Open Access Case Report

MRCP for Cholangiocarcinoma and Viability of Artificial Intelligence to Oncological Care in Pakistan: A Case Report and Literature Review

Khurram Khaliq Bhinder, Ammara Tariq, Zouina Sarfraz, Azza Sarfraz, . Ameena, Zainab Malik

International Research Journal of Oncology, Page 28-32

Introduction: Cholangiocarcinoma (CCA) is a primary malignancy arising from cholangiocytes of the biliary tract. In majority of the cases, late presentations are noted, where there is vascular encasement with perineural and lymphatic invasion. Curative resection with negative tumor margins is a viable option in only 30% patients.

Objective: To describe a clinical case of cholangiocarcinoma with respect to the diagnostic radiological perspective and radiomics-artificial intelligence in Pakistan.

Case Presentation: A 60 years old male patient visited a tertiary care hospital with complaints of jaundice, weight loss and off and on fever over past few months. On MRCP, moderate intra and extrahepatic biliary dilatation with abrupt, irregular narrowing of proximal common bile duct revealing a ‘gloved finger appearance’ was documented. The coronal reformatted MRCP imaging findings showed intrahepatic biliary duct dilatation with abrupt irregular cut off at the proximal CBD. The diagnostic radiological findings pointed to a malignant stricture, possibly cholangiocarcinoma. On obtaining biopsy proceedings of the suspicious mass, a final diagnosis was made of adenocarcinoma of the common hepatic duct (cholangiocarcinoma). While the patient ultimately underwent surgery at the hospital, there was loss to follow-up post diagnostic radiological/pathological confirmation of the case, and surgical intervention.

Conclusion: While we relied on MRCP findings, the conventional imaging choice for CCA, we envision that AI, a novel technique, will be an essential step in radiological diagnosis, oncological prognosis, and surgical treatment options. Radiomics knowledge systems are a technology of the future that will help in primarily identifying, segmenting, and extracting features from regions of interest.

Open Access Case Study

Recurrent Dermatofibrosarcoma Protruberance over Shoulder: An Unresolved Problem

Sachin S. Kadam, Tejaswini Kadam

International Research Journal of Oncology, Page 11-20

Introduction: We are reporting a case of recurrent Dermatofibrosarcoma protuberans (DFSP) over right shoulder in a 36 year young lady who underwent re-excision with secondary healing. DFSP is common in both, men and women with a slight male predominance. They are characterized by a unique translocation of chromosome i.e. t(17;22) (q22;q13). Majority of DFSPs are low grade (85-90 %) while the rest contain a high-grade sarcomatous component (DFSP-FS) and are considered to be intermediate-grade sarcomas. Trunk and proximal extremities are the most common location, usually on the chest and shoulders. Persistently recurring tumors have an increased risk for transformation into a more malignant form (DFSP-FS). Metastases to regional lymph nodes are extremely rare and distant hematogenous metastases are even rarer. Adequate lateral and deeper margin resection is necessary for excision of resectable primary DFSP and team approach is must for tackling recurrent and metastatic DFSP.

Open Access Original Research Article

Lymphatic Injury and Peripheral Lymphedema as Complications of Central Venous Catheter: A Case Report and a Literature Review

Luis Lopez Montoya, D. Yucari Lopez, Joceline Sandoval, Angel Lopez Montoya, Roberto Garcia Valadez, Claudia Paz Luna, Itzel Alcaraz Arevalo

International Research Journal of Oncology, Page 1-10

Introduction: Secondary lymphedema is defined as a chronic-progressive disease which causes a rich protein edema of the limbs, this may be caused due to the damage or obstruction of lymphatic structures; secondary peripheral lymphedema may be considered a complication of central venous catheter procedures.

Objective: To describe a clinical case of upper extremity lymphedema as venous port catheter related complication and present a review of literature of lymphatic complications of central venous catheter.

Case Presentation: A 57-year-old woman received previous medical attention between 2019-2020 due to Hodgkin lymphoma; the patient was diagnosed by left cervical lymph node biopsy and received 12 chemotherapy cycles through right subclavian catheter. The patient arrived to our facilities in March 2021 to assess her case due to increased right arm volume related to progressive edema that did not improve with rest or elevation and began to limit movements and basic activities; the situation began after a previous right catheter infection and a change of it in January 2020 with no evidence of venous thrombosis and identified a worsening tendency with time since last chemotherapy in May 2020. After clinical history, physical examination and ICG NIR lymphography study, lymphedema was confirmed as a result of subclavian catheter related complication. We decided to present the case along a literature review on the topic.

Conclusion: Lymphatic injury and peripheral lymphedema related to Central Venous Catheter procedures and its complications is a clinical reality that might be underrecognized and underdiagnosed by scientific literature and clinicians; this condition should be properly studied and deeply considered with the adequate assessment strategies in patients undergoing CVC procedures in the mid and long term to avoid its undertreatment.

Open Access Original Research Article

A Prospective Observational Study of the Efficacy of Neoadjuvant Chemotherapy in Newly Diagnosed Inoperable Patients of Epithelial Ovarian Cancer

S. Janarthan Babu, Rakesh Sharma, A. V. S. Suresh, S. S Nirni, P. S. Dattatreya, A. Vindhya Vasini

International Research Journal of Oncology, Page 21-27

Introduction: Ovarian cancer is the leading cause of death from gynecological cancers in developed countries. More than 70% of patients have Stage III – IV disease at diagnosis. The standard of care for advanced ovarian cancer is primary debulking surgery (PDS) followed by adjuvant (ADJ) chemotherapy. There are very few prospective randomized Indian studies that have evaluated the effectiveness of neoadjuvant chemotherapy (NACT) in advanced ovarian cancer. This study attempted to evaluate the efficacy of NACT in advanced epithelial ovarian cancer patients who were unfit for upfront surgery.

Methods: This was a prospective observational study involving newly diagnosed patients with inoperable epithelial ovarian cancer, conducted over a period of 18 months from October 2016 to March 2018 at the department of Medical Oncology at a tertiary care oncology center, situated in Hyderabad, India. Detailed clinical history, laboratory reports, imaging and histopathological reports were obtained and maintained in a standard proforma.

Results: The median age at presentation was 51 years with a range of 37 to 70 years. 82.8% of the cases belonged to international federation of obstetrics and gynecology (FIGO) stage III. The objective response rate to NACT was 85.93% and the optimal cytoreduction rate was 85.96%. Post operative grade 3 or 4 adverse events were observed in 19.3% of the patients.

Conclusion: Neoadjuvant chemotherapy is an alternative approach to primary debulking surgery for advanced ovarian cancers. Among inoperable advanced epithelial ovarian cancer patients, neoadjuvant chemotherapy is associated with good objective response rates. Patients undergoing interval debulking surgery following neoadjuvant chemotherapy had less peri-operative morbidity and mortality.

Open Access Original Research Article

Analysis of the Influence of Age, Size, and Gender on the Relationship Reporting and Data System (ACR TI-RADS) and the Incidence of Thyroid Cancer in Surakarta between Ultrasonography Classified by American College of Radiology Thyroid Imaging

M. Ihya Ulumuddin Rahawarin, Kristanto Yuli Yarso, . Widiastuti, Akhmad Azmiardi

International Research Journal of Oncology, Page 33-42

Background: The study aims to see if the age, tumor size and gender factors affect TI-RADS sensitivity. Ultrasonography examination (USG) plays a major role in the initial diagnosis process of a suspected thyroid tumor or cancer to evaluate thyroid nodules. ACR TI-RADS is a classification created with the aim of adapting the BI-RADS concept for thyroid pathology. Several studies have shown a positive correlation between ultrasound results and TI-RADS while on the opposite, several studies have shown decreased sensitivity and specificity of TI-RADS ultrasound classification with respect to increasing age groups. Study on the effect of age on USG and TI-RADS classification has an important role for the improvement of diagnostic procedure.

Objective: To find out whether age, size and gender has an effect on the sensitivity and specificity of USG diagnostics with the TI-RADS classification on the incidence of thyroid cancer in the Surakarta area.

Methods: This study is an analytical observational study with a retrospective design, with the sample population in the form of all results of thyroid ultrasound examination of thyroid cancer patients were carried out at Two General Hospitals in Surakarta to obtain the n=114 of research subjects who match the inclusion criteria and do not match within the predetermined exclusion criteria.

Results: The results of statistical tests carried out on several variables, namely age, gender, and tumor size on the sensitivity and specificity of TI-RADS showed mixed results. After comparing the sensitivity between groups, we used a cutoff point of 55 years and when we compared  two groups of patients ( >55 vs ≤55 years old) , we found no statistically significant difference (p=0.496). In the comparison of the sensitivity to the gender variable, which was divided into two groups, the male patient group, and the female patient group with a p-value of 1.000. For comparison of the sensitivity of the size variable, grouped into two categories, patients with small-sized tumor ≤ 1 cm and those with large-sized tumor > 1 cm, a p-value of 0.160 was obtained (Table 10). The p-value for the comparison of specificity of the age variable was 0.062, of the gender variable 1.000, and he size variable 0.208 (Table 11).

Overall, it can be interpreted that the TI-RADS ultrasound examination on some variables above did not show a significant difference (validity) in sensitivity and specificity (p-value > 0.05).

Conclusion: Age, size and gender does not affect the sensitivity and specificity of USG diagnostics with the TI-RADS classification in thyroid cancer patients at Two General Hospital in Surakarta.