Association between type 2 diabetes mellitus and anthropometric measurements - a case control study in South India.

INTRODUCTION: Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). Clinical evidence indicates a stronger association of diabetes with central obesity than general obesity. The present study aimed to compare the association between type 2 diabetes mellitus and different anthropometric measurements and evaluate the usefulness of these measurements in clinical practice. METHODS: A case-control study was done among 102 individuals; of whom 51 cases included diagnosed T2DM (≥ 20 years age) patients attending the Medicine out-patient consultation of a tertiary care hospital and 51 controls who were screen negative for T2DM and recruited from the local community. Various anthropometric measurements were used according to standard World Health Organization (WHO) protocols. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 15. RESULTS: The proportion of cases with Body Mass Index (BMI) ≥ 25 kg/m2 was 55% as compared to 22% of controls and this association was statistically significant (p < 0.05). The proportion of cases with high waist circumference cut-offs (WC) was 74.5% as compared to 45.1% healthy individuals and this association was also statistically significant (p < 0.05, OR = 3.56). A Receiver Operating Characteristic (ROC) curve for both gender revealed highest area under the curve for body mass index (area = 0.787). Body mass index had the best discriminatory power. Waist to hip ratio was not a sensitive marker especially for females. CONCLUSIONS: A strong association between obesity indices and diabetes was identified. BMI and WC could be used in clinical practice for suggesting life style modifications.

Cell-free epstein-barr viral loads in childhood hodgkin lymphoma: a study from South India.

Cell-free Epstein-Barr viral (EBV) DNA is detectable in plasma of patients with EBV-related lymphomas. The aim of this study was to evaluate the utility of plasma EBV DNA as a biomarker of EBV association in childhood Hodgkin lymphoma (HL). Furthermore, an attempt was made to evaluate the effectiveness of viral quantitation for assessing response to chemotherapy. Thirteen cases of childhood HL were included in this study. All 13 cases were EBV associated as reflected by expression of EBV LMP1 in the tumor specimen. Eighty-five percent had detectable EBV DNA levels; viral loads ranging from 2.9 to 156.2 × 10³ copies/ml (mean 29 × 10³ copies/ml); while in 2 patients and 30 controls tested, viral DNA was undetectable. In four patients, follow-up samples were available after three cycles of chemotherapy; all had EBV DNAemia prior to chemotherapy but undetectable EBV DNA posttherapy. This corroborated with complete response in these four patients. Plasma EBV viral load quantification maybe a useful tool for detecting EBV association with lymphomas and in monitoring response to treatment in childhood HL in centers with limited resources, more so in India where majority of childhood HL is likely to be EBV associated. This is the first Indian study estimating plasma EBV viral loads in HL.

Primary Parotid Lymphoma From A Regional Cancer Center in South India.

UNLABELLED: Primary parotid lymphoma (PPL) is an unusual entity and there is limited data in Indian population. Hence we undertook this retrospective observational study of primary parotid lymphoma at our Center in Southern India. This study includes 7 consecutive cases diagnosed as PPL by tissue biopsy/superficial/deep parotidectomy confirmed by immunohistochemistry between January 2007 and December 2012. RESULTS: Median age was 54 years (range 29- 78 years), and it was more common in males. According to Ann Arbor stage, Advanced stage (stage III and IV) was seen in 2 (28.57%). According to the International Prognostic Index (IPI), most (6) were low risk (85.7%). Overall survival ranged from 1-45 months with median OS of 18 months. To conclude, PPL presents more often in early stage and low IPI score. Surgery +/- chemoimmunotherapy with radiotherapy to the parotid is the standard treatment at present.

Squamous cell carcinoma arising in endometriosis of the ovary.

Squamous cell carcinoma arising in ovarian endometriosis is extremely rare, but a case is reported in a 62 year old woman. If such an ovarian tumour is discovered evidence of teratoma, Brenner tumour, or endometriosis should be sought. Extensive sampling is mandatory as the developing tumour often overgrows the foci of endometriosis, thus obliterating evidence of its origin.

Association of Burkitt's lymphoma with the Epstein-Barr virus in two developing countries.

The clinical presentation of Burkitt's lymphoma (BL) and it's association with the Epstein-Barr virus (EBV) varies in different geographic areas, BL in developing countries being "intermediate" between the sporadic and endemic types, both in it's clinical presentation and it's association with EBV, which varies from 25-80%. In this study we have analysed the clinical features, EBV association, subtype and prevalence of the deleted variant of the Latent Membrane Protein-1 (LMP-1) of EBV in forty-two cases from two developing countries- India (n = 25) and Argentina (n = 17). In both countries the abdomen was the site most commonly involved while jaw involvement was rare. EBV was detected by in-situ hybridization using the EBER-1 RNA probe. 47% of cases from Argentina and 80% of cases from India were EBER positive. EBV typing using EBNA-3C primers showed a predominance of Type A in both countries (India-13/16 and Argentina-(7/8)). The 30bp deletion of the LMP-1 gene was detected in all evaluated cases from Argentina while the wild type of the gene was seen in all the evaluable Indian cases. Our study highlights the similarities and differences in the clinical presentation and EBV association of BL in two developing countries and also indicates that the subtype of EBV and prevalence of the LMP-1 deletion may reflect the predominant subtype in a particular population.

Magliant melanoma of the oral cavity: report of 14 cases from a regional cancer centre.

Fourteen patients with oral mucosal malignant melanomas seen at a regional cancer centre over a 10-year period were analysed. All the patients presented with symptoms of short duration, with extensive local disease at initial evaluation in 11 patients. The palate was the commonest site involved. Ten patients had regional nodal disease and of these four also had distant metastases to the liver and/or the lung. Coincidental melanosis was identified clinically in three patients and histologically confirmed in two patients. Only four patients underwent radical surgery. Of the five patients who received DTIC-based chemotherapy, only one achieved a complete response. No significant correlation between stage of the disease at presentation, histological features or type of treatment and survival could be seen as the number of cases is small.

Mandibular metastasis in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) presenting initially as a bony metastasis is rare. Involvement of maxillofacial bones is even more rare and only 20 cases have been reported. A case of a 65-year-old male patient presenting with metastasis to the mandible from a primary HCC is described.

Fine needle aspiration cytology of Wilms' tumor. A study of 17 cases.

The cytologic features of 17 cases of Wilms' tumor are described. All three elements identifiable histologically are usually present in the fine needle aspiration smears. In our cases the blastemal component predominated, with varying degrees of epithelial and stromal differentiation, which was identifiable in the form of skeletal and smooth muscle. Early epithelial differentiation was identified as rosette-like and gland-like structures, groups of cells with peripheral palisading and spherical, tightly bound clusters of cells. More-differentiated epithelial cells were seen individually, in small, loose clusters, in sheets with a honeycomb appearance and as elongated tubules. Coarse, magenta, granular material was seen in the background of the smears in the majority of our cases. Fine needle aspiration under ultrasound guidance to accurately localize the tumor and a posterior approach to avoid peritoneal spillage are recommended. In difficult cases, a cell block of the aspirated material is a useful adjunct.

Parapharyngeal ganglioneuroma. Report of a case diagnosed by fine needle aspiration.

A case of ganglioneuroma presenting in a parapharyngeal location in a 4-year-old girl was subjected to fine needle aspiration cytology. A preoperative diagnosis of ganglioneuroma was subsequently confirmed on histopathologic examination. Only a few reports on the cytologic features of this tumor exist. The importance of considering this diagnosis for a tumor at an unusual site and in an uncommon age group is stressed.

Cystosarcoma phyllodes. Diagnosis by fine needle aspiration cytology.

The cytologic features of 10 benign, 2 borderline and 5 malignant phyllodes tumors were studied, and an attempt was made to correlate the cytologic findings with corresponding histologic categories. Seventy-five percent of the benign and borderline tumors were interpreted as benign cystosarcoma phyllodes on fine needle aspiration cytology. Eighty percent of the malignant phyllodes tumors were identified as malignant lesions cytologically. The cytologic features assessed were the epithelial:stromal ratio and morphology of the stromal component, including the degree of atypia, mitotic activity, capillary vessels traversing the stromal fragments, presence of foamy macrophages, histiocytic giant cells and bipolar naked nuclei. A diagnosis of phyllodes tumor was suggested cytologically by the presence of both epithelial and stromal elements; the stroma was present as cellular "phyllodes fragments" and isolated mesenchymal cells. The parameters suggesting malignancy were extreme paucity or absence of epithelial elements and stromal cells in diffuse sheets and clusters less cohesive than normal, with marked stromal atypia and mitotic activity.

Fine needle aspiration cytology of chondroblastoma and chondromyxoid fibroma. A report of two cases.

The fine needle aspiration cytology in two cases of chondroblastoma and chondromyxoid fibroma are described. The diagnosis of chondroblastoma was made on a recurrent tumor of which the histopathology was known, whereas chondromyxoid fibroma was diagnosed initially on fine needle aspiration cytology. The radiologic appearances and differential diagnoses of these chondroid neoplasms are discussed.

Aspiration biopsy cytology of primary bone lesions.

Fine needle aspiration cytology of 79 primary bone lesions was done, and the clinical and radiologic features were correlated with cytopathology. Seventy-four of these cases were primary malignant bone tumors, two cases each were tumor-like or inflammatory lesions, and one case was a benign bone tumor. Osteosarcoma (37.7%) and Ewing's sarcoma (15.6%) were the most common primary lesions. Correlation with histopathology was possible in 37 cases, and an accuracy rate of 94.1% was achieved. There was an 89% correlation between radiologic and cytologic diagnoses. It was concluded that in this oncology center a working diagnosis based on cytology was possible in almost all cases after correlating with the radiologic findings. However, when there was a discrepancy between the clinical, radiologic and cytologic diagnoses, an open biopsy was mandatory.

Melanotic neuroectodermal tumor of infancy initially diagnosed by fine needle aspiration cytology.

A five-month-old male child presented with a tumor of the maxilla, which was clinically diagnosed as an eruption cyst or a rhabdomyosarcoma. Fine needle aspiration smears showed two types of cells: neuroblastlike cells and cells containing melanin pigment. A cytologic diagnosis of melanotic neuroectodermal tumor of infancy was made. This diagnosis was confirmed by histopathologic examination of the subsequently excised mass.

Diagnosis of clival chordoma by fine needle aspiration of an oropharyngeal mass. A case report.

A sphenooccipital chordoma presenting as a large nasopharyngeal mass extending into the oropharynx was diagnosed by transoral fine needle aspiration biopsy (FNAB) and confirmed by subsequent histologic studies. The cytologic features of chordoma are presented, and the diagnostic utility of FNAB in evaluating similar lesions in the head and neck region is discussed.

A comparison of the effect of combined frusemide and controlled-release potassium tablets (Diumide-K continus tablets) and frusemide and slow-K tablets in elderly patients with cardiac failure.

Serum potassium levels, weight, heart function and patient's opinion of therapy were assessed in a study comparing 40 mg of frusemide and 600 mg of controlled-release potassium chloride in a combined tablet to frusemide and potassium supplements given as separate tablets in thirty elderly patients in cardiac failure. Potassium levels were significantly higher, heart function was significantly improved and patient's opinion of therapy was better after the combined tablet therapy than both pre-trial and after the separate tablet therapy. There was no significant difference in weight reduction.

Parotid tuberculosis simulating malignancy.

An interesting case of parotid tumour simulating malignancy is reported. The rarity of this lesion and the associated clinical and diagnostic problems are emphasized together with the relevant literature.

Association of primary central nervous system lymphomas with the Epstein-Barr virus.

The incidence of primary central nervous system lymphoma (PCNSL), previously a rare tumor, has increased significantly over the past few decades, partly due to the AIDS epidemic but also in immunocompetent individuals. Studies from Western countries have shown a consistent association of tumors occurring in immunocompromised individuals with the Epstein-Barr virus (EBV) suggesting an important role for the virus in the pathogenesis of these tumors, but an infrequent association of the virus with PCNSL in the immunocompetent host has also been noted. We studied 11 patients with PCNSL who had no evidence of an immunocompromised state. All the tumors were aggressive B cell lymphomas. EBV association was studied using EBER in-situ hybridization. 10 out of the 11 tumors were negative for EBV, indicating that tumors in immunocompetent individuals in developing countries are also infrequently EBV associated and that a different pathogenetic mechanism is operative in the evolution of these tumors.

Hepatocellular carcinoma metastatic to bones (Case report with review of literature).

A seventy year old man presented with bone pains. Investigation revealed a metastatic bone lesion in the humerus. The primary was found in the liver. The patient achieved good palliation with chemotherapy and radiotherapy and survived for one year.

Primary central nervous system lymphoma a report of nine cases.

Primary Central Nervous System Lymphoma (PCNSL) is a rare neoplasm of B cell origin and constitute less than 1% of Non-Hodgkin's lymphoma (NHL). Histology is mainly of high grade and intermediate type. Although NHL is known to be highly sensitive to both irradiation and cytotoxic drugs, being a curable malignancy, the therapeutic results remain disappointing. Clinical observations on nine cases of PCNSL seen in one of the major cancer centres in India is presented in this paper. Radiotherapy combined with Chemotherapy although yielded encouraging initial response in these patients, the long term response was unsatisfactory with median survival for these patients being only 19 months. This warrants an alternative therapeutic approach to improve the dismal prognosis of PCNSL.

Hemangiopericytoma of bone--a case report.

A case of low grade hemangiopericytoma of three years duration occurring in the upper end of the femur of a 70 year old man is described. Radiologically, the upper third of the right femur showed a destructive expansile osteolytic lesion with soft tissue extension. The tumour was partially encapsulated. Mitoses were 0-1 per 10 high power fields, suggesting the low grade malignant nature of the lesion. It is felt that all hemangiopericytomas occurring in bone should be considered biologically malignant.