Distribution Of Histological Subtypes Research Articles

Relapses of congenital mesoblastic nephroma: description of three clinical cases and literature review

Congenital mesoblastic nephroma (CMN) is a rare renal tumor of young children with intermediate biological behavior, accounting for 3.5-4% of all renal tumors in children. СMN is characterized by a favorable prognosis in case of radical surgical treatment. Relapses of CMN are considered to be quite a rare occurrence (4% of all cases), however, both local and metastatic relapses are possible. There are no fully standardized treatment approaches for patients with relapsed CMN. In our study, we performed a retrospective analysis of patients (n = 3) with a verified relapse of CMN who had received treatment at the D. Rogachev NMRCPHOI between 2012 to 2022 (132 months). At relapse, all the patients underwent at least one part of treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. The diagnosis of CMN was established at the Pathology Department of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation, based on a histological examination. The patients with the cellular histological subtype of CMN underwent fluorescent in situ hybridization testing for ETV6 gene rearrangements. The demographic characteristics, clinical data, the extent of initial treatment and relapse therapy were assessed. Here, we describe three clinical cases of relapse in patients with CMN. The median age at initial diagnosis was 0.8 months (range 0.7–1.4). Our analysis of the extent of primary surgical treatment, including nephrectomy, in all cases revealed the following factors associated with a higher risk of relapse: preoperative tumor rupture – 1, intraoperative tumor rupture – 1, inability to confirm tumor-free margins – 1. The distribution of histological subtypes was as following: classical CMN (n = 1), cellular CMN (n = 1), and mixed CMN (n = 1). One patient had local stage II and 2 patients had local stage III. The median time from diagnosis to disease relapse was 0.8 months (range 2.3–4.3). One patient with mixed CMN died 10.6 months after diagnosis from complications of intensive therapy carried out for extremely aggressive relapse. Two patients are alive after repeated surgical treatment (R1 resection) and adjuvant therapy with actinomycin D and vincristine (AV regimen) for 27 weeks in one case, and neoadjuvant therapy (AV regimen for 4 weeks), delayed surgery (R0 resection), and adjuvant therapy (AV regimen for 4 weeks) in the other case. These patients were followed up for 92.2 and 21.3 months, respectively. By acknowledging the possibility of recurrent CMN, it seems important to provide multidisciplinary clinical care to young children with renal tumors involving a detailed planning of surgical procedures, radical surgeries in accordance with practice guidelines and standards in surgical oncology, and careful follow-up, especially during the first year after surgery. The patients' parents gave consent to the use of their children's data, including photographs, for research purposes and in publications.

Racial Disparities in Nasopharyngeal Carcinoma Characteristics and Survival

Objective: To investigate and compare the distribution of histological subtypes, stage at presentation, and survival outcomes among Chinese American, Non-Hispanic White, and African American patients with nasopharyngeal carcinoma (NPC). Materials and methods: We identified Chinese American, Non-Hispanic White, and African American patients with NPC who were diagnosed between 2010 and 2017. Statistical analyses were conducted using the chi-square test, propensity score matching, Kaplan-Meier analysis, and multivariate Cox proportional hazards models. Results: A total of 1646 eligible patients with NPC were included. Non-Hispanic White accounted for 1049 (63.7%), African Americans for 265 (16.1%), and Chinese Americans for 332 (20.2%), and their median age at diagnosis was 59, 55, and 53 years, respectively ( P < .001). Chinese Americans most frequently harbored undifferentiated non-keratinizing squamous cell carcinoma subtype (n = 134, 40.4%) than Non-Hispanic White (n = 164, 15.6%) or African American patients (n = 44, 16.7%) ( P < .001). Histological subtype distribution was similar between Non-Hispanic White and African American patients ( P = .338). African American patients had the highest rate of stage III to IV disease (n = 206, 77.7%) compared to Non-Hispanic White (n = 704, 67.1%) and Chinese American patients (n = 210, 63.2%) ( P = .009). No significant difference in stage distribution was observed between Chinese American and Non-Hispanic White patients ( P = .494). Non-Hispanic White patients [hazard ratio (HR) 1.344, 95% confidence interval (CI) 1.007-1.479, P = .045] and African American patients (HR 2.314, 95% CI 1.405-3.813, P < .001) had significantly worse overall survival compared to Chinese American patients. However, race was not associated with NPC-specific survival in the multivariate analysis. Similar results were found after propensity score matching. Conclusions: Race influences the distribution of histological subtypes, stage at presentation, and survival outcomes in NPC.

The Landscape of Breast Cancer Molecular and Histologic Subtypes in Canada.

Purpose: To characterize the histologic and molecular subtype distribution of, and survival from, breast cancer (BC) among Canadian women overall, and by stage and age at diagnosis. Methods: Invasive BC cases from the Canadian Cancer Registry for women aged 15-99 years between 2012 and 2017 in Canada, excluding Quebec, were examined using pre-existing mortality linkages. Stage at diagnosis, molecular, and histologic subtypes, and 5-year net survival (NS) by age, subtype, and stage were determined. Results: 107,271 women with BC were included. Luminal A was the most common subtype, present in increasing proportions as women aged, up to a maximum of 55% of cases in 70-74. Ductal and luminal A were most likely to be diagnosed at stage I, while HER2+ had the highest proportion of diagnosis at stage III; triple negative (TN) and unknown had the highest proportion of stage IV. For all stages combined, luminal A had a five-year NS of 98%, while TN was 74%. NS for stage I BC was 99-100% for all subtypes, excepting TN, which was 96%. Survival decreased with advancing stage, most markedly for TN, for which stage III was 47% and stage IV 7%. Survival by equivalent stage and subtype was comparable across age groups but declined in older age categories. Conclusions: The varying natural histories of BC subtypes and histologies can inform prognoses, health system economics, and screening practices. The NS of 96% or greater for stage I, regardless of subtype, highlights the importance of early detection for all subtypes of BC, especially in aggressive subtypes.

Establishment of artificial intelligence model for precise histological subtyping of lung adenocarcinoma and its application to quantitative and spatial analysis.

The histological subtype of lung adenocarcinoma is a major prognostic factor. We developed a new artificial intelligence model to classify lung adenocarcinoma images into seven histological subtypes and adopted the model for whole-slide images to investigate the relationship between the distribution of histological subtypes and clinicopathological factors. Using histological subtype images, which are typical for pathologists, we trained and validated an artificial intelligence model. Then, the model was applied to whole-slide images of resected lung adenocarcinoma specimens from 147 cases. The model achieved an accuracy of 99.7% in training sets and 90.4% in validation sets consisting of typical tiles of histological subtyping for pathologists. When the model was applied to whole-slide images, the predominant subtype according to the artificial intelligence model classification matched that determined by pathologists in 75.5% of cases. The predominant subtype and tumor grade (using the WHO fourth and fifth classifications) determined by the artificial intelligence model resulted in similar recurrence-free survival curves to those determined by pathologists. Furthermore, we stratified the recurrence-free survival curves for patients with different proportions of high-grade components (solid, micropapillary and cribriform) according to the physical distribution of the high-grade component. The results suggested that tumors with centrally located high-grade components had a higher malignant potential (P<0.001 for 5-20% high-grade component). The new artificial intelligence model for histological subtyping of lung adenocarcinoma achieved high accuracy, and subtype quantification and subtype distribution analyses could be achieved. Artificial intelligence model therefore has potential for clinical application for both quantification and spatial analysis.

Global Incidence of Ovarian Cancer According to Histologic Subtype: A Population-Based Cancer Registry Study.

Ovarian cancer can be categorized into distinct histologic subtypes with varying identifiable risk factors, molecular composition, clinical features, and treatment. The global incidence of ovarian cancer subtypes remains limited, especially in low- and middle-income countries (LMICs) without high-quality cancer registry systems. We used data from population-based cancer registries of the Cancer Incidence in Five Continents project to calculate the proportions of serous, mucinous, endometrioid, clear cell, and other histologic subtypes of ovarian cancer. Proportions were applied to the estimated numbers of patients with ovarian cancer from Global Cancer Observatory 2020. Age-standardized incidence rates were calculated. Globally, an estimated 133,818 new patients of serous cancer, 35,712 new patients of mucinous cancer, 29,319 new patients of endometrioid cancer, and 17,894 new patients of clear cell cancer were identified in 2020. The distribution of ovarian cancer histologic subtypes exhibited regional variation. Eastern Europe had the highest rate of serous and mucinous carcinomas, whereas Northern Africa and Eastern Asia had the highest burden of endometrioid and clear cell carcinomas, respectively. This study provides a global incidence landscape of histologic subtypes of ovarian cancer, particularly in LMICs lacking comprehensive registry systems. Our analysis offers valuable insights into disease burden and guidance for tailored strategies for prevention of ovarian cancer.

Molecular Subgrouping Based on Immunohistochemistry in Medulloblastoma: A Single-Center Experience.

To investigate the efficacy of immunohistochemical methods to determine molecular subgroups and prognostic predictions of medulloblastomas (MBs). β-catenin, GAB1, YAP1, filamin A and p53 were immunohistochemically stained, and MYC and MYCN fluorescent in situ hybridization (FISH) procedures were applied to 218 cases in our series. Based on the histomorphological characteristics of the cases, 67.9% were deemed classic MB; 15.6% as desmoplastic/ nodular medulloblastoma (DNMB); 12.8% as large cell/anaplastic (LC/A) MB; 3.7% as medulloblastoma with extensive nodularity (MBEN). Molecular characteristics revealed that 50.5% had non-WNT/non-SHH; 33.9% had SHH-activated and TP53-wildtype; 8.7% had WNT-activated; 6.9% had SHH-activated and TP53-mutant. According to the survival curves, LC/A MBs or non-WNT/ non-SHH tumors showed the worst prognosis, whereas DNMBs and WNT-activated tumors showed the best prognosis. Classic MBs or SHH-activated tumors showed a moderate course. MYCN amplification was found to act as an independent poor prognostic factor in the study. The distribution of histological subtypes and molecular subgroups, amplification rates, and prognostic data obtained through immunohistochemical methods in our study were consistent with those reported in the literature. It was therefore hypothesized that the determination of molecular subgroups by immunohistochemical methods can be useful in daily diagnostic practice, especially in centers with limited access to molecular techniques.

Clinical and radiologic features of soft tissue sarcoma in trunk and extremities that underwent unplanned excision.

To identify the clinical and imaging characteristics of soft tissue sarcomas (STS) of the trunk and extremities that undergo unplanned excision. This retrospective study evaluated the data of patients with STS in the trunk or extremities between January 2008 and December 2021. Patients were divided into unplanned and planned excision groups based on their initial treatment. The distribution of histologic subtypes was analyzed, and the magnetic resonance imaging features were evaluated. Multivariable logistic regression was performed to identify variables independently associated with unplanned excision. A total of 305 patients (mean age±standard deviation, 51±16.4 years; 179 males) were analyzed. The most prevalent subtype in the unplanned excision group was myxofibrosarcoma (22.3%). The unplanned excision group had a significantly smaller tumor size (p < 0.001) and more frequent superficial (p < 0.001) locations. Lobulated shape and peritumoral abnormalities were present in 70.0% and 50.0% of the unplanned excision group, respectively. Tumor size (adjusted odds ratio [OR], 0.87 per 1 cm increase; 95% confidence interval [CI], 0.77-0.98; p = 0.025) and superficial location (adjusted OR, 3.48; 95% CI, 1.57-7.72; p = 0.002) were independently associated with unplanned excision. Myxofibrosarcoma is associated with a high frequency of unplanned excision. A significant number of patients in the unplanned excision group demonstrated a lobulated shape and peritumoral abnormalities. Only small tumor size and superficial location were independently associated with unplanned STS excision.

Spatial distribution of histological subtypes of Meningioma: A 14-Year longitudinal study in a developing country

BackgroundMeningiomas are extra-axial tumors that arise from meningothelial cells, accounting for about one-third of primary central nervous system malignancies. While they are often classified by location and histology, the role of the molecular profile in their development and progression is significant. The topographic distribution of meningiomas has not been extensively studied, and it is unclear whether specific histological subtypes have predilection sites. Therefore, this study analyzes the preferred locations of meningiomas according to different biological characteristics and their association with different gradings. MethodsThis is a retrospective chart review of patients in tertiary institutes over 14 years. The data were retrieved from medical and pathological record archives. An association between the biological nature of tumors and the location of meningiomas was analyzed. SPSS version 25 was used to analyze the data. ResultsOut of 272 patients, the predominant location for meningioma distribution was convexity (33.5%), followed by parafalcine (12.5%). WHO Grade I meningiomas were the most common, accounting for 84.2% of all meningiomas. The transitional histological subtype is the common variant (34.6%). The distribution of the histological subtype of meningioma in relation to tentorium was statistically significant. However, that was not the case with the skull base. ConclusionThe spatial distribution of meningiomas within the brain is not uniform. The most frequent locations for meningiomas were found to be convexity and parafalcine. Transitional and fibroblastic meningiomas were the predominant subtypes.

Orbital Liposarcoma: A Surveillance, Epidemiology and End Results Database Study.

Orbital liposarcoma is a challenging tumor to treat due to its rarity and high rate of local recurrence, and the role of radiotherapy and chemotherapy remain unclear. Analysis of big data may improve our overall understanding of orbital disease and role of adjuvant therapies. Data were extracted from the Surveillance, Epidemiology and End Results (SEER) Research Plus database from 1975 to 2017. All patients with a diagnosis of liposarcoma (ICD-O3 codes 8850-8858, 8869-8862, 8870, 8880, 8881) were included. Cases were divided into 4 groups by primary site: orbit, retroperitoneum, soft tissue, and other. A total of 16,958 patients were included. Patients with orbital involvement were younger and more likely to be female ( p < 0.05). Among orbital lesions, myxoid liposarcoma was the most common histologic subtype (6/19; 31.6%) followed by well differentiated (5/19; 26.3%). This differed from the distribution of histologic subtypes encountered elsewhere, for which well-differentiated liposarcoma was the most common (retroperitoneum 979/3,136; 31%, soft tissue 3,493/11,671; 30%, and other sites 497/2,132; 23%, p < 0.05). Dedifferentiated histologic subtype was the second most common subtype found in the retroperitoneum (946/3,136; 30%), whereas it was less common in the orbit (2/19; 11%) and soft tissue (1,396/11,671; 12%) ( p < 0.001). Patients with orbital liposarcoma had similar disease-specific mortality compared with soft-tissue location ( p = 0.825) and lower disease-specific mortality compared with retroperitoneal location ( p < 0.001). When all locations were combined, patients with well-differentiated liposarcoma had the lowest disease-specific mortality. Patients with orbital liposarcoma tend to be younger, female, and have a better prognosis than those with retroperitoneal disease, likely due to the lower incidence of dedifferentiated histologic subtype.

Histologic heterogeneity predicts patient prognosis of HER2-positive metastatic breast cancer: A retrospective study based on SEER database.

Human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (MBC) is a subtype of breast cancer with a worse prognosis. Little is known about the relationship between histology and prognosis among different distant metastasis sites (DMS). Our aims were to explore the prognostic value of histologic subtypes in different DMS and screen out specific subtypes with particular DMS that need more attention in HER2+ MBC. HER2+ MBC patient data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2014. Chi-squared tests were utilized to compare histologic subtypes in four DMS. The logistic regression analyses were used to control confounding factors. The log-rank tests were used to analyze the correlation of histologic subtype with disease-specific survival and overall survival. The survival data was analyzed using Kaplan-Meier methods. A total of 1174 HER2+ MBC patients were involved. First, the distribution of histological subtypes varied across metastatic sites, and the proportions of metastatic sites in different histological subtypes were also different. Furthermore, different histological subtypes within specific DMS showed divergent prognoses, and the different outcomes were shown by distinct DMS for specific histological subtypes. Among them, lobular carcinoma (ILC) subtypes showed the worst prognosis in bone metastasis, and lung metastasis predicted the worst prognosis in infiltration duct and lobular carcinoma (IDC-ILC) subtypes. After further consideration of hormone receptor (HR) status, the IDC-ILC subtype with liver metastasis in HR+/HER2+ MBC patients and the ILC subtype with bone metastasis in HR-/HER2+ MBC patients proved to be noteworthy. Histological subtypes are involved in determining the heterogeneity of HER2+ MBC patient prognosis, which is helpful to guide the prognosis prediction and monitoring of HER2+ breast cancer patients in clinics.

Distribution and survival outcomes of primary head and neck hematolymphoid neoplasms in older people: a population-based study.

Primary head and neck hematolymphoid neoplasms (PHNHLN) are defined as a series of hematolymphoid system-derived neoplasms which primarily emanate in head and neck region. Due to the rarity and absence of symptomatic specificity, PHNHLN is easily neglected. The objective of this study is to investigate demographics, pathological subtype distribution, anatomical location, survival outcomes and prognostic factors of PHNHLN among older patients aged ≥ 60. The individual patient information in our study was derived from Surveillance, Epidemiology and End Results database. Descriptive epidemiological methods were used to analyze the distribution of histologic subtypes and primary anatomical sites. Kaplan-Meier survival curves and log-rank test were conducted to evaluate the effect of variables on the prognosis. Cox hazard regression was conducted to identify the independent prognostic factors. The male-to-female ratio in most pathological subtypes was close to 1:1. The most common pathological subtype was diffuse large B-cell lymphoma. The most commonly involved sites outside the lymph nodes were salivary glands, especially parotid gland, followed by tonsil, thyroid gland and tongue. The prognosis of mature T- and NK-cell non-Hodgkin lymphoma (NHL) was bleaker than Hodgkin lymphoma, mature B-cell NHL and plasma cell neoplasm. Age at diagnosis, presence of second primary malignancy (SPM), pathological subtype, Ann-Arbor stage, chemotherapy and radiation were independent prognostic factors of overall survival. Our study comprehensively reported the subtype distribution, anatomical sites and survival outcomes of PHNHLN among older patients, improving understanding of this rare group of cancer entities.

Primary extranodal lymphomas: Five-year experience from a tertiary care center of North India.

Primary extranodal lymphomas (pENL) are lymphomas with minimal nodal involvement and dominant extranodal disease. We aimed to study the prevalence and clinicopathological characteristics of pENL presenting at our center over 5 years from January 2015 to January 2020. This is a cross-sectional study of pENL patients in which relevant clinical and laboratory data was collected including demography, site, stage, international prognostic index-revised, imaging findings, hematological, and biochemical parameters and comorbidities including underlying immunodeficiency. The paraffin blocks were subjected to routine hematoxylin and eosin stain and immunohistochemistry with standard lymphoma panel. Of 341 lymphomas, 73 (21.4%) were pENL with commonest site being gastrointestinal tract (31.5%) followed by head and neck (23.2%) and soft tissues (9.6%). Diffuse large B-cell lymphoma (DLBCL) (39.7%) was the commonest histological type (germinal center type-48%, nongerminal center-52%) followed by marginal zone lymphomas (MZL) (23.3%) and primary CNS lymphoma (8.2%). Primary breast lymphoma, primary bone marrow lymphoma, and follicular lymphoma constituted 4.1, 5.4, and 4.1% of pENL, respectively. There was a case of high grade B cell lymphoma of ileum with features intermediate between DLBCL and Burkitt. Other unusual pENL were anaplastic DLBCL of tonsils, DLBCLs of bone marrow with M band, MZL of base of tongue, Richter's transformation of tonsillar small lymphocytic lymphoma, and follicular lymphoma presenting as pericardial mass. Of 12 cases of T-non-Hodgkin lymphoma, commonest were mycosis fungoides (4/12) followed by mediastinal T-lymphoblastic lymphoma (2/12) and peripheral T-cell lymphoma (2/12). pENL has unique clinical presentation depending on the location with site-specific distribution of histological subtypes.

Cervical cancer after the Manchester procedure: a nationwide cohort study.

The Manchester procedure is a successful operation to treat uterine prolapse. However, the influence on cervical cancer remains unknown. We hypothesized a lower risk of cervical cancer after the Manchester procedure. We included all Danish women undergoing the Manchester procedure during 1977-2018 (N = 23,935). Women undergoing anterior colporrhaphy (N = 51,008) were included as references due to comparable health-seeking behaviors. The study cohort is as previously described. We assessed the risk of cervical cancer mortality after the Manchester procedure versus anterior colporrhaphy using cumulated incidence plots and Cox hazard regressions. We applied Fisher's exact test to compare the distribution of histological subtypes after the operations. Generally, few women were diagnosed with cervical cancer (0.1% after Manchester procedure and 0.2% after anterior colporrhaphy). After the Manchester procedure, the risk of cervical cancer was reduced (HR 0.60 [95% CI 0.39-0.94]). Furthermore, we found a slightly reduced risk of overall death (HR 0.96 [95% 0.94-0.99]), but no association regarding death due to cervical cancer (HR 0.66 [95% 0.34-1.25]). The distribution of histological subtypes was not changed. Women undergoing the Manchester procedure are at lower risk of being diagnosed with cervical cancer, while the risk of cancer specific mortality is unchanged compared to women undergoing anterior colporrhaphy. Based on this study, we cannot recommend that women exit ordinary screening programs for human papillomavirus/cervical dysplasia after a Manchester procedure.

Prevalence and distribution of primary glomerular diseases in Africa: a systematic review and meta-analysis of observational studies.

Glomerulonephritis (GN) is a predominant cause of kidney failure in Africa. The prevalence of primary GNs varies widely across Africa depending on the relative proportion of secondary GNs and genetic predispositions. We assessed the overall and sub-regional prevalence of primary GN and its histologic subtypes in Africa. We searched PubMed, EMBASE and African Journals Online for studies of biopsy-proven primary GNs across all age groups in Africa published between 2010 and 2022. Data for primary GNs [minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), mesangioproliferative GN (MesPGN), membranoproliferative GN (MPGN), post-infectious GN (PIGN), IgA Nephropathy (IgAN), and crescentic GN (CresGN)] were extracted. Pooled prevalence was determined using the random effects model. Seventeen eligible articles (n = 6,494 individuals) from 8 African countries met the inclusion criteria. The overall pooled prevalence of FSGS, MCD, MN, MPGN, MesPGN, PIGN, IgAN and CresGN was 26.10%, 22.40%, 8.40%, 6.40%, 6.40%, 2.60%, 2.60%, 1.40%, respectively. Only 4 studies (23.5%) used light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM) for diagnosis. There were significant differences in the distribution of histologic subtypes in the paediatric compared to the adult population and across geographic sub-regions, with West Africa having a higher prevalence of FSGS. Overall, the dominance of FSGS across most regions and age groups has implications for disease diagnosis and ongoing care. Research efforts to understand the impact of this trend on kidney disease outcomes and efforts to improve kidney biopsy practice as a means of early disease detection are needed in Africa.

Does the morphology of cutaneous melanoma help to explain the international differences in survival? Results from 1 578 482 adults diagnosed during 2000–2014 in 59 countries (CONCORD-3)

BackgroundCONCORD‐3 highlighted wide disparities in population‐based 5‐year net survival for cutaneous melanoma during 2000–2014. Clinical evidence suggests marked international differences in the proportion of lethal acral and nodular subtypes of cutaneous melanoma.ObjectivesWe aimed to assess whether the differences in morphology may explain global variation in survival.MethodsPatients with melanoma were grouped into the following seven morphological categories: malignant melanoma, not otherwise specified (International Classification of Diseases for Oncology, third revision morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722–8723, 8726–8727, 8730, 8740–8741, 8746, 8761, 8770–8774, 8780). We estimated net survival using the nonparametric Pohar Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All‐ages survival estimates were standardized using the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death.ResultsWorldwide, the proportion of nodular melanoma ranged between 7% and 13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). Overall, 36% of tumours were classified as superficial spreading melanoma. During 2010–2014, age‐standardized 5‐year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but was only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66% and 95%. Nodular melanoma had the poorest prognosis in all countries. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes.ConclusionsThis study provides the broadest picture of distribution and population‐based survival trends for the main morphological subtypes of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment. What is already known about this topic? The histopathological features of cutaneous melanoma vary markedly worldwide.The proportion of melanomas with the more aggressive acral lentiginous or nodular histological subtypes is higher in populations with predominantly dark skin than in populations with predominantly fair skin. What does this study add? We aimed to assess the extent to which these differences in morphology may explain international variation in survival when all histological subtypes are combined.This study provides, for the first time, international comparisons of population‐based survival at 5 years for the main histological subtypes of melanoma for over 1.5 million adults diagnosed during 2000–2014.This study highlights the less favourable distribution of histological subtypes in Asia and Central and South America, and the poorer prognosis for nodular and acral lentiginous melanomas.We found that later stage at diagnosis does not fully explain the higher excess risk of death for nodular and acral lentiginous melanoma compared with superficial spreading melanoma.

Clinical and histopathological pattern of lung cancer in Morocco.

lung cancer is the most common cancer and the leading cause of cancer death worldwide. This study aimed to provide an overview of the epidemiology of primary lung cancer in Morocco. The distribution of histological subtypes by sex and smoking status was also assessed. this was a retrospective and descriptive study using medical records of patients with primary lung cancer, diagnosed at two university hospitals in Morocco between 2014 and 2017. a total of 606 patients (average age = 58.5 ± 10.64 years, men = 521) were included. Four hundred and forty-three men had a history of smoking against sex women. Most patients (85.68%) had respiratory symptoms at diagnosis. Over half of patients (53.03%) had a performance status <2 and 38.94% had at least another pulmonary disease at presentation. Chronic obstructive pulmonary disease (COPD) and tuberculosis were present in 23.43% and 18% of patients, respectively. The majority (72.27%) of men practiced an occupation associated with a significant risk of lung cancer. Adenocarcinoma was the main histological type in our series with 60.40%. Most (79.55%) patients were diagnosed at stage IV. Only 7.83% of patients benefited from surgery. The distribution of histological subtypes by sex and smoking habits showed that adenocarcinoma was more frequent in women (p=0.011), and squamous cell carcinoma in men (p=0.014). No differences between smokers and non-smokers were noted. our results showed a decrease in the age of diagnosis and a late stage of the disease. Adenocarcinoma was the most frequent histological type.

Is classical Hodgkin lymphoma a different disease in the elderly? A single-center retrospective cohort study.

Although the clinical features and treatment results of Hodgkin lymphoma (HL) in young adults are well known, it is thought that the disease may have different characteristics in elderly patients with HL, which constitutes almost 25% of the group. In this study, our aim is to evaluate the clinicopathological features, treatment outcomes, and survival of elderly classical Hodgkin lymphoma (CHL) patients. Patients aged 60 and over who were treated with a diagnosis of CHL were included in our retrospective cohort study. Patients under the age of 60, those with a diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) were excluded from the study. The median age of 51 patients in the study was 66 (60-76). Forty (78.4%) patients had at least one comorbid disease. The most common histological subtype was mixed cellular HL (n = 23, 45%) and 23 (45%) patients had B-symptoms. Thirty-two (62.8%) patients were in the advanced stage. The most preferred regimen in first-line treatment was doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) combination chemotherapy (n: 45; 88.2%). Forty-three (84.3%) patients were able to complete the initially planned treatment. Complete response was achieved in 34 (66.7%) patients. During the median follow-up period of 45.2 months, 23 (42.6%) patients had died. The 5-year OS was 57.4%. In conclusion, it was observed that the distribution of histological subtypes was different in elderly patients with CHL, B-symptoms were more common in elderly patients, and OS decreased with increasing age.

The effect of race/ethnicity on histological subtype distribution, stage at presentation and cancer specific survival in urethral cancer

ObjectiveTo test the effect of race/ethnicity on histological subtype, stage at presentation, and cancer specific mortality (CSM) in urethral cancer patients. Material and MethodsStratified analyses (Surveillance, Epidemiology and End Results [2004–2016]) tested the effect of race/ethnicity on histology and stage. Cumulative incidence-plots and multivariable competing-risks regression models (CRR), addressed CSM, after matching for TNM-stage, histology, age, and gender. ResultsOf 1,904 urethral cancer patients, 71% were Caucasian, 16% African American, 7% Hispanic and 5% other. African Americans were younger (66 years) than Caucasians (73 years) and Hispanics (74 years). In African Americans, adenocarcinoma (25%) and squamous cell carcinoma (SCC; 29%) were more frequent than in Caucasians (12% and 23%) or Hispanics (15% and 20%). African Americans with adenocarcinoma exhibited higher stage than other adenocarcinoma patients. In CRR, African Americans (35%) and Hispanics (29%) exhibited highest and second highest 3-year CSM, even after matching. After further multivariable adjustment of matched CRRs, CSM was higher in Hispanics (HR: 1.93, P= 0.03) and in African Americans (Hazard ratio 1.35, P= 0.07), relative to Caucasians. ConclusionRace/ethnicity impacts important differences on urethral cancer patients. African American race/ethnicity predisposes to higher rate of SCC and adenocarcinoma. Moreover, African Americans are younger and present with higher stage at diagnoses. Finally, even after most detailed matching for stage, age, gender, and adjustment for treatment and systemic therapy and socioeconomic status, African Americans and Hispanics exhibit higher CSM than Caucasians.

The Phenotype and Genotype of Congenital Myopathies Based on a Large Pediatric Cohort

BackgroundCongenital myopathies (CMs) are a clinically and genetically heterogeneous group of hereditary muscular disorders. The distribution of genetic and histologic subtypes has been addressed in only a few cohorts, and the relationship between phenotypes and genotypes is only partially understood. MethodsThis is a retrospective cross-sectional data collection study conducted at a single center. The clinical, histopathological, and molecular characterization of 104 patients with CM is reported. ResultsThe most common histopathological subtype was core myopathy (42%). Patients with severe endomysial fibrosis were more commonly unable to walk than patients with only a mild-grade endomysial fibrosis (56% vs 16%). Inability to walk was also more prevalent in patients with severe fatty replacement (44% vs 19%). The genetic etiology was more frequently identified among those patients with “specific” histologic findings (74% vs 62%). A definite molecular diagnosis was reached in 65 of 104 patients (62%), with RYR1 (24/104) and TTN (8/104) being the most frequent causative genes. Neonatal onset occurred in 56%. Independent ambulation was achieved by 74%. Patients who walked late were more likely to become wheelchair-dependent. Respiratory support was needed in one of three patients. Gastrostomy placement was required in 15%. Cardiac involvement was observed in 3%, scoliosis in 43%, and intellectual disability in 6%. ConclusionsThis study provides an updated picture of the clinical, histopathological, and molecular landscape of CMs. Independently of the causative gene, fibrosis and fatty replacement in muscle biopsy specimens are associated with clinical severity. Mutations in TTN are responsible for a higher proportion of cases than previously thought.

Cancer statistics for adolescents and young adults, 2020.

Cancer statistics for adolescents and young adults (AYAs) (aged 15-39 years) are often presented in aggregate, masking important heterogeneity. The authors analyzed population-based cancer incidence and mortality for AYAs in the United States by age group (ages 15-19, 20-29, and 30-39 years), sex, and race/ethnicity. In 2020, there will be approximately 89,500 new cancer cases and 9270 cancer deaths in AYAs. Overall cancer incidence increased in all AYA age groups during the most recent decade (2007-2016), largely driven by thyroid cancer, which rose by approximately 3% annually among those aged 20 to 39 years and 4% among those aged 15 to 19 years. Incidence also increased in most age groups for several cancers linked to obesity, including kidney (3% annually across all age groups), uterine corpus (3% in the group aged 20-39 years), and colorectum (0.9%-1.5% in the group aged 20-39 years). Rates declined dramatically for melanoma in the group aged 15 to 29 years (4%-6% annually) but remained stable among those aged 30 to 39 years. Overall cancer mortality declined during 2008 through 2017 by 1% annually across age and sex groups, except for women aged 30 to 39 years, among whom rates were stable because of a flattening of declines in female breast cancer. Rates increased for cancers of the colorectum and uterine corpus in the group aged 30 to 39 years, mirroring incidence trends. Five-year relative survival in AYAs is similar across age groups for all cancers combined (range, 83%-86%) but varies widely for some cancers, such as acute lymphocytic leukemia (74% in the group aged 15-19 years vs 51% in the group aged 30-39 years) and brain tumors (77% vs 66%), reflecting differences in histologic subtype distribution and treatment. Progress in reducing cancer morbidity and mortality among AYAs could be addressed through more equitable access to health care, increasing clinical trial enrollment, expanding research, and greater alertness among clinicians and patients for early symptoms and signs of cancer. Further progress could be accelerated with increased disaggregation by age in research on surveillance, etiology, basic biology, and survivorship.