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September-October 2018
Volume 7 | Issue 5
Page Nos. 167-197
Online since Thursday, January 10, 2019
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ORIGINAL ARTICLES
Role of topical aloe vera gel in the recovery of high-grade, radiation-induced dermatitis
p. 167
Veenita Yogi, OP Singh, Varsha Mandloi, Manish Ahirwar
DOI
:10.4103/ccij.ccij_14_18
Introduction:
Radiation-induced dermatitis (RID) is a common adverse effect of radiation therapy, in spite of skin-sparing effect of megavoltage. Approximately 90% of the patients who received radiation therapy may develop skin reaction of any grade during therapy, leading to therapy delays, diminution of patients' health state, and quality of life. It has been noticed by many authors that there are several topical agents available which may be used for the prevention of RID. In this study, we used topical
Aloe vera
gel for the treatment of high-grade radiation dermatitis.
Materials and Methods:
This prospective study was conducted on 85 patients of head and neck, breast, and cervical cancer during 2015–2016. All the patients have received external beam radiotherapy by cobalt-60, at least 46 Gy (dose completed with high-dose rate brachytherapy in cancer cervix). According to the Radiation Therapy Oncology Group skin reaction grading, patients with Grade III and Grade IV skin reaction were advised to use
A. vera
gel on irradiated area thrice daily with routine skin and nursing care.
Results:
In this study, head and neck cancer patients were 42%, breast 23%, and cervical 35%. Sixty-seven percent were female and 33% were male patients. The median age of the patients was 43.3 years (range, 25–70 years). The prescribed radiation doses were 46–70 Gy, 2 Gy per fraction, for treatment duration of 32–52 days, using a field size of 80–380 cm
2
according to the treatment site. Of 85 patients, 65 were treated with concurrent weekly chemotherapy. Grade III (65.8%) and Grade IV (34.1%) dermatitis occurred in the 5
th
week of radiotherapy, which causes treatment delay, ranging 2–10 days, according to the severity and patient-related factors. It has been noticed that after application of
A. vera
gel, dermatitis completely recovered within 3–7 days. The recovery time was prolonged in operated versus nonoperated patients of head and neck cancer.
Conclusion:
Rapid cell division in the skin leads to RID. 35%–40% of dose is received by the skin despite skin-sparing effect of megavoltage, and it increases in parallel opposing field. Till date, no treatment is available which can prevent RID. In our observational study, it was noticed that
A. vera
gel was effective in fast recovery of high-grade RID without any adverse reaction. This single-institution study is not large enough to justify its standardized use; further studies are required to establish
A. vera
gel as a treatment measure for RID.
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Ultrasound-guided fine-needle aspiration cytology of head and neck masses: Experience in Ado-Ekiti, Southwestern Nigeria
p. 171
Abidemi Emmanuel Omonisi, Olufunso Simisola Aduayi, John Adetunji Omotayo, Ganiyu Olusola Akanbi, Olusola Olusoga Akute
DOI
:10.4103/ccij.ccij_87_17
Background:
A multidisciplinary approach to the evaluation of head and neck masses is crucial to achieving optimum patient care and enhancing diagnostic accuracy for definitive treatment. This is exemplified by the clinical and radiopathologic correlation of head and neck masses subjected to diagnostic evaluation using ultrasound-guided fine-needle aspiration cytology (FNAC) in a tertiary health institution.
Subjects and Methods:
A prospective study was carried out on 51 patients with head and neck lesions referred to the FNAC Clinic of the Department of Anatomic Pathology of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. The study was conducted over a period of 2 years between February 2014 and January 2016. The FNAC was done under imaging guidance with a 7.5 MHz ultrasound probe. Clinical, radiological, and pathological findings were correlated. The data were analyzed using SPSS version 15. Results: The study population consisted of 12 (23.5%) males and 39 (76.5%) females. The age range was 2–80 years with a mean age of 44.7 ± 18.4 years. A significant proportion (80.4%) of the masses was located in the anterior neck. Multinodular goiter (
n
= 22, 43.1%) was the predominant clinical diagnosis. On ultrasonography, the predominant echotexture of the masses was heterogeneous (
n
= 29, 56.9%), only 4 (7.84%) of the masses had internal calcifications while the predominant composition of the masses was a mixture of solid and cystic portions (
n
= 30, 58.8%). There was a strong radiopathologic correlation (Spearman correlation value of 0.910).
Conclusion:
Ultrasound-guided FNAC of head and neck masses provides a synergistic approach to patient care and should be encouraged in our setting for optimum diagnostic yields.
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Computed tomography-guided fine-needle aspiration and concurrent core biopsy in diagnosis of intrathoracic mass: An evaluation of 54 cases in a tertiary care hospital
p. 176
Rajashree Pradhan, Sajeeb Mondal, Subrata Pal, Mrinal Sikder, Biswajit Biswas
DOI
:10.4103/ccij.ccij_81_17
Introduction:
Fine-needle aspiration cytology (FNAC) is a simple, safe, and effective tool for cytological diagnosis of different neoplastic lesions. Computed tomography (CT)-guided core biopsy is also essential for tissue diagnosis.
Aims and Objectives:
The aim of this study is to assess the diagnostic value and limitations of fine-needle aspiration and core biopsy in diagnosis of intrathoracic lesions; we have done this retrospective study.
Materials and Methods:
In all 54 cases with mean age of 57.37 years, CT-guided FNAC and core biopsy were performed on same sittings. 20–22 G Chiba needle was used for FNAC, and core biopsy was performed by 18–20 G coaxial automated cutting needle. The cytological and histological evaluations were done in our cytology and histopathology laboratory. Complications were managed by pulmonologists.
Results:
On the evaluation of FNAC smears, diagnosis was done in 44 cases and 10 cases were inconclusive. In core biopsy, five cases were inconclusive. Most of the tumors were of epithelial origin (43 cases, 87.75%) and 95.59% cases were malignant in our series. Sensitivity and diagnostic accuracy of core biopsy (90.38% and 90.74, respectively) were higher than FNAC (84.62% and 85.18%, respectively).
Conclusion:
CT-guided core biopsy was more effective and accurate in diagnosis and tumor classification than FNAC in spite of higher complication rate.
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Operational role of apoptotic index in premalignant and malignant squamous lesions: An apprise
p. 180
Sheetal Arora, Deepshikha Rana, Indrani Dhawan, Rashmi Arora
DOI
:10.4103/ccij.ccij_80_17
Background:
The aim of the study was to evaluate the role of apoptotic index (AI) in premalignant and malignant squamous lesions of different sites on light microscopy.
Materials and Methods:
Retrospective study of 75 cases of premalignant and malignant squamous epithelial lesions of different sites was done. All slides were H and E stained, screened for apoptosis under ×40. AI was calculated as the number of apoptotic cells and apoptotic bodies, expressed as percentage of total number of tumor cells counted in each case.
Results:
On statistical analysis, it was found that the difference in the apoptotic indices in all the subgroups of dysplasia was not statistically significant. However, the significant statistical difference was found within the malignant group,
P
value between well-differentiated squamous cell carcinoma (SCC) and moderately differentiated SCC (MDSCC) was <0.0001.
P
value obtained between MDSCC and poorly differentiated SCC was 0.0006.
Conclusion:
We conclude that apoptotic indices are useful in distinguishing between benign and malignant squamous lesions. Several indices such as proliferating index (Ki-67) and AgNOR count are not routinely available in various hospitals, especially in developing countries. The advantage of this technique is that it can be calculated in routine H and E stained sections, and so it saves time. Although it is labor-intensive, it is cost-effective method which can benefit the patient as it correlates well with tumor aggressiveness and thereby increasing the prognosis of the patients.
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CASE REPORTS
Recurrent pilocytic astrocytoma after 5 years with anxiety and headache
p. 184
Mazaher Ramezani, Shima Jalalvandi, Zahra Torkchin, Masoud Sadeghi
DOI
:10.4103/ccij.ccij_66_18
Pilocytic astrocytomas (PAs) account for 25% of all pediatric brain tumors and commonly occur in the first two decades of life. Recurrence and/or regrowth of residual tumors are not common and mostly occur within 4–5 years of the first surgery. Herein, we reported a 16-year-old male adolescent with neurological symptoms and signs that pathologic specimens confirmed the diagnosis of PA. The patient underwent 27 sessions of radiotherapy without surgery. After 5 years, at the age of 21, the patient readmitted with anxiety and headache and the recurrence of the same tumor with the same grade. We suggest follow-up of the patient after initial treatment for at least 5 years with considering any neurological symptoms including behavioral changes.
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Carcinosarcoma of the submandibular gland with a rhabdomyosarcoma component: A case report and review of the literature
p. 187
Suma M Narayana, Smrita Singh, Rekha V Kumar
DOI
:10.4103/ccij.ccij_83_18
Carcinosarcoma of the salivary gland is a rare and aggressive malignancy with a poor prognosis. These neoplasms are composed of malignant epithelial and mesenchymal elements. This report describes a new case of carcinosarcoma arising in the submandibular gland, which had a rhabdomyosarcoma component, without clinical or histological evidence of a preexisting pleomorphic adenoma. Till date, only two case reports have described the occurrence of carcinosarcoma with a rhabdomyosarcoma component in the salivary gland, to the best of our knowledge. Histological and immunohistochemical results are presented. The literature is reviewed, and the possible histogenesis and pathogenesis of carcinosarcoma (true malignant mixed tumor) of the salivary gland are briefly discussed.
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Psammomatoid juvenile ossifying fibroma of maxilla: An uncommon neoplasm
p. 191
Jyotsna Naresh Bharti, Ashok Singh, Jitendra Singh Nigam
DOI
:10.4103/ccij.ccij_8_18
Juvenile ossifying fibroma (JOF) is a rare variant of ossifying fibroma. JOF is classified into two distinct clinicopathological variants: Trabecular and psammomatoid JOF. Based on the age group involved, most common site of occurrence and clinical behavior, JOF differs from the larger group of ossifying fibromas. We report a case of psammomatoid JOF of maxilla in a 10-year-old female who presented with a swelling over the right side of the face.
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Osteosarcoma of the mandible: A case report and short literature review
p. 193
Niharika Bisht, Sankalp Singh, Samir Gupta, Harinder Pal Singh, Prabha Shankar Mishra, Deepak Mulajker
DOI
:10.4103/ccij.ccij_6_18
Osteosarcomas comprise of a heterogeneous group of tumors with a predilection for involving long bones commonly. The jaw remains a rare site of involvement, and these tumors can be considered a distinct entity. The key for managing them lies in histological and radiological correlation for an early diagnosis. Surgery and chemotherapy remain the main modalities of treatment. We present a case of osteogenic sarcoma of the mandible that after radical treatment had local recurrence and distant metastasis.
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LETTER TO THE EDITOR
Levels of tumor markers in human immunodeficiency virus patients: Results of a pilot study
p. 196
Saif Ullah Munshi, Afsana Anwar Miti, Md Nazmul Karim, Shahina Tabssum
DOI
:10.4103/ccij.ccij_45_18
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© Clinical Cancer Investigation Journal | Published by Wolters Kluwer -
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Online since 01 December, 2011