Recurrent posterior reversible encephalopathy syndrome after chemotherapy in hematologic malignancy-posterior reversible encephalopathy syndrome can strike twice!!!

Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome characterized by seizures, altered level of consciousness, visual disturbance, and hyperintense lesions on magnetic resonance imaging most commonly in the posterior regions. PRES is typically associated with a number of complex clinical conditions including: Preeclampsia/eclampsia, allogeneic bone marrow transplantation, solid organ transplantation, autoimmune diseases, and high-dose anti-neoplastic therapy. We herein describe a case of recurrent PRES in a 29-year-old lady of refractory anaplastic large-cell lymphoma who was on second-line chemotherapy with Ifosfamide-Carboplatin-etoposide regimen. We have also tried to illustrate the pathogenesis, radiological features, and management of PRES. Although reversible in most cases, PRES may be recurrent even in chemotherapy - induced cases and result in fatal outcomes despite appropriate intervention. This is the first - reported case of recurrent PRES with such a fatal outcome, as a complication of anti-neoplastic systemic therapy

Accessory breast tissue in axilla masquerading as breast cancer recurrence

Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen

Rhabdoid variant of lung cancer: Clinicopathological details of a case and a review of literature

Primary rhabdoid tumor of lung is a rare histological and clinical entity. Lung tumors with rhabdoid features have been included as variants of large-cell carcinoma in the 1999 World Health Organization (WHO) classification of lung tumors. A large-cell carcinoma with a rhabdoid phenotype (LCCRP) is unusual, with only 38 cases reported till date. We report the clinical details of one such case that was treated with pneumonectomy and adjuvant chemotherapy. We also present a review of the literature. To identify relevant articles, we searched PubMed, Ovid, and IngentaConnect databases using the key words ′rhabdoid,′ ′lung cancer,′ and ′primary rhabdoid tumor of lung.

Execution of mantle field with multileaf collimator: A simple approach

Background: Until very recently mantle field radiotherapy remained the gold standard for the treatment of favorable early-stage Hodgkin\u2032s lymphoma. The classic mantle includes all the major lymph nodes above the diaphragm and extends from the inferior portion of the mandible to the level of the insertion of the diaphragm. Aims: To describe a simple technique that has been devised to treat the mantle field with the help of multileaf collimator and using computed tomography (CT)-based treatment planning. Materials and Methods: CT scan was performed with the patient in the supine position and the datasets were transferred to the Eclipse\u2122 treatment planning system. Elekta Precise\u2122 linear accelerator equipped with 40 pairs of multileaf collimator (MLC) was used for the execution of the mantle field. The MLC\u2032s shapes were designed to take the shape of the conventional customized blocks used for treatment of mantle field. The anterior mantle field was divided into three separate MLC segments with the collimator kept at 0\ub0. The first MLC segment was shaped to cover the neck, clavicular regions, and mediastinum. The second and the third MLC segments covered the right and left axilla, respectively. The posterior fields were opposed to the anterior subfields in a similar fashion. The dose was prescribed at the midplane, using reference points. Results and Conclusion: The technique described in this study is very simple, easy to implement, and avoids unnecessary delay in the execution of the mantle field. The mantle field can be easily shaped with the multileaf collimators, without any collimator rotation