Background: Maharishi Amrit Kalash (MAK) is an ayurvedic compound containing many herbs rich in antioxidants. We evaluated its role in reduction of chemotherapy toxicity among women with breast cancer. Patient and Methods: We recruited 214 patients with breast carcinoma receiving cyclophosphamide, methotrexate and 5- flourouracil (CMF) or cyclophosphamide, adriamycine,& 5-flourouracil (CAF), adjuvant or neo-adjuvant chemotherapy. The toxicity of chemotherapy was assessed according to WHO criteria. Statistical analysis was carried out on Epi-info 6 and STATA-7. All patients received same antiemetic therapy with ondensetron and dexamethasone. Results: There was a significant reduction in toxicities observed in MAK group throughout chemotherapy cycles: Poor performance status was prevented by concomitant administration of MAK along with chemotherapy.(Prevented Fraction (PF)=60.6% (95% confidence interval 22.1 to 80.1 ; p value =0.005 ). Vomiting was prevented by MAK {PF=40.3%, (95% confidence interval 15.1 to 58.1; p value=0.002)}. Similarly anorexia was reduced with PF= 35.6%. (95% confidence interval 17.6 to 49.7, p value = 0.0001) in MAK group. No improvement occurred in stomatitis, diarrhea, alopecia and leucopenia. No overgrowth of tumours occurred in the group treated with Neoadjuvant chemotherapy receiving MAK. Conclusion: MAK may be used as a supplement along with chemotherapeutic drugs for reducing chemotherapy induced vomiting, anorexia and improving general well being of patients.

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Borderline ovarian tumours are clinical entities less frequently encountered by obstetricians and gynecologists. Management options keep on changing with time and fertility sparing procedures and laparoscopy keep emerging. Surgical removal of all visible tumours still remains the most effective management. So far, non surgical treatment modalities have not been found to be beneficial. Pathologists are increasingly able to identify poor prognostic features in histology. Molecular biological studies are progressively being elucidated as prognostic features which might help us more in understanding the carcinogenic process and progression of the disease. This review outlines the recent literature regarding pathology, diagnosis, treatment, prognosis and recurrence. Oncologic concerns are discussed with emphasis on mode of surgery, fertility sparing surgery and the outcomes.

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The majorities of non-Hodgkin's lymphomas in children are lymphoblastic lymphoma, Burkitt's lymphoma, anaplastic large cell lymphoma and diffuse large B-cell lymphoma. Follicular lymphoma is primarily a disease of adulthood with a median age of 59 years. It is rare in pediatric patients. Childhood follicular lymphoma differs from its adult counterpart in several aspects. We report a rare case of childhood low grade mature B-cell non- Hodgkin's lymphoma wherein the tumour cells were CD20 +, focally bcl-6 +, CD3 -, CD5 -, CD10 -, CD23 -, Cyclin D1 -, bcl-2 -, and had a low ki-67 proliferation index. A diagnosis of follicular lymphoma was made on the basis of the focal bcl-6 positivity. Despite non-intervention in the form of chemotherapy or radiotherapy, the patient remained symptom free even after a followup of 39 months. This case is being reported for its rarity. This is one of the initial case reports on follicular lymphoma in pediatric age group from the Indian subcontinent.

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Umbilical nodule, universally known as Sister Mary Joseph's Nodule, mostly is a metastatic manifestation of an underlying advanced malignant disease and is associated with a grave prognosis. Umbilical swelling due to any benign disease is called Pseudo Sister Mary Joseph's nodule. A 41- year-old woman presented with a gradually increasing peri-umbilical nodule. Fine needle aspiration cytology of the nodule proved to be metastatic adenocarcinoma and search for the primary revealed an advanced gastric malignancy. An apparently insignificant umbilical nodule, may be the only manifestation of an underlying advanced malignant disease and therefore clinicians should be aware of such nodule. Histological/cytological examination of such a nodule not only confirms the diagnosis but also helps the clinician to search for the possible primary site.

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Background: Most cancer patients with metastatic disease have abnormal coagulation parameters. Although many abnormal blood coagulation tests have been reported in malignancies, there is little agreement regarding which tests are most useful to predict disease progression and hence this study was undertaken. Methods: In this prospective study, baseline and special coagulation tests were performed on 23 patients with ovarian adenocarcinoma. The baseline tests were PT, APTT, TT and platelet count. The special tests included factor VIII, factor IX and fibrinogen assay and semiquantitative measurement of D-dimer and FDP levels The cases were grouped into early and advanced disease groups. The results of the coagulation tests were analysed using suitable statistical methods. The results were compared between limited and advanced disease by chi square and Mann Whitney U test Results: The percentage of cases with increased D-dimer and fibrin degradation products (FDP) values were higher in the advanced disease compared to early disease. Two cases in stage IV had DIC. The PT, APTT, TT and platelet count did not show any statistically significant differences between the early and advanced disease groups. Factor VIII, factor IX and fibrinogen levels were not significantly different between two groups. Conclusion: Elevated D dimer& FDP are associated with advanced stage ovarian adenocarcinoma.

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Soft tissue and bone secondaries in supraglottic carcinoma are extremely rare. A 55 year old male presented with history of hoarseness of voice, lump in left side of neck and pain in right shoulder region. Patient underwent Radiotherapy to primary as well as metastatic sites. After 10 months of follow-up, patient presented with distant metastasis to left shoulder, lumbar vertebra and sacrum. This case is being reported on account of its rarity.

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Isolated Leptomeningeal metastasis in breast cancer is rare. The diagnosis requires T1W MR scan of brain with gadolinium enhancement and demonstration of malignant cells in CSF. The treatment is palliative, which includes whole brain radiotherapy and chemotherapy.

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Carcinoma of thyroid gland is rare in pediatric age group before the age of 15 years. A 11 months old child presented with swelling in midline of neck which showed cold nodule on thyroid scan. On fine needle aspiration biopsy (FNAC) papillary carcinoma of thyroid was detected and the patient underwent subtotal thyroidectomy followed by radioiodine ablation and thyroid supplementation. The case is being reported on account of its rarity.

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