Ibrutinib is a recent Food and Drug Administration-approved drug for the treatment of lymphoid malignancies: mantle cell lymphoma and chronic lymphocytic leukemia (CLL). It is a Bruton's tyrosine kinase (BTK) inhibitor which increases the apoptotic susceptibility of malignant lymphocytes and also causes tissue redistribution of lymphocytes. Strong biological rationale makes BTK an ideal target for therapy of CLL and other B-cell malignancies. We are presenting a comprehensive review of this promising drug, highlighting its metabolism, safety profile, trials, and approved uses.

Background: Tumor invasion involves complex interactions between tumor and stromal cells and is bidirectional and such a mutual support allows for the progression of malignancy. The Aim of the study was to predict the biological behaviour of tumors by evaluating the changes in the connective tissue i.e. stromal response in different histopathological grades of oral squamous cell carcinoma (OSCC). Materials and Methods: A total number of '30' cases of oral squamous cell carcinoma were examined using Connective Tissue Special Stains and Immunohistochemical Staining. Result: All the 3 grades of OSCC's were noted for staining intensity of α-SMA(alpha smooth muscle), collagen, neutral mucins and acidic mucins around tumor islands and within connective tissue. Conclusion: Understanding cancer by stromal cell genomic and histochemical analysis, provide more comprehensive and meaningful data, as this surrounding stroma plays an important role in the progression of cancer. The cancer associated with a reactive stroma is typically diagnostic of poor prognosis. So this study confirms that characterizing the stromal cells and their reciprocal interaction with tumor cells will provide supportive evidence that stromal therapy can be a rewarding approach for cancer prevention and intervention.

Background: Brain metastases represent an important cause of morbidity for cancer patients. Its incidence has increased overall overtime as a consequence of improved detection by magnetic resonance imaging (MRI). However, in Indian literature, scant data are available. At this moment, we have analyzed our data from a single tertiary care center in North India. The purpose of the study was to analyze the clinical profile of patients with brain metastases. A retrospective study from a single tertiary care center. Patients and Methods: A retrospective review of records of all patients who were registered in hospital-based cancer registry and developed brain metastases from June 2011 to June 2013 yielded 95 patients for analyses. Results: Majority of cases were seen in the 6^th decade of life. Lung cancer was the most common primary followed by breast. On imaging (computed tomography or MRI), multiple lesions were more common than single. Most of the patients presented with a headache (37.9%). Supratentorial involvement was seen in 87.3% against 12.6% infratentorial involvement. Median time interval from diagnosis of primary and development of brain metastases was 13.8 months. A median survival of only 3 months was seen after development of brain metastases. Conclusion: The present study highlights that brain metastases occur mainly in elderly people with lung being the most common primary malignancy. It is a deadly event with a median survival of only 3 months.

Background: Gastric cancer is a cancer with a poor prognosis. Surgery with adequate lymph node dissection is the only potentially curative treatment for gastric cancer. The aim of this work is to determine the prognostic factors after curative resection for gastric cancer.Patients and Methods: We retrospectively assessed 66 patients who underwent operation for gastric cancer (excluding the eso gastric junction cancer) in a single institution between 2001 and 2015. Results: There were 25 women and 40 men. The median age was 60 years (21–87). Four patients died (6.1%). A total gastrectomy was performed in 35 cases, and a subtotal gastrectomy was performed in 30 cases. The type of lymphadenectomy was D2 lymphadenectomy in 35 cases and D2 without spl énectomy in 30 cases. The pathologic review of the slides revealed that the tumors were stage T3–T4 in 49 cases. The median number of lymph node removed was 14. Median survival rate was 34 months. The median follow-up was 24 months. In multivariate analysis, the location in the fundus, lymph nodes involvement, and involvement of located organs were associated with poor prognosis. Conclusion: After R0 resection with DII lymphadenectomy, fundus location, lymph node Involvement, and involvement of organs were independent predictive factors for survival.

Background: To review the clinical characteristics and outcomes of patients with Ewing's sarcoma (EWS) treated at our institute with radiation, chemotherapy, and surgery. Materials and Methods: Patients of EWS treated between January 2009 and December 2014 were retrospectively analyzed. Multimodality treatment with chemotherapy, radiation, and/or surgery has been used. Pattern of failure, locoregional control rates, and disease-free survival (DFS) was estimated using Kaplan–Meier method. Univariate and multivariate analysis was done to identify various poor prognostic factors for local control and survival. Results: Eighty-three patients were reviewed. Eleven patients (13.2%) had metastatic disease at presentation, out of which 7 (8.4%) had lung metastasis. The most frequent location was extremities (53%), followed by ribs, clavicle, and scapula (18.1%), axial site (10.8%), pelvis (7.2%), extraosseous site (6%), and skull (4.8%). The median follow-up period was 16 months. Out of 72 patients with localized disease, 37 (44.6%) patients failed the treatment. The most common site of distant failure was lung (18.1%), followed by bone (10.8%) and brain (4.8%). The 1 year, 2 years, and 5 years DFS were 73.8%, 45.7%, and 33.2%, respectively. The 1 year, 2 years, and 5 years local control rates were 73.3%, 65.1%, and 55.8%, respectively. The median time to local failure was 10 months. Age >12 years (P < 0.05) was found to be the only factor associated with poor prognosis for survival by both univariate and multivariate analysis. Axial site (P < 0.03), and chemotherapy regimen with vincristine, adriamycin (doxorubicin), cyclophosphamide only (P < 0.03) were found to be associated with a poor prognosis for local control by univariate analysis. By multivariate analysis, however, none of the factors were found to be a poor prognostic factor for local control. Conclusions: Aggressive combined modality approaches should be considered for all patients with EWS. Survival after progression was dismal.

Background: Image-guided core biopsy (CB) is a reliable technique for the diagnosis of various deep-seated lesions. It allows precise localization and documentation of the biopsy needle and target lesions. CB imprint cytology (IC) is a rapid, reliable, and accurate technique which enhances the known benefits of CB. Aims: The aim of this study was to study the diagnostic accuracy of IC when performing computerized tomography (CT)-guided coaxial CB of lung and mediastinal lesions and to assess whether it could optimize the biopsy procedure. Methodology: A total of 30 CT-guided core biopsies with imprint smears were studied. All biopsies were performed using 18 gauge coaxial needle and spring loaded gun. On-site assessment for the adequacy of the sample was done by the pathologist after staining with toluidine blue. The imprint smears were compared with the histopathology (HP) of CB specimens and the accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated. Results: The overall accuracy of IC when compared to the HP was 96.7%, with a sensitivity of 100%, specificity of 85.7%, positive predictive value of 95.8%, and negative predictive value of 100%. The value of P< 0.001. Conclusion: With an on-site approach, IC helps to assess the adequacy of the sample and reduce the number of passes and the possibility of redo procedures. Since the sensitivity of IC is high, it provides a valuable lead time to the clinician, for planning the management protocols, before a final histopathological diagnosis is available.

Background: Approximately two-thirds of all patients with newly diagnosed nonsmall cell lung cancer (NSCLC) have advanced disease (Stage IIIB or IV) that is only amenable to palliative chemotherapy. Switch maintenance therapy with a different active agent aims to hit clonal variants resistant to the first-line therapy before they have had time to increase in number. Based on this, we conducted a randomized Phase III study to compare gemcitabine (Gem) versus best supportive care (BSC) as maintenance therapy. Methods: Between July 2011 and January 2012, chemo-naive patients with Stage IIIB/IV NSCLC were initially treated with six cycles of cisplatin (40 mg/m² day 1, 2) and paclitaxel (175 mg/m² day 1) every 3 weeks. Subsequently, nonprogressors were randomized 1:1 to receive maintenance G (1000 mg/m² on days 1 and 8 every 3 weeks) or BSC alone till disease progression. The primary endpoint was a comparison of overall survival (OS) between two arms, and the secondary endpoint was progression-free survival (PFS). Results: Exactly 134 patients were enrolled (median age: 50 years, males 76.8%, Stage IV disease 50.7%, Eastern Cooperative Oncology Group performance status 0/1: 67.9%). Following 6 cycles of initial therapy, the Response Rate (RR) was 35.1% (Complete Response (CR) 3%, Partial Response (PR) 32.1%), and 38.8% had stable disease. Ninety-nine nonprogressors were randomized to receive Gem (n = 50) or BSC (n = 49). The median OS for Gem was 10 months (95% confidence interval [CI]: 9.2–10.7) and 8 months (95% CI: 6.7–9.2) for BSC, with a hazard ratio (HR) 0.64 (95% CI: 0.51–0.77, P = 0.002). The median PFS was 9 months (95% CI: 8.1–9.9) for G versus 7 months (95% CI: 6.3–7.7) for BSC, with a HR 0.67 (95% CI: 0.50–0.84, P = 0.009). Maintenance therapy was tolerated well despite a higher incidence of grade 3/4 toxicity (anemia 12% vs. 8.1%; neutropenia 18% vs. 4.1%; thrombocytopenia 14% vs. 2%; and fatigue 8% vs. 2%). Conclusion: Switch maintenance therapy with gemcitabine, following initial platinum-based doublet chemotherapy in advanced NSCLC can produce significantly longer PFS and OS compared to BSC alone at the cost of higher grade 3/4 hematological toxicities.

Pulmonary hamartoma are benign, well-circumscribed single nodule in the lung parenchyma. They are composed of an abnormal mixture of epithelial and mesenchymal elements. Patients are usually asymptomatic and discovered by chance. We report a case of 65-year-old male patient who presented with cough with hemoptysis, dyspnea, and chest pain. Lumpectomy was done, which revealed histological features of chondroid hamartoma.

Ectopic breast tissue, a developmental anomaly, is a rare occurrence. Isolated pathologies in ectopic breast tissue with normal breast architecture are even rarer. Cases with primary invasive ductal carcinoma, invasive lobular carcinoma, secretory carcinoma, and mucinous carcinoma have been reported in ectopic breast tissue. We report a case of primary adenoid cystic carcinoma of axillary ectopic breast tissue, which to our belief has never been reported earlier.

Radioiodine (RI) has been widely used in treatment of hyperthyroidism and thyroid cancer. The development of acute or chronic leukemia is a very rare complication of RI therapy. Here, we report two cases of acute myeloid leukemia occurring after the completion of RI therapy for follicular thyroid carcinoma along with a brief review of literature.

Invasive ductal carcinoma is the most common histological pattern of breast cancer. Breast cancer metastasis has been observed at various sites but solitary metastasis to parotid gland is rare. Around 15 cases have been reported so far. We report a case of 61-year-old lady with early breast carcinoma metastasizing to ipsilateral parotid gland. She underwent breast conservation surgery with axillary dissection. Pathological stage was pT2(m) N0. Immunohistochemistry revealed hormone receptor positive, HER2-neu negative. She received adjuvant chemotherapy, radiotherapy, and hormonal therapy. Seven months later, she had parotid gland metastasis. She underwent superficial parotidectomy and right neck dissection. Hormonal therapy was changed to 2^nd line.

Sinonasal adenocarcinomas (SNACs) are rare tumors which include two broad categories – the salivary and the nonsalivary type. Nonsalivary type adenocarcinomas arising within the sinonasal tract are composed of intestinal type and nonintestinal type of adenocarcinoma each of which can be either low grade or high grade. The intestinal type is clinically aggressive and generally presents at an advanced stage. Nonintestinal type adenocarcinomas are rare tumors; the majority of these are of a histological low grade and show excellent prognosis. We report a case of this rare entity in a 53-year-old male and discuss the pathologic features of the low-grade SNAC.

Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor which occurs mostly in the mandible. It is primarily seen in fifth to seventh decades with a female predilection. We report a case of CCOC in the maxillary arch of a 66-year-old woman. Morphologic examination along with histochemical and immunohistochemical markers led to the establishment of the diagnosis. It is important to diagnose this entity and differentiate it from other clear cell tumors in the head and neck region as it is a locally aggressive tumor with a propensity for regional, nodal, and distant metastasis.

Yolk sac tumors (YSTs) in gastrointestinal tract are rare. YST of metastatic sigmoid colon, managed with surgery and chemotherapy, showed excellent response, contrary to poor prognosis has been reported in literature.

Noncaseating epithelioid granuloma, also designated as sarcoid-like granuloma, has been described in association with malignancies. These granulomas are rare in carcinoma, more so when associated with renal cell carcinoma. Here, we describe an association between clear cell renal cell carcinoma and noncaseating granulomas in a 50-year-old female. We also discuss the differential diagnosis that should be considered before establishing such diagnosis, which might have therapeutic and prognostic implications.

The glandular odontogenic cyst (GOC) is a rare entity with around 111 cases available in the literature. The occurrence of GOC with ameloblastoma as a collision tumor is rarest, and such a case poses problems in the form of diagnostic dilemma and management. The present case report describes and discusses a rare case of GOC with ameloblastomatous component occurring in right maxilla of a 54-year-old male patient with a chief complaint of painful swelling.

Worldwide approximately 1,200,000 new cases of colorectal carcinoma (CRC) are diagnosed annually, and about half of them died. Lack of exercise along with obesity and consumption of red meat are thought to be associated with the development of CRC. Surgery is the primary modality of treatment which depends on size, site, and stage beside other associated factors. Histopathology along with general condition and extent of disease are stablished as an important prognostic factor. Chemotherapy and radiotherapy are used in the adjuvant and palliative setting. Here, we are reporting an interesting case of sigmoid colon carcinoma presenting as an advanced lesion over a very short span of time along with emphasizing the harm of unnecessary multiple investigations for diagnosis putting in the dilemma to both the patient as well as treating physician. This case also explains the interobserver variability as well as difference between the types of scan as well as reporting.

Recurrence of pleomorphic adenoma after excision is a well-known phenomenon and can present years after surgical resection of the primary tumor. Recurrent lesions are frequently located in the parapharyngeal space whereas transcranial spread with intracranial invasion is exceptionally rare and has only been sparsely reported. A rare case of transcranial spread of recurrent Pleomorphic adenoma in a 40-year-old patient with preauricular swelling is presented.

Rhabdomyosarcoma (RMS) is a highly malignant soft tissue sarcoma (STS). It is the most common childhood STS and is exceedingly rare in adults. The pleomorphic subtype affecting patient older than 45 years is the least common subtype. It is histologically similar to a malignant fibrous histiocytoma. Many pleomorphic RMSs (PRMSs) have been reclassified as fibrous histiocytomas, thereby making the diagnosis of PRMS more unusual. Here, we report a case of PRMS in a 45-year-old male who reported with the painless soft tissue swelling over the posterior aspect of left shoulder for 1 year. Magnetic resonance (MR) imaging and MR angiography showed a large well defined heterogeneously enhancing soft tissue mass lesion arising from posterior fibers of left Deltoid muscle. The patient received nine cycles of neoadjuvant chemotherapy with ifosfamide, epirubicin every 3 weeks. The patient underwent wide local excision of the tumor and received four cycles of adjuvant chemotherapy ifosfamide, epirubicin, and etoposide every 3 weeks. Locoregional adjuvant radiotherapy 66 Gy in 33 fractions was given by 3-dimensional conformal radiotherapy. Now the patient has a complete response on follow-up imaging 2 years after completion of radiotherapy. PRMS in adults has a significantly worse prognosis than that for other pleomorphic sarcomas with 12.5–50% of 1-year to 20-month disease-free survival and 27% rate of 5-year disease free survival. Thus, the correct and early diagnosis of PRMS is important.

Schwannomas (neurilemmomas) are benign encapsulated, slow growing peripheral nerve sheath tumors. Primary orbital schwannomas are uncommon, accounting for about 1–4% of orbital tumors. Characteristically, they arise from the first division of the trigeminal nerve. Oculomotor schwannomas are rare tumors with only one case reported till date. Here, we report a 28-year-old male presenting with an axial proptosis of left eyeball with progressive loss of vision. Magnetic resonance imaging of orbit revealed a large left-sided orbital mass extending into cavernous sinus. Surgical excision of the mass was done, and based on clinical, histological, and immunohistochemical analysis, a final diagnosis of oculomotor nerve schwannoma with left orbital extension was made.

Spindle cell (sarcomatoid) carcinoma is a rare variant of squamous cell carcinoma (SCC). It compromises of 2–3% of laryngeal cancers. Tumor arises from the oral cavity, tonsil larynx, and pharynx. Tumor is majority times misdiagnosed as reactive lesions or mesenchymal malignancies. It is considered to be a biphasic tumor that is composed of an SCC (in situ or invasive) and spindle cell carcinoma (SpCC) with sarcomatous appearance. In this case report, 61-year-male with minimal throat pain and acute onset dysphonia misdiagnosed and treated as a case of bronchial asthma with gastroesophageal reflux confirmed to have exophytic laryngeal growth is the cause for clinical presentation. We performed fiberoptic laryngoscopy and diagnosed to have SpCC of larynx. High index of suspicion is a must in geriatric cases with documented history of smoking and fiberoptic laryngoscopy/bronchoscopy found to be crucial in the evaluation. Histopathology expertise in surgical oncology is essential while planning treatment.

Acute leukemia generally present with nonspecific symptoms such as fatigue, weakness, malaise, anorexia, weight loss, fever, bone pains, bruising, or bleeding that begin gradually and are the consequence of associated cytopenias. Polyserositis with predominant pericardial effusion clinically manifested as heart failure as the presenting feature of acute myeloid leukemias (AMLs) has been rarely described. In this report, we describe a case of a 21-year-old male, who presented with symptomatic serositis and leukemia cutis and was subsequently diagnosed as AML-myelomonocytic type (AML-M4).

Primary non-Hodgkin's lymphoma (NHL) of the female genital tract is a rare tumor mainly affecting the elderly age group. A preoperative diagnosis is difficult to reach due to varied clinical presentation and lack of diagnostic features on radiological investigations. We present an unusual case of primary NHL affecting uterus, cervix, and bilateral ovaries in a 27-year-old female.