A. Kichloo, J. Poddar, Sakina Mankada, U. Suryanarayana
Most cases of chronic myeloid leukemia (CML) manifest in chronic phase with high granulocyte count. Medical management with imatinib renders complete hematological and cytogenetic remission in almost all patients. Only 5%–10% of the patients progress to accelerated phase and terminal phase, i.e., blast crisis. Blast crisis is defined as the presence of ≥20% blasts in the bone marrow (BM) or peripheral blood, or a large focus of blasts in the BM, or presence of extramedullary infiltration with blast cells. The penetration of imatinib in the central nervous system (CNS) is very poor, and thus, CNS may become a sanctuary site in patients on prolonged treatment with imatinib. The CNS as a site of extramedullary crisis is extremely rare. We report a case of Philadelphia-positive CML on imatinib with cerebrospinal fluid cytology positive and approach to its management.
{"title":"Chronic myeloid leukemia with isolated central nervous system blast crisis a rare case presentation","authors":"A. Kichloo, J. Poddar, Sakina Mankada, U. Suryanarayana","doi":"10.4103/oji.oji_42_19","DOIUrl":"https://doi.org/10.4103/oji.oji_42_19","url":null,"abstract":"Most cases of chronic myeloid leukemia (CML) manifest in chronic phase with high granulocyte count. Medical management with imatinib renders complete hematological and cytogenetic remission in almost all patients. Only 5%–10% of the patients progress to accelerated phase and terminal phase, i.e., blast crisis. Blast crisis is defined as the presence of ≥20% blasts in the bone marrow (BM) or peripheral blood, or a large focus of blasts in the BM, or presence of extramedullary infiltration with blast cells. The penetration of imatinib in the central nervous system (CNS) is very poor, and thus, CNS may become a sanctuary site in patients on prolonged treatment with imatinib. The CNS as a site of extramedullary crisis is extremely rare. We report a case of Philadelphia-positive CML on imatinib with cerebrospinal fluid cytology positive and approach to its management.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125372344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cell block: A boon in the world of cytology!","authors":"S. Nayak","doi":"10.4103/oji.oji_37_19","DOIUrl":"https://doi.org/10.4103/oji.oji_37_19","url":null,"abstract":"","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124166878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Goyal, Sneha Botra, M. Sharma, Manoj Gupta, V. Koyyala, A. Jajodia, Pradosh Kumar Sarangi
Colorectal cancer and lung cancer are the most common malignancies in the world. However, not all pulmonary nodules in a case of colon cancer are considered as metastasis, especially with features suggestive of limited colon disease without any nodal or liver involvement. The morphology of the pulmonary nodules is also an important consideration before subjecting the patient to another invasive procedure, as solitary pulmonary nodule with irregular margins, suggestive of another primary lesion. We describe a case of a patient with colon cancer, nonsmall cell lung cancer with single bone lesion, and neuroendocrine tumor of appendix. Initially suspected to be a case of metastatic colon cancer, the patient was later diagnosed as epidermal growth factor receptor-mutant metastatic pulmonary adenocarcinoma, with localized microsatellite instability high phenotype colon cancer.
{"title":"Sporadic synchronous triple primary cancers in elderly female: Microsatellite instability high resectable colon cancer, epidermal growth factor receptor-mutated metastatic lung cancer, and neuroendocrine tumor of appendix","authors":"S. Goyal, Sneha Botra, M. Sharma, Manoj Gupta, V. Koyyala, A. Jajodia, Pradosh Kumar Sarangi","doi":"10.4103/oji.oji_19_19","DOIUrl":"https://doi.org/10.4103/oji.oji_19_19","url":null,"abstract":"Colorectal cancer and lung cancer are the most common malignancies in the world. However, not all pulmonary nodules in a case of colon cancer are considered as metastasis, especially with features suggestive of limited colon disease without any nodal or liver involvement. The morphology of the pulmonary nodules is also an important consideration before subjecting the patient to another invasive procedure, as solitary pulmonary nodule with irregular margins, suggestive of another primary lesion. We describe a case of a patient with colon cancer, nonsmall cell lung cancer with single bone lesion, and neuroendocrine tumor of appendix. Initially suspected to be a case of metastatic colon cancer, the patient was later diagnosed as epidermal growth factor receptor-mutant metastatic pulmonary adenocarcinoma, with localized microsatellite instability high phenotype colon cancer.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125972593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carcinosarcoma or mixed Müllerian malignant tumors are a rare entity representing 1% of all the malignant ovarian neoplasms. It has poor prognosis, and the survival outcome is worst. We report a case of carcinosarcoma of the ovary in a 68-year-old female. The patient was treated with cytoreductive surgery followed by platinum- and taxane-based combination chemotherapy regimen. Now, the patient is under regular follow-up with long-term overall survival for 76 months without any disease. Therefore, our case highlights the importance of cytoreductive surgery followed by adjuvant chemotherapy with platinum- and taxane-based combination regimen in the form of improved survival demanding a long-term follow-up for such cases.
{"title":"Carcinosarcoma of ovary with long-term overall survival","authors":"P. Priyadarshini, S. Majumdar, D. Parida","doi":"10.4103/oji.oji_32_19","DOIUrl":"https://doi.org/10.4103/oji.oji_32_19","url":null,"abstract":"Carcinosarcoma or mixed Müllerian malignant tumors are a rare entity representing 1% of all the malignant ovarian neoplasms. It has poor prognosis, and the survival outcome is worst. We report a case of carcinosarcoma of the ovary in a 68-year-old female. The patient was treated with cytoreductive surgery followed by platinum- and taxane-based combination chemotherapy regimen. Now, the patient is under regular follow-up with long-term overall survival for 76 months without any disease. Therefore, our case highlights the importance of cytoreductive surgery followed by adjuvant chemotherapy with platinum- and taxane-based combination regimen in the form of improved survival demanding a long-term follow-up for such cases.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"149 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130553903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gynecological malignancy in reproductive age group is not uncommon. Around 12.5% of women with female genital tract malignancy are aged <45 years at the time of diagnosis.[1] Earlier, cancer treatment emphasized mainly on the survival outcome. But now, with the advent of newer chemotherapeutic agents, better surgical techniques, and newer treatment regimens, mortality rates are decreasing, and more emphasis can be given to improve the morbidity profile following cancer treatment. And, talking about morbidity, fertility preservation is one of the major concerns of young patients seeking cancer treatment.
{"title":"Role of fertility-sparing surgery in gynecological malignancy","authors":"P. Priyadarshini","doi":"10.4103/oji.oji_35_19","DOIUrl":"https://doi.org/10.4103/oji.oji_35_19","url":null,"abstract":"Gynecological malignancy in reproductive age group is not uncommon. Around 12.5% of women with female genital tract malignancy are aged <45 years at the time of diagnosis.[1] Earlier, cancer treatment emphasized mainly on the survival outcome. But now, with the advent of newer chemotherapeutic agents, better surgical techniques, and newer treatment regimens, mortality rates are decreasing, and more emphasis can be given to improve the morbidity profile following cancer treatment. And, talking about morbidity, fertility preservation is one of the major concerns of young patients seeking cancer treatment.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114536546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Bhushan, G. Yadav, D. Tripathi, L. Kumar, V. Kishore, R. Chowdhary, G. Kumar, Soumya Datta, S. Mitra, M. Gairola
Background: Metallic implant in radiotherapy leads to difficulty in tumor target and critical organ delineation. Four-field box technique is conventional approach to treat pelvic malignancies. Aim of the Study: The aim of study is to evaluate the dosimetric impact of calculation algorithms in the treatment of carcinoma cervix with metallic implants. Materials and Methods: A paraffin wax-coated iron rod was used to evaluate the beam characteristics under the influence of metallic implant. Beam characteristics such as tissue phantom ratio (TPR20,10) were measured and analyzed. 15 patients with and without metallic prosthesis of carcinoma cervix were compared in the study. Planning was done for the prescription dose of 45 Gy/25 fractions. Plans were calculated using AAA algorithm and recalculated using Acuros XB (AXB) and pencil beam convolution algorithms for the same monitor units. RTOG and Quantec Protocol were used for plan evaluation. Results: Transmission and TPR20,10increases with field size and beam energy. Surface dose Dsalso increases with field size. D98%and D2%of planning target volume showed a significant difference for AAA versus AXB. 4FN (AAA) are significantly better for all the 4F plans, calculated by three algorithms in case of V15Gyof small bowel. Analyzed data indicated the significant attenuation caused by high-Z material. Analyzed value of conformity index showed that value of index comes >1 in all the cases. Conclusion: The results indicate that when creating treatment plans for cervical cancer lesions with metallic prosthesis, the AAA algorithm would be a more appropriate choice.
{"title":"Clinical dosimetric impact of AAA and Acuros XB on high-density metallic implants in case of carcinoma cervix","authors":"M. Bhushan, G. Yadav, D. Tripathi, L. Kumar, V. Kishore, R. Chowdhary, G. Kumar, Soumya Datta, S. Mitra, M. Gairola","doi":"10.4103/oji.oji_18_19","DOIUrl":"https://doi.org/10.4103/oji.oji_18_19","url":null,"abstract":"Background: Metallic implant in radiotherapy leads to difficulty in tumor target and critical organ delineation. Four-field box technique is conventional approach to treat pelvic malignancies. Aim of the Study: The aim of study is to evaluate the dosimetric impact of calculation algorithms in the treatment of carcinoma cervix with metallic implants. Materials and Methods: A paraffin wax-coated iron rod was used to evaluate the beam characteristics under the influence of metallic implant. Beam characteristics such as tissue phantom ratio (TPR20,10) were measured and analyzed. 15 patients with and without metallic prosthesis of carcinoma cervix were compared in the study. Planning was done for the prescription dose of 45 Gy/25 fractions. Plans were calculated using AAA algorithm and recalculated using Acuros XB (AXB) and pencil beam convolution algorithms for the same monitor units. RTOG and Quantec Protocol were used for plan evaluation. Results: Transmission and TPR20,10increases with field size and beam energy. Surface dose Dsalso increases with field size. D98%and D2%of planning target volume showed a significant difference for AAA versus AXB. 4FN (AAA) are significantly better for all the 4F plans, calculated by three algorithms in case of V15Gyof small bowel. Analyzed data indicated the significant attenuation caused by high-Z material. Analyzed value of conformity index showed that value of index comes >1 in all the cases. Conclusion: The results indicate that when creating treatment plans for cervical cancer lesions with metallic prosthesis, the AAA algorithm would be a more appropriate choice.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127184401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hidradenoma papilliferum (HP) is an uncommon benign cutaneous adnexal neoplasm of the anogenital region commonly seen in middle-aged, Caucasian females. Anastomosing and branching tubules, lined by columnar cells, and a basal layer of myoepithelial cells are the characteristic histopathological features. We report a case of HP in a 60-year-old female presented with a vulvar lesion. The case was evaluated for malignancy, with the initial histopathology showing extensive squamous metaplasia but ultimately found to have HP.
{"title":"Hidradenoma papilliferum of the vulva with extensive squamous metaplasia mimicking malignancy: Rare entity with diagnostic challenge","authors":"D. Jetly, R. Dabral, D. Goel","doi":"10.4103/oji.oji_23_19","DOIUrl":"https://doi.org/10.4103/oji.oji_23_19","url":null,"abstract":"Hidradenoma papilliferum (HP) is an uncommon benign cutaneous adnexal neoplasm of the anogenital region commonly seen in middle-aged, Caucasian females. Anastomosing and branching tubules, lined by columnar cells, and a basal layer of myoepithelial cells are the characteristic histopathological features. We report a case of HP in a 60-year-old female presented with a vulvar lesion. The case was evaluated for malignancy, with the initial histopathology showing extensive squamous metaplasia but ultimately found to have HP.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122583708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Congenital mesoblastic nephroma (CMN) is a rare tumor of infancy and consists of 3%–10% of cases among all the pediatric renal tumors. Histologically, it can be classic, cellular, and mixed subtypes, with the cellular variant being difficult to differentiate from Wilms tumors and more aggressive. In this report, macroscopic hematuria was noticed first, and a right renal mass was detected in a 32-week-old premature female neonate, who was born to a 30-year-old woman by emergency cesarean section. Nephrectomy was performed, and histopathological examination of the operated specimen revealed features of cellular variant of CMN.
{"title":"Congenital mesoblastic nephroma in a premature neonate with initial presentation of hematuria – A case report with review of literature","authors":"I. Dhal, Goutami Dasnayak, S. Saxena","doi":"10.4103/OJI.OJI_4_19","DOIUrl":"https://doi.org/10.4103/OJI.OJI_4_19","url":null,"abstract":"Congenital mesoblastic nephroma (CMN) is a rare tumor of infancy and consists of 3%–10% of cases among all the pediatric renal tumors. Histologically, it can be classic, cellular, and mixed subtypes, with the cellular variant being difficult to differentiate from Wilms tumors and more aggressive. In this report, macroscopic hematuria was noticed first, and a right renal mass was detected in a 32-week-old premature female neonate, who was born to a 30-year-old woman by emergency cesarean section. Nephrectomy was performed, and histopathological examination of the operated specimen revealed features of cellular variant of CMN.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124165770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibro-osseous lesions are bony lesions where the bone is replaced by fibrous connective tissue and include fibrous dysplasia (FD), cemento-osseous dysplasia, and ossifying fibroma (OF). OF is a benign osteogenic mesenchymal tumor and clinicopathologically divided into juvenile and conventional subtypes. Juvenile OF (JOF) is a rare rapidly growing tumor of the craniofacial bones having aggressive clinical behavior with high recurrence rate. Pathologically, JOF is classified into juvenile trabecular OF (JTOF) and juvenile psammomatoid OF. JTOF microscopically shows proliferation of fibrocellular connective tissue stroma along with immature and woven bony trabeculae with varied histologic features. We report a case of JTOF of the mandible in a 12-year-old male with the initial presentation of painless swelling on the right side lower jaw. Clinicoradiologically, the case was suspected as central giant cell granuloma and odontogenic tumors. He was successfully treated with wide local excision and reconstruction and was on follow-up for 8 months without any recurrence of the disease.
{"title":"Juvenile trabecular ossifying fibroma of the mandible","authors":"S. Fatma, S. Das, Sasmita P. Singh, Rachna Rath","doi":"10.4103/oji.oji_10_19","DOIUrl":"https://doi.org/10.4103/oji.oji_10_19","url":null,"abstract":"Fibro-osseous lesions are bony lesions where the bone is replaced by fibrous connective tissue and include fibrous dysplasia (FD), cemento-osseous dysplasia, and ossifying fibroma (OF). OF is a benign osteogenic mesenchymal tumor and clinicopathologically divided into juvenile and conventional subtypes. Juvenile OF (JOF) is a rare rapidly growing tumor of the craniofacial bones having aggressive clinical behavior with high recurrence rate. Pathologically, JOF is classified into juvenile trabecular OF (JTOF) and juvenile psammomatoid OF. JTOF microscopically shows proliferation of fibrocellular connective tissue stroma along with immature and woven bony trabeculae with varied histologic features. We report a case of JTOF of the mandible in a 12-year-old male with the initial presentation of painless swelling on the right side lower jaw. Clinicoradiologically, the case was suspected as central giant cell granuloma and odontogenic tumors. He was successfully treated with wide local excision and reconstruction and was on follow-up for 8 months without any recurrence of the disease.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121702004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Sukumaran, N. Nayak, Rari P. Mony, J. Kaur, S. Nair
Osteosarcoma is an aggressive primary bone tumor arising from primitive bone-forming cells. The most frequent site of metastasis is the lung followed by bone. However, osteosarcoma presenting as malignant pleural effusion during the initial presentation is extremely rare. Involvement of more than one bone at the time of initial presentation is rare and it is confusing whether these multiple lesions represent multiple primaries or metastasis. We report the case of a 17-year-old male who presented with fever and breathlessness of 1-month duration. Examination revealed massive pleural effusion. Pleural fluid cytology showed malignant cells. On examination, a scalp swelling was also noted. Radiological evaluation revealed multiple bony lesions involving the skull, femur, humerus, and vertebrae. Biopsy of the lesion in the humerus confirmed the diagnosis of osteosarcoma.
{"title":"Osteosarcoma presenting with massive malignant pleural effusion","authors":"R. Sukumaran, N. Nayak, Rari P. Mony, J. Kaur, S. Nair","doi":"10.4103/oji.oji_7_19","DOIUrl":"https://doi.org/10.4103/oji.oji_7_19","url":null,"abstract":"Osteosarcoma is an aggressive primary bone tumor arising from primitive bone-forming cells. The most frequent site of metastasis is the lung followed by bone. However, osteosarcoma presenting as malignant pleural effusion during the initial presentation is extremely rare. Involvement of more than one bone at the time of initial presentation is rare and it is confusing whether these multiple lesions represent multiple primaries or metastasis. We report the case of a 17-year-old male who presented with fever and breathlessness of 1-month duration. Examination revealed massive pleural effusion. Pleural fluid cytology showed malignant cells. On examination, a scalp swelling was also noted. Radiological evaluation revealed multiple bony lesions involving the skull, femur, humerus, and vertebrae. Biopsy of the lesion in the humerus confirmed the diagnosis of osteosarcoma.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131801323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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