Basal cell carcinoma (BCC) accounts for 80% of all nonmelanoma skin cancers. Its metastasis is extremely rare, ranging between 0.0028 and 0.55 of all BCC cases. The usual metastasis to lymph nodes, lungs, bones, or skin is from the primary tumor situated in the head and neck region in nearly 85% cases. A 69-year-old male developed progressively increasing multiple, fleshy, indurated, and at places pigmented noduloulcerative plaques over back, chest, and left axillary area 4 years after wide surgical excision of a pathologically diagnosed basal cell carcinoma. The recurrence was diagnosed as infiltrative BCC and found metastasizing to skin, soft tissue and muscles, and pretracheal and axillary lymph nodes. Three cycles of chemotherapy comprising intravenous cisplatin (50 mg) and 5-florouracil (5-FU, 750 mg) on 2 consecutive days and repeated at every 21 days were effective. As it remains unclear whether metastatic BCC is itself a separate subset of basal cell carcinoma, we feel that early BCC localized at any site perhaps constitutes a biological continuum that may ultimately manifest with metastasis in some individuals and should be evaluated as such. Long-standing BCC is itself potentially at risk of recurrence/dissemination; it is imperative to diagnose and appropriately treat all BCC lesions at the earliest.
Paraneoplastic pemphigus (PNP), a clinically and immunopathologically distinct mucocutaneous blistering dermatosis, is a severe form of autoimmune multiorgan syndrome generally associated with poor therapeutic outcome and high mortality. This IgG-mediated disease is initiated by an obvious or occult lymphoproliferative disorder in most cases. Clinically severe mucositis, and polymorphic blistering skin eruptions, and histologically acantholysis, keratinocyte necrosis and interface dermatitis are its hallmark features. A 58-year-old female presented with recurrent, severe, recalcitrant stomatitis and widespread erosions/blistering lesions of one-year duration. Treatment with repeated courses of systemic corticosteroids at a peripheral center would provide temporary relief. She also had fever, productive cough, odynophagia and poor oral intake, herpes zoster ophthalmicus, pain in the abdomen, and watery diarrhea. An array of investigations revealed chronic lymphocytic leukemia (CLL), mediastinal and para-aortic lymphadenopathy, bronchiolitis obliterans, and vertebral osteoporosis/fractures. With the diagnosis of CLL-associated PNP she was managed with dexamethasone-cyclophosphamide pulse (DCP) therapy for 3 cycles initially, followed by COP regimen (cyclophosphamide, vincristine, and prednisolone) for 5 cycles. Remission is being maintained with chlorambucil and prednisolone pulse therapy once in 3 weeks with complete resolution of skin lesions and adequate control of CLL.
Objectives: To illustrate our institutional experience about the challenges we faced and steps taken in the management of the patients with Glioblastoma multiforme during Covid 19 crises at Dr. R.P.G.MC Tanda. Methods:In the period of complete lockdown, patients were treated surgically without much delay. Patients with incomplete resection were given radiation while the ones with complete resection were started on tablet temozolamide (TMZ) alone and were sent home after counselling. At the period of partial lockdown patients below 70 years were given option of starting on hypofractionated radiation or tab temozolamide, 55% of the patients preferred radiation over temozolamide while rest continued on tablet temozolamide. Further, the patients above 70 years were continued on tablet temozolamide and were kept on telephonic check for the onset of any neurological symptoms, those developing symptoms were immediately called and started on short course radiotherapy to a dose of 40GY/15#/3 weeks or 34GY/10#/1 weeks or 25GY/5#/1 week or were treated by Stereotactic radiotherapy 8GY/5# by Volumetric Arc Radiotherapy. Results:In our institute all of our GBM patients below 70 years remained asymptomatic when started on the non standard treatment-on tab temozolamide only post surgery or on hypofractionated course of radiotherapy and only 2% patients above 70 years developed slight symptoms showed progression of disease on check MRI scan were given hypofractionated radiotherapy. Conclusion:Covid 19 pandemic has resulted in unprecedented global healthcare crises. Our institution has illustrated the challenges we faced in managing patients with highly dreadful Glioblastoma multiforme. Due to the fear of increased risk of Covid 19 infection in the cancer patients which would result in devastating complications and very poor outcome, the non standard strategy of keeping the patients on tab temozolamide only post surgery or on hypofractionated course of radiotherapy resulted in symptomatic relief in patients below 70 years of age and only 2% patients above 70 years who developed slight symptoms showed progression of disease on check MRI scan. . Though, not standard this strategy can be considered in covid-19 crises.
Alveolar soft-part sarcoma (ASPS) is an extremely rare connective tissue tumor, predominantly seen in adolescents and young adults, with a female preponderance. Alveolar soft-part sarcoma (ASPS) is a slow growing tumor, but with high likelihood of metastasis, leading to high mortality. A classical histopathological feature of an alveolar pattern from the biopsy of the lesion favors the diagnosis. We report a case of 14 years old male patient who presented with a history of single painless swelling over thigh for which surgical excision was done. Histopathology was suggestive of Alveolar soft-part sarcoma (ASPS). There was no evidence of distant metastases. He was treated with external beam radiotherapy in view of vascular invasion.
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