Bilateral Carcinoma Research Articles

Retrospective cohort study on the bilateral occurrence of invasive lobular breast cancer

ObjectiveInvasive lobular carcinoma (ILC) is the second most common histological subtype of invasive breast cancer, following the no special type (NST) invasive carcinoma. It has historically been assumed that ILC occurs bilaterally in 20–29 % of cases, which has influenced the inclusion of MRI in the standard workup of ILC according to European guidelines. However, challenging this long-held belief regarding the bilateral occurrence of ILC opens up the possibility of revising the guidelines and using MRI only for more specific indications. This study aims to evaluate whether the previously reported high percentage of bilaterality still holds true and to question the added value of MRI in the standard workup of ILC. Study designA retrospective cohort study was conducted following approval from the institutional review board (EC 21/18/249) at Antwerp University Hospital (UZA). The cohort comprised female patients of all ages who had been diagnosed with either ILC or NST invasive carcinoma and had sought consultation at the UZA breast clinic. A comprehensive database was established to collect information on patient characteristics, imaging, and pathology. ResultsA total of 271 patients with ILC were included in the study, with incidence dates ranging from 01/01/2007 to 01/01/2023. Among these patients, a synchronous bilateral ILC lesion was observed in 1.85 % (5/271) of cases. This proportion is significantly lower than the reported percentage of patients with a bilateral lesion in the literature population, which stands at 4.95 %. The reference group consisted of 809 patients with NST invasive carcinoma, with incidence dates ranging from 01/01/2017 to 01/01/2023. In the control group, a synchronous bilateral NST lesion was observed in 3.96 % (32/809) of cases. There is no significant difference in the bilaterality rates between the group of ILC patients and the group of NST patients. Furthermore, MRI did not detect any histopathologically confirmed contralateral ILC lesion that had not already been detected by mammography or ultrasound. ConclusionsThe study results indicate a lower occurrence of bilateral ILC than previously assumed. Additionally, the incidence of synchronous bilateral lesions in ILC patients is not higher compared to patients with NST invasive carcinoma. Performing an MRI does not provide additional value in detecting bilateral carcinomas in ILC. Consequently, it is recommended that the current European guidelines be reassessed, and the indications for undergoing an MRI should be adjusted accordingly.

Extent of surgical procedure in triple negative breast carcinomas.

Triple negative breast carcinomas (TNBC) account for approximately 15-20% of all breast carcinomas. This subtype is characterised by an unfavourable prognosis with early locoregional recurrence a metastases. Only few studies have focused on the impact of local surgery on the overall therapeutic outcome. However, decisions are difficult to make in the case of TNBC, and no particular molecular subtype or marker exists that would make the decision-making process easier. The aim of our retrospective study was to analyse the TNBC surgical management outcomes at EUC Clinic in Zlin. 440 women with breast carcinoma were operated on at EUC Clinic from 2014 to 2016, including 29 patients with TNBC; bilateral carcinoma was present in one case. Neoadjuvant chemotherapy (NAC) was indicated in 6 cases. The tumour centre was marked with a clip. The extent of surgery depended on the residual size of the tumour. Sentinel lymph node biopsy was indicated in clinically negative lymph nodes; further management followed the Z0011 study if the biopsy was positive. Axillary lymph node dissection was performed after NAC. In all cases, surgery was followed by systemic chemotherapy, and by radiotherapy in the case of breast-conserving procedures. The group included 29 women and one patient with bilateral carcinoma, i.e. 30 cases of TNBC. Mean age was 57 years and median age was 55.5 years. Mean follow-up was 62.9 months, with the median of 69.9 month. NAC was indicated in 6 patients; complete pathological response was achieved in one case. NAC was followed by mastectomy in 5 cases including a bilateral procedure in one case, and by breast-conserving surgery in one case. Axillary dissection was performed in all cases. Breast-conserving surgery and sentinel node biopsy predominated in the group (16 cases). Local recurrence was observed in 4 cases, 2 times as an isolated local recurrence after one year and 2 times as part of generalization, always after mastectomy. Six patients died of generalized disease. No regional recurrence was observed. TNBC is characterised by a worse prognosis and a higher rate of local recurrence. As confirmed by our study, the results of breast-conserving surgery can be comparable to those of radical procedures, and thus radical surgery should be indicated prudently.

Inherited Unconjugated Hyperbilirubinemias and Radical Cancer surgery: Perioperative Concerns for Bilateral Modified Radical Mastectomy

Inherited defects of Uridine 5'-diphospho-glucuronosyltransferase (UDPGT) can cause congenital unconjugated hyperbilirubinemia. The perioperative anesthetic management of such patients poses several challenges. Here we report a case of bilateral carcinoma breast with congenital unconjugated hyperbilirubinemia posted for bilateral modified radical mastectomy. The patient was administered general anesthesia with no perioperative deterioration of liver function.

Development of Histologically Verified Thyroid Diseases in Women Operated for Breast Cancer: A Review of the Literature and a Case Series.

Background: The possible relationships between breast and thyroid diseases have been reported in the literature. The purpose of our study was to evaluate the occurrence of histologically verified thyroid pathologies in women who were diagnosed with breast cancer and, after mastectomy/quadrantectomy complemented by oncological treatment, were thyroidectomized based on their periodic thyroid evaluation. Patients and Methods: Our series consist of 31 women with a mean age of 62.9 ± 10.9 years (range, 45–81) treated for breast cancer (18 right-sided, 11 left-sided, and 2 bilateral), of whom 29 were thyroidectomized, since two women who developed Graves’ disease refused thyroidectomy. These 31 women belong to a cohort of 889 women who referred to the Breast Surgery Unit of our university hospital during the period January 2010 through December 2020. Results: The mean time interval between breast cancer and thyroid pathologies was 48.1 ± 23.4 months (range, 12–95). The final diagnosis at histopathology was infiltrating ductal breast carcinoma in 26 women (with 2/26 patients having bilateral carcinoma) and infiltrating lobular breast carcinoma in the other 5 women. Ten of the twenty-nine thyroidectomized women (34.5%) had a thyroid malignancy on histology: five papillary carcinomas, three papillary micro-carcinomas and two follicular carcinomas. Two of the five women with papillary carcinoma also had histological evidence of chronic lymphocytic thyroiditis/Hashimoto’s thyroiditis, which was also detected in another five women with benign thyroid diseases. Conclusions: We suggest that breast cancer survivors should be made aware of the possible increased risk of thyroid pathologies (including thyroid malignancy) so that they can undergo screening and follow-up.

Bilateral Pleomorphic Ductal Carcinoma Of Breast- A Rare Presentation With Its Diagnostic Dilemma

Pleomorphic carcinoma of breast is a rare morphological subtype of Invasive Breast Carcinoma No Special Type (IBC NST), which has histomorphological overlap with other entities. Here we present such a case with bilateral breast involvement in 45 years old nulliparous woman with family history of breast carcinoma. Typical numerous multinucleated cells (>50%) with marked pleomorphism and wide areas of necrosis were histopathological presentation. AE1/AE3 and Vimentin were positive. Ki-67 labelling index was high along with HER2 amplification. Important differentials were IBC NST with Osteoclast-like giant cells, Choriocarcinomatous pattern, metaplastic carcinoma & metastatic disease all of which was ruled out with proper clinical, histological & immunohistochemical approach. Despite the aggressive nature of the neoplasm and presence of adverse prognostic factors, this case responded well with adjuvant chemotherapeutic regimen.International Journal of Human and Health Sciences Vol. 06 No. 02 April’22 Page: 213-216

Is bladder preservation safe? The oncology outcomes of patients after 2-sided radical nephroureterectomies due to bilateral upper urinary tract urothelial carcinomas.

The prognosis of patients undergoing 2-sided radical nephroureterectomies (RNUs) with a residual bladder due to bilateral upper tract urothelial carcinoma (UTUC) is poorly understood. This study was aimed toward surveying the oncology outcomes and prognostic factors that may help in shared decision-making related to bladder preservation in patients preparing to receive 2-sided RNUs. Patients with synchronous or metachronous bilateral UTUC who received bilateral RNUs with a residual bladder in our hospital were retrospectively reviewed. Clinical and pathological data were analyzed for potential variables affecting the oncology outcomes. A total of 50 patients were included. The average age at completion of the 2-sided RNU was 62.7 ± 12.4years, with a mean follow-up of 88.4 ± 59.3months after the 2-sided RNUs. The medium overall survival was 13.4 ± 1.8years. Twenty-six patients (52%) had cancer recurrence in the residual bladder, but only 2 (8%) of the recurrences were muscle invasive. The highest UTUC stage was the only predictive factor for cancer-specific survival (CSS) rather than intravesical recurrence. The 5year CSS rates in patients with the highest UTUC stage ≦ pT2 and ≧ pT3 were 90% and 51%, respectively (p = 0.007). Risk of cancer recurrence in the residual bladder is high, but does not affect survival outcomes. The highest UTUC stage plays a significant role in cancer-specific survival. With a careful patient surveillance, bladder preservation may be reasonable in patients with bilateral UTUC preparing for 2-sided RNUs.

Risk factors for local recurrence of early bilateral vocal cord carcinoma treated with transoral CO2 laser microsurgery

Background The incidence of local recurrence after transoral CO2 laser microsurgery for T1b–T2 glottic carcinoma is relatively low. Multiple risk factors have been described for the development of local recurrence after treatment. However, to date, there is no analysis or systematic review investigating the relationships between clinical and histopathological factors and the appearance of local recurrence after transoral CO2 laser microsurgery in T1b–T2 glottic carcinoma patients. Aims/objective To investigate risk factors for local recurrence after CO2 laser surgery in T1b–T2 glottic carcinoma involving bilateral vocal cords. Material and methods We retrospectively studied patients undergoing CO2 laser surgery for T1b–T2 glottic carcinoma involving bilateral vocal cords. Multiple follow-up laryngoscopies and computed tomographies were performed. Main outcome measures: survival rate, local recurrence rate, and independent risk factors for recurrence. Results All 85 patients (83 male; age, 63.33 ± 10.59 years; 36 T1b and 49 T2 lesions; 28 cases with and 57 without anterior commissure (AC) involvement) survived; 15 exhibited postoperative local recurrence. Recurrence rates differed between the following groups: patients without (6/57) versus patients with AC involvement (9/28) (p = .007); patients with negative (11/77) versus positive resection margins (4/8) (p = .014); p53-negative (5/51) versus p53-positive patients (10/34) (p = .0132). AC involvement, positive resection margins, and p53 expression were independent risk factors for recurrence. Conclusions Patients with stage T1b and T2 glottic carcinoma with AC involvement, positive resection margins, and p53 expression should be followed up at shorter intervals. Significance This article provided valid clinical data for risk factors for local recurrence after CO2 laser surgery for T1b–T2 glottic carcinoma involving bilateral vocal cords.

Multiple endocrine neoplasia type 2a (men 2a) case with bilateral medullary thyroid carcinoma and papillary thyroid carcinoma presentation

Multiple endocrine neoplasia type 2a (men 2a) case with bilateral medullary thyroid carcinoma and papillary thyroid carcinoma presentation

Bilateral secondary testicular, epididymal and spermatic cords carcinoma of prostatic origin: a case report and review of the\xa0literature

BackgroundProstatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases.Case presentationA 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence.ConclusionSince it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.

Atypical image of pneumoperitoneum secondary to colon perforation

The case was a 66-year-old female with a diagnosis of bilateral ovarian carcinoma with peritoneal carcinomatosis and liver metastases. She had only undergone one cycle of chemotherapy and could not be given other cycles because of her poor general condition. She was admitted due to intermittent vomiting for a week and severe heartburn, with the last stool passed two days before, presenting abdominal distension and lower abdominal pain, without signs of peritonism and no peristaltic sounds. After performing several complementary tests a computed tomography scan showed a large amount of intra-abdominal air, which was thought to be a possible transverse colon volvulus, that caused extrinsic compression on the stomach. A colonoscopy was performed in an attempt to devolvulate, which was unsuccessful.

Synchronous Bilateral Solid Papillary Carcinoma of Breast: A Rare Case Report

Background: Solid papillary carcinoma is a rare type of carcinoma that accounts for less than 1% of all breast cancers and mostly seen in postmenopausal women. This report presents a rare case of synchronous bilateral solid papillary carcinoma of the breast. Case Report: A 74-year-old female patient had a mass in her right and left breast. Bilateral total mastectomy and sentinel lymph node biopsy were performed. The pathologic diagnosis was synchronous bilateral solid papillary carcinoma. No lymph node metastasis was detected in either of the breasts. Conclusion: To our knowledge, little is known about simultaneous bilateral solid papillary carcinomas. Solid papillary carcinoma should be kept in mind in the differential diagnosis of bilateral breast masses with neuroendocrine differentiation in elderly patients.

Bilateral Invasive Ductal Carcinoma in Male Breast

Bilateral Invasive Ductal Carcinoma in Male Breast

Abstract 4572: mONCR-177 oncolytic virotherapy stimulates anti-tumor and anti-viral immunogenicity

Abstract Oncolytic viruses represent a promising class of therapeutic agents for the treatment of cancers that poorly respond to immune checkpoint inhibitors. Oncorus is developing ONCR-177, an oncolytic herpes simplex virus engineered for potent oncolysis and stimulation of antitumor immunity. ONCR-177 is replication competent in tumor cells, but its replication and neuropathic activities are attenuated in healthy cells using microRNA-dependent degradation of viral transcripts and by mutations in UL37 that prevent retrograde transport in neurons. In addition, ONCR-177 encodes five immune-stimulatory transgenes: IL-12, CCL4, FLT3LG, a PD-1 humanized antagonist VHH nanobody, and a CTLA4 blocking monoclonal antibody. Transgenes were chosen to efficiently recruit effector T (CD8 and CD4 Th1), NK, and classical dendritic cells to the tumor, and to counter upregulation of immune checkpoints. The individual and collective mechanisms of action of the transgenes are designed to augment local and distant innate and adaptive anti-tumor immune responses. Tumor-specific response was evaluated using mONCR-177, a mouse functional surrogate for ONCR-177, that is built on the same base vector ONCR-159 but expresses the immune transgenes suitable for murine studies. In a CT26 bilateral colon carcinoma tumor model and a MC38 colon adenocarcinoma model, immune responses elicited by intratumoral injection of mONCR-177 and ONCR-159 were compared. Intratumoral T cell responses were evaluated for a tumor-associated antigen (TAA) and an HSV specific antigen in the MC38 model. In the CT26 tumor model, treatment with mONCR-177 resulted in greater immune infiltration with a higher activation status and an improved CD8:Treg ratio. Treatment with mONCR-177 elicited significantly more tumor antigen specific IFNγ and TNFα producing, intratumoral CD8T cells. The increase in anti-tumor response with mONCR-177 treatment was further evidenced by the increase in polyfunctional CD8 T cells producing IFNγ, TNFα, and/or IL-2 in response to TAA stimulation. In the MC38 tumor model, treatment with mONCR-177 resulted in greater immune infiltration in both the injected and non-injected tumor. The CD8:Treg ratio was improved and PD-1 expression was decreased. Tumor antigen specific cytokine production was higher with mONCR-177 treatment. Additionally, a significant increase in HSV-specific polyfunctional CD8+ T cells was observed. mONCR-177 effectively stimulates an intratumoral immune response to both tumor and viral antigens. Treatment results in increased infiltrating immune cells, activation, and polyfunctional CD8+ T cells. These results highlight the dual modality mechanism of action of mONCR-177 treatment through direct tumor cell killing and immune stimulation through the antiviral response, and their enhancement by the immune stimulatory transgenes. Citation Format: Melissa Hayes, Agnieszka Denslow, Jacqueline Hewett, Daniel Wambua, Lingxin Kong, Jacob Spinale, Peter Grzesik, Jennifer Lee, Terry Farkaly, Edward M. Kennedy, Lorena Lerner, Christophe Queva, Brian Haines, Sonia Feau. mONCR-177 oncolytic virotherapy stimulates anti-tumor and anti-viral immunogenicity [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4572.

Abstract B74: Dual mechanism of ONCR-177 enhances antitumor immunogenicity

Abstract Oncolytic viruses represent a new class of therapeutic agents for the treatment of cancers that poorly respond to immune checkpoint inhibitors. Oncorus is developing ONCR-177, an oncolytic herpes simplex virus engineered for enhanced oncolysis and antitumor immunity. ONCR-177 is replication competent in tumor cells, but its replication and neuropathic activities are attenuated in healthy cells using miRNA-dependent degradation of viral transcripts and by mutations in UL37 that prevent retrograde transport in neurons. Efficacy is enhanced by a gain of function in the fusogenic glycoprotein B to enhance viral entry and inactivation of US12 to restore antigen processing. ONCR-177 is armed with five immunostimulatory transgenes: IL-12, CCL4, FLT3LG, a PD-1 humanized antagonist VHH nanobody, and the CTLA4 blocking monoclonal antibody ipilimumab. The antitumor effect of ONCR-177 utilizes two distinct modalities of immune stimulation. First, ONCR-177 is specific for tumor cells where infection and replication result in direct tumor cell killing. Second, lysis of tumor cells and expression of ONCR-177 immune payloads stimulate the immune environment through multiple mechanisms: innate signaling through production of PAMP/DAMP signals, immune cell recruitment, exposure of tumor-specific antigens, and activation of the adaptive immune response. Tumor-specific immunogenicity was evaluated using mONCR-171, a mouse functional surrogate for ONCR-177, that is built on the same base vector ONCR-159 but expresses the immune transgenes suitable for murine studies. In a CT26 bilateral colon carcinoma tumor model, immune responses elicited by intratumoral injection of mONCR-171 and ONCR-159 were compared. Intratumoral T cells were evaluated for effector phenotype and function in response to a tumor-associated antigen. We observed a shift toward enhanced activation in the mONCR-171 treatment group. Treatment with mONCR-171 resulted in more tumor-associated CD8+ T cells, higher activation, and more effector cells. This group also had lower PD-1 expression, fewer Treg cells, and a favorable CD8:Treg ratio. The tumor-specific response was assessed using the CT26 tumor-associated antigen AH1, a peptide derived from envelope glycoprotein 70 (gp70) of endogenous murine leukemia virus (MuLV). Treatment with mONCR-171 elicited significantly more IFNγ and TNFα producing, intratumoral CD8+ T cells, producing significantly higher levels of IFNγ. The increase in antitumor immunogenicity with mONCR-171 treatment was further evidenced by the increase in polyfunctional CD8+ T cells, producing IFNγ, TNFα, and/or IL-2 in response to antigen stimulation. These results highlight the dual modality mechanism of action of mONCR-171 treatment though the direct tumor cell killing and immune stimulation through the antiviral response and their enhancement by the immune stimulatory transgenes. Citation Format: Melissa Hayes, Agnieska Denslow, Jacqueline Gurshaw, Daniel Wambua, Shreeya Khatiwada, Lingxin Kong, Jacob Spinale, Prajna Behera, Peter Grzesik, Jennifer Lee, Terry Farkaly, Edward Kennedy, Lorena Lerner, Christophe Quéva, Brian Haines, Sonia Feau. Dual mechanism of ONCR-177 enhances antitumor immunogenicity [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr B74.

Multiple endocrine neoplasia type 2A in a family

The authors present the case of a multiplex endocrine neoplasia type 2A (MEN2A). The 55-year-old woman underwent detailed examinations for abdominal complaints. Bilateral adrenal masses and thyroid nodular goiter were found. Based on metanephrine excretion and MIBG imaging, bilateral phaeochromocytomas were diagnosed. The thyroid nodules were confirmed by thyroidectomy as bilateral medullary thyroid carcinoma. Asymptomatic primary hyperparathyroidism was also detected. Laparoscopic adrenalectomy and parathyroid adenoma removal were performed. Based on family history and the characteristic clinical presentation, MEN2A syndrome was confirmed by genetic testing. During genetic screening of first-degree relatives, the patient's 25-year-old daughter was shown to be a gene carrier. Preventive thyroidectomy was performed and histology proved multifocal medullary thyroid cancer. In addition to the importance of genetic testing, the authors emphasize the guideline-based, but individualized approach to patients with suspected MEN2A syndrome. Orv Hetil. 2020; 161(2): 75-79.

Abstract 1452: Development of ONCR-148, a miR-attenuated oncolytic HSV-1 designed to potently activate antitumor T cell response

Abstract Oncolytic viruses, through cancer cell-selective lysis and accompanying release of danger signals that promote immune activation, have demonstrated antitumor efficacy in monotherapy of metastatic melanoma and have shown promising activity in combination with checkpoint inhibitors. We present here the activity of ONCR-148, a recombinant oncolytic Herpes Simplex Virus (oHSV) designed to be a safe and efficacious therapy for the treatment of solid tumors. Neuron-specific miR attenuation of ICP4 gene inhibits viral replication in neurons while preserving its potent oncolytic activity in tumor cells. The antitumor potency of the virus is enhanced by incorporating in its genome a transgene expressing fibroblast activation protein (FAP)- and CD3- bispecific antibody that recruits and re-directs the cytolytic activity of T cells toward FAP-expressing stromal cells. FAP is a cell-surface serine protease that is almost exclusively found in fibroblasts within tumor stroma. However, systemic administration of a FAP-CD3 bispecific antibody was not tolerated due to the toxicity toward FAP-expressing bone marrow mesenchymal cells (Tran et al., 2013. J.Exp.Med, 210(6), 1125-1135). Thus, the local intra-tumoral delivery of FAP-CD3 is an attractive approach to promote tumor lysis and T cell activation against cancerous lesions. To test the in vivo activity of ONCR-148, as FAP is poorly expressed in syngeneic mouse tumor models, we developed a bilateral mouse FAP-expressing MC38 syngeneic colon carcinoma model (MC38-FAP), allowing to test local antitumor activity in oHSV-injected tumors and abscopal efficacy mediated by immune cells in the non-injected tumors. Intra-tumoral administration of ONCR-148 in the MC38-FAP model resulted in tumor growth inhibition of 60% (p<0.03) and 46% (p<0.01) on the injected (ipsilateral) and non-injected (contralateral) tumor, respectively. We then investigated additional transgenes that could potentiate the antitumor activity of ONCR-148. We combined in vivo ONCR-148 with ONCR-153, an oHSV armed with the NK and T cell activating cytokine IL-12 and the chemokines CXCL10 and CCL4, allowing for expansion and recruitment of T cells and antigen presenting cells in the tumor milieu. Combined intra-tumoral administration of ONCR-148 and ONCR-153 increased the antitumor response to 90% on the injected tumor (p<0.0001), leading to complete tumor remission in 5 out of 9 treated mice and to 80% on distant tumors (p<0.0001, with no complete responses observed).These data indicate that oHSV expressing bispecific antibodies, while being well tolerated, is efficacious in injected tumors and mediate systemic antitumor immune response. The efficacy can be potentiated by a local co-expression of immunostimulatory cytokines. Such data support the further development of oHSV-1 armed with CD3 bispecific antibodies for the therapy of patients with metastatic cancer. Citation Format: Agnieszka Denslow, Brian B. Haines, Michael S. Ball, Jacqueline Gursha, Daniel Wambua, Cecilia Kwong, Lingxin Kong, Allison Colthart, Prajna Behera, Peter Grzesik, Jennifer Lee, Terry Farkaly, Caitlin Goshert, Edward M. Kennedy, Lorena Lerner, Christophe Quéva. Development of ONCR-148, a miR-attenuated oncolytic HSV-1 designed to potently activate antitumor T cell response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1452.

Experience in diagnosis and treatment of non-hereditary bilateral synchronous renal carcinoma

Objective To investigate the principles of diagnosis and treatment of non-hereditary bilateral synchronous renal cell carcinoma. Methods This retrospective study analyzed 36 cases of non-hereditary bilateral synchronous renal cell carcinoma in our hospital from January 2008 to December 2016, including 30 males and 6 females. A total of 74 renal tumors were found, in which 34 patients had bilateral single kidney tumor and 2 patients had two tumors in one kidney. The diameter of tumors ranged from 1cm to 11 cm, with an average of (6.8±4.1)cm. The patients that underwent nephron-sparing surgery(NSS) got 4-12 points, with an average of (6.1±3.4) points in R. E.N.A.L. score and 3-13 points, with an average of (6.9±3.7) points in Zhongshan score. The patients are classified into 4 groups according to operation methods. In group A, 16 patients underwent bilateral NSS, which the preoperative creatinine was 63-103 μmol/L with an average of (80.9±11.4)μmol/L. In group B, 7 patients underwent one side of NSS before contralateral radical nephrectomy (RN), which preoperative creatinine was 59-87 μmol/L with an average of (75.7±8.9)μmol/L. In group C, 7 patients underwent one side of RN before contralateral NSS, preoperative creatinine was 57-107 μmol/L, with an average of (77.6±19.2)μmol/L. In group D, 6 patients underwent one side of NSS or RN and spare the contralateral side, 2 of which shifted from NSS to RN after finding tumor invaded pelvis and upper ureter during surgery. Of all the 16 patients with bilateral NSS, 4 patients underwent surgery on the side where tumor had a higher score in the first phase and then the side where tumor had a lower score in the second phase, 11 underwent surgeries in an opposite order. One patient underwent bilateral NSS simultaneously. Group A, B and C are taken into final analysis. Result All the 30 patients underwent surgery successfully. The operation time of NSS ranged from 60 to 110 min with an average of (88.6±23.6)min and RN ranged from 40 to 90 min with an average of (72.3±21.4)min. The warm ischemia time of NSS was 12-40 mins with an average of (29.5±9.7)min. The creatinine of Group A was 62-117 μmol/L with an average of (89.4±15.8)μmol/L and 57-392 μmol/L with an average of (129.6±74.9)μmol/L one month after the first and second surgery respectively. The creatinine of Group B was 64-115 μmol/L with an average of (94±14.4)μmol/L and 93-453 μmol/L with an average of (190.4±117.2)μmol/L one month after the first and second surgery respectively. The creatinine of Group C was 84-113 μmol/L with an average of (90.1±12.1)μmol /L and 88-156 μmol/L with an average of (121.4±24.8)μmol/L one month after the first and second surgery respectively. One patient in Group B and C developed lung metastases. One patient in Group B occurred oliguria after the second stage of surgery, and gradually improved after one week of hemodialysis. The creatine showed no significant difference among Group A, B and C before operation, after the first and second stage(P>0.05). Postoperative hospital stay after the first stage surgery was 3-16 days with an average of (6.7±3.4)d, and 3-16 d with an average of (6.2±3.2)d after the second stage, respectively. Conclusions In principle, bilateral renal tumors should be treated with NSS, which can protect renal functions as much as possible. Among patients who can undergo bilateral NSS, the first-stage surgery should be operated on the simpler and easier side to preserve the kidney of one side as much as possible to lay a good foundation for the second stage surgery. Among patients who undergo one side of RN and the other side of NSS, NSS is recommended for the first stage, and RN for the contralateral second stage after the renal function of the operated side was restored. Key words: Renal carcinoma; Surgery; Nephron-sparing surgery

Bilateral ovarian carcinoma in a young women

Introduction: We present a case report of mucinous cystadenoma ovary in a 27 year old multiparous female who presented in SJH gynae outpatient department. Case Report: Patient presented with abdominal mass which was rapidly growing and associated with pain abdomen since 2 months. On General examination patient’s condition was fair and she was thin built. On palpation- an abdominal mass of around 20 cm size whose lower margins could not be reached and was firm in consistency. Tumor mass was moving side to side, it’s margins were ill defined and extending till xiphisternum and reaching iliac fossa both sides. Her CA125 levels were 219 IU/ml and S.LDH level was 553 IU/ml. All other tumour markers are normal. Ultrasound examination showed entire abdomen and pelvis was occupied by a multicystic mass which showed septae within it. No significant omental thickening noted. Uterus is normal and shows ET-4mm. ovaries cannot be visualised separately. CECT whole abdomen and pelvis showed large multiloculated multicystic lesion appears to be originating from the right adnexa of size ~19.8*10.5*21.8cm in the abdomino-pelvic region with enhancing septae and internal vascularity was seen. Few of the septae appears thickened. Another small solid cystic lesion of size 86*40*85mm is seen in left adnexa with enhancing solid component and enhancing thickened septae with internal vascularity within. Uterus is seen separately and appears normal.There is no free fluid in abdomen. Explorative laprotomy was planned. A midline incision was given and after excision of mass the specimen was sent for scrape cytology and findings were suggestive of malignant epithelial tumour (possibly mucinous) of ovary. Excision of Left sided ovarian mass and total hysterectomy with partial omentectomy was performed. The ex­amination of the pelvis, abdominal walls, diaphragmatic sur­face, and peritoneum did not show any implants or me­tastases but omental metastases were present. Free fluid was absent in the abdomen. There was no normal ovarian tissue on both sides so bilateral salpingo-oopho­rectomy was performed. Histopathological examination gave confirmatory diagnosis of mucinous cystadenoma of the ovary. Patient and relative were counselled for further treatment and prognosis. On 14th day suture removal done and patient sent for chemotherapy and was discharged in good condition. Keywords: Bilateral, Mucinous cystadenoma, CA125.

A case of synchronous bilateral calyx urothelial carcinoma: combined treatment approach

Upper urinary tract urothelial carcinoma is a rare tumor. Data about its correct management are controversial. Investigational technology development made it possible to diagnose asymptomatic small tumors, which can be successfully managed endoscopically. We report the case of bilateral urothelial cancer and hydronephrosis in patient aged 38. After management of acute post-renal kidney insufficiency, the neoadjuvant platinum-based chemotherapy was used followed by the kidney-sparing surgery split in two interventions on both sides. The patient does not have any relapse or further progression after one year of initial treatment with good performance status and high life quality level. We believe that the kidney preserving strategy can be considered as an option even in high-risk patients. The renal function in such cases is a crucial parameter affecting the outcome.

EP19.07: Bilateral clear cell carcinoma with atypical features: difficulties and differential diagnosis

EP19.07: Bilateral clear cell carcinoma with atypical features: difficulties and differential diagnosis