Intracranial cystic metastases are difficult to differentiate from non neoplastic lesions like a cystic abscess on routine magnetic resonance imaging (MRI) sequences in patients with a known primary cancer. Diffusion weighted MRI sequences can help in differentiating between the two. This carries significant implications on the intent and nature of treatment. We present a case of a forty five-year- old patient of squamous cell carcinoma of larynx who developed an intracranial cystic ring enhancing lesion following chemotherapy. Though routine MRI was equivocal, MR diffusion was highly suggestive of an abscess and this led to surgical excision which confirmed the diagnosis. We discuss this case and review the literature regarding the role of newer MRI sequences and the ramifications on patient treatment.

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Cancer is a leading cause of morbidity and mortality in the modern world. Treatment modalities comprise radiation therapy, surgery, chemotherapy and hormonal therapy. Radiation therapy can be performed by using external or internal radiation therapy. However, each method has its unique properties which undertakes special role in cancer treatment, this question is brought up that: For cancer treatment, whether external radiation therapy is more efficient or internal radiation therapy one? To answer this question, we need to consider principles and structure of individual methods. In this review, principles and application of each method are considered and finally these two methods are compared with each other.

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Radiation is an important modality in cancer treatment and estimates are that between one third and one half of all patients will require ionizing irradiation therapy during some point in their clinical management. However, the radiation-induced damage to the normal tissues restricts the therapeutic doses of radiation that can be delivered to tumors and thereby limits the effectiveness of the treatment. The use of chemical compounds (radioprotectors) represents an obvious strategy to improve the therapeutic index in radiotherapy. However, most of the synthetic radioprotective compounds studied have shown inadequate clinical application owing to their inherent toxicity and high cost. These observations necessitated a search for alternative agents that are less toxic and highly effective. Studies in the recent past have shown that some medicinal plants possess radioprotective effects. Two species of the commonly used aromatic herb mint, Mentha piperita and M. arvensis protected mice against the γ-radiation-induced sickness and mortality. Detail investigations have also shown that the aqueous extract of M. piperita protected the vital radiosensitive organs: the testis, gastrointestinal and hemopoetic systems in mice. The radioprotective effects are possibly due to free radical scavenging, antioxidant, metal chelating, anti-inflammatory, antimutagenic, and enhancement of the DNA repair processes. This review for the first time summarizes the observations and elucidates the possible mechanisms responsible for the beneficial effects. The lacunae in the existing knowledge and directions for future research are also addressed.

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Tamoxifen is a selective estrogen receptor modulator widely used in the treatment of hormone-responsive breast cancer. Tamoxifen-induced ocular complications are very rare. A post-menopausal woman, diagnosed and treated case of carcinoma of left breast, on follow-up presented with history of gradual diminution of vision in both eyes of 3 months duration. Patient was on tamoxifen therapy 20 mg daily for the last 2 years. Fundus examination showed crystalline maculopathy. Fluorescein angiography, ocular coherence tomography confirmed the diagnosis. Tamoxifen therapy was discontinued. Although ocular toxicity is rare, careful evaluation of patients with visual symptoms on tamoxifen therapy is required.

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Osteosarcoma as a second cancer occurring in an adolescent male previously treated with only chemotherapy for Hodgkin's lymphoma is rare. A 14 year old male presented with gradual swelling of right jaw and numbness of lip and chin for last three months. He was treated with only chemotherapy for Hodgkin's lymphoma four years back. Incisional biopsy was taken from mandibular swelling, histopathology suggesting osteosarcoma. Right hemimandibulectomy and reconstruction with metallic implant were done along with excision of right parotid lymph node. Chemotherapy was started with cisplatin and doxorubicin regimen. Absence of radiation as a risk factor and very young age of the patient presenting with a second cancer made this case a rarity and hence the case is being reported.

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We describe a 45-year-old man, heavy smoker, presenting with 6.5 Χ 5.3 cm painless solitary growth over right temporal region. Chest radiograph showed opacity over left lung abutting mediastinum. Computed tomogram revealed homogenous ill-defined opacity indicative of bronchogenic carcinoma with metastases to right lung, liver and adrenal glands. The carina was involved with tumor along with partial obliteration of the left main bronchus over bronchoscopy; the biopsy confirmed squamous cell carcinoma. The biopsy from scalp lesion and cervical lymph node also established metastatic squamous cell carcinoma. Although cutaneous metastasis with primary lung cancer has been reported, the scalp lesion as a sole presenting feature of underlying quiescent squamous cell lung cancer, which is described here, has not been reported frequently.

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Rituximab is a chimeric anti-CD20 monoclonal antibody used to treat CD20+ non-Hodgkin's lymphoma (NHL). Some pulmonary adverse reactions such as cough, rhinitis, bronchospasm and dyspnea are relatively common. Severe respiratory conditions like cryptogenic organizing pneumonia, interstitial pneumonitis have rarely been reported. We present a case of interstitial pneumonitis in a patient who was treated with R-CHOP for extranodal NHL. He responded to the steroids.

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Primary bone lymphoma (PBL) is an uncommon tumor accounting for approximately 4-5% of extra nodal lymphoma and less than 1% of all non-Hodgkin's lymphoma. Disease may be complicated at presentation by pathological fracture or spinal cord compression. Diffuse large-B-cell lymphoma (DLBCL) accounts for the majority of cases of PBL. Owing to its rarity, only a few retrospective studies have been published addressing the prognosis and treatment of primary bone lymphoma. In this paper, we report our experience with two cases of PBL treated with chemotherapy and radiotherapy and review literature to elucidate the optimal treatment of primary bone lymphoma.

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We present the diagnostic inaccuracies encountered in a case of multiple fibroadenoma with malignant transformation. A 30-year-old lady presented with lump in the right breast of one month duration which on clinical examination, X-ray mammogram, sonomammogram were suggestive of multiple fibroadenomas. Fine needle aspiration cytology of the largest lump revealed features of malignancy and a core biopsy showed pleomorphic cells that could not be categorized. Due to the clinical, radiological and pathological diagnostic ambiguity, lumpectomy was performed and frozen section showed features of only conventional fibroadenoma. Representative bits on routine processing showed only features of fibroadenoma. Hence, complete submission of all lumps was done, which revealed fibroadenoma with invasive ductal carcinoma in one. Patient underwent modified radical mastectomy which showed multiple fibroadenomas, focal fibrocystic disease with a focus of residual invasive tumor and metastatic deposit in one axillary lymph node. This case report highlights the diagnostic challenges in detecting malignancy in fibroadenoma and a need for extensive tissue sampling in multiple fibroadenomas to detect the rare occurrence of carcinoma.

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Metastatic carcinomas from a distant primary malignancy involving the temporal bone particularly the jugular foramen are rare tumors. A 57-year-old gentleman had multiple gradually increasing swellings over the body since many years. For last two years, he noticed enlargement of the swelling in left calf and rapidly enlarging painful new swelling over the left chest wall in back for last one year. He had recent involvement of left seventh, eighth and lower cranial nerves. CT scan showed an extensive lesion in left jugular foramen region with bone destruction. The patient underwent decompression of the left jugular foramen mass lesion. The tumor was extremely vascular and a partial decompression could only be performed. Although there was relief in the headache but the neurological deficits were persisting. Histopathology of the tumor showed features of metastatic small ling cancer. In the present case, there was presence of long standing multiple swelling all over the body and the patient had painful enlargement that he perceived as an ongoing process of the von Recklinghausen's disease and made a delay in seeking the medical advice resulting in a well advanced disease and with poor prognosis.

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We report a rare case of endometrial adenocarcinoma involving both horns of a bicornuate uterus in a postmenopausal woman. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection following an initial positive diagnosis of well differentiated endometrioid adenocarcinoma on endometrial biopsy. Incidentally, the left ovary revealed a well differentiated sertoli leydig cell tumor. Endometrial carcinoma arising in malformed uterus is rare. Its simultaneous occurrence with an ovarian sertoli leydig cell tumor has not been reported in English literature so far. This case is reported for its rarity.

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We recently treated one patient presenting with a disseminated non-operable Merkel cell carcinoma (MCC) by lanreotide (somatostatin analog), with a complete remission of the disease and a follow up of 17 months. We present in this paper a case report with a review of the utilization of somatostatin analogues in the treatment of MCC.

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Neurofibroma of kidney is an extremely rare tumor. To our knowledge, only five such cases have been reported worldwide till date. Here, we report a solitary neurofibroma of right kidney in a 54-year-old woman. Radiological investigations (ultrasonography and computed tomography) detected a solid mass in the upper pole of right kidney and clinicoradiologically renal cell carcinoma was suspected. A radical nephrectomy was performed under diagnosis of cancer. Microscopically, tumor consisted of benign spindle-shaped cells accompanied by fibrous tissue. Differential diagnoses of neurofibroma and solitary fibrous tumor (SFT) were made on morphological features. Immunohistochemically, the tumor cells were positive for S-100 protein, but negative for CD34 and CD99. Thus, a diagnosis of neurofibroma was established.

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Papillary cystadenocarcinoma is an extremely rare malignant neoplasm characterized by cysts and papillary endophytic projections. It was first defined in 1991 by World Health organization as a separate entity. Major locations of this neoplasm are the parotid gland, the sublingual gland, and minor salivary glands, while occurrence in the submandibular gland is extremely rare. We present a case of papillary cystadenocarinoma arising from the submandibular gland in a 67-year-old male patient. Further, we have discussed the cytological and histopathological features of this rare entity and reviewed the current literature.

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Corynebacterium species are normal flora of skin and mucous membrane. In recent years, coryneforms have emerged as important opportunistic pathogens in immunocompromised patients. Majority of the Corynebacterium macginleyi isolates are from conjunctiva and cornea. The only reported non ocular isolates are from urinary tract infection, intra-venous catheter related infection, valvular endocarditis and septicaemia. We report herein a rare case of C. macginleyi isolated from tracheostomy site secretions in a patient with carcinoma larynx which was treated successfully with Cefoperazone-sulbactum for seven days and replacing tracheostomy tube. This is the first case of C. macginleyi reported from India.

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Over 8,00,000 new cases are diagnosed and 5,50,000 deaths occur annually due to cancer in India. The dramatic increase in morbidity and mortality due to cancer is a matter of concern for the society. Though the burden of cancer involves the entire nation, but the rural and underprivileged population represents majority of patients. Despite an already overwhelming burden of health problems, it is high time we must address the cancer pandemic and its alarming share of morbidity and mortality. Many large scale and innovative initiatives have been launched to counter the deadly disease. This includes efforts to expand the resources for health education and increase awareness of cancer prevention to the people and health care providers. These initiatives call for an unprecedented level of cooperation among international agencies, government and nongovernmental organizations, international foundations, healthcare system and local institutions. This review signifies the need for special attention to cancer prevention and early diagnosis with emphasis to rural and remote places of India.

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Carcinoma of the lip is a slow-growing locally-advanced disease with low metastatic potential. Distant skeletal metastasis is reported very rarely and the vertebral column is the most common site. A 58-year-old male smoker presented with pain and massive swelling of the left scapula for six months. He also noticed a slowly-growing painful ulcerated lesion on the outer aspect of the right lower lip for last two years. Biopsy from the lip ulcer, as well as cytologic smears from the scapular mass, revealed features of squamous cell carcinoma. Though no neck node was detected, patient was found to have extensive skeletal metastasis on whole body bone scan. It is rare as well as clinically appealing to have such disfiguring symptomatic massive scapular meastasis as the chief presenting feature in carcinoma of the lip.

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Heart is rarely involved in metastatic cancer. A 44-year-old woman diagnosed with melanoma, with extensive metastases to whole body including interatrial septum demonstrated by PET/CT and echocardiography, was presented and discussed in light of the literature.

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Background: Tumor markers are a major part of the secondary prevention and thus the detection of malignancies. Neoplasms often have an increased concentration of sialic acid on the tumor cell surface and are shed or secreted by some of these cells which increase the concentration in blood. Materials and Methods: The study was conducted on 90 subjects equally divided into three groups viz, healthy individuals, oral cancer and precancer. The estimation of serum total sialic acid level was done according to Plucinsky et al by resorcinol reagent method. The statistical analysis was carried out by using SPSS 10.0 software. Results: The mean serum total sialic acid (TSA) level in oral precancer and oral cancer group was statistically significant (P<0.05). In oral cancer group when stage I and stage II were compared with stage III and stage IV, it was statistically significant (P<0.05). Histopathologically, oral cancer and precancer did not show statistically significant values (P>0.05). The present study also suggested that no correlation exists between habit of tobacco chewing / betel nut chewing / smoking or alcohol consumption with that of serum total sialic acid levels. Conclusion: Serum total sialic acid levels can be used as an adjunctive diagnostic marker in head and neck cancer.

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Radiofrequency ablation (RFA) recently has been applied to benign thyroid nodules, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of well-differentiated thyroid cancer, in the high-risk reoperative condition or for the palliative purpose. But no report has been made on the RFA for primary thyroid cancer to date. We report on a patient with primary papillary carcinoma of thyroid gland who had undergone RFA before the cytological diagnosis of malignancy, later referred and treated with robotic surgery successfully. We can learn the following lessons from our case; (1) the RFA for operable primary thyroid malignancy should be avoided, because of the possibility of remnant viable cancer and undetectable nodal metastasis, and (2) robotic or endoscopic thyroid surgery may be a feasible operative method for benign or malignant thyroid nodules previously treated with RFA.

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Neuroblastoma is a tumor of pediatric age group and is extremely rare in adults. Common sites involved in adults are almost similar to that seen in children like retroperitoneum, adrenal gland, pelvis and mediastinum. Ovarian neuroblastoma has never been reported in the literature before. We, hereby, present a case of a 38-year-old lady with bilateral ovarian neuroblastoma diagnosed as Krukenberg's tumor clinicoradiologically.

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Gefitinib is an orally active, highly selective, reversible inhibitor of the tyrosine kinase domain associated with the epidermal growth factor receptor (EGFR). EGFR gene mutations, never smoking status, Asian origin and adenocarcinoma histology are associated with good clinical responses to geftinib. Geftinib has generally been tried in the setting of chemotherapy refractory disease in patients who have failed at least one line of therapy. Trials are exploring use of geftinib as first line therapy in patients harboring EGFR mutations and also in the elderly. The most exciting feature of geftinib use is its potential for Lazarus responses in patients with poor performance status. Its use is associated with little toxicity. The success of geftinib suggests that it is important to understand the basic mechanisms underlying lung cancer in order to evolve better therapies. The review has been prepared after conducting extensive PubMed and Medline search for related articles.

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Several mechanisms have been described in the literature for mandibular fractures. However, it is to be noted that fracture of mandible can occur spontaneously, especially in elderly persons with atrophic edentulous mandible. It is important to rule out local and systemic factors that can be the possible causes for fractures in these cases. We describe a case of spontaneous fracture of the mandible in an elderly lady with a review on possible mechanisms that can result in such fractures.

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Introduction: The present study identifies the prognostic factors influencing oral cancers in a large cohort of patients treated at a single institute. Materials and Methods: This is an audit of 1180 patients treated from 1990 to 2004 in the service setting with prospective data collection. Patients were treated with radical radiotherapy or were planned for surgery and post operative radiotherapy (PORT). None of the patients received postoperative concurrent chemoradiation. For analysis, patients were divided into Group 1 and Group 2 based on the oral cavity subsite. Results: Of the entire cohort, 810 patients had tumors of the Gingivo-alveolo-buccal complex, lip and hard palate (Group 1) and 370 patients had primaries in tongue and floor of mouth (Group 2). Three year locoregional control for the entire cohort was 58%. The three year local control (LC), locoregional control (LRC) and disease free survival (DFS) for PORT group were 74%, 65% and 60%, respectively, with pathological nodal status, perinodal extension and cut margin status showing statistical significance (P <0.001). In the definitive radiotherapy group, the three year LC, LRC and DFS were 34%, 31% and 30%, respectively, with age, T stage, nodal status and stage being significant. Group 1 patients showed significantly better LC, LRC and DFS than Group 2 patients for the entire cohort. Conclusion: The results indicate superior outcomes with PORT particularly in advanced stages of oral cancer and inferior outcomes in tongue and floor of mouth subsites. There is scope for improving outcomes by adopting treatment intensification strategies.

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Background: The role of oxidative stress in the genesis of various types of cancers is well established. Several chemical, cell culture and animal studies also indicate that antioxidants may slow or even prevent the development of cancer. Brain is considered abnormally sensitive to oxidative damage as brain tissue has high rate of oxygen consumption, high lipid content and relatively low antioxidant defenses, compared to other tissues. Materials and Methods: The study design chosen for the present study was cross sectional. The biochemical parameters that were estimated in saliva manually using spectrophotometric methods were ferric reducing antioxidant power (FRAP) assay - a direct measure of total antioxidant activity of biological fluids and protein thiols. The physical parameters of saliva that were also assessed were salivary flow rate, pH of the saliva and the osmolality of the saliva. Results: The mean values of salivary flow rate and pH were significantly decreased among malignant and benign tumor patients whereas the salivary osmolality was significantly increased in both the groups of patients. The mean values of salivary FRAP were significantly reduced among malignant and benign tumor patients. However, the salivary protein thiols were significantly increased in these patients. Conclusion: Hence with these observations it can be concluded that in saliva, besides the physical characteristics, salivary FRAP and protein thiol levels are appropriate indicators of the antioxidant status in brain tumor patients.

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Mucoepidermoid carcinomas (MECs) of lung are rare neoplasms originating in bronchial submucosal glands and comprising 0.1-0.2% of primary lung cancers. MECs, the most common malignancy in salivary glands, were earlier thought to occur only in salivary glands. Later studies showed that they can arise as a primary in bronchus, esophagus, lacrimal glands, pancreas, thymus and thyroid gland. Initially described as a benign adenoma, it is now considered to be a malignant epithelial tumor. There have been reports of metastases to regional lymph nodes, other parts of the lung and distant organs. Cavitary lesion in MEC of lung is rare. Here, we report a case of MEC of lung with metastases to skeletal muscles of thigh and arm. To the best of our knowledge, this is the only case of MEC of lung presenting with such unusual pattern of metastasis as presenting feature with almost no symptoms of primary lesion.

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Gall bladder cancer is uncommon and histologically most of these are adenocarcinomas. Signet ring cell carcinoma is a rare malignancy of gallbladder. Only few cases of this histologic type have been published and detailed knowledge of this disease is not available. Here, signet ring cell carcinoma of the gallbladder in a 32-year-old man is being reported. The patient had metastasis in the celiac group of lymph nodes at the time of diagnosis. The patient underwent radical surgery, followed by chemotherapy but succumbed to the illness two months post-operatively. Newer treatment modalities and advanced information may improve the prognosis of the disease.

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Basaloid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma of the trachea. We describe the case of an unresectable basaloid squamous cell carcinoma of the trachea treated with concurrent chemoradiotherapy up to a dose of 60 Gy in 33 fractions with weekly paclitaxel and carboplatin. The pathological recognition of basaloid squamous cell carcinoma and its distinction from adenoid cystic carcinoma of the trachea is important for its management. Combining systemic chemotherapy with locoregional radiation is a logical approach to treatment, especially for the basaloid squamous cell carcinoma of the trachea, given its tendency to metastasize early after definitive therapy.

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Squamous cell carcinoma of urinary tract is a rarely encountered tumor. It is more frequently reported in urinary bladder and male urethra than renal pelvis. Squamous cell carcinoma of renal pelvis is usually associated with nephrolithiasis. However, coexistence of keratinizing squamous cell carcinoma with xanthogranulomatous pyelonephritis is exceedingly rare with only one case on record so far. We report two such cases detected incidentally in patients who have undergone nephrectomy for hydronephrosis. The post operative histological evaluation revealed unsuspected squamous cell carcinoma of renal pelvis with concomitant xanthogranulomatous pyelonephritis.

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Complete androgen insensitivity is a rare X-linked disorder characterized by a female phenotype in a chromosomally male individual. Malignant transformation of the un-descended testis is a rare phenomena compared to other inter-sex syndromes. This is a case of a 32-year-old female who was diagnosed with androgen insensitivity and presented to the emergency room with pelvic pain. Later the pelvic pain was found to be due to testicular masses, one of which was pure seminoma. We reviewed the literature emphasizing the biochemical and endocrinologic abnormalities leading to the syndrome, as well as the potential for malignant changes of the un-descended testes, diagnosis, and therapeutic management. We discuss the importance of early diagnosis and the consequence associated with misdiagnosis.

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Neuroendocrine tumor (Merkel cell carcinoma-MCC) of the vulva is a very rare entity with less than 15 cases reported in the English literature. It is known for its aggressive behaviour and propensity for early dissemination. The actual cell of origin and etiology of this disease is controversial. In absence of any definite guidelines for management (due to its rarity), extrapolation of data from extra-vulvar MCC seems logical. We present a case of vulvar neuroendocrine tumor who presented at a locally advanced stage.

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Aims: (1) To map the extent of disease in women with stage I and II carcinoma cervix by multislice spiral computed tomography (CT), magnetic resonance imaging (MRI) and sentinel nodes. (2) To assess accuracy of each modality individually and in conjunction with FIGO clinical staging. Design and Setting: Prospective, single-blind study. Departments of Obstetrics and Gynaecology, Radiodiagnosis, and Pathology, UCMS and GTBH and Division of Radiological Imaging and Bioinformatics, INMAS, Delhi. Material and Method: The study was conducted on 25 women with cervical cancer FIGO stage I and II. Each woman underwent clinical staging, multislice spiral CT and MRI which was compared to the gold-standard histopathology/cytology. The overall accuracy of each modality and improvement of clinical staging by CT/MRI were noted. Sentinel nodes were evaluated by intracervical Patent Blue V dye injection. Statistical Analysis: Sensitivity, specificity, positive and negative predictive values were calculated by 2Χ2 contingency tables. Results: The accuracy of staging by FIGO, CT and MRI was 68%, 52% and 80%, respectively. MRI and CT improved the overall accuracy of FIGO staging to 96% and 80%, respectively. Sentinel nodes were identified in 89% of patients with 91% accuracy. Conclusion: MRI emerges as the most valuable stand-alone modality improving accuracy of FIGO staging to 96%. Sentinel lymph-node evaluation appears promising in evaluating spread beyond cervix.

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Aims: Retrospective analysis of outcome with PET-CT imaging used for various clinical situations. Materials and Methods: Whole body PET-CT scan of 29 patients was evaluated. In first group, PET-CT was used for response evaluation after curative radio-chemotherapy. In second group, PET-CT was used as an additional diagnostic tool. In third group, PET-CT was used for delineating target volume. For first and second group, uptake was recorded with respect to primary, regional and distant site of involvement and confirmed through PET-CT guided biopsies whenever required. For third group, hypermetabolic volume delineated on PET image was compared with gross target volume delineated on CT image. Results: In first group, 50 % (6/12) of the patients had distant systemic disease, 33% (4/12) had residual regional disease and 58% (7/12) had residual/recurrent local disease. In second group, 30% (3/10) patients had distant systemic disease on PET-CT where CT was inconclusive. 25% (4/10) had variable extent of disease involvement on PET-CT that changed the technique of radiotherapy treatment. In 20% (2/10) patients, PET-CT changed the sequence of treatment. In third group (n=7), PET delineated volume was significantly higher (10-50%) than CT delineated volume for local site but for regional targets the difference was <10%. Conclusions: With the initial use of FDG18 PET-CT imaging, we realized that rate of distant metastasis is much higher which usually remain unnoticed because of conventional approach of investigation. PET-CT imaging has potential to improve the method of conventional IMRT planning.

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Lymphomas occur with an increased frequency in patients with Human Immunodeficiency Virus (HIV) infection. These are usually high-grade immunoblastic lymphomas and primary central nervous system lymphomas. Anaplastic large cell lymphoma (ALCL) is a distinct type of non-Hodgkin's lymphoma. It is uncommon in HIV infected individuals. We describe here an uncommon presentation of this relatively rare lymphoma in the form of spinal cord compression syndrome in a young HIV infected individual.

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Radiation therapy has become an important component of various cancer treatments. The development of second malignancy as a result of radiation therapy is a well-known sinister complication. However, radiation-induced sarcomas (RIS) are rare complications of radiation therapy. The timescale between completion of the radiotherapy and the development of a second malignancy, known as the latent period, can vary widely from as little as 5 years to 50 years later. Radiation-induced sarcomas per se are very rare and those with histomorphology of chondrosarcomas are even rarer. We report a rare case of RIS of left iliac bone in a 62-year-old lady after combined chemotherapy and external beam radiation therapy for cervical carcinoma (stage IIb). This case is being reported for its extreme rarity, vivid histology and clinical presentation.

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A seven-years-old boy presented with recurrent episodes of right parotid gland swelling that was presumptively being treated as sialoadenitis. Interrogation with ultrasonography, computerized tomography and magnetic resonance imaging revealed a heterogeneous mass occupying the right parapharyngeal space, imperceptibly merging with adjoining parotid gland, scalloping the vertical ramus of the mandible and involving the base skull with widening of the foramen ovale. The findings at surgery and histopathology provided a final diagnosis of parotid gland primitive neuroectodermal tumor. This report emphasizes on the imaging findings of this rare tumor occurring in such an unusual location.

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Prophylactic cranial irradiation has been a part of multimodality management of acute lymphoblastic leukemia (ALL). With optimum treatment and the resultant long-term cure rates, long-term side effects of radiation including radiation-induced neoplasms have been increasingly unearthed. We report a rare case of development of both a meningioma and a cavernous angioma following prophylactic cranial irradiation as a part of treatment of ALL. Regular follow-up and high index of suspicion for late radiation sequelae after treatment are therefore justifiable in leukemia survivors with history of prophylactic cranial irradiation.

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Primary classical Hodgkin lymphomas of the gastrointestinal tract are rare lymphoproliferative neoplasms as against other well established mucosa-associated lymphoid tissue (MALT) lymphomas. The primary nature of these cases is established based on chest radiograph, computed axial tomography, positron emission tomography, peripheral blood and bone marrow biopsy examination. Here, we report a 79-year-old male patient, who presented to the emergency department with complaints of abdominal discomfort on right side and low grade fever. An ultrasonogram was performed which suggested of an intestinal perforation. An emergency laporotomy was done with resection of the ileal segment. The histomorphology of the resected ileal segment revealed features of classical Hodgkin lymphoma which were confirmed by immunohistochemistry. Epstein Barr virus encoded RNA (EBER) via in-situ hybridization was positive and provided substantial evidence of EBV etiology.

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Merkel cell carcinoma is a primary neuroendocrine carcinoma of the skin. It is a highly aggressive tumor which commonly metastasizes to lymph nodes, liver, lung and bone. The diagnosis is based on histology and immunohistochemistry. Renal metastasis, with sparing of other common sites of hematogenous spread (lung and liver), is a unique feature of this case.

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A case of orbital rhabdomyosarcoma had a localised recurrence 13 years after being treated with chemo radiotherapy. Late recurrences are rare in orbital RMS. Only two cases have been reported to have recurred after five years of follow up. Pathological similarity of both the lesions and occurrence outside the irradiated field excluded a radiationinduced second neoplasm. Immunohistochemistry staining with p 53 was positive. Patient had good response to chemotherapy and radiotherapy. Surgical resection of residue showed complete necrosis. Retreatment with combined modality therapy resulted in complete remission and the patient is on follow up.

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Primary malignant tumors of heart are rare with unfavorable prognosis and are mostly diagnosed on autopsy. They have varied presentation and are difficult to diagnose. Most of the cases are benign and others are sarcomas. Here we present a case of primary cardiac sarcoma which had varied presentation and was undiagnosed due to non specific symptoms. Diagnosis of atrial tumor was confirmed on histopathological examination of tissue obtained after thoracotomy. Being inoperable, the patient was given palliative chemotherapy with which we could provide her a better quality of life.

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Cutaneous metastases from asymptomatic colonic carcinoma have been documented rarely in the literature. But cutaneous metastasis to an already present operative scar as the mode of presentation of otherwise asymptomatic colon cancer is an extremely rare phenomenon which has been described only thrice till now. We report such a case of adenocarcinoma of sigmoid colon which presented as a large subcutaneous metastasis to an already existing scar of hysterectomy.

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A 54-year-old man, a non-smoker, suffering from metastatic lung adenocarcinoma presented with extensive bilateral pulmonary infiltrates. He was dyspneic at rest. Performance status (PS) was 4. Institution of gefitinib resulted in relief from dyspnea within two weeks. Positron emission tomography done after 10 months revealed only a 2 cm residual lesion. However, the patient stopped therapy on his own and died two months later. An 80-year-old female, a non smoker, presented with metastatic lung adenocarcinoma and right sided pleural effusion. Her PS was 4. She was started on gefitinib. Within four weeks, she showed marked improvement. At six months, she was radiologically documented to be in partial remission. She continues to be asymptomatic at one year follow-up. These are the first reports of dramatic responses to gefitinib when used as front-line therapy in patients with poor performance status from India.

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Introduction: The optimal radiotherapeutic management of poor-prognosis (elderly and/or poor performance status) high-grade gliomas (HGG) remains controversial. Hypofractionated radiotherapy (hypoRT) has been shown to be non-inferior to daily conventionally fractionated radiotherapy. This study aimed to assess the compliance to treatment and efficacy of a resource-sparing hypoRT regimen in this subset. Materials and Methods: The resource-sparing hypoRT regimen was delivered once weekly (5Gy/fraction) for seven fractions to a total dose of 35Gy in seven fractions over six weeks. Compliance to planned treatment and factors that could potentially influence it were analyzed. Results: Between January 2004 and October 2009, 63 patients with poor-prognosis HGG (age range 40-78 years; Karnofsky performance score ?70) were offered resource-sparing hypoRT regimen. Twenty eight of 63 patients completed planned course of treatment giving a treatment compliance rate of 44%. Six (9.5%) patients did not receive even a single fraction of radiation after simulation/planning. Thirty eight patients (60%) received ?3 fractions and were on treatment for at least two weeks. Performance status (P=0.05) and grade (P=0.04) significantly impacted upon compliance. Median overall survival for the cohort of 28 patients who completed planned course of treatment was 7.4 months (95% confidence interval: 4.4-10.5 months). Conclusions: The treatment compliance to a resource-sparing once-weekly hypoRT regimen in poor-prognosis HGG has been somewhat suboptimal and discouraging, possibly due to the protracted scheduling over six weeks. Over 60% of patients were on treatment for two weeks, suggesting that short-course schedules could more likely ensure compliance.

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