Oral leukoplakia is one of the most common potentially malignant disorders of the oral cavity. Many variants of oral leukoplakia exist, with oral proliferative verrucous leukoplakia (OPVL) being one. OPVL, a slow growing, long-term progressive lesion was first described in 1985 by Hansen et al. It is an aggressive form of oral leukoplakia with multifocal presentation, high rates of malignant transformation and recurrence. It is a rare clinico-pathological entity, which remains an enigma even today. The term proliferative verrucous leukoplakia (PVL) has been the subject of an ongoing discussion with regard to its definition. Its etiology too remains unclear until date. Tobacco use does not seem to have a significant influence on the appearance or progression of PVL. These lesions are known to occur in both smokers and nonsmokers. In the light of current information available, this article describes the etiology, clinical aspects, histological features, and various diagnostic criteria of OPVL.

Small cell carcinoma (SCC) of the urinary bladder is a rare presentation, accounting for <1% of all bladder carcinomas. It has been considered as an aggressive variant of bladder carcinoma, with high incidence of distant relapse. Though cisplatin-based chemotherapy is considered the gold standard approach for this variety of bladder tumor, the role of radical cystectomy and radiotherapy cannot be neglected, due to its frequent association with transitional cell carcinoma. Different management strategies have been adopted by oncologists worldwide, in an effort to obtain survival benefits. Recently, neoadjuvant chemotherapy before surgery has been tried and the results are encouraging. This review article particularly focuses on the treatment evolution of SCC of bladder, various treatment options and their effects on the outcome, so that an optimal management can be planned for individual cases.

Neoadjuvant (NA) chemotherapy is the standard of care for patients with large, inoperable tumors or inflammatory breast cancer, but it is also considered for women with operable disease. Several trials have demonstrated equivalent survival benefits for the administration of chemotherapy before or after surgery. Moreover, preoperative treatment allows a higher rate of breast conserving surgery. NA treatment with a sequential anthracycline-taxane based chemotherapy in combination with targeted human epidermal growth factor receptor 2 (HER2) therapy is the gold standard treatment for patients with HER2-positive breast cancer. This approach is based on the higher pathologic complete response (pCR) seen with the addition of trastuzumab. The pCR can be increased with dual HER2-receptor blockade and chemotherapy. Patients with a pCR after chemotherapy and trastuzumab showed a significantly better outcome. This review, based on an exhaustive summary of current literature, highlights the benefits of NA systemic therapy in HER2 positive operable breast cancer.

Metastatic breast cancer disease is one of the leading causes of cancer-related death among women worldwide. Meanwhile, it is well-established that the epithelial-mesenchymal transition (EMT) is a major event in the development of cancer metastases. On the other hand, recent studies revealed that Aspirin could play an important role in preventing cancer development and its progression. Herein, we explored the effect of aspirin on breast cancer cells and EMT. We found that aspirin-treatment initiates mesenchymal to epithelial transition, which is the opposite event of EMT; thus, aspirin-treatment can potentially inhibit cancer invasion and metastasis. These data suggest that aspirin could be useful to prevent breast cancer progression as well as other human carcinomas and their metastases.

Background: Advanced and metastatic gastric cancers present at late stages and have very dismal prognosis. Many modifications have been tried for improving the outcome. Docetaxel, cisplatin and fluorouracil/epirubicin, cisplatin and fluorouracil regimen have been established as a standard combination in clinical trials; however, they are limited by their toxicities. Aim : We conducted a study to assess the maximal tolerated dose (MTD) of docetaxel given at days 1 and 8 along with fixed doses of oxaliplatin (days 1 and 8) and capecitabine (days 1-14), toxicity profile, response rate and efficacy of the triplet combination in advanced/metastatic gastric and GEJ malignancies. Materials and Methods: Study was conducted in two phases; Phase I study assessed the MTD and Phase II assessed toxicity, response and efficacy of polychemotherapy. Escalating doses of docetaxel was tested in Phase I design along with oxaliplatin 50 mg/m ² (days 1 and 8) and capecitabine 625 mg/m ² (days 1-14). MTD dose of docetaxel was used in Phase II along with the other two drugs for assessment of primary and secondary endpoints. Results: A total of 24 patients were evaluated in Phase I design as per modified Fibonacci series. The MTD for docetaxel was 40 mg/m ² given on days 1 and 8. On evaluation of 27 patients in Phase II, hematological, neurological and biochemical toxicities were tolerable. Grade 3 diarrhea and hand-foot syndrome were the most common toxicities. Overall response rates were 66.6%. Median progression-free survival (PFS) was 8.4 months. Conclusion: The MTD of docetaxel was 40 mg/m ² (days 1 and 8) administered along with oxaliplatin 50 mg/m ² (days 1 and 8) and capecitabine 625 mg/m ² (days 1-14). The regimen had proven to be efficacious with appreciable overall response rates, PFS with tolerable and manageable toxicities.

Background: Breast carcinoma is the most common cancer among women in the urban Indian population and second only to cervical cancer in the rural population based on cancer registry data. Prognosis and management of breast cancer are influenced by classic variables such as histologic type, grade, tumor size and lymph node status. More recently hormone receptor (HR) status of estrogen receptor (ER), progesterone receptor (PR), and HER-2/neu expression have opened a new gateway in the field of adjuvant hormonal and/or chemotherapeutic regimen. Objective: The objective of this study was to assess the ER, PR, and HER-2/neu reactivity pattern in breast carcinomas at our hospital. Materials and Methods : A study of 100 patient samples of breast carcinoma was carried out from June 2011 to June 2014 in the Department of Pathology, ESIC Medical College and PGIMSR, ESIC Model Hospital, Rajaji Nagar, Bengaluru. Brief demographic and clinical data were obtained. Immunohistochemistry (IHC) was done by peroxidase antiperoxidase technique for detection of ER, PR, and HER-2/neu receptor status. Details regarding histopathological diagnosis, pathological grading, staging, and HR status of breast carcinoma were collected. Obtained parameters were evaluated using descriptive statistical analysis and presented in terms of percentage. Results : The age of the patients ranged from 24 to 75 years. Majority of tumors were infiltrating ductal carcinomas-not otherwise specified and predominantly histological grade 2. By IHC 52% were ER+/PR+, 25% were HER-2/neu positive and 20% of triple negatives. Conclusion : Detection of hormone expression is of paramount importance since these are one among the classic variables needed for providing suitable adjuvant hormonal and/or chemotherapeutic options, targeted treatment, and predicting prognosis.

Background: Oral squamous cell carcinoma (OSCC) being the most common head and neck cancer, involves the interplay of several free radicals and antioxidant molecules. The potential role of salivary nitric oxide (NO) and uric acid in cancer development needs to be explored as there are a few studies highlighting their association with each other and with oral cancer. Aims: The present study was designed to measure the NO and uric acid levels in the saliva of patients with OSCC as compared with healthy controls and to highlight any possible correlations between them. Materials and Methods: The present study involved 50 subjects, 25 with OSCC (study) and 25 healthy individuals (controls). Saliva samples collected from patients were subjected to NO and uric acid analysis by griess method and uricase method, respectively. Statistical Analysis: The results were analyzed using Student's t-test and Pearson's Chi-square test. Results: A significant increase in the salivary levels of NO was seen in study subjects as compared to healthy controls. On the contrary, a significant decrease in salivary uric acid level was observed in the study group as compared to healthy controls. In addition, there exists an inverse correlation between NO and uric acid levels in study and control groups. Conclusion: Salivary levels of NO and uric acid may act as key bimolecular markers in the detection of oral cancer, which could be further confirmed by larger sample size and future studies.

Background: Trials have shown some statistically nonsignificant survival advantage of taxane, platin and 5-FU (TPF) induction chemotherapy before definitive chemoradiation. We tried to find the role of induction chemotherapy in the prediction of tumor response to radiotherapy and survival in the treatment of oral cavity cancers. Patients and Methods: Patients of stage III and IV (M0) unresectable oral cavity squamous cell carcinoma were assigned to receive two cycles of TPF. On the basis of response to chemotherapy, two groups were made. Those who had partial or more than partial response and another group who had stable disease or disease progression during chemotherapy. Concurrent chemoradiotherapy was given to all patients after induction chemotherapy. Results: A total of 128 patients who received TPF, 29 (22.6%) had complete response, 57 (44.5%) had partial response, 38 (29.7%) had stable disease and 4 (3.1%) had progressive disease. Definitive chemoradiotherapy lead to complete response in 48 (55.8%) patients who had partial or more than partial response (total 86) to chemotherapy and 10 (23.8%) patients among those who had stable disease or disease progression during chemotherapy (total 42). This difference in response is statistically significant (P = 0.001). Three years survival was significantly better after treatment in patients who responded more than partial (hazard ratio 0.463, 95% confidence interval 0.2789-0.7689), with an estimated 3-year survival of 35% in patients in group 1 and 14% in group 2. Conclusion: Response to induction chemotherapy can be a predictive marker for response to subsequent chemoradiotherapy and survival, with acceptable toxicities.

Background: Granulocyte colony stimulating factor (G-CSF) is used in clinical practice to mobilize neutrophils alone or in combination with chemotherapy. However, its influence in physiological indices has not been addressed well in certain animal models such as Wistar rats. Aims: To evaluate the single and combinatorial effects of G-CSF and cyclophosphamide (CTX) on physiological indices in Wistar rat. Materials and Methods : Naïve female Wistar rats were treated with subcutaneous injection of pharmaceutical benefits scheme, (5 μL/day/rat) G-CSF for 5 consecutive days and single intraperitoneal injection of CTX (4 mg/rat). Body weights were obtained daily. Rats were sacrificed 1-day after the last injection to obtain different organ weight and to analyze the physiological indices in plasma and the liver. Results: G-CSF alone induced increases in body weight, splenomegaly, white blood cells, platelets, and alanine aminotransferase (ALT) activity. It, however, decreased neutrophils and monocytes, aspartate aminotransferase (AST) activity, red blood cells and hemoglobin level. CTX alone induced decreases in body weight, white blood cells, neutrophils, red blood cells and hemoglobin level. It, however, increased spleen weight, lymphocytes, monocytes, ALT activity and AST. G-CSF + CTX induced increases in body weight, splenomegaly, lymphocytes and ALT. It, however, decreased white blood cells, platelets number, neutrophils, monocytes, red blood cells and hemoglobin level. Conclusion : Among different physiological indices, treatment with single or combinatorial G-CSF increases the total number of white blood cells in Wistar rats which need to be considered while using this model animal disease.

Background: The present study is designed to evaluate the role of pleural fluid cytology and pleural biopsy in diagnosing pleural diseases and to study the advantages and disadvantages of thoracocentasis and pleural biopsy. Materials and Methods: We prospectively included 66 consecutive indoor patients over a duration of 1-year. Pleural fluid was collected, cytological smears were made from the fluid. Plural biopsy was obtained in the same patient by Cope's needle. Adequate pleural biopsy tissue yielding specific diagnosis was obtained in 47 (71.2%) of cases. Results: Tuberculosis was the commonest nonneoplastic lesion followed by chronic nonspecific pleuritis comprising 60% and 33.3% of the nonneoplastic cases respectively and tuberculosis was predominantly diagnosed in younger age group. Majority (70.8%) of malignancy were in the age group of >50-70. Adenocarcinoma was found to be the commonest (66.7%) malignant neoplasm in the pleurae followed by small cell carcinoma (20.8%). Conclusion: Pleural biopsy is a useful and minimally invasive procedure. It is more sensitive and specific than pleural fluid smears.

The occurrence of malignancies in somatic elements of mature cystic teratoma of ovary is rare. The malignancies that may be encountered in dermoid cyst include squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, melanoma, sarcoma, carcinoid, and germ cell neoplasms. The development of transitional cell carcinoma (TCC) in dermoid cyst is extremely rare with only four such cases having been reported in literature so far. Here we report the fifth case of such an occurrence in a 50-year-old postmenopausal multiparous female patient. She presented with pain and gradual swelling of abdomen for 1 month. Abdominal computed tomography revealed a solid space occupying lesion with few cystic components at right pelvis, raising the possibility of an ovarian neoplasm. The level of CA-125 was slightly raised (56∙45 U/ml). Total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed. Microscopic examination showed cyst wall lined by stratified squamous epithelium. Beneath the cyst wall, a tumor mass was present, histological features of which resembled that of high-grade TCC (stage pT1aNXMX). On immunohistochemical analysis, the tumor was found to be positive for CK7 and CK20 and negative for WT-1. These results were consistent with a diagnosis of TCC arising in urothelium of mature cystic teratoma. Reporting of such extremely rare cases is important for the assessment of prognostic factors and treatment protocols.

Renal angiomyolipoma (AML) is an uncommon benign tumor of kidney. It is composed of abnormal thick walled blood vessels, smooth muscles, and adipose elements. It has an incidence of 0.3-3% among kidney tumors. These tumors are isolated in 80% of cases and are associated with tuberous sclerosis in 20% of the cases. Here, we report a case of renal AML in a 57-year-old female with review of literature.

Ectopic breast is a congenital anomaly of the breast which can have varied presentations because of its different sites and pathologies arising from it. Lesions of ectopic breast tissue (EBT) are commonly seen due to persistence of embryonic remnants along the milk line. They have also been reported from other sites like face, vulva, and perineum. They are prone to the same physiological and pathological alterations seen in the normal breast. Only 0.3% of breast carcinomas arise in the ectopic breast, whereas only a few cases of fibroadenoma have been reported at this site. We present a case of polymastia in a 21-year-old female in the inframammary region. We report two cases of fibroadenoma and carcinoma arising from EBT in the axilla of a 26 and 45-year females. Fibroadenoma was treated by simple excision while for carcinoma modified radical mastectomy was done followed by radiation and chemotherapy. Patient developed metastasis in the sternum. Carcinoma arising from EBT has a poorer prognosis and needs early diagnosis and treatment.

Helical tomotherapy (HT) can achieve a homogenous dose distribution in the planning target volume while minimizing the dose to the organ at risk. Tomotherapy has been used for complex breast cancer radiotherapy including bilateral breast irradiation, pectus excavatum, and internal mammary chain (IMC) nodal irradiation. This report details our experience of using HT in breast cancers in newer clinical indications. Three patients with SCF nodal involvement (case 1), high level III axillary node recurrence (case 2), and composite irradiation of SCF, IMC, and whole breast (case 3) were treated using brachial plexus sparing HT. It was possible to boost the SCF, reirradiate the high level III axillary nodal recurrence and treat complex volume of breast, SCF, and IMC with acceptable and safe dose volume histogram constraints and with good homogeneity and conformity indices. The treatment was successful in controlling disease locoregionally at a 15 months follow-up. No patients reported symptoms suggestive of brachial plexopathy

Small cell carcinoma of the cervix is a rare, poorly differentiated neuroendocrine tumor of cervix showing a high propensity to spread to lymph nodes as well as distant metastasis. Earlier considered to be a variant of squamous cell carcinoma, it is now acknowledged as a distinct entity showing markers of neuroendocrine differentiation. Because of the dismal prognosis, it is important to make early diagnosis and to differentiate it from a small cell variant of squamous cell carcinoma and other differentials. We present a case of a 45-year-old female who presented with cervical growth.

Primary peritoneal serous carcinoma (PPSC) is a rare entity that diffusely involves the pelvic peritoneum seen predominantly in elderly postmenopausal women. Exclusion of serous carcinoma arising from the ovary and fimbrial end of fallopian tube is required to diagnose the above entity. Recent studies show an increased incidence of primary peritoneal serous carcinoma as it is better recognized

Chronic dyspnea, chest pain, cough, and hemoptysis for more than 2 weeks often indicate a diagnosis of infective etiology of the respiratory tract in a tropical country. However, in a young reproductive female, these complaints with an episode of hemoptysis may rarely be the presenting symptomatology of pulmonary metastasis of choriocarcinoma. A young female of reproductive age group presented with hemoptysis, cough, and breathlessness. Chest X-ray revealed bilateral lower lobe opacities. Fine-needle aspiration cytology of the lung lesions depicted choriocarcinoma metastasis. Ultrasonography and magnetic resonance imaging revealed endomyometrial mass lesion suggestive of invasive gestational trophoblastic disease. β hCG levels were high. Dilatation and curettage and histopathological analysis of the mass confirmed the diagnosis of choriocarcinoma. This young female who presented with respiratory complaints was finally diagnosed to be a case of choriocarcinoma with lung metastasis. Therefore, choriocarcinoma metastasis must be considered as a differential diagnosis in a female of childbearing age presenting with respiratory complaints and hemoptysis.

Retroperitoneal sarcomas are rare tumors accounting for only 1-2% of all solid malignancies. Only 10-20% of sarcomas are retroperitoneal sarcomas, and the overall incidence is 0.3-0.4%/100,000 of the population. The peak incidence is in the fifth decade of life. These tumors grow very large as they have a very large retroperitoneal space to grow and producing very vague and mild symptoms like abdominal fullness and pain. We are hereby presenting a case of a 24-year-old female who presented with increasing abdominal girth, intermittent abdominal discomfort, palpable abdominal mass, and a 5 kg weight loss.

Rhabdomyosarcoma (RMS) can mimic acute leukemia both clinically and morphologically and can express a few surface markers characteristic of leukemic blasts. We report a case of a 21-year-old male patient who presented with pancytopenia. Bone marrow studies showed the atypical cells resembling blasts, expressing CD19 on flow cytometry and desmin by immunocytochemistry in bone marrow aspirate smears. A diagnosis of RMS infiltrating the bone marrow was made.

Composite pheochromocytoma (CP) is a rare tumor of the adrenal medulla that refers to a pheochromocytoma that has a component resembling neuroblastoma, ganglioneuroblastoma, ganglioneuroma or even a malignant peripheral nerve sheath tumor. There are very few reported cases of CP, with majority of the cases having elements of ganglioneuroma with pheochromocytoma. We report the case of a 27-year-old female with a history of systemic lupus erythematosus, sustained hypertension, and an adrenal mass. Computed tomography guided fine needle aspiration cytology of the mass revealed CP with elements of neuroblastoma. We report this case because of its rarity.

Burkitts's lymphoma is the commonest subtype of B-cell non-Hodgkins lymphoma in childhood. Though gastrointestinal tract is the commonest extra nodal site, intussusception secondary to Burkitt's lymphoma is an uncommon presentation. We report a case of an 8-year-old female child who presented with acute abdomen. A tumor arising from ileocaecal valve was the lead point causing intussusception that was reduced, and a limited right hemi colectomy was performed. A final diagnosis of Burkitt's lymphoma was made based on immunohistochemistry.

Development of clinically apparent bone marrow involvement is a rare occurrence in metastatic breast cancer. We are reporting a case of 60-year-old female patient with breast carcinoma and simultaneous total bone marrow replacement by the carcinoma cells, mimicking an acute leukemia at presentation, which has not been reported in the literature.

Carcinoma of the adrenal cortex is a rare malignancy and account for only 0.05-0.2% of all cancers. It has a slight predilection for female patients. It has a poor prognosis due to aggressive behavior. Here, we report a case of a male patient who suffered from adrenocortical carcinoma with metastasis in the abdominal wall. To the best of our knowledge, this is the first case where we have noticed metastasis in the abdominal wall. This case is presented for of its rarity.

Solitary fibrous tumor (SFT) is a mesenchymal origin tumor mainly confined to pleura and peritoneum. The extrapulmonary location is rare in incidence up to the level that fewer than 40 cases are described in literature in soft parts of extremities most of which are benign in nature with a mean age of presentation 52 years. The extrapulmonary SFT with malignant features at young age is an extremely rare mesenchymal neoplasm. A 20 years old female presented with a mass in the left thigh. The positron emission tomography scan performed, showed a hypermetabolic lesion at medial side of the left thigh. Subsequently, en bloc excision of mass was done along with adductor longus and brevis. Based on the histomorphology and immunohistochemical markers, diagnosis of malignant SFT was made. We report this case because of its rarity and to add on to literature and list of differential diagnosis of soft tissue tumors in the extremities.

Ameloblastoma is a rare benign odontogenic tumor which arises from the odontogenic epithelium. It usually exhibits a range of histopathologic features, such as follicular, plexiform, acanthomatous, granular, basal cell, and desmoplastic variants, which are well recognized. This study reports a case of giant acanthotic ameloblastoma that developed at the anterior mandible in a 70-year-old male. Radiologically, it was diagnosed as ameloblastoma, benign tumor of the jaw which is rare. Biopsy was taken intra-orally, it was confirmed as acanthomatous ameloblastoma. When extensive squamous metaplasia, often associated with keratin formation occurs in central portions of the epithelial islands of follicular ameloblastoma, the term acanthomatous is sometimes applied.

Ollier's disease characterized by multiple skeletal enchondroma is a rare noninherited disease of unknown etiology. Majority of the skeletal enchondroma are present in the metaphyses and diaphysis of tubular limb bones. Ollier's disease has a predilection for unilateral distribution. Malignant changes in Ollier's disease may occur in adult patients. Radionuclide bone scanning is one method used to assess lesions depicted on radiographs or magnetic resonance images that are presumed to be enchondromas. Furthermore, a bone scan may give a clue to the multifocality of the disease. We report a case of right first phalangeal enchondroma in a 23-year-old male, who underwent bone scintigraphy detected multifocal asymmetric right side involvement of radius, humerus, femur, and tibia which confirm a diagnosis of Ollier's disease.

Worldwide, ovarian carcinoma continues to be responsible for more deaths than all other gynecologic malignancies. It usually occurs in older women and the average age at presentation is 50 years. Brenner tumor of the ovary is very rare, mostly benign, small, and unilateral. Malignant Brenner tumor is much rarer. These tumors are believed to arise from urothelial metaplasia of ovarian surface epithelium. Malignant Brenner tumor of ovary closely resembles the transitional cell carcinoma of ovary. They must be differentiated because the latter has a worse prognosis. A case of unilateral malignant Brenner tumor in a postmenopausal woman is reported here and its features are briefly discussed.

Basaloid squamous carcinoma (BSC) is a rare aggressive variant of squamous cell carcinoma and occurs mainly at the larynx, oropharynx and tongue of the head and neck region. Neuro-endocrine differentiation of BSC is further rare occurrence in laryngeal cancers. We report here a case of BSC of supraglottic larynx with neuro-endocrine differentiation, which was treated by radiotherapy and its response to treatment.