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Indian Journal of Medical and Paediatric Oncology
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   Table of Contents - Current issue
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October-December 2016
Volume 37 | Issue 4
Page Nos. 209-320

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EDITORIAL COMMENTARY  

Classical or pylorus-preserving pancreatoduodenectomy in pancreatic and periampullary cancer: “The jury is still out!” p. 209
Savio George Barreto
DOI:10.4103/0971-5851.195747  PMID:28144083
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REVIEW ARTICLES Top

Should every patient with pancreatic cancer receive perioperative/neoadjuvant therapy? p. 211
Ulrich Nitsche, Bo Kong, Alexander Balmert, Helmut Friess, Jörg Kleeff
DOI:10.4103/0971-5851.195731  PMID:28144084
Pancreatic ductal adenocarcinoma is a highly aggressive disease, and medical as well as surgical therapeutic options are limited. This article reviews stage dependent treatment options, with a special focus on the current controversy of perioperative treatment regimens in initially borderline resectable or locally advanced patients. Neoadjuvant treatment can potentially increase the rate of complete tumor resection and may be more effective than adjuvant systemic therapy. Further, in the case of disease progression during or after neoadjuvant therapy, patients can be spared extensive surgery. Today, common therapeutic regimens include gemcitabine/nab-paclitaxel and FOLFIRINOX, as well as chemoradiation. However, because of the paucity of evidence from randomized trials, most guidelines do not recommend neoadjuvant therapy in resectable tumors, and for borderline or locally advanced tumors only within clinical trials. Importantly, every patient should be discussed in multidisciplinary tumor boards.
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Skin: A mirror of internal malignancy p. 214
Rita V Vora, RahulKrishna S Kota, Nilofar G Diwan, Nidhi B Jivani, Shailee S Gandhi
DOI:10.4103/0971-5851.195730  PMID:28144085
Skin manifestations are a reflection of many of the internal diseases. Sometimes, skin disease may be the only manifestation of the internal disease. Internal malignancies may give rise to a number of cutaneous manifestations through their immunological, metabolic, and metastatic consequences. Curth proposed criteria to establish a causal relationship between a dermatosis and a malignant internal disease. Malignancy can present with a plethora of cutaneous manifestations. Here, we describe in brief about various skin manifestations of internal malignancies.
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Status of barium studies in the present era of oncology: Are they a history? p. 223
Abhishek Mahajan, Subash Desai, Nilesh Pandurang Sable, Meenakshi Haresh Thakur
DOI:10.4103/0971-5851.195740  PMID:28144086
With the advent of the modern imaging technologies, the present era of oncology is seeing steady decline in requests for barium studies due to the many reasons. It is prudent to mention here, that, barium examinations cannot be made obsolete! Our aim to preserve the age old technique of barium studies not only to keep it going on but also for the betterment and appropriate management of the patient. Our goal is not to “save” barium studies simply to keep this technology alive, per se, but rather to preserve barium radiology for the quality in patient care.
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ORIGINAL ARTICLES Top

Protection behaviors for cytotoxic drugs in oncology nurses of chemotherapy centers in Shiraz hospitals, South of Iran p. 227
Khadijeh Abbasi, Maryam Hazrati, Abolfazl Mohammadbeigi, Jasem Ansari, Mahboubeh Sajadi, Azam Hosseinnazzhad, Esmail Moshiri
DOI:10.4103/0971-5851.195748  PMID:28144087
Context: The use of antineoplastic agents for the treatment of cancer is an increasingly common practice in hospitals. As a result, workers involved with handling antineoplastic drugs may be accidentally exposed to these agents, placing them at potential risk for long-term adverse effects. This study aimed to determine the occupational protection status of clinical nursing staff exposed to cytotoxic drugs. Subjects and Methods: The study was designed as an analytic descriptive survey. The research settings took place in six centers of chemotherapy in Shiraz, Iran. The participants were 86 nurses who worked in oncology units and administered cytotoxic drugs. Data were collected using a questionnaire and a checklist which was developed by the investigators to determine occupational protection status of clinical nursing staff exposed to cytotoxic drugs. Percentage calculations and the independent samples t-test were used to see the general distribution and analysis of data. To statistically analyze of the data, SPSS software (version 16) was applied. Results: The mean age of participants was 30.52 ± 6.50 years and 66.27% of the nurses worked on inpatient oncology wards. The mean practice score was 21.1 ± 3.76 that ranged from 12.5 to 31. The independent samples t-test showed the outpatient nurses were weaker in practice (17.2 ± 2.52) in comparison with university hospitals (23.35 ± 3.02, P< 0.001). Occupational protection status of clinical nursing staff exposed to cytotoxic drugs especially during administration and disposal of medicines was poor and rarely trained with this subject and was observed under the standard conditions. Conclusions: There is deficiency in the understanding and related protection practices of clinical nursing staff vocationally exposed to cytotoxic drugs. It is recommended that all clinical nursing staff should receive full occupational protection training about these matters and the authorities provide standard conditions of oncology wards.
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Outcomes, cost comparison, and patient satisfaction during long-term central venous access in cancer patients: Experience from a Tertiary Care Cancer Institute in South India p. 232
K Govind Babu, MC Suresh Babu, D Lokanatha, Gita R Bhat
DOI:10.4103/0971-5851.195732  PMID:28144088
Introduction: Prolonged treatment, frequent administration of chemotherapy, antibiotics and blood products in cancer patients requires long term venous access. Central venous catheters (CVC) inserted into the subclavian vein or internal jugular vein, peripherally inserted central venous catheters (PICC) and chemoport (CP) are the commonly used central venous access devices (CVAD). Aim: This study was envisaged to review our experience of CVADs over a one year period and analyze the outcome with regard to catheter life, reasons for removal, complications, patient satisfaction and cost comparison between the CVAD types in the Indian setting. Settings and Design: This was a prospective, observational study carried out in a tertiary care cancer institute. Materials and Methods: 180 CVADs placed in patients with hematological malignancies and solid tumors from January 2014 to December 2014 were included. Statistical Analysis Used: Data was analyzed using descriptive statistics, Mann Whitney U test. P <0.05 was taken as statistically significant. Results: 180 CVADs were placed in 160 patients. The median catheter indwelling period was 76 days (16 days to 313 days) for CVC, 59 days (20days – 313 days) for PICC and 137 days (70 days – 258 days) for CP. 66 out of 160 patients developed complications (41.2%). 108 complication events were noted in 66 patients. There were 40 episodes of CRBSI. Out of the 68 mechanical complications, 37 were encountered during insertion of the CVAD and 31 were during the catheter indwelling period. Out of 160 patients, 138 (86.25%) were satisfied with the CVAD. The cost incurred for CVC/PICC (INR 4,480) was lower than that for CP (INR 24,150) and it was statistically significant (P < 0.0001). Our patients were highly satisfied with the CVAD. Conclusion: Use of CVC and PICC is a safe, reliable and cost saving way of administration of chemotherapy in developing countries. The incidence of complications and catheter loss was acceptable. Our patients were highly satisfied with the CVAD.
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Effect of areca nut chewing and maximal mouth opening in schoolgoing children in Ahmedabad p. 239
Azizfatema Munawer Khan, Megha S Sheth, Romsha R Purohit
DOI:10.4103/0971-5851.195734  PMID:28144089
Context: Areca nut is chewed by itself and in various scented preparations. Areca nut chewing is widely practiced in many parts of Asia, including India. Users often consider it harmless and report a sense of well-being, but evidence has shown that it is far from harmless and can have multiple oral health implications such as oral submucosal fibrosis posing difficulty in opening mouth and carcinogenesis. Studies in India have reported increasing prevalence of this habit among schoolgoing children. The objectives of the study were to find the effect of areca nut chewing on mouth opening, compare it with the children not having this habit, and to find correlation between maximal mouth opening (MMO) and months of areca nut chewing. Aims: The aim of this study is to find the effect of areca nut chewing on MMO in schoolgoing children in Ahmedabad. Settings and Design: An observational analytical study was conducted across various schools of Ahmedabad. Subjects and Methods: A total of eighty male students of 12–14-year-old were included in the study. Group A included children having the habit of eating areca nut for 6 months or more, and Group B had children who did not have the habit of areca nut chewing. Children who had just started eating for <6 months were excluded from the study. MMO was calculated as distance from the edge of the upper incisor teeth to the edge of the lower incisor teeth using a calibrated fiber ruler. Statistical Analysis Used: Statistical analysis was performed by SPSS software version 20.0, with level of significance set at 5%. Results: Mean and standard deviation of MMO for Group A was 3.69 ± 0.5 cm and for Group B was 4.46 ± 0.4 cm. Statistically significant difference was found using Mann–Whitney U-test with U = 239.500 and P = 0.0001. Pearson's coefficient r = −0.623 and P = 0.0001 showed moderate correlation between months of chewing and MMO. The mean duration of chewing was found to be 1.5 years. Conclusion: There is difference in MMO between children chewing areca nut and not chewing it with a moderate correlation between months of eating areca nut and MMO.
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Clinicopathological features and outcomes in advanced nonsmall cell lung cancer with tailored therapy p. 242
Stalin Bala, Sadashivudu Gundeti, Vijay Gandhi Linga, Lakshmi Srinivas Maddali, Raghunadha Rao Digumarti, Shantveer G Uppin
DOI:10.4103/0971-5851.195735  PMID:28144090
Context: Lung cancer is an important cause of cancer-related deaths worldwide. There is an increasing incidence of lung cancer in never smokers and a shift of histology from squamous cell to adenocarcinoma globally in the recent past. Data on treatment outcomes with newer platinum doublets is scant from India. Aims: To study the clinicopathological features, response rates (RRs), progression-free survival (PFS), overall survival (OS), and the 1, 2, and 3 years survival, in patients with advanced nonsmall cell lung cancer (NSCLC). Materials and Methods: Data of all patients who received chemotherapy for Stage IIIB and IV NSCLC between January 2010 and June 2014 were retrospectively analyzed. Statistical Analysis Used: Univariate analysis for OS was done by plotting Kaplan–Meier curves and the log-rank test was used to calculate P values. Logistic regression analysis for OS was carried out using MedCalc statistical software. Results: A total of 353 patients received chemotherapy. Of these, 256 were evaluable for outcome parameters. The median age at presentation was 58 years with a male:female ratio of 2.53:1. The smoker:nonsmoker ratio was 1:1. Adenocarcinomatous histology was the most common both in smokers and nonsmokers reported in 70.8% patients. Epidermal growth factor receptor (EGFR) mutation and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase translocation were seen in 35% and 3% of patients, respectively. The RR, median PFS, OS, 1, 2, and 3 years survival were 80%, 8 months, 12.1 months, 51.5%, 12.7%, and 4.2%, respectively. There was no significant survival difference among the treatment regimen used but the response to I line chemotherapy impacted survival. Female gender, performance status, and nonsquamous histology were significant predictors of OS (P = 0.0443, P = 0.0003, P = 0.048, respectively). Conclusions: There was an increase in the incidence of nonsmokers. Adenocarcinoma was the most common histology in both smokers and nonsmokers. Treatment outcomes in advanced lung cancer were better compared to the past with the advent of newer platinum doublets and EGFR tyrosine kinase inhibitors. The response to first-line chemotherapy significantly impacts outcomes in advanced NSCLC.
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Clinicopathological profile of gastrointestinal lymphomas in Kashmir p. 251
Mehnaaz Sultan Khuroo, Summyia Farooq Khwaja, Ajaz Rather, Zhahid Hassan, Ruby Reshi, Naira Sultan Khuroo
DOI:10.4103/0971-5851.195736  PMID:28144091
Background: The histological categorization of lymphoma has been a source of controversy for many years for both clinicians and pathologists. Clinicopathologic information of gastrointestinal lymphomas in Indian subcontinent is lacking. We studied histopathological spectrum of Primary Gastrointestinal Lymphomas (PGIL) and attempted to classify the G.I. lymphomas based on the recent WHO classification in to major histological types and immunological categories. Material and Methods: This study was done to evaluate the clinicopathological pattern of 100 cases with a histopathological diagnosis of primary gastrointestinal lymphoma at a tertiary care hospital. All patients of primary gastrointestinal lymphomas were included with the help of medical records over a 11-years period that is, January 2005 to December 2015. Results: The study included 100 cases (60 males, 40 females; mean age 51.43 years; age range 4.5-90 years) . The disease involved stomach in 82 (82%), small intestine in 8 (8%), large bowel and rectum in 8 (8%), gall bladder in 1 (1%) and oesophagus in 1 (1%). 82 (82%) of the 100 cases were Diffuse Large B cell lymphomas; 12 (12%) were Extra Nodal Marginal Zone Lymphomas (ENMZL of MALT type) 2 (2%) IPSID 2 (2%) of Mantle cell lymphoma morphology, 1 (1%) Burkitt's and 1(1%) enteropathy associated T cell lymphoma. The commonest presenting symptom was abdominal pain. 99 (99%) of 100 tumours were classified as B-cell lymphomas immunohistochemically and majority exhibited monoclonal light chain restriction on kappa/lambda staining. In addition; Burkitt's lymphoma showed positivity for CD 10. One tumour (1%) showed positivity for T-cell markers. The data demonstrated that primary GI NHL is more common among males, mainly in their fifth decade. Abdominal pain is the most common presenting symptom, with stomach being the most commonly involved site. Diffuse large cell lymphoma is the most frequent histologic subtype, followed by extranodal marginal-zone B cell lymphoma (MALT type). H. Pylori infection was observed in cases with low grade MALT lymphomas. Striking was the observation of two cases of IPSID (a disease commonly found in Mediterranean countries) and one case of enteropathy associated T cell lymphoma. Conclusion: EGD, imaging, light microscopic examination and immunohistochemical workup for B and T cell markers and staining for light chains to assist documentation of monoclonality are of precise diagnostic value in gastrointestinal lymphomas and form a part of the diagnostic workup.
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Metabolic toxicities in patients undergoing treatment for nonhematological malignancy: A cross-sectional study p. 256
Subhash Gupta, Kunhi Parambath Haresh, Soumyajit Roy, Lakhan Kashyap, Narayan Adhikari, Rambha Pandey, Dayanand Sharma, Pramod Kumar Julka, Goura Kishor Rath
DOI:10.4103/0971-5851.195737  PMID:28144092
Objectives: The objective of this study was to evaluate the prevalence of metabolic toxicities in patients with different nonhematological malignancies admitted in oncology ward of a tertiary cancer care center while on treatment. Methods: We did this cross-sectional study over a period of 7 months (January–July 2013) for all adult patients (n = 280) who, while undergoing anti-cancer therapy at our center, got admitted to our oncology inpatient ward with metabolic toxicity. Grading of toxicity was done using National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0. Results: A total of 46 events of metabolic toxicities were noted in 31 patients over this period. The most common of them was hyperglycemia (n = 10). The others were hypokalemia (n = 9), hyponatremia (n = 9), hypernatremia (n = 5), hyperkalemia (n = 5), tumor lysis syndrome (n = 4), hypercalcemia (n = 2), and grade ≤2 hypomagnesemia (n = 2). Majority of the patients were asymptomatic (n = 26). However, death occurred in five patients. Treatment interruptions took place in 19 patients. Age ≤40 years (P = 0.03), Eastern Cooperative Oncology Group performance status ≥2 (P = 0.023), history of addiction (P = 0.02), comorbidities (P = 0.037) were associated with increased risk of having metabolic toxicities on univariate analysis. While on multivariate analysis, only age, performance status, and history of addiction retained their statistical significance. Age ≤40 years (P = 0.02), use of more than one modality of treatment (P = 0.013), and hyperglycemia (P = 0.037) were associated with higher risk of death. Conclusion: Metabolic toxicities are common phenomena among cancer patients, especially those with young age, comorbidities, and having history of addictions. In young age, they might even be fatal, especially when they are treated with combined modality of treatment.
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Managing metastatic renal cell carcinoma-challenges, pitfalls, and outcomes in the real world p. 260
Karnam Ashok Kumar, Gundeti Sadashivudu, KV Krishnamani, Vijay Gandhi Linga, Lakshmi Srinivas Maddali, Raghunadha Rao Digumarti
DOI:10.4103/0971-5851.195738  PMID:28144093
Introduction: Renal cell carcinoma (RCC) is the most common cancer of the kidney accounting for 85% of renal tumors. Metastatic RCC (mRCC) had a poor prognosis and with the introduction of tyrosine-kinase inhibitors, such as sunitinib, pazopanib the outcomes improved. There is only one study reported from India on the use of sunitinib in mRCC. We present our analysis of mRCC and use of sunitinib at our institute over 5 years. Materials and Methods: All patients with mRCC receiving sunitinib were analyzed with respect to patient characteristics, response, toxicity, and outcomes. Results: A total of 108 patients were seen during the study period. The male to female ratio was 9.8:1. The median age of patients at presentation was 58 years (range: 15–80 years). Of the 108 patients, 68.51% had metastatic disease at initial presentation. The most common sites of metastases were lung followed by bone. Of the 97 patients eligible for sunitinib, only 76 received at least one cycle of sunitinib, out of which only 48 received further cycles (range: 2–36). The median progression-free survival (PFS) and overall survival (OS) in our patients were 10.2 and 28.2 months, respectively. The most common adverse effect noticed in our population was mucositis followed by hand-foot syndrome. Conclusion: Sunitinib is an option for the treatment of mRCC and shows a good PFS in Indian patients. Median OS and PFS in this study are similar to other reported studies despite the presence of poor risk factors in the patient population. The pitfall in this study is significant attrition due to poor compliance to treatment and follow-up, which is a major factor in the clinic thereby compromising outcomes.
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Evaluation of thyroid lesions by fine-needle aspiration cytology based on Bethesda system for reporting thyroid cytopathology classification among the population of South Bihar p. 265
Richa Bhartiya, Mahasweta Mallik, Nawanita Kumari, Brijendra Narayan Prasad
DOI:10.4103/0971-5851.195742  PMID:28144094
Background: Fine-needle aspiration (FNA) of the thyroid gland has proven to be an important and widely accepted, cost-effective, simple, safe, and accurate method triaging patients with thyroid nodules. Awareness and understanding of wide spectrum thyroid disorders are of great value because most lesions are treatable by medical or surgical management. Aim: The aim of this study is to determine the accuracy of FNA cytology (FNAC) in the diagnosis of thyroid lesion using the Bethesda system for reporting thyroid cytopathology nomenclature (BSRTC) and to correlate these with histopathological findings. Materials and Methods: FNA was performed in 238 patients from January 2014 to October 2015 at a Tertiary Teaching Hospital in Bihar presenting with the thyroid swelling and its histopathological correlation was done in 105 patients. Results and Observations: Out of 238 patients with thyroid swelling, majority were females (196) and in younger age group (n = 104 [43.6%], 21–40 years). In 224 cases, adequate smears for cytological interpretation were obtained. Among them, colloid goiter was the most common lesion. Of these, 105 cases were surgically treated, and tissue was submitted for histopathological examination, which showed 97 nonneoplastic lesions and eight neoplastic lesions. Conclusion: FNAC is rapid, simple, safe, and cost-effective diagnostic modality in the investigation of thyroid disease with high sensitivity, specificity, and accuracy. It can be used as an excellent first-line method for investigating the nature of lesion. Bethesda system is very useful as it is simplified, systematic, standardized system for reporting thyroid cytopathology, which provides better communication between cytopathologist and clinicians, leading to more consistent management approach.
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Oxaliplatin-related neuropathy in Indian patients – no difference between generic and original molecules p. 271
Bhawna Sirohi, Vikas Ostwal, Shaheenah Dawood, Gilberto Lopes, Sanjay Talole, Chaitali Nashikkar, Shailesh Shrikhande
DOI:10.4103/0971-5851.195745  PMID:28144095
Background: Oxaliplatin-induced neuropathy is a dose-limiting toxicity that significantly affects patients' quality of life. The aim of this study was to compare its occurrence between a generic versus the original molecule in Indian patients. Materials and Methods: Between August 2012 and July 2013, 163 patients receiving oxaliplatin were prospectively enrolled. A data recording form was used in the clinic to record detailed information. Results: The median age of patients was 55 years (range, 19–79). Chemotherapy regimens used included: capecitabine, oxaliplatin (59), epirubicin, oxaliplatin, and capecitabine (20), docetaxel, oxaliplatin, and capecitabine (11), 5-FU, leucovorin, oxaliplatin (9), and gemcitabine-oxaliplatin (64). The median cumulative dose of oxaliplatin was 780 mg/m2. Eighty patients received the original version and 83 the generic one. Overall, 63 patients (38%) developed neuropathy. There was no significant difference in the incidence of neuropathy between the two forms of oxaliplatin used (P = 0.50). Forty-nine percent of female patients had neuropathy as compared to 30% of male patients (P = 0.014). Older patients had a trend toward a higher incidence of neuropathy: 44% of patients above age fifty developed neuropathy compared to 30% of patients younger than 50 (P = 0.06). Conclusion: This is the first study to specifically show that neuropathy rates do not vary with the use of generic versus original oxaliplatin.
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Burden of cervical cancer and role of screening in India p. 278
Saurabh Bobdey, Jignasa Sathwara, Aanchal Jain, Ganesh Balasubramaniam
DOI:10.4103/0971-5851.195751  PMID:28144096
Background: Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings. Materials and Methods: MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as “cervical cancer”, “screening”, “early detection”, “cervical cytology” and “visual inspection”, and their corresponding MeSH terms in combination with Boolean operators “OR, AND.” Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study. Results: In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively. Conclusions: In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.
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Cognizance and utilization about breast cancer screening among the health professional female students and staffs of University Kuala Lumpur, Royal College of Medicine Perak, Malaysia p. 286
ATM Emdadul Haque, Muhammad Afif Bin Mohd Hisham, Noor Azwa Laili Binti Ahmad Adzman, Nur Atiqah Binti Azudin, Nursakinah Binti Shafri, Mainul Haque
DOI:10.4103/0971-5851.195752  PMID:28144097
Background: Breast cancer (BC) is a major life-threatening problem and a global concern including Malaysia. BC is an equal threat for both developing and developed countries. The aim of this study was to determine the relationship between sociodemographic factors with knowledge, attitude, and perception on BC screening among the females of University Kuala Lumpur, Royal College of Medicine Perak (UniKL RCMP). Materials and Methods: This cross-sectional study was conducted from 2015 to 2016. The populations included were the students and staff of UniKL RCMP. The simple sampling method was used and a set of questionnaire was prepared and distributed to the participants who were willing to participate. The data were analyzed by using the SPSS version 17. Results: Of the 220 only 203 questionnaires were returned. Nearly 87.7% of participants indicated genetic factors as the cause of BC, followed by exposure to carcinogenic and X-ray. Excessive smoking (54.2%) and sedentary lifestyle (52.2%) were the risk factors of the BC. 100% of participants thought that breast self-examination (BSE) is important to detect a breast lump and most of them (76.8%) knew what a mammogram is but only 2.0% went for a mammogram. Chemotherapy (71.9%) and surgery (71.9%) were treatments options according to study participants. Nearly 91.1% agreed that regular mammogram could help to detect BC at an early stage. Nearly 88.2% thought BC is not easily curable. Finally, for the attitude on BC screening, most of them knew how to perform BSE (69.0%) with the frequency of 36.0% doing it once a year. Conclusions: The majority of the participants found the good knowledge on BC and on how to perform BSE. Although most of them knew what a mammogram is, only a few have gone for it since perhaps it is recommended for those who are above 50-year-old. Therefore, researchers believe and trust that there is an urgent need of state-funded multicenter study to prevent and early diagnosis of BC in Malaysia.
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CASE REPORTS Top

Juvenile granulosa cell tumor associated with Ollier disease p. 293
Abhilasha Ashok Sampagar, Rahul R Jahagirdar, Vibha Sanjay Bafna, Sandip P Bartakke
DOI:10.4103/0971-5851.195749  PMID:28144098
Juvenile granulosa cell tumor (JGCT) is a rare neoplasm of childhood. Interestingly, it is known to be associated with Ollier disease, which is a rare bone disease characterized by multiple enchondromatosis. There is paucity of literature about the co-occurence of these two conditions. However, this association is noteworthy because these two conditions share a common pathogenesis. We report a case of JGCT in a 2.5-year-old female child in which multiple enchondromas mimicking bony metastasis were an incidental finding during routine workup for tumor staging, thus leading to a diagnosis of Ollier disease.
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Thymoma masquerading as transfusion dependent anemia p. 296
Javvid Muzamil, Aejaz Aziz Shiekh, Gull Mohammad Bhat, Abdul Rashid Lone, Shuaeb Bhat, Firdousa Nabi
DOI:10.4103/0971-5851.195729  PMID:28144099
Pure red cell aplasia (PRCA) is a known entity in clinical medicine. Patients are often transfusion dependent for their whole life. Ascertaining its etiology is always a herculean task. We received a similar transfusion-dependent patient, who on evaluation was found to have thymoma as an etiological factor. Thymoma presenting as PRCA is seen in 2%–5% patients and evaluating PRCA for thymoma is seen in 5%–13% patient. As per the WHO histopathological classification, thymoma has six types and Type A is associated with PRCA and Type B is associated with myasthenia gravis. This correlation was not seen in our patient, who had Type B thymoma. Surgical resection of thymus improves 30% of PRCA and rest needs immunosuppression. Our patient was not the surgical candidate, and hence he was put on chemotherapy.
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PRACTITIONER SECTION Top

A rare case of lung cancer presenting as an ischioanal fossa mass p. 300
Nishitha Shetty, Ranvijay Singh, Maryam Naveed, Ashwini M Ronghe, Falguni Shashikant Barot
DOI:10.4103/0971-5851.195743  PMID:28144100
Lung cancer metastasis commonly involves the adrenal glands, liver, bone, and brain. However, it can have some rarer forms of metastatic presentation making diagnosis difficult, especially in nonsmokers. We describe a rare case of lung cancer with metastasis to the ischioanal fossa. Overall, this case emphasizes that consideration should be given to wide range of diagnosis in atypical cases of anorectal masses. Lung cancer presenting as an ischioanal mass is not reported so far.
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Multiple solitary extramedullary anaplastic plasmacytomas p. 303
Sandesh Madi, Vishnu Senthil, Monappa Naik, Sandeep Vijayan
DOI:10.4103/0971-5851.195727  PMID:28144101
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LETTERS TO EDITOR Top

Folate supplementation in transfusion-dependent thalassemia: Do we really need such high doses? p. 305
Gaurav Tripathi, Manas Kalra, Amita Mahajan
DOI:10.4103/0971-5851.195746  PMID:28144102
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Early tumor shrinkage as an “on-treatment” clinical predictor of long-term outcome in solid organ cancers p. 306
Pratishtha Banga Chaudhari
DOI:10.4103/0971-5851.195733  PMID:28144103
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Cancer risk of general people due to using joss stick for religious worshiping p. 307
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/0971-5851.195741  PMID:28144104
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A rare case of hepatoid carcinoma of the ovary with pancytopenia and hypocellular marrow p. 307
Manoj Lakhotia, Hans Raj Pahadiya, Akanksha Choudhary, Ronak Gandhi, Ramesh Chand Purohit
DOI:10.4103/0971-5851.195744  PMID:28144105
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Multiple cutaneous malignancies in a child with xeroderma pigmentosum: A case report p. 309
Rita V Vora, RahulKrishna SureshKumar Kota, Nilofar G Diwan
DOI:10.4103/0971-5851.195750  PMID:28144106
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The masquerading splenic lesion p. 311
Mansoor C Abdulla, Jemshad Alungal, Ram Naryan, Neena Mampilly
DOI:10.4103/0971-5851.195728  PMID:28144107
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ASCO 2016 GI CANCER UPDATE Top

Focused update on Gastrointestinal (GI) Oncology from ASCO 2016 p. 314
Ravi Kumar Paluri
DOI:10.4103/0971-5851.195753  PMID:28144108
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ERRATUM Top

Erratum: Evaluation of myeloid cells (tumor associated tissue eosinophils and mast cells) infiltration in different grades of oral squamous cell carcinoma p. 319

DOI:10.4103/0971-5851.195754  PMID:28144109
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Erratum: Isolated humeral recurrence in endometrial carcinoma p. 320

DOI:10.4103/0971-5851.195755  PMID:28144110
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