The Gujarat Cancer & Research Institute

Over the past decade, Hospital-acquired infections (HAIs) have become a significant concern within Indian Tertiary Healthcare Centers. The effectiveness of infection control practices heavily relies on the diligence of healthcare workers, directly impacting the success of these measures. It's crucial to closely examine any disparities between ideal and actual practices to ensure optimal infection control outcomes. To find any gap between ideal and actual infection control practices and analyze associated factors which is actually responsible for the that gap. A cross-sectional study was carried out at a tertiary healthcare center in north Gujarat over six months, spanning from February 2023 to July 2023. The study included a total of 293 participants, comprising 61 doctors, 154 nurses, 33 paramedical staff, and 45 housekeeping staff. Data were collected using a pretested, structured, self-administered questionnaire covering different aspects of infection control practices. Knowledge, attitude, and practice (KAP)Scores of 70% or less were considered below average, scores between 71 and 80% average, 81 to 90% good and above 90% were very good. KAP score is 98.8% in knowledge, 88.70% in attitude and 89% in self-reported practices. Cumulative KAP score was 92.16% which is under very good category. Around 88.52% (54 out of 61) of doctors, 69.48% (107 out of 154) of nurses, 78.78% (26 out of 33) of paramedical staff, 64.44% (29 out of 45) of housekeeping staff scored above 90% in KAP score which is under very good category. Regular training, post training assessments and strict enforcement of infection control measures in hospitals can help to fill gaps in the knowledge, attitudes, and self-reported practices of healthcare workers regarding infection control.

A BSTRACT Leiomyosarcomas represent a group of aggressive soft-tissue sarcomas arising from smooth muscle cells primarily found in the uterus and gastrointestinal tract. Leiomyosarcomas of the bone are extremely rare. We report a rare case of leiomyosarcoma of the tibia. A 71-year-old male patient presented to our department with the chief complaint of painful swelling over the left knee for 3 months. Magnetic resonance imaging (MRI) with gadolinium of the left knee showed a 7.5 cm × 6 cm × 5 cm bony lesion associated with a soft-tissue component in the upper epimetaphysis of the left tibia. A biopsy of the lesion showed a malignant spindle cell tumor, following which the patient was offered two cycles of adriamycin single-agent chemotherapy. Postchemotherapy MRI showed progression of the lesion to the size of 9.9 cm × 8.2 cm × 6.5 cm, involving the articular surface of the tibia. Following progression, the patient was planned for wide local excision of the lesion, which turned out to be leiomyosarcoma Grade III with a mitotic rate of 30/10 high power field, and the size of the lesion’s largest diameter was 8 cm with soft-tissue infiltration. Margins were clear, and there were no adverse features of lymphovascular and perineural invasion or articular cartilage infiltration. Immunohistochemistry markers were used to confirm the bony origin of the leiomyosarcoma, which is extremely rare. Actin, calponin, and S 100 were positive, and CD 34, SOX 10, and SATB2 were negative. All surgical slides examined showed no evidence of osteoid. Postoperative positron emission computed tomography revealed no evidence of any disease, and thereby, the plan was to keep the patient on close follow-up. Multiple studies have reported a poor response of leiomyosarcoma of the bone to chemotherapy, as well as minimal overall survival benefit. The radical surgical excision of a bony lesion with the achievement of negative margins is similar to that of other primary malignant bone tumors. Sarcomas are generally believed to be radioresistant in nature, and thereby, their role in either a neoadjuvant or adjuvant setting is controversial. A multidisciplinary approach should be used in such rare cases as leiomyosarcomas of osseous origin.

Metallosis is a medical condition that shows local and systemic clinical symptoms due to the deposition of heavy metal debris in soft tissues and bones due to metallic prostheses. The estimated incidence of Metallosis is around 5%. Clinical presentation and imaging findings can mimic tumor likely situation, However local reactions of Metallosis shows some peculiar features on cross-sectional imaging, and here we present two such cases of Metallosis with its imaging findings.

Coronavirus disease 2019 (COVID-19) has caused a massive pandemic in world. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is also a doorway for other opportunistic bacterial and fungal infections. Mucormycosis is strongly connected with patients suffering from COVID-19 disease. The major factors attributed are steroid induced immunosuppression; systemic disorders especially diabetes mellitus, hypoxia, and metabolic acidosis. Unusual presentations of post-COVID mucormycosis in young patients without diabetes mellitus were observed. The new concept focuses on pathophysiology of the post-COVID mucormycosis which might involve other factors of coagulopathy and microembolism of vessels which provides a niche for fungal infection to invade in patients. The new concept of treating post Covid mucormycosis by combining the anti-fungal drugs along with fibrinolytic agents reduces the microcoagulopathy, increases the recovery rate and healing of the mucormycosis. Based on the clinical and application of scientific knowledge, this concept paper focuses on new hypothesis and treatment plans of post-COVID mucormycosis and an attempt to explain the difference between conventional mucormycosis and post-COVID mucormycosis.

Cervical cancer (CC) is the leading cause of morbidity and mortality due to cancer among women in Indian. This study was conducted to determine the prevalence and distribution of HPV16/ 18 and epidemiological profile of CC patients from, Gujarat Western India. CC biopsy specimens of 400 patients were analyzed for HPV16 and 18 by type-specific PCR. In our study 74% of CC cases were positive for HPV, 67% had HPV16, 14.8% had HPV18 and 7.7% had both HPV16/18. The median age of the women with CC was 50 years and peak incidence (31.8%) was between 40 to 50 years. Majorities (68.5%) were postmenopausal. The median age of marriage was 20years. Squamos cell carcinoma (SCC) was found in 91% and adenocarcinoma (ADC) in 7.3% of the patients. As per study 7.8%, 16.3%, 58% and 2.5% of CC patients presented in FIGO stage I, II, III, and IV respectively. HPV16 was exhibited in, 68.8% and 66.4%, HPV18 in 14.9% and 15.9% of pre and postmenopausal patients respectively. HPV16 and HPV 18 positivity was 68.7% and 51.7% and 13.2% and 31% in SCC and in ADC respectively. HPV16 infection was higher in stage I and HPV18 in stage IV malignancy. There were two peaks of HPV16, first between 21 to 30 and second between 51 to 60 years among CC patients. HPV 16 is highly prevalent among all groups. In patients with adenocarcinoma, Stage IV malignancy & who had marriage before 18years, incidence of HPV18 was relatively high.

The incidence of synchronous second primary cancer (SSPC) with DIfferentiated Thyroid Cancers (DTC) is a very rare entity. Very few case reports and case series were published in the literature. To enumerate the clinicopathological data of patients with DTC with SSPC. This is a single-center retrospective study. All the patients diagnosed with DTC and SSPC from January 2016 to July 2023 were included in the study. The demographic, clinicopathological data, and survival data were collected from the institute's database. Twelve patients were found to have DTC with SSPC. All the patients had papillary thyroid cancer. Ten patients had head and neck squamous cell carcinoma, one patient had malignant phyllodes tumor, and another patient had endometrioid adenocarcinoma as the SSPC. Six patients were diagnosed during preoperative evaluation, one patient was diagnosed 3 months after the oral malignancy diagnosis, and five patients were diagnosed with PTC in cervical nodes after neck dissection. Complete thyroid removal was done in six patients and hemithyroidectomy in two patients. The median follow-up was 25.55 months. The median overall survival was 40.97 months. Head and neck SCC is the most common SSPC with DTC. Since these are rare scenarios multi-disciplinary panel discussion can help in deciding management.

Aim and Objective This article determines the diagnostic accuracy of frozen section (FS) in case of mucinous ovarian tumor (MOT) and tailoring of intraoperative treatment decision. Material and Methods This was an observational study in which retrospective data was analyzed prospectively from January 2008 to December 2015 at the Regional Cancer Center. This study included 158 patients with MOT who underwent FS analysis during staging laparotomy at our institute. FS's sensitivity, specificity, and diagnostic accuracy were calculated and compared with final paraffin histopathological examination (HPE). Univariate and multivariate analyses were done to decide factors associated with changes in final HPE. Results FS analysis and final HPE report were concordant in 77.8% (123/158) of the cases and discordant in 22.1% (35/158). Out of 35 discordant cases, 29 (18.3%) were upgraded and 06 (5.6%) were downgraded. Out of 33 borderline cases, 16 (48.4%) were upgraded to malignant MOT and 6 (18.1%) were downgraded to benign MOT on final HPE. Out of 40 malignant MOT, 40 (100%) showed malignancy on final HPE. In the case of benign MOT on FS, 13 out of 85 (15.2%) upgraded to borderline or malignant. Sensitivity and specificity of FS were 76.60 and 55.17%, respectively, for benign MOT, 55.17 and 86.96% for borderline MOT, and 86.96 and 100% for malignant MOT. Conclusion In MOT, due to its large size and heterogeneous nature, it displays spectrum of appearance ranging from benign cyst adenoma, and borderline tumor to adenocarcinoma. Our study showed significant discordance between FS and final histopathological diagnosis in borderline MOT.

Purpose The purpose of this study was to assess the feasibility and efficacy of helical intensity-modulated radiation therapy (IMRT) for Craniospinal Irradiation (CSI) on tomotherapy, aiming to enhance target coverage while minimizing radiation dose to nearby organs at risk (OARs) and to assess acute toxicities. Methods It was a prospective observational single-arm study, 24 patients meeting inclusion criteria were enrolled, with most common histology being medulloblastoma. Planning was executed using the Accuray Precision system, adhering to European Society of Paediatric Oncology guidelines for contouring. Dosimetric analysis encompassing target coverage, conformity, homogeneity, and OAR sparing was performed. Acute side effects were assessed using CTCAE 4.0. Results Tomotherapy showed acceptable target coverage and spared organs at risk (OARs), although some patients exceeded QUANTEC dose limits due to factors like target volume, prescribed dose and proximity to OARs. Hematological and skin-related adverse events were observed, mostly mild to moderate. These toxicities were generally acceptable. Plans with 2.5 cm field width had higher toxicity rates compared to 5 cm width, attributed to increased monitor units and beam-on times. Conclusion Tomotherapy demonstrated effectiveness in target coverage and OAR sparing, careful consideration of dose limits and field width is crucial to minimize toxicity risks. These findings contribute to the understanding of the feasibility and safety profile of Tomotherapy in Craniospinal Irradiation. Larger cohorts and extended follow-up periods are necessary to evaluate late toxicities comprehensively.

Background A novel nanosomal paclitaxel lipid suspension (NPLS), free from Cremophor EL (CrEL) and ethanol, was developed to address the solvent-related toxicities associated with conventional paclitaxel formulation. Objective To evaluate the efficacy and safety of NPLS versus CrEL-based paclitaxel (conventional paclitaxel) in patients with metastatic breast cancer (MBC). Design A prospective, open-label, randomized, multiple-dose, parallel, phase II/III study. Methods Adult (18–65 years) female patients with MBC who had previously failed at least one line of chemotherapy were randomized (2:2:1) to NPLS 175 mg/m² every 3 weeks (Q3W, n = 48, arm A), NPLS 80 mg/m² every week (QW, n = 45, arm B) without premedication or conventional paclitaxel (Taxol®, manufactured by Bristol-Myers Squibb, Princeton, NJ, USA) 175 mg/m² Q3W (n = 27, arm C) with premedication. In the extension study, an additional 54 patients were randomized (2:1) to arm A (n = 37) or arm C (n = 17). Results Pooled data from the primary study and its extension phase included 174 patients. The primary endpoint was the overall response rate (ORR). As per intent-to-treat analysis, ORR was significantly better in the NPLS QW arm as compared to conventional paclitaxel [44.4% (20/45) versus 22.7% (10/44), (p = 0.04)]. An improvement in ORR with NPLS Q3W versus conventional paclitaxel arm [29.4% (25/85) versus 22.7% (10/44)] (p = 0.53) was observed. Disease control rates observed were improved with NPLS Q3W versus conventional paclitaxel Q3W (77.7% versus 72.7%, p = 0.66) and with NPLS QW versus conventional paclitaxel Q3W (84.4% versus 72.7%, p = 0.20), although not significant. A lower incidence of grade III/IV peripheral sensory neuropathy, vomiting, and dyspnea was reported with NPLS Q3W versus conventional paclitaxel Q3W arms. Conclusion NPLS demonstrated an improved tumor response rate and a favorable safety profile versus conventional paclitaxel. NPLS 80 mg/m² QW demonstrated a significantly better response versus conventional paclitaxel 175 mg/m² Q3W. Trial registration Clinical Trial Registry-India (CTRI), CTRI/2010/091/001344 Registered on: 18 October 2010 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MjEzNQ==&Enc=&userName=CTRI/2010/091/001344), CTRI/2015/07/006062 Registered on: 31 July 2015 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTE2Mjc=&Enc=&userName=CTRI/2015/07/006062)

Background Atypical glandular cells (AGCs) diagnosis on Pap (Papanicolaou) smears are uncommon and may represent various benign and malignant lesions. Objective This study aims to report the incidence of AGC on Pap smear, to study the relationship of AGC with malignancy, and to determine cytomorphological features that help in predicting malignancy. Materials and Methods Retrospective analytical study conducted in the Department of Oncopathology at Tertiary Cancer and Research Institute. In this retrospective study, we included cases diagnosed with AGC between July 2017 to July 2022. All slides were reviewed and subclassified according to the Bethesda 2014 classification system (TBS). The predetermined cytomorphological features observed in the smears were recorded. The follow-up histopathological diagnoses of the cases were retrieved. The significant cytomorphological and clinicopathological findings for malignancy were determined. Results Pearson χ ² test with SPSS software version 22 to compare cytologic features of cases with benign and malignant follow-up. The significant cytomorphological features observed in neoplastic cases were cells in 3-dimensional clusters, nuclear overlapping, reniform nucleus, irregular nuclear membrane, increased nuclear size, single macronucleoli, engulfed neutrophils, and prominently vacuolated cytoplasm. Conclusions The diagnosis of AGC on cytology is associated with clinically significant lesions, and cytomorphologic parameters can be used to predict the benign and malignant outcome.

Background The “International System of Reporting Serous Fluid Cytology (TIS)” together with cytomorphology promotes the use of ancillary techniques to resolve difficulties in reporting serous fluid cytology. Objective To classify serous effusion fluid samples received at our department in line with “TIS”, indicating the risk of malignancy (ROM), and directing appropriate usage of ancillary testing. Materials and Methods Prospective study carried out from October 2021 to September 2022. The study included all pleural, ascitic, and pericardial fluid samples, reported according to ‘TIS’. Flow cytometry and immunocytochemistry were ancillary methods utilized to assist in reporting. Cases with available history and convincing correlations didn’t require further assessment. Results A total of 1200 serous effusion samples were evaluated including 604 pleural, 591 ascitic, and 5 pericardial fluid samples. After categorization, there were 23 samples in non-diagnostic (ND, 1.9%), 575 in negative for malignancy (NFM, 47.91%), 44 in atypia of undetermined significance (AUS, 3.66%), 64 in suspicious for malignancy (SFM, 5.33%), and 494 in malignant category (MAL, 41.16%). Ancillary studies were beneficial in the recategorization of 26% (11/44) AUS cases, 29.6% (19/64) SFM cases, and it helped refine tumor characteristics in 35.42% (175/494) cases categorized as malignant. Final ROM calculated for each category: ND 25%, NFM 18.6%, AUS 66.6%, SFM 88%, and MAL 100%. Conclusion Serous fluid is an easily obtainable sample that can provide opportunities for ancillary testing with clinical implications. In AUS and suspicious category although, diagnostic yield is increased however, a larger number of cases are required to obtain definite results.

Successfully restoring lateral lip defects, while ensuring proper mouth opening, oral competence, and the creation of an aesthetically pleasing vermilion, has consistently posed a challenging undertaking. In a prospective study conducted from 2006 to 2022, we employed our modified version of the McGregor fan flap technique to reconstruct post-oncosurgical pure lateral lower lip and complete lower lip defects. The study excluded cases involving a central lip defect or accompanying buccal mucosa involvement. A total of 126 flap procedures were performed on 122 patients, encompassing lower lip defects ranging from 30 to 100% in size. Unilateral flaps were performed on 118 patients, while four patients necessitated bilateral flap procedures. The reconstruction of the vermilion was accomplished using our modified flap technique in 114 patients, tongue flaps in two patients, and six patients, the flap’s skin was folded to mimic the vermilion. Remarkably, no complications such as hematoma, necrosis, flap loss, infection, microstomia, or dribbling were encountered. The labial sulcus was found to be adequately formed. All patients achieved preoperative mouth opening within 3 months following surgery, with a mean oral sphincteric recovery time of 4.2 months. The color match of the reconstructed vermilion was excellent. Our modified fan flap technique stands as a dependable and robust choice for addressing moderate to large full-thickness lateral defects of the lower lip offering effective vermillion reconstruction in a single surgical procedure. The cases involving associated buccal mucosa or submucous fibrosis may necessitate alternative vermilion reconstruction approaches.

Introduction Giant Cell Tumours (GCT) are benign tumours with aggressive potential that disrupt the local bony architecture, which can be especially problematic in peri-articular locations. There is no universally accepted treatment method for GCT distal ulna. Our aim is to assess the functional outcome of patients with GCT of the distal ulna who were treated by resection without reconstruction. Methods The study included 21 patients with distal ulna GCT that was resected without reconstruction. There were 12 males and 9 females, with a mean age of 30.4years (range 14–45 years). The patients mean follow-up period was 4.4 years, with a two-year minimum follow-up. Results Painful swelling was the main complaint in all cases. Nineteen patients had Campanacci grade 3 and two had Campanacci grade 2. The Musculoskeletal Tumor Society average score was 26.1. (range 22–28). Grip strength of the affected hand was reduced by 10.5% on average. (Range 0%–16%). One case had a local recurrence which was treated with surgery. Conclusion Based on current study, GCT of the distal ulna, en bloc resection without reconstruction can be recommended as a valuable treatment option for Campanacci grades 2 and 3 tumours. Resection of the distal end of the ulna without reconstruction results in excellent functional outcomes, with forearm rotational movement and hand function preserved.

Spindle epithelial tumor with thymic like elements (SETTLE) is a biphasic tumor composed of epithelial and spindle cell components. It is an uncommon indolent tumor arising in the thyroid gland and most commonly affects the children and young adults. This entity is mostly overlooked because of its rarity and diagnostic difficulty on morphology. We discuss two cases of SETTLE with varied presentation, diagnostic challenges and lessons learnt from them. SETTLE should be considered as a differential especially when dealing with a thyroid lesion in young and adolescent. The article discusses the histologic details and common mimickers to be borne in mind aiding in arrival at the final diagnosis on biopsy specimens.

Graphene and graphene oxide (GO) have garnered significant attention due to their exceptional properties. GO, enriched with various functional groups such as epoxy, hydroxyl, and carboxylic groups, has exhibited remarkable potential in biomedical applications. The combination of GO with metals has proven to be a promising platform for cellular imaging, with this study focusing on the preparation of diverse hybrids of GO with metal oxides (GO/MO) and their potential as anticancer agents. In this research, GO is functionalized with MOs like TiO 2 , Fe 3 O 4 , and Cu 2 O using specific chemical methods and investigated for the anticancer activity for the application as cancer therapeutic agent. The resulting GO/MO hybrids exhibits favorable thermal and mechanical properties. Moreover, their cytotoxicity against human lung cancer cells is assessed in vitro, revealing the promising anticancer activity of GO/MO hybrids. Notably, the GO/Cu 2 O hybrid demonstrates particularly high cytotoxicity in human lung cancer cells.