INDIAN JOURNAL OF CANCER

Carcinoma colon masquerading as bleeding per vagina
Muralee M, Srinidhi M, Bharath VM and Sivanandan CD
Isolated vaginal metastasis from colorectal cancer is a rare entity with very few reports in the literature. Here we report a patient who presented with bleeding per vagina from a vaginal mucosal lesion. Biopsy of the vaginal lesion indicated a metastatic adenocarcinoma from a colorectal primary. Further workup of the patient with colonoscopy and Positron emission tomography (PET CT) indicated a primary in the sigmoid colon. As the patient had a single site of metastasis, she was planned for definitive management. The colonic primary, as well as the vaginal deposit were managed surgically. Further, the patient received adjuvant chemotherapy as well as adjuvant external beam radiation to the site of the vaginal lesion. Vaginal metastases from colorectal primary are usually part of systemic dissemination with multiple metastatic sites and hence has poor prognosis. When the patient presents with an isolated metastasis in the vagina., the survival appears reasonable as per the few reports available in the literature. Due to the rarity of the presentation, there are no standard treatment guidelines available. Surgical management, radiation and adjuvant chemotherapy have been used in varying combinations in the reports available in the literature. To conclude, vaginal metastasis should be included in the differential diagnosis of patients presenting with vaginal bleeding, especially with a history of colorectal carcinoma. Available limited evidence suggests that isolated vaginal metastasis from colorectal cancer that is amenable to local surgical resection has a reasonable outcome. Hence, isolated vaginal metastasis should be treated with curative intent in a multidisciplinary context like other sites of oligometastatic disease.
Gene of the month: C-KIT
Kumari N and Lingaiah R
KIT is a gene coding for tyrosine kinase receptor, which was identified as the ligand of stem cell factor. Its role in disease was first identified in gastrointestinal stromal tumor. However, later, this gene was found to be implicated in many other benign and malignant tumors. C-KIT has been studied as the first biomarker for targeted therapy. Herein we review its structure, function and role in various non-neoplastic and neoplastic diseases.
Role of adaptive radiotherapy during concomitant chemoradiotherapy for limited-stage small-cell lung cancer
Ozdemir BS and Yavuz AA
Tumor shrinkage is frequently observed during conventionally fractionated chemoradiotherapy for limited-stage small-cell lung cancer (SCLC). The specific goals of this study are to evaluate the gross tumor volume (GTV) changes due to treatment-induced tumor reduction during the course of radiotherapy (RT) and to examine its potential use in adaptive radiotherapy (ART) for tumor dose escalation or normal tissue sparing in patients with SCLC.
Assessment of quality of life in head and neck cancer patients visiting the Palliative Care outpatient department in a tertiary care oncology centre in India
Gulia A, Gupta N, Sharma P, Kumar V, Kumar R, Mishra S and Bhatnagar S
Patients with head and neck cancers (HNCs) are at an increased risk of developing functional symptoms associated with eating, speaking, and breathing along with symptoms caused by a fungating tumour (e.g., cosmetic change, malodor, and bleeding). These may substantially reduce their physical functioning and quality of life (QoL). This observational study aimed to find out the QoL in patients with HNC in a tertiary care oncology centre.
Introduction of HPV vaccine in universal immunization programme of India: A step in the right direction for the elimination of cervical cancer
Bashar MA and Khan IA
An ominous cause of hirsutism: Adrenocortical carcinoma
Singhania P, Bhattacharjee R and Chowdhury S
Bartholin's gland adenoid cystic carcinoma: Report of three cases and the review of literature
Güral Z, Yücel S and Agaoglu F
The adenoid cystic carcinoma (ACC) of Bartholin's gland is a very rare tumor that usually grows aggressively due to perineural invasion. Although there is no guideline for the treatment due to the small number of patients, the primary treatment is considered as surgery. Adjuvant radiotherapy has also been shown to be beneficial. Three cases, which were histopathologically confirmed as ACC of Bartholin's gland and received adjuvant radiotherapy treatment, were presented in this study.
Chimeric Antigen Receptor T-cell based cellular therapies for cancer: An introduction and Indian perspective
Rathod RJ, Sukumaran RK, Kedia N, Kumar J, Nair R, Chandy M, Gandikota L and Radhakrishnan VS
Using one's own immune system for curing cancer has been an active field of research in cancer biology and therapeutics. One such opportunity in cellular immunotherapy is adoptive cell transfers. With the recent approval of CAR-T therapy as a cancer treatment, a whole new paradigm of cancer treatment has opened-up, with a ray of hope for relapsed/refractory cancer patients. Despite promising clinical outcomes, the therapy is in its early phase and remains out of reach for most patients due to its high cost and logistic challenges. In India, these therapies are unavailable and further confounded by the economic challenges and a large population. In this review, we discuss various aspects of T-cell immunotherapies with a special focus on CAR-T in the Indian scenario. We touch upon the basic scientific aspects, mechanism of action, manufacturing, clinical aspects and commercial aspects of the CAR-Tcell therapies and its future worldwide and in India.
Misconducts in research and methods to uphold research integrity
Rao KN, Mair M, Arora RD, Dange P and Nagarkar NM
Research misconduct refers to deliberate or accidental manipulation or misrepresentation of research data, findings, or processes. It can take many forms, such as fabricating data, plagiarism, or failing to disclose conflicts of interest. Data falsification is a serious problem in the field of medical research, as it can lead to the promotion of false or misleading information. Researchers might engage in p-hacking - the practice of using someone else's research results or ideas without giving them proper attribution. Conflict of interest (COI) occurs when an individual's personal, financial, or professional interests could potentially influence their judgment or actions in relation to their research. Nondisclosure of COI can be considered research misconduct and can damage the reputation of the authors and institutions. Hypothesis after results are known can lead to the promotion of false or misleading information. Cherry-picking data is the practice of focusing attention on certain data points or results that support a particular hypothesis, while ignoring or downplaying results that do not. Researchers should be transparent about their methods and report their findings honestly and accurately. Research institutions should have clear and stringent policies in place to address scientific misconduct. This knowledge must become widespread, so that researchers and readers understand what approaches to statistical analysis and reporting amount to scientific misconduct. It is imperative that readers and researchers alike are aware of the methods of statistical analysis and reporting that constitute scientific misconduct.
MCQs on 'ALL induction outcome: Realworld data from a paediatric oncology centre in an LMIC setup with rural predominance'
D'souza HH
Ocular relapse of acute lymphoblastic leukemia - A clinicopathological correlation
Mohan S and Biswas J
Evaluation of mtDNA common deletion in esophageal squamous cell carcinoma
Ghadyani F, Sharif S and Morovvati S
Mitochondrial defects are thought to play a role in cancer initiation and progression for a long time. Because of the absence of protective histones and an inefficiency in the DNA repair process, mitochondrial DNA is known to be prone to mutations. The deletion of 4977bp is one of the most common mutations in human cancers. This study aimed to investigate the relationship between 4977bp common deletion and Esophageal Squamous Cell Carcinoma Disease (SCC) to provide prognostic information.
Postoperative pain management following minimally invasive abdominal cancer surgeries -An audit
Bakshi SG, Gupta S and Jain PN
There is limited data comparing pain management following various minimally invasive oncological surgeries (MIOS). This retrospective audit was planned to determine the severity of pain and to study the analgesic modalities offered to these patients. Secondary objectives included studying opioid requirements, non-opioid analgesics, their side effects, and the influence of comorbidities on the choice of pain modalities.
Concordance of breast cancer services in an urban tertiary care institute in India to EUSOMA guidelines: An audit of Indian breast cancer practices
Kadayaprath G, Gupta S and Gupta N
The provision of breast cancer care tends to vary substantially from one breast unit to another. To provide state-of-the-art patient-centered care to women diagnosed with breast cancer, adoption and adherence to structured treatment algorithms, protocols, and international guidelines are essential. In this review, we endeavor to audit breast cancer care at our tertiary cancer center against published EUSOMA guidelines. This was a retrospective study with an observational design. All patients who completed recommended treatment for breast diseases at our institute from January 1, 2018 to December 31, 2018 were included and evaluated. Data were retrieved from patient e-prescriptions and medical records. Analysis was performed using Microsoft Office 2010 to measure how our practices compared to EUSOMA quality indicators (QIs). Clinical assessments, imaging, and preoperative work-up of breast cancer patients met EUSOMA standards. Prognostic and predictive characterization of tumors was performed in all cases. Surgical management of invasive cancer and ductal carcinoma in situ (DCIS) was in accordance with the guidelines. Adherence to postoperative radiation and adjuvant endocrine therapy was adequate. More mastectomies were performed in patients with invasive cancers measuring <3 cm. Overtreatment was avoided in every other subgroup. Adjuvant and neoadjuvant chemotherapy and targeted adjuvant therapy were adequately utilized unlike neoadjuvant targeted therapy. Minimal attrition was noted in patient follow-up. This extensive audit has set a benchmark for future annual audits and helped highlight areas where improvement of service delivery is needed.
Pancreatic neuroendocrine tumor with abundant mitochondria
Shetty D, Raj A and Amarapurkar A
A 40-year-old woman presented with dull, boring periumbilical region pain radiating to the back and vomiting for 1 year. Magnetic resonance cholangiopancreatography detected a polypoid growth in the ampullary region. The patient underwent Whipple's procedure. The specimen revealed a 4.9 × 4.5 × 3.7 cm tumor arising from the pancreas, abutting the posterior pancreatic surface and infiltrating the terminal common bile duct and the ampulla. Microscopic examination showed a pancreatic tumor composed of neuroendocrine cells. In addition, many large foci showing solid sheets of oncocytic cells with abundant granular eosinophilic cytoplasm were observed. Immunohistochemistry studies revealed positivity for synaptophysin, chromogranin, and Ki67 index above 70%. A diagnosis of oncocytic neuroendocrine tumor of Grade 3 was made. In electron microscopy, oncocytic cells showed abundant mitochondria dispersed throughout the cytoplasm. Oncocytic pancreatic neuroendocrine neoplasms are uncommon and can be diagnosed only on histopathological examination. These tumors tend to show a malignant behavior.
Editorial commentary
Jain H
A young boy with a rare tumor presenting as an upper gastrointestinal bleed
Jain AK, Jain S and Ware S
We describe an interesting upper gastrointestinal endoscopy image of a mass seen in the stomach of a 19-year-old boy who presented to us with an upper gastrointestinal bleed without any history of pain or illness in the past and was diagnosed as a primitive neuroectodermal tumor or Ewing's sarcoma of the stomach.
The relationship between clinical and pathological findings and FDG - PET uptake in metastatic colorectal cancers
Kurt İnci B, Gürler F, Sütcüoğlu O, Tahtacı G, Üner A, Özet A, Günel N and Yazıcı O
In metastatic colorectal cancer (mCRC), the genetic structure and cell metabolism of the primary tumor lesion might be different from metastatic lesions. It is thought that cell-level glucose metabolism may differ due to the difference in RAS wild and mutant mCRC patients' prognosis. In this study, we aimed to compare 2-deoxy-2-[fluorine-18]-fluoro-D-glucose Positron Emission Tomography (18F-FDG PET/CT) uptake levels for KRAS mutation status and primary-metastatic tumor localization.
Psychometric analysis of Marathi version of an updated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N43)
Waghmare CM, Pawar HJ, Bhalwar R and Thakur PK
The aim of this study was to perform a psychometric analysis of the Marathi version of an updated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N43) in patients of head and neck squamous cell carcinoma (HNSCC).
Varied presentations of primary cutaneous lymphoma: A case series from a tertiary care center in South India
Shana B, Ambooken B, Balakrishnan S, Neelakandan A and Ajithkumar K
Recent studies indicate an upsurge of primary cutaneous lymphoma (PCL) in the Indian population. Of late, we too have come across varied presentations of PCL in relatively younger individuals. Hence, we decided to study the clinical and immunohistological profile of patients with PCL in our department.
Epithelioid angiosarcoma of the pericardium: Case report of the challenges in the management of a rare malignancy with poor prognosis
Guleria B, Guleria P, Husain A, Jain A, Raphael J and Sengupta P
A primary epithelioid angiosarcoma of the pericardium is a rare soft tissue malignancy. This report describes a young adult woman who presented with progressive dyspnea and pericardial effusion. She was found to have pericardial mass on imaging along with extensive myocardial infiltration. The biopsy of the mass revealed epithelioid angiosarcoma, which was CD34 and CD31-immuno-positive. Due to unresectable disease, she was given a trial of immunotherapy followed by conventional chemotherapy. She showed partial response on interim assessment, but progressed soon after the completion of six cycles and succumbed to her rapidly progressive illness within nine months of diagnosis. This report discusses the diagnostic and therapeutic challenges faced while managing this disease of aggressive tumor biology.