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   Table of Contents - Current issue
Coverpage
January-April 2020
Volume 4 | Issue 1
Page Nos. 1-37

Online since Monday, April 20, 2020

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ORIGINAL ARTICLES  

Epidemiology of Gastrointestinal Malignancies in Nigeria:Port Harcourt Cancer Registry Study p. 1
Christopher Chinedu Obiorah, Emeka Ray-Offor
DOI:10.4103/oji.oji_30_19  
Background: Undocumented observations suggest a rising incidence of gastrointestinal tract cancers (GITc) among urban dwellers in Nigeria. Aim: The aim is to report on the incidence and clinic-pathological characteristics of GITc in Port Harcourt and its environs. Materials and Methods: Clinical, pathological, and demographic information on cancer patients obtained from various hospitals, radiology centers, and pathology laboratories within Port Harcourt and Obio-Akpor local government areas of Rivers state between 2008 and 2017 were reviewed. The information was coded using the International Classification of Diseases for Oncology, 3rd Edition and stored in Canreg 4 software in the Port Harcourt cancer registry. Results: GITc constituted the third-most common systemic cancers consisting of 12.2% (328 cases) with a male-to-female ratio of 1.05:1. The annual age-standardized rate ranged between 1.1–21.6/100,000 for females and 1.8–15.9/100,000 for males, with the highest rate recorded in 2017. The mean age was 51.2 ± 15.8 years with bimodal peak age groups of 50–54 and 55–59 years. The most common sites for GITc were colorectal followed by the liver and stomach consisting of 44.5%, 16.5%, and 15.2% of cases, respectively. Epithelial malignancies, i.e., carcinomas markedly predominated over malignancies of other cell types such as mesenchymal cell malignancies, lymphoreticular cell malignancies, and germ cell malignancies and constituted 92.4% of total GITc. Conclusion: GITc is posing a public health challenge in Port Harcourt and environs. A government-sponsored health plan on cancer control, including awareness campaigns on the adoption of more healthy lifestyles, hepatitis B vaccination, colonoscopy screening with prompt treatment, is advocated.
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Spectral technique for monitoring cervical cancer treatment following radiotherapy p. 8
Siddanna R Palled, Nadiah Yousef Aldaleeli, KM Ganesh, Masilamani Vadivel, S Mohammed AlSalhi
DOI:10.4103/oji.oji_43_19  
Background: The pre- and post-treatment evaluation of cervical cancer is usually done by clinical examination and radiological imaging depending on the facility available. The biochemistry of tumor tissues gets dramatically altered after chemoradiation, and such changes could be monitored by the spectral analysis of blood and urine for biochemical component. Aim: This study aims to evaluate the pre- and post-treatment biochemical changes through spectral analysis of blood and urine samples. Materials and Methods: Sixty-nine diagnosed cases of cervical carcinoma were taken for the study. The pre- and post-treatment evaluation of disease was done by clinical examination and radiological imaging. The biochemical component of blood and urine samples of all patients was analyzed spectroscopically before and after radiotherapy by exciting at 400 nm and capturing the emission spectrum over the range of 425 nm–675 nm. Results: The majority of cervical carcinoma patients were clinical International Federation of Gynecology and Obstetrics Stage IIIB followed by Stage IIB and Stage IB consisting of 49.28%, 33.33%, and 8.70% of cases, respectively. Rest of 8.70% of patients were postoperative. The initial results were found to be encouraging with good correlation (up to 66.67%) between spectral biomarker measurement, and the clinical and abdominal ultrasound scan monitoring. Conclusion: This proof of concept study with a limited number of patients, there was good clinical correlation and supplementary information for monitoring the patients. Spectral biomarker analysis could become a reliable, inexpensive tool complementing or supplementing expensive techniques like computed tomography scan.
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Implementation of the Bethesda system of reporting thyroid cytopathology in a referral center p. 13
Kaumudee Pattnaik, Goutami Dasnayak, Asaranti Kar, Smruti Swain, Chitta Ranjan Sarangi
DOI:10.4103/oji.oji_39_19  
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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A successful model of cancer screening in low-resource settings: Findings of an integrated cancer screening camp from a rural setting of North India p. 19
M D Abu Bashar, Arun K Aggarwal, Divya Valecha
DOI:10.4103/oji.oji_31_19  
Background: Cancers of cervix, breast, and oral cavity claim millions of deaths each year globally and are the three most common cancers in India. There is a need to develop and test models for organizing integrated cancer screening camps in low-resource settings with intersectoral coordination between different stakeholders. Aim: To test a model of community based integrated screening camp for it's feasibility and to early detect these three common cancers in low-resource rural settings. Materials and Methods: A community-based integrated cancer screening camp was organized in a rural setting of North India in coordination with district health administration and local governing body (Panchayati Raj Institution). Screening methods included clinical breast examination for breast cancer, visual inspection under 5% acetic acid (VIA) for cervical cancer, and oral visual examination (OVE) for oral cavity cancer. Men and women found to be screen positive in the camp were referred to the district hospital and a tertiary care center for further diagnostic tests and were followed up. Results: A total of ninety individuals (forty men and fifty women) above 30 years of age attended the screening camp were included in the study. One (2.5%) out of these forty males was screened positive for precancerous lesion of the oral cavity. Out of the fifty women attending the camp, two were detected with suspected breast lumps, which on further diagnostic tests at district hospital were diagnosed as benign tumors. About half (52.0%) of the women consented for cervical cancer screening, out of which one (3.9%) was screened positive on VIA, which on colposcopy examination and biopsy at a referral center was confirmed as early-stage cancerous lesion of the cervix and was instituted on treatment. Conclusion: The screening camp sets a successful example of community-based cancer control activity for the early detection and management of three common cancers through intersectoral coordination in low-resource settings.
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Importance of endothelial markers in detection of lymphovascular invasion in carcinoma breast and its correlation with axillary lymph node metastasis p. 23
Khurshida Rahman, Nageswar Sahu, Urmila Senapati, Subrat Kumar Sahu
DOI:10.4103/oji.oji_52_19  
Background: Lymphovascular invasion (LVI) is one of the important prognostic factors in carcinoma breast and its accurate diagnosis is important, particularly in node-negative cases for making the decision regarding aggressive adjuvant chemotherapy. Sometimes, it becomes very difficult to diagnose LVI on routine hematoxylin and eosin (H and E) stained tissue sections. Staining with endothelial immunomarkers makes the identification easy. Aim of the Study: This study aims to compare LVI detection on H and E and immunohistochemistry (IHC) stained sections and its correlation with axillary lymph node metastasis. Materials and Methods: A total of 45 cases of invasive breast carcinoma were studied. LVI was evaluated in routine H and E and IHC stained sections. The results were compared. The LVI status on IHC was correlated with axillary lymph node status. Results: The accuracy of H and E stained sections in detection of LVI was 75.6% with a false-positive and false-negative rate of 20% and 4.4%, respectively. There was no significant association between LVI on IHC and axillary lymph node status. Conclusions: The detection of LVI on routine H and E sections can be erroneous. IHC should be done in cases with confusing focus on routine H and E stained sections, particularly in node-negative cases.
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Relevance of tumor node metastasis staging in salivary gland tumors – a retrospective analysis from a tertiary cancer center p. 28
Aswin A Nagarajan, Rajaraman Swaminathan, Ganesharajah Selvaluxmy, Ramya Ravichandar
DOI:10.4103/oji.oji_34_19  
Background: Salivary gland malignancies are generally not appropriately staged and are treated based on the high-risk features. Prognosis is not routinely predicted based on the tumor node metastasis (TNM) staging. Aim of this Study: The aim of the study was to identify whether TNM staging is useful in the prognosis of salivary gland malignancies. Materials and Methods: The patients of salivary gland malignancies treated during the period of years 2010–2014 were analyzed retrospectively. Age, gender, location, histology, stage, treatment received, and survival were analyzed. Results: A total of 79 cases were analyzed. The median age at presentation was 45 years. The male-to-female ratio was 1.63:1. Mucoepidermoid (37.9%) and adenoid cystic carcinoma (31.6%) were the common histological types. The 5-year disease-free survival (DFS) was 73.4% and overall survival was 82.3%. The 5-year DFS was significantly higher in women, mucoepidermoid and adenoid cystic carcinomas histology types, T1 versus T4 (P = 0.027), and N0 versus N2 (P = 0.004) and significantly lower in age ≥55 years than age < 35 and 35–44. DFS for different sites and treatment groups did not show any significant differences. The factors with significant result on univariate analysis showed an increasing risk of recurrence with increasing T-status (P = 0.459), increasing age at diagnosis (P = 0.035), nodal status (P = 0.059), and histology type (P = 0.02). Conclusion: There is an increasing trend to differentiate 5-year DFS for salivary gland malignancies between different T- and N-status suggesting usefulness of TNM staging before treatment and needs further evaluation.
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CASE REPORT Top

Clear cell odontogenic carcinoma an enigmatic diagnostic challenge p. 34
Shanti Sudha Sahu, Surya Narayan Das, Rachna Rath
DOI:10.4103/oji.oji_10_20  
Clear cell odontogenic carcinoma (CCOC) is an extremely rare odontogenic carcinoma with few cases reported in literature. In 2005, the WHO reclassified CCOC as a malignant odontogenic neoplasm, exhibiting an aggressive growth pattern with a propensity for regional, nodal, and distant metastasis. Being characterized histopathologically by sheets and islands of clear and vacuolated cells, it poses a diagnostic challenge to the clinician and pathologist to distinguish CCOC from other perplexing clear cell entities and requires immunohistochemical analysis. Here, we report a case of CCOC in a 50-year-old woman who presented with a solitary, diffuse, and tender swelling in the posterior aspect of the mandible for 1½ months. Wide local excision was performed for the case. The present case may aid to delineate its biological behavior along with shedding light on its histopathological and immunohistochemical character, thus contributing to the literature.
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