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Sadangi S, Saraiya H, Salunke AA, Bharwani N, Patel K, Pandya S, Warikoo V, Pandya S. The surgical management and oncologic outcomes of patients with fungating soft tissue sarcoma treated at a tertiary cancer centre and review of literature. J Orthop 2024; 53:94-100. [PMID: 38495576 PMCID: PMC10940886 DOI: 10.1016/j.jor.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024] Open
Abstract
Background Currently there is limited literature available on fungating soft tissue sarcoma and its effect of outcomes. In the current study we evaluated the surgical management and oncologic outcomes of patient with fungating soft tissue sarcoma. Materials and methods This was a retrospective observational study of patients with fungating sarcoma between January 2015 till January 2019 at a tertiary cancer care centre. A total of 59 patients were considered of which 16 had metastasis at presentation. The duration of symptoms prior to presentation averaged 10.2 months (median, 7.2months; range, 1-57 months). Median tumor length was 10 cm. Results 56% patients underwent amputation and 44% were treated with limb salvage. Following limb salvage surgery in10 cases primary closure of defect was performed and 6 cases required skin grafting for closure of defect. In 6 patients local flap was used for coverage of defect and 4 patients required free flap surgery. Two-year overall survival (OS) of the study cohort were 52.2% and 58% respectively. Two-year disease free survival (DFS) and OS in 43 non metastatic patients at presentation was seen in 58%(95% CI,38%-74%) and 66.5%(95% CI,42%-81%) respectively. The two-year disease OS in 16 patients with metastasis at presentation was 33.2 %. On univariate analysis, tumor size and metastatic at presentation had significant effect on survival. Conclusion Tumor size and metastatic at presentation has significant impact on survival in these patients. The oncologic outcomes including Disease free survival, overall survival and local recurrence rates similar amongst the two surgical modalities (amputation versus limb salvage). Amputation rates are more amongst fungating soft tissue sarcoma but limb salvage can be attempted whenever feasible keeping tumor free surgical margins under consideration.
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Affiliation(s)
- Sudam Sadangi
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Hemant Saraiya
- Department of Onco-Plastic Surgery, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Shivam Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
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Banala TR, Salunke AA, Bharwani N, Patel K, Maharjan D, Patel S, Warikoo V, Sharma M, Pandya S. Distal Ulna Giant Cell Tumor treated by Resection without Reconstruction: What were the functional outcomes and review of literature. J Orthop 2024; 53:118-124. [PMID: 38495577 PMCID: PMC10940127 DOI: 10.1016/j.jor.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Giant Cell Tumours (GCT) are benign tumours with aggressive potential that disrupt the local bony architecture, which can be especially problematic in peri-articular locations. Our aim was to assess the outcomes of patients with GCT of the distal ulna who were treated by resection without reconstruction. Methods The study included 21 patients with distal ulna GCT that were treated with resection without reconstruction. There were 12 males and 9 females, with a mean age of 30.4years (range 14-45 years). The patients mean follow-up period was 4.4 years, with a two-year minimum follow-up. Results Painful swelling was the presenting symtom in all cases. Nineteen patients had Campanacci grade 3 and two had Campanacci grade 2. The mean resected length of the distal ulna was 6.8 cm (range 4-10) cm. The Musculoskeletal Tumor Society score (MSTS) was 26.1. (range 22-28). Grip strength of the affected hand was reduced by 10.5% on average. (range 0%-16%). Two patients were having multi-centric disease on presentation and none of the cases had pathological fracture on presentation. One case had a local recurrence which was treated with surgery. Conclusion Based on current study, GCT of the distal ulna, en bloc resection without reconstruction can be recommended as a valuable treatment option for Campanacci grades 2 and 3 tumours. Resection of the distal end of the ulna without reconstruction results in excellent functional outcomes, with forearm rotational movement and hand function preserved. According to review of literature this is the largest series of GCT Ulna and we recommend a multicentre and comparitive studies on this topic.
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Affiliation(s)
- Tarun Reddy Banala
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Dipendra Maharjan
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shailesh Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Mohit Sharma
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
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Salunke AA, Nandy K, Kamani M, Parmar R, Bharwani N, Pathak S, Patel K, Pandya S. Is polypropylene mesh reconstruction functionally superior to non reconstructive group following total scapular resection? A retrospective analysis of 16 patients and a systematic review of the literature. J Orthop 2024; 52:37-48. [PMID: 38404696 PMCID: PMC10891286 DOI: 10.1016/j.jor.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the ideal method of reconstructions has been still debatable. The purpose of the current study was to assess whether polypropylene mesh reconstruction is superior as compared to non reconstructive group following total scapular resection.We also evaluated how our method of reconstruction fare as compared to reported reconstruction methods in the published literature. Methods During 2014 to 2019; Total scapulectomy (Type III scapular resection) was performed in 16 patients for malignant tumor involving scapula bone. Reconstruction with polyprolene mesh(Group I) was performed in 56 % patient and non reconstruction technique (Group II) was observed in 44 % patient. The mean follow-up duration of current study was 28.3 months (range 13-67 months). The search method of PubMed and Cochrane databases provided 121 articles; of which 5 studies having 144 cases were utilised for final analysis. The reconstruction method used were dynamic humeral suspension (39.5%), non reconstruction method (35 %), scapular prosthesis (18 %) and static humeral suspension (5.5%). Results The mean Musculoskeletal tumor society score (MSTS) of the study cohort was 19.8(0-23); and that in polyprolene mesh or static suspension method (Group I) and non reconstructive technique (Group II) was 67 % and 61% respectively. The emotional acceptance score in group I was 4.5 and that in group II was 4.2 points. There was no difference in the shoulder movements in both the groups. The mean surgical durations in group I and group II was was 186 min and 140 min respectively. The systematic review showed the mean Musculoskeletal tumor society score (MSTS) of dynamic suspension and non reconstruction method were 63 % and 63.5% respectively. The mean Musculoskeletal tumor society score (MSTS) of scapula prosthesis tended to be higher than those with dynamic suspension (77 % vs 65 %). Conclusions The reconstruction with polypropylene mesh had better functional outcome and emotional acceptance as compared to non-reconstructive group in patients with total scapular resection surgery. The findings of systematic review suggest that; patients treated by reconstruction with polypropylene mesh and non-reconstructive group as compared to scapular prosthesis had limited shoulder movements with no difference in hand position, manual dexterity and lifting ability.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Mayur Kamani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Rahul Parmar
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | | | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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Shukla S, Salunke AA, Trivedi M, Patel K, Pandya S, Suthar R, Reddy T, Kapoor K, Yala P, Krishna G, Bharwani N, Pandya S. Clinicopathological and oncological outcomes in upper extremity Ewing's sarcoma: A single institutional experience. J Orthop 2024; 49:148-155. [PMID: 38682008 PMCID: PMC11043629 DOI: 10.1016/j.jor.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 05/01/2024] Open
Abstract
Background Ewing's sarcoma is highly aggressive bone tumor having predilection for younger age groups with t (11,22) translocation, recombines the FLI-1 and EWS genes on chromosome 22. This disease requires multi-disciplinary treatment withneo-adjuvant chemotherapy followed by surgery or radiotherapy and adjuvant chemotherapy. This study was aimed to assess the demographic distribution, clinical behaviour and oncological outcome of Ewings Sarcoma involving upper extremity. Methods From 2015 to 2022, 45 patients of upper extremity Ewing's sarcoma underwent treatment at a territory cancer centre. A total of 26 patients treated with surgical management were included in the study comprising 15 males (57.7 %) and 11 females (42.3 %). Mean age of presentation was 26 years (3-43 years). The most common site for Ewings sarcoma of upper extremity was Humerus(42 %) followed by Scapula(27 %), Radius(15 %), Ulna(8 %), Metacarpals(4 %) and Clavicle(4 %). Out of 26 cases, 19 (73%) underwent limb salvage surgery and 7 (27%) underwent ampuation surgery. Results In limb salvage group reconstruction with Extra-corporeal radiotherapy (ECRT), Ulna centralization, Megaprosthesis and 3D printed scapula was performed following wide resection of tumor. In Amputation group ray resection in one case and forequarter amputation was performed in six cases. Mean serum LDH value was 335 IU/L (2.3X Normal value) and serum albumin was 4.04 gm/dl. Mean tumour necrosis after neo-adjuvant chemotherapy was 68 %. Out of 26 cases, 19(73 %) cases underwent limb salvage and 7 patients underwent amputation surgery. Out of 26, 13 (50 %) patients developed metastasis on follow up. The Event free survival (EFS) in current study was 70 % at 12 months and 40 % at 24 months. Mean Event free survival (EFS) in current study was 33.5 months (22.3-44.6) and Median Event free survival (EFS) in current study was 25 months (19.7-30.2). Conclusion This study characterises demographic and oncologic outcomes of upper extremity ewings sarcoma in Indian subpopulation. Pain and swelling were prominent clinical findings at presentation in patients with upper extremity Ewing's sarcoma. The survival rate following limb salvage surgery in Ewings sarcoma of upper extremity was comparable to that of patients with amputation surgery. Ewings sarcoma of upper extremity was associated with higher LDH level which was raised more than twice the normal range and can led to worse oncologic outcomes. A comparative study on upper extremity and lower extremity ewings sarcoma will be of help to improve literature on this rare disease.
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Affiliation(s)
- Shivang Shukla
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | | | - Maharshi Trivedi
- Gujarat Cancer and Research Institute, (Medical Oncology), Ahmedabad, Gujarat, India
| | - Keval Patel
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Shivam Pandya
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Ritesh Suthar
- Gujarat Cancer and Research Institute, (Nuclear Medicine), Ahmedabad, Gujarat, India
| | - Tarun Reddy
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Kanika Kapoor
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Poojitha Yala
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Geetha Krishna
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
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Gami A, Shah A, Shankaralingappa S, Salunke AA, Gandhi J, Patel K, Bharwani N, Trivedi P, Pandya S. Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor? J Orthop 2024; 48:13-19. [PMID: 38059219 PMCID: PMC10696180 DOI: 10.1016/j.jor.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Opinion remains divided as to whether excision of needle biopsy tract is beneficial and affect the prognosis. The aim of the study was to compare the outcomes in patients of primary malignant bone tumor who had undergone surgery with or without biopsy tract excision. Methods From January 2017 to June 2020, 240 patients with primary malignant bone tumors who underwent percutaneous needle biopsy followed by surgery were included. We categorized patients into Biopsy tract excision (Group1:185 patients) and Non Biopsy tract excision (Group 2:55 patients). Median follow-up of patients was 58.6 months (range; 12-61.8months). Results Demographics, histopathological type, tumor location, type of surgery were similar in biopsy tract excision and non excision group. We found biopsy tract seeding in two cases out of 185 (1.1 %). Local recurrence in biopsy tract excision and non excision group was observed in 3.2 % and 1.8 % respectively with p value 0.58. The mean local recurrence free survival rate in group 1 and 2 was 60 and 44 months respectively. Limb salvage was performed in 71.6 % and in amputation in 28.3 % cases. The local recurrence in limb-salvage and amputation group was observed in 3.4 % (6/172) and 1.4 % (1/68) respectively. Conclusion There was no significant difference in the rate of local recurrence between patients who were treated by biopsy tract excision or non tract excision. Percutenous needle bone biopsy tract leads to minimal risk of tumor seeding during surgical resection of primary bone tumors.We recommend the further multi centre studies with more number of patients to reach a consensus on resection of needle biopsy tract during surgical management of primary bone tumors.
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Affiliation(s)
- Amisha Gami
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Ashini Shah
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Jahnavi Gandhi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Suthar R, Bharwani N, Pareek P, Salunke AA, Patel K, Shukla S, Aron J, Kapoor K, Yalla P, Rathod P, Pandya S, Pandya S. Role of bone scintigraphy (bone scan) in skeletal osteosarcoma: A retrospective audit and review from tertiary oncology centre. J Orthop 2024; 48:20-24. [PMID: 38059218 PMCID: PMC10696193 DOI: 10.1016/j.jor.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Bone scan is a investigation which uses radionuclide phosphonate compound for whole skeletal survey. In this current study we have done the analysis of the role of bone scan in skeletal osteosarcoma at tertiary oncology care centre. Material & methods This is a retrospective study conducted in a tertiary oncology centre from January 2022 to February 2023. A total of 92 patients with skeletal OGS were included in our study undergone 99 mTCcMDP whole body bone scan. 99 mTc MDP was prepared freshly every morning and dose for each patient were calculated as per EANM guidelines. Images were acquired 2-3 h of post injection. All images were acquired at GE infinia dual head machine with peak setting at 140Kev and LEAP collimator. Suspicious lesions on planer bone scan were correlated with SPECT fused with CT. All the bone scans were reviewed retrospectively by two independent nuclear medicine physicians. Results In this study group, 86 patients with biopsy proven skeletal OGS underwent 99 mTCcMDP bone scan of which 63 were males and 23 were females (2.7:1) with age of study group ranging from 7years to 48years. Patients referred for bone scan were retrospectively categorized in two groups, first group patients (52) were referred for initial staging of disease and second group of patients (34) were referred for follow-up or re-staging of the disease. Total 09 patients showed distant skeletal metastases on bone scan, out of which 05 were in initial staging group and 04 in follow up group. Conclusion Osteosarcoma has propensity to metastasize to many sites in the body however most common site being lung followed by skeletal, nodal and rarely soft tissue metastasis. Bone scan enjoys a optimal sensitivity in case of osteosarcoma to detect skeletal metastasis but have low specificity. However being a cost effective and faster investigation makes it a wise investigation of choice in case of osteosarcoma for skeletal metastasis evaluation.
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Affiliation(s)
- Ritesh Suthar
- Nuclear Medicine, Gujarat Cancer Research Institute(GCRI), Ahemdabad, Gujarat, India
| | - Nandlal Bharwani
- Orthopedic Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Pravin Pareek
- Nuclear Medicine, Gujarat Cancer Research Institute(GCRI), Ahemdabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Orthopedic Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Keval Patel
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shivang Shukla
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Jebin Aron
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Kanika Kapoor
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Poojitha Yalla
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Priyank Rathod
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shivam Pandya
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shashank Pandya
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
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Singh M, Bansal M, Singh A, Bharwani N, Bhati M. Atypical Lumbar Scheuermann's Disease: A Rare Entity and Literature Review. J Orthop Case Rep 2023; 13:48-50. [PMID: 37144077 PMCID: PMC10152931 DOI: 10.13107/jocr.2023.v13.i02.3552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/08/2022] [Indexed: 05/06/2023] Open
Abstract
Introduction Atypical Scheuermann disease involves one or two vertebral bodies which result in kyphosis. Case Report An 18-year-old male presented in OPD with a complaint of chronic lower back pain without any lower limb pain and neurological deficit. Radiological imaging and blood parameters were in favor of atypical Scheuermann disease. Conclusion Radiological and blood investigations are required to rule out other possible causes of chronic back pain to make a diagnosis of atypical Scheuermann disease which should be treated conservatively initially.
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Affiliation(s)
- Mahendra Singh
- Department of Orthopaedics, Dr. S.N. Medical College, Jodhpur. Rajasthan, India
| | - Mohit Bansal
- Department of Orthopaedics, Dr. S.N. Medical College, Jodhpur. Rajasthan, India
- Address of Correspondence: Dr. Mohit Bansal, Post Graduate Resident, Department of Orthopaedics, Dr. S.N. Medical College, Jodhpur, Jodhpur, Rajasthan, India. E-mail:
| | - Amit Singh
- Department of Orthopaedics, Dr. S.N. Medical College, Jodhpur. Rajasthan, India
| | - Nandlal Bharwani
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahesh Bhati
- Department of Orthopaedics, Dr. S.N. Medical College, Jodhpur. Rajasthan, India
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Singh B, Gehlot R, Saxena M, Bharwani N, Raichandani K, Bhati M. An unusual presentation of mycetoma around knee joint as a subcutaneous mass - A case report. J Orthop Case Rep 2022; 12:22-25. [PMID: 36874900 PMCID: PMC9983373 DOI: 10.13107/jocr.2022.v12.i010.3350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/18/2022] [Indexed: 03/07/2023] Open
Abstract
Introduction Mycetoma is a form of chronic granulomatous disease which involves subcutaneous tissues and causes bone destruction in advanced stages. The characteristic features are sinus formation, granules formation, and mass in subcutaneous region. Case Report A 19-year-old male presented to our out-patient clinic with complaint of a painless swelling around the medial aspect of the right knee joint for 8 months with no sinus or discharge of granules. Pes anserinus bursitis was thought of as differential diagnosis for the present condition. "Staging-classification of mycetoma" is commonly used for classifying mycetoma and as per classification, the present case had Stage-A. Conclusion Single-stage local excision was performed and supplemented with anti-fungal agent for 6 months, which showed good outcome at the final follow-up of 13 months.
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Affiliation(s)
- Bhupendar Singh
- Department of Radiodiagnosis, Dr. SN Medical College, Jodhpur, Rajasthan, India
| | - Rishita Gehlot
- Department of Pathology, Dr. SN Medical College, Jodhpur, Rajasthan, India
| | - Medhavi Saxena
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nandlal Bharwani
- Department of Orthopaedics, Dr. SN Medical College, Jodhpur, Rajasthan, India
| | | | - Mahesh Bhati
- Department of Orthopaedics, Dr. SN Medical College, Jodhpur, Rajasthan, India
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Singh B, Saxena M, Sheoran P, Bharwani N, Bhati M. Ganglionic Cyst of Periosteal Origin Mimicking as Pes Anserine Bursitis - A Rare Entity and Literature Review. J Orthop Case Rep 2022; 12:44-47. [PMID: 36873320 PMCID: PMC9983404 DOI: 10.13107/jocr.2022.v12.i09.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/13/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Periosteal ganglion is a form of cystic swelling commonly seen around long bones of lower extremities. Case Report A 55-year-old male presented to outdoor clinic with gradually increasing swelling around anteromedial aspect of the right knee joint with intermittent pain on prolonged standing and walking for 8 months. Magnetic resonance imaging was suggestive of ganglionic cyst which was confirmed later by histopathological examination. Conclusion Ganglionic cyst of periosteal origin is a rare entity. Complete excision is the recommended treatment option; if not performed appropriately chances of recurrence are high.
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Affiliation(s)
- Bhupendar Singh
- Department of Radiodiagnosis, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Medhavi Saxena
- Department of Anaesthesia, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradish Sheoran
- Department of Orthopaedics, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Nandlal Bharwani
- Department of Orthopaedics, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Mahesh Bhati
- Department of Orthopaedics, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
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Rishita, Singh D, Singhvi A, Bharwani N, Jain H, Bhati M. Synovial Hemangioma Presenting as Anterior Knee Pain - A Case Series. J Orthop Case Rep 2022; 12:61-64. [PMID: 36873337 PMCID: PMC9983408 DOI: 10.13107/jocr.2022.v12.i09.3018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Synovial hemangioma is a benign soft-tissue tumor of vascular origin. The knee joint is most common joint affected and with highest incidence noted till date. For diagnosis, of such rare presentation radiological investigations such as digital radiograph and magnetic resonance imaging are of utmost importance, and magnetic resonance imaging being considered as investigation of choice. The gold standard treatment being complete excision of the growth. Case 1 A 13-year-old boy presented in out-patient clinic with chief complaint of right sided anterior knee pain since 10 months and patient had history of trauma in past. Magnetic resonance imaging of knee joint showed well circumscribed lesion in infra-patellar area (Hoffa's fat pad), with internal septations present within lesion. Case 2 A 25-year-old female presented to out-patient clinic with chief complaint of left sided anterior knee pain since 2 year, with no history of prior injury. The magnetic resonance imaging of knee joint showed ill-defined lesion around anterior patella-femoral articulation adherent to quadriceps tendon, internal septations present within lesion. For both cases, en bloc excision was performed and good functional outcome was achieved. Conclusion Knee joint synovial hemangioma is rare presentation to orthopedic outdoors, has slight female predominance with pre-existing history of trauma. In the present study, both cases were of patella-femoral type (anterior and infra-patellar fat pad). For such lesions, en bloc excision is gold standard procedure to prevent recurrence, same procedure was followed in our study, and good functional outcome was achieved.
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Affiliation(s)
- Rishita
- Department of Pathology, Dr. S. N Medical College, Jodhpur, Rajasthan, India
| | - Devendra Singh
- Department of Orthopaedics, Dr. S. N Medical College, Jodhpur, Rajasthan, India
| | - Arpita Singhvi
- Department of Pathology, Dr. S. N Medical College, Jodhpur, Rajasthan, India
| | - Nandlal Bharwani
- Department of Orthopaedics, Dr. S. N Medical College, Jodhpur, Rajasthan, India
| | - Hemant Jain
- Department of Orthopaedics, Dr. S. N Medical College, Jodhpur, Rajasthan, India
| | - Mahesh Bhati
- Department of Orthopaedics, Dr. S. N Medical College, Jodhpur, Rajasthan, India
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Singh M, Singh B, Singh A, Bharwani N, Bhati M. Unusual Presentation of Aggressive Hemangioma of Thoracic Vertebrae–A Case Report. J Orthop Case Rep 2022; 12:44-46. [PMID: 37065519 PMCID: PMC10092392 DOI: 10.13107/jocr.2022.v12.i06.2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Hemangioma is most common lesion frequently encountered in dorsolumbar region. Although most of these lesions are asymptomatic and are incidental findings on imaging such as computed tomography (CT)-scan and magnetic resonance imaging (MRI). Case Report: A 24-year-old young male presenting to orthopedic outdoor with complaint of severe mid backache and lower limb paraparesis which developed after trivial trauma and increases with daily routine activities such as sitting, standing, and postural changes. For these lesion, “Enneking staging” was used. Conclusion: In such unusual cases, it is very important to differentiate these lesions from vertebral body metastasis, pott’s spine, or aggressive bone tumors to reduce intraoperative or post-operative complications.
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Singh B, Gehlot R, Saxena M, Bharwani N, Bhati M. An unusual presentation of mycetoma around knee joint as a subcutaneous mass – A case report. J Orthop Case Rep 2022. [DOI: 10.13107/jocr.2022.v12.i10.3350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Mycetoma is a form of chronic granulomatous disease which involves subcutaneous tissues and causes bone destruction in advanced stages. The characteristic features are sinus formation, granules formation, and mass in subcutaneous region. Case Report: A 19-year-old male presented to our out-patient clinic with complaint of a painless swelling around the medial aspect of the right knee joint for 8 months with no sinus or discharge of granules. Pes anserinus bursitis was thought of as differential diagnosis for the present condition. “Staging-classification of mycetoma” is commonly used for classifying mycetoma and as per classification, the present case had Stage-A. Conclusion: Single-stage local excision was performed and supplemented with anti-fungal agent for 6 months, which showed good outcome at the final follow-up of 13 months. Keywords: Eumycetoma, wide excision, antifungal agents, knee.
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Bharwani N, Ranjan N, Bishnoi PC, Bhati M. Mycetoma Presenting as Knee Swelling - "A Rare Entity". J Orthop Case Rep 2021; 11:44-46. [PMID: 35415134 PMCID: PMC8930372 DOI: 10.13107/jocr.2021.v11.i12.2560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction It is a form of chronic granulomatous infection involving skin, subcutaneous tissue, and skeletal system. The authors report a case of mycetoma presenting as knee swelling. Case Report A 25-year-old male presented to outdoor with painless swelling around medial aspect of the right knee joint with intermittent discharge of black granules from sinus since 6 months. The patient reported for mycetoma around knee joint belongs to Stage-B as per "Staging-classification of mycetoma." Conclusion Knee mycetoma is a very rare presentation. Wide surgical excision and medical treatment are considered as gold standard.
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Affiliation(s)
- Nandlal Bharwani
- Department of Orthopaedics, DR. S. N Medical College, Jodhpur, India,Address of Correspondence: Dr. Nandlal Bharwani, C/O Dr. Chandan Prakash Bharwani Near Maloo Guest House, Gangashahar, Bikaner, India. E-mail:
| | - Navendu Ranjan
- Department of Orthopaedics, DR. S. N Medical College, Jodhpur, India
| | | | - Mahesh Bhati
- Department of Orthopaedics, DR. S. N Medical College, Jodhpur, India
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Raichandani K, Agarwal S, Jain H, Bharwani N. Mortality profile after 2 years of hip fractures in elderly patients treated with early surgery. J Clin Orthop Trauma 2021; 18:1-5. [PMID: 33936949 PMCID: PMC8079428 DOI: 10.1016/j.jcot.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In geriatric age group, hip fractures tend to become a major public health hazard. Due to this high occurrence, there is a need to develop standardized, effective, and multidisciplinary management for treatment. These elderly patients have excessive mortality that can extend ahead of the time of recovery. Early surgery after hip fractures has lead to a notable reduction in mortality rates. Still, it is considerably high as compared to other fractures. METHODS 266 patients of >65 years who were operated within 72 h hours in a tertiary level health care centre for hip fractures were included. They were evaluated with X-rays and grade of Singh's index was noted. Mortality rates and the factors associated with it such as age, sex, co morbidities (using Charlson's co morbidity Index/CCI) were evaluated after 2 year follow up. RESULTS The overall 2-year mortality reported in our study population was 11.2%. It was broadly lower as compared to most of the other studies. It was 6.3% in females as compared to 18.1% in males. While it was reported to be only 6% in 65-74 years of age, it was 25% in patients who were 85 years and above. 76.6% of the patients had Singh's index of ≤ grade 3 showing osteoporosis. The patients with Low Charlson's score showed only 4.2% mortality while those with high Charlson's score showed 25.5% mortality. CONCLUSION It was concluded that Mortality among elderly patients after early surgery after osteoporotic hip fractures is quite significant. The factors for improvement in long term survival post-hip fracture may include changing treatment patterns, increasing life expectancy and early surgery. Increase in age, female sex, and high CCI Scores were major risk factors of mortality after hip fractures in a 2-year follow-up period.
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Affiliation(s)
| | - Shubham Agarwal
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
| | - Hemant Jain
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
| | - Nandlal Bharwani
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 2016; 27:2765-2775. [PMID: 27921160 PMCID: PMC5486785 DOI: 10.1007/s00330-016-4673-z] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/05/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
Abstract Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. Key Points • This report provides guidelines for MRI in endometriosis. • Minimal and optimal MRI acquisition protocols are provided. • Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4673-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Bazot
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France.
| | - N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, 3rd Floor Queen Elizabeth the Queen Mother Building, Praed Street, London, W2 1NY, UK
| | - C Huchon
- Department of Obtetrics and Gynaecology, CHI Poissy Saint-Germain en Laye,Versailles University France, 10 rue du champ Gaillard, 78300, Poissy, France
| | - K Kinkel
- Institut de radiologie, Clinique des Grangettes, 7, chemin des Grangettes, CH 1224, Chêne-Bougeries, Switzerland
| | - T M Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - A Guerra
- Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | - L Manganaro
- Department of Radiological Sciences, Sapienza University of Rome, Vle. Regina Elena 324, 00162, Rome, Italy
| | - L Buñesch
- Department of Radiology (Urogenital Section), Hospital Clínic Barcelona, Villarroel, 170, Barcelona, 08036, Spain
| | - A Kido
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - K Togashi
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France
| | - A G Rockall
- Department of Radiology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
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Cuthbert F, Bharwani N, Rockall A. Detection of gynaecological cancer in pregnancy. Cancer Imaging 2015. [PMCID: PMC4601834 DOI: 10.1186/1470-7330-15-s1-p34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Papadopoulou I, Qureshi M, Butterfield N, Bharwani N, Rockall A. Fertility preservation in gynaecologic malignancy: imaging role in treatment planning. Cancer Imaging 2015. [PMCID: PMC4601859 DOI: 10.1186/1470-7330-15-s1-p35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lakhani A, Khan S, Bharwani N, Stewart V, Rockall A, Barwick T, Khan S. FDG-PET/CT pitfalls in gynecological and genitourinary oncological imaging. Cancer Imaging 2015. [PMCID: PMC4601111 DOI: 10.1186/1470-7330-15-s1-p42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Borley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V, Carson I, Hird E, McIndoe A, Farthing A, Blagden S, Ghaem-Maghami S. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG 2015; 122:843-849. [PMID: 25132394 DOI: 10.1111/1471-0528.12992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer. DESIGN Two-phase retrospective cohort study. SETTING West London Gynaecological Cancer Centre, UK. POPULATION Women with stage 3 or 4, ovarian, fallopian or primary peritoneal cancer undergoing cytoreductive surgery. METHODS Preoperative CT images were reviewed by experienced radiologists to assess the presence or absence of disease at predetermined sites. Multivariable stepwise logistic regression models determined sites of disease which were significantly associated with surgical outcomes in the test (n = 111) and validation (n = 70) sets. MAIN OUTCOME MEASURES Sensitivity and specificity of CT in predicting surgical outcome. RESULTS Stepwise logistic regression identified that the presence of lung metastasis, pleural effusion, deposits on the large-bowel mesentery and small-bowel mesentery, and infrarenal para-aortic nodes were associated with debulking status. Logistic regression determined a surgical predictive score which was able to significantly predict suboptimal debulking (n = 94, P = 0.0001) with an area under the curve (AUC) of 0.749 (95% confidence interval [95% CI]: 0.652, 0.846) and a sensitivity of 69.2%, specificity of 71.4%, positive predictive value of 75.0% and negative predictive value of 65.2%. These results remained significant in a recent validation set. There was a significant difference in residual disease volume in the test and validation sets (P < 0.001) in keeping with improved optimal debulking rates. CONCLUSIONS The presence of disease at some sites on preoperative CT scan is significantly associated with suboptimal debulking and may be an indication for a change in surgical planning.
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Affiliation(s)
- J Borley
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - J Yazbek
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - R Williamson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - N Bharwani
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - V Stewart
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - I Carson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - E Hird
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A McIndoe
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A Farthing
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Blagden
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
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Tang Y, Bharwani N, Micco M, Akker S, Rockall A, Sahdev A. The prevalence of incidentally detected adrenal enlargement on CT. Clin Radiol 2014; 69:e37-42. [DOI: 10.1016/j.crad.2013.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/13/2013] [Accepted: 08/27/2013] [Indexed: 11/16/2022]
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Bharwani N, Miquel ME, Powles T, Dilks P, Shawyer A, Sahdev A, Wilson PD, Chowdhury S, Berney DM, Rockall AG. Diffusion-weighted and multiphase contrast-enhanced MRI as surrogate markers of response to neoadjuvant sunitinib in metastatic renal cell carcinoma. Br J Cancer 2013; 110:616-24. [PMID: 24366299 PMCID: PMC3915138 DOI: 10.1038/bjc.2013.790] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 11/17/2013] [Accepted: 11/21/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current imaging criteria for categorising disease response in metastatic renal cell carcinoma (mRCC) correlate poorly with overall survival (OS) in patients on anti-angiogenic therapies. We prospectively assess diffusion-weighted and multiphase contrast-enhanced (MCE) MR imaging (MRI) as markers of outcome. METHODS Treatment-naive mRCC patients on a phase II trial using sunitinib completed an MRI substudy. Whole-tumour apparent diffusion coefficient (ADC) maps and histograms were generated, and mean ADC and AUC(low) (proportion of the tumour with ADC values lying below the 25th percentile of the ADC histogram) recorded. On MCE-MRI, regions of interest were drawn around the most avidly enhancing components to analyse enhancement parameters. Baseline (n=26) and treatment-related changes in surviving patients (n=20) were correlated with OS. Imaged metastases were also analysed. RESULTS Forty-seven per cent of the patients showed significant changes in whole-tumour mean ADC following therapy, but there was no correlation with outcome. Patients with a high baseline AUC(low) and greater-than-median AUC(low) increase had reduced OS (HR=3.67 (95% confidence interval (CI)=1.23-10.9), P=0.012 and HR=3.72 (95% CI=0.98-14.21), P=0.038, respectively). There was no correlation between MCE-MRI parameters and OS. Twenty-eight metastases were analysed and showed positive correlation with primary tumour mean ADC for individual patients (r=0.607; P<0.001). CONCLUSION Primary RCC ADC histogram analysis shows dynamic changes with sunitinib. Patients in whom the tumour ADC histogram demonstrated high baseline AUC(low) or a greater-than-median increase in AUC(low) with treatment had reduced OS.
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Affiliation(s)
- N Bharwani
- Department of Radiology, Barts Health NHS Trust, St Bartholomew's Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - M E Miquel
- 1] Department of Clinical Physics, Barts Health NHS Trust, St Bartholomew's Hospital, 4th Floor Dominion House, 60 St Bartholomew's Close, London EC1A 7BE, UK [2] Barts and the London NIHR Cardiovascular Biomedical Research Unit, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Bonner Road, London E2 9JX, UK
| | - T Powles
- Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - P Dilks
- Department of Radiology, Barts Health NHS Trust, St Bartholomew's Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - A Shawyer
- Department of Radiology, Barts Health NHS Trust, St Bartholomew's Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - A Sahdev
- Department of Radiology, Barts Health NHS Trust, St Bartholomew's Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - P D Wilson
- Department of Medical Oncology, St Bartholomew's Hospital, 7th Floor Gloucester House, London EC1A 7BE, UK
| | - S Chowdhury
- Department of Medical Oncology, Guys and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - D M Berney
- Barts Cancer Institute, Molecular Oncology and Cellular Pathology, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - A G Rockall
- Department of Radiology, Barts Health NHS Trust, St Bartholomew's Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
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Bharwani N, Crofton M. Peritoneal pseudocysts: aetiology, imaging appearances, and natural history. Clin Radiol 2013; 68:828-36. [DOI: 10.1016/j.crad.2013.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/27/2013] [Accepted: 03/06/2013] [Indexed: 12/21/2022]
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Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is now widely used as a standard imaging sequence for evaluation of the liver. The technique is easy to implement across different MRI platforms, and results in enhanced disease detection and characterization. With careful implementation, the quantitative apparent diffusion coefficient derived shows good measurement reproducibility, which can be applied for tissue characterization, the assessment of tumour response and disease prognostication. There is now a body of evidence that highlights the relative strengths and limitations of the technique for the assessment of liver diseases. The potential for more sophisticated analysis of DW-MRI data is currently being widely investigated.
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Affiliation(s)
- N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Miquel ME, Scott AD, Macdougall ND, Boubertakh R, Bharwani N, Rockall AG. In vitro and in vivo repeatability of abdominal diffusion-weighted MRI. Br J Radiol 2012; 85:1507-12. [PMID: 22674704 DOI: 10.1259/bjr/32269440] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To study the in vitro and in vivo (abdomen) variability of apparent diffusion coefficient (ADC) measurements at 1.5 T using a free-breathing multislice diffusion-weighted (DW) MRI sequence. METHODS DW MRI images were obtained using a multislice spin-echo echo-planar imaging sequence with b-values=0, 100, 200, 500, 750 and 1000 s mm(-2). A flood-field phantom was imaged at regular intervals over 100 days, and 10 times on the same day on 2 occasions. 10 healthy volunteers were imaged on two separate occasions. Mono-exponential ADC maps were fitted excluding b=0. Paired analysis was carried out on the liver, spleen, kidney and gallbladder using multiple regions of interest (ROIs) and volumes of interest (VOIs). RESULTS The in vitro coefficient of variation was 1.3% over 100 days, and 0.5% and 1.0% for both the daily experiments. In vivo, there was no statistical difference in the group mean ADC value between visits for any organ. Using ROIs, the coefficient of reproducibility was 20.0% for the kidney, 21.0% for the gallbladder, 24.7% for the liver and 28.0% for the spleen. For VOIs, values fall to 7.7%, 6.4%, 8.6% and 9.6%, respectively. CONCLUSION Good in vitro repeatability of ADC measurements provided a sound basis for in vivo measurement. In vivo variability is higher and when considering single measurements in the abdomen as a whole, only changes in ADC value greater than 23.1% would be statistically significant using a two-dimensional ROI. This value is substantially lower (7.9%) if large three-dimensional VOIs are considered.
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Affiliation(s)
- M E Miquel
- Clinical Physics, Barts Health NHS Trust, London, UK.
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Bharwani N, Newland A, Tunariu N, Babar S, Sahdev A, Rockall A, Reznek R. Re: Can MRI predict the diagnosis of endometrial carcinosarcoma? Clin Radiol 2011; 67:396; author reply 396-7. [PMID: 22188764 DOI: 10.1016/j.crad.2011.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 09/27/2011] [Indexed: 11/30/2022]
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Bharwani N, Miquel ME, Sahdev A, Narayanan P, Malietzis G, Reznek RH, Rockall AG. Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer. Br J Radiol 2011; 84:997-1004. [PMID: 21896664 DOI: 10.1259/bjr/14980811] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Endometrial cancer is the most common gynaecological malignancy in developed countries. Histological grade and subtype are important prognostic factors obtained by pipelle biopsy. However, pipelle biopsy "samples" tissue and a high-grade component that requires more aggressive treatment may be missed. The purpose of the study was to assess the use of diffusion-weighted MRI (DW-MRI) in the assessment of tumour grade in endometrial lesions. METHOD 42 endometrial lesions including 23 endometrial cancers and 19 benign lesions were evaluated with DW-MRI (1.5T with multiple b-values between 0 and 750 s mm(-2)). Visual evaluation and the calculation of mean and minimum apparent diffusion coefficient (ADC) value were performed and correlated with histology. RESULTS The mean and minimum ADC values for each histological grade were 1.02 ± 0.29×10(-3) mm(2) s(-1) and 0.74 ± 0.24×10(-3) mm(2) s(-1) (grade 1), 0.88 ± 0.39×10(-3) mm(2) s(-1) and 0.64 ± 0.36×10(-3) mm(2) s(-1) (grade 2), and 0.94 ± 0.32×10(-3) mm(2) s(-1) and 0.72 ± 0.36×10(-3) mm(2) s(-1) (grade 3), respectively. There was no statistically significant difference between tumour grades. However, the mean ADC value for endometrial carcinoma was 0.97 ± 0.31, which was significantly lower (p<0.0001) than that of benign endometrial pathology (1.50 ± 0.14). Applying a cut-off mean ADC value of less than 1.28 × 10(-3) mm(2) s(-1)we obtained a sensitivity, specificity, positive predictive value and negative predictive value for malignancy of 87%, 100%, 100% and 85.7%, respectively. CONCLUSION Tumour mean and minimum ADC values are not useful in differentiating histological tumour grade in endometrial carcinoma. However, mean ADC measurement can provide useful information in differentiating benign from malignant endometrial lesions. This information could be clinically relevant in those patients where pre-operative endometrial sampling is not possible.
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Affiliation(s)
- N Bharwani
- Department of Imaging, Barts and The London NHS Trust, London, UK.
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Druce MR, Bharwani N, Akker SA, Drake WM, Rockall A, Grossman AB. Intra-abdominal fibrosis in a recent cohort of patients with neuroendocrine ('carcinoid') tumours of the small bowel. QJM 2010; 103:177-85. [PMID: 20123681 DOI: 10.1093/qjmed/hcp191] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Fibrosis is a hallmark of neuroendocrine tumours (NETs) arising in the jejunum and ileum and may manifest in the mesentery and elsewhere. It is clinically important and once-established, there are few effective therapies. AIM To examine the frequency, radiological manifestations and clinical significance of intra-abdominal fibrosis in a patient cohort using modern cross-sectional imaging. Current prevalence is compared to historical series and correlation with cardiac fibrosis evaluated. DESIGN Cross-sectional, retrospective survey of a cohort of patients with mid-gut NETs from a single centre. METHODS Review of clinical features, biochemistry and imaging of patients with sporadic mid-gut NET and available imaging between 2002 and 2008. RESULTS Thirty-one patients were included: 26 (83.9%) had liver metastases and 11 (35.4%) had small-bowel wall thickening; 17 patients (55%) had mesenteric involvement, with a mass, which contained coarse calcification in seven patients and fine calcification in a further two. There was soft-tissue stranding in 13 patients (plus in a further patient with no mass) and 'indrawing' of tissues in 11 patients. Two patients had a 'misty' mesentery and two had early retroperitoneal fibrosis. Mesenteric involvement was unrelated to gender and urinary 5HIAA excretion. CONCLUSION Intra-abdominal fibrosis can be detected radiologically in around half of patients with mid-gut NET using contemporary cross-sectional imaging. Although not statistically significant, small-bowel obstruction was seen more frequently in the group with fibrosis. There was no relationship with cardiac fibrosis. Prospective studies are needed to evaluate predictors of fibrosis onset and clinical course and determine optimal methods of prevention and treatment.
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Affiliation(s)
- M R Druce
- Department of Endocrinology, Barts and the London School of Medicine, London, UK.
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Abstract
Epithelioid angiomyolipoma is a recently described rare variant of renal angiomyolipoma. It can occur in patients with or without tuberous sclerosis, and may potentially be malignant. We report the imaging findings from two cases of epithelioid angiomyolipoma: the first in a patient with tuberous sclerosis complex, arising in a horse-shoe kidney and growing into the inferior vena cava and right atrium; the second in a 62-year-old hypertensive man.
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Affiliation(s)
- N Bharwani
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK.
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Edey AJ, Sidhu PS, Amaechi I, Bharwani N, Stephens NJ, Heenan SD, Lee L, Pilcher J. Picture Quiz. Imaging 2008. [DOI: 10.1259/imaging/30617615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bharwani N, Stephens NJ, Heenan SD. Imaging of bladder cancer. Imaging 2008. [DOI: 10.1259/imaging/52298432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Queen WD, Bharwani N, Phillips EA, Ruether BA, Phillips TM, Jerry LM. Biochemical classification of circulating immune complexes in human malignant melanoma and hematologic neoplasms. Oncology 1989; 46:14-25. [PMID: 2915889 DOI: 10.1159/000226674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Circulating immune complexes (CIC) in human cancer are known to be very heterogeneous in size and composition. In 95 staged malignant melanoma patients and 71 individuals with leukemia and lymphoma, this heterogeneity was analyzed biochemically in sera positive for CIC. CICs were measured by a multiassay system and individual complexes were isolated and analyzed by immunological and biochemical methods. Analyses of sera from 100 normal individuals, from 25 rheumatoid women, and a group of 12 laboratory staff who work with human melanoma were included for comparison. Three basic patterns of complexes were identified circulating in the sera of the cancer patients. Type I are medium-sized (17-23S), complement-fixing complexes usually occurring in combinations. The prototype in melanoma contained IgG antibody and additional glycoprotein components and bound complement by the classical pathway. In hematological malignancies four subtypes could be identified depending on whether the antibody class was IgG or IgM, the nonimmunoglobulin component was glycoprotein or protein, and whether complement fixation occurred by the classical or alternate pathway. Type II complexes were noncomplement-fixing, medium-sized complexes (15-21S), which in melanoma contained IgG antibody and additional protein components. In the hematologic malignancies two subtypes could be identified depending on whether the antibody class was IgG or IgM. Both subtypes contained a glycoprotein nonimmunoglobulin component. Both melanoma and hematologic tumors had type III heavy complexes (36-44S) which were noncomplement-fixing and contained only immunoglobulin components, either IgG-IgG or IgM-IgG. As expected the rheumatoid arthritis patients frequently had both 7S and 21-23S CICs containing IgG as well as IgM rheumatoid factor with complement fixation via the classical pathway. No CICs were detected in normal young men and women (20-30 years); a few individuals in middle age (31-50 years) had small (7-11S) CICs which bound complement by the classical pathway and contained IgG and a protein nonimmunoglobulin component. The frequency of these 7S complexes increased with advancing age, with the appearance of 23S IgG-IgG or IgM-IgG complexes. IgG antibodies from only the melanoma patients reacted with cytoplasmic components of fresh melanoma cells, except the laboratory workers where all of their isolated CIC antibodies also reacted with melanoma cells. Thus the heterogeneity of complexes in melanoma is not random, but can be classified into three basic biochemical patterns. The hematologic group provides a slightly richer variation of subtypes within this basic scheme.
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Affiliation(s)
- W D Queen
- Immunochemistry Laboratory, George Washington University Medical Center, Washington, D.C
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Bharwani N. Initial management of cutaneous malignant melanoma. CMAJ 1986; 135:128-9. [PMID: 3719498 PMCID: PMC1491188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Appropriate initial surgical management of primary cutaneous malignant melanoma is important since no effective treatment exists once the tumour metastasizes. The author reviews methods of initial treatment, excisional biopsy with adequate margins being the most common. He also reports results from a questionnaire survey on the type of microstaging used at hospitals across Canada. Two thirds of the pathologists who responded to the questionnaire preferred to use both Clark's and Breslow's method of microstaging. As a result, the author believes that the best histopathologic classification to use for predicting outcome has yet to be established.
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Bharwani N, Campbell L, Ashley P, Queen WD, Phillips TM, Jerry LM. Circulating immune complexes in malignant melanoma: serial studies in 130 patients. Oncology 1986; 43:143-8. [PMID: 3703459 DOI: 10.1159/000226353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We evaluated the ability of repeated measurements of circulating immune complexes (CIC) to predict for tumor recurrence in 130 patients with malignant melanoma. Twenty-two patients had level 2, 45 had level 3, and 51 had level 4/5, stage I disease in remission at the start of monitoring, while 12 had stage II disease. The polyethylene glycol precipitation assay was used for serial studies, based on an initial comparative evaluation with the Clq-binding and Raji assays. The study averaged 22 +/- 11 months (6-43 months) and an average of 22 +/- 5.3 assays were performed per patient (range 3-36), with a follow-up of 4 years. CIC were present in sera in recurrent, irregular 'bursts' of activity. Serial measurements doubled the incidence of CIC compared to single determinations. Only 23% of these bursts of activity were clearly related temporarily to documented recurrences, while 34% occurred with treatment events such as surgery or immunotherapy, and 42% occurred without correlation to either recurrence or treatment. CIC activity was greater and more closely related to recurrence in high-risk stage I (level 4,5) and stage II patients. Whether analyzed as positive sera or as bursts of elevated CIC activity, CIC assays predicted for recurrence at the 5% significance level. The assay was highly sensitive (97%), but with poor specificity (21%) with many false positives (79%). The assay was helpful at ruling out recurrences (95%), but poor at ruling them in (29%). The advantage was seen only in high-risk stage I and II patients, and there was no advantage to serial assays over random single determinations. Although generally, CIC in the sera of melanoma patients were found to predict for recurrence, the use of serial CIC measures monitoring of individual patients cannot be recommended.
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Bharwani N. Bizarre presentation of abdominal lymphangioma in children. Can Med Assoc J 1983; 128:1349. [PMID: 6850455 PMCID: PMC1875792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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