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We report a case of pyrexia of unknown origin presenting with lactic acidosis and hypoglycaemia. He further developed Guillain-Barre syndrome (GBS) and Hemophagocytic lymphohistiocytosis (HLH). The bone marrow biopsy ultimately reported Diffuse large B cell lymphoma (DLBCL). A 74-year-old gentleman visited the hospital in January 2024 with a fever since 2 weeks. He further developed hypoglycemic episodes and lower limb followed by upper limb weakness. On physical examination, he was febrile, tachypnoec with hepatomegaly and bilateral lower limb weakness with grade 3 power proximally and extensor plantar reflexes. Peripheral smear showed a leucoerythroblastic picture and 3% atypical lymphoid cells. Procalcitonin, lactate dehydrogenase and Ferritin were markedly elevated, suggestive of HLH. The bone marrow biopsy ultimately revealed DLBCL. He was diagnosed with GBS, Warburg phenomenon and HLH secondary to DLBCL. Intravenous steroids were started for secondary HLH and after he became hemodynamically stable was initiated on chemotherapy with Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone (R-CHOP) regimen. After four cycles of R mini-CHOP, positron emission tomography-computed tomography showed a good response. Further two cycles of R mini-CHOP was given with methotrexate for central nervous system prophylaxis. This case portrays an atypical presentation of DLBCL with Warburg syndrome, GBS and HLH. Despite the adverse clinical course, the patient responded favourably to chemotherapy.

Background: Adenoid cystic carcinoma of the breast (ACCB) is a rare histological subtype of breast cancer characterised by unique clinical features and management challenges. ACCB remains poorly understood, with limited data on its epidemiology, treatment outcomes and prognostic factors. This study aimed to elucidate the landscape of ACCB in a real-world context.

Methods: A retrospective cohort study was conducted on patients diagnosed with ACCB in a Brazilian cancer center between January 2007 and October 2021. Clinical and pathological data were systematically collected from electronic medical records. Statistical analyses were performed to identify factors associated with prognosis and assess the impact of treatment interventions.

Results: Twenty-one female patients with confirmed ACCB were included in the study. The median age at diagnosis was 55.2 years. Most patients had basaloid (38.1%) or classic (19.0%) histological subtypes. Adjuvant radiotherapy was associated with a trend towards better recurrence-free survival among patients with localised disease HR 0.21, CI 95% 0.04-1.06, p = 0.059). In the metastatic setting, systemic chemotherapy used for breast cancer demonstrated limited efficacy, with a median progression-free survival of 1.8 to 2.8 months. Despite the overall poor prognosis, two patients with low-volume metastatic disease had long-term survival following local therapy.

Conclusion: Given the rarity of ACCB and the absence of a standard management approach, this small study suggests a potential benefit of local therapies in adjuvant and metastatic settings while indicating the limited efficacy of systemic chemotherapy. Personalised treatment strategies tailored to ACCB are essential to optimising patient outcomes.

Endometrial cancer (EC) treatment changed substantially with the introduction of molecular classification. There is a paucity of data regarding the added value of L1CAM in patients with p53 aberrant tumours. The present study aimed to analyse the prognostic value of L1CAM associated with p53 aberrant EC. Patients with EC treated between 2010 and 2016 were retrospectively evaluated. Patients included in this analysis must have reviewed high-grade histologies (endometrioid grade 3, serous, clear cell, carcinosarcoma, mixed and undiffrentiated). Samples were subjected to immunohistochemistry for L1CAM and p53. Recurrence-free survival (RFS) and overall survival (OS) were analysed by the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was performed for multivariable analysis. From 2010 to 2016, 464 patients met the inclusion criteria. Patients with p53 wild type and L1CAM negative (p53wt/L1CAMneg) corresponded to 13.6% (59 patients) of the population, p53 wild type and L1CAM positive (p53wt/L1CAMpos) to 11.7 % (51 patients), aberrant p53 and L1CAM negative (p53ab/L1CAMneg) to 32.9% (143 patients) and aberrant p53 with L1CAM positive (p53ab/L1CAMpos) to 41.8% (182 patients). In univariate and multivariate analysis, compared to patients with p53wt/L1CAMneg, the presence of p53wt/L1CAMpos, p53ab/L1CAMneg and p53ab/L1CAMpos was statistically associated with a worse RFS (HR 2.02; HR 2.20 and HR 2.99, respectively) and OS (HR 2.39; RH 2.31 and RH 2.94, respectively). In the present analysis of a high histological risk population, stages I-IV, we observed that the presence of p53ab/L1CAMpos was associated with a worse RFS and OS when comparing p53wt/L1CAMneg patients. Patients with L1CAMpos had the same worse prognosis as p53ab tumours.

Background: Cervical cancer remains a significant public health issue, particularly in low-income countries. It is the fourth most common cancer among women globally, with an estimated 570,000 new cases and 311,000 deaths in 2018.

Objective: This study aimed to examine the stages of cervical cancer at diagnosis and identify factors contributing to late-stage presentation among women in a tertiary care hospital in Nigeria.

Methods: A retrospective study analysed data from women diagnosed with cervical cancer between 2017 and 2021. Demographic, reproductive and clinical data were extracted from medical records.

Results: Of the 102 women who presented during the study period, only 57 (55.9%) had complete staging, clinical and demographic data; these complete cases were included to ensure data integrity. From this population, 73.7% were aged 50 years or older and 56.1% presented with late-stage disease. Additionally, anaemia (packed cell volume <30%) was present in 75.4% of women. Postcoital bleeding was reported in 35.1% of cases. Women with no formal education had higher odds of late-stage diagnosis odds ratios (OR: 4.40, 95% CI: 1.08-17.82). Postmenopausal women also had higher odds of late-stage diagnosis (OR: 4.46, 95% CI: 1.27-15.70).

Conclusion: A late-stage cervical cancer diagnosis is prevalent among women in Nigeria, particularly among those with lower educational levels and postmenopausal women. Targeted awareness programmes, expanded screening (including integration into well-woman/postmenopausal care) and improved healthcare infrastructure, including consistent documentation of screening history and human papillomavirus vaccination, are essential for reducing the burden of cervical cancer in this context.

Collaborative trials of co-operative groups have currently established interval compressed chemotherapy (ICC) as the standard of care, though there are concerns regarding the application of the same in low middle-income countries (LMICs). This study is a retrospective analysis of the long-term outcomes of a follow-up cohort (n = 200), constituted by patients (<15 years) with Ewing sarcoma (ES) treated with curative intent (including localised and metastatic patients) during January 2013-June 2017 on a non-dose dense chemotherapy protocol, EFT-2001. Local therapy was planned at 9-12 weeks of therapy and was delivered in all but three patients who had events before local control. At a median follow-up of 97 months (95%CI:91-103 months), 7-year event-free survival (EFS) and overall survival (OS) of the whole cohort were 55% (95%CI:49%-63%) and 69% (95%CI:63%-76%), respectively. Seven-year EFS and OS for the localised cohort were 60% (95%CI:53%-69%), 73% (95%CI:66%-80%) and for metastatic cohort were 37% (95%CI:24%-55%) and 53% (95%CI:39%-72%), (p = 0.003, p = 0.015), respectively. Non-relapse mortality was 8% (n = 16). Anthracycline dose, axial location, poor histological necrosis and older age group were associated with adverse outcomes. Cardiotoxicity was reported in 13%, with one-third developing symptomatic cardiac dysfunction. Long-term outcomes for children with ES treated on a non-dose dense chemotherapy protocol, in the setting of a higher treatment-related mortality, have relatively fair outcomes, though suboptimal compared to the ICC approach. ICC could be introduced in a phased manner in high-risk subsets in LMICs with better resources and an active nutritional rehabilitation and supportive care programme, while EFT-2001 protocol still could be a practical solution in resource-constrained settings.

Synopsis: We found a significant increase in serum IL-6 levels of 214.9 ng/mL (95% CI: 60.1-369.7, p = 0.007) among women with cervical cancer (CC) compared to their cancer-free counterparts.

Objectives: Despite growing evidence of the role of interleukin-6 (IL-6) in CC, studies assessing this association among women of sub-Saharan African origin remain limited. This study investigated the association between serum IL-6 and CC and explored the effects of serum IL-6 levels on prognosis in patients with CC in Lagos, Nigeria.

Methods: We conducted a cross-sectional study among women with and without CC in two hospitals. A venous blood sample was collected from each participant for laboratory analysis of serum IL-6 levels. We performed simple and multiple linear regression analyses to compare the unit increase in serum IL-6 levels between study groups while adjusting for relevant confounders.

Results: Our study found a significant unit increase of 214.9 ng/mL (95%CI: 60.1-369.7, p = 0.007) in serum IL-6 levels among women with CC compared to their cancer-free counterparts. The area under the curve of 0.814 demonstrated a good discriminatory ability at an optimal serum IL-6 cut-off value of 365.1 ng/mL. IL-6 levels were significantly elevated in patients with advanced-stage CC compared to those with early-stage disease (156.7 (IQR: 130.4-227.6) versus 324.7 (IQR: 188.5-516.2) ng/mL) and in patients diagnosed with squamous cells carcinoma (SCC) compared to those without SCC (523.9 (IQR: 365.1-682.1) versus 203.6 (IQR: 131.3-334.3) ng/mL).

Conclusion: Our study findings highlight the potential utility of serum IL-6 as a biomarker for CC diagnosis and prognosis. However, further studies are needed to explore the utility of IL-6 as a target for therapeutic intervention and in the treatment monitoring of CC patients.

Glomus tumour is a soft tissue neoplasm that is associated with the subungual region owing to the presence of the glomus body. A 53-year-old female patient was referred to the Department of Oral and Maxillofacial Pathology with the chief complaint of a swelling on the tongue of 3 months' duration. An ultrasound of the tongue suggested a vascular malformation. Histopathology revealed a well-defined proliferation of cells around blood vessels, surrounded by muscle and collagen fibres. A majority of the cells were clear with distinct nuclei. Some cells had an eosinophilic granular cytoplasm. Histopathology was augmented with immunohistochemistry to arrive at a diagnosis of glomus tumour of the tongue. The oral cavity is an unusual site for the occurrence of glomus tumour. This case emphasises the importance of a comprehensive diagnostic work-up in the diagnosis of swellings in the head and neck region, particularly in the context of rare tumours arising from cells that are not native to this site.

Introduction: Oral cancer is a major public health issue in India. Despite various prevention strategies, the incidence of oral cancer continues to rise. This study aimed to assess awareness of tobacco's harmful effects and tobacco control measures in patients with oral cancer.

Methods: This cross-sectional study was conducted from August 2023 to June 2024. Totally, 116 adult patients with histopathologically confirmed oral cancer were recruited using convenience sampling. Data were collected using a pretested interview schedule covering sociodemographics, tobacco and alcohol use, awareness of oral cancer and tobacco control policies. Descriptive statistical methods were used to analyse the data, and chi-Square and Fisher's Exact tests were used to identify factors associated with awareness of the carcinogenic nature of tobacco.

Results: The mean age of participants was 47.9 ± 11.1 years, with 87.9% male and 97.4% from upper, lower/lower socioeconomic backgrounds. 54.3% of participants used smokeless tobacco, 10.3% were smoking and 27.6% were using both. Most consumed tobacco daily, with 52.6% quitting tobacco consumption after getting diagnosed with oral cancer. 66.4% were aware of the link between tobacco and oral cancer, primarily from tobacco packaging (48.1%) and anti-tobacco advertisements (36.3%). However, all were unaware of the early symptoms of oral cancer and self-examination methods. Awareness of free government screenings was very low (0.9%), and only 7.8% knew of laws regulating tobacco. Awareness that tobacco causes cancer was significantly higher among literate participants, those who noticed the warning sign, and felt fear from the warning signs on tobacco products (p < 0.05).

Conclusion: This study reveals significant gaps in awareness regarding tobacco-related oral cancer risks and preventive measures among patients with oral cancer. Targeted awareness campaigns and improved access to screening could help reduce oral cancer in India.

Multiple myeloma (MM) represents a significant global health challenge, with its incidence and mortality rates steadily increasing over recent decades. This review critically examines the current landscape of MM management, with a specific focus on resource-limited settings, where the disparities in diagnostic capabilities and treatment options are most pronounced. A comprehensive literature search was performed using multiple databases, encompassing peer-reviewed articles, clinical guidelines and conference abstracts from 2010 to 2024. Our analysis delineates the stark differences between therapeutic approaches in high-income versus low- and middle-income countries (LMICs). In high-income settings, the standard of care involves advanced induction regimens, autologous stem cell transplantation and maintenance therapy with novel agents, which collectively have contributed to improved patient outcomes. Conversely, LMICs often rely on more affordable yet less effective treatments, such as bortezomib- or thalidomide-based regimens, largely due to limited access to advanced diagnostics and high-cost therapies. Key challenges identified include late presentation, inadequate diagnostic infrastructure, economic constraints and a paucity of trained healthcare personnel. To address these issues, we propose a multifaceted strategy that emphasises the enhancement of diagnostic capacity, the adaptation of resource-stratified treatment guidelines and the strengthening of healthcare systems through targeted policy interventions and international collaborations. By bridging the gap between evidence-based MM care and the practical realities of under-resourced healthcare systems, this review aims to inform future clinical practice and policy, ultimately improving survival outcomes and reducing global health inequities in MM management.

Introduction: Malignant ovarian germ cell tumours (MOGCTs) are rare and account for 70% of malignant ovarian tumours in adolescents. Hence, fertility preservation is an important issue among this population. In this study, we aim to analyze our experience of MOGCT treatment with special emphasis on outcomes of fertility-preserving treatment and on survival outcomes.

Materials and methodology: All patients with MOGCT who underwent treatment in our institution, from January 2010 to December 2018, were included and the clinicopathologic characteristics, chemotherapy details, recurrence characteristics and follow-up data were analysed. The patients who underwent fertility-sparing surgery were contacted over the telephone to collect reproductive and menstrual outcome details.

Results: A total of 84 patients were included in the study of which upfront surgery was followed by adjuvant chemotherapy in 44 (52.4%) patients and neoadjuvant chemotherapy was followed by interval debulking surgery and adjuvant chemotherapy in 8 patients. Fertility-sparing surgery was performed in 49 (58.3%) patients and 17 patients attempted conception and 13 (76.5%) succeeded in spontaneous pregnancy, resulting in 11 live births. All of them resumed their menstrual cycle within 1 year of treatment. With the median follow-up of 46 months, the mean 3-year disease-free survival and overall survival of 84 patients with MOGCT were 86.9% and 96.4%, respectively.

Conclusion: Fertility-preserving surgery with appropriate adjuvant treatment has excellent survival and fertility outcomes among patients with early as well as advanced-stage disease. Hence, it is a safe and effective option for young females with MOGCTs.