Asem Mansour

Impact of telemedicine on pediatric neuro-oncology in a developing country: The Jordanian-Canadian experience

Telemedicine is widely used in industrialized countries for educational purposes. Twinning experiences using telemedicine between institutions in industrialized and developing countries (DC) have been limited. Pediatric neuro‐oncology is a complex multidisciplinary discipline that is underserved in most of DC and provides a model to test the feasibility of such tool for twinning purposes.

Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

Background and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE) in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described. Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness. Results: During the study period, 34 patients with incidental PE were identified. The mean age (±SD) was 57.7 (±12.4) years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77%) patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79%) patients had their PE while undergoing active treatment with chemotherapy (68%) or radiotherapy (12%); none, however, were on hormonal therapy. Most (74%) patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%), all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26%) died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated. Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension, and sudden death.

Acute Coronary Artery Air Embolism Following CT-Guided Lung Biopsy

CT-guided needle biopsy is a common procedure for obtaining a tissue diagnosis and consequently correctly managing patients. This procedure has many potential complications, ranging from simple pneumothorax or self-limiting hemoptysis to life-threatening pulmonary hemorrhage and air embolism. Though the latter is a rare complication of CT-guided needle biopsy, it has attracted a lot of interest. We report a case of right coronary air embolism resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of the lung.

(18) F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of recurrent bone and soft tissue sarcoma.

The clinical utility of modern hybrid imaging modalities for detecting recurrent bone or soft tissue sarcoma remains to be determined. In this report, the authors present a clinical study on the diagnostic accuracy and incremental value of integrated 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) in patients with a history of sarcoma who have clinically suspected disease recurrence.

Closing the survival gap: implementation of medulloblastoma protocols in a low-income country through a twinning program.

Successful twinning initiatives have been reported in childhood leukemia. Pediatric neuro‐oncology requires a complex multidisciplinary approach and the feasibility of similar twinning programs is unknown. Twinning between King Hussein Cancer Center in Amman and the Hospital for Sick Children in Toronto started with e‐mail communications, and subsequently included monthly videoconferences and exchanges between institutions. The outcome of 35 newly diagnosed medulloblastoma patients (22 high‐risk and 13 average‐risk) treated during this period is reported. The 3‐year overall survival for average risk and high‐risk patients was 100 and 81%, respectively. This experience suggests that twinning may facilitate the implementation of multidisciplinary neuro‐oncology programs in low‐income countries. Videoconferencing allows interactive exchanges with a significant learning impact.

Cancer care in Jordan.

Cancer is the second leading cause of death in Jordan after cardiovascular diseases. Due to increase in life expectancy and prolonged exposure to risk factors, cancer mortality and morbidity are expected to increase as the young population ages. This increase will constitute a challenging burden on healthcare systems in Jordan and many other neighboring countries. Planning is key to managing the expected rise in the demand for cancer care, and this will require public health initiatives to guarantee access to quality cancer care. Over the past decade, cancer care in Jordan has witnessed remarkable improvement through access to advanced diagnostics and therapeutics. In this review, we address the history of cancer care in Jordan, including cancer statistics, infrastructure, workforce as well as cancer care outcomes. We also discuss many of the challenges that we face and offer suggestions for the improvement of cancer management in Jordan and the region.

Closing the survival gap

Successful twinning initiatives have been reported in childhood leukemia. Pediatric neuro‐oncology requires a complex multidisciplinary approach and the feasibility of similar twinning programs is unknown. Twinning between King Hussein Cancer Center in Amman and the Hospital for Sick Children in Toronto started with e‐mail communications, and subsequently included monthly videoconferences and exchanges between institutions. The outcome of 35 newly diagnosed medulloblastoma patients (22 high‐risk and 13 average‐risk) treated during this period is reported. The 3‐year overall survival for average risk and high‐risk patients was 100 and 81%, respectively. This experience suggests that twinning may facilitate the implementation of multidisciplinary neuro‐oncology programs in low‐income countries. Videoconferencing allows interactive exchanges with a significant learning impact.

MR imaging features of intracranial primary CNS lymphoma in immune competent patients.

We aimed to characterize specific MRI findings seen in immune competent patients with intracranial primary CNS lymphoma (PCNSL) and to determine their value in the management of such patients. Pre-treatment MRI examinations of 21 immunocompetent patients with biopsy-proven PCNSL were retrospectively evaluated. T1 and T2 signal characteristics as well as contrast enhancement features are described in all patients. Diffusion, perfusion and proton-MR-spectroscopy features are described in a subset of these patients. In the proper clinical and radiologic setting, suggesting the diagnosis of PCNSL can help institute proper treatment in a timely fashion and avoid unnecessary attempts at surgical resection and the associated morbidity.

Thymoma and Thymic Carcinoma Arising in a Thymolipoma: Report of a Unique Case

Thymic carcinoma arising within a thymolipoma has not been reported previously. The authors present a unique case of thymoma and undifferentiated thymic carcinoma arising within a thymolipoma in a 36-year-old woman. The bulk of the resected mass was composed of benign fatty tissue admixed with foci of unremarkable thymic tissue; however, it also harbored a central solid mass showing undifferentiated thymic carcinoma associated with a type B2 thymoma. The carcinoma cells were positive for cytokeratin AE1/AE3, cytokeratin 19, and cytokeratin 8/18. They were negative for vimentin, cytokeratin 7, cytokeratin 20, CD5, epithelial membrane antigen, CD30, placental alkaline phosphatase, carcinoembryonic antigen, CD99, leukocyte common antigen, Epstein-Barr virus, inhibin alpha, and protein gene product 9.5. Rare tumor cells showed positive staining for chromogranin and synaptophysin.

Solid (stromal predominance) hepatic mesenchymal hamartoma

Received: 25 July 2004 Revised: 9 August 2004 Accepted: 11 August 2004 Published online: 12 October 2004 Springer-Verlag 2004 A 4-year-old girl was well apart from a huge, right-upper-quadrant abdominal mass of 1-year duration that had enlarged over the previous 4 months. Contrast-enhanced CT showed a 12.5 cm·15 cm·10-cm, well-defined, upper abdominal softtissue mass, most likely arising from the quadrate lobe of the liver, with heterogeneous contrast enhancement. The mass was completely surgically removed. The histological diagnosis was hepatic mesenchymal hamartoma (HMH). Liver tumours comprise only 1–2% of all paediatric tumours; two-thirds are malignant. HMH constitutes about 8% of all paediatric hepatic tumours [1]. Two patterns are described: cystic predominant and stromal predominant, with the former being much more common [2]. The tumours are usually large at presentation, 16 cm on average, and usually present in the first 2 years of life. Boys are affected twice as often as girls [3]. Clinically, abdominal distension and a painless mass are the most common symptoms. The radiological appearances reflect the gross pattern, ranging from a predominantly cystic mass to a complex solid mass. The stromal predominant variant shows a complex solid mass on US while the CT appearances are of an enhancing solid mass (Fig. 1). Stromal predominant lesions on MRI demonstrate hypointense signal relative to normal liver on both T1and T2-weighted images due to fibrotic changes: they show intense heterogeneous contrast enhancement. The differential diagnosis includes hepatoblastoma, hepatocellular carcinoma, infantile haemangioendothelioma and undifferentiated embryonal sarcoma. In endemic areas, hydatid cyst should also be considered.