Prognostic Impact of Pattern of Mandibular Involvement in Gingivo-Buccal Complex Squamous Cell Carcinomas: Marrow and Mandibular Canal Staging System

Purpose

To study the pattern of mandibular involvement and its impact on oncologic outcomes in patients with gingivo-buccal complex squamous cell carcinoma (GBC-SCC) and propose a staging system based on the pattern of bone involvement (MMC: Marrow and mandibular canal staging system) and compare its performance with the 8th edition of the American Joint Committee on Cancer (AJCC8).

Methods

This retrospective observational study included treatment-naïve GBC-SCC patients who underwent preoperative computed tomography (CT) imaging between January 1, 2012, and March 31, 2016, at a tertiary care cancer center. Patients with T4b disease with high infratemporal fossa involvement, maxillary erosion, and follow-up of less than a year were excluded. The chi-square or Fisher’s exact test was used for descriptive analysis. Kaplan–Meier estimate and log-rank test were performed for survival analysis. Multivariate analysis was done using Cox regression analysis after making adjustments for other prognostic factors. p-Value <0.05 was considered as significant. Based upon the survival analysis with different patterns of bone invasion, a new staging system was proposed “MMC: Marrow and mandibular canal staging system”. “Akaike information criterion” (AIC) was used to study the relative fitted model of the various staging (TNM staging—AJCC8) with respect to survival parameters.

Results

A total of 1,200 patients were screened; 303 patients were included in the study. On radiology review, mandibular bone was involved in 62% of patients. The pattern of bone involvement was as follows: deep cortical bone erosion (DCBE) in 23%, marrow in 34%, and marrow with the mandibular canal in 43% of patients. Patients with DCBE and no bone involvement (including superficial cortical) had similar survival [disease-free survival (DFS) and locoregional recurrence-free survival (LRRFS)], and this was significantly better than those with marrow with or without mandibular canal involvement (for both DFS and LRRFS). Patients with DCBE were staged using the MMC, and when compared with the AJCC8, the MMC system was better for the prediction of survival outcomes, as AIC values were lower compared with those of the AJCC8. There was a significant association (p = 0.013) between the type of bone involvement and the pattern of recurrence.

Conclusions

For GBC-SCC, only marrow with or without mandibular canal involvement is associated with poorer survival outcomes. As compared with the AJCC8, the proposed Mahajan et al. MMC staging system downstages DCBE correlates better with survival outcomes.

Inexplicable Abdominal Pain in a Patient with Advanced Recurrent Osteogenic Sarcoma: A Case Report

Abdominal pain is one of the most common causes of emergency department visits. Comprehensive patient assessment is required to identify the cause of abdominal pain. The origin of abdominal pain can be intra-abdominal or extra-abdominal. The majority of the cases with abdominal pain will have typical symptoms, suggesting intra-abdominal pain. A small subset of patients has atypical symptoms suggesting an extra-abdominal cause for the pain. Reports suggest that patients who presents with pain in the abdomen have the primary aetiology from the spinal column. This case report presents a patient with abdominal pain in advanced, recurrent Osteogenic Sarcoma (OGS) with spinal metastasis as the primary aetiology. Compression of nerve roots due to spinal bony metastasis lead to abdominal pain in the present case. Even though it was of spinal origin, clinically it micmicked to be of abdominal origin, so oncologists have to be vigilant in considering the rare causes of abdominal pain. Detailed history and clinical examination of the patients is ideal approach to identify the cause.

Rapid Plasma Reagin Card Test: A Screening Method for Syphilis in Antenatal Patients of Bastar, Chhattisgarh, India

Introduction: Sexually Transmitted Disease (STD) like syphilis is one of the important factor leading to adverse pregnancy outcomes in antenatal mothers. The infant and neonatal mortality rate itself is higher in the tribal region of Chhattisgarh like Bastar due to poor educational status and limited availability of health infrastructures. To prevent the disease related adverse pregnancy outcomes, early diagnosis and treatment of STDs is important by rapid screening method like Rapid Plasma Reagin (RPR) card test, which is comparatively cost effective tool available at clinical settings. Aim: To detect the incidence of syphilis among antenatal mothers of Bastar, Chattisgarh, India by using RPR card test. Materials and Methods: The present cross-sectional study was conducted on 150 blood samples of patients attending Obstetrics and Gynaecology out-patient and in-patient Department (OPD and IPD) from August 2021 to October 2021. The samples referred to Microbiology laboratory of Late Baliram Kashyap Memorial Government Medical College Jagdalpur, Chhattisgarh, India, were tested by RPR card test taking all aseptic precautions. The data were collected in Microsoft Excel sheet and results were presented in counts and percentages using descriptive statistics. Results: Out of 150 samples, 11 (7.33%) were tested positive by RPR card test while rest 139 (92.67%) were found negative. Out of the 11 (7.33%) samples which tested positive, 3 (27.27%) were from Anti Retroviral Therapy (ART) centre (concurrent Human Immunodeficiency Virus (HIV) and syphilis positive), 7 (63.64%) were from Obstetrics and Gynaecology OPD and 1 (9.09%) sample was from labour ward. Age of the patients attending antenatal clinic ranged between 11-50 years with maximum patients 103 (68.67%) were in 21-30 years of age group. Conclusion: RPR card test is one of the important cost effective, rapid screening tools for STDs like syphilis, especially in the resource poor areas like tribal region of Bastar, Chattisgarh, India. Comparatively higher percentage of syphilitic infection reported in the study may contribute in improving health infrastructure policies in the affected regions of Bastar, Chattisgarh, India.