One quarter of the global population is estimated to have nonalcoholic fatty liver disease (NAFLD). The incidence of nonalcoholic steatohepatitis (NASH) is projected to increase by up to 56% in the next 10 years. NAFLD is already the fastest growing cause of hepatocellular carcinoma (HCC) in the USA, France and the UK. Globally, the prevalence of NAFLD-related HCC is likely to increase concomitantly with the growing obesity epidemic. The estimated annual incidence of HCC ranges from 0.5% to 2.6% among patients with NASH cirrhosis. The incidence of HCC among patients with non-cirrhotic NAFLD is lower, approximately 0.1 to 1.3 per 1,000 patient-years. Although the incidence of NAFLD-related HCC is lower than that of HCC of other aetiologies such as hepatitis C, more people have NAFLD than other liver diseases. Urgent measures that increase global awareness and tackle the metabolic risk factors are necessary to reduce the impending burden of NAFLD-related HCC. Emerging evidence indicates that reduced immune surveillance, increased gut inflammation and gut dysbiosis are potential key steps in tumorigenesis. In this Review, we discuss the global epidemiology, projections and risk factors for NAFLD-related HCC, and propose preventive strategies to tackle this growing problem.

Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention

Cancer of the breast

Breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Data reports from various latest national cancer registries were compared for incidence, mortality rates. The age adjusted incidence rate of carcinoma of the breast was found as high as 41 per 100,000 women for Delhi, followed by Chennai (37.9), Bangalore (34.4) and Thiruvananthapuram District (33.7). A statistically significant increase in age adjusted rate over time (1982-2014) in all the PBCRs namely Bangalore (annual percentage change: 2.84%), Barshi (1.87%), Bhopal (2.00%), Chennai (2.44%), Delhi (1.44%) and Mumbai (1.42%) was observed. Mortality-to-incidence ratio was found to be as high as 66 in rural registries whereas as low as 8 in urban registries. Besides this young age has been found as a major risk factor for breast cancer in Indian women. Breast cancer projection for India during time periods 2020 suggests the number to go as high as 1797900. Better health awareness and availability of breast cancer screening programmes and treatment facilities would cause a favorable and positive clinical picture in the country.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajco.12661

Epidemiology of breast cancer in Indian women.

Nonalcoholic fatty liver disease (NAFLD) is a spectrum of disease, extending from simple steatosis to inflammation and fibrosis with a significant risk for the development of cirrhosis. It is highly prevalent and is associated with significant adverse outcomes both through liver-specific morbidity and mortality but, perhaps more important, through adverse cardiovascular and metabolic outcomes. It is closely associated with type 2 diabetes and obesity, and both of these conditions drive progressive disease toward the more advanced stages. The mechanisms that govern hepatic lipid accumulation and the predisposition to inflammation and fibrosis are still not fully understood but reflect a complex interplay between metabolic target tissues including adipose and skeletal muscle, and immune and inflammatory cells. The ability to make an accurate assessment of disease stage (that relates to clinical outcome) can also be challenging. While liver biopsy is still regarded as the gold-standard investigative tool, there is an extensive literature on the search for novel noninvasive biomarkers and imaging modalities that aim to accurately reflect the stage of underlying disease. Finally, although no therapies are currently licensed for the treatment of NAFLD, there are interventions that appear to have proven efficacy in randomized controlled trials as well as an extensive emerging therapeutic landscape of new agents that target many of the fundamental pathophysiological processes that drive NAFLD. It is highly likely that over the next few years, new treatments with a specific license for the treatment of NAFLD will become available.

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Nonalcoholic Fatty Liver Disease in Adults: Current Concepts in Etiology, Outcomes, and Management.

Aims: 1) To evaluate the estrogen receptor(ER), progesterone receptor (PR) and Her-2 /neu expression in invasive breast carcinomas by immunohistochemistry and 2) to compare the pattern of expression with clinicopathological parameters like patient’s age, tumor size, mitotic index, histological type and grade and lymph node metastasis. Methods: This is a retrospective study of 321 female invasive breast carcinomas diagnosed in the Department of Histopathology, Apollo Speciality Hospital, Chennai from January 2009 to June 2010. Results: The age of the patients ranged from 24 to 99 years, with a mean of 53.8, and the majority of the tumors were T2 (83.8% in range of 2-5 cms), predominantly histological grade 2 (57.3%), followed by grade 3 (33.3%). ER, PR and Her-2/neu expression was seen in 59, 51 and 27% of cases respectively. Triple-negative breast cancers constituted 25 % of our cases. We also found characteristic associations between hormonal receptor and Her-2/ neu expression and various clinico-pathological parameters. Conclusions: The hormonal receptor expression appears to be lower in the Indian population compared to the West. A significant proportion of tumors in our study with Her2/neu overexpression also showed ER and PR positivity. Triple-negative breast tumors were most commonly grade 3, in women aged more than 50 years.

/pdf/immunohistochemical-profile-of-breast-cancer-patients-at-a-5azexbnj87.pdf

Immunohistochemical Profile of Breast Cancer Patients at a Tertiary Care Hospital in South India

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cause of cancer related deaths. HCC typically arises in the background of cirrhosis, however, about 20% of cases can develop in a non-cirrhotic liver. This particular subgroup of HCC generally presents at an advanced stage as surveillance is not performed in a non-cirrhotic liver. HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population. Interestingly, F3 fibrosis in non-alcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infections are associated with high risk of developing HCC. Even though considerable progress has been made in the management of this entity, there is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients. This comprehensive review details the epidemiology, risk factors, clinical features, diagnosis and management of HCC in non-cirrhotic patients and provides future directions for research.

Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review.

Background and Aims: We carried out this study in order to know the epidemiology and management strategies for breast cancer patients in our patient population. Settings and Design: The epidemiological data pertaining to demography and risk factors for carcinoma breast were analyzed retrospectively in patients admitted to a tertiary care hospital of North India. Materials and Methods: Hospital records of 304 patients admitted for over a period of five years (January 1998 to December 2002) were used for data analysis. Statistical Analysis Used: Paired T-test . Results: Mean age of our female breast cancer patients was found to be lower compared to the western world, with an average difference of one decade. A majority of the patients were from a rural background and had a longer duration of symptoms compared to urban patients. Lump in the breast was a dominant symptom. Familial breast cancer was uncommon. Left sided breast cancer was slightly preponderant. Screening by mammography and staging procedures such as bone scan, Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI) were sparsely used. The most common histology was infiltrating duct carcinoma. Conclusion: Modified radical mastectomy was found to be a safe operative procedure. Breast conservative surgery, although considered the gold standard in early breast cancer, was found unsuitable for our patients, due to the social background and lack of intensive radiotherapy and chemotherapy backup. Infiltrating duct carcinoma was more commonly associated with positive lymph nodes compared to other histopathologies. Cases operated by surgical oncologists had better axillary clearance. Neoadjuvant chemotherapy was used mainly by surgical oncologists suggesting a more rational approach toward the management of breast carcinoma.

Profile of breast cancer patients at a tertiary care hospital in north India.

Objectives Our review aims to present existing data on the safety of Intravenous thrombolysis (IVT) use in acute ischemic stroke (AIS) patients with concomitant central nervous system or systemic malignancies, with attention to special circumstances pertaining to specific cancer subtypes to help in acute decision making, especially for neurologists and emergency medicine physicians. Methods A literature search was conducted on electronic databases inclusive of Medline, EMBASE and CINAHL for articles published or available in English between January 1, 2000 to June 1, 2020 using the following search terms: “acute ischemic stroke,” “cerebrovascular disease,” “Intravenous thrombolysis,” “tissue plasminogen activator,” “cancer patients,” and “neoplasm”. Conclusion Recognition of stroke symptoms in patients with active cancer, in particularly those involving the brain, requires astute clinical judgement. Decision-making can be improved by understanding baseline functional status, cancer prognosis and expected disability from stroke, as well as utilizing diagnostic modalities such acute MRI where needed. While this article does not encourage use of IVT in patients with all malignancies, it lays the groundwork for decision making should thrombolysis be a consideration in a patient with AIS in a cancer patient.

Use of Intravenous Thrombolysis in Acute Ischemic Stroke Management in Patients with Active Malignancies: A Topical Review.

Background Neurofibromas are tumors comprised of peripheral nerve sheath and connective tissue components. They can occur sporadically or as part of familial syndromes such as neurofibromatosis type 1. Isolated colonic neurofibroma without systemic manifestations is a rarely reported clinical entity. Here we present a case of a 51 years old male with an isolated colonic neurofibroma seen on a screening colonoscopy. Case summary Fifty-one years old male who was otherwise healthy without a significant family history of cancer underwent a screening colonoscopy and was found have a 2.3 cm × 1.4 cm lesion in the colon. Tissue biopsy revealed a spindle cell tumor. Magnetic resonance imaging of the pelvis was negative for adenopathy. He underwent an endoscopic ultrasound that showed an ill-defined avascular lesion of mixed echogenicity measuring 2.8 cm × 15.2 cm in the submucosa with no communication with muscularis mucosa or propria. Immunohistochemistry staining of the tumor was strongly positive for S100, with rare penetrating axons deep within the tumor. Tumor cells were negative for c-kit and desmin and had low Ki-67 index. These findings were consistent with a solitary colonic submucosal neurofibroma. A detailed history and physical examination did not reveal any evidence of extraintestinal neurofibromatosis. He underwent transanal surgical resection of the tumor. The patient tolerated the procedure well without any complications. Conclusion While neurofibromas have been well described in literature, an isolated colonic neurofibroma is a rare pathological entity. Malignant transformation of neurofibromas has been reported in patients with neurofibromatosis syndromes. We report a case of isolated colonic neurofibroma and highlight the importance of resection due to the increased risk of tumorigenesis.

Sonia Sandhu

Papers

Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review.

Profile of breast cancer patients at a tertiary care hospital in north India.

Use of Intravenous Thrombolysis in Acute Ischemic Stroke Management in Patients with Active Malignancies: A Topical Review.

Isolated colonic neurofibroma, a rare tumor: A case report and review of literature

Mutational Patterns and Clonal Architecture of Therapy-Related Acute Myeloid Leukemia