Background: Metastatic disease of the skeleton occurs in at least 20% to 30% of patients with malignancy, but metastasis to the foot and hand (acrometastasis) is extremely rare (0.007% to 0.3%). Metastases to the feet are even rarer and have been reported in half to one-third the rate for hand metastases. Failure to recognize these lesions has led to delayed diagnosis and/or inappropriate treatment. The purpose of this report is to highlight the clinical and radiologic features that aid in the diagnosis and potential treatment of this condition along with a pertinent review of the literature. Materials and Methods: In a retrospective review of 694 patients with histologically proven metastatic skeletal disease (January 1988 to January 2007), 14 cases of metastatic lesions to the foot were identified. Results: The most frequent primary site was in the genito-urinary system in eight patients and the most common bones involved were the calcaneus and the talus in six patients each. All patients died after a m...

Metastatic skeletal disease of the foot: case reports and literature review.

Background: Bone is an uncommon site of metastasis in patients with advanced hepatocellular carcinoma (HCC). Therefore, there are few studies concerning the natural history of bone metastasis in patients with HCC. Patients and Methods: Data on clinicopathology, survival, skeletal-related events (SREs), and bone-directed therapies for 211 deceased HCC patients with evidence of bone metastasis were statistically analyzed. Results: The median age was 70 years; 172 patients were male (81.5%). The median overall survival was 19 months. The median time to the onset of bone metastasis was 13 months (22.2% at HCC diagnosis); 64.9% patients had multiple bone metastases. Spine was the most common site of bone metastasis (59.7%). Most of these lesions were osteolytic (82.4%); 88.5% of them were treated with zoledronic acid. At multivariate analysis, only the Child Score was significantly correlated with a shorter time to diagnosis of bone metastases (p=0.001, HR=1.819). The median survival from bone metastasis was 7 months. At multivariate analysis, HCC etiology (p=0.005), ECOG performance status (p=0.002) and treatment with bisphosphonate (p=0.024) were associated with shorter survival after bone disease occurrence. The site of bone metastasis but not the number of bone lesions was associated with the survival from first skeletal related event (SRE) (p=0.021) and OS (p=0.001). Conclusions: This study provides a significant improvement in the understanding the natural history of skeletal disease in HCC patients. An early and appropriate management of these patients is dramatically needed in order to avoid subsequent worsening of their quality of life.

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Natural History of Malignant Bone Disease in Hepatocellular Carcinoma: Final Results of a Multicenter Bone Metastasis Survey

Background and objective Little is known about the extent to which asbestos use ban has affected global trends in malignant mesothelioma. This study investigated recent global mortality trends of malignant mesothelioma. Methods Data were collected from International Agency for Research on Cancer/World Health Organization mortality database to examine age-standardized, gender-specific mortality rates for malignant mesothelioma (ICD10-C45). Cross-sectional mortality rates (2009-2013) as well as trends over time (1994-2013) were also reported. Gender-specific annual percent change (APC) was calculated to examine trends over time for each country. Results Among the 30 countries with highest mesothelioma mortality in men, there is almost 10-fold variation in mortality rates during 2009-2013 ranging from 6.25 per 100 000 for United Kingdom to 0.64 per 100 000 in Portugal; whereas, among the 30 countries with highest mesothelioma mortality in women, there is a 4-fold variation in mortality rates during 2009-2013 ranging from 1.08 per 100 000 for United Kingdom to 0.26 per 100 000 in Ireland. Mortality rates were higher in men compared to women in 32 out of 35 evaluable countries. Among males and over the last 10 years of covered years, mesothelioma mortality was significantly declining in 9 countries (United Kingdom, Sweden, France, Germany, Netherlands, Canada, United States, Australia, and New Zealand); whereas, it was significantly rising in 5 countries (Poland, Spain, China-Hong Kong, Japan, and Republic of Korea). In the remaining countries, APC was stable. Among females and over the last 10 years of covered years, mesothelioma mortality was significantly declining in 1 country only (Italy); whereas, it was significantly rising in 3 countries (Poland, Argentina, and Republic of Korea). In the remaining countries, APC was stable. Conclusions There is a worldwide variability in the burden and trends of mesothelioma mortality; and despite the ban on asbestos in many countries, mesothelioma still represents an important cause of mortality.

Global trends in mortality from malignant mesothelioma: Analysis of WHO mortality database (1994-2013).

Bone is an uncommon site of metastasis in patients with hepatocellular carcinoma (HCC), and often overlooked. We report two cases that had isolated bone metastasis; one of them had prolonged disease-free survival. The present series, along with the literature review, reinforces the idea that HCC should be considered in the differential diagnoses in patients presenting with metastases in bone. The presence of isolated bone metastases need not necessarily indicate poor prognosis, and all such patients need to be offered chemotherapy and at least one of the bone-directed therapies (either local radiation in cases of localized disease or bisphosphonates in the presence of extensive disease) as they may have a better outcome with therapy.

/pdf/bone-metastasis-in-hepatocellular-carcinoma-need-for-3j56ela8an.pdf

Bone metastasis in hepatocellular carcinoma: need for reappraisal of treatment.

Astrocytomas of the cerebellum in children.

Hepatocellular carcinoma metastasizing to bones and soft tissues of extremities is an unusual occurrence The present report describes two such cases, where this unusual happening was the presenting feature Role of immunohistochemistry for diagnosis is emphasized

Unusual metastases of hepatocellular carcinoma (hcc) to bone and soft tissues of lower limb.

Background: Conventional transurethral resection of urinary bladder tumour (TURBT) using a wire loop diathermy violates the basic principle of oncological surgery, i.e. dissection through normal tissue. However, in the en bloc technique, the tumour is removed as a single specimen. We compared the quality of specimen and recurrence rate at three months (first check cystoscopy) in both the en bloc and conventional resection techniques. Methods: The subject accrual was done from June 1 st , 2017 till June 30 th , 2019 at a tertiary care hospital. Patients with newly diagnosed bladder tumour, solitary or multiple ≤ 3cm were included in the study. Patients with carcinoma in situ, prior TURBT, or muscle-invasive bladder cancer were excluded. Eighty-two patients were available for final analysis, 41 in each group. Results: Mean age, gender ratio, tumour features (grade, stage, median number, and size) were comparable in the two groups.  Median Operative time [interquartile range- (IQR)] was 30 (25 – 39.5) minutes in the en bloc group as compared to 45 (33 – 63.5) minutes in the conventional group ( p < 0.001). The detrusor muscle was seen at the base of the primary tumour in all 41 (100%) en bloc cases as compared to 23 (56 %) cases in the conventional group ( p <0.001). Overall recurrence at the first surveillance cystoscopy was 17%, with an insignificant difference between the groups. Recurrence at primary site was 19.5% in conventional TURBT compared to en bloc resection (n = 1, 2.4%), ( p = 0.013). Conclusion: En bloc resection decreases the recurrence rate at the primary site. En bloc TURBT is a safe technique, providing high-quality specimens for histopathological evaluation and reducing the need for the second TURBT. Keywords: En bloc TURBT; conventional TURBT; non-muscle-invasive bladder cancer; recurrence rate; detrusor muscle

Comparison Of Recurrence Rate Between "EN BLOC" Resection Of Bladder Tumour And Conventional Technique For Non-Muscle Invasive Bladder Cancer.

Background Pilocytic astrocytoma (PA) is the most prevalent central nervous system (CNS) tumor in pediatric population and accounts for an approximate of 5-6% of all gliomas. This neoplasm can occur at all levels of the neuraxis, with majority (67%) arising in the cerebellum and optic pathway. PAs are World Health Organization Grade I tumors and are the most benign of all astrocytomas characterized by an excellent prognosis. Other differentials include subependymal giant cell astrocytoma (SEGA), ependymoma, meningioma, and low-grade gliomas such as pilocytic or diffuse astrocytoma; calcification is more commonly regarded as a feature of benign or slow-growing tumors. Case description We present a case of a 17-year-old female presenting with an unusual cause of hydrocephalus, a rare case of a calcified pilocytic astrocytoma as an intraventricular tumor. Conclusion PA rarely presents as an intraventricular tumor and should be included in the differential diagnosis of a large mass with massive intratumoral calcification.

Pilocytic astrocytoma: A rare presentation as intraventricular tumor.

Case reports and case series documenting unfortunate patients with more than one malignant neoplasm are rare but well established. While majority of such patients have two malignancies, cases with three or even four malignant neoplasms in the same patient have been published in literature. A number of factors influencing carcinogenesis have been implicated in such cases including exposure to large amounts of radiation, chemotherapy for the original malignancy; prolonged history of heavy smoking and exposure to other environmental carcinogens; aging; and underlying genetic alterations. Concomitant multiple malignant neoplasms may be synchronous-two or more malignant neoplasms histologically distinct from each other, arising in the same site and detected simultaneously (for example during the same hospital admission) or detected one after the other in sequence in a period less than 6 months; or metachronous-two or more malignant neoplasms of similar or distinct histologic type detected at different times (after an interval of greater than 6 months) in different anatomic sites. Any combination of malignant tumors can occur in the same patient for example carcinomas with other carcinomas, carcinomas with Non-Hodgkin or Hodgkin lymphomas, carcinomas with mesotheliomas, carcinomas with sarcomas etc. We have reported several cases with multiple malignancies during our practice, and these cases were composed of the different combinations described above. The aim of the present study is to document 10 such cases of combined carcinoma and Non Hodgkin lymphoma in the same patient which were diagnosed in our section.

http://journal.waocp.org/article_49379_9cb9e7ba9da66968562f37101464230f.pdf

Synchronous and Metachronous Malignant Epithelial and Lymphoid Tumors: a Clinicopathologic Study of 10 Patients from a Major Tertiary Care Center in Pakistan

Converting carbon dioxide (CO2) into substitute natural gas (SNG) has received renewed interests recently. It not only realizes large scale CO2 conversion, but also provides a synthetic source for those countries lacking natural gas. This study firstly attempts to explore and evaluate alternative processes for CO2 methanation, in which four schemes (six processes overall) based on adiabatic and/or non-adiabatic fixed-bed reactors are focused. Rigorous process design, optimization, waste heat recovery, economic and environmental evaluation, and control are covered. From this work, the most promising configuration (i.e. Scheme 4B) uses only two reactors. A counter-current cooling, non-adiabatic reactor equipped with internal recycle goes first, and an adiabatic reactor follows. This process reveals great CO2 reduction potential (i.e. CO2-e: −3.338 kg/kg), as compared with other previously developed processes converting CO2 to value-added chemicals (i.e. CO2-e: −0.154 to 2.242 kg/kg). More importantly, better operability of the first reactor is indicated by the generated temperature profile. Finally, a suitable control strategy is developed for this scheme, which results in satisfactory closed-loop responses under throughput and composition disturbances. For future work, clarifying how the feed impurities influence the reaction kinetics, and developing a less expensive hydrogen source, will be recommended. 

Zeeshan Uddin

Papers

Unusual metastases of hepatocellular carcinoma (hcc) to bone and soft tissues of lower limb.

Comparison Of Recurrence Rate Between "EN BLOC" Resection Of Bladder Tumour And Conventional Technique For Non-Muscle Invasive Bladder Cancer.

Pilocytic astrocytoma: A rare presentation as intraventricular tumor.

Synchronous and Metachronous Malignant Epithelial and Lymphoid Tumors: a Clinicopathologic Study of 10 Patients from a Major Tertiary Care Center in Pakistan

Evaluation of alternative processes of CO2 methanation: Design, optimization, control, techno-economic and environmental analysis