Dentigerous cyst is the second most common odontogenic cyst and constitutes around 20-24% of all the odontogenic cysts involving the jaws. Usually, these cysts remain asymptomatic and rarely cause enlargement and displacement of associated tooth. In this paper, we present a case of a displaced mandibular third molar, which was associated with a large dentigerous cyst. A conservative treatment modality was adopted with a 2 year radiographic follow-up of the patient. A brief review of previously reported cases with dentigerous cyst causing displacement of the mandibular impacted third molars is also discussed, highlighting the treatment modality followed in all these cases.

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Background: Primary extranodal non-Hodgkin's Lymphomas (NHL) is an uncommon entity. It is diverse in its presentation, morphology, histology, and immunophenotyping. No clear-cut consensus exists regarding its management. Indian data is lacking regarding biology and treatment of disease. Aim: The aim of this study is to analyze the clinicopathological features and assess treatment modalities utilized and their outcomes in patients with primary extranodal NHL and also the outcome with involved field radiotherapy (IFRT). Settings and Design: This is a retrospective observational study from prerecorded hospital data. Materials and Methods: Cases of primary extranodal NHL attending the radiotherapy outpatient department of our institute during the last 5 years (July 2007-June 2012) were taken for this study. Hospital recorded data were taken and analyzed regarding the demography, clinical features, histopathological features, and treatment modalities and their outcomes. Result: Total 41 patients were identified, out of which six patients did not turn up for any form of treatment. Almost all patients (33 out of 35, 94.28%) received chemotherapy while around 55% (19 out of 35) patients received radiotherapy. During follow-up, around 23% patients had relapsed, that too mostly outside the primary site. Conclusion: Immunohistochemistry is essential in all cases to identify the subset which would respond excellently to rituximab (CD20 positive). IFRT has definite role in the management of extranodal NHL in patients having residual disease following chemotherapy.

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The diagnosis and treatment of lesions are currently based on histopathology, which is the gold standard for the diagnosis of cancer and dysplasia at the molecular level. Recently, there has been an increasing trend of optical spectroscopy methods for the detection of oral premalignant and malignant lesions and the same is highlighted in this paper. It depends on the optical spectrum derived from any tissue that contains information about the histological and biochemical make-up of that tissue. It provides tissue diagnosis in real-time, non-invasively, and in situ.

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Enlarged axillary lymph nodes in case of breast carcinoma patients are not always due to metastases and can be reactive in nature. Very rarely enlarged axillary lymph nodes may be due to reactivated dormant axillary tubercular lymphadenitis. A case of infiltrating ductal carcinoma of breast along with metastasis to axillary lymph node harboring primary tubercular granuloma in the same lymph node is being reported due to rarity.

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Purpose: In order to obtain an improvement in preoperative staging accuracy for rectal cancer, new imaging modalities are now under investigation. The purpose of our study was to evaluate the accuracy of endorectal coil magnetic resonance imaging (ECMRI) in the preoperative local staging of rectal cancer and correlation with intraoperative and histopathologic staging of retrieved specimen with respect to depth of tumor invasion and lymph node metastasis. Materials and Methods: The study was a prospective one and included 38 patients with biopsy proved rectal cancer. ECMRI studies were performed on a 1.5 Tesla MR unit using a standard endorectal coil. All patients underwent surgery and a comparative evaluation of ECMRI and surgical and pathological staging was done. Accuracy, sensitivity, specificity, and positive and negative predictive value (PPV and NPV) were assessed. Results: The diagnostic accuracy of ECMRI for T1/T2 tumors was 90%; for T3 and T4 tumors accuracy was 100% each. For perirectal lymph node metastasis, the diagnostic accuracy of ECMRI was 83.3%. Conclusion: ECMRI is a reliable radiologic tool for local (T) staging of rectal cancer and has excellent diagnostic accuracy, sensitivity, and specificity. ECMRI is also useful in detecting perirectal lymph node metastasis, but accuracy is not as good as that for T staging.

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Introduction: In our institution, adjuvant taxanes are currently offered to fit node-positive breast cancer patients who are either Her2 positive (any ER/PR) or triple negative (ER/PR/Her2 negative). The FE ₁₀₀ C-D (FE100C × 3 → docetaxel 100 mg/m ² × 3) regime, based on the PACS 01 trial1 is used. Materials and Methods: We retrospectively audited our experience with FE ₁₀₀ C-D at Salmaniya Medical Complex. Over a 2-year-period, 100 patients commenced adjuvant FE100C-D chemotherapy. Data was matched with the FE ₁₀₀ C-D arm of the PACS 01 trial. Results: Median age was 54 years. Twenty-six patients (26%) had ≥1 episode of febrile neutropenia (FN), including one fatal episode; 29% patients required treatment interruption ≥1 week; 30% patients had dose reductions; and 30% patients received < 90% dose intensity of docetaxel. Conclusion: The FN rate was substantially higher and docetaxel dose intensity substantially lower in our unselected sample of patients than in the trial population, this "real-life" data demonstrates the problems of applying clinical trial data to the more generalised patient population. Meanwhile, the routine use of prophylactic G-CSF support with this protocol is warranted.

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Context: Gallbladder cancer represents the most common among the biliary tree cancers. Complete surgical resection offers the best chance for cure. Adjuvant chemotherapy and radiotherapy have increasing role in adjuvant management of carcinoma gall bladder, particularly in subgroup patients with high risk features. Aims: To analyze and identify the risk factors for role of adjuvant chemoradiotherapy in resectable patients of carcinoma gallbladder. Materials and Methods: The study designed as retrospective analysis of 40 postoperative patients of carcinoma gallbladder treated in our institute from 2008 to 2011. Patients treated with curative intent were included in this analysis. Clinical characteristic and treatment in form of surgery, radiotherapy, and chemotherapy were evaluated. For statistical analysis, data was arranged using SPSS 19 version. Descriptive studies were done for all parameters and Kaplan-Meier analysis used for survival analysis. P < 0.05 is considered as statically significant. Results: Forty patients were available for final analysis. Median age of patients was 51 years there were 10 male and 30 female patients. Eleven patients received only adjuvant radiotherapy, 16 patients received adjuvant chemotherapy, and 13 patients received both chemotherapy and radiotherapy. At end of treatment, 85% patients had no evidence of disease and 15% had recurrence. Patients on combined chemotherapy and radiotherapy had better 2-year disease free survival (DFS). Liver infiltration by tumor was found to be a bad prognostic factor with DFS at 1-year of 0.8 vs. 0.5 patients with no liver infiltration (P = 0.06). Conclusion: The present analysis reveals better overall survival in patients who received chemotherapy and radiation rather than single modality treatment. Liver infiltration and adequate lymph node dissection have been found to be two important prognostic factors for considering this subgroup of patients for adjuvant chemotherapy as well as radiotherapy.

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Background: RapidArc is a volumetric modulated arc therapy (VMAT) technique that can deliver conformal dose distribution to the target while minimizing dose to critical structures. The main purpose of this study was to compare dosimetric quality of full double arc (full DA), full single arc (full SA), and partial double arc (partial DA) techniques in RapidArc planning of prostate cancer. Materials and Methods: Twelve cases of prostate cancer involving seminal vesicles were selected for this retrospective study. For each case, RapidArc plans were created using full DA (two full arcs), full SA (one full arc), and partial DA (two partial arcs with anterior and posterior avoidance sectors) techniques. For planning target volume (PTV), the maximum and mean doses, conformity, and inhomogeneity indices were evaluated. For bladder and rectum, volumes that received 70, 50, 40, and 20 Gy (V _70Gy , V _50Gy , V _40Gy and V _20Gy , respectively), and mean dose were compared. For femoral heads, V _40Gy , V _20Gy , and mean dose were evaluated. Additionally, an integral dose and monitor units (MUs) were compared for each treatment plan. Results: In comparison to full DA and full SA techniques, the partial DA technique was better in sparing of rectum and bladder but delivered higher femoral head dose, which was nonetheless within the planning criteria. No clear dosimetric differences were found between full DA and partial DA plans for dose conformity and target homogeneity. The number of MUs and integral dose were largest with the partial DA technique and lowest with the full SA technique. Conclusion: The partial DA technique provides an alternative RapidArc planning approach for low risk prostate cancer.

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Nuclear medicine and radioactive tracers have considerable application in dental research, because they provide one of the few practical methods for studying the limited metabolic activities of bones and teeth. The ease with which minute amounts of these radioactive materials may be accurately measured and distinguished from the mass of inert element in the tooth is particularly valuable. They are useful in studying many problems of calcification and mineral exchange. There are also opportunities of their use in investigating fluorosis, caries protection, periodontal disease, micro leakage studies of dental materials, root resorption, nutritional, and endocrine effects, as well as numerous other dental problems. Other usages of nuclear medicine in dentistry are listed below: Age written in teeth by nuclear tests, scintigraphic evaluation of osteoblastic activity, and evaluation of osteoblastic activity around dental implants using bone scintigraphy. Nuclear medicine can be an indicator of "active" alveolar bone loss. Nuclear medicine techniques are used as an adjunct for the diagnosis of oral diseases (benign tumors and carcinomas) and temporomandibular joint disease. This review article discusses these indications of nuclear medicine.

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Renal cell carcinoma (RCC) is the most common renal tumor and accounts for 3% of all adult cancers. The treatment of metastatic renal cell carcinoma (mRCC) has recently evolved from being a predominantly cytokine-based treatment to the use of targeted agents, which include Sorafenib, Sunitinib, Bevacizumab, Temsirolimus, Everolimus, Pazopanib, Axitinib, and most recently Tivozanib. Despite these advances mRCC remains a major health problem. Additional studies are needed to optimize the use of these agents in both advanced and early stage disease, either in combination or sequentially. In addition the development of biomarkers should be a priority in order to guide rational tailored development of emerging agents. This literature review was conducted using PubMed, Medline, and Cochrane databases for articles published until January 2013. Abstracts from relevant meeting of the American Society of Clinical Oncology and the European society of medical oncology were also included.

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In literal terms, the melanoma is malignant tumors comprising of melanocytes in which cells are derived from the neural crest that basically constitute the melanin pigment in the basal and supra basal layers of the epithelium. The oral malignant melanoma (OMM) is seen with maxillary gingiva of males was previously considered as a fatal disease; however, in recent literature search illustrates the biological nature and behavior of the disease at the molecular levels. Even if these lesions are biologically aggressive, they often go unnoticed since, they are clinically a symptomatic in the early stages and usually present merely as a hyperpigmented patch on the gingival surface. These lesions if diagnosed at a nearly in situ stage are potentially curable and definitely have a better prognosis, but unfortunately as they are clinically asymptomatic, it results in delayed diagnosis thus making the prognosis extremely poor.

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Sertoli-Leydig cell tumors (SLCTs) account for less than 0.5% of all ovarian tumors. The patients can present with androgenic as well as estrogenic manifestations. Poorly differentiated tumors are very difficult to diagnose under microscope. Here, we report a rare case of poorly differentiated SLCT (Meyer's type III) presenting with androgenic manifestations. Histopathologically, we got a variety of features from which the final diagnosis was quite impossible. Preoperative clinical features, hormonal level, and immunohistochemistry played a great role in finalizing the diagnosis.

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We report a sporadic case of a familial adenomatous polyposis coli (FAP) in a 25-year-old male who came with no family history of the same. FAP is the most common inherited adenomatous polyposis syndrome. Because of its rarity, the incidence in a developing country like ours is unknown. It is characterized by more than 100 adenomatous polyps and if left untreated carries a 100% risk of progression to colorectal cancer by the fourth decade. The early recognition and characterization of the polyposis syndrome is vital since early intervention and surgery will help in prevention against the development of invasive colorectal cancer.

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Bone metastasis in bronchogenic carcinoma usually occurs at axial skeleton-like vertebrae, ribs, etc., Here we report a case of a 60-year-old male presenting to us with a sternal swelling. Fine-needle aspiration cytology of the swelling showed features suggestive of metastatic adenocarcinoma. Contrast-enhanced computed tomography (CECT) of thorax showed a mass in the left lung hilar area measuring 3 × 4 cm along with sternal metastasis. CT-guided trucut biopsy of the lung mass suggested diagnosis of adenocarcinoma of lung. Immunohistochemistry of a histopathological section from the lung mass confirmed the diagnosis of adenocarcinoma of lung. To conclude, it was a case of adenocarcinoma of lung presenting as solitary sternal metastasis. We want to report the case as solitary sternal metastasis without involvement of other bones is rare as a presenting feature of underlying malignancy. To the best of our knowledge, sternal metastasis as a presentation of bronchogenic carcinoma is not reported in the literature.

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We report a case of a 22-year-old young male presenting with radicular pain of lower limbs, with urinary retention and erectile dysfunction due to cauda equina compression by a pre-sacral mass, which was shown to be an extramedullary myeloid sarcoma on histopathology and immunohistochemistry. However, the patient did not have any evidence of acute myelogenous leukaemia either in peripheral blood or bone marrow. He responded favourably to treatment by local external beam radiotherapy and systemic chemotherapy using the 3 + 7 protocol. Isolated extramedullary myeloid sarcoma causing cauda equina compression is extremely rare, with very few case reports published earlier. Our case also emphasizes the importance of aggressive combined-modality treatment in such patients to achieve durable remission and preserve reasonable quality of life.

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Primitive neuroectodermal tumor (PNET)/ewing's sarcoma is a rare neural crest tumor of central nervous system, thoracopulmonary regions, pelvis, and lower extremities. Visceral involvement by PNET is a rare phenomenon, with kidney being the most commonly involved organ. We report a 35-year-old Asian female presenting with left inguinal swelling, with computed tomography scan evidence of conglomerate lymph nodal mass in the left external iliac and inguinal region. A clinico-radiological diagnosis of lymphoproliferative disorder was made. She subsequently underwent excision biopsy. Histopathology of the biopsy specimen revealed completely effaced lymph nodal architecture, which was replaced by a tumor composed of nests of small, round, blue cells. On immunohistochemistry, the tumor cells were positive for CD99 and negative for CD3, CD20, leucocyte common antigen, epithelial membrane antigen, cytokeratin, desmin, vimentin, synaptophysin, and chromogranin A. Extensive search regarding any possible different site of involvement by the tumor was negative. The clinical presentation and histological, cytological, and immunohistochemical pattern, lead to the diagnosis of metastatic PNET of the left external iliac and inguinal lymph node with unknown primary origin. To the best of our knowledge, it is the first ever reported case of inguinal lymphadenopathy as the solitary metastatic presentation of PNET of unknown origin.

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Primary liver lymphomas are uncommon, accounting for only 0.4% of all the extra nodal lymphomas. Burkitt's lymphoma is a rare type of Non-Hodgkin's lymphoma. It is classified into three types: Endemic, sporadic and immunodeficiency associated. Endemic type is found in Africa, associated with Epstein-Barr Viral infection. Non-endemic type usually involves mesenteric lymph nodes or ileocecal area and usually presents as an abdominal mass. Primary hepatic Burkitt's lymphoma is a very rare neoplasm. Here, we present the case of a 28-year-old male presenting with right upper quadrant pain and generalized weakness. A core needle biopsy of the liver was performed, which revealed cytologic and immunohistochemical findings compatible with Burkitt's lymphoma.

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Portal vein thrombosis (PVT) is a rare condition whose exact prevalence is unknown. In developing countries like India it is most often due to umbilical or intra-abodominal sepsis in young patients. In South-East Asia, PVT is usually seen in middle age and above commonly when due to hepatitis-B related chronic liver disease or HCC, and other malignancies, being extremely rare in those below 30 years. We report a case of abrupt onset PVT with incidentally detected hepatitis-B associated cirrhosis of liver and HCC in a previously healthy young man, presenting with acute hepatic decompensation and some unusual features in the involvement of the portal vein.

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A 9-year-old female child, known case of beta thalassemia major and human immunodeficiency virus seropositive, presented with two slowly growing masses in the temporoparietal region of the skull on both sides. Irregular bony erosion at left parietal area with underlying scalp hematoma with similar change at the right side to a lesser degree were found. Fine needle aspiration cytology from masses showed abundant plasmacytoid cells some of which are binucleated along with free erythroblasts. Cytological features were suggestive of plasmacytoma. Serum protein electrophoresis showed no M-band. Urine was negative for Bence-Jones protein. Bone marrow biopsy showed no plasma cell neoplasm. Diagnosed as first reported case of primary multiple solitary plasmacyomas affecting bilateral temporoparietal bones in a pediatric patient, the child was treated with external beam radiation therapy to scalp lesions showing excellent results and on further follow-up showed no evidence of progressive disease.

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Epithelioid hemangioendothelioma is a rare intermediate grade neoplasm of the vascular endothelium. This tumour has wide spectrum of behaviour having high rate of local recurrence, distant metastatic potential, and malignant transformation. We present a case of a 25-year-old female with epithelioid hemangioendothelioma of the left lower limb that was excised by wide local excision. There was no bone or skin involvement. The patient is on regular follow-up without recurrence since last one and a half years.

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Primary squamous cell carcinoma of the breast (PSCCB) is an extremely rare disease. Origin is controversial; it is thought to arise through the metaplasia of various benign and malignant breast lesions. It usually present with rapidly growing large mass, otherwise similar to that of ductal breast carcinoma. Fine needle aspiration cytology (FNAC) is an accurate and safe diagnostic procedure for breast malignancies. However, cytologists are still facing some difficulties in specific diagnosis of various subtypes of breast malignancy. Extensive squamous cells on cytology should be evaluated with the great caution. Ductal breast carcinoma with squamous metaplasia, squamous carcinoma of the breast skin, and metastasis from non-mammary tissues should be consider before the making the diagnosis of PSCCB. Specific management and prognosis of PSCCB is still debatable. We present a case of 52-year-old woman with a breast mass. FNAC revealed predominantly clusters and dispersed malignant squamous cells, without any ductal cells, suggest PSCCB; possibility of secondary or ductal breast carcinoma with squamous metaplasia should be ruled out. After modified radical mastectomy histology confirmed the diagnosis of PSCCB. Post-operative cisplatin and 5-fluouracil were administered. Patient is disease free at 12 months of follow-up.

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Cannon ball opacities in lungs are usual manifestation of secondary's arising due to extra-thoracic malignancy. We report a rare case of primary lung cancer with presentation of multiple pulmonary nodules in a 62-year-old male laborer by occupation, chronic smoker (40 pack-years) who presented with 6 month history of dry cough, exertional breathlessness and fever off and on.

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The metastatic disease which leads to cancer patients' mortality results from a multi-step process of tumor progression caused by gene alteration and cooperation. Accordingly, it was recently demonstrated that alteration level of insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3) are associated with the risk of cancer related death in several human malignancies including breast cancer. On the other hand, epithelial-mesenchymal transition (EMT) is described as a crucial event in cancer progression and metastasis. Herein, we discuss the association between IGF-1, IGF-1/IGFBP-3 ratio, EMT, and breast cancer mortality.

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The odontogenic keratocysts (OKC) usually represent a particular entity that has been of interest mainly due to biological aggressiveness and to its frequent recurrence. Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome is a hereditary condition characterized by a wide-range of developmental abnormalities and a predisposition to neoplasms. There are several possible reasons why OKC recur so frequently and require meticulous surgical planning and execution. This mini review has attempted to show that there is a lack of published evidence regarding the cause of frequent recurrent of OKC that presented in NBCCS. However, the findings of the study revealed differences in opinion regarding the treatment modalities, which necessitates further long term clinical studies that could precisely document certain reliable guidelines in this perspective.

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