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   Table of Contents - Current issue
July-December 2019
Volume 2 | Issue 2
Page Nos. 37-88

Online since Monday, December 30, 2019

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The mala fides of BRAF in oncogenesis p. 37
Anurag Mehta, Garima Gupta, Shrinidhi Nathany
BRAF is a proto-oncogene that encodes a serine threonine kinase belonging to intracellular RAS-RAF-MEK& ERK signaling cascade downstream of surface Receptor Tyrosine Kinase. The gain of function mutations in BRAF gene have been shown to have a powerful oncogenic effect especially a transversion at nucleotide 1,799 from thymidine to adenine (p.V600E), accounting for greater than 80% of the observed mutations in BRAF. This one mutation has been identified as an oncogenic driver in a diverse set of solid and hematologic cancers. Fortunately, introduction of BRAF & MEK inhibitors has modestly transformed the treatment outcomes in patients with BRAF mutations, especially those with non-small cell lung carcinoma, melanoma and thyroid cancers. Besides, the predictive nature of BRAF mutation, the mutational analysis also helps predict prognosis and secure diagnosis of a varied group of malignancies. This review comprehensively addresses to the various mala fides of BRAF in oncogenesis, as well as elucidates the nucleotide variants which have been reported in literature, the diagnostic and prognostic utility, and the testing methods which are available to test the same.
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Immune checkpoint inhibitors in the driver’s seat: Evaluating the evolving evidence in the treatment of extensive-stage small-cell lung cancer p. 43
Yasar Ahmed, Paula Calvert, Colum Dennehy, J Lee
Until recently, improving treatment-related outcomes remained an unmet medical need for patients with extensive-stage small-cell lung cancer (ES-SCLC). Because of its rapid growth profile and tendency to metastasize early in the disease course, ES-SCLC accounts for approximately two-thirds of all SCLC diagnoses. Although treatment-naïve ES-SCLC is highly responsive to initial therapy with a platinum compound in combination with etoposide (EP), most patients experience disease recurrence within six months, and fewer than 5% survive to five years. In the platinum resistant/refractory settings, there are no standard guidelines for treatment, with various studies showing similar response rates (RRs) and survival outcomes for different single agent chemotherapies.Immune checkpoint inhibitors (ICIs) have been shown to improve outcomes in patients with a range of tumor types, especially in those characterized by high tumor mutational burden (TMB). The success of studies evaluating ICIs in multiple treatment settings and tumors, including SCLC, has led to trials assessing their role in ES-SCLC. Results from these trials suggest that this modality can improve outcomes, including in the first-line setting. Recent data show improved survival for patients with treatment-naïve ES-SCLC who received an ICI in combination with standard chemotherapy. Multiple trials evaluating a potential role for ICIs in the first-line setting are currently ongoing, with results expected within the next year.This paper incorporates clinical trial data and current guideline recommendations to show current evidence related to clinical decision making and patient management for those receiving ICI-containing regimens as first-line therapy for ES-SCLC.
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Radical brachytherapy for early-stage external auditory canal squamous cell carcinoma: A dosimetric feasibility study using plastic earbud as an applicator p. 49
Kanhu Charan Patro, PS Bhattacharyya, Sayan Paul, Chira Ranjan Khadanga, EB Rajmohon, Chitta Ranjan Kundu, Venkata Krishna Readdy P., Madhuri Palla, AC Prabu, Subhra Das, A Anil Kumar, Aketi Srinu, Susovan Banerjee, Sanjukta Padhi, Suman Das
Squamous cell carcinoma (SCC) of external auditory canal (EAC) is extremely rare. Although surgery followed by radio (chemo) therapy is the contemporary standard of care, radical radio (chemo) therapy has been successfully used as an anatomical as well as functional organ preservation modality. Radical brachytherapy is a promising alternative in early-stage SCC-EAC. We report our initial experience on the feasibility of using commercially available plastic earbud along with soft flexible earpiece of stethoscope as a radioactive source career applicator of remote after-loading high-dose rate radioactive sources (Ir192).
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Serum l-fucose levels as a potential biomarker in the early detection of oral potentially malignant epithelial lesions and oral squamous cell carcinoma: An original research article p. 53
Farheen Anjum Taqdeerullah Khan, Rakhi Chandak, Abhishek Singh Nayyar, Ajay Chandran, S Nachiappan, G Santosh Reddy
Context and Aim: Tumor markers are specific substances released either by the tumor or, the host while combating the tumor into the serum. Altered concentration of these biomarkers in the serum or, saliva of an individual, then, gives the signal of the future alarming condition pertaining to the process of frank malignant transformations. l-Fucose is one such tumor marker detectable in serum which can be used as an important biomarker for the detection, monitoring and for prognostic assessment of the potentially malignant disorders. The purpose of the present study was to estimate and evaluate the efficacy of serum l-Fucose levels as a potential biomarker in the early detection of oral potentially malignant epithelial lesions (PMELs) including leukoplakia, OSMF and OSCC patients. Materials and Methods: The present observational study was conducted over a period of 2 years wherein a total of 100 subjects aged between 18 to 60 years clinically diagnosed and histopathologically confirmed as patients with oral leukoplakia, OSMF and OSCC between the age range of 20-60 years were included. The patients were subjected to incisional biopsy after routine hematological investigation. The same sera samples were, then, used for the analysis of serum l-Fucose levels. Statistical Analysis Used: The statistical analysis was done using the Statistical Package for Social Sciences (SPSS version 17.0, EPI-INFO 6.0 version) and Graph Pad Prism version 5.0 (Chicago, USA). Comparison of serum L-Fucose levels with the control group was performed using one way Analysis of Variance (one way ANOVA) test (F-Test) while frequencies were compared with the help of chi-square test. Inter-group comparisons and multiple comparisons were done with the help of Tukey’s Test. P < 0.05 was considered statistically significant. Results: On comparing serum l-Fucose levels in the patients of the four groups, a statistically significant difference was found in the values of the mean serum l-Fucose levels in all the four groups (p < 0.05). Conclusion: The observations of the present study revealed that serum l-Fucose levels were found to be raised in all the three groups and showcased an increasing trend with the progression of the severity of the disease from the potentially malignant to the malignant stages.
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Hand-sewn versus stapled cervical esophagogastric anastomosis for esophageal carcinoma: A study of postoperative clinical outcomes from a high-incidence center of northeast India p. 61
Joydeep Purkayastha, Hemish H Kania, Abhijit Talukdar, Gaurav Das, Niju Pegu, Dwipen Kalita
Anastomotic leak from cervical esophagogastric anastomoses is a serious problem after esophagectomy. We explored the efficacy of partial or total mechanical anastomoses accomplished with the endoscopic linear cutting and stapling device as an alternative to hand-sewn anastomotic techniques. Along that we compared various clinical outcomes associated with the same.
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Synchronous tumors in head neck oncology: A rare case and its management p. 67
Hemish H Kania, Aditya Joshipura
Although double cancers in the upper aerodigestive tract mucosa are not uncommon collision tumors that are composed of a papillary thyroid carcinoma and a laryngeal giant cell tumour are rare. The term ‘synchronous tumor’ refers to the coexistence of two histologically distinct malignant tumors within the same mass. There are case reports of the Synchronous Tumour composed of papillary thyroid carcinoma with laryngeal squamous cell carcinoma. However, even isolated presentation of giant cell tumour of the larynx is very rare and only 8 cases have been reported. Giant cell tumors of the larynx (GCTL) are extremely rare benign tumors arising in the osteocartilaginous tissue of the larynx. Complete surgical resection is adequate for local control in all the reported cases. Radiation therapy and/or chemotherapy are not a necessary adjunct in the treatment of these laryngeal tumors. This paper reports the case of a 55-year-old male who presented with a synchronous tumor in the neck.
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Primary Pleural Primitive Neuroectodermal Tumor: Incidental Diagnosis of a Rare Pathology p. 71
Prriya B Eshpuniyani, Ramakant Deshpande, Kumar Doshi, Sameer Pathan, Sagar Sharma
Primitive neuroectodermal tumors (PNETs), a part of Ewing’s sarcoma family of tumors (ESFT), are small round cell tumors, arising from embryonic neural crest cells. They usually present with chest pain , and dyspnea. There is tenderness of chest wall. Primary pleural PNETS are a rare entity. We present a rare case of primary PNET which was incidentally diagnosed in a young patient with blunt chest trauma.
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Small-cell carcinoma of nasal cavity and approach to its management: A case report p. 74
Amit Kichloo, Ankita Parikh, Sakina Mankada, Ubrangala Suryanarayana
Most common site for small-cell neuroendocrine carcinoma (SNEC) is lung. Incidence of extrapulmonary small-cell carcinoma (SCC) is infrequent and very few cases of primary SNEC of head and neck have been reported in the literature. Nasal cavity as a primary site for SCC is extremely rare and thus we report a case of primary SCC of nasal cavity and paranasal sinuses who presented to our institute and approach to its management.
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Adult-onset clavicular Ewing’s sarcoma/peripheral neuroectodermal tumor: A diagnostic challenge p. 79
Himanshu Rohela, Sewanti Limaye, Pranav Chadha, Shraddha Adamane, Raj Vhatkar
Primary Ewing’s sarcoma (ES) of clavicle is rare; moreover, an adult patient diagnosed with clavicular ES is extremely rare. We report a case of adult-onset clavicular ES under our tracking and review of the related literature on the management of this rare tumor. A 24-year-old adult presented with an incidentally detected clavicle mass. A biopsy from the clavicle was diagnosed as ES. Whole body positron emission technique scan was suggestive of nonmetastatic presentation. The patient received both neoadjuvant and adjuvant chemotherapy. Medial clavicle resection was performed and adjuvant XRT was started. At follow-up, the patient had good range of painless shoulder movement. In conclusion, it was observed that ES of clavicle is a very rare tumor and poses a diagnostic challenge. Clavicular tumors rarely need reconstruction after resection.
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Acute necrotizing pancreatitis after esophagectomy: A nail in the coffin? p. 84
Abhay K Kattepur, Nizamudheen M Pareekutty, John J Alapatt, Satheesan Balasubramanian
Postoperative pancreatitis is an extremely rare complication associated with a high mortality rate. This report describes the case of a 62-year-old man who developed acute necrotizing pancreatitis post transhiatal esophagectomy for esophageal adenocarcinoma. The diagnosis can be challenging, first, owing to the confounding similarities of anastomotic leak in the postoperative period, and second, the rarity of this entity, which precludes a clinical suspicion at the outset. Hence, the appearance of pancreatitis becomes the final “nail in the coffin” in such patients who run the risk of death or severe long-term morbidity.
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