THE ROLE OF DIAGNOSTIC OESOPHAGO-GASTRODUODENOSCOPY (OGD) AND COLONOSCOPY IN CANCER OF UNKNOWN PRIMARY

Objective: To study the role of gastrointestinal procedures, namely oesophago-gastroduodenoscopy (OGD) and colonoscopy, in helping to establish a definitive primary tumour site in cancer of unknown primary. Study Design: Prospective observational study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore Pakistan, from Jan 2018 to Jan 2019. Methodology: A total of 115 patients included in the study were those, who underwent OGD and a colonoscopy for the diagnosis of a cancer of unknown primary. Data collected included demographics, baseline clinical characteristics, definitive diagnosis, tissue diagnosis and immune-histochemical stains. Primary outcome was the attainment of a definitive diagnosis via OGD and/or colonoscopy. Results: A total of 115 patients underwent a diagnostic gastrointestinal procedure. Of these 70 (61%) were males. Mean age was 63 ± 12.6 years (range 22-88 years). Abdominal pain comprised the most common presenting complaint, found in 61 (53%). The most common tissue diagnosis of the metastatic sites was adenocarcinoma 81 (70.45%). Tumour markers including carcinoembryonic antigen, alpha-fetoprotein and carbohydrate antigen 19-9 were checked in 90 (78.2%), 46 (40%) and 69 (60%) patients respectively. No patient reached a definitive diagnosis by means of OGD and/or colonoscopy. Conclusion: OGD and colonoscopy when done collectively as diagnostic procedures to look for a primary tumour, have no value in the evaluation of patients with cancer of unknown primary.

Torsion of ovarian mass-A diagnostic dilemma to tissue diagnosis

A holistic and multidisciplinary approach is required for ovarian cancer diagnosis and management. Ovarian tumor diagnosis is based on clinical symptomatology followed by radiological confirmation. Tumor markers are considered just adjunct. Management of ovarian mass is surgical and intra -op frozen section aids in understanding the nature of the mass but histopathology is definitive. Ovarian torsion affects 2.5 to 7.4% of all ovarian tumors. The present case will highlight the destructive changes brought about by torsion which could ultimately result in missed tissue diagnosis.

Curative lobectomy without a preoperative tissue diagnosis in a tuberculosis endemic country: A case report and discussion

Curative surgery for a localized tumour at the early and pre-symptomatic stage is the main aim of lung nodule assessment. As part of the process, pre-operative tissue diagnosis is a key step in making appropriate clinical decisions and avoiding unnecessary invasive surgical intervention which is associated with high morbidity. In this case report, we describe a patient who had a curative lobectomy for a growing nodule without a preoperative tissue diagnosis although the initial discussion deemed it mandatory, and we dissected the arguments supporting it in the setting of a tuberculosis endemic country.

1068 Cranial Fasciitis of the Temporal Bone

We present the case of a child with a rare benign tumour of the temporal bone. A nine-month-old girl was referred to her local paediatric hospital with a painless right-sided, post-auricular swelling increasing in size in the preceding two months. On examination there was a 2x2cm mass overlying the temporal bone posterior to the right ear. The mass was firm, immobile, non-tender and well circumscribed. Ultrasound demonstrated a 1.9cm subcuticular mass with evidence of intracranial extension through the suture. Vascular flow and hyperechoic foci were demonstrated within the lesion. The local paediatric team requested magnetic resonance imaging (MRI) and computed tomography (CT) of temporal bone prior to referral to tertiary care centre. Imaging displayed a 2cm expansile lesion of the temporal bone with cortical loss and effacement of underlying dural venous sinus. The patient proceeded to incisional biopsy for tissue diagnosis which was suggestive of cranial fasciitis. Following discussion at the regional multidisciplinary meeting, she underwent surgical excision of the tumour in a joint Neurosurgery/Otology case. The tumour was fully resected macroscopically, with the normal surrounding bone and mastoid air cells preserved. Final histopathology showed a highly cellular lesion composed of spindle cells arranged in fascicles, with areas of myxoid background and confirmed the tumour to be cranial fasciitis. The child has made a good recovery and will be kept under close clinical follow-up. This case demonstrates a rare benign tumour of the temporal bone that may present to an otolaryngologist and the importance of tissue diagnosis, imaging and multidisciplinary management.