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   Table of Contents - Current issue
Coverpage
January-April 2021
Volume 5 | Issue 1
Page Nos. 1-41

Online since Wednesday, April 14, 2021

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ORIGINAL ARTICLES  

Comparative evaluation of alteration in salivary flow rate between betal Nut/Gutkha chewers with and without OSMF, and healthy subjects: A prospective case-control study p. 1
F Lalfamkima, Suresh Babu Bommaji, Kailasa Kumar Reddy, K Venkata Chalapathi, Manisha B Patil, Tejal R Patil, Abhishek Singh Nayyar
DOI:10.4103/oji.oji_22_20  
Context: Oral submucous fibrosis (OSMF) has infested the oral cavities of “betel nut” and “gutkha” chewers in a pandemic manner. It has one of the highest rates of malignant transformation among the various oral potentially malignant epithelial lesions. Chewing of gutkha alters the salivary parameters including salivary flow rate (SFR) as well as salivary pH. Aim: The present study intended to assess and compare the SFR between betel nut/gutkha chewers with and without OSMF and healthy controls. Materials and Methods: We conducted a prospective case–control study comprising 90 individuals within an age range of 15–50 years who were divided into three groups with Group A consisting of 30 patients who were betel nut/gutkha chewers with OSMF, Group B consisting of 30 individuals who were betel nut/gutkha chewers but without OSMF and Group C consisting of 30 healthy controls who were included as normal controls. The assessment of the SFR was done and the results obtained were subjected to statistical analysis. Results: The mean SFR in Group B patients was significantly more than Group A and Group C individuals. Moreover, the mean SFR in patients with OSMF Stage I was significantly more as compared to patients in Stage II and Stage III OSMF. Conclusion: We concluded that reduced SFR could be an initial subjective sign of OSMF. An early diagnosis and management of these changes can help such patients to improve their quality of life significantly and decreases the chance of the ongoing malignant transformation with early intervention.
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The utility of screening ultrasound in early diagnosis of gall bladder cancer among high-risk population p. 8
Amit Sreen, Ravi K Anadure, HP Singh, Anuj K Sharma, Rohit Sharma, Aneesh Mohimen, Simmi Gupta
DOI:10.4103/oji.oji_51_20  
Background: Screening has led to reduction in mortality for cancers of the cervix, prostate, and colon. Advanced gall bladder carcinoma (GBC) have a poor prognosis, compared to early-stage GBC. The aim of this study was early detection of GBC by ultrasound screening, in a high-risk population. Data were analyzed to look at the impact of screening on staging, operability, and survival. Materials and Methods: In this prospective study spanning 4 years, 978 high-risk individuals as per defined criteria, were screened by ultrasound of the abdomen. The clinical profile of patients with screened GBC (S-GBC) and clinically evident GBC (C-GBC) was studied in terms of stage of detection, operability, and median overall survival (mOS). Results: Six cases of GBC were detected as S-GBC. These were compared with a control population of 119 GBC cases presenting to the cancer outpatient department (C-GBC) in the same period. It was found that S-GBC patients compared to C-GBC, had early stages of diagnosis (P = 0.001) and all underwent curative radical cholecystectomy compared to only 18.8% in C-GBC cases (P = 0.004). At 2 years follow-up, mOS was not reached for S-GBC patients as all patients were alive, compared to 9 months mOS in C-GBC cases (P < 0.05). Conclusions: Screening for GBC leads to the detection of GBC in early stages, ensures surgical resection, and significantly improves mOS. Ultrasound screening in high-risk population is recommended to improve the poor prognosis of GBC.
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Response to neoadjuvant chemotherapy in locally advanced breast cancers in association with different clinicopathological parameters p. 13
Barasha Sarma Bharadwaj, Neelakshi Mahanta, Bibhash Chandra Goswami, Kanakeshwar Bhuyan
DOI:10.4103/oji.oji_26_20  
Introduction: Breast cancer being a multifactorial disorder outcome depends on various clinicopathological and molecular factors. Neoadjuvant chemotherapy (NACT) is increasingly used before surgery to obtain pathological complete response (pCR) as it is associated with increase event-free survival and overall survival. Aim: The aim of this study is to evaluate the response to NACT in locally advanced breast cancer (LABC) in association with various clinicopathological factors in a tertiary care setting. Materials and Methods: LABC patients (clinical Stage IIB and III) who underwent either modified radical mastectomy or breast conservative surgery after NACT treatment in a 1-year period were retrospectively reviewed for the clinical and pathological response. Effect of clinicopathological and molecular factors on treatment response were evaluated. pCR was evaluated on final histopathology. Results: Fifty LABC patients fulfilled the study criteria and were reviewed. pCR was present in 6 (12%) cases. All the pCR cases were invasive ductal carcinoma. A statistically significant association between the presence of tumor necrosis in initial biopsy and pCR to NACT was observed (P = 0.024) with a high negative predictive value of 94%. All the 11 patients (100%) with positive lymphovascular emboli (LVE) on initial biopsy did not show pCR. Four out of 6 pCR cases had preclinical tumor size ≤5 cm. Ductal carcinoma in situ (DCIS) was present in 15 cases and only 1 pCR patient had the presence of DCIS. Conclusion: Preclinical tumor size, histopathological tumor type, DCIS, and presence of tumor necrosis and LVE on initial core biopsy are some of the notable factors for pCR among LABC patients who received NACT.
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Lymph node metastasis in cT1/T2 buccal mucosa squamous cell carcinoma: A subsite-specific study p. 20
Siddharth Mahesh Vyas, Rajesh Arvind Kantharia, Shehnaz Rajesh Kantharia, Zahoor Ahmad Teli, Yogesh Matadin Mistry
DOI:10.4103/oji.oji_54_20  
Objectives: To analyze the incidence of cervical lymph node metastasis in cT1/T2 buccal mucosa cancers, correlate it with the depth of invasion and study the percentage of occult metastasis. Through this study, we also attempt to look into subsite-specific buccal mucosa data which are lacking in literature and will help us improve the understanding of the disease. Materials and Methods: Retrospective analysis of the prospectively collected data of 109 patients with cT1/T2 buccal mucosa cancer operated from January 2018 to August 2019 was done. Information regarding the pathological T stage, depth of invasion, presence or absence of cervical node metastasis, occult metastasis, size of the metastatic lymph nodes, and the presence of extracapsular extension was collected from the final histopathology reports. Results: Twenty-five out of 109 (22.94%) patients had cervical node metastasis. Nine out of 93 (9.68%) clinically N0 patients had occult metastasis. No metastasis was observed for the patients with depth of invasion <4 mm. Of these 25 patients, 17 were pathologically staged T2 (68%), whereas 8 were staged T1 (32%). P value obtained by the Fisher's exact test was 0.003 and validated the hypothesis generated by our results. Conclusion: Through this study, we can conclude that the possibility of cervical node metastasis in cT1/T2 buccal mucosa cancers with depth of invasion <4 mm is negligible and the percentage of occult metastasis stands low. Our study also reflects the lack of robust data in context to early-stage buccal mucosa cancers and offers an insight on the importance of subsite specific research.
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Quantification of risk of recurrence associated with high risk factors in Stage II colon cancer: A retrospective study from a tertiary cancer institute in India p. 25
Lalatendu Moharana, Lokanatha Dasappa, M C Suresh Babu, KN Lokesh, AH Rudresha, LK Rajeev, Smitha Saldanha, Linu Abraham Jacob
DOI:10.4103/oji.oji_4_21  
Background: Surgery is the primary modality of treatment for Stage II colon cancer, and the role of adjuvant chemotherapy is not well defined. Attempts have been made to find out various high-risk sub-groups within Stage II colon cancer, who might benefit from the adjuvant chemotherapy. Most of these studies do not quantify the risks associated with each of the high-risk factors and the survival benefits conferred by adjuvant chemotherapy based on them. Aim: This study aimed to analyze the prognostic and predictive significance of various high-risk factors among patients with Stage II colon cancer and to define the role of adjuvant chemotherapy among these if any with respect to various high-risk factors. Materials and Methods: An audit on postoperative Stage II colon carcinoma patients was performed retrospectively from the patient database of our hospital, registered over the period from January 2010 to August 2017. Results: A total of 41 pathological Stage II colon carcinoma patients were reviewed. Twelve (29.3%) patients without any high-risk features were spared of adjuvant chemotherapy. Twenty-nine (70.7%) patients had at least one high-risk feature and received adjuvant chemotherapy. Mean disease-free survival (DFS) after a minimum 20-month follow-up period was 26.8 months. On univariate analysis, there was a statistically significant difference in mean DFS according to the T stage (T3 vs. T4; P = 0.04), lympho-vascular invasion (LVI) status (absent vs. present; P < 0.01), perineural invasion status (absent vs. present; P = 0.03) and number of lymph nodes in the histopathology specimen (≥12 vs. <12; P < 0.01). On multivariate analysis, LVI positivity and inadequate lymph node dissection (<12 lymph nodes in the specimen) were independent high-risk factors for recurrence. Conclusion: The presence of LVI, inadequate lymph node dissection, or presence of multiple high-risk factors are associated with higher risks of recurrence even with adjuvant 5-flourouracil-based chemotherapy.
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CASE REPORTS Top

Carcinoma cervix with ectopic kidney, its treatment and outcome p. 30
Mridul Anand, Ankita Parikh, Sonal Patel Shah
DOI:10.4103/oji.oji_28_19  
The occurrence of pelvic malignancies along with an ectopic kidney is a rare finding. In the patients of early stage carcinoma of cervix presenting with pelvic kidney, surgery is preferred to radiation to avoid irradiating the kidney. However, advanced stage carcinoma of cervix in such scenario poses a therapeutic dilemma and conformal radiotherapy in the form of intensity-modulated radiotherapy (IMRT) is preferred option. This helps to achieve the desired dose to the target while reducing the dose to the surrounding organs at risk particularly to the pelvic kidney. Herein, we present a case of International Federation of Gynecology and Obstetrics Stage IIB carcinoma of cervix having ectopic right pelvic kidney in a 40-year-old female, and the patient was successfully treated with chemoradiotherapy in IMRT technique. The patient is disease free with normal renal function at 2-year follow-up. The previously reported cases of pelvic malignancies with ectopic kidney in the literature are discussed here briefly.
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Primary osteosarcoma of breast p. 33
Sakina Mankada, Maitrik Mehta, Jyoti Poddar, Amit Kichloo, Akash Pandya, Ubrangala Suryanarayana
DOI:10.4103/oji.oji_38_19  
Primary osteosarcoma of breast is an extremely rare entity with a poor prognosis. Although resection is the main treatment, the optimal treatment remains uncertain. It has early tumor recurrence with a propensity for hematogenous spread, most commonly to the lungs rather than lymphatic spread. Herein, we report a case of primary osteosarcoma of the left breast in a 50-year-old female. Her metastatic workup did not show any evidence of regional or distant metastasis. The patient was treated by simple mastectomy with axillary lymph node dissection followed by adjuvant chemotherapy. The patient is disease free at a follow-up of 11 months.
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Sarcomatoid carcinoma of the larynx: An aggressive tumor p. 36
Ipsita Dhal, Krishna Gopal Birmiwal, Bhagat Singh Lali, Aseem Mishra
DOI:10.4103/oji.oji_29_20  
Sarcomatoid carcinoma of the larynx is a rare and aggressive tumour with a unique biologic behavior and histogenesis. They were earlier called as collision tumors. They are classified under “epithelial tumors” in the World Health Organization classification. Due to the aggressive clinical behavior, they obstruct the airways soon and the patients present early. We present a case of a 55-year-old female who presented in acute state to the emergency department with dyspnea. On evaluation, a locally advanced laryngeal malignancy was detected radiologically. The biopsy was performed wherein a spindle cell pleomorphic tumor was seen which was positive for AE1/AE3 and vimentin, thus rendering a final diagnosis of sarcomatoid carcinoma. We discuss the clinical features, biological behavior, and management of these rare carcinomas.
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Isolated dural metastasis in breast cancer after 22 years and approach to its management p. 39
Sakina Mankada, Maitrik Mehta, Amit Kichloo, Akash Pandya, Chinmay Prajapati, Ubrangala Suryanarayana
DOI:10.4103/oji.oji_30_20  
Breast cancers are the second most common cause of intracranial metastasis, after lung cancer, mostly occurring in brain parenchyma. However, dural metastasis (DM) is a rare site representing only < 1% of all metastasis in breast cancers. Median age of occurrence of DM is after 2–3 years of primary diagnosis. DM is usually associated with other skeletal metastasis and isolated DM in a treated case of breast carcinoma is rarer. We report a case of DM in a 67-year-old female patient previously treated for breast cancer 22 years back. The patient underwent surgical excision for DM followed by whole brain radiation and is on palliative chemotherapy.
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