Michael T. Sheaff

The efficacy and safety of weekly vinorelbine in relapsed malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is a rapidly progressive invariably lethal tumor. Treatment options remain limited and the outcome in relapsed disease is poor warranting new therapeutic options. Following our previous experience in the first-line setting, we conducted a phase 2 open-label non-comparative study to assess the safety and efficacy of weekly vinorelbine chemotherapy, each cycle consisting of 30 mg/m(2) for 6 weeks, in patients with previous exposure to chemotherapy. In 63 individuals with relapsed MPM who had not received previous vinorelbine, we observed an objective response rate of 16% and an overall survival of 9.6 months (95% confidence interval 7.3-11.8 months). The main grade III/IV toxicity observed was neutropenia and toxicity was similar to weekly vinorelbine when used in the first-line setting. Weekly vinorelbine appeared to have a reasonable response rate with an acceptable toxicity profile in the second-line treatment of MPM. Its use should be prospectively evaluated in a randomised trial in the first or second-line therapy of MPM.

Efficacy and safety of first- or second-line irinotecan, cisplatin, and mitomycin in mesothelioma

Malignant pleural mesothelioma (MPM) is a rapidly progressive lethal tumor. Treatment options remain limited and the outcome in recurrent disease is poor.

Post mortem technique handbook

Foreword to the 1st edition Foreword to the 2nd edition Preface to the 1st edition Preface to the 2nd edition 1. Before the post mortem 2. General inspection and initial stages of evisceration 3. Evisceration techniques 4. Block dissection 5. Organ dissection - cardiovascular system 6. Organ dissection - respiratory system 7. Organ dissection - gastrointestinal system 8. Organ dissection - genitourinary system 10. Organ dissection - haematopoietic and lymphoreticular systems 11. Organ dissection - musculoskeletal system 12. Organ dissection - nervous System 13. After dissection 14. Fetal, perinatal and infant autopsies Bibliography and websites Appendix 1 List of cases to refer to Coroner Appendix 2 Weights and measures table Index

Verrucous carcinoma of the renal pelvis : case presentation and review of the literature

Squamous cell carcinoma (SCC) of the renal pelvis is an uncommon tumour that has occasionally been associated with horseshoe kidney. The verrucous form of well-differentiated SCC has not been described previously at this site. We describe such a tumour in a 41-year-old man, who presented with gross haematuria and recurrent pyelonephritis caused by staghorn calculi within a horseshoe kidney. Histology showed extensive keratinising squamous metaplasia of the pelvic urothelium with an area of verrucous acanthosis and underlying invasion of the pelvic smooth muscle by broad tongues of squamous epithelium without atypia. Local lymph nodes were not involved by tumour. Immunohistochemistry and polymerase chain reaction revealed no evidence of human papillomavirus infection. The literature regarding verrucous carcinoma of the urothelial tract is reviewed.

Phase II trial of irinotecan, cisplatin and mitomycin for relapsed small cell lung cancer.

There is no standard therapy for relapsed small cell lung cancer (rSCLC). We evaluated the efficacy and toxicity of a new triplet consisting of irinotecan (100 mg/m2 Days 1 and 15 q28), cisplatin (40 mg/m2 Days 1 and 15 q28) and mitomycin (6 mg/m2 d1 q28) administered to a maximum of 6 cycles in individuals with rSCLC that had relapsed following first line treatment. Partial remisions were observed in 35% and progression in 30% of patients. Progression free survival measured 4.5 months (95% CI 0.8–8.2) and overall survival was 7.8 months (95% CI 5.3–10.3). QoL showed improvement in activity symptoms and stabilization of physical symptoms. As IPM was a well‐tolerated regimen with activity in rSCLC, a phase III trial comparing this triplet with other regimens in this setting is warranted.

Organ dissection — cardiovascular system

The routine removal of the heart and the examination of the major arteries and veins has already been described in the evisceration and block dissection chapters. This chapter starts by detailing the routine dissection of the heart, including the coronary arteries, and includes both techniques that are in common usage. It then details the special techniques that need to be employed during the dissection of the heart in a variety of special circumstances that may be encountered. This is followed by a description of other special techniques that may be necessary in the examination of the cardiovascular system. Although it is obviously impossible to include every possible situation, this chapter does deal with the vast majority of situations that are likely to be encountered by a non-specialised pathologist.

Intraabdominal desmoplastic small cell tumor mimicking adenocarcinoma : A case report

BACKGROUND Fine needle aspirates and washings from intraabdominal desmoplastic small cell tumors (IADSCTs) are rarely encountered by pathologists. Immunocytochemical examination of histologic material is usually necessary for a definitive diagnosis. CASE A 23-year-old man presented with abdominal pain, ascites and bilateral pleural effusion. Examination of ascitic fluid suggested adenocarcinoma, but histologic and immunocytochemical examination of surgically resected tissue showed features of an IADSCT. CONCLUSION This case is a reminder that IADSCT should be included in the differential diagnosis of intraabdominal neoplasms and that its diagnosis in cytologic preparations requires a high index of suspicion. In particular, this case appears to be the first reported example of IADSCT mimicking adenocarcinoma.

Prolymphocyte transformation of chronic lymphocytic leukaemia manifesting as a cerebellar lymphoma

A 75-year-old woman presented with symptoms related to a space occupying lesion in the cerebellum which histology showed to be a malignant lymphoma of prolymphocytic type. A diagnosis of chronic lymphocytic leukaemia (CLL) had been made over 1 year before. This form of lymphoma complicating CLL has not been described previously in the nervous system.

Treatment outcomes from a multiethnic lupus cohort with proliferative nephritis

Objective: To assess treatment responses and long-term outcomes in a multiethnic lupus cohort with proliferative lupus nephritis (LN) from a single United Kingdom (UK) center. Methods: 86 lupus patients were diagnosed with active proliferative LN between 1995 and 2015 at Barts Health, a large inner city hospital in London, UK. They were grouped by ethnicity into South Asians (Bangladeshi, Indian, Pakistani, and Sri Lankan), blacks (African Blacks and Afro-Caribbeans), and Caucasians. Remission rates were analyzed at 6 and 24 months after induction treatment with cyclophosphamide (CYC) or mycophenolate mofetil (MMF). Prognostic factors for the treatment response were identified by regression analysis. Kaplan-Meier method was applied to assess long-term renal survival and Cox proportional hazards model for risk factors for developing end-stage renal disease. Results: MMF achieved a higher remission rate in blacks compared to CYC (70% vs. 16.7%, P = 0.005) at 6 months, showed a trend in Asians (77.8% vs. 38.9%, P = 0.057), and comparable response in Caucasians (42.9% vs. 55.6%, P = 0.614). Low baseline serum creatinine was the strongest predictor for favorable treatment response (odds ratio 0.98, 95% confidence interval [95% CI]: 0.97-0.99, P = 0.045). Renal survival glomerular filtration rate (GFR >15 ml/min/1.73 m 2 ) was 79.8% and 75.6% at 5 and 10 years, lowest in blacks (60.5%) followed by Asians (86.7%) then Caucasians (88.9%) ( P = 0.030). Low GFR (GFR 2 ) on presentation was an independent risk factor for poor 10 years renal survival (hazard ratio 32.55, 95% CI: 3.70-286.64, P = 0.002). Conclusions: MMF appears to be at least as effective as CYC as an induction agent in this multiethnic cohort but there were important differences in long-term renal outcomes based on ethnic group and baseline GFR and creatinine.

Concurrent granulomatous polyangiitis and squamous cell carcinoma of the lung: a case of balancing treatment

Granulomatous polyangiitis (GPA) is a rare small-vessel vasculitis characterised by lesions in the upper respiratory tract, lungs and kidneys. Diagnosis of lung lesions can be difficult and misdiagnosis as lung cancer is not uncommon.1 Aggressive, long-term immunosuppression with drugs such as cyclophosphamide is necessary to prevent lung disease and development of end-stage renal failure. We describe a case of a 79-year-old woman with a history of previous breast malignancy who presented with a 6-month …