Objectives:To compare the presentation of cervical cancer and the treatment modalities received by the patients at a semi-urban/rural area of Western India with that of published literature from urban centers.Materials and Methods:We conducted a retrospective analysis of patients with cervical cancer who presented at a semi-urban/rural cancer center between 2010 and 2013. A total of 141 patients with the median age of 51 years (25-81) were studied. The demographic and clinical variables included age, annual family income, profession, comorbidities, baseline hemoglobin, prior screening, clinical stage, treatment administered, and complications. The pathological variables included tumor type and grade.Results:In our study, all patients presented with vaginal bleeding. Majority of the patients (51 patients, 37.7%) had Stage 3B disease. Since majority presented at later stages (Stage 3B), chemotherapy-radiotherapy was the most common treatment modality used in our population. On histopathology, 127 patients (90%) had squamous cell carcinoma while 14 patients (10%) had adenocarcinoma. In 96 patients (68%), the tumor grade was not known while it was a high, intermediate, and low grade in 6 (4%), 18 (13%), and 21 (15%) patients, respectively. The follow-up data of our study were not adequate; hence, the long-term survival results could not be presented.Conclusion:Patients in rural India setting present at later stages which could be improved by creating awareness, improving their personal hygiene, and adequate screening.

Autoimmune hepatitis (AIH) is a progressive inflammatory condition hypothesized to be a T-lymphocyte (Tcell)-mediated immune response that commonly affects females more than males. Given its proposed mechanism associated with immune response, it is more likely to present with other autoimmune conditions, particularly autoimmune disorders associated with the thyroid. AIH can be difficult to diagnose as it is a diagnosis of exclusion. AIH lacks validated algorithms for proper diagnosis and can seldom present with negative antibodies. If not fully worked up, AIH may progress to cirrhosis and even increase the risk of malignancy. Therefore, a liver biopsy is a crucial step in the workup for AIH. We report a rare case of acute severe AIH associated with negative antibodies and undiagnosed Graves' disease.

Basal cell carcinoma (BCC) of the scalp is the most common cancer of the skin and is locally invasive. The patched/hedgehog intracellular signaling pathway is responsible for regulating cell growth and tumor formation by inactivating mutation of protein patched homolog 1 (PTCH1) or activating mutation of Smoothened (SMOm). BCC can cause significant morbidity from local destruction if neglected. The risk of metastasis and death is 6.5% in tumors greater than or equal to 2 cm in size. The gold standard treatment is surgical excision. Radiation therapy is used to treat skin cancers as an adjuvant or in patients who are not candidates for surgical intervention or who refuse therapy. It works by using low-energy X-rays or electron beam radiation. They work on the superficial skin and do not affect the organs deeper. Here, we describe the case of a man who presented with an unwitnessed seizure and was found to have a large ulcer on his forehead, which was later diagnosed to be BCC of the scalp eroding the calvarium. The base of the ulcer was the patient's dura and brain. He was successfully treated with electron beam radiation therapy for six weeks with careful preservation of brain tissue. The patient's skin was re-epithelialized and the bone was recalcified. The ulcer on the forehead has completely regressed. This case report and literature review illustrates the evidence to propose the importance of radiation therapy and its potential to be the first-line treatment in BCC, especially in similar cases like ours. Multimodality treatment with a radiation oncologist, dermatologist, and medical oncologist can save patients from devastating outcomes.

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