Chondroid syringoma of an upper eyelid tumor: Unusual case report

We present the case report of a 58?year?old man with recurrent chondroid syringoma, which was histopathologically confirmed, who underwent exenteration surgery of the right eye. Furthermore, the patient was receiving postoperative radiation therapy, and presently there is no local and/or distant evidence of disease in the patient

Recurrence Developing 21 Years after Treatment of Breast Cancer

Background: Breast cancer is a very common cancer among females. In which most recurrence (around 75%) occurs within the initial 5 years after diagnosis, especially within 3 years. Recurrence after 20 years is very less reported in the last few decades. Case Information: We are presenting a case of a 67-year old female patient presented with pleural based nodules suggestive of lung metastasis followed by brain metastasis. After reviewing history we came to know that the patient was a previously treated case of breast carcinoma treated 22 years back with mastectomy. Conclusion: We report late recurrence of breast cancer occurring 21 years after mastectomy suggesting that possibility of recurrence in carcinoma breast with 21-years latency period although rare should be taken into consideration when making decisions regarding patients who may need long term follow up.

Multiple Osseous Metastases in Malignant Phyllodes Tumor

Introduction : Phyllodes Tumors (PT) arises from intralobular stroma of breast, accounts for 0.3 to 1% of all primary breast cancers. Only few cases of PT metastatic to bone have been reported so far. Case report : A 33 years old female was presented with a 3 month history of pain and swelling of right thigh and functional deformity of right leg. She had a past history of post lumpectomy with metastasis to left iliac bone; histopathology was suggestive of malignant phyllodes tumor (MPT). She had a pathological fracture of her right femur. Later she developed metastases to multiple bones. Palliative irradiation was considered for left iliac bone, right femur and right scapular metastasis. She then received adriamycin and ifosfamide chemotherapy and zolendronic acid. Currently, she has no symptoms and in a stable condition. Conclusion : MPT is an aggressive neoplasm of the breast with high rates of local recurrence and distant metastases. The limited role of surgery, chemotherapy and irradiation gives a poor prognosis. The metastases occur in a swift manner and average survival is less than 2 years.

AcralPrimary Malignant Melanoma of Breast: Case Report

Metastasis to acral skeleton is uncommonly encountered in routine clinical practice. Originating frequently from lung, breast or gastrointestinal malignancies & these are often associated with an underlying widespread disease. Timely diagnosis and intervention are important for improvement of the quality of life of these patients. Here we report a case of pathological fracture of proximal phalanx of left index finger in a case of carcinoma of left lung treated with radiotherapy with good pain palliation.

Acral Metastasis from Carcinoma Lung Presenting As Pathological Fracture of Index Finger: A Case Report

Introduction : Guillain-Barré syndrome (GBS) is a common cause of acute peripheral neuropathic disease. Electrodiagnostic studies (EDX) are important in diagnosis, classification, treatment and prognosis. Objective : To evaluate & define the early and common parameters of EDX for diagnosis of GBS. Methods : EDX of total 95 patients with clinical diagnosis of GBS were reviewed & analyzed. Results : Out of total 95 patients of GBS, 75 were demyelinating, 13 were axonal and 7 were of mixed type. In demyelinating group, there were 42 men and 33 women from ages 8 to 86; Hoffman reflex was absent in 100% patients; median sensory nerve action potential (SNAP) amplitude was abnormal in 66.6%patients compared to sural SNAP in 19.6%; F wave abnormalities, temporal dispersion and conduction block were found in 64%, 42.2% and 45% respectively. In axonal group, there were 7 men and 6 women from ages 11 to 83; compound motor nerve action potential (CMAP) amplitude was abnormal in (84%) studies & most commonly in tibial nerve. Conclusion : In demyelinating GBS, abnormal Hoffman reflex was found to be the most sensitive test and sural nerve sparing is frequently noticed. In axonal GBS, low CMAP in lower extremity was found the most sensitive test for diagnosis of GBS

Results of 2 Dimensional Postoperative Radiotherapy Treatment in Carcinoma Buccal Mucosa Patients: A Regional Cancer Centre Experience.

Purpose/Objective(s): In India > 1 million new cases of cancer diagnosed every year. 40-50% of these cases are of head and neck cancer because of tobacco overuse. In our institute we have almost 1000-1300 new cases of Carcinoma Buccal Mucosa reported every year. From which 70-75% are surgically operable. For post-operative Radiotherapy treatment, we treat most of our patients by 2 Dimensional conventional treatments. Purpose of this study is to assess toxicity & long term results of postoperative carcinoma buccal mucosa cases treated by 2 Dimensional conventional treatment planning. Materials/Methods: From January 2009 to January 2012, almost 1980 postoperative cases of Carcinoma Buccal mucosa were referred for radiotherapy treatment. From which 1584 cases were suitable for postoperative 2 Dimensional Conventional planning. In selected cases, 71%, 18%, 11% cases were of Stage IV, III, II (close margin) respectively. Postoperative chemotherapy and radiotherapy was indicated in 475 patients. For all patients Plaster of Paris cast was prepared & X-ray was taken on Simulator machine. Target volume was drawn on x-ray & treatment plan generated on contour drawn with 90-95% isodose line covering the target, with hot spot of +10% on 2D Plato treatment planning system. All patients were treated with unilateral Anterior Posterior Lateral wedge pair technique for buccal mucosa and unilateral lower neck was given in indicated patients. Dose prescribed was 60 Gy/30#, 2Gy/#, 5 days a week, total 6 weeks treatment. Treatment plan verified on day 2 and treatment started. In patients where postoperative chemotherapy and radiotherapy was used, chemotherapy was given Cisplatin 30mg/m2 every weekly for 6 weeks. In most of the patients, treatment break was not required. All patients completed treatment successfully. Patients were assessed for locoregional control, acute & late toxicity and followed up for 3 years for disease free survival and overall survival. Results: Grade II & III acute mucositis was 82% & 18% respectively in 1109 patients who received only postoperative radiotherapy. For patients who received postoperative radiotherapy and chemotherapy Grade II and Grade III acute mucositis was seen in 75% & 25% respectively and side effects related to Cisplatin were managed conservatively. Almost all patients had Grade II skin reactions. Grade III skin reactions were observed in 8% of patients on post operative radiotherapy alone and 19% of patients on postoperative radiotherapy and chemotherapy but were manageable. All patients tolerated treatment well. For 1584 patients, follow up dropout rate was 20%. None of the patients developed significant late toxicity. As opposite parotid spared, no late complication of xerostomia observed. For 1268 patients, 1-, 2-, 3- year locoregional control rates were 82%, 75%, 68% respectively. Disease free survival rate was 63% (799 patients) & overall survival was almost 55% (697 patients) at median follow up for 40 months. Conclusion: 2D Conventional Radiotherapy Treatment Planning in our set up has shown very good results with almost 50% survival rates. It is less toxic treatment with fewer complications & less time consuming. It is highly cost effective treatment approach & results are very much encouraging.

5 Years Local Recurrencce Rates Following Post- Operative 2D Radiotherapy Treatment Planning Patients – An Institutional Experience.

Introduction: In India, almost 150,000 women are diagnosed with breast cancer every year and almost half of patients expected to die of the disease. In India most of patients with breast cancer diagnosed with advanced stage of the disease. As breast cancer treatment is multimodality approach Radiation therapy has significant impact on prevention of local recurrence. So, purpose of the study is to assess 5 year rates of local recurrence following post-operative 2D Radiotherapy treatment planning. Methods and Materials: We have selected 198 patients treated for post-operative 2D Radiotherapy treatment planning from September 2009-September 2010. All patients had undergone surgery in form of mastectomy or modified radical mastectomy. None of the patients with breast conservation surgery had been selected. All patients underwent chemotherapy either Induction chemotherapy following surgery or chemotherapy after surgery. All patients had been treated with 2D conventional Radiotherapy treatment plan with tangential fields and supraclavicular and axillary fields according to histopathology report. Patients were first taken on simulator machine and planning was done with breast wedge in position and fully abducted arm of the patient. Radiotherapy treatment dose was – 45Gy/20#, 2.25Gy/#, 5 days/week, total 4 weeks of treatment. Patients were assessed for acute toxicity every week. Patients were followed every monthly for 2 years, 2 monthly for 3rd year, 4 monthly for 4th year up to 5 year. Patients were assessed for Local recurrence up to 5 years. Results: 152 (77%) patients had undergone upfront Surgery. 46 (23%) patients were diagnosed with LABC, and had undergone chemotherapy first for downstage of the disease. After a median follow up of 34 months (range: 9-67 months), out of total 198 patients, 8.6% patients developed local recurrence. In which 6.5% (10 patients out of 152) in upfront surgery group and 15.2% (7 patients out of 46) in LABC group developed local recurrence. So, total 5% (10 patients) in upfront surgery group and 3.5% (7 patients) in LABC group out of 198 total patients developed local recurrence. Conclusion: Local recurrence after treatment of breast cancer with mastectomy+radiotherapy+/-systemic therapy is associated with a significantly higher risk of distant metastasis and death. So, in this retrospective study we have shown comparable results after 2D Conventional Radiotherapy Treatment Planning for prevention of local recurrence. Approach is safe, easy, and feasible, less time consuming and in Indian scenario where patients come in advanced stage of the disease and most of the time death is due to disease itself it is quite suitable approach at our centre. Also, we use hypofractionation regimen of 45Gy/20#, which is also feasible to reduce total treatment time and it has also shown equivalent results.