Background: Although color Doppler ultrasonography (CD-USG) is useful in the diagnosis of various diseases of the head and neck, flow signals in the malignant oral tumors are less studied; hence, the present study was designed to study the usefulness of CD-USG in quantifying oral squamous cell carcinoma (OSCC) vascularization and in determining the hemodynamic parameters by spectral analysis obtained during CD-USG procedure. Aims: To study the usefulness of CD-USG in mapping OSCC of buccal mucosa, tongue, and lip. Materials and Methods: This was a case-control study, conducted among 60 subjects aged 20–70 years. Group A consisted of 30 cases of OSCC of buccal mucosa, tongue, and lip while Group B consisted of 30 controls. CD-USG investigation of each mass was carried out. The spectral waveform (time-velocity Doppler spectrum) of flow signal was analyzed for the pulsatility index, resistivity index (RI), peak systolic velocity (PSV) (m/s), and end diastolic velocity (EDV) (m/s). All patients had real-time, gray-scale sonography and CD-USG with spectral wave analysis. Results: In this study, the mean value for RI in patients with malignancy was 0.40 ± 0.14 whereas for healthy subjects, it was 0.83 ± 0.07. Mean value for PI in patients with malignancy was 0.86 ± 0.20 whereas for healthy subjects, it was 2.61 ± 0.77. In the present study, the mean PSV in malignant masses was 31.72 ± 13.48 whereas for healthy subjects, it was 43.87 ± 20.95, and the EDV in malignant masses was 10.33 ± 5.21 whereas for healthy subjects, it was 7.07 ± 3.44. Conclusion: The said Doppler indices were shown to be sensitive as well as specific for the diagnosis of malignant oral tumors. Although CD-USG cannot replace histopathological procedures, it plays a definite role as an adjunct to the clinical evaluation of OSCC cases.

Background: Acute lymphoblastic leukemia (ALL) is considered as one of the most common cancer in pediatric malignancies. Among ALL, B-cell Acute Lymphoblastic Leukemia (B-ALL) represents 80% to 85% of the childhood ALL. Problem: Although anti B-ALL chemotherapy kill B-ALL, it associates with alteration in the numbers of CD4⁺ and CD8⁺ T-cells, and thus impacts the overall immunity. Aim: To evaluate the impact of anti B-ALL on the numbers of CD4⁺ and CD8⁺ T-cells in correlation to the numbers of CD10⁺ B cells in B-ALL pediatric patients. Materials and Methods: Peripheral blood samples were drawn from previously diagnosed B-ALL before (n = 10 cases) and after (n = 10 cases) chemotherapy as well as from healthy controls (n = 10 cases). The numbers of CD4⁺, CD8⁺ T-cells and CD10⁺ B cells were measured in these samples by flow cytometry. Results: As expected, the numbers of CD10⁺ B-cells were increased in B-ALL patients before chemotherapy which were associated with increases in the numbers of CD4⁺ and CD8⁺ T-cells. Chemotherapy of B-ALL patients, during the induction phase, induced dramatic decreases in the numbers of CD10⁺ B cells, which were associated with decreases in the numbers of CD4⁺ and CD8⁺ T-cells. Tin spite of this alteration, the ratio of CD4/CD8 in B-ALL patients were remained similar before and after chemotherapy as compared to those in healthy controls. Conclusion: Anti B-ALL chemotherapy induces alterations in the frequencies of T-cell subsets. Given the importance of these cells in anti-tumor immunity, our data may lead to further studies to investigate the different subsets of these cells, in particular regulatory T-cells.

Background: To compare concurrent cisplatin-based chemoradiation in an adjuvant setting for high-risk squamous cell carcinoma of oral cavity terms of toxicity, local-regional control, and overall survival. Materials and Methods: A total of 54 patients of postoperative squamous cell carcinoma of oral cavity with high-risk features were randomized into two groups; postoperative radiation (60 Gy/30#/6 weeks) or postoperative concurrent chemoradiation (60 Gy/30#/6 weeks with weekly concurrent cisplatin 50 mg) arms. Results: Buccal mucosa was the most common sub site (44.4%) affected, followed by lower alveolus/alveolar ridge (37%) and most tumors (64.3%) were well-differentiated. About 67.3% of the patients completed their course of radiation within 6 weeks with only 69 patients receiving the scheduled 60 Gy of external beam radiation therapy dose. Only 6 patients out of 22 completed the 6 cycles of weekly chemotherapy with compliance decreasing most after 3 cycles. Mucositis and dysphagia were significantly higher in the chemoradiation arm. After a median follow-up of 47 months, the loco-regional control rate was 51.4% in the postoperative chemoradiation arm as compared to 35.56% in the postoperative radiation arm. The 5 years overall survival was 56.4% in postoperative chemoradiation arm as compared to 51.3% in the postoperative radiation only. Conclusion: Postoperative concurrent chemoradiation with weekly cisplatin in high-risk oral cancer gave an advantage in the loco-regional control rate and overall survival at the end of 47 months, with significant increase in acute toxicities Grade III and Grade IV toxicities.

Background: Diseases are primarily affecting the prostate gland ranged from inflammation to hyperplasia to malignant tumors. Carcinoma of the prostate is most common nonskin cancer in the west and the second leading cause of cancer death among men. Gleason's microscopic grading is a paramount feature and with prostate-specific antigen (PSA) are important for diagnosis, management, and prognosis of carcinoma. Objectives: The objectives were to evaluate the patterns of prevalence of prostatic lesions among the insured persons of the model hospital and to correlate histology with respect to serum PSA levels. Materials and Methods: Clinicopathological study of prostatic biopsies was conducted over a period of 1-year with emphasis on Gleason's grading and correlation of the same with PSA levels. Results: Individuals with PSA >10 had 18 times more chance of being biopsy positive in comparison to PSA <10. Conclusion: Confirmation for malignancy/screening in high-risk people is needed when PSA value is more than 4 since sensitivity is 100%, rather than PSA more than 10.

Background: Comparison of setup errors for various immobilization devices in head and neck cancer and to determine the treatment margin in high precision radiotherapy using bony landmark based matching. Materials and Methods: Total 20 patients were immobilized with BrainLAB immobilization device (BL) or thermoplastic ray cast (RC) for high precision radiotherapy. Total, systematic, and random errors in mediolateral (ML), craniocaudal (CC) and antero-posterior directions were determined and clinical target volume (CTV) to planning target volume (PTV) margin by Stroom's formula was compared. Unpaired t-test was used for comparing errors. The standard deviations (systematic and random errors) in different groups were compared by variance ratio test (Levene's test) and P < 0.05 was considered significant. Results: The total error in ML direction (BL vs. RC) was 1.00 mm versus 1.39 mm (P = 0.03), systematic error 0.09 cm versus 0.197 cm and random error 0.116 cm versus 0.258 cm (F-test, P = 0.001). CTV to PTV margin was significantly lower in BL (0.26 cm vs. 0.57 cm, P < 0.05). In CC direction, BL system had lower total error (0.075 cm vs. 0.157 cm) and a significantly less systematic error (0.116 cm vs. 0.258 cm, F = 7.149, P = 0.015). CTV to PTV margin was less in BL than RC in CC direction (0.34 cm vs. 0.92 cm, P = 0.06). Conclusion: In head and neck region, when electronic portal imaging device based verification is used, for BL margins ranged from 2.6 to 3.7 mm. For RC in the PTV margin was 5.7–9.2 mm. Therefore, a margin of 3 mm for BL and 5–10 mm for RC with online correction in head and neck is adequate.

Background: Acute lymphoblastic leukemia (ALL) is biologically and clinically considered as a heterogeneous neoplasm of lymphoid progenitor cells. About 85% of children with ALL are diagnosed as B-ALL, expressing CD19; the typical marker of normal B cells. Problem: Given that the chemotherapy associated with leucopenia, in particular myeloid cells (CD33⁺ cells), Aim: the main aim of this study was to analyze the numbers of these cells in children with B-ALL before and after induction of chemotherapy. Materials and Methods: The frequencies of CD33⁺ myeloid cells and CD19+ B-cells were analyzed in the peripheral blood patients before (n = 10) and after (n = 10) induction of chemotherapy as well as in healthy volunteers (n = 10) using multiparametric flow cytometry. Results: As expected, B-ALL patients showed high numbers of CD19⁺ cells before induction of chemotherapy; where the numbers of these cells were reduced upon the induction of chemotherapy. CD33⁺ myeloid cells showed decrease in numbers in B-ALL patients before chemotherapy as compared to healthy control volunteers. Interestingly, treatment of B-ALL patients with chemotherapy-induced almost recovery of the numbers of these cells. Conclusion: CD33⁺ myeloid cells are increased in numbers after induction of chemotherapy, indicating to a dynamic mobilization or differentiation of their precursors into circulation. This study opens a new avenue to characterize the phenotype and function of these cells in different hematological malignancies; in particular, they may harbor regulatory cells.

Background: Pleural effusions are common and devastating complication of advanced malignancies. Lung and breast cancers cause approximately 75% of all malignant pleural effusions. Pleural effusions associated with carcinoma breast (either malignant or paramalignant) pose diagnostic and therapeutic dilemmas for the treating chest physician. Materials and Methods: In a prospective study of analysis of unexplained pleural effusions, we performed medical thoracoscopy in 9 cases of carcinoma breast between April 2011 and September 2014. All the relevant clinical and paraclinical were collected and analyzed. Results: Sole pleural effusion was the most common radiological finding. This article reviews 9 cases of carcinoma breast patients, who had developed recurrent lymphocytic exudative pleural effusion, within a year of diagnosis. Thoracoscopy was diagnostic in all 9 cases with a histological diagnosis of metastatic carcinoma arising from the breast. Surprisingly malignant cells were negative in pleural fluid of all cases on three consecutive occasions. Conclusion: Carcinoma breast related pleural effusion is a common condition encountered in respiratory medicine and oncology. Thoracoscopic guided pleural biopsy is an effective and safe technique in patients with undiagnosed pleural effusion. It not only gives an accurate diagnosis but also gives a high degree of relationship between thoracoscopic appearance and primary disease or tumor classification.

Background: New developments in thoracic oncology have challenged the way pathologists approach pulmonary carcinoma. Categorization as small cell or nonsmall cell is no longer adequate, and a distinction between adenocarcinoma (ADC) and squamous cell carcinoma (SqCC) is necessary for specific therapy. Aim: To determine the diagnostic accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis and subtyping of primary lung carcinoma and reliability of the cytological parameters. Settings,Design, and Subjects and Methods: Histologically confirmed lung carcinomas diagnosed on FNAC were evaluated for various cytological parameters by three pathologists, and data were statistically analyzed. Results: A total of 39 cases (22 ADCs, 9 SqCCs, 6 small cell carcinomas and 2 poorly differentiated carcinomas) were studied. The features frequently observed in small cell carcinoma included small cell size (83%), scant cytoplasm (83%), nuclear molding (100%), and granular chromatin with nuclear streaks (67%) in the background. SqCCs showed single cells (66%), distinct cell borders (44%), abundant homogenous cytoplasm (78%), hyperchromatic nuclei (56%), and keratinous debris (22%) whereas ADCs showed glands (45%), three-dimensional (68%) and papillary (23%) clusters, indistinct cell borders (77%), cytoplasmic vacuolation (55%), vesicular chromatin (45%), and mucinous (23%) background. There was a statistically significant agreement between cytologic and histologic diagnosis (P < 0.001) with a very good level of agreement (κ = 0.9). The overall percentage of agreement was 97%, with substantial agreement between the observers (κ = 0.73). Cell size, cohesion, cell borders, molding, chromatin texture, and cytoplasmic characteristics were significantly associated with the diagnosis. Conclusion: Cytologic subtyping of lung carcinoma is feasible and reasonably accurate.

Background: A new advancement in daily monitoring of patient positioning is the use of hybrid technologies where two separate online imaging modalities are integrated to achieve precise treatment delivery. Our center has a set-up that integrates Elekta Linear accelerator device (EPID) with BrainLAB ExacTrac imaging for the first time in the world. We calculated planning target volume (PTV) margin for brain radiotherapy with thermoplastic mask immobilization with conventional EPID and BrainLAB ExacTrac image guidance system. Materials and Methods: EPID (iViewGT) and ExacTrac verification images of 32 patients in total 784 radiotherapy sessions were acquired and analyzed. Systematic (Σ) and random errors (σ) were calculated in cranio-caudal, lateral and anteroposterior directions. PTV margins calculated using van Herk (2.5 Σ +0.7 σ) formula for each imaging system. Result: Of total 784 sessions EPID image were obtained in 723 sessions, ExacTrac obtained in 431 sessions. In cranio-caudal direction, the systematic error, random error, and the calculated PTV margin were 0.09 cm, 0.12 cm, and 0.31 cm, respectively, with EPID image and 0.17 cm, 0.13 cm, and 0.51 cm, respectively, with ExacTrac. The corresponding values in lateral direction were 0.11 cm, 0.15 cm, and 0.40 cm with EPID and 0.16 cm, 0.10 cm, and 0.47 cm, respectively, with ExacTrac image. The same parameters for anteroposterior were 0.10 cm, 0.13 cm, 0.37 cm with EPID and 0.144 cm, 0.10 cm, and 0.43 cm with ExacTrac image. Pearson's correlation coefficient was found to be 0.66, 0.67, 0.62 in these three directions. Conclusion: With dual imaging modalities, our calculated adequate PTV margin for brain radiotherapy cases are 0.51 cm, 0.47 cm, is 0.43 cm in cranio-caudal, right-left, and anteroposterior directions, respectively.

Malignant nodular hidradenoma (MNH) also known as hidradenocarcinoma is very rare adnexal tumor with exceedingly low incidence of 0.001%. The recognition is very important because eccrine carcinomas have potential of local destruction and distant metastasis. Given the relative paucity of published data with only just over 50 case reports and small case series, there is little information available on the natural history and appropriate management for this disease. It has been reported most frequently in the head and neck and rarely on the extremities. There is no consensus treatment for metastatic hidradenocarcinoma since it is a rare and aggressive tumor. We report a rare case of MNH in a 70-year-old female presented with inguinal lymphadenopathy and discuss cytological findings and histopathological features with review of literature. Adnexal tumors need thorough histopathological analysis to conclude their biological behavior. This study will highlight the importance of appropriate wide excision of primary adnexal tumors and thereby preventing metastatic presentations in future.

Esophageal cancer, most commonly presents with upper digestive symptoms such as dysphagia, odynophagia. Lymph nodes are among the most common metastatic sites of this cancer. An isolated scalp metastases as a sole signature of an underlying esophageal carcinoma has never been addressed in any surgical literature till to date. In our case report, we have shared our clinical experience of coming across through such a scenario where an orthopedically handicapped gentleman with 44 years of age, presented with isolated scalp mass later on proved to be metastatic squamous cell carcinoma from underlying esophageal cancer is being discussed in brief. It is a rare presentation of esophageal cancer without the upper gastrointestinal symptoms.

Extra-abdominal desmoid tumor is a rare tumor and only a few cases occurring in the foot have been reported. They are benign but locally aggressive, and wide local surgical excision is the treatment of choice owing to the high rate of recurrence in the lower extremities. Invasiveness into the surrounding soft tissue structures often makes wide excision difficult without compromise of function. A 30-year-old woman presented with gradually increasing swelling in the dorsal aspect of the right foot. This case had a large mass in the right foot with metastasis in lungs. Biopsy confirmed the diagnosis of extra-abdominal desmoid tumor of the foot.

Malignant melanoma is the malignancy derived from melanocytes. Cutaneous melanoma is more common than mucosal melanoma. Anorectal malignant melanoma is a rare tumor with a poor prognosis. It is <1% of all anorectal malignancies and 1 to 2% of melanoma. In view of the late presentation and natural course of the disease, most of the cases reported in an advanced stage. In this report of 35-year-old female admitted with features of inguinal mass and deep vein thrombosis (DVT) due to anorectal melanoma. The most common presentation of anorectal melanoma was hematochezia and mass in the anal canal. Till now few cases reported with DVT.

Desmoplastic small round cell tumor (DSRCT) is a rare subtype of "small round blue cell tumors" typically arising from the peritoneum. An 18-year-old male patient presented with palpable nontender abdominal mass associated with dragging sensation. Imaging revealed a large heterogenous soft tissue mass in the pelvis and lower abdomen along with irregular peritoneal thickening. Histopathology and immunohistochemistry suggested DSRCT. Neoadjuvant chemotherapy followed by laparotomy with debulking surgery of the pelvic mass was done after 5 months of starting chemotherapy. Follow-up contrast enhanced computed tomography abdomen showed a reduction of the size of residual disease. However, follow-up magnetic resonance imaging done after 3 months of surgery showed disease recurrence. The tumor should be suspected in young males when imaging is showing a pelvic mass along with multiple peritoneal soft tissue deposits.

Sclerosing stromal tumor (SST) is a rare benign sex cord-stromal ovarian tumor typically encountered in young females. These tumors are hormonally inactive and usually present with nonspecific symptoms. Histopathology is essential in the diagnosis of this uncommon tumor. We present a case of SST in a young female with a review of current literature. This patient presented with abdominal pain. She underwent right salpingo-oophorectomy. The histopathological examination and immunohistochemistry of the tumor was consistent with the diagnosis of SST.

Primary signet-ring cell carcinoma (SRCC) is an extremely rare and aggressive type of malignant gallbladder (GB) neoplasm, which is comprised predominantly (>50%) of signet-ring cells. Owing to its diffusely invading nature, SRCC often confers a "linitis plastica" like appearance to GB. Such a gross morphology in the background of nonspecific clinical presentation creates confusion with several other benign and more common pathological entities. This dilemma can effectively be settled through clinical, radiological, and pathological correlation. We, here, describe a case of SRCC affecting the GB in a 43-year-old lady. The tumor produced diffuse thickening of GB wall and infiltrated up to subserosa, but not beyond the GB parenchyma.

Cutaneous leiomyomas are uncommon, benign smooth muscle neoplasm and comprise approximately 5% of all leiomyomas. Pilar leiomyoma is the most common type of cutaneous leiomyoma and arises from arrector pili muscle in the skin. Cutaneous pilar leiomyomas present in second and third decades of life as multiple, painful red-brown papulonodular lesions on the trunk or extremities. Clinically this lesion is easily misdiagnosed for other cutaneous conditions. Hence, this lesion should always be taken into consideration in the clinical differential diagnosis of papulonodular skin lesions. Herein, we report a case of 34-year-old male who presented with a small nodule on his left arm. Clinically differential diagnosis was fibroma or neuroma. Surgical excision was performed. Histopathological examination, special stain (Masson's trichrome) and Immunohistochemistry confirmed the diagnosis of cutaneous pilar leiomyoma.

Ovarian cancers are commonly diagnosed gynecological malignancies worldwide. It ranks among the top ten diagnosed cancers and top five deadliest cancers in most countries. However, in spite of this squamous cell carcinoma (SCC) of the ovary is extremely rare. Here, we present a review of the literature along with a case of a 66-year-old postmenopausal female who presented with swelling, pain abdomen with constipation, and weight loss. She was diagnosed with pure (de novo) primary SCC of left ovary. No pre/co-existing ovarian lesion was identified. Despite external radiation and adjuvant chemotherapy, the patient died in 2 months.