Anil Khurana

A rare presentation of primary leiomyosarcoma of ovary in a young woman.

Primary ovarian leiomyosarcoma is a very rare tumour which is most commonly seen in postmenopausal women. A case is described here involving a 30-year-old female who presented with pain in the abdomen. The patient underwent laparotomy with peritoneal lavage, bilateral salpingo-oophorectomy, and total abdominal hysterectomy. Microscopic and immunohistochemical findings established the diagnosis of primary ovarian leiomyosarcoma. Similar to sarcoma of other tissues, an adjuvant chemotherapy regimen consisting of vincristine, epirubicin, and cyclophosphamide was given for this present case. Six months after treatment completion, the patient is on regular follow-up and disease-free on clinical and radiological examination.

Primary Non Hodgkin's Lymphoma of Left Adrenal Gland - A Rare Presentation.

Primary adrenal lymphoma is rare and constitutes for 3% of extranodal lymphoma cases. Approximately 70% of patients present with bilateral disease and have adrenal insufficiency. Prognosis of primary adrenal lymphoma (PAL) is poor, most of patient die within one year of diagnosis. Moreover, there are no standard treatment protocols on such cases. Patients are generally treated with regimens similar to other nonhodgkin lymphoma which includes surgery, combination chemotherapy and or radiotherapy. We are presenting a successfully treated case of primary diffuse large B cell non Hodgkin lymphoma of adrenal gland in a 57-year-old patient. The patient had unilateral adrenal involvement (left adrenal gland), without adrenal insufficiency and normal Serum lactate dehyrogenase level. The patient was treated with left adrenalectomy followed by combination chemotherapy. Two years after diagnosis and treatment the patient is disease free on clinical and imaging studies.

Adenoid Cystic Carcinoma of Cervix: Treatment Strategy

Adenoid Cystic Carcinoma (ACC) of cervix behaves aggressively and it has a propensity for local infiltration, invasion in lymphatic vessels as well as perineural spaces, with subsequent haematogenous spread. In advanced disease (Stage III and IV), outcome is invariably poor. Moreover, these cases have a high tendency to recur locally and also to metastasize to distant sites. There are no standard treatment protocols because of rarity of disease. The guidelines for its management are established similarly as for staged squamous cell carcinoma of cervix. Therefore, recommended treatment in advanced disease is aggressive multimodality treatment, which includes chemotherapy and radiotherapy. We are presenting a case of adenoid cystic carcinoma of cervix in 55 years old patient, staged as III B. The patient was treated with concomitant radiotherapy and chemotherapy. The patient responded well to treatment and is disease free, three years after treatment.

A Retrospective Evaluation of Clinical Profile of Second Primary Head and Neck Cancer

INTRODUCTION Incidence of Second Primary Malignancy (SPM) after successful treatment of primary is increasing and may cause the problem for optimal treatment. AIM This study was conducted retrospectively to analyse incidence, disease free survival between malignancies, pattern of treatment and outcome. MATERIALS AND METHODS Sixteen out of 22 patients of previously treated cases of head and neck cancer those develop SPM of head and neck region managed over a period of January 2012 to December 2015 in Department of Radiotherapy-II, Pt. BD Sharma PGIMS, Rohtak were analyzed retrospectively. Sixteen patients with unresectable disease were given reirradiation with external beam radiotherapy. RESULTS Median age of presentation of first malignancy was 27 years (Ranged 26 -65 years), whereas median age was 60 years for second malignancy (range 45-71 years). All patients were smokers during first malignancy; 87.5% (14/16) had historyof smoking during second malignancy. Oropharynx (50%) was most common site of presentation of primary tumor whereas oral cavity was most common site of presentation in second primary tumor. CONCLUSION Incidence of Second primary head and neck tumor after successful treatment for primary Head and neck cancer are increasing due to newer treatment strategies, longer survival and follow up. Reirradiation, surgery and or chemotherapy are treatment modalities. However second primary tumor of this region are associated with poor prognosis.

A Prospective Randomized Study Evaluating the Role of Oral Curcumin along with Chemoradiationin Management of Locally Advanced Head and Neck Carcinoma

Aim: This study was to evaluate the role of Curcumin along with or without chemoradiation in the management of locally advanced head and neck cancers (LHNC) in terms of tolerability, toxicity and response. Sixty treatment naive histopathologically proved cases LHNC were included in this prospective randomized study. Materials and Methods: Patients were randomly assigned to receive radical external beam radiotherapy (EBRT) with weekly cisplatin and capsule Curcumin from the first day of EBRT till the Original Research Article Kumar et al.; IJTDH, 16(1): 1-7, 2016; Article no.IJTDH.25780 2 completion in the dose of 1gm every 8 hourly (Group I/Study Group) and EBRT with weekly cisplatin only (Group II/Control Group). Results: There were lower grades of statistically insignificant haemoglobin (grade 2 p value0.300) and total leucocyte count (grade 1 p value0.313), toxicities in group II in compared to group I during treatment. The acute skin and mucosal reactions were less in group I than group II without any statistically significant association during treatment and follow ups. Statistically significant less blood urea (grade 1 p value0.019) toxicities observed in group I, in compared to group II during treatment. There were statistically significant fewer grade 3 and 4 vomiting (p value0.037) in group II. At one year follow up 67% was disease free in group I in comparison to 56% in group II. Conclusion: Curcumin, in management of LHNC, seems to decreases haematological, renal, skin and mucosal chemoradiation induced toxicities results in timely completion of intended treatment without any financial burden on patients and improves the disease control.

Squamous Cell Carcinoma of Gallbladder - An Uncommon Presentation

A 51-year-old male patient presented with pain in the upper right quadrant of abdomen since two months, associated with weight loss and fever. Contrast enhanced computed tomography abdomen revealed gallbladder with wall thickening which was asymmetric and heterogeneous at junction of body. An initial diagnosis of cholecystitis with element of cholangitis and abnormal wall thickening with multiple tiny calculi was considered. Open radical cholecystectomy was done. Microscopic and immunohistochemical findings established the diagnosis of moderately differentiated squamous cell carcinoma of the gallbladder. Adjuvant chemotherapy regimen consisting of paclitaxel 175 mg/m 2 and carboplatin AUC 6 was given three weekly for six cycles in the present case. Six months after treatment completion, patient is on regular follow up and disease free on clinical and radiological examination.

Dermatofibrosarcoma Protuberans of Lumbar Region with Metastasis to Lung: A Rare Presentation

Dermatofibrosarcoma protuberans (DFSP) is a cutaneous slow growing soft tissue sarcoma associated with a high local recurrence rate. Common site of presentation is trunk followed by proximal extremity and head and neck region. A case of recurrent DFSP of left lumbar region with metastasis in lung in a 50-year-old woman presented here. Absence of symptoms often leads to a delay in diagnosis. DFSP is often mistaken for other skin conditions, particularly in its early stages.