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   2018| March-April  | Volume 7 | Issue 2  
    Online since March 8, 2018

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Genetics and Epigenetics of Glioblastoma: Therapeutic Challenges
Saleh Rasras, Kazem Zibara, Tina Vosughi, Zeinab Deris Zayeri
March-April 2018, 7(2):43-49
Glioblastoma is a brain tumor that develops due to both genetic and epigenetic risk factors. Crosstalk between the genetic and the epigenetic offers new possibilities for therapy. Abnormal methylation of methylguanine-DNA methyltransferase (MGMT) promoter region and isocitrate dehydrogenase 1 (IDH1) mutations are prognostic and therapeutic response markers in glioblastoma. Mutations in genes such as epidermal growth factor receptor, TP53, and P16 have been reported in glioblastoma; therefore, they might associate with survival and worth to be used in estimating survival risks. MKI67 expression associates with posttreatment such as adjuvant radiotherapy results evaluation. On the other hand, monosomies, such as deletions of chromosome 10, especially q23 and q25–26, are good markers for estimating the progression and aggressiveness of glioblastoma. The profile of MGMT methylation is modified in glioblastoma and hence can be a good target for epigenetic drugs. Other useful strategies in the treatment of gliomas include several micro-RNAs (MiRs) which are alerted in glioblastoma and which affect the regulation of mRNAs are associated with gene expression profiles of the disease. Epigenetic drugs, such as azacitidine and decitabine, which belong to the DNA methyltransferases (DNMT) inhibitor 5-aza-2'deoxycytidine (5-aza-dC), can suppress DNMT1 and stimulate tumor suppressor genes expression. MGMT methylation status and IDH mutational status are two valuable prognosis and therapeutic response markers in glioblastoma. Regulation of glioblastoma through epigenetic drugs, such as not only inhibitors of EZH2, histone deacetylase, and DNMT, but also MiRs, are promising approaches in glioblastoma treatment. Improves in understanding cancer genetic and epigenetic disruptions is the key point in solving the puzzle of glioblastoma treatment.
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Frozen Section versus Paraffin Section in Diagnosis of Breast Lesions: A Comparative Study
Vaanika Kaira, Anil Kumar Gupta, Asha Agarwal, Sanjay Kala, Pankaj Kaira
March-April 2018, 7(2):70-73
Background: Frozen section (FS) examination has a number of indications such as identification of tissue type, benign versus malignant nature of the tissue, type of malignancy, determination of surgical margins, positivity of lymph nodes, and presence of malignant implants and/or metastasis in other tissues. Contraindications to the use of FS exist such as small lesions that could be destroyed by the freezing and sectioning and leaving no tissue for a definitive diagnosis. Therefore, this prospective study was planned to compare the accuracy of FSs versus paraffin sections in diagnosis of breast lesions. Subjects and Methods: The present prospective study was conducted from December 2008 to September 2010 in the Department of Pathology, GSVM. Medical College, Kanpur. A total of 115 cases were studied including benign and malignant breast lesions. Results were compared between FS diagnosis, and gold standard paraffin section diagnosis was evaluated, following Hematoxylin and Eosin staining and analyzed for accuracy in terms of false positivity and false negativity. Results: Out of 115 cases in our study, concordance was found in 109 cases. In our study, concordance for malignant breast lesion was 100%, whereas for benign lesions, it was 95.9%. Four cases (3.5%) were deferred to paraffin section diagnosis and two cases (1.8%) were misdiagnosed on FS. Conclusions: Diagnosis by FS is accurate to 100% in case of malignancy and confirming up to 96% for benign lesions. Its use, thus during breast surgery, is advocated for better clinical management of patients.
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Alveolar Rhabdomyosarcoma of the Prostate in a Young Adult Presenting with Acute Retention of Urine
RB Nerli, Adarsh C Sanikop, Vishal Kadeli, Shridhar C Ghagane, Neeraj S Dixit, Murigendra B Hiremath
March-April 2018, 7(2):77-80
Prostate rhabdomyosarcoma is rare in adults. It is characterized by a high degree of aggressiveness, rapid local growth with the formation of large pelvic masses, often leading to urethral obstruction, and systemic spread, commonly to the lungs, liver, and bone. A 23-year-old male was referred to our department with symptoms of acute retention of urine, hematuria and constipation. He was earlier admitted in another hospital, wherein he was catheterized, evaluated and underwent both transurethral as well as transrectal biopsy of the prostate. Our case was clinically advanced, and chemotherapy treatment seemed adequate to control the disease, and reduce the symptoms and improve the quality of life.
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Adipokine Role in Normal and Neoplastic Bone Marrow Niche
Behrouz Yazdanpanah, Mohammad Shahjahani, Faezeh Seif, Elahe Khodadi, Saeid Shahrabi
March-April 2018, 7(2):37-42
Bone marrow (BM) niche is an appropriate site for the growth of mesenchymal stem cells and their differentiation into adipocytes. Adipocytes are metabolically active cells affecting the function of their neighboring cells through the secretion of adipokines, growth factors, and inflammatory mediators. Although the pathological roles of adipokines have not been elucidated, the changes in their levels have been observed in various malignancies. Adipokines also affect tumor growth in the BM niche. Decreased levels of adipokines and increased levels of leptin have been reported in a number of cancers. Adipocytes can be introduced as a diagnostic marker of metastasis in some cancers. Identification of the relationship between different adipokines secreted from adipocytes and the signaling pathways activated by these adipokines, as well as the detection of molecules involved in the development of various types of malignancies, can contribute to the recognition of drug resistance factors and appropriate treatment of malignancies. In this review paper, we examine the effects of various BM-derived adipokines on the growth and metastasis of tumor cells in the neoplastic BM niche.
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Evaluation of DNA Damage in Peripheral Blood Leukocytes in Oral Potentially Malignant and Malignant Disorders by Comet Assay
Garima Rawat, Aadithya B Urs, Anita Chakravarti, Priya Kumar
March-April 2018, 7(2):50-55
Purpose: Oral squamous cell carcinoma (OSCC) and potentially malignant disorders (PMD) are associated with DNA damage which can be caused by exposure to carcinogens, genotoxins, or increased oxidative stress. Early detection and assessment of the amount of DNA damage using a biomarker such as a comet assay can prove to be extremely beneficial for the patients. The present study evaluated the efficacy of comet assay in assessing DNA damage in peripheral blood leukocytes (PBLs) in oral potentially malignant and malignant disorders. Materials and Methods: The study included fifty-five patients each of leukoplakia, oral submucous fibrosis (OSMF), and OSCC along with fifty-five healthy individuals as control. The patients with deleterious oral habits were categorized into smokeless, smoked, and mixed habit groups. DNA damage was evaluated by measuring the mean tail length (μm). Results: An increased mean tail length (μm) and higher DNA damage were found in OSCC (22.4335 ± 1.52341), and there was a progressive stepwise increase in mean tail length from control (6.8307 ± 0.84261) to PMD (leukoplakia [13.0022 ± 0.74316]; OSMF [10.6085 ± 0.88140]) to OSCC. Although there was a significant increase in the DNA damage in different habit groups (smokeless [14.9380 ± 5.18516]; smoked [15.4947 ± 4.59589], and mixed [16.3650 ± 5.62407]) compared to controls, there was no significant difference between the habit groups. Conclusion: Thus, comet assay technique can be used as a sensitive and reliable indicator for DNA damage evaluation.
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KAI-1 ad p53 Expression in Odontogenic Cysts: An Immunohistochemical Marker Study
Namrata N Patil, Vijay Wadhwan, Abhishek Singh Nayyar, Minal Chaudhary, Santhosh D Reddy, KV Chalapathi
March-April 2018, 7(2):62-69
Background: KAI-1/CD82 is a tumor suppressor gene with decreased gene expression being associated with increased invasive ability of oral squamous cell carcinoma and as hypothesized for various odontogenic cysts and tumors. p53 protein functions in G1-S phase of the cell cycle to allow the repair of damaged DNA. In the present study, p53 and KAI-1 expression was investigated using monoclonal antibodies in the various odontogenic cysts. Aims: To detect KAI-1 and p53 expression in radicular cysts, dentigerous cysts, and odontogenic keratocysts (OKCs) and to assess the relation between p53 and KAI-1 expression in the aforementioned cysts. Materials and Methods: The present study included histopathologically diagnosed cases of radicular cysts, dentigerous cysts, and OKCs for the expression of KAI-1 and p53 antibodies. Results: Among odontogenic cysts, radicular cysts expressed maximum positivity of KAI-1 (20.92%) while p53-positive cells were maximum in OKC (4.04%). The correlation between KAI-1 and p53 expression in the various odontogenic cysts was not found to be significant. Conclusion: The increased KAI-1 expression in the radicular cysts and its downregulation in OKCs may be indicative of aggressive clinical behavior and the fact that OKCs are hypothesized as neoplastic rather than being developmental in origin.
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Orofacial Rhabdomyosarcoma: A 5-year Clinicopathologic Study from Sub-Saharan Africa
Adebayo Aremu Ibikunle, Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Kabir Abdullahi, Usman A Malami
March-April 2018, 7(2):56-61
Background: Rhabdomyosarcoma (RMS) is an aggressive malignant neoplasm of mesenchymal origin. Its common sites of occurrence are the extremities and the genitourinary system, being less frequently seen in the orofacial region. There is paucity of literature, especially from sub-Saharan Africa on orofacial RMS. Materials and Methods: Records of all patients managed for orofacial RMS between January 2013 and November 2017 at the Department of Dental and Maxillofacial surgery of Usmanu Danfodiyo University Teaching Hospital were obtained. Data retrieved include sociodemographics, clinical features (including the tumor, node, and metastasis [TNM] stage and Intergroup RMS Study risk classification), histological type, and mode of treatment. Data were recorded and analyzed using IBM SPSS Statistics for Windows version 20 (Armonk, IBM Corp., NY, USA). Results: Twenty-one patients were included. There were 17 (81.0%) males and 4 (19.1%) females, giving a male-to-female ratio of 4.3:1. Age ranged from 2 to 76 years (mean [±standard deviation] of 15.8 [±16.8]). Majority of them belonged to the low socioeconomic group. The duration of the symptoms ranged from 2 to 9 months. The midface was the most commonly involved sites. Majority of the cases were nonparameningeal 14 (66.7%). Regional nodal metastasis was clinically present in 9 (42.9%) cases. Embryonal RMS was the most frequently encountered histological type (11 [52.4%]). Treatment was multimodal in 11 (52.4%) cases and 3 (14.1%) had recurrence. Conclusion: Orofacial RMS may occur in any age group although it may be more commonly seen in the first decade of life. Unimodal treatment may be successfully deployed in carefully selected cases. Prognosis remains poor in our climes.
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Renal Cell Carcinoma in Pregnancy: Radical Nephrectomy and the Use of Dexmedetomidine
Uma Hariharan, Neha Kator, Vijay Nagpal, Lalita Chaudhary
March-April 2018, 7(2):74-76
Renal cell carcinoma is sinister cancer, uncommon during pregnancy. A 26-week period of gestation, primigravida pregnant women presented with painless hematuria and left flank fullness. She was found to have left-sided renal cell carcinoma, with no metastasis or vascular invasion. All her preoperative investigations were within normal limits, except for mild anemia. An obstetric evaluation was unremarkable, with normal fetal heart sounds. Perioperative care of pregnant patients for oncosurgery poses great challenges, affecting both the mother and the fetus. Preoperative tocolytic therapy was started to prevent preterm labor, and an obstetrician was kept standby during surgery. A combined general anesthesia with rapid sequence induction and cricoid pressure along with preinduction epidural catheter was administered, followed by the insertion of invasive monitoring lines. Dexmedetomidine use is also highlighted, as it has several beneficial effects and has been safely used in pregnant patients. The tumor was successfully removed, and the patient was transferred to the high-dependency-care unit after extubation. We hereby describe the perioperative anesthetic challenges in this unique case report.
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Pure Transitional Cell Carcinoma of the Ovary: A Recently Recognized Rare Subtype of Ovarian Epithelial Cancer
Banyameen Mohamad Iqbal, Bedarshi Banerjee, Tushar Kambale, Iqra Mushtaq
March-April 2018, 7(2):81-83
Transitional cell carcinoma (TCC) of the ovary is a nomenclature given by Austin and Norris to a group of malignant Brenner tumors having a benign component. It is to be noted that transitional cells tumors of the ovary are not equivalent to Brenner tumor. Microscopically, Brenner tumors consist of solid and cystic nests of epithelial cells resembling transitional epithelium (urothelium), and not transitional cell epithelium in actual, surrounded by an abundant stromal component of dense, fibroblastic nature. Most authors currently favor for Brenner tumor, an origin from surface ovarian epithelium or the cysts derived from them, through a process of metaplasia. This subtype of ovarian tumor has a favorable response to chemotherapy than other ovarian surface epithelial cancers; therefore, it warrants early recognition. We hereby present a rare case report of isolated TCC of ovary.
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Esophageal Squamous Cell Carcinoma, Human Papillomavirus and p16
Mala R Gowda
March-April 2018, 7(2):85-85
  1,241 17 -
Bronchoscopic Characterization of Lesions and Use of Technique Accordingly During Bronchoscopy
Sora Yasri, Viroj Wiwanitkit
March-April 2018, 7(2):84-84
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