Tubercular abdominal cocoon- a rare cause of intestinal obstruction

Termed as a rare entity so far “abdominal cocoon” which is an encasing of the small bowel within the fibrous membrane is usually of unknown origin, although at times, it may be seen secondary to a variety of conditions. Though described in literature as a rare entity we report a case of tubercular abdominal cocoon in 15 year old boy. This case report emphasizes the importance of this surgical condition in a tuberculosis endemic region.

Female genital tuberculosis: early diagnosis by laparoscopy and endometrial polymerase chain reaction

OBJECTIVE

To evaluate the efficacy of laparoscopic visual inspection vs. endometrial tuberculosis (TB) polymerase chain reaction (PCR) for an early diagnosis and management of female genital TB (GTB) in India.

DESIGN

Observational case study.

RESULTS

Both laparoscopy and endometrial (endo) TB-PCR were performed on 162 infertile women: 52 endo TB-PCR-positive patients were diagnosed as definite GTB, of whom 44 (84.6%) also showed laparoscopic findings suspicious of TB (Type I). Subgroup analysis showed a similar PCR positivity of 54.5% (24/44) in the strongly suspicious and 54.1% (20/37) in the mildly suspicious patients. Using the Bayesian approach, the maximum likelihood estimates of the sensitivity and specificity of laparoscopy in diagnosing GTB were 0.96 and 0.93 and those of a positive PCR were respectively 0.59 and 0.92. Of the 52 women who were TB-PCR positive, 16 (30.8%) conceived following treatment.

CONCLUSIONS

Endo TB-PCR had high specificity to diagnose GTB, as did laparoscopy. Laparoscopy may therefore be avoided in TB-PCR-positive patients for diagnosis but may still be required to rule out GTB in PCR-negative cases.

Evaluation of Testosterone Supplementation during Anastrozole Therapy in a Breast Explant Model

Background: Aromatase inhibitors (AI) are currently used as first line adjuvant therapy for postmenopausal women with estrogen receptor (ER) positive breast cancer. Side effects of AI therapy, such as arthralgia, can cause significant patient discomfort leading to compliance issues. This may be exacerbated by low tissue testosterone (T), which is naturally lower post-menopause and may be decreased further following chemotherapy. T supplementation has emerged as a potential means to treat AI-associated arthralgia and has generated favourable results in a phase II clinical trial (NCT00497458). However, T replacement in breast cancer had been contraindicated until the advent of powerful 3rd generation AIs such as anastrozole. AIs are highly efficacious in blocking conversion of T to estrogen, thereby increasing the potential for 5α-reduction of T to its more active tissue form, 5α-dihydrotestosterone (DHT), which counterbalances estrogen induced proliferative effects in hormonally sensitive breast tumors1. Our objective was to test the effects of T supplementation during AI administration on tumor growth in a human breast explant system.Materials and Methods: Fresh breast tumor samples collected from 17 post-menopausal women were cut into 3 mm3 pieces, cultured for 24h on gelatine sponges submersed in culture media with 10% steroid depleted fetal calf serum and treated with vehicle (control), T (5nM) and/or AI (25ng/ml). Tissues were stained with antibodies for ER, progesterone receptor (PR), androgen receptor (AR), and Ki67, a marker of cell proliferation that has been used to predict the outcome of therapy with anastrozole2. Tissue sections were scanned using a high resolution image scanner (NanoZoomer) and the percent Ki67 positive cells was determined by counting at least 2000 cells per slide.Results: All tumor tissues were positive (>30%) for ER, AR and PR, with the exception of 1 tumor that lacked PR. As expected for primary tissues, percent Ki67 positivity (mean; range) in the control was highly variable (6.45; 1-43.2). Tissue responses to T (7.9; 0.1-46), AI (6.06; 1.4-35.3), and T+AI (4.97; 0.7-26.1) were not significantly different from control (Wilcoxon signed rank test). However, the combination of T+AI showed a trend towards reduced Ki67 positivity compared to AI alone (p=0.07). In two patients T significantly increased Ki67 positivity by 2-4 fold, and in both instances this stimulatory effect of T was reduced to or below control values by treatment with AI.Discussion: Our results suggest that T supplementation during adjuvant AI therapy does not compromise AI-mediated inhibition of breast tumor growth. Indeed, combined therapy with T and AI may further enhance tumor suppression through elevation of DHT levels in the breast. This finding supports the clinical potential of T supplementation in post-menopausal women on adjuvant AI therapy to prevent or relieve AI-associated side effects.1. Peters A et al Cancer Res (In Press)2. Dowsett M et al JNCI 2007

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4089.

166. MATERNAL OBESITY IS ASSOCIATED WITH AN INCREASED INCIDENCE OF PROSTATE ABNORMALITIES IN ADULT RAT OFFSPRING

The World Health Organization has stated that 75% of adults worldwide are overweight, and in Australia nearly 25% of men are obese. Obesity is associated with an increased risk of cardiovascular disease, type 2 diabetes and cancer, with 30 to 40% of the latter possibly preventable by maintaining a healthy weight (The International Association for the Study of Obesity). Prostate cancer is the most commonly diagnosed cancer in men and there is increasing evidence that obesity increases the risk of prostate cancer mortality. High birth weight, an indication of excess nutrition during foetal development, has been associated with an increased risk of childhood and adult obesity, and for cancer. Using an animal model, we investigated whether obese mothers are more likely to have obese sons who are at an increased risk of developing prostate abnormalities and thus prostate cancer, in adulthood. Female rats were fed with either a control diet (4g fat/kg) or high fat diet (100g fat/kg) from before mating and throughout pregnancy. Prostate tissues were collected from the male offspring at 90 days (post-puberty) and 180 days (young adult). Histological analysis of the day 90 prostates identified hyperplasia in 100% of the ventral lobes (VL) and 64% of the dorsolateral lobes (DLP) in offspring of the maternal high fat group compared to 0% in each respectively, in those of the maternal control diet group. The VL is the most hormone sensitive prostate lobe of the rat, while the DLP is considered the equivalent of the human peripheral zone, the region from which the majority of human prostate cancers arise. These results suggest for the first time that maternal high fat diet may induce prostate abnormalities in male offspring that may in turn, predispose to an increased risk of prostate cancer in later life.

Hemifacial microsomia: a case report

Hemifacial microsomia is a congenital malformation in which there is a deficiency in the amount of hard and soft tissue on one side of the face. It is primarily a syndrome of the first branchial arch, involving underdevelopment of the temporomandibular joint, mandibular ramus, masticatory muscles and the ear. The affected ear may have an external soft-tissue malformation in addition to being lower set than on the contra lateral side. Hearing loss may result from underdevelopment of the osseous components of the auditory system and a diminished or absent external auditory meatus. Occasionally, second branchial arch defects involving the facial nerve and facial muscles coexist with Hemifacial microsomia. Radiographic examination in case of Hemifacial microsomia is of limited value because of superimposition of normal and abnormal bony structures. The skeletal and soft-tissue findings of a patient with Hemifacial microsomia who underwent three-dimensional computerized tomography is presented here to improve our knowledge and diagnostic skill of this uncommon entity.

415. Increased expression of an androgen receptor regulated gene, kit ligand, in polycystic ovaries

Polycystic ovaries (PCO) are induced by pathological or pharmacological female androgen excess, but the role of the androgen receptor (AR) in the pathogenesis of PCO is unknown. We therefore tested the hypothesis that PCO have increased expression of AR or kit ligand (KITL), a cytokine that was recently identified as a candidate AR-regulated gene in the ovary (1). Immunohistochemical analysis of AR and KITL expression was performed on archival paraffin-embedded sections of 8 morphologically normal and 8 polycystic ovaries from women under the age of 40 years. Stained sections were scanned with a NanoZoomer Digital Pathology System and immunoreactivity was qualitatively assessed using a 0-3+ scale, where 3+ represents the most intense staining. Electronic images of follicles at different stages of folliculogenesis were assessed by two independent observers who were blinded to the morphology of the source ovary. Each individual ovary contributed a minimum of 1 follicle per size class and a minimum of 10 follicles per size class were analysed. AR immunoreactivity was present in granulosa cells at all stages of folliculogenesis, in thecal cells of large antral follicles, and in the ovarian stroma. Staining intensity for AR did not differ between normal and polycystic ovaries. KITL expression, summarised in Table 1, was found to be significantly elevated in the oocytes of primordial and primary follicles and in the granulosa cells of follicles at all stages of folliculogenesis. These results show that AR expression is normal in PCO but expression of an AR-regulated gene is increased, potentially due to an excess of androgen hormone that is characteristic of women with PCO. Based on the roles of KITL established by murine studies, increased expression of KITL could explain many of the features of PCO including follicle excess, hyperthecosis and abnormal androgen secretion.