Association of vascular endothelial growth factor single nucleotide polymorphisms on the prognosis of breast cancer patients.

BACKGROUND: Vascular endothelial growth factor (VEGF), a major mediator of vascular permeability and angiogenesis, may play a pivotal role in mediating the development and progression of breast cancer. In the present study, we examined the genetic variations of the VEGF gene to assess its possible relation to breast cancer. MATERIALS AND METHODS: A total of 200 patients with histologically confirmed cases of breast cancer and 200 healthy women were genotyped for VEGF single nucleotide polymorphisms (405G > C and −1154G > A) by polymerase chain reaction‑restriction fragment length polymorphism analysis. Pre‑operative plasma VEGF levels were determined by enzyme‑linked immunosorbent assay in 200 women with breast cancer and in 200 normal female controls. RESULTS: The genotype frequencies of the +405G > C, −1154G > A polymorphisms did not show a significant deviation from the Hardy‑Weinberg expectation. The minor allele frequencies of the +405G > C and −1154G > A polymorphisms among cases and controls were 33.5% (C allele), 31.5% (A allele) and 35% (C allele), 34.5% (A allele) respectively. +405GG and −1154GG genotypes were associated with higher levels of VEGF among breast cancer cases and controls. Increased plasma VEGF levels were significantly associated with, clinical stage of the disease (P = 0.035). CONCLUSION: Although none of the polymorphisms were significantly associated with breast cancer, some of the VEGF genotypes may influence tumor growth through an altered expression of VEGF and tumor angiogenesis.

Primary synchronous bilateral breast cancer.

Background: Primary synchronous bilateral breast cancer (PSBBC) is a rare clinical entity. The reported incidence ranges between 0.3% and 12%. There are several controversial issues regarding PSBBC pertaining to the diagnostic criteria, nomenclature, and management policies. Materials and Methods: Fourteen cases of PSBBC treated between 2001 to 2010 at our institute were retrospectively analysed in regards to demographic data, management and follow up. Results: PSBBC constituted 0.19% of total breast cancer patients at our institute. Age ranged from 28 to 78 years. PSBBC were detected by clinical examination in eight cases and by mammography in six cases. Twelve patients underwent bilateral modified radical mastectomy, one had unilateral mastectomy on one side and breast conservation on the other side and one patient has bilateral breast conservation. Majority of patients belonged to stage 2 and stage 3. All patients were found to have invasive ductal carcinoma. Five cases were ER/PR positive and 8 patients were triple hormone receptor negative. Eight patients received unilateral and six received bilateral adjuvant radiotherapy. Nine patients received adjuvant chemotherapy. 5 patients received adjuvant hormonal therapy. Median follow up of patients was 15.4 months. Conclusion: PSBBC is a rare event warranting awareness and screening of the contralateral breast in patients with unilateral breast cancer. These patients require individualized treatment planning based on the tumor factors of the index lesion. Further multi institutional prospective studies are needed for adequate understanding of management of PSBBC.

Male breast cancer in Indian patients: Is it the same.

Background: Cancer of the male breast accounts for about 1% of all malignancies in men and 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. This study was done to analyse the demographic data, management and survival of male breast cancers in Indian subset of patients and compare it with that of western literature. Materials and Methods: A 10 year (2001-2010) retrospective study of all male breast cancers was done. Data regarding the incidence, presentation, histopathology, stage and grade of tumor, management and outcome of patients were analysed. Results: 26 cases of male breast cancer were encountered. This comprised 0.4% of all breast cancers seen in our department during the 10 year period. The ages of patients ranged from 45-75 years with a mean age of 57 years. Family history was present in 4 patients. Clinically, symptoms included self-detected lump in 23 (88.5%) patients, nipple retraction in 12 (46.1%) and pain in 12 (46.1%). All cases were unilateral (16 on right, 10 on left). Disease most commonly involved central quadrant (9 patients). Grade 3 disease was found in 13 patients and Stage 3 disease was most commonly encountered (13 patients). None of our patients received neo adjuvant chemotherapy. 20 (76.9%) patients had modified radical mastectomy and 6 (23.1%) had radical mastectomy. Most of our patients were hormone receptor positive (21 patients). Bilateral orchidectomy, Adjuvant chemotherapy, Adjuvant radiotherapy and Tamoxifen were offered in 3 (11.5%), 16 (61.5%), 17 (65.4%) and 15 (57.7%) patients respectively. Follow up ranged from 1-59 months. Conclusion: Male breast cancer is rare in our centre. Late presentation with advanced disease is a common feature in our environment. Further multiinstitutional, prospective studies are needed for better understanding of management of male breast cancers in Indian subset of patients.

Giant solitary fibrous tumour of the pleura.

Solitary fibrous tumour of the pleura is a rare primary pleural neoplasm. These tumours are usually asymptomatic and are incidentally detected. Majority of these neoplasms are benign and surgical excision provides excellent results. With the widespread use of imaging and better diagnostic criteria, this tumour is likely to be detected more frequently. We encountered a patient with a giant solitary fibrous tumour of the pleura. In this report, we describe the case of a patient with a giant solitary fibrous tumour of the pleura, review the literature and present the details of management of this patient.

Pheochromocytoma in Indian patients: A retrospective study.

Aim: To review the clinical experience on pheochromocytoma in Indian subset of patients. Materials and Methods: Ten patients diagnosed with pheochromocytoma between 2001 and 2010 at our institute were retrospectively studied for clinical, laboratory, radiological and surgical data. Results: A total of 10 patients (5 females and 5 males) aged between 23 and 64 years diagnosed as pheochromocytoma were managed at our institute. The most frequent symptoms were abdominal pain (90%) and hypertension (50%). The tumor was intra-adrenal in 70% and extra-adrenal in 30%. 20% were on right side and 50% on left side. CT scan of abdomen was the most widely used method for tumor localization. Among laboratory assays, 24-h urinary vanillylmandelic acid (VMA) was the most widely used. None of our patients were found to be associated with hereditary pheochromocytoma syndrome. All hypertensive patients were preoperatively treated with phenoxybenzamine and propranolol. All underwent explorative laparotomy and adrenelectomy. Malignancy was reported in 40% of cases and these received adjuvant radiotherapy. Among hypertensive patients, surgery caused remission of hypertension in 60%. All patients were followed up with 24-h urinary VMA levels and CT scan of abdomen regularly. Survival ranged from 1 to 9 years. Conclusions: The present study confirms that the clinical presentation of pheochromocytoma is variable and non-specific. Often the tumor is discovered incidentally. Though pheochromocytoma is a rare tumor, proper evaluation, preoperative preparation and complete surgical excision are important for its management.

ErbB-2 expression and its association with other biological parameters of breast cancer among Indian women.

Objectives: Overexpression of the epidermal growth factor receptor family genes, which include ErbB-1, 2, 3 and 4, has been implicated in a number of cancers. We have studied the extent of ErbB-2 overexpression among Indian women with sporadic breast cancer. Methods: Immmunohistochemistry and genomic polymerase chain reaction (PCR) were used to study the ErbB2 overexpression. ErbB2 status was correlated with other clinico-pathological parameters, including patient survival. Results: ErbB-2 overexpression was detected in 43.2% (159/368) of the cases by immunohistochemistry. For a sub-set of patients (n = 55) for whom total DNA was available, ErbB-2 gene amplification was detected in 25.5% (14/55) of the cases by genomic PCR. While the ErbB2 overexpression was significantly higher in patients with lymphnode (χ2 = 12.06, P≤ 0.001), larger tumor size (χ2 = 8.22, P = 0.042) and ductal carcinoma (χ2 = 15.42, P ≤ 0.001), it was lower in patients with disease-free survival (χ2 = 22.13, P ≤ 0.001). Survival analysis on a sub-set of patients for whom survival data were available (n = 179) revealed that ErbB-2 status (χ2 =25.94, P ≤ 0.001), lymphnode status (χ2 = 12.68, P ≤ 0.001), distant metastasis (χ2 = 19.49, P ≤ 0.001) and stage of the disease (χ2 = 28.04, P ≤0.001) were markers of poor prognosis. Conclusions: ErbB-2 overexpression was significantly greater compared with the Western literature, but comparable to other Indian studies. Significant correlation was found between ErbB-2 status and lymphnode status, tumor size and ductal carcinoma. ErbB-2 status, lymph node status, distant metastasis and stage of the disease were found to be prognostic indicators.

Laryngectomy: a quality of life assessment.

Cosmetic disfigurement and loss of voice following a total laryngectomy can cause major psychosocial problems. Fifty patients who had undergone a total laryngectomy and completed more than six months following surgery, were randomly selected during a routine follow-up, and asked to answer a questionnaire, to asses their degree of disability and extent of rehabilitation. The questionnaire have five main components viz. general information, functional evaluation, vocal rehabilitation, social assessment and economic sequelae. Results revealed that these patients suffered from a significant decrease in social acceptance (70%), social activity (82%), sexual activity (62%), ability to communicate vocally (58%), and severe financial repercussions (78%). A large number of patients (40%) were dissatisfied with the present level of rehabilitation offered. Inspite of these problems the majority (80%) were willing to accept a total laryngectomy as treatment of their cancer. This emphasizes the need for greater interaction between the treating surgeon, speech therapist, occupational therapist, and psychotherapist to rehabilitate these patients adequately.

Morbidity & mortality following craniofacial resections.

A seven year experience with twenty patients undergoing the craniofacial approach for excision of tumours of the paranasal sinus and orbit is presented. Results indicate a low postoperative morbidity and mortality with excellent cosmesis. Good palliation is achieved in the presence of extensive disease, while large tumours which would have been considered inaccessible can be resected. Its advantage recommend it as the treatment of choice for tumours of the orbit and paranasal sinuses.

Serum leucine amino peptidase levels as a marker in testicular tumours.

Serum levels of leucine aminopeptidase (LAP) were studied in 60 patients with testicular tumours and 26 normal individuals, and were found to be significantly elevated in patients with seminomas, nonseminomas and benign tumours of the testis. After treatment the LAP levels decreased in patients with seminomas, nonseminomas and mixed cell carcinomas indicating response to therapy. The quantitative method used for estimation of LAP, which is simple, quick, accurate and cost-effective, could be used more effectively as a tumour marker in testicular malignancies.

Gastric transposition & deltopectoral flap for peristomal recurrence following total laryngectomy--a case report.

Stomal recurrence following laryngectomy presents a difficult problem with an incidence of 8.3-15%. Wide excision of the recurrence with mediastinal dissection, although the operation of choice,m is technically demanding and has a high morbidity and mortality. We recommend a technically easier procedure for reconstruction after palliative excision and present a case to illustrate it.

Primary tracheo oesophageal puncture our initial experience.

Our initial experience of 9 primary tracheo oesophageal punctures with Blom Singer prosthesis is reported. Patient selection was based on motivation, intelligence and socioeconomic status. Excellent speech resulted in 7 out of 9 patients (77%), with 2 failures (23%). There were no major complications. The results are encouraging, but a larger study is required to determine the role of this procedure in our conditions.

Hyperamylasaemia & related enzyme factors in renal failure associated with benign & malignant conditions.

Total serum amylase activity, its isoenzymes and pancreatic to salivary amylase (P/S) ratio were studied in 40 normal subjects and 47 patients with renal failure, 32 with benign and 15 with malignant conditions. Amylase to creatinine clearance (Cam/Ccr) was studied in 17 normals and 14 patients with renal failure, 10 benign and 4 with malignant diseases. Total amylase activity, and pancreatic and salivary fractions were found to be increased by about 3.4 times the normal in both benign and malignant conditions producing renal failure though the P/S ratio was within the normal range. However, the increase in the urea and creatinine levels in patients could not be related to the increase in serum total amylase. Besides the Cam/Ccr ratio was elevated in patients with both benign and malignant conditions producing renal insufficiency whereas the Cam and Ccr were individually found to be decreased. Why patients with chronic renal failure in both conditions without clinical evidence of pancreatitis should have elevated Cam/Ccr ratio is not clear.

Study of total serum amylase, its salivary and pancreatic fraction and the pancreatic to salivary amylase ratio in testicular tumours.

Serum levels of total amylase, its pancreatic fraction (P), salivary fraction (S), and the ratio of pancreatic to salivary fraction (P/S) were determined in 52 cases of histologically proved testicular germ cell tumours and 33 healthy controls. Total serum amylase remained unchanged, but the salivary fraction had a lower mean value. P/S ratio and the pancreatic fraction were significantly elevated in both seminomatous and non- seminomatous tumours. The ratio was more frequently raised in non-seminomatous (100%) as compared to seminomatous (66.67%) tumors. Following treatment there was no appreciable fall in P/S ratio in non-seminomatous tumors whereas in seminomas there was a slight increase in the ratio. The pancreatic fraction showed a transient fall in seminomatous but not in non-seminomatous tumors following treatment. The pancreatic fraction of amylase and the P/S ratio may help in the diagnosis of testicular germ cell tumor but does not appear to be of use in assessment of prognosis or monitoring the course of the disease during treatment.

Serum lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase and ratio of alpha-hydroxybutyrate dehydrogenase to lactate dehydrogenase in testicular tumours.

Serum levels of Lactate Dehydrogenase (LDH), alpha-Hydroxybutyrate Dehydrogenase (HBDH) and the relative ratio of alpha-Hydroxybutyrate Dehydrogenase to Lactate Dehydrogenase (HBDH/LDH) were determined in 51 cases of histologically proved testicular germ cell tumors and 40 healthy controls. Serum LDH and HBDH levels were found to be raised in both seminomatous and non-seminomatous germ cell tumors. The ratio of HBDH/LDH was found to be statistically significant in seminomas and insignificant in non-seminomatous germ cell tumors. Furthermore, the levels of LDH and HBDH showed a fall, following treatment indicating response to therapy. Serum LDH and HBDH could both be used as tumor markers in the diagnosis of testicular germ cell tumors as well as prognostic indicators in monitoring therapy, HBDH, being more specific in monitoring therapy as compared to serum LDH.