Intriguing Insights From 100 Consecutive Colorectal Cancer Cases in Mid-Kerala: Sparse BRAF Gene Mutations and Mismatch Repair Deficiency (MMR-D).

Colorectal cancer (CRC) is among the most prevalent types of cancer globally. It is well established that the development of CRC primarily results from the sequential activation of oncogenes and the simultaneous inactivation of tumor suppressor genes. It has also been noted that after the initial oncogenic mutation, many subpopulations with different mutational profiles are created, causing heterogeneity among the tumors. This retrospective study analyzed 100 patients diagnosed with CRC through colectomy over an eighteen-month period at a tertiary referral center in mid-Kerala, India. Pathology records and histological slides were reviewed by two pathologists, and clinicopathological data were collected from pathology reports. Immunohistochemical analysis for BRAF mutation and possible microsatellite instability (MSI) (by mismatch repair (MMR) protein study) was conducted on tumor tissue blocks sent to an external center due to the lack of an automated platform at the hospital. The study utilized Roche's Benchmark XT platform for BRAF analysis and assessed MMR protein expression using antibodies for MLH1, MSH2, MSH6, and PMS2. The mean age of patients was 58.36 years, with a male predominance (58.0%). Most tumors were classified as T3 (71.0%, n-71) and T2/T4a (14.0% each, n-14), while nodal involvement included N0 (35.0%, n-35), N1 (26.0%, n-26), N2 (19.0%, n-19), and NX (20.0%, n-20). Histological examination revealed predominantly well-differentiated tumors (78.0%, n-78), with lymphatic invasion noted in 41.0% (n-41) and vascular invasion in 5.0% (n-5) of cases. Left-sided tumors predominated (33.0%, n-33), followed by rectal carcinoma (37.0%, n-37), and right-sided colon cancers (30.0%, n-30). Genetic profiling showed sparse BRAF mutations (1.0%, n-1) and MSI (1.0%, n-1), with some cases exhibiting loss of MMR proteins (MLH1, PMS2, MSH2, and MSH6) by immunohistochemistry (IHC). The study highlights the rarity of BRAF mutations in this cohort and emphasizes the diverse pathological and molecular characteristics observed. The discussion focuses on the implications of these findings, suggesting that CRC in this population exhibits unique clinicopathological features potentially influenced by factors beyond genetic mutations. Further multicentric studies are warranted to comprehensively explore these factors and refine risk stratification and treatment strategies for CRC patients in similar demographics.

Difficult Terrains of Research Publications Faced by Researchers: A Cross-Sectional Study.

Background The publication of scholarly work in peer-reviewed journals is a well-established method for disseminating knowledge and findings to a global audience. However, the publishing process is constantly evolving and encountering various obstacles that hinder progress. Despite a significant increase in the number of research projects undertaken, there are few studies evaluating the challenges faced by investigators in publishing their research. This study aims to identify the factors and elements that influence the publication process after the completion of research. Methods This study included 759 projects approved by the Institutional Ethics Committee (IEC) from 2016 to 2021 at a tertiary care centre in South India. A list of these approved projects was analysed for overall output in terms of publication and completion. Investigators were contacted and interviewed using a validated, 15-question survey to identify various factors influencing scientific publications. Results A total of 759 projects approved by the IEC from 2016 to 2021 were analyzed. It was found that only 36.72% of studies were completed by faculty members, and the publication conversion rate was 34.24%. A single-point analysis showed a statistically significant lower conversion rate for resident articles (p = 0.032). The 15-point analysis detailed the factors influencing publication conversion, revealing that the majority of researchers publish based on academic and research interests (68.89% and 72.12%, respectively). Various deterrents to publication, such as study design, statistical analysis, journal selection, and knowledge about journal submission, were identified. Notably, 98.4% of researchers expressed a desire to publish more in the future, highlighting the importance of this study. Conclusion The study highlights areas that require attention to facilitate and augment research. It identifies the real gaps in the publication process and suggests points of intervention needed to enhance the research environment, increase publication rates, and establish demand-based research support units in the medical education sector.

Outcomes of the Electrothermal Bipolar Vessel Sealing Device and Electrocautery in Modified Radical Mastectomy Patients.

Introduction With the rising trends in breast cancer throughout the world, the traditional modus of intraoperative tissue dissection using a scalpel, scissors, or electrocautery needs to be re-evaluated in the wake of newer modalities, such as electrothermal bipolar vessel sealing (EBVS) devices, which may theoretically reduce the postoperative complications and morbidity in these patients. Aim and objective The objective of this study is to compare an EBVS device to electrocautery (diathermy) in modified radical mastectomy (MRM), based on selected intraoperative and postoperative outcomes. Study procedure This was a comparative cross-sectional section study that included 60 patients with operable breast cancer (stages I and II, TNM classification, and post-neoadjuvant stage III disease). Patients were divided into two groups for surgery: one group underwent an MRM using the EBVS device (Group A), while the other group had the procedure performed using conventional electrocautery (Group B), as per the surgeon's choice depending on theatre slot and equipment availability. Intraoperatively, the total operative time, time for raising the flaps, time taken for breast tissue dissection, time for axillary dissection, and blood loss were recorded. Postoperative parameters included total drainage volume, number of days of drainage, seroma formation, and other complications. Patients were followed up for one month after surgery, with early postoperative complications such as wound infection, upper limb lymphedema, seroma, flap necrosis, and nerve injuries being documented. Results The groups were found to be comparable in terms of the age distribution, TNM staging, stage grouping, and nodal status of the patients. The EBVS device group demonstrated statistically significant advantages in total operative time, axillary dissection time, flap raising time, breast tissue dissection time, intraoperative blood loss, total drainage volume, and days of drainage. However, no statistically significant difference was found between the two devices in terms of seroma formation, early postoperative complications, and duration of postoperative stay at the hospital. Conclusion While the use of EBVS in MRM provides a considerable decrement in the total operative duration, duration of the various steps of surgery, intraoperative blood loss, and postoperative volume and duration of drainage, these devices do not offer an evident advantage in terms of the postoperative complications or morbidity.

Unraveling the Enigma: A Five-Year Comprehensive Analysis of Hurthle Cell Tumors in South India's Tertiary Care Center.

BACKGROUND: Hurthle cell tumors of the thyroid gland constitute a rare and enigmatic group of neoplasms, characterized by the presence of Hurthle cells exhibiting abundant eosinophilic cytoplasm and numerous mitochondria. Despite their low incidence, they pose diagnostic challenges and display diverse clinical outcomes. This study aims to provide a comprehensive analysis of the clinicopathological profile of Hurthle cell tumors within a tertiary care center in South India. METHODS: Through a retrospective approach, we analyzed cases of Hurthle cell tumors diagnosed and treated at a tertiary care center over a five-year period. Clinical, radiological, and histopathological data were meticulously collected and scrutinized. The study focused on examining demographic details, presenting symptoms, imaging features, cytological findings, surgical management, and postoperative outcomes of the patients. RESULTS: A total of 32 cases of Hurthle cell tumors were identified during the study period. The majority of patients were female (84%), with a mean age of 49.6 years for Hurthle cell carcinoma. Thyroid enlargement and neck mass were the most common presenting complaints. Fine-needle aspiration cytology showed characteristic features suggestive of Hurthle cell tumors in 33% of cases. Total thyroidectomy remains the mainstay surgical approach. Histopathological evaluation confirmed 62.5% of cases as benign adenomas and 37.5% as malignant carcinomas. Among malignant cases, 67% showed capsular invasion and 33% demonstrated vascular invasion. Of the patients, 33.3% received adjuvant radiotherapy. The overall survival rate was 100%. In our study, we found that thyroid nodules larger than 3 cm demonstrated a higher propensity for Hurthle cell carcinoma. CONCLUSION: Our findings support the multidisciplinary approach in managing Hurthle cell tumors, with a focus on tailored treatment plans for each patient based on individual characteristics. By recognizing the female predominance, assessing nodule size, and employing a combination of thyroidectomy and ablative therapy, clinicians can optimize patient care and contribute to better long-term prognosis and quality of life for those affected by Hurthle cell tumors. Continued research and collaborative efforts are necessary to advance our understanding and refine treatment strategies, paving the way for improved outcomes and enhanced patient management in the future.

Navigating the Cervico-Axillary Canal: A Rare Encounter With Double Dumbbell Space Sarcoma Involving the Neck and Axilla.

Space sarcomas are exceedingly rare neoplasms, and double dumbbell space sarcoma in the cervicoaxillary canal has not been previously reported. We present a case of a 63-year-old male who presented with a swelling in the neck and axilla of four years' duration, which rapidly increased in size over the last three months. Clinical examination and imaging revealed a multiseptate mass extending from the posterior triangle of the neck to the right axilla and chest wall through the cervicoaxillary canal. This lesion encased major vessels and components of the brachial plexus but did not infiltrate them. A trucut biopsy confirmed the diagnosis of well-differentiated liposarcoma. Surgical intervention was performed, achieving complete resection with preservation of neurovascular structures. This case highlights the unique challenges and complexities associated with managing double dumbbell space sarcomas in the cervicoaxillary canal. Additionally, it underscores the importance of a multidisciplinary approach to achieving successful outcomes while preserving limb function and minimizing complications. Long-term follow-up is essential for monitoring potential recurrences.

Proportion of papillary thyroid microcarcinoma in Kerala, India, over a decade: a retrospective cohort study.

Background: Overdiagnosis is a phenomenon where an indolent cancer is diagnosed that otherwise would not have caused harm to the patient during their lifetime. The rising incidence of papillary thyroid cancer (PTC) in various regions of the world is attributed to overdiagnosis. In such regions, the rates of papillary thyroid microcarcinoma (PTMC) are also rising. We aimed to study whether a similar pattern of rising PTMC is found in Kerala, a state in India, where there has been a doubling of thyroid cancer incidence over a decade. Methods: We conducted a retrospective cohort study in two large government medical colleges, which are tertiary referral facilities in the state of Kerala. We collected data on the PTC diagnosis in Kozhikode and Thrissur Government Medical colleges from 2010 to 2020. We analysed our data by age, gender and tumor size. Results: The incidence of PTC at Kozhikode and Thrissur Government Medical colleges nearly doubled from 2010 to 2020. The overall proportion of PTMC in these specimens was 18.9%. The proportion of PTMC only marginally increased from 14.7 to 17.9 during the period. Of the total incidence of microcarcinomas, 64% were reported in individuals less than 45 years of age. Conclusion: The rise in the number of PTCs diagnosed in the government-run public healthcare centres in Kerala state in India is unlikely to be due to overdiagnosis since there was no disproportionate rise in rates of PTMCs. The patients that these hospitals cater to may be less likely to show healthcare-seeking behavior or ease of healthcare access which is closely associated with the problem of overdiagnosis.

Squamous Cell Carcinoma Scalp With Intracranial Extension: Challenging Case of Multidisciplinary Care.

Squamous cell carcinoma (SCC) of the scalp is the second most common non-melanoma cancer of the skin. The incidence of squamous cell carcinoma on the scalp is on the rise, but the intracranial extension is rare. Cranial invasion is rare in SCC of the scalp, but when present, it is associated with a poor prognosis. A 62-year-old female presented with complaints of swelling over the back of her scalp for three months, which rapidly increased in size. She also had a throbbing headache, alopecia in that area, and multiple episodes of pustules in that area. On examination, she had an ulceroproliferative lesion measuring 5*5*3 cm with an irregular surface and varying consistency over the occipital area in the midline surrounded by ulcerations and crusted discharge and fixed to the bone. Contrast-enhanced magnetic resonance imaging (MRI) showed an irregular lesion with the destruction of the right parietal and occipital bones involving both inner and outer tables with intracranial and extracranial components, and the lesion was abutting the superior sagittal sinus. The treatment is surgical resection of the tumor with margin clearance. The treatment plan was designed using a multidisciplinary approach with the collaboration of oncosurgery, neurosurgery, and plastic surgery. The patient underwent wide local excision of the tumor with adequate skin and cranial bone clearance. The tumor was found to have infiltrated the dura mater overlying the superior sagittal sinus. The defect was then closed using a vault prosthetic cover and a scalp transposition flap from the left parietal area. This case report intends to highlight the need for a multidisciplinary approach to the proper management of advanced squamous cell carcinoma to decrease the morbidity and mortality in patients.

Hidden Intruder: A Rare Encounter of Dirofilaria Masquerading as a Breast Lump.

Dirofilaria, commonly known as heartworm, is a parasitic nematode that primarily infects canines. However, human infections have been reported and can present as subcutaneous nodules in different parts of the body. We present a case of a 43-year-old female who presented with a breast lump that was ultimately diagnosed as a Dirofilaria infection, a rare occurrence in humans. This case report shows that considering parasites in unusual presentations is of utmost importance, especially in regions known to have a high prevalence of such infections.

Groove Pancreatitis: A Case Report and Review of a Hidden Type of Chronic Pancreatitis.

Groove pancreatitis is a chronic type of segmental or focal pancreatitis seen to affect the groove, which is the region between the head of the pancreas, the duodenum, and the common bile duct. Despite its incidence remaining unknown, it accounts for 2.7% to 24.5% of pancreaticoduodenectomies performed for chronic pancreatitis. A diverse etiology has been implicated but the exact cause is yet to be identified. As it closely mimics pancreatic malignancy and remains mostly undiagnosed preoperatively, many patients often end up undergoing a pancreaticoduodenectomy. Awareness of this entity and early diagnosis will help us address this issue with more conservative measures than by resorting to a morbid procedure such as a pancreaticoduodenectomy. We report a case of a 50-year-old male, a chronic alcoholic, with a two-year history of upper abdominal pain, postprandial vomiting, and weight loss. An abdominal contrast-enhanced computed tomography (CECT) scan was suggestive of either a pancreatic malignancy or a possibility of groove pancreatitis. However, postoperative histopathological examination confirmed the lesser known groove pancreatitis. Here, we review the clinical, radiological, and pathological characteristics of groove pancreatitis, as its diagnosis and management still pose a challenge.

An Unusual Stomach Tumour: Plexiform Angiomyxoid Fibroma Stomach-A Case Report.

Plexiform angiomyxoid myofibroblast tumour (PAMT) is a rare mesenchymal tumour of the stomach. To date, about 45 cases of PAMT have been reported in the literature. This is an extremely rare mesenchymal gastric tumour with definite histological pattern and is a tumour typified by spindle cells with myofibroblast characteristics. A 70-year-old woman was admitted with vague upper abdominal pain and dyspepsia and on OGD was found to have a polypoidal lesion with ulceration on the posterior wall of the body of the stomach towards the greater curvature. The endoscopy biopsy suggested the above diagnosis. The patient was investigated with CT scan and CT showed a large nodular growth 10 × 8 cm with pancreatic tail involvement and splenic involvement. The patient was treated with multi-visceral resection and favourable outcome was achieved. This entity of PAMT was a histological rarity and a technically challenging case and hence was analysed and presented. PAMT is a rare mesenchymal tumour of the stomach and is characterised by spindle cells with myofibroblast characteristics with a potential to differentiate towards smooth muscle cells. These tumours have a benign course and rarely can have an infiltrative behaviour. PAMT of the stomach is a very rare mesenchymal tumour with a unique histological appearance, and it needs to be distinguished from GIST and other gastrointestinal mesenchymal tumours, although extra gastric extension and vascular invasion are sometimes observed. Here, we are reporting this case as a case of PAMT arising from the body of the stomach which required multi-visceral resection.

Hormone-receptor expression and survival patterns in operated cases of female invasive ductal breast carcinoma in Kerala: a retrospective cohort study.

BACKGROUND: Though breast cancer is the most common cancer among women in Kerala, India, epidemiological data on breast cancer in the state is largely lacking. The objectives of this study were to analyze the survival pattern of female breast carcinoma in this region of the country and to compare the differences in survival with different hormone-receptor expressions. METHODS: One hundred eighty-nine female breast cancer patients who were operated between 1 August 2008 and 3 July 2009 were followed up over telephone to obtain data on five-year survival. Grade, stage of the disease, and hormone-receptor (HR) status were obtained from treatment records. Logistic regression and the Kaplan-Meier survival analysis were used for statistical analysis. RESULTS: The mean age of the study population was 49.07 (SD, 10.35) years. A majority of the patients had estrogen receptor (ER)+/progesterone receptor (PR)+tumors (n=103, 54.5%), followed by 72 (38.1%) ER-/PR-, 10 (5.3%) ER-/PR+, and 4 (2.1%) ER+/PR-. Stage of the disease, axillary nodal status, and hormone-receptor status showed statistically significant association with overall survival in breast cancer. Overall survival rate at the end of 5 years was 71.4%. Mortality was found to be highest for the ER-PR-group (47.2%). CONCLUSIONS: Women in Kerala are diagnosed with breast carcinoma at a relatively younger age, yet the overall five-year survival for the disease is low when compared to developed nations. It is imperative that comprehensive breast cancer screening and treatment strategies be developed to enable earlier diagnosis and improve the survival of breast cancer in the state.

Epidemiology, Pathological Characteristics and Estrogen and Progesterone Receptor Status of Operated Cases of Female Breast Cancer: A Retrospective Review of 266 Cases from Kerala.

Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The objectives of this study were to analyze the epidemiology and pathological characteristics of female breast carcinoma in Kerala. 266 patients who were diagnosed with operable breast cancer between April 2009 and June 2010 were studied. Various pathological characteristics including stage, grade, axillary lymph nodal status, tumor size, and estrogen and progesterone receptor status were studied. Estrogen and progesterone receptor status were evaluated by immunohistochemistry. Chi-square test and frequency tables were used for statistical analysis. The mean age at presentation was 50 years. 48.9 % of the patients were premenopausal. 53.76 % had grade II tumors. Positive axillary lymph nodes were found in 70.3 % patients, and 68 % presented with stage II disease. 54.13 % were ER positive and 62 % were PR positive. The relatively young age at diagnosis, late presentation of the disease, and lower estrogen and progesterone receptor expression compared to patients from the West point toward the need for better breast cancer awareness and screening programmes in Kerala.