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Background: Myeloid sarcoma (MS) is an extramedullary disease of immature myeloid cells with incidence of 1-2% among all acute myeloid leukemia (AML) cases. Less than twenty cases of aleukemic MS with initial presentation as intestinal mass have been described in the English literature. Case report: Here we report a case of 45 year old female with normal haematology workup who presented with acute abdominal pain and distension. On evaluation, she was found to have ileocolic intussusception of gangrenous bowel, so managed by limited right hemicolectomy and initially reported as Non Hodgkin lymphoma (NHL).During follow-up she was found to have a globular mass in right lumbar region that was diagnosed as myeloid sarcoma. On further followup, her TLC count was gradually increasing. Conclusion: The index case highlights the unusual presentation of isolated intraabdominal MS which was clinical diagnosed as subacute intestinal obstruction in a young female with normal hematological profile.

Objectives: The aim of this study was to study patient, disease, and treatment related characteristics in geriatric patients 65 years and older treated by Radiotherapy (RT). Material and methods: A retrospective observational and descriptive study was conducted in a tertiary care gov- ernment institute with academic and research potential. The electronic medical records, medical documents, and Radiotherapy treatment charts were retrieved and studied. Results: 247 patients aged 65 years and older were included over 2-year study period. Mean age was 70.3 years and the oldest patient treated was of 94 years. 66% patients were males. 82 patients (33%) had metastatic disease. The common sites of origin were head and neck (28%), lung (23%), genitourinary (20%), and gastrointestinal malig- nancies (15%). 125 patients (51%) were having one or more co-morbidities. 135 patients (55%) were treated with radical intent. 66 patients (27%) received chemotherapy in concurrent setting. 89 patients (36%) were hospitalized for some duration of their RT course. In 58 patients (23%), RT was interrupted briefly. 46 patients (19%) could not complete the prescribed RT. 8 patients (3%) developed Grade 3 and 4 hematological toxicities. 57% patients developed Grade 2,3 mucocutaneous toxicities. 53% patients developed Grade 2,3 GI toxicities. Mortality rate while on treatment was 4%. Conclusion: Geriatric patients, though more prone to develop systemic and site-specific toxicities warranting supportive care in indoor or outdoor setting, can be offered Radiotherapy either alone or concurrently with che- motherapy. Such patients present with heterogeneous spectrum of entities often posing a therapeutic challenge to clinicians; but proper selection of cases and diligent supervision may allow these patients to be treated with Radiotherapy with radical or palliative intent as indicated.

Introduction: Carcinoma cervix is the most common gynecological malignancy in India and a major cause of cancer mortality and morbidity in the females despite Concurrent chemoradiotherapy (CCRT). Attempts are on to improved overall survival by addition of adjuvant chemotherapy (ACT) to CCRT. Aim: The aim of this study is to establish toxicity profile of double-agent ACT after CCRT and ICRT in locally advanced cervical cancer (LACC) and to compare it with standard chemoradiation protocol. Materials and Methods: Patients were randomized into two arms: in conventional arm (Arm 1, n = 23), patients received a standard protocol of weekly injection cisplatin 40 mg/m2 concurrently with pelvic external beam radiotherapy (5040cGy/28 fractions) followed by ICRT (03 fractions of 7 Gy each). In interventional arm (Arm 2, n = 24), patients received CCRT/ICRT protocol; and were further offered ACT with three cycles of consolidation chemotherapy using injection paclitaxel and injection carboplatin every 3 weeks after CCRT and ICRT. Results: The incidence of anemia was 14/23 (50% Grade 1) in Arm 1 and 12/24 in Arm 2 (17% Grade 1, rest higher grade). In Arm 2, 37% of patients had ≥Grade 2 neuropathy and 16% of patients had Grade 1 alopecia, whereas nil incidence was reported in Arm 1 (P = 0.005 and 0.04, respectively). Grade 3 neutropenia was observed in 4/23 (17%) patients of Arm 1 and 8/24 patients (33%) of Arm 2. None of the patients in Arm 1 required indoor supportive care while 4/24 patients (17%) were managed as an indoor patient. Among late toxicities, in Arm 2, the incidence of Grade 2 and Grade 3 anemia was 42%, whereas in Arm 1, its incidence was 22%. In Arm 1, no patient exhibited features of neuropathy, whereas, in Arm 2, 12/24 (50%) of the patients had neuropathy (P value for these two late events was

Survival rates for childhood cancer diagnosed before the age of 18 years have improved due to aggressive multidisciplinary therapeutic approaches. Parents have been found to be psychologically affected by their child’s diagnosis, treatment, side-effects of the treatment and child’s health status. Though parental emotional difficulties, such as depression and anxiety, have been reported to decrease after cancer treatment, parents continue to experience chronic post-traumatic stress (PTS) for a long time after their child’s treatment. Parents may also report persistent feelings of loss, uncertainty, and anxiety about the recurrence of the disease or the emergence of late effects in their child. Such illness-specific distress of the parents should be assessed in order to fully understand their psychosocial functioning. Sensitizing health care professionals to the identification of this factor and its associated difficulties is essential for the implementation of efficient intervention strategies. General health of parents plays an important role in continuation of care for the sick child and the treatment follow up. Parental distress and PTS are associated with the emotional and behavioral functioning of children with cancer. There is a genuine need to offer programs of psychological attention to parents of children with cancer in order to reduce their emotional and cognitive psychopathology and to help them adopt adequate coping strategies.

Context: Burkitt's lymphoma (BL) is one of the fastest growing malignancies. It is the most common subtype of Non-Hodgkin's lymphoma in childhood. It has three major subtypes – endemic, sporadic, and immunodeficiency-associated types. Aims: This study aims to study the clinicomorphologic features of this disease entity and to find optimal imaging technique for such cases. Setting and Design: A retrospective observational study in a tertiary care center of academic and research potential. Subjects and Methods: We are presenting three unusual cases of sporadic type of BL who presented initially as localized right iliac fossa mass mimicking as acute appendicitis. Initially, localized presentation progressed to diffuse abdominal mass lesions causing intestinal obstruction. Results: These cases had emphasized the importance of accurate diagnosis by the ultrasonography (USG) or computed tomography (CT) scan for early diagnosis so as to manage such cases simply by early appropriate medical treatment. Conclusion: In this article, we will discuss the clinical and imaging features of BL with the role of USG, CT scan and positron emission tomography/CT in the abdominopelvic imaging of pediatric patients.

Patients diagnosed with localized prostate cancer have many curative treatment options including several forms of advanced conformal Radiotherapy. Proton radiation is one such radiation treatment modality and, due to its unique physical properties, offers the appealing potential of reduced side effects without sacrificing cancer control. Patients of proton beam therapy PBT for prostate cancer had been continuously growing in number due to its promising characteristics of high dose distribution in the tumor target and a sharp distal fall off. While theoretically beneficial, its clinical values are still being demonstrated from the increasing number of patients treated with proton therapy, from several dozen proton therapy centers around the world. High equipment and facility costs are often the major obstacle for its wider adoption. The picture will be clearer in coming decade as more and more centers throughout the world avail access to this technique and more data emerges on PBT. Suhag V | Sunita BS | Vats P "Proton Beam Therapy for Prostate Cancer: An Overview" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21439.pdf

Concurrent chemoradiation (CCRT) is the mainstay of treatment for majority of locally advanced head and neck carcinomas (LAHNC). Addition of chemotherapy to radiotherapy increases the probability of local control and improved disease-free survival but at the cost of acute and delayed toxicities. A retrospective observational study. To compare the tolerance of CCRT and its toxicity profile amongst two groups, first arm (Arm A) being outdoor patients and the second group (Arm B) was hospitalized patients of LAHNC in an oncology centre of a tertiary care hospital. A total of 100 patients were enrolled, 50 in each arm. Overall, the most common site was oropharynx, followed by larynx and hypopharynx. 38 patients in Arm A received full 6 cycles of weekly chemotherapy with Inj Cisplatin infusion. 39 of the hospitalized patients completed 6 cycles of weekly Cisplatin, 04 patients also received 3 weekly Cisplatin. Average duration of treatment was 49.18 days in arm A and 50.92 days in arm B. Incidence of Grade II onwards dysphagia was 48 and 45 (96 and 90%) in Arm A and Arm B respectively; Chi Square value—0.6 (Yate’s corrected); P value—0.43. Grade III oral mucositis was seen in 14% patients in Arm A and 34% patients in Arm B. 3 patients (6%) in Arm A and 14 patients (28%) in Arm B has Grade II and III hematological toxicities and nephrological toxicities. Aspiration pneumonia was seen in 2 patients (4%) in Arm A and in 4 patients (8%) in Arm B, Chi Square value—0.2 (Yate’s corrected) P value—0.67. The incidence of febrile neutropenia was 3 and 10 in Arms A and B (6 and 20%) respectively. The tolerance of CCRT in hospitalized patients is marginally better, with relatively few associated complications as compared to outdoor setting. Every institute should promulgate its own guidelines regarding hospitalization of such patients.

Background: The burden of oncology patients in the most developing countries including India has witnessed a steady, progressive, and significant upward trend attributed mainly to increased life span, availability of better imaging modalities, increased awareness, and lifestyle and environmental changes. The management of such patients in government setup often presents lots of challenges such as advanced stage of presentation, existence of medical comorbid conditions, scarcity of beds, and long multimodal treatment often complicated with therapy-induced toxicities. Materials and Methods: A prospective study was undertaken in a Radiation Oncology ward catering to male patients over 6-month duration in a superspecialty hospital of defense services. The clinical, pathological, and treatment-related attributes were recorded. Wherever possible, the clinical course of stay, complications during admission, and the response to primary management were studied. Results: A total of 570 patients were admitted for 6-month duration. Of these patients, 240 were transferred in from other peripheral service hospitals while the remaining were admitted directly from this hospital or transferred from various wards of this hospital. The mean age of the patients was 46.5 years. Most common histology was squamous cell carcinoma. The most common site of primary was head and neck, followed closely by central nervous system tumors and gastrointestinal tract. A total of 185 patients were fresh cases admitted for workup and complete duration of definitive management (of which 82 received concurrent chemoradiation), 280 patients were for follow-up, 70 patients were admitted briefly for supportive care during a while on chemoradiation, and 15 patients were admitted for administrative reasons. Fifty-eight patients developed Grade II and onward therapy-induced hematological, gastrointestinal, cutaneous complications, and 14 patients suffered from febrile neutropenia. Thirty patients developed other significant complications warranting cross-referrals to other specialists. One hundred and thirty patients underwent more than one imaging modalities (contrast-enhanced computed tomography, magnetic resonance imaging, bone scan, and positron emission tomography-computed tomography). The duration of stay varied from 3 to 64 days, with an average duration of 38 days. There were 18 deaths during the study period. Conclusion: The course of hospitalization for oncology cases is often prolonged and complicated by significant complications, warranting aggressive supportive care by various concerned specialists. These patients often require multiple imaging for primary and metastatic workup. There is a need for judicious selection of patients meriting admission for optimum utilization of existing resources.

Context: Increased levels of prostaglandins have been detected in cancers of several anatomic sites, including those of endometrium. Several studies have shown that cyclooxygenase-2 (COX-2) expression is aberrantly increased in various human epithelial cancers, and cellular up-regulation of COX-2 may be a common mechanism in epithelial carcinogenesis. Aims: To examine the expressions of COX-2, p53 and vascular endothelial growth factor (VEGF) in endometrial cancer and their relationships with clinicopathologic characteristics. Setting and Design: A retrospective observational study in a tertiary care center of academic and research potential. Subjects and Methods: Sections from fifty cases of endometrial carcinoma were stained imunohistochemically with COX-2, p53, and VEGF. The expressions of COX-2, p53, and VEGF in endometrial cancer were examined. Results: COX-2 was positive 19 cases (38%) of endometrial carcinoma. The COX-2 immunopositivity was 50%, 28%, and 41% in Grade 1, Grade 2, and Grade 3; and 27%, 46%, 67%, and 100% cases of Stage I, II, III, IV, respectively. p53 was positive in 24 cases (48%); 0%, 33%, and 67% in Grade 1, Grade 2, and Grade 3; and 27%, 77%, 83%, and 100% cases of Stage I, II, III, IV, respectively. VEGF was positive in 21 cases (42%); of which 0%, 33%, and 67% cases were in Grade 1, Grade 2, and Grade 3; and 17%, 77%, 83%, and 100% cases were in Stage I, II, III, IV, respectively. Conclusion: The expression of COX-2 increase with stage of the endometrial tumor and with the expression of p53 and VEGF in the endometrial carcinomas. COX-2 inhibitors may have role in the prevention of endometrial carcinomas in high-risk cases and in preventing recurrences after treatment.

Background: Palliative radiotherapy (PRT) plays a significant role in the palliation of symptoms in patients with cancer and constitutes nearly 50% of the workload in different settings. Aims: The aim is to study patient-, disease-, and treatment-related characteristics in locoregionally advanced and metastatic malignancies meriting palliative management. Setting and Design: This was a retrospective observational study in a tertiary care government institute with academic and research potential. Methodology: The electronic medical records, medical documents, and radiotherapy (RT) treatment charts were retrieved and studied. Observations: A total of 460 patients were included in the study over 2 years, forming 30% of the total number of patients treated during the study period. Three hundred and ninety-six patients received PRT to the metastatic sites, while 64 patients received extremely hypofractionated PRT to the primary for symptomatic relief. Totally 442 patients showed good symptomatic response to PRT. One hundred and thirty-eight patients underwent re-irradiation. Lung was the most common primary site seen in 155 cases. The most common indication for PRT was palliation of pain from painful metastases as seen in 240 cases, and the next common indication was palliative whole-brain RT for brain metastases as seen in 159 cases. Conclusion: PRT forms an integral and important aspect of palliative care to the vast number of patients harboring metastatic disease that warrants some form of treatment for symptomatic relief. Short course of PRT in outdoor setting is a preferred mode of treatment to improve the quality of life of these distressed patients.

Pulmonary artery aneurysm is rare condition in neonates which usually presents with compression on the surrounding vital structures. By definition, an aneurysm is focal dilatation of a blood vessel that involves all three layers of vessel wall. Pulmonary artery aneurysm is defined as focal or fusiform dilatation of the PA beyond its maximum normal caliber. Early recognition and treatment are important for reducing morbidity and preventing mortality. The patients of PAA can be absolutely asymptomatic clinically and may be detected on radiograph or computed tomography or echocardiography. They may present as chest pain, dysnoea, or hemoptysis. It requires multidisciplinary approach for the diagnosis and treatment. It is very important to diagnose and manage the PAA as early as possible due to its high morbidity and mortality. Hence CTA is most important for the accurate evaluation of the PAA for its prompt diagnosis and treatment to reduce the risk of morbidity and mortality. Management of the PAA is surgical as well as medical depending upon the risk factors. The conservative management of PAA is serial follow up and periodic assessment of PAA. This is first case report of congenital aneurysm of pulmonary artery causing extrinsic compression over the left main bronchus leading to collapse. The case was successfully managed with surgical translocation of RPA in front of Ascending aorta, angioplasty of MPA & LPA and repair of the ASD; thereby relieving the compression over the left main bronchus and future complications. Key words: Pulmonary artery aneurysm, Congenital, CT Scan, CT Angiography, Surgery.

As a result of vast global improvement of health care and living conditions, the world population is aging. In developed countries, more than half of the cancers occur in patients aged 70 and older. In booming Asian nations, such as India, the aging trend is particularly striking, and therefore geriatric oncology is rapidly coming at the foreground of oncology practice. As these patients have special needs and a different approach to treatment, there is a strong need for the emergence of geriatric oncology as a sub specialty in oncology. Scientific data show that a geriatric assessment identifies many problems in older people with cancer, adds prognostic information, and might improve the outcomes of these patients. There is a genuine unmet requirement to design and implement the following: development of individually tailored geriatric assessment tools for different oncology centers; cooperation of aging and cancer research in the understanding of cancer biology, aging and physiology; improved clinical study designs; development of geriatric oncology programs; and screening tools for geriatric patients made accessible to family physicians.

Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments causing malabsorption. The cachexia-anorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, anorexia, early satiety, fatigue and weakness due to shifts in metabolism caused by tumour by-products and cytokines. Cachexia is a distressing and debilitating condition, affecting significant numbers of patients with advanced disease and is the primary cause of death in about 20% of all patients with cancer. Though cachexia is most commonly associated with particular tumours, such as head and neck, gastrointestinal tract, pancreas, central nervous system and lung, it may affect any patient with any tumour at any site; no patient and no tumour are excluded. Current treatment for principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. A careful decision based on good clinical judgement is necessary before deciding to start either enteral or parenteral nutrition, to avoid a useless, costly and difficult treatment. Treatment should be directed toward improvement in the quality of life of the patient and should often include nutritional counseling. It should take into consideration both disease and treatment related factors as well as the cachexia syndrome itself.

Background Cells with stem cell like properties in solid organ malignancies like breast and pancreas have been studied over the last decade and have been found to be associated with poor prognosis. Presence of CD44 positive and CD24 negative tumor cells in breast carcinoma (cells with ‘stem cell’ like property) as marker of aggressiveness and poor prognosis was checked for association with various markers of disease aggression like age at presentation, size of tumor, histological grade of tumor, triple negative status, level of micro-vessel density, and nodal status. Methods Single and double staining immunohistochemistry protocol was used for CD24 and CD44 staining. The staining protocol was repeated with more contemporary techniques using fluorescent chromogen also. Results 52 cases, all females who underwent modified radical mastectomy at a tertiary care hospital over a period of 3 years, were evaluated. No association was found between presence of stem cells and size of lesion, histological grade, triple negative status or micro-vessel density. However, significant association was found with respect to younger age of presentation ( p value = 0.044). 20 out of 25 cases with nodal metastasis were positive for presence of stem cells ( p value is 0.0003). Further, 18 of these 20 cases also had stem cells in the metastatic nodule. Fluorescent chromogens (FITC and Cyanine Red) revealed similar results. Conclusion Cases positive for stem cells showed earlier onset of disease and proneness to nodal metastasis.

Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients’ wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.

Central nervous system neoplasms include diverse group of tumors with a wide spectrum of morphologies, tissues of origin, histologic subtypes and molecular abnormalities. Despite their relatively rare occurrences, these tumors can result in considerable mortality as well as morbidity.

Extramedullary plasmacytoma (EMP) is defined as neoplastic proliferation of plasma cells in the soft tissue. It represents approximately 3% of all plasma cell neoplasms. EMP of the head and neck are very uncommon tumors, representing approximately 0.4% of all head and neck malignancies; amongst them, plasmacytoma of the maxilla is extremely rare. We present a rare case of EMP which had metastasized to multiple cervical lymph nodes and was associated with aspergillosis. The possibility of extramedullary plasmacytoma should be considered when an elderly patient presents with symptoms of recurrent rhinosinusitis not responding to conservative management and imaging shows a destructive soft tissue mass.

Objectives: To compare locoregional control with alternating chemo radiation and radiation alone in patients with locally advanced head and neck carcinoma.Study Design: A prospective randomized study.Setting: Tertiary academic referral center.Patients: 50 patients of biopsy proven locally-advanced carcinoma of head and neck.Intervention: 25 patients were kept in Group I or study group (i.e. alternating chemo-radiation) and 25 patients in Group II or control group (i.e. radiation alone). In the study group, patients were given 3 cycles of chemotherapy (Cisplatin 20 mg/m[2] and Inj. 5-FU 200mg/m[2] from day 1–5 of each week) during weeks 1,5 and 9 alternated with radiation dose of 10Gy/week was given during weeks 2,3,4 and 6,7,8. In the control group, patients were given a total dose of 60Gy in 6 weeks.Outcome measures: The response rate at the primary site and nodal site was better in study group as compared to control group.Results: On comparing the response at the primary and nodal site together, 72% (18/25) patients of group I and 44% (11/25) patients of group II showed CR. PR was seen in 28% (7/25) and 36% (9/25) patients in group I and II respectively. No response was seen in 5/25 (20%) of patients in Group II.Conclusion: Our study has revealed that alternating/ sequential chemoradiation is a promising and feasible approach for patients in advanced head and neck cancer.

Over the past few decades, the incidence and prevalence of most cancers has witnessed a consistent upward trend in majority of developing countries due to various reasons. Unfortunately, most of these countries continue to battle lots of challenges in cancer care, including poverty, illiteracy, lack of awareness, lack of dedicated oncology centers, non-existent hospice care, administrative hurdles, shortage of skilled manpower and indifferent attitude of most governments. These countries need the support of developed countries in various forms in their fight against cancer. Time has come when we need to push ourselves out of our comfort zones to evolve a multipronged realistic approach to decrease the suffering from cancer and to make this world a happy healthy place.

Buccal mucosa squamous cell carcinoma (BMSCC) is a rare but aggressive form of oral cavity cancer, associated with a high rate of locoregional recurrence and poor survival [1]. Patients with BMSCC have a worse stage-for-stage survival rate than the patients with other oral cavity sites [2]. It is not known to spread to distant organs. In these patients combined modality treatment incorporating surgery, adjuvant radiotherapy and chemotherapy should be considered as the best practice [3]. We report a case of locally advanced BMSCC which metastasised to left adrenal on presentation, picked up by PET-CT and later confirmed by CT-guided FNAC. An exhaustive pubmed search suggests that this is the first case of carcinoma buccal mucosa metastasising to adrenals, though rarely other sites of distant metastases have been reported; including brain, pericardial cavity, liver, lung, thyroid, bone and bone marrow [4]. We recommend a thorough metastatic workup including PET-CT for patients who present with advanced head and neck squamous cell carcinomas.

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Unusually it can be found in other locations as well. Ectopic thymoma rarely presents as an intrathoracic tumor. We report a case of an ectopic thymoma presenting as a giant right intrathoracic tumor that was treated with resection. The patient was a 49-year-old postmenopausal lady who presented with heaviness in chest and breathlessness. Detailed investigation including chest computed tomography scan and magnetic resonance imaging revealed a well-defined large solid tumor in the right thoracic cavity. Surgery was performed based on the radiological findings. A large solid tumor measuring 12 cm x 10 cm x 8 cm was found in the thoracic cavity, adherent to the pericardium, diaphragm and the right mediastinal pleura without apparent invasion. The tumor was completely resected. The diagnosis given as World Health Organization classification-Type B1 Muller-Hermelink classification-predominantly cortical thymoma.