nervous system lymphoma post kidney transplantation: a case report

Introduction: Primary central nervous system (PCNS) posttransplant lymphoproliferative disease (PTLD) is a rare complication of solid organ transplantation and treatment is not yet standardized.Case presentation: Here we report the case of a 54-year-old man who underwent renaltransplantation 22 years ago for end-stage renal disease. He had been on long-term immunosuppressive treatment consisting of orally administered prednisolone 10 mg and then 5 mg daily and orally administered Mycophenolate Mofetil 500 mg twice daily. He presented in January 2019 to emergency with aphasia and then partial seizure. On brain MRI there was an expansive cortical mass in the left temporal lobe with perilesional edema. Biopsy revealed a diffuse large B-cell lymphoma. He was treated with one cycle of Cytarabine with his usual immunosuppressive treatment. In view of his renal allograft, he was not suitable for Methotrexate due to the risk of toxicity. He died on day 15 caused by a sepsis choc secondary to febrile neutropenia.Conclusion: PCNS-PTLD is regarded as one of the most serious posttransplant complications due to its high mortality. Further clinical and experimental investigations are required to develop optimal diagnostic and treatment modalities

A case of severe paraneoplastic itch resistant to antihistamines and responding to serotonin reuptake inhibitors

Abstract This article covers an interesting topic. Paraneoplastic pruritus is rare but can be severe. It can sometimes be resistant to usual treatments. In our case, it was resistant to antihistamines but was relieved by inhibitors of serotonin scrapping

Predominance of the Rare EGFR Mutation p.L861Q in Tunisian Patients with Non-Small Cell Lung Carcinoma

Objectives: Several new cancer therapies targeting signaling pathways involved in the growth and progression of cancer cells were developed as personalized medicine. Our study aimed to identify epidermal growth factor receptor (EGFR) mutations for TKI treatment in non-small-cell lung cancer (NSCLC) Tunisian patients. Methods: Analysis of the TKI sensitivity mutations in exons 18 to 21 of the EGFR gene and exon 15 of the B-raf gene was performed in 79 formalin fixed-paraffin embedded (FFPE) NSCLC samples using pyrosequencing. Results: EGFR mutations were detected in 34 cases among 79 (43%), with the predominance of the L861Q in exon 21 found in 35.3% of the cases (12 out of 34). Deletions in exon 19 were found in 8 cases (23.5%), and only one young male patient had the T790M mutation. Three patients harbored composite EGFR mutations (p.E746_A750del/p.L861R, p.E746_S752>V/p.S768I, and p.G719A/p.L861Q). Furthermore, the EGFR mutated status was significantly more frequent in female patients (p = 0.019), in non-smoker patients (p = 0.008), and in patients with metastasis (p = 0.044). Moreover, the B-raf V600E was identified in 5 EGFR negative patients among 39 analyzed samples (13.15%). Conclusion: The p.L861Q localized in exon 21 of the EGFR gene was the most common mutation identified in our patients (35.3%), whereas the “classic” EGFR mutations such as Del19 and p.L858R were found in 23.5% and 11.7% of the cases, respectively. Interestingly, most of p.L861X mutation-carrying patients showed good response to TKI treatment. Altogether, our findings suggest a particular distribution of the EGFR-TKIs sensitivity mutations in Tunisian NSCLC patients

International recommendations for plasma Epstein-Barr virus DNA measurement in nasopharyngeal carcinoma in resource-constrained settings: lessons from the COVID-19 pandemic

The effects of the COVID-19 pandemic continue to constrain health-care staff and resources worldwide, despite the availability of effective vaccines. Aerosol-generating procedures such as endoscopy, a common investigation tool for nasopharyngeal carcinoma, are recognised as a likely cause of SARS-CoV-2 spread in hospitals. Plasma Epstein-Barr virus (EBV) DNA is considered the most accurate biomarker for the routine management of nasopharyngeal carcinoma. A consensus statement on whether plasma EBV DNA can minimise the need for or replace aerosol-generating procedures, imaging methods, and face-to-face consultations in managing nasopharyngeal carcinoma is urgently needed amid the current pandemic and potentially for future highly contagious airborne diseases or natural disasters. We completed a modified Delphi consensus process of three rounds with 33 international experts in otorhinolaryngology or head and neck surgery, radiation oncology, medical oncology, and clinical oncology with vast experience in managing nasopharyngeal carcinoma, representing 51 international professional societies and national clinical trial groups. These consensus recommendations aim to enhance consistency in clinical practice, reduce ambiguity in delivering care, and offer advice for clinicians worldwide who work in endemic and non-endemic regions of nasopharyngeal carcinoma, in the context of COVID-19 and other airborne pandemics, and in future unexpected settings of severe resource constraints and insufficiency of personal protective equipment