Evidence Of Cancer Recurrence Research Articles

Leveraging GPT-4 for identifying cancer phenotypes in electronic health records: a performance comparison between GPT-4, GPT-3.5-turbo, Flan-T5, Llama-3-8B, and spaCy's rule-based and machine learning-based methods.

Accurately identifying clinical phenotypes from Electronic Health Records (EHRs) provides additional insights into patients' health, especially when such information is unavailable in structured data. This study evaluates the application of OpenAI's Generative Pre-trained Transformer (GPT)-4 model to identify clinical phenotypes from EHR text in non-small cell lung cancer (NSCLC) patients. The goal was to identify disease stages, treatments and progression utilizing GPT-4, and compare its performance against GPT-3.5-turbo, Flan-T5-xl, Flan-T5-xxl, Llama-3-8B, and 2 rule-based and machine learning-based methods, namely, scispaCy and medspaCy. Phenotypes such as initial cancer stage, initial treatment, evidence of cancer recurrence, and affected organs during recurrence were identified from 13646 clinical notes for 63 NSCLC patients from Washington University in St. Louis, Missouri. The performance of the GPT-4 model is evaluated against GPT-3.5-turbo, Flan-T5-xxl, Flan-T5-xl, Llama-3-8B, medspaCy, and scispaCy by comparing precision, recall, and micro-F1 scores. GPT-4 achieved higher F1 score, precision, and recall compared to Flan-T5-xl, Flan-T5-xxl, Llama-3-8B, medspaCy, and scispaCy's models. GPT-3.5-turbo performed similarly to that of GPT-4. GPT, Flan-T5, and Llama models were not constrained by explicit rule requirements for contextual pattern recognition. spaCy models relied on predefined patterns, leading to their suboptimal performance. GPT-4 improves clinical phenotype identification due to its robust pre-training and remarkable pattern recognition capability on the embedded tokens. It demonstrates data-driven effectiveness even with limited context in the input. While rule-based models remain useful for some tasks, GPT models offer improved contextual understanding of the text, and robust clinical phenotype extraction.

Pneumorrhachis With FDG Uptake Cervical Lesions on PET/CT of a Patient With Suspected Recurrent Hypopharyngeal Cancer.

A 57-year-old man presented with odynophagia for 1 week was referred for FDG PET/CT scan to rule out recurrent hypopharyngeal cancer. The FDG PET/CT showed hypermetabolic lesions in hypopharyngeal area and adjacent cervical spine with pneumorrhachis, the presence of intraspinal air, on attenuation CT images, which might indicate a life-threatening infection. An emergency MRI confirmed the presence of cervical spondylodiscitis with an epidural abscess. The patient rapidly progressed to quadriplegia and difficulty voiding on the same day as the PET/CT scan, leading to emergent operation. The patient received antibiotics treatment and discharged 4 months later without evidence of cancer recurrence.

Electromyography findings in radiation-induced unilateral tongue immobility.

We used electromyography to characterize hypoglossal nerve function among radiation-treated head and neck cancer survivors with later onset unilateral tongue immobility. Patients with unilateral tongue immobility without evidence of recurrent cancer were seen at a tertiary academic institution between February and September 2021. All patients were at least 2 years post-treatment with radiation therapy for head and neck squamous cell carcinoma. Participants were under annual surveillance and displayed no evidence of operative injury to the hypoglossal nerve. The median symptom-free interval for the 10 patients included in this study was 13.2 years (range 2-25 years). Myokymia alone was present in 3 of 10 patients, fibrillation potentials alone were present in 3 of 10 patients, and 1 subject displayed both fibrillation and myokymia. Three out of 10 patients had normal hypoglossal nerve function. These findings highlight how disparate mechanisms may underlie similar clinical presentations of radiation-induced neuromuscular dysfunction.

Clinical Observation and Analysis of Thyroglossal Duct Cyst Carcinoma: A Report of 5 Cases.

Thyroglossal duct cyst carcinoma (TGDCCa) is a rare condition with only approximately 300 cases reported to date. There is a lack of comprehensive reporting on its clinical manifestations, ultrasound, contrast-enhanced computed tomography, magnetic resonance imaging (MRI) features, immunophenotyping, procedure, and prognosis following modified Sistrunk's procedure. This study aimed to address these gaps by analyzing and summarizing the clinical features of 5 cases of papillary carcinoma arising in thyroglossal duct cysts (TGDC).Five patients with papillary carcinoma in TGDC treated by modified Sistrunk's procedure were included. Their clinical manifestation, physical examination findings, iconography, pathological findings, treatment, and outcomes were analyzed in aiding the diagnosis and treatment of TGDCCa. Immunohistochemistry was used to confirm the papillary carcinoma subtype. The BRAFV600E mutation was detected in 2 patients. No evidence of cancer recurrence, distant metastases, and malignant changes in the thyroid was found after a mean follow-up of 29.8 months.The management of TGDCCa with papillary carcinoma in low-risk patients can be accomplished by performing a modified Sistrunk's procedure along with a regular follow-up imaging of the thyroid and neck. Although postoperative pathological diagnosis is the gold standard for diagnosis, it is equally crucial to comprehend the clinical manifestations and auxiliary diagnostic techniques before surgical intervention.

Value-driven colorectal cancer survivorship through partnership with primary care.

6649 Background: The risk of recurrence for colorectal cancer (CRC) is low after 5 years (<1.5% per year) hence, surveillance visits, CEA blood tests and annual CT scans are not recommended beyond this period (NCCN guidelines). Importantly, right-siting survivorship care to the community allows primary care providers (PCP) to focus on preventive health beyond cancer. The National University Cancer Institute, Singapore, a tertiary, academic cancer center developed a program to transition CRC survivorship care to the community after 5-years of active surveillance. Patients (Pts) are discharged to the community with a survivorship care plan and followed-up via phone calls. We hypothesize that by transitioning CRC survivors to the community, we can optimize healthcare resources by reducing specialist visits and tests at the cancer center without compromising outcomes. Methods: From July 2018, CRC pts beyond 5-years from diagnosis with no evidence of cancer recurrence were eligible for transition. Pts were followed prospectively to determine date of cancer recurrence, issues preventing transition to the community and a phone survey on pt satisfaction was conducted for those who transitioned to primary care. Data on healthcare utilization amongst pts who transitioned vs. pts who remained in tertiary care was collected. Data cutoff was June 2022. Statistical analysis was performed with IBM SPSS Statistics (v28.0). Results: Between July 2018 - June 2022, there were 791 CRC pts who were eligible for transition, of which 534 pts (67.5%) had no clinical issues preventing transition and included in this analysis. 54.3% (N= 290) were males and stage distribution of cancers were 14.2%, 34.0%, 47.1% and 4.7% for stages I, II, III and IV, respectively. The mean number of years since diagnosis was 6.88 (range: 5-16 years; SD 2.25). 380 pts (71.2%) were transitioned to the community. There was consistently higher utilization of healthcare resources in the group not transitioned vs. transitioned: mean number of consults (2.86 vs 1.02; p<0.001); CEA (1.23 vs 0.31; p<0.001); CT scans (0.08 vs 0.05; p=0.221) and colonoscopies (0.25 vs 0.16; p=0.031). Mean healthcare expenditure (mean gross bill per year) was consistently higher in pts across all categories for the group not transitioned vs. transitioned: consults ($158 vs $56; p<0.001); CT scans ($60 vs $39; p=0.273); CEA ($26 vs $7; p<0.001) and colonoscopies ($208 vs $126; p=0.018). Importantly, recurrence rates were low with no difference in both groups (0.8% vs 1.3%; p=0.629). 82% of CRC pts were satisfied or very satisfied with follow-up care provided by their PCPs on a subsequent survey. Conclusions: We have demonstrated value-driven survivorship care by right-siting CRC survivors into the community. Healthcare resources were optimized with reduction in specialist visits and tests which lead to lower costs while recurrence rates remain low. Pt satisfaction in the community was also high.

Forearm Muscle Activity During the Handgrip Test in Breast Cancer Survivors: A Cross-Sectional Study

Introduction/BackgroundBreast cancer survivors (BCS) frequently show upper limb dysfunctions. The forearm muscle activity measured by surface electromyography (sEMG) in this population has not been studied. This study aimed to describe forearm muscle activity in BCS, as well as to assess its possible relationship with other variables related to upper limb functionality and cancer-related fatigue (CRF). Materials and MethodsA cross-sectional study was carried out including 102 BCS as volunteers at a secondary care in Malaga, Spain. BCS were included if they were aged between 32 and 70 years old, without evidence of cancer recurrence at the time of recruitment. The forearm muscle activity (microvolts, µV) was assessed by sEMG during the handgrip test. The handgrip strength was assessed by dynamometry (kg), the upper limb functionality (%) was measured by the upper limb functional index (ULFI) questionnaire and the CRF was also assessed by revised Piper Fatigue Scale (0-10 points). ResultsBCS reported reduced forearm muscle activity (287.88 µV) and reduced handgrip strength (21.31 Kg), a good upper limb functionality (68.85%), and a moderate cancer-related fatigue (4.74). Forearm muscle activity showed a poor significant correlation (r = –0.223, P = .038) with the CRF. Handgrip strength showed a poor correlation with the upper limb functionality (r = 0.387, P < .001) and age (r=-0.200, P = .047). ConclusionBCS showed a reduced forearm muscle activity. BCS also presented a poor correlation between forearm muscle activity and handgrip strength. Both outcomes tended to lower values with higher levels of CRF, while preserving a good upper limb functionality.

A CASE OF PERSISTENT IN-SITU PULMONARY THROMBOSIS DESPITE LONG-TERM ANTICOAGULATION THERAPY

TYPE: Case Report TOPIC: Pulmonary Vascular Disease INTRODUCTION: In-situ pulmonary thrombosis refers to de novo thrombus formation in the pulmonary arteries without any distant source. In-situ thrombosis has been associated with radiation therapy and lung lobectomy. However, little is known about thrombosis resolution after anticoagulation therapy. We present a case of a patient with a persistent pulmonary thrombus despite adequate anticoagulation therapy. CASE PRESENTATION: A 70-year-old male with a past medical history of chronic obstructive lung disease, right-sided lobectomy secondary to non-small cell lung cancer, and subsequent restrictive lung disease due to lobectomy and radiation therapy presented to the pulmonary clinic with shortness of breath. Further evaluation that included a CT scan of the chest with contrast revealed an incidental in-situ thrombosis in the right main pulmonary artery extending into the right upper lobar branch. There was no evidence of cancer recurrence. Previous imaging did not reveal a similar thrombosis. Venous duplex and echocardiography were normal. The patient was anticoagulated with rivaroxaban for over nine months and remained on anticoagulation. Despite this, follow-up imaging has not demonstrated resolution, propagation, or improvement of the thrombus. After optimization of his comorbidities, the patient has remained symptom-free. DISCUSSION: In-situ pulmonary thrombosis may be associated with prior lung radiation therapy and lobectomy. While studies have shown that most pulmonary embolisms resolve over three months with anticoagulation, little is known about the resolution of in-situ thrombosis. CONCLUSIONS: Pulmonary thrombosis may become chronic despite anticoagulation. Therefore, it may be clinically relevant to identify the speed of clot resolution for evaluating patients with suspected recurrent thrombosis. DISCLOSURE: Nothing to declare. KEYWORD: IN-SITU PULMONARY THROMBOSIS, RADIATION THERAPY, LOBECTOMY, ANTICOAGULATION

Unexpected High-Grade Neuroendocrine Carcinoma in Lung Explant

<h3>Introduction</h3> Rarely, malignancies are incidentally detected in lung transplant (LT) explants. These can remain unidentified before LT due to significant architectural distortion of the lung parenchyma, despite appropriate radiographic surveillance. <h3>Case Report</h3> We present the case of a 74-year-old man with history of bilateral LT (03/2021), complicated by grade 2 primary graft dysfunction, for fibrotic hypersensitivity pneumonitis after which a high-grade neuroendocrine carcinoma was unexpectedly found in the right explanted lung. The tumor was 2.1 cm and 3/11 peribronchial lymph nodes were positive for metastatic carcinoma. The left lung explant was negative for malignancy. The tumor was strongly positive for TTF-1 and synaptophysin (<b>Figure 1</b>) with dot-like positivity of the pancytokeratin (AE1/AE3) and CAM 5.2 stains. Tumor cells were negative for CD45, PHH3 demonstrated >50 mitoses/10 high-power fields, and MIB-1 highlighted approximately 60% of tumor nuclei. Whole-body imaging was negative for other masses or acute processes. Maintenance immunosuppression was decreased, and the patient was discharged after LT in stable condition with need for outpatient oncology follow-up. Given the aggressive nature of the explant tumor, the patient decided to pursue adjuvant chemotherapy after recovery from the early post-LT period. The patient received 2 cycles of carboplatin/etoposide, but further treatment was stopped due to severe pancytopenia and need for blood products including platelets. At 6 months post-LT, allograft function is stable - FEV₁ at 2.56 L (88%) - with no evidence of acute cellular rejection or antibody-mediated rejection. There is no evidence of cancer recurrence. <h3>Summary</h3> This is a rare case of high-grade neuroendocrine carcinoma in a lung explant after LT. Recommended etoposide/platinum-based chemotherapy may be limited by adverse effects. Prognosis and feasibility of adjuvant chemotherapy after LT is insufficiently understood.

Spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis: a case report

BackgroundSpindle cell squamous cell carcinoma is an uncommon variant of squamous cell carcinoma; its diagnosis is sometimes challenging because it histopathologically resembles neoplastic or reactive spindle cell lesions of mesenchymal origins. Here, we report a rare case of spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis.Case presentationA 69-year-old Japanese man presented with pain and a polypoid mass on the lower left gingiva. He had received chemoradiotherapy for squamous cell carcinoma of the buccal mucosa 15 years prior to this consultation. In addition, he was treated for mandibular osteonecrosis 6 years after chemoradiotherapy without evidence of cancer recurrence. A biopsy revealed atypical spindle or pleomorphic cells scattered in the edematous and fibrin-rich stroma; however, no malignant squamous components were apparent. These atypical cells frequently contained neutrophils within their cytoplasm that formed cell-in-cell figures. Immunohistochemically, the atypical cells were negative for cytokeratins, epithelial membrane antigen, and E-cadherin, but positive for p63, vimentin, and p53. Although these findings suggested spindle cell squamous cell carcinoma, it was difficult to reach a definitive diagnosis. Based on a clinical diagnosis of a malignant tumor, the patient underwent a hemimandibulectomy. The surgically resected specimen had a typical spindle cell squamous cell carcinoma histology consisting of biphasic spindle cells and conventional squamous cell carcinoma components. Moreover, the surgical specimen also exhibited spindle tumor cells that frequently included neutrophils, around which intense staining for lysosomal-associated membrane protein 1 and cathepsin B was observed. This suggested that the cell-in-cell figures represent active neutrophil phagocytosis by tumor cells, and not emperipolesis.ConclusionThe presence of neutrophil phagocytosis may be a potent indicator of malignancy.

"Will It Affect Our Chances of Having Children?" and Feeling "Like a Ticking Bomb" -The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer.

Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence.Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18–45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses.Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important.Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an “add-on” was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.

Treatment and Outcomes of Early Stage Breast Cancer in Patients with Hepatic Dysfunction

BackgroundThere exists a dogma of surgical nihilism for patients with cirrhosis and breast cancer causing de-escalation of surgery and impacting survival. We hypothesized that breast cancer surgery would not result in a significant change in the Model for End-Stage Liver Disease-Sodium (MELD-Na) scores before and after surgery. MethodsWe performed a single institutional retrospective review of medical records between January 2013 and July 2019 of patients with concurrent cirrhosis and breast cancer. We used the nonparametric Friedman test to compare differences in MELD-Na scores. ResultsEight patients with both cirrhosis and breast cancer were identified. Median follow-up was 30.5 mo. Half of the patients had Child-Pugh class A cirrhosis and half had Child-Pugh class B cirrhosis. Six (75%) patients underwent lumpectomy and two (25%) underwent mastectomy. There was no statistically significant difference (P = 0.66) in median MELD-Na score before surgery (16) and after surgery (18). Two (25%) patients experienced postoperative complications. Three patients were listed for liver transplantation. Of three listed patients, two (25%) patients underwent successful liver transplantation after breast surgery. One (12.5%) patient died without transplant. Three (37.5%) patients were alive for more than 5 y after breast cancer diagnosis without evidence of cancer recurrence. The eighth patient has remained breast cancer free for more than 6 mo since her surgery. ConclusionsSurgery for patients with Child-Pugh class A and B cirrhosis and early stage breast cancer did not result in a significant change in MELD-Na score before and after surgery, suggesting that selected patients may benefit from breast cancer surgery with curative intent.

Residual esophageal necrosis after radical esophagectomy for esophagogastric cancer: A case report.

A 66-year-old man was diagnosed with advanced esophagogastric junction cancer and referred to our institution (Department of Gastroenterological Surgery, Chiba Cancer Center) for treatment. Computed tomography imaging confirmed the presence of a tumor, extending from the lower thoracic esophageal to the esophagogastric junction, with swelling of the upper mediastinal lymph nodes. Based on the criteria of the International Union against Cancer Committee (UICC, 8th Edition), the staging was confirmed as follows: 101R, 107 and 106 pre. Based on these findings, a clinical diagnosis of EGJ cancer was made, with a UICC 8th classification of cT3N1M0 c-stage-III. Preoperative chemotherapy was performed, with tumor shrinkage obtained after three courses of chemotherapy (using S-1 plus oxaliplatin). Subsequently, esophagectomy with three-field lymph node dissection and gastric tube reconstruction, via the intrathoracic route, was performed. On postoperative day 2, the patient developed an idiopathic pneumothorax, with brown-green drainage from the chest tube. A repeat thoracotomy was performed, confirming the presence of brown-green pleural fluid and necrosis of esophageal tissue. The area of necrosis was situated 4 cm on the oral side of the anastomosis, with greater necrosis of the right than left side. There was no evidence of necrosis of the gastric tube. The necrotic residual esophagus was excised and reconstructed, as an external fistula on the left side of the neck. On day 38, after the second surgery, reconstruction of the esophageal conduit and gastric tube, via the jejunum, was performed. At 7 months after discharge, the patient was symptom free, with no evidence of cancer recurrence.

Reconstructed uterine length is critical for the prevention of cervical stenosis following abdominal trachelectomy in cervical cancer patients.

Although the procedure of abdominal trachelectomy has been remarkably improved, preventing subsequent cervical stenosis remains challenging. In this study, we analyzed the clinicopathological risk factors for cervical stenosis to explore the appropriate surgical procedures for the prevention of cervical stenosis following trachelectomy. Thirty-two patients who underwent abdominal extended and radical trachelectomy were assessed retrospectively (median follow-up period = 33 months). To evaluate the risk factors, the clinicopathological factors were analyzed by univariate and multivariate analyses. The reconstructed uterine length (UtL), that is, the length between the vaginal end of the neo-cervix and the uterine fundus, was measured by transvaginal ultrasound after surgery. The cut-off value for the UtL was assessed by a receiver operating characteristic (ROC) curve analysis. Cervical stenosis of any grade was observed in 12 patients (grade 1 = 9, grade 3b = 3). Among the various clinicopathological factors, the UtL and cervical length (CL) were significantly related to cervical stenosis following trachelectomy. The multivariate analysis revealed that the UtL, but not CL, is an independent risk factor for stenosis. The ROC curve analysis revealed that stenosis was significantly more likely to occur in patients with a UtL shorter than 53 mm (area under the ROC curve = 0.902). UtL in the patients who became pregnant was longer than that in the patients who did not. No evidence of recurrent cancer was observed during the follow-up period. Our proposed method may provide a functional reconstructed uterus with preserving fertility by remaining UtL more than 53 mm.

MON-356 Disseminated Histoplasmosis Mimicking Metastatic Rectal Cancer

Background: Various etiologies account for bilateral adrenal masses including infections, malignancies and adrenal hemorrhage. Accurate diagnosis is needed to provide the best care for the patient. Clinical case: A 63-year-old Thai male patient with locally advanced rectal cancer was treated with concurrent chemoradiotherapy in 2013. He had been followed up at the oncology clinic regularly after his cancer treatment and there was no evidence of cancer recurrence. In early 2018, he presented with anorexia, weight loss and non-productive cough. His chest X-ray showed the presence of patchy opacity of the left lung. The CT of the chest and whole abdomen revealed multiple bilateral pulmonary nodules, bilateral adrenal masses (sized 3.4x5.4 and 4.3x5.5 cm) and an enlarged spleen without definite space-taking lesion. At that time, he was diagnosed with recurrent rectal cancer and presented at the emergency department due to acute diarrhea and hypotension. Multiple discrete umbilicated papules at face, tongue and hands were noted on the physical examination. Hypotension persisted after volume resuscitation. Random cortisol level was 11 µg/dL before hydrocortisone was initiated. Wright stain of the skin lesion showed intracellular yeast-like organism and culture of the skin biopsy showed Histoplasma capsulatum. Bone marrow involvement from the same organism was also documented. After reviewing his clinical course, the diagnosis was compatible with disseminated histoplasmosis (skin, pulmonary, adrenal, spleen and bone marrow involvement). He was treated with amphotericin B for 3 weeks before switching to itraconazole. Two months after antifungal treatment, CT showed increased in size and number of multiple hypodensity lesions at spleen. Therefore, bilateral adrenalectomy with splenectomy was performed without complication. Pathological findings showed diffuse necrotizing areas with surrounded histiocytes, foamy macrophages and multinucleated giant cells in both adrenal glands and spleen. GMS showed presence of numerous small ovoid yeasts, compatible with histoplasmosis. This patient had been doing well with his long-term treatment with itraconazole and glucocorticoid replacement. Conclusion: This was the case of disseminated histoplasmosis whose presentation mimicked metastatic rectal cancer. Misdiagnosis caused delay in the diagnosis and treatment of adrenal insufficiency.

High Risk Breast Cancer Patient with Silicone Breast Implant and Q Inside SafetyTM Micro Transponder

Motiva Implants® (Establishment Labs Holdings Inc., NY, USA) contains a RFID micro transponder RFID(RT) (RT = registered trademark) known as Q Inside Safety Technology which provides an added safety feature embedded in the shell of the Motiva breast implant [1] [2]. Because this RFID micro transponder has Ferric components, a concern over breast MRI imaging susceptibility artifact has arisen. Among breast images, a single high risk breast cancer patient was imaged at our institution (January 2018). All breast imaging modalities were used to determine if this high risk patient had a recurrence of her cancer or any new breast cancer. The MRI showed a susceptibility artifact on the posterior margin of the implant but breast ultrasound showed no abnormalities in the area of the susceptibility artifact. By using high risk screening including Mammography, Tomosynthesis, Breast Ultrasound and Breast MRI, an adequate survey of the high risk patient was completed [3]. Our high risk clinic examined the patient and the imaging results and came to the following conclusion: This patient showed no evidence of recurrent cancer and no new masses were identified. The conclusion was BIRADS 2 benign: normal findings post-mastectomy and implants. Recommendation was for routine high risk screening at yearly interval.

Analysis of unexplained carcinoembryonic antigen elevation after curative treatment of locally advanced rectal cancer.

To analyze the causes and patterns of unexplained carcinoembryonic antigen (CEA) elevation after curative treatment in locally advanced rectal cancer patients. Among the 1309 locally advanced rectal cancer patients treated with curative resection and radiotherapy between January 2001 and June 2011, 325 patients who postoperatively developed abnormal CEA elevation were reviewed. The unexplained CEA elevation was defined as a CEA level higher than 5ng/mL with no evidence of cancer recurrence at the time of elevation. Of the 325 patients, 143 (44%) had unexplained CEA elevations. The causes were categorized as delayed recurrence (n = 29, 20%), non-colorectal malignancy (n = 10, 7%), and non-malignancy-related conditions (n = 104, 73%). Shorter intervals between treatment and the first CEA elevation, and a higher peak CEA level, were observed in the delayed recurrence group compared with the non-colorectal malignancy or non-malignancy-related group (intervals of 6.8 vs. 44.9 vs. 23.2 months, respectively, p = 0.002; and peak CEA levels of 9.9 vs. 7.1 vs. 6.2ng/mL, respectively, p = 0.034). In patients who showed delayed recurrence, the interval between the first CEA elevation and diagnosis of recurrence was a median of 13.0months (range 3.8-60.6months). Smoking was the most common cause for non-malignancy-related conditions. The patterns of unexplained CEA elevations were defined as sporadic (n = 78, 55%), stationary (n = 37, 26%), and increasing (n = 28, 20%). The patterns were significantly different depending on the cause (p < 0.001). Analysis of the patterns of unexplained CEA elevations is a reasonable approach to predict the cause of the cancer.

Successful resection of liver metastasis detected by exacerbation of skin symptom in a patient with dermatomyositis accompanied by rectal cancer: a case report and literature review

BackgroundDermatomyositis (DM) is a rare syndrome that belongs to the group of idiopathic inflammatory myopathies. The association between DM and malignancy is well recognized, and the severity of DM symptoms has been linked to the progression of metastatic disease.Case presentationWe report the case of a 42-year-old man that was diagnosed with dermatomyositis (DM) and rectal cancer. Proctectomy was performed, and DM symptoms were resolved postoperatively. One year and 9 months after the surgery, liver metastasis occurred accompanied by the exacerbation of DM symptom. Partial resection of the liver was performed, and postoperative course was uneventful. DM symptoms improved postoperatively, and no evidence of cancer recurrence or DM symptoms was observed 2 years after the second surgery. To date, few reports have described recurring cases of DM accompanied by colorectal cancer in detail. We reviewed four similar cases that were reported poor prognoses with treatment resistance. However, our case report demonstrates good long-term results with resection of metastatic lesion.ConclusionsIt is important to check the exacerbation of DM symptoms, as this symptom sometimes preceded cancer relapse during the follow-up of our patient with DM and colorectal cancer.

P1.05-059 Factors Associated with Recurrence and Survival in Patients with Curatively Resected Stage IA Adenocarcinoma of the Lung

Even when meticulously clinically and pathologically studied, completely resected stage IA adenocarcinoma of the lung does recur. However, there are few data regarding the patterns of recurrences and their risk factors in this population. Therefore, this study characterizes cancer recurrence and its risks and assesses recurrence-free survival in patients with curatively resected stage IA adenocarcinoma. Between January 1990 and December 2005, a total of 214 patients were given a final diagnosis of pathologic stage IA (UICC-7) adenocarcinoma of the lung. The medical records of these patients were retrospectively reviewed with regard to patient characteristics, tumor pathologic findings and follow up status. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. The median follow up after curative resection was 83 months. Cancer recurred in 28 patients (13%). Among them, local recurrence occurred in 10 patients (5%), whereas distant recurrence occurred in18 patients (8%). Recurrence earlier and later than 5 years after surgery was in 15 patients (7%) and in 13 patients (6%), respectively, with nearly constant risk. At 5 years after index resection, 175 patients (82%) were alive without evidence of cancer recurrence, 11 patients (8%) had experienced recurrence of cancer but still alive and 11 patients (5%) had died with non-cancer causes. Recurrence-free 5- and 10-year survival rates were 92.5 and 70.0%, respectively. Univariate analysis revealed five significant prognostic factors: gender (p=0.0177); lepidic component (p =0.0007); tumor location (p=0.0099); pleural invasion (p=0.0274) and lymphatic or vascular vessel invasion (LVI) (p< 0.0001). Multivariate analysis revealed lepidic component, tumor location, and LVI as significant factors. Hazard ratios for recurrence were 0.381 for having lepidic component (95% CI, 0.147-0.979; p= 0.0451), 0.361 for right sided tumor (95% CI, 0.188-0.692; p= 0.0022), and 2.785 for having LVI (95% CI, 1.392-5.555; p= 0.0038). Surgically “cured” stage IA adenocarcinoma of the lung recurs. Our analyses indicate no-lepidic component, tumor location, LVI as an independent indicator for cancer recurrence. Identifying high-risk patients for recurrence will simplify decision making for postoperative treatment strategies.

Care in the Final Month of Life among Adolescent and Young Adult Cancer Patients in Kaiser Permanente Southern California.

Little is known about the care that adolescent and young adult (AYA) patients with cancer receive at the end of life (EOL). To examine care in the last month of life among AYA patients with cancer. Medical record review of the last 30 days of life. One hundred eleven AYA patients aged 15-39 years at death with either stage I-III cancer and evidence of cancer recurrence or stage IV cancer at diagnosis. Patients received care in Kaiser Permanente Southern California, an integrated healthcare delivery system, and died from 2007 to 2010. Use of intensive measures, including chemotherapy in the last 14 days of life and emergency room visits, hospitalizations, and intensive care unit admissions in the last 30 days; documented care preferences; symptom prevalence and treatment; advance care planning; hospice use; and location of death. One hundred seven patients (96%) had documented care preferences in the last month of life. At first documentation, 72% of patients wished for life-prolonging care, 20% wished for care focused on comfort, and 8% were undecided. Forty-seven percent of patients had documented changes in preferences in the last month, with 40% wishing for life-prolonging care when preferences were last noted before death, 56% preferring comfort, and 4% undecided. Seventy-eight percent of patients received at least one form of intensive EOL care, including 75% of those who preferred comfort measures at last documentation. Many AYA patients enter the last month of life wishing for life-prolonging care. While most ultimately wish for comfort, intensive care is prevalent even among such patients.

Dysplasia Involves Enteritis Cystica Profunda in the Setting of Crohn’s Disease

Enteritis cystica profunda is a rare non-neoplastic condition characterized by misplaced glands deep to the muscularis mucosae of the small bowel, likely as a result of trauma or inflammation such as Crohn’s disease, a disease with increased risk for small bowel adenocarcinoma. Clinically, enteric cystica profunda and adenocarcinoma can present with obstruction and/or stricture in patients with Crohn’s disease and should be differentiated from each other. Neoplastic involvement of enteritis cystica profunda by dysplasia has not been reported previously. Herein, we report a case of enteritis cystica profunda involved by high-grade dysplasia of gastric type. High-grade dysplasia and intramucosal adenocarcinoma of gastric type were also present in the overlying mucosa. Additionally, the adjacent mucosa demonstrated marked chronic active enteritis with pyloric gland metaplasia. The neoplastic epithelium showed diffuse and strong nuclear immunoreactivity for p53. The presence of lamina propria deep to the dysplastic epithelium-lined cysts/diverticula supported a non-invasive nature of this lesion. No metastatic disease was noted in 15 nodes identified. All surgical resections were free of neoplasm. The patient was doing well 9 months after surgery without evidence of cancer recurrence or metastasis on abdominal computed tomography. J Med Cases. 2016;7(6):202-207 doi: https://doi.org/10.14740/jmc2415w