Recurrent Giant Cell Tumor of Sphenoid Bone: A Rare Finding.

Giant Cell Tumors of the skull are rare and mostly occur in the middle cranial fossa. Radiological investigations serve as adjunct modalities; however, histopathological confirmation is mandatory. Ten to forty% of GCTs may be recurrent. Complete surgical resection is the treatment of choice, however, partial resection with adjuvant radiotherapy can serve as a secondary alternative. Recurrent cases require post-op radiotherapy. Here, we describe a case of recurrent giant cell tumor of sphenoid bone in a young male, who underwent surgical resection twice, after which he was advised adjuvant radiotherapy and denosumab. The patient did not take radiotherapy.

Radiotherapy in Extramedullary Plasmacytoma of the Tongue with Nodal Involvement: A Case Report with One-Year Follow-Up.

Tongue extramedullary plasmacytoma (EMP) with regional lymph node metastases is a very rare pathology. Despite being a rare entity, extramedullary plasmacytoma should be considered a differential diagnosis in cases of a mass or ulcer in the tongue. A 60-year-old lady presents with an ulcerative lesion over the right lateral border of the tongue with dimensions 3.5 × 2 cm for one year. Initially, on histopathological examination, a possibility of plasma cell neoplasm was suspected; on further IHC, serum protein electrophoresis, and radiological investigations, a definite diagnosis of solitary EMP of the right lateral border of the tongue with regional nodal metastases was confirmed. The patient received radiotherapy for the primary disease along with the involved neck nodal sites.

Hand Foot Syndrome Induced by Lenvatinib - A Case Report.

INTRODUCTION: Hand-Foot Syndrome (HFS), also known as palmar-plantar erythrodysesthesia, is a common reaction to Tyrosine Kinase Inhibitors ( TKIs), which can often lead to discontinuation of the drug. Lenvatinib is a recently approved drug for the treatment of endometrial carcinoma, which has been proven to provide a better overall survival rate and longer duration of progression-free survival among patients with advanced endometrial cancer. Herein, we have reported a case of carcinoma endometrium with metastasis who had to discontinue the use of lenvatinib due to the adverse drug reaction. CASE REPORT: A 60-year-old female patient with carcinoma endometrium with metastasis, post radical hysterectomy with bilateral salpingo-oophorectomy with omentectomy, was started on tablet lenvatinib 8 mg once daily orally for 15 days. After 12 days of treatment, the patient noticed painful lesions with reddish-black discoloration over the left forearm and dorsal aspect of the left hand and fingers, and was diagnosed with lenvatinib-induced hand-foot syndrome. Lenvatinib was discontinued and tab. prednisolone 30mg was taken orally. The reaction subsided after five days. CONCLUSION: Hand-foot syndrome is one of the commonest ADRs due to the use of lenvatinib. Lenvatinib is an oral formulation that patients can take at their homes. Hence, educating patients regarding the HFS is important so that they report it to the treating physicians on time. It is also essential to educate patients regarding the precautions to be taken to avoid hand-foot syndrome. This will help the physicians with the early discontinuation and appropriate treatment with corticosteroids, which will help in improving the quality of life of the patients already suffering from cancer.

A Dosimetric Comparison of Volumetric-modulated Arc Therapy and IMRT for Cochlea-sparing Radiation Therapy in Locally Advanced Nasopharyngeal Cancer.

Background: Head-and-neck cancer treatment includes radiotherapy as a crucial component. However, radiotherapy, like other treatment modalities, has its own side effects, some of which can be avoided using the latest medical technology and understanding the illness. Despite being a relatively uncommon subtype of head-and-neck cancer, radiation is essential in the treatment of nasopharyngeal carcinoma (NPC). Because of the complex anatomy of the nasopharyngeal region, it is difficult to plan radiotherapy without sparing the cochlea, an important part of the auditory system, and the radiotherapy dosage to it may cause sensorineural hearing loss. In the modern era, volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) have become the gold standard in radiotherapy. With the advancement of these techniques, cochlear sparing is now possible without compromising the tumor dose. Materials and Methods: We reviewed 14 plans for patients with locally advanced NPC who had received radiation in our department. VMAT plans were created for patients who had IMRT radiotherapy and vice versa. Both approaches were evaluated in terms of cochlea sparing while maintaining the coverage of the planned target volume (PTV). Results: Our study compared the results of two different radiation techniques for locally advanced NPC, IMRT, and VMAT in 14 cases, and we found that VMAT was associated with a lower maximum dose to the cochlea, a lower mean dose to the cochlea, a higher PTV D98% (Gy), a lower PTV D2% (Gy), a higher PTV V95% (%), a lower heterogeneity index, and a higher conformity index. The P value for each comparison was <0.05, which indicates that the difference is statistically significant. These results suggest that VMAT is a better radiation technique than IMRT for locally advanced NPC. VMAT is associated with a lower dose to the cochlea and other organs at risk, which can improve the quality of life and survival of patients. Conclusion: These results suggest that VMAT is a better radiation technique than IMRT for locally advanced NPC. VMAT is associated with a lower dose to the cochlea and other organs at risk, which can improve the quality of life and survival of patients.

Epithelial-Myoepithelial Carcinoma of Nasal Cavity at an Unusual Age: A Case Report and Review of Literature.

Introduction: Epithelial-myoepithelial carcinoma (EMC) was recognised as a distinct pathologic entity in World Health Organisation classification. It is an extremely rare low grade carcinoma of salivary gland, with characteristic biphasic tubular structures. It predominantly occurs in Parotid gland but can also be seen in nasopharynx, lacrimal gland, paranasal sinuses, larynx, lung. Nasal EMC (excluding the paranasal sinuses as primary tumour site) are very rare with only 13 cases reported till date. In this case report, we described a case of nasal EMC extending into nasopharynx, its clinical features and management. We have also done a literature review of all the relevant cases of nasal EMC. Material and Methods: We searched the PubMed database for articles between January 1950 and December 2022 for nasal EMC for this review. Results: We found 13 relevant case reports of nasal EMC and median age was 58 years with female preponderance. We found that our patient was the youngest to be reported till date. Two cases, including the current study, showed epicentre of the tumour in posterior nasal cavity, extending to choana and nasopharynx. Most common presentation was epistaxis, followed by nasal obstruction. Only 4 out of 14 cases had information on surgical margin status, out of which only one has positive surgical margin. Five patients (including the patient in the current study) received adjuvant radiotherapy; however 6 patients (42.8%) did not receive any adjuvant radiotherapy.

Solitary Extraosseous Plasmacytoma of Submandibular Gland - Report of a Rare Case.

BACKGROUND: Plasmacytomas are tumors involving plasma cells that can be either osseous or extraosseous. Solitary extraosseous plasmacytomas are rarely found in the head and neck region. Various pathological, immuno-histochemistry, and radiological investigations must be done to distinguish it from multiple myeloma. CASE: A 41-year-old female presented with a progressively increasing mass in right submandibular region for 1 year. She also had complaints of dysphagia and dyspnea for 3 months. Histopathological examinations showed lymphoplasmacytic infiltrate and possibility of plasma cell neoplasm was suspected. On further investigations like immunohistochemistry, bone marrow biopsy, quantitative immunoglobulin, immunoelectrophoresis, and urine analysis, diagnosis of extraosseous plasmacytoma was made. Positron emission tomography-computed tomography (PET-CT) scan did not show any distant foci of the disease. The patient received definitive radiotherapy to the primary region and tolerated well. The patient is asymptomatic after 1 month of radiotherapy and is on regular follow-up. CONCLUSIONS: Extraosseous plasmacytoma of the submandibular region is very rare but radiosensitive tumor. Multiple myeloma must be ruled out prior to start of any treatment. Long term follow ups are required to comment on disease progression, dissemination, or recurrence.

Advancing Precision in Post-mastectomy Chest Wall Radiotherapy: A Comparative Dosimetric Analysis of Volumetric-Modulated Arc Therapy (VMAT) and Intensity-Modulated Radiotherapy (IMRT) Based on Institutional Experience.

BACKGROUND: Post-mastectomy radiation therapy (PMRT) is an important component in the management of breast cancer patients who have undergone mastectomy. Intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are two popular methods of delivering PMRT. With IMRT, high radiation doses are directed at the tumor, while exposure to healthy tissue is kept to a minimum. VMAT, on the other hand, is a more advanced version of IMRT that allows for faster radiation dose delivery while maintaining precision. The complexity of the VMAT treatment planning and delivery process, on the other hand, may increase the risk of technical errors, which can reduce treatment effectiveness.  Studies have compared VMAT and IMRT in PMRT for breast cancer patients, but most have found no significant differences in treatment outcomes between the two methods. Individual patient factors such as treatment goals, available resources, and other characteristics may influence the choice between the two techniques. PURPOSE:  This prospective observational study aimed to compare the dosimetry of two cutting-edge modern radiotherapy techniques for post-mastectomy breast cancer patients receiving hypofractionated doses. METHODS:  For 58 patients with breast cancer, 116 plans for radiotherapy treatment were generated by both VMAT and IMRT. To maintain the uniformity of contouring, every CT image was contoured by the same physician, and Radiotherapy Oncology Group (RTOG) contouring guidelines were strictly followed during contouring. RESULTS: Both techniques had comparable target volume coverage, but VMAT produced a significantly better conformity index than IMRT for both the left (0.71 vs. 0.65) and right (0.72 vs. 0.66) breasts (p-value < 0.05). VMAT plans had significantly higher low-dose spillage to the ipsilateral lung (V5Gy and V10Gy) but significantly lower high-dose spillage (V20Gy, V30Gy, and V40Gy) than IMRT plans (p-value < 0.05). Dmax and Dmean for the ipsilateral lung were comparable for both techniques. When compared to alternative treatment approaches, IMRT treatment plans were found to be more effective in minimizing radiation exposure to the heart for all patients with right-sided breast cancer, resulting in considerably lower levels of Dmean, V5Gy, V10Gy, V20Gy, and V35Gy. Plans for VMAT treatment were found to be significantly superior to left-side chest wall radiotherapy in terms of lower exposure to the heart for higher doses. IMRT plans, on the other hand, were successful in dramatically lowering the levels of Dmax that reached the spinal cord for both right- and left-sided breast cancers. CONCLUSION: Apart from similar planning target volume (PTV) coverage to IMRT plans, VMAT produced significantly better conformity. VMAT plans have more low-dose spillage to normal tissues, while IMRT plans spare various organs at risk significantly better at lower doses in both right and left-sided breast cancer. VMAT was found to be better at sparing the heart (in left-sided breast cancer only) and ipsilateral lung at a high dose range. The best radiotherapy approach for breast cancer should be established on an individual basis, taking into account tumor laterality and the risk-benefit ratio.

Diffuse White Adipose Tissue 18F-FDG Uptake-An Unusual Finding on 18F-FDG PET/CT.

ABSTRACT: Brown adipose tissue of cervical, supraclavicular, and paravertebral regions can show increased FDG uptake. But human white adipose tissue (WAT) shows negligible FDG uptake on 18F-FDG PET/CT scan. We present a case of carcinoma cervix treated with concurrent chemoradiation. 18F-FDG PET/CT shows altered biodistribution of FDG with intense FDG uptake throughout the WAT. Later on, patient confirmed taking herbal medication for herpes zoster infection, which could contain corticosteroids, resulting in enhanced WAT uptake of 18F-FDG.

Double primary malignant tumor in a centenarian female: Case report and review of literature.

A hundred and three year old female patient was evaluated for ulcer over the nasion area and a mass arising from the right upper eyelid, appearing two months apart. Histopathology revealed nasion ulcer as basal cell carcinoma while right eyelid mass was diagnosed as poorly differentiated squamous cell carcinoma. Based on these findings and the time gap between two lesions a diagnosis of synchronous double primary malignant tumor was made. Although the prevalence of multiple primary malignant tumor is highest in breast, colo-rectum and prostate cancer we report a rare case of double primary malignant tumor of the eyelid and nasion in a centenarian female.

Precision of intraocular lens power prediction in eyes shorter than 22 mm: An analysis of 6 formulas.

PURPOSE: To analyze the precision of 6 intraocular lens (IOL) power calculation formulas in predicting refractive outcome in eyes with an axial length (AL) less than 22.0 mm. SETTING: Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, India. DESIGN: Retrospective observational study. METHODS: Patients with an AL less than 22.0 mm were included in the study. If both eyes were eligible, a randomly selected eye was chosen. Optical biometry with partial coherence interferometry (PCI) was performed in all cases. Six formulas were analyzed: Barrett Universal II, Haigis, Hoffer Q, Holladay 2, RBF Method and SRK/T. The mean numerical error was defined as the difference between the actual postoperative spherical equivalent (SE) at the 1-month follow-up and the predicted postoperative SE. The median absolute error was calculated and compared between all 6 formulas after the zeroing of the mean numerical error by adjusting the lens constant individually for each formula. RESULTS: The study comprised 50 eyes of 50 patients. The Friedman test was applied to compare the median absolute error between the 6 formulas after the zeroing of the mean numerical error. Post hoc analysis and Bonferroni correction for multiple comparisons showed no significant statistical difference between them. CONCLUSION: The Barrett Universal II, Haigis, Hoffer Q, Holladay 2, RBF method and SRK/T formulas were equally accurate in predicting the IOL power in eyes shorter than 22.0 mm.