Introduction Cachexia in cancer patients, especially in advanced stage, is recently known as an emerging problem. Cachexia occurs in about half of all patients with neoplastic disease. The diagnosis of cachexia needs comprehensive evaluation of body weight and body composition for several months. Cachexia will give negative impacts such as increased mortality, chemotoxicity, and decreased quality of life. Here, we review the current evidence describing the definition, stages, mechanisms, diagnosis and treatment of cachexia in cancer patients. Methods We identified 75 studies and/or review articles evaluating cachexia and weight loss in cancer patients by searching PubMed and EMBASE databases. Results Cachexia is reported across all stages and types of cancers. The most recent definition of cachexia is reported in a 2011 paper by International Consensus. The mechanism of cachexia in cancer is complex and involved many factors which elaborate together to produce cachexia. The diagnostic evaluation and cut-off measurement of cachexia, especially in cancer varied across studies. The loss of weight that happens during chemotherapy will make a poor prognosis. Cachexia can worsen chemotherapy toxicity. Combination of dietary modification and exercise with supplementation of medication that control appetite and inflammation are important in the management of cachexia in cancer patients. Conclusion Patients with cancer are the population at risk for developing cachexia before and after chemotherapy. Cachexia diagnosis needs evaluation of body weight and body composition. Nonpharmacological treatments, such as dietary modification and physical exercise, are the best strategy to reduce cachexia in cancer patients.

Introduction Unresectable stage III nonsmall cell lung cancer (NSCLC) continues to have dismal 5-year overall survival (OS) rate. However, a subset of the patients treated with chemoradiation show significantly better outcome. Prediction of treatment outcome can be improved by utilizing machine learning tools, such as cluster analysis (CA), and is capable of identifying complex interactions among many variables. We have utilized CA to identify a cluster with good prognosis within stage III NSCLC. Materials and Methods Retrospective analysis of treatment outcomes was done for 92 patients who underwent chemoradiation for inoperable locally advanced NSCLC from 2012 to 2018. Using various patient- and treatment-related variables, an exploratory factor analysis was performed to extract factors with eigenvalue > 1. An appropriate number of homogeneous groups were identified using agglomerative hierarchical cluster analysis. Further K-mean cluster analysis was applied to classify each patient into their homogeneous clusters. The newly formed cluster variable was used as an independent variable to estimate survival over time using Kaplan–Meier method. Results With a median follow-up of 18 months, median OS was 14 months. Using CA, three prognostic clusters were obtained. Cluster 2 with 36 patients had a median OS of 36 months, whereas Cluster 1 with 34 patients had a median OS of 20 months (p = 0.004). Conclusion A cluster could thus be identified with a relatively good prognosis within stage III NSCLC. Using CA, we have attempted to create a model which may provide more specific prognostic information in addition to that provided by tumor node metastasis-based models.

Primary osteosarcoma arising in breast is a rare form of extra skeletal osteosarcoma, accounting for less than 1% of all breast cancers and 12.5% of sarcomas arising in breast. Fewer than 150 cases of primary osteosarcoma of breast have been reported in the medical literature in the last 50 years. It was reported to have worse outcome compared to typical skeletal osteosarcoma. Osteosarcoma of breast presents in elderly age group unlike skeletal osteosarcoma, which occurs in young people. Diagnosis is by histopathological examination of malignant osteoid and ruling out underlying skeletal involvement.

Abstract Advances in the treatment of Ewing's sarcoma family of tumors (ESFTs) are a result of improvements in systemic and local therapies. VACA (vincristine, Adriamycin [doxorubicin], cyclophosphamide, dactinomycin) chemotherapy alone versus VACA + IE (VACA with alternate ifosfamide, etoposide) improve survival, but this regimen cannot be given to all patients due to poor tolerance and 5-day schedule chemotherapy in VACA + IE schedule. We reviewed the records of 50 patients treated as per our institutional protocols from 2007 to 2011. Two schedules of chemotherapy followed were vincristine, Adriamycin, cyclophosphamide (VAC) and VAC with alternate ifosfamide, etoposide (VAC + IE). Factors predictive of local failure and distant recurrence were analyzed. A total of 50 patients were analyzed. The median age at diagnosis was 14 years. Thirty-two patients were male, whereas 18 were female. Approximately, 95% of the patients relapsed after a median time gap of 1.6 years. The median 5-year disease-free survival was 30%. Systemic treatment with VAC or VAC + IE–based chemotherapy had equal local control and distant control rates. Smaller tumors had a better local control and lesser systemic failure than those of larger sizes. Successful treatment of Ewing's sarcoma requires optimal systemic and local therapy. Both the chemotherapy regimens showed equal survival rates. Control of both the local and distant diseases is a result of the combined modality approach. Stage at presentation is the most important factor for prognosis. Complete surgery and local radiotherapy are important predictive factors for local and systemic control.

A 52-year-old male presented to the dermatology department on account of itching for 3 years and mild hypoanesthesia of the skin for 5 years in the region of the gluteal cleft and right thigh anteriorly. Viral screens for HIV I and II, Hepatitis B surface Ag, and Hepatitis C virus antibodies were also negative. Contrast computed tomography (CT) demonstrated tumorous nodular thickening of skin and subcutaneous fat of the gluteal cleft [Figure 1a] and anterior right thigh [Figure 1b]. On laboratory investigations, her hemoglobin was 7.5 g%, total leukocyte count was 8500/mm3, and platelet count was 240,000/mm3. Peripheral smear showed no atypical cells. There was no involvement of the bone marrow. FNAC of the skin lesions revealed features compatible with non-Hodgkin's lymphoma. Skin biopsy showed diffuse lymphoid infiltrate involving the full thickness of epidermis and extending to the subcutaneous dermis, more around the perivascular spaces [Figure 2a]. These lymphoid cells were atypical and large with convoluted nuclei. Histopathological diagnosis of mycosis fungoides-tumor stage was made. Immunohistochemistry showed CD3 [Figure 2b], CD4, and leukocyte common antigen positivity. He was diagnosed in the early stages, stage 1B (T2 N0 M0 B0) according to the modified tumor-node-metastasis-blood classification. The patient was placed on topical glucocorticoids and commenced on eight courses of IV cyclophosphamide 750 mg/m2, IV epirubicin 25 mg/m2, and prednisolone tablets 40 mg/m2 daily for 5 days. Each course was given in 21-day intervals. He completed all courses of chemotherapy and did well, evidenced by disappearance of symptoms except for the dyspigmentation on the skin which is still resolving.

Invasive apocrine carcinoma of the breast is rare. The criteria for the diagnosis are uncertain with the variable reported incidence in the literature. The use of androgen receptor studies by immunohistochemistry and its potential response to androgen analogs necessitates the subtyping of this tumor. We report a case of giant invasive apocrine carcinoma of the breast involving the entire breast parenchyma without skin and chest wall infiltration. The clinical, pathological, immunohistochemical, and ultrastructural findings are discussed with emphasis on morphological and immunohistochemical features that aid in the diagnosis of this rare tumor.

Abstract Lung cancer is one of the most common cancers in the world affecting both men and woman. Common site of metastasis includes liver, adrenals, bone, and brain. Metastasis to the maxilla is very rare with only a few cases being reported so far. Here, we present a case of a 32-year-old male where metastatic lesion was discovered before primary tumor.

Abstract Epithelioid sarcoma (ES) is a rare mesenchymal tumor of unknown histogenesis which displays multidirectional differentiation, predominantly epithelial. They have no normal cellular counterpart and differ from both synovial sarcoma and other carcinomas. It mainly affects young adults. It has two variants, classic type and proximal type. The more common classic type presents as a slowly growing painless nodule or plaque on the distal extremities. It is rare in children and older individuals. There is male predominance. The size varies from few millimeters to several centimeters. Central deeply seated lesions in pelvis and genital tract are termed as proximal ES. It has a multinodular growth pattern and usually occurs in older patients. These are comparatively more aggressive and metastasize early. On histopathological examination, these lesions need to be distinguished from other tumors showing epithelioid morphology. Primary ES of scalp is an exceedingly rare tumor. We present a case of nodular tumor on the scalp with cervical lymph node metastasis.