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   2017| July-August  | Volume 6 | Issue 4  
    Online since November 17, 2017

 
 
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ORIGINAL ARTICLES
Volumetric modulated arc therapy treatment planning assessment for low-risk prostate cancer in radiotherapy
Hafiz Mubibbullah Zulkafal, Muhammad Afzal Khan, Muhammad Waqas Ahmad, Muhammad Akram, Saeed Ahmad Buzdar, Khalid Iqbal
July-August 2017, 6(4):179-183
DOI:10.4103/ccij.ccij_38_17  
Aims: This research study was carried out for dose verification of volumetric modulated arc therapy (VMAT) plan in the patients of low-risk prostate cancer using different indices in radiotherapy. Materials and Methods: Twenty patients with low-risk prostate cancer after histopathological confirmation were included which were divided into two groups with prescribed dose of 7400 and 6000 cGy according to their disease and 3 mm sliced for each patient by computed tomography was obtained for planning. To evaluate the dose conformity and its distribution using VMAT plans such as homogeneity index (HI), radial dose HI, moderate dose HI, coverage, and uniformity index for each patient. These plans were constructed for each patient separately using Eclipse Treatment planning software. Statistical Analysis Used: Statistical Package for the Social Sciences statistical software is used to calculate mean standard deviation and standard error of all these indices. Results: Obtained results and findings enabled this research work to conclude that VMAT is a better treatment technique for the patients of low-risk prostate cancer with uniform dose distribution. Conclusion: It has been suggested that VMAT with Eclipse Treatment planning system is a good treatment modality to treat the patients of low-risk prostate cancer with better results.
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CASE REPORTS
Primary retrosternal goiter mimicking as teratoma of anterior mediastinum: A diagnostic enigma
Ramana Reddy Naru, Manilal Banoth, Mohammed Basheeruddin Inamdar, Aruna K Prayaga
July-August 2017, 6(4):190-193
DOI:10.4103/ccij.ccij_42_17  
Primary intrathoracic goiters arising from aberrant thyroid tissue are rare, representing <1% of all retrosternal goiters (RGs). We report a rare case of primary RG in a male patient with symptoms of mediastinal mass lesion alone. By careful examination and with the help of radiological imaging, we could pick up a thyroid swelling with a mediastinal mass which led to a diagnostic dilemma, as the thyroid swelling was reported as a multinodular goiter and the mediastinal mass was misdiagnosed as teratoma. We subjected the patient to a functional imaging with a thyroid scintigraphy, which revealed a thyroid swelling with retrosternal extension that was managed by surgery (total thyroidectomy and mediastinal mass excision) with only a Kocher's neck crease incision.
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Triple-negative metaplastic breast carcinoma with extensive squamous differentiation in a 55-year-old woman: A rare entity
Banyameen Mohamad Iqbal, Harsh Kumar, Tushar Kambale, Abhishek Baravkar
July-August 2017, 6(4):194-196
DOI:10.4103/ccij.ccij_46_17  
The World Health Organization in 2003 classified the metaplastic breast carcinomas into, pure epithelial metaplastic carcinomas and mixed epithelial/mesenchymal metaplastic carcinomas, which comprises of squamous cell carcinoma, adenocarcinoma with spindle cell metaplasia, adenosquamous carcinoma, and mucoepidermoid carcinoma in the former and only mixed types in the latter. Metaplastic carcinoma is a rare form of cancer which accounts for <1% of invasive breast cancer and is characterized by areas of metaplasia typically with squamous, spindle, osseous, or chondroid differentiation in the background of adenocarcinoma. We are presenting a case of a 55-year-old female with a fungating, ulceroproliferative mass involving her whole breast including the nipple areola complex which turns out to be a rare form metaplastic breast carcinoma with extensive squamous differentiation.
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Aggressive angiomyxoma: An uncommon entity with literature review
Vaanika Kaira, Anil Kumar Gupta, Amandeep Kaur
July-August 2017, 6(4):197-199
DOI:10.4103/ccij.ccij_39_17  
Aggressive angiomyxoma (AA) is a soft-tissue tumor of mesenchymal origin, not so common, but it occurs and exhibits marked tendency for local recurrence with extremely low risk of distant metastasis. The most common sites of origin include vulvovaginal region, perineum, and pelvis of reproductive age females. We report a case of AA in a 36-year-old female presenting with polypoidal vulval growth on the right side with a previous history of surgical resection at the same site 4 years before. Fine needle aspiration cytology of the growth revealed only blood and no cellular component. The tumor was excised and submitted for histopathological examination. A diagnosis of aggressive angiomyxoma was made based on characteristic histological features
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Primary leiomyosarcoma of spleen masquerading adrenal tumor - A rare case
Zeenat Ara, Piyabi Sarkar, Keya Basu, Probhas Kumar Sarkar
July-August 2017, 6(4):200-202
DOI:10.4103/ccij.ccij_40_17  
Leiomyosarcoma (LMS) is a malignant smooth muscle tumor which is predominantly intra-abdominal in location. LMS arising from vascular smooth muscle is quite uncommon which usually arises from inferior vena cava and is aggressive in nature. Primary venous LMS of splenic vein is exceedingly rare and has unpredictable clinical course with complete surgical resection representing the only potentially curative treatment. We hereby report a case of primary splenic vein LMS in a 59-year-old male patient mimicking an adrenal tumor radiologically.
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Primary intraosseous carcinoma of the mandible
Revati Deshmukh, Priya Nimish Deo, Surekha Chavan, Rajshekhar Halli
July-August 2017, 6(4):203-206
DOI:10.4103/ccij.ccij_41_17  
Primary intraosseous carcinoma (PIOC) is a rare neoplasm occurring in the jaw bones, especially in younger patients which is locally aggressive and has a poor prognosis. It is believed to arise from the odontogenic epithelium. It is called as PIOC because it arises de novo which makes it primary and it develops centrally within the bone hence called as intraosseous. The early lesions are asymptomatic or a painful swelling is seen. To diagnose PIOC, basic criteria have been proposed. (1) Absence of ulcer in the oral mucosa overlying the tumor, (2) Absence of another primary tumor at the time of diagnosis and for at least 6 months during the follow-up, and (3) Histological evidence of squamous cell carcinoma. Till date, around 60 cases of PIOC are reported. Being rare, we would like to discuss the review of literature and a case report on PIOC.
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ORIGINAL ARTICLES
Squamous cell carcinoma antigen reproducible marker and its clinicopathological correlation with preinvasive and invasive cervical cancer
Meenakshi Singh, Pushplata Sachan, Munna Lal Patel, Radhey Shyam, Rekha Sachan
July-August 2017, 6(4):184-189
DOI:10.4103/ccij.ccij_43_17  
Background: Squamous cell carcinoma antigen (SCC-Ag) is a serologic tumor marker detected in SCC of the cervix. The aim of this study is clinical features and their histopathological correlation between preinvasive and invasive cervical cancer and its association with SCC-Ag levels. Materials and Methods: This case–control study was carried out over a period of 1 year in the Department of Obstetrics and Gynaecology, with collaboration of pathology and medicine. After informed consent and ethical clearance, totally 3200 women were recruited. Out of these, 76 women who were histopathological proven, 30 preinvasive, and 46 of invasive cervical malignancy (International Federation of Gynecology and Obstetrics Stage I–IV) enrolled for study. 15 healthy cytology negative were considered as controls. Per speculum, per vaginam examination was done in every women and pap smear was obtained. Pretreatment 5 ml venous blood samples were drawn into sterile vials. SCC-Ag levels were measured by enzyme-linked immunosorbent assay (ELISA) technique using ELISA Kit as per producer protocol. Results: Among preinvasive group, 35.46% women complained white discharge per vaginam. Blood mixed discharge and postcoital bleeding were observed in 3.4% and 0.71%, respectively. In malignant group, foul smelling discharge and postmenopausal bleeding were reported in 1.68% and 1.87% women, respectively. Serum SCC-Ag levels were increased from controls to cases. In controls, 0.27 ± 0.12 ng/ml, preinvasive 0.85 ± 0.37 ng/ml and in invasive malignancy Stage I, II, III, IV, 2.10 ± 0.55 ng/ml, 3.15 ± 0.84 ng/ml, 4.12 ± 0.89 ng/ml, and 2.71 ± 1.05 ng/ml, respectively. Moderately differentiated and poorly differentiated SCC were reported in 80.43% and 19.56%, respectively. Expired patients had significantly (P < 0.01) higher premean SCC Ag level as compared to those who remain alive. Conclusion: Serum SCC-Ag is not only useful in the detection of preinvasive lesions and early invasive cases of cervical cancer but also a definite indicator for advanced Stage malignancy. Its value was quite high in late stages of cervical malignancy, thus it can be used as reproducible marker in cervical cancer.
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