Multiple intraosseous calvarial hemangiomas mimicking metastasis from renal cell carcinoma.

Renal cell carcinomas are known to metastasise to the bones in the form of lytic lesions. However, not all osteolytic lesions in patients with renal cell carcinoma are metastatic in nature. The report describes the case of a 68-year old lady who was diagnosed with a renal cell carcinoma 3 and half years back and treated with radical nephrectomy along with excision of an inferior vena cava tumour thrombus. The tumour was completely excised and she remained disease free till date. Subsequently, multiple lytic lesions were detected incidentally on the cranial vault, which on biopsy demonstrated intraosseous hemangioma. Though it is well known that renal cell carcinomas can metastasise to the bones in the form lytic lesions, it is important for clinicians to remember a few other differentials, one of which would be an intraosseous hemangioma, which is a benign pathology. Many times patients would be treated as having metastatic disease merely on radiological findings. In this case report, there was a high index of radiological suspicion for metastases, however establishing diagnosis by biopsy prevented overtreatment in this instance.

Prospective evaluation of concomitant tumour bed boost with whole breast irradiation in patients with locally advanced breast cancer undergoing breast-conserving therapy.

BACKGROUND AND PURPOSE: To evaluate prospectively the feasibility of concomitant weekly tumour bed electron boost along with whole breast radiotherapy (RT) following breast-conserving therapy (BCT) in patients with locally advanced breast cancer (LABC) with the aim of reducing overall treatment time. MATERIALS AND METHODS: Thirty patients with LABC suitable for BCT following neoadjuvant chemotherapy (CAF/CEF) were accrued in the study. Conventional RT (CRT) to the whole breast was delivered 5 days a week to a dose of 50Gy using 6-10MV photons. In addition, an electron boost to the tumour bed was delivered every Saturday, eventually delivering 5 such weekly fractions to a boost dose of 12.5Gy. Patients were evaluated for acute reactions during the treatment and cosmetic evaluation was done before, at the end of radiation therapy and at follow up by 2 independent observers blinded to each other. The study population (concomitant boost (CB) group) was compared with a similar cohort of 32 patients treated conventionally with tumour bed boost of 15Gy in 6 fractions delivered after the completion of whole breast irradiation (CRT group). RESULTS: All patients completed RT within the stipulated time with no grade IV skin toxicity in either group. At conclusion of RT, in the CB group, confluent moist desquamation (grade III) developed within the tumour bed region in 1 patient (3.3%) and outside tumour bed region in 3 patients (10%). In the CRT group, 3 and 4 patients (9.4% and 12%) developed moist desquamation within and outside the tumour bed regions, respectively. CB did not affect the global cosmesis as compared with CRT group (p=0.23) at the end of 3 years. CONCLUSION: Concomitant tumour bed boost along with whole breast RT appears to be safe and feasible in a select group of patients. As the treatment is completed earlier by 6-10 days than conventional practice, it has favourable time and resource implications, particularly attractive for patients travelling long distances for treatment. Based on these encouraging results, we are planning to confirm the results in an appropriately designed and powered randomised trial.

High dose rate brachytherapy boost for primary nasopharyngeal carcinoma: preliminary results of an ongoing prospective study.

BACKGROUND: The exact role of brachytherapy boost in primary nasopharyngeal carcinoma (NPC) is yet to be completely elucidated. We conducted this prospective study to evaluate outcome of patients with NPC treated with high dose rate brachytherapy (HDR-BT) boost, following radical external beam radiotherapy (EBRT) with or without chemotherapy. METHODS: Between 1998 and 2003, 10 patients of primary NPC were prospectively considered for HDR-BT boost. Median EBRT dose was 66 Gy (range: 60-70 Gy). Median HDR-BT boost dose was 12 Gy (range: 5-14 Gy) given in 1-4 fractions. RESULTS: At a median follow-up of 28 months (range: 5-66 months), the local control rate was 90%. Two patients developed distant metastases and one patient developed a second primary in the lower alveolus. The 3-year disease free survival rate was 60%. Grade III mucositis developed in 2 (20%) patients. CONCLUSIONS: HDR-BT is an efficacious boost modality with acceptable morbidity in selected patients with NPC.

Vanishing bone disease involving the pelvis.

Vanishing bone disease is a rare condition characterized by progressive osteolysis of the bony structures by vascular tissue and their replacement by fibrous, vascular connective tissue. A 38-year-old lady who had a previous history of angioma of the left iliac bone presented with vague symptoms of a limping gait and pain during walking since 2 years duration. The radiologic findings were suggestive of degenerative changes. A possibility of metastatic disease was also considered. However the biopsy and Positron emission tomography (PET) scan ruled out any active disease. Like in most other cases this was possibly a self-limited disease where bone resorption had spontaneously arrested.

Primary, multifocal extranodal lymphoma presenting with multiple cranial nerve palsies: an unusual presentation of an uncommon entity.

Primary lymphoma of the bone is a relatively rare entity. There are very few reported cases in literature of synchronous, multifocal Non-Hodgkin's Lymphoma (NHL) of the bone. Here, we report a patient with extranodal NHL of the clivus and scapula presenting with cranial nerve palsies and a scapular mass. He was treated with combination chemotherapy followed by involved field radiotherapy. At 15 months of follow-up, he is asymptomatic and in complete remission.

Gliosarcoma occurring 8 years after treatment for a medulloblastoma.

CASE REPORT: We present a rare case of a gliosarcoma occurring 8 years following treatment for a medulloblastoma. The patient was diagnosed with a medulloblastoma at the age of 13 years. We considered the possibility of a radiation-induced tumour and present evidence supporting this view. The second cerebral tumour was excised and confirmed to be a gliosarcoma. The tumour bed was re-irradiated with three-dimensional conformal radiotherapy (3DCRT). She remained well for 6 months, after which there was clinicoradiological progression. CONCLUSIONS: During long-term follow-up of patients with medulloblastomas, the possibility of radiation-induced neoplasms must be borne in mind.