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Indian Journal of Medical and Paediatric Oncology
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   2018| April-June  | Volume 39 | Issue 2  
    Online since March 21, 2018

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Blueberry muffin baby: An unusual presentation of infantile neuroblastoma
Mritunjay Kumar, Gaurav Batra, Aditya Saun, Ragini Singh
April-June 2018, 39(2):263-265
Neuroblastoma is the most common solid tumor of infancy presenting clinically in a plethora of different and sometimes unpredictable ways with a wide range of symptoms. Young children can present with bluish skin metastases that may resemble bruising secondary to child abuse. Blueberry muffin baby had been reported to be a manifestation of either dermal erythropoiesis secondary to some congenital viral infections or neoplastic infiltrations. Among the neoplastic diseases, neuroblastoma has been the most common association with these subcutaneous skin metastases. Here, we report 2 months infant with neuroblastoma who presented with abdominal distension and multiple blueberry muffin nodules.
  2,138 144 -
Assessment of BCR-ABL1 fusion transcripts and their association with response to imatinib treatment in chronic myeloid leukemia patients
Sailaja Kagita, Tulasi Krishna Mamidi, Leela Digumarti, Sadasivudu Gundeti, Raghunadharao Digumarti
April-June 2018, 39(2):165-171
Objectives: BCR-ABL1 fusion transcripts with contrasting data on response to imatinib therapy have been reported from different parts of the world. Hence, the present study aimed to determine the frequencies of transcripts and their association with response to imatinib therapy in chronic myeloid leukemia (CML) patients. Methods: A total of 170 (76 follow-up and 94 imatinib-resistant) CML samples were included in the study. BCR-ABL1 fusion transcripts and expression status were analyzed in all cases using multiplex reverse transcriptase PCyR and real-time PCyR. Sanger sequencing was used for tyrosine kinase domain (TKD) mutation screening in imatinib mesylate-resistant patients. Results: Of 170 CML patients, 36.36% showed b2a2, 63.53% had b3a2, and 2.94% had b2a2 + b3a2 isoforms. Mean platelet counts and blasts were significantly lower in b2a2 carriers (P = 0.0092; P ≤ 0.0001). Patients with b2a2 transcript were found to be more in responders group (both hematological and cytogenetic), whereas b3a2 patients were more in partial responders group and death (P = 0.763; P = 0.309). In follow-up patients, mean baseline BCR-ABL1 expression levels are significantly higher in b2a2 versus b3a2 carriers (P = 0.0351). Of 94 imatinib-resistant patients, 36 (38.29%) had acquired TKD mutations. Among 36 patients, mean BCR-ABL1 levels are significantly higher in b2a2 and b2a2 + b3a2 group (P = 0.0002; P ≤ 0.0001). TKD mutation frequency was more in b3a2 (61.11%) compared to other types. With respect to follow-up status in 36 patients, 17 patients died while 19 were on imatinib higher doses or 2nd-generation tyrosine kinase inhibitors. Of 17 patients, 41.66% had b2a2 transcript and 54.54% had b3a2 transcript. Conclusion: Patients with b3a2 transcripts might be associated with poor response and worse prognosis in CML with imatinib treatment.
  1,523 171 -
Cancer of unknown primary: Opportunities and challenges
LK Rajeev, Vikas Asati, KN Lokesh, AH Rudresh, Suresh Babu, Linu Abraham Jacob, D Lokanatha, Govind Babu, KC Lakshmaiah
April-June 2018, 39(2):219-226
Cancer of unknown primary (CUP) is defined as histologically proven metastatic tumors whose primary site cannot be identified during pretreatment evaluation. Among all malignancies, 3%–5% remained as CUP even after the extensive radiological and pathological workup. Immunohistochemistry and molecular gene expression tumor profiling are being utilized to predict the tissue of origin. Unfortunately, the survival of these patients remains poor (6–9 months) except in 20% of patients who belong to a favorable subset (12–36 months). There is a need to understand the basic biology and to identify the molecular pathways which can be targeted with small molecules. This article reviews our current approach as well as treatment evolution occurred in the past three decades.
  1,344 222 -
The biology of chronic myelogenous leukemia in childhood and young adolescents: An indian perspective
Dinesh Chandra, Jasdeep Singh, Roopam Deka, Richa Chauhan, Sudha Sazwal, Pravas Mishra, Tulika Seth, Manoranjan Mahapatra, Renu Saxena
April-June 2018, 39(2):142-145
Objective: The purpose of this study was to determine the clinical, biological, and molecular characteristics at diagnosis in children and adolescents with chronic myelogenous leukemia (CML) in the Indian scenario at our tertiary patient care center. Subjects and Methods: We evaluated 51 children and adolescents with CML registered at our clinic, from January 2007 to December 2015. The mean and median of various parameters were calculated using a Microsoft excel sheet and SPSS software version 16. Results: The median age of presentation in children was 16 years; 92.2% of them were older than 10 years, with a higher prevalence in boys than girls (gender ratio 2.6:1). The symptoms at presentation were fatigue, fever, awareness of mass due to splenomegaly, and bleeding manifestations. One patient presented with Bell's palsy. Markedly raised leukocyte counts were present in 29.4% patients (median white blood cell count >400 × 109/L). Most of the patients presented in the chronic phase of the disease, four each were in accelerated phase and blast crisis, respectively. Majority of patients were categorized as intermediate risk as per Sokal and Hansford score. About 60.7% of these pediatric patients fell in low-risk category as per European Treatment and Outcome Study score at baseline. A predominance of transcript P210-b3a2 (68%) was observed in the children who were studied for the type of chimeric BCR-ABL mRNA. Conclusions: This is one of the most recent reported series of CML in children and adolescents from India highlighting the difference in presentation from adults; mainly hepatomegaly, bleeding manifestations, and higher leukocyte count. Presence of b3a3 transcript of p210 breakpoint of BCR-ABL was more common in children (68%) than b2a2 transcript (32%) when compared to adults as recently described in a study from India, which may explain the differences at presentation.
  1,243 266 -
Nonsteroidal anti-inflammatory drugs and clinical outcomes among men with prostate cancer: A systematic review and meta-analysis
Divyesh Thakker, Amit D Raval, Nilixa Raval, Ami Vyas
April-June 2018, 39(2):127-141
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown properties of inhibiting the progression of prostate cancer (PCa) in preclinical studies. However, epidemiological studies yield mixed results on the effectiveness of NSAIDs in PCa. Objective: The objective of this study was to determine the effect of NSAID use on clinical outcomes in PCa using systematic review and meta-analysis. Methods: Original articles published until the 1st week of October, 2016, were searched in electronic databases (Medline-Ovid, PubMed, Scopus, The Cochrane Library, and Web of Science) for studies on NSAID use in PCa. The main clinical outcomes for the review were: PCa-specific (PCM) and all-cause mortality (ACM), biochemical recurrence (BCR), and metastases. Meta-analysis was performed to calculate the pooled hazard ratio (pHR) and their 95% confidence interval (95% CI). Heterogeneity between the studies was examined using I2 statistics. Appropriate subgroup analyses were conducted to explore the reasons for heterogeneity. Results: Out of 4216 retrieved citations, 24 observational studies and two randomized controlled studies with a total of 89,436 men with PCa met the inclusion criteria. Overall, any NSAID use was not associated with PCM, ACM, and BCR, with significant heterogeneity. Neither precancer treatment aspirin use (pHR: 1.00, 95% CI: 0.83, 1.19, P = 0.97, 5 studies, I2: 51%) nor postcancer treatment aspirin use (pHR: 0.94, 95% CI: 0.72, 1.23, P = 0.67, 8 studies, I2: 86%) was associated with PCM. Similar findings, that is, no significant association was observed for NSAID use and ACM or BCR overall, and in subgroup by types of NSAID use, and NSAID use following radiation or surgery. Conclusion: Although NSAID use was not associated with ACM, PCM, or BCR among men with PCa, significant heterogeneity remained in the included studies even after subgroup analyses.
  1,169 211 -
Adding olanzapine to three drugs anti emetic regimen: Is it time to jump the gun?
Aditi Aggarwal, Vinod Sharma, Sameer Rastogi
April-June 2018, 39(2):125-126
  1,112 231 -
Breast cancer awareness among women in an urban setup in Western India
Ranvijay Singh, Nishitha Shetty, Parashar Rai, Ghanshyam Yadav, Mukti Gandhi, Maryam Naveed, Ashwini M Ronghe
April-June 2018, 39(2):215-218
Introduction: Breast cancer is a leading cause of death among women globally. Better outcomes for patients can be ensured by early detection and treatment. Early detection requires a high degree of awareness about the various aspects of cancer including etiology, risk factors, signs and symptoms, and breast self-examination (BSE) practices. The purpose of this study was to assess the knowledge and awareness related to breast cancer along with willingness for treatment, among women in an urban setup in Western India. Materials and Methods: We conducted a cross-sectional study with 500 women belonging to the age group of 18–70 years residing in an urban area of Mumbai. Data were obtained through the use of a structured questionnaire over a period of 6 months (April–September 2016). Results: Over half of the respondents (71.42%) knew the symptoms of breast cancer. Awareness regarding the risk factors was varied. Although most (85.71%) of the respondents knew about BSE, contrastingly very few (38.09%) actually performed it. Awareness regarding diagnostic tests was limited to mammography and biopsy, but 90.47% of the women were willing to undergo these tests. 66.67% of women reported that the best treatment for breast cancer was surgery. Conclusion: Awareness of the different presentations of breast cancers (other than lump) is limited and so is the knowledge pertaining to risk factors. A lower level of education is most likely responsible for the low level of awareness and this is the main obstacle for undergoing regular cancer screening and early detection. There is a need of developing an effective health education programs to educate women about breast cancer, propagate valid information via the media, and promote early detection of breast cancer to ensure better outcomes.
  1,126 150 -
Monoclonal gammopathy in chronic lymphocytic leukemia: A case report and review of its literature
Vasu Babu Goli, Reetu Jain, Ganapathi Bhat, Anjana Sainani, SH Advani
April-June 2018, 39(2):257-259
The presence of monoclonal gammopathies in B-cell malignancies occurs frequently. Monoclonal proteins are present in a significant number of patients with chronic lymphocytic leukemia (CLL), which is a disorder of antigen-stimulated mature B-cells. The recognition of monoclonal proteins or light chains in the serum and/or urine is increased in the majority of CLL patients with the use of highly sensitive laboratory methods such as serum immunofixation studies. A different autoimmune phenomenon may explain the presence of some of these monoclonal proteins. Some reports indicate that the finding of monoclonal proteins has a negative impact on patients' survival. However, there is no clear evidence to suggest the prognostic significance of monoclonal proteins in patients with CLL. Although the presence of monoclonal proteins in CLL occurs usually at an incidence of 60%–80%, there are very few cases reported in literature. We report a case of CLL diagnosed in 2009 who developed disease progression along with the presence of immunoglobulin kappa monoclonal gammopathy. Although the presence of monoclonal gammopathy might be due to the use of highly sensitive methods, this can be due to autoimmune phenomenon or development from the same or different clone of B-cells.
  1,114 98 -
CT-guided lung fine needle aspiration biopsy: Analysis of efficacy, yield and intricacies
Anirudh V Nair, Soumya Anirudh, Srikanth Moorthy, P Cyril, Bindhu Mangalath Rajamma, PV Ramachandran
April-June 2018, 39(2):178-183
Aim: This study aims to evaluate various factors that affect the cytological yield while performing computed tomography (CT) guided lung fine needle aspiration biopsy and to determine the complication rate of this procedure. Materials and Methods: In this cross sectional study, we analyzed 70 patients undergoing CT-guided transthoracic lung fine-needle aspiration biopsy (FNAB). 22-gauge spinal needle was used in sixty patients and 20-gauge in ten patients. The presence and absence of an onsite cytopathologist affecting the adequacy of yield for a conclusive cytodiagnosis was compared in groups of 35 patients each. The incidence of complications such as pneumothorax, pulmonary hemorrhage was recorded. Results: Cytological yield was adequate for a conclusive cytodiagnosis in 59 cases (84.2%). Thirty-seven cases (52.8%) were malignant with adenocarcinoma (70.2%) being the most common, 22 cases (31.4%) had benign etiology. Cytological yield was adequate for a conclusive diagnosis in the group (n = 35) with an onsite cytopathologist (100%) compared with those cases without an onsite cytopathologist (68.6%) (P = 0.005). Pneumothorax was observed in 16 cases (22.8%), the incidence of pneumothorax was higher when there was an intervening parenchyma (P = 0.005). Conclusion: CT-guided transthoracic FNAB is an accurate method to rule out malignancy with a reasonable rate of complications. The presence of an onsite-cytopathologist significantly improves the adequacy of yield for a conclusive cytodiagnosis, and should be routinely employed. Pneumothorax and pulmonary hemorrhage are the most common complications as a result of FNAB. The incidence of pneumothorax is higher when there is intervening lung parenchyma.
  1,008 135 -
Tumor infiltrating cytotoxic CD8 T-Cells predict clinical outcome of neuroblastoma in children
Mahtab Rahbar, Mitra Mehrazma, Mersedeh Karimian
April-June 2018, 39(2):159-164
Context: Neuroblastoma is often infiltrated by inflammatory cells, particularly macrophages and T lymphocytes, but the significance of these cells remains unclear. One possible role of these inflammatory cells is that they represent a cell-mediated immune response against cancer. CD8+ lymphocytes are a known crucial component of cell-mediated immunity. The purpose of this study was to explore the prognostic value of tumor-infiltrating CD8+ cytotoxic lymphocytes in Neuroblastoma. Subjects and Methods: Tumor-infiltrating CD8+ lymphocytes were assessed by immunohistochemical staining of tumor tissue from 36 neuroblastoma from April 2008 to May 2015. The number of CD8+ T-cells was counted in tumor nest (intratumoral) and in the fibrovascular stroma of tumor (peritumoral), and their relationship with clinicopathologic outcome was determined. Results: The total number of CD8+ cells was inversely correlated with tumor histology grade (P < 0.001), vascular invasion (P < 0.001), capsular invasion (P < 0.002), calcification (P < 0.005), necrosis of tumor (P < 0.001), regional lymph nodes invasion (P < 0.003), distant metastasis (P < 0.003), stage (P < 0.003), and was positive correlated with N-myc oncogene presentation (P < 0.002) in neuroblastoma. However, there were no correlation between patient's age, sex, and size of tumor with infiltration of CD8+ cells (P < 0.097, P < 0.142, and P < 0.722, respectively). Conclusions: In this analysis, total CD8 T-cell count was a dependent prognostic factor in children. Total number and stromal CD8 lymphocytes were associated with better patient survival (P < 0.003 and P < 0.05, respectively) in children. These results suggest that tumor-infiltrating CD8 T lymphocytes have antitumor activity and influence the behavior of neuroblastoma and might be potentially be exploited in the treatment of neuroblastoma in children.
  945 123 -
Infections during induction chemotherapy in children with acute lymphoblastic leukemia – Profile and outcomes: Experience from a cancer center in South India
Binitha Rajeswari, Reghu K Sukumaran Nair, CS Guruprasad, Manjusha Nair, Priyakumari Thankamony, Kusumakumary Parukutty
April-June 2018, 39(2):188-192
Objective: The objective of this study is to describe the incidence, clinical, laboratory and microbiological profile, treatment, and outcome of infections during induction chemotherapy in children with acute lymphoblastic leukemia (ALL). Materials and Methods: This was prospective, observational study. All children aged 1–14 years, newly diagnosed to have ALL and attending the Pediatric oncology division at our center were included. Induction chemotherapy was administered as per a modified Berlin-Frankfurt-Münster protocol. The study period was from January 2014 to June 2015. Results: Two hundred and twenty-seven patients with ALL were included in the study. One hundred and fifty episodes of infection occurred among 117 patients. Major sites of infection were lung (n = 35) and gastrointestinal tract (n = 30). Blood cultures were positive in 45 episodes (30.6%) with Gram negative organisms being the predominant isolates. The most common organisms isolated were Pseudomonas aeruginosa and Klebsiella spp. The response to antibiotics was good with only 18% of episodes requiring a third-line antibiotic. One hundred and thirty-six (90.6%) episodes resolved without sequelae. Overall induction mortality (12 out of 227-5.3%) was mainly accounted for by infections. Conclusions: Infections are the major cause of mortality and morbidity in patients with ALL on induction chemotherapy. The outcomes are good for the majority of patients if they receive adequate antibiotics early in the course of infection.
  892 157 -
Neoadjuvant chemotherapy for larynx preservation: Has it lost importance?
Rony Benson, Supriya Mallick, GK Rath
April-June 2018, 39(2):227-233
Over the time, the aim of treatment for locally advanced laryngeal and hypopharyngeal carcinoma has changed from cure to cure with the functional larynx. Chemoradiation has emerged as the most important therapeutic modality for patients with locally advanced disease. However, systemic failure remains an important area of concern. Induction chemotherapy has emerged as promising organ preservation approach as it gives an window to select responders and continuing treatment with nonsurgical approach as well as reduces systemic recurrence and improve survival with a functional larynx. However, there are questions about the efficacy of this approach. In this context, we aim to evaluate the trials for locally advanced laryngeal and hypopharyngeal cancer attempting to optimize therapeutic outcome with addition of induction chemotherapy. This present review intends to look into the therapeutic ratio of induction chemotherapy for disease control, organ preservation.
  900 139 -
Malignancy associated microangiopathic hemolytic anemia and thrombocytopenia
Mansoor C Abdulla, Jemshad Alungal, Lekha K Nair, Mohthash Musambil
April-June 2018, 39(2):254-256
Disseminated malignancy can rarely present with microangiopathic hemolytic anemia and thrombocytopenia clinically similar to thrombotic thrombocytopenic purpura (TTP), but does not respond to plasma exchange. TTP carries a grave prognosis if plasma exchange is delayed. Evaluating patients presenting with microangiopathic hemolytic anemia and thrombocytopenia is challenging for clinicians. Thrombotic thrombocytopenic purpura (TTP) should be considered in such patients and emergency plasma exchange is to be initiated. But all the clinical features seen in TTP can be caused by a disseminated malignancy. The awareness of such a rare presentation of disseminated malignancy helps clinicians to avoid unnecessary delay in appropriate treatment and the complications due to plasma exchange. We report two patients who presented with microangiopathic hemolytic anemia and thrombocytopenia due to disseminated malignancy.
  942 87 -
Pediatric differentiated thyroid carcinoma risk factor for analysis for disease free survival
Yohana Azhar, Dimyati Achmad, Kiki Lukman, Dani Hilmanto
April-June 2018, 39(2):153-158
Context: The context of this study was epidemiology pediatric thyroid cancer in Bandung, Indonesia. Aims: The aim of this study is to evaluate clinical characteristics and outcome between children and young adult patients with differentiated thyroid cancer (DTC) treated in our hospital. Settings and Design: This was a cohort retrospective study. Materials and Methods: The medical records of 144 patients with DTC who underwent thyroid surgery followed by radioiodine and thyroid hormone suppression were retrospectively reviewed. Thyroid cancers were diagnosed between January 2007 and December 2010. Participants consisted of 43 patients who were younger than 21 years old and 101 young adult patients (older than 21 years old but younger or equal to 40 years). The clinical characteristics and outcomes were analyzed and compared, and then, recurrence-free survival was evaluated using Kaplan–Meier methods. Statistical Analysis Used: Software R 3.3.0 version for Windows was used in this study. Results: Female has higher tendency to have thyroid cancer than male (P = 0.006). Based on histopathology report, classic papillary thyroid cancer is the most common cancer type in children than young adult. However, there was no significant difference between two groups regarding thyroid cancer size and multifocality (P = 0.815 and P = 0.370). The risk of recurrent ratio of children to young adults is 3.88 (95% confidence interval [CI] 1.38; 10.91). A similar result trend has been shown for sex type, histopathology type, number of nodules, surgical technique, and metastasis parameters (adjusted hazard ratio = 7.91, 95% CI 2.11; 29.67). Conclusions: DTC in children shows more aggressive behavior compared to young adult patients.
  843 121 -
Mixed nonseminomatous germ cell tumor with rhabdomyosarcomatous malignant transformation in a pediatric patient
Robin L Pham, Anish Ray, Linda R Margraf
April-June 2018, 39(2):250-253
Testicular germ cell tumors (GCTs) are the most common malignancy in males aged 15–34. The transformation of GCTs into secondary somatic-type malignancies is rare, and the lack of clear treatment guidelines presents a clinical challenge for treating physicians, especially when chemosensitivities do not overlap. We present the case of a 15-year-old-male with a mixed nonseminomatous malignant GCT with an embryonal rhabdomyosarcoma component, which made up 60% of the primary tumor. He was successfully treated with surgical resection and chemotherapy. We highlight our experience in diagnosing and treating this tumor, and through literature review, suggest treatment guidelines for treating a pediatric patient with similar tumor presentation.
  863 88 -
Malignant peripheral nerve sheath tumor of the pelvic retroperitoneum misdiagnosed as carcinoma ovary
Murali Subbaiah, Bhawna A Badhe, Gowri Dorairajan, Priyadarshini Dehuri
April-June 2018, 39(2):234-236
A 52-year-old postmenopausal female was found to have a large solid cystic adnexal mass, compressing the right ureter, and was suspected to have carcinoma ovary. However, it turned out to be a retroperitoneal neurogenic tumor. Malignant peripheral nerve sheath tumors (MPNST) may have cystic areas and may be misdiagnosed as ovarian tumors. Treatment of MPNST involves complete surgical excision of the tumor with a wide margin.
  772 72 -
Elevated p63 expression as an indicator for poorer prognosis in squamous cell carcinomas of the oral cavity: An immunohistochemical study
Arvind Venkatesh, Vijay Wadhwan, Pooja Aggarwal, Vandana Reddy, Preeti Sharma, Suhasini Palakshappa Gotur, Chitrapriya Saxena
April-June 2018, 39(2):146-152
Background: Oral cancer remains one of the most debilitating and disfiguring of all malignancies. The survival rates for oral cancer vary, depending on several factors. Although p63 is an accepted prognostic marker in various other carcinomas, no consensus has been obtained till date regarding the applicability of p63 as a prognostic marker in head and neck squamous cell carcinomas (SCC). Aim and Objectives: The present study was conducted to determine the applicability of p63 as a prognostic marker in oral squamous cell carcinomas (OSCC) using incisional biopsies. Materials and Methods: Incisional biopsies of 27 candidates who were histopathologically diagnosed with SCC (8070/3) of the oral cavity (C06.9) (OSCC) between January 2013 and June 2014 were included in the trial. Sections were subjected to immunohistochemistry with p63 as the primary antibody. The percentage p63 expression was calculated and compared based on their Broders' and Anneroth's multifactorial grading systems with the overall survival status of the patients. Results and Observations: A statistically significant increase (P = 0.0203) was found between p63 expression and the histological grading of the tumor (from Grade I OSCC to Grade III OSCC). Similarly, a statistically significant correlation (P = 0.013) was obtained between mean Anneroth score (MAS) and the Broders' grading. Log-rank (Mantel-Cox) test showed statistical significance for the survival curves when the candidates were classified based on % p63 expression (P = 0.0049) and MAS (P = 0.0003). Conclusion: We have shown expression of p63 to correlate with survival in OSCCs, where high expression was seen in tumors with poorer survival after treatment. Furthermore, the usage and importance of Anneroth's multifactorial grading system over Broders' grading system in routine histopathological reporting for incisional biopsies of OSCCs is stressed.
  732 109 -
KRAS and NRAS testing in metastatic colorectal cancer in Central Iran (Tehran): A review on literature of the middle east
Ali Shahriari-Ahmadi, Nafise Ansarinejad, Farshid Fardad, Mehrdad Abbaszadeh, Masoud Sadeghi
April-June 2018, 39(2):210-214
Context: The incidence of colorectal cancer (CRC) in the past three decades in Iran has made it as a major public health burden. Aims: The aim of this study is to report the prevalence of KRAS and NRAS mutations in Iran and the correlation between KRAS mutation status with clinicopathological factors and survival. Materials and Methods: In a cross-sectional study, 144 patients were entered into the study based on the criteria. Age, sex, tumor site, grade, metastasis location, familial history, KRAS/NRAS status, and survival were checked for all patients, and the patients were followed for 1 year. DNA was extracted with FFPE QIAGEN kit and then polymerase chain reaction for amplification of gene segments of KRAS and NRAS genes. Results: The mean age at diagnosis was 52.9 years (range: 27–72 years) that 39.6% patients had age <50 years and 54.2% were men. KRAS mutation was significantly more in the patients with age ≥50 compared with KRAS wild type. Furthermore, the 6-month overall survival rate in KRAS mutation patients was significantly more than KRAS wild-type patients. Liver metastasis (72.9%) had the highest prevalence of metastasis in the patients, and Grade II with 64.6% had the most prevalence. Conclusions: The metastatic CRC was more prevalent in men than women, and the mean age varied around 50–60 years. The results showed that the present study had the highest prevalence of KRAS mutation in the Middle East and Pakistan with the lowest prevalence in CRC patients.
  685 95 -
Recurrent atypical meningioma with pleural metastases
Sarah Premraj, Femela Muniraj, Juhi Riaz, Balamurugan Senthilnayagam
April-June 2018, 39(2):241-243
Meningiomas are the most common primary intracranial tumors in adults. Although Grade I meningiomas are considered benign, Grade II/III (atypical and anaplastic) meningiomas are known to be locally aggressive, recurrent, and rarely present with distant metastases. We report a 40-year-old female with recurrent atypical meningioma (WHO Grade II) who presented with features suggestive of a massive right-sided pleural effusion. Imaging showed bilateral large pleural-based lesions, and histopathological examination and immunohistochemistry of the mass were consistent with metastatic atypical meningioma. A high index of suspicion is warranted to detect extracranial metastases, especially in patients with recurrent meningiomas and higher WHO grade of tumor.
  692 84 -
Isolated primary non-hodgkin's lymphoma of the esophagus
Pavan Thulasi Sugoor, Sabita Jiwnani, Bharat Rekhi, George Karimundackal, Nilendu Purandare, CS Pramesh
April-June 2018, 39(2):244-246
Isolated primary esophageal lymphoma, defined as a lymphoma developing in the esophageal wall, is a distinctly rare presentation and accounts for <1% of all gastrointestinal lymphomas and <0.1% of all malignant lymphomas. The clinical and biological characteristics of the disease are not well known due to its rarity, compounded with a low index of suspicion during diagnosis. We report a rare case of an immunocompetent patient diagnosed with an isolated primary esophageal non-Hodgkin's lymphoma of diffuse large B-cell type. Clinicoradiological and histopathological features, treatment, and outcome, along with a brief review of the literature, are discussed herewith.
  680 88 -
Peculiarities of yolk sac tumor in head and neck: A case report and literature review
K Devaraja, Kapil Sikka, Pankaj Kumar Singh
April-June 2018, 39(2):260-262
Yolk sac tumor (YST) is the most common malignant germ cell tumor of head and neck region, constituting around 1% of all malignant germ cells. The rarity of the tumor has led to a relatively sparse collective description of clinical and prognostic factors of such a tumor affecting head and neck region. In this case report with review of the literature, we have highlighted certain peculiar features of YSTs affecting the head and neck region. They seem to commonly affect female children. These tumors seem to fare poorly in children of <1 year of age. Multimodality of treatment consisting of combination chemotherapy with the cisplatin-based regimen and surgery and/or radiotherapy helps in achieving long-term disease-free survival in those affected.
  635 90 -
Study of clinicopathological spectrum and pattern of expression of Cyclooxygenase-2 in urothelial carcinomas of bladder
Ranjana Bandyopadhyay, Ujjwal Bandyopadhyay, Uttara Chatterjee, Sukla Naskar, Sumit Nandy, Keya Basu
April-June 2018, 39(2):172-177
Introduction: Overexpression of cyclooxygenase-2 (COX2) in urothelial carcinoma of bladder (UCB) had been studied in the past by different workers and the results were contradictory. The objective of the present study was to evaluate the prognostic implication of COX2 expression in primary urothelial carcinomas of the urinary bladder and its correlation with clinical parameters, tumor stage, grade, and recurrence. Materials and methods: A total of 68 cases who underwent surgery for urothelial carcinoma in our medical college from January 2013 to December 2015 were evaluated in our study. Hematoxylin and eosin-stained slides were examined by two faculties applying standard reporting protocol. Tumor staging and grading was performed as per the WHO guidelines. Immunohistochemistry for expression of COX2 was performed to study any correlation of tumor grade with COX2 expression. The distribution of COX2 positivity was studied in tumors stratified according to established bladder cancer prognostic factor, for example, tumor size, grade, invasion, and spread. Results: Out of 68 cases, 42 cases showed COX2 positivity (61%). In low-grade cases of bladder carcinoma, COX2 positivity was 16 out of 24 cases (60%), and in high-grade cases, COX2 positivity was 10 out of 18 cases (64.28%). Conclusion: In the present study, the association of COX2 overexpression with advanced tumor invasion and tumor grade has been substantiated. Hence, COX2 expression can be taken as a prognostic factor along with other usual prognostic factors in patients of UCB.
  643 77 -
Epstein–Barr virus infection in adult patients with gastric cancer in Northeast of Iran
Sakineh Amoueian, Armin Attaranzadeh, Zeinab Gholamimoallem, Masoud Sadeghi, Seyed-Mehdi Hashemi, Abolghasem Allahyari
April-June 2018, 39(2):206-209
Background: Epstein–Barr virus (EBV) is a DNA virus from human herpes virus that associates with many of the human cancers including gastric cancer (GC). Aims: The aim of the present study was to report infection of EBV in adult patients with GC in Northeast of Iran and the correlation between a number of clinicopathology factors with EBV status. Materials and Methods: In a case–control study in 2016, 56 GC patients and 56 controls were selected for the analysis. All patients had gastric adenocarcinoma untreated patients with age >18 years. EBV status detected by the polymerase chain reaction method. Results: Out of 56 GC patients, 35 (62.5%) were EBV positivity and out of 56 controls 3 (5.4%) were EBV positivity (P < 0.001). There is not a significant correlation between the variables with the EBV status (P > 0.05). Furthermore, the progression-free survival rate for the patients with EBV negativity was 95.2% compared with 82.9% for EBV positivity (P = 0.174). Conclusions: This study reported a very high prevalence of EBV-associated GC in the Northeast of Iran compared with other areas of the World and showed a significant correlation between EBV infection and incidence of GC.
  624 85 -
Bowel lymphoma in children: Management and outcome
R Veerabhadra, G Krishna Kumar, J Bibekanand, N Bikash Kumar, S Kumaravel, B Bhawana, D Biswajit
April-June 2018, 39(2):184-187
Background: Primary bowel lymphoma is an uncommon neoplasm in children and not well documented in literature with regard to its outcome and management. Materials and Methods: A case record review of children with bowel lymphoma was undertaken in a tertiary care institute, from 2010 to 2016 and the relevant data were recorded. Results: 21 children were managed with bowel lymphoma over a period of 7 years. Pain abdomen was the most common presenting symptom (19/21). Ileum was the site of involvement in most children (17/21). Localised disease was seen in 13/21 while 8 had diffuse involvement. Predominantly (13/21) children presented at an advanced stage (III/IV). Surgical intervention was needed in 14/21 while 7/21 were managed only with chemotherapy. Majority (15/21) had Burkitt's lymphoma on histology. 13 of 21 (61.9%) have completed chemotherapy and on regular follow up. Among 8 who died, 6 were directly related to disease progression despite aggressive management. Conclusion: Bowel lymphoma in children is distinctly different in the site of presentation from that of the adults. Advanced stage at presentation portends poor prognosis. Bowel lymphoma is to be considered in case of recurrent intussusception in children.
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Effect of ethanol as an adjuvant to extended curettage on recurrence rate of unicameral bone cyst
Saeed Solooki, Hamideh Mahdaviazad, Amir Reza Vosoughi, Yaghoob Keikha, Babak Pourabbas, Seyed Ali Hashemi
April-June 2018, 39(2):193-195
Background: To assess the efficacy of ethanol as an adjuvant in the treatment of unicameral bone cyst (UBC). Materials and Methods: Surgically treated patients with UBC lesion were reviewed. Definite treatment of UBC lesions was conducted using a combined four-step alcohol-using approach, consisted of curettage, burring, ethanol 96%, and electrocauterization of the lesion, consecutively. Results: Twenty-one patients (mean age 14, range: 2–30, male 62%) were followed from 1 to 10 years. Among 18 cases, only one recurrence was seen in a 5-year-old boy with UBC of the left calcaneus. Conclusions: Using ethanol as an adjuvant may be a good choice for treatment of UBC lesions.
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Xeroderma pigmentosum and bone marrow aplasia: A rare association
Sakthisankari Shanmugasundaram, Prasanna N Kumar, S Vidhya Lakshmi, V Chaitra
April-June 2018, 39(2):247-249
Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder characterized by hypersensitivity to ultraviolet rays and predisposition to cutaneous malignancies. Hematological disorders associated with XP include myelodysplastic syndrome and acute leukemia. We report a 7-year-old child with XP along with squamous cell carcinoma and bone marrow aplasia.
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Pretherapeutic assessment by multidetector computed tomography for thyroid cartilage invasion in laryngeal cancer: A double-edged sword
Manali Arora, Vishal D Thakker, Geetika Sindhwani, Jayesh Bhatt, Monica Gupta, Jay Shah
April-June 2018, 39(2):196-202
Introduction: Almost one-fourth of head and neck cancers in India are laryngeal cancers. Both conservative and surgical therapeutic approaches are available. According to present tumor-node-metastasis staging protocol, thyroid cartilage invasion is a crucial criterion for diagnosing advanced stages of the disease. A major cartilage invasion depicts T4A stage of disease for which surgical treatment is required. Aims: The present study aims to evaluate the accuracy of multidetector computed tomography (MDCT) in evaluation thyroid cartilage invasion in T3 and T4 stage of laryngeal cancers. Materials and Methods: It is a retrospective analysis done in the Department of Radiology, Pramukhswami Medical College, Anand, Gujarat, on 22 patients of T3 and T4 stage of laryngeal cancer who presented for pretherapeutic MDCT neck evaluation. The MDCT results were retrospectively reviewed and compared with postoperative histopathological results. Statistical analysis was done for each parameter as positive predictive value (PPV) (main statistical parameter), negative predictive value, sensitivity, and specificity. Results: MDCT showed a PPV of 60.00% in detecting any type of thyroid cartilage invasion, 66.66% for major and 33.33% for minor cartilage invasion. Extralaryngeal spread of disease was the most specific marker for cartilage involvement. In total, 31.8% of cases were downgraded in staging by pathology. Conclusion: Overestimation of thyroid cartilage invasion by MDCT is a reality which should be in mind before making final therapeutic decisions. Although crucial, it should not be the sole criteria preventing while making a surgical versus conservative therapeutic call.
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Pediatric intraparotid neurofibroma: Rare entity
Sushil Suresh Chavan, Prakash S Nagpure, Ravi Ganeshkar
April-June 2018, 39(2):203-205
Aim: This case report provide an awareness of intraparotid facial nerve neurofibroma as a cause of parotid masses and to describe their characteristics and management considerations. Material: It is a case report of a pediatric patients with intraparotid facial nerve neurofibromas which is a rare entity. Method: It was preoperatively diagnosed as intraparotid benign tumor likely to be pleopmorphic features on fine needle aspiration cytology.Tumors arising from the extratemporal course of the facial nerve are quite rare. The tumors arise from Schwann cells and include the schwannoma and the neurofibroma. Conclusion: The overwhelming benign nature of these lesions necessitates a conservative course of treatment. Histological diagnosis should be followed by a limited tumor excision with emphasis on retaining normal facial nerve function. Malignant lesions require wide excision with facial nerve grafting or facial nerve reanimation.
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Borderline phyllodes tumor arising in a complex fibroadenoma with extensive squamous metaplasia: A complex pathological presentation
Rajeshwari K Muthusamy, Sangita S Mehta
April-June 2018, 39(2):266-267
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A rare nonhepatocytic primary liver neoplasm with an unusual presentation: Ossifying malignant mixed epithelial and stromal tumor
Albina Venus, Sangita Sharma Mehta, Sumathi Natarajan
April-June 2018, 39(2):237-240
We present a case of a rare liver neoplasm – Ossifyimg malignant mixed epithelial and stromal tumor. This entity has well-delineated morphological and immunohistochemical features, and so can be easily diagnosed, even with core biopsy tissue. Our patient was a middle-aged male, which is unheard of in the literature of this disease. He had a bad recurrence of the disease after surgical removal of the tumor, unlike the previously reported cases with the same diagnosis, where the patients lived for almost a decade after surgery without recurrence. This neoplasticdisease can thus take a destructive course, and a change in treatment methods such as neoadjuvant or adjuvant chemotherapy should be thought of, to make it more beneficial and effective.
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