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   2017| April-June  | Volume 6 | Issue 2  
    Online since June 22, 2017

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An observational study on safety and efficacy of povidone-iodine for pleurodesis in cancer patients
Ayush Makkar, Sanjeev Patni, Anjum Khan Joad, Kamal Kishor Lakhera
April-June 2017, 6(2):79-80
DOI:10.4103/2278-330X.208849  PMID:28702414
Introduction: Pleurodesis is a time-honored procedure for malignant effusion as one of the palliative procedures to treat recurrent effusions. Various agents have been used in the past such as tetracycline, talc, bleomycin, and povidone-iodine. This paper aims at evaluating safety and efficacy of povidone-iodine for the procedure. Materials and Methods: One hundred and four patients underwent of pleurodesis with povidone-iodine done at our center for malignant effusion between June 2008 and August 2015. The safety and efficacy of the procedure was analyzed. Results: One hundred and four patients of malignant effusion with mean age of 53 years and a mean follow-up of 7.8 months were evaluated. A total of 79% patients did not show any reaccumulation of fluid in their follow-up. There was no periprocedural mortality. Eight patients had severe pain; eleven patients had fever, while one patient had arrhythmia.Conclusion: Povidone-iodine is a simple, cheap, and effective method of pleurodesis with no major complication and a high success rate.
  1,712 182 -
Efficacy and safety of short course adjuvant trastuzumab combination chemotherapy in breast cancer
Sachin S Hingmire, Mahesh B Sambhus, Dhananjay S Kelkar, Sujit Joshi, Purvish M Parikh, R Bharath
April-June 2017, 6(2):47-50
DOI:10.4103/sajc.sajc_68_17  PMID:28702403
Background: The adjuvant short course 9-week trastuzumab combination therapy for human epidermal receptor 2 positive breast cancer patients may often be considered as a cost-effective and safe option and has important implications for the Indian subcontinent as well as other developing countries. However, such regimens of shorter duration trastuzumab therapy like FinHer, offered in view of economic constraints, may not be able to achieve globally comparable cure rates in early breast cancer especially with high-risk women with more than 3 lymph node positive. Methods and Material: Outcome of 21 patients with HER2 positive breast cancer was treated with short course trastuzumab combination chemotherapy in the adjuvant setting was studied. Results: Out of 21 patients 15 are alive and disease free with a follow up of up to 73 months (median follow up 42 months).
  1,535 237 -
Megakaryocytic morphology in Janus kinase 2 V617F positive myeloproliferative neoplasm
Shuchi Ghai, Sharada Rai
April-June 2017, 6(2):75-78
DOI:10.4103/2278-330X.208854  PMID:28702412
Context: Alterations in megakaryocyte morphology are the hallmark of myeloproliferative neoplasms (MPNs). These neoplasm are also associated with Janus kinase 2 (JAK2) V617F mutation in nearly 95% patients with polycythemia vera (PV), 40% patients of essential thrombocythemia (ET) and 50% patients of myelofibrosis (MF). The utility of megakaryocyte morphology in these disorders in correlation with JAK2 V617F remains unresolved. Aims: The aim of the study was to assess the morphology of megakaryocytes in bone marrow aspirates (BMAs) and bone marrow biopsies of patients of BCR-ABL negative MPNs with JAK2 V617F mutation. Settings and Design: This study was a retrospective and prospective, hospital-based study undertaken for a period ranging from January 2011 to April 2015. Subjects and Methods: Assessment of morphological features of megakaryocytes in 15 BMAs and their respective biopsies which included seven cases of PV, three cases of ET, and five cases of MF with JAK2 V617F mutation. Statistical Analysis Used: Chi-square test and Fisher exact test were used to compare the different features of megakaryocytes. Software version SPSS 13.0 was used. Results: Megakaryocytes in ET were found to have characteristically large size with staghorn multinucleated nuclei and exhibiting large amount of cytoplasm. MF showed dense clustering of megakaryocytes with staghorn nucleus along with sinusoidal dilatation and intrasinusoidal hematopoiesis. PV showed loose and dense clustering of megakaryocytes with a predominance of cloud-like nuclei. Few of the megakaryocytic morphologic features showed overlap between MF and PV and between ET and early MF. Conclusions: Megakaryocytic morphology can aid in the accurate diagnosis of the different subcategories of MPNs. This would help in categorization of clinically suspicious patients of JAK2 V617F negative patients.
  1,441 219 -
Outcome of HER2 Testing by FISH applying ASCO/CAP 2007 and 2013 guideline in IHC equivocal group of breast cancer: Experience at tertiary cancer care centre
Manoj Kumar Panigrahi, Dushyant Kumar, Anurag Mehta, Kandarpa Kumar Saikia
April-June 2017, 6(2):45-46
DOI:10.4103/2278-330X.208841  PMID:28702401
Background and Objectives: HER2 testing guideline of ASCO/CAP for interpretation and reporting has recently been revised. The study is aimed to measure the impact of 2013 CAP guideline on equivocal HER2 test outcome (immunohistochemistry [IHC] 2+) when tested by fluorescent in situ hybridization (FISH). The study also aims at finding the frequency of polysomy and monosomy of chromosome 17. Materials and Methods: Specimens were collected in Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India. IHC was performed in every case, and FISH was performed in IHC2+ cases. Results: In final analysis includes 557 subjects on the basis of CAP guideline 2007 and CAP guideline 2013. One hundred ninety-two subjects (34.4%) were HER2 amplified according to CAP scoring 2007, and 246 subjects (44%) according to 2013 CAP scoring. Conclusions: FISH results were evaluated (IHC2 + interpreted according to CAP 2007 guideline) with both 2007 and 2013 ASCO/CAP scoring criteria, we identified significantly more HER2 positive cases as compared to cases evaluated using the 2007 criteria (P < 0.05). We also found that in breast carcinoma, HER2 status in the presence of polysomy 17 may vary with the scoring criteria used. Evaluation of FISH result using 2013 ASCO/CAP criteria means that more patients with breast cancer may be appropriate for targeted treatment with trastuzumab, potentially improving their outcome.
  1,367 231 -
Breast cancer in young women: A retrospective study from tertiary care center of north India
Deepti Sharma, Garima Singh
April-June 2017, 6(2):51-53
DOI:10.4103/2278-330X.208859  PMID:28702404
Aim: Breast cancer is the most common cause of cancer in women worldwide. They have more aggressive clinical behaviour with poor outcomes in younger patients. The aim of this study was to evaluate the impact of age on prognosis of breast cancer in women above and under 40 years of age. Material and Methods: Medical record of 415 patients with invasive breast cancer were analysed from January 2011 to December 2014 in our department.The last was done in December 2015.All cases diagnosed with breast cancer stages I to IV were evaluated, and grouped on the basis of age [less than 40 and above 40 years].Baseline categorical variables were analysed using the Chi-square test or Fisher's exact test. Non categorical variable were analysed using t-test. Result: A total of 372 patients were reviewed because 42 patients defaulted. The median age at the time of diagnosis was 44.6 years (range 23 to 90 years).Metastasis to distant organs were more in women with age <40. Tumour relapse occurred in 131 cases, among which 84 cases died, 35 patients (26.31%) in less than 40 group vs.49 patients (20.50%) in above 40 groups. The estimated median OS in the two groups are 32 and 41 months respectively. Conclusion: The biological behaviour of breast cancer in younger age group has been shown to be associated with aggressive nature and has a worse clinical outcome as compared to that in older group.
  1,301 249 -
Plasmablastic lymphoma in immunocompetent and in immunocompromised patients: Experience at a regional cancer centre in India
AH Rudresha, KC Lakshmaiah, Ankit Agarwal, K Govind Babu, D Loknatha, Linu Abraham Jacob, Suresh Babu, KN Lokesh, LK Rajeev
April-June 2017, 6(2):69-71
DOI:10.4103/sajc.sajc_186_16  PMID:28702410
Introduction: Plasmablastic lymphoma (PBL) is a rare lymphoma associated with immunosuppression. It is strongly associated with immunosuppression (human immunodeficiency virus [HIV]) and often occurs within the oral cavity. PBL is also seen in patients receiving immunosuppressive therapy; however, despite its predisposition for the immunocompromised patients, PBL has been diagnosed in immunocompetent patients. Aim: This study aims to prognostic factors and outcome of PBL in immunocompromised and in immunocompetent patients. Materials and Methods: We conducted a retrospective study at our institute from the year 2008 to 2015. Results: A total of 13 patients (8 males and 5 females) with PBL were identified. Eight patients (61.5%) had extraoral PBL (median age 30.2 years) and 5 patients (38.5%) had oral PBL (median age 44 years). Most common extraoral site was gastrointestinal tract. Eight (61.5%) out of 13 patients were HIV positive. More than 50% of patients had Ann Arbor Stage III or IV. All the cases were CD20 negative and CD138 positive. Seven out of 13 patients had Ki-67 more than 80%. Nine patients received cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. Three patients were on best supportive care due to poor performance status (PS). One patient received intensive chemotherapy with CODOX-M/IVAC. The median overall survival was 9 months in HIV-positive patients and 6 months in HIV-negative patients. The prognosis was worse in patients with Ki-67 of >80%. Statistical Analysis: Survival curves were generated using the Kaplan–Meier method and analyzed using log-rank test and Fisher's t-test. Conclusion: The present study confirms that PBL in both HIV-positive and in HIV-negative patients has an overall unfavorable outcome. The most important prognostic factors are stage, ki-67, and the Eastern Cooperative Oncology Group PS of the patient at the time of presentation.
  1,064 165 -
The impact of irradiation dose on the computed tomography radiographic response of metastatic nodes and clinical outcomes in cervix cancer in a low-resource settingLetter to the Editor
Matthew Ryan McKeever, Lindsay Hwang, Jennifer Barclay, Yin Xi, April Bailey, Kevin Albuquerque
April-June 2017, 6(2):54-58
DOI:10.4103/2278-330X.208856  PMID:28702405
Introduction: The aim of this study is to investigate the relationship between the radiation dose to pelvic and para-aortic lymph nodes, nodal response, and clinical outcomes in a resource-poor setting based on computed tomography (CT) nodal size alone. Materials and Methods: This retrospective study from 2009 to 2015 included 46 cervical cancer patients with 133 metastatic pelvic and para-aortic lymph nodes definitively treated with chemoradiation and brachytherapy in a public hospital with limited access to positron emission tomography (PET) scans. Hence, short axis of the lymph node on CT scan was used as a measure of metastatic nodal disease, before and following radiation therapy. Inclusion criteria required the pelvic and para-aortic nodes to have the shortest axis diameter on CT scan of ≥8 mm and ≥10 mm, respectively. Based on PET resolution, a node that decreased to half of its inclusion cutoff size was considered to have a complete response (CR). Relevant clinical outcomes were documented and correlated with nodal features, nodal radiation doses, and treatment characteristics. Results: After controlling for other predictive factors, increased nodal dose was associated with increased probability of CR per study definition (P = 0.005). However, there was no statistically significant association between dose and pelvic/para-aortic, distant and total recurrence (TR), and any recurrence at any location (P = 0.263, 0.785, 1.00, respectively). Patients who had no CR nodes had shorter pelvic/para-aortic recurrence-free survival (PPRFS) and TR-free survival (TRFS) than patients who had at least one CR node (P = 0.027 and 0.046, respectively). Patients with no CR nodes also had shorter PPRFS than patients who had all nodes completely respond (P < 0.05). Conclusions: Using CT-based measures, we found that increased nodal dose is associated with an increased probability of CR (as defined) and nodal CR is associated with increased PPRFS and TRFS. We were unable to determine the cutoff dose required for a CR.
  1,013 148 -
In the era of next generation sequencing, is the cytogenetic analysis still important in polycythemia vera?
Prakas Kumar Mandal, S Kartthik
April-June 2017, 6(2):46-50
DOI:10.4103/2278-330X.208843  PMID:28702402
  988 140 -
Complete response with crizotinib in two children with chemotherapy resistant neuroblastoma
Priyanka Verma, Sandeep Jain, Gauri Kapoor
April-June 2017, 6(2):89-90
DOI:10.4103/2278-330X.208855  PMID:28702420
  970 143 -
Phase IIb trial comparing two concurrent cisplatin schedules in locally advanced head and neck cancer
Lekha Madhavan Nair, R Rejnish Kumar, Kainickal Cessal Thomachan, Malu Rafi, Preethi Sara George, K M. Jagathnath Krishna, Kunnambath Ramadas
April-June 2017, 6(2):64-68
DOI:10.4103/2278-330X.208840  PMID:28702409
Background: Concurrent chemoradiation with 3 weekly cisplatin (100 mg/m2) is the standard of care for locally advanced head and neck cancer. However, this regimen has been shown to be associated with lesser compliance and higher toxicities. Hence, there is a need to explore alternative concurrent cisplatin regimens. Objectives: The objective of this study was to compare the efficacy and toxicities of 3 weekly cisplatin (100 mg/m2) with weekly cisplatin (40 mg/m2) concurrently with radiation in patients with locally advanced head and neck cancer. Patients and Methods: This phase IIb trial randomized 56 patients with Stage III and IV squamous cell carcinoma of oropharynx, hypopharynx, and larynx to Arm A or Arm B. Arm A received cisplatin 100 mg/m2 3 weekly and Arm B received cisplatin 40 mg/m2 weekly concurrently with radiation. The primary end point was disease-free survival (DFS) and secondary end points were overall survival (OS) and acute toxicity. DFS and OS were estimated using Kaplan–Meier method, and log-rank test was used to assess the difference in these distributions with respect to treatment. Results: The 2-year DFS in Arm A and Arm B was 64.5% and 52.8%, respectively (P = 0.67). The OS at 2 years was 71% and 61.1% in Arm A and Arm B, respectively (P = 0.61). There were no significant differences in acute hematological, renal, or mucosal toxicities between the two arms. Conclusion: This study showed a nonsignificant improvement in DFS and OS in the 3 weekly cisplatin arm over the weekly arm with comparable toxicities. The trial is registered with Clinical Trial Registry of India (CTRI registration number: CTRI/2013/05/003703, URL-
  968 145 -
Diffuse large B-cell lymphoma in elderly: Experience from a tertiary care oncology center in South India
KN Lokesh, M C. Suresh Babu, KC Lakshmaiah, K Govind Babu, Smitha C Saldanha, D Loknatha, Linu Abraham Jacob, S Vishwanath, CS Premalatha, PR Kiran
April-June 2017, 6(2):72-74
DOI:10.4103/2278-330X.208847  PMID:28702411
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most frequent non-Hodgkins lymphoma in the elderly. With the rising proportion of older persons in India, it is important to study current patterns and management of this disease, given that data in this regard are scarce in Indian settings. The aim of this study was to document the clinical features of DLBCL among elderly patients and their outcome over 7 years at a tertiary care oncology center. Materials and Methods: This was a retrospective records review of 119 DLBCL cases between January 2007 and January 2015 aged 60 years and above done at Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India. Clinical staging was done according to Ann Arbor staging as modified by Cotswold's and International Prognostic Index (IPI) calculated. Results: The mean age was 69.54 years (±5.44) with male: female ratio of 1.52:1. B symptoms were seen in 33% of patients. Thirty-six percent of the patients had stage II disease. The advanced stage was seen in 12% and bulky disease in 9.5%. Bone marrow was involved in 12%. The most common extranodal site was the head and neck region. The distribution according to the IPI was as follows: Low risk 38 (31.93%), low-intermediate risk 53 (44.54%), high-intermediate risk 20 (16.80%), and high risk 8 (6.72%). Among 119 patients, 98 (64.7%) received treatment with either combination of rituximab, cyclophosphamide, adriamycin, vincristine, epirubicin, and prednisolone. Overall response rate was 63.26% with a complete response rate of 38.77%. The overall survival ranged from 2 to 123 months with the median being 9.5 months. Conclusion: In elderly, DLBCL is common in seventh decade and most of them present in an early stage and low IPI. The incorporation of rituximab to anthracycline based chemotherapy shows a significant improvement in survival in elderly DLBCL.
  916 144 -
Verrucous carcinoma of foot at an unusual site: Lessons to be learnt
D Nagarajan, Malarvizhi Chandrasekhar, Jim Jebakumar, K Aravind Menon
April-June 2017, 6(2):63-78
DOI:10.4103/2278-330X.208839  PMID:28702408
  910 124 -
18F-fluorodeoxyglucose positron emission tomography-computed tomography scan after gastric endoscopy in those who present with non-specific symptoms, is it necessary or not?
Haoping Xu, Rui Guo, Weihui Xu, Yanying Pan, Tao Ma
April-June 2017, 6(2):59-63
DOI:10.4103/2278-330X.208853  PMID:28702407
Background and Aims: Retrospectively analyze the sensitivity of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in the diagnosis of gastric malignancy compared with gastric endoscopy in persons with nonspecific symptoms and evaluate the necessity of 18F-FDG PET-CT scan before surgery. Materials and Methods: A total of 53 patients with gastric malignancy proven by surgery and pathology were enrolled in the study. All the patients underwent gastric endoscopy and PET-CT scan before surgery. And the PET-CT images were interpreted by the observers who were blinded to the results of the gastric endoscopy. The sensitivity of gastric endoscopy, 18F-FDG PET-CT, and serum tumor markers in the diagnosis of gastric malignancy were calculated ultimately. Results: Of 53 gastric malignancy patients, five cases were proven to be false-negative detected by gastric endoscopy, and the sensitivity of which was 90.57%. The sensitivity of PET scan alone was 86.79%, which was observed no significant difference to that of gastric endoscopy diagnosis, P = 0.54. While all of the patients had been detected positive on PET-CT images, the sensitivity of which was significantly higher than that of the gastric endoscopy diagnosis or that of the serum tumor markers, P < 0.001. And the FDG uptake was positively correlated with the depth of the cancer invasion into the gastric wall (P < 0.0001) and the degree of lymph nodes infiltration (P = 0.02). It also various from different differentiation degree significantly, P = 0.04. Conclusions: 18F-fluorodeoxyglucose PET-CT could detect gastric carcinoma in persons with nonspecific symptoms which showed negative in gastric endoscopy. And it is necessary to be aware of the possibility of gastric malignancy when the result of PET-CT scan is positive.
  859 105 -
Carotid blowout syndrome: An oncological emergency less discussed
Karthik K Prasad, Nagesh T Sirsath, Kiran V Naiknaware, K Sandhya Rani, Manish S Bhatia
April-June 2017, 6(2):85-86
DOI:10.4103/sajc.sajc_211_16  PMID:28702416
  820 134 -
Long-term survival following repeat liver resections in metastatic ovarian granulosa cell tumor: Case report with review of the literature
Michelle Aline Antony, K Pavithran, DK Vijaykumar, OV Sudheer
April-June 2017, 6(2):87-88
DOI:10.4103/2278-330X.208852  PMID:28702418
  812 112 -
Folfox encephalopathy: A rare case series
Ullas Batra, Venkata Pradeep Babu Koyyala, Akhil Jain, Chaturbhuj Agrawal, Udip Maheswari
April-June 2017, 6(2):86-87
DOI:10.4103/2278-330X.208850  PMID:28702417
  771 127 -
Impact and prognostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan in the evaluation of residual head and neck cancer: Single-center experience from Pakistan
Saima Riaz, Humayun Bashir, Hassan Iqbal, Arif Jamshed, Ahmad Murtaza, Raza Hussain
April-June 2017, 6(2):81-83
DOI:10.4103/2278-330X.208851  PMID:28702415
Background: Overview of clinical impact of positron emission tomography-computed tomography (PET-CT) scans in patients with head and neck carcinomas at our center. Methods: Retrospective review of posttreatment 18F-fluorodeoxyglucose (18F-FDG) PET-CT scans in patients with head and neck carcinomas with risk of residual disease. Clinical outcome served as the reference standard. Results: This study included 93 patients (65.6% males, mean age: 48.8 years ± 17.2 standard deviation) with squamous cell carcinoma as most frequent histopathology (91.4%). PET-CT scans were performed on average 6 months posttreatment. Diagnostic accuracy, positive predictive value, and negative predictive value of PET-CT for disease were found to be 88%, 88%, and 92%, respectively. A median follow-up of 24 months was available for 91 patients. Kaplan–Meier curves showed significantly higher disease-free survival with negative PET-CT as compared to positive PET-CT (P = 0.01) and maximum standardized uptake values of <5.0 (P = 0.01). Conclusion: FDG PET-CT has diagnostic and prognostic implications in treated patient of head and neck cancers.
  782 95 -
Presentation of mucinous adenocarcinoma of renal pelvis masquerading as gross hydronephrosis: A histopathological surprise
Kajal Nitin Patel, Nitin A Patel, Shruti P Gandhi
April-June 2017, 6(2):78-84
DOI:10.4103/2278-330X.208838  PMID:28702413
  753 107 -
Carcinomatous meningitis as first sign of relapse in a patient with gastric Adenocarcinoma: A rare presentation
Akash Mathur, Dinesh Gurjar, Ramkrishna Sai, Arvind Lakesar, Hemant Malhotra
April-June 2017, 6(2):91-92
DOI:10.4103/2278-330X.208848  PMID:28702422
  740 111 -
Epithelioid angiosarcoma: 10 years postrenal transplant
Nitin Gupta, Natasha Singh, Ameya D Puranik, Akshay Bedmutha
April-June 2017, 6(2):58-63
DOI:10.4103/2278-330X.208846  PMID:28702406
  748 91 -
Scoring criteria for the evaluation of micronuclei in oral exfoliated cells
Sonal Grover, B R. Ahmed Mujib
April-June 2017, 6(2):89-89
DOI:10.4103/2278-330X.208842  PMID:28702419
  607 89 -
Estimation of cancer risk due to exposure to lead contamination in Joss paper
Beuy Joob, Viroj Wiwanitkit
April-June 2017, 6(2):90-91
DOI:10.4103/2278-330X.208857  PMID:28702421
  612 84 -