Perivascular Epithelioid Cell Tumor (PEComa) of Vulva: a Rare Occurrence.

Perivascular epithelioid cell tumor (PEComa) is a tumor of mesenchymal origin, with features of perivascular epithelioid cells. The primary sites of PEComa reported are the uterus, vulva, rectum, heart, breast, urinary bladder, abdominal wall, pancreas, retroperitoneum, liver, and uterus. But what is unique is that PEComa of the gynecological tract is very rare. Uterus is the most common location of PEComa reported from female genital tract. PEComa of vulva is extremely rare. A 36-year-old woman presented with vulvar mass. Her final histopathological report came as PECOMA. Ours is the third case of PEComa vulva reported in English literature. After extensive literature search, we found only two previous cases reported of PEComa of vulva. One case was of primary PEcoma of vulva reported from Japan and other from China. Distinguishing among mesenchymal neoplasms, including PEComas, endometrial stromal sarcomas, and leiomyosarcomas, can be difficult. Careful analysis of morphologic and immunohistochemical features is of the utmost importance. Ours is the third such case of PEComa of vulva reported in English literature.

Impact of the Interval between Neoadjuvant Chemotherapy and Gastrectomy on Pathological Response and Survival Outcomes for Patients with Locally Advanced Gastric Cancer: A Meta-analysis.

Background: It is still unknown what is the appropriate time between neoadjuvant chemotherapy (NACT) and gastrectomy in cases of gastric cancer. To comprehend the relationship more clearly between waiting time after NACT before having a gastrectomy and survival results, a meta-analysis was done. Methods: Retrospective and prospective research from the PubMed, Embase, and Cochrane Library databases were thoroughly reviewed. Research examining the impact of delays of 4, 4-6, and above 6 weeks between the conclusion of NACT and surgery in patients with locally advanced gastric cancer qualified as eligible studies. The pathologic complete response (pCR) rate served as the main outcome indicator. Additional outcome metrics were overall survival (OS) and survival free of illness. Results: The meta-analysis showed that patients with locally advanced gastric cancer with a waiting time for surgery of above 4 weeks compared to those with a waiting time for surgery of below 4 weeks saw a significantly higher pCR rate (pCR) [odds ratio (OR): 1.67; 95% confidence interval (CI): 1.07-2.60; p = 0.02]. The meta-analysis found no appreciable OS differences [hazard ratio (HR): 0.93; 95% CI: 0.76-1.13; p = 0.44). Conclusions: Time to surgery (TTS) had no effect on the survival results, according to our data. Only in the group where delaying surgery by more than 4 weeks after the end of NACT improved pathological response, but had no effect on survival. How to cite this article: Naveed S, Banday SZ, Qari H, et al. Impact of the Interval between Neoadjuvant Chemotherapy and Gastrectomy on Pathological Response and Survival Outcomes for Patients with Locally Advanced Gastric Cancer: A Meta-analysis. Euroasian J Hepato-Gastroenterol 2022;12(2):81-91.

Neoadjuvant Chemotherapy for Advanced Gallbladder Cancer: Do We have Enough Evidence? A Systematic Review.

BACKGROUND: Recently for advanced gallbladder carcinoma, neoadjuvant chemotherapy has emerged as an important strategy in place of adjuvant chemotherapy with the hope that it will help to improve the resectability and survival. AIM AND OBJECTIVE: The goal was to conduct a systematic review of published publications on the benefits of neoadjuvant chemotherapy for advanced gallbladder cancer treatment. MATERIALS AND METHODS: This systematic review followed the Meta-analysis Of Observational Studies in Epidemiology standards. The clinical benefit rate of neoadjuvant chemotherapy, curative resectability rate, and R0 resection were the major outcomes of interest. The secondary outcomes of interest were overall and disease-free survival. RESULTS: Six published papers were included (n = 420). One-hundred and twenty-eight cases (30.47%) despite receiving neoadjuvant chemotherapy had disease progression. Although 67.38% of patients (283 of 420) in this systematic review showed good response to the neoadjuvant chemotherapy, just 51.66% (217 of 420 cases) were operated, out of which only 171 cases were deemed to be feasible for surgical resection and had curative resection. Out of the cases that underwent curative surgery, 91.81% had R0 resection (157 out of 171 patients). The overall survival rate was found to be 18.5-50.1 months for patients in whom curative surgery was done and 5.0-10.8 months for nonsurgery patients. CONCLUSION: No sufficient data exist to advocate the regular use of neoadjuvant chemotherapy in advanced gallbladder carcinoma, as data showed that only 1/3 of patients benefited and had a R0 resection. Further research should be the randomized controlled trials to further quantify the benefit of neoadjuvant chemotherapy in advanced gallbladder carcinoma. HOW TO CITE THIS ARTICLE: Naveed S, Qari H, Thau CM, et al. Neoadjuvant Chemotherapy for Advanced Gallbladder Cancer: Do We have Enough Evidence? A Systematic Review. Euroasian J Hepato-Gastroenterol 2021;11(2):87-94.

Lymph Node Ratio is an Important Prognostic Factor in Curatively Resected Gallbladder Carcinoma, Especially in Node-positive Patients: An Experience from Endemic Region in a Developing Country.

BACKGROUND: Metastasis to lymph nodes is a bad prognostic factor in patients with gallbladder carcinoma who undergo radical cholecystectomy. During the past decade, studies have brought focus on lymph node ratio (LNR) as an additional valuable prognostic factor in these cases.Our research studied the factors that predicted the recurrence of disease and survival of patients with gallbladder carcinoma who were treated with surgical resection, concentrating especially on the lymph nodal status as a prognostic factor and LNR in node-positive T1-T3 cases. METHODS: In our hospital, Mahavir Cancer Institute and Research Centre, we reviewed retrospective data, from 2009 to 2014, of 60 patients who had undergone radical cholecystectomy for gallbladder carcinoma. We staged the patients as per the AJCC eight edition. Predictive factors that affect disease-free survival (DFS), like age, gender, postoperative complications, lymphovascular invasion (LVI) and perineural invasion (PVI), lymph node dissection, differentiation, T stage, N stage, number of lymph nodes involved, and LNR, were examined statistically. RESULTS: Lymph nodal involvement was found to be a principal predictive factor in cases in whom radical cholecystectomy was done. The number of lymph nodes dissected determined the prognosis in N0 cases. LNR was a strong prognostic factor for DFS in cases of curatively resected gallbladder cancer. CONCLUSION: LNR is a strong predictive factor in radically resected gallbladder carcinoma cases. HOW TO CITE THIS ARTICLE: Naveed S, Qari H, Thau CM, et al. Lymph Node Ratio is an Important Prognostic Factor in Curatively Resected Gallbladder Carcinoma, Especially in Node-positive Patients: An Experience from Endemic Region in a Developing Country. Euroasian J Hepato-Gastroenterol 2021;11(1):1-5.

Patterns of Failure After Trimodal Treatment in Esophageal Squamous Cell Carcinoma: Initial Experiences from a High-Risk Endemic Area.

Recurrence is a significant problem faced in patients with esophageal cancer even after treatment with trimodal approach. We report patterns of failure in our patients of esophageal squamous cell cancer (ESCC) treated with trimodal approach. This is a single-institution retrospective analysis of 46 patients of locally advanced ESCC (treated between 2013 and 2017) managed by trimodal treatment approach. Variables were summarized using descriptive statistics. Survival statistics were estimated using Kaplan-Meier method. With a median follow-up of about 28 months, we noted an overall recurrence rate of 37% (17/46), with most of the failures being distant, with or without locoregional recurrence (4 isolated distant and 6 combined distant and locoregional). Median RFS was 34 months and median OS was yet to be reached at the last follow-up. To conclude, optimization of treatment approaches in ESCC is of utmost importance and need of the hour to further improve outcomes in these patients.

Evaluation of Clinicopathological Findings on 255 cases of Inoperable Locally Advanced Breast Carcinoma: A Tertiary Care Experience.

INTRODUCTION: Breast cancer is the second most common cancer in the Indian female population. LABC and metastatic breast cancer are the most common stages at presentation in most low-resource countries. Although the incidence of LABC has decreased significantly in countries with enhanced resources thanks to widespread education and screening programs, it remains a daily encounter for surgeons and oncologists in low-resource countries. Neoadjuvant therapy has been studied widely for the treatment of LABC and is followed by locoregional therapy. OBJECTIVES: As per our hospital data, breast cancer is also found to be the second leading malignancy in women and locally advanced breast cancer is the most common type of breast cancer. Hence, we undertook this study to evaluate the clinical profile, histopathologic types and grade of the disease in our patients. MATERIALS AND METHODS: This study was undertaken over a period of three years comprising of 255 patients who underwent modified radical mastectomy following neoadjuvant chemotherapy after preliminary diagnosis of carcinoma on histopathological examination of the trucut biopsy specimens. Clinicopathological evaluation was done in all of these cases following standard protocols. RESULTS: The study comprised of 252 female patients and 3 male patients in the age range of 26 to 70 years. Majority (255, 66.6%) of the cases were within the age range of 31­60 years. Three females had bilateral breast cancer. Invasive ductal carcinoma no special type was the most common histopathologic pattern, and was seen in 254 (98.4%) cases. Most tumors were Scarff Bloom Richardson grade II and American Joint Committee on Cancer pathologic stage 3. CONCLUSIONS: The present study has provided information about the clinicopathological aspects of locally advanced breast cancer in patients who are from rural areas. LABC remains a daily encounter and challenge for medical and surgical oncologists in developing low-resource countries. Neoadjuvant chemotherapy is recommended for inoperable LABC at all resource levels.

Liver abscess in the tropics: an experience from Jammu.

OBJECTIVE: To study the various types of liver abscesses. This prospective study was conducted over a period of one year, from November 2011 to October 2012, at the Department of General Surgery in Acharya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu. MATERIALS AND METHODS: The patients in this study were admitted from the emergency wing, and from indoor and outdoor departments of surgery and medicine over a period of one year (November 2011 to October 2012) to the Department of General Surgery in Acharya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu. Patients of all age groups and both genders who presented with clinical suspicion of liver abscess, or had already been diagnosed, were included in the study. A definitive diagnosis of liver abscess was made based on compatible clinical features, ultrasonography and aspiration or drainage of pus. Diagnostic criteria for the various types of abscesses were as follows: Amoebic abscess: demonstration of Entamoeba histolytica trophozoites in aspirated pus. Pyogenic abscess: positive cultures of blood or aspirated pus. If both of the above sets of criteria were satisfied, the abscess was considered to be of mixed aetiology. Tuberculous abscess was diagnosed by identifying acid-fast bacilli in aspirated material and polymerase chain reaction. The abscess was classified as indeterminate if none of the above criteria were satisfied. RESULTS: The majority of patients in our study had amoebic liver abscesses (73.33%). Escherichia coli and Klebsiella were the most common organisms cultured from the pyogenic abscesses. The majority of patients with amoebic liver abscesses were treated with drug therapy alone, whereas all pyogenic liver abscesses required some form of drainage.

Mucinous Cystic Neoplasms of Pancreas.

The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the key words "pancreatic mucinous cystic neoplasm", "pancreatic mucinous cystic tumor", "pancreatic mucinous cystic mass", "pancreatic cyst" and "pancreatic cystic neoplasm" to identify English language articles describing the diagnosis and treatment of the MCN of the pancreas. In total, 16,322 references ranging from January 1969 to December 2009 were analyzed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucin-producing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis and positron emission tomography-CT. Surgery is indicated for all MCNs.