Transcriptome analysis identifies putative multi-gene signature distinguishing benign and malignant pancreatic head mass.

BACKGROUND: Most often, the patients with pancreatic diseases are presented with a mass in pancreatic head region and existing methods of diagnosis fail to confirm whether the head mass is malignant or benign. As subsequent management of the disease hugely depends on the correct diagnosis, we wanted to explore possible biomarkers which could distinguish benign and malignant pancreatic head masses. METHODS: In order to address that gap, we performed a case-control study to identify genome-wide differentially expressed coding and noncoding genes between pancreatic tissues collected from benign and malignant head masses. These genes were next shortlisted using stringent criteria followed by selection of top malignancy specific genes. They subsequently got validated by quantitative RT-PCR and also in other patient cohorts. Survival analysis and ROC analysis were also performed. RESULTS: We identified 55 coding and 13 noncoding genes specific for malignant pancreatic head masses. Further shortlisting and validation, however, resulted in 5 coding genes as part of malignancy specific multi-gene signature, which was validated in three independent patient cohorts of 145 normal and 153 PDAC patients. We also found that overexpression of these genes resulted in survival disadvantage in the patients and ROC analysis identified that combination of 5 coding genes had the AUROC of 0.94, making them potential biomarker. CONCLUSIONS: Our study identified a multi-gene signature comprising of 5 coding genes (CDCA7, DLGAP5, FOXM1, TPX2 and OSBPL3) to distinguish malignant head masses from benign ones.

Castleman's disease--a rare disease with varying presentation.

Castleman's disease is a relatively rare immunoproliferative disease primarily involving the lymph nodes. It occurs in two forms- unicentric and multicentric. Though it is a benign disorder the multicentric form can be difficult to treat and can have a poor prognosis. The treatment is often delayed as its differential diagnosis includes several common diseases including lymphoma, benign and malignant lymph node mass, thymoma, rheumatoid nodules. It is at times associated with pemphigus vulgaris as a paraneoplastic syndrome as has occurred in one of the cases. This makes the diagnosis even more difficult as the patients generally undergo a prolonged treatment initially for the associated condition without significant improvement. Three such cases were encountered in the last three years, all of which occurred in relatively young patients and caused great diagnostic dilemma. They responded well to treatment and are currently doing well in follow-up. This disease though rare should be considered in the differential diagnosis of lymphoma, reactive nodular hyperplasia, malignant lymph node enlargement. It is also important to rule out this disease in the diagnosis of treatment-refractory cases of pemphigus vulgaris.

An unusual presentation of foreign body in the common carotid artery.

Penetrating trauma to neck resulting in arteriovenous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening consequences. We report here a case of a young factory worker who developed a traumatic AV fistula with false aneurysm, with however, no other complications. He was successfully operated when he presented to us two months after the injury and is doing well in follow-up.

A case of splenic torsion and rupture presenting as ruptured ectopic pregnancy.

Splenic torsion with rupture of spleen is an extremely rare phenomenon. The clinical picture mimics several common conditions which are causes of acute abdomen and so it is seldom detected pre-operatively. An 18 year old female patient was admitted with an acute abdomen and shock. The provisional diagnosis was of a ruptured ectopic pregnancy. Peri-operatively we found a spontaneous rupture of the spleen following torsion along with early intrauterine pregnancy. Splenectomy was carried out and patient recovered well. Our report confirms that this rare entity can present as an acute abdomen which is very difficult to diagnose preoperatively and can masquerade as ruptured ectopic pregnancy in women of childbearing age group.

Gastric tuberculosis - a diagnostic dilemma.

Gastric tuberculosis is an extremely rare entity particularly when it is not associated with pulmonary tuberculosis or an immunodeficient state. Here one patient required surgery for gastric outlet obstruction and was subsequently put on antituberculous drugs. The patient responded well to treatment and is currently doing well in follow-up. This disease though rare should be considered in the differential diagnosis of gastric malignancy and severe peptic ulcer disease.

Is estrogen receptor study useful in prognostication of breast cancer patients in India?

BACKGROUND: To assess the validity of estrogen receptor (ER) status of breast tumor as a prognostic marker in clinical practice in the Indian perspective. MATERIALS AND METHODS: Sixty-three patients of breast cancer attending breast clinic IPGMER, Kolkata were included in this study. All patients underwent surgery. Metastatic status and tumor were done. Immunohistochemistry was also used for further analysis. RESULTS: Statistically we have proved that advancing course of the disease, there is a tendency of the tumors to become hormone insensitive. CONCLUSIONS: ER has a strong prognostic importance in early breast cancer and can play a major role in optimizing treatment modalities in node negative early breast cancer.

A study of 500 cancer patients to know any relation between malignancy and socio-economic status.

It was a common belief that cancer is more prevalent among the lower socio-economic group. It was also generally accepted that mortality was higher in this group due to various reasons. In this hospital based study, an attempt had been made to find out any association between cancer incidence and socio-economic factors like age, sex, education, occupation, and income. The relative distribution of cancers in different parts of the body was also analysed. Collected data for cancers of the breast, lung, cervix and gall bladder were also analysed separately. It was found that there was a significant association between the occurrence of cancer and the middle income group earning Rs 12000-60000 annually. On the other side people having higher education and higher income were less likely to suffer from cancer and presented at an earlier stage.