Common Site Of Malignancy Research Articles

Lymphocytic Host Response and other Prognostic Factors in Early Stage Squamous Cell Carcinoma of Tongue: Retrospective Analysis from a Tertiary Cancer Center.

Aswin Anapathoor NagarajanIntroduction The tongue is the most common site of malignancy in the oral cavity, and squamous cell carcinoma is the commonest histology. The prognosis remains unfavorable despite treatment, resulting in higher mortality rates. Early stage carcinoma of the tongue is a distinct entity and is primarily treated with either surgery or radiotherapy. Various factors have been implicated in the prognosis of early stage tongue carcinomas. The main objective of this study is to access whether the lymphocytic host response (LHR) and other prognostic factors influence the survival. Patients and Methods The data of 129 patients with Stage I and Stage II (T1-2, N0) tongue cancer treated in our institute from January 2012 to December 2016 were retrospectively abstracted from the hospital case records. The various clinical and pathological factors were recorded. The Kaplan-Meier model was used for survival analysis. The disease-free survival (DFS) and the overall survival (OS) with respect to stage and LHR were calculated. Results On multivariate analysis, site of lesion, comorbidities, habits, grade of the tumor, perineural infiltration (PNI) did not influence the survival. The main factor which was found to be significant in DFS was LHR. The DFS was better for the patients who had lymphocytic infiltration of ≥ 70% (strong LHR) when compared with <70%(weak LHR) ( p = 0.037). The OS with respect to stage ( p = 0.608) and LHR ( p = 0.164) was not found to be statistically significant. Conclusion The patients with weak LHR had less DFS when compared with patients with strong LHR. Larger studies are needed to evaluate whether adding adjuvant therapy may benefit the patients with weak LHR in early stage tongue cancer.

To Study the Role of PTEN, EGFR and HER2 in Early Glottic Squamous Cell Carcinoma.

Laryngeal carcinoma is the most common site of malignancy in head and neck region worldwide. Surgical options are limited in cases of laryngeal malignancy and moajority of cases are treated with chemoradiotherapy. Targeted therapy is an evolving novel approach to treat laryngeal carcinoma. The study was conducted to evaluate the role of PTEN, EGF and HER2 in early glottic squamous cell carcinoma cases. 52 samples of early glottis carcoinoma were collected in UCMS and GTB hospital, New Delhi after patients had undergone CO2 laser excision at the centre. Histopathologic and IHC examination was conducted on the specimen for PTEN, EGFR and HER2 molecules. PTEN was negative in 82.69% cases compared to the stroma with three year local control rate of 72.09%. EGFR was positive in 67.31% samples with three year local control rate of 68.57%. HER2 was negative in all the samples. PTEN and EGFR can be used as prognostic markers as well as novel agents for targeted therapy in the future.

Cancer in Kashmir Valley: Current trends, burden and pattern.

There is an overall surge of malignancies in most of the developing countries including India. Dearth of data from Kashmir prompted us to embark upon a study on burden and pattern of cancer in Kashmir over previous 5 years. Data acquisition from January 2016 to December 2020 was accomplished from the departmental archives of a large tertiary care institute of Kashmir valley. All histologically proven malignant cases were included for the present study. Information regarding the age, gender, site of primary malignancy and histological diagnosis was obtained. A total of 5,392 cases of malignancies were considered for final analysis with a mean age at diagnosis of 56.73 years (SD = 15.96). Maximum number of cases were recorded in the age group of 60-69 years. Maximum number of malignancies were encountered in year 2018 with substantial drop in subsequent years. Gastrointestinal malignancies constitute more than one-third of total number of malignancies across both genders. In males, stomach was the common site of malignancy followed by lung and colorectal region whereas in females most common sites were breast, colorectal, and stomach. This study portrays close reflection of the cancer patterns within the valley in recent years which is strikingly different from rest of the country and world.

Clinicopathological profile and outcomes of treatment of head and neck cancer patients in a tertiary care center: a hospital-based prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Globally head and neck cancers constitute among the 10 most common cancers. The study's main purpose was to study the epidemiological and demographic factors and outcomes of treatment of head and neck cancer patients in a tertiary centre. A Chi-square test was used to analyse the association of various factors. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective observational study, 52 patients with head and neck cancers were evaluated and data regarding age, gender, risk factors, clinical features, grading, staging, and treatment modality received were taken. Presenting symptoms of patients at the 1st follow-up (at 1 month), 2nd follow-up (at 2 months), and 3rd follow-up (at 6 months) were statistically analysed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Results showed that the mean age group was between 61 to 70 years. Gender distribution showed that 75% were males and 25% were females. The most common site of malignancy was the oropharynx (23.08%). The majority of the tumors were squamous cell carcinoma (88.46%) and are of moderately differentiated type (53.85%). Majority of the tumors (42.31%) presented with stage III lesions. Most of the patients 35 (67.31%) received concurrent chemoradiation (CT-RT). The most common complaint in the first and second follow-up was mucositis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The majority of the tumors are squamous cell carcinoma and are moderately differentiated. Most of the tumors were in stage III, and most received chemoradiation (CT-RT) for treatment.&lt;/p&gt;

Characterizing “no treatment” decisions in patients with advanced-stage cancers.

76 Background: Cancer (CA) is one of the leading causes of death worldwide. In 2020 CA was the second leading cause of mortality in the US. Novel treatments for various malignancies are discovered each passing year. Despite these advancements, some patients refuse to receive treatment. Our study focused on characterizing the group of patients with advanced malignancies who refused therapy. Methods: We performed a retrospective chart review of patients diagnosed with advanced malignancies, aged 18-75 years, between 01/01/ 2010 and 12/31/2015, who refused any therapy. We used Geisinger Health System’s data. Results: Our search provided 644 patients who met our inclusion criteria. The mean age of patients was 63.2 years (standard deviation (σ) 8.3). Female patients made up 40.4% (260/644), while 59.6% (384/644) were male. Most patients were Caucasian (96.9%, 624/644), 1.9% (12/644) were Black; 0.6% (4/644) were Asian, and 0.6% (4/644) were of unknown racial background. Marital status was evenly distributed with 50.0% (322/644) being married and 50.0% (322/644) being non-married. Most of the study population (52.3%, 337/644) had government-funded insurance at the time of CA diagnosis; 46.6% (300/644) had private insurance, and 1.1% (7/644) had no insurance. Stage 3 disease, according to American Joint Committee on Cancer staging was noted in 21.1% (136/644), while 78.9% (508/644) had stage 4 disease. The mean BMI was 28.2 (σ 8.3). Most patients were either overweight or obese (60.6%, 350/577; 67 patients did not have data on BMI available). A history of cigarette smoking was present in 73.0% (438/600). Adenocarcinomas (323/639, 50.5%) were the most prominent histological subtype. The most common site of malignancy was the respiratory system (220/644, 34.2%). Only 9.6% (62/644) of patients had a history of previous CA, while a family history of CA was present in 29.5% (190/644). Most patients (62.1%, 400/644) had a Charleston Comorbidity Index (CCI) &gt; 5; the mean CCI was 6.4 (σ 3.7). In 17.1% (110/644) a palliative medicine referral was made. Substance use disorders were present in 23.8% (153/644); 14.4% (93/644) had a history of depression, and anxiety 10.1% (65/644). Conclusions: Male patients made up a larger proportion of the group of advanced-stage patients who declined therapy. The racial distribution in this group of patients appeared to reflect the local population. Most patients who refused therapy had stage 4 disease, and they appeared to have severe underlying comorbidities, with an average CCI &gt;5. Despite treatment refusal, a surprisingly low percentage of patients were referred to palliative medicine.[Table: see text][Table: see text]

A prospective observational study of ototoxicity in head and neck cancers treated with chemoradiotherapy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Head and neck cancer is a major global health problem. Cisplatin has been widely used in the treatment of head and neck malignancies. Ototoxicity is considered as the primary outcome of interest and the type of hearing loss is the secondary variable of interest. The Chi-square test/Fisher’s exact test is used to test statistical significance. P value&amp;lt;0.05 is considered statistically significant. IBM statistical package for the social sciences (SPSS) version 22 is used for statistical analysis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective observational study, 62 patients with head and neck cancers were evaluated for chemoradiotherapy-induced ototoxicity. The hearing assessment included air and bone conduction thresholds, frequency, and pattern of hearing loss. The assessment was done at baseline, at the end of treatment, and after 8 weeks of completion of chemoradiotherapy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Results showed the mean age group to be, between 61 to 70 years. Gender distribution showed that 80.65% are males and 19.35% are females. The most common site of malignancy is the larynx (20.97%). Cisplatin is used in 51 patients (82.26%) and carboplatin in 7 patients (11.29%). Radiotherapy was given to 82.26% of the patients. Results showed an increased incidence of sensorineural hearing loss (SNHL) after 8 weeks of treatment. There was a statistically significant difference between pure tone average (PTA) values before treatment, at the end of treatment, and after 8 weeks of chemoradiotherapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Pure-tone hearing threshold was most affected at 8 kHz and sensorineural hearing loss at higher frequencies is the most common finding.&lt;/p&gt;

Significance of Ki67, BCL 2 Immunoexpression in Urothelial Carcinoma and their Association with Grading and Staging: A Descriptive Cross-sectional Study

Introduction: Urinary bladder is the most common site of malignancy in the urinary tract and the most common type of cancer of urothelial origin is urothelial cell carcinoma. This subtype constitutes more than 90% of bladder cancer. Histological grade of tumour is one of the most important predictive parameter for prognosis and biological behavior of urothelial carcinoma. As some crucial discordances may arise between pathologists because of subjectivity, so immunohistochemistry can be used for accurate diagnosis and prediction of prognosis. Aim: To study the immununohistochemical expression of B-Cell Lymphoma 2 (BCL 2) and Ki(Kiel)-67 markers and their association with tumour grade and stage in urothelial carcinomas. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Pathology of a tertiary care R G Kar Medical College and Hospital, Kolkata, West Bengal, India. West Bengal, India, on a total of 75 cases from January 2018 to June 2019. The study population comprised of cases of urothelial lesions as diagnosed by cystoscopy, who underwent standardized operative procedures. Relevant sections were taken from different parts of the fixed specimens. Histopathological Examination (HPE) was done to confirm the presence or absence of non-invasive and invasive carcinoma, and the depth of invasive tumour cells for pathological staging. Evaluation of the level of cytological and architectural disorder at low and medium magnification (100X and 200X) were done for grading. Cytological disorder were defined as abnormalities in nuclear size, shape, and chromatin, while architectural disorder were defined as abnormalities in the orientation of the cells in relation to each other and to the basement membrane of the papillae. Immunohistochemical analysis was done for Ki67 and BCL 2 expression in paraffin embedded sections in all the cases. In this study, chi-square test was done with International Business Management(IBM) Statistical Package for Social Sciences (SPSS), as per which, the association between two variables is statistically significant if p value is &lt;0.05. Results: Out of total 75 cases(mean age: 67.3 years) analysed, 58 cases (77.3%) had Invasive type of bladder neoplasm, followed by low grade papillary urothelial carcinoma 10 (13.3%), and papillary urothelial neoplasm of low malignant potential 07 (9.3%). Ki67 expression in urothelial carcinoma has more significance because 59 cases (78.7%) showed high level expression (&gt;20%) out of 75 cases, whereas only 12 (16%) cases show high level expression (4+) of BCL 2 marker. Conclusion: Ki67 overexpression is seen more commonly, than BCL 2, in high grade tumours as well as in advanced stage. So Ki67 may be used as a marker to predict aggressive behavior and to differentiate low grade and high grade tumours also.

Histopathological Findings of Pancreaticoduodenectomy Specimens in a Tertiary Care Hospital in Nepal

Introduction: Among the gastrointestinal malignancies, 5% of the tumors comprise peri-ampullary carcinomas. Adenocarcinoma is the commonest malignancy in the peri-ampullary region. The important histopathological prognostic factors are tumor size, location, extension, resected marginal status, lymphovascular (LVI) and perineural invasion (PNI) and lymph nodal status. This study was conducted to analyze the lesions and to describe the associated histopathological parameters. Methods: This study was carried out in the Department of Pathology, TUTH, Kathmandu, includes pancreatico-duodenectomy specimens submitted from April 2016 to September 2020. The related details were obtained from the archives of reports in the Department. Statistical analysis was performed using IBM SPSS v26. Results: Among 111 specimens, 100 (90%) malignant lesions, 10 (9.1%) benign lesions and 1(0.9%) pre-malignant lesions were seen. M:F ratio was 1.2:1 with mean age 55.5 years. Ampulla was the most common site of malignancy (61%) and adenocarcinoma was the commonest histological type. Chronic pancreatitis (4.5%) accounted for most of the benign lesions. Ampullary and pancreatic malignancies were detected in T2 stage, 55.7% and 77.8% respectively. LVI was seen in 61% and PNI in 72% of pancreatic malignancies. Positive resected margin was seen in 6% of malignancies. SMA was the most common positive margin. Conclusion: Pancreatico-duodenectomy was performed mostly for adenocarcinomas of ampulla. Pancreatic tumors were common in the older age group and they presented with LVI and PNI and at a higher T and N status as compared to ampullary or duodenal tumors.

Histopathological spectrum of ovarian lesions in a tertiary care centre: A retrospective study

Background: A broad range of pathological conditions including non-neoplastic and neoplastic lesions are commonly encountered in the ovary in routine practice. Majority of the ovarian neoplasms are benign and is also a common site for malignancy, even though metastasis can occcur. Ovarian cancer is the third most common cancer among women in India. Histopathological examination plays a major role in diagnosing these lesions. Aim: The aim of present study is to assess the frequency of ovarian lesions and to study the gross and histopathological patterns of different ovarian lesions.Materials and Method: The present study is a retrospective study conducted for a period of 2 months. Clinical data, gross findings and histopathology slides were retrieved using simple random sampling technique. A total of 100 cases were studied. Results thus obtained was analysed using SPSS 20.0 version.Results: Of the 100 ovarian lesions, 64% were non-neoplastic lesions and 36% were neoplastic. Age group ranges from 20 to 82 years with fourth decade being the most common age group affected in our study. 83% of ovarian lesions are cystic, 11% are solid and 6% are partly solid and cystic. Among the non-neoplastic lesions surface inclusion cysts were more common (43.8%). Out of all the ovarian neoplasms surface epithelial tumours were most common 30 out of 36 cases (83.3%) followed by germ cell tumours (16.7%). Benign tumours are more common compared to their malignant counterpart.Conclusion: Ovarian lesions show diverse histological types due to its complex architecture. Non-neoplastic lesions are more common than the neoplastic lesions. Histopathological examination is necessary in diagnosing and categorizing all ovarian lesions for proper treatment and patient care.

Treatment pattern and outcomes of leptomeningeal carcinomatosis in India: CRSF201901 study.

e14012 Background: Leptomeningeal carcinomatosis (LCM) is a rare event and has a dismal prognosis. Limited data is available from India on LCM. Hence we did this country wise audit of LCM. Methods: This was a retrospective, multicentric audit of adult (age ≥ 18 years) patients with diagnosis of LCM, conducted across India in 2020 for patients treated from 2010 to 2020. Baseline characteristics, previous treatments, cancer sites, LCM diagnosis details, treatment pattern and overall survival (OS) were collected. Descriptive statistics were performed and Kaplan Meier analysis was performed for estimation of OS. Results: We had 84 patients diagnosed with LCM. The diagnosis of LCM was confirmed in 52 (61.9%) and probable 32 (38.1%) patients. The mean age was 51.8 years (SD-10.8) and we had 46 (54.8%) females. The three most common site of malignancy were lung, breast and gastrointestinal with 45 (53.6%), 22 (26.1%) and 9 (10.7%) patients. The ECOG PS at the presentation of LCM was 1, 2 in and 3-4 in 41 (48.8%), 28 (33.3%) and 15 (17.9%) respectively. LCM was seen at diagnosis in 2 patients (2.4%) and at progression in rest. The status of the extracranial disease at the occurrence of LCM was progressive disease in 39 patients (46.1%). The treatment offered was best supportive care in 24 patients (28.6%), systemic therapy only in 27(32.1%), systemic therapy and intrathecal therapy in 22 (26.2%) and only intrathecal therapy in 11(13.1%). Among 33(39.3%) patients receiving IT methotrexate was used in 23 (27.4%) and the combination of methotrexate, AraC and hydrocortisone was used in 10 (11.9%). The CSF clearance rate was assessed in 24 (28.6%) patients and the clearance rate was 13.1% (n=11). The median duration of therapy was 4 weeks (IQR 1-14). The median os was 90 days (95% CI 46.2-133.8). Conclusions: LCM has a grave prognosis and nearly 1/3rd patients are treated with best supportive care. Intrathecal therapy though part of all guidelines is administered in 39% of patients. This data can serve as a benchmark for further improvement to facilitate studies for further improving the outcomes.

Reconstruction of Large Nasal Alar Squamous Cell Carcinoma Defect Using a Superiorly - Based Nasolabial Flap

The nasal skin is the most common site of malignancy in the face accounting for as much as 25.5 percent by virtue of its location and propensity for direct exposure to ultraviolet radiation from the sun.1-3 Among the various cutaneous malignancies, basal cell carcinoma is the most ommon, but other types of cancer such as squamous cell carcinoma, cutaneous malignant melanoma, and basosquamous carcinoma are also common.4 Following surgical resection of a malignant lesion, the defect calls for a reconstructive option that will restore aesthetics and function. We present a squamous cell carcinoma of the nasal alar skin which underwent excision and reconstruction of the defect using a superiorly - based nasolabial flap.&#x0D; CASE REPORT&#x0D; A 66-year-old man consulted at the outpatient clinic due to a nasal alar mass on the right. The mass started one year prior to consult as a pimple-like lesion on the right nasal ala. There was no history of manipulation or trauma to the aforementioned area. He consulted at a local hospital where he was given unrecalled antibiotics that did not cure the lesion. Instead, he noticed that it gradually enlarged, and a deep ulceration developed within the mass. This prompted consult at our outpatient clinic where a 3 x 2 cm ulcerating mass with crusting and necrotic areas was noted on his right nasal ala. (Figure 1) Anterior rhinoscopy showed an intact mucosa in the right nostril with no gross evidence of tumor involvement. There were no enlarged cervical lymph nodes palpated in the neck. A wedge biopsy revealed a well-differentiated squamous cell carcinoma. He claimed that he had no family history of cutaneous malignancy. However, he had a 20 pack-year history of smoking and was a heavy alcoholic beverage drinker. He previously worked as an electrician and denied chronic exposure to sunlight.&#x0D; He consequently underwent excision of the right nasal alar mass with 5-mm margin. (Figure 2A, B) A histologic evaluation of the margins revealed that the borders and tumor base were negative for malignancy. The alar cartilage was not involved by tumor. Reconstruction of the defect was done using a superiorly - based nasolabial flap on the right. (Figure 3A, B, C) Two weeks postoperatively, the patient came in for follow-up with a healed, aesthetically - pleasing, and well-coaptated wound. (Figure 4) He remains free of any evidence of recurrence after 1 year.&#x0D;

The severity of anemia does not correlate with the risk of gastrointestinal cancer in subsequent evaluation

Introduction: Iron deficiency anemia (IDA) is a risk factor for gastrointestinal (GI) malignancies. Little is known regarding the correlation between the depth of anemia and the risk for GI malignancy. The aim of this study was to test the hypothesis that very low hemoglobin levels pose an additional risk compared to low hemoglobin levels.Methods: Patients 40–70 years old, presenting to the ER with IDA during years 2016–2017 were retrospectively analyzed. Comparison was performed between two groups, one with a very low hemoglobin level (below 8 g/dL) and the other a low hemoglobin level (between 8–10 g/dL).Results: 1020 patients were analyzed, and 107 fulfilled the inclusion criteria. Seventy-five patients (70%) were in the very low hemoglobin group and 21 patients (19.6%) were diagnosed with a new GI malignancy. Mean age was 56, 49 (45%) were females, and 68 (63%) underwent esophagogastroduodenoscopy (EGD) or/and colonoscopy during the index hospitalization. The median hemoglobin and MCV were 7.3 G/dL, and 73 fL, respectively. New malignancies were found in 15/75 (20%) and 6/32 (19%) of patients with very low and low hemoglobin levels, respectively (p = .88). GI malignancies were more commonly found in females compared to males, 14 (29%) vs. 7 (12%), p = .032, respectively. The right colon was the most common site for malignancy. Active GI bleeding was not a risk factor for GI malignancy.Conclusions: Very low hemoglobin levels and overt GI bleeding do not pose an additional risk factor for GI malignancy, compared to low hemoglobin levels and no overt GI bleeding.

P1497INCIDSENCE OF CANCER IN HEMODIALYSIS-TREATED PATIENTS

Abstract Background and Aims In recent decades, there has been an increase in the incidence and prevalence of patients with end stage renal disease (ESRD) worldwide. Previous studies have shown an increased incidence of malignancies among ESRD patients, compared to age-matched controls, although it was unclear whether different etiologies of ESRD ( diabetes, hypertension, cystic disease) confer different risk ratio. Our present study intends to re-examine relationships between ESRD, classified according to the etiology of renal disease, cancer incidence and types of malignancies in hemodialysis treated patients. Method We conducted a retrospective study, analyzing hemodialysis (HD) treated patients over the age of 18 at the Wolfson Medical Center in Holon, Israel, from 2008-2017. Patients diagnosed with cancer prior to dialysis or with history of transplantation were excluded. Data on etiology of chronic kidney disease and ESRD, comorbidities and cancer diagnosis was collected from patients' files and verified using the Israeli National Cancer Registry. A single, multivariate survival analysis was conducted to examine the relationship between the various predictors and the incidence of cancer. Results The study included 333 patients, 211 (63.4%) were males, mean age 67.2±13.1 years. The median follow was 4 years (95% CI: 2-6.5). Twenty eight (8.4%), developed primary malignancy during hemodialysis, annual rate: 2.1%, Vs 0.35% age-adjusted annual rate in Israeli general population. The average age of all patients diagnosed with cancer over the study period was higher than that of patients without cancer (72.3±7.7 Vs 66.7±13.4 years. P=0.001). The most common sites of malignancy were colon (33%), bladder (16.7%), kidney (10%) and prostate (10%). Older age was the only risk factor associated with the onset of malignancy. No statistically significant relationship was found between ESRD etiology, comorbidities and occurrence of malignancy. Conclusion Among our cohort of patients on chronic hemodialysis, annual cancer incidence rate is 6 times higher than age matched controls in the Israeli general population. Older age is a risk factor associated with onset of malignancy. We did not found associations between ESRD etiology, comorbidities and cancer incidence. This study constitutes a platform for a longer period multicenter study.

Temporal relationship between idiopathic inflammatory myopathies and malignancies and its mortality: a nationwide population-based study.

To examine the temporal relationship between malignancies and idiopathic inflammatory myopathies (IIMs) and its impact on mortality. A retrospective cohort for IIM patients was conducted using the Korean National Health Insurance Service databases. We observed more than 5years before and after the diagnosis of IIM (2002~2016) to identify IIM patients who developed any malignancy and classified these patients into two groups: the cancer-associated myositis (CAM) group, who developed malignancy within 3years before or after the diagnosis of IIM and the cancer-not-associated myositis (CNAM) group, who developed malignancy beyond 3years of IIM onset. The survival rates of the two groups were compared. We identified 1072 incident cases of IIM between 2007 and 2011. A total 225 patients of these patients were diagnosed with malignancy. The development of malignancy was frequent within 1year before and after the time of IIM diagnosis. The common sites of malignancies in the CAM group differed from those in the CNAM group: the lung, hematologic malignancy, and the liver were common in both groups, but thyroid and oropharynx followed them in CAM while prostate, stomach, breast, and thyroid followed them in CNAM. CAM patient mortality was worse compared with CNAM patients (log-rank test, p < 0.01). Among IIM patients with malignancy, common sites of malignancy were different between the CAM and CNAM groups, and patients with CAM had poor prognosis compared with CNAM patients. Key Points • The malignancies commonly occurred in incident idiopathic inflammatory myopathy (IIM) patients, especially within 1year before and after the initial IIM diagnosis. • Patients with malignancy had poor survival compared with patients without malignancy. • Among the IIM patients with malignancy, patients who developed malignancy within 3years of IIM diagnosis (cancer-associated myositis, or CAM, group) showed higher mortality than cancer-not-associated myositis, CNAM group. • We also found that the common types of malignancy were different between the CAM and CNAM groups.

392O - Treatment outcomes of colorectal cancer patients enrolled in a comprehensive benefits program of the National Health Insurance System in the Philippines: Data from the program pilot site

BackgroundColorectal cancer is the third most common site of malignancy in the Philippines. This has led the Philippine Health Insurance Corporation (PhilHealth), an attached agency of the Philippine Department of Health, to create the Z-Package Colorectal Cancer Benefit Program to fund the treatment of Filipinos with stage I-III colorectal cancer. This program intends to provide quality care through a multidisciplinary team approach to optimize treatment outcomes for this disease without causing financial toxicity on the part of the patients. The University of the Philippines - Philippine General Hospital (UP-PGH) is the pilot site of this program. This is the first study to report data from the colorectal cancer Z-package program. MethodsThree-year data from patients enrolled under the Z-Package Colorectal Cancer Benefit Program from 2016 to 2018 were reviewed by the UP-PGH colorectal cancer study group. Descriptive statistics and Cox proportional hazards regression were employed to summarize patient characteristics and analyze treatment outcomes. ResultsA total of 251 patients were enrolled in the Z-package Benefit Program from 2016 to 2018. The mean age at enrolment was 57 years old. 66% of patients were males. 78% of patients had rectal cancer and 82% were diagnosed with Stage 3 disease. Compliance to the prescribed surgery, chemotherapy, and/or radiation treatment were 90%, 77%, and 96% respectively. Recurrence, morbidity, and mortality rates of enrolled patients from 2016-2018 were 17%, 22%, and 19%, respectively. Morbidities were mostly due to chemotherapy. Patients in this program had a 2-year survival rate of 74% and 3-year survival rate of 70%. ConclusionsThe results of this study show that a multidisciplinary-approach to patient care funded by a comprehenesive benefits program can positively impact patients’ overall survival in colorectal cancer. This study serves to promote the support for this program by PhilHealth in the future. Legal entity responsible for the studyUniversity of the Philippines - Philippine General Hospital. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

The Conundrum of Dual Primary Malignancies: Four Years’ Experience of a Single Tertiary Care Institute in India

Abstract Background: Encountering more than one malignancy in a cancer patient is no longer uncommon; this increasing incidence is mostly attributable to the improvements in life expectancy, awareness, and diagnostic facilities. This article aims to highlight this institute’s experience in diagnosis and treatment of patients of multiple primary malignancies and a comprehensive review of literature. Materials and Methods: This is a descriptive study of retrospectively collected data of a single institution over 4 years from 2013 to 2016. Known cases of cancer who were diagnosed with a second primary malignancy were included in the study. Various details such as age, sex, site of disease, temporal relation of two cancers (synchronous or metachronous), family history, tobacco use, treatment given, and survival at 1 year were recorded, organized in a tabular form, analyzed, and described. Results: A total of 29 cases of dual malignancies comprising 0.74% of a total of 3879 patients of cancer were encountered. Seventy-two percent of the cases were metachronous and 5 years was the mean time interval between tumors. There was a female preponderance, and the average age was 56 years. Breast was the most common site of malignancy. At 1 year from diagnosis of second primary, 69% of the patients were alive and 27% were disease-free. Conclusion: Second primary in a patient of cancer is becoming increasingly common and the suspicion of the same should always be borne in mind during follow-up. Prognosis as well as intent of treatment depends on respective stages of the two malignancies.

Use of the term atypical cells in the reporting of ascitic fluid cytology: A caveat.

Background:Abdominal paracentesis is a routine diagnostic procedure for assessment of patients with recent onset or worsening of ascites.Objectives:The objective of the study is to (1) review clinically confirmed cases of malignancy with negative, atypical, and suspicious cytology reports and provide reasoning for discrepancies and (2) recalculate sensitivity, specificity, and predictive values after review.Materials and Methods:Papanicolaou smears of ascitic fluid paracentesis samples received over one calendar year were reviewed retrospectively by an expert in cytopathology blinded to the final clinical and/or histopathological diagnoses. Cases with discrepancies after review were noted. Sensitivity, specificity, and predictive values were calculated before and after review of slides. Data were analyzed using SPSS version 16.Results:Malignant etiology was identified in 49/115 cases (42.6%) with female genital tract being the most common site of malignancy (22, 44.8%). The remaining 66 (57.4%) had a benign etiology with hepatic cirrhosis in 42 cases (63.6%). A review revealed discrepancies in five cases, three of which were earlier called negative for malignant cells (one case each of ovarian adenocarcinoma, cecal adenocarcinoma, and cholangiocarcinoma). Two cases of ovarian adenocarcinoma that were reported as atypical/reactive mesothelial hyperplasia showed malignant cells upon review. Sensitivity and specificity after review were 69.4% and 100%, respectively, with 100% positive predictive value.Conclusion:Being a minimally invasive procedure, abdominal paracentesis continues to be an important diagnostic tool in guiding patient management. A proper morphological assessment with adequate clinical information and correlation with other investigations can be used to arrive at a definitive diagnosis in most cases. The term “atypical” can be misleading and is often used for want of clinical information and is best avoided.

PS02.205: MALIGNANCY DEVELOPING IN CORROSIVE INJURED ESOPHAGUS

Abstract Background Malignancy developing in a corrosive injured esophagus has been described in the literature. Though the possibility of malignancy developing in a corrosive esophagus is expected to be around 1000 fold no team has managed large numbers. The aim of this study is to analyse the pattern of presentation and problems encountered in managing these difficult patients. Methods 13 patients with corrosive malignancy encountered between 1991 and 2016 were included in this study. Patients basic demographic profile, incidence, time interval between ingestion of corrosive and occurrence of malignancy, site of malignancy, symptoms at presentation, stage, management and survival were analysed. Results There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months. Conclusion There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient.. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months. Disclosure All authors have declared no conflicts of interest.

Interpretation of Upper Gastrointestinal Tract Mucosal Biopsies – A Tertiary Care Centre Experience

Background: Endoscopy is one of the initial diagnostic tests performed for the evaluation of upper gastrointestinal (GI) symptoms in clinical practice. Accurate interpretation and confirmation can be achieved by histopathological study of endoscopic biopsies and is one of the bases for planning proper treatment. Methods: Total 200 endoscopic biopsies, 50 from oesophagus, 50 from stomach and 100 from duodenum received in the department of pathology of a tertiary care medical college and hospital, Ahmedabad, Gujarat, India, over a period of two years from patients of all ages and sex with upper GI symptoms were included. Specimens were processed according to standard protocol and then reported by pathologist. The spectrum of histopathological lesions, whether inflammatory, non – neoplastic or neoplastic was evaluated along with the overall frequency, age and sex distribution of various upper gastrointestinal lesions. Result: Out of 200 cases of endoscopic biopsies received, 114 were males and 86 were females (M:F- 1.3:1). Majority were non-neoplastic lesions comprising of 153 (76.5%) cases. Out of 38(19%) malignant cases, oesophagus was the most common site comprising 78.9% and duodenum was the least common site comprising 10.5% of total malignancy. In duodenum 25% cases of celiac disease were also identified. Conclusion: In this prospective study, the commonest site for upper GI endoscopic biopsy was from the duodenum (50%). Overall Inflammatory lesions were more common (76.5%), the predominant sites being stomach (88%) and duodenum (68%). Most common site for malignancy was oesophagus, histological type was Squamous Cell Carcinoma predominantly. Endoscopic biopsy serves as an effective tool for the diagnosis and management of upper gastrointestinal lesions.

English

The purpose of this study was to evaluate the proportion of eyelid tumors, compare the clinical diagnosis with histopathological diagnosis in all possible cases in a tertiary eye hospital over a 5-year period. MATERIALS AND METHODS: Retrospective chart review was performed for patients with eyelid tumors from June 2009 to June 2014.Data were collected and analyzed on location of tumor, types of treatment, and pathologic findings. Histopathological diagnosis of benign and malignant tumors was stratified based on age, gender and tumor location. RESULTS: Total number of 235 patients was evaluated of which, 216 (91.9%) cases were benign and 19(8.1%) cases were malignant neoplasms. Most common benign tumors included epidermal cyst(30.5%), nevi (17.5%), dermoid cyst (13.8%) and papilloma (6.5%).Most frequent malignant tumors included Sebaceous gland carcinoma (SGC) (31.6%), Basal cell carcinoma (BCC) (26.3%), Squamous cell carcinoma (21%), Malignant melanoma (10.5%), Merkel cell carcinoma(5.3%) and Lymphoma (5.3%).Most common site for malignancy was lower lid followed by upper lid. BCC recurred in 1case in lower lid. CONCLUSION: Epidermal cyst, nevi, dermoid cyst and papilloma are the most common benign lesions and SGC is the most common malignant lesion. Recurrence is a feature of BCC in lower lid.