Twin Malignancy of Acute Myeloid Leukemia and Multiple Myeloma in a Chemotherapy-Naïve Patient: A Rare Occurrence.

Synchronous diagnosis of acute myeloid leukemia (AML) and multiple myeloma in chemotherapy-naïve patients is a rare event and poses a serious therapeutic challenge as it imparts a poor prognosis. We report a case of concurrent AML with multiple myeloma in a 44-year-old male along with a PUBMED-based research of previously reported similar cases in published literature.

Clinico-Hematological Profile of Acute Leukemia Cases in Bihar: A Multiparameter Study in a Tertiary-Care Hospital.

Objective The actual incidence and demographic profile of hematological malignancies are unknown in Bihar because of lack of population-based cancer registry (PBCR) data and specialized tertiary cancer center facilities. The objective of this study was to estimate the prevalence, clinico-hematological profile and subtyping of acute leukemia cases by retrospective medical records. Materials and Methods A retrospective study was conducted in the Department of Hematology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, over 2 years from July 2019 to June 2021. A total of 176 cases with relevant clinical features and hematological findings were involved in the study. Medical records were studied and data were retrieved. Statistical Analysis Data were recorded and analyzed using SPSS version 25. Results A total of 176 cases with relevant clinical features and hematological findings were involved in the study. Acute myeloid leukemia (AML) was most prevalent (52.8%), followed by acute lymphoblastic leukemia (ALL) (34.1%) and unclassified acute leukemia cases (13.1%). Flow cytometry correlation was available in 150 cases. The ratio of males (62.5%) to females (37.5%) is 1.6:1. There was statistically significant difference in physical examination findings between AML and ALL patients. Splenomegaly, lymphadenopathy, and sternal tenderness were more often seen in ALL than in AML patients ( p < 0.05). Pallor was more significantly associated with AML than with ALL patients ( p < 0.05). Anemia and leucocytosis were found to be significantly associated with acute leukemia patients ( p < 0.000). Conclusion AML M2 was the most common subtype of AML, and B-ALL was the most common subtype of ALL cases.

Vancomycin-Induced Maturation Arrest with Reactive Promyelocyte Proliferation: A Diagnostic and Therapeutic Challenge.

Drug-induced leukopenia is a diagnostic and therapeutic challenge. A detailed clinical history is a must to come to a right diagnosis. Certain drugs are known to cause bone marrow suppression, leukopenia, myeloid maturation arrest, and reactive promyelocyte proliferation. Here, we report an unusual case of vancomycin-induced maturation arrest with marked promyelocyte proliferation in a 47-year-old male patient who was being treated for novel coronavirus disease 2019 (COVID-19) infection. Most times, this reactive promyelocyte proliferation is confused with neoplastic promyelocytes, leading to incorrect diagnosis and management.

Metastasis of primary signet ring cell carcinoma of prostate to bone marrow: A rare occurrence with review of literature.

We report a case of a 65-year-old male who presented with multiple enlarged intraabdominal lymph nodes with lytic lesions over pelvic and lumbar vertebrae. His serum prostate-specific antigen (PSA) was markedly raised. Bone marrow investigation revealed the presence of diffuse infiltration of single cells having hyperchromatic nuclei, moderate amount of eosinophilic cytoplasm, and eccentrically placed nuclei resembling signet ring cells. Hence, a diagnosis of metastatic signet cell carcinoma of prostate was made on bone marrow biopsy. This variant of prostatic carcinoma is very rare and accounts for only 2.5% of all prostatic adenoacarcinomas that make our case worth reporting. To emphasize the rare occurrence of this variant, we performed a Pubmed-based literature review of 25 years.

Ultrasonic and Histopathological Evaluation to Exclude Premalignant and Malignant Lesions in Perimenopausal and Postmenopausal Women Presenting as Abnormal Uterine Bleeding.

INTRODUCTION: Abnormal uterine bleeding may be defined as bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause. AIM AND OBJECTIVE: The aim of this study was (1) to identify the different benign, premalignant and malignant conditions as the cause of abnormal uterine bleeding in perimenopausal and postmenopausal women and (2) to find out the different histopathological patterns of endometrium and cervix in these women. MATERIALS AND METHODS: This is a prospective study done in gynaecological oncology in 100 cases attending the OPD. Pap smear and cervical biopsy were done following clinical examination and then, the patients were sent for abdominal and pelvic ultrasound examination. Endometrial biopsy was done if endometrial thickness was increased with respect to age. The cut-off value of endometrial thickness in perimenopausal women was 11 mm, and for postmenopausal women, it was 4 mm, respectively. All the tissue specimens were sent for histopathological examination. RESULT: A total of 100 women were evaluated in which 50% were in the perimenopausal age group and 50% in the menopausal age group. Cervical pathology was present in 47% of cases, organic cause of uterine body like fibroid and adenomyosis was present in 26% of women, and thickened endometrium was seen in 24% of cases and endometrial polyp in 3 cases only. In this study, the incidence of benign cases was 49%, premalignant 9% and malignant condition 42%, respectively. Out of 42 malignant cases, 37 (88.09%) were cervical cancer, 3 (7.14%) endometrial carcinoma, 1 (2.38%) vulval cancer and 1 sarcoma of uterus. With regard to histology of endometrium, 34.48% had simple hyperplasia without atypia, 20.68% hyperplasia with atypia and secretory endometrium, and 10.34% endometrial carcinoma. Histologically, 94.59% of cervical cancer was squamous cell carcinoma and 5.40% was adenocarcinoma. CONCLUSION: Evaluation of cases of perimenopausal and postmenopausal bleeding differentiated premalignant and malignant lesions of the uterine body, endometrium and cervix. As our centre is a Regional Cancer Centre of Bihar, incidence of malignant lesions is higher in our centre.

Prognostic Value of HER-2/neu Gene Amplification in Epithelial Ovarian Carcinoma.

BACKGROUND: Human epidermal growth factor receptor 2 (HER2) has tyrosine kinase activity and is a member of the epidermal growth factor receptor family. This initiates a variety of signal for pathways which leads to cell proliferation and tumourigenesis. In approximately 15-30% of breast cancers and 10-30% of gastric/gastroesophageal cancers, amplification or overexpression of HER2 occurs, and it serves as a prognostic and predictive biomarker. HER-2/neu is one of the most frequently studied molecular biological parameters in epithelial ovarian cancer (EOC), but its prognostic impact has not been fully assessed. The objective of the current study was firstly to analyse the presence of HER-2 overexpression in EOC patients and secondly to evaluate association between human epidermal growth factor receptor 2 (HER-2/neu) expression and progression-free survival in patients with EOC. METHOD: In this prospective study of 2 years in our department, 186 gynaecological cancers were operated out of which 98 cases were operated for epithelial ovarian cancer and rest for cervical cancer, endometrial cancer, and other subtypes of ovarian cancer. In this study, HER2 gene status was evaluated in EOC by immunohistochemistry analysis, and overall survival of these patients was evaluated. RESULTS: HER-2 overexpression was found in 22 of the 98 investigated cases (22.45%), in which 14 OC (14.29%) were weakly positive and 8 OC (8.16%) were moderately to intensely positive. In the study, increased HER2 expression was associated with decreased progression-free survival (PFS) and hence poor prognosis (P 0.054). CONCLUSIONS: The introduction of HER2-directed therapies has dramatically influenced the outcome of patients with HER2 positive breast and gastric/gastroesophageal cancers. The present study findings provided that HER-2/neu expression in patients with OC has an adverse impact on the PFS. Therefore, our results show that the decision algorithm usually used in breast cancer by HER2 may be appropriate in ovarian cancer.

Comparison of conventional Pap smear and liquid-based cytology: A study of cervical cancer screening at a tertiary care center in Bihar.

BACKGROUND: Cervical cancer is the fourth leading cause of cancer in women in the world and it is the second most common cancer in women 15-44 years of age. Strict implementation of screening programs has led to a large decrease in cervical cancer incidence and mortality in the developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening programs. Conventional Pap smear method has been the mainstay of most of the screening programs for many decades. However, this technique is not without limitations, and the sensitivity and specificity of cervical cytology are relatively low. To overcome the limitations of conventional Pap smear (CPS), liquid-based cytology (LBC) was introduced in 1990s as a better tool for processing cervical samples. OBJECTIVES: This study was undertaken to compare CPS with liquid-based methods, to assess the effectiveness and feasibility of LBC over CPS in our setting, and also to evaluate the prevalence of human papillomavirus (HPV) in our population. MATERIALS AND METHODS: This study was conducted in Gynecological Oncology Unit of Regional Cancer Center at Indira Gandhi Institute of Medical Sciences, Patna, Bihar. About 310 women were enrolled in this study and the sample was taken for both conventional cytology and LBC. The smears were studied in detail and were interpreted as per the Bethesda system of reporting Pap smears. The results were compared and analyzed statistically. RESULTS: Unsatisfactory smears were more commonly reported by conventional method (7.1%) than with liquid-based method (1.61%), and this difference is statistically significant. There was no difference in the detection of epithelial cell abnormalities using both the methods. HPV DNA for high-risk oncogenic strains (16 and 18) was detected in 6.45% of women in this study. CONCLUSION: LBC has been found to be more superior to conventional smears only with respect to lesser number of unsatisfactory smears, but considering the economic implications of LBC, conventional Pap is more feasible in our setting.

Retrospective analysis of patients of cervical cancer a tertiary center in Bihar.

OBJECTIVE: A retrospective analysis of all patients with cancer of the cervix attending regional cancer center of Indira Gandhi Institute of Medical Sciences, Patna, from June 2015 to June 2017. The aim of this study was to know patient demographics, histology, age, stage and status of presentation, compliance with treatment and follow-up. MATERIALS AND METHODS: Five hundred and eighteen consecutively registered patients with cancer of the cervix were included in the study. RESULTS: The prevalence of cervical cancer among gynecological malignancy was 52%. It is the second most common cancer after breast cancer at our center. Patients hailed from the various districts of Bihar (89%), India, and from Nepal (10.61%). The majority (>50%) were aged 40-59 years. Stage information was available for 71.81% of the patients, of which Stage I comprised 12.36%, Stage II, 35.21%; Stage III, 50%; and Stage IV, 2.41%. Squamous cell carcinoma was the most common reported histopathology (~90%). A significant proportion of the women defaulted after registration, or after undergoing investigations (17%). Of the 68% cases planned for treatment, 50% initiated it, but only 38% completed it, About 11% of cases underwent Wertheim's hysterectomy and rest of patients were treated by radiotherapy with or without chemotherapy. CONCLUSION: The incidence of cervical cancer is still unacceptably high at our center. Organized cervical cancer screening needs to be adopted for early diagnosis.

Primary Ewing Sarcoma of Sphenoid Bone with Intracranial Extension: A Common Tumour at an Uncommon Location.

Primary Ewing Sarcoma of the cranial bone is rare, contributing to only 1% of all Ewing Sarcomas. Primary cranial Ewing Sarcoma occurs most commonly in temporal bone followed by parietal and occipital bones. Sphenoid bone is less commonly involved. We report a case of Ewing Sarcoma of the sphenoid bone with intra-cranial extension in a 20-month-old boy. On CT scan a provisional diagnosis of rhabdomyosarcoma was made. Fine Needle Aspiration Cytology (FNAC) and histopathological examination of core needle biopsy showed small round cell tumour. On Immunohistochemistry (IHC), CD99 (MIC2) and FLI 1 were strongly positive and final diagnosis of Ewing Sarcoma was made. Considering the rarity of this unusual site, we report a case of primary Ewing Sarcoma arising in the sphenoid bone with erosion of adjacent bones and intra-cranial extension.