Rajeev Kumar

• All India Institute of Medical Sciences

Background Oral verrucous lesions are relatively rare, and management guidelines for these tumours are extrapolated from squamous cell carcinoma. There is a paucity of knowledge about the need for elective neck treatment, adjuvant therapy, and the role of pathological prognosticators. Methods A retrospective study was conducted on consecutive cases...

Purpose Orocervical (OCF) or pharyngocutaneous fistula (PCF) are one of the disastrous complications of head and neck cancer surgery. Conventional standards of management are predominantly conservative. Though a majority of such patients respond to conservative management, it nevertheless causes significant delay in wound healing. This study explor...

Background Direct laryngoscopy and biopsy have been the standard of care for biopsy of lesions arising from the upper aerodigestive tract (UADT). The requirement of general anesthesia is often a prerequisite. Procedures performed under the laryngeal block and local anesthesia are not viewed as appropriate from the point of view of patient comfort....

Introduction Owing to the aggressive biology of head and neck squamous cell carcinoma (HNSCC), new biomarkers that can facilitate the diagnosis and tracking of tumour growth are the need of the hour. Liquid biopsy has emerged as an easier tool than tissue biopsy to monitor the emergence of treatment resistance or the recurrence of disease at the mo...

Background Direct laryngoscopy and biopsy have been the standard of care for biopsy of lesions arising from the upper aerodigestive tract (UADT). The requirement of general anesthesia is often a prerequisite. Procedures performed under the laryngeal block and local anesthesia are not viewed as appropriate from the point of view of patient comfort....

Background: Malignant transformation of neurofibromas into malignant peripheral nerve sheath tumors (MPNST) is a rare but aggressive phenomenon, particularly in the head and neck region, and is associated with a poor prognosis. The primary treatment modality is surgical excision, often followed by radiotherapy. This is a case report of MPNST in the...

Introduction To evaluate the feasibility, safety, and effectiveness of different pyeloplasty procedure approaches for pelvicureteric junction (PUJ) obstruction in kidney anomalies. The presence of difficult, unfamiliar and anomalous anatomy makes pyeloplasty challenging in these conditions. Patients and Methods We conducted a retrospective review...

Background Pre‐vascular facial nodes (PV‐FNs; perifacial lymph nodes) are supra‐mandibular lymph nodes above the inferior border of the mandible. These are not part of routine neck dissection done for OCSCC. These lymph nodes can be sentinel station for metastatic lymph nodes from gingivobuccal complex cancers and are missed during routine neck dis...

TPS149 Background: The SWOAR is a phase III trial (ClinicalTrials.gov ID NCT05187091) evaluating sparing of dysphagia/aspiration related structures (DARS) & submandibular gland by IMRT. Methods: Patients with T1-4, N0-3, M0 of oropharynx, larynx and hypopharynx treated with radical RT were randomized to arm A (standard IMRT) or arm B (DARS IMRT) in...

Introduction The blood-based inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), is a reliable prognostic biomarker for several cancers. Although the literature supports the correlation between preoperative NLR, clinicopathological characteristics, and oncological outcomes in upper tract urothelial carcinoma (UTUC), the cutoff of NLR is stil...

OBJECTIVES: Perimarginal nodes (PMN) lie in close relationship with marginal mandibular nerve (MMN), in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible and remain unaddressed in conventional neck dissection. We have aimed to define the boundaries of perimarginal node dissection, explore incidence o...

6069 Background: Perimarginal nodes (PMN) are a group of perifacial lymph nodes that lie in close relationship with marginal mandibular nerve (MMN). They lie in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible which forms the superior limit of conventional neck dissection and thus remain unaddressed...

TPS12150 Background: Head and neck squamous cell carcinoma (HNSCC) is common in the Indian subcontinent and majority (65%) patients present in an advanced stage. Chemotherapy related cognitive impairment (CRCI) is a poorly defined and underestimated phenomenon in the HNSCC population. Through this study, we are attempting to establish evidence of a...

Context.— Salivary gland (SG) neoplasms (SGNs) display considerable immunophenotypic diversity. A significant proportion of SG carcinomas develop metastases with increased diagnostic difficulty at metastatic sites. Transcriptional repressor GATA binding 1 (TRPS1), a novel immunohistochemical marker for breast cancer, has been found to stain certain...

The evidence on bladder cancer in the young population remains fragmented due to lack of literature and conflicting results from the existing studies. We aim to elucidate such conflicting data and define the clinicopathologic characteristics, management trends, and outcomes of urothelial bladder carcinoma in young adults as compared to their older...

To evaluate the risk of acquiring COVID-19 infection in patients who have undergone adeno-tonsillectomy (AT) as compared to their siblings. In this bidirectional cohort control study, 36 cohorts, younger than 18 y, who underwent AT, and 27 controls (siblings of the enrolled cohorts, younger than 18 y) were recruited. Incidence of COVID-19 was analy...

A girl in her middle childhood presented to the outpatient department (OPD) with a congenital melanocytic naevi (CMN) of the right nasal alar lobule. Her parents had aesthetic concerns and expressed their desire to get the lesion removed. The full-thickness excision of CMN was performed with the reconstruction of the defect using the nasolabial and...

Objective To determine if systemic administration of low-molecular-weight heparin impacts venous compromise in loco-regional flap reconstruction for head and neck subsites. Methods This prospective study was conducted on patients who had developed features of venous compromise of the flap. The case group received low-molecular-weight heparin (dalt...

Abstract Introduction Upto 40% of patients with suspected PCa have a negative prebiopsy MRI (nMRI) and upto 15% of them may have clinically significant PCa (csPCa). The ability to predict presence of csPCa despite nMRI may help avoid unnecessary biopsies. We aimed to determine the negative predictive value (NPV) of mpMRI, the influence of MRI repor...

Cochlear implantation has become a standard of care for a child diagnosed with bilateral profound sensorineural hearing loss with a structured surgical standard operating procedure. A 3-year-old boy with bilateral profound prelingual sensorineural deafness underwent a Med-EL Sonata Ti100 implant. We faced a peculiar situation intraoperatively after...

Background There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy. Methods Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6-month period using FEES and PAS scale, MDAD...

Objective To assess the microvascular density (MVD) in juvenile nasopharyngeal angiofibroma (JNA) with CD34 immunostaining and evaluate its relationship with clinico-demographic features. Methods This prospective study included patients with JNA undergoing endoscopic excision. The histopathological specimen was stained using CD-34 antibodies to ca...

Introduction Elevated serum prostate-specific antigen (PSA) is the most common trigger for a prostate biopsy. However, the range of normal PSA is poorly defined in many populations. Men with “elevated” PSA may not harbor cancer, and it is unclear if such men with a prior negative prostate biopsy should be biopsied again. We conducted a cohort study...

Study Objective- Patients with pheochromocytoma (PCC) and paraganglioma (PGL) have contracted volume status due to intense catecholamine mediated vasoconstriction. These patients are prescribed plenty of oral and/or intravenous fluids to improve their volume status as part of pre-operative optimization strategy. This purportedly helps in improving...

BACKGROUND - Occasional coexistence of Juvenile Angiofibroma (JA) and Familial Adenomatous Polyposis (FAP) has been previously noted, and emerging understanding of molecular mechanisms in JA indicates similarities with FAP by involvement of beta-catenin/Wnt pathway. Congenital Hypertrophy of Retinal Pigmented Epithelium (CHRPE) is the earliest extr...

A man in 30s had complaints of glabellar and upper nasal swelling for 8 years. It was insidious in onset and gradually progressive causing epiphora and restriction of nasal visual field. Fine-needle aspiration cytology and biopsy revealed features which were suggestive of Kimura’s disease (KD). CT scans showed a well-defined subcutaneous swelling i...

Nomograms help to predict outcomes in individual patients rather than whole populations and are an important part of evaluation and treatment decision making. Various nomograms have been developed in malignancies to predict and prognosticate clinical outcomes such as severity of disease, overall survival, and recurrence-free survival. In prostate c...

Background: Liquid biopsy is emerging as a non-invasive tool, providing a personalized snapshot of a primary and metastatic tumour. It aids in detecting early metastasis, recurrence or resistance to the disease. We aimed to assess the role of circulating tumour cells (CTCs) as a predictive biomarker in recurrent/metastatic head and neck cancer (he...

Background: Men with idiopathic obstructive azoospermia (OA) are candidates for surgical reconstruction with a vasoepididymal anastomosis (VEA) performed on one or both testis. There are no randomised trials comparing the success of unilateral versus bilateral VEA. Objective: We conducted a randomised trial to compare the two surgical options....

Background: "Depth of invasion" is an additional index incorporated in 8th AJCC staging system for oral cavity squamous cell carcinoma based on its prognostic significance. Pre-operative assessment by clinical palpation and imaging modalities has been used with limitations. The aim of the study is to compare different techniques including clinical...

Nasopharyngeal carcinoma

Background: To assess the promise of surgical magnification and of intraoperative indocyanine green (ICG) assisted near-infrared fluorescence (NIRF) in improving parathyroid identification and viability assessment during thyroidectomy. Methods: Prospective comparative study. Parathyroid gland identification sequentially assessed by naked eye, su...

Background Fine‐needle aspiration cytology (FNAC) is the first‐line diagnostic procedure for salivary gland masses. Secretory carcinoma (SC) is characterized by ETV6 and RET rearrangements detected by fluorescence in situ hybridization (FISH) or reverse transcriptase‐polymerase chain reaction optimized for paraffin‐embedded and fresh‐frozen tissue,...

To describe clinico-demographical profile for post-lingual hearing loss in the adults undergoing cochlear implantation and their outcomes. A retrospective chart review was conducted including adult patients (> 18 years) with bilateral post-lingual severe to profound hearing loss who underwent cochlear implantation in a tertiary care hospital of nor...

Sinonasal tumors are a relatively rare and heterogeneous group of tumors. Owing to their nonspecific presentation and rarity, they can be potentially overlooked resulting in delayed diagnosis and management, and increased patient morbidity. Imaging is crucial for the detection, staging, surgical planning, follow-up as well as surveillance of sinona...

Small cell lung carcinomas (SCLC) are aggressive tumors with high propensity to metastasize. Recent NCCN guidelines have incorporated immunotherapy in extensive stage SCLC. Limited benefit in few patients compounded by side effects of unwonted immune-checkpoint-inhibitor (ICPI) usage necessitates identification of potential biomarkers predicting re...

Generalized weakness and bony pain are the predominant symptoms. In all cases, the tumor was located using 99Tc MIBI / SPECT scintigraphy and Ultrasonography. Hemithy-roidectomy and tumor excision were done as the surgery of choice. All are disease-free at the 12th-month follow-up. We suggested that parathyroid hormone testing be performed in all b...

We report the case of a female in her 50’s with slowly progressive neck mass for 9 years. For last 2 years the mass has rapidly grown to present size. The size of the mass was 5 × 6 cm and underwent fine needle aspiration cytology six months earlier. Histopathological studies confirmed papillary thyroid carcinoma and cutaneous needle track seeding...

We thank Eric M. Anderson et al. (1) for describing and identifying the probability and predictors of pN+ among patients with cN0 pharynx and larynx cancer in a large national dataset. We have a few questions about this retrospective study and would like to discuss them with the author so that we can better comprehend them. Laryngoscope, 2022

Background: Olfactory neuroblastoma (ONB) is a rare neuroectodermal tumor with a propensity for lymph node and distant metastases in a proportion of cases, presenting opportunities for cytological diagnosis. Insulinoma-associated protein 1 (INSM1) is a recently identified marker of neuroendocrine differentiation with higher sensitivity and specifi...

Introduction: Nasopharyngeal carcinoma (NPC) is a rare malignancy in India except in north- eastern states. We present our institutional experience of 16 years highlighting management, outcomes, responses and toxicities . Materials and methods: Nasopharyngeal carcinoma patients registered at our center during the period of 2000-2015. The primary...

Pleomorphic adenoma is the most common benign salivary gland tumour of the head and neck region, most commonly seen in parotid glands. These may arise also from minor salivary glands of the upper aerodigestive tract comprises the upper lip, cheek, floor of the mouth and rarely from mucoserous glands in the nasal cavity and paranasal sinuses. A midd...

Adamantinoma-like Ewing sarcoma (ALES) is a histological subtype of Ewing sarcoma that demonstrates the morphological and immunohistochemical features of the latter, harbors the EWSR1::FLI1 gene fusion, and additionally demonstrates complex epithelial differentiation on morphology and immunohistochemistry. Accurate preoperative diagnosis has potent...

Background: Head and neck squamous cell carcinoma (HNSCC) is a huge burden in India with the majority of patients presenting in advanced unresectable stages. Innovative, low-cost but efficacious regimens that can be easily administered in the outpatient setting are the need of the hour. We envisaged assessing whether a readily available triplet th...

Preoperative assessment of depth of invasion (DOI) is critical in the surgical management of early stage carcinoma tongue. Intraoral ultrasound (IOUS) has been recently described as a cost-effective alternative to MRI in the accurate measurement of DOI. We describe the technique of IOUS in different types of lesions (surface, ulcerative, and exophy...

When the outcomes are equivalent to the open technique, conventional laparoscopy is a preferred surgical approach because of its minimal invasiveness. However, outcomes following laparoscopy depend on the surgeon’s expertise, and there is a significant learning curve to attain efficiency in complex reconstructing laparoscopic procedures. Robotic as...

Abstract Objective. Commercially available suction devices are expensive, large and heavy, and need electricity, and thus restrict the outdoor activity of tracheostomised children and their carers. This study evaluated the efficacy and usability of a simple suction assembly using a syringe and feeding tube in paediatric tracheostomised patients. Me...

Unlabelled: Renal tumors in young population are relatively rare. We reviewed our experience with renal masses in patients below 45 years of age. Our objective was to analyze clinico-pathological and survival characteristics of renal malignancy in young adults in contemporary era. The medical records of patients below 45 years of age who underwent...

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma that develops from dermal fibroblasts and spreads within the dermis and subcutaneous fat. It is locally aggressive, with a high local recurrence rate after excision but has extremely low metastatic potential. In the case of recurrent tumors, surgical excision with adequate margins i...

Differentiating obstructive (OA) from non‐obstructive (NOA) azoospermia is clinically important in managing infertile men. Classically, the differentiation has been based on clinical, hormonal and histological analysis. Histological tests are invasive and may miss spermatogenic areas. Seminal fluid can serve as a medium to assess the status of sper...

Introduction: For the purpose of prognostication of sinonasal mucormycosis, a detailed analysis of the clinical, diagnostic, therapeutic and outcome parameters has been contemplated. Materials and Methods: Retrospectively data was collected for all patients of sinonasal mucormycosis managed in a tertiary care hospital in last 5years. Results: Diabe...

Objective: To evaluate metabolic and genetic abnormalities in children with nephrolithiasis attending a referral center in North India. Methods: The patients aged 1-18 y old with nephrolithiasis underwent biochemical evaluation and whole-exome sequencing. The authors evaluated for monogenic variants in 56 genes and compared allele frequency of 3...

Introduction: Human papillomavirus (HPV) is a known risk factor of penile cancer (PeCa). However, studies evaluating its true association are limited. In this study, we aimed to estimate HPV prevalence and its true association with PeCa in terms of molecular biological activities. Materials and methods: This single-institutional prospective obse...

Background: CCRT using 3 weekly cisplatin (DDP) 100mg/m 2 is considered standard nonsurgical option for LAHNSCC. Many prefer DDP 40 mg/m 2 weekly assuming this to be non inferior, with better radio sensitization, and less toxic but without robust supporting evidence. We designed this non inferiority trial to compare 3 weekly DDP to weekly DDP. Meth...

e18038 Background: Head and neck cancer is a huge burden in South East Asia with frequent relapse after curative therapy while the rest presenting in advanced unresectable stages. Financial constraints for targeted and immunotherapy make it inaccessible for the bulk of population. Thus, low-cost but efficacious regimen is highly implicated. We asse...

To compare the outcomes between cutaneous ureterostomy and ileal conduit urinary diversion in patients with solitary functioning kidney, undergoing radical cystectomy. This study was a retrospective analysis of the patients, with solitary functioning kidney, who underwent radical cystectomy with either cutaneous ureterostomy or ileal conduit from J...

We aimed to compare surgical, oncological, and functional outcomes of robot-assisted radical prostatectomy (RARP) in prostate cancer patients with and without prior history of transurethral resection of the prostate (TURP), using a matched cohort analysis. In an IRB-approved protocol, all patients who underwent RARP at our institution between April...

Introduction/Background With the advent of TransOral Robotic Surgery (TORS) the ease of transoral procedures has been dramatically improved. TORS is already established for its feasibility, functional and oncological outcomes for selected lesions of oral cavity, oropharynx and laryngopharynx. This study reports on preliminary results with TransOral...

Introduction: Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as "high-risk" prostate cancer (PCa). However, among Indian men, PSA elevation is often seen even in the absence of PCa and patients with PSA as the sole criterion for the high-risk disease may have different outcomes from those categorized as hi...

Objective: This study is a retrospective analysis of patients with cervical ganglioneuromas highlighting the clinical course, radiological features, and histopathological characteristics. Methods: A retrospective chart review of patients with cervical ganglioneuroma who were managed in a tertiary care center between January 2018 and December 2019...

Objectives: The objective of this study was to evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and 68Ga prostate‑specific membrane antigen positron emission tomography–computed tomography (PSMA PET‑CT) and respective quantitative parameters (Ktrans – influx rate contrast, Kep – efflux rate constant, ADC – appa...

Alveolar soft part sarcoma (ASPS) is infrequent in children. While head and neck locations, including the orbit and tongue, are described, only six cases of sinonasal ASPS are reported in the literature. We report two cases of pediatric oro-maxillofacial ASPS. The first case presented as a sinonasal mass in a 13-year-old girl, while the second was...

Vaccination against SARS CoV-2 has resulted in COVID-19 illness with reduced incidence and milder symptomatology. With the intent to analyze the olfactory and gustatory disturbances in breakthrough COVID-19 illness, we conducted a prospective observational study on a cohort of COVID-19 positive symptomatic otolaryngol- ogist physicians. These docto...

The ongoing COVID-19 pandemic has given rise to unique challenges related to healthcare management. The problems have arisen due to the direct effect of COVID 19 infection and treatment or as repercussions of administrative efforts being undertaken to check the rapid spread of the epidemic. The management of some of the diseases has been hampered w...

Endourology is the standard of care in the contemporary management of urolithiasis. However, in certain special situations, laparoscopic stone surgery offers a minimally invasive option to achieve stone-free status rapidly. With the laparoscopic approach, most series have shown a high stone-free rate in a single setting. This highlights the limited...

Intra-corporeal lithotripters can be broadly divided into laser- and non-laser-based devices. With the advent of laser technology, the use of mechanical lithotripters has declined considerably. However, for certain procedures like percutaneous nephrolithotomy and semi-rigid ureteroscopy, mechanical lithotripters still have a role. Newer advanced co...

Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of its close proximity to the mucosa of the upper aerodigestive tract. Retrospective review of all head and neck surgical procedures is undertaken during the pandemic from 23rd April 2020 to 30th September 2020....

A 16-year-old patient presented with sudden-onset difficulty in swallowing food especially for liquids with nasal regurgitation and rhinolalia with no history of fever and limb weakness. Examination revealed bilateral palatal palsy with absence of gag reflex. Other neurological examinations were normal. Investigations were done to rule out any know...

Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We...

Objectives To study the presentation and natural course of cystitis cystica et glandularis. Methods A retrospective analysis of patients with histopathologically confirmed cystitis cystica et glandularis from March 2016 to March 2018 who at least completed their 2 years’ follow-up was performed. Perioperative details along with the last available...

Background IgG4-related disease (IgG4-RD) is a multi-organ immune-mediated disorder characterized by fibroinflammatory mass-forming lesions, mimicking malignancy or infection. While well-documented in salivary glands, orbit and thyroid in the head and neck, sinonasal IgG4-RD is rare. Methods Cases of sinonasal IgG4-RD were retrieved, and clinicopa...

Objective Rapid on-site evaluation (ROSE) is a fine needle aspiration (FNA) technique for ensuring adequacy and triaging samples. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardized reporting system which aims at improved risk stratification. There is scant literature on diagnostic value and agreement of MSRSGC on...

The rapid emergence of COVID-19 has led to increase in the number of patients requiring prolonged ventilation and tracheostomy. Though global guidelines are evolving, there is a paucity of literature about optimal timing and outcome after tracheostomy in COVID-19 patients. We set out to assess the clinical characteristics and outcome of COVID-19 pa...

Objective Digastric ridge (DR) is an important landmark to locate facial nerve (FN) and sigmoid sinus for mastoid surgeries and transmastoid approaches. We aim to look for the effect of temporal bone pneumatization on the morphometry of the DR and its relation to the adjoining structures. Methods Temporal bones were harvested from unclaimed cadave...

Introduction Gingivo-buccal complex cancers (GBCC) have an aggressive clinical course in the presence of skin and bone involvement. Objective This study intends to analyze the clinico-pathological factors affecting local control and survival outcomes in GBCC. Methods This is a retrospective study conducted on 125 GBCC cases from January 2011 to A...

Objective To study the mRNA and protein expression of GRP78 in tumor and serum of the RCC patients and compare with the controls and to correlate the expression with the grade and stage of RCC. Materials and methods A prospective cohort study involving 60 patients planned for radical/partial nephrectomy for primary RCC between July 2017 to June 20...

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP...