Computed tomography (CT) versus magnetic resonance imaging (MRI) "shades of grey"

Drawing created and kindly provided by @instant.oncology: Wang, L., 2020. Login • Instagram. [online] Instagram.com. Available at: <https://www.instagram.com/p/B-d8KlUAhCP/> [Accessed 30 October 2020].

∝: proportional to; DWI: diffusion-weighted imaging; STIR: short-T1 inversion recovery; Rx: x-rays; Z: atomic number or proton number.

"CT (...) uses kilovoltage x-rays, which interact with matter via photoelectric interactions, and are attenuated depending on the Z-number of the material. (...). Metalwork (such as hip prostheses or dental implants) can also lead to substantial artifacts because they attenuate the x-rays so much that a surrounding “shadow” is created. (...).

MRI (...) does not involve radiation exposure, but (...) [is] also highly prone to artifact by metal implants, even more so than CT. Artifacts tend to affect only CT axial slices containing the implant; but with MRI the distortion can extend to several slices above and below the implant. (...)."

Bibliographic reference: Wang, L., 2020. Login • Instagram. [online] Instagram.com. Available at: <https://www.instagram.com/p/B-d8KlUAhCP/> [Accessed 30 October 2020].

Cutaneous areas at risk for non-melanoma skin cancer

The National Comprehensive Cancer Network (NCCN) guidelines (squamous cell carcinoma [1] and basal cell carcinoma [2]) classify high-risk lesions by size and location, as follows:

• 2 cm or more in diameter in low-risk locations (areas L):
• trunk and extremities, but not including the pretibia, hands, feet, ankles, and nail units.
• 1 cm or more in diameter in moderate-risk locations (area M):
• cheeks, forehead, scalp, neck, and pretibia.
• The area H, independent of size:
• The "mask area" of the face:
• Central face, eyelids, eyebrows, periorbital, nose, lips (cutaneous and vermillion), chin, mandible, preauricular and postauricular skin/sulci, temple, and ear.
• Genitalia, hands, and feet.

Head and neck H and M areas:

Source: [3]

Source: [4]

Body H, M, and L areas [3]:

Bibliographic references:

[1] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), Squamous Cell Skin Cancer, Version 2.2020 - July 14, 2020 [Internet]. Nccn.org. 2020 [cited 12 October 2020]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf.

[2] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), Basal Cell Skin Cancer, Version 1.2020 - October 24, 2020 [Internet]. Nccn.org. 2020 [cited 12 October 2020]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf.

[3] Blechman et al. Application of Mohs micrographic surgery appropriate-use criteria to skin cancers at a university health system. J Am Acad Dermatol. 2014 Jul;71(1):29-35. Available at: https://doi.org/10.1016/j.jaad.2014.02.025.

[4] Dębski T, et al. Basal cell carcinoma. Current views (Part II). Diagnostics and treatment. Borgis - Postępy Nauk Medycznych 2009;9:706-13 [cited 12 October 2020]. Available at: http://ksiaznica.home.pl/pnm/spnm.php?ktory=518.

Castleman disease

It «is a rare disease of lymph nodes and related tissues. It was first described by Dr. Benjamin Castleman in the 1950s. It is also known as Castleman’s disease, giant lymph node hyperplasia, and angiofollicular lymph node hyperplasia (AFH). Castleman disease is not cancer. Instead, it is called a lymphoproliferative disorder. This means there is an abnormal overgrowth of cells of the lymph system that is similar in many ways to lymphomas (cancers of lymph nodes).

Even though Castleman disease is not officially cancer, one form of this disease (known as multicentric Castleman disease) acts very much like lymphoma. In fact, many people with this disease eventually develop lymphomas. And like lymphoma, Castleman disease is often treated with chemotherapy or radiation therapy.»

«Castleman disease is classified by how much of the body it affects. The main forms of Castleman disease are called localized and multicentric.»

«Infection with certain viruses plays a role in at least some cases of Castleman disease.

Multicentric Castleman disease is more common in people infected with HIV (human immunodeficiency virus), (...). Doctors sometimes group patients with multicentric Castleman disease into those who are infected with HIV (HIV positive) and those who are not infected (HIV negative).

In recent years, it’s become clear that another virus, known as human herpesvirus-8 (HHV-8) or Kaposi sarcoma herpesvirus (KSHV), is often found in the lymph node cells of people with multicentric Castleman disease. In fact, HHV-8 is found in the lymph nodes of nearly all Castleman disease patients who are HIV positive. Some doctors have suggested classifying Castleman disease based on whether the cells contain HHV-8.»

Bibliographic reference: The American Cancer Society medical and editorial content team, 2018. What Is Castleman Disease? [online] Cancer.org. Available at: <https://www.cancer.org/cancer/castleman-disease/about/what-is-castleman-disease.html> [Accessed 4 October 2020].

FoundationOne® Heme test

It «is a comprehensive genomic profiling test combining DNA (deoxyribonucleic acid) sequencing of 406 genes and RNA (ribonucleic acid) sequencing of 265 genes for patients with hematologic malignancies, sarcomas or solid tumors where RNA sequencing is desired [1].» It «detects known, novel, and complex fusion events as well as other common genomic alterations [2]» «(base substitutions, insertion and deletions [indels], [...] copy number alterations [CNAs] [3], and copy number variations [CNVs]) (...) to identify potential targeted therapy options, detect alterations in prognostic genes, and sub-classify sarcoma diagnoses [2].» It identifies «somatic genomic alterations in genes known to be unambiguous drivers of hematologic malignancies (...) and sarcomas [3].» It «is validated to detect the four main classes of genomic alterations in more than 400 cancer-related genes [4].»

Bibliographic references:

[1] Foundation Medicine. 2020. Foundationone Heme. [online] Available at: <https://corpsite.foundationmedicine.com/genomic-testing/foundation-one-heme> [Accessed 4 October 2020].

[2] Foundationmedicine.com. 2020. Foundationone Heme | Foundation Medicine. [online] Available at: <https://www.foundationmedicine.com/test/foundationone-heme> [Accessed 4 October 2020].

[3] Foundationmedicineasia.com. 2017. Foundationone®Heme - Technical Information. [online] Available at: <https://www.foundationmedicineasia.com/content/dam/rfm/apac_v2-en/FoundationOne_Heme_Technical_Information.pdf> [Accessed 4 October 2020].

[4] Foundation Medicine. 2020. Foundation Medicine. [online] Available at: <https://www.foundationmedicine.ca/foundationOneHeme.aspx> [Accessed 4 October 2020].