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   2014| March-April  | Volume 3 | Issue 2  
    Online since April 9, 2014

 
 
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CASE REPORTS
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.
  18,789 55 -
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.
  10,955 232 2
ORIGINAL ARTICLES
Correlation between gallstones characteristics and gallbladder mucosal changes: A retrospective study of 313 patients
Sunder Goyal, Sanjeev Singla, Amrita Duhan
March-April 2014, 3(2):157-161
DOI:10.4103/2278-0513.130215  
Background and Aim: Gallbladder (GB) cancer has poor prognosis as it progresses very fast. Etiology or pathogenesis of GB cancer is still obscure and very little is known about it. A better understanding of risk factors that lead to its development could help improve the management options. Presence of stones in GB generates varied mucosal reaction which results in different types of histopathological changes. Our aim was to correlate the various types of mucosal response like inflammation, hyperplasia, metaplasia, and carcinoma to different gall stones characteristics (like number and morphology type). Materials and Methods: A retrospective study of 346 cases of removed GB was done which was based on the histological changes. A total of 313 (90%) were associated with gallstones and the rest 33 cases (10%) were of acalculous cholecystitis. The changes in mucosa of calculous GB (313 cases) were studied and correlation between the mucosal changes and the number and type of stones was evaluated. Varied parameters of gall stones like number and morphological type were studied. Tissue section for histopathological studies was taken from fundus, body, neck, and from abnormal looking areas while doing grossing. Results: Gender study revealed a higher incidence of inflammatory changes in males, while GB hyperplasia, intestinal metaplasia, and cancer were only found in females. A progressive increase in the average age was noticed fromintestinal metaplasia to carcinoma, suggesting that the metaplasia-carcinoma succession may occur in GB cancer. Conclusion: Correlation of mucosal changes with size and morphological type of stones has suggested that there could be an association between some histological alterations of GB and cancer.
  4,541 108 1
CASE REPORTS
Acantholytic squamous cell carcinoma of the tongue: A diagnostic challenge
Deepak Donthi, Anikode Subramanian Ramaswamy, Prashant B Mahalingasetti
March-April 2014, 3(2):179-181
DOI:10.4103/2278-0513.130222  
Squamous cell carcinoma is the commonest malignancy encountered in the head and neck. However, certain variants of this tumor can pose diagnostic dilemma due to their morphological mimicry. An incisional biopsy taken from a growth over the tongue presented with a similar diagnostic challenge. The unique histomorphological features of the rare acantholytic variant of squamous cell carcinoma and its differential diagnosis have been addressed in this report.
  2,539 85 1
Delayed cardiac migration of totally implantable central venous access catheter
Shailesh Solanki, M Narendra Babu, BC Gowrishankar, S Ramesh
March-April 2014, 3(2):182-184
DOI:10.4103/2278-0513.130223  
Chemo ports (or totally implantable venous devices) are increasingly being used for venous access for chemotherapy in cancer patients, especially in the pediatric age group. They improve the quality of life of children requiring long-term chemotherapy. Despite the advances made in the design, material of the catheter and the technique of insertion, various complications are associated with their use. Cardiac embolization of such a catheter is a life-threatening complication. We report, cardiac migration of a chemo port catheter 6 months post-insertion and discuss the diagnosis and management of this rare complication.
  2,370 62 2
Anal carcinoma presenting as gluteal mass: A rare experience
Debraj Saha, Debajyoti Mandal, Soumya Mondal, Subhasish Saha, Subhayan Mandal, Shivanand Prakash
March-April 2014, 3(2):168-169
DOI:10.4103/2278-0513.130218  
An isolated gluteal mass as a sole signature of underlying anal carcinoma has never been addressed in any surgical literature till to date. In our case report, we have shared our clinical experience of coming across through such a scenario where a 45-year-old lady initially presenting with an isolated apparently innocuous right gluteal mass later proved to be having an anal carcinoma is being discussed in brief. This entails a very cautious approach to any gluteal mass by a treating surgeon as an anal carcinoma may hide itself in this apparently benign rarely malignant surgical entity.
  2,261 59 -
ORIGINAL ARTICLES
A prospective randomised controlled trial of concurrent chemoradiation versus concurrent chemoradiation along with gefitinib in locally advanced squamous cell carcinoma of head and neck
Biswamit Bhattacharya, Santanu Pal, Bitoti Chattopadhyay, Shyam Sundar Adhikary, Joydeep Basu, Tanmoy Ghosh
March-April 2014, 3(2):146-152
DOI:10.4103/2278-0513.130160  
Background: The primary aim of the study was to find out whether addition of Gefitinib to standard cisplatin-based chemo-radiation can offer better treatment outcome at the cost of acceptable toxicities. Materials and Methods: Between January 2011 and June 2012, 64 patients were enrolled in the study following obtaining institutional ethical committee clearance and proper informed consent from the patients. Patients recruited were randomly allocated into a control arm (who received External Beam Radiotherapy with conventional 2 Gy/fraction, 5 days a week for 7 weeks up to total dose of 66 Gy along with concomitant injection cisplatin at the dose of 30 mg/m 2 of body surface area on every week during radiation) and study arm (who received radiotherapy with 2 Gy/fraction, 5 days a week for 7 weeks up to total dose of 66 Gy, along with concomitant injection cisplatin at the dose of 30 mg/m 2 of body surface area on every week during radiation, plus Tablet Gefitinib (250 mg/day orally) during the total duration of radiation treatment). However, only 61 patients (31 in the control arm and 30 in the study arm) were available for analysis. The two groups were comparable in terms of age distribution, sex distribution, performance status, stage, primary site and histological grade. Results: 29.03% patients achieved complete response (CR) in the control arm while 36.67% patients achieved CR in the study arm (CR), but the difference was not significant statistically (P = 0.5255). Total number of patients achieving overall response (CR + partial response) in control arm was 19 (61.29%) while it was 23 in the study arm (76.67%). However, the difference of overall response between the study arm and the control arm was not statistically significant (P = 0.1947). Disease free survival (DFS) rate at 1 year was 22.58% for the control arm and 33.33% for the study arm but it was not statistically significant (P = 0.515). Addition of Gefitinib to standard concurrent cisplatin-based chemoradiation was well-tolerated with no significant increase in acute skin or mucosal toxicity. There was no significant increase in late toxicities like subcutaneous tissue fibrosis and xerostomia in the study arm. The only acute toxicity that was significantly worse in the study arm was diarrhea. However, it could be managed easily with supportive measures and did not contribute to delay in completion of treatment. Conclusion: We can conclude that addition of Gefitinib to standard concurrent cisplatin based chemoradiation is well-tolerated, and in our study we found better overall response and DFS (at 1 year) with addition of Gefitinib to standard concurrent chemoradiation. However, these encouraging results did not reach the level of statistical significance. Larger studies involving much greater number of patients across multiple institutions are required to validate those encouraging results and clearly define the role of addition of Gefitinib to current standard of care in locally advanced squamous cell carcinoma of head and neck.
  2,189 105 2
CASE REPORTS
Pindborg's tumor: Report of a case with 6 years of follow-up
Kanaram Choudhary, R Rajeev
March-April 2014, 3(2):170-172
DOI:10.4103/2278-0513.130219  
Calcifying epithelial odontogenic tumor (Pindborg's Tumor) is an odontogenic tumor derived from dental lamina. It is relatively an uncommon odontogenic tumor, which shares clinical features with ameloblastoma. Here, we are reporting a case of Pindborg's tumor with 6 years of follow-up we are presenting this case with all the available clinical data. There was no recurrence within the 6 years of follow-up.
  1,997 65 -
A rare case of recurrent malignant phyllodes tumor of the breast in a young nulliparous woman
Zeeshanuddin Ahmad, Mahim Koshariya, Sameer Shukla, Vikram Vatti, Abhijeet Diwan
March-April 2014, 3(2):173-175
DOI:10.4103/2278-0513.130220  
Phyllodes tumors (PT) are fibroepithelial neoplasm characterized by a combination of hypercellular stroma and cleft-like or cystic spaces lined by epithelium, into which the stroma classically project in a leaf-like fashion and have a potential to recur and metastasize. These tumors are more common in 3 rd to 4 th decade. Here we present a case of recurrent malignant PT of the breast in a young nulliparous woman.
  1,988 64 -
Ectopic hidradenoma papilliferum with apocrine differentiation: A case report and review of the literature
Satyaveer Kumar Mathur, Ekta Boombak, Parul Tanwar, Rajeev Sen
March-April 2014, 3(2):165-167
DOI:10.4103/2278-0513.130217  
Hidradenoma papilliferum (HP) is a benign neoplasm involving anogenital mammary-like glands and occurs most commonly in the vulva or perianal region of adult white women. It is histopathologically similar to intraductal papilloma of the breast. The lesions are usually solitary, well-demarcated papules or nodules covered with normal skin and are generally less than 10 mm in diameter. The prognosis for HP is good. When these tumors are not located in the anogenital area, they are termed ectopic HP. We present a case of ectopic hidradenoma that presented as a mass on the right arm of a 65-year-old female. To the best of our knowledge, only a single case of ectopic HP has previously been reported on the arm.
  1,942 58 -
Primary primitive neuroectodermal tumor of the urinary bladder: A rare case report and review of literature
Aloke Ghosh Dastidar, Anindya Chakrobarty, Susmita Sadhukhan, Anirban Halder, Anjana Basu
March-April 2014, 3(2):162-164
DOI:10.4103/2278-0513.130216  
We report a rare case of primary primitive neuroectodermal tumor (PNET) of the urinary bladder. Primary PNETs of the bladder are very aggressive neoplasms. They are extremely rare and only few cases have been reported in the literature. A 26-year-old female patient who presented to us after excision biopsy is reported here. Initial histopathology examination report said the case to be small cell variant of malignant mesothelioma. Review and immunohistochemistry report confirmed the case as urinary bladder small round cell tumor with tumor cells expressing MIC-2. After excision of the tumor, bladder cystoscopy reveals normal study and patient is undergoing chemotherapy now.
  1,893 90 -
ORIGINAL ARTICLES
Best supportive care compared with chemotherapy and radiotherapy for unresectable gallbladder cancer: A tertiary care institute experience
Pramod Kumar Singh, Rakesh Kapoor, Ritesh Kumar, Amit Bahl, Narendra Kumar, Rajesh Gupta, Suresh Chendra Sharma
March-April 2014, 3(2):153-156
DOI:10.4103/2278-0513.130214  
Context: Gallbladder represent the most common cancer among biliary tree, complete surgery offers only chance of cure, but most of patients with unresectable or metastatic stage, in such patients only palliative treatment be given. Aims: The aim of this retrospective study is to evaluate efficacy of chemotherapy with gemcitabine and oxaliplatin (GEMOX), and or with radiotherapy over best supportive care (BSC)) in unresectable gallbladder cancer (GBC). Materials and Methods: Patients with unresectable GBC were evaluated from our center between 2008 and 2011. Three cohorts were identified. Group A, BSC, Group B chemotherapy with GEMOX two weekly for maximum of six cycles. Group C, Chemotherapy with GEMOX and Radiotherapy. Patients underwent percutaneous transhepatic biliary drainage (PTBD) or Endoscopic retrograde cholangiopancreatography (ERCP) when required. Results: Total 50 patients included in analysis. 19 are male and 31 are female. 14 patients in Group A. 18 patients in Group B and 18 in Group C. Median follow up was 8.8 month. The progression free survival (PFS) of patients who received of BSC at 15 month was 18%. PFS of patients who received chemotherapy (CCT) at 28 month was 30%. PFS of patients who received CCT Chemotherapy and radiotherapy PFS at 15 month was 38%. When compared all three group none is statically significant (P = 0.538). Conclusion: Judicious used of BSC along with chemotherapy and or with radiotherapy may help in increase in period of stable disease along with overall survival (OS) in selected group. In our retrospective analysis CCT with GEMOX and with radiotherapy has helped in improving the OS and PFS in few patients who had good performance status.
  1,695 90 -
CASE REPORTS
Benign mesenchymoma of foot: A rare occurrence
Kavita Mardi
March-April 2014, 3(2):185-186
DOI:10.4103/2278-0513.130224  
Benign mesenchymomas comprising of two or more mesenchymal elements along with fibrous tissue are extremely rare soft tissue tumors. Their occurrence in foot is extremely rare with only one case reported so far. We report on such case of benign mesenchymoma in the foot of 27-year-old male. Microscopic examination of excised mass revealed islands of hyaline cartilage, bone, adipose tissue, and blood vessels embedded in fibrous tissue.
  1,387 54 -
LETTERS TO THE EDITOR
Use of partial-arc planning technique for the treatment of prostate cancer
Narayan Kharel
March-April 2014, 3(2):187-187
DOI:10.4103/2278-0513.130225  
  888 47 -
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