Letters to Editor chemotherapy in recurrent, metastatic and locally advanced head and neck cancers. Clin Oncol (R Coll Radiol) 2013;25:388. 4. André N, Banavali S, Snihur Y, Pasquier E. Has the time come for metronomics in low‑income and middle‑income countries? Lancet Oncol 2013;14:e239‑48.
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Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146786 PMID: *********
Oral cutaneous leishmaniasis mimicking carcinoma of tongue: A case report
Sir, Leishmaniasis is an arthropod borne zoonosis transmitted via female sandflies. It is broadly grouped into cutaneous, mucocutaneous and visceral leishmaniasis as per the clinical manifestations of each group. [1] PKDL ‑ Post Kala Azar Dermal Leishmaniasis is a sequel of visceral leishmaniasis caused by L. donovani and usually presents two years after the visceral leishmaniasis. It presents as hypopigmented macules/indurations anywhere in the body usually on the upper trunk. However, there are several documented unusual presentations of cutaneous leishmaniasis which includes pretibial ulcers, painful nipple swelling in males, unilateral erythema nodosum,ulceroproliferative growth over sternum, painful solitary nasal nodule[2]Other differential diagnosis includes dermatofibrosarcoma protuberans, squamous cell carcinoma,chalazion like ulcers, tuberculous lymphadenopathy,myeloma like Pictures [3] . Here we present a case report of one such patient with past history of leishmaniasis who presented to us with a lesion over the lateral border of the tongue mimicking as carcinoma tongue. A 52‑year‑old male patient from Bihar with past history of visceral leishmaniasis treated by Amphotericin B about six years ago, presented to us with a bilateral nodular lesion over the tongue of about 2 × 3 cm on right side and 2 × 2 cm on the left side for past 5 years [Figure 1]. There was a cm sized submental node. His labs were suggestive of hyperglobulinemia, relative monocytosis and leucopenia. The patient’s MR imaging showed a soft tissue thickening seen in anterior 2/3rd s of the tongue along the right and left lateral borders with postcontrast enhancement suggestive of chronic inflammation vs carcinoma. Biopsy of both lesions showed rich infiltrate of lymphoid and plasma cells, with T cells (CD3), B cells (CD 20), plasma cells (CD 138). A skin biopsy was done which showed diffuse dense infiltrate of lymphocytes, plasma cells and macrophages involving the upper and mid dermis with semblance of granuloma formation. Nerve, erector pilorum muscle and appendages were spared with Overlying hypertrophic epidermis. A diagnosis of PKDL was made. The patient was managed with Rifampicin and Ketoconazole. After two months of treatment the lesion showed significant reduction in the size with symptomatic improvement as well [Figure 2]. Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Figure 1: Before treatment
Figure 2: After treatment
The diagnosis of PKDL is based on clinical and epidemiological parameters. Demonstration of parasite in the slit smear or by culture of the dermal tissue is considered to be the gold standard. [4] The main factors responsible for the difficulties in arriving at the diagnosis of cutaneous leishmaniasis are presentations mimicking other diseases and the fact that amastigote forms are difficult to detect in several cases of microscopy. However in countries like India, these presentations should be kept in mind more so if the patient belongs to one of the endemic areas. Joshi A, Dhumal SB, Noronha V, Bonda A, Pandey A, Raja Manickam DK, Kumar Prabhash Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India Correspondence to: K Prabhash, E-mail: [email protected]
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References
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1. World Health Organization. Control of Leishmaniases: Report of the WHO Expert committee Meeting, Geneva. 22‑26 March 2010.WHO Technical Report Series 2010;949:1. 2. Bari AU, Rahman SB. Many faces of cutaneous leishmaniasis. Indian J Dermatol Venerol Leprol 2008;74:23‑7. 3. Jombo GT, Gyoh SK. Unusual presentations of cutaneous leishmaniasis in clinical practice and potential challenges in diagnosis: A comprehensive analysis of literature reviews. Asian Pac J Trop Med 2010;3:917‑21. 4. Singh RP. Observation on dermal leishmanoid in Bihar. Indian J Dermatol 1968;13:59‑63.
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Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146789 PMID: *********
News 31st ICON Conference. Organizing Secretary : Dr. T. P. Sahoo, 12th - 14th September, 2014 Web: www.iconconferences.com Mail: [email protected]
News Next APLCC meeting will be held in Kuala Lumpur from 6-8 November 2014. The deadline for abstract submission is 1 July 2014. Conference Secretariat of 2014 IASLC Asia Pacific Lung Cancer Conference (APLCC2014): 19-5, Dutaria, Jalan Dutamas Raya, 51200 Kuala Lumpur, MALAYSIA Tel: +60 3 6241 3850 Mobile: +60 17 2215 123 Email: [email protected] Website: www.aplcc2014.com News Congratulations Padamshree Awardee Dr. Ramakant Deshpande: He is presently the chief of thoracic surgical oncology and Executive Vice Chairman at the Asian Institute of Oncology, Mumbai. He graduated from Karnataka Medical College, Hubli and completed his post-graduation at the Tata Memorial Hospital, Mumbai. He was later trained at the Memorial Sloan Kettering Cancer Centre (USA) and began his surgical oncology career at the Bangalore Kidwai Cancer Centre in 1982. He worked in the capacity of chief of thoracic services at the Tata Memorial Hospital, Mumbai from 1985 till 2002. He was the first person to introduce thoracoscopic surgery at the Tata Memorial Hospital and many enthusiastic surgeons have trained under him. He is an ardent speaker, is multilinguistic and an eminent scholar. He has over 50 publications to his credit in national and international journals including chapters on management of cancer in lung in the Textbook of Cancer published by the National Book Trust of India. News Congratulations First rank at ESMO Examination: Dr. Manish K Singhal, MD, DM: A leading medical oncologist working at Noida (NCR), he is a graduate of AIIMS (All India Institute of Medical Sciences), New Delhi where he did post-doctoral training in Medical Oncology. He learned bone marrow transplant at Barabara Ann Karmanos Cancer Institute, Michigan University, Detroit, USA. He visited Oxford University regarding randomized controlled clinical trials. He is presently in charge of the department of Medical Oncology at, Fortis hospital, Noida under the aegis of International Oncology Group. He has made us proud by scoring the highest marks in the prestigious ESMO (European Society of Medical Oncology) Examination 2013, the first Indian to do so. He will be presented with the Best exam Award at the forthcoming ESMO meeting in Sept 2014 at Spain, Madrid. 402
Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Copyright of Indian Journal of Cancer is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146786 PMID: *********
Oral cutaneous leishmaniasis mimicking carcinoma of tongue: A case report
Sir, Leishmaniasis is an arthropod borne zoonosis transmitted via female sandflies. It is broadly grouped into cutaneous, mucocutaneous and visceral leishmaniasis as per the clinical manifestations of each group. [1] PKDL ‑ Post Kala Azar Dermal Leishmaniasis is a sequel of visceral leishmaniasis caused by L. donovani and usually presents two years after the visceral leishmaniasis. It presents as hypopigmented macules/indurations anywhere in the body usually on the upper trunk. However, there are several documented unusual presentations of cutaneous leishmaniasis which includes pretibial ulcers, painful nipple swelling in males, unilateral erythema nodosum,ulceroproliferative growth over sternum, painful solitary nasal nodule[2]Other differential diagnosis includes dermatofibrosarcoma protuberans, squamous cell carcinoma,chalazion like ulcers, tuberculous lymphadenopathy,myeloma like Pictures [3] . Here we present a case report of one such patient with past history of leishmaniasis who presented to us with a lesion over the lateral border of the tongue mimicking as carcinoma tongue. A 52‑year‑old male patient from Bihar with past history of visceral leishmaniasis treated by Amphotericin B about six years ago, presented to us with a bilateral nodular lesion over the tongue of about 2 × 3 cm on right side and 2 × 2 cm on the left side for past 5 years [Figure 1]. There was a cm sized submental node. His labs were suggestive of hyperglobulinemia, relative monocytosis and leucopenia. The patient’s MR imaging showed a soft tissue thickening seen in anterior 2/3rd s of the tongue along the right and left lateral borders with postcontrast enhancement suggestive of chronic inflammation vs carcinoma. Biopsy of both lesions showed rich infiltrate of lymphoid and plasma cells, with T cells (CD3), B cells (CD 20), plasma cells (CD 138). A skin biopsy was done which showed diffuse dense infiltrate of lymphocytes, plasma cells and macrophages involving the upper and mid dermis with semblance of granuloma formation. Nerve, erector pilorum muscle and appendages were spared with Overlying hypertrophic epidermis. A diagnosis of PKDL was made. The patient was managed with Rifampicin and Ketoconazole. After two months of treatment the lesion showed significant reduction in the size with symptomatic improvement as well [Figure 2]. Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Figure 1: Before treatment
Figure 2: After treatment
The diagnosis of PKDL is based on clinical and epidemiological parameters. Demonstration of parasite in the slit smear or by culture of the dermal tissue is considered to be the gold standard. [4] The main factors responsible for the difficulties in arriving at the diagnosis of cutaneous leishmaniasis are presentations mimicking other diseases and the fact that amastigote forms are difficult to detect in several cases of microscopy. However in countries like India, these presentations should be kept in mind more so if the patient belongs to one of the endemic areas. Joshi A, Dhumal SB, Noronha V, Bonda A, Pandey A, Raja Manickam DK, Kumar Prabhash Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India Correspondence to: K Prabhash, E-mail: [email protected]
401
Letters to Editor
References
Access this article online
1. World Health Organization. Control of Leishmaniases: Report of the WHO Expert committee Meeting, Geneva. 22‑26 March 2010.WHO Technical Report Series 2010;949:1. 2. Bari AU, Rahman SB. Many faces of cutaneous leishmaniasis. Indian J Dermatol Venerol Leprol 2008;74:23‑7. 3. Jombo GT, Gyoh SK. Unusual presentations of cutaneous leishmaniasis in clinical practice and potential challenges in diagnosis: A comprehensive analysis of literature reviews. Asian Pac J Trop Med 2010;3:917‑21. 4. Singh RP. Observation on dermal leishmanoid in Bihar. Indian J Dermatol 1968;13:59‑63.
Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146789 PMID: *********
News 31st ICON Conference. Organizing Secretary : Dr. T. P. Sahoo, 12th - 14th September, 2014 Web: www.iconconferences.com Mail: [email protected]
News Next APLCC meeting will be held in Kuala Lumpur from 6-8 November 2014. The deadline for abstract submission is 1 July 2014. Conference Secretariat of 2014 IASLC Asia Pacific Lung Cancer Conference (APLCC2014): 19-5, Dutaria, Jalan Dutamas Raya, 51200 Kuala Lumpur, MALAYSIA Tel: +60 3 6241 3850 Mobile: +60 17 2215 123 Email: [email protected] Website: www.aplcc2014.com News Congratulations Padamshree Awardee Dr. Ramakant Deshpande: He is presently the chief of thoracic surgical oncology and Executive Vice Chairman at the Asian Institute of Oncology, Mumbai. He graduated from Karnataka Medical College, Hubli and completed his post-graduation at the Tata Memorial Hospital, Mumbai. He was later trained at the Memorial Sloan Kettering Cancer Centre (USA) and began his surgical oncology career at the Bangalore Kidwai Cancer Centre in 1982. He worked in the capacity of chief of thoracic services at the Tata Memorial Hospital, Mumbai from 1985 till 2002. He was the first person to introduce thoracoscopic surgery at the Tata Memorial Hospital and many enthusiastic surgeons have trained under him. He is an ardent speaker, is multilinguistic and an eminent scholar. He has over 50 publications to his credit in national and international journals including chapters on management of cancer in lung in the Textbook of Cancer published by the National Book Trust of India. News Congratulations First rank at ESMO Examination: Dr. Manish K Singhal, MD, DM: A leading medical oncologist working at Noida (NCR), he is a graduate of AIIMS (All India Institute of Medical Sciences), New Delhi where he did post-doctoral training in Medical Oncology. He learned bone marrow transplant at Barabara Ann Karmanos Cancer Institute, Michigan University, Detroit, USA. He visited Oxford University regarding randomized controlled clinical trials. He is presently in charge of the department of Medical Oncology at, Fortis hospital, Noida under the aegis of International Oncology Group. He has made us proud by scoring the highest marks in the prestigious ESMO (European Society of Medical Oncology) Examination 2013, the first Indian to do so. He will be presented with the Best exam Award at the forthcoming ESMO meeting in Sept 2014 at Spain, Madrid. 402
Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Copyright of Indian Journal of Cancer is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
