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   2020| May-June  | Volume 9 | Issue 3  
    Online since June 16, 2020

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Cystic renal cell carcinoma: Our series
RB Nerli, Shridhar C Ghagane, Sushant Deole, Sreeharsha Nutalapati, Priyeshkumar Patel, Neeraj S Dixit, Murigendra B Hiremath
May-June 2020, 9(3):79-83
Introduction: Complex renal cystic lesions have long posed a clinical dilemma to clinicians as they represent a heterogeneous group of both benign and malignant conditions sharing similar clinical and radiological features. The Bosniak classification system based on computed tomography (CT) imaging remains the gold standard to predict the risk of malignancy in cystic renal masses. We retrospectively reviewed our series of patients who underwent surgery for renal cysts, their histopathological diagnosis, the outcome of surgery, and follow-up. Materials and Methods: We retrospectively reviewed the inpatient charts of the hospital for patients with renal cysts undergoing surgery for the same during the period January 2000-December 2017. CT images of these patients were re-reviewed. Clinical, surgical, radiological, pathological, and postoperative outcomes were analyzed. Based on the final pathology findings, the patients were stratified into a renal cell carcinoma (RCC) or a benign tumor subgroup. Results: During the 18-year study period, 31 patients with Bosniak I simple renal cysts, 23 with Bosniak 2 cysts, 1 patient with Bosniak IIF cyst, 8 with III cyst, and 11 with IV cyst underwent surgery. None of the patients with Bosniak I, II, and IIF had malignancy on histopathological examination (HPR) of the resected cyst wall. Five of the eight patients with Bosniak III and all 11 patients with Bosniak IV cysts had malignant lesions. Histopathological variety of RCC was clear cell type with Fuhrman Grade 1–2 in all the 16 patients. None of the patients have had either local or systematic recurrence of the malignancy. Five patients died during the follow-up period due to causes other than malignancy. Conclusions: Patients with unifocal cystic RCC evaluated and managed using standard imaging carry an excellent prognosis. Bosniak classification system is very effective in predicting malignancy in categories II, IIF, and IV, but low in category III, and that 37.5% of Bosniak III cysts were benign on HPR.
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The expression of cyclooxygenase-2 in carcinoma of uterine cervix
Priya Jain, Sunita Singh, Mayank Jain, Megha Ralli, Rajiv Sen
May-June 2020, 9(3):69-74
Background: Cancer of the cervix is the second leading cause of cancer deaths in women worldwide and remains a leading cause of mortality among women of reproductive age in developing countries. In India, 27% deaths is attributed to cervical cancer among females between 15 and 44 years of age. Studying the expression of COX-2 in cancer tissues and its role in the growth of malignant tumours is important because NSAIDs might help to prevent cancer. Furthermore, selective COX-2 inhibitors are available that block the effects of COX-2 expression but spare the expression of COX-1. Aim and Objectives: The aim of our study is to classify carcinoma of uterine cervix using WHO criteria and to determine the differential expression pattern of cyclooxygenase-2 (COX-2) in carcinoma cervix and to compare this expression with clinicopathological parameters. Materials and Methods: A total of hundred (100) cases of cervical carcinoma were included in the study material submitted as cervical biopsies or hysterectomy specimens in the Department of Pathology, The tissue block was sectioned at 4-5 μm and the sections were stained for Haematoxylin and Eosin stains (H and E). The tumours were classified and graded using the WHO criteria. Immunohistochemistry was performed on the representative sections with COX-2 antibodies using standard protocols. Cases of colon cancer were taken as positive control and negative control were obtained by omitting the primary antibody in the staining protocol. Positive cases showed cytoplasmic positivity. The raw data was converted to immunohistochemical score (IHC Score) by multiplying the quantity and staining intensity scores. The scores theoretically ranged from 0-12. Score of 0-3 was considered Negative, 4-8- Moderate and 9-12 as Strong. Using the Chi-square test the distribution of COX-2 positive cases was analysed according to clinicopathological features. P-value < 0.05 was regarded as statistically significant. Results: In our study there was a significant correlation observed between expression of COX-2 and inflammation. No significant correlation was found between other parameters. Conclusion: The data suggests that COX-2 induction may play a role in high cervical inflammation and carcinogenesis. The patients with a high COX-2 expression could possibly be benefitted with more individualized treatments such as COX-2 inhibitors
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Metronomic chemotherapy for head-and-neck cancers in coronavirus disease 2019 pandemic
Navin Kumar, Kanak Lata, Deepika Mishra, Sunil Kumar, S V. S Deo
May-June 2020, 9(3):96-97
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Is combination chemotherapy of cisplatin and gemcitabine in the first-line treatment of advanced gallbladder cancer the right choice? A study in indian patients from the gangetic belt
Rahul Sud, Kishore Kumar, Pradeep Jaiswal
May-June 2020, 9(3):63-68
Background: Owing to presentation at advanced stage, most of the time, gallbladder carcinoma is nonresectable. Nonsurgical palliative procedures such as stenting help in a limited number of patients. Although anecdotal Western data are present, combination chemotherapy data from Indian scenario are scanty. The present study was carried out with an aim to evaluate the response to first-line chemotherapy with cisplatin and gemcitabine in Indian patients with advanced gallbladder carcinoma. This observational study was conducted in the Departments of Oncology at the Army Command Hospital (Central Command), Lucknow, between April 2013 and May 2016. All patients presenting to this center with histologically proven advanced carcinoma of gallbladder were screened for eligibility for inclusion in the study. Patients and Methods: No prior approach for sample size calculation was followed owing to rarity of disease. Hence, all the patients falling in the sampling frame were included in the study. Power analysis was done post hoc. A total of 60 patients falling in sampling frame and completing 6 months of treatment protocol were enrolled in the study. Statistical Analysis Used: Chi-square test and independent samples t-test were used to compare and evaluate the data. P < 0.05 indicated a statistically significant association. Results: At 3 months, majority of the patients (28; 46.7%) had a progressive disease, and at 6 months, the number of patients having progressive disease increased to 36 (60%). Six-month mortality did not show a significant association with age, gender, stage, or mean duration of complaints. However, a significant association with a mean number of drug cycles and mean compliance rate was observed. Conclusions: Combination gemcitabine and cisplatin which is the standard first-line therapy in advanced gallbladder carcinoma patients showed limited response in the Indian patients, leading to invariable disease progression by 6 months.
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Investigation of prostate cancer associated with prevalence
Farhad Tadayon, Zahra Tolou-Ghamari, Sajad Norouzi
May-June 2020, 9(3):75-78
Context: Prostate cancer (PCa) incidence rates (IRs) are highly variable worldwide. Aims: The aim was to evaluate the period prevalence (PP) and IRs of PCa in Isfahan/Iran. Materials and Methods: Data from March 24, 2011, to March 19, 2015, were obtained from the Isfahan Cancer Registry. PCa was distinguished by the related established topography code (C61). IRs and PP were calculated and expressed per 100 000 males. Statistical Analysis Used: The statistical analyses of dBase were performed using Microsoft Excel and SPSS version 20 (IBM Corp., Chicago, IL, USA) for windows. Results: Over a period of study, there were 1648 males that were identified with PCa. For the total population, the PP was calculated as 65.2/100,000 males. Histologically, of the total population studied, 99% reported adenocarcinoma that majority of them had mild or moderate gleason score. According to available information monographic code M with no definition regarding to subtype showed code 81140 as generally named adenoma (n = 1156), code 8000 generally named neoplasm (n = 468), transitional cell papilloma (n = 9), and acinar cell adenoma (n = 5). IRs were calculated for each year, that is, 2011–2012, 2012–2013, 2013–2014, and 2014–2015, as 14.5, 17.4, 15.5, and 17.8 (per 100,000 males), respectively. The mean (standard deviation, min-max) age of the patients was 72.0 (10.6, 16–110) years. In relation to the age of the study population, PCa occurred in 84% of patients aged >60 years. Conclusions: The number of deaths versus alive in patients with PCa was 583 versus 1065, respectively. Further studies toward pharmacotherapy management and genetic and environmental factors in PCa carcinogenesis recommended to be clarified in Iran.
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Working together to reduce the incidence of cancers in low- and middle-income nations: World Health Organization
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
May-June 2020, 9(3):61-62
Cancer has been regarded as one of the major global public health concerns owing to the morbidity and mortality attributed to them. In-fact, the World Health Organization has forecasted that in the absence of implementation of targeted strategies on a war-foot basis, we are on the track to see a rise in the number of global cancer cases by 60% in the coming two decades, of which 80% will be in low- and middle-income nations. Considering all these estimates, it is high time that the nations act in a targeted manner and start at least with the strengthening of the prevention activities and expedition of research activities. In conclusion, the battle against the prevention and control of cancer needs to be fast-tracked in low- and middle-income nations and we have to work together as a team if we really want to improve the quality of life of the affected people and reduce the incidence of the cancers.
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Breaking the survival barriers: A case of stage IV carcinoma ovary with brain metastasis
Shabnum Thakur, Lalit Chandrakant, Vikas Fotedar, Manish Gupta
May-June 2020, 9(3):92-95
The case report ascribed a patient of Stage IV carcinoma ovary papillary serous cell carcinoma, who has survived this disease for past 8 years. The patient was treated with neoadjuvant chemotherapy and cytoreductive surgery followed by adjuvant chemotherapy. The patient remained disease free for 1 year thereafter, developed biochemical relapse.. However, for past 8 years, the patient never achieved a complete remission and despite developing progressive disease, responded substantially to the treatment given and is leading her normal life with minimal imperilment. The patient's long-term survival may be attributed to the favorable responses to the treatment received. The management of ovarian cancer is most impressive when tailored to the individual needs of the patient, maximizing its virtue and prolonging the patient's survival rate. The present case may permit pragmatic acumen into the clinical management of Stage IV ovarian cancer.
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Coexistence of ten-eleven translocation 2 and calreticulin mutations in myeloproliferative neoplasms: Possible prognostic value
Soheila Bagherpour, Tina Vosoughi, Maryam Tahmasebi Birgani, Ali Ehsanpour, Najmaldin Saki
May-June 2020, 9(3):84-88
Background: Mutations in the genes regulating epigenetic factors such as Ten-Eleven Translocation 2 (TET2) along with other mutations are highly effective in the patient's prognosis. The aim of this study was to evaluate the prevalence of TET2 and calreticulin (CALR) mutations among myeloproliferative neoplasms (MPNs) patients to determine if there is a prognostic value for these mutations coexistence. Materials and Methods: Blood sample was collected from patients. For the evaluation of mutations, polymerase chain reaction (PCR) was performed on the patient's DNA and PCR products were subsequently sequenced. Results: No significant correlation between coexistence of TET2 and CALR mutations with complete blood count parameters in patients was seen. However, platelet count was lower in patients with TET2 and CALR mutations compared with patients with CALR mutations only. Conclusion: The coexistence of CALR and TET2 mutations in MPN patients can be used as a prognostic factor.
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Solid pseudopapillary tumor of the pancreas
Vivek Agrawal, Ashesh Kumar Jha
May-June 2020, 9(3):89-91
Solid pseudopapillary neoplasia of the pancreas is a rare tumor. It accounts for <1%–2% of exocrine pancreatic tumors. This relatively indolent tumor has the propensity to affect young women. We herein report a case of solid pseudopapillary tumor of the pancreas in a 24-year-old woman; for which curative distal pancreatectomy with splenectomy was performed. Postoperative period was uneventful, and during a follow-up of 2 years, she remains asymptomatic.
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