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   2014| November-December  | Volume 3 | Issue 6  
    Online since October 11, 2014

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Age shift: Breast cancer is occurring in younger age groups - Is it true?
Brinder Chopra, Vaneet Kaur, Kamaljit Singh, Minni Verma, Sukhpreet Singh, Ajmer Singh
November-December 2014, 3(6):526-529
Context: Carcinoma of the breast is the most common malignancy in females. At present carcinoma breast is the leading cancer in urban India and has overtaken cancer cervix in incidence. Epidemiological studies at regional and global levels suggest the occurrence of carcinoma breast at a younger, premenopausal age in Indian and Asian women as compared with western women. Knowledge of this factor emphasizes the need to modify the timing of modalities of detection of early carcinoma and its management. According to literature, majority of carcinoma breast cases in the western countries present in Stages I and II of the disease whereas in India majority cases present in Stage III of the disease. The objective of this study is to observe age of occurrence of breast cancer and stage of cancer in this health facility. Other epidemiological factors such as diabetes and obesity were also recorded. Materials and Methods: A record based descriptive study was conducted in 100 patients of histopathologically confirmed breast cancer. Results: Mean age of subjects was 50.1 ± 10.5 years. Age distribution showed two peaks at 41-50 years and 51-60 years with 42 and 24 patients, respectively. Subjects who also had co-existing diabetes, hypertension, and obesity were 14, 14 and 6%, respectively. This study shows that 45% of the total patients were having advanced carcinoma breast (Stage III) at the time of reporting and 77% of these patients were below 50 years of age. Conclusion: Breast cancer is now occurring increasingly in younger age groups in India when compared with western countries and a more aggressive nature of the disease strikes Indian women in their reproductive period. This stresses the need for change in modalities of early cancer detection, modifying, and adjusting control efforts and multidisciplinary therapeutic efforts.
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Immunohistochemical expression of carcinoembryonic antigen-related cell adhesion molecules 5, CEACAM6, and SLC7A5: Do they aid in predicting the response to neo-adjuvant chemotherapy in locally advanced breast cancer?
Anju Bansal, Mukesh Garg, Chintamani Chintamani, Sunita Saxena
November-December 2014, 3(6):521-525
Context: Neo-adjuvant chemotherapy (NACT) has become an integral part of multimodality treatment for locally advanced breast cancer (LABC) worldwide. Predictors of therapeutic response to NACT are lacking. Whether carcinoembryonic antigen-related cell adhesion molecules (CEACAMs) like CEACAM5 and CEACAM6 can act as a predictor of response to therapy is unclear. SLC7A5 gene in humans encodes a large neutral amino acid transporter protein, which has an essential role in tumor cell growth and survival. Materials and Methods: Thirty histopathologically proven cases of LABC, being given NACT, were included in the study. Immunohistochemical examination of the tumor sections was performed for CEACAM5, CEACAM6, and SLC7A5. Response to chemotherapy was assessed using "Response Evaluation Criteria in Solid Tumors" (RECIST) 1.1 criteria. A total of three cycles were given at 3 weekly intervals. After 3 weeks of the last cycle of NACT, the patients were taken up for modified radical mastectomy. The specimen was subjected to histopathological examination. The immunohistochemical results were correlated with response to NACT based on RECIST criteria and histopathology. Results: 12/30 (40%) of the patients had objective clinical response of which 4 (13.33%) patients had pathological complete response. The relationship between CEACAM5 and CEACAM6 and response to NACT was found to be statistically significant, P = 0.004 and P = 0.020, respectively. Furthermore, relationship between response to NACT and node-positive tumors with SLC7A5 immunoreactivity was found to be highly significant (P = 0.009). Conclusion: Biomarkers (CEACAM5, CEACAM6, and SLC7A5) showed promise as predictors of poor response to NACT and can help plan an alternative regime in likely nonresponders to prevent the toxicity of chemotherapy and also in tailoring the therapy in a patient with LABC.
  3 1,294 52
Primary small cell carcinoma of the larynx
Jagannath Dev Sharma, Nizara Baishya, Tashnin Rahman, Manigreeva Krishnatreya, Amal Chandra Kataki, Abhishek Singh
November-December 2014, 3(6):542-544
Squamous cell carcinoma is a common histological type for laryngeal cancer and primary laryngeal small cell carcinoma (LSCC) is a rare occurrence. The prognosis of LSCC is also considered to be poor. We present here a case of 40-year-old female with localized primary small cell carcinoma of the larynx. The diagnosis of LSCC was made after histopathological examination and confirmed by immunohistochemistry study. The patient was treated by concurrent radiotherapy and chemotherapy. In our limited experience, there was a good therapeutic response to treatment of localized primary small cell carcinoma of the larynx.
  2 3,348 40
Cutaneous metastasis involving face in breast cancer: A series of three patients
Daleep Singh, Akhil Kapoor, Mukesh Kumar Singhal, Prakash Singh, Vanita Kumar, Harvindra Singh Kumar
November-December 2014, 3(6):545-547
Breast carcinoma is the most common malignancy encountered in clinical practice presenting with cutaneous metastasis (CM). CM all over the body with involvement of eyelids is very rare. Here, we present a case series of three patients, two with common nodular metastasis to facial skin and one, a rare case of carcinoma breast with multiple diffuse CM all over the body and face involving eyelids.
  2 4,098 39
GSTP1 expression and promoter methylation in epithelial ovarian carcinoma
V Shilpa, Rahul Bhagat, CS Premalata, VR Pallavi, Lakshmi Krishnamoorthy
November-December 2014, 3(6):487-492
Context: GSTP1 is a subgroup of glutathione-S-transferase family, which provides cellular protection against free radical and carcinogenic compounds due to its detoxifying function. Altered GSTP1 activity due to down regulation of enzyme activity and DNA methylation has been reported in many tumors, although data for ovarian cancer are few. In this study, we aimed at determining the expression of GSTP1 in relation to the methylation of the GSTP1 promoter in epithelial ovarian cancer (EOC). Materials and Methods: GSTP1 mRNA expression and GSTP1 enzyme concentration were assessed by quantitative reverse transcriptase polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay, respectively, in 88 EOCs, 14 low malignant potential (LMP) tumors, and 20 benign tumors. The promoter methylation of GSTP1 gene was evaluated by methylation-specific PCR. Results: Reduced GSTP1 mRNA expression was observed in 49% EOCs, 21.4% LMP, and 45% benign tumors. Significantly lower levels of plasma GSTP1 were observed in all tumor samples compared to normal. GSTP1 promoter methylation was detected in 10 (11.4%) EOCs and 1 (7.3%) LMP tumors. No methylation was observed in benign tumors and normal ovaries. Conclusions: Our results show that there is a significant down regulation of GSTP1 expression while hypermethylation of the GSTP1 gene promoter is not very frequent in EOC. Further studies are needed to study underlying mechanisms leading to decreased expression.
  2 2,197 55
Role of lectins in clinical settings
Charu Kapoor, Sharad Vaidya, Harpreet Kaur, Ajay Jain
November-December 2014, 3(6):472-477
Lectins are a diverse class of proteins derived from either plants, microbial or animal sources and may be soluble or membrane bound. It is a tetramer made up of four nearly identical subunits. In humans, lectins have been reported to cause digestive distress, carbohydrate, and other disorders. This review intends to put forward basic foundation in carbohydrate structure and function, lectin biology and the implications of glycobiology in human health and disease, particularly in cancer therapeutics. These topics are among the hundreds included in the field of glycobiology and form the cornerstone of glycobiology.
  2 4,738 110
Chronic myeloid leukemia with myelopathy: Rare complication of common malignancy
Faheem Arshad, Bashir Ahmad Shah, Showkat Ahmad Mufti, Irshad Ahmad Parry
November-December 2014, 3(6):551-553
Myelopathy due to a spinal cord epidural mass is an extremely rare presentation of hematological malignancies. We report a case of 50-year-old male who was diagnosed with chronic myeloid leukemia 2 years back and was on imatinib. He presented with paraplegia due to spinal epidural mass likely chloroma. Chloroma or granulocytic sarcoma should be considered in the differential diagnosis of an epidural mass in patients with hematological malignancy. Chronic myeloid leukemia (CML) is a common chronic myeloproliferative disorder, both bleeding and thrombosis occur less frequently during stable phase. Our patient presented with paraplegia with an epidural mass likely chloroma which settled after emergent treatment, receiving radiotherapy and steroids. We believe this is the first case report of myelopathy in a patient of previously diagnosed CML in stable phase showing marked improvement after treatment.
  1 3,018 44
A rare case report of triple malignancy: Carcinoma urinary bladder, larynx, and breast in a single patient
Mukesh Kumar Singhal, Akhil Kapoor, Satya Narayan, Raj Kumar Nirban, Ramesh Purohit, Puneet Kumar Bagri, Harvindra Singh Kumar
November-December 2014, 3(6):558-560
Triple malignancy is a very rare occurrence. We report a case of transitional cell carcinoma of the urinary bladder (UB) that subsequently developed squamous cell carcinoma of the larynx after 2 months of diagnosis. He was given radiotherapy for both the primaries. However, after 3 years of completion of treatment, the patient developed a nodular lesion in the right breast just below the nipple. Excision biopsy of the lesion revealed invasive ductal carcinoma. Thus, triple malignancies with different histologies in all the primaries were established in the patient with UB cancer and laryngeal cancer developing synchronously followed by breast cancer metachronously.
  1 1,320 50
Comparative efficacy of newer antioxidants spirulina and lycopene for the treatment of oral submucous fibrosis
Santosh Patil, Suneet Khandelwal, Sneha Maheshwari
November-December 2014, 3(6):482-486
Context: Oral submucous fibrosis (OSMF) is a high-risk premalignant condition predominantly seen in the Indian subcontinent. The aim of the present study was to compare the efficacy of spirulina and lycopene in the management of OSMF. Materials and Methods: Sixty-eight subjects with clinico-pathologically diagnosed OSMF were included in the study which was conducted from March, 2013 to July, 2013. They were divided equally in two groups, Group A (spirulina group) and Group B (lycopene group). Group A was administered 500 mg spirulina in two divided doses for 3 months, and Group B was given 8 mg lycopene in two divided doses of 4 mg for 3 months. Evaluation for different clinical parameters was done at regular intervals and data was analyzed using the Student's paired t-test and Chi-square test. P <0.001 was considered to be statistically significant. Results: The patients in both the groups showed improvement in all the parameters measured. Clinical improvements in mouth opening was significant in Group B (P = 0.0006), whereas ulcers/erosions/vesicles significantly (P = 0.0001) improved in the Group A. However, there was no significant improvement in pain associated with the lesion (P = 0.004) and burning sensation (P = 0.005) among the two groups. Conclusion: Lycopene can bring about significant clinical improvements in the symptoms like mouth opening, while spirulina can significantly improve ulcers/erosion/vesicles. Both the drugs also showed improvement in pain associated with the lesion and burning sensation. Thus, both the drugs appear to be promising for the treatment of OSMF.
  1 3,837 101
Role of glutamine versus placebo in prevention of acute gastrointestinal toxicity in pelvic radiotherapy: A randomized control study
Kazi Sazzad Manir, Bhadra Kallol, Kumar Gaurav, Adhikari Arnab, Manna Amitabha, Sarkar Kumar Shaymal
November-December 2014, 3(6):508-513
Context: Nausea, vomiting, diarrhoea, abdominal cramping, ano-proctitis are common acute gastrointestinal (GI) toxicities during pelvic radiotherapy (RT), having important impact on treatment outcome. Glutamine has a major role in mucosal growth and function. This phase III study is conducted to evaluate the role of prophylactic glutamine supplementation in prevention of acute GI toxicities during pelvic RT. Materials and Methods: Eighty five nonmetastatic patients with pelvic malignancy needing pelvic RT are included in this double blind randomized control trial. During RT 42 patients (Arm A) received 10 g glutamine oral supplementation 1 h before every RT fraction. Forty three patients received glycine as placebo (Arm B) in same schedule. Patients were assessed weekly for common acute RT induced GI toxicities. Toxicities were graded according to Common Terminology Criteria for Adverse Events version 4.02. Results: Two arms were well balanced with all baseline parameters. Median age was 57. 56.47% (n = 48) patients had cervical cancer. There was no significant difference between two arms in grade wise incidence of any of the GI toxicities. Trends of diarrhoea during weekly assessments also similar in both arms. Conclusion: There is no significant beneficial effect of glutamine during pelvic RT. As per our study data and our dose schedule glutamine should not be indicated in pelvic RT.
  1 1,743 48
Radically treated carcinoma lung with early metastasis to the tongue: A case report and review of literature
Alagu Ganesh, Sisha Liz Abraham, Shaji Thomas, KR Anila
November-December 2014, 3(6):530-532
Metastatic lesions to the oral cavity are rare and constitute 1% of all oral lesions. Soft tissues in the oral cavity are less commonly affected when compared with bone. In males, lung is the most common primary site, and the overall survival is low. We present a case of sarcomatoid carcinoma (spindle cell carcinoma) of lung that developed metastasis to the tongue alone soon after completing radical treatment. Immunohistochemistry plays a major role in differentiating a primary tongue lesion from a metastatic lesion.
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Multiple cutaneous metastases in laryngeal carcinoma: A rare occurrence
Kishore Das, Manigreeva Krishnatreya, Nizara Baishya, Anupam Sarma, Amal Chandra Kataki
November-December 2014, 3(6):533-535
Metastasis to the skin in laryngeal squamous cell carcinoma is an extremely rare occurrence. We report a case of multiple cutaneous metastases in the follow-up of a 60-year-old male with squamous carcinoma of the vocal cords that were treated with surgery and radiotherapy. The patient presented with multiple painful skin nodules at 3 months following the completion of treatment. Clinically the skin nodules mimicked an inflammatory skin lesion. The diagnosis of metastatic skin lesions was made by cytological examination. Appearance of new painful skin lesions soon after the completion of treatment in patients treated for squamous carcinoma of the larynx should warrant a clinical suspicion of cutaneous metastases.
  - 1,763 40
Primary squamous cell carcinoma of the renal parenchyma: A rare occurrence
Rina Mukherjee, Madhumita Mondal, Shyamalendu Modal, Debit Banerjee
November-December 2014, 3(6):536-538
Primary squamous cell carcinoma (SCC) of renal parenchyma is a very rare entity although renal pelvic SCC is common. We probably are reporting the third case in a 35 years female presenting with left lumbar pain and weight loss. Lower pole mass was found on contrast enhanced computed tomography (CECT) study of abdomen for which left total nephrectomy was done. Histopathological examination revealed a well differentiated squamous cell carcinoma. Her physical condition did not permit for any adjuvant therapy. Two months after surgery she expired.
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Isolated gluteus maximus muscle metastasis as an initial presentation and primary asymptomatic nonsmall cell lung cancer detected using fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography imaging
Koramadai Karuppusamy Kamaleshwaran, Sudhakar Natarajan, Anjali Malaikkal, Vyshakh Mohanan, Ajit Sugunan Shinto
November-December 2014, 3(6):539-541
Isolated skeletal muscle metastasis in nonsmall cell lung cancer (NSCLC) is a rare event particularly when it is detected at initial staging. Our case report describes the whole body imaging with fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography detecting asymptomatic primary NSCLC causing the solitary symptomatic metastasis to the gluteus maximus muscle. Patient underwent systemic chemotherapy.
  - 1,440 31
Colonic gastrointestinal stromal tumor: A diagnostic dilemma on cytology
Shailja Puri Wahal, Reetika Sharma, Neelam Gupta, Anchana Gulati
November-December 2014, 3(6):561-563
Gastrointestinal stromal tumors (GIST) is mesenchymal tumors arising from the interstitial cells of Cajal (pace maker cells) of the gastrointestinal tract (GIT). Stomach is the most common site (60-65%) of these tumors. Large intestine and rectum constitute only 5-10% of GIT tumors. Pre-operative diagnosis helps in the management of this tumor as it responds well to c-kit inhibitors. The cytological diagnosis of GIST is characteristic, however, associated with many pitfalls leading to erroneous diagnosis. Morphological resemblance is seen with other spindle cell and epithelioid cell tumors. The differentiation between high grade and low grade GISTs is described but not reliable. Cytology combined with cell block and Immunocytochemistry helps in making a confident diagnosis. Here we present colonic GIST diagnosed as GIST on cytology and confirmed on histopathology. We report this case to describe the cytological features of GIST and pitfalls in the cytology.
  - 1,962 41
Mandibular metastasis from follicular variant of papillary carcinoma of thyroid: Report of an uncommon initial presentation
Subrata Pal, Sanjay Sengupta, Kingshuk Bose, Biplab Kr Biswas
November-December 2014, 3(6):564-566
Follicular carcinomas of thyroid have more prone to metastasize through hematogenous route and commonly involve bone, whereas papillary carcinomas spread through lymphatics. However, mandibular metastasis from thyroid malignancy is rare. Few cases have been reported until now. We are presenting a case of metastatic carcinoma of mandible and gingiva from follicular variant of papillary carcinoma of thyroid and interestingly secondary malignancy identified before the diagnosis of primary tumor.
  - 1,022 41
Giant mixed germ cell tumor of the testis: A rare presentation
Divya Khosla, Rohit Mahajan, Uma Handa, Kislay Dimri, Awadhesh K Pandey
November-December 2014, 3(6):567-569
We report a rare case of a 16-year-old male who presented with a large swelling in the right lower abdomen and groin region. After investigations, the patient was diagnosed as malignant mixed germ cell tumor with lung metastasis. In view of large size of tumor, orchiectomy was not feasible and patient has been started on chemotherapy. We report this case due to its rarity and for documentation.
  - 1,659 47
Multifocal incidental papillary microcarcinoma of thyroid: Diagnostic pitfall in cytology
Viral M Bhanvadia, Shamim S Sheikh, Pravina M Santwani
November-December 2014, 3(6):570-572
Papillary microcarcinoma (PMC) of a thyroid tumor measuring 10 mm or less in maximum diameter. PMC of thyroid is an incidental finding, and some of them show multifocality. Here, we present a case of 33-old adult male diagnosed on cytology as benign follicular nodule and subsequently diagnosed as multifocal incidental PMC in the colloid nodule of thyroid on histopathology. PMC of thyroid is a diagnostic pitfall on cytology and ultrasonography-guided aspiration should be done. Optimal therapeutic and management strategy needs to be determined for PMC of thyroid.
  - 2,734 78
Intracranial metastasis from carcinoma of the cervix: A rare case report
Tanvi Aggarwal, Nilima Sawke, G Sawke
November-December 2014, 3(6):573-575
Brain metastasis from cervical carcinoma is very rare and have poor prognosis. We report an interesting and rare case of cervical carcinoma who developed brain metastasis following total hysterectomy with bilateral salpingoophorectomy and radiotherapy, within 6 months of primary diagnosis. Since patient prognosis is very poor, oncology physicians should anticipate the presence of this condition in order to give prompt and comprehensive treatment.
  - 2,305 35
Paratesticular embyronal rhabdomyosarcoma in an adolescent: A rare case report
BR Vani, K Geethamala, V Srinivasa Murthy, MU Thejaswini, KP Padmaja
November-December 2014, 3(6):554-557
Embyronal rhabdomyosarcoma (RMS) accounts for approximately 49% of all RMS. After head and neck, this tumor is most commonly found in genitourinary region, which includes paratesticular RMS. Paratesticular RMS is rare constituting 4-7% of all RMS in children and young adults. It has been regarded as highly malignant tumor with frequent recurrence. The management protocol is of multimodal approach of surgery, chemo, and radiotherapy. We herein report a case of left paratesticular RMS in an 18-year-old male, which posed a diagnostic dilemma clinically and by imaging. Histopathology with added immunohistochemistry brought out the confirmatory diagnosis. The patient was successfully treated and on follow-up is disease free until date.
  - 1,428 47
Giant retroperitoneal liposarcoma: A very rare case report
RS Mohil, Umesh Jethwani, GJ Singh, J Arora, Ravi Saroha, Rahul Verma, Fouzia Siraj
November-December 2014, 3(6):548-550
Soft-tissue sarcomas are very rare entity, seen in <1% of all malignancies. Sarcoma accounts for about one-third of all retroperitoneal malignancies. Management of retroperitoneal sarcoma is challenge for surgeons because of its rare presentation and no standard guidelines for it. A 65-year-old male presented to surgery out-patient department with the complaints of abdominal distention and pain in abdomen since 3 years. On imaging, he was diagnosed as case of retroperitoneal tumor and managed by radical surgery including resection of the tumor with left kidney, spleen, and descending colon. Postoperative period was uneventful.
  - 1,462 53
Primary intraparenchymal squamous cell carcinoma of the kidney: A challenge to exclude the histologic mimickers
Kaushik Saha
November-December 2014, 3(6):457-458
  - 1,526 152
Role of cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen in patients of primary central nervous system lymphoma: Is it justifiable?
Akhil Kapoor, Prakash Singh Rajput, Satya Narayan, Harvindra Singh Kumar
November-December 2014, 3(6):576-577
  - 806 40
Blinatumomab: A ray of hope for relapsed/refractory adult B-cell acute lymphoblastic leukemia
Akhil Kapoor, Prakash Singh Rajput, Surender Beniwal, Harvindra Singh Kumar
November-December 2014, 3(6):577-578
  - 2,015 62
Human papillomavirus in esophageal squamous cell carcinoma
Akshay Chandra Deka, Vidhya Srinivasan, Ananta Madhab Dutta, Pratap Chandra Sarma
November-December 2014, 3(6):478-481
Context: We studied the role of Human papillomavirus (HPV) in esophageal squamous cell carcinoma from North East India. Methods: Fifteen archival paraffin embedded esophageal squamous cell carcinoma tissues were retrieved. Thin sections were made to extract DNA from the tissues. HeLa cell lines which harbor HPV DNA were used as a positive control. Nested polymerase chain reaction (PCR) was performed to analyze the presence of HPV DNA. Amplified products were analyzed on a 2% agarose gel and visualized by ethidium bromide staining. Positive product was sequenced for confirmation of the result. Results: HPV DNA was not able to detect in any esophageal squamous cell carcinoma tissue. Positive control HeLa cells DNA was found to be positive for HPV DNA by nested PCR. Conclusions: Our study shows the negative association of HPV in esophageal squamous cell carcinoma. However, further studies are needed with a large number of sample size to rule out the role of HPV in this region.
  - 1,706 114
Current trends of carcinoma tongue at a Medical College in Central India: A retrospective study
Vikrant Ranjan, Sanjay Desai, Tulika Joshi, Dewesh Kumar, Mayank Pancholi, Raghvendra Singh Yadav
November-December 2014, 3(6):493-496
Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly affected site. Aims and Objectives : The current study assesses the clinico-epidemiological trends of carcinoma tongue, its survival rates in different stages and relationship between different variables in central India. Materials and Methods : This was a retrospective study of 121 carcinoma tongue patients admitted between the period of 2½ years in a hospital of central India. The data collected were age and sex distribution, location and site of the tumor, tumor stage, histopathological type and grade, nodal status, modality of treatment, recurrences and survival. The disease free survival (DFS) was analyzed against stage, nodal status and recurrences using log rank test. Results : In this study, the incidence of cancer was more in males (male: female = 6.1:1) particularly in their fifth decade (mean 52.7 years) and the most common location was anterior 2/3 rd of the tongue mainly on right lateral side. Most of the patients presenting to out-patient department were having neck nodes positive status. The clinical stage at presentation was mainly advanced stages with well-differentiated squamous cell carcinoma. The most common treatment offered was surgery with radiotherapy (RT), followed by chemotherapy plus RT. The mean DFS time was of 27.8 ± 1.68 months, and it was directly related to tumor stage (P < 0.0001) in comparison to nodes positivity and recurrences. Conclusion : The study signifies better prognosis of carcinoma tongue in early stages and warrants more awareness campaigns and health education in the health facilities as well as in community for early diagnosis of the disease with proper staging and subsequently multimodal treatment for increasing survival rates.
  - 2,332 58
Role of blood grouping as a prognostic marker in breast carcinoma its relationship with histological and hormonal prognostic markers
Lokesh Haswani, TN Suresh, A Hemalatha, ML Kumar, A Bhaskaran
November-December 2014, 3(6):497-501
Context: Breast carcinomas are one of the leading causes of mortality and morbidity in our country. Estrogen receptor (ER) and progesterone receptor (PR) status plays a very important role in therapeutic decisions in managing these patients. ABO and Rh blood type has been associated with risk and survival for several malignancies. Aims and Objectives: To know the frequency of ER and PR positivity status in the semi-urban population. To relate ABO/Rh blood group, ER and PR status with histopathological stage and Nottingham prognostic index (NPI). Materials and Methods: This was a retrospective study carried out on 45 cases from July 2012 to December 2013 who underwent mastectomy for breast cancer were included in our study. Histopathological grade of the tumor, lymph node invasion was noted. NPI was calculated. Immunohistochemistry was done using antibodies against ER and PR. Blood grouping and Rh typing was done. Descriptive statistics and Chi-square tests were done using SPSS package 20. P < 0.05 was considered to be significant. Results: In our study, maximum number of cases were in the fourth decade of life with a mean age of 52 years. ER and PRs were positive in 23/45 (51.1%) of cases. Most of the ER and PR negative patients were in the premenopausal group. Lymph node-positive tumors were ER negative (54%) and PR negative (58%). Patients in our study belonged to Group B (35.5%) and Group O (35.5%). Eighty percent of Rh negative cases were ER and PR positive. A 2 × 2 table correlating ER and PR positivity with Rh negative status revealed a positive correlation with P < 0.05. Majority of ER and PR negative tumors belonged to Groups B and O. Conclusion: Majority of the patients were in premenopausal age group with 51.1% of our cases were ER and PR positive. Majority of Rh negative17 patients were ER and PR positive.
  - 1,510 57
Does desmin immunohistochemistry have a role in assessing stage of urothelial carcinoma in transurethral resection of bladder tumor specimens?
Kaushik Saha, Arpita Saha, Chhanda Datta, Uttara Chatterjee, Suchandra Ray, Malay Bera
November-December 2014, 3(6):502-507
Context: Pathological stage is the most important determinant of clinical outcome of bladder carcinoma patients. pT 1 carcinoma is defined by invasion into lamina propria, including muscularis mucosae (MM), but not into muscularis propria (MP) (pT 2 ). However, pathological staging of the tumor is a complicated task for pathologists. "Splitting of MP" or "hypertrophy of MM" caused by tumor invasion are important causes of interpretation subjectivity leading to intra-pathologist variation and disagreement. The aim of the study was to prospectively evaluate the utility of desmin immunohistochemical expression for evaluation of muscle invasion in transurethral resection of bladder tumor (TURBT) specimens. Materials and Methods: A total of 40 TURBT cases was taken. Specimens were processed, stained with H and E, graded and evaluated to determine whether MP invasion was present. Desmin immunohistochemistry (IHC) was used to assess muscle invasion and compare the result with H and E stained sections. Tumors with radiological evidence of gross invasion and those of stage T is were excluded. Results: Among 40 TURBT cases, there were 37 cases of transitional cell carcinoma. Among them, 17 were high grade and 20 were low grade. On H and E, 17/37 cases showed MP invasion, 8/37 cases showed no MP invasion and the rest 12/37 had questionable MP invasion. Desmin staining intensity was graded from 0 to 3+. MM showed negative (0) and moderate (2+) staining in one case each, mainly (35/37) showed mild (1+) staining intensity. MP showed moderate (2+) (3/37) to strong (3+) (34/37) staining intensity. Among 12/37 questionable cases (on H and E) desmin staining showed definite MP invasion in eight cases. Conclusions: Although morphology remains the gold standard, desmin IHC has diagnostic utility in the evaluation of questionable MP invasion and hence in staging of urothelial carcinoma.
  - 2,123 52
Primary central nervous system lymphoma: An Indian Perspective
KC Lakshmaiah, Vishwanath Sathyanarayanan, K Govind Babu, D Lokanatha, KN Lokesh, MC Babu, Clementina Rama Rao, CS Premalatha, TM Suresh, Vineetha Unnikrishnan, Linu Jacob Abraham
November-December 2014, 3(6):514-520
Context: Primary central nervous system lymphoma (PCNSL) is an unusual entity comprising around 5% of extra nodal lymphomas with a dismal prognosis in spite of a multi-modality treatment protocol involving chemotherapy and radiotherapy. There is sporadic data from this part of the world and hence we took up this study to analyze the outcome with various modalities of treatment. Materials and Methods: We undertook this study between January 2007 and January 2013 on 33 consecutive patients diagnosed with PCNSL to analyze the clinical profile and treatment outcomes of PCNSL at a tertiary care oncology center in South India. Twelve patients received the DeAngelis protocol and the remaining 21 patients received either radiotherapy or a combination of radiotherapy and anthracycline based therapy or steroids. This study also compared the outcomes with protocols of DeAngelis et al. and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen with/out radiotherapy. Results: A total of 33 patients with PCNSL were studied. Median age was 40 years (range 22-75 years). Male: Female ratio was 3.1:1. All 33 were histologically diffuse large B-cell lymphoma (DLBCL). HIV was positive in 1. The most common presenting symptom was focal neurological deficits in 19 (58%). Cerebrospinal fluid was positive in 2 (6%). The area of involvement was mainly cerebral hemispheres 20 (61%). The treatment protocols followed were DeAngelis in 12, cyclophosphamide, doxorubicin, vincristine and prednisolone with radiotherapy (CHOP + radiation therapy [RT]) in 12, RT alone in 6, CHOP in 2 and 1 received no therapy. On a median follow-up of 17 months, the median overall survival was 15 months (range 1-60 months) with DeAngelis protocol and 12 months (range 8-24 months) with CHOP + RT. Conclusions: DeAngelis protocol has improved the prognosis in patients with PCNSL compared with other protocols as shown in our study. Newer chemotherapy regimens or targeted therapies need to be evaluated to further improve the survival.
  - 4,949 67
Obstacles of cancer survivorship: Sexuality issues - Need to break communication barriers
Lokanatha Dasappa, Nagesh T Sirsath, Kuntejowdahalli C Lakshmaiah, TM Suresh, Kakanshetty Govind Babu, MC Suresh Babu
November-December 2014, 3(6):459-466
Many types of cancer and cancer therapies are frequently associated with sexual dysfunction. Previously sexual problems in cancer patients were mostly linked to breast or gynecologic cancer in females and prostate cancer in males. However, recent studies indicate that several other cancers are associated with sexual problems with estimates of sexual dysfunction ranging from 40% to 100% across various sites. Conversation related to sexual problems is not often the comfort zone for both patients and doctors. Numerous barriers contribute to this lack of communication, including lack of provider training, lack of time and lack of access to resources should the need arise to tackle the problem. Although clinicians often worry that patients will be offended or embarrassed if asked about sexual health, it is important to remember that multiple studies clearly indicate that patients want to talk about this topic with their doctors and that they desire more information about possible sexual side effects of treatment. It is essential that clinicians prepare patients for potential changes that may be encountered and let them know that discussion about sexual health concerns is welcome. Patients should be offered sexual counseling and informed about the availability of therapies for sexual dysfunctions. In this article, we aim to provide a concise review of the most common sexual problems experienced by survivors and discuss treatment options to overcome the problem.
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Chronic myeloid leukemia in children: A brief-review
Lalit S Raut
November-December 2014, 3(6):467-471
Chronic myeloid leukemia (CML) in children is rare. The disease biology is the same as adults. Managing CML in children is challenging because of various issues like the rarity of the disease, lack of uniform guidelines, need of long-term medications, ensuring compliance and many more. This is a brief overview of some of these issues.
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