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ORIGINAL ARTICLES
Are all left supraclavicular lymphadenopathies Virchow's? A retrospective study of 320 left cervical lymphadenopathy
Veena Raja, Chinnaiya Subramaniam, Babu Rajendra Prasad, Mari Lingiah Harendra Kumar, Balluru Vasudeva Swaroop Raj
January-February 2016, 5(1):15-19
DOI:10.4103/2278-0513.172029  
Background: Cervical Lymphadenopathy is one of the commonest and sometimes only clinical finding for a benign and malignant lesion. Fine needle aspiration cytology (FNAC) is a simple, safe, rapid and inexpensive method for establishing the diagnosis of lesions. Metastasis is more common in cervical lymph node and enlarged cervical nodes in an elderly patient must be considered as metastatic until proved otherwise. Methods: Retrospectively, 320 cases of left cervical lymph node FNAC were collected from five years record (May 2010 - June 2014) at Sri Devaraj Urs Medical College, Tamaka, Kolar. Review of all cytological reports were done according to standard guidelines and the morphological features of all non-neoplastic and neoplastic lesions were analysed. Results: Out of 320 cases 33% showed reactive lymphadenitis, 29% showed metastatic deposits, 14% showed features of granulomatous and necrotizing lymphadenitis, 9% were tuberculous lymphadenitis. In the present study, reactive lymphadenitis was the most common cause of enlarged lymph nodes followed by metastatic deposits. Squamous cell carcinoma is the most common metastatic lesions of lymphnode and comprise of 65% of the cases. Out of 62 cases of SCC 74% were keratinized, 16% were non keratinized, 29% cases showed granulomas. Non keratinization, presence of granuloma, plasma cells and eosinophils favours metastasis from nasopharyngeal carcinoma. Keratinization favours squamous cell carcinoma and absence of eosinophils and plasma cells in the background favors SCC metastasis from other sites. Conclusion: The present study highlight the usefulness of FNAC in left cervical lymphadenopathy where metastasis is common. Thus the knowledge about the cytological features and patterns will help the clinician to detect the respective cases early for investigations and treatment.
  32,372 23 -
CASE REPORTS
Cannon ball opacities in chest from primary lung cancer: A rare presentation
Ruchi Sachdeva, Sandeep Sachdeva, Prem P Gupta
July-September 2013, 2(3):269-270
DOI:10.4103/2278-0513.119250  
Cannon ball opacities in lungs are usual manifestation of secondary's arising due to extra-thoracic malignancy. We report a rare case of primary lung cancer with presentation of multiple pulmonary nodules in a 62-year-old male laborer by occupation, chronic smoker (40 pack-years) who presented with 6 month history of dry cough, exertional breathlessness and fever off and on.
  21,318 99 -
Primary sarcoma of the lung: A very rare diagnosis and poor prognosis
Rhizlane Belbaraka, Nabil Ismaili
March-April 2014, 3(2):176-178
DOI:10.4103/2278-0513.130221  
Primary lung sarcoma is a very rare malignant tumor, accounting for less than 0.5% of all lung tumors. We describe the case of a 50-year-old man who presented with primary pulmonary sarcoma. X-ray chest and thoracic computed tomography (CT) revealed a 40 mm Χ 60 mm mass in the right upper lobe. Biopsy was reported as fusiform sarcoma. Extensive clinical examination, followed by full body CT scan was performed to exclude primary synovial sarcoma located peripherally and distant metastases. Hence, surgical excision was planned after three cycles of chemotherapy, but the patient died after the second cycle. Because a sarcoma of the lung is rare, data regarding its natural history and published cases are limited. Further investigation and data collection are required to optimize the treatment of this group of rare and aggressive tumors.
  16,159 55 -
REVIEW ARTICLES
Myoepithelial cells: Current perspectives in salivary gland tumors
C Pramod Redder, V Suresh Kandagal, Nupura Vibhute, Pramod S Ingaleshwar, Sharan J Shetty, Sameer Ahamad
April-June 2013, 2(2):101-105
DOI:10.4103/2278-0513.113624  
Myoepithelial cells are normal constituent of the salivary acini and smaller ducts, and are found between the epithelial cells and the basement membrane. Microscopic examination shows that myoepithelial cells are thin and spindle-shaped and situated between the basement membrane and epithelial cells. Ultrastructurally they possess a number of cytoplasmic processes that extend between and over the acinar and ductal-lining cells. They display features of both smooth muscle and epithelium, such as numerous microfilaments with focal densities in the cytoplasmic processes, and desmosomes which attach the myoepithelial to the epithelial cells. Neoplastic myoepithelial cells in both benign and malignant tumors can take several forms, including epithelioid, spindle, plasmacytoid, and clear, and this variability largely accounts for difficulties in histopathological diagnosis. This review article highlights the role of myoepithelial cells in salivary gland tumors.
  15,273 566 4
ORIGINAL ARTICLES
Studies on the genomic association between schistosomiasis and hepatitis C virus infection
Akram M Abou-Zied, Tarek M El-Beltagy, Hekmat M Tantawy, Rasha H Soliman, Fouad M Badr
May-June 2015, 4(3):318-322
DOI:10.4103/2278-0513.151937  
Background: Schistosomiasis is an infection caused by blood flukes of the genus Schistosoma. Schistosomes are successful parasites, apparently as a result of prolonged co-evolution with their hosts. Studies done nationwide in Egypt found the highest risk of hepatitis C virus (HCV) co-infection is in those infested with schistosome without history of blood transfusions. However, the association between schistosomiasis and HCV infection is incompletely understood. Aims: The overall aim of this study was to assess whether or not a genomic association between schistosomal infestation and HCV infection exists. Materials and Methods: Oligonucleotide specific primers of HCV-polymerase chain reaction (PCR) diagnostics were used to screen the genomic DNA and cDNA library pool of Schistosoma mansoni as templates based on the end-point PCR approach. Results: Screening of schistosome DNA by PCR, lead to the detection of sequences similar to HCV. PCR products were obtained when adult worms genomic DNA were used as templates while no PCR products were amplified from S. mansoni λZAPII cDNA library pool. The resulting PCR products were sequenced and compared with the other closely related HCV sequence database at the website < http://hcv.lanl.gov>. Conclusions: This work demonstrates the existence of HCV and its replication in the genomic DNA of S. mansoni. In addition, it highlights the fact that the parasite can carry the virus genome and therefore, is considered as a nonhuman vector for the transmission of HCV infections.
  13,115 83 -
Clinical outcome and pattern of recurrence in patients with triple negative breast cancer as compared with non-triple negative breast cancer group
Aramita Saha, Subrata Chattopadhyay, Mohammad Azam, Prabir K Sur
October-December 2012, 1(4):201-205
DOI:10.4103/2278-0513.106256  
Aim: To compare the clinical characteristics and outcomes in terms of survival, propensity and time of local and distant recurrence for women with triple-negative breast cancer (TNBC) to women with non-triple negative breast cancer (NON TNBC). Materials and Methods : A retrospective cohort study was done with 1,026 breast cancer patients with known receptors and Her2neu status diagnosed between January 2005 and January 2011. Statistical Analysis: Comparison of clinical outcomes between the two groups was done using t-tests for mean and chi square tests for frequencies. For overall and recurrence-free survival Kaplan-Meier survival analyses were done. Results: The mean follow-up time for TNBC was 2.9 years and NON TNBC was 4.1 Years. Among the total 1026 patients, 312 patients (30.4%) had TNBC. Compared with non TNBC, those with TNBC had an increased likelihood of death [27.8% vs. 17.8%, P < 0.0008, > 95% confidence interval (CI)], and distant recurrence (41.48% vs. 33.17%; P = 0.02, C I >95%). Visceral metastasis was high in TNBC which showed Brain metastasis (21.11% vs. 6.18%, P < 0.0002), liver metastasis (15.56% vs. 5.02%, P < 0.0002), lung metastasis (25.19% vs. 10.03%, P < 0.0002); while bone metastasis was higher in NON TNBC group (5.2% vs. 20.55%, P < 0.0002). Conclusions: TNBC have a more aggressive clinical course and adverse outcomes as compared to NON-TNBC, but local tumor size and propensity of local recurrence do not vary significantly with receptor status. Though, chance of visceral metastasis is higher in TNBC, bone metastasis is high in NON-TNBC.
  11,667 1,317 3
Fine-needle aspiration cytology and biopsy in hepatic masses: A minimally invasive diagnostic approach
Jitendra G Nasit, Viren Patel, Biren Parikh, Manoj Shah, Kajal Davara
April-June 2013, 2(2):132-142
DOI:10.4103/2278-0513.113636  
Aims and Objective: To evaluate the diagnostic sensitivity, usefulness and limitations of fine-needle aspiration cytology (FNAC) and fine-needle aspiration biopsy (FNAB) in the diagnosis of hepatic masses. Materials and Methods: FNAC was performed on 150 cases of hepatic masses under guidance of ultrasound or computed tomography (CT) scan. Adequate diagnostic aspirates were obtained in 147 cases (98.0%). Smears were stained with hematoxylin and eosin (H and E), and Papanicolaou stains. FNAB was obtained from the same 149 cases (except one) and stained with HE stain. The hepatic masses were categorized into benign, malignant and inflammatory groups. Results: Out of 150 hepatic masses, 3.3% were benign, 94.26% were malignant and 2% were inflammatory lesions. FNAC and FNAB were unsatisfactory for evaluation in 3 out of the 150 cases (2%) and 6 out of 149 cases (4.02%), respectively. Correct cytological diagnoses were achieved in 129 out of the 150 cases (diagnostic sensitivity: 86%). FNAB gave satisfactory results in 143 out of 149 cases (diagnostic sensitivity: 95.77%). Cytological diagnoses of 21 cases were not consistent with histology (false negativity: 14%). Cyto-histological correlation showed 87.32% diagnostic sensitivity of FNAC for malignant tumors, whereas benign tumors posed maximum diagnostic problems, with sensitivity of 40%. This difference was statistically significant (P < 0.05). FNAB showed a statistically significant difference (P < 0.05) compared with FNAC in the diagnosis of benign and malignant hepatic masses. FNAC showed 100% diagnostic sensitivity for inflammatory lesions. Conclusion: Malignant tumors of liver can be confidently diagnosed on FNAC. However, FNAC has a few limitations and diagnostic challenges in benign lesions, well-differentiated and poorly differentiated hepatocellular carcinoma, and metastatic carcinoma. Microhistology by FNAB allows architectural, cellular and immunohistochemical evaluation. To obtain maximum diagnostic information with reduction of indeterminate reports, a combined approach of FNAC and FNAB with clinical findings, tumor markers and ancillary techniques should be used.
  11,716 206 3
CASE REPORTS
Fibroadenoma in male breast: Case report and review
Sunder Goyal, Snigdha Goyal, Aseem Trikha
March-April 2015, 4(2):220-222
DOI:10.4103/2278-0513.152754  
Fibroadenoma is very common in females, but rare in male breast. Gynecomastia and/or lobular differentiation have been known to coexist in both types of fibroepithelial lesion in men. We report a young adult having gynecomastia associated with fibroadenoma.
  10,737 21 -
REVIEW ARTICLE
Vital tissue staining in the diagnosis of oral precancer and cancer: Stains, technique, utility, and reliability
Udyavara Sridhara Sudheendra, Huchanahalli Sheshanna Sreeshyla, Raju Shashidara
March-April 2014, 3(2):141-145
DOI:10.4103/2278-0513.130156  
Early diagnosis is the single most factors that improve the prognosis and survival rate of cancer patients. Numerous adjuncts are available to aid in its diagnosis. Vital tissue staining is one such adjunct used in the diagnosis of cancer. Though not a new technique, its application to cancer diagnosis especially in its premalignant stage is still uncertain. While the efficiency of toluidine blue (TB) is established to certain extent, the role of other vital stains needs to be researched. This article reviews the various vital tissue staining techniques available in the diagnosis of oral precancer and cancer.
  10,020 231 2
REVIEW ARTICLES
Recent advancements in the diagnosis of oral premalignant and malignant lesions: A comprehensive review
Manish Gupta, Manas Gupta, Avanti Aggarwal, Ravish Ahuja
July-September 2013, 2(3):181-184
DOI:10.4103/2278-0513.119249  
The diagnosis and treatment of lesions are currently based on histopathology, which is the gold standard for the diagnosis of cancer and dysplasia at the molecular level. Recently, there has been an increasing trend of optical spectroscopy methods for the detection of oral premalignant and malignant lesions and the same is highlighted in this paper. It depends on the optical spectrum derived from any tissue that contains information about the histological and biochemical make-up of that tissue. It provides tissue diagnosis in real-time, non-invasively, and in situ.
  9,489 704 2
CASE REPORTS
Dentigerous cyst involving mandibular third molar: Conservative treatment with radiologic follow-up and review of literature
Ankit Goel, Prashant Patil, Richa Bansal, Robin Sabharwal
July-September 2013, 2(3):233-236
DOI:10.4103/2278-0513.119266  
Dentigerous cyst is the second most common odontogenic cyst and constitutes around 20-24% of all the odontogenic cysts involving the jaws. Usually, these cysts remain asymptomatic and rarely cause enlargement and displacement of associated tooth. In this paper, we present a case of a displaced mandibular third molar, which was associated with a large dentigerous cyst. A conservative treatment modality was adopted with a 2 year radiographic follow-up of the patient. A brief review of previously reported cases with dentigerous cyst causing displacement of the mandibular impacted third molars is also discussed, highlighting the treatment modality followed in all these cases.
  9,938 169 1
REVIEW ARTICLE
Interventional role of Haridra (Curcuma longa Linn) in cancer
Zankhana M Buch, Jayashree Joshi, Ashok Amonkar, Ashok B Vaidya
April-June 2012, 1(2):45-50
DOI:10.4103/2278-0513.99556  
Haridra (Curcuma longa Linn (Zingiberaceae family)) is a rhizomatous household spice and has been a widely used herb in India since ancient times. Ayurvedic pharmacodynamics of C. longa are described as follows: Rasa - tikta and katu, Guna - rukhsha and laghu, Virya - ushna, Vipak - katu and Doshaghnata - tridoshshamak. It is used as a tonic, carminative, antidiarrheal, hepatoprotective and as a purifying agent. It is also used in cancer management. Since years, haridra has been used as a hemostyptic agent. However, the oncopreventive aspect of haridra has drawn the scientists towards it. Use of haridra in medoja arbuda is documented in Sushrut Samhita. Recently, it has been found that chronic inflammation has played a role in cancer formation. The kapha and vata shamaka property is responsible for the shothghna activity of haridra. Several studies have also proved the anti-inflammatory condition of haridra. The essential oil, containing ar-turmerone, as a major component has been shown to possess anti-inflammatory effect of haridra. Experimental studies 'in vitro and in vivo' in diverse models have also proved the anti-tumor activity of haridra. Curcumin,the chief ingredient, of it is mainly responsible for anticancer property. However other constituents like Turmerone and polysacchrides also play a major role in anti cancer activity. The free radical scavenging activity as well as inhibition of lipid peroxidation by curcumin has been reported by Kuttan et al. The mechanisms underlying the anticancer potential of curcumin are complex. Many reports in literature mention about that work carried out regarding the suppression of proliferation of cells of different tumors. They include the down regulation of transcription factors, inhibiting COX2, LOX, inducible nitric oxide synthase, matrix metalloproteinases 9, cell adhesion molecules along with TNF-α. Curcumin inhibits TNF-α-induced AKT activation whereby levels required for NFkβ gene expression are suppressed. Curcumin suppresses the tumor angiogenesis resulting in regression in the tumor metastatic growth. Goel et al. have shown the inhibition of expression of COX2 in human colon tumor cell line (Vaidya et al.). Kuttan et al. showed that the ethanol extract of turmeric as well as the ointment of curcumin produced remarkable symptomatic relief in 62 patients with external cancerous lesions. Scientists at institute of cytology and preventive oncology (ICPO) based in Noida, UP, have found that curcumin protects body from HPV that is one of the primary causes of cervical cancer. Bhide et al. showed the therapeutic effect of turmeric oil and turmeric oleoresin on oral submucous fibrosis (SMF) patients. At MRC KHS, a cervical cancer prevention study was approved by an independent ethics committee. The primary objective was to see whether administration of oral turmeric oil for a period of 12 weeks, resulted in the arrest or regression of the premalignant condition, LGSIL, i.e. low grade squamous intraepithelial lesion as detected by Pap smears during the therapy period. It was observed that the lesion in Pap smears was arrested in 3/19 cases and regressed in 16/19 cases (Joshi et al, Asian Pac J Cancer Prev 2011). Experimental data suggest that curcumin acts at each stage of promotion, progression, and metastasis of cancer. Haridra which has anticancer potential ,can be considered as complementary medicine for cancer treatment as well as prevention.
  9,536 322 -
ORIGINAL ARTICLE
Carcinoma breast related metastatic pleural effusion: A thoracoscopic approach
Chetan Basavaraj Patil, Ankur Gupta, Rakesh Gupta, Ramakant Dixit, Neeraj Gupta, Varna Indushekar
September-October 2015, 4(5):633-636
DOI:10.4103/2278-0513.162246  
Background: Pleural effusions are common and devastating complication of advanced malignancies. Lung and breast cancers cause approximately 75% of all malignant pleural effusions. Pleural effusions associated with carcinoma breast (either malignant or paramalignant) pose diagnostic and therapeutic dilemmas for the treating chest physician. Materials and Methods: In a prospective study of analysis of unexplained pleural effusions, we performed medical thoracoscopy in 9 cases of carcinoma breast between April 2011 and September 2014. All the relevant clinical and paraclinical were collected and analyzed. Results: Sole pleural effusion was the most common radiological finding. This article reviews 9 cases of carcinoma breast patients, who had developed recurrent lymphocytic exudative pleural effusion, within a year of diagnosis. Thoracoscopy was diagnostic in all 9 cases with a histological diagnosis of metastatic carcinoma arising from the breast. Surprisingly malignant cells were negative in pleural fluid of all cases on three consecutive occasions. Conclusion: Carcinoma breast related pleural effusion is a common condition encountered in respiratory medicine and oncology. Thoracoscopic guided pleural biopsy is an effective and safe technique in patients with undiagnosed pleural effusion. It not only gives an accurate diagnosis but also gives a high degree of relationship between thoracoscopic appearance and primary disease or tumor classification.
  9,556 19 2
CASE REPORTS
Umbilical cutaneous nodule: A diagnostic dilemma
Sunder Goyal, Amit Jain, Snigdha Goyal
September-October 2014, 3(5):420-422
DOI:10.4103/2278-0513.138070  
Umbilical cutaneous nodule can be due to infection, skin ailments and tumors. It can be primary or secondary in origin. When it is secondary due to metastasis from visceral malignancy then it is named as Sister Mary Joseph nodule. It can be a presenting symptom and sign of hidden malignancy and thus poses a diagnostic dilemma for physician. Our case presented to us with ulcerated umbilical nodule and subsequent ultrasound revealed accompanied urinary bladder malignancy. Mostly, these nodules are adenocarcinoma but our was an unusual case of transitional cell carcinoma.
  9,288 63 -
ORIGINAL ARTICLES
Clinico-pathological study of breast carcinoma: A prospective two-year study in a tertiary care hospital
Kaushik Saha, Gargi Raychaudhuri, Bitan Kumar Chattopadhyay
January-March 2013, 2(1):34-40
DOI:10.4103/2278-0513.110773  
Background: Breast cancer is the most frequent cancer in female, both in developed and developing regions, and ranks second overall next only to lung cancers. International variation in both incidence and mortality is one of the most striking features of breast cancer. Aims: To assess the clinical profile of the patients of breast carcinoma as well as relevant macroscopic and microscopic features of the mastectomy specimens. Materials and Methods: The present prospective study was carried out on clinically suspected and pre-operative FNAC-confirmed 120 cases of breast carcinoma who were admitted in the department of surgery for mastectomy during the study period of two years. In addition to relevant clinical features, macroscopic and microscopic features of mastectomy specimens were noted. Results: Mean age of the study population was 46.53 years. Most of the patients presented with breast lump with or without other features. Mean tumor size in the study population was 5.91 cm with standard deviation ± 2.59. Most of the cases (90.8%; 109 cases out of 120 cases) were diagnosed as IDC, NOS (Infiltrating ductal carcinoma, not otherwise specified). Mostly (62 cases; 51.7%), we got the histological grade 3 tumors. Lympho-vascular invasion was identified in 25.8% cases (31 cases out of 120 cases). Skin and nipple areola was involved in 15.0% cases (18 cases). Conclusion: IDC, NOS is the most common histologic type of breast cancer in our study population. Most commonly affected age group by breast cancer is 35-50 years. In most of the cases, size of the mass was more than 5 cm involving multiple quadrants of breast and with positive lymph nodes. Histologically, grade 3 tumor is most prevalent in this population.
  7,731 1,550 -
Bone marrow metastasis in nonhematologic malignancies: Data from a cancer hospital
Kriti Chauhan, Monica Jain, Sshruti Grover, Pragya Shukla, Usha Rusia, Rajesh Kumar Grover
March-April 2016, 5(2):103-109
DOI:10.4103/2278-0513.177131  
Background: Bone marrow metastasis by a nonhematologic malignancy signifies advanced stage of disease and confers a poor prognosis. The aim of this study was to analyze clinical presentation, hematological profile, biochemical profile, radiological presentation, and patterns of bone marrow involvement in patients with metastatic nonhematologic malignancies retrospectively. Materials and Methods: Ninety bone marrow procedures were done in cases of nonhematologic malignancies for suspected involvement or as a part of staging procedure. Results: Sixteen out of 90 patients showed metastasis by nonhematologic malignancies. The most common malignancy to metastasize was malignant small round cell tumor (Ewing's sarcoma and rhabdomyosarcoma) followed by carcinoma breast and prostate. The most common clinical presentation was backache, fever anorexia, and abdominal pain. The biochemical findings included raised serum calcium and lactate dehydrogenase. 62.5% had anemia and 37.5% had thrombocytopenia. Leukocytosis was seen in 37.5% of patients. Leukoerythroblastic picture was seen in 43.75% cases. Of the eleven cases where both bone marrow aspirate and biopsies were done, 10 cases showed malignant cells in both. Immunohistochemistry was conclusive in four cases. The combined procedure of aspiration and biopsy gives a higher yield and are essential in patients with suspected bone marrow metastasis in nonhematologic malignancies.
  8,218 19 1
REVIEW ARTICLES
Nuclear medicine in dentistry revisited: New avenues to explore
Vinita Boloor, Rajesh Hosadurga, Sruthy Pratap, Anupama Rao
July-September 2013, 2(3):189-194
DOI:10.4103/2278-0513.119253  
Nuclear medicine and radioactive tracers have considerable application in dental research, because they provide one of the few practical methods for studying the limited metabolic activities of bones and teeth. The ease with which minute amounts of these radioactive materials may be accurately measured and distinguished from the mass of inert element in the tooth is particularly valuable. They are useful in studying many problems of calcification and mineral exchange. There are also opportunities of their use in investigating fluorosis, caries protection, periodontal disease, micro leakage studies of dental materials, root resorption, nutritional, and endocrine effects, as well as numerous other dental problems. Other usages of nuclear medicine in dentistry are listed below: Age written in teeth by nuclear tests, scintigraphic evaluation of osteoblastic activity, and evaluation of osteoblastic activity around dental implants using bone scintigraphy. Nuclear medicine can be an indicator of "active" alveolar bone loss. Nuclear medicine techniques are used as an adjunct for the diagnosis of oral diseases (benign tumors and carcinomas) and temporomandibular joint disease. This review article discusses these indications of nuclear medicine.
  7,563 227 -
CASE REPORTS
Anaplastic cerebral hemangiopericytoma: Rare variant of a rare disease
Purnima Thakur, Mukesh Sharma, Manish Gupta, Debajyoti Chatterjee, Vikas Fotedar
March-April 2015, 4(2):277-279
DOI:10.4103/2278-0513.148978  
Intracranial hemangiopericytoma (HPC) is a rare tumor of central nervous system, anaplastic type (grade 3) being the rarest. HPC closely mimics meningiomas in clinical and radiological features, thus, its diagnosis and treatment is a challenge. We report a rare case of histopathologically diagnosed anaplastic HPC of frontal lobe of the brain. A lady in her 60's presented with neurological signs of impaired memory, headache, decreased vision and slurring of speech that gradually progressed to aphasia over a period of 2 months. A space occupying lesion was identified on magnetic resonance imaging in the left frontal region. Left frontal craniotomy and Simpson grade 1 excision of the tumor was done. Postoperative radiotherapy was administered in view of positive margins on histopathological specimen. We describe the clinical, radiological, and histological features of this tumor, its outcome on completion of treatment and on subsequent follow-up along with a review of the literature.
  7,166 23 -
ORIGINAL ARTICLES
Cytological evaluation of enlarged lymph nodes in metastatic disease: A hospital-based assessment
Ghazala Mehdi, Amit Kumar Singh, Mahboob Hasan, Hena A Ansari, Suhailur Rehman, Sadaf Mirza, Rana K Sherwani
March-April 2015, 4(2):152-157
DOI:10.4103/2278-0513.152736  
Background: Lymphadenopathy is a heterogeneous entity with many underlying causes, ranging from self-limiting benign disease to severe neoplastic proliferations. Fine-needle aspiration is a cost-effective and reliable tool for initial investigation of enlarged lymph nodes. Materials and Methods: A study was conducted on 326 patients with metastatic disease in order to evaluate the efficacy of cytology in diagnosing malignancies metastatizing to the lymph node and predicting their primary origin as well as to find the relative frequency of different malignancies. The findings were also correlated with histopathology. Results: Cervical lymph nodes were the most frequently involved group, followed by axillary, supraclavicular, and inguinal lymph nodes. Squamous cell carcinoma (SCC) and adenocarcinoma were the most common cytological diagnosis. Among the cases with known primary tumors, head and neck was the most common site followed by breast carcinoma. Most common lymph node group to be aspirated in cases with unknown primary was cervical lymph node, and SCC was most frequently diagnosed cases. Sensitivity and positive predictive value of cytological diagnosis were calculated to be 100% and 93.1%, respectively. Conclusion: Fine-needle aspiration cytology has a very high sensitivity and positive predictive value and hence, a presumptive diagnosis can be made along with the detection of the primary site in case of metastatic disease.
  7,103 19 -
REVIEW ARTICLES
Volumetric intensity modulated arc therapy in lung cancer: Current literature review
Suresh B Rana
January-March 2013, 2(1):9-13
DOI:10.4103/2278-0513.110758  
The volumetric intensity modulated arc therapy (VMAT) is a novel radiation technique that delivers a highly conformal radiation dose to the target by allowing the simultaneous variation of gantry rotation speed, dose rate and multiple-leaf collimators leaf positions. The aim of this study was to review the current literature on two VMAT systems, RapidArc and SmartArc with main focus on planning studies of lung cancer. A systematic review of available data was conducted using MEDLINE/PubMed with the keywords ''lung'' and "VMAT". The published data show that VMAT techniques have clear superiority over three-dimensional conformal radiation therapy with regard to improving dose conformity and sparing of organs at risks (OARs). The data indicates that for lung tumor VMAT and intensity modulated radiation therapy (IMRT) provide equivalent dose homogeneity, dose conformity and target volume coverage; however, contradictory results were obtained in terms of OARs sparing. The major advantages of VMAT over IMRT are the reduction in the number of monitor units and faster treatment delivery times without compromising the quality of the treatment plans. Moreover, faster delivery time is more patient-friendly and it minimizes intra-fractional patient motion allowing treatment volumes stay within their respective treatment margins. Current literature data shows that VMAT can be a good option to treat lung cancer; however, data on clinical trials are still lacking. The clinical trials are essential to confirm the safety and efficacy of VMAT techniques.
  6,179 868 2
CASE REPORTS
Giant cell tumor of ilium: An unusual location
Satyavir K Mathur, Monika Garg, Divya Sethi, Sheena Khetarpal
April-June 2012, 1(2):80-82
DOI:10.4103/2278-0513.99572  
Giant-cell tumor (GCT) is a histologically benign, locally aggressive tumor that typically affects the ends of long bones, most commonly involving distal femur, proximal tibia, distal radius, and proximal humerus in the order of frequency. The involvement of flat bones of pelvis is extremely rare. We herein describe the unusual case of histologically benign GCT at ilium distinguished by marked destructive features on X-ray, CT, MRI, and histological examination necessitating hemi-pelvectomy in a 15-year-old female. Characteristics features of the giant cell tumor and its treatment options are reviewed.
  6,238 169 1
Fibroadenoma of axillary ectopic breast tissue: A rare clinical entity
Sunder Goyal, Ritu Bawa, Sudeep Sangwan, Prem Singh
May-June 2014, 3(3):242-244
DOI:10.4103/2278-0513.132120  
Supernumerary breast or polymastia is a well-documented anomaly of the breast and commonly presents along the embryonic milk line extending between the axilla and groin. Reported incidence of accessory breast is 0.4-6% in females. During 2 years period, we encountered only two cases out of twenty cases of axillary lumps. We present one case of fibroadenoma in ectopic breast tissue (EBT) in axilla. Ectopic breast denotes breast tissue at more than two pectoral regions, which is mostly benign but at times can be malignant. EBT is at a greater risk of malignancy. Fibroadenoma of ectopic axillary breast tissue (EBT) is quiet rare, but should always be kept in mind for differential diagnosis of an axillary mass.
  6,234 84 1
ORIGINAL ARTICLES
Tumor angiogenesis: A potential marker of the ongoing process of malignant transformation in leukoplakia patients, removing the veil
Mubeen Khan, Abhishek Singh Nayyar, HC Gayitri, UD Bafna, Siddique Ahmed
July-September 2012, 1(3):127-134
DOI:10.4103/2278-0513.102880  
Context: The diagnosis of malignant and potentially malignant epithelial lesions of the oral mucosa is based on a careful histologic evaluation of a representative biopsy specimen. The site for the biopsy, however, is always a subjective choice that raises doubts about its representativeness. So far, no simple and reliable method is available for selecting the most appropriate area for biopsy. Colposcopy, a well-known gynecological diagnostic procedure, is helpful in the selection of these sites of epithelial dysplasia depending upon the vascular patterns. Aims: The present study aimed at assessing the vascular patterns by colposcopic findings and selecting the biopsy site in leukoplakia patients and compared the two methods, clinical criteria, and colposcopic examination, for selecting the biopsy site. Settings and Design: Sixty patients between the ages of 30-60 years clinically diagnosed with leukoplakia were included in the study. Materials and Methods: For each of the subject, a thorough clinical examination was carried out followed by colpospopic examination for the selection of biopsy site. The histopathological findings were then compared in the two cases. Statistical Analysis Used: The statistical analysis was done using paired t-test. Results: Based on clinical criteria, a sensitivity of 0.5714 (57%) and a specificity of 0.5000 (50%) and that guided by colposcopic examination to be 0.8571 (85%) and 0.6667 (66%), respectively, was found. Conclusions: From the study, it was concluded that colposcopic examination could prove to be a valuable diagnostic adjunct in the selection of biopsy site for leukoplakia patients.
  6,108 199 1
CASE REPORTS
Malignant Brenner tumor of ovary: A rare entity
Ashok Sangwaiya, Shilpa Garg, Shivani Kalhan, Rahul N Satarkar, Pawan Singh, Manmeet Kaur Gill
July-August 2015, 4(4):584-586
DOI:10.4103/2278-0513.157821  
Worldwide, ovarian carcinoma continues to be responsible for more deaths than all other gynecologic malignancies. It usually occurs in older women and the average age at presentation is 50 years. Brenner tumor of the ovary is very rare, mostly benign, small, and unilateral. Malignant Brenner tumor is much rarer. These tumors are believed to arise from urothelial metaplasia of ovarian surface epithelium. Malignant Brenner tumor of ovary closely resembles the transitional cell carcinoma of ovary. They must be differentiated because the latter has a worse prognosis. A case of unilateral malignant Brenner tumor in a postmenopausal woman is reported here and its features are briefly discussed.
  6,131 22 -
Malignancy in pilonidal disease: Uncommon occurrence
Snigdha Goyal, Sunder Goyal, Monika Garg
April-June 2013, 2(2):153-155
DOI:10.4103/2278-0513.113640  
Development of malignancy in pilonidal sinus is a rare complication. The disease occurs most frequently in men. About 69 cases have been reported so far in literature. The lesion is mostly a well-differentiated squamous cell carcinoma. Best treatment is local wide excisions along with a short period of local wound care. After healthy granulation tissue, definitive closure of the defect is done with rotational flaps or skin grafts. Fine needle aspiration cytology is mandatory for palpable inguinal nodes. The prognosis is very poor if inguinal node has metastatic deposits. Radiation therapy may be used as palliative therapy for local bone or soft tissue recurrences. Recently, both topical and systemic chemotherapy have been used without promising results.
  6,008 76 -
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