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Background: Paclitaxel-platinum and optimal cytoreductive surgery are the standard of care for ovarian carcinoma. Poor socioeconomic profile and therapeutic constraints in rural India poses a therapeutic challenge. Aim: To evaluate outcomes of epithelial ovarian carcinoma. Objectives: To calculate disease-free survival (DFS), overall survival (OS), and factors affecting outcomes. Materials and Methods: Data of patients diagnosed as ovarian carcinoma registered between March 2009 and March 2014 were retrieved. Demographic profile, chemotherapy and response, surgery, and disease progression were collected. Patients who underwent surgery or completed three cycles of chemotherapy were selected. Kaplan-Meir survival was used to determine disease-free and OS. Log-rank test used to evaluate factors affecting outcome. Results: Median follow-up is 26 months. 93/102 patients (91%) underwent cytoreductive surgery, of which 37 had primary cytoreduction (40%) while 56 had interval cytoreduction. 21/93 (23%), 57/93 (61%), and 15/93 (16%) patients were operated by local surgeons, surgeons of our hospital, and trained oncosurgeons, respectively. Induction paclitaxel-platinum was used in 35/63 (56%) patients while 28/63 patients (44%) received neoadjuvant metronomic chemotherapy. Median DFS and OS are 17 and 54 months respectively while 3 year OS of 66%. Median DFS of patients operated by oncosurgeons versus local surgeons were 22 months versus 15 months (P = 0.01), OS was 54 versus 26 months (P = 0.01).40/88 (45%) patients received maintenance metronomic therapy after adjuvant chemotherapy with median of 6 months (range 2-18 months). Patients receiving metronomic maintenance had better DFS, 18 months versus 15 months (P = 0.69). Conclusion: Induction therapy in ovarian carcinoma helps in selecting patients for cytoreductive surgery. Outcomes are better if operated by trained oncosurgeons. Maintenance metronomic has potential to delay disease progression.

Objective: This series of six intestinal T cell lymphomas (ITCL) attempts to document enteropathy-associated T cell lymphoma (EATCL) in India. Materials and Methods: A total of six ITCL were selected from 170 gastrointestinal lymphomas in last 10 years. Results: The cases studied included EATCL (4), ITCL with a CD4 positive phenotype (1) and ITCL NK/T cell type (1). Of the four EATCL, two occurred in the ileum, one in right colon and one in duodenum. In three EATCL cases, there was history of celiac disease or lactose intolerance and enteropathic changes were noted in the adjacent mucosa. These tumors had CD3+/CD8+/CD56 (+/-)/CD4-/ Granzyme B+ immunophenotype. One EATCL was monomorphic small cell type (type II EATCL) with a CD3+/CD8-CD56+/CD4-/ Granzyme B+ phenotype. EBER- ISH (Epstein Barr virus coded RNA′s- in situ hybridization) revealed positive tumor cells in ITCL NK/T cell type and in bystander cells in three EATCL. Conclusion: ITCL are rare in Indian patients but do occur and comprise a mixture of the enteropathic and non-enteropathic subtypes.

Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic tumor and often poses a diagnostic and therapeutic challenge to the involved clinicians. We report a case of epithelioid trophoblastic tumor in a young woman which involved the uterus, parametrium and the right ovary. Misdiagnosis as a choriocarcinoma led to improper treatment and progressive disease. Microscopically it revealed a relatively monotonous population of epithelioid cells arranged in nests with hyaline-like matrix surrounding the tumor cells. Differential diagnosis between placental site trophoblastic tumor and carcinoma was ruled out based on histology and immunohistochemistry. The patient developed lung and brain metastasis after 10 months and is alive with disease 1½ years thereafter and is taking palliative chemotherapy. The patient had β-HCG level of 85.1 mIU/mL at the time of diagnosis; but just before metastasis, the levels rose. Awareness of the histological features of ETT is essential to avoid misdiagnosis, as it represents a tumor which is primarily treated by surgery rather than with chemotherapy.

In health systems with little public funding and decentralized procurement processes, the pricing and quality of anti-cancer medicines directly affects access to effective anti-cancer therapy. Factors such as differential pricing, volume-dependent negotiation and reliance on low-priced generics without any evaluation of their quality can lead to supply and demand lags, high out-of-pocket expenditures for patients and poor treatment outcomes. While pooled procurement of medicines can help address some of these challenges, monitoring of the procurement process requires considerable administrative investment. Group negotiation to fix prices, issuing of uniform contracts with standardized terms and conditions, and procurement by individual hospitals also reduce costs and improve quality without significant investment. The National Cancer Grid, a network of more than 250 cancer centres in India, piloted pooled procurement to improve negotiability of high-value oncology and supportive care medicines. A total of 40 drugs were included in this pilot. The pooled demand for the drugs from 23 centres was equivalent to 15.6 billion Indian rupees (197 million United States dollars (US$)) based on maximum retail prices. The process included technical and financial evaluation followed by contracts between individual centres and the selected vendors. Savings of 13.2 billion Indian Rupees (US$ 166.7 million) were made compared to the maximum retail prices. The savings ranged from 23% to 99% (median: 82%) and were more with generics than innovator and newly patented medicines. This study reveals the advantages of group negotiation in pooled procurement for high-value medicines, an approach that can be applied to other health systems. Lorsque les systemes de sante recoivent peu de fonds publics et que leurs processus d'achat sont decentralises, le prix et la qualite des medicaments contre le cancer ont un impact direct sur l'acces aux traitements efficaces contre la maladie. Des facteurs tels que l'application de prix differencies, les negociations en fonction des volumes ainsi que la confiance placee dans des generiques bon marche dont la qualite n'a pas ete evaluee peuvent entrainer des decalages entre l'offre et la demande, d'enormes depenses non remboursables pour les patients et de pietres resultats therapeutiques. Bien que les acquisitions groupees de medicaments puissent contribuer a resoudre certains de ces problemes, le suivi du processus d'achat requiert un engagement considerable au niveau administrad Les negociations collectives en vue de fixer les tarifs, l'etablissement de contrats types assortis de conditions generales standardisees, mais aussi les achats effectues par des hopitaux en particulier peuvent egalement faire baisser les couts et ameliorer la qualite sans necessiter d'importants investissements. Le National Cancer Grid, un reseau reunissant plus de 250 centres d'oncologie en Inde, a teste un dispositif d'achat groupe visant a assurer une meilleure negociabilite pour des medicaments et soins de soutien essentiels contre le cancer. Au total, 40 substances ont ete prises en compte dans ce projet pilote. La demande groupee en medicaments emise par 23 centres equivalait a 15,6 milliards de roupies indiennes (197 millions de dollars americains) d'apres le prix maximal de vente au detail. Ce processus prevoyait une evaluation technique et financiere, puis des contrats entre chaque centre et les distributeurs selectionnes. Des economies de 13,2 milliards de roupies indiennes (166,7 millions de dollars americains) ont pu etre realisees par rapport au prix maximal de vente au detail. Ces economies etaient comprises entre 23 et 99% (mediane: 82%) et concernaient davantage les medicaments generiques que les marques et les medicaments recemment brevetes. La presente etude revele les avantages que representent les negociations collectives lors des achats groupes de medicaments essentiels, une approche applicable a d'autres systemes de sante. En los sistemas sanitarios con escasa financiacion publica y procesos de adquisicion descentralizados, el sistema de fijacion de precios y la calidad de los medicamentos contra el cancer afectan directamente al acceso a una terapia eficaz contra dicha enfermedad. Factores como los diferentes sistemas de determinacion de precios, la negociacion en funcion del volumen y la dependencia de genericos de bajo precio sin evaluacion de su calidad pueden generar retrasos en la oferta y la demanda, elevados gastos para los pacientes y malos resultados en el tratamiento. Aunque la adquisicion conjunta de medicamentos puede ayudar a abordar algunos de estos retos, el seguimiento del proceso de adquisicion requiere una inversion administrativa considerable. La negociacion colectiva a la hora de determinar los precios, la emision de contratos unificados con terminos y condiciones estandarizados y la adquisicion por parte de algunos hospitales tambien reducen los costes y mejoran la calidad sin necesidad de realizar una gran inversion. La Red Nacional de Cancer, una red que cuenta con mas de 250 centros oncologicos en la India, puso a prueba la adquisicion conjunta con el fin de mejorar la negociabilidad de medicamentos oncologicos y de tratamiento complementario que resultaban costosos. En esta prueba piloto se Incluyo un total de 40 medicamentos. La demanda conjunta de medicamentos por parte de 23 centros fue equivalente a 15 600 millones de rupias indias (197 millones USD) segun los precios minoristas maximos. El proceso incluyo una evaluacion tecnica y financiera, asi como contratos entre centros independientes y proveedores seleccionados. Se logro un ahorro de 13 200 millones de rupias indias (166,7 millones USD) en comparacion con los precios minoristas maximos. El ahorro oscilo entre el 23 y el 99% (media: 82%) y fue mas alto con los medicamentos genericos que con los de marca y los recien patentados. Este estudio pone de manifiesto las ventajas de la negociacion colectiva en lo que respecta a la adquisicion conjunta de medicamentos costosos, un enfoque que se puede aplicar a otros sistemas sanitarios. [phrase omitted], Introduction Systemic anti-cancer therapy constitutes a key component of cancer management. (1) Over the years, advances in our understanding of cancer biology, coupled with discovery of different classes of anti-cancer [...]

Byline: Tabassum. Wadasadawala, Shalaka. Joshi, Sushmita. Rath, Palak. Popat, Ayushi. Sahay, Seema. Gulia, Prabhat. Bhargava, Revathy. Krishnamurthy, Dileep. Hoysal, Jessicka. Shah, Mitchelle. Engineer, Jyoti. Bajpai, Bhavika. Kothari, Rima. Pathak, Dushyant. [...]

Abstract Background Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm. The commonest site of their occurrence in female genital tract is body of the uterus. MMMT of the cervix is extremely rare. Case presentation We report the clinical, pathological and immunohistochemical profile and diagnostic difficulties in a case of giant MMMT of the cervix in a postmenopausal woman who presented with a large cervical mass. On microscopic examination, initially tumor appeared to be endometrial stromal sarcoma, however, immunohistochemical examination revealed the biphasic nature of the tumor. The malignant epithelial component was basaloid squamous carcinoma with homologous sarcomatous component. The patient was treated with surgery. However, she experienced vaginal vault recurrence four months after the initial treatment, which was successfully treated with pelvic radiotherapy. Conclusion Accurate diagnosis of cervical MMMT is important for appropriate treatment of the patient.

Abstract Background Epithelial ovarian neoplasms are an important cause of morbidity and mortality in women. The surgical management of ovarian neoplasms depends on their correct categorization as benign, borderline or malignant. This study was undertaken to evaluate the accuracy of intra-operative frozen section in the diagnosis of various categories of ovarian neoplasms. Methods Intraoperative frozen section diagnosis was retrospectively evaluated in 217 patients with suspected ovarian neoplasms who underwent surgery as primary line of therapy at our institution. This was compared with the final histopathologic diagnosis on paraffin sections. Results In 7 patients (3.2%) no opinion on frozen section was possible. In the remaining 210 patients frozen section report had a sensitivity of 100%, 93.5% and 45.5% for benign, malignant and borderline tumors. The corresponding specificities were 93.2%, 98.3% and 98.5% respectively. The overall accuracy of frozen section diagnosis was 91.2%. The majority of cases of disagreement were in the mucinous and borderline tumors. Conclusion Intraoperative frozen section has high accuracy in the diagnosis of suspected ovarian neoplasms. It is a valuable tool to guide the surgical management of these patients and should be routinely used in all major oncology centers.