Cancer registration is pivotal for cancer epidemiology and for planning and implementation of cancer policy and research. Morbidity and mortality burden of cancer in India is one of the highest in the world. India has a network of cancer registry distributed across the country, a process which began in the 1960s. The cancer registration in India has expanded including many new hospital-based and population-based cancer registries. Some new initiatives such as cancer atlas and online software programmes have been started for streamlining the process. However representativeness, urban-centric data, timeliness, and quality of cancer data are some of the problems still troubling the process of cancer registration in India. In this context, we should look for a unified systemic framework using newer information and management systems for capturing a complete and clear picture of cancer in India.

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Groin node metastases are predominantly seen in primary malignancies of infradiaphragmatic location. However, sparse cases of inguinal metastases from tumors above the diaphragm have been reported in the medical literature. Here, we report a case of small-cell carcinoma of the lung with metastatic inguinal lymph node at the initial presentation in a 57-year-old man. The case was diagnosed and managed congruously as per the stage of the disease, which was metastatic. However, the patient was died due to disease progression after 8 months of diagnosis. This case edifies to a clinical oncologist's knowledge that patients with commodious and disseminated malignancies of supradiaphragmatic location may present with lymph nodes in the inguinal region.

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Aim: The aim of this study is to analyze the correlation/diagnostic accuracy of cytology and frozen section (FS) preparations in the intraoperative diagnoses of central nervous system (CNS) lesions. Materials and Methods: A total of 63 cases of CNS lesions were included in the study from July 2012 to January 2015 at a tertiary care referral hospital. Intraoperative specimens were used for crush/squash smears and FS and correlated with the final histopathological diagnosis. Results: Majority of the patients (73.02%) were presenting in the age range of 21–50 years. There was a slight female preponderance with male-to-female ratio of 1:1.1. Two out of 63 cases were excluded from the cytology correlation analysis due to inadequate materials and 3 out of 63 cases were excluded from the FS correlation analysis due to freezing artifacts. The diagnostic accuracy of cytological preparation was 80.33% for complete correlation with histopathology and was increased to 93.44% for adding the partial correlations. The corresponding figures for FS were 81.67% and 93.33%, respectively, and the difference was insignificant (P = 0.971). The sensitivity, specificity, positive predictive value, and negative predictive value in detecting neoplastic condition on cytology were 94.4%, 85.7%, 98.07%, and 66.67%, respectively, and that of FS were 96.15%, 75%, 96.15%, and 75%, respectively. The corresponding P = 0.872, 0.652, 0.986, and 0.561, respectively. Conclusion: Crush and FS preparation are considered as effective diagnostic procedures for rapid intraoperative diagnosis in CNS lesions without any significant difference in results and when applied simultaneously can produce a higher diagnostic accuracy complementing each other's results.

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B-acute lymphoblastic leukemia (ALL) often presents as pancytopenia/bicytopenia with thrombocytopenia being very common. A 15-year-old child with high-grade fever showed bicytopenia on peripheral smear with 10% blasts. Bone marrow examination showed 65% lymphoblasts which were negative for myeloperoxidase. The blasts suppressed the erythroid population but not the megakaryocytic population. On flow cytometry, a diagnosis of common – ALL antigen-positive B – precursor ALL was given. To conclude, ALL cannot be excluded in patients who present with a normal platelet count. A bone marrow aspirate is crucial in patients with bi/pancytopenia.

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Calcaneal osteosarcoma is a rare entity, which presents with chronic heel pain and swelling and often clinically misdiagnosed as a traumatic or inflammatory process. The diagnostic confusion is because of the rarity of this entity and unawareness of such rare areas of affection of osteosarcoma. This usually leads to delayed diagnosis and treatment and may severely affect the prognosis. We present a rare case of osteosarcoma involving calcaneus in a 10-year-old female who presented with long-standing left heel pain and swelling where the diagnosis of a sinister underlying bone lesion was delayed.

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Aim of the Study: The aim of this study is to evaluate the demographic and clinicopathological profile of the patients with gallbladder cancer (GBC). Materials and Methods: A total of 68 diagnosed cases of GBC were taken in the study during the study period from January 2016 to December 2017. A detail questionnaire was filled through the counseling to take demographic profile including socioeconomic status, nonclinical characteristics, dietary, and other risk factors apart from clinicopathological profile of patients. Results: We found most of the patients were females with median age 51.8 years. More than half of them were postmenopausal (56.60%), and high parity was seen in 39.62% of females. Obesity was associated factor mainly in females (28/53), and none of the males were obese. Nearly 83.82% (57/68) of patients had advanced stage disease, with metastatic disease in 72.06% (49/68) patients. Majority of the patients had at least two sites of metastasis (73.47%), with liver (57.14%), omentum (40.82%), and nonregional lymph nodes (53.06%) being common sites of dissemination. Bony metastasis, being rare in literature, was found in 6 (12.24%) of patients, most of them developed it later during the disease course. Conclusion: Majority of the patients was female within the age group of 41–60 years, associated with gallstones and had advanced disease. We did not find greater impact of diet on the incidence as vegans and nonvegans were almost equally divided in our study. A high index of suspicion and health education seems to be the only answers available for early detection and improvement of survival.

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Primary synovial chondromatosis (PSC) is an uncommon benign disease process of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that progressively undergo detachment, mineralization, and even ossification forming loose bodies. It is usually a monoarticular disease with involvement of large joints with knee being the most common. Involvement of smaller joints such as distal radioulnar, tibiofibular, metacarpophalangeal, and metatarsophalangeal joint has also been reported. This disease process is usually intra-articular. Involvement of extra-articular tissues such as bursae and tendon sheaths is rare, and combination of intra- and extra-articular diseases described here is an extremely rare condition. Herewith, we report a male patient with PSC of left knee with involvement of suprapatellar bursa who presented with recurrent knee swelling and pain with diagnostic delay of 2 years. We have also highlighted the role of imaging in the early diagnosis of this disease and briefly reviewed relevant literature.

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India is going through a significant epidemiological transition with the rising of chronic diseases such as cancer. An accompanying aspect is social stigma and negative perceptions regarding cancer. This not only affects cancer care and treatment but also puts a strain on prevention efforts. It is particularly worrisome in a low- and middle-income country like India with low levels of health literacy and the lack of access to cancer care. There have been attempts by the government and positive changes toward mitigating stigma, but a lot needs to be done to address this issue. The family and the community need to be significant players in synergy with the health system in the efforts to minimize the stigma in cancer.

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Giant cell tumor (GCT) of bone is a benign tumor with locally aggressive nature. The presence of mononuclear stromal cells and multinucleated giant cells is the microscopic characteristic feature of the GCT. It is an osteoclastic tumor with destruction of tumor is mediated by the receptor activator of nuclear factor kappa-B ligand (RANKL). Denosumab, a RANKL inhibitor, may reduce or eliminate tumor giant cells, the relative content of proliferative, densely cellular tumor stromal cells, replacing with nonproliferative, differentiated woven new bone. We report a case of GCT of the right distal femur in a 20-year-old female, treated with 6 cycles of denosumab as neoadjuvant therapy, which shows consolidation of the lesion and became amenable for extended curettage with phenol cauterization and cementing without going for any radical surgery shown to have very good functional outcome.

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The biological heterogeneity of breast cancer accounts for variations in natural course of disease and differences in response to various therapeutic modalities. These variations pose as major challenges in clinical management of patient. The quest for markers that would accurately define prognosis and response to particular therapeutic modality has led us to the molecular makeup of these tumors. The technique of gene expression profiling has been pivotal in this regard. With the study of thousands of genes simultaneously in breast cancer patients, a molecular classification of breast carcinoma was proposed in the early 21^st century. High-throughput commercial assays proved to be useful in predicting prognosis for the patients but are expensive. Classification of breast cancers using immunohistochemistry that can be used as a surrogate of this molecular classification is inexpensive, easier, and more convenient to use. However, the accuracy of this classification is closely dependent on accurate immunohistochemical measurement of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki67. The initial surrogate classification has undergone revisions to make it more relevant in the 13^th St Gallen International Breast Conference. Newer molecular subtypes such as claudin low have also been identified but are included in the basal-like subtype in surrogate classification due to its triple-negative nature. The utility of the surrogate classification in the Indian setting is immense due to limited access to molecular techniques. This review covers in detail the evolution, prognostic, and therapeutic implications of the surrogate molecular classification of breast cancers.

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Intraosseous lipoma (IL) is a rare benign bone lesion, and it constitutes about 0.1% of all bone tumors. The majority of cases are located in the metaphyseal region of the long bones in the lower limbs. We report a rare case of lipoma of the ilium in a 12-year-old male child presenting with mass over the right gluteal region. Meticulous marginal dissection was done, and a pedunculated mass originating from the lower right sacroiliac region was excised in toto. The case was an atypical example of an IL with a large outgrowth involving sacroiliac region with inconclusive magnetic resonance imaging and needle biopsy findings.

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Hidradenoma papilliferum (HP) is an uncommon benign cutaneous adnexal neoplasm of the anogenital region commonly seen in middle-aged, Caucasian females. Anastomosing and branching tubules, lined by columnar cells, and a basal layer of myoepithelial cells are the characteristic histopathological features. We report a case of HP in a 60-year-old female presented with a vulvar lesion. The case was evaluated for malignancy, with the initial histopathology showing extensive squamous metaplasia but ultimately found to have HP.

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Hand pain is a common presenting symptom in orthopedic, but digital pain due to glomus tumor is a rare entity. It is a benign vascular neoplasm arising from glomus body with subungual space of nail plate of the hand being the common location. Bluish- or pinkish-red discoloration of the nail plate with classical triad of localized tenderness, severe pain, and cold sensitivity are the common presentations of the glomus tumor. Treatment is purely surgical, i.e., complete surgical excision with dramatic results. We report three cases of subungual glomus tumor in the hand, and all the cases underwent complete excision of the tumor followed by complete relief of the symptoms.

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Background: Metallic implant in radiotherapy leads to difficulty in tumor target and critical organ delineation. Four-field box technique is conventional approach to treat pelvic malignancies. Aim of the Study: The aim of study is to evaluate the dosimetric impact of calculation algorithms in the treatment of carcinoma cervix with metallic implants. Materials and Methods: A paraffin wax-coated iron rod was used to evaluate the beam characteristics under the influence of metallic implant. Beam characteristics such as tissue phantom ratio (TPR2_0,10) were measured and analyzed. 15 patients with and without metallic prosthesis of carcinoma cervix were compared in the study. Planning was done for the prescription dose of 45 Gy/25 fractions. Plans were calculated using AAA algorithm and recalculated using Acuros XB (AXB) and pencil beam convolution algorithms for the same monitor units. RTOG and Quantec Protocol were used for plan evaluation. Results: Transmission and TPR_20,10increases with field size and beam energy. Surface dose D_salso increases with field size. D_98%and D_2%of planning target volume showed a significant difference for AAA versus AXB. 4FN (AAA) are significantly better for all the 4F plans, calculated by three algorithms in case of V_15Gyof small bowel. Analyzed data indicated the significant attenuation caused by high-Z material. Analyzed value of conformity index showed that value of index comes >1 in all the cases. Conclusion: The results indicate that when creating treatment plans for cervical cancer lesions with metallic prosthesis, the AAA algorithm would be a more appropriate choice.

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Glioblastoma multiforme (GBM) is the most aggressive, malignant primary brain tumor with increasing frequency in older age group. The majority of cases occur in the 6^th to 8^th decade of life, with a male predominance. GBM is unusual in the pediatric age group and accounts for only 3% of all the childhood brain tumors. The treatment of GBM is still challenging in children. We report a case of GBM in an 11-year-old male child located in the right cerebral hemisphere. Right fronto-parietal craniotomy and gross total excision of the tumor were performed successfully.

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Aim: This study aimed to document the total number of osteosarcomas of bone diagnosed in a referral hospital differentiating from its close mimics with biologic behavior. Materials and Methods: This study analyzes the total cases diagnosed as osteosarcoma from 2014 to 2016 in the Department of Pathology, SCB Medical College, Cuttack, Odisha. Results: A total of 21 cases were diagnosed with osteosarcoma, the most common subtype being conventional osteosarcoma. This subtype constituted the majority (18 cases); the age range varied between 14 and 20 years. This article describes two rare histologic subtypes; small cell variant and giant cell-rich osteosarcoma, a rare bone involvement, like mandibular jaw bone, in an elderly female was also documented along with histologic features of each one. Conclusion: Three cases with unusual histologic subtypes and rare bone involvement, gnathic type, prompted us to report these cases.

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Liposarcoma is a malignant tumor of the adipose tissue and is primarily a tumor of adults above the age group of 50 years. It may occur anywhere in the body. However, the most common sites are thigh and retroperitoneum. Liposarcoma with the chest wall primary is a rare entity with only few cases reported. We report a case of well-differentiated liposarcoma of the anterior chest wall in a 75-year-old male with a presentation of large growth extending to the anterior neck and successfully operated.

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Aim of the Study: The present study attempts to explore various types of lesion of the uterine cervix and to find target age groups in which screening efforts can be concentrated for early detection of cervical cancers. Materials and Methods: The study was carried out at a tertiary care institute during the period from May 2016 to December 2017. All the previously conducted cervical Papanicolaou (Pap) smears were analyzed and reported as per the 2001 Bethesda system. The data were noted in a structured pro forma and evaluated. Results: A total of 5025 Pap smears were examined. Maximum number of patients was in the age group of 31–40 years (33.25%). Out of 5025 pap smears, 6.60% (332) of cases were found to be unsatisfactory or inadequate samples, 90.97% (4571) cases were reported as negative for intraepithelial lesion or malignancy, and 2.43% (122) cases had epithelial cell abnormality (ECA). Premalignant lesions such as: atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade intraepithelial lesion (HSIL) and atypical squamous cells-cannot exclude HSIL (ASCH), and malignant lesions such as squamous cell carcinoma and adenocarcinoma were reported under the ECA positive cases. Majority of premaligant lesions found in the age group of 41–50 years and constitute 44.64% (25/56). Whereas, majority of frank malignancy cases found in the age group of 51–60 and >60 years constituting 43.94% and 37.88%, respectively. Among all the ECA positive cases, 54.10% of cases found to be with malignancies. Conclusion: Proper implementation of Pap smear screening examination can decrease the incidence of cancer cervix along with its downstaging by early detection of precancerous lesions.

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Background: Metaplastic carcinoma of the breast (MCB) is a rare histological subtype of breast carcinoma containing glandular and nonglandular components with mixed epithelial and mesenchymal differentiations. Aim of the Study: The study aimed to report clinical, radiological and pathological profiles, treatment and outcome of patients diagnosed with MCB from a tertiary care institute along with literature review. Materials and Methods: Diagnosed cases of MCB were obtained from the record over a period of January 2010 to December 2017, and data were recorded in a structured pro forma. Results: A total of 9 (0.9%) cases of MCB were identified out of 1031 breast cancer patients with the median age of presentation of 53 years. The palpable lump was the most common presentation (77.78%). The mean tumor size was 4.9 cm in greatest dimension. Sonographically, most of the lesions were solid (44.44%) followed by cystic (33.33%). Mammographically, microcalcifications were absent in eight cases. Histologically, 55.56% of cases were purely epithelial subtype (3: pure squamous and 2: adenosquamous) and 4 (44.44%) cases were mixed epithelial and mesenchymal subtypes (3: carcinosarcoma and 1: invasive lobular carcinoma with sarcomatous component and osseous metaplasia). All the cases were having triple-negative receptor status. Modified radical mastectomy (MRM) was performed in all cases and 33.33% of cases had axillary node positive. About 77.88% and 88.89% of cases received adjuvant chemotherapy and adjuvant radiotherapy, respectively. At median follow-up of 27 months, local recurrence and distant metastases were seen in 1 and 3 cases, respectively. At present, 33.33%, 22.22%, and 44.45% of patients were died, alive, and lost for follow-up, respectively. Conclusion: MCB is a rare histologic subtype of breast cancer with larger tumor size at presentation and MRM is the preferred surgical procedure over breast conservation surgery. Long-term and regular follow-up is necessary to know the outcome.

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Giant cell tumor (GCT) commonly arises from epiphysis of the long bones, and the most common sites for primary are distal femur, proximal tibia, proximal humerus, and distal radius. Patella is a very rare site for the development of primary GCT. We report two cases with primary GCT of the patella. Both the patients presented with a long history of intermittent right anterior knee pain and knee swelling and were treated by radical excision. In one case, temporary immobilization done by knee arthrodesis with cross K-wires followed by mobilization using hinged knee brace.

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Endobronchial malignancies are usually associated with bronchogenic carcinoma. About 1.1% of cases may be due to extrapulmonary source of metastasis. Only few case reports have mentioned about the carcinoma of prostate with mediastinal lymph node and endobronchial metastasis. Here, we report such a case where endobronchial lesions were removed bronchoscopically and the patient improved symptomatically. Biopsy showed the metastatic adenocarcinoma and immunohistochemistry was positive for prostate-specific antigen.

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Background: Sellar and parasellar/juxtasellar regions are complex areas of the brain, and different varieties of tumors can occur in this area. Preoperative noninvasive diagnosis with magnetic resonance imaging (MRI) is essential for treatment planning. Aim of the Study: The aim of this study is to characterize MRI features of the sellar and juxtasellar tumors and to correlate MRI diagnosis with histopathological diagnosis in order to evaluate the efficiency of MRI. Materials and Methods: Patients with sellar and juxtasellar lesions who were operated during September 2015–August 2017 and the pathological reports were compared with the MRI findings retrospectively. Results: A total of 50 patients were enrolled in the study, and the mean age of presentation was 34.6 years. MRI-based radiological diagnosis showed 21 cases of pituitary macroadenoma, 15 cases of craniopharyngioma, 9 cases of meningioma, 2 cases of germinoma, 1 case of glioma, and 2 cases of epidermoid cysts. Histopathological correlation revealed MRI accuracy of 94.12%, 94%, 100%, 98%, 100%, and 100% for the diagnosis of pituitary macroadenoma, craniopharyngioma, meningioma, germinoma, glioma, and epidermoid cyst, respectively. One case each of pituitary macroadenoma and germinoma diagnosed on MRI comes out to be as craniopharyngioma after final histopathological correlation, whereas one case of craniopharyngioma turned out to be macroadenoma after final histopathological examination. Conclusions: The present study revealed a strong correlation between MRI and histopathological diagnosis for sellar and juxtasellar tumors. MRI is the modality of choice for characterizing sellar and suprasellar lesions.

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Objectives: Touch imprint cytology (TIC) of biopsy specimen can be utilized for a rapid on-site evaluation of tumors. Its usefulness for intraoperative diagnosis is well known. We evaluated the advantages and limitations of TIC of trucut biopsies of intraabdominal tumors. Materials and Methods: TIC was obtained in 42 consecutive cases of intraabdominal masses. The sensitivity, specificity, and diagnostic accuracy of TIC were evaluated by comparing it with the final biopsy diagnosis. Results: The study included retroperitoneal tumors (13 cases, 30.95%), liver mass (11 cases, 26.19%), gall bladder mass (4 cases, 9.53%), pelvic mass (3 cases, 7.14%), iliac bone mass (2 cases, 4.76%), mesenteric nodule (4 cases, 9.53%), kidney mass (3 cases, 7.14%), and 1 case (2.38%) each of epigastric mass and loin mass. Thirty-two (76.19%) cases were diagnosed as malignant and 10 (23.81%) cases were diagnosed as benign/negative on TIC. The overall sensitivity was 87.88%, the specificity was 77.78%, the positive predictive value was 93.55%, and the negative predictive value was 63.60%. The accuracy of the test was 85.71%.Conclusions: TIC is a simple and cost-effective method that aids in the diagnostic evaluation of tumors. It is fairly accurate with high positive predictive value and hence can be used as an adjunct to the biopsy diagnosis.

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Introduction: The introduction of the Bethesda System of Reporting Thyroid Cytopathology (TBSRTC), following the “National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference” held in Bethesda, in 2007, offered the opportunity to establish a uniform six-tiered reporting system for thyroid fine-needle aspiration (FNA). Aim of the Study: The aim of the study was to implement and to evaluate the diagnostic accuracy and risk of malignancy (ROM) of categories of TBSRTC. Materials and Methods: FNA was taken from the thyroid swelling during the study period and smears were stained with hematoxylin and eosin, Diff-Quik, or papanicolaou stains. Nodular thyroid swelling cases were subjected to histopathological correlation. Results: Of the 1724 FNAs, a total of 223 cases of palpable nodular thyroid swelling were studied with cytohistopathological correlations. About 13.90% of the cases were diagnosed as malignant. The ROM for Bethesda Category V and VI was 100% each, whereas it was 47.62%, 10%, and 2.82% for Category III, IV, and II, respectively. The overall sensitivity, specificity, positive predictive value, negative predictive value, and the diagnostic accuracies of TBSRTC were 83.87%, 89.58%, 56.52%, 97.18%, and 88.79%, respectively. Conclusion: In our study, a more specific cytologic diagnosis was offered based on criteria laid down in the standardized nomenclature of the Bethesda System 2018 citing diagnostic accuracy and ROM in each category.

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