Adjuvant radiotherapy (RT) in buccal mucosa cancers is guided by histopathological factors. The decision to treat ipsilateral or bilateral draining lymph node is on physician discretion and guidelines do not have a defined indication regarding this. We aimed to analyze the failure patterns and survival in buccal mucosa cancers treated with adjuvant ipsilateral RT. Materials and Methods: One hundred sixteen cases of post-operative buccal mucosa cancers-pT3 or more, node positive, close margins (1-5 mm), lymphovascular invasion positive, perineural invasion positive, depth of invasion >4 mm-treated with RT to primary and ipsilateral nodes from May 2013 to May 2019 were retrospectively analyzed. Patients were treated to a dose of 60-66 Gy (44 Gy in the first phase and a coned down boost of 16-22 Gy in the second phase) with three-dimensional conformal radiotherapy on a linear accelerator. Primary end point was to assess control rates and secondary end point was to evaluate the overall survival (OS) and disease-free survival (DFS) outcomes. Results: Median age was 46 years with male; female ratio of 110:6. The edition of the American Joint Committee on Cancer stage distributions were I (3.4%), II (34.4%), III (24.1%), and IV (37.9%). At a median follow-up of 22 months, crude rates of local failure, regional failure, and contralateral neck failure were 9.4%, 10.3%, and 3.4%, respectively. The 2-year contralateral neck control rate was 94.9%. Pathological positive node portended poorer OS (86.6% vs. 68.6%; p = 0.015) and DFS (86.5% vs. 74.9%; p = 0.01). Conclusion: Incidence of contralateral recurrence with ipsilateral irradiation in buccal mucosa cancers is low with descent survival outcomes, particularly in node negative cases.

Amelanotic melanoma of cervix is a rare and aggressive neoplasm and only few cases have been reported in the literature. We report a rare case of an amelanotic melanoma of the uterine cervix with extensive metastases and multiple subcutaneous nodules. Due to the unusual site and amelanotic nature of the lesion, chances of misdiagnosis are high and immunohistochemical markers for melanoma help establish the diagnosis. The possibility of metastasis from a primary malignant melanoma of the skin needs to be ruled out. The present case was initially misdiagnosed and treated on the regimen for squamous cell carcinoma, but progressed despite chemotherapy. After a thorough re-evaluation and applying extensive panel of immunohistochemistry, the diagnosis of an amelanotic malignant melanoma of uterine cervix was established.

Subependymal giant cell astrocytoma (SEGA) is a slow-growing tumor originating in the walls of the lateral ventricles, usually presenting in the first two decades of life, and is often associated with tuberous sclerosis complex. However, few cases of SEGA without any clinical features of tuberous sclerosis complex have been reported. Here, we present a case of an 11-year-old boy with right hemibody weakness and headache for 1.5 years. He was diagnosed with solitary SEGA without any clinical features of tuberous sclerosis complex. Magnetic resonance imaging of the brain showed an intracranial space-occupying lesion in the left internal capsule. Biopsy was consistent with SEGA. There were no stigmata of tuberous sclerosis complex. The patient was treated with curative intent by radiotherapy.

Material for study -Right and Left adrenal . No. of Suicidal cases -HundredNo. of Accidental cases (control)-Twenty . Results: On Histological study it was found that the cells in Zona Glomerulosa showed increased nuclear density. Hypertrophy and hyperplasia of Zona Fasciculata with intracytoplasmic lipid depletion varying from mild to extensive giving rise to parenchymal cord-like arrangement of cells .Sinusoidal prominence in all the three zones including medulla.A normal pattern of Adrenal gland is informative of receipt of sudden violence i.e accident. Conclusion: The present study concludes and supports the idea that chronic stress as in suicide usuallyinduces adrenal growth which may have implications for forensic people in revealing the cause of unknown deaths.

Malignant melanoma is a rare neoplasm originating from skin and rarely, from mucosal membranes. Genital melanomas are a rare variant of the malignancy. Vulvar and vaginal malignant melanomas are the most common form of melanomas in the female genital tract. Vaginal malignant melanoma is a rare and aggressive neoplasm of the genital tract, presenting in the 5 th and 6 th decade and is associated with early dissemination and metastasis. It presents a diagnostic dilemma as it is confused with squamous cell carcinoma of vagina or cervix, hence, resulting in late diagnosis and poor prognosis. Vaginal melanomas differ from cutaneous melanomas in both pathology and molecular biology, with BRAF being detected in very few cases as opposed to cutaneous melanomas. We present a case of malignant melanoma of vagina which was extensively metastatic at diagnosis. It was initially diagnosed after a frontal craniotomy done for a space occupying lesion in the brain. Subsequently, multiple nodes were detected in axillary and inguinal regions. We treated her whole brain radiotherapy and then she was started with chemotherapy, paclitaxel and carboplatin. Her disease progression is stable and her KPS has improved with the treatment. High degree of clinical suspicion and a detailed gynaecological examination can help in early diagnosis and start of treatment. Complete surgical resection and radiotherapy, whenever possible should be done. A combination of chemotherapy and immunotherapy afterwards can control the disease progression in both localised and metastatic cases.