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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 7 | Issue 1
Page Nos. 1-48

Online since Monday, March 2, 2020

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REVIEW ARTICLE  

Clinical application of 18F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography for cancer cells in lung cancer p. 1
Seyyed Hossein Hassanpour, Jafar Nikbakht, Seyyedeh Zeinab Karami
DOI:10.4103/JCRP.JCRP_16_19  
Purpose: One of the most important tools used in the diagnosis and treatment of lung cancer in patients with or suspected of having lung cancer is positron emission tomography-computed tomography XS(PET-CT). The popularity of this method is rapidly increasing. Material and Review Method: We searched papers on the topic of the recognition of cancer cells in lung cancer using18F-fluoro-2-deoxy-D-glucose (FDG) PET-CT using keywords such as18F-FDG PET-CT and lung cancer, 18F-FDG PET-CT imaging in oncology, cancer and nuclear medicine, diagnosis of lung cancer and imaging, molecular imaging in cancer, false-positive18F-FDG PET-CT scans and oncology, application of18F-FDG PET-CT in staging and metabolic activity assessment of cancer, and PET-CT imaging method. Results: In this review, we found the following results: 1.Due to the high diagnostic sensitivity of PET-CT scans, it is possible to reject malignancy in pulmonary cells using this method 2. PET-CT scans decrease the number of unnecessary procedures. 3. According to the findings of this review study, high sensitivity in PET-CT is the major advantage compared to other methods used to rule out the possibility of malignancy of lung cells; it is necessary but not sufficient. Conclusions: Regarding the imaging of abnormal pulmonary cells using PET-CT, except for a few exceptions, if the result of a PET-CT scan is negative, these abnormalities can confidently be considered to be benign. These exceptions include nonsolid and small (<1 cm) pulmonary nodules. Until all metastases in the pulmonary cells are imaged and detected by PET-CT, no drug regimen should be started. Finally, lymph node tumor metastasis cannot be ruled out solely based on a negative result of PET-CT imaging with these abnormalities, and to confirm it, aggressive staging should be performed in most patients before mediastinal metastasis is confirmed or rejected.
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ORIGINAL ARTICLES Top

Considering blood samples for early diagnosis of prostate cancer by evaluating prostate cancer antigen 3 expression values p. 11
Reza Mahmoudi Lamouki, Elham Moslemi, Amir Izadi, Maedeh Mashhadikhan
DOI:10.4103/JCRP.JCRP_25_19  
Background: Prostate cancer antigen 3 (PCA3) is the most specific biomarker for an early diagnosis of prostate cancer (PCa), and it is routinely evaluated in urine samples. Recent investigations consider blood as a reliable source to determine PCA3 expression levels and fast diagnosis of PCa since in addition to bacterial and viral contaminations and the hygienic problems, if the area of the prostatic duct is not involved PCa, the obtained urine samples may not contain any cancerous cells. Materials and Methods: This study investigated blood expression values of the PCA3 gene in patients with PCa and multiple endocrine neoplasia compared with normal volunteers in an Iranian population. A total of 150 blood samples from three groups were assessed for PCA3 expression using real-time polymerase chain reaction. Prostate-specific antigen (PSA) serum levels, age, and family history of PCa were also analyzed. Results: PCA3 expression analysis showed a significant increase in PCa patients and in patients with PSA serum levels higher than 7 ng/ml (P = 0.005 and P= 0.0011, respectively). Analysis of blood samples from men with an older age and positive family history also showed significant PCA3 expression values. Results of this study suggests that evaluating PCA3 gene expression in blood samples is an adequate method for an early diagnosis of PCa. The decision to perform a prostate biopsy should be made more cautiously in patients with a PSA serum level between 4 and 7 ng/ml. Patients with a positive PCa family history and higher age should be considered for PCa diagnostic procedures.Conclusion: Blood samples can be considered for PCA3 evaluating as a promising alternative of urine samples for PCa diagnosis.
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Modified 3-weekly cisplatin or cisplatin-5-fluorouracil 5-day infusion as the concurrent chemoradiotherapy regimen in locally advanced squamous cell carcinoma of the head and neck: Comparison of efficacy and toxicity p. 17
Nai-Wen Su, Kaun-Jer Tsai, Yi-Shing Leu, Jehn-Chuan Lee, Chung-Ji Liu, Chieh-Yuan Cheng, Jiun-Sheng Lin, Yu-Jen Chen, Shih-Hua Liu, Chun-How Chen, Yi-Fang Chang
DOI:10.4103/JCRP.JCRP_27_19  
Background: Concurrent chemoradiotherapy (CCRT) is an important therapeutic strategy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). We evaluated the efficacy and toxicity of two CCRT regimens in treating LA-SCCHN. Materials and Methods: LA-SCCHN patients receiving CCRT with either a modified 3-weekly cisplatin 75 mg/m2 (Group A, n = 86) or 5-day continuous infusion of cisplatin 12 mg/m2 plus 5-fluorouracil (5-FU) 600 mg/m2 (Group B, n = 87) were enrolled. The Kaplan−Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRFS). Univariate and multivariate analyses were performed using Cox proportional hazard models to assess correlations between clinical parameters and survival. Results: With a median of 35.8 months' follow-up, the median OS and PFS in Group A and Group B were 65.9 versus 55.0 months (P = 0.546) and 34.6 versus 33.3 months (P = 0.948), respectively. LRFS was not reached in either group. Group B patients had more Grade 3−4 mucositis (53.7% vs. 32.28%, P= 0.001) and dermatitis (49.8% vs. 21.5%, P= 0.0001). Trends of higher incidence rates of Grade 3−4 hematologic and renal toxicity were observed in Group A. After statistical adjustment, higher disease stage (Stage IVb) (hazard ratio [HR] = 6.657, 95% confidence interval [CI] 1.786−24.81, P= 0.005) and pretreatment anemia (hemoglobin <13 g/dL) (HR = 1.896, 95% CI 1.063−3.391, P= 0.030) were associated with poor OS. Conclusion: A 5-day cisplatin-5-FU regimen was associated with more frequent Grade 3−4 mucositis and dermatitis than a 3-weekly cisplatin regimen. A multiagent CCRT regimen did not provide survival benefits but increased adverse events.
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CASE REPORTS Top

Rituximab, cyclophosphamide, vincristine, and prednisolone with high-dose methotrexate as an effective regimen in a frail patient with intravascular large B-cell lymphoma p. 25
Yu-Hsuan Shih, Ren Ching Wang, Chieh- Lin Jerry Teng, Cheng-Hsien Lin
DOI:10.4103/JCRP.JCRP_17_19  
Intravascular large B-cell lymphoma (IVLBCL) is a rare non-Hodgkin lymphoma characterized by the presence of lymphoma cells within the lumina of small vessels. Membranous CD20 is universally expressed on IVLBCL cells in immunohistochemical staining. The outcome of IVLBCL was dismal in the prerituximab era; however, rituximab in combination with chemotherapy has been proposed to be an effective treatment for IVLBCL. Herein, we report a 68-year-old female with “Asian variant” IVLBCL diagnosed from a pleural biopsy. We administered rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) with high-dose methotrexate as the initial treatment. The patient achieved a complete response after the treatment. Therefore, R-CVP with high-dose methotrexate can be considered as a treatment option for frail IVLBCL patients.
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Germline BRCA2 mutation pancreatic adenocarcinoma p. 29
Wen-Chun Chen, Ming-Huang Chen
DOI:10.4103/JCRP.JCRP_20_19  
Pancreatic adenocarcinoma is one of the most challenging malignancies. Its surgical resection is regarded as the only potential curative treatment. However, most patients present with advanced stages, associated with very poor prognosis. Germline BRCA1 and BRCA2 (BRCA1/2) mutations account for few advanced pancreatic adenocarcinomas and thus present as disease-specific entities. Cancers harboring BRCA1/2 mutations are relatively more chemosensitive and have exhibited survival benefits with platinum-containing combination treatments. FOLFIRINOX has been evaluated in various trials and is a well-established first-line chemotherapy for metastatic pancreatic cancer in patients with good performance status. Here, we report the case of a patient with germline BRCA2-mutation pancreatic adenocarcinoma who exhibited a good response to modified FOLFIRINOX, achieving an 18-month complete response.
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A rare case of colliding cancer of the esophagus with small cell neuroendocrine, squamous, and adenocarcinoma components p. 34
Jiun-I Lai, Yi-Chen Yeh, Ming-Huang Chen
DOI:10.4103/JCRP.JCRP_21_19  
Esophageal cancer is one of the top ten prevalent cancers in the world with a poor prognosis, especially in advanced stages. The prevalent cell type is different according to the location: squamous cell carcinoma is the prevalent subtype in the proximal (upper) esophagus, while adenocarcinoma is more prevalent in lower/distal esophagus. Primary small cell carcinoma of the esophagus is rare in prevalence and only limited cases have been reported. We report a 62 year old female patient who was newly diagnosed of esophageal cancer and subsequently received surgical resection. Interestingly, the pathology from the resected esophageal lesion revealed a mixed histology type with small cell carcinoma , squamous cell carcinoma, and adenocarcinoma. Currently in the literature, a triple combined histology type cancer is rarely reported. The etiology is unclear, one possibility being multi-focal primary cancers, another being a collision of distinct primary cancers. This patient was started on postoperative CCRT and currently treatment is still ongoing. Our case presents with an interesting finding of triple cancer of the esophagus which contributes to medical knowledge and is valuable for oncologists encountering this rare scenario.
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Very late relapse of plasma cell myeloma after allogeneic hematopoietic stem cell transplantation p. 38
Yu-Tin Hsiao, Wen-Chi Yang, Sheng-Fung Lin, Yu-Chieh Su
DOI:10.4103/JCRP.JCRP_23_19  
Very late (more than 10 years) relapse of plasma cell myeloma after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. The most common relapse pattern in such cases involves the bone marrow. Here, we report the case of a 51-year-old woman whose myeloma relapsed 15 years after allo-HSCT. She retained full donor chimerism, and the myeloma presented as soft tissue in the colonic wall. According to our review of the literature, this case presents the longest time to relapse after allo-HSCT. Patients with myeloma who undergo allo-HSCT should continue to receive regular follow-up even after 15 years.
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Mantle cell lymphoma presented as cryoglobulinemic vasculitis p. 41
Sung-Nan Pei, Chih-Cheng Chen, Shang-Hung Lin, Chang-Hsien Lu
DOI:10.4103/JCRP.JCRP_28_19  
Mantle cell lymphoma (MCL) is an uncommon subtype of B-cell lymphoproliferative neoplasm which often presents as lymphadenopathy or organomegaly. Herein, we present the case of a 69-year-old male who developed the rapid onset of cyanotic digits and nose. Cryoglobulin was detected, and a skin biopsy showed occlusive vasculopathy, which suggested cryoglobulinemic vasculitis. A bone marrow biopsy confirmed the diagnosis of cyclin D1-negative, SOX11-positive MCL. He received systemic immunochemotherapy including bortezomib and rituximab, and his cryoglobulinemia completely resolved. In addition, his lymphoma remains in complete remission 2 years after the diagnosis.
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Squamous cell carcinoma of the urinary bladder associated with large vesical calculus p. 45
Sankalp Singh, Niharika Bisht, Samir Gupta, Arijit Sen, Richa Joshi
DOI:10.4103/JCRP.JCRP_29_19  
Squamous cell carcinoma is a histological diagnosis rarely seen in bladder cancers. It is classically associated with chronic mucosal inflammation or urinary retention. Very few studies have clearly defined the management guidelines, however multimodality treatment is frequently offered along the lines of more common transitional cell cancer. We report the case of a 50-year-old male who presented with obstructive urinary symptoms and on evaluation was found to have a large vesical calculus associated with squamous cell cancer of the bladder. He was treated with surgery in the form of radical cystectomy followed by adjuvant locoregional radiotherapy. He has remained on regular follow-up for the last 2 years and has been disease free.
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