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   2012| April-June  | Volume 1 | Issue 2  
    Online since August 10, 2012

 
 
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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.
  9,160 322 -
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.
  6,084 169 1
Diagnostic significance of Peutz-Jeghers syndrome: A case report with oral physician's perspective
Divya Ananda, Natarajan Kannan, Rajendra Patil, Venkata Sarath, Jayaprakash S Gadagi
April-June 2012, 1(2):74-76
DOI:10.4103/2278-0513.99567  
Peutz-Jeghers syndrome is a genetic disorder characterized by intestinal polyposis and pigmentation of skin and mucous membrane. Gastrointestinal polyps are considered as premalignant and also the occurrence of rare malignancies at nongastrointestinal sites is high in these patients. This article demonstrates the importance of oral physician in the diagnosis of this inherited syndrome, thereby minimizing the morbidity in a young male patient who presented with multifocal pigmentation.
  4,129 181 -
Psoas abscess like metastasis mimicking Koch's spine
Dhiraj V Sonawane, Sanjay A Jagtap, Ambarish A Mathesul, Tushar N Rathod
April-June 2012, 1(2):103-105
DOI:10.4103/2278-0513.99584  
In endemic country like India, psoas abscess is commonly associated with dorsolumbar tuberculosis. A 56-year-old HIV-negative female treated case of carcinoma of cervix presented to rural hospital with psoas abscess like lesion and vertebral involvement. Patient was managed as tuberculosis of lumbar spine. Patient presented to us after 1 year with progressive neurodefecit and huge psoas abscess. USG-guided FNAC of psoas abscess revealed squamous malignant cell. This was recurrence of the operated FIGO stage 1b carcinoma of cervix, presenting as metastasis to lumbar spine and psoas muscle. We report a rare case of cervical carcinoma in HIV-negative women presenting as lumbar vertebra involvement and psoas abscess like metastasis initially managed as tuberculosis of spine. This case report also highlights possible errors that could be made in such rare cases.
  3,189 162 1
ORIGINAL ARTICLES
Cancerogenesis in colorectal neoplasms: Evidence from early onset colorectal cancer
Mahsa Molaei, Babak Khoshkrood Mansoori, Somayeh Ghiasi, Fatemeh Nemati, Shohreh Almasi, Seyed Reza Fatemi, Ali Ghanbari Motlagh, Mohammad Reza Zali
April-June 2012, 1(2):57-64
DOI:10.4103/2278-0513.99562  
Objective: Majority of colorectal cancers (CRC) happen via two distinct mechanisms of genomic instability: chromosomal and microsatellite instability. The proportion to which colorectal cancers belong to these pathways is well addressed in literature. However, there is much paucity and controversy regarding this proportion in early onset CRC; therefore, in the present study, major proteins involved in chromosomal and microsatellite instability pathways were determined in 104 early-onset CRC specimens. Materials and Methods: Outcome measures comprised expression of 4 mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, PMS2), and two representative proteins of chromosomal instability pathway (P53 and β-catenin), which were determined by immunohistochemistry. Results: Twenty-nine cases (27.9%) had loss of expression of MMR proteins, of which 17 belonged to MutSα pathway and 12 to MutLα. Four tumors had solitary loss of PMS2. Tumors with abnormal MMR status were more likely to be right sided, and occurred mainly in familial setting (P<0.05). Seventy-four specimens (71.2%) had abnormal expression of P53 or β-catenin, of which 58 had P53 over-expression and 32 had abnormal β-catenin expression. There was an inverse association between P53 over-expression and abnormal MMR status (P<0.05). Conclusions: Taken together, our study demonstrated that loss of expression of MMR proteins happens more frequently in early-onset CRC, and on the contrary, the role of CIN pathway is less highlighted at the same time. Moreover, because of its ability to track the losses of expression of PMS2, IHC is recommended for determining the eligibility of mutation analysis of MMR genes, especially in younger ages.
  3,108 203 2
Low power ultrasound inhibits cell proliferation and invasion of human cancer cells in vitro
Etienne Mfoumou, Sivakumar Narayanswamy, Ion Stiharu, Ala-Eddin Al Moustafa
April-June 2012, 1(2):51-56
DOI:10.4103/2278-0513.99558  
Background: Applications of ultrasound in medicine for therapeutic purposes have been accepted, and they have several beneficial uses for many years. However, the outcome of low power ultrasound waves on cell proliferation, especially cell cycle progression and invasion as well as their associated genes on human breast and cervical cancer cells has not been investigated yet. Therefore, we examined the effect of low power ultrasound on BT20, BT20-E6/E7 and HeLa cell lines. Materials and Methods: BT20, BT20-E6/E7 and HeLa cell lines were used in this study. On the other hand, cell proliferation, cell cycle, and invasion assays were applied to study the effect of low ultrasound irradiation on these cell lines. Meanwhile, western blot was performed to study the expression patterns of some selected genes associated with this effect. Results: We found that low power ultrasound inhibits cell proliferation and provokes G0-G1 cell cycle arrest and reduction of S as well as an increase in the G2-M phase of HeLa cells in comparison with the untreated cells. This is accompanied by a down-regulation of Cdk-6 (cyclin dependent kinase) which is a major control switch for the cell cycle. Moreover, low power ultrasound inhibits cell invasion and consequently down-regulates the expression of Id-1, caveolin, and EGF-R which are widely considered as main regulators of cell invasion and metastasis of human cancer. Conclusion: These results suggest that application of low power ultrasound on human breast and cervical cancer could be an effective method to reduce cell proliferation and invasion of these cancers.
  2,937 210 1
CASE REPORTS
Poland syndrome and renal cell cancer
Ruken Yuksekkaya, Fatih Celikyay, Caglar Deniz, Berat Acu
April-June 2012, 1(2):77-79
DOI:10.4103/2278-0513.99570  
Poland's syndrome is a rare congenital anomaly characterized by chest wall and upper limb abnormalities. Some lymphreticular and solid malignancies have been reported with this syndrome. Renal cell carcinoma associated with Poland's syndrome has not been described previously. We herein describe the first case of a Poland's syndrome associated with renal cell carcinoma diagnosed incidentally after a road accident. All the cases with Poland's syndrome should be aware of onchologic attention by the radiologists and clinicians.
  2,716 304 2
ORIGINAL ARTICLES
An evaluation of three dimensional conformal radiation therapy versus intensity modulated radiation therapy in radical chemoradiation of esophageal cancer: A dosimetric study
Soumik Ghosh, Rakesh Kapoor, Rajesh Gupta, Divya Khosla, Rakesh Kochhar, Arun S Oinam, Reena Sharma, Suresh C Sharma
April-June 2012, 1(2):65-70
DOI:10.4103/2278-0513.99565  
Aims: To evaluate the feasibility whether intensity-modulated radiotherapy (IMRT) can be used to reduce doses to normal thoracic structures than three-dimensional conformal radiotherapy (3DCRT) in treating esophageal cancer and to compare normal tissue complication probability (NTCP) for lung between two treatment plans. Materials and Methods: A prospective study was carried out from 2009 to 2011, in which 15 inoperable patients of esophageal cancer who were suitable for radical chemoradiation were enrolled. All patients were treated with 3DCRT. In first phase, patients were treated with external beam radiation therapy (EBRT) dose of 36Gy in 20 fractions in 4 weeks, along with concurrent weekly chemotherapy with cisplatinum and 5-fluorouracil (5 FU). In second phase, boost dose of 18Gy in 10 fractions in 2 weeks was given. An IMRT plan was generated for each patient. Plan sum of both the 3D CRT and IMRT plans were compared. Doses to critical structures and NTCP for lung were compared between 3DCRT and IMRT plans. Results: The mean lung dose and volumes of lung receiving 20 Gy, 10 Gy, and 5 Gy (V20, V10, and V5) were significantly lower with 3DCRT plans as compared to IMRT plans. The mean dose to heart and spinal cord was higher in 3DCRT arm. There was no difference in dose distribution to the liver between the 3D CRT and IMRT techniques. The NTCP for lung was lower with 3D CRT than IMRT. Conclusion: IMRT technique needs further dosimetric study as well as further clinical trials before implication of this technique replacing 3D CRT technique with escalated dose for the treatment of esophageal cancer in our setup. IMRT using seven fields provided no improvement over 3DCRT.
  2,746 217 1
CASE REPORTS
Sclerosing mucoepidermoid carcinoma of the submandibular gland: Report of two rare cases
Kavita Mardi, Siddharth Madan
April-June 2012, 1(2):86-88
DOI:10.4103/2278-0513.99575  
Although mucoepidermoid carcinoma is the most common primary malignancy of the salivary glands, the sclerosing morphologic variant of this tumor is extremely rare, with only 15 reported cases. As its name suggests, sclerosing mucoepidermoid carcinoma is characterized by an intense central sclerosis that occupies the entirety of an otherwise typical tumor, frequently with an inflammatory infiltrate of plasma cells, eosinophils, and/or lymphocytes at its peripheral regions. The sclerosis associated with these tumors may obscure their typical morphologic features and result in diagnostic difficulties. Two cases of mucoepidermoid carcinoma of the submandibular gland associated with extensive central sclerosis and peripheral lymphoid response are reported. This unusual but distinctive variant of mucoepidermoid carcinoma can be difficult to recognize and may be confused with chronic sialoadenitis or even metastasis to an intra-parotid lymph node.
  2,477 159 2
Renal angiomyolipoma: A radiopathological diagnosis
Divya Sethi, Charanjeet Ahluvalia, Sheena Khetarpal, Himanshu Arora
April-June 2012, 1(2):100-102
DOI:10.4103/2278-0513.99582  
Angiomyolipoma (AML) is a benign renal neoplasm derived from perivascular epithelioid cells and composed of fat, and vascular and smooth muscle element besides spindle cells. It has an incidence of 0.3 - 3% and has increased due to advances in imaging modalities. The overall female to male ratio is approximately 4:1 which is suggesting hormonal component to tumor growth. It can occur sporadically or may be associated with tuberous sclerosis complex. We present a case of renal angiomyolipoma in a 28 year old woman who presented with symptoms of pain off and on and the diagnosis was based on the computed tomography and was confirmed on histopathology.
  2,437 159 -
Intrapericardial immature teratoma in the new-born
Kavita Mardi, Shailja Puri, Ashish Chaudhary
April-June 2012, 1(2):106-108
DOI:10.4103/2278-0513.99586  
Intrapericardial teratomas are rare causes of mediastinal masses in children. Pericardial teratoma is a potentially curable lesion that may become life threatening when it induces mediastinal compression and fetal hydrops. Majority of the reported cases have been diagnosed prenatally. We report a case of an infant with intrapericardial immature teratoma, which was detected in a newborn infant presenting with respiratory distress. The tumor was excised completely, and histopathological examination of the resected tumor was suggestive of immature teratoma. The patient was asymptomatic three months postoperatively.
  2,276 136 1
Metastatic balloon cell melanoma-a rare differential in the diagnosis of clear cell tumors: Report of two cases
Kavita Mardi, Vijay Kaushal, Neha Bakshi
April-June 2012, 1(2):89-91
DOI:10.4103/2278-0513.99576  
Two patients aged 65 and 66 years old presented with an enlarged inguinal lymph node. Clinically and radiographically, the inguinal mass was considered to be metastatic; however, first patient had no history of primary neoplasm. A fine-needle aspiration (FNA) cytologic examination of inguinal lymph node in both the cases showed numerous discohesive, pleomophic tumor cells with abundant, vacuolated cytoplasm and eccentrically placed round to ovoid nucleus with inconspicuous nucleoli and frequent intranuclear cytoplasmic pseudoinclusions. Pigment was not identified in the FNA of both the cases. Histopathological examination of the inguinal lymph node biopsy confirmed the diagnosis. These features, along with strong immunohistochemical positivity for HMB-45, suggested the diagnosis of metastatic balloon cell melanoma.
  2,260 124 1
Metastatic breast lump: A rare presentation of squamous cell lung cancer
Amitabha Sengupta, Kaushik Saha, Debraj Jash, Sourindra N Banerjee
April-June 2012, 1(2):97-99
DOI:10.4103/2278-0513.99581  
Breast metastases from extramammary neoplasm are uncommon with an incidence of 0.5% to 3% of patients with extramammary malignancy. We reported an extremely rare case of breast metastasis from squamous cell lung carcinoma. A 60-year-old woman suffered from dry cough with shortness breath for one month with simultaneous development of breast lump. The histological diagnosis, achieved by bronchoscopic lung biopsy with the aid of immunohistochemistry was squamous cell lung carcinoma. Breast lump was a metastasis from lung, confirmed by histopathology and immunohistochemistry after core needle biopsy. Secondary malignancy metastatic to the breast is uncommon, yet this entity does exist. In view of the therapeutic implication, a metastatic breast lesion should not be mistaken for a primary breast carcinoma. Only with the awareness of such a possibility can prompt diagnosis and optimal treatment be achieved.
  1,938 132 -
LETTER TO THE EDITOR
Operable breast cancer in a young female: A rare presentation
Rikki Singal, Samita Gupta
April-June 2012, 1(2):109-110
DOI:10.4103/2278-0513.99588  
  1,829 139 -
CASE REPORTS
De-novo squamous cell carcinoma of an edentulous ridge
Harkanwal P Singh, Prince Kumar, Palakk Aggarwal, Roshni Goel
April-June 2012, 1(2):83-85
DOI:10.4103/2278-0513.99574  
Squamous cell carcinoma is the most common malignancy affecting the oral cavity which is usually associated with habit of smoking and smokeless tobacco. It occurs more frequently in males, usually in the 5 th -6 th decade of life. The current case is presented in an elderly female with no habit history and the diagnosis was based on the clinical and histopathological examination. Hence, we emphasize that patients with ulcers without any habit history should not be overlooked, and biopsy is deemed necessary for such cases.
  1,777 165 -
Declining total leucoyte count, an indication of transient abnormal myelopoisis
Yogesh K Yadav, Varuna Mallya, Oneal Gupta
April-June 2012, 1(2):94-96
DOI:10.4103/2278-0513.99580  
Neonates with Down syndrome have an increased predisposition to transient abnormal myelopoisis, a haematological abnormality which is characterized by uncontrolled proliferation of myeloblasts. The unique ability of this disorder to spontaneously enter in to a state of remission led to the creation of a new class in 2008 World Health Organization (W.H.O.) classification of haemopoitic and lymphoid tumours. It has now been classified as transient abnormal myelopoisis (TAM). The cause of remission is still not clear although it is possibly linked to the abnormal expression of GATA-1 transcription factor and to a switch from hepatic haematopoesis to medullary haematopoesis. Simple laboratory monitoring by serial complete blood count and peripheral smear can give indication of this rare disorder. As very few cases of this disorder exist we share our experience and report a case of transient myeloproliferative disorder in a male newborn having Down syndrome.
  1,676 130 -
Cytodiagnosis of serous oligocystic adenoma of the pancreas with an unusual clinical presentation
Kannusamy Bharathi, Subramaniyam Anuradha
April-June 2012, 1(2):71-73
DOI:10.4103/2278-0513.99566  
Benign serous oligocystic adenoma, also known as "macrocystic adenoma" is a rare variant of serous cystadenoma of exocrine pancreas which often mimics a malignant tumor clinically as well as radiologically. It has no age or sex predilection and occurs in children also. Here we report a case of serous oligocystic adenoma of 12 cm diameter occurring in a young female, located in the head of pancreas. She presented with a mass abdomen and progressive obstructive jaundice. Clinical and radiological findings simulated a pancreatic carcinoma. Preoperative ultrasound-guided trans-abdominal fine-needle aspiration cytology was done which revealed groups of bland epithelial cells with round nucleus. A benign cystic epithelial neoplasm was diagnosed through cytological features. The patient underwent surgery and the neoplasm was enucleated sparing the major portion of pancreas. Postoperative period was uneventful. Histopathology examination of the specimen confirmed it as "serous oligocystic adenoma of the pancreas." It is essential to diagnose serous oligocystic adenoma preoperatively through cytology to avert a major surgery and the uninvolved pancreas can be spared.
  1,566 116 -
Primary neuroblastoma of ovary in an adult: A case report and review of literature
Kumari Shobha, Uttamchand D Bafna, Uma K Devi, Usha Amirtham
April-June 2012, 1(2):92-93
DOI:10.4103/2278-0513.99577  
Primary neuroblastoma of ovary is an extremely rare case. We present a case of a 26-year-old female with pain abdomen and right ovarian mass for which surgery was done. Histopathology revealed primary neuroblastoma without other elements of teratoma/neuroectodermal tissue. She later received adjuvant chemotherapy and is in follow-up for 13 months and is currently disease-free.
  1,421 115 -
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