Primary pulmonary Hodgkin's lymphoma with pulmonary histoplasmosis.

Primary pulmonary Hodgkins lymphoma is a rare and enigmatic neoplasm commonly seen in females. The aim of this case report is to emphasize that pulmonary lymphoma should be considered as a differential diagnosis in a young patient presenting with a lung mass and B symptoms. Extensive clinical details, imaging should be done to rule out the secondary involvement of lung by other lymphomas.

A Rare Case of Mediastinal Non-seminomatous Germ Cell Tumour with Acute Megakaryocytic Leukaemia.

The most common extragonadal site of Nonseminomatous Germ Cell Tumours is the mediastinum. These are similar to their gonadal counterparts in histology but have a poorer prognosis. The association of mediastinal germ cell tumours with blood borne malignancies has been established in many case reports. However, the association of concomitant mediastinal non seminomatous germ cell tumours with Acute Megakaryocytic Leukemia is very rare with only 26 cases reported in the last 07 Decades. These patients have a very poor prognosis with only one survivor being reported till present date. AML (M7), a rare variant of Primary AML, has been more commonly associated with non seminomatous germ cell tumours. Here, we report such a rare case of dual malignancy, Non Seminomatous Germ Cell Tumour with AML (M7) which was managed at our centre.

Efficacy and safety of concurrent chemoradiotherapy with or without Nimotuzumab in unresectable locally advanced squamous cell carcinoma of head and neck: Prospective comparative study - ESCORT-N study.

BACKGROUND: Nimotuzumab is an anti-epidermal growth factor receptor monoclonal antibody which can be added to chemoradiotherapy (CRT) to improve efficacy for management of locally advanced squamous cell carcinoma of the head and neck (LASCCHN). We prospectively evaluated the efficacy and safety of nimotuzumab with CRT for LASCCHN and compared with CRT alone. MATERIALS AND METHODS: In this prospective study, 29 LASCCHN (Stage III-IVb) patients received Nimotuzumab plus CRT or CRT alone. Treatment included six cycles of cisplatin (40-50 mg/week) or carboplatin (area under the curve-based), nimotuzumab (200 mg/week), and radiotherapy (60-70 Gy). Tumor response was evaluated as per response evaluation criteria in solid tumors criteria. MoS was estimated using the Kaplan-Meier method. Toxicity and adverse events (AE's) were assessed as per CTCAE v 4.0. RESULTS: At 24 weeks after completion of treatment, the tumor response rate (complete response, partial response, stable disease) was 53.3% and 35.7% favoring nimotuzumab arm while progression of disease was 40% and 35.7% in Nimotuzumab plus CRT and CRT groups, respectively. However, the objective response rate was 57% and 30% in favor of nimotuzumab arm. At median follow-up of 45.5 months, MoS was 33 months in Nimotuzumab plus CRT and 27 months in CRT group. The 5-year survival rate was 33.3% in Nimotuzumab plus CRT versus 7.1% in CRT group. Nimotuzumab was observed to be safe with no additional AE's such as hypersensitivity, hypomagnesemia, and allergic reaction was reported. CONCLUSION: Addition of Nimotuzumab to standard CRT showed improved survival rate in unresectable, LASCCHN patients without producing additional toxicity.

Diagnostic Accuracy of Stress Myocardial Perfusion Imaging in Diagnosing Stable Ischemic Heart Disease.

OBJECTIVE: To determine the diagnostic accuracy of Stress Myocardial Perfusion Imaging (MPI) in diagnosing Stable Ischemic Heart Disease (SIHD). METHODS: To analyze the sensitivity and specificity of Stress Myocardial Perfusion Imaging (MPI) in diagnosing Stable Ischemic Heart Disease (SIHD) by comparing with "gold standard" Coronary Angiogram. RESULTS: A total of 80 patients were studied (51 male, 29 female). 52 patients had significant stenosis in coronary angiography and 49 patients had reversible perfusion defect in myocardial perfusion imaging (MPI). MPI had a sensitivity of 88.46% and a specificity of 89.29% in diagnosing stable ischemic heart disease. CONCLUSION: Coronary Angiography remains the near gold standard in diagnosing ischemic heart disease but is associated with serious complications like stroke, arrhythmias, acute renal failure, infection, etc. Though Myocardial perfusion imaging cannot replace coronary angiogram, it can be used as a reliable and sensitive non-invasive alternate investigation to diagnose stable ischemic heart disease in high risk individuals who are unwilling for angiogram.

Post-transplant Lymphoproliferative Disorder.

Post-transplant lymphoproliferative disorders (PTLDs) are life-threatening complications of solid-organ transplantation and bone marrow transplantation leading to a high mortality. PTLD represents a heterogeneous group of lymphoproliferative diseases. They become clinically relevant because of the expansion of transplantation medicine together with the development of potent immunosuppressive drugs associated now with long survival. The risk of PTLD is highest in the early post-transplant period, but the cumulative risk increases with time. We report a case of two sequential malignancies - carcinoma bladder occurring -13 years and now gastric lymphoma -15 after renal transplantation in a 73-year-old man.

Paraneoplastic Inverse Myasthenic Syndrome as a Presentation of Bronchogenic Carcinoma.

Tumours may produce growth factors and cytokines responsible for signs and symptoms distant to the primary or metastatic site. This may be the first sign of a malignancy and its recognition may be critical for early cancer detection. Moreover, proper diagnosis spares the patient of extensive and expensive search for an alternate cause of the neurological dysfunction. In neurological paraneoplastic syndromes like Lambert Eaton Myasthenic syndrome associated with small cell lung cancer, evidence of autoimmunity against presynaptic neuro-muscular junction by anti voltage gated calcium channel anti bodies is well documented. 60% of patients with LEMS are associated with an underlying cancer, usually SCLC. We report a 49 year old male, with over thirty pack years of smoking, who presented with dysautonomia, constitutional symptoms and weakness of all four limbs. Investigations confirmed axonal motor neuropathy with limited stage SCLC with fibro nodular lesions right upper lobe and mediastinal lymphadenopathy. He improved dramatically following chemotherapy and radiotherapy.