Shahid Ali Siddiqui

Primary squamous cell carcinoma of the parotid gland: a rare entity

Primary squamous cell carcinoma of the parotid gland is a rare aggressive malignancy. It is a rapidly advancing lesion which, if not recognised and treated early, results in high morbidity and mortality. Despite radical surgery and adjuvant radiotherapy, prognosis of this cancer continues to be poor. Careful clinical and histological examination is mandatory to differentiate this tumour from metastatic squamous cell carcinoma and other primary malignancies of the parotid. The authors hereby report the case of a 50-year-old male patient who presented with a progressively increasing, painless mass in parotid region of 6 months duration. An initial fine-needle aspiration cytology and subsequent histopathological examination confirmed that the tumour was squamous cell carcinoma. As no other primary source could be demonstrated in the patient, a final diagnosis of primary squamous cell carcinoma of parotid was offered. Currently the patient is on regular follow-up without any signs of recurrence.

Papular skin lesions: Clue to a recurrence of breast cancer on fine needle non-aspiration cytology (FNNAC)

Cutaneous metastasis from underlying carcinoma is relatively uncommon in clinical practice. A high index of suspicion is required to diagnose these lesions, as these lesions can mimic benign skin lesions and clinical findings may be subtle. Fine needle aspiration cytology (FNAC) is commonly employed for diagnosing these skin lesions. However, it is often difficult to aspirate adequate material from small papular lesions. In these clinical situations, fine needle non-aspiration cytology (FNNAC) is proposed as an alternative procedure. FNNAC eliminates the negative suction pressure employed in FNAC and decreases the dilution of tumor cells by blood and hence yields adequate diagnostic material. We report here a case in which FNNAC was used in place of FNAC in diagnosing papular skin lesions. This procedure was carried out in a treated patient of carcinoma breast who was on regular follow-up and presented to us with a 20-day history of papular skin lesions over the chest and back. This article enlightens the clinicians about the utility of FNNAC, which is a relatively uncommon procedure.

Solitary fibular metastasis from nonsmall cell lung carcinoma

Solitary bone metastasis to fibula in patients of lung carcinoma is a rare entity, with only four cases reported in literature. We, hereby, present a case of a 50 year-old-male who was given three cycles of chemotherapy for lung carcinoma with no distant metastasis but presented 2 months later with a fusiform, painful swelling around the knee that was clinically suspected to be inflammatory in nature but proved to be fibular metastasis on cytology. There was no evidence of skeletal metastasis on initial bone scan. He was given palliative radiotherapy for this with symptomatic relief.

Infiltrating ductal carcinoma of breast with coexistent neurofibroma-a rare association

Breast cancer accounts for approximately one-quarter of all cancers in females worldwide and 27% of all cancers in developed countries with a western lifestyle [1]. It’s by far, the most frequent cancer among women, with an estimated 1.67 million new cases of breast cancer diagnosed in 2012 [2]. In India, about 145,000 new cases were diagnosed in 2012 and 70,000 deaths were attributed to it. The WHO Working Group has agreed on a more clinical follow-ups and a need of a genetic data for a better understanding of the natural history of these lesions [3]. Neurofibromatosis 1 is one of the most common genetic diseases in humans, presenting with multiple neurofibromas and an increased risk of various benign and malignant tumors, including breast cancer [4]. Neurofibromatosis type I (NF-1) is a complex multisystem autosomal dominant human disorder caused by the mutation of a gene on chromosome 17 which is responsible for production of a protein called neurofibromin. First report of an association between NF1 and breast cancer was published in 1972 [5] and subsequently several clinical cases of NF1 patients with breast cancer have been reported in the literature. Neurofibromatosis type II is a genetic condition which may be inherited or arise spontaneously. It’s caused by mutations in chromosome 22, also called as Merlin gene. The main manifestation of the condition is the development of symmetric, benign brain tumors in the region of the cranial nerve VIII. Schroeder et al. [5] first demonstrated an association between NF-2 and breast cancer [5]. Although only a minority of patients with NF1 develops malignancy as a complication of their disorder, cancer remains an important cause of morbidity and mortality in the disorder [4]. Moreover, oncologists may encounter patients with NF1 in the course of treatment for cancer, and need to be familiar with the diagnosis of the disorder and its clinical features.

Transition of Immunohistochemical Expression of E-Cadherin and Vimentin from Premalignant to Malignant Lesions of Oral Cavity and Oropharynx.

OBJECTIVES We sought to study the expression of epithelial-to-mesenchymal transition markers E-cadherin and vimentin in precancerous lesions of the oral cavity and oropharynx and to use the specific pattern of expression to predict invasiveness. METHODS This cross-sectional study looked at 87 cases of oral and oropharyngeal lesions obtained between December 2012 and November 2014 in the Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, India. Fifty-three biopsies from the buccal mucosa, tongue, and pharynx and 34 resected oral specimens were evaluated for premalignant and malignant lesions using hematoxylin and eosin and immunohistochemical stains. Immunohistochemical expression of epithelial marker E-cadherin and mesenchymal marker vimentin was evaluated wherever possible. Slides were examined for staining pattern (cytoplasmic or membrane), proportion, and intensity of staining of tumor cells. Patients follow-up and therapy related changes were also studied. RESULTS There were 64 premalignant and 23 malignant cases in our study with 65 (74.7%) cases seen in males and 22 (25.3%) cases seen in females. The majority of malignant cases, (n = 15; 64.2%) were seen in the fifth and sixth decades of life while most of the premalignant lesions (n = 36; 56.4%) were seen in the fourth and fifth decade. Amongst the 64 premalignant oral lesions, leukoplakia comprised of 14 cases (21.9%), of which three cases had associated mild to moderate dysplasia. The majority of premalignant lesions showed strong E-cadherin expression and decreased expression of vimentin with negative and weak expression in both dysplasias and carcinoma in situ (p = 0.013). E-cadherin expression was significantly reduced in invasive carcinomas compared to dysplasias and carcinoma in situ and the difference in immunoreactivity was statistically significant (p < 0.050). Vimentin expression increased as the tumor progressed from dysplasias to carcinoma in situ to invasive carcinomas (p < 0.050). CONCLUSIONS Invasiveness of cancer can be analyzed using E-cadherin and vimentin immunohistochemical stains, which can help in predicting tumor behavior. These biomolecules can also be used as biomarkers for further research on the microinvasion of oral cancers for early diagnosis.

Induction chemotherapy with cisplatin and ifosfamide in locally advanced inoperable squamous cell carcinoma of the head and neck: A single-institution experience

BACKGROUND Induction chemotherapy (ICT) in patients with head and neck cancer has been studied since a long time. The addition of taxanes to the cisplatin and 5-fluorouracil (5FU) (PF) regimen results in superior antitumor activity. We did this study to see the response and toxicity of ICT with cisplatin and ifosfamide followed by concurrent chemoradiotherapy (CRT) in locally advanced, unresectable squamous cell carcinoma of head and neck (SCCHN). AIMS The aim of this study was to see the results of ICT using cisplatin and ifosfamide regimen in locally advanced unresectable SCCHN in terms of acute and chronic toxicity and response to treatment. MATERIALS AND METHODS Patients with Stage III and IV, nonmetastatic SCCHN were enrolled in the study. They were given two cycles of ICT with cisplatin and ifosfamide followed by CRT. RESULTS After ICT, the overall response rate (ORR) was 75.0% at the primary site and 70.0% at the nodal site. ORR for combined primary and nodal disease was observed to be 67.5%. The complete response (CR) and partial response (PR) for combined primary and nodal site were seen in 4 (10.0%) and 23 (57.5%) patients. Of 32 patients who received CRT after ICT, CR was 53.1% and PR was 31.3%. Mucositis, skin reaction, and pharyngeal and laryngeal toxicities were the most common but tolerable. CONCLUSION ICT with cisplatin and ifosfamide gives comparable results to the standard paclitaxel, PF regimen. We conclude that this combination regimen for ICT is not only an economical alternative of taxol-based regimen but also well tolerated by the patients.

Pure primary squamous cell carcinoma of breast: A rare entity

Squamous cell carcinoma (SCC) of the breast is very rare malignancy, and only few cases have been reported in the literature. Also, it is aggressive in nature, and the standard treatment is still debated. We share our experience of a case of primary SCC of breast which was initially misdiagnosed as adenocarcinoma on fine needle aspiration cytology but later confirmed to be pure primary squamous cell carcinoma of breast on histopathological examination.

Associations of Age and Chemotherapy with Late Skin and Subcutaneous Tissue Toxicity in a Hypofractionated Adjuvant Radiation Therapy Schedule in Post-mastectomy Breast Cancer Patients

Aim: This retrospective study was conducted to evaluate the associations of age and two different types of chemotherapy regimens with late skin and subcutaneous tissue toxicities in an adjuvant hypofractionated radiation therapy (HFRT) schedule. Methods: We retrospectively reviewed the records of 120 breast cancer patients. Patients underwent modified radical mastectomy (MRM) and received anthracycline- and taxane-based chemotherapy before the application of HFRT. Late skin and subcutaneous toxicity were evaluated in accordance with the Radiation Therapy Oncology Group grading scheme. Univariate logistic regression analysis was used to predict the associations of old age (> 50) and taxane-based chemotherapy with late skin and subcutaneous tissue toxicities. Results: Grade 2 skin toxicity was found in 44 (42.3%) patients and Grade 2 subcutaneous tissue toxicity was found in 38 (36%) patients. Neither Grade 3 nor Grade 4 toxicity was observed. There was higher but not statistically significant risk of Grade 2 skin and subcutaneous tissue toxicity in patients over 50 years old. Types of chemotherapy were not significantly associated with Grade 2 skin toxicity and subcutaneous tissue toxicity. Conclusion: Old age (> 50) and taxane-based chemotherapy do not adversely affect late skin and subcutaneous tissue toxicity in adjuvant HFRT schedule in post-MRM breast cancer patients.

FNAB of metastatic lesions with special reference to clinicopathological analysis of primary site in cases of epithelial and non-epithelial tumors.

Aims: To ascertain the cytological diagnosis of metastatic lesions with special reference to the clinicopathological analysis of the primary site in cases of epithelial and non-epithelial tumors. Materials and Methods: One hundred seventy-one suspected metastatic lesions were aspirated with a 22-23G needle and the smears were fixed and stained. The cases in which the primary site was not evident at the time of initial presentation were subsequently subjected to thorough physical examination followed by radiological investigations for the search of the primary site. Histopathological examination was performed in 16 cases with inconclusive cytological impression. Observations: Of the total cases of metastatic lesions, 155 cases (90.6%) were diagnosed by fine needle aspiration biopsy and 16 cases (9.4%) by histopathology. The majority of the cases, 81 (47.4%), were observed in the fifth decade of life, followed by 76 cases (44.4%) in the sixth decade and 11 cases (6.4%) in the seventh decade of life. Lymph nodes were the most frequent site of metastasis in 115 cases (67.3%), with the majority in the cervical group. The oropharynx, including the oral cavity and pharyngolarynx, was observed to be the most common primary site, 55 cases (32.2%). Conclusion: The most critical aspect of the evaluation of metastatic cases is the accurate pathologic assessment of the malignant tissues in conjunction with pertinent clinical data. Such close collaboration between the clinician and the pathologist may maximize the diagnostic potential in treatable primary tumors.

Fine needle aspiration biopsy of metastatic lesions with special reference to clinicopathological analysis of primary site in cases of epithelial tumors

Aims and Objective : To ascertain the cytological diagnosis of metastatic lesions with special reference to clinicopathological analysis of primary site in cases of epithelial tumors. Materials and Methods: One hundred and seventy-one suspected metastatic lesions were aspirated with a 22-23-G needle and smears were fixed and stained. The cases in which the primary site was not evident at the time of initial presentation were subsequently subjected to thorough physical examination followed by radiological investigations for the search of the primary site. Histopathological examination was performed in 16 cases with inconclusive cytological impression. Results: Of the total 171 cases of metastatic lesions, 155 (90.6%) were diagnosed by fine needle aspiration biopsy and 16 (9.4%) were diagnosed by histopathology. Majority of the cases [81 (47.4%)] were observed in the fifth decade of life, followed by 76 cases (44.4%) in the sixth decade and 11 cases (6.4%) in the seventh decade of life. Lymph nodes were the most frequent site of metastasis [115 cases (67.3%)], with a majority in the cervical group. The oropharynx including the oral cavity and pharyngolarynx was observed to be the most common primary site in 55 cases (32.2%). Conclusion: An accurate pathologic assessment of the malignant tissues in conjunction with pertinent clinical data helps in the evaluation of metastatic cases.