With improving average life expectancy of individuals in most countries, there has been increase in the incidence of cardiovascular diseases and cancers. Radiation oncologists therefore are likely to encounter an increasing number of cancer patients with in situ cardiac pacemaker devices needing radiation treatments. Pacemaker technology has advanced rapidly in recent years. As a result, the potential interactions of these devices with radiation therapy have changed since American Association of Physicists in Medicine (AAPM) issued guidelines in 1994. Current approaches to treatment in patients who have these devices vary among radiation oncology centers. Furthermore, the recommendations given by the devices' manufacturers differ considerably. Common knowledge about pacemaker in radiation oncology community is vital as radiation management needs to be tailored to individual patients in accordance to the information of available for the device. Some general practical guidelines can be gleaned from the literature. It is felt that more robust information is required using web based database sharing to develop total safe practice guidelines in such patients. This article reviews the information available to help create such guidelines and presents recommendations for treatment in this increasingly common clinical situation.

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Primary adenoid cystic carcinoma of lung is an unusual thoracic neoplasm, which is considered as a slow-growing low-grade malignancy. The primary treatment for this tumor is surgery. The role of radiotherapy, chemotherapy, and targeted agents is less well defined. Here we report a case of inoperable adenoid cystic carcinoma of the lung in a 42-year-old male, presenting with an unusual aggressive behavior. The patient received radiotherapy and oral tyrosine kinase inhibitor imatinib with effective palliation.

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Background: Traditionally, surgeons have resorted to placing drains following major gastrointestinal surgery. In recent years, the value of routine drainage has been questioned, especially in the light of their role in post-operative pain, infection, and prolonged hospital stay. The aim of this study was to compare the peri-operative outcomes following the use of a single versus two drains for gastric and pancreatic resections. Materials and Methods: Patients undergoing resections for gastric and pancreatic malignancies were included in the study. Patients were subdivided into two groups depending on the number of drains placed, viz. one drain (Group 1) or two drains (Group 2). Clinico-pathologic outcomes were recorded and compared. Results: Of the 285 patients included in the analysis, group 1 consisted of 226 patients while group 2 included 59 patients. Overall, drains alerted the surgeon to existence of complications in 62% of patients - 70% in group 1 and 44.4% in group 2 (P < 0.19). The morbidity and mortality rates in groups 1 and 2 were 25.2% and 3.9%, and 23.7% and 0%, respectively (P < 0.61 and P < 0.12). There were no drain-related complications. Median hospital stay was significantly lower in group 1 (11 vs. 14 days) (P < 0.001). Conclusion: The insertion of drains did aid in the detection of complications following gastric and pancreatic surgery. Two drains offer no further advantage over one drain in terms of detection of complications. While the number of drains did not contribute to, or reduce, the morbidity and mortality in the two groups, the use of one drain significantly reduced hospital stay. Taken together, these findings support the prophylactic insertion of a single intra-abdominal drain following gastric and pancreatic resections.

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Primary mediastinal neuro-endocrine tumor is very rare. The primary modality to evaluate the lesion is computed tomography, to know disease extent, involvement of various structures, vascular invasion and metastasis. Histo-pathological and immuno-histochemical confirmation is mandatory. We report a rare case of primary neuroendocrine mediastinal tumor/atypical carcinoid in a young male who presented with carcinoid syndrome and left supraclavicular lymphadenopathy. Complete diagnostic work up was done followed by histo-pathological and immuno-histochemical confirmation. Later on patient underwent radical surgery followed by chemotherapy. The patient is currently on follow up. Neuroendocrine carcinoma of the thymus generally follows an aggressive clinical course.The biologic behavior is directly related to grade and degree of differentiation. This case report of primary low grade neuroendocrine tumor/atypical carcinoid adds to the biological behavior of this tumor and sheds light on the radiological and pathological features of neuroendocrine carcinomas.

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Aim: To assess the usefulness of single-staged posteriorly based dorsal tongue flap in oral cavity reconstruction following ablative surgery, in terms of flap viability, functional outcome and donor site morbidity. Materials and Methods: A prospective database of patients who were reconstructed with dorsal tongue flap between July 2006 and November 2010 was used. Results: There were 27 patients who had tongue flap reconstruction in this period. Size of the defect following excision ranged from 3.5-5 cm in greatest dimension. Marginal mandibulectomy was done in thirteen patients and in twelve patients mucoperiosteal stripping was done. There was no partial or total flap loss in our series. Two patients had minor salivary leak which was managed conservatively. All the patients had adequate mouth opening, good swallowing and speech following surgery. Conclusion: Dorsal tongue flap is a simple and reliable flap for intra oral reconstruction. It provides good functional results without much morbidity.

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Approximately 3-10% of patients of breast cancer present with metastatic disease. Traditionally the treatment of these patients has been systemic only with local therapy in form of surgery or RT offered only to palliate local complications like ulceration or haemorrhage, etc. We review and analyse the current literature on surgical removal of primary breast tumor in metastatic disease. Data for this review was compiled by searching the PubMed database. Though current evidence is not strong enough to recommend surgical removal in all MBC patients, there seems a subset of MBC patients who, when carefully selected, have a survival benefit from surgical removal of primary tumor. A carefully structured RCT with large number of patients and long follow up is needed.

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Background: The 'field cancerization' theory tries to explain the risk of local recurrences and development of second primary tumors in oral sqamous cell carcinoma (OSCC) patients. According to this theory it is assumed that clinically normal mucosa adjacent to oral cancer, except molecular, has already developed certain premalignant histopathological changes. Aims: The aim of this study was to determine histological characteristics of clinically normal-looking mucosa at different distances from the apparent tumor lesion margins in OSCC patients. Materials and Methods: Normal-appearing oral mucosa biopsy specimens were obtained from 30 new (untreated) oral cancer patients from sites at a distance of 10 mm and 20 mm from the tumor lesion margins and were compared with normal oral mucosa from 30 control patients with benign oral lesions. Results: A total of 21 patients (70%) in the OSCC group demonstrated histological abnormalities under microscopic examination versus 7 (23.3%) control patients (P<0.01). Seventeen oral cancer patients (57%) showed significant difference in incidence and type of histological changes of normal-looking mucosa at a distance of 10 mm from the tumor lesion; 8 (27%) demonstrated reactive changes, 6 (20%) mild dysplasia and 3 (10%) squamous cell carcinoma, compared to histological abnormalities registered in 11 (OSCC) patients (36%) at a distance of 20 mm from the tumor; 10 (33%) displayed reactive changes and 1 (3%) mild dysplasia. Conclusions: Histological abnormalities of clinically normal-looking oral mucosa taken at different distances from the tumor lesion indicated the existence of subclinical field change and represent an important parameter during the assessment of the adequacy of surgical resection margins in oral cancer management.

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Purpose: To investigate the association between various risk factors and precancerous lesion of gastric cancer (PLGC) in patients from eastern China. Materials and Methods: 501 cases of PLGC and 523 cases of superficial gastritis were included. A comparative study of the relation between different risk factors and PGLC was performed. Results: Statistical differences were noted in a series of indexes including Helicobacter pylori (HP) infection, family history of esophageal cancer (EC), gastric cancer (GC) and chronic atrophic gastritis (CAG), a history of CAG, gastric polyps (GP) and gastric ulcer (GU), usage of non-steroids (e.g., aspirin), gastroesophageal reflux disease (GERD), consuming alcohol, eating food rich in nitroso compounds, irregular eating habits with no breakfast, ingestion of smoked meat, fried food and spicy food, anxiety and depression. The risk factors associated with PLGC ranked in an order of a history of CAG, GP, family history of GC, usage of non-steroids (e.g., aspirin), ingestion of spicy food frequently, HP infection, family history of EC, consuming alcohol, anxiety, a history of GU, GERD and family history of CAG. Conclusions: A history of CAG was most associated with PLGC in patients from eastern China, followed by a history of GP and family history of GC.

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Context: Free radical associated damages play a major role in causation of cancer in tobacco habituates. The free radicals released by tobacco bring about alterations in antioxidant levels in humans and these free radical associated damages are reflected through antioxidant enzyme activities in blood. Aims: To evaluate the effects of tobacco consumption on the erythrocyte Antioxidant enzymes-Superoxide dismutase (SOD) and Glutathione Peroxidase (GPx) as they act as first line of defense antioxidants. Materials and Methods: A case control study comprising of 4 study groups of healthy controls (n = 27), smokers (n = 27), tobacco chewers (n = 30) and combination habit (n = 22) were included. Erythrocyte SOD and GPx enzyme activities were measured by spectrophotometry. The results were statistically analyzed using one way-Anova and Mann Whitney test. Results: The data analysis revealed an alteration in mean SOD levels as it was decreased in cases compared to control group where as mean GPx was seen to be increased in cases compared to controls. When SOD and GPx were compared for the frequency and duration of habit, GPx showed a significant decrease in chewers with increase in frequency and duration of habit. Conclusions: The present study gave us an insight about the relationship between antioxidant enzyme activity, oxidative stress and tobacco. The altered antioxidant enzyme levels observed in this study will act as a predictor for pre potentially malignant lesions. Therefore an early intervention of tobacco habit and its related oxidative stress would prevent the development of tobacco induced lesions.

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Oral sub mucous fibrosis is an insidious chronic disease affecting any part of the oral cavity. Worldwide estimates of oral sub mucous fibrosis indicate that 2.5 million people are affected, with most cases concentrated in the Indian subcontinent, especially eastern and southern India. Oral sub mucous fibrosis has a propensity for malignant transformation. The association of betel quid chewing, oral sub mucous fibrosis, and oral squamous cell carcinoma is quite profound, especially in Taiwan and the Indian subcontinent where up to 80% of oral squamous cell carcinoma is associated with the habit. Epidemiological studies have shown that the rate of malignant transformation ranges from 3 to 19%.

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Primary neuroendocrine carcinoma of the female genital tract is a rare entity with aggressive clinical behavior and a poor prognosis. This kind of malignancy arising in the vagina is extremely rare. We report a case of primary neuroendocrine carcinoma of vagina arising in a setting of atypical vaginal adenosis.

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Aim: Neoadjuvant chemotherapy (NACT) is used as a primary treatment for locally advanced breast carcinoma (LABC) and also extended to operable breast cancer. The aim of this study was to evaluate the predictive value of different histological parameters in core biopsy of LABC patients treated with anthracycline-based chemotherapy regimen. Pathological assessment of the excised tumor bed is the gold standard and is essential for identifying the group of patients with pathologic complete response (pCR) or pathologic noncomplete response (pNR). Materials and Methods: A total of 50 patients with stage II and III breast carcinoma were included in the study. Pretreatment core biopsy histological features include tumor type, histological grade, presence of tumor necrosis, lymphovascular emboli (LVE) and immunohistochemical stains for estrogen receptor (ER) and progesterone receptor (PR) were obtained. Patients were given 3-6 cycles of NACT. Pathological response was assessed. Result: Seven out of 50 patients achieved pCR. A total of 71.4% patients who achieved pCR had tumor necrosis on initial core biopsy while only 30% pNR cases had this feature (P =0.035). Breast carcinoma other than ductal type was chemoresistant. Of 47 core biopsies, LVE was observed in 13 cases (28 %) of which 11 showed axillary node metastasis. None of these 13 cases had pCR, thus having poor predictive value. Conclusion: Pathological parameters like type of tumor, presence of LVE and tumor necrosis in the core biopsy can predict the response to NACT in routine stain. Tumor necrosis and type of breast carcinoma are predictive parameters for tumor responsiveness to NACT. LVE was reliable in predicting axillary lymph node metastasis.

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Aim: The aim of this study was to evaluate the expression of type IV collagen in three histological grades of oral squamous cell carcinoma (SCC) in comparison with that in normal oral mucosa, to determine whether this protein can be used as a marker in early detection of the biological behavior of phenotypically altered cells. Material and Methods: The staining intensity, staining pattern, and distribution mode for type IV were compared among the four groups by two pathologists, and the differences between observers and disease groups were statistically analyzed by Chi-square test or Fisher's exact test. Results: The type IV staining intensity was more enhanced in well-differentiated (w) SCC than poorly-differentiated (p) SCC (P = 0.004). The staining was more linear (P = 0.001) and continuous (P = 0.003) in early invasive SCCs than in highly invasive SCCs. Its distribution was more continuous in wSCC than in less differentiated SCC (P = 0.003). There were statistically significant differences in the staining intensity between wSCC and pSCC (P = 0.005) or between wSCC and moderately differentiated SSC (P = 0.003) and in the staining pattern between wSCC and pSCC (P = 0.001). Conclusion: The results indicated that there was a direct relationship between the presence of type IV collagen and the differentiation degree of SCC cells and thus that SCC cells loose their capability to form the basement membrane as they become less differentiated.

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Aim of Study: To explore the ability of two Ayurvedic formulations, Brahma Rasayana (BRM) and Chyavanaprash (CHM) in alleviating Cisplatin (Cis-dichlorodiammineplatinum [II] CDDP) induced acute nephrotoxicity. Materials and Methods: Swiss albino mice were administered with CDDP (12 mg/kg, i.p) and two doses of BRM or CHM (1 and 2 g/kg). Various antioxidant parameters in the kidney as well as release of marker enzymes in the serum were assayed. Histology of the kidney was also performed to check for CDDP induced damages. Results: Administration of either BRM or CHM (1 and 2 g/kg) maintained the antioxidant status in the kidney thereby preventing tissue damage as well as the release of marker enzymes. CDDP induced variation of renal architecture was also prevented by BRM and CHM administration. Conclusion: BRM and CHM administration could prevent CDDP induced acute renal toxicity.

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Mesenchymal neoplasms of the larynx are rare and make up approximately 0.3% to 1.0% of all malignancies at this location. Low grade myofibroblastic sarcoma (LGMS) of larynx is a rare entity. We describe a rare case of LGMS of larynx who presented with complaint of hoarseness of voice. The patient was treated with total laryngectomy plus partial pharyngectomy followed by post-operative radiotherapy. Histopathologically, the lesion was composed of spindle cells that manifested variable cellular anaplasia and expressed smooth muscle actin (SMA) and focally S-100.One of the resection limits was involved so patient was given post-operative radiotherapy. The patient is alive and disease free 14 months after surgery. The characteristic clinical, histopathological features and treatment of this case are described with a literature review.

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Juvenile Ossifying Fibroma may be considered a fibro-osseous tumor which usually occurs in young children and arises in craniofacial bones, most commonly seen in the maxilla. This kind of lesion usually occurs in young patients and because of its aggrssive nature, clinicians should try to recognize it as soon as possible in order to avoid future functional and aesthetics problems. Moreover, untreated cases over a long period may result in large bone defects during the surgical removal of the lesion. Here reported is a case of a six-year-old girl who developed a rare aggressive fibroma localized in the right upper jaw. The clinical, radiographic and histopathologic findings, plus differential diagnoses of the case and treatement options are also presented.

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Intra-nodal palisaded myofibroblastoma (IPM) is a rare benign lymph node mesenchymal tumor. It presents as a slow growing, painless nodular mass confined mostly to the inguinal area. Histologically, it shows palisading spindle cells, hemorrhages, hemosiderin laden macrophages, and amianthoid fibers, almost totally replacing the lymph node. Recent genetic evidence supports viral etiology. A case of IPM occurring in a 25-year-old woman is presented and the differential diagnosis of this lesion is discussed. IPM occurs between 4 ^th and 6 ^th decade of life, male to female ratio is 2:1 and the inguinal region is the commonest location. Origin of this tumor is from myofibroblasts or smooth muscle fibers. Though benign, morphologically it can be confused with malignant tumors like Kaposi's sarcoma, melanoma, and leiomyosarcoma. Prognosis is excellent and surgical excision is the only needed treatment. There are no reports of malignant transformation though an occasional case has recurred.

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Context: Hypofractionated intensity-modulated radiotherapy (IMRT) under image guidance using helical tomotherapy for prostate cancer improves therapeutic ratio. Aims: To report on clinical and dosimetric experience using hypofractionated helical tomotherapy for prostate cancer. Settings and Design: Prospective consecutive case series as feasibility study approved by Institutional Review Board (IRB) (2007-11). Materials and Methods: The staging work-up, risk stratification, simulation, contouring, planning, online matching and treatment delivery methodology are described in detail. The doses to (prostate and nodal) PTV and organs at risk (bladder, rectum, bowel and femoral heads) are described. The audit of online matching was used to determine set-up errors, PTV margins and resultant translational vector. We also report the outcomes in terms of biochemical relapse-free survival and acute toxicity. Results: Fifty-three consecutive patients were included. The baseline PSA was 23 ng/ml (1.60-100.37). The prostate BED3 ranged from 110-129 Gy (α/β for prostate 1.5-3 Gy) and nodal 72-87.68 Gy. The required PTV margin by van Hark's formula for lateral, longitudinal and vertical axes were 11.30, 9.95 and 13.49 mm, respectively with resultant vectors 3-15 mm. There was 7% to 8% chance of missing part of CTV in absence of image guidance. There was only one patient requiring premature conclusion at 45 Gy due grade 3 genitourinary toxicity. At median follow-up of 23 months, biochemical relapse-free survival rate is 95.2%. Conclusions: Hypofractionated IMRT under image guidance using helical tomotherapy for prostate cancer is feasible with acceptable acute toxicity and may be advantageous in high throughput centers.

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Context: The advent of monoclonal antibodies such as Rituximab, in recent years, has brought about decisive progress in the treatment of aggressive and indolent non-Hodgkin's lymphoma. Aims: A further tried and tested improvement to the unmodified antibody has been its coupling to the beta-emitters Y-90. The optimization of ⁹⁰ Y-antiCD20 radioimmunoconjugate production and quality control methods for future clinical studies in the country was targeted in this work. Materials and Methods: The antibody was labeled with ⁹⁰ Y-yttrium chloride (185 MBq) after conjugation with freshly prepared ccDTPA. Y-90 chloride was obtained by thermal neutron flux (4 × 10 ¹³ n/cm ² /s) of a natural Y ₂ O ₃ sample, dissolved in acidic media. Radiolabeling was completed in 24 h by the addition of DTPA-Rituximab conjugate at room temperature. Statistical Analysis Used: All values were expressed as mean ± standard deviation (mean ± SD), and the data were compared using Student's t-test. Statistical significance was defined as P < 0.05. Results: Radiochemical purity of 96% was obtained by using ITLC method for the final radioimmunoconjugate (specific activity = 440-480 MBq/mg). The final isotonic ⁹⁰ Y-Rituximab complex was checked by gel electrophoresis for protein integrity retention. Biodistribution studies in normal rats were carried out to determine the radioimmunoconjugate distribution up to 72 h. Conclusion: The results showed that ⁹⁰ Y-DTPA-Rituximab could be considered for further evaluation in animals and possibly in humans as a radiopharmaceutical for use in radioimmunotherapy against non-Hodgkin's lymphomas. Because of the importance of developing anti-lymphoma B agents in nuclear medicine for country use, an optimized radiolabeling method has been introduced.

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Primary osteogenic sarcomas of the breast are exceptionally uncommon. We describe such a case occurring in a 50 year-old woman who presented with a large painful mass in her left breast. Simple mastectomy of the left breast was performed. Microscopical and immunohistochemical findings established the diagnosis of primary osteogenic sarcoma. Similar to extremity osteosarcoma, adjuvant adriamycin and cisplatin based chemotherapy and external beam radiotherapy was given to the present case. She remained well 57 months later, without tumor recurrence. The current article made a literature search proving the rarity of this lesion type and discusses in detail the diagnostic implications and the treatment of this rare site tumor entity.

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Introduction: The Xeroderma pigmentosum group D (XPD, also referred to as excision repair cross complementing gene 2, ERCC2) is one of key genes involved in nucleotide excision repair and two potentially functional polymorphisms of XPD (Asp312Asn and Lys751Gln) have been widely investigated in various cancers including prostate cancer. However, the results were conflicting rather than conclusive. Aims: Thus, we conducted a meta-analysis to evaluate the associations between these two polymorphisms of XPD and the risk of prostate cancer. Materials and Methods: An electronic search of PubMed and Embase was conducted to select relevant studies. Studies containing available genotype frequencies of XPD Asp312Asn and Lys751Gln were chosen, and the associations were assessed by pooled odds ratios with 95% confidence intervals. Results: According to PubMed and Embase databases, we identified seven eligible studies from six articles, including 2641 cases and 3259 controls for Asp312Asn and nine eligible studies from eight articles, including 3255 cases and 3654 controls for Lys751Gln. The meta-analysis showed that no overall association was observed between XPD Asp312Asn and prostate cancer risk. However, the significantly increased risk of 312Asp allele was found among Asians and Africans, but it seemed to be protective in Caucasians when stratified by ethnicity. For XPD Lys751Gln, overall findings had implicated null effects. Conclusion: These findings indicated that the Asn allele of XPD Asp312Asn might be a risk-factor for developing prostate cancer among Asian and African men but protective for Caucasian population.

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Metastatic tumors to the jawbones are uncommon. Metastatic lesions to the oro-facial region may be the first evidence of dissemination of an unknown tumor from its primary site. Follicular thyroid carcinoma rarely presents initially as a distant metastatic lesion within the mandible. This case of metastatic follicular thyroid carcinoma is presented to emphasize its unusual initial presentation within the body of the mandible, which mimicked an odontogenic tumor. It's important to detect the carcinoma early so that it can be treated successfully and also improves the prognosis of the patient. The histopathological features and immunohistochemical findings are also discussed.

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The perivascular epithelioid cell tumor (PEComa) family of tumors includes angiomyolipoma, lymphangioleiomyomatosis, clear cell sugar tumor of the lung, clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres, and rare clear cell tumors of other anatomical sites (PEComas-NOS). Among the PEComas-NOS, pigmented variants are extremely rare. The case concerns a 50-year-old female who presented with pain in right hypochondrium. The resected specimen included a 24 × 18 × 9 cm mass. The tumor was histologically characterized by both spindle and epithelioid cells with round to oval nuclei and clear to eosinophilic cytoplasm containing abundant melanin pigment. The stroma demonstrated intervening, thin, fibrovascular septa. Immunohistochemically, the tumor cells were strongly positive for HMB-45, weak positive for smooth muscle actin (SMA), and negative for Hep Par 1, Glypican 3, MUM-1, and S-100 protein. The patient had no evidence of disease 24 months after surgery. Pathologists and clinicians should know about the existence of pigmented perivascular epithelioid cell tumor of the liver.

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Background: Thymomas are the most common tumors of the mediastinum. They have varied presentation ranging from asymptomatic incidental mediastinal masses to locally extensive tumor with compressive symptoms and distant metastases. The authors present our institute's experience in combined modality management of thymomas. Materials and Methods: We retrospectively reviewed 36 patients of thymoma treated in our institute from January 2004 to December 2010. Clinical characteristics and treatment modality in form of surgery, radiotherapy (RT) and chemotherapy (CCT) were noted. Statistical analysis was done with regard to progression free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis. Results: A total of 17 patients had associated Myasthenia gravis and 3 patients had associated Cushing syndrome. Masaoka Stage 4a was the most common stage (13 patients) followed by stage 3 (10 patients), stage 2 (9 patients) and stage 1 (4 patients). Twenty seven patients underwent primary surgery, out of which 20 received adjuvant RT and five received both RT and CCT. Of nine non-surgical cases, four received only palliative RT whereas 5 received systemic CCT followed by local mediastinal RT. Overall, 23 patients had complete response while 13 had partial response. 1 patient had local recurrence. Three year PFS was 60% and 3 year OS was 83%. Conclusions: Most common presentation in our series was locally advanced tumors. Most of these patients require adjuvant mediastinal radiation, which helps in significant loco-regional control. Systemic CCT benefits in inoperable, advanced and high-risk tumors. Risk-adapted and multimodality approach is the need of the hour to achieve good control rates while minimizing treatment related toxicity.

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Clear cell carcinoma of the salivary glands is a rare tumor that represents less than 1% of all salivary tumors and is a new disease that is only recognized in recent years. It is rare and the standard treatment is still under investigation. This tumor often follows an indolent course and treatment includes wide surgical excision with or without adjuvant radiotherapy. Recurrence of the hyalinizing clear cell carcinoma (HCCC) after complete surgical resection is uncommonly documented. We hereby report a case of post-radiotherapy locoregional recurrence of HCCC of the palate and recommend further clinicopathological study and long-term follow-up to document the biological behavior of this entity along with highlighting the role of special stains and immunohistochemistry in its diagnosis.

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Most pelvic smooth muscle tumors are believed to be malignant, leiomyomas are extremely rare; more so in male patients. Very few cases of symplastic leiomyomas have been described in males. We report an extremely unusual case of a soft tissue mass of periprostatic and periseminal vesicle region in a young adult, which necessitated a radical surgery. Histologically, tumor comprised of smooth muscle bundles with numerous bizarre tumor cells which were immunoreactive with smooth muscle actin (SMA), desmin and h-caldesmon. The diagnostic and treatment dilemmas of these unusual tumors are discussed.

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Anaplastic lymphoma kinase positive, anaplastic large cell lymphoma (ALCL) is an uncommon T-cell non-Hodgkin lymphoma. A rare morphological variant-small cell variant of ALCL may pose diagnostic challenge especially when it presents primarily as a soft tissue mass. We present a rare case of small cell variant of ALCL in a 14-year-old female presented with arm swelling with emphasis on clinical, morphological and immunohistochemical aspects. Pathologists should be aware of this entity when considering a differential diagnosis of malignant round cell tumor as early and correct diagnosis has important clinical implications.

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Neuroblastoma is the second most common malignant solid tumor in children, and often metastasizes to liver, most notably in patients with stage 4S tumors. Solid pseudopapillary tumor of the pancreas (SPT) is a pancreatic borderline tumor with low malignant potential. Coexistence of these two tumors in one patient has never been reported before. Hereby, we present a case of an 8-month-old infant with coexisting tumors of SPT and metastatic neuroblastoma of liver. Dysdifferentiation of neural crest might be responsible for histogenesis of the coexisting tumors.

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Renal collecting duct carcinoma (CDC) is a rare and aggressive type of renal cell cancer (RCC), which is difficult to confirm before surgery. We present a case of CDC presenting a hypovascular mass on renal CTA and deteriorated renal function of the affected kidney on single photon emission computed tomography (SPECT), which are different from the most common RCC, clear cell RCC. Considering these findings, it would be worthwhile investigating the role of CTA and SPECT in CDC diagnosis.

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Background: The incidence of sarcoma diagnosed in the elderly population may be rising due to the increasing life expectancy. The purpose of our study was to evaluate the efficacy of lung metastasectomy and radiofrequency (RF) ablation in elderly sarcoma patients (65 years or older) with lung metastases, compared with adult sarcoma patients younger than 65 years (20-64 years). Materials and Methods: We retrospectively evaluated the clinical efficacy of metastasectomy and lung RF ablation in sarcoma patients with lung metastases. Results: Between 2001 and 2010, lung metastases were detected in 66 adult patients with musculoskeletal sarcomas. Twenty-five patients with lung metastasis were elderly. Twelve of the 25 patients were treated with lung metastasectomy and/or RF ablation. In contrast, 41 patients were adult patients younger than 65 years. Twenty of these 41 patients were treated with lung metastasectomy and/or RF ablation. The 1 and 3-year survival rates after initial treatment for lung metastases were 81.8% and 38.4% in 12 elderly patients, respectively. Compared with the control group, the survival rate in the elderly patients was not significantly different. Conclusion: We conclude that elderly sarcoma patients with lung metastases should always be considered for either metastasectomy or RF ablation.

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Purpose: To investigate the dosimetric characteristics of accelerated partial breast irradiation technique by MammoSite^® applicator using thermoluminescent dosimeter (TLD) and Monte Carlo simulation to comparing them with treatment planning system calculation for planning target volume (PTV) and organs at risk such as skin, lung and chest wall. Materials and Methods: The Monte Carlo MCNP-5 code was used to simulate dose rate in the PTV that is a MammoSite^® balloon with 1 cm margin around it. Experimental dosimetry was carried out within a female-equivalent chest phantom with TLD dosimeter after insertion of ¹⁹² Ir source into the MammoSite^® applicator. Three dimensional planning (TP) was done for dose delivery to the specific points within the phantom by means of FlexiPlan software. Results: Statistical comparisons were done between TP calculation, Monte Carlo simulation and TLD. Our results showed good agreement for surface doses between simulation and measurement. The mean skin dose for the simulation and TLD result was 61.7% and 56.8% of prescription dose, respectively. The maximum dose to the chest wall for Monte Carlo and TLD were 114.4% and 111.8% of prescription dose, respectively. The maximum dose to the lung for Monte Carlo and TLD results were 28.4% and 27.3% of prescription dose, respectively. Using Monte Carlo simulation and an average female chest phantom, it was possible to demonstrate the accuracy on the calculated dose rate in the PTV of a MammoSite^® dose delivery system with ¹⁹² Ir HDR sources. Conclusions: The results showed acceptable agreement between simulation, treatment planning, and experimental dosimetry results.

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Osteoclast like-giant cell tumor of the salivary gland is an extremely rare tumor with distinct pathological features and unknown histogenesis. The neoplastic nature of these tumors in itself is questionable. We present the twentieth case in English literature of primary osteoclast like-giant cell tumor with accompanying low to intermediate grade salivary duct carcinoma of parotid gland, metastasizing to the ipsilateral cervical lymph node. As far as we know this is the second case with lymph node metastasis. Due to the rarity of the tumor its exact biological course is uncertain. We present and discuss this rare case with special emphasis on the histology, immunohistochemistry, and histogenesis.

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Diffuse large B-cell lymphoma (DLBCL) usually present with rapidly growing lymph nodes or extra-nodal masses. Central nerve system involvement and pregnancy are rare in DLBCL. Here, we report an unusual case of DLBCL with cavernous sinus syndrome during pregnancy. A 24-year-old woman presented cavernous sinus syndrome as the initial presentation during pregnancy. Magnetic resonance imaging (MRI) revealed enlargement of bilateral cavernous sinus. Tonsil and ovary biopsy indicated malignant lymphoma-DLBCL. Bone marrow smear showed infiltration by tumor cells. The case delivered a viable baby by cesarean section and then took chemotherapy of rituxan, cyclophosphamide, adriamycin, eldisine and dexamethasone. The disease deteriorated rapidly, especially after the pregnancy was terminated. Fortunately, a complete response was achieved after six cycles of chemotherapy. With the accumulation of clinical practice of such cases, we would be able to recognize minimal symptoms of DLBCL at the beginning and confirm the most suitable timing of the initiation of chemotherapy during pregnancy.

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Background: Activating mutations in the epidermal growth factor (EGFR) gene confer sensitivity to the tyrosine kinase inhibitors (TKIs) in patients with advanced non-small cell lung cancer (NSCLC). TKI treatment efficacy and EGFR mutation implications were evaluated in clinically selected advanced NSCLC patients treated with TKIs in routine clinical practice. Materials and Methods: A retrospective chart review for clinicopathological characteristics and mutation status (EGFR, KRAS) analysis of 40 consecutive patients treated with TKIs between 2005 and 2010 was performed. Statistical Analysis Used: PFS and OS were estimated by the Kaplan-Meier method, the log-rank test was used to test for differences. The strength of the associations between the EGFR mutation status and clinicopathological characteristics were tested with the Mann-Whitney U-test or the Kruskal-Wallis H-test. Results: The prevalence of EGFR mutations was 45% with a predominance of deletion mutations in exon 19 (55.5%). Significant correlations between gender, histology, and EGFR mutations were observed. Median progression-free survival (mPFS) for the entire group of patients was 8.7 months and median overall survival (mOS) was not yet reached. Patients with EGFR mutant tumors derived significantly higher benefit from TKI therapy compared to patients with mutation-negative disease; with mPFS of 22.0 vs. 3.2 months (HR: 3.9, 95% CI 1.56-9.89) and with a trend towards better OS (probability of survival at 12 months 82.0 vs. 63.0%, P = 0.080). Conclusion: We demonstrated that screening for EGFR mutations is reliable in a routine clinical setting and might allow for a better selection of NSCLC patients for anti-EGFR TKI therapy.

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We are reporting a case of pneumonia associated with pleural effusion during the neutropenic phase of induction chemotherapy. In spite of being Adenosine deaminase negative, the pleural effusion responded only to empiric therapy with antitubercular agents. The diagnosis was confirmed with positive PCR testing for mycobacterium tuberculosis.

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A 71 year-old obese woman complained of obstructive sleep apnea syndrome (OSAS) related symptoms. The apnea-hypopnea index (AHI) was 73.5/hour. She presented with nasal bleeding to an ENT doctor. A mass on the nasal septum was seen and biopsy was performed. Histological confirmation showed malignant melanoma. The tumor stage proved to be cT4aN2M1 (stage IV) due to multiple metastatic lesions. After palliative irradiation, the nasal tumor was reduced in size and her symptoms of OSAS were improved. The second AHI revealed 13.5/hour. This case was considered to be OSAS caused by a tumor obstructing the nasal cavity. This might suggest the necessity of routine work-up of the upper airway in cases of patients with sleep disorder. Otherwise, OSAS caused by such obstruction might be missed. We report a very rare case with secondary OSAS caused by malignant melanoma in the nasal cavity and paranasal sinus.

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This is a rare case report of osteosarcoma with lepromatous leprosy. A 15 year old male patient presented with swelling around the right knee joint. Imaging and biopsy were consistent with osteosarcoma. After his first cycle of adjuvant chemotherapy (ACT), the patient developed fever, erythematous nodules, perichondritis of ear lobe, and thickened nerves. His slit-skin smear examination showed acid-fast bacilli in clumps, and a diagnosis of multibacillary leprosy was made. He was treated with anti-leprosy medications with steroids, and once his condition stabilized, his ACT was continued. On follow-up, his skin lesions completely recovered.

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Objective: To investigate the clinico-pathologic importance of Heparanase mRNA expression in hepatocellular carcinoma and its relationship with prognosis. Materials and Methods: Fresh tumors and noncancerous liver tissues were obtained from 30 hepatocellular carcinoma patients after hepatectomy. Expression levels of Heparanase and glyceraldehyde-3-phosphate dehydrogenase mRNA were quantitatively analyzed by real-time reverse transcriptase-polymerase chain reaction. Results: The relative Heparanase mRNA expression level (Heparanase: glyceraldehyde-3-phosphate dehydrogenase ratio) in hepatocellular carcinoma was lower than that in noncancerous tissue (P < 0.05). Conclusion: Reduced Heparanase mRNA expression might result in abnormal cell growth and correlate with hepatocellular carcinoma progression.

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