Kapil Dev

Cystosarcoma phyllodes: Pathological enigma: A retrospective review of 162 cases.

PURPOSE Phyllodes tumor (PT) is a rare fibroepithelial neoplasm comprising <1% of all breast tumors. Clinical spectrum ranges from benign (B), borderline (BL), and locally recurrent to malignant (M) and metastatic type. The aim of our study was to analyze the clinicopathological factors, compare treatment options, and evaluate outcome in patients with PT. METHODS We retrospectively reviewed 162 women with PT. The surgical intervention varied from simple excision (lumpectomy)/wide local excision (WLE) in benign cases to simple/modified radical or radical mastectomy (SM/MRM/RM) in malignant and recurrent tumors. RESULTS Out of 162 patients, B, BL, and M were 95 (58.64%), 29 (18%), and 38 (23.45%), respectively. Mean age, duration of lump, and size were 38 ± 8 years, 28 ± 10 months, and 12 ± 5 cm, respectively. Recurrence rate with B, BL, and M was 15.78%, 41.37%, and 55.26%, respectively (P = 0.00001). As compared to WLE (22%), SM (23.8%), and MRM/RM (14.2%), recurrence was higher with lumpectomy (48.9%) (P = 0.004). Positive correlation was found between recurrence rate with the size of tumor (P = 0.008) and also number of recurrence with holoprosencephaly (P = 0.047). There was no association between the number of recurrences and size of tumor (P = 0.63). Malignant PT was seen in 38 (24%) and distant metastasis was seen in 7 (18%). Mean duration of follow-up was 42 months. CONCLUSION WLE with negative margins should be the initial surgery for PT. The role of adjuvant radiotherapy and chemotherapy is uncertain. PT is pathological enigma. Till date, no factors can accurately predict the recurrence and outcome. PT is known for unpredictable behavior and high recurrence rates, hence long-term follow-up is advised.

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

BACKGROUND The number of lymph node retrieved in the surgical specimen is important for tumor staging and has paramount impact on prognosis in colorectal cancer and imitates the adequacy of lymph node surgical clearance. The paucity of lymph node yields in patients undergoing resection after preoperative chemo radiotherapy (CRT) in rectal cancer has seen. Lower total number of lymph nodes in the total mesoractal excision (TME) specimen after CRT, could a marker of better tumor response. METHODS We retrospectively reviewed the prospectively managed data of patients underwent excision for rectal cancer, who treated by neoadjuvant radiotherapy with or without chemotherapy in locally advanced rectal cancer. From 2010 to 2014, 364 patients underwent rectal cancer surgery, of which ninety-one treated with neoadjuvant treatment. Standard surgical and pathological protocols were followed. Patients were categorized into two groups based on the number of total harvested lymph nodes with group 1, having 12 or more nodes harvested, and group 2 including patients who had <12 lymph nodes harvested. The total number of lymph nodes retrieved from the surgical specimen was correlated with grade of tumor regression with neoadjuvant treatment. RESULTS Out of 91 patients, 38 patients (42%) had less than 12 lymph nodes examined in specimen. The difference in median number of lymph nodes was observed significantly as 9 (range, 2-11) versus 16 (range, 12-32), in group 2 and 1, respectively (P<0.01). Patients with fewer lymph node group were comparable with respect to age, BMI, pre-operative staging, neoadjuvant treatment. Pathological complete response in tumor pCR was seen with significantly higher rate (40% vs. 26%, P<0.05) in group 2. As per Mandard criteria, there was significant difference in tumor regression grade (TRG) between both the groups (P<0.05). Among patients with metastatic lymph nodes, median LNR was lower in <12 lymph nodes group at 0.167 (range, 0.09-0.45) versus 0.187 (range, 0.05-0.54), difference was not statistically significant (P=0.81). CONCLUSIONS Retrieval of fewer than 12 lymph nodes in surgical specimen of rectal cancer who had received neo-adjuvant radiotherapy with or without chemotherapy should be considered as a good indicator of tumor response with better local disease control, and a good prognostic factor, rather than as a pointer of poor diligence of the surgical and pathological assessment.

Unilateral renal metastases after definitive chemoradiation in squamous cell carcinoma of esophagus: A case report and review literature

Kidney is considered to be the fifth most common site of metastases of esophageal carcinoma. Most of the metastatic renal tumors are bilateral, but a unilateral renal metastasis is extremely rare. There are only ten cases of unilateral renal metastases after curative treatment reported in literature. Herein is reported, a case of solitary, unilateral renal metastasis in a case of carcinoma esophagus after definitive chemoradiation treatment.

Inguinal Lymph Nodes in Carcinoma Penis-Observation or Surgery?

INTRODUCTION In Indian sub-continent the presentation of carcinoma penis is variable. Mostly presents with palpable inguinal lymph nodes but not confirm of metastases. AIM To evaluate whether all clinically positive nodes are metastatic and decide when to address inguinal lymph node. MATERIALS AND METHODS A retrospective observational study on carcinoma penis from a regional cancer centre of south India over a period from 2001 to 2012. All the clinical, investigational, operative, pathology details and follow-up data were collected from patient records. RESULTS Two hundred and thirty cases of carcinoma penis have been identified and 112 cases had clinically positive nodes. In 74 cases fine needle cytology was positive for malignancy and they have been addressed with block dissection with surgery of primary lesion. At two years follow up, 70 patients were identified with inguinal lymph node metastasis and block dissection was performed and all was were positive for malignancy on histology. The rate of recurrence is related to the T stage of the primary tumour. CONCLUSION It can be concluded that elective surgery is appropriate for palpable inguinal lymph nodes and prophylactic nodal dissection in high risk cases of carcinoma penis.

Oblique Pectoralis Anterior Muscle: a Rare Anatomical Variation of the Pectoral Region

The “oblique pectoralis anterior” an accessory muscle anterior to pectoralis major muscle originates from 4th and 5th costochondral junction with oblique orientation and inserts inferiorly to the anterior rectus sheath. We noticed an accessory muscle, superficial to pectoralis major with similar anatomy during mastectomy for

Solitary Gingival Metastases in Ewing’s Sarcoma of the Tibia

Oral soft tissue metastases are rare, accounts for 1%-8% of all oral cancers. Gingiva is the most common site among all soft tissue in oral cavity. Ewing’s sarcoma rarely metastasizes to gingiva. Here, we are presenting a case of Ewing sarcoma metastasized to lower gingiva after a long interval of primary treatment. Patient was managed with local radiotherapy, which has responded well and was followed by palliative chemotherapy. Although, its early recognition and local treatment by radiotherapy helps in improving quality of life but it is a poor prognostic sign.

Umbilical Metastasis in Ovarian Cancer: An Erroneous Sign of Advance Malignancy

Umbilical metastasis in ovarian cancer carries ominous clinical importance generally heralding the demise of the patient over relatively short period of time despite all attempts at controlling disease. Sister Mary Joseph’s nodule (SMJN) is defined as an irregular lump on the umbilicus, ranging from 0.5 to 2 cm, reaching up to 10 cm as a result of metastasis from visceral malignancies. It can be smooth, non-ulcerated or ulcerated necrotic mass with or without blood, mucinous, serous or purulent discharge [1,2]. Umbilical metastasis from intra-abdominal visceral malignancies is a form of SMJN. The term “Sister Mary Joshep’s nodule” was projected by Sir Hamilton Bailey for the umbilical metastasis of an abdominal malignancy in 1948. It can be a presenting symptom or sign of undiagnosed malignancy. Here, we have presented a classical example of SMJN with a diagnosis of umbilical metastasis in ovarian cancer as a primary presentation.

The Burden of Unplanned Excision of Soft Tissue Tumours in Developing Countries: A 10-Yearsâ Experience at a Regional Cancer Centre

Background: Local recurrence in soft tissue sarcomas is the major onus of the disease which could result in nonfunctioning extremities. The local recurrence of soft tissue tumours is the major morbidity and cause for this is the unplanned surgery at inexperienced peripheral centers. We noticed that a major proportion approximate one fourth patient with soft tissue tumours presented in outdoor, were with residual or recurrent lesion. Aim: The aim was to examine the clinical and pathological profile of soft tissue tumours that had undergone unplanned excision in aspect to the natural event of recurrence in respect to surgery which has been performed. Materials and methods: In total, 126 patients who had undergone prior surgery of the tumour without oncological planning presented to our institute with residual or recurrent soft tissue tumours between January 2005 to December 2014 were analyzed in a retrospective study. Results: There were a total of 126 patients analyzed. The mean age was 44.3 ± 16.9 years. Average duration from previous unplanned excision to presentation was 5.3 months (1-57 months). 29 patients were presented immediately after the first surgery with clinical residual lesion with a diagnosis of soft tissue sarcoma, while 97 patients presented after apparent local recurrence. Most of the tumours were almost evenly distributed among low and high grade (40.5% vs. 59.5%), superficial and deep seated (48.4% vs. 51.6%), and <5 cm in size (62.9%). 99 (78.6%) patients presented within 24 months after unplanned excision. 22 (17.4%) patients were presented with distant metastasis also with local recurrence. Conclusion: The appropriate planning regarding as diagnosis as treatment purpose for the soft tissue sarcoma without assuming the soft tissue mass as benign lesion. It helps to reduce the morbidity due to recurrence after inadequate surgical excision.