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   Table of Contents - Current issue
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May-August 2021
Volume 5 | Issue 2
Page Nos. 43-84

Online since Saturday, August 21, 2021

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ORIGINAL ARTICLES  

Vocal fold leukoplakia: An experience of a tertiary care teaching hospital of Eastern India p. 43
Santosh Kumar Swain, Swaha Panda
DOI:10.4103/oji.oji_3_21  
Background: Vocal fold leukoplakia (VFL) is a term used to document a white patch on the mucosa of the vocal folds. It is caused by prolonged use of smoking, consumption of alcohol, excessive drying, or voice abuse and is considered premalignant lesion of the larynx. Aim: The study aims to analyze the demographic and clinical parameters, pathological findings, and management of VFL patients, as well as the incidence of laryngeal cancer among these patients. Materials and Methods: We retrospectively collected 92 VFL patients who received treatment during November 2015 to December 2018 and followed up for a minimum period of 2 years up to December 2020. The detail clinical characteristics including endoscopic findings, postoperative pathological findings, and management were assessed from the patient's file. Results: The mean age of presentation was 64.3 years, with 52 male and 40 female patients. We found cigarette smoking as the most common etiological factor, which was seen in 45 patients (48.91%) followed by alcohol consumption and laryngopharyngeal reflux. Seventy-seven patients underwent surgery (42: carbon dioxide laser excision and 35: coblation-assisted excision), and rest 15 patients treated conservatively. On postoperative, the different pathological variants encountered were nondysplasia (n = 41); low-grade dysplasia (n = 24); high-grade dysplasia (n = 5); carcinoma in situ (n = 4); and invasive carcinoma (n = 3). Factors such as age (P < 0.001) and morphological types (P = 0.043) have been significantly correlated with pathological grades of VFL. Conclusion: The invasive laryngeal cancer detection rate underlying VFL at first diagnosis was 3.90%. The early diagnosis of VFL and treatment are challenge for clinicians to decrease the incidence of laryngeal malignancy. The patient's age and morphological types may guide treatment of VFL due to risk stratifications.
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Conservative management of rhabdomyosarcoma of uterine cervix: A case series p. 49
Susan Mathews, PS Veena, Nithiyaanandan Natarajan
DOI:10.4103/oji.oji_5_21  
Background: Rhabdomyosarcoma (RMS) of the uterine cervix is a rare disease, usually affects pediatric and adolescent girls. Excellent treatment outcomes have been reported with combined modality treatment employing surgery, chemotherapy, and radiation therapy. Fertility-sparing treatment options can be considered in young patients without compromising outcome. Aim: This study aimed to analyze the outcome of patients with cervical RMS who were managed conservatively. Materials and Methods: We retrospectively reviewed the clinical and pathologic data of all patients with cervical RMS who were registered at our institution during 1995–2010. Long-term outcome data of patients who had conservative surgery were analyzed. Results: During this period, six patients with cervical RMS were registered. Five patients, managed conservatively, were eligible for analysis. The median age was 20 years (range: 14–21 years). Excessive vaginal discharge was the most common presenting symptom (n = 3). All patients initially had either a polypectomy (n = 4) or gross tumor resection (n = 1) followed by received chemotherapy with VAC regimen (Vincristine, Actinomycin-D and Cyclophosphamide). One patient received local radiation (HDR brachytherapy) for microscopic residual disease. All patients were disease-free at the completion of primary therapy. At a median follow-up of 10 years, four patients remain relapse-free; three, having retained fertility, had successful pregnancies and healthy children. One patient developed ovarian failure consequent to radiation treatment but remains disease free. One patient developed local recurrence, 8 years after primary treatment, and underwent salvage hysterectomy followed by second-line chemotherapy. This patient too remains disease-free, 3 years after salvage treatment. Conclusion: RMS of the uterine cervix is highly curable in early stages. The focus now is on improving the quality of life by reducing treatment-related morbidity and late effects. Fertility preservation approaches should be considered in young females with RMS of cervix.
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Sensitivity and specificity of cluster differentiation and friend leukemia integration1 for the diagnosis in a series of molecularly confirmed ewing sarcoma family of tumors p. 55
Sudha S Murthy, Daphne Fonseca, Sundaram Challa, Suseela Kodandapani, Sahithi Shilpa Arya, Sandhya Devi Gundimeda, B Vishal Rao, Faiq Ahmed, Manasi Mundada, Nambaru Lavanya, Senthil J Rajappa, Krishnam Raju Alluri, Veeraiah Koppula, T Subramanyeshwar Rao
DOI:10.4103/oji.oji_8_21  
Background: Immunohistochemistry (IHC) is a cost-effective and routinely available ancillary technique for the diagnosis of Ewing sarcoma family of tumors (ESFT). However, molecular confirmation is needed for precise diagnosis. Aim: This study aimed to determine the sensitivity and specificity of the commonly used IHC markers cluster differentiation (CD99) and friend leukemia integration1 (FLI1) in a series of molecularly confirmed ESFT. Materials and Methods: Retrospective review of the ESFT confirmed by either fluorescence in situ hybridization (FISH) or reverse transcriptase polymerase chain reaction (RT-PCR) during a period of 10 years was done. The demographic, clinical, and radiologic data were noted from medical records. The histology was reviewed with CD99, FLI1, and additional markers, wherever performed. The sensitivity and specificity of CD99 and FLI1 for the diagnosis of ESFT were calculated. Results: There were 72 ESFT patients in the study period, confirmed by FISH (EWSR1 rearrangement) in 53 and RT-PCR (EWS-FLI1) in 19. The female-to-male ratio was 1.06. The median age at diagnosis was 21 years. The cases included 22 skeletal and 50 extraskeletal sites. The positivity of CD99 and FLI1 was 98.46% and 94.83%, respectively, and both were positive in 55/72 (76.39%) cases. The sensitivity and specificity of CD99 were 98.46% and 20%, and those of FLI1 were 94.83% and 28.57%, respectively. Conclusion: Although the sensitivity for CD99 and FLI1 was high, the specificity was low toward the diagnosis of ESFT. The combined use of CD99 and FLI1 could confirm only 76.39% of molecularly confirmed ESFT, emphasizing the need for a precise diagnosis by molecular technique.
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Oral cavity reconstruction with pedicled and free flaps: A single institutional experience p. 60
Zahoor Ahmad Teli, Rajesh Arvind Kantharia, Shehnaz R Kantharia, Siddharth Mahesh Vyas, Yogesh Bhatt, Piyush Doshi
DOI:10.4103/oji.oji_10_21  
Background: In Indian subcontinent, oral cavity cancer is the most common cancer in males and the 4th most common in females. Seventy percent of these patients present in advanced stages and resection of these advanced cancers lead to complex orofacial defects requiring primary reconstruction to restore form, function, and cosmesis. Aim: This study aims to evaluate the results of pedicled and microvascular free flaps (MFFs) for oral cavity defects following resection of locally advanced oral cancer. Materials and Methods: A retrospective analysis of prospectively collected data of patients who underwent composite resection followed by reconstruction with pedicled or MFFs for locally advanced oral cancer from January 2018 to September 2019 was done. The demographic details, primary tumor site, tumor stage, defect type, flap type, and complication rates were analyzed. Results: Primary reconstruction was offered to 540 patients with pedicled flaps for 421 patients and MFFs for 119 patients. Patient distribution as per current Tumor, Node, and Metastasis staging was pT1/T2: 91, pT3: 179, and pT4: 270. Reconstruction offered for different oral cavity subsites was – buccal mucosa (n = 374), retromolar trigone (n = 10), alveolus (n = 75), tongue (n = 52), lower gingivobuccal sulcus (n = 11), floor of mouth (n = 4), upper gingivobuccal sulcus (n = 5), and lower lip (n = 9). We classified the types of defects into mucosal (n = 32), mucosal with bone (n = 370), mucosal with bone and skin (n = 101), mucosal with skin (n = 14), skin (n = 3), and central mandibular arch (n = 20). The overall rate of complications in pedicled flaps was 12.11% and MFFs was 20.16%. The success rate for pedicled flaps was 100% and for MFFs was 94.96%. Conclusion: In our study, MFF reconstruction had a good success rate with satisfactory functional and cosmetic outcomes.
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Total orbital exenteration - Experience from a tertiary cancer care center in Northern India p. 67
Yogendra Singh Bhakuni, Kailash Chand Sharma, Suhas Kodasoge Rajappa, Dharma Ram, Ajay Kumar Dewan, Rashika Chand, Udip Maheshwari, Ankush Jajodia, Venkata Pradeep Babu Koyyala
DOI:10.4103/oji.oji_11_21  
Introduction: Orbital exenteration (OE) is a defacing procedure reserved for advanced head and neck malignancies involving the orbit. Even though it is cosmetically unappealing and associated with complete loss of vision in one eye, the procedure has low surgical morbidity and recurrence rates and should be considered in appropriate patients after adequate patient counseling. Due to relative rarity of the procedure, there is a paucity of literature, particularly in India. Aim: To analyze the role and indications of OE, operative details, morbidity, and postoperative complications in patients who had undergone total OE in a tertiary care cancer hospital. Materials and Methods: We retrospectively reviewed 5-year (2011–2016) data of those who had OE from our computerized database. The retrieved data were analyzed for demographic profile, operative details, morbidity, and survival rates. Results: Out of 20 patients analyzed, 13 were male and 7 were female. Majority of the patients have secondary eyeball extension (15/20). Most frequent indication for exenteration was tumor of eyelid origin. Reconstruction after surgery was done by temporalis flap (n = 10), anterolateral thigh-free flap (n = 6), and split skin graft (n = 4). None of the patients had any intraoperative complications. One patient developed flap necrosis and managed by flap revision. One patient had wound dehiscence and managed conservatively. At a mean follow-up of 20 ± 9.6 months, two patients had recurrence of primary disease. Mortality occurred in two patients; 1 case for disease related and another one for other medical condition. Conclusion: The OE has still a role and is indicated for a variety of conditions. The surgical procedure remains safe, and major morbidity is dictated by the type of reconstruction. Although skin graft is the simplest reconstructive option, many a times, myocutaneous/free flap is required in advanced cases.
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Carboplatin in combination with 3-weekly paclitaxel as first-line therapy in patients with recurrent/metastatic head-and-neck cancers: A regional cancer center experience p. 71
Pooja Babbar, AH Rudresha, Lokanatha Dasappa, Linu Abraham Jacob, M C Suresh Babu, KN Lokesh, LK Rajeev, Smitha Saldanha, Vinay Kakkar
DOI:10.4103/oji.oji_14_21  
Background: Head-and-neck cancers (HNCs) collectively are the sixth most common malignancy diagnosed worldwide and treatment in recurrent/metastatic setting is challenging. This retrospective study aimed to evaluate the efficacy and tolerability of carboplatin and paclitaxel as first-line treatment in patients with recurrent and/or metastatic (R/M HNCs). Materials and Methods: A total of 182 patients with recurrent and/or metastatic HNC who received carboplatin and paclitaxel combination 3 weekly as first-line therapy at medical oncology department of our tertiary care cancer institute in Bangalore between January 2018 and January 2020 were reviewed. The patients who progressed during chemotherapy were receiving oral metronomic chemotherapy or best supportive chemotherapy. The patients were followed up every 2 monthly. Results: At the completion of treatment, the overall response rate was 15.4%. The median progression-free survival was 4.3 months (95% confidence interval [CI]: 2.9–5.6), and the median overall survival was 8.2 months (95% CI: 6.8–9.7). The main toxicities in the present study were Grade 3–4 hematologic 19.8%, mucositis 1.6%, and diarrhea 2.7%, and the rate of febrile neutropenia was 6.6%. None of the patients died of treatment-related toxicity. Conclusion: The combination of carboplatin with 3-weekly paclitaxel is effective in R/M HNC patients.
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Prescription pattern of drugs in pediatric cancer patients in a tertiary care hospital: An observational study p. 76
PS Manjesh, Yashashri C Shetty, Girish Chinnaswamy, Panini Shrikant Patankar
DOI:10.4103/oji.oji_20_21  
Aims: The objective of the current study was to evaluate prescription pattern and to assess off-label use of drugs used in treatment of pediatric cancer patients. Subjects and Methods: This was a cross-sectional, observational study where patients who presented to the hemato-oncology and solid tumors Outpatient department at a tertiary cancer care hospital were prospectively recruited. Patients of either gender or age between 3 months and 15 years diagnosed with cancer and who has received treatment for at least 6-week duration were included. Demographic details, diagnosis, medication details, and off-label use were analyzed. Prescribing indicators and off-label use were analyzed by descriptive statistics using Microsoft Excel version 2019. Results: Of 300 patients recruited, 67% were male and 33% were female, with a median age of 75 months (interquartile range: 42–129 months). One hundred and seventy-one (57%) patients suffered from hematological cancers, while those having solid tumors were 129 (43%). Most common hematological cancer was found to be acute lymphoblastic leukemia – 126/171 (73.68%) and among 129 solid tumor patients, the most common cancer was found to be Ewing's sarcoma (29). A total number of 944 drugs were prescribed in 300 prescriptions studied. Out of 944 drugs prescribed, 346 (36.65%) were anticancer drugs and 598 (63.35%) were concomitant drugs. Most common anticancer drug prescribed in hematologic cancer was found to be vincristine (60/270), and in solid tumors also, it was vincristine in 24/76. Off-label prescriptions were found mainly in solid tumors in 80.26% (61 out of 76 anticancer drugs), whereas for hematological cancers, it was 3.33% only. The most common drug use off label in solid tumors was Cyclophosphamide. Conclusions: The study reflects the general pattern of drugs used in the treatment of various pediatric cancers and the extent of unavailability of chemotherapeutic agents – more so in the solid tumors' treatment.
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CASE REPORT Top

A rare presentation of myelomatous pleural effusion in immunoglobulin g subtype of multiple myeloma p. 82
Yawar Yaseen, Parvaiz Ahmad Shah, Bilal Ahmad Mir, Saika Amreen
DOI:10.4103/oji.oji_32_20  
Myeloma is a disease of neoplastic plasma cells that synthesize an abnormal amount of immunoglobulins (Igs) or Ig fragments. Multiple myeloma is associated with many complications such as impaired hematopoiesis resulting in anemia and other cytopenias, osteolytic bone lesions, hypercalcemia, and renal dysfunction. However, myelomatous pleural effusion is a rare complication of multiple myeloma, particularly at initial presentation. Herein, we report such a rare complication of myelomatous pleural effusion as initial presentation in a 65-year-old female with IgG type of myeloma.
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