Inoperable Cases Research Articles

Embryonal Tumor with Multilayered Rosettes, C19MC-Altered: Clinical, Pathological, and Neuroimaging Findings.

Embryonal tumor with multilayered rosettes (ETMR), C19MC-altered, is a recently described, rare central nervous system tumor. To our knowledge, the imaging findings of this tumor have not been systematically evaluated in the neuroradiology literature. We present here the clinical, radiological, and pathological correlation of a case series of this very rare tumor, including the full range of anatomic compartment presentations (supratentorial, infratentorial, and spinal). We retrospectively analyzed 7 (4M, 3F) pathologically-proven cases of ETMR referred to our institution between 2007 and 2017. We demonstrate the imaging characteristics of this tumor on CT and MRI with advanced imaging. All of the patients are children (ages 1-12). On MR imaging of ETMR, contrast enhancement is often heterogeneous and minimal if any, and there is no significant surrounding T2 fluid-attenuated inversion recovery (FLAIR) hyperintensity to suggest edema. The lesions were often expansile with no evidence of infiltration of the fiber tracks that were displaced by the tumor mass. Diffusion-weighted imaging often demonstrated restricted diffusion within ETMRs. On magnetic resonance spectroscopy (MRS), the choline/creatine (Cho/Cr) ratio is increased, with low N-acetylaspartate (NAA) or NAA/Cho ratio, typical of high-grade tumors. We demonstrate the conventional and advanced imaging characteristics of ETMR, including MRS and diffusion tensor imaging, which, to our knowledge, have not been systematically evaluated in the radiology literature. The knowledge gained may potentially impact patient management, especially in inoperable cases and in locations where it is risky to perform a biopsy.

A study on role of neo adjuvant chemotherapy in locally advanced non-metastatic breast cancer

Background: Nearly 1.7 million new breast cancer cases were diagnosed worldwide in 2012.Breast cancer is the second most common cancer in women worldwide. Globally, breast cancer now represents one in four of all cancers in women. breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,00 women and mortality 12.7 per 100,000 women. Around 90,000 new cases of breast cancer are diagnosed every year in India and majority present as Locally Advanced Breast Cancer (LABC). Neo adjuvant chemotherapy is a commonly used modality for LABC, that gives an upfront systemic therapy in high risk patients with expected micro metastatic burden and also helps in down staging the disease and offering radical cure.Methods: All Locally Advanced Non-Metastatic Breast Carcinoma (T3 N0, T3 N1, T4a, T4b, T4c, Any N2/N3, MO patients who received Neo Adjuvant Chemotherapy and underwent surgery were included. All these patients received 5-Fluorouracil, Adriamycin and Cyclophosphamide (FAC) regime, following therapy patients were offered either Modified Radical Mastectomy or Breast Conservative Surgery with axillary node dissection and Radiotherapy.Results: Complete response was achieved in 20 (66.6%) patients,3 (10%) of the patients had partial response and 7 (23.3%) progressed clinically.Conclusions: Neo adjuvant chemotherapy helped to study response of tumour size to NAC, down stage disease and to convert inoperable cases to resectability.

Dermatofibrosarcoma protuberans en región perianal: estudio de un caso, revisión y actualización

Dermatofibrosarcoma protuberans is a low-grade sarcoma typically originating in the dermis but with local invasion of subcutaneous cell and muscle tissue. We report a case of perianal dermatofibrosarcoma protuberans in a 41-year-old male complaining of anal pain and constipation. To date, only two cases of perianal dermatofibrosarcoma protuberans have been reported. The unusual location hinders surgical treatment. The characteristic translocation t(17;22)(q22;q13) leading to the formation of COL1A1/PDGFβ fusion transcripts is not only of diagnostic value but also enables an alternative imatinib-based therapy in inoperable or metastatic cases. The pertinent literature is reviewed.

18F FDG PET-CT for EBRT Planning in Inoperable Rectal Carcinoma after Receiving Chemotherapy– A

<p><span><span style="font-size: medium;">Colorectal cancer (CRC) is the third most commonly diagnosed cancer in men and the second in women globally. The incidence varies with geographic difference. In Bangladesh, hospital based cancer registry shows rate of CRC in male 10.1%- 12% and in female 3% - 12.0%. The prognosis of the disease and treatment planning depends upon the staging of the disease. Surgery is usually a common way of treatment of rectal cancer except some cases with advanced stage. Radiation therapy, often with chemotherapy, is frequently used in the adjuvant or neoadjuvant setting for the treatment of rectal cancers. External beam radiation therapy (EBRT) is a well practiced method of treatment in the in-operable cases of rectal cancer. 18F FDG PET-CT is a well recognized imaging tool in the pretreatment evaluation of colorectal cancer worldwide. Accurate staging is needed for proper selection of treatment and cost effectiveness. Here, we discussed a case of rectal cancer (stage IV) with post chemotherapy state with history of palliative loop iliostomy bypass. The patient was referred for 18 F FDG PET-CT scan for restaging of the disease and to localize functioning tumor site for external beam radiotherapy (EBRT) planning. FDG PET-CT imaging revealed FDG avidity at the primary tumor site, perircetal fat and multiple FDG avid hypermetabolic lymphnodes in pelvic cavity. A focal FDG avid lesion in anterior aspect of liver suggests hepatic involvement. The fusion PET-CT imaging has played an important role in the further management of the patient by providing guidelines in EBRT.</span></span></p><p><span><span style="font-size: medium;">Bangladesh J. Nuclear Med. 19(1): 56-60, January 2016</span></span></p>

Evaluation of Estrogen and Progesterone Receptors and Her-2 Expression with Grading in the Fine-needle Aspirates of Patients with Breast Carcinoma.

Background:There has been a limited literature with regards to comparison between the pre-operative hormonal/Her-2 neu assessment by immunostaining on fine-needle aspiration (FNA) versus core needle biopsies (CNBs) and their correlation with grading of breast carcinoma.Materials and Methods:Two hundred fifty FNAs and 201 CNBs from 252 patients with breast carcinoma were subjected immunocytochemical/histochemical (ICC/IHC) staining along with the grading by the Robinson cytologic and modified Scarff-Bloom-Richardson scoring systems, respectively. Depending on the material adequacy, IHC was also performed on cell blocks. Sensitivity, specificity, and predictive values of ICC were calculated. The kappa statistics was performed to see the power of the study. Cytologic versus histologic gradings were compared and analysed by percentage analysis.Results:Sensitivity of ICC on FNAs for ER, PR, and Her-2neu was 49%, 28.8%, and 46%, respectively, while specificity was 84.5%, 90.6%, and 86.6%, respectively, with a fair agreement on kappa statistics. Her-2neu positivity on CNB versus FNA had a moderate agreement. Her-2neu staining of 3+ was seen in most of the Grade-2 tumours on FNA.Conclusions:Fairly reliable results on grading and hormonal/Her-2neu status are possible when ICC is performed on qualitatively superior FNA material. This is particularly useful in the management of patients in certain settings like inoperable cases.

Laparoscopy and Computed Tomography Imaging in Advanced Ovarian Tumors: A Roadmap for Prediction of Optimal Cytoreductive Surgery.

Introduction:Comprehensive staging laparotomy and cytoreductive surgery followed by chemotherapy has been the standard of care in advanced ovarian cancer. Neoadjuvant chemotherapy is an alternative in inoperable advanced cases. To select patients amenable for successful cytoreduction, major determinants including CT imaging and laparoscopy could be of value. There is no general accepted model for selection and reproducibility of techniques are a major challenge due to different clinical practice and complexity of scoring systems. Some lesions as small size (<5 mm) peritoneal deposits and mesenteric affection are hard to see on CT so, complementary laparoscopy may play a role in the preoperative assessment. The aim of this study was evaluation of the role of laparoscopy in advanced ovarian tumors for prediction of optimal cytoreductive surgery in relation to CT and surgical peritoneal carcinomatosis index (PCI).Aim:Was to evaluate laparoscopic assessment in advanced ovarian tumors for prediction of optimal cytoreductive surgery in relation to CT and surgical peritoneal carcinomatosis index (PCI).Setting:Gyne-oncology specialized center, El-Shatby maternity university hospital, Alexandria Egypt.Methods:From January 2016 to December 2016, 15 patients were recruited from gyne-oncology specialized center, Alexandria, Egypt. Patients underwent a special design described later then laparoscopy using palmar point entry was done for assessing small lesions and the extent of affection in surface peritoneal, mesentery, serosa of the gut especially small intestine (terminal ileum affection, more or less than 50% affection) mainly with evaluating other sites as liver surface and diaphragm peritoneal surface affection after removal of ascites by aspiration. Findings were correlated with laparotomy and CT scan findings. Surgery was performed in the same setting which is better or with in two weeks.Results:There were two cases with upper abdominal surgeries (cholecystectomy and splenectomy) where no visualization of liver and stomach on laparoscopy but were free on CT scan and surgical evaluation. Douglas pouch was not assessed in two patients with large fixed bilateral ovarian masses on laparoscopy. Two cases with diaphragmatic affection on CT scan related to the posterior surface were not detected on laparoscopy. These findings were correlated with surgical findings as the gold standard. The pathology was ranging from low grade to high grade serous cyst adenocarcinoma.Conclusions:Laparoscopic evaluation is a useful adjunct with CT prior to performing ovarian cancer cytoreductive surgery for assessment of operability. Laparoscopy is better for evaluating extent of serosal affection in advanced tumors in cases with omental cakes on CT. A roadmap for prediction of operability in advanced ovarian cancer can be used by combing CT PCI and laparoscopic assessment.

Radiotherapy for locally advanced resectable T3-T4 laryngeal cancer-does laryngeal preservation strategy compromise survival?

With the advancement of chemotherapy, a laryngeal preservation (LP) strategy was explored with the aim of improving maintenance of quality of life. Induction chemotherapy (ICT) following radiotherapy (RT) was considered a viable option because of its high initial response rate without hampering of overall survival (OS). Subsequently, concurrent chemoradiotherapy (CCRT) using CDDP became the standard of care for LP, showing the best LP ratio. For enhancing treatment intensity, ICT with taxan + CDDP + 5-FU (TPF-ICT) followed by RT showed superiority over ICT with CDDP + 5-FU (PF-ICT) followed by RT. Given that almost all randomized controlled trials investigating ICT include not only operable (endpoint, LP) but also inoperable (endpoint, OS) cases, physicians are faced with a dilemma regarding application in daily practice. In addition, increased treatment intensity causes augmentation of adverse events, which might reduce compliance. Thereafter, cetuximab, an effective drug with fewer adverse effects [bioradiotherapy (BRT)], emerged as another option. However, little evidence has confirmed its superiority over RT (or CCRT) in laryngeal cancer subpopulations. In spite of these developments, the OS of patients with laryngeal cancer has not improved for several decades. In fact, several studies indicated a decrease in OS during the 1990s, probably due to overuse of CCRT. Fortunately, the latter was not the case in most institutions. Currently, no other treatment has better OS than surgery. The eligibility criteria for LP and/or surgery largely depend upon the available expertise and experience, which differ from one institution to another. Therefore, a multidisciplinary team is required for the treatment of LP.

MS 24.04 Possibility of Radiotherapy for GGO-Containing Tumors

The popularization of computed tomography (CT) in clinical practice have increased a frequency of discovering ground-glass opacity (GGO)-containing tumor in lung. Surgery has been regarded as the general treatment including a purpose of histological examination for such tumors and its prognosis is better than that of solid-type tumors. Stereotactic body radiation therapy (SBRT) is a rapidly prevailing treatment modality in the radical treatment of mainly inoperable or high risk operable cases with stage I non-small cell lung cancer (NSCLC), but the most tumors treated with SBRT were solid type because SBRT has been performed principally for the pathology-proven tumors and it is generally difficult to acquire histological specimen in the tumors composed of GGO.

Reduction of resection volume in patients with non-small cell lung cancer after neoadjuvant chemoand photodynamic therapy

OBJECTIVE. The research evaluated efficacy of combined treatment of initially nonresectable and inoperable cases of non-small cell lung cancer. The treatment consisted of preoperative endobronchial and intraoperave photodynamic therapies. MATERIAL AND METHODS. The prospective investigation included patients with central non-small cell lung cancer. These cases were initially considered as nonresectable (the trachea was involved in tumor) or inoperable (functional intolerance of pneumoectomy/ bilobectomy). Neoadjuvant chemotherapy (2-6 courses) and endobronchial photodynamic therapy (PDT) were conducted for these patients in preoperative period. PDT of resection edge was carried out during the operation and it was straight away after specimen removal and ipsilateral lymphodissection. RESULTS. The research was made on 38 patients. Lung resections underwent 30 (79 %) patients. Surgeries included 20 pneumoectomies and 10 lobectomies. Bronchial resection was performed by crossing an initially affected zone. It was noted that 5-year survival consisted of 68 %. CONCLUSIONS. Photodynamic therapy was important in combination with chemotherapy and surgical treatment of central non-small cell lung cancer. These measures allowed doctors to decrease the resection volume in part of inoperable patients or patients with initially nonresectable tumors.

Early Evaluation For Residual Uterine Cervical Cancer 4 Weeks After Definitive Radiation Therapy to Identify Patients Who May Benefit From Adjuvant Salvage Hysterectomy

After definitive radiation therapy (RT) for locally advanced uterine cervical cancer, local residual tumor has been subsequently found in approximately 5–10% of patients. Although adjuvant salvage hysterectomy is often attempted for those patients, radiation induced fibrosis and regrowth of the tumor after long elapsed time from RT can lead to high-risk surgery or inoperable cases. The aim of the current study was to clarify the significance of early evaluation for residual cervical cancer after RT to identify patients who may benefit from adjuvant salvage hysterectomy. We performed a retrospective cohort study between February 2012 and July 2016 of 179 patients with FIGO stage IB1–IVA cervical cancer treated with RT. For all patients, we have been conducting early evaluations for residual tumor 4 weeks after RT. In our institution, the decision to perform adjuvant salvage hysterectomy is based on at least 2 of these following 4 criteria: tumor-like cervical mass in magnetic resonance imaging (MRI) findings, abnormal fluorodeoxyglucose uptake in positron emission tomography-computed tomography (PET-CT) images, suspicious cytology or histology, and elevated tumor marker values (SCC, CA19-9, CA125, or CEA). Patients who were strongly suspected to have residual tumor underwent adjuvant salvage hysterectomy. Statistical analyses were conducted with Fisher’s exact test and Mann-Whitney’s U test. Among 179 patients, 11 patients (6%) underwent adjuvant salvage hysterectomy. The histology was squamous cell carcinoma (SqCC) in 6 patients and adenocarcinoma in 5 patients (4 of mucinous adenocarcinoma and 1 of endometrioid adenocarcinoma). The median tumor size prior to RT was 57mm (range: 45-77mm) in patients with SqCC and 42mm (range: 35-67mm) in those with adenocarcinoma (P = 0.12). In all patients, tumor was detected on MRI images after 4 weeks from RT. The median tumor-size of after RT was 22mm (range: 10-30mm) in patients with SqCC, and 30mm (range: 18-55mm) in those with adenocarcinoma, respectively (P = 0.17). No significant difference was observed in the SUV-max values on PET-CT images after RT between patients with SqCC (median: 3.9, range: 1.8-4.1) and those with adenocarcinoma (median: 3.9, range: 3.1-27.8, P = 1.0), and the ratio of the elevated tumor marker values (SCC: 17% vs. CA19-9: 20%, P = 1.0). Pathological examination after adjuvant salvage hysterectomy showed that viable tumor was observed in 1 of 6 patients with SqCC (17%) and all 5 patients with adenocarcinoma (100%): the difference was statistically significant (P < 0.05). After adjuvant salvage hysterectomy, local control was 100% in all 11 patients, and distant metastasis was shown in 1 patient with SqCC and 1 patient with adenocarcinoma. Patients with suspicious residual uterine cervical tumor of adenocarcinoma 4 weeks after RT have a higher incidence of viable tumor compared to those with SqCC, and might benefit from adjuvant salvage hysterectomy for local control.

The Five Years Survival after Surgery of Primary Tracheal Squamous Cell Carcinoma: A Case Report and Review of the Literature

Unlike the primary tracheal tumors, squamous cell carcinoma of trachea is common, especially in smokers. This type of tumor has a low rate of survival and it is diagnosed too late on account of late presentation of its signs. The treatment of choice is surgical removal followed by adjuvant radiotherapy; Primary radiotherapy is the appropriate treatment in inoperable cases. In this study, we present the case with a long history of smoking, who was suffering from cough and dyspnea for a long time. During diagnostic evaluations a vegetated tumor was observed about 5 centimeters below the vocal cords. Pathologists reported the tumor as a squamous cell carcinoma, and the patient underwent an operation for resection of involved trachea. Through presenting this patient, we aimed to draw attention to this uncommon malignancy and recommend considering it as a probable diagnosis when evaluating a patient with treatment-resistant respiratory symptoms

PD62-11 PREDICTIVE ROLE OF EPITHELIAL TUMOR MARKER LEVEL ELEVATION AT FOLLOW-UP FOR TUMOR RECURRENCE AND ONCOLOGICAL OUTCOMES IN UROTHELIAL BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2017PD62-11 PREDICTIVE ROLE OF EPITHELIAL TUMOR MARKER LEVEL ELEVATION AT FOLLOW-UP FOR TUMOR RECURRENCE AND ONCOLOGICAL OUTCOMES IN UROTHELIAL BLADDER CANCER Soroush T Bazargani, Hooman Djaladat, Anne Schuckman, Gus Miranda, Jie Cai, Sarmad Sadeghi, Tanya Dorff, David Quinn, and siamak Daneshmand Soroush T BazarganiSoroush T Bazargani More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Sarmad SadeghiSarmad Sadeghi More articles by this author , Tanya DorffTanya Dorff More articles by this author , David QuinnDavid Quinn More articles by this author , and siamak Daneshmandsiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2783AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have previously reported that elevated pre-cystectomy serum levels of epithelial tumor markers (TM) and lack of TM response to neoadjuvant chemotherapy (NAChT) are associated with worse oncological outcome in patients with invasive urothelial bladder cancer (UBC). Herein, we evaluate elevation of TM levels during follow-up and their predictive role in tumor recurrence. METHODS Under IRB approval, serum levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 409 patients with invasive UBC between August 2011 and August 2016. Excluded from the study were metastatic (13), palliative or inoperable (5) cases. Markers were measured at different time points during follow-up. RESULTS A total of 391 cystectomy patients were included in the study with median age of 71 years and 79% males. Pathology was organ-confined in 59% and NAChT was given in 35% of population. Elevated precystectomy level of any of the tumor markers (31% of patients) was independently associated with worse RFS (p<0.001; HR=2.81) and OS (p<0.001; HR=3.97). After completion of cystectomy, we were able to document normal serum marker levels from 288 cases, of whom 26 patients (9%) developed tumor marker relapse later during follow up. This subset showed significantly more clinical recurrences (89% in elevated vs. 12% in stable group, RR= 7.41), and death (24% vs. 7%, RR=3.4). Median time from tumor marker relapse to clinical recurrence was 46 days (IQR 0-179), and median time to mortality was 308 days (IQR 119-574). Details of tumor markers course in the 23 patients with marker relapse followed by clinical recurrence is shown in figure 1. Further Survival analysis using landmark time-point with log rank showed there is a significant difference in cancer-specific survival between the groups (median 284 vs 547 days; p=0.01) (Figure 2). CONCLUSIONS To our knowledge, this is the first pilot study showing predictive role of epithelial tumor marker for recurrence of invasive urothelial bladder cancer. Patients with marker relapse following cystectomy are at significant increased risk of recurrence and mortality. A larger, controlled study with longer follow up is needed to determine their role in predicting survival. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1197 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Soroush T Bazargani More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Sarmad Sadeghi More articles by this author Tanya Dorff More articles by this author David Quinn More articles by this author siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High STMN1 level is associated with chemo-resistance and poor prognosis in gastric cancer patients

Background:Stathmin1 (STMN1) is a cytosolic phosphoprotein that regulates cellular microtubule dynamics and is known to have oncogenic activity. Despite several reports, its roles in gastric cancer (GC) remain unclear owing to a lack of analyses of highly metastatic cases. This study aimed to investigate STMN1 as a prognostic and predictive indicator of response to paclitaxel therapy in patients with GC, including inoperable cases.Methods:Immunohistochemical analysis of STMN1 was performed on both operable (n=95) and inoperable GC (n=61) samples. The roles of STMN1 in cancer cell proliferation and sensitivity to a microtubule-targeting drug, paclitaxel, were confirmed by knockdown experiments using GC cell lines.Results:Multivariate and Kaplan–Meier analyses demonstrated that high STMN1 was predictive of poor prognosis in both the groups. In the operable cohort, STMN1 expression correlated with cancer curability, recurrence, and resistance to adjuvant therapy. A correlation with paclitaxel resistance was observed in inoperable cases. Knockdown of STMN1 in GC cell lines inhibited proliferation and sensitised the cells to paclitaxel by enhancing apoptosis.Conclusions:STMN1 is a possible biomarker for paclitaxel sensitivity and poor prognosis in GC and could be a novel therapeutic target in metastatic GC.

Long-term results of treatment of advanced dermatofibrosarcoma protuberans (DFSP) with imatinib mesylate – The impact of fibrosarcomatous transformation

BackgroundDermatofibrosarcoma protuberans (DFSP) is rare, infiltrating dermal neoplasm, characterized by indolent growth and low probability of metastases. The first effective systemic therapy in DFSP introduced into clinical practice was imatinib, demonstrating high activity in advanced cases. The aim of the study was to perform an analysis of patients with advanced DFSP treated with imatinib, with or without surgery, in routine clinical practice with long-term follow-up. Patients and methodsWe analyzed the data of 31 Caucasian patients (14 male, 17 female; median age 56 years) with locally advanced/initially inoperable and/or metastatic DFSP who started therapy with imatinib at initial dose 800 mg daily between 12/2004 and 07/2014. All diagnoses were confirmed cytogenetically for the presence of specific COL1A1-PDGFB fusion. Median follow-up time was 5.3 years. ResultsMetastases were present in 15 cases (8 – lungs, 5 – soft tissue, 2 – lymph nodes). Fibrosarcomatous transformation (FS-DFSP) was confirmed in 16 patients (52%). 5-year progression-free survival (PFS) rate was 58% (median 6.8 years), 5-year overall survival (OS) rate was 64% (median time for OS was not reached). The shorter PFS and OS correlated with FS-DFSP and presence of metastatic disease. 5-year PFS rate was 93% for classic DFSP and 33% for FS-DFSP. The best overall responses were: 21 partial responses (68%, including 8 FS-DFSP, but the responses were shorter than for classic DFSP), 6 stable disease (19%) and 4 progressive diseases (13%). Thirteen patients (47%) underwent resection of residual disease and nine of them remained free of disease, although imatinib was discontinued. Median survival after progression on imatinib was 19 months, and longer survival were observed only in cases were rescue surgery/radiotherapy was possible. ConclusionsOur results indicate the long-term activity of imatinib in therapy of inoperable and/or metastatic cases of DFSP, including FS-DFSP. Some DFSP patients initially evaluated as unresectable/metastatic or necessitating mutilating surgery turned resectable after imatinib therapy and this rational approach leading to complete remission maybe potentially curative.

What is changing in the surgical treatment of gastrointestinal stromal tumors after multidisciplinary approach? A comprehensive literature's review.

Gastrointestinal stromal tumors (GIST) represent the most common mesenchymal neoplasms of the gastrointestinal tract. Surgery is the only curative treatment for GIST. The aim of our review was to highlight the changes in the surgical treatment of GIST after the introduction of TKI therapy in a multimodality management (neo-adiuvant or adiuvant setting). We carried out a review of the recent literature about surgical treatment of GIST according to its anatomical location and size according to PRISMA STATEMENT to systematic review. We searched the Cochrane Library, MEDLINE, and EMBASE, limited to the final search date [31/12/2015], limited to English language publications. We used the search terms "GIST" in combination with the terms "surgery" or "multidisciplinary approach" or "TKI therapy" or "neo-adiuvant - adiuvant treatment". The optimal surgical technique to achieve the best results in terms of Overall Survival, Relapse Free Survival and Disease Free Survival is oncological resection with disease free margins. Proper preoperative staging is essential to decide the surgical approach. Data reported in literature showed that laparoscopic approach to GIST obtains the same oncological results as conventional surgery. The medical oncologist, radiologist and surgeon must collaborate to determine the appropriateness of primary surgery, with curative intent, after neoadiuvant therapy or as palliative treatment. Laparoscopy is feasible and safe for small GIST, but there is no international consensus for large GIST yet. The introduction of imatinib as neoadjuvant therapy with the goal of reducing tumor size, minimizes surgical morbidity and, in some cases, makes operable the inoperable cases. In addition, the use of imatinib in the adjuvant setting, to eradicate micrometastases and to prevent recurrence, has shown promising results in reducing relapse rates.

Pleurodesis with pseudomonas aeruginosa-mannose\u2013sensitive hemagglutinin for pneumothorax secondary to COPD: a retrospective study

BackgroundPneumothorax is a potentially life-threatening complication of chronic obstructive pulmonary disease (COPD) that leads to cardiopulmonary compromise. According to the British Thoracic Society (BTS) guidelines, medical pleurodesis is recommended for inoperable patients suffering from COPD-related pneumothorax. Several sclerosing agents are currently in use, but none have been proven to be the best choice, as each one has effectiveness and safety issues. Recent research has shown that Pseudomonas aeruginosa-mannose–sensitive hemagglutinin (PAMSHA) is a safe bioagent with low toxicity and good immune-boosting effects that can induce the aseptic inflammation necessary to cause pleural adhesion.The aim of this study is to report our experience using PAMSHA in medical pleurodesis to treat inoperable cases of persistent pneumothorax secondary to COPD.MethodsRecords of 78 inoperable patients with persistent pneumothorax secondary to COPD treated with PAMSHA pleurodesis were retrospectively reviewed. Pleurodesis was performed by administering 1 ml of PAMSHA (mixed with lidocaine and 30-40 ml of normal saline) intrapleurally.ResultsThe resolution of pneumothorax was observed in all of the patients treated with PAMSHA pleurodesis (success rate = 100%). Some of them experienced mild chest pain and fever, but no long-term side effects were reported.ConclusionOur data suggest that PAMSHA pleurodesis is a safe and effective option for the treatment of persistent pneumothorax secondary to COPD.

P1.02-019 Complex Mutation of Epidermal Growth Factor Receptor (EGFR) in Patients with Non-Small Lung Cancer

Analysis of the epidermal growth factor receptor (EGFR) gene is currently one of the most important tests in establishment of a treatment strategy for primary lung cancer. Major mutations of exon 19 deletion and exon 20 point mutation (L858R) are particularly well known in adenocarcinomas, and tyrosine kinase inhibitors (TKIs) have provided significant benefits to patients with such mutations. Complex mutation patterns of EGFR have also been reported, but their significance is unknown. Clinicopathological features and response to treatment of non-small lung cancer (NSCLC) with complex mutation of the EGFR gene were investigated in cases treated at Kanagawa Cardiovascular and Respiratory Center from June 2014 to March 2016. EGFR gene analysis was performed in 334 cases, of which 108 had EGFR mutations. These cases included 7 (6.5%) with complex mutations: two males (28.6%) and five females (71.4%) with an age of 71.0±6.0 (mean±SD) years. Five of the 7 cases underwent surgery and two were inoperable. The histological diagnoses were adenocarcinomas (n=6) and squamous cell carcinoma (n=1). The pathological stage in the surgical cases (all adenocarcinomas) were IB, IIA, and IIIA in 2, 1 and 2 cases, respectively. Both inoperable cases were clinical stage IV. The EGFR complex mutation patterns were 19 deletion and 20 T790M (n=2, with one case with acquired TKI resistance), 18 G719X and 21 L861Q (n=3), 19 deletion and 21 L858R (n=1), and 20 T790 and 21 L858R (n=1). In the five surgical cases, two (pStage IIA, 19 deletion and 20 T790M; pStage IIIA, 18 G719X and 21 L861Q) received postoperative TKI therapy because of recurrence. Both patients had a poor response to TKIs and both died. The patients in another three surgical cases are alive without receiving TKI therapy. Two inoperable cases (19 deletion and 20 T790M; 18 G719X and 21 L861Q) were treated with standard chemotherapy and TKIs, and also died. The disease-free survival period in the surgical cases was 532±319 days and the overall survival period in the case with postoperative recurrence and the inoperable cases was 810±563 days. The progression-free survival period in patients treated with TKIs was 101.5±90.6 days. In patients with EGFR mutation, 6.5% have complex mutations, of which 85.7% are minor-on-minor or minor-on-major mutations. Lung cancer with complex mutation of EGFR tends to have a poorer response to TKIs compared to cases with a major single mutation.

Analysis of Advanced or Postoperative Recurrent Non-small Lung Cancer Cases Treated with Nivolumab

Recent developments in cancer immunotherapy are remarkable. Many reports have described the clinical effects of immune checkpoint inhibitors (ICIs), supporting their utility as a promising therapy that will achieve prominent effects even in patients resistant to cytotoxic anticancer drugs or gene-targeting therapy. ICIs may also prolong overall survival. We analyzed 10 cases of advanced lung cancer targeted with nivolumab, which is one of ICIs in our hospital and reviewed the literature regarding ICIs. We retrospectively analyzed 10 cases that consisted of 6 males and 4 females, which comprised 7 adenocarcinomas, 2 squamous cell carcinomas and one pleomorphic carcinoma. Epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase mutations were negative in all the adenocarcinoma cases. The 10 analyzed cases included 9 inoperable cases and 1 postoperative recurrent case, 8 second-line cases, a third-line case, and a fourth-line case. The average frequency of administrations of nivolumab was 7.4 times. The survival rate was calculated by using the Kaplan-Meier method. The clinical responses to nivolumab were partial response in 2 cases, stable disease in 4 cases, and progressive disease in 4 cases. In the 10 cases, the response rate and disease control rate were 20% and 60%, respectively. The median progression-free survival time and median survival time were 115 days and 126 days, respectively. We observed 2 cases of dermatitis and one each of pyrexia, general fatigue and drug-induced pneumonia as adverse events (AEs). One of these AEs was severe (Stevens-Johnson syndrome grade 4) but could be treated by steroid pulse therapy, steroid ointment and instillation. Among the 10 examined cases of advanced lung cancer treated with ICIs at our hospital, ICIs proved effective in 2 cases. However, we also experienced a case with Stevens-Johnson syndrome grade 4 as a severe AE. These findings suggest that while ICIs may be effective in treating patients, candidates for ICIs must be carefully selected and cautiously observed.

Steroid Cell Tumour - A Rare Cause of Hirsuitism in a Female

AbstractSteroid cell tumours of the ovary account for &amp;lt; 0.1 % of all the ovarian tumours. It is a functioning sex cord stromal tumour. Previously designated as lipoid cell tumours, one-third of these tumours are considered malignant with the mean age of presentation at around 40 years. We present a case of 20 year old unmarried girl with regular cycles who came with sudden onset amenorrhea, hirsuitism, abdominal distension and signs of virilizationof 5 month duration and recent onset of dyspnea to Obstetrics and Gynaecology outpatient department. Moderate ascites was present. Clinical and radiological evaluation revealed a right adnexal mass with elevated serum testosterone. She was diagnosed with right ovarian benign functioning tumour and underwent right sapling oophorectomy. Histopathology confirmed the diagnosis. 2 weeks post operatively her testosterone levels decreased. Surgery is the treatment of steroid cell tumours although medical therapy using Gonadotrophin Releasing Hormone [GnRH] analogues has been tried recently in recurrent or inoperable cases.

Gastrointestinal stromal tumours (GISTs): A descriptive study on 29 cases

Background and study aimGastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, originating from Cajal cells in different sites of the digestive tract. The aim of the study is to report on epidemiological, clinical, histological, and therapeutic characteristics of GISTs. Patients and methodsA retrospective descriptive study of 29 cases of GIST in gastroenterology and general surgery departments of Mohamed Tahar Maamouri Hospital (Nabeul, Tunisia) was conducted from January 2005 to March 2012. ResultsAmong the 29 patients, there were 18 males (62%) and 11 females (38%) with a median age of 63 years (range, 30–96years). The main symptoms were abdominal pain (40%) and weight loss (28%). The tumour was revealed by a complication in 5 cases (17%). Six patients (20.7%) had metastatic lesions. The most common sites were the stomach (41.4%) and the small intestine (17.3%). The median tumour size was 9.5cm (range, 1–30cm). Spindle cell tumours were the main histological type (62%). KIT was positive in the majority of cases (75%). Twenty-one patients with primary disease (72%) underwent a surgical resection. Imatinib was prescribed in 7 patients (24%). Sunitinib malate was indicated in 3 patients who had tumour progression under imatinib. Median survival was 17 months (range, 1–69months). Ten patients died. ConclusionThe management of GISTs has considerably evolved during the last years. Surgical resection, which remains the mainstay of treatment, was indicated in the majority of patients. Imatinib treatment has not improved overall survival in metastatic and/or inoperable cases.