Expression of Neuron-Specific Enolase and Other Neuroendocrine Markers is Correlated with Prognosis and Response to Therapy in Non-Hodgkin Lymphoma.

Objective Non-Hodgkin lymphoma (NHL) is a common hematological malignancy. There is very little known about the expression of neuroendocrine immunohistochemical markers and their clinical significance in NHL due to the paucity of studies. Our objective was to study the expression of neuroendocrine immunohistochemical markers in NHL and correlate with clinical parameters. Materials and Methods All cases diagnosed as NHL on morphology and immunohistochemistry (World Health Organization, 2016 classification) were included in the study. Immunohistochemistry for neuron-specific enolase (NSE), synaptophysin, and chromogranin A was performed. The results were correlated with clinical parameters and response to chemotherapy. Results A total of 66 cases were included in the study with a male-to-female ratio of 3.1:1. The most frequent subtypes observed were diffuse large B-cell lymphoma not otherwise specified and follicular lymphoma. Among the neuroendocrine markers, positivity was observed only for NSE, whereas the other markers were uniformly negative. It was positive in both B- and T-cell lymphomas and in many different subtypes. No relation with the age and sex of the patients was observed. However, NSE-positive cases, more frequently, presented in the advanced stage as compared with NSE negative (61 vs. 38%). All NSE-positive cases showed remission with chemotherapy. Conclusion Among the neuroendocrine immunohistochemical markers, positivity was observed only for NSE. This isolated positivity suggests cross-binding of NSE antibodies with some other isoenzyme of NSE. NSE positivity was associated with higher stage and better response to therapy. Despite this apparent paradox, it is recommended that NSE should be part of routine immunohistochemical panel for NHL.

Correlation of Prognostic Markers {CEA, Ca19.9, Neutrophil To Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR)} With Progression Free Survival (PFS) in Advanced/Metastatic Gallbladder Carcinoma.

Gallbladder carcinoma (GBC) is likely to be diagnosed at progressive stages and shows a very poor prognosis. Combination of gemcitabine and cisplatin (GEMCIS) has been widely used as first line palliative chemotherapy. Prognostic significance of inflammatory markers Neutrophil to lymphocyte ratio (NLR) and Platelet to lymphocyte ratio (PLR) in advanced gallbladder carcinoma (GBC) is not well established. MATERIAL: 30 patients who were diagnosed as advanced/ metastatic gallbladder carcinoma with age more than 18 years were included. All patients who were fit to receive chemotherapy was started on gemcitabine 1000mg/m2 and cisplatin 25mg/m2 (GEMCIS) administered intravenously on days 1 and 8 every 3 weeks. The treatment was repeated for a total of 6 cycles or until the occurrence of unacceptable toxicity, loss to follow up, confirmation of disease progression or death. All the patients underwent Contrast enhanced CT scan along with markers NLR, PLR, carcinoembryonic antigen (CEA), carbohydrate antigen 19.9 (CA19.9) at the baseline and at the end of 3 and 6 cycles of chemotherapy and the tumour response was assessed based on Response Evaluation Criteria in Solid Tumours RECIST 1.1 criteria. Progression free survival was calculated from the date of documentation of best response. The response was correlated with markers CEA, CA19.9, NLR and PLR. OBSERVATION: At a cut-off of NLR (>3 ng/ml) and PLR (>190) predicts progression with a sensitivity of 91% and 100% respectively and both with a specificity of 100%. Out of 30 participants 11 (36.7%) had disease progression (p<0.001). Disease progression noted in 8 participants (26.7%) after 3 cycles (P<0.001) and in 3 participants (13.6%) after 6 cycles of chemotherapy (p <0.001). Disease control rate was 63.33%: 01(3.3%) patient with complete response, 07(23.3%) patients with partial response, 11(36.7%) patients with stable disease. Mean progression free survival in participants associated with progressive disease was 11.45±5.54 weeks (p <0.001). Neutrophil to lymphocyte ratio (NLR) >3 (95%CI 7.6-13.6; log rank test P<0.01) and Platelet to lymphocyte ratio (PLR) >190 (95%CI 7.67-8.83; log rank test p<0.001) were significantly associated with worse progression free survival. CONCLUSION: Increased levels of NLR (>3) and PLR (>190) have prognostic value to predict progression free survival (PFS) in advanced gallbladder carcinoma patients on palliative chemotherapy. NLR and PLR can be used as prognostic markers in advanced gallbladder carcinoma.

Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends.

The significant physical and emotional effects of chemotherapy-induced nausea and vomiting (CINV) are experienced by cancer patients. Severe symptoms decrease the patient's quality of life and potentially deters further treatment. The five main forms of CINV (i.e., acute, delayed, anticipatory, breakthrough, and refractory) require different treatment regimens, which often include 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids. Despite a significant amount of research and development of antiemetic agents, management of CINV remains a great challenge with many needs waiting to be adequately addressed, such as controlling non-acute CINV, developing appropriate CINV treatment protocols for multiple-day chemotherapy patients, and providing options for those prone to CINV despite treatment. Further research is required to optimize CINV management for these patients.

Practical consensus recommendation on when to do BRCA testing.

BRCA-mutation associated breast cancer and to future cancer risks and sensitivity to systemic therapies. Now that rapid genetic testing for BRCA1 and BRCA2 mutations is available, BRCA mutation status can be considered when making treatment and prevention decisions for BRCA testing, BRCA mutation carriers with breast cancer. Expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.

Growing Teratoma Syndrome.

Growing teratoma syndrome, a disease characterized by presence of benign metastasis increasing in size and number after chemotherapy, is infrequent occurrence. Being unfamiliar with the disease entity, many oncologists misinterpret it as disease progression. Though the exact etio-pathognesis of the disease is still unidentified, but clinical characteristics are well defined. Being a chemo and radio-resistant disease, surgery offers only cure. We present a case of ovarian immature teratoma, who after chemotherapy presented with increased tumor size. Resected specimen confirms the diagnosis of mature teratoma leading to recognition of GTS. Surgery resulted in cure.

Chemotherapy-induced palmer planter erythrodysesthesia.

We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.

Disseminated histoplasmosis with reactive haemophagocytosis presenting as PUO in an immunocompetent host.

Disseminated histoplasmosis (DH) with reactive haemophagocytosis has been described in literature mainly in immunocompromised hosts. Only sporadic case reports exist in immunocompetent hosts. Here, we present a rare case of DH with reactive haemophagocytosis in an immunocompetent host presenting as PUO.

Bone metastasis in ovarian cancer.

Bone involvement in carcinoma of ovary occurs rarely. In a review of 103 patients over last 3 years we have seen 4 such patients (serous-2, mucinous-1, mixed germ cell tumour-1). Patients presented with severe localized bone pain, bony swelling and difficulty in walking. The common sites of involvement were vertebrae, pelvic bones and skull. Radiologically the osteolytic lesions were commonest. Bone lesions were associated with abdomino-pelvic disease in 3 patients. Cisplatinum based chemotherapy in addition to local radiation resulted in significant response in 2 patients; one complete and one partial response. The median survival was 7.5 months (range 6-39 months) after bone metastasis. We conclude bone involvement in cancer ovary is associated with poor prognosis.

Male genital tract tumors in Punjab, India.

A total of 95,797 tissue specimens were submitted to our laboratory for histopathological examination during the 21-year period from January 1964 to December 1984. Out of 21,281 cases diagnosed as tumors, 9,254 were found in the male population, comprising 6,846 malignant neoplasms and 2,408 benign neoplasms. There were 1,175 tumors of the male genital tract of which 1,118 were malignant and 57 were benign. The incidence of male genital tract cancer represented 16.33% of male malignancies. The relative frequency of malignant tumors of various organs in the male genital tract was penis, 42.49%; prostate, 40.34%; testis, 15.92%; scrotum, 0.71%; epididymis, 0.36%; spermatic cord, 0.09%; and urethra, 0.09%. All these tumors were classified into various histopathological types and their relative frequency was determined. Some of the rare tumors diagnosed included leiomyosarcoma of the penis, transitional cell carcinoma of the prostate gland, orchioblastoma of the testis, and carcinoma of the urethra. A separate study by this department on the pattern of cancer distribution revealed that cancer of the uterine cervix is the most common malignancy in females in this geographic region. We postulate that a common carcinogenic agent, either a virus or a biochemical (smegmatic) factor, may be responsible for the high incidence of carcinoma of the penis in males and carcinoma of the cervix in females. Educating people about the importance of penile hygiene, and, in particular, educating mothers to retract the foreskin of male babies and to wash it with soap and water when bathing them, will hopefully reduce the incidence of these cancers in regions of high prevalence.

Enuresis: analysis of 100 cases.

One hundred children with enuresis were studied to find out various factors responsible for this condition. Enuresis was more frequent in first born, service class and bottle fed children. There was a significant role of stress factors in causation of enuresis. We found a higher frequency of behavioral symptoms among children with enuresis. There was no significant correlation between enuresis and sex, education of parents, social class, sleep patterns, age of mother at marriage and intellectual grades of the children. Worm infestations, giardiasis, amebiasis and urinary infection were seen in 70% of cases. General body weakness, cold and nervousness were the common causes of enuresis in the parents' opinion. The main reason for not seeking the treatment at an early stage in view of parents' was that they thought enuresis a normal variant.