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2022| April-June | Volume 18 | Issue 3
Online since
July 25, 2022
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CASE REPORTS
A rare case of cardiac toxicity in a patient with imatinib treatment: Case report
Nilay Sengul Samanci, Murat Guliyev, Ezgi Degerli, Emir Celik, Zeynep Hande Turna
April-June 2022, 18(3):792-794
DOI
:10.4103/jcrt.JCRT_188_19
Imatinib, a tyrosine kinase inhibitor, primarily used to treat chronic myeloid leukemia, has shown a survival benefit in gastrointestinal stromal tumors (GISTs). The most common toxicities of imatinib include fluid retention, diarrhea, nausea, fatigue, muscle cramps, abdominal pain, and rash. Imatinib-related cardiotoxicity is a rare condition, and its clinical severity varies between asymptomatic mild ventricular dysfunction and severe congestive heart failure (CHF). We report the case of a 64-year-old woman with a history of GIST who presented to our clinic with rapidly progressive dyspnea. After 8 weeks of imatinib treatment, the patient developed CHF. Echocardiography showed decreased ejection fraction. Imatinib was stopped and diuretic therapy was started. Two weeks later, she died. Cardiac shock was her cause of death.
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ORIGINAL ARTICLES
Effect of coexisting adenomyosis on patients with endometrioid adenocarcinoma: Determination of intraoperative risk factors for tumor metastasis and estimation of prognosis
Alpay Yilmaz, Hakan Cokmez, Aysegul Gulbahar
April-June 2022, 18(3):599-602
DOI
:10.4103/jcrt.JCRT_1277_20
Context:
We sought to clarify the impact of adenomyosis on the clinical and pathological prognosis of endometrial cancer to aid the selection of appropriate surgical intervention based on the diagnosis of adenomyosis.
Aims:
Our study aimed to report the frequency of adenomyosis in patients with endometrioid cancer and correlate its incidence rate with the survival and prognostic factors.
Materials and Methods:
This retrospective study included 357 patients. Patients with endometrioid adenocarcinoma were divided into two groups based on the presence of adenomyosis. The groups were compared in terms of tumor diameter, lymphovascular space invasion (LVSI), low-high risk pathologic status, stage of the disease, and survival outcome.
Statistical Analysis Used:
Continuous variables were analyzed using the Student's
t
or Mann–Whitney U-test. Survival data were analyzed using the Kaplan–Meier test.
Results:
The average age was similar between the two groups. In total, 47 (13.2%) of 357 patients had adenomyosis. A total of 43 (91.4%) cases with adenomyosis and 258 (83.2%) cases without adenomyosis had Stage I endometrioid adenocarcinoma (
n
= 301, 84.3%). Moreover, 32 (68.1%) cases with adenomyosis and 187 (60.3%) cases without adenomyosis were in the low-risk group. There was no statistically significant correlation between the risk groups (
P
= 0.309) and overall survival between the two groups (
P
= 0.416).
Conclusion:
No correlation was seen between the characteristics of endometrioid type endometrial cancer and survival rates in patients with or without adenomyosis. The impact of adenomyosis as a factor in evaluating the perioperative prognosis and planning postoperative adjuvant therapy for endometrial cancer should be assessed by further studies.
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REVIEW ARTICLE
An overview of targets and therapies for glioblastoma multiforme
Gayathri Chandrasekar, Vinay Scheel Bansal, Manas Panigrahi, Satish S Kitambi
April-June 2022, 18(3):591-598
DOI
:10.4103/jcrt.jcrt_1324_21
Glioblastoma multiforme (GBM) affects individuals above 65 years of age and has low median survival rate. Due to limited treatment options, lack of effective diagnosis, and palliative care, there is an urgent need to develop new therapeutic strategies to combat GBM. This review provides an overview of the current clinical trial scenario with a special focus on new targets, repurposed drugs, and technologies in the field of GBM. The use of technological advances and artificial intelligence in diagnosis and imaging is also discussed. In addition, this review also highlights the need to design a dynamic palliative care strategy for end-of-life management of patients with GBM.
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ORIGINAL ARTICLES
Prognostic significance of novel inflammatory markers in extensive-stage small-cell lung cancer
Hatice Yilmaz, Özlem Yersal
April-June 2022, 18(3):691-696
DOI
:10.4103/jcrt.jcrt_1937_21
Objective:
Novel hematological inflammation-based parameters, such as neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), lymphocyte-to-C-reactive protein ratio (LCR), systemic inflammatory response index (SIRI), and hemoglobin-to-red cell distribution width ratio (HRR), have been determined to be linked to prognosis of various cancer types, although the predictive impact of these parameters on extensive-stage small-cell lung cancer (SCLC) is not exactly known. In this study, we aimed to demonstrate the prognostic significance of these novel parameters.
Materials and Methods:
This retrospective study included 162 patients who were under follow-up with a diagnosis of extensive-stage SCLC. The receiver operating characteristic curve analysis revealed that the optimal cutoff values for NLR, SII, PNI, LCR, SIRI, and HRR were 2.34, 787, 46.13, 0.29, 1.5, and 1.05, respectively. Cox regression analyses were done to determine the predictive impact of these parameters on progression-free survival (PFS) and overall survival (OS).
Results:
Patients with higher LCRs and HRRs had longer PFS and OS than patients with lower LCRs and HRRs (
P
< 0.001,
P
< 0.001,
P
< 0.001,
P
< 0.001, respectively). PFS and OS were significantly shorter in the group with high SIRIs than in the group with low SIRIs (
P
< 0.001,
P
< 0.001, respectively). A multivariate analysis identified LCR and SIRI as independent prognosticators for both PFS and OS (
P
< 0.001,
P
< 0.001;
P
= 0.002,
P
< 0.001, respectively), and HRR as an independent prognostic factor only for OS (
P
= 0.046).
Conclusion:
LCR, SIRI, and HRR are independent prognostic parameters that predict survival times in patients with extensive-stage SCLC.
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Proton therapy for skull-base adenoid cystic carcinomas: A case series and review of literature
Sapna Nangia, Utpal Gaikwad, MP Noufal, Srinivas Chilukuri, Kartikeswar Patro, Vineet Nakra, Pankaj Kumar Panda, Ashwathy Susan Mathew, Dayananda S Sharma, Rakesh Jalali
April-June 2022, 18(3):629-637
DOI
:10.4103/jcrt.jcrt_1236_21
Purpose:
An indolent nature, with a high risk of local recurrence along with the potential for distant metastases, makes the relatively rare adenoid cystic carcinomas (ACCs) of the head-and-neck region, a unique entity. In the base of skull (BOS) region, these cancers require radiation doses as high as 70–72 GyE in proximity to critical structures. Proton therapy (PT) confers physical and radiobiological advantages and local control at 2–5 years exceeding 80% in most series, compared with below 60% with photon-based techniques. We report a case series of ACCs of the BOS, treated with image-guided, intensity-modulated PT (IMPT).
Materials and Methods:
During 2019–2020, we treated six patients with skull-base ACC IMPT with on-board, cross-sectional image guidance. Dosimetric data, toxicity, and early outcomes were studied, and a comparative review of literature was done.
Results:
Three patients underwent PT/proton–photon treatment for residual/inoperable lesions and three patients underwent reirradiation for recurrent lesions. The prescription was 70 GyE in 31–35 fractions, and 95% of the clinical target volume (CTV) received 98% of the prescribed dose in five of the six patients. Grade 3 mucositis and skin reactions were noted in two patients and one patient, respectively. Five of the six patients were controlled locally at a median follow-up of 15 months.
Conclusion:
The radiobiological and physical characteristics of PT help to deliver high doses with excellent CTV coverage in skull-base ACCs, adjacent to critical neurological structures.
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The importance of weight loss during definitive radiotherapy in patients with laryngeal carcinoma
Vuslat Yurut-Caloglu, Murat Caloglu, Gorkem Turkkan
April-June 2022, 18(3):638-643
DOI
:10.4103/jcrt.JCRT_727_20
Background:
The aim of this study is to determine the prognostic significance of weight loss (WL) on overall survival (OS) and progression-free survival (PFS) in patients with locally advanced unresectable laryngeal carcinoma undergoing definitive radiotherapy (RT) or chemo-RT (CRT) in a single institution.
Patients and Methods:
One hundred and thirty-two patients with newly diagnosed locally advanced laryngeal carcinoma were included in this study retrospectively. All patients were treated with definitive RT or CRT. The tumor and metastatic lymph nodes received 70 Gy. Subclinical disease (low-risk and high-risk area) was irradiated 50–60 Gy prophylactically. Unintentional WL ≥5% was defined as the “critical level.” Bodyweight was evaluated on the 1
st
day of RT and once a week during RT. Caloric needs were calculated as 25–30 kcal/kg/day.
Results:
Median follow-up was 17.8 months (range: 2.35–85 months). During treatment, there was a statistically significant WL in patients (
P
= 0.004). WL was ≥5% in 62 (47%) of the patients. There was a statistically significant relationship between WL and tumor differentiation (
P
= 0.004), completion of treatment (
P
= 0.004), WHO performance status (
P
< 0.0001), T stage (
P
= 0.003), N stage (
P
= 0.049), and supraglottic tumor location (
P
= 0.005). In the univariate analysis, WL, WHO performance status, T stage, N stage, tumor localization, and tumor differentiation, were seen to affect OS. Additionally, WL, WHO performance status, N stage, and tumor differentiation were prognostic factors for PFS. In the multivariate analysis, it was observed that only WL and WHO performance status were significant factors for both OS (
P
= 0.001, and
P
< 0.01) and PFS (
P
< 0.001, and
P
< 0.001), respectively. Three-year OS and PFS was 50.3% and 19.5% for patients with WL versus 77.8% and 49.0% for patients without WL.
Conclusions:
It is clear that WL has prognostic significance in patients who have undergone definitive RT or CRT due to locally advanced laryngeal carcinoma. In particular, it should be taken into consideration that patients with supraglottic tumor, lymph node involvement, and poor performance status are at greater risk for WL.
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Enhanced expression of death receptor 5 is responsible for increased cytotoxicity of theophylline in combination with recombinant human TRAIL in MDA-MB-231 breast cancer cells
Poulami Tapadar, Ambika Pal, Siddhartha Dutta, Ranjana Pal
April-June 2022, 18(3):754-759
DOI
:10.4103/jcrt.JCRT_352_21
Background:
Theophylline has been reported to induce cytotoxicity and cell cycle arrest in cancer cells. On the other hand, TRAIL, a secretory ligand, is known for its unique ability to induce cell death only in tumor cells. In the present study, we elucidated the mechanism behind the cytotoxic effect of theophylline in combination with recombinant human TRAIL (rhTRAIL) on cancer cell line MDA-MB-231.
Materials and Methods:
Cytotoxicity of theophylline in combination with TRAIL was measured via trypan blue assay and MTT assay. Protein levels were assessed using Western hybridization. Reactive oxygen species (ROS) levels were measured using 2',7'–dichlorofluorescin diacetate and mitochondrial membrane potential (MMP) assay was conducted using tetramethylrhodamine, ethyl ester.
Results:
We observed theophylline in combination with rhTRAIL to be significantly cytotoxic to the cancer cells in comparison to theophylline and rhTRAIL alone. Next, western hybridization showed combination treatment to upregulate cleaved form of caspase-8, 9 and 3, in comparison to the cells treated with rhTRAIL and theophylline alone. Theophylline in combination also increased the levels of ROS and reduced MMP. Interestingly, combination treatment increased the protein level of death receptor 5 (DR5), sensitizing the cells towards TRAIL-induced apoptosis.
Conclusion:
Theophylline in combination with TRAIL significantly increases cytotoxicity in the MDA-MB-231 breast cancer cell line when compared to theophylline and rhTRAIL alone via upregulation of DR5 levels.
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Microsatellite instability in colon cancer: A single center experience from North India
Savita Arora, Narayan Adhikari, Arun Kumar Rathi, Kishore Singh, Puja Sakhuja
April-June 2022, 18(3):656-660
DOI
:10.4103/jcrt.jcrt_423_21
Background:
Due to the defects of mismatch repair (MMR) genes MLH1, PMS2, MSH2
,
and MSH6, the mutations which occur in microsatellite region are not repaired during deoxyribonucleic acid synthesis, leading to microsatellite instability (MSI). MSI is one of the major molecular changes that occur in colorectal carcinoma (CRC). Studies have shown that MMR deficient CRC has different clinicopathological characteristics and a better stage adjusted survival when compared to microsatellite stable tumors.
Materials and Methods:
We have retrospectively analyzed the cases of colon cancers treated in our institute for 3 years from 2017 to 2019. Most of the patients underwent surgery and received adjuvant chemotherapy. MSI testing was done in surgical specimen with immunohistochemistry. The clinical details of the patients were tabulated in Microsoft Excel, and statistical analysis was done using IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, NY, USA).
Results:
A total of 52 patients who were treated in our institution from 2017 to 2019 were analyzed. The mean age was 46.8 ± 13.5 (19–72) years. The male-to-female ratio was 8:5. No significant association in patient demographics and clinicopathological parameters was observed between MSI stable and unstable disease. However, lymphovascular invasion showed a significantly higher trend in MSI unstable patients (
P
= 0.052). The median progression-free survival (PFS) of the entire cohort was 27.8 months (95% confidence interval = 22.7–32.9) and the median overall survival (OS) is not reached. The median PFS is 21.3 months in MSI stable patients whereas it is not reached in MSI unstable patients (
P
= 0.049). The median OS is 27.1 months in MSI stable patients, but it is not reached in MSI unstable patients and the difference shows a trend towards statistical significance (
P
= 0.061).
Conclusion:
MSI unstable tumors were found to have higher PFS and higher OS in our study. It needs prospective validation in larger studies in Indian scenario.
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Antiproliferative, apoptosis-inducing activity and molecular docking studies of sydnones compounds
Syed Lidia Hossain, Manoj Mathews, Veerabhadra Swamy Bhyranalyar Nagarajappa, B Kiran Kumar, Channabasa Veshwar Veerappa Yelamaggad, C Rajendra Singh
April-June 2022, 18(3):681-690
DOI
:10.4103/jcrt.JCRT_1614_20
PMID
:34708812
Objective:
To evaluate the antiproliferative and apoptosis inducing activity of different sydnones on cancer cell lines and their interaction with cancer proteins by molecular docking studies.
Material and Methods:
Antiproliferative activity was carried out by MTT assay and apoptosis inducing activity was performed by DAPI and Annexin V and propidium iodide staining. Molecular docking studies were performed using AutoDock Tools 1.5.6. Pharmacokinetics properties like ADME and toxicity were analysed by pkCSM web server.
Result:
In this study, four new sydnone compounds 3-(4-nonylbiphenyl-4'-yl) sydnone (MC-182), 3-(4-propylbiphenyl-4'-yl) sydnone (MC-454), 3-(4-hexylbiphenyl-4'-yl) sydnone (MC-433), and 3-(4-methylbiphenyl-4'-yl) sydnone (MC-431) were screened for antiproliferative and apoptotic effect against BT-474 (human breast cancer), HeLa (human cervical cancer) and Jurkat (human myeloid leukemia) Mostly, all the sydnone compounds exhibited decent antiproliferative effectiveness, but compound MC-431, MC-433, and MC-454 showed more antiproliferative activity (IC50 1.71, 10.09 and 2.87 μM against BT-474, Hela and Jurkat cell line, respectively). The changes of morphological characteristics of cancer cells determined by staining techniques indicate the apoptotic cell death. The molecular docking and interaction studies were carried out between sydnones with cancer proteins (epidermal growth factor domain receptor tyrosine kinase [EGF-TK], tumor necrosis factor-alpha [TNF-α] and Caspase3. Among all four sydnone molecules, two compounds MC-454 and MC-431 showed good binding energy with targeted proteins. Drug-like property was predicted by ADME toxicity study.
Conclusion:
The results indicate sydnone compounds were found to exhibit anticancer activity by inducing apoptosis. The molecular docking study of sydnones with cancer proteins showed a decent interaction affinity. The results of absorption, distribution, metabolism, excretion and toxicity studies by the Insilco approach also proved that MC-454 sydnone showed better In-Vivo administration. Thus, the current research work indicates that these sydnone compounds would be prospective in developing anticancer medicines.
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Randomized controlled study for comparison of efficacy and safety between thermocoagulation and cryotherapy in visual inspection with acetic acid positive cervical lesions
Manju Lata Verma, Uma Singh, Ruby Kumari, Rekha Sachan, Pushp Lata Sankhwar, Vandana Solanki
April-June 2022, 18(3):603-611
DOI
:10.4103/jcrt.jcrt_832_21
Background:
Less literature is available on the performance of thermocoagulation for treatment of premalignant cervical lesions and its comparison with cryotherapy from low- and middle-income countries like India.
Materials and Methods
: A prospective randomized controlled study was done in the Department of Obstetrics and Gynecology from August 2018 to September 2019 after obtaining ethical clearance from Institutional Review Board (Reg no: ECR/262/Inst/Up/2013/RR/16) Ref no: 278/Ethics/R. cell-18). A total of 68 women with Visual inspection with acetic acid (VIA) positive cervical lesion were randomized into two groups. Group A was treated with cryotherapy and Group B was treated with thermocoagulation. Estimates of cure, adverse effects or complications were presented as frequencies, percentages, and mean ± standard deviation.
Results:
Out of 667 patients, 624 patients underwent VIA testing among which 68 were VIA positive (10.89%, 68/624). The efficacy of thermocoagulation was 93.54% and that of cryotherapy was 90.32%. Immediate side effects were significantly lesser in thermocoagulation group (
P
= 0.008) in comparison to cryotherapy.
Conclusion:
Thermocoagulation is better treatment modality than cryotherapy for VIA-positive cervical lesions may not be in terms of efficacy but definitely in terms of patient comfort and safety.
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Late outcomes in children and adolescents with non-Hodgkin lymphoma: A single-center experience
Nurdan Tacyildiz, Hatice Mine Çakmak, Emel Ünal, Handan Dinçaslan, Yasin Yılmaz, Ömer Kartal, Gülşah Tanyıldız, Sonay İncesoy Özdemir, Gülsan Yavuz
April-June 2022, 18(3):712-717
DOI
:10.4103/jcrt.jcrt_80_21
Background:
Non-Hodgkin lymphoma (NHL) includes pathologies of different clinical courses, treatments, outcomes. Our study aims to investigate the late effects of NHL survivors (NHLS).
Materials and Methods:
Among 59 NHL cases, 50 survivors completed their NHL treatment between 2003 and 2019. Out of 59 patients, the cumulative survival rates and event-free survival rates after 10 years since diagnosis were 82.9% ±5.2% and 84.1% ±5.2%, respectively. In addition, we compared the data related to chronic health and psychosocial conditions with their siblings (
n
= 61).
Results:
The age and gender ratios were similar in the NHLS (
n
= 50) and the control group (
n
= 61). The rate of nephrotoxicity (
P
= 0.02) and the frequency of admission to the hospital (
P
< 0.01) were significantly higher in the survivors than in the control group. Cardiotoxicity is detected in 3 (6%) of NHLS with cumulative anthracycline dose <300 mg/m
2
. The social status (being married [
P
< 0.01], having children [
P
= 0.003]) is impaired in NHLS. The alcohol and smoking habits, education status, and health conditions (endocrinologic, cardiac, neurological, and pulmonary) were similar in both groups. One patient had acute myeloid leukemia as a secondary malignancy. Twenty NHLS took rituximab, two of them took brentuximab vedotin plus chemotherapy. NHLS have impairment in health status, social life.
Conclusion:
Nephrotoxicity is a statistically more common late effect than the others in the survivors. We observe cardiotoxicity in low cumulative doses of anthracycline. A more significant number of patients is required to reveal late side effects on novel drugs.
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Submandibular gland in squamous cell carcinoma of the tongue: Can preservation during neck dissection be a pragmatic option?
Kamal Deep Joshi, Poonam Joshi, Muddasir Bhati, Sudhir Nair, Pankaj Chaturvedi
April-June 2022, 18(3):612-616
DOI
:10.4103/jcrt.JCRT_1661_20
Context:
The submandibular glands (SMGs) excision during head-and-neck oncosurgeries lead to significant morbidity and degradation of quality of life (QOL). The preservation of SMGs during head-and-neck oncosurgeries, without affecting oncological safety, will improve QOL by preventing xerostomia in these patients.
Aims:
The aim of this retrospective study was to assess the involvement of SMG by malignancy during neck dissection being done for the squamous cell carcinoma (SCC) of tongue and to evaluate oncological safety of SMG preservation in SCC of the tongue. Settings and Design: The study design was a retrospective analytical study.
Subjects and Methods:
The study included 391 patients of SCC of tongue operated at Quaternary oncological center from January 2016 to February 2020. The treatment records of 371 patients were reviewed for demographical data, nodal metastasis, and histopathological involvement of SMG by SCC. The statistical analysis was done using SPSS 22.
Results:
A total of 555 necks dissected were assessed, out of which 95 necks dissected were positive for nodal metastasis at level Ib. The SMG was involved by SCC in only two cases, both of which were poorly differentiated SCC. No intraglandular lymph nodes were detected in any of the SMG dissected.
Conclusions:
The study showed that involvement of the SMG by SCC of the tongue is not very common, and it may be possible to preserve the SMG during neck dissection in selected cases in SCC of the tongue. The preservation will definitely improve QOL of the patients, as excision of the SMG is one of the prominent factors, resulting in xerostomia.
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Bone invasion in oral squamous cell carcinoma: Comparative analytic study in orthopantomogram and technetium 99 m bone scan
Jigna S Shah, Jaya Dubey, Yogesh Kumar Rathva
April-June 2022, 18(3):617-622
DOI
:10.4103/jcrt.JCRT_1642_20
Aims and Objective:
To compare the bone invasion in orthopantomogram (OPG) and technetium 99 m bone scan in oral squamous cell carcinoma (OSCC).
Materials and Methods:
Clinically and histopathologically proven 30 cases of OSCC were randomly selected. OPG and Tech 99m bone scan was carried out in all selected patients. The results were analyzed according to age, sex, and site of involvement. OPG findings and bone scanning uptake were also compared according to site, grade, and difference of uptake.
Results:
Group of patients which showed definite bone invasion in OSCC were positive in radionuclide uptake imaging while another group of patients which showed no changes in OPG had some patients which were positive on radionuclide uptake imaging while few were negative on both OPG and bone scanning.
Conclusion:
Combination of OPG and Tech 99m bone scan was more accurate in detecting bone invasion in OSCC than OPG and bone scan alone.
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LETTERS TO THE EDITOR
Durable complete response after stereotactic body radiation therapy in immunotherapy-resistant non-small cell lung cancer
Miguel J Sotelo, Santiago Cabezas-Camarero, Alejandro Riquelme, Coralia Bueno
April-June 2022, 18(3):868-869
DOI
:10.4103/jcrt.JCRT_954_20
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ORIGINAL ARTICLES
The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel prognostic factor for patients with diffuse large B-cell lymphoma
Perisa Vlatka, Lucijanić Marko, Mrđenović Stefan, Laslo Dorian
April-June 2022, 18(3):725-732
DOI
:10.4103/jcrt.jcrt_174_21
Context:
The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic marker in several types of malignant tumors. The prognostic value of HALP score in diffuse large B-cell lymphoma (DLBCL) remains unknown.
Aim:
We aimed to determine the prognostic value of baseline HALP score in DLBCL patients.
Subjects and Methods:
We retrospectively analyzed data from 153 newly diagnosed DLBCL patients treated with R-CHOP or R-CHOP-like regimens at our university hospital center. We evaluated the significance of HALP score as a predictor of response to treatment, overall survival (OS), and event-free survival (EFS).
Results:
The median follow-up time for all patients was 40 months. Lower HALP score was found in patients with advanced stages of disease (
P
= 0.005) and in those with poor response to therapy (
P
= 0.004). Patients with a HALP score ≤20.8 had significantly worse 5-year OS (47.3% vs. 79.5%,
P
< 0.001) and 5-year EFS (40.6% vs. 76.7%,
P
< 0.001). These observations remained statistically significant in the multivariate Cox regression models independently of International Prognostic Index (IPI) and age.
Conclusion:
Lower HALP is associated with unfavorable clinicopathological characteristics of DLBCL and seems to be an IPI independent negative prognostic factor. HALP score can be easily and inexpensively applied to timely recognize DLBCL patients under higher risk of unwanted outcomes in everyday clinical practice.
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CASE REPORTS
Remarkable response to radiation therapy with concurrent chemotherapy in Stewart–Treves syndrome
Atsuto Katano, Hideomi Yamashita
April-June 2022, 18(3):840-842
DOI
:10.4103/jcrt.jcrt_215_21
Stewart–Treves syndrome (STS) is a rare, cutaneous angiosarcoma associated with chronic lymphedema. The prognosis of this syndrome is extremely poor, with a median survival time of 5–8 months, if untreated. An 82-year-old Asian woman noticed a painless elastic mass with partial discoloration (purplish discoloration) on the left thigh. She had lower lymphedema for 15 years. Lesion biopsy and immunohistochemistry analysis led to the diagnosis of angiosarcoma, which was considered to be STS. She was referred to our department for concurrent chemoradiotherapy. Radiation therapy consisted of 25 daily fractions of 2 Gy each (prescription dose: 50 Gy). Concurrent chemotherapy consisted of 2 monthly cycles of docetaxel (75 mg/body on day 1) and recombinant interleukin-2 (700,000 units/body on days 1–5). She experienced acute adverse events such as Grade 2 dermatitis, Grade 2 anemia, and Grade 4 leukopenia. Posttreatment computed tomography images revealed that lesions had disappeared. Moreover, the accumulation patterns on positron emission tomography images were markedly weakened after the treatment. She exhibited no signs of recurrence for 4 years.
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ORIGINAL ARTICLES
Tim-3 and PD-1 blocking cannot restore the functional properties of natural killer cells in early clinical stages of chronic lymphocytic leukemia: An
in vitro
study
Mojgan Astaneh, Hadiseh Rezazadeh, Hadi Hossein-Nataj, Ramin Shekarriz, Ehsan Zaboli, Mahdi Shabani, Hossein Asgarian-Omran
April-June 2022, 18(3):704-711
DOI
:10.4103/jcrt.jcrt_52_21
Background:
Programmed death-1 (PD-1) and T-cell immunoglobulin- and mucin-domain-containing molecule-3 (Tim-3) are two major immune checkpoint receptors expressed on immune cells and their expression is related to the exhaustion phenotype. In the present
in vitro
study, blocking of PD-1 and Tim-3 molecules was performed on isolated natural killer (NK) cells from patients with chronic lymphocytic leukemia (CLL) to restore their functional properties.
Materials and Methods:
NK cells fraction was positively isolated from fresh peripheral blood of 18 CLL patients, treated with anti-PD-1 and anti-Tim-3 blocking monoclonal antibodies and co-cultured with K562 target cells to evaluate their apoptosis induction by Annexin V-PI method. Blocked NK cells were also incubated with anti-CD107a antibody to assess their degranulation properties by flow cytometry. The level of secreted tumor node factor-alpha (TNF-α) and interferon-gamma (IFN-γ) by NK cells was also measured by ELISA.
Results:
Our results showed similar functional properties in terms of degranulation and apoptosis of K562 target cells by isolated NK cells from CLL patients in PD-1/Tim-3 blocked and control groups. It was also shown that blocking of PD-1 and Tim-3 could not improve the production of pro-inflammatory TNF-α and IFN-γ cytokines by isolated NK cells from CLL patients.
Conclusion:
Altogether, our results indicated that pretreatment of NK cells with anti-PD-1 and anti-Tim-3 blocking antibodies in CLL patients at early clinical stages cannot improve their functional properties. Besides many other malignancies, the application of checkpoint inhibitors in CLL needs more investigations and complementary studies.
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Expression of glucose transporter 1 (
SLC2A1
) – Clinicopathological associations and survival in an Indian cohort of colorectal cancer patients
Smreti Vasudevan, Anurag Mehta, Sanjeev Kumar Sharma, Anurag Sharma
April-June 2022, 18(3):650-655
DOI
:10.4103/jcrt.jcrt_42_21
Background:
Glucose transporter 1 (GLUT1) facilitates the uptake of glucose in malignant cells. We investigated
GLUT1
transcript expression in colorectal cancer (CRC) tumors and explored its relationship to clinicopathological features, diabetes condition, and patient survival.
Materials and Methods:
The expression of
GLUT1
was determined using fluorescent probe-based quantitative real-time polymerase chain reaction assay of tumor tissue and corresponding normal mucosa from 180 archived formalin-fixed, paraffin-embedded tissue blocks of ninety upfront surgically resected colorectal adenocarcinoma cases. Clinical information was collected from the hospital medical records and statistical analyses were performed.
Results:
Compared to normal mucosa tissue, the
GLUT1
expression was significantly elevated in CRC tumor tissue (0.024 ± 0.056 vs. 0.004 ± 0.005;
P
< 0.0001). The expression was significantly more in poorly differentiated tumors than well/moderately differentiated tumors (
P
= 0.024) and in patients with liver metastasis (
P
= 0.013). The high GLUT1 expression correlated with advanced tumor stage (
P
= 0.003), liver metastasis (
P
= 0.003), poor tumor differentiation (
P
= 0.02), and death (
P
= 0.001). In univariate Cox regression analysis for survival, high GLUT1 expression, presence of any comorbidity, diabetic condition, advanced or metastatic stage, and liver metastasis were significant risk factors for death. CRC patients with high GLUT1 expression showed worse survival outcomes than those with low GLUT1 expression (
P
= 0.001). Furthermore, the high GLUT1/diabetes (+) patients had an inferior survival outcome than the patients with low GLUT1/diabetes (+) condition.
Conclusions:
GLUT1
is significantly upregulated in colorectal adenocarcinoma. The expression correlated with poor tumor histology, higher stage, hepatic metastases, and adverse survival in the study cohort.
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Transcription factor 4 expression and correlation with tumor progression in gallbladder cancer
Kaushik Neogi, Mallika Tewari, Ashish Kumar Singh, Kavyanjali Sharma, Gullanki Naga Venkata Charan Tej, Sumit Singh Verma, Subash Chandra Gupta, Prasanta Kumar Nayak
April-June 2022, 18(3):668-676
DOI
:10.4103/jcrt.jcrt_1381_21
Background:
Dysregulation in Wnt/β-catenin signaling has been associated with the initiation and metastasis of cancer cells. Transcription factor 4 (TCF4) (also named as transcription factor 7-like 2) is a key transcriptional factor of the Wnt signaling pathway, which, when interact with β-catenin activates Wnt genes which plays an essential role in tumor development. The expression pattern and clinical significance of TCF4 in gallbladder cancer (GBC) are not yet established.
Aims:
This study was performed to assess the expression pattern of TCF4 in GBC tissue and attempted to correlate its expression with different clinicopathological parameters.
Materials and Methods:
The study was conducted on 33 surgically resected specimens of gallbladder carcinoma (GBC) and 12 cases of chronic cholecystitis (CC) as control, which had been confirmed from histology. The expression of TCF4 was performed by the reverse transcription polymerase chain reaction and immunohistochemistry.
Results:
Relative mRNA expression levels of β-catenin and TCF4 in GBC tissues were significantly (
P
< 0.05) higher than in CC samples. TCF4 protein expression was observed in 81.82% (27/33) GBC cases. Specifically, among GBC samples, 21.21% (7/33) was graded as strongly positive, 60.61% (20/33) graded as moderately positive, whereas 18.18% (6/33) graded as negative. All 12 CC samples graded as negative. Overall, TCF4 expression in GBC tissues was statistically significant over CC samples (
P
< 0.05). Moreover, we observed that TCF4 expression was significantly higher (
P
< 0.05) in high tumor grades than low grade, higher (
P
< 0.05) in Stage 2 and Stage 3 than Stage 1.
Conclusion:
The present study suggests that TCF4 may exert an oncogenic role in the progression of GBC and may serve as a new potential candidate biomarker for tumor progression, and it might be a potential therapeutic target against GBC.
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LETTERS TO THE EDITOR
Refined cancer stem cells-enriched lung cancer model systems: Cross-talk and fine-tuning Notch1 inhibition
PK Suresh
April-June 2022, 18(3):866-867
DOI
:10.4103/jcrt.JCRT_807_20
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40
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ORIGINAL ARTICLES
Panorama of multidetector-row computed tomography findings of carcinoma gall bladder - A retrospective observational study
Sudipta Mohakud, Simran Sidhu, Nerbadyswari Deep, Suprava Naik
April-June 2022, 18(3):661-667
DOI
:10.4103/jcrt.jcrt_235_21
Background:
Carcinoma of the gall bladder (Ca GB) has marked ethnic and geographical variations with a broad spectrum of imaging findings on multidetector-row computed tomography (MDCT). We aim to study the spectrum of the imaging findings of Ca GB on MDCT in an Eastern Indian hospital as these imaging findings help in accurate diagnosis and staging of this lethal disease.
Materials and Methods:
The MDCT images of 100 biopsy-proven cases of adenocarcinoma of GB performed from January 1, 2017, to December 31, 2018, in our hospital were retrospectively reviewed by two experienced radiologists blinded to the diagnosis. The CT protocol was a plain scan followed by triple-phase contrast-enhanced CT. Reconstructed images in the form of maximum intensity projection, volume-rendered technology, and minimum intensity projection images were also assessed. Descriptive statistics were used for data analysis.
Results:
Ca GB showed a female predominance (female:male –1.9:1). The mean age of presentation was 54.7 years (females) and 58 years (males). The morphological patterns were a mass replacing the GB (46%), focal or diffuse wall thickening (26%), and an intraluminal polypoidal mass (28%). Direct extension was to liver (76%), duodenum (32%), colon (19%), pancreas (9%), and abdominal wall (1%). Biliary dilatation (53%), vascular invasion (14%), omental involvement (23%), ascites (22%), N1 (40%), and retroperitoneal lymphadenopathy (33%) were common. Distant metastasis comprised of hepatic (42%), pulmonary (7%), Krukenberg's tumor (6%), and osseous (1%) lesions. The stages at diagnosis were I or II (3%), IIIA (4%), IIIB (16%), IVA (10%), and IVB (67%).
Conclusions:
Ca GB has a broad spectrum of findings on MDCT and it mostly presents at an advanced stage. MDCT with reconstructions is beneficial in the assessment of locoregional and distant spread and cancer staging which has a direct implication on patient management, survival, and mortality.
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Acute myeloid leukemia patients with variant or unusual translocations involving chromosomes 8 and 21 – A comprehensive cytogenetic profiling of three cases with review of literature
TV Akhila Raj, Preethi Gopinath, JA Geetha Raj, Geetha Narayanan, Sreejith G Nair, Deepa Susan Joy Philip, Suresh Raveendran, Priya Geetha, Hariharan Sreedharan
April-June 2022, 18(3):697-703
DOI
:10.4103/jcrt.jcrt_190_21
Background:
t(8;21)(q22;q22) is the most frequent recurrent translocation in acute myeloid leukemia (AML) resulting in an in-frame fusion of
RUNX1/RUNX1T1
that regulates various genes involved in the signaling pathways. This leukemogenic alteration is usually associated with a favorable clinical outcome. Variants of t(8;21) can be formed involving a third or fourth chromosome in ~3-4% of t(8;21)-AML. Due to the rarity of variant t(8;21), its clinicopathological features and prognostic significance are still unclear. Here we present three AML cases with cryptic rearrangements of chromosomes 8 and 21 without standard
RUNX1/RUNX1T1.
Materials and Methods:
Conventional karyotyping and fluorescence
in situ
hybridization and/or spectral karyotyping of the pretreatment bone marrow aspirate of
de novo
AML patients were performed to delineate chromosomal abnormalities.
Results:
We identified three cases with novel variants of t(8;21); der(13)t(8;21;13), isodicentric derivative 8 with chromosome 21[,+idicder(8)(q11.1)t(8;21)(q22;q11.1)] and der(21)t(8;12;21)(q22;q?;q22).
Conclusion:
AML with t(8;21)(q22;q22);RUNX1-RUNX1T1 forms a distinct WHO subcategory and hence the identification of variants or unusual translocations associated with t(8;21) deserves more attention. Contribution to the variant/ unusual t(8;21) database will further refine the risk stratification and may help to significantly advance the current treatment regimen.
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40
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CASE REPORTS
Acute lymphoblastic leukemia masquerading as hemophagocytic lymphohistiocytosis
Gopinathan Mathiyazhagan, Anshul Gupta, Khaliqur Rahman, Soniya Nityanand
April-June 2022, 18(3):774-776
DOI
:10.4103/jcrt.JCRT_679_20
Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by immunological imbalance due to inappropriate activation of macrophage, T/NK cells resulting in hypercytokinemia and subsequent tissue damage. We present an interesting case of acute lymphoblastic leukemia (ALL) who presented to us with clinical and laboratory features of HLH. High index of suspicion for malignancy based on clinical history and bone marrow examination led us to reach at definitive diagnosis of ALL.
[ABSTRACT]
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548
38
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Multifocal primary pseudomyogenic hemangioendothelioma of bone managed with denosumab: A rare case with diagnostic and therapeutic challenge
Sunil Pasricha, Anila Sharma, Manish Pruthi, Garima Durga, Ankush Jajodia, Gurudutt Gupta, Meenakshi Kamboj, Manoj Gupta, Anurag Mehta
April-June 2022, 18(3):817-819
DOI
:10.4103/jcrt.JCRT_1138_20
Pseudomyogenic hemangioendothelioma (PMH) is a rare tumor of vascular origin with intermediate malignant potential which commonly presents as a subcutaneous and soft-tissue mass with or without concurrent bone involvement. However, PMH presenting as primary multifocal bone lesions is rare. Histomorphologically, it mimicks other epithelioid tumors and cytokeratin expression in PMH can prompt an erroneous diagnosis of metastatic carcinoma, especially in an elderly patient. Diligent histopathological examination and judicious immunohistochemistry panel can guide to the correct diagnosis. Due to its rarity, the optimal therapeutic strategy has not been established till date. We present a rare case of PMH of primary bone with multifocal bony disease in a 23-year-old male who presented with severe bone pains. The patient has been managed with four weekly denosumab, and the disease is stable with symptomatic relief after 6 months.
[ABSTRACT]
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548
27
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ORIGINAL ARTICLES
Effects of tyrosine kinase inhibitors for controlling Ph+ clone and additional clonal abnormalities in a chronic myeloid leukemia
Bani Bandana Ganguly, Shouvik Mandal, Debasis Banerjee, Nitin N Kadam
April-June 2022, 18(3):760-764
DOI
:10.4103/jcrt.JCRT_1755_20
Purpose:
The chronic myeloid leukemia (CML) is characterized by the presence of t(9;22)(q34;q11) that results in chimerization of
BCR
and
ABL
genes on the rearranged chromosome 22 or Philadelphia chromosome (Ph). Imatinib has been established as the first line of therapy for CML; in case of Imatinib failure or resistance, other second or third generation tyrosine kinase inhibitors (TKIs) are considered. However, acquisition of additional clonal abnormalities (ACAs) interferes in management of CML. We described a complex scenario of cytogenetic remission, relapse, response to TKIs and behavior of ACAs in a case of CML.
Materials and Methods:
Conventional G-banding and FISH cytogenetics, and quantitative PCR studies were conducted in the bone marrow for diagnosis and follow up (FU) of the changes of
BCR-ABL
gene and ACAs at different time intervals.
Results:
Ph− chromosome disappeared within 6 months of Imatinib therapy, and re-appeared within a year. Subsequent change of TKI to dasatinib eliminated the Ph+ clone, but established an ACA with trisomy 8 (+8). Further change to Nilotinib, eliminated +8 clone, but re-emergence of Ph+ clone occurred with an ACA with monosomy 7 (−7). Reinstate of Dasatinib eliminated Ph+ and −7 clones, but with gradual reappearance of Ph+ and +8 clones. The patient discontinued FU, though participated in a long term examination.
Conclusion:
The complexity of ACAs and Ph+ clones needs frequent monitoring with changes of TKI and technologies.
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54
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Assessment of angiogenesis using endoglin in salivary gland tumors – An immunohistochemical study
Pratyusha Prakash Gaonkar, Sangeeta R Patankar, Gokul Sridharan
April-June 2022, 18(3):623-628
DOI
:10.4103/jcrt.jcrt_8_21
Background:
Endoglin, a co-receptor of transforming growth factor (TGF)-β1 and TGF-β2, is indispensable for endothelial cell proliferation and modulation of tumor promotion activities of TGF-β1. The assessment of neovascularization using endoglin expression has been considered a potential predictor of prognosis in various solid malignancies.
Aims and Objectives:
To analyze the expression of endoglin by immunohistochemistry in both benign and malignant salivary gland tumors.
Materials and Methods:
Fifteen cases of benign salivary gland tumors and seventeen cases of malignant salivary gland tumors were included in the study, and immunohistochemistry was performed using anti-CD105 antibody using standard protocol.
Results and Conclusion:
The study demonstrated that there is increased endoglin expression in malignant tumors as compared to their benign counterparts which is suggestive of increased angiogenic activity in tumor areas and could be responsible for the aggressive behavior of the malignancies. The highest density of endoglin-positive blood vessels was observed in the inflammatory tumor stromal areas. Furthermore, a significant increase in endoglin expression was evident as the grade of malignant salivary gland tumor increased. The results of the study indicate that the increased expression of endoglin in high-grade malignancies contributes to their aggressive nature.
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43
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LETTERS TO THE EDITOR
Both
Kras
gene mutation and
Her2
gene mutation tend to exist in an inverse manner but not mutually exclusive in mucinous ovarian carcinoma: An analysis of 21 taiwanese women
Chiew-Loon Koo, Ming-Yung Lee, Wan-Ru Chao, Chih-Ping Han
April-June 2022, 18(3):862-863
DOI
:10.4103/jcrt.JCRT_1358_20
[FULL TEXT]
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494
37
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ORIGINAL ARTICLES
Comparative analyses of paclitaxel/carboplatin with cisplatin/5-fluorouracil-based chemoradiation in locally advanced inoperable upper and middle third esophageal cancer: A randomized prospective pilot study
Divyesh Kumar, Treshita Dey, Divya Khosla, Sandeep Gedela, Arun S Oinam, Rakesh Kapoor
April-June 2022, 18(3):747-753
DOI
:10.4103/jcrt.jcrt_100_21
Introduction:
Chemoradiation therapy (CRT) remains the treatment of choice for inoperable locally advanced esophageal cancer (LAEC). Several CRT regimens are existent in esophageal cancer, but definitive conclusions are lacking. We performed a pilot study to compare treatment outcome, survival, and toxicities in inoperable upper and middle third esophageal cancer patients undergoing CRT using either paclitaxel/carboplatin or cisplatin/5FU based regimen.
Methods:
Patients were randomised in two arms (arm A and arm B). In Arm A, taxane-based (Paclitaxel+carboplatin) and in arm B non-taxane-based (cisplatin+5FU) doublet chemotherapy drugs were given concurrently with external beam radiation therapy (EBRT). EBRT in two phases up to a total dose of 54 Gy/27#@2Gy/# was given. Response was subsequently assessed using Response evaluation criteria in solid tumors (RECIST v1.1) and toxicities utilizing Common Terminology Criteria for Adverse Events (CTCAE v 4.0).
Result:
The overall response rate (ORR) in the taxane-based group was higher than the non-taxane-based group, but was not significantly different (p=0.851). Regarding hematological toxicities, anaemia and reduced cell counts were more in the taxane group compared to the non-taxane group while non-hematological toxicities were comparable. Similarly, better survival with late toxicities were seen with taxane-based arm when compared to non-taxane-based arm, though it was not statistically significant.
Conclusion:
Our pilot analysis highlights the fact that paclitaxel/carboplatin CRT shows better response, survival, and comparable toxicities when compared to cisplatin/5FU, though statistically nonsignificant. Further randomised prospective trials with large sample size are warranted.
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CASE REPORTS
Primary pulmonary epithelial-myoepithelial carcinoma: Report of a rare and under-diagnosed low-grade malignancy
Shivani Sharma, Aditya Tayal, Sameer Khatri, Satyasundar G Mohapatra, Sambit Kumar Mohanty
April-June 2022, 18(3):795-800
DOI
:10.4103/jcrt.JCRT_559_20
Primary epithelial-myoepithelial carcinoma (EMC) is a rare low-grade malignant neoplasm of the lung that originates from the submucosal bronchial glands. It behaves in an indolent fashion, although rare cases with high-grade transformation have been reported. Because of the rarity, optimal therapy for this entity has not been clearly defined. Herein, we report a case of primary pulmonary EMC in a 38-year-old Indian man who had a short history of dyspnea and a computed tomographic (CT) scan revealed a 3 cm diameter homogeneous mass in the lower lobe of the right lung. A CT-guided biopsy revealed a mildly atypical and mitotically quiescent tumor with solid and focal acinar arrangement; foci with biphasic arrangement by inner epithelial and outer myoepithelial cells were identified. The neoplasm revealed cytokeratin (CK) 7 positivity in the epithelial cells, while the myoepithelium expressed smooth muscle actin and p63. The tumor had a low (8%) Ki-67 proliferation index. The neuroendocrine markers, thyroid transcription factor 1, CK5/6, p40, and napsin A were negative. Positron emission tomography-CT was negative for any other mass lesion. The mass was excised with negative margins and the patient was on close follow without any evidence of disease for the past 17 months. A custom made, targeted DNA- and RNA-based 5 gene lung cancer next-generation sequencing panel (Epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), Ros protocol-oncogene 1 tyrosine kinase (ROS1), B-rapidly accelerated fibrosarcoma family oncogene (BRAF), and mesenchymal epithelial transition molecule (MET)), compatible with the Ion S5 system was performed; however, no mutation was identified. This case depicts awareness about this entity and use of appropriate immunostains, particularly the myoepithelial markers are essential to arrive at a correct diagnosis. Importantly, high-grade transformation, recurrence, and metastases are not very uncommon in EMC, warranting a correct and timely diagnosis for therapeutic decision-making and prognostication of the patient.
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Basal cell adenocarcinoma of the minor salivary gland - A rare case report involving the upper lip
A Jacob Prakash, S Sushmitha Christina, M Vijaya Lakshmi, Naveen Polishetty
April-June 2022, 18(3):765-769
DOI
:10.4103/jcrt.JCRT_108_20
Minor salivary gland neoplasms constitute up to approximately 25% of all salivary gland tumors. The incidence of malignancy of these tumors is slightly greater than half. Basal cell adenocarcinoma (BCAC) is a rare salivary gland malignancy that occurs most commonly in the parotid gland. In this report, we describe a case of an older woman presenting with BCAC of the upper lip arising from the minor salivary gland.
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430
49
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Primary pulmonary T-cell lymphoma
Mahesh Babu Vemuri, Manju Rajaram, Archana Malik, Pampa CH Toi
April-June 2022, 18(3):843-845
DOI
:10.4103/jcrt.jcrt_227_21
Primary pulmonary lymphoma (PPL) is a rare clonal proliferation of lymphoid tissue involving one or both lungs. It is of two types, B-cell and T-cell lymphomas among which T-cell lymphoma is a rare entity and it is sparsely considered as a differential diagnosis in neoplastic lesions of the lung. Here, we are reporting a case of primary pulmonary T-cell lymphoma. PPL is a rare disease and can present with nonspecific symptoms. Radiologically, it can easily be confused with more common malignancies such as bronchogenic carcinoma with or without metastases. PPL carries different therapeutic and prognostic implications. Therefore, physicians should make every effort to achieve histopathological diagnosis before prognosticating a patient presenting with lung cancer.
[ABSTRACT]
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410
29
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Primary ectopic breast carcinoma arising in the inguinal region in a male patient
Vivek Y Bansal, Varun V Bansal, Shakuntala V Shah, Akash R Bellige
April-June 2022, 18(3):837-839
DOI
:10.4103/jcrt.JCRT_777_20
Carcinoma arising in ectopic breast tissue is a rare entity, especially in males, in whom the diagnosis is often delayed due to a low index of suspicion. Conventional imaging techniques fail to characterize the tumor, adding further to the diagnostic dilemma. We report the first case in our knowledge of an extramammary primary breast carcinoma arising in the inguinal region in a male. Our patient, a 69-year-old male, presented with a swelling in the left inguinal region, which was excised and diagnosed as luminal A type invasive ductal carcinoma. He received adjuvant external beam radiotherapy (50 Gy administered in 25 fractions) and tamoxifen. A follow-up examination performed 6 months after the completion of the last dose of radiotherapy showed no residual disease. The modalities of treatment for such tumors have been discussed, with emphasis on surgery and radiotherapy, given the aggressive nature of the disease.
[ABSTRACT]
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404
25
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ORIGINAL ARTICLES
Diagnostic utility of CK19 and galectin-3 in differentiating papillary thyroid carcinoma from nonneoplastic lesions of thyroid
Priyanka Arvind Prasad, Kalyani Raju
April-June 2022, 18(3):644-649
DOI
:10.4103/jcrt.jcrt_563_21
Background:
Thyroid neoplasm is one of the most common endocrine neoplasms. The diagnosis and the distinction between malignant and benign neoplasms can be difficult, but it has clinical, therapeutic, and prognostic significance. Hence, it is necessary to make precise diagnosis by using biomarkers.
Materials and Methods:
This is a laboratory observational study considering histologically diagnosed cases of papillary thyroid carcinoma (PTC) and nonneoplastic thyroid lesions. Immunohistochemistry (IHC) staining was done on tissue sections of all cases for CK19 and galectin-3 using appropriate positive and negative controls. The expression of immunomarkers was evaluated by a semi-quantitative method as negative, weak positive, moderate positive, and strong positive. The data were entered in Microsoft Excel sheet and were analyzed using SPSS 22 version software.
Results:
A total of 52 cases were considered for the study, of which 26 cases each were PTC and nonneoplastic lesions of thyroid. Among the 26 PTC cases, 6 were classical variant of PTC (CVPTC) and 20 were follicular variant of papillary thyroid carcinoma (FVPTC). Among 26 nonneoplastic cases, 13 each were nodular hyperplasia cases and lymphocytic thyroiditis. There was a statistically significant (
P
< 0.01) association of CK19 and galectin-3 expression between CVPTC and FVPTC. There was no statistically significant association (
P
= 0.271) of CK19 expression between PTC and nonneoplastic cases. There was a statistically significant association (
P
= 0.003) of galectin-3 expression between PTC and nonneoplastic cases.
Conclusion:
Galectin-3 expression can be used to differentiate PTC from nonneoplastic lesions of thyroid in ambiguous cases. Galectin-3 and CK19 expression can be used to classify PTC into CVPTC and FVPTC.
[ABSTRACT]
[FULL TEXT]
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389
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Immunohistochemical expression of beta-catenin in hepatoblastoma and its clinical significance
B Archana, Lawrence D'Cruze, Sarah Nazneen, J Thanka, Julius Xavier Scott
April-June 2022, 18(3):677-680
DOI
:10.4103/jcrt.jcrt_1575_21
Background:
Primary hepatic malignancies account for 0.5-2% of all solid tumours in childhood. Hepatoblastoma, a rare embryonic tumour in the general population, represents the most frequent primary hepatic malignancy in the paediatric age group, with an incidence of one new case per million under 15 years of age, median age at diagnosis being 1 year. Aberrant activation of the Wnt/beta-catenin signalling pathway is likely to result in tumorigenesis of hepatoblastoma. The nuclear and intra-cytoplasmic accumulations of beta-catenin correlate with the likely prognosis of the disease. Nuclear expression of beta catenin is associated with a shorter survival, higher stage, and seen in embryonal/undifferentiated types.
Aim:
To study the expression of beta-catenin in hepatoblastoma by immunohistochemistry and correlate it with the tumour histology and survival outcome.
Materials & Methods:
This is a retrospective study of 11 children over a period of 5 years with the diagnosis of hepatoblastoma. These children underwent partial hepatectomy or liver transplantation at the Department of Paediatric Surgery. The clinical, histological and survival data were collected. Immunohistochemical analysis with beta-catenin was done and analysed.
Results:
Mean birth weight of the children was 2.75kg.63.6% had an epithelial type of histology.Beta catenin expression by IHC was studied in 11 cases and found to be positive in 4 cases. Nuclear positivity was noted in 2/4 cases of embryonal type and Cytoplasmic and membranous positivity was seen in the other 2/4 cases. Normal liver showed a membranous pattern of positivity in one case. Negative staining was seen in 6 out of 11 cases.
Conclusion:
Beta catenin is considered to be an useful tool for assessing the prognosis of patients with hepatoblastoma and its expression is associated with a poor survival outcome. There are no validated biomarkers for prognosis so far. However, larger studies incorporating molecular profiling is warranted to establish prognostic factors for planning effective treatment strategies.
[ABSTRACT]
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CASE REPORTS
Metachronous bilateral breast cancer diagnosed with primary breast lymphoma and mucinous carcinoma: The first case in the literature
Melih Simsek, Fatma Aykas, Ahmet Ozgen Yildirim
April-June 2022, 18(3):846-848
DOI
:10.4103/jcrt.JCRT_1008_20
Introduction:
Breast cancer is the most common cancer in women and 2-11% of the cases are bilateral. Bilateral breast cancer frequently emerges as a second primary cancer. Lymphoma and mucinous carcinoma of breast are very rare. Here we present a case, of bilateral breast cancer with metachronous lymphoma and mucinous carcinoma.
Case History:
57-year old female had received chemotherapy and radiotherapy for stage IA Diffuse Large B Cell Lymphoma (DLBCL) located in right breast. At 14th month of her breast DLBCL diagnosis, a diagnosis of mucinous carcinoma was determined in her left breast. After surgery, adjuvant anastrozole was initiated. The patient is still in follow-up with remission at her sixth year of DLBCL diagnosis and fifth year of mucinous carcinoma diagnosis.
Conclusions:
The evaluation of unilateral breast cancer patients in terms of bilateral breast cancer occurrence risk has become important.
[ABSTRACT]
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Breast cancer to thyroid gland: An unconventional metastatic site
Emir Celik, Tulin Ozturk, Nilay Sengul Samanci, Nebi Serkan Demirci, Burak Akovali, Fuat Hulusi Demirelli
April-June 2022, 18(3):788-791
DOI
:10.4103/jcrt.JCRT_561_20
Thyroid gland blood supply is rich but it is not an open area for metastasis. Only 1%–3% of the neoplastic lesions seen in the thyroid are of extrathyroidal origin. Thyroid, lung, bone, lymph node metastasis were detected at the time of diagnosis in a 78-year-old woman with metastatic breast cancer. Control imaging was performed 3 months after hormone therapy was started. All lesions were regressed except thyroid lesion and neck lymph. Tru-cut biopsy was performed to the lesion in the thyroid. The result is consistent with breast cancer metastasis. With this breast cancer metastasis to thyroid case, we want to emphasize the differential diagnosis of neoplastic lesions in the thyroid is important in those diagnosed with malignancy. If there is clinical suspicion after a nondiagnostic thyroid sampling, repeated biopsies should be performed.
[ABSTRACT]
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368
36
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Signet ring cell lymphoma of follicular type with BCL2 gene rearrangement: A rare case with a short review of literature
Pritinanda Mishra, Amit Kumar Adhya, Madhabananda Kar, Mayur Parihar, Swagatika Samal, Mukund Sable
April-June 2022, 18(3):807-811
DOI
:10.4103/jcrt.JCRT_676_19
A case of signet ring cell lymphoma of presacral lymph node is reported. The patient was diagnosed as follicular lymphoma on the basis of clinical and laboratory features, including immunohistochemistry (IHC) and gene rearrangement studies. Light microscopy examination showed neoplastic atypical cells with signet ring cell morphology in core biopsy of lymph node that stained for B-cell markers by IHC. In addition, the neoplastic cells expressed CD20, CD10, BCL-2, and BCL-6, indicating follicular center origin. Fluorescence
in situ
hybridization study demonstrated BCL2 gene arrangement. Especially in the case of deep-seated intra-abdominal lymph nodes with atypical presentation, the differential diagnosis arises with nonhemopoietic tumors, and this needs to be distinguished by specific immunostaining and gene arrangement studies.
[ABSTRACT]
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Spindle cell carcinoma masquerading as a benign polyp of the soft palate
Jyoti R Kini, Deviprasad Dosemane, K Kshithi, Sourjya Banerjee
April-June 2022, 18(3):804-806
DOI
:10.4103/jcrt.JCRT_617_20
Spindle cell carcinoma of the head and neck is a rare biphasic neoplasm. The presentation mimics other head-and-neck malignancies and hence the diagnosis hinges upon histopathological confirmation along with positive immunohistochemistry (IHC) markers denoting the presence of both epithelial and mesenchymal components. At present, there are no standard management criteria for these tumors with the options varying from surgery alone to surgery combined with adjuvant radiotherapy. We discuss here the case of a patient presenting with an oropharyngeal mass that had benign clinical features and the final diagnosis of spindle cell carcinoma could only be established after histopathology with IHC typing.
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Extensive mucoepidermoid carcinoma-like differentiation in follicular carcinoma of the thyroid
Garima Vijayvergiya, Ashwani Tandon, Hemlata Panwar, Tummidi Santosh, Vikas Gupta, Neelkamal Kapoor
April-June 2022, 18(3):857-859
DOI
:10.4103/jcrt.JCRT_1422_20
Mucoepidermoid carcinoma (MEC) is a rare malignant thyroid neoplasm. Cases of MEC with papillary, insular, and anaplastic thyroid carcinoma have been reported. Here, we present a case of follicular carcinoma with extensive MEC-like differentiation. A 62-year-old female presented with complaint of thyroid swelling for 10 years. Cytological features were suggestive of follicular neoplasm. Contrast-enhanced computed tomography showed metastasis to lung and vertebrae. Salivary glands and breasts were normal on examination and imaging. Subtotal thyroidectomy with bilateral neck dissection surgery was performed. The specimen was submitted for histopathological examination. Microscopy showed features of follicular carcinoma with capsular and vascular invasion along with an additional MEC-like morphology. Follicular carcinoma with extensive MEC-like differentiation is a rare observation. Since the tumor was sparing salivary glands and breasts, we considered it as mucoepidermoid differentiation over a collision tumor. However, immunohistochemistry and molecular analysis were the limitations.
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ERRATA
Erratum: Prognostic factors of patients who received chemotherapy after cranial irradiation for non-small cell lung cancer with brain metastases: A retrospective analysis of multicenter study (Anatolian Society of Medical Oncology)
April-June 2022, 18(3):870-870
DOI
:10.4103/0973-1482.345920
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CASE REPORTS
Pediatric extremity rhabdomyosarcoma treated with re-brachytherapy in recurrent setting
Ankita Rungta Kapoor, Manish Chandra, Rajendra Bhalavat, Chetna Bakshi, Chetan Anchan, Pratibha Bauskar, Saurabh Markana
April-June 2022, 18(3):812-816
DOI
:10.4103/jcrt.JCRT_680_20
Rhabdomyosarcomas (RMS) are pediatric soft-tissue sarcomas arising from immature mesenchymal cells that are intended to form striated skeletal muscles. Brachytherapy delivers high-dose of precised radiation to the target tissue with high conformity, sparing the nearby normal tissues, hence allowing dose escalation and reducing the likelihood of normal tissue toxicity. There is a scarcity of reports on the use of brachytherapy for extremity RMS. We report the case of pediatric extremity RMS treated with re-brachytherapy in recurrent setting. A 4-year-old boy diagnosed with RMS of right upper arm underwent local excision of the lesion. Postoperative magnetic resonance imaging showed suspicious residual lesion. Revision surgery followed by brachytherapy with 30 Gy in 10 fractions twice a day over 5 days was delivered. The child developed local recurrence after 12 months. Reexcision and re-irradiation with brachytherapy were done delivering 27 Gy in 9 fractions twice a day over 5 days. The child is disease-free 18 months posttreatment with no significant disparity in limb length suggestive of successful preservation of growth epiphysis. Re-irradiation with interstitial brachytherapy can be considered as an option for the treatment of recurrent pediatric extremity rhabdomyosarcoma, in conjunction with surgery and chemotherapy, despite treated previously with brachytherapy.
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351
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Metastatic malignant melanoma: A case of metastasis from foot to mandibular anterior region
Anita D Munde, Ravindra R Karle, Sudharani Biradar, Sunil Mishra
April-June 2022, 18(3):849-852
DOI
:10.4103/jcrt.JCRT_1123_20
Metastatic malignant melanoma (MMM) of the oral cavity is extremely rare which generally presents in the setting of disseminated disease and have extremely poor prognosis. The most common site for MMM in the oral cavity is tongue followed by buccal mucosa for soft-tissue lesions and posterior mandible for bone involving lesions. Primary tumor sites of oral MMM are usually cutaneous lesions of the trunk, head and neck, limbs, and nasal septum mucosa. Patients bearing this diagnosis face median survival time of approximately 9 months with a probability of surviving 5 years after the initial presentation is <5%; hence, an early detection and treatment for the primary and metastatic lesion is crucial. Here, we present an unusual case of MMM of oral cavity involving gingiva and alveolar bone of the mandibular anterior region metastasizing from a primary lesion on the foot.
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LETTERS TO THE EDITOR
FAST-Forward in breast radiotherapy: Really fast, but how much forward?
Anusheel Munshi, Khushboo Rastogi
April-June 2022, 18(3):864-865
DOI
:10.4103/jcrt.JCRT_938_20
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CASE REPORTS
Cervical gestational trophoblastic neoplasia: A rare form of gestational trophoblastic disease
Shyam Pyari Jaiswar, Monica Agrawal, Sujata Deo, Sumaiya Saad
April-June 2022, 18(3):827-830
DOI
:10.4103/jcrt.JCRT_959_20
Gestational trophoblastic neoplasia (GTN) is a rare disease and is characterized by an abnormal proliferation of trophoblastic cells of placenta. Since majority of them are chemotherapy sensitive, they are one of the highly curable cancers. However, due to its varied presentation, clinicians still face many challenges in its diagnosis and management. We present a case of 26-year-old woman, P0 + 3 (previous 3 abortions) who presented to us with a history of vaginal bleeding postuterine evacuation after 2 months of incomplete abortion. After clinical, radiological assessment and high human chorionic gonadotropin (hCG) titers, the patient was diagnosed as a case of cervical GTN. Risk assessment by the WHO prognostic scoring system was done and “Low Risk” was assigned to her. She was given total nine cycles of single agent chemotherapy including two consolidation cycles after normalization of hCG titers which patient tolerated well and remained asymptomatic.
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Carcinoma male breast with tracheal and endobronchial metastasis, masquerading as nonsmall-cell lung cancer, presenting with superior vena cava obstruction - A rare case report
Astha Srivastava, Rambha Pandey, VR Anjali, Aruna Nambirajan, Meivel Angamuthu, Anant Mohan
April-June 2022, 18(3):831-833
DOI
:10.4103/jcrt.JCRT_894_20
Cancer male breast is not very common. It comprises <1% of all breast cancers. Primary sites of metastasis are bone, brain, lung, and liver. Endobronchial and tracheal metastasis is very rare. To the best of our information, this is the first case of male breast carcinoma with upfront tracheal and endobronchial metastasis which presented as Superior vena cava obstruction (SVCO), initially evaluated on the lines of metastatic nonsmall-cell lung cancer. A 60-year-old gentleman presented with shortness of breath and features of SVCO. On primary evaluation, he was thought to be a case of nonsmall-cell lung cancer. Later on, it was confirmed to be carcinoma male breast with endobronchial and tracheal metastasis, which was reconfirmed with biopsy. The case we came across had symptoms associated with endobronchial metastases from primary extrapulmonary tumor and which was later found out to be breast. Treatment options are very different from lung primary and thus, we should be aware of the unusual disease presentation.
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ORIGINAL ARTICLES
To evaluate the use of tandem and cylinder as an intracavitary brachytherapy device for carcinoma of the cervix with regard to local control and toxicities
Irfan Rasool Gadda, Nazir Ahmad Khan, Shaqul Qamar Wani, Misba Hamid Baba
April-June 2022, 18(3):740-746
DOI
:10.4103/jcrt.jcrt_243_21
Introduction:
Brachytherapy always remains a keystone in the treatment of gynecological carcinoma for both definitive and adjuvant treatments. Due to the rapid fall-off nature of brachytherapy, the target gets a high dose with a low dose to the normal organs nearby and thereby increasing the tumor control probability.
Aims and Objectives:
This study aims at the evaluation of local control and toxicities in the carcinoma of the cervix using tandem and cylinder as brachytherapy applicator.
Materials and Methods:
The study was conducted between January 2014 and December 2018 in a tertiary care hospital. Thirty-one patients who fulfilled our set criterion of Clinical stage IB3–IVA, Performance status Eastern Cooperative Oncology Group 0–2 were selected. All patients were treated initially with external beam radiotherapy and later by high dose rate intracavitary brachytherapy after completion of external beam radiation therapy (EBRT). A dose of 18–21 Gy was delivered to the residual disease in three sessions with a 1-week interval between each session. The dose was optimized in such a way that the organs at risk (OAR), namely bladder and rectum received doses within their tolerance levels. The patients were continuously monitored using Common Terminology Criteria for Adverse Events version 5.0 for both acute and late toxicities and by imaging for local control. Statistical analysis using SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA) was used to evaluate the results. Continuous variables were expressed as mean ± standard deviation, and categorical variables were summarized as frequencies and percentages.
Results:
Out of the 31 patients, 5 (16.1%) experienced radiation-induced Grade 1 skin changes which were due to EBRT, 1 (3.2%) had Grade 1 G. I. T toxicity, 1 (3.2%) had Grade 1 radiation-induced vaginal mucositis after brachytherapy. At 6–8-week follow-up, all the patients showed no evidence of disease on radiological imaging. At 3 months of follow-up, 1 (3.2%) patient had radiation-induced proctitis of Grades 2 and 3 (9.7%) had radiation-induced cystitis of Grades 1 and 1 (3.2%) had Grade 2 cystitis. At 6 months of follow-up, 1 (3.2%) had Grade 1, 1 (3.2%) had Grade 2, and 1 (3.2%) had Grade 3 radiation-induced proctitis. At 3 months of follow-up, 29 (93.5%) patients had no evidence of disease, while 2 (6.5%) were having residual disease on imaging. At 6 months of follow-up, all the patients were disease-free. At 12 months of follow-up, 26 (83.9%) patients were disease-free, 1 (3.2%) had local recurrence, 2 (6.5%) had distant metastasis, and 2 (6.5%) had expired. At 24 months of follow-up, 26 patients were disease-free. Acute and late toxicities were similar to those used in the treatment of carcinoma cervix by standard brachytherapy applicators. Local control was achieved in 83.87% of cases. Two-year survival was 93.5%.
Conclusion:
We observed that the tandem and cylinder applicator is an acceptable applicator to be used for intracavitary brachytherapy. It is safe and simple besides this; the toxicities and local control are similar to the other standard applicators used in brachytherapy in carcinoma cervix. However, the required dose prescription to point A was not possible in all the patients due to limitations of OARs. Furthermore, long-term follow-up is needed to see the patterns of failure, recurrence-free survival, overall survival, and long-term toxicities in the treated patients.
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Prediction of chronic kidney disease in abdominal cancers radiation therapy using the functional assays of normal tissue complication probability models
Ameneh Haghbin, Ahmad Mostaar, Reza Paydar, Mohsen Bakhshandeh, Alireza Nikoofar, Mohammad Houshyari, Susan Cheraghi
April-June 2022, 18(3):718-724
DOI
:10.4103/jcrt.jcrt_179_21
Aim:
The purpose of this study is to predict chronic kidney disease (CKD) in the radiotherapy of abdominal cancers by evaluating clinical and functional assays of normal tissue complication probability (NTCP) models.
Materials and Methods:
Radiation renal damage was analyzed in 50 patients with abdominal cancers 12 months after radiotherapy through a clinical estimated glomerular filtration rate (eGFR). According to the common terminology criteria for the scoring system of adverse events, Grade 2 CKD (eGFR ≤30–59 ml/min/1.73 m
2
) was considered as the radiation therapy endpoint. Modeling and parameter estimation of NTCP models were performed for the Lyman-equivalent uniform dose (EUD), the logit-EUD critical volume (CV), the relative seriality, and the mean dose model.
Results:
The confidence interval of the fitted parameters was 95%. The parameter value of D
50
was obtained 22–38 Gy, and the n and s parameters were equivalent to 0.006 –3 and 1, respectively. According to the Akaike's information criterion, the mean dose model predicts radiation-induced CKD more accurately than the other models.
Conclusion:
Although the renal medulla consists of many nephrons arranged in parallel, each nephron has a seriality architecture as renal functional subunits. Therefore, based on this principle and modeling results in this study, the whole kidney organs may have a serial–parallel combination or a secret architecture.
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CASE REPORTS
Extra-axial adult cerebellopontine angle medulloblastoma: Revisiting a rare entity
Ishita Pant, Sujata Chaturvedi, Vinod K S. Gautam, Pragyan Sarma, Dinesh Kumar Satti
April-June 2022, 18(3):770-773
DOI
:10.4103/jcrt.JCRT_675_20
A purely extra-axial position of medulloblastoma in adults at cerebellopontine (CP) angle is extremely rare. To the best of our knowledge, only ten cases have been reported till date. The authors report a case of extra-axial medulloblastoma in a 30-year-old female located at right CP angle. It was surgically treated with a provisional diagnosis of meningioma. Histopathological diagnosis of desmoplastic/nodular medulloblastoma was made with the routine hematoxylin eosin (HE) stain and immunohistochemical markers. This case report highlights the fact that, although extremely rare, the possibility of an extra-axial CP angle mass being a medulloblastoma still needs to be considered in the differential diagnoses, even in adults.
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Reappraisal of SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1/INI-1 deficient tumor: Report of two cases
Niteeka Gurung, Neha Kapoor, Urmi Mukherjee, Anuj Khurana
April-June 2022, 18(3):780-783
DOI
:10.4103/jcrt.JCRT_577_20
SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1 is a tumor suppressor gene located at chromosome 22q11.2. In the past decade, a major stride has been taken for decoding the molecular genesis of various tumors which has resulted in the addition of newer tumors harboring loss of this gene.
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LETTERS TO THE EDITOR
Have we ignored the sweetbread for long – Is it time to spare the pancreas?
Soorej Balan Kaliyath, Sorun Shishak, Sameer Rastogi, DN Sharma
April-June 2022, 18(3):860-861
DOI
:10.4103/jcrt.JCRT_1581_20
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CASE REPORTS
Melanotic neuroectodermal tumor of infancy (MNTI) – A rare entity
Divya Goel, Sumaira Qayoom, Madhu Mati Goel, Jiledar Rawa
April-June 2022, 18(3):784-787
DOI
:10.4103/jcrt.JCRT_612_20
Melanotic neuroectodermal tumor of infancy is a rare pigmented pediatric tumor seen at craniofacial sites with the most common site being maxilla. This tumor arises from neural crest origin with a polyphenotypic expression of epithelial, neuroblastic, and melanotic markers. It is a locally aggressive tumor with rapid, expansile, and destructive growth. The tumor has fairly high chances of recurrence and malignant transformation, if not diagnosed and treated with time. There is no standard protocol for management owing to its rarity. Hereby, we present one such case of a 2-month-old male child with rapidly enlarging upper jaw swelling. The patient was treated with wide local excision, followed by two cycles of chemotherapy. The patient is in follow-up and doing well with no evidence of any local recurrence or metastasis till date.
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Ovarian squamous cell carcinoma
Paulina Reyes Tobar, Roberto Altamirano Assad, Omar Nazzal Nazal, Eugenio R Suárez
April-June 2022, 18(3):777-779
DOI
:10.4103/jcrt.JCRT_562_20
Ovarian squamous cell carcinoma is a rare and aggressive ovarian neoplasm, where most of the cases arise from mature teratoma, which represents up to 20% of all ovarian tumors. Moreover, primary squamous cell carcinoma is considered to be related to human papillomavirus infection. The diagnosis is difficult and metastasis from bladder, genital tract, lung, and digestive tract cancers must be ruled out. There are no guidelines for treatment, however, radical surgery combined with adjuvant chemotherapy and radiation therapy, are the most common approach. We present the case of a young women diagnosed with a
de novo
ovarian squamous cell carcinoma, as well as the treatment and follow-up that she received.
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Prosthetic management of a midfacial defect
KP Dholam, Sandeep Gurav, Gurkaranpreet Singh, Aishwarya Chatterjee
April-June 2022, 18(3):853-856
DOI
:10.4103/jcrt.JCRT_1141_20
Surgical ablation of a large tumor creates a defect which is technically difficult to reconstruct. Radiated tissue bed poses a challenge to reconstruction and is complicated in presence of osteoradionecrosis. This report describes a case of a 62 year old gentleman with oral cancer who underwent surgery and radiotherapy twice. He developed an orocutaneous defect (OCD) following surgery and radiotherapy. Prosthetic rehabilitation of OCD was done. Full facial impression with irreversible hydrocolloid was made and wax sculpture made on the model obtained. Standard laboratory steps were followed for mould fabrication and maxillofacial silicone was used to fabricate the prosthesis. It was retained to the spectacle with silicone adhesives. The silicone facial prosthesis provided to the patient was easy to use, covered the defect and improved the quality of life of the patient.
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ORIGINAL ARTICLES
Impact of head-and-neck radiation oncology clinical fellowship on multidisciplinary assessment, radiation workflow, and survival of adult patients with nasopharyngeal carcinoma
Issa Mohamad, Fawzi Abuhijla, Dalia Al-Rimawi, Ibrahim Al-Maayta, Abdellatif Al Mousa, Ramiz Abu-Hijlih, Ali Hosni
April-June 2022, 18(3):733-740
DOI
:10.4103/jcrt.jcrt_226_21
Purpose:
The purpose of the study wast to evaluate the influence of head-and-neck clinical fellowship training on multidisciplinary assessment, radiation workflow, and clinical outcomes of patients with nasopharyngeal carcinoma (NPC).
Materials and Methods:
This was a retrospective review of patients with NPC treated between 2010 and 2017. The study cohort was allocated into prefellowship cohort (pre-FSC) (January 2010–September 2014) and postfellowship cohort (post-FSC) (October 2014–December 2017). Patient demographics, tumor characteristics, multidisciplinary assessment, radiation workflow, and treatment were reviewed. Univariable, multivariable, and relapse-free survival (RFS) and overall survival (OS) were performed.
Results:
One hundred and forty-three patients were included, 68 in the pre-FSC and 75 in the post-FSC. For the post-FSC versus pre-FSC, there were increased multidisciplinary referrals to dental (100% vs. 79.4%,
P
= 0.001), nutritional (94.7% vs. 70.6%,
P
= 0.0001), peg-tube insertion (84% vs. 64.7%,
P
= 0.0001), speech and swallow (94.7% vs. 13.2%,
P
= 0.0001), psychosocial (100% vs. 26.5%,
P
= 0.0001), and smoking cessation clinic (33.3% vs. 5.9%,
P
= 0.0001). For the post-FSC versus pre-FSC, there were statistically significant differences in the elements of radiation workflow; mean time required for contouring was 3.2 vs. 8.8 days (
P
= 0.0001), radiotherapy plan implementation: 1.9 vs. 4.8 days (
P
= 0.0001), and plan approval: 0.4 vs. 0.9 day (
P
= 0.00012). On multivariable analysis, smoking was associated with poor RFS (
P
= 0.04). There were no statistically significant differences in OS (94.7% vs. 87.2% at 3 years;
P
= 0.126) and RFS (88.4% vs. 84.4% at 3 years;
P
= 0.281) between post and pre-FSCs, respectively.
Conclusions:
Clinical fellowship training results in increase multidisciplinary referrals to supportive services, improves radiotherapy workflow, but had no significant impact on survival outcomes.
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CASE REPORTS
Intracranial hemorrhages associated with meningiomas: Own experience and literature review
Zygmunt Siedlecki, Karol Nowak, Sebastian Grzyb, Maciej Śniegocki
April-June 2022, 18(3):820-826
DOI
:10.4103/jcrt.JCRT_958_20
Intracranial hemorrhage associated with meningioma is rare. Relatively, few such cases are described in the source literature, and it is estimated that intracranial meningiomas presenting with hemorrhage account for about one percent of all meningiomas. Hemorrhage can occur in both meningioma tissue and on the tumor surface. It can lead to intracerebral, subdural and subarachnoid hematoma. This can in turn cause high intracranial pressure with rapid neurological deterioration. Urgent neurosurgical intervention is often necessary. In our department, three patients with meningioma-related hemorrhage were treated surgically from 2006 to 2020. One patient was operated on as an emergency, due to the patient's poor neurological condition, while the two others underwent surgery following supplementary diagnosis several days following their admission. The outcomes of the three patients were good. The three meningiomas associated with hemorrhage described in the present manuscript constitute 2.2% of all 136 meningiomas treated surgically from 2006 to 2020 at our department. All three hemorrhages described in this study were associated with WHO I convexity meningiomas. Similar data can be found in some sources also describing meningioma WHO I-related hemorrhages; nevertheless, other literature references indicate a higher risk of bleeding into meningiomas of a higher degree of malignancy. The hemorrhage mechanism remains unclear; however, the proposed mechanism is rupture of defective intratumoral blood vessels and stretching of the superficial veins including bridge veins by the growing tumor, leading to their rupture. Our observations regarding the incidence of meningioma hemorrhage and tumor location are consistent with the source literature data.
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270
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Radiation therapy for squamous cell cancer of the skin in a patient with xeroderma pigmentosum
Pelin Altinok, Ertugrul Tekçe, Selma Sönmez Ergün, Alpaslan Mayadagli
April-June 2022, 18(3):801-803
DOI
:10.4103/jcrt.JCRT_534_20
Xeroderma Pigmentosum is an autosomal recessive disease characterized by increased sensitivity to ultraviolet radiation. Adjuvant radiotherapy (RT) is an important locoregional treatment modality for high-risk skin squamous cell cancers (SCCs). We present a case of an adult with high-risk skin SCC treated with standard adjuvant RT and followed-up for >4 years with acceptable side effects.
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218
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ERRATA
Erratum: Gnathic variant of primary adenoid cystic carcinoma: A unique case report
April-June 2022, 18(3):871-871
DOI
:10.4103/0973-1482.351854
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CASE REPORTS
Prosthetic management of a postsquamous cell carcinoma patient with maxillomandibular resection including lip
Phibadahun Sohmat, Sunit Kumar Jurel, Raghuwar Dayal Singh, Pooran Chand, Neeti Solanki
April-June 2022, 18(3):834-836
DOI
:10.4103/jcrt.JCRT_1132_20
Maxillofacial defects not only create esthetic and functional problems for the patient but also have psychological and social impact on the patient. The present clinical report describes the management of a patient who had undergone partial maxillectomy, hemimandibulectomy, and partial resection of the lip on the left side. Rehabilitation of this patient was done using silicone lip prosthesis and maxillary obturator. These prostheses improve the esthetics, function, and provide confidence to the patient, hence improving his social life. The lip prosthesis was retained by two magnets that were attached to the denture cum obturator to provide good retention and stability to the lip prosthesis.
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