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   Table of Contents - Current issue
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July-August 2020
Volume 41 | Issue 4
Page Nos. 441-628

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COVID-19: EDITORIAL COMMENTARIES  

COVID-19 management: What we need to know? Highly accessed article p. 441
Manikandan Dhanushkodi, Padmaj Kulkarni
DOI:10.4103/ijmpo.ijmpo_192_20  
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Midst of COVID-19 crisis – Lookout for one another to practice humanity! p. 446
Reetu Jain, Rima Pathak, Padmaj Kulkarni, Prashant Mehta, Tilak TVSVGK, Jyoti Bajpai
DOI:10.4103/ijmpo.ijmpo_198_20  
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COVID-19: ORIGINAL ARTICLES Top

Laboratory biosafety issues related to coronavirus disease 2019 Highly accessed article p. 450
Vivek Bhat, Preeti Chavan, Sanjay Biswas, Sudeep Gupta, Navin Khattry, Prafulla Thakkar
DOI:10.4103/ijmpo.ijmpo_176_20  
Indroduction: The outbreak of Novel Coronavirus Pneumonia SARS-CoV-2 has necessitated the reinforcement of infection control measures in the hospital and laboratory setting. Contact and droplet infection control measures are advised for handling patients diagnosed with COVID-19 and airborne precautions for procedures that generate aerosols. Pre-ananalytical Phase: Risk assessment is conducted for all steps of laboratory processes viz. preanalytical, analytical and postanalytical. Standard Precautions must be followed at all times when laboratory staff handle clinical specimens that may contain infectious microorganism. Standard precautions must include hand hygiene along with the use of personal protective equipment (PPE). All samples are collected in appropriate containers and all containers are decontaminated by 62-71% ethanol (alcohol) before transporting them to the laboratory in triple packaging. Analytical Phase: All samples should undergo initial processing in a biosafety cabinet (BSC). It should be ensured while undertaking all technical procedures that there is minimal formation of aerosols and droplets. Post-analytical Phase: All biomedical waste should be disposed as per state and national guidelines. Decontamination includes use of 1% sodium hypochlorite, 62-71% ethanol for surface disinfection or Hydrogen peroxide (0.5%). Conclusion: These laboratory biosafety measures are important to minimise the risk of laboratory transmission of COVID-19 to health care workers.
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Braving the SARS-CoV-2 pandemic – Quandary of health-care workers p. 454
Arjun Gurmeet Singh, Pankaj Chaturvedi
DOI:10.4103/ijmpo.ijmpo_245_20  
Context: Determining how bad health-care providers have been affected by the severe acute respiratory syndrome coronavirus 19 (SARS-CoV-19) pandemic is difficult because governments and organizations have not released this data. Aims: The aim of the study was to determine the number of health-care workers infected and dead globally due to SARS-CoV-2 infection. Subjects and Methods: To circumvent these issues, an unconventional approach using Google's programming platform was adopted to aggregate relevant articles reporting the number of confirmed cases and deaths among health-care workers. Locally sourced country-specific data were ensured by individually searching the regional domains of 179 countries. Results: Reports covering 67 countries showed that 99,847 health-care workers (HCWs) have been reported to be infected with SARS-CoV-2 virus, with a majority reported in Europe. This included confirmed reports of 1732 doctors and 348 nurses. Five hundred and thirty-eight deaths were reported in 32 countries, amounting to a mortality among HCWs globally of 4%. Conclusions: Although this number might be an underrepresentation of the actual figures out there, it underscores the dire reality of the situation. The information provided is paramount for policymakers to improve services among this vulnerable group.
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COVID-19: REVEIW ARTICLES Top

Mask etiquette amidst COVID-19 crisis and personal protection equipment shortage p. 458
Gaurav Salunke, SK Biswas, Vivek Bhat
DOI:10.4103/ijmpo.ijmpo_165_20  
The COVID-19 virus is transmitted through close contact between people, via droplets and possibly via airborne transmission. Wearing a mask is one of the recommended preventive measures that can reduce the transmission of COVID-19. But due to panic buying and increased demands, the health institutes are facing severe shortages of these PPEs. This article reviews the types of masks available, the feasibility of reusing them and the dos and don'ts of each suggested method.
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A critical review of outcomes of cancer during the COVID-19 pandemic p. 461
Florida Sharin, Arjun G Singh, Burhanuddin Qayyumi, Pankaj Chaturvedi
DOI:10.4103/ijmpo.ijmpo_187_20  
The recent outbreak of COVID-19 has created an alarming fear, apprehension, and worry world over. Cancer patients represent a subgroup that is vulnerable and is under high risk. It is, therefore, necessary to analyze factors that predict outcomes in these patients so that they can be triaged accordingly in order to mitigate the effects of COVID-19 on cancer management. To determine the factors affecting cancer patients in COVID-19. A systematic search was performed to identify all relevant studies on PubMed, Embase, and Google Scholar published until April 5, 2020. Relevant articles that reported the incidence, demographic and clinical characteristics, treatment, and outcomes of cancer patients infected by COVID-19 were included in the analysis. Among 559 articles that were further screened, 14 articles fulfilled the inclusion criteria. The incidence of cancer across various studies ranged from 0.5% to 2.43%. Males were more than females, and the mean age affected was 63.1–66 years. Lung cancer was the most common subtype (25%–58.3%). Cancer patients, as reported, had a higher risk of progressing to severe events (hazard ratio:3.56, 95% confidence interval: 1.65–7.69; P < 0.0001). Nearly 39%–53.6% of patients who had a recent history of anticancer therapy developed severe events. Individuals with cancer feared the risk of complications. Cancer patients have worse outcomes from COVID-19, compared to the general population, providing a reason to pay more timely attention. High-risk patients should have vigorous screening and intensive surveillance. Anticancer treatment during COVID-19 should be modified based on the type and prognosis of cancer.
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COVID-19: LETTER TO EDITOR Top

Containing coronavirus (COVID-19) spread in an oncology day care facility in India p. 468
Santosh Kumar Chellapuram, Prabhat S Malik, Lalit Kumar
DOI:10.4103/ijmpo.ijmpo_270_20  
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EDITORIAL COMMENTARIES Top

Alcohol and cancer: Waiting for the storm to pass or dancing in the rains! p. 473
Richa Vaish, Jyoti Bajpai
DOI:10.4103/ijmpo.ijmpo_91_20  
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Advanced thyroid cancer controversy and consensus p. 476
Karthik N Rao, Anuja D Deshmukh, Prathamesh S Pai, Gouri H Pantvaidya
DOI:10.4103/ijmpo.ijmpo_145_20  
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High-grade, low prostate-specific antigen prostate cancer: Unique hormone-resistant entity with poor survival p. 481
Vikash Kumar
DOI:10.4103/ijmpo.ijmpo_55_20  
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Interventional radiological management of hepatocellular carcinoma p. 484
Abhishek Bansal, Arvind K Chaturvedi
DOI:10.4103/ijmpo.ijmpo_256_19  
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Stereotactic body radiation therapy in hepatocellular carcinoma p. 488
Gagan Saini
DOI:10.4103/ijmpo.ijmpo_67_20  
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REVIEW ARTICLES Top

Hodgkin lymphoma in children and adolescents: Advances in pathology, diagnosis, and treatment strategies p. 492
Adil Abdelhameed Abbas, Hatim Qasim Almaghraby
DOI:10.4103/ijmpo.ijmpo_135_20  
Strategies used for the treatment of children with Hodgkin lymphoma (HL) over the last four decades have resulted in excellent long-term survivals. However, the short- and long-term treatment-associated morbidities were high. In an attempt to reduce complications, the current treatment strategies apply initial risk stratification principles based on certain host and tumor risk factors to help assign patients to the appropriate risk group and tailor therapy based on response to chemotherapy (CTR). Radiotherapy (RT) was only given to certain groups of patients who show suboptimal response to CTR. Enrollment of patients in clinical trials allowed testing newer treatment strategies, which has improved the outcome significantly. High-dose CTR with stem cell support remains the mainstay of treatment for relapsed and refractory HL. Newer targeted medications are being increasingly used for the treatment of patients with relapsed and refractory HL, but results are variable. In this review report, we give extensive account about the pathophysiology, clinical presentation, histopathological diagnosis, modern investigation techniques, the most recent risk adapted treatment strategies, and the use and effect of novel medications. In addition, we discuss in details the short- and long-term therapy-related complications and future prospects in the management of HL.
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Addictions causing head-and-neck cancers p. 510
Arjun Singh, Florida Sharin, Hitesh Singhavi, Pranav Sathe, A Gnanamoorthy, Pankaj Chaturvedi
DOI:10.4103/ijmpo.ijmpo_99_20  
Background: Head-and-neck cancers pose a serious economic burden, with most countries investing significant resources to reduce the incidence, primarily focusing on understanding addictive etiologies. The traditional literature focused on tobacco and alcohol use, with few studies on contemporary factors such as e-cigarette, waterpipe smoking, and human papillomavirus. This article attempts to collate and present an update on the globally identified etiologic factors. Aims: The aim of this study was to identify and review the addictive etiologic factors causing head-and-neck cancers. Methods: An electronic search was performed on Medline, Embase, and Google Scholar to identify the etiologies causing head-and-neck cancers and narrowed down on those driven by addiction. Further, we identified their constituents, mechanism of action, and the risks attributable to various forms of products. Results: Substances identified included smoked and chewed tobacco, alcohol, mate, marijuana, areca nut and betel quid, and viruses. An alarming majority of youth are now utilizing these substances. Furthermore, migrant movements have led to the spread of traditional practices across the regions, especially from the Asian subcontinent. Conclusion: Ironically, despite modern advances and technology, we still see that a large proportion of population succumb to these cancers, emphasizing the need for more effective and targeted policies to combat this menace at the grassroots level.
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ORIGINAL ARTICLES - HEAD AND NECK Top

R248W mutations in p53 gene are rare among Indian patients with head-and-neck cancer p. 519
Ashna Gauthaman, Anbalagan Moorthy
DOI:10.4103/ijmpo.ijmpo_248_19  
Aim: Cancer is one of the curses to humankind, decades of research in eradicating the disease from the society is proven difficult. Close interaction between clinicians and scientists helps us to translate clinical observations into molecular mechanism of the disease. The Cancer Genome Atlas data suggest that genetic alterations in p53 gene play a crucial role in head-and-neck squamous cell carcinoma (HNSCC) tumorigenesis. Understanding p53 aberrations and their impact on other cellular activities can help with the design of new, more effective therapeutic strategy that target p53 mutation-bearing HNSCC, thereby producing a personalized medicine approach for the disease. Materials and Methods: In an effort to identify the role of R248W mutation of p53 gene in HNSCC patients of Indian origin, tumor samples were collected from 55 patients (n = 55), and polymerase chain reaction–restriction fragment length polymorphism technique was used to screen for the mutation using genomic DNA isolated from the tumors. Results: The results reveal that except for one patient (heterozygous), all the patients were negative for the mutation. Conclusion: These results suggest that p53 R248W mutations are less prevalent in HNSCC Indian patients.
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ORIGINAL ARTICLES - HEMATOLOGY Top

Cerebral sinus venous thrombosis in indian pediatric patients with acute lymphoblastic leukemia: Incidence, risk factors, and outcome p. 523
Akanksha Garg, Rajesh Kashyap, Hira Lal, Prabhakar Mishra
DOI:10.4103/ijmpo.ijmpo_206_19  
Background: Cerebral sinus venous Thrombosis (CSVT) is a rare complication of acute lymphoblastic leukemia (ALL) treatment, with an incidence rate ranging from 1.1% to 2.9%. Steroids and L-asparaginase (LASP) are the major risk factors. Methods: The aim of this study was to find the incidence rate and risk factors for CSVT in our patients. Ninety-two pediatric ALL diagnosed and treated with ALL-Berlin–Frankfurt–Munster-95 protocol over a period of 5 years (2013–2017) were the subject of the study. Six (6.5%) patients developed CSVT during their therapy and were further analyzed. Results: Six (five males and one female) patients had a CSVT event. The mean age at presentation was 13.5 ± 4.1 years. CSVT event occurred during the induction/re-induction phase of chemotherapy. The superior sagittal sinus was the most frequent site of thrombosis. The timing of CSVT was related to using of LASP and steroids. High-risk disease was associated with an increased risk of thrombosis. Infection and dehydration were other important risk factors. No association was observed between the risk of CSVT and age, sex, immunophenotype, and white blood cell count. All the patients were treated with low-molecular-weight heparin and one patient developed heparin-induced thrombocytopenia. No death occurred due to CSVT. Conclusions: The Incidence of CSVT was 6.5% in our study which is significantly high but comparable with studies from other Asian countries. It is, therefore, important to be vigilant for the detection of CSVT during treatment of ALL and initiate the appropriate treatment to prevent adverse events.
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The efficacy and safety of plerixafor in hematopoietic stem cell mobilization in patients with Non-Hodgkin lymphoma, multiple myeloma, and Hodgkin lymphoma who failed mobilization with granulocyte-colony-stimulating factor alone: A single-center experience p. 530
Girish Badarkhe, Radheshyam Naik
DOI:10.4103/ijmpo.ijmpo_154_19  
Introduction: Plerixafor is a CXCR4 antagonist which is administered along with granulocyte-colony-stimulating factor (G-CSF) to mobilize hematopoietic stem cells in patients with Non-Hodgkin lymphoma (NHL) or multiple myeloma (MM), who failed the mobilization with G-CSF alone. Methodology: This was a single-center, retrospective study of the efficacy of the plerixafor and G-CSF in 32 patients with NHL (n = 11), MM (n = 11), and Hodgkin lymphoma (HL) (n = 10) who failed mobilization with G-CSF alone. Results: A median number of 1.21 × 106, 1.32 × 106, and 6.73 × 106 CD34 + cells were mobilized in patients with MM, NHL, and HL, respectively. Overall, 31 (96.8%) patients mobilized more than 2 × 106 CD34 + stem cells and 21 (33.75%) patients mobilized more than 5 × 106 CD34 + stem cells. All 32 (100%) patients underwent hematopoietic stem cell transplantation. There were no adverse drug events reported. Conclusion: This retrospective study shows that plerixafor is an effective and safe mobilization agent in patients with NHL, MM, and HL who have failed mobilization with G-CSF alone.
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ORIGINAL ARTICLES- THORACIC Top

Validation of superiority of p40 over p63 in differentiating squamous cell carcinoma and adenocarcinoma lung p. 535
Vamshi Krishna Thamtam, Shantveer G Uppin, Monalisa Hui, N Narendra Kumar, K Bhaskar, Stalin Chowdary Bala, G Sadashivudu, GK Paramjyothi
DOI:10.4103/ijmpo.ijmpo_51_19  
Context: In this era of targeted therapy, it is important to distinguish the various subtypes of nonsmall cell lung carcinoma (NSCC). Diagnosis based on morphology alone is challenging in poorly differentiated carcinomas and core biopsies. Immunohistochemistry (IHC) helps in specifying the lineage for the subtype of NSCC. Till date, p63 is the most frequently used and sensitive marker for squamous cell carcinoma (SQCC). However, it is not specific and stains a subset of adenocarcinoma (ADC). Thus, a more reliable and specific marker is required for the diagnosis of SQCC. Objective: The objective of the study was to validate the diagnostic utility of p40 over p63 in differentiating pulmonary SQCC from ADC and NSCC-not otherwise specified (NOS). Materials and Methods: A total of 123 cases of NSCC were initially reviewed and subtyped blinded to the results of IHC. This was followed by a review of IHC slides which included p63, p40, thyroid transcription factor 1, Napsin-A, cytokeratin (CK) 5/6, and CK7. Results: There were 64 ADC, 19 SQCC, and 40 NSCC-NOS. IHC helped to confirm the morphological diagnosis in 62/64 ADCs and19/19 SQCCs. IHC classified the cases of NSCC-NOS into NSCC favoring ADC – 12 cases, NSCC favoring SQCC – 10 cases, and NSCC favoring AD-SQCC – 4 cases. Both p63 and p40 showed near equal sensitivity for SQCC (100% and 97%, respectively), whereas p63 showed far lower specificity when compared to p40 (51.3% vs. 100%). Conclusion: The present study confirms and validates that p40 is equally sensitive but highly specific than p63 in detecting SQCC. Hence, we recommend the routine use of p40 instead of p63 for the definite categorization of NSCC of the lung.
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ORIGINAL ARTICLES - OTHERS Top

A multicenter retrospective study to evaluate safety and efficacy of tocopheryl polyethylene glycol succinate docetaxel in various cancers p. 543
Shirish S Alurkar, Chanchal Goswami, Kamlesh Bokil, Nirmal Vivek Raut, Govind Babu
DOI:10.4103/ijmpo.ijmpo_214_19  
Introduction: In order to overcome the polysorbate induced hypersensitivity reactions with chemotherapy drugs, novel drug-delivery mechanisms have been developed in the last decade. D-alpha-tocopheryl polyethylene glycol succinate (TPGS) is formed by esterification of alpha-tocopheryl succinate and polyethylene glycol 1000. Materials and Methods: This was a real-world retrospective analysis designed to evaluate safety and efficacy of TPGS-docetaxel in various cancers. Patients hospitalized between June 2018 and May 2019 were included in the data set. While the efficacy was assessed by the Response Evaluation Criteria in Solid Tumors criteria, safety was assessed by the National Cancer Institute Common Terminology Criteria-adverse event (AE) criteria. Results: A total of 61 patients who received at least one dose of TPGS-docetaxel were incorporated into the analysis set. The dose of TPGS docetaxel ranged from 20 mg/m2 to 120 mg/m2, commonly prescribed dose being 75 mg/m2. While 25 (40.98%) patients had a partial response, 17 (27.86%) patients had stable disease. Five (8.19%) patients progressed and 4 (6.55%) patients died during the chemotherapy, which was adjudicated to be unrelated to the drug as opined by the treating clinician. AE were reported in 42 patients in the safety data set. There were no AEs pertaining to hypersensitivity reported during the study. One AE of Grade 3 hand foot syndrome was encountered. Conclusion: The preliminary evidence suggests that the novel TPGS-based docetaxel formulation is efficacious in various cancers, and importantly, it has an enhanced safety profile, as it is devoid of polysorbate 80 induced hypersensitivity reactions.
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TRAINEE’S CORNER Top

Survival plots p. 547
Sneha Jatan Bothra, Arpan Jain
DOI:10.4103/ijmpo.ijmpo_35_20  
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Pharmacogenomics p. 550
MS Shivashankara
DOI:10.4103/ijmpo.ijmpo_61_20  
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DRUG REVIEW Top

Ivosidenib – Another feather in the hat of treatment for acute myeloid leukemia p. 552
Jayachandran Perumal Kalaiyarasi
DOI:10.4103/ijmpo.ijmpo_81_20  
The treatment of acute myeloid leukemia has undergone a paradigm shift in the past few years. Multiple new targeted and nontargeted agents have been approved in the recent past. Isocitrate dehydrogenase (IDH) mutation is one such target that has been identified, and two new drugs, ivosidenib and enasidenib have been approved. The former is an IDH1 inhibitor, and the latter is an IDH2 inhibitor. The mechanism of action, key trials, adverse events, and monitoring of ivosidenib has been discussed in this article.
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Venetoclax – The game-changer in hematology p. 555
Tanmoy Kumar Mandal, Somnath Roy, Lingaraj Nayak, BK Mishra
DOI:10.4103/ijmpo.ijmpo_260_20  
The introduction of small molecule inhibitors in many hematological malignancies made a landmark achievement in this field with a dramatic change in the survival outcome. Venetoclax is a B-cell lymphoma-2 inhibitor which has become the game-changer molecule in chronic lymphocytic leukemia and acute myeloid leukemia. This review is intended to summarize the mechanism of action, side effects, dosage, and different phases of clinical trials of this drug with review of literature.
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GRAND ROUND Top

The treatment of gastric mucosa-associated lymphoid tissue lymphoma using radiotherapy p. 559
Aswin Nagarajan, Arun Sakthivelu, Alexander John, Ramya Ravichandar
DOI:10.4103/ijmpo.ijmpo_196_20  
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ONCOLOGY BEYOND SCIENCE Top

The quandary of a healthy (child) sibling stem cell donor p. 562
Manish Raturi
DOI:10.4103/ijmpo.ijmpo_261_20  
Feelings of abandonment in a healthy (child) sibling donor (HSD) merit ethical consideration; more so, when he is needed to undergo a minimally risky, yet painful, procedure of stem cell donation (SCD) for the benefit of his ill sibling (child suffering from blood cancer). The varied feelings of the HSD undergoing SCD procedure are being presented in the form of a poem.
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“My feet remained numb… my mind was quiet… but my soul danced” p. 563
Shubhada Varadkar
DOI:10.4103/ijmpo.ijmpo_130_20  
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IMAGES IN ONCOLOGY Top

A child with unusual liver lesions in a case of neuroblastoma p. 565
Abhijeet Taori, Divya Malpani
DOI:10.4103/ijmpo.ijmpo_205_20  
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REPORT ON INTERNATIONAL PUBLICATION Top

“Choosing Wisely” for cancer care in India p. 567
CS Pramesh, Harit Chaturvedi, Vijay Anand Reddy, Tapan Saikia, Sushmita Ghoshal, Mrinalini Pandit, K Govind Babu, KV Ganpathy, Dhairyasheel Savant, Gunita Mitera, Richard Sullivan, Christopher M Booth
DOI:10.4103/ijmpo.ijmpo_304_20  
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Commentary on cefepime versus cefoperazone/sulbactam in combination with amikacin as empirical antibiotic therapy in febrile neutropenia p. 570
Smita Kayal, Ponraj Madasamy, Jogamaya Pattnaik
DOI:10.4103/ijmpo.ijmpo_237_20  
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HOW I TREAT Top

How I treat medulloblastoma in children p. 577
Amita Mahajan
DOI:10.4103/ijmpo.ijmpo_136_20  
Medulloblastoma (MB) is the most common malignant tumor of the central nervous system in children with up to a third of these tumors presenting in children under 3 years of age. Its exquisite radio and chemosensitivity renders high cure rates in children in whom optimal resection has been achieved. Optimal surgery followed by radiation alone can cure about half of these children. The addition of chemotherapy has improved the outcomes dramatically and over 70% of children over 3 years of age with optimal resection and no metastasis can expect to be cured. Increasingly, the focus is on limiting the long-term sequelae of treatment. Precise molecular characterization can enable us to identify patients who can achieve optimal outcomes even in the absence of radiation. Insights into disease biology and molecular characterization have led to dramatic changes in our understanding, risk stratification, prognostication, and treatment approach in these children. In India, there is limited access to molecular profiling, making it challenging to apply biology driven approach to treatment in each child with MB. The Indian Society of Neuro-Oncology guidelines and the SIOP PODC adapted treatment recommendations for standard-risk MB based on the current evidence and logistic realities of low-middle income countries are a useful adjunct to guide clinical practice on a day-to-day basis in our setting.
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COURTING CONTROVERSY Top

Immunotherapy in nonsmall cell lung cancer (basket of choices) p. 587
Abhishek Raj
DOI:10.4103/ijmpo.ijmpo_101_20  
The advent of immunotherapy has changed the landscape of lung cancer management over the past few years. Once a uniformly fatal disease with limited therapeutic options, the physicians now have a myriad of options to choose from while offering therapy to a patient of metastatic nonsmall cell lung cancer.
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CASE REPORTS AND REVIEW OF LITERATURE Top

Primary hepatoid adenocarcinoma of the lung: A study of two cases with review of literature p. 591
Ashwini Nargund, Mohit Agrawal, Priya Dharmalingam, Usha Amirtham, Malathi MukundaPai
DOI:10.4103/ijmpo.ijmpo_245_19  
Primary hepatoid adenocarcinoma (HAC) is a rare extrahepatic adenocarcinoma with morphological and phenotypical resemblance to hepatocellular carcinoma (HCC). It can occur in lung, stomach, gallbladder, pancreas, ovary, and uterus, with most common site being stomach. Morphological features of primary HAC of the lung are similar to HCC, so exclusion of metastatic HCC is necessary. In this report, we describe two cases of elderly men with primary pulmonary HAC who presented in advanced clinical stage and diagnosed by fine-needle aspiration cytology with immunohistochemistry. Both patients succumbed to death despite starting first cycle of chemotherapy.
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CASE REPORT Top

Waldenström macroglobulinemia: A clinicopathological profile and review of six cases p. 596
Priyanka Samal, Prantar Chakrabarti
DOI:10.4103/ijmpo.ijmpo_234_19  
Waldenström macroglobulinemia (WM) is an indolent B-cell neoplasm in which lymphoplasmacytic cells are accumulated in the bone marrow. This rare disease is incurable with the available treatments and its management is generally based on risk-adapted methods. We present here six cases of WM with their clinicopathological profile and response to therapy. This is a retrospective observational study conducted in a tertiary referral center in Eastern India from October 2014 to December 2016. The clinical manifestations, diagnostic challenges, and response to therapy for WM were analyzed. A total of six cases of WM were analyzed, of which five were male; the mean age was 65 years. The most common presentation was transfusion-dependent anemia, followed by hyperviscosity. All the patients had bone marrow infiltration by lymphoplasmacytoid cells, and serum protein electrophoresis and immunofixation showed immunoglobulin M kappa monoclonal protein. Bortezomib, dexamethasone, and rituximab (BDR) was the most commonly used regimen. Complete and very good partial responses were seen in one patient (16.7%) each and partial response in 3 (50%) patients. There was disease progression to diffuse large B-cell lymphoma in one patient (16.7%). After a 26-month follow-up, four of six patients (66.67%) remained free of disease progression. A very low incidence of WM was reported, and patients had a varied clinicopathological spectrum. A combination of BDR is a promising frontline therapy in the patients of WM.
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PRACTITIONER SECTION Top

Adult jejuno-jejunal intussusceptions due to gastrointestinal stromal tumor p. 602
Jayabal Pandiaraja
DOI:10.4103/ijmpo.ijmpo_203_18  
Intussusception is telescoping of proximal segment of the intestine within the lumen of adjacent segment of intestine. In children, most of the intussusception is idiopathic, whereas in adults, it is always associated with pathological lead point. In adults, jejuno-jejunal intussusception is very rare compared to children. Preoperative diagnosis is difficult in most of the cases, so adequate negative margin is mandatory when a gastrointestinal stromal tumor (GIST) is suspected as the cause of jejuno-jejunal intussusception. This case is reported because jejunal intussusception is one of the rare presentations of GIST.
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Primary pulmonary liposarcoma with pancreatic metastasis: A rarest of rare intrathoracic malignancy p. 605
Anirban Halder, Rituparna Biswas, Sujit Shukla, Nisha Rana, Vikas Yadav, Jaspreet Kaur
DOI:10.4103/ijmpo.ijmpo_114_19  
Liposarcoma of the lung is an extremely rare malignancy with <20 cases reported so far. With such limited evidence, natural history and appropriate management of this unusual tumor is unclear. We experienced a case of primary pulmonary myxoid liposarcoma in a 34-year-old male who presented with multiple distant site metastases including pancreas, which is again an extremely rare finding accounting for approximately 2% of pancreatic malignancies. Indexed case was treated with systemic chemotherapy.
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Takatsuki syndrome – Not really a polyneuropathy, organomegaly, endocrinopathy, M-spike, and skin change!!! p. 608
Vashe Keshava Vineeth, Vijith Shetty
DOI:10.4103/ijmpo.ijmpo_137_19  
Polyneuropathy, organomegaly, endocrinopathy, M-spike, and skin changes (POEMS) is a rare multisystem disorder, with its prevalence in India being 1 in 330,000. It is a demyelinating neuropathy accompanied by dermatoendocrine syndrome. The cause of POEMS is unknown. The diagnosis of POEMS syndrome requires two mandatory criteria plus more than one major and more than one minor criterion. A middle-aged male with no known comorbidities from South India presented with complaints of burning micturition, increased frequency of micturition, and pain in the abdomen for 3 weeks. The patient was evaluated earlier at another center with a rise in serum creatinine from 1.9 to 2.9 mg/dl within a span of 3 days. The patient had pleural effusion, hypercalcemia, renal failure, and splenomegaly with lytic lesions. Due to the presence of typical skin lesions with polyneuropathy, workup for POEMS was carried out. Positron-emission tomography scan and vascular endothelial growth factor levels were checked and fulfilled the criteria. Early treatment was initiated, and POEMS has a good prognosis. As POEMS is very rare, early diagnosis improves the outcome.
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An unusual case of acute myeloid leukemia with t(8:21) presenting with hypereosinophilia showing dysplastic features p. 612
Pragya Singh, Meetu Aggrawal, Leelawathi Dawson, Amitabh Singh
DOI:10.4103/ijmpo.ijmpo_197_19  
Acute myeloid leukemia (AML) with specific genetic abnormalities is a clinically, biologically, and prognostically distinct category with some of the entities in it displaying characteristic morphology. AML with t(8:21) is one such subtype carrying favorable prognosis with specific blast morphology. Eosinophilia, characteristically, has been described till date in AML with inv (16); however, hypereosinophilia with prominent dysplastic features has yet not been seen with any AML subtype. We report the case of an 8-year-old child presenting with massive splenomegaly, hypereosinophilia, and low marrow blast percentage. The initial clinical and hematological impression was that of a chronic myeloproliferative neoplasm, which was later diagnosed as AML with t(8:21) with the help of cytogenetic studies. The case report highlights the unusual and extremely rare presentation of this AML subtype and the importance of cytogenetic studies in definite categorization, especially in cases with overlapping morphological and immunophenotypic findings.
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A large cervical immature cystic teratoma in a new-born-simulating lymphatic malformation p. 615
Prashant Jain, Ashish Prasad, Aparna Prasad, Sarika Jain
DOI:10.4103/ijmpo.ijmpo_120_20  
Cervical teratomas are rare and challenging tumors. Although most are benign in nature, there location near vital neck structures can cause significant morbidity. Sometimes, making a diagnosis can be a challenge, especially when it is purely cystic and closely resembles lymphatic malformation.
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Management of synchronous locally advanced carcinoma tongue and early-stage carcinoma esophagus in a tertiary cancer center: A rare case report p. 618
Aswin Nagarajan, Arun Sakthivelu, Selvaluxmy Ganesharajah
DOI:10.4103/ijmpo.ijmpo_38_20  
Synchronous malignancy of tongue and esophagus is difficult to diagnose and treat since both the malignancies are aggressive and have poor survival. We report an unusual case study of locally advanced carcinoma tongue (Stage IVA) with early-stage carcinoma esophagus (Stage II) in a 43-year-old male for whom both the malignancies were treated with concurrent chemoradiation in a sequential manner and the patient had a complete response of both malignancies without much treatment-related morbidity and the patient is coming for follow-up with the disease-free survival of 6 months.
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Drawback of chimerism analysis by XY-fluorescence in situ hybridization: Deception of a relapse p. 621
D VS Kiran Kumar, Jayachandran Perumal Kalaiyarasi
DOI:10.4103/ijmpo.ijmpo_60_20  
Chimerism is monitored by various methods in posttransplant patients. Interphase fluorescence in situ hybridization (FISH) for XY (sex) chromosomes is one of the methods commonly employed. It is a sensitive method in terms of the number of cells analyzed. Chimerism testing is done to detect graft rejection/failure which eventually may be a sign of relapse of the malignancy. The relapse of the disease initially happens in the marrow and then spreads to the peripheral blood. Hence, performing chimerism by XY-FISH in the peripheral blood may miss an early relapse. Here, we present one such case where there was 98% donor chimerism with the evidence of relapse in the bone marrow with all recipient metaphases in the bone marrow by conventional cytogenetics.
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LETTERS TO EDITOR Top

Concurrent hairy cell leukemia and chronic lymphocytic leukemia: Diagnostic and therapeutic implications p. 624
Parameswaran Anoop, Channappa N Patil, Venkatachalam Sandhya, Sonal Dhande, Kalpana Janardan, Shivali Ahlawat
DOI:10.4103/ijmpo.ijmpo_136_19  
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Drop metastasis in glioblastoma multiforme p. 625
Mintu Mathew, TM Anoop, P Rona Joseph
DOI:10.4103/ijmpo.ijmpo_208_20  
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ERRATA Top

Erratum: Blood and Bone Marrow Transplantation in India: Past, Present, and Future p. 627

DOI:10.4103/0971-5851.293846  
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Erratum: 100-Year-Old Vaccine for a Novel Virus: Killing Two Birds with One Stone! p. 628

DOI:10.4103/0971-5851.293847  
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