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October-December 2017
Volume 13 | Issue 6
Page Nos. 883-1080

Online since Wednesday, December 13, 2017

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REVIEW ARTICLES  

Optical coherence tomography in oral cancer: A transpiring domain Highly accessed article p. 883
Reddy Sudhakara Reddy, Kotu Nagavenkata Sai Praveen
DOI:10.4103/0973-1482.180684  PMID:29237948
Identification of oral cancer at an early curable stage not only aids in controlling the mortality and morbidity rate but also improves the quality of life of the patient. Indeed, regular monitoring of such life-threatening disease has held an imperative role in cancer diagnostics. Various light-based diagnostics are currently available to the clinician for early diagnosis of oral cancer. Optical coherence tomography (OCT) is one such emerging light-based diagnostic modality that provides noninvasive, real-time images at a depth of 1.5–2 mm and can also be compared to corresponding histopathological sections, hence this procedure can also be referred as optical biopsy. This technique can also be used as an adjunct to histopathology in circumstances where large areas are needed to be examined, screening apprehensive patients, larger populations, and for regular monitoring of patients. The current article is a brief review that highlights basic principle, various versions, and applications of OCT in the diagnosis of oral cancer.
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Diagnosis and management of gastrointestinal stromal tumors: An up-to-date literature review p. 889
Ayman El-Menyar, Ahammed Mekkodathil, Hassan Al-Thani
DOI:10.4103/0973-1482.177499  PMID:29237949
Gastrointestinal stromal tumors (GISTs) are rare life-threatening forms of cancer that may arise anywhere in the GI tract. Herein, we aimed to review the literature to describe the incidence, management, and outcomes of GISTs. We conducted a traditional narrative review using PubMed and EMBASE, searching for English-language publications for GISTs between January 2001 and January 2016 using keywords “”gastrointestinal” “stromal tumors.” Among 4582 retrieved articles, 50 articles were relevant over the last 15 years. Several risk stratification systems exist to predict the outcomes of GISTs based on certain criteria such as the primary site of occurrence, size of the tumor, mitotic activity, staining for proliferating cells, and tumor necrosis. Risk stratification is crucial in the management and outcomes of the disease. Surgical resection remains the gold standard option of GISTs treatment. Complete resection of the tumor is the main predictor of the postoperative patient's survival. Laparoscopic resections are associated with less intraoperative blood loss, early return of bowel function, early resumption of diet, and short hospital stay. However, laparoscopy is difficult to perform in large and unfavorably placed GISTs and may result in disease progression, recurrence, and poor survival. Robot-assisted laparoscopic resections provide instruments for surgeons to perform technically demanding operations. Moreover, extensive research work including large clinical trials is ongoing to establish promising role of the adjuvant and neo-adjuvant therapy for better disease- free survival in GIST patients.
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Occupational doses of cardiologists in cath labs and simulation method p. 901
Reza Fardid, Fatemeh Mirzadeh, Hadi Rezaei
DOI:10.4103/0973-1482.192767  PMID:29237950
In recent years, using the ionizing radiation in the interventional cardiology has been increased; this is because of the rapid growth of the number of interventional procedures and the high levels of radiation dose in these examinations. Therefore, it is necessary to develop procedures for managing the use of fluoroscopy radiation to ensure that patients and personnel are not exposed to excessive levels of radiation. It seems that by the new generation devices of fluoroscopy that are equipped with a real dosimeters or dose area product (DAP)-meter which are able to record the produced dose rate in the area of patient's body in each procedure, it is possible to calculate the cardiologist dose with simulation. In addition, a relationship can be made between the patient DAP and cardiologist dose that is defined as an appropriate conversion factor. Hence, in each procedure, besides the record of patient's DAP, the cardiologist dose is recorded as well.
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Optical diagnostics in oral cancer: An update on Raman spectroscopic applications p. 908
Aditi Sahu, C Murali Krishna
DOI:10.4103/0973-1482.191032  PMID:29237951
Raman spectroscopy (RS) is a sensitive vibrational spectroscopic method that can detect even subtle biochemical changes during the onset of disease. Consequently, RS has been extensively investigated for disease diagnosis, including cancers. Oral cancers are known to suffer from dismal survival rates, which have not improved for several decades. As delayed diagnosis contributes to the low disease-free survival rate observed in oral cancers, RS has also been explored for the early diagnosis of oral cancers. This review summarizes the major developments in the field, including diagnosis, surgical margin assessment and prediction of treatment response, and in the overall management of oral cancers. The article comprises an overview of epidemiology, diagnosis, treatment, and recently introduced diagnostic adjuncts for oral cancers, the basic principle, instrumentation of RS, multivariate analysis that impart objectivity to the approach, and finally a discussion on the recent applications in oral cancers. PubMed and Google Scholar database have been used to compile information available online till December 2015.
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Cancer-related fatigue treatment: An overview p. 916
Hemanth Mohandas, Saravana Kumar Jaganathan, Mohan Prasath Mani, Manikandan Ayyar, GV Rohini Thevi
DOI:10.4103/jcrt.JCRT_50_17  PMID:29237952
Cancer-related fatigue is a symptom of cancer where most patients or the general practitioners tend to misinterpret due to the insufficient understanding or knowledge of cancer-related fatigue (CRF). This paper will provide a better perspective for the patients and the health professionals on how to manage and handle CRF for both mild and severe fatigue patients. Articles were selected from the searches of PubMed database that had the terms “randomized controlled trials,” “cancer,” “fatigue,” “pharmacologic treatment,” and “nonpharmacologic treatment” using both Mesh terms and keywords. The authors have reviewed the current hypothesis and evidence of the detailed etiology of the CRF present in the literature for healthier management, directives, and strategies to improve the treatment of cancer-related fatigue. An algorithm has been blueprinted on screening, and management, of the CRF, and various kinds of effective treatments and assessment tools have been briefly studied and explained. Although many strategies seemed promising, the quality of randomized controlled trials is generally quite low in studies, making it difficult to draw conclusions about the effectiveness of each self-care strategies. Therefore, future studies require better design and reporting of methodological issues to ensure evidence-based self-care recommendations for people receiving cancer treatment.
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ORIGINAL ARTICLES Top

Quantitative determination of tumor platinum concentration of patients with advanced Breast, lung, prostate, or colorectal cancers undergone platinum-based chemotherapy Highly accessed article p. 930
Hesameddin Mostaghimi, Ali Reza Mehdizadeh, Mohammad Jahanbakhsh, Amir Reza Dehghanian, Ramin Askari
DOI:10.4103/jcrt.JCRT_1224_16  PMID:29237953
Context: Previous studies have reported direct relationship between tumor reduction and its platinum concentration following platinum-based (Pt-based) chemotherapy. However, quantitative data of tumor platinum concentration have not yet been reported for the most common cancers. Aims: Determination of tumor platinum concentration of breast, lung, prostate, and colorectal cancers after Pt-based chemotherapy; and evaluation of the influence of chemo drug type, chemotherapy regimen, and time lapse from last chemotherapy on tumor platinum concentration. Materials and Methods: Tumor samples of patients with advanced breast, lung, prostate, and colorectal cancers undergone Pt-based chemotherapy were collected from pathology collection of various hospitals. The platinum concentration of each sample was measured by inductively coupled plasma optical emission spectrometry. The data were categorized by drug type, time lapse from last chemotherapy, and regimen type to evaluate their effects on platinum concentration. Statistical Analysis: ANOVA, Mann–Whitney U and Kruskal–Wallis tests were used. Results: Tumor platinum concentrations of breast, lung, prostate, and colorectal cancers were all obtained in the range of 1–10 μg/g tumor tissue. Large values of P (>0.05) indicate no significant differences between various chemo drug, regimen, and time groups. Conclusions: In general, the platinum concentration was higher in prostate and lower in lung tumors. The type of Pt-based chemo drug, time lapse from the last chemotherapy, and concurrency of other antineoplastic agents administered with Pt-based chemo drugs had no significant effect on tumor platinum concentration.
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Assessment of the scatter correction procedures in single photon emission computed tomography imaging using simulation and clinical study p. 936
Mehravar Rafati, Hemmatollah Rouhani, Ahmad Bitarafan-Rajabi, Mahsa Noori-Asl, Bagher Farhood, Hadi Taleshi Ahangari
DOI:10.4103/jcrt.JCRT_1085_16  PMID:29237954
Background: Compton-scattered photons transfer incorrect spatial information. These photons are detected in used photo-peak energy window. In this study, three scatter correction procedures including dual-energy window (DEW), three energy window (TEW), and new approach were evaluated, and then the best procedure based on simulation and clinical conditions introduced. Materials and Methods: In this study, simulation projections and three-dimensional nonuniform rational B-spline–based Cardiac-Torso phantoms were produced by GEANT4 application for emission tomography simulation code. For clinical study, 2-day stress/rest myocardial perfusion imaging (MPI) protocol was performed with 99m Tc-sestamibi for 46 patients. Image quality parameters including contrast, signal-to-noise ratio (SNR), and relative noise of the background (RNB) were evaluated. Results: The simulation results showed that contrast values for DEW, TEW, and new approach were (0.45 ± 0.07, 0.5 ± 0.08, and 0.63 ± 0.09), SNR values (4.74 ± 0.94, 5.58 ± 1.08, and 6.56 ± 1.24), and RNB values (0.33 ± 0.06, 0.33 ± 0.07, and 0.33 ± 0.05), respectively. In clinical study, the contrast values for DEW, TEW, and new approach were 0.53 ± 0.03, 0.57 ± 0.07, and 0.62 ± 0.04 in rest MPI and were 0.52 ± 0.04, 0.57 ± 0.06, and 0.6 ± 0.05 in stress MPI, respectively. Moreover, for the rest images, the SNR values were 7.65 ± 1.9, 9.08 ± 2.2, and 10.2 ± 1.75 and for stress images were 7.76 ± 1.99, 9.12 ± 2.25, and 10.17 ± 2.04, respectively. Finally, RNB values for rest and stress images were 0.12 ± 0.03, 0.13 ± 0.03, and 0.13 ± 0.03, respectively. Conclusion: The simulation and the clinical studies showed that the new approach could be better performance than DEW, TEW methods, according to values of the contrast, and the SNR for scatter correction.
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Accelerated hypofractionation (OCTA SHOT): Palliative radiation schedule in advanced head and neck carcinoma p. 943
Shankar Lal Jakhar, Ramesh Purohit, Akankhsha Solanki, P Murali, Trupti Kothari, Neeti Sharma, Harvinder Singh Kumar
DOI:10.4103/jcrt.JCRT_767_16  PMID:29237955
Background: Head and neck cancers are attributed to be the most common type of malignancy in the developing countries with most cases presenting in advanced stage. This pilot study was performed to evaluate the effect of an accelerated hypofractionated 4 days schedule (octa shot) in providing palliation to such advanced cases of head and neck cancer. Materials and Methods: Twenty-two patients with advanced (Stage VIB-IVB) squamous cell carcinoma of head and neck region were enrolled in the study. All these patients were planned for radiotherapy at Cobalt Unit with a fractionation schedule of 3.5 Gy/fraction, 2 fractions/day with 6 h interval between two fractions, for four days (28 Gy/8Fr/4 days). Patients were reviewed at 2 and 4 weeks to assess change in tumor size, any symptomatic relief, or toxicity. The tumor response, dermal, and mucosal toxicities were assessed using WHO criteria. Results: Median age of these 22 patients (17M male + 5F female) in the study was 59.8 years. After completion of radiotherapy, first response evaluation done at 15th day showed ≥50% objective response in 14 patients. At 1 month, this response increased to ≥75% in 16 patients and 50%–75% in three patients. None of the patients had disease progression. Improvement in symptoms was reported with respect to pain and dysphagia by patients subjectively. Only two patients reported Grade III mucositis; remaining patients had mucositis and dermatitis up to Grade II. Conclusion: The study concludes that this “octa shot” is an effective palliative radiotherapy schedule. With a decreased duration of hospital stay, it is also favorable for outpatients.
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Utility of the laminin immunohistochemical stain in distinguishing invasive from noninvasive urothelial carcinoma p. 947
Dinesh Pradhan, Milon Amin, Shveta Hooda, Rajiv Dhir, Sheldon Bastacky, Anil V Parwani
DOI:10.4103/0973-1482.179523  PMID:29237956
Background: To study the utility of the laminin immunostain in distinguishing invasive from noninvasive urothelial carcinoma (UC). The distinction is difficult but clinically significant as it can affect the decision to administer intravesical Bacillus Calmette–Guerin or can even lead to cystectomy. Materials and Methods: Representative sections of the transurethral resection of bladder tumor specimens from 25 cases of formalin-fixed paraffin-embedded invasive UCs and 25 cases of noninvasive UCs were selected for immunohistochemical (IHC) staining with laminin (Ventana, Oro Valley, AZ, USA). These cases were selected using a computer-assisted search of our laboratory information system (Cerner CoPath). Tissue from five paraffin-embedded tissue blocks containing unremarkable urothelial-lined bladder parenchyma was chosen as controls. Results: All five control cases demonstrated crisp linear staining of the basement membrane underlying the unremarkable urothelium. Similar findings were also noted in the 25 cases of noninvasive UC. All 25 cases of the invasive UC demonstrated a complete absence of the staining around invasive and malignant urothelial cells. Laminin staining was also noted in both the muscularis mucosae and the detrusor muscle, although the pattern of staining in these areas was granular and was distinguishable from the crisp linear staining of the basement membrane. Conclusion: Laminin IHC staining can be useful in differentiating invasive from noninvasive UC.
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Efficacy of centrifuged liquid-based cytology over conventional cytology: A comparative study p. 951
Veda Hegde, Shwetha Nambiar, Nikhil Yadav
DOI:10.4103/0973-1482.177219  PMID:29237957
Background: Exfoliative cytology is the microscopic examination of a shed or desquamated cells from the epithelial surface. Centrifuged liquid-based cytology (CLBC) is a modified technique that is used in the current study. Aims: To compare the efficacy of CLBC with conventional cytology in apparently normal mucosa and histologically proven cases of oral squamous cell carcinoma after staining with Papanicolaou stain. Materials and Methods: The study sample was collected from fifty individuals with no habits and apparently normal oral mucosa (Group 1) and forty cases of histologically proven cases of oral squamous cell carcinoma (Group 2). One smear was taken and spread on the slide by a conventional technique. The second sample was flushed out in a suspending solution, centrifuged, and the cell pellet obtained was used to make the smear. The stained smears were compared for nine parameters such as adequate cellularity, clear background, uniform distribution, cellular overlapping, cellular elongation, mucus, inflammatory blood, and microbial colonies. Chi-square test was used for statistical analysis and P ≤ 0.05 was considered statistically significant. Results: There was a statistically significant result with parameters such as adequate cellularity, clear background, uniform distribution, cellular overlapping, and cellular elongation in CLBC technique, in comparison with the conventional technique. The presence of mucus, microbial colonies, and inflammatory cells were also less in CLBC technique in comparison with the conventional technique. Conclusion: CLBC has better efficacy over conventional method in all the parameters analyzed.
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The effect of ciprofloxacin on the growth of B16F10 melanoma cells p. 956
Dalal Fares Jaber, Mary-Ann Nabil Jallad, Alexander Micheal Abdelnoor
DOI:10.4103/0973-1482.180610  PMID:29237958
Objective: The antitumor effect of ciprofloxacin has been widely assessed in-vitro, and positive results have been reported. The aim of this study was to investigate the influence of ciprofloxacin treatment on the growth of B16F10 melanoma cells both in-vitro and in-vivo. Materials and Methods: Groups of C57BL/6 female mice challenged with B16F10 melanoma cells were kept untreated or were treated with sterile water, intraperitoneal ciprofloxacin, or ciprofloxacin through drinking water for 10 days. The serum levels of vascular endothelial growth factor (VEGF) were measured by ELISA 1 and 3 h after the last dose of ciprofloxacin. Mice were monitored for an additional 10 days for survival assessment. Moreover, B16F10 melanoma cells were cultured in 24-well plates and exposed to different concentrations of ciprofloxacin (10–1000 μg/ml). Viability was determined, after 24 and 48 h, using trypan blue. Results: The serum levels of VEGF significantly decreased in ciprofloxacin-treated mice when compared to the controls. None of the control mice survived beyond day 8, whereas 16.67% of those treated with ciprofloxacin survived up to 18 days. In addition, the viability of B16F10 melanoma cells, in-vitro, significantly decreased with increasing concentrations of ciprofloxacin after 24 and 48 h. Conclusion: Ciprofloxacin seems to exhibit antitumor activity both in-vivo and in-vitro. This effect might be explained by several mechanisms such as directly inducing cancer cell death or altering the immune response through the modification of the normal microbiota.
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Cardiotoxicity associated with bortezomib: A single-center experience p. 961
Murali Krishna Gurram, Swaroopa Pulivarthi, Kirsten Ehresmann, Josy Mathew
DOI:10.4103/0973-1482.172126  PMID:29237959
Background: Studies evaluating the prevalence of cardiotoxicity associated with bortezomib are limited. We proposed this study to evaluate the prevalence of cardiotoxicity associated with bortezomib and its relation to multiple myeloma and other malignancies. Materials and Methods: This is a retrospective, chart review study. Subjects who received bortezomib at the HealthEast care system for various oncologic conditions were evaluated after obtaining IRB approval. Results: A total of 64 patients received bortezomib for various malignancies. Nine out of 64 (14%) patients developed cardiotoxicity during treatment with bortezomib, and the majority of these patients had a prior cardiac history and other cardiac risk factors. On further review, we did not find any significant causal relationship between these cardiac events and bortezomib. Conclusion: Cardiotoxicity is probably not related to bortezomib, even though there are some case reports suggestive of cardiac events related to bortezomib. Our findings need to be confirmed in multicenter, prospective studies.
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Spritzer: For diagnostic cytopathology p. 964
Rashmi Metgud, Surbhi , Smitha Naik, Shrikant Patel
DOI:10.4103/0973-1482.174548  PMID:29237960
Background: Exfoliative cytology is an easy, economical, noninvasive, and feasible method for early detection and screening program of any premalignant or malignant lesion. In case of routine cytological procedure, classical Papanicolaou (PAP) stain is widely used while Romanowsky stains are sparingly used. Leishman-Giemsa (LG) cocktail, being a easier, cost effective staining technique, has not been used in exfoliative cytology. Therefore, this pilot study was carried out to compare and contrast the role of LG stain in routine cytological procedure which is very cost-effective, less time-consuming and requires less infrastructural support. Aim and Objectives: To study the diagnostic efficiency of LG cocktail in comparison with PAP stain and Feulgen stain in mucosal cells for evaluating cellular changes of oral squamous cell carcinoma (OSCC). Materials and Methods: Three cytological smears were prepared from 10 healthy controls and 10 patients clinically diagnosed with OSCC, and they were stained with LG cocktail stain, PAP stain, and Feulgen stain. The stained smears were evaluated for cytologic diagnosis and the staining characteristics such as nuclear and cytoplasmic details were recorded as per criteria by Sujathan et al. Statistical Analysis: The data were statistically evaluated with analysis of variance test using SPSS 15 software for windows. Results: The results from the cases diagnosed as OSCC by PAP and LG cocktail were almost identical and superior to Feulgen stain both in diagnostic ability and in staining characteristics. Conclusion: The one-step LG cocktail is easy, very cost-effective, less time-consuming with less infrastructural support as compared to PAP stain; however, it warrants further evaluation for screening of oral cancer as a potential aid.
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Assessment the accuracy of dose calculation in build-up region for two radiotherapy treatment planning systems p. 968
Bagher Farhood, Mohammad Taghi Bahreyni Toossi, Mahdi Ghorbani, Elahe Salari, Courtney Knaup
DOI:10.4103/0973-1482.176421  PMID:29237961
Aim: Our objective is to quantify dose calculation accuracy in the build-up region using TiGRT and Prowess Panther treatment planning systems (TPSs). Materials and Methods: Thermoluminescent dosimeter-100 chips were used in a phantom for dose measurement. TiGRT Version 1.2 (LinaTech, Sunnyvale, CA, USA) and Prowess Panther version 5.1 (Prowess Inc., Concord, CA, USA) TPSs were also used for dose calculations. Finally, the confidence limit values obtained to quantify dose calculation accuracy of the TPSs at build-up region for different field sizes and various gantry angles. Results: For 8 cm × 10 cm, 10 cm × 10 cm, and 15 cm × 10 cm field sizes, the confidence limit values for TiGRT TPS were 16.64, 16.56, and 25.85; for Prowess TPS with fast photon effective (FPE) algorithm were 15.17, 14.22, and 9.73; and for Prowess TPS with collapsed cone convolution superposition (CCCS) algorithm were 10.53, 9.97, and 9.76, respectively. For wedged field with gantry angles of 15°, 30°, and 60°, the confidence limit values for TiGRT TPS were 12.11, 12.96, and 22.69 and for Prowess TPS with FPE algorithm were 24.50, 22.07, and 7.82, respectively. Conclusions: It is concluded that for open field sizes without gantry angulation, dose calculation accuracy in Prowess TPS with CCCS algorithm is better than TiGRT and Prowess TPSs with FPE algorithm. Furthermore, it is concluded that for wedged field with large gantry angle, dose calculation accuracy of Prowess TPS with FPE algorithm is better than TiGRT TPS while, for medium and small gantry angles, dose calculation accuracy of TiGRT TPS is better than Prowess TPS with FPE algorithm.
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Evaluation of the effect of soft tissue composition on the characteristics of spread-out Bragg peak in proton therapy p. 974
Mahdi Ghorbani, Sayyed Bijan Jia, Mohsen Khosroabadi, Hamid Reza Sadoughi, Courtney Knaup
DOI:10.4103/0973-1482.220420  PMID:29237962
Aim: The aim of this study is to evaluate the effect of soft tissue composition on dose distribution and spread-out Bragg peak (SOBP) characteristics in proton therapy. Subjects and Methods: Proton beams with nominal energies of 70, 120 and 210 MeV were considered. The soft tissues and tissue equivalent materials implemented in this study are: 9-component soft tissue, 4-component soft tissue, adipose tissue, muscle (skeletal), lung tissue, breast tissue, A-150 tissue equivalent plastic, perspex and water. Each material was separately defined inside a 20 cm × 20 cm × 40 cm phantom. A multilayer phantom was evaluated as well. The effect of tissue composition on the relative dose in SOBP region (relative to the dose in SOBP region in water), range of SOBP, length of SOBP, and uniformity index of SOBP was evaluated. Results: Various soft tissues and tissue equivalent materials have shown different dose level in SOBPs, ranges of SOBPs, lengths of SOBPs and uniformity indices. Conclusions: Based on the obtained results, various soft tissues and tissue equivalent materials have quite different SOBP characteristics. Since in clinical practice with proton therapy, only the range of SOBP is corrected for various tissues, omission of the above effects may result in major discrepancies in proton beam radiotherapy. To improve treatment accuracy, it is necessary to introduce such effects in treatment planning in proton therapy.
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Analysis of factors affecting initial cyclosporine level and its impact on post transplant outcomes in acute leukemia Highly accessed article p. 981
Alok Gupta, Sachin Punatar, Jayant Gawande, Libin Mathew, Sadhana Kannan, Navin Khattry
DOI:10.4103/0973-1482.157338  PMID:29237963
Background: Trough cyclosporine (CsA) blood level can influence incidence of graft-versus-host disease (GVHD) and relapse in patients with acute leukemia undergoing allogeneic hematopoietic stem cell transplant (HSCT). We sought to determine factors affecting initial trough CsA level (CsA-1) and its impact on transplant outcome in acute leukemia. Materials and Methods: Seventy-seven patients underwent HSCT for acute leukemia between January 2008 and March 2013 and were included. GVHD prophylaxis included CsA + methotrexate. (MTX) in 53 patients and CsA + mycophenolate mofetil (MMF) in 24 patients CsA-1 was measured on day 3–5 of starting CsA and subsequent dose was modified to achieve therapeutic level of 150–200. ng/mL. According to CsA-1, patients were divided into three groups - 27 in Group A (dose escalated), 13 in Group B (dose de-escalated), and 37 in Group C (same dose continued). Results: On univariate analysis, cyclophosphamide with total-body irradiation (TBI) based conditioning regimen and lower body mass index (BMI) were associated with lower CsA-1, while use of fludarabine and higher BMI were associated with higher CsA-1. On multivariate analysis, only fludarabine use and BMI affected CsA-1. Incidence of acute and chronic GVHD (aGVHD and cGVHD), transplant-related mortality, relapse incidence, and relapse-free and overall survival (OS) were similar in the three groups. Conclusion: While fludarabine use in conditioning regimen and higher BMI leads to higher CsA-1, transplant outcomes are not affected by CsA-1.
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Myeloid sarcoma: A clinicopathological study with emphasis on diagnostic difficulties p. 989
Ranjini Kudva, Vidya Monappa, Girish Solanke, Manna Valiathan, Anuradha C. K. Rao, V Geetha
DOI:10.4103/0973-1482.220418  PMID:29237964
Background: Myeloid sarcoma (MS) is a rare tumor composed of proliferation of myeloid precursors at extramedullary sites. They can arise de-novo or in association with hematological malignancies, most commonly acute myeloid leukemia. Clinically, it can masquerade as an abscess, cutaneous ulcer, or mass lesion. Morphologically, MS can mimic a variety of small round cell tumors including lymphomas and rhabdomyosarcoma. Aims: (1) To study the clinical presentations and laboratory findings in patients with MS; (2) to revisit the histomorphological findings and the differential diagnosis of MS; (3) to evaluate the diagnostic role of immunohistochemistry (IHC) and determine the useful markers for accurate diagnosis of MS. Materials and Methods: We reviewed cases of MS reported in our institution over a 10-year period from January 2004 to December 2013. The clinical presentations, laboratory data, and histopathological and immunohistochemical findings were studied. Results: There were nine cases in our database, none of which were clinically suspected to be MS. Age ranged from 3 to 55 years, with a slight female preponderance. Cervical lymph nodes were the most common site involved. Histologically, the common finding was the presence of medium- to large-sized cells with fine granular chromatin, small nucleolus, and scant cytoplasm along with scattered eosinophil precursors. Myeloperoxidase was the most useful IHC marker. All cases were also positive for leukocyte common antigen contributing to the diagnostic confusion with lymphoma. Conclusion: The possibility of MS should be considered when dealing with unusual lymphoma-like neoplasms that cannot be categorized as any of the Non-Hodgkin lymphoma subtypes.
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Investigating different computed tomography techniques for internal target volume definition p. 994
SA Yoganathan, KJ Maria Das, V Siva Subramanian, D Gowtham Raj, Arpita Agarwal, Shaleen Kumar
DOI:10.4103/0973-1482.220353  PMID:29237965
Purpose: The aim of this work was to evaluate the various computed tomography (CT) techniques such as fast CT, slow CT, breath-hold (BH) CT, full-fan cone beam CT (FF-CBCT), half-fan CBCT (HF-CBCT), and average CT for delineation of internal target volume (ITV). In addition, these ITVs were compared against four-dimensional CT (4DCT) ITVs. Materials and Methods: Three-dimensional target motion was simulated using dynamic thorax phantom with target insert of diameter 3 cm for ten respiration data. CT images were acquired using a commercially available multislice CT scanner, and the CBCT images were acquired using On-Board-Imager. Average CT was generated by averaging 10 phases of 4DCT. ITVs were delineated for each CT by contouring the volume of the target ball; 4DCT ITVs were generated by merging all 10 phases target volumes. Incase of BH-CT, ITV was derived by boolean of CT phases 0%, 50%, and fast CT target volumes. Results: ITVs determined by all CT and CBCT scans were significantly smaller (P < 0.05) than the 4DCT ITV, whereas there was no significant difference between average CT and 4DCT ITVs (P = 0.17). Fast CT had the maximum deviation (−46.1% ± 20.9%) followed by slow CT (−34.3% ± 11.0%) and FF-CBCT scans (−26.3% ± 8.7%). However, HF-CBCT scans (−12.9% ± 4.4%) and BH-CT scans (−11.1% ± 8.5%) resulted in almost similar deviation. On the contrary, average CT had the least deviation (−4.7% ± 9.8%). Conclusions: When comparing with 4DCT, all the CT techniques underestimated ITV. In the absence of 4DCT, the HF-CBCT target volumes with appropriate margin may be a reasonable approach for defining the ITV.
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A study of the pathological outcome of positron emission tomography-computed tomography 2-(18F)-fluro-2-deoxy-D-glucose avid lesion: A 5 years retrospective study p. 1000
Gurudutt Gupta, Jatin S Gandhi, Anila Sharma, Sunil Pasricha, Anurag Mehta, Avinash Rao, Meenakshi Kamboj
DOI:10.4103/0973-1482.165874  PMID:29237966
Introduction: Positron emission tomography-computed tomography (PET-CT) has been commonly used for staging and follow-up in cancer patients. The present study compares radiological and pathological outcomes at all the sites. The benign nonphysiological uptake reduces the specificity of the modality due to high false positive (FP) rate although sensitivity for malignant lesions may be high. Aims and Objectives: To study the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of PET-CT in the detection of malignant lesions for all sites using pathological and final clinical outcome. Materials and Methods: A retrospective study of 195 cases of PET-CT detected lesions subjected to pathological diagnosis in the form of fine-needle aspiration cytology (FNAC) and/or Tru-cut biopsies were performed on patients with proven or suspected malignancy over a period of 1-year (2009) with a 5 years follow-up. During the same period, 2900 PET-CT imaging studies were performed, of which 195 were suspected to be malignant or benign. Of these, 193 patients were subjected for tissue diagnosis for confirmation. FNAC smears and Tru-cut biopsy were prepared and examined as per standard protocols. Results: Of 195 aspirates in 183 aspirates, a conclusive tissue diagnosis was rendered. The follow-up was available in 79 cases of suspicious PET avid lesions for a period of 1–5 years. The PET-CT correlation with the tissue diagnosis and clinical outcome showed the sensitivity of 97.7% and an overall accuracy of 83% for malignant lesions. However, due to a large number of FP (n = 28) the specificity was only 43% and FP rates were 57%. PPV and NPV for malignant lesions was 82.4% and 87.5%, respectively. Conclusion: PET-CT is a sensitive investigation for detection of malignant lesions in treated and newly diagnosed cases of malignancy.
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Evaluation of dose calculation accuracy of various algorithms in lung equivalent inhomogeneity: Comparison of calculated data with Gafchromic film measured results p. 1007
Teerth Raj Verma, Nirmal K Painuly, Surendra P Mishra, Navin Singh, M. L. B. Bhatt, Naseem Jamal, MC Pant
DOI:10.4103/0973-1482.168992  PMID:29237967
Aim: To evaluate dose calculation accuracy of various algorithms in lung equivalent inhomogeneity comprising tumor within it and comparison with Gafchromic film data. Materials and Methods: Gafchromic film measured central axis absorbed dose in lung insert (−700 Hounsfield unit [HU]), in racemosa wood cylindrical inhomogeneity (−725 HU) and at three surfaces of tumor (−20 HU) created in cylindrical inhomogeneity, put in the cavity of computerized imaging reference systems (CIRS) thorax phantom were compared with convolution (CON), superposition (SP), fast SP (FSP), and X-ray voxel Monte Carlo (XVMC) algorithms calculated dose using 6 MV beams of field size 2 cm × 2 cm, 3 cm × 3 cm, 4 cm × 4 cm, 5 cm × 5 cm, and 8 cm × 8 cm. Results: XVMC was in good agreement with film measured results for all selected field sizes except 3 cm × 3 cm. SP under estimated by 5.7% at the center of the lung insert while deviation up to 6% was found at the cent of wood inhomogeneity in 2 cm × 2 cm. Except CON, increase in dose from proximal to the central surface of the tumor and then dose falloff from central to the distal surface for field size 2 cm × 2 cm to 4 cm × 4 cm was recorded. The change in film measured percentage depth dose from 2 cm × 2 cm to 3 cm × 3 cm field sizes was found –8% however for consecutive field size(s) larger than 3 cm × 3 cm this difference was less. CON and FSP produced overestimated results. Conclusion: Out of four algorithms, XVMC found consistent with measured data. The electronic disequilibrium within and at the interface of inhomogeneity make the accurate dose predictions difficult. These limitations results in deviations from the expected results of the treatments.
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Atypical teratoid rhabdoid tumor of the central nervous system: Case series from a regional Tertiary Care Cancer Centre in South India p. 1015
L Appaji, BS Aruna Kumari, K Govind Babu, CS Premalata, K. P. R. Pramod, Gita R Bhat, Chinchu Prem
DOI:10.4103/0973-1482.174536  PMID:29237968
Background: Atypical teratoid rhabdoid tumors (AT/RT) constitute a rare group of pediatric brain tumors. Aim: To study the clinical, histopathological, and immunohistochemical (IHC) profile, management and outcome of children with AT/RT of the central nervous system who presented between the years 2007 and 2015 in a regional tertiary care center in South India. Materials and Methods: This was a retrospective study. Demographic and clinical data were obtained from the clinical case files. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections. IHC was available in all the cases. Results: There were eight cases with the mean age of presentation being 4 years (range: 4 months to 15 years) and with slight male predominance (male:female = 1.66:1). Most of the presenting complaints were due to raised intra-cranial tension. The median duration of symptoms was 0.75 months. About 62.5% of the tumors were infratentorial in location. The tumors were heterogeneous showing variable expression of cytokeratin, epithelial membrane antigen, glial fibrillary acid protein, and synaptophysin. Loss of integrase interactor-1 expression was demonstrated in seven cases in which it was done. Multimodal treatment comprising surgical resection, radiotherapy and chemotherapy was tailored based on location of tumor, resectability and patient's age. The median overall survival was 2.5 months (range: 1.5–30 months). Conclusion: Awareness of this tumor is important as it portends a poor outcome in most patients, in spite of multi-modal treatment. Several new molecules which aim to prolong survival and improve quality of life are being developed to combat this enigmatic tumor.
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Agreement analysis between three different short geriatric screening scales in patients undergoing chemotherapy for solid tumors p. 1023
Amit Joshi, Nidhi Tandon, Vijay M Patil, Vanita Noronha, Sudeep Gupta, Atanu Bhattacharjee, Kumar Prabhash
DOI:10.4103/0973-1482.179062  PMID:29237969
Background: Comprehensive geriatric assessment (CGA) in routine practice is not logistically feasible. Short geriatric screening tools are available for selecting patients for CGA. However none of them is validated in India. In this analysis we aim to compare the level of agreement between three commonly used short screening tools (Flemish version of TRST (fTRST), G8 and VES-13. Methods: Patients ≥65 years with a solid tumor malignancy undergoing cancer directed treatment were interviewed between March 2013 to July 2014. Geriatric screening with G8, fTRST and VES-13 tools was performed in these patients. G8 score ≤14, fTRST score ≥1 and VES-13 score ≥3 were taken as indicators for the presence of a high risk geriatric profile respectively. R version 3.1.2 was used for analysis. Cohen kappa agreement statistics was used to compare the agreement between the 3 tools. p value of 0.05 was taken as significant. Results: The kappa statistics value for agreement between G8 score and fTRST, between VES-13 and fTRST and between VES-13 and G8 were 0.12 (P = 0.04), 0.16 (P = 0.07) and 0.05 (P = 0.45) respectively. It was found that maximum agreement was observed for VES-13 and fTRST. The agreement value of VES-13 and fTRST observed was 59.44 %(39.63% for high risk profile and 19.81% for low risk profile). The agreement value of G-8 and fTRST was 39.62% (2.83% only for high risk profile and 36.79% for low risk profile). The lowest agreement was between G8 and VES-13, 35.84% (7.54% for high risk detection and 28.30% for low risk detection). Conclusion: There was poor agreement (in view of kappa value been below 0.2) between the 3 short geriatric screening tools. Research needs to be directed to compare the agreement level between these 3 scales and CGA, so that the appropriate short screening tool can be selected for routine use.
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A dosimetric comparison between three-dimensional conformal radiation therapy and intensity-modulated radiation therapy in the treatment of posterior fossa boost in medulloblastoma p. 1027
Meenu Gupta, Ravi Kant, Vipul Nautiyal, Jyoti Bisht, Shalindra Raghuvanshi, Manju Saini, BP Kalra, Mushtaq Ahmad
DOI:10.4103/0973-1482.220416  PMID:29237970
Aims: To compare three-dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) in posterior fossa (PF) boost in children with medulloblastoma (MB); dosimetrically evaluating and comparing both techniques with regard to target coverage and doses to organs at risk. Settings and Design: Structured. Subjects and Methods: Seven previously irradiated patients of MB were retrieved and re-planned with both 3DCRT and IMRT techniques. Dosimetric comparison was done by performing two plans for the PF boost for the same patient. Prescription dose and normal tissue constraints were identical for both plans. Statistical Analysis Used: SPSS, version 19, statistical software package was used. For quantitative data, paired t-test was applied to calculate the difference between two means. Results: Mean values of planning target volume (PTV); PTV95% and PTV5% in IMRT were 97.19% and 106.07% and for 3DCRT were 96.57% and 106.33%, respectively. The dose homogeneity was better in IMRT (1.091) as compared to 3DCRT (1.100), but was not statistically significant (P = 0.341). Conformity index was comparable in both the plans, i.e., 3DCRT (0.979) and IMRT (0.976) with P = 0.819. IMRT plan provided reduced mean dose to cochlea relative to the 3DCRT plans with P = 0.032 for the right cochlea and 0.020 for the left cochlea. IMRT showed no advantage over 3DCRT in sparing the anterior cranial structures where mean doses to the right and left lens were 0.61 Gy and 0.56 Gy for IMRT and 0.16 Gy and 0.09 Gy for 3DCRT, respectively. Conclusions: IMRT technique was able to improve homogeneity index, spare the cochleae, but 3DCRT plans were superior in sparing anterior cranial structures without compromising the dose to PF.
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Expression of WW domain-containing protein 2 is correlated with pathological grade and recurrence of glioma p. 1032
Jun Liang, Wei-Feng Qi, Shao Xie, Wei-Feng Wang, Xian-Li Zhang, Xiu-Ping Zhou, Qiong-Shi , Jin-Xia Hu, Ru-Tong Yu
DOI:10.4103/0973-1482.176176  PMID:29237971
Objective: WW domain-containing protein 2 (WWP2) is an E3 ubiquitin ligase, which belongs to the NEDD4-like protein family. Recently, it is reported to play a key role in tumorigenesis and development of tumors such as prostate and lung cancer. However, there has been not related report on glioma until now. The aim of this study is to detect the expression of WWP2 and analyze its correlation to the pathological grade and tumor recurrence in patients with glioma. Materials and Methods: Western blot and immunohistochemistry were separately used to detect the expression of WWP2 protein in 31 brain glioma tissue samples and 80 brain glioma paraffin specimens. The method of Kaplan–Meier was used to analyze the correlation between the WWP2 expression and glioma recurrence. Results: The protein expression level of WWP2 in glioma tissue was significantly higher than that in nontumorous brain tissue (P < 0.05), and the protein expression level of WWP2 in high-grade glioma (Grade III–IV) was significantly higher than that in low-grade glioma (Grade I–II) (P < 0.05). Kaplan–Meier analysis indicated that the patients with high WWP2 expression had significantly shorter tumor recurrence time than the patients with low WWP2 expression (P < 0.05). Conclusion: Our study suggests that WWP2 may play a role in the genesis and development of glioma; it may be a potential biomarker to predict pathological grade and tumor recurrence in patients with glioma.
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BRIEF COMMUNICATIONS Top

Multinodular fibroepithelioma of Pinkus with an isolated focus of evolving basal cell carcinoma in chronic lymphedematous lower limb p. 1038
Kaushik Majumdar, Ujjawal Khurana, Dinesh Asati, Garima Goel, Deepti Joshi, Neelkamal Kapoor
DOI:10.4103/0973-1482.220454  PMID:29237972
Fibroepithelioma of Pinkus (FEP) is a rare, indolent variant of basal cell carcinoma (BCC) with a unique anastomosing type of epidermal hyperplasia. Certain benign and neoplastic conditions including BCC are known to develop in a setting of chronic lymphedema. We report for the 1st time the histological spectrum of evolution of a large exophytic multinodular FEP, bearing a single initiating focus of BCC, in preexisting chronic lymphedema of the lower limb. The lesion possibly evolved from long-standing local immune suppression, and clinically resembled a high-grade carcinoma. Oozing lymphatic fluid may interfere with the success of skin grafting following wide local excision in a lymphedematous limb, thus offering a challenging scenario from the management point of view.
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Detection of balanced translocations in acute lymphoblastic leukemia by a novel multiplex reverse transcriptase reverse transcription-polymerase chain reaction p. 1042
Jyoti Kotwal, Madakshira Gopal Manoj, Rajan Kapoor
DOI:10.4103/0973-1482.172128  PMID:29237973
Fusion transcripts detection is essential for subtyping and diagnosis of acute lymphoblastic leukemia (ALL). This enables institution of appropriate therapy and provides a parameter to monitor disease progression and response to therapy. This study endeared to detect and analyze various balanced translocations known in ALL by using a novel polymerase chain reaction (PCR) method. A pilot study was done in which 16 consecutive cases of ALL were analyzed and followed-up for a period of 1 year. Diagnosis of ALL was established after subjecting blood/bone marrow aspirate samples to morphological examination, immunophenotyping, and detection of fusion transcripts by multiplex reverse transcription (RT)-PCR using HemaVision kit. Results were analyzed by correlating with morphology, immunophenotype, and response to therapy. Epi-Info statistical software was used. 43% (seven cases) showed balanced translocations, with all seven cases being B-ALL and t(9;22) being the most common. There was a consistent association of CD25 cases with t(9;22). Analyses of relation to other parameters were as expected by their respective WHO 2008 subtype. No significant correlation in terms of survival benefit was seen between cases with and without balanced translocations (P = 0.7472). The study demonstrated the utility of multiplex RT-PCR in the initial evaluation, subtyping, and monitoring minimal residual disease in ALL cases with balanced translocations, thereby guiding both therapy and prognosis. The consistent association of CD25 in cases of t(9;22) ALL indicated that CD25 could be used as a surrogate marker.
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CORRESPONDENCES Top

Multiple pelvic cysts in a patient with familial Mediterranean fever: Benign cystic mesothelioma p. 1047
Melek Karakurt Eryilmaz, Hasan Mutlu, Gokhan Tazegul, Ramazan Eryılmaz, Fatma Yalçın Müsri, Derya Kıvrak Salim, Betül Ünal, Hasan Şenol Coşkun
DOI:10.4103/jcrt.JCRT_125_16  PMID:29237974
Benign cystic mesothelioma (BCM) is a rare tumor arising from endothelial cells of the pelvic visceral or parietal peritoneum. It is a clinically and histopathologically benign disease. Etiology and pathogenesis of BCM remain unclear. Familial Mediterranean fever (FMF) is an inherited disorder characterized by episodes of fever, and abdominal, chest and/or joint inflammation. Association between malignant mesothelioma and FMF has been reported previously; however, co-existence of FMF and BCM is rare. Here, we report a case of BCM in a 43-year-old male patient with FMF.
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Intrarectal fixative for positioning of the prostate for intensity modulated radiotherapy p. 1050
Janos Stumpf, Subathira Balasundaram, P. G. G. Kurup, Rathnadevi Ramadas, Murali Venkatraman, Karthikeyan Perumal
DOI:10.4103/0973-1482.179163  PMID:29237975
Dose escalation improves local control in carcinoma prostate, but rectal toxicity remains a concern. Various techniques have been there to reduce the dose to the rectum. Mobility of the prostate results in a necessary expansion of the target volume. We describe a new intrarectal fixative, developed in-house with transrectal ultrasonography through the fixative itself for localization of the organ by reporting a case with early carcinoma prostate. Concerns of rectal toxicity limit dose escalation in the treatment of prostate cancer. Intra- and interfraction prostate motion is a concern in dose conformity techniques. The intrarectal fixative system developed in-house physically separates the prostate and rectum during radiation treatment. Thus, both intra- and inter-fractional movement of the organ are addressed, therefore planning target volume expansion can be kept minimal.
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Two cases of non-Hodgkin lymphoma of urinary bladder: Primary and secondary p. 1053
Nischith DíSouza, Ashish Verma, Avinash Rai
DOI:10.4103/0973-1482.179071  PMID:29237976
Lymphoma of urinary bladder is rare and can be primary (0.2% of all bladder neoplasms) or secondary (1.8% of secondary tumors of the bladder), the latter being more common. Here, we report a case each of primary and secondary lymphoma of the bladder who had undergone treatment at our hospital. Both patients underwent cystoscopy and resection of the bladder growth followed by immunohistochemical staining which revealed them to be lymphomas.
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Blastic plasmacytoid dendritic cell neoplasm presenting as leukemia without cutaneous lesion p. 1056
Namrata Punit Awasthi, Sumaira Qayoom, Sunil Dabadghao
DOI:10.4103/0973-1482.220358  PMID:29237977
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy, recognized as a distinct entity in the WHO 2008 classification of hematolymphoid neoplasm. Described for the first time in 1994 as CD4+ cutaneous lymphoma with high expression of CD56, BPDCN has been known previously with various names such as blastic natural killer (NK) leukemia/lymphoma, agranular CD4+ CD56+ hematodermic neoplasm, and agranular CD4+ NK cell leukemia. This disease usually presents with cutaneous involvement as the first manifestation, with subsequent or simultaneous spread to bone marrow and peripheral blood. Leukemia as the first presenting symptom without any cutaneous involvement is a rare finding and can masquerade as acute undifferentiated leukemia. We present here such a case of a 59-year-old male who presented as leukemia without any cutaneous lesion but subsequently developed a scalp nodule.
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Triple malignancy involving breast, ovary, and uterine vault: A case report and literature review p. 1059
Mohammad Shadab Alam, Roshan Perween, Shahid Ali Siddiqui
DOI:10.4103/0973-1482.220419  PMID:29237978
The occurrence of two or more primary malignant neoplasms in the same person is rare. We report a case report of a 45-year-old woman with triple malignancy involving breast, ovary, and uterine vault managed at our center for 5 years. Our patient presented as a postoperated case of two primary malignant neoplasms of carcinoma, breast and ovary. For carcinoma ovary, she underwent adjuvant chemotherapy and interval cytoreductive surgery. For carcinoma breast, she received adjuvant locoregional radiotherapy and chemotherapy. After 42 months, the patient was diagnosed with squamous cell carcinoma vault, for which she received pelvic radiotherapy. She is on regular follow-up. Our patient had two synchronous and one metachronous malignancy. She was diagnosed with carcinoma uterine vault when she was in regular follow-up, and the two previous primaries were controlled. This emphasizes the importance of a regular follow-up and the need of a meticulous workup for early diagnosis and prompt management of any metachronous malignancy.
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Choroidal metastases as the presenting feature of adenocarcinoma of the lung: A case report and an overview of the role of radiotherapy in its management p. 1062
Krishna Sharan, S Shailaja, Vijaya H Pai, Donald J Fernandes
DOI:10.4103/0973-1482.176413  PMID:29237979
Although metastasis to the eye is the most common ophthalmic malignancy, it is usually asymptomatic and rarely a presenting symptom that leads to the diagnosis of a primary. Here, we report a patient who was evaluated for visual symptoms and was eventually diagnosed to have disseminated adenocarcinoma of the lung. He was treated with external radiotherapy to the choroidal metastasis, attaining an excellent response that was sustained until his death. A brief review on the role of radiotherapy in the management of uveal metastases is also presented.
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To B(iopsy) or not to B(iopsy) p. 1065
Matthew M Gestaut, Edana D Strober, Sameer G Jhavar, Mehul K Patel
DOI:10.4103/0973-1482.220417  PMID:29237980
Often in metastatic disease, biopsy confirmation of suspicious central nervous system (CNS) lesions is not mandated according to the American College of Radiology, International Radiosurgery Association, and the National Comprehensive Cancer Network. We present a case of an individual who was thought to have metastatic nonsmall cell lung cancer (NSCLC) T2aN0M1b with motor deficits and CNS metastasis to the left postcentral gyrus. The patient underwent biopsy of the primary lung mass confirming NSCLC. He subsequently underwent treatment with stereotactic radiosurgery (SRS) for presumed CNS oligometastatic disease and palliative chemotherapy. Two months after SRS, the patient had progression of CNS disease with new motor deficits. A magnetic resonance imaging revealed and enlarging mass in the previously radiated area. The patient underwent craniotomy with tumor resection and a second primary CNS tumor was discovered. That patient was downstaged from a Stage IV to a Stage IIB lung cancer with concomitant CNS primary.
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Incision site metastasis: Adding insult to injury p. 1068
Ranil Johann Boaz, Tanush Vig, Ramani Manojkumar, Antony Devasia
DOI:10.4103/0973-1482.180679  PMID:29237981
Incision site metastasis is a rare yet well-recognized complication of oncologic operations. We describe the case of a 60-year-old man with a large mass at the site of abdominal incision for a nephrectomy. The operation was performed for infection in an obstructed kidney, which in retrospect harbored malignancy. Percutaneous core biopsy of the mass revealed metastatic conventional renal cell carcinoma (RCC). Surgical resection was obviated by the presence of nodal disease on imaging. Palliative targeted therapy with tyrosine kinase inhibitor was initiated. RCC can not only mimic an inflammatory renal mass radiologically but also coexist with infective renal conditions. Diligent histopathological examination as a routine following nephrectomy for complicated diagnoses is imperative.
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Small bowel and cecal Involvement: Unusual metastasis sites from adenoid cystic carcinoma of the minor salivary gland p. 1070
Yakup Bozkaya, Erdinç Çetinkaya, Gokmen Umut Erdem, Ayşe Yılmaz Çiftçi, Ercan Aydın Karahaliloğlu, Nuriye Özdemir
DOI:10.4103/0973-1482.183549  PMID:29237982
Adenoid cystic carcinoma (ACC) is a rare neoplasm and the most frequent pathology occurring in the minor salivary glands. Lung, bone, liver, and brain are the most frequent metastasis sites in ACC cases. To our knowledge, cecal and ileum metastasis from ACC has not been previously reported in literature. Herein, we reported a case of cecal and small bowel metastasis (ileum) in a patient with ACC. A 41-year-old male patient with ACC developed iron and Vitamin B12 deficiency anemia during further controls. Lower gastrointestinal (GI) endoscopy detected an ulcerated polypoid lesion with raised margins in cecum. Pathological evaluation of polyp biopsy was consistent with metastasis from ACC. The patient underwent surgery of right hemicolectomy. Pathological examinations revealed an ACC of cecum and small bowel (ileum) showing positive staining with CD117, CK7, and panCK. We aimed to emphasize that performing GI stromal screening in ACC patients presenting with iron deficiency is important for early diagnosis of metastasis.
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LETTERS TO THE EDITOR Top

Neurofibromatosis type-1 in a patient with ataxia-telangiectasia p. 1073
Serhan Kupeli
DOI:10.4103/0973-1482.183212  PMID:29237983
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Middle East respiratory syndrome virus: Is there any carcinogenicity property? p. 1074
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/0973-1482.183185  PMID:29237984
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The feasibility of smoker's surcharge policy in tobacco control p. 1075
Eby Aluckal, Sanju Lakshmanan
DOI:10.4103/0973-1482.199384  PMID:29237985
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Isolated myeloid sarcoma of cervix: Aleukemic presentation p. 1076
Meenakshi Kamboj, Anila Sharma, Gurudutt Gupta, Sunil Pasricha
DOI:10.4103/0973-1482.176418  PMID:29237986
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Extramedullary sarcomatoid variant of plasmablastic plasmacytoma p. 1078
Urmila Majhi, Shirley Sundersingh, Kanchan Murhekar, Krishnamurthy Radha
DOI:10.4103/0973-1482.183196  PMID:29237987
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ERRATUM Top

Erratum: Occupational doses of cardiologists in cath labs and simulation method p. 1080

DOI:10.4103/0973-1482.220415  PMID:29237988
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