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Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
There is often evidence of malnutrition, the degree of which is dependent on the duration and severity of dysphagia and whether there has been a history of alcoholism. In cases of oesophageal obstruction the patient could even be dehydrated owing to poor fluid intake. Women with Plummer–Vinson syndrome can appear anaemic and have koilonychia, while alcoholics may have stigmata of chronic liver disease. There is usually no palpable evidence of disease although an epigastric mass is sometimes palpable in tumours of the lower third of the oesophagus and if there are large intra-abdominal lymph nodes. The cervical and supraclavicular lymph nodes should be palpated carefully. Hepatomegaly suggests metastatic disease but also fatty infiltration or cirrhosis in heavy drinkers.
Superior Vena Caval Syndrome
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Histological diagnosis, prerequisite to chemotherapy or irradiation, may be provided by supraclavicular lymph node biopsy in case of clinical involvement. We believe mediastinoscopy not to be contraindicated in SVC syndrome: every time lymph node compression is advocated as an etiology, it provides excellent specimens for histological diagnosis. When a mediastinal tumor is suspected on CT scan, diagnosis can be provided either by transcutaneous needle biopsy, or through surgical approach if the tumor is deemed resectable.
Clinical Features of Colorectal Adenoma and Adenocarcinoma
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Jamie Murphy, Norman S. Williams
Abdominal distension due to flatus may be present in patients whose growths are responsible for subacute intestinal obstruction. The tumour itself may be palpable; right-sided lesions are stated to be palpable more often than left-sided ones, although this is not the authors’ experience. Palpable left-sided lesions can be differentiated from inspissated faeces by the fact that they fail to indent on pressure with the finger. Carcinomas at the splenic and hepatic flexures may be palpable, but in order for them to be felt, the clinician must purposefully perform a bimanual palpation of both loins during full inspiration and expiration. Examination of the inguinal regions for the presence of palpable lymph nodes is rarely helpful in rectal cancer. Spread to these nodes is unusual in rectal cancer only and occurs in anal margin tumours or if the tumour has invaded distally into the anal canal. Supraclavicular lymph nodes may occasionally be enlarged in advanced cases.
Rosai-Dorfman disease in a symptomatic elderly man
Published in Baylor University Medical Center Proceedings, 2022
Gaurav Synghal, Risha Bhavan, Sharad K. Jain, Umesh D. Oza
An 81-year-old man presented to a hematologist with fatigue, a 10-pound weight loss, and laboratory findings suggesting anemia of chronic disease with elevated ferritin, decreased total iron binding capacity, decreased iron, and a low-normal iron percent saturation. The patient had multiple negative stool guaiac tests to rule out underlying colon carcinoma. He was started on iron and B12 supplementation, and a bone marrow biopsy showed a normocellular marrow with trilineage hematopoiesis. At the same time, the patient visited his urologist due to persistent urinary tract infections; computed tomography (CT) showed large retroperitoneal lymphadenopathy and soft tissue density infiltrating the kidneys (Figure 1a, 1b). Additional workup revealed an enlarged 3.8 cm supraclavicular lymph node amenable to surgical excision. Upon histopathologic and immunohistochemical evaluation, the lymph node demonstrated marked sinus histiocytosis with co-expression of S100 and CD68, suggesting RDD. Next-generation sequencing demonstrated no targetable mutations, 5% positive PD-L1 expression, and lack of PDGFRA expression. Positron emission tomography (PET)/CT helped evaluate the full extent of the patient’s disease burden (Figure 1c). The patient was started on corticosteroids with subsequent symptomatic improvement, stable hemoglobin, and improving adenopathy over the course of 12 months of follow-up.
Should isoniazid prophylaxis be prescribed to the patients under tumor necrosis factor-alpha antagonists independent of tuberculin skin test?
Published in The Aging Male, 2020
Fatih Alaşan, Ege Güleç Balbay, Şengül Cangür, Öner Balbay, Leyla Yılmaz Aydın, Ali Nihat Annakkaya
The primary disease of male patients was predominantly AS while it was psoriasis in female. In both cases, there was no previous history of TB. The female patient had a TB contact due to pulmonary TB treatment history of her husband in 2007. She was started infliximab therapy in 2010 and she had completed daily 300 mg INH prophylaxis for 9 months. She had no other complaints except from the skin lesions in 2012, sputum requested because of the infiltration on annual chest x-ray. Bronchoscopy was performed and it was detected as acid resistant bacteria (ARB) (+++) in the post bronchoscopic sputum. Therefore, anti-TNF-α therapy was stopped and then anti-TB treatment was started. Her antibiogram came as sensitive for pyrazinamide, ethambutol, rifampin, streptomycin and INH. Male patient who had under the treatment of etanercept, he admitted with the complaints of the swelling and discharge in the cervical and axillary region as well as cough and sputum. Opacity was determined on the annual chest X-ray, ARB was requested from sputum and discharge of cervical region. Biopsy was also performed and then non-specific antibiotic therapy was started. Chest computed tomography was taken since patient did not respond to antibiotic treatment and had sputum smear negativity. Supraclavicular lymph node biopsies were performed. Anti-TB treatment was started because of the necrotizing granulomatous pathology, mycobacterial culture was seen positive in the lymph discharge and sputum, INH and streptomycin (S) resistance was observed in the antibiograms of sputum and smears, it was sensitive to other drugs (Table 4).
Impact of unfavorable factors on outcomes among inoperable stage II-IV Nonsmall cell lung cancer patients treated with proton therapy
Published in Acta Oncologica, 2019
He J. Zhu, Romaine C. Nichols, Randal H. Henderson, Christopher G. Morris, Stella Flampouri, Dat C. Pham, Christopher L. Klassen, Vandana Seeram, James D. Cury, Lisa Jones, Lisa McGee, Bradford S. Hoppe
OS from conventional fractionation was not significantly different between favorable-risk and unfavorable-risk patients (2-year overall survival, 52% and 43%). These rates are similar to those reported in the RTOG 0617 study of 58% for patients treated to 60 Gy and 43% for those treated to 74 Gy [18]. The RTOG 0617 study, however, further excluded patients with supraclavicular lymph node involvement and bilateral hilar involvement, who are included in the present study. There were noticeably more patients (25.7%) in the unfavorable-risk group who died with intercurrent disease than in the favorable-risk group (18.1%). However, the unfavorable-risk group included 8 patients (11.4%) with stage IIA and 4 patients (6%) with stage IIB disease, which have historically shown much better survival outcomes. The favorable group included only 1 stage IIB patient (4.8%). In a subgroup analysis excluding these stage II patients, OS was again found to be similar with or without unfavorable risk factors.