occult malignancy
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2021 ◽  
Author(s):  
Deniz Yavuz Baskiran ◽  
Talha Sarigoz ◽  
Adil Baskiran ◽  
Sezai Yilmaz

Abstract AIM AND BACKGROUND: Preparation of the patients for liver transplantation is a meticulous process and includes evaluation of tumor markers to rule out occult malignancy. Present study evaluated the significance of serum tumor markers in patients bound for liver transplantation due to viral and other etiologies of liver failure.PATIENTS AND METHODS: 381 patientswho underwent liver transplantation were included in the study. Demographic data, Model for End stage.Liver Disease (MELD) scores and serum tumor marker levels were prospectively collected.RESULTS: AFP levels were significantly higher in viral etiologies when compared to other etiologies (p<0.05).Ca 19-9 was significantly higher in viral etiologies (p<0.05). Among the viral etiologies HCV related liver failure had higher carcinoembryonic antigen (CEA) and Carbohydrate antigen 19-9 (Ca 19-9) levels (p<0.05). A correlation was found between increasing MELD scores and serum levels of tumor markers (p<0.05)CONCLUSIONS: Tumor markers such as AFP, CEA, Ca 125 and Ca 19-9 can be elevated in end stage liver disease. Their levels vary according to etiology and severity of disease. The diagnostic capabilities of these markers are reduced in end stage liver disease setting but they contribute to the evaluation of the pathophysiology of chronic liver disease. Transplantation can be performed safely in cases with high tumor marker levels provided that any occult malignancy is ruled out by means of imaging and endoscopic techniques. Tumor markers can guide the physician in determining the severity of liver cirrhosis and further studies are needed to validate such a relationship.


2021 ◽  
Vol 9 (1) ◽  
pp. 86
Author(s):  
Sreenidhi G. M. ◽  
Jyothi S.

Background: Over the past few decades, the incidence of thyroid cancer has dramatically increased. Thyroid malignancy in multinodular goitre is considered to be high and these occult malignancies are detected only in post operative histopathological analysis. The study helps in finding association between multinodular goitre and thyroid malignancy. Objective was to find the association between multinodular goitre and thyroid malignancy in those who underwent total thyroidectomy.Methods: A cross sectional study conducted in department of general surgery, KIMS hospital, Bangalore. The 236 randomized cases of multinodular goitre who underwent total thyroidectomy were selected. Patients underwent thorough clinical examination pre operatively and were reassessed in post-operative period following surgery. Later, histopathology report on thyroidectomy specimen of the patients were obtained. This report was considered the gold standard for the diagnosis of thyroid malignancy.Results: Occult malignancies were commoner in middle aged females. Most of the patients in the study underwent total thyroidectomy. The prevalence of thyroid malignancy in our study was found to be 7.2%.  In the study, 17 incidental malignancies were papillary carcinomas. It revealed a highly significant relation between the lymphocytic thyroiditis and occult malignancy (p<0.0001)Conclusions: The prevalence of malignancy in multinodular goitre is 7.2%. The only variant of incidental malignancy detected in histopathological examination of excised thyroid was papillary carcinoma. There is a statistically significant association between presence of thyroiditis in preoperative FNA and presence of occult malignancy carcinoma.


Author(s):  
H. ENGELS ◽  
M. LEMMERLING ◽  
J. DE BLEECKER

Stroke as the first manifestation of an occult malignancy: typical pattern on a diffusion-weighted MRI An 89-year-old woman was admitted to the emergency department with temporary loss of coordination in her right arm. Diffusion-weighted imaging revealed the ‘three territory sign’ (TTS): multiple high-signal intensities in the territories of both the anterior and posterior circulations. Although a cardioembolic source is often suggested as the cause of multiple ischemic lesions, TTS is frequently seen in patients with a concomitant malignancy. When further investigated, the patient was diagnosed with a pancreatic carcinoma. The ischemic stroke was considered the first manifestation of the carcinoma, as conventional causes were excluded. Patients with a malignancy have an increased risk of an ischemic stroke. A potential explanation for this phenomenon is cancer-associated hypercoagulability. The treatment of cancer-associated hypercoagulability remains a challenge for clinicians. By analogy with the therapy for venous thromboembolic disorders in cancer patients, low-molecular-weight heparins (LMWH) could also be used safely and effectively for cancer-associated ischemic stroke. In different studies, variable results are observed with direct oral anticoagulants (DOACs) in the treatment of cancer-associated ischemic stroke. Despite the strong theoretical considerations, no clear benefit has been demonstrated for the use of anticoagulant versus antiplatelet therapy in this population. Further prospective research is needed.


2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Salema Khalid ◽  
Steven Young Min

Abstract Case report - Introduction Antiphospholipid syndrome (APS) is a rare autoimmune disease that can cause venous and arterial thrombosis in virtually any organ. The spectrum of vascular events can range from superficial thrombosis to life-threatening multiple organ thromboses (catastrophic APS or CAPS). CAPS occurs in genetically susceptible individuals in response to a “trigger” such as infection, cancer, trauma, surgery, anticoagulation/immunosuppression withdrawal and SLE flares. The diagnosis of CAPS can be extremely challenging and is associated with a high morbidity and mortality. Thus, early diagnosis and treatment are critical to prevent the progression of disease and improve the prognosis. Case report - Case description We report the case of a 78-year-old gentleman who was diagnosed with systemic lupus erythematosus and antiphospholipid syndrome in 2001 after he presented with a DVT, PE, rash and arthralgia. He had positive anti-cardiolipin antibodies, Rheumatoid Factor, Ro and La antibodies, but negative anti-dsDNA. He had remained stable on warfarin, hydroxychloroquine 400mg and prednisolone 7mg for 17 years. In 2018, hydroxychloroquine was reduced to 200mg OD and steroid taper was started. Unfortunately, he presented to the Emergency Department in July 2020 with a left leg swelling. DVT was confirmed on ultrasound, despite a therapeutic INR of 2.4. He was also noted to have thrombocytopenia. Haematology advised this was in keeping with ITP and started him on 70mg of prednisolone daily. No cause for the DVT was seen on CT. However, it did show subpleural nodules within the right costophrenic angle and a repeat CT in 4 months’ time was advised. INR target was increased to 3.0—4.0 and patient was discharged. He was re-admitted 4 days later with an acute drop in haemoglobin, raised inflammatory markers and worsening kidney function. CT showed extensive retroperitoneal haematoma. It also revealed a PE as well as colonic distension with gradual tapering to normal calibre, thought to represent pseudo-obstruction. Rheumatology, haematology, general surgery and ITU were involved in the management. He was started on treatment dose clexane, given intravenous immunoglobulins and supportive blood transfusions. IVC filter was put in. Unfortunately, he dropped his GCS and an urgent CT brain showed a left posterior fossa mass with a bleed. The case was discussed with neurosurgery and neuroradiology who felt that the top differential for the intracranial lesion was an underlying metastasis – particularly a colonic met. Colonoscopy was advised. However, due to severe frailty and multiple pathologies, the patient was made palliative and was fast-tracked home. Case report - Discussion Definite CAPS is defined as thromboses in three or more organs developing in less than a week, microthrombosis in at least one organ and persistent antiphospholipid antibody (aPL) positivity. The diagnosis of probable CAPS requires three out of these four criteria. Although pathological confirmation of microthrombosis is one of the requirements for CAPS, biopsy may not be possible during an acute episode due to severe thrombocytopenia and/or unstable clinical course, as in our case. There is another category called ‘CAPS-like’ disease, where aPL-positive patients do not fulfil the definite or probable CAPS criteria. However, they still represent a significant challenge for physicians and require close monitoring and aggressive treatment. Initially, we felt that we had triggered probable CAPS or ‘CAPS-like’ disease, by reducing his hydroxychloroquine and steroids. However, he did not improve with high-dose steroids given for his thrombocytopenia. Also, autoimmune screen including anti-dsDNA and complement levels were not significant. CAPS occurs in 46% of patients with a previous diagnosis of APS, and a precipitating factor is present in half the patients. It is speculated that aPL-related clinical events respond to the two-hit theory: a second hit or trigger is needed to activate the prothrombotic properties of aPL, which is the first hit. In CAPS, the most frequently recognised trigger is infection, followed by cancer. A study showed that 9% of patients with CAPS presented with an underlying malignancy, with haematological malignancies being most common, followed by lung and colon carcinoma. Similarly, Ozguroglue et al. showed an association between high level of anticardiolipin antibody and thromboembolic events in patients with colorectal, breast, ovarian, lung, and pancreatic cancer. Recent studies also suggest an increased prevalence of certain cancers in aPL-positive patients, thereby prompting an extensive search for an occult malignancy in such cases. Case report - Key learning points Given the increased prevalence of cancers in aPL-positive patients, this case highlights the need to thoroughly investigate for an occult malignancy as a trigger for APS (classic form or CAPS) with a new episode of thrombosis, despite adequate anticoagulation. While we were focusing on tapering of the immunosuppressive medication as a possible trigger, this episode was most likely triggered by the possible metastatic malignancy – especially given the lag of almost 2 years between reduction in hydroxychloroquine and steroids and development of symptoms. It is also important to bear in mind, especially in elderly patients, that thrombotic events associated with aPL can be the first manifestation of malignancy. This emphasises the need for continuing research on the association between antiphospholipid syndrome and malignancies. While the survival rate of patients with CAPS is poor overall, the outcome of patients with CAPS is worse in the presence of malignancy. A study showed that only 40% of CAPS patients with malignancies improved. This may be due to the presence of the malignancy as well as the older age of the patients. We are looking forward to discussing CAPS at the BSR case-based conference and hope it will shed more light on diagnosis and management of this incredibly challenging condition.


Author(s):  
M. Aldea ◽  
L. Cerbone ◽  
A. Bayle ◽  
C. Parisi ◽  
C. Sarkozy ◽  
...  

2021 ◽  
Vol 74 (3) ◽  
pp. e277
Author(s):  
Viraj Pandit ◽  
Kelly Kempe ◽  
Steven Vang ◽  
Hyein Kim ◽  
Kimberly C. Zamor ◽  
...  

Author(s):  
Kamal Gautam ◽  
Sansar Tiwari ◽  
Suraj Shrestha ◽  
Malati Dulal ◽  
Bibek Shrestha ◽  
...  

Maxillary sinus melanoma is a rare mucosal melanoma difficult to diagnose in the absence of pigmentation. Intranasal masses presenting with the features of occult malignancy and rapid progression should always be investigated in the line of melanoma irrespective of pigmentation. The histopathological and immunohistochemical examination helps to confirm the diagnosis.


2021 ◽  
Vol 20 (2) ◽  
pp. 10-16
Author(s):  
S. V. Chernyshov ◽  
E. A. Khomyakov ◽  
R. K. Sinitsyn ◽  
Yu. E. Vaganov ◽  
Yu. L. Trubacheva ◽  
...  

Aim: to analyze the diagnostic value of the digital rectal examination, colonoscopy, MRI and ERUS for detecting occult adenocarcinoma in rectal adenomas.Patients and methods: the study included 100 patients with newly identified epithelial rectal neoplasms, which undergone transanal endoscopic microsurgery from December 2019 to December 2020. All the patients underwent digital rectal examination, colonoscopy, ERUS with sonoelastography, and pelvic MRI. The diagnostics value of this methods was estimated with determination of sensitivity and specificity.Results: the study included 67 (67%) females and 33 (33%) males. The mean age of the patients was 64.4 ± 10.7 years. The median distance from the tumor to the anal verge was 6.0 ± 2.9 cm. The sensitivity of the digital rectal examination in the occult malignancy verification was 0.44 (95% CI 0.24–0.65), specificity — 0.93 (95% CI 0.85–0.97). The sensitivity of the colonoscopy — 0.56 (95% CI 0.34–0.75), the specificity — 0.84 (95% CI 0.73–0.91). The sensitivity of MRI — 0.40 (95% CI 0.21–0.61), specificity — 0.89 (95% CI 0.80–0.95). The sensitivity of ERUS was 0.48 (95% CI 0.27–0.68), the specificity — 0.73 (95% CI 0.61–0.82). Pair wise comparison of diagnostic methods revealed the absence of significant differences in their diagnostic value (p > 0.05).Conclusion: at least one of diagnostic methods allows to verify the presence of malignant transformation in 100% of cases. So, only combination of diagnostic methods can help to choose the optimal treatment option.


Author(s):  
Tiyas Sen Dutt

Interstitial lung diseases (ILD) are a group of conditions with varied etiology, clinical presentation, management, outcome and complications. Although studies have described lung cancer as a sequel of ILD, the association of ILD with non-lung malignancies or ILD presenting as a paraneoplastic syndrome of an underlying occult malignancy deserves further study. In this case series, we describe eight patients with an ILD and an associated neoplasm and discuss the different questions raised by this association.


2021 ◽  
pp. 109-114
Author(s):  
Marwa Makboul ◽  
Shimaa Farghaly ◽  
Murad A Jabir ◽  
Ramy A Hassan ◽  
Mahmoud Refaat Shehata

Background: Breast MRI has demonstrated excellent sensitivity in determining the extent of breast cancer and occult malignancy. This study aimed to evaluate the added value of breast MRI compared to mammography and ultrasonography in surgical decision.Methods: A cross-sectional study was conducted on 84 female patients with newly diagnosed breast cancer by ultrasonography and mammography where conservative breast surgery was initially considered, and then bilateral breast MRI was performed and the multidisciplinary decision was revised. The data was analyzed to determine the additional value of breast MRI in treatment planning.Results: Eighty-four patients were included of whom 44 (52.4%) patients had additional findings on MRI. The treatment plan was changed after the second ultrasonography and histopathology in 44 patients (52.4%) with a remarkable increase in the rate of modified radical mastectomy after MRI. Conclusion: Preoperative breast MRI has great value in defining the surgical decision in patients with early breast cancer.


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