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   2016| July-August  | Volume 5 | Issue 4  
    Online since July 12, 2016

 
 
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CASE REPORTS
A rare case of giant cell fibroma in a pediatric patient
Sangeeta Rajesh Patankar, Nidhi Somnath Tripathi, Pratyusha Prakash Gaonkar, Gokul Sridharan
July-August 2016, 5(4):327-329
DOI:10.4103/2278-0513.186104  
Fibrous hyperplastic lesions are frequently encountered in the oral cavity. Although clinically similar, these lesions show variations histologically. Giant cell fibroma (GCF) is one such nonneoplastic fibrous lesion with a characteristic histopathological feature of stellate-shaped multinuclear or mononuclear fibroblasts known as giant cell fibroblasts. In the recent years, more and more GCF cases have been reported in pediatric patients. This case report describes a papillary soft tissue growth in the lower right posterior region of the mandible in a 5-year-old child with a review on giant cell fibroblasts.
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Breast cancer as second malignant neoplasm after acute myeloid leukemia: A rare occurrence
Govind Babu, Smitha Carol Saldanha, Mallekavu Suresh Babu, Lakshmaiah Chinnagiriyappa Kuntegowdanahalli, Lakkavalli Krishnappa Rajeev, Kadabur Nagendrappa Lokesh, Lokanatha Dasappa, Linu Abraham Jacob, Rudresha Antapura Haleshappa
July-August 2016, 5(4):333-335
DOI:10.4103/2278-0513.186105  
Cancer survivors after successful treatment of hematological and lymphoid malignancies are at an increased risk for second malignant neoplasms. As the overall survival has increased in these cancers, solid tumors are emerging as a serious long-term complication. In this article, we describe such a rare occurrence, in literature, of breast cancer after the treatment of acute myeloid leukemia.
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Giant cell tumor of acromion process with secondary aneurysmal bone cyst
Mohd Faizan, Aamir Bin Sabir, Saifullah Khalid, Latif Zafar Jilani, Bushra Siddiqui, Mazhar Abbas
July-August 2016, 5(4):342-344
DOI:10.4103/2278-0513.186102  
Giant cell tumor (GCT) or osteoclastoma develops after attaining physeal closure with the most common sites of involvement being the ends of long bones. It is uncommon in the small bones of hands and feet and extremely rare in the flat bones. GCT is a locally aggressive tumor, but in rare cases, it may metastasize to lungs, ribs, regional lymph nodes, and skull. Secondary aneurysmal bone cyst (ABC) may also develop in some cases. Histopathological appearance is pathognomonic in most of the cases of GCT with secondary ABC formation, and immunohistochemistry is rarely needed for a confirmatory diagnosis. The usual treatment is excision or curettage with an adjuvant such as bone cement, liquid nitrogen, and phenol. Involvement of the acromion process is extremely rare. Here, we report a case of a young male having GCT of the acromion process with secondary ABC, and it is the second case reported in literature.
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ORIGINAL ARTICLES
Primary intracranial germ cell tumors: A single institution experience from a South Indian tertiary cancer center
Lokanatha Dasappa, Govind Babu, Lakshmaiah Kuntegowdanahalli Chennagiriyappa, Lingegowda Appaji, K. P. R. Pramod, Usha Amirtham, Linu Abraham Jacob, Suresh Babu, Aparna Sreevatsa
July-August 2016, 5(4):299-304
DOI:10.4103/2278-0513.186099  
Background: Intracranial germ cell tumors (ICGCTs) are rare tumors seen in the pineal and suprasellar regions. The World Health Organization has classified ICGCTs into germinoma and nongerminomatous GCT (NGGCT). Germinoma is radiosensitive and has excellent survival rate. Patients with NGGCTs are less sensitive to radiotherapy and have less favorable outcome. Objective: This retrospective observational study was carried out to determine the clinical features, treatment, and outcome of patients diagnosed as ICGCT from June 2006 to June 2014.Materials and Methods: Patients' medical records were reviewed for information regarding age, gender, presenting features, treatment instituted, complications, and treatment outcome. Results: Seven patients with ICGCT were studied. Their age ranged from 4 to 24 years, with median age being 13 years. All of them were male. Four patients had germinoma and three had mixed NGGCT. Four patients had pineal region mass, two patients had suprasellar mass, and one patient had bifocal disease with both pineal and suprasellar involvements. Following surgical debulking or ventriculoperitoneal shunt, patients received radiation and chemotherapy. One patient of germinoma and another patient of NGGCT died due to febrile neutropenia/sepsis. The overall survival was 4 years for patients with both germinoma and NGGCT. Conclusions: ICGCTs are rare tumors seen in the second decade of life, with male preponderance. With judicious use of chemotherapy and radiotherapy, germinoma has excellent survival outcome. The outcome of NGGCT can be improved with multimodality treatment.
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CASE REPORTS
Favorable response in “locally advanced stage” of adenocarcinoma lung to erlotinib: Quality of life and clinical and radiological outcome are satisfactory after 24 weeks
Shital Patil, Umesh Kanade
July-August 2016, 5(4):315-319
DOI:10.4103/2278-0513.186103  
Lung cancer is one of the most common types of cancer and the leading cause of human cancer deaths worldwide. Adenocarcinoma is the most common histological type of lung cancer. Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) have been reported to exert a significant impact in the treatment of nonsmall cell lung cancer, particularly in patients harboring mutations in the EGFR gene. In this case report, 41 years male with “locally advanced stage” of lung cancer presented with shortness of breath on routine work and compromised quality of life, diagnosed to have malignant pleural effusion after pleural fluid cytology evaluation. We performed bronchoscopy guided transbronchial lung biopsy and confirmed to have adenocarcinoma lung after histopathology evaluation. We further analyzed thyroid transcription factor-1 and EGFR mutation study in histopathology sample and started “targeted therapy” with erlotinib. We documented excellent clinical and radiological response with complete resolution of pleural fluid and lung parenchymal lesion, and significant improvement in quality of life after 6 weeks of erlotinib. We used erlotinib as a “maintenance therapy” in adenocarcinoma lung for 24 weeks.
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Malignant transformation of ectopic thyroid tissue in the orbit: A rare case report
Tuhin Bhattacharya, Wang Hao Chhang, Mintu Saha, Riti Tushar Kanti Sinha
July-August 2016, 5(4):320-322
DOI:10.4103/2278-0513.186101  
Ectopic thyroid tissue refers to the presence of thyroid tissue in locations other than normal anterior neck region. It is the most frequent type of thyroid dysgenesis. Lingual thyroid is the most common type accounting for 90% of the cases. The presence of thyroid tissue in orbit is extremely rare along with malignant transformation and the presence of normal thyroid gland. We report a very rare case of follicular carcinoma arising in the ectopic thyroid tissue in the left orbit along with normal thyroid gland. To the best of our knowledge, it is the first ever reported case of this type.
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Rare case presentation of symplastic leiomyoma in nulliparous female
Rajshree Dayanand Katke
July-August 2016, 5(4):323-326
DOI:10.4103/2278-0513.186100  
We present a case of a 26–year-old female, nulligravida, who presented in outpatient department in our hospital with ultrasound suggestive of multiple huge fibroids at posterior wall and right lateral wall. Patient gave a history of myomectomy done in the past 2 years back. Histopathology was suggestive of benign leiomyoma. Ultrasound Doppler and magnetic resonance imaging were suggestive of multiple large size highly vascular fibroids in posterior and lateral wall of uterus of size 11 cm × 10 cm × 5 cm, compressing uterus and bladder with venous congestion. Intraoperatively, uterus was enlarged with multiple fibroids with sarcomatous changes in it. Largest of size 20 cm × 15 cm × 10 cm with increased vascularity with ovaries and bowel adhered to uterus. Total abdominal hysterectomy with B/L pelvic lymph node dissection with omentectomy was done. Histopathology was suggestive of symplastic leiomyoma. Diagnosis was confirmed by immunohistochemistry as symplastic leiomyoma.
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Brain metastasis in soft-tissue sarcoma
Ashutosh Das Sharma, Jyoti Poddar, Sonal Patel, Ubrangala Suryanarayan Kunikullaya
July-August 2016, 5(4):336-338
DOI:10.4103/2278-0513.186109  
Brain metastasis in soft-tissue sarcoma is an uncommon event. It usually follows lung metastasis, with a lag period between the occurrences of the two events. We present such a case of soft-tissue sarcoma with lung and brain metastases, with the intention of drawing attention toward this rare occurrence and need of anticipation of brain metastasis in patients who are asymptomatic for the same and have already developed lung metastasis.
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Radiation therapy for a rare association of maxillary neoplasm in xeroderma pigmentosum: Is it really contraindicated?
Saurabh Samdariya, Sumer Chand Jain, Abhishek Onkar, Chendil Viswanthan
July-August 2016, 5(4):339-341
DOI:10.4103/2278-0513.186110  
Dermatologic malignancies are common in xeroderma pigmentosum (XP) patients; they can develop maxillary sinus cancers on rare occasions. Despite their extreme sensitivity to ultraviolet light, the patients of XP can be treated with standard doses of ionizing radiation for the treatment of cancers. The examples of use of radiotherapy as a treatment modality for maxillary neoplasms in patients of XP are rare. This report highlights a rare association of maxillary carcinoma in a patient of XP who received the tumoricidal doses of therapeutic X-rays with acceptable toxicities.
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Carcinoma buccal mucosa in a treated case of carcinoma cervix: A rare presentation
Varsha Mandloi, Abhishek Shrivastava, Hameeduzzafar Ghori, Vivek Tiwari, Omprakash Singh, Veenita Yogi
July-August 2016, 5(4):330-332
DOI:10.4103/2278-0513.186108  
Second malignancy in an adequately treated cancer is a rare occurrence. Second cancer arising beyond the treated region and its draining lymphatic is even more sporadic. We report a treated case of carcinoma cervix with a metachronous presentation of carcinoma buccal mucosa and provide a brief literature review.
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Intracystic papillary carcinoma in the male breast: A diagnostic challenge
Veena Raja, Chinnaiya Subramaniam Babu Rajendra Prasad, Prashanth Murthy
July-August 2016, 5(4):345-348
DOI:10.4103/2278-0513.183500  
Breast carcinoma in men is rare, and “intracystic papillary carcinoma (IPC)” of a male breast is an extremely rare entity accounting for <1% of all breast malignancies. It represents a small distinctive subgroup of noninvasive breast cancer. We discuss a case of a 70-year-old male presented with left breast lump of 6 months duration which rapidly increasing in size over 10-day period showed cystic mass with a mural nodule on ultrasonography. A diagnosis of papillary neoplasm was awarded (suspicious for malignancy-C4) on cytology. The patient underwent simple mastectomy, and a final diagnosis of “IPC” was confirmed on histopathology. IPC of the male breast is an extremely rare entity with favorable prognosis. Triple assessment (clinical examination and radiological and histological assessment) is necessary to diagnose IPC. Pathologic diagnosis can be difficult at classical histological examination; thus, the absence of myoepithelial cells layer by immunohistochemical study can be useful.
  - 1,556 17
Peripancreatic cystic lymphangioma with secondary hemorrhage: A rare case report
Kanapilly Francis Magdalene, Krishnan Prasad, Jose Shwetha
July-August 2016, 5(4):349-352
DOI:10.4103/2278-0513.183547  
Lymphangiomas are thought to be true neoplasms, hamartomas or lymphangiectasias. Intra-abdominal lymphangiomas are rare and occur most frequently in children. This is a case report of a 27-year-old female with recurrent episodes of the left-sided upper abdominal pain of 2 years duration. She gives a history of intermittent nausea and vomiting. Liver function test and complete blood count with differential were normal. During the initial stages of illness, the serum lipase was elevated; the serum amylase level was normal all through the entire period. The upper gastrointestinal endoscopy suggested hiatal hernia and mild duodenitis. Two computed tomography scans done at 5 months interval showed a hypodense lesion in the distal tail of pancreas with irregular margins. The size of lesions had decreased from 15 mm × 14 mm to 13.5 mm × 10 mm during this period. Endoscopic ultrasound showed ill-defined area in the distal tail of pancreas and pseudocyst was suspected. Magnetic resonance cholangiopancreatography after 2 months showed a cystic lesion in the tail of pancreas of size 11 mm × 10 mm. Due to increasing severity of pain and fainting spells, the patient was taken up for a distal pancreatectomy. The histopathologic examination confirmed a diagnosis of peripancreatic cystic lymphangioma with secondary hemorrhage. During the postoperative period, the drain amylase was high suggestive of grade A pancreatic fistula. Gradually, the levels decreased, the patient became stable and discharged after pneumococcal vaccination.
  - 1,370 19
Nasopharyngeal cancer with solitary femoral bone recurrence after 7 years
RK Spartacus, Pradeep Gaur, AR Kalla, Kanchan Rathore
July-August 2016, 5(4):353-355
DOI:10.4103/2278-0513.183494  
The skeleton is the most common site of distant metastasis from nasopharyngeal carcinoma. The commonly affected sites are the spine, and the pelvis and lesions are multifocal. However, solitary bone involvement with no evidence of loco-regional failure nor any other metastasis, 7 years after achieving a complete response to initial definitive chemoradiotherapy, is rare. We report the case of a 41-year-old man who developed a solitary femoral bone recurrence. He received local radiotherapy to the femur followed by cisplatin-based chemotherapy. He presently enjoys good functional status.
  - 1,387 17
Sternocleidomastoid tumor – rare infantile neck mass diagnosed by fine-needle aspiration cytology: Report of two cases
Shilpa Bairwa, Ashok Sangwaiya, Shivani Kalhan, Rahul Narayan Satarkar, Pawan Singh, Sonia Hasija
July-August 2016, 5(4):356-358
DOI:10.4103/2278-0513.183533  
Sternocleidomastoid tumor, also known as fibromatosis colli, is a rare form of fibromatosis in infants which is a rare, benign, and self-limiting tumor of infancy presenting as a well-circumscribed, hard, immobile, and fusiform swelling in the lower or middle portion of the sternocleidomastoid muscle. Birth injury associated with difficult labor is the most favored hypothesis. We describe using two cases as an example how this condition can be diagnosed by careful clinical history taking and fine-needle aspiration cytology so to avoid the surgical intervention. Here, we highlighted the cytological features of the sternocleidomastoid tumor so that it can be easily differentiated from congenital, inflammatory, and neoplastic masses in the neck in an infant.
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Cytology and histopathology of an unusual neck mass: Extraskeletal myxoid chondrosarcoma
Pooja Chauhan, Neelam Sharma, Lalita Negi, Sudershan Kumar Sharma
July-August 2016, 5(4):359-362
DOI:10.4103/2278-0513.186106  
Extraskeletal myxoid chondrosarcomas (EMCs) are rare soft tissue tumors with estimated incidence of 2.3% among all soft tissue sarcomas. Most of these tumors occur in the extremities with only a few cases reported in the head and neck region. Histologically, these tumors exhibit a broad spectrum of morphologic features, which make distinction from other neoplasms difficult, particularly when the tumor occurs at an unusual anatomic location. We present a case report of a 55-year-old male with colloid goiter who presented with a recent increase in his long-standing anterior neck swelling. A computed tomography scan demonstrated a cartilaginous lesion in the soft tissue of the neck. Subsequent cytological and histological examination revealed EMC.
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LETTER TO THE EDITOR
Cysticercosis of neck – A rare cutaneous tumor
Sarita Asotra
July-August 2016, 5(4):363-364
DOI:10.4103/2278-0513.186111  
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ORIGINAL ARTICLES
A study of usefulness of washes and brush cytology with respect to histopathology in diagnosis of lung malignancy by using fiberoptic bronchoscopy
Abhishek Bandyopadhyay, Mallika Pal, Indranil Das, Supriya Sarkar, Ranu Sarkar, Pranita Taraphdar
July-August 2016, 5(4):293-298
DOI:10.4103/2278-0513.186107  
Background: Examination of specimens obtained through flexible fiberoptic bronchoscope is important and often the initial diagnostic technique performed in patients with suspected malignant lung lesion. Aims: To evaluate the usefulness of cytological findings of bronchial washings (pre-and post-bronchoscopy) and bronchial brushing in the diagnosis of lung malignancy with histopathology of bronchial biopsy, taking the latter as the confirmatory diagnostic test. Settings and Design: It was a cross-sectional observational study conducted in a tertiary care center. Subjects and Methods: A total of fifty patients with suspected lung malignancy (clinically and radiologically) were included in this nonrandomized cross-sectional study. Bronchial brushings were obtained from all fifty cases. Prebiopsy bronchial washing (washing collected before the brushing and biopsy procedure) and postbiopsy washing (washing at the end of the procedure) were collected. Results: Prebiopsy (prebrushing) and postbiopsy washing showed high specificity of 92.31%, but a very low sensitivity of 32.43% and 35.14%, respectively. Sensitivity and specificity of brushing were found to be 74.36% and 81.82%, respectively. Positive predictive value of prebiopsy (prebrushing) washing, postbiopsy washing and brushing are 92.31%, 93.55%, and 92.86%, respectively. There was no significant difference in sensitivity between prebiopsy (prebrushing) and postbiopsy washing (Fisher exact probability test; PA= 0.99). However, there was statistically significant difference between sensitivity of brushing with prebiopsy (prebrushing) washing (Fisher exact probability test; PA = 0.0012793) and postbiopsy washing (Fisher exact probability test; PA = 0.00310282). Conclusions: Bronchial washing cytology in combination with brush cytology aids in the early diagnosis of lung malignancy in addition to histopathology.
  - 3,212 17
Defining the T status in breast cancer: Where do we stand?
Ramamurthy Rajaraman, Subbiah Shanmugam, Anitha Gandhi, Deepa Shunmugam
July-August 2016, 5(4):305-308
DOI:10.4103/2278-0513.183495  
Background: Tumor size in breast cancer is a key factor for staging, prognosticating, and deciding the choice of treatment. Currently, there are no standard rules for measuring the T status in breast cancer. The purpose of this study was to determine an accurate method to evaluate the T status by various parameters compared with the actual size in fresh specimens. Materials and Methods: This prospective study was conducted on 134 breast cancer patients scheduled to undergo a modified radical mastectomy. The paired t-test was used for analyses. Results: Using a paired t-test, the differences in tumor size as measured by physical examination (P ≤ 0.001) and in the formalin-fixed specimen (P ≤ 0.001) when compared with the postoperative fresh specimen were highly significant. These differences indicated that the physical examination and formalin-fixed specimen measurements were inaccurate in estimating tumor size. Tumor size, as measured by a mammogram and ultrasonogram when compared with the referenced P= 0.077 and 0.149, respectively, showed that the ultrasonogram is the most accurate method of determining tumor size in vivo. The mean percentage decrease in size of the formalin-fixed specimen was 7.8, which was significant enough to downstage two patients from T2 to T1 and seven patients from T3 to T2. Conclusion: An ultrasonogram is the most accurate way of defining tumor size in vivo as measured in postoperative fresh specimens. Tumor shrinkage with formalin fixation may give a false T status.
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Morphometric assessment of microvessel density in head and neck squamous cell carcinoma using immunomarker CD105 and its correlation with clinicopathological parameters
Nisha Marwah, Padam Parmar, Sanjeev Parshad, Taruna Yadav, Sumiti Gupta, Rajeev Sen
July-August 2016, 5(4):309-314
DOI:10.4103/2278-0513.183546  
Background: Blood vessel counts using CD105 staining are more informative marker of prognosis as compared with staining by other endothelial markers. We conducted a study to compare intratumoral (IT) and peritumoral (PT) microvessel density (MVD) in head and neck squamous cell carcinoma (HNSCC) using endothelial marker CD105 and its correlation with lymph node metastasis, histological grading, and other clinicopathological parameters. Materials and Methods: Fifty cases of HNSCC with modified radical neck dissection specimens were included in the study group. Representative blocks were prepared from tumor, PT tissue, tumor margins, and all the lymph nodes. Histopathological diagnosis and other parameters were established on the routine hematoxylin and eosin stain. Immunohistochemical profile of blood vessels in IT and PT tissues was assessed by subjecting one section each from a representative block of the tumor and PT tissue to CD105 immunostain. To determine MVD, four fields with the highest MVD (hotspots) were identified. The mean values were calculated by taking an average of all the measurements. Results: No significant association was seen between MVD, IT-MVD, and PT-MVD and different age groups, male/female patients, risk factors, site of tumor, size of tumor, presence/absence of inflammation, pushing/infiltrating margin, and different stages of tumors. When compared in node positive and negative groups, a significantly higher MVD, IT-MVD, and PT-MVD was seen in association with lymph node metastasis. The comparison of MVD between PT and IT area revealed significantly higher IT-MVD (P = 0.001). Conclusion: In the study, we found a significant association of IT-MVD with lymph node metastasis and also observed CD105 as a highly specific marker for IT microvessels while PT vessels were not stained or weakly stained.
  - 1,837 17
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