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Fulltext PET-CT imaging in non-small cell lung carcinoma – a review of cases from a northern Malaysia referral centre

Bing, Joni Fei Teoh, Paniandi, Vikneswary, Fadzilah Hamzah, H., Mohamed Ali Abdul Khader, Loh, Li-Cher

International e-Journal of Science, Medicine & Education, 2008;2(2):23-26.
MyJurnal

Background: Positron Emission Tomography and Computed Tomography (PET-CT) imaging is shown to influence a decision change in managing non-small cell lung carcinoma (NSCLC). The introduction of such a facility in Malaysia is relatively recent, and its impact from its utility is currently being assessed.
Aim: In a tertiary referral centre possessing the only PET-CT facility in northern Peninsular Malaysia, we evaluated the potential roles of PET-CT in referred patients with non-small cell lung carcinoma.
Methodology: Sixty eligible adult cases with NSCLC, between September 2005 and December 2007, were retrospectively reviewed. Relevant data was collected using standard questionnaire for indications, staging of disease, and outcomes in terms of recurrence and response to prescribed cancer-specific therapy.
Results: The indications for PET-CT were: staging of a newly diagnosed non-small cell lung carcinoma (25.0%); post-operative restaging (21.7%); exclusion of recurrence or metastasis (18.3%); establishing diagnosis of carcinoma (13.3%); assessment of response to treatment (11.7%), and for surveillance (10.0%). The use of PET-CT was shown to induce a change in the staging, compared with non-PET conventional means in 69.2% of patients with newly diagnosed lung carcinoma (upstaged in 55.5%; downstaged in 44.5%) and in 65.0% of patients who underwent cancer-specific treatments (upstaged in 38.5%; downstaged in 61.5%). PET-CT detected recurrence in 62.5% who underwent the imaging to exclude a recurrence or metastasis.
Conclusion: PET-CT has affected the staging of a large proportion of our local Malaysian patients. Like elsewhere, the availability of such a facility is likely to have important influence in overall management of NSCLC in Malaysia.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Cases of mucocele treated in the Dental Department of Penang Hospital

Rashid, A.K., Anwar, N., Azizah, A.M., Narayan, K.A.

Archives of Orofacial Sciences, 2008;3(1):7-10.
MyJurnal

A mucous cyst is a benign, self limiting mucous containing cyst of the salivary glands commonly occuring in the oral cavity. Mucocele may develop following the obstruction of the salivary flow from secretory apparatus of the salivary gland. Mucoceles commonly occur on the lower lip but may occur in other locations too. The objective of the study was to determine the factors associated with mucocele in patients attending the dental clinic of Penang Hospital from January 2000 to December 2005. This is a retrospective record review analysis of all the total 35 cases treated during this period, comprising of 20 males (57.1%) and 15 females (42.9%) with Malays as the largest group of patients treated and, mainly students had seek treatment. Mucocele was frequently treated in patients aged 21 to 24 year old. The site of the mucocele was the lower lip and all of the cases were treated surgically. The size of the mucocele ranged from 0.5 to 5 centimetres with 1.0 cm as the most common size. Most of the patients gave a history of spontaneous development (71.4%), followed by lip biting (25.7%) and trauma (2.9%). Lip biting was more common among students (55.6%) as compared to others. There were only two recorded cases of recurrence.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Management of large mandibular ameloblastoma - a case report and literature reviews

Kahairi, A., Ahmad, R.L., Wan Islah, L., Norra, H.

Archives of Orofacial Sciences, 2008;3(2):52-55.
MyJurnal

Ameloblastoma is a slow growing benign tumour of the jaw and patients usually present late after the tumour achieved considerable size to cause facial disfigurement. Diagnosis mainly from tissue biopsy and characteristic findings on plain X-rays does assist in differentiating between types of ameloblastoma. The challenges in the management of this tumour are to provide complete excision as recurrence may occur in incomplete removal and also to reconstruct the bony defect in order to give reasonable cosmetic and functional outcome to the patient.

Matched MeSH terms: Neoplasm Recurrence, Local
Third S. S. Ratnam memorial lecture 2007. Ovarian cancer: Is there hope for women?

Sivanesaratnam V

J Obstet Gynaecol Res, 2009 Jun;35(3):393-404.
PMID: 19527374 DOI: 10.1111/j.1447-0756.2009.01049.x

Ovarian cancer is today the most lethal female cancer with an overall survival of only 49.9%. The currently available screening modalities are disappointing in detecting highly curable early stage ovarian cancer. Natural history of ovarian cancer is unknown; it appears it can develop quickly from normal looking ovaries. Timely referral of women with non-specific symptoms (such as abdominal bloating, pelvic pain) for an ultrasound scan or blood CA125 assessments may help in the early diagnosis. Patients with Stage IA or IB disease with grade 1 tumors have a cure rate of >90%; this is likely to be compromised by laparoscopic surgery. In selected patients fertility preservation with good obstetric outcome is possible. However, the relapse rate in 'high risk' early stage ovarian cancers is 40-45%; adjuvant chemotherapy is needed. Only 20-25% of those with stage III and IV disease are cured. Despite a high primary response (70%) majority (70-75%) will relapse and all are likely to succumb. Optimal debulking surgery followed by adjuvant chemotherapy are needed for stages III and IV disease; the outcome is superior if managed by gynecologic oncologists. Where cost of drugs is an important consideration, an alternative is carboplatin (an affordable and equally effective drug). The role of vaccines needs further study. When relapses occur palliation will be the aim in most instances. Oral contraceptives, breast feeding, tubal sterilization and hysterectomy also have a protective effect. Risk-reducing salpingo-oopherectomy has been suggested in women with BRCA mutations.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Endoscopic nasopharyngectomy: the Sarawak experience

Rohaizam J, Subramaniam SK, Vikneswaran T, Tan VE, Tan TY

Med J Malaysia, 2009 Sep;64(3):213-5.
PMID: 20527270 MyJurnal

Shifting the paradigm of treatment of a locally recurrent nasopharyngeal carcinoma (NPC) from the non-surgical management to a surgical modality has always been a challenge. However, many studies on endoscopic nasopharyngectomy have proven it to be a reliable form of treatment with an excellent outcome. Since 2007, in Sarawak General Hospital, six cases of endoscopic nasopharyngectomy for locally recurrent NPC have been performed with encouraging results.

Matched MeSH terms: Neoplasm Recurrence, Local/surgery
Fulltext Colorectal cancer patients in a tertiary referral centre in Malaysia: a five year follow-up review

Rashid MR, Aziz AF, Ahmad S, Shah SA, Sagap I

Asian Pac J Cancer Prev, 2009;10(6):1163-6.
PMID: 20192604

BACKGROUND: Colorectal cancer (CRC) is one of the major malignancies in the world. In Malaysia, CRC is fast becoming the commonest cause of cancer death. Its etiology is complex, involving both environmental and genetic factors. This study looked at the profile and outcome of five-year follow-up of patients with CRC.

MATERIALS AND METHODS: Retrospective case review study done on CRC patients at University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Patientsandapos; socio-demographic characteristics, modalities of treatment, cancer characteristics and outcome at 5-year follow up were extracted from the case records.

RESULTS: A total of 107 case records of patients were analyzed. Peak age of CRC presentation was 40-69 years (71.1%). Male to female ratio was 1.2:1 with Chinese predominance (52.3%). Anaemia and its related symptoms including per rectal bleeding was the commonest clinical presentation. The median duration of clinical presentation was 13 weeks (IQR 21.8). More than two-thirds presented as non-emergency cases (69.2%). Most patients presented with Dukes C stage (40.2%). The overall 5-year survival rate was 40% with local recurrence rate of 19.6%. Metastasis after curative-intend treatment (surgery with adjuvant therapy) developed in 26% of patients. Lower recurrence (p = 0.016, OR = 0.205) and metastatic disease (p = 0.02, OR = 0.24) found among the Chinese patients. Almost half of the patients defaulted follow up care (43%), most often within the first year of treatment (22.4%) and the Chinese were the least likely to default (p= 0.04, OR = 0.45).

CONCLUSION: Socio-demographic profile of CRC patients in UKMMC is comparable to Asia pacific region. Apparent delay in seeking treatment gives rise to poor overall survival and local recurrence rates.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Mucosal malignant melanoma of the maxillary sinus

Norhafizah M, Mustafa WM, Sabariah AR, Shiran MS, Pathmanathan R

Med J Malaysia, 2010 Sep;65(3):218-20.
PMID: 21939172

Mucosal malignant melanoma (MMM) is an aggressive tumour occurring in the upper respiratory tract. It is rare compared to malignant melanoma of the skin. We report a case of a 53-year-old man with left paranasal swelling. A biopsy showed high-grade spindle cell tumour. Subsequently a subtotal maxillectomy was performed. Histopathological examination revealed a hypercellular tumour composed of mixed spindle and epitheloid cells with very occasional intracytoplasmic melanin pigment. The malignant cells were immunopositive for vimentin, S-100 protein and HMB-45. It was diagnosed as mucosal malignant melanoma (MMM). This article illustrates a rare case of MMM where the diagnosis may be missed or delayed without proper histopathological examination that include meticulous search for melanin pigment and appropriate immunohistochemical stains to confirm the diagnosis. Malignant melanoma can mimic many other types of high-grade malignancy and should be considered as a differential diagnosis in many of these instances.

Matched MeSH terms: Neoplasm Recurrence, Local/pathology*
Fulltext Recurrent multiple myeloma presenting as a breast plasmacytoma

Kalyani A, Rohaizak M, Cheong SK, Nor Aini U, Balasundaram V, Norlia A

Med J Malaysia, 2010 Sep;65(3):227-8.
PMID: 21939175

We describe a patient with multiple myeloma, who initially responded to chemotherapy and went into remission. She presented 10 months later with a right breast lump which was confirmed by core biopsy to be a plasmacytoma. Further treatment with radiotherapy, thalidomide and later second line chemotherapy appeared unsuccessful and she showed rapid disease progression with rising paraproteins and new extramedullary plasmacytoma lesions in the forehead, supraclavicular region, nasopharynx, liver, spleen, pancreas and paraaortic lymph nodes.

Matched MeSH terms: Neoplasm Recurrence, Local/pathology*
Immunolocalization of notch signaling protein molecules in a maxillary chondrosarcoma and its recurrent tumor

Siar CH, Ha KO, Aung LO, Nakano K, Tsujigiwa H, Nagatsuka H, et al.

Eur J Med Res, 2010 Oct 25;15(10):456-60.
PMID: 21156405

BACKGROUND: notch receptors are critical determinants of cell fate in a variety of organisms. Notch signaling is involved in the chondrogenic specification of neural crest cells. Aberrant Notch activity has been implicated in numerous human diseases including cancers; however its role in chondrogenic tumors has not been clarified.
METHOD: tissue samples from a case of primary chondrosarcoma of the maxilla and its recurrent tumor were examined immunohistochemically for Notch1-4 and their ligands (Jagged1, Jagged2 and Delta1) expression.
RESULTS: both primary and recurrent tumors were histopathologically diagnosed as conventional hyaline chondrosarcoma (WHO Grade I). Hypercellular tumor areas strongly expressed Notch3 and Jagged1 in spindle and pleomorphic cells suggesting up-regulation of these protein molecules at sites of tumor proliferation. Expression patterns were distinct with some overlap. Differentiated malignant and atypical chondrocytes demonstrated variable expression levels of Jagged1, and weak to absent staining for Notch1, 4 and Delta1. Protein immunolocalization was largely membranous and cytoplasmic, sometimes outlining the lacunae of malignant chondrocytes. Hyaline cartilage demonstrated a diffuse or granular precipitation of Jagged1 suggesting presence of soluble Jagged1 activity at sites of abnormal chondrogenesis. No immunoreactivity for the other Notch members was observed. Calcified cartilage was consistently Notch-negative indicating down-regulation of Notch with cartilage maturation. Stromal components namely endothelial cells and fibroblasts variably expressed Notch1, 3 and Jagged1 but were mildly or non-reactive for the other members.
CONCLUSIONS: Results indicate that Notch signaling pathway may participate in cellular differentiation and proliferation in chondrosarcoma. Findings implicate Notch3 and Jagged1 as key molecules that influence the differentiation and maturation of cells of chondrogenic lineage.

Matched MeSH terms: Neoplasm Recurrence, Local/metabolism
High tumour stage and margin clearance are still important prognostic factors for post-mastectomy locoregional recurrence in Malaysia

Choong LP, Taib NA, Rampal S, Saad M, Bustam AZ, Yip CH

Asian Pac J Cancer Prev, 2010;11(5):1409-16.
PMID: 21198302

BACKGROUND: Locoregional recurrence after mastectomy for breast cancer may predict distant recurrence and mortality. This study examined the pattern and rates of post-mastectomy locoregional recurrence (PMLRR), survival outcome and prognostic factors for isolated PMLRR (ILR) in a breast cancer cohort in University of Malaya Medical Center (UMMC).
METHODS: We studied 522 patients who underwent mastectomy between 1998 and 2002 and followed them up until 2008. We defined PMLRR as recurrence to the axilla, supraclavicular nodes and or chest wall. ILR was defined as PMLRR occurring as an isolated event. Prognostic factors for locoregional recurrence were determined using the Cox proportional hazards regression model.
RESULTS: The overall PMLRR rate was 16.4%. ILR developed in 42 of 522 patients (8.0%). Within this subgroup, 25 (59.5%) remained disease free after treatment while 17 (40.5%) suffered disease progression. Univariate analyses identified race, age, size, stage, margin involvement, lymph node involvement, grade, lymphovascular invasion and ER status as probable prognostic factors for ILR. Cox regression resulted in only stage III disease and margin involvement as independent prognostic factors. The hazard of ILR was 2.5 times higher when the margins were involved compared to when they were clear (aHRR 2.5; 95% CI 1.3 to 5.0). Similarly, compared with stage I those with Stage II (aHRR 2.1; 95%CI 0.6 to 6.8) and stage III (aHRR 4.6; 95%CI 1.4 to 15.9) had worse prognosis for ILR.
CONCLUSION: Margin involvement and stage III disease were identified to be independent prognostic factors for ILR. Close follow-up of high risk patients and prompt treatment of locoregional recurrence were recommended.

Matched MeSH terms: Neoplasm Recurrence, Local*
Fulltext Adenoid cystic carcinoma – a case report and review of literature

Kanneppady, Sham Kishor, Sakri, Santosh B., Chatra, Laxmikanth, Prashanth, Shenoy K.

Malaysian Dental Journal, 2010;31(2):79-83.
MyJurnal

Adenoid cystic carcinoma (ACC) is a rare malignant tumor that arises within secretary glands, most commonly the major and minor salivary glands. It has a tendency for a prolonged clinical course, perineural invasion, with local recurrences and distant metastases. The three recognized histopathologic pattern of ACC are cribriform, tubular, and solid with the cribriform being most common. Standard treatment for salivary gland ACC is surgery and postoperative radiotherapy. We report a case of ACC of palate in a 30-year-old female and review the literature.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext An Unusual Presentation of a Thyroid Malignancy: A Case Report

Irfan, M., Baharuddin, A., Ananda Dorai, A.

International Medical Journal Malaysia, 2010;9(1):55-57.
MyJurnal

Patient with thyroid mass rarely presents in emergency situation. It is because the nature of the mass is that it usually increases slowly in size. Thus, any surgical intervention can be planned electively. The most common condition that necessitates urgent intervention, is upper airway compromise due to sudden rapid increase in size of the swelling. This can be due to intralesional bleeding or superimposed infection on the enlarged gland. We report a case of urgent completion thyroidectomy performed to a patient with fungating recurrent papillary carcinoma who present with bleeding from the mass externally.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext An Undiagnosed Non Functioning Retroperitoneum Paraganglioma, Complicating A Gynaecological Surgery; A Case Report

Noraziana, A.W., Hakim, B., Mokhtar, A., Alik, R.

International Medical Journal Malaysia, 2010;9(1):59-61.
MyJurnal

Paragangliomas are uncommon tumors arising from the neuroendocrine elements (chief cells) of the paraganglia and symmetrically distributed along the aorta in close association with the sympathetic chain. Although functional tumors are easier to diagnose due to the clinical fi ndings caused by excess secretion of catecholamines and an elevation of the urinary catecholamine levels, however the diagnosis of nonfunctioning paraganglioma of the retroperitoneum is diffi cult and only few cases have been made before exploratory laparotomy. Although our patient was initially planned and operated by our gynaecological team, the incidental findings had to involve the general surgeons. She is fortunate that the tumour did not show any features of malignancy nor metastasis, however a long time follow up is needed in case of any possible recurrence.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Thymoma: a case report and review of the literature

Hamidah, A., Poulsaeman, V., Suria, A.A., Zarina, A.L., Zulfiqar, M.A., Jamal, R.

Medicine & Health, 2010;5(1):49-54.
MyJurnal

Thymomas comprise about 1% of all mediastinal tumours and are rare in children. Typically, these tumours are aggressive, with a poor outcome. The current treatment of invasive thymoma is often multidisciplinary. We report a 16-year-old boy with invasive thymoma who was successfully treated with systemic chemotherapy, surgical resection and irradiation. The patient has been in continuous remission for 6 years without radiographic evidence of tumour recurrence.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Oncocytic schneiderian papilloma: a rare sinonasal papilloma removed via endoscopic medial maxillectomy

Faizah, A.R., Mazita, A., Marina, M.B., Jeevanan, J., Isa, M.R.

Medicine & Health, 2010;5(1):55-59.
MyJurnal

There are three types of papilloma which arises from the Schneiderian membrane namely inverted, fungiform and oncocytic. Oncocytic papilloma is the rarest type and occurs predominantly in the older age group. Clinically, its behaviour is similar to inverted papilloma in having both local recurrence and associated malignancy. We report a rare case of oncocytic papilloma arising from the maxillary sinus, extending into the nasal cavity and nasopharynx, in a 78-year-old lady. Despite the longstanding history there was no evidence of associated malignancy in this lesion. An endoscopic medial maxillectomy was successfully utilized for approach and complete tumour excision. In conclusion, oncocytic papilloma should be considered as a differential diagnosis in patients presenting with unilateral polypoid nasal lesions especially in the elderly. In addition, endoscopic medial maxillectomy can provide an adequate approach for complete tumour removal.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Patterns of breast cancer relapse at University of Malaya Medical Centre

Rozita, A.M., Marniza, S., Mastura, M.Y., Wan Zamaniah, W.I., Yip, C.H., Taib, N.A.

JUMMEC, 2010;13(1):24-32.
MyJurnal

Despite being the major cause of cancer-related death in Malaysian women,local data on patterns of breast cancer relapse and their long term outcomes are still scarce. We conducted a retrospective study on all patients treated for non-metastatic invasive breast cancer in 1999-2000 at the University of Malaya Medical Centre (UMMC), who subsequently developed relapse. We sought to analyse the patterns of relapse, their associated clinicopathological features and the overall survival ratefollowing the relapses. Univariate and multivariate analyses were used to analyse demographics and clinicopathological factors. Survival was analysed using the Kaplan and Meier method and compared by the log rank test. A total of 268 patients with a mean age of 50, were identified for the study. At a median follow-up of 50 months, 73 patients (27.2%) had relapsed. Local, regional and distant relapse rates were 5.5%, 1.9% and 19.8% respectively, whereas, the 5-year survival rates were 61%, 40% and 21% respectively (p < 0.01). Most relapses occurred within the first five years of diagnosis. Patients with long disease-free interval had better survival. The most common distant relapse site was the lungs while bone was the distant relapse site with the best prognosis. Disease stage, nodal status and oestrogen receptor status were found to have correlation with the risk of relapse. We concluded that the survival of patients with relapsed breast cancer was associated with the site(s) of first relapse and the disease free interval and clinicopathological factors can be used to predict the risk of relapse.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Minimal residual disease status in childhood acute lymphoblastic leukaemias by flow cytometry and their clinical and haematological features

Azma, R.Z., Zarina, A.L., Hamidah, A., Cheong, SK, Jamal, R., Hamidah, N.H.

Medicine & Health, 2010;5(1):22-33.
MyJurnal

Residual disease in patients with acute leukaemia indicates unfavorable prognosis. The evaluation of remission using flow cytometry allows a better estimation of minimal residual disease (MRD) after induction chemotherapy in childhood acute lymphoblastic leukaemia (ALL) cases. Patients in morphological marrow remission with presence of blast cells of less than 5%, may still have up to 1010 leukaemic cells. However with flow cytometric analysis, lower levels of the residual leukaemic cells (1 in 104 cells) can be detected and it can be used as a tool to predict relapse. This study compared the presenting clinical and haematological features of children with ALL and their residual disease status determined by flow cytometry. Analysis of their MRD status following remission-induction chemotherapy were done at day-28, week-12 and week-20. The cases were also followed up to five years, to determine their survival status. Their residual disease status by flow cytometric immunophenotyping was also compared with their bone marrow findings morphologically. Thirty-eight cases of precursor B-ALL in pediatric patients from UKM Medical Centre (UKMMC) were analyzed. There was no significant correlation between demographic, clinical and haematological features with MRD status at day-28. However, there was a significant correlation between MRD status by flow cytometry and by morphological marrow examination at week-12. Three cases showed persistent MRD findings until week-20 where two of the cases relapsed and died subsequently. Twenty four patients were still alive after five years of follow up.

Matched MeSH terms: Neoplasm Recurrence, Local
A recurrent nasopharyngeal carcinoma with lacrimal sac involvement: a case report

Tang IP, Periyannan P, Prepageran N, Shashinder S, Singh A, Bhagubhai PN

Eur J Cancer Care (Engl), 2011 Jan;20(1):93-5.
PMID: 20088917 DOI: 10.1111/j.1365-2354.2009.01147.x

We report a very rare case of recurrent nasopharyngeal carcinoma with local involvement of lacrimal sac. The patient was treated with chemotherapy and there was no recurrence noted after 1 year of follow-up.

Matched MeSH terms: Neoplasm Recurrence, Local/pathology*
Recurrence of multiple myeloma with soft tissue plasmacytoma presenting as unilateral proptosis

Pan SW, Wan Hitam WH, Mohd Noor RA, Bhavaraju VM

Orbit, 2011 Mar;30(2):105-7.
PMID: 21322793 DOI: 10.3109/01676830.2010.546553

To describe a rare case of soft tissue plasmacytoma of the orbit presenting with proptosis.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Endoscopic management of sinonasal inverted papilloma

Bathma S, Harvinder S, Philip R, Rosalind S, Gurdeep S

Med J Malaysia, 2011 Mar;66(1):15-8.
PMID: 23765136 MyJurnal

Inverted papillomas (IPs) are benign sinonasal epithelial tumors that are locally aggressive and has a preponderance to recur if incompletely excised. This is a retrospective report describing 13 patients who underwent endoscopic excison from March 2004 to December 2010. Data was summarized into age, sex, location of tumor, surgical outcome and disease free status. Majority of the patients were males with the remaining 3 females, with a mean age of 50.9 years (range 24-76 years). Two patients needed an additional procedure of endoscopic dacrocystorhinostomy (EDCR) for epiphora. Out of the 13 patients surveyed, three patients underwent revision surgery for recurrences, of which one was a referred from another instituition. All patients are currently disease free. The mean follow-up period is 40 months.

Matched MeSH terms: Neoplasm Recurrence, Local

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