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Background and Aims: Outcome analysis of patients with Wilms’ tumors (WT) is presented. Materials and Methods: A retrospective analysis of 23 children having WT managed by a single surgeon over 3 years (2021–2024) using the International Society of Paediatric Oncology Umbrella protocol was done. Results: The median age at presentation was 36 months; 32 months and 24 months for the unilateral WT (uWT) (n = 19) and bilateral WT (bWT) (n = 4), respectively. M: F ratio was 2.3: 1. WTs were localized in 19 (uWT-16; bWT-3) and metastatic in 4 (uWT-3; bWT-1) patients. Core-needle biopsy was done in 22 patients (26 renal units). Pre-therapy contrast-enhanced computed tomography volumetry (n = 20) showed a median tumor volume of 1023 ml (range: 47–2680 ml). Post-neoadjuvant chemotherapy (NACT) median tumor burden (n = 19) was 612 ml (range 59–3775 ml). Post-NACT, tumor volume decreased in 11/18 patients but increased in seven patients. NACT was avoided in one neonate. Nephroureterectomy (including one with excision of bladder cuff) and nephron-sparing surgery were done in 17 and 10 renal units including 3 with multifocal WT, respectively. Risk stratification was intermediate in 21 and High in 2. Overall staging in 19 uWT included Stage I-7, Stage II-5, Stage III-4, and Stage IV-3 (local staging-stage I in 1 and stage II in 2). Local staging in 8 renal units with bWT was Stage I in 7 and II in 1. One stage IV uWT had bilateral pulmonary metastatectomy. Adjuvant chemotherapy has been completed in 18 patients; two patients are still on adjuvant chemotherapy; flank radiation was administered in six patients. Three patients with synchronous bWT died; two due to acute kidney injury in the immediate postoperative period and one with metastatic disease who had abandoned adjuvant chemotherapy after the 1st cycle. Another patient died of a huge metachronous tumor in the contralateral kidney after a year of completion of therapy. One patient had successful multimodality treatment of local relapse with liver metastasis. 1-year overall and event-free survivals are 84% and 76%, respectively. Conclusions: Excellent short-term results for localized uWT from a center in a low-middle-income country are reported.

Asthma is a chronic inflammatory disorder characterized by hyperresponsiveness and inflammation of conducting airways. It is a heterogeneous disease with different phenotypes based on clinical, functional or inflammatory parameters [1]. The disease presents with recurrent episodes of wheezing, tightness of chest and shortness of breath, with cough particularly in early morning.[2] Prevalence of the disease varies between 1-18 % of population in different countries with 300 million people affected worldwide [3,4]. It occurs at all ages and its prevalence has been increasing in developing countries. The disease increases health burden in the population, decreases productivity and causes considerable morbidity and mortality [5]. The clinical severity of asthma ranges from mild to severe. The common symptoms are usually due to variable bronchoconstriction causing limitation of airflow [6]. The disease is episodic in nature with increase in frequency and intensity over time. It can be triggered by viral infections, allergens, tobacco smoke, exercise, stress and drugs like aspirin, beta blockers and NSAIDS. Asthma is now hypothesized to be a T helper type 2 (Th2) inflammatory disorder with increase in the number of Immunoglobulin E (IgE) producing cells. The Th2-type cytokines, such as interleukin 4 (IL-4) and interleukin 5 (IL-5) are responsible for numerous effects important in bronchial asthma. IL4 has been implicated as the main cytokine involved and causes stimulation of mucus producing cells and fibroblasts, leading to airway remodeling [7-10]. Eosinophil is the main effector cell in allergic inflammation. IL-5 is the primary cytokine involved in in-vivo production, differentiation, maturation and activation of the eosinophils. Expression of IL-5 mRNA correlates with clinical indices of disease severity in asthma and the expression of IL 5 receptor in bronchial biopsies is more than 90% restricted to eosinophils.[11] Short-term treatment mainly consists of oral or inhaled corticosteroids (ICS). Long term medications include Anti-IgE and anticholinergic drugs which are useful in patients with severe asthma. Anti-IL5 (mepolizumab) and anti IL5R (benralizumab) medications are being offered to patients with severe uncontrolled eosinophilic asthma on high dose ICS. Anti-IL4R (Dupilumab) is also an option for these patients.

Thyroid gland, despite being a highly vascular organ, is an extremely unusual site for metastasis from primary carcinoma like breast. We, hereby, report a case of metastatic lesion in the thyroid with breast carcinoma as a primary, in a 55-year-old postmenopausal female. The metastatic focus had masqueraded as nodular goitre, thereby, creating diagnostic difficulty. The case was suspected on Fine Needle Aspiration (FNA) and confirmed by immunocytochemistry on cell block with progesterone and Her2neu positivity. Also, we have attempted to review the literature reporting similar occurrences. Although breast cancer is less frequent to metastasize to thyroid, it is advised to always exclude metastasis from breast carcinoma especially if new thyroid lesions occur in patients with this malignancy. Such cases create diagnostic dilemma on cytology due to morphologic similarities between primary and metastatic thyroid lesions. Cell block is a crucial technique where ancillary techniques like immunocytochemistry can be applied and help in early and timely diagnosis, hence, rendering better prognostic outcome.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.