Gunjesh Kumar Singh

Multiple cutaneous metastases in a patient of carcinoma tonsil – Report of a rare case

Carcinoma tonsil with visceral metastasis is a rare entity, and cutaneous metastasis is seen even more infrequently. We present a case of a 55-year-old male with carcinoma tonsil having received concurrent chemo radiotherapy, presenting with multiple cutaneous metastases to the scalp and thigh. To the best of our knowledge, till date only two similar cases of carcinoma tonsil with cutaneous metastasis have been reported in the English literature.

Spectrum of fungal infection in head and neck cancer patients on chemoradiotherapy

BACKGROUND Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrier predisposing it to colonization and infection. Such infections often result in pain and burning sensation thus contributing to major morbidity. OBJECTIVE MATERIALS AND METHODS: Study was done on 50 patients of HNC treated with concurrent chemoradiotherapy. Three samples (throat, urine, blood) were collected for fungal culture and sensitivity. These samples were collected before the start of radiotherapy, during radiotherapy (2nd and 6th week) and post radiotherapy (10th week). RESULTS Only 49 patients were available for analysis. Fungal infection was found in 27/49 patients (55.10%) out of which Non-albicans Candida was isolated in 18/49 (36.73%) and Candida albicans in 9/49 (18.36%) cases. About 66.66% (18/27) isolates were sensitive to fluconazole. Maximum isolation of yeast was during 6th week of radiotherapy. All grade 4 and 71.42% of grade 3 oral mucositis were found in patients who were positive for fungal infection. CONCLUSION The spectrum of fungal species in throat swab was: Non-albicans Candida and Candida albicans observed in 36.73% and 18.36% of patients respectively. Higher rate of fungal colonization and infection was found in patients with grade 3/4 oral mucositis. Prophylactic fluconazole in HNC patients on concurrent chemoradiotherapy has the potential to reduce emerging invasive fungal infection and its associated morbidity.

Isolated Clavicular Metastasis in a Patient with Endometrial Adenocarcinoma

Endometrial adenocarcinoma metastasizing to bones is rare, and isolated metastasis to clavicle is even more uncommon. We report a case of a 60-year-old woman diagnosed with endometrial adenocarcinoma found to have isolated metastasis to the clavicle during adjuvant radiotherapy. Following radiation therapy to the clavicle, patient was started on injection zoledronic acid. She was then planned for chemotherapy comprising of Paclitaxel and Carboplatin for six cycles. Due to lack of compliance, 5months after the initial diagnosis, she developed severe dyspnea due to disease progression and expired. We hereby discuss the treatment options as well as review the literature of prior published reports on endometrial adenocarcinoma with bone metastasis.

Second primary malignancy: A retrospective analysis report from a tertiary cancer center of North India

AIM OF STUDY We analyzed the data of second primary malignancy (SPM) from one of the tertiary cancer centers of North India, and the basic aim was to retrieve incidence, prognosis, and outcomes. MATERIALS AND METHODS A retrospective study was conducted in the Department of Radiation Oncology in a tertiary cancer center between January 1, 2011, and December 31, 2015. A total of 6000 cases of cancer were analyzed, out of which cases who presented with histological proven synchronous SPM were included in this study. RESULTS The present study showed three cases (8.1%) of SPM who are attributed to field carcinogenesis. There were five cases in which metachronous malignancy develops in the previous radiation therapy field. There is 26% of synchronous malignancy as compared to 74% of metachronous malignancy. In the present study, most diagnosed synchronous malignancies were carcinoma breast, while in metachronous malignancies, carcinoma breast and gynecological cancers were most common. CONCLUSIONS SPMs are not very rare. Hence, pretreatment and follow-up evaluation should be meticulous to rule out SPMs.

Radiation-Induced Malignancies Making Radiotherapy a “Two-Edged Sword”: A Review of Literature

Radiotherapy is one of the modalities of treatment of malignancies. Radiation-induced malignancies (RIMs) are late complications of radiotherapy, seen among the survivors of both adult and pediatric cancers. Mutagenesis of normal tissues is the basis for RIMs. The aim of this review of literature was to discuss epidemiology, factors affecting and different settings in which RIM occur.

Unusual Sites of Metastases in Carcinoma Tongue – A Case Report

Cutaneous and renal metastasis in patients with squamous cell carcinoma of head and neck is a rare phenomenon. The reported incidence of skin metastasis in these cases is less than 1%, while the exact incidence of renal metastasis is still unknown. In the literature available only one case of renal metastasis from carcinoma tongue has been reported so far. We report a rare occurrence of isolated cutaneous and renal metastasis in an already treated case of carcinoma tongue.

Cytological diagnosis of a rare case of cutaneous metastasis from transitional cell carcinoma, renal pelvis

Transitional cell carcinoma (TCC) arising from renal pelvis rarely gives rise to cutaneous metastasis. Due to the insufficient literature, the exact incidence is not known till date. Moreover, the diagnosis is confirmed on histopathological examination with the aid of immunohistochemistry wherever needed. We are presenting a case of a 70-year-old female with metastatic TCC from the renal pelvis to the abdominal skin, which was diagnosed on cytology alone along with the cell block preparation. We also highlight the important cytomorphological and immunohistochemical features noted, which need to be known to avoid any diagnostic delay.

Lung metastasis in primary cutaneous adenoid cystic carcinoma – Clinicopathological evaluation of a rare case with review of literature

Primary cutaneous adenoid cystic carcinoma (ACC) is an extremely rare and indolent cutaneous malignancy with very infrequent distant metastasis. We present a case of primary cutaneous ACC with bilateral lung metastases in a 57-year-old male along with literature review. To the best of our knowledge this is the tenth case of primary cutaneous ACC reported presenting with distant metastasis.

Venous thromboembolism in cancer patients – magnitude of problem, approach, and management

Cancer is hypercoagulable state. Patients with cancer are at high risk to develop venous thromboembolism (VTE). Relative risk of developing VTE is approximately seven times higher in patients with active cancer. The incidence of occult malignancy is 7%-12% in patients with idiopathic deep vein thrombosis (DVT). However, little research has been focused on cancer with thromboembolism. Lowmolecularweight heparin most frequently used pharmacologic agents as recommended by established guidelines. The aim was to evaluate the magnitude of problem in cancer patients and treatment option as per established guidelines. EMBASE, MEDLINE, and PubMed search of the literature were done to evaluate the association of DVT with various malignancy, magnitude of problem, approach, and various guidelines for the management of DVT. References of all publication were also searched to enrich this article for recent update. Thromboprophylaxis in cancer patient is gray zone area. This need lot of investigational work to find highrisk patients who would benefit from primary thromboprophylaxis.

Clinico-pathological profile of colorectal cancer in first two decades of life: A retrospective analysis from tertiary health center

AIM This retrospective observational study was done to analyze age, gender, site of primary tumor and histological characterstics in patients of colorectal carcinoma in the first two decades of life. MATERIAL AND METHOD A total of 373 patients of colorectal patients were registered in the Department of Radiation Oncology from January 2010 to December 2015. Patients who were <20 years of age were analyzed for clinicopathological characteristic. RESULTS In our study, a total of 29 out of 373 patients (7.75%) were ≤20 years. Male to female distribution was 2.2:1. Younger age group presented with advanced Stage III and IV 58.62% and 10.34% patients, respectively. Only 9 (30.5%) patients were of Stage I and II. The most common involved site was rectum in 21 (72.41%) patients, followed by rectosigmoid involvement in 5 (17.24%). CONCLUSIONS Colorectal carcinoma in young adults is usually locally advanced or metastatic. Therefore, the diagnosis of CRC should be done at early and curable stage. Bleeding per rectum in a younger age group should not be ignored but must be properly evaluated.