Background: Teratoma refers to neoplasm containing at least two germ cell layers derivatives foreign to the site of origin. Sacrococcygeal teratoma is most common congenital tumor commonly present as an exophytic mass of varying size at coccyx. Aims and Objectives: (1) The aim is to find age, sex, and clinical presentation of cases of sacrococcygeal teratoma. (2) Application of American Academy of Pediatrics' surgical section classification and histological grading in all cases. Materials and Methods: A retrospective, observational study was conducted in the Department of Pathology in collaboration with the Department of Pediatric Surgery from February 2009 to January 2014. A total 13 cases of sacrococcygeal teratoma were included in the present study. The records of these patients were reviewed, and clinical profiles were noted. An average 12 slides were examined in each case to evaluate histological type and grades. Results: A retrospective study was conducted including thirteen cases of histologically confirmed sacrococcygeal teratoma over 5 years period. Male to female ratio was 1:2. As per as age distribution is concerned, 3 neonates (23%) presented with sacrococcygeal mass. Associated congenital malformation was seen in 2 cases (15.4%). According to the American Academy of Pediatrics (Altman's) classification, 23% of cases were Type I, 31% of cases patients Type II, 31% of cases Type III and 15% were for Type IV. The significant presacral component was noted in all malignant tumors. Conclusion: Two clinical patterns were observed in sacrococcygeal teratoma related to the age of presentation. As sacrococcygeal teratoma has potential to become malignant, meticulous search for the malignant component is required for histopathological categorization.

Context: Recent studies show that enzymatic contents of the neutrophil granules have a remarkable ability to modulate the tumor microenvironment by causing apoptosis of T-lymphocytes which leaves the host's cell-mediated immunity at stake. The preoperative neutrophil to lymphocyte ratio (NLR) is considered to be an indicator of the immune status of the patients with oral squamous cell carcinoma (OSCC), which will thereby help in predicting the course of the disease. Aims: The aim is to assess the NLR and histopathological prognostic factors pertinent to infiltration of the surrounding structures and correlate them with the clinical prognostic outcomes of OSCC. Settings and Design: This retrospective study involved the retrieval of formalin-fixed, paraffin-embedded, hematoxylin, and eosin-stained sections of 55 cases of OSCC from the departmental archives from 2006 to 2014. Subjects and Methods: Grading of each case was done by Bryne's grading system. The preoperative complete blood counts, relevant case history, and clinical data of the patients involved in the study were collected from the institutional medical records. The NLR was calculated by dividing the serum neutrophil count by the serum lymphocyte count. Statistical Analysis Used: The median NLR was compared between the controls and OSCC cases using Wilcoxon-signed rank test, and the Kaplan-Meier survival analysis was carried out to predict the survival and recurrence status of OSCC. Results: Higher NLR was seen in lymph node and margin-involved cases and also in patients who had tumor recurrence. Kaplan-Meier survival analysis showed that the mean survival dropped from 26 to 4.5 months when NLR ≥5 (P = 0.052). Conclusion: Neutrophil-to-lymphocyte ratio can be used as a prognosticator of survival, recurrence, lymph node status, and margin status in OSCC.

Background: There is a paucity of data on pediatric nonblastic non-Hodgkin's lymphoma (NHL) from developing countries. We conducted this study to study outcome and identify risk factors that can predict survival in pediatric nonblastic NHL at our center. Methods: Patients <18 years of age who were diagnosed with nonlymphoblastic NHL at our hospital from January 1, 2005, to December 31, 2014, were included. Data were collected retrospectively from case records. Results: One hundred and two patients with median age of 12 years (range: 1–18) were included in the study. There were 69/102 (68%) male and 33/102 (32%) female patients. The most common histological diagnosis was Burkitt's lymphoma (BL) in 59/102 (58%) patients followed by anaplastic large cell lymphoma (ALCL) in 28/102 (28%) patients and diffuse large B-cell lymphoma (DLBCL) in 12/102 (12%) patients, T-cell lymphoma in 2/102 patients, and primary mediastinal B-cell lymphoma in 1/102 patients. The LMB-89 protocol was the most common protocol used for treatment in 74/102 (72%) patients. The 2-year event-free survival (EFS) for patients with BL, ALCL, and DLBCL was 72%, 55.8%, and 27.5%, respectively (P = 0.037). On univariate analysis, factors that significantly predicted poor EFS included non-BL histological subtype, poor performance status, malnutrition, use of less intense chemotherapy, and not achieving complete response on interim radiological assessment. Conclusions: Outcomes in nonblastic NHL from our center are worse compared to data from the west. This is because a large proportion of patients present with advanced stage and in moribund condition. Patients with BL have better outcome compared to other subtypes.

Background: Cervical metastasis has a tremendous impact on prognosis in patients with head and neck squamous cell carcinomas (HNSCCs). However, to date management of clinically negative neck in HNSCC is still a controversial subject. Tumor thickness (TT) is a strong predictor for lymph node involvement in oral squamous cell carcinomas (SCCs). However, controversy exists about the optimal TT cutoff point for a clinically relevant risk to the neck. Aim and Objectives: The aim is to evaluate the relationship between TT and the risk of cervical lymph node involvement and to determine optimal TT cutoff point for prompting prophylactic neck management. Materials and Methods: The clinical files and histological sections of 35 SCC (T1/T2) at buccal mucosa site from clinically determined N0 patients were retrospectively analyzed who underwent surgical treatment of their primary lesion with simultaneous neck dissection. An ocular micrometer was used to measure the TT both in exophytic and ulcerated lesions. Chi-square contingency tables were used to correlate TT and other clinicopathological parameters with metastasis in the neck. Results: Clinically, negative necks turned out pathologically positive in 42.8% (n = 15/35). In the group in which tumor depth exceeded 1.5 mm, the metastatic rate was 86.7% (13/15). In contrast, when the depth of invasion was <1.5 mm, the incidence of cervical metastasis was 13.3% (2/15) irrespective of the 2 stages. Conclusion: TT is a highly significant, objectively measurable prognostic factor in early stage oral cancers and elective neck therapy is indicated for tumors exceeding 1.5 mm invasion.

Background: The incidence of renal cell cancer (RCC) is increasing worldwide. However, scant information is available from the Indian subcontinent regarding its clinicopathological characteristics and survival outcomes. We retrospectively analyzed data of patients suffering from RCC at our center over the last one decade (2004–2013) to generate information on these aspects. Materials and Methods: Case records of 423 patients treated between 2004 and 2013 were retrospectively analyzed. Baseline characteristics, histopathological information, and survival outcomes were assessed. Overall survival was calculated from the time of diagnosis to death due to any cause. Results: The median age was 52 years (range: 18–87 years). Male: female ratio was 3.5:1. The median duration of symptoms was 3 months (range: 0–24 months). Thirty-five patients (8.3%) were detected in asymptomatic state. The most common symptom was hematuria (53.2%) followed by flank pain (46.3%). The most common histology was clear cell subtype (71.4%). Two hundred and ninety-three (69.3%) patients presented with nonmetastatic disease whereas 130 (30.7%) had upfront metastatic disease. Five-year survival in Stages 1, 2, 3, and 4 was 92.7%, 72.9%, 54.6%, and 11.5%, respectively. Conclusion: Younger age, higher male–female ratio, lower proportion of asymptomatic patients, higher proportion of advanced stage at diagnosis, and lower stage-wise survival were some of the key findings.

Background: The treatment of breast cancer is based on a multi-modality approach. Analysis of the hormone receptor has been accepted as a standard procedure, in the routine management of breast cancer patients. Triple negative breast cancers (TNBCs) are those which are negative for expression of all three markers, i.e., estrogen receptor, progesterone receptor (PR), and human epidermal growth factor receptor. High expression of Ki-67, a proliferation index, has been associated with a worse prognosis in TNBC. TN cancers are aggressive in nature as they do not respond to routine targeted therapy. The role of the androgen receptor (AR) in breast carcinomas is important as AR has been suggested as a potential therapeutic target. We did this study to assess AR immunoreactivity in TNBCs and correlate with Ki-67 index. Materials and Methods: In this study group, there were 45 cases of TN invasive breast carcinomas. These tumors were analyzed with respect to AR and Ki-67 index. Results: Of 45 TN breast carcinomas analyzed, 42 were infiltrating duct cell carcinoma (IDCC) of not otherwise specified type. There were one medullary and two metaplastic carcinomas. The median age was 46 years. AR was positive in 20% (9/45) of cases. All the AR positive cases were an IDCC (nos). Out of the nine AR positive cases, six showed positivity for Ki-67. The statistical analysis using Pearson's Chi-squared method did not reveal any correlation between AR and Ki-67 index (P = 0.574). Conclusion: Although our study did not reveal any statistically significant correlation between AR and Ki-67 index, assessment of AR status in TNBC patients is desirable as it may help to develop a targeted therapy in future in these aggressive cancers.

Background: A novel fusion gene of echinoderm microtubule-associated protein-like 4 (EML4) and anaplastic lymphoma kinase (ALK) has been identified in a subset of non-small-cell lung cancers (NSCLCs). Patients with the ALK-EML4 fusion gene demonstrate unique clinicopathological and physiological characteristics. Here we present an analysis of clinicopathological profile of patients of metastatic adenocarcinoma harboring the ALK-EML4 fusion gene. Methods: A retrospective analysis of advanced ALK positive NSCLC, who presented at this tertiary care hospital of armed forces from September 2014 to December 2016 was conducted. The primary goal was to evaluate demographic and clinicopathological profile of ALK positive advanced NSCLC. Detection of ALK fusion was done by IHC on formalin fixed paraffin embedded cell blocks. Results: Out of 270 patients of NSCLC, 15 (7.4%) tested positive for ALK-EML4 fusion. Rate of positivity was higher in females (13.7%) than in males (5%). The correlation of the ALK-EML4 fusion gene and clinicopathological characteristics of NSCLC patients demonstrated a significant difference in smoking status, histological types, stage, and metastatic pattern. Conclusion: Our analysis indicated that ALK-EML4 positive NSCLC comprised a unique subgroup of adenocarcinomas with distinct clinicopathological and radiological characteristics. Incidence of ALK positivity was found to be higher in females and never smokers. These patients have distinct pathological and radiological characteristics.

Introduction: Around 80% of colorectal carcinoma are associated with chromosomal instability while rest of 20% are euploid, possessing defect in mismatch repair system (MMR) quintessential for surveillance and correction of errors introduced into microsatellites. The microsatellite instability (MSI) phenotype has three major clinical applications: prognosis of colorectal cancer (CRC), prediction of response to 5 fluorouracil, and irinotecan, and genetic assessment of Lynch syndrome. Materials and Methods: We analyzed all Stage II and Stage III colorectal cancer (CRC) for MSI, who presented at Army Hospital, Research and Referral, New Delhi, from January 2014 to December 2016. Although patients of Stage II CRC were taken throughout the study period, Stage III CRC was included in last 1½ years to compare the prevalence of MSI in these two subsets of patients. Results: 26.2% of Stage II and 11.3% of Stage III patients were found to be MSI-high (MSI-H) (P = 0.04). Nineteen (86%) of 22 MSI-H patients were below 30 years of age (P = 0.01). Of 22 MSI-H patients, 18 had right-sided tumors (P = 0.03) and only three patients had rectal tumors. Most common pattern of MSI-H tumors was loss of expression of MLH1 and PMS2, seen in 15 of 16 (88%) of Stage II and three of 6 (50%) of Stage III CRC (P = 0.04). Conclusion: We conclude higher prevalence of MSI-H tumors in Stage II, as compared to Stage III CRC, which was demonstrated slightly higher in our study compared to published literature. MSI-H tumors tend to occur with high frequency in younger population, with right-sided colonic tumors, histopathology characterized by mucinous subtype with high prevalence of tumor infiltrating lymphocytes. Loss of expression of two MMR proteins, namely, PMS2 and MLH1 has been identified in most of MSI-H patients of our study, of which 86% were <30 years of age. This is in contrast to observation in previous studies where loss of PMS2 and MLH1 proteins was observed in older (>70 years) patients with MSI-H tumors, and in younger patients, MSI-H status was associated with loss of MLH1, MSH2, and MSH6.

Background: Geographic variations with regard to incidence, clinical presentation, and histological subtypes are known to occur in several cancers. This study was aimed to see if similar differences existed in non-Hodgkin's lymphoma (NHL) also during pre-immunohistochemical era. Materials and Methods: Cases of NHL seen at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi from January 1997 to December 2000, were analyzed for baseline clinical features and histology. Results: Total cases: 241, median age: 47 years (range 2–84 years), male-female ratio: 2.2:1, primary extranodal NHL: 44.2%, the most common histological subtype: Diffuse large cell (6.2% of the cases). Conclusion: Our patients presented at younger median age, had more male to female ratio, had diffuse large cell histology as the most common histological subtype.

Background: In advanced esophageal cancer, combination chemotherapy regimens provide effective palliation but result in substantial toxicity. Aim: The aim of the study was to evaluate outcomes of recurrent and metastatic esophageal carcinoma treated with weekly paclitaxel. Objectives: The objective of the study was to determine the clinical and laboratory factors predicting response and affecting overall survival (OS) in patients receiving palliative chemotherapy for advanced esophageal/gastroesophageal cancer. Materials and Methods: Retrospective analysis of patients with advanced esophageal cancer, not amenable to definitive intent therapy that was treated with intravenous weekly paclitaxel was done. Progression-free survival (PFS) and OS were calculated with Kaplan–Meir analysis while factors affecting outcome were subjected to log rank test and multivariate analysis. Results: Between September 2010 and October 2014, 350 patients were included in analysis. Median follow-up is 8 months. Median age was 55 years, with a male:female ratio of 2.4:1. Nearly 34.5% were mid esophageal and 51% were lower third and gastroesophageal junction tumors. Almost 58% of the tumors had squamous histology. Performance status was >2 in 25.4%. Almost 62% patients had received prior therapy. Median number of cycles of weekly paclitaxel delivered was 12 with median duration of 3 months. Nearly 51% of patients had improvement in dysphagia, with time to symptom improvement of 20 days. In 31% patients, feeding nasogastric tube could be removed. Overall response rate was 32% (complete remission, 2.5% + partial remission, 29.5%). Median PFS was 4.0 months (95% confidence interval [CI]: 3.6–4.3 months) and median OS was 10 months (95% CI: 8.5–11.4 months). Performance status and pretreatment albumin significantly affected OS. Conclusion: Metronomic weekly paclitaxel chemotherapy provides good palliative benefit in advanced unresectable/metastatic esophageal cancer with minimal toxicity. Eastern Cooperative Oncology Group Performance Status (PS 0 and 1) and baseline serum albumin level >3.7 g/dl significantly improved survival.

Background: Gastric cancer accounts for 7.8% of cancers worldwide and adenocarcinoma is the commonest histological type. Both gastric and intestinal phenotypic cell markers are expressed in gastric carcinomas. CDX2 is an intestinal transcription factor, which can be demonstrated in intestinal metaplasia and gastric carcinomas of the intestinal type. Unlike colorectal carcinomas, the role of CDX2 in gastric carcinomas as a prognostic variable is yet to be established. Ki-67 is a transcription factor expressed in the growth and synthetic phases of the cell cycle. Aims and Objectives: The aims of the study were to analyze CDX2 expression and Ki-67 labeling index in different histological types of gastric carcinomas and their relationship with the patients' clinicopathological parameters. Materials and Methods: A total of 50 gastric carcinoma cases were evaluated histologically and phenotypically, along with assessment of CDX2 expression and Ki-67 labeling index. Gastric carcinomas were grouped into intestinal and diffuse types, according to Lauren classification. A semiquantitative microscopic evaluation of CDX2 expression and Ki-67 labeling index was performed and correlated with the patients' clinicopathological parameters. Results: Increased CDX2 expression correlated with higher proportion of intestinal type gastric carcinomas and a lower proportion of lymph node metastasis, lymphovascular and perineural invasion. On the other hand, high Ki-67 labeling index was found in high grade tumors with lymphovascular invasion. Conclusions: The results of our study suggest that CDX2 might be a useful marker in predicting the prognosis of patients with gastric carcinoma. Accordingly, Ki-67 index seems to be useful in identifying a group of patients with aggressive tumors.

Background: Bilateral breast cancer (BBC) is a rare clinical entity with limited data regarding clinicopathological aspects and treatment guidelines. Materials and Methods: This was an observational study of patients diagnosed with BBC from August 2012 to July 2014. Synchronous breast cancers (SBCs) was defined as two tumors diagnosed within an interval of 6 months and metachronous breast cancer (MBC) as second cancer diagnosed after 6 months. Results: Out of 750 breast cancer patients seen during a 2-year period, 35 had BBC. Ten patients were diagnosed as SBC whereas 25 patients as MBC. Among patients with MBC, the average time for development of contralateral breast cancer was 5 years. In 8 patients, the contralateral breast cancer was detected mammography whereas rest 27 patients were detected by clinical breast examination. At a median follow-up of 24 months, 23 (66%) patients were disease free, 9 (26%) patients had disease relapse, and 3 (8%) patients succumbed to the progressive disease. Conclusions: Every patient with breast cancer should be regularly followed up with clinical breast examination at a more frequent interval. The role of frequent clinical breast examination appears more than mammography especially beyond 5 years for early detection of contralateral breast cancer.

Background: The incidence of multiple myeloma (MM) is known to be variable according to ethnicity and is increasing rapidly in Asian countries. Because of huge disparities in economy, lack of adequate health-care infrastructure and the lack of access to novel drugs in our country, treatment of multiple myeloma is still a challenge to medical field in India. Methods: This was a descriptive longitudinal study conducted in the medicine and oncology units of a tertiary care hospital in south India. During the one year period of data collection, 37 cases of multiple myeloma were diagnosed, of which 5 cases were excluded. The diagnosis of MM was made based on the International Myeloma Working Group: Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders. The clinical and laboratory characteristics, and treatment were studied. Results: The male to female ratio was 1.3:1. The commonest symptoms noticed were fatigue 32 (100%) and bone pain 31 (96.9%). 6 (18.8%) patients had hypercalcemia and 7 (21.9%) patients had elevated serum creatinine levels. 29 (91%) of 32 had lytic lesions in the skull and 27 (84%) had lytic lesions in the spine. One patient expired during the course of the treatment. 20 (64%) of 32 patients had partial response to treatment, 7 (23%) had complete response and 4 (13%) of them had stable disease not responding to treatment. Conclusions: To conclude, the patients with multiple myeloma in the present study had a male preponderance. Most common symptoms noticed were fatigue and bone pain and majority had spine tenderness on examination. The presentation of MM is non-specific and patient can come with varied presentations at onset. The quality of life and survival in MM patients can be improved significantly if there is access to newer therapies.

Context: Patients with early stage extranodal natural killer/T-cell lymphoma, nasal type (ES-NKTCL) and local tumor invasiveness (LTI) show poor treatment outcomes with standard approaches. Dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) is an intensive, highly active protocol mainly studied in advanced/recurrent disease. No prior study has utilized this protocol in high-risk ES-NKTCL. Methods: Between 2011 and 2016, all patients with ES-NKTCL with LTI at presentation were uniformly treated at our institute with a combination of SMILE chemotherapy for 5–6 cycles, and involved-field radiotherapy (IFRT). Records of these patients were retrospectively reviewed. Results: Sixteen patients were identified, 69% stage IE and 31% stage IIE. The majority of patients had B-symptoms (75%), paranasal sinus (PNS) invasion (81%), facial skin invasion (56%), palatal perforation (69%), or orbital extension (56%). 12/16 had B-symptoms, and 6/16 had elevated lactate dehydrogenase. All patients received the entire planned 5–6 cycles. IFRT was delivered after a mean 4 cycles. Complete remission was achieved in 13/15 (87%) patients. At a median follow up of 18.5 months, 1-year progression-free survival and overall survival was 84% and 94%, respectively. Grade 3–4 toxicity was seen in 81%, most commonly neutropenia (75%), anemia (44%), and thromobocytopenia (31%). Six patients required dose adjustments (predominantly in the first 1 or 2 cycles). No treatment-related mortality was noted. Conclusion: SMILE with RT is a toxic but tolerable protocol for ES-NKTCL with LTI with high efficacy. Prospective studies are warranted.

Introduction: There is a saying that “cancer cures smoking” as people often quit tobacco after diagnosis of cancer. Very few studies have analyzed the change in tobacco habits of a user after diagnosis of cancer in a relative or friend. Materials and Methods: In this cross-sectional study, 161 friends and relatives of 40 patients treated at Tata Memorial Hospital, Mumbai, India, were interviewed. They were given a questionnaire related to their tobacco habits. The results were analyzed statistically using Wilcoxon signed-rank test and Mann–Whitney test using SPSS. Results: Of the studied individuals, 114 were friends and 47 were blood relatives. 141 used smokeless tobacco, 18 were smokers, and 2 consumed tobacco in both the forms. The mean frequency of tobacco consumption among the friends and relatives before diagnosis of cancer was 12.24 per day and that at the time of interview was 9.76 per day. 35 persons (21.7%) stopped consumption whereas 19 (11.8%) reduced usage after diagnosis of cancer. The difference in mean consumption at median duration of 174 days is statistically significant (P = 0.0005). Conclusions: The diagnosis of tobacco-related cancer has significant impact on the tobacco consumption of friends and relatives. The abstinence rate is comparable to that of various tobacco deaddiction therapies in vogue.

Vitamin D is the name given to a group of fat-soluble prohormones. Two major forms of Vitamin D that are important to humans are Vitamin D2 or ergocalciferol and Vitamin D3 or cholecalciferol. Vitamin D2 is made naturally by the body when the skin is exposed to ultraviolet radiation (in particular, ultraviolet B [UVB] radiation) in sunlight. Vitamin D2 and Vitamin D3 can also be commercially manufactured. The active form of Vitamin D in the body is 1,25-dihydroxyvitamin D or calcitriol, which can be made from either Vitamin D2 or Vitamin D3. Evidence suggests that Vitamin D helps in the prevention of various cancers such as breast cancer, colorectal cancer, prostate cancer, head and neck cancer, and other cancers. This review article briefs about the role of Vitamin D in the prevention of cancer.

The human epidermal growth factor receptor-2 (HER2)-targeted therapies have improved clinical outcomes for patients at any stage of HER2-positive breast cancer (BC). Trastuzumab, a monoclonal antibody that targets the HER2 receptor on BC cells, showed improved survival in metastatic BC (MBC). However, resistance to therapy arises in the majority of patients with advanced disease. Antibody–drug conjugate (ADC) is a relatively new development to deliver cytotoxic drugs specifically to cancer cells. Trastuzumab emtansine (T-DM1) is a HER2-targeted ADC, composed of trastuzumab, a stable thioether linker, and the potent cytotoxic agent, emtansine (DM1, derivative of maytansine). T-DM1 has been approved for use in patients with MBC who have failed prior therapy with trastuzumab and a taxane. Dose finding Phase I study established the maximum tolerated dose at 3.6 mg/kg every 3 weeks. Phase I and II studies of T-DM1 have shown clinical activity and a favorable safety profile in HER2-positive MBC patients. The Phase III randomized EMILIA and TR3RESA trials demonstrated that T-DM1 significantly improves progression-free and overall survival in pretreated HER2-positive MBC patients. Nausea and fatigue are most commonly reported adverse drug reactions with T-DM1 and cardiac toxicity comparable with standard of care therapies. The drug is well tolerated in most patients, with a predictable pharmacokinetic profile and minimal systemic exposure to free cytotoxic DM1. T-DM1 has emerged as an effective therapeutic option for the management of patients with HER2-positive MBC.

Primary ovarian involvement by Burkitt's lymphoma is rare and accounts for 0.5% of nonHodgkin lymphoma and 1.5% of ovarian tumors. We herein describe a very rare case of primary bilateral ovarian lymphoma in a 14-year-old presenting as ovarian torsion.

Vocal cord paralysis may arise from neurogenic paralysis or mechanical fixation. It is sometimes the only sign of an underlying disease. Thus, it is clinically important to diagnose the primary disease in cases of vocal cord paralysis because many of its potential causes, such as symptom-free malignant tumors, can be fatal or cause serious morbidity if detected late. Radiologic evaluation is often useful for determining the etiology of vocal cord paralysis.

Pyomyositis is extremely rare after chemotherapy for nonhematological malignancies. We report a patient of alveolar rhabdomyosarcoma, who developed multifocal pyomyositis in bilateral lower limbs after the first cycle of neoadjuvant chemotherapy with vincristine, ifosfamide, mesna, and etoposide. The diagnosis of pyomyositis was reached after ultrasound and contrast-enhanced computed tomography scan of bilateral lower limbs. Staphylococcus and Streptococcus were isolated from pus. This patient was treated with 4 weeks of antibiotics, besides ultrasound-guided pus aspiration and open surgical debridement. To the best of our knowledge, no case of rhabdomyosarcoma with pyomyositis following chemotherapy has been reported so far.

Conventional X-ray galactogram (CG) is an underutilized procedure in modern breast imaging despite offering the highest spatial resolution among all modalities available for imaging of the breast ducts. The superior diagnostic performance of CG as compared to that of both conventional mammogram and high-resolution ultrasonography makes it a valuable imaging modality for the evaluation of pathological nipple discharge (PND). In addition, CG should always be considered in women with bloody nipple discharge but normal ultrasound and mammogram. CG also has an important role in the preoperative localization of intraductal lesions. CG may be especially useful in resource-restricted settings where breast magnetic resonance imaging is not readily available as it can be easily performed at any mammography facility without the need for additional equipment. In this article, we describe two cases of PND, one of benign and the other of malignant etiology, to demonstrate the value of CG in these cases. We also review the current literature and compare CG with other modalities used for imaging of ductal system of the breast.

Primary myelofibrosis (PMF) is a clonal disorder of a multipotent hematopoietic progenitor cell that occurs predominantly in the elderly age group. We report here an 11-year-old girl who presented with headache, fever, and splenomegaly. Full blood cell count revealed severe thrombocytosis. Laboratory and radiology examinations excluded the diagnosis of essential/reactive thrombocytosis. Bone marrow biopsy showed megakaryocytic hyperplasia, reticulin and collagen fibrosis, and erythroid and myeloid hypoplasia, findings compatible to PMF. The patient was put symptomatically on hydroxyurea and hydration due to thrombocytosis and platelet number decreased. Hematopoietic stem cell transplantation was scheduled to avoid delaying definitive therapy and secondary complications such as infections and transfusion dependency. To the best of our knowledge, this is the first reported case of PMF in childhood in Greece.

Epithelioid hemangioendothelioma (EH) is a rare locally aggressive intermediate grade malignant vasoformative tumor. Bone is a rarer primary site accounting for less than 1% of all malignant bone tumors. Multicentricity and/or multifocality are a relatively frequent occurrence, most commonly clustered in the bones of lower extremities. The axial skeleton is less commonly affected, and concomitant visceral involvement is rarer. We report a unique case of a 20-year-old male who presented with multiple lytic lesions in the skull vault, vertebral bones, bilateral proximal femur, and both radii and humerii with metastasis to the lungs and liver. A final diagnosis of EH was established on biopsy from the right iliac bone. He initially received multiagent chemotherapy and is currently on antiangiogenic therapy. On follow-up positron emission tomography–computerized tomography done 6 months later, marked reduction in fluoro-D-glucose avidity of the hepatic and most skeletal lesions was noted.

Longitudinally extensive transverse myelitis (LETM) is an unusual manifestation of systemic malignancy. It has been mainly reported with lung cancers and lymphoproliferative malignancy. LETM in systemic malignancy can be caused by either intramedullary metastases or paraneoplastic syndrome. Occurrence of LETM as the first manifestation of malignancy has been rarely reported. We present clinical, laboratory, and imaging findings of a 66-year-old man with nonsmall-cell lung (adeno) carcinoma, who presented with LETM without having any cardinal manifestations of lung malignancy. The rarity of the disease and especially such a presentation can cause considerable delay in the diagnosis and treatment.

Late recurrence (after more than 10 years) of choroidal melanoma, though infrequent, has been documented well in Western countries. In India, however, this disease being uncommon, there is no data regarding its late recurrence. Here, we report a case of late metastatic manifestation of choroidal melanoma in the form of liver metastases in a 45-year-old man who presented with abdominal pain; metastases to liver occurred 10 years after enucleation of the right eye.

We report a case which presented with pyrexia of unknown origin (PUO) with eosinophilia and multiple hypoechoic lesions in the liver resembling secondaries. After secondary causes were ruled out, aspiration of liver lesions revealed eosinophilic abcesses. A diagnosis of idiopathic hypereosinophilic syndrome (HES) was made and the patient responded to steroid therapy. HES remains a diagnosis of exclusion. HES presenting with PUO and liver abcesses is very rare. A high index of suspicion is required to recognize the involvement of different organ systems due to HES.

Pseudoepitheliomatous hyperplasia (PEH) is a benign reactive inflammatory reaction of the epithelial cells to various conditions. It is a diagnostic dilemma which simulates malignancy, especially squamous cell carcinoma (SCC). Many articles of PEH involving the oral mucosa are available on the internet, but ocular involvement is infrequent. The ocular lesion in our case resembled SCC but turned out to be PEH. We report a rare case of PEH in a 20-year-old male.

Retroperitoneal teratoma (RPT) is an exceedingly rare neoplasm in infancy. We came across a 3-month-old infant with large RPT in the left suprarenal area. The tumor was completely excised, and the patient was successfully discharged. Histopathological examination suggested the diagnosis of mature cystic teratoma.

Acute lymphoblastic leukemia (ALL) is a common pediatric malignancy. Methotrexate is the widely used chemotherapy for ALL. The polymorphism (rs1051296) of SLC19A1 is proposed for its effect on serum methotrexate. To explain this observation, the authors hereby studied the interrelationship between SLC19A1 polymorphism and blood methotrexate level in the patients with ALL. Here, the authors use a quantum chemistry analysis for explaining of this observation.