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   2013| October-December  | Volume 9 | Issue 4  
    Online since February 11, 2014

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Encapsulated papillary carcinoma of the breast: An overview
Kyrgias George, Zygogianni Anna, Kostopoulou Evanthia, Kouloulias Vassilios
October-December 2013, 9(4):564-570
DOI:10.4103/0973-1482.126448  PMID:24518697
Any papillary growth of the breast presents both a diagnostic and a therapeutic challenge: For each one of them a diagnosis of whether they are malignant or benign in nature is required as well as appropriate staging and suitable treatment. In the international literature, we find a considerable amount of different terms being used for papillary breast growths. As a result, pathological and clinical evaluation is somewhat problematic. Encapsulated papillary carcinoma (EPC) is an interesting subgroup of breast papillary tumours. Because of its rarity, there have been only a limited number of large clinical studies that safely assess its appropriate treatment and expected outcome. However, more safe data exist in terms of prognosis - which seems to be excellent, as almost all published studies regarding these tumours have confirmed so far. We present a systematic overview of breast EPC and of the most important studies published on this topic in order to make diagnosis and treatment more straightforward for cancer clinicians. The information for this review was compiled by searching the Pubmed, Medline, Scopus, Embase, and ISI Web of Science databases for articles published from 1980 through December 2012. Electronic early-release publications were also included.
  25,701 655 -
Literature review with PGI guidelines for delineation of clinical target volume for intact carcinoma cervix
Anshuma Bansal, Firuza D Patel, Bhavana Rai, Abhishek Gulia, Bhaswanth Dhanireddy, SC Sharma
October-December 2013, 9(4):574-582
DOI:10.4103/0973-1482.126450  PMID:24518699
For definitive treatment of carcinoma cervix with conformal radiation techniques, accurate target delineation is vitally important, yet a consensus definition of clinical target volume (CTV) remains variable within the literature. The aim of the present article is to review the guidelines for CTV delineation published in the literature and to present the guidelines practiced at our institute. For this a literature pub med/medline search was performed from January 2000 to December 2012 and reviewed to identify published articles on guidelines for CTV primary and pelvic lymph node (LN) delineation for carcinoma cervix. Taking into consideration the traditional bony landmark based fields for treating cancer cervix, the knowledge of the patterns of disease spread and recurrence and the findings from imaging studies identifying typical anatomic distributions of areas at risk of harbouring subclinical disease, the differences in various guidelines have been analyzed and discussed. The CTV in cervical cancer consists of the CTV nodal and CTV primary. In all the published guidelines, CTV nodal consists of common iliac, external iliac, internal iliac, pre-sacral and obturator group of lymph nodes, and CTV primary consists of the gross tumor volume, uterine cervix, uterine corpus, parametrium, upper third of vagina and uterosacral ligaments. The various guidelines differ however, in the definition for these individual component structures. This is the first report to provide the complete set of guidelines for delineating both the CTV primary and CTV nodal in combination.
  14,977 2,136 -
Sarcomatoid variant of urothelial carcinoma of the urinary bladder
Anshuma Bansal, Narendra Kumar, Suresh C Sharma
October-December 2013, 9(4):571-573
DOI:10.4103/0973-1482.126449  PMID:24518698
Sarcomatoid carcinoma of the urinary bladder is a rare presentation. Less than 100 case reports have been published in the literature. It has been considered as an aggressive variant of bladder carcinoma. Though different treatment modalities have been tried in the literature, yet radical cystectomy followed by adjuvant chemotherapy and radiation should be preferred in all patients, in view of high incidence of local and distant metastasis.
  10,283 377 -
Repeat stereotactic body radiation therapy for patients with pulmonary malignancies who had previously received SBRT to the same or an adjacent tumor site
Vladimir Valakh, Curtis Miyamoto, Bizhan Micaily, Philip Chan, Toni Neicu, Shidong Li
October-December 2013, 9(4):680-685
DOI:10.4103/0973-1482.126481  PMID:24518717
Objectives: Retrospective analysis of patients with recurrences at or closely adjacent to the site of prior lung stereotactic body radiation therapy (SBRT) who received repeat SBRT. Materials and Methods: Nine patients with non-small cell lung cancer (n = 8) or oligometastatic colonic adenocarcinoma (n = 1) were treated with image-guided lung SBRT to a median of 60 Gy (range, 30-60) in a median of 3 fractions (3-5). Patients developed in-field relapse (n = 3) or recurrence adjacent (≤3.5 cm away) to the previous tumor location (n = 6) and received 2 nd lung SBRT to a median of 60 Gy. Results: Median follow-up after 2 nd SBRT was 22 months (4-40). All completed prescribed course of repeat SBRT and acute toxicity was limited. There was no grade >3 late toxicity. 3 (33.3%) patients developed Grade 3 late reactions: 2 pulmonary and 1 chest wall pain. Late pulmonary toxicity included 2 (22.2%) patients with Grade 3 and 3 (33.3%) with Grade 2. One patient (11.1%) had late Grade 3 and 1 (11.1%) Grade 2 chest wall pain. 1 (11.1%) developed Grade 2 late brachial plexopathy. No myelopathy was observed. Two patients developed progression of tumors treated by 2 nd SBRT. Local recurrence free survival and overall survival was 75% and 68.6%, respectively at 2 years. Relative volume of ipsilateral lung receiving 5 Gy (V5) and V10 were lower for 2 nd SBRT. Conclusion: Repeat image-guided SBRT for patients with small peripheral recurrences was feasible and severe toxicity was not observed. Additional studies are needed to evaluate the safety and efficacy of lung reirradiation using 2 nd SBRT.
  4,836 183 -
Sphingosin 1-phosphate contributes in tumor progression
Maryam Tabasinezhad, Nasser Samadi, Parisa Ghanbari, Mahsa Mohseni, Amir Ata Saei, Simin Sharifi, Nazli Saeedi, Abolfazl Pourhassan
October-December 2013, 9(4):556-563
DOI:10.4103/0973-1482.126446  PMID:24518696
Sphingosine-1 phosphate (S1P) is a bioactive lipid that mediates diverse cellular responses. Signaling of S1P is carried out by a family of G-protein coupled receptors (GPCRs), which show differential expression patterns depending on tissue and cell types. Activation of S1P receptors induces signaling pathway, which can subsequently lead to physiological process. Intercellular S1P concentration is regulated and determined by several enzymes including S1P lyase, S1P kinase and S1P phosphatase. Numerous studies showed the role of S1P in malignant behavior of cancer cells including breast, lung, colon, and leukemia cell lines. In the past decade, extensive research activities have focused on elucidating S1P signaling pathway, its receptors, enzymes involved in S1P metabolism, and its performance in cancer biology. In this review, we will explain the function of S1P in tumor progression that demonstrated in past research articles and we will express its importance as a target for designing futuristic anticancer drug.
  4,366 276 1
Assessment of periodontal changes in patients undergoing radiotherapy for head and neck malignancy: A hospital-based study
Rafeek Rahim Ammajan, Rosamma Joseph, R Rajeev, Kanaram Choudhary, K Vidhyadharan
October-December 2013, 9(4):630-637
DOI:10.4103/0973-1482.126461  PMID:24518708
Background: Surgical resection, radio and chemotherapy, either used singly or in combination, are the three most common modalities used in head and neck cancer treatment. These modalities are effective in eradicating the tumor; they also negatively impact the normal head and neck structures surrounding the tumor. Direct damage to the oral structures (soft and hard tissue) frequently occurs from radio and chemotherapy, and indirect damage may also arise from systemic toxicity. Materials and Methods: This prospective study was designed to analyze the effect of radiotherapy on periodontal parameters in oncology patients prior to irradiation in the head and neck area, compared with 6 months following treatment. The statistical analysis was done using SPSS. Results: The study sample consisted of total 29 patients of head and neck malignancy (M = 17, F = 12), of mean age 45.66 years. Only 22% of patients had various habits (smoking, tobacco chewing, and alcohol consumption) and majority (27.59% patients) had tongue malignancy. All periodontal parameters - oral hygiene index Siller (OHIS), clinical attachment level (CAL), gingival recession (GR), except probing pocket depth (PPD) - were significantly increased after radiotherapy. When comparison was made between doses and fractions, only in mandible statistically significant difference were observed in GR. Conclusion: Although there was no significant change in PPD, there was increased GR, CAL, and plaque index associated with radiotherapy. In this study, 61.5% cases of mandibular teeth and 34.4% cases of maxillary teeth showed attachment loss greater than 0.2 mm. So, all patients with head and neck malignancy should undergo an oral examination before the initiation of cancer therapy with adequate prophylaxis.
  3,879 362 -
Leiomyosarcoma of prostate: A rare, aggressive tumor
Jitendra Pratap Singh, Debashis Chakraborty, Malay Kumar Bera, Dilipkumar Pal
October-December 2013, 9(4):743-745
DOI:10.4103/0973-1482.126482  PMID:24518734
Leiomyosarcoma of prostate is a rare, aggressive tumor with bizarre presentation at advanced stage. Though definite treatment modalities are not recommended till now, innovative combined multimodality treatment strategies may help to improve the prognosis of patients with this tumor of poor survival rate. Here we report a case of leiomyosarcoma of the prostate which presented with chest metastasis.
  3,660 199 -
Toxicity and outcomes in combined modality treatment of head and neck squamous cell carcinoma: cisplatin versus cetuximab
Allison Y Ye, John H Hay, Janessa J Laskin, Jonn S Wu, Cheryl C Ho
October-December 2013, 9(4):607-612
DOI:10.4103/0973-1482.126455  PMID:24518704
Aims: The standard of care for locally advanced head and neck squamous cell carcinoma (HNSCC) is radiation therapy (RT) with concurrent cisplatin (CIS). Patients with renal or cardiac dysfunction, hearing loss or poor performance status (PS) may receive RT and cetuximab (CET) at our institution. This study compares treatment toxicities and outcomes. Methods and Materials: All patients treated with curative intent RT and concurrent CIS (100 mg/m 2 Day 1, 22, 43) or CET (400 mg/m 2 Day -7, 250 mg/m 2 weekly during RT) between August 2007 and July 2010 were reviewed and toxicity and outcomes analyzed. Results: Among 349 subjects (262 RT-CIS, 87 RT-CET) characteristics were similar except in age, head and neck subsite and RT fractionation. RT-CIS required more dose reductions, delays, and unplanned admissions and received less intended systemic therapy (ST). Weight loss and gastrostomy-tube use were similar. RT-CIS caused more nausea/vomiting, while RT-CET was associated with more dermatitis and acneiform rash. With mean follow-up of 20 months and 16 months, RT-CIS subjects experienced improved 1-year locoregional control (LRC) (90% vs. 72%, P < 0.01), disease-free survival (DFS) (83% vs. 67%, P < 0.01) and overall survival (OS) (90% vs. 80%, P = 0.04). On multivariate analysis type of ST was associated with LRC and DFS, but not OS. Conclusions: In patients with locally advanced HNSCC, CIS and CET were associated with different toxicity profiles. RT-CIS was associated with improved LRC and DFS, but similar OS compared to RT-CET.
  3,633 219 -
Zoledronic acid treatment for cancerous bone metastases: a phase IV study in Taiwan
Po-Hui Chiang, Hwei-Chung Wang, Yuen-Liang Lai, Shin-Cheh Chen, Wayne Yen-Hwa, Chit-Kheng Kok, Yen-Chuan Ou, Jen-Shen Huang, Tzu-Chuan Huang, Tsu-Yi Chao
October-December 2013, 9(4):653-659
DOI:10.4103/0973-1482.126471  PMID:24518712
Aim of study: To investigate the features, adverse effects, bone marker changes in patients with breast cancer, prostate cancer, and multiple myeloma with bone metastases under Zometa® therapy. Materials and Methods: This post-marketing study included 414 Taiwanese patients with bone metastases secondary to breast cancer, prostate cancer, or multiple myeloma who received Zometa® for 48 weeks. The patients' characteristics, medication and adverse events were recorded, meanwhile changes in four serum bone metabolic markers and pain reduction were assessed every three months for one year. Results: A total of 3,711 doses of Zometa® were infused, accounting for 294.5 patient-years. Adverse events occurred in 9.4% of patients, with bone pain, insomnia, constipation, and pyrexia as the most frequently reported. There was no osteonecrosis of the jaw. The incidence of skeletal-related events decreased significantly from 44.9% to 18.8%. Serum NTx, BAP, and TRACP5b steadily decreased to nadir at six months, but serum OPG was persistently elevated until the end of one year. The average decrease in pain score was 14.1, 14.3, and 16.7 for prostate cancer, breast cancer, and multiple myeloma patients, respectively. Conclusion: Zometa® can be safely administered in Taiwanese patients with bone metastases secondary to breast cancer, prostate cancer, and multiple myeloma. There are concomitant decreases in skeletal-related events and bone pain.
  3,198 222 2
Assessment of a novel mass detection algorithm in mammograms
Ehsan Kozegar, Mohsen Soryani, Behrouz Minaei, Inês Domingues
October-December 2013, 9(4):592-600
DOI:10.4103/0973-1482.126453  PMID:24518702
Context: Mammography is the most effective procedure for an early detection of the breast abnormalities. Masses are a type of abnormality, which are very difficult to be visually detected on mammograms. Aims: In this paper an efficient method for detection of masses in mammograms is implemented. Settings and Design: The proposed mass detector consists of two major steps. In the first step, several suspicious regions are extracted from the mammograms using an adaptive thresholding technique. In the second step, false positives originating by the previous stage are reduced by a machine learning approach. Materials and Methods: All modules of the mass detector were assessed on mini-MIAS database. In addition, the algorithm was tested on INBreast database for more validation. Results: According to FROC analysis, our mass detection algorithm outperforms other competing methods. Conclusions: We should not just insist on sensitivity in the segmentation phase because if we forgot FP rate, and our goal was just higher sensitivity, then the learning algorithm would be biased more toward false positives and the sensitivity would decrease dramatically in the false positive reduction phase. Therefore, we should consider the mass detection problem as a cost sensitive problem because misclassification costs are not the same in this type of problems.
  2,845 192 -
Oral squamous cell carcinomas in age distinct population: A comparison of p53 immunoexpression
Akhilesh Chandra, Anil Singh, Bastian Thattil Sebastian, Archana Agnihotri, Ruchita Bali, Pushpendra Kumar Verma
October-December 2013, 9(4):587-591
DOI:10.4103/0973-1482.126452  PMID:24518701
Aims: The study aimed to assess the diffused expression of p53 protein in patients with OSCC and its association with age at diagnosis (using 50 years as a cut point). Study Design: Ten normal oral mucosa and sixty OSCC lesions from age-distinct patient populations were immunohistochemically analyzed for the expression of p53 protein. Results: In OSCC cases, 31 out of total 60 cases (51.67%) showed positive expression for p53 protein and it was more common in older study group (56.67%) than in younger study group (46.67%) but the difference was not statistically significant. Moreover, there was also no significant difference in the p53 indices (percentage of p53 positive cells) between the two study groups (P = 0.827). Conclusion: The alteration rates were found to be slightly higher in older patients although not statistically significant.
  2,722 169 -
Recurrent sebaceous carcinoma of the scalp in a young male treated with adjuvant radiotherapy
Puja Sahai, Karuna Singh, Aman Sharma, Ranajoy Ghosh, Prerna Nembang, Chitra Sarkar, Bidhu Kalyan Mohanti
October-December 2013, 9(4):730-732
DOI:10.4103/0973-1482.126472  PMID:24518729
Sebaceous carcinoma is a rare malignancy of the skin appendages. It tends to occur in elderly patients. Orbital region is the most commonly involved site seen in 75% of cases. The involvement of extra-orbital sites is infrequent. Herein, a case of extra-ocular sebaceous carcinoma arising in the scalp of a 20-year-old man is described.The patient developed tumor relapse after excision biopsy. He was treated with wide local excision of the tumor. However, the patient developed local recurrence after an interval of four months for which he again underwent wide local excision. He did not manifest any regional or distant metastases. In view of the locally aggressive tumor, he received adjuvant radiation therapy. The patient was successfully treated with no evidence of any local recurrence seen after a follow-up period of one year. The timely recognition of sebaceous carcinoma is imperative so as to execute the primary treatment i.e., wide local excision. Adjuvant radiotherapy may be considered to improve the clinical outcome for recurrent tumors.
  2,701 105 -
Cytotoxic effect of Pouteria torta leaf extracts on human oral and breast carcinomas cell lines
Silvia T Elias, Paloma M Salles, José E de Paula, Luiz A Simeoni, Dâmaris Silveira, Eliete N.S Guerra, Andrea B Motoyama
October-December 2013, 9(4):601-606
DOI:10.4103/0973-1482.126454  PMID:24518703
Aims: This study aimed at investigating the cytotoxic activity and the type of cell death induced by Pouteria torta (P. torta) leaf extracts on human oral squamous cell carcinoma and breast carcinoma cell lines. Material and Methods: The effects of P. torta leaf hexanic (PTH), ethanolic (PTE) and aqueous (PTA) extracts at the concentration of 500 mg/mL were evaluated on OSCC-3 and MCF-7 cell lines, using crystal violet staining after 24 and 48 h of treatment. To obtain the dose-response curve, cells were treated with decreasing concentrations of the extracts (1000, 750, 500, 250, 125 mg/mL) for 24 h. To investigate the mechanism of cell death (apoptosis vs. necrosis), DNA fragmentation assay was performed. Results: All extracts were cytotoxic to both OSCC-3 and MCF-7, albeit at differing levels. PTH and PTE were effective at the concentration of 500 ΅g/mL, resulting in nearly 50% of cell death in both cancer cell lines. PTA was more effective at lower concentrations, with more significant cell death at 125 ΅g/mL. Treatment with PTA and PTE caused apoptosis in MCF-7, whereas in OSCC-3 cells, the same effect could only be caused by PTH. On the other hand, PTA was able to induce necrosis in OSCC-3. Conclusions: These findings demonstrated that P. torta leaf extracts may contain useful compounds to combat oral and breast cancer, and this study highlights the potential biological relevance of the Brazilian Cerrado Biome in cancer therapy.
  2,611 191 -
Diagnosis of sclerosing hemangioma of lung: Don't rely on fine-needle aspiration cytology diagnosis alone
Kaushik Saha, Niranjan Kr. Sit, Debraj Jash, Arnab Maji
October-December 2013, 9(4):748-750
DOI:10.4103/0973-1482.126486  PMID:24518736
Sclerosing hemangioma is a rare variety of benign pulmonary neoplasm. It usually presents as asymptomatic, solitary, peripheral, circumscribed lesions in middle-aged women. Here, we describe a 46-year-old woman presenting to us for evaluation of right parahilar lung mass. Previous chest radiography done 10 years back showed a lung mass of almost similar size. Computed Tomography (CT)-guided fine-needle aspiration cytology (FNAC) was suggestive of adenocarcinoma of lung. A well-circumscribed, capsulated, ovoid mass measuring 5.6 cm × 4 cm × 3 cm, adjacent to the transverse fissure of the right lung was excised by lateral thoracotomy. Histopathological examination along with immunohistochemistry was suggestive of sclerosing hemangioma of lung. A pathologist must consider the clinicoradiological features before coming to a final diagnosis of lung malignancy from FNAC. Whenever there is any confusion regarding lung mass, thoracotomy must be done for arriving at an exact diagnosis from histopathology.
  2,653 137 -
Raltitrexed combined with bevacizumab in heavily pretreated metastatic colorectal cancer
Ke Cheng, Ye Chen, Long-Hao Li, Ji-Yan Liu
October-December 2013, 9(4):727-729
DOI:10.4103/0973-1482.126470  PMID:24518728
No standard chemotherapy regimen has been established for metastatic colorectal cancer (mCRC) after progression on 5-fluorouracil, oxaliplatin, and irinotecan. Here, we report the combination of raltitrexed and bevacizumab as a salvage regimen for the treatment of three heavily pretreated patients with KRAS mutant mCRC. All three patients had stable disease (SD) according to response evaluation criteria in solid tumors (RECIST) criteria, progression free survival (PFS) were 3.0, 3.2 months for the first two patients and have not been reached for over 5 months for the third patient and no severe adverse effect was observed. The combination of raltitrexed plus bevacizumab in mCRC seems worthy of further investigation.
  2,674 110 -
Isolated skull base primary Ewing's sarcoma: An extremely rare location
Goutham Cugati, Manish Singh, Anil Pande, Nigel Peter Symss, Vasudevan M Chakravarthy, Ravi Ramamurthi
October-December 2013, 9(4):741-742
DOI:10.4103/0973-1482.126479  PMID:24518733
A 16-year-old boy presented with history of headache and blurring of distant vision. He had UMN facial paresis and papilledema. Imaging revealed a heterogenous space occupying lesion in the middle cranial fossa base with mass effect and midline shift and non homogenous contrast enhancement with erosion of the petrous bone. He underwent gross total excision of the lesion. Histopathology and immunohistochemistry were suggestive of skull base Ewing's sarcoma. Bone scan was done to rule out primary involvement of other extracranial location. We have discussed the epidemiology, presentation, management and prognosis of such cases.
  2,642 119 -
Emphasizing on heat shock protein 90's utility in head and neck squamous cell carcinoma treatment
Samapika Routray, Aparajita Sunkavalli, Niharika Swain, Akhil A Shankar
October-December 2013, 9(4):583-586
DOI:10.4103/0973-1482.126451  PMID:24518700
Heat shock protein 90 (Hsp90) a member of the heat shock proteins (HSPs) family, is an adenosine triphosphate dependent molecular chaperone protein, which integrates multiple oncogenic pathways. Clinically, encouraging results have been demonstrated in melanoma, acute myeloid leukemia, castrate refractory prostate cancer, non-small cell lung carcinoma and multiple myeloma using the first generation Hsp90 inhibitors. Hsp90 as the target of anticancer activity of geldanamycin sparked much interest in the inhibition of Hsp90 as a strategy for the treatment of cancer. Hsp90 inhibitors demonstrate rapid clearance from normal tissues and the blood compartment with prolonged retention in tumors making it a sought after modality for treating cancer. Our review emphasizes its role as anti-cancer therapy for head and neck squamous cell carcinoma.
  2,573 171 1
Differential cytotoxicity of the glycolytic inhibitor 2-deoxy-D-glucose in isogenic cell lines varying in their p53 status
Archana Vibhuti, Kambadur Muralidhar, Bilikere S Dwarakanath
October-December 2013, 9(4):686-692
DOI:10.4103/0973-1482.126484  PMID:24518718
Context: Earlier studies have shown that cytotoxicity of glycolic inhibitor 2-deoxy-D-glucose is heterogeneous among different tumor cell lines due to a number of reasons including difference in p53 status. Aim: To investigate the cytotoxic effects of 2-DG in isogenic cell systems that differ in their p53 status. Material and Methods: Head and neck carcinoma cells KB and its two p53 mutants (KB68-mutation in transactivation domain (Arg/Cys) at position 68 and KB110-mutation in proline rich deoxyribonucleic acid binding domain (Glu/Gly) at position 110) were used as the model. Clonogenecity, cell proliferation, cell cycle, annexin V assay, intracellular levels of ROS and NADP+/NADPH levels were investigated as parameters for 2-DG induced cytotoxicity. Results: Macrocolony assay showed that the cytotoxicity of 2-DG was time- and concentration-dependent. However, the sensitivity of the three cell lines were quantitatively different, with KB110 being more sensitive than the parental cell line KB and KB68. The effects of 2-DG on growth inhibition, cell cycle, and apoptosis correlated well with the changes in cell survival in these cells. A higher degree of 2-DG induced enhancement in the metabolic oxidative stress was evident in both the mutant cell lines (elevated ROS level and NADP+/NADPH ratio) suggestive of a higher degree of compromize in the antioxidant defense in the mutant cells. Conclusions: 2-DG could be considered as a potential therapeutic agent that induces cell death (which could be linked to induced oxidative stress) selectively in tumors with p53 mutations (particularly in the proline rich region).
  2,616 112 1
HSP70 induces TLR4 signaling in oral squamous cell carcinoma: An immunohistochemical study
Sindhu Nair, Vijayalakshmi S Kotrashetti, Ramakant Nayak, Kishore Bhat, Pradeep Somannavar, Jagadish Hosmani
October-December 2013, 9(4):624-629
DOI:10.4103/0973-1482.126460  PMID:24518707
Objectives: Toll like receptors play an important role in innate and adaptive immune responses. Heat shock proteins play a significant role in cell proliferation, differentiation and oncogenesis. HSP70 acts as one of the ligands of TLR4 and binds to it in a CD14 dependent fashion to bring about proinflammatory cytokine production leading to an anti-tumor response. On the contrary, TLR4 has been implicated in carcinogenesis by secretion of anti-apoptotic proteins. Thus the aim of this study was to compare and correlate the association of HSP70 and TLR4 in various grades of oral squamous cell carcinoma. Study Design: Twenty-seven cases of oral squamous cell carcinoma were considered. Ten cases each of well-differentiated (WDSCC) and moderately differentiated (MDSCC), 7 cases of poorly differentiated carcinoma (PDSCC) were considered. Sections were stained for HSP70 and TLR4 and were evaluated for staining degree and intensity. Results and Conclusion: Positive expression of both HSP70 and TLR4 was found in all cases of WDSCC and MDSCC, whereas in PDSCC out of 7 cases only 6 showed positivity for TLR4 and 4 cases showed positivity for HSP70. Those cases that were positive for TLR4, also showed positivity for HSP70. HSP70 acts as a ligand and binds to TLR4 thus activating the My88 pathway resulting in production of proinflammatory cytokines, chemokines, growth factors etc., enhancing anti-cancer immunity in the early stages of disease. In later stages, TLRs expressed on cancer cells can produce anti-apoptotic proteins contributing to carcinogenesis and cancer cell proliferation.
  2,565 155 -
A benzophenanthridine alkaloid, chelerythrine induces apoptosis in vitro in a Dalton's lymphoma
Sanjay Kumar, Praveen Deepak, Sanjay Kumar, Pramod K Gautam, Arbind Acharya
October-December 2013, 9(4):693-700
DOI:10.4103/0973-1482.126485  PMID:24518719
Purpose: The aim of this study was to investigate the effect of chelerythrine on DL cell apoptosis in an in vitro experimental setup. Materials and Methods: For tumor model, spontaneous occurring T-cell lymphoma designated as Dalton's lymphoma (DL) was selected. Double staining, transmission electron microscope (TEM), fluorescence microscopy, Western blotting, Reverse Transcriptase-Polymerase Chain Reaction, and DNA fragmentation assay were used to detect heat shock factor 1 (HSF1) and hsp70 expression and PKC phosphorylation, and apoptotic characteristic of DL cells. Results: Chelerythrine exposure resulted in significant morphological alteration comparable to that of apoptosis. Furthermore, it was confirmed by fluorescence microscopy, TEM analysis, and DNA fragmentation assay that 10 ΅g/mL of chelerythrine is capable of inducing apoptosis in DL cells. The suppression in HSF1 expression and subsequent inhibition of hsp70 expression in chelerythrine-treated DL cells suggest that chelerythrine induces apoptosis in DL cells by inhibiting the expression of these cytoprotective proteins. Conclusion: Chelerythrine is capable of inducing apoptosis DL cells in vitro and therefore, it could be useful in combating tumor growth and progression.
  2,578 132 1
Anaplastic large cell lymphoma: A single institution experience from India
KC Lakshmaiah, B Guruprasad, Ashish Shah, S Kavitha, Linu Jacob Abraham, K Govindbabu, BS Aruna kumari, L Appaji
October-December 2013, 9(4):649-652
DOI:10.4103/0973-1482.126468  PMID:24518711
Background: Systemic anaplastic large cell lymphoma (ALCL) accounts for 2-8% of non-Hodgkin's lymphoma in adults and 10-15% in children. While there is ample data in the world literature about the clinical features and outcome of this disease, prognosis in Indian patients is largely unknown. Objective: To study the clinical, pathologic profile and outcome ALCL. Materials and Methods: Fifty patients who had pathologically proven diagnosis of systemic ALCL at our institute from June 2003 to May 2011 were included for retrospective analysis. This included 30 cases of anaplastic lymphoma kinase+ (ALK+), ALCL and 20 cases of anaplastic lymphoma kinase- (ALK−), ALCL. The hospital protocol for treatment of these patients included CHOP chemotherapy regimen in >15 years of age and MCP842 protocol with vinblastine for 1 year in <15 years of age. Event free survival was noted. These outcomes were correlated with ALK status, International Prognostic Index (IPI) score, and stage at presentation. Results: At a median follow-up of 36 months (range: 6-72 months) ALK− ALCL had a poor outcome. The 3 year event free survival in pediatric ALCL was 66.7%. In adults, this was 60% ALK+ ALCL was 60% and 20% in ALK− ALCL. Conclusions: Systemic ALCL is an aggressive disease. CD3 + positivity is commonly seen in ALK− ALCL and ALK+, epithelial membrane antigen + positivity is seen in ALK+ ALCL. ALK− ALCL, advanced stage III, IV and high IPI score were associated with poor prognosis. The demographic profile and outcome in our study was similar to the world literature. With new drugs like crizotinib and brentuximab vedotin the future looks very promising.
  2,313 165 -
Primitive neuroectodermal tumor of adrenal: Clinical presentation and outcomes
Deep Dutta, KS Shivaprasad, Ram Narayan Das, Sujoy Ghosh, Subhankar Chowdhury
October-December 2013, 9(4):709-711
DOI:10.4103/0973-1482.126459  PMID:24518722
Primitive neuroectodermal tumor (PNET) of adrenal is an extremely rare tumor of neural crest origin. A nonfunctional left adrenal mass (14.6 × 10.5 × 10.0 cm) on computed tomography (CT) was detected in a 40-year-old lady with abdominal pain, swelling, and left pleural effusion. She underwent left adrenalectomy and left nephrectomy with retroperitoneal resection. Histopathology revealed sheets and nest of oval tumor cells with hyperchromatic nuclei, prominent nucleoli, scanty cytoplasm, brisk mitotic activity, necrosis, lymphovascular invasion, capsular invasion, and extension to the surrounding muscles; staining positive for Mic-2 (CD-99 antigen), vimentin, synaptophysin, and Melan-A. Thoracocentesis, pleural fluid study, and pleural biopsy did not show metastasis. She responded well to vincristine, adriamycin, and cyclophosphamide followed by ifosfamide and etoposide (IE). This is the first report of adrenal peripheral PNET (pPNET) from India. This report intends to highlight that pPNET should be suspected in a patient presenting with huge nonfunctional adrenal mass which may be confused with adrenocortical carcinoma.
  2,366 92 -
Treatment and outcome in cancer cervix patients treated between 1979 and 1994: A single institutional experience
Shyamkishore Shrivastava, Umesh Mahantshetty, Reena Engineer, Hemant Tongaonkar, Jagadeesh Kulkarni, Ketayun Dinshaw
October-December 2013, 9(4):672-679
DOI:10.4103/0973-1482.126480  PMID:24518716
Introduction: A retrospective review in patients with carcinoma cervix to evaluate the changes and trends in demographics, evolution of protocols, and outcome analysis over 16 years. Materials and Methods: This is a retrospective study of 6234 patients with carcinoma of the cervix treated with radical intent between 1979 and 1994. All the work-up, staging investigations, treatment details, radiation protocols, outcomes, and toxicities were noted, compiled, and analyzed. Results: With a mean age of 46 years (range: 18-90 years; median: 45 years), 669 (11%) patients were in stage Ib, 284 (5%) were in stage IIa, 1891 (30%) were in stage IIb, 69 (1%) were in stage IIIa, and 3321 (53%) were in stage IIIb. With a median follow-up of 68 months (57-79 months) for the entire group, there was no significant difference in the outcome of 953 patients with international federation of gynecology and obstetrics (FIGO) Ib-IIa treated after radical surgery, pre-operative radiation therapy (pre-op RT) + Sx or after radical radiation; their disease-free survival (DFS) was 60-62% at 8 years. In our series of 1891 patients with stage IIb and 3321 with stage IIIb, a respective DFS of 56% and 40% was achieved at 8 years. Conclusion: Over the last two decades, with the acquisition of newer facilities and inception of Joint Clinics, there has been a significant refinement in the treatment protocols and outcome. Improving radiation strategies to improve therapeutic ratio is the key to success.
  2,234 211 -
Influence of the modulation factor on the treatment plan quality and execution time in Tomotherapy in head and neck cancer: In-phantom study
Adam Ryczkowski, Tomasz Piotrowski
October-December 2013, 9(4):618-623
DOI:10.4103/0973-1482.126458  PMID:24518706
Purpose: The overall aim was to conduct an analytical study of the impact of the modulation factor (MF) on the quality of the head and neck treatment plans and their execution time on Tomotherapy. Materials and Methods: In-phantom (RANDO® Alderson) planning study of the head and neck cancer was performed. Thirteen different plans in terms of MF were prepared. Other optimization parameters were the same for all plans. Results: Analysis of treatment plans in terms of quality shows that MF < 1.4 does not provide an accepted dose distribution (physician decision). Statistically significant differences were observed for plans with an MF < 1.6. No differences were obtained for plans with MF from 6.0 to 1.8. Decreasing of MF leads to a shorter time of irradiation. The maximum rotational speed has been reached for an MF = 3.0. Further reducing this however produces no decrease in the time of irradiation. The actual and planned values of the MF were compared. The optimal range of MF for head and neck was determined as 3.0 > MF > 1.8. The lower limit increases to 2.4 when hard reduction of the dose in critical organs is required. Conclusions: It was showed that the final MF value is less than the value calculated after each loop of optimization. The computer system reduces MF by shortening the longest time and increasing the average time of leaves opening. Increase in the average time is obtained by eliminating the use of leafs with the shortest times of opening, thereby reducing the dose in critical organs that are outside the direct irradiation area.
  2,306 109 -
Angiogenesis and mast cell density as predictors of patient survival in squamous cell carcinoma of lung
Ehsan Ullah, Abdul Hannan Nagi, Muhammad Ashraf
October-December 2013, 9(4):701-705
DOI:10.4103/0973-1482.126487  PMID:24518720
Background: Measuring the microvascular and mast cell density in squamous cell carcinoma of lung and correlating them with the patient survival may be helpful to guide the use of cancer chemotherapeutic agents which target molecular mechanisms of tumour angiogenesis and mast cells. Materials and Methods: It was an observational study. It included 39 newly diagnosed, adult patients of pulmonary squamous cell carcinoma. Angiogenesis was determined by Chalkley's method after immunohistochemical staining of micro-vessels with CD34. Mast cells per HPF were counted in Tolouidine blue stained sections. Results: Mean age of the patients was 58.33 ± 9.14 years. Male to female ratio was 9:1. Most (92.3%) patients were current smokers. Majority of tumours (71.8%) were localised to major bronchi and/or near to hilum and many of them (74.4%) were poorly differentiated. Mean micro-vascular density was 11.80 ± 3.66 per HPF which showed strong negative correlation (r = -0.481, p =0.002) between microvascular density (MVD) and tumour grade. Mean mast cell density was 1.60 ± 2.04 which showed strong negative correlation (r=-.683, p =0.0001) with grade. Angiogenesis and mast cell density were found to be positively correlated (r=0.439, p =0.005). High MVD, but not the MCD was associated with poor survival. Conclusion: Angiogenesis and mast cell density are positively correlated with each other however; only high MVD is associated with decreased survival. Thus, the anti-angiogenic agents may be useful in squamous cell carcinoma lung, especially the well differentiated tumours.
  2,282 109 1
Endobronchial ultrasound-guided transbronchial needle aspiration: The standard of care for evaluation of mediastinal and hilar lymphadenopathy
Preyas J Vaidya, Arvind H Kate, Prashant N Chhajed
October-December 2013, 9(4):549-551
DOI:10.4103/0973-1482.126430  PMID:24518694
  2,191 193 -
Combined adenocarcinoma-carcinoid tumor of transverse colon
Prosanta Kumar Bhattacharjee, Shyamal Halder
October-December 2013, 9(4):746-747
DOI:10.4103/0973-1482.126483  PMID:24518735
A 65-year-old male presented with painless hematochezia associated with episodic cramps in upper abdomen, watery diarrhea, and a slowly growing mass in upper abdomen. Examination revealed a firm 6 x 5 cm, intra-abdominal, epigastric mass. Colonoscopy up to 90 cm showed a stenosing, ulcero-proliferative lesion in the transverse colon. No synchronous lesion was detected. Biopsy revealed mucin secreting adenocarcinoma. Exploration showed the growth involving the transverse colon proximal to the splenic flexure with a part of ileum, approximately three feet proximal to ileo-caecal junction, adherent to it. No significant mesenteric lymph node enlargement was evident. The patient underwent resection of the growth along with the segment of adherent ileum. Continuity was re-established by a colo-colic and ileo-ileal anastomosis respectively. Patient received adjuvant chemotherapy. Post-operative histopathology demonstrated a composite histological pattern with an admixture of carcinoid tumor and adenocarcinoma, invasion of ileal serosa and adenocarcinomatous deposits in mesocolic lymph nodes, the tumor staging being (T4, N0, M0/Stage II) for carcinoid and (T4, N1, M0/Stage III) for adenocarcinoma. Patient was followed-up for a year and was doing well without any evidence of recurrence.
  2,267 99 -
A comparison of two intravenous infusion devices in lung carcinoma patients receiving combined radiotherapy and chemotherapy
Xing-Hua Bai, Shuang Zang, Ling Yu
October-December 2013, 9(4):664-667
DOI:10.4103/0973-1482.126475  PMID:24518714
Purpose: To investigate the clinical effects of intravenous (IV) devices in the patients with lung cancer undergoing radiotherapy and chemotherapy. Materials and Methods: A total of 128 patients were divided into two groups : t0 hose who received chemotherapy through a peripherally inserted central catheter (PICC group; n = 64), and those who received therapy through an IV remaining needle (n = 64). Statistical Analysis: Patient characteristics and complication rates were compared using Fisher's exact tests or the χ2 test. During the treatment times, the time and the average nursing costs for both infusion methods and their complications were compared using the student's t -test. Data is presented as mean ± SEM 0 P value <0.05 was considered significant. Statistical analyses were carried out using SPSS V.12.0 for Windows (SPSS, Inc.). Results and Conclusions: The non-retention type venous detaining needle appears to be the preferred patient choice for those undergoing combined radiotherapy and chemotherapy.
  2,238 104 -
Primary squamous cell carcinoma of the small intestine
Shirish S Nandedkar, Karunakar K Trivedi, Kamal Malukani
October-December 2013, 9(4):739-740
DOI:10.4103/0973-1482.126477  PMID:24518732
Squamous cell carcinoma of the small intestine is very rare. Only four cases have been reported so far. We report a case of primary squamous cell carcinoma arising in the small intestine and unusually causing strangulation of sigmoid colon in a 59-year-old female, the first case in India.
  2,227 86 -
The X factor: An Indian perspective on women in academic oncology
Vanita Noronha
October-December 2013, 9(4):552-555
DOI:10.4103/0973-1482.126431  PMID:24518695
  2,139 152 -
Sparganosis in a patient with diffuse large B cell lymphoma
Sang-Young Roh, Jun Yong Lee, Kyun Woo Park, Sung-No Jung
October-December 2013, 9(4):712-714
DOI:10.4103/0973-1482.126462  PMID:24518723
Sparganosis is the human infection by plerocercoid, the larvae of sparganum. Clinically, subjective symptoms do not occur in the incipient stage, but as the worm migrates, pruritus or tenderness may occur. On physical examination, soft, palpable, and sometimes migratory, subcutaneous nodules are found in sparganosis patients. As rare cases; sparganosis from the orbit, the abdominal viscera, and the breast have been reported. However, there have been no reports relating such disease to the patients' immunocompromised status.We experienced a case of sparganosis from a patient with lymphoma whose immune system was suppressed by anticancer therapy, suggesting that the immunosuppression might affect the onset and the exacerbation of the disease. We report our case with a review of the literature.
  2,163 101 -
Non-thrombotic superior sagittal sinus occlusion with intracranial hypertension following metastatic Burkitt's lymphoma
Ankur Wadhera, Prasant Peter, M Joseph John, Rajesh Chakravarti
October-December 2013, 9(4):751-753
DOI:10.4103/0973-1482.126488  PMID:24518737
Intracranial metastasis is a known complication of Burkitt's lymphoma, however, superior sagittal sinus invasion by dural metastasis from Burkitt's lymphoma is rare. We report a young adult, known case of Burkitt's lymphoma, who presented with features of raised intracranial pressure secondary to dural sinus invasion from metastasis. Prompt radiotherapy to these lesions can bring about recanalization of the sinus with elevation of symptoms.
  2,163 70 -
Inflammatory myofibroblastic tumor occurs in the mediastinum
Xiangjiao Meng, Renben Wang
October-December 2013, 9(4):721-723
DOI:10.4103/0973-1482.126467  PMID:24518726
Inflammatory myofibroblastic tumor (IMT) is a rare disease. We report a rare case of inflammatory myofibroblastic tumor occurs in the mediastinum. Chest contrast-enhanced computed tomography (CT) showed a heterogeneously enhanced irregular mass in the anterior mediastinum; a small pericardial effusion was also noted. The diagnosis was confirmed by histopathology and immunohistochemical study.
  2,064 132 -
Rare case of gastrointestinal stromal tumor of the anal canal
Madhu Kumar, Madhu Mati Goel, Devendra Singh
October-December 2013, 9(4):736-738
DOI:10.4103/0973-1482.126476  PMID:24518731
Gastrointestinal stromal tumor (GIST) is a rare mesenchymal neoplasm of the gastrointestinal tract. GIST of anal canal is very rare representing only 3% of all anorectal mesenchymal tumors. We report an extremely rare case of GIST of the anal canal in 60-years-old man with history of irregular bowel habits with dark colored stool mixed with blood and constipation from 6 month. Diagnosis was made on the basis of histomorphological and immunohistochemical examination.
  1,966 135 1
Apoptosis-related molecular differences for response to tyrosin kinase inhibitors in drug-sensitive and drug-resistant human bladder cancer cells
Jixia Li, Bo Lv, Xiangyong Li, Zhiwei He, Keyuan Zhou
October-December 2013, 9(4):668-671
DOI:10.4103/0973-1482.126478  PMID:24518715
Context: The epidermal growth factor receptor (EGFR) family is reportedly overexpressed in bladder cancer, and tyrosine kinaseinhibitors (TKIs) have been suggested as treatment. Gefitinib is a selective inhibitor of the EGFR and lapatinib is a dual inhibitor of both the EGFR and HER2 (human EGFR type 2 receptor). Both compounds compete with the binding of adenosine triphosphate (ATP) to the tyrosine kinase domain of the respective receptors to inhibit receptor autophosphorylation causing suppression of signal transduction. Unfortunately, resistance to these inhibitors is a major clinical problem. Aims: To compare the apoptosis signaling pathway(s) induced by gefitinib and lapatinib, in UM-UC-5 (drug-sensitive) and UM-UC-14 (drug-resistant) bladder cancer cells and to identify molecular differences that might be useful predictors of their efficacy. Materials and Methods: Cell proliferation, cell cycle and apoptosis assay were used to detect the effect of TKIs on UM-UC-5 and UM-UC-14 cells. Molecular differences for response to TKIs were examined by protein array. Results: TKIs strongly inhibited cell proliferation and induced cell cycle G1 arrest and apoptosis in UM-UC-5 cells. Most notable apoptosis molecular differences included decreased claspin, trail, and survivin by TKIs in the sensitive cells. In contrast, TKIs had no effect on resistant cells. Conclusions: Claspin, trail, and survivin might be used to determine the sensitivity of bladder cancers to TKIs.
  1,975 123 -
Role of Cyclooxygenase-2, Ezrin and Matrix metalloproteinase-9 as predictive markers for recurrence of basal cell carcinoma
Mohamed A El-Khalawany, Amany A Abou-Bakr
October-December 2013, 9(4):613-617
DOI:10.4103/0973-1482.126456  PMID:24518705
Context: Recurrence of basal cell carcinoma (BCC) may form a prognostic problem that couldn't be fully predicted. Although there are different clinical and histologic risk factors for BCC recurrence, few reports are available for the role of biologic markers. Aim: The aim of this study was to assess the value of Cyclooxygenase-2 (COX-2), Ezrin and Matrix metalloproteinase-9 (MMP-9) in recurrence of BCC. Settings and Design: A retrospective controlled study. Materials and Methods: Primary tumors of 22 patients who had recurrent basal cell carcinoma (R-BCC) and 22 matched controls that showed non-recurrent basal cell carcinoma (NR-BCC) were collected. Clinical, histopathological, and immunohistochemical results were recorded and analyzed. Statistical analysis used: SPSS software version 13 and Pearson χ2 test. Results: R-BCC showed COX-2 expression in 20 (90.9%) cases compared to 13 (59.1%) in NR-BCC with a significant difference (P = 0.04). Moderate to strong intensity was recorded in 13 recurrent and two non-recurrent tumors. Higher frequency for Ezrin immunopositivity was noted in R-BCC (72.7%) than NR-BCC (40.9%), but the difference did not reach the level of significance (P = 0.07). Twelve R-BCC and three NR-BCC revealed moderate to strong staining. For MMP-9, there was no statistically significant difference (P = 1) between recurrent cases (63.6%) and controls (68.2%). No correlation was found between marker expressions and clinical or histologic features of R-BCC. Conclusions: Biologic markers may have a promising role in assessment of BCC prognosis and early detection of recurrence. High COX-2 expression could be considered as a risk factor of BCC recurrence that can be added to other clinical and histologic factors.
  1,842 134 -
Association between TGM5, PPAP2B and PSMA4 polymorphisms and NSCLC in never-smoking Chinese population
MM Yongjun Zhang, Aiqin Zhang, MM Hua Shi, MM Xiangming Kong
October-December 2013, 9(4):660-663
DOI:10.4103/0973-1482.126473  PMID:24518713
Aim: To explore the potential association between SNPs in transglutaminase 5 (TGM5), phosphatidic acid phosphatase type 2B (PPAP2B) and proteasome subunit, alpha type 4 (PSMA4) and non-small cell lung cancer (NSCLC) susceptibility in Chinese patients who were non-smokers. Setting and Design: A case-controlled study was conducted among Chinese population. Materials and Methods: Two hundred NSCLC patients and 200 healthy controls who were age and sex matched were genotyped for rs504417 of TGM5, rs1261411 of PPAP2B and rs7164594 of PSMA4. Genotyping was performed using the Sequenom MassARRAY system based on the chip-based matrix-assisted laser desorption ionization time-of-flight mass spectrometry platform. Statistical Analysis Used: The association between genotype and lung cancer risk was evaluated by computing the odds ratio (OR) and 95% confidence interval (CI) from multivariate unconditional logistic regression analyses. Results: There was no significant difference for the TGM5 rs504417, PPAP2B rs1261411 and PSMA4 rs716459 in allele or genotype frequencies, whether between controls and NSCLC or between controls and subgroups. Conclusions: polymorphisms of TGM5, PPAP2B and PSMA4 are not major contributors to NSCLC susceptibility, this primarily be attributed to the significantly distinct genetic background of Asian populations from western populations.
  1,870 82 -
Efficacy of neoadjuvant chemotherapy in down staging locally advanced pre-menopausal breast cancer in Eastern Nigeria: Is four courses adequate?
Ochonma Amobi Egwuonwu, Stanley Nnamdi Anyanwu, Alexander Maduaburochukwu Nwofor
October-December 2013, 9(4):638-643
DOI:10.4103/0973-1482.126463  PMID:24518709
Context: Breast cancer is the most frequent cancer among women in most part of the world and in Nigeria. Neoadjuvant chemotherapy (NAC) has been demonstrated to be a helpful strategy in the context of locally advanced breast cancer (LABC). Aims: To determine if the use of four courses of doxorubicin based neoadjuvant chemotherapeutic regimen will result in significant primary tumor down-staging. Settings and Design: One year prospective study of premenopausal breast cancer patients presenting to the specialty breast clinic. Methods: The patients were recommended for four courses of doxorubicin based NAC and response assessed using response evaluation criteria in solid tumors (RECIST) methodology. Statistical Analysis Used: Simple frequency and descriptive statistics were used to analyze data using SPSS statistical software. Results: One hundred and fourteen patients presented with breast cancer. Their ages ranged from 26 to 51 years with a mean age of 42.1 years ± 7.7 years. Thirty-one patients completed the four courses of NAC. At the end of NAC, 23 (74.2%) patients had more than 30% reduction in primary tumor size and 8 (25.8%) had no response (NR). The response according to the modified RECIST methodology was 12.9% for a complete clinical response, 61.3% for partial response, and 25.8% for NR. Significant clinical response was seen in 74.2% of patients (P < 0.0001) (one sample t-test). Conclusions: Four courses of antracycline based NAC is effective in premenopausal patients with LABC in our environment
  1,844 106 -
Gastric cancer: A case study in Turkey
Deniz Tural, Fatih Selçukbiricik, Emre Akar, Süheyla Serdengeçti, Evin Büyükünal
October-December 2013, 9(4):644-648
DOI:10.4103/0973-1482.126466  PMID:24518710
Objective: The aim of this study was to determine age-specific incidence ratios, gastric cancer localization trend, histologic subtype and cancer related survival that whether have changed during the period from 1999 to 2010. Materials and Methods: A total of 866 gastric cancer patients treated at the hospital were retrospectively evaluated. Categorical and continuous variables were summarized using descriptive statistics and were compared using the Chi-square and Mann-Whitney U-tests, respectively. Cancer related survival rates were estimated by the Kaplan-Meier method. Results: The median age at diagnosis was 58 years. Trends concerning the median ages of the patients were increased (from 57 years to 59 years). The proportion of diffuse histological subtype gastric adenocarcinoma increased during the period from 1999 to 2010, and it was 27% between 1999 and 2002 and 32% between 2007 and 2010 (P = 0.04). The proportion of gastric adenocarcinoma localized in cardia increased during the period from 1999 to 2010, and was 7.2% between 1999 and 2002; and 22.5% in 2007 and 2010 (P = 0.004). For stage I that was diagnosed between 1999 and 2002, the relative survival was 67% and in patients diagnosed between 2007 and 2010 the rate was 85%. For stage II that was diagnosed between 1999 and 2002, the relative survival was 35% and in patients diagnosed between 2007 and 2010, the rate was 65%. Cox regression analysis was conducted based on age subgroup, diagnosis time, and gastric localization (proximal/distal) and for adenocarcinoma subtypes. Hazard ratio was 31.6 for stage IV (confidence interval [CI] = 10-42), 1.3 for cardia localization (CI = 1.04-1.6) and 1.37 for patients who had been diagnosed between 1999 and 2002 (1.14-1.78). Conclusions: The ratio of median age at diagnosis and proximal gastric adenocarcinoma, diffuse histologic subtype increased between 1999 and 2010. Cancer related survival significantly improved for stage I and stage II. Cardia localization and time of diagnosis between 1999 and 2002 had significantly poor outcome on relative survival.
  1,831 111 -
Intramural solitary fibrous tumor of the ileum: A case report and review of the literature
Yong-Qiao Liu, Jun-Qiu Yue
October-December 2013, 9(4):724-726
DOI:10.4103/0973-1482.126469  PMID:24518727
Solitary fibrous tumor (SFT) is a rare spindle cell tumor, which has never been reported to be derived from the wall of the small intestine. To describe a case of ileum intramural SFT. An ileum intramural SFT was observed in a healthy 26-year-old woman during cesarean section. Complete resection was performed to remove the tumor. Surgical specimens were used for pathological examination and immunohistochemistry, which confirmed the diagnosis of SFT. The patient had an uneventful recovery from the operation without any complications, recurrence, or metastasis during the 4-month follow-up. This report shows for the first time that SFT can occur in the intestinal wall and that complete resection can successfully remove the tumor with promising short-term prognosis. Thus, SFT should be considered in the differential diagnosis of any mesenchymal lesion arising from the gastrointestinal tract.
  1,812 85 -
The demonstration of extension of high-grade glioma beyond magnetic resonance imaging defined edema by the use of 11 C-methionine positron emission tomography
Sridhar P Susheela, Swaroop Revannasiddaiah, N Madhusudhan, Mahesh Bijjawara
October-December 2013, 9(4):715-717
DOI:10.4103/0973-1482.126464  PMID:24518724
The use of magnetic resonance imaging (MRI) is the current standard for the delineation of target volumes for high-grade gliomas (HGG). While the peritumoral edema as per T2-weighted (T2W) imaging is utilized as basis to delineate the initial borders of the clinical target volume (CTV), those areas enhancing on T1-weighted (T1W) images with gadolinium contrast (T1-Gd) are considered for treatment with further boost. However, recent data has emerged concerning the use of positron emission tomography (PET) with 11 C-methionine, which seemingly provides additional information beyond MRI. We present the case of a gentleman with an inoperable HGG which was imaged with 11 C-methionine-PET ( 11 C-MET-PET)/CT as well as MRI as part of the radiotherapy treatment planning (RTP) process. The differences noted between the MRI and the PET defined volumes are presented. This being a patient who was not operated, the potentially confounding issue of surgery-induced PET-avidity is absent.
  1,707 93 -
Intractable nausea in a patient with synchronous pancreatic cancer and a fourth-ventricular ependymoma
Varun K Chowdhry, David A Carter, Anna Shapiro
October-December 2013, 9(4):733-735
DOI:10.4103/0973-1482.126474  PMID:24518730
Symptoms of nausea and vomiting can present a diagnostic challenge for physicians. In this article, we report a patient who was found to have synchronous presentation of an ependymoma and pancreatic cancer. This case illustrates some of the diagnostic challenges in patients with constitutional symptoms. Furthermore, it illustrates the importance of surgical intervention as both a diagnostic as well as a therapeutic measure when managing patients with presumed metastatic disease to the brain.
  1,654 65 -
Organ conservation approach for primary mucosal malignant melanoma of the larynx
Arvind Krishnamurthy, Vijayalakshmi Ramshanka, Urmila Majhi
October-December 2013, 9(4):758-759
DOI:10.4103/0973-1482.126495  PMID:24518742
  1,625 61 -
Balloon cell melanoma of the anal canal: A wolf in sheep's clothing?
Munita Meenu Bal, Mukta Ramadwar, Kedar Deodhar
October-December 2013, 9(4):706-708
DOI:10.4103/0973-1482.126457  PMID:24518721
Balloon cell melanoma (BCM) is a rare histologic variant of cutaneous malignant melanoma with exceptional reports of occurrences at non-cutaneous sites. Herein we present a case of primary amelanotic BCM of anal canal, a heretofore undescribed location. Histologically, the tumor was characterized by sheets of pale cells that bore striking resemblance to foamy macrophages. Presence of rare atypical mitoses confirmed the malignant nature of the cells. Neoplastic cells were immunoreactive for S100, Melan-A, and focally for HMB-45 while were negative for myogenic, gastrointestinal stromal tumor, epithelial and neuroendocrine markers. Resemblance to foamy macrophages, bland cytology and absence of pigment imparts this tumor a deceptively benign histological appearance making it prone to diagnostic pitfalls. Awareness of this rare entity and judicious employment of immunohistochemistry is imperative in segregating it from its diverse mimics.
  1,616 63 -
Thermochemoradiotherapy using superselective intra-arterial infusionfor N3 cervical lymph node metastases of tongue cancer
Hiroaki Nishiguchi, Kenji Mitsudo, Noriyuki Yamamoto, Iwai Tohnai
October-December 2013, 9(4):718-720
DOI:10.4103/0973-1482.126465  PMID:24518725
A case of squamous cell carcinoma of the tongue with advanced N3 cervical lymph node metastases in an 80-year-old female is reported. The patient was treated with a combination of radiotherapy (2 Gy/day, total 60 Gy), superselective intra-arterial chemotherapy via a superficial temporal artery and a femoral artery (docetaxel, total 124 mg; cisplatin, total 135 mg), and four sessions of hyperthermia for cervical lymph node metastases. The tumor responded well to therapy, and 18-fluorodeoxyglucose uptake in both primary and neck lesions disappeared on positron emission tomography-computed tomography. The patient has shown no clinical or radiological evidence of local recurrence or distant metastases 6 years after the end of treatment. Advanced oral cancer patients with N3 cervical lymph node metastases are particularly difficult to treat and have a poor prognosis. This method of thermochemoradiotherapy seems a promising modality for patients with N3 cervical lymph node metastases of oral cancer.
  1,567 75 -
Health-related quality of life among metastatic breast cancer patients
Ladislav Slovacek
October-December 2013, 9(4):755-756
DOI:10.4103/0973-1482.126490  PMID:24518739
  1,403 93 -
Discordance in 68Ga-DOTANOC and 177Lu-DOTATATE uptake in diagnostic and post-therapy scans in patients with medullary thyroid cancer-likely reasons
Nishikant Avinash Damle, Chandrasekhar Bal, Santosh Gupta, Abhinav Singhal
October-December 2013, 9(4):754-755
DOI:10.4103/0973-1482.126489  PMID:24518738
  1,303 65 -
Michael Gazzaniga: Who's in charge? Free will and science of the brain
Cooram Sridhar
October-December 2013, 9(4):763-764
  1,276 60 -
Neoadjuvant bronchoscopic intervention: Bridge to lung parenchyma sparing surgery
Arvind H Kate, Parth S Shah, Nikhil B Shukla, Shishir N Shetty, Prashant N Chhajed
October-December 2013, 9(4):760-761
DOI:10.4103/0973-1482.126497  PMID:24518744
  1,212 65 -
Phytochemicals: The future of radiation induced mucositis prevention
Trinanjan Basu, Sarbani G Laskar, Tejpal Gupta, Ashwini Budrukkar, Vedang Murthy, Jai P Agarwal
October-December 2013, 9(4):761-762
  1,168 104 -
Quality of life assessment in breast cancer patients: The need for stratification of patients, and of the use of appropriate questionnaires
Swaroop Revannasiddaiah, Nalini Rao, Sridhar P Susheela, Ramesh S Bilimagga
October-December 2013, 9(4):760-760
DOI:10.4103/0973-1482.126496  PMID:24518743
  1,149 91 -
Severe intracranial hypertension mimics intracranial hypotension radiologically
Hsin Tung, Chieh-Lin Jerry Teng, Hung-Chieh Chen
October-December 2013, 9(4):756-757
DOI:10.4103/0973-1482.126491  PMID:24518740
  1,144 63 -
Neurocognitive functioning in patients of high-grade gliomas
Slovacek Ladislav
October-December 2013, 9(4):757-758
DOI:10.4103/0973-1482.126493  PMID:24518741
  865 63 -