Publications by authors named "Narayanaswamy Kathiresan"

9 Publications

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Factors Predicting Nodal Metastasis in Penile Cancer: Analysis from a Tertiary Center.

Urol Int 2021 Nov 24:1-6. Epub 2021 Nov 24.

Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India.

Introduction: Lymph node metastasis is an important prognostic marker in penile cancer. Identification of occult metastasis is by lymphadenectomy based on the histological features of primary tumor; however, this leads to unnecessary surgical morbidity in node negative patients.

Methods: A retrospective analysis of all surgically treated penile cancer patients managed at our institute from January 2011 to March 2014 was performed. Patient characteristics, histological factors, and lymph node involvement were identified. Logistic regression analysis was used to compute odds ratio (OR) in univariate and multivariate analysis.

Results: Ninety seven patients underwent surgical management at our institute during the abovementioned period. Grade III tumor, presence of lymphovascular invasion, tumor thickness >10 mm, perineural invasion (PNI) and Ki67 >50% were significantly associated with nodal metastasis. On multivariate analysis, only presence of PNI was found to be significant (OR: 6.82) (95% confidence interval: 1.72-27.03) (p = 0.006).

Conclusion: PNI is a strong independent predictor of occult lymph node metastasis in penile cancers. Its inclusion in stratification of clinically node negative patients will identify high-risk patients who will benefit from prophylactic lymphadenectomy.
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November 2021

Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: results from a randomized clinical trial.

Scand J Urol 2021 Sep 23:1-6. Epub 2021 Sep 23.

Apollo Cancer Hospital, Chennai, India.

Background: Post-operative lymphorrhea is a well-known complication of inguinal lymph node dissection. However, the interventions to reduce the duration of drain have not been sufficiently elaborated.

Objectives: We evaluated the potential role of intra-operative mapping of lymphatic leakage with peri-incisional methylene blue injection and clipping of lymphatics after inguinal block dissection in reducing postoperative lymphorrhea.

Methods: We randomized 39 inguinal dissections done for various malignancies such as for carcinoma penis, urethra, malignant melanoma, rectum into 19 dissections (Interventional group) and 20 dissections (Control group). In the interventional group, after the completion of inguinal dissection, two ml of methylene blue dye was injected 4-8cm from the incision to identify the leaking lymphatics and they were clipped.

Results: The primary outcome was the decrease in duration of days of drain and was found to have significant reduction of 3.07 days in the interventional arm. (p value-0.02). The secondary outcome was the reduction of 21 ml of mean drain output in the interventional group ( = 0.09). The number of lymphatics clipped was not found to have statistical correlation with the duration of drain and the mean drain output.

Conclusion: The intraoperative mapping of lymphatic channels using methylene blue after inguinal dissection reduces the number of days of drain .
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September 2021

Primary Synovial Sarcoma of the Kidney with Inferior Vena Caval Thrombus.

Indian J Surg Oncol 2016 Sep 22;7(3):345-8. Epub 2016 Jan 22.

Department of Surgical Oncology and Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036 India.

Synovial sarcomas occurs primarily in the soft tissues, mostly in para-articular regions of the extremities. These tumors have been described in other unusual locations like the pleura, lungs, mediastinum, and kidneys. Primary synovial sarcoma of the kidney is a recently described entity; to date, a total of approximately 35 cases have been reported. Only three cases of primary synovial sarcoma of kidney with IVC thrombus have been reported so far. Here we present the case of a 44 year old gentleman, with primary synovial sarcoma of the left kidney with caval thrombus.
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September 2016

Ruptured Retroperitoneal Node Presenting as Hemoperitoneum-An Unusual Presentation of testicular tumour.

Indian J Surg Oncol 2014 Sep 15;5(3):252-4. Epub 2014 May 15.

Division of Urologic Oncology, Department of Surgical Oncology, Cancer Institute, Adyar, Chennai, India.

Herewith we are reporting an unusual presentation of testicular tumour. The patient is a 37 years old gentleman diagnosed with Stage III seminoma post orchidectomy on chemotherapy and had spontaneous rupture of retroperitoneal nodal mass and presented with hemoperitoneum and hypovolemic shock. He was successfully salvaged by aggressive resuscitation, emergency laparotomy and resection of ruptured nodal mass and is presently disease free. This article is aimed at highlighting this unusual presentation and complication of advanced testicular tumour and the need for aggressive surgery even in the so called hopeless situations. The need for multidisciplinary care in the cure of advanced testicular care is once again reemphasized.
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September 2014

A rare case of synchronous adrenocortical carcinoma and renal cell carcinoma.

Indian J Endocrinol Metab 2011 Jul;15(3):214-6

Department of Pathology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.

We present here a rare case of synchronous adrenocortical carcinoma (ACC) and renal cell carcinoma (RCC). A 27-year-old woman presented with gradual abdominal distension, hematuria, and loss of weight of 3-months duration. She gave a history of treatment for hypertension. The computed axial tomography (CT) scan revealed a large retroperitoneal mass. Her urinary VMA was slightly elevated. Her 24-h urinary metanephrine level was normal. The patient underwent left adrenalectomy, left nephrectomy, spleenectomy, and distal pancreactomy with segmental colonic resection. Postoperative pathology revealed ACC of left suprarenal measuring 22 × 19 × 18 cm(3) and RCC involving the left upper pole of kidney measuring 3 × 2 × 1 cm(3).
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July 2011

Metastatic malignant melanoma of the small bowel--report of two cases.

J Gastrointest Cancer 2012 Jun;43(2):332-5

Pathology, Cancer Institute (WIA), Chennai, India.

Case Report: We report two cases of malignant melanoma metastasizing to the ileum and jejunum in a 48-year-old female and 62-year-old male, respectively. The female patient was a known case of vaginal melanoma who on follow-up developed pain abdomen 4 years after excision of the primary, whereas the male patient who was initially referred as pleomorphic spindle cell sarcoma of the groin presented with complaints of bleeding per rectum and melena 6 years later.

Results: After preliminary investigations both underwent laparotomy and resection of segments of ileum and jejunum with tumor. Histopathological examination with immunohistochemistry showed features suggestive of metastatic malignant melanoma.

Discussion: Metastasis should be suspected in patients with malignant melanoma who develop gastrointestinal symptoms such as abdominal pain, anemia, melena, fatigue, constipation, small bowel obstruction, or perforation. This helps in avoiding a delay in the diagnosis and complications that arise due to metastatic disease.

Conclusion: Our first patient with primary vaginal melanoma died of multiple metastases 11 months following surgery for the ileal metastasis while the second patient with jejunal metastasis developed recurrent disease in the small bowel and iliac lymph nodes 10 months after surgery. However, in a patient with isolated gastrointestinal metastasis, diagnosed early, with good general condition surgical management should be encouraged when a complete resection of the disease is feasible as no other treatment option is as good for relief of symptoms and prolongation of life.
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June 2012

Risk factors for lymph node metastasis in clinically node-negative penile cancer patients.

Int J Urol 2009 Apr 17;16(4):383-6; discussion 386-7. Epub 2008 Feb 17.

Department of Surgical Oncology, Cancer Institute (WIA), Annexe Campus, Chennai, India.

Objectives: To analyze the effects of pathological T stage, grade, extent of surgery for primary tumor, and age group on the risk of developing lymph node metastasis in clinically node-negative penile cancer patients.

Methods: We performed a retrospective analysis of 200 clinically node-negative penile cancer patients who were kept under surveillance, after treatment of the primary tumor in our institution. The primary outcome parameter was cytologically or histologically proven lymph node metastasis. Logistic regression analysis was used to compute odds ratios in univariate and multivariate settings.

Results: Lymph node metastasis occurred in 31 patients at a median time of three months. Histological grade 3 and grade 2 tumors had a statistically significant increased odds ratio for lymph node metastasis, (7.1[P < 0.001] and 2.7 [P = 0.04], respectively), compared with grade 1 tumors. Although increasing pT stage was associated with increasing odds ratios, the differences were not statistically significant. Nor did the extent of surgery of the primary tumor or the age group significantly influence the risk of developing lymph node metastasis.

Conclusions: Histological grade is the most significant parameter influencing the risk of lymph node metastasis in clinically node-negative penile cancer patients on surveillance. Patients with grade 3 and grade 2 tumors may benefit from elective inguinal lymphadenectomy.
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April 2009