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   Table of Contents - Current issue
Coverpage
November-December 2018
Volume 7 | Issue 6
Page Nos. 199-243

Online since Friday, January 18, 2019

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ORIGINAL ARTICLES  

Association of pulmonary tuberculosis with lung carcinoma: An epidemiological study p. 199
Partha Dasgupta, Kakali Choudhury, Nishana Paul, Krishnangshu Bhanja Choudhury, Bodhisatta Roy, Shampa Maity
DOI:10.4103/ccij.ccij_35_18  
Introduction: Tuberculosis (TB) is a serious public health problem in developing countries, with India bearing highest burden. Lung cancer (LC), especially adenocarcinoma, is also increasing all over the world, with India having highest mortality in males due to lung cancer. Both diseases do co-exists producing diagnostic dilemma and treatment controversies. We intended to explore the incidence of both diseases at a tertiary cancer centre. Materials and Methods: This longitudinal study was conducted between 2014 to 2017. Diagnosis and treatment of TB were according to DOTS protocol. For lung cancer biopsy was mandatory for diagnosis. Results: Our study was conducted on 42 patients at the Department of Radiotherapy, R.G. Kar Medical College. In 19 of the 42 patients, the diagnosis of TB and LC occurred simultaneously, whereas, in 23, the occurrence was sequential. Fifteen (35.7%) patients reported having had TB twice. TB treatment was given as Category 1 of DOTS in 21 patients (50%) and Category 2 in 15 (35.7%). In 6 (14.3%) patients, the data on treatment regimen were either not provided or unavailable. Regarding carcinoma lung management, 50% of patients were purely treated as palliative intent. Twenty percent of patients received chemotherapy with platinum doublet. Thirty percent of patients were given best supportive care. Conclusion: The symptoms of TB and lung carcinoma overlap with each other. If we get any patient with lung cancer not much improving after anticancer treatment, diagnosis of TB should be kept in mind. Similarly, in any diagnosed case of pulmonary TB, development of lung cancer should be considered if not improved with anti-tubercular treatment.
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Human epidermal growth factor receptor-2 assessment in cancerous and precancerous lesions of the stomach in presence of Helicobacter pylori p. 203
Zahra Heidari, Hamidreza Mahmoudzadeh-Sagheb, Nadia Sheibak, Mehran Panahi, Setareh Jami
DOI:10.4103/ccij.ccij_98_18  
Aims: Importance of human epidermal growth factor receptor-2 (HER-2) testing in cancer is increasing, and in the other hand, there is a hypothesis about roles of Helicobacter pylori (H. pylori) in gastric cancer (GC) development. We seek to investigate the HER-2 expression in the presence of H. pylori infection in patients with gastric GC and precancerous lesions. Subjects and Methods: From 224 archived blocks, 58 samples with chronic gastritis, 58 intestinal metaplasia (IM), 58 gastric dysplasias, and 50 gastric adenocarcinoma cases were selected as our principal groups. Each group was subdivided into H. pylori-positive and H. pylori-negative subgroups. Immunohistochemical method was performed for detection of HER-2 expression in gastric biopsies using a polyclonal antibody. The staining intensity was quantified and differences among groups were compared using Mann–Whitney U and Kruskal–Wallis tests. P < 0.05 was set as statistically significant. Results: Results showed that HER-2 expression among the four principal groups was statistically significant (P < 0.05). There was a significant increase of immunohistochemical expression of HER-2 in H. pylori-positive chronic gastritis in comparison with H. pylori-negative subgroup (P < 0.05). Difference of HER-2 expression between H. pylori-positive and H. pylori-negative subgroups in dysplasia, IM, and GC groups was not statistically significant (P > 0.05). Conclusion: The present study proposed that HER-2 overexpression in gastric tissues probably had important roles in the progression of cancer and above-mentioned process was probably associated with H. pylori infection in the early stages of precancerous lesions.
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The familial experiences of women with breast cancer referring to chemotherapy clinic: A qualitative study p. 210
Hajar Noorisanchooli, Mozhgan Rahnam, Maryam Jahantigh Haghighi, Seyed Ali Hashemi, Zeinab Younesbarani
DOI:10.4103/ccij.ccij_92_18  
Background: Breast cancer and its treatment affect both the patient and her family, where the entire family and their functioning undergo disturbance. Therefore, this study has been conducted with the aim of interpreting the experiences of women with breast cancer with regard to their family. Materials and Methods: The present study has been done through the qualitative method with conventional content analysis approach. The sampling has been done through the purposeful method with the participation of 12 patients with breast cancer referring to Chemotherapy Clinic in Zabol in 2016. The data collection method was semi-structured interview. Data analysis has been done using the proposed stages by Grenham and Landman. The accuracy and robustness of the data were investigated, and ethical considerations were also taken into account. Results: Based on the results, three main classes including mutual supports, mutual sufferings, and ambivalent feelings as well as six subclasses were extracted. “Mutual involvement of the patient and family with the disease” was also identified as the theme of this research. Conclusion: The findings of the research suggested that the experiences of these patients with regard to their family can be described as mutual involvement of the patient and family. The reason is that women and their family, due to experiencing the suffering from the disease, tried to support each other and these conditions had set the ground for the development of ambivalent feelings, such that some of them felt a sense of emptiness (deficiency) due to lack of familial support, while others had experienced a sense of competence thanks to motivation and encouragement. Investigation of the relevant papers suggested that through presenting educational and supportive interventions for the families of these patients, one can help them to indirectly gain better experiences about their family.
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Incidence and epidemiology of urologic cancers in North of Iran p. 217
Ghasem Janbabaei, Majid Yaghoubi Ashrafi, Zainab Ghazizadeh, Mahdi Afshari, Razieh-Sadat Mousavi, Mohammad Eslami Jouybari, Ehsan Zaboli, Ramin Shekarriz, Akbar Hedayatizadeh-Omran, Reza Alizadeh-Navaei, Mohsen Aarabi, Mahmood Moosazadeh
DOI:10.4103/ccij.ccij_52_18  
Introduction: Urinary system malignancies are considered as one of the main public health concerns with high morbidity and mortality. These cancers have various patterns in different regions over time. This study aims to determine the incidence of these malignancies in the northern part of Iran (Mazandaran Province). Materials and Methods: This cross-sectional study carried out among patients with urologic cancers in 2014. A population-based cancer registry in Mazandaran University of Medical Sciences was the source of information. Stata software version 14 was applied for descriptive statistics and analysis. The WHO standard population was used for estimating the age and sex-standardized incidence of urologic cancers. Results: In 2014, 261 patients with cancers of the urinary system have been registered in Mazandaran Province, northern Iran. Mean, standard deviation, minimum, and maximum age of patients were 64.4, 15.6, 1, and 94, respectively. More than two-thirds of patients aged over 60 and most of them were male. The standardized incidence of cancers of the bladder, kidney, ureter, and other parts of the urinary system among men was estimated as 7.98, 1.54, 0.05, and 0.3 per 100,000, respectively. The standardized incidence of cancers of the bladder, kidney, pelvis, and ureter among women were 0.09, 0.14, 0.09, and 0.39, respectively. Conclusion: The majority of urologic cancers in the northern part of Iran are among men and those aged over 60. Moreover, bladder and renal cancers are the most common cancers in both genders.
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Role of induction chemotherapy in downstaging of locally advanced head-and-neck squamous cell cancer p. 221
Manish Kumar Ahirwar, Veenita Yogi, OP Singh, HU Ghori, Vivek Tiwari, Bibin Francis
DOI:10.4103/ccij.ccij_42_18  
Aims and Objectives: To study the effect of induction chemotherapy (CT) in locally advanced head-and-neck squamous cell carcinoma (LAHNSCC) and to compare the two commonly used regimens of CT, including paclitaxel and cisplatin (CDDP) in one arm and CDDP, methotrexate (MTX), and bleomycin in the other arm as induction CT. Materials and Methods: It is a retrospective study, including 100 histopathologically proven cases of LAHNSCC who received treatment at a government medical college and hospital in Central India between November 2015 and June 2016. All the patients were randomly divided into two arms: arm A received paclitaxel + cisplatin (TP) and arm B received cisplatin + MTX + bleomycin as induction CT had adequate hematologic, hepatic, and renal functions, and their response to treatment was evaluated clinically after each cycle up to three cycles before external beam radiotherapy. Results: The present study showed beneficial effects of induction CT in HNSCC as 82% of the patients showed response or T-downstaging. Among the patients responding to induction CT, 34% showed complete and 48% showed partial response at the primary tumor site according to Response Evaluation Criteria in Solid Tumors. The difference in response between the two arms was statistically significant (P = 0.037). Conclusion: The current study shows the beneficial effects of induction CT in LAHNSCC. No statistically significant difference was seen in the response of both regimens of induction CT in terms of overall survival, but significant disease-free survival and progression-free survival were obtained in the TP arm.
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CASE REPORTS Top

Peripheral ameloblastoma of the buccal mucosa: Case report of a rare tumor p. 227
Karpal Singh Sohal, Sira Stanslaus Owibingire, Jeremiah Robert Moshy, Baraka Fredrick Kileo
DOI:10.4103/ccij.ccij_93_18  
Peripheral ameloblastoma (PA) refers to a rare neoplasm that accounts for approximately 1%–5% of all ameloblastomas. It arises in the soft tissues overlying a tooth-bearing region, and those found in nontooth-bearing locations, such as the buccal mucosa, lips, and palate. This article aims at describing a case of a rare form of extragingival PA in the nontooth-bearing region and challenges in its management in settings with limited resources. A 55-year-old African male presented with a painless swelling on the right cheek for about 6 years, which was clinically diagnosed as pleomorphic adenoma; however, both pre- and postoperative histopathological results reported the swelling to be follicular ameloblastoma. Extragingival PA is a rare variant of ameloblastoma, which needs to be included as one of the differential diagnoses of the buccal mucosal swellings.
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Cytological diagnosis of bilateral supraclavicular swellings – Be aware of the rare p. 231
K Geethamala, Aruna Sharanappa, Shreekant K Kittur
DOI:10.4103/ccij.ccij_94_18  
Cervical lymphadenopathy is the most common clinical presentation in many infective and neoplastic lesions. Most common lesions among them are reactive lymphoid hyperplasia, tuberculosis, and metastatic deposits. Fine-needle aspiration cytology is a reliable diagnostic tool for patients with cervical lymphadenopathy to know the various lesions and helps in deciding further management. The American Joint Committee on Cancer classifies cervical lymph nodes into level 1 to 7, of which supraclavicular lymph nodes comprise level 5. The major cause for enlargement of supraclavicular lymph nodes is metastatic malignancy deposits followed by either Hodgkin's disease or non-Hodgkin's lymphoma. We present an interesting case of a male patient clinically manifested with initial asymptomatic bilateral supraclavicular swellings and finally diagnosed with metastatic deposits of germ cell tumor, seminoma, from testis on cytological study in constellation with clinical and radiological findings.
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Ovarian-type serous papillary tumor of the paratestis presenting with calcified lymph node metastases: A rare entity p. 234
Hilal Sahin, Recep Savas, Deniz Nart, Burak Turna
DOI:10.4103/ccij.ccij_97_18  
A 65-year-old male patient was referred to our hospital due to calcified lymphadenopathies in the neck. Positron emission tomography/computed tomography demonstrated a cystic mass in the right scrotum with slightly increased fluorodeoxyglucose uptake in its wall. In addition, calcified hypermetabolic lymph nodes were found in the neck and abdomen. After the operation, the patient was diagnosed as metastatic ovarian-type serous papillary tumor of the paratestis and he was treated with chemotherapy. This case demonstrates that when calcified lymph nodes are present in a male, he should be examined carefully for the primary malignancy which can be determined in an unusual location such as the scrotum.
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A report of a rare case of breast metastasis from cutaneous malignant melanoma p. 238
Anirban Halder, Vikas Yadav, Sujit Shukla, Rituparna Biswas, Jaspreet Kaur
DOI:10.4103/ccij.ccij_44_18  
Benign and primary malignant breast tumors are rather common, but secondary tumors in the breast from extramammary malignancies are uncommon. Breast metastases from melanoma are rare but could reflect a widespread disease. We present a case of melanoma of the right lateral chest wall with metastasis to the right breast and subcutaneous tissue in a postmenopausal female. She was planned for palliative chemotherapy with cisplatin and dacarbazine. Interim imaging after three cycles of chemotherapy showed stable disease. The long-term prognosis of patients with breast metastasis from malignant melanoma is extremely unfavorable.
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Endometrial stromal sarcoma: Unexpected guest! p. 241
Subhashini Ramamoorthi, Sankappa P Sinhasan, Ramachandra V Bhat, A Bupathy
DOI:10.4103/ccij.ccij_89_18  
Endometrial Stromal Sarcoma (ESS) are very rarely encountered malignancies of uterus that account for only 1% of all uterine malignancies. ESS is commonly seen in perimenopausal women, typically presents with abnormal uterine bleeding and most commonly, pre-operative diagnosis will be leiomyomas. We report an interesting case of 42 year old female presenting with irregular cycles and excessive bleeding per vaginum. With provisional clinical diagnosis of fibroid uterus, total abdominal hysterectomy was done. Histopathological examination and immunohistochemistry staining with CD 10 confirmed the diagnosis of Low Grade ESS. The case is presented in view of its rarity and showing very much distinguishing gross and microscopy appearance. It highlights the unsuspected uterine malignant tumor, which was mimicking leiomyoma both clinically and radiologically. The histopathological examination again proved as gold standard to confirm the diagnosis of this rare entity.
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