Issue No. 16, July 2014
  Issue No. 16 - Jul 2014
7-13 Thrombin Generation with Hematological Malignancies among Sudanese patients
  A.M. Ehab1, M.H. Fathelrahman2, A.M. Babiker3
1 Faculty of Applied Medical Science in AL Qurayyat, Clinical laboratory Sciences, Aljouf University, Saudi Arabia.
2 College of Medical Laboratory Science, Sudan University of Science and Technology, Sudan.
3 Sudanese specialized Medical commission, Sudan
    Introduction: Hematological malignancies can change the levels of plasma molecules involved in coagulation and fibrinolysis such as fibrinopeptide A, fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and D-dimer (1), markers of endothelial cell integrity (soluble E-selectin, van Willebrand factor and soluble thromboembolism) (1, 2) and of platelet function (beta-thromboglobulin) (3). The aim of this study was to identify the hemostatic abnormalities and vascular damage among the major Sudanese hematological malignancy patients.  

Materials and Methods: This study was undertaken at the Radiation and Isotopes Center Khartoum (RICK), Sudan, during the period of February 2009 to October 2011. 202 patients (in and out patients) who were diagnosed of having hematological malignancies in different age groups on treatment or of treatment were selected as a study group and compared against 50 apparently healthy males and females as a control group. Prothrombin time, activated partial thromboplastic Time (APTT), antithrombin III, protein C, platelet count, von Willebrand factor (vWF), Plasminogen Activator Inhibitor-1 (PAI-1) activity and fibrinogen were gathered from the study group and the control group.  

Results: The results showed that the highest prevalence of hematological malignancy was among the study group (CML, 36.6%), while ET, MF and PCV were the lowest (0.5% for any) (P= 0.000). 38.1% of the 202 hematological malignancy patients were female and 61.9% were male. Mean age was 41 years (range 2-86 years). PTT, PT and PC values were not affected by disease, on the other hand there was a decrease in the levels of fibrinogen (P=0.000) and antithrombin III (P= 0.000), elevated vWf (P= 0.000), and PAI-1 was significantly elevated in ALL (P= 0.000) and in AML (P= 0.002) patients.  

Conclusion: Markers of coagulation were clearly observed in hematological malignancy patients; also, an indication of fibrinolysis and endothelial activation was confirmed. Some alterations in hemostasis and thrombotic events have frequently been found in hematological malignancy patients. These hemostatic changes may help the thrombotic and bleeding tendency in these patients.  

Keywords: Cancer, Hematological Malignancies, Coagulation, Thrombin generation
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2 14-20 Multiple myeloma: A clinical and pathological profile
    P. Kaur1, B.S. Shah2, P. Bajaj3
1 Giansagar Medical College and Hospital, Banur, Dist Patiala, Punjab, India.
2 Guru Teg Bahadur Hospital, Ludhiana, Punjab, India.
3 Pathology Department, Dr.Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India
    Introduction: Multiple myeloma is a plasma cell neoplasm with a spectrum spanning from localized to disseminated forms, plasma cell infiltration of various organs, plasma cell leukemia and abnormal immunoglobulin chain deposition in the tissues. In the bone marrow, myeloma cells are seen, and vary from mature forms to immature pleomorphic, anaplastic cells. M component is found in the serum or urine in 99% of the patients.  

Materials and Methods: This study included all cases of MM diagnosed at Dayanand Medical College and Hospital, Ludhiana, India from March 2003 to August 2004. Clinical findings were recorded and relevant investigations done.  

Results: Multiple myeloma comprised 11.1% of all hematological malignancies. The mean age was 58.8 years. Bony pain was the most common presenting complaint. Other findings were anemia, raised serum creatinine levels, high serum lactate dehydrogenase and C-reactive protein levels. Plasmablastic morphology was seen in 60% patients with diffuse marrow involvement being the most common pattern.  

Conclusion: The percentage incidence of Multiple Myeloma, out of all hematological malignancies reported in our study is comparable with other studies as regards to the median age of incidence, male to female ratio, clinical presentation and percentage of M band positivity. However, a higher percentage of our patients had hypercalcemia, higher Serum Lactate Dehydrogenase levels and C –Reactive protein positivity and more lytic lesions. This corresponds with a higher tumor cell burden and a more frequent diffuse pattern of bone marrow involvement in our study group. This could be due to the smaller size of our study group, or due to late referral of patients to our tertiary care hospital.  

Keywords: Multiple Myeloma, Plasma cells, Bone Marrow
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3 21-26 Eye Cancer in Yemen

A.A. Bawazir1, A.A. Bawazir2,3, S.S. Basaleh4, A.B. Ba-Amer5, H. Basaleem2
1 Dept. of Ophthalmology, Faculty of Medicine, University of Hadhramout.
2 Dept. of Community Medicine, Faculty of Medicine, University of Aden.
3 Dept. of Community and Environmental Health, College of Public Health and Health Informatics, KSAU-HS, KSA.
4 Dept. of Ophthalmology, Faculty of Medicine, University of Aden.
5 Dept. of Community Medicine, Faculty of Medicine, University of Hadhramout

    Purpose: Variation in types and incidence of ocular tumors are frequently seen from one region to another; however in Yemen, publication of eye cancer statistics were not available. This study aims to describe the socio-demographic characteristics and types of eye cancers in Yemen.  

Methods: Data were collected from two population cancer registries in Aden and Hadhramout regions (South-Eastern governorates of Yemen) from 1997 to 2008. All cancers related data were analyzed using CanReg4 computer program (IACR, Lyon, France).  

Results: A total of 92 eye cancer cases were reported with 51 male cases and 41 females and mean age of 40 years (SD±26.6). The calculated annual age-standardized incidence of eye cancers was 1.3 per million male populations and 1.15 per million female populations in the studied areas in Yemen. Around one quarter of cases were reported with squamous cell carcinoma (26%), followed by retinoblastoma (25%). The last was seen dominant among children < 15 years of age (91%) with a mean age of 6.7 years.  

Conclusion: The low proportions of other types of eye cancer in Yemen are probably due to registration of cases with less accurate specification. Thus, under-reporting could be found for those cases living in remote areas where access to specialized health care center is difficult. The given trend of eye cancer will be helpful to provide ophthalmologists and decision makers in the health field with a foundation to monitor future disease patterns in Yemen. Moreover, these data could be utilized for comparison with other selected populations elsewhere.  

Keywords: eye cancer, Aden, Yemen, Retinoblastoma, Pattern
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4 27-31 Adult medulloblastoma: A single institution experience
    M. Nazmy 1,2, Y. Khafaga 1,2, A. Al Hebshi 2, M. Hassounah 3, S. Albadawy 1,2
1 Radiation Oncology Department, NCI Cairo University, Egypt.
2 Radiation Oncology Department King Faisal Specialist Hospital and Research Center.
3 Neurosurgery Department, King Faisal Specialist Hospital and Research Center
    Background and Objectives: Medulloblastoma is an aggressive posterior fossa tumor which is rare in adult. We aim to study the clinical features and outcome of adult medulloblastoma patients, and to identify poor outcome predictors.  

Patients and methods: From January 1995 to December 2006, 35 adult patients (>15 years of age at the time of diagnosis) underwent surgery for medulloblastoma followed by full dose of radiotherapy (54 Gy), with or without systemic chemotherapy.  

Results: The mean age was 24 years (maximum 52). There were 19 male and 16 female patients. CSF spread was documented in 23 patients. Eight patients developed relapse. Four patients developed isolated CNS relapse, two patients developed isolated lung metastasis and 2 patients developed both lung metastasis and CNS relapse. The craniospinal radiation dose ranged from 34 to 36 Gy and the total posterior fossa dose ranged from 54 to 56 Gy. The 10 year disease free survival rate reached 65% +/- 10. The relapse free survival was significantly different according to the M stage (M0, M1, M2 & 3), as none of the patients in the M0 group had relapsed while 4 patients in the M1 group and 4 patients in the M2&3 group relapsed (p=0.0026).  

Conclusion: The distinction between adult and pediatric medulloblastoma is not clear. Overall, M stage is an important prognostic factor. Although chemotherapy is a part of standard practice in pediatric treatment protocols, its role in older patients should be further evaluated in clinical studies.  

Keywords: Medulloblastoma, Adult, PNET
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5 32-39 Five Years Treatment Outcomes of Postoperative Radiotherapy in Saudi Women with Uterine Cancers: Single Institutional Experience

M. Al Asiri1, M.A. Tunio1, Y. Bayoumi2, R. Mohamed2, E.Al Saeed3, A. Al Hadab1, A. Al Amro1
1 Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 59046, Saudi Arabia.
2 Radiation Oncology, National Cancer Institute, Cairo University, Cairo- Egypt.
3 Radiation Oncology, King Khalid University Hospital, Riyadh, Saudi Arabia

    Purpose: We aimed to evaluate long-term treatment outcomes and toxicity profile of postoperative radiotherapy (PORT) in Saudi women with uterine cancers.  

Methods and Materials: Medical records of patients with histopathologically proven uterine cancers were reviewed and identified those who received PORT (45-50.4 Gy in 25-28 fractions) followed by vaginal brachytherapy (15-20 Gy in 3 to 4 sessions) after total abdominal hystrectomy and bilateral salpingo-oophorectomy (TAHBSO) in our center between August 2007 and April 2012. Data regarding the safety profile, locoregional control (LRC) or distant metastases control (DMC) and overall survival (OS) rates were analyzed.  

Results: Median follow-up period was 60 months (range, 12-70) for 89 patients. Predominant histological type was endometrial (59 patients), followed by carcinosarcoma (17 patients) and leiomyosarcoma (13 patients). Median age at time of diagnosis was 57.6, 56 and 51.1 years for endometrial, carcinosarcoma and leiomyosarcoma respectively. LRC rates were 80.9%, 87.1% and 100% for leiomyosarcoma, carcinosarcoma and endometrial carcinoma respectively (p 0.4). DMC rates were 69.3%, 45% and 16.3% for endometrial, leiomyosarcoma and carcinosarcoma respectively (p 0.0001). Five-year OS rates were 71.1%, 60% and 16.3% for endometrial, leiomyosarcoma and carcinosarcoma respectively (p 0.001). Coxproportional hazard ratio model showed body mass index, FIGO stage, lymphovascular invasion in endometrial carcinoma, tumor size in leiomyosarcoma and histology in carcinosarcoma important prognostic factors for LRC. Acute grade 3 and 4 proctitis/enteritis seen only in 4 patients (4.5%) and late toxicities were minimal.  

Conclusion: PORT in Saudi women with uterine cancers showed better LRC, DMC and OS rates with minimal toxicity  

Keywords: Postoperative radiotherapy, uterine carcinomas, Saudi women
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6 40-45 Metastases to breast - A 29-year experience in a tertiary care hospital

P. Shah1, F. Mustafa1, A. Aiman1, O.J. Shah2, S. Shafi1, A. Charak1, D. Mateen1, I. Feroz1
1 Dept. of Pathology, 2 Dept. of Surgical Gastroenterology,
Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India

    Metastatic lesions to the breast are unusual. We present a series of 26 cases of metastatic tumors to breast from extra-mammary sites over a period of 29 years. There were 14 female and 12 male patients, and their ages ranged from 28 to 70 years. The tumor was in the upper outer quadrant in 16 patients. All 26 cases noticed a mass in the breast and more than half of the patients complained of discomfort and pain. The mammary symptoms were present for more than 4 months in all patients. Of the 26 cases, 13 cases had metastatic adenocarcinoma, 12 cases had metastatic squamous cell carcinoma and one case had poorly differentiated carcinoma. On mammography, 16 patients showed high density lesions and on ultrasonography lesions were hypoechoic. Prognosis is poor but appears slightly improved since more refined chemo and immunotherapeutic regimens were available. The clinical, pathologic, and radiographic features of this problem are described.  

Keywords: Breast metastasis, Extra-mammary site, Mammography
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7 46-55 Inadequate lymph node sampling as a risk factor in stage II colon cancer
    F. Zakaria and N. EL- Mashad
Clinical Oncology Department. Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
    Purpose: The aim of this study is to clarify the magnitude of the risk-to-benefit ratio with adjuvant therapy in high risk stage II colon cancer. Patients and Methods: 162 patients with pathologically documented stage II colon cancer were randomly distributed into two groups. The first group (80 patients) received Capecitabine for 6 cycles and the second group (82 patients) received FOLFOX4 for 6 cycles . All patients in both groups were assessed for disease-free survival (DFS) and overall survival (OS) as regards to chemotherapy regimen and high risk factors. Tolerability and safety were assessed for all study population in both groups.  

Results: Three-year DFS rates were 73% and 87% (Hazard ratio (HR)=2.051, 95%Cl(1.13-3.721) , P-value= 0.018), 3-year OS rates were 87% and 93% (P-value=0.26); corresponding 5-year OS rates for patients with stage II disease were 34% and 93% (HR=2.555, 95%Cl(1.276-5.119), P-value=0.008) in the Capecitabine and Folfox4 groups, respectively. Statistical significant differences in 5-year DFS and OS with lymph node sampling > 12 lymph nodes in favor Folfox4 group (HR=0.172, 95%Cl(0.0080- 0.370), P-value=<0.001) and (HR=0.087, 95%Cl(0.028-0.268), P-value=0.001) respectively. Multivariate analysis for all study population stated that the only significant risk factor was the inadequate lymph node sampling as regards to relapse (HR= 0.244, 95%CI (0.094-0.631), P-value=0.004) in stage II colon cancer. Diarrhea and peripheral sensory neuropathy (PSN) were the most pronounced side effects in FOLFOX4 treatment arm.  

Conclusion: This study has demonstrated that patients with microscopic disease do behave more like stage III colon cancer patients; our data suggest that we must analyze tumors at this level if at all possible and those patients with <12 lymph nodes resection should received adjuvant chemotherapy in favor of FOLFOX4 regimen with significant improvement in DFS which can be translated into an OS benefit.
    full article
8 56-63 Impact of New Chemotherapeutic agents on the outcome of Egyptian patients with Advanced Malignant Pleural Mesothelioma

R. Gaafar, Y.A. Sallam, H. E. Shafik, F.A. Aboulkassem, M. Emara, H. Khaled
Medical Oncology Department, NCI, Cairo University, Egypt

    Purpose: Patients with malignant pleural mesothelioma (MPM) are well known to have poor response to chemotherapy. Aim of this work was to evaluate the efficacy and safety of new chemotherapeutic agents for the treatment of Egyptian MPM patients.  

Patients and methods: The first study was a non-randomized, open-label trial. It included 34 eligible patients who were assigned to receive either cisplatin/ pemetrexed or pemetrexed alone if cisplatin was contraindicated for a maximum of 8 cycles. In the second trial, 21 chemo-naïve patients with histologically proven advanced MPM were included. They received cisplatin and raltitrexed for a maximum of 6 cycles.  

Results: In the first trial, the median age was 43.5 years (range 25–69), partial response (PR) was achieved in 37.5%, stable disease (SD) in 50%. Median time to progression (TTP) and overall survival (OS) were 7 and 14 months respectively. Survival at 1 year was 64.7%. No toxicity was observed in 17.6% of patients, grade 3-4 toxicity was evident in 11.8% (neutropenia), 8.8% (anemia), and 2.9% (vomiting and diarrhea). In the second trial, median age was 46 years (range 19- 71), PR was achieved in 23.2%, one complete remission (CR) was reported. SD was noticed in 61.9%. The median TTP and OS were 6 and 12 months respectively. Survival at 1 year was 51.6%.  

Conclusion: Both cisplatin/pemetrexed and cisplatin/ raltitrexed are effective and safe regimens in the treatment of MPM.  

Keywords: Mesothelioma, Egypt, chemotherapy
    full article
9 64-72 Renal Function of Cancer Patients “Fit” for Cisplatin Chemotherapy: Physician Perspective
    J. Montoya1, H. G. Luna1, J.R. Amparo1, C. Casasola2, G. Cristal-Luna1
1 Section of Medical Oncology, Department of Internal Medicine, National Kidney and Transplant Institute, Philippines.
2 Department of Nephrology, National Kidney and Transplant Institute, Philippines
    Introduction: Renal insufficiency is prevalent among cancer patients and it poses a hindrance in using cisplatin. We sought to describe the baseline renal function of our patients who were considered “fit” for cisplatin, along with saline hydration and mannitol diuresis, and determine occurrence of nephrotoxicity during chemotherapy.  

Methods: A retrospective study from 2008 to 2012 of 100 patients who were given cisplatin was done. Demographic and clinical variables were recorded. Creatinine Clearance was calculated using Cockcroft-Gault formula. Nephrotoxicity was defined as an increase of 0.5mg/dL or more after cisplatin infusion. Descriptive statistics, ANOVA, logistic regression analysis were done.  

Results: A total of 100 patients were “fit” for cisplatin, with a mean age of 52 years, mean creatinine of 0.83mg/dL, CrCl of 94.14ml/ min, and ECOG performance status of 0-2. 12 patients have Chronic Kidney Disease (CKD) stage of 3, 42 patients with stage 2, 46 patients with stage 1. After cisplatin treatment, mean creatinine increased to 0.95mg/dL, and mean CrCl decreased to 83.7ml/min. Nine patients developed nephrotoxicity; all resolved with hydration. Patients with nephrotoxicity were significantly different from those without, in terms of weight p 0.012. None of the variables were predictors of nephrotoxicity.  

Conclusion: With hydration and mannitol diuresis, patients with ECOG 2, normal creatinine, CKD stage 3 or better, CrCl of 50ml/min and above are “fit” for cisplatin. During the study period, 9% of the patients “fit” for cisplatin developed nephrotoxicity, all resolved with conservative management. There was an increase in mean creatinine and a decrease in the mean CrCl after cisplatin.  

Keywords: cisplatin, creatinine, chemotherapy
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10 73-78 Role of imprint cytology in intra-operative diagnosis of thyroid lesions
    K.R. Anila1, G. Krishna2
1 Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.
2 Department of Pathology, Medical College, Thiruvananthapuram, Kerala, India
    Background: Intra-operative imprint cytology is an important diagnostic modality in the diagnosis of thyroid lesions. A correct intra-operative diagnosis helps eliminate the need for second surgery.  

Aim: To study diagnostic accuracy of imprint cytology and to compare the imprint cytology results with that of the corresponding paraffin section diagnosis in thyroidectomy cases.  

Materials and Methods: This is a prospective study of 84 patients who have undergone thyroidectomies over a period of one year at the Department of Surgery, Thiruvananthapuram, Kerala, India. The intraoperative imprint cytology smears were stained by Papanicolaou method. The imprint cytology interpretation was later compared with the paraffin section diagnosis.  

Results: Of the 84 patients using haematoxylin and eosin stained histopathology sections as the gold standard, the diagnostic sensitivity of imprint cytology was 75% and specificity was 100%. Positive predictive value was 100%. Negative predictive value was 98.74%.  

Conclusions: Imprint cytology has high sensitivity and specificity in diagnosing lesions of the thyroid. The problems faced were in diagnosing follicular carcinomas and differentiating low grade lymphoma from lymphocytic thyroiditis. Imprint cytology is a simple, reliable diagnostic technique. It has high sensitivity and specificity in intra-operative diagnosis of lesions of thyroid. In spite of the advent of newer diagnostic modalities like frozen sections, imprint cytology still holds its unique position in the current perspective.  

Keywords: Thyroid, imprint cytology, intra-operative diagnosis.
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11 79-83 Monitoring of Photobleaching in Photodynamic Therapy Using Fluorescence Spectroscopy
    A. Sharwani1,2, F.A. Alharbi3,4
1 Department of Oral and Maxillofacial Surgery, Eastman Dental Institute for Oral Healthcare Sciences, London, UK.
2 Department of Oral-Maxillofacial Surgery, King Fahd Central Hospital, Jazan, Saudi Arabia.
3 Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Jazan University, Saudi Arabia.
4 Department of Otolaryngology, Head & Neck Surgery, King Fahd Central Hospital, Jazan, Saudi Arabia
    Photodynamic therapy (PDT) utilizing aminolevulinic acid (ALA) as a photosensitiser has been used to ablate premalignant/malignant skin conditions including superficial basal cell carcinoma (BCC) with acceptable cosmetic outcome. Clinicians continue however to face difficulties in determining the exact dose that is sufficient to achieve a complete healing from the condition where the experience of the clinician remains the only determinant factor. This inaccuracy sometimes leads to undertreating these lesions. Here, we have clinically evaluated the use of fluorescence imaging system as monitor of protoporphyrin IX (PpIX) photobleaching in patients with BCC and compares this to the clinical outcome. Four readings were acquired from each patient (n=14) “pre-PDT”, “peri-PDT” (333secs), “peri-PDT” (660secs) and post-PDT. It was found that red fluorescence values decreased markedly during PDT, and considered to be significant when compared to pre-PDT (P = 0.0018) and post- PDT (P = 0.0025). The red fluorescence value in pre-PDT was found to be higher in BCC of cheek and scalp (where the response rate, RR = 100%) in comparison to the temple (RR = 75%) and nose (RR = 33%). By comparison, the post- PDT red fluorescence values in cheek and scalp were lower than that of the temple and nose, respectively; this may be a useful indicative of the response rate of tissue to therapy.  

Keywords: photodynamic therapy, fluorescence spectroscopy, basal cell carcinoma, aminolevulinic acid, optical monitoring.
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12 84-88 Anterior Skull Base Reconstruction After Cranio-Facial Resections Using Galeal Pericranial Flap
    P.G. Balagopal1, N.A. George1, R. Ajith2, M.I. Ahamed1, P. Sebastian1
1 Department of Surgical Oncology, Head & Neck Division, Regional Cancer Centre, Trivandrum, India
2 Department of Neuro Surgery, Medical College, Trivandrum, India
    The tumors of the anterior cranial cavity can either be malignant or benign. They usually arise in the nasal or Para nasal sinuses. Treatment of these tumors includes major craniofacial resection and reconstruction to prevent cerebrospinal fluid leak and meningitis. In this study we are presenting a technique which is simple and cost-effective. We are reporting a series of nine cases in which this technique was tried out and we found that it can be used for dural repair and anterior cranial fossa reconstruction with no major complications.  

Keywords: Skull base reconstruction, cranio-facial resection, fascia lata graft, abdominal pad of fat, galeal pericranial flap.
    full article
13 89-93 Case Report: Recurrent Olfactory Neuroblastoma Nasal Cavity in Young Boy Refractory to Chemotherapy with Remission after Radiotherapy and Sparing of Left Eye
  A. Mukherji, K.S. Reddy, S. Vivekanandham
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry-605006, India
    Olfactory neuroblastomas make up about 3-5% of malignant intra-nasal tumors and originate from the olfactory neuroepithelium lining the roof of the nasal vault. There exist no optimum treatment guidelines from randomized data due to paucity of patients. Treatment options range from minimal surgery to extensive cranio-facial resections and adjuvant radiotherapy. In this case a tumor engulfing optic nerve and globe was safely treated by 3D-CRT with complete remission and relative sparing of the eye as well as late toxicities were avoided. 3D-CRT permits increased dose to tumor sparing critical areas and is a feasible option in centres without IMRT.  

Keywords: Esthesioneuroblastoma, olfactory neuroblastoma, malignant tumors of nasal cavity, refractory olfactory neuroblastoma
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14 94-100 Schwannoma base tongue: Case report and review of literature
    N.A. George1, M.Wagh1, P.G. Balagopal1, S.Gupta1, R. Sukumaran2, P. Sebastian1
1 Department of Surgical Oncology Regional Cancer Centre, Trivandrum, Kerala, India.
2 Department of Pathology Regional Cancer Centre, Trivandrum, Kerala, India
    Schwannomas are benign peripheral nerve sheath tumors. These are rare in the oral cavity (1%). The most common site of involvement in oral cavity is the tongue. Posterior third of tongue is not frequently involved. The aim of this paper is to present a case report of base tongue schwannoma and review literature of this rare tumor. Data from literature were analyzed for age, gender, presenting symptom, size at presentation, and surgical approach.

We report a case of 26 year-old male who presented with swelling posterior 1/3rd tongue and change in quality of voice. He was evaluated for the same with MR and incision biopsy and was planned for surgery. Surgery was abandoned at a district hospital due to difficulty in intubation. At our center he underwent fibro optic bronchoscopy guided intubation followed by general anesthesia. He underwent excision of mass using left paramedian lip spitting approach with mandibulotomy and mandibular swing. Tumor was excised in toto. His postoperative recovery was uneventful.

Literature review between 2001 and 2012 was done. 15 cases of base tongue schwannoma were identified. The most common age group involved was between 30-40 years. There was a slightly higher incidence in females. All patients were symptomatic at presentation. Most common complaints were related to swallowing and throat pain. Most patients underwent transoral excision of the tumor.  

Keywords: schwannoma, base of tongue, tongue schwannoma, lingual schwannoma, tongue neurilemmoma
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15 101-104 Rare Association of Myeloid Leukaemia of Down Syndrome with Granulocytic Sarcoma
    M.A. Obaid1, M. Bourusly1, P. Ancliff2, E. AlMatter1
1 Department of Haematology, NBK Children’s Cancer Hospital, Al-Sabah Hospital, Kuwait.
2 Great Ormond Street Hospital, London
    We report an 18-months old boy with trisomy 21 who initially presented with myelodysplastic syndrome MDS, and later transformed into acute megakaryoblastic leukaemia AML. At presentation he was found to have some unusual findings namely multiple soft tissue masses over scalp, left elbow and over the knee joints as well as hard mass felt in left hip. Biopsy of soft tissue of scalp revealed granulocytic sarcoma. Generally granulocytic sarcoma is seen with AML-M2 and its association with AML-M7, to our belief has rarely been reported previously.  

Keywords: Down syndrome, Megakaryoblastic leukemia, granulocytic sarcoma
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16 105-107 A case report of rare Ovarian Neuroendocrine carcinoma
    M. Jaloudi1, H. El-Salhat2, J. Kanbar1
1 Department of Oncology, Tawam Hospital, Al-Ain, Abu-Dhabi.
2 Department of Oncology Surgery, Tawam Hospital, Al-Ain, Abu-Dhabi.
    “Unlike lung cancer, which arises from the lung, or a breast cancer that arises from the breast, neuroendocrine tumors arise from a cell type. These neuroendocrine cells can really arise from [almost] anywhere in the body.” – Dr. Lowell Anthony

Historically misunderstood to be rare and relatively benign, neuroendocrine tumors (NETs) are increasingly common and are now regarded as malignant neoplasms that can cause debilitating symptoms and potentially life threatening issues for patients.

Neuroendocrine tumors are a heterogeneous group of separate clinico-pathological entities that share a common characteristic i.e. expression of endocrine differentiation potential. In the ovary, the term “neuroendocrine” relates mainly to widely-known carcinoids, but it may also be applied to neuroendocrine carcinomas of nonsmall- cell type and small cell carcinomas of pulmonary type. Ovarian carcinoids develop in pure form or in association with other tumors, mainly teratomas. They originate from endocrine cells, either of teratomatous origin or possibly also indigeneous. Ovarian neuroendocrine carcinomas belong most probably to surface epithelial neoplasms, which express endocrine pathway of differentiation. The neuroendocrine carcinomas of non-smallcell type are characterized by the presence of islands, sheets, and trabeculae with little intervening stroma (organoid growth pattern) and cellular homogeneity. However, they are higher-grade than carcinoids. Primary ovarian small cell carcinomas of the pulmonary type do not differ histologically from their counterparts in other organs. They are composed of small cells with scanty cytoplasm and oval to spindleshaped nuclei.  

Keywords: NETs, neuroendocrine, tumor
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17 108-115 Detection of metastases in oral squamous cell carcinoma: A diagnostic impasse
    S. Rana1, P.V. Angadi2, S. Hallikerimath2, A.D. Kale2
1 Department of Oral pathology, Rajasthan Dental College and Hospital, Jaipur, India.
2 Department of Oral Pathology and Microbiology, KLEVK Institute of Dental Sciences and Hospital, Belgaum-590010, Karnataka, India
    Oral squamous cell carcinoma (OSCC) being the most common malignancy of the oral cavity poses a significant public health problem due its impact on the speech, mastication, taste, swallowing and esthetics. Moreover, the presence of metastasis either regional or distant worsens the prognosis and reduces the survival rate in these patients. This makes it imperative to diagnose metastasis at an early stage to facilitate appropriate therapeutic management to reduce the morbidity and mortality associated with this disease. There have been several modalities that have been developed and in wide-use for recognition of metastasis with their inherent advantages and disadvantages making it a perplexing dilemma to the clinician and surgeon alike. This paper aims to give an insight into the diagnostic workup available for the evaluation of metastasis in patients with OSCC and reinforces the need for further research to develop more accurate methods.  

Keywords: Oral squamous cell carcinoma, regional metastasis, distant metastasis, diagnosis
    full article