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   Table of Contents - Current issue
Coverpage
January-June 2018
Volume 4 | Issue 1
Page Nos. 1-35

Online since Thursday, July 19, 2018

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ORIGINAL ARTICLES  

Role of ultrasonography in the diagnosis of gall-bladder carcinoma: A boon for low-resource settings p. 1
Sachin Khanduri, Aakshit Goyal, Tarim Usmani, Shreshtha Jain, Arun Goyal, Mriganki Chaudhary, Hritik Sharma, Tushar Sabharwal, Santosh Yadav, Shobha Khanduri, Taruna Singh
DOI:10.4103/ASJO.ASJO_12_18  
Purpose: The present study was done with an aim to evaluate the usefulness of ultrasonography (USG) in early diagnosis of gall-bladder carcinoma for low-resource settings. Materials and Methods: A total of 264 clinically suspicious cases were enrolled in the study. The patients underwent USG followed by computed tomography (CT). Histopathological specimens were obtained from 208 cases. Final diagnosis was confirmed histopathologically/CT. Sensitivity, specificity, positive predictive, and negative predictive values of USG were calculated. Results: A total of 29 cases were confirmed as gall-bladder carcinoma, 58.6% were diagnosed at advanced stage (Stage III/IV). USG diagnosed 42 cases as neoplastic, however, 24 were true positive and 18 were false positive. USG was 82.8% sensitive and 92.5% specific. The positive and negative predictive values were 57.1% and 97.8%, respectively, diagnostic efficacy was 91.5%. 94.1% advanced stage gall bladder cancers were diagnosed correctly by USG. Sensitivity for early stages was promising (61.9%), however false positive was higher. Cost of USG was nearly five times lesser as compared to that of CT. Conclusion: USG was a useful economical imaging modality for the screening of gall bladder cancer in low-resource settings, especially for advanced stages. However, for early stages too, it seemed useful. We recommend to encourage the use of USG in early detection of gall-bladder carcinoma in socially and economically disadvantaged settings.
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An audit of gastrointestinal stromal tumors from a tertiary medical college hospital in Eastern India p. 6
Samrat Dutta, Bidisha Naskar Ghosh, Rupsha Dutta Pal, Prashant Pandey, Madhumita Mukhopadhyay, Amit Saklani, Kaustav Chatterjee
DOI:10.4103/ASJO.ASJO_17_18  
Introduction: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of GI tract. They are recently recognized as a distinct pathological entity although previously they were grouped with sarcomas of smooth muscle origin, i.e., leiomyomas, leiomyoblastomas, or leiomyosarcomas. However, apart from GI tract, GIST can occur in any smooth muscle-like in the urinary bladder. Proper diagnosis by immunohistochemistry stain CD133 and risk stratification by morphological parameters has been the cornerstone of treatment. Materials and Methods: This study was conducted as a retrospective analysis to audit the number of cases presenting as GIST in the tertiary medical colleges of eastern India and find out the patterns of care with the available modalities of therapy. Results: Out of total 15 cases, the median age of presentation was 45 years; the Male: Female (M: F) ratio was 2:3 and persisting dragging prolonged chronic abdominal pain was present in the majority. Intestinal complications were few (20%). All were treated with imatinib mesylate 400 mg once daily. However, two patients progressed for whom the dose of imatinib was escalated and one patient was metastatic at onset who was later switched over to sorafenib even after disease progression with dose escalation with imatinib. The median follow-up was 17.5 months and the median time to response to imatinib was 3.2 months. The 2-year actuarial overall survival was 79.12%, and progression-free survival was 86.67%. Conclusions: The future directions are to determine appropriate duration of imatinib therapy in adjuvant/neoadjuvant and therapeutic setting.
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REVIEW ARTICLE Top

Emergence of micronuclei and apoptosis as potential biomarker of oral carcinogenesis: An updated review p. 11
Dipak Baliram Patil
DOI:10.4103/ASJO.ASJO_15_18  
More than 95% cancers of oral cavity are squamous cell carcinoma. They contribute major health problems in developing countries like India. The critical etiological factor for oral squamous cell carcinoma (OSCC) is the consumption of tobacco in various forms. OSCC results from alterations in genes that control the cell cycle or that are involved in deoxyribonucleic acid repair and are characterized by the loss of ability of cells to evolve to death when genetic damage occurs. The occurrence of chromosomal damage can be evaluated by counting micronuclei (MNs) and degenerative alterations, indicative of apoptosis such as karyorrhexis, pyknosis, and condensed chromatin. Apoptosis has been associated with the elimination of potentially malignant cells, hyperplasia, and tumor progression. Hence, reduced apoptosis or its resistance plays a vital role in carcinogenesis. MNs are one of such biomarkers that are cytoplasmic chromatin masses with the appearance of small nuclei that arise from lagging chromosomes at anaphase or from acentric chromosome fragments. They are induced in the cells by numerous genotoxic agents that damage the chromosome. Bigger MNs result from exclusion of whole chromosome following damage to the spindle apparatus of the cell (aneugenic effect), whereas smaller MNs result from structural aberrations causing chromosomal fragments (clastogenic effect). Thus, MN count and apoptosis can be a useful biomarker, and it can be used as a screening test for patients with habit of tobacco consumption and patients with manifestations of oral lesion including premalignant and malignant conditions.
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CASE REPORTS Top

Iatrogenic implantation of myxoid dedifferentiated chondrosarcoma at donor site: A case report and review of literature p. 17
Chira Ranjan Khadanga, Jagadishwar Goud Gajagowni
DOI:10.4103/ASJO.ASJO_86_16  
Iatrogenic implantation of chondrosarcoma (CS) is not only extremely rare but also technically avoidable and impacts with morbidity, mortality, and quality of life (QoL). We report a similar case of myxoid dedifferentiated CS at remote tissue-graft donor site (left chest-wall pectoralis major myocutaneous flap). Although the exact mechanism of primary tumor cells seeding is not clear, the probable causes are direct contamination from surgical instruments and altered blood circulation at the graft-donor site.
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Giant apocrine carcinoma of the breast: A case report with review p. 21
Rajeshwari K Muthusamy, Sangita S Mehta
DOI:10.4103/ASJO.ASJO_112_16  
Invasive apocrine carcinoma of the breast is rare. The criteria for the diagnosis are uncertain with the variable reported incidence in the literature. The use of androgen receptor studies by immunohistochemistry and its potential response to androgen analogs necessitates the subtyping of this tumor. We report a case of giant invasive apocrine carcinoma of the breast involving the entire breast parenchyma without skin and chest wall infiltration. The clinical, pathological, immunohistochemical, and ultrastructural findings are discussed with emphasis on morphological and immunohistochemical features that aid in the diagnosis of this rare tumor.
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Pleuropericardial mesotheliomas: A report of two unusual cases p. 25
Harsha Vardhana Kuruba Ramanjaneyulu, Anu Kapoor, Chinmayee Biswal, Phani Chakravrty Mutnuru
DOI:10.4103/ASJO.ASJO_41_17  
Mesothelioma is an aggressive malignant tumor of the mesothelium. The majority of mesotheliomas arise from the pleura. However, less commonly mesothelioma can arise in other locations such as peritoneal, pericardium, or tunica vaginalis testis. We report two rare cases here, one with pericardial mesothelioma and another with malignant pleural mesothelioma with synchronous colonic carcinoma. The clinical, radiological, and pathology findings in these cases are discussed along with a brief review of pertinent literature.
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Rare case of an isolated myeloid sarcoma presenting as dysphagia p. 30
Rishu Sangal, Vivek Mahawar, Ankush Jajodia, Himanshu Mahanthi, Venkata Pradeep Babu Koyyala
DOI:10.4103/ASJO.ASJO_19_18  
Myeloid sarcoma (MS) is an unusual neoplasm whose understanding is principally based on the case reports and/or theoretically dated contributions. MS represents the proliferation of myeloblasts of acute myeloid leukemia (AML) at extramedullary sites. While extramedullary involvement in AML is unusual in itself, isolated (de novo) MSs that is MSs devoid of any bone marrow involvement are exceptionally rare. The present case report study expands the gamut of our acquaintance showing that MS can occur de novo, with no apparent sign or symptom of concomitant hematological disease and may show a significant response to treatment this may be omitted here. This case reports described a middle-aged male presenting as with dysphagia with isolated MS in the stomach, a very rare site.
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LETTER TO EDITOR Top

Radio-pathological correlation of mycosis fungoides p. 34
Reddy Ravikanth, Ashwin Chandrasekhar
DOI:10.4103/ASJO.ASJO_24_18  
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