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BACKGROUND: Renal cell carcinoma (RCC) is highly resistant to systemic chemotherapy, and historically a poor prognosis for metastatic disease has been reported, with a 5-year survival rate of <10%. Significant advances have been made in the last decade since the introduction of different tyrosine kinase inhibitors (TKIs) such as sunitinib, pazopanib, and sorafenib. Unfortunately, even though the TKIs have been used for a long time, there are very few published data regarding the experience of TKI therapy in metastatic RCC (mRCC) from India. MATERIALS AND METHODS: This is a single institutional review of mRCC patients treated between January 2012 and July 2017. Patients who received at least 1 month of first-line TKIs were included for analysis of response rates, toxicity, survival outcomes, and prognostic factors. RESULTS: Of the 40 mRCC patients, 31 (77.5%) were males. Median age at diagnosis was 58 years (range: 38–80 years). The most common site of metastasis was lungs (n = 24) followed by bone (n = 19) and liver (n = 7). Three patients had favorable risk disease, whereas 25 had intermediate risk and 12 had poor risk disease according to the MSKCC risk criteria. First-line TKI therapy used was sunitinib in 24, pazopanib in 11, and sorafenib in 5 patients. Toxicities of TKIs were Grade 1 or 2 in 13 patients and Grade 3 or 4 in 9 patients; the most common being fatigue, followed by hand-foot syndrome, skin rash, mucositis, and hypertension. Overall, 29 patients (72.5%) had disease control (complete responses in 1, partial responses in 10, and stable disease in 18 patients), whereas 11 had progression of disease at initial evaluation. At a median follow-up of 16 months (range: 2–38 months), median progression-free survival (PFS) was 10.8 months and median overall survival was 19.1 months. CONCLUSIONS: Sunitinib and pazopanib are viable first-line options for mRCC and showed a comparable PFS in Indian patients. Careful patient selection, tailoring of TKI doses, and careful toxicity management are essential for optimum therapy. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to investigate the efficacy, toxicity, and impact of induction chemotherapy (IC) in technically unresectable T4a oral cavity squamous cell cancers (OSCCs). Materials and Methods: Patients diagnosed with technically unresectable locally advanced T4a OSCC from January 2013 and November 2016 at our center, who received 2-3 cycles of IC and then assessed for resectability, were reviewed retrospectively. Patients' profile, response rates and toxicity of IC, resectability status, and overall survival (OS) were evaluated. Statistical analyses were performed using SPSS version 17.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: Totally 80 patients received IC, and of them 58 (72.5%) were males. Median age at diagnosis was 44 years (range, 34-62 years). All our patients received IC with doublet regimen. Majority of the patients had buccal mucosa cancers (73.8%), followed by gingivobuccal complex (21.2%) and oral tongue (5%) primaries. After IC, partial response was achieved in 17 (21.3%) patients, stable disease in 49 (61.3%) patients and disease progression was noted in 14 (17.4%) patients. Post-IC, resectability was achieved in 19 (23.8%) of 80 patients, but 4 of them did not undergo surgery due to logistic and personal reasons. The median OS of patients who underwent surgery followed by adjuvant local therapy (n = 15) was 16.9 months (95% CI: 15.2-19.8 months) and for those treated with nonsurgical local therapy (n = 65) was 8.8 months (95% CI: 6.8-10.6 months) (log-rank P = 0.000). Conclusions: IC had a manageable toxicity profile and achieved resectability in 23.8% of our patients with technically unresectable T4a OSCC. Patients underwent resection had a significantly better median OS than those who received nonsurgical local treatment. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is a major health burden and the seventh most common cause of cancer-related death in India. Patients with advanced unresectable HCC have a poor prognosis with a reported median survival of only 2-3 months with the best supportive care (BSC). Sorafenib is the only drug that has demonstrated a survival benefit over BSC in advanced HCC. Unfortunately, even though it has been used for a long time, there are very few published data regarding the experience of sorafenib therapy in advanced HCC from India.Materials and Methods: Patients diagnosed with advanced HCC from January 2012 to July 2017 at our center were reviewed retrospectively. Patients' profile, time to progression, survival, and toxicity of sorafenib therapy were evaluated.Results: Of the 48 advanced patients with HCC, 35 (72.9%) were male. The median age at diagnosis was 52 years. The most common presenting symptom was abdominal pain (77%, n = 37), followed by abdominal distension (37.5%, n = 18), loss of appetite and/or weight (33.3%, n = 16), and jaundice (16.7%, n = 8). Hepatitis B virus infection was documented in 37 patients (77%), whereas 4 patients had hepatitis C virus infection. Patients were treated with standard dose sorafenib (n = 30), BSC alone (n = 14), or transarterial chemoembolization followed by sorafenib (n = 4). Sorafenib therapy was well-tolerated in most cases. The median progression-free survival with upfront sorafenib was 4.3 months. The median overall survival (OS) of the patients who received upfront sorafenib was significantly better than those treated with BSC alone (5.9 vs 3.0 months; log-rank P= 0.00).Conclusion: Sorafenib therapy was well-tolerated and provided about 3 months longer median OS in our patients with advanced HCC than those treated with BSC alone. [ABSTRACT FROM AUTHOR]

Introduction: Bone metastasis is a rare site of metastasis, seen in only 3.7-11% of clinical cases. Isolated bone involvement has been reported very rarely in literature. Moreover, the patients who have bone metastasis at presentation are even rare.Objectives: To discuss the demographic characteristics, carcinoembryonic antigen (CEA) levels, pattern of bone involvement, and their correlation with survival in patients of colorectal cancer that have bone metastasis at the time of presentation.Materials and Methods: Retrospectively, tumor registry was analyzed for the cases of colorectal cancer presenting with bone metastasis between 2008 and 2013. Survival curves were generated by Kaplan-Meier method and analyzed using the log-rank test.Results: Ten such patients were identified (male:female = 7:3) of the total 410 patients. Median age was 41 years (22-50 years). All patients were Conclusions: In this study, the patients of colorectal cancer presenting with bone metastasis were of male sex and younger age. The factors that were associated with reduced survival were extraosseous and liver involvement. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to investigate the efficacy, toxicity, and impact of induction chemotherapy (IC) in locally advanced T4b oral cavity squamous cell cancers (OSCCs).Materials and Methods: Patients diagnosed with locally advanced T4b OSCC from January 2013 to October 2016 at our center, who received 2-3 cycles of IC and then assessed for resectability, were reviewed retrospectively. Patients' profile, response, and toxicity of IC, resectability status, and overall survival (OS) were evaluated. Statistical analyses were performed by SPSS software version 17.Results: A total of 116 patients received IC, and out of them 90 (77.6%) were males. Median age at diagnosis was 43 years (range 31-62 years). Nearly 103 (88.8%) of our patients received doublet chemotherapy and the rest of the patients received triplet regimen. Majority of the patients had buccal mucosa cancers (71.6%), followed by gingivobuccal complex (21.6%) and oral tongue (6.9%) primaries. After IC, partial response was achieved in 20 (17.3%) patients, stable disease in 68 (58.6%) patients, and disease progression was noted in 28 (24.1%) patients. Post-IC, resectability was achieved in 22 (19%) of 116 patients, but 6 of them did not undergo surgery due to logistic and personal reasons. The median OS of patients who underwent surgery followed by adjuvant local therapy (n = 16) was 19.7 months (95% confidence interval [CI]: 16.0-22.8 months) and for those treated with nonsurgical local therapy (n = 100) was 7.1 months (95% CI: 5.8-8.2 months) (log-rank P = 0.000).Conclusions: IC had a manageable toxicity profile and achieved resectability in 19% of our patients with T4b OSCC. Patients underwent resection had a significantly better median OS than those who received nonsurgical local treatment. [ABSTRACT FROM AUTHOR]

Introduction: Since patients with similar International Prognostic Index scores have varied outcomes, molecular signatures, including BCL2 overexpression have been studied to prognosticate diffuse large B-cell lymphoma (DLBCL), which have shown varied outcomes. Objective: The aim of this study is to correlate BCL2 protein expression with survival in two biologic subgroups of DLBCL. Materials and Methods: A total of 112 adults with DLBCL between 2008 and 2012 were identified. BCL2 overexpression was determined using immunohistochemistry. Results: Median survival was greater in BCL2 negative (n = 52) than positive (n = 44) (36 vs. 24.5 months; P = 0.003). In nongerminal center B-cell type (NGCB), BCL2 negativity had a survival advantage over BCL2 positive (36.5 vs. 17 months; P = 0.02), similarly in GCB (36 vs. 33 months; P = 0.032). Of 109, 66 received CHOP and 43 R-CHOP. R-CHOP arm had a significant survival advantage over CHOP arm (38 vs. 24 months; P < 0.05). In CHOP group, GCB had a survival advantage over NGCB (32 vs. 14 months; P < 0.05). In R-CHOP group, no significant difference was seen. BCL2 negativity had a survival advantage in CHOP (31 vs. 20.5 months; P < 0.05) as well as R-CHOP group (39 vs. 26.5 months; P < 0.05). Analysis was performed in each treatment arm (CHOP and RCHOP) based on BCL2 expression (positive or negative) in GCB and NGCB arms. No statistically significant difference was seen in the four arms. Conclusions: BCL2 although an indicator of poor outcome, its use to predict outcomes alone in the absence of study of the expression of concomitant markers, such as myc/BCL6 would cause a bias in results. Furthermore, its relevance in the rituximab era needs further validation. [ABSTRACT FROM AUTHOR]

Background: Bone marrow involvement by solid tumor implicates advanced disease and dismal prognosis. Bone marrow aspiration and biopsy are routinely performed as staging workup for certain small round cell tumors and also for unexplained cytopenia in other solid tumors. It is important to rule out bone marrow involvement before planning for curative treatment. Materials and Methods: This was a retrospective observational study. The aim of our study was to evaluate the pattern of bone marrow involvement by different solid tumors and their correlation with the hematological abnormalities. We retrospectively evaluated bone marrow aspirations and biopsy performed in past 3 years. Results: At our institution, bone marrow examinations were performed in 440 patients during past 3 years for solid malignancies. Out of 440, 206 were pediatric cases and 234 were adult cases. Bone marrow was involved in 56 (12.7%) patients. Among the pediatric cases, bone marrow involvement was present in 30 (12.8%) cases, and in adult cases, bone marrow was involved was in 26 (11.1%) cases. Neuroblastoma (40%) was the most common malignancy, which involved the bone marrow among pediatric cases, followed by retinoblastoma (26.6%) and Ewing’s sarcoma (20%). Among adult patients, neuroendocrine carcinoma (23%) was at the top of the list of tumors involving bone marrow, which is followed by Ewing’s sarcoma (19.2%) and nasopharyngeal carcinoma (11.5%). Conclusion: Neuroblastoma and neuroendocrine carcinoma are the major cause of bone marrow involvement among the solid malignancies in pediatric and adult population, respectively. Use of immunohistochemistry markers on bone marrow biopsies may result in higher detection rate. [ABSTRACT FROM AUTHOR]

A concise, economical, and highly enantioselective synthesis of bismesylate intermediate of lurasidone HCl, an antipsychotic, has been developed. The key steps involved in the synthesis are thionyl chloride–catalyzed esterification of tetrahydrophthalic anhydride in MeOH, epimerization ofcistotransisomer, hydrolysis of the diester, resolution of the diacid, reduction with Red-Al, and finally bismesylation of the corresponding diol, which provided the desired intermediate ((1 R,2 R)-cyclohexane-1,2-diyl)bis(methylene) dimethanesulfonate in overall good yield. [ABSTRACT FROM PUBLISHER]

A new sub-population of Cycas beddomei Dyer (Cycadaceae), hitherto believed to be endemic to the Seshachalam Hills (Tirupati-Kadapa Hills) of Andhra Pradesh is discovered from Velikonda Hills (Nellore-Kadapa districts) of Andhra Pradesh. Hence its global distribution status is hereby revised endemic to Seshachalam and Velikonda hills of Eastern Ghats of Andhra Pradesh. Combined datasets of our earlier studies with the latest indicated no change in its 'Endangered' status. [ABSTRACT FROM AUTHOR]

BACKGROUND: After failing oxaliplatin-based first-line chemotherapy (CT), approximately 4%–21% of patients with metastatic colorectal cancer (mCRC) respond to irinotecan-based second-line treatment. Earlier studies have demonstrated that arsenic trioxide (ATO) can significantly resensitize resistant colon cancer to 5-fluorouracil (5-FU) by downregulating thymidylate synthase (TS). We hypothesized that a combination of ATO with infusional 5-FU, leucovorin, and irinotecan (FOLFIRI) regimen in mCRC patients refractory to first-line FOLFOX/CAPOX could further improve the outcome of second-line CT. MATERIALS AND METHODS: Patients were administered ATO 0.15 mg/kg/day on days 1–2 along with FOLFIRI regimen at standard doses every 2 weeks, until disease progression, unacceptable toxicity, or patients' refusal. Responses to CT were reported according to RECIST 1.1. Adverse events were classified based on CTCAE version 4.0. RESULTS: Between September 2016 and July 2017, 17 patients with refractory mCRC were treated with this investigational combination. The median age was 49 years; 13 males and 4 females; ECOG PS 0–1/2, 14/3. The most common site of metastases was liver (n = 11) followed by peritoneum (n = 7) and number of involved metastatic sites 1–2/≥3, 9/8. After 6 cycles of CT, overall response rate and disease control rate were 17.6% and 82.4%, respectively (complete remission = 0, partial remission = 3 patients, stable disease = 11 patients). Median progression-free survival was 5.3 months (95% confidence interval [CI]: 4.3–7.0) and median overall survival was 9 months (95% CI: 7.4–10.5) from the initiation of ATO plus FOLFIRI. The toxicities were as follows: Grade 1/2 toxicity: fatigue (7 patients), constipation (2), and nausea and vomiting (2); Grade 3 toxicity: fatigue (3), neutropenia (2), febrile neutropenia (1), diarrhea (2), and QTc prolongation (1). No patient experienced Grade 4 toxicities. CONCLUSIONS: The addition of ATO to FOLFIRI regimen as second-line CT in patients with refractory mCRC offered an encouraging antitumor effect at the cost of manageable toxicity. [ABSTRACT FROM AUTHOR]

Introduction: Multiple myeloma (MM) is a plasma cell dyscrasias and an incurable clonal B-cell malignancy, with an annual incidence of 1% of all malignancies. The mainstay of treatment of myeloma is induction treatment followed by consolidation with autologous stem cell transplant (ASCT). However, still in a developing country like India where affordability is a major hurdle for health care, a number of MM patients are not able to undergo ASCT.Aim: To study the epidemiological features and outcome of MM patients treated in a limited resource setting.Materials and Methods: We conducted a retrospective study at our institute to identify patients diagnosed as MM from 2005 to 2016. We studied the epidemiological profile and the outcome of the treatment in terms of response rates and overall survival.Statistical Analysis: Survival analysis was performed using Kaplan-Meier curve.Results: Median age at diagnosis is 54 years (range: 39-85 years). IgG myeloma was the most common type seen in 72% of patients. The International Staging System (ISS) was ISS I (31%), ISS II (30%), and ISS III (39%). The median duration of treatment for thalidomide + dexamethasone (TD) and bortezomib + TD (VTD) was 9 and 7 months, respectively. Median survival for the TD versus VTD regimen (in a nontransplant setting) for the ISS I, ISS II, and ISS III groups was 49 and 55 months (P = 0.056), 42 and 48 months (P < 0.05), 21 and 27 months (P < 0.05), respectively.Conclusion: Proteasome inhibitors significantly improved the median survival for patients with MM (ISS II and ISS III) treated in a limited resource setting. [ABSTRACT FROM AUTHOR]

Background: Apart from its common occurrence in the oral cavity in HIV-positive patients, plasmablastic lymphoma (PBL) has also been described at extraoral sites and among immunocompetent individuals. There is sparse data quoting prognostication of PBL depending on the site of occurrence and HIV status of patients. Aims: The present study was carried out at a tertiary oncology center to address the issue whether PBLs occurring at oral and extraoral sites differ prognostically and whether HIV status of patient has any impact on prognosis. Materials and Methods: This was a retrospective observational study conducted at our center on consecutive patients diagnosed with PBL, from January 2008 to December 2012. Results: We had four patients with oral PBL; three male and one female. Sites of involvement were oral tongue and buccal mucosa. Two patients died within 6 months of diagnosis due to disease progression while on treatment. One patient was lost to follow-up after achieving complete remission (CR) after chemotherapy. Only one patient completed the prescribed schedule of chemotherapy and radiotherapy and is in CR with 33 months follow-up. There were four extraoral PBL patients; three female and one male. Extraoral sites were ileocaecal region, ovary, clavicle and rectum. Three patients died within 6 months due to progressive disease during treatment. Only one patient has completed chemotherapy and is in CR with 18 months follow-up. Among all these eight oral and extraoral PBL patients, four were HIV positive. Two of them are in CR after treatment (18 months and 33 months follow-up). One patient died during treatment and one patient was lost to follow-up after being in CR. Unfortunately, none of the other four HIV-negative patients could survive for more than 6 months after diagnosis. Conclusion: Both oral and extraoral PBLs have aggressive clinical course and an overall unfavorable outcome. Prognosis of HIV-associated PBL seems to be better with addition of highly active antiretroviral therapy to chemotherapy. Further large sample studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

The seeds of prevention should be sown early in the life to have its benefits in evidence. When it comes to the pediatric age group the information delivered by the school teachers will have better impact. With this background in the mind the survey was designed to assess the school teachers' knowledge regarding dental aspects and also to make them aware about their indispensible role as oral health messengers. The survey contained questions related to their knowledge about dentition, exposure to dental health education, awareness on caries, experience and knowledge on providing first-aid in instances of dental trauma. A total of 850 school teachers were selected from rural and urban areas in and around Guntur city and the questionnaire was distributed. When answers obtained were summarized it was found that the overall knowledge of school teachers regarding the above mentioned dental aspects was relatively low which gives an alarming signal to improvise the knowledge of school teachers. This survey was an effort to interact with the teachers so that the knowledge, attitude and practice of the teachers regarding dental issues can be identified. Thus few recommendations were suggested to achieve the goal. [ABSTRACT FROM AUTHOR]

Background: The first case of plasma cell leukemia (PCL) was recognized by Gluzinski and Reichentein. It is the most aggressive among the monoclonal gammopathies. It is diagnosed by the presence of more than 20% plasma cells in the peripheral blood or an absolute plasma cell count of> 2000/mm3. Because of the relatively low incidence, most data come from case reports and retrospective studies. No prospective series have been published, and only seven reports including more than twenty patients have been identified. We report a retrospective series of 18 patients identified as PCL.Aim: To study the clinical features and outcome of patients with PCL.Materials and Methods: A retrospective study was conducted from the year 2006 to 2015 wherein all the patients diagnosed with PCL were identified. Complete clinical and treatment details and outcome were obtained from the records.Results: There were total 18 cases of PCL (3.7% of cases with multiple myeloma) diagnosed between the year 2006 and 2015. 16 cases (84%) were primary PCL, and two cases were secondary PCL. Twelve patients were males and six were females. The median age was 56.5 years. All patients had aggressive clinical course and median overall survival even with immunomodulatory agents was only 3 months.Conclusion: PCL is a very aggressive disease, and no prospective trials have been conducted. Patients with PCL require induction with immunomodulators, proteasome inhibitors, and further trials are needed to evaluate the role of autologous stem cell transplant in this disease. [ABSTRACT FROM AUTHOR]

Background - T-cell prolymphocytic leukemia (T-PLL) is a rare lymphoid malignancy with dismal prognosis. Most patients have increased lymphocyte count (>1, 00, 000/dL) and widespread disease at presentation. Despite high response rate seen with alemtuzumab, the disease relapse is inevitable. Methods - This was a retrospective observational study done at a tertiary cancer centre in South India. All patients diagnosed with T-PLL from August 2010 to July 2015 were studied for the clinical characteristics, pathological findings and treatment outcomes. Results - Seven patients were diagnosed as T-PLL over a period of 5 years. The median age at diagnosis was 51 years. In the present series, 6 patients (86%) had splenomegaly and 3 had hepatomegaly (43%). Generalized lymphadenopathy was seen in 4 (57%) patients at presentation. Skin lesions were seen in 5 (71%) patients whereas pleural effusion in only one patient (14%). All had elevated total leukocyte count, with more than 1, 00, 000/ dL in 4 patients. The median survival was 5 months with different chemotherapy (CT) regimens (5 received CT and 2 patients on best supportive care). Conclusion - T-PLL is a rare diagnosis with no definite treatment guidelines. Treatment with alemtuzumab and stem cell transplant have the best outcome at present, but invariably the disease relapse. [ABSTRACT FROM AUTHOR]

The article provides an answer to a question of bilateral inherited progressive retinal degeneration disease called retinitis pigmentosa (RP).

Competing Interests: Competing interests: None declared.

Background: The present era of individualized treatment for breast cancer is influenced by the initial disease status including the anatomical extent, grade, and receptor status. An accurate preoperative staging is the basis of treatment planning and prognostication. Our study aims to determine the discordance between the preoperative clinical and the postoperative pathological stages of breast cancer patients., Methodology: The medical records of all non-metastatic breast cancer patients from January 2017 to December 2018 who underwent upfront surgery were reviewed. They were staged as per the eighth AJCC and the concordance between the clinical (c) and pathological T (tumor), N (nodal), and final AJCC stage was studied. A Chi-square test was used to determine factors that significantly correlate with disease discordance., Results: A total of 307 breast cancer patients were analyzed. Among these, 43.3% were hormone receptor-positive, 30.6% were Her2 positive and 26% were triple-negative. Overall stage discordance was seen in 48.5% (n = 149) patients (upstaging in 22.1%, downstaging in 26.4%). The discordance rate was 48.9% for T stage (cT versus pT) and 57.4% for N stage (cN versus pN). Among patients with clinically node-negative disease, 53.4% were found to have positive nodes on histopathology, while 27.2% had vice versa. Overall, the factors associated with upstaging were ER-positive, Her2 positive and triple-negative status (all p < 0.05), while none of the factors showed significant association with downstaging., Conclusions: About half of breast cancer patients had discordance between clinical and pathological staging with higher discordance in the nodal stage. This changes the disease prognosis, and may also affect the offered surgical treatment and radiotherapy. Thus highlighting the need for a precise pre-operative staging. Also, this information will aid clinicians in discussions with patients, keeping in mind the likelihood of change in disease staging and management.

This study was aimed to analyze the spectrum of time intervals, from the onset of symptoms to the commencement of treatment in esophagogastric cancers. Factors influencing these time delays and correlation between these time points with variables including socioeconomic strata, educational level, histopathology, location of tumor and the initial modality of treatment were assessed., Study Setting and Methods: A prospective analysis of patients with esophagogastric cancer presenting to a single tertiary care unit over a period of 12 months was performed. Histopathology other than adenocarcinoma and squamous cell were excluded., Results: 202 patients were enrolled in the study. Most patients presented with advanced disease, i.e. 91.5 % of esophageal and 90 % of gastric malignancies belonged to either stage 3 or stage 4 as per American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The median delay from the appearance of the first symptoms to initiation of treatment was 15 weeks (range 4-64). Patient related factors contributed to a significant delay [median of 5 weeks (range 1-24)]. Administrative factors were responsible for median delay of 3 weeks (range 0.5-20). Curative multimodality treatment was administered in 62.5 % of patients. Significant longer delay was influenced by socioeconomic strata, educational level, evaluation by non-specialist (p < 0.05). No relationship was noted between histopathology, location of tumor or initial modality of treatment., Conclusions: Delays in our setting is much more than that is seen in Western and even some Asian countries. An important component of delay is administrative related factors. These may be intervened at the hospital level compared to other factors which may need long term community oriented approaches., Competing Interests: Declaration of Competing Interest On behalf of all the contributors I hereby declare that there are no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: India has the third largest population of people living with HIV/AIDS (PLHA). Lymphoma is the second most common malignancy among PLHA. However, data are lacking regarding HIV/AIDS-related lymphoma (ARL) in India. This study evaluated the epidemiology and clinical outcomes of ARL from a regional cancer center in India., Methods: This retrospective analysis included cases of ARL between March 2011 and September 2017. Data were obtained from patient record files for the assessment of epidemiology and clinical outcomes. Statistical analysis was performed using GraphPad Prism 6. Comparisons of subtype-specific survivals were performed using log-rank tests., Results: Of 1,226 lymphoma cases, 80 (6.5%) were ARL. Details were available for 70 patients. The median age at diagnosis was 40.5 (9-74) years with a male:female ratio of 2:1. AIDS-defining lymphomas (ADL) constituted 78.6% of cases, while 21.4% had non-AIDS defining lymphoma (NADL). The mean CD4 counts were 193.15±92.85 and 301.93±107.95 cells/µL, respectively (t-test; P =0.0002). Extranodal involvement was present in 55.7%, B symptoms were reported in 60%, and lactate dehydrogenase (LDH) was elevated in 64.3% of patients. The median overall survival times were 6 months for plasmablastic lymphoma (PBL), 23 months for diffuse large B-cell lymphoma (DLBCL), and was not reached for Hodgkin's lymphoma (log-rank test; P =0.0011). Other histological subtype cases were too few to draw meaningful survival outcomes., Conclusion: ARL is a heterogeneous disease. Histologic subtype is a major determinant of the clinical outcome. ADL has significantly lower CD4 counts than those of NADL. There is an urgent and unmet need for uniform management guidelines for improving outcomes in this under-represented patient population., Competing Interests: Authors' Disclosures of Potential Conflicts of Interest: No potential conflicts of interest relevant to this article were reported., (© 2019 Korean Society of Hematology.)

Background: Breast cancer is a heterogeneous disease which is divided broadly into luminal, HER2 and basal type based on molecular profiling. Increased body mass index (BMI) has been associated with the risk of developing breast cancer but the association based on molecular subtype remains conflicting., Methods: This was an observational study carried out over a period of 2 years. Nonmetastatic breast cancer patients were evaluated for the tumour subtype based on surrogate markers (ER, PR and HER2). The BMI of these patients was correlated with the tumour subtype and size., Results: We studied 476 patients with breast cancer with the median age of 46 years (range, 25-86) and 58% were premenopausal. The mean BMI of the cohort was 24.1, which was significantly higher in postmenopausal women (24.9 versus 23.6, p < 0.05). Overall, only 10% of patients were obese. The mean BMI in the luminal, HER2 and TNBC subtypes was 24.7, 22.4 and 23.9, respectively ( p < 0.01). Also, the mean tumour size in luminal, HER2 and TNBC subtype was 4.02, 3.80 and 4.27 cm, respectively ( p = 0.158)., Conclusion: The average BMI was higher in patients with luminal subtype followed by TNBC and lowest for HER2 at the time of diagnosis. The mean tumour size was numerically higher for TNBC and lowest for HER2 subtype although the difference was not statistically significant. Larger studies may provide clarity of association between the BMI and tumour subtype.

Multiple myeloma (MM) is a plasma cell neoplasm and constitutes 10% of hematologic malignancies. Malignant myelomatous pleural effusions are very rare and occur in <1% of cases of MM. In this article, we report a rare case of a patient who initially presented with pleural effusion and was subsequently found to be secondary to MM with an underlying raised IgG paraprotein. The patient symptomatically improved and was in partial remission with palliative radiotherapy, VTD chemotherapy, and bisphosphonates., Competing Interests: There are no conflicts of interest.

Introduction: Bone metastasis is a rare site of metastasis, seen in only 3.7-11% of clinical cases. Isolated bone involvement has been reported very rarely in literature. Moreover, the patients who have bone metastasis at presentation are even rare., Objectives: To discuss the demographic characteristics, carcinoembryonic antigen (CEA) levels, pattern of bone involvement, and their correlation with survival in patients of colorectal cancer that have bone metastasis at the time of presentation., Materials and Methods: Retrospectively, tumor registry was analyzed for the cases of colorectal cancer presenting with bone metastasis between 2008 and 2013. Survival curves were generated by Kaplan-Meier method and analyzed using the log-rank test., Results: Ten such patients were identified (male:female = 7:3) of the total 410 patients. Median age was 41 years (22-50 years). All patients were Conclusions: In this study, the patients of colorectal cancer presenting with bone metastasis were of male sex and younger age. The factors that were associated with reduced survival were extraosseous and liver involvement.

Background: Few investigators have reported on the quality of life of family members of children with inflammatory bowel disease. Psychological symptoms have been reported in parents and siblings, but the problems that which give rise to these symptoms are seldom examined. In this pilot study, some of the issues that affect the quality of life of parents and siblings of children with inflammatory bowel disease were examined., Methods: Focus group meetings were held separately with 20 parents and 7 siblings of children with inflammatory bowel disease. The participants were encouraged to identify voluntarily problems related to the disease that affected their lives, and the discussions were tape recorded. Each participant subsequently wrote down the three most important concerns., Results: Thirteen (65%) parents were very concerned about the effect of the disease on the child's future jobs, marriage, independence) and 11 (55%) were worried about problems the ill child was encountering at school. Other issues of most concern to parents included side effects of medication (n = 7), limited job prospects (n = 3), persistent feelings of guilt (n = 3), and restricted family lifestyle (n = 1 ). Most siblings (57%) were concerned about their parents' keeping information about the illness from them, and three (43%) of them were also concerned about others bullying the ill child at school. Other issues of concern to siblings included fear about the disease and treatment (n = 3), parents overprotecting the ill child, and feelings of jealousy (n = 1)., Conclusion: Families of children with inflammatory bowel disease experience many problems that may affect their quality of life. Resources should be made available to help families with these concerns.

Background: Focus group meetings were held with two groups, each containing 12 children with Crohn's disease aged 8 to 12 and 12 to 17 years. The children were asked broad questions about how Crohn's disease and its treatment affected their lives. To explore these areas in more detail, an 88-item questionnaire was developed and read to an additional 16 of 20 children with Crohn's disease selected at random from outpatients. At first, many of the children denied that Crohn's disease affected their lives at all, but it soon became apparent that many were frustrated or angry about physical symptoms, lack of understanding about Crohn's disease, unpleasant investigations, treatment, and hospitalisation., Methods: The questionnaire covered six domains of health-related quality of life including symptoms and treatment, social, emotional, family, educational, and future aspects., Results: Elemental diet was the preferred treatment, although surgery was more effective in controlling symptoms. Children receiving steroids had more depressive symptoms. Absenteeism from school and inability to engage in school sports, swimming, and running were frequent problems. There were also difficulties with taking holidays and staying at friends' houses. Worry was reported in 14 of 16 children, anger and frustration and feeling fed up in 12 of 16., Conclusions: In addition to being a symptomatically disabling condition, Crohn's disease has a great impact on the health-related quality of life of affected children. Future studies of treatment in children with inflammatory bowel disease should include an attempt to assess the impact on the child's health-related quality of life.