Case Reports
Our oncology case reports highlight real patient journeys showcasing how early diagnosis, advanced surgical techniques, and compassionate care lead to successful cancer treatment outcomes.
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Carcinoma Anorectum, 35 Female
- Initially received 13# pre-operative chemoradiation in June 2024.
- Defaulted treatment due to personal reasons.
- Presented after 10 months with persistent complaints of bleeding per rectum.
Investigations
PET-CT Findings
Nearly circumferential, FDG-avid proliferative wall thickening involving lower rectum, anorectal junction & upper anal canal (11–7 o’clock), with mild luminal narrowing and lower mesorectal fat stranding & nodularity. The lesion was abutting the posterior left levator ani muscle with focal fat plane loss and had an associated exophytic partially necrotic nodule causing focal involvement of the posterior vaginal wall. Residual malignant lesion was confirmed.
Max. wall thickness: 11.5 mm; Craniocaudal extent: 55 mm; SUVmax: 7.8 (down from 13.9 earlier). Lower lesion margin approx. 10 mm from anal verge.
Surgical Management
Histopathology
Key Takeaways / Learning Points
- Always complete treatment as advised, stopping midway can worsen disease and outcomes.
- Even in patients with delayed presentation, curative surgery is possible in selected cases.
- Multidisciplinary oncology care is crucial for optimizing survival and quality of life.
Left Lung Lower Lobectomy (VATS), 73 Female
- A 73-year-old female presented with a localized lung lesion diagnosed as adenocarcinoma of the left lower lobe.
- Staging workup and PET-CT were performed prior to surgical planning.
Investigations
PET-CT Findings
A mild-grade FDG-avid, well-defined soft tissue nodule was identified in the superior segment of the left lower lobe along the oblique fissure.
Size: ~28.5 × 28.7 × 31.9 mm, SUVmax: 5.97
Small necrotic areas and pleural tail noted,No encasement of segmental bronchi or vascular structures.
Rest of the lung fields were unremarkable
Surgical Management
Procedure:
Video-Assisted Thoracoscopic Surgery (VATS)–guided left lung lower lobectomy with mediastinal lymph node dissection. The surgery was completed successfully using minimally invasive thoracoscopic access.
Postoperative Course
Recovery was smooth, with no major complications. The patient was discharged on the 5th postoperative day in stable condition.
Histopathology
Histopathological analysis confirmed adenocarcinoma of the left lung, with resection margins clear and mediastinal lymph nodes examined for staging and treatment planning.
Key Takeaways / Learning Points
- Advanced age is not a contraindication for surgery, excellent outcomes can still be achieved with proper preoperative assessment.
- Minimally invasive VATS surgery offers faster recovery, less postoperative pain, and shorter hospital stays compared to traditional open thoracotomy.
- Precision imaging and surgical planning enable complete cancer removal while preserving lung function.
Advanced Ovarian Cancer (Cytoreductive Surgery), 71 Female
- Diagnosis: Carcinoma Ovary with Peritoneal Metastases
- Comorbidities: Cardiac stenting (post–heart attack), Diabetes, Hypertension
Clinical Background
- A 71-year-old woman with significant medical comorbidities was diagnosed with advanced ovarian cancer that had spread to the peritoneum. She had previously undergone neoadjuvant chemotherapy (Paclitaxel + Carboplatin) to shrink the tumor before surgery.
Investigations
MDCT Abdomen, Pelvis, and Thorax Findings
Right ovarian mass measuring 44 mm
Multiple nodules seen along the omentum, falciform ligament, right subdiaphragmatic peritoneum, and bilateral paracolic peritoneum
Peritoneal Carcinomatosis Index (PCI) ≥ 20, indicating extensive disease spread
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Surgical Management
- Procedure: Cytoreductive Surgery (CRS)
- Diagnostic laparoscopy followed by exploratory laparotomy
- Total parietal peritonectomy with small bowel mesenteric peritoneal stripping
- Right subdiaphragmatic peritonectomy
- Pan-hysterectomy with pelvic peritonectomy
- Omentectomy
- Small bowel resection and anastomosis
Duration
10 hours, Despite her age and multiple health issues, the patient tolerated the surgery well.
Postoperative Course
Histopathology
Key Takeaways / Learning Points
- Cytoreductive Surgery (CRS), when performed by trained and experienced oncologists, can achieve excellent results even in advanced (Stage IV) ovarian cancer.
- Extensive cancer surgery is possible in elderly patients and those with multiple comorbidities when managed in expert centers.
- Team-based oncologic care, including surgeons, anesthetists, intensivists, and nursing staff plays a crucial role in achieving safe and successful outcomes.
Advanced Ovarian Cancer Managed with Curative Surgery, 67 Female
- Comorbidities: Hypertension
- Presenting Complaints: Large abdominal lump and pelvic pain
Clinical Background
- A 67-year-old woman presented with a large abdominal mass and persistent pelvic pain. Laboratory evaluation revealed elevated CA-125 levels (1800 U/ml), suggestive of a possible ovarian malignancy.
Investigations
CT Scan (Abdomen and Pelvis)
- Two large multilocular masses observed:
- 14 × 13 cm lesion in the lower abdomen
- 11 × 10 cm lesion in the pelvic region
Surgical Management
Postoperative Course
The patient recovered well and was discharged on postoperative day 5 in stable condition
Postoperative Course
Histopathology
Histopathology
- High-grade serous carcinoma of both ovaries (pT3bN1a)
- Metastatic involvement of regional lymph nodes present
Key Takeaways / Learning Points
- Early consultation with an oncologist is crucial- neglecting symptoms like abdominal lump or pelvic pain can delay diagnosis.
- Even in advanced stages, ovarian cancer can be treated effectively through comprehensive surgical management and expert oncologic care.
- Multidisciplinary surgical planning ensures curative outcomes and faster postoperative recovery.
Large Retroperitoneal Sarcoma Successfully Managed with En-bloc Resection
- Age/Sex: 69-year-old Male
- Diagnosis: Huge Retroperitoneal Mass
Clinical Background
- A 69-year-old male presented with a progressively enlarging abdominal lump and discomfort. Imaging studies revealed a massive retroperitoneal tumor compressing adjacent organs and major vessels.
Investigations
Imaging Findings (CT Scan)
- A 21 × 30 × 21 cm mass was noted in the right perinephric space, involving the anteromedial aspect of the right kidney and crossing the midline at supraumbilical, umbilical, and infraumbilical levels.
- The lesion caused displacement of the duodenal C-loop, head of pancreas, and distal CBD, along with small and large bowel loops.
- The tumor abutted the IVC and aorta, indicating close relation to vital structures.
Surgical Management
Intraoperative Findings
- Large, lobulated retroperitoneal tumor weighing 6.4 kg.
- Complete removal achieved with preservation of major vascular structures.
Postoperative Course
Uneventful recovery; patient discharged in stable condition.
Histopathology
- Diagnosis: High-grade spindle cell sarcoma suggestive of Dedifferentiated Liposarcoma (pT4)
- Patterns Observed:
- Well-differentiated
- liposarcoma – 70%
- Pleomorphic spindle cell sarcoma – 30%
- FNCLCC Grade: Grade 2 (Score 4)
Key Takeaways / Learning Points
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Even in advanced stages, large retroperitoneal tumors can be successfully resected with careful staging evaluation and multidisciplinary teamwork.
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Early consultation and prompt imaging are crucial to prevent extensive organ involvement.
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Comprehensive surgical planning and coordinated team effort ensure improved outcomes and quality of life for patients.
Laparoscopic Left Hemicolectomy in a High-Risk Patient
Age/Sex: 75-year-old Male
Diagnosis: Carcinoma of the Descending Colon
Clinical Background
- A 75-year-old male presented with bleeding per rectum. He had multiple comorbidities including hypertension, diabetes, prior cardiac stenting (on blood thinners), a single functioning kidney (post-left nephrectomy), and a left lumbar hernia, making him a high-risk surgical candidate.
Investigations
PET-CT Findings
- 4–5 cm mass lesion in the distal descending colon with moderate luminal narrowing.
- Pericolic and mesocolic lymph nodes noted.
Colonoscopy
Mass lesion identified 26–30 cm from the anal verge.
Surgical Management
Postoperative Course:
Recovery was smooth; patient discharged in stable condition.
Histopathology
- Diagnosis: Moderately differentiated adenocarcinoma of the descending colon
- Stage: pT3N1b
Key Takeaways / Learning Points
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Laparoscopic colorectal surgery is feasible and safe even in elderly patients with multiple comorbidities, under expert hands.
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Technological advancements such as ICG fluorescence imaging enhance surgical precision by confirming anastomotic vascularity and improving postoperative outcomes.
Laparoscopic Right Adrenalectomy for Pheochromocytoma
Age/Sex: 49-year-old Male
Diagnosis: Pheochromocytoma (Right Adrenal Gland)
Clinical Background
- The patient presented with headache, burning sensation in legs and palms, insomnia, and fluctuating blood pressure. These symptoms are classic indicators of a hormone-secreting adrenal tumor.
Investigations
Imaging
A 24 × 24 × 23 mm lesion was detected in the right suprarenal (adrenal) region, suggestive of pheochromocytoma, a rare, usually benign tumor that can cause severe hypertension due to excess adrenaline secretion.
Surgical Management
After achieving optimal blood pressure control, the patient underwent laparoscopic right adrenalectomy.
The procedure was completed safely under expert supervision. Postoperatively, the patient’s blood pressure normalized, and he was discharged in stable condition on the 4th postoperative day.
Histopathology
Findings confirmed Pheochromocytoma, Stage pT1
Key Takeaways / Learning Points
- Do not ignore fluctuating blood pressure, it may sometimes indicate an underlying adrenal disorder.
- Hypertension can occasionally be curable through surgical treatment, as seen in this case.
- Pheochromocytoma management requires specialized expertise for safe pre-operative stabilization and surgical removal.
Ovarian Malignancy (High-Grade Endometrioid Carcinoma)
Age/Sex: 43-year-old Female
Diagnosis: Poorly Differentiated High-Grade Endometrioid Carcinoma of the Ovary
Clinical Background
- The patient presented with lower abdominal pain, constipation, and a palpable lower abdominal mass- symptoms that often indicate an underlying pelvic or ovarian condition requiring thorough evaluation.
Investigations
Imaging
A 13 × 12 × 9 cm complex mass was identified in the right pelvis and central abdomen, adherent to small bowel loops and the anterior parietal peritoneum.
The lesion was also compressing the right mid-ureter and iliac vessels, suggesting locally advanced disease.
Surgical Management
Postoperative recovery
It was smooth and the patient was discharged in stable condition on postoperative day 5.
Histopathology
Findings confirmed Poorly Differentiated High-Grade Endometrioid Carcinoma, Stage pT1c N0.
Key Takeaways / Learning Points
- Ovarian cancers are typically seen after 60 years of age, but certain aggressive variants can appear much earlier, as in this case.
- Early evaluation of persistent abdominal symptoms can lead to timely diagnosis and successful treatment.
- With expert surgical and oncological care, even high-grade ovarian cancers can be treated curatively, enabling patients to lead long and healthy lives.
Gastrointestinal Stromal Tumour (GIST) of the Stomach
Age/Sex: 66-year-old Male
Diagnosis: Gastrointestinal Stromal Tumour (GIST) of the Stomach- Incidental Finding
Clinical Background
- During evaluation for unrelated complaints, imaging revealed a mass in the stomach, later confirmed as a Gastrointestinal Stromal Tumour (GIST)- a rare cancer originating from the digestive tract’s
Investigations
CT Scan Findings
An 8 × 7 × 6 cm multilobular, heterogeneously dense soft tissue lesion was seen in the lesser curvature of the stomach, abutting the inferior surface of the left lobe of the liver.
Treatment & Surgical Management
The patient first received targeted therapy (Imatinib) to shrink the tumour before surgery.
Later, a Laparoscopic GIST Excision was successfully performed using advanced staplers and energy devices like LigaSure, ensuring precision and minimal blood loss.
Postoperative recovery
The patient was discharged in stable condition post-surgery.
Histopathology
Findings confirmed spindle cell type GIST, ypT3, with clear surgical margins.
Key Takeaways / Learning Points
- GIST is a rare form of gastrointestinal cancer, often detected incidentally.
- Multimodality treatment- a combination of targeted therapy and minimally invasive surgery, can achieve excellent outcomes even in advanced cases.
- Modern surgical innovations such as staplers and energy devices help ensure safer, quicker, and more precise surgeries with faster recovery.
Carcinoma Stomach
- Age/Sex: 71-year-old Male
- Comorbidities: COPD
- Diagnosis: Carcinoma Stomach
Clinical Background
- The patient presented with persistent gastric discomfort and was diagnosed with carcinoma of the stomach. Considering his overall health and comorbid COPD, treatment was carefully planned for maximum safety and effectiveness.
- Received 4 cycles of CAPOX neoadjuvant chemotherapy to shrink the tumour and control disease spread before surgery
Investigations
PET-CT Findings
- Heterogeneous FDG-avid wall thickening (26 mm length, 14 mm thickness) involving the antrum of the stomach.
- Perigastric lymph nodes noted, the largest measuring 11 × 8 mm in the right gastroepiploic region.
Treatment & Surgical Management
- Heterogeneous FDG-avid wall thickening (26 mm length, 14 mm thickness) involving the antrum of the stomach.
- Perigastric lymph nodes noted, the largest measuring 11 × 8 mm in the right gastroepiploic region.
Postoperative recovery
The patient was discharged in stable condition post-surgery.
Treatment & Surgical Management
Underwent Exploratory Laparotomy + D2 Subtotal Gastrectomy + Roux-en-Y Gastrojejunostomy, ensuring oncological precision and complete tumour removal.
The patient recovered well and was discharged in stable condition on post-operative day 5.
Histopathology
Findings revealed a moderately differentiated adenocarcinoma of the stomach, with pathological stage ypT3N3a.
Key Takeaways / Learning Points
- Multimodality treatment- a combination of chemotherapy and surgery, is now the standard of care for locally advanced stomach cancers.
- Oncological D2 resection significantly improves survival compared to non-oncological gastrectomies.
- Even in older patients with comorbidities like COPD, precise surgical planning and multidisciplinary care enable safe and effective treatment outcomes.
Early Stage Breast Cancer
- Age/Sex: 46-year-old Female
- Diagnosis: Carcinoma Left Breast
Clinical Background
- The patient presented with a palpable mass in the left breast. Early detection allowed planning for breast-conserving treatment with optimal outcomes.
Investigations
Sonomammography
Hypoechoic mass measuring 13 × 16 × 15 mm in the lower inner quadrant at 6–7 o’clock position
Biopsy
- Invasive ductal carcinoma
- ER/PR: Positive
- HER2: Negative
Treatment & Surgical Management
Underwent Left Breast Conserving Surgery (BCS) + Sentinel Lymph Node Biopsy (SLNB) to remove the tumour while preserving breast tissue.
Patient recovered well with no post-operative complications.
Histopathology
- pT1N0 invasive breast carcinoma, NOS type
- Margins and lymph nodes free of disease
Key Takeaways / Learning Points
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Early-stage breast cancer has excellent prognosis.
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Breast conservation is possible with good cosmetic outcomes.
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Regular screening and prompt evaluation of breast lumps are critical for early detection and successful treatment.
Breast Conservation in High-Risk Patient
Age/Sex: 60-year-old Female
Diagnosis: Carcinoma Right Breast
Clinical Background
- The patient presented with a palpable mass in the right breast. Despite multiple comorbidities, careful preoperative planning enabled safe breast-conserving surgery.
Investigations
Sonomammography
Lesion measuring 20 × 18 × 17 mm in the 4–5 o’clock position of the right breast
- Subcentimeter lymph nodes noted in the right axilla
- BIRADS V
Biopsy
- Infiltrating duct carcinoma
- ER/PR: Positive
- HER2: Negative
Treatment & Surgical Management
- Right Breast Conserving Surgery (BCS) + Sentinel Lymph Node Biopsy (SLNB)
- Patient discharged in stable condition with excellent cosmetic outcome
Histopathology
- pT2N0(sn) invasive ductal carcinoma
- Margins and sentinel nodes free of disease
Key Takeaways / Learning Points
- Breast conservation is achievable even in older patients with multiple comorbidities.
- Meticulous planning and expert surgical care are crucial for safe outcomes and good cosmesis.
- Early detection and coordinated oncology care improve survival and quality of life
Curative Surgery in Oligometastatic Pancreatic Cancer
Age/Sex: 46-year-old Female
Diagnosis: Carcinoma Head of Pancreas with Single Liver Metastasis
Clinical Background
- The patient presented with upper abdominal pain. Imaging revealed a heterogeneously enhancing hypermetabolic lesion in the head of the pancreas, involving the uncinate process, lower CBD, and adjacent MPD. A single liver metastasis in segment V was also noted
Investigations
PET-CT Findings
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USG-guided biopsy of liver lesion: Metastatic adenocarcinoma of pancreatic origin
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PET-CT after 4 cycles of FOLFIRINOX neoadjuvant chemotherapy:
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Pancreatic head lesion reduced to 1.9 × 1.3 cm
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Liver lesion decreased to 7 mm, non-FDG avid(previously 11 mm)
Treatment & Surgical Management
- Whipple’s procedure (Total mesopancreatic excision)
- Radiofrequency ablation (RFA) of single liver metastasis
- Unique challenge: Right hepatic artery arising from SMA
- Surgery and RFA were uneventful
- Discharged in stable condition on post-op day 6
Histopathology
- ypT2N0 moderately differentiated adenocarcinoma
- Total lymph nodes retrieved: 24 (from total mesopancreatic excision)
- Margins free
Histopathology
- pT2N0(sn) invasive ductal carcinoma
- Margins and sentinel nodes free of disease
Key Takeaways / Learning Points
- Curative treatment is possible even in oligometastatic pancreatic cancer with careful planning.
- Multimodality treatment (neoadjuvant chemotherapy + surgery + RFA) is essential in such cases.
- Expert multidisciplinary discussion ensures optimal outcomes for complex, high-risk surgical cases
Carcinoma of Left Pyriform Sinus
Age/Sex: 41-year-old Male
Clinical Background
- The patient presented with complaints of difficulty in swallowing, pain on the left side of the neck, voice changes, and a small lump in the left neck for 5–6 months.
Investigations
PET-CT Findings
Heterogeneously enhancing, FDG-avid lesion involving the left aryepiglottic fold, pyriform sinus, lateral wall of the oropharynx, thyroid cartilage, hyoid bone, and left strap muscles. Findings were suggestive of locally advanced malignant disease.
Biopsy
Direct laryngoscopic biopsy confirmed Squamous Cell Carcinoma of the pyriform sinus involving adjacent structures as seen on imaging.
Treatment & Surgical Management
After multidisciplinary tumor board discussion, radical surgery was planned to achieve complete tumor removal. The patient underwent Total Laryngectomy + Left Hemithyroidectomy + Bilateral Selective Neck Dissections + Tube PMMC Flap Reconstruction.
Post-operative recovery was uneventful, and the patient was discharged in stable condition on Post-Operative Day 7.
Histopathology
Final Diagnosis: Moderately differentiated Squamous Cell Carcinoma of the left pyriform sinus. Pathological Staging: pT4aN1. Margins were uninvolved by carcinoma.
Key Takeaways / Learning Points
- In advanced head and neck cancers, radical surgery remains the cornerstone of curative treatment.
- Careful pre- and post-operative oncological management ensures improved outcomes and recovery.
- Successful outcomes in such complex cases depend on multidisciplinary planning and surgical expertise.
Papillary Thyroid Carcinoma
Age/Sex: 36-year-old Female
Clinical Background
- Presented with a painless neck swelling noted for about 30 days.
Investigations
Ultrasound (USG)
- Right thyroid lobe: heterogeneous hypoechoic solid nodule, 6 × 8 × 9 mm, taller-than-wide, TIRADS 5.
- Left thyroid lobe: similar hypoechoic lesion 4 × 5 × 4 mm, TIRADS 5.
Treatment & Surgical Management
Procedure performed: Total thyroidectomy + Bilateral selective neck dissections + Central compartment neck dissection.
Post-operative course was uneventful; patient discharged in stable condition on post-op day 4.
Histopathology
Final report: pT3bN1b papillary carcinoma of the thyroid, involving both lobes.
Lymph nodes: 10 of 51 dissected nodes positive for tumor.
Key Takeaways / Learning Points
- Total thyroidectomy with neck dissection is an effective treatment for multifocal papillary thyroid cancer with nodal spread.
- Meticulous surgical technique is critical because the nerves that control voice and breathing (recurrent laryngeal nerves, external branch of the superior laryngeal nerve) lie very close to the thyroid and must be preserved to maintain vocal and respiratory function.
- Early evaluation of new neck lumps and prompt specialist care allow curative treatment with good functional outcomes.