High Rate Of Malignancy Research Articles

P119 Hereditary Colorectal Cancer Syndromes and Inflammatory Bowel Diseases: an ECCO CONFER Multicenter Case Series

Abstract Background Hereditary colorectal cancer syndromes (HCCS) are rare polyposis or nonpolyposis syndromes with a higher risk of developing colorectal cancer (CRC). Coexisting inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), with HCCS is exceedingly rare and presumably increases the risk of early-onset colorectal cancer. Methods This was a multicenter case series performed as a part of the European Crohn’s and Colitis Organisation (ECCO) Collaborative Network of Exceptionally Rare case reports (CONFER) project. Results This report includes 26 patients with IBD (10 UC, 15 CD, and one with IBD unclassified (IBD-U)) and concomitant HCCS. Among these 26 patients (median age 33 years, IQR 20–44), 15 (57.7%) were males, 24 (92.3%) Caucasians and 2 (7.7%) of Arab origin. Among patients with UC, 4 (40%) had proctitis, 3 (30%) left-sided colitis and 3 (30%) an extensive disease; while, among patients with CD, 8 (53.3%) had ileal, 5 (33.3%) ileocolonic, 2 (13.3%) colonic disease. One of these patients had ileocolonic disease associated with upper disease location and six (40%) had an associated perianal disease. Many of patients with CD had a non-stricturing non-penetrating phenotype (53.3%, n=8), while 20.0% (n=3) and 26.7% (n=4) had a stricturing or penetrating phenotype, respectively. HCCS was diagnosed before the IBD diagnosis in 11 patients (42.3%), after diagnosis of IBD in 11 patients (42.3%) and concurrently in 4 patients (15.4%). Sixteen patients had Lynch syndrome, 7 had FAP, 2 had AFAP and one had MAP. The most frequent genetic mutations were those of APC (n=7) and MLH1 (n= 7). Thirteen patients were treated with immunomodulatory (IMM) therapy. During IMM therapy, only 5 patients developed drug-induced side-effects which did not require drug interruption. One patient treated with vedolizumab developed CRC, despite yearly colonoscopy surveillance, after 4 years of treatment. Overall, CRC developed in 38.5% of patients (n=10): in 5 patients (50%) after IBD diagnosis, in 4 (40%) patients before IBD diagnosis, and in 1 patient the 2 conditions were diagnosed simultaneously. Eighteen (69.2%) patients underwent colectomy or abdominal surgery: 9 patients due to CRC diagnosis, 7 patients preventively due to the underlying HCCS and 2 patients because of active IBD disease. On follow-up, one patient died due to CRC. Conclusion This case series describes the largest series to date of patients with IBD patients and HCCS, with special emphasis on the use of IMM in this population. The most frequent diagnosis of HCCS associated with IBD was Lynch syndrome. These data demonstrate the high malignancy rate and surgical intervention rate in this IBD cohort. The optimal medical approach still needs to be addressed.

Proliferative verrucous leukoplakia: a clinicopathological comparative study

A retrospective clinicopathological analysis was performed to compare 35 proliferative verrucous leukoplakia (PVL), 40 leukoplakia without dysplasia (LK), 48 oral lichen planus (OLP)/oral lichenoid lesions (OLL), and 11 verrucous carcinoma (VC) (N = 134). The PVL group comprised 24 female and 11 male patients (mean age 66.5 years), with two to six sites involved (mean 3.1 sites) and multiple biopsies over time (mean 7.1/case). All PVL cases developed malignancy: 77.1% squamous cell and 40% verrucous carcinoma; 68.6% had multiple sites of malignancy. None showed local or distant metastatic spread. Five-year disease-specific survival was 88.6%. In LK and OLP/OLL, malignant transformation was significantly lower than in PVL (2.5% and 2.1%, respectively). Invasive squamous cell carcinoma was not reported in any conventional VC. Immunohistochemical histomorphometric analysis for p53, COX-2, and podoplanin showed no significant differences between the groups. PVL may overlap with LK, OLP/OLL, and VC, but has a persistent aggressive behaviour and high malignant transformation rate. The overlapping features may delay recognition as PVL. The results emphasize the need for a detailed clinicopathological definition of PVL, and long-term close monitoring to ensure progression to PVL and malignancy are recognized in time. The management of this persistent aggressive condition is challenging.

Endoscopic and Pathological Characteristics of Cronkhite– Canada Syndrome: A Retrospective Analysis of 76 Cases

Cronkhite-Canada syndrome (CCS) is a disease of unknown etiology characterized by the presence of multiple gastrointestinal polyps, chronic diarrhea, loss of appetite, alopecia, onychodystrophy, and cutaneous hyperpigmentation. CCS is a rare disease with an incidence rate of 1 per million. Clinicians are not aware of this disease, and the discovery of gastrointestinal polyps is often a starting point for the diagnosis of this disease. By analyzing the endoscopic and pathological characteristics of CCS, this study aims to deepen our understanding of gastrointestinal polyposis and facilitate early diagnosis of CCS.We screened databases, including the Chinese Biomedical Literature Database (CBM Web), the China Academic Journals Fulltext Database (CJFD), and PubMed for CCS cases reported from January 2010 to January 2020, and conducted a retrospective analysis of endoscopic and pathological characteristics of these cases.The endoscopic data of the 76 retrieved cases revealed that CCS is gastrointestinal polyposis with the intensive and confluent distribution. The greater the number of polyps and the higher their distribution, the brighter their color. A pathological assessment revealed that both gastric polyps and intestinal polyps are mainly juvenile hamartomatous polyps and have a high malignant transformation rate. Interstitial edema, eosinophil infiltration, and cystic dilation of glands are common features of CCS polyps, distinguishing them from other gastrointestinal polyposis syndromes.CCS is a polyp disease different from other gastrointestinal polyposis. Analysis of its endoscopic and pathological characteristics can contribute to the understanding and early diagnosis of the disease.

Performance of the Bethesda System for Reporting Thyroid Cytology in Multi-Institutional Large Cohort of Pediatric Thyroid Nodules: A Detailed Analysis.

Background: To evaluate the performance of TBSRTC through multi-institutional experience in the paediatric population and questioning the management recommendation of ATA Guidelines Task Force on Paediatric Thyroid Cancer; Methods: A retrospective search was conducted in 4 institutions to identify consecutive thyroid FNAC cases in paediatric population between 2000 and 2018. Following the 2nd TBSRTC, the risk of malignancy ratios (ROMs) was given in ranges and calculated by 2 different ways. Sensitivity, specificity, PPV, NPV and DA ratios were calculated using histologic diagnosis as the gold standard; Results: Among a total of 405 specimens, the distribution of cases for each category was, 44 (11%) for ND, 204 (50%) for B category, 40 (10%) for AUS/FLUS, 36 (9%) for FN/SFN, 24 (6%) for SFM and 57 (14%) for M categories. 153 cases have a histological diagnosis. The ratio of surgery was 23% in ND, 16% in the B, 45% for AUS/FLUS, 75% for SFN/FN and 92% for SFM and 75% in M categories; Conclusions: The data underlines the high ROM values in paediatric population which might be clinically meaningful. The high rate of malignancy of the cohort of operated patients (50%) also underlines the need of better preoperative indicators for stratification. Considering that more than half of the nodules in AUS/FLUS category were benign, direct surgery recommendation could be questionable as proposed in ATA 2015 guidelines.

Assessment of quality of life of patients with oral sub mucous fibrosis before and after treatment with topical curcumin

Background and aim: Oral Submucous Fibrosis (OSMF) is potentially pre-malignant condition of the oral cavity with a high malignant transformation rate. The condition not only affects the oral function of the patients but has a huge impact on their social and psychological wellbeing affecting the overall quality of life. To evaluate the effectivity of the treatment assessing the quality of the life of these patients before and after treatment is of utmost importance but till now has not been an integral part of the management strategy. This study was carried to assess the change in quality of life before and after treatment with curcumin in patients with OSMF. Methods: Quality of life was assessed before and after 3 months of treatment with topical curcumin in 50 patients with OSMF using European Organization for Research and Treatment of Cancer Quality of Life head and neck Questionnaire (EORTC QLQ35). Results: At the end of 3 months there was significant (p < 0.05) change in the quality of life of patients with OSMF as suggested by assessment of the multi-item and single item scale used in the questionnaire. Conclusion: The study emphasizes the use of assessing Quality of life as an integral part of treatment strategy for OSMF and suggests curcumin as a promising treatment modality for patients with OSMF.

Colocolic intussusception because of lipoma in a 44-year-old adult

Lipoma is an uncommon mesenchymal tumor of the colon. They are typically symptom free, the large lipomas within the colon are rare, and can cause obstruction, bleeding, or intussusception. Intussusception is comparatively common in pediatrics and in adults, it could be a rare entity. Pathologic lesions are usually found with a major percentage of malignancy. This is a retrospective evaluation of an adult with an intestinal intussusception who underwent oncosurgical treatment. He was diagnosed with surgically proven intussusception. Using ultrasound and colonoscopy as diagnostic studies, colocolic intussusception was discovered. The patient underwent oncosurgical exploration. Intestinal resection with abrupt anastomosis was the procedure of choice for the patient. The etiology was benign lipoma. Adult intussusception should be evaluated in any patient with subacute abdominal discomfort with bearing in mind the high rate of malignancy and a lower rate of benign tumors. intestinal resection without reducing is highly recommended for colonic intussusceptions.

Second primary malignancies in chronic lymphocytic leukaemia: Skin, solid organ, haematological and Richter's syndrome.

Chronic lymphocytic leukaemia (CLL) is invariably accompanied by some degree of immune failure, and CLL patients have a high rate of second primary malignancy (SPM) compared to the general population. We comprehensively documented the incidence of all forms of SPM including skin cancer (SC), solid organ malignancy (SOM), second haematological malignancy (SHM) and separately Richter's syndrome (RS) across all therapy eras. Among the 517 CLL/small lymphocytic lymphoma (SLL) patients, the overall incidence of SPMs with competing risks was SC 31.07%, SOM 25.99%, SHM 5.19% and RS 7.55%. Of the 216 treated patients, 106 (49.1%) had at least one form of SPM, and 63 of 106 (29.2% of treated patients) developed an SPM 1.5 years (median) after treatment for their CLL. Melanoma accounted for 30.3% of SC. Squamous cell carcinoma (SCC), including eight metastatic SCCs, was 1.8 times more than basal cell carcinoma (BCC), a reversal of the typical BCC:SCC ratio. The most common SOMs were prostate (6.4%) and breast (4.5%). SHM included seven acute myeloid leukaemia (AML) and five myelodysplasia (MDS) of which eight (four AML, four MDS) were therapy‐related. Any SPM occurred in 32.1% of 53 Monoclonal B‐lymphocytosis (MBL) patients. Age‐adjusted standardised rates of SPM (per 100,000) for CLL, MBL and the general Australian population were 2648, 1855 and 486.9, respectively. SPMs are a major health burden with 44.9% of CLL patients with having at least one SPM, and apart from SC, associated with significantly reduced overall survival. Dramatic improvements in CLL treatment and survival have occurred with immunochemotherapy and targeted therapies, but mitigating SPM burden will be important to sustain further progress.

Laparoscopic Resection of Retroperitoneal Schwannoma: Report of 3 cases

Background: Schwannoma is a neoplasm that arises from Schwann cells in the peripheral nerve sheath. They are mainly benign tumors, Ohigashi T et al. reported that only 0.7% is located in the retroperitoneum and these are associated with a higher rate of malignancy. The preoperative diagnosis is a challenge due to its low frequency and the low specificity of imaging studies. Treatment consists of its complete surgical resection, avoiding its rupture since it is associated with local recurrences. The laparoscopic approach presents technical limitations due to the usually large size of these tumors, and few cases of laparoscopic excision have been reported in the world literature to date. Methods: the results of 3 retroperitoneal schwannomas of different location, size and complexity are presented, all resolved laparoscopically by a highly complex laparoscopic surgery team. Results: all surgeries were performed completely laparoscopically, there were no complications associated with the mini-invasive procedure and all the benefits of it were obtained. The anatomopathological and immunohistochemical examination was compatible with schwannomas in all 3 cases. To date, the patients do not present recurrences. Conclusions: although the location, size and relationship with other anatomical structures make the laparoscopic surgical approach difficult, with a well-trained team in laparoscopic surgery, these procedures can be performed safely, without increased morbidity and with all the benefits that mini-invasive procedures provide

Accurate segmentation of breast tumors using AE U-net with HDC model in ultrasound images

Breast cancer poses a great threat on women health due to its high malignant rate. In China, ultrasound screening is the commonly-used method for breast cancer diagnosis, and the localization and segmentation of the lesions in ultrasound images are helpful for breast cancer detection. In this paper, an Attention Enhanced U-net with hybrid dilated convolution (AE U-net with HDC) model was proposed and employed to segment the breast tumors in ultrasound images. First, based on Attention U-net, we added a new loss function to update the weight matrix in the AGs module, in order to enhance the weight of the lesion area. Combined with fine-tuning training method, the precision of breast ultrasound image lesion region segmentation was improved from 82.38% to 86.28% and the M-IOU was improved from 76.27% to 81.81%. Second, three groups of HDC with expansion rates of [1,2,5] were integrated into AE U-net to replace the four convolution operations. HDC module brought larger receptive field and reduced the loss of spatial information. The experimental results proved that HDC module was helpful to improve the Acc of image segmentation results from 94.18% to 95.81% and the Recall from 78.69% to 80.48%. Combined with U-net, the F1 score, AUC, Acc and M-IOU of the network proposed in this paper had significantly improved. It proved that AE U-net with HDC model would have very important research value and application prospect for modern medicine.

Prevalence and outcomes of cardiac amyloidosis in all-comer referrals for bone scintigraphy

Abstract Objectives Cardiac amyloidosis (CA) is increasingly identified as a cause of heart failure due to diagnostic advances and enhanced disease awareness. Screening ascertainments have unveiled a significant proportion of (coexisting) CA for various cardiac conditions, but the true prevalence of CA in the general population as well as prognostic implications remain unknown. Methods Consecutive all-comer referrals for 99mtechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy between January 2010 and August 2020 were included retrospectively. CA was defined as positive cardiac tracer uptake (Perugini grade 0: negative; grades 1 to 3: increasingly positive). Owing to the study design, CA subtype (transthyretin vs. light chain) was not assessed. Indications for DPD, laboratory, and clinical data were retrieved from medical records. Mortality was captured from the Austrian death registry. Combined hospitalization for heart failure (HHF) and all-cause death was defined as study endpoint. Outcome analysis was performed using Kaplan Meier estimates and multivariate Cox regression. Results 17202 scans from 11549 subjects (61.2±16.1 y/o, 62.9% female, 73.7% cancer patients) were analyzed. Follow-up scans for patients with >1 test yielded identical Perugini grades in all cases. Prevalence of CA for the overall population was 5.5% (n=638/11549; grade 1: 4.0%, grade 2/3: 1.5%), increased with age (<60 y/o: 2.5%, 60–70 y/o: 5.4%, 70–80 y/o: 7.6%, >80 y/o: 14.2%, p<0.001, Figure), and was higher in men vs. women (7.4% vs. 4.4%, p<0.001). Also, CA was more prevalent in cardiac (19.1%, n=207/1081) vs. non-cardiac referrals (4.1%, n=431/10468; p<0.001). Across all age groups of non-cardiac referrals, CA patients more often had atrial fibrillation and cardiomyopathy, and displayed worse renal function (p for all<0.05). Following DPD, 3490 patients (30.2%) had reached the study endpoint (84 HHF, 3313 death, 93 both) after 5.9±3.3 years. By Kaplan Meier estimates, the presence of CA among all-comers predicted adverse outcomes (log-rank, p<0.001, Figure). After adjustment for age and cancer, CA remained significantly associated with outcomes by multivariate Cox regression (hazard ratio [HR]: 1.30, 95% confidence interval [CI] 1.14–1.48, p<0.001). This effect was consistent across subgroups of cardiac (HR: 1.41, 95% CI 1.06–1.89, p=0.018) and non-cardiac referrals (HR: 1.20, 95% CI 1.03–1.39, p=0.018). Outcomes were similar in grade 1 vs. 2/3 CA patients (p>0.05). Conclusion Cardiac tracer uptake is present in 1 in 20 patients referred for bone scintigraphy, and independently predicts prognosis – even in this population with significantly reduced life expectancy due to the high rate of malignancy. With novel CA-specific drugs available – especially for transthyretin CA – diagnosis of CA is even more crucial to improve patient outcomes. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer Cardiac Tracer Uptake in DPD Referrals

Comparison of Afirma GEC and GSC to Nodules Without Molecular Testing in Cytologically Indeterminate Thyroid Nodules.

BackgroundAnalysis of cytologically indeterminate thyroid nodules with Afirma Gene Expression Classifier (GEC) and Genomic Sequencing Classifier (GSC) can reduce surgical rate and increase malignancy rate of surgically resected indeterminate nodules.MethodsRetrospective cohort analysis of all adults with cytologically indeterminate thyroid nodules from January 2013 through December 2019. We compared surgical and malignancy rates of those without molecular testing to those with GEC or GSC, analyzed test performance between GEC and GSC, and identified variables associated with molecular testing.Results468 indeterminate thyroid nodules were included. No molecular testing was performed in 273, 71 had GEC, and 124 had GSC testing. Surgical rate was 68% in the group without molecular testing, 59% in GEC, and 40% in GSC. Malignancy rate was 20% with no molecular testing, 22% in GEC, and 39% in GSC (P = 0.022). GEC benign call rate (BCR) was 46%; sensitivity, 100%; specificity, 61%; and positive predictive value (PPV), 28%. GSC BCR was 60%; sensitivity, 94%; specificity, 76%; and PPV, 41%. Those with no molecular testing had larger nodule size, preoperative growth of nodules, and constrictive symptoms and those who underwent surgery in the no molecular testing group had higher body mass index, constrictive symptoms, higher Thyroid Imaging Reporting and Data System and Bethesda classifications. Type of provider was also associated with the decision to undergo surgery.ConclusionImplementation of GEC showed no effect on surgical or malignancy rate, but GSC resulted in significantly lower surgical and higher malignancy rates. This study provides insight into the factors that affect the real-world use of these molecular markers preoperatively in indeterminate thyroid nodules.

Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review.

Objective:This report serves to showcase four cases of rare, malignant primary neoplasms of the anterior chest wall [chondrosarcoma and basal cell carcinoma (BCC)] that thoracic surgeons may encounter, and different approaches to complex reconstruction that may be necessary following resection.Background:Approximately 60% of the anterior chest wall neoplasms are malignant. The most common types of primary sternal tumors are chondrosarcoma and osteosarcoma. While guidelines for resection of these tumors have been previously described in the literature, guidelines regarding reconstructive techniques of the subsequent large defects are infrequently demonstrated.Methods:The medical records of four adult patients with primary chest wall tumors who underwent resection of the sternum from October 2016 to March 2021 were retrospectively reviewed. Radical resection with tumor-free surgical margins offers the best chance for survival, but results in a wide full-thickness defect. Hence, closure of the anterior chest wall defect with skeletal reconstruction is an essential step of the procedure and allows us to highlight surgical techniques and materials that have been used over recent years. Methods described herein include skeletal reconstruction with various hardware or allograft, as well as defect coverage using regional flaps, free tissue transfer, and mesh.Conclusions:Primary chest wall tumors of the sternum are an extremely rare diagnosis with a high malignancy rate. Full-thickness radical en-bloc resection is the most effective treatment option. Subsequent reconstruction of a wide chest wall defect is the most challenging aspect, though crucial in the preservation of the rigidity of the chest wall and protection of underlying structures. Different techniques and materials have been described without clear guidelines in treatment approaches; this paper serves to delineate and describe techniques that achieved successful outcomes.

The Prediction of Malignancy Risk in Thyroid Nodules Classified as Bethesda System Category III (AUS/FLUS) and the Role of Ultrasound Finding for Prediction of Malignancy Risk

ObjectiveTo predict the risk of malignancy in category III of the Bethesda System for Reporting Thyroid Cytopathology "Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS)" at King Abdulaziz Medical City, Riyadh, Saudi Arabia. It also intends to determine other possible contributing predictors of malignancy in thyroid nodules such as age, sex, and ultrasound (US) findings.MethodThis retrospectively designed study included 187 patients (mean age, 43.9 ± 14.1 years) with thyroid nodules, which were diagnosed as AUS/FLUS and all patients included had total thyroidectomy or lobectomy between January 2013 and December 2018 at King Abdulaziz Medical City in Riyadh, Saudi Arabia. The electronic medical records, US images, and final cytopathology and histopathology reports were reviewed and analyzed.ResultThe overall incidence of AUS/FLUS was (46.5%). Multivariate analysis of US features revealed that malignancy was significantly associated with nodules with irregular margins, microcalcification, multiple numbers (P < 0.001), and hypoechogenicity (P 0.04).ConclusionDespite the high rate of malignancy of nodules AUS/FLUS, it is still consistent with previously reported studies. The highly suspicious ultrasound features (irregular margins, microcalcification, multiple nodules, and hypoechogenicity) could be helpful in the diagnosis of thyroid cancer.

Suspicious thyroid nodules 4 cm require a diagnostic lobectomy regardless of their benign fine needle aspiration results

Background/objectiveThe diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm. MethodsThe records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared. ResultsForty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001). ConclusionsPreoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.

Does fine needle aspiration from a different nodule other than the dominant nodule provide additional benefit in thyroid diseases with nodules?

Objectives: The incidence of thyroid nodules has increased significantly and malignancy detected in 5-15% of them. While biopsy is recommended for all nodules larger than 1 cm in multinodular goiter, this is practically not possible in many patients. In addition, the relationship between nodule size and malignancy is not clear. We aimed to examine the value of additional biopsy from a nondominant nodule in terms of changing treatment and follow-up decisions and the relationship between nodule size and malignancy risk.&#x0D; Material and Method: Patients (n=2,541) with thyroid nodules who applied to our clinic for various indications and performed fine needle aspiration between January 1, 2016 and March 1, 2021 were included in the study. Some of our patients with multinodular goiter were biopsied from a second additional nodule. Cytologic evaluations reported according to the Bethesta system. Pathology reports of the operated patients were scanned retrospectivelly.&#x0D; Results: Fine needle aspiration biopsy was performed from a total of 3382 nodules of 2541 patients. The average age of our patient group was 56 (46-65) and 79% of them were women. When a comparison was made between nodule size and malignancy rate; the highest malignancy rate was detected in nodules between 1-2 cm (61,8%). Finally, a diagnosis of Bethesta-4,-5,-6 was reached in only 7 (0.9%) of 823 patients who underwent additional biopsy from nondominant nodule.&#x0D; Conclusion: The value of an additional biopsy from a second nodule in terms of changing follow-up is very low and not significant and most of the cancers arise from nodules between 1-2 cm. According to our study, the assumptions that the malignancy risk increases as the nodule size or nodule count increase were not found to be correct.

Malignant Transformation of Labial Lichen Planus: A Case Report and a Review of the Literature

Oral Lichen Planus (OLP) is a chronic inflammatory dermatosis usually benign that can affect skin, integuments and mucosal membranes presented with various clinical appearances. Typically characterized by the presence of white lace-like lesions, with or without atrophic or erosive areas. Its diagnosis is based on the clinical examination and histological analysis. In most of the cases, the OLP has a benign evolution but malignant transformation may occur justifying the strict surveillance of the disease and effective treatment of relapses. We report the case of a 58-year-old man, without specific and non-smoking history, reported to the Oral Surgery Department of the Consultation Center of Dental Treatment of Rabat, presenting oral lesions lasting for three years. The intraoral examination and biopsy were concluded an erosive oral lichen planus. Two years after, the labial lesion changed its appearance. Pathological diagnosis confirmed the presence of squamous cell carcinoma. Total surgical excision was performed with respect of carcinologic resection margins. The present case supports the view that OLP may undergo malignant transformation, and that this does not require exogenous carcinogens. Oral lichen planus is a potentially malignant disorder with a capacity, although low, for malignant transformation. Of all the factors related to the process of malignant transformation, the chronic inflammation seems to be the key factor in the development of oral cancer. The highest rate of malignancy was noted in erythematous and erosive lesions. In this way, follow-up of OLP patients could be carried out more efficiently and appropriately.

Integrated workflow for urinary prostate specific antigen N-glycosylation analysis using sdAb partitioning and downstream capillary electrophoresis separation

Prostate cancer represents the second highest malignancy rate in men in all cancer diagnoses worldwide. The development and progression of prostate cancer is not completely understood yet at molecular level, but it has been reported that changes in the N-glycosylation of prostate-specific antigen (PSA) occur during tumor genesis. In this paper we report on the development and implementation of a high-throughput capillary electrophoresis based glycan analysis workflow for urinary PSA analysis. The technology utilizes selective, high yield single domain antibody based PSA capture, followed by preconcentration and capillary electrophoresis coupled with laser-induced fluorescence detection, resulting in high resolution N-glycan profiles. Urinary PSA glycan profiles were compared to a commercially available PSA standard revealing differences in their α2,3- and α2,6-sialylated isomers, proving the excellent selectivity of the suggested workflow. This is important as sialylation classification plays an important role in the differentiation between indolent, significant and aggressive forms of prostate cancer.

A Scoping Review on Gaps in the Diagnostic Criteria for Proliferative Verrucous Leukoplakia: A Conceptual Proposal and Diagnostic Evidence-Based Criteria.

Simple SummaryProliferative verrucous leukoplakia is considered as an oral potentially malignant disorder that presents the highest tendency to recurrence and malignant transformation, alt-hough published diagnostic criteria are inconsistent. A precise evidence-based diagnosis is im-portant to differentiate this lesion from others on the oral mucosa with less tendency for cancer progression, and thus establish specific management protocols aimed at the early diagnosis of oral cancer. In this scoping review the published conceptual and diagnostic criteria for prolifera-tive verrucous leukoplakia were comprehensively analyzed, and a conceptual proposal for fu-ture diagnosis is proposed based on current evidence.Proliferative verrucous leukoplakia (PVL) is considered as an oral potentially malignant disorder (OPMD) that presents with a high tendency to recurrence after treatment and has the highest malignant transformation ratio among all OPMD (50%). Evidence-based publications have indicated that the malignant evolution reported is significantly related to the inconsistent diagnostic criteria used in primary-level studies; so, it has been hypothesized that the risk of oral cancer for this disease could even be underestimated. This is important because PVL requires specific management protocols, evidence-based, aimed at the early diagnosis of cancer developing in these lesions. We present a scoping review—a novel approach to mapping the available literature on a given topic to provide an overview of the available research evidence and to highlight possible gaps in the evidence—especially related in our study to the diagnostic aspects of PVL, and to issue a conceptual proposal and diagnostic criteria for PVL. We conclude that PVL is a white, multifocal and progressive lesion with a high malignant transformation rate which is diagnosed mainly around the age of 60 years without any specific histological characterization. We also advise a personal reflection on the level of certainty with which the clinician makes the diagnosis of a particular case of PVL.

A Rare Case of Ileocecal Intussusception in an Adult

Question: A 91-year-old woman with ulcerative colitis in clinical and endoscopic remission on mesalazine presented with a 2-day history of severe right lower abdominal pain, nausea, and vomiting. Physical examination showed abdominal distention and tenderness in the right side of the abdomen. A computed tomography scan of the abdomen showed dilated small bowel loops and a typical target sign (Figure A, arrow), suggesting colonic intussusception and a lead point intussusception with invaginated mesenteric fat and vessels (Figure B, arrow). Colonoscopy revealed the invagination of the terminal ileum (intussusceptum) into the ascending colon (Figure C) and localized marked edematous swelling of the ileocecal valve as the lead point. The ileocecal region showed no mucosal changes suggestive of ischemia. What is the most likely diagnosis? How should the patient be managed? See the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. The swollen ileocecal valve was punctured with an endoscopic needle knife, causing clear fluid to leak out (Figure D, E). The submucosa was confirmed to be highly edematous and filled with fluid. The swollen mucosa then became completely deflated, and the intussusception was immediately resolved (Figure F, Video). Histologic findings of the biopsy specimens revealed no pathological findings other than edema in the submucosa and the lamina propria. No malignant cells were found in the examined fluid. There was no evidence of a causal factor of intussusception, such as bowel ischemia, inflammation, diverticulum, lesions that were either benign or malignant, or any other pathological trigger. The cause of the localized edema of the ileocecal valve was unknown. Based on these findings, the diagnosis of adult idiopathic ileocecal intussusception was made. The patient completely recovered and was discharged without procedure-related complications. No recurrence of intussusception occurred over a 3-year follow-up period. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%–5% of bowel obstructions in adults, and most cases involve identifiable etiologies such as benign or malignant tumors.1Azar T. Berger D.L. Adult intussusception.Ann Surg. 1997; 226: 134-138Crossref PubMed Scopus (677) Google Scholar In contrast, idiopathic intussusception is frequent in children, but rare in adults. Owing to the high rate of malignancy or other structural change causing adult intussusception, a surgical approach has been served as the treatment of choice.1Azar T. Berger D.L. Adult intussusception.Ann Surg. 1997; 226: 134-138Crossref PubMed Scopus (677) Google Scholar,2Lindor R.A. Bellolio M.F. Sadosty A.T. et al.Adult intussusception: presentation, management, and outcomes of 148 patients.J Emerg Med. 2012; 43: 1-6Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar However, intestinal resection surgery may be overly invasive when the intussusception does not involve neoplastic lesions.3Imasato M. Kim H.M. Higashi S. et al.Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy.J Anus Rectum Colon. 2019; 3: 49-52Crossref PubMed Google Scholar If endoscopic reduction is possible, as in our case, emergency surgery can be avoided and appropriate treatment can be performed. Therefore, a nonoperative approach with endoscopic reduction should be attempted when the lead point is thought to be benign or idiopathic. https://www.gastrojournal.org/cms/asset/f81955b8-fb7a-47f7-b5b2-a48da942c0eb/mmc1.mp4Loading ... Download .mp4 (45.01 MB) Help with .mp4 files Supplementary Video

Abstract 1956: Lycorine promotes cell senescence of hepatocellular carcinoma by regulating CDK1

Abstract Hepatocellular carcinoma (HCC) is a serious threat to human health because of its high malignancy and low survival rate. The abnormal expression of genes along with the development of HCC, especially the genes related to the cell cycle. The abnormal expression of these genes in the growth of tumor cells makes them out of the original orbit and out of control. CDKs play critical part in cell cycle control, transcription, and development. Lycorine, a natural products, extract from lycoris radiate, possess biological activities. In this study, we found that Lycorine could up regulated the senescence related protein expression such as p16,p27,p21, however, CDK1 knockout also promote the occurrence of senescence. Unexpectedly, we found that lycorine inhibited CDK1 expression and promoted senescence with a dose-dependent manner in HCC cells, the results of CETSA and DARTS assay also showed that Lycorine could slow down the degradation rate of CDK1 protein; all findings indicated that lycorine might directly inhibit the expression of CDK1 to restrain the occurrence and development of HCC. These findings may provide a new perspective for the treatment of HCC. Citation Format: Haiyang Yu, Shuangshuang Yin, Yuling Qiu, Yanming Luo, Gaoyong Hu, Jia Lu, Shiyue Zhou, Tao Wang. Lycorine promotes cell senescence of hepatocellular carcinoma by regulating CDK1 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1956.