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Lung cancer is the most common malignancy in Hong Kong, with more than 4,000 new cases every year (source: Hong Kong Cancer Registry, Hospital Authority).
Endoscopic ultrasound (EUS) is a flexible endoscope coupled with a small ultrasound device at its tip. To assess the diagnostic yield and complication rate of EUS for various suspicious lesions in the chest, 125 patients with abnormal shadows on chest X-ray were recruited from 1998 to 2007 by the Faculty of Medicine at The Chinese University of Hong Kong (CUHK). Prince of Wales Hospital, the teaching hospital of CUHK, was the first centre that introduced this novel investigation in Hong Kong, and it is now one of the leading EUS centres in Asia.
Singapore General Hospital (SGH) is Singapore's flagship hospital offering comprehensive range of medical specialties and services for our patients spanning over two centuries. Hepatitis B is the most common strain here and can cause liver cancer.  One in 35 adults here is a hepatitis B carrier.
More than 90 per cent of hepatitis B cases are transmitted from mother to child during birth, said Dr Tan Hui Hui, consultant at Singapore General Hospital  gastroenterology and hepatology department.
Many people are unaware that they are carriers and find out only when they have a blood test done, she added. However, if they do not find out about their condition and if the virus remains in the body for more than six months, the condition becomes chronic. Carriers can unknowingly infect others through blood and body fluids, such as during sexual contact. However, most people who are infected in adulthood are able to fight off the disease without any help within months. On the contrary, the majority of children who contract the virus through birth will not be able to fight off the infection and will carry the virus for life. The hepatitis A and E viruses cause acute infection but are seldom fatal and infected people usually build immunity against any subsequent attacks. There is no specific treatment for these acute infections and the diseases have to run their course, which can last up to six months. A vaccine is available for hepatitis A, one has been developed for hepatitis E but it is not commercially available yet.
Often associated with shared needle use, unchecked blood transfusions and non-sterile medical procedures, it is the leading cause of liver disease in countries such as the United States and China.
Hepatitis D and G, both transmitted through blood, are not usually found here and hepatitis F has been delisted because of insufficient proof that it causes disease.
Hepatitis B, though the most common here, is unfortunately hard to detect in young patients who largely get the disease during birth.
Their immune system tolerates the virus and they do not suffer from liver inflammation like older patients, said Dr Yap Chin Kong, a liver disease specialist at Mount Elizabeth Medical Centre.
However, as the young carriers reach their 20s, their immune system starts fighting the virus and this causes liver inflammation. If the patient's body does not win this fight, prolonged inflammation can occur, leading to liver damage and cirrhosis, said Dr Yap.
Hepatitis B vaccination was introduced in the national immunisation programme in 1987, with children offered the three-course jabs over six months.
These days, babies of mothers found to be carriers of hepatitis B are given immunoglobulins and vaccinations to ward off the infection.
The threat remains for the middle-aged and older folk, who did not have the benefit of early screening and vaccination.
Liver cancer, of which hepatitis B infection is a major cause here, shows no symptoms in the early stages.
Adults at risk C such as those who have family members with hepatitis B, have many sex partners or are immigrants from endemic areas C should get a blood screen. About 95 per cent of people who take the set of three injections will develop an immune response. More than a decade ago, having hepatitis B and liver cancer was the last thing on physical education teacher Yue Keng Siang's (right) mind. More than 90 per cent of hepatitis B cases are transmitted from mother to child during birth. Mr Yue and his eight siblings were asked to test for hepatitis B but he put off his own screening until the following year.
Even when the polyclinic where he did his test summoned him urgently to get his blood test results, he still thought it could not be something that serious. He was then told he had hepatitis B and the liver function test showed high levels of cancer markers. Not only was he fit, he did not have any symptoms of hepatitis B or liver cancer because these tend to show up only in the later stages of the diseases. After further scans confirmed he had early stage liver cancer, he had an operation to remove the tumour that same year. Mr Yue switched to a healthier diet of vegetables and fish and he went for check-ups twice a year. When a second relapse came a year later in 2006, doctors told him that the cancer had spread too much and that he would need a liver transplant to survive.
Throughout those years, Mr Yue did not have any symptoms of the disease except for jaundice in 2007 while waiting for the transplant.
These days, the father of a boy, 14, and a girl, 11, is back to leading an active lifestyle. He is still a physical education teacher at a tertiary institution, teaching swimming and basketball five days a week.
All published work is licensed under a Creative Commons Attribution 4.0 International License. 1Junior Resident, Department of Radiotherapy, RG Kar Medical College and Hospital, Kolkata 700004.
2Assistant Professor, Department of Radiotherapy, RG Kar Medical College and Hospital, Kolkata 700004. 3RMO-cum-Clinical tutor, Department of Radiotherapy, RG Kar Medical College and Hospital, Kolkata 700004. 4Junior Resident, Department of Pathology, RG Kar Medical College and Hospital, Kolkata 700004. 5RMO-cum-Clinical tutor, Department of General Surgery, Calcutta National Medical college and Hospital, Kolkata. 6Professor, Department of Radiotherapy, RG Kar Medical College and Hospital, Kolkata 700004. Breast cancer in males is a rare disease accounting for less than 1% of all cancers in men.
In January 2012, a 68-year-old male presented to emergency department suffering from hoarseness of voice for last three months and progressive respiratory distress with productive cough for last four months, which was associated with profuse foul smelling expectoration.
Contrast enhanced computed tomography of thorax showed widening of mediastinum with a soft tissue mass at superior mediastinum predominantly on the right side encircling the great vessels suggesting mediastinal lymphadenopathy, moderate pericardial effusion, multiple thin walled lucencies representing centrilobular emphysema in left lung upper lobe and right lung upper and middle lobes.
Patient was planned for four cycles of chemotherapy, consisting of cyclophosphamide, epirubicin and 5-fluorouracil. Figure 1: Mass of 5x5 cm, over the central quadrant of left breast, with peau-d’orange changes of overlying skin and no nipple retraction suspecting breast neoplasm of malignant nature. Figure 2: An ulcerated, firm to hard in feeling, tender mass over the scalp 3x3 cm in diameter. Figure 3: (A) A soft tissue density nodular enhancing lesion seen at the left mammary region, (B) Computed tomography scan of thorax (in lung parenchymal window) showing multiple thin walled lucencies representing centrilobular emphysema in left lung upper lobe and right lung upper and middle lobes, (C) Skiagram of chest, Posterior-Anterior view, showing mediastinal widening. The etiology of male breast cancer is unclear, but hormonal levels may play a role in the development of this disease.

Lobular carcinoma in situ is very rare because the male breast lacks terminal lobules, but has been reported in association with invasive lobular carcinoma. The most common presenting symptoms in male breast cancer patients are a painless subareolar lump, nipple retraction, and bleeding from the nipple. In general, the approach to the treatment of metastatic breast cancer is similar in male and female patients with breast cancer.
We report a rare case of scalp metastasis in an elderly male patient with breast cancer who presented with superior vena cava obstruction syndrome.
Mr Anderson graduated from Edinburgh Medical School with a First Class Honours Intercalated BSc in Pharmacology. He trained in General Medicine at Addenbrooke's Hospital in Cambridge, passing his MRCP exam in 2001. College London, Training Programme Director for Geriatrics in South East London and Deputy Head of the London School of Medicine. Lung Institute, and an Honorary Specialist Registrar in Respiratory and General Internal Medicine at St.
Aizpea Zubia and Fernando Cossio are the visible heads of the team from the Faculty of Chemistry of the University of the Basque Country that was awarded the 10th Research Prize granted by the Esteve Foundation. Fernando Cossio: Cancer cells have membrane proteins which provide anchorage to healthy cells. The results of your work suggest that more than 50% of liver metastases were blocked in experimental melanoma (the so-called B16). FC: Mimicking the properties of the active loop of the natural ligand of VCAM-1 was not too complicated. FC: Probably, our key differentiating feature is the synergy between theory and experiment.
Your work has also won an entrepreneurship prize on account of combining university research and enterprise. FC: I think it will, because these two approaches provide a sound distribution of technological risks. Finally, how did your team feel about winning the 10th Research Prize granted by the Esteve Foundation? AZ: Our team was greatly honored to receive this prize, which encourages us to carry on with future works.
FC: Because research is quite a stressing and solitary activity, such an acknowledgement gave us a great boost of confidence to help us through the inevitable hard times of a research process, which is highly uncertain and where negative results are more frequently obtained than positive ones.
Application of stereocontrolled stepwise [3+2] cycloadditions to the preparation of inhibitors of alpha(4) beta(1)-integrin-mediated hepatic melanoma metastasis, published in the German journal Angewandte Chemie on 13 April 2005, is the article that was awarded the 10th Research Prize granted by the Esteve Foundation and endowed with 18,000 Euros. Gastroenterologist inserts this endoscope through the patient?¦s mouth into the oesophagus and stomach. The diagnosis in about half of these patients remained obscure despite conventional investigations. Although hepatitis B is the most prevalent strain in Singapore, other types of the virus can be found here too. This could happen when a person eats tainted shellfish harvested from water that has been contaminated with the viruses. Those who had blood transfusions before screening for hepatitis C was established in the 1990s are at risk and the infection is asymptomatic until liver damage sets in years later. There is no complete cure for those whose bodies cannot fight the hepatitis C virus but antivirals and protein interferons can be used to prevent viral replication.
They are, however, not compulsory by law.The number of hepatitis B cases has been falling since.
Also, people who had blood transfusions before the mid-1980s are at risk because blood screening methods for hepatitis B were not as established then.
His wife was ready to give him part of her liver, but fortunately he was able to get a cadaveric liver transplant in 2007.
He works out at Bukit Timah Nature Reserve once a week with his 49-year-old wife, who is a part-time tutor.
The most common growth patterns are papillary and cribriform, and the majority of these tumors are low grade.
Both the upper arms and neck were swollen with puffiness of face with venous engorgement over right arm and thorax. However after two cycles, the patient condition deteriorated with fall in LVEF to 45% along with appearance of multiple skin nodules. Testicular abnormalities such as undescended testes, congenital inguinal hernia, orchiectomy, orchitis, and infertility have been associated with elevations in breast cancer risk. Cutaneous metastases from internal cancer are relatively uncommon in clinical practice, accounting for 2–4% of metastatic sites, but they are very important to recognize. Given that the vast majority of men have estrogen receptor–positive tumors, hormonal therapy is often the first approach, depending on age, performance status and co-morbidities.
Histologic types and hormone receptors in breast cancer in men: a population-based study in 282 United States men.
An analysis of male and female breast cancer treatment and survival among demographically identical pairs of patients.
2014; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited.
His PhD was in molecular immunogenetics relating to rheumatoid arthritis and Felty's syndrome. Among 45 nominated articles, the development of a family of synthetic molecules able to restrain liver metastases by 50% in experimental melanoma was considered by the international jury as the best pharmacological work published by a Spanish team between 2004 and 2005.
The idea is to design a small molecule that gathers all the geometric and electronic properties of the active part of the healthy cell’s ligand. However, beside being active against the therapeutic target, these medicaments must meet many other requirements, such as administration being preferably by oral route, suitable pharmacokinetic and pharmacodynamic properties, etc. On the one hand, there was an acidic residue which we thought acted as some sort of electrostatic beacon that rapidly attracted integrin. There are optimal, top-level groups of synthetic chemists, and the same applies to computational chemists. Do you think this combination will ensure the survival of university research in the future? While an academic institution may face quite risky synthetic methodologies or designs, a biotech company –much more agile in carrying out projects– may focus all its power on any worthy results. The awards ceremony was held on 11 July 2005 at the Edificio Korta of the Guipuzcoa Campus of the University of the Basque Country.
The choice of treatment relies heavily on accurate staging through tissue sampling of suspicious sites which are often deeply seated. The tip of EUS generates ultrasound wave, which penetrates the wall of the gut and produces visual images of the surrounding internal organs. Using EUS, the causes of abnormal chest X-ray shadows in 83% of the cases were established. Larry Lai, the in-charge endoscopist in EUS service and Honorary Clinical Tutor of the Department of Medicine and Therapeutics, Faculty of Medicine, CUHK. Apart from lung cancers, EUS has been applied in diagnosing cancers in digestive system, as well as other liver and bile duct problems. Exact incidences of cutaneous metastases in male breast cancer patients have not been reported.
Fine-needle aspiration cytology (FNAC) from an ulcerated, firm to hard, 3x3 cm tender scalp mass was suggestive of metastatic adenocarcinoma.

Cutaneous metastases in males, accounting for 3–10%, are from melanoma, kidney, lung, gastrointestinal and oral cavity malignancies. Additional finding included a soft tissue density nodular enhancing lesion seen at the left mammary region. Though the primary lesion and the metastatic scalp lesion were reduced in size, no further treatment was attempted. Benign breast conditions, including history of breast trauma and nipple discharge, have also been reported to increase risk. The cutaneous metastases occasionally manifests as firm, round or oval, mobile, non-painful, solitary or multiple nodules of varying color and size.
Tamoxifen has established efficacy in metastatic male breast cancer, with an approximate 50% response rate, and is considered the preferred first-line approach.
Its merit: designing inhibitors that trick cancer cells by imitating the protein properties that allow these cells to invade healthy tissue.
These small molecules are introduced at the protein’s binding site used by the cancer cell for metastasis and prevent their anchorage.
All this is pending and we’ll have to see if each and every condition required to reach the market is overcome. We also thought that introducing this electrostatic beacon into a relatively rigid hydrophobic environment would offer good opportunities for having a reasonably powerful inhibitor of the interaction.
Like I said, there were top-level synthesis groups and top-level computational groups, but very few mixed the two approaches.
It was Professor Vidal Vanaclocha who had developed a metastasis model involving VLA-4 VCAM-1 interaction and who stated the biological nature of the problem. I think that this distribution of novelty, technological risk and transition effectiveness offers the best of both worlds.
Traditionally, clinicians use computer tomography (CT) scan, bronchoscopy, or even operation under general anaesthesia to evaluate the extent of cancer invasion. Approximately 90% of male breast cancers express the estrogen receptor, and 81% express the progesterone receptor. The exact incidence of cutaneous metastases in male breast cancer patients has not been reported. Gynecomastia, a common phenomenon in elderly healthy males, has been reported in association with breast cancer. Luteinizing hormone–releasing hormone agonists, with or without antiandrogens, have also been reported to be effective in male breast cancer.
In this case, the advantage is that both the integrin structure and that of its ligand are known, which provides far greater precision to our work.
On the other hand, we were then conducting a very intensive cycloaddition program to obtain 5-link rings. We were also lucky to work with a biotech company, Dominion Pharmakine, which co-funded a good part of the project and also performed biological experiments. However, because universities are just beginning to develop these approaches, the coupling processes of these two types of institutions are not always easy. Moreover, EUS can safely sample abnormal lymph nodes and lung tissues through the esophagus without the need of general anaesthesia or open surgery. After two cycles of FEC (fluorouracil (5FU), epirubicin and cyclophosphamide) chemotherapy, the patient condition deteriorated with fall in left ventricular ejection fraction (LVEF) to 45% and appearance of multiple skin nodules.
His condition was stable, with eastern cooperative oncology group (ECOG) status of 4, pericardial effusion was treated with closed balloon pericardiotomy and was on 24 hours morphine analgesics. Other specific patterns include carcinoma erysipeloides (sharply demarcated red patch due to local spread of primary cancer blocking lymphatic blood vessels in adjacent skin), en cuirasse or sclerodermoid carcinoma (indurated fibrous scar-like plaques due to cancer cells infiltrating collagen in the skin) and carcinoma telangiectodes (red patches with numerous blood vessels (telangiectasia) or lymphatic vessels (lymphangioma-like).
For male patients with hormone-refractory disease or rapidly progressing visceral metastases, chemotherapy can provide significant palliation.
In former research, conversely, knowing only the ligand’s structure made it all more complicated technically. These rings are very well balanced in terms of flexibility and rigidity –they are neither too flexible nor too rigid– and thus provide good frameworks where suitable, interesting groups may be hanged. In fact, before performing the cycloaddition reactions included in our study, we had previously studied the reaction, the transition states and the mechanism, and we already knew that only one product had to be formed. But I believe that this is the path to the future as far as innovating, high-risk projects are concerned. Though the primary and metastatic scalp lesions were reduced in size, no further treatment was attempted. We report here a rare case of scalp metastasis in an TNBC elderly male patient presenting with SVCO. Men with a family history of breast cancer in a female relative have 2.5 times the odds of developing breast cancer. Tumors on the scalp, although most commonly non-melanoma skin cancers, may be a sign of an internal malignancy. Generally, a similar approach is used for chemotherapy in metastatic male breast cancer as in female breast cancer.
He was put on best supportive care and at the time of last follow up in June, 2012, was stable, eastern cooperative oncology group (ECOG) status 3, pericardial effusion was treated with closed balloon pericardiotomy and was on 24 hours schedule of oral morphine analgesics.
Other risk factors are exposure to chest wall radiation, such as in patients previously treated with mantle radiation for Hodgkin’s disease, alcohol use, liver disease, obesity, electromagnetic field radiation, and diet. One study reported cutaneous metastasis to be the third most common cause of a malignancy on the scalp following basal cell carcinoma and squamous cell carcinoma.
Roughly, our differentiating feature is that, before initiating experimentation, we acquire in-depth knowledge of the reactions we intend to develop and of the novelties we wish to add in order to know whether they will or will not work.
Additional clinical finding included an ulcerated, firm to hard in feeling, tender mass over the scalp 3x3 cm in diameter.
Echocardiography showed borderline 62% left ventricular ejection fraction (LVEF) with pericardial effusion, anteriorily 9 mm and posteriorily 28 mm. Mutations in BRCA1 and BRCA2 also increase the risk of affected men developing breast cancer, although not to the same absolute risk as in women. Spread to the scalp is thought to occur through the valveless vertebral venous system and may possibly localize to the scalp due to the vascularity of this region. As our patient is both estrogen receptor and progesterone receptor negative so no cope of hormone therapy could be initiated.
The reported rates of androgen-receptor expression have ranged from 34–95%, but this receptor has not been associated with breast cancer prognosis.
The most common primary sites of scalp metastases in males are kidney, colon, lungs and stomach.
Due to co-morbidities and poor performance status palliative treatment could not be completed and patient was put on best supportive care.
There was no family history of breast cancer or other tumors; neither was there any sign of exposure to epidemiologic risk factors.
In this regard this patient is suffering from rare variant invasive ductal carcinoma of breast: triple-negative breast cancer.
The incidences of cutaneous metastases are not available even after extensive research of literature.

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