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   Table of Contents - Current issue
Coverpage
October-December 2021
Volume 8 | Issue 4
Page Nos. 127-169

Online since Friday, December 3, 2021

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REVIEW ARTICLE  

Success is not final, failure is not fatal: The changing landscape of systemic therapy for advanced hepatocellular carcinoma Highly accessed article p. 127
Chiun Hsu
DOI:10.4103/JCRP.JCRP_21_21  
Objective: To review the history of development of systemic therapy for advanced hepatocellular carcinoma (HCC). Data Sources: Published clinical trials of single-agent targeted agents, single-agent immune checkpoint inhibitors (ICI), and ICI-based combination regimens. Results: Key lessons learned from previous positive and negative clinical trials included design of more efficient clinical trials and incorporation of trial endpoints most relevant to clinical benefit. Major challenges included prioritization of novel combination therapies for clinical trials and development of predictive biomarkers. Conclusion: The improved efficacy and safety of systemic therapy will impact on future multi-disciplinary management of HCC through more extensive integration with liver-directed therapy for different stages of HCC patients.
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ORIGINAL ARTICLES Top

Using interim positron emission tomography as a predictor for relapse-free survival in hodgkin lymphoma: Experience from a single Institution p. 134
Hung- Lin Liu, Ming- Chung Wang, Chin- Yuan Kuo, Ming- Chun Ma, Chun- Kai Liao
DOI:10.4103/JCRP.JCRP_14_21  
Background: Since the emergence of 18F-fluoro-2-deoxyglucose positron emission tomography (PET), PET has been widely implemented for the initial staging and evaluation of treatment response of classical Hodgkin lymphoma (cHL). Interim PET after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) has been proven to be a reliable tool to predict clinical outcomes in patients with cHL, and response-adapted therapies based on interim PET results have become the standard method of treatment. The aim of this study was to report our experience of using interim PET in our institution and determine whether it is a predictive marker for cHL. In addition, we also analyze associations between other patient characteristics and interim PET results at initial diagnosis. Materials and Methods: This retrospective study enrolled patients verified to have newly diagnosed cHL and who received ABVD as frontline treatment between 2008 and 2019 in our hospital. Interim PET was arranged after 2-3 cycles of ABVD, and we used Deauville 5-point score to evaluate the response. Subgroup analysis was performed to assess correlations between interim PET and patient characteristics. Results: Sixty patients underwent interim PET examinations. The age ranged from 14 to 74 years with a medium follow-up of 18.3 months (range: 4–113 months). The patients who had negative interim PET results (n = 36, 60%) had significantly longer relapse-free survival than those with positive results (P < 0.001). Patients with bulky disease, B-symptoms, or neutrophil to lymphocyte ratio (NLR) >6 were more likely to have positive interim PET-computed tomography results (P < 0.001, 0.023, and 0.037, respectively). Conclusion: Interim PET plays an important role in predicting relapse free survival for patients with Hodgkin lymphoma at our institution. A high NLR was correlated with interim PET results in this study.
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Histologic characteristics of invasive oral carcinoma and the role of epithelial-mesenchymal transition in cancer progression p. 139
Sujata Jetley, Beenish Sultan, Safia Rana, Shaan Khetrapal, Arun Prakash Sharma, Khaja Naseeruddin, Zeeba S Jairajpuri
DOI:10.4103/JCRP.JCRP_25_21  
Background: To find the association of tumor budding, depth of invasion (DOI), and epithelial-to-mesenchymal transition (EMT) markers (E-cadherin and smooth muscle actin [SMA] expression) with prognostic factors of oral squamous cell carcinoma (OSCC). Materials and Methods: A cross-sectional study conducted on 50 cases of histologically proven OSCC were selected for the assessment of TNM staging, tumor budding, DOI, and EMT markers (E-cadherin and SMA expression). Associations were evaluated between established clinical prognostic factors and histological parameters. Statistical analysis was performed using SPSS version 21.0. (IBM, Chicago, Illinois, USA) and P < 0.05 was considered statistically significant. Results: In the study, the median age of distribution was 48.5 years with 86% of males. Tobacco consumption was seen among 90% of patients. A significant association of pathological TNM staging with tumor budding and DOI (P < 0.05). There was a loss of E-cadherin expression with loss of tumor differentiation, progressive TNM stage, increasing DOI and more tumor budding (P < 0.05). On the contrary, α-SMA (% stained cells) expression showed an increase with increasing pathological T stage, N stage, tumor budding, and DOI (P < 0.0001). However, the tumor differentiation showed no significant association with SMA expression (P = 0.44). Conclusion: It can be concluded that EMT has a strong association with OSCC demonstrated by loss of E-cadherin and increased expression of α-SMA at the invasive front in higher grade carcinomas, in tumors with increased DOI, high-risk tumor budding, and increased pathological T and cases showing lymph node metastasis. Hence, SMA can be used in conjunction with loss of E-cadherin expression for determining the aggressive nature of OSCC and predicting the survival rates of the patients.
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CASE REPORTS Top

Pleural effusion as the initial presentation of synchronous small lymphocytic lymphoma and non-small cell lung cancer p. 148
Chao- Hung Wei, Yih- Leong Chang, Hsin- An Hou
DOI:10.4103/JCRP.JCRP_20_21  
We report a case of a 64-year-old woman who presented with chronic cough for 2 months. A chest X-ray showed new-onset left pleural effusion, and chest computed tomography confirmed left pleural effusion in addition to small ground-glass nodules in both lungs. Analysis of the pleural effusion including culture and cytology did not show specific findings at a local hospital. Due to suspected lung cancer with malignant pleural effusion, thoracoscopic surgery was performed. Histopathological and immunohistochemical examinations revealed Stage I lung adenocarcinoma and concurrent primary pulmonary small lymphocytic lymphoma (SLL). This is a very rare case of primary pulmonary SLL and a concurrent lung adenocarcinoma.
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Durable response of immune checkpoint inhibitor after failure of gemcitabine-based chemotherapy for a patient with metastatic biliary tract cancer p. 152
Chien- Huai Chuang, Chiun Hsu
DOI:10.4103/JCRP.JCRP_22_21  
Patients with advanced or metastatic biliary tract cancer (BTC) have poor survival and limited options of systemic anticancer therapy besides the combination of gemcitabine plus cisplatin. Recent advances in molecular screening have identified that a minor proportion of BTC patients may benefit from specific targeted agents, e.g., fibroblast growth factor receptor or isocitrate dehydrogenase 1 inhibitors. The role of immune checkpoint inhibitor therapy in advanced BTC remains unclear. In this report, we describe a patient with intrahepatic cholangiocarcinoma who suffered from rapid progression of extrahepatic metastases after surgery and progression of the tumors after chemotherapy. Pembrolizumab was given, and the patient remained in partial response at the time of writing this report, after 1½ years of pembrolizumab therapy, without evident adverse events. We also review and discuss the current landscape of systemic therapy for advanced BTC and the possible role of immune checkpoint inhibitor therapy.
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Aldosterone-producing adrenocortical carcinoma with unusual initial presentations: A rare disease and case report p. 159
Jen- Chieh Chen, Tzu- Chun Wei, Chin- Chen Pan, Yen- Hwa Chang, William J Huang
DOI:10.4103/JCRP.JCRP_23_21  
Aldosterone-producing adrenocortical carcinoma (APAC) is extremely rare. It is not only the rarest functional adrenocortical carcinoma (ACC) but also the most infrequent cause of primary hyperaldosteronism (PH). Furthermore, if hypertension and hypokalemia present in a patient with ACC, they are more likely secondary to overproduction of glucocorticoid, rather than PH. To our knowledge, APAC has not yet been reported in Taiwan with detailed clinical manifestations. We present a patient diagnosed with APAC due to an unusual initial presentation, predominantly right-sided varicocele, treated successfully by en bloc resection, being disease-free for 10 months. Due to the rarity and unfavorable outcomes of APAC, we report the patient's clinical course, treatment, and follow-up outcomes.
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Laparoscopic resection of an adrenaline secreting para-aortic paraganglioma p. 163
Basil Badruddin, Samir Gupta
DOI:10.4103/JCRP.JCRP_18_21  
Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal chromaffin tissue. About half of paragangliomas occur in the para-aortic region, and only a few are functional. Although surgical resection remains the definitive treatment, only a few cases of laparoscopic resection of para-aortic paragangliomas have been reported. Here, we report a case of catecholamine-secreting left para-aortic paraganglioma resected laparoscopically. Laparoscopic resection of these tumors is associated with lesser blood loss, lesser postoperative pain, and shorter hospital stays. The close cooperation between the surgeon and anesthesiologist is highlighted.
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Light chain myeloma presenting as chronic diarrhea p. 166
Mansoor C Abdulla
DOI:10.4103/JCRP.JCRP_15_21  
Light chain myeloma represents one-fifth of all cases of myeloma and light chain amyloidosis is associated with 10% of cases of myeloma. Multiple myeloma is a plasma cell disorder with diverse presentations. Here, we present a 72-year-old male with light chain myeloma with colorectal amyloidosis. Chronic diarrhea secondary to isolated colorectal amyloidosis as an initial presentation of multiple myeloma is extremely rare. Early diagnosis is important for timely therapeutic interventions which can improve the treatment outcome in this otherwise uniformly fatal disease.
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CORRIGENDUM Top

Corrigendum: A Patient with Tonsillar Lymphoma with Invasive Listeriosis Imitating acute Ischemic Stroke p. 169

DOI:10.4103/2311-3006.331655  
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