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1.  Comparison of the efficacy and safety of Rituximab (Mabthera™) and its biosimilar (Reditux™) in diffuse large B-cell lymphoma patients treated with chemo-immunotherapy: A retrospective analysis 
Rituximab (Mabthera™) have been in use in India since 2000. A biosimilar molecule of rituximab (Reditux™) was approved in India in 2007. This retrospective audit was done to compare the efficacy and safety of Mabthera™ with Reditux™.
Materials and Methods:
We reviewed the charts of 223 adult diffuse large B-cell lymphoma patients who had received cyclophosphamide, doxorubicin, vincristine and prednisolone with rituximab chemotherapy. Tumor recurrence, survival and toxicities experienced during chemotherapy were obtained from the patient charts. The survival analysis was restricted to patients who received at least 4 cycles of the same brand.
Of the 223 patients evaluated, 101 received Mabthera™, 72 received Reditux™. There were no differences in the infusional reaction rates, grades 3 and 4 neutropenia and oral mucositis between the two brands. Complete-remission (CR) rates were similar with Mabthera™ and Reditux™ (75% and 82%, respectively; P = 0.294). The progression free survival (PFS) rate at 5 years were 72% in Mabthera™ and 81% in Reditux™ (P = 0.382). The overall survival (OS) at 5 years were comparable in the two groups (66% in Mabthera™ and 76% in Reditux™; P = 0.264).
We observed no significant differences in the toxicity, tumor response rates, PFS and OS between the two available brands of rituximab.
PMCID: PMC3932598  PMID: 24604960
Anti-CD20; biosimilar; lymphoid neoplasms; monoclonal antibody; observational study; survival outcomes
2.  Mucin histochemistry of stomach in metaplasia and adenocarcinoma: An observation 
There is a variable pattern of occurrence of gastric carcinomas world-wide, partially reflecting the frequency of various changes of gastric mucosa from, which such neoplasm occur. Many cases of gastric carcinoma originate in the background of chronic gastritis caused by Helicobacter pylori. Subsequent intestinal metaplasia (IM) can be morphologically classified by routine and special histopathological stains.
Materials and Methods:
The present study was conducted over the 2 years at NRSMC & H, Kolkata. Aims of the present study were to search for evidences of H. pylori infection, classification of different metaplastic and/or malignant changes, identification of types of mucin by mucin histochemistry and their interrelationship in gastrectomy and gastric biopsy specimens (total 70). After obtaining clinical history, radiological and endoscopic findings were noted. After macroscopic study of the specimen, hematoxylene and eosin, southgate mucicarmine, periodic acid schiff-alcian blue (PAS-AB) and gomori aldehyde fuchsin (GAF)/AB staining were performed to classify gastric carcinoma and metaplastic changes and to correlate with staining patterns of mucin.
The overall male to female ratio was 2.89:1. Age ranged from 22 years to 78 years and the commonest age group of gastric carcinomas being 41-50 years (26 cases, 37.1%). Gastric adenocarcinoma was found in 61 (87.1%) cases (22.9% were of intestinal type and 77.1% of diffuse type) and only IM was found in 9 (12.9%) cases. Overall the rapid urease test was positive in 18 (25.7%) cases majority of which showing either pure IM or IM associated with intestinal type of gastric carcinoma. All diffuse types of gastric carcinoma (47 cases, 77.1%) were showed PAS positive staining (indicating neutral mucin) whereas in 15 (65.2%) cases of IM columnar cells stained with AB (representing acidic mucin). GAF/AB stain revealed Type II IM in 10 (43.5%) cases and Type III IM in 4 (17.4%) cases.
Routine and special histological staining is particularly useful for histological subtyping of gastric carcinomas and IMs.
PMCID: PMC3932586  PMID: 24604948
Gastric carcinoma; histochemistry; intestinal metaplasia of stomach; mucin stain
3.  Cisplatin based chemotherapy in patients with advanced differentiated thyroid carcinoma refractory to I131 treatment 
The purpose of the study was to evaluate the activity and toxicity of cisplatin based chemotherapy in patients with advanced differentiated thyroid cancer refractory to radioactive iodine (I131).
Patients and Methods:
We retrospectively reviewed the records of 20 patients with advanced thyroid cancer treated with cyclophosphamide 500 mg/m2 on day 1, doxorubicin 50 mg/m2 day 1 and cisplatin 50 mg/m2 day 1 of a 21 days cycle community-acquired pneumonia (CAP) or the same regimens without cyclophosphamide adriamycin and Platinum (AP).
Median age of patients was 65 years (range 54-80). The majority of patients had lung metastases (60%). 4 (20%) patients achieved a partial response. Stable disease was achieved in 6 (30%) patients. Overall clinical response was 50%. Mean follow-up time was 8 months (range 4-17). Mean progression free survival was 6 months (range 3-12). Mean overall survival was 9 months (range 4-17). Patients with partial remission had a mean time to disease progression of 9 months. 4 (20%) patients had Grade 3 or 4 neutropenia. One patient had febrile neutropenia. Mild neuropathy was recorded in 5 (25%) of patients. There were no treatment related deaths.
The combination of CAP is active in the treatment of advanced thyroid cancer with tolerable toxicity. This regimen may still be used in patients who could not be treated with targeted therapy or combined with antiangiogenic drugs in future studies.
PMCID: PMC3932587  PMID: 24604949
Advanced; chemotherapy; differentiated; thyroid cancer
4.  A retrospective study of central venous catheters GCRI experience 
The use of central venous catheters (CVCs) has greatly improved the quality-of-care in cancer patients, yet these catheters may cause serious infectious and thrombotic complications. The aim of this retrospective study was to study the various types of CVCs and their complications.
Materials and Methods:
We studied retrospectively 213 cases of CVCs in our institute with their indications, type and complications from August 2010 to July 2011.
A total of 213 CVCs were inserted in patients with hematological (62%) and solid organ malignancies (38%). Ninety-eight patients (46%) had peripheral inserted central catheter (PICC), 90 (42%) patients had Hickman catheters and 25 (12%) had a port. The median duration of retention of Hickman catheters was 104 days (3-365 days), for the peripherally inserted central catheters was 59 days (3-100 days) and for the port it was 280 days (45-365 days). Non-infective complications were more than infective (12% vs. 7%). The most common complication was non-infective occlusion and thrombophlebitis. In one patient with PICC thrombosis occurred in the cephalic, radial and ulnar vein and in one patient with port thrombosis occurred in the superior vena cava. Organisms were isolated in 60% (12 out of 20) of cultures. Common organisms isolated were Pseudomonas aeruginosa in 5 (42%), Staphylococcus aureus in 2 (16%), Escherichia coli in 2 (16%) and Aspergillus in 3 (25%) patients. 7 out of 12 infected patients had negative blood cultures within 7 days of antibiotic treatment, 5 patients remained positive for more than 7 days with antibiotics. In 155 patients (73%), the desired treatment protocol was completed and at present there are still 28 patients (13%) with catheters. 5 patients (2.3%) died of febrile neutropenia and septicemia with multi-organ failure. In 5 patients (2.3%), the catheters (1 Port, 1 Hickman and 3 PICC) were prematurely removed because of thrombosis.
CVCs are better options to facilitate the long-term vascular access provided infection is prevented with meticulous care and treated promptly with proper antibiotics. Most CVCs is acceptable to patients.
PMCID: PMC3932588  PMID: 24604950
Central venous catheter; chemo port; Hickman central venous catheter; peripheral inserted central catheter
5.  Malignant lymphoma in Eastern India: A retrospective analysis of 455 cases according to World Health Organization classification 
Malignant lymphoma (ML) is one of the most common cancers and is most prevalent in developed countries. The distribution of different subtypes of ML varies in the different geographical locations according to World Health Organization (WHO) Classification.
Aims and Objectives:
The study was aimed to analyze the different patterns of ML in Eastern India and to compare it with other geographical locations.
Materials and Methods:
Four hundred and fifty five patients of two large hospitals in Eastern India were included over a period of four years and were categorized according to WHO classification, using the morphology and immunohistochemistry.
There were 347 (76.3%) non Hodgkin lymphomas (NHL), and 108 (23.7%) Hodgkin lymphomas (HL). Diffuse large B-cell lymphoma was the most common of the NHL type (35.2%) followed by the follicular lymphoma (19.3%). B-cell lymphoblastic lymphoma was the least common type of NHL (1.4%). Mixed cellularity (33.3%) and nodular sclerosis (26.9%) were the two most common type of HL. Childhood lymphoma comprised of 12.5%of all ML. T-cell NHL and HL were the common lymphomas in this age group.
Incidence of follicular lymphoma is lower compared to western studies and mixed cellularity is the most common subtype of HL unlike nodular sclerosis subtype in Western world. Burkitt's type NHL though is the most common subtype of childhood ML in many studies. However, in our study, T-cell NHL is the most common type of childhood ML.
PMCID: PMC3932589  PMID: 24604951
Eastern India; immunophenotyping; lymphoma; World Health Organization
6.  Factors affecting wound complications in head and neck surgery: A prospective study 
Head and neck surgeries are complex. Wound complications are associated with considerable morbidity and can result in delay in the adjuvant treatment. Identification of factors will help in formulating preventive guidelines.
The aim of this study is to identify perioperative factors responsible for wound complications.
Settings and Design:
Prospective study of 186 head and neck patients.
Subjects and Methods:
Pre-operative, intraoperative and post-operative factors were recorded. Each patient was evaluated for minor and major wound complications twice daily during the hospital stay.
Statistical Analysis:
Chi-square test was used for univariate and log regression test was used for multivariate analysis.
The overall wound complication rate was 29% with 7% major and 22% minor complications. On univariate analysis, laryngeal and hypopharyngeal location, advanced T stage, poor oral hygiene, clean-contaminated surgery, low Karnofsky performance status (KPS), flap reconstruction, blood loss more than 1000 ml, perioperative blood transfusion, duration of surgery greater than 4.3 h and post-operative hemoglobin lesser than 11 g%, post-operative tracheostomy and resection of mandible were statistical significant factors. On multivariate analysis, post-operative tracheostomy, low KPS, post-operative serum albumin less than 3.7 g/dl and duration of surgery greater than 4.3 h were significant factors.
Apart from unavoidable factors, it is essential to take care of certain factors viz nutrition, haemoglobin, oral hygiene, asepsis and repeating antibiotics in prolonged surgery.
PMCID: PMC3932590  PMID: 24604952
Head and neck cancers; risk factors; wound complications; wound infection
7.  Needle core biopsy for breast lesions: An audit of 467 needle core biopsies 
Breast cancer is the commonest cancer among women in urban India. Triple assessment includes clinical, radiological and cytological assessment of breast lesions. Guided core needle biopsy has replaced fine needle aspiration cytology in most of the western countries. In resource poor countries FNAC is still a very valuable and cost effective method to diagnose breast lesions. Pitfalls include increased rates of non diagnostic smears, and inadequate smears. Further procedures may be required and this increases the cost, anxiety and delay in diagnosis.
The aim of this study is to analyze the concordance of radiological and histopathology findings in BI-RADS category 3,4,5 lesions following a core biopsy.
Materials and Methods:
Data was retrospectively collected from consecutive symptomatic and opportunistic screen detected patients with abnormalities who underwent ultrasound guided interventional procedures from Jan 2010 to Aug 2011. Symptomatic patients underwent clinical examination, mammogram and breast ultrasound. Women under 35 years of age had only breast ultrasound. Core biopsy was performed under ultrasound guidance or clinically by a breast surgeon/ radiologist for BI-RADS category 3,4,5 lesions.
Statistical Methods:
Chi square test was done to show the strength of association of imaging findings and histopathology results of core biopsy.
437 patients were symptomatic and 30 patients had screen detected abnormalities. The positive predictive value for BI-RADS 5 lesions for malignancy is 93.25% and the negative predictive value of BI-RADS category 3 lesions for cancer is 98.4%. False negative diagnosis on core biopsy was 0.85%. We were able to defer surgery in 60% of the patients with a clear radiological and pathological benign diagnosis.
The PPV and NPV for cancer is high with needle core biopsy in BI-RADS 3,4,5 lesions. Where there is no discordance between clinical, radiology and pathology findings, surgery can be avoided in benign lesions. While in resource poor countries FNAC continues to be a valuable method in the diagnosis of palpable and non palpable breast lesions, the practice of needle core biopsy provides the most accurate and optimal diagnostic information.
PMCID: PMC3932591  PMID: 24604953
Breast lesion; fine needle aspiration cytology; needle core biopsy
8.  Tumor bed boost in breast cancer: Brachytherapy versus electron beam 
The prospective study aimed to evaluate the effectiveness of Electron beam or HDR 192Ir Interstitial Implant used as a boost in breast Conservation cases after completion of EBRT. The two therapeutic modalities were compared in terms of the following parameters; i.e. cosmesis, optimization of tumor bed boost, local control, toxicity, and DFS.
Materials and Methods:
The EBRT dose used was 50 Gy in 25 fractions over 5 weeks time. Target delineation of boost treatment was done by CT scan or by high resolution USG. EBRT will be immediately followed by local boost at the primary tumor bearing site of breast with 8 to12 MeV electron beam to a dose of 15 Gy in 6 fractions (Arm A) or with HDR 192Ir interstitial brachytherapy to a dose of 15 Gy in 3 fractions at 6 hours apart (Arm B).
The excellent cosmesis achieved with electron beam therapy in Arm A was found to be statistically significant (P = 0.025). Local relapse was absent in both the arms. One distant metastasis occurred in Arm A within 10 months of initiation of treatment and one distant metastasis in Arm B came out within 3 months of starting of therapy.
The study has shown good cosmetic result with electron boost and 100% local control with both the technique. However if there is a more number of patients with longer period of follow up we could have got the actual picture to verify our results and assess long term survival data.
PMCID: PMC3932592  PMID: 24604954
Early stage breast cancers; electron; interstitial
9.  Rare childhood tumors in a Turkish pediatric oncology center 
It has been estimated that rare tumor rate is about 15% of all childhood cancer in United States. According to Turkish Pediatric Oncology Group (TPOG) datas, 8889 children were diagnosed between 2002 and 2008 in our country and 3.7% of them were diagnosed as rare tumors.
To investigate the frequency and clinical features of rare tumors in our pediatric oncology center.
Materials and Methods:
A total of 43 cases that have diagnosed as rare tumor in 574 cancer patients between the yaer 2002 and 2012 were reviewed retrospectively. All cases definitive diagnosis were established by histopathological and immunohistochemical studies.
Frequency of rare tumors was 7.4% in our center. Benign and border line rare tumors were 27 (62.7%) cases, malignant rare tumor were 16 (37.2%) cases. Median follow-up period was 48 months (between 1 and 110 months). Six of the malignant rare tumors were died with progressive disease (synovial sarcoma, mixed malignant mesenchymal tumor, undifferentiated sarcoma, plexus choroideus carcinoma, renal peripheral primitive neuroectodermal tumor, adrenocortical carcinoma). Malignant rare tumor mortality rate was found 37.5% in our clinic.
We have found that our rare tumor rate (7.4%) was higher than Turkish rare tumor rate (3.7%) according to TPOG's datas. However, it was still lower than rare tumor rates of western countries (15%), probably due to difficulties of diagnosis and referral problems.
PMCID: PMC3932593  PMID: 24604955
Benign rare tumors; border-line rare tumors; malignant rare tumors
10.  Comparison of granisetron plus dexamethasone versus an antiemetic cocktail containing midazolam and diphenhydramine for chemotherapy induced nausea and vomiting in children 
Chemotherapy induced nausea and vomiting (CINV) is one of the most disturbing side-effects in children receiving highly emetogenic chemotherapy. We aimed to assess whether the addition of an antiemetic cocktail containing midazolam and diphenhydramine to granisetron plus dexamethasone combination could ameliorate CINV in this study.
Patients and Methods:
A total of 23 children aged between 1 and 16 years to receive cisplatin containing chemotherapy in our clinic were included in this study from April 2007 to April 2008. 76 cycles in 23 patients were randomly assigned to receive either antiemetic regimen 1 or antiemetic regimen 2. Antiemetic regimen 1 containing granisetron 0, 04 mg/kg plus dexamethasone 0, 2 mg/kg were given in 45 chemotherapy cycles. In 31 cycles, an antiemetic cocktail containing midazolam 0, 04 mg/kg, diphenhyramine 2, 5 mg/-kg in addition to granisetron plus dexamethasone was given. Number of vomiting, severity of nausea, the use of rescue therapy and adverse events were assessed between day 1 and day 5.
Complete response for the acute phase was observed 38/45 (84, 4%) cycles in regimen 1 as compared with 28/31 (90, 3%) in regimen 2, antiemetic cocktail regimen (P > 0.05). Complete response for delayed emesis after 24 h of the beginning of chemotherapy was observed in 29/45 (64, 4 %) in regimen 1 and 16/31 (51, 6%) in regimen 2. Antiemetic cocktail was not superior to the granisetron plus dexamethasone combination in controlling emesis in acute and delayed phase. Furthermore, patients receiving antiemetic regimen 2 were noted significantly more side effects.
Our data showed that antiemetic cocktail containing midazolam and diphenhydramine was not better in controlling acute and delayed emesis. A slightly more toxicity with additional drugs was also observed.
PMCID: PMC3932594  PMID: 24604956
Antiemetics; cancer; chemotherapy; children; nausea; vomiting
11.  Retrospective analysis of the clinical and demographic variables on the outcomes after second-line treatment in advanced non-small cell lung cancer 
Platinum based doublets chemotherapy are the standard of care for metastatic or advanced non-small cell lung carcinoma. This leads to modest survival advantage and improve quality-of-life. However, patients with advanced or metastatic disease eventually present disease progression and needs second-line systemic therapy in a selected group of patients or other supportive measures. There is very little knowledge available from the literature about the prognostic variables in patients, who receive second-line therapy.
Materials and Methods:
We retrospectively reviewed 329 patients received second-line treatment from July 2007 to September 2011 in the Department of Radiation Oncology, Burdwan Medical College and Hospital. For statistical analysis, 12 potential prognostic variables included. Univariate and multivariate regression analysis carried out to identify the prognostic variables associated with survival.
The results of univariate analysis for overall survival (OS) and survival after second-line therapy identified to have prognostic significance: Age, sex, performance status, smoking history, serum lactate dehydrogenase, histopathology, first-line chemotherapy and its response and second-line therapy except the stage at diagnosis and site of failure after first-line therapy. The multivariate Cox regression analysis has shown that only performance and second-line therapy were independent prognostic variables for survival after second-line treatment and above these prognostic factors; age, smoking status and progression free survival also for OS.
The performance status has shown consistent result as a prognostic factor in univariate and multivariate analysis for OS and survival after second-line therapy. These findings may also facilitate pretreatment prediction of survival and be used for selecting patients for the correct choice of cytotoxic therapy.
PMCID: PMC3932595  PMID: 24604957
Non-small cell lung carcinoma; overall survival; prognostic variables; second-line chemotherapy
12.  Surveillance and expected outcome of acute lymphoblastic leukemia in children and adolescents: An experience from Eastern India 
Research in Eastern India especially among children and adolescents for acute lymphoblastic leukemia (ALL) have not been well documented until recently when it was conducted at a cancer institute of tertiary care with primary objectives of examining and correlating different cell surface markers involved with respect to disease surveillance thereby highlighting it as a strong prognostic marker for future diagnosis and treatment.
Materials and Methods:
A total of 500 consecutively selected ALL patients were diagnosed and treated according to National Cancer Institute protocol (MCP 841) for a period of 24-88 months during this hospital-based study.
Of the total, 50.4% had a higher incidence of T-ALL and 47.6% had pro-B, B-cell precursor ALL. Disease free survival and event free survival were remarkably higher in B-ALL adolescent patients as compared to T-ALL, who had significantly lower overall survival ratio. Prevalence of T-ALL was also observed in relapse cases for adolescent patients.
We conclude that there is an increased prevalence of T-ALL among adolescents in Eastern India. Immunophenotypic analysis might help in proper evaluation and prediction of treatment outcomes with an increased thrust on studying age-specific incident rates enabling well planned future treatments for improved and better outcome.
PMCID: PMC3932596  PMID: 24604958
Acute lymphoblastic leukemia; B-acute lymphoblastic leukemia; immunophenotype; prognostic marker; T-acute lymphoblastic leukemia
13.  Cyclin D1 expression in multiple myeloma by immunohistochemistry: Case series of 14 patients and literature review 
Cyclin D1 dysregulation is an early and unifying oncogenic event in patients of multiple myeloma (MM). This may be detected up to 30% cases by immunohistochemistry (IHC) and up to 40-50% cases by molecular studies. However, studies on the clinical significance of cyclin D1 dysregulation in MM have been inconclusive. We aimed to study the pattern of cyclin D1 expression in MM by IHC and correlate with selected clinicopathologic features.
Materials and Methods:
Formalin fixed, decalcified, bone marrow trephine sections from 14 symptomatic patients of MM (13 newly diagnosed and one relapsed) were subjected to cyclin D1 IHC by using a rabbit monoclonal antibody to cyclin D1 (clone EPR2241).
Cyclin D1 expression (in ≥10% tumor cell nuclei) was observed in 8 of 14 cases (57%). Cyclin D1 positive (+) group had significantly lower hemoglobin level (P = 0.03) than cyclin D1 negative (−) group (n = 6); though both groups showed no statistical significance (P > 0.05) in regard to age, gender, Durie and Salmon stage, lytic bone lesions, light chain phenotype, creatinine, calcium, lactate dehydrogenase, leukocyte and platelet count and bone marrow histology. Ten of 14 (71.5%) showed a favorable response (follow-up; 7 days to 34 months) to thalidomide and/or bortezomib based chemotherapeutic regimen. Four of eight cyclin D1− patients showed complete response, two had a partial response (PR) and two died of the disease; whereas 4/6 cyclin D1 − patients had PR, one refused definitive therapy and one was lost to follow-up (P > 0.05, Fischer's exact test).
IHC may be a feasible tool for the demonstration of cyclin D1 expression on adequately processed trephine biopsy specimen in MM patients in a resource poor setting. Negative IHC results should be correlated with molecular techniques for prognostication.
PMCID: PMC3932597  PMID: 24604959
Bone marrow; cyclin D1; immunohistochemistry; multiple myeloma; prognosis
14.  Histopathological pattern of lymphomas and clinical presentation and outcomes of diffuse large B cell lymphoma: A multicenter registry based study from India 
The distribution of various subtypes of lymphomas in India is different from other parts of the world. There is scarce multicentric data on the pattern and outcomes of lymphomas in India.
The aim of this study is to evaluate the histopathological and the clinical pattern and treatment outcomes of lymphomas in India based on the retrospective data collected from a multicenter registry.
Materials and Methods:
Retrospective data was collected at 13 public and private hospitals in India for patients diagnosed with lymphoma between January 2005 and December 2009. The data collection was performed in the setting of a multicenter lymphoma registry Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test.
Non-Hodgkin's lymphoma (NHL) constituted 83.17% and Hodgkin's lymphoma (HL) for 16.83% of the 1733 registered and analyzed cases. Diffuse large B cell lymphoma (DLBCL) was the most common NHL (55%) followed by follicular lymphoma (11%). CHOP was the most common chemotherapy regimen administered (84%) while rituximab was used in 42.7% of those with DLBCL. Survival analysis of treatment naïve DLBCL patients (n = 791) was performed. Of these, 29% were lost to follow-up, 20% with active disease. The median follow-up in surviving patients is 31 (range: 1-88) months. Median progression-free survival (PFS) and overall survival (OS) in DLBCL patients has not reached. There was no significant difference in median PFS (69 months vs. 61 months, P = 0.1341), but OS was significant not reached (NR) vs. NR, P = 0.0012) within international prognostic index high or intermediate subgroups. Rituximab use was associated with significantly prolonged PFS (NR vs. 82 months, P = 0.0123), but not OS (NR vs. NR, P = 0.2214). Cox regression analysis in treatment naïve DLBCL patients showed a performatnce status, stage and receipt of six or more cycles of chemotherapy to be significantly associated with OS and all of the preceding plus rituximab use significantly associated with PFS.
Our analysis confirms previous reports of distribution of lymphoma subtypes in India and suggests that patients who are able to receive the full course of chemotherapy achieve a better outcome. This indicates the importance of ensuring compliance to treatment utilizing various measures including patient and family counseling. Prospective studies are required to confirm these findings.
PMCID: PMC3932599  PMID: 24604961
Diffuse large B cell lymphoma; India; lymphoma pattern; survival
15.  Fanconi anemia presenting as an “evolving” acute leukemia-diagnostic challenges 
Fanconi anemia (FA) is a genetically and phenotypically heterogeneous recessive disorder characterized by diverse congenital malformations, progressive pancytopenia and predisposition to both hematologic malignancies and solid tumors. We report, a 14-year-old boy who presented with clinical features of aplastic anemia (AA). Subsequent bone marrow examination and multiparametric flowcytometric immunophenotyping revealed an evolving hypoplastic acute myeloid leukemia. Chromosomal breakage studies using clastogenic agent mitomycin C showed 88% stress induced chromosomal/chromatid breaks, gaps and rearrangements revealing an underlying FA. The case emphasizes upon the role of a systematic clinico-investigative approach in diagnosing such patients who by clinical criteria appear to have idiopathic AA and appear phenotypically normal. A timely and accurate diagnosis becomes vital in these cases to implement appropriate therapy.
PMCID: PMC3932600  PMID: 24604962
Acute myeloid leukemia; chromosomal breaks fanconi; cytogenetics; flowcytometric immunophenotyping; hypocellular; mitomycin C
16.  Primary mediastinal seminoma; resistance and relapse: An aggressive entity 
Seminoma is one of the most radio and chemo sensitive tumors. Aggressive variant of primary mediastinal seminoma (PMS) are rarely described in the literature. We here discuss an interesting case of young male (22 years) presenting with superior vena cava syndrome due to PMS that showed poor response to conventional platinum based chemotherapy and radiotherapy. Furthermore, with a short disease free interval (one year) relapsed at unusual sites of bone and soft-tissue deposits in check. This emphasizes the importance of identifying methods to pre-screen such aggressive variants for more effective treatment options.
PMCID: PMC3932601  PMID: 24604963
Bone metastasis; chemoresistance; extra-gonadal germ cell tumor; mediastinal seminoma; radio-resistance; soft-tissue metastasis
17.  Successful outcome of mucormycosis in two children on induction therapy for acute lymphoblastic leukemia 
Zygomycetes are one of the less common causes of invasive fungal infections in patients with the hematological malignancies. We report two cases of acute lymphoblastic leukemia in the pediatric age group, complicated by disseminated cutaneous mucormycosis during induction chemotherapy. In one of our cases, cutaneous mucormycosis progressed to osteomyelitis of the proximal ulna while in the other it disseminated to lungs and distant cutaneous site. Aggressive treatment, which included intravenous administration of amphotericin B; radical surgical intervention in the form of serial wound debridement in the former and wedge pulmonary resection in the later, allowed successful salvage, and administration of planned anti-leukemia treatment in both of our cases. High index of suspicion, timely diagnosis, and appropriate treatment are key components of a successful outcome.
PMCID: PMC3932602  PMID: 24604964
Children; cutaneous; leukemia; mucormycosis
18.  Follicular dendritic cell sarcoma with paraneoplatic pemphigus: Rare case and a brief review of literature 
Paraneoplastic pemphigus (PNP) is often a fatal autoimmune bullous disease characterized by severe stomatitis, polymorphous skin eruptions, and underlying neoplasms. We describe a patient with PNP associated with follicular dendritic cell sarcoma (FDCS), a rare neoplasm originating from follicular dendritic cells, which are non-lymphoid, non-phagocytic accessory cells of the lymphoid system and play an integral role in regulation of the germinal center reaction and present antigens to B-cells. The presence of rich vascularity around the tumor and few hyalanized vascular follicles found in histopathological examination gives the clue that the tumor might have developed from Castleman's disease (CD). As for the mechanisms by which CD induces PNP, it has been proposed that autoantibodies secreted from the Castleman's tumor play pivotal role. This hypothesis seems to be supported by the present case, in which CD may have triggered both the FDCS and the PNP.
PMCID: PMC3932603  PMID: 24604965
Castleman's disease; follicular dendritic cell sarcoma; paraneoplatic pemphigus
19.  Inflammatory myofibroblastic tumor of kidney with heterotopic bone formation: An unusual case mimicking a renal malignancy 
Inflammatory myofibroblastic tumor (IMFT) or pseudotumor is a rare tumor that can be seen in various organs. It is an enigmatic tumor of unknown etiology and difficult to differentiate from malignancy, clinically as well as radiologically. Histologically, it is composed of variable proportions of proliferating spindle myofibroblasts, fibroblasts, extracellular collagen, lymphocytes and plasma cells. This mainly affects the urinary bladder or prostate. Renal involvement is extremely rare and may pose diagnostic difficulty to the clinician. We describe a renal IMFT, mimicking renal malignancy, having unusual histological features.
PMCID: PMC3932604  PMID: 24604966
Inflammatory; myofibroblastic; renal
20.  Human immunodeficiency virus Infection in a patient of chronic myelogenous leukemia 
Association of Cancer and HIV infection is seen in practice. Commonly observed cancer in HIV infected patients are Non-Hodgkin's Lymphoma, cervical cancer and Kaposi Sarcoma, Coexistent Chronic Myelogenous Leukemia (CML) and HIV infection are rare. We report a case where these two diseases were found in a patient and were treated with a single agent Hydroxyurea.
PMCID: PMC3932605  PMID: 24604967
CML; HIV; Hydroxyurea
21.  Acute promyelocytic leukemia relapsing into acute myeloid leukemia-M2 with normal cytogenetics 
The use of all trans-retinoic acid (ATRA) and combination chemotherapy has made acute promyelocytic leukemia (APL) a potentially curable leukemia. Late sequelae of the treatment of APL have therefore become an important consideration in the overall treatment strategy. We report a patient with APL who achieved complete clinical and molecular remission after treatment with daunorubicin and ATRA. Three years later, she developed acute myeloid leukemia (AML), M2 subtype without any evidence of relapse of the APL clone. Karyotypic analysis showed a normal female karyotype.
PMCID: PMC3932606  PMID: 24604968
Acute promyelocytic leukemia; acute myeloid leukemia (AML); secondary AML; therapy related AML
22.  Cisplatin induced paroxysmal supraventricular tachycardia 
Cisplatin or cis-diamminedichloroplatinum (CDDP) is the first member of a class of platinum-containing anti-cancer drugs that act by binding to and causing cross-linking of deoxyribonucleic acid, which ultimately triggers apoptosis. Cisplatin has a broad-spectrum antineoplastic activity against various types of human tumors. Unfortunately, the optimal usefulness of Cisplatin is limited secondary to its dose related toxicity especially nephrotoxicity. Cisplatin chemotherapy is also associated with cardiotoxic effects that may range from silent arrhythmias to heart failure and even sudden cardiac death. These effects are more pronounced when cisplatin is combined with other cardiotoxic drugs. Here, we report a case of patient of cancer lung who developed paroxysmal supraventricular tachycardia following administration of Cisplatin. A brief review of the literature follows.
PMCID: PMC3932607  PMID: 24604969
Cisplatin; lung cancer; paroxysmal supraventricular tachycardia
23.  Hand foot syndrome associated with standard dose cytarabine 
Hand-foot syndrome, is a side effect of cytotoxic chemotherapy, causes erythema, dysthesias, swelling of palms and soles and sometimes blisters. Rarely, it may ulcerate. The most commonly used drug that frequently causes this reaction is 5-fluorouracil or its prodrug oral capecitabine. High dose cytarabine is known to cause HFS. Here we report a case of HFS caused by standard dose cytarabine.
PMCID: PMC3932608  PMID: 24604970
Cytarabine; hand-foot syndrome; palmar-plantar erythrodysesthesia
24.  Flagellate erythema induced by bleomycin toxicity 
Bleomycin is a chemotherapeutic antibiotic used in various malignancies. Its toxicity is mainly lung and skin with marrow sparing effect. Here we would like to describe a characteristic skin reaction developed because of bleomycin in a case of intracranial germ cell tumor. Flagellate erythema which is a self-limiting toxic reaction can cause residual hyperpigmentation.
PMCID: PMC3932609  PMID: 24604971
Bleomycin; flagellate erythema; hyperpigmentation; skin toxicity

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