The significance of the presence of extranodal extension in the metastatic node of differentiated thyroid cancer: a proposal for modification in the American Thyroid Association (ATA) risk stratification

BACKGROUND

Multiple factors contribute to recurrences in differentiated thyroid cancers (DTC). Though the nodal size and number of positive nodes along with the presence of extranodal extension (ENE) have been mentioned in the present ATA risk stratification, the weightage given for ENE seems inadequate compared to the former two.

METHODOLOGY

Factors predicting recurrences were analysed in this retrospective study of patients with DTC operated in a tertiary care centre. Based on our findings, we propose a modification in the present risk stratification. We have done so by comparing with existing risk stratification for fit and discrimination of this system.

RESULTS

Out of 1428 patients, 859 (60.2%) patients had pathological nodal metastases (pN +) with ENE being present in 26.8% of these. The recurrence rate was 6.4% (92 patients). Recurrence rates in patients with ≤ 5 nodes without ENE, > 5 nodes without ENE, ≤ 5 nodes with ENE and > 5 nodes with ENE were 2.7%, 1.3%, 8.3% and 10.3%, respectively. Recurrence rates in patients with 0.2-3 cm without ENE, 0.2-3 cm with ENE and > 3 cm with/without ENE were 1.8%, 8.5% and 13.4%, respectively. A modified risk stratification incorporating ENE and excluding the number of metastatic nodes was proposed. The modified risk stratification had a better fit than the present system in terms of higher C index and lower AIC.

CONCLUSIONS

Extranodal extension in differentiated thyroid cancer had the maximum influence on recurrence risk (recurrence-free survival) in our cohort. The prognostic impact of ENE supersedes the number of positive nodes in the risk of recurrence.

Network pharmacology integrated with molecular docking reveals the anticancer mechanism of Jasminum sambac Linn. essential oil against human breast cancer and experimental validation by in vitro and in vivo studies

Jasminum sambac L. (J. sambac) belongs to the family Oleaceae and it is an ornamental subtropical evergreen shrub used in traditional treatments of certain ailments and diseases. This study aimed at devising an integrated strategy attempts to evaluate the bioactive components in the J. sambac essential oil (JEO) against human breast cancer. JEO extracted by distillation process and analyzed by GC-MS was subjected to screening of therapeutic components in their allegiance to the drug-likeness index. The utility and efficacy of its molecular mechanism relating to anticancer potential were probed with network pharmacology analysis. Gene ontology, pathway enrichment, and compound-target-pathway network by Cytoscape helped to harp on hub targets and pathways involved in curative action. Drawing from the network data, molecular docking analysis of selected compounds on breast cancer targets was approached. The anti-proliferative study was carried out in MCF-7 and MDA-MB-231 to evaluate the cytotoxicity of JEO. Finally, in vivo anticancer activity was verified using rat models. The results showed MDA-MB-231 cell growth was highly inhibited than the MCF-7 cell line. Alongside this in vitro trial, in situ effectiveness of JEO was evaluated using female Sprague-Dawley rat animal models. In vivo experiments and histopathological analysis showed convincing results in DMBA tumor-induced rats. The larger aim of this study is to identify the potential ingredients of the JEO in cancer apoptosis by integrating network pharmacology and experimental validation achieved to certain extent confers credence to the concept of hiring J. sambac as floral therapy in dealing with the disastrous disease.

Impact of Changes in Treatment Paradigms on Survival in Oral Squamous Carcinoma-a Population-Level Study

There have been notable improvements in the treatment of oral cancers. The objective of this study was to see whether these improvements have translated into survival benefits at the population level from the SEER database. This is a retrospective study using the SEER 19 Custom database which included patients diagnosed with oral cancer between January 1, 1995, and December 31, 2015. The overall stage, age, sex, and treatment modalities were the covariates. For analysis, the patients were divided into four cohorts as per their year of diagnosis-cohort I included patients who were diagnosed between 1995 and 2000 (n = 3873), cohort II between 2001 and 2005 (n = 5881), cohort III between 2006 and 2010 (n = 6233), and cohort IV between 2011 and 2015 (n = 12567). Patients undergoing surgery with adjuvant therapy have increased significantly across cohorts and there is a significant fall in patients undergoing non-surgical treatment. Pairwise comparison by the Mantel-Cox test showed that cohort IV had significantly improved median overall survival (OS) and disease-specific survival (DSS) as compared to other cohorts and there was a significant impact of treatment modality on OS and DSS, especially in cohorts III and IV (p<0.001). Though geographical variations in the presentation and habits limit the generalization of these results, this study demonstrates that the changes and improvements in treatment paradigms incorporating level I evidence and surgical techniques have translated into improved survival outcomes at the population level. We recommend further studies on the local population to lend further credence to our observation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13193-023-01790-0.

Sentinel lymph node biopsy in early oral cancers: are we ready for it yet? Results from a survey among Indian surgeons treating oral cancers

OBJECTIVE

Emerging evidence has shown that sentinel node biopsy (SNB) is an oncologically safe option in patients with early oral cancer compared with elective neck dissection (END). However, its use on a routine basis could be associated with many challenges.

STUDY DESIGN

This online survey was conducted among the Indian surgeons treating patients with oral cancer to understand and comprehend the incidence and patterns of usage of SNB in their practice, their approach toward the use of SNB, and the possible challenges they face or perceive in its routine use in patients with early oral cancer.

RESULTS

We received 352 responses with a response rate of 47.63%. Most of the respondents (82.6%) were managing N-zero necks with END, only 15.1% (n = 53) respondents practiced SNB currently. Most respondents believed that SNB offered the advantage of better shoulder function compared with END (76.4% [n = 269]). The deterrents considered for routine use of SNB in early oral cancer were additional costs (71.9% [n = 253]), the unavailability of necessary expertise and infrastructure (87.2% [n = 307]), SLNB being a more time-consuming treatment (58.8% [n = 207]), a higher false negative rate (74.1% [n = 261]), and the possible need of a second surgery (82.4% [n = 290]).

CONCLUSIONS

Though SNB presently could be considered as an alternative treatment option, there seem to be various issues that need to be addressed before it can be adopted as a standard of care across centers.

Regression Derived Staging Model to Predict Overall and Disease Specific Survival in Patients With Major Salivary Gland Carcinomas With Independent External Validation

The current American Joint Cancer Committee (AJCC) staging system for salivary gland tumors does not include histology and grade in its classification despite their proven prognostic importance. We planned to analyze if a modified staging system integrating these two factors into the staging improves prognostic performance and then validate it externally.

Incorporation of tumor grade and histology in current AJCC staging results in better hazard discrimination.

Parotid fistula and/or salivary collection: an underrecognized and underreported preventable complication following surgery for oral cancer

BACKGROUND

Parotid fistula after surgery for oral cancer is a less commonly recognized and less reported complication. In this study, we aimed to report its incidence and identify factors predisposing patients to it and the management of the patients in our cohort.

METHODS

This was a retrospective study of treatment-naive patients with oral cancer who underwent surgery from January 2019 to December 2020 in a single unit of our institute. Patients who were operated for recurrence and second primary were excluded.

RESULTS

A total of 434 patients were included in the study. Most were men (n = 352; 81.1%) and presented with an advanced clinical stage (n = 318; 73.2%). The incidence of parotid fistula in our study was 6.9% (n = 30 of 434). Buccal mucosa/gingival buccal sulcus subsite (P = .05; odds ratio [OR] = 3.423; 95% CI, 0.969-12.087) and advanced clinical T stage (P = .003; OR = 6.15; 95% CI, 1.835-20.608) were the 2 most important factors predisposing patients to the development of parotid fistula after surgery for oral cancer.

CONCLUSIONS

Parotid fistula is a less common complication after surgery for oral cancer. A conservative treatment approach is usually successful in treating this complication.

Importance and implications of neurovascular bundle involvement and other MRI findings of oral tongue squamous cell carcinoma (OTSCC) on prognosis

BACKGROUND

The description for T4a oral tongue cancer in the 8th edition AJCC staging can be improved further. In this article we attempted to identify the important radiological (MRI) findings that could possibly be included in the staging eventually.

METHODS

We included all oral tongue squamous cell carcinoma patients who underwent surgery at TMH between Jan 2012 to Dec 2018 and whose MRIs were available for review. The relation of the tumor to the neurovascular bundle (NVB) on MRI was classified as Type I to IV. The association of the type of NVB involvement with DFS and the presence of PNI in the final HPR was analyzed.

RESULTS

Two-hundred and fifty-nine patients satisfied the eligibility criteria. The majority of them were men (82.6%), with a median age of 49 Yrs. Sixty-nine percent of patients had either abutment (Type III) or encasement (Type IV) of the NVB. The presence of Abutment/encasement of the NVB was significantly associated with the presence of PNI in the final HPR (p < 0.001). This abutment/encasement was seen in clinically advanced T-stage tumors. However, the presence of abutment/encasement of the NVB influenced the DFS in the univariate analysis only.

CONCLUSION

Abutment/encasement of the NVB in patients with carcinoma oral tongue is often seen in advanced-stage tumors and is significantly associated with the presence of PNI in the final HPR. Hence, the relation of the tumor with the NVB should be further assessed to understand its importance and its possible inclusion in the AJCC T-staging.

Recurrent angioleiomyoma of the middle turbinate

We present a case of a middle-aged woman with a history of not only progressive nasal obstruction, facial pain, hyposmia and epistaxis, but also excision of the nasal mass diagnosed as a vascular leiomyoma. On examination, a smooth bulge was seen over the middle turbinate. Surgical excision along with histopathology and immunohistochemistry revealed a diagnosis of recurrent vascular leiomyoma of the middle turbinate.

Neuroprotective effect of Rhodiola rosea Linn against MPTP induced cognitive impairment and oxidative stress

BACKGROUND

Ageing and age-related neurodegenerative changes including Parkinson's disease are characterized by an important role of reactive oxygen species. It is characterized by signs of major oxidative stress and mitochondrial damage in the pars compacta of substantia nigra.

PURPOSE

Present study was designed to investigate whether Rhodiola rosea extract would prevent MPTP induced neurotoxicity in Male wistar rats.

METHODS

Male Wistar rats were divided into following five groups: Group I received vehicle (saline (10 ml/kg for 21 days) orally); Group II received Rhodiola rosea extract (250 mg/kg for 21 days) orally; Group III was treated with 20 mg/kg MPTP i.p. for 21 days; Group IV received 20 mg/kg MPTP, i.p. along with 100 mg/kg Rhodiola rosea orally for 21 days. Group V received 20 mg/kg MPTP i.p. along with 250 mg/kg Rhodiola rosea orally for 21 days.

RESULTS

MPTP induced rats showed behavioral alterations in elevated plus maze testing. Group III rats elicited significant increase in lipid hydroperoxide along with reduction in level of glutathione peroxidase, catalase, superoxide dismutase and total antioxidants. Histological evidence revealed that MPTP treated rats shown pathological changes like cellular inflammation and vascular degeneration in brain tissue.

CONCLUSION

The oxidative stress and related biochemical alteration by MPTP were attenuated by Rhodiola rosea treatment. However, further studies may be necessary to elucidate the precise mechanism to support the clinical use of a plant source as antiparkinsonism drug.

Evaluation and quantification of angiogenesis activity of terminalia bellirica roxb, by mice sponge implantation method

Angiogenesis represents an excellent therapeutic target for the treatment of cardiovascular diseases. It is a potent physiological process that underlies the natural manner in which our bodies respond to a diminution of blood supply to vital organs, namely the production of new collateral vessels to overcome the ischemic state. This present study is aimed to evaluate and quantify the Angiogenic potential of Terminalia bellirica Roxb, by in vivo mice sponge implantation assay. Here, gelatin sponge with or without Ethanolic extract of Terminalia bellirica leaf (EETB - 0.3 mg and 0.5 mg, respectively) were subcutaneously injected into Swiss albino mice, and 14 days later, the implanted sponges was excised and histologically examined. The stained section showed that sponge containing EETB had produced more vessels in gels than sponges alone. The new vessels were abundantly filled with intact Red blood corpuscles (RBCs), which indicate the formation of a functional vasculature inside the sponges and blood circulation in newly formed vessels by angiogenesis which is induced by EETB. It also measured that the hemoglobin content inside the sponges: Whereas, hemoglobin in control was nearly 0.3 μg, EETB cases the hemoglobin quantity was markedly enhanced to about 17 μg. Taken together, it demonstrated that Ethanolic extract of Terminalia bellirica leaf exhibited a profound angiogenic activity in vivo. The phytochemical screening and qualitative instrumental analysis of EETB reveals the presence of proteins and Phytosterols. The promising angiogenic potential may be due to the presence of the above chemical constituents. Further study is required to define more precisely the molecular mechanisms by which Ethanolic extract of Terminalia bellirica leaf modulates endothelial cell function and gene expression, as well as the pathological relevance of these findings.

Objective structured clinical examination in radiology

There is a growing need for introducing objective structured clinical examination (OSCE) as a part of radiology practical examinations in India. OSCE is an established, reliable, and effective multistation test for the assessment of practical professional skills in an objective and a transparent manner. In India, it has been successfully initiated and implemented in specialties like pediatrics, ophthalmology, and otolaryngology. Each OSCE station needs to have a pre-agreed "key-list" that contains a list of objective steps prepared for uniformly assessing the tasks given to students. Broadly, OSCE stations are classified as "manned" or "unmanned" stations. These stations may include procedure or pictorial or theory stations with clinical oriented contents. This article is one of a series of measures to initiate OSCE in radiology; it analyzes the attributes of OSCE stations and outlines the steps for implementing OSCE. Furthermore, important issues like the advantages of OSCE, its limitations, a strengths, weaknesses, opportunities, and threats (SWOT) analysis, and the timing of introduction of OSCE in radiology are also covered. The OSCE format in radiology and its stations needs to be validated, certified, and finalized before its use in examinations. This will need active participation and contribution from the academic radiology fraternity and inputs from faculty members of leading teaching institutions. Many workshops/meetings need to be conducted. Indeed, these collaborative measures will effectively sensitize universities, examiners, organizers, faculty, and students across India to OSCE and help successfully usher in this new format in radiology practical examinations.

Inhibition of CCl4-induced liver fibrosis by Piper longum Linn.?

This study was carried out to evaluate the antifibrotic effect of ethanol extract of the fruits of Indian herb Piper longum Linn. Liver fibrosis was induced in rats by CCl(4) administration. The extent of liver fibrosis was assessed by measuring the level of liver hydroxy proline (HP) and serum enzyme levels. Following CCl(4) administration HP was significantly increased and serum enzyme levels were elevated. Treatment with the ethanol extract of Piper longum Linn. reduced the HP and also the serum enzymes. The liver weight that increased following CCl(4) administration due to the deposition of collagen was reduced by the ethanol extract. Hence, it is concluded that this extract inhibits liver fibrosis induced by CCl(4).

Visceral manifestations of von Hippel-Lindau disease: value of ultrasound and CT imaging

Visceral manifestations of von Hippel-Lindau disease (VHLD) are generally asymptomatic and their early detection is of considerable help in the management. This communication documents the usefulness of imaging studies in detecting visceral manifestations in two cases of VHLD.

Desmoplastic infantile ganglioglioma -- a case report

Desmoplastic infantile ganglioglioma is a very rare supratentorial tumor occurring in the first two years of life. A five-month-old female infant presented with recurrent seizures, large head and loss of acquired milestones. Computerized Tomographic Scan of brain showed a large subarachnoid cyst with a solid intensely contrast enhancing tumor in the right temporoparietal region with severe degree of mass effect. Craniotomy and total excision of the tumor followed subsequently by subduro-peritoneal shunt for the extracerebral fluid collection was done. The child made good recovery. Histopathology revealed features of desmoplastic infantile ganglioglioma, viz., marked desmoplastic component with glial and neuronal elements. Immunohistochemistry showed positive staining for glial fibrillary acidic protein (GFAP) with areas of synaptophysin and chromogranin positivity. Desmoplastic infantile ganglioglioma is a rare tumor of infancy, which has excellent prognosis after total excision. No adjuvant therapy is required. This is the first Indian report of desmoplastic infantile ganglioglioma out of less than fifty cases reported worldwide.

Anticarcinogenic activity of Withania somnifera Dunal against Dalton's ascitic lymphoma

The effect of ethanolic extract of the root of Withania somnifera Dunal (REWS) against Dalton's Ascitic Lymphoma has been evaluated in Swiss albino mice. A significant increase in the life span and a decrease in the cancer cell number and tumour weight were noted in the tumour-induced mice after treatment with REWS. The hematological parameters were also corrected by REWS in tumour-induced mice. These observations are suggestive of the protective effect of REWS in Dalton's Ascitic Lymphoma (DAL).

Effect of Indigofera aspalathoides against Dalton's ascitic lymphoma

The effect of intraperitoneal injection of 400 mg/kg of ethanolic extract of Indigofera aspalathoides (EEIA) against Dalton's ascitic lymphoma has been evaluated in Swiss albino mice. A significant increase in the life span, a decrease in the cancer cell count and body weight were noted in the tumour-induced mice after treatment with EEIA. These observations indicate that the plant is having protective effect in Dalton's ascitic lymphoma.