Browsing by Author "Roli Purwar"

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An unusual case of post-menopausal bleeding
(BioMed Central Ltd, 2025) Roli Purwar; Jyothi Kanugonda; Mridula Shukla; Manoj Pandey
Background: Metastasis from Renal cell carcinoma at presentation is seen in nearly one fifth of the patients and commonly occur to lung, bone and liver. Synchronous vaginal and cervical metastasis is extremely rare. Several pathways have been proposed of which blood reflux from left renal vein to ovarian vein is most plausible. The prognosis is usually very poor as they are often associated with disseminated metastasis. Case presentation: A 55-year-old women presented with post-menopausal vaginal bleeding, on examination a smooth mass occupying the vagina and obscuring the view of cervix with normal mucosa was found. Biopsy and Immunohistochemistry showed it to be renal cell carcinoma. Further investigations lead to identification of left renal mass with pulmonary, vaginal and cervical metastasis. Patient was started on Pazopanib 800 mg PO per day, and was lost to follow-up. Conclusion: Vaginal metastasis presenting as post-menopausal bleeding is one of the rarest presentation of renal cell carcinoma with only 3 cases reported in literature before this. Metastatic tumors to the vagina are more common than primary tumors and are mostly from cervix, endometrium and ovary. A high index of suspicion and through examination and investigation is the key to correct diagnosis and management. © The Author(s) 2025.
Cancer surgery during COVID increased the patient mortality and the transmission risk to healthcare workers: results from a retrospective cohort study (NCT05240378)
(BioMed Central Ltd, 2022) Kishan Soni; J.F. Neville; Roli Purwar; Tarun Kumar; Ghanshyam Yadav; Nimisha Verma; Manoj Pandey
Background: India encountered two waves of COVID-19 pandemic with variability in its characteristics and severity. Concerns were raised over the safety of treatment, and higher morbidity was predicted for oncological surgery. The present study was conducted to evaluate and compare the rate of morbidity and mortality in patients undergoing curative surgery for cancer before and during the COVID-19 pandemic. Method: The prospectively obtained clinical data of 1576 patients treated between April 2019 and May 2021 was reviewed; of these, 959 patients were operated before COVID-19 and 617 during the pandemic. The data on complications, deaths, confirmed or suspected COVID-19 cases, and COVID-19 infection among health workers (HCW) was extracted. Results: A 35% fall in number of surgeries was seen during the COVID period; significant fall was seen in genital and esophageal cancer. There was no difference in postoperative complication; however, the postoperative mortality was significantly higher. A total of 71 patients had COVID-19, of which 62 were preoperative and 9 postoperative, while 30/38 healthcare workers contracted COVID-19, of which 7 had the infection twice and 3 were infected after two doses of vaccination; there was no mortality in healthcare workers. Conclusion: The present study demonstrates higher mortality rates after surgery in cancer patients, with no significant change in morbidity rates. A substantial proportion of HCWs were also infected though there was no mortality among this group. The results suggest higher mortality in cancer patients despite following the guidelines and protocols. © 2022, The Author(s).
Lymphadenectomy in ovarian cancers: a meta-analysis of hazard ratios from randomized clinical trials
(BioMed Central Ltd, 2022) Roli Purwar; Rakesh Ranjan; Kishan Soni; Manoj Pandey; Satyanshu K. Upadhyay; Esha Pai; Tarun Kumar
Background: The debate surrounding systematic lymphadenectomy in the epithelial cancers of the ovary (EOC) was temporarily put to rest by the LION trial. However, there was a glaring disparity between the number of patients registered and the number of patients randomized suggesting inadvertent selection. A subsequent meta-analysis after this trial included all types of studies in the literature (randomized, non-randomized, case series, and, retrospective cohort), thus diluting the results. Methods: We conducted a meta-analysis of hazard ratios of randomized controlled trials, to study the role of systematic para-aortic and pelvic lymph node dissection in the EOC. A detailed search of MEDLINE, Cochrane, and Embase databases was done to look for the published randomized controlled trials (RCT) comparing lymphadenectomy versus no lymphadenectomy in EOC. A meta-analysis of hazard ratios (HR) was performed for overall survival (OS) and progression-free survival (PFS) using fixed and random effect models. The quality of the RCTs was evaluated on Jadad’s score, and the risk of bias was estimated by the Cochrane tool. Results: A total of 1342 patients with EOC were included for quantitative analysis. On meta-analysis, HR for PFS was 0.9 (95% CI 0.79–1.04) favoring lymphadenectomy. HR for OS was 1 (95% CI 0.84–1.18) signifying no benefit of systematic lymphadenectomy. Conclusion: The results show a trend towards increased PFS which did not reach statistical significance nor translate into any meaningful benefit in OS. There is still a need for a greater number of well-conducted, suitably powered trials to convincingly answer this question. © 2022, The Author(s).
MAP kinase and mammalian target of rapamycin are main pathways of gallbladder carcinogenesis: results from bioinformatic analysis of next generation sequencing data from a hospital-based cohort (NCT05404347)
(Springer Science and Business Media B.V., 2022) Monika Rajput; Satyavjiay Chigurupati; Roli Purwar; Mridula Shukla; Manoj Pandey
Background: Gallbladder Cancer (GBC) is one of the most common cancers of the biliary tract and the third commonest gastrointestinal (GI) malignancy worldwide. The disease is characterized by the late presentation and poor outcome despite treatment, and hence, newer therapies and targets need to be identified. Methods: The current study investigated various functionally enriched pathways in GBC pathogenesis involving the genes identified through Next Generation Sequencing (NGS) in a hospital-based cohort. The Pathway enrichment analysis and Gene Ontology (GO) were carried out after NGS, followed by the construction of the protein–protein interaction (PPI) network to discover associations among the genes. Results: Of the thirty-three patients with GBC who were screened through next-generation sequencing (NGS), 27somatic mutations were identified. These mutations involved a total of 14 genes. The p53 and KRAS were commonly found to be mutated, while mutations in other genes were seen in one case each, the mean number of mutations were 1.2, and maximum mutation in a single case (eight) was seen in one case. The bioinformatics analysis identified MAP kinase, PI3K-AKT, EGF/EGFR, and Focal Adhesion PI3K-AKT-mTOR signaling pathways and cross-talk between these. Conclusion: The results suggest that the complex crosstalk between the mTOR, MAPK, and multiple interacting cell signaling cascades can promote GBC progression, and hence, mTOR–MAPK targeted treatment will be an attractive option. © 2022, The Author(s), under exclusive licence to Springer Nature B.V.
Novel mutations in a second primary gastric cancer in a patient treated for primary colon cancer
(BioMed Central Ltd, 2023) Roli Purwar; Madhumita Tripathi; Monika Rajput; Manjusha Pal; Manoj Pandey
A 60-year-old man presented with complaints of abdominal pain and melena. Patient had a history of colon cancer 16 years back and had undergone right hemi colectomy for microsatellite instability (MSI) negative, mismatch repair (MMR) stable, T2N0 disease with no mutations on next-generation sequencing (NGS). Investigations revealed a second primary in stomach (intestinal type of adenocarcinoma) with no recurrent lesions in colon or distant metastasis. He was started on CapOx with Bevacizumab and developed gastric outlet obstruction. Total gastrectomy with D2 lymphadenectomy and Roux-en-Y oesophageao-jejunal pouch anastomosis was done. The histopathology showed intestinal type of adenocarcinoma with pT3N2 disease. NGS showed 3 novel mutations in KMT2A, LTK, and MST1R gene. The pathway enrichment analysis and Gene Ontology were carried out, followed by the construction of protein–protein interaction network to discover associations among the genes. The results suggested that these mutations have not been reported in gastric cancer earlier and despite not having a direct pathway of carcinogenesis they probably act through modulation of host of miRNA’s. Further studies are needed to investigate the role of KMT2A, LTK, and MST1R gene in gastric carcinogenesis. © 2023, The Author(s).
Printing of lyocell fabric with rubia cordifolia and acacia catechu using guar gum and chitosan as thickening agent
(National Institute of Science Communication and Information Resources (NISCAIR), 2019) Divya Ojha; Sangita Deodiya; Roli Purwar
In the present work the natural madder dye (Rubia Cordifolia) and Kattha (Acacia catechu) was applied on the regenerated cellulosic fabric-Lyocell through hand screen printing method. In the first part of the study printing paste was developed, using various ratios of guar gum and chitosan for printing with Madder and Kattha. The printed fabric was then characterized with respect to colourfastness and antimicrobial activity against S. aureus and E. coli. For durability tests, both the dyes showed a moderate to good light fastness and fastness to perspiration and good to excellent fastness to washing. © 2019, National Institute of Science Communication and Information Resources (NISCAIR). All right reserved.
Role of PARP inhibitors beyond BRCA mutation and platinum sensitivity in epithelial ovarian cancer: a meta-analysis of hazard ratios from randomized clinical trials
(BioMed Central Ltd, 2023) Roli Purwar; Rakesh Ranjan; Manjusha Pal; Satyanshu K. Upadhyay; Tarun Kumar; Manoj Pandey
Background: PARP inhibitors (PARPi) have a well-established role in platinum-sensitive ovarian cancer (PSOC), in BRCA mutant (BRCAm), and homologous recombination deficiency (HRD) population. However, their role in wild type and homologous recombination proficient population is still not clear. Methods: A meta-analysis of hazard ratios (HR) of randomized control trials (RCTs) was conducted to study the role of PARPi. The published RCTs comparing the efficacy of PARP inhibitors alone or in combination with chemotherapy and/or target therapies versus placebo/chemotherapy alone/target therapy alone in primary or recurrent ovarian cancer settings were selected. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints. Results: A total of 14 primary studies and 5 updated studies are considered, consisting of 5363 patients. Overall, HR for PFS was 0.50 [95% CI 0.40–0.62]. HR of PFS was 0.94 [95% CI 0.76–1.15] in the PROC group, 0.41 [95% CI 0.29–0.60] was in HRD with BRCA unknown (BRCAuk), 0.38 [95% CI 0.26–0.57] in HRD with BRCAm, and 0.52 [95% CI 0.38–0.71] in HRD with BRCAwt. In the HRP group, overall HR for PFS was 0.67 [95% CI 0.56–0.80], 0.61 [95% CI 0.38–0.99] in HRD unknown with BRCA wt, and 0.40 [95% CI 0.29–0.55] in BRCAm HR for PFS. Overall, HR for OS was 0.86 [95% CI 0.73–1.031]. Conclusions: The results suggest that PARPi have a meaningful clinical benefit in PSOC, HRD, BRACm, and also in HRP and PROC; however, the evidence is not sufficient to recommend their routine use and further studies are needed to expand their role in the HRP and PROC groups. © 2023, The Author(s).
TFE3-associated perivascular epithelioid cell tumor with complete response to mTOR inhibitor therapy: report of first case and literature review
(BioMed Central Ltd, 2022) Roli Purwar; Kishan Soni; Mridula Shukla; Ashish Verma; Tarun Kumar; Manoj Pandey
Background: Perivascular epitheloid cell tumor (PEComas) are characterized by expression of both muscles, most often smooth muscle actin (in ~80% of cases) and melanocytic markers (mainly HMB-45 and Melan A). TFE 3-associated PEComas are new variant which are poorly defined due to their limited reports in literature. These tumors lack response to targeted mTOR inhibitor therapy due to lack of mutation in TSC gene. Hereby, we are reporting a case of TFE3 associated pelvic PEComa showing excellent response to Everolimus. Case presentation: A 45-year-old female presented with complaint of abdominal mass and bleeding per vaginum for 4 months. She had a history of total abdominal hysterectomy 3 years back in view of abnormal uterine bleeding and exploratory laprotomy 7 months back to remove some pelvic mass. Imaging suggested of ill-defined heterogenous mass of 9.3 x 9.2 x 16 cm involving the uterus, cervix, and upper 1/3 vagina. Multiple omental and peritoneal deposits were also seen, making probable diagnosis of carcinoma endometrium. USG guided biopsy showed cores of fibrous tissue with the presence of cells in sheets with granular eosinophillic cytoplasm; IHC showed positivity for TFE-3, H Caldesmon, GATA-3, and Melan A- and HMB-45; and Ki 67 index was 35%. The basis of above diagnosis of PEComa was made and she was started on Everolimus; repeat imaging after 3 months of therapy showed complete response. Conclusion: We are reporting first case of malignant pelvic TFE 3 PEComa showing response to mTOR therapy. Identification of TFE 3 PEComa is important because they showed different biologic behavior then their conventional PEComa. © 2022, The Author(s).
Tubo-ovarian mass with raised CA-125 in a 21-year-old female
(BioMed Central Ltd, 2022) Roli Purwar; Kishan Soni; Ragini Tilak; Ashish Verma; Manoj Pandey
Introduction: Peritonitis associated with fungal species Curvularia lunata seldom occurs with only five cases reported in the literature, all in middle-age patients with comorbidities undergoing dialysis. Case report: A 21-year-old female who was referred to surgical oncology OPD with a diagnosis of ovarian malignancy, based on raised cancer antigen 125 (CA 125) and suspected tubo-ovarian mass (TOM) on magnetic resonance imaging (MRI). A review of the MRI showed a pelvic collection with TOM, suggestive of infective pathology. Fungal culture and mass spectroscopy of the cystic collection identified the presence of Curvularia lunata. She was treated with oral itraconazole which showed symptomatic improvement and radiological response. In the follow-up period, the patient developed chest wall swelling, aspiration and geneXpert® revealed multidrug-resistant (MDR) tuberculosis, and treatment was started. Conclusions: Unusual causes of TOM and raised CA 125 should be kept in mind when dealing with young patients, as the possibility of epithelial ovarian cancer in this age is very low. © 2022, The Author(s).