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Synchronous splenic metastases from oesophageal squamous cell carcinomas are extremely rare. Most of the cases of splenic metastases reported in the literature are mainly metachronous and occur usually from adenocarcinoma primary. The treatment options range from splenectomy to palliative chemotherapy with standard doses in fit individuals. However, in cases with poor performance status, the management is often the best supportive care only due to the fear of tolerance and toxicities with standard dose chemotherapy. Herein, we report a case of squamous cell carcinoma of the distal thoracic oesophagus in a poorly fit elderly male diagnosed with synchronous splenic metastases and successfully treated with palliative chemotherapy with reduced flat doses and radiotherapy with no significant toxicities.

Primary intestinal lymphomas comprise of a wide variety of histological subtypes with varied presentation. The objective of this study was to determine the presentation, histological type, treatment, and outcome of patients of primary intestinal lymphoma. A retrospective analysis of 27 patients of primary intestinal lymphoma treated at our institute from 2004 to 2010 was carried out. Patients were staged according to Musshoff’s modification of Ann Arbor classification. The median age was 51 years (range, 7–76 years). Abdominal pain was the most common presenting symptom followed by mass abdomen, loss of appetite, constipation, and vomiting. The most common site of disease presentation was ileocecal region and jejunum. Diffuse large B cell lymphoma was the predominant histological type observed in 55.6 %. Eighteen patients underwent surgery with or without chemotherapy. Chemotherapy, either alone or with radiotherapy, was given to nine patients. The median follow-up was 48.3 months (range 5–94 months). The 5-year overall survival (OS) and event-free survival were 53.5 and 53 %, respectively. The 5-year OS for patients who underwent both surgery and chemotherapy was 79.5 % and for those without surgery was 13.9 %, respectively. Primary intestinal lymphomas are heterogenous diseases. Patients who underwent surgery had better survival and outcome than those without surgery. Chemotherapy is necessary for improving the survival of these patients. Optimal management is still uncertain due to the rarity of this disease.

Esthesioneuroblastoma (ENB) constitutes 3 % of all malignant intranasal tumors. As the tumor is very rare, the number of patients of ENB treated in individual departments is small. We present our institute's experience in combined modality management of 15 successive patients of ENB treated from 2006 to 2010. Clinical characteristics and treatment modality in form of surgery, radiotherapy and chemotherapy were noted. Kadish stage C was the most common stage (12 patients) followed by stage B (3 patients). Fourteen patients underwent primary surgery, of which nine had total excision and five had subtotal excision. One patient was treated with combination of chemotherapy (CT) and radiotherapy (RT). Median RT dose delivered was 54 Gy. Twelve patients received CT with cisplatin and etoposide. Overall, eight patients had complete response, five had partial response, while one had static disease and progressive disease each. Two patients had distant metastases. Four-year loco-regional control (LRC) was 25 % and 4-year overall survival (OS) was 45 %. Most common presentation in our series was locally advanced tumors. Most of these patients require adjuvant RT, which helps in significant LRC. Systemic CT benefits in inoperable, advanced and high risk tumors. Risk-adapted and multimodality approach is the need of hour to achieve good control rates while minimizing treatment related toxicity.