Complete Local Resection Research Articles

Association of circulating tumor DNA (ctDNA) molecular disease (MRD) detection with lymph node metastasis after local excision of pathological T1 colorectal cancer: First results from DENEB, a CIRCULATE-Japan GALAXY substudy.

23 Background: Patients with pathological T1 (pT1) colorectal cancer (CRC) at high risk for lymph node metastasis (LNM) after complete local resection are recommended to receive additional intestinal resection along with lymph node dissection. However, the existing pathological criteria for risk stratification of LNM are inadequate, such that ~90% of patients without LNM are exposed to potentially unnecessary treatment. Based on the CIRCULATE-Japan platform, we launched DENEB, a new prospective substudy within the GALAXY observational study, to explore the ability of predicting LNM using circulating tumor DNA (ctDNA) detection compared to the standard pathological criteria. Methods: This study included patients with pT1 CRC who underwent complete local resection and were scheduled for additional intestinal resection with lymph node dissection based on the standard pathologic risk-stratification criteria for LNM. The additional surgery was indicated for patients meeting any of the following criteria: (1) depth of submucosal invasion (>1000µm); (2) lymphovascular invasion; (3) poorly differentiated adenocarcinoma, signet-ring cell carcinoma, or mucinous carcinoma; and (4) high-grade tumor budding (BD2/3) at the site of deepest invasion according to the Japanese guideline. ctDNA was analyzed from plasma samples collected within 4 weeks before the additional intestinal resection using a personalized, tumor-informed assay (Signatera bespoke multiplex-PCR NGS assay). The study assessed the diagnostic concordance rate between ctDNA detection and the occurrence of LNM. Results: Of 208 CRC patients enrolled between July 2021 and May 2023 in DENEB, 166 patients met the inclusion criteria. Of these, 22 (13.3%) were ultimately diagnosed with pStage III due to the presence of LNM in additional intestinal resection. Among the 166 patients, 6 patients tested ctDNA-positive; all 6 had LNM, yielding a positive predictive value of 100.0%. On the other hand, 160 patients had ctDNA-negative results, 144 of whom did not have LNM, resulting in a negative predictive value of 90.0%. The overall diagnostic concordance rate for ctDNA in detecting LNM was 90.4% (95% confidence interval, 84.8% to 94.4%). All 6 patients with a ctDNA-positive result and LNM had left-sided colorectal cancer and a tumor diameter greater than 13 mm. Conclusions: This analysis showed that ctDNA testing has the potential to improve risk stratification of LNM in patients with pT1 CRC who underwent complete local resection. Clinical trial information: UMIN000039205 .

DENEB: Development of new criteria for curability after local excision of pathological T1 colorectal cancer using liquid biopsy.

According to the current international guidelines, high‐risk patients diagnosed with pathological T1 (pT1) colorectal cancer (CRC) who underwent complete local resection but may have risk of developing lymph node metastasis (LNM) are recommended additional intestinal resection with lymph node dissection. However, around 90% of the patients without LNM are exposed to the risk of being overtreated due to the insufficient pathological criteria for risk stratification of LNM. Circulating tumor DNA (ctDNA) is a noninvasive biomarker for molecular residual disease and relapse detection after treatments including surgical and endoscopic resection of solid tumors. The CIRCULATE‐Japan project includes a large‐scale patient‐screening registry of the GALAXY study to track ctDNA status of patients with stage II to IV or recurrent CRC that can be completely resected. Based on the CIRCULATE‐Japan platform, we launched DENEB, a new prospective study, within the GALAXY study for patients with pT1 CRC who underwent complete local resection and were scheduled for additional intestinal resection with lymph node dissection based on the standard pathologic risk stratification criteria for LNM. The aim of this study is to explore the ability of predicting LNM using ctDNA analysis compared with the standard pathological criteria. The ctDNA assay will build new evidence to establish a noninvasive personalized diagnosis in patients, which will facilitate tailored/optimal treatment strategies for CRC patients.

Pediatric Malignant Sacrococcygeal Germ Cell Tumor with Intraspinal Extension.

Aims:The study aimed to evaluate the presentation, management, and outcome of patients of sacrococcygeal malignant germ cell tumors (SC-MGCTs) with intraspinal extension.Materials and Methods:Case records of all cases of SC-MGCT were reviewed to identify cases with intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms if any, and outcome.Results:Of the three cases of SC-MGT, two had intraspinal extension. One had Altman Type 3 disease and another had Altman Type 4 disease; both had Stage 4 disease. The intraspinal extension in both patients was detected on contrast computed tomography scan and magnetic resonance imaging. One patient had bladder and bowel incontinence. All the tumors responded to preoperative chemotherapy. Gross complete local resection could be achieved in all patients. Neurological recovery was complete. All were alive with no recurrence on follow-up.Conclusions:Malignant sacrococcygeal GCTs with intraspinal extension are rare and can be managed with neoadjuvant chemotherapy which obviates the need for extensive exploration for excision and has got good neurological and oncological prognosis.

The pocket-creation method of endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is rapidly becoming the standard treatment for superficial gastrointestinal tumors because ESD can achieve complete local resection facilitating thorough pathological examination of the resected specimen. The pocket-creation method (PCM) has been established to perform safe and reliable ESD obtaining a high-quality pathological specimen. A minimal mucosal incision using PCM minimizes leakage of submucosally injected solution, which results in prolonged mucosal elevation. A limited-space submucosal pocket created using PCM makes the endoscope tip stable. A conical cap, small-caliber-tip transparent (ST) hood is used when performing PCM. The submucosa can be cut along the ideal dissection line just above the muscularis with minimal thermal damage because the tip of the ST hood produces both traction and countertraction to stretch the submucosal tissue in the pocket. PCM is recommended as the standard strategy not only for colorectal ESD but also for upper-gastrointestinal ESD. It is expected that the use of traction techniques will make PCM easier to perform.

Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany

BackgroundSince 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center.Patients and methodsData were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan–Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis.ResultsDuring the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien–Dindo 3–4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%.ConclusionTaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.

Management of Chondroblastoma of the Femoral Head by Controlled Hip Dislocation Technique and Use of Allograft: Case Report

Epiphyseal Chondroblastoma (EC) is known to be a very rare tumor with highly aggressive local capacity despite its benign nature. We report a case of a female patient treated for long lasting right hip pain diagnosed with EC of the femoral head. The lesion was treated with complete local resection by means of controlled surgical hip dislocation,

Revision of Pancreatic Neck Margins Based on Intraoperative Frozen Section Analysis Is Associated With Improved Survival in Patients Undergoing Pancreatectomy for Ductal Adenocarcinoma.

To test the hypothesis that complete, tumor-free resection at the pancreatic neck, achieved either en-bloc or non-en-bloc (ie, revision based on intraoperative frozen section [FS] analysis), is associated with improved survival as compared with incomplete resection (IR) in pancreatic ductal adenocarcinoma. Given the likely systemic nature of pancreatic ductal adenocarcinoma, the oncologic benefit of achieving a histologically complete local resection, particularly through revision of a positive intraoperative FS at the pancreatic neck, remains controversial. Clinicopathologic and treatment data were reviewed for 986 consecutive patients with ductal adenocarcinoma at the head, neck, or uncinate process of the pancreas who underwent open pancreatectomy as well as intraoperative FS analysis between 1998 and 2012 at Massachusetts General Hospital and between 1998 and 2013 at the University of Verona. Overall survival (OS) and perioperative morbidity and mortality were compared across 3 groups: complete resection achieved en-bloc (CR-EB), complete resection achieved non-en-bloc (CR-NEB), and IR. The CR-EB cohort comprised 749 (76%) patients, CR-NEB 159 patients (16%), and IR 78 patients (8%). Other than a higher incidence of vascular resection among CR-NEB and IR patients, no demographic, pathologic (eg, tumor grade, lymph node positivity, superior mesenteric artery involvement), or treatment factors (eg, neoadjuvant and adjuvant therapy use) differed between the groups. Median OS was significantly higher in patients with CR-EB (28 mo, P = 0.01) and CR-NEB resections (24 mo, P = 0.02) as compared with patients with IR resections (19 mo). After adjusting for clinicopathologic and treatment characteristics, CR-EB and CR-NEB margin status were found to be independent predictors of improved OS (relative to IR, CR-EB hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.49-0.86; CR-NEB HR 0.69, 95% CI 0.50-0.96). There were no intergroup differences in perioperative morbidity and mortality, including rates of pancreatic fistula. For patients with ductal adenocarcinoma at the head, neck, or uncinate process of the pancreas undergoing pancreatectomy, complete tumor extirpation via either en-bloc or non-en-bloc complete resection based on FS analysis is associated with improved OS, without an associated increased perioperative morbidity or mortality.

Near-infrared intraoperative imaging during resection of an anterior mediastinal soft tissue sarcoma.

Sarcomas are rare malignancies that are generally treated with multimodal therapy protocols incorporating complete local resection, chemotherapy and radiation. Unfortunately, even with this aggressive approach, local recurrences are common. Near-infrared intraoperative imaging is a novel technology that provides real-time visual feedback that can improve identification of disease during resection. The presented study describes utilization of a near-infrared agent (indocyanine green) during resection of an anterior mediastinal sarcoma. Real-time fluorescent feedback provided visual information that helped the surgeon during tumor localization, margin assessment and dissection from mediastinal structures. This rapidly evolving technology may prove useful in patients with primary sarcomas arising from other locations or with other mediastinal neoplasms.

Clinicopathological Characteristics, Surgery and Survival Outcomes of Patients with Duodenal Gastrointestinal Stromal Tumors

Background: Duodenal gastrointestinal stromal tumors (GISTs) are a rare subset of GISTs (3-5%), and their clinicopathological features have not been fully described. The purpose of this retrospective study was to examine these characteristics and compare the operative procedures. Methods: Twenty-five patients with duodenal GIST underwent complete resection, local resection (LR) or pancreaticoduodenectomy (PD) from 1990 to 2014 at our 2 hospitals. We analyzed patient characteristics, treatments, histological examinations, postoperative complications and survival outcomes. Results: Twelve patients (48%) with no symptoms were incidentally diagnosed for unrelated reasons. Sixteen patients (64%) had c-kit mutations while 6 (24%) were wild-type, including 4 with a history of neurofibromatosis type 1. Comparing LR (n = 16) and PD (n = 9), the recurrence-free survival rate was significantly worse for PD. On multivariate analysis, however, tumor size was an independent and significant prognostic factor, but not operative procedure. There was no body weight change with LR, but body weight decreased by 7% with PD. Conclusion: Duodenal GISTs had different characteristic genetic mutations compared to other GISTs. LR for duodenal GISTs appears to be oncologically and nutritionally feasible.

A giant neurothekeoma of the left shoulder blade: A case report.

Neurothekeoma is a rare myxoma of the peripheral nerve sheath. The current report presents a case of a giant neurothekeoma with a partially-formed capsule, scapula erosion and unclear biological behavior, which originated in the intermuscular space between the left trapezius muscle and scapula. The patient was initially misdiagnosed with a fibromatosis using computed tomography and magnetic resonance image scanning. Diagnosis of the neoplasm was confirmed by pathological and immunohistochemical examination, revealing a neurothekeoma with unclear biological behavior. The patient underwent a wide and complete local resection. Using a comprehensive postoperative follow-up strategy, it was determined that the patient recovered well. The tumor was ~17×16×10 cm in size and was in contact with the scapula. The purpose of the present study was to describe a rare giant neurothekeoma and review the diagnostic techniques utilized to reach a definitive diagnosis. Histopathological and immunohistochemical analyses were recommended for the diagnosis of neurothekeoma. There have been no previous reports regarding neurothekeomas exhibiting malignant transformation. Early and complete surgical resection is considered to be an effective method of treating this type of neurothekeoma.

Malignant recurrence and distal metastasis after complete local resection of colorectal "high-grade intraepithelial neoplasia": incidence and risk factors.

Colorectal high-grade intraepithelial neoplasia is defined as a high-grade neoplastic lesion with no invasion of submucosa. Because pathological evaluation has inevitable sampling errors, invasive cancer may be underdiagnosed as high-grade intraepithelial neoplasia by regarding submucosa invasion as an indispensable criterion for malignancy. This study was to evaluate the reliability of colorectal "high-grade intraepithelial neoplasia" diagnosis and identify predictive factors of underdiagnosis. Colorectal high-grade intraepithelial neoplasia patients treated with complete local excision were followed up. Clinicopathologic features were compared between cases with malignant recurrence or distal metastasis and those without. Of 491 lesions reviewed, 13 (2.6 %) developed local malignant recurrence or distal metastasis, which were statistically significantly associated with rectal location (p = 0.047), sessile growth (p = 0.002), large diameter (p = 0.005), villous adenoma (p = 0.00), transanal local resection (p = 0.001), and piecemeal specimens (p = 0.009). Of the 13 cases, 11 were located in the rectum, including 10 in the low position (<=6 cm from the anal verge, mean 3.6 cm). Deeper pathological examination was performed on the paraffin-embedded tissue blocks of the 13 primary tumors and revealed no evidence of submucosa invasion. The diagnosis of colorectal high-grade intraepithelial neoplasia based on local resection is relatively reliable. However, regarding invasion of submucosa as an indispensable criterion for malignancy may contribute to the choice of overly conservative treatment, especially in the situation that the radical resection requires removing the anus.

Sacrococcygeal malignant germ cell tumor (SC-MGCT) with intraspinal extension

BackgroundNeurological involvement due to intraspinal extension in sacrococcygeal malignant germ cell tumors (SC-MGCTs) has rarely been reported. AimTo evaluate the incidence, presentation, management and the outcome of patients of SC-MGCT with intraspinal extension. Materials and MethodsCase records of all cases of SC-MGCT from 2001 to 2008, were reviewed to identify cases with vertebral involvement and intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms and outcome. ResultsOf the 31 cases of SC-MGCT, 5 (16%) had intraspinal extension. Age ranged from 12 to 84months (median 24months). Four patients had Altman type 4 disease (stage 4) and 1 had Altman type 3 (stage 3) disease. The intraspinal extension in all patients was detected on contrast CT scan. Patients presented with neurological symptoms in the form of lower limb paresis (80%), bowel and bladder (20%) incontinence. All the tumors responded to pre-operative chemotherapy. Gross complete local resection could be achieved in 4(80%). Neurological recovery was complete in all except for persisting neurogenic bladder in one. During follow up of 3–32months, all were alive with no recurrence. ConclusionsSC-MGCT presenting with neurological deficits due to intraspinal extension is usually advanced disease. These patients respond to chemotherapy and surgical resection and most have complete neurological improvement.

Fibrous soft tissue tumors: Factors predictive of recurrence

Background/PurposeFibrous soft tissue tumors (FSTT) of infancy and childhood present a challenge to surgeons due to ambiguous histological interpretation, propensity for local recurrence, and uncertainty regarding appropriate therapy. MethodsRecords were reviewed for patients diagnosed and treated for FSTT at our institution from 1992 to 2010. Data included demographics, tumor location, operative treatment, histopathology, margin status, mitotic index, and recurrence. ResultsEighty-six patients underwent treatment of FSTT. Mean follow-up time was 62months (range 1 to 201months). There were 11 recurrences (13%), with a mean time to recurrence of 23months. Extremity and digital lesions were most likely to recur with 21% of such lesions recurring compared to 7% of lesions located elsewhere. Recurrences were seen more frequently in older children. Despite the presence of positive margins in 92% of cases, margin status, histopathology, and mitotic index were not significant predictors of recurrence. ConclusionsDigital and extremity fibrous soft tissue tumors and tumors of older children have an increased risk for local recurrence. Margin status did not predict recurrence rates in this series. While the surgical goal is to obtain complete local resection with clear margins, this may be challenging in particular locations and may not ultimately impact recurrence.

Factors associated with complete local excision of small rectal carcinoid tumor

Although small rectal carcinoid tumors can be treated using local excision, complete resection can be difficult because tumors are located in the submucosal layer. We evaluate the factors associated with pathologically complete local resection of rectal carcinoid tumors. Data were analyzed of 161 patients with 166 rectal carcinoid tumors who underwent local excision with curative intent from January 2001 to December 2010. A pathologically complete resection (P-CR) was defined as an en bloc resection with tumor-free lateral and deep margins. The study classified treatments into three categories for analysis: conventional polypectomy (including strip biopsy, snare polypectomy, and hot biopsy), advanced endoscopic techniques (including endoscopic mucosal resection with cap and endoscopic submucosal dissection), and surgical local excision (including transanal excision and transanal endoscopic microsurgery). We evaluated the P-CR rate according to treatment method, tumor size, initial endoscopic impression and the use of endoscopic ultrasound (EUS) or transrectal ultrasound (TRUS). The mean tumor size was 5.51 ± 2.43mm (range 2-18mm) and all lesions were confined to the submucosal layer. The P-CR rates were 30.9, 72.0, and 81.8% for conventional polypectomy, advanced endoscopic techniques, and surgical local excision, respectively. Univariate analysis showed that P-CR was associated with treatment method, use of EUS or TRUS, and initial endoscopic impression. Multivariate analysis showed that only treatment method was associated with P-CR. Pathologically complete resection of small rectal carcinoid tumors was more likely to be achieved when using advanced endoscopic techniques or surgical local excision rather than conventional polypectomy.

Retrospective Analysis of the Results of Strip Biopsies to Determine the Indication for Endoscopic Submucosal Dissection for Early Gastric Cancer

To determine the indication for endoscopic submucosal dissection, we retrospectively analyzed the results of strip biopsies for early gastric cancer. We studied 374 lesions of 360 patients with early gastric cancer. The resection results were classified into complete local resection and incomplete resection. The relations among the resection results and maximum tumor diameter, tumor location, and 1-year recurrence were analyzed. Complete local resection was achieved by strip biopsy for 206 of the 374 lesions (55.1%). For the 168 lesions with incomplete resection, local recurrence was found in 22. The rate of complete local resection in strip biopsy was significantly low, and the rate of local recurrence was significantly high for lesions exceeding 2 cm in diameter as well as for lesions of the cardiac part and the angular part of the lesser curvature. Our strip biopsy results suggest that endoscopic submucosal dissection is needed for early gastric cancer lesions larger than 2 cm in diameter and for those located in the cardiac part and angular part of the lesser curvature.

The TME Trial After a Median Follow-up of 6 Years

To investigate the efficacy of preoperative short-term radiotherapy in patients with mobile rectal cancer undergoing total mesorectal excision (TME) surgery. Local recurrence is a major problem in rectal cancer treatment. Preoperative short-term radiotherapy has shown to improve local control and survival in combination with conventional surgery. The TME trial investigated the value of this regimen in combination with total mesorectal excision. Long-term results are reported after a median follow-up of 6 years. One thousand eight hundred and sixty-one patients with resectable rectal cancer were randomized between TME preceded by 5 x 5 Gy or TME alone. No chemotherapy was allowed. There was no age limit. Surgery, radiotherapy, and pathologic examination were standardized. Primary endpoint was local control. Median follow-up of surviving patients was 6.1 year. Five-year local recurrence risk of patients undergoing a macroscopically complete local resection was 5.6% in case of preoperative radiotherapy compared with 10.9% in patients undergoing TME alone (P < 0.001). Overall survival at 5 years was 64.2% and 63.5%, respectively (P = 0.902). Subgroup analyses showed significant effect of radiotherapy in reducing local recurrence risk for patients with nodal involvement, for patients with lesions between 5 and 10 cm from the anal verge, and for patients with uninvolved circumferential resection margins. With increasing follow-up, there is a persisting overall effect of preoperative short-term radiotherapy on local control in patients with clinically resectable rectal cancer. However, there is no effect on overall survival. Since survival is mainly determined by distant metastases, efforts should be directed towards preventing systemic disease.

Elective Esophagectomy of Early Barrett's Adenocarcinoma After Endoscopic Mucosal Resection (EMR) Due to Incompleteness Or T1 sm Stages

EMR has a diagnostic value in staging early Barrett's neoplasia (BE-Npl), especially with regard to the discrimination between mucosal and submucosal (sm) infiltration. Furthermore, it has the potential of curative resection in early Barrett's adenocarcinoma. Prerequisites for cure are complete local tumor resection and histopathological confirmation of mucosal neoplasia in the EMR specimen. In case of sm-infiltration surgical resection is mandatory due to an increased risk of lymph node metastases. Methods: A prospectively collected database of EMR (cap-technique) in either diagnostic or therapeutic intention of consecutive patients with early BE-Npl was analyzed with regard to surgical interventions. Indications for surgery were incomplete resection with the inability of proceeding further endoscopic resection, usually due to scar formation (technical failure) and/or histopathological proof of sm- infiltration in the EMR specimen. Results: Of 89 patients with early BE-Npl treated between 11/1999 and 12/2005 14 (16%) underwent surgical resection in 3 different hospitals with transhiatal (n = 4), transthoracic (n = 8; 7/8) or abdominocervical esophagectomy (n = 2) (mean age 66 (45-82) years; LSBE n = 10, SSBE n = 4). Indications for surgery were histopathological proof of sm-infiltration in 9, incomplete EMR in 5 patients (due to stenosis n = 3 or widespread residual neoplasia n = 2). Histopathology of the surgically resected specimen showed no residual neoplasia in 7 of 9 patients (78%) with sm-involvement, residual neoplasia of the same stage (m-type) in 4 and downgraded residual neoplasia in 2 patients. None of these 13/14 patients had lymph node metastases. The final diagnosis in one patient was pT2, N1 who had been referred for diagnostic EMR. Complications: One patient died after surgery due to a severe haemorrhage with shock and unsuccessful resuscitation (1/14 = 7%). Other complications were anastomotic stricture (n = 1), anastomotic insufficiency (n = 2), cardiac arrhythmias (n = 2), transient cerebral confusion with drop (n = 1) and pneumonia (n = 2). Conclusion: These data confirm the diagnostic value of EMR with regard to adequate patient stratification according to the histopathological stage of disease. Patients with sm-infiltration should be referred for surgery including lymphadenectomy considering the potential risk of lymph node metastases even though the lesion was completely removed in 78% by EMR in this subgroup. With regard to high surgical morbidity and mortality rates it seems necessary to improve endoscopic resection techniques in patients requiring multiple resections to avoid stricture formation and consecutive inability of proceeding EMR.

Place de la néphrectomie dans la prise en charge des cancers du rein métastatiques

Metastatic kidney cancer is still a devastating disease but it represents a very heterogeneous situation. Some patients will have a median survival limited to some months, while others will live several years. If the initial diagnosis of kidney cancer at metastatic stage is quite uncommon, it raises the question of whether or not performing initial nephrectomy. The point was long debated as it was suggested that initial nephrectomy could result in a spontaneous metastase regression and protect against local complications (hematuria, local pain,…). Today, nephrectomy must not be systematic, as effective alternative treatments are often available. Furthermore spontaneous postoperative metastasis regression is unusual. Two recent prospective randomized trials clarified the impact of initial nephrectomy. It is now accepted that initial surgery prior to systemic immunotherapy results in 30% survival benefit. However this procedure should only be considered for highly selected cases: patients in otherwise good condition (ECOG 0-1), macroscopically complete local resection, no supra-hepatic caval thrombus, and patients suitable for systemic immunotherapy treatment. Several questions remain unanswered, such as lymph node dissection to be performed, and its real survival impact. Furthermore the definition of “suitable” patients for immunotherapy has to be clarified, based on the recent results from the Percy Quatro study. It would probably be more effective to consider only patients with an expected good survival benefit using immunotherapy, such as those classified as “good prognosis” based on the CRECY criteria. Finally the development of new drugs, targeting mainly the angiogenic pathway may lead to different future indications in this setting.

Ossifying fibromyxoid tumor of the nasal septum

The fibromyxoid tumor is quite a rare soft tissue tumor and typically presents as an ossifying fibromyxoid tumor (OFMT) in the subcutis of the extremities of adults. Most authors favour schwannian or chondroid origin of this lesion with somehow uncertain biologic dignity. Local recurrence is seen in 27% of patients after primary excision. We present a case of a fibromyxoid tumor of the nasal septum in a 49-year-old female who complained of nasal airway obstruction and enlargement of the right contour of the nose. Endonasal, endoscopic tumor excision was performed. The tumor contained spindle-shaped and polygonal cells, mucoid pseudocysts and a fibromyxoid stroma with local calcifications. The clinical behaviour of OFMT in general is benign but some reports have documented atypical tumors with histologic signs of malignancy. Complete local resection is the treatment of choice. Because of the high rate of local recurrence, clinical follow-up examinations are necessary.

Molecular detection of occult tumor cells in pelvic tissue of cervical cancer patients

Purpose: Local recurrences of surgically treated cervical cancer patients occur in about 20% despite of complete local tumor resection and radical lymphonodectomy. Occult tumor cell deposits (OTCD) remaining in situ might be involved in the development of local recurrences.