Cancer stem cells (CSCs) are tumor cells with stem-like features that possess the ability to self-renew, but can also give rise to more differentiated progeny. CSC can be identified based on increased in vitro spheroid- or colony formation, enhanced in vivo tumor initiating potential, or expression of cell surface markers. Since CSCs are thought to be required for the maintenance of a tumor cell population, these cells could possibly serve as a therapeutic target. Therapeutics based on CSC markers, epithelial mesenchymal transition, developmental pathways, or tumor micro-environment could potentially be used to target CSC which may lead to a reduction of tumor growth, metastatic events and chemoresistance in various cancers.

Gallbladder cancer (GBC) represents the most common malignancy among the biliary tree cancers representing 3% of such tumors. Complete surgical resection offers the best chance for cure. Adjuvant chemotherapy and radiotherapy are less well-defined and need to be further evaluated to increase local and systemic control. Local recurrences as high as 75% have been reported after radical cholecystectomy in GBC. The patterns of failure and poor overall prognosis in GBC, justify administration of adjuvant treatments. Only an estimated 20% of patients receive radiotherapy or chemotherapy after resection and fewer than 10% of all presenting patients undergo surgery, radiotherapy and chemotherapy. Recent series have suggested that local-regional control and possibly ultimate outcome can be improved by the use of adjuvant therapy.

Introduction: The novel agents bortezomib and lenalidomide have demonstrated improved clinical outcomes in multiple myeloma (MM), yet most relapsed MM patients will become refractory to therapy. Methods: Pomalidomide is a second generation immunomodulatory agent that has been recently approved in the USA for the treatment of relapsed and refractory MM after two prior therapies, including lenalidomide and bortezomib. Results: Pomalidomide has several potential mechanisms of action which include anti-angiogenic effects, immunomodulation, an effect on the myeloma tumor microenvironment and the protein cereblon. Discussion: Several trials demonstrate the efficacy and safety of this novel compound in relapsed and refractory MM, including subjects refractory to lenalidomide and bortezomib. In the following review article, we discuss the role of pomalidomide as a new clinical treatment option for MM.

Background: Fine needle aspiration cytology (FNAC) is a cost-effective and time saving diagnostic test used to specifically distinguish between benign and malignant lesions by histocytology. The aim of this study was to study the spectrum of thyroid lesions and to correlate the FNAC findings with histopathology of excised specimens. Materials and Methods: A total of 300 patients with thyroid swelling were included in this study who had FNAC during 3 years study period, from July 2011 to July 2013, at a tertiary care hospital. All patients with thyroid swelling were assessed by medical history, clinical examination, biochemical tests and radiological investigations. The FNAC diagnoses were correlated with clinical features, radiological investigations, hormonal findings and subsequent histological examination of the thyroid specimens. Results: Out of 300 patients, females outnumbered males in thyroid diseases and revealed preponderance toward younger population (21-40 years). Nodular colloid goiter was the most common cause of thyroid swelling presented during 1 month to 1-year period. There were 104 patients (34.7%) who had surgical intervention and 86 (28.7%) patients reported for follow-up and had thyroid function tests done. The diagnostic accuracy, sensitivity and specificity for malignancy were 94.2%, 50% and 100% respectively in our study. Conclusion: FNAC is a reliable, safe and accurate method as an initial simple diagnostic test for thyroid nodules in decision making about surgical intervention. Our study suggested that FNAC has higher specificity than sensitivity in detecting thyroid malignancy; hence its use as a reliable diagnostic tool for evaluation of thyroid swelling cannot be overemphasized.

Context: One of the major toxicity of paclitaxel is peripheral neuropathy. Sensory components are affected more than motor and autonomic dysfunction. Aims: Acetyl-L-carnitine (ALC), methylcobalamine, vitamin E and glutamine have been used in various trials against placebos. With head on trials among these four drugs missing, this randomized study was conducted to compare the efficacy in relieving symptoms of paclitaxel induced peripheral neuropathy. Settings and Design : This single institutional, prospective, multi-arm, randomized study was conducted as per Helsinki protocol and with local ethical committee clearances. Materials and Methods: Patients of carcinomas of lung, breast and ovary recruited, would receive paclitaxel 175 mg/m ² intravenous as 1 ^st or 2 ^nd line drug. They underwent randomization to any of four treatment arms: Arm A (vitamin E 400 mg OD day 1 of the cycle to 1 month after completion of clinical trial [CT]); Arm B (ALC 250 mg OD from day 1 to day 7 in each cycle of CT); Arm C (glutamine 10 mg TDS from day 2 to day 5 in each cycle) and Arm D (methylcobalamine 500 μg TDS from day 1 of the first cycle to 1 month after completion of CT). All drugs were started at the onset of symptoms. CTCAE v 4.02 was used for assessments. Statistical Analysis Used : Changes in scores for sensory, motor and pain symptoms over the study period were compared using repeated measures of General Linear Model of SPSS version 17. Results : 22, 24, 21 and 23 patients were eligible for analysis in four arms. Vitamin E was producing comparable relief as methylcobalamine of peripheral neuropathy. Both vitamin E and methylcobalamine was superior to glutamine and ALC in relieving sensory, motor and pain symptoms. Glutamine and ALC had comparable effects. Conclusions: All four drugs were effective in the alleviation of symptoms with vitamin E and methylcobalaine more effective than glutamine and ALC in control of symptoms of paclitaxel induced peripheral neuropathy.

Background: Lung cancer is presently the most common malignant disease (12.34% of all cancers) and the leading cause of cancer deaths (17.8% of all cancer deaths) in the world in all age groups and in both sexes. It is the leading cause of cancer deaths in developed countries and is also rising at an alarming rate in developing countries. Objective: The present study was undertaken to explore the clinicopathological profile of bronchogenic carcinoma. Materials and Methods: A total of 60 consecutive patients with histopathologically proven bronchogenic carcinoma, hospitalized between 2009 and 2011 at a tertiary care Hospital, Eastern India, Kolkata, West Bengal, India, were analyzed. Result: Out of a total of 60 diagnosed cases, with an average age of 63 years, nearly 75.0% were males. Smoking was the risk factor in 71.67%. About 26.67% of female patients were smokers with a significant overlap in use of smoking objects. Four (6.67%) patients were <40 years of age at the time of diagnosis. Fiber optic bronchoscopy (15%) and fine-needle aspiration cytology (58.33%) were found to be the most efficient diagnostic procedures. Histologically, squamous cell carcinoma, adenocarcinoma, small cell carcinoma and large cell carcinoma were seen in 31.67%, 43.33%, 10% and 3.24% cases, respectively. Nearly 11.67% patients showed malignant cells only and marked as unclassified. Early stages (1 or 2) were found in 11.67% and late stages (3 or 4) in 88.33%. Metastases to nodes, liver, adrenals and bones were present in 55%, 13.33%, 8.33% and 16.67% respectively. Conclusion: This study shows that the most common type of lung cancer is adenocarcinoma. Patients with persistant pulmonary symptoms should be promptly evaluated for malignancy.

Introduction: Effective health care reform has been slow, in part due to patient expectations and demands. We solicited cancer patients and their friends or family about the cost of cancer care. Materials and Methods: Individual demographics, opinions about expenditures in curable and incurable settings, for strangers and who should primarily be responsible for costs were included. Results: A majority of respondents were female (57.9%), over 50 years old (74%) and Caucasian (81.5%). In a curable setting, 44.4% and 56.7% of respondents believed there should be no limit to the amount the individual or insurance should pay for 1 year of life, respectively. Respondents believed that less should be spent on care in an incurable setting. There were no differences between patients and family/friends (P = 0.95), gender (P = 0.33), age group (P = 0.94) or ethnicity (P = 0.20) with regards to spending for curable versus incurable scenarios. Non-Caucasians were significantly more likely to believe that more should be spent on themselves than strangers; 7.1% versus 2.0% (P = 0.03). Conclusions : The amount that respondents believed should be spent on cancer care far exceeds sustainable health care spending in the United States. To contain health care costs, attitudes among patients, the public and policy makers must be understood aligned.

Involvement of the ovary by malignant lymphoma is a well-known late manifestation of disseminated nodal disease. Lymphoma presenting with ovarian mass as an initial manifestation is a rare entity and may cause confusion for the clinician since its presentation might resemble other, much more frequent primary ovarian tumors. We present a case of non-Hodgkin's lymphoma where the initial presentation was an ovarian tumor. The patient underwent surgery and was receiving chemotherapy when she developed generalized lymphadenopathy. She did not respond well to the therapy, had a progressive disease and expired after 5 months.

Most testicular sarcomas arise from germ cell tumors (GCTs) viz. teratoma or spermatocytic seminoma. Pure intratesticular sarcomas are very rare. We present an autopsy report of non-germ cell primary intratesticular sarcoma with synchronous mediastinal sarcoma and lung metastasis in a young male who presented with symptoms of mediastinal compression and simultaneously had a significant gradually enlarging testicular mass.

An adult male patient got hospitalized with fever, anorexia, weight loss, generalized weakness, and visual problem. Examination revealed solitary axillary lymphadenopathy and soft tissue swellings over scalp and left shoulder. Tests detected severe anemia and raised erythrocyte sedimentation rate (ESR), lactate dehydrogenase, and uric acid. Magnetic resonance imaging (MRI) brain showed irregular soft tissue swellings both outside and inside the skull with pressure effect on brain. Fundoscopy revealed bilateral choroidal metastatic deposits with papilledema. Histopathology findings of biopsy from scalp mass and bone marrow were consistent with metastatic high grade neuroblastoma. No primary lesion was found on computed tomography (CT) scan of thorax, abdomen, and pelvis. There was also suggestion of paraneoplastic neuropathy. The patient responded fairly to chemotherapy. Neuroblastoma is usually known to be a childhood malignancy that often presents with vague symptoms or symptoms due to tumor mass or with metastatic or paraneoplastic features. Most common metastatic sites are bone, lymph node, liver, cranium, and chest. But in this case apart from bony and dural metastases there was also choroidal metastasis which is previously not reported in adults. Likewise, non-detection of primary tumor is also uncommon.

Supernumerary breast or polymastia is a well-documented anomaly of the breast and commonly presents along the embryonic milk line extending between the axilla and groin. Reported incidence of accessory breast is 0.4-6% in females. During 2 years period, we encountered only two cases out of twenty cases of axillary lumps. We present one case of fibroadenoma in ectopic breast tissue (EBT) in axilla. Ectopic breast denotes breast tissue at more than two pectoral regions, which is mostly benign but at times can be malignant. EBT is at a greater risk of malignancy. Fibroadenoma of ectopic axillary breast tissue (EBT) is quiet rare, but should always be kept in mind for differential diagnosis of an axillary mass.

Angioleiomyomas are infrequent benign soft tissue tumors. They arise from smooth muscle cells of the vessel wall. They are common in lower extremities. Neck is an uncommon site. Recurrence and malignant transformation are extremely rare. We report a case of 55-year-old male with recurrent angioleiomyoma in neck. Rapidly growing tumors can mimic malignant clinically. Careful histological examination and immunohistochemistry are indispensible for definitive diagnosis. Treatment is surgical resection and extended follow-up.

Cervical cancer is the most common malignancy in females in the developing world. Squamous cell carcinoma and adenocarcinoma are the most common histological types. Papillary squamous cell carcinoma is a rare variant of squamous cell carcinoma associated with recurrence and more aggressive behavior. Adenoid cystic carcinoma is a rare variant of adenocarcinoma which is associated with early lymph node and vascular metastasis.

Neuroblastic tumor are from embryonic tumor of the sympathetic nervous system having neural crest origin and arise in the adrenal medulla, the adult population. Here, we present a case of an adult male of 23-year-old with retroperitoneal nodular ganglioneuroblastoma metastasized to the adrenal gland and regional lymph node. With the best of the knowledge, fewer than 50 cases reported in the English medical literature.

Kikuchi-Fujimoto disease (KFD) is a rare, benign, self-limiting disorder that generally presents with cervical lymphadenopathy. Recognition and early diagnosis of this condition is very critical as it can be easily mistaken for tuberculosis, lymphoma or systemic lupus erythematosus. It predominantly affects young adults (mean age 20-30 years), with a slight preponderance in females. There have been very rare reports of KFD in childhood or elderly. We report case of a 9-year-old female child who presented with fever and cervical lymphadenopathy. Examination of other systems and laboratory investigations were normal. Biopsy of the cervical node showed features suggestive of histiocytic necrotizing lymphadenitis (KFD). CD20, CD3 and CD68 stained positive while CD15 and CD30 were negative, thus confirming the diagnosis. The child was treated with steroids and complete remission occurred in few weeks. Although the incidence of KFD is rare, clinicians should be aware of this condition as early recognition and diagnosis of the disease will minimize unnecessary investigations and cytotoxic treatments.

Endometrial stromal sarcomas ESS are rare malignant mesenchymal tumors that usually develop in the uterus in perimenopausal women. The report describes a rare extra uterine low grade ESS presenting as a cervical polyp in a young female for which local tumor resection was performed. Histological examination revealed a spindle cell tumor. The diagnostic challenge was to differentiate ESS from cellular leiomyoma and other spindle cell tumors for which immunohistochemistry was carried out. The case report highlights that ESS is to be included in the differential diagnosis of spindle cell tumor in cervix even though rare. We also discuss the differential diagnosis of cervical polypoidal lesions.

Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor which usually occurs in the age group 40-60 years. Our patient is an adolescent girl of 17. A case of ESS in a 30 year old female has been reported once before. A high level of suspicion is required for pre-operative diagnosis in younger age group. Type 1 hysterectomy with removal of tubes and ovaries is the treatment. The patient requires regular follow up

Pituitary tumors are common in sellar area. The prevalence of clinically apparent pituitary lesions is estimated to comprise approximately 10% of all intracranial lesions, while incidental pituitary tumors are detected in approximately 11% of individuals at autopsy. Pituitary tumors are mostly found to be benign adenomas, however pituitary carcinoma has been reported to comprise about 0.5% of pituitary tumors. Pituitary adenomas are associated with an immense diversity in their endocrine manifestations secondary to hypo or hyperfunction of pituitary gland and ophthalmological manifestations due to mass effect. Progress in the diagnostic examination of pituitary adenomas and advances in the treatment of these tumors offers excellent prospects for a successful therapeutic outcome. We hereby discuss a case of pituitary macro-adenoma in a young adult male and review the recent advances in the classification and diagnosis of pituitary adenoma.