Mridula Shukla

Banaras Hindu University, Benares, Uttar Pradesh, India

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Publications (30)19.47 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Melanomas occurring in the tongue are rarer, and when nonpigmented they are often misdiagnosed as squamous cell carcinoma. We report a 50-year-old woman who presented with a 3 × 2 cm soft swelling of mucosal color on the right lateral border of the tongue. The patient had multiple recurrences and was treated by radical radiotherapy, was operated thrice and received adjuvant 5 MIU interferon weekly. During the last surgery, she developed multiple cerebral infarcts and died on the fifth postoperative day. Oral amelanotic melanoma is a very aggressive and potential lethal tumor that often presents as diagnostic dilemma.
    Indian Journal of Surgery 06/2013; 75(1). · 0.09 Impact Factor
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    ABSTRACT: Polymorphous low-grade adenocarcinoma (PLGA) is a minor salivary gland tumor with a low malignant potential. It is twice more common in females, with a mean age of presentation at 59 years. It is a very slow-growing tumor with mean duration of symptoms that range from 27 months to as long as 40 years. We report a case of a male patient who was found to have PLGA with symptoms since birth. The patient was treated with wide local excision with good results. The lip is a rare location for PLGA, and its occurrence in adolescent age groups is even rarer.
    Indian Journal of Surgery 04/2013; 75(2). · 0.09 Impact Factor
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    ABSTRACT: Background: Cancer of the gallbladder is a relatively rare neoplasm with a poor prognosis. The exact mechanisms of its genesis are not known and very little information is available on molecular events leading to labeling this as an orphan cancer. Materials and Methods: In this prospective case control study we evaluated the expression of p16, pRb and cyclin D1 by immunohistochemistry to study the G1-S cell-cycle check point and its possible role in gallbladder carcinogenesis. A total of 25 patients with gallbladder carcinoma (group I), 25 with cholelithiasis (group II) and 10 normal controls. were enrolled Results: Cyclin D1 expression was seen in 10 (40%) patients each with carcinoma and cholelithiasis while only in 2 (20%) of the normal gallbladders but differences were not statistically significant (p value=0.488). p16 was expressed in 12% patients of carcinoma of the gallbladder and 28% of cholelithiasis, however this difference was not statistically significant (p value=0.095). Retinoblastoma protein was found to be expressed in 50% of normal gallbladders and 6 (24%) of carcinoma and 8 (32%) of gallstones. The present study failed to demonstrate any conclusive role of cyclin D1/RB/ p16 pathway in carcinoma of the gallbladder. Conclusions: The positive relation observed between tumor metastasis and cyclinD1 expression and p16 with nodal metastasis suggested that higher cyclin D1/p16 expression may act as a predictive biomarker for aggressive behavior of gallbladder malignancies.
    Asian Pacific journal of cancer prevention: APJCP 01/2013; 14(5):2711-2715. · 1.27 Impact Factor
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    ABSTRACT: Primay Gastric Tuberculosis Ruhi Dixit, Vineeta Srivastava, Mohan Kumar, Mridula Shukla and Manoj Pandey World Journal of Medical and Surgical Case Reports 2012, 1:3 Abstract Introduction Primary isolated gastric tuberculosis in absence of pulmonary tuberculosis in immune competent host is rare. Case Report We present here a case of 25 year old male who presented with persistent vomiting and was diagnosed as having tuberculosis on endoscopic biopsy examination. The patient was successfully treated with four drug anti tubercular treatment without any surgical intervention. Conclusion High degree of suspicion is needed as the tuberculosis may mimic numerous other benign and malignant diseases. http://www.npplweb.com/wjmscr/content/1/3
    World Journal of Medical and Surgical Case Reports. 10/2012; 2(1):6-10.
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    World Journal of Pathology. 09/2012; 1(1):55-63.
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    World Journal of Surgical Medical and Radiation Oncology. 06/2012; 1(1):53-59.
  • Mridula Shukla, Vinay Kumar, Manoj Pandey
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    ABSTRACT: Squamous cell carcinoma is the most common malignant neoplasm of the upper aerodigestive tract. The disease is characterized by frequent lymphatic spread; however, blood-borne distant metastasis is rare. Isolated cutaneous metastasis is even rarer. We present two cases of oropharyngeal carcinoma that presented with cutaneous metastasis in the absence of disease recurrence. Both patients were treated with wide excision of the metastatic nodule and were disease-free at the 1.5-year follow-up. This article highlights the importance of cutaneous metastasectomy.
    Ear, nose, & throat journal 06/2012; 91(6):E19-21. · 1.03 Impact Factor
  • World Journal of Psycho-Social Oncology. 02/2012; 1(1).
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    World Journal of Pathology 2277-3460. 01/2012; 1(1):1-5.
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    Kumar Gaurav, R K Goel, Mridula Shukla, Manoj Pandey
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    ABSTRACT: Treatment of cancer is associated with short- and long-term side-effects. Cancer produces a state of glutamine deficiency, which is further aggravated by toxic effects of chemotherapeutic agents leading to increased tolerance of tumor to chemotherapy as well as reduced tolerance of normal tissues to the side-effects of chemotherapy. This article reviews the possible role of glutamine supplementation in reducing the serious adverse events in patients treated with anticancer drugs. The literature related to the possible role of glutamine in humans with cancer and the supportive evidence from animal studies was reviewed. Searches were made and the literature was retrieved using PUBMED, MEDLINE, COCHRANE LIBRARY, CENAHL and EMBASE, with a greater emphasis on the recent advances and clinical trials. Glutamine supplementation was found to protect against radiation-induced mucositis, anthracycline-induced cardiotoxicity and paclitaxel-related myalgias/arthralgias. Glutamine may prevent neurotoxicity of paclitaxel, cisplatin, oxaplatin bortezomib and lenolidamide, and is beneficial in the reduction of the dose-limiting gastrointestinal toxic effects of irinotecan and 5-FU-induced mucositis and stomatitis. Dietary glutamine reduces the severity of the immunosuppressive effect induced by methotrexate and improves the immune status of rats recovering from chemotherapy. In patients with acute myeloid leukemia requiring parenteral nutrition, glycyl-glutamine supplementation could hasten neutrophil recovery after intensive myelosuppressive chemotherapy. Current data supports the usefulness of glutamine supplementation in reducing complications of chemotherapy; however, paucity of clinical trials weakens the clear interpretation of these findings.
    Indian journal of medical and paediatric oncology 01/2012; 33(1):13-20.
  • World Journal of Surgical Medical and Radiation Oncology. 01/2012; 1(1).
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    ABSTRACT: 2 Radiology, and 3 Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi India 4 Currently working as Lab Head, SRL Religere, Varanasi This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim: This study was carried out to evaluate the feasibility and role of sentinel lymph node biopsy by using blue dye in identifying occult metastasis in neck in N0 neck patients with carcinoma buccal mucosa. Material and Methods: A prospective study was carried out between 2006 to 2008, a total of 28 patients of carcinoma buccal mucosa with clinically negative neck were recruited. Sentinel lymph node biopsy was carried out by peritumoral injection of 1-2 ml of 2.5% isosulphan blue dye. Any blue lymph node visualized during neck dissection was dissected out and sent for histological examination and immunohistochemistry for cytokeratin was performed using PAP peroxidase and anti-peroxidase method. Results: Sentinel nodes were identified In 27 patients. A total of 37 sentinel nodes were harvested with average of 1.3 lymph nodes per neck, the harvest in our cases was lower than that reported in literature. Of the 37 harvested nodes, 14 were positive and 23 were negative for metastases. One of the 14 positive sentinel nodes (3.7%) patient showed micro metastases that were identified by cytokeratin immunostaining though this node was negative on histology. Out of 14 positive necks level Ib was positive in 6, Level IIa in 6 and Level Ia in 2 cases. Six patients had only sentinel nodes positive for metastases while others also had other positive nodes beside sentinel. Conclusion: Results of the present study show that sentinel node biopsy using the blue dye alone is feasible, it further demonstrates an orderly spread in cancers of the buccal mucosa, none of the patients with negative sentinel nodes had node positivity in other nodes, suggesting a definite role of sentinel node biopsy in N0 cancers of the buccal mucosa. World J Surg Med Radiat Oncol 2012; 1:1-8 Introduction Carcinoma of the buccal mucosa is the commonest tobacco associated cancer among males in India; the incidence is particularly high in North India. This is a locally aggressive malignancy with a low propensity to nodal or distant metastasis. Presence of lymph node
    World Journal Of surgical Medical Radiation Oncology. 12/2011; 1(1):1-8.
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    ABSTRACT: Splenic angiosarcoma is a rare neoplasm that often remains asymptomatic till the onset of massive intra abdominal bleeding that require emergency splenectomy. We report here a case of 60 year old male who presented with on and off fever and a splenomegaly was found on clinical examination suggesting a lymphoproliferative disorder. A contrast enhanced computerized tomography suggested splenic trauma with intracapsular bleed. A splenectomy was carried out that revealed splenic angiosarcoma. Splenomegaly and fever is a very rare presentation of angiosarcoma. Though rare it should be kept in mind when investigating pyrexia of unknown origin.
    Indian journal of medical and paediatric oncology 10/2011; 32(4):230-2.
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    ABSTRACT: Surgery is one of the established modes of initial definitive treatment for a majority of oral cancers. Invasion of bony or cartilaginous structures by advanced upper aero-digestive tract cancer has been considered an indication for primary surgery on the basis of historic experience of poor responsiveness to radiation therapy [1]. The mandible is a key structure both in the pathology of intra-oral tumours and their surgical management. It bars easy surgical access to the oral cavity, yet maintaining its integrity is vital for function and cosmesis. Management of tumours that involve or abut the mandible requires specific understanding of the pattern of spread and routes of tumour invasion into the mandible. This facilitates the employment of mandibular sparing approaches like marginal mandibulectomy and mandibulotomy, as opposed to segmental or hemimandibulectomy which causes severe functional problems, as the mandibular continuity is lost. Accurate preoperative assessment that combines clinical examination and imaging along with the understanding of the pattern of spread and routes of invasion is essential in deciding the appropriate level and extent of mandibular resection in oral squamous cell carcinoma. Studies have shown that local control rates achieved with marginal mandibulectomy are comparable with that of segmental mandibulectomy. In carefully selected patients, marginal mandibulectomy is an oncologically safe procedure to achieve good local control and provides a better quality of life. This article aims to review the mechanism of spread, evaluation and prognosis of mandibular invasion, various techniques and role of mandibular conservation in oral squamous cell carcinoma.
    Surgical Oncology 08/2011; 21(2):109-18. · 2.14 Impact Factor
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    Kumkum Jha, Mridula Shukla, Manoj Pandey
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    ABSTRACT: Survivin a multifunctional protein that controls cell division, inhibition of apoptosis and promotion of angiogenesis. It is expressed in most human neoplasm, but is absent in normal and differentiated tissues. The purpose of this article is to overview the expression of survivin, effect of its expression in response to treatment, correlation with other markers and newer advancement in targeting survivin. A detailed search of Medline was carried out using the following search strategy: "((survivin) OR ((apoptosis) AND (inhibitor OR inhibitors))) AND ((breast) AND (neoplasm OR neoplasms OR tumor OR tumor OR cancer OR carcinoma))". Abstract of all articles thus identified were reviewed to identify the relevant studies, full articles of studies thus identified were then obtained and reviewed. All relevant data was extracted and tabulated. Survivin expression by Immunohistochemistry was identified in 65.3% (55.2-90.0%) of the breast cancer patients among the identified studies while survivin mRNA by RT-PCR was identified in 93.6% (90-97%). Survivin expression has been reported to be associated with over expression of HER 2, vascular endothelial growth factor (VEGF), urokinase plasminogen activator (uPA)/PAI-1. Survivin is over expressed in majority of breast cancers. The over expression of survivin is found to correlate with HER 2 and EGFR expression. Survivin expression has been found to confer resistance to chemotherapy and radiation. Targeting survivin in experimental models improves survival. More studies are needed on the role of survivin in multi drug resistance (MDR) in the presence of Pgp/uPA/PAI-1 and the impact of survivin over expression in triple negative breast cancer.
    Surgical Oncology 02/2011; 21(2):125-31. · 2.14 Impact Factor
  • Manoj Pandey, Mridula Shukla, C S Nithya
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    ABSTRACT: With emerging evidence, focus is shifting to conservative neck procedures aimed at achieving good shoulder function without compromising oncologic safety. Retrospective analysis of 100 consecutive neck dissections for carcinoma of the buccal mucosa was carried out to evaluate the pattern of lymphatic spread. Pathologic results were correlated with clinical/radiologic findings. Survival was calculated with the Kaplan-Meier method and log-rank test. Only 36 patients were found to harbor metastasis in the lymph nodes on pathologic examination. Most of these were present in levels I and II only. Skip metastasis was not detected in any patient. None of the patients was found to have involvement of level V nodes, whereas 1 patient had involvement of level IV. Thirty-four patients developed recurrences; 3-year disease-free survival was 48%. Lymphatic spread from carcinoma of the buccal mucosa is low. Involvement of level IV is seen in only 1% of patients. A more conservative approach to the neck in patients with carcinoma of the buccal mucosa is recommended.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 02/2011; 69(2):340-5. · 1.58 Impact Factor
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    ABSTRACT: Oral cancer is the most common cancer diagnosed in Indian men and is the leading cause of cancer deaths. Helicobacter pylori have been reported to be present in 0-40% of the cases with head neck cancer. A higher percentage has been identified in laryngeal and pharangeal cancer. We here carried out a hospital-based, case- control study of 20 patients with newly diagnosed oral cancer and 20 healthy controls without any cancer to evaluate associations between H pylori infection and oral cancer using culture and 16sRNA PCR technique for bacterial identification. H pylori was isolated from the culture of three cases and one control, while three cases and two control showed PCR positivity for H Pylori 16sRNA. The odds ratio by culture was 3.0, 95% CI 0.34- 26.4 and 1.5, 95% CI 0.28-8.03 by PCR. None of the observed odds ratio was statistically significant. However, the results of this pilot study suggest a possible association of H. pylori with an increased risk of oral cancer. Additional studies in larger populations are necessary to confirm and to quantify this possible association more accurately.
    Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(5):1333-6. · 1.27 Impact Factor
  • Manoj Pandey, Mridula Shukla
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    ABSTRACT: ‘Agni karma’, also known as ‘dahan karma’, is a process used in Ayurveda for various benign diseases that are characterised by pain or bleeding. In this process, the heated rods of gold, silver, iron, copper and pancha dhatu (five metals) are applied directly on the skin at the affected site. The temperature varies according to the process used and is lowest for gold and highest for silver. The ‘agni karma’ is not recommended for arbuda (tumour/malignancy). Here the authors present two cases of soft tissue sarcoma of lower extremity where ‘agni karma’ was tried in vain by traditional healers at their local village. Both the patients presented with progressive disease that was treated with wide excision and limb conservation, and the whole of the overlying skin scarred by previous healed burns of various degrees had to be sacrificed making a simple surgery difficult.
    Case Reports. 01/2010; 2010.
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    ABSTRACT: Gallbladder cancer is an uncommon neoplasm of uncertain etiology and poor survival. Recently, interest has been generated in bacterial infections and cancers. Helicobacter is one such bacterium found to be associated with gastric MALToma, gastric adenocarcinoma and hepatobiliary neoplasms. Fifty four gallbladder cancer and 55 controls with cholelithiasis were studied. Helicobacter bilis was identified using 16S rRNA PCR. Relative risk and odds ratio with 95% CI were estimated. A detailed search of literature was carried out and selected relevant articles were extracted. A meta analysis was carried out using a random effect model. Helicobacter bilis was identified in 32/54 patients and 32/55 controls, The relative risk of gallbladder cancer in H. bilis positive cases was 1.05 (95% CI 0.49 to 2.24). Of the 10 identified case control studies on Helicobacter in the hepatobiliary tract 3 each were on gallbladder cancer and H. bilis. In meta analysis a pooled odds ratio of 4.13 (95% CI 2.68-6.36) favoring Helicobacter was observed. Pooled analysis of published studies on gallbladder cancer showed an odds ratio of 1.24 (95% CI 0.63-2.44). The present study failed to demonstrate any increase in risk of gallbladder cancer in presence of Helicobacter bilis. It may be hypothesized that increased risk observed in earlier studies may be indirectly due to increase in the risk of gallstones, although lack of any study specifically looking at this aspect and absence of normal controls in the present study makes this assumption superfluous.
    Asian Pacific journal of cancer prevention: APJCP 01/2010; 11(2):343-7. · 1.27 Impact Factor
  • Otolaryngology Head and Neck Surgery 11/2009; 141(5):657-8. · 1.73 Impact Factor