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   2012| October-December  | Volume 8 | Issue 4  
    Online since January 29, 2013

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Cytomorphological profile of neoplastic effusions: An audit of 10 years with emphasis on uncommonly encountered malignancies
Sanjay Gupta, Pushpa Sodhani, Shyama Jain
October-December 2012, 8(4):602-609
Context: The diagnosis of metastatic cancer in fluids is of capital importance as, in most such instances, a rapid fatal outcome of the disease is anticipated. Aim: To determine the spectrum and cytomorphological features of the common and unusual malignancies presenting with effusions. Methods and Materials : A total of 11,562 effusion samples received for cytopathological examination over a 10-year period were analyzed retrospectively. Cytomorphological features of neoplastic effusions were studied. Special stains and immunocytochemistry (ICC) were performed to aid the diagnosis in difficult cases. Observations : The effusion samples comprised of pleural (5018), peritoneal (6340) and pericardial (204) fluids. A definitive diagnosis of classifiable malignancy could be given in 836 (7.3%) of these cases (5.7% adenocarcinomas and 1.6% uncommon malignancies). Adenocarcinoma was the most frequent cause of malignant pleural (70%) and peritoneal effusions (86.9%). The most common primary site for pleural metastasis was lung (35.7%), while for peritoneal metastasis, it was the ovary (54.3%). Among the uncommon neoplastic effusions, hematopoeitic malignancies were the most frequent, followed by squamous cell carcinomas. Primary malignant mesotheliomas were the most challenging to diagnose on effusion cytology. ICC was useful to arrive at a definitive diagnosis in difficult cases. Conclusions: Cytology is a useful tool to detect malignant effusions. However, in uncommon malignancies presenting as effusions, a detailed clinical history and ancillary investigations are often required to make a correct diagnosis.
  9,785 406 2
Advantages of surgical extirpation in addition to radioiodine therapy in differentiated thyroid carcinoma patients with a solitary large-volume skeletal metastasis with small-volume oligometastatic disease in the rest of the whole body
Sandip Basu, Chaitanya R Borde, Amit Abhyankar
October-December 2012, 8(4):656-657
  7,979 81 -
Fine needle aspiration cytology of oral and oropharyngeal lesions with an emphasis on the diagnostic utility and pitfalls
Nalini Gupta, Tarak Banik, Arvind Rajwanshi, Bishan D Radotra, Naresh Panda, Pranab Dey, Radhika Srinivasan, Raje Nijhawan
October-December 2012, 8(4):626-629
Aim: This study was undertaken to evaluate the diagnostic utility and pitfalls of fine needle aspiration cytology (FNAC) in oral and oropharyngeal lesions. Materials and Methods: This was a retrospective audit of oral and oropharyngeal lesions diagnosed with FNAC over a period of six years (2005-2010). Results: Oral/oropharyngeal lesions [n=157] comprised 0.35% of the total FNAC load. The age ranged 1-80 years with the male: female ratio being 1.4:1. Aspirates were inadequate in 7% cases. Histopathology was available in 73/157 (46.5%) cases. Palate was the most common site of involvement [n=66] followed by tongue [n=35], buccal mucosa [n=18], floor of the mouth [n=17], tonsil [n=10], alveolus [n=5], retromolar trigone [n=3], and posterior pharyngeal wall [n=3]. Cytodiagnoses were categorized into infective/inflammatory lesions and benign cysts, and benign and malignant tumours. Uncommon lesions included ectopic lingual thyroid and adult rhabdomyoma of tongue, and solitary fibrous tumor (SFT), and leiomyosarcoma in buccal mucosa. A single false-positive case was dense inflammation with squamous cells misinterpreted as squamous cell carcinoma (SCC) on cytology. There were eight false-negative cases mainly due to sampling error. One false-negative case due to interpretation error was in a salivary gland tumor. The sensitivity of FNAC in diagnosing oral/oropharyngeal lesions was 71.4%; specificity was 97.8% with diagnostic accuracy of 87.7%. Conclusions: Salivary gland tumors and squamous cell carcinoma (SCC) are the most common lesions seen in the oral cavity. FNAC proves to be highly effective in diagnosing the spectrum of different lesions in this region. Sampling error is the main cause of false-negative cases in this region.
  7,232 413 8
Immunohistochemical expression of IDH1 in gliomas: A tissue microarray-based approach
Varuna Sipayya, Ira Sharma, KC Sharma, Avninder Singh
October-December 2012, 8(4):598-601
Background: Mutations in the gene encoding isocitrate dehydrogenase (IDH1) have been reported in gliomas. This study analyses a series of 184 glioma cases in a tissue microarray (TMA)-based approach to assess the frequency of R132H point mutations in formalin-fixed, paraffin-embedded tissue samples. Materials and Methods : A total of 195 gliomas (30 pilocytic astrocytoma (PA), 45 diffuse astrocytoma [DA], 75 glioblastoma multiforme [GBM], 25 oligodendroglioma [OLIG] and 20 ependymoma [EPEN]). A TMA of core size 1.0 mm was constructed using a semi-automatic tissue arrayer. Immunohistochemical staining for IDH1, p53 and EGFR proteins was performed by the labeled sterptavidin avidin biotin LSAB method. Results : The frequency of mutant IDH1 detection by immunohistochemistry on formalin-fixed, paraffin-embedded tissue was 15.8% in 29/184 tumors found suitable for evaluation. DA, OLIG and GBM showed IDH1 expression in 17/40 (42.5%), 5/22 (22.7%) and 7/72 (9.7%) cases, respectively. Of all the GBMs, prim-GBM showed immunoexpression in 1/7 (1.5%) while sec-GBM showed IDH1 expression in 6/7 (85.7%). PA and EPEN did not react with anti-IDH1 antibody. DA and GBM showed positive correlation with p53, but IDH1 and EGFR coexpression was rare. Conclusion : Monoclonal antibody to IDH1 (R132) is a useful and less-labor-intensive method to detect mutations in gliomas. IDH1 is a useful immunohistochemical marker to differentiate reactive gliosis from low-grade astrocytoma, has potential as an independent prognostic marker and also helps in distinguishing primary from secondary GBM. Its sensitivity and specificity need to be assessed by simultaneous sequencing and its validation on clinically annotated samples.
  5,344 319 13
Establishing a framework to implement 4D XCAT Phantom for 4D radiotherapy research
Raj K Panta, Paul Segars, Fang-Fang Yin, Jing Cai
October-December 2012, 8(4):565-570
Aims: To establish a framework to implement the 4D integrated extended cardiac torso (XCAT) digital phantom for 4D radiotherapy (RT) research. Materials and Methods: A computer program was developed to facilitate the characterization and implementation of the 4D XCAT phantom. The program can (1) generate 4D XCAT images with customized parameter files; (2) review 4D XCAT images; (3) generate composite images from 4D XCAT images; (4) track motion of selected region-of-interested (ROI); (5) convert XCAT raw binary images into DICOM format; (6) analyse clinically acquired 4DCT images and real-time position management (RPM) respiratory signal. Motion tracking algorithm was validated by comparing with manual method. Major characteristics of the 4D XCAT phantom were studied. Results: The comparison between motion tracking and manual measurements of lesion motion trajectory showed a small difference between them (mean difference in motion amplitude: 1.2 mm). The maximum lesion motion decreased nearly linearly (R 2 = 0.97) as its distance to the diaphragm (DD) increased. At any given DD, lesion motion amplitude increased nearly linearly (R 2 range: 0.89 to 0.95) as the inputted diaphragm motion increased. For a given diaphragm motion, the lesion motion is independent of the lesion size at any given DD. The 4D XCAT phantom can closely reproduce irregular breathing profile. The end-to-end test showed that clinically comparable treatment plans can be generated successfully based on 4D XCAT images. Conclusions: An integrated computer program has been developed to generate, review, analyse, process, and export the 4D XCAT images. A framework has been established to implement the 4D XCAT phantom for 4D RT research.
  4,385 169 8
The in vivo antitumor effects on human COLO 205 cancer cells of the 4,7-dimethoxy-5-(2-propen-1-yl)-1,3-benzodioxole (apiole) derivative of 5-substituted 4,7-dimethoxy-5-methyl-l,3-benzodioxole (SY-1) isolated from the fruiting body of Antrodia camphorate
Po-Li Wei, Shih-Hsin Tu, Hsiu-Man Lien, Li-Ching Chen, Ching-Shyang Chen, Chih-Hsiung Wu, Ching-Shui Huang, Hui-Wen Chang, Chien-Hsi Chang, How Tseng, Yuan-Soon Ho
October-December 2012, 8(4):532-536
Context: The compound 4,7-dimethoxy-5-(2-propen-1-yl)-1,3-benzodioxole (apiole) has been isolated from several different plant species, including Petroselinum sativum. Our recent study found that apiole is a chemical derivative of 4,7-dimethoxy-5-methyl-l,3-benzodioxole (SY-1), which has been isolated from dried Antrodia camphorata (AC ) fruiting bodies, a traditional Chinese medicine with antitumor properties. Aims: Our previous in vitro study demonstrated that apiole inhibits the growth of human colon (COLO 205) cancer cells through the arrest of the cell cycle in G0/G1 phase. The in vivo antitumor effects of apiole were evaluated in this study. Setting and Design: Apiole was administered to mice at 1-30 mg/kg body weight through intraperitoneal (I.P.) injection three times per week (defined as a dosage of 1×-30×). Materials and Methods: The in vivo antitumor effects of apiole were evaluated in mice with xenografts of COLO 205 cells. Statistical Analysis: All of the data are reported as the means ± S.E. Comparisons were performed with a one-way analysis of variance (ANOVA) followed by a Fisher's least significant difference test. Significance was defined as P < 0.05. Results: Apiole (> 1×) markedly decreased the growth of COLO 205 human colon cancer cell tumor xenografts in an athymic nude mouse model system through the up-regulation of cell cycle regulators, such as p53, p21/Cip1, and p27/Kip1. The apiole-induced increase in G0/G1 phase cell cycle regulators was also associated with a significant decrease in the expression of cyclins D1 and D3. Surprisingly, statistically significantly higher tumor volumes were observed in mice that received 5× apiole compared with 30× apiole-treated mice (P < 0.05). No gross signs of toxicity were observed (e.g., body weight changes, general appearance, or individual organ effects) in any group. Conclusions: Our results show, for the first time, the promising antitumor effects of apiole against colon tumors in an in vivo xenograft model.
  4,095 246 7
Antimetabolites: Established cancer therapy
Manjul Tiwari
October-December 2012, 8(4):510-519
DOI:10.4103/0973-1482.106526  PMID:23361267
Cell death has been divided into two main types: programmed cell death, in which the cell plays an active role, and passive (necrotic) cell death. Senescence arrest, accelerated senescence and differentiation are also responses that can be induced in response to DNA-damaging agents. Apoptosis may occur as a primary event following chemotherapy, in which genes that regulate apoptosis will influence the outcome of therapy or, alternatively, as an event secondary to the induction of lethal damage that involves the subsequent processing of cellular damage. The particular type of response induced is highly dependent on the agent and dose employed, the type of DNA damage induced as well as the genetic and cellular phenotypes. It has been proposed that apoptosis may play a lesser role in tumor response to radiation in comparison with the induction of cell death through mitotic catastrophe or a senescence-like irreversible growth arrest. However, in comparison with the induction of apoptosis, there is a lack of as much definitive information on other cell death processes that occur in cancer cells in response to chemotherapeutic agents, including antimetabolites. This article reviews what is known about these processes at the present time in response to experimental or clinically used agents that are analogs of 5-fluorouracil, cytidine or purines, hydroxyurea, or that belong to the family of folate antagonists.
  3,815 447 12
Skull-base Ewing sarcoma with multifocal extracranial metastases
Sumit Thakar, Sunil Furtado, Nandita Ghosal, Jethwani Dilip, Anita Mahadevan, Alangar Hegde
October-December 2012, 8(4):636-638
Intracranial occurrence of Ewing sarcoma (ES) is unusual, with a skull-base location being anecdotal. We report a 29-year-old man who presented with rapidly progressive ophthalmoplegia, and was found to be harboring an infiltrative lesion involving the sphenoid sinus, sella, and clivus. He underwent trans-sphenoidal decompression of the lesion which was histologically suggestive of ES. He developed paraparesis 2 weeks after commencing adjuvant therapy. Imaging revealed two thoracic extradural lesions and florid vertebral and pulmonary metastases. This is the first report in indexed literature of a primary intracranial ES on the skull-base with disseminated extracranial disease.
  4,001 117 4
Primary cutaneous adenoid cystic carcinoma of the chest wall: A rare entity
Sujata Raychaudhuri, KV Santosh, HV Satish Babu
October-December 2012, 8(4):633-635
Primary Cutaneous Adenoid Cystic Carcinoma (PCACC) is a rare form of cutaneous carcinoma. It closely resembles adenoid cystic carcinoma of salivary glands. The lesion tends to infiltrate and recur locally but rarely metastasizes to distant organs and lymph nodes. We present here a case of a31-year-old male with complaints of swellings in the chest wall and scalp, progressively increasing in size over a period of 10 years. Clinical diagnosis of sebaceous cysts of scalp and chest wall was made. Histopathology revealed PCACC of the chest wall and dermoid cyst of the scalp.
  3,772 139 2
Autoimmunity in the elderly: Implications for cancer
Michele Malaguarnera, Erika Cristaldi, Giulia Romano, Lucia Malaguarnera
October-December 2012, 8(4):520-527
Immunosenescence is the aging process involving the immune system competencies. These changes imply a reduced level of immunosurveillance against cancer onset and the occurrence of autoimmune phenomena. The clinical presentation of autoimmune diseases in the elderly is characterized in most cases by atypical features, insidious presentation and poor specificity of laboratory parameters. The role of autoimmune reactivity in the elderly either as a consequence of or as a risk factor for cancer development has aroused great interest among clinicians and researchers, as well as the influence of a chronic inflammatory state as a predisposing factor for autoimmunity and cancer occurrence. Particularly, we have investigated the pathogenetic effect of two cell subsets, Treg cells and Th17 lymphocytes, involved in the control mechanisms both of autoimmune reactions and cancer onset, as the possible future approach to treat cancer in older adults.
  3,500 248 2
Cannabinoid receptor 2 is upregulated in melanoma
Zigang Zhao, Jie Yang, Hua Zhao, Xiangdong Fang, Hengjin Li
October-December 2012, 8(4):549-554
Aims: To investigate the expression of CB 2 in normal skin, pigmented nevus, and malignant melanoma; analyze its relation with genesis; and development of malignant melanoma. Materials and Methods: In our study, we detected the expression of CB 2 in 20 cases of melanoma, nevus tissue, and normal skin tissues, respectively, by using immunohistochemistry, in situ hybridization, and RT-PCR. Moreover, we investigated the localization and expression of CB 2 in human melanoma cell line A375 and human immortalized keratinocyte cell line HaCaT by using immunofluorescence and western blotting. Results: Our data revealed that CB 2 is unregulated in melanoma. Conclusions: CB 2 plays a role in the development of melanoma.
  3,377 175 5
Pre-cancerous (DNA and chromosomal) lesions in professional sports
Radhika Sharma, Shailey , Gursatej Gandhi
October-December 2012, 8(4):578-585
Context: Exhaustive exercises may become detrimental, causing disturbance of intracellular oxidant-antioxidant balance and damage to macromolecules, leading to genomic instability when DNA/chromosomes get damaged. As these are precancerous lesions, cancer occurrence is probable. Because professional sports requires high-intensity training and increasing physical demand, there may occur cellular genomic instability. Aim: To evaluate genetic damage at DNA and chromosomal levels in hockey and baseball-soft ball players and compare with levels in age- and sex-matched sedentary controls. Setting and Design: Players professionally active in their sport from 3 to 11 years on a daily training session of 4h/day were contacted during their camps, and the study was approved by the Institutional Ethics Committee. All participants were healthy individuals, not on any medication and were not taking any supplements. Materials and Methods: Genetic damage using the single cell gel electrophoresis assay and buccal micronucleus cytome assay of 56 individuals (36 players and 20 controls) was evaluated. Statistical Analysis Used: Student's t -test, ANOVA, Pearson correlation and linear regression and Chi-square analysis were performed. Results: Players had significantly elevated levels of genetic damage. There were no gender differences and also no significant difference in the genetic damage incurred in both sports types. However, the extent of DNA migration in hockey players was higher. Conclusion: Significantly increased genomic instability in players of both sports was observed. Both repaired and repairable genetic damage cells were observed in different tissues of the same subject. The presence of such genetic damage implies that these players are at an individual risk from cancer- and age-related diseases.
  3,392 134 1
Gall bladder cancer in a child: A rare occurrence
Dillip K Muduly, Surya V Satyanarayana Deo, Nootan K Shukla, Ashwin A Kallianpur, Ravi Prakash, Thejus Jayakrishnan
October-December 2012, 8(4):653-654
  3,321 124 -
A rare posterior cranial fossa tumor
Bevinahalli N Nandeesh, Manmeet Singh Chabra, Manjaly K Babu, Ashish K Chand
October-December 2012, 8(4):644-646
Among tumors of the central nervous system, tumors of the mixed glioneuronal type form an important recognized subset. Some of the examples for mixed glioneuronal tumors include gangliocytoma, dysembryoplastic neuroepithelial tumor (DNT), ganglioglioma, anaplastic ganglioglioma, and central neurocytoma. The rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a new entity that has only slowly emerged in the literature due to its prior classification with other low-grade mixed glial and neuronal tumors. These tumors are relatively infrequent lesions, and therefore, they can be challenging to diagnose for the practicing pathologist. This is a rare biphasic tumor with clearly defined neurocytic and glial components. The tumor is found exclusively in the posterior fossa, where it arises in the midline, usually occupying a substantial fraction of the fourth ventricle, and it is observed by magnetic resonance imaging (MRI) as a circumscribed, solid mass with heterogeneous contrast enhancement. We describe here a case of RGNT occurring in a 22-year-old male.
  3,258 115 -
Oral tuberculosis following successful treatment of oral malignancy
Preeti Bagga, Abhinav Dewan, Pankaj Agarwal, Charu Garg, Niloy R Datta
October-December 2012, 8(4):650-651
Coexistence of tuberculosis and neoplastic lesion in the oral cavity is a rare phenomenon. Till date, only three such cases have been reported in the English literature. A case of oral tuberculosis manifesting 3 months following the successful treatment of cancer of the oral tongue with chemoradiotherapy is presented. The diagnostic dilemma it posed, and its eventual successful control by anti-tubercular treatment, is discussed.
  3,183 117 1
A comparative analysis of langerhans cell in oral epithelial dysplasia and oral squamous cell carcinoma using antibody CD-1a
Juhi Upadhyay, Nirmala N Rao, Ram B Upadhyay
October-December 2012, 8(4):591-597
Background: The integrity of the immune system is necessary to control tumor progression and a compromised state contributes to tumor escape. Aims: The study intends to evaluate the presence and distribution pattern of Langerhans cells (LC) in Oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) oral epithelial dysplasia and oral squamous cell carcinoma and elucidate their role. The study analyses LC in histological zones of the epithelium and connective tissue, which has seldom been attempted previously. Materials and Methods: Forty-five microscopic sections (i.e. 5 normal, 15 OED and 25 OSCC) were examined for expression of LC marker CD1a using immunohistochemistry. LCs were counted in zones of epithelium and connective tissue. Statistical Analysis Used: Results were analyzed using SPSS Version 16.0 and subjected to one-way ANOVA comparison and Student's t-test and Wilcoxon Z test. Results: Significant decline in LC count was observed with progressing grade of OED and OSCC. The basal and suprabasal zones in OED and superficial zone in OSCC exhibited the highest density of LCs. The low LC count in severe dysplasia was attributed to paucity in the basal zone. There was a significant paucity of LCs in the sub-epithelial zone of all the grades of OSCC, with high influx of LCs within the tumor stroma. Also, poorly differentiated OSCC exhibited a significant decrease in the LC count within the overlying epitheilium as well as the tumor stroma. Conclusion: The present study suggests that there is a recruitment of LCs in the neoplastic process. Changes observed in LC distribution within the zones of dysplastic epithelium and tumor stroma can be interpreted as their pathophysiologic function.
  2,894 224 3
Primary malignant lymphoma of the parotid gland
Sudha H Metikurke, Rashmi Krishnappa, Sreevathsa M Ramachar, Iteeka Arora
October-December 2012, 8(4):641-643
Lymphoma of the salivary gland accounts for 5% of cases of extranodal lymphoma and 10% of malignant salivary gland tumors. Most primary salivary gland lymphomas are B marginal zone lymphomas arising on a background of sialadenitis associated with an autoimmune disorder such as Sjorgen's syndrome. This report describes a case of primary B-cell lymphoma arising in the parotid gland in a middle-aged female, which was not associated with an autoimmune disorder. Immunohistochemistry studies confirmed the clonal B-cell nature of the tumor. This case highlights the fact that B-cell lymphoma in the salivary gland can go unrecognized due to its non-specific symptoms and requires immunohistochemistry studies for confirmation. We present this case for its rarity.
  2,871 138 1
The factors that have an impact on the development of brain metastasis in the patients with breast cancer
Adem Dayan, Dogan Koca, Tulay Akman, Ilhan Oztop, Hulya Ellidokuz, Ugur Yilmaz
October-December 2012, 8(4):542-548
Background: To evaluate the factors that have an impact on the development of brain metastasis in patients with breast cancer. Materials and Methods: Among the patients who were followed-up and treated for breast cancer between January 2000 and January 2010, the ones with brain metastasis were included to the analysis. Metastatic breast cancer patients without brain metastasis, which had similar duration of follow-up and median age were included as the control group. Both group were compared for prognostic and predictive factors in terms of relationship between with or without brain metastasis and survival. Results: There were a total of 63 female patients with metastatic breast cancer who had brain metastasis and the researchers enrolled the same number of female patients as the control group. In the univariate analysis, as a significant finding, it was found that, the patients with breast cancer who had brain metastasis had vascular invasion positivity, human epidermal growth factor receptor-2 (HER-2) positivity, a rare detection of invasive lobular carcinoma component in the tumor, estrogen receptor negativity, and no bone and liver metastasis and they did not receive chemotherapy due to several reasons after the detection of metastasis in any organ. In the multivariate analysis, HER-2 positivity, no bone and liver metastasis and not receiving chemotherapy due to several reasons after the detection of metastasis in any organ were detected as significant findings. Conclusions: As the prognostic and predictive factors showing the development of brain metastasis in breast cancer patients may be identified, follow-up also including the brain is important in order to take preventive measures.
  2,812 186 2
Angiogenesis and mast cell density in invasive pulmonary adenocarcinoma
Ehsan Ullah, Abdul H Nagi, Raees A Lail
October-December 2012, 8(4):537-541
Introduction: Angiogenesis and mast cells affect the behavior of pulmonary adenocarcinoma. Measuring the angiogenesis and mast cell density (MCD) and their effect on survival of the patients may be helpful to guide the use of cancer chemotherapeutic agents which target tumor angiogenesis and mast cells. Materials and Methods: It was a descriptive study, conducted at Gulab Devi Chest Hospital and University of Health Sciences Lahore. It included 23 newly diagnosed, adult patients of invasive pulmonary adenocarcinoma. Clinical history was obtained and biopsy specimen was processed. Angiogenesis was determined by immunohistochemical staining with CD34. Mast cells were counted in toluidine blue stained sections. Patients were followed-up till death. Results: Mean age of the patients was 54.83 ± 2.799 years. Majority (60.9%) were males. Only 39.1% patients were smokers. Morphologically, large proportions of tumors (73.9%) were nonmucinous and moderately or poorly differentiated. Majority (69.6%) of patients presented at advanced stage (Tumor-Node-Metastasis staging (TNM )III and IV). Mean microvascular density (MVD) was 13.04 ± 1.12 and mean MCD was 3.26 ± 0.36 per high power field (HPF). High MVD was associated with poor differentiation and advanced stage and correlated with poor survival (P = 0.0001). High MCD was associated with high grade but not with the advance stage of disease. However, high MCD correlated with poor survival (P = 0.047). Moreover, MCD was positively correlated with angiogenesis (r = 0.727, P = 0.0001). Treatment did not affect the survival significantly (P = 0.069). Conclusion: High angiogenesis and MCD predict poor survival and are positively correlated with each other and with the histological grades in pulmonary adenocarcinoma. High angiogenesis is also associated with advance TNM stage of disease.
  2,669 279 3
Dose verification to cochlea during gamma knife radiosurgery of acoustic schwannoma using MOSFET dosimeter
Sunil D Sharma, Rajesh Kumar, Philomina Akhilesh, Anil M Pendse, Sudesh Deshpande, Basant K Misra
October-December 2012, 8(4):528-531
Aim: Dose verification to cochlea using metal oxide semiconductor field effect transistor (MOSFET) dosimeter using a specially designed multi slice head and neck phantom during the treatment of acoustic schwannoma by Gamma Knife radiosurgery unit. Materials and Methods: A multi slice polystyrene head phantom was designed and fabricated for measurement of dose to cochlea during the treatment of the acoustic schwannoma. The phantom has provision to position the MOSFET dosimeters at the desired location precisely. MOSFET dosimeters of 0.2 mm x 0.2 mm x 0.5 μm were used to measure the dose to the cochlea. CT scans of the phantom with MOSFETs in situ were taken along with Leksell frame. The treatment plans of five patients treated earlier for acoustic schwannoma were transferred to the phantom. Dose and coordinates of maximum dose point inside the cochlea were derived. The phantom along with the MOSFET dosimeters was irradiated to deliver the planned treatment and dose received by cochlea were measured. Results: The treatment planning system (TPS) estimated and measured dose to the cochlea were in the range of 7.4 - 8.4 Gy and 7.1 - 8 Gy, respectively. The maximum variation between TPS calculated and measured dose to cochlea was 5%. Conclusion: The measured dose values were found in good agreement with the dose values calculated using the TPS. The MOSFET dosimeter can be a suitable choice for routine dose verification in the Gamma Knife radiosurgery.
  2,793 147 -
Correlation of expression pattern of aquaporin-1 in primary central nervous system tumors with tumor type, grade, proliferation, microvessel density, contrast-enhancement and perilesional edema
Prabal Deb, Seerat Pal, Vibha Dutta, Dibyajyoti Boruah, Vijai M Chandran, Harjinder S Bhatoe
October-December 2012, 8(4):571-577
Objectives: Brain edema, a hallmark of malignant brain tumors, continues to be a major cause of mortality. The underlying molecular mechanisms are poorly understood and thought to be mediated through membrane water-channels: aquaporins (AQP1,4,9). The abnormal upregulation of AQP1 in certain glial neoplasms has suggested a potential role in tumor pathogenesis, apart from being a novel target for newer therapeutic regimen. This study was undertaken to evaluate the expression of AQP1 in primary CNS tumors of various histologic types and grades, and its correlation with contrast-enhancement, perilesional edema, histomorphology, proliferation index and microvessel density. Materials and Methods: Biopsy tissues from 30 patients (10 each from gliomas, meningiomas and other primary CNS tumors) were studied. Autopsy brain sections served as control. AQP1-immunoreactivity was correlated with histomorphology, radiology, proliferation index and microvessel density (MVD). Results: AQP1 expression was increased in gliomas and ependymal tumors as compared to meningiomas. Intratumoral expression was homogenous in high-grade and membranous in low-grade neoplasms, while peritumoral areas showed expression around vessels and reactive astrocytes. High-grade tumors showed peritumoral upregulation, while low-grade had intense intratumoral expression. A trend of positive correlation was observed between AQP1-immunopositivity and increasing grade, higher MIB-1LI, increasing contrast-enhancement and more perilesional edema, and elevated MVD with raised AQP1:MVD ratio. Conclusions: AQP1-immunoexpression had a good correlation with high-grade tumors. AQP-upregulation in perilesional areas of high-grade tumors suggests its role in vasogenic edema. Further studies involving other AQP molecules, vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1 α (HIF-1α) should be undertaken to evaluate its possible role as a potential surrogate marker of high-grade tumors heralding poor outcome, inhibition of which may serve as the basis for future targeted therapy.
  2,721 157 14
Extranodal Rosai-Dorfman Disease presenting as spinal extradural lesion: A case report with a review of the literature
Chhaya Roy, Animesh Saha, Subhendu Roy, Angshuman Ghosh
October-December 2012, 8(4):647-649
Sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease (RDD) is a rare, but well-documented entity. We report a male patient who presented with progressive paraparesis, with thoracolumbar extradural lesion (from D11 to L2 level) on magnetic resonance imaging (MRI). He underwent D12-L2 laminectomy followed by total removal of extradural spinal space-occupying lesion (SOL). Histopathological diagnosis of the lesion was RDD. Four weeks after surgery, he was treated with external beam radiotherapy, total dose: 50.4GY in 28 fractions. On three-month follow-up, he did not have any neurological deficits. There was no evidence of other extranodal or lymph node involvement. This case has been reported on account of rare presentation of this disease as spinal extradural lesion. Pertinent literature has been reviewed.
  2,580 117 2
Dosimetry parameters calculation of two commercial iodine brachytherapy sources using SMARTEPANTS with EPDL97 library
Navid Ayoobian, Kamal Hadada, Barry D Ganapol
October-December 2012, 8(4):610-618
Aim: Simulating Many Accumulative Rutherford Trajectories Electron Photon and Neutral Transport Solver (SMARTEPANTS) is a discrete ordinates S N Boltzmann/Spencer-Lewis solver that was developed during 1988-1993 by William Filippone and his students. The code calculates particle fluxes, leakage currents as well as energy and charge deposition for coupled electron/photon in x-y-z geometries both in forward and in adjoin modes. Originally, SMARTEPANTS was designed to utilize CEPXS cross-section library for shielding calculation in satellite electronics. The aim of this study was to adapt SMARTEPANTS to use a new photon cross-section library from Evaluated Photon Data Library, 1997 version (EPDL97) for intravascular brachytherapy 125 Isimulations. Materials and Methods: A MATLAB (MathworkNatick, Massachusetts) program was written to generate an updated multigroup-Legendre cross-section from EPDL97. The new library was confirmed by simulating intravascular brachytherapy Best® Model 2301 and Intersource 125 I dosimetry parameters using SMARTEPANTS with different energy groups (g), Legendre moments (L) and discrete ordinate orders (S). Results: The dosimetry parameters for these sources were tabulated and compared with the data given by AAPM TG-43 and other reports. The computation time for producing TG-43 parameters was about 29.4 min in case of g = 20, L = 7 and S = 16. Conclusion: The good agreement between the results of this study and previous reports and high computational speed suggest that SMARTEPANTS could be extended to a real-time treatment planning system for 125 I brachytherapy treatments.
  2,595 91 -
Immunohistochemical correlation of epidermal growth factor receptor and c-erbB-2 with histopathologic grading of mucoepidermoid carcinoma
Monir Moradzadeh Khiavi, Sepideh Vosoughhosseini, Shirin Saravani, Monireh Halimi
October-December 2012, 8(4):586-590
Objective: Mucoepidermoid carcinoma is the most common salivary gland malignancy with highly variable biologic potential that correlates with the histopathologic grade of the tumor. Therefore, identification of the histopathologic grade of the mucoepidermoid carcinoma is very important in the treatment and determination of the final prognosis. The present study was performed to survey immunohistochemically Epidermal Growth Factor ReceptorEGFR and c-erbB-2 expression in different grades of mucoepidermoid carcinoma. Materials and Methods: This retrospective study included 46 formalin-fixed, paraffin-embedded blocks of mucoepidermoid carcinoma. Based on histopathologic parameters, samples were classified into three grades. Then new sections were made and stained by immunohistochemistry (IHC) method for EGFR and c-erbB-2. Finally, EGFR and c-erbB-2 expression and their correlation with histopathologic grading were statistically analyzed by ANOVA. Nineteen samples of normal salivary gland tissue were also chosen as control group. Results: The means of EGFR and c-erbB-2 were 71%, 71%, respectively. Statistically significant correlation was found between EGFR expression and histopathologic grading of mucoepidermoid carcinoma of salivary glands (P < 0.001). There was no statistically significant correlation between histopathologic grading of salivary gland mucoepidermoid carcinoma and c-erbB-2 expression (P = 0.60). Conclusion: There is a parallelism between an increase in EGFR expression and increase in the histopathologic grading of salivary gland mucoepidermoid carcinoma. Therefore, the biologic behavior of salivary gland mucoepidermoid carcinoma can be determined by EGFR expression and it is a useful technique for determination of tumor grades and probably their prognosis.
  2,401 167 3
Positron emission tomography/computed tomography and esophageal cancer in the clinical practice: How does it affect the prognosis?
Anna R Cervino, Laura Evangelista, Rita Alfieri, Carlo Castoro, Vanna Chiarion Sileni, Fabio Pomerri, Luigi Corti, Pier C Muzzio
October-December 2012, 8(4):619-625
Aims: The aim of this study was to assess the diagnostic value of positron emission tomography/computed tomography (PET/CT) in staging of esophageal cancer and to evaluate the prognostic role of metabolic parameters before and after neo-adjuvant treatment. Settings and Design: Mono-institutional retrospective study. Materials and Methods: We retrospectively evaluated 29 patients who underwent PET/CT at initial staging and after neo-adjuvant therapy. Metabolic parameters were calculated: mean, average, maximum standardized uptake value (SUVmax), and total lesion glycolysis (TLG). Diagnostic advantages of PET/CT over conventional imaging (CI) were determined. The relationships between baseline and after-therapy SUVmax and TLG, change in SUV and TLG (reported as ∆) for the primary tumor and prognosis were assessed. Statistical Analysis Used: Non-parametric statistic (e.g. Wilcoxon test and chi-square test). Results: Twenty-nine patients were eligible for the initial staging. Thirteen patients were incorrectly staged based on CI; PET/CT was able to identify distant lymph nodes in seven patients (59%) and distant metastases in four (31%). The median SUVmax before and after neoadjuvant therapy was 10.38 and 3.53 (P = 0.0005), respectively. Only few semi-quantitative parameters obtained by PET/CT after neoadjuvant therapy seemed to have a prognostic value. TLG and ∆TLG were significantly different between disease-free and died patients (0.49 versus 15.51 and 100% versus 94%, respectively; all P = <0.05). Conclusions: PET/CT is confirmed as being able to detect distant metastases and to avoid unnecessary surgery. Although not routinely reported, post-neoadjuvant TLG and ∆TLG might be considered as useful prognostic parameters and should be further evaluated prospectively.
  2,265 124 3
Extensive 99m Tc-MDP uptake in metastasis to contralateral pleura from osteosarcoma of femur: An indirect measure of extent of disease involvement at diagnosis
Sandip Basu, Abhishek Mahajan
October-December 2012, 8(4):655-656
  2,289 95 -
Norathyriol suppresses transformation in JB6 P+ cells by the inhibition of Akt
Jixia Li, Xiangyong Li, Zhiwei He, Keyuan Zhou
October-December 2012, 8(4):561-564
Context: Chemoprevention has been acknowledged as an important and practical strategy for the management of skin cancer. Norathyriol, a naturally occurring compound present in various plants, has a potent anticancer-promoting activity. Aims: The aim was to investigate the chemopreventive activity of norathyriol on JB6 P+ cells. Materials and Methods: A soft agar assay was used to detect the effect of norathyriol on cell transformation. The activator protein-1 (AP-1) transactivation activity was examined by the luciferase assay. Results: Norathyriol inhibited epidermal growth factor (EGF)- and 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced neoplastic cell transformation in a dose-dependent manner. The activation of activator protein-1 was dose dependently suppressed by norathyriol treatment. Western blot data revealed that norathyriol attenuated the phosphorylation of Akt. Conclusions: Norathyriol exerts a potent chemopreventive activity by inhibiting Akt activation in neoplastic cell transformation.
  2,229 106 1
Experimental and Monte Carlo study of the effect of the presence of dry air, cortical bone inhomogeneities and source position on dose distribution of the mHDR-v2 source
Rakesh M Chandola, Samit Tiwari, Manjula Beck, Pradeep Kumar Chandrakar, Suresh Kumar Thakur
October-December 2012, 8(4):555-560
Background: Recently it was data wise established that there is a considerable dose difference due to source position from the surface of the patient, and due to the presence of inhomogeneities. Aim: It aims at to find out the dose difference due to source position, and inhomogenieties in water phantom of high dose rate (HDR) 192 Ir mHDR-v2 source by experiment and by Monte Carlo (MC) simulation GEANT4 code. Materials and Methods: The measured study of the source was done using an in-air ionization chamber, water phantom while the calculated study was done by modeling the water phantom and its water, inhomogeneities, position of source, and points of calculation. Results: The measured and calculated dose differences are 5.48 to 6.46% and 5.43 to 6.44% respectively higher in the presence of dry air and 4.40 to 4.90% and 4.38 to 4.88% respectively lower in the presence of cortical bone. However, for the study of the effect of source position on dose distribution, when the source was positioned at a 1 cm distance from the surface of water phantom, the near points between 1 cm and 2 cm are 2 to 3.5% and 2.1-3.7% underdose and for distant points from 3 cm to 8 cm from the source are 4 to 15% and 4.1 to 15.8% underdose for measured and calculated studies, respectively, to the dose when the source was positioned at midpoint of water phantom. Conclusion: These results can be used in the treatment planning system.
  2,212 122 -
Choroid as the first recurrence site: 13 years after breast carcinoma
Ting Liu, Yuanyuan Xu, Lei Wan, Bin Yu
October-December 2012, 8(4):639-640
Breast carcinoma is one of the most common primary tumors of metastatic choroidal tumors. The average time from the breast cancer diagnosis to metastasis to the eye and orbit has been reported to be approximately 4 years. We report an unusual case of the choroid as the first recurrence site in a 48-year-old woman with a history of breast cancer. In our reported case, the patient had a 13-year interval between the breast cancer surgery and the identification of the first and sole metastasis to the choroid. We present this unusual case, and to analyze the clinical, histopathological and immunohistochemical findings, so as to differential diagnosis from other choroidal tumors.
  2,116 93 1
Nexus: Plexus redeeming doctors
Nagraj G Huilgol
October-December 2012, 8(4):509-509
  1,697 269 -
Squamous cell carcinoma of lung metastasizinig in breast
Sarbani Chattopadhyay, Ranen Kanti Aich, Amitava Sengupta, Poonam Kumari
October-December 2012, 8(4):630-632
Metastasis in breast from extra-mammary malignancy is rare and lung is the third most common primary site when such a metastasis occurs. Small cell carcinoma and adenocarcinoma are two histological varieties of lung carcinoma that may metastasize to breast and squamous cell type is very rare. Here we report a case of squamous cell carcinoma of lung that metastasized in the breast and mimicked primary breast carcinoma.
  1,814 128 1
Dance with Chance - Making luck work for you
CR Sridhar
October-December 2012, 8(4):662-663
  1,667 229 -
Medical Ethics in Ayurveda
Nagraj G Huilgol
October-December 2012, 8(4):661-661
  1,756 135 -
Immunoglobulin a multiple myeloma associated with sweet syndrome
I Tazi, H Nafil, L Mahmal
October-December 2012, 8(4):652-653
  1,615 91 -
Interview with Dr. Ramesh Bilimagga
PS Sridhar
October-December 2012, 8(4):658-660
  1,483 94 -
Requesting clarifications concerning the case report on 'extraskeletal Ewing sarcoma of the sinonasal tract
Priyanka Thakur, Swaroop Revannasiddaiah, Madhup Rastogi, Sudesh Kumar
October-December 2012, 8(4):652-652
  1,251 99 -