Incidence Of Neoplasms In Patients Research Articles

Incidence of Neoplasm in Patients Referred for Epistaxis.

Objectives: The primary objective was to identify the incidence of neoplastic disease in patients referred for epistaxis. Secondary objectives included identification of any mass lesion, and the need for further workup with imaging and/or biopsy as well as risk factors associated with identification of a mass lesion. Study Design: Retrospective cohort study. Methods: Medical records of adult patients who presented to Tufts Medical Center over an 11 year period (2010-2021) with a chief complaint of epistaxis were reviewed. The primary outcome was identification of a nasal or nasopharyngeal mass. Patient characteristics including age, sex, race, smoking status, anticoagulation, comorbidities (hypertension, allergic rhinitis, vasculitis), and treatment of epistaxis (used as surrogate for severity of epistaxis) were also examined. Results: A total of 1164 patients met inclusion and exclusion criteria. Thirty-six nasal masses were found among patients presenting with epistaxis (3.09%, P < .001), comprised primarily of benign etiology (2.66%) including nasal polyposis and thornwaldt cyst. Asian race correlated with finding of mass lesion (75%, P = .007). Five malignancies were found (0.43%) including nasopharyngeal carcinoma (2 patients), extranodal natural killer T-cell lymphoma (2 patients), and nasal adenocarcinoma (1 patient). Conclusions: Epistaxis is a common cause for referral to otolaryngology. Although the incidence of neoplasm in our patient population was low, nasal mass lesions warranting further workup were identified in 36 patients. Findings of neoplasm were more common in patients of Asian ethnicity, which may reflect the increased prevalence of nasopharyngeal carcinoma in this population. Otolaryngologic evaluation and nasal endoscopy should be considered in all cases of epistaxis.

Key genetic disorders in the pathogenesis of neuroblastoma

Neuroblastoma (NB) is a malignant neoplasm of the sympathetic nervous system of embryonic origin, consisting of undifferentiated neuroectodermal cells of the neural crest.In the structure of the incidence of malignant neoplasms in patients under one year of age, NB is the most common tumor. At the same time, mortality of this disease ranks third, behind leukemias and tumors of the central nervous system, and amounts to 13% in the structure of child mortalityfrom malignant tumors in developed countries. The stratification of patients to the risk groups and the subsequent determination of treatment tactics depends on several prognostic factors, including genetic aberrations identified in tumor cells. Moreover, processes such as spontaneous regression and transformation into benign tumors are due to the genetic characteristics of NB. Thus, the study of genetic disorders underlying the pathogenesis of NB is necessary for adequate subdivision of patients into risk groups and developing of new methods of treatment.

The Body Weight Alteration and Incidence of Neoplasm in Patients With Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.

ObjectiveWhether hypoglycemic treatments with weight-alternating effects influence the incidence of neoplasm in type 2 diasbetes (T2D) remains uncertain. Therefore, we performed a meta-analysis to assess the association between the weight alteration and incidence of neoplasm in patients with T2D.Research Design and MethodsSystematic searches were conducted for studies published between the inception of 1950s and September 2019. Randomized controlled trials conducted in T2D patients with at least 48-week follow-up, significant weight change difference between treatment arms and reports of neoplasm events were included. Fixed-effects model and meta-regression analysis were accordingly used.ResultsIn all, 46 studies were included. Analysis indicated weight reduction was not associated with a decreased incidence of neoplasm (OR = 1.01, 95% CI, 0.96 to 1.07, I2 = 17%) and weight elevation was not associated with an increased incidence of neoplasm (OR = 0.91, 95% CI, 0.76 to 1.09, I2 = 0%). Meta-regression analysis showed a slower weight reduction rate (β = −5.983, 95% CI, −11.412 to 0.553, P = 0.03) instead of weight change difference (β = −0.030, 95% CI, −0.068 to 0.007, P = 0.115) was significantly associated with reduced risk of neoplasm in patients with T2D. Moreover, a decreased incidence of prostate, bladder, and uterine neoplasm was observed in T2D patients with weight reduction difference while an increased incidence of thyroid neoplasm was found in glucagon-like peptide-1 receptor analog (GLP-1RA) users with weight reduction difference.ConclusionsAdditional weight change achieved by current hypoglycemic agents or strategies in short and medium periods was not associated with incidence of most neoplasm in patients with T2D. However, a decreased incidence of prostate, bladder, and uterine neoplasm was shown in T2D patients with weight reduction difference while an increased risk of thyroid neoplasm was observed in T2D patients on GLP-1RA treatments with weight reduction difference. A more sustained and persistent weight reduction process may confer reduced risk of neoplasm in patients with T2D.

Appendicular neoplasms and consequences in patients undergoing surgery for suspected acute appendicitis

IntroductionIn patients treated with an appendectomy for acute appendicitis, the specimen is generally sent for histological evaluation. In an era of increasing non-operative treatment for acute appendicitis, it is important to know the incidence, the diagnostic accuracy, and treatment consequences of appendicular neoplasms that are found in acute appendicitis. We hypothesize that pre- and intra-operative parameters might predict an appendicular neoplasm.MethodsData was used from our previous prospective observational cohort study. All patients undergoing surgery for suspected acute appendicitis were included. The primary outcome was the incidence of appendicular neoplasms in patients operated for acute appendicitis. Secondary outcomes were pre-operative diagnostics and imaging outcomes, intra-operative surgical judgment, and postoperative management and outcome. Possible predictors of an appendicular neoplasm were identified and used in multivariable logistic regression. Patients with an appendicular neoplasm were followed for 3 years after initial appendectomy.ResultsA total of 1975 patients underwent surgery for suspected acute appendicitis and in 98.3% (1941/1975) the appendix was removed. In 1.5% (30/1941) of these patients, an appendicular neoplasm was found. Among the malignant neoplasms, the majority were grade 1 neuroendocrine tumors (NET) in 65% (13/20). On pre-operative imaging, there was no suspicion of malignancy. In three cases, there was an intra-operative suspicion of malignancy. Multivariable analysis showed only age as an independent predictor for appendicular neoplasms. No recurrent or new malignancy was found during follow-up.DiscussionThe incidence of appendicular neoplasm in patients undergoing an acute appendectomy is very low and clinical risk factors could not be identified.

Secondary T-cell lymphoblastic lymphoma in a child after anticancer therapy for neuroblastoma: clinical case

Neuroblastoma (NB) is the most common extra-cranial solid tumor in infants with the most heterogeneous clinical course to compare with other malignant diseases. Due to intensive multimodal anticancer treatment there are an increased number of survivors and issues related to long-term effects are becoming increasingly important. One of them is the risk of secondary malignant neoplasms. This article represents a clinical case of T-cell lymphoblastic leukemia in a child aged 2 years and 5 months who received combined antitumor therapy for NB with an intermediate risk group under the age of one year. We observed literature data to investigate the incidence of second malignant neoplasms in patients with NB for the period from 1948 to 2018 and analyzed risk factors.

Glycemic control and the incidence of neoplasm in patients with type 2 diabetes: a meta-analysis of randomized controlled trials.

Previous epidemiologic studies indicate an increased risk of cancer and cancer mortality in patients with type 2 diabetes (T2D). Whether the resolution of hyperglycemia will lead to reduced risk of neoplasm in T2D remains uncertain. Therefore, we performed a meta-analysis to assess the association between glycemic control and incidence of neoplasm in T2D patients. Randomized controlled trials (RCTs) in T2D with significant HbA1c reduction difference between intensive/active and standard/control groups plus follow-up ≥48 weeks were included and analyzed by fixed-effect models, random-effect model, and meta-regression analysis accordingly. Overall, 52 studies were included. Compared with standard/control treatment, intensive/active treatment led to significantly greater HbA1c reduction from baseline (WMD = -0.51%, 95% CI, -0.55 to -0.46%, P < 0.001), but was not associated with a decreased incidence of neoplasm (OR = 0.99, 95% CI, 0.94-1.03, I2 = 2%) in T2D. Meta-regression analysis indicated that HbA1c reduction difference between intensive/active treatment and standard/control treatment was not associated with the incidence of neoplasm in T2D patients (β = -0.0011, 95% CI, -0.0058 to 0.0035, P = 0.625). In neoplasm-site subgroup analysis, a decreased incidence of breast neoplasm was observed in T2D patients using dipeptidyl-peptidase-4 inhibitor (OR = 0.56, 95% CI, 0.35-0.89, I2 = 0%) and incidence of prostate neoplasm was reduced in T2D patients with glucagon-like peptide-1 receptor agonist treatment (OR = 0.66, 95% CI, 0.47-0.91, I2 = 0%). Improved glycemic control in short and medium periods achieved by existing glucose-lowering drugs or strategies may not confer reduced risk of neoplasm in patients with T2D. Studies with longer follow-up duration are needed to better elucidate the long-period effects.

Use of Molecular Imaging to Differentiate Liver Metastasis of Colorectal Cancer Metastasis From Neuroendocrine Tumor Origin

Synchronous malignant neoplasms in a single patient are well documented in the literature. It is also recognized that there is increasing incidence of synchronous non-neuroendocrine neoplasm in patients with neuroendocrine tumor (NET). We present a case, of a patient with synchronous colorectal cancer and pancreatic NET, both cancers presenting with liver metastasis. By using 18F-FDG PET and 68Ga-DOTATATE PET imaging, we showed 2 different tumor types within the liver, which was subsequently confirmed on liver biopsy. This case report shows the utility of molecular imaging using different PET peptides. These newer modalities are useful in understanding the biology of the NET and in determining the best patient management.

Incidence of Neoplasms in Patients Who Develop Sustained Leukopenia During or After Treatment With 6-Mercaptopurine for Inflammatory Bowel Disease

Studies to date have not confirmed an association between neoplasms and inflammatory bowel disease (IBD) treated with 6-mercaptopurine (6-MP). We have observed the occurrence of some neoplasms in IBD patients who developed sustained leukopenia as a result of treatment with 6-MP. As a result, we sought to compare the incidence of neoplasms in patients who developed sustained leukopenia after taking 6-MP compared with patients treated with 6-MP without sustained leukopenia. A database containing the medical records of more than 600 patients treated with 6-MP for IBD at 1 center between 1965 and 2002 was searched. The patients were divided into 2 groups. The study group consisted of patients who developed sustained leukopenia, defined as a white blood cell count of less than 4000 for 20 or more days. The control group patients matched those in the study group for age and sex. There were 3 matched controls for each patient in the study group. Eighteen patients developed sustained leukopenia and, of these, 4 developed neoplasms (22%)-2 leukemias, 1 non-Hodgkin's lymphoma, and 1 breast cancer. Of the 54 patients in the control group, 4 developed neoplasms (7%) (P = .10). Post hoc analysis revealed a statistically significant difference in the number of hematologic malignancies in the group with sustained leukopenia (P = .014). There was no significant difference between the 2 groups for all confounding variables examined. There was a trend toward a greater number of total malignancies in the sustained leukopenic patients. The data suggest that it is those patients who develop sustained leukopenia while taking 6-MP/azathioprine who are most at risk.

INCREASED INCIDENCE OF NEOPLASMS IN PATIENTS WHO DEVELOP SUSTAINED LEUKOPENIA DURING OR AFTER TREATMENT WITH 6 MP FOR INFLAMMATORY BOWEL DISEASE

Purpose: Studies to date have not confirmed an association between neoplasms and IBD treated with 6MP. We have observed the occurrence of a number of neoplasms in IBD patients who developed sustained leukopenia due to treatment with 6MP. As a result, we sought to compare the incidence of neoplasms in patients who developed sustained leukopenia after treatment with 6 MP relative to patients treated with 6 MP who did not develop sustained leukopenia. Methods: A database representing the medical records of over 600 patients treated with 6MP for IBD at one center between 1969 and 2004 was searched. The patients were divided into 2 groups. The study group consisted of patients who developed sustained leukopenia, defined as a white blood cell count below 4,000 for greater than 2.5 weeks. The control group patients matched those in the study group for date of birth, sex and type of IBD (UC vs. CD). There were 3 matched controls for each patient in the study group. Data collected included disease location, cbcs, 6MP dosing information, malignancy history, family history and smoking history. Results: 31 patients developed sustained leukopenia, and of these, 8 developed neoplasms(26%). Median duration of leukopenia was 45 (17–1514) days. Of 93 patients without sustained leukopenia in the control group, 7 developed neoplasms (8%)(p = .017). The neoplasms in the study group were assorted, including 2 leukemias, 1 NHL but no colon cancers. 2 of the 7 neoplasms in the control group were colon cancers. There was no significant difference between the two groups in terms of family history, history of smoking and disease location. Cases also developed neoplasms significantly earlier than controls (log rank test = 4.34, p = .037)(Fig.1). [figure 1]FigureConclusions: There is an increased risk of neoplasms, in total number and in earlier onset, in patients who develop sustained leukopenia following treatment with 6MP. Perhaps, persistence of leukopenia for greater than 2.5 weeks should prompt discontinuation of 6MP.

Zum Auftreten epithelialer Neubildungen im Kopf-Hals-Bereich bei Non-Hodgkin-Lymphomen

There is an increased risk of malignancy in patients with genetically determined or acquired immunosuppression. The authors report a case of a 70-year-old patient with a lymphoplasmocytic immunocytoma who developed 19 squamous-cell carcinomas (SCC) and nine basal-cell carcinomas (BCC) over a three-year period. This was the reason to review 100 cases of malignant lymphomas for evidence of additional malignancies. Of these patients, 15% had one or more SCC or BCC in the head and neck area. The age range was 59 to 79 years (mean, 71.7 years) and the male:female ratio 11:4. One or more SCC arose in 93% of these patients, 36% developed an additional one or more BCC, and BCC alone occurred in 7%. The usual ratio of BCC:SCC is 10:1; in the authors' patients, by contrast, this ratio was 6:14. In 12 cases, SCC and BCC were located on the skin. The remaining cases of SCC developed in the oral mucosa, the tonsils and the hypopharynx. In 13 cases, low-grade malignant lymphomas were found and in two cases high-grade malignant lymphomas were found. The SCC were clinically aggressive. Thirty-six percent of the patients had recurrent lesions, 43% multiple neoplasms, and 50% metastases. Histologically, the SCC showed moderate to poor differentiation, a high degree of cell polymorphism and mitotic activity, and deep tissue infiltration. There are several explanations for the increased incidence of neoplasms in patients with immunodeficiency disorders. The surveillance function of the immune system may be impaired due to the disease itself or due to the treatment for immunosuppression. Immunosuppressive and cytotoxic agents are potential carcinogens.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer in Patients on CAPD

Many workers have reported a high incidence of cancer in persons with uremia or on hemodialysis but there is no agreement on this point. Because the incidence of neoplasms in patients on CAPD is unknown, we reviewed the medical records of the 328 patients treated with CAPD at the TWH from 1977 to 1985. Of these, nine developed cancers, of whom three had been treated with immunosuppressive agents previously. Whether or not these three patients are included, we found no significant difference in cancer incidence between the CAPD and the control population (p = 0.12 and 0.51 respectively). In conclusion, this review found no evidence that our CAPD patients had an increased incidence of cancer. Although an increased incidence of cancer has been reported in patients with chronic renal failure, before or while on hemodialysis, there is no agreement on the issue. The reported incidence of tumors in different studies ranged widely between 0.84 and 9.5% (I, 2). Even though an increasing number of patients have been treated on CAPD, the literature contains no information regarding the incidence of cancer in this population. The present study was undertaken to provide an answer to this question.

Incidence of neoplasms in patients with rheumatoid arthritis exposed to different treatment regimens

Immunosuppressive drugs have been used during the last 30 years in treatment of patients with severe rheumatoid arthritis. The drugs commonly used are cyclophosphamide and chlorambucil (alkylating agents), azathioprine (purine analogue), and methotrexate (folic acid analogue). There is evidence that all four immunosuppressive drugs can reduce synovitis, but disease activity almost always recurs after therapy is stopped. Since adverse reactions are frequent, less than 50 percent of patients are able to continue a particular drug for more than one year. Since it takes three to 12 months to achieve maximal effects, those patients who are unable to continue the drug receive little benefit from it. Patients treated with alkylating agents have an increased risk of development of acute nonlymphocytic leukemia, and both alkylating agents and azathioprine are associated with the development of non-Hodgkin's lymphoma. Cyclophosphamide therapy increases the risk of carcinoma of the bladder. There have been several long-term studies of patients with rheumatoid arthritis treated with azathioprine and cyclophosphamide and the incidence of most of the common cancers is not increased. Data on the possible increased risk of malignancy in rheumatoid arthritis are still being collected, and until further information is available, the use of immunosuppressive drugs, particularly alkylating agents, in the treatment of rheumatoid arthritis should be reserved for patients with severe progressive disease or life-threatening complications.

Mediastinal Choriocarcinoma in a Chromatin-Positive Boy

A case of primary mediastinal choriocarcinoma in a chromatin-positive boy is reported. The incidence of neoplasms in patients with so-called Klinefelter’s syndrome is discussed as well as embryogenesis and diagnostic evaluation in patients presenting with this tumor.