Pretreament neutrophil-lymphocyte ratio (NLR): A felicitous prognostic marker in carcinoma lung.

BACKGROUND: Mechanics of inflammation and oncogenesis are intertwined with each other. Thus, the role of inflammatory markers like neutrophil-lymphocyte ratio (NLR) as a foreteller of lung carcinoma is retrospectively appraised in this study. MATERIAL AND METHODS: Retrospective assessment of hospital records of carcinoma lung patients was done between January 2018 and January 2020 and pretreatment NLR was calculated. Median NLR was taken as cut off and thereafter correlation was studied between pretreatment NLR and overall survival, using Kaplan-Meier survival analysis. Cox regression analysis was applied to identify factors affecting survival. RESULTS: Study population included 135 eligible patients with median age of 60 years and male to female ratio of 8.6:1. 47.41% patients were of stage III and 52.59% patients belonged to stage IV. The duration of follow-up ranged between 0.5 and 22 months. Median NLR was 3.1 (range, 0.90-11.25) and median overall survival in patients with NLR <3.1 and ≥3.1 was 6 months versus 3 months, respectively (P-value = 0.001). NLR value in nonsmall cell and small cell lung cancer was analyzed separately and showed significant variation in median survival in nonsmall cell lung cancer patients only (P-value = 0.001). CONCLUSIONS: Study results summarized that pretreatment NLR can be taken as a cheap and easily available predictor of prognosis in carcinoma lung cases and more so in nonsmall cell lung carcinoma cases. Large prospective trials are warranted to further potentiate this fact.

Major Risk Factors in Head and Neck Cancer: A Retrospective Analysis of 12-Year Experiences.

BACKGROUND: Head and neck cancer (HNC) is the seventh most common type of cancer in the world and constitute 5% of the entire cancers worldwide. The global burden of HNC accounts for 650,000 new cases and 350,000 deaths worldwide every year and a major proportion of regional malignancies in India. More than 70% of squamous cell carcinoma of the head and neck are estimated to be avoidable by lifestyle changes, particularly by effective reduction of exposure to well-known risk factors such as tobacco smoking and alcohol drinking. METHODS: A retrospective analysis of 12 years (2001 - 2012) of HNC patients attending RCC, PGIMS Rohtak was done. Total numbers of cancer patients seen were 26,295 and out of these 9,950 patients were of HNCs, which were retrospectively analyzed for their associated risk factors in different HNC subtypes. Most of the patients, i.e. 92.3%, were presented as locally advanced HNC (stages III and IV). RESULTS: It has been observed that smoking and alcohol are the strongest independent risk factors responsible for increased risk of HNC and are further having synergetic correlations. CONCLUSION: The present study confirms the principal role of alcohol consumption and smoking in HNC carcinogenesis, as well as the differential associations with HNC subtypes, and a significant, positive, multiplicative interaction with different risk factors.

Comparative study of tumor markers in patients with colorectal carcinoma before and after chemotherapy.

BACKGROUND: Colorectal carcinoma (CRC), the second leading cause of cancer-related deaths in US, has a rising time-trend in India. Tumour markers in CRC are extensively researched, and there's still debate on their diagnostic and prognostic values. METHODS: In this hospital-based longitudinal study in north India, 51 male diagnosed CRC cases (pre-chemotherapy) were contrasted against 50 age and sex matched controls. Nine biomarkers: carcinoembryonic antigen (CEA), prolactin (PRL), alfa feto protein (AFP), total human chorionic gonadotropin (hCG), cancer antigen-125 (CA-125), serum testosterone, prostate specific antigen (PSA) and ferritin were measured by direct chemiluminescence technique. Further, follow-up was done on 47 cases after treatment with six cycles of 5-flurouracil (5-FU) and oxaliplatin. RESULTS: Mean serum CEA (case: 5.94±8.27 ng/mL, control: 2.5±0.79 ng/mL, P<0.05), PRL (case: 28.12±13.39 ng/mL, control: 14.24±13.13 ng/mL, P<0.0001), AFP (case: 10.9±6.65 ng/mL, control: 4.02±1.26 ng/mL, P<0.0001) levels were significantly raised in CRC cases compared to controls. On the contrary, mean testosterone level (P<0.05) was lower among the cases. After chemotherapy, the mean serum CEA (P<0.05), AFP (P<0.0001) and CA-125 (P<0.05) levels among the cases decreased significantly compared to their pretreatment levels. CONCLUSIONS: The present study strongly indicates the role of CEA, PRL, AFP, CA-125 and testosterone as important biomarkers in male CRC patients from north India. Further, AFP, CA-125 and CEA may be used to assess the effectiveness of chemotherapy in such patients.

Dermatofibrosarcoma Protuberans of Lumbar Region with Metastasis to Lung: A Rare Presentation.

Dermatofibrosarcoma protuberans (DFSP) is a cutaneous slow growing soft tissue sarcoma associated with a high local recurrence rate. Common site of presentation is trunk followed by proximal extremity and head and neck region. A case of recurrent DFSP of left lumbar region with metastasis in lung in a 50-year-old woman presented here. Absence of symptoms often leads to a delay in diagnosis. DFSP is often mistaken for other skin conditions, particularly in its early stages.

Primary Non Hodgkin's Lymphoma of Left Adrenal Gland - A Rare Presentation.

Primary adrenal lymphoma is rare and constitutes for 3% of extranodal lymphoma cases. Approximately 70% of patients present with bilateral disease and have adrenal insufficiency. Prognosis of primary adrenal lymphoma (PAL) is poor, most of patient die within one year of diagnosis. Moreover, there are no standard treatment protocols on such cases. Patients are generally treated with regimens similar to other nonhodgkin lymphoma which includes surgery, combination chemotherapy and or radiotherapy. We are presenting a successfully treated case of primary diffuse large B cell non Hodgkin lymphoma of adrenal gland in a 57-year-old patient. The patient had unilateral adrenal involvement (left adrenal gland), without adrenal insufficiency and normal Serum lactate dehyrogenase level. The patient was treated with left adrenalectomy followed by combination chemotherapy. Two years after diagnosis and treatment the patient is disease free on clinical and imaging studies.

Primary adenocarcinoma of the upper oesophagus.

Upper oesophageal adenocarcinoma is a rare malignancy that occurs in the ectopic gastric mucosa, in the upper part of the oesophagus. Only 29 cases so far have been reported. We report the 30th case in a 50-year-old Asian female presenting with difficulty in swallowing.

Adenoid cystic carcinoma of cervix: treatment strategy.

Adenoid Cystic Carcinoma (ACC) of cervix behaves aggressively and it has a propensity for local infiltration, invasion in lymphatic vessels as well as perineural spaces, with subsequent haematogenous spread. In advanced disease (Stage III and IV), outcome is invariably poor. Moreover, these cases have a high tendency to recur locally and also to metastasize to distant sites. There are no standard treatment protocols because of rarity of disease. The guidelines for its management are established similarly as for staged squamous cell carcinoma of cervix. Therefore, recommended treatment in advanced disease is aggressive multimodality treatment, which includes chemotherapy and radiotherapy. We are presenting a case of adenoid cystic carcinoma of cervix in 55 years old patient, staged as III B. The patient was treated with concomitant radiotherapy and chemotherapy. The patient responded well to treatment and is disease free, three years after treatment.

Amidomethylation of elemental tellurium: synthesis and solid state structures of N-substituted amidomethyltellurium(IV & II) derivatives.

Amidomethylation of Te(0) (elemental tellurium) as well as Te(II) (aryltellurium bromide, in situ) proceeds readily under mild conditions. It involves oxidative insertion of low valent tellurium into the C-Br bond of N-substituted alpha-bromoacetamides and provides a direct synthetic route to the stable, crystalline amidomethyltellurium(IV) dibromides, (RR'NCOCH(2))(2)TeBr(2) (RR'N = Et(2)N (1b), MePhN (2b), Me(c-Hex)N (3b), O(CH(2)CH(2))(2)N (4b)) and (Et(2)NCOCH(2))ArTeBr(2) (Ar = mesityl, 5b; 1-naphthyl, 6b). Biphasic bisulfite reduction of the dialkyltellurium dibromides afforded yellow to orange coloured amido functionalized symmetrical telluroethers, (RR'NCOCH(2))(2)Te (RR'N = Et(2)N (1), MePhN (2), Me(c-Hex)N (3), O(CH(2)CH(2))(2)N (4)), of which compound 2 was isolated as a crystalline solid. Oxidation of the new dialkyltelluroethers with dihalogens (Br(2), I(2)) or SO(2)Cl(2) afforded the corresponding amidomethyltellurium(IV) dihalides, (RR'NCOCH(2))(2)TeX(2) (RR'N = Et(2)N, X = Cl (1a), Br (1b), I (1c); RR'N = MePhN, X = Cl (2a), Br (2b), I (2c); RR'N = Me(c-Hex)N, X = Cl (3a), Br (3b), I (3c); RR'N = O(CH(2)CH(2))(2)N, X = Cl (4a), Br (4b), I (4c)) that were characterized by elemental analyses and multinuclear ((1)H, (13)C, (125)Te) NMR. Single crystal X-ray data on 1b, 1c, 2, 2b, 2c, 4b, 5b and 6b suggest that the N-substituted amidomethyl group acts as a small-bite chelating ligand, via intramolecular 1,4-Te...O coordination, towards the Te(IV) centre. Steric congestion around Te(IV) due to intramolecular secondary bonding interaction(s), reduced electrophilicity of Te(II) and the partial positive charge on N due to the resonating character of the amido group presumably prevents these atoms from participating in the intermolecular associative forces in the solid state. Instead, weak C-H...O and C-H...X H-bonding interactions take centre-stage in the self assembly.

Acylmethyl(aryl)tellurium(IV,II) derivatives: intramolecular secondary bonding and steric rigidity.

Electrophilic substitution of acylmethanes (methyl ketones), RCOCH3 (R = i-Pr, 1; Et, 2; Me, 3) with aryltellurium trichlorides, ArTeCl3 (Ar = 1-C10H7, Np, A; 2,4,6-Me3C6H2, Mes, B; 4-MeOC6H4, Anisyl, C) under mild conditions affords the corresponding acylmethyl(aryl)tellurium dichlorides (RCOCH2)ArTeCl2. Reduction of the dichlorides, gives tellurides, (i-PrCOCH2)ArTe, 1A-1C, which give the corresponding dihalides, (i-PrCOCH2)ArTeX2 (X = Cl, 1Aa-1Ca; Br, 1Ab-1Cb; I, 1Ac-1Cc) when reacted in situ with SO2Cl2, Br2 or I2. The unsymmetric tellurides are labile towards disproportionation and attempts to obtain them lead to the isolation of Ar2Te2 except in the case of (i-PrCOCH2)MesTe (1B), which represents an interesting example of a kinetically stable aryl(alkyl)telluride. All the dihalomesityltellurium(IV) derivatives show separate 1H and 13C NMR signals for the ortho methyls irrespective of the sizes of R and X ligands. The telluride, 1B with free rotation about Te-C(mesityl) bond shows, like the unsymmetric diorganotellurium(IV) dihalides, only one 125Te NMR signal. The 1,4-chelating behavior of the acyl ligand among diorganotellurium(IV) compounds is inferred from the X-ray diffraction data for 1Aa, 1Ac, 1Ba, 1Bb, 1cA and 1Cc which are indicative of the presence of intramolecular Te...O secondary bonding interactions (SBIs) at least in the solid state. As a consequence, steric repulsion in case of the mesityltellurium(IV) derivatives, 1Ba and 1Bb, reaches the threshold so as to cause loss of two-fold rotational symmetry of the mesityl group about the Te-C(mesityl) bond axis. Intermolecular C-HO...O H-bonding interactions appears to stabilize such an orientation of the aryl ligand at least in the solid state.