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   Table of Contents - Current issue
March-April 2019
Volume 8 | Issue 2
Page Nos. 41-78

Online since Tuesday, June 4, 2019

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Response assessment of gefitinib therapy in the epidermal growth factor receptor- mutant advanced adenocarcinoma lung at a tertiary care center in North India p. 41
Anubhuti Singh, Anand Srivastava, Abhishek Verma, Rajiv Garg
Context: Oral tyrosine kinase inhibitors (TKIs) have been proven to improve response rates (RRs) and progression-free survival in a chemo-naïve setting in the epidermal growth factor receptor (EGFR)-mutant advanced lung adenocarcinoma patients in studies conducted in Western countries. Similar data from India are currently sparse. Aims: The aim is to study the epidemiological, clinical, and radiological profile of advanced-stage of lung adenocarcinoma patients harboring an EGFR mutation and to assess the response of TKIs in these patients. Settings and Design: This was a prospective observational study performed at a tertiary care hospital. Materials and Methods: A total of 40 advanced-stage lung adenocarcinoma patients who harbored an EGFR mutation and received an oral TKI (gefitinib) were included in the study and response was evaluated using the Response Evaluation Criteria for Solid Tumors. Statistical Analysis Used: Qualitative variables were compared using the Chi-square test/Fisher's exact test as appropriate. Results: A total of 30 (75%) patients had an exon 19 mutation and 3 (7.5%) patients had an exon 21 mutation. The overall RR to gefitinib was 57.5%. Eleven (27.5%) patients had partial response, 12 (30%) patients had stable disease (SD), and 6 (15%) patients had progressive disease. The RR was more favorable among females, rural residents, nonsmokers, patients having good performance score, and stage III disease. Conclusions: The overall RR to gefitinib was comparable to those reported in western studies but lower than those reported in Asian studies at our center.
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Surgical margins and nodal metastasis are prognostic factors in oral squamous cell carcinoma: A meta-analysis p. 47
Mohammad Akheel, Rinku K George, Amit Jain, Qutubuddin Chahwala, Ashmi Wadhwania
Background: To find out whether surgical margins and nodal metastasis are prognostic factors in oral squamous cell carcinoma (OSCC). Materials and Methods: PubMed search was done to look for studies done on surgical margins and nodal metastasis of OSCC from 2008 to 2018. Results: Fixed effects meta-analysis showed a pooled estimate absolute risk reduction of −3% (95% confidence interval [CI] [−8, 2.5%]). P =0.2819 from the fixed margin model shows no statistically significant difference between close margins with cases of deaths due to recurrence or metastasis. The pooled odds ratio was 0.87 (95% CI 0.63–1.99, P = 0.3928) for the comparison between clear and closed margins for estimating the odds. It should be noted that the mean unweighted local recurrence rate for margins 5 mm or greater was 4.9% with 95% CI as −10.7%, 0.8%. Conclusion: The study shows that close surgical margins with nodal metastasis have a poor prognosis in OSCC; however, no statistical significance was seen in this meta-analysis.
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Impact of body mass index on breast cancer subtypes in Iranian women p. 52
Hamid Ahmadi, Bita Eslami, Sadaf Alipour, Adel Yazdankhahkenary, Ramesh Omranipour
Background: The incidence of obesity as one of the risk factors of breast cancer (BC) is increasing dramatically. Our objective was to evaluate the association between body mass index (BMI) and three subtypes of BC in Iranian women. Materials and Methods: In this retrospective study, BC patients' information was recorded by referring to their medical records in the Cancer Institute of Imam Khomeini Hospital, Iran, from 2015 to 2017. The data of 374 patients were entered into the study, and tumor data were classified into three groups by molecular markers (human epidermal growth factor receptor 2 [HER2] enriched, triple negative, and luminal). Results: Luminal subtype comprised the majority (71.1%) of all diagnosed BC patients. The proportion of obese women was higher in triple-negative group (35.3%), although the differences between three subtypes of BC were not statistically significant (P = 0.30). Multivariate logistic among cases only, considering luminal as the comparison group, indicated a positive association between age of menarche and HER2-enriched subtype (odds ratio [OR] = 1.18, 95% confidence interval [CI]: 0.99–1.41, P = 0.07) and also suggested a reverse association between age at time of diagnosis and triple-negative subtype (OR = 0.97, 95% CI: 0.95–1, P = 0.09) with borderline significance. Conclusion: We did not find any statistically significant differences in BMI between three subtypes of BC. It seems that there is a correlation between triple-negative subtypes of BC in Iranian population and obesity. However, further studies with larger sample size are needed.
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An evaluation of special AT-rich sequence-binding protein 2 expression in primary epithelial tumors and metastatic tumors of the ovary p. 57
Esra Oz, Zehra Bozdag, Neslihan Bayramoglu Tepe, Zeynep Bayramoglu, Omer Faruk Dizibuyuk, Metin Karakok
Background: Ovarian cancer is the second most common gynecologic cancer in women. Differential diagnosis between primary and metastatic neoplasms can be problematic in some cases. The special AT-rich sequence-binding protein 2 (SATB2) is a nuclear matrix-associated protein that is important for growth and development. SATB2 has been shown to be a sensitive and highly specific marker for colorectal carcinomas (CRCs). SATB2 expression has also been reported in lung, breast, pancreas, renal, laryngeal, esophageal carcinomas and bone cancers. In this study, we aimed to evaluate SATB2 expression in primary epithelial and metastatic ovarian tumors and determine its significance in differentiating between subtypes. Material and Methods: The study group comprised 148 cases of primary epithelial tumor and 29 cases of metastatic ovarian tumor. Immunohistochemical analysis was performed by applying SATB2 on paraffin blocks. Results: SATB2 expression was identified in 54.5% of mucinous carcinomas, 51.7% of endometrioid carcinomas, 18.2% of high-grade serous carcinomas, 17.9% of borderline mucinous tumors, 6.7% of borderline serous tumors, and 51.7% of metastatic ovarian tumors. SATB2 expression did not show specificity for any of the subgroups. Metastatic ovarian tumors originating from the colon, breast, upper gastrointestinal tract, and appendix also showed SATB2 expression at different rates. All of the metastatic CRCs showed SATB2 positivity. Conclusion: It must be considered that primary carcinomas and metastatic carcinomas may manifest varying levels of SATB2 expression with different intensity and extensiveness. Extensive and strong SATB2 expression indicates metastatic colon carcinoma, consistent with the literature. Further comprehensive studies are needed in order to investigate SATB2 specificity for different subtypes.
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A study of clinicopathologic features of thyroid cancer in Western Iran: A 9-year experience p. 64
Babak Izadi, Somayeh Jalilian, Mazaher Ramezani, Masoud Sadeghi, Sedigheh Khazaei
Introduction: Thyroid cancer is reported as the most rapidly increasing and third-most common cancer among females. This study aimed to evaluate the data related to thyroid cancer in Kermanshah, Iran, for the first time. Materials and Methods: The data of thyroid cancers were obtained between March 2008 and March 2017. Tumors were classified into four groups: papillary, follicular, medullary, and anaplastic; age was divided into two groups (<45 years and ≥45 years); and tumor size was divided into three groups (≤2, 2–4, and >4 cm) according to the National Comprehensive Cancer Network guidelines for patients: Thyroid cancer, version 1, 2017. Results: A total of 296 thyroid cancer patients with the mean age of 41.1 years, 75% of whom were female, were studied. Most patients (89%) had papillary thyroid cancer. Of all patients, 8.8%, 21.3%, 20.6%, 27%, 5.7%, and 16.9% of patients had extrathyroidal invasion, lymph node metastasis, capsular invasion, Hashimoto's thyroiditis, distant metastasis, and goiter, respectively. With regard to the stage, 82.4% of patients had Stage I. There were significant differences between the two genders in the mean age and Hashimoto's thyroiditis. There were significant differences between the two age groups in sex and Hashimoto's thyroiditis. In addition, there were significant differences between tumor size group and laterality and vascular invasion. Conclusions: The mean age and female/male ratio in this study were similar to those of other areas of Iran. Papillary thyroid carcinoma is the most common kind of thyroid cancer in Iran. In addition, more attention should be paid to the role of Hashimoto's thyroiditis in Iranian patients with thyroid cancer in the future.
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Metaplastic chondroid breast carcinoma: A diagnostic challenge p. 70
Milind Anil Bhatkule
Metaplastic carcinoma of the breast is a rare entity. Extensive chondroid differentiation is even rarer in metaplastic breast carcinoma (MBC). Here, we report a case of metaplastic chondroid carcinoma of the breast with very few areas showing usual ductal carcinoma and pseudosarcomatous areas. The tumor was characterized by an abundant chondromyxoid matrix. The definitive areas of classic invasive ductal carcinoma were very few. The peripheral portion of the tumor showed increased cellularity with pleomorphism and invasive growth pattern with giant tumor cells. This case is presented for its rarity and also of a diagnostic challenge, especially if the tumor is composed mainly of sarcomatous elements with extensive chondroid differentiation. Standard chemotherapy regimens are ineffective against MBC.
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Superficial extraskeletal ewing's sarcoma of forefoot with inguinal lymph node metastasis and lung metastasis: A rare case p. 73
Poorva Vias, Shabnum Thakur, Rajeev K Seam, Vikas Fotedar, Ashish Saklani
Ewing's sarcoma is the 2nd most common paediatric bone tumour but can also be seen in extraskeletal sites. Superficial extraskeletal ES is a rare entity and is rarely seen in foot. Majority of these patients are females in second decade of life, presenting with small, single mass, mobile, sometimes painful. They usually have a favourable outcome due to infrequent metastasis.
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Priapism in a pediatric chronic myeloid leukaemia patient: Unusual presentation of a rare disease in children p. 76
Purnima Thakur, Vishal Verma, Vikas Fotedar, Kalindi Singh
A rare case of chronic myeloid leukemia (CML) presenting with priapism is reported in a pediatric patient. CML accounts for around 15% of hematological malignancies. It is still rarer in the pediatric age group. Investigations revealed hyperleukocytosis due to CML. When conservative management failed, priapism was relieved by shunt procedures and the patient was treated with oral chemotherapy. This case demonstrates the importance of early identification of the underlying cause of priapism, and that the possibility of CML may be kept in mind in pediatric patients too, as it directly influences the management and early diagnosis may preserve sexual function in later life.
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