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D. Jain
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P1.02 - Poster Session with Presenters Present (ID 454)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.02-028 - Detection of Oncogenic Drivers in Pleural Effusions and Archived FNA Smears of Pulmonary Adenocarcinoma (ID 5176)
14:30 - 14:30 | Author(s): D. Jain
- Abstract
Background:
Cytological materials are widely used in diagnosis and staging of lung cancer due to advanced stage of disease at the time of presentation. Mutational oncogenic drivers in pulmonary adenocarcinoma (ADC) include EGFR, Kras and Her-2/neu. We utilized archived FNA smears and pleural effusion samples of ADC for detection of oncogenic molecular drivers.
Methods:
Pleural fluids (36) and May Grunwald stained FNA smears (18) were used for mutation anaysis. Sanger sequencing and ARMS and Scorpions PCR performed. Each tumor sample was evaluated for all classes of genomic alterations, including base-pair substitutions, insertions/deletions, as well as intronic/CDS polymorphisms.
Results:
There were 31 males and 23 females, aged 18 to 82 years with mean age 65.5 years. A total of 9 patients (16.6%) were found positive for EGFR mutations (Table 1, Figure 1). EGFR exon 18 intronic poylmorphism was seen in 4 cases and EGFR exon 20 showed intronic and CDS polymorphism in most cases. However, none of the cases were found to be positive for EGFR, exon 18, 20, Kras and Her-2/neu mutation. Figure 1 Figure 2
Conclusion:
These findings verify the feasibility of analysis of oncogenic drivers in cytological specimens in advanced ADC. Stained aspiration smears can be used after establishing diagnosis and checking adequacy of the specimen.
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-072 - Mediastinal Lymphnodes Staging by PET CT for Resectable Non-Small Cell Lung Cancer in a Tuberculosis Endemic Country (ID 4155)
14:30 - 14:30 | Author(s): D. Jain
- Abstract
Background:
Integrated 18 fluorine fluorodeoxyglucose (18F-FDG) PET-CT has shown somewhat variable sensitivity and specificity for nodal staging in tuberculosis endemic areas. This variation mainly because PET scans show falsely increased 18F-FDG uptake in inflammatory nodes, which may be observed in lymph nodes containing calcification or showing higher attenuations than those of surrounding great vessels on unenhanced CT scans. TB is a major health problem in India, incidence is around 2.1 million cases annually.The purpose of the study was to evaluate the efficacy of PET-CT for mediastinal nodal staging in non-small cell lung cancer (NSCLC) patients in a tuberculosis-endemic country.
Methods:
Prospective assessment of the diagnostic efficacy of integrated PET-CT for detecting mediastinal nodal metastasis was performed from February 2012 to February 2016. A total 160 patients underwent surgery for pathologically proven NSCLC. Patients who received chemotherapy or radiotherapy prior to surgery were excluded from study. Thus assessment of the diagnostic efficacy of integrated PET-CT for detecting nodal metastasis was performed in 46 patients (Male to Female ratio:4; mean age- 55 years). Patients underwent an integrated PET-CT examination and subsequent surgical nodal staging. One radiologist and 1 nuclear medicine specialist together prospectively evaluated PET-CT datasets.Nodes showing greater 18F-FDG uptake at PET without benign calcification or high attenuation >70 household unit (HU) at unenhanced CT were regarded as being positive for malignancy. All patients underwent hilar and mediastinal lymph nodes dissection according to the AJCC lymph node map (nodal stations 2R, 4R, 7, 8 and 9 for a right-sided tumour; 4L, 5, 6, 7, 8 and 9 for a left-sided tumour) after resection of the main tumour. Histologic nodal assessment results were used as reference standards. Of these 55 patients, 10 (20%) had a past history of pulmonary tuberculosis as determined by clinical or imaging studies.
Results:
Of 230 mediastinal nodal stations evaluated in 46 patients, 5(2%) stations in 4(8%) patients proved to be malignant by histopathologic assessment. Mean number of lymph node stations evaluated were 5. On a per-nodal station basis, the overall sensitivity, specificity, accuracy, PPV, NPV of PET-CT were 60%, 97%, 96%, 38%,99% for mediastinal lymph nodes staging(N2) respectively.
Conclusion:
Integrated PET-CT provides high specificity and high accuracy, but low sensitivity for mediastinal staging of NSCLCs. The high specificity is achieved at the expense of sensitivity by interpreting calcified nodes or nodes with high attenuation at CT, even with high FDG uptake at PET, as benign in a tuberculosis-endemic region.
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-048 - Predictive Factors of Outcome in Locally Advanced NSCLC Patients Treated with Neo-Adjuvant Chemotherapy in Resource-Constrained Settings (ID 5350)
14:30 - 14:30 | Author(s): D. Jain
- Abstract
Background:
Locally advanced lung cancer is an important cause of cancer-related morbidity and mortality in resource-constrained settings. Investigations and treatment options should be prioritized for optimal management based on availability and cost-effectiveness. We studied the impact of various factors on the risks of recurrence and survival in NSCLC patients undergoing surgery after NACT.
Methods:
We analysed prospectively maintained computerised database of operated carcinoma lung patients. Among 160 patients with NSCLC operated, 40(25%) received NACT. ALl patients underwent staging workup; physical examination, imaging(PET CT or CECT, brain CT), fibrooptic bronchoscopy. Chemotherapy regimen consisted of paclitaxel and carrboplatin for squamous cell carcinoma and pemtrexed based regimen for for adenocarcinoma. The decision of NACT before surgery was taken in multidisciplinary clinic in view of N2 disease or possibility of pneumonectomy. Histopathologic evaluation of gross residual tumour was done and percentage of residual tumour was estimated. Association between clinical, imaging and histopathologic factors with Disease Free Survival(DFS ) was assessed by univariate and multivariate cox propotional hazards model using stata software.
Results:
Median age of cohort was 57 years and male to female ratio 4:1. Squamous cell histology was present in 21 patients. Pathologic complete response(pCR) was achieved in 9 patients(22.9%). Median follow up period was 25 months. All patients with pCR are disease free. Median DFS was 27 months. Median overall survival not reached. Two year survival was 76%. All deaths were cancer related(n=6) and all these patients had post surgery residual N2 disease. Thre were 12 recurrences and all were distant metastasis. Cox regression analysis revealed that major pathological response and post surgery pathological N0/N1 status associated with improved DFS Figure 1
Conclusion:
Neoadjuvant chemotherapy is a feasible in resources constrained settings, result in major pathological response in a proportion of patients with locally advanced NSCLC. Major pathological response and post-surgery pathological N0/N1 status associated with good outcome
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P3.01 - Poster Session with Presenters Present (ID 469)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 2
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.01-012 - P40 in Metastatic Pulmonary Trophoblastic Tumour: Potential Diagnostic Pitfall with Pulmonary Squamous Cell Carcinoma (ID 4931)
14:30 - 14:30 | Author(s): D. Jain
- Abstract
Background:
p40, one of the two isomers of p63, is nowadays widely used for diagnosis of squamous cell carcinoma, especially in subtyping non-small cell carcinoma on lung biopsies.
Methods:
We describe a case in which lung tumour was misdiagnosed as squamous cell carcinoma due to p40 immunopositivity.
Results:
A 36-year-old lady presented with cough and left sided chest pain for 2 months duration. Chest imaging revealed a lesion in left lower lobe of lung and biopsy was suggestive of squamous cell carcinoma (Fig1). However, past history revealed amputation of great toe for non-healing discharging ulcer which on histopathology was diagnosed as choriocarcinoma. She developed similar nodules and ulcers over the left arm, followed by a gradually worsening dry cough and progressive shortness of breath. On imaging, she was found to have a septated left sided pleural effusion. A positron emission tomography–computed tomography (PET-CT) revealed a large hypermetabolic soft tissue mass in left lower lobe with bilateral lung metastases and multiple liver deposits. On reviewing obstetric history, she also had a history of hysterectomy five years ago, details of which were not available. Post-amputation β-hCG levels were high and she had been treated with multimodality chemotherapy for choriocarcinoma. She had good response to chemotherapy initially, however became resistant later on. Review of lung biopsy in the light of the past history along with extensive literature review led to the final diagnosis of metastatic trophoblastic tumour to lung. Figure 1- The lung biopsy shows an invasive tumour (A) (H&E, 10x); composed of polygonal cells with moderate amount of eosinophilic cytoplasm, round to oval nuclei and inconspicuous nucleoli (B) (H&E, 20x). Hyaline eosinophilic material is seen amid tumour cells with mitotic activity (C) (H&E, 20x). These tumour cells show strong nuclear immunopositivity for p40 in approximately half of the tumour cells (D) (IHC, 20x).
Conclusion:
Hence, awareness that p40 immunopositivity can be seen in trophoblastic tumours is essential to avoid misdiagnosis, especially in sites like lung where squamous cell carcinoma is common.
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P3.01-025 - Primary Pulmonary Sarcomas: An Entity Lost in Misdiagnosis (ID 5930)
14:30 - 14:30 | Author(s): D. Jain
- Abstract
Background:
Primary pulmonary sarcomas are very rare with an incidence rate of <0.5% of all lung malignancies. Their low incidence has impeded comprehensive evaluation of their association with smoking, definitive diagnostic and treatment-regimes. They are often misdiagnosed, both on radiology as well as on fine-needle-aspirate/small-biopsies. We present a series of primary pulmonary sarcomas diagnosed over the last two and a half years.
Methods:
All cases of primary pulmonary sarcomas (2014-2016) were retrieved and reviewed.
Results:
A total of 21 sarcomas were identified. The most common was synovial sarcoma. Four exceptionally rare cases included pulmonary-artery intimal sarcoma, primary pulmonary myxoid sarcoma, malignant peripheral nerve-sheath tumor and follicular dendritic-cell sarcoma. The clinical and pathology details of which are provided in table1. The patients were distributed over a wide-age range (range:9-65 years, median:34 years) with a male-preponderance (M:F=2.2:1). Radiological features were non-specific except in case1(table1). Histopathology revealed spindle-cell tumor in all cases(figure1) and an extensive immunohistochemical-panel and cytogenetic testing was required to clinch the diagnosis. Figure 1 Figure 2
Conclusion:
This is a series of primary thoracic sarcomas with a highlight on four extremely rare cases which bring to light their unique clinical, radiological, histopathological and immunohistochemical findings. Awareness of such entities is essential for proper diagnosis, appropriate molecular-testing and treatment.
