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July 2019
Volume 40 | Issue 5 (Supplement)
Page Nos. 1-201

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ORIGINAL ARTICLES  

Bone marrow infiltration by nonhematopoetic small round cell tumors: A clinicopathological study from a tertiary care centre in South India Highly accessed article p. 1
Triveni Bhopal, Abid Hussain, Sai Mallikarjun, Sree Lakshmi, Sudha Sinha
DOI:10.4103/ijmpo.ijmpo_218_17  
Objectives: The objective of this study to comprehensively analyze bone marrow (BM) infiltration by nonhematological round cell tumors. Materials and Methods: A total of 206 diagnosed cases of small round blue cell tumors (excluding lymphomas) during a period of 2½ years, referred for BM examination were included in the study. Clinical details were obtained from medical records. BM aspiration (BMA) and BM biopsies (BMBx) were performed under local anesthesia for staging workup. BMBx were studied for cellularity, presence of infiltration by round cells (nonhematopoietic), histologic patterns (island/nests and diffuse sheets), fibrosis, necrosis and other secondary changes. Immunohistochemistry panel was used depending on the morphology. Results: The cases included age range from 45 days to 25 years with a median age of 12 years. There was a male predominance with male:female 1.5:1. Among these, 37/206 cases (17.9%) were positive for BM involvement (BMI) on BMBx. Of these, 24 cases were neuroblastoma (64.8%), 9 cases Ewing's sarcoma/primitive neuroectodermal tumor (24.3%), and 4 Rhabdomyosarcoma (10.8). BMBx was done in all the 206 cases. Among these, 37/206 cases were positive for BMI on BMBx while 35/206 cases were positive on BM imprints and 33/206 cases were positive on BMA. Conclusion: Detection of metastasis in the BM has both therapeutic and prognostic significance. BMBx are complementary in the diagnosis of small round cell tumor.
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Toxicity profile of double-agent adjuvant chemotherapy after concurrent chemoradiation and brachytherapy in locally advanced cervical cancer: Comparison with standard chemoradiation protocol Highly accessed article p. 6
Tejas Pandya, Virender Suhag, Subhash Ranjan, BS Sunita, Sujata Pandya
DOI:10.4103/ijmpo.ijmpo_171_17  
Introduction: Carcinoma cervix is the most common gynecological malignancy in India and a major cause of cancer mortality and morbidity in the females despite Concurrent chemoradiotherapy (CCRT). Attempts are on to improved overall survival by addition of adjuvant chemotherapy (ACT) to CCRT. Aim: The aim of this study is to establish toxicity profile of double-agent ACT after CCRT and ICRT in locally advanced cervical cancer (LACC) and to compare it with standard chemoradiation protocol. Materials and Methods: Patients were randomized into two arms: in conventional arm (Arm 1, n = 23), patients received a standard protocol of weekly injection cisplatin 40 mg/m2 concurrently with pelvic external beam radiotherapy (5040cGy/28 fractions) followed by ICRT (03 fractions of 7 Gy each). In interventional arm (Arm 2, n = 24), patients received CCRT/ICRT protocol; and were further offered ACT with three cycles of consolidation chemotherapy using injection paclitaxel and injection carboplatin every 3 weeks after CCRT and ICRT. Results: The incidence of anemia was 14/23 (50% Grade 1) in Arm 1 and 12/24 in Arm 2 (17% Grade 1, rest higher grade). In Arm 2, 37% of patients had ≥Grade 2 neuropathy and 16% of patients had Grade 1 alopecia, whereas nil incidence was reported in Arm 1 (P = 0.005 and 0.04, respectively). Grade 3 neutropenia was observed in 4/23 (17%) patients of Arm 1 and 8/24 patients (33%) of Arm 2. None of the patients in Arm 1 required indoor supportive care while 4/24 patients (17%) were managed as an indoor patient. Among late toxicities, in Arm 2, the incidence of Grade 2 and Grade 3 anemia was 42%, whereas in Arm 1, its incidence was 22%. In Arm 1, no patient exhibited features of neuropathy, whereas, in Arm 2, 12/24 (50%) of the patients had neuropathy (P value for these two late events was <0.05 statistically significant). No therapy-induced mortality was noted. Conclusion: Exhibition of ACT with injection Paclitaxel and injection carboplatin in locally advanced carcinoma cervix is a technically viable option with manageable toxicity.
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Treatment refusal and abandonment remain major concerns despite good outcomes with multi-modality management in pediatric medulloblastoma: Experience from a cancer center in Eastern India Highly accessed article p. 13
Anirban Das, Rimpa Basu Achari, Lateef Zameer, Saugata Sen, Shekhar Krishnan, Arpita Bhattacharyya
DOI:10.4103/ijmpo.ijmpo_213_17  
Context: Survival in medulloblastoma, the most common pediatric brain tumor, has lagged behind in developing countries in comparison to the West. Aim: The aim of this study was to analyze the clinical profile and outcome in a cancer center in Eastern India. Methods: Twenty-nine children were retrospectively analyzed over 6 years. Results: Vomiting (79%), headache (69%), and unsteadiness (55%) were the presenting complaints. The majority (67%) had classical histology. High-risk (HR) disease (61.6%) exceeded average-risk (AR) (38.4%) disease in numbers. Treatment-refusal (27.6%) and abandonment (6.9%) were major concerns. Four-year EFS was 81% and 52%, excluding and including refusal/abandonment, respectively. There was no relapse/progression among AR patients. Four-year EFS in HR was 63%. Posterior fossa syndrome (37.5%), febrile neutropenia (29%), and ototoxicity (16.7%) were the main treatment-related morbidities. Implications: Following this audit, patient tracking to reduce abandonment, coordination to limit delay in postsurgical referral, developing strategies for molecular subgrouping, and reducing cumulative cisplatin exposure were measures adopted to improve outcome in the unit.
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Expected hepatocarcinoma cancer rate due to escape mutant among local population in Thailand: The situation after the implementation of universal hepatitis B vaccination at birth p. 16
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/ijmpo.ijmpo_228_17  
Background: Chronic hepatitis B infection is an etiology of hepatocellular carcinoma. The high prevalence of hepatitis B can be seen in several regions including Indochina. In Thailand, a country in Indochina, according to the local public health policies, the universal hepatitis B vaccination is freely given to any infant at birth without charge. Despite the universal vaccination, the hepatitis B seropositive rate is still observed, and it can still be a cause of hepatocellular carcinoma among the hepatitis B carriers in the future. Methods: Here, the authors try to estimate the expected hepatocarcinoma cancer rate due to escape mutant among local population in Thailand, the situation after the implementation of universal hepatitis B vaccination at birth. Results: Based on the present study, the mutant escape contributes to only a few parts of overall estimated cancer cases in the situation that there is an implementation of universal hepatitis B vaccination at birth. Conclusion: Efficacy of theuniversal hepatitis B vaccination is not improved by specific management on escape mutants.
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Head and neck squamous cell carcinoma in young adults: A hospital-based study p. 18
Jagannath Dev Sharma, Nizara Baishya, Amal Chandra Kataki, Chandi Ram Kalita, Ashok Kumar Das, Tashnin Rahman
DOI:10.4103/ijmpo.ijmpo_252_17  
Background: Head and neck cancers (HNCs) account for 30% of all cancers in India. In north eastern India, tobacco-related cancers are very common because of the widespread use of tobacco. The paucity of any study from this region in young head and neck patients has prompted us to take up this study. Methodology: A retrospective study was conducted at Dr. B Borooah Cancer Institute, Guwahati during January 2015–December 2015. Data regarding tumor site, age, sex, education, habit of tobacco (smokeless and smoke), and betel nut consumption were analyzed using IBM SPSS version 19. P < 0.05 was considered as statistically significant. Results: About 75.1% patients were males. Among patients ≤39 years, 83.7% were tobacco chewers, 50.5% were smokers, and 83.7% betel nut chewers, and among >39 years, these proportions were 83.7%, 56.2%, and 78.7%, respectively. The most common site among ≤39 years and >39 were mouth (40.8%) and hypopharynx (36.8%). Among tobacco and betel nut chewers and smokers, the most common sites were mouth (40.3%, 42.5%) and hypopharynx (41.5%). The site of head and neck squamous cell carcinoma was highly associated with chewing and smoking habit (P < 0.05). Among illiterate patients, proportions of tobacco and betel nut chewers and smokers were 65.3%, 61.6%, and 67.9%, respectively. Conclusion: A positive association between tobacco use, male gender, and low education levels were found. The younger generation should be made aware about the adverse health consequences of tobacco use to reduce the preventable risk factors of HNC.
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Inhalation exposure to dioxins air pollutant generated by dead body incineration at buddhist temple: Cancer risk estimation p. 23
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/ijmpo.ijmpo_231_17  
Background: Dioxin is accepted as an important toxic chemical that can induce carcinogenesis. The dioxin contamination in air is accepted as an important air pollutant. Apart from the industry, the dioxin in air can be generated by other little mentioned sources. Methods: Here, the authors assessed the cancer risk due to inhalation exposure to dioxins air pollutant generated by dead body incineration at Buddhist temple based on situation in Indochina. Indeed, there are many thousand Buddhist temples in Indochina and the dead body incineration is routinely done at the temple every day and the dioxin generated from this activity is little mentioned. Results: According to this study, the risk of cancer due to exposure to dioxins air pollutant generated by dead body incineration at Buddhist temple is high and should be the issue for proper public health management. Conclusion: Dioxins air pollutant generated by Dead bodyIncineration at Buddhist temple is an important cancer risk for both adult and children living in that area.
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Thermo mammogram as a tool to assess response to neoadjuvant chemotherapy in breast carcinoma p. 25
Subbiah Shanmugam, Gopu Govindasamy, Sujay Susikar, Muniasamy Palaniyandi
DOI:10.4103/ijmpo.ijmpo_144_17  
Introduction: Response to neoadjuvant chemotherapy (NACT) is predicted by clinical examination alone in locally advanced breast carcinoma. This study uses thermo mammogram (TMG) to assess the response. Aim and Objectives: The aim is to study TMG changes during NACT in breast cancer and predict response to NACT in locally advanced carcinoma and to compare clinical response with TMG response/changes in any form. Patients and Methods: All patients with locally advanced breast cancer who had treated with NACT were included in this study. Baseline TMG picture was taken using illumina360° (digital robotic rotational thermography device for 360 degree view of each breast) system before chemotherapy. TMG was repeated before next cycle. All patients were also assessed clinically during and after each cycle of chemotherapy. To assess the potential of TMG in predicting tissue response to chemotherapy, the precool, postcool, and the temperature difference between precool and postcool before every cycle were analyzed. Results: A total of 19 patients were analyzed. Eight patients had complete clinical response, six patients had partial response, and five patients had static disease. Median of precool, temperature difference between precool and postcool for patients between no response and complete response did not show statistically significant difference. However, the median of postcool spot temperature showed statistically significant difference. Median of postcool temperature difference for patients between partial response and complete response showed statistically significant difference. The median of postcool spot temperature for patients with no response and partial response did not show statistically significant difference. Precool temperature difference for all the visits showed no statistically significant difference. Conclusion: This preliminary study suggests that the TMG has potential for monitoring NACT response in breast cancer patients. Postcool temperature measurement is an early indicator of response to NACT.
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Clinicopathological presentation of cervical cancer in Bhopal p. 33
Rubal Jain, Rajendra Kumar Nigam, Reeni Malik, Pramila Jain
DOI:10.4103/ijmpo.ijmpo_185_17  
Aim: To study the clinicopathological spectrum of cervical cancers in tertiary care center to assess scenario in Central India. Materials and Methods: Retrospective study in the Department of Pathology in our institution to evaluate cases of cervical cancers from January 2014 to August 2015. Histopathological diagnosis was correlated with age, symptoms, gravida, Federation of Gynecology and Obstetrics staging, and other relevant clinical details wherever deemed necessary. The biostatical analysis was performed for quantitative data student's t-test was applied. P value was considered statistically significant if P < 0.05. Results: A total of 180 cases were of neoplasia cervix. Majority of cases were squamous cell carcinoma type, i.e., 96.6% (174 cases) followed by adenocarcinoma constituting only 2.8% (5 cases) with a mean age of 50.7 years and average gravida of 3.78. Majority of cases (50.01%) complained of postmenopausal bleeding followed by abnormal spotting (26.67%) and lower abdominal pain (7.78%). The most common presentation was in Stage IIB with 45.56% (82) cases. Conclusion: Histomorphology remains the mainstay of diagnosis of cervical cancers. In low compliance settings such as ours, colposcopy-guided biopsy is the preferred course of management, especially in elderly females to be definite to rule out or diagnose neoplasia. National level cervical cancer program is immediate need of the hour and should include human papilloma virus vaccine, awareness, and screening programs as well as treatment assistance for low socioeconomic strata.
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Pediatric bone sarcomas: Outcome of multimodality treatment in a single institution in South India over a decade p. 38
Subbiah Shanmugam, Gopu Govindasamy, Syed Afroze Hussain, S Prinith Siga Fells
DOI:10.4103/ijmpo.ijmpo_235_17  
Context: Pediatric bone sarcoma is a rare entity with low incidence of around 2.5–6 per million population in India. Management of this condition is well standardized, and global survival data are available; however, there is a paucity of data in the Indian perspective. Aim of the Study: The aim of this study is to analyze various prognostic factors and survival outcome. The purpose of this study is to assess the role of surgery, multiagent chemotherapy, and radiation in the management of these tumors. Patients and Methods: Retrospective analysis of patients aged 18 and less, diagnosed as bone sarcomas and treated in our tertiary cancer center. All the patients received at least one form of therapy depending on stage and site of the primary lesion. Results: Twenty-one patients of Ewing sarcoma and 20 patients of osteosarcomas were eligible and were included in the study. In Ewing sarcoma, completing the full course of standard chemotherapy and radiotherapy to the local site was associated with improved survival. In osteosarcoma, limb salvage surgery (LSS) had a significant difference in overall survival compared to amputation. Induction chemotherapy was associated with better percentage of necrosis and showed improved survival. The percentage of necrosis correlated positively with survival which was statistically significant (P = 0.015). Conclusion: The median survival in both these bone sarcomas is inferior to global trends. Probable reasons for such discrepancy are lack of compliance to treatment protocols due to age factors and late presentation. Completion of multiagent chemotherapy in both the tumors add to better survival. Radiotherapy in Ewing sarcoma improves survival. In osteosarcoma, LSS is an oncologically safe alternative to amputation. The percentage of necrosis following chemotherapy in osteosarcoma is a reliable predictor of prognosis.
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Clinical profile of acute myeloid leukemia in North India and utility of nontransplant measures in its management p. 44
Nadeem Shoket, Javvid Muzamil, Tasneef Banoo Zargar, Burhan Wani, Vishal Toka, Javid Rasool Bhat, Gull Mohammad Bhat, Aejaz Aziz Shiekh
DOI:10.4103/ijmpo.ijmpo_175_17  
Introduction: Acute myeloid leukemia (AML) is a clonal accumulation of myeloid precursors in body tissues, which ultimately leads to bone marrow failure. This is an 8-year prospective, observational study in which 254 patients were enrolled. Aim of the Study: To document the clinical profile of AML and differential outcome in M3 versus non-M3 phenotype and to see impact of different variables on its survival. Methods: Patients enrolled in the study were examined, evaluated, and given standard 3:7 induction protocol, and acute promyelocytic leukemia (APML) patients were given the ICAPL 2006 protocol. Results: In our study, males outnumbered females and most of our patients were in 20–60 years of age group. The better prognosis was in patients who were in the second decade of life. Total leukocyte count and platelet count had a significant impact on the survival of the a patient. Bone marrow morphology of M3 type has extremely good prognosis and was the most common FAB type seen in our study. Flow cytometric markers such as CD15, CD33, CD117, and myeloperoxidase had positivity among 90% of patients. Overall survival is around 40% in whole-study group, 87% in APML group, and 16.5% in non-M3 group. There are still unmet needs in managing the non-M3 patients in resource-constraint countries where allogenic transplant and newer drugs have the least access. For improving the outcome in M3 AML, further newer molecules such as Flt3 and PIK3 inhibitors are being used in trials. Conclusion: There are still unmet needs in managing the non-M3 patients in resource-constraint countries where allogenic transplant and newer drugs have the least access. For improving the outcome in M3 AML, further newer molecules such as Flt3 and PIK3 inhibitors are being used in trials.
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A study of hormone receptor status in breast carcinoma and use of HER2-targeted therapy in a tertiary care center of India p. 54
Sandeep Bhaskar, Kartick Rastogi, Shivani Gupta, Arpita Jindal, Aseem Rai Bhatnagar, Sandeep Jain
DOI:10.4103/ijmpo.ijmpo_172_17  
Aims: The aim is to study the hormone receptor status, association of HER2 expression with prognostic factors and use of HER2-targeted therapy in North Indian breast cancer patients. Subjects and Methods: Immunohistochemistry reports of 288 breast cancer patients registered in the department of Radiotherapy, SMS Medical College, Jaipur in 2015–2016 were analyzed for estrogen receptor (ER), progesterone receptor (PR), and c-erb B-2 protein (HER2/neu) expression. Equivocal HER2 (2+) was further confirmed by fluorescent in situ hybridization (FISH). Number of patients receiving HER2/neu-targeted therapy was also studied. Results: For ER, positive status was more common (56%), whereas for PR and HER2/neu, negative status was more common (59% and 60% resp.). HER2 status was unknown for 25% patients. The percentage of equivocal HER2 (immunohistochemistry 2+) cases showing amplification on FISH was also high (56.7%). The percentage of eligible cases for targeted therapy actually receiving it was low (28%). The percentage of triple negative phenotype (ER-/PR-/HER2-) was high (29.8%). Triple-negative breast cancer phenotype was more common in young-aged premenopausal women but was not statistically significant. All HER2/neu + cases were infiltrating ductal carcinoma. HER2/neu expression was significantly higher with large tumor size (P = 0.001), high tumor grade (P < 0.001), advanced stage (P = 0.001), greater number of positive lymph nodes (P = 0.02), and ER/PR negativity (P < 0.001). Conclusions: Most of the breast cancer patients are ER and/or PR positive and HER2/neu negative. The percentage of triple-negative phenotype is higher. More than half of HER2/neu 2+ cases show amplification on FISH assay. The percentage of eligible patients actually receiving targeted therapy is low. HER2/neu protein expression is significantly higher with adverse features such as large tumor size, high grade, advanced stage, greater number of positive lymph nodes, and ER/PR negativity.
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Oral microflora among oral cancer patients undergoing radiotherapy in regional cancer center, Indira Gandhi Medical College, Shimla p. 61
Vikas Fotedar, Suniti Ganju, Shailee Fotedar, Purnima Thakur, Aman Sharma, Vinay Bhardwaj
DOI:10.4103/ijmpo.ijmpo_247_17  
Objective: The objective of this study was to identify the microflora, especially Gram-positive, Gram-negative, and Candida species, in patients with oral squamous cell carcinoma during various stages from diagnosis through radiotherapy. Materials and Methods: A total of 17 cases with histological diagnosis of squamous cell carcinoma of the oral cavity were enrolled in the study. For each patient, the sample was collected thrice, i.e., at the time of diagnosis (Sample 1), 14th–15th day (Sample 2), and on the 29th–30th day of radiotherapy (Sample 3). The swab stick was rolled across the oral mucosa in the cases and was sent immediately to the Department of Microbiology, Indira Gandhi Medical College, Shimla, for processing. The swabs were inoculated on MacConkey agar, blood agar, and Sabouraud dextrose agar. After overnight incubation at 37°C, the organisms were identified by colony characteristics, catalase, coagulase test, Gram staining, and standard biochemical tests. Results: Out of 17, there was a loss to follow up in three patients, so after analyzing on 14 patients, we had 12 (85.7%) males and 2 (14.3%) females. The mean age of the population was 47.6% ± 12.2%. We had significantly higher proportion of Gram-positive microorganisms in Sample 1 as compared to Sample 3 and the same proportion of Gram-negative organisms in Sample 1 and Sample 3. Candida species was also proportionately higher in Sample 3 as compared to Sample 1. Conclusion: There is a shift of oral microflora from Gram-positive to Candida species from Sample 1 to Sample 3 and Gram-negative being same in Sample 1 and Sample 3.
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Demographic and histopathologic profile of pediatric patients with primary brain tumors attending a regional cancer center p. 65
Dhruv Pankaj Mehta, Asha S Anand, Dipak Patel, Priti Trivedi, Harsha Panchal, Apurva Patel, Sandip A Shah
DOI:10.4103/ijmpo.ijmpo_137_17  
Background: Primary brain tumors (PBTs) are the most common solid childhood malignancies. However, epidemiologic profile of these tumors is scarce in developing nation like India. Objective of Study: The objective of this study was to study the demographic and histopathologic profile of pediatric patients with PBTs residing in Gujarat, and attending the Gujarat Cancer and Research Institute, Ahmedabad. Materials and Methods: Data regarding age, gender, anatomical site, and histopathology (according to the World Health Organization classification) of 242 patients with brain tumors (0–18 years) operated over 10 years (January 2006 to December 2015) were collected retrospectively, and analyzed. Results: Of total 242 patients with PBTs, 78.1% were from 5 to 14 years age group with the mean age being 9.38 ± 3.82 years (95% confidence interval). Brain tumors were more common in males (64.1%) as compared to females (35.9%) with a male-to-female ratio of 1.78:1. The most common anatomical site was cerebellum (46.3%), followed by cerebral hemispheres (14.1%). Infratentorial tumors (60.9%) were predominant than supratentorial tumors (39.1%) in 0–14 years age group while supratentorial tumors (58.3%) were predominant than infratentorial tumors (41.7%) in 15–18 years age group. Astrocytic tumors (38.9%) and embryonal tumors including medulloblastomas, supratentorial primitive neuroectodermal tumors, and atypical teratoid/rhabdoid teratomas (34.7%) were the most common histological subtypes comprising three-quarters of all tumors. Ependymomas (16.1%) and craniopharyngiomas (5%) were third and fourth most common tumors, respectively. Among astrocytic tumors, 71.3% were of lower grade histology (Grade I and II). Conclusions: Astrocytomas and medulloblastomas, which form the major histologic subtypes in children residing in Gujarat, needs special attention with respect to the distribution of infrastructure and resources. Histopathological profiles of cohort in this study do not differ substantially from other hospital-based and population-based studies.
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Demographic and clinical characteristics of chronic myeloid leukemia patients: A study on confined populations of Southern India p. 70
Manjula Gorre, RB Sashidhar, Sandhya Annamaneni, Raghunadharao Digumarti, Vishnupriya Satti
DOI:10.4103/ijmpo.ijmpo_141_17  
Context: Chronic myeloid leukemia (CML) is one of the most common hematological malignancies in all populations throughout the world. Even though the pathophysiology of CML was well explained in majority of the studies, the incidence of CML was shown to exhibit population diversity, and hence, the demographic factors underlying CML origin remain to be understood. Further, the introduction of tyrosine kinase inhibitors had revolutionized the treatment of CML over the years; however, there is a need for developing tailoring therapy to individual risk since the patient clinical heterogeneity poses a major problem during drug response. Therefore, the study of basic clinical picture may aid in planning treatment strategies for CML patients. Aim: The aim of this article is to study the epidemiological and clinical variables associated with the prognosis of CML. Subjects and Methods: We have considered the distribution of various demographic and clinical variables among 476 CML patients diagnosed at Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. Statistical Analysis Used: All the analyses were performed through SPSS software (version 21.0). Correlation and Cox regression analyses were also performed. Results: Apart from the elevated male sex ratio in CML incidence, high frequency of males was observed to be nonresponders to imatinib mesylate (IM). IM response was shown to be dependent on phase of diagnosis, whereas overall survival of CML patients depends on the age at onset and response to IM. Conclusions: The study of epidemiology and clinical picture of CML patients may help in planning better treatment strategies at diagnosis to achieve long-term progression-free survival.
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Profile of pediatric chronic myeloid leukemia in the era of imatinib: A study from South India p. 77
Catherene Bernard, Febe R Suman, Rajendran Rashmika, Magatha Sneha Latha, Julius Xavier Scott, V Rajesh
DOI:10.4103/ijmpo.ijmpo_234_17  
Introduction: Chronic myeloid leukemia (CML), a chronic hematologic malignancy, is rare in pediatric patients. Studies of the tyrosine kinase inhibitor imatinib are required so that uniform guidelines may focus on disease therapy and follow-up for children. We analyzed the clinicohematologic features of the disease, treatment response to imatinib, follow-up measures, and the impact of the disease on the patients and their family. Materials and Methods: All pediatric patients diagnosed with CML and treated and followed-up were studied regarding demographics, clinical features at presentation, and diagnostic profile, including laboratory parameters, peripheral blood smear test, fluorescent in situ hybridization and karyotyping, and reverse-transcriptase polymerase chain reaction for the BCR-ABL fusion gene. Treatment modalities, adverse reactions, remedial measures, assessment at every follow-up visit, patient's education, parents' socioeconomic status, and economic and psychological stresses were also evaluated. Results: Six patients were administered upfront therapy with a standard dose of imatinib. Hematological and biochemical parameters were monitored after the drug administration. We assessed the treatment response using molecular detection of the BCR-ABL transcripts. All patients who complied with drug therapy showed a complete molecular response and minimal toxic symptoms. However, parents found it difficult to cope socially and economically. Conclusion: Imatinib mesylate is effective and has a good molecular response, minimal toxicity, and good patient compliance. However, due to its cost, families reacquire financial debt, and the disease creates uncertainty about the child's future, thereby necessitating psychosocioeconomic support for parents. Changes in the policies of cancer support groups are urgently needed to provide lifelong, lifesaving drugs free of cost.
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Profile of childhood non-hodgkin lymphomas at a tertiary care hospital p. 82
Ratnaprabha Anil Gunge, Alka D Kalgutakar
DOI:10.4103/ijmpo.ijmpo_230_17  
Context: Lymphoma was the second most common malignancy accounted for 22% of pediatric cases, of which 34 (68%) were non-Hodgkin's lymphoma (NHL). Aims: To find the incidence, clinical presentations, laboratory findings, proportion of extranodal involvement, and to study histological subtypes (REAL/WHO classification) of NHL, compare them with reported case series in the world literature. Settings and Design: Gross specimens and biopsies of pediatric NHL were retrieved from the Department of Surgical Pathology from the year 2004 to 2013 at a tertiary care hospital. Patients and Methods: Gross and microscopy of incisional biopsies and surgically resected specimens of pediatric cases were studied using hematoxylin and eosin stain and wherever needed special stain and immunohistochemistry were used. Results: The incidence of NHL was higher in more than 10 years of age group with male predominance. Burkitt's lymphoma (BL) (41.2%) was the most common subtype followed by T-lymphoblastic lymphoma (T-LL) (29.4%). Predominantly extranodal presentation was seen, BL presented as ileocecal masses (five cases) and orbital swelling (three cases). T-LL presented as a mediastinal masses (six cases). Rare cases of precursor B-LL involving orbital mass and plasmablastic lymphoma involving paranasal sinuses were studied. Among bone marrows studied a case of T-LL developed pancytopenia, during chemotherapy showed giant pronormoblast (Parvovirus infection). HIV association was seen in five cases of NHL. Postchemotherapy disease-free survival was very low and many patients died during chemotherapy. Conclusion: Although the incidence of HL is higher in children, in the present study, NHL with extranodal presentation (58%) involving rare sites with poor prognosis is higher, 15% of all cases showed HIV seropositivity.
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Cancer awareness amongst nurses in a tertiary care hospital in North Delhi, India p. 89
Ranga Raju Ranga Rao, Rudra Prasad Acharya, Peush Bajpai, Waseem Abbas, Ruchika Khetrapal
DOI:10.4103/ijmpo.ijmpo_159_17  
Background: Nursing staff is the first of a constant line of contact with the patients and serve a prodigious responsibility. They play a pivotal role in disseminating knowledge to the patients in their daily practice. The present study was conducted to assess the level of cancer awareness among hospital nurses, identify the knowledge gaps and to incorporate them into training. Cancer is the most prominent cause of morbidity and mortality in both developed and developing countries like India where nearly 5 lakh deaths per year occur according to the recent GLOBOCAN data. Materials and Methods: A cross-sectional survey was conducted among nurses in a tertiary care hospital in North Delhi. Of 458 employed nurses, 53.3% nurses working in the hospital participated in the study on a voluntary basis. A structured pretested questionnaire was administered to the study subjects. The questionnaires were coded, and information on personal details was not included. To warrant an effective measure of study outcomes, a Cancer Awareness Score (CAS) was developed. CAS of individual participants was achieved by dividing the total average score of each subject by ten that will help in quantifying the cancer awareness. A total of 244 nurses (53.3%) out of 458 employed were surveyed. A total of 146 forms were filled manually and 78 forms were completed electronically. Results: The return rate was 65.5% of the CAS. The completion rate was 100% and the rejection rate was zero. Of these 223 were female and 21 were male. The study subjects were in the age range of 19–56 years. Out of the 244 nurses, 75.81% were aware about general aspects of cancer. 77.5% of the nurses acknowledged that cancer is a serious health problem in India, and 79.9% were aware of the increasing incidence of cancer. About 66.4% subjects knew that cancer is a lifestyle disease. About 75.4% were aware that cancer is preventable, and 78.7% agreed that early detection is possible. About 23% believed that all lumps are cancerous. Almost 75% of the study subjects were aware of warning symptoms of cancer, nearly 90% of them were aware about all the causative factors. In this study, 21% of nurses were observed to have one or more myths about cancer during the survey. 23.4% believed that cancer is contagious; 25% of the study subjects believed that cancer is familial, 13.9% believed that cancer is due to God's curse! Another alarming observation is that they believe that procedures such as biopsy (17%) or surgery (21.7%) can spread cancer!. It is vital to work on removing these myths. Conclusion: Authors perceive that the study subjects lack adequate knowledge about cancer. The total average score of the study subjects was <75%. General awareness about cancer treatment needs to be reinforced. There is a pressing need to bust the myths by using appropriate information education communication strategies. Repeated training of nurses on cancer awareness is warranted. If well equipped with knowledge on cancer, they can further impart information to patients, caregivers and other hospital staff.
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Metastatic synovial sarcoma: Experience from a tertiary care center from India p. 95
K Govind Babu, Rajesh Patidar, C Lakshmaiah Kuntegowdanahalli, Lokanatha Dasappa, Linu Abraham Jacob, Suresh Babu, AH Rudresha, Lokesh N Kadabur, LK Rajeev, Deepak Koppaka, Vikas Asati
DOI:10.4103/ijmpo.ijmpo_237_17  
Background: Synovial sarcoma represents 8% of all soft-tissue sarcoma (STS). It is a high-grade STS, and 50% of patients develop metastasis. The most common site of metastasis is the lungs, lymph nodes followed by bones. Ifosfamide-based chemotherapy is associated with improved outcome. In this study, we report our experience of metastatic synovial sarcoma according to primary sites, metastatic pattern, and their outcome. Materials and Methods: This was a retrospective observational study carried out at our institute from January 2013 to December 2016. The aim of our study was to evaluate the pattern of metastasis, response to chemotherapy, and survival in patients with metastatic synovial sarcoma. Results: Over a period of 4 years, 43 patients with metastatic synovial sarcoma were diagnosed with median age of 30 years. Nearly 70% of patients had lung metastasis, other site of metastasis were lymph node, bone, and liver. Thirty patients received chemotherapy with a combination of ifosfamide and doxorubicin. The overall response rate was 87% with median progression-free survival of 8 months. Patients with lung only metastasis had better survival compared with nonpulmonary metastatic site (18 months vs. 12 months). The median survival was 18 months. Conclusion: Metastatic synovial sarcoma is chemoresponsive tumor with lung being the most common metastatic site. Patients with lung only metastasis had a better outcome than nonpulmonary metastasis.
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Pattern of bone marrow involvement by solid tumors: Experience from a tertiary care center from South India p. 99
AH Rudresha, Rajesh Patidar, Kuntegowdanahalli C Lakshmaiah, K Govind Babu, Dasappa Lokanatha, Linu Abraham Jacob, MC Suresh Babu, NR Namrata, N Lokesh Kadabur, LK Rajeev, Abhishek Anand, Vikas Asati
DOI:10.4103/ijmpo.ijmpo_170_17  
Background: Bone marrow involvement by solid tumor implicates advanced disease and dismal prognosis. Bone marrow aspiration and biopsy are routinely performed as staging workup for certain small round cell tumors and also for unexplained cytopenia in other solid tumors. It is important to rule out bone marrow involvement before planning for curative treatment. Materials and Methods: This was a retrospective observational study. The aim of our study was to evaluate the pattern of bone marrow involvement by different solid tumors and their correlation with the hematological abnormalities. We retrospectively evaluated bone marrow aspirations and biopsy performed in past 3 years. Results: At our institution, bone marrow examinations were performed in 440 patients during past 3 years for solid malignancies. Out of 440, 206 were pediatric cases and 234 were adult cases. Bone marrow was involved in 56 (12.7%) patients. Among the pediatric cases, bone marrow involvement was present in 30 (12.8%) cases, and in adult cases, bone marrow was involved was in 26 (11.1%) cases. Neuroblastoma (40%) was the most common malignancy, which involved the bone marrow among pediatric cases, followed by retinoblastoma (26.6%) and Ewing's sarcoma (20%). Among adult patients, neuroendocrine carcinoma (23%) was at the top of the list of tumors involving bone marrow, which is followed by Ewing's sarcoma (19.2%) and nasopharyngeal carcinoma (11.5%). Conclusion: Neuroblastoma and neuroendocrine carcinoma are the major cause of bone marrow involvement among the solid malignancies in pediatric and adult population, respectively. Use of immunohistochemistry markers on bone marrow biopsies may result in higher detection rate.
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Outcomes of breast cancer management from an Urban specialist breast center in South India p. 102
Naga Amulya Mullapudi, Kabeer Katherine Kirti, Naveen Padmanaban, Ramesh Nimmagadda, Selvi Radhakrishna
DOI:10.4103/ijmpo.ijmpo_206_17  
Context and Aims: The disease pattern and presentation of breast cancer in India are thought to differ from the West. The purpose of this study is to describe and to discuss the presentation, clinicopathological data, and survival from an urban specialist breast center in Southern India. Materials and Methods: Prospectively collected data were analyzed for clinicopathological details, treatment variables, and survival outcomes were analyzed. Cumulative survival curves were estimated using the Kaplan–Meier method for patients treated from 2007 to 2011. Results: A total of 1671 patients were operated at our center from January 2007 to December 2016. Average age at diagnosis was 54.2 years. Over 70% had Stage I and Stage II disease, infiltrating duct carcinoma was predominant in 88.2%. Average clinical tumor size was three centimeters. Breast conservation was performed in 22.4%. Sentinel lymph node biopsy was performed in 44.6%. Estrogen-receptor positivity was seen in 64.6%, 22.2% were Her2Neu positive. Triple negative disease was seen in 19.1%. Survival analysis was done using the Kaplan–Meier curves for 540 patients treated from 2007 to 2011. The median follow-up of surviving patients was 70 months with 10% lost to follow-up. In our study population, the 5 years overall survival rate is 88.3% and disease-free survival is 85.7%. Conclusion: Our study reflects a higher percentage of early breast cancer with outcomes comparable to the West. More research is required to understand the genetic predisposition in our population.
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Atypical presentation of ewing's sarcoma p. 109
Veenita Yogi, Haridas P Mani, Om Prakash Singh, Hameeduzzafar Ghori
DOI:10.4103/ijmpo.ijmpo_176_17  
Background: Ewing's sarcoma (ES) is an osseous malignancy of small round blue cells which may manifest even in soft tissue. It is the second most common primary tumor of bone in childhood. The common areas of occurrence are the diaphyses of femur followed by tibia, humerus, pelvis, and clavicle. However, there are many unusual presentations of ES on the basis of the site, e.g., craniofacial bones, paravertebral mass, and visceral organs. Chemotherapy with radiation therapy and cytoreductive surgery/limb salvage surgery is the mainstay treatment along with a strict patient compliance and counseling, critically being important for long-term survival. This study depicts presentations of ES who either presented with some unusuality at the time of diagnosis or developed peculiar features uncharacteristic of ES during their course of treatment. Context: This study provides an insight into the patterns of unusual presentation of ES and prognosis of such patients with current line of management. Multiple sites of metastases have a very poor dismal outlook. Aims: This study purports the importance of considering ES as a systemic disease rather an osseous malignancy and reviews the pattern of unusual sites of presentation. Setting and Design: This observational study was carried out in the Department of Radiotherapy, Gandhi Medical College, Bhopal. Only patients with unusual patterns of metastases were included in the study cohort. Materials and Methods: We systematically reviewed patients with confirmed and immunohistochemistry-proven ES from July 2014 to July to 2017. A total of 69 patients were registered within the time frame. Of the 69 patients, 36 (52.2%) were males and 33 (47.8%) were females. Of the 11 (16%) unusual presentations, 8 were males and 3 were females. The mean age of presentation was 22.5 (3–52 years). All patients received chemotherapy as per treatment guidelines. Each patient was individually followed up and metastatic workup was performed in a systematic manner. Statistical Analysis: Since the pattern of metastasis was observed, no significant statistical analysis was required for this study. Results: Of the 11 patients, six succumbed during the course of treatment, one patient was lost to follow-up, while four patients are on regular follow-up. Of the six patients who succumbed, four had multiple metastases at the time of presentation to our outpatient department, while the other two patients had paraspinal ES with paraplegia. Two patients, one male and one female, had associated comorbidities with spherocytosis and bronchial asthma. The youngest patient was a 3-year-old child with paraspinal ES, while the oldest was a 52-year-old with extraosseous ES of the right thigh who presented with lung, liver, and supraclavicular metastases. Conclusion: In our study, pattern of metastases determined the patients' survival. Those patients who presented with multiple metastases at the time of presentation had a very poor prognosis, with death occurring within 2–3 months. The chemotherapy protocols were neither modified nor changed. They were evaluated after every cycle. Those patients who had developed multiple metastases at the time of admission to our outpatient clinic fared the worst. Those who had metastases to the brain and lung also succumbed to the malignancy. It is time we consider ES as an osseo-systemic malignancy and incorporate newer techniques such as circulating tumor cells in the investigation and evaluation portfolio for better and aggressive management. A multidisciplinary tumor board is absolutely essential and weekly meetings mandatory to individualize the treatment scenario. In our study, uncustomary as it may seem, their metastatic sites demand a certain degree of limelight in the Annals of Oncology.
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CASE REPORTS Top

Burkitt leukemia in a 5-year-old girl with Williams–Beuren syndrome: Review of the literature p. 114
Turkan Patiroglu, Alper Ozcan, Musa Karakukcu, Mehmet Akif Ozdemir, Ekrem Unal
DOI:10.4103/ijmpo.ijmpo_240_17  
Williams–Beuren syndrome (WBS) is a rare neurodevelopmental genetic disorder associated with microdeletion at the long arm of chromosome 7 (7q11.23). Few cases have been reported with WBS with hemato oncological malignancies. Herein, we report Burkitt leukemia in a 5 year old girl with WBS. We like to call attention to the management of this rare combination.
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Nasal cavity cancer with distal phalanx metastasis: An extremely rare case report p. 117
Kartick Rastogi, Prashant Dadhich, Sandeep Bhaskar, Shivani Gupta
DOI:10.4103/ijmpo.ijmpo_255_17  
Cancers of nasal cavity are relatively uncommon; and osseous metastases distal to the elbow and knee joints are also very rare. We herein report the two rare occurrences of nasal cavity carcinoma and acrometastasis together in the same patient, which is the first such case report to the best of our knowledge. The features associated with acrometastasis in the present study are similar to what has been cited in the literature, such as male gender, older age, widespread metastasis, single bone metastasis, lytic lesion, third finger, distal phalanx, poor prognosis, and short survival; however, involvement of left hand and nasal cavity as the primary site of tumor were the exceptions.
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Post-transplant Epstein–Barr virus-related lymphoproliferative disorder: A case report and review of literature p. 120
Vasu Babu Goli, Preet Shah, M Ganapathi Bhat, Aabha Nagral
DOI:10.4103/ijmpo.ijmpo_241_17  
Post transplant lympho-proliferative disorders (PTLD) are a serious complications of solid organ transplantation. Solid organ recipients have an increased risk of cancers related to immunosuppression and the Epstein-Barr virus (EBV)-in particular lymphomas and majority of PTLD are of B-cell origin. The occurrence of PTLD in solid organ recipients can have varied clinical presentation and histopathological features. Although lymphoproliferative disorders were initially reported to be rare complication of transplantation, observations in past decade shown that they are common and are associated with poor outcomes. We report the case of a patient with deceased donor liver transplantation for Budd-chiari syndrome, who presented, four years after liver transplantation, with an EBV-associated Burkitt lymphoma with gastrointestinal and extensive skeletal metastasis recovered completely after adjustment of immunosuppressive treatment and chemo-immunotherapy. Our suggestion is that patients with the risk factors like T-cell depleting agents or increasing immunosuppressive therapy must be closely monitored with quantitative EBV PCR. Improvements in immunosuppressive strategies for transplantation and advances in treatment resulted in improved outcomes and long term survival for patients with PTLD.
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An unusual tumor of the vagina p. 123
Archana , Saritha Shamsunder, Amit Yadav, Sunita Malik
DOI:10.4103/ijmpo.ijmpo_239_17  
A 28-year-old female came with complaints of swelling in the perineal area; examination revealed a nontender and fixed mass of approximately 4 cm × 3 cm on the right vulvovaginal junction extending into the vaginal wall. Wide excision of the mass was performed; histopathological examination revealed features suggestive of Merkel cell carcinoma of vagina.
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Acinic cell carcinoma of parotid gland presenting as disseminated cutaneous and subcutaneous metastasis after 20 years of initial presentation p. 126
Ashini Shah, Shailee Mehta, Amisha Gami, Dhaval Jetly
DOI:10.4103/ijmpo.ijmpo_167_17  
Acinic cell carcinoma (ACC) is an uncommon variety of salivary gland neoplasms, constituting about 17% of all salivary gland malignancies. Although ACC is a low-grade tumor, approximately 35% of patients experience recurrence and 16% have distant metastasis, often decades after the initial presentation. We report a rare case of disseminated metastatic ACC in skin and subcutaneous tissue in a 50-year-old male, with a history of surgery in parotid region 20 years back. After thorough search of literature, this is the second case being reported, to the best of our knowledge.
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A rare case report of high-grade endometrial stromal sarcoma in a seemingly healthy uterus of a young patient – Optimally managed by minimally access surgery p. 130
Kanika Jain, Debasis Dutta, Kanika Chopra, Pallav Gupta
DOI:10.4103/ijmpo.ijmpo_184_17  
Endometrial stromal sarcomas (ESSs) are a rare entity, constituting 10% of all uterine sarcomas and 0.2% of all uterine malignancies. We report a very rare case of high-grade endometrial stromal sarcoma in a 34-year-old female with fibroids uterus diagnosed postlaparoscopic hysterectomy. Thereafter, laparoscopic paraaortic and pelvic lymphadenectomy and bilateral oophorectomy were done. The diagnosis of high-grade endometrial stromal sarcoma Stage 1A was made, with lymph nodes and ovaries free from the disease. The patient is undergoing chemoradiotherapy at present and is in a close follow-up with us. ESS should be included as differential diagnosis of abnormal uterine bleeding so that best possible management of the patient can be done.
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Acute pancreatitis caused by pemetrexed, carboplatin, and gemcitabine in a patient with lung cancer: A rare case report p. 133
Vishal Kulkarni, BJ Srinivasa, PK Kiran, Vinu Sarathy, S Shivakumar Swamy, Radheshyam Naik
DOI:10.4103/ijmpo.ijmpo_189_17  
Drug-induced pancreatitis is reported as one of the less common causes of acute pancreatitis. Many drugs such as sulfonamides, estrogens, tetracyclines, valproic acid, antiretroviral drugs, some chemotherapy drugs such as azathioprine, and 6 MP are known to cause acute pancreatitis. We report a case of acute pancreatitis following administration of chemotherapy for non-small cell lung cancer (NSCLC). The patient was diagnosed to have NSCLC (histologically proven adenocarcinoma). After thorough evaluation including radiological investigations consisting of a positron-emission tomography computed tomography scan, he was staged as a Stage III B NSCLC. As per protocol, he was started on combination chemotherapy with pemetrexed and carboplatin. After 2 weeks of chemotherapy, he developed acute pancreatitis which was managed conservatively. He was administered different drug combination during the next cycle involving gemcitabine and carboplatin. However, he developed recurrent acute pancreatitis which was managed conservatively. He was then referred to the radiotherapy department as it was deemed that he is at risk of recurrent episodes of pancreatitis if further cycles of chemotherapy are continued.
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Successful usage of external beam radiation to myeloma cutaneous lesions in patient with refractory, relapsed multiple myeloma p. 136
Chira Ranjan Khadanga, B Saikumar, K Sujatha, Anand Kumar Vaggu, Sambasivaiah Kuraparthy
DOI:10.4103/ijmpo.ijmpo_140_17  
Cutaneous myeloma lesions are rare. External beam radiation is effective in inducing remission in cutaneous myeloma lesions.
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Primary renal leiomyosarcoma arising from renal vein: A case report of rare entity with review of literature p. 139
Reetu Kundu, Mahesh Chandra, Rajpal Singh Punia, Purnima Aggarwal
DOI:10.4103/ijmpo.ijmpo_232_17  
Primary renal sarcomas are extremely rare neoplasms accounting for about 1% of all malignant renal neoplasms. Among all the sarcomas of kidney, leiomyosarcoma is the most common histotype. The histogenesis of these tumors is unclear, and presumably, they arise either from renal capsule or smooth muscle of renal vessels or renal pelvis. We report a case of a 65-year-old woman, who presented with intermittent abdominal pain for 1 year. The correct diagnosis was established only after the histopathological analysis of the resected specimen. The poor prognosis borne by these tumors mandates a thorough evaluation of all renal masses with unusual gross and histomorphology.
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Conjunctival mass as the initial presentation of acute lymphoblastic leukemia in a child p. 142
Jagdish Prasad Meena, Aakanksha Sharma, Aditya Kumar Gupta, Anuj Singh, Prafulla Kumar Maharana, Ravi Hari Phulware, Rachna Seth
DOI:10.4103/ijmpo.ijmpo_254_17  
Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy with excellent survival. ALL has varied presentations. Presentation of ALL as a conjunctival mass is very rare. We report a child who presented to us with redness of the left eye and was found to have conjunctival mass. On biopsy, this mass was later diagnosed as ALL. The bone marrow examination supported the diagnosis. Timely diagnosis and initiation of treatment are essential to salvage the vision and to improve survival in such cases.
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Angiomatous granuloma mimicking verruciform lesion p. 145
Harsha Bhayya, Avinash Tejasvi, Pavani Donempudi, Geetha Paramkusam, Swetha Kardalkar
DOI:10.4103/ijmpo.ijmpo_198_17  
Angiomatous granuloma also called as pyogenic granuloma (PG) is a benign soft-tissue tumor of the skin and mucous membrane arising in response to various stimuli such as local irritation, traumatic injury, or hormonal factors. PGs show a striking predilection for the gingiva. Extragingivally, it can be seen in areas of frequent trauma. It predominantly occurs in the second decade of life and is more common in females than males due to vascular effects of female hormones; here, we present a unique case in a 4-year-old female patient with a gingival growth mimicking a verrucous hyperplasia which is very rare in that age.
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An alternate method of fabrication of an obturator in a patient diagnosed with melanotic neuroectodermal tumor of infancy p. 148
Kanchan P Dholam, Gurkaran Preet Singh, Sandeep V Gurav, Arati A Shinde
DOI:10.4103/ijmpo.ijmpo_256_17  
The quality of treatment and rehabilitation for the pediatric head and neck cancer patient has greatly improved due to interdisciplinary management. Surgical resection of maxilla leads to functional impairment which can be adequately restored with an obturator. However, its fabrication can be challenging in a pediatric patient. A simple, practical, and time-saving procedural modification in the fabrication of obturator in a patient diagnosed with rare melanotic neuroectodermal tumor of infancy has been presented.
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A rare disease of the breast: Bowen's disease p. 152
Nabal Kumar Mishra, Atul Jain, Gaurav Patel, Sajid Makbul Nurbhai
DOI:10.4103/ijmpo.ijmpo_223_17  
Bowen's disease is also known as squamous cell carcinoma in situ and it occurs predominantly in older patients. Etiological factors for Bowen's disease include ultraviolet light mainly, and in some cases, carcinogenic agents such as arsenic coal tar and petroleum products. It is frequently seen in sun-exposed area; however, other unexposed area can also be affected in few patients. Among the unexposed area, this disease affecting breast is a rare entity. These lesions are erythematous with raised, well-defined borders and a scaly appearance that may be confused with psoriasis. They present with an indolent history, having been present for years with slow growth. Histopathologically, there is atypia of the full thickness of the epidermis without dermal invasion. Progression to squamous carcinoma is slow, but 5% ultimately develop dermal invasion. Treatment generally requires complete excision for both definitive diagnosis and to rule out invasion and cure.
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Unusual renal and colonic mass: Description of a rare case p. 154
Manika Khare, Arvind Ahuja, Minakshi Bhardwaj, Nikhil Khattar
DOI:10.4103/ijmpo.ijmpo_190_17  
Seminoma is a germ cell tumor which accounts for approximately 40% of all germ cell tumors. Testicular seminoma is usually localized to the testis, and in 25% of cases, lymph node metastasis is seen. However, rarely, it can metastasize to visceras. We report a rare case of metastatic seminoma in a 40-year-old male who presented with renal and intestinal mass 2 years after orchidectomy.
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Large plaque parapsoriasis in a child: A rare entity in pediatric oncology p. 157
Bahareh Abtahi-Naeini, Farahnaz Fatemi Naeini, Mohammad Faranoush, Najmeh Bolandnazar
DOI:10.4103/ijmpo.ijmpo_229_17  
Parapsoriasis is exceedingly rare in children. The presentation, course, and prognosis of parapsoriasis in children have not yet been completely elucidated. Here, a case of large plaque parapsoriasis in 10-year-old boy is reported who was diagnosed recalcitrant pediatrics eczema for about 5 years. Other clinicians had previously treated him with emollients and topical corticosteroids with temporary relief but without improvement. The erythematous scaly patches were situated on the trunk and flank. On skin biopsy, the lymphocytic infiltrate was composed mainly of CD4+ and CD45RO+ lymphocytes. No T-cell receptor gene rearrangements were found. The paucity of knowledge about the evolution of this entity in childhood and its relationship to mycosis fungoides makes follow-up critical.
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Pleurodesis in pulmonary langerhans cell histiocytosis in children: A life-saving measure p. 160
Anand Prakash, Tarangini Durugappa, Priya Ramachandran, AV Lalitha
DOI:10.4103/ijmpo.ijmpo_250_17  
Isolated pulmonary Langerhans cell histiocytosis (LCH) is uncommon in children. Often recurrent pneumothorax complicates therapy and contributes to morbidity. Chemotherapy does not always prevent the complications of pneumothorax. We report here a young girl with isolated pulmonary LCH who presented with respiratory failure, successfully treated with chemotherapy, and pleurodesis. We report this case to highlight the use of pleurodesis in this setting.
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Isolated splenic recurrence of treated jejunal cancer: A case report with brief review of literature p. 163
Chaturbhuj Ramanand Agrawal, Manish Sharma, Vineet Talwar, Varun Goel, Ajit Pratap Singh
DOI:10.4103/ijmpo.ijmpo_242_17  
Spleen is a very infrequent site of metastasis despite the fact that it is the most vascular organ in the body. Even if systemic metastasis occurs, splenic metastasis largely remained asymptomatic due to its large functional reserve, and most often, the metastasis is detected incidentally on follow-up scan. Many cases of asymptomatic splenic metastasis detected on follow-up scans are reported in literature from different primary sites. Herein, we report a similar case of a 33-year-old male who presented with isolated splenic recurrence after a long treatment-free interval following curative treatment of adenocarcinoma jejunum. As stated, there are few previous reports of isolated splenic metastasis from carcinoma colon, but considering small intestinal adenocarcinoma, this is the first unique case reported to the best of our knowledge. Due to rarity of clinical scenario and lack of established guidelines, the treatment of such cases varies from patient to patient, and the knowledge, whatever we owe, is on the basis of case reports only.
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Squamous cell carcinoma developing De Novo in an untreated, nonsun-exposed psoriatic plaque p. 166
Sidharth Tandon, Prafulla Kumar Sharma, Kezhaleto Zutso, Ajeet Singh
DOI:10.4103/ijmpo.ijmpo_224_17  
Psoriasis is a chronic inflammatory dermatosis, which causes hyperproliferation of skin. Patients afflicted with psoriasis are also at a risk of developing nonmelanoma skin cancers, with the risk of such a possibility being attributed to the administration of systemic immunosuppressive agents, phototherapy, and biological agents. We present a case of psoriasis with de novo development of squamous cell carcinoma, in a photoprotected site, with no history of administration of systemic immunosuppressive agents, phototherapy, or biological agents.
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ALK-negative anaplastic large-cell lymphoma diagnosed on liver biopsy in a child presenting with nonresolving pyrexia p. 169
Aanchal Kakkar, Bhavna Sharma, Prasenjit Das, Siddharth Jain, Siddharth Dattagupta, Rita Sood
DOI:10.4103/ijmpo.ijmpo_153_17  
ALK-negative anaplastic large-cell lymphoma (ALCL) is a rare non-Hodgkin lymphoma occurring in adulthood. We report a case of a 13-year-old boy who presented with a 6-month history of fever with jaundice and pancytopenia. Computed tomography abdomen showed multiple hypodense lesions in the liver. Bone marrow biopsy revealed necrotizing granulomas. The patient was treated with antitubercular treatment but failed to show a response. Liver biopsy performed subsequently showed features of ALK-negative ALCL. Extranodal involvement in ALK-negative ALCL can have unusual clinical presentations. This case highlights the utility of timely tissue diagnosis in patients with nonresolving pyrexia and organ lesions on imaging.
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Pseudoprogression in rectal gastrointestinal stromal tumor p. 173
Virendra Meena, Binit Sureka, Poonam Elhence, Mayuresh Gautam, Pawan Garg, Pushpinder Singh Khera
DOI:10.4103/ijmpo.ijmpo_148_17  
Although gastrointestinal stromal tumors (GISTs) are common mesenchymal intestinal neoplasms, rectal GISTs are rare mesenchymal tumors of the GI tract. We describe a case of rectal GIST in a 63-year-old male. The patient was given imatinib monotherapy and was further followed up by contrast-enhanced computed tomography abdomen for response assessment. We conclude that although rectal GISTs are extremely uncommon, it should be considered as a differential when any rectal mass is incidentally detected. Oncologists and radiologists should also be aware of pseudoprogression phenomena of GISTs in evaluating tumor response.
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PRACTITIONER SECTION Top

Langerhans cell histiocytosis in a 5-year-old girl: A case report and review of literature p. 176
Shruthi Rao, Shruthi Hegde, PS Gopinath Thilak, G Subhas Babu, Vidya Ajila, Urvashi Shetty, Sajad Ahmad Buch
DOI:10.4103/ijmpo.ijmpo_258_17  
Langerhans cell histiocytosis (LCH) is an uncommon hematological disorder affecting infants and young children. LCH is a rare disorder of the reticuloendothelial system associated with proliferation of Langerhans cells and mature eosinophils. LCH can involve any bone, but the most common are pelvis, ribs, skull, long bones, vertebra, and facial bones. In the skull, frontal and parietal bones are commonly involved followed by the jaws, where mandible is more commonly affected than the maxilla. In this article, we report a case of LCH in a 5-year-old child involving the mandible. Swelling of one side of the face and aggressive periosteal reaction led to the diagnosis of monostotic LCH. The manuscript also summarizes the results of a literature search in PubMed of reported cases of LCH over the past 10 years.
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A rare case of endobronchial metastasis in a case of carcinoma tongue p. 181
Niharika Bisht, Sankalp Singh, Prabha Shankar Mishra, Samir Gupta, Amul Kapoor
DOI:10.4103/ijmpo.ijmpo_205_17  
Cancer of the tongue and other parts of the oral cavity are a leading cause of death in the worldwide population. The common sites of metastasis from oral cavity cancers are lung and bone. Endobronchial metastasis of an extra-thoracic malignancy is a rare phenomenon and such metastases from a malignancy of the tongue are almost unheard of. We present a case of carcinoma oral cavity with subsite tongue that after radical therapy of local site had an unusual site of distant metastasis in the right main bronchus, along with metastases to the lung parenchyma and right third rib.
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Solitary duodenal metastasis from renal cell carcinoma with metachronous pancreatic neuroendocrine tumor: Review of literature with a case discussion p. 185
Saphalta Baghmar, SM Shasthry, Rajesh Singla, Yashwant Patidar, Chhagan B Bihari, SK Sarin
DOI:10.4103/ijmpo.ijmpo_214_17  
Renal cell cancinoma (RCC) is a unique malignancy with features of late recurrences, metastasis to any organ, and frequent association with second malignancy. It most commonly metastasizes to the lungs, bones, liver, renal fossa, and brain although metastases can occur anywhere. RCC metastatic to the duodenum is especially rare, with only few cases reported in the literature. Herein, we review literature of all the reported cases of solitary duodenal metastasis from RCC and cases of neuroendocrine tumor (NET) as synchronous/metachronous malignancy with RCC. Along with this, we have described a unique case of an 84-year-old man who had recurrence of RCC as solitary duodenal metastasis after 37 years of radical nephrectomy and metachronous pancreatic NET.
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Calcium-sensing receptor polymorphisms at rs1801725 and high circulating calcium in breast cancer: Possible molecular explanation p. 191
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/ijmpo.ijmpo_195_17  
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3 doses versus 2 doses cervical cancer vaccination regimen: Cost–utility analysis based on tropical Southeast Asian Country, Thailand, situation p. 192
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/ijmpo.ijmpo_163_17  
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Organizing a cancer screening camp in low-resource settings: Experience from North India p. 194
MA Bashar, AK Aggarwal
DOI:10.4103/ijmpo.ijmpo_146_17  
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Pathologist's feast: Intranuclear inclusions in myeloma patient p. 196
Rateesh Sareen, Menka Kapil, GN Gupta
DOI:10.4103/ijmpo.ijmpo_178_17  
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Papillary tumor of the pineal region in an adolescent p. 199
Rituparna Biswas, Kalpana Kumari, KP Haresh, Subhash Gupta, Anirban Halder, GK Rath
DOI:10.4103/ijmpo.ijmpo_251_17  
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