Diverse Roles of Macrophages in Oral Inflammatory and Benign Lesions - A Narrative Review

Background: Macrophages are immune cells with diverse profiles and functions. Macrophages play significant roles in the repair and resolution of inflammatory and reactive lesions. They secrete cytokines and modulate the tissue microenvironment and surrounding cellular responses. Objectives: The present article reviews the histological presentation and role of macrophages in the pathogenesis of oral inflammatory and benign lesion. Materials and Methods: Data was collected by electronic search of databases including PubMed and Google Scholar for Mac- rophages, Periapical Granuloma, Mucocele, and Verruciform Xanthoma. Result: Distinct profiles of macrophages participate in regulation of pathogenesis, lesion size, and resolution of periapical lesions. In trauma-associated reactive or benign lesions, macrophages show phagocytosis and exhibit characteristic foamy his- tological appearance. The immunohistochemical profiles of macrophages aid in identifying the surface receptors and profiles of macrophages in oral lesions. Conclusion: Identifying and understanding macrophage-mediated pathogenesis can help diagnose and develop targeted therapies against various oral lesions.

Efficacy of radical radiotherapy alone for functional preservation of larynx in laryngeal carcinoma: A retrospective analysis.

PURPOSE: Concurrent chemoradiation is the current standard of care in locally advanced head and neck cancer. But, in our setup, many patients of carcinoma larynx are treated with only radical radiotherapy because of poor general condition of the patients. This study was performed to assess the influence radical radiotherapy alone on functional preservation of larynx. MATERIALS AND METHODS: 110 previously untreated patients with invasive squamous cell carcinoma of larynx were treated with radical radiotherapy alone between January 2006 and June 2009. Conventional one daily fraction of 2 Gy with total doses of 60–66 Gy was used. Voice preservation and local control at median follow-up period of 2 years were analyzed. Several host, tumor, and treatment parameters were also analyzed. RESULTS: Among 110 patients, preservation of larynx was possible in 78 patients (71%). With radical radiotherapy alone, excellent preservation of larynx was achieved in stage I (88.9%) and stage II (75%) disease, while in advanced stages, results were not so encouraging. In stage III and stage IVA, larynx preservation was only 72.4% and 65.3%, respectively. Patients without any cartilage invasion had significantly better laryngeal preservation rate as compared to patients with cartilage invasion. (78.9% vs. 35.3%; P = 0.008). CONCLUSION: Though concurrent chemoradiation is the standard of care in preservation of voice in laryngeal cancer, definitive radiotherapy alone may also be a good option in terms of preservation of larynx in patients of laryngeal cancer in community practice in the developing world where most of the patients cannot tolerate concurrent chemoradiation.

Results of letrozole in postmenopausal women after tamoxifen treatment for advanced breast cancer.

AIM: To analyze overall and progression-free survival after letrozole in postmenopausal women with advanced breast cancer who failed after tamoxifen therapy. MATERIALS AND METHODS: This is a retrospective analysis of 95 patients with breast cancer who were postmenopausal and had failed after tamoxifen therapy. Dose of letrozole was 2.5 mg daily until disease progressed. Patients had estrogen receptor- and/or progesterone receptor-positive tumors or both receptors were unknown. One complete course of (6 cycles) chemotherapy for metastatic disease was allowed. The primary end point was time to progression (TTP). Secondary end points included overall objective response rate (ORR), its duration, time to treatment failure (TTF), overall survival and tolerability. RESULTS: Median TTP was 10 months. ORR was 21% with complete response rate of 9%. Nine patients died of disease during treatment. Median overall survival was 36 months. Median time to response was three months and median duration of response was 13 months. Time to chemotherapy was 13.5 months and TTF was 9.3 months. Treatment failure was seen in 76% of patients. Disease progression was the main cause for treatment failure. Treatment was well-tolerated by all patients. CONCLUSION: This retrospective analysis shows that letrozole is quite effective as second line therapy in postmenopausal patients with advanced breast cancer who had failed after tamoxifen therapy.

Optimization of dose and fractionation of endobronchial brachytherapy with or without external radiation in the palliative management of non-small cell lung cancer: a prospective randomized study.

AIMS: Endobronchial brachytherapy (EBBT) is an established modality for the palliation in advanced non-small cell lung cancer. We compared three different schedules using EBBT with or without external radiation (XRT) in this setting. MATERIALS AND METHODS: Forty-five patients were randomized to three treatment arms. Arm A received XRT to a dose of 30 Gy/10 fr/2 weeks and two sessions of EBBT 8 Gy each. Arm B received the same XRT and a single session of EBBT 10 Gy at 1 cm. Arm C received only a single fraction of brachytherapy to a dose of 15 Gy at 1 cm without XRT. Symptomatic response rates, duration of symptom palliation, obstruction scores, quality of life outcomes and complications were assessed and compared. RESULTS: The overall symptomatic response rates were 91% for dyspnea, 84% for cough, 94% for hemoptysis and 83% for obstructive pneumonia. There was no significant difference between the arms. The median time to symptom relapse was 4-8 months for all symptoms and the median time to symptom progression was 6-11 months. The results were comparable between groups except for hemoptysis, where a shorter palliation was seen in Arm C that achieved statistical significance (P < 0.01). Quality of life showed significant improvement, with maximum benefit in Arm A. Complication rates were low. Only one patient died of fatal hemoptysis. CONCLUSION: EBBT is thus a safe and effective palliative tool in advanced non-small cell lung cancer, either alone or in conjunction with XRT. The difference between the treatment arms were not statistically significant in most categories, but patients treated with XRT and two endobronchial sessions of 8 Gy had the most consistent benefit in terms of all the parameters studied.

Management and Outcome of Thymoma: A Retrospective Analysis

Thymoma is a rare disease. The treatment of invasive thymoma remains controversial. To evaluate the outcome of thymoma we reviewed aseven years [1996-2002] experience with 26 patients at PGIMER Chandigarh. It constituated about 16% of all mediastinal tumours in our institutions. All the patients had surgical intervention and diagnosis was made on pathologicalstudy. Post-operative staging was made on mordified Masoaka staging system. Out of 26 patients, six were with stage-1, 5 with stage- 2, 7 with stage-3 and 8 with stage 4. The pathological classification included 6 lymphocytic predominant,12 epitheloid and 8 mixed lymphoepitheloid histology. Myasthenia gravis was associated with 12 patients. Ten patients had complete surgical resection, 7 had incomplete surgery and 9 had only biopsy. All thepatients received external beam radiation with doses ranging from 3000 Cgy to 5000 Cgy in 3 to 5 weeks with a fraction size of 180-200 Cgy. Three patients received systemic chemotherapy with multidrug platinum based regimens. The median follow up was 26.2 months. Patients who received adjuvant external radition after complete surgery did better than who had incomplete surgery or only biopsy. Overall five years survival was 56.85. Post operative radiotherapy improved locoregional controls, however clinical stage and type of surgery were the two most important prognostic factors. Role of chemotherapy needs to be further assessed.

Local control of high-grade gliomas with limited volume irradiation versus whole brain irradiation.

INTRODUCTION: To evaluate the role of limited field radiation therapy in the management of high-grade gliomas and glioblastoma multiforme (GBM). MATERIAL AND METHODS: From July '96 to January '98, 50 newly diagnosed patients of high-grade gliomas (Grade III and IV) and glioblastoma multiforme who underwent surgery in the form of partial, sub-total or near-total excision as the primary treatment were enrolled in this study. The patients were randomized to receive two different postoperative external radiation protocols, Study Group A: Localized field external radiotherapy 50 Gy/25#/5 wks followed by Boost 10 Gy/5#/1 wk, Control Group B: Whole brain external radiotherapy 40 Gy/20#/4 wks followed by Boost 20 Gy/10#/2 wks by localized field. RESULTS: 20/25 (80%) patients in the study group and 14/25 (56%) patients in the control group showed improvement in their Karnofsky Performance Status (KPS). Thus a significant difference in the performance status was noted in favor of limited field irradiation. No significant difference in the local response was seen between the two groups after radiotherapy. Six months progression-free survival of the study group was 44% as compared to 26% in the control group. Six months overall survival was 66.67% in the study group and 50.72% in the control group (P<0.01). Maximum recurrences were noticed within 2 cm of the original tumor margin in both the groups. CONCLUSIONS: Although local control and survival of the patient in both the groups were same, performance status definitely improved in patients treated with localized field irradiation only.

Clastogenic effects of dietary supplement--Spirulina alga, and some medicinal plant products from Boswellia serrata, Withania somnifera on mice.

Pretreatment of aqueous extracts of Zyrulina (Spirulina), Aswagandha (Withania) and Nopane (Boswellia) on colchicine induced chromosome damage showed weakness of clastogenic activity in Swiss albino mice. None of the treatments increased significantly the number of chromosome aberrations.

Mixed germ cell tumour of the pineal region: a case report.

An intracranial mixed germ cell tumour with germinoma and teratoma components is reported. The patient presented with parinaud's syndrome and precocious puberty. The treatment involved partial surgical debulking followed by whole brain radiotherapy (4500 cGY in 25 fraction over 5 weeks) and chemotherapy (consisting of cisplatin and etoposide). Post treatment MRI showed no residual lesion. The controversies in the management are discussed.

Carcinoma of the esophagus presenting with esophagocutaneous fistula--a case report.

An interesting manifestation of carcinoma of the esophagus, hitherto undescribed is reported. The patient at the time of diagnosis had presented with an esophagocutaneous fistula. He was treated by feeding jejunostomy and local palliative radiotherapy and showed good clinical improvement. The extreme rarity of such a presentation is highlighted.

Occult carcinoma esophagus metastatic to spine producing paraplegia--a case report and review of literature.

An extremely rare case of asymptomatic squamous cell carcinoma of the esophagus metastatic to the spine leading to paraplegia is reported. The rarity of such an event signifies the relationship between hypercalcaemia and carcinoma of the esophagus. Its occurrence as a second silent primary neoplasm and its association with a negative esophagogram is highlighted.

Stricture urethra: aetiology and management.

Seventy-four male cases of stricture urethra, in all age groups up to 70 years were studied with regard to the aetiology of stricture, clinical presentation, investigations and treatment in Medical College Hospitals, Calcutta during June 1984 to May 1986. Depending on the site of affection and the aetiological consideration the treatment consisted of meatal dilatations, meatotomy, urethral dilatation and various methods of urethroplasty. Sixty-seven patients could be rendered asymptomatic. Traumatic strictures specially of the anterior urethra was found to have a better prognosis. Preventive aspects like gentle urethral instrumentation, use of appropriately sized catheters made of non-reactive material and referral of patients with stricture urethra to urological centres were stressed upon.