Abhishek Pathak

An extremely rare case of metastatic retinoblastoma of parotids presenting as a massive swelling in a child

Retinoblastoma (Rb) is a common childhood malignancy but bilateral Rb with metastasis to parotids is very uncommon. To the best of our knowledge, bilateral Rb metastasizing to parotids is very rare and this is the fifth such case reported in world literature till date in a 2-year-old male child who underwent exenteration of left eye for bilateral Rb and later developed recurrent metastasis to left parotid requiring parotidectomy. A year later he presented again with swelling left parotid region extending from occipital region reaching upto left anterior chest wall with intra-cranial extension on magnetic resonance imaging. Histopathological examination of the parotid swelling and immunohistochemistry showed metastasis from Rb. He was treated with chemotherapy followed by radiotherapy to local site and brain to which he responded well. Presently on regular follow up without any signs of locoregional and distal metastasis. Till date different types of primary parotid tumors have been reported in literature but a metastatic parotid tumor is extremely rare and therefore this case is being reported to highlight the extreme rarity, the diagnostic and therapeutic challenges, the highly aggressive nature and overall dismal prognosis of this disease entity.

Primitive neuroectodermal tumor of lungs in adults: a rare series of three cases treated with upfront chemo-radiation

Primitive neuroectodermal tumors (PNETs) are highly malignant small round blue cell tumors of neuroectodermal origin belonging to either central nervous system, autonomic nervous system or peripheral Askins or Ewings group of neoplasms. The latter generally arise in soft tissues of trunk or axial skeleton in children and early adolescents. However in adults this entity is very uncommon. Of all peripheral entities, primary PNET of lungs without chest wall or pleural involvement in adults are extremely rare and have been scarcely reported in world literature as single case reports. We hereby report a series of three interesting cases of adult PNET of lung diagnosed and treated in our institute. The chief presenting complaints of these patients were of chest pain, cough and dyspnea. The cases were diagnosed on the basis of imaging and biopsy which confirmed these lesions to be of PNET histology, confirmed by immunopositivity for neuron specific enolase (NSE), synaptophysin, chromogranin, CD 99 and vimentin on immunohistochemistry (IHC). All three were deemed unresectable in view of infiltration of nearby vital organs and high chances of morbidity. They were treated with upfront chemotherapy followed by conformal radiotherapy (RT) to the residual disease to which they showed significant response both clinically and radiologically. Presently these patients are on regular follow-up for over 6 months without any evidence of progression of disease or distant metastasis.

Changing paradigm in treatment of lung cancer

Changing paradigm in treatment of lung cancer Sundaram Viswanath, Abhishek Pathak, Amul Kapoor, Anvesh Rathore, Bhupendra Nath Kapur Medical Oncology, Army Hospital Research and Referral, New Delhi 110010, India. Correspondence to: Dr. Abhishek Pathak, Medical Oncology, Army Hospital Research and Referral, New Delhi 110010, India. E-mail: drabhipat@gmail.com Lung cancer is one of the most common and deadliest forms of cancer. It accounts for 13% of all new cancer cases and 19% of cancer-related deaths. In India, lung cancer constitutes 6.9% of all new cancer cases and 9.3% of all cancer cases. There has also been a dramatic rise worldwide in both the absolute and relative frequencies of lung cancer occurrence. In 1953 it became the most common cause of cancer mortality in men. By 1985, it became the leading cause of cancer deaths in women, causing almost twice as many deaths as breast cancer. The demographic profile of lung cancer has changed greatly over the years; however, methods for diagnosing, screening, and managing lung cancer patients have improved. This is due to our growing understanding of the biology of lung cancer. It is now possible to further define lung cancer types beyond small cell lung carcinoma and non-small cell lung carcinoma. Moreover, new histology-based therapeutic modalities have been developed, and more new lung cancer biomarkers have been uncovered. Therefore, more detailed histological characterization of lung cancer samples is warranted in order to determine the best course of treatment for specific patients. This review article describes how these new molecular technologies are shaping the way lung cancer can be treated in future.

Carcinoma of gall bladder: Demographic and clinicopathological profile in indian patients

Aim of the Study: The aim of this study is to evaluate the demographic and clinicopathological profile of the patients with gallbladder cancer (GBC). Materials and Methods: A total of 68 diagnosed cases of GBC were taken in the study during the study period from January 2016 to December 2017. A detail questionnaire was filled through the counseling to take demographic profile including socioeconomic status, nonclinical characteristics, dietary, and other risk factors apart from clinicopathological profile of patients. Results: We found most of the patients were females with median age 51.8 years. More than half of them were postmenopausal (56.60%), and high parity was seen in 39.62% of females. Obesity was associated factor mainly in females (28/53), and none of the males were obese. Nearly 83.82% (57/68) of patients had advanced stage disease, with metastatic disease in 72.06% (49/68) patients. Majority of the patients had at least two sites of metastasis (73.47%), with liver (57.14%), omentum (40.82%), and nonregional lymph nodes (53.06%) being common sites of dissemination. Bony metastasis, being rare in literature, was found in 6 (12.24%) of patients, most of them developed it later during the disease course. Conclusion: Majority of the patients was female within the age group of 41–60 years, associated with gallstones and had advanced disease. We did not find greater impact of diet on the incidence as vegans and nonvegans were almost equally divided in our study. A high index of suspicion and health education seems to be the only answers available for early detection and improvement of survival.

Microsatellite instability in stage II and III colorectal cancer: Patterns and profile

Introduction: Around 80% of colorectal carcinoma are associated with chromosomal instability while rest of 20% are euploid, possessing defect in mismatch repair system (MMR) quintessential for surveillance and correction of errors introduced into microsatellites. The microsatellite instability (MSI) phenotype has three major clinical applications: prognosis of colorectal cancer (CRC), prediction of response to 5 fluorouracil, and irinotecan, and genetic assessment of Lynch syndrome. Materials and Methods: We analyzed all Stage II and Stage III colorectal cancer (CRC) for MSI, who presented at Army Hospital, Research and Referral, New Delhi, from January 2014 to December 2016. Although patients of Stage II CRC were taken throughout the study period, Stage III CRC was included in last 1½ years to compare the prevalence of MSI in these two subsets of patients. Results: 26.2% of Stage II and 11.3% of Stage III patients were found to be MSI-high (MSI-H) (P = 0.04). Nineteen (86%) of 22 MSI-H patients were below 30 years of age (P = 0.01). Of 22 MSI-H patients, 18 had right-sided tumors (P = 0.03) and only three patients had rectal tumors. Most common pattern of MSI-H tumors was loss of expression of MLH1 and PMS2, seen in 15 of 16 (88%) of Stage II and three of 6 (50%) of Stage III CRC (P = 0.04). Conclusion: We conclude higher prevalence of MSI-H tumors in Stage II, as compared to Stage III CRC, which was demonstrated slightly higher in our study compared to published literature. MSI-H tumors tend to occur with high frequency in younger population, with right-sided colonic tumors, histopathology characterized by mucinous subtype with high prevalence of tumor infiltrating lymphocytes. Loss of expression of two MMR proteins, namely, PMS2 and MLH1 has been identified in most of MSI-H patients of our study, of which 86% were <30 years of age. This is in contrast to observation in previous studies where loss of PMS2 and MLH1 proteins was observed in older (>70 years) patients with MSI-H tumors, and in younger patients, MSI-H status was associated with loss of MLH1, MSH2, and MSH6.

Clinicopathological profile of anaplastic lymphoma kinase-positive nonsmall cell lung cancer: An Indian perspective

Background: A novel fusion gene of echinoderm microtubule-associated protein-like 4 (EML4) and anaplastic lymphoma kinase (ALK) has been identified in a subset of non-small-cell lung cancers (NSCLCs). Patients with the ALK-EML4 fusion gene demonstrate unique clinicopathological and physiological characteristics. Here we present an analysis of clinicopathological profile of patients of metastatic adenocarcinoma harboring the ALK-EML4 fusion gene. Methods: A retrospective analysis of advanced ALK positive NSCLC, who presented at this tertiary care hospital of armed forces from September 2014 to December 2016 was conducted. The primary goal was to evaluate demographic and clinicopathological profile of ALK positive advanced NSCLC. Detection of ALK fusion was done by IHC on formalin fixed paraffin embedded cell blocks. Results: Out of 270 patients of NSCLC, 15 (7.4%) tested positive for ALK-EML4 fusion. Rate of positivity was higher in females (13.7%) than in males (5%). The correlation of the ALK-EML4 fusion gene and clinicopathological characteristics of NSCLC patients demonstrated a significant difference in smoking status, histological types, stage, and metastatic pattern. Conclusion: Our analysis indicated that ALK-EML4 positive NSCLC comprised a unique subgroup of adenocarcinomas with distinct clinicopathological and radiological characteristics. Incidence of ALK positivity was found to be higher in females and never smokers. These patients have distinct pathological and radiological characteristics.

Role of onco-trained nurses in a tertiary care cancer institute

Submit Manuscript | http://medcraveonline.com radiation, surgical, medical, gynaecologic, and paediatric oncology wards. They are involved in direct patient care and practice at the grass-root level, with 43% working at hospital level, 24% in the outpatient setting, 11% in physician offices, and 3% in hospice or home care [1]. Their involvement in outpatient and home care setting has increased as more patients are being treated out of the hospital setting. This mini-review discusses the role of the onco-trained nurses in patient care and coordination of care, patient education, management of symptoms and supportive care.

Prospective evaluation of the BISAP score and its correlation with Marshall score in predicting severity of organ failure in acute pancreatitis

Background: The bedside index for severity in acute pancreatitis (BISAP), a newer prognostic scoring system, has been proposed as a simple and clinically oriented severity scoring system for early identification of patients with acute pancreatitis. This study evaluates the efficacy of BISAP score to predict the severity of organ failure in patients of acute pancretitis and its correlation with Marshall score. Methods: The clinical, laboratory and radiological data for all patients admitted with a diagnosis of acute pancreatitis conducted at tertiary hospital of Armed Forces over a two-year period, was prospectively collected for this study. BISAP score was calculated within 24hrs of presentation. Markers of severity were the development of organ failure and presence of pancreatic necrosis. Outcome at 28 days (viz. recovery, organ failure and mortality) was studied for each patient. BISAP score computed at 24h was correlated with the above and its efficacy to predict the severity of organ failure in Acute Pancreatitis, was assessed. Results: Out of 50 patients in the study group, 41 were male and 9 were female with the mean (±SD) age 43.74±16.85 years. Majority of the study population had alcohol (56%) as the etiology followed by gall stones (28%). Outcome assessed at 28 days revealed recovery of 54%, complication of 36% and mortality of 10% of study population. BISAP score computed within 24 hours of admission of 2 or more significantly predicted the severity and complication with P value <0.001. Statistically significant trends of increasing severity and organ failure (P<0.001) with increasing BISAP was observed. Conclusions: BISAP score is a reliable means of predicting the severity and organ failure and stratifying patients with Acute Pancreatitis within 24 hours of admission. The statistically significant incidence of increasing severity and mortality with increasing BISAP score will help us to risk stratify the patients within 24 hours of admission and help improve clinical care and facilitate necessary interventions as early as possible.