MIXED GERM CELL TUMOR OF OVARY AND MAYER ROKITANSKY KUSTNER HAUSER SYNDROME: AN UNUSUAL COMBINATION!
Germ cell tumor of ovary in young female is most common ovarian neoplasm but represent less than three percent of all ovarian malignancies in females. Mixed germ cell tumor is a variant of germ cell tumors and its presentation with Mayer Rokitansky Kustner Hauser Syndrome, which represents the most common type of utero-vaginal agenesis, is very unusual. However, for patients with primary amenorrhea, Mayer Rokitansky Kustner Hauser syndrome is the second common cause. We describe an interesting, uncommon and unexpected case in a young Indian female patient with primary amenorrhea due to this syndrome coexisting with mixed germ cell...
Primary involvement of vulva or breast by non-hodgkin lymphoma (NHL) is known to occur uncommonly. Only 24 cases of NHL vulva and around 250 cases of NHL breast alone have been reported, so far; but none with simultaneous involvement of the two sites together. We report the first case having both sites involved in a 35 year old Indian female.
Anaplastic large cell lymphoma (ALCL) represents 2 to 3% of non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase negative (ALK-) subtype accounts for 15-50% of all ALCL. Primary bone involvement in lymphoma is uncommon and constitutes less than 1% of all lymphomas and 4-5% of all extranodal NHL. Hence extra-nodal primary bone involvement in ALCL is even rarer. We report the 14th case of primary ALCL in a 38 year old Indian female. Other than the uncommon site, there is no reason not to keep NHL as differential diagnosis, as the condition responds too well to standard...
Background- Astroblastoma is partially understood, poorly reported and rare in occurrence tumor with significant dilemma regarding cellular origin, diagnostic criteria, clinical behavior, and management protocol. Material and method– Thorough search of published English scientific literature was made with search word Astroblastoma through Google Search, PubMed, Research Gate and Cochrane Library till June 2018. The reports thus collected were examined for data regarding age, gender, location and laterality of disease, pathological grade, treatment received, and outcome of treatment. Results– Data of 161 patients was retrieved from 72 publications. Median age at presentation was 18 years. Females were affected much more frequently than males. Most common site of involvement was the frontal lobe. Laterality data was inconsistent and sparingly reported. Most common presenting complaint was headache followed by history of seizure. Surgery was performed in majority of patients-79.6% of the patients underwent a gross total resection, 45% (44 out of 98 reported) had a high-grade tumor. Sixty patients received adjuvant radiation with a median dose of 54 Gy (Range 20-72), mostly for high grade, residual or recurrent disease. Adjuvant chemotherapy was used in 25 patients. Median follow-up was 43 months (range 1-238). Median overall survival was 138 months. Patients with a higher-grade tumor had significantly worse overall survival. Conclusion- Astroblastoma is rare but known to have two distinct grades, with higher-grade tumors bearing significantly poor survival. Maximal safe surgery is the standard. Though there is lack of consensus, adjuvant radiotherapy with or without Temozolamide should be considered in view of high rates of local...
Chronomodulated therapy or chronotherapy has gained popularity, beyond a fancy term, as a novel and logical method to exploit the best, by administering anti-cancer treatment at an optimal timing according to circadian rhythms of their anti-cancer action and/or repair mechanism of cancer & normal cells. Understanding of chronobiology and the results of clinical studies back up this new concept. Chronotherapy seems to have all the potential to become tomorrow’s accepted, refined oncology practice without adding much to the cost of existing...
Peripheral neuropathy is a structural or functional abnormality of peripheral nerves giving rise to neuropathic symptoms. Neuropathic symptoms can be motor, sensory and autonomic or varied combination of these major categories. Chemotherapeutic agents frequently cause various neuropathic symptoms and signs depending upon culprit agent, its dose and duration. Chemotherapy-Induced Peripheral Neurotoxicity is a common, disabling and dose-limiting side-effect of cancer treatment and its assessment is difficult. Some patients complain of tingling, numbness and pain in distal extremities while others may also develop motor and autonomic symptoms. Some patients remain symptomatic even after discontinuation of offending drugs. Patients with chemotherapy induced neuropathy bear higher healthcare cost than cancer patients without neuropathy. As new chemotherapeutic agents are being developed it is important to measure chemotherapy induced peripheral neuropathy accurately so that it can be recognized at an earlier stage, the treatment can be modified appropriately and disease progression can be monitored. An added advantage would be a possibility of reliable comparison between neuropathic side effect of newer and older chemotherapeutic...
Partial nephrectomy is performed more commonly for small, low-stage renal tumors. The main advantage of partial nephrectomy over radical nephrectomy is the avoidance of renal insufficiency. The major disadvantages are the possibility of local recurrence and perioperative complications. In this article, we discuss the technical aspects of the nephron-sparing surgery and review the literature pertaining to it, in order to put the management of renal cancer into a modern...
Intensity modulated radiation therapy (IMRT) is a technique to deliver a highly conformal radiation dose distribution, that too with wide spectrum ranging from conventional IMRT, through Volumetric Modulated Arc Therapy (VMAT) to most advanced form called Dense Angularly Sampled and Sparse Intensity Modulated Radiation Therapy (DASSIM-RT). The article intends to overview the current status of the technology....
Primary renal Non-hodgkin lymphoma is rare. Most of the cases are unilateral though bilateral cases have been reported. Extrarenal involvement is to be excluded by imaging/ staging laprotomy for definitive diagnosis. We are presenting a case of 40-year-old Indian female who was attended with history of right flank pain for 3 years, found to have right renal mass on CT scan, underwent right radical nephrectomy and six courses of chemotherapy with CHOP (Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone) regimen subsequent to histo-pathological confirmation. Patient is asymptomatic on follow up of 18...
CONCOMITANT CHEMORADIATION IN LOCALLY ADVANCED CARCINOMA CERVIX: COMPARING DOUBLET VERSUS SINGLE AGENT CHEMOTHERAPY.
Abstract Purpose: To compare the efficacy and toxicity of two definitive concomitant chemoradiotherapy schedules (doublet combination and single agent) along with radical external beam radiotherapy (EBRT) in the management of locally advanced carcinoma of the uterine cervix (LACCx). Material and method: Previously untreated, 60 patients of LACCx (FIGO stage IIB-IIIB) were taken for definitive treatment by concurrent chemo-radiation. These patients were randomly assigned either; Study group I, the Doublet chemotherapy(Gemcitabine + Cisplatin) administration and Control group II, the Single-agent chemotherapy(Cisplatin) administration group. EBRT was given as 50Gy/ 25Fr/ 5 weeks. Chemoradiation was followed by weekly HDR Intra-cavitory brachytherapy (ICBT), 3 sessions of 700cGy each. Observations were made at the end of treatment and 6 months of follow up. Response to treatment and toxicity were investigated. Results: At the end of treatment, disease response in study and control respectively at the end of treatment was as follows: Stage IIB (CR- 52.63% versus 38.09%), Stage IIIA (CR- 100% versus 100%) and Stage IIIB (CR- 55.56% versus 25.0%). Overall disease response for the group I and II, at the end of sixth months follow up was as follows: CR- 93.33% versus 83.33%, PR- 3.33% versus 13.33%, and recurrence- 3.33% versus 3.33% respectively. Most severe acute hematological toxicity observed was Grade 2 in 40.0% versus 16.67% patients, respectively. Similar was the trend of acute skin & mucosal reactions and acute gastrointestinal toxicity. Though a higher number of patients in the study group experienced more acute toxicities, these were acceptable and manageable. Skin and mucosal reactions at 6 months follow up were not significantly higher in the doublet group compared to the single agent group. Conclusion: Administration of doublet combination chemotherapy; is better compared to single-agent chemotherapy administration in terms of disease control (though not statistically significant)with manageable toxicity profile; given concurrent with EBRT, for management of locally advanced carcinoma cervix. A larger study may establish the very role of the new regimen, especially in a resource-limited setup where patients present with advanced/ bulky...