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  Citation statistics : Table of Contents
   2012| January-March  | Volume 8 | Issue 1  
    Online since April 19, 2012

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Evaluation of diffusion-weighted imaging as a predictive marker for tumor response in patients undergoing chemoradiation for postoperative recurrences of cervical cancer
Supriya Chopra, Ashish Verma, Sayan Kundu, Reena Engineer, Seema Medhi, Umesh Mahantshetty, Sudeep Gupta, Shyam K Shrivastava
January-March 2012, 8(1):68-73
Purpose: To investigate diffusion-weighted imaging (DWI) as a response biomarker in patients undergoing chemoradiation for postoperative recurrences of cervical cancer. Materials and Methods: From October 2008 to March 2011, 20 patients were included. All underwent T2-weighted (T2W) and DWI before and after chemoradiation. Gross tumor volume (GTV), lateral extent, apparent diffusion coefficient (ADC), and presence of regions of focally restricted diffusion were determined at baseline. Response to chemoradiation was categorized as either partial or complete. Receiver operator characteristics (ROC) curve identified thresholds of GTV and ADC that best predict for partial response. Univariate and multivariate analysis were performed on SPSS version 15. Results: The median GTV was 24.5 cc (4.1-110 cc). Central and lateral disease was present in 8 and 12 patients, respectively. The median ADC was 1 × 10 -3 mm 2 /s (0.8-1.3 × 10 -3 mm 2 /s) and 12/20 (60%) patients had focal restricted diffusion. Overall 10/20 patients had partial response. ROC analysis identified volume of 25 cc or higher [sensitivity = 80%, specificity = 80%, area under curve (AUC) = 0.76, P = 0.04] and ADC more than 1 × 10 -3 mm 2 /s (sensitivity = 70%, specificity = 50%, AUC = 0.62; P = 0.34) to best predict for partial response. On univariate analysis bulky disease (77.7% vs. 27%; P = 0.03), lateral disease (66.6% vs. 25%; P = 0.08), and focal regions of restricted diffusion (66.6% vs. 25%; P = 0.06) predicted for partial response to chemoradiation. All factors continued to be significant on multivariate analysis. On restricting analysis to bulky tumors ADC greater than 0.95 × 10 -3 mm 2 /s predicted partial response with high sensitivity (85.7%) and specificity (100%) (AUC 0.96; P = 0.05). On univariate analysis lateral disease (P = 0.04), high baseline ADC (P = 0.07) predicted for partial response. Conclusions: Baseline ADC and focal regions of ADC restriction predict for partial response with moderate sensitivity and specificity in patients with postoperative recurrences of cervical cancer and need to be validated in larger cohort.
  10 3,574 364
Nano cancer therapy strategies
Manjul Tiwari
January-March 2012, 8(1):19-22
DOI:10.4103/0973-1482.95168  PMID:22531508
Cancer is a leading cause of deaths. Millions of people are diagnosed with cancer every year. Many cancer cells have a protein all over their surface, while healthy cells typically do not express the protein as strongly. By conjugating, or binding, the gold nanoparticles to an antibody the researchers were able to get the nanoparticles to attach themselves to the cancer cells which may help us unravel the inner workings of a cancer cell and produce better treatments. In terms of drug delivery systems, nano particles enable unique approaches for cancer treatment. A large number of nanoparticle delivery systems have been developed for cancer therapy and currently they are in the preclinical stages of development. More recently developed nanoparticles are demonstrating the potential sophistication of these delivery systems by incorporating multifunctional capabilities and targeting strategies in an effort to increase the efficacy of these systems against the most difficult cancer challenges. This article reviews the available preclinical and clinical nanoparticle technology platforms and their impact on cancer therapy.
  9 5,690 776
Erlotinib-induced acute interstitial lung disease associated with extreme elevation of the plasma concentration in an elderly non-small-cell lung cancer patient
Yukari Tsubata, Akinobu Hamada, Akihisa Sutani, Takeshi Isobe
January-March 2012, 8(1):154-156
We herein describe a case of drug-induced interstitial lung disease (ILD) following treatment with erlotinib. The plasma trough concentration of erlotinib at the time of the ILD diagnosis was extremely elevated compared with the plasma maximum concentration on day 1. We hypothesized that this phenomenon was associated with the pharmacodynamic interaction with a concomitant drug. The present case indicates that erlotinib-induced ILD was associated with a high plasma concentration of erlotinib. Oncologists should be aware of the possibility of ILD induced by erlotinib, especially for patients with co-morbidities.
  7 3,802 343
Low voltage irreversible electroporation induced apoptosis in HeLa cells
Wei Zhou, Zhengai Xiong, Ying Liu, Chenguo Yao, Chengxiang Li
January-March 2012, 8(1):80-85
Background: High-voltage electric field pulses can make cell membrane electroporated irreversibly and eliminate malignant cells via necrosis. However, low-voltage is not efficient as that. Aims: This study determined the differential effects of high- and low-voltage electric field pulses on HeLa cells, when the power of low-voltage was enhanced by increasing quantity of pulses. Materials and Methods: Pulses electric fields with permanent frequency (1 Hz) and pulse length (100 μs) were performed on HeLa cells. Voltage and pulse sets (8 pulses/set) were various during treatment. CCK-8 assay was used to detect cell viability. The quantitative determination of apoptosis and necrosis were performed by flow cytometry with Annexin V and PI staining. Transmission electron microscopy was used to observe the ultrastructure of HeLa cells. Caspase-3 and caspase-8, the enzymes in apoptotic pathway, were determined by western blot. Results: The data showed that low-voltage electric field pulses also could make cell irreversible electroporation (IRE) and ablate HeLa cells effectively by induction of apoptosis. The ablating effect due to low-voltage treatments delivered with a greater number of pulses may be as satisfactory as high-voltage, or even preferable because it causes less necrosis and more apoptosis. Conclusions: IRE induced by low voltage with more pulses could ablate HeLa cells effectively as high voltage, and it was preferable that less necrosis and more apoptosis occurred under such condition.
  7 5,218 428
Rare case of extraskeletal Ewings sarcoma of the sinonasal tract
Sunil Kumar Yeshvanth, Kurian Ninan, Sathish Kumar Bhandary, Kishan Prasad H Lakshinarayana, Jayaprakash K Shetty, Jagdish H Makannavar
January-March 2012, 8(1):142-144
Ewings sarcoma (ES) and primitive neuroectodermal tumor are closely related family of small round cell tumors seen in childhood and adolescence. The incidence of these tumors occurring in the head and neck region is just 2-7%. Mandible and maxilla are the most common sites, whereas involvement of the sinonasal tract is very rare. We report a case of extraskeletal ES of the sinonasal tract in a 29-year-old female who presented with nasal obstruction and epistaxis. The patient was treated with 14 cycles of chemotherapy, combined with surgery and radiotherapy with complete recovery. We present this case due to its rarity, to analyze the clinical, histopathological and immunohistochemical findings, so as to differentiate from other small round cell tumors of the sinonasal tract for appropriate treatment.
  5 3,975 385
Cut margins and disease control in oral cancers
SR Priya, AK D'Cruz, PS Pai
January-March 2012, 8(1):74-79
Aim: This retrospective study was done to evaluate the impact of cut margins on disease-free survival in patients with previously untreated oral squamous cell cancers. Materials and Methods: Records of 306 cases were reviewed for clinical details and status of margins at resection. The independent influence of margins on recurrence was analyzed. The impact of frozen section analysis on achieving free margins was also examined. Results: 190 (62.1%) patients had negative margins of resection (≥5 mm), 102 (33.3%) patients had close margins (1-5 mm), while 14 (4.6%) patients had positive margins (≤1 mm). The median follow-up for the entire cohort was 26.5 months. There were 79 (25.8%) recurrences, of which, 46 (58.2%) were local, 9 (11.3%) were locoregional, 16 (20.2%) were regional, and 8 (10.1%) were distant metastasis. 42 (22.2%) cases with negative margins developed a recurrence as compared to 31 (30.4%) cases with close margins and 6 (42.8%) cases with positive margins (P value 0.01). Average time to recurrence in case of negative margins was 34.8 months, for close margins was 33.9 months, while in those with positive margins was 10.18 months (P value 0.002). Close and positive margins were found to be significantly associated with increased local recurrence (P values 0.01 and 0.03, respectively) and with overall recurrence (P values 0.003 and 0.003, respectively). Frozen section was seen to influence margins in 20.4% cases. Conclusion: Margins are an important predictor of disease control. The surgeon must aim for adequate margins at initial resection.
  5 4,229 467
Overexpression of interferon regulatory factor 1 enhances chemosensitivity to 5-fluorouracil in gastric cancer cells
Jinbo Gao, Yuan Tian, Jinghui Zhang
January-March 2012, 8(1):57-61
Purpose: To investigate the effects of interferon regulatory factor 1 (IRF-1) gene overexpression on chemotherapeutic sensitivity of gastric cancer cells. Materials and Methods: An AGS cell system with tetracycline-inducible IRF-1 expression (AGS/IRF-1) was established. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blotting were used to detect the expression of the IRF-1 gene. Chemosensitivity to 5-fluorouracil (5-FU) was assessed by cell proliferation assay and cell apoptosis. Results: IRF-1 mRNA and protein level were significantly increased in AGS/IRF-1 cells induced with tetracycline. Compared with control cells, the growth inhibition rate of cells with IRF-1 overexpression was significantly increased when treated with 5-FU (P<0.01). Treatment with 5 μmol/l 5-FU resulted in 12.6% apoptotic cells, whereas such treatment after overexpression of IRF-1 resulted in 39.4% apoptotic cells. Moreover, more poly(adenosine diphosphate-ribose) polymerase (PARP) cleavage was seen in cells with IRF-1 overexpression. Conclusions: Overexpression of IRF-1 enhanced the chemosensitivity of gastric cancer cells to 5-FU through induction of apoptosis.
  4 2,967 303
Positron emission tomography scan for predicting clinical outcome of patients with recurrent cervical carcinoma following radiation therapy
Daya Nand Sharma, Goura Kisor Rath, Rakesh Kumar, Arun Malhotra, Sunesh Kumar, Jagadesan Pandjatcharam, Sagar Maharjan
January-March 2012, 8(1):23-27
Purpose: To evaluate the role of positron emission tomography (PET) for predicting the clinical outcome of patients with recurrent cervical carcinoma following definitive radiation therapy (RT). Materials and Methods: Twenty two patients of post irradiated recurrent cervical carcinoma (PIRCC) were enrolled in this prospective study. 18-fluorodeoxyglucose (FDG) PET imaging was performed in each patient before the salvage therapy. The maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were measured and correlated with cumulative progression free survival (PFS). Results: Median age of patients was 42 years. Majority of patients had stage III disease at the initial presentation and all 22 patients had received prior definitive RT. The median recurrence free period was 11 months. Salvage therapy consisted of surgical resection or re-irradiation depending upon the various clinical and radiological factors. Median SUVmax was 5.8 (range 1.8-50.6) and median MTV was 43 cm 3 (range 5.8-243). The cumulative PFS for all patients was 20% at 30 months. The one-year PFS was 28% for patients with SUVmax value of >5.8 versus 42% for those with SUVmax value of <5.8 (P value 0.01). The one-year PFS was 43% for patients with MTV value of >43 cm 3 versus 45% for those with MTV value of <43 cm 3 (P value 0.8). Conclusion: Our preliminary experience has suggested that FDG uptake on PET scan can predict the clinical outcome of PIRCC patients. Further randomized studies may be conducted with large sample size and longer follow up to establish its definite predictive value.
  4 2,582 344
CYP 2D6 polymorphism: A predictor of susceptibility and response to chemoradiotherapy in head and neck cancer
Pragya Shukla, Deepak Gupta, Mohan Chand Pant, Devendra Parmar
January-March 2012, 8(1):40-45
Aims: A major problem in cancer pharmacology is the unpredictability of the outcome of therapy, both in terms of tumor response and host toxicity. Pharmacogenetic variability associated with the drug metabolizing enzyme systems is a major determinant of variations in these outcomes. Materials and Methods: A case-control study of 100 male cases of head and neck squamous cell carcinoma and equal number of healthy controls was conducted. Genomic DNA isolated from blood samples collected from controls and patients was studied by PCR-RFLP technique for CYP2D6 polymorphism. All patients received three cycles of cisplatinum-based sequential chemoradiotherapy. Results: The increased frequency of variant genotypes was associated with a statistically significant increase in the risk in the cases both in CYP2D6*4 and *10. The effect of interaction of the risk modifiers such as cigarette smoking or tobacco chewing or alcohol drinking with the CYP2D6 genotypes in the controls and patients was found to be significant. Response to therapy in patients with variant genotypes of CYP2D6 (CYP2D6*4 and CYP2D6*10) and treated with radio and chemotherapy regimen was poor. Conclusions: Functional enzyme deficiencies due to polymorphism in CYPs are not only important in enhancing susceptibility to head and neck squamous cell carcinoma but also in determining chemotherapeutic response.
  4 4,608 462
Functional magnetic resonance imaging in cervical cancer: Current evidence and future directions
Sayan Kundu, Supriya Chopra, Ashish Verma, Umesh Mahantshetty, Reena Engineer, Shyam Kishore Shrivastava
January-March 2012, 8(1):11-18
Carcinoma cervix is one of the most common cancers amongst Indian women. Though treatment strategies continue to evolve, there are no established predictive biomarkers of prognosis or therapeutic response. Novel imaging techniques using magnetic resonance (MR) and positron emission tomography (PET) can facilitate time resolved spatial evaluation of biological characteristics (perfusion, permeability, cellularity, proliferation, oxygenation, and apoptosis) thereby serving as early surrogate biomarkers for prognosis and therapeutic response. Several of these imaging modalities such as dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DW-MRI), MR spectroscopy (MRS) and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) are now being evaluated for gynecological oncology, with the majority of work being performed on cervical tumors. PUBMED database was searched for this review from January 1966 till February 2011. This review examines the basic principles of functional MR imaging for cervical cancer and its current status as a diagnostic and predictive biomarker for cervical cancer.
  4 7,034 910
Complete response to chemotherapy in primary hepatic lymphoma
Mir Sadaqat Hassan Zafar, Shyam Aggarwal, Sunita Bhalla
January-March 2012, 8(1):114-116
Primary hepatic lymphoma is an uncommon lymphoid tumor with varied clinical presentations and treatment outcomes. The median age of involvement is 50 years (male preponderance) with median survival as 8-16 months. Here we report a 68-years-old female who presented with right hypochondriac pain and anorexia with hepatomegaly on physical examination. Ultrasonography (USG) with subsequent contrast enhanced computed tomography (CECT) of abdomen depicted a hypoechoic mass in the left lobe of liver. CECT of chest and neck showed no abnormality. Liver biopsy proved to be Non-Hodgkin lymphoma (NHL) diffuse large B cell type, CD20 positive. Bone marrow examination showed no infiltration by NHL. The patient was started on three weekly R-CHOP, given a total of 8 cycles. Patient attained a complete remission documented by negative computed tomography (CT) and positron emission tomography (PET) scans.
  3 3,506 329
Chondrosarcoma of the distal phalanx of the right great toe: Report of a rare malignancy and review of literature
Santosh Kumar Mondal
January-March 2012, 8(1):123-125
Foot is an uncommon site for chondrosarcoma and involvement of phalanges is extremely rare. Here, a case of low-grade chondrosarcoma of the distal phalanx of the right great toe in a 37-year-old male patient is being reported. The patient complained of gradual swelling of the right great toe and pain for last 2 years. X-ray showed a lytic lesion destroying the distal phalanx with soft tissue extension. Amputation of the great toe was done and specimen was sent for histopathological examination. Microscopical examination revealed grade 1 chodrosarcoma infiltrating the surrounding soft tissue and muscle. The patient is on 1-year follow-up which is uneventful.
  3 5,602 221
A survey of breast cancer knowledge and attitude in Iranian women
Nahid Nafissi, Masoud Saghafinia, Mohammad Hosein Kalantar Motamedi, Mohammad Esmaeil Akbari
January-March 2012, 8(1):46-49
Background: Breast cancer (BC) is the most common cancer among Iranian women. It is recommended that women be under national screening for early detection of cases to improve survival and decrease mortality. Because of shortage of facilities, breast self-examination (BSE) instead of clinical-based examination (CBE) and mammography is advocated as the first step of screening in developing countries including Iran. It is quite clear that the related knowledge, attitude, and practice (KAP) of the community is necessary to have a successful screening program particularly for BSE. Materials and Methods: A community-based descriptive study on 650 females aged more than 18 years was carried out with a well-structured and valid questionnaire to demonstrate the knowledge and practice of women for BSE, CBE and mammography. Results: The mean age of participants was 40.72 years with standard deviation (SD) of 9.58. Eighty-two point six percent (82.6%) were married and 48.4% were post graduates. A painless mass (60.8%) and bloody discharge (44.9%) were reported as the two important symptoms for BC. In this assay, 80.3% of participants knew females are at risk of BC and 70.6% of them perceived that early detection and operation in early stages are effective issues. Thirty point eight percent (30.8%) of respondents knew the BSE and this knowledge had significant association with their educational status. Fifty-nine point nine percent (59.9%) of participants were able to do BSE but only 12.9% of respondents practiced BSE regularly. Conclusion: Community awareness and education level are important elements in BSE as a substitute for traditional screening in BC for early detection.
  3 5,977 825
Survival outcome and neurotoxicity in patients of high-grade gliomas treated with conformal radiation and temozolamide
Anil Kumar Anand, Amal Roy Chaudhory, Har Narain Aggarwal, Pushpender Kumar Sachdeva, Pritam Singh Negi, Sujit Nath Sinha, Ananda Giri Babu, Amarnath Jena, Avinash Rao, Partha S Chaudhury
January-March 2012, 8(1):50-56
Background: To study the survival outcome and neurotoxicity grades in patients of high-grade glioma (HGG) treated with conformal radiation and temozolamide. Materials and Methods: Forty-six patients of HGG received conformal post operative radiation and temozolamide in the period 2003 to 2007. Twenty seven patients had near total resection, 17 had subtotal resection and 2 had biopsy only. 33 patients (71.7%) were treated with IMRT and 13 (28.3%) received 3DCRT (conformal radiation). Median dose delivered to PTV2 was 61.58Gy and PTV1 was 54.3Gy. Neurotoxicity was assessed with sequential MRI and cognitive disturbance was evaluated and grading was done according to CTCAE version 2.0 and 3.0 respectively. Results: At a median follow-up of 12 months, median progression free and overall survival was 9 months and 15 months respectively. At 6 months, MRI neurotoxicity of grade 1, 2, and 3 was seen in 34.3, 11.4 and 2.9% patients. At 24 months, 35.3 and 29.4% patients had grade 1 and 2 neurotoxicity respectively. Cognitive disturbance was grade 0, 1, 2 and 3 in 55, 34.4, 6.8 and 3.4% patients at 6 months and grade 0 and grade 1 in 51.1 and 42.8% patients respectively at 24 months. Conclusion: Conformal Radiation yields low grades of MRI assessed neurotoxicity and cognitive disturbance in patients of HGG with no adverse impact on local control and survival.
  3 5,231 341
Reconstruction of oncological oro-mandibular defects with double skin paddled-free fibula flap: A prudent alternative to double flaps in resource-constrained centres
Prabha S Yadav, Quazi G Ahmad, Vinay K Shankhdhar, GI Nambi
January-March 2012, 8(1):91-95
Objective: The free fibula flap is the choice flap for mandibular reconstruction following extensive tumor resections. While large defects are managed with a second flap [free or pedicle] in advanced centres, a free fibula flap with a large skin paddle that can be de-epithelised to provide outer skin and inner lining is the best alternative in resource- constrained centres. Materials and Methods: From January 2005 to December 2009 a total of 386 free fibula flaps were used of which 307 flaps had de-epithelised double skin paddle in reconstructing complex oral and mandibular defects after tumor ablative surgeries. Results: Complete flap survival was seen in 282/307 patients. Complete flap loss was seen in 9/307 patients. Partial flap loss was seen in 16 patients. Re - exploration was done in 30 patients and the flap was salvaged in 21 patients. Conclusion: The vascular supply of the free fibula osteo myocutaneous flap is reliable and a flap with a large skin paddle can be used to provide both inner lining and outer cover in resource-constrained centres.
  3 6,326 335
Microarrays and cancer diagnosis
Manjul Tiwari
January-March 2012, 8(1):3-10
DOI:10.4103/0973-1482.95166  PMID:22531505
Cancer can be considered a "developmental disorder" because it involves a disruption in the normal development of cells, in terms of both differentiation and proliferation (Dean M,1998). Cancer cells generally contain the full complement of biomolecules that are necessary for survival, proliferation, differentiation, cell death, and expression of cell type-specific function. Human Cancer diagnosis and classification by Microarray analysis has yet to be widely accepted despite the exponential increase in microarray studies reported in the literatures. Additionally, recent microarrays were inspired by the nucleotide-based technology, which have created to better define the molecular basis of malignancy which have shown that microarray have clinical utility in cancer diagnosis, risk stratification, and patient management.
  3 4,228 852
Colorectal carcinoma in a ten-year-old girl: A case report
Sarbani Chattopadhyay, Phalguni Gupta, Ranen Kanti Aich, Asit Ranjan Deb
January-March 2012, 8(1):120-122
Colorectal carcinoma is very rare in childhood. In this case report, we depict a ten-year-old girl who presented with features of intestinal obstruction which turned out to be due to poorly differentiated mucin secreting adenocarcinoma of descending colon. Only increased awareness of this malignancy in this age-group and a high index of suspicion can help when a child complains of persistent pain of abdomen, altered bowel habits or rectal bleeding, and may provide diagnosis at an earlier stage, thereby improving the prognosis.
  2 2,926 296
Obesity as the initial manifestation of central nervous system relapse of acute lymphoblastic leukemia: Case report and literature review
Li-Dan Zhang, Yan-Hong Li, Zhi-Yong Ke, Li-Bin Huang, Xue-Qun Luo
January-March 2012, 8(1):151-153
A 6-year-old boy with acute lymphoblastic leukemia in remission experienced hyperphagia, obesity, and emotional disorders. Cytomorphologic examination of cerebral spinal fluid (CSF) and cranial MRI did not help in differentiating between central nervous system leukemia (CNSL) and other CNS diseases including tuberculosis in this boy. Flow cytometric CSF analysis on repeated lumber puncture detected lymphoblasts, while microscopic CSF examination did not definitively show relapse disease. The diagnosis of CNSL was thus made and confirmed by the response to leukemia treatment. Obesity can be the first manifestation of CNSL and the diagnosis can be challenging. A combination of CSF cytomorphology, CSF flow cytometry, and cranial MRI can be useful in the diagnosis of the disease. Two mechanisms of CNSL-related obesity are discussed based on the literature review.
  2 3,725 373
Lymphadenopathy resulting from acute toxoplasmosis mimicking relapse of non-Hodgkin's lymphoma on fluorodeoxyglucose positron emission tomography/computed tomography
Prathamesh Joshi, Vikram Lele, Pravin Mahajan
January-March 2012, 8(1):126-128
We report a case documenting fluorodeoxyglucose (FDG) accumulation in cervical, supraclavicular and axillary lymph nodes resulting from acute toxoplasmosis. A 50-year-old Indian female with history of non-Hodgkin's lymphoma (NHL) of left breast, postchemotherapy status, was found to have hypermetabolic right cervical, supraclavicular and axillary lymph nodes on a surveillance FDG positron emission tomography/computed tomography (PET/CT) scan. Her previous two PET/CT scans were unremarkable with no evidence of metabolically active disease. Therefore, a differential diagnosis of relapse of NHL versus infectious/inflammatory pathology was raised in the report. Biopsy of axillary lymph node demonstrated features characteristic of toxoplasmosis. The serological test results were also compatible with acute toxoplasmosis infection. Infective and inflammatory diseases are known to accumulate FDG, resulting in false positives for malignancy. This case demonstrates lymph nodal toxoplasmosis as a potential cause of false positive FDG PET/CT findings in patients with known malignancy and highlights the importance of histopathological and laboratory correlation for the accurate interpretation of FDG PET/CT scans.
  2 5,869 287
F-18 flourodeoxyglucose positron emission tomography/computed tomography findings in a case of hepatosplenic T-cell lymphoma
Prathamesh V Joshi, Vikram R Lele, Ganapathi M Bhat, Sonal Garg, Arun Chitale
January-March 2012, 8(1):106-108
T-cell lymphoma (TCL) is a biologically diverse and uncommon group of lymphoid malignant diseases. Compared with its B-cell counterparts, TCL is notably more difficult to diagnose and manage owing to its rarity and biologic heterogeneity. Hepatosplenic TCL is an extremely rare subtype of TCL. A 37-year-old Indian male presented to his physician with swelling and pain in left hypochondrium. Clinical examination revealed pallor, icterus and massive splenomegaly. His blood examination revealed pancytopenia. His bone marrow biopsy was suggestive of lymphoma. Whole body F-18 flourodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan revealed diffuse increased metabolic activity in massively enlarged spleen, liver and bone marrow. There was no evidence of metabolically active lymphadenopathy anywhere in the body. Guided by the FDG PET/CT findings, a liver biopsy was advised. Liver histopathology revealed the presence of hepatosplenic TCL. A final diagnosis of hepatosplenic TCL with liver, spleen and bone marrow involvement was made. Even though rare, hepatosplenic TCL should be considered as a possible diagnosis in patients presenting with similar clinical picture and FDG PET/CT scan findings.
  2 2,983 240
Correlation of fluorodeoxyglucose uptake and tumor-proliferating antigen Ki-67 in lymphomas
Yi Shou, Jianping Lu, Tao Chen, Dalie Ma, Linjun Tong
January-March 2012, 8(1):96-102
Objective: To investigate the correlation between cellular proliferation and the fluorodeoxyglucose (FDG) uptake in positron emission tomography/computed tomography (PET/CT) imaging by comparing 50 cases of different subtypes of lymphoma. Materials and Methods: Fifty cases of lymphomas were collected. Each case was labeled with Ki-67 stain, a marker of cellular proliferation, and a PET/CT examination was performed. All lymphoma cases were sorted according to the World Health Organization's classification, and the International Non-Hodgkin's Lymphoma Working Formulation was used to differentiate groups of large and small cell non-Hodgkin's lymphoma. The Ki-67 staining was described as slight, mild, middle, or strong according to the nuclear staining of positive cells. FDG uptake by lesions in PET/CT images was semi-quantitatively analyzed to calculate the average standard uptake value. The statistics software SPSS13.0 was used to calculate the mean and standard deviation of the FDG uptake value of the lymphoma subtypes, the difference between the large and small cell lymphoma group with a Student's t-test, and the correlation between the Ki-67 level and FDG uptake of lesion with a Spearman's analysis. Results: The FDG uptake value of large cell origin lymphoma was significantly higher than that of small cell origin lymphoma (t = 6.19, P < 0.01). The correlation coefficients between the Ki-67 level and FDG uptake value in lymph nodal and extranodal lesions was 0.750 and 0.843, respectively. Conclusions: Ki-67 staining, a reflection of tumor-proliferation activity, was significantly related to the FDG uptake value in lymphoma lesions.
  2 2,695 261
Radiologic and pathologic correlation of aneurysmal bone cysts at unusual sites
Umesh C Parashari, Shobha Khanduri, Deepika Upadhyay, Samarjit Bhadury, Sanjeev Singhal
January-March 2012, 8(1):103-105
Aneurysmal bone cyst (ABC) is a benign solitary lesion. It usually occurs in the long bones but uncommonly in the calcaneum, mandible, femur and clavicle. Its frequency of occurrence in skull and mandible is 4%, clavicle and ribs is 5%, femur is 13% and foot is 3%. Only a few cases of ABC of these unusual sites have been reported till date. Here we report four cases of ABC at unusual sites namely the calcaneum, mandible, femur and clavicle diagnosed primarily on the basis of different imaging modalities and later confirmed on histopathology.
  1 5,502 509
Meningioma with hemorrhagic onset: Two case reports
Mukul Vij, Sushila Jaiswal, Awadhesh Kumar Jaiswal, Sheo Kumar, Sanjay Behari
January-March 2012, 8(1):145-147
Haemorrhage is a rare complication of meningiomas that can occur spontaneously, after embolization, stereotactic radiation and perioperatively. Our first case was a 16 year old male, admitted with spastic quadriparesis, and retention of urine. Magnetic Resonance Imaging (MRI) revealed anteriorly placed cervical intradural extramedullary mass. Patient underwent emergency surgery following sudden worsening of neurological symptoms and intratumoral bleed was noted peroperatively. Tumor was labeled as angiomatous meningioma with hemorrhage. The second case was of a 45 year female who presented with history of sudden onset weakness in right upper and lower limb followed by unconsciousness. MRI revealed heterogeneous lesion in left parasagittal area with intratumoral bleed. Left frontal craniotomy with tumour decompression was performed. Tumour was labelled as meningothelial meningioma with haemorrhage. Meningiomas with hemorrhagic onset remain rare, and pathophysiology is still incompletely understood. Prevention and outcome of intratumoral haemorrhage highly depends on early diagnosis and adequate treatment.
  1 5,864 346
Primary diffuse large B cell lymphoma of the base of tongue
Joo Han Lim, Jae-Yol Lim, Young Mo Kim, Chul Soo Kim, Suk Jin Choi, Hyeon Gyu Yi, Woong Gil Choi, Moon Hee Lee
January-March 2012, 8(1):135-137
Primary non-Hodgkin's lymphoma of tongue is very rare. We report a case of an elderly female who presented with a mass lesion and pain primarily involving the tongue and was diagnosed with diffuse large B cell lymphoma. Computed tomography revealed a 3-cm enhanced mass localized to the right tongue base. The patient was treated with three cycles of combination rituximab and CHOP chemotherapy, followed by external beam radiotherapy. The patient had a complete response after treatment, and three years following treatment, the patient has no signs of recurrence.
  1 4,742 279
Long-term survival in a patient with metastatic oropharynx squamous cell carcinoma to liver
Varun Kumar Chowdhry, Jack Hsu, Sheila Lemke, Dilip Kittur, Seung Shin Hahn
January-March 2012, 8(1):138-141
The traditionally held view is that the patients with metastatic disease cannot be cured and should be treated palliatively as it was believed that the patients will eventually succumb to the disease progression due to lack of effective treatments for systemic disease. In this article, we report our experience in a patient who was diagnosed with metastatic oropharynx squamous cell carcinoma to the liver, who has now survived five years since the original diagnosis, and is three years disease free. This case report illustrates the curative potential in selected patients with limited burden of metastatic disease with aggressive local therapy to all known sites of disease. It underscores the importance of imaging modalities in monitoring progression of disease, and most importantly illustrates the importance of multidisciplinary care for oncology patients.
  1 9,355 204
Giant lipoblastoma of the thigh: A rare soft tissue tumor in an infant
Tanveer Akhtar, Anand Alladi, Siddiq M Ahmed, Odda S Siddappa
January-March 2012, 8(1):157-158
Lipoblastoma is a rare lipomatous tumor encountered almost exclusively in infants and young children. It arises from embryonic white fat. The common site of involvement is the extremities. In spite of their potential for local invasion, they are benign tumors. We report a case of a lipoblastoma in an infant and review the literature pertaining to clinical management of these tumors.
  1 3,198 223
The neurobiological basis of anti-cancer therapy induced cognitive dysfunction and the promising pharmacological modalities against the same
Swaroop Revannasiddaiah, Manish Gupta, Rajeev Seam, Manoj Gupta
January-March 2012, 8(1):162-163
  1 1,637 185
Arabs and kaposi sarcoma
Hamdi Shelleh, Hamad A Fahhad, Mohammad N Qasabah
January-March 2012, 8(1):163-164
  1 1,524 134
Conformal fields in prostate radiotherapy: A comparison between measurement, calculation and simulation
Seied R Mahdavi, Hamed Rezaeejam, Alireza Shirazi, Mohammad Hosntalab, Ahmad Mostaar, Mohsen Motamedi
January-March 2012, 8(1):34-39
Aims: The objective of this study is to evaluate the accuracy of a treatment planning system (TPS) for calculating the dose distribution parameters in conformal fields (CF). Dosimetric parameters of CF's were compared between measurement, Monte Carlo simulation (MCNP4C) and TPS calculation. Materials and Methods: Field analyzer water phantom was used for obtaining percentage depth dose (PDD) curves and beam profiles (BP) of different conformal fields. MCNP4C was used to model conformal fields dose specification factors and head of linear accelerator varian model 2100C/D. Results: Results showed that the distance to agreement (DTA) and dose difference (DD) of our findings were well within the acceptance criteria of 3 mm and 3%, respectively. Conclusions: According to this study it can be revealed that TPS using equivalent tissue air ratio calculation method is still convenient for dose prediction in non small conformal fields normally used in prostate radiotherapy. It was also showed that, since there is a close correlation with Monte Carlo simulation, measurements and TPS, Monte Carlo can be further confirmed for implementation and calculation dose distribution in non standard and complex conformal irradiation field for treatment planning systems.
  1 5,227 331
Squamotous-type sarcomatoid carcinoma of the lung with rhabdomyosarcomatous components
Figen Turk, Gokhan Yuncu, Ferda Bir, Gokhan Ozturk, Yasin Ekinci
January-March 2012, 8(1):148-150
Lung carcinosarcoma is an infrequently biphasic tumor composed of carcinomatous and sarcomatous components. It is divided into endobronchial (squamous-type) and peripheral (glandular type) categories. The carcinomatous component is usually a squamous carcinoma, and the sarcomatous component usually resembles a fibrosarcoma or a malignant fibrous histiocytoma. The presence of rhabdomyoblastic differentiation in such neoplasms is exceedingly rare. There are strong associations with smoking and asbestosis. In this study, we describe a unique case of a 43-year-old man with a 75 packet/year smoking history in whom a rare mixed malignant tumor of the lung was diagnosed and treated by left pneumonectomy. Histological examination of the resected specimen showed squamous cell carcinoma and rhabdomyosarcoma components. Although rare, the association of a sarcomatoid carcinoma of the lung with squamous cell carcinoma and rhabdomyosarcomatous component is possible and should be kept in mind when dealing with these unusual tumors.
  - 3,756 237
Synchronous bilateral medullary carcinoma of breast: Is it metastasis or second primary?
Chandrika , Harish S Permi, HL Kishan Prasad, Rajashekar Mohan, K Jayaprakash Shetty, Channappa Patil
January-March 2012, 8(1):129-131
Bilateral breast cancer is a rare event accounting for 2-5% of all breast malignancies. A second tumor in contralateral breast may be either synchronous or metachronous lesion. Synchronous bilateral invasive ductal carcinoma is known but medullary carcinoma is rare. The etiology of bilateral breast cancer is uncertain and prognosis in these cases once thought to be poor but recent data suggest a similar survival compared to unilateral disease. We report a case of triple negative synchronous bilateral medullary carcinoma in a 38-year-old female who presented with lump in both the breasts for three months. Multidetector computed tomography breast scan revealed bilateral heterogeneously enhancing well-defined lesion in both the breasts. Fine needle aspiration cytology from both the breast lump was suggestive of malignancy. Patient underwent bilateral modified radical mastectomy with axillary clearance in a single sitting. Histopathology showed synchronous bilateral medullary carcinoma of breast with ER, PR and HER- 2/ neu negativity. Patient was treated with chemoradiation and she is on regular follow up for one year without any recurrence or metastasis.
  - 3,569 320
Acute leukemic appendicitis in a patient with acute promyelocytic leukemia
Hatim Karachiwala, Subhraleena Das, Srivalli Gopaluni, Ajeet Gajra
January-March 2012, 8(1):132-134
Leukemic and lymphomatous infiltration of the appendix is a rare complication. We present the case of a 31-year-old male with acute promyelocytic leukemia who developed acute abdomen on day 11 of induction chemotherapy with idarubicin and cytarabine. After appropriate work-up, a clinical diagnosis of acute appendicitis was made. Despite severe pancytopenia, he successfully underwent laparoscopic appendectomy. The final pathology revealed leukemic infiltration of the appendix. It is hypothesized that the leukemic infiltration may play a role in the development of acute appendicitis. Further, this case demonstrates the need to maintain a high index of suspicion and prompt surgical intervention for surgical pathologies in neutropenic patients.
  - 3,262 257
Primary leiomyosarcoma of epididymis
Dillip Kumar Muduly, Ashwin Anand Kallianpur, SV Suryanarayana Deo, Nootan Kumar Shukla, Aravind S Kapali, Rajni Yadav
January-March 2012, 8(1):109-111
Primary leiomyosarcomas rarely arise from epididymis. But they are the most common histopathological types of sarcoma arising from the epididymis. Primary epididymal leiomyosarcoma occurs usually in older patients. We report a young patient of 35 years presenting with leiomyosarcoma of left epididymis. He did not have any metastasis and underwent left high inguinal orchiectomy. He is on regular follow-up and disease free for last two years.
  - 2,851 244
Malignant fibrous histiocytoma of the spleen: An extremely rare entity
Leelavathi Dawson, Oneal Gupta, Ketan Garg
January-March 2012, 8(1):117-119
Primary malignant fibrous histiocytoma (MFH) of the spleen is extremely rare. Since the first description of primary splenic MFH reported by Govoni et al in 1982, to the best of our knowledge, only twelve cases of MFH of the spleen have been reported in the literature. We herein report a rare case of primary splenic MFH in a 30-year-old Indian male who presented with abdominal pain with a history of recurrent hydatid cyst of liver and spleen. A computed tomography (CT) scan was performed and a diagnosis of splenic hydatid cyst was made. Splenectomy was done. On histopathological examination, a diagnosis of malignant mesenchymal tumor, possibly storiform variant of malignant fibrous histiocytoma, was made. On immunohistochemistry, the tumor was positive for vimentin and CD68. The post operative period was uneventful. Compared with the twelve previously cases of MFH of the spleen, our patient is the youngest case reported so far.
  - 2,809 203
Classic Kaposi's sarcoma with colonic involvement: A rare presentation with successful treatment with oral etoposide
Faruk Tas, Serkan Keskin, Gulcin Yegen, Nurhan Gozubuyukoglu
January-March 2012, 8(1):112-113
Kaposi's sarcoma (KS) is currently regarded as a low-grade vascular malignancy. KS is a multicentric and multisystem disease that involves the skin and less commonly visceral organs, such as the gastrointestinal system including colonic involvement. KS with colonic involvement in HIV-negative patients is a rare clinical manifestation. In this regard, we report an immunocompetent, HIV-negative elderly female patient with classic KS presenting with colonic involvement.
  - 2,928 247
Neurologic complications of cancer therapy
Nagraj G Huilgol
January-March 2012, 8(1):167-167
  - 1,036 127
India-magical realism
Nagraj G Huilgol
January-March 2012, 8(1):1-2
  - 2,601 418

January-March 2012, 8(1):18-18
  - 1,014 80
Author's reply
Pramod Kumar
January-March 2012, 8(1):164-165
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Lesson for management of cancerous patient in the big flooding
Beuy Joob, Viroj Wiwanitkit
January-March 2012, 8(1):165-166
  - 1,403 111
Branch chain amino acid supplementation for correction of ascites in liver cancer postembolization
Kamon Chaiyasit, Viroj Wiwanitkit
January-March 2012, 8(1):159-159
  - 2,273 205
Primary thyroid lymphoma arising from hashimotos thyroiditis diagnosed by fine needle aspiration cytology
Sunil Kumar Yeshvanth, Kishan Prasad H Lakshminarayana, Vidya S Upadhyaya, Jayaprakash K Shetty
January-March 2012, 8(1):159-161
  - 2,980 307
Isolated axillary lymph node metastasis at presentation in bronchogenic carcinoma
Arvind Krishnamurthy, Vijayalakshmi Neelakantan
January-March 2012, 8(1):161-162
  - 4,278 180
Transcriptome network analysis reveals candidate genes for renal cell carcinoma
Wei Zhai, Yun-Fei Xu, Min Liu, Jun-Hua Zheng
January-March 2012, 8(1):28-33
Context: Renal cell carcinoma (RCC) is a kidney cancer that originates in renal parenchyma and it is the most common type of kidney cancer with approximately 80% lethal cases. Aims: To interpret the mechanism, explore the regulation of TF-target genes and TF-pathway, and identify the potential key genes of renal cell carcinoma. Settings and Design: After constructing a regulation network from differently expressed genes and transcription factors, pathway regulation network and gene ontology (GO) enrichment analysis were made. Materials and Methods: The gene expression profile set GSE6344, a renal cell carcinoma sample set, was collected from NCBI, pathway data from KEGG, and regulationship data from database TRANSFAC and TRED. Statistical Analysis Used: Besides different expressed genes obtained by limma, impact analysis method and GO enrichment were applied to find the significant expressed pathways. Results: Finally, we constructed a TF-target gene and TF-pathway regulation network of renal cell carcinoma. And some genes proved to be highly related to renal cell carcinoma were identified. Conclusions: This study illustrated that by incorporating significantly expressed pathway into a regulation network based analysis, one can derive greater insights into the underlying mechanisms of renal cell carcinoma.
  - 3,082 369
Dosimetric validation of new semiconductor diode dosimetry system for intensity modulated radiotherapy
Rajesh Kinhikar, Suresh Chaudhari, Sudarshan Kadam, Dipak Dhote, Deepak Deshpande
January-March 2012, 8(1):86-90
Introduction: The new diode Isorad was validated for intensity modulated radiotherapy (IMRT) and the observations during the validation are reported. Materials and Methods: The validation includes intrinsic precision, post-irradiation stability, dose linearity, dose-rate effect, angular response, source to surface (SSD) dependence, field size dependence, and dose calibration. Results: The intrinsic precision of the diode was more than 1% (1 σ). The linearity found in the whole range of dose analyzed was 1.93% (R 2 = 1). The minimum and maximum variation in the measured and calculated dose were found to be 0.78% (with 25 MU at ioscentre) and 4.8% (with 1000 MU at isocentre), respectively. The maximal variation in angular response with respect to arbitrary angle 0° found was 1.31%. The diode exhibited a 51.7% and 35% decrease in the response in the 35 cm and 20 cm SSD range, respectively. The minimum and the maximum variation in the measured dose from the diode and calculated dose were 0.82% (5 cm × 5 cm) and 3.75% (30 cm × 30 cm), respectively. At couch 270°, the response of the diode was found to vary maximum by 1.4% with ΁ 60 gantry angle. Mean variation between measured dose with diode and planned dose by TPS was found to be 1.3% (SD 0.75) for IMRT patient-specific quality assurance. Conclusion: For the evaluation of IMRT, use of cylindrical diode is strongly recommended.
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Bone marrow involvement by lymphoproliferative disorders after renal transplantation: PTLD. Int. Survey
Morteza Izadi, Mozhgan Fazel, Seyed Hasan Saadat, Saeed Taheri
January-March 2012, 8(1):62-67
Context: Renal graft recipients who develop post-transplant lymphoproliferative disorders (PTLD) that complicate bone marrow (BM). Aims: To investigate features, predictors and prognosis of BM involvement by PTLD in renal transplant patients. Settings and Design: A comprehensive search for the available data though PubMed and Google Scholar for reports of PTLD localization in BM in renal allograft recipients. Materials and Methods: Data of 168 PTLD cases in renal transplant context who have developed bone marrow PTLD gathered from 18 studies and were pooled and analyzed. Statistical Analysis Used: Chi-square test, Student's t test and fissure's exact test were employed. Results: Chi-square test showed that renal recipients with BM PTLD were significantly more likely to represent multi-organ disease (P<0.001), and disseminated PTLD (P<0.001). BM PTLD was also more frequently seen among pediatric renal recipients who had developed PTLD (P=0.016). PTLD, in BM PTLD renal recipients more significantly complicated liver (P=0.008), but less commonly affected skin (P=0.045). BM PTLD lesions were relatively more likely to be of monomorph phenomenon (P=0.06). Conclusions: Renal recipients with BM PTLD represent worse outcome and more unfavorable histopathological phenomenon than in other organ involvements. Moreover, a concomitant PTLD involvement site in liver was found which necessitates full hepatic evaluation for a potential complication by the disease in renal recipients whose BM is involved.
  - 2,974 216