Clinical characteristics of renal cell carcinoma: Five years review from a tertiary hospital in Eastern India.

BACKGROUND: Renal cell carcinoma (RCC) is the one of the dreadful urological carcinoma. In comparison to the West, it is very rarely seen in Asia as well in India. Very small number of studies is available in this geographical area. AIMS: We studied the demographic pattern, presentation, risk factors and survival of RCC in an Eastern Indian institution. We characterized and compared these data with available literature SETTINGS AND DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 81 patients of RCC from January 2008 to December 2012 were enrolled. Their pre‑operative data were reviewed. They were followed as per institutional follow‑up protocol. STATISTICAL ANALYSIS USED: Kaplan‑Meier plot was constructed for survival analysis. Comparison of survival curves was performed by Logrank test. P < 0.05 was considered to be significant. RESULTS: A total of 75 patients were analyzed with a mean follow‑up of 26.3 ± 17.7 months. The mean age of presentation in our study was 52.79 years with a peak at 5th decade. Nearly 73.33% patients having one or more risk factors. 9 out of 10 had presented with some symptoms. The survival for localized RCC was 100% and significantly greater than advanced RCC ( P < 0.0001). Similarly in the stage III, significant greater survival ( P < 0.0001) was noted compare to stage IV. CONCLUSIONS: The age of presentation of RCC in India has been found in 5th decade, which is a decade earlier than the western countries. Symptomatic RCC is still majority in India. Organ confined tumors have good prognosis. When it metastasizes to lymph node or distant organ, the outcome is poor. Our results may form the basis for further studies and it may be used as future reference.

Genito-urinary tuberculosis revisited - 13 years' experience of a single centre.

Background: Tuberculosis had been declared by the World Health Organization (WHO) as ‘public health emergency’ in 1993. Extra pulmonary tuberculosis (E.P.T.B.) comprises 20-25% total burden of the disease in which genitourinary tuberculosis (G.U.T.B.) is 4%. Timely diagnosis and treatment will prevent the sequelae of this disease. Aims: To know the varied clinical presentations, diagnostic modalities and management of G.U.T.B. Methods: During a 13-year-period, 117 retrospective cases of GUTB were admitted in the tertiary care centre. They were analyzed for clinical presentation, diagnostic modalities and management. Results: Young patients mainly in third decade of life were commonly affected with higher incidence in females. In our study, the most common presentation was irritative voiding symptoms (66.47%) followed by haematuria (47.60%). Although it can affect the entire organ in genito-urinary system but, in the present study, kidney was the most affected organ (64.9%) following ureter (27.35%), urinary bladder (17.09%), prostate (3.4%) and epididymis (5.19%). In this study, we had not encountered any case of testicular and penile tuberculosis. Among the different diagnostic modalities in this study, the diagnostic positivity rate was 41.6% for the urine AFB test, 55.4% for the urine M. tuberculosis culture test and 67.7% for PCR. Chest x-ray was positive in 25.6% (30). ESR was raised in 62.5% and Mantoux test was positive in 61.2% patients. Conclusion: A high index of suspicion and a wide range of investigations may be required to achieve a complete diagnosis of genitourinary tuberculosis. Though short course chemotherapy with four-drug-regimen for sixmonth- duration is the mainstay of treatment, surgical interventions were required in 60% of cases of this study.

Coronary Angiographic Patency in Patients With Acute Myocardial Infarction With or Without Thrombolytic Therapy.

Background: The myocardial infarction (MI) is a leading cause of morbidity and mortality in developed countries as well as in developing countries including Bangladesh. Streptokinase since its introduction has been shown to reduce mortality significantly. The outcome of MI treated with streptokinase can be evaluated either by CAG measurement of TIMI blood flow or by the measurement of ST segment resolution in 12 lead ECG. Methods: This cross sectional comparative study was conducted in the department of Cardiology in Sylhet M A G Osmani Medical college, to compare the patency between MI patients with or without streptokinase therapy, from Jan 2008 to Dec 2009. Considering enrollment criteria a total of 96 patients with acute MI were evaluated. All patients were categorized into two groups. Group-I (n=48), who received streptokinase and Group-II (n=48), who did not received the same(due to late presentation). CAG was done with in 7- 28 days of on set of pain. The patients admitting in coronary care unit with the diagnosis of STEMI were taken as the study subjects. Results: Adequate TIMI (thrombolysis in myocardial infarction) flow was higher who received streptokinase (85.4%) than those who did not receive the therapy (52.1%). Conclusion: This study indicates that streptokinase therapy is associated with rapid and sustained reperfusion of the infarct related artery in the treatment of acute myocardial infarction.

Inverted papilloma of the urinary bladder: Rigorous surveillance needed: An Indian experience.

Aims: Inverted papilloma (IP) is an uncommon benign neoplasm of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) leads to conflicting clinical conclusions regarding its biological behavior, and hence, the need for rigorous follow-up protocols. In this study, we review all cases of urinary bladder IP in our institution and determine the need for strict follow-up. Materials and Methods :0 We included consecutive patients from August 2004 to August 2008 with IP of the urinary bladder in this study who did not have prior or concurrent urothelial carcinoma. A single pathologist performed the histologic review. The patients had undergone strict a follow-up schedule every 6 months. Results: In our study of the 24 patients, the mean age at presentation was 53.5 (range 22-81) years. The mean follow-up period was 25.8 months (range 6-58 months). Of the 24 patients, 21 were men and 3 were women. No patient had a synchronous or previous bladder tumor. The most common presenting symptoms were macroscopic hematuria and dysuria. All were solitary tumors except one, most commonly found at the bladder neck and trigone. The average follow-up period was 2.5 years without any evidence of recurrence. Conclusions: We conclude that when diagnosed by strictly defined criteria, IP as benign urothelial neoplasm was with extremely low incidence of recurrence and good prognosis. It does not seem to be a risk factor for TCC, especially if located in the bladder. Therefore, a good transurethral resection is adequate therapy and follow-up protocol as rigorous as those for TCC may not be necessary.

Wunderlich's syndrome with hepatic angiomyolipoma in tuberous sclerosis.

We present a patient of tuberous sclerosis complex with bilateral renal angiomyolipoma and hepatic angiomyolipoma with spontaneous retroperitoneal hemorrhage from right angiomyolipoma (Wunderlich's syndrome). Nephron preserving approach was tried but the right kidney could not be salvaged. Hepatic angiomyolipoma was managed conservatively. Wunderlich's syndrome has been found in around 10% of cases of renal angiomyolipomas. Hepatic Angiomyolipoma is a benign mesenchymal neoplasm of the liver which is rarely reported in literature.

A study of proliferative activity, angiogenesis and nuclear grading in renal cell carcinoma.

To evaluate the role of proliferative marker, proliferating cell nuclear antigen (PCNA) and microvessel density (MVD) as prognostic markers in renal cell carcinoma (RCC) and to see their relationship with the clinical stage and nuclear grades, we studied 30 cases of RCC for nuclear grading (Fuhrman's nuclear grade), MVD (using anti CD-34 antibody), and PCNA labeling index (using anti-PCNA antibody) over a period of 2.5 years. Staging was assessed by peroperative and radiologic findings. The area of highest MVD within the tumor was selected for microvessel count (MVC) per high-power field (0.1885 mm 2 area). PCNA labeling index was determined by counting percentage of positively stained tumor cell nuclei. PCNA labeling index above 60% was taken as high PCNA index and up to 60% was considered low. There was significant positive correlation between PCNA labeling index with both nuclear grade and clinical stage using Spearman's correlation coefficient. No association was noted between MVC with PCNA, nuclear grade, and clinical stages. Evaluation of proliferative status of RCC is a useful adjunct as a prognostic parameter as it is seen to correlate well with both clinical stage and nuclear grade. In our study, MVD was not seen to correlate with either of these.

Lungs: victim of synchronous double malignancies.

A 20 year young man was referred to our institution with superior vena cava (SVC) syndrome, multiple lung opacities and a mass lesion in the right upper zone (RUZ). CT-guided FNAC from the mass lesion was consistent with the diagnosis of non-small cell lung carcinoma (NSCLC). A lump in his left testis was detected during clinical examination. Both FNAC and excisional biopsy of the testicular mass confirmed the diagnosis of immature teratoma with choriocarcinoma, a form of non-seminomatous germ cell tumour (NSGCT). With chemotherapy all metastatic lesions of lung and SVC syndrome disappeared, and the tumour-marker levels decreased. However, the opacity in RUZ progessed to involve right recurrent laryngeal nerve at thoracic inlet, metastasized to the brain, and the patient expired after 4th cycle of chemotherapy. This case of synchronous double primary malignancies (SDPM) is being reported for its rarity.

Syndrome of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE).

RS3PE syndrome, often mimicking rheumatoid arthritis (RA) or polymyalgia rheumatica (PMR), has puzzled the rheumatologists until late'80s. Though the nature of the disease still remains illusive, the outcome is excellent. This present study analyzes the clinical, radiological and immunogenetical characteristics of five patients diagnosed with RS3PE syndrome, with review of literature.

Carcinoma of the gall bladder presenting as dermatomyositis.

Dermatomyositis (DM), manifested as paraneoplastic syndrome, is not a very common clinical entity but its association with various internal malignancies is well-documented in literature. We present such a case of DM associated with characteristic skin lesions and subacute onset of proximal muscle weakness, acquired from a very rare malignancy like adenocarcinoma of gall bladder.

Amiodarone-induced systemic lupus erythematosus.

Drug-induced lupus is not a very common entity. Drugs like hydralazine, procainamide have been reported to induce lupus, but so far there is no case report of amiodarone-induced lupus in Indian literature. A case of atrial fibrillation in an elderly man who came with systemic features of lupus after amiodarone therapy for one and half years is reported.

Typhoid hepatitis.

Though typhoid fever is quite common, typhoid hepatitis is a very rare entity which may have a variety of presenting features similar to other more common conditions. One case of typhoid hepatitis is reported here because of its ratity.