Increasing sophisticated information suggests that cancer cells express constitutively active oncogenic kinases such as breakpoint cluster region- c-abl oncogene 1, non-receptor tyrosine kinase (BCR-ABL1) that promote carcinogenesis independent of extrinsic growth factors. It is a well-established fact that through the aberrant activation of BCR-ABL1 signal transduction cascade, the perception of cellular growth signals becomes disconnected from the processes promoting cell growth, and this underlies the pathophysiology of leukemia. In this particular review we discuss the oncogenes and tumor suppressors comprising the regulatory network upstream and downstream of BCR-ABL1 and dismantle how derailed BCR-ABL1 signaling provides cell a selective growth advantage. Besides, we discuss why activation of BCR-ABL1, as an outcome of distinct oncogenic events, results in miscellaneous clinical outcomes, and how the intricacy of the BCR-ABL1 signaling network might dictate therapeutic approaches. In this review, our current comprehension of BCR-ABL1 signaling will be summarized.

Leukemia is a many-sided molecular disorder that arises because of over expression of oncogenes, suppression of tumor suppressor genes, and chromosomal translocations. These chromosomal rearrangements are nonetheless among the many determinants that underlie transformation of cells from normal to a cancerous phenotype and predispose cells to refractoriness against interventions by reduced drug influx and substantial drug efflux. This review unfolds current understanding of BCR-ABL1 (break point cluster region-c-abl oncogene 1, non-receptor tyrosine kinase) signaling with a focus on apoptotic suppressive mechanisms and alternative approaches to chronic myeloid leukemia therapy.

Breast cancer is a leading problem in developing world and India can be considered as one of the major contributors for incidence of breast cancer. In this article authors have reviewed quality of life studies on Indian breast cancer population. There are many factors which may hear common but cannot be neglected in case of Indian population. Policies and future directions to be implemented for breast cancer are also discussed.

Background and Purpose: Advanced epithelial ovarian cancer is associated with high relapse rates. Various consolidative therapies, including whole abdominal radiationtherapy (WAR), have been tried in the past with limited success. We report here a feasibility study and clinical outcome of WAR with helical tomotherapy (HT). Materials and Methods: Eight patients with relapsed carcinoma ovary after standard treatment and deemed not suitable for further chemotherapy were treated with WAR using HT. All patients underwent intensity-modulated radiotherapy (IMRT) planning process and a dose of 25Gy/25#, at 1Gy/# to the whole of the abdomen [abdominal planning treatment volume (PTV)] with a simultaneous boost of 45Gy/25#, at 1.8Gy/# to the pelvic PTV was prescribed. Results: There was an excellent coverage in both abdominal and pelvic PTVs.The V _95% (volume covered by the 95% isodose) and V _107% (volume receiving 107% dose) was 95.6 (±2.7)% and 2.6 (±0.5)% for abdominal PTV and 95.7 (±2.4)% and 0% for pelvic PTV, respectively. With a median follow-up of 15 months (10-24 months, mean: 14 months), 3patients developed disease recurrence. All 3recurred in the peritoneum, one progressed to intestinal obstruction and fatal septicemia. Conclusion: WAR in recurrent/relapsed epithelial ovarian cancer is feasible with acceptable toxicities.

Aim: The present study was designed to explore the radiation-resistance mechanism by interfering in checkpoints kinase 1 (CHK1) and DNA-activated protein kinase (DNA-PK) genes with short hairpin RNA (shRNA) transfection into Skov3 cells derived from ovarian cancer and HeLa cells derived from cervical cancer. Materials and Methods: The cultured Skov3 and HeLa cells were transfected with plasmid vectors containing CHK1 shRNA and DNA-PK shRNA, respectively, through Lipofectimine™ 2000 mediation, and cultured for 20 hours before exposure to 2 Gy X-radiation. The cells were harvested 4 and 28 after X-irradiation respectively then washed 3 times with PBS. These cells were stained with Annexin V/PI and applied by flow cytometer to analyze alteration of apoptosis with software CellQuest. Results: The apoptotic response in Skov3 cells to X-radiation was significantly lower than that in HeLa cells at 4 hour (t = 15.22, P < 0.001) and 28 hours (t = 15.78, P < 0.001) of post-irradiation. The shRNA might not affect the apoptosis of Skov3 and HeLa cells, while shRNA-transfection significantly enhanced the apoptotic response in Skov3 cells to X-radiation as compared with that in HeLa cells. Conclusions: The present work suggests that the CHK1 and DNA-PK genes are very likely to play a role in developing a radiation resistance in ovarian cancer.

Context: Cervical cancer is a preventable disease; it is the primary cancer amongst women in South Africa. Aims: The objective of this study is to assess the awareness and detection methods of cervical cancer. Settings and Design: This was a cross-sectional study conducted among 180 full time final year undergraduate female university students. Materials and Methods: A multistage sampling technique was used to select the sample and self administered questionnaire was used to collect the information. Statistical Analysis Used: Chi-square test and logistic regression were used to find association and the significant predictor for doing Pap smear test. Results: Over half (53.3%) of the participants had heard about cervical cancer and its detection method. More than half (60%) and over a third (37.8%) of the participants knew about human papilloma virus (HPV) and multiple sexual partner respectively as risk factors for cervical cancer. More than half (55.3%) indicated that they were not aware if cervical cancer can be prevented. Majority (76.7%) knew that Papanicolau's (Pap) smear test is used for detection or prevention of cervical cancer. Among those who were sexually active and knew about Pap smear test 79.3% did not do the test mainly because of personal factors such as fear of the procedure, or were not ill. Conclusions: Level of awareness regarding cervical cancer and its detection method was low among these female students. The university management should focus on developing policies on health education and promotion to prevent transmission of the HPV.

Aim of Study: In this study, we detected epithelial circulating tumor cells (CTCs) that expressed cytokeratins and potential circulating tumor cells (pCTCs) that had lost expression of cytokeratins in metastatic breast cancer (MBC) patients. The aim of the study was to evaluate the prognostic significance of these two kinds of CTCs in MBC patients. Materials and Methods: We detected CTCs and pCTCs from 66 MBC patients using MACS immunomagnetic enrichment technology combined with immunocytochemistry (ICC). A cutoff score of 5 CTCs (or pCTCs) was set as a benchmark for prognosis in patients. Progression free survival (PFS) was calculated and analyzed during the following 24 months. Results: We evaluated the sensitivity of this method and recovery rates of the CTCs by spiking experiments. The loss number of tumor cells by our method was 0-15. The population with fewer than 5 CTCs showed significantly higher PFS than the group with 5 or more CTCs. The difference in PFS between the patients with 5 or more pCTCs and those with fewer than 5 pCTCs was statistically significant. The presence of these pCTCs more accurately predicted poor prognosis than the CTCs that express cytokeratins. Conclusions: There is a subset of CTCs that lose epithelial markers such as pCTCs. Due to the heterogeneity of the expression of epithelial antigens in CTCs, different subtypes of CTCs exist. Independently of CTCs, the groups of patients with pCTCs had poorer prognoses.

Background: Gestational trophoblastic neoplasia (GTN) includes a spectrum of disease ranging from hydatidifrom mole to choriocarcinoma. Low risk GTN is defined as persistent molar pregnancy with a WHO score lower than seven. The optimal chemotherapeutic regimen still remains controversial. Aim: The objectives of this study was to determine efficacy and safety of weekly intramuscular methotrexte in the treatment of low risk gestational trophoblastic neoplasia.(LRGTN) and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Materials and Methods: Sixty-six women with LRGTN from 2001 to 2009 were treated with weekly intramuscular methotrexate at 40mg/m ² as first line therapy.Monitoring of treatment was done with weekly checking of βhCG level. Three consecutive negative βhCG measurements showed complete response. After first negative βhCG measurement, one additional dose was administered for consolidation. Results: Of 66 patients, who started the treatment five continued their treatment in other medical centres and were excluded from final analysis for treatment evaluation, and seven discontinued first line therapy because of hepatotoxicity. Of the remaining 54, complete remission occurred in 43 (79.6%) and eleven were resistant to first line therapy. Mean WHO score prior to starting chemotherapy was significantly different between two groups of response and resistance according to our data. Change of treatment to second line Actinomycin-D was necessary in eigtheen cases because of resistance to first line in eleven and liver enzyme elevation in seven patients. Sixteen of these 18 responded to Actinomycin-D as second line and one needed hysterectomy for complete response. One patient received multiagent chemotherapy for complete remission. Conclusion: We recommend this effective and safe method of chemotherapy for women with LRGTN. According to our data, lower mean WHO score predicts a better outcome for this regimen.

Context: The data on histological and receptor status in breast cancer in an Indian population is limited as receptor status is not routinely carried out for these patients. In the present study, receptor status was analyzed and it was correlated with morphological prognostic parameters. Objective: To analyze the morphological prognostic parameters and its correlation with receptor status in Indian women. Design: The sample consisted of 126 specimens of invasive breast cancer received in department of pathology of our institution with teaching hospital attached to it, situated in South Canara district of, Karnataka, South India between year 2009 and 2011. Result: Sixty-seven percent of patients were 50 years or younger. Histological types were invasive ductal carcinoma, not otherwise specified (58.7%), and overall (15.9%) were grade 3. Estrogen receptor was positive in 36.5%, HER/neu was overexpressed in only three cases; 50.0% were "triple" negative (estrogen receptor, progesterone receptor, HER/neu negative). Estrogen receptor (ER) and progesterone receptor (PR) positivity decreased with increase in tumor grade. There was significant association between tumor size and ER positivity. Conclusions: Breast carcinoma in our population presents at younger age than Western population. Our results showed very high proportion of triple-negative breast cancers. The tumor size and grade is related to expression of only ER. The findings suggest that women in our population more often have histologically aggressive breast carcinoma at young age, likely to be less susceptible to conventional hormonal and targeted antibody treatment. Detecting and treating this increasing important cause of mortality will be an enormous challenge.

Aim of the Study: To study the effect of Thespesia populnea on Cisplatin induced Nephrotoxicity. Materials and Methods: Experiments were conducted on Male Sprague Dawley Rats (4-6 weeks old) weighing 100-120g B.Wt. The drug under study was cisplatin, which is an anticancer drug. Thespesia populnea extract was used to test its ability to alleviate the harmful effects of cisplatin. The animals were divided into three groups: Group I was considered as normal, Group II was given a single dose of cisplatin (6 mg/kg/b.wt., i.p) and they constituted the control animals and Group III was treated with cisplatin along with Thespesia populnea (5 mg/kg/b.wt., i.p) for 10 consecutive days. Results: Administration of cisplatin resulted in significant (P < 0.05) increase in the levels of serum urea (137 ± 1.6), creatinine (1.69 ± 0.14), ALT (96.18 ± 3.44), AST (80.84 ± 3.34) and bilirubin (4.57 ± 0.08) as compared to normal animals. On the other hand, introduction of Thespesia populnea extract caused a significant (P < 0.05) reduction in the levels of serum markers namely urea (112 ± 2.16), creatinine (0.54 ± 0.004), ALT (76.4 ± 1.45), AST (58.80 ± 1.6) and bilirubin (3.96 ± 0.85). Discussion: Increase in the levels of urea and creatinine in serum as well as ALT, AST and bilirubin is suggestive of both kidney and liver damage. Thespesia populnea extract ameliorated cisplatin induced kidney and liver damage as indicated by reduction in the levels of serum urea, creatinine, AST, ALT and bilirubin. Reduction in the levels of these biochemical markers is an indication of regeneration process. Thus it is concluded that the extract might contain nephroprotective compounds such as flavonoids, alkaloids, etc. which are responsible for alleviating cisplatin induced toxicity.

Objectives: To investigate the effect of M-ds-P21 on the apoptosis of bladder cancer T24 cells and its potential mechanism. Materials and Methods: Effect of M-ds-P21 on T24 cells were assessed by cell morphology and Western blot. Apoptosis was quantified by Annexin-V flow-cytometry analysis. To uncover the role of P53 in M-ds-P21-mediated apoptosis of T24 cells, we knocked down P53 before treating cells with M-ds-P21, and then assayed P21 and apoptosis-related protein by Western blot. To uncover the mechanism by which M-ds-P21 played stronger effect than ds-P21, we performed confocal microscope analyses. Results: Both M-ds-P21 and ds-P21 treatment changed the cell morphology, leading to cell apoptosis after 3 days. Apoptosis induced by M-ds-P21 and ds-P21 treatment is not P53-dependent but caspase-dependent. Compared with ds-P21, M-ds-P21 significantly increased the bioavailability of ds-RNA in T24 cells. Conclusions: M-ds-P21 treatment induces more apoptotic population than ds-P21 does. The mechanism for stronger effect of M-ds-P21 is partly due to the enhanced bioavailability of ds-RNA in human bladder cancer T24 cells, and not P53-dependent but caspase-dependent.

Objective: We retrospectively analyzed patients with spinal ependymomas who were treated in our institute. We correlated outcome and recurrence with clinical and pathological features. Materials and Methods: Between January 2000 and January 2010, we treated 14 patients with spinal ependymoma (10 males, 4 females; mean age: 48.3±18 years, range: 18-79 years). All patients were operated and received standard postoperative care. The outcome was estimated based on Frankel scale. Results: The most common presenting symptom was pain. All tumors were operated through a posterior approach and gross total resection was performed in 13/14 cases. Histopathological examination revealed the presence of one anaplastic ependymoma, nine grade II ependymomas, and four myxopapillary ependymomas. The mean Ki-67 index was 1.5%. All the patients were followed up postoperatively for an average of 5.1 years. One patient was reoperated because of recurrent disease and another received radiotherapy due to dissemination of disease. No association was found between extent of resection, tumor location, Ki-67 index, and recurrence of disease. There was a trend toward a higher risk of recurrence in myxopapillary ependymomas. Eight patients improved postoperatively. Interestingly, during the follow-up period, four patients developed a secondary neoplasia. Conclusion: Early intervention and gross total resection of spinal ependymomas are associated with a favorable outcome. Further studies are needed to clarify the incidence of the development of a second cancer in these patients.

Aim: Complex geometry of breast tissue causes perturbation in dose distribution. This problem can beget overdose or under-dose points in match region of three fields. The aim of this study is to create dose homogeneity distribution in match region between tangential and supraclavicular fields (SCF) with Gafchromic external beam therapy (EBT) film. Materials and Methods: In this study, an anatomical slab phantom was designed with cork lung inhomogeneity and plexiy colored heart part. Conventional and three dimensional (3D) methods were utilized along with Gafchromic EBT film. Results: In asymmetric fields (3D method) much better results in match region were observed (i.e., maximum amount overlap area of 0.43 cm ² , overlap depth of 3.55 cm and an average overlap width of 0.75 cm). Conclusion: This study revealed that EBT film is a proper tool for two dimensional (2D) relative-dose measurements. The study showed difficulties in achieving homogenous dose distribution in match region of tangential and supraclavicular.

Introduction: The classification of acute leukemias has revolutionized over the years. Immunophenotyping of acute leukemia has gained popularity because of its influence on treatment and prognosis of the disease. The various antigens expressed by the leukemic cells can be assessed by flowcytometry (FCA) and can be used in rendering specific treatment and predicting the outcome of the different types of acute leukemia. Aims: The main aim of this study was to compare the morphologic and cytochemical diagnoses with flowcytometric diagnoses in acute leukemia and to analyze the usefulness of FCA over morphology. Results: In this study we analyzed 50 cases of acute leukemia and found concordance rate as high as 86% between morphologic/cytochemical diagnosis and flowcytometric diagnosis. Of these, complete concordance was seen in 58% of the cases and partial concordance was seen in 22% of the cases. Non-concordance was seen in only 4% of our cases. In remaining 16% of our cases FCA helped in sub classifying the acute leukemia where morphology and cytochemistry had failed to do so. CD19 and 20 were found to be consistent B-cell markers and CD3 was a very specific marker for T-cell leukemia. CD13 and 33 were important myeloid markers and were aided by other secondary panel of markers like CD14, CD117 and CD41. Conclusion: FCA not only helps in confirming morphologic diagnosis in acute leukemia but also helps in assigning specific lineage to the blasts, particularly in acute lymphoid leukemia. Immunophenotyping is of utmorst importance in classifying acute leukemia as it greatly influences the treatment and the prognosis.

Background: Microsatellite instability (MSI) is a form of genetic instability characterized by new alleles not present in the normal genotype. This mutation occurs by altered DNA mismatch repair (MMR) genes. Studies of limited numbers of patients have reported conflicting results regarding the association of the MSI phenotype with gastric cancer. This study aims to evaluate the clinical significance of mismatch repair genes in gastric cancer. Materials and Methods: We studied 156 gastric cancer patients who underwent gastrectomy from March 2010 to February 2011 in our hospital. Mismatch repair status was determined by the immunohistochemical analysis of human MutL Homolog 1 (hMLH1) and human MutS Homolog 2 (hMSH2) expression. Results: Seventeen (10.9%) cases did not express hMLH1 but all cases expressed hMSH2. In univariate analyses, the expression of hMLH1 was associated with age, nodal status, and Lauren's classification. In multivariate analyses, there was no statistically significant association between the loss of hMLH1 expression and selected clinical parameters. Conclusion: The expression of hMLH1 was associated with age, nodal status, and Lauren's classification. Our results suggest that MMR gene abnormalities play an important role in the tumorigenesis of patients demonstrating gastric cancer.

Background: Tobacco use has been associated with various carcinomas including lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix. Biomarkers such as concentration of cotinine in the blood, urine, or saliva have been used as objective measures to distinguish nonusers and users of tobacco products. A change in the cut-off value of urinary cotinine to detect active tobacco use is associated with a change in sensitivity and sensitivity of detection. Aim: The current study aimed at assessing the impact of using different cut-off thresholds of urinary cotinine on sensitivity and specificity of detection of smoking and smokeless tobacco product use among psychiatric patients. Settings and Design: All the male subjects attending the psychiatry out-patient department of the tertiary care multispecialty teaching hospital constituted the sample frame for the current study in a cross-sectionally. Materials and Methods: Quantitative urinary cotinine assay was done by using ELISA kits of Calbiotech. Inc., USA. We used the receiver operating characteristic (ROC) curve to assess the sensitivity and specificity of various cut-off values of urinary cotinine to identify active smokers and users of smokeless tobacco products. Results: ROC analysis of urinary cotinine levels in detection of self-reported smoking provided the area under curve (AUC) of 0.434. Similarly, the ROC analysis of urinary cotinine levels in detection of self-reported smoking revealed AUC of 0.44. The highest sensitivity and specificity of 100% for smoking were detected at the urinary cut-off value greater than or equal to 2.47 ng/ml. Conclusions: The choice of cut-off value of urinary cotinine used to distinguish nonusers form active users of tobacco products impacts the sensitivity as well as specificity of detection.

The incidence of bone metastasis in head and neck Squamous cell carcinoma is very uncommon. Aim: This retrospective study was done to identify the frequency, clinical presentation, and the clinical course of the metastatic disease to bone from head and neck primary. Material and Methods: Out of 624 patients of head and neck cancers seen in our clinic 6 patients developed metastasis to solitary or multiple bones during the course of the disease. Results: Postoperative patients had multiple bone involvement whereas others had solitary bone involvement. Main bones involved were parietal bone of skull, shaft of humerus and femur, sacrum, and ribs. All the patients had survival of few months only after developing metastasis. Conclusion: Improvement in technology has resulted in improved results in advanced head and neck cancer patients; hence measures should be taken for complete responders to diagnose this metastasis early and treat them appropriately.

A 45-years old man complained of hematuria, and subsequent examination and ultrasonography revealed a mass in the left kidney. Nephrectomy was performed and macroscopically an ill-defined pale-cream, irregular mass was identified which occupied predominantly the renal medulla. Histopathologic examination showed slit like tubular ducts lined by atypical cuboidal to polygonal cells and a marked desmoplastic stromal reaction. The diagnosis of collecting duct carcinoma was made. Patient is now doing well after 11 months of follow up.

Adrenal neuroblastomas, although quite common in children, are extremely rare in adulthood. Here, we are reporting the case of a 47-year-old male who presented with right flank pain and had a palpable mass in the same region. Contrast-enhanced computed tomography showed an irregular, poorly marginated heterogeneous mass lesion arising from the right suprarenal position. Urinary catecholamines were within normal limits. There was no evidence of metastatic disease. The mass was resected en-block along with the right kidney. Histopathologic examination revealed the diagnosis of a neuroblastoma. Adjuvant chemotherapy was instituted, but the pain recurred after 9months. Despite subsequent chemotherapy, the mass continued to grow over the next 6months with further infiltration into the liver and surrounding muscles. The patient has currently been started on external palliative radiation. We have also reviewed the literature to present a discussion on presentation, diagnosis, and management of this rare tumor.

A 35-year-old female presented with 13-year history of unilateral recurrent nasal mass, epistaxis and facial pain. Nasal examination revealed a pale glistening mass in the right nasal cavity. On probing, mass was insensitive to touch and bled on handling. Computed tomographic scan showed a mass filling the right nasal cavity, ipsilateral maxillary and ethmoid sinuses. Diagnosis of pansinusitis polyposis was made.Transnasal endoscopy-assisted excision of the mass was done, and the diagnosis of olfactory neuroblastoma was established by histopathology and confirmed by immunohistochemistry. The mass was classified as a Kadish stage B tumor. Further intervention including medial maxillectomyand ethmoidectomy, and complete endoscopic-resection of the tumor from cribriform plate was done via lateral rhinotomy approach. The tumor was found adhered to the lateral wall-the middle meatus and was easily peeled away from the cribriform plate and ethmoids. Patient was referred for radiotherapy. No evidence of loco-regional recurrence or systemic metastasis observed at 10-month follow-up.

We report a case of retroperitoneal intra-abdominal primary monophasic synovial sarcoma (SS) with hemangiopericytomatous (HPC) pattern in a 25-year-old male arising from the triangular ligament on the superior surface of liver encasing the inferior vena cava (IVC) and masquerading as a hepatic tumor. A large heterogeneously enhancing, well defined, lobulated, exophytic lesion was seen involving segment VIII of the liver with foci of calcification in the periphery. A biopsy, followed by total resection of the tumor, showed a spindle cell sarcoma with HPC pattern, which was consistent with monophasic SS on histology and immunohistochemistry. The unusual clinical presentation, radiology, pathology, and differential diagnosis will be discussed in detail.

The oral cavity constitutes a site of low prevalence for metastasis of malignant tumors. However, oral metastasis of a renal origin is relatively more common and represents 2% of all cancer deaths. Renal cancer may metastasize to any part of the body, with a 15% risk of metastasis to the head and neck regions, and pose one of the greatest diagnostic challenges in medical sciences. Approximately 25% of patients have a metastatic disease at initial assessment, which is often responsible for initiating the diagnosis in the first place. Here we present a review of literature of renal cell carcinoma along with a case of gingival metastasis.

Bone metastases from recurrent cervical cancer is a rare scenario, with commonly involved sites being lumbar spine and pelvic bones report an extremely rare manifestation of cervical cancer recurrence presenting as a painful jaw swelling due to metastasis to the mandibular condyle.

Breast conservative therapy (BCT) is a well accepted form of treatment for patients with early stage breast cancer. The incidence of ipsilateral breast tumor recurrence is higher in patients undergoing BCT than in those patients undergoing Modified Radical Mastectomy (MRM) without any adverse effect on survival. Patients treated with BCT are put on active surveillance using clinical breast examination and mammography. The radiologist reading the follow-up mammograms is on high alert and any neo-density is viewed with suspicion. MRI may be used as a problem solving tool. At such a time, an innocuous intra-mammary node can mimic malignancy on MRI. We want to showcase one such typical example with histological proof and highlight that type III curve may be seen in an intramammary node. Our case also reinforces the utility of second look ultrasound which is a faster, cheaper and easier method for localization and biopsy of abnormalities seen on MRI.

Primary adrenal mesenchymal tumors are exceptionally rare. Diagnosis is based entirely on histological and immunohistochemical evaluation which is indispensable not only for determining tumor type but also for predicting biological behavior. We report a rare case of primary leiomyosarcoma of the left adrenal gland, in a 60 year old woman who presented with flank pain. Computed tomography revealed a well defined left adrenal tumor which was surgically resected. Histological examination of the tumor showed malignant spindle cells in interlacing fascicles and whorls. Nuclear pleomorphism, tumor giant cells and abnormal mitotic figures were seen. On immunohistochemistry, the tumor cells showed reactivity for smooth muscle actin, vimentin and desmin; and were negative for cytokeratin, S100 protein, CD117 and HMB-45. A diagnosis of primary adrenal leiomyosarcoma was offered. Postoperative recovery of the patient was uneventful and the patient was symptom free with no evidence of tumor metastasis or recurrence 21 months after surgery.

Renal cell carcinoma is the most frequent kidney neoplasm, with a high tendency to metastasize. The occurrence of renal carcinoma metastasis to the head and neck region is extremely rare. Here we present one such case where the tongue metastasis was the initial presenting feature of disease.

Struma ovarii is the presence of thyroid tissue as the major cellular component in an ovarian tumour. Papillary carcinoma in strumaovarii is exceptionally rare. A tall cell variant of papillary carcinoma arising from a strumaovarii has not been reported so far. We present a case of a 40-year-old female with a tall cell variant of papillary carcinoma arising in strumaovarii.

We described a special infiltration manner of gallbladder carcinoma with tumor thrombus in the common bile duct. Between February 2003 and January 2005, the patients with gallbladder carcinoma who were identified of tumor thrombus in the common bile duct in surgical procedure were retrospectively analyzed. Abdominal ultrasound and magnetic resonance cholangiopancreatography were used for preoperative diagnosis. All three patients were given radical operation. All three patients recovered well after surgery, whowere respectively alive for 30 months, 17 months, and 23 months without tumor recurrence, and 58 months, 41 months, and 40 months for survival time after operation. Gallbladder carcinoma with tumor thrombus in the common bile duct was very rare but with relatively special clinical manifestation and characteristic radiography manifestation.

Epithelioid hemangioendothelioma is a rare, low-grade malignant vascular tumour. It is frequently seen in the liver, but can occur in the lungs, bones, and other soft tissues. Although survival time might be reasonable in cases that can undergo liver transplantation, there is no consensus on the treatment of metastatic patients. We report a 24-year-old female patient with rapidly progressing malignant epithelioid hemangioendothelioma that presented with acute abdominal distension. The patient was refractory to anthracycline and Interferon treatment and died 6.5 months after the diagnosis.

Burkitt's lymphoma is an uncommon form of non-Hodgkin lymphoma in adults. The diagnostic workup for Burkitt's lymphoma includes radiological imaging and like any other form of non-Hodgkin's lymphoma definitive diagnosis is by histopathology. Imaging is necessary to determine the distribution and severity in terms of extent and organs of involvement to further assist in staging and thence to implement appropriate therapy. High incidence of intraabdominal involvement is seen in American Burkitt lymphoma.

Perineurioma is an uncommon soft tissue tumor with characteristic histological and immunohistochemical features. Herein, this tumor is presented within a rare clinical setting, in a 45-year-old gentleman, with multiple soft tissue swellings and a previous history of surgical excision of a thigh mass. Four years back, he developed multiple soft tissue tumor swellings for which he lately underwent multiple wide excisions, elsewhere that were reported as multiple dermatofibrosarcoma protuberans (DFSPs). Histopathological review of the thigh and axillary tumor showed a perineurioma (EMA+, S100-P-ve, CD34-ve, low MIB1), whereas the recurrent leg mass disclosed a high-grade perineurial malignant peripheral nerve sheath tumor (MPNST) (EMA+, CD56+, S100-P-, high MIB1, CD34-ve, p53+ve). Within four months of post-excision, he developed additional swellings, and died of respiratory insufficiency. This case forms the first documented case of perineurial MPNST with multiple, metachronous soft tissue perineuriomas. Available literature review of perineurial MPNSTs and diagnostic implications are discussed herewith

Branchiogenic carcinoma, which is squamous cell carcinoma arising in a branchial cyst, is extremely rare and a highly contentious clinicopathologic entity. A 56-year-old male presented with a well-defined, fluctuant, painless mass on the right side of the neck which was excised with a diagnosis of branchial cyst. The pathological diagnosis was branchial cleft squamous cell carcinoma, which was characterized microscopically by a branchial cleft cyst with a tumour and a non-tumour transitional zone. The report highlights the controversy surrounding this entity and establishes the diagnosis based ona set of histopathologic criteria proposed by Martin et al. and later modified by Khafif et al.

The finding of a gastrointestinal stromal tumor along with other epithelial cancers has been previously reported. Most commonly occurring in the GI tract, a second malignancy has been reported in nearly 13-20% patients with GIST. An elderly woman with a moderately differentiated adenocarcinoma of the rectum underwent low anterior resection. Histology revealed a low-grade GIST along with adenocarcinoma of the rectum, with no lymph node involvement or metastatic disease. This seems to be the first case of a simultaneous occurrence of a GIST along with a rectal adenocarcinoma. The high incidence of a second malignancy in patients with GIST points toward an increased susceptibility to cancer. Is it necessary to treat such patients as generalized cancer syndromes with intensive surveillance and cancer screening?

Intravascular large B-cell lymphoma is a rare and aggressive variant of diffuse large B-cell non-Hodgkin's lymphoma. Its atypical presentation often delays the diagnosis and due to its aggressive behavior, the diagnosis is made post-mortem in half of the cases. We present FDG PET/CT findings in a case of IVLCL. In our case, the report of the patient's bone marrow biopsy after death of the patient revealed the presence of IVLCL. After availability of final diagnosis, we reviewed the literature and a better explanation of the FDG PET/CT findings could be obtained. We describe this case, to call for heightened awareness in physicians for the rare but possible diagnosis of IVCLL, particularly in an elderly patient who presents with fever of unknown origin and demonstrates similar FDG PET/CT findings. Considering the characteristic scan findings described in our patient and other cases in literature, FDG PET/CT can be used in suspected cases of IVLCL for early diagnosis of this rapidly fatal malignancy.

We report a case of metastatic lung cancer presenting as scalp metastases. Immunohistochemistry and radiological investigations helped in making the diagnosis. We also report better survival as seen in our present case using newer chemotherapeutic agents. The report emphasizes the need to look carefully for skin lesions as they provide easily accessible tissue for histopathology and also aid in proper staging as they can be missed out on routine radiological investigations. The case also reflects improvement in cancer care and outcomes in recent times.

We report a known case of adenoid cystic carcinoma of right parotid gland in a 36-year-old Indian male, diagnosed 5 years ago for which he underwent surgery followed by radiotherapy. Now the patient has presented to the surgical oncologist with a mass near angle of right jaw. Computed tomography (CT) performed elsewhere was reported negative for local recurrence. Subsequently, ¹⁸ F Fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) demonstrated local recurrence in right parotid bed. Surprisingly, metabolically active metastatic skeletal deposits were also identified, thus the disease was upstaged and management was changed. Trucut biopsy from left iliac bone lesion confirmed metastases from adenoid cystic carcinoma. Thus a whole body PET-CT has a significant impact on management of patients with salivary gland malignancies in assessing both local recurrence as well as distant metastases, especially in atypical and unsuspected sites.

Small cell carcinoma of the urinary bladder is very rare. Small cell carcinoma of the urinary bladder is a mass with swiftly aggressive and metastatic, and with a poor prognosis. Due to its scarcity, no forward-looking researches assessing the most effective treatment have been issued in the medical literature. It can happen either in connection with urothelial (transitional cell) carcinoma or in a pure form. Its treatment should include surgery, chemotherapy and radiotherapy. In this article,we report a case occurring in a mixed form in the urinary bladder diverticulum and we concisely review the published literature with respect to the clinical manifestation, pathology,differential diagnosis, treatment and prognosis.

Purpose: We examined the effects of large breast separation (BS) on dosimetric and positional differences of radiation treatment plans of locally advanced breast cancers during a free-breathing respiratory cycle. Materials and Methods: Computed tomography (CT) datasets of 18 patients were acquired using 3D, 4D-0% (end-inspiration), and 4D-50% (end-exhalation). BS was examined in relation to the positional and dosimetric changes to organs-at-risk (OAR). Based on dosimetric analysis of all three plans, we compared 4D-0% and 4D-50% for V ₅ , V ₁₀ , and V ₂₀ to 3D for heart and ipsilateral lung. Using 4D-0% and 4D-50% CTs, we recorded positional variations of the organs' centroid (centers of mass) and their effects on dosimetry. Results: Median BS was 23.95 cm (range: 16.86-29.48 cm). There was a strong positive correlation between BS and dose to the ipsilateral lung for V ₅ , V ₁₀ , and V ₂₀ , with the greatest linearity observed at V ₂₀ (R ² = 0.23). At BS ≥27 cm, the dose increased during inspiration at V ₅ , V ₁₀ , and V ₂₀ (P < 0.05). When comparing 4D and 3D for the heart, V ₅ and V _10, decreased by average of 0.94% and 0.96% (P < 0.008), respectively. Conclusions: This study offers the first evidence of the impact of a large BS on radiation dose to the ipsilateral lung.