Background: Bone marrow metastasis by a nonhematologic malignancy signifies advanced stage of disease and confers a poor prognosis. The aim of this study was to analyze clinical presentation, hematological profile, biochemical profile, radiological presentation, and patterns of bone marrow involvement in patients with metastatic nonhematologic malignancies retrospectively. Materials and Methods: Ninety bone marrow procedures were done in cases of nonhematologic malignancies for suspected involvement or as a part of staging procedure. Results: Sixteen out of 90 patients showed metastasis by nonhematologic malignancies. The most common malignancy to metastasize was malignant small round cell tumor (Ewing's sarcoma and rhabdomyosarcoma) followed by carcinoma breast and prostate. The most common clinical presentation was backache, fever anorexia, and abdominal pain. The biochemical findings included raised serum calcium and lactate dehydrogenase. 62.5% had anemia and 37.5% had thrombocytopenia. Leukocytosis was seen in 37.5% of patients. Leukoerythroblastic picture was seen in 43.75% cases. Of the eleven cases where both bone marrow aspirate and biopsies were done, 10 cases showed malignant cells in both. Immunohistochemistry was conclusive in four cases. The combined procedure of aspiration and biopsy gives a higher yield and are essential in patients with suspected bone marrow metastasis in nonhematologic malignancies.

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The role of tobacco smoking as a causative factor in the development of the periodontal disease has long been debated and recently a large number of papers have been published in the literature regarding this symbiosis. Smoking also gives an encouraging environment for microbes in the mouth such as Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans because the by-products of smoking prevent the mechanisms that limit the growth of harmful bacteria in the oral cavity. Thus, smoking promotes early stages of periodontal disease. Smoking in the form of cigars and pipes have similar deleterious effects that cigarettes do on oral health. Much of the literature has also showed that smokers affected with periodontitis respond less favorably to periodontal treatment be it nonsurgical and surgical. In this paper, we have reviewed the effects of smoking on various aspects of the periodontal disease process.

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Sarcomas are malignant soft tissue tumors that constitute <1% of malignancies and liposarcoma (LS) is the most common sarcoma with about 20%. Majority of LSs are well-differentiated (40%). About 5–10% of them will further progress and develop abrupt shift into dedifferentiated neoplastic tissue and contain nonlipogenic component that are labeled as dedifferentiated LSs. LSs commonly affect age group of 50–70 years and commonly occur over extremities and in retroperitoneum. Prognosis of LS depends on various parameters such as histological grade, type, size, location, and presence, or absence of metastasis. We hereby, report a case in 30 years adult male patient with clinical and radiological diagnoses as “intramuscular lipoma” over the thigh. Cytological examination revealed malignant nature of the soft tissue lesion. Histopathology revealed dedifferentiated LS containing highly bizarre tumor giant cells. This case report reemphasizes the cytology findings of this rare entity and reviews the literature on a dedifferentiated variant of LS.

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Background: Fine needle aspiration cytology (FNAC) is often considered as the initial mode of investigation in the evaluation of the soft tissue tumors (STTs). This study was undertaken to explore the utility and accuracy of FNAC in STT by correlating their histopathological diagnoses. Materials and Methods: A total of 220 FNAC of STT was retrieved and evaluated retrospectively between January 2012 and June 2015 and correlated with their subsequent histopathological diagnoses. Results: On FNAC, 175 (79.6%) were benign, 26 (11.8%) were malignant and 19 (8.6%) were inconclusive. On the correlation of subsequent histopathology, 173 cases were confirmed as benign (true negative) and 22 cases were confirmed as malignant (true positive). There were four false positive and two false negative results. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive values of FNAC for diagnosing malignant STT were 91.7%, 97.7%, 97%, 84.6%, and 98.9%, respectively. Conclusion: The present study concluded that FNAC can be used as a reliable diagnostic tool for preoperative triaging of benign and malignant STT with fair sensitivity, specificity, and accuracy, even though a specific diagnosis may not be possible in all cases. In addition, we have found a considerable proportion of difficulties in the diagnosis of certain STT; hence, care should be taken while interpreting these challenging FNAC cases.

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Background: Uterine prolapse is a common complaint in gynecology. It is defined as an abnormal downward displacement or protrusion of the pelvic structures in the vaginal canal. Aim: The aim of this study was to know the gross and microscopic cervical changes in uterine prolapse and their association with clinical findings. Materials and Methods: The present study was conducted in the histopathology section of the Department of Pathology in Rural Institute of Medical Science and Research, Saifai, Etawah, Uttar Pradesh, on hysterectomy specimens with prolapse uterus from January 2012 to May 2015. Results: The minimum age of patients with prolapse was 25 years and maximum age was 70 years, maximum number of patients belonged to 41–50 years age group (38.72%). Common clinical complaint was something coming out per vagina (53.61%). On gross examination, hypertrophy of cervix was a common pathology (46.38%). Histopathology examination of prolapse uterus showed chronic cervicitis (87.65%), cervical intraepithelial neoplasia I (21.70%), and others, but carcinoma cervix was not present. Conclusion: Prolapse uterus was a common gynecological complaint among rural women, usually clinically presenting with something coming out per vagina. Grossly, the cervix appeared hypertrophied in the majority. Histopathological examination showed chronic cervicitis in bulk. Chronic cervicitis paves the way for premalignant and malignant lesions of cervix, though cervical carcinoma is rare in prolapse uterus. Prolapse uterus must be diagnosed early so as to provide early treatment before the complications arise.

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Krukenberg tumor is quite rare, accounting for 1–2% of all ovarian tumors. In pregnancy, its incidence is 0.4–0.5%. It is associated with very poor prognosis in pregnancy due to widespread metastasis at the time of diagnosis. We report a case of 25-year-old full term pregnant female presenting with fetal distress. Bilateral enlarged ovaries were found incidentally at the time of cesarean section. A diagnosis of Krukenberg tumor with a primary from stomach was rendered on histopathology. Our case is interesting in view of its unusual presentation, young patient age, and the diagnostic dilemma it poses. Our report highlights the fact that early diagnosis of Krukenberg tumor in pregnancy may be difficult at times owing to the masquerading effects, implying widespread metastasis and a poor maternal survival.

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Massive edema of the ovary is a rare benign entity affecting young women. Most cases are thought to result from venous and lymphatic obstruction. The ultrasonographic appearance is nonspecific and can mimic neoplasia, and the definitive diagnosis requires histological examination. Massive ovarian edema should be suspected in women in reproductive age group presenting with solid enlargement of the ovary. Awareness of this rare entity among surgeons and pathologists is essential in the diagnosis and to avoid unnecessary oophorectomy. We describe one such rare case of massive ovarian edema in a 22-year-old female.

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Background: Pulmonary lymphangitic carcinomatosis (LC) secondary to cervical squamous cell carcinoma (SCC) is an uncommon cause of diffuse infiltrative lung disease. Its reported incidence is quiet low. Materials and Methods: Fifty cases of cervical carcinoma were studied from 2005 to 2014. There was only one case of squamous cell carcinoma cervix that developed pulmonary lymphangitic carcinomatosis subsequently. Clinical manifestations of LC such as dyspnea and non-productive cough can mimic with clinical picture of pneumonia, pneumonitis, pulmonary embolism, congestive heart failure, asthma, and sarcoidosis and thus can be a diagnostic dilemma for treating physician. A review of world literature was also done to examine all the reported cases of cervical carcinoma which presented as pulmonary lymphangitic carcinomatosis. A few cases have been reported so far. Concussion: Pulmonary lymphangitic carcinomatosis is a rare manifestation of metastatic Squamous Cell Carcinoma (SCC) of the cervix and is associated with a poor prognosis. Increased clinical alertness of such patterns of metastases in cervical cancer along with accurate pathological diagnosis is compulsory to guide proper therapy in these patients.

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Background: (1) To study and correlate the mast cell numbers in benign prostatic hyperplasia (BPH) and prostate carcinoma lesions. (2) To compare mast cell numbers of intratumoral and peritumoral regions in prostate adenocarcinomas. (3) To ascertain a relationship between the number of mast cells and age, prostate-specific antigen (PSA) levels, and Gleason Grade. Subjects and Methods: One-hundred cases of prostate lesions, consisting of 75 cases of BPH and 25 cases of prostatic adenocarcinoma, received in the form of transurethral resection of prostate chips in the Department of Pathology, were included in the study. After histopathological diagnosis, the paraffin sections were stained with toluidine blue. Results: The mean value of mast cell count per mm² in benign and malignant lesion was 37.05 and 92.20, respectively. The difference in mean mast cell count in BPH and prostatic adenocarcinoma was found to be statistically significant (P = 0.001). The correlation between mast cell count and Gleason Grade was found to be statistically significant (P: Grades I–III - 0.043; 0.002; 0.012). However, no correlation was found between mast cell count with age and PSA levels. Conclusion: In this study, an increase in the number of mast cells was observed in patients with prostate cancer than in benign lesions. This suggests a stimulating role of mast cells in the progression of cancer.

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Folliculosebaceous cystic hamartoma (FSCH) is a rare cutaneous hamartoma composed of follicular, sebaceous, and mesenchymal elements. Especially interesting is its differential with another benign tumor sebaceous trichofolliculoma with which it shares several histologic features. This case report highlights the association of FSCH with neurofibroma and discusses its possible common pathogenesis.

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Fibrous dysplasia is also called fibrocystic disease, osteitis fibrosa localisata, focal osteitis fibrosa, fibro osteodystrophy, and Jaffe-Lichtenstein. It is an asymptomatic regional alteration of bone in which the normal architecture of bone is replaced by fibrous tissue and nonfunctional trabeculae-like osseous structures. Fibrous dysplasia may be monostotic or polyostotic, with or without associated endocrine disturbances. Here, we are discussing two cases with monostotic fibrous dysplasia of maxilla with emphasis on various radiographic features that the lesion shows during its different stages.

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We report a case series of three extremely rare and unusual cases of intracranial hemangiopericytoma diagnosed and treated in our institute, scarcely reported in world literature until date. These are highly aggressive and uncommon tumors accounting for <1% of all intracranial neoplasms, arising from Zimmerman's pericytes around capillaries and postcapillary venules. First two patients presented in 2011 and 2012 and were diagnosed as hemangiopericytoma Grade II with vimentin and CD34 positivity on immunohistochemistry. In 2014, a third patient was diagnosed as an anaplastic Grade III tumor, positive for vimentin and negative for epithelial membrane antigen. All three patients were treated with adjuvant radiotherapy to the brain and were kept on follow-up. However, the first patient recurred after 5 years for which he underwent redo-surgery. Other two patients are on follow-up with no evidence of recurrence or distant metastasis.

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Background: Hairy cell leukemia (HCL) is an indolent neoplasm of small mature B lymphoid cells. It is characterized by pancytopenia, splenomegaly, bone marrow fibrosis, and presence of atypical lymphoid cells with hairy projections in peripheral blood, bone marrow and spleen. HCL is potentially curable and treatment with purine analog cladribine induces complete remission (CR). Materials and Methods: This is a retrospective analysis of 10 HCL cases diagnosed in the Department of Medical Oncology at a Tertiary Regional Cancer Institute, South India, over 7 years. The clinical features, laboratory parameters, bone marrow findings, cytochemistry, immunophenotyping, and outcome with treatment were studied. Results: Among 8 cases of HCL who were treated with cladribine, 7 achieved remission and 1 succumbed to infection during course of treatment. Median overall survival in these 7 cases was 61 months. Conclusion: HCL is a chronic lymphoproliferative neoplasm with potentially curative treatment. Cladribine is treatment of choice and majority of patients achieve long-lasting CR. Upon relapse, these patients can be successfully salvaged with cladribine retreatment.

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Background: Carcinoma of uterine cervix is the commonest cancer affecting females in developing countries. Concurrent chemoradiation has remained the sole definitive treatment available in the advanced stages. The study was planned to take the advantage of radiosensitisation accruing due to chemotherapy at the time of brachytherapy, when approximately 40% of total tumor dose is applied. Subjects and Methods: Sixty-four patients were enrolled who had locally advanced uterine cervix carcinoma (Federation of Gynecology and Obstetrics Stage IIB–IVA) from July 2011 to May 2013 for concurrent chemotherapy and intracavitory brachytherapy after completion of concurrent chemotherapy and external beam radiotherapy followed by three insertion of brachytherapy separated by a week by flexitron brachytherapy unit to Point A, for each application was 6 Gy by high dose rate. Cisplatin was given (35 mg/m²) 1 day before brachytherapy in each application. Results: At medium follow-up of 19 months (range 8–30 months) clinical complete response rate was found to be 89% at 3 months of follow-up. Acute side effect as nausea and vomiting Grades I and II were recorded as 55% and 28% respectively, no renal dysfunction and no thrombocytopenia were encountered. No patients had Grade IV or life threatening toxicity. Overall survival and disease free survival after 30 months of follow-up is 88% and 75% respectively. Conclusion: Use of concurrent chemotherapy with brachytherapy is effective and feasible with acceptable toxicity for locally advanced carcinoma of the uterine cervix.

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Xanthogranulomatous osteomyelitis (XO) is a very rare chronic granulomatous inflammation. It can mimic malignant bone tumors on its clinical presentation, gross features, and radiological imaging. However, histopathological examination can differentiate it from malignancy. We describe the case of a 20-year-old male presented with fever and pain in the right knee joint for 4 months. Plain radiography and magnetic resonance imaging of the right knee joint revealed osteolytic lesion in the lower metaphyseal region of femur. With this clinical presentation and radiological imaging, a diagnosis of primary bone tumor was made. However, XO was confirmed by histopathological examination. This case highlights the rare occurrence and also it can mimic as bone tumor.

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Background: Several trials using sequential and concurrent chemoradiation have established the role of concurrent chemoradiation in treatment of locally advanced esophageal carcinoma with encouraging but unsatisfactory results. We investigated the efficacy and toxicity of gemcitabine concurrent with radiotherapy against cisplatin concurrent with radiotherapy in locally advanced unresectable squamous cell carcinoma of the esophagus. Materials and Methods: Eighty patients were randomly allocated to two arms during the study. Arm 1 received cisplatin 40 mg/m² weekly concurrent with external beam radiotherapy to a total dose of 65 Gy while Arm 2 received gemcitabine 200 mg/m² weekly concurrent with external beam radiotherapy up to a total dose of 65 Gy. Results: Median follow-up was 11 months and 14.5 months in Arm 1 and Arm 2, respectively. Complete response was achieved in 20% of patients in Arm 1 and 32.5% of patients in Arm 2, with manageable acute toxicities in both arms. The progression-free survival in Arm 1 was 5.7 ± 4.7 months and 12.4 ± 6.8 months in Arm 2. The 2-year overall survival was longer in Arm 2. Conclusion: This study demonstrated that both cisplatin and gemcitabine concurrent with radiotherapy in locally advanced squamous cell carcinoma of the esophagus is safe and feasible with better response and progression-free survival with gemcitabine.

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Carcinoma cervix is the most common malignancy in Indian women. Squamous cell carcinoma (SCC) of cervix with metastasis to duodenum is a rare occurrence. Until now, we could find only six cases in the literature. We found such rare case and hence report here a case of a 67-year-old female patient with carcinoma cervix with duodenal metastasis diagnosed after 4 years of cervical carcinoma. On gastroduodenoscopy thickened mucosal folds were seen in the second and third part of the duodenum. Histopathology confirmed it as metastatic SCC. She was started on palliative chemotherapy but succumbed to the disease. This case is being reported due to its rare occurrence.

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Malignant fibrous histiocytoma (MFH) is an extremely rare tumor of the breast that arises from the connective tissue of glands. Its complex and various histological patterns, adds difficulty to the diagnosis. We report a case of MFH of left breast in a 70-year-old male who presented with gradually increasing painless mass over a period of 1–2 years. Fine-needle aspiration cytology revealed malignant spindle cell lesion and wide local excision was performed without axillary lymph node dissection. Histopathological examination along with immunohistochemistry confirmed the diagnosis of MFH of left breast. To the best of our knowledge, this is the 6^th case of MFH of left breast in an elderly male reported in the literature.

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Chronic myeloid leukemia is a clonal bone marrow stem cell disorder characterized by the presence of Philadelphia chromosome t(9;22)(q34;q11) leading to fusion oncogene BCR-ABL. Tyrosine kinase inhibitors (TKIs) act by competitively inhibiting BCR-ABL oncoprotein with significant response rates. However, up to 30% of patients fail to achieve complete cytogenetic remission on 1^st line TKI imatinib, one of the reasons being mutations in BCR-ABL kinase domain leading to imatinib resistance. Over 80 such mutations have been documented in the literature; however, some of the rare mutations still remain to be studied for their impact in development of resistance and their responsiveness to currently available therapeutic options. Here, we report one such case of a rare mutation leucine replaced by methionine at 273 position and its clinical implications.

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Background: Pediatric ovarian tumors are rare with an approximate incidence of 2.6 per 100,000 girls per year. Aims and Objectives: This study was done to delineate the clinicopathological profile of pediatric ovarian masses encountered in a tertiary care hospital over 5 years. Materials and Methods: A retrospective study was conducted for a period of 5 years during which all patients whose age did not exceed 20 years and underwent surgical resection of ovarian masses, were included. History, operative notes, gross findings, and microscopic features of each case were noted. Results: A total of 76 cases were included in the study. The age of patients ranged between 2 and 20 years with a mean of 17 ± 2.5 years. Of the 76 cases, 53 (69.7%) were benign and 23 (30.3%) malignant tumors. The benign tumors included 16 cases each of teratoma (21.1%) and serous cystadenoma (21.1%), and 21 cases of mucinous cystadenoma (27.6%). Germ cell tumors were the commonest malignant tumors in patients up to 15 years of age and they included four cases of dysgerminoma (5.3%) and one case of immature teratoma (1.3%). Between 16 and 20 years, 8 cases of serous cystadenocarcinoma were found (10.5%), in addition to seven malignant germ cell tumors (9.2%). One case (1.3%) each of granulosa cell tumor and sertoli leydig cell tumor was also found in the same age group. Conclusion: Pediatric ovarian tumors require early attention and institution of appropriate treatment since they bear important implications on the future lives of young females.

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Gemcitabine is a cytotoxic drug with superior toxicity profile and widely used in the management of various solid malignancies. The common side effects associated with gemcitabine are myelosuppression, diarrhea, and flu-like symptoms. Cardiac side effects due to gemcitabine are very rare. We present a case of an elderly female aged 69 years, diagnosed to have metastatic carcinoma gallbladder, and without any cardiac risk factors, who developed supraventricular tachycardia 3 days after gemcitabine infusion. We emphasize the need for careful and routine cardiac monitoring in an elderly patient who develops symptoms of tachyarrhythmia when on gemcitabine therapy.

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Lymphatic filariasis is endemic in 250 districts in 20 states and union territories of India. Microfilariae have been reported in body cavity fluids and cytological evaluation of various lesions including benign as well as malignant neoplasms. Here, we present a rare case of incidentally found microfilariae in a cytological smear from gallbladder adenocarcinoma. Along with supporting the cytology as an important tool in detection of asymptomatic filariasis, we wish to draw the attention toward a more dedicated approach to eliminate this disease entity and toward unnoticed comorbidities in carcinoma patients.

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Background: Cisplatin (CDDP)-based concurrent chemoradiotherapy (CRT) is the standard of care in locally advanced head and neck cancers (HNCs). CDDP, a known nephrotoxic drug, has been administered in three different protocols. Baseline renal function needs to be known before CRT. Renal function can be measured directly by measuring the measured glomerular filtration rate (mGFR) using radioisotope and indirectly by either serum creatinine (SCR) levels or estimated GFR (eGFR) using mathematical formulae “abbreviated modification of diet in renal disease (aMDRD)” and “Cockcroft–Gault (CG).” The present study was performed to see the prevalence of pretreatment renal insufficiency (RI) in HNC patients and to find a realistic method using CG and aMDRD formulae for assessing RI instead of doing mGFR and to compare the nephrotoxicity in three CDDP protocols. Materials and Methods: The study was carried out between January 2005 and December 2006. Consecutive patients of HNC undergoing RT/CRT were included. Renal function using parameters SCR, mGFR, and eGFR using CG and aMDRD formulae was estimated for pre- and post-treatment and during follow-up. Results: Of 295 eligible patients, baseline prevalence of RI was in 17% by mGFR, 6% by SCR, 13% by aMDRD, and 41% patients by CG formula. aMDRD correlated better than CG with the mGFR. Of the 145 patients of CRT, pretreatment RI was seen in 9% by aMDRD and 30% by CG formula as compared to 12% by mGFR and post treatment RI was seen in 12% by aMDRD and 43% by CG formula. All the three CDDP protocols showed similar fall in GFR post treatment, and late renal injury at 6 months was seen in 2%, 4%, and 3%, respectively. Conclusions: RI exists in HNC patient. RI assessment by SCR is inadequate and should be done by eGFR estimation using aMDRD or CG formula if not able to do mGFR. Different CDDP protocols have similar nephrotoxicity.

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Inflammatory myofibroblastic tumor (IMT) of the liver is a rare disease, often confused with hepatic neoplasm. A 60-year-old man underwent liver resection for suspected hepatocellular carcinoma with concurrent appendicectomy for incidentally detected diseased appendix. Histopathology revealed IMT involving both the liver and appendix. We present the diagnostic challenge and approach in a patient with IMT of the liver with the synchronous incidental involvement of appendix treated successfully by liver resection and appendicectomy.

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