Sacrococcygeal neoplastic lesions are very rare entities and therefore, a diagnostic and therapeutic challenge. They include developmental cysts, inflammatory, neurogenic, osseous and miscellaneous lesions. In this review, we discuss the incidence, symptoms, characteristics, diagnostic methods and treatment strategies of these enigmatic lesions. We have to highlight the high index of suspicion that is necessary when dealing with chronic sacrococcygeal pain or multiple perianal abscesses or persistent perianal drainage, because any misinterpretation may result in unfavorable outcomes.

Fractionated beam radiotherapy, in other terms, external beam radiotherapy (EBRT) and continuous beam radiotherapy or Brachytherapy are two modes of radiotherapy techniques. Although in many ways, they appear to be different, radiobiologically, with the help of mathematics, it can be proved that the biological effective dose (BED) of EBRT is similar to BED of Brachytherapy, when irradiation time is small. Here an attempt is made to correlate these two predominant modes of radiotherapy techniques.

Conventional tissue fixation and processing is as old as 100 years and still remains the gold standard against which all new technologies and methods need to be assessed. Tissue processing is one of the important steps for obtaining good thin sections without artifacts. Though conventional tissue-processing methods are most commonly followed, they are well-known as very laborious and tedious procedures. Microwaves a form of electromagnetic wave-induced heat, when applied in histotechnology, reproducibly yields histolologic material of similar or superior quality to that provided by conventional processing methods, making it more popular in the recent years. A laboratory microwave offers features like maximum output of 2000-3000 watts, an in-built source of adjustable temperature probe, facility for ventilation of hazardous fumes, but is expensive. Considering the usefulness of microwave in histotechnology, i.e., reducing the time required for the diagnosis, replacing the conventional equipments of laboratories by microwave-guided ones is a remarkable and an acceptable change.

Gastric cancer is a complex disease that involves a range of biological individuals and tumors with histopathological features. The pathogenesis of this disease is multi-factorial and includes the interaction of genetic predisposition with environmental factors. Gastric cancer is normally diagnosed in advanced stages where there are few alternatives to offer and the prognosis is difficult to establish. Metastasis is the leading cause of cancer deaths. Identification of key genes and signaling pathways involved in metastasis and recurrence could predict these events and thereby identify therapeutic targets. In this context, the extracellular matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) represent a potential prognostic tool, because both genetic families regulate growth, angiogenesis, invasion, immune response, epithelial mesenchymal transition and cellular survival. Proteolytic parameters based on MMP/TIMP expression could be useful in the identification of patients with a high probability of developing distant metastases or peritoneal dissemination for each degree of histological malignancy. It is also probable that these parameters can allow improvement in the extent of surgery and dictate the most suitable therapy. We reviewed papers focused on human gastric epithelial cancer as a model and focus on the potential use of MMPs and TIMPs as molecular markers; also we include literature regarding gastric cancer risk factors, classification systems and MMP/TIMP regulation.

Aim: To investigate the potential of the anti-oxidant ascorbic acid glucoside (AA-2G) to modulate neurotoxicity induced by high doses of nitrotriazole radiosensitizer. Materials and Methods: Male and female C56Bl/6xCBA hybrid mice aged 8-14 weeks (weight 18-24 g) were used. Nitrotriazole drug radiosensitizer sanazole at a high dose of 2, 1 g/kg was per os administered to induce neurotoxicity at mice. Ascorbic acid glucoside was given 30 min before the sanazole administration. Serum ascorbic acid, brain glutathione level, as well as behavioral performance using open field apparatus were measured. Results: Administration of high (non-therapeutic) doses of the nitrotriazole drug sanazole results in neurotoxicity in mice as evidenced from behavioral performance, emotional activity and depletion of the cellular antioxidant, glutathione, in the brain. The serum levels of ascorbic acid was also found reduced in high dose sanazole treated animals. Per os administration of ascorbic acid glucoside significantly reduced the neurotoxicity. This effect was associated with the prevention of glutathione depletion in mouse brain and restoring the ascorbic acid level in serum. Conclusion: Administration of ascorbic acid glucoside, but not ascorbic acid, before sanazole administration protected from sanazole-induced neurotoxicity by preventing the decrease in the brain reduced glutathione level and providing high level of ascorbic acid in plasma.

Introduction: Polymorphisms in FGFR2 are important markers for breast cancer susceptibility in the general population. CHEK2 and FGFR2 polymorphisms with known susceptibility alleles of BRCA1, BRCA2, PTEN, and TP53, can be investigated as potential modifiers of high penetrant risk alleles. Although the B7-H4 gene is highly expressed in many different tumors, there is one published study showing the association of polymorphisms with breast cancer. We aimed to investigate FGFR2 and B7-H4 polymorphisms in breast cancer in the Turkish community. Materials and Methods: In a group of 31 cases diagnosed with breast cancer and 30 healthy women with matched ages, the single-nucleotide polymorphisms (SNPs) rs1219648, rs2981582 in FGFR2 gene were identified by sequence analysis and the SNPs rs10754339, rs10801935, and rs3738414 in the B7-H4 gene were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Statistical analysis was performed using SPSS. Results: Although statistically not significant, the frequency of FGFR2 heterozygous polymorphisms in the group with breast cancer was detected to be higher. In the B7-H4 SNP rs10801935, polymorphic AA, and AG genotype distributions were found in higher frequencies in the breast cancer patients. In contrast to the results of a published study, the present study shows that B7-H4 rs3738414 polymorphism GG genotype was found in higher frequency in the control group than the breast cancer group and the result was statistically significant (P=0.018). Conclusion: Larger scale studies are necessary to determine the prevalence of these polymorphisms and association with breast cancer in Turkish community, as this study is the first study performed.

Background: Recent evidence has indicated that the trefoil factor family possesses pivotal roles in the progression of human cancer. Aberrant expression of trefoil factor 3 (TFF3) has been reported to correlate with an aggressive tumor phenotype. However, the clinical importance of TFF3 expression in colorectal carcinomas (CRCs) has rarely been addressed. Purpose: To investigate the putative role of TFF3 in colorectal carcinogenesis and progress, and to clarify whether TFF3 could be a serum marker for CRCs. Materials and Methods: Fifty-six CRCs were sequenced for TFF3 mutations; subsets of the primary tumors were subjected to real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry analyses and serum TFF3 was detected by enzyme-linked immunosorbent assay (ELISA) for patients with CRCs. Results: No variants were detected in the code area of TFF3; TFF3 mRNA is increased in CRCs but not up to statistic significance when compared with paired normal colonic mucosa; TFF3 staining by immunohistochemistry in primary CRCs showed that increased expression of TFF3 is associated with lymph node metastases(LNM), and no significant differences were found with respect to patient's sex, cancer cell differentiation and stage. Serum TFF3 is significantly elevated in patients with CRCs, especially CRCs with LNM. Conclusion: The results indicate that TFF3 point mutations seem to be a rare event in colorectal carcinogenesis; TFF3 expression may play a role in promoting lymph node metastases of CRCs and serum TFF3 may be a potential useful marker for patients with CRCs and their metastases.

Objective: To study the clinical results and prognostic factors of patients with glioblastoma multiforme (GBM) treated by postoperative radiation therapy (PORT) and concomitant temozolomide followed by adjuvant temozolomide. Methods: From 2005 to 2008, 215 patients (median age 48 years) with GBM were treated with PORT plus temozolomide chemotherapy. Radiation therapy (RT) was employed with a dose of 60 Gy in 30 fractions over 6 weeks by conventional fractionation with concomitant temozolomide (75 mg/m ² /day). Adjuvant therapy consisted of 6 cycles of temozolomide (150 mg/m ² for 5 days, 28 days cycle). The primary end point of the study was overall survival (OS), and the secondary end points were progression free survival (PFS) and toxicity. OS was determined with respect to different variables to study the prognostic significance. Results: Median follow up was 11 months (range 2-50 months). Median OS and PFS were 13 months and 11 months respectively. The 1-year and 2-year OS was 44% and 18% respectively. There was no statistical significant impact of age, sex, KP score, anatomical location and extent of surgery. Presentation without seizures (on univariate analysis) and 6 cycles of adjuvant temozolomide therapy (on univariate as well as multivariate analysis) were found significant prognostic factors. Sixteen patients developed grade III-IV neutropenia/thrombocytopenia during the course of RT. Conclusion: Our results authenticate the role of concomitant and adjuvant temozolomide chemotherapy in combination with PORT for the management of GBM patients. We strongly recommend complete 6 cycle of adjuvant temozolomide since it significantly improved the survival in our study.

Objective: Neo-vascularization is vital for an expansion and metastasis of a tumor and is influenced by a number of mediators. Mast cells are believed to release many pro-angiogenic mediators that may help in tumor expansion and invasion. This study describes the role of mast cells and angiogenesis in oral squamous cell carcinoma (OSCC). Study Design: It was a prospective study in which 37 biopsies of well-differentiated OSCC were obtained. Micro-vessels were stained with cluster of differentiation (CD)-34 and mast cells were counted using the Toluidine blue stain. Results: When compared to normal oral mucosal tissue, it was seen that micro-vessel density and mast cell density indeed increases significantly in squamous cell carcinoma; however, they are not correlated to each other. Conclusion: This study reports that angiogenesis does increase in OSCC and mast cells also invade the peri-tumor tissue, but they are not directly correlated.

Objectives: Addition of docetaxel in the treatment regimen has shown improvement in survival of head and neck squamous cell carcinoma (HNSCC) patients. This study was conducted to evaluate the maximum tolerated dose of weekly docetaxel when combined with concurrent administration of weekly cisplatin, daily gefitinib, and radiation therapy. Materials and Methods: 21 patients with newly diagnosed HNSCC were included. Radiation therapy was planned to a dose of 66 Gy/33 fractions. Doses of cisplatin and gefitinib were kept constant at 30 mg/m ² and 250 mg respectively. Dose of weekly docetaxel started with 5 mg/m ² and escalated 5 mg/m ² up to a maximum of 20 mg/m ² . Serious adverse event was defined as grade 3/4 hematological and non-hematological toxicities. Results: All patients (three in dose level 1 [5 mg/m ² ], level 2 [10 mg/m ² ] and level 3 [15 mg/m ² ]) did not experience any hematological serious adverse events. Weekly docetaxel of 20 mg/m ² could not be tolerated with the combination, and we encountered two hematological (neutropenia) serious grade 4 adverse event and one grade 3 mucositis at level 4. Six patients were treated by omitting week 3 chemotherapy reducing the number of weekly cycles to a minimum of four. Gefitinib was continued throughout the treatment period. All patients tolerated the treatment well although with grade 2 hematological/non hematological toxicities. Conclusion: The maximal tolerated dose of weekly docetaxel added to weekly cisplatin and daily gefitinib during concurrent chemoradiation is 15 mg/m ² . Toxicity profile is tolerable with a break in the chemotherapy regimen during radiation therapy. Aggressive nutritional support is essential prior to this regimen.

Aim: Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. Design and Setting: The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. Materials and Methods: After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. Results: The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). Conclusion: The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

Purpose: For the treatment of nasopharnx carcinoma (NPC) using brachytherapy methods and high-energy photon sources are common techniques. In the common three dimensional (3D) treatments planning, all of the computed tomography images are assumed homogeneous. This study presents the results of Monte Carlo calculations for non-homogeneous nasopharynx phantom, MAGICA normoxic gel dosimetry and 3D treatment planning system (TPS). Materials and Methods: The head phantom was designed with Plexiglas cylinder, head bone, and nasopharynx brachytherapy silicon applicator. For the simulations, version 5 of the Monte Carlo N-particle transport code (MCNP5) was used. 3D treatment planning was performed in Flexiplan software. A normoxic radiosensitive polymer gel was fabricated under normal atmospheric conditions and poured into test tubes (for calibration curve) and the head phantom. In addition, the head phantom was irradiated with Flexitron afterloader brachytherapy machine with ¹⁹² Ir source. To obtain calibration curves, 11 dosimeters were irradiated with dose range of 0-2000 cGy. Evaluations of dosimeters were performed on 1.5T scanner. Results: Two-dimensional iso-dose in coronal plan at distances of z = +0.3, –0.3 cm was calculated. There was a good accordance between 3D TPS and MCNP5 simulation and differences in various distances were between 2.4% and 6.1%. There was a predictable accordance between MAGICA gel dosimetry and MCNP5 simulation and differences in various distances were between 5.7% and 7.4%. Moreover, there was an acceptable accordance between MAGICA gel dosimetry and MCNP5 data and differences in various distances were between 5.2% and 9.4%. Conclusion: The sources of differences in this comparison are divided to calculations variation and practical errors that was added in experimental dosimetry. The result of quality assurance of nasopharynx high dose rate brachytherapy is consistent with international standards.

Context: The excision repair cross-complementation group 1 (ERCC1) codon 118 C/T polymorphism has been associated with clinical outcome in cancer patients treated with platinum chemotherapy. Ethnic differences in the frequency of this polymorphism have been observed in Caucasian and African populations. Aim: The aim of this study was to evaluate the frequency and survival benefit of the ERCC1 codon 118 C/T polymorphism in a high-altitude population with advanced gastric cancer. Materials and Methods: Polymerase chain reaction-restriction fragment length polymorphism was used to determine the frequency of ERCC1 118 codon C/T polymorphism in 206 advanced gastric cancer patients residing in the high-altitude Qinghai-Tibetan plateau. The influence of the ERCC1 codon 118 C/T polymorphism on its micro ribonucleic acid (mRNA) and protein expression, clinicopathological features; response to the platinum-based combination chemotherapy, and the outcome was evaluated. Statistical Analysis: The Kaplan-Meier method was used for survival analysis. The correlation of ERCC1 codon 118 polymorphism with ERCC1 mRNA and protein expression, clinicopathological characteristics, and first-line oxaliplatin, 5-fluorouracil, and leucovorin (FOLFOX-4) response was determined by χ² -test. Results and Conclusions: ERCC1 codon 118 C/T polymorphism was not associated with ERCC1 mRNA and protein expression, FOLFOX-4 response, and progression-free survival (PFS) or overall survival (OS). High ERCC1 mRNA and protein expression levels were associated with significantly lower FOLFOX-4 responses, PFS, and OS. ERCC1 codon 118 C/T polymorphism is not an important prognostic marker for advanced gastric cancer. Determination of ERCC1 mRNA and protein levels may be beneficial in predicting the response and outcome of FOLFOX-4 therapy in gastric cancer.

Background: Mediastinal lymphadenopathy in patients with malignancy is a common clinical problem in tuberculosis-endemic countries. The recently developed endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure enables direct and real-time aspiration of mediastinal and hilar lymph nodes. The aim of the study was to determine the efficacy of EBUS-TBNA results in the evaluation of mediastinal lymph nodes in patients with extrathoracic malignancy. Materials and Methods: Retrospective analysis was performed in 40 patients with proven (n = 38) or suspected metastasis of unknown origin (n = 2) who underwent EBUS-TBNA between July 2007 and August 2011. Results: All 40 patients successfully underwent EBUS-TBNA and no complications were observed. EBUS-TBNA diagnosed metastasis from extrathoracic malignancy in 16 (40%) patients, new lung cancer in 2 (5%), reactive lymph node in 9 (22.5%), sarcoidosis in 5 (12.5%), anthracosis in 5 (12.5%) and tuberculosis in 3 (7.5%). The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of EBUS-TBNA based on the number of patients were 90.0%, 100%, 100%, 90.9% and 95.0%, respectively. In 33 patients with available data of fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) scans, the diagnostic sensitivity, specificity, PPV, NPV and accuracy of PET/CT scan based on the number of patients were 94.7%, 35.7%, 66.6%, 83.3%, and 69.6%, respectively. The association between larger lymph node size on EBUS and malignancy of lymph node sample on pathological examination was statistically significant (P = 0.018). Conclusions: EBUS-TBNA is a sensitive, specific, minimally invasive and a safe procedure for the diagnosis of mediastinal and hilar metastasis from extrapulmonary malignancy in a tuberculosis-endemic country.

Context: Possible benefits of inverse planning. Aims: To analyze possible benefits of inverse planning intensity modulated radiation therapy (IMRT) over field-in-field 3D conformal radiation therapy (FIF-3DCRT) and to evaluate the differences if any, between low (6 Million Volts) and high energy (15 Million Volts) IMRT plans. Materials and Methods: Ten patients with squamous cell carcinoma of oropharynx, previously treated with 6 MV step and shoot IMRT were studied. V ₁₀₀ , V ₃₃ , V ₆₆ , mean dose and normal tissue complication probabilities (NTCP) were evaluated for parotid glands. Maximum dose and NTCP were the parameters for spinal cord. Statistical Analysis Used: A two-tailed t-test was applied to analyze statistical significance between the different techniques. Results: For combined parotid gland, a reduction of 4.374 Gy, 9.343 Gy and 7.883 Gy were achieved for D ₁₀₀ , D ₆₆ and D ₃₃ , respectively in 6 MV-IMRT when compared with FIF-3DCRT. Spinal cord sparing was better in 6 MV-IMRT (40.963 ± 2.650), with an average reduction of maximum spinal cord dose by 7.355 Gy from that using the FIF-3DCRT technique. The uncomplicated tumor control probabilities values were higher in IMRT plans thus leading to a possibility of dose escalation. Conclusions: Though low-energy IMRT is the preferred choice for treatment of oropharyngeal cancers, FIF-3DCRT must be given due consideration as a second choice for its well established advantages over traditional conventioan technique.

Purpose: The purpose of this study is to assess the dosimetric impact of Acuros XB dose calculation algorithm (AXB), in comparisons with Anisotropic Analytical Algorithm (AAA) calculations in prostate cancer treatment using RapidArc. Materials and Methods: A computed tomography (CT) dataset of low-risk prostate cancer patients treated at Arizona Center for Cancer Care was selected and contoured for prostate, seminal vesicles, and organs at risk (OARs)(rectum, bladder, and femur heads). Plans were created for 6 MV photon beam using RapidArc technique in Eclipse treatment planning system. Dose calculations were performed with AAA and AXB for same number of monitor units and identical beam setup. Mean and maximum doses to planning target volume (PTV) and OARs were analyzed. Additionally, minimum dose to PTV and V100 was analyzed. Finally, point-dose difference between planar dose distributions of AAA and AXB plans was investigated. Results: The highest dose difference was up to 0.43% (range: 0.05−0.43%, P> 0.05) for PTV and 1.98% (range: 0.22−1.98%, P> 0.05) for OARs with AAA predicting higher dose than AXB. The V100 values of AAA plans (95 %) and AXB plans (range: 93.1−97.9 %) had an average difference of 0.89±1.47% with no statistical significance (P = 0.25411). The point-dose difference analysis showed that AAA predicted higher dose than AXB at significantly higher percentage (in average 94.15) of total evaluated points. Conclusion: The dosimetric results of this study suggest that the AXB can perform the dose computation comparable to AAA in RapidArc prostate cancer treatment plans that are generated by a partial single-arc technique.

Background: Adrenocortical carcinomas (ACC) are rare tumors with an incidence of 1-2/million/year. They account for 0.05-0.2% of all malignancies. Aims and Objectives: This study was aimed to evaluate the Weiss system to diagnose ACCs and to compare it with TNM staging. The role of immunohistochemistry (IHC) was also evaluated to differentiate ACC from other differential diagnoses especially, renal cell carcinoma (RCC). Materials and Methods: A total of 10 ACCs were included from April, 2000 to March, 2012. All the relevant information like weight, tumor size, gross features was recorded. Multiple sections were taken for histologic examination. Immunomarkers like vimentin, synaptophysin, Melan-A, calretinin, inhibin, EMA, cytokeratin, and Ki-67 were used. Results: Out of 10 cases of ACCs (diagnosed by the Weiss system), the tumors were in TNM stage I (1 case), stage II (2 cases), stage III (5 cases), and stage IV (2 cases). The Weiss score in stages I-IV was 4; 5-7; 6-8; and 5-9 respectively. ACCs were positive for vimentin, inhibin, Melan-A, calretinin and negative for EMA and cytokeratin. Proliferative index (Ki-67/MIB-1) was ≥ 20 % (20-65%). Conclusion: Both the Weiss system and TNM staging are useful in predicting the malignant behavior and prognosis of ACC. Weight and tumor size, though originally not included in the Weiss system, are also important parameters. In lower stages (stages I and II), the Weiss score is low (4-7) while the score is high (6-9) when the tumor is in higher stages (stages III and IV). IHC plays a vital role to confirm the diagnosis and to exclude the possibility of RCC.

Aim: This study was aimed to assess the in vivo anti-tumoral potency of the novel 6-nitro-2-(3-chloropropyl)-1H-benz[de]isoquinoline-1,3-dione [Compound 1] that has earlier demonstrated excellent cytotoxicity in 15 out of 17 human tumor cell lines tested. Materials and Methods: Two murine tumors namely Sarcoma-180 (S-180) and Ehrlich ascites carcinoma (EAC) were used to measure its in vivo anti-tumor activity through the increase in median survival times (MST) of drug treated (T) over untreated control (C) mice. Drug-induced toxicity in respect of hematological parameters, femoral bone marrow and splenic cellularity as well as biochemical parameters and histopathology of liver and kidney were assessed in vivo in normal and S-180 bearing mice sequentially on days 9, 14 and 19 following drug treatment at the optimum dose of 60 mg/kg administered from day 1 to 7. Results: Results revealed significant tumor regression effects in S-180 and EAC as T/C _max values of 138 and 189 were obtained at its optimum dose of 60 mg/kg for QD _1-7 . Toxicity assay indicated no significant cardiotoxicity, hepatotoxicity or nephrotoxicity of the compound in normal and S-180 bearing mice. An initial hyposplenic cellularity and the femoral bone marrow suppression effect observed on day 9 reached normalcy by day 19. HPLC analysis revealed that it has appreciable stability (half-life ~ 3 h) in murine blood plasma in vitro. Conclusion: Above results justify potential candidature of the compound for further drug development.

Background: Conformational thoracic radiotherapy (CTR) is a key-treatment in locally advanced nonsmall cell lung cancer (LA-NSCLC). Acute radiation pneumonitis (ARP) is one of the major complications. Aims: To evaluate the predictors of ARP after CTR in the treatment of LA-NSCLC. Materials and methods: A total of 47 consecutive patients (pts) were treated with CTR for LA-NSCLC and retrospectively analyzed. The mean total dose of radiation therapy (RT) was 65 Gy, with respiratory gating (RG) in 19 cases. Induction and concomitant chemotherapy was performed in 33 pts (70%) and 41 pts (87%), respectively. Results: Eleven pts (23%) had an ARP resulting in death for one pt. In univariate analysis, age, sex, pretherapeutic value of forced expiratory volume (FEV), not-gated radiotherapy and type of concomitant chemotherapy did not appear as contributing factors in contrast to the administration of induction gemcitabine ( p = 0.03). The occurrence of ARP was significantly associated with nontumor lung volumes irradiated to 13 Gy (V13, p = 0.04), 20 Gy (V20, p = 0.02), and 25 Gy (V25, p = 0.006), the mean lung dose ( p = 0.008) and lung normal tissue complication probability (NTCP) ( p = 0.004). In multivariate logistic regression analysis, the occurrence of ARP was significantly associated with age >75 years (odds ratio (OR) = 16.72, confidence interval (CI) 95% 1.77-157.87) and administration of induction gemcitabine (OR = 18.08, CI 95% 1.09-300.08). Conclusion: ARP is a common acute complication, requiring close posttreatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of CTR must be carefully analyzed, according to the dosimetric parameters.

Objective: Carotid artery damage has been reported secondary to radiotherapy. We report the feasibility of implementing hypofractionated laryngeal irradiation using carotid sparing tomotherapy (HT) and analyze the image guidance (IG) policy. Materials and Methods: Five patients with early glottic cancer (EGC) had radiotherapy using 3D conformal technique (conf) while repeat treatment plans were produced with helical tomotherapy using carotid sparing techniques (cstomo). Inverse and forward planned dose volume histograms were analyzed. Three hundred and sixty four daily images of 14 patients having daily Megavoltage head and neck CT imaging prior to irradiation were analyzed to assess errors. Results: There was no significant difference in the maximum and mean dose to the PTV (P = 0.058, 0.66). The left / right carotid median doses were significantly less in the cstomo plans as compared to conf plans (P = 0.0001/ 0.026). Cstomo plans had significantly better PTV Conformity Index (CI) (P = 0.0006) with comparable Homogeneity Index. A CTV-PTV margin of 5.3, 4, 5.3 cm in the 3 axes were calculated using Van Herks formula. After average shifts from imaging for first 5 fractions (AS5) were applied to remaining fractions, the residual shifts in the calculated CTV-PTV margins reduced to 2.9, and 2.1 in the X, Y axes respectively allowing further adaptation of PTV margin from fraction 6. Conclusions: Carotid sparing was possible using cstomo plans with significantly better conformity. Applying AS5 could enable us to reduce the PTV (3 mm) margin in X, Y axes for the remaining 15 fractions.

Breast cancer is the second leading cause of death for women all over the world. The correct diagnosis of breast cancer is one of the major problems in the medical field. From the literature it has been found that different pattern recognition techniques can help them to improve in this domain. This paper presents a novel hybrid intelligent method for detection of breast cancer. The proposed method includes two main modules: Clustering module and the classifier module. In the clustering module, first the input data will be clustered by a new technique. This technique is a suitable combination of the modified imperialist competitive algorithm (MICA) and K-means algorithm. Then the Euclidean distance of each pattern is computed from the determined clusters. The classifier module determines the membership of the patterns using the computed distance. In this module, several neural networks, such as the multilayer perceptron, probabilistic neural networks and the radial basis function neural networks are investigated. Using the experimental study, we choose the best classifier in order to recognize the breast cancer. The proposed system is tested on Wisconsin Breast Cancer (WBC) database and the simulation results show that the recommended system has high accuracy.

Context: Colorectal cancer is the second leading cause of cancer deaths worldwide. DNA microarray-based technologies allow simultaneous analysis of expression of thousands of genes. Aim: To search for important molecular markers and pathways that hold great promise for further treatment of patients with colorectal cancer. Materials and Methods: Here, we performed a comprehensive gene-level assessment of colorectal cancer using 35 colorectal cancer and 24 normal samples. Results: It was shown that AURKA, MT1G, and AKAP12 had a high degree of response in colorectal cancer. Besides, we further explored the underlying molecular mechanism within these different genes. Conclusions: The results indicated calcium signaling pathway and vascular smooth muscle contraction pathway were the two significant pathways, giving hope to provide insights into the development of novel therapeutic targets and pathways.

Aims and objectives: To evaluate the effect of frequency, duration and type of areca nut products on the incidence and severity of oral submucous fibrosis (OSMF). Materials and methods: Patients with the limited mouth opening and associated blanched oral mucosa with palpable fibrous bands were included in this study. Biopsies were done and the informed consent was taken from each patient included in this study. The tissues were taken from the affected areas and then studied histopathologically. The data was analysed statistically using X ² -test. Results: In this present prospective study done in 197 subjects (189 males and 8 females) who were screened and diagnosed clinically having OSMF with age ranging from 22 to 61 years with mean 38.8 years. Gutkha-chewing habit alone was identified in 58 subjects and those associated with gutkha and tobacco were 33 with mean age of 28.2 years and 32.3 years, respectively. The number of people getting affected with OSMF is more associated with gutkha and areca nut with the P-value of the analysis ranging from 0.05 to 0.01. Conclusion: The occurrence of OSMF is related to areca nut and its products. The duration and frequency of its use and type of areca nut product has effect on the incidence and severity of OSMF. Gutkha and pan masala have more deleterious and faster effects on oral mucosa. The gutkha-chewing habit along with the other habits does not have any significant effect on the rate of occurrence and incidence and severity of the OSMF.

Purpose: To estimate specific organ and effective doses to patients resulting from the ¹⁸ F-FDG ( ¹⁸ F-2-deoxy-D-glucose) and ¹⁸ F-FDOPA (6-fluoro-( ¹⁸ F)-L-3, 4-dihydroxyphenylalanine) PET/CT examinations for whole body and brain. Materials and Methods: Three protocols for whole body and three for brain PET/CT were used. The CTDI values were measured using standard head and body CT phantoms and also computed using a software CT-Expo for dose evaluation from the CT component. OLINDA software based on MIRD method was used for estimating doses from the PET component of the PET/CT examination. Results: The organ doses from ¹⁸ F-FDG and ¹⁸ F-FDOPA whole body and brain PET/CT studies were estimated. The total effective dose from a typical protocol of whole body PET/CT examination was 14.4 mSv for females and 11.8 mSv for male patients from ¹⁸ F-FDG, whereas it was 11 mSv for female and 9.1 mSv for male patients from ¹⁸ F-FDOPA. The total effective doses from a typical protocol for PET/CT studies of brain was 6.5 mSv for females and 5.1 mSv for males from ¹⁸ F-FDG whereas it was 3.7 mSv for females and 2.8 mSv for males from ¹⁸ F-FDOPA. Conclusions: The effective radiation doses from whole body PET/CT examination was approximately 4-8 times higher than the background radiation dose from both ¹⁸ F-FDG and ¹⁸ F-FDOPA scans, while it was 1-3 times the background radiation dose from PET/CT scans of brain.

The concomitant occurrence of pregnancy and chronic myeloid leukemia is uncommon. We describe the successful management of a 30-year-old G3 P0, A2 woman who was diagnosed to have chronic myelogenous leukemia (CML) in the third trimester of her pregnancy with intra-uterine growth retardation and oligohydroamnios. She was started on hydroxyurea and imatinib, and was continued till delivery and beyond. The use of imatinib did not have any adverse effects on the fetus, except for low birth weight and low APGAR at birth, but the later progress of the child was normal. We conclude that imatinib and hydroxyurea can be continued even at the third trimester in a pregnant lady with CML, if necessary.

A 20-year-old student presented with 2 months history of fever and night sweats, 15 days history of low backache, progressive weakness of both limbs of 7 days duration, and urinary retention for last 24 h. Examination revealed a sensory level at D 10 dermatome and grade two power in both the lower limbs with absent reflexes. Examination of spine revealed a knuckle at T8 level, which was tender on palpation. MRI spine showed erosion of D11-12 and L1 in vertebral bodies with destruction of left pedicles, transverse processes and lamina, and a prominent psoas abscess. Post gadolinium study revealed ring-enhancing lesions in the D11-12 and L1 vertebrae as well as the dural sac. Fine needle aspiration cytology (FNAC) and bone biopsy demonstrated a non-Hodgkin's lymphoma (NHL, large cell high-grade) of the spine (primary), which as per age is the youngest case of NHL ever reported in literature with multiple vertebral involvement.

Cardiac metastasis in thyroid cancer is extremely rare. Iodine-131-d whole-body scan has been used widely to detect thyroid metastasis. However, in dedifferentiated cases, iodine scan has low diagnostic value particularly for diagnosing cardiac metastasis. In the absence of ¹³¹ I uptake, ¹⁸ F-fluoro-2-deoxyglucose positron emission tomography ( ¹⁸ F-FDG PET) can be used as an alternative and has a high sensitivity for thyroid metastasis, but still low sensitivity for cardiac metastasis. Therefore, meticulous attention to the pattern of uptake and comparison with patients' previous studies is critical. Additionally, cardiac magnetic resonance imaging (MRI) can provide additional and critical information.

The mixed lineage leukemia (MLL) gene at chromosome band 11q23 is commonly involved in reciprocal translocations that is detected in acute leukemia. The MLL gene, coomonly known as mixed lineage leukemia or myeloid lymphoid leukemia, has been independently identified and cloned from the 11q23 breakpoint of acute leukemia. We describe a patient with acute lymphoblastic leukemia whose cells had shown reciprocal translocation between short arm (p21) of chromosome 2 and long arm (q23) of chromosome number 11 [t(2;11) (p21;q23)] by cytogenetic analysis. Fluorescence in situ hybridization analysis (FISH) was also performed for reconfirmation with a probe for MLL which showed split signals, hybridizing to both the derivative 2 and 11 chromosomes. Our study confirmed FISH as the most suitable assay for detecting MLL rearrangements because of its sensitivity and speed. It recommended that FISH should be used as complementary to conventional cytogenetic analysis. In conclusion, evaluation of the t(2;11)(p21;q23) was done by molecular clarification and flow cytometry.

Chordoma of thoracic vertebras is a very rare locally invasive neoplasm with low grade malignancy arising from embryonic notochordal remnants. Radical surgery remains the cornerstone of the treatment. We describe a case of multifocal T1-T2 chordoma, without bone and disc involvement, incidentally misdiagnosed as a paraganglioma, occurring in a 47-year-old male asymptomatic patient. Neoplasm was radically removed by an endocrine surgeon through a right extended cervicotomy. A preoperative reliable diagnosis of chordoma, as in the reported case, is often difficult. Radical surgery can provide a favorable outcome but, given the high rates of local recurrence of this neoplasm, a strict and careful follow-up is recommended. Although very rare, chordoma should be suggested in the differential diagnosis of the paravertebral cervical masses of unknown origin. Spine surgeon consultation and a FNB should be routinely included in the multidisciplinary preoperative work-up of these neoplasms.

Bleomycin induced flagellate dermatitis is a rare and unique adverse effect. With the declining use of bleomycin, this complication is becoming increasingly infrequent in common clinical practice. We herein describe a case of a 22-year-old Indian male with Hodgkin's lymphoma, Ann Arbor stage IIBEX developing flagellate dermatitis following 1 ^st cycle of chemotherapy with ABVD regimen. The diagnostic dilemma in the illustrative case underscores the importance of awareness and prompt identification and treatment of this dermatological toxicity in limiting morbidity in patients undergoing bleomycin based combination chemotherapy. In patients having severe rash, bleomycin should be expeditiously discontinued. Omission of bleomycin does not compromise the treatment outcome in the majority of patients with Hodgkin's lymphoma.

Diminished vision due to choroidal metastasis as the primary symptom of lung cancer is very uncommon. Here, we report such a presentation in a 54-year-old male patient of small cell lung cancer. The outcome is usually dismal with this kind of presentation. The patient received systemic chemotherapy as well as intravitreal bevacizumab but with no improvement in vision. The patient had been given external beam radiotherapy and showed subjective improvement in his ocular symptoms.

Solid pseudo-papillary tumor (SPT) of the pancreas is a rare pancreatic tumor, well known for its predilection for young women. As the tumor has favorable prognosis, differentiating it from other pancreatic tumors with aggressive behavior is necessary. We present a rare case of SPT and review the literature about SPT cases published from India.

Progressive painless enlargement of peripheral lymph nodes is the most common presentation of Hodgkin's lymphoma. The bone involvement is seen particularly in the later stages, but very rarely in early stages of the disease. Primary osseous Hodgkin lymphoma is exceedingly rare. Here, we report a case of Primary osseous Hodgkin lymphoma in a 35-year-old male presenting with osteolytic lesions of iliac and sacral bone without other symptoms. Histopathology examination revealed Hodgkin's disease. All other investigations (including computed tomography of the chest, abdomen and pelvis, bone marrow aspiration) were negative for occult disease. Polychemotherapy was started and the symptoms resolved. The case report highlights the importance of clinical suspicion of primary Hodgkin lymphoma of the bone, especially those involving the pelvis bones.

Here we present a rare case of primary mucinous adenocarcinoma of vagina treated successfully with wide local excision and post-operative radiotherapy. There was no recurrence even after four years.

This is a case report of a young adult presenting with hemorrhagic pleural effusion. Chest CT scan showed loculated pleural effusion with pleural nodule. Whole body PET scan showed thickening of pleura with multiple enhancing pleural nodules with different metabolic activity. Pleural nodule was biopsied which on histopathology showed pleural synovial sarcoma.

At present, the available clinical practice guidelines for the management of patients with germ cell tumor (GCT) assign to Positron Emission Tomography (PET) scan a role in the evaluation of the residual mass at the end of the treatment of advanced seminoma, while a possible role of this tool in the strategy of follow-up has not been defined yet. We are presenting a case of a patient treated for a GCT with an increase of the marker levels during the follow-up where a PET/CT with 18F-FDG was the only noninvasive examination able to correctly identify the site of disease recurrence. This case shows how this tool could have a role, in addition to morphological examinations, in the management of patients with GCT during the follow-up.

Adenomyoepithelioma is a rare tumor characterized by proliferation of two different cell populations. These tumors have a variable biological behavior. Majority of them are benign but have a tendency to recur locally. Malignant transformation is rare in this disease and distant metastasis is rarer still. We report here an unusual case of bilateral adenomyoepithelioma at an unusual age and showing a remarkable response to an unconventional drug, tyrosine kinase inhibitor "imatinib".

Hodgkin's lymphoma of the breast is very rare. We report a case of Hodgkin's lymphoma of the breast in a 61 year old post-menopausal female who presented with a 3 month history of left breast painless lump. Excision biopsy was done and histology showed nodular sclerotic Hodgkin's lymphoma confirmed by immunohistochemical staining.

A 55-year-old female presented with abdominal pain and 10 cm mass per abdominal examination. Computerized tomography scan of abdomen and pelvis revealed a heterogeneously enhancing solid cystic mass right ovarian mass and mild ascites. Surgery was performed. Specimens were sent for examination. Microscopic examination revealed an admixture of benign but occasionally atypical appearing mullerian type glands with sarcomatous stroma. Solid area showed undifferentiated tumour cells. Atypical mitoses and necrosis were also seen. Areas with extensive benign osteoid surrounded by fibroblastic stroma were also present. Glandular component showed positivity for CK-7, AE-1 and EMA while sarcomatous areas showed positivity for vimentin only. Mullerian adenosarcoma of ovary with sarcomatous overgrowth (SO) having heterologous component was confirmed. Postoperative 3 cycles of chemotherapy was given and the patient was well till date (three months after surgery).

For the first time in Algeria, we report on the presentation, diagnosis and management of two cases of diffuse large B cell NHL with chronic HCV infection. Both Algerian patients came for medical consult without HCV-related symptoms. Systematic serological tests to identify HIV and hepatitis B and C infections which performed on all patients led to HCV diagnosis. Chemotherapy was given to both patients without exacerbation of the HCV infection. These observed cases shed new light on the possible pathogenesis of NHL in Algerian population. Indeed, in Algeria, HCV may partly been responsible of the unexplained increase of NHL incidence in Eastern region of Algeria especially among those who are frequently exposed to HCV risk factors (haemodialysis and dental care). Furthermore, our observations underscore the importance of prevention programmes including screening to control HCV in Algeria.

Post-transplant lymphoproliferative disorder (PTLD) can occur after solid organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT). The majority of PTLDs are related to the reactivation of Epstein-Barr virus (EBV) in the lymphoid organs. PLTDs in HSCT recipients tend to present with systemic involvement, and isolated PTLD in these patients is rare. Only 14 isolated cerebral PTLDs have been reported in HSCT recipients, and none have been reported in lymphoma patients. When diagnosing PTLD in a lymphoma patient, it is challenging to discriminate between a PTLD that originated from previous disease and a newly developed clone and to distinguish between donor and recipient origin. In this report, we present the first case of a B-cell lymphoma patient who developed isolated PTLD in the CNS, and we confirmed that the PTLD originated in a distinct clone and from a different origin. Furthermore, the role of EBV-DNA monitoring in such patients is discussed.

Solid pseudopapillary tumor of pancreas is a rare pancreatic neoplasm affecting young women, has low malignant potential and amenable for surgical excision with good long-term survival. Sickle cell trait is benign condition, which involves one normal beta-globin chain and one HbS chain. Although it is a benign condition, individuals are prone to have rare complications that may predispose to death under certain circumstances. We report a rare coexistence of solid pseudopapillary tumor of pancreas with sickle cell trait in an 18-year-old female who underwent distal pancreatectomy with splenectomy. Histopathological examination and haemoglobin electrophoresis confirmed the diagnosis.

Plethora of pathologic conditions may affect the normal morphologic characteristics and intactness of the oral mucosa, presenting as surface alterations.The prevalence of the different types of HPV worldwide has implications for the effectiveness of HPV vaccinations against HPV-induced carcinogenesis. This article discusses HPV related lesions with emphasis on verrucopapillary lesions.

The odontogenic keratocysts (OKC) usually represent a particular entity that has been of interest primarily due to biological aggressiveness and to its frequent recurrence. Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome is a hereditary condition characterized by a wide-range of developmental abnormalities and a predisposition to neoplasms. There are several possible reasons why OKC recur so frequently and require meticulous surgical planning and execution. This article has attempted to show that there is a lack of published evidence regarding the cause of frequent recurrent of OKC that presented in NBCCS. However, the findings of the study revealed differences in opinion regarding the treatment modalities, which necessitates further long term clinical studies that could precisely document certain reliable guidelines in this point of view.