Second malignancies after multiple myeloma: from 1960s to 2010s

Based on small numbers, recent reports from 3 randomized trials have consistently demonstrated more hematologic malignancies in patients treated with lenalidomide as maintenance (vs placebo). This fact has prompted concern and highlighted the association between multiple myeloma and second malignancies. Furthermore, an excess of acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) after multiple myeloma has been known for over 4 decades. Most prior studies have been restricted because of small numbers of patients, inadequate follow-up, and limitations of ascertainment of second malignancies. Although the underlying biologic mechanisms of AML/MDS after multiple myeloma are unknown, treatment-related factors are presumed to be responsible. Recently, an excess risk of AML/MDS was found among 5652 patients with IgG/IgA (but not IgM) monoclonal gammopathy of undetermined significance, supporting a role for disease-related factors. Furthermore, there is evidence to suggest that polymorphisms in germline genes may contribute to a person's susceptibility to subsequent cancers, whereas the potential influence of environmental and behavioral factors remains poorly understood. This review discusses current knowledge regarding second malignancies after multiple myeloma and gives future directions for efforts designed to characterize underlying biologic mechanisms, with the goal to maximize survival and minimize the risk for second malignancies for individual patients.     

Postoperative sore throat with 0.05% betamethasone gel and 2% lignocaine jelly used as a lubricant for ProSeal LMA (PLMA) insertion

Postoperative sore throat (POST) is a minor complication after general anaesthesia. Many agents have been used as lubricant to reduce the incidence of POST with variable efficacy. We conducted a study to compare the incidence of POST with 0.05% betamethasone gel and 2% lignocaine jelly as a lubricant for PLMA insertion in patients undergoing general anaesthesia.Sixty subjects were divided randomly into two groups. Patients in Group I (n = 30) had 2.5 ml of 0.05% of betamethasone gel while the Group II had 2.5 ml of 2% lignocaine jelly applied on the cuff of PLMA. After standard induction and insertion of PLMA cuff inflated to 60 cm of H₂O and was maintained at the same throughout the surgery. In PACU, patients were inquired about sore throat at immediate and 24 h post operative period.POST was not observed in any of the patients of Group I. In group II 33% of the patients had 1st degree and 10% had 2nd degree of sore-throat in immediate post-operative period. After 24 h 16% patients had 1st degree sore-throat and 3% patients had 2nd degree of sore-throat in Group II patients. We conclude that lubricating cuff of PLMA with 0.05% of betamethasone gel is effective in reducing the incidence of POST.     

Impact of genomic assays on treatment and outcomes in locally advanced breast cancer

Breast Cancer Research and Treatment - Genomic profiling in early-stage breast cancer provides prognostic and predictive information. Genomic profiling assays have not been validated in locally...     

Ossifying fibromyxoid tumor: Fine‐needle aspiration cytology findings of a rare soft tissue neoplasm

Ossifying fibromyxoid tumors (OFMTs) are rare tumors of uncertain origin and intermediate (rarely metastasizing) biologic potential, with characteristic morphology of an encapsulated tumor containing polygonal cells in an abundant fibromyxoid matrix surrounded by a peripheral layer of metaplastic lamellar bone. FNA cytology of OFMT has not been sufficiently reported and till date cytological features of only seven cases have been reported so far. We report another case of OFMT in a 55‐year‐old female presenting with longstanding swelling in thigh. On fine‐needle aspiration, a tumor with moderate cellularity and myxoid areas was seen; coupled with compatible radiological findings, a diagnosis of OFMT was suggested. Establishing a correct diagnosis is important as although OFMT is benign in nature, local recurrences or rarely distant metastasis have been seen of this tumor. Hence, a high degree of suspicion with radiological correlation is of utmost importance for identification of this entity.