Gestational trophoblastic neoplasia with pulmonary embolism mimicking tuberculosis.

Gestational trophoblastic neoplasia (GTN) comprises a group of human neoplastic diseases that derive from fetal trophoblastic tissues. They are proliferative as well as degenerative disorders of placental elements and include complete hydatidiform mole (CHM) or partial hydatidiform mole (PHM) (90%), invasive mole (IM) (5-8%), which could also be metastatic, villous, or villous choriocarcinoma (CC) (1-2%), and placental site trophoblastic tumor (PSTT) (1-2%). We present three cases of GTN, two mimicking tuberculosis radiologically, and all three are associated with pulmonary embolism.

Factors that Impact the Outcomes in Ewing's Sarcoma: Experience from a Regional Cancer Center in Southern India.

Ewing's sarcoma family of tumors (EWSFT) is common in the second decade of life. Achieving good outcomes in EWSFT requires a multimodality approach. We report the clinico-pathological features, treatment, and survival outcomes of patients with EWSFT treated at our center. Patients diagnosed and treated for EWSFT at our center from 2009-2017 were included in this study. Data was collected from the patient's case records. Event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The study included 173 patients among whom 44 (25%) patients were metastatic at diagnosis. The median age of patients was 16 years. The most common site of the primary tumor was the pelvis (16.1%), followed by long bones. The median follow-up was 75 months and the 5-year EFS and OS were 43.7% and 45.1% respectively for the overall cohort whereas for the localized disease were 56.6% and 57.2% respectively. Metastatic disease, tumor volume > 200 ml, tumor diameter > 8 cm, pelvic site, hemoglobin < 10 gms%, elevated lactate dehydrogenase, positive margin, and necrosis less than 90% were significantly associated with inferior OS on univariate analysis. On multivariate analysis, metastasis disease, tumor diameter > 8 cm, and necrosis < 90% were significantly associated with inferior OS. Large tumors, advanced disease, and poor response to chemotherapy are associated with poor outcomes in EWSFT. Whether the use of dose-dense chemotherapy and/or autologous stem cell transplant would improve outcomes without increased toxicity in resource-limited settings needs to be explored. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-023-01817-6.

Sarcoidosis associated with Trastuzumab in a young female with carcinoma of breast.

Trastuzumab is a humanized monoclonal antibody against human epidermal growth factor, useful in breast cancer. It is well tolerated but sometimes may associate with significant adverse effects. Sarcoidosis is a granulomatous disease involving multiple organs with poorly understood aetiology. Mediastinal lymphadenopathy is the most common presenting feature of Sarcoidosis. Reported cases of Sarcoidosis associated with Trastuzumab are quite less in number. High degree of suspicion of the above is thought of in a scenario of malignancy patients receiving chemotherapy. Newly appearing FDG avid lymph node in PET scan may give first impression of metastasis and treatment failure or infection. However correct diagnosis is a must (differentiating metastasis, treatment failure or infection) to provide correct treatment and avoid side effects of inappropriate therapies. Correct diagnosis also helps in appropriate prognostication and unnecessary stoppage of Trastuzumab. Here we are describing Sarcoidosis associated with Trastuzumab in a patient with breast cancer.

Two-drug versus three-drug induction chemotherapy in pediatric acute myeloid leukemia: a randomized controlled trial.

The benefit of three-drug induction chemotherapy over a two-drug induction has not been evaluated in pediatric acute myeloid leukemia (AML). We, therefore, conducted a randomized controlled trial to ascertain the benefit of a three-drug induction regimen. Patients aged 1-18 years with newly diagnosed AML were randomized to two cycles of induction chemotherapy with daunorubicin and ara-C (DA) or two cycles of ara-C, daunorubicin, and etoposide (ADE). After induction, patients in both arms received consolidation with two cycles of high-dose ara-C. The study's primary objective was to compare the event-free survival (EFS) between the two arms. The secondary objectives included comparing the composite complete remission (cCR) rates, overall survival (OS), and toxicities. The study randomized 149 patients, 77 in the DA and 72 in the ADE arm. The median age was 8.7 years, and 92 (62%) patients were males. The median follow-up was 50.9 months. The cCR rate in the DA and ADE arm were 82% and 79% (p = 0.68) after the second induction. There were 13 (17%) induction deaths in the DA arm and 12 (17%) in the ADE arm (p = 0.97). The 5-year EFS in the DA and ADE arm was 34.4% and 34.5%, respectively (p = 0.66). The 5-year OS in the DA and ADE arms was 41.4% and 42.09%, respectively (p = 0.74). There were no significant differences in toxicities between the regimens. There was no statistically significant difference in EFS, OS, CR, or toxicity between ADE and DA regimens in pediatric AML. The trial was registered with the Clinical Trial Registry of India (Reference number: CTRI/2014/11/005202).

Haploidentical Hematopoietic Stem Cell Transplantation in Leukemia's: Experience from a Cancer Center in India.

There has been a surge in haploidentical hematopoietic stem cell transplantation (HSCT) in India recently. However, there is a paucity of data on haploidentical HSCT from India. The report is an analysis of data of haploidentical HSCT performed at our center. Analysis of patients with acute leukemia or chronic myeloid leukemia who underwent haploidentical HSCT during 2014-2019 was performed. The graft versus host disease (GVHD) prophylaxis was post-transplant Cyclophosphamide with Mycophenolate-mofetil and Cyclosporine. All patients were transfused peripheral blood stem cells from donors. Overall survival (OS) was calculated using the Kaplan-Meier method. Twenty-one patients underwent haploidentical HSCT. Fourteen-patients were males. The median age of patients was 15 years. Fludarabine with total body irradiation was the most common conditioning regimen (n = 15, 71.4%). The median duration for neutrophil and platelet engraftment was 14 days. Cumulative incidence of acute and chronic GVHD was 19%, and 38% respectively. The median follow-up was 26 months and the two-year OS was 38%. Twelve (57%) patients died during the study period, 8 patients (38%) died from transplant-related mortality (TRM), and 4 from disease relapse. Sepsis was the cause of death in six of the eight TRM. Nine out of 21 patients (42.8%) are leukemia-free on follow-up. Haploidentical HSCT is a promising modality of treatment in patients who have no suitable matched donors. Though the TRM remains high, good disease control was achieved in 42.8% of patients. Multi-drug resistant bacterial infection remains a challenge in performing haploidentical HSCT in developing countries.

Masson's Hemangioma of Knee: A Rare Case Report.

INTRODUCTION: Intrasynovial hemangioma, a rare benign vascular lesion of joint cavities, is also called intrasynovial papillary endothelial hyperplasia or Masson's hemangioma (MH). These lesions are characterized by abnormal proliferation of endothelial cells with mild atypia with an organized thrombus. MH follows an individualized protocol for its management. CASE REPORT: A 22-year-old male gave a 10-year history of the diagnosed and operated (arthroscopically) case of synovial hemangioma of the left knee and presented with similar complaints. There was no history of trauma or infection over the left knee. The movements of the left knee were normal except with terminal restriction of movements. MRI of the left knee suggested intrasynovial low flow vascular malformation within the substance of the synovium. The patient underwent synovectomy of the hemangiomatous lesion in toto without any recurrence in the follow-up period for 8 months. Histopathology confirmed the diagnosis of intravascular papillary endothelial hyperplasia/MH. CONCLUSION: Although intrasynovial hemangioma is a very rare clinical entity, Orthopedic surgeons should have a high index of suspicion for MH, when a long-standing pain and hemarthrosis of the knee joint is being encountered in the clinical practice.