Case Of Cell Carcinoma Research Articles

P59.05 Integration of Molecular Cancer Classification and NGS to Identify Metastatic Cancer Patients Eligible For Lung Cancer Directed Therapy

For patients with metastatic disease, identification of both the primary tumor type and molecular alterations increases eligibility for targeted therapies. The 92-gene assay (CancerTYPE ID) is a validated gene expression classifier of 50 tumor types and subtypes for metastatic patients with unknown or uncertain diagnoses. Multimodal biomarker testing identifies actionable alterations to guide therapy selection. Here, a database of metastatic cases integrating molecular cancer classification with secondary biomarker analysis was analyzed to assess clinical utility in patients with lung cancer with known histology but unknown primary site of origin. MOSAIC (Molecular Synergy to Advance Individualized Cancer Care) is an IRB-approved, de-identified database of metastatic cases with unknown or uncertain diagnoses submitted for CancerTYPE ID testing and tissue type-guided multimodal biomarker testing (NeoTYPE profiles, Neogenomics). Metastatic cancers classified as adenocarcinoma, squamous cell carcinoma (SqCC), carcinoid and small/large cell carcinoma were evaluated by next-generation sequencing (NGS), fluorescent in situ hybridization (FISH) and immunohistochemical (IHC) analyses to identify primary site of tumor. Molecular diagnoses by CancerTYPE ID of 2151 patients included 271 (12.6%) with non-small cell lung carcinoma features [NSCLC; 157 lung adenocarcinomas (7.3%), 114 SqCCs (5.3%)], 10 (0.5%) lung carcinoid tumors and 71 (3.3%) with small/large cell carcinoma features. Gene fusion analysis by FISH identified 5 ALK (5.9%), 5 MET (6.0%), 1 RET (1.2%), and 1 ROS1 (1.2%) alterations in adenocarcinoma, as well as 2 MET alterations (3.4%) in SqCC. The mutational frequency of the 10 most commonly mutated genes for each lung cancer subtype are shown in Table 1. Mutations identified included genes for which targeted therapies are available, including capmatinib for MET exon 14 skipping mutations and dabrafenib for BRAF V600E mutations. Multimodal biomarker testing for pan-TRK identified 1 (1.5%) lung adenocarcinoma, 7 (15.2%) SqCC and 6 (24.0%) small/large cell carcinoma cases, which were eligible for larotrectinib and entrectinib. PD-L1 expression was seen in 95 (83.3%) lung adenocarcinoma, 58 (74.4%) SqCC, 5 (62.5%) lung carcinoid and 32 (62.8%) small/large cell carcinoma cases.Table 1Top 10 gene mutations frequency by NGSMain Type (Subtype)Top 10 Gene Mutations Detected by NGSNSCLCLung AdenocarcinomaTP53KRASKEAP1KMT2DSTK11ARID2BRCA2CHD2EPHA5KMT2C65.6%41.9%26.7%20.0%15.6%14.3%14.3%14.3%14.3%14.3%Squamous Cell Carcinoma (Lung)TP53KMT2DARID1ASMARCA4FAT1PIK3CAKEAP1LRP1BMTORNTRK371.0%32.4%23.5%23.5%22.2%20.0%17.7%16.7%16.7%16.7%OtherNeuroendocrine (lung carcinoid)*----------Neuroendocrine Small/large cell lung carcinomaTP53CTNNB1APCDICER1RANBP2RB1RUNX1SETD2SMARCA4TSC267.4%27.3%18.2%18.2%18.2%18.2%18.2%18.2%18.2%18.2%*low case number, unable to analyze; % indicated cases with detected gene abnormalities out of all cases with available test results. Open table in a new tab *low case number, unable to analyze; % indicated cases with detected gene abnormalities out of all cases with available test results. Analysis of the MOSAIC database identified a subset of patients with metastatic cancers eligible for lung cancer directed targeted therapy and immunotherapy based on tumor type, genetic alterations, and PD-L1 expression. Molecular profiling combined with cancer classification may lead to improved therapy options for patients with advanced disease of unknown primary and may provide further evidence for subsequent combination trials of targeted therapies or immunotherapies to improve patient outcomes.

S2571 A Case of Donor-Derived Small Cell Carcinoma of the Liver in a Liver Transplant Patient

S2571 A Case of Donor-Derived Small Cell Carcinoma of the Liver in a Liver Transplant Patient

S1510 A Rare Case of Squamous Cell Carcinoma of the Bile Duct

S1510 A Rare Case of Squamous Cell Carcinoma of the Bile Duct

S2569 A Rare Case of Small Cell Carcinoma of the Liver Without Pulmonary Involvement

S2569 A Rare Case of Small Cell Carcinoma of the Liver Without Pulmonary Involvement

Clinical T4b Squamous Cell Carcinoma Resection With Hemimandibulectomy and Temporomandibular Joint Reconstruction With Bridging Plate and Modified Dautrey Procedure

Clinical T4b oral squamous cell carcinoma is traditionally considered nonoperable. We present a case of right mandibular squamous cell carcinoma (PT4bN0M0, stage IVB). The tumor had extended to the right mandibular condylar head and masticatory space. The patient received right modified radical neck dissection and radical operation with hemimandibulectomy to remove the right mandibular condyle. Then, we reconstructed the resected portion with an anterior lateral thigh free flap and bridging plate, which was bent to form an artificial condyle and fixed using the modified Dautrey procedure. The patient had stable postoperative occlusion and normal hinge movement of the temporomandibular joint. After postoperative concurrent chemotherapy and radiotherapy, the patient is under regular out patient department follow-up with satisfactory jaw function and oral intake.

Epithelial\u2013mesenchymal transition (EMT) in vulvar cancer with and without inguinal lymph node involvement

PurposeEpithelial-mesenchymal transition (EMT) is associated with increased metastatic spread and poor prognosis. Data on vulvar carcinoma are limited.MethodsThirty-two cases of squamous cell carcinoma of the vulva (16 with and 16 without inguinal lymph node metastases) and their lymph node deposits were evaluated for immunohistochemical expression of EMT markers (vimentin, cyclin D1, e-cadherin), p16, p53 and Ki-67. Results of EMT-immunostainings were compared to lymph node involvement and expression of p53 and p16. The micro-anatomical staining pattern for EMT markers comparing the tumor center with the front of invasion was analysed in each tumor.ResultsThere was no difference in the expression of EMT markers between node negative and node positive tumors. Staining for vimentin and cyclin D1 was seen within tumor cells at the front of invasion in 100 and 84.4% of the tumors, respectively. The majority of cases (68.7%) showed negative or reduced staining for e-cadherin in this micro-anatomical localization. Tumor cells within the lymph node metastases showed positive staining for e-cadherin in 75% and for cyclin D1 in 49% of the cells but were negative for vimentin in 13 out of 16 cases (81.3%). Tumors with aberrant p53 staining represented a non-significant higher vimentin but significantly higher cyclin D1 expression at the front of invasion than those with p53 wild-type pattern.ConclusionThe present study shows no differences in the expression of EMT markers between node positive and node negative vulvar cancers. The evaluation of immunostaining within the micro-anatomical context indicates that an EMT-phenotype is restricted to the tumor cells at the front of invasion. Paired analyses of vulvar carcinomas and their lymph node deposits suggest mesenchymal-epithelial transition (MET) in the metastatic deposits. Immunohistochemical staining results may suggest that EMT is more prevalent in vulvar cancer with aberrant p53 staining.

Simultaneous giant adrenocortical and renal cell carcinoma associated with lead exposure from residual gun pellets after shotgun injury: case report

BackgroundA case of simultaneous adrenocortical and renal cell carcinoma due to long-term lead exposure from residual gun pellets is a rare and relatively unknown topic in the literature.Case presentationWe present a 43-year-old male patient with a giant retroperitoneal tumor. Thirteen years before he had a shotgun injury of the left upper side of the abdomen and residual gun pellets are present in the abdominal wall. Extirpation of the tumor and the left kidney was performed. Histopathological examination described adrenocortical and renal cell carcinoma.ConclusionContinuous and long-term exposure to toxic lead effects from residual gun pellets and traumatic injury represent likely carcinogenic factors in the presented patient.

Use of Supraclavicular Flap by End to Side Technique in Pharyngeal SCC: A Case Report and Review of Literature

Objectives In recent years, conservation laryngeal surgeries, including partial pharyngectomy, have been introduced as an alternative procedure for selected cases of hypopharyngeal squamous cell carcinoma (HSCC). Reconstruction of these defects presents a considerable challenge for the surgeon after partial pharyngectomy due to its circumferential nature. In this case report, we represent the innovative “End to side” technique to reconstruct hypopharyngeal defect using the rolled supraclavicular flap after laryngeal-preserving partial pharyngectomy. Methods and Results A 70-year-old female presented with a history of progressive dysphagia and odynophagia. The evaluations revealed a T3N0M0 SCC of pyriform sinus. The mass was successfully resected through partial pharyngectomy, and the hypopharyngeal defect reconstruction was achieved using the rolled supraclavicular flap via the “End to side” technique. The patient was discharged after decannulation on day 10. The 3-week barium swallow was performed with no evidence of anastomotic leakage, and the oral feeding was started after NG tube removal. At week 5, complete movement of the true vocal cord on the one side and good phonation and deglutition was observed. There was no evidence of recurrence after 1 year. Conclusions Laryngeal-preserving partial pharyngectomy and hypopharyngeal reconstruction with the rolled supraclavicular flap via the “End to side” technique could lead to good oncological and functional outcomes in selected cases of pyriform sinus.

Ovarian Clear Cell Carcinoma which Detected in Ascitic Fluid Smear

Objective: To report the case of ovarian clear cell carcinoma with involvement of both ovaries and metastatic to ascitic fluid and the label mass in the bladderMethod: Case Report Case: A 51 years old female presented with enlarging abdominal with gradual pain. The result of transabdominal sonography were multiple cysts with solid mass, suspected solid cystic ovarian neoplasm and ascites. The patient prepared for laparotomy; optimal debulking surgery, mass resection from bladder. Cytology examination was performed from ascitic fluid and it was confirmed by histopathology examination.Result: Microscopic features on cytology examination of ascitic fluid smear was suggest carcinoma. Histological examination was confirmed the diagnosis and the result was ovarian clear cell carcinoma. Discussion: Ovarian clear cell carcinoma is a rare subtype of epithelial ovarian cancer and comprises about 5-10% of ovarian carcinomas. Clear cell carcinoma tends to occur in the fifth to seventh decades. Cytology examination showed the cellular smear consists of groups of epithelial cells with large nucleus, hyperchromatic, pale-staining, vacuolated cytoplasm. There is also eosinophilic, extracellular substance. The presence of a tumor in ascitic fluid and the label mass in the bladder can categorize become IIB. This determined based on the FIGO’s ovarian tumor staging system.Keywords: ovarian clear cell carcinoma; ascitic fluid.

Pre-diagnosis neutrophil-to-lymphocyte ratio and mortality in individuals who develop lung cancer

PurposeThe neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been reported to be associated with survival after chronic disease diagnoses, including lung cancer. We hypothesized that the inflammatory profile reflected by pre-diagnosis NLR, rather than the well-studied pre-treatment NLR at diagnosis, may be associated with increased mortality after lung cancer is diagnosed in high-risk heavy smokers.MethodsWe examined associations between pre-diagnosis methylation-derived NLR (mdNLR) and lung cancer-specific and all-cause mortality in 279 non-small lung cancer (NSCLC) and 81 small cell lung cancer (SCLC) cases from the β-Carotene and Retinol Efficacy Trial (CARET). Cox proportional hazards models were adjusted for age, sex, smoking status, pack years, and time between blood draw and diagnosis, and stratified by stage of disease. Models were run separately by histotype.ResultsAmong SCLC cases, those with pre-diagnosis mdNLR in the highest quartile had 2.5-fold increased mortality compared to those in the lowest quartile. For each unit increase in pre-diagnosis mdNLR, we observed 22–23% increased mortality (SCLC-specific hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.02, 1.48; all-cause HR = 1.22, 95% CI 1.01, 1.46). SCLC associations were strongest for current smokers at blood draw (Interaction Ps = 0.03). Increasing mdNLR was not associated with mortality among NSCLC overall, nor within adenocarcinoma (N = 148) or squamous cell carcinoma (N = 115) case groups.ConclusionOur findings suggest that increased mdNLR, representing a systemic inflammatory profile on average 4.5 years before a SCLC diagnosis, may be associated with mortality in heavy smokers who go on to develop SCLC but not NSCLC.

Cardiac Metastasis in a Living Patient With Laryngeal Squamous Cell Carcinoma

Metastatic cardiac tumors are mainly diagnosed postmortem, while cardiac metastases of laryngeal cancer are exceedingly rare. We report a case of laryngeal carcinoma with subsequent metastatic disease to the heart diagnosed nine months after surgical resection of laryngeal cancer. Additionally, we attempted to summarize published case reports of laryngeal cancer with cardiac metastasis. Retrospective chart review and literature search via PubMed and Google Scholar were performed. Twenty cases of laryngeal squamous cell carcinoma (SCC) with cardiac metastatic tumors were identified. We described demographics, typical features seen on diagnostic studies, and analyzed current literature on incidence, diagnostic studies, treatment options, and prognosis of secondary cardiac tumors. More data are needed to decide on the optimal treatment strategy for metastatic cardiac disease.

IMPLICATIONS AND POTENTIAL ROLE OF HUMAN TELOMERASE REVERSE TRANSCRIPTASE (HTERT) IN BLADDER CARCINOGENESIS

Bladder cancer is a heterogeneous disease and ranks as 10th most common cancer worldwide. Urothelial carcinoma (UC) is the most common histologic type of BC and majority constitute of papillary tumors that are well-differentiated (low-grade). Several genetic changes may occur in bladder cancer, but hTERT promoter mutations and its expression has been detected in most cases of transitional cell carcinoma. Numerous researches have led to the findings which suggest that the hTERT promoter mutations in conjunction with the common polymorphism and hTERT expression have potential of being used as clinical biomarkers in bladder cancer. Further studies need to explore the potential use of hTERT gene in bladder cancer detection, diagnosis and prognosis. This review focuses on the role of hTERT in bladder tumors in the backdrop of various studies published.

PLASTIC SURGERY & ADVANCED SCALP TUMORS: EPIDEMIOLOGICAL PROFILE AND SURGICAL MANAGEMENT ABOUT 65 CASES

The scalp is the most frequent site of occurrence of malignant tumors. As an area that is generally neglected by the patient and not closely monitored during physical examinations. Plastic surgery has a double interest in the management of malignant tumors of the scalp: it allows oncologic tumor excision and coverage of defects induced. The present study reports 65 cases of giant malignant tumors of the scalp and who underwent surgical management, from January 2011 to June 2019. It included oncologic resection and repair of the defect. The average age in our series was 69.3 years, with a sex ratio of 5.1. Disease duration before consultation was on average 21 months. The location of the tumor was mostly parietal in 75%. The histological types were found in our series: 36 cases of squamous cell carcinoma, 16 cases of basal cell carcinoma, 6 cases of melanoma, 3 cases of trichilemmal carcinoma, 2 cases of dermatofibrosarcoma protuberans and one case of sarcoma and one case of adenoid cystic carcinoma . To cover the defect we used: skin graft in 44 cases and by local flaps in 21 cases. 42 patients benefited from radiotherapy and the evolution was marked by a reactivation in 3 cases of squamous cell carcinoma. The management of malignant tumors of the scalp is surgical and consists of two components: surgical excision and coverage. This repair is achieved through multiple techniques, facilitated by the vascular richness of this anatomical region.

370 Pure Primary Small Cell Carcinoma of the Prostate: A Rare Entity

Abstract Introduction We report a case of small cell carcinoma of the prostate (SCCP) which is a rare, high-grade malignant neoplasm accounting for 1% of all prostate cancers (CPa). Case Presentation A 56-year-old male patient initially presented to primary care with a six-month history of frequency, nocturia and pain in the perineal region when seated. A positive family-history for CPa was noted, serum PSA was 11.58, and a rectal examination found a large, irregular mass. He was treated with antibiotics for possible prostatitis and referred to the colorectal team. MRI rectum confirmed a mass between the prostate and rectum, which was found to be pure SCCP on biopsy. Whole-body scanning found multiple lung and pelvic metastases. The patient was commenced on six cycles of Etoposide and Carboplatin therapy. The patient reported that his pelvic discomfort has improved following the first cycle. Conclusions SCCP metastasizes early and therefore the clinical presentation is often in an advanced stage. It is noted that there is limited value of serum PSA for SCCP diagnosis. Instead, pathological examinations and MRI rectum are vital. In terms of treatment, chemotherapy provides relief of the clinical symptoms and its use is in in accordance with the 2016 National Comprehensive Cancer Network guidelines.

Squamous Cell Carcinoma of the Thyroid Gland in an elderly Female

Background: Squamous cell carcinoma of the thyroid gland is a rare tumor. The tumor may arise as a primary tumor within the thyroid gland. Case Presentation: A 62-years-old lady with history a history of a long-standing left neck mass presented with progressive enlargement of the mass for the last 2 months. The mass was associated with dyspnea, dry cough, and difficulty in swallowing but no change of voice. On examination, it was hard and fixed, and other parts of the general examination were unremarkable. Fine needle aspiration revealed malignant cells with squamous cell cancer (BETHESDA VI). On surgical exploration, there was a mixed cystic and solid mass arising from the left thyroid gland locally invading strap muscles, esophagus and trachea. Complete excision was not possible, debulking was done with modified radical neck dissection. The histopathology showed Invasive poorly differentiated squamous cell carcinoma of the thyroid with cystic changes in background of Hashimoto’s thyroiditis. Conclusion: Thyroid squamous cell carcinoma is a rare malignancy with significant management implications. Less than three hundred clear cases of thyroid squamous cell carcinoma have been reported. In this report we describe one additional case of a thyroid squamous cell carcinoma and provide a comprehensive discussion of the clinical significance, and appropriate surgical management.

A Rare Case of Synchronous Ovarian Adenocarcinoma and Squamous Cell Carcinoma of Cervix

Synchronous tumours of gynaecological malignancies occur rarely and most of these cases are represented by synchronous ovarian and endometrial cancer. Synchronous malignancies of cervix and ovary are rare with poor prognosis. Only few cases of synchronous cancer of cervix and ovary are found in the literature as case reports. Here, we report a case of a 63 year old patient who was diagnosed with synchronous squamous cell carcinoma of cervix and high grade serous carcinoma of ovary in which her clinical presentation, investigation and intraoperative findings were atypical. Patient presented with postmenopausal bleeding and mass per abdomen. Pipelle sampling revealed squamous cell carcinoma of cervix. Examination under anaesthesia noted endocervical growth measuring 3×4 cm with endoluminal extension into the whole endometrial cavity. Computerized tomography (CT) imaging showed left ovarian mass measuring 10.0×11.7 cm. Uterine corpus involvement in this case mislead us to the initial diagnosis of ovarian metastasis in cervical cancer. The distinct histopathological features of the ovary, cervix and endometrial lesion post operatively helped in establishing the diagnosis of two separate primaries which was synchronous cervical and ovarian cancer rather than metastatic spread of one primary malignancy.

Treatment difficulties during COVID 19 pandemic in a patient with giant renal tumor. A small town general hospital perspective

Introduction: We present an unusual case of papillary renal cell carcinoma, which is a rare subtype of kidney malignancy. Objective: The present case report emphasizes a voluminous left renal tumoral mass causing bowel obstruction and necessity of emergency surgical intervention. Presentation of case: A 74 year old patient with a history of multiple severe cardiovascular conditions, presented in the emergency room accusing abdominal distension and pain, nausea, vomiting and lack of intestinal transit for about 72 hours. Based on the symptomatology, physical examination and imagistic explorations a clinical diagnosis of bowel obstruction was arisen, caused by a voluminous tumor with compression of the large vessels and invasion of the left colon. Given the severity of the cardiovascular comorbidities and the complexity of the case, the possibility of patient’s transfer to a university hospital was arisen, which was not practicable due to the COVID 19 pandemic. During surgical intervention en-bloc resection of the left kidney and tumoral mass was practiced. Histopathologic examination identified the tumoral mass as type I papillary carcinoma of the left kidney. The postoperative evolution was unfavorable, due to the severe cardiovascular comorbidities, on maximal vasoactive support the patient remained hemodynamically unstable, showed progressive myocardial infarction with the persistence of arrhythmias and severely reduced ejection fraction which led to his unfortunate death. Conclusion: Careful patient selection is needed to ensure a favorable risk-benefit ratio. Also a thorough multidisciplinary evaluation of patient and the possible therapeutic options is necessary, in order to create an optimal and individualized treatment plan

A case of a long-neglected basal cell carcinoma on the scalp

A case of a long-neglected basal cell carcinoma on the scalp

Recurrent Cutaneous Metastasis of Clear Cell Type Renal Cell Carcinoma: Case Report

Cutaneous metastases of internal malignancies are rare events occurring rather late in the primary tumors' progression. We are reporting a recurrent case of cutaneous metastatic renal cell carcinoma (RCC) in a 70-year old male present with a nodular lesion on the scalp, who underwent surgical treatment and histopathological diagnosis at the Lady Davis Carmel Medical Center in Haifa, Israel. The patient had consequently twice in his history similar cutaneous lesions on the scalp which were histologically proved to be clear cell type RCC (classic and eosinophilic variant). The currently excised tumor was an oval white dense lobulated, well-demarcated lesion, up to 2 cm in diameter, in the subcutis, without epidermal involvement. The histopathologic findings consisted of atypical cells, arranged in an organoid pattern, with irregularly distributed eosinophilic cytoplasmic granularity. Immunohistochemically, the tumor cells were found positive for CD10, PAX8, EMA, and vimentin, which is consistent with cutaneous metastatic RCC, conventional (clear cell) variant with eosinophilic features. Revision of the histopathologic material from the previous surgeries of the same patient revealed even higher-graded metastatic RCC comparing with the current one. Our reported case and the revised previous one, as well as medical literature data, reflect dissemination of the primary clear sell type RCC and its characteristic metastatic dermatotropism. However, its recurrent metastases, especially to the same body area, are still to be gathered and studied further to make a statistically relevant conclusion about their prognostic value.

A study of histomorphology and immunohistochemistry of papillary squamotransitional cell carcinoma: A rare variant of squamous cell carcinoma of cervix.

Background: Papillary squamotransitional cell carcinoma is a histopathological subcategory of squamouscell carcinoma of the uterine cervix that often resembles transitional cell carcinoma of the urinary tract.Histologically, it can be misdiagnosed as transitional cell carcinoma or other papillary lesions of thecervix. Stromal invasion on biopsy is difficult to diagnose due to the exophytic papillary growth of thetumor. It also has a propensity for local recurrence and late metastasis. The study is performed to diagnoseand categorize this uncommon variant of carcinoma cervix.Materials and Methods: Eighteen cases of Papillary squamotransitional cell carcinoma were diagnosedon a punch biopsy specimen on routine hematoxylin and eosin-stained sections. The tumors werecategorized into three groups according to the percentage of squamous and transitional components.Further, immunohistochemical evaluation for cytokeratin7 and cytokeratin20 was done.Results: The mean age of the patients was 51.61 years (range 37-62 years). The most common clinicalpresentation was postmenopausal bleeding. All the cases showed papillary architecture with fibrovascularcores. The papillae were lined by three cell types: clear, intermediate, and basaloid. Stromal invasionwas seen in all the cases. All the cases showed positive immunostaining for cytokeratin7 and negativeimmunostaining for cytokeratin20.Conclusions: Papillary squamotransitional cell carcinoma deserves accurate pre-operative biopsydiagnosis due to the risk of misdiagnosis as benign papillary or malignant transitional lesions.Immunohistochemistry plays an important role in the diagnosis of these tumors and is recommended inevery case. Late recurrence and metastasis warrants a longer duration of follow up.