Modified pectoralis major myocutaneous flap for the total glossectomy defects: Effect on quality of life.

BACKGROUND: There is a general notion that, total glossectomy with laryngeal preservation leads to high dependency of tracheostomy and/or feeding tube. The objective of this study is to analyze the quality of life in terms of tube dependency following total glossectomy with a modified pectoralis major myocutaneous flap (PMMC) reconstruction and laryngeal suspension. MATERIALS AND METHODS: The retrospective study included consecutive patients operated from July 2012 to February 2015 proven advanced Carcinoma of tongue. We analyzed the time to wean off tracheostomy and feeding tube in 56 patients who underwent total glossectomy and a modified technique of PMMC reconstruction. RESULT: The median time for tracheostomy weaning was 10 days and nasogastric tube was 16 days. CONCLUSION: Modified technique of reconstruction with PMMC in total glossectomy is a viable option with minimal functional morbidity. Quality of life in terms of tracheostomy and feeding tube dependency is minimal. J. Surg. Oncol. 2016;114:32-35. © 2016 Wiley Periodicals, Inc.

Open total mesometrial resection for cervical cancer.

Introduction: Cervical cancer management often relies on surgical interventions, among which open total mesometrial resection (TMMR) has gained prominence. This abstract gives an insight into the technique of TMMR in the surgical treatment of cervical cancer. TMMR involves precise dissection of the mesometrium surrounding the cervix, aiming for optimal oncological outcomes while minimizing surgical morbidity. Methods or Technique: TMMR entails meticulous dissection of the mesometrium surrounding the cervix, following embryonic planes to ensure complete removal of the primary tumour and associated lymphadenectomy. Access to the abdomen is achieved through either a muscle-cutting transverse or midline abdominal incision. The procedure emphasizes meticulous dissection and removal of the tumour-containing area, with careful attention to preserving vital structures such as the ureters and pelvic autonomic nerves to minimize postoperative complications. Extensive lymphadenectomy, including first and second echelon nodal groups, and in selected cases, third echelon nodes such as lower paraaortic nodes, is performed. Conclusion: TMMR offers several advantages, including precise identification and preservation of vital structures, thorough lymphadenectomy, and favourable oncological outcomes with improved survival rates. Importantly, TMMR allows for the avoidance of radiation therapy in the majority of operable cervical cancer cases. In conclusion, TMMR represents a cornerstone in the surgical management of cervical cancer, striking a balance between oncological efficacy, radiation avoidance, and preservation of patients' quality of life.

Synchronous radiation-induced enterovesical and enterocervical fistulas in carcinoma of the uterine cervix.

Radiation-induced fistulas (RIF) are uncommon therapeutic complications of radiotherapy in patients treated for carcinoma of the uterine cervix. Synchronous occurrence of enterocervical and enterovesical fistulas secondary to radiation is extremely rare and previously unreported in the literature. We report a case of synchronous enterovesical and enterocervical fistulas in a patient with carcinoma of the cervix treated using chemotherapy and radiation along with a brief overview of etiopathogenesis of RIF.

Utility of GATA-3 and associated immunohistochemical markers in the differential diagnosis of poorly differentiated urothelial carcinoma.

Aims: The aims are to study the utility of GATA-3 along with panel of immunohistochemical (IHC) markers in the differential diagnosis of primary and metastatic poorly differentiated urothelial carcinoma (UC). Settings and Design: This is a prospective and retrospective observational study. Subjects and Methods: Poorly differentiated carcinomas of urinary tract and metastatic sites from January 2016 to December 2017 were subjected to a panel of four IHC markers including GATA-3, p63, Cytokeratin (CK) 7, and CK20. Additional markers such as p16, an enzyme called alpha-methylacyl-CoA racemase, CDX2, and thyroid transcription factor 1 were also done depending on the morphology and site. Statistical Analysis Used: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GATA-3 in making the diagnosis of UC were calculated. Results: Forty-five cases were included in the study and after appropriate IHC, the diagnosis was resolved as UC in 24 cases. GATA-3 was positive in 83.33% of UC; all the four markers positive in 33.33% and all negative in 4.17% of UC. However, at least one of the four markers was present in 95.83% of UC, except in sarcomatoid UC. GATA-3 had 100% specificity in differentiating from prostate adenocarcinoma. Conclusion: GATA-3 is a useful marker in the diagnosis of UC in the primary and metastatic sites with a sensitivity of 83.33%. GATA-3 along with other IHC markers in correlation with clinical and imageological features is necessary for making specific diagnosis of poorly differentiated carcinoma.

Accuracy of Tumor Bed Biopsy for Predicting Pathologic Complete Response After Chemotherapy Among Women With Breast Cancer: Complete Responders in the Breast Study.

PURPOSE: With the advent of taxanes and targeted agents in neoadjuvant chemotherapy (NACT) for breast cancer, the rates for pathologic complete response (pCR) have been steadily increasing. Surgery in these women serves as a biopsy to confirm or negate a pCR. METHODS: All newly diagnosed patients with nonmetastatic breast cancer, planned for NACT, were screened. Eligible patients with a complete or near-complete response to NACT as seen on a mammogram and ultrasound (US) were recruited. A magnetic resonance imaging was performed for these patients for documentation. US-guided core biopsies of the tumor bed (Core Bx) using a 14G needle was performed (minimum four in number), and the results were compared with the final histopathology report after surgery for standard performance parameters. RESULTS: This study recruited 65 women of whom 94% were node-positive, and 60% were hormone receptor-negative. The pCR rate was 41.5% and 53.8% for the whole cohort and the hormone receptor-negative subgroup, respectively. The false-negative rate (FNR) for Core Bx was 42.1% (95% CI, 26.3 to 59.2), with a negative predictive value of 59.0% (95% CI, 42.1 to 74.4). Among the hormone receptor-negative tumors, the FNR was 44.4% (95% CI, 21.5 to 69.2) with a negative predictive value of 70.4% (95% CI, 49.8 to 86.2). CONCLUSION: The Complete Responders in the Breast study results suggest that ultrasound-guided 14G core needle biopsy of the tumor bed may not be a reliable predictor of pCR in the breast. These results highlight the importance of further research into the omission of surgery in the breast after chemotherapy. This study is registered with Clinical Trials Registry of India (CTRI/2018/01/011122).

Mucoepidermoid Carcinoma of the Salivary Gland: Long Term Outcomes from a Tertiary Cancer Center in India.

To analyze the patterns of failure and factors affecting recurrence and overall survival in mucoepidermoid carcinoma of the salivary gland. The hospital records were retrospectively analyzed from October 2010 to January 2016. Patients diagnosed as mucoepidermoid carcinoma of the salivary gland were eligible for analysis. All patients received surgery as the primary treatment modality with or without post operative radiotherapy. Statistical analysis for factors affecting recurrence was done by cox regression analysis and p value less than 0.05 was considered significant. A total of 116 patients were diagnosed to have malignant salivary gland tumors of which 69 were mucoepidermoid carcinomas (69.5%). The median age was 43 years (8-75 years). Majority of the tumors occurred in major salivary glands gland (77%). 51% patients were females. Most common stage was stage II (36%) followed by stage I (27.5%), stage IV (20.3%) and stage III (16%). High grade carcinomas comprised 34.8%, intermediate grade 30.4% and low grade 34.8%. 36 patients (52.2%) received adjuvant radiotherapy (60 Gy in 30 fractions). At a median follow up of 42 months (8-70 months), 8 (11.6%) patients died (7 cancer related and 1 noncancer related). The locoregional recurrence rate was 4.3% whereas the distant metastasis rate was 11.6%. Most common site of distant metastasis was lung. The mean disease free survival time was 61.4 months and the mean overall survival was 62 months. On univariate analysis, age < 50 years, node positive, presence of PNI, high grade, presence of LVI and local recurrence were significant factors for distant metastasis (p < 0.05). On multivariate analysis, high grade, presence of LVI and local recurrence were significant factors for distant metastasis (p < 0.05). Mucoepidermoid carcinomas of salivary gland have good long term local control and overall survival. Majority of the recurrences are distant metastasis. High grade, LVI and local recurrence are significant risk factors for distant relapse.

The core four - A panel of immunohistochemistry markers to diagnose and subtype testicular germ cell tumors.

CONTEXT: Immunohistochemistry (IHC) to differentiate germ cell tumors. AIMS: The aim of the study is to differentiate seminomatous and nonseminomatous germ cell tumors (GCTs) with morphological overlap using a minimal and affordable panel of IHC markers. SETTINGS AND DESIGN: This is a retrospective observational study. SUBJECTS AND METHODS: All testicular GCTs (TGCT) which were diagnosed on biopsies and/or resection specimens (prechemotherapy) between January 2014 and June 2019. The demographic, clinical, and imaging findings were noted from the medical records. Hematoxylin and eosin (H and E)-stained sections were reviewed for morphology. The IHC markers constituted Octamer-binding transcription factor (OCT) 3/4, glypican 3 (GPC3), CD117, CD30, placental-like alkaline phosphatase, Sal-like protein 4, and ß-human chorionic gonadotropin (HCG). IHC markers were performed in various combinations depending on the morphology, and a panel constituting OCT 3/4, CD117, GPC3, and CD30 was performed on cases with diagnostic dilemma and morphological overlaps. STATISTICAL ANALYSIS USED: Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) were calculated for suggested panel of IHC OCT 3/4, CD117, GPC3, and CD30. RESULTS: The study included 36 patients with TGCT with a mean age of 27 (15-58) years. Nonseminomatous tumors were the most common (86%). The concise panel was performed in 20/36 (56%) tumors to resolve the diagnosis. The sensitivity, specificity, PPV, and NPV for OCT3/4 were 80%, 55%, 31%, and 92% in seminomas and 65%, 100%, 100%, and 46% in embryonal carcinomas (EC), for CD117 was 89%, 82%, 73%, and 93% in seminomas and 60%, 77%, 60%, and 77% in yolk sac tumors (YST), for GPC3 was 95%, 90%, 95%, and 90% in YST, CD30 96%, 100%, 100%, and 91% in ECs, respectively. CONCLUSIONS: Designing a novel concise and affordable IHC panel constituting OCT 3/4, CD117, GPC3, and CD30 has good sensitivity and specificity in differentiating seminomas, YST, and EC, respectively. Additional markers, namely ß-HCG, can be used in identifying the choriocarcinoma component.

Malignancy in an Undescended Intra-abdominal Testis: a Single Institution Experience.

Cryptorchidism is one of the most common congenital anomalies of the genitourinary tract, encountered in 1% of men. The cancer risk in an ectopic testis is 40 times higher than a scrotal testis. However, not much literature is available on the management of this rare presentation of testicular cancer. A retrospective analysis was conducted at our institute of patients who were diagnosed with carcinoma in an undescended intra-abdominal testis between 2014 and 2019. Patients with an intra-abdominal mass with an empty hemiscrotum/scrotum were included in the study. In all 10 patients were identified with a mean age of 32 years. Four patients were non-seminomatous germ cell tumors, and other 6 were seminomatous tumors. Five were in stage I, two in stage II, and three in stage III. Six patients received induction chemotherapy with bleomycin, etoposide, and cisplatin, and four had complete response. Five patients underwent laparoscopic excision, and five underwent open surgery. Two patients with bilateral (B/L) cryptorchidism underwent contralateral orchidopexy. Two patients with B/L intra-abdominal gonads and uterus underwent excision of the malignant testicular mass with removal of atrophic uterus and contralateral dysgenetic gonad. One patient developed peritoneal recurrence within 3 months of completion of surgery. Both recurrence-free and overall survival were 90% after a median follow-up of 35 months. Malignancy in an undescended intra-abdominal testis is a rare presentation of testicular cancer, diagnosis of which requires a sharp correlation between clinical and radiological findings. There management and prognosis remains similar to classical testicular cancer.

Minimally Invasive Esophagectomy the Standard of Care: Experience from a Tertiary Care Cancer Center from India.

For localized esophageal cancer, esophageal resection remains the prime form of treatment but is a highly invasive procedure associated with prohibitive morbidity. Minimally invasive esophagectomy (MIE) by laparoscopic or thoracoscopic approach was therefore introduced to reduce surgical trauma and its associated morbidity. We thereby review our minimally invasive esophagectomy results with short- and long-term outcomes. From January 2010 through December 2016, 459 patients with carcinoma esophagus and gastro-esophageal junction undergoing minimally invasive esophagectomy were retrospectively reviewed. The morbidity, mortality data with short- and long-term results of the procedure were studied. Patients were stratified into two arms based on the approach into minimally invasive transhiatal esophagectomy (MI-THE) and minimal invasive transthoracic esophagectomy TTE (MI-THE). Thirty days mortality in the whole cohort was 3.5% (2.5% in MI-THE vs. 5% in MI-TTE arm). Anastomotic leak rates (5 vs. 4.9%), median intensive care unit (ICU) stay (4 days), hospital stay (9 days), were similar between both the approaches. Major pulmonary complications were significantly higher in MI-TTE arm (18.9% vs 12.5%) (p 0.047). Cardiac, renal, conduit-related complication rates, vocal cord palsy, chyle leak, re-exploration, and late stricture rates were similar between the groups. The median number of nodes resected was higher in the MI-TTE arm (14 vs. 12) (p 0.002). R0 resection rate in the entire cohort was 89% (87.4% in MI-THE, 92% in MI-TTE arm p 0.12). The median overall survival and disease-free survival were also not different between MI-THE and MI-TTE arms (34 vs. 38 months, p 0.64) (24 vs. 36 months, p 0.67). Minimally invasive esophagectomy either by transhiatal or transthoracic approach is feasible and can be safely accomplished with a low morbidity and mortality and with satisfactory R0 resection rates, good nodal harvest, and acceptable long-term oncological outcomes.

Operative Challenges with Minimally Invasive McKeown Esophagostomy with Two-Field Lymphadenectomy in a Case of Situs Inversus Totalis with Carcinoma Esophagus: A Case Report with Review of the Literature.

Situs inversus totalis is an uncommon anatomical congenital anomaly characterized by complete transposition of viscera with right-to-left reversal across the sagittal plane. Consequently, surgery in such cases is more technically challenging and requires a complete reorientation of visual-motor coordination skills. We describe a case of a 50-year-old gentleman with locally advanced lower esophagus carcinoma post-neoadjuvant chemoradiotherapy with situs inversus totalis and treated with minimally invasive McKeown esophagectomy using a left thoracoscopic, laparoscopic-assisted and right cervical approach. The operative procedure and difficulties during surgery are highlighted. Minimal invasive esophagectomy is safe and feasible in situs inversus totalis. Recognition of the anatomy with a meticulous preoperative planning is advocated for an uneventful operative intervention.

The Value of Lymphadenectomy Post-Neoadjuvant Therapy in Carcinoma Esophagus: a Review.

Lymph nodal metastasis is one of the most important prognostic factors determining survival in patients with carcinoma esophagus. Radical esophagectomy, with the resection of surrounding lymph nodes, is considered the prime treatment of carcinoma esophagus. An extensive lymphadenectomy improves the accuracy of staging and betters locoregional control, but its effect on survival is still not apparent and carries the disadvantage of increased morbidity. The extent of lymphadenectomy during esophagectomy also remains debatable, with many studies revealing contradictory results, especially in the era of neoadjuvant therapy. The pattern of distribution and the number of nodal metastasis are modified by neoadjuvant therapy. The paper reviews the existing evidence to determine whether increased lymph node yield improves oncological outcomes in patients undergoing esophagectomy with particular attention to those patients receiving neoadjuvant therapy.

Evaluation of genitourinary fistulas in pelvic malignancies with etiopathologic correlation: role of cross sectional imaging in detection and management.

OBJECTIVE: Genitourinary fistulas in pelvic malignancies are abnormal communications occurring due to either locally advanced tumours invading the surrounding organs or post-therapeutic complications of malignancies. In this article we review and describe the role of cross-sectional imaging findings in the management of genitourinary fistulas in pelvic malignancies. METHODS: A retrospective study, for the period January 2012 to December 2018, was undertaken in patients with pelvic malignancies having genitourinary fistulas. The cross-sectional (CT and MRI) imaging findings in various types of fistulas were reviewed and correlated with the primary malignancy and the underlying etiopathology. RESULTS: Genitourinary fistulas were observed in 71 patients (6 males, 65 females). 11 types of fistulas were identified in carcinomas of cervix, rectum, ovary, urinary bladder, sigmoid colon, vault, endometrium and prostate. The commonest were rectovaginal and vesicovaginal fistulas. 13 patients had multiple fistulas. The sensitivity, specificity, positive and negative predictive values of CT and MRI are 98%, 100%, 66%, 98% and 95%, 25%, 88% and 50% respectively. Contrast-enhanced CT with oral and rectal contrast is more sensitive and specific than MRI in the evaluation of genitourinary fistulas. CONCLUSION: Imaging findings significantly influence the management and outcome of genitourinary fistulas in pelvic malignancies. Contrast-enhanced CT is the imaging modality of choice in the evaluation of pelvic fistulas associated with malignancies and MRI is complimentary to it. ADVANCES IN KNOWLEDGE: To our knowledge, this study is the first of its kind wherein the mean duration of occurrence of fistulas in pelvic malignancies is correlated with the underlying etiopathology.

Tracheal/Laryngeal Infiltration in Thyroid Cancer: a Single-Centre Experience.

Around 1/3 of patients of locally advanced carcinoma thyroid present with tracheal infiltration either alone or along with infiltration of other adjacent structures. Even though trachea is infiltrated, adequate resection is the main modality of treatment in these patients. We retrospectively analysed carcinoma thyroid patients who were operated at our institute, between January 2011 and December 2018, and underwent thyroidectomy with tracheal or laryngeal resection. Seventeen patients underwent tracheal/laryngeal resection with thyroidectomy. The mean age of patients was 57 years. Six and eleven were male and female, respectively, 0.14 (82%) patients had dyspnoea on presentation, 6 had hoarseness of voice, 6 had haemoptysis, and in 2 patients, neck swelling was the only complain. Two patients in our study presented with acute stridor, underwent emergency intubation and subsequently surgery. Two other patients had bulky pedunculated tumour in preoperative bronchoscopy and required tracheostomy for intubation before proceeding with surgery. In 11 patients, sleeve resection followed by end-to-end anastomosis was done, window resection was done in 3 patients, partial laryngectomy in 1, and total laryngectomy in 2 patients. In 10 patients (59%), the site of infiltration was in the lateral tracheal wall, with relatively small posterior primary (mean size 3.7 cm) in the thyroid lobe. Two patients developed postoperative complication, one patient with sleeve resection had secondary haemorrhage, and one patient who underwent window resection with myochondrial thyroid lamina flap reconstruction developed salivary fistula. These patients underwent re exploration with tracheostomy and were subsequently decannulated. Preoperative diagnosis of tracheal infiltration helps in better planning of surgery and counseling the patients of any possible complication. Clinical workup and pre-emptive diagnosis is therefore of paramount importance.

Differentiation of renal cell tumors with morphological cocktails using a minimal panel of immunohistochemical markers.

CONTEXT: Morphological cocktails in renal cell carcinoma (RCC). AIMS: Minimal immunohistochemistry (IHC) panel to resolve the diagnosis of renal cell cacinoma (RCC) with morphological overlaps. SETTINGS AND DESIGN: RCC is the most common malignancy in kidney accounting for 90% of all kidney cancers. Clear cell RCC is the most common histological type followed by papillary RCC. However, many of the RCCs show morphological cocktails which may pose diagnostic difficulties in small biopsies and even in the resection specimens. Accurate diagnosis has both prognostic and therapeutic implications; hence, correct differentiation is necessary. SUBJECTS AND METHODS: This retrospective study includes all renal cell tumors diagnosed on core biopsies, radical and partial nephrectomies between January 2015 and September 2017 were studied. The demographic, clinical, and gross findings were noted. The cases that had morphological overlap among the subtypes were subjected to a panel of IHC markers, including CD10, CK7, alpha-methyl acyl-coenzymeA racemase (AMACR), and CD117. RESULTS: There were 128 RCC in the study period, and morphological overlap was seen in 36 (27.9%) specimens including 13 core biopsies, 16 radical, and 7 partial nephrectomies. IHC resolved 35/36 (97.2%) cases rendering a diagnosis of clear cell (11), papillary (15), chromophobe (4), and oncocytoma (5). However, in one case where the provisional diagnosis was oncocytic tumor, all IHC markers were negative rendering IHC noncontributory. CONCLUSIONS: Difficulty in diagnosis was encountered in many core biopsies, resection specimens which when subjected to IHC panel of CD10, CK7, AMACR, and CD117 helped in resolving the diagnosis of subtypes of RCC.

Single-Dose Prophylactic Antibiotic Versus Extended Usage for Four Days in Clean-Contaminated Oncological Surgeries: a Randomized Clinical Trial.

The optimal duration of prophylactic antimicrobial usage in clean-contaminated elective oncological surgeries is not clear. This single-center randomized trial evaluated the effectiveness of single-dose antimicrobial prophylaxis in clean-contaminated surgeries for the reduction of surgical site infection (SSI). Between April 2018 and January 2019, 315 patients undergoing major oncological clean-contaminated surgeries where the gastrointestinal or genital tract was opened under controlled conditions were randomized into 2 groups i.e., single dose versus extended dose groups. The single dose group received a 1.5 g dose of cefuroxime immediately before surgery while the extended group received the same dose of cefuroxime thrice daily for 4 days from the day of surgery till postoperative day 3. In addition, patients undergoing esophageal and colorectal surgeries received metronidazole. The overall SSI rate of the single dose group was not significantly different from that of the extended group (11.3% vs. 14.7%, respectively, p 0.40), with absolute difference of 3.4% and relative risk of 0.85 (95% C.I, 0.59 to 1.22). The rate of remote site infection was also not different between the two groups (14.4% vs 10.2%, p 0.31) with absolute difference of 4.2% and relative risk 1.19 (95% C.I, 0.89 to 1.59). In univariate analysis, parameters like nodal dissection, colorectal surgery, smoking, and hospital stay were significantly associated with SSI. In multivariate analysis, age, smoking, nodal dissection, and hospital stay retained significance. Single-dose antimicrobial prophylaxis is as effective as extended usage for 4 days in the prevention of postoperative SSI in patients undergoing clean-contaminated major oncological surgeries. Trial was registered with the clinical trial registry of India (CTRI/2018/06/014344).

Carcinoma vulva patterns of recurrence and treatment outcomes: A single-institution experience.

AIM: The aim of this study was to evaluate the patterns of recurrence and outcomes in patients with vulvar cancer treated with surgery, with or without postoperative radiotherapy (RT) or RT alone. MATERIALS AND METHODS: The hospital records were retrospectively analyzed from February 2007 to May 2016. All patients that had biopsy-proven carcinoma vulva were included for analysis. Surgery was done by simple or radical vulvectomy with or without lymph node dissection. Radical RT dose was 60 Gy (photons alone or with electron boost). Adjuvant RT was administered in case of node positivity or positive margins. RESULTS: A total of 76 patients were diagnosed as squamous cell carcinoma of vulva. The median age was 59 years. About 59 patients were treated by surgery and 17 patients were treated by radical RT. The most common stage was IB. Adjuvant RT was administered in 10 patients. About 13 patients (22%) underwent inguinal lymphadenectomy. At a median follow-up of 35 months, 49 patients (64.4%) were alive, 27 died, and 6 patients were lost to follow-up. Locoregional recurrence rate was 24.5% in radical surgery group, 12% in surgery plus adjuvant RT group, and 47% in radical RT group. Distant metastasis rate was 4%. The progression-free survival at 3 years was 45.3% and 35.5% in the surgery group and radical RT group, respectively. CONCLUSION: Surgery resulted in favorable local control rates in early-stage carcinoma vulva. Adjuvant RT is indicated in case of nodal positivity or positive margins. Radical RT can be considered as an alternative in patients with comorbidities.

Uterine Sarcomas: Experience from a Tertiary Cancer Care Center from India.

Uterine sarcomas are uncommon and aggressive tumors comprising 3-7% of all uterine malignancies. The aim is to evaluate clinical presentation, histopathologic pattern, recurrence pattern, and outcome of patients with uterine sarcomas presenting to a tertiary care cancer center over an 8-year period. A total of 11 cases of uterine sarcoma were diagnosed. The median age of patients at presentation was 51 years (range 30-67 years). Six patients had leiomyosarcoma (54.5%), 4 had endometrial stromal sarcoma (36%), and 1 had adenosarcoma (9%). The main presenting symptoms were abnormal vaginal bleeding, low abdominal pain, and white discharge. Median follow-up was 11 months ranging from 3 to 200 months. Median survivals for leiomyosarcoma, endometrial stromal sarcoma, and adenosarcoma were 6.5, 18, and 56 months. The 3- and 5-year survival by Kaplan-Meier survival analysis of the entire cohort was 30 and 20%. The mitotic index, age, adjuvant therapy (chemotherapy, radiotherapy), and performance of pelvic nodal dissection did not impact survival significantly in the patient with leiomyosarcoma. Stage and histology had the strongest bearing on survival and leiomyosarcoma has the worst survival, whereas adenosarcoma had the best prognosis. Adequately powered prospective studies are required to define the role of radiation therapy and chemotherapy in this rare disease.

Accuracy of core biopsy in predicting pathologic complete response in the breast in patients with complete/near complete clinical and radiological response (Complete Responders in the Breast - CRBr) - Trial design and conduct.

INTRODUCTION: With the advent of taxanes and targeted agents in neoadjuvant chemotherapy (NACT) for breast cancer, the rates of pathologic complete response (pCR) have been steadily increasing. One of the roles of surgery in these women is to serve as a biopsy to confirm or negate a pCR. DESIGN: This is a prospective validation study. All newly diagnosed non-metastatic breast cancers, of any luminal subtype, planned for neoadjuvant chemotherapy (NACT) with a titanium clip placed in the tumor, will be screened. Eligible patients who have a complete/near complete response to NACT as seen on a mammogram and ultrasound of the breast, will undergo multiple core biopsies of the tumor bed under ultrasound guidance as an outpatient procedure. A minimum of four core biopsy specimens will be mandatory. An MRI will also be done for these patients for documentation and analysis. The core biopsy will be compared to the final histopathology report after definitive surgery. OBJECTIVES: The objective is to study the false negative rate and accuracy of ultrasound guided core biopsies of the tumor bed in predicting pCR. Additionally, the correlation of pCR in the breast with axillary response and the incremental benefit of an MRI in predicting pCR will be evaluated. DISCUSSION: The concept of using image guided core biopsies to predict pCR could be useful in designing future studies aimed at avoiding redundant surgery in women with a complete response to NACT. This study is registered with Clinical Trials Registry of India (CTRI/2018/01/011122).

The Impact of Stage and Molecular Subtypes on Survival Outcomes in Young Women with Breast Cancer.

Young women form a unique cohort in breast cancer, with evidence suggesting a later stage at presentation with more aggressive cancers. We aimed at evaluating the prognostic significance of young age and the impact of stage and molecular subtypes on survival. We conducted an audit of a prospectively maintained database at our institute between 2010 and 2014. All women with available receptor status and documented follow-up were included. The young breast cancer (YBC) cohort comprised 103 women and 230 women constituted the comparator arm (45-55 years). The median follow-up was 4 years. The YBC had a higher incidence of hormone negative tumors (61.1% vs. 46.3%, p = 0.012, significant [S]); however, both groups were similar in their stage at presentation. On classification into luminal subtypes, triple negative breast cancer was more common in the YBC cohort (50.5% vs. 29.6%, p = 0.001, S). The 5-year disease-free survival (DFS) was significantly worse in the YBC cohort (70.3% vs. 78%, p = 0.03, S). This detriment appeared to be significantly more in women presenting with operable breast cancer (77.2% vs. 82.6%, p = 0.012, S). Among the Luminal subtypes, there was no significant difference in the DFS between the two groups. Young age is a negative prognostic factor among women presenting with breast cancer. Further studies are required to evaluate whether any specific stage or molecular sub-type is particularly vulnerable to a poor outcome despite treatment.

Carcinoma of the Tongue in Renal Transplant Recipients: An Unusual Spectrum of De novo Malignancy at a Tertiary Care Center in India Over a Period of 26 Years.

Renal transplant recipients are at a higher risk of malignancy. We report our experience and the critical differences in the presentation of malignancy in kidney transplant patients performed at our tertiary care center and followed up over the period of 1990-2015. A total of 338 live donor transplants performed in 332 patients were analyzed. Induction immunosuppression was used in 22 cases with interleukin-2 (IL-2) receptor antibody. Overall 299 patients were continued on calcineurin inhibitor (CNI)-based triple drug immunosuppression, 33 were off CNI with 13 of them receiving sirolimus additionally. A total of 16 malignancies including post transplant lymphoproliferative disease (5), oral cancer (5), lung cancer (2), hepatobiliary cancer (2), colon cancer (1), and skin cancer (1) were diagnosed in 15 patients. Over the 26-year follow up, 138 patients died of whom 12 died due to cancer. Cancer occurred in 4.7% of patients but accounted for 9.4% of deaths. Oral cancer occurred after a significantly longer latency of over 10 years (212 vs. 94 months, P = 0.00652). Despite the longer latency, oral cancer patients were younger at diagnosis (44.0 vs. 52 years, P = 0.01016) and had better outcome (Fisher's exact test, P = 0.0275). This was despite a longer overall follow-up for the oral cancer patients, reflecting the better outcome for these patients (24 vs. 4 months, P = 0.0278). This might be the result of relatively early diagnosis of oral cancers.