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   2012| October-December  | Volume 1 | Issue 4  
    Online since January 21, 2013

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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
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.
  11,566 1,317 2
Squamous cell carcinoma of the alveolus and buccal mucosa in a renal transplant recipient on long-term immunosuppression
Tamojit Chaudhuri, Kamlesh Yadava
October-December 2012, 1(4):245-247
An increased risk of skin, head-neck (particularly lip) and lymphoreticular malignancies is well documented in renal transplant patients receiving long-term immunosuppressive therapy, but squamous cell carcinoma of the alveolus and buccal mucosa has not been reported previously in these patients.
  4,708 115 -
Oral cancer as a leading annoyance of the South Asian territory: An epidemiologic and clinical review
Vineet Gupta, Puneet Kumar, Prince Kumar, Suresh Yadav, Ashish Khattar, Shallu Tyagi
October-December 2012, 1(4):196-200
Oral cancer is one of the most fatal health problems faced by the mankind today. In India, because of cultural, ethnic, geographic factors, and the popularity of addictive habits, the frequency of oral cancer is high. It ranks number one in terms of incidence among men and third among women. Several factors such as tobacco and tobacco-related products, alcohol, genetic predisposition, and hormonal factors are suspected as possible causative factors. The exciting opportunity provided by the well-established oral precancerous lesions for intervention and early detection programs is also discussed. The poor survival revealed by existing studies is mainly due to the overwhelming proportion of advanced cases. The excellent opportunity for more research and efforts in prevention and control of oral cancer in India is highlighted in this review. Here authors sought to epidemiologically review oral cancer in South Asian province with special focus on major risk factors and future perspectives.
  4,541 181 1
Feasibility of Simultaneous Integrated Boost Intensity Modulated Radiotherapy treatment plans in patients with localized carcinoma prostate
Anshuma Bansal, Rakesh Kapoor, Narendra Kumar, Arun S Oinam, Suresh C Sharma
October-December 2012, 1(4):206-211
Aim: To dosimeterically analyze Simultaneous Integrated Boost Intensity Modulated Radiotherapy (SIB-IMRT) treatment plan in prostate cancer patients, in terms of target coverage and dose to organs at risk. To determine radiobiological effect of this technique on target and normal tissues using Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP). Materials and Methods: Twenty patients with localized prostate cancer were enrolled. In all, the target consisted of PTV P + SV (Prostate and seminal vesicles) and PTV LN (lymph nodes) where PTV refers to planning target volume and the critical structures included: bladder, rectum, small bowel, penile bulb and bilateral femoral heads. For all patients, SIB IMRT plan was created. The prescription dose to the PTV P + SV is 74 Gy delivered in 27 fractions over 5.5 weeks and the dose to PTV LN is 54 Gy delivered in 27 fractions over 5.5 weeks. The treatment plan was analyzed in terms of their dose-volume histograms, target volume covered by 95% of the prescription dose (V 95%), and maximum and mean structure doses (Dmax and Dmean). Also an analysis was done on TCP and NTCP obtained with the plan. NTCP was calculated by Lyman Kutcher Burman (LKB) model. Results: All the critical structures received doses within the dose constraints specified for the SIB IMRT plan. The volume of rectum and bladder receiving 65 Gy or more (V > 65 Gy) was 18.23% and 24.05%. The mean doses to both bladder and rectum were 59 ± 3 Gy and 57 ± 4 Gy respectively. NTCP of 0.01 ± 0.02% for bladder, 4.31 ± 2.61% for rectum and 8.25 ± 7.98% for small bowel was achieved with SIB-IMRT plans. Conclusions: SIB-IMRT is dosimetrically and radiobiologically feasible treatment technique for prostate cancer IMRT.
  4,240 199 -
Trastuzumab-induced pulmonaryfibrosis: A case report and review of literature
Tamojit Chaudhuri, Saurabh Karmakar
October-December 2012, 1(4):242-244
Optimal treatment for human epidermal growth factor receptor 2 (HER2)/neu-positive, node-positive early breast cancer should include the monoclonal antibody trastuzumab. This relatively new targeted agent has shown very limited pulmonary toxicity. We report a case of Trastuzumab-induced pulmonary fibrosis in a 41-year-old female that occurred 4 months after starting adjuvant trastuzumab. To the best of our knowledge, this is the first ever report of trastuzumab-induced pulmonary fibrosis in the world of medical literature.
  3,302 139 2
Primary clear cell adenocarcinoma of the uterine cervix in a young woman not associated with diethylstilbestrol: A case report and review of literature
Tamojit Chaudhuri, Deepti Sharma
October-December 2012, 1(4):239-241
We report an extremely rare case of primary clear cell adenocarcinoma (CCA) of the uterine cervix in a 21-year-old Asian female, with no maternal history of diethylstilbestrol ingestion during pregnancy. A review of the relevant literature regarding the possible etiology and treatment of primary CCA of cervix is done.
  3,285 153 -
Fasting inhibits human cancer progression via the epithelial-mesenchymal transition process: Important evidence unraveled
Ala-Eddin Al Moustafa
October-December 2012, 1(4):181-183
Metastatic cancer disease is responsible for the majority of cancer-related deaths in human cancer patients. In parallel, recently it was pointed-out that fasting could play an important role during cancer treatment and progression via the deregulation of insulin-like growth factor-1 (IGF-1) as well as others growth factors and genes. Meanwhile, it is established that the epithelial-mesenchymal transition (EMT) is a major process for the progression of cancer cells from non-invasive to invasive form. We believe that fasting can inhibit cancer progression and metastasis though the reduction of IGF-1 level and consequently the inhibition of EMT; in this paper, we present some evidence to confirm this association.
  2,812 213 -
Imperative role of early diagnosis in precancerous lesions: Oldideas, new findings, yet more questions
Puneet Kumar, Roshni Dupare, Prince Kumar, Harkanwal P Singh, Suresh Yadav, Shallu Tyagi
October-December 2012, 1(4):184-189
In India, cancers of the oral cavity and oropharynx are most common of all malignancies. Over 90% of these tumors are squamous cell carcinomas (SCCs), which arise from the oral mucosal lining. In spite of the ready accessibility of the oral cavity to direct examination, these malignancies still are often not detected until a late stage, and the survival rate for oral cancer has remained essentially unchanged over the past three decades. The purpose of this article is to review the clinical features of premalignant oral lesions, with an emphasis on early detection.
  2,751 196 1
The challenge of relapsed/refractory myeloma: An emerging role of bortezomib
Bhargav Vyasa, Arun Maseeh
October-December 2012, 1(4):190-195
The treatment of multiple myeloma (MM) has undergone significant developments in recent years. The availability of the novel agents includes thalidomide and its analogs, proteasome inhibitors, arsenic trioxide, farnesyltransferase inhibitors 2-methoxyestradiol and lenalidomide has extended treatment options and has improved the outcome and quality of life of patients with MM. This review presents the totality of evidence through a systematic review that assessed the efficacy, safety or toxicity of bortezomib in patients with relapsed/refractory myeloma with or without concomitant complications. This review has precisely covered the role of bortezomib in patients with relapsed/refractory myeloma and not the newly detected populace.
  2,551 203 -
Gastric lipoma presenting as obstruction: Role of intraoperative frozen section in diagnosis
Susan Cherian, Aradhana Mishra, Richa D Patel, Nitin P Chikhale
October-December 2012, 1(4):254-256
Lipomas are benign tumors of adipose tissue. Lipomas are rare in the gastrointestinal tract, located mostly in the colon. Gastric lipomas are very rare constituting 5% of all gastrointestinal lipomas. We report a case of a large submucosal gastric lipoma presenting with features of gastric obstruction. The frequency of gastric lipoma, its differential diagnosis, means of diagnosis, and treatment are discussed.
  2,232 91 -
Tobacco overexploitation in India: An issue urgently to be addressed
Prince Kumar, Ashish Khattar, Roshni Goel, Ashish Kumar
October-December 2012, 1(4):261-262
  1,872 97 -
Infiltrative optic neuropathy as an initial presentation of acute lymphoblastic leukemia
Tamojit Chaudhuri, Somnath Roy, Parag Roy
October-December 2012, 1(4):262-263
  1,755 138 -
Efficacy of Cytokeratin 19 expression on fine needle aspiration cell blocks in pre-operative diagnosis of malignant thyroid neoplasms
Vimal Bhandari, Yogesh K Yadav, Geetika Khanna, Mrinalini Sharma, Mohit Singh, Rajni
October-December 2012, 1(4):212-216
Context: Accurate diagnosis of malignant lesions of thyroid remains a challenge, especially when classical features are lacking on cytological examination. Aims: To evaluate the expression of Cytokeratin 19 (CK 19) on cell blocks made from thyroid swellings diagnosed as papillary carcinoma or follicular adenoma/carcinoma on fine needle aspiration cytology (FNAC) smears. Materials and Methods: Aspirates from fifty patients diagnosed as papillary or follicular lesions on FNAC were enrolled in the study. Cell blocks were simultaneously made along with aspiration using standard cell block techniques. These cell blocks were subjected to Cytokeratin 19 immunoassay using immunoperoxidase ABC (avidin biotin complex). Statistical Analysis Used: Chi-square test for statistical significance and Goldman test for sensitivity and specificity. Results: Evaluation of the expression of Cytokeratin 19 on cell blocks revealed that almost all papillary thyroid carcinomas stained strongly positive while all follicular adenomas and follicular carcinomas were found to be negative for CK 19 immunostaining. The difference in frequency of Cytokeratin 19 positive papillary carcinoma and follicular adenomas was statistically significant. The predictive value of a positive CK 19 test was found to be 100% while that of a negative test was 93.9%. Conclusions: Cytokeratin 19 immunostaining in conjunction with fine needle aspiration cell blocks can be a valuable marker in pre-operative diagnosis of papillary thyroid carcinoma along with its variants (sclerosing and follicular). This can help the clinician in formulation of treatment as papillary thyroid carcinoma is treated by radical measures as against the more conservative approach for benign follicular lesions.
  1,693 127 1
Mediastinal thymoma in children: A cytological diagnosis
Sheena Khetarpal, Sumiti Gupta, Jyotsna Sen, Rajeev Sen, Divya Sethi
October-December 2012, 1(4):251-253
Mediastinal masses in children comprise a heterogeneous group of malignant and benign neoplasms. The majority of malignant tumors of mediastinum are Hodgkins and non-Hodgkins lymphomas, germ cell tumors, and neuroblastomas. Thymomas, thymic carcinoid, and thymic carcinomas constitute thymic epithelial neoplasms (TEN). Thymoma is a primary tumor of the thymus epithelial cells and one of the most common neoplasms in the anterosuperior mediastinum, especially in middle-aged or older adults. Thymic epithelial neoplasms are usually seen in the latter decades of life and rarely occur in children. We hereby report a case of 13-year-old girl presenting with thymoma.
  1,634 105 1
Osteosarcoma of maxilla mimicking neurofibroma
CD Mounesh Kumar, KV Suresh, RC Pramod, Rajendra Baad, Sreeja P Kumar, B Karthik
October-December 2012, 1(4):233-235
Osteosarcoma (OS) is a primary malignant bone tumor producing osteoid or bone. It occurs less frequently in the jaws and in maxilla occurrence is rare. Jaws are less affected compared to long bones (4-13%). The mean age of occurrence is third to fourth decade. The histopathologic features of OS are highly variable. Herein, we report a rare case of a 72 year old female patient with a swelling in right posterior maxilla, whose clinical, radiographic findings were non-specific, An initial incisional biopsy confirmed neurofibroma. Later, a wide surgical excision was done as there was a spontaneous exacerbation of the growth, and histopathology report came as chondroblastic osteosarcoma.
  1,597 119 -
Psycho-social and general health status after surgical treatment in cancer patients: An Indian prospect
Alay P Brahmbhatt, Sunil B Bothara, Ashish M Kaushal
October-December 2012, 1(4):222-229
Objective : The objective of this study was to evaluate the psychological, social well-being and general state of health in patients suffering from cancer, before and after surgical treatment. Experimental/Computational Work Done: Subjects were selected from HCG MEDI-SURGE Hospital, India, who had undertaken surgical treatment for various cancers. The present study consists of a single centered, behavioral, prospective study designed to evaluate 100 cancer patients with their psycho-social and general health status. The population of patients chosen for the study contained patients of both sexes. Data were obtained by using two questionnaires, i.e., General Health Questionnaire (GHQ-28) and Hospital Anxiety and Depression Scale (HADS). Obtained data were evaluated for correlation of incidence of psycho-sociological aspect with gender, age, and family background history. Statistical analysis was carried out by using the Student t-test and ANOVA. Results and Discussion: Higher percentage of depression and anxiety were observed after surgical treatment among breast cancer patients and head and neck cancer (HNC) patients. Stage I and III colorectal cancer, stage I-IV breast and HNC cancer patients did not show significant change in GHQ-28 and HADS scores after surgical treatment. The female patients of colorectal and HNC cancer showed higher total GHQ-28 and HADS scores compared to male. Conclusions: From this study it can be concluded that cancer patients after surgical treatment show an increase in the prevalence of psychiatric morbidity. Depression and anxiety disorders are especially common and detection of these disorders is an important in the overall disease management in India.
  1,554 116 -
Synchronous squamous cell carcinoma of lung and adenocarcinoma of esophagus in a patient with progressive systemic sclerosis: A case report and review of literature
Tamojit Chaudhuri, Deepti Sharma
October-December 2012, 1(4):236-238
We report an extremely rare case of synchronous metastatic squamous cell carcinoma of lung and adenocarcinoma of esophagus in a 32-year -old, non-smoker, Asian male with progressive systemic sclerosis. The short history and rapid progression of both the malignancies and systemic sclerosis in our patient suggested the possibility that systemic sclerosis may represent a systemic manifestation of malignancy.
  1,410 104 -
Patterns of nucleolar organizer region in urinary bladder cancer in view of 2004 WHO classification of urothelial neoplasms
Priti Soin, Yogesh K Yadav, Manna Valiathan, Varuna Mallya
October-December 2012, 1(4):217-221
Context: The last decade has seen a tremendous upheaval since introduction of WHO-1998 classification (modified in 2004) of bladder carcinoma, which only recently seems to have settled down. We compare both old (WHO-1973) and new (2004) classifications with argyrophilic nucleolar organizer region (AgNOR) score. Aims: To compare WHO/ISUP (World Health Organization/International Society of Urologic Pathologists) consensus classification-2004 and WHO-1973 classification of bladder carcinoma and to establish correlation between AgNOR scores and various grades of carcinoma bladder. Materials and Methods: Sixty H and E (Hematoxylin and Eosin) stained sections of transitional cell carcinoma bladder were graded according to WHO/ISUP (2004) and WHO (1973) classification systems and the results were compared. This was then followed by AgNOR staining of the paraffin-embedded sections and subsequent AgNOR scores were calculated and given as total score, extranucleolar score, intranucleolar score, and nucleolar score. These were correlated with the grade of the tumor. Statistical Analysis Used: ANOVA test. Results: It was observed that the two grading systems, WHO/ISUP (2004) and WHO (1973) correlated with each other. Also it was observed that the total AgNOR score and extranucleolar AgNOR score increased with the grade of the tumor and thus increasing scores carry significance in assessment of the grade of the tumor. However, intranucleolar and nucleolar scores showed variable degree of overlap in various grades of the bladder tumors. Conclusions: WHO/ISUP (2004) classification correlated well with the WHO (1973) classification. The total AgNOR score was found to be helpful in assessment of the grade of the tumor but the distribution of the AgNOR carried little significance.
  1,387 109 -
Chiasmatic pilocytic astrocytoma in childhood with leptomeningeal dissemination at recurrence: A case report and review of literature
Tamojit Chaudhuri, Deepti Sharma
October-December 2012, 1(4):248-250
Pilocytic astrocytoma is a benign variety of gliomas, which rarely spreads along the neuraxis. Leptomeningeal dissemination of pilocytic astrocytoma in children, either at the time of initial presentation or at recurrence, is a rare event. We report a case of chiasmatic pilocytic astrocytoma in a 4-year-old child with leptomeningeal dissemination at recurrence. A review of the literature is done regarding dissemination patterns, clinical picture, treatment, and outcome of pilocytic astrocytoma with leptomeningeal dissemination.
  1,327 102 -
Porcelain gall bladder in a case of papillary renal cell carcinoma: A rare occurrence and its impact on treatment verdict
Raghavan V. Sugi Subramaniam, Vilvapathy S Karthikeyan, Sarath C Sistla, Lalgudi N Dorairajan, Kaliaperumal Muruganandham, Sheik M Ali, Duvuru Ram
October-December 2012, 1(4):230-232
Multiple primary malignant neoplasms (MPMN) is a rare clinical entity in which two primary malignancies are encountered in the same individual which can be synchronous (second primary within 6 months) or metachronous (beyond 6 months). We present a case of a 41-year-old male who underwent left partial nephrectomy for suspected renal cell carcinoma and it was confirmed based on histopathology. The gallbladder was normal on contrast-enhanced computed tomogram (CECT) abdomen. Follow-up CECT done 1 year later showed no enhancing masses in both kidneys, but incidentally porcelain gallbladder was detected. An elective open cholecystectomy was done for acalculous porcelain gall bladder owing to its premalignant nature. We report this case to highlight the relative risk of second primaries in patients treated for primary malignancies and that relevant premalignant conditions should be managed as possible second malignancies to avoid potential complications.
  1,286 79 -
Low grade malignant eccrinespiradenoma with florid squamous differentiation: A Potential Diagnostic Pitfall
Kavita S Mardi
October-December 2012, 1(4):257-260
Malignant eccrinespiradenomas (MES) are rare, fatal neoplasmsand typically manifest as rapid enlargement of long-standing benign eccrinespiradenomas. Low grade malignancyarising in benign eccrinespiradenomas are difficult to diagnose as the morphological changes are subtle and needs careful examination by the pathologist. MES frequently shows focal squamous differentiation, which may be florid in rare instances. We herein report a case of low grade malignancy in an eccrinespiradenoma with florid squamous differentiation. The present tumor was removed twomonths after rapid increase in size of a long standing nodule over the left forearm was noted by the patient. Histopathological examination showed the earliest stage of malignant transformation within eccrinespiradenoma. The early changes of malignant transformation was characterized by nuclear pleomorphism, loss of two cell types, increased mitotic activity with atypical mitoses, partial loss of PAS positive basement membrane material and florid squamous differentiation. Immunostaining for p53 revealed absent staining in benign areas and increased expression in malignant areas. Ki 67 score was less than 1% in benign areas and was increased (4-5%) in the malignant area. Since patient had tumor free margin, no palpable lymph node in the axilla or evidence ofdistant metastasis, he was not put on any adjuvant therapy. Such cases must be followed up carefully. In conclusion, we need more information about low grade malignant eccrinespiradenoma, its biological behavior, and treatment modalities.
  1,157 72 -