Cutaneous metastasis in hypopharyngeal carcinoma: a case report.

Background: Occurrence of cutaneous metastasis in hypopharyngeal carcinoma is an extremely rare event reported in the literature, with an incidence of only 0.8%-1.3%. Early diagnosis of cutaneous metastasis would have a positive impact on treatment response and disease prognosis with diagnosis mainly dependent on physical examination and radiological imaging (ultrasonography, computed tomography scan or PET-CT). Palliative care is, however, the mainstay of treatment for cutaneous metastasis. Case presentation: We report a middle-aged female patient, with known case of hypopharyngeal squamous cell carcinoma, who initially showed partial response to chemoradiotherapy but developed cutaneous nodules in the region of the right axilla and bilateral lateral chest wall posterior to the posterior axillary fold. Excision biopsy of one of these nodules showed metastatic squamous cell carcinoma. The patient was again referred to the Oncology Department of INMOL Hospital and her chemotherapy was planned for cutaneous metastasis. Conclusion: Being uncommon, the occurrence of cutaneous lesions in a patient with hypopharyngeal carcinoma should prompt detailed evaluation to rule out metastasis. Early detection will help in improving disease prognosis and median survival.

THE Role of Preoperative carcinoembryonic antigen in recurrence of resectable colorectal carcinoma.

In colorectal carcinoma, carcinoembryonic antigen (CEA) is a recommended marker for surveillance after curative resection. The aim of the present study was to determine the association of preoperative CEA with recurrence of colorectal carcinoma in our population. The study included 55 patients with all operable stages of colorectal adenocarcinoma treated during the 2012-2014 period, evaluated retrospectively and followed-up for recurrence for 2 years. Data on the baseline (preoperative) CEA levels were retrieved from patient files. On data analysis, SPSS 16.0 was used. In patients with normal preoperative CEA, the rate of recurrence was significantly low (p=0.008) and the likelihood of no recurrence 1.55-fold greater as compared to patients with raised initial CEA levels (p=0.028). In patients with raised preoperative CEA, the risk of recurrence was 5.26-fold greater as compared to those with normal CEA levels (p=0.028). A significant weak positive correlation (rs=0.297) was found between raised CEA and recurrence. A highly significant (p=0.002) moderate positive correlation was recorded in patients aged <50 and moderate positive correlation of borderline significance in males (rs=0.324, p=0.058). Sensitivity was 94.4% and specificity 32.4% in predicting recurrence. Accordingly, preoperative elevated CEA showed a significant weak positive correlation with recurrence while normal preoperative CEA moderately decreased the likelihood of recurrence.

Epidemiology and Treatment Outcomes of Sinonasal Tumors: A Single Institute's Experience in Pakistan.

OBJECTIVE: To find the epidemiology and risk factors of sinonasal tumors and treatment outcomes in squamous cell carcinoma. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: The Institute of Nuclear Medicine and Oncology Lahore (INMOL), Lahore, from May 2016 to March 2017. METHODOLOGY: All histopathologically proven cases of paranasal sinuses and nasal cavity were selected from the hospital record for epidemiological analysis. Survival outcomes of patients with squamous cell histopathology were determined, which is commonly occurring type. Relevant information was obtained from patient record and telephone communication. The data were analysed using SPSS V.20. RESULTS: Sinonasal malignancies are rare, making (n=81) 0.2% of all registered tumors; out of which, 46 (56.7%) had squamous cell histology. Median age was 50.0 years (IQR: 60.7-40.0) with male predominance (1.7:1). Most of patients presented at advanced stage, T3/ T4 in more than two-thirds of cases, and associated with nodal metastasis in 43.5% of squamous cell carcinoma. In patients with squamous cell histology, median disease-free survival was 19.00 months (SE: 1.65, 95% CI, 15.75 - 22.25), median overall survival remained 34.00 months (SE: 1.84, 95% CI, 30.00 - 38.00). Nodal status had significant effect (p<0.001) on survival. Radiotherapy had significant effect on improved survival (p=0.001) and distant metastasis remained negative prognostic factor (p=0.001). Disease stage was also significantly associated with overall survival (Log Rank 0.014). Tumour size, surgery, chemotherapy, and chemoradiotherapy were not significantly associated with survival. Cumulative survival at 1, 2, and 3 years was 87%, 48% and 29%, respectively. CONCLUSION: Sinonasal malignancies are rare, advanced stage is common, and radiotherapy improves overall survival.

Disease Characteristics and Treatment Outcome of Testicular Germ Cell Tumors Treated with Platinum-Based Regimens.

OBJECTIVE: To determine the disease characteristics of testicular germ cell tumor, biochemical/radiological response to chemotherapy and common toxicity profile. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from January 2010 to December 2013. METHODOLOGY: Fifty-one patients with histologically proven testicular germ cell tumor, who fulfilled the pre-defined eligibility criteria, were selected. Presenting symptoms and disease stage were studied. Patients were staged according to the AJCC 2010 staging criteria and prognosis was classified according to the IGCCCG Classification of Metastatic Germ Cell Cancer. Initial chemotherapy treatment was based upon the International Germ Cell Consensus Classification, 1997. Patients were also evaluated for chemotherapy-induced toxicity based on Common Toxicology Criteria version 4. SPSS version 16.0 was used for statistical analysis. RESULTS: Main presenting symptoms included testicular pain (37.3%), testicular swelling (25.5%), and abdominopelvic pain (11.8%). Most of the patients had mixed germ cell histology (p <0.001) and presented with advanced disease stage. Out of 51 patients, 41 (80.3%) achieved complete clinical remission after first line chemotherapy. All patients having complete response achieved 2-year survival and 37 (90.2%) had no evidence of recurrent disease. Four patients with recurrent disease achieved complete remission with second line chemotherapy. Five (9.8%) had partial response after first line chemotherapy while 2 (3.9%) progressed on treatment. All patients developed alopecia, 21 (41.1%) experienced other toxicities which were managed symptomatically and with minor dose modifications. CONCLUSION: Many patients with germ cell tumors presented with pain, and in an advanced stage, with mixed histology. Overall response rate was 90.2% with platinum-based chemotherapy.