Primary sinonasal meningioma in a child.

Meningiomas are common intracranial extra-axial masses. They are rarely encountered in extracranial locations; when they are, the most common head and neck locations are the paranasal sinuses and the temporal bone. Meningiomas in children are very rare, especially in the neonatal period. The clinical presentation and clinical findings are often nonspecific. The diagnosis can be established by imaging and histopathologic examination with immunohistochemistry. We describe a case of primary sinonasal meningioma in a 2-year-old boy whose onset of symptoms had begun during the neonatal period. We discuss the clinical features, imaging results, and histopathologic and immunohistochemical findings in this case.

Role of oral glutamine in alleviation and prevention of radiation-induced oral mucositis: A prospective randomized study.

BACKGROUND: Oral mucositis is the most frequently occurring painful and dose-limiting side-effect of radiation of the head and neck region. Few studies demonstrated that oral glutamine suspension may significantly reduce the duration and severity of objective oral mucositis during radiotherapy. MATERIALS AND METHODS: A randomized, prospective single institutional case control study was performed between April 2012 and November 2012 comparing the influence of oral glutamine on radiation induced mucositis in head and neck malignancy patients. Seventy biopsy proven patients with head and neck cancer receiving primary or adjuvant radiation therapy were randomized to receive either oral glutamine suspension daily 2h before radiation in the study arm (10 g in 1000 ml of water) (n = 35) or nothing before radiation; control arm (n = 35). RESULTS AND ANALYSIS: Total 32 patients (91.43%) in the glutamine arm and total 34 patients (97.15%) developed mucositis. Grade 3 mucositis (14.29%) and grade 4 mucositis (2.86%) in the study arm (who received oral glutamine) were significantly less (P = 0.02 and P = 0.04, respectively) in the glutamine arm. The mean duration of grade 3 or worse mucositis (grade 3 and grade 4) was significantly less (6.6 days vs. 9.2 days) in study arm with P < 0.001. Mean time of onset of mucositis was significantly delayed in patients who took glutamine in comparison to control arm with P < 0.001. CONCLUSION: Glutamine delays oral mucositis in the head neck cancer patients. Moreover, it reduces the frequency and duration of grade 3 and grade 4 mucositis.

Adrenocortical carcinoma with skeletal metastases in a postmenopausal woman.

Adrenocortical cancer is a very rare tumor with a poor prognosis. About half of them are hormone-secreting tumors. In most cases, hormonal investigations reveal an excess secretion of steroids, mostly cortisol and androgens. A 54-year-old lady presented with history of pain in left shoulder and leg for 6 months and features of virilization. CT-guided fine-needle aspiration cytology of an abdominal mass revealed the presence of a carcinoma of the left adrenal cortex. A whole-body radionuclide bone scan revealed increased uptake in the left clavicle and left femur. The patient has received palliative radiotherapy for the skeletal lesions and 3 cycles of palliative chemotherapy at present.

Clinicopathological study and its prognostic implication in male breast carcinoma.

The aim of the present study is to analyse the cases of male breast carcinoma as regards its incidence, family history, clinical presentation, staging, histopathological grade, hormone receptor status and to identify the prognostic significance of the above factors on the final outcome. Seventy-nine cases of male breast carcinoma were treated in the radiotherapy department of Medical College, Kolkata from 1994-2003 (10 years). The hospital data were used to analyse the epidemiological and clinicopathologic parameters as well as the treatment offered and outcome. Incidence of male breast cancer was 0.6% among all male cancer cases and 2.5% among all breast cases. The median age of presentation was 67 years. Lump in the breast was the commonest presenting feature; 90% had advanced disease at presentation. All patients were treated by mastectomy. Majority received radiotherapy (93%) and chemotherapy (81%) as well. Hormone therapy was given to 83% patients. Five-year disease-free survival was 58% for node negative patients and 47% for node positive patients Two most important prognostic factors that affect the survival were nodal status and tumour size. Male breast carcinoma is a rare disease. Median age of presentation is much higher than the female counterpart. The prognosis and survival is similar but the incidence of positive hormone receptor is much more than breast carcinoma of females. In absence of prospective randomised trial retrospective review data from various centres could provide useful guidelines regarding therapy.

Role of chemoradiotherapy in advanced carcinoma cervix.

Carcinoma cervix is the commonest female malignancy in India. In advanced stages radiotherapy was the only treatment options available. Recently there is interest in chemotherapy but the combination, dosage and timing are not well standardised. With this background a trial was undertaken to evaluate the role of chemotherapy along with radiotherapy in advanced carcinoma cervix. One hundred and sixty patients of stages II B-IV A carcinoma cervix were randomised into two arms. Patients of radiotherapy alone arm were treated by external radiotherapy of 5000 cGy in conventional fractionation followed by brachytherapy. The second group received the same schedule of radiotherapy plus chemotherapy with injection cisplatin 30 mg/m2 once weekly for 5 weeks during the course of external radiotherapy. Patients were well matched in both the arms. Compliance rate is similar. The complete response rate was 83% with chemoradiotherapy arm while it was 73% with radiotherapy (p-value > 0.1). Neutropenia was the major dose limiting toxicity, the incidence and severity being more in chemoradiotherapy arm (grade 3 neutropenia 12% versus 0%). Radiation proctitis was the commonest late effect observed. In the median follow-up of 54 months, there is an increased overall survival (56% versus 47%); p-value > 0.1) and disease-free survival (51% versus 37%; p-value > 0.05) in the chemoradiotherapy arm.

Role of mycobacterium w as adjuvant treatment of lung cancer (non-small cell lung cancer).

Mycobacterium w (immuvac), a new potent immunomodulator was evaluated as an adjuvant therapy in the management of non-small cell lung cancer in a controlled clinical trial. The standard therapy employed was combination chemotherapy in the form of cisplatin and etoposide along with radiotherapy. The group receiving mycobacterium w tolerated the chemotherapy and radiotherapy well and completed it as planned, in contrast to premature stoppage of radiotherapy in 50% of patients in the control group. Improvement in quality of life as measured by Karnofsky performance status was significantly better in patients receiving mycobacterium w. Similarly, effect on lung cancer was also significant with two-third showing regression in tumour size in mycobacterium w group. These also get reflected in improvement in the lung function.