Spontaneous Regression of Dermal Metastases in Merkel Cell Carcinoma

Introduction: Merkel cell carcinoma (MCC) or cutaneous neuroendocrine carcinoma is a rare and aggressive cutaneous malignancy. Interestingly, despite its aggressive nature, complete spontaneous regression of MCC has been reported, mostly of the head and neck sites, and after biopsy or fine-needle aspiration sampling. There has been speculation that the biopsy of MCC may trigger complete spontaneous tumor regression via stimulation of the immune system. Spontaneous regression of metastatic MCC lesions after the excision of the main lesion, however, has not been reported in English literature.Presentation of case: We report an extremely rare case of MCC of the left gluteal region with left inguinal lymphadenopathy and metastatic dermal nodules who underwent excision of the main lesion and was noted to have spontaneous regression of his dermal metastases post-operatively.Conclusions: Spontaneous regression of MCC remains a poorly understood phenomenon. Further research into the histopathological features and immunity status should be considered to elucidate the mechanism underlying this phenomenon, as it will potentially be life-saving for patients with this rare malignancy, whose median survival will otherwise be measured in months

An Unusual Case of Presacral Carcinoid Tumor and the Approach of Management

Introduction: Gut derived neuroendocrine tumors (NETs) are a heterogenous group of tumors classified as Gastroenteropancreatic (GEP) NETs. These tumors can be found along the gastrointestinal tract from the foregut, mid, to the hindgut. They are referred to as carcinoid tumors due to their potential to secrete bioactive hormones.Presacral tumors are a subset of GEP NETs that are histologically similar. They are uncommon tumors that are found at the presacral space and are often clinically silent with no associated carcinoid syndrome. Presentation of Case: We report a case of 49 year old female who was diagnosed with a presacral carcinoid tumor. Her initial presentation, investigations that led up to the final diagnosis and management of the tumor are discussed. Conclusion: Presacral carcinoid tumors are NETs that are clinically and histologically similar to GEPs arising from the colon or rectum. Management of such tumors is often surgical resection of localized disease with a long follow-up of surveillance to detect recurrence and metastasis

A Case of Lung Cancer with Isolated Skip Metastasis to an External Iliac Lymph Node

Introduction: Isolated skip metastases to intra-abdominal lymph nodes from lung cancer are rare and management of such disease remains controversial.  Presentation of case: We report a case of lung adenocarcinoma in the right upper lobe with isolated lymph node metastasis to an external iliac lymph node detected by Positron Emission Tomography (PET) scan which was confirmed histopathologically.  Conclusion: Isolated intra-abdominal lymph nodes from lung cancer are a rare occurrence.  In these patients, lymphadenectomy can be considered together with definitive treatment of the lung primary

Management of Ovarian Cancer — Is There a Role for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?

Ovarian cancer is one of the commonest malignancy in women worldwide, and is the most lethal of all the gynaecological malignancies. Ovarian cancer often presents at an advanced stage, with the involvement of the peritoneal surface either at the initial diagnosis or at recurrence. Despite the advances made in the surgical techniques and chemotherapeutic options regarding agents, schedule, and route of administration, majority of the patients recur and eventually succumb to their disease. The change in the surgical approach supporting more radical and extensive surgical procedures, in a bid to attain optimal cytoreduction with no gross residual disease, has seen improvement in the survival, as has the use of intraperitoneal chemotherapy in combination with i.v. agents. Although peritoneal carcinomatosis has always been a poor prognostic factor, it ceases to be a factor of much importance if complete cytoreduction can be achieved. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) provide the combined benefits of surgical eradication and effective chemotherapy, and can be performed with acceptable morbidity and mortality. Further trials are being undertaken to examine its role in the primary, as well as recurrent settings of advanced ovarian cancer and to determine the ideal drug combinations and dosages. We aim to discuss the role of CRS and HIPEC in the treatment of ovarian cancer

Association of Researchers in Construction Management

Construction projects have a potentially large economic, social, ecological and cultural impact on the communities in which they take place. As these communities become increasingly empowered, educated, connected and organised, there is increasing evidence that they are able and willing to mobilise action when they become concerned about the impact of construction projects on their lives. From a construction project management perspective, there has been virtually no research into the structure of these groups and how best to interact with them for mutually beneficial outcomes. Using a thematic story telling approach which draws on ethnographic method and social contagion theories, an in-depth analysis of community action against a construction project is presented. It is concluded that these groups are largely anarchic but are held together and sustained by a core group of activists which are often invisible to outsiders. This raises numerous challenges for project managers in addressing community concerns and in mitigating potential cost and time escalations associated with such action

Lung Metastases Presenting as Multiple Bleeding Ulcers in the Small Bowel: A Case Report

Introduction: Lung cancer is a leading cause of cancer mortality worldwide and approximately half of the patients are diagnosed at an advanced stage.  Gastrointestinal metastases from lung cancer are very rare.Case Report: Here, we present a case of a 73-year-old gentleman with gastrointestinal metastases from lung cancer, presenting as acute gastrointestinal bleeding from multiple bleeding ulcers in the small bowel.Conclusion: Early detection of gastrointestinal metastases will help with determining clinical management. Whilst likely palliative in nature, treatment may incorporate surgical resection which if to be undertaken, should be performed early for prompt palliation of symptoms and improvement of quality of remaining life

Measuring impacts and risks to the public of a privately operated toll road project by considering perspectives in cost-benefit analysis

Decision making about transport infrastructure investment is based on the net impacts and risks to the community. The private sector is often involved in toll road projects, including various schemes to design, build, operate and/or finance the project either in a partnership with a host government, independently, or in some combination. Cost-Benefit Analysis of a privately operated toll road require careful allocations of project impacts, in order to properly reflect the net impacts and risks to the community from the host government’s perspective. This study investigates whether alternative assumptions are valid from differing perspectives, when toll roads are delivered and operated privately rather than by a host government. Treatments of tolls and other toll road project related payments are considered from different perspectives. Cost-Benefit Analysis is conducted for a synthesised toll tunnel project case by considering alternating treatments of some impacts. This leads to the exploration of analyses outcomes when the treatment of tolls differ when two perspectives of “toll as a transfer payment” and “toll as an end user cost” are considered. Various scenarios are explored including public versus private operations. The Monte Carlo simulation approach is used to account the risks of variables in the analysis. The synthesised case study revealed that, for privately operated toll roads, treating toll charges as a transfer payment, and alternatively as an end user cost, can both be valid approaches but from two perspectives. Moreover, the analysis outcomes under different perspectives are particularly helpful to make decisions on the basis of the impacts and risks solely from the perspective of the host government. The proposed methodology can examine various scenarios other than the ones examined in this study and is extremely useful in the project evaluation of privately operated toll road projects