Hepatoid Adenocarcinoma of the Stomach - A rare pathological entity

Hepatoid adenocarcinoma is a rare cancer with an extremely poor prognosis. Here, we describe two cases referred to our hospital with suspected gastric cancer. Gastrointestinal endoscopy revealed lesions in the stomach. Biopsy from the lesions was reported as adenocarcinoma. Both the patients underwent exploratory laparotomy. One was an operable lesion and the other was an inoperable lesion. Total gastrectomy was done in the operable lesion and feeding jejunostomy was done in the inoperable case. Histologically, both turned out to be hepatoid adenocarcinomas. Retrospective analysis showed the serum levels of alphafetoprotein (AFP) are markedly elevated in both cases. We describe this rare entity of hepatoid adenocarcinoma of the stomach, and review the literature concerning the clinicopathological aspects of the cases. Keywords: Gastric cancer, Hepatoid adenocarcinoma, Alpha Feto Protein, Stomach.     

An unusual variant of prostatic adenocarcinoma with metastasis to testis.A case report

Ductal adenocarcinoma of the prostate is considered to be a rare variant of prostatic adenocarcinoma when compared to the more common acinar adenocarcinoma. We report here a case of ductal adenocarcinoma of the prostate in a 68-year old man who presented with complaints of abdominal pain, retention of urine and hematuria of one month duration. Clinical examination showed prostatomegaly. The serum Prostate Specific Antigen (PSA) value was raised to 79ng/mL. Histopathological and immunohistochemical evaluation of resected specimen of prostate revealed ductal adenocarcinoma of the prostate. The patient was lost to follow up and presented four years after the initial diagnosis with metastasis to the bone and testis. Though prostatic cancers have the ability for wide spread dissemination, metastasis to testis is rare. Immunohistochemical staining with PSA and Prostatic Acid Phosphatase (PAP) can help in establishing prostatic nature of the neoplasm. We are reporting this case because of the rarity of metastasis of prostatic carcinoma to testis and for stressing the need for keeping in mind the possibility of metastatic carcinoma also while dealing with testicular tumors. Keywords: Prostate, ductal adenocarcinoma, metastasis, testis.     

Role of mucosal high‐risk human papillomavirus types in head and neck cancers in central India

Mucosal high‐risk (HR) human papillomaviruses (HPV) cause a subset of head and neck cancers (HNC). The HPV‐attributable fraction of HNC varies substantially between countries. Although HNC has a very high incidence in the Indian subcontinent, information on the contribution of HPV infection is limited. Here, we evaluated the HPV‐attributable fraction in HNC (N = 364) collected in a central region of India. HNC from three different anatomical subsites were included, namely, oral cavity (n = 252), oropharynx (n = 53) and hypopharynx/larynx (n = 59). In this retrospective study, HPV‐driven HNC were defined by presence of both viral DNA and RNA. Overexpression of p16^INK4a was also evaluated. HR‐HPV DNA was detected in 13.7% of the cases; however, only 2.7% were positive for both HPV DNA and RNA. The highest percentage of HPV DNA/RNA double positivity was found in oropharynx (9.4%), followed by larynx (1.7%) and oral cavity (1.6%) (p = 0.02). More than half of HPV DNA/RNA‐positive cases were p16^INK4a‐negative, while a considerable number of HPV RNA‐negative cases were p16^INK4a‐positive (17.9%). HPV16 was the major type associated with HNC (60.0%), although cases positive for HPV18, 35 and 56 were also detected. Our data indicate that the proportion and types of mucosal HR‐HPV associated with HNC in this central Indian region differ from those in other (developed) parts of the world. This may be explained by differences in smoking and/or sexual behaviour compared with North America and northern Europe. Moreover, we show that p16^INK4a staining appeared not to be a good surrogate marker of HPV transformation in the Indian HNC cases.     

Psychosocial interventions after tsunami in Tamil Nadu, India

Any response to the mental health needs of the affected community following any disaster depends upon a number of factors, including disaster preparedness, existence of mental health services, resources in human and financial terms, along with the magnitude, cause and suddenness of the event. In India, groups of islands in the Bay of Bengal and the coast of Tamil Nadu were very badly hit. The survivors needed basic physical and emotional support. The response by two non-governmental organizations (NGOs) is described in this paper. Normalization was seen as an important first step. Using a number of training materials, volunteers were trained to deal with the mental health needs of the survivors. A consistent well resourced and accessible mental health network is necessary for appropriate intervention.     

An optimised patient-specific approach to administration of contrast agent for CT pulmonary angiography

Objectives

To investigate pulmonary vasculature opacification during CTPA using an optimised patient-specific protocol for administering contrast agent.

Methods

CTPA was performed on 200 patients with suspected PE. Patients were assigned to two protocol groups: protocol A, fixed 80 ml contrast agent; protocol B used a patient-specific approach. The mean cross-sectional opacification profile of 8 central and 11 peripheral pulmonary arteries and veins was measured and the arteriovenous contrast ratio (AVCR) calculated. Protocols were compared using Mann–Whitney U non-parametric statistics. Jack-knife alternative free-response receiver-operating characteristic (JAFROC) analyses assessed diagnostic efficacy. Interobserver variations were investigated using kappa methods.

Results

A number of pulmonary arteries demonstrated increases in opacification (P?<?0.03) for protocol B compared to A, whilst opacification in the heart and veins was reduced in protocol B (P?=?0.05). Increased AVCR in protocol B compared with A was observed at all anatomic locations (P?<?0.0002). Increased JAFROC (P?<?0.0002) and kappa variation were observed with protocol B (κ?=?0.78) compared to A (κ?=?0.25). Mean contrast volume was reduced in protocol B (33?±?9 ml) compared to A (80?±?1 ml).

Conclusions

Significant improvements in visualisation of the pulmonary vasculature can be achieved with a low volume of contrast agent using injection timing based on a patient-specific contrast formula.

Key points

? Optimal opacification of the pulmonary arteries is essential for CT pulmonary angiography. ? Matching timing with vessel dynamics significantly improves vessel opacification. ? This leads to increased arterial opacification and reduced venous opacification. ? This can also lead to a reduced volume of contrast agent.     

Early detection of cervical cancer with visual inspection methods: a summary of completed and on-going studies in India

India is a high-risk country for cervical cancer which accounts a quarter (126,000 new cases, 71,000 deaths around 2,000) of the world burden. The age-standardized incidence rates range from 16-55 per 100,000 women in different regions with particularly high rates in rural areas. Control of cervical cancer by early detection and treatment is a priority of the National Cancer Control Programme of India. There are no organized cytology screening programmes in the country. The technical and financial constraints to organize cytology screening have encouraged the evaluation of visual inspection approaches as potential alternatives to cervical cytology in India. Four types of visual detection approaches for cervical neoplasia are investigated in India: a) naked eye inspection without acetic acid application, widely known as 'downstaging'; b) naked eye inspection after application of 3-5% acetic acid (VIA); c) VIA using magnification devices (VIAM); d) visual inspection after the application of Lugol's iodine (VILI). Downstaging has been shown to be poorly sensitive and specific to detect cervical neoplasia and is no longer considered as a suitable screening test for cervical cancer. VIA, VIAM and VILI are currently being investigated in multicentre cross-sectional studies (without verification bias), in which cytology and HPV testing are also simultaneously evaluated, and the results of these investigations will be available in 2003. These studies will provide valuable information on the average, comparative test performances in detecting high-grade cervical cancer precursors and cancer. Results from pooled analysis of data from two completed studies indicated an approximate sensitivity of 93.4% and specificity of 85.1% for VIA to detect CIN 2 or worse lesions; the corresponding figures for cytology were 72.1% and 91.6%. The efficacy of VIA in reducing incidence of an mortality from cervical cancer and its cost-effectiveness is currently being investigated in two cluster randomized controlled intervention trials in India. One of these studies is a 4-arm trial addressing the comparative efficacy of VIA, cytology and primary screening with HPV DNA testing. This trial will provide valuable information on comparative detection rates of CIN 2-3 lesions by the middle of 2003. The expected outcomes from the Indian studies will contribute valuable information for guiding the development of public health policies on cervical cancer prevention in countries with different levels of socio-economic and health services development and open up new avenues of research. This paper is available too at: http//www.insp.mx/salud/index.html.     

How sustained is sustained viral response in patients with hepatitis C virus infection?

Background  

Sustained virological response (SVR) is achieved in a high proportion of patients with chronic hepatitis C infection, particularly those with genotype 2 or 3 HCV infection. However, data on long-term durability of virological response in patients who achieve SVR are limited.