Immunotherapy with Autoimmune Complication in Renal Cancer.

INTRODUCTION: Newer modalities like immunotherapy with checkpoint inhibitors are widely being used in oncology. Complete remission with immunotherapy comes along with immune related adverse effects which warrant prompt diagnosis and treatment. Below is a case metastatic RCC treated with pembrolizumab, humanized monoclonal antibody to programmed cell death receptor with autoimmune complications during therapy and subsequent complete remission after re-challenge. MATERIALS: 72 year old gentleman with background history of diabetes mellitus, hypertension presented with complaints of hematuria and neck pain. Upon evaluation, found to have RCC with metastasis to lungs and left occipital condyle. Patient underwent excision nd prosthesis for unstable atlanto-occipital joint, left nephrectomy for malignant focus in left kidney. He was then started on immunotherapy, inj. pembrolizumab +tab. axitinib. RESULT: After three cycles of immunotherapy, patient presented with easy fatigability, weakness and drowsiness. Baseline TSH and liver functions were normal. Investigations revealed high TSH and transaminitis. Autoimmune hepatitis was treated with steroids and oral levothyroxine was started for autoimmune thyroiditis. Patient improved with treatment and immunotherapy was re-challenged. After 12 cycles of pembrolizumab, review PET-CT scan showed no lung lesions and complete metabolic response. CONCLUSION: Immunotherapy has very good results in advance malignancies. It has unique side effects of auto immune phenomenon. Therapy can be re-challenged if its complications of autoimmune adverse events are diagnosed and treated promptly. References Nagra NK, Siddique A, Singhvi G, et al. S2684 pembrolizumab induced hepatitis: a severe complication effectively treated with steroids. Am J Gastroenterol 2020;115:S1405-S1406. Choueiri TK, Tomczak P, Park SH, et al. Adjuvant pembrolizumab after nephrectomy in renal-cell carcinoma. N Engl J Med 2021;385:683-694.

Sialography: a pictorial review.

Non-tumour inflammatory and obstructive salivary gland pathologies such as sialadenitis, sialolithiasis, sialadenosis, ductal strictures, etc. require precise radiological evaluation and mapping of salivary gland ductal system for better treatment outcome. Conventional sialography is considered as a useful and reliable technique in evaluation of salivary glands especially intrinsic and acquired abnormalities involving the ductal system and is useful for detection of non-radiopaque sialoliths which are invisible on routine plain radiographs. Primarily sialography is used as a diagnostic tool, additionally it plays an important therapeutic role as salivary gland lavage in cases of recurrent salivary gland infections and in obstructive salivary gland disorders by helping in clearance of mucous plugs or small sialoliths within the ducts. Recently, diagnostic performance of computed tomography (CT) sialography is being explored and has been reported to have high sensitivity in detection of small sialoliths and allows differentiation of sialoliths from other calcifications in glandular ductal system. Multiplanar three dimensional (3D) reconstructed CT images have been reported to play a key role in determination of anatomical location or extent of salivary gland disease without superimposition or distortion of structures. This review aims to discuss the disease specific applications of sialography and CT Sialography in particular for visualization of salivary gland disorders.

Oral Submucous Fibrosis: Correlation of Clinical Grading to Various Habit Factors.

OBJECTIVES: The aim of this study was to correlate the clinical grading of oral submucous fibrosis (OSMF) with various habit factors and to observe the habit factors associated with the severity of OSMF. MATERIALS AND METHODS: This study was carried out in the Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India. Two hundred patients clinically diagnosed with OSMF were included in the study. The observations were tabulated and subjected to statistical analysis using chi-square test and Spearman's rank correlation test. RESULTS: A total of 200 subjects participated in the study of which 182 were males and 18 were females. Forty-eight males and nine females had Grade I OSMF. One hundred nineteen males and eight females had Grade II OSMF. Fifteen males and only one female had Grade III OSMF. On the basis of functional staging, the total participants in stage I, stage II, and stage III were 185, 14, and 1, respectively. The participants having Grade I, Grade II, and Grade III OSMF with functional staging I were 57, 122, and 6, respectively. The participants having Grade II and Grade III OSMF with functional staging II were 5 and 9, respectively. CONCLUSION: It is alarming that nearly half of the total subjects were in the younger age group and were having OSMF. Also, as the age increased, the subjects were found to be more attracted to consuming areca nut derivatives in the form of betel quid with or without tobacco. It is recommended that community-oriented outreach programs on oral health awareness be developed, emphasizing children who represent the upcoming future, to avoid/quit areca nut and its derivatives.

Bilateral necrotising sialometaplasia.

Necrotising sialometaplasia is a benign, necrotising, self-healing inflammatory condition categorised as idiopathic disease of salivary glands. This condition holds diagnostic importance because of its clinical and histopathological presentation, which is ambiguous, and can be misdiagnosed as carcinoma particularly squamous cell carcinoma or mucoepidermoid carcinoma. This report describes a case of bilateral necrotising sialometaplasia occurring in a 38-year-old male patient.