with areas of metaplastic carcinoma-osteoclastic giant cell rich variant hence we present this rare entity. Osteoclastic giant cells are seen in 2% of breast cancers, including infiltrating ductal carcinoma, invasive lobular carcinoma, sarcomas and metaplastic carcinomas. [4] Osteoclastic giant cells are usually seen in approximation to thin walled blood vessels giving it a gland like appearance and show an association with chondroid/osseous differentiation. Our case showed similar appearance. Osteoclastic giant cells are cytokeratin negative and vimentin positive. Nodal metastasis is less in metaplastic carcinomas (6-26%) than infiltrating duct carcinoma but distant metastasis to lung is frequent. This variant tends to be hormone receptor negative (ER, PR negative), an attribute typically associated with worse outcome. Survival of metaplastic carcinomas-osteoclastic giant cell rich variant is better-68% as compared to carcinosarcoma 49%. [2-5] In our case with a clinical diagnosis of PT, lumpectomy was done, she needs a further axillary clearance in view of metaplastic carcinoma. However patient did not return for follow-up since one year.
Sebaceous carcinoma is a rare malignancy of the skin appendages. It tends to occur in elderly patients. Orbital region is the most commonly involved site seen in 75% of cases. The involvement of extra-orbital sites is infrequent. Herein, a case of extra-ocular sebaceous carcinoma arising in the scalp of a 20-year-old man is described.The patient developed tumor relapse after excision biopsy. He was treated with wide local excision of the tumor. However, the patient developed local recurrence after an interval of four months for which he again underwent wide local excision. He did not manifest any regional or distant metastases. In view of the locally aggressive tumor, he received adjuvant radiation therapy. The patient was successfully treated with no evidence of any local recurrence seen after a follow-up period of one year. The timely recognition of sebaceous carcinoma is imperative so as to execute the primary treatment i.e., wide local excision. Adjuvant radiotherapy may be considered to improve the clinical outcome for recurrent tumors.
PurposeIn cervical intracavitary brachytherapy, it is mandatory to evaluate if the doses to bladder and rectum are within tolerance limits. In this study, an effort has been made to evaluate the effect of respiration on the doses to bladder and rectum in patients undergoing brachytherapy.Material and methodsFifteen patients with cervix cancer treated with concurrent chemoradiation followed by intracavitary brachytherapy were included in this study. At the time of brachytherapy, all patients underwent 4D computed tomography (CT) imaging. Five out of fifteen patients were scanned with empty bladder while the rest had full bladder during sectional imaging. Four sets of pelvic CT image datasets with applicators in place were acquired at equal interval in a complete respiratory cycle. Treatment plans were generated for all the CT datasets on a PlatoTM Sunrise planning system. A dose of 7 Gy was prescribed to Point A. Doses to ICRU (Report No.38) bladder (IBRP) and rectal (IRRP) reference points were calculated in all the CT datasets.ResultsThe mean of maximum dose to IBRP at four different respiratory phases for full and empty bladder were 53.38 ± 19.20%, 55.75 ± 16.71%, 56.13 ± 17.70%, 57.50 ± 17.48% and 60.93 ± 15.18%, 60.29 ± 16.28%, 60.86 ± 15.90%, 60.82 ± 15.42% of the prescribed dose respectively. Similarly, maximum dose to IRRP for full and empty bladder were 55.50 ± 18.66%, 57.38 ± 14.81%, 58.00 ± 14.97%, 58.38 ± 17.28% and 71.96 ± 6.90%, 71.58 ± 7.52%, 68.92 ± 6.21%, 71.45 ± 7.16% respectively.ConclusionsOur study shows that respiration affects the dose distribution to the bladder and rectum in intracavitary brachytherapy of cervix cancer. It is advisable to reduce the critical organ dose to account for the dose variation introduced by respiratory motion.
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