Ashish Singhal

Association of Tuberculous Endometritis with Infertility and Other Gynecological Complaints of Women in India

ABSTRACT Endometrial biopsy samples derived from 393 patients with assorted gynecological complaints were investigated for mycobacterial infection. By employment of four different techniques, mycobacterial pathogens were detected irrespective of the nature/type of clinical complaint. Mycobacterium tuberculosis was the predominant pathogen detected among the samples investigated.

Vascular endothelial growth factor expression in oral cancer and its role as a predictive marker: A prospective study

Background: Oral cancer is one of the common cancers in India with dismal survival in advanced stages. Most of the patients present in advanced stages with borderline operability and such patients may be helped by chemotherapy to render them operable. It is well known that tumor growth is angiogenesis-dependent and thus vascular endothelial growth factor (VEGF) may be a surrogate marker of growth and angiogenesis. At present, there is a scarcity of predictive markers for oral cancer. In this prospective study, we studied VEGF expression and its role as a predictive marker in oral cancer. Materials and Methods: Patients with locally advanced oral cancer having borderline operability or unfit to undergo surgery in the primary setting were included in the study. VEGF expression of the cancerous tissue was studied in all patients. Three cycles of neoadjuvant chemotherapy (NACT) was administered before definitive treatment in locally advanced cases and response is assessed. VEGF levels were analyzed in cancer tissue and compared with normal surrounding mucosa. The response to chemotherapy was then correlated with VEGF score in patients receiving NACT to evaluate it as a predictive marker. Results: All forty patients were VEGF-positive and had a mean score of 1023 with 63% patients having Grade 3 expressions, whereas the normal surrounding mucosa had a VEGF score of 30. It was seen that in patients showing no response to treatment, the mean total VEGF score was significantly higher as compared to those showing complete or partial response. VEGF score correlated inversely with chemotherapy response, but no significant association was seen between VEGF grade and chemotherapy response. Conclusion: We can conclude from this study that VEGF is significantly overexpressed in cancer mucosa as compared to normal mucosa and overexpression of VEGF was found to be associated with chemoresistance and thus may serve as a negative predictive marker.

EpCAM-based Flow Cytometric Detection of Circulating Tumor Cells in Gallbladder Carcinoma Cases

Purpose: Liquid biopsy has entered the arena of cancer diagnostics in the past decade and detection of circulating tumor cells (CTC) is one diagnostic component. CTCs in gallbladder cancer (GBC) have hitherto not been comprehensively analysed. Methods and Results: The current study focused on the diagnostic role of CTCs in 27 cases of treatment-naive GBC and 6 normal controls as well as 6 cases of cholecystitis. An EasySep kit featuring negative immunomagnetic bead separation and flow cytometric detection of EpCAM positive and CD45 negative cells revealed CTCs in 25 of the 27 cases. At a cut-off point of ≥1, the CTC count discriminated GBC from controls with a sensitivity, specificity and diagnostic accuracy of 92.6%, 91.7% and 92.3%, respectively. CTC levels in turn correlated significantly with clinico-pathological parameters of cases in terms of known prognostic indicators, with significant diagnostic potential at a cut-off point of >4, to discriminate disease stage I and II vs. III and IV GBC. With a cut-off of >3, the CTC count discriminated tumor stages I and II vs. III and IV and at >6 CTCs could discriminate metastatic vs. non metastatic GBCs with a sensitivity, specificity and diagnostic accuracy of 55. 6%, 100.0% and 85.2, respectively. A review of CTC in pancreatico-biliary malignancies is included. Conclusion: Detection and quantification of CTCs may serve as a non-invasive biomarker for GBC diagnosis in correlation with radiological studies.

An unusual presentation of carcinoma sigmoid colon

Worldwide approximately 1,200,000 new cases of colorectal carcinoma (CRC) are diagnosed annually, and about half of them died. Lack of exercise along with obesity and consumption of red meat are thought to be associated with the development of CRC. Surgery is the primary modality of treatment which depends on size, site, and stage beside other associated factors. Histopathology along with general condition and extent of disease are stablished as an important prognostic factor. Chemotherapy and radiotherapy are used in the adjuvant and palliative setting. Here, we are reporting an interesting case of sigmoid colon carcinoma presenting as an advanced lesion over a very short span of time along with emphasizing the harm of unnecessary multiple investigations for diagnosis putting in the dilemma to both the patient as well as treating physician. This case also explains the interobserver variability as well as difference between the types of scan as well as reporting.

Chondrosarcoma of chest wall metastasising to the larynx: Case report and review of literature.

Chondrosarcoma is the most common malignant tumor of the chest wall. Most patients present with painful progressive swelling in the anterior chest wall arising from the costochondrosternal junction. CT scan with intravenous contrast is the investigation of choice. Wide excision with adequate margins is the standard treatment for localized disease after image guided biopsy. The role of chemotherapy and radiotherapy is limited. Lung is the most common site for metastasis. Metastasis to the larynx from chondrosarcoma has not been reported in the literature though primary chondrosarcoma can occur in the larynx. We hereby report a case of laryngeal metastasis from chondrosarcoma of the chest wall as a part of disease failure.

Carcinosarcoma of the uterus: Possible sequelae of long-term tamoxifen therapy for breast cancer

Carcinosarcoma (CS) of the uterus is rare and accounts for 1–2% of all uterine malignancies, occur commonly in postmenopausal women. These are highly aggressive tumors with poor prognosis and often present at advanced stage. Tamoxifen (TAM) has been known to increase the incidence of endometrial carcinoma from 1 to 2 cases per 1000 women/year and of uterine sarcoma from 0.04 to 0.17 cases per 1000 women/year. TAM has weakly estrogenic properties that can produce endometrial cell proliferation and, consequently, TAM use increases the risk of endometrial cancer by approximately two- to three-fold. Currently, no consensus is present regarding the management of Uterine CS. However, surgery plays an important role in the management along with chemotherapy (CT) and radiotherapy as an adjuvant. We report a case of a woman who developed malignant mixed mullerian tumor of uterus after taking TAM for 6 years as adjuvant hormonal therapy for breast carcinoma.

Osteosarcoma of the maxilla: A case report and review of literature

Osteosarcoma (OS) is the most common primary bone tumor of the jaw. It is rare, and the biological behavior differs from other skeletal bone tumors. OS of jaw is characterized by lower incidence of metastasis and better prognosis than OS of long bones. Surgery with adjuvant radiotherapy is the mainstay of treatment. The complicated three-dimensional anatomy of the head and neck region makes it difficult to obtain wide resection margins, leading to higher chances of recurrence. Death is usually caused by the uncontrollable local spread. We present a case of 61-year-old man with diabetes mellitus, who presented with an upper jaw swelling, which was histologically confirmed as OS of the maxilla. He underwent surgery and adjuvant radiation for the same. 1 year later, patient developed recurrence at the base of the skull which was inoperable. He received palliative chemotherapy for the same and is now under follow-up.