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   Table of Contents - Current issue
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January-March 2021
Volume 8 | Issue 1
Page Nos. 1-38

Online since Monday, March 1, 2021

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REVIEW ARTICLES  

Molecular biology of urothelial carcinoma p. 1
Peir- In Liang, Ti- Chun Chan, Yow- Ling Shiue, Chien- Feng Li
DOI:10.4103/JCRP.JCRP_1_21  
Objective: Urothelial carcinoma (UC) is a common malignant tumor worldwide. Extensive genomic data analysis revealed that UC has a complex molecular character. From the perspective of cancer hallmarks reviewed the molecular biology participated in the tumorigenesis of UC. Data Sources: We inspected the results of multiple studies of UC focusing on the hallmarks of cancer. Results: UC has distinctive molecular pathways involved in sustained proliferative signaling, evasion of growth suppressors, resistance to cell death, promotion of replicative immortality, induction of angiogenesis, activation of invasion and metastasis, genome instability and mutation, tumor-promoting inflammation, reprogramming of energy metabolism, and evasion of immune destruction. Conclusion: From the perspective of the hallmark of cancer, we revealed the many-sided biological behavior of UC.
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Chemotherapy for osteosarcoma: Literature review and experience of Taipei veterans general hospital p. 9
Tien- Hua Chen, Giun- Yi Hung, Chueh- Chuan Yen
DOI:10.4103/JCRP.JCRP_24_20  
Objective: This article reviews the current standard of care for osteosarcoma and the experience of Taipei Veterans General Hospital. Data Sources and Study Selection: We searched PubMed using the keyword “osteosarcoma” and article type “Clinical Trial.” Prospective, randomized, Phase II/III clinical trials which resulted in practice change were enrolled. In addition, retrospective studies from Taipei Veterans General Hospital were also included. Results: For localized conventional osteosarcoma, combined perioperative chemotherapy with surgical resection dramatically improved long-term outcomes. Combination chemotherapy with methotrexate, Adriamycin, and cisplatin (MAP) is currently widely accepted to be the optimal regimen. The efficacy of chemotherapy has increased the likelihood of a limb-salvage approach, which has become the mainstay of surgery. In Taipei Veterans General Hospital, MAP plus ifosfamide was used and could achieve a 5-year overall survival (OS) rate of 77% and progression-free survival (PFS) rate of 70% for all patients. For nonmetastatic osteosarcoma, the 5-year OS and PFS rates reached 90% and 83%, respectively. For recurrent/metastatic disease, there is currently no satisfactory systemic therapy. Removal of all tumors should be attempted if clinically feasible, because one-third of patients may survive for 5 years or more if the tumors are completely resected. Conclusion: Perioperative chemotherapy is associated with excellent OS, PFS, and limb salvage rates and is the current standard of care for osteosarcoma.
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ORIGINAL ARTICLES Top

Safety and efficacy of oxycodone in cancer patients with moderate-to-severe cancer pain: A single-medical center experiences p. 13
Chien- Chang Lu, Hong- Hwa Chen
DOI:10.4103/JCRP.JCRP_15_20  
Background: The study aimed at evaluating the safety and tolerability of oxycodone in patients with moderate-to-severe cancer pain at a medical center in southern Taiwan. Materials and Methods: This was a subgroup analysis of a 12-week, uncontrolled, open-label, multicentric study. During the treatment phase, all participants received control-released (CR) oxycodone and/or immediate-released (IR) oxycodone. The primary end point was the number and percentage of patients with adverse events (AEs) and serious adverse events (SAEs). The secondary end points included patient-reported outcomes and titration of oxycodone. Results: A total of 19 patients were enrolled at this medical center. A total of 56 AEs were documented in 12/19 (63.2%) patients, of which, only 4/56 (7.1%) AEs were treatment-related adverse events occurring in 3/19 (15.8%) patients and no treatment-related SAEs were observed. Most AEs were mild and typical for opioids administered to patients with cancer pain. The most AEs involved the gastrointestinal systems (23%), such as nausea, constipation, and vomiting. At the study end, pain intensity of Numeric Rating Scale score had significantly decreased from 6.3 to 1.6 points; the quality of life on the European Quality of Life Visual Analog Scale (EQ-VAS) median score had improved from 50 to 60 points; and proportion of good/excellent? quality of analgesia (QoA) had increased from 5.3% to 100%. The interesting findings of EQ5D item analyses that the top two improvements were anxiety/depression and pain/discomfort, whereas “mobility” and “self-care” became worse, demonstrated that improvement in cancer pain seems to have more improvement on patients' anxiety/depression.” The median stable dose was 20 mg/day and the median time to reach stable dose was 1 day. Conclusion: CR and IR oxycodone are tolerable and effective in managing moderate-to-severe cancer pain among patients with colorectal cancers s at this medical center. Neither new safety signals nor significant bowel function disorders were noted. Together with the high acceptability and improvements on anxiety/depression and pain/discomfort on Taiwanese cancer patients, CR and IR oxycodone can be another valuable pain management option used for the daily control of moderate-to-severe cancer pain.
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Role of micronucleus assay as an indicator of chromosomal instability in aspirates of breast carcinoma p. 20
Shubhangi Natthuji Mangam, Abhay Vilas Deshmukh, Vitaladevuni B Shivkumar
DOI:10.4103/JCRP.JCRP_26_20  
Background: A micronucleus (MN) is a small additional nucleus, morphologically identical to but smaller than the main nucleus. It is a sensitive indicator of chromosomal instability, and it can be detected in fine-needle aspiration (FNA) smears with the Giemsa stain by light microscopy and the acridine orange (AO) stain by fluorescent microscopy. The objective of this study was to analyze the MN score in FNA smears of patients with breast carcinoma and fibroadenoma (FA). Materials and Methods: This was a prospective observational study which included 78 cases of infiltrating duct carcinoma (IDC) and 82 of FA (as controls). Giemsa- and AO-stained FNA smears were analyzed and MN scores were compared between the IDC and FA cases. Results: The mean MN scores of the FA and IDC groups were 0.28 ± 0.45 and 11.28 ± 7.22 in the AO-stained smears and 0.13 ± 0.34 and 9.79 ± 6.5 in the Giemsa-stained smears (P = 0.0002 and 0.0001), respectively. The MN score increased in a stepwise manner from FA to Grade I, II, and III of IDC in Giemsa-stained smears. Comparisons of mean MN score between FA and the three different grades of IDC and between Grade I and II and Grade III were statistically significant (<0.001 in each category). Although the mean MN score with AO stain was higher than the mean MN score with Giemsa stain, this difference was not statistically significant (P = 0.17). Conclusion: The MN score in FNA smears in the IDC group was significantly higher than in the FA group, suggesting that it can be used as a potential additional surrogate marker for diagnosing and grading breast carcinoma. Both AO and Giemsa stains were equally good for MN scoring of the FNA smears.
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CASE REPORTS Top

An advanced-stage large-cell neuroendocrine lung carcinoma with intramedullary spinal metastases detected by positron emission tomography p. 26
Shao- Ming Yu, Yu- Chuan Chang, Wen- Chi Chou
DOI:10.4103/JCRP.JCRP_28_20  
Large-cell neuroendocrine carcinoma (LCNEC) is a rare form of lung cancer with an aggressive behavior that frequently metastasizes to liver, brain, and bone. Intramedullary spinal cord metastasis (ISCM) is a rare clinical presentation of solid cancer and always indicates a dismal prognosis. This article presents a 72-year-old male patient diagnosed with an advanced-stage LCNEC who initially presented with ISCM that was diagnosed by positron emission tomography-computed tomography (PET-CT). This case demonstrates the diagnostic performance of PET-CT for ISCM. PET may be an alternative diagnostic modality for patients intolerant or unable to receive magnetic resonance imaging study to detect ISCM in those with LCNEC.
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Krukenberg tumor of the ovary from cecal carcinoma in a young woman p. 29
Padmapriya Balakrishnan, Vijayan Sharmila, Thirunavukkarasu Arun Babu
DOI:10.4103/JCRP.JCRP_29_20  
Krukenberg tumor of the ovary is not commonly encountered in routine practice. It is a special type of metastatic bilateral ovarian tumor characterized by the presence of mucin-laden signet cells infiltrating the ovarian stroma. Signet ring cells metastasize from primary tumors of the stomach, colon, breast, appendix, and pancreatobiliary tract. We report a rare case of a Krukenberg tumor of the ovary from adenocarcinoma of the colon diagnosed in a 35-year-old female. This case report emphasizes the importance of history taking, clinical examination, and diagnostic evaluation, as there is a propensity for delayed diagnosis in majority of patients due to nonspecific and vague clinical presentation.
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A patient with tonsillar lymphoma with invasive listeriosis imitating acute ischemic stroke p. 33
Jing- Gu Jiang, Pei- Ying Hsieh
DOI:10.4103/JCRP.JCRP_33_20  
Prior cytotoxic chemotherapy and the long-term use of prednisone can impair immunity. Listeria monocytogenes can cause invasive infections in these immunocompromised patients with a lower number of microorganisms. This can lead to central nervous system infections which may have similar initial clinical presentations to ischemic stroke.
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Unusual bilateral adrenal tumors: Primary adrenal diffuse large B-cell lymphoma p. 36
Ya- Lun Ke, Jui- Feng Hsu, Yu- Ching Wei, Hui- Hua Hsiao
DOI:10.4103/JCRP.JCRP_34_20  
Primary adrenal non-Hodgkin lymphoma is an extremely rare disease confined wholly or chiefly to extranodal involvement. We report the case of an old woman who presented with progressive malaise and was diagnosed with primary adrenal diffuse large B-cell lymphoma pathology using laparoscopic adrenalectomy. Enhanced computed tomography and positron emission tomography revealed bilateral adrenal involvement.
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