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   Table of Contents - Current issue
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May-June 2019
Volume 8 | Issue 3
Page Nos. 79-128

Online since Wednesday, July 24, 2019

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ORIGINAL ARTICLES  

11q23 translocation in children with acute lymphocytic leukemia following primary response to chemotherapy: prognostic significance and diagnostic accuracy Highly accessed article p. 79
Arash Alghasi, Kaveh Jaseb, Mohammad Pedram, Bijan Keikhaei, Hadi Rezaeeyan, Hamid Galehdari, Ali Mohammad Malekaskar, Fakher Rahim, Marziyeh Abbasi Nasab
DOI:10.4103/ccij.ccij_30_19  
Background: Cytogenetic abnormalities in leukemia cells have strong prognostic values for different clinical subgroups, clinical features, and therapeutic outcomes. Patients and Methods: This study was conducted on 100 children with acute lymphocytic leukemia referred to Ahvaz Shafa Hospital during 2012–2017. The patients were diagnosed by a specialist through examination of morphology and flow cytometry, testing bone marrow specimen on the 7th day of treatment, and a karyotype and cytogenetic test are performed. Results: There was no relationship between the t(11q23) and gender nor age of children. Besides, the mean white blood cell (WBC) counts in patients who were negative for 11q23 and those positive revealed a statistically significant relationship between WBC count and 11q23 (P = 0.022). Conclusion: A significant association between the 11q23 translocation and primary response to chemotherapy is existed. Diagnostic accuracy of these tests for detecting t(11q23) is generally high, as well as sensitivity and specificity are optimal for all anomalies.
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Bevacizumab and capecitabine in relapsed platinum-resistant epithelial carcinoma of ovary: A retrospective study p. 84
Amitabha Chakrabarti, Santu Mondal, Soumita Poddar, S K M D Rejakul Islam
DOI:10.4103/ccij.ccij_31_19  
Background: Relapsed platinum-resistant epithelial carcinoma of the ovary is a disease with a dismal prognosis. Bevacizumab and capecitabine have been used in carcinoma of ovary both as a single agent and with other chemotherapeutic medicine. A retrospective study has been performed to assess the efficacy of bevacizumab + capecitabine in relapsed platinum-resistant epithelial carcinoma of the ovary. Materials and Methods: Patients who suffered from relapsed platinum-resistant epithelial carcinoma of the ovary and received bevacizumab and capecitabine were included in the present study. The primary objective of this study was to assess response rate and progression-free survival (PFS). Treatment: Patients received capecitabine at a dose of 1250 mg/m2 twice daily from day 1 to day 14 in each cycle. Bevacizumab was given at a dose of 7.5 mg/kg on day 1 in each cycle. The cycle was repeated in every 3 weeks. Response evaluation was done using the Response Evaluation Criteria in Solid Tumor criteria and by Rustin criteria. Statistical Analysis: Statistical analysis was done using statistical software (SPSS 16, SPSS for Windows, SPSS Inc., Chicago, IL, USA). Results: We analyzed the data of 32 patients. The PFS was 10.51 (95% confidence interval [CI], 8.65–12.37) months. The overall survival (OS) was 20.53 (95% CI, 17.21–23.85) months. Four (12.5%) patients achieved complete response. Eighteen (56.25%) patients achieved partial response. The response rate was 68.75%. Four (12.5%) patients had progressive disease. Conclusion: Response rate, PFS, and OS of patients in this study are comparable to those of other published studies. Hence, bevacizumab + capecitabine can be used in relapsed platinum-resistant carcinoma of the ovary. The incidence and severity of bevacizumab-induced side effects are relatively lower in this study. Hence, bevacizumab can be given at a lower dose with comparable efficacy and tolerable side effects.
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Correlation between ki-67 labeling index and mitotic index in oral squamous cell carcinoma p. 90
Archana Buch, Niladri Haldar, Supriya Kheur, Shirish Chandanwale, Harsh Kumar
DOI:10.4103/ccij.ccij_23_19  
Background: Oral squamous cell carcinoma (OSCC) is the most prevalent type of oral cancer. Counting of mitotic figures as well as the detection of Ki-67 expression by immunohistochemistry have been used to detect cell proliferation in malignant tumors. We correlated Ki-67 expression with mitotic activity and observed any notable relationship between them, to ascertain the role of Ki-67 protein as a tumor proliferative marker in OSCC. Subjects and Methods: A cross-sectional study was undertaken at a tertiary care hospital in Western Maharashtra over a period of 2 years. Fifty paraffin blocks of patients diagnosed as OSCC were included in our study, who were classified into well-differentiated squamous cell carcinoma (n = 24), moderately-differentiated squamous cell carcinoma (n = 23), and poorly differentiated squamous cell carcinoma (n = 3). Two slides per case were stained with H and E and Ki-67 marker, then observed under light microscopy to obtain Mitotic Index (MI) and Ki-67 Labeling Index (LI), respectively. Results were analyzed using mean, standard deviation, Chi-square test, and unpaired t-test. Results: Hyperplastic epithelium revealed higher Ki-67 LI as compared to normal epithelium. There was a statistically significant (P = 0.045) increase in Ki-67 LI in the proliferating margin with grade of OSCC. Positive linear correlation was noted between Ki-67 and MI in tumor proper (r = 0.186) and proliferating margin (r = 0.337) and was statistically significant in the latter (P = 0.017). Conclusions: Ki-67 LI can reliably detect the proliferative potential of cells at the invasive margin of a tumor. MI, on the other hand, can detect the cell proliferation rate of the tumor that is in correlation with the histopathological grade of OSCC.
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The effect of matrix metalloproteinases and adhesion molecules on the prognosis in gastric carcinoma p. 96
Zehra Bozdag, Hale Kirimlioglu
DOI:10.4103/ccij.ccij_27_19  
Background: Matrix metalloproteinases (MMPs), adhesion molecules, and receptors are needed in the process of cancer growth. This study aims to investigate the role of MMP-3, MMP-10, MMP-11, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) in gastric cancer. Materials and Methods: Fifty-two gastric carcinoma cases who underwent gastrectomy were included in the study. The cases were inspected with regard to the presence/absence of lymph node and distant metastases. The selected paraffin blocks were immunohistochemically stained with MMP 3, MMP 10, MMP 11, ICAM (CD 54), and VCAM (CD 106). Results: Most of the cases (n: 50, 94%) with gastric cancer manifested cytoplasmic staining with MMP-11. MMP-10 expression was found in 45 of 52 (86.5%), MMP-3 staining was determined in 43 (82.6%) of gastric carcinomas. Different areas of differentiation within the tumor showed differences in MMP expression in terms of intensity and extensiveness. ICAM-1 expression was found in 47 of 52 (90.4%) cases and with VCAM-1, 46/52 (88.5%) of gastric cancers manifested positive staining. Its expression was found to be higher in the nonmetastatic group both in intestinal and diffuse types. VCAM-1 was diffusely expressed in gastric cancers. However, we did not determine a significant correlation concerning differentiation and lymph node and distant metastasis. Conclusions: MMP-3, MMP-10, MMP-11, ICAM-1, and VCAM-1 are expressed in gastric cancers and are thought to be involved in tumor development. Levels of expression that decrease in parallel to decreasing differentiation in areas of differentiation within tumor corroborate the idea that they are related to tumor progression. Due to its relationship with metastasis, ICAM-1 expression in noncohesive cells supports the idea that ICAM-1 is a significant factor involved in metastasis development in gastric cancers. Decreased MMP-10 and MMP-11 expression in metastases suggest that these enzymes may also be linked to the metastatic potential of gastric cancers.
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Frequent methylation of genes encoding wnt pathway antagonists: Secreted frizzled-related protein 1 and dickkopf 3 in invasive breast cancer p. 106
Mahnaz M Kazi, Hemangini H Vora, Kinjal K Gajjar, Toral P Kobawala, Nandita R Ghosh
DOI:10.4103/ccij.ccij_14_19  
Introduction: Wnt signaling pathway is often dysregulated in the pathogenesis of various malignancies, including breast cancer. This might be related to methylation of the genes encoding antagonists of this signaling pathway. Aim: The aim of the study was to analyze the methylation status of the promoter regions of Wnt antagonists-secreted frizzled-related protein 1 (sFRP1) and Dickkopf 3 (DKK3) and to determine their correlation with clinicopathological parameters and survival outcome in patients with primary invasive ductal breast cancer. Materials and Methods: The methylation status of sFRP1 and DKK3 was analyzed in 160 breast tumor samples using methylation-specific polymerase chain reaction. Statistical analysis was performed using SPSS software. P ≤ 0.05 was considered as statistically significant. Results: The promoter region of sFRP1 and DKK3 genes was found to be methylated in 76% and 64% of total invasive ductal breast cancer patients, respectively. The promoter methylation in sFRP1 and DKK3 genes was significantly associated with larger tumor size, positive lymph nodes, advanced stage, and perinodal extension of breast tumors. Further, sFRP1 methylation was associated with human epidermal growth factor receptor 2-positive tumors while DKK3 methylation was associated with Grade 3 tumors. Survival analysis demonstrated that sFRP1 methylation was correlated with reduced overall survival in breast cancer patients. Conclusion: Promoter methylation of Wnt pathway antagonists is frequent in breast cancer ultimately leading to probable upregulation of the pathway in these tumors. Hence, sFRP1 and DKK3 methylation may be used as a valuable biomarker in clinical breast cancer management.
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Subcutaneous adipose tissue as a biomarker of pancreatic cancer: A pilot study in male patients p. 114
Federico Greco, Carlo Augusto Mallio, Vincenzo Cirimele, Rosario Francesco Grasso, Bruno Beomonte Zobel
DOI:10.4103/ccij.ccij_36_19  
Purpose: The purpose of this study was to evaluate the relationship between subcutaneous adipose tissue (SAT) and pancreatic cancer (PC) in male patients. Methods: In this retrospective study, two groups were included. Quantitative assessment of adipose tissue was performed by measuring total adipose tissue (TAT) area, visceral adipose tissue (VAT) area, and the SAT area in both the groups. Then, VAT/SAT ratio was calculated. Results: Statistically significant differences between the two groups were found in the SAT area (P < 0.05), TAT area was slightly above the threshold of significance, while no significant difference was found in the VAT area and VAT/SAT ratio. Conclusions: The results of this study suggest an association between SAT reduction and PC risk.
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Sinonasal nonsalivary-type adenocarcinoma: A 9-year experience from a tertiary cancer center in South India p. 119
KR Anila, K Ramadas, Elizabeth Mathew Iype, TR Preethi, Anitha Mathews, Thara Somanathan, K Jayasree
DOI:10.4103/ccij.ccij_33_19  
Background: Sinonasal tract malignancies are uncommon, representing not more than 5% of all head and neck neoplasm. Primary non-salivary type adenocarcinomas of the sinonasal tract are rare and may originate from respiratory surface epithelium or the underlying seromucinous glands. They are classified into intestinal type adenocarcinoma (ITAC) and non-intestinal type adenocarcinoma (non-ITAC) based on immunophenotypic features. Materials and Methods: We retrieved five cases of ITACs and twelve cases of non-ITACs from our archives over a period from 2010-2018. Results: All cases of ITACs occurred in the nasal cavity. There was a male predilection with ratio of 4:1, mean age being 48 years. Two cases had association with occupational risk factors. All cases showed positivity for CK20. Non-ITACs occurred in older age group with mean age of 52 years. Male to female ratio was 2:1. Apart from nasal cavity, ethmoid, maxillary, frontal and sphenoid sinuses were involved. Though occupational risk factors have not been established for non-ITAC, five of our cases gave history of exposure to risk factors. Non-ITACs showed positivity for CK7 and were negative for CK20. Conclusion: Surgery is the first line of management followed by adjuvant radiotherapy. Three cases of non-ITACs developed recurrence while on follow up. Recurrence in one case was after five years of initial diagnosis. Follow-ups over long period of time are required. Multiinstitutional studies are needed for better understanding these rare cancers.
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CASE REPORTS Top

Iris metastases as an unusual ocular manifestation in renal cell carcinoma p. 123
Bijnya Birajita Panda, Sucheta Parija
DOI:10.4103/ccij.ccij_16_19  
The most common intraocular malignancy in adults is metastases from a systemic malignancy. The choroid is the most common site followed by iris and ciliary body; other sites being orbit, eyelids, lacrimal glands, extraocular muscles, and bulbar conjunctiva. However, iris metastases from renal cell carcinoma (RCC) have been reported sparsely in the literature. The present case report describes the unique morphology of iris metastases thought initially to be a benign iris cyst which later proved to be secondary metastases from RCC. This article also describes briefly the review of the relevant literature and the management protocol in such patients.
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Pediatric chylolymphatic mesenteric cyst: A rare entity p. 126
Sonu Kalyan, Jyoti Sharma
DOI:10.4103/ccij.ccij_6_16  
Mesenteric cysts are uncommon cystic lesions with variable clinical presentations. These are infrequently encountered lesions reported both in children and in adults. Chylolymphatic cysts are rare variants of mesenteric lesions and constitute 7.3%–9.5% of all abdominal cysts. Very few cases of pediatric chylolymphatic cysts have been reported in the literature. Herein, we report a case of chylolymphatic cyst in a 1½-month-old child, which is a rare entity.
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