Successful Outcome of Metastatic Pancreatoblastoma in an Adolescent: A Case Report and Review of the Literature.

Pancreatoblastoma, an orphan disease, is the most common malignant epithelial neoplasm of the pancreas in children. With vague clinical features, diagnosis is made by radiological suggestions and histopathology. The presence of metastatic disease and inoperable/incomplete excision remains the poor prognostic markers. We present a rare instance of an adolescent who has survived metastatic pancreatoblastoma after neoadjuvant chemoreduction/complete surgical excision.

Type C1 radical hysterectomy in advanced squamous cell carcinoma of the cervix postdefinitive concurrent chemoradiation: An argument.

Aims: This study aimed to evaluate the feasibility and outcomes of patients with advanced cervical cancer treated with definitive concurrent chemoradiotherapy followed by Type C 1 nerve-sparing radical hysterectomy. Settings and Design: This is a prospective study to assess the feasibility of Type C 1 nerve-sparing radical hysterectomy postdefinitive chemoradiation in advanced carcinoma cervix. Subjects and Methods: We analyzed 25 patients with cervical cancer evaluated and treated with concurrent chemoradiation followed by surgery. Twenty patients underwent Type C 1 nerve-sparing radical hysterectomy by open surgery and five patients by laparoscopic approach. Postoperative morbidity and pathology were analyzed. Statistical Analysis Used: Analysis of the outcomes was done by arithmetical calculations. Results: Eight patients (32%) had persistent residual disease after definitive chemoradiation followed by surgery. Rest of the patients had pathological complete response. Two patients (8%) had node-positive disease. None of the patients in the laparoscopic group had bladder morbidity. One patient in the laparoscopic group had persistent vaginal discharge. Conclusions: Type C1 nerve-sparing radical hysterectomy is technically feasible with minimal morbidity following definitive chemoradiation in advanced squamous cell carcinoma of the cervix.

Increased Plasma Nitrite and von Willebrand Factor Indicates Early Diagnosis of Vascular Diseases in Chemotherapy Treated Cancer Patients.

Chemotherapy induced cardiotoxicity leads to development of hypertension, conduction abnormalities, and congestive heart failure. However, there is no simple test to detect and assess cardiovascular risk in a chemotherapy treated cancer patient. The aim of the present study on cancer patients treated with (n = 66) and without (n = 66) chemotherapy is to identify indicators from plasma for vascular injury. The levels of plasma nitrite, asymmetric dimethyl arginine (ADMA), von Willebrand factor (vWF), cardiac troponins, lipid peroxidation (MDA), and lactate dehydrogenase (LDH) were estimated. An R package, namely, Optimal Cutpoints, and a machine learning method-support vector machine (SVM) were applied for identifying the indicators for cardiovascular damage. We observed a significant increase in nitrite (p < 0.001) and vWF (p < 0.001) level in chemotherapy treated patients compared to untreated cancer patients and healthy controls. An increased MDA and LDH activity from plasma in chemotherapy treated cancer patients was found. The R package analysis and SVM model developed using three indicators, namely, nitrite, vWF, and MDA, can distinguish cancer patients before and after chemotherapy with an accuracy of 87.8% and AUC value of 0.915. Serum collected from chemotherapy treated patients attenuates angiogenesis in chick embryo angiogenesis (CEA) assay and inhibits migration of human endothelial cells. Our work suggests that measurement of nitrite along with traditional endothelial marker vWF could be used as a diagnostic strategy for identifying susceptible patients to develop cardiovascular dysfunctions. The results of the present study offer clues for early diagnosis of subclinical vascular toxicity with minimally invasive procedure. Schematic representation of chemotherapy induced elevated plasma nitrite level in cancer patients.

The role of limb salvage surgery and custom mega prosthesis in multiple myeloma.

Nine patients with multiple myeloma underwent limb salvage surgery and custom megaprosthesis replacement for tumours involving long bones. The lower limb was commonly involved with an average age of 47.7 years at presentation. All patients had pathological fractures. Resection and reconstruction was done using custom megaprostheses. A proximal femoral prosthesis was used for proximal femoral tumours and an intercalary prosthesis for tumours involving the femoral shaft. One patient each had total femoral prosthesis and total knee prosthesis. With an average follow-up of 88.2 months, three patients died of their disease. One patient with total knee prosthesis had delayed deep infection requiring removal of the prosthesis and another patient with an intercalary prosthesis had a periprosthetic fracture and declined revision surgery. Radiological evidence of loosening was seen in one patient. The functional outcome was excellent in 3 and good in 3 patients. The 5-year Kaplan-Meier survival rate of the patients was 66.7%.

Anastomotic Recurrence of Colon Cancer-is it a Local Recurrence, a Second Primary, or a Metastatic Disease (Local Manifestation of Systemic Disease)?

The aim of this study is to review the literature to find out the exact etiology of anastomotic cancers of colon post resection and differentiate them between a recurrence, second primary, and metastatic disease (local manifestation of systemic disease). Web-based literature search was done, and datas collected. We searched PubMed for papers using the keywords colon cancer recurrence, anastomotic recurrence, and recurrent colon carcinoma. We also searched for systematic review in the same topic. In addition, we used our personal referrence archive. Anastomotic recurrences of colon are postulated to arise due to inadequate margins, tumor implantation by exfoliated cells, altered biological properties of bowel anastomosis, and missed synchronous lesions. Some tumors are unique with repeated recurrence after repeated resection. Duration after primary surgery plays a major role in differentiating recurrent and second primary lesions. Repeated recurrences after repeated resections have to be considered a manifestation of systemic disease or metastatic disease due to the virulence of the disease. A detailed analysis and study of patients with colonic anastomotic lesion are required to differentiate it between a recurrent, a second primary lesion, and a metastatic disease (local manifestation of a systemic disease). The nomenclature is significant to study the survival of these patients, as a second primary lesion will have different survival compared to that of recurrent lesions.

Distal femoral tumours treated by resection and custom mega-prosthetic replacement.

We have analysed the results of 246 cases of distal femoral tumours treated by resection and prosthetic replacement between 1988 and 2002. Patient ages ranged from 6-67 years averaging 24 years; 133 were males. The most common tumour was osteosarcoma (67% of patients). The follow-up ranged from 2 to 14 years. Stage II tumours were seen in 72% of patients. The technique of sleeve resection of the quadriceps musculature was followed to achieve local clearance of the tumour. The prosthesis used was a rotating hinge custom mega-prosthesis manufactured locally. The functional result achieved was excellent or good in 87%; 86% of the patients had no evidence of disease, and 13% had died. The 10-year patient survival was 76.9%. Periprosthetic fracture and infection were the most common complications.