Shankar Lal Jakhar

Giant cell variant of malignant fibrous histiocytoma of male breast: A rare case report

Malignant fibrous histiocytoma (MFH) is the most common form of soft tissue sarcoma during middle and late adulthood in the deep connective tissue of the extremities, abdominal cavity, and retroperitoneum. However, primary breast sarcoma is a rare disease entity, comprising less than 1% of all breast malignancies. MFH of the male breast is very rare. We present a case of MFH of giant cell variant of the right breast in a 50-year-old male who presented with a painless lump. Following cytological investigation, simple mastectomy was performed. Immunohistochemical staining confirmed the diagnosis.

Astroblastoma of cerebrum: A rare case report and review of literature.

Astroblastoma is a rare neuroepithelial primary brain tumor of uncertain origin. They form 0.45-2.8% of all the neuroglial tumors. This tumor is usually localized in the cerebral hemisphere of young adults and children. The authors report a case of low-grade astroblastoma in a 16-year-old male and review the relevant literature. The patient presented with 2 months history of progressive headache with projectile vomiting for last 2 months. He underwent gross total resection of the lesion through right temporo-occipital craniotomy. Since tumor showed no evidence of high-grade lesion, adjuvant radiotherapy was not planned. However, the patient developed recurrence of the tumor after 12 months. Localized three-dimensional conformal radiotherapy was planned. In patients harboring anaplastic astroblastoma, gross-total resection and adjuvant therapy after the initial surgery seems to be the best choice. They can be easily misdiagnosed as they are rarely encountered in clinical practice and share common radiological and histopathologic appearance with other glial neoplasms.

Necessity of CT-MRI based treatment planning for cervical tumors with retroverted uterus: A case report with review of literature

Treatment of carcinoma cervix is a complex issue influenced by numerous factors, including the patients age, clinical stage of the disease, position of the uterus, comorbidities, etc. The major drawback of the conventional four-field box technique is the lack of complete information about the flexion of the uterus and topography of the tumor. These are further influenced by bladder and rectal filling, which may lead to geographical miss of the clinical target volume (CTV). This problem was noticed mainly in the anterior and posterior borders of the lateral fields and in the superior and lateral borders of the anteroposterior fields. We demonstrate the need for computed tomographic-magnetic resonance imaging (MRI)-based 3D planning of each patient and necessity of sagittal MRI for designing lateral portal in case of conventional four-field technique through an example of a patients sagittal MRI of pelvis showing retroverted uterus.

Kikuchi-Fujimoto disease: A diagnostic and therapeutic challenge

Kikuchi-Fujimoto disease (KFD) is a rare, benign, self-limiting disorder that generally presents with cervical lymphadenopathy. Recognition and early diagnosis of this condition is very critical as it can be easily mistaken for tuberculosis, lymphoma or systemic lupus erythematosus. It predominantly affects young adults (mean age 20-30 years), with a slight preponderance in females. There have been very rare reports of KFD in childhood or elderly. We report case of a 9-year-old female child who presented with fever and cervical lymphadenopathy. Examination of other systems and laboratory investigations were normal. Biopsy of the cervical node showed features suggestive of histiocytic necrotizing lymphadenitis (KFD). CD20, CD3 and CD68 stained positive while CD15 and CD30 were negative, thus confirming the diagnosis. The child was treated with steroids and complete remission occurred in few weeks. Although the incidence of KFD is rare, clinicians should be aware of this condition as early recognition and diagnosis of the disease will minimize unnecessary investigations and cytotoxic treatments.

Is There Hope For Breast Cancer Patients Without Surgery??: An Institutional Retrospective Disease Free Survival Study.

Background: Recently incidence of carcinoma breast has increased many folds and surpassed cervical malignancy. Management of breast carcinoma has multi modality treatment. One or the other modality, sometimes surgery is not acceptable for patients due to many reasons. Material and method: In retrospective disease free survival study, a group of disease free patients were found who had refused for surgery and were treated by chemoradiotherapy alone. Results: Among the 25 patients, 17 patients (68%) were treated more than 10 years back, 5 patients (20%) 6 years back and 3 patients (12%) 2 years back. All these patients were disease free for above post treatment periods till april 2017. Conclusion: Hope should not be lost for those in whom surgery is not done, this method of alone chemoradiotherapy may also yield acceptable results in terms of survival, disease free survival and cosmetic effects in some patients.

Age wise distribution of colorectal cancer: An institutional observational study

Background: Overall, the incidence of colorectal cancer appears to be stable or diminishing. However, based on our regional cancer institute’s datas, we have observed the increasing incidence of colorectal cancer in patients ≤40 age. The aim of this study was to verify the rising trend, clinico-pathological features and survival in colorectal cancer in patients ≤40,in comparison to patients >40 age. Materials and methods: A retrospective study was conducted to review all patients≤ 40 age and more than 40 year of age separatly with a diagnosis of colorectal cancer from January 2004 to December 2012. Results: Young patients were 24.17% of total 1096 colorectal cases. In young patients 60.37% were male and 39.63% were female. 9% young had family history & only 8% had history of alcohol intake. Onset of symptoms to reaching diagnosis period is longer in younger patients.(Range 3 months to 1 year in young, while 1 months to 6 months in older). Higher pathological T stage was seen in the younger age group when compared with patients above 40 years. Also the younger age group showed more advanced N stage when compared with patients above 40 years. With final TNM staging, in younger age group 66% were in stage IV and 30% were in stage III. Eighty percent of all young cancer deaths were within 22 months (from 8months to 22 months). Conclusion: Above results show the aggressive nature and late diagnosis of carcinoma colorectal in young. These data highlight a need for thorough evaluation of young with colorectal symptoms and in high risk population, also life style modification agenda by Govt .or non Govt. organization.

Superiority of Concurrent Chemo Radiation Over Sequential Chemo Radiotherapy for Palliation of Dysphagia in Carcinoma Esophagus, A Reterospective Study

Aim: Positive results of many Trials have incorporated concurrent and sequential chemo radiotherapy in treatment of inoperable carcinoma esophagus. But concurrent chemo radiation therapy is similar to that achieved by surgery alone. The main plea of concurrent chemoradiation in esophageal cancers is early regression and palliation of dysphagia for long time. The aim of this study to analyse the modalities of treatment available for palliation of dysphagia in carcinoma esophagus and determine the most effective option among them. Materials and Methods: Between September 2011 to December 2013,50 patients of esophageal cancers were treated in our institute, 25 patients in sequential and 25 in concurrent chemo radiotherapy arm. Swallowing function was assessed in these patients by the use of a swallowing-function scoring system. Results: Assessment of response in two arms were done for grade of dysphagia palliation, Complete Response at 6 months and toxicity. Dysphagia scores improved in 88% in study arm and 64% in control arm. In study arm 28% male and 52% female patients, while in control arm 40 % male and 28% female patients presented with CR in primary tumor and mediastinal lymph node. There was statistical significant difference in toxicities of TLC and ANC between both arms. Grade 2 and 3 toxicities were 40% and 4% for TLC and were 28% and 0% for ANC in study and control arm respectively (p = 0.013 ,p=.014). This may be due to concurrent use of chemotherapy with radiation in study arm that also showed synergism for toxicity of TLC and ANC. Conclusion: Concurrent Chemo Radiotherapy is a more aggressive approach for dysphagia control, which is beneficial for those patients with good performance status .This approach is used as an alternative to stenting. This combination is more effective than neoadjuvant chemoradiation for improving dysphagia scores and QoL in inoperable esophageal cancers .

Maintenance gemcitabine versus best supportive care following platinum-paclitaxel chemotherapy for patients with advanced nonsmall cell lung cancer

Background: Approximately two-thirds of all patients with newly diagnosed nonsmall cell lung cancer (NSCLC) have advanced disease (Stage IIIB or IV) that is only amenable to palliative chemotherapy. Switch maintenance therapy with a different active agent aims to hit clonal variants resistant to the first-line therapy before they have had time to increase in number. Based on this, we conducted a randomized Phase III study to compare gemcitabine (Gem) versus best supportive care (BSC) as maintenance therapy. Methods: Between July 2011 and January 2012, chemo-naive patients with Stage IIIB/IV NSCLC were initially treated with six cycles of cisplatin (40 mg/m2 day 1, 2) and paclitaxel (175 mg/m2 day 1) every 3 weeks. Subsequently, nonprogressors were randomized 1:1 to receive maintenance G (1000 mg/m2 on days 1 and 8 every 3 weeks) or BSC alone till disease progression. The primary endpoint was a comparison of overall survival (OS) between two arms, and the secondary endpoint was progression-free survival (PFS). Results: Exactly 134 patients were enrolled (median age: 50 years, males 76.8%, Stage IV disease 50.7%, Eastern Cooperative Oncology Group performance status 0/1: 67.9%). Following 6 cycles of initial therapy, the Response Rate (RR) was 35.1% (Complete Response (CR) 3%, Partial Response (PR) 32.1%), and 38.8% had stable disease. Ninety-nine nonprogressors were randomized to receive Gem (n = 50) or BSC (n = 49). The median OS for Gem was 10 months (95% confidence interval [CI]: 9.2–10.7) and 8 months (95% CI: 6.7–9.2) for BSC, with a hazard ratio (HR) 0.64 (95% CI: 0.51–0.77, P = 0.002). The median PFS was 9 months (95% CI: 8.1–9.9) for G versus 7 months (95% CI: 6.3–7.7) for BSC, with a HR 0.67 (95% CI: 0.50–0.84, P = 0.009). Maintenance therapy was tolerated well despite a higher incidence of grade 3/4 toxicity (anemia 12% vs. 8.1%; neutropenia 18% vs. 4.1%; thrombocytopenia 14% vs. 2%; and fatigue 8% vs. 2%). Conclusion: Switch maintenance therapy with gemcitabine, following initial platinum-based doublet chemotherapy in advanced NSCLC can produce significantly longer PFS and OS compared to BSC alone at the cost of higher grade 3/4 hematological toxicities.

Recurrent epithelioid sarcoma of wrist: A case report and review of literature

Epithelioid sarcoma is a rare variety of soft tissue sarcoma that affects young adults mostly involves forearm and hand. It mainly presents as a painless slow growing mass, but can present as multifocal lesions. It has a high rate of recurrence and metastasis. A 35-year-old male presented to our department in November 2013 with a painful ulcer with bloody discharge in the medial side of left wrist. The patient gave a history of swelling with serous discharge from 11 years. Local excision was done 6 times from 2003 to 2011. The patient also gave a history of falling on an outstretched hand and swelling at same site in July 2013, this time again wide local excision was done. The histopathology report was suggestive of high-grade osteogenic sarcoma. Immunohistochemistry (IHC) showed expression of cytokeratin, epithelial membrane antigen, CD34 and CA-125; tumor cells had lost INI-1 expression. IHC confirmed the diagnosis of epithelioid sarcoma of left wrist. Contrast-enhanced computed tomography thorax was suggestive of lung metastasis. Thus, doxorubicin based chemotherapy was planned.

Prognostic factors affecting the survival of patients with brain metastasis treated by whole brain radiotherapy: A regional cancer center experience from North West India

Background: Brain metastases are unfortunate consequences frequently found in patients with advanced cancer. The prognosis is poor with an average expected survival time of <6 months by all possible efforts (including radiotherapy). This retrospective study aims to determine survival and prognostic factors in patients with brain metastases who underwent whole brain radiotherapy (WBRT). Materials and Methods: From January 2005 to August 2010, a total of 186 patients with brain metastasis was analyzed with the help of available medical records. Of these, 140 patients who received WBRT ΁ chemotherapy were included in this study. The prognostic factors evaluated for overall survival were age, gender, Eastern Cooperative Oncology Group performance status, number of lesions, primary tumor site, extracranial metastases, chemotherapy, and radiotherapy. Results: The median overall survival was 4 months (95% confidence interval: 3.56-4.43), while 1- and 2-year survival rates were 8.57% and 3.57%, respectively. The most common primary tumor sites were the lung (n = 82; 44.08%) followed by the breast (n = 46; 24.73%), kidney (n = 11; 5.91%), and unknown primary (n = 11; 5.91%). The median overall survival was maximum (4 months) in patients with breast cancer. The 1-year overall survival rate was 8.57% (n = 12) for the whole group and 18.2% (6/33) in breast cancer patients (P = 0.058). In this study, the patients with higher performance status (P = 0.199), solitary brain metastasis (P < 0.0001), female (P = 0.201), and primary tumor under control (P = 0.223) had better survival. Conclusion: This study suggests that overall prognosis of patients with brain metastasis remains to be poor, 1-year survival being <10%. Patients with solitary metastasis and carcinoma breast have comparatively better prognosis.