Huge Inflammatory Myofibroblastic Tumor in Teenager

Huge Inflammatory Myofibroblastic Tumor in Teenager Abstract Background: Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm. The huge IMT of chest is even rarely observed and there is few literatures described the disease. Case presentation: A 17-year-old girl who suffered from a dry cough with right chest pain. Contrast-enhanced CT showed a huge heterogeneous mass with calcified plaques. A surgical management strategy was successfully undertaken. Increasing physician awareness of this entity should facilitate recognition of its clinical characteristics and laboratory findings. Conclusions: This case suggests that a rarely huge and surgically treated IMT in a teenager and concerned with the radioclinical, histopathological, therapeutic aspects of this disease. Keywords Inflammatory myofibroblastic tumor, Lung, Surgery Background Inflammatory myofibroblastic tumor (IMT) is a rare benign tumor that often affects children. It has been first described by Brunn in 1939 [1] and it accounts for 0.71% of all lung tumors. [2, 3]. The origin of the IMT is unknown, but recent studies have shown that it is a true tumor rather than a reaction process [4]. Different terms used to describe IMT include inflammatory pseudotumor, cellular inflammatory pseudotumor, plasma cell granuloma and inflammatory fibrosarcoma. This lesion consists of inflammatory cells and myofibroblastic spindle cells [5, 6]. We report a case with a rarely huge and surgically treated IMT in a teenager and concerned with the radioclinical, histopathological, therapeutic aspects of this disease. Case presentation A 17-year-old girl was referred to our hospital with a 15 days history of right chest and cough without sputum. She denied the following symptoms including the presence ofhoarseness, hemoptysis, anddyspnea. Her medical history and family history were uneventful. Physical examination revealed normal breath sounds in both of the lung fields. The results of laboratory examinations, including arterial blood gases, hematology tests and biochemistry tests, were within normal limits. Her Pulmonary function tests and cardiovascular examination revealed normal performance. Contrast-enhanced chest computed tomography (CT) showed an 18Ãâ€"16Ãâ€"15 cm heterogeneous mass with calcified plaques invading the entire right hemithorax and mediastinal shift to the left (Fig 1A, 1B). However, the patient refused to have the bronchoscopic examination and fine-needle biopsy of the mass. As diagnosis was not established through imaging, surgery was scheduled. Under general anesthesia with selective intub ation, a huge mass (measuring 20Ãâ€"17Ãâ€"17 cm and weighing 2010g) with inferior vena cava and right pericardium invasion was found and the right middle and lower lobes bronchus appeared encased by the mass. At last, the neoplasm was completely excised. The patient underwent a right middle and lower lobectomy, inferior vena cava angioplasty and partial resection of pericardium. Mediastinal lymph node dissection was also accomplished. The feeding vessels of the mass were ligated and the mass was removed without tumor spillage or capsular injury. After that, reexpansion of the right upper lobe was observed and a chest tube was placed to drain the pleural cavity. A postoperative roentgenogram of the chest showed that the mediastinum had returned to its normal position and the right lung was well expanded. Microscopic examination revealed a proliferation of regular spindle cells arrayed in fascicles, admixed with lymphocytes, plasma cells and eosinophils. Additional immunohistochemis try with anaplastic lymphoma kinase (ALK)-1 and smooth muscle actin (SMA) revealed positive and the translocation of the ALK gene was found by fluorescence in situ hybridisation (FISH). The results for desmin, S-100, CD99, CD34, Myogenin, EMA and pankeratin were negative. Ki-67 proliferative activity was 8%. Based on these data, the diagnosis of inflammatory myofibroblastic tumor was retained. Histologic diagnosis showed a negative bronchial margin and lymph nodes free of malignancy. The patient made an uneventful postoperative recovery and was followed up for two months without evidence of recurrence to date. Conclusions Inflammatory myofibroblastic tumor (IMT) is a rare massforming lesion characterized by fibroblastic or myofibroblastic spindle cell proliferation with varying degrees of inflammatory cell infiltration. The World Health Organization (WHO) classified IMT as a distinct entity in 1994 [7]. However, the huge inflammatory myofibroblastic tumor of chest is even rarely observed and there is few literatures described the disease (Table). The cause of IMT tumors is unclear, but an immunological response to an infectious agent or noninfectious agent remains possible [8]. Whereas some reporters demonstrated that IMT tumors are true neoplasms and some believe the IMT tumors to be a low-grade sarcoma with inflammatory cells as it has a potential for local recurrence, infiltration, multicentricity, and rarely metastases [9]. Also, ALK positivity is detected in 36% to 60% of cases and the presence of chromosomal aberrations in these tumors suggests that IMT is a neoplastic proliferation of clonal or igin [10]. In our case, there was no evidence of infection or inflammatory response and no history of trauma in her chest. The tumor was single and circumscribed, and movable. The IMT affects both sexes, at any ages, with a slight predominance in children and young adults [4, 11]. Most patients are asymptomatic and the tumor is discovered incidentally on a chest X-ray performed for another reason [4, 11].From the table, all of the four patients were young adults and were referred to the hospital with a common symptom of cough. In our patient, the tumor was discovered at an early age and the only symptoms were dry cough and right chest pain. Radiological aspects are capricious. Chest radiographs are the most generally performed imaging study to evaluate the neoplasm. Most patients have a mass or a pulmonary nodule, generally measuring 1 to 6 cm in diameter [12]. On CT scans, these tumors shows typically heterogenous attenuating enhancement [6]. Sometimes the tumor can extend towards the hilum, mediastinum, pleura or diaphragm [1, 3]. As recorded in the table, all the sizes of masses were huge and two of them were observed the invasion of the mediastinal or the chest wall. There is also a word of caution in our case that the representative calcifications were observed in the centure of heterogeneous mass and it invaded the inferior vena cava and right pericardium. Microscopically the IMT tumor consists of spindle shaped cells that are mixed with a chronic inflammatory component that consists of plasma cells, lymphocytes, and occasional histiocytes. Immunohistochemistry for ALK discovered cytogenetic abnormalities on chromosome 2p23 is relatively specific for IMF tumor among the spectrum of fibroblastic-myofibroblastic tumors and other potential mesenchymal mimics of IMF tumor [13]. The recent WHO classification of soft tissue tumors recognizes 3 basic variants of IMT: (1) loosely organized myofibroblasts in an edematous myxoid background with plasma cells, lymphocytes, eosinophils, and blood vessels, resembling nodular fasciitis; (2) dense aggregates of spindle cells arrayed in a variable myxoid and collagenized background and admixed with a distinctive inflammatory infiltrate, diffuse clusters of plasma cells, and lymphoid nodules, resembling fibrous histiocytoma or fibromatosis; and (3) collagen sheets with scattered plasma cells and eosinop hils resembling a scar or desmoid tumor [14]. The differential diagnosis of IMT is follicular dendritic cell tumor and inflammatory pseudotumor. Follicular dendritic cell sarcoma (FDCS), which was first reported by Monda et al. in 1986, is a rare neoplastic proliferation that exhibits the morphological and immunophenotypic features of FDCS that are among the accessory cells of the lymphoid system. The tumor cells exhibited positive immunohistochemical staining for vimentin, CD21 and CD35 as well as negative staining for ALK-1 and SMA. Inflammatory pseudotumors are benign tumors commonly found in the lung and they are characterized by proliferation of spindle cells (fibroblasts and myoblasts), with variable numbers of mitoses, and inflammatory cells infiltration, particularly plasma cells. More recently, the presence of anaplastic lymphoma kinase (ALK 1) staining in some cases has been postulated to be of value in the confirmation of IMT and in its distinction from other entities. A series of studies found the translocation of th e ALK gene by fluorescence in situ hybridisation (FISH) in IMT (16). In our case, the mass was spindle cell lesion with severe atypism and some mitosis. As shown in Fig 2 (A, B, C), ganglion-like cells were present and the immunohistochemistry result for ALK-1 shows strong positivity of tumor cytoplasm and translocation of the ALK gene. Based on these findings, her tumor may be very aggressive. Despite IMT is a benign tumor, it is considered by some authors as a low grade tumor because of malignant features such as local invasiveness, recurrence or malignant transformation. Complete surgical resection is the appropriate treatment for IMT. Cerfolio and colleagues reported an excellent prognosis in patients undergoing complete resection of pulmonary IMT, with a 5-year survival rate of 91.3%. However, a 60% recurrence rate in those receiving incomplete resection has been reported in the same study [15]. Corticosteroid monotherapy may result in rapid resolution of the disease and sustained remission (17, 18). Non-steroidal anti-inflammatory agents (NSAIDs) as solitary therapy may be extremely efficacious and anecdotal response to chemotherapy has also been reported (19). As the literature reviewed in the table, three patients had the operations by a standard posterolateral thoracotomy. Among them, two patients had the lobectomy and the other had the complete resection with two through fourth ribs. The patient whose neoplasm invaded superior vena cava, heart atrium and right pulmonary vein underwent chemotherapy with bleomicin, etoposide and cisplatin. After two cycles of chemotherapy, the tumorslightly reduced in size and the patient only survived for 12 months. In summary, inflammatory myofibroblastic tumor is a rare benign tumor. Because of its local invasiveness and its tendency to recur, IMT tumor can be confused with malignant lesions. Because the treatment of IMT tumor is conservative surgery, preoperative recognition is important to avoid radiation therapy, and intensive multi-agent chemotherapy that would be appropriate treatments for soft tissue sarcomas. Clinical and radiological presentation is variable and nonspecific and the diagnosis is rarely made before chirurgical management. Also, because the tumor with cellular atypia, ganglion-like cells, ALK and SMA reactivity has a more aggressive clinical behavior, a careful follow-up is required. Figure legend Figure 1: CT features of the case. A and B: Contrast-enhanced CT showed a huge heterogeneous mass with calcified plaques. Figure 2: Histological and immunoistochemical features. A: Hematoxylin-eosin staining demonstrating spindle cells sprinkled, with a predominance of plasma cells and lymphocytes. (X400) B: Immunohistochemical staining showing strong reactivity for anaplastic lymphoma kinase (ALK)-1(X400) C: Immunohistochemical staining showing strong reactivity for smooth muscle actin (SMA) (X400) 1

Childrens Comprehension of Television Messages Essay -- Children Tele

Children's Comprehension of Television Messages The literature surveyed so far regarding children's attention to television has relied on observation of visual attention by the child viewers. Measures of visual attention alone do not provide an indication of what aspects of the message children are extracting from the television screen. In order to acquire indications of this, researchers have relied on post-viewing measures of children's recognition and recall of information from the program. This research will be considered in this section on children's understanding of television messages. Here the concern is not with what children are looking at and listening to, but what they remember from the TV and what meaning the TV content has for them. Much of the research which has adopted a cognitive developmental perspective on studies of children and television has examined children's comprehension of television messages. The underlying assumption of these studies is that children bring different cognitive abilities and social experiences to the TV-viewing situation and that these influence how children made sense of the messages. Younger children with more limited inference-making ability are more likely to focus on the consequences of actions rather than the motivations of the actors, and often are shown to construe the television plot line quite differently from children and adults. The way in which children construe meaning from television cannot be directly inferred from cognitive development theory. Cognitive development theory may aid us in describing how children make sense of television, but we should examine children's understanding of television directly. How, then, has cognitive development the... ...hat appropriate learning materials will be developed to teach children about the medium of television, both its programming and advertising content. Such materials should help children overcome their misunderstandings of television messages. By improving the skills children bring to the viewing situation we may be able to moderate the impact television has on the child. NOTES The argument advanced here does not mean to imply, however, that children are as active when watching television as they are when engaged in athletics or doing other sorts of activities. Activity here is relative. Multidimensional scaling is a statistical technique that looks at how subject's ratings of a variety of variables group together; that is, it seeks to determine underlying dimensions which describe the relationship among a set of variables for a given group of subjects.

Energy Drinks: Liquid Meth? Essay

Over the last decade, drinks containing high amounts of caffeine, sugar, and other ingredients that increase energy have been rapidly growing in popularity. Clearly these beverages are known as energy drinks. Energy drinks have gotten so popular that it is extremely rare to find a convenience store that doesn’t sell a variety of them. Students use energy drinks to cram the night before a test, athletes use them to exercise, party animals mix them with alcohol to drink more than humanly possible, and some people just drink them to stay awake at work after a sleepless night. Red Bull, one of the most popular energy drinks in the market, claim to enhance productivity, concentration, energy and help handle stressful situations. It seemed these beverages were a godsend to overworked employees and sleep-deprived college students. But after a few deaths were linked to the drink, controversy arose. Apparently Red Bull gives you wings, but what other side-effects can these sugary, over-caffeinated drinks cause? Many people have been asking this question lately, wondering how harmful drinking them really is. Despite that consuming a large amount of the drink may be dangerous, as long as people drink energy drinks responsibly they are relatively safe. Energy drinks have a lot in common with other popular drinks. All these drinks contain high amounts of sugar and caffeine. These drinks are consumed daily by millions of people, despite the caffeine and sugar content in the drinks. Many Americans have made a habit of getting together with friends or old acquaintances to drink coffee and catch up. The increasing number coffee shops prove that most Americans don’t have a problem with the distribution of coffee. In addition, sodas which also contain high amounts of sugar and caffeine are widely accepted. Some would even consider a person who throws a party without coke just cruel. Despite the similarities between energy drinks and these other beverages (coffee, soda) they are put two different categories. According to the people who oppose energy drinks the most dangerous ingredient in them is the high amount of caffeine. A 16-ounce cup of Starbucks coffee contains about 330 milligrams of caffeine, the same size can of Coca-Cola has 45. 3 mg, and a 16oz Red Bull has 154mg (Meier). According to the Food and Drug Administration or F. D. A. a person can safely consume 400 mg of caffeine a day, even though some experts argue that 600 mg of caffeine won’t cause any adverse side effects (Meier). Either way all these drinks are safe as long as they aren’t abused. Basically, people drinking coffee in glass houses shouldn’t throw stones. Most warning labels on energy drinks recommend that children, pregnant or nursing women, and persons sensitive to caffeine stay away from the drink. For obvious reasons certain groups of people should stay away from overly-caffeinated beverages but what kind of negative effects can they have on normal adults? From 2007 to 2010 visits to emergency rooms of people who drank high amounts of energy drinks have doubled from 10,000 to 20,700 (Anderson). Some of the negative side-effects people in the E. R. reported experiencing are insomnia, anxiety, irritability, headaches, irregular heart rhythms, and muscle twitching (Liberatore). In addition, people with a heart condition could face more severe consequences like a heart attack. Since it’s hard to prove that energy drink were the exact cause of the heart attack, there aren’t that many documented cases of people dying from heart attacks solely because of energy drinks. However, common sense dictates that any substance that stresses the heart can lead to health problems. Strangely enough, most deaths related to energy drinks aren’t from heart attacks but of alcohol poisoning. Because energy drinks cause alertness many alcohol consumers mistake being alert and awake for being sober. This causes the user to continue drinking past safe limits. The FDA informed Americans how dangerous the mixture of the two was while they banned Four Loko (mixture of alcohol with an energy drink) and Joose (Benac). Despite all the controversy, most people can agree how useful a jolt of extra energy can be some days. Energy drinks can help a doctor be more alert during surgery during a graveyard-shift, help college students get that â€Å"A† they have been working towards all semester, or keep police officers vigilant and energized on the job. There’s no way of knowing exactly how many college students that graduated owe their diploma to caffeine, but it sure didn’t hurt to be able to pull all-nighters while being alert. People that enjoy exercise can lift-weights or do cardio way more effectively by drinking one before the work-out. Energy drinks are not only safe but they are making people more effective workers, students, or athletes. Besides the obvious and immediate effects of drinks containing high amounts of caffeine there are a few long-term benefits worth mentioning. Depression is a horrible condition that slowly eats away at a person until there is nothing left of them. Coffee has been shown to fight depression (â€Å"Does Caffeine Reduce the Risk of Depression? ). By drinking a few cups of coffee or one can of an energy drink chances of depression decrease (â€Å"Does Caffeine Reduce the Risk of Depression? â€Å"). Caffeine also helps prevent various diseases. People suffering from Parkinson’s disease can better control their motor-skills by taking caffeine (â€Å"Caffeine may ease Parkinson’s symptoms†). Energy drinks can be extremely harmful if abused or they could be a great source of energy. Like most things in life it can be destructive if done in excess. Most of the negative side-effects can be avoided if by taking the recommended doses. The companies that create these drinks should put warning labels on cans to prevent uninformed consumers from getting hurt. In addition, more research is needed to find out about the long-term effects of these drinks. Aside from that, energy drinks are safe in moderation. The benefits of them far outweigh the potential harmful effects. It is surprising how little evidence there is suggesting energy drinks are not safe. The reputation of these drinks was most likely was tarnished by lazy reporters, mob mentality and a few great people that just didn’t want the party to end. Work Cited Benac, Nancy. â€Å"United States Food and Drug Administration signals crackdown on caffeinated alcohol drinks. † CMAJ: Canadian Medical Association Journal 11 Jan. 2011: E47+. Academic OneFile. Web. 10 Apr. 2013. â€Å"Caffeine may ease Parkinson’s symptoms. † Obesity, Fitness & Wellness Week 18 Aug. 2012: 158. Academic OneFile. Web. 10 Apr. 2013. â€Å"Does Caffeine Reduce the Risk of Depression? † OB/GYN Clinical Alert 1 Jan. 2013. Academic OneFile. Web. 10 Apr. 2013. Liberatore, Stephanie. â€Å"Q: With the increasing popularity of energy drinks, I wonder-are these drinks safe? How do they affect teens? † The Science Teacher 76. 2 (2009): 64. Academic OneFile. Web. 10 Apr. 2013. Meier, Barry. â€Å"Doctors Urge F. D. A. to Restrict Caffeine in Energy Drinks. † New York Times 20 Mar. 2013: NA(L). Academic OneFile. Web. 10 Apr. 2013.

Using Agile at Blue Cloud Free Essay Example, 750 words

In my opinion, before continuing or discontinuing the use of Agile in the company, overall assessments are done collectively within the company must be made first before coming to a decision. First, there must be a comparison of the previous company outputs and results prior to the use of Agile and after implementing Agile, then check which method has more cons than pros. Also, employee feedback must be welcomed as well, since they are mostly the ones that would be using the methods and programs hands-on. Lastly, if clarifications with the objectives of the Agile method are needed to be disseminated or reviewed for the employees that did not understand it fully, then it must be done as well. After weighing the cons and pros, only then would the continuation or discontinuation of Agile can be decided. It is expected that some changes may not take effect fully within a year after implementing new strategies within an organization (Paton McCalman, 2008). Also, the statistics of using the system for 30 months as compared to previous statistics of the company output before implementing Agile would speak better of the need to either keep using the method or sourcing another method for the improvement of the work program in Blue Cloud, since this is a timeframe which is inclusive of the learning curve and the adjustment period for all company employees. We will write a custom essay sample on Using Agile at Blue Cloud or any topic specifically for you Only $17.96 $11.86/pageorder now Thus, I would personally recommend continuing the use of Agile for the next 18 months, as well as strengthening the importance of its use within the company. Following up with the suggestion of using Agile for the next 18 months, in order to fully harness the full potential of implementing the program, feedback and reviews of the previous year in using Agile would be initiated. After assimilating the feedback and reviews as well as evaluating the circumstances that led to these opinions, changes that needed to be implemented would be done and monthly assessments on whether certain changes did improve productivity and output within the company or not (Spector, 2012).