Background: Peripherally inserted central venous catheters (PICCs) have been increasingly utilized in treating patients in intensive care. The purpose of this study is to analyze the related complications and to evaluate effect of a comprehensive intervention on long-term PICCs. Materials and Methods: We selected 217 and 243 cases before and after comprehensive intervention respectively from the department of radiotherapy in our hospital. Various possible factors affecting PICCs insertions and maintenance were analyzed. A quality control circle was formed for nursing care. The comprehensive intervention was performed both on catheter insertion and post-PICCs care. Complication rates were compared before and after the intervention. Results: The duration for PICCs was 90 days. In the control group (before intervention), the complications were as follows: Tube feeding difficulties (23.5%), catheter dislodgment (23.5%), infection (17.6%), catheter obstruction (17.6%), puncture failure (5.9%), allergy (5.9%), and pain (5.9%). The incidence of unplanned extubations was 7.8%. The incidence of complications was significantly decreased in the test group (after intervention). Moreover, one episode of catheter obstruction (5.9%) and one episode of allergy (5.9%) were found (P < 0.01) in this study. Conclusion: Comprehensive intervention programs effectively reduce the incidence of complications in long-term PICCs lines.

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Fallopian tubes are one of the uncommon sites for neoplastic lesions in the female genital tract. Haemangiomas of the fallopian tubes are rare benign neoplasms that are documented as isolated case reports only. We present a rare case of incidentally detected cavernous haemangioma of the fallopian tube in a post menopausal female who underwent hysterectomy and bilateral salphingoopherectomy for dysfunctional uterine bleeding.

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Vitiligo is a common depigmentation disorder of skin, etiology of which is poorly understood. It has been rarely reported as a consequence of radiation at the site of irradiation, more so in patients with prior history of vitiligo. We report a rare clinical vignette that documents radiation-induced skin depigmentation, which started at the irradiated site and later manifested as generalized vitiligo, in a breast cancer patient with no family history of vitiligo. Studies describing the relationship between skin depigmentation and radiotherapeutic dose are scanty. The possible etiopathological mechanisms of vitiligo and radiation as a potential triggering factor for its development, which has been described in the literature, have been highlighted in this article.

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Ancient Schwannomas are rare variants of tumors which arise from the peri-neural Schwann cells. These tumors are termed "ancient" because of the degenerative features acquired with increasing age in these tumors. They are benign, slow growing and usually detected only incidentally or due to local symptoms. Some tumors may demonstrate nuclear atypia, and may be mistakenly termed malignant. Malignant change is usually associated with von Recklinghausen's syndrome in 5% to 18% of cases. Retroperitoneal schwannomas account for only 0.5% to 5% of all cases and are extremely uncommon. They are well encapsulated and recurrences following complete surgical excision are uncommon.

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Aggressive angiomyxoma is a rare, locally aggressive, myxoid mesenchymal neoplasm, preferentially arising in the pelvic and perineal regions of young adult females. It may also occur in males, in the inguinoscrotal area. Here we report a case of a young male, who presented with a firm, diffuse, nontender swelling in the abdomen and right-sided pleural effusion. Contrast-enhanced computed tomography (CT) of the abdomen showed the presence of a large, cystic mass, almost filling the entire abdominal cavity. On laparotomy, a huge mass, approximately 25 cm × 20 cm × 4 cm in size, arising from the greater omentum, with increased vascularity, and occupying the entire abdomen, was excised. Histopathological examination along with immunohistochemistry established the diagnosis of an aggressive angiomyxoma. Here, we report the case of an aggressive angiomyxoma, originating from the greater omentum, in a young male, associated with right-sided pleural effusion.

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Acantholytic variant of penile squamous cell carcinoma (SCC) is an exceedingly rare and associated with bad prognosis. Histologically it mimics angiosarcoma due to pseudovascular spaces. Vimentin immunopositivity in such cases represent epithelial to mesenchymal transition manifested by cellular discohesion. We describe a case of vimentin positive acantholytic penile SCC in a 55-year-old patient.

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Primary Ewing's sarcoma (EWS) of the cranium is extremely rare. It accounts for <1% of cases. We retrospectively analyzed our EWS cases to determine those which had a primary cranial involvement. Out of a total of 332 cases of EWS registered between the years 2000 and 2011, 7 were of the primary cranial involvement. Treatment modalities included surgery, chemotherapy, and radiotherapy (RT), as indicated. The follow-up ranged from 8 months to 7.5 years. In our study, parieto-occipital region was the commonest site. Most patients presented with localized disease and swelling of the scalp. Excision followed by chemotherapy or RT appears to have good survival rates. At a median follow-up of 32.2 months, only one patient had a recurrence, and was successfully salvaged with second line chemotherapy. These cases illustrate that a multi-disciplinary approach in patients with EWS of the cranium results in a good outcome.

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Acute promyelocytic leukemia (APL) is an uncommon malignancy in the pediatric population, accounting for only 5-10% of pediatric acute myeloid leukemias, and for this disease to present with bone lesions at diagnosis is extremely unusual. We wish to convey that very rarely, in a pediatric cancer patient presenting with multiple extensive lytic bone lesions, the diagnosis can be APL. The treatment protocol and prognostic implications are vastly different. Histopathology is the gold standard in arriving at a correct diagnosis and delivering proper treatment in such cases. This patient had excellent response to chemotherapy.

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Mucoepidermoid carcinomas (MEC) are rare malignant tumors that originate in the submucosal bronchial glands, and complete resection usually correlates with favorable prognosis. A 54-year-old male patient was diagnosed with high-grade MEC in the left main bronchus via bronchoscopy. After the patient was diagnosed with metastatic lung cancer, chemotherapy was started. Two years after the diagnosis, the patient is still alive.

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A 40-year-old male presented with visuospatial processing disturbances. Family history was free. Conventional and advanced magnetic resonance imaging (MRI) studies were performed. On T2 and fluid attenuation inversion recovery images, an increased signal intensity extra-axial lesion was demonstrated. Post-contrast scans depicted homogeneous intense contrast medium enhancement. T2* star sequence was negative for hemorrhagic or calcification foci. Diffusion-weighted imaging findings were indicative of malignant behavior and magnetic resonance venography confirmed superior sagittal sinus infiltration. Increased cerebral blood volume values were observed and peri-lesional oedema on perfusion-weighted imaging was also demonstrated. The signal intensity-time curve depicted the characteristic meningioma pattern. Spectroscopy showed increased choline and alanine levels, but decreased N-acetyl-aspartate levels. Conventional MRI is adequate for typical types of meningiomas. However, the more atypical ones, in which even the histopathologic specimen may demonstrate characteristics of typical meningioma, could be easier diagnosed with advanced MRI techniques.

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Primary cutaneous sweat gland carcinoma is a rare neoplasm of malignant sweat gland lesions. It is characterized clinically with non-symptomatic, slow-growing nodules. We report the case of a patient with cutaneous sweat gland carcinoma with local recurrence and metastasis to the lung that was treated with surgical resection therapy and chemotherapy. The initial neoplasm was excised but biopsy was not performed. The tumor then recurred 7 years later, was re-excised, biopsy was performed, and diagnosed as a low-grade hidradenocarcinoma. We presented a very good result of chemotherapy in the treatment of this rare malignant disease. It demonstrates that adjunct chemotherapy is effective to control the condition of malignant sweat-gland carcinomas patient.

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Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome characterized by seizures, altered level of consciousness, visual disturbance, and hyperintense lesions on magnetic resonance imaging most commonly in the posterior regions. PRES is typically associated with a number of complex clinical conditions including: Preeclampsia/eclampsia, allogeneic bone marrow transplantation, solid organ transplantation, autoimmune diseases, and high-dose anti-neoplastic therapy. We herein describe a case of recurrent PRES in a 29-year-old lady of refractory anaplastic large-cell lymphoma who was on second-line chemotherapy with Ifosfamide-Carboplatin-etoposide regimen. We have also tried to illustrate the pathogenesis, radiological features, and management of PRES. Although reversible in most cases, PRES may be recurrent even in chemotherapy - induced cases and result in fatal outcomes despite appropriate intervention. This is the first - reported case of recurrent PRES with such a fatal outcome, as a complication of anti-neoplastic systemic therapy.

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To report the first case of rare isolated breast metastasis from carcinoma gall bladder. Single patient case report. A 35-year-old pre-menopausal female presented with 2 * 2 cm right upper outer quadrant breast lump. Post-mastectomy, histology confirmed it to be metastatic adenocarcinoma positive for both Cytokeratin (CK) 7 and CK20. Past history as told by the patient revealed that 2 years back, cholecystectomy was performed for gall stones, of which no histology reports were present; she had a port site scar recurrence which showed it to be adenocarcinoma. Adjuvant chemotherapy and radiotherapy was advised which the patient did not complete. This is probably the first case reported of isolated breast metastasis from gall bladder carcinoma, diagnosed retrospectively. It also highlights the importance of adjuvant treatment in gall bladder malignancy.

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A 33-year-old man presented with a lump at the right side of chest wall of 4 months duration which started bleeding suddenly from an ulcer at its center. Examination revealed a globular ulcerated mass 2 cm in diameter, on the anterior axillary fold, with adherent clot at its center. No regional lymphadenopathy was noted. Wide local excision with 2 cm margin was done. Biopsy report revealed malignant small round-cell tumor. Immunohistochemistry showed it to be cytokeratin-20-positive and S100-negative, suggesting the diagnosis of Merkel cell carcinoma. The patient did not receive any other adjuvant therapy. He is being followed-up for the last 4 years and has shown no features of recurrence so far.

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Hepatocellular Carcinoma (HCC) is a growing cause of mortality world over. The common risk factors include cirrhosis, viral infections, aflatoxin amongst others. Alpha Fetoprotein (AFP) levels and Ultrasonography (USG) are the preferred surveillance tools in early diagnosis of HCC. Here we present an unusual case of a young female with no known risk factors, no cirrhosis, no viral markers, and normal AFP levels who had a Acute hepatic failure eventually diagnosed as Primary Hepatocellular carcinoma.

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Malignant kidney tumors are rare neoplasms accounting for 3% of adult malignancies. Majority of these arises in the renal parenchyma and are adenocarcinomas. Malignant mesenchymal tumors of kidney are extremely rare. We report on the clinical behavior, the radiological and histopathological details of one such case of malignant mesenchymal tumor, we encountered.

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Mucosa-associated lymphoid tissue (MALT) lymphoma is frequently reported in the gastrointestinal tract (GIT), but the incidence is low in the upper aerodigestive tract. In particular, MALT lymphoma of the tongue is very rare. Only four cases have been reported in the English literature to date. We report a case of 29-year-old woman who had a past history of peripheral T cell lymphoma of the head and neck and a new mass at the right base of tongue 3 years later. An incisional biopsy of the base of tongue revealed a new pathology, one that of extranodal marginal zone B cell lymphoma (MALT lymphoma). After staging work-up, she was diagnosed to be at the Ann Arbor stage IE. She was treated with 30.6 Gy of radiation therapy alone and there was no recurrence after 3 years follow-up.

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A few cases with bilateral renal enlargement in acute lymphoblastic leukemia (ALL) are reported in literature. In this article, we report an unusual case of ALL in an adult presenting as multiple lesions in both kidneys and multiple bone lesions.

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Rectal cancers may rarely metastasize in bone and when it occurs, is usually preceded by lung and/or liver metastasis. However, whether it may ever bypasses other organs, particularly lung and liver and metastasizes directly to bone or not, is debatable. Some authors have described the presence of isolated bone metastasis from colo-rectal cancers, whereas others have questioned its' existence in the absence of lung or liver metastasis. A case of isolated bone metastasis from rectal cancer in the absence of lung or liver metastasis is reported here.

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Mucosal malignant melanoma (MMM) of the nasopharynx is extremely rare. We report a case of MMM of the nasopharynx in a 56-year-old male patient presenting with a polypoidal mass in the nasopharynx. It was increasing gradually and obstructing breathing. Computed tomography scan was suggestive of a malignant neoplasm in the nasopharynx. A biopsy of the lesion was done with a clinical suspicion of carcinoma. Microscopy revealed features suggestive of malignant melanoma with focal melanin pigmentation. Subsequently, wide local excision was done.

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We report a case of a well-differentiated fetal adenocarcinoma (WDFA) of the lung in a 50-year-old male smoker. The literature regarding this uncommon tumor is limited. This rare variant of adenocarcinoma is more common in females, in the third and fourth decades. Microscopically it is composed of neoplastic glands and tubules that resemble the fetal lung. Well-differentiated fetal adenocarcinoma is a low-grade malignancy and surgery is the preferred mode of therapy. This uncommon case of a well-differentiated fetal adenocarcinoma in an adult male patient is reported, with relevant immunohistochemical findings, along with a discussion of the current literature.

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Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma occurring in adults. This entity was first described by O'Brian and Stout in 1964. Apart from the soft-tissues, this tumor has been reported to occur in all other parts of the body including bone. It has male predilection and is usually noticed in the fifth to seventh decades of life. It commonly affects extremities and retroperitoneum, whereas involvement of the head and neck region is comparatively rare. However, when the head and neck region is affected, the most common sites are the maxillary sinus and the nasal cavity, in which case, later involvement of the maxillary alveolar bone can happen. The oral cavity is a relatively less common site for MFH. This article describes clinical, computed tomographic and microscopic features of a MFH of the maxillary alveolar ridge extending to the hard palate in a 46-year-old female patient. Histogenesis, advanced imaging features, differential diagnosis, and management of MFH are also discussed.

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Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal neoplasm of intermediate malignant potential. It may occur in various anatomic locations, but rarely in the rectum. This is a case discussion of a 36-year-old male patient with IMT of the rectum. After the patient underwent radical surgery, recurrence was seen after 18 months. Because the tumor was very close to the surrounding tissue, palliative tumor resection was performed followed by concurrent chemo-radiation and non-steroidal anti-inflammatory drugs (NSAID). After 2-year follow-up, the patient has no evidence of recurrence or metastasis. Surgical resection is very important for patient with rectal IMT, even in relapse cases. And adjuvant chemoradiotherapy and NSAID are in favor of the incompletely resected tumors as our case. But perhaps, the adjuvant treatments could be helpful after radical resection of rectal tumor.

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Renal replacement lipomatosis (RRL) is a rare condition that occurs as an end result of renal atrophy or destruction of renal parenchyma by excessive lipomatous tissue in renal sinus and perinephric space. We report a case of RRL presenting as a right renal mass clinically. Intra-venous pyelography and renal scan revealed a left non-functioning kidney. A left nephrectomy was performed. After histopathological examination and extensive literature search, a diagnosis of RRL was given. In majority of cases, it is associated with renal calculi. Idiopathic variety is not common. It is a rare entity and the diagnosis may be missed due to lack of experience. It has to be differentiated from other fat-containing tumors such as renal lipoma, xanthogranulomatous pyelonephritis, angiomyolipoma and liposarcoma.

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Differentiated thyroid cancer frequently metastasizes to regional cervical lymph nodes and in advanced cases metastases can be seen in the lungs and skeleton. Metastases to the skin or subcutaneous tissue are rare. Here we present a 49-year-old female patient with solitary scalp metastasis from follicular thyroid carcinoma FTC which was revealed with positron emission tomography (PET)/computed tomography (CT) imaging. PET showed flourodeoxiglucose avid lesion in the left vertex scalp. Scalp lesion was removed totally and histopathological examination revealed well-differentiated thyroid cancer metastasis.

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Lipoleiomyoma of uterus are a rare variant of uterine leiomyoma. Clinically the symptoms are indistinguishable from an ordinary leiomyoma. It is diagnosed pre-operatively as leiomyoma or mature ovarian teratoma. Majority of them are post operative chance finding. Solid tumors of broad ligament are also rare. Most of them are lateral extensions from the uterine tumors. Primary lipomas of broad ligament are rare. They are asymptomatic in majority of cases and are incidental post-operative finding. We report this case because of the rarity of individual lesions and rarity of the combination and also speculate their histogenesis as adipose tissue is rare absent at both locations.

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Merkel cell carcinoma (MCC) is a rare but aggressive cutaneous primary small cell carcinoma with an unfavorable prognosis. It is a disease of the sun exposed skin of the elderly commonly involving the head, neck, and extremities. Though most cases present as localized disease, treatment should be definitive with wide excision of the primary lesion (2-3 cm margin) and prophylactic lymphadenectomy followed by irradiation to the primary site. Even when locoregional control is achieved, close surveillance is required due to high rates of local and systemic relapses. Chemotherapy is preserved for systemic disease, though the success of this treatment is limited and no chemotherapy protocol has been shown to improve survival.

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Intestinal Entamoeba Histolytica infection can lead to colitis, abscess formation, colonic perforation and rarely amoeboma. We report a case of colonic amoebiasis, in which the presenting symptoms and radiological findings closely resembled an obstructing right-sided colonic carcinoma, with liver metastases.

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Both multiple endocrine neoplasia type 1 (MEN1)-related gastrinomas and gastrointestinal stromal tumors (GISTs) are rare neoplasms, and their association has been rarely reported. We describe an unusual association between a GIST and a MEN1-related gastrinoma. A 44-year-old man had undergone surgical removal of a pancreatic gastrinoma in 2004 and was then administered long-term somatostatin analogs, and diagnosed as having MEN1 syndrome. Following an uneventful follow-up, in April 2009, an upper gastrointestinal tract endoscopy showed esophageal narrowing, with evidence of a 2-cm solid mass on endoscopic ultrasonography. Histology revealed a tumor composed of elongated cells with plump cytoplasm arranged in a storiform pattern. The immunophenotype of the lesion was CD117 and Platelet Derived Growth Factor (PDGF) positive, whereas alpha-1 muscle actin and S-100 protein were negative. Due to morphological and immunohistochemical results, a final diagnosis of esophageal GIST was made. The association between GISTs and MEN1 could be casual, although a single case of the coexistence of a GIST and a MEN1-related gastrinoma has already been reported. A role of the MEN1 gene in the pathogenesis of GISTs could be hypothesized.

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Plasmacytomas can be classified as osseous (medullary) or non-osseous (extramedullary). Extramedullary plasmacytomas (EMP) are uncommon and may be primary or associated with multiple myeloma (MM). EMP arising from the mediastinum is extremely rare. We report two patients who presented with symptomatic mediastinal masses. On evaluation, these turned out to be EMP with coexisting MM.These two cases are being presented for their rarity and to highlight the unusual presentations of MM.

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Background: Oral cancer accounts for 5% of all malignant tumors and 60% of these lesions are well advanced at the time of diagnosis. The early diagnosis could prevent a large number of deaths due to this disease. Aims: This study aims to evaluate and compare the clinical usefulness of exfoliative cytology, modified brush biopsy (without computer assisted analysis), and biopsy in early detection of oral premalignant and malignant lesions. Materials and Methods: Modified oral brush biopsy (using baby toothbrush) and exfoliative cytology was performed on 225 clinically diagnosed oral precancerous lesions (suspected) selected from among 1099 lesions in 877 patients. Scalpel or punch biopsy was performed based on clinic-cytological evidence (test result and/or clinical judgment) on only 117 lesions. All the specimens were analyzed manually in a double-blinded fashion. Statistical Analysis Used: Results were analyzed using Statistical package for Social Sciences version 12 (SPSS Inc., Chicago, IL, USA) and subjected to Fischer exact test. Results: Of 117 lesions that underwent all the three tests, modified oral brush biopsy showed a reasonably higher specificity (68.42%) and sensitivity (81.69%) when compared with specificity (86.48%) and sensitivity (48.57%) of cytology. Conclusion: The results demonstrate that modified oral brush biopsy has higher efficacy than routine cytology and can be used as a potentially practical oral cancer screening tool in resource challenged settings. However, clinical judgment is of prime importance. Immediate biopsy is mandatory in highly suspicious lesions proposed under the diagnostic criteria of "clinically diagnosed carcinoma in situ".

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Background: Previous studies indicated that carcinoembryonic antigen (CEA) could predict the therapeutic objective response (OR) and overall survival (OS) of patients with cancers, including non-small cell lung cancer (NSCLC). However, the role it could play in evaluating therapeutic responses and OS in patients with NSCLC requires further elucidation. Herein, we investigated the potential role of CEA in predicting OR and OS in patients with NSCLC. Materials and Methods: For this retrospective study, the medical records of 689 patients with NSCLC who were treated at Nanjing Jinling Hospital between January 2000 and August 2011 were reviewed. Serum levels of CEA of these patients were measured before and after chemotherapy. The relatedness between CEA levels and OR, and between CEA and OS were investigated for correlations via a series of statistical analyses. Results: The baseline serum CEA level of 689 patients was 54.18 ± 143.45 ng/mL. Serum CEA significantly decreased after two cycles of chemotherapy (t = 2.196, P = 0.031). The receiver operator characteristic (ROC) curve analysis showed that a 5.28% reduction in CEA level was an appropriate cut-off value for predicting the OR to chemotherapy, with a sensitivity of 61.3% and a specificity of 62.4%. The Kaplan-Meier survival analysis indicated no significant correlation between baseline CEA and OS (P = 0.079). Conclusion: Our study shows that while the baseline level of CEA was not a prognostic factor, the post-treatment reduction of CEA can predict the OR in patients with NSCLC.

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Background: Oral cancer accounts for 6% of all cancers. The most prevalent form of oral cancer is oral squamous cell carcinoma (OSCC), which accounts for 90% of the oral cancer cases. The major risk factor for development of OSCC is the use of tobacco in various forms. NO has been studied widely over the years due to its role in various physiological and pathophysiological processes, including its complex role in carcinogenesis. Materials and Methods: A total of 20 cases of OSCC in tobacco habituers and tobacco non-habituers were retrieved respectively from the archival biopsy specimens. Immunohistochemistry was done to assess the inducible nitric oxide synthase (iNOS) protein. Results: This study was performed to assess the correlation between tobacco and nitric oxide in OSCC in order to know the association of these two in the process of carcinogenesis. The results showed the enhanced expression of iNOS in tobacco habituers in comparison with tobacco non-habituers. Though the increased expression of iNOS is found, significant difference is not obtained with scores, but significant difference was found with intensity of staining. Conclusions: The results of the present study indicate the enhanced expression in OSCC of tobacco habituers when compared to OSCC of tobacco non-habituers indicating the effect of tobacco on nitric oxide. Carcinogenic chemical compounds in Tobacco induce nitric oxide production by iNOS, by its tumor-promoting effects which may enhance the process of carcinogenesis.

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Aim: We retrospectively reviewed the treatment outcomes of docetaxel plus prednisolone chemotherapy in Korean men with metastatic castration-resistant prostate cancer (mCRPC). Patients and Methods: This Study included 106 consecutive Korean patients with mCRPC who were treated with a 3-weekly regimen of docetaxel plus prednisolone chemotherapy between 2005 and 2011. The oncologic results and treatment-related adverse events were analyzed. Results: The mean patient age was 66 years. Of the 106 patients, 70 (66.0%) received docetaxel as the first-line chemotherapy. A 50% reduction in prostate-specific antigen and objective response in measurable lesion were observed in 45 (48.9%) and 14 (17.9%) patients respectively. Fifteen (14.4%) patients experienced grade 3 or higher neutropenic fever. One patient had a treatment-related death. median follow-up time was 26.5 months. The median progression-free survival and overall survival (OS) were 6.0 and 16.0 months respectively. Of several factors examined, multivariate analysis Identified good performance status and first-line setting predict longer OS. The median OS of the patients in the first- and second-line setting was 23.0 versus 11.0 months (Hazard ratio 2.485, 95% confidence interval 1.558-3.966, P < 0.001). The survival rates in the first-line at 12 and 24 months were 73.8% and 47.2% respectively. Conclusion: Korean castration-resistant prostate cancer patients that receive docetaxel chemotherapy have a relatively longer survival outcome compared with western countries in the first-line setting. In addition, good performance status and first-line setting predicts longer survival. A prospective study including genetic background associated with the prognosis of mCRPC patients might be required.

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Objective: Cyclin-D1 has been strongly implicated in cell cycle proliferation particularly in the G1/S checkpoint in the cell cycle, and prognosis in many human malignancies. The present study evaluates its prognostic significance with chemoradiation response in patients of locally advanced oral squamous cell carcinoma (OSCC). Materials and Methods: A total of 97 OSCC patients (females = 19 and males = 78), aged 20-67 years and stage III/IV were recruited. Treatment response was assessed according to World Health Organization criteria. Cyclin-D1 expression in tumor tissue was estimated by immunohistochemical method and quantified as percentage positive nuclei. Results: The Cyclin-D1 expression showed significant (P < 0.01 or P < 0.001) association with tumor size, lymph node status, and clinical stage. After chemoradiation, there were 53.6% complete response (CR) and 34.0% partial response (PR) in primary tumor, and 49.5% CR and 39.2% PR in lymph node; giving an overall response rate of 85.6%. Further, the mean Cyclin-D1 expression showed significant (P < 0.05 or P < 0.001) and inverse association with chemoradiation responses (tumor size, lymph node status and overall treatment response). The 2-year progression-free and overall survival (OS) was 95.89% and 83.31% respectively. Multivariate Cox regression analysis found site of primary tumor, clinical stage, and Cyclin-D1 expression the significant (P < 0.05 or P < 0.01) and independent prognostic markers of OS and among these Cyclin-D1 expression showed the worst prognosis. The high Cyclin-D1 expression (>50%) also showed significantly lower survival in OSCC patients when compared with those had low (<10%) and moderate expressions (10-50%) (Logrank test: χ² = 44.42, P < 0.001). Conclusion: The high Cyclin-D1 expression may serve as a poor prognostic marker in OSCC.

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Background: A functional  single-chain fragment variable (scFv) recognizing the  MCF-7 breast cancer carcinoma cell line was constructed from the C3A8 hybridoma using phage display technology. Aim of Study: This study was conducted to evaluate the binding activity of scFv antibody recognise MCF-7 breast cancer cells carcinoma, the scfv antibody constructed and expressed in Escherichia coli periplasmic. Materials and Methods: The scFv coding sequence was cloned in frame with the pIII phage coat protein. The signal sequence included in the C terminus directed the expression of the scFv in the Escherichia coli periplasm. Following several rounds of biopanning, colonies that expressed a scFv that recognized MCF-7 cells in Western blots, ELISAs, and flow cytometry test were isolated. Results: A 750-bp scFv gene was successfully isolated. Cloning and two rounds of biopanning isolated the candidate with the highest activity (clone B7), as screened by ELISA. Following poly-acrylamide gel electrophoresis (SDS-PAGE) of the purified product, a 32-kDa band was observed. A similar-sized band was observed following Western blot analysis with an E tag-specific antibody. Binding reactivity of scFv antibody with MCF cells was determined using indirect ELISA and compared with monoclonal antibodies' reactivity. Also, flow cytometry was useful in further characterization to the binding reactivity of scFv antibody with MCF-7 cells. Conclusions: The recombinant antibody technology used in this study is a rapid and effective approach that will aid in the development of the next generation of immunodiagnostic reagents.

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Objectives: This work is aimed on the study of doxorubicin cardiotoxicity and hepatotoxicity in rats and the evaluation of protective effect of trimetazidine administrated concomitantly with doxorubicin for 3 days. Materials and Methods: Male Wistar rats used were subjected to different types of treatment (3 days); A: Control, B: Doxorubicin treatment and C: Trimetazidine and doxorubicin treatment. After sacrifice, tissular distribution of doxorubicin, cardiac scintigraphy, histological examination of the myocardium, and evaluation of liver function were assessed. Results: Obtained results show that doxorubicin has a high affinity to tissues especially the heart. It causes hepatotoxicity and cardiotoxicity marked by a significant increase of aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT) levels and drop of the left ventricular ejection fraction (EF _LV ) by scintigraphy. Histological examination showed general alteration of myocardium structure. Concomitant administration of trimetazidine attenuates significantly the cardiotoxicity and hepatotoxity induced by doxorubicin. Conclusion: We have evaluated the protective effect of trimetazidine on an animal model of doxorubicin-induced cardiotoxicity and hepatotoxicity. The evaluation of these effects were assessed by several means; tissular distribution of doxorubicin, histological examination, assessment of liver function, and EF _LV by scintigraphy that characterizes the originality of this study.

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Introduction: Nodal stage is the most important prognostic factor and one of the indicators for loco-regional radiation in patients with breast cancer. N1 (patients with 1-3 lymph node metastases in axilla) nodal stage is a controversial area as far as axillary and supraclavicular fossa (SCF) irradiation is concerned. We conducted a retrospective analysis at our institute to assess the impact of post-mastectomy radiotherapy (PMRT) beyond chest wall (CW) in N1- nodal stage breast cancer patients. Materials and Methods: Since January 2004 to December 2007, 293 post-mastectomy patients with N1 nodal stage breast cancer were analyzed for patient-related characteristics such as age, menopausal status, pathological stage/tumour size, tumour location, histology, oestrogen/progesterone receptor status, histological grade, extra capsular extension, lymph vascular invasion and treatment-related factors, PMRT and systemic therapy. Outcome studied were locoregional recurrence rate (LRR), disease free survival (DFS) and overall survival (OS). Results: At a median follow up of 55m, 260 patients received radiotherapy; 212 to CW+SCF, 48 to the CW only; and 33 patients did not receive radiotherapy. LRR was 5% in patients who received radiotherapy to CW+SCF and 8% in CW only (P = 0.34). There was no difference in the DFS between the two groups. OS at 5 year was 88% in CW+SCF group and 76% in CW only group respectively (P < 0.001). Conclusion: In N1 nodal stage patients with breast cancer LRR was not significantly different after radiation to CW+SCF or to the CW only but OS was significantly better.

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Aims/Background: Tumor necrosis is visualized on CT scan as non enhancing hypodense area. Necrotic areas contain less oxygen and results in poor response of chemo-radiotherapy. Literature review (1) has shown that for hypodense lesions in head and neck cancer the complete response rate is lower than the isodense lesions. Locally advanced head and neck cancer require the addition of surgery but after a radical dose of radiation that is, 7000 cGy, surgery become difficult but there is no tool initially that can be used for selection of patients after delivery of 4500 cGy, that is the dose after which surgery can be performed without much difficulty. The hypothesis is that, hypodense lymph nodes even when they are small will show less response to various schedules of chemoradiotherapy so hypodensity of lymph nodes can be used as a tool to select patient, who will go for surgery after initial 4500 cGy of radiotherapy. Surgery is usually performed 2 to 3 weeks after radiotherapy, so primary can be treated to full dose while the skin in region of lymph nodes radiation field will recover from acute radiation reaction. Correlation of C T density patterns of lymph nodes in head and neck cancer patients with treatment results when two different chemoradiotherapy schedules are used is studied. Materials and Methods: Eighty three patients with locally advanced head and neck cancer were treated with two schedules of concurrent chemoradiotherapy prospectively from August 2010 to July 2011. CT Scans of the entire neck region including primary were performed. An iodine based contrast material (150 ml) was injected intravenously starting with a bolus of 50ml (3ml/s), followed by a slow (1ml/s) infusion of the remaining dose. The total tumor volume of the primary and involved neck nodes was calculated as a cuboid volume using maximum dimension in each plane: Vc= (a x b x c). Nodal density was graded. Results and Conclusion: No statistically significant association between recovery and CT density was found (X ² = 0.306; P > 0.05).

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Aim: To study the clinico-radiological and clinic-pathological features of orbital alveolar soft-part sarcomas (ASPS). Materials and Methods: We retrieved 9 cases of orbital ASPS. Histopathological and immunohistochemical features and clinico-radiological findings were evaluated. Results: Age at presentation varied from 1 to 31 years. Both, children and adults were affected. Proptosis was the most common clinical presentation. PAS-positive diastase-resistant crystals and granules were found in all cases. All patients received adjuvant radiotherapy. Two cases had positive surgical margins and were treated with additional adjuvant chemotherapy. None of the patients had recurrence or metastases till the last follow up. Conclusion: Early diagnosis with a multidisciplinary, multimodal approach of treatment is quintessential in achieving a long disease-free survival in patients with ASPS.

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Aims of Study: Natural killer (NK) cells and cytolytic T lymphocytes (CTL) have been implicated as important effectors of antitumor defense. High mobility group nucleosomal-binding domain 2 (HMGN2) may be one of the effector molecules of CTL and NK cells. The antitumor effect and mechanism of HMGN2 was investigated in this study. Materials and Methods: HMGN2 was isolated and purified from the human monocyte cell line THP-1 and then characterized by Tricine-SDS-PAGE, western blot, and mass spectrum determination. Confluent T24 cells were incubated with Klebsiella pneumoniae for 2 h, after which the extracellular bacteria were killed by the addition of gentamicin. The cells then were treated with a variety of concentrations of HMGN2. The effect of HMGN2 on the proliferation of T24 cells was analyzed with MTT, Hoechst and flow cytometry assays. Results: Cell growth assay results demonstrated that HMGN2 significantly inhibited the growth of T24 bladder cancer cell lines infected by K. pneumoniae. Furthermore, results of the Hoechst and flow cytometry assays indicated that HMGN2 may promote apoptosis in this experimental model. These results suggest HMGN2 could inhibit the growth of the infected human bladder cancer cells in vitro. Conclusion: HMGN2 protein could inhibit the growth of infected T24 cells in vitro, and the anti-tumor action of HMGN2 was due to induce apoptosis.

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Introduction: Plasma imatinib levels vary widely in patients with the chronic myeloid leukemia-chronic phase, and studies have shown improved hematological, cytogenetic, and molecular responses in patients with the higher trough imatinib levels. Materials and Methods: We analyzed 50 consecutive patients with the chronic myeloid leukemia-chronic phase and performed plasma imatinib levels at 1 month and 12 months and correlated them with complete hematological response at 3 months and molecular response at 12 months, respectively. Results: Trough plasma imatinib levels at 1 month correlated well with complete hematological response at 3 months (P = 0.007) and levels at 12 months correlated with molecular response at 12 months (P = 0.04). Compliance to imatinib also significantly correlated with imatinib levels at 1 month (P = 0.0008) and imatinib levels at 12 months (P = 0.0002). Conclusion: Plasma imatinib levels may be of benefit in patients not achieving desired response at defined time intervals. The plasma level monitoring also helps in the assessment of drug compliance.

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Background: Micronuclei scoring can be used as a biomarker of genotoxic and chromosomal damage. Aims: 1. To score the spontaneously occurring micronuclei in the baseline population (fibroadenomas) and infiltrating ductal carcinoma, 2. Compare micronuclei frequency in benign tumors and various grades of infiltrating ductal carcinomas. Materials and Methods: Study was done at a tertiary hospital where 40 cases of fibroadenoma and 40 cases of infiltrating ductal carcinoma were taken up. May Grunwald Giemsa stained smears were analyzed for micronuclei scoring. Statistical Analysis: Independent sample test (Student t test) was done to look for significant difference occurring between the controls among all grades of infiltrating ductal carcinoma. Results: Mean micronuclei range in fibroadenoma was 1.8 ± 1.9. It was 12.1 ± 9.2, 27.4 ± 27.2 and 100 ± 36.5 in grade I, grade II and grade III carcinomas respectively. Conclusion: An increase in micronuclei values was seen from fibroadenoma to infiltrating ductal carcinoma. Micronuclei scoring can be used as a biomarker on fine needle aspiration cytology smears of breast carcinoma.

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Context: Functional studies of the survivin splice variants have been performed almost exclusively in various types of cancer and produced remarkable advances in our understanding of cancer biology and cancer genetics. Aim: To observation the expression of survivin 2α in thyroid nodules and estimate its potential as a new molecular marker in thyroid nodules screening and malignant thyroid, as well. Setting and Design: We detected the expression of a splice variant of survivin, survivin 2α, in thyroid nodules. Materials and Methods: Expression of survivin 2α mRNA was evaluated with specific primers by Hemi-Nested RT-PCR in 77 thyroid nodules including malignant and benign tumors, non-tumoral (goiter and thyroiditis) as well as surgical margin, non-neoplastic normal tissues adjacent to the malignant lesions. Result: Our data revealed for the first time the expression of survivin 2α in thyroid nodules. It was detected in 85.7% of non-neoplastic surgical margin tissues, 71.4% of non tumoral, 63.2% of tumoral samples. Also, the expression of survivin 2α in benign tumor samples (64.2%) is more than malignant groups (62.8%). Conclusion: Survivin 2α expression is the highest in non-neoplastic surgical margin rather than other samples and the lowest expression was that of malignancy. According to the results, it can be concluded that survivin 2α protein may be has a vital protective effect throw survivin quenching due to the high expression in normal tissue compared with lesions.

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Aim: The present study was aimed to analyze the chromosomal changes obtained by using FISH. Fluorescence in situ hybridization (FISH) is a powerful technique used in the detection of chromosomal abnormalities. Materials and Methods: During the present study, FISH technique was carried out in 26 cases of Squamous cell carcinoma of the cervix using Centromere Enumeration Probes, CEP for chromosome 3 and 17. Statistical tests including ANOVA and Chi square tests were used to analyze the numerical chromosome aberration data obtained by FISH analysis. FISH technique was also carried out in 10 healthy samples (control) by using both CEP 3 and CEP 17 probe. Results and Discussion: FISH results of CEP 3 in the present study showed the frequent gains of chromosome 3 in Squamous cell carcinoma over the chromosome 17. ANOVA results were found to be significant for both CEP 3 and CEP-17 in Squamous cell carcinoma of the cervix. Chi square test (disease v/s control) was also used to study the significant difference between the patients and the controls and it was found to be significant for both chromosomes 3 and 17.

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Background and Aims: The purpose of this study was to investigate the potential therapeutic efficiency of resveratrol in the treatment of experimental endometriosis in rats. Settings and Design: Experimental study was carried out in a University hospital. Materials and Methods: Endometriosis was surgically induced in 24 female rats. Four weeks after this procedure, the viability and dimensions of the endometriosis foci were recorded. Rats were then randomly divided into three groups: (1) Control group (n = 8); (2) low dose (10 mg/kg) resveratrol group (n = 8); (3) high dose (100 mg/kg) resveratrol group (n = 8). At the end of the 7-day treatment, blood samples were taken and laparotomy was performed. The endometrial implants were processed for biochemical, histological and immunohistochemical studies. Statistical Analysis Used: The Kruskal-Wallis H test and one-way ANOVA test were used. Results: Resveratrol-treated rats showed significantly reduced endometriotic implant volumes (P = 0.004). After treatment, a significant and dose-dependent increase in activities of superoxide dismutase and glutathione peroxidase in serum and tissue of the rats in Group 2 and Group 3 was detected. Similarly, serum and tissue malonyl dialdehyde levels and tissue catalase levels were significantly higher in Group 3 than that of control animals. Histological scores and proliferating cell nuclear antigen expression levels were also significantly reduced in Group 2 and Group 3 than that of control group. Conclusion: In a rat endometriosis model, resveratrol showed potential ameliorative effects on endometriotic implants probably due to its potent antioxidative properties.

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Background: Cervical cancer is the most common gynecological cancer in Indian women. This study was initiated to assess whether the combination of paclitaxel and cisplatin with radiation was feasible in Indian women. Aims and Objectives: The aim of this study was to assess the immediate tumor response and toxicity of weekly cisplatin and paclitaxel along with radiotherapy in the treatment of cervical cancer. Materials and Methods: Women with primary untreated squamous cell carcinoma of the cervix with FIGO stages IB2 to IIIB were treated with weekly injections of cisplatin 30 mg/m2and paclitaxel 40 mg/m2 for 4 weeks along with radiotherapy. A total of 25 patients were enrolled in this study. Disease was assessed prior to treatment by pelvic examination and contrast enhanced computed tomography scan of the abdomen and pelvis. Response was assessed 6 weeks after completion of treatment using the same parameters. Clinical and radiological response was documented. The toxicity was assessed and was graded using the common toxicity criteria Version 3.0. Intention to treat analysis was used when reporting results. Results: A total of 23 patients completed the intended treatment. There was a complete response rate of 88%, 12% were not available for response assessment. The major toxicity was Grade 3 diarrhea (48%). The mean duration of treatment was 58 days. Conclusions: Combination chemotherapy with cisplatin and paclitaxel along with radiotherapy in patients with locally advanced squamous cell carcinoma of cervix had a high incidence of acute toxicity. There was no increase in immediate tumor response and progression free survival with this treatment regimen. Hence, this regimen offers no added benefit when compared to the chemo radiation with cisplatin alone.

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Aims and Objectives: To report the results of treatment with intraluminal brachytherapy (ILRT) after concurrent chemoradiotherapy for esophageal carcinoma with respect to disease free survival (DFS), dysphagia free interval (DFI), and complications of treatment. Materials and Methods: The study retrospectively analyzed the records of 26 eligible patients with nonmetastatic carcinoma of the esophagus treated with definitive chemoradiotherapy followed by ILRT between 2008 and 2011. The DFS and DFI were estimated and factors likely to influence them were analyzed. Results: Nineteen (73%) patients were males. The mean age at presentation was 60 years (range: 47-90 years). All the patients had squamous cell carcinomas. Following treatment, the median DFS was 12.7 months (range: 0-27 months). Sixteen patients (61.5%) had local control of their disease, while one had residual disease at completion of treatment. Other than three patients who were not evaluated for recurrent dysphagia, six (23.1%) had proven local recurrence on follow-up. The estimated mean DFI was 13.8 months (range: 0-27 months). One patient died of tracheoesophageal fistula following treatment. On statistical analysis, only the location of tumor was prognostically significant, with lower third tumors performing worse. Other probable predictors of poor outcome included large volume (> 40 cc), tumor length (> 6 cm), and eccentric location. Conclusion: ILRT boost following concurrent chemoradiotherapy is well tolerated and potentially improves outcomes. It might be beneficial in selected patients with esophageal carcinoma. Further studies are required to identify its role in definitive treatment.

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Purpose: The purpose of this study was to analyze the impact of intra-cavitary brachytherapy (ICBT) as boost radiation after external beam radiotherapy (EBRT) in carcinoma of the external auditory canal and middle ear (EACMA): A retrospective analysis. Materials and Methods: A retrospective study of 18 patients with carcinoma of the EACMA who were treated with a curative intent from the year 1998 to 2010 was carried out. The age of the patients ranged from 25 years to 67 years. There were 11 male patients (61.1%) and 7 female patients (38.9%). A total of 15 (88.2%) patients were treated with curative radiation alone after a biopsy and two patients received post-operative radiation therapy. The patients were initially treated with EBRT with cobalt 60 machine up to 60-64 Gy. In our department, all the patients who were technically suitable for ICBT received an ICBT boost. Results: The overall survival (OS) in these patients ranged from 7 months to 151 months (9 out of 17 patients, no evidence of disease 53%). The OS in patients treated with a combination of EBRT with ICBT was (8 out of 11) 72.7%, P value statistically significant (P value: 0.0024). The multivariate analysis shows statistically significant difference only for patients who got an ICBT boost (P Value: 0.020). Conclusion: ICBT as a boost after EBRT has got a positive impact on the OS. In conclusion, our results demonstrate that radical radiation therapy (EBRT and ICBT) is the treatment of choice for stage T2, carcinoma of EACMA.

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Purpose: Surgery is the definitive treatment for early colon cancers. Adjuvant therapies are used with the aim of eradicating micrometastases and improving cure rates. Recent studies have proposed that adiponectin might be responsible for obesity-related malignancies. We investigated the prognostic value of this cytokine. Materials and Methods: Patients who underwent surgical removal of stage II or III (TNM staging) primary tumors and were followed for at least three years were included in the study given adequate specimen for immunohistochemical evaluation. Based on these criteria, 53 patients were included. Results: Mean age was 58.3 ± 10.1 years (35-78 years). The mean follow-up time was 41 months (10-96 months). Immunohistochemical evaluation identified 21 patients (39.6%) with cytoplasmic adiponectin present in their specimens. The rates of recurrence were 42.9% (9/21) and 34.4% (11/32) in patients with and without adiponectin expression, respectively. In cases with adiponectin expression, mean disease - free survival was 60.3 ± 9.03 months, and in cases without adiponectin expression, mean disease - free survival was 68.7 ± 6.67 months (P = 0.414). Mean overall survival of patients with adiponectin expression was 65 months compared to 67 months for patients without (P = 0.786). Conclusion: Adiponectin, which is secreted by adipose tissue, may have a role in the development and progression of cancer via its pro-apoptotic and/or anti-proliferative effects. Adiponectin expression in tumor tissues is likely to have a negative effect on disease - free survival in patients with stage II/III colon cancer; however, no statistically significant effect was demonstrated.

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Background: Malignant lymphoma (ML) is one of the most common cancers and is most prevalent in developed countries. The distribution of different subtypes of ML varies in the different geographical locations according to World Health Organization (WHO) classification. Aims and Objectives: The study was aimed to analyze different patterns of ML in Eastern India and to compare it with other geographical locations. Materials and Methods: Four hundred and fifty five patients of two large hospitals in Eastern India were included over a period of four years and were categorized according to WHO classification, using morphology and immunohistochemistry (IHC). Results: There were 347 (76.3%) non Hodgkin lymphomas (NHL), and 108 (23.7%) Hodgkin lymphomas (HL). Diffuse large B cell lymphoma (DLBCL) was the most common of the NHL type (35.2%) followed by the follicular lymphoma (19.3%). B cell lymphoblastic lymphoma was the least common type of NHL (1.4%). Mixed cellularity (33.3%) and nodular sclerosis (26.9%) were the two most common type of HL. Childhood lymphoma comprised of 12.5% of all ML. T cell NHL and HL were the common lymphomas in this age group. Conclusion: Incidence of follicular lymphoma is lower compared to western studies and mixed cellularity is most common subtype of HL unlike nodular sclerosis subtype in western world. Burkitt's type NHL though is the most common subtype of childhood ML in many studies but in our study T cell NHL is the most common type of childhood ML.

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