December, 2013 – Bangalore
USE OF SURGICEYE FOR
MANAGEMENT OF
OCCULT LESION
PAEDIATRIC LIVER
TUMOURS
Ahmedabad | Bangalore | Baroda | Chennai | Cuttack | Delhi | Hassan
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Dr. BS Ajaikumar
Chairman, HCG Group
As we move towards advancement in cancer care, the greatest interest lies in the area
of genomics. Next generation sequencing is a very important part of personalised
medicine. HCG has assumed a leadership role in this – we are already using
genomics for select patients. Since January, we have been putting together a plan
where genetic sequencing will be done for all patients of breast cancer, colon cancer
and lung cancer. This will help us significantly in the area of personalised medicine,
where, based on the genomics we will be able to decide the actual therapy for these
patients, whether it is chemotherapy, bio-therapy, radiation or surgery. We are at the
forefront of this next step in the fight against cancer.
In the HCG group of hospitals, our best efforts have been going into organ
preservation. Breast preservation has become the hallmark of HCG. Various reports
have clearly shown that the medical outcome from HCG centres are equal to those of
the best medical centres in the world.
We have recently inaugurated our first HCG cancer centre in Mumbai. We have
launched plans for further expansion with state-of the-art equipment along with an
integrated oncology department. The centre was launched by Bollywood actor
Ms. Priyanka Chopra, who has dedicated the centre to her father. We are very happy
and proud to be associated with Ms. Priyanka Chopra and her family in our
endeavours in creating high awareness about cancer – not only about early detection
but also about the fact that cancer has become a chronic disease today. We should
start thinking of cancer patients as individuals with a particular disease like diabetes
or high blood pressure, which are looked upon as lifestyle and chronic diseases. We
know breast cancer, colon cancer and lung cancer are now classified as lifestyle
diseases. The focus should now be more on managing cancer.
We believe that in the future, survival of cancer patients in India will be as good as in
any of the best cancer centres in the world, and the quality of life will be equally good.
India has come of age in the field of research and development and we can now
compete with best centres in the world. Apart from all this, I believe, the focus should
be on organised research, clinical trials and data collection.
The following is a case of a
39-year-old lady. She had
come to us during one of our
screening programmes, and
we gave her a routine
Dr. Krithika Murugan
Consultant
mammogram. She was fit and
Surgical Oncology
well with no family history,
and no lesions were detected
clinically, so the index of
suspicion was quite low. The
mammogram revealed a 2 cm
scattered lesion which was
given a BI-RADS rating of
III-IV. In view of this, we
decided to do a core biopsy which showed up as
suspicious of malignancy. After discussion at our MDT she
was offered an excision biopsy, though we were prepared
for a BCS and SLNB, just in case frozen confirmed it as
malignant.
USE OF SURGICEYE FOR
MANAGEMENT OF
OCCULT LESION
Given the fact that the case was unclear, we had to choose
between two treatment options – Wire guided localisation
and ROLL. We decided to go ahead with ROLL and this
time we decided to use our SurgicEye instead of the plain
sentinel probe.
After the normal procedure of admission, consent and
counselling, a small amount of radioactive dye was
inserted in the lesion during pre-surgery. She was also
given sentinel injection.
Normally a sentinel probe would have picked up signals all
over the breast, making it difficult to be accurate. With the
SurgicEye it was possible to accurately get the gamma
count, visualise the various areas emitting the signal and
then decide the appropriate area of excision as per the
count and 3D visualisation. This lesion so excised was
sent for frozen, which could not differentiate if it was just
DCIS or invasive ductal carcinoma. To be on the safe side,
we decided to proceed with an SLNB. After the procedure,
she was sent home the same evening. She was instructed
about post-op arm exercises by the physiotherapists.
The review histopathology revealed that hers was a high
grade DCIS with no element of invasion. This was further
confirmed by histo-chemistry.
The patient is currently well with no complications, and
has been put on radiation and Tamoxifen subsequently.
References
1. Alkureishi LW, Burak 2, Alvarez JA et al. (2009) The
European Association of Nuclear Medicine (EANM)
Oncology Committee and European Sentinel Node
Biopsy Trial (SENT) committee. Joint practice
guidelines for radionuclide lymphoscintigraphy for
sentinel node localization in oral/oropharyngeal
squamous cell carcinoma. Ann. Surg. Oncol. 16,
3190-3210
2. Alkureishi LW, Ross GL, Shoaib T et al. (2010)
Sentinel node biopsy in head and neck squamous cell
cancer: S-year follow-up of a European multicentre
trial. Ann. Surg. Oncol. 17, 2459-2464
3. Ross GL, Soutar DS, MacDonald G et al. (2004)
Sentinel node biopsy in head and neck cancer:
preliminary results of a multicentre trial. Ann. Surg.
Oncol. ll, 690-696
4. Wendler T, Hartl A, Lasser T et al. (2007) Towards
intraoperative 3D nuclear imaging: reconstruction of 3D
radioactive distributions using tracked gamma probes.
Med. Imag. Comput. Assist. Intervenf. 10, 909-917
5. Wendler T, Hermann K, Schnelzer A et al. (2010) First
demonstration of 3D lymphatic mapping in breast
cancer using freehand single photon emission
computed tomography. Eur. I. Nucl. Med. Mol. Imag.
37, 1452-146L
Irregular speculated lesion
Sonomammo mass with irregular margins
Embryonal cell sarcoma
A four-year-old male was
PAEDIATRIC LIVER
referred with a diagnosis of
TUMOURS
hydatid liver disease after
several
ultrasonographic
Dr. Basant Mahadevappa
Consultant
reports
suggested
the
Liver Transplant Surgeon
parasitic origin of the liver
condition. This Child was
evaluated for abdominal
complaints. Alfa feto protein
levels were normal.
The
Child then underwent a CT
abdomen with triple phase
contrast CT scan of liver.
Strong suspicion of hydatid
cystic disease of liver was reported. Family was
counseled and the child was planned for surgical
excision of the same in the form of cystopericystectomy.
EMBRYONAL CELL SARCOMA
At laparotomy, it was found to be a solid tumour with
cystic/necrotic changes. Frozen section was
performed and was reported as being of malignant
origin. A right hepatectomy was performed after
discussion with the family. Child recovered well from
surgery. Histopathological examination revealed
Embryonal Cell Sarcoma. Child is receiving adjuvant
treatment.
Several reports have been published in literature. It is
important to take cognizance of such occurrence and
deal with them in the best possible way in a
multidisciplinary approach.
Hepatoblastoma
A 13-month-old male child was evaluated for constant
irritability. Ultrasonogram of the abdomen revealed a
mass in segment 4 of the liver. On further evaluation with
a contrast enhanced CT scan of the liver showed
hepatoblastoma in segments 4, 5 and 8 of the liver with
no metastasis. Patient was adviced that surgical removal
is not an option.
The child consulted Paediatric Oncology group at HCG
hospital, where his situation was evaluated. He was
advised surgical excision followed by chemotherapy, if
required. Due to financial constraints, HCG foundation
was involved in the funding the surgical procedure.
The child was further worked up with AFP, remaining
laboratory studies. High AFP levels above 50,000 ng/ml
was reported. The patient was planned for curative
surgical procedure.
Child underwent resection of segments 4, 5 and 8.
Histopathological examination revealed hepatoblastoma
with margins free of tumour. Chemotherapy is advised
to high AFP levels. Child recovered well after surgery.
Child is on regular follow up and doing well.
HEPATOBLASTOMA
Choledochocele
A 3½ year old female child while being evaluated for right
upper quadrant abdominal pain was diagnosed with
choledochocele with cholangitis. The child was placed on
parenteral antibiotics and analgesics while being further
worked up. MRCP was performed which revealed
Choledochal cyst Type IVA with sludge while she was
being evaluated for abdominal pain.
Once the child was asymptomatic, child was advised to
undergo excision of the cyst. Parents were explained
CHOLEDOCHOCELE
about the recurrence of symptoms and malignant
potential of the condition if left untreated.
Child underwent excision of choledochal cyst and
hepaticojejunostomy. Child recovered well after surgery
and is asymptomatic. Histopathological examination
confirmed choledochal cyst with inflammatory changes.
Regular f/u with ultrasonography is required to check
progression of disease into the intrahepatic portion of
the bile ducts.
References
1.
A case of undifferentiated embryonic liver sarcoma mimicking cystic hydatid disease in an
endemic region of the world.
Oral A, Yigiter M, Demirci E, Yildirim ZK, Kantarci M, Salman AB.
J Pediatr Surg. 2011 Nov;46(11)
2.
Characterization of translocations in mesenchymal hamartoma and undifferentiated embryonal
sarcoma of the liver.
Mathews J, Duncavage EJ, Pfeifer JD.
Exp Mol Pathol. 2013 Oct 10;95(3):319-324
3.
Current therapeutic strategies for childhood hepatic tumours: surgical and interventional
treatments for hepatoblastoma.
Hishiki T.
Int J Clin Oncol. 2013 Oct 17
4.
Surgical treatment of primary liver tumours in children: Outcomes analysis of resection and
transplantation in the SEER database.
McAteer JP, Goldin AB, Healey PJ, Gow KW.
Paediatric Transplant. 2013 Dec;17(8):744-50
5.
Cystic biliary atresia: a wolf in sheep’s clothing.
Hill SJ, Clifton MS, Derderian SC, Wulkan ML, Ricketts RR.
Am Surg. 2013 Sep;79(9):870-2
HCG uses a new technology for the first time in the world to
create awareness on breast cancer
In India it is 1 in 22 and the incidence in Bangalore is the highest.
Bangalore, October 26th 2013 – HealthCare Global Enterprises
Ltd., The specialist in cancer care, believes that awareness is the
key to reducing the incidence of breast cancer. For a city with the
highest incidence of breast cancer in India, an awareness
initiative has to be conducted on a larger scale.
Technology plays a very important role in creating awareness.
Keeping in mind that the world is moving towards 3D
communication and that this is the era of smart phones and
social media, HCG cancer centre has ventured into creating the
world’s first 3D mapping of a building to create awareness on
breast cancer.
The 3D Mapping was done on the Jewels De Paragon building,
MG Road on the 25th and 26th of October 2013 between 7:30pm
and 9:30pm. The theme of the 3D animation was the ‘Power to
fight breast cancer is in your hands’. The animation revolved around the concept of the creation of the universe, the
woman being the essence of that creation, causes of breast cancer, incidence and prevention.
This unique initiative will be extensively used on social media to allow the communication to go viral, in an effort to
connect with the younger generation. Of late, Bangalore is seeing a lot of women below the age group of 30 being
diagnosed with breast cancer.
Shreya, an onlooker, said, “This is really amazing. I haven’t seen anything like this happening in India. I am really
glad HCG took the initiative of doing this event as this will go a long way in spreading awareness on a disease like
breast cancer.”
Dr. BS Ajaikumar, Chairman, HCG Group, said, "The incidence of breast cancer is the highest in Bangalore. Creating
awareness is the only way for women to undergo preventive health checkups. With increased awareness, the majority
of breast cancer cases are diagnosed early, which helps in better medical outcomes. Events of this magnitude will
create more awareness, which will help in the early detection of breast cancer."
Dinesh Madhavan, Director of Marketing, HCG, said, "HCG has been at the forefront in creating awareness on cancer
prevention and early diagnosis through path breaking activities over the years. The aim of this event is to create
awareness and educate women, as there has been a significant increase in the incidence of breast cancer. With the
help of technology today, we are creating awareness on breast cancer.”
National Cancer Helpline no 33669999 E-mail: info@hcgoncology.com
No 8, P. Kalinga Rao Road, Sampangi Rama Nagar, Bangalore: 560027
Ahmedabad | Bangalore | Baroda | Chennai | Cuttack | Delhi | Hassan | Hubli | Kanpur | Kochi | Mangalore | Mumbai | Mysore
| Nasik | Ongole | Ranchi | Shimoga | Trichy | Uganda | Vijayawada | Vizag