Primary Anorectal Melanoma: A Case Report.

Primary anorectal melanoma is an extremely rare and aggressive mucosal melanocytic malignancy of the anorectal region. Because of the rarity of the tumor and vague clinical presentations, diagnosis at an early stage is a challenge for clinicians. In our context, where the hemorrhoid is a diagnosis of cultural familiarity for any sort of rectal pathology, these patients often present to us at a very advanced stage of the disease. Here, we present a case of a 55-year-old male patient with stage 2 anorectal melanoma who is on adjuvant chemotherapy following abdominoperineal resection with a permanent colostomy. Five cycles of dacarbazine and carboplatin have been given and the patient is doing well with the treatment. Abdominoperineal resection with excision of the tumor remains the mainstay of treatment; however, poor patient compliance with permanent colostomy is a major limiting factor of abdominoperineal resection. Even with the best interventions and care, the survival rate is not very good. Keywords: abdominoperineal resection; adjuvant chemotherapy; case reports; melanoma.

Promising Response of Paclitaxel in Metastatic Transitional Cell Carcinoma of Distal Ureter Complicated with Hydroureteronephrosis: A Case Report.

Ureteric carcinoma is the rarest of all urothelial malignancies, and little attention has been given to it. Palliation in these groups of patients is a dilemma in the clinics. Use of chemotherapeutic agents in ureteric carcinoma is a double edged sword, as these patients had already impaired renal function due to post-renal failure and nephrotoxic nature of most of the chemotherapeutic agents can further deteriorate the renal function, making the management approach, a relatively visionary task. Here, we present a case of a 77-year-old female with metastatic ureteric carcinoma locally complicated with hydroureteronephrosis, coming to us with gross haematuria, lower abdominal pain along with cough. Apart from age factor of the lady, presence of hydroureteronephrosis and pulmonary metastases was another challenge for us. Paclitaxel remains the mainstay of our treatment. Keywords: carcinoma; case reports; metastasis; paclitaxel.

Lung Cancer with Brain Metastases Treated with Radiotherapy Followed by Bevacizumab Maintenance: A Case Report.

Brain metastases in a patient with non-small cell lung cancer carry a grave prognosis. Without effective interventions, the average survival rate is 6 months. Here, we present a case of a 59-year-old male with non-small cell lung cancer and multiple brain metastases treated with radiotherapy followed by bevacizumab maintenance with prolonged survival. There are limited studies establishing the efficiency and toxicity profile of anti-vascular endothelial growth factors for brain metastases. This reported case had a remarkable response with marked clinical and radiological improvement along with a tolerable toxicity profile. Showing the extent of effectiveness and efficacy of anti-vascular endothelial growth factor agents in the case of lung cancer with brain metastases is the main motto of our study. Keywords: bevacizumab; brain metastases; radiotherapy.

Evans Syndrome: A Case Report.

Evans syndrome is defined as the concomitant or sequential association of warm autoimmune hemolytic anaemia with immune thrombocytopenia, and less frequently autoimmune neutropenia. It is associated with non-cross-reacting auto-antibodies directed against antigens specific to red blood cells, platelets or neutrophils. Clinical symptoms could be related to hemolysis and thrombocytopenia. Evans syndrome is a rare diagnosis of exclusion. The first-line treatment of Evans syndrome is intravenous corticosteroids or intravenous immunoglobulins and second-line treatment with rituximab or splenectomy for those who are refractory to steroids. Here is a case of a fifty-year-old- female who presented with bleeding from the mouth and gums, bluish patches over the shin and trunk along with generalised weakness and severe backache. We are interested in reporting this case because the presentation of patients with such scenarios on our part will compel the treating physician to overlook Evans syndrome and get it underdiagnosed. Keywords: case reports; immunoglobulins; neutropenia; thrombocytopenia.

Plasmablastic Lymphoma Involving Kidney in an HIV Positive Patient: A Case Report with Review of the Literature.

Plasmablastic lymphoma (PBL) is an aggressive lymphoma commonly associated with HIV infection. It most commonly presents in the oral cavity and rarely involves the kidney. Herein, we report a case of HIV positive male with renal involvement of PBL. The patient presented with unilateral severe hydronephrosis with unaltered renal functions. Despite aggressive management, there was an early relapse and the patient died within 2 years of the diagnosis. Despite the recent advances in the therapy of HIV-associated aggressive lymphomas, patients with PBL have a poor prognosis. Multimodal treatment with chemotherapy, newer targeted and biological agents, along with hematopoietic stem cell transplantation is essential for the treatment of PBL.

Pituitary hyperplasia due to Himalayan endemic hypothyroidism.

Pituitary hyperplasia due to hypothyroidism can be treated medically. This condition should not be mistaken for adenoma and surgery should be avoided.

Pituitary hyperplasia in childhood primary hypothyroidism: a review.

INTRODUCTION: Pituitary hyperplasia following primary hypothyroidism in pediatric age group population is considered rare with reports of unnecessary neurosurgical intervention for this medically treatable condition. Given the paucity of information on this topic, it is timely to provide clinicians with a comprehensive summary of available research. METHODS: A search of published studies in Pubmed, PsychInfo and Cochrane Database with the terms "pituitary hyperplasia" or "pituitary hypertrophy" and "hypothyroidism" was performed and the results filtered for English language, pediatric (0-18 years) population and CT or MRI confirmed findings. 55 studies met the inclusion criteria. Data for a total of 110 patients with pituitary hyperplasia following primary hypothyroidism were extracted. The study population included 29 males and 81 females (M: F= 0.35:1). Patient age varied from 3 weeks to 18 years with a mean age of 10.22 years. RESULTS: The most common clinical presentations included growth retardation, constipation and features of myxedema which were present in 78, 36 and 18 percent of children included in our review. Neuroimaging showed the mean (SD) pituitary height being 13.48 mm (4.72 mm). All of the patients achieved resolution of their pituitary mass and clinical as well as biochemical abnormalities 1 to 26 months after initiation of thyroid hormone replacement therapy, with an average time interval of 7.22 months. Our review has tried to delve in the pathophysiology as well as clinical, biochemical and radiological aspects of pediatric pituitary hyperplasia secondary to primary hypothyroidism and provide recommendations for treatment and follow-up. This may help anyone concerned gain a substantial knowledge on this topic.

Bilateral Neuroendocrine Carcinoma of Breast: A Case Report.

Primary neuroendocrine carcinomas of the breast are rare of all breast carcinomas. They may be welldifferentiated, poorly differentiated, or invasive breast cancers with neuroendocrine differentiation. They are staged and treated similarly to conventional breast cancer. Herein, we report a case of invasive ductal carcinoma with neuroendocrine differentiation of the breast in a 73 years female with a history of breast lump initially in the lower inner quadrant of left breast and a month later, similar lump at the same site in right breast. Patient underwent Modified Radical Mastectomy bilaterally followed by adjuvant chemotherapy based on Carboplatin and Etoposide regimen.

Analysis of Peripherally Inserted Central Catheter Line in Cancer Patients: A Single-Center Experience.

Background Peripherally inserted central venous catheters are now widely used in cancer patients who require long-term treatment, for delivering multiple infusates. We aimed to evaluate the overall use of peripherally inserted central catheter (PICC) line in cancer patients, with the objective to study the demographic profile, complications, and safety related to PICC line in cancer patients. Methods All the patients undergoing treatment for hematological and solid malignancies with PICC line inserted at the Healthcare Global Hospital during the study were evaluated prospectively. The complications related to PICC and its safety were analyzed. Results Five hundred PICCs were inserted over a period of 2 years to 8 months for a total of 62,440 catheter days (mean of 24 days, i.e., 4.2 months, range: 1-434 days). The most common indication for PICC was for delivering chemotherapy (100%). Of these, 51 (10.2%) PICCs had complications at the rate of 0.82/1000 PICC days, and hence, 41 PICCs were removed. Hematological malignancies had more complications as compared with those with solid malignancies. Conclusions PICCs are comparatively safe method for the central venous access in cancer patients.

Prospective Analysis of Patients with Metastatic Breast Cancer receiving Eribulin Mesylate as Second or More Lines of Chemotherapy: An Indian Experience.

BACKGROUND: Eribulin mesylate is a non-taxane microtubule inhibitor which can be used after anthracycline and taxane treatment in patients with metastatic breast cancer (MBC). The purpose of this study was to investigate the efficacy and safety of eribulin monotherapy in heavily pretreated patients with MBC. METHODS: In this study, a total of 45 eligible patients with MBC who received eribulin in HCG Cancer Speciality Center from November 2014 to March 2016 were prospectively analyzed. Breslow (generalized Wilcoxon) survival analysis was carried out for progression-free survival and for overall survival. Patients were excluded if they had not taken treatment for 3 cycles and defaulted/expired during the treatment. RESULTS: In this study, median age of patients was 52 years. A total of 27 (60%) patients had estrogen receptor and progesterone receptor (PR) positive primary tumors, whereas HER2 was overexpressed or amplified in 7 (15.6%); a triple negative subtype was recorded in 13 patients (28.9%). Regarding toxicity, 30 patients (66.67%) tolerated treatment well and 3 patients (6.67%) got anemia, 6 patients (13.3%) experienced neutropenia, and 7 (15.62%) patients had neurological toxicity. About 14 (31.1%) patients showed PR, 12 (26.7%) patients had stable disease (SD), whereas 19 (42.25%) patients showed progression disease (PD). Response evaluation at 6 cycles was possible in 18 patients and revealed that 4 (22.5%) patients showed PR, 10 (55.5%) patients had SD, whereas 4 (22.2%) patients had PD. Progression-free survival of the overall study population was 3.95 months. CONCLUSIONS: Eribulin mesylate is efficacious and tolerable chemotherapy as second- and third-line treatment options for MBC.

Pediatric oncology services in Nepal.

Cancer in children is one of the emerging noncommunicable diseases in Nepal with significant morbidity and mortality. Significant efforts are being made at the government and nongovernment level to provide awareness, early diagnosis, and effective treatment to improve the cure rate of children with cancer. The major challenges include: lack of education, late diagnosis, advanced disease at presentation, financial problems, geographical and transportation difficulties, and inconsistent supply of chemotherapy medicines.