IntroductionLymph node involvement is the most important predictor of prognosis in oesophageal cancer. The present study describes our single-centre experience of lymphadenopathy in oesophageal carcinoma cases at a tertiary care centre in the Marathwada region of Maharashtra state in western India. MethodsThis descriptive study included 31 patients who were operated for oesophageal carcinoma at the State Cancer Hospital in Marathwada from August 2015 to September 2017. Thirty patients underwent three-field lymph node dissections, and one patient underwent Ivor Lewis surgery with two-field lymph node dissections. Three-field lymph node dissections were through a thoracotomy, followed by laparotomy and left cervical incision. The lymphatic metastases were categorised as (a) adjacent node metastases, (b) multiple levels of lymph node metastases, and (c) skip node metastases. The histopathological assessment of the removed specimen and lymph nodes was done. Pathologists evaluated the character and depth of the primary tumour and its invasion and node involvement. The location and numbers of positive and negative nodes were recorded. ResultsA total of 31 patients were included in the study, of which 17 had lymph node involvement. A total of 946 lymph nodes were dissected and examined, and the average number of lymph nodes removed per patient was 30.51. Among the 28 squamous cell carcinoma cases, lymph node involvement was found in 14 cases (50%) whereas, in adenocarcinoma, all the three cases showed lymph node involvement. In 11 cases of squamous cell carcinoma, thoracic lymph nodes were involved, whereas abdominal lymph nodes were involved in nine and cervical lymph nodes in two cases. Thoracic lymph nodes were involved in two cases of adenocarcinoma and abdominal lymph nodes were involved in one case of adenocarcinoma. ConclusionsSquamous cell carcinoma was the predominant type, and lymph node metastasis was observed in 50% of these cases. Thoracic lymph nodes were more commonly involved. Tumour staging T2 and T3 had an increasing percentage of lymph nodes involved. Lymph node involvement was more in moderately differentiated and undifferentiated oesophageal cancers.

The aim was to study and analyze in detail various parameters of Whipple resection specimen. Whipple procedure is a radical surgery performed for operable tumors of ampullary-periampullary region, head of pancreas, common bile duct and duodenum. Pathologic assessment of Whipple’s resection specimen needs special attention because of peculiar complex anatomy of head of pancreas and related structures, and also because of difference of opinion about grossing protocols of dissection of the specimen and confusion about terms like ‘margins’ and ‘surfaces’A histopathologist has to be aware of these intricacies so as to diagnose and accurately evaluate factors of prognostic importance.This is the first major mono-center surgical pathology study of Whipple resections reported from Department of Oncopathology, Government Cancer Hospital, Aurangabad, a newly started state level cancer hospital serving patients from Marathwada region of Maharashtra, India. This is surgical pathology study of total 31(thirty one) cases of Whipple resections performed during 2017-19. All relevant histopathologic details pertaining to grossing, microscopic diagnosis, grading and staging, and histopathologic prognostic factors were comprehensively studied. Dissection and grossing was done as per the protocols followed at Tata Memorial Hospital MumbaiOut of total 31 Whipple resections performed at this hospital, 01(one) was classical Whipple’s PD, seventeen (17) were pylorus preserving pancreaticoduodenectomy(PPPD) andthirteen (13) were of extended pancreaticoduodenectomy resections.The patients had age ranging from 38 to 76 years. There were 20 male patients and 11 female patients (M:F-2:1). As far as site of lesion is concerned 16(52%) cases had periampullary lesion. 06(19%)hadlesion in head of pancreas,07(22%) tumors were of common bile duct and there were 02(7%) cases of duodenal carcinoma. Histopathology revealed 29(94%) cases of malignant neoplasm and 02(6%) of benign lesion which included one(01) case of Brunner's gland hyperplasia withpancreatitis in adjacent pancreas, and the remaining 01 was of necrotizing pancreatitis( acute on chronic inflammation) with pseudocyst formation involving head of pancreas.Pathological stage of most of the tumors (55%) was T3, followed by T1(25%) and T2(20%)Amongst total 29 cases of malignant neoplasm, 08(28%) had well differentiated adenocarcinoma. 17 cases (58%) were of moderately differentiated adenocarcinoma and 02(7%) each were of mucinous carcinoma and neuroendocrine carcinoma. Microscopic involvement of margin/surface (CRM) was noted in 05 (17%)cases. In three(03) cases SMA surface and in 02 posterior surface were involved.PNI was noted in 12(41%) cases and LVI in 05(17%)cases. Peripancreatic lymph node metastasis was seen in 05(17%) cases. Specimens of regional lymphnodes were received separately & were negative for deposits in all the cases. Retroperitoneal lymph nodes received along with specimen of Extended Whipple’s were negative for metastasis in all the cases.From this study we conclude that important prognostic factors were location, extension, pathologic stage, histologic grade, status of margins / surfaces, LVI, PNI, and lymph node status. Therefore pathologic assessment of surgical specimen of pancreaticoduodenectomy (Whipple resection) needs special attention to evaluate these factors. To fulfill this purpose there is need of evolving standardized grossing protocols as well as uniform terminology related to terms ‘margin’ & ‘surface’.

Adrenocortical carcinoma is a rare tumour with incidence of 1 per million all over the world. Age distribution is bimodal with peaks occurring at 5-20 years and 40-50 years. Tumours greater than 9 cm commonly involve inferior vena cava (IVC) or right side of heart. 80 percent of the carcinomas are functional. We describe a case report of a rare tumour of a non-functioning adrenocortical carcinoma in a 40 year old female having incidence of 0.5/million world over with no extra-adrenal spread at presentation without IVC or right heart involvement in spite of having a large size of 12 cm. Patient underwent successful surgical extirpation with adjuvant radiotherapy with regular follow ups and disease free survival since the surgery. It is imperative to determine hormone levels in symptomatic and asymptomatic patients with adrenal masses. The possibility of adrenocortical carcinoma should not be ruled out in a functioning/non-functioning tumour. All solid incidentalomas on computed tomography (CT)/magnetic resonance imaging (MRI) greater than 5 cm in size should be removed surgically with adjuvant therapy consideration after histopathological reporting.

Background and objectiveEsophageal carcinoma remains a disease associated with high mortality rates among patients even after receiving treatment. Management with surgery alone offers a five-year survival of only 20%. Hence adjuvant and neoadjuvant therapies were instituted to treat this condition along with surgery. Neoadjuvant chemoradiotherapy (NACRT) followed by surgery is currently the standard of care. Neoadjuvant chemotherapy (NACT) is also recommended by some authors as a method of adequate care. There is a scarcity of studies in the literature comparing NACRT with NACT. In light of this, we employed the criteria of pathological response as a primary endpoint to compare the effectiveness of NACT and NACRT in treating esophageal carcinoma. Materials and methodsA total of 50 patients with esophageal cancer having Eastern Cooperative Oncology Group (ECOG) scores 0-2 with cancer stages cT2-T4a, cN0-N1, and cM0 were enrolled. The patients were further classified into two groups of 25 each. While one group received chemotherapy using inj. paclitaxel and carboplatin (NACT group), the other was managed with inj paclitaxel and carboplatin as well as 42 Gy of fractionated irradiation (NACRT group). Six weeks after the last dose of radiation or three weeks after chemotherapy, they were evaluated and offered transthoracic esophagectomy (TTE). ResultsSquamous cell carcinoma was found in 39 (78%) cases and 11 (22%) cases had adenocarcinoma. Pathologically complete or near-complete responses were seen in 42% of patients in the NACRT group and 22% in the NACT group. ConclusionWhile NACT and NACRT are both effective therapies for esophageal cancers, NACRT offers better tumor regression compared to NACT. Given the higher rates of complete or near-complete response in the NACRT group, NACRT is likely to offer higher overall survival rates than NACT.

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