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   2018| April-June  | Volume 14 | Issue 3  
    Online since June 12, 2018

 
 
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REVIEW ARTICLE
Primary pulmonary synovial sarcoma: A reappraisal
Manoj Kumar Panigrahi, Gourahari Pradhan, Nibedita Sahoo, Pritinanda Mishra, Susama Patra, Prasanta Raghab Mohapatra
April-June 2018, 14(3):481-489
DOI:10.4103/0973-1482.204883  PMID:29893303
Synovial sarcoma (SS) is a malignant mesenchymal tumor with variable epithelial differentiation that affects mostly young adults and can arise at any anatomic site. Primary intrathoracic SS is very rare accounting for <0.5% of all lung tumors. Most commonly, it arises from the lung followed by pleura and mediastinum. Primary pulmonary SS (PPSS) affects both sexes equally with no preference for any hemithorax. The morphology, immunostaining properties, cytogenetic features, and management strategy of PPSS are similar to that of soft tissue SS. Histologically, there are two main types of SS – monophasic and biphasic with a feature of poor differentiation seen in both types. Most patients present with large intrathoracic masses with or without ipsilateral pleural effusion. Bone invasion or mediastinal adenopathy is very rare. SS is characterized by a specific chromosomal translocation producing SS18-SSX fusion gene in more than 90% of cases. Identification of this fusion gene remains the gold standard for the diagnosis in the presence of consistent histology and immunophenotype. Multimodality treatment including wide excision, chemotherapy, and radiotherapy is the mainstay of therapy. SS is relatively chemosensitive, and ifosfamide-based regimen showed improved survival in metastatic disease. Generally, SS is considered as high-grade tumors with a poor prognosis. Novel therapies targeted at fusion oncogene, SS18-SSX-derived peptide vaccine, epidermal growth factor receptor, and vascular endothelial growth factor are the future hope in SS. We describe a prototype case and present an elaborate review on primary SS of lung.
  3,846 219 -
ORIGINAL ARTICLES
Hesperidin inhibits insulin-induced phosphoinositide 3–kinase/Akt activation in human pre-B cell line NALM-6
Roghayeh Shahbazi, Makan Cheraghpour, Reza Homayounfar, Maryam Nazari, Javad Nasrollahzadeh, Sayed Hossein Davoodi
April-June 2018, 14(3):503-508
DOI:10.4103/0973-1482.157323  PMID:29893306
Context: It has been shown that hesperidin induces apoptosis in NALM-6 cells through inhibition of nuclear factor-kappa B (NF-κB) activation. Aims: To investigate the effect of hesperidin on inhibition of NF-κB activation through blocking phosphoinositide 3–kinase (PI3K)/Akt pathway as a main target in cancer treatment, in NALM-6 cells. Materials and Methods: NALM-6 cells were incubated with two concentrations of hesperidin (25, 50 μM) in the presence or absence of insulin (100 nM), as a potent activator of Akt. The cytotoxic activity of hesperidin was determined by 3-(4,5-methylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Cell apoptotic death was measured by ELISA test using cell death detection ELISA Plus kit. To assay the effect of hesperidin on Akt pathway, the phosphorylation levels of Akt, inhibitor of kappa B alpha (IκBα), and glycogen synthase kinase-3 beta (GSK-3β) and expression level of IκB kinase alpha (IKKα) were determined by Western blot analysis. Results: Hesperidin (both concentrations) significantly reduced cells survival in the presence and absence of insulin compared to untreated cells in a time-dependent manner (P < 0.05). Hesperidin also significantly increased apoptosis in NALM-6 cells even in hyperinsulinemia condition (P < 0.0001). Hesperidin inhibited insulin-induced phosphorylation and activation of Akt, IκBα, and GSK-3β and decreased expression of IKKα. Conclusion: The results of this study demonstrated that cytotoxic and proapoptotic actions of hesperidin are partly mediated through the suppression of PI3K3/Akt/IKK signaling pathway. So, hesperidin might act as a chemotherapeutic agent by targeting cell survival pathways.
  3,488 157 -
Immunohistochemical evaluation of tumor angiogenesis and the role of mast cells in oral squamous cell carcinoma
Arpita Kabiraj, Rohit Jaiswal, Anil Singh, Jagriti Gupta, Arun Singh, Fahad M Samadi
April-June 2018, 14(3):495-502
DOI:10.4103/0973-1482.163693  PMID:29893305
Background: Increased angiogenesis has been associated with neoplastic progression, metastasis and outcome in several studies and in a number of malignancies. Among the various host immune cells, mast cells have been implicated in tumor progression by promoting angiogenesis. The aim of this study is to examine the relationship between angiogenesis, mast cells with that of the normal oral mucosa (NOM) and oral squamous cell carcinoma (OSCC). Materials and Methods: The study was conducted using routine haematoxylin and eosin staining procedure and included immunohistochemical staining for microvessels and toluidine blue staining for mast cells. Results: The microvessel density (MVD) and mast cell density (MCD) of two groups (NOM and OSCC). The MVD and MCD in OSCC ranged from 59.18 to 263.31 microvessel/mm 2 and 41.65 to 193.28 cells/mm 2 respectively with mean (±standard deviation) 161.73 ± 48.27 microvessel/mm 2 and 83.59 ± 40.67 cells/mm 2. In both NOM and OSCC, the mean MCD was comparatively lower as compared to respective MVD (MCD < MVD) and comparatively lower in NOM as compared to OSCC (normal < OSCC). Conclusion: A significant correlation is present between MCD and MVD in OSCC and also that both these entities are significantly increased in the disease process when compared to that of the NOM.
  3,385 211 -
Nuclear factor-kappa B as potential therapeutic target in human colon cancer
Danuta Plewka, Andrzej Plewka, Adam Miskiewicz, Michał Morek, Edyta Bogunia
April-June 2018, 14(3):516-520
DOI:10.4103/0973-1482.180607  PMID:29893308
Background: It has been proved that nuclear factor-kappa B (NF-κB) is activated in all cells, promotes proliferation of cells, regulates the immunological and inflammatory response, and contribute to the pathogenesis of many conditions, including cancer. Many studies pointed to constitutive activation of NF-κB in cells of certain malignant tumors. Objective: The aim of the study was to analyze the role of nuclear growth factor κB as colon cancer marker and prognostic factor. Materials and Methods: The study included 59 primary colorectal tumor patients and 15 patients in control group. The tumor samples were taken during partial colectomy and colonoscopy in control group. Tissues samples were fixed and embedded in paraffin blocks and cut. Sections were used for schedule immunohistochemical staining with the application of specific antibody for NF-κB epitope. The marker expression was compared with well-known prognostic factors in colon tumors such as tumor type, stage, and grade to establish if it might be a potential prognostic factor. Results: The results showed statistically significant difference between control group and cancer group. Conclusions: The expression NF-κB did not depend on the stage and grade of colon tumors.
  3,398 187 -
Antioxidant and anticancer activities of extract of Inula helenium (L.) in human U-87 MG glioblastoma cell line
Kubra Koc, Ozlem Ozdemir, Aysenur Ozdemir, Unsal Dogru, Hasan Turkez
April-June 2018, 14(3):658-661
DOI:10.4103/0973-1482.187289  PMID:29893335
Aims: The aim of this study is to explore the antioxidant and antiproliferative activities of aqueous extract from aerial parts of Inula helenium (L.) against human U-87 MG glioma cell line. Materials and Methods: The 3'-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide and lactate dehydrogenase assays were used to study antiproliferative and cytotoxic activities against U-87 MG cell after 48 h exposure. In addition, to assess the oxidative effects, total antioxidant capacity and total oxidant status levels were also measured. Results: Finally, the aqueous extracts displayed antiproliferative and cytotoxic activities at high concentrations tested, particularly at 200 μg/ml, without causing to oxidative stress. Conclusion: The results strengthen the evidence that I. helenium could be considered a natural resource of potential antitumor agents for brain cancer. In addition, this study is expected to expand the existing information on the anticancer activity of I. helenium and to assist in a more focused design of further research as chemotherapeutic agents.
  3,207 280 -
Malignancy associated hemophagocytic lymphohistiocytosis in children
Amitabh Singh, Lesa Dawman, Rachna Seth
April-June 2018, 14(3):559-562
DOI:10.4103/0973-1482.188437  PMID:29893316
Aim of Study: Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of immune dysregulation resulting in abnormal T-cell activation and inflammatory cytokine production which produces a constellation of clinical features unique to HLH. Pediatric secondary HLH is usually triggered by infection, malignancy, or rheumatological disorders. The diagnosis of malignancy-associated HLH (MA-HLH) poses a difficult challenge as clinical features may be attributed to the underlying disease or chemotherapy. Our study aimed to see the occurrence of this rare entity at our centre. Materials and Methods: Data were collected from all pediatric oncology patient treated at our center with the diagnosis of MA-HLH from January 2012 to December 2014. Data were collected for age, sex, underlying disease, treatment protocol, stage of chemotherapy, any underlying infection, treatment given for HLH, and outcome. Results: There were five patients with a diagnosis of MA-HLH in the study period. Age ranged from 18 months to 9 years. Of the five MA-HLH, two patients had acute lymphoblastic leukemia, two acute myeloid leukemia, and one had Hodgkin lymphoma. The three patients who had documented microbiological infection also did not improve after appropriate treatment. Two patients died during treatment. One patient improved completely on steroid alone. One patient received HLH 2004 induction. Conclusion: The delay in the diagnosis of MA-HLH in pediatric patients may be due to decrease awareness about the condition the timely diagnosis of MA-HLH is crucial for a better outcome. Herein, we discuss our experience with this rare entity in pediatric oncology patients with review of literature.
  3,032 235 -
The epidemiological and histological trend of bladder cancer in Iran
Hosein Rafiemanesh, Zahra Lotfi, Sima Bakhtazad, Mahshid Ghoncheh, Hamid Salehiniya
April-June 2018, 14(3):532-536
DOI:10.4103/0973-1482.172134  PMID:29893311
Introduction: Bladder cancer is the ninth common cancer in the world, the third common cancer among men in the Arabic and Western Asian countries, and the second in some regions of Iran (a country in the Middle East). There was no study on the epidemiological and histological trend of bladder cancer in Iran. This study aimed to the epidemiological and histological trend of bladder cancer in Iran. Materials and Methods: In this study, data were extracted from annual cancer registry reports of Iranian Ministry of Health between 2003 and 2008. Standardized incidence rates were calculated using the world standard population and incidence rate was calculated by age groups, sex, and histological type. Data on epidemiologic trend and histology were analyzed using Joinpoint software package. Results: A total of 23,291 cases were reported. Almost 17.70% (4127 cases) were women and 82.30% (19,170 cases) men. The sex ratio (male to female) was 4.65. Joinpoint analysis showed the significant increased trend of age-standardized incidence rate (ASIR) for both sexes. The annual percentage change of standardized incidence rate was 11.5 (confidence interval [CI]: 9.0–14.0) in women and 10.8 (CI: 8.0–13.6) in men. Two histological types of transitional cell carcinoma (TCC), not otherwise specified and papillary TCC included 43.89% and 49.86% of all cancer cases, respectively. Conclusion: According to this study the trend of ASIR of bladder cancer in Iran is rising, so it is necessary to conduct further researches in future to provide accurate information on the cancer and investigate related risk factors and implement prevention programs in Iran.
  2,943 257 -
CORRESPONDENCE
An atypical presentation of POEMS syndrome with IgG kappa type M protein and normal VEGF level: Case report and review of literature
Swaroopa Pulivarthi, Murali Krishna Gurram
April-June 2018, 14(3):679-681
DOI:10.4103/0973-1482.172123  PMID:29893339
POEMS syndrome is a multisystem disorder characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. We present an atypical case of POEMS syndrome with subclinical polyneuropathy, splenomegaly, hypogonadism, and myeloma of immunoglobulin G kappa type. The typical osteosclerotic lesions and skin lesions were absent, and vascular endothelial growth factor (VEGF) level was normal. Our patient also had chronic kidney disease due to focal segmental glomerulosclerosis. The patient died due to multisystem complications nine months after presenting with acute on chronic renal failure. POEMS syndrome is an uncommon, potentially fatal paraneoplastic syndrome presenting with plasma cell neoplasm and multisystem involvement. Despite the normal VEGF level, our patient was diagnosed to have possible POEMS syndrome due to other clinical manifestations. It may be reasonable to expand the diagnostic criteria of POEMS syndrome if further atypical cases are reported in the future.
  3,060 136 -
ORIGINAL ARTICLES
Tooth agenesis: A susceptible indicator for colorectal cancer?
MV Paranjyothi, KL Kumaraswamy, Lubna Firdose Begum, K Manjunath, Litha , Shaini Basheer
April-June 2018, 14(3):527-531
DOI:10.4103/0973-1482.168997  PMID:29893310
Context/Background: Tooth agenesis (excluding third molars) is a common congenital disorder that affects 2.2–10% of the general population. A number of different genes have been shown to be associated with cases of tooth agenesis including AXIN2, IRF6, FGFR1, MSX1, PAX9, and TGFA. Wingless/integration signaling gene, AXIN2, is linked to tooth agenesis and also to colorectal cancer (CRC). Aims: To analyze the correlation between tooth agenesis and CRC. Materials and Methods: The study included 50 individuals, who were divided into two groups. Group A: 25 individuals diagnosed with CRC and Group B: 25 individuals as a control group. The clinical details were recorded using preformed questionnaire, approved by ethical committee. Orthopantomogram was obtained for all the cases and controls. Results: We observed that 16% of cases and 8% of controls reported having tooth agenesis and there was no statistical significance of difference between them (P = 0.384). Among the study group, 4% reported oligodontia and 12% cases reported hypodontia. In the control group 8% reported hypodontia, there was no incidence of oligodontia. Additional finding in the study group was that 24% cases had fissured tongue which was not seen in the control group. Conclusion: Individuals with tooth agenesis might have an increased risk for CRC. A larger epidemiological study along with genetic mapping and gene sequencing is necessary to rule out the risk and relationship between tooth agenesis and CRC.
  3,014 175 -
A survey of computed tomography dose index and dose length product level in usual computed tomography protocol
Akbar Aliasgharzadeh, Ehsan Mihandoost, Mehran Mohseni
April-June 2018, 14(3):549-552
DOI:10.4103/0973-1482.172713  PMID:29893314
Background: Nowadays, the use of computed tomography (CT) as a diagnostic tool has been considerably increased. Therefore, implementation of the program to conform the protection regulations on the CT scan is necessary to reduce the detrimental effects of radiation. Objective: This study was performed to measure weighted CT dose index (CTDIW) and dose length product (DLP) in routine CT protocols of the adult patients. Methods: In this study, the patient dose was determined in routine CT protocols. The CT scanner used in this study was a single-slice Toshiba model. Scan parameters for each protocol were registered for 10 standard sized patients and then by applying it to the CT system, CTDIw and DLP mean values were calculated and finally the values of dose were compared with the reference dose limit. Results: The mean values of CTDIw and DLP for head, para nasal sinuses, chest, abdomen, and pelvis protocols were 34.11, 19.67, 15.47, 13.95, 10.08 mGy and 362.67, 153.97, 307.33, 346.07, 189.37 mGy.cm, respectively. The mean values of CTDIW and DLP obtained in all of the protocols were less and even less than half in some of the protocols compared with the European guidelines and the UK reference values. However, mean values of CTDIw in the Chest and Abdomen protocols, were greater than IAEA reported values. Conclusions: Using lower milli Amperes and higher kilo voltage peak as well as minimizing scan area and number of slices should be considered for more reduction in patients' dose.
  2,916 236 -
CORRESPONDENCE
Huge primary mediastinal synovial sarcoma fully occupying the right hemithorax
Ahmed Abu-Zaid, Asma AlNajjar, Sarah Alotaibi, Rasha Alshawaf, Noor Alqeshtaini, Rwan Alhaidar, Shamayel Mohammed, Khaled AlKattan
April-June 2018, 14(3):682-686
DOI:10.4103/0973-1482.172137  PMID:29893340
Primary mediastinal synovial sarcomas are exceedingly uncommon tumors. Herein, we present the case of primary mediastinal synovial sarcoma (monophasic spindle cell-shaped variant) fully occupying the right hemithorax in a 37-year-old woman who presented to clinic with a 2-month history of right-sided chest pain and shortness of breath. Although extremely rare, however, synovial sarcoma should be considered in the differential diagnosis of all monophasic and biphasic spindle cell neoplasms of the mediastinum. Despite molecular testing for (t[x; 18] [p11.2; q11.2]) is characteristically positive in 90% of synovial sarcoma cases, it is not routinely done. Histopathological and immunohistochemical analyses can greatly confirm the diagnosis. Optimal surgical resection is the standard of care. Adjuvant therapy (radiotherapy and/or chemotherapy) is indicated in inoperable advanced disease or unachieved surgical tumor-free surgical margins. Prognosis is poor with a 5-year overall survival (OS) rate of 35.7%. Early diagnosis and prompt appropriate management yield better disease-free and OS rates.
  2,963 148 -
ORIGINAL ARTICLES
Comparing surgical outcome and ovarian reserve after laparoscopic hysterectomy between two methods of with and without prophylactic bilateral salpingectomy: A randomized controlled trial
Zahra Asgari, Afsaneh Tehranian, Safoura Rouholamin, Reihaneh Hosseini, Mahdi Sepidarkish, Mahroo Rezainejad
April-June 2018, 14(3):543-548
DOI:10.4103/0973-1482.193114  PMID:29893313
Background: This study aimed to compare the surgical outcome and ovarian reserve in premenopausal women undergoing laparoscopic hysterectomy (without oophorectomy) for benign cause between two methods of with and without prophylactic bilateral salpingectomy. Materials and Methods: In a prospective randomized clinical trial, 62 premenopausal women with benign indication underwent a laparoscopic hysterectomy. Patients were then randomized to undergo hysterectomy with bilateral salpingectomy (Group 1; n = 15) or without bilateral salpingectomy (Group 2; n = 15). We evaluated the impact of bilateral salpingectomy on surgical outcome and ovarian reserve using serum levels of anti-Mullerian hormone (AMH) and follicle stimulating hormone (FSH) that were measured preoperatively and at 3 months postoperatively (P < 0.001). Results: Baseline characteristics such as age, uterine size, body mass index, and preoperative AMH and FSH levels were similar between the two study groups. The average operative time, estimated blood loss, uterine size, uterine weight, and intraoperative complication were similar between two groups. The mean AMH levels were not significantly different at baseline (1.44 ng/mL vs. 1.2 ng/mL) and at 3-month postoperatively (1.13 ng/mL vs. 0.97 ng/mL) among women with salpingectomy versus no salpingectomy. At 3-month follow-up, in both groups, postoperative AMH levels were significantly lower and FSH levels were significantly higher than before surgery. Conclusion: Prophylactic bilateral salpingectomy at the time of laparoscopic hysterectomy neither has a negative effect on ovarian reserve nor increases the surgical risk. Therefore, we may recommend gynecologic surgeons to perform prophylactic bilateral salpingectomy during laparoscopic hysterectomy to conserve both ovaries.
  2,917 186 -
Oral submucous fibrosis: A clinico-histopathological correlational study
Sudharani Basawaraj Biradar, Anita Dnyanoba Munde, Basawaraj Chanabasappa Biradar, Safia Shoeb Shaik, Shweta Mishra
April-June 2018, 14(3):597-603
DOI:10.4103/0973-1482.176177  PMID:29893325
Aim of the Study: The aim of this study was to correlate the clinical staging (clinical severity) with the histopathological staging (histopathological changes) of oral submucous fibrosis (OSF) patients, which would further assist the clinicians to formulate a definite treatment plan. Materials and Methods: The study group consisted of 50 subjects who were clinically and histologically diagnosed as OSF. Detailed information was gathered in a pretested proforma with emphasis on the various addictions. The clinical findings were noted; punch biopsy was performed followed by histological examination. Clinical and histological staging were divided into four stages, as Stages I–IV according to Khanna and Andrade classification. Results: The 50 subjects were in the age range of 18–70 years, of which 20 patients were in clinical Group III, 15 were in histopathological stage III, 2, 1, and 2 in Stage II, Stage I, and Stage IV, respectively, out of 5 patients in clinical Group IV, 4 were in histopathological staging IV and 1 was in Stage III, out of 5 patients in clinical Group I, 3 and 2 were in histologic Stages II and I, respectively. Statistical analysis with Chi-square test showed high significance with P < 0.001. Conclusion: The correlation of clinical and histopathological staging was found to be highly significant, thus suggesting that the subject with clinically advanced OSF had extensive fibrosis histologically.
  2,842 206 -
LETTER TO THE EDITOR
Hepatic metastasectomy and paclitaxel provide long-term survival for a young woman with recurrent triple-negative metastatic breast cancer: 16 years follow-up
Victor C Kok
April-June 2018, 14(3):722-723
DOI:10.4103/0973-1482.179087  PMID:29893352
  2,914 112 -
ORIGINAL ARTICLES
A correlation of immunohistochemical expression of TP53 and CDKN1A in oral epithelial dysplasia and oral squamous cell carcinoma
Jay Ashokkumar Pandya, Karen Boaz, Srikant Natarajan, Nidhi Manaktala, KP Nandita, Amitha J Lewis
April-June 2018, 14(3):666-670
DOI:10.4103/0973-1482.180683  PMID:29893337
Purpose: Oral epithelial dysplasia (OED) occurs on exposure of epithelial cells to carcinogens and genetic alteration. Once the reversible cell damage is surpassed, cells either undergo apoptosis or transform into malignancy, chiefly oral squamous cell carcinoma (OSCC). Progressive accumulation of genetic errors (including mutations in TP53 and CDKN1A) is associated with the initiation and progression of potentially malignant oral lesions toward frank malignancy. The present study attempted to correlate the immunohistochemical expression of CDKN1A and TP53 with increasing severity of OED along with increased aggressiveness of OSCC as reflected in the clinicopathologic variables. Materials and Methods: Tissue sections from forty biopsy-proven cases of OED and OSCC were stained with anti-TP53 and anti-CDKN1A mouse monoclonal antibodies. One hundred cells in each case were counted under high power magnification. Results: Poorly differentiated OSCC showed the highest TP53 expression (mean = 70.285), with least expression seen in mild dysplasia (mean = 22.125) (P < 0.001). Higher TP53 count was seen in cases with margin involvement, without recurrence and lymph node involvement and in cases which died of disease. CDKN1A expression was seen only in five cases and that too focally in the cytoplasm, thereby warranting removal of analysis of CDKN1A positivity from the study. Conclusion: The expression of TP53 in OED highlights its role in initial carcinogenesis. Although the role of CDKN1A in the cell cycle has been documented, its relationship to various clinical and pathological variables of OSCC and its different treatment modalities could not be adequately assessed.
  2,817 204 -
The clinical impact of serous tubal intraepithelial carcinoma on outcomes of patients with high-grade serous carcinoma of the ovary, fallopian tube, and peritoneum
Tayfun Toptas, Elif Pestereli, Tayup Simsek, Selen Bozkurt, Gulgun Erdogan, Seyda Karaveli
April-June 2018, 14(3):587-592
DOI:10.4103/0973-1482.172130  PMID:29893323
Aims: To investigate whether the presence of serous tubal intraepithelial carcinoma (STIC) is associated with clinical outcomes in a nonselected (unknown BRCA status) cohort of patients with a high-grade serous carcinoma (HGSC) of the ovary, fallopian tube, and peritoneum. Settings and Design: A prospective case-series with planned data collection. Subjects and Methods: The study was conducted in a total of 131 patients, who underwent primary cytoreductive surgery between 2007 and 2012. Histological examination of the fallopian tubes included the “sectioning and extensively examining the fimbriated end” protocol. The diagnosis of STIC was based on the combination of morphology and immunohistochemistry. The patients were divided into two groups according to the absence or presence of STIC and compared clinicopathologically. Statistical Analysis Used: Analyses were performed using PASW 18 (SPSS/IBM, Chicago, IL, USA) software. The primary outcome was progression-free survival (PFS), and the secondary outcome was overall survival (OS). Results: STIC was identified in 20.6% of patients. Median follow-up time was 49.5 months for the STIC-positive group and 38.0 months for the STIC-negative group. Study groups were comparable in terms of clinicopathological characteristics with the exception that patients with STIC had less lymph node involvement (55.0% vs. 65.4%, P = 0.001), and more diagnosis of primary tubal carcinoma (29.6% vs. 3.8%, P = 0.001) compared to those without STIC. No statistically significant differences in terms of PFS (P = 0.462) and OS (P = 0.501) were observed between the groups. Conclusions: The absolute identification of the origin of tumor cell does not seem to significantly affect the clinical course of the patients with HGSC.
  2,770 150 -
Breast specific functional and symptom analysis in female breast cancer survivors
Shaqul Qamar Wani, Talib Khan, Saiful Yamin Wani, Mohammad Ashraf Teli, Nazir Ahmad Khan, Liza Rafiq Mir, Mohammad Maqbool Lone, Fir Afroz
April-June 2018, 14(3):521-526
DOI:10.4103/0973-1482.165867  PMID:29893309
Context: The disease and surgery of the breast not only evoke a fear of mutilation and loss of feminity but is also responsible for psychosocial, behavioral, and sexual problems. Aim: To analyze prospectively the time trends in “breast specific functional and symptom scale scores in female breast cancer survivors.” Settings and Design: The prospective study was conducted in the Department of Radiation Oncology at Tertiary Referral Hospital. Materials and Methods: A total of 154 operated (mastectomy) female breast cancer patients who were referred to the Department of Radiation Oncology for chemoradiation ± target therapy (trastuzumab) ± hormonal therapy (tamoxifen) were included in the study. Seven patients were excluded from the final analysis due to their refusal to consent. The patients were assessed by using European Organization for Research and Treatment of Cancer Quality of Life-BR23 questionnaire module (which incorporates five multi-item and three single items scales) at 1st visit (0 month), 6, 12, and 24 months interval, respectively. Results: The symptom scores and future perspectives scale showed improvement with time, but body image and sexual functioning and enjoyment scales showed the deteriorating trend. P < 0.05 was considered as significant. Conclusion: The female breast cancer survivors failed to improve their body image, sexual functioning, and sexual enjoyment scales but did well in other BR23 scales. Besides the family and spousal/marital support these patients got closer to their religion which has been seen to influence their psychosocial well-being optimistically and need further studies to establish the role of religious practices/beliefs.
  2,752 161 -
The value of serum survivin level in early diagnosis of cancer
Meral Gunaldi, Nilgun Isiksacan, Hakan Kocoglu, Yildiz Okuturlar, Omur Gunaldi, Turkan Ozturk Topcu, Mehmet Karabulut
April-June 2018, 14(3):570-573
DOI:10.4103/0973-1482.171369  PMID:29893319
Objective: Survivin is one of the apoptosis inhibitor proteins, and it plays a key role in tumor angiogenesis and cancer progression. This study was conducted to investigate the serum level of survivin to determine its diagnostic value in cancer patients. Materials and Methods: Blood samples were taken from cancer patients (n = 67) prior to surgery or chemo/radiotherapy and age-matched healthy volunteers (n = 23). The serum levels of survivin were analyzed by enzyme-linked immunosorbent assays. The difference in serum levels between patients and control was evaluated by using statistical methods. Correlation between the serum levels of survivin and clinicopathological features of cancer patients were also evaluated. Results: The diagnoses of patients were breast cancer (49.3%), colon cancer (25.4%), ovarian cancer (14.9%), and other cancers (10.4%). Serum survivin levels were significantly higher in cancer patients than healthy subjects (196.23 pg/ml vs. 117.73 pg/ml, respectively, P = 0.019). No significant relations were found between serum survivin level and demographic characteristics of cancer. The optimal cut-off value of serum survivin was determined at >120.8 pg/ml, and its serum levels above this cut-off value were associated with 4.198 times increased risk of cancer. Conclusion: Our study results may suggest that high serum survivin levels can show 4 times increased risk of cancer in a subject with a high suspicion of cancer. Furthermore, survivin level was not influenced with demographic characteristics of breast, gastric, colorectal, prostate, ovarian cancer, and glioblastome multiforme.
  2,658 210 -
Predictive polymorphisms for breast cancer in postmenopausal Mexican women
Mónica Sierra-Martinez, Leticia Hernández-Cadena, José Rubén García-Sánchez, Gustavo Acosta-Altamirano, Carmen Palacios-Reyes, Patricia García Alonso-Themann, Liliana García-Ortiz, Laura Itzel Quintas-Granados, Octavio Daniel Reyes-Hernández
April-June 2018, 14(3):640-646
DOI:10.4103/0973-1482.179109  PMID:29893332
Context: Several factors contribute to the increase in breast cancer (BC) incidence, such as lifetime exposure to estrogen, early menarche and older ages at first birth, menopause, and the increased prevalence of postmenopausal obesity. In fact, there is an association between an increased BC risk and elevated estrogen levels, which may be involved in carcinogenesis via the estrogen receptor alpha (ERα) encoded by the ESR1 gene. Interestingly, there is an antagonistic relationship between ERα and the aryl hydrocarbon receptor (AhR) in BC cells. Aims: Herein, we explore the combined effects of the ESR1 (XbaI, PvuII) and AhR polymorphisms on BC development in Mexican women according to their menopausal status. Settings and Design: Investigation was performed using a cases and controls design. Subjects and Methods: In a group of 96 cases diagnosed with BC and 111 healthy women, the single-nucleotide polymorphisms ESR1 (XbaI, PvuII) and AhR gene were identified by qPCR. Statistical Analysis Used: Chi-square test or Fisher's exact test were used. Statistical analyses were conducted using the STATA statistical package (Version 10.1, STATA Corp., College Station, TX, USA). Results: The G/G XbaI genotype was more prevalent in the cases than in the controls (P = 0.008). Moreover, Mexican women carrying the XbaI (wild type [WT]/G or G/G) ESR1 genotype have higher risk (12.26-fold) for developing postmenopausal BC than individuals carrying the WT/WT genotype. Conclusions: The presence of the G/G genotype of XbaI may be considered a susceptibility allele in Mexican women. Due to increased postmenopausal BC risk, the XbaI (WT/G or G/G) alleles may be used as a postmenopausal predictive factor for BC in Mexican women.
  2,457 208 -
CORRESPONDENCE
Chondrosarcoma third metacarpal: Diagnosis and management options
Vipin Sharma, Lucky Verma, Bal Chander, Seema Sharma
April-June 2018, 14(3):719-721
DOI:10.4103/0973-1482.175429  PMID:29893351
Chondrosarcoma is a rare malignant tumor of cartilage commonly arising in the pelvis, proximal femur, and humerus, but quite uncommon in the small bones of the hand. Although limited surgical procedures such as curettage are mentioned as a management option in low-grade chondrosarcomas, they tend to have a high rate of recurrences. Hence, wide excision is recommended as a treatment option even in low-grade chondrosarcomas of the hand.
  2,531 122 -
ORIGINAL ARTICLES
Correlation of proliferative index with various clinicopathologic prognostic parameters in primary breast carcinoma: A study from North India
Nisha Marwah, Ashima Batra, Sanjay Marwah, Veena Gupta, Samta Shakya, Rajeev Sen
April-June 2018, 14(3):537-542
DOI:10.4103/0973-1482.167614  PMID:29893312
Aim: Routine assessment of cell proliferation is recommended in the pathologic evaluation for all breast cancers. Considering the poor reproducibility and interobserver variability in mitotic counts, Ki-67 is an easily available and reliable substitute for mitotic counts and has been shown to have a significant relationship with the histologic grade of malignancy and the mitotic activity of tumors. Our study aimed at exploring Ki-67 expression and studying its correlation with other established prognostic parameters. Materials and Methods: Seventy-five cases of primary breast cancer undergoing radical or modified radical mastectomy constituted the study group. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)/neu, and Ki-67 was assessed in each case. Ki-67 labeling index (Ki-67-LI) was estimated as the number of positive nuclei divided by total number of nuclei scanned counting a minimum of 1000 cells in 10 selected high power fields that displayed the highest immunoreactivity and was expressed as percentage. Ki-67 expression was correlated with various clinicopathologic prognostic parameters including age, tumor size, tumor type, axillary lymph node status, and histologic tumor grade. Results: A statistically significant direct association was observed between Ki-67-LI and tumor size, histologic grade and Nottingham prognostic index. A statistically significant inverse association was observed between Ki-67-LI and ER and PR expression. However, no association was observed between Ki-67-LI and menopausal status, lymph node involvement and HER2/neu expression. Conclusion: Based on our results, we concluded that modified Bloom–Richardson (MBR) grading has been recognized as a treatment related indicator. The accuracy and reliability in grading have always been a matter of concern, hence, the reproducibility of grading should be enhanced. Ki-67-a proliferation marker is easily identified and provides comparable accurate information. In contrast to poor reproducibility of mitotic counts, Ki-67 can achieve high agreement between pathologists; is more reproducible; adds complementary value to the MBR grading system and correlates well with other clinicopathologic parameters. It may act as a significant prognostic indicator for routine clinical use and be helpful for selection of adjuvant treatment. It can also add value in categorizing Grade II tumors into two prognostic subgroups with prognosis equivalent to Grades I and III, respectively.
  2,415 178 -
Effects of food insecurity on the women esophageal cancer in the Zanjan Province
Amir Najafi
April-June 2018, 14(3):490-494
DOI:10.4103/0973-1482.206303  PMID:29893304
Background: Nowadays one of the principal challenges of any country is improving the chronic disease and cancers. One of the most important of cancers is esophageal cancer in Iran. No doubt, esophageal cancer is an outcome of the interaction and combination of different factors. Cancer of the esophagus is one of the most common causes of death in adults (especially women) in Iran, where the incidence of this cancer is among the highest in the world. Objective: The main aim of this cross-sectional study was to test the hypothesis that food insecurity could create esophageal cancer among women in Iran (Zanjan Province). Methods: The method of this paper has been based on the analytical and descriptive research using fuzzy cognitive maps (FCMs) method. The subjects were 580 women aged 40–70 years (150 women have esophageal cancer), and they are selected randomly in the Zanjan Province of Iran. Results: The food insecurity (such as hunger and hidden hunger) in the Zanjan Province, according to the 24 h food-recall questionnaire was 23% and 38%, respectively. Only 39% of the study population was secure in terms of having access to all key nutrients. The accuracy of the questionnaire for screening for hunger in the population was 88.78%, respectively, and the corresponding value for hidden hunger was 83.4%. The average value of esophageal cancer predicted using fuzzy cognitive maps is equal to 75.43% (for 36 months). Conclusion: Our findings showed an association of food insecurity and body mass index (BMI) in the study population. Food insecurity increased the rate of underweight and decreased the rates of overweight and obesity.
  2,434 138 -
Prognostic factors of patients who received chemotherapy after cranial irradiation for non-small cell lung cancer with brain metastases: A retrospective analysis of multicenter study (Anatolian Society of Medical Oncology)
Ali Inal, Hilmi Kodaz, Hatice Odabas, Ayse Ocak Duran, Mehmet Metin Seker, Mevlide İnanc, Emin Tamer Elkıran, Yusuf Gunaydın, Serkan Menekse, Turkan Ozturk Topcu, Zuhat Urakcı, Didem Tastekin, Mehmet Bilici, Sener Cihan, Caglayan Geredeli, Emel Sezer, Dogan Uncu, Erkan Arpacı, Banu Ozturk, Oznur Bal, Mukremin Uysal, Ozgur Tanrıverdi, Mahmut Gumus, Bala Basak Oven Ustaalioglu, Ali Suner, Suna Cokmert, İlhan Hacıbekiroglu, Kubra Aydın, Abdurrahman Isıkdogan
April-June 2018, 14(3):578-582
DOI:10.4103/0973-1482.176417  PMID:29893321
Purpose: Almost half of all patients diagnosed with non-small cell lung cancer (NSCLC) have distant metastases at presentation. One-third of patients with NSCLC will have brain metastases. Without effective treatment, the median survival is only 1 month. However, it is difficult to treat brain metastases with systemic chemotherapy since the agents have difficulty crossing the blood-brain barrier. Therefore, it is important to estimate the patient's survival prognosis. The aim of this study was to analyze prognostic factors for survival in Turkish patients who received chemotherapy after cranial irradiation for NSCLC with brain metastases. Methods: We retrospectively reviewed 698 patients with brain metastases resulting from NSCLC. Ten potential prognostic variables were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors associated with overall survival (OS). Results: Among the 10 variables for univariate analysis, six were identified to have prognostic significance; these included sex, smoking history, histology, number of brain metastases, extracranial metastases, and neurosurgical resection. Multivariate analysis by the Cox proportional hazard model showed that a smoking history, extracranial metastases, and neurosurgical resection were independent negative prognostic factors for OS. Conclusion: Smoking history, extracranial metastases, and neurosurgical resection were considered independent negative prognostic factors for OS. These findings may facilitate pretreatment prediction of survival and can be used for selecting patients for more appropriate treatment options.
  2,416 154 -
CORRESPONDENCE
Dedifferentiated adenoid cystic carcinoma ex pleomorphic adenoma of the parotid
Minakshi Bhardwaj, Prajwala Gupta
April-June 2018, 14(3):706-708
DOI:10.4103/0973-1482.179522  PMID:29893347
Carcinoma ex pleomorphic adenoma (Ca ex PA) is defined as a carcinoma arising from a primary (de novo) or recurrent benign pleomorphic adenoma. The most common histological subtype is adenocarcinoma, not otherwise specified, salivary duct carcinoma, mucoepidermoid carcinoma, and adenoid cystic carcinoma (ACC). Few case reports of de novo dedifferentiation in ACC are there in the literature, mostly involving minor salivary glands. The dedifferentiated adenoid cystic carcinoma arising in a pleomorphic adenoma of the parotid gland has not been reported earlier. The present case highlights this rare histological subtype seen in Ca ex PA and the role of extensive histopathological examination and immunohistochemistry.
  2,353 139 -
ORIGINAL ARTICLES
Adjuvant chemotherapy for gastric cancer in elderly patients has same benefits as in younger patients
Mustafa Karaca, Deniz Tural, Hakan Kocoglu, Fatih Selcukbiricik, Irem Bilgetekin, Ahmet Özet
April-June 2018, 14(3):593-596
DOI:10.4103/0973-1482.172588  PMID:29893324
Objective: The age-adjusted mortality rate due to gastric cancer was reported to increase with age. This study aims to investigate the results of adjuvant chemotherapy in patients aged 65 years or older comparing with younger patients and focusing on its impact on survival. Materials and Methods: A total of 406 patients with nonmetastatic gastric cancer that consisted of 283 patients younger than 65 years (range: 23–64 years) and 123 patients 65 years of age or older (range: 65–75 years) were retrospectively evaluated. Categorical and continuous variables were summarized using the descriptive statistics and compared with Chi-square and Mann–Whitney U-tests, respectively. Cancer-specific survival rates were estimated by the Kaplan–Meier method. Results: Median age at diagnosis was 58 years (range: 23–75 years). There was no significant difference in gender, tumor localization in the stomach (cardia/noncardia), tumor histology, perineural invasion, lymphovascular invasion, histopathological characteristics of the tumor, and tumor stage between groups. No significant difference was detected in survival between groups. The median survivals were 20.8 months (range: 17–24.6) in patients younger than 65 years and 19.5 months (range: 14.8–24.1) in patients 65 years of age or older (P = 0.9). Conclusions: We showed that adjuvant chemotherapy in elderly patients with gastric cancer has same effectiveness as nonelderly patients. However, further well-designated prospective studies are needed to confirm these findings.
  2,203 146 -
CORRESPONDENCE
Interdigitating dendritic cell tumor: A rare case report with review of literature
Irappa Madabhavi, Apurva Patel, Gaurang Modi, Asha Anand, Harsha Panchal, Sonia Parikh
April-June 2018, 14(3):690-693
DOI:10.4103/0973-1482.183189  PMID:29893342
Interdigitating dendritic cell tumor/sarcoma (IDCT) is a very rare and aggressive neoplasm arising from antigen-presenting cells. It usually involves lymph nodes, but extranodal sites can also be involved. Because of the rarity of the disease, consistent standard treatment guidelines have not been established till date. We report a case of a 35-year-old female who presented with right-sided neck swelling and anterior mediastinal mass. Histopathology revealed large mononucleated cells with background of mixed polymorphous inflammatory cells suspicious of Hodgkin's lymphoma. Hence, to confirm the diagnosis, immunohistochemistry was done. Immunohistochemistry revealed that the tumor was CD30 – negative, CD10 – negative, CD2 – negative, leukocyte common antigen – positive, vimentin – positive, and S-100 – positive, diagnostic of IDCT. Patient was treated with eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen chemotherapy followed by involved field radiotherapy and showed dramatic response with complete resolution of mediastinal mass.
  2,199 113 -
ORIGINAL ARTICLES
In vivo autofluorescence of oral squamous cell carcinoma correlated to cell proliferation rate
Kriti Bagri-Manjrekar, Minal Chaudhary, Gokul Sridharan, Satyajit Raje Tekade, Amol Ramchandra Gadbail, Komal Khot
April-June 2018, 14(3):553-558
DOI:10.4103/0973-1482.172710  PMID:29893315
Context: Loss of cell differentiation and increased cellular proliferative activity during malignant transformation leads to alteration of biochemical content of cells. This is reflected in the fluorescence profile of tissues. Aims: (1) To evaluate the efficacy of autofluorescence in clinical detection of oral cancer. (2) To correlate it with the rate of cell proliferation by analyzing argyrophilic nucleolar organizer regions (AgNORs). Subjects and Methods: Autofluorescence status was studied by devising a visual enhancement system using ultraviolet light, followed by an incisional biopsy. Tissue was sent for fluorescence spectroscopy and analyzed by routine histopathology and AgNORs staining. The obtained results were statistically analyzed using Chi-square test (P < 0.05) and one-way analysis of variance. Results: A statistically significant correlation was seen between autofluorescence (AF) and clinical diagnosis as well as autofluorescence and histopathological diagnosis. The importance of autofluorescence as a screening tool was further supported by a statistically significant correlation between autofluorescence status and cell proliferative rate. Conclusion: A preliminary effort was attempted at delving into this relatively unexplored arena of optical biopsy systems through this study. They can be used to monitor treatment and potential complications, surgical margins, detection of nodal metastasis, etc. They can provide a diagnosis noninvasively, in situ, and in real time.
  2,131 140 -
Breast cancer tumor type recognition using graph feature selection technique and radial basis function neural network with optimal structure
Payam Zarbakhsh, Abdoljalil Addeh
April-June 2018, 14(3):625-633
DOI:10.4103/0973-1482.183561  PMID:29893330
Context: Breast cancer is a major cause of mortality in young women in the developing countries. Early diagnosis is the key to improve survival rate in cancer patients. Aims: In this paper an intelligent system is proposed to breast cancer tumor type recognition. Settings and Design: The proposed system includes three main module: The feature selection module, the classifier module and the optimization module. Feature selection plays an important role in pattern recognition systems. The better selection of features usually results in higher accuracy rate. Methods and Material: In the proposed system we used a new graph based feature selection approach to select the best features. In the classifier module, the radial basis function neural network (RBFNN)is used as classifier. In RBF training, the number of RBFs and their respective centers and widths (Spread) have very important role in its performance. Therefore, artificial bee colony (ABC) algorithm is proposed for selecting appropriate parameters of the classifier. Statistical Analysis Used: The RBFNN with optimal structure and the selected feature classified the tumors with 99.59% accuracy. Results: The proposed system is tested on Wisconsin breast cancer database (WBCD) and the simulation results show that the recommended system exhibits a high accuracy. Conclusions: The proposed system has a high recognition accuracy and therefore we recommend the proposed system for breast cancer tumor type recognition.
  2,111 147 -
CORRESPONDENCE
Sinonasal malignant melanoma with metastasis: Immunohistochemistry meeting the diagnostic challenge
Prajwala Gupta, Minakshi Bhardwaj
April-June 2018, 14(3):709-711
DOI:10.4103/0973-1482.180612  PMID:29893348
Sinonasal malignant melanoma is one of the uncommon and highly aggressive tumors of the sinonasal cavity. Cytomorphological features in a metastatic lymph node may reveal a diagnosis of malignant melanoma. This case had nondiagnostic cytological and histopathological features, which could suggest malignant melanoma. Immunohistochemistry in such cases becomes the primary method for establishing the diagnosis of malignant melanoma at an uncommon site.
  2,148 91 -
Multiple subcutaneous metastases as the solitary presenting site of colorectal cancer
Chandran Nallathambi, Indibor Yengkhom Singh, Zuchamo Patton
April-June 2018, 14(3):716-718
DOI:10.4103/0973-1482.172586  PMID:29893350
Skin metastases, as a presenting symptom of gastrointestinal malignancies, are very rare and signify aggressive disease. They usually occur after a long period of diagnosis and along with other visceral metastases. We present the case of an 18-year-old male with diffuse subcutaneous metastases as a presenting feature and as the only site of distant metastases due to rectosigmoid adenocarcinoma. They clinically mimic benign skin lesions and the patient might not present to an oncologist. The diagnosis has to be established by skin biopsy, which will show tumor cell infiltration of the epidermis, dermis, and/or subcutaneous fat. There is no established local treatment for diffuse lesions. Systemic chemotherapy indicated for metastatic colon carcinoma was employed with not much favorable response. Irinotecan based chemotherapy also resulted in posterior reversible encephalopathy syndrome in this patient. Overall, the disease carries a poor prognosis and with no effective treatment available the survival is less than a year.
  2,033 127 -
Primary mesenchymal chondrosarcoma of the kidney: A case report and review of literature
Pedro Valente, José António Macedo-Dias, Carlos Lobato, Mário Reis, Francisco Pina
April-June 2018, 14(3):694-696
DOI:10.4103/0973-1482.172121  PMID:29893343
Primary mesenchymal chondrosarcoma of the kidney is extremely rare, with only nine cases reported in the English literature. We report a new case of this disease. A 35-year-old man, presented with flank pain, episodic gross hematuria and a painless palpable mass in left abdominal quadrant. Computed tomography scan identified a left renal tumor with 20 cm, with no evidence of regional or metastatic spread disease. The patient underwent radical nephrectomy. The immunohistopathological diagnosis was mesenchymal chondrosarcoma of the kidney. At 18 months of follow-up, there was no evidence of recurrence or distant metastasis. Primary renal chondrosarcoma is so rare that its prognosis is unknown. Disease recurrence is unpredictable and when it is detected, the prognosis is poor. The radical nephrectomy with complete resection of the tumor with wide resection free margins is recommended, and the patients need long-term and close surveillance, with particular attention to local recurrence and uncommon sites of metastization.
  2,067 91 -
ORIGINAL ARTICLES
The importance of stromal and intratumoral tumor lymphocyte infiltration for pathologic complete response in patients with locally advanced breast cancer
Melek Karakurt Eryilmaz, Hasan Mutlu, Betül Ünal, Derya Kıvrak Salim, Fatma Yalçın Musri, Hasan Şenol Coşkun
April-June 2018, 14(3):619-624
DOI:10.4103/0973-1482.174550  PMID:29893329
Objective: Increased tumor-infiltrating lymphocytes (TILs) in breast carcinoma tissues is an independent predictive factor for pathologic complete response (pCR). The increased intratumoral and stromal TILs (sTILs) in breast cancer (BC) have significant prognostic effects. In this study, we evaluated whether pCR rates to neoadjuvant chemotherapy (NACT) are higher in tumors with increased number of TILs in the pretreatment biopsy. Materials and Methods: We retrospectively evaluated the number of TILs in intratumoral TILs (iTILs) and sTILs compartments from pretreatment full-face hematoxylin and eosin-stained sections of 62 patients with locally advanced BC (LABC) who received NACT. The capacity of sTILs and iTILs in predicting pCR to NACT in LABC analyzed using receiver operating characteristic (ROC) curve analysis. Results: According to ROC curve analysis, the optimum sTILs and iTILs cut-off points (the number of positive cells per square millimeter of tissue) for patients with LABC patients with pCR (+) were 19 (area under the curve (AUC): 0.668, 95% confidence interval [CI] [0.501–0.835],P = 0.064) and 4 (AUC: 0.786, 95%CI [0.666–0.907],P = 0.002), respectively. Of the 62 patients, 26 had sTILs >19 and 25 had iTILs >4. The patients were divided into two according to percent of sTILs (sTILs >19 and sTILs ≤19 groups) and iTILs (iTILs >4 and iTILs ≤4 groups). Both sTILs >19 and iTILs >4 patients were associated with development higher pCR. While pCR was significantly higher in iTILs >4 patients (P = 0.002), it was not significantly in sTILs >19 patients (P = 0.107). Conclusions: There is significantly an association between pCR and increased number of intratumoral TILs (>4 cells/mm 2 of tissue) in BC who received NACT.
  2,017 133 -
Assessment of accuracy of out-of-field dose calculations by TiGRT treatment planning system in radiotherapy
Mohammad Taghi Bahreyni Toossi, Shokouhozaman Soleymanifard, Bagher Farhood, Shokoufeh Mohebbi, David Davenport
April-June 2018, 14(3):634-639
DOI:10.4103/0973-1482.176423  PMID:29893331
Aim: The objective was to quantify the accuracy of dose calculation for out-of-field regions by the commercially available TiGRT version 1.2 (LinaTech, Sunnyvale, CA, USA) treatment planning system (TPS) for a clinical treatment delivered on a Siemens Primus with the single energy of 6 MV. Materials and Methods: Two tangential open fields were planned by TiGRT TPS to irradiate the left breast of a RANDO phantom. Dose values to out-of-field points were calculated by TiGRT TPS. A RANDO phantom was then irradiated, and dose values at set points were measured using thermoluminescent detectors-100 (TLDs-100) which were located within the phantom. Finally, the TLD-measured dose was compared to the TPS-calculated dose and the accuracy of TPS calculations at different distances from the field edge was quantified. Results: The measurements showed that TiGRT TPS generally underestimated the dose of out-of-field points and this underestimation worsened for regions relatively close to the treatment field edge. The mean underestimation of out-of-field doses was 39%. Nevertheless, the accuracy of dose calculation by this TPS for most in-field regions was within tolerance. Conclusion: This study highlights the limitations of TiGRT TPSs in calculating of the out-of-field dose. It should be noted that out-of-field data for this TPS should only be applied with a certain understanding of the accuracy of calculated dose outside the treatment field. Therefore, using the TPS-calculated dose could lead to an underestimation of secondary cancer risk as well as a weak clinical decision for patients with implantable cardiac pacemakers or pregnant patients.
  1,982 135 -
Therapeutic effects of oleuropein on cisplatin-induced pancreas injury in rats
Murat Bakir, Fatime Geyikoglu, Kubra Koc, Salim Cerig
April-June 2018, 14(3):671-678
DOI:10.4103/jcrt.JCRT_1040_16  PMID:29893338
Aims: Cisplatin (CIS) is an influential chemotherapeutic agent in the treatment of several types of malignant solid tumors, but its clinical use is related with ototoxicity. Oleuropein (OLE) is a natural antioxidant and scavenging free radicals. Here, we first explore the efficacy of OLE in pancreas against to the toxicity of CIS and also analyses its mechanism. Materials and Methods: Fifty-six Sprague-Dawley rats were equally divided into eight groups, including, control group which received 7 mg/kg/day CIS intraperitoneally (i.p.) for 24 h, groups treated with doses of 50, 100, and 200 mg/kg OLE i.p. for 3 days, and groups which received same dose of CIS with three doses of OLE. After the treatments, animals were sacrificed. The oxidative DNA damage (8-hydroxy-2'-deoxyguanosine [8-OHdG]), total oxidative stress (TOS), total antioxidant status (TAS), and malondialdehyde (MDA) levels were evaluated in the pancreas. The histopathology of the pancreas was examined using three different staining methods: hematoxylin-eosin, periodic acid–Schiff, and alcian blue. Serum was provided to assess pancreatic function the lipase and amylase values. Results: The results showed that CIS significantly increased the level of TOS, MDA, and 8-OHdG in tissue as compared to the control group. Moreover, severe tissue damages were detected in the pancreas. Whereas, OLE at high dose significantly decreased the formations of 8-OHdG, the level of MDA, and increased levels of TAS in tissue samples. In the CIS group, the levels of amylase and lipase increased compared with the control group. However, there were statistically significant differences among the CIS group and the CIS + OLE groups in the values of both amylase and lipase. In addition, histopathological findings observed in CIS group in the pancreatic tissue alleviated in CIS + OLE groups. Conclusion: We hope that the results of this study will provide an impetus for future investigations of novel treatment strategies for OLE in pancreas due to CIS.
  1,956 151 -
Role of human Cytomegalovirus in the etiology of nasopharyngeal carcinoma
Hussain Gadelkarim Ahmed, Rania Saad A Suliman, Ibraheem M Ashankyty, Zaid Ali Albieh, Aymen A Warille
April-June 2018, 14(3):583-586
DOI:10.4103/0973-1482.176175  PMID:29893322
Objective: The purpose of this study was to identify human Cytomegalovirus (HCMV) in tissue blocks obtained from patients with nasopharyngeal carcinoma (NPC). Materials and Methods: Formalin-fixed paraffin wax processed NPC tissue were obtained from 150 tissue blocks and retrospectively investigated for the presence of HCMV using polymerase chain reaction. Results: Of the 150 NPC tissue specimens, HCMV was identified in 53/150 (35.3%) of the samples. Out of the 53 samples infected with HCMV, 33/97 (34%) were among males and 20/53 (37.7%) were among females. Of the 53 positive samples, 36/53 (68%) were found to harbor Epstein–Barr virus (EBV). Conclusion: The present study has shown a relatively considerable association between HCMV and NPC. The great majority of samples sheltering HCMV were also found to hide EBV, which proposes the potentiality of EBV over HCMV.
  1,940 139 -
CORRESPONDENCE
Intermediate dose cytarabine in treatment myeloid sarcoma of the bilateral breast after allogeneic stem cell transplantation: A case report and literature review
Mozaffar Aznab, Mansour Khazaie
April-June 2018, 14(3):703-705
DOI:10.4103/0973-1482.174174  PMID:29893346
Myeloid sarcoma can be occurred bofore acute myeloid leukemia, concomitantly, at relapse or after allogenic stem cell transplantation, rarely. In this investigation, we reported a 38-year-old woman with a history of AML relapsed 9 months after allo-SCT as an MS in the bilateral breast. She underwent bilateral mastectomy. The patient was a candidate for systemic chemotherapy. An intermediate dose of cytarabine with mitoxantrone was considered for the patient, and it was repeated at the specified intervals. Currently, the patient is still being followed up, and there is no sign of local or systemic recurrence.
  1,929 121 -
Intraosseous neurofibroma in a 13-year-old male patient: A case report with review of literature
Asif Iqbal, Sandhya Tamgadge, Avinash Tamgadge, Mayura Chande
April-June 2018, 14(3):712-715
DOI:10.4103/0973-1482.176173  PMID:29893349
Neurofibroma is a benign tumor of nerve tissue origin, derived from the cells that constitute the nerve sheath. It is commonly found in soft tissues, but the intraosseous occurrence of solitary neurofibroma in the head and neck is comparatively rare, with the most common site being mandible. This article presents a case report of neurofibroma on the posterior right side of the mandible of a 13-year-old boy who is the youngest patient in the series along with a review of literature.
  1,914 136 -
ORIGINAL ARTICLES
Evaluating the expression of cyclooxygenase-2 enzyme by immunohistochemistry in normal and tumoral tissue before and after neoadjuvant chemoradiotherapy in patients with esophageal cancer in Khorasan Province
Yousef Jalalabadi, Alireza Shirazi, Mohammad-Reza Ghavam-Nasiri, Seyed Amir Aledavood, Dariush Sardari, Bahram Memar, Soodabeh Shahidsales, Fatemeh VarshoeeTabrizi, Parvane Dehghan, Hassan Vosughiniya
April-June 2018, 14(3):509-515
DOI:10.4103/0973-1482.199428  PMID:29893307
Background: Esophageal cancer is the third most common cancer in Iran. Neoadjuvant chemoradiotherapy (NCRT) is the appropriate treatment for esophageal cancer. Aim: This study investigated the expression of cyclooxygenase (COX)-2 enzyme in normal and tumoral tissues before any treatment in patients with esophageal cancer, this study also assessed the effect of NCRT on the expression of COX-2 enzyme in normal and tumoral tissue in samples derived by surgery furthermore, and this study investigated the relationship between expression of COX-2 enzyme and the pathologic tumor regression grade (PTRG) patients. Materials and Methods: In this study, a total of 120 patients admitted to Omid Hospital, Imam Reza Hospitals, and Reza-Mashhad Medical Center, who were treated with NCRT, were recruited and the expression of the COX-2 enzyme in normal and tumoral tissues was assessed by immunohistochemistry before and after treatment by an expert pathologist between zero and 300. PTRG was determined by a pathologist after treatment. Results: The mean levels of COX-2 expression, obtained from tumoral and normal tissue baseline biopsy in patients, were 177.69 and 64.29, respectively, while in surgical specimen were 177.25 and 49.84, respectively. A significant association was found between PTRG of surgical specimen and COX-2 expression in normal tissue (baseline biopsy) at diagnosis (P = 0.034). Conclusions: The results indicated that expression of COX-2 in tumoral tissues exceeds the expression of COX-2 in normal tissue of the baseline biopsy. Patients with a high expression of COX-2 in baseline tumor biopsies had less response to treatment of pathology compared to patients with lower expression of COX-2 in baseline tumor biopsies.
  1,894 137 -
The diagnostic accuracy of colonoscopic brush cytology in diagnosis of colorectal malignancies: A study of 49 patients
Simorjot Kaur, Reetika Sharma, Vijay Kaushal, Anchana Gulati, Brij Sharma
April-June 2018, 14(3):574-577
DOI:10.4103/0973-1482.176416  PMID:29893320
Aims: To find the spectrum and frequency of lower gastrointestinal malignancies and diagnostic accuracy of colonoscopic brush cytology in their diagnosis. Materials and Methods: This was a prospective study carried out on 49 patients in the Department of Pathology over 1 year. Brushing material was smeared directly onto at least two clean glass slides. The air dried smears were stained with May Grunwald Giemsa stain. The endoscopic biopsies were examined grossly and were fixed in 10% formalin, processed and stained with Hematoxylin and Eosin stain, respectively. Special stains were used wherever required. Observation and Results: The study was done on 49 patients presented with colorectal and anal lesions. Age of the patients ranged from 17 to 72 years with male to female ratio being 1.57:1. On statistical analysis, the sensitivity of colonoscopic brush cytology was found to be 85.71% and specificity 61.53%. The accuracy came out to be 79.16%. Conclusion: Brush cytology is a reliable, safe, inexpensive, and rapid method of diagnosing gastrointestinal lesions. Since brushing is a relatively noninvasive procedure, routine use of brushings of colonoscopically visible lesions should be done, in addition, to biopsy to increase the diagnostic yield.
  1,904 100 -
Application of bi-nanoparticle on dose enhancement effect in two different polymer gel dosimeter using spectrophotometer
P Sathiyaraj, E James Jebaseelan Samuel
April-June 2018, 14(3):662-665
DOI:10.4103/0973-1482.187295  PMID:29893336
Purpose: This study aimed at proving the ability of bismuth-nanoparticle (Bi-np) in dose enhancement effect (DEE) using the polymer gel dosimeter. Two different polymer gels, namely poly acrylamide gelatin tetrakis hydroxymethyl phosphonium chloride (PAGAT) and N-isopropylacrylamide (NIPAM) gels were chosen for this study. Materials and Methods: The gels were doped with Bi-np particle with various concentrations of 0.5 mM, 1 mM, and 2.5 mM and were then irradiated with a CO-60 gamma radiation source of energy 1.25 MeV. Gel samples were analyzed by spectrophotometer. The dose enhancement factor (DEF) was calculated for both gels for all concentrations of Bi-np particle. Results: The higher DEF for PAGAT and NIPAM was calculated as 1.3415 and 1.1823, respectively, for 0.5 mM concentration of Bi-np. Conclusion: From our results, we infer that 0.5 mM is the optimal concentration in polymer gel to obtain good DEEs in the energy range of 1.25 MeV.
  1,874 111 -
RAD51 135G>C polymorphism and risk of sporadic colorectal cancer in Iranian population
Nasrin Yazdanpanahi, Rasoul Salehi, Sara Kamali
April-June 2018, 14(3):614-618
DOI:10.4103/0973-1482.183558  PMID:29893328
Background and Aim of Study: Colorectal cancer (CRC) is among the most common cancers and accounts as the second leading cause of death from cancers in the world. RAD51 plays a crucial role in double-strand breaks repair of DNA. Single nucleotide polymorphisms within this gene could influence on the potential of DNA repair and in consequence on the susceptibility to various tumors such as CRC. This is the first report about the role of RAD51 polymorphisms in Iranian CRC susceptibility. The study was conducted to evaluate the association of 135G>C polymorphism of RAD51 gene with sporadic CRC in a subset of Iranian population. Materials and Methods: The current case–control study was performed from 2013 to 2015. One hundred patients with sporadic CRC and one hundred controls were enrolled from two referral centers in Isfahan. All samples were genotyped for the RAD51 gene using polymerase chain reaction-restriction fragment length polymorphism assay. Results: The results revealed no significant association between the RAD51 135G>C and sporadic CRC (odds ratio = 0.86, 95% confidence interval = 0.464–1.595). The frequency of genotypes and also alleles of the mentioned polymorphism were not significantly different between case and control groups (P = 0.2 and 0.4, respectively). Conclusion: The results suggest that RAD51 135G>C probably has not a crucial role in Iranian CRC risk and is not an important potential risk factor in molecular diagnostics of mentioned disease among Iranian population.
  1,791 126 -
Up-regulated expression of miR-155 in human colonic cancer
Hongliang Cao, Shaojun Huang, Aihua Liu, Zhidan Chen
April-June 2018, 14(3):604-607
DOI:10.4103/0973-1482.175432  PMID:29893326
Objective: The aim of this study is to investigate the expression of miR-155 in colonic cancer tissue and to assess the potential predictive value of miR-155 in colonic cancer patients. Materials and Methods: From March to September of 2011, we included 57 patients with primary colonic cancer who underwent curative surgical resection. Total RNAs were extracted from colonic cancer tissues and adjacent normal tissues. Then the expression of miR-155 in colonic cancer and paracancerous tissues was investigated using real time quantitative reverse transcription-polymerase chain reaction. And the relationship between miR-155 expression level and the clinical, pathological parameters of colonic cancer was analyzed. Results: The relative expression level of miR-155 in colonic cancer tissues was significantly higher than that in paracancerous tissues and related to tumor-node-metastasis staging, tumor invasion, metastasis, and differentiation. Conclusion: The expression of miR-155 is up-regulated in colonic cancer tissues. MiR-155 may acts as proto-oncogenes involved in carcinogenesis, development, and invasion of colon cancer making it a potential target for gene therapy of colon cancer.
  1,770 111 -
The clinical importance of serum urokinase plasminogen activator receptor and carbonic anhydrase IX levels and the effect of anthracycline-based adjuvant chemotherapy on these biomarkers in breast cancer
Turkan Ozturk Topcu, Feyyaz Ozdemir, Halil Kavgaci, Meral Gunaldi, Hakan Kocoglu, Goksen Inanc Imamoglu, Ahmet Mentese, Serap Ozer Yaman, Asim Orem, Fazil Aydin
April-June 2018, 14(3):608-613
DOI:10.4103/0973-1482.174547  PMID:29893327
Introduction: Breast cancer mortality rates after metastasis is high. Urokinase plasminogen activator receptor (uPAR) and carbonic anhydrase IX (CAIX) play very important roles during tumor cell invasion and metastasis. The purpose of this study was to evaluate plasma levels of uPAR and CAIX and the effect of anthracycline-based chemotherapy on these biomarkers in patients with operable breast cancer. Materials and Methods: Sixty-five patients and 25 age-matched healthy controls were enrolled. Levels of uPAR and CAIX were investigated before and after adjuvant chemotherapy. Basal (prechemotherapy) uPAR and CAIX levels in patients were compared with those in healthy controls and in patients after 3 cycles of chemotherapy. Levels of uPAR and CAIX were determined using the ELISA method. Results: uPAR and CAIX levels were significantly higher in patients (P: 0.02 and P: 0.03, respectively). Postchemotherapy uPAR and CAIX levels were higher than basal levels (P: 0.645 and P < 0.001, respectively). A cut-off value of 27.99 pg/mL for uPAR was associated with 45.31% sensitivity and 84.62% specificity, and with a positive predictive value (PPV) of 87.9% and a negative predictive value (NPV) of 38.6%. A cut-off value of 777.84 pg/mL for CAIX was associated with 90.62% sensitivity and 30.77% specificity, and with a PPV of 76.3% and an NPV of 57.1%. Conclusion: We determined that uPAR and CAIX levels were higher in the fluorouracil, epirubicin, and cyclophosphamide (FEC) chemotherapy group than in the control group, but there was no difference between the FEC and epirubicin/adriamycin chemotherapy groups in terms of basal and postchemotherapy uPAR, CAIX levels. Furthermore, uPAR is more specific, and CAIX is more sensitive in the diagnosis of breast cancer.
  1,723 108 -
Percutaneous nephrostomy via the central venous catheter in combination with selective ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment
Dapang Rao, Haifeng Yu, Haibo Zhu, Kaiyuan Yu, Youhua He, Ping Duan
April-June 2018, 14(3):567-569
DOI:10.4103/0973-1482.174183  PMID:29893318
Objective: To explore the therapeutic outcome and significance of preoperative percutaneous nephrolithotomy (PCNL) via the central venous catheter in combination with two-step hard ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment. Methods: The success rate and the occurrence of severe infection and perirenal hematoma were analyzed retrospectively in 37 patients who received preoperative PCNL via the central venous catheter in combination with two-step hard ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment in our hospital between July 2012 and November 2014. Results: The operation duration was 12–38 min with a mean of 18.5 min. The procedure was performed successfully in all patients without the postoperative occurrence of perirenal hematoma in any patient. No severe infection occurred in any patient according to the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis (2012). Conclusion: Preoperative PCNL via the central venous catheter can significantly improve the success rate of ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment, and reduce postoperative occurrences of severe infection and perirenal hematoma.
  1,678 86 -
CORRESPONDENCE
Benign mesenchymoma of bone: A rare case report
Shirish Nandedkar, Kamal Malukani, Aparna Khandelwal, Ashish Jain
April-June 2018, 14(3):701-702
DOI:10.4103/0973-1482.172578  PMID:29893345
Benign mesenchymomas, exceptionally rare tumors, composed of two or more nonepithelial mesenchymal elements are not usually found together in a tumor. We report herein a rare case of benign mesenchymoma in the lower end of tibia in a 36-year-old female showing fibrous, fatty, and osseous elements.
  1,625 136 -
ORIGINAL ARTICLES
The effect of gel homogeneity on dose response in a low-density polymer gel dosimeter for radiation therapy
Mehrdad Gholami, Daryoush Shahbazi-Gahrouei
April-June 2018, 14(3):563-566
DOI:10.4103/0973-1482.183204  PMID:29893317
Background: The human body consists of a variety of tissues and cavities with different physical and radiological properties. The most important among these are tissues and cavities including lungs, oral cavities, teeth, nasal passages, sinuses, and bones. Thus, the dose distribution in these tissues cannot be verified with soft tissue equivalent polymer gel dosimeters. This study is conducted to evaluate the effect of homogeneity on dose response of an anoxic low-density polymer gel dosimeter for radiation therapy. Materials and Methods: The low-density polymer gel dosimeter is composed of 12% gelatin, 5% methacrylic acid, 0.15% sodium dodecyl sulfate, 10 mm tetrakis (hydroxymethyl) phosphonium chloride, and 83% ultrapure deionized water. The time between irradiation and scanning for all gels experiments was 18 h. The gel dosimeters were imaged using a 1.5 T clinical magnetic resonance imaging scanner in a transmitter/receiver head coil. Results: The low-density gels had a mass density between 0.35 g/cm 3 and 0.45 g/cm 3 and the computed tomography (CT) values varied from approximately −650 to −750 Hounsfield units. It is clear that the CT numbers of the fabricated gel are close to those of the normal human lung tissue, which ranges from −770 to −875 Hounsfield units. Conclusion: Findings of the present study showed that if the density and homogeneity of the low-density polymer gel dosimeters are equal to those of the normal lung tissue, it may be used to measure the three dimensional dose distributions in lung tissue during radiation therapy.
  1,621 109 -
Modulation of risk of squamous cell carcinoma head and neck in North Indian population with polymorphisms in xeroderma pigmentosum complementation Group C gene
Suresh Kumar Yadav, Sudhir Singh, Shalini Gupta, Madan Lal Brahma Bhatt, Durga P Mishra, D Roy, Somali Sanyal
April-June 2018, 14(3):651-657
DOI:10.4103/jcrt.JCRT_358_17  PMID:29893334
Background: Genetic variations in nucleotide excision repair genes can alter the risk of squamous cell carcinoma of head and neck (SCCHN). Materials and Methods: The present study has genotyped 334 subjects from North Indian population for xeroderma pigmentosum complementation Group C (XPC) rs2228001A>C, XPC rs77907221 polyadenylate (PAT) deletion/insertion (D/I), xeroderma pigmentosum complementation Group D - rs13181A>C, and xeroderma pigmentosum complementation Type G rs17655 G>C polymorphisms with polymerase chain reaction (PCR)-restriction-fragment length polymorphism or allele-specific PCR methods. Results: Compared to D allele, I allele for XPC PAT D/I polymorphism was associated with significantly decreased the risk of SCCHN (odds ratios = 0.67, 95% confidence interval [CI] =0.48–0.94, P = 0.03). Haplotype CI constituted from XPC polymorphisms was also associated with decreased risk of SCCHN (P = 0.004). In contrast, haplotype Crohn's disease significantly increased the risk for SCCHN (P < 0.00). A significant early onset of SCCHN was observed in individuals with CC genotype for XPC A>C polymorphism (P = 0.004). Conclusion: Our results suggest a possible risk modulation for SCCHN with XPC polymorphisms in North Indian population.
  1,576 89 -
Validation of GATE for bone and bone marrow with calculation specific absorbed fraction for photons
Seydeh Zahra Ghaseminezhad, Alireza Sadremomtaz, Hossein Rajabi
April-June 2018, 14(3):647-650
DOI:10.4103/0973-1482.183191  PMID:29893333
Purpose: GATE/GEANT is a Monte Carlo code dedicated to nuclear medicine that allows calculation of the dose to organs (bone and bone marrow) of voxel phantoms. On the other hand, Medical Internal Radiation Dose (MIRD) is a well-developed system for estimation of the dose to human organs. In this study, results obtained from GATE/GEANT using leg of Snyder phantom is compared to published MIRD data. Materials and Methods: For this, the mathematical leg of Snyder phantom was discretized and converted to a digital phantom of 100 × 100 × 200 voxels. The activity was considered uniformly distributed within bone and bone marrow. The GATE/GEANT Monte Carlo code was used to calculate the dose to the bone and bone marrow of the leg phantom from mono-energetic photons of 10, 15, 20, 30, 50, 100, 200, 500, and 1000 keV. The dose was converted into a specific absorbed fraction (SAF) and the results were compared to the corresponding published MIRD data. Results: On average, there was a good correlation between the two series of data for self-absorption (r 2 = 0.99) and for cross-irradiation (r 2 = 0.99). However, the GATE/GEANT data were on average 1.01 ± 0.79% higher than the corresponding MIRD data for self-absorption. As for cross-irradiation, the GATE/GEANT data were on average 8.11 ± 7.95% higher than the MIRD data. Conclusion: In this study, the SAF values derived from GATE/GEANT and the corresponding MIRD published data were compared. On average, the SAF values derived with GATE/GEANT showed an acceptable correlation and agreement with the MIRD data for the photon energies of 50–1000 keV. For photons of 10–30 keV, there was an only poor agreement between the GATE/GEANT results and MIRD data.
  1,520 122 -
CORRESPONDENCE
Surgical resection of solitary distant metastasis from locoregionally controlled advanced hypopharyngeal malignancy: A ray of hope
Chelakkot G Prameela, Rahul Ravind, K Sruthi, Haridas M Nair, M Dinesh
April-June 2018, 14(3):697-700
DOI:10.4103/0973-1482.172124  PMID:29893344
Head and neck malignancies have always been challenging for the clinician, both with regards to locoregional control and distant metastasis. Aggressive approaches translate to an acceptable locoregional control, but distant failures pose a dilemma. Newer, sophisticated, imaging modalities have helped in early diagnosis of solitary metastasis, and in turn have opened up an array of interventional procedures, which to some extent improve the disease-free survival and quality of life, as was seen in the present case of locoregionally controlled advanced hypopharyngeal malignancy who presented with solitary distant metastasis. Still, diligent care needs to be taken not to aggravate the scenario with these interventions.
  1,546 89 -
Glottic neurogenic tumor: A highly uncommon site for schwannomas
Shuchita Singh, Rakesh Kumar, Maitrayee Roy, Asit Ranjan Mridha
April-June 2018, 14(3):687-689
DOI:10.4103/jcrt.JCRT_878_14  PMID:29893341
Schwannomas are benign encapsulated neurogenic tumors, arising from Schwann cells embedded in neurilemal sheath as multinucleated syncytial network. Head and neck schwannomas account for 25%–45% of all schwannomas, majority developing in parapharyngeal space. Laryngeal schwannoma in itself is a rarity, and a glottic origin further complicates its diagnosis. To the best of our knowledge, this is the second case of glottic schwannoma being reported in medical literature. Symptomatology is attributable to mass effect of a slow-growing laryngeal tumor, ranging from sore throat to stridor. The gold standard method for their excision is still debatable. For small tumors, endoscopic or direct laryngoscopic approach is preferred, but for large glottic tumors, external approach is advocated for better exposure and facilitating mucosal grafting. Index case is being presented not only for its rare site of origin, but also to stress on the importance of meticulous histopathological examination to advocate appropriate treatment.
  1,342 71 -
NOTICE OF RETRACTION
Retraction: Predictive value of excision repair cross-complementation group 1 protein in locoregionally advanced nasopharyngeal carcinomas receiving cisplatin-based concurrent chemoradiotherapy

April-June 2018, 14(3):724-724
DOI:10.4103/0973-1482.234267  PMID:29893353
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