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P. Mishra



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    P1.01 - Poster Session with Presenters Present (ID 453)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Epidemiology/Tobacco Control and Cessation/Prevention
    • Presentations: 1
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      P1.01-058 - Demographic Profile of Lung Cancer from Eastern India (ID 4654)

      14:30 - 15:45  |  Author(s): P. Mishra

      • Abstract

      Background:
      The clinico-pathological profile of primary lung cancer has changed considerably over the last few decades in India. Available literature suggests that the features of lung cancer in India like prevalence, incidence, aetio-pathogenesis and presentation vary markedly from the west. We performed a prospective evaluation of the unique demographic features of lung cancer with specific emphasis on smoking and histopathological trends.

      Methods:
      We analysed all pathologically proven lung cancer cases registered over a period of initial 30 months in the department of Pulmonary Medicine of this All India Institute of Medical Sciences, Bhubaneswar. The patients were evaluated for their epidemiological, clinical and pathological profiles. The data were recorded in MS Excel spreadsheets and subjected to appropriate statistical analysis. Data was collected directly from patients’ paper and electronic medical records. All patients of histologically proven lung cancer were included.

      Results:
      A total of 179 patients were included in the database of which 6 patients were excluded for significant missing data. There were 114 male and 59 women) average age 57.24 with a M:F ratio of 1.93 :1. Over half (56%) of the patients were active or past smokers, while 48% patients had not been exposed to active or passive smoking. Bidi (tobacco flake wrapped in tendu leaf) smoking was more common (37%) than cigarettes (19%) while 9% smoked both. Exclusive chewed tobacco use was seen in 12% while combined use of chewed and smoked tobacco was seen in 4% patients. The proportion of women never-smokers with lung cancer was significantly higher (89%) compared to men (28%). More than two-thirds patients (69.8%) presented with metastatic disease. Amongst patients with a definitive cytohistological diagnosis, the prevalence of adenocarcinomas was highest (56.3%) followed by squamous (30.8%), small cell (8%) and NSCLC NOS (4.9%).

      Conclusion:
      Adenocarcinoma is the commonest histological subtype in this region. Prevalence of lung cancer among non-smokers is also high in the eastern part of India. The demographic profile of patients with lung cancer in eastern India is unique with a much higher proportion of tobacco chewers and non-smoker especially in women. There is significant epidemiological trends towards a predominant adenocarcinoma histology. Most of the patients present at an advanced stage, probably due to lack of awareness and limited diagnostic resources in this part of the country. Although there are direct association with smoking, there has been an increase in the non-smoking lung cancers worldwide.

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    P1.07 - Poster Session with Presenters Present (ID 459)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: SCLC/Neuroendocrine Tumors
    • Presentations: 1
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      P1.07-054 - Second Primary Small Cell Carcinoma of Lung in Previously Treated Carcinoma Breast (ID 6385)

      14:30 - 15:45  |  Author(s): P. Mishra

      • Abstract

      Background:
      Breast cancer is the major cause of cancer among women worldwide. Some of the patients are treated with surgery followed by adjuvant chemotherapy and radiation therapy. It is presumed that the radiation of surrounding tissues during breast radiotherapy may cause cancer in other areas of body.

      Methods:
      A 40 year old woman presented with chest pain and breathing difficulties for four months. She was diagnosed as infiltrating duct cell carcinoma of right breast and undergone modified radical mastectomy. Her 1 of 20 lymph nodes showed tumour metastases with perinodal extension. Triple marker (oestrogen receptor, progesterone receptor, her 2 neu receptor) was negative. She was given four cycles of CEF regimen cyclophosphamide,epirubicin,5-FU) and four cycles of paclitaxel. She had also received 25 fraction of radiotherapy completed over one year before. There was no other co-morbid conditions, family history was not significant. She had average body built and nutrition. On general examination mild pallor was only positive finding, no peripheral lymphadenopathy or clubbing. Contrast enhanced computed tomogram of chest revealed bilateral lung nodular infiltrates more predominantly in left lower lobe, mediastinal lymphadenopathy with left lower lobe collapse. Ultrasound abdomen detected no significant abnormality. Bronchoscopy showed multiple nodules present over carina, infiltration in right lower lobe segmental opening, left main bronchus lumen narrowed due to diffuse infiltrative growth. The endobrochial biopsies were taken from this area.

      Results:
      Endobronchial biopsy revealed tumour cells were strongly and diffusely positive for synaptophysin and negative for chromogranin and TTF1 . The diagnosis of small cell carcinoma lung was made. MRI of brain showed ring enhancing lesions in right cerebellar hemisphere suggestive of metastases. Staging of the tumour came to T4N2M1a according to 8th edition of IASLC TNM classification for lung cancer. Her performance status improved to ECOG 2. She was given cisplatin and etoposide in addition to brain radiation therapy.

      Conclusion:
      The second primary malignancy refers to a different type of cancer in a person who has survived an earlier cancer. There are series of non- small cell lung cancer (NSCLC) reported as second primary after breast cancer. To our knowledge, this is the first case presented as small cell lung cancer as second malignancies in lung in a fully treated breast cancer patient. This may be related risk of second malignancies associated with radiotherapy exposure to lung applied for breast cancer or due to adjuvant treatment as in this case.

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    P3.01 - Poster Session with Presenters Present (ID 469)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P3.01-011 - Clinocopathological Profile and Role of Immunohistochemistry in the Diagnosis of Primary Lung Cancer - A Prospective Study from Eastern India (ID 4922)

      14:30 - 15:45  |  Author(s): P. Mishra

      • Abstract

      Background:
      The clinico-pathological profile of lung cancer has changed considerably over the time in India. The histologic type also has changed from a predominant squamous histology to adenocarcinoma.We performed a prospective evaluation of primary lung cancers (PLCs) on the basis of clinical characteristics, histopathology and immunohistochemistry (IHC).

      Methods:
      The clinicohistopathological features and IHC characteristics of all PLCs(as per 2015 WHO classification) were described prospectively over a period of two years (2014-2016).The antibodies that were used were TTF-1, napsin A, P40, CK7, CK20, vimentin, synaptophysin, chromogranin, BCL-2, CD34, LCA, CD99, AFP & βHCG.

      Results:
      We have studied 140 PLCs (78.6% male and 21.4%females) with age ranging from 25 to 85 years.Most common symptoms were cough and chest pain observed in 65% of our cases. In 14.2% cases the patients primarily presented with metastasis. The most common site was brain (40 %), cervical nodes (45%) and skin (15%) in our record. There were 84cases of NSCLC and 5 cases of small cell carcinoma. 95.2% of NSCC could be further classified with the help of TTF-1,napsin A, CK7 & P40 into adenocarcinoma (71.4%), 23.8% cases of squamous cell carcinoma, and 4.8% of cases could not be subtyped further. TTF-1 was seen in all the cases of adenocarcinoma, where as p40 waas seen in all the cases of squamous cell carcinoma.Only in 4.8% of cases neither the morphology nor the staining pattern supported adenocarcinoma or squamous and hence was diagnosed as NSCC-NOS. In addition to these usual types,other unusual morphological variants seen were3 cases each of carcinoid, large cell neuroendocrine carcinoma, & synovial sarcoma. There were also few rarer ones such as lymphoepithelioma like carcinoma, choriocarcinoma and yolk sac tumor. In 39 cases the biopsy was inadequate and hence could not be opined.

      Conclusion:
      Accurate categorization of primary lung tumors, has both therapeutic and prognostic significance. TTF1 and P40 are very sensitive markers for differentiating adenocarcinoma and squamous cell carcinoma of the lung. Addition of napsinA contributes to a higher sensitivity for adenocarcinomas