ABSTRACT Fine needle aspiration cytology, though, is a reliable, minimally invasive procedure with high sensitivity, specificity and diagnostic accuracy, still it has its limitations in making out diagnosis of thyroid nodules. Here we present an uncommon case of 52 years old Indian female with complaint of mass on antero-medial aspect neck. Fine needle aspiration cytology was suggestive of colloidal goiter. For cosmetic indication, thyroidectomy was done and histopathological examination sought to confirm the cytological diagnosis. The incidental finding was uncommon, revealing papillary thyroid microcarcinoma. Worth emphasizing is the possibility of uncommon malignant disease like thyroid microcarcinoma, in view of limitations of fine needle aspiration cytology in apparently benign thyroid...
Abstract Nodular hidradenoma or clear cell hidradenoma is a rare skin adnexal tumor arising from eccrine sweat glands. Skin adnexal tumors situated in breast parenchyma are very rare and is one of differential diagnosis of breast masses. We report a case of 60 years old female with a left breast lump and bloody nipple discharge being suspected as a malignant breast mass. A final diagnosis of nodular hidradenoma breast was made after excision biopsy and immunohistochemistry study. A patient is a diagnosed case of carcinoma endometrium and underwent panhysterectomy in 2007. Postoperative histopathology revealed well-differentiated endometrial adenocarcinoma without invasion of the myometrium. She received postoperative radiation therapy and intravaginal brachytherapy in 2008 and is on regular follow-up since...
With the advent of effective and intensive chemotherapy, we are able to achieve better response rates as well as improved survival but the side effects remain a constraint. This article intends to discuss one of the side effects of chemotherapy i.e. neuropathy; culprit agents, mechanism and therapeutic strategies to manage it.
ROLE OF PHYSIOTHERAPY IN PREVENTION AND MANAGEMENT OF LYMPHEDEMA IN POST-OPERATIVE BREAST CANCER PATIENTS
After surgery for breast cancer, the most common postoperative complication is secondary lymphedema which may sometimes be more challenging to manage than the disease itself. This systematic literature review aims to highlight the role of physiotherapy in management of secondary lymphedema in post-operative patients of breast cancer and its current status. The literature review has been conducted using available textbooks and online database of PubMed, Medline, SciELO, LILACS (Latin American and Caribbean Literature) and EMBASE. Online search has been made through English literature mainly, from 1990 to 2015 and focused on research or review articles. Review found physiotherapy; with appropriate combination of techniques, started early; has been very effective in prevention and management of lymphedema in post-operative breast cancer...
Head and neck cancer forms the major chunk of cancer patients in developing country like 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. MACH-NC 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 and survival in locally advanced head and neck cancer. Oral chemotherapeutic agent gives the ease of self medication on daily basis without the need for hospital admission and intravenous infusion. Theoretically daily administration of oral chemotherapy agent mimics the continous infusion of a parenteral agent. Since infusional 5-FU along with Radical RT has achieved a complete response rate of 68% for 5-FU arm versus 56% for placebo arm (p=0.04) with the overall median survival of 33 months for 5-FU versus 25 months for placebo arm, Capecitabine (analog of 5-FU) in low doses have been used in concomitant setting for locally advanced head and neck cancer. Overall response rate observed has been 33-89% with manageable toxicity and near total patient compliance. The maximally tolerated dose to be given daily during radiation therapy is 500 mg/m2 b.i.d. Lower dose doses of 250-350 mg/m2 have also been used in concomitant with lesser toxicity and greater...
PALLIATIVE CHEMORADIOTHERAPY VERSUS RADIOTHERAPY ALONE FOR MANAGEMENT OF LOCALLY ADVANCED HEAD & NECK CARCINOMA PATIENTS WITH POOR PERFORMANCE STATUS
Introduction: Palliative external beam radiotherapy (EBRT) and chemotherapy is commonly practiced for management of locally advanced head & neck carcinoma (LAHNC) patients with poor performance status. This study compares EBRT alone and EBRT along with low dose Gemcitabine. Method: Study was conducted in Department of Radiotherapy, PGIMS Rohtak, in 2008-09; on histopathologically proven, untreated 60 cases of LAHNC, having KPS 60-70. Patients were randomly assigned either control group (n=30), given EBRT alone as 20Gy/5Fr/5days or study group (n=30), given EBRT as 20Gy/ 5Fr/ 5days and Gemcitabine 200 mg/m2 i.v. 2 hour prior to radiotherapy on day 1. Mean age was 53 years (26-84 years). Male:female ratio was 5:1. Most common primary site was base of tongue followed by larynx. Major symptoms were pain, difficulty in swallowing and altered voice. Patients were staged as per AJCC 2002; 2/3rd were stage IVA and 1/3rd were IVB. Despite randomization, there was no significant difference between two groups in age, sex, primary site, stage, and performance status. The side effects were graded as per RTOG criteria. Results: Objective response, 3 months post-treatment, in the chemoradiotherapy and radiotherapy alone group respectively was: CR 7% vs 0%; PR 30% vs 33%; stable disease 56% vs 46% and progressive disease 7% vs 20%. Subjective response, similarly was better in study group through out; even significantly better in dysphagia at 3 months follow up. Acute skin reactions were: Grade I- 73% vs 47% at 2 weeks and 60% vs 40% at 1 month respectively. Acute mucosal reactions were: Grade I- 30% vs 17%, Grade II- 43% vs 17% respectively. No hematological and grade III/IV skin or mucosal reactions observed. Differences in reactions were not statistically significant. Conclusion: In management of LAHNC patients with poor performance status, addition of low dose Gemcitabine to palliative radiotherapy gives better disease control and symptomatic relief without unmanageable side...
Cancer cells have a multitude of mechanisms to avoid and suppress immunity. Normal cells when exposed to chemical carcinogens, irradiation and certain viruses get transformed to cancer cells which can grow indefinitely. These cells have decreased requirements for growth factors; do not undergo apoptosis resulting in malignancy. The tumor cells have various antigens which are responsible for the generation of immune responses towards that particular tumor. There are two types of tumor antigens; tumors specific transplantation antigens (TSTAs) and tumor associated transplantation antigens (TATAs). The TSTAs are specific to tumor, result from mutations which alter the cellular proteins while TATAs may be proteins present in or during some stages of fetal development but not expressed or expressed at low levels in normal adult cells. Adoptive T-cell therapy involves the ex vivo cultivation of T cells with activity against a specific target cancer antigen to increase the frequency of these T cells to achieve therapeutic levels and then infuse them back into the patient. Oncolytic viruses selectively infect, replicate in, and kill tumor cells with no or limited impact on normal tissues which means that tumor cells have surface receptors to bind the virus. Monoclonal antibodies (mAbs) are immunoglobulins derived from a single clone of B cells, act by targeting an antigen which acts a ligand of receptor involved in signal transduction within the...