Leiomyosarcoma of left atrium extending into left pulmonary vein—a case report

Left atrial leiomyosarcoma is an uncommon entity and accounts for 0.25 % of all cardiac tumors. Though long term survival is a rarity, surgical excision of the tumor helps in prolonging life. Its diagnosis is almost always confirmed on histopathology. We report a 72 years old male who presented with severe dyspnoea. A diagnosis of left atrial myxoma was made before surgery. The tumor was found to occupy the whole of the left atrial cavity and extended into left pulmonary vein. The left atrial tumor mass was excised along with the left atrial wall but due to his advanced age and severe pulmonary hypertension no attempt was made to do a left pneumonectomy.     

Utility of [<Superscript>18</Superscript>F]FSPG PET to Image Hepatocellular Carcinoma: First Clinical Evaluation in a US Population

Purpose

Non-invasive imaging is central to hepatocellular carcinoma (HCC) diagnosis; however, conventional modalities are limited by smaller tumors and other chronic diseases that are often present in patients with HCC, such as cirrhosis. This pilot study evaluated the feasibility of (4S)-4-(3-[¹⁸F]fluoropropyl)-L-glutamic acid ([¹⁸F]FSPG) positron emission tomography (PET)/X-ray computed tomography (CT) to image HCC. [¹⁸F]FSPG PET/CT was compared to standard-of-care (SOC) magnetic resonance imaging (MRI) and CT, and [¹¹C]acetate PET/CT, commonly used in this setting. We report the largest cohort of HCC patients imaged to date with [¹⁸F]FSPG PET/CT and present the first comparison to [¹¹C]acetate PET/CT and SOC imaging. This study represents the first in a US HCC population, which is distinguished by different underlying comorbidities than non-US populations.

Procedures

x_C? transporter RNA and protein levels were evaluated in HCC and matched liver samples from The Cancer Genome Atlas (n = 16) and a tissue microarray (n = 83). Eleven HCC patients who underwent prior MRI or CT scans were imaged by [¹⁸F]FSPG PET/CT, with seven patients also imaged with [¹¹C]acetate PET/CT.

Results

x_C? transporter RNA and protein levels were elevated in HCC samples compared to background liver. Over 50 % of low-grade HCCs and ~70 % of high-grade tumors exceeded background liver protein expression. [¹⁸F]FSPG PET/CT demonstrated a detection rate of 75 %. [¹⁸F]FSPG PET/CT also identified an HCC devoid of typical MRI enhancement pattern. Patients scanned with [¹⁸F]FSPG and [¹¹C]acetate PET/CT exhibited a 90 and 70 % detection rate, respectively. In dually positive tumors, [¹⁸F]FSPG accumulation consistently resulted in significantly greater tumor-to-liver background ratios compared with [¹¹C]acetate PET/CT.

Conclusions

[¹⁸F]FSPG PET/CT is a promising modality for HCC imaging, and larger studies are warranted to examine [¹⁸F]FSPG PET/CT impact on diagnosis and management of HCC. [¹⁸F]FSPG PET/CT may also be useful for phenotyping HCC tumor metabolism as part of precision cancer medicine.

     

New mosquito records of an area known for Japanese encephalitis hyperendemicity, Gorakhpur District, Uttar Pradesh, India

During long-term ecological studies carried out between 1990 and 2000, a total of 67 mosquito species were collected from Gorakhpur District, Uttar Pradesh, India, of which 43 were documented for the 1st time. The genus Aedes was represented by 15 species, Anopheles by 15, Culex by 24, Mansonia by 3, and Mimomyia, Ochlerotatus, and Verrallina by 2 each. The genera Aedeomyia, Armigeres, Coquillettidia, and Uranotaenia were represented by single species. The impact of ecological changes on mosquito fauna in Gorakhpur District is discussed. The role of culicine mosquitoes in disease transmission in the area is highlighted.     

Experience with Neoral versus Sandimmune in primary liver transplant recipients

We compared results using Neoral versus Sandimmune, each in combination with steroid and azathioprine immunosuppression, in primary liver transplantation recipients. There were 15 patients in each group with similar demographic distributions. Intravenous cyclosporine was stopped at 4.3 ± 1.9 days in the Neoral group vs 7.8 ± 4.9 days in the Sandimmune group (P < 0.025). Cyclosporine levels in the first 10 days were higher (mean 306 ng/ml vs 231 ng/ml) in the Neoral group than the Sandimmune group (P < 0.05). The Neoral dose was less than the Sandimmune dose (mean 5.5 ng/kg per day vs 7.9 ng/kg per day) to achieve these levels in that time period (P < 0.05). Two patients (13 %) experienced three episodes of biopsy-proven rejection in the Neoral group compared to nine patients (60 %) with 12 episodes of rejection in the Sandimmune group (P < 0.025). Incidences of neurological and renal complications were similar between the groups. Infections requiring treatment were also similar. Liver function, renal function, and marrow function, evaluated at days 7, 14, 21, 28, and 2, 4, 6, and 12 months post-transplant, were not different between the groups. In summary, shorter use of intravenous cyclosporine and quicker stabilization of trough cyclosporine levels was achieved with Neoral than with Sandimmune. In the early posttransplant period, higher levels with lower doses were achieved with Neoral than with Sandimmune. In our experience, the incidence of rejection was lower with Neoral than with Sandimmune. There were similar lengths of hospitalization, mortality, adverse events, retransplantation, and similar liver, renal, and marrow function up to 1 year posttransplantation. Because of this experience, we continued to use Neoral in a total of 59 primary liver transplant recipients. We have not used intravenous cyclosporine in the last 44 patients. Follow-up was a mean of 11.4 months, ranging from 1 to 27 months. The incidence of rejection was 24 % in these 59 patients compared to our historical experience of 70 % using Sandimmune.     

Cervical carcinoma in the elderly: an analysis of patterns of care and outcome

BACKGROUND: Advanced age often is considered a poor prognostic factor for cervical carcinoma. The authors investigated the patterns of care and treatment outcomes of elderly women with cervical carcinoma. METHODS: A hospital-based tumor registry was used to identify patients with invasive cervical carcinoma who were treated between 1986 and 2003. Patients were divided into 2 cohorts: women age < 70 years and women age > or = 70 years. Survival was examined using the Kaplan-Meier method. Single and multivariate Cox proportional hazards modeling was used to estimate hazard ratios with 95% confidence intervals (95% CI). RESULTS: In total, 1582 patients were identified, including 1385 patients age < 70 years and 197 patients age > or = 70 years. The elderly patients presented with more advanced stage tumors at diagnosis (P <0.0001) and were more likely to have nonsquamous neoplasms (P=0.002). A marked difference in treatment was noted for the elderly cohort, even after stratifying by disease stage. Only 16% of the older patients underwent surgical treatment compared with 54% of the younger patients (P <0.0001). Elderly women were 9 times more likely to receive no treatment (P <0.0001). In a multivariate model of known prognostic factors, the hazard ratio for death from any cause in women age > 70 years was 2.1 (95% CI, 1.5-3.0). The hazard ratio for death from cervical carcinoma in the elderly women was 1.6 (95% CI, 1.1-2.5). CONCLUSIONS: Age is an important factor in the allocation of treatment and survival for patients with cervical carcinoma. Elderly women with cervical carcinoma are more likely to receive primary radiotherapy, to forego treatment, and to die from their disease.