Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

Cetuximab Monotherapy and Cetuximab plus Irinotecan in Irinotecan-Refractory Metastatic Colorectal Cancer

India is a high incidence area for gallbladder cancer (GBC) and contributes to about 10% of the global GBC burden. Within India, the incidence is high in North, North-East, Central and Eastern India, and less common in South and West India. The incidence has been on a steady rise in both genders. The presentation is often with advanced disease and carries dismal prognosis. GBC in India usually affects younger patients in the 5th and 6th decade in contrast to the west. Gallstones are present in 80% of the Indian patients with GBC and its presence increases the vulnerability of the GB to mucosal injury. The incidence of GBC is out of proportion to the prevalence of gallstones in the country. Additional co-factors such as older age, lower socio-economic status, chronic Salmonella typhi (S. typhi) infection, Helicobacter pylori (H. pylori) infection, exposure to pollutants, heavy metals, chemicals, adulterated mustard oil and smoking in patients with gallstones have been identified which promote carcinogenesis. These risk factors act in tandem in an additive manner resulting in higher incidence of GBC as well as hasten the development of GBC. Environmental risk factors such as soil and water contamination by industrial wastes, agricultural effluents and human sewage have been identified as putative risk factors. Combination of a toxic environment, vulnerable GB and a susceptible host play a key role in the pathogenesis of GBC in the country. Large multicentric comprehensive studies are required in India to assess the attributable risk of each of the identified putative risk factors. This will help in formulating cost effective national strategies in preventing GBC related mortality in the country. Meanwhile a high index of suspicion to pick up incidental GBC, and improved access to healthcare facilities to manage GS appropriately will help in reducing GBC related mortality.

Epidemiology of gallbladder cancer in India.

Report from India.

Members of the tetraspanin family have been identified as essential cellular membrane proteins in infectious diseases by nearly all types of pathogens. The present review highlights recently published data on the role of tetraspanin CD151, CD81, and CD63 and their interaction partners in host cell entry by human cytomegalo- and human papillomaviruses. Moreover, we discuss a model for tetraspanin assembly into trafficking platforms at the plasma membrane. These platforms might persist during intracellular viral trafficking.

Tetraspanins in infections by human cytomegalo- and papillomaviruses.

Primitive neuroectodermal tumors (PNETs) are highly malignant small round blue cell tumors of neuroectodermal origin belonging to either central nervous system, autonomic nervous system or peripheral Askin's or Ewing's group of neoplasms. The latter generally arise in soft tissues of trunk or axial skeleton in children and early adolescents. However in adults this entity is very uncommon. Of all peripheral entities, primary PNET of lungs without chest wall or pleural involvement in adults are extremely rare and have been scarcely reported in world literature as single case reports. We hereby report a series of three interesting cases of adult PNET of lung diagnosed and treated in our institute. The chief presenting complaints of these patients were of chest pain, cough and dyspnea. The cases were diagnosed on the basis of imaging and biopsy which confirmed these lesions to be of PNET histology, confirmed by immunopositivity for neuron specific enolase (NSE), synaptophysin, chromogranin, CD 99 and vimentin on immunohistochemistry (IHC). All three were deemed unresectable in view of infiltration of nearby vital organs and high chances of morbidity. They were treated with upfront chemotherapy followed by conformal radiotherapy (RT) to the residual disease to which they showed significant response both clinically and radiologically. Presently these patients are on regular follow-up for over 6 months without any evidence of progression of disease or distant metastasis.

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Primitive neuroectodermal tumor of lungs in adults: a rare series of three cases treated with upfront chemo-radiation.

Retinoblastoma (Rb) is a common childhood malignancy but bilateral Rb with metastasis to parotids is very uncommon. To the best of our knowledge, bilateral Rb metastasizing to parotids is very rare and this is the fifth such case reported in world literature till date in a 2-year-old male child who underwent exenteration of left eye for bilateral Rb and later developed recurrent metastasis to left parotid requiring parotidectomy. A year later he presented again with swelling left parotid region extending from occipital region reaching upto left anterior chest wall with intra-cranial extension on magnetic resonance imaging. Histopathological examination of the parotid swelling and immunohistochemistry showed metastasis from Rb. He was treated with chemotherapy followed by radiotherapy to local site and brain to which he responded well. Presently on regular follow up without any signs of locoregional and distal metastasis. Till date different types of primary parotid tumors have been reported in literature but a metastatic parotid tumor is extremely rare and therefore this case is being reported to highlight the extreme rarity, the diagnostic and therapeutic challenges, the highly aggressive nature and overall dismal prognosis of this disease entity.

/pdf/an-extremely-rare-case-of-metastatic-retinoblastoma-of-28061xuruv.pdf

An extremely rare case of metastatic retinoblastoma of parotids presenting as a massive swelling in a child.

The two important enabling characteristics of cancer cells are uncontrolled proliferation and loss of programmed cell death (enhanced survival). These processes are tightly controlled by the discrete integration of signalling cascades that translate extracellular and intracellular cues into specific output responses.  Alterations in these pathways in cancer cells by mutation, amplification/deletion, chromosomal translocation, over expression, or epigenetic silencing lead to constitutive activation or suppression of signalling. We will review the major signal transduction cascade well known as the receptor tyrosine kinase pathway, focussing on their common alterations in human cancers and their clinical implications and therapeutics. Since major drug development efforts are presently being focused on the development of targeted inhibitors of oncogene-activated signalling pathways, a detailed understanding of these normal physiological pathways along with their deregulation in cancer will be required of both basic cancer researchers and practicing clinical oncologists for betterment of mankind suffering. Hence with this requirement in mind we have written this article to highlight some of the most important signal transduction pathways that is receptor tyrosine signalling pathways.

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Receptor tyrosine kinase signaling pathways: a review -

Aim of the Study: The aim of this study is to evaluate the demographic and clinicopathological profile of the patients with gallbladder cancer (GBC). Materials and Methods: A total of 68 diagnosed cases of GBC were taken in the study during the study period from January 2016 to December 2017. A detail questionnaire was filled through the counseling to take demographic profile including socioeconomic status, nonclinical characteristics, dietary, and other risk factors apart from clinicopathological profile of patients. Results: We found most of the patients were females with median age 51.8 years. More than half of them were postmenopausal (56.60%), and high parity was seen in 39.62% of females. Obesity was associated factor mainly in females (28/53), and none of the males were obese. Nearly 83.82% (57/68) of patients had advanced stage disease, with metastatic disease in 72.06% (49/68) patients. Majority of the patients had at least two sites of metastasis (73.47%), with liver (57.14%), omentum (40.82%), and nonregional lymph nodes (53.06%) being common sites of dissemination. Bony metastasis, being rare in literature, was found in 6 (12.24%) of patients, most of them developed it later during the disease course. Conclusion: Majority of the patients was female within the age group of 41–60 years, associated with gallstones and had advanced disease. We did not find greater impact of diet on the incidence as vegans and nonvegans were almost equally divided in our study. A high index of suspicion and health education seems to be the only answers available for early detection and improvement of survival.

Carcinoma of gall bladder: Demographic and clinicopathological profile in Indian patients

Background: The bedside index for severity in acute pancreatitis (BISAP), a newer prognostic scoring system, has been proposed as a simple and clinically oriented severity scoring system for early identification of patients with acute pancreatitis. This study evaluates the efficacy of BISAP score to predict the severity of organ failure in patients of acute pancretitis and its correlation with Marshall score. Methods: The clinical, laboratory and radiological data for all patients admitted with a diagnosis of acute pancreatitis conducted at tertiary hospital of Armed Forces over a two-year period, was prospectively collected for this study. BISAP score was calculated within 24hrs of presentation. Markers of severity were the development of organ failure and presence of pancreatic necrosis. Outcome at 28 days (viz. recovery, organ failure and mortality) was studied for each patient. BISAP score computed at 24h was correlated with the above and its efficacy to predict the severity of organ failure in Acute Pancreatitis, was assessed. Results: Out of 50 patients in the study group, 41 were male and 9 were female with the mean (±SD) age 43.74±16.85 years. Majority of the study population had alcohol (56%) as the etiology followed by gall stones (28%). Outcome assessed at 28 days revealed recovery of 54%, complication of 36% and mortality of 10% of study population. BISAP score computed within 24 hours of admission of 2 or more significantly predicted the severity and complication with P value <0.001. Statistically significant trends of increasing severity and organ failure (P<0.001) with increasing BISAP was observed. Conclusions: BISAP score is a reliable means of predicting the severity and organ failure and stratifying patients with Acute Pancreatitis within 24 hours of admission. The statistically significant incidence of increasing severity and mortality with increasing BISAP score will help us to risk stratify the patients within 24 hours of admission and help improve clinical care and facilitate necessary interventions as early as possible.

/pdf/prospective-evaluation-of-the-bisap-score-and-its-4ojyf0zcab.pdf

Abhishek Pathak

Papers

Primitive neuroectodermal tumor of lungs in adults: a rare series of three cases treated with upfront chemo-radiation.

An extremely rare case of metastatic retinoblastoma of parotids presenting as a massive swelling in a child.

Receptor tyrosine kinase signaling pathways: a review -

Carcinoma of gall bladder: Demographic and clinicopathological profile in Indian patients

Prospective evaluation of the BISAP score and its correlation with Marshall score in predicting severity of organ failure in acute pancreatitis