Issue No. 12 - JULY 2012


Pages Title /Authors/ Abstract


Penile cancer in India: A clinicoepidemiological study

  M. Pahwa, M. Girotra, A. Rautela, R. Abrahim
Maulana Azad Medical College, New Delhi, India

Introduction: Penile cancer is one of the most common genitourinary cancers encountered in developing countries like India. The incidence of carcinoma of the penis varies according to circumcision practice, hygienic standard, phimosis, the number of sexual partners, HPV infection, exposure to tobacco products, and other factors. The aim of the study was to study the clinic-epidemiological profile of penile cancer. Materials and methods: 54 patients were enrolled and studied from May 2005 to June 2006. Clinicoepidemiologic profile and patients’ characteristics were assessed in a questionnaire including demographic data, presence of risk factors like smoking, phimosis, circumcision, history of promiscuity, history of sexually transmitted disease etc., clinical features, pathological features of tumor like size, site, appearance, histological type, grade, presence of lymph nodes, treatment performed and response. 5 year survival rates were also calculated. Results: Of the 54 patients, about three-fourths patients were older than 50. About one quarter patients presented with phimosis and 20% patients had undergone circumcision after attaining adulthood. 70% patients were found to be smokers. Most patients presented with T2 disease whereas lymphadenopathy, both benign and malignant, was present in 55.5% and 76% patients in T1 and T2 patients respectively. 5 year survival rates were found to be 87% and 60% respectively in stage I and II respectively. Conclusion: penile cancer is one of the most common genitourinary cancer affecting mostly aged, uncircumcised males with history of smoking. Most patients present at advanced age and hence a national awareness campaign against this disease should be promoted. Keywords: penile cancer, circumcision, phimosis, HPV, sexually transmitted diseases

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Gastric Cancer: A Retrospective analysis from AIIMS, New Delhi

R. Hadi1, B.K. Mohanti2, S. Pathy2, G.K. Rath2, N.K. Shukla3, S.V.S. Deo3, A. Sharma4, V. Raina4
1Department of Radiation Oncology, Dr RMLIMS, Lucknow-226010, Uttar Pradesh, India 2Department of Radiation Oncology, 3Department of Surgical Oncology, 4Department of Medical Oncology, Dr BRA IRCH, AIIMS, New Delhi, India

Carcinoma of stomach is the leading cause of cancer related death in the last century worldwide. However in many parts of the world, the incidence has gradually decreased due to changes in food habit and the environment. The proximal gastric and gastro-esophageal junction (GE junction) cancer has markedly increased in the last three decades. The only proven curative treatment is surgery, but due to high recurrence rate, efforts are still going on regarding better systemic and regional adjuvant therapies. The present study is a retrospective analysis of all the post-operative (post-op) cases of carcinoma stomach and the GE junction being registered and treated in our department from June 1995 to February 2008.

The total number (no.) of patients (pts) were 69 (54 stomach, 15 GE junction), males 49, females 20, KPS 50-90 (median 80), length of the lesion was <5cm in 28 pts, transmural infiltration along with serosa involvement was found in 40 pts. Histologically, adenocarcinoma was detected in 61 pts and metastatic spread in 50 pts. Thirty-six pts had surgery in another center prior to registration. Forty-nine pts had subtotal gastrectomy, while lymph nodes dissection was done in 64 pts. Chemo-radiotherapy (CRT) was given in 49 pts, and 54 pts received >30 Gy dose of radiation. Macdonald’s regimen was used in 49 pts.

Treatment compliance was found in 53 pts, but only 05 pts were hospitalized for supportive management. Pts were followed up from 01-69 months (median 12 months) and the recurrence was found in 13 pts (median 14 months). The multimodality intervention is better treatment option in the management of carcinoma of stomach. Keywords: Gastric cancer, Adenocarcinoma, Chemoradiotherapy, Macdonald’s regimen, Helicobacter pylori

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Intensity Modulated Radiotherapy (IMRT) In Head And Neck Cancers – An Overview

  C.M. Nutting
Department of Radiotherapy and Clinical Oncology, Royal Marsden NHS foundation trust Hospital, London, United Kingdom

Radiotherapy (RT) is effective in head and neck cancers. Following RT, dryness and dysphagia are the 2 major sequelae which alter the quality of life (QOL) significantly in these patients. There is randomized evidence that Intensity Modulated Radiotherapy (IMRT) effectively spares the parotid glands. IMRT has been attempted in all head and neck subsites with encouraging results (discussed below). Role of IMRT in swallowing structure (constrictor muscles) sparing is less clear.Further improvement in results may be possible by using functional imaging at the time of RT planning and by image guidance/verification at the time of treatment delivery. The following text discusses these issues in detail. Keywords: Head and neck cancer, IMRT

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Adult T-Cell Leukemia/Lymphoma

  K.I. Rasul, Z. Barwari
Al-Amal Hospital, Hamad Medical Corporation, Doha, Qatar

The adult T-cell leukemia/lymphoma (ATLL) syndromes comprise neoplasms that arise in peripheral lymphoid tissues but a high frequency present with blood involvement mimicking T-cell leukemia. Clinically ATLL is sub-classified into four groups: acute, lymphomatous, chronic and smoldering. ATLL is etiologically linked to the human T-cell lymphotropic virus type I (HTLV-I). The diagnosis of ATLL is based upon a combination of characteristic clinical manifestations, morphological and immunophenotypic changes of the malignant cells, in addition to the confirmation of HTLV-I infection. ATLL is an aggressive malignancy with a median survival of less than 12 months and no successful treatment yet available. Patients are either refractory or only transiently respond to chemotherapy or purine analogues. Smoldering and chronic ATLL pursue an indolent course and survival for years until the disease progresses and becomes refractory to therapy. The major causes of death in ATLL are opportunistic pulmonary infections and progressive disease, often in association with hypercalcemia. Keywords: Adult T-cell leukemia/lymphoma, HTLV-1, Cutaneous T-cell lymphomas, pneumocystis jirovecii (Carinii) pneumonia and Hypercalcaemia

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Adrenocortical Tumors in Children: A Kuwait Experience

  R. Mittal1, D. G. Ramadan2, N. M. Khalifa1, S. O. Khalifa1, Z. Mazidi2, M. Zaki3
1Unit of Pediatric Oncology, Department of Medical Oncology, Kuwait Cancer Control Centre, Kuwait 2Endocrine Unit, Pediatric Department, Al Sabah Hospital, Kuwait 3Pediatric Department, Farwaniya Hospital, Kuwait

Introduction: Adrenocortical tumors (ACT) are rare tumors of childhood. The majority of these tumors is hormone-producing and cause virilization and Cushing syndrome or feminization. Methodology: The authors describe 6 cases of adrenal cortical tumors treated at the Kuwait Cancer Center which were presented over a period of 20 years (1989-2009). Results: The mean age was 5.5 years (range 15 months – 12 years). All had signs of virilization. One child had hypertension, while 2 had a metastatic disease at presentation. The diagnosis was made by clinical signs and symptoms, high levels of relevant adrenal hormones and imaging. Two children were not fit for surgery; one was too sick for any treatment and died shortly after diagnosis, while the other died after receiving one cycle of palliative chemotherapy. Four patients underwent complete surgical resection and achieved complete remission, three of whom later had recurrence (distant in one and local in two patients) and succumbed due to progressive disease. Mitotane was used in two children. Only one patient is currently surviving and well nearly 13 years after her surgery. In our series, the long-term outcome of children with adrenocortical tumors was very poor. Conclusions: Virilization is an important clue to the diagnosis of ACT. Early diagnosis and complete surgical resection are important for survival. Metastasis at presentation or as recurrence carries very dismal prognosis. Keywords: Adrenocortical tumor, Adrenal neoplasm, Virilizing adrenal tumor, Pediatric hormone secreting tumors.

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Limb sparing surgery in soft tissue sarcoma of extremities: An Indian Perspective

  R.V. Bhargavan, P. Kumar, K.C. Kothari
Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Gujarat, India

This is a retrospective study of 57 patients with extremity soft tissue sarcomas treated at Gujarat Cancer Research Institute, Gujarat, India from January 2005 to December 2007. It aims to review the feasibility of limb sparing surgery for extremity soft tissue sarcoma in Indian population. Twenty-eight percent (28%) of tumors were located in the upper limbs and 72% in the lower extremities. The goal of treatment was limb salvage if feasible. The treatment consisted of amputation in 17 (30%) and local wide excision i.e. limb salvage surgery (LSS) in 40 (70%) patients. The most common histology was pleomorphic sarcoma (21%). Sixty-four percent (64%) of the patients were treated with surgery alone, 32% with surgery plus radiation and 4% with surgery plus systemic chemotherapy. Inadequate margins were present in 12% of the patients. All the patients were followed up for at least 2 years. Recurrence in the form of local and distant occurred in 39% of the patients. Local recurrence occurred in 18% of the patients who underwent LSS and in 35% of those who underwent amputation. Pulmonary metastasis was detected in 16% of patients. The 2 year mortality was 10.5% with the most common etiology being lung metastasis and the most common histology being leiomyosarcoma. We concluded that limb salvage surgery for soft tissue sarcoma is feasible in the Indian population (70%) although the rate is lower than that of world literature at 90%. Keywords: soft tissue sarcoma, wide excision, amputation, limb salvage surgery, Indian population

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Mixed germ cell tumor of ovary and Clitoromegaly in Swyer's Syndrome: A case report

  S. Aminimoghaddam1, B. Mokri2, F. Mahmoodzadeh3
1Department of Obstetrics and Gynecology, Firouzgar Clinical Research Development Center (FCRDC), Firouzgar Hospital, Tehran University of Medical Sciences, I.R. Iran 2Department of Internal Medicine &Critical Care Medicine, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University. M.C, I.R. Iran 3Medical Student, Mazandaran University of Medical Sciences, I.R. Iran

Swyer syndrome is a type of pure gonadal dysgenesis correlating with 46 XY karyotype, primary amenorrhea, and female internal and external genitalia. It reveals a testicular differentiation abnormality. A 16-year old girl admitted to our center with primary amenorrhea and abdominal mass. In spite of the absence of normal testis, clitoromegaly was noticed. Peripheral blood karyotype analysis showed 46 XY. Histopathology of the excised gonads determined mixed germ cell tumor in right ovary and streak left gonad without gonadoblastoma in left side. In patients suffering from Swyer syndrome, high risk of gonadal neoplasia dictates early prophylactic gonadal excision to lengthen survival. Keywords: gonadal dysgenesis, 46 XY, Swyer Syndrome, germ cell tumor

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Palmar Fasciitis and Arthritis Syndrome Associated With Metastatic Ovarian Cancer: A Paraneoplastic Syndrome

   I.K. Nahar and M. S. Al-Rajhi
Mubarak Al-Kabir Hospital, Al-Jabriya, Kuwait  

Palmar fasciitis and polyarthritis syndrome (PFPA) is an uncommon syndrome that affects predominantly elderly women and characterized by symmetrical polyarthritis followed by flexioncontracture of the hands. It is usually associated with a metastatic malignant neoplasm, and therefore implies a poor prognosis. We report a case of a 54-year old woman presented with palmar fasciitis and polyarthritis six months before the diagnosis of a metastatic adenocarcinoma of the ovary. Surgical excision of the tumor and adjuvant chemotherapy caused remission of the polyarthritis. Keywords: Palmar fasciitis and arthritis, paraneoplastic syndrome, polyarthritis ovarian cancer .

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Trichilemmal Pilar Tumor of the Scalp: A Case Report

  K. Al-Saleh1, H.S. Hooda1, H. El-Wakiel1, R. Safwat1, A. Bedair1, W. Eskaf2
1Radiation Oncology Department, 2Pathology Department Kuwait Cancer Control Center (KCCC), Ministry of Health, Kuwait

Proliferating trichilemmal tumors (PTTs) are uncommon exuberant growths of cells derived from the external root sheath. They tend to occur in older women, with a predilection for the scalp. Wide local excision has been the standard treatment. Recent reports have described a rare malignant variant with an aggressive clinical course and a propensity for nodal and distant metastases which, therefore, merits aggressive treatment. Keywords: PTT, trichilemmal pilar tumors, scalp

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Carcinosarcoma of Renal Pelvis with Immunohistochemical Correlation  

  S.D. Deshmukh1, V.L.Gaopande1, D.P. Pande2, G.S. Pathak1, B.K. Kulkarni2
1Dept of Pathology, 2Dept of Surgery, Smt Kashibai Navale Medical College, Pune, Maharashtra, India

Carcinosarcoma, a malignant tumor with biphasic morphology is uncommon in the renal pelvis. Immunohistochemistry (IHC) plays an important role in establishing the diagnosis and differentiating it from other biphasic malignant tumors. We present a rare case of immunohistogically confirmedcarcinosarcoma of renal pelvis in a 42-year old female, which possibly developed on a background of multicentric squamous cell carcinoma arising as a consequence of chronic irritation caused by calculi. Keywords: carcinosarcoma, immunohistochemistry, multicentric squamous cell carcinoma

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5-Flourouracil Cardiotoxicity – An Elusive Cardiopathy: Case Report

G. M. Bhat, M. H. Mir, H. I. Showkat, B. Kasanna, F. Bagdadi, A. H. Sarmast, S. Qadri
Sher-I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir

5-Flourouracil (5-FU) is an S-phase specific, synthetic pyrimidine antimetabolite. It is a frequently administered chemotherapeutic agent for a variety of malignant lesions, either singly or in multidrug regimens. Its adverse side effects involving bone marrow, skin, mucous membranes, GIT and CNS are well known, whereas its cardiotoxicity is relatively uncommon and occurs in 1.2-18%. Keywords: 5-Flourouracil, Cardiotoxicity, S-phase specific

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An Unusual Variant Of Prostatic Adenocarcinoma With Metastasis To Testis: A Case Report

K. R. Anila, T. Somanathan, A. Mathews, K. Jayasree
Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala 

Ductal adenocarcinoma of the prostate is considered to be a rare variant of prostatic adenocarcinoma when compared to the more common acinar adenocarcinoma. We report here a case of ductal adenocarcinoma of the prostate in a 68-year old man who presented with complaints of abdominal pain, retention of urine and hematuria of one month duration. Clinical examination showed prostatomegaly. The serum Prostate Specific Antigen (PSA) value was raised to 79ng/mL. Histopathological and immunohistochemical evaluation of resected specimen of prostate revealed ductal adenocarcinoma of the prostate. The patient was lost to follow up and presented four years after the initial diagnosis with metastasis to the bone and testis. Though prostatic cancers have the ability for wide spread dissemination, metastasis to testis is rare. Immunohistochemical staining with PSA and Prostatic Acid Phosphatase (PAP) can help in establishing prostatic nature of the neoplasm. We are reporting this case because of the rarity of metastasis of prostatic carcinoma to testis and for stressing the need for keeping in mind the possibility of metastatic carcinoma also while dealing with testicular tumors. Keywords: Prostate, ductal adenocarcinoma, metastasis, testis

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Mammary Fibromatosis In A Male Breast

  N. Al-Saleh1, T. Amir1, I. N. Shafi2
Department of Surgical Oncology, Depatment of Cytopathology Kuwait Cancer Control Center, Kuwait

Fibromatosis of the breast is a relatively benign, though locally invasive neoplasm. It is rare and difficult to diagnose. Risk of recurrence is there if it was inadequately excised. The best treatment is local wide excision with negative margins. We report a 46-year old gentleman with mammary fibromatosis. To the best of our knowledge, there are only few cases reported on male breast fibromatosis. The optimal management of it is unknown because of the rarity of the disease. Keywords: Fibromatosis, excision, margins

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Primary Isolated Extramedullary Plasmacytoma of Mesentry: A Rare Case Report

R. Galhotra, K. Saggar, K. Gupta, P. Singh
Department of Radiodiagnosis, Dyanand Medical College & Hospital, Ludhiana, India

Extramedullary plasmacytoma (EMP) is an uncommon entity that most commonly involves nasopharynx and upper repository tract. Involvement of GIT occurs in approximate 10% of cases. According to WHO plasma cell tumors have been classified into two main groups: Multiple myeloma and plasmacytoma. Plasmacytoma includes solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. EMP can be either primary without evidence of bone marrow involvement or may occur simultaneously with multiple myeloma representing extramedullary spread of the disease. It may occur in association with multiple myeloma and it may precede, accompany or follow the onset of multiple myeloma. Diagnosis of primary EMP requires the exclusion of associated multiple myeloma as shown by negative Bence Jones Proteins in urine, normal serum electrophoresis, normal bone marrow biopsy, normal skeletal survey and normal calcium levels. Here we present a case of 55-year male who came to Nephrology Department for urinary tract infection and pain abdomen. Patient was referred to Radiology for ultrasonography which revealed bilateral renal parenchymal disease with a well-defined mass in the mesentry which was further confirmed on computed tomography. Patient was surgically operated and diagnosis of primary EMP of mesentry was made on histopathological examination. Only three cases have been reported so far in the literature. Keywords: Extramedullary plasmacytoma, mesentry, plasma cell dyscrasias

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