Hemangiopericytoma (HPC) is a rare tumor of uncertain malignant potential arising from mesenchymal cells with pericytic differentiation. It accounts for 3-5% of soft tissue sarcomas and 1% of vascular tumors. It usually presents in 5th to 6th decade of life. Most common sites are limbs, pelvis and head and neck. About 20% of all hemangiopericytomas are seen in head and neck, mostly in adults. Usually it presents in orbit, nasal cavity, oral cavity, jaw, parotid gland, parapharyngeal space, masticator space and jugular foramen. Long term follow up is important because of imprecise nature of the histological criteria for prediction of biologic behavior.We report herein a case of HPC in 66-year-old man, who presented in our department with headache, nasal obstruction and dysphagia. A neck computer tomography scan and magnetic resonance imaging showed a large left parapharyngeal mass bulging into nasopharynx and oropharynx with extension to pharyngeal mucosal surface and causing narrowing of airways and total obstruction of left posterior nostril. Angiography showed a highly vascular neoplasm. Initially he was managed as a case of schwannoma and embolization was done but with no response. An attempt to do complete surgical resection was made, but due to its critical position, it was not possible. During surgery, highly vascularised tumor was found. The histopathologic examination revealed a vascular tumor consistent with hemangiopericytoma G-II. The patient had normal postoperative course of healing and was given adjuvant radiation. He is on regular follow up without signs of recurrence or metastases.In summary, parapharyngeal space is a rare site of presentation for hemangiopericytoma which is highly vascular tumor, requiring extensive work up including magnetic resonance imaging, computed tomography scan and angiography. Complete surgical excision should be attempted. Postoperative radiation is indicated in cases of incomplete resection.

BackgroundThyroid gland lacks squamous epithelium (except in some rare situations like embroyonic remnants or in inflammatory processes); for that reason the primary squamous cell carcinoma (SCC) of thyroid is extremely rare entity, seen only in less than 1% of all thyroid malignancies and is considered almost fatal. So, far, only few case reports have been published in literature.Case presentationHerein we present a 54 years old Saudi female with 3 months history of progressive neck swelling and hoarse voice, who was referred to us by her primary care physician as suspected case of anaplastic carcinoma of thyroid for radical external beam radiation therapy (EBRT). Fine Needle aspiration cytology (FNAC) revealed squamous cell carcinoma. Computed tomography (CT) neck showed 10 × 10 cm mass in left lobe of thyroid invading trachea and skin. Extensive staging work up ruled out the possibility of any primary site of SCC other than thyroid gland. Tumor was found unresectable and was referred to radiation oncology. She received palliative EBRT 30 Gy in 10 fractions. After completion of EBRT, there was progression of disease and patient died 3 months after completion of EBRT by airway compromise.ConclusionPrimary SCC of thyroid is rare and aggressive entity. FNAC is reliable and effective tool for immediate diagnosis. Surgery is a curative option, but it is not always possible as most of cases present as locally advanced with adjacent organs involvement. EBRT alone was found ineffective. Aggressive combined modality (debulking surgery, radiation and chemotherapy) shall be considered for such cases.

BackgroundTo present our experience of intensity-modulated radiotherapy (IMRT) with simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC).MethodsSixty eight patients of NPC were treated between April 2006 and December 2011 including 45 males and 23 females with mean age of 46 (range 15–78). Stage distribution was; stage I 3, stage II 7, stage III 26 and stage IV 32. Among 45 (66.2%) evaluated patients for presence of Epstein-Barr virus (EBV), 40 (88.8%) were positive for EBV. Median radiation doses delivered to gross tumor volume (GTV) and positive neck nodes were 66–70 Gy, 63 Gy to clinical target volume (CTV) and 50.4 Gy to clinically negative neck. In addition 56 (82.4%) patients with bulky tumors (T4/N2+) received neoadjuvant chemotherapy 2–3 cycles (Cisplatin/Docetaxel or Cisplatin/Epirubicin or Cisplatin/5 Flourouracil). Concurrent chemotherapy with radiation was weekly Cisplatin 40 mg/m2 (40 patients) or Cisplatin 100 mg/m2 (28 patients).ResultsWith a median follow up of 20 months (range 3–43), one patient developed local recurrence, two experienced regional recurrences and distant failure was seen in 3 patients. Estimated 3 year disease free survival (DFS) was 94%. Three year DFS for patients with EBV was 100% as compared to 60% without EBV (p = 0.0009). Three year DFS for patients with undifferentiated histology was 98% as compared to 82% with other histologies (p = 0.02). Acute grade 3 toxicity was seen as 21 (30.9%) having G-III mucositis and 6 (8.8%) with G-III skin reactions. Late toxicity was minimal and loss of taste was seen in 3 patients (7.5%) at time of analysis.ConclusionsIMRT with SMART in combination with chemotherapy is feasible and effective in terms of both the clinical response and safety profile. EBV, histopathology and nodal involvement were found important prognostic factors for locoregional recurrence.

Background: The current standard of care for locoregionally advanced nasopharyngeal carcinoma (LANPC) is concurrent chemoradiation (CRT). Unfortunately, 20% patients with LANPC still experience distant failure after CRT. Recently published prospective clinical trials and two meta-analyses have shown that, addition of induction chemotherapy (IC) before CRT, could potentially improve oncological outcomes in comparison to CRT alone. Although it remains unclear, which is the best IC regimen to be offered and for how many cycles. Unfortunately till date, there is no published data from India, regarding the outcomes of various commonly used IC regimens before CRT, in LANPC. Methods: Patients diagnosed with LANPC from January 2012 to March 2018, who received 3 cycles IC before definitive CRT, were reviewed. The inclusion criteria were: age 18 years, pathologically proven NPC, ECOG PS 2; and adequate organ functions. Major exclusion criteria were: previous therapy for NPC and evidence of metastatic disease. Patients received IC with either paclitaxel and cisplatin (TP) or paclitaxel/docetaxel, cisplatin and 5-FU (TPF) at standard doses, every 3 weeks along with primary G-CSF prophylaxis. Results: Total 38 pts received either TP (n ¼ 20) or TPF (n ¼ 18) as IC. The median age was 36 years (range, 18-62); 66% males; WHO histological type 1/2/3, 0%/18%/82%; TNM stage III/IVA/IVB, 37%/34%/29%. The ORR after 3 cycles of TP and TPF IC were 70% and 78% respectively; and the corresponding rates were 85% and 94%, after CRT. At a median follow-up of 26 months, 2-year failure-free survival and OS for TP arm were 80% and 90%; and the corresponding rates for TPF arm were 89% and 94% respectively. All Grade III-IV toxicities were numerically higher with TPF than TP: neutropenia (33% vs 15%), febrile neutropenia (17% vs 5%), mucositis (11% vs 0%) and diarrhea (11% vs 0%). Conclusions: In this retrospective analysis, there was no significant difference between taxane-based doublet and triplet IC regimens in patients with LANPC, in terms of survival outcomes; although grade III-IV toxicities were non-significantly higher with TPF. Clearly, these hypothesis generating findings should be tested in a prospective randomized setting. Legal entity responsible for the study: