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   2014| January-February  | Volume 3 | Issue 1  
    Online since January 27, 2014

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New serum biomarkers for prostate cancer diagnosis
Kailash C Chadha, Austin Miller, Bindukumar B Nair, Stanley A Schwartz, Donald L Trump, Willie Underwood
January-February 2014, 3(1):72-79
Background: Prostate-specific antigen (PSA) is currently used as a biomarker for diagnosis and management of prostate cancer (CaP). However, PSA typically lacks the sensitivity and specificity desired of a diagnostic marker. Objective: The goal of this study was to identify an additional biomarker or a panel of biomarkers that is more sensitive and specific than PSA in differentiating benign versus malignant prostate disease and/or localized CaP versus metastatic CaP. Methods: Concurrent measurements of circulating interleukin-8 (IL-8), Tumor necrosis factor-α (TNF-α) and soluble tumor necrosis factor-α receptors 1 (sTNFR1) were obtained from four groups of men: (1) Controls (2) with elevated prostate-specific antigen with a negative prostate biopsy (elPSA_negBx) (3) with clinically localized CaP and (4) with castration resistant prostate cancer. Results: TNF-α Area under the receiver operating characteristic curve (AUC = 0.93) and sTNFR1 (AUC = 0.97) were strong predictors of elPSA_negBx (vs. CaP). The best predictor of elPSA_negBx vs CaP was sTNFR1 and IL-8 combined (AUC = 0.997). The strongest single predictors of localized versus metastatic CaP were TNF-α (AUC = 0.992) and PSA (AUC = 0.963) levels. Conclusions: The specificity and sensitivity of a PSA-based CaP diagnosis can be significantly enhanced by concurrent serum measurements of IL-8, TNF-α and sTNFR1. In view of the concerns about the ability of PSA to distinguish clinically relevant CaP from indolent disease, assessment of these biomarkers in the larger cohort is warranted.
  7 2,468 149
Micronuclei as prognostic indicators in oral cytological smears: A comparison between smokers and non-smokers
Venkatesh Vishwanath Kamath, Praveen Anigol, Krishnanand Setlur
January-February 2014, 3(1):49-54
Background: Micronucleus is a microscopically visible round or oval cytoplasmic chromatin mass in the extra nuclear vicinity, originated from aberrant mitosis, which consists of eccentric chromosomes that have failed to reach spindle poles during mitosis and are used as biomarkers for assessment of DNA damage. Micronuclei are characteristically seen in exfoliated cells of the buccal mucosa and urinary bladder wall in precancerous and cancerous conditions. Oral habits of smoking tobacco or chewing areca nut damage the oral tissues. An assessment of the damage is feasible by the detection of micronuclei in exfoliated cells of the oral tissues using smears. Objectives: The present study was designed to assess the presence or increase of micronuclei in buccal smears of individuals with tobacco habits against a control group of teetotalers. Materials and Methods: Two groups (smokers and non-smokers) of 50 individuals each were examined. Buccal smears of all participants were taken using cytobrush and stained with standard Papanicolaou's (PAP) stain. Presence of micronuclei was assessed under Χ100 magnification and a count per 500 cells was determined. The results were analyzed statistically using t-test and Mann-Whitney test. Results: Smears of individuals with tobacco habits showed a significant increase in the total number of micronuclei per 500 cell counts. There was a definite correlation between the occurrence of micronuclei and the frequency and duration of smoking. A paradoxical age related increase in middle-aged groups was also observed. Conclusions: The genotoxic effects of tobacco smoke cause chromosomal damage in the epithelial cells of the oral mucosa and are reflected in the increased micronuclei in smokers. This is present even in the absence of clinically evident changes. This observation is vital in utilization of the micronuclei detection in smears as a prognostic, educational and interventional tool in the management of patients with smoking habits.
  4 4,297 235
Primary ovarian carcinoid in mature cystic teratoma: A rare entity
Reetika Sharma, Biswajeet Biswas, Shailja Puri Wahal, Neelam Sharma, Vijay Kaushal
January-February 2014, 3(1):80-82
Primary ovarian carcinoids are rare, accounting for 0.3% of all carcinoid tumors; however, carcinoid tumors metastatic to the ovary are common. A majority of primary ovarian carcinoids occur in association with mature cystic teratoma. In this paper, we present a case of carcinoid tumor developing in a mature cystic teratoma in a 50-year-old female.
  3 4,564 96
Squamous cell carcinoma arising in an ovarian mature cystic teratoma
Kavita Mardi, Sudershan Sharma,
January-February 2014, 3(1):96-98
Malignant transformation in a mature cystic teratoma of the ovary is rare. We describe a case of advanced-stage squamous cell carcinoma arising from a mature cystic teratoma in a 63-year-old postmenopausal woman. The initial investigation by ultrasound showed a left adnexal mass with mixed echo pattern, which arose the suspension of malignancy. She underwent a hysterectomy with left salpingo-oophorectomy for the removal of ovarian cyst. Histopathology was compatible with well-differentiated squamous cell carcinoma arising in a mature cystic teratoma. The tumor was invading the fallopian tube as well as serosa and myometrium of the uterus. Subsequently, she underwent two courses of combination chemotherapy with cisplatin, leucovorin, and 5-fluorouracil with no response. She died from progression of the disease, within 1 year after the initial operation.
  2 1,868 81
Sacrococcygeal chondroid chordoma: A case report with brief literature review
GK Sawke, Nilima G Sawke
January-February 2014, 3(1):116-118
Chondroid-chordoma is an uncommon variant of chordoma that originates from the remnants of notochord. These tumors have axial distribution particularly at the upper and lower ends of the vertebral column. However, they may occur in unusual sites in ectopic notochordal tissue. This paper reports a rare occurrence of chondroid variant of chordoma at sacrococcygeal region. The characteristic presentation, radiological appearance, findings at surgery, pathology and treatment of this lesion are discussed due to its predilection for occurrence at the sacrococcygeal region and its more favorable prognosis compared with that of conventional chordoma.
  1 2,459 61
Taxane induced pneumonitis in a case of carcinoma esophagus treated with chemo-radiation: Case report and review of literature
Vivek Tiwari, Subodh C Pande, Sandeep Goel, Gopinath Menon
January-February 2014, 3(1):119-122
Taxanes are the preferred chemotherapy (CT) modality in treatment of carcinoma esophagus. Taxane use is associated with toxicities such as myelosuppression, neuropathy and musculoskeletal effects. Pneumonitis arising with the use of taxanes is a relatively rare and less explored entity. The present case report addresses this phenomenon in a patient who received Neoadjuvant and concurrent treatment with taxane and presented with symptoms and signs of pneumonitis. Patient initially presented with flu like symptoms and dyspnea that was unresponsive to antibiotic treatment. She presented 12 days after, the completion of concurrent CT-Radiotherapy. Despite all the measures, she ultimately succumbed to the pneumonitis. In any such case of development of pneumonitis/interstitial lung disease/fibrosis related symptoms and signs in relation to CT-RT, taxane induced pneumonitis should be kept in the differential diagnosis. Clinicians should be aware of this entity to appropriately manage such a rare and life-threatening occurrence.
  1 2,299 95
Clinicopathological profile of gastric cancer in a tertiary care hospital in Eastern India: A prospective 2 year study
Ayandip Nandi, Pranab Kumar Biswas, Manoranjan Kar, Swapan Kumar Sinha
January-February 2014, 3(1):14-20
Context/Background : Gastric malignancy is a major cause of morbidity and mortality throughout the world. Majority of gastric cancers present in late stages, so early detection is of paramount importance. Aim/Objective: To assess clinicopathological parameters of gastric carcinoma and to study expression of mucin by simple histochemical methods. Materials and Methods: Present prospective study were carried out over 2 years on surgically resected or endoscopically confirmed 116 cases of gastric carcinoma (>5 and <90-year-old) and their clinical profile, relevant investigation, and gross and microscopic features were studied. Periodic acid Schiff (PAS) and alcian blue (AB) staining were done along with hematoxylin and eosin (H and E) to study nature of mucin. Results: Mean age of study population were 53.02 years with overall male predominance (male:female (M:F) =2.41:1). Majority presented with vague dyspepsia, blood group A was most prevalent. Endoscopy revealed fungating growth in 41.37%, rapid urease test (RUT) was negative in most of patients. Majority of masses were located in antrum, mean diameter of masses being 3.56 cm. Poorly differentiated carcinoma were most prevalent histological type closely followed by equal percentage of diffuse and intestinal adenocarcinomas. Most carcinomas belonged to stage II or higher in TNM staging. Mucin stain reveals weak or absent PAS stain in diffuse and AB stain in most intestinal adenocarcinoms. Conclusion: Gastric carcinoma mainly affects elderly males. Poorly differentiated cases are on the rise. Simple mucin stains like PAS and AB can prove valuable adjunct to routine histological diagnosis, especially in cases with suspicious margin involvement, lymph node metastasis, and true depth of invasion assessment.
  1 2,904 112
Cytomorphological analysis in oral squamous cell carcinoma lesions and normal controls using rub and rinse technique
Shaila Mulki, Pushparaj Shetty, Prakash Pai
January-February 2014, 3(1):38-42
Context: Early diagnosis of oral cancer requires simple noninvasive screening tools. Aim: To analyze the cytomorphological features of keratinocytes in smears obtained from the oral mucosa of oral squamous cell carcinoma (OSCC) lesions and normal controls using oral rub and rinse technique. Settings and Design: Oral smears were prepared using oral rub and rinse method in subjects with OSCC cases (n = 35) and apparently healthy normal controls (n = 35). They were subjected to cytomorphometric analysis. Materials and Methods : The smears prepared with the rinse method were stained with Papanicolaou stain. Quantitative assessment of nuclear diameter (ND), cytoplasmic diameter (CD), cellular area (CA), nuclear area (NA), and nuclear cytoplasmic ratio (N:C) was carried out. Statistical Analysis Used: Unpaired Student's t-test was used to compare the mean value between the groups. Results: There was a significant difference between ND, CD, CA, NA, and N: C of oral cancer cells and that of the normal controls. There was increase in the mean ND, NA, and N: C; and decrease in CA and CD of cancer subjects when compared to that of normal controls. Conclusion: Cytomorphometric analysis of keratinocytes obtained with oral rinse method can serve as a useful adjunct in the early diagnosis of OSCCs.
  1 3,206 194
Implementation of cervical cancer screening: A demonstration in a rural community of North India
Satyanarayana Labani, Smita Asthana, Suresh Bhambhani, Pushpa Sodhani, Sanjay Gupta
January-February 2014, 3(1):43-48
Context: S trategies for implementation of cervical screening are the need of the hour while effective screening tests for early detection exist. Aim: To demonstrate the implementation of cervical cancer screening by aided visual tests in a North Indian rural community. Setting and Design: Cross-sectional study in a rural setting. Subjects and Methods: Baseline survey of community perspectives of screening and identification of eligible women of age 30-59 years was performed by Accredited Social Health Activists (ASHAs). Screening was targeted on 7604 women by the methods of visual inspection of cervix using acetic acid (VIA), by using lugol's iodine (VILI) tests and by Pap test. Screen positives were referred to colposcopy and further management. Data on evaluation parameters was collected. Statistical Analysis: Screening test performances were assessed by sensitivity, specificity and positive/negative predictive values (PPV/NPV) for detection of histological CIN II+. Results: Study showed coverage of 65.6% of total eligible women (7604). Extent of agreement of visual testes (VIA/VILI) between nurses and doctor was 77.3-100%. Screen positivity rates by VIA, VILI and Pap were 9.7%, 13.5% and 2.6%, respectively. Screen positives turned up for confirmatory diagnosis were 78%. Acceptance of treatment was 76%. Screen positivity of VIA and VILI declined (P < 0.001) with increase in age. Sensitivity, specificity, and PPV of VIA were 59.0%, 92.3% and 3.6% and of VILI were72.7%, 89.6% and 3.3% respectively. NPV was 99% in all the tests. Conclusion: Implementation of screening by aided visual tests was successfully demonstrated through utilization of ASHAs for motivation, achievement of good coverage and good response in clinical management of screen positives.
  1 2,795 112
Single voxel 1 H magnetic resonance spectroscopy in the diagnosis of musculoskeletal mass lesions
Shalini Agarwal, Zile S Kundu, Sanjay Kumar, Sukhbir S Sangwan
January-February 2014, 3(1):66-71
Introduction: In vivo magnetic resonance spectroscopy (MRS) is an established technique for evaluation of malignant tumors in brain, breast, prostate, etc., However, its efficacy in the diagnosis of musculoskeletal (MSK) mass lesions is yet to be established. We present our experience with MRS of these lesions. Materials and Methods: Magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI and single-voxel 1 H MRS was performed in 30 consecutive patients with histologically proven benign and malignant MSK tumors/mass lesions each, on a 1.5-T magnetic resonance scanner. MRS was performed with echo times (TE) of 40, 135 and 270 ms. A clearly identifiable peak at 3.2 ppm in at least two of the three spectra acquired at the three TE was taken as positive for choline. MRS imaging and enhancement patterns were compared in these two groups and were analyzed by a Radiologist blinded to the histopathological findings. Results: Ages of patients in the malignant age group ranged from 2 to 65 years (M: F - 19:11) while that of patients in the benign group ranged from 7 months to 56 years (M: F - 17:13). There were two patients with Type I curve, 18 with Type II curve and 10 with Type III curve on dynamic contrast enhanced images in the malignant group while there were no patients with Type I curve, 5 with Type II curve and 25 with Type III curve in the benign group. The sensitivity of MRS for predicting malignancy was 60%, specificity was 93.33%, positive predictive value was 90%, negative predictive value was 70% and accuracy was 76.66%. Conclusion: MRS is a promising technique for evaluation of MSK mass lesions. The accuracy at present remains low. We recommend that it be used as an adjunct to routine MRI.
  1 1,619 84
Orbital tumor preceded the development of acute myeloid leukemia: A case report and literature review
Partha Pal, Sayantan Ray, Sisir Kumar Patra, Anjan Kumar Das, Nikhil Sonthalia, Arunansu Talukdar
January-February 2014, 3(1):83-86
Acute myeloid leukemia (AML) may rarely involve the orbit as a solid tumor termed granulocytic sarcoma (GS). Orbital GS is a localized tumor consisting of immature myeloid cells. The histological diagnosis is difficult especially in patients with poorly differentiated tumors with no evidence of systemic leukemia. Special stains and immunohistochemistry have a significant role in the diagnosis. This report describes the case of a 14-year-old boy who presented with rapidly progressive unilateral proptosis which was found to be round cell tumor on histopathology. The diagnosis is made by clinical examination, computed tomography (CT), and confirmed by immunohistochemical findings. After 8 months, the patient developed AML with blast cells in the peripheral blood. The patient was treated by a combination of chemotherapeutic drugs. A literature review suggests that leukemia might be the most likely diagnosis in a child with orbital tumor and in many cases GS precedes the systemic manifestations of AML.
  - 2,947 95
Prostatic sarcoma: A case report with review of literature
Parveen Rana, Amrita Duhan, MK Garg, Vijay Punia
January-February 2014, 3(1):87-89
Nonepithelial neoplasms of prostate are relatively infrequent and include a broad array of entities including both benign and highly aggressive tumors. Because of their rarity and limited understanding, when encountered, they may pose a diagnostic challenge, due to histological overlap between them or their rarity. The ancillary studies including immunohistochemistry (IHC) have often limited utility and the main criteria for diagnosis lies on morphology findings by hematoxylin and eosin (H and E) staining. We present here this rare entity which was not suspected either clinically or radiologically, was diagnosed on routine H and E staining after excision biopsy and confirmed with use of limited IHC panel.
  - 1,845 77
Extramedullary plasmacytoma in the posterior triangle of neck: A rare entity
Mahesh Kumar Mittal, Binit Sureka, Veena Singh, Minal Chaudhary, Mukul Sinha, Brij Bhushan Thukral
January-February 2014, 3(1):99-101
Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm of soft tissue without involvement of bone marrow or other systemic characteristics of multiple myeloma. It accounts for only 4% of all plasma cell tumors. We have reported herein a rare case of EMP involving soft tissues of the neck.
  - 1,375 71
Thumb polydactyly associated with secondary chondrosarcoma arising from a solitary enchondroma: A rare case report
Md Sohaib Akhtar, AH Khan, M Fahud Khurram, Kiran Alam
January-February 2014, 3(1):90-93
The most common type of polydactyly in the hand is thumb polydactyly. Enchondromas are benign cartilaginous tumors and usually present in phalanx of hands. Transformation of enchondromas into chondrosarcomas is very rare, which is commonly associated with multiple enchondromatous lesions. Association of thumb polydactyly and secondary chondrosarcoma arising from a solitary enchondroma is even rarer. We present a 50-year-old female patient with right thumb polydactyly associated with secondary chondrosarcoma arising from a solitary enchondroma. To our knowledge this association has not been described previously.
  - 1,493 60
A rare occurrence primary adenomyoma of the Fallopian tube-incidental finding of a tumor
Kavita Mardi, Neelam Gupta
January-February 2014, 3(1):94-95
Adenomyoma of the fallopian tube is a rare entity. We report a rare case of adenomyoma localized only in the left fallopian tube in a 38-year-old woman, who was presented with dysfunctional uterine bleeding. Patient underwent hysterectomy, and on gross examination, there was a well-circumscribed and well-encapsulated tumor arising from the left fallopian tube. Postoperative histopathology showed that the tumor comprised of circumscribed nodular aggregates of smooth muscle along with endometrial glands, accompanied with endometrial stroma. The case was diagnosed as primary adenomyoma of the left fallopian tube.
  - 1,557 63
Mystery within a fibroadenoma
BR Vani, K Geethamala, V Srinivasa Murthy, M Sudha Rao
January-February 2014, 3(1):123-125
Fibroadenomas (FA) are the most common benign biphasic neoplasms in young women. Occurrences of malignant changes within FA are rare. A 32-year-old female patient presented with a lump in the left breast since 1 month. On clinical and ultrasound examination, patient was diagnosed as having multiple FAs. Cytology revealed atypical cells and excision of the lump was suggested. Histopathological examination (HPE) of the lump diagnosed as infiltrating ductal carcinoma with FA. Patient thereafter underwent modified radical mastectomy and further treatment. Patient remained well on follow-up. The present case highlights the need for extensive sampling on fine-needle aspiration and conscientious search for malignancy during the HPE.
  - 2,000 96
Pindborg tumor of maxilla: Unusual presentation with review
Suresh Kumar Sachdeva
January-February 2014, 3(1):126-129
The calcifying epithelial odontogenic tumor (CEOT), also known as the Pindborg tumor, is a rare benign odontogenic neoplasm, accounts for 0.4-3% of all odontogenic tumors. The CEOT is a benign, locally invasive, slow growing neoplasm occurring as intraosseous and extraosseous forms. The extraosseous variant is diagnosed slightly earlier (mean age 34.4 years) than the intraosseous type (mean age 38.9 years), with equal gender predilection. The most frequent location is the mandibular premolar and molar area; less frequently the lesion is found in the maxilla. This case report is a peculiar case of Pindborg tumor characterized by a rare localization of the lesion extending from anterior to the posterior of the maxilla in a 76-year-old female.
  - 2,523 84
Post-operative refractory hypotension and diuresis in a case of bilateral pheochromocytoma
Somak Kumar Das, Uttam Biswas, Sarmila Ghosh, Saibal Mukherjee
January-February 2014, 3(1):130-132
Pheochromocytomas are relatively uncommon tumors, with prevalence of 0.3-0.95% in autopsy series. Patients with pheochromocytomas have a potentially curable cause of hypertension. Following surgical removal of pheochromocytoma 80% of patients are expected to become normotensive. Persistent post-operative hypertension may be due to residual tumor, metastatic disease or intra-operative injury to the renal artery or the kidney. Around 20% of patients will remain hypertensive without biochemical evidence of residual tumor; however, due to associated essential hypertension or due to acquired renovascular changes. We present a rare case of refractory hypotension in a post-operative case of bilateral pheochromocytoma.
  - 3,114 70
Solid variant of alveolar rhabdomyosarcoma with patent ductus arteriosus
Archana Chirag Buch, Pradeep S Jadhav, Narayanan Krishnankutty Panicker, Sukanya Pal
January-February 2014, 3(1):133-135
Alveolar rhabdomyosarcoma is a high-grade malignant soft tissue tumor of mesenchymal origin. It is a rare tumor with an annual incidence of one per million. It is generally seen between 10 and 25 years of age. We present a rare case of solid variant of alveolar rhabdomyosarcoma in a 6-month-old child with patent ductus arteriosus. There was no evidence of lung or lymph node metastasis. She was treated by wide local excision.
  - 1,790 68
Triple independent primaries of female genital tract: A rare event
Suprio Ray Chaudhury, Bhawna Bhutoria Jain, Subhra Bilas Sil, Sumedha Dey, Sarbani Chattopadhyay
January-February 2014, 3(1):136-138
The synchronous presence of endometrioid carcinoma of ovary and uterus in a single patient is an uncommon occurrence; but, finding a patient having a third simultaneous primary in cervix along with carcinoma ovary and endometrium is an extremely rare entity. In this article we describe a 40-year-old female who presented with gradual distension of abdomen, and underwent extended radical hysterectomy operation following diagnosis of an ovarian tumor on ultrasonography. On examination of the specimen, it was found to harbor endometrioid carcinoma of uterus and endometrioid carcinoma of ovary along with a small focus of well-differentiated squamous cell carcinoma of cervix. The presence of three coexistent primary tumors in female genital tract is an extremely rare event. Further molecular and genetic studies may throw light on the probable etiology of such rare cases.
  - 1,561 79
Giant cell tumor of C2 (axis): A case report and short review of literature
Ahmed Bakhsh, Khalid Mukkaram Ali Siddiqui, Ghada Moumneh, Tarek El Maghrabi
January-February 2014, 3(1):102-104
This is a hospital-based case report of giant cell tumor of C2 vertebra (axis) in skeletally immature patient. It is difficult to diagnose giant cell tumor both clinically and radiologically therefore to differentiate it from other lesions, molecular and genetic studies are warranted. Initial aggressive surgical resection should be adopted if possible. Since giant cell tumor is a radioresistant and no known chemotherapy is available, therefore an alternative medical treatment should also be explored where resection is not possible. Use of denosumab and bisphosphonate may be best alternative in inoperable cases.
  - 2,702 80
Cytodiagnosis of extragonadal pure yolk sac tumor of sacrococcygeal region
Kavita Mardi, Neha Bakshi
January-February 2014, 3(1):105-107
Yolk sac tumors (YST) are rare in extragonadal location. Cytologic diagnosis of YST in such instances may be a challenge to the pathologist. We studied Fine needle Aspiration (FNA) material from a sacrococcygeal mass in a 18-month-old female child presenting with a progressively increasing sacrococcygeal mass. Cytologic features include large pleomorphic balls of tumor cells with high nuclear to cytoplasmic ratios, papillary or micro-glandular pattern of growth, cytoplasmic and intra-nuclear vacuoles, and prominent nucleoli. Per Iodic Acid Schiff (PAS) positive intra-cytoplasmic as well as extracellular hyaline globules were also seen. The subsequent biopsy was consistent with the FNA diagnosis, and immuno-histochemically, the tumor cells were positive for Alpha Feto Protein (AFP) supporting the diagnosis.
  - 1,576 65
Hyalinizing trabecular tumor of the thyroid gland: A puzzling entity on fine needle aspiration cytology
Jitendra Nasit, Gauravi Dhruva
January-February 2014, 3(1):108-111
Hyalinizing trabecular tumor (HTT) is a rare unique but controversial thyroid neoplasm, characterized by prominent trabecular growth pattern and stromal hyalinization. Whether HTT is a benign tumor or a variant of papillary thyroid carcinoma (PTC) is still unclear. Cytology findings of HTT have been described in few reports. Cytological features of HTT frequently overlap with those of PTC and medullary thyroid carcinoma, which can lead to frequent misdiagnosis. In order to avoid overtreatment like total thyroidectomy, pathologist should be aware of cytological features of HTT. We present a case of 35-year-old female with a right-side thyroid swelling for three years. Fine needle aspiration cytology was performed. According to The Bethesda System for Reporting Thyroid Cytopathology, cytological diagnosis of benign thyroid neoplasm was made. Histopathology of the right thyroidectomy specimen showed HTT. Accurate preoperative diagnosis of HTT requires a very meticulous and cautious approach in the evaluation of cytological features. Trabecular pattern of cells, vague curved nuclear palisading, radiating arrangement of cells around hyaline material, spindled to elongated cells, filamentous cytoplasmic processes with ill-defined cell border and yellow bodies are important diagnostic features of HTT. Nuclear features alone are insufficient for the diagnosis of HTT. Any suspicious cytology of thyroid lesion should follow hemithyroidectomy and histopathological evaluation.
  - 3,886 80
Sweet's syndrome in accelerated chronic myelogenous leukemia: A case report and review of literature
Akhil Kapoor, Surender Beniwal, Satya Narayan, Ashok Kalwar
January-February 2014, 3(1):112-115
Sweet's syndrome (acute febrile neutrophilic dermatosis) is a well documented entity in acute leukemia. However, there have been only rare reports of its association with chronic leukemia. We report a case of sweet's syndrome in a patient of BCR-ABL positive chronic myelogenous leukemia in accelerated phase for its rare association, classical clinical presentation and dramatic therapeutic response to corticosteroids.
  - 2,106 71
Importance of pneumonitis induced by taxane-based chemotherapy and chemoradiotherapy for esophageal cancer
Anikó Maráz
January-February 2014, 3(1):1-2
  - 390 61
Learning gestures and ethical issues in oncology and nuclear medicine
Aboubakr Matrane, Mouna Khouchani, Nabil Ismaili, Tarik Chekrine, Souha Sahraoui
January-February 2014, 3(1):9-13
Purpose: The purpose of this study is to show the importance of learning gestures in three medical procedures (chemotherapy, brachytherapy, and bone scan). It allows us to assess complications, lack of benefit, and ethical questions to which resident physicians are confronted in their training. Materials and Methods: The study is based on a questionnaire divided into two parts distributed to 70 resident physicians and 90 patients: 60 physicians radiation oncologists and 10 nuclear physicians completed the first part of 24 items. It concerned the learning of medical practices. The second part of 18 items was completed by 90 patients (30 patients in the chemotherapy unit, 30 patients in the brachytherapy unit, and 30 patients in the nuclear medicine department; it was related to patients' information prior to the completion (performance) of the gesture. Results: The training of medical residents physicians took place mainly during the first year on conscious and well-informed patients, with the exception of brachytherapy taught later in the second year. It was preceded by a theoretical education in 56.7%, 43.3%, and 100%, respectively, in case of chemotherapy, brachytherapy, and bone scan unit, but the previous observation by a senior had failed in 16.7% in case of chemotherapy and in 36.7% in case of brachytherapy unit. Despite the almost constant presence of a senior, four incidents were associated with the first acts of chemotherapy and brachytherapy unit and one incident with the bone scan unit. These incidents had been generated, respectively, from 23.4%, 26.7%, and 20% of resident physicians surveyed (in chemotherapy, in brachytherapy, and in bone scan) and had a consequence of a loss of opportunity for patient, in 20%, 13.3%, and 40%, respectively. Most patients were informed before the completion of the medical procedure, and cause ethical problems. Alternative ways of learning were known by most of the resident physicians in training. Conclusion: Despite a relatively low rate of incidents associated with a loss of opportunity for the patient, our study has highlighted a high rate of observation and supervision prior to the first medical procedure, and the importance of ethics for the resident physician throughout his medical training.
  - 2,135 91
The role of fine needle aspiration cytology in the diagnosis of orbital lesions
Dipanwita Nag, Ranjana Bandyopadhyay, Santosh Kumar Mondal, Ayandip Nandi, Gautam Bhaduri, Swapan Kumar Sinha
January-February 2014, 3(1):21-25
Context: Fine needle aspiration cytology (FNAC) in orbital lesions has gained importance over the last 3 decades, especially with the advent of imaging studies. Aims: The study was undertaken to evaluate the role of FNAC as a diagnostic tool in patients presenting with orbital mass lesions. Subjects and Methods: Patients of different age groups presenting with orbital lesions were studied over a period of 2 years. The 38 patients selected for this study were evaluated clinically by thorough general and ophthalmological examination, and then were investigated with computed tomography (CT) scanning (both axial and coronal planes). Each patient included in this study was then subjected to FNAC under direct vision or under ultrasonography or CT guidance with a sterile 22 gauge needle without anesthesia. Results: The age of the patients varied from 2 to 72 years. On cytology, four cases were diagnosed as nonneoplastic and the remaining 34 (89.48%) as neoplastic lesions. In the neoplastic group, benign tumors (20; 58.8%) outnumbered malignant (14; 41.2%). The distribution of malignant lesions was more heterogeneous with a predominance of lymphoma involving the orbit. Surgical biopsy was done in 27 cases. Surgical biopsy report correlated with the FNAC report in 23 out of 27 cases. The sensitivity was 86.6%, specificity 100%, and positive predictive value 100%. Conclusion: FNAC is a useful, safe and cost-effective method of diagnosing orbital pathology. Image guidance is helpful especially in deeply situated nonpalpable lesions.
  - 2,250 111
Can we consider metastatic colon cancer in the ambit of chronic disease in present scenario? Experience of a tertiary care centre from India
Rakesh Kapoor, Tapesh Bhattacharyya, Amit Bahl, Rajesh Gupta, Naveen Kalra, Bhaswanth Dhanireddy
January-February 2014, 3(1):26-31
Background: Colorectal cancer (CRC) is one of the most commonly diagnosed cancers and it is ranked the third most common globally. Nearly, one fourth of the CRC patients have metastasis at diagnosis and overall survival (OS) was not more than 6 months to 1 year. With availability of plethora of new chemotherapeutic drugs, biological agents and advent of newer techniques like radiofrequency ablation or hyperthermic intraperitoneal chemotherapy, it is possible to achieve OS of more than 2 years. Materials and Methods: A retrospective review of 105 case files of colon cancer was done, who were treated in our institute between January 2006 and December 2010. Patients with carcinoma colon were evaluated by a team of surgeons and radiation oncologists and underwent treatment according to the protocol designed by the same team. Only the histologically proven adenocarcinomas of colon were included. Out of 105 patients, 61 (58%) patients had metastatic disease either synchronous or metachronous and those patients were taken up for analysis. Various treatment modalities used in this group of patients in our setting were analyzed and correlated with progression-free survival (PFS) and OS. Results: This heterogeneous group of metastatic colon cancer patients, which had been given various modalities of treatment, could be able to achieve a median survival of around 18 months and 2 year PFS of 28%. Conclusion: So metastatic colon cancer is no longer an acutely fatal disease, rather it is in the ambit of chronic disease.
  - 2,179 95
Epidemiological, clinical, pathological, and therapeutic aspects of gastric cancer in Morocco
Sanna Elmajjaoui, Nabil Ismaili, Hanane Zaidi, Hanane Elkacemi, Khalid Hassouni, Taib Kebdani, Noureddine Benjaafar
January-February 2014, 3(1):3-8
Purpose: Gastric cancer is a relatively frequent cancer and has poor prognosis. The present study is the first Moroccan study to investigate the epidemiological, clinical, pathological, therapeutic characteristics, and outcomes of gastric cancer. Materials and Methods: We conducted a retrospective study including 154 cases of gastric cancer treated at the National Institute of Oncology between January 2007 and December 2007. Results: The mean age at diagnosis was 55 years (18-87 years) and the sex ratio was 2.14. Risk factors were dominated by tobacco use (30.5%) and gastric ulcer (4.5%). The average interval between symptom presentation and consultation was 8.7 months (1-48 months). The clinical symptoms were dominated by epigastric pain (88.7%), vomiting (62.3%), and weight loss (80.5%). Oeso-gastric fibroscopy was performed in all patients and showed an ulcerated aspect in 77.9% of the cases. The location of the tumor was antropyloric in 42.2% of the cases. The most common histology was adenocarcinoma (72.8%), followed by non-Hodgkin lymphoma (22%), gastrointestinal stromal tumors (GIST; 3.2%), and neuroendocrine tumors (NET; 2%). Tumor stage was metastatic in 62% of the cases, locally advanced in 18.5% of the cases, and localized in only 8% of the cases; however, 11.5% of patients were not staged. Also, 46% of the patients with adenocarcinoma (n = 111) were not treated, 6.4% received chemotherapy first (non-resectable) (one patient was operated), 20.6% received surgery first followed by adjuvant treatment, 4.5% received chemo-radiotherapy, 5.4% received chemotherapy only, and 27% received palliative chemotherapy. In the sub-group of patients diagnosed with non-Hodgkin lymphoma (n = 35), 48.5% received chemotherapy based on Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) regimen. In the sub-group diagnosed with GIST (n = 5) histology, all cases received surgery first and 2 cases received adjuvant chemotherapy based on doxorubicin. Finally, in the NET (n = 3) sub-group, 2 patients received surgery and 1 was not treated. The mean follow-up was 10 months for locally advanced tumors and 7.6 months for metastatic tumor. The overall survival rate at 3 years was not exceeding 20%. Conclusion: Clinical and pathological aspects of Moroccan patients are the same of those in developing countries. The majority of our patients were diagnosed at late stages, which explains the poor prognosis of gastric cancers in our population.
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A randomized comparative study between neoadjuvant 5-fluorouracil and leukovorin versus 5-fluorouracil and cisplatin along with concurrent radiation in locally advanced carcinoma rectum
Priyanjit Kumar Kayal, Animesh Saha, Aloke Ghosh Dastidar, Antara Mahata, Anuradha Das, Ratan Sarkar
January-February 2014, 3(1):32-37
Context: Concurrent chemoradiotherapy (CCRT) with cisplatin-5-fluorouracil (CDDP-5FU) in rectal cancer is based on the concept of biochemical modulation. Aims: The study was designed to evaluate whether CCRT with CDDP and 5-FU is noninferior to CCRT with leukovorin (LV) and 5FU in downstaging locally advanced rectal adenocarcinoma and to compare the toxicities between the two arms. Settings and Design : Single institutional, noninferiority, prospective, randomized study. Subjects and Methods : In control arm (N = 24) patients received chemotherapy. With bolus 5FU 350 mg/m 2 /day and LV 20 mg/m 2 /day for days 1-5 and 29-33. In study arm (N = 25), patients received chemotherapy with bolus 5 FU 350 mg/m 2 /day for days 1-5 and 29-33 and CDDP 100 mg/m 2 /day at days 1 and 29. Patients in both the arm received concurrent radiation (50.4 Gy in 28#, in conventional fractionation of 1.8 Gy per fraction). Six to eight weeks after concurrent chemoradiation patients underwent assessment and surgery. Postoperatively, adjuvant chemotherapy with m-FOLFO × 6 of 4 months was given to all patients. Statistical Analysis : The Chi-square test was used to compare categorical variables between the groups. Results: Response rate as assessed by Response Evaluation Criteria in Solid Tumors (RECIST criteria) was comparable between the two treatment arms (P = 0.9541). Pathological complete response rate of study arm was comparable to control arm (20 vs 20.83%, P = 0.7778 was not significant). Surgery with R0 resection was possible in 72% cases of study arm compared to 62.5% cases of control arm; P = 0.6861, not significant. Grade III toxicities were quite comparable between two treatment arms. Conclusions : In terms of pathologic complete response (pCR), R0 resection and toxicity profile of both the arms were comparable.
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Radiotherapy in pediatric patients without anesthesia or sedation: Feasibility and challenges
Ayan Basu, Rajni Gupta, Franklin Prabudoss
January-February 2014, 3(1):55-57
Conventionally fractionated radiotherapy treatment involves strict immobilization for accurate delivery and typically is delivered in five daily fractions every week for several weeks. To ensure rigid immobility during treatment planning and delivery in children, anesthesia or sedation has been used but valid concerns have been raised about the safety and long-term consequences of such practice on daily basis for prolonged periods. We tested the feasibility of avoiding daily anesthesia or sedation in our pediatric radiotherapy patients by extensive pretreatment counseling and demonstration of the treatment procedure ensuring their comfort and compliance.
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Latissimus dorsi myocutaneous flap for cover of soft tissue defects: Experience of a regional cancer center of North East India
Abhijit Talukdar, Joydeep Purkayastha, Bibhuti B Borthakur, Bhabesh K Das, Amal C Kataki, Manigreeva Krishnatreya
January-February 2014, 3(1):58-61
Background: Most of the oncological surgeries require extensive resection of tumors and repair of the defects with flaps. Aim: In this series the role of using latissimus dorsi myocutaneous flap (LDMF) for oncoplastic replenishment of soft tissue defects involving breast, chest wall, and back was explored. Materials and Methods: The patients in this study are cases treated at a regional cancer center in the northeast India. During the period from January 2010-January 2013, 18 cases of LDMF reconstruction were performed in our center and are included in this series. Results: The patients were in the age range of 10-50 years with a follow-up period ranging from 6-24 months. All patients underwent immediate reconstruction of the primary defect. In our series out of 18 patients, in 13 patients the flap had healed primarily without flap congestion, margin necrosis, or infection. The following minor postoperative complications were observed, like wound infection with skin necrosis in one patient (5.5%) and seroma formation was see at both the donor site and at the defect site in four patients (22%). Conclusion : LDMF should be utilized more often, as it is technically a straightforward procedure that provides adequate coverage of varied defects, acceptable cosmetic outcomes with minimal postoperative complications.
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Gastrointestinal stromal tumors: A single institute experience from South India
KC Lakshmaiah, TM Suresh, Govind Babu, Suresh Babu, Samit Purohit, B Guruprasad, Linu Jacob, D Loknath
January-February 2014, 3(1):62-65
Background: Gastrointestinal stromal tumors (GIST) represent an uncommon form of malignancy and one of best paradigms of molecularly targeted therapy. While the natural history of GIST following treatment with imatinib mesylate is relatively well known from various series in western literature, rarely any series from India has been published in this regard. Materials and Methods: Forty-four GISTs cases diagnosed and treated with imatinib between 2005 and 2011 were retrieved from the Department of Medical Oncology database, KMIO, Bangalore. Their clinical, histopathological data, and treatment outcome were analyzed. Kaplan-Meier survival analysis was done. Anatomic site, tumor size, mitotic activity, and extent of resection were correlated with overall survival (OS) using the logrank test. Results: Median age was 56 years with a male: female ratio of 2:1. Stomach was the most common site involved. Twenty-nine patients had localized disease of which majority had high risk (65%) features, with a mean tumor size of 10.5 cm (range 4-18 cm) and mitotic rate of 6 (range 4-9)/50 high-power field (HPF). Fourteen patients had metastatic disease at presentation with liver being the most common site. In the adjuvant group, median follow-up was 42 months (m) (range 10-70 m). Estimated recurrence free survival (RFS) and OS at 42 m were 59.9 and 80.6%, respectively. In metastatic group, median follow-up was 28 m (range 2-54 m). The median progression free survival (PFS) and OS were 18 m (95% CI 8.65-27.34 m) and 28 m (95% CI 17.90-38.09 m), respectively. Estimated PFS and OS at 28 m were 38.7 and 46.7%, respectively. Conclusion: Patients with GIST still present with larger bulky tumor at diagnosis, this leads to slightly inferior survival in our scenario. Nongastric GISTs; R1 and R2 resection; and mitotic rate >5/50 HPF are the other a factors which have a negative impact on survival.
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