Histological risk score and its role in predicting recurrence in early-stage oral squamous cell carcinomas

Context: Oral squamous cell carcinoma (OSCC) comprises more than 90% of oral cancers and is the most common carcinoma affecting the oral cavity. Early stage T1/T2 OSCC have a heterogeneous prognosis and a significant number of patients develop loco regional recurrence (LRR) and have reduced disease free survival (DFS) with increased disease related mortality. Aims and Objectives: To assess the impact of the three parameters used in Brandwein-Gensler risk model along with lympho-vascular invasion (LVI), depth of invasion (DOI) and lymph node metastases in predicting LRR in early stage OSCC. Materials and Methods: This was a retrospective study on early stage T1/2 OSCC patients over a period of 2 years who received treatment by surgical resection and had follow-up data. LRR was assessed based on recurrence of OSCC at the initial site or in regional lymph nodes. Results: Out of 1135 OSCC cases during our study period a total of 207 cases befitted our inclusion criteria. Recurrence was noted in 113 (54.6%) cases. Univariate analysis identified LVI (P < 0.00001), DOI (P < 0.00001), nodal involvement (P < 0.00001), worst pattern of invasion (WPOI) (P < 0.00001), lymphocytic host response (LHR) (P = 0.004), perineural invasion (PNI) (P = 0.012) as strong statistically significant risk factors for LRR. Conclusion: Adequate assessment of simple parameters on routine H and E by incorporating Brandwein-Gensler histological risk scoring model at the initial presentation can help prognosticate and predict LRR and select patients for post-surgical adjuvant therapy.

Percutaneous pigtail catheter drainage of pancreatic pseudocysts.

AIM: To evaluate the efficacy of percutaneous pigtail catheter drainage (PCD) in the management of pancreatic pseudocysts otherwise meriting surgical intervention. METHODS: Fourteen consecutive patients with pancreatic pseudocysts (five following acute pancreatitis and nine with chronic pancreatitis) were subjected to PCD. For uncomplicated chronic pseudocysts, an algorithm using endoscopic retrograde pancreaticography to demonstrate ductal communication with obstruction was followed. Five patients had complicated pseudocysts and nine uncomplicated cysts persisting > 6 weeks and > 6 cm in size. RESULTS: All uncomplicated and two complicated pseudocysts resolved in 6-58 days (mean 19.7). No recurrences were seen. Three patients with complicated cysts had pancreatic fistulae; two of these were treated by surgery and one by pancreatic stenting. Sepsis required sump drainage in two patients. Four patients required early surgery: two for pancreatic fistula and one each for hemorrhage and residual cyst. Two patients were subjected later to pancreatico-jejunostomy for pain of chronic pancreatitis. CONCLUSIONS: Patients with acute pseudocysts and uncomplicated noncommunicating chronic pseudocysts respond to PCD. In complicated chronic pseudocysts, sepsis may be controlled by PCD.

Pseudomyxoma peritoneii.

A middle aged male patient presented with gradual distension of the abdomen. Imaging modalities showed classical features of pseudomyxoma peritoneii which was confirmed by aspiration cytology. Details of the case are described and relevant literature is reviewed.

Percutaneous sump drainage of pancreatic abscess.

Pigtail drainage often falls to drain thick, infected collections. Percutaneous wide-bore sump drainage has been successfully used in such cases. We report one such case of pancreatic abscess which was successfully managed using an indigenously made percutaneous sump drain.

Organoaxial volvulus of the stomach following corrective surgery for gastric outlet obstruction.

We report an unusual complication following vagotomy and pyloroplasty for chronic gastric outlet obstruction. Persistence of increased gastric aspirate led to the diagnosis of organoaxial volvulus of the stomach on barium studies. We postulate that laxity of the gastric suspensory ligaments after gastric decompression and postoperative adhesion were responsible for its development.