CORRELATION BETWEEN STANDARDIZED UPTAKE VALUE AND HISTOPATHOLOGY OF OESOPHAGEAL CARCINOMA: A SINGLE CENTER ANALYSIS

Aim: This study aims to evaluate the correlation between oesophageal cancer histopathology and the standardised uptake value (SUV) of the primary lesion on positron emission tomography/computed tomography (PET/CT) scan.Methods: We reviewed clinical data of consecutive newly diagnosed oesophageal cancer patients who underwent positron emission tomography with 2-deoxy-2-[ uorine-18] uoro-D glucose integrated with CT (18F-FDG PET/CT) between September 2009 and July 2014. Results: A total of 289 baseline scans were performed in this 55-month period. Of these, 171 (59%) were male. The mean age was 52.6 years (standard deviation ± 12.4 years). On histological review, 214 were squamous cell carcinomas (SCCa) and 75 were adenocarcinomas. Of the SCCa, 15.9% were poorly differentiated, 70.6% were moderately differentiated and 13.5% were well differentiated. Of the adenocarcinomas, 20% were poorly differentiated, 45% were moderately differentiated, 28% were well differentiated and signet ring cell was 7%. Mean maximum SUV (SUVmax) for SCCa was 12.6 ± 5.14 and 10.5 ± 6.2 for adenocarcinomas. In bivariate analysis, being a female was associated with a higher SUV in the primary lesion by 1.66 units (P = 0.011) compared to males. Adenocarcinomas were associated with a lower SUV by 2.14 units (P = 0.004) compared to SCCa. In bivariate analysis, no signi cant correlation was found between the T-stage of the tumour and the SUVmax of the primary tumour (P = 0.339). Multivariate analyses showed no association of the SUV of the primary oesophageal tumour with the degree of differentiation of either SCCa or adenocarcinoma. There was no correlation between the SUVmax of the primary lesion and the presence or activity level of a metastatic focus, whether visceral or nodal. Conclusion: At our centre, three-fourths of patients with oesophageal carcinoma had squamous cell carcinoma on histology. Adenocarcinoma is associated with a lower SUV compared to SCCa. There is no association between the SUVmax and degree of differentiation of the primary oesophageal cancer. Key words: Fluorodeoxyglucose, oesophageal adenocarcinoma, oesophageal squamous cell carcinoma, positron emission tomography/computed tomography, standardised uptake value

A rare case of medullary carcinoma thyroid metastasizing to bilateral breast parenchyma

Medullary carcinoma of the thyroid (MTC) commonly spreads through the lymphatics to distant sites such as lung, liver and bone. Spread to the breast is rare. We report a case of metastatic MTC which progressed to develop nodal metastases to cer­vical and mediastinal regions, visceral metastases to the liver, lung and ultimately to bilateral breasts. Clinically it is important to distinguish metastatic breast lesions from primary breast cancer as each is managed differently. Both cytological and radio­logical investigations were done followed by excision biopsy. Histopathological examination of post excision breast specimen revealed metastatic medullary carcinoma, with positive immunohistochemical staining for calcitonin. A brief review of literature and differential diagnosis is also presented

SURVIVAL IMPACT OF SKELETAL METASTASIS ON BONE SCINTIGRAPHY IN PATIENTS WITH GERM CELL TUMOURS

Objective: Our aim was to determine the frequency of skeletal metastasis in germ cell tumours (GCT) at baseline and relapse on conventional technetium-99m methylene diphosphonate (Tc-99m MDP) whole body bone scan (bone scan) and to evaluate the effect of bone metastases on survival. Materials and Methods: Electronic medical records of histologically proven GCT over 64 months were retrospectively analysed. Basic demographic and histologic information were correlated with the presence of osseous and visceral metastases. 5-year disease-free survival (DFS) and overall survival (OS) were calculated in presence, the absence of bone metastases at baseline and at relapse. Results: A total of 130 gonadal and extragonadal GCT patients underwent Tc-99m MDP bone scans; four with insuf cient data were excluded from the study. 47% were females and 53% were males with the age range of 1 month – 72 years. 105 (83%) were under 18 years of age. Osseous metastasis was detected in 12 (9.5%). Two (17%) had solitary and 10 (83%) had multifocal skeletal metastases. Clinically, 83% had localised bone pain. Osseous metastases were more frequently associated with mixed GCT and yolk sac tumour. 50% of mediastinal GCT developed bone metastases. 42% died within 4–18 months. There was a statistically signi cant impact of visceral metastases on DFS and OS. OS at 5 years in patients without bone metastases, with bone metastases at baseline and bone metastases at relapse, was 77%, 38% and 75%, respectively. 5-year DFS for the same cohort groups was 63%, 38% and 20%, respectively. Conclusion: Osseous involvement was found in 9.5% of GCT patients undergoing diagnostic Tc-99m MDP bone scan. Baseline skeletal evaluation for metastases should be done, particularly in the case of bone pains or known systemic metastases. Although skeletal relapses are rare, they have a grim outcome. Key words: Bone scintigraphy, germ cell tumours, skeletal metastases

CASTLEMAN DISEASE: A GREAT MIMICKER OF METASTASES IN RADIOIODINE REFRACTORY THYROID CANCER

A 27-year-old male underwent total thyroidectomy for thyroid swelling. Histopathology showed papillary thyroid carcinoma [T3 - 6.0 cm] with extra-thyroidal extension. The patient was treated with 150 mCi radioactive iodine(RAI) as adjuvant ablative therapy. Radioiodine refractory disease was identified 1-year post-RAI therapy with elevated thyroglobulin levels and negative I-131 whole body scan. F-18 FDG positron emission tomography/computedtomography scan showed activity in the right thyroid bed and multilevel right cervical nodes. Right-sided modified neck dissection was done, which showed Castleman disease (hyaline vascular type) in right cervical nodes. The most probable cause of elevated tumour markers was found out to be 0.6 cm right thyroid bed nodule on follow-up ultrasonography. Our patient also had coexistent conditions as; osteopoikilosis and Hepatitis C along with thyroid carcinoma.Key words: Castleman disease, lymph node, radioiodine, thyroid cance

Glyphosate: cancerous or not? Perspectives from both ends of the debate

Glyphosate is non-selective herbicide. Studies published in the last decade, point towards glyphosate toxicity. Shikimic acid pathway for the biosynthesis of folates and aromatic amino acids is inhibited by glyphosate. Glyphosate carcinogenicity is still considered to be a controversial issue. The World Health Organizations’ International Agency recently concluded that glyphosate is “probably carcinogenic to humans.” Some researchers believed that glyphosate is not linked with carcinogenicity

Retrospective Diagnosis of Ca Thyroid on Thyroid Pertechnetate Scan –A part of Routine Post Thyroidectomy Work up For Nontoxic Multi Nodular Goiter

Unsuspected thyroid cancer can be detected in multinodular goiter (MNG) where the risk of malignancy is 7-9%. Fine needle aspiration (FNAc) is performed in case of suspicious findings on ultrasound. With benign FNAC results there is no need for surgery unless the patient has pressure symptoms or cosmetic concerns, but the risk of overlooked malignancy is always present. We present the case of a patient with unexpected detection of papillary thyroid cancer on thyroid scan. Keywords:Thyroid Cancer Papillary, Multi-nodular Goitre, Thyroid Neoplasm,

Differentiated Thyroid Carcinoma: Distant Metastasis as an Unusual Sole Initial Manifestation

Objective:The objective of this study was to identify the characteristic features of patients with distant metastasis as the only manifestation of well-differentiated thyroid cancers and to analyze the treatment outcomesMethods:A retrospective review of all patients with well-differentiated thyroid cancers and distant metastasis as the sole initial presentation was carried out. Data regarding age, gender, tumor histology, site, symptoms, and treatment outcomes were collected.Results:There were 10 patients who presented with distant metastasis as the only presentation. The mean age was 56.1 years. Eight (80%) patients had osseous metastasis, one (10%) had pulmonary and one (10%) had both. Follicular thyroid carcinoma was more common and seen in six (60%) patients. Seven (77.8%) out of nine patients had demised within five years of initial presentation.Conclusion:Distant metastases without a neck lump as the initial presentation of well-differentiated thyroid cancers are extremely rare. No specific guidelines are available to manage such patients due to lack of relevant data in the literature

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

Rapidly growing massive abdominal sarcomatoid carcinoma on F18-FDG PET-CT scan

Sarcomatoid carcinoma is a rare type of tumour and most commonly arises in the lungs. However, rarely can it also be found in the abdomen. Sarcomatoid tumours are aggressive with large tumoural volume showing cancerous epithelial cells mixed with sarcomatous (nerve, muscle, fat etc.) features on histopathology. Most of the carcinosarcomas arise in the background of pleomorphic adenoma, originating from a myoepithelial precursor. These tumours are resistant to treatment and rapidly metastasize. We present a unique case of hepatocellular sarcomatoid sarcoma, evaluated through F18-FDG PET/CT. Keywords: Sarcomatoid sarcoma, 18F FDG PET-CT, massive abdominal mass