Five Simultaneous Primary Tumors in a Single Patient: A Case Report and Review of the Literature

Multiple primary malignancies (MPMs) are present when a patient is diagnosed with more than one primary malignancy and when each tumor is histologically unrelated to the others. MPMs are considered synchronous when they present within 6 months of one another. Here, we report the case of a 57-year-old woman with a past medical history significant for melanoma in 1988, who presented in 2014 with 5 distinct tumors within 4 months: malignant melanoma of the right popliteal fossa, invasive lobular breast carcinoma, diffuse large B cell lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, and a giant cell tumor of tendon sheath/pigmented villonodular synovitis. We discuss her treatment and also present a brief review of the literature. The incidence of MPMs appears to be on the rise, which demands an interdisciplinary, multimodal, and personalized approach to care.Key Words: Multiple malignancies, Melanoma, Breast cancer, Lymphoma, Giant cell tumor     

Four-decade maintenance of analgesia with percutaneous cordotomy

The management of severe, medically intractable pain is a significant challenge for neurosurgeons and pain management physicians. An existing technique that can effectively alleviate contralateral chronic pain is cordotomy, interruption of the lateral spinothalamic tract of the spinal cord. Since 1912, cordotomy has evolved from a relatively morbid open surgical procedure to a percutaneous radiofrequency procedure with low morbidity. However, since cordotomy is utilized primarily in cancer pain patients, long-term patient follow-up is rare, and the potential duration of analgesia following cordotomy is not known. Here we describe a case with a 41-year follow-up of percutaneous cordotomy for noncancer pain that resulted in over 35 years of complete analgesia, the longest recorded in the literature to date. This case demonstrates that percutaneous cordotomy can provide long-lasting, complete analgesia in some patients and merits continuation as a part of the neurosurgical arsenal of pain therapies.     

Evaluation of the prevalence and severity of pain in patients with stable chronic heart failure

AIM:To evaluate the prevalence and severity of pain in patients with chronic stable heart failure(HF) in an outpatient clinic setting.METHODS:This is a cross-sectional study evaluating symptoms of generalized or specific pain in patients with chronic stable heart failure.A standardized questionnaire(Edmonton Symptom Assessment System) was administered during a routine outpatient clinic visit.The severity of pain and other symptoms were assessed on a 10 point scale with 10 being the worst and 0 representing no symptoms.RESULTS:Sixty-two patients [age 56 ± 13 years,51 males,11 females,mean ejection fraction(EF) 33% ± 17%] completed the assessment.Thirty-two patients(52%) reported any pain of various character and location such as chest,back,abdomen or the extremities,with a mean pain score of 2.5 ± 3.1.Patients with an EF less than 40%(n = 45,73%) reported higher pain scores than patients with an EF greater than 40%(n = 17,27%),scores were 3.1 ± 3.3 vs 1.2 ± 1.9,P < 0.001.Most frequent symptoms were tiredness(in 75% of patients),decreased wellbeing(84%),shortness of breath(SOB,76%),and drowsiness(70%).The most severe symptom was tiredness with a score of 4.0 ± 2.8,followed by decreased wellbeing(3.7 ± 2.7),SOB(3.6 ± 2.8),and drowsiness(2.8 ± 2.8).CONCLUSION:Pain appears to be prevalent and significantly affects quality of life in HF patients.Adequate pain assessment and management should be an integral part of chronic heart failure management.     

Lipodystrophy of Abdominal Pannus: A Severe Complication of Phosphatidyl Choline Injections

“Injection lipolysis” or “mesotherapy” is done for introducing various substances into deeper layers of the skin with the aim to dissolve subcutaneous fat. However, the safety profile of these chemicals is poorly regulated. Therefore, they may cause side effects or long-term sequelae that can be disastrous for the patient. We present such a case that required surgical management to salvage it and to give an aesthetically acceptable result.     

Episcleral plaque brachytherapy using 'BARC I-125 Ocu-Prosta seeds' in the treatment of intraocular tumors: a single-institution experience in India

Context:

To analyze the results of episcleral plaque brachytherapy using indigenous Bhabha Atomic Research Centre (BARC) Iodine-125 Ocu-Prosta seeds for the management of intraocular tumors from a single institute.

AIM:

To report our initial experience and learning curve on the use of ‘BARC I-125 Ocu-Prosta seeds’ for the management of intraocular tumors such as choroidal melanomas, retinoblastomas and vasoproliferative tumors (VPT).

Materials and Methods:

We retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between May 2008 to March 2012. Nine cases had choroidal melanomas; three had retinoblastomas while one case had VPT.

Results:

For choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm, respectively, which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow-up of 24 months (range 10-43 months). Retinoblastoma and VPT also showed good regression after brachytherapy.

Conclusion:

Plaque radiotherapy using ¹²⁵I seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. Patients in our studies experienced excellent local tumor control. With the availability of indigenous ‘BARC I-125 Ocu-Prosta seeds’ locally, cost effective ophthalmic brachytherapy can be performed in India.