Vivek Kaushal

We are presenting a 2-year male child with large abdominal mass extending from right inguino-scrotal region to suprapubic region of size 4.0 × 5.0 cm. Mass causing pressure effect over bilateral kidneys and ureters with bilateral dilated renal pelvis and extending into the right inguinal region and pelvis. Histopathologically and immunocytochemically patient was confirmed as rhabdomyosarcoma of the retroperitoneum. Patient treated with six cycles of infusion chemotherapy with 3- weekly VAC regimen and was having progressive disease because of the aggressive behaviour of the disease and further treated with second line chemotherapy. The present case is a very unusual and rare site of metastatic presentation of the Rhabdomyosarcoma.

We report here a rare case of primary malignant melanoma of the female urethra. A 60-year-old female presented at our hospital with a two month history of painful lump right inguinal region, dysuria, poor stream, gross hematuria, intermittent blood spots and a mass at the external urethral meatus. The physical examination revealed a soft, small, peanut-sized lesion through the urethral orifice. The mass was tan colored, non ulcerated, and protruded from the external urethral meatus. It was resected by wide local excision under spinal anesthesia. The histopathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen showed evidence of metastasis to liver. We discuss the clinicopathologic features and treatment of this tumor.

For the last 50-years, hepatocellular carcinoma (HCC), the primary liver carcinoma, possess a major worldwide risk to public health. Although it is still more prevalent in developing countries; there is a recent positive growth pattern in developed countries, more so 2000 onwards, as a consequences of higher prevalence of hepatitis C infection and increase in consumption of alcohol. Further appearance of extrahepatic metastasis makes it more vulnerable. New multimodality approaches are explored in literature for advanced metastatic disease which are unresectable. Although local therapy and liver transplant are carried out in a lots of case series, targeted therapies are still the standard of care in many centres especially for inoperable, metastatic cases. Here we present an atypical case of multifocal hepatocellular carcinoma with extrahepatic adrenal metastasis treated by oral targeted agent sorafenib only.

Esophageal cancer is the seventh most common cancer constituting 3.2% of all cancer cases and sixth most common cause of mortality constituting 5.3% cases worldwide in 2018. Most common presenting symptom is dysphagia which is seen in 80–90% of patients. Most patients present in locally advanced stage and because of extensive local disease palliative radiotherapy plays a significant role. Aim and objectivesAim of the study was to compare two palliative radiotherapy schedules- 30 Gy in 10 fractions over 2- weeks versus 20 Gy in 5 fractions over 1-week in locally advanced carcinoma esophagus. Objectives were to compare above schedules based upon symptomatic relief and tolerability by the patient. Material and methodsThe study was a randomized control study done from July 2017 - December 2018 on 60 previously untreated, histo-pathologically proven patients of squamous cell carcinoma esophagus (locally advanced) reporting in the Department of Radiation oncology, Pandit B. D. Sharma PGIM...

Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the study was designed to reduce the treatment time and increase efficacy. Aims: Comparative evaluation of the efficacy, toxicity, local control, and survival of concomitant boost radiotherapy (CBRT), CBRT with concurrent chemoradiation (CBRT + CCT) and conventionally fractionated radiotherapy with concomitant chemotherapy (CFRT + CCT) in locally advanced HNC (LAHNC). Materials and Methods: Patients with LAHNC were randomly assigned to 3-groups of 30-patients each. Group I (CBRT) received, 45 Gy/25#/5-weeks and 18 Gy/10# concomitant boost in the last 2-week of treatment, receiving a total dose of 63 Gy. Group II (CBRT + CCT) received CBRT with concomitant cisplatin 75 mg/m 2 on day 1, 17, and 34. Group III (CFRT + CCT) received 64 Gy/32#/6.2 weeks, concurrent with injection cisplatin 75 mg/m 2 on day 1, 22, and 42. Statistical Analysis Used: Stata 9.0 SPSS and Chi-square test were used for analysis and disease-free survival (DFS) rates were calculated using the Kaplan–Meier method. Results: The median follow-up period was 8.2 months. At last follow-up, locoregional control was 36%, 57%, and 40% and DFS was seen in 33%, 53%, and 40% of patients in Group I, II, and III, respectively. Grade-3 cutaneous reactions were significantly higher in Group-II as compared to that of Group-III (P = 0.033) and Group-I (P = 0.715). Conclusion: All three groups have similar response rates and DFS with manageable toxicity.

To study the levels of neutrophil gelatinase associated lipocalin (NGAL) in head and neck squamous cell carcinoma (HNSCC). This was a non randomized case control study conducted at Department of Biochemistry, in collaboration with Regional Cancer Center over a period of one year. The study population included 50 adult newly diagnosed HNSCC patients reporting in outpatient department at Regional Cancer Center and compared with 50 healthy controls. NGAL was estimated by ELISA technique. Student t test and χ(2) test were applied for comparison of means of study groups. Correlations between groups were analyzed using Pearson correlation coefficient (r) formula. Patients with HNSCC exhibited significantly increased levels of NGAL (P < 0.05) as compared to healthy controls (978.88 ± 261.39 ng/mL vs 34.83 ± 7.59 ng/mL). Out of 50, 26 patients (52%) were in stage IV, 21 (42%) in stage III, 1 (2%) patient in stage II and 2 (4%) patients were in stage I. Metastasis was absent in 98% patien...

Head and neck cancer forms the major chunk of cancer patients in India. About 2/3rd of the patients present in locally advanced stage in which the cure rates are low. Concomitant chemoradiation with platinum compounds is the standard treatment for such patients as it offers organ and function preservation with better quality of life. Meta analysis of chemotherapy in head and neck cancer update (2009) shows that concomitant chemoradiation provides an absolute survival benefit of 6.5% at 5 years. Many chemotherapeutic agents including 5-FU, taxanes and biologically targeted therapy have been investigated in an effort to maximize the locoregional control and survival in locally advanced head and neck cancer. Oral chemotherapeutic agent gives the ease of self administration on daily basis without the need for hospital admission and intravenous infusion. Theoretically, daily administration of oral chemotherapy agent mimics the continuous infusion of a parenteral agent. Capecitabine (oral...

Approximately three-quarters of all invasive breast cancers in women are hormone receptor positive. Endocrine manipulation is an integral component of breast cancer treatment. Hormonal therapy in breast cancer can be given in adjuvant, neo-adjuvant, therapeutic or preventive setting but the most common and most important indication is the adjuvant therapy. Adjuvant hormonal therapy has a time tested and strongly established role to lower the risk of breast cancer coming back and new cancer developing in the other breast after defmitive treatment with surgery. Hormonal therapy also plays a significant role in palliative treatment of advanced or metastatic disease. Nee-adjuvant therapy before definitive surgery and chemoprevention in women with high risk of developing breast cancer are newer avenues of hormonal therapy. Hormonal therapy at present is only indicated for hormone receptor positive breast cancers however NCCN 2009 has recommended the consideration of trial for endocrine t...

The driving force behind the use of proton therapy in clinical radiotherapy is to exploit its physical and biological characteristics. Proton beam has the properties of; sharper penumbra, relatively low entrance skin dose (Plateau), Bragg peak and relative biological effectiveness (RBE) close to unity. With proton beam normal tissues can be spared due to rapid dose fall off leading to less side effects and complications. Proton beam has the ability to treat tumors close to the critical organs, which is especially beneficial in treating benign conditions. With the help of Pro ton beam therapy dose escalation and re-irradiation of recurrent tumors is possible. Proton therapy in indications including pediatric tumors is well established. In near future, proton therapy may replace the conventional radiotherapy if the portable proton therapy project succeeds.

Cervical vagal neurilemmomas are rare, usually asymptomatic, slow-growing tumours and defined as a benign, encapsulated neoplasm that arises in the nerve fibre. Magnetic resonant imaging (MRI) plays a central role in diagnosing vagal nerve neoplasm and in fact, provides important pre-operative information useful in planning optimal surgical treatment. A rare case of giant neurilemmoma is presented with a large swelling in the right side of the neck associated with breathlessness and paroxysmal cough. X-ray chest revealed large homogenous opacity in apical area of the right lung extending into the lower neck. MRI revealed a large 6 x 8 x 13 cm soft tissue, well defined mass with lobulated contours on the right side of the neck. The mass was pushing sternomastoid muscle anteriorly and carotid artery was pushed anteromedially. The mass was abutting the brachial plexus and compressing internal jugular vein. The mass was extending into the mediastinum up to the level of carina. The mass ...

Radiotherapy and combination chemotherapy are the available curative modalities of treatment for Hodgkin Iymphoma (HL). Traditionally HL has been treated with radiotherapy alone to full doses (30-50 Gy ) and extended fields to encompass involved and uninvolved contiguous regions. The role of RT in the management of HL has changed considerably over the last century with the advent of better staging, risk stratification strategies, effective chemotherapy and salvage regimens, and the progress in RT techniques and technology. According to our current knowledge, a stage and risk factor-based allocation into early favorable, early unfavorable, and advanced stages remains a suitable instrument to tailor risk-adapted therapy. In early-stage HL, combined modality therapy (CMT) is the established standard of careo The recomrnendations for the treatment of early HL are 2 to 4 cycIes of ABVD followed by IFRT of 20-36Gy with the ESMO group making further recommendations that favourable early HL...

Carcinomas are considered to be associated with increased cellular proliferation under antigenic stimulation and inflammation. Therefore, the markers of increased cellular turnover such as adenosine deaminase and uric acid were estimated quantitatively along with markers of inflammation such as C-reactive protein in squamous cell carcinoma of head and neck region. The levels of adenosine deaminase, uric acid, and C-reactive protein were estimated in 50 patients of squamous cell carcinoma of head and neck region before starting any treatment and compared with their corresponding levels in 30 healthy age and gender matched controls. The patients were divided into four groups depending on their staging and their results were compared statistically and the coefficient of correlation was calculated using Pearson's formula. The levels of adenosine deaminase, uric acid, and C-reactive protein were found to be significantly higher in patients of head and neck cancers as compared to the levels in controls (p < 0.001). The levels were also observed to rise with staging. A positive correlation was observed between adenosine deaminase and uric acid (r = 0.743, p < 0.001), adenosine deaminase and C-reactive protein (r = 0.648, p < 0.001) and also between C-reactive protein and uric acid (r = 0.712, p < 0.001). Thus, estimation of adenosine deaminase, uric acid, and C-reactive protein can help in making the diagnosis and assessing the severity of disease in patients of head and neck carcinoma.

Abstarct Leiomyosarcoma of the scrotum is a rare tumor. These tumors usually present as firm, rubbery, nontender, irregular masses. Scrotal leimyosarcomas tend to be slow growing tumors that tend to be present for years. It is best treated by wide local excision. We present a case of recurrent leiomyosarcoma of scrotum in a 57 year old patient, who recurred four

Langerhans cell histiocytosis is a rare disorder, usually occurring in children and young adults. A five year old male child presented with ulcers in lower left alveolar ridge with mobility of adjacent teeth of four months duration. After all relevant radiological and histopathological investigations final diagnosis of multicentric langerhans cell histiocytosis stage - II was made. The patient was put on chemotherapy with CHOP (Cyclophosphamide, Adriamycin, Vincristine and Prednisolone) regimen three weekly for eight courses. Now after six months of cessation of chemotherapy, the patient is in complete clinical remission.

Link between cancer and obesity appears paradoxical as cancer is classically seen as illness producing anorexia and massive weight loss. To measure obesity, researchers commonly use a formula based on weight and height known as the body mass index (BMI). According to WHO approximately 1.6 billion of the world’s adult are overweight and over 400 million are obese. Cancers of the endometrium, kidney, gallbladder, breast, colon and adenocarcinoma of the esophagus have been linked to obesity. Obesity and physical inactivity may account for 25 to 30 percent of several major cancers. Those with a body-mass index of at least 40 had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. On the basis of associations observed in some studies, it has been estimated that current patterns of overweight and obesity could account for 14 percent of all deaths from cancer in men and 20 percent of...

Hyperthermia in oncology refers to the application of concentrated therapeutic heat to treat cancer. Hyperthermia is known to cause direct cytotoxicity and also act as a radio sensitizer. The mechanism of action of hyperthermia appears to be complementary to the effects of radiation with regard to inhibition of potentially lethal damage and sublethal damage repair, cell cycle sensitivity, and effects on blood flow and tumor physiology which may be of particular interest with regard to tumor oxygenation and combination therapy with liposomal agents. Various clinical studies have shown that the critical temperature at which tumor needs to be heated is 41°C to 43°C. The enhanced cell killing is defmed as thermal enhancement ratio (TER) as the ratio of radiation doses without and with heat to produce same biological effect. Therapeutic Gain Factor is defined as the ratio of the TER in the tumor to the TER in surrounding normal tissue. Many chemotherapeutic agents have demonstrated syner...

Oral squamous cell carcinoma (OSCC) is the most common oral malignant neoplasm, mainly affecting individuals over 50 years old with a history of tobacco and alcohol use. The occurrence of this alveolar cancer in young individuals less than 20 years is unusual and, when it does occur, shows a weaker relation to those risk factors and a more aggressive clinical course. Due to the paucity of reports in this population, it is difficult to prove its increasing trend. A rare case of alveolar squamous cell carcinoma in a 16-year-young female with no history of tobacco or alcohol use is reported. Clinicopathological findings, etiology, and treatment are discussed. The increasing trend of oral squamous cell carcinoma in young women without known risk factors highlights the need for clinicians to be prepared to diagnose these lesions quickly and precisely, providing a better prognosis, chance of survival, and quality of life for the patient.

Gefitinib induced skin reactions especially acneiform and vesiculo-bullous pustular lesion are very common particularly in summer season or the area where climate temperature is towards the higher side. Almost 50% of the patients, who take Gefitinib, develop dermal reactions. Gefitinib induced acne may be related to excessive follicular hyperkeratosis, obstructions of the follicular ostium, follicular plugging and alteration of hair cycle progression, which lead to an inflammatory response. Here, we explored different treatment possibilities for the management of these types of cutaneous reactions and also the recommendations for the use of Gefitinib therapy. Multidisciplinary treatment approach in the form of oral antibiotics and topical application with proper education to the patient to prevent or manage the dermatological reactions in patients who are treated with Gefitinib are essential in order to minimize the negative likelihood of treatment disruptions or modifications.

Primary signet-ring cell carcinoma (SRCC) of the colon and rectum are rare form, which present at an advanced stage and have poor prognosis. Different treatment policies of SRCC during different gestational age of pregnancy are explored from the literature. A 26-year-old young pregnant female with 10-week gestation presented with constipation and blood in stools and on per rectal examination a tender circumferential stricture was present 2 cm above the anal verge. Magnetic resonant imaging (MRI) pelvis of the patient revealed rectal thickening, the biopsy of which revealed characteristic appearance of "linitis plastica" and diagnosed as poorly differentiated adenocarcinoma with signet ring morphology with wide spread positivity for cytokeratin & p53. With this diagnosis, patient underwent medical termination of pregnancy (MTP). SRCC of the colon comprises about only 1% of all cases of colon cancer. When compared with other types of adenocarcinoma, patients with SRCC in the...

The field of oncology is studded with fascinating case reports of rarities, and management of breast cancer by the oncologist has, at times, resulted in the surfacing of such instances of rarities. Pure squamous cell carcinoma (SCC) of the breast is such an example of a rare and generally aggressive malignancy constituting < 0.1% of invasive breast cancers. To the best of our knowledge, until 2006, only 5 patients of primary SCC of the breast, which presented clinically as breast abscess, have been reported in medical literature. We report the sixth worldwide case of pure primary SCC of the breast presenting as an abscess. In this report, we highlight the fact that a benign lesion like breast abscess can harbor such a rare malignancy. Clinicians should be aware of that fact, and adequate investigations should be done to rule out that possibility. Extensive literature review has been done to discuss the clinical and radiologic features as well as management of this rare lesion.

Primary gastrointestinal malignancies constitute only 1% of all paediatric neoplasms. The aim of this study was to describe our 18 years' experience with non-familial paediatric colorectal malignancies, outlining pertinent features of diagnosis, treatment and outcome. 9 patients of non-familial paediatric colorectal malignancies were admitted in PGIMS, Rohtak, Haryana between 1990 and 2008. After the initial surgical management, the advanced cases underwent chemotherapy and radiation therapy where required and were followed up. There were six male and three female patients (age range: 7 to 16 years). Three tumours arose in the rectum, three in the sigmoid colon, one each in the splenic flexure and appendix, and there was one case of diffuse colonic polyposis. All cases presented with obstruction and rectal bleeding. Two cases of sigmoid carcinoma were unresectable and expired 4 months post-surgery. The rest responded to radical resection. Three patients required palliative radia...

Carcinomas are considered to be associated with increased cellular proliferation under antigenic stimulation and inflammation. Therefore, the markers of increased cellular turnover such as adenosine deaminase and uric acid were estimated quantitatively along with markers of inflammation such as C-reactive protein in squamous cell carcinoma of head and neck region. The levels of adenosine deaminase, uric acid, and C-reactive protein were estimated in 50 patients of squamous cell carcinoma of head and neck region before starting any treatment and compared with their corresponding levels in 30 healthy age and gender matched controls. The patients were divided into four groups depending on their staging and their results were compared statistically and the coefficient of correlation was calculated using Pearson's formula. The levels of adenosine deaminase, uric acid, and C-reactive protein were found to be significantly higher in patients of head and neck cancers as compared to the ...

Gastrointestinal stromal tumors (GISTs) are malignant and rare form of soft tissue sarcoma of the digestive tract. The incidence of gastrointestinal stromal tumors is very low Kramer et al. 2005 Jejunal GISTs are extremely rare. Here we present a rare case of jejunal GIST with unusually large size at presentation. The patient presented with severe abdomen pain, exophytic growth, and dimorphic anemia. Surgical resection of the tumor was carried out, and operative findings revealed a 15 × 10 cm growth, arising from serosal surface of jejunum, at the antimesenteric surface. Diagnosis in this case was made by subjecting the resected specimen to immunohistochemical analysis. In view of large size of the resected tumor, and high-risk histopathological features, imatinib mesylate 400 mg once daily was given as adjuvant chemotherapy. Patient is asymptomatic without any evidence of tumor recurrence after six months of postoperative followup. Imatinib as such is recommended in metastatic, res...