Issue No. 26
Issue No. 26, Jan. 2018
Issue No. 26 - Jan 2018
6-10 Cytomorphologic Spectrum of Hurthle Cell Lesions of Thyroid: A Study of 54 Cases

K.R. Anila1, Nileena Nayak1, Preethi Sara George2, K. Jayasree1
1 Department of Pathology, 2 Department of Epidemiology and Statistics,
Regional Cancer Centre, Thiruvananthapuram, India

  Introduction: Lesions of the thyroid gland composed of Hurthle cells constitute a wide spectrum of pathological entities ranging from benign hyperplastic nodules with Hurthle cell metaplasia at one end to malignancies like Hurthle cell carcinomas. The cytological distinction of these entities is not only diagnostically challenging but are also critical since they influence treatment decisions.

Aim: To critically analyze the cytomorphology of cases of Hurthle cell lesions in FNACs and to characterize cytological features shown to be statistically significant in predicting Hurthle cell neoplasm (HCN).

Methods: During the period from January 2014 to August 2015, 1667 cases of thyroid FNAs were done at our centre, of which 54cases,showed a predominance of hurthle cells, i.e. more than or equal to 50% hurthle cells (>/=50%).These cases were included in the study and were critically reviewed for 9 cytomorphologic features which included cellularity, architecture, and percentage of Hurthle cells, background colloid, chronic inflammation, nucleoli, intranuclear cytoplasmic inclusions (INCI), nuclear grooves and transgressing blood vessels (TBV). The results were evaluated by using univariate and stepwise logistic regression (SLR) analysis; statistical significance was achieved at P-value < 0.05.

Results: Out of the 9 parameters studied, the cytological features shown to be statistically significant in predicting HCN and distinguishing them from benign hurthle cell lesions(BHCLs) were increased cellularity, non-macro follicular architecture, >90% Hurthle cells, absence of background colloid and absence of chronic inflammation.

Keywords: Hurthle cells, hurthle cell neoplasm, cytology, statistical analysis
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2 11-17 Rosai-Dorfman Disease – Five Years Retrospective Analysis from Tertiary Cancer Center

K. Aradhana, B. Thejaswini, Shamsundar, R. Nanda, Usha Amritham, G.V. Giri
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology (KMIO), India

  Aim: To study the pattern of presentation and management of nodal and extranodal primary RDD.

Methodology: From 2010 to 2015, eleven patients diagnosed with Rosai-Dorfman Disease (RDD) presented at our institute. Nine of them were analyzed as they received treatment at our center. We had five neck primaries, three intracranial and one cutaneous disease. Hematological, radiological, histopathological and immunohistochemistry evaluation along with the treatment data was collected and analyzed.

Results: Nine cases treated at our institute had a median follow up of 41 months. Four of the five neck node primaries were treated with corticosteroids. Of the four, two had complete and two partial responses locally. Remaining one patient had partial response to surgery and corticosteroids. Three patients with CNS presentation treated with radiotherapy to a total dose of 20-40 Gy, had complete response locally. However, two patients had simultaneous neck nodes during presentation. Partial response was seen with corticosteroids alone in one and with radiation to the neck in the other patient, of which one succumbed to myocardial infarction within 3 months post treatment. Two of them received re-irradiation to the recurrent lesions with good results.

Conclusion: Due to its rarity there is no particular guidelines regarding the management of patients with RDD. We conclude that low dose radiation either in combination with surgery or corticosteroids in nodal or extranodal lesions has shown a better local control.

Keywords: RDD; Rosai-Dorfman Disease; SHML; Sinus histiocytosis; Lymphoproliferative disease; Radiotherapy; Corticosteroids
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3 18-22 Lung cancer epidemiology among the Bahraini population, 1998-2011

Najat Mohamed Abulfateh1 Randah R. Hamadeh2, Majida Fikree1
1 Ministry of Health, Manama, Kingdom of Bahrain,
2 Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain

  Background: Lung cancer is the fourth most common cancer in the Gulf Cooperation Council countries among males and the third among females. It is the commonest cancer among Bahraini males accounting for 16.9% of all cancers and the third in Bahraini females contributing to 5.8 % of all female cancers. The aim of this study was to describe the epidemiology of lung cancer among the Bahraini population during the period 1998-2011.

Methods: All Bahraini registered lung cancer cases in the national cancer registry from 1 January 1998 to 31 December 2011 were included in the study. Incidence rates were calculated using the CANREG software, in which the annual crude incidence rates, age specific incidence rates and the age standardized incidence rate (ASR) were computed.

Results: Six hundred sixty-four lung cancer cases (72.4%, males and 27.6% females) were diagnosed during the study period. The annual average number of cases was 47.5 per year. The mean age at diagnosis during the study period was 68.7±11.7 years. The average annual ASR was 26.1/100,000 among males and 10.0/100,000 among females. There was a tendency for a decreased trend of the ASR during 1998-2011 in both sexes. Twenty-six percent of lung cancer cases were squamous cell carcinoma and 17.9% adenocarcinoma. The grades of 70.3% were unknown and 13.4% were poorly differentiated. The stage was unknown for 65.0% of the cases, while 18.5% had distant metastasis and 9.8% were localized. The majority (88.9 %) of the lung cancer cases were dead by the end of the study period with a five-year survival rate of 3.0%.

Conclusion: A welcomed decline in the incidence of lung cancer has been noted over the past 14 years. However, more efforts should be put to reduce the proportion of lung cancer cases with unknown stage and grade. The incidence of histological types, which are strongly dependent on tobacco smoking, notably small cell, squamous cell and large cell carcinomas, accounted for over one third of lung cancer cases. Future research should be directed towards better understanding of the lung cancer risk factors and the effectiveness of tobacco control measures in in the country.

Keywords: Lung cancer, epidemiology, trends, cancer registry, survival, incidence.
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4 23-26 Epidemiology of Colorectal Cancer in Iraq, 2002-2014
  Safauldeen Abdulrahman Al Dahhan1, Faris H. Al Lami2
1 Iraq Ministry of Health, Directorate of Public Health
2 Baghdad University, College of Medicine, Department of Community Medicine
  Objectives: After cardiovascular diseases, cancer is one of the major causes of death in Iraq but there is scarcity of data on cancer. This study aimed to estimate the incidence rate of colorectal cancer in Iraq and its distribution and determine its trend in Iraq from 2002 to 2011.

Methods: The necessary data for recording the incidence of colorectal cancer in Iraq were obtained from three main sources including the cancer registry for the period of 2002-2014. Data included information on gender, age, geographical distribution, site of tumors, and histology types.

Results: A total of 7,246 cases of CRC were registered in the cancer registry for the period 2002-2011 and 706 cases in the National Cancer Hospital between 2012 and 2014. Male to female ratio varied from 1.17:1 to 1.28:1. About 40%-46% of cases were diagnosed in the age group of 40-59 years. The incidence rate increased from 2.75/105 pop in 2002 to 3.26/105 pop in 2011. Adenocarcinoma constituted 84.0% of all cases. Of the 706 registered cases during 2012-2014, 95% were diagnosed by histology of primary site. The degree of differentiation was moderate in 56% of cases. About 26% of cases were localized, 55.9% and 16% were with regional, and distant metastasis, respectively.

Conclusion: Iraq has a low CRC incidence rate but with a steady increase overtime. It is crucial to implement preventive strategies to control CRC in Iraq and to establish public awareness program about CRC and the importance of screening. Keywords: colorectal cancer, epidemiology, trend, Iraq
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5 27-32 Profile of High Grade Gliomas – A Single Center Experience

Basharat Mujtaba Jan2, Arif Hussain Sarmast1, Abdul Rashid Bhat2, Altaf Rehman Kirmani2
1 Dept. of Neurosurgery, Jawaharlal Nehru Medical College Aligarh Muslim University Aligarh Uttar Pradesh
2 Dept. of Neurosurgery, Sher I Kashmir Institute of Medical Sciences Srinagar J&K

  Introduction: The term high grade glioma (HGG), is usually used to describe WHO grade III and IV tumours. There has been a recent increase in incidence of HGGs in the Western world, particularly in the elderly population. This probably reflects the easy availability of vastly improved diagnostic imaging. A five year retroprospective study was planned to study demography, clinical presentation, imaging, surgical intervention, histopathological examination of specimens and postoperative outcome of patients of high grade gliomas.

Objectives: To determine the demographic, clinical, histopathogical and radiological profile of patients of High Grade Gliomas (HGG) and to ascertain post-operative mortality at 24 hours and 7 days Material & Methods: The present study of 226 cases from our institute for the last 5 years (retrospective 3 years and prospective 2 years) extending from August 2010 to July 2015 is based on study about demography, clinical presentation, imaging, surgical intervention, histopathological examination of specimens and postoperative outcome. The clinic-pathological vis-a-vis imaging was also studied. The analyzed data from the results and observations of this study were compared with the previous studies.

Results: The study was retrospective as well as prospective. Total of 226 patients were registered. Out of these, 225 patients were operated (except one patient). The provisional diagnosis was based on the radio-imaging basis and the final diagnosis confirmed by histopathological examination. Majority of patients operated for HGG, irrespective of the procedure or extent of resection had good surgical outcome after the procedure.

Conclusion: The overall survival is multifactorial in HGGs. The surgical intervention particularly in patients with features of raised ICP due to mass lesion provides symptomatic relief and improves quality of life in majority of patients and are discharged reasonably in better state of health.

Keywords: high grade, glioma, brain, tumour, glioblastoma multiforme
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6 33-36 Assessment of Sunitinib Alternative Prescription Schedules in Metastatic Kidney Cancer: A Study of 10 Cases

Habib Diallo, Hasnae Alaoui Mhamdi, Salma Elouarzazi, Mohamed Fadli, Rhizlane Belbaraka
Oncology Center of Marrakech, Morocco

  Background: Managing metastatic Renal Cell Carcinoma (mRCC) has been revolutionized during the first decade of the 21st century due to the development of targeted therapies. The sunitinib is an oral multi-targeted receptor Tyrosine Kinase Inhibitor (TKI). It became the first targeted therapy as first-line treatment to improve the survival of patients with metastatic kidney cancer. This treatment consists in the oral intake of 50 mg of sunitinib per day in a 6 -week cycle including 4 weeks of treatment intake (the “on” week) followed by a 2-week break (the off week). The strong impact of the treatment dose reduction or discontinuation and the associated adverse effects encouraged the investigators to enquire about other sunitinib schedules: continuous regimen at 37.5 mg of sunitinib, 2 weeks out of 3 at the dose of 50 mg. The aim of this work is to assess the efficiency and the tolerance of the other prescription regimens of sunitinib.

Methods: This is a transversal study conducted from March 2013 until November 2017 in the Oncology/ Hematology Center of the Med VI University Hospital Center in Marrakech. All patients under supervision and treatment for metastatic kidney cancer evaluated after 3, 6 and 9 months are part of our study. The parameters studies are epidemiological data, histological type, used protocols efficiency and tolerance.

Results: A total of 10 patients under supervision for metastatic kidney cancer were gathered in the Oncology/Hematology Center of the Med VI University Hospital Center in Marrakech. At the end of the 9-month evaluation period, 10 patients (40%) had radiological and clinical stability, 1 patient had complete lesion response, 3 patients had radiological progression and 1 case of death was recorded. As regards toxicity, all different regimen used during the study were well tolerated by the majority of the patients. The toxicities mostly encountered were asthenia, hand-foot skin reactions, mucositis and grade II diarrhea for 4 patients (40%) and 1 case of HTA. In only one case of temporary cessation vomiting and grade II diarrhea were noted.

Conclusion: The regimen 2/1 appears to be effective and demonstrates a better toxicity profile, treatment adherence, and dose intensity in relation to treatment, suggesting that the 2/1 regimen may become the future standard sunitinib treatment for patients with mRCC.

Keywords: Renal cell carcinoma, Sunitinib, regimen, Efficacy, Toxicity.
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7 37-42 Human Papilloma Virus (HPV) in Sinonasal Papillomas and Squamous Cell Carcinomas: A PCR-based Study of 60 cases
  Ambreen Beigh1, Ruby Reshi1, Sheikh Junaid2, Mehnaz Sultan Khuroo1, Summyia Farook1
1 Department of Pathology, 2 Department of Surgery, Government Medical College, Srinagar, India
  This study was carried out to observe the association of Human Papilloma Virus (HPV) with papillomas and squamous cell carcinomas of the sinonasal region. The present study was a hospital-based study conducted over a period of three years from May, 2014 to May, 2017 in the Department of Pathology, Government Medical College, Srinagar. A total of 196 cases of non-neoplastic and neoplastic lesions of nasal cavity and paranasal sinuses were observed during the study period. Out of total 196 cases, 102 were non-neoplastic and 94 were neoplastic. Of the 94 neoplastic lesions, 58 were benign and 36 were malignant. A total of 60 cases which included 38(63.33%) inverted papillomas, 12(20%) exophytic papillomas and 10 (16.66%) squamous cell carcinomas were included in the present study for HPV association. We studied the association of HPV with sinonasal papillomas and squamous cell carcinomas by polymerase chain reaction (PCR). HPV positivity was seen in 5(13.16%) out of 38 cases of inverted papillomas, whereas 4 out of 12(33.33%) exophytic papillomas tested positive for HPV. Out of 10 squamous cell carcinomas HPV positivity was seen in 2(20%) cases. Low risk HPV types 6 and 11 showed an association with sinonasal papillomas and oncogenic HPV types 16 and 18 with squamous cell carcinomas.

Keywords: Sinonasal, inverted, exophytic, Human Papilloma Virus (HPV).
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8 43-48 Cancer Statistics in Giresun Province, Turkey: A 12-Years Retrospective Review

Ayşegül Çebi1, Egemen Akgün2, Tuncer Öztürk3, Esin Avcı4
1 Faculty of Health Sciences, 2 Department of Medical Biology, 3 Department of General Surgery,
4 Faculty of Science and Art, Department of Statistics, Giresun University, Giresun, Turkey

  Aim: The aim of this retrospective study was to analyze 6,613 diagnosed cancer cases in the Black Sea Turkish province of Giresun over a period of 12 years.

Material and Method: Data of this retrospective crosssectional study was collected from 6,613 cancer patients at Prof. Dr. A. İlhan Özdemir Education and Research Hospital between 2005- 2016. MINITAB 15 package software was used for statistical analysis. Chi-Square test and differences between two ratios significance test were used to calculate the relationship between two nominal (categorical) variables.

Results: Total 6,613 cancer patient’s (3,759 men, 56.8% and 2,854 women, 43.2%) average age is 66.27±17.17. The most frequent types of cancer found among men included prostate (24.4%), bronchus-lung (12.5%) and colorectal (11.15%) cancer; whilst among for women it was breast (26%), thyroid (14.9%) and skin (10.6%) cancer, respectively. Kidney, bronchus-lung, skin, larynx, breast, bladder and thyroid cancer types were determined to be statistically significant according to gender (p<0.05).

Conclusion: We reviewed the diagnosed cancer cases in Giresun province from 2005 to 2016. For men, the order of the most frequent cancer types mentioned is consistent with the statistics of both the European Union (EU) as well as the United States of America (USA); whereas for women it was consistent with Turkey’s own national statistics. However, our findings state that thyroid cancer is the second most common cancer type among Turkish women, this is in contrast to most other parts of the world, the EU and USA.

Key words: Cancer, statistics, Giresun
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9 49-57 Risk Factors of Cancer in the United Arab Emirates
  Hira Abdul Razzak, Alya Harbi, Wael Shelpai, Ahmad Qawas
Statistics and Research Centre, Ministry of Health and Prevention, Dubai, UAE
  Cancer is recognized to be a major healthcare problem globally. Cancer is a disease that mainly occurs when alterations in a normal cell group within the body leads to uncontrolled growth, mainly causing a lump referred to as a tumor. The aim of this study is to systematically review and extract studies reporting the risk factors of cancer in UAE between 2007 and 2016. A systematic literature search was performed by using “PubMed, Scopus databases, Science direct, and local journals” and appropriate key terms to retrieve studies carried out in United Arab Emirates with regards to risk factors of the cancer. 75 articles were extracted in the beginning. After screening for exclusion criteria and retrieval of full texts, overall 16 articles were used in this study. Search limits were restricted to studies in English language, between 2007 and 2016, and on UAE population (both citizens and expatriates). This review yielded 16 studies about the cancer risk factors in United Arab Emirates, including cross sectional studies (n = 9), population-based crosssectional retrospective survey (n = 1), retrospective cohort studies (n = 4) and qualitative studies (n = 2). Tobacco use, unhealthy diet, family history, infection with HPV, physical activity, and radiation exposure were among the factors investigated. There was insufficient evidence available on some potentially essential risk factors such as use of alcohol, aging, and being overweight. This systematic review signifies an increasing cancer prevalence in the United Arab Emirates and suggests that extra effort is needed with a multi-sectorial approach in future at both the national and international level to effectively tackle the burden of cancer.

Keywords: Cancer, risk, cancer screening, prevalence, early detection, prevention, UAE.
  full article
10 58-60 Lymphoid proliferation in Eyelid: A Primary Follicular Lymphoma Case
  Deivy Cruzado-Sánchez1,2, Walter Andree Tellez3, Solon Serpa-Frias1, Grisnery Maquera1
1 Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
2 Ophthalmology Center Macula D&T. Clinical Research Unit, Lima, Peru
3 Sociedad Científica de Estudiantes de Medicina Villarrealinos (SOCEMVI), Universidad Nacional Federico Villarreal, Lima, Peru
  Ocular adnexal lymphoma (OAL) constitutes 8% of all extranodal lymphomas, being rare in the eyelids (5-20%). The objective was to report a case of eyelid follicular lymphoma in a young adult woman. A 35-year-old female with swelling in left lower eyelid with development for 2 months. The visual acuity was 20/20 in both eyes, the tumor mass was 3 cm wide and 1.5 cm long. The contrast-enhanced computed tomography showed a soft-tissue injury in the left lower eyelid but had no signs of local spread according to description. Grade 2 follicular lymphoma was diagnosed by biopsy. Oncological evaluation assessed positron emission tomography scan and bone marrow aspiration with negative results for systemic spread of disease. Patient started radiotherapy. This case highlights that young patients may present painless swelling lesions that may be largely underdiagnosed and should take into consideration some oncological pathologies.

Keywords: Eyelid neoplasms, Lymphoma, Follicular Lymphoma
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11 61-63 Transanal Minimally Invasive Surgery (TAMIS), First in Kuwait: A Case Report
  Abdullah A. AlHaddad1, Ali S. Mouzannar1, Bader Marafi1, Ibtisam Albader2, Mosa A. Khoursheed2, Ali Sayed Ahmed Alsayed1
1 Mubarak Al Kabeer Hospital, Kuwait City, Kuwait,
2 Kuwait Medical School, Al Jabriah, Kuwait.
  Transanal Minimally Invasive Surgery (TAMIS) is a one of new platform used to help and achieve better outcome in using transanal approach for the treatment of rectal neoplasm. High definition camera and high tech equipment are used to perform this kind of surgery. The main benefit of using this approach is to provide the best outcome or the patient compared to the traditional transanal approach. This platform can be used for a variety of cases, benign and malignant tumor and for the benign condition. We report the first TAMIS performed in the Kuwait and probably in the Middle East with 2 years of follow up. We had no complication and patient returned home and to normal activity in next day. More studies needed to validate this technique.

Keywords: TAMIS, Kuwait, Transanal, Minimally invasive, Rectal neoplasm
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12 64-66 Tumor Recurrence at Donor Site of Pectoralis Major Myocutaneous Flap with Tumor-free Primary Oral Carcinoma
  Rakesh Kain, Suvashis Dash
Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and
Safdarjung Hospital, New Delhi, India
  Pectoralis major myocutaneous flap is an important option for post onco reconstruction in head and neck region. Among the several complications mentioned in the literature, tumor recurrence at the donor site of flap is late and rare complication. Tumor implantation at the donor site of flap is a possible explanation. The occurrence of this type case is rare. We are reporting a case of tumor recurrences of pectoralis major myocutaneous flap donor site without presence of index tumor or detectable systemic disease. The recurrence was operated in our case. Clinicians should be aware of this condition for better management of patients with similar presentation.

Keywords: Pectoralis major flap; Pectoralis major myocutaneous flap; Flap complication; tumor recurrence; Head and neck reconstruction.
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13 67-71 Vaginal metastasis of renal clear-cell cancer
Rehailia-Blanchard Amel1, Morel Adeline2, Rancoule Chloé1, He MingYuan1, Magné Nicolas1, Falkowski Sabrina3
1 Dept. of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
2 Dept. of Oncology, Curie Institute, Rene Huguenin Hospital, Saint Cloud, France
3 Department of Oncology, CHU Limoges
  Background: Vaginal metastases originating from renal cancer remain a rare event, with less than 100 cases reported in the literature. The spreading mechanism is still under scrutiny. The tumoral bleeding often is a symptom revealing vaginal metastases. Case: The present work reports patient case having vaginal metastasis of renal clear-cell cancer. The vaginal metastasis was treated by a 3-D conformational radiotherapy. Our experience is discussed with respect to an updated literature review concerning the medical management of vaginal metastasis related to kidney cancer. Conclusion: In our case, a 15 Gy hypofractionatedradiotherapy is efficient to control bleeding on the vaginal metastases of the kidney cancer. To add up a 15 Gy hypofractionated-radiotherapy in 5 fractions is an option if bleeding is still present. The tolerance of the treatment is excellent and no side effects have been described.

Keywords: Vaginal metastases, Renal cell carcinoma, bleeding, radiotherapy
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14 72-74 T cell Large Granular Lymphocytic Leukemia with Pulmonary Hypertension
  Sidra Khalid1, Hamed Daw2, Miriam Jacob3, Megan Nakashima4
1 Internal Medicine, 2 Department of Hematology and Oncology, 3 Department of Cardiovascular Medicine,
Department of Clinical Pathology Fairview Hospital – Cleveland Clinic, Cleveland, USA
  T cell large granular lymphocytic leukemia is a hematological disorder which is characterized by the proliferation of CD 3+ cytotoxic T cells. We present a case about a patient who was diagnosed with T cell large granular lymphocytic leukemia and then developed pulmonary hypertension. He was treated for his leukemia with methotrexate and simultaneously treated for his pulmonary hypertension with selexipag and ambrisentan. As his leukemia improved, we also noticed an improvement in his pulmonary hypertension from a NYHA class IV to class I. Hence, we believe there is an etiopathological link between the T cell large granular leukemia and associated pulmonary hypertension.

Keywords: T cell LGL leukemia, pulmonary hypertension, methotrexate.
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15 75-78 Fatal Outcome of Recurrent Infantile Pelvic Desmoid Tumor Treated with Tamoxifene
  Lamiae Amaadour1, Zineb Benbrahim1, Othmane Zouiten1, Nezar Bourdi2, Youssef Lamrani Alaoui2, Asmae El Mazti3, Nawal Hammas3, Nawfel Mellas1
1 Department of Medical Oncology, 2 Department of Radiology, 3 Department of Pathology,
Hassan II University Hospital FEZ, Morocco
  Desmoid tumors are rare benign neoplasms with an aggressive local growth. In children, intra-abdominal localization is less frequent and few reports exist in the literature about the management of DTs in those special patients. In our report, we describe a case of a 13-year old patient with a bifocal intra-abdominal DT, treated unsuccessfully with tamoxifene, and we discuss briefly the existing literature data.

Keywords: infantile desmoid tumor, Recurrence, Tamoxifene, intra-abdominal site.
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