P A Kurkure

Tata Memorial Centre, Mumbai, Mahārāshtra, India

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Publications (122)181.6 Total impact

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    ABSTRACT: Congenital rhabdomyosarcomas (RMSs) are rare tumors with variable clinical presentations. A 2 month-old, term male neonate (37 weeks, 4 days), weighing 3.2 kg, born to a 24 year-old primigravida, by simple vaginal delivery presented with multiple erythematous papulonodular lesions over his trunk that progressed to his whole body, on the first day of delivery. Prior to conception, his mother was treated for polycystic ovarian disease. On the tenth day, his chest computed tomogram scans revealed multiple, heterogeneously enhancing, bilateral pleural-based soft tissue density nodular lesions, along with multiple soft tissue density lesions, involving skeletal muscles of all his body parts. Microsections from two biopsies (on 10th day and after 2 months) revealed a malignant round cell tumor with cells arranged in a diffuse, solid pattern, comprising embryonal and solid alveolar components. Immunohistochemically, the tumor cells were diffusely positive for desmin, myoD1 and myogenin. Diagnosis of embryonal and alveolar (mixed type) RMS was offered. Further molecular cytogenetic analysis was negative for PAX3-FKHR and PAX7-FKHR. The patient was induced on chemotherapy as per intergroup rhabdomyosarcoma study IV protocol. There was treatment response with near total remission after 8 weeks of treatment. Thereafter, new lesions started appearing that also disappeared after modification of the chemotherapy drugs. However, after 16 months, the baby died of brain metastasis. The present case forms the fourth case report of an aggressive form of a congenital RMS with extensive cutaneous involvement and brain metastasis. A review of previously diagnosed cases of congenital RMSs is discussed herewith.
    Pathology - Research and Practice 01/2014; · 1.21 Impact Factor
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    ABSTRACT: Primary cervical (CN) and cervicothoracic neuroblastoma (CTN) is generally associated with good outcome; however, surgical resection can be challenging and not without morbidity. The aim of this study is to assess the overall outcome and compare the clinico-radiological features, treatment, and complications of CN and CTN. Sixteen consecutive patients, (CN = 9, CTN = 7) treated between November 2006 and December 2012 were selected from the prospective database for this analysis. The 2-year overall and event-free survival of entire cohort is 100 and 72 %, respectively. Respiratory symptoms due to compression of airway and intraspinal extension were common in CTN. Gross total resection was feasible in all patients with CN; in contrast, incomplete excision along with significantly longer duration of surgery and more blood loss occurred in CTN. Postoperative morbidity was seen in three patients with CN and only one patient with CTN. The extent of surgery did not affect the overall and event-free survival of CTN (p = NS). CN and CTN have characteristic clinico-radiological presentation and surgical specification. However, both have a favorable outcome, even though with a distinct but acceptable morbidity. The favorable outcome in CTN is unrelated to the extent of surgical excision.
    Pediatric Surgery International 11/2013; · 1.22 Impact Factor
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    ABSTRACT: Background Medulloblastoma has recently been found to consist of 4 molecularly and clinically distinct subgroups: WNT, Sonce hedgehog (SHH), Group 3, and Group 4. Deregulated microRNA expression is known to contribute to pathogenesis and has been shown to have diagnostic and prognostic potential in the classification of various cancers.Methods Molecular subgrouping and microRNA expression analysis of 44 frozen and 59 formalin-fixed paraffin embedded medulloblastomas from an Indian cohort were carried out by real-time RT-PCR assay.ResultsThe differential expression of 9 microRNAs in the 4 molecular subgroups was validated in a set of 101 medulloblastomas. The tumors in the WNT subgroup showed significant (P < .0001) overexpression of miR-193a-3p, miR-224, miR-148a, miR-23b, and miR-365. Reliable classification of medulloblastomas into the 4 molecular subgroups was obtained using a set of 12 protein-coding genes and 9 microRNAs as markers in a real-time RT-PCR assay with an accuracy of 97% as judged by the Prediction Analysis of Microarrays. Age at diagnosis, histology, gender-related incidence, and the relative survival rates of the 4 molecular subgroups in the present Indian cohort were found to be similar to those reported for medulloblastomas from the American and European subcontinent. Non-WNT, non-SHH medulloblastomas underexpressing miR-592 or overexpressing miR-182 were found to have significantly inferior survival rates, indicating utility of these miRNAs as markers for risk stratification.Conclusions The microRNA based real-time PCR assay is rapid, simple, inexpensive, and useful for molecular classification and risk stratification of medulloblastomas, in particular formalin-fixed paraffin embedded tissues, wherein the expression profile of protein-coding genes is often less reliable due to RNA fragmentation.
    Neuro-Oncology 11/2013; · 6.18 Impact Factor
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    ABSTRACT: The aim of the study was to determine the impact of negative but close resection margins on local recurrence in children with extraskeletal Ewing sarcoma (EES). We reviewed records of 32 patients with EES treated between March 2005 and March 2013. All patients except one underwent surgical excision either upfront or after induction chemotherapy. Patients with viable tumor and negative surgical margins, which were categorized as less than or greater than 1 cm, were selected. Local control and survival analysis were performed for patients in both the groups. The 5-year event-free and overall survival rates of entire cohort is 68 and 77 %, respectively. Surgical margins were negative in 23/26 (90.3 %) patients. There were no local recurrences in any of the patients with margins of less than 1 cm. Only one patient with a margin greater than 1 cm had a local recurrence along with distant metastases. A tumor-free margin of more than 1 cm did not affect overall or event-free survival (p = NS). Optimal local control is feasible in children with EES regardless of the quantitative extent of negative margins. Achieving a three-dimensional tumor-free margin should be the goal of surgical resection.
    Pediatric Surgery International 08/2013; · 1.22 Impact Factor
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    ABSTRACT: The rarity of Ewing sarcoma of rib has resulted in paucity of data, particularly on the prognostic factors and pattern of relapses. We analyzed the recurrences in patients with primary nonmetastatic Ewing sarcoma of the rib and examined prognostic factors of poor outcome. From January 2004 to January 2011, 37 patients were treated. After induction chemotherapy, complete (from costal cartilage to vertebra) or partial excision of involved rib with or without adjacent ribs was performed. Postoperative radiotherapy was administered for positive margins, poor response to chemotherapy, and large primary tumors with significant soft tissue component at presentation. Disease relapsed in 16 patients: at the local site (n = 5), both local and distant (n = 2), and distant site only (n = 9). The projected 5-year cause-specific, relapse-free survival and local control were 50%, 44%, and 72%. Poor response to chemotherapy (>5% residual tumor) and resection of adjacent lung parenchyma (a surrogate for tumor extension) were adverse prognostic factors for relapse-free survival in multivariate analysis. Relapses occurred more often at distant sites and had a poor outcome. In this study, poor histologic response to chemotherapy (P = .04) and the infiltration of adjacent lung parenchyma (P = .01) are adverse prognostic factors.
    Journal of Pediatric Surgery 04/2013; 48(4):764-70. · 1.38 Impact Factor
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    ABSTRACT: AIMS: To identify and validate clinico-pathologic factors including molecular sub-grouping that correlate with outcome in Indian patients with medulloblastoma. METHODS: Patients with medulloblastoma accrued and treated post-operatively on prospective clinical trials with available tumor tissues (either fresh-frozen or paraffin blocks) were identified from a prospective neuro-oncology database. Molecular sub-classification was done by mRNA expression levels of select protein-coding marker genes by real-time reverse transcriptase polymerase chain reaction. Univariate and multivariate analysis was done to identify factors associated with poor outcomes. RESULTS: Electronic search identified 40 patients with complete clinical details and analyzable tissues. The median age of the study cohort was 10 years (inter-quartile range 8-14 years) with a predominant male distribution (n = 29). Post-operative adjuvant therapy was based on conventional clinico-pathologic risk-stratification. Twenty six (65%) patients were classified as high-risk, including 10 (25%) with metastatic disease at presentation. Molecular analysis identified four distinct sub-groups viz. WNT (n = 10), SHH (n = 6), C (n = 11), and D (n = 13) as per consensus classification. There was substantially high incidence (55%) of metastases at presentation in molecular sub-group C. With a median follow-up of 26 months (inter-quartile range 9-40 months), the 5-year (+standard error) event-free survival and overall survival for the entire cohort was 53.2% (+9.7%) and 62.1% (+9.3%) respectively. On univariate analysis, risk-strata (average-risk vs high-risk metastatic, p = 0.017); histology (classical vs anaplastic, p = 0.016); and molecular sub-groups (WNT vs C, p = 0.003, and WNT vs SHH, p = 0.005) were significant prognostic factors. Cox regression analysis identified molecular sub-group C as the worst prognostic factor independently associated with significantly poor survival (p = 0.015). CONCLUSION: Molecular sub-group C, high-risk metastatic disease, and anaplastic histology are associated with significantly poorer outcomes in Indian patients with medulloblastoma consistent with published data from the western world.
    Neuro-Oncology 06/2012; 14(suppl 1-10.1093/neuonc/nos093):i82-105. · 6.18 Impact Factor
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    ABSTRACT: AIM: To discuss the detailed demographic profiles of various molecular subtypes in Indian meduloblastoma patients. METHODS: The molecular sub-typing for 78 consecutive patients of medulloblastoma presenting at a single institute neuro-oncology clinic (2003-11) was done by mRNA expression levels of select set marker genes using real time RT-PCR. The demographic details of these patients including age, sex and histological type were obtained from electronically maintained prospective database and analysed using descriptive statistics. RESULTS: The mean age at presentation was 10.8yrs (median-8.5; range1-45) with 12% infants(0-3yrs), 71% children (4-15yrs) and 17% adults(>15yrs). Males were predominant with only 24 females (30.8%). The most common histology was classical 66(84.6%) followed by 6 desmoplastic & 6 anaplastic types. On molecular subtyping there were 18(23%) WNT, 20(25.6%) SHH, 13(16.7%) C and 27(34.6%) D. The mean (median; range) age in various molecular subtypes were 15 yrs(10;7-45) WNT, 13yrs(8;1-36)SHH, 5.6yrs(5;2-11) C and 8.6yrs(8.5;3-21) D. In infants 44% were SHH and C type each, with 12% D. In children 43% were D, 23% WNT, 18% C and 16% SHH. In adults 54% were SHH, 38.5% WNT and 7.5% D. There were no infants in WNT and none > 11 yrs in C. There was a bimodal age distribution of 1-10 yrs(50%) and 20-36 yrs(50%) in SHH. Out of 24 females in total 38% were SHH, 33% WNT, 21% C and 8% D. The male were more common in all subgroups. All patients were of classical histology in WNT; 25% were desmoplastic & 10% anaplastic in SHH; 31% anaplastic in C and only one patient desmoplastic in D; rest all being classical. CONCLUSION: The demographic profiles of Indian medulloblastoma is similar to described in western literature; except that various age of presentation in all subgroups is older by 2-3 years and males are much more common than females.
    Neuro Oncol. 06/2012; 14(suppl 1-doi: 10.1093/neuonc/nos100):i43-8.
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    ABSTRACT: Acute lymphoblastic leukemia (ALL) is the commonest childhood malignancy with high cure rates due to recent advances in central nervous system (CNS) prophylaxis. The disease per se, as well as the prophylactic therapy, predisposes the child to complications such as cerebrovascular events, infections, drug toxicities, etc. The purpose of this study is to highlight the pathophysiology and the imaging features (with appropriate examples) of these complications and to propose a diagnostic algorithm based on MRI. Interpreting these scans in the light of clinical inputs very often helps the radiologist reach an appropriate diagnosis and help treatment and management.
    The Indian journal of radiology and imaging 04/2012; 22(2):98-105.
  • Pathology & Oncology Research 03/2012; 18(4):917-27. · 1.56 Impact Factor
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    ABSTRACT: Interest in international health is growing, and international electives have become increasingly popular among medical students and residents. Subspecialty fellowships have so far been excluded from this growing popularity, but as health care indicators improve in low-income countries (LIC), a role in global health initiatives for subspecialty fellows is imminent. Improvements in patient care made in one subspecialty can carry over to other areas of health care or can represent models for the development of the health care system. In this commentary, the authors argue that global health training during subspecialty fellowships, including international electives, both represents a moral imperative and matches the goals defined by the Royal College of Physicians and Surgeons of Canada. Although international electives pose complex ethical, personal, financial, organizational, and cultural issues, to mention a few, subspecialty fellows can significantly contribute to clinical activity, provide education to colleagues and other allied health care professionals, conduct research, and help establish collaborations in LIC settings. At the same time, they gain a diverse clinical experience as well as a better understanding of cultural diversity, which will be applicable in their local practice and community. Global health training in subspecialty fellowships represents a valuable learning opportunity for both sides of international partnerships.
    Academic medicine: journal of the Association of American Medical Colleges 02/2012; 87(2):139-41. · 2.34 Impact Factor
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    ABSTRACT: Extraneural metastases in medulloblastoma are rare. We report a boy with medulloblastoma who was initially treated with gross total excision of primary tumor followed by radiotherapy. Six years later, he developed disseminated osteosclerotic bony relapse associated with bone marrow involvement. He was successfully salvaged with metronomic low-dose cyclophosphamide, etoposide, and zoledronic acid. In patients with medulloblastoma and bone pain, metastases to bone should be excluded, and medulloblastoma should be considered while investigating osteosclerotic bone lesions. Furthermore, metronomic chemotherapy should be considered in this setting until better therapeutic modalities emerge.
    Journal of Pediatric Hematology/Oncology 01/2012; 34(5):e195-8. · 0.97 Impact Factor
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    ABSTRACT: In patients with persistent fever and netropenia, amphotericin B is administered empirically for early treatment and prevention of systemic fungal infections. Despite this treatment, there are chances of breakthrough fungal infections and drug is also toxic. A multicentric, randomized, controlled clinical trial was conducted to compare liposomal amphotericin B two doses with conventional amphotericin B as empirical antifungal therapy. The average body weight of patients was 26.4 ± 14.8 (n=22), 32.9 ± 19.4 (n=23) and 37.9 ± 20.0 (n=20) kg in 1 mg, 3 mg Fungisome (liposomal amphotericin B) and 1 mg/kg/day conventional amphotericin B group, respectively. The mean age was 16.2 ± 13.4, 16.0 ± 10.9 and 22.7 ± 16.2 yrs in 1 and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional AMP B group, respectively. The average duration of treatment with 1 mg and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional amphotericin B was 17 ± 9.8, 16.2 ± 8.3, and 14.7 ± 10.7 days, respectively. The time to resolve fever was 13.3 ± 10.2, 10.9 ± 7.1, 10.1 ± 6.7 days, and for absolute neutrophil count (ANC) to be above 500 cells per microliter, it took 13.4 ± 9.6, 10.6 ± 7.6 and 7.3 ± 3.4 days, respectively. Liposomal formulations were well-tolerated compared to conventional amphotericin B. This small randomized study showed that the indigenous liposomal formulation Fungisome appears to be equally efficacious and safer than conventional amphotericin B. Also, the lower dose Fungisome (1 mg/kg/day) appears to be equally efficacious and was well-tolerated as compared to higher dose Fungisome (3 mg/kg/day). Treatment cost would be a major factor for limiting use of higher dose of Fungisome.
    Indian Journal of Cancer 01/2012; 49(1):107-13. · 1.13 Impact Factor
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    ABSTRACT: Infantile hepatic hemangioendothelioma (IHE) is a rare angiogenic tumour with diverse clinical presentations and varied course ranging from spontaneous regression to life-threatening complications. The authors report a 2-year boy who presented with respiratory distress and was identified as a case of inoperable multi-focal hepatic IHE. He showed a transient response to trans-arterial-chemo-embolisation and liver resection but had progressive disease despite chemotherapy (prednisolone/vicristine/ifosfamide/cisplatin). Thereafter, he was successfully managed with metronomic therapy using cyclophosphamide and tamoxifen.
    Case Reports 01/2012; 2012.
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    ABSTRACT: Advanced cases of retinoblastoma are treated with chemoreduction followed by enucleation. Further adjuvant therapy is recommended in patients with known pathologic risk factors (PRFs). To determine the PRFs in enucleated specimens after chemoreduction and their association for adverse events of recurrence, metastasis, or death. This was a retrospective study of 77 enucleation specimens from patients treated between January 2000 and September 2008 with prior chemoreduction that were accessioned in the pathology department of a tertiary referral cancer center with an average follow-up of 24 months. Various PRFs were noted and their association with the development of an adverse event was recorded. Of 77 patients, (male to female ratio, 51∶26), the incidence of overall PRF was 51.9%, and retrolaminar optic nerve invasion (32.5%), optic nerve cut margin (12.9%), massive choroidal invasion (26%), scleral invasion (23.4%), vitreous seedings (44.2%), and anterior segment invasion (20.8%). Undifferentiated tumor (>60%) was seen in 60.3% of cases (41 of 68 patients with differentiation available). Adverse event occurred in 18 of 72 patients with available follow-up (25%). Retrolaminar optic nerve invasion, optic nerve cut margin involvement, and scleral invasion were independent prognostic factors predicting the occurrence of an adverse event. Undifferentiated tumor (>60%) was a significant risk factor in univariate analysis, which is the unique feature in this study. Classic PRF with the addition of a predominant presence from the undifferentiated component were associated with adverse outcomes in retinoblastoma treated with anterior chemotherapy. The latter may represent chemoresistant clones and more intensive adjuvant chemotherapy may be warranted in these patients.
    Archives of pathology & laboratory medicine 08/2011; 135(8):1017-23. · 2.78 Impact Factor
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    ABSTRACT: Brain tumors are the second most common childhood tumors and remain the leading cause of cancer related deaths in children. Appropriate diagnosis and management of these tumors are essential to improve survival. There are no clinical practical guidelines available for the management of brain tumors in India. This document is a consensus report prepared after a National Consultation on Pediatric Brain Tumors held in Delhi on 06 Nov 2008. The meeting was attended by eminent experts from all over the country, in the fields of Neurosurgery, Radiation Oncology, Pediatric Oncology, Neuropathology, Diagnostic Imaging, Pediatric Endocrinology and Allied Health Professionals. This article highlights that physicians looking after children with brain tumors should work as part of a multidisciplinary team to improve the survival, quality of life, neuro-cognitive outcomes and standards of care for children with brain tumors. Recommendations for when to suspect, diagnostic workup, initial management, long-term follow up and specific management of individual tumors are outlined.
    The Indian Journal of Pediatrics 06/2011; 78(12):1510-9. · 0.72 Impact Factor
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    ABSTRACT: Pancreas is a rare location for desmoplastic small round cell tumor. The present case highlights the dilemma in diagnosis and ascertaining the site of tumor origin. Morphologic and immunohistochemical features were complemented with the molecular markers and tumor origin which was initially nebulous was subsequently confirmed on exploratory laparotomy.
    Journal of Indian Association of Pediatric Surgeons 04/2011; 16(2):66-8.
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    ABSTRACT: To evaluate the prognostic factors and treatment outcome of patients with Askin-Rosai tumor of the chest wall treated at a single institution. Treatment comprised multiagent chemotherapy and local therapy, which was either in the form of surgery alone, radical external-beam radiotherapy (EBRT) alone, or a combination of surgery and EBRT. Thirty-two patients (40%) were treated with all three modalities, 21 (27%) received chemotherapy and radical EBRT, and 19 (24%) underwent chemotherapy followed by surgery only. One hundred four consecutive patients aged 3-60 years were treated at the Tata Memorial Hospital from January 1995 to October 2003. Most (70%) were male (male/female ratio, 2.3:1). Asymptomatic swelling (43%) was the most common presenting symptom, and 25% of patients presented with distant metastasis. After a median follow-up of 28 months, local control, disease-free survival, and overall survival rates were 67%, 36%, and 45%, respectively. Median time to relapse was 25 months, and the median survival was 76 months. Multivariate analysis revealed age ≥18 years, poor response to induction chemotherapy, and presence of pleural effusion as indicators of inferior survival. Fifty-six percent of patients with metastatic disease at presentation died within 1 month of diagnosis, with 6-month and 5-year actuarial survival of 14% and 4%, respectively. Primary tumor size, pleural effusion, response to chemotherapy, and optimal radiotherapy were important prognostic factors influencing outcome. The combination of neoadjuvant chemotherapy, surgery, and radiotherapy resulted in optimal outcome.
    International journal of radiation oncology, biology, physics 01/2011; 79(1):202-7. · 4.59 Impact Factor
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    ABSTRACT: Primary Ewing's sarcoma or primitive neuroectodermal tumor of the genital tract of women is uncommon. Rarer still is its occurrence in the vagina, with only five cases described so far. Out of these, only one case was confirmed using molecular analysis. We present an extremely rare case of Ewing's sarcoma or primitive neuroectodermal tumor in a 17-year-old Indian girl. She presented with a vaginal mass that was initially diagnosed as a malignant round cell tumor. Immunohistochemistry showed diffuse positivity for vimentin, membranous positivity for MIC2, and positivity for BCL2 and FLI-1. On the other hand, she was negative for cytokeratin, epithelial membrane antigen, desmin, Myo D-1, myogenin and smooth muscle actin. A diagnosis of primitive neuroectodermal tumor was thus offered. Furthermore, a molecular analysis of our patient using reverse transcription-polymerase chain reaction technique showed positivity for t(11; 22) (q24; q12) (EWSR1-FLI1), thus confirming the diagnosis of a Ewing's sarcoma/primitive neuroectodermal tumor. Our patient was offered chemotherapy on Institutional protocol EFT 2001. This is a rare case of primary vaginal Ewing's sarcoma or primitive neuroectodermal tumor, which was confirmed with molecular analysis, in the youngest patient known so far. This study reinforces the value of integrating morphological features with membranous MIC2 positivity, along with application of molecular techniques in objective identification of an Ewing's sarcoma or primitive neuroectodermal tumor at uncommon sites.
    Journal of Medical Case Reports 03/2010; 4:88.
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    ABSTRACT: Up to 10% of patients who develop a nosocomial blood stream infection (BSI) in the hospital have an underlying malignancy. The treatment of infections in patients with malignancy often relies on the use of established guidelines along with the consideration of the local microbiology and antibiotic sensitivity patterns of possible etiologic agents. This study attempts to identify the likely etiologic agents and the antibiotic sensitivity profile of BSIs in cancer patients. This was a retrospective study. The study was conducted at a tertiary care center for cancer patients, in which samples representing blood stream infections sent from the Medical Oncology services of the hospital during the year of 2007 were analysed. The microbiological profile and antibiotic sensitivity pattern of these isolates was studied. There were 484 isolates that represented BSIs. The most common bacterial isolates from patients with cancer were Pseudomonas spp. (30.37%), Staphylococcus aureus (12.6%) and Acinetobacter spp. (11.57%). Meropenem was the most effective antibiotic with 71.2% sensitivity to the bacterial isolates it was tested against. Oxacillin resistance was seen in 18% of S. aureus isolates. Gram-negative bacteria were more common as etiologic agents of BSIs in cancer patients. The poor activity of the primary empirical agents for infections in cancer namely ceftazidime and piperacillin-tazobactam is alarming.Strict regulation of vancomycin use should be considered in areas where there is a low prevalence of methicillin-resistant S. aureus (MRSA).
    Indian Journal of Cancer 01/2010; 47(2):184-8. · 1.13 Impact Factor
  • B Arora, P A Kurkure
    Indian Journal of Cancer 01/2010; 47(2):93-4. · 1.13 Impact Factor

Publication Stats

477 Citations
181.60 Total Impact Points

Institutions

  • 1988–2014
    • Tata Memorial Centre
      • • Pathology
      • • Department of Radiation Oncology
      Mumbai, Mahārāshtra, India
  • 2008
    • Children's Hospital at Westmead
      • Children's Hospital at Westmead Clinical School
      Sydney, New South Wales, Australia
  • 1996
    • National Cancer Institute (USA)
      Maryland, United States