[show abstract][hide abstract] ABSTRACT: 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.
Indian journal of medical and paediatric oncology 01/2014; 34(4):309-312.
[show abstract][hide abstract] ABSTRACT: We report the case of a 49-year-old man with a diagnosis of gastric diffuse large B cell non-Hodgkin's lymphoma, treated with two lines of chemotherapy followed by radiotherapy, and presented about 3 months after completing therapy with recurrent episodes of epigastric pain, gastrointestinal (GI) bleeding. Computed tomography scan, positron emission tomography scan, and upper GI endoscopy revealed gastric wall thickening and lymphadenopathy. Biopsy and histopathology ultimately revealed Strongyloides stercoralis infection that was mimicking disease recurrence. Opportunistic parasitic infections represent one of the major challenges in the management of cancer patients.
Indian journal of medical and paediatric oncology 04/2013; 34(2):114-6.
[show abstract][hide abstract] ABSTRACT: Brain metastasis is the most common intracranial tumor in adults. The incidence of brain metastasis is rising with the increase in survival of cancer patients. Magnetic resonance imaging with contrast enhancement is the imaging procedure of choice to diagnose and characterize brain metastases. Multiple lesions with marked vasogenic edema and mass effect are typically seen in patients with brain metastases. The classical appearance of a metastasis is a solid enhancing mass with well-defined margins and extensive edema. Occasionally, central necrosis produces a ring enhancing mass. Here, we report a case of Non Small Cell Lung Cancer with multiple ring enhancing lesions in brain, and the approach to diagnosis of such patients.
South Asian journal of cancer. 04/2013; 2(2):98-101.
[show abstract][hide abstract] ABSTRACT: Reporting a case, 53 years old male with stage IV Nonsamall cell lung cancer in view of cytologically proven malignant pleural effusion. Usually the management of stage IV lung cancer is with palliative intent where the patient receives palliative chemotherapy along with palliative radiotherapy and surgery if required. Most of the data on curative management of oligometastatic non-small cell lung cancer includes patient with adrenal metastasis and some reports with brain metastasis. There is scarce literature on the surgical management of stage IV lung cancer with pleural effusion.
Indian journal of medical and paediatric oncology 04/2013; 34(2):121-5.
[show abstract][hide abstract] ABSTRACT: This study studied the coorelation between radiological response to induction chemotherapy and acheivement of pCR or near pCR. It was a retrospective analysis in which all patients who received NACT from 2008 till april 2012 were subjected to inclusion criteria. Coorelation analysis was performed between CR + PR and acheivement of pCR or near pCR. Twenty four patients were identified.The primary site of tumor was oral cavity in 19 patients (79.2%), maxilla in 2 patients (4.2%), laryngopharynx in 2 patients (4.2%) and oropharynx in 1 patient (4.2%). The clinical stage was stage IVA in 16 patients ( 66.7%) and IVB in 8 patients (33.3%). The overall response rates ie a combination of CR and PR was seen in 11patients (45.8%). The pCR was seen in 15 patients (62.5%) and rest had near pCR. There was no linear coorelation between radiological size decrement and tumor response. On coorelation analysis the spearman correlation coefficent was -0.039 (P = 0.857). This suggest that presently used radiological response criterias for response assesment in head and neck cancers severly limit our ability to identify patients who would have pCR or near pCR.
[show abstract][hide abstract] ABSTRACT: A young male patient was diagnosed to have laryngeal papillomas at the age of 3 years for which he underwent permanent tracheostomy and also multiple surgical and laser excision procedures. Then, later in life, the patient had progressive breathlessness and dysphagia. On examination, he had supraclavicular lymphadenopathy showing squamous carcinoma pathology. Since laryngeal papillomas have a high propensity to transform into laryngeal squamous cell carcinoma, he was first evaluated for laryngeal carcinoma which was negative. Esophagoscopy showed a growth in the esophagus, the biopsy of which was positive for squamous malignant cells. Patient was then started on palliative chemotherapy with combination of paclitaxel and carboplatin, and at progression with weekly nanoxel with stable disease. This is a rare case of childhood laryngeal papillomatosis progressing to metastatic esophageal carcinoma. This case has been presented to highlight the fact that patients with laryngeal papillomas are not only at high risk of progressing to laryngeal carcinoma but can also have other malignancies of the upper aerodigestive tract and lung. Most of them have been correlated to human papilloma virus (HPV), but in our patient HPV DNA was negative.
Indian journal of medical and paediatric oncology 01/2013; 34(1):34-7.
[show abstract][hide abstract] ABSTRACT: Screening for EGFR mutation is a key molecular test for management of lung cancer patients. Outcome of patients with mutation receiving EGFR tyrosine kinase inhibitor is known to be better across different ethnic populations. However, frequency of EGFR mutations and the clinical response in most other ethnic populations, including India, remains to be explored. We conducted a retrospective analysis of Indian lung cancer patients who were managed with oral tyrosine kinase inhibitors. Majority of the patients in the study had adenocarcinoma and were non-smokers. 39/111 patients tested positive for EGFR kinase domain mutations determined by Taqman based real time PCR. The overall response to oral TKI therapy was 30%. Patients with an activating mutation of EGFR had a response rate of 74%, while the response rate in patients with wild type EGFR was 5%, which was a statistically significant difference. Progression free survival of patients with EGFR mutations was 10 months compared to 2 months for EGFR mutation negative patients. Overall survival was 19 months for EGFR mutation patients and 13 months for mutation negative patients. This study emphasizes EGFR mutation as an important predictive marker for response to oral tyrosine kinase inhibitors in the Indian population.
PLoS ONE 01/2013; 8(4):e61561. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Anaplastic lymphoma kinase (ALK) gene rearrangements are present in a small subset of non-small-cell lung cancers. ALK-positivity confers sensitivity to small-molecule ALK kinase inhibitors, such as crizotinib. The integration of crizotinib into standard treatment practice in NSCLC will rest on the widespread implementation of an effective screening system for newly diagnosed patients with NSCLC which is flexible enough to incorporate new targets as treatments are developed for them. Phase I and II studies of crizotinib in ALK-positive lung cancer have demonstrated significant activity and impressive clinical benefit, which led to its early approval by USFDA in 2011. Although crizotinib induces remissions and extends the lives of patients, there have been reports of emerging resistance to Crizotinib therapy. In this review, we discuss the history, mechanism of action, uses, adverse effects, dose modifications and future challenges and opportunities for patients with ALK-positive lung cancers.
South Asian journal of cancer. 01/2013; 2(2):91-97.
[show abstract][hide abstract] ABSTRACT: Carcinoma penis is one of the common malignancies in developing world especially among rural population. Multimodality treatment with surgery, radiation and chemotherapy for advanced penile carcinoma with groin nodal metastasis is crucial to optimise the outcome. Cisplatin, fluorouracil, methotrexate, vinorelbine, bleomycin and paclitaxel are the common chemotherapeutic agents used along with local therapy. Paucity of data to show superiority of one chemotherapeutic regime over another and only modest response to any combination chemotherapy. Progression of disease after surgery, radiation and chemotherapy is associated with poor outcome and quality of life. Nimotuzumab, Anti EGFR monoclonal antibody, along with paclitaxel in our case of resistant metastatic penile carcinoma has shown good symptomatic palliation and clinical response.
Indian journal of medical and paediatric oncology 01/2013; 34(1):24-7.
[show abstract][hide abstract] ABSTRACT: During the past decade, the incidence of EGFR mutation has been shown to vary across different ethnicities. It occurs at the rate of 10-15% in North Americans and Europeans, 19% in African-Americans, 27-62% in various East Asian series including Chinese, Koreans, and Japanese. Frequency of EGFR mutations in India however remains sparsely explored.
We report 23% incidence of Epidermal growth factor receptor (EGFR) mutations in 907 Non small cell lung cancer (NSCLC) patients of Indian ethnicity. In this study, EGFR mutations were found to be more common in never-smokers 29.4% as compared to smokers 15.3%. Consistent with other populations, mutation rates among adenocarcinoma-males were predominantly lower than females with 32% incidence. However unlike Caucasians, EGFR mutation rate among adenocarcinoma-never-smoker females were comparable to males suggesting lack of gender bias among never smokers likely to benefit from EGFR targeted therapy.
This study has an overall implication for establishing relevance for routine EGFR mutation diagnostics for NSCLC patients in clinics and emphasizes effectiveness for adoption of EGFR inhibitors as the first line treatment among Indian population. The intermediate frequency of EGFR mutation among Indian population compared to Caucasians and East Asians is reminiscent of an ancestral admixture of genetic influence from Middle Easterners, Central Asians, and Europeans on modern- Indian population that may confer differential susceptibility to somatic mutations in EGFR.
PLoS ONE 01/2013; 8(10):e76164. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Sebaceous gland carcinoma is a rare malignant tumor, which arises from the adnexal epithelium of sebaceous glands. Sebaceous glands are present all over the body and hence have variable sites of origin, histological growth patterns, and clinical presentations. Here, we report a case of recurrent extraocular sebaceous carcinoma of left occipital region with lung metastases who went into complete remission with chemotherapy for lung metastasis. Role of chemotherapy in the management ofmetastatic sebaceous carcinoma is evolving. Combination chemotherapy can result in long term remission as described in this case report.
Indian journal of medical and paediatric oncology 10/2012; 33(4):239-41.
[show abstract][hide abstract] ABSTRACT: The therapy of ITP has recently been revolutionized with the introduction of thrombopoeitin stimulating agents. However, these medications are known to increase the platelet count only while the medication is being administered, with a rapid fall of the platelet count to baseline pre-therapy levels on discontinuation. We report the case of a patient with chronic refractory ITP who has attained a prolonged remission after a short course of eltrombopag, with normalization of the platelet count, which is sustained 8 months after discontinuation of the medication.
International journal of hematology 08/2012; 96(3):380-2. · 1.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: Gardner's syndrome is a variant of familial adenomatous polyposis. A multitude of extra-colonic manifestations including various endocrine tumors have been associated with this syndrome, the commonest of which is thyroid cancer. Majority of the patients with thyroid cancer and Gardner's syndrome are females. Here we describe a male patient with Gardner's syndrome who subsequently developed thyroid cancer.
South Asian journal of cancer. 07/2012; 1(1):43-7.
[show abstract][hide abstract] ABSTRACT: Lung cancer has varied epidemiology depending on the geographic region. Globally, there have been important changes in incidence trends amongst men and women, histology, and incidence in non-smokers. Indian epidemiological data on lung cancer is scarce.
We set out to study the epidemiological patterns and clinical profile of lung cancer in India.
We interviewed patients discussed in the thoracic oncology multidisciplinary meetings between 2008 and 2009. Demographic data, smoking history, place of residence, histology, stage at presentation, and treatment details were collected. Data was entered and analyzed in SPSS.
There were 489 patients, with a median age of 56 years, of which 255 (52%) were non-smokers and 234 (48%) were smokers. One hundred and thirty-three patients had consumed smokeless tobacco. The male-to-female ratio was 3.5:1. Sixty-nine patients (14.1%) were incorrectly diagnosed and treated with anti-tuberculosis treatment, which delayed the diagnosis of lung cancer by four months. Eight percent of patients had small-cell carcinoma; of the 92% patients with non-small-cell carcinoma (NSCLC), the most common histology was adenocarcinoma (43.8%), followed by squamous cell (26.2%), large cell (2.1%) and other (8.3%). Eighteen percent of patients were diagnosed by cytology, therefore were diagnosed as NSCLC, without further histologic subtyping. Most patients (43%) were in Stage III at presentation. Lung followed by bone were the common sites of metastases. The majority of the patients (49%) received palliative chemotherapy. Among definitive therapy, concurrent chemo-radiation (13%) was offered more frequently than surgery (6%).
Considerably higher numbers of Indian patients with lung cancer are non-smokers, compared to the West. The global trend of rise in adenocarcinoma is paralleled in India. Non-tobacco-related risk factors need further investigation.
Indian Journal of Cancer 01/2012; 49(1):74-81. · 1.13 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background. The standard initial management of patients with locally advanced pharyngolaryngeal presenting with stridor is tracheostomy. Tracheostomy has been shown to negatively impact cancer-related outcomes. Methods. Retrospective analysis of prospectively collected data of 9 patients, who underwent induction chemotherapy with the aim of prevention of tracheostomy. Presenting features, time to resolution of stridor, and further management are reported. Results. Eight out of 9 patient received chemotherapy within 12 hours of presentation with stridor. There were 4 patients each with primary hypopharynx and larynx. The stage was IVA in 6 patients and IVB in 2 patients. In all patients receiving immediate chemotherapy, clinical stridor resolved within 48 hours. The radiological response rate was 62.5%. The median reduction in size of tumor was 37%. Conclusion. Immediate neoadjuvant chemotherapy is a feasible and safe option for patients presenting with early stridor and helps in resolution of stridor and avoiding tracheostomy.
Chemotherapy research and practice. 01/2012; 2012:549170.
[show abstract][hide abstract] ABSTRACT: The efficiency of haematopoietic stem and progenitor cells (HSPCs) is important when donor cell numbers are limiting. Stable white blood cell (WBC) and platelet engraftment is crucial for the outcome of haematopoietic stem cell transplantation (HSCT). Design: This article evaluates CD26/dipeptidyl peptidase-IV expression on mobilised peripheral blood stem cell (PBSC) harvest of donors and its correlation with engraftment in HSCT. We have analysed CD26 expression on cells in various gates, that is, lymphocytes, monocytes, neutrophils and all populations using flow cytometry tool.
Ours is the first study on human mobilised PBSC harvest from cancer patients or allogeneic related donors (n = 28) to demonstrate that increased CD26 expression leads to early engraftment in transplanted cancer patients. Correlation of CD26 expression with WBC engraftment was statistically significant (lymphocyte gate: P < 0.00001; monocyte gate: P < 0.00001; neutrophil gate: P < 0.00001; all populations: P < 0.00001). CD34 expression is a known predictor of engraftment. Nevertheless, there was no correlation between CD34 and CD26 expression in these cases.
This study has given important leads indicating that CD26 expression may be an independent predictor of engraftment. Further study with large number of patients as well as study on circulatory CD26 may add valuable information towards improving current knowledge on CD26.
Annals of Oncology 09/2009; 21(3):582-8. · 7.38 Impact Factor