Umesh Das - Academia.edu (original) (raw)
Papers by Umesh Das
Indian Journal of Health Sciences and Biomedical Research (KLEU)
Pulmonary blastoma (PB) is a very rare primary lung neoplasm. Morphologically, they mimic fetal l... more Pulmonary blastoma (PB) is a very rare primary lung neoplasm. Morphologically, they mimic fetal lung tissue before 4 months gestation. As monophasic variety is extremely rare, we have reported here a case of monophasic PB in a young adult patient who came with cough and hemoptysis for 4 months. On computed tomography scan of the chest, findings showed left upper lobe mass with few specks of calcification within the lesion. The patient underwent left upper lobectomy. The diagnosis was confirmed through histopathological examination with immunohistochemical evaluation. Because of its extreme rarity, we report this case with special interest to help and improve in faster diagnosis and management of the patients diagnosed with PB in future.
Journal of the Scientific Society, 2016
Introduction: Aflibercept in combination with FOLFIRI has been shown to improve overall survival ... more Introduction: Aflibercept in combination with FOLFIRI has been shown to improve overall survival in the pivotal VELOUR study. Aflibercept has not yet been marketed in India. Sanofi has made available this drug for Indian patients under a program called Named Patient Access Program (NPP). We present a limited clinical experience with the use of aflibercept at our center. Materials and Methods: We analyzed the data of the patients who received aflibercept under NPP. Aflibercept was given in combination with FOLFIRI as second-line for patients who progressed on oxaliplatin based therapy. Aflibercept was given at 4 mg/kg intravenous (IV) every 15 days. Chemotoxicities were assessed as per CTCAE. Response evaluation was done every four cycles. Results: Five patients were enrolled. The median age was 34 years. The median number of aflibercept cycles administered was 12. Common grade 2/3 toxicities were mucositis, diarrhea, neutropenia thrombocytopenia, and hypertension seen in three (60%), three (60%), two (40%), two (40%), and one patient respectively. After four cycles, the response was assessed as: One complete remission (CR), three partial remissions (PR), and one progressive disease (PD). Three patients completed 12 cycles of chemotherapy and aflibercept. At the end of 12 cycles, one patient still in CR and two patients were in PR. Four patients were alive till date. Conclusion: As we had very less number of patients, it was very difficult to compare it with VELOUR data. It is one of option as second-line in metastatic colorectal cancer (mCRC) who progressed on oxaliplatin chemotherapy. Mucositis, diarrhea, and hematological toxicity were the most common toxicity in our patient.
Journal of the Scientific Society, 2015
Portal vein thrombosis is commonly forgotten as a possible cause of abdominal pain, portal system... more Portal vein thrombosis is commonly forgotten as a possible cause of abdominal pain, portal systemic encephalopathy, or gastrointestinal haemorrhage caused by oesophageal varices, splenomegaly, and/or ascites. It can complicate the underlying pathology and can increase morbidity and mortality. There can be varied aetiology and pathogenesis of portal vein thrombosis. Usually, the radiologic diagnosis is made either by duplex Doppler ultrasonography and/or colour Doppler ultrasonography. CT scan, magnetic resonance angiography (MRA) and arterial portography or splenoportography. MRI seems a very promising method. The treatment, course, and the prognosis of portal vein thrombosis depends on the aetiology of the disease. Here we are presenting three cases of portal vein thrombosis with different aetiology.
Hypercalcaemic crisis is a life-threatening condition that is currently rather rare 1. Hypercalca... more Hypercalcaemic crisis is a life-threatening condition that is currently rather rare 1. Hypercalcaemic crisis is a condition involving the decompensation of hypercalcaemia, which could have existed for a longer period or could be acute at the first instance of this electrolyte disturbance 2,3. We report a case of hypercalcaemic crisis which was a first presentation in a patient of metastatic carcinoma in skull bone with unknown primary cancer. JIACM 2010; 11(2): 157-60
Pleural effusion in chronic myeloid leukaemia (CML) is poorly understood and rarely reported in t... more Pleural effusion in chronic myeloid leukaemia (CML) is poorly understood and rarely reported in the literature. Chronic myelocytic leukaemia (CML) has been reported to show extra-medullary involvement in 10% of cases and affects mostly lymph nodes and spleen. Extensive pleural involvement of leukaemic cells is very rare. In chronic myelocytic leukaemia (CML), the pleura is a very uncommon site of extramedullary involvement. We describe a patient who presented with moderate pleural effusion due to pleural infiltration – suggestive of extra-medullary blast crisis. His peripheral picture blood was suggestive of CML in chronic phase, Ph chromosome was positive and the leucocyte alkaline phosphatase level was low. Cytological examination of the pleural fluid revealed cells with the morphological features of myeloblasts. There was an excellent response to imatinib. Key words: Chronic myelocytic leukaemia (CML), Ph chromosome, leucocyte alkaline phosphatase level, extra-medullary blast cri...
Ecancermedicalscience, 2013
We report an unusual case of a 6-year-old male child who presented with fever and a cough of one ... more We report an unusual case of a 6-year-old male child who presented with fever and a cough of one month's duration. A bone marrow aspiration and cytogenetics were suggestive of acute myeloid leukaemia with t(8;21)(q22;q22). A chest x-ray and computed tomography of the thorax showed a soft tissue lesion in the right lung. The fine needle aspiration cytology (FNAC) of this lesion was suggestive of pulmonary granulocytic sarcoma. The patient was successfully treated with induction chemotherapy (cytosine arabinoside + daunomycin), followed by consolidation with high-dose cytosine arabinoside. In view of the persistent lesion in the right lung, the patient was given external beam radiotherapy (EBRT), which resulted in near total resolution of the lung granulocytic sarcoma. We report this case in view of its rarity and clinical importance, and to highlight the treatment options in this scenario.
Ecancermedicalscience, 2013
We report a rare case of a 68-year-old male who presented with fever, weight loss, nasal blockage... more We report a rare case of a 68-year-old male who presented with fever, weight loss, nasal blockage, and epistaxis. Examination revealed cervical and axillary lymphadenopathy with no evidence of organomegaly. On evaluation, bone marrow aspiration showed lymphoplasmacytic infiltration. The computed tomography of the neck showed nasopharyngeal mass and the biopsy of this mass and cervical lymph node showed lymphoplasmacytic lymphoma (LPL) with high serum IgM level. Hence, a diagnosis of Waldenstrom's macroglobulinemia (WM) was made. The patient received six cycles of chemotherapy with a combination of cyclophosphamide, vincristine, and prednisolone (COP regimen). Currently, the patient is under follow-up and in complete remission (CR), one year after completion of therapy. Nasopharyngeal involvement is extremely rare in WM, and hence we report this case.
Journal of Medical Sciences, 2015
Journal of the Scientific Society, 2014
We present this unusual case of the clinical importance of a 50-year-old male patient who present... more We present this unusual case of the clinical importance of a 50-year-old male patient who presented with foreign body sensation in the throat and halitosis of 20 days duration. On examination, there were no palpable lymph nodes and oral cavity revealed an ulcero proliferative growth over the right tonsil. Computed tomography of the paranasal sinuses and neck revealed a heterogeneously enhancing mass involving the right tonsil measuring 3.8 cm × 3 cm. Biopsy of the tonsillar mass was suggestive of anaplastic large cell lymphoma (ALCL) with neoplastic large cells positive for CD30, epithelial membrane antigen and CD3 and negative for Tdt, CD56, anaplastic lymphoma kinase (ALK) and cytokeratin. A diagnosis of ALK negative ALCL Stage IA was made and the patient was started on chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone every 3 weeks. He received six cycles of chemotherapy followed by 33 gray involved region radiotherapy and reassessment showed total regression of the tonsillar lesion. The patient is in complete remission and now under follow-up for the last 2 years.
Indian Journal of Rheumatology, 2006
Forty newly diagnosed patients of RA (as per ACR 1987 criteria) were evaluated for disease activi... more Forty newly diagnosed patients of RA (as per ACR 1987 criteria) were evaluated for disease activity (using DAS Score) along with the estimation of ESR, CRP and lipid profile (Group-I). These parameters were again estimated at 12 weeks of DMARD therapy. The lipid profile was also estimated in 40 healthy individuals taken as control (Group-II). Results: The mean age was 43.68±12.19 years in Group-I while it was 43.95 ± 9.37 years for Group-II (P > 0.05) with an equal male : female ratio of 1 : 3. Both ESR and CRP decreased significantly (P < 0.001) at 12 weeks from their baseline values after DMARD therapy. The DAS28 score decreased significantly from 7.76 ± 0.44 to 3.21 ± 0.85 (P < 0.001) at 12 weeks. On comparing the lipid profile, serum Triglyceride, HDL cholesterol and VLDL cholesterol did not show any variability from control group both at baseline and 12 weeks of therapy (P > 0.05). The serum cholesterol was 168.75 ± 47.62 mg%, LDL cholesterol was 103.55 ± 37.68 mg% and LDL/HDL ratio was 2.70 ± 0.83 when compared to values of 146.60 ± 7.30 mg%, 85.88 ± 7.33 mg% and 2.24 ± 0.19, respectively, in control group (P < 0.05 in all). With DMARD therapy, at 12 weeks serum cholesterol was 147 ± 17.94 mg%, LDL cholesterol was 89.20 ± 10.55 and LDL/HDL ratio was 2.32 ± 0.35 (all values were comparable to control group, P > 0.05 at 12 weeks). Conclusion: The present study indicates that lipid profile parameters (serum cholesterol, LDL and LDL/HDL) return to control values after control of disease activity with DMARD therapy indicating that dyslipidaemia may lead to accelerated atherosclerosis and may expose patients of active RA to increased cardiovascular risk.
The Chinese-German Journal of Clinical Oncology, 2013
ABSTRACT We present a rare case of a 50-year old lady who presented with pain abdomen and bleedin... more ABSTRACT We present a rare case of a 50-year old lady who presented with pain abdomen and bleeding per vaginum of 3 months duration. Per vaginal examination revealed an exophytic growth arising from vault. Histopathological examination of the vault biopsy showed malignant neoplasm with features suggestive of carcinosarcoma of vault with immunohistochemistry showing stromal cells positive for CD10 and negative for SMA. Ki67 index was 40%–50%. She received external beam radiotherapy to pelvis 50.4 Gy/25 fractions but did not respond to the same. The lesion was not surgically resectable and hence referred to the division of medical oncology for chemotherapy. She was started on ifosphamide with cisplatin with growth factor support. It was planned to do a reassessment after 3 cycles of chemotherapy, but patient succumbed to the illness.
Journal of Cancer Research and Therapeutics, 2014
Background: Extra nodal involvements of non-Hodgkin's lymphomas (NHL) are not so uncommon, but th... more Background: Extra nodal involvements of non-Hodgkin's lymphomas (NHL) are not so uncommon, but the involvement of oral cavity by NHL is very rare.
Case Reports in Oncological Medicine, 2013
Neuroendocrine neoplasms are defined as epithelial neoplasms with predominant neuroendocrine diff... more Neuroendocrine neoplasms are defined as epithelial neoplasms with predominant neuroendocrine differentiation. They can arise in almost every organ of the body although they are most commonly found in the gastrointestinal tract and respiratory system. Nasal cavity and paranasal sinuses are a rare site for neuroendocrine carcinoma. In contrast to the other regions, neuroendocrine tumours of the sinuses have been reported to be recurrent and locally destructive. Very few cases of paranasal sinus neuroendocrine carcinoma have been reported till date. Difficulty in pathologic diagnosis and rarity of this malignancy have hindered the progress in understanding the clinical course and improving outcomes. We herein report a case of poorly differentiated neuroendocrine tumour of ethmoid and sphenoid sinus with invasion of orbit and intracranial extension. The patient had complete response at the end of chemoradiation and he was disease-free for 9 months duration after which he developed bone metastasis without regional recurrence.
Indian journal of pediatrics, 2014
Brain tumors are the second most common cancers after hematological malignancies accounting for a... more Brain tumors are the second most common cancers after hematological malignancies accounting for approximate 21% of all childhood malignancies in children between ages of 0 and 14 y. The present study was undertaken to determine the spectrum of the brain tumors diagnosed in a tertiary cancer center in South India. A retrospective analysis of the data of pediatric brain tumors diagnosed between 2003 and 2009 was done and data was classified according to the age, gender and histology types. Out of 2,844 pediatric patients, 341 (11.99%) were diagnosed as having brain tumors. Most of the patients were in the age group of >5-14 y. Male to female ratio was 1.58:1. The most common pediatric brain tumor was medulloblastoma followed by astrocytoma and ependymoma. Glioblastoma multiforme was the most common subtype of astrocytoma. Other common tumors were glioma, oligodendroglioma, periphereral neuroectodermal tumor and germ cell tumor. As compared to western data, incidence of brain tumors...
Turkish Journal of Hematology, 2014
Eosinophilia associated with FIP1L1-PDGFRA rearrangement represents a subset of chronic eosinophi... more Eosinophilia associated with FIP1L1-PDGFRA rearrangement represents a subset of chronic eosinophilic leukemia and affected patients are sensitive to imatinib treatment. This study was undertaken to learn the prevalence and associated clinicopathologic and genetic features of FIP1L1-PDGFRA rearrangement in a cohort of 26 adult patients presenting with profound eosinophilia (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.5x10(9)/L). Reverse-transcriptase polymerase chain reaction and gel electrophoresis were used for the detection of FIP1L1-PDGFRA rearrangement. Five male patients with splenomegaly carried the FIP1L1-PDGFRA gene rearrangement. All patients achieved complete hematological response within 4 weeks of starting imatinib. One patient had previous deep vein thrombosis and 1 patient had cardiomyopathy, which improved with steroids and imatinib. Conventional cytogenetics was normal in all these patients. No primary resistance to imatinib was noted. This study indicates the need to do the FIP1L1-PDGFRA assay in patients with hypereosinophilic syndrome. Prompt treatment of this condition with imatinib can lead to complete hematological response and resolution of the organ damage that can be seen in this setting.
Annals of medical and health sciences research, 2014
Triple negative breast cancers (TNBCs) are a diverse and heterogeneous group of tumors that by de... more Triple negative breast cancers (TNBCs) are a diverse and heterogeneous group of tumors that by definition lack estrogen and progesterone receptors and amplification of the HER-2 gene. The majority of the tumors classified as TNBCs are highly malignant, patients are usually young and only a subgroup of patients responds to conventional chemotherapy with a favorable prognosis. Various studies have been reported in western literature on TNBCs, all highlighting the poor prognosis of this subtype. However, extensive data from India is lacking. The aim of this study was to analyze the epidemiological and clinical profile of TNBCs at our institute. This was the retrospective study carried out in Tertiary Cancer Care Center in South India. Case files of all breast cancer patients were reviewed from the hospital database registered in 1 year and TNBC patients were selected for the study. Patient's characteristic, treatment, and histological features were analyzed. A total of 322 patients...
Journal of Cancer Research and Clinical Oncology, 2014
46.25 %). Seventy-two patients were stage III and 8 were stage II disease. Bilateral breast cance... more 46.25 %). Seventy-two patients were stage III and 8 were stage II disease. Bilateral breast cancer was seen in 8 patients. Most common histological type was invasive ductal carcinoma (95 %). estrogen receptor (eR) and/ or progesterone (PR) positive were seen in 47 (58.75 %) patients. ten patients were HeR2 positive and eR/PR negative, and 5 patients were triple positive. triple-negative patients were 22 (27.5 %). the most common neoadjuvant chemotherapy protocol used was FeC. Clinical response before surgery was CR 13 %, PR 68.68 %, stable disease 11.62 %, and progressive disease 4.65 %. Pathological CR was seen in 6.9 % of tumors. nodal status at surgery was ypn0-40 %, ypn1-28. 5 %. ypn2-27 %, and ypn3-4.28 %. Conclusion In a population of predominantly locally advanced patients, naCt with anthracyclines yielded pCR rates comparable to published studies. there were a high proportion of HeR2-positive patients, most of whom could not receive anti-HeR2 therapy due to financial reasons.
memo - Magazine of European Medical Oncology, 2014
Indian Journal of Health Sciences and Biomedical Research (KLEU)
Pulmonary blastoma (PB) is a very rare primary lung neoplasm. Morphologically, they mimic fetal l... more Pulmonary blastoma (PB) is a very rare primary lung neoplasm. Morphologically, they mimic fetal lung tissue before 4 months gestation. As monophasic variety is extremely rare, we have reported here a case of monophasic PB in a young adult patient who came with cough and hemoptysis for 4 months. On computed tomography scan of the chest, findings showed left upper lobe mass with few specks of calcification within the lesion. The patient underwent left upper lobectomy. The diagnosis was confirmed through histopathological examination with immunohistochemical evaluation. Because of its extreme rarity, we report this case with special interest to help and improve in faster diagnosis and management of the patients diagnosed with PB in future.
Journal of the Scientific Society, 2016
Introduction: Aflibercept in combination with FOLFIRI has been shown to improve overall survival ... more Introduction: Aflibercept in combination with FOLFIRI has been shown to improve overall survival in the pivotal VELOUR study. Aflibercept has not yet been marketed in India. Sanofi has made available this drug for Indian patients under a program called Named Patient Access Program (NPP). We present a limited clinical experience with the use of aflibercept at our center. Materials and Methods: We analyzed the data of the patients who received aflibercept under NPP. Aflibercept was given in combination with FOLFIRI as second-line for patients who progressed on oxaliplatin based therapy. Aflibercept was given at 4 mg/kg intravenous (IV) every 15 days. Chemotoxicities were assessed as per CTCAE. Response evaluation was done every four cycles. Results: Five patients were enrolled. The median age was 34 years. The median number of aflibercept cycles administered was 12. Common grade 2/3 toxicities were mucositis, diarrhea, neutropenia thrombocytopenia, and hypertension seen in three (60%), three (60%), two (40%), two (40%), and one patient respectively. After four cycles, the response was assessed as: One complete remission (CR), three partial remissions (PR), and one progressive disease (PD). Three patients completed 12 cycles of chemotherapy and aflibercept. At the end of 12 cycles, one patient still in CR and two patients were in PR. Four patients were alive till date. Conclusion: As we had very less number of patients, it was very difficult to compare it with VELOUR data. It is one of option as second-line in metastatic colorectal cancer (mCRC) who progressed on oxaliplatin chemotherapy. Mucositis, diarrhea, and hematological toxicity were the most common toxicity in our patient.
Journal of the Scientific Society, 2015
Portal vein thrombosis is commonly forgotten as a possible cause of abdominal pain, portal system... more Portal vein thrombosis is commonly forgotten as a possible cause of abdominal pain, portal systemic encephalopathy, or gastrointestinal haemorrhage caused by oesophageal varices, splenomegaly, and/or ascites. It can complicate the underlying pathology and can increase morbidity and mortality. There can be varied aetiology and pathogenesis of portal vein thrombosis. Usually, the radiologic diagnosis is made either by duplex Doppler ultrasonography and/or colour Doppler ultrasonography. CT scan, magnetic resonance angiography (MRA) and arterial portography or splenoportography. MRI seems a very promising method. The treatment, course, and the prognosis of portal vein thrombosis depends on the aetiology of the disease. Here we are presenting three cases of portal vein thrombosis with different aetiology.
Hypercalcaemic crisis is a life-threatening condition that is currently rather rare 1. Hypercalca... more Hypercalcaemic crisis is a life-threatening condition that is currently rather rare 1. Hypercalcaemic crisis is a condition involving the decompensation of hypercalcaemia, which could have existed for a longer period or could be acute at the first instance of this electrolyte disturbance 2,3. We report a case of hypercalcaemic crisis which was a first presentation in a patient of metastatic carcinoma in skull bone with unknown primary cancer. JIACM 2010; 11(2): 157-60
Pleural effusion in chronic myeloid leukaemia (CML) is poorly understood and rarely reported in t... more Pleural effusion in chronic myeloid leukaemia (CML) is poorly understood and rarely reported in the literature. Chronic myelocytic leukaemia (CML) has been reported to show extra-medullary involvement in 10% of cases and affects mostly lymph nodes and spleen. Extensive pleural involvement of leukaemic cells is very rare. In chronic myelocytic leukaemia (CML), the pleura is a very uncommon site of extramedullary involvement. We describe a patient who presented with moderate pleural effusion due to pleural infiltration – suggestive of extra-medullary blast crisis. His peripheral picture blood was suggestive of CML in chronic phase, Ph chromosome was positive and the leucocyte alkaline phosphatase level was low. Cytological examination of the pleural fluid revealed cells with the morphological features of myeloblasts. There was an excellent response to imatinib. Key words: Chronic myelocytic leukaemia (CML), Ph chromosome, leucocyte alkaline phosphatase level, extra-medullary blast cri...
Ecancermedicalscience, 2013
We report an unusual case of a 6-year-old male child who presented with fever and a cough of one ... more We report an unusual case of a 6-year-old male child who presented with fever and a cough of one month's duration. A bone marrow aspiration and cytogenetics were suggestive of acute myeloid leukaemia with t(8;21)(q22;q22). A chest x-ray and computed tomography of the thorax showed a soft tissue lesion in the right lung. The fine needle aspiration cytology (FNAC) of this lesion was suggestive of pulmonary granulocytic sarcoma. The patient was successfully treated with induction chemotherapy (cytosine arabinoside + daunomycin), followed by consolidation with high-dose cytosine arabinoside. In view of the persistent lesion in the right lung, the patient was given external beam radiotherapy (EBRT), which resulted in near total resolution of the lung granulocytic sarcoma. We report this case in view of its rarity and clinical importance, and to highlight the treatment options in this scenario.
Ecancermedicalscience, 2013
We report a rare case of a 68-year-old male who presented with fever, weight loss, nasal blockage... more We report a rare case of a 68-year-old male who presented with fever, weight loss, nasal blockage, and epistaxis. Examination revealed cervical and axillary lymphadenopathy with no evidence of organomegaly. On evaluation, bone marrow aspiration showed lymphoplasmacytic infiltration. The computed tomography of the neck showed nasopharyngeal mass and the biopsy of this mass and cervical lymph node showed lymphoplasmacytic lymphoma (LPL) with high serum IgM level. Hence, a diagnosis of Waldenstrom's macroglobulinemia (WM) was made. The patient received six cycles of chemotherapy with a combination of cyclophosphamide, vincristine, and prednisolone (COP regimen). Currently, the patient is under follow-up and in complete remission (CR), one year after completion of therapy. Nasopharyngeal involvement is extremely rare in WM, and hence we report this case.
Journal of Medical Sciences, 2015
Journal of the Scientific Society, 2014
We present this unusual case of the clinical importance of a 50-year-old male patient who present... more We present this unusual case of the clinical importance of a 50-year-old male patient who presented with foreign body sensation in the throat and halitosis of 20 days duration. On examination, there were no palpable lymph nodes and oral cavity revealed an ulcero proliferative growth over the right tonsil. Computed tomography of the paranasal sinuses and neck revealed a heterogeneously enhancing mass involving the right tonsil measuring 3.8 cm × 3 cm. Biopsy of the tonsillar mass was suggestive of anaplastic large cell lymphoma (ALCL) with neoplastic large cells positive for CD30, epithelial membrane antigen and CD3 and negative for Tdt, CD56, anaplastic lymphoma kinase (ALK) and cytokeratin. A diagnosis of ALK negative ALCL Stage IA was made and the patient was started on chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone every 3 weeks. He received six cycles of chemotherapy followed by 33 gray involved region radiotherapy and reassessment showed total regression of the tonsillar lesion. The patient is in complete remission and now under follow-up for the last 2 years.
Indian Journal of Rheumatology, 2006
Forty newly diagnosed patients of RA (as per ACR 1987 criteria) were evaluated for disease activi... more Forty newly diagnosed patients of RA (as per ACR 1987 criteria) were evaluated for disease activity (using DAS Score) along with the estimation of ESR, CRP and lipid profile (Group-I). These parameters were again estimated at 12 weeks of DMARD therapy. The lipid profile was also estimated in 40 healthy individuals taken as control (Group-II). Results: The mean age was 43.68±12.19 years in Group-I while it was 43.95 ± 9.37 years for Group-II (P > 0.05) with an equal male : female ratio of 1 : 3. Both ESR and CRP decreased significantly (P < 0.001) at 12 weeks from their baseline values after DMARD therapy. The DAS28 score decreased significantly from 7.76 ± 0.44 to 3.21 ± 0.85 (P < 0.001) at 12 weeks. On comparing the lipid profile, serum Triglyceride, HDL cholesterol and VLDL cholesterol did not show any variability from control group both at baseline and 12 weeks of therapy (P > 0.05). The serum cholesterol was 168.75 ± 47.62 mg%, LDL cholesterol was 103.55 ± 37.68 mg% and LDL/HDL ratio was 2.70 ± 0.83 when compared to values of 146.60 ± 7.30 mg%, 85.88 ± 7.33 mg% and 2.24 ± 0.19, respectively, in control group (P < 0.05 in all). With DMARD therapy, at 12 weeks serum cholesterol was 147 ± 17.94 mg%, LDL cholesterol was 89.20 ± 10.55 and LDL/HDL ratio was 2.32 ± 0.35 (all values were comparable to control group, P > 0.05 at 12 weeks). Conclusion: The present study indicates that lipid profile parameters (serum cholesterol, LDL and LDL/HDL) return to control values after control of disease activity with DMARD therapy indicating that dyslipidaemia may lead to accelerated atherosclerosis and may expose patients of active RA to increased cardiovascular risk.
The Chinese-German Journal of Clinical Oncology, 2013
ABSTRACT We present a rare case of a 50-year old lady who presented with pain abdomen and bleedin... more ABSTRACT We present a rare case of a 50-year old lady who presented with pain abdomen and bleeding per vaginum of 3 months duration. Per vaginal examination revealed an exophytic growth arising from vault. Histopathological examination of the vault biopsy showed malignant neoplasm with features suggestive of carcinosarcoma of vault with immunohistochemistry showing stromal cells positive for CD10 and negative for SMA. Ki67 index was 40%–50%. She received external beam radiotherapy to pelvis 50.4 Gy/25 fractions but did not respond to the same. The lesion was not surgically resectable and hence referred to the division of medical oncology for chemotherapy. She was started on ifosphamide with cisplatin with growth factor support. It was planned to do a reassessment after 3 cycles of chemotherapy, but patient succumbed to the illness.
Journal of Cancer Research and Therapeutics, 2014
Background: Extra nodal involvements of non-Hodgkin's lymphomas (NHL) are not so uncommon, but th... more Background: Extra nodal involvements of non-Hodgkin's lymphomas (NHL) are not so uncommon, but the involvement of oral cavity by NHL is very rare.
Case Reports in Oncological Medicine, 2013
Neuroendocrine neoplasms are defined as epithelial neoplasms with predominant neuroendocrine diff... more Neuroendocrine neoplasms are defined as epithelial neoplasms with predominant neuroendocrine differentiation. They can arise in almost every organ of the body although they are most commonly found in the gastrointestinal tract and respiratory system. Nasal cavity and paranasal sinuses are a rare site for neuroendocrine carcinoma. In contrast to the other regions, neuroendocrine tumours of the sinuses have been reported to be recurrent and locally destructive. Very few cases of paranasal sinus neuroendocrine carcinoma have been reported till date. Difficulty in pathologic diagnosis and rarity of this malignancy have hindered the progress in understanding the clinical course and improving outcomes. We herein report a case of poorly differentiated neuroendocrine tumour of ethmoid and sphenoid sinus with invasion of orbit and intracranial extension. The patient had complete response at the end of chemoradiation and he was disease-free for 9 months duration after which he developed bone metastasis without regional recurrence.
Indian journal of pediatrics, 2014
Brain tumors are the second most common cancers after hematological malignancies accounting for a... more Brain tumors are the second most common cancers after hematological malignancies accounting for approximate 21% of all childhood malignancies in children between ages of 0 and 14 y. The present study was undertaken to determine the spectrum of the brain tumors diagnosed in a tertiary cancer center in South India. A retrospective analysis of the data of pediatric brain tumors diagnosed between 2003 and 2009 was done and data was classified according to the age, gender and histology types. Out of 2,844 pediatric patients, 341 (11.99%) were diagnosed as having brain tumors. Most of the patients were in the age group of >5-14 y. Male to female ratio was 1.58:1. The most common pediatric brain tumor was medulloblastoma followed by astrocytoma and ependymoma. Glioblastoma multiforme was the most common subtype of astrocytoma. Other common tumors were glioma, oligodendroglioma, periphereral neuroectodermal tumor and germ cell tumor. As compared to western data, incidence of brain tumors...
Turkish Journal of Hematology, 2014
Eosinophilia associated with FIP1L1-PDGFRA rearrangement represents a subset of chronic eosinophi... more Eosinophilia associated with FIP1L1-PDGFRA rearrangement represents a subset of chronic eosinophilic leukemia and affected patients are sensitive to imatinib treatment. This study was undertaken to learn the prevalence and associated clinicopathologic and genetic features of FIP1L1-PDGFRA rearrangement in a cohort of 26 adult patients presenting with profound eosinophilia (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.5x10(9)/L). Reverse-transcriptase polymerase chain reaction and gel electrophoresis were used for the detection of FIP1L1-PDGFRA rearrangement. Five male patients with splenomegaly carried the FIP1L1-PDGFRA gene rearrangement. All patients achieved complete hematological response within 4 weeks of starting imatinib. One patient had previous deep vein thrombosis and 1 patient had cardiomyopathy, which improved with steroids and imatinib. Conventional cytogenetics was normal in all these patients. No primary resistance to imatinib was noted. This study indicates the need to do the FIP1L1-PDGFRA assay in patients with hypereosinophilic syndrome. Prompt treatment of this condition with imatinib can lead to complete hematological response and resolution of the organ damage that can be seen in this setting.
Annals of medical and health sciences research, 2014
Triple negative breast cancers (TNBCs) are a diverse and heterogeneous group of tumors that by de... more Triple negative breast cancers (TNBCs) are a diverse and heterogeneous group of tumors that by definition lack estrogen and progesterone receptors and amplification of the HER-2 gene. The majority of the tumors classified as TNBCs are highly malignant, patients are usually young and only a subgroup of patients responds to conventional chemotherapy with a favorable prognosis. Various studies have been reported in western literature on TNBCs, all highlighting the poor prognosis of this subtype. However, extensive data from India is lacking. The aim of this study was to analyze the epidemiological and clinical profile of TNBCs at our institute. This was the retrospective study carried out in Tertiary Cancer Care Center in South India. Case files of all breast cancer patients were reviewed from the hospital database registered in 1 year and TNBC patients were selected for the study. Patient's characteristic, treatment, and histological features were analyzed. A total of 322 patients...
Journal of Cancer Research and Clinical Oncology, 2014
46.25 %). Seventy-two patients were stage III and 8 were stage II disease. Bilateral breast cance... more 46.25 %). Seventy-two patients were stage III and 8 were stage II disease. Bilateral breast cancer was seen in 8 patients. Most common histological type was invasive ductal carcinoma (95 %). estrogen receptor (eR) and/ or progesterone (PR) positive were seen in 47 (58.75 %) patients. ten patients were HeR2 positive and eR/PR negative, and 5 patients were triple positive. triple-negative patients were 22 (27.5 %). the most common neoadjuvant chemotherapy protocol used was FeC. Clinical response before surgery was CR 13 %, PR 68.68 %, stable disease 11.62 %, and progressive disease 4.65 %. Pathological CR was seen in 6.9 % of tumors. nodal status at surgery was ypn0-40 %, ypn1-28. 5 %. ypn2-27 %, and ypn3-4.28 %. Conclusion In a population of predominantly locally advanced patients, naCt with anthracyclines yielded pCR rates comparable to published studies. there were a high proportion of HeR2-positive patients, most of whom could not receive anti-HeR2 therapy due to financial reasons.
memo - Magazine of European Medical Oncology, 2014