Lobe Tumors Research Articles

Prognosis of overall and disease-free survival in patients with grade 3 astrocytomas (anaplastic astrocytoma, WHO 2016)

A retrospective study included 389 patients diagnosed with grade 3 astrocytoma. We analyzed dependence of overall and disease-free survival from the following factors: gender, age of onset of disease, tumor extent, surgery, neurological disorders before and after surgery (NANO grading system), Ki67 index, postoperative radio- and chemotherapy (number courses, treatment regimens). Significant risk factors for overall and disease-free survival were spread and volume of tumor, postoperative neurological aggravation, Ki67 index, IDH mutation, radio- and chemotherapy. Age, frontal lobe tumor and disease manifestation variant were significant only for overall, but not for disease-free survival. This study was based on material of one of the largest clinical series of patients with AA operated on in one center in «molecular» era. Our results are consistent with previous data. Analysis of tumor biology and risk factors for IDH-negative AA without molecular signs of glioblastoma may be perspective.

Intraoperative visual evoked potential recording in occipital tumor surgery

To evaluate the effectiveness of intraoperative monitoring of cVEP in patients with occipital lobe tumors. Ten patients with occipital lobe tumors have undergone surgery with neurophysiological monitoring since 2020. Mean age of patients was 57 years. There were 6 women and 4 men. In 7 patients, neoplasms were located in the right hemisphere, in 3 patients - in the left hemisphere. According to preoperative automatic perimetry data, 7 patients had various visual field defects, and other ones had intact visual fields. All patients underwent pre- and postoperative MRI for visualization of optic radiation, its relationship with tumor and control of resection quality. Intraoperative monitoring of cVEPs was performed in all patients. Biopsy verified glioblastoma in 5 cases, metastasis of adenocarcinoma - 2 cases, diffuse glioma - 1 case, ganglioglioma - 1 case, CNS lymphoma - 1 case. Postoperative MRI confirmed total or subtotal resection of tumor in all cases. Enlargement of visual fields occurred in 3 patients after surgery. Two ones had deterioration and/or new homonymous defect. No changes of visual fields was observed in other cases. Analysis of visual field defects after surgery found no correlation with functional state of visual tract according to fractional anisotropy before and after surgery. MR tractography of optic radiation and intraoperative monitoring of cVEP allow choosing the safest approach for resection of occipital tumor and minimizing the risk of damage to visual cortex and optic radiation fibers. In most cases, postoperative visual functions do not worsen after intraoperative mapping of visual cortex and determining the safest trajectory for resection of occipital lobe tumors. Moreover, improvement is observed in some cases.

Factors associated with preoperative and postoperative seizures in patients undergoing resection of brain metastases.

Epileptic seizures are a common and potentially devastating complication of metastatic brain tumors. Although tumor-related seizures have been described in previous case series, most studies have focused on primary brain tumors and have not differentiated between different types of cerebral metastases. The authors analyzed a large surgical cohort of patients with brain metastases to examine risk factors associated with preoperative and postoperative seizures and to better understand the seizure risk factors of metastatic brain tumors. Patients who underwent resection of a brain metastasis at the University of California, San Francisco (UCSF), were retrospectively reviewed. Patients included in the study were ≥ 18 years of age, required resection of a brain metastasis, and were treated at UCSF. Primary cancers included melanoma, non-small cell lung adenocarcinoma, breast adenocarcinoma, colorectal adenocarcinoma, esophageal adenocarcinoma, gastric adenocarcinoma, renal cell carcinoma, urothelial carcinoma, ovarian carcinoma, cervical squamous cell carcinoma, and endometrial adenocarcinoma. Patients were evaluated for primary cancer type and seizure occurrence, as well as need for use of antiepileptic drugs preoperatively, at time of discharge, and at 6 months postoperatively. Additionally, Engel classification scores were assigned to those patients who initially presented with seizures preoperatively. Univariate and multivariate regression analyses were used to assess the association of tumor type with preoperative seizures. Data were retrospectively analyzed for 348 consecutive patients who underwent surgical treatment of brain metastases between 1998 and 2019. The cohort had a mean age of 60 years at the time of surgery and was 59% female. The mean and median follow-up durations after the date of surgery for the cohort were 22 months and 10.8 months, respectively. In univariate analysis, frontal lobe location (p = 0.05), melanoma (p = 0.02), KRAS mutation in lung carcinoma (p = 0.04), intratumoral hemorrhage (p = 0.04), and prior radiotherapy (p = 0.04) were associated with seizure presentation. Postoperative checkpoint inhibitor use (p = 0.002), prior radiotherapy (p = 0.05), older age (p = 0.002), distant CNS progression (p = 0.004), and parietal lobe tumor location (p = 0.002) were associated with seizures at 6 months postoperatively. The final multivariate model confirmed the independent effects of tumor location in the frontal lobe and presence of intratumoral hemorrhage as predictors of preoperative seizures, and checkpoint inhibitor use and parietal lobe location were identified as significant predictors of seizures at 6 months postoperatively. Within this surgical cohort of patients with brain metastases, seizures were seen in almost a quarter of patients preoperatively. Frontal lobe metastases and hemorrhagic tumors were associated with higher risk of preoperative seizures, whereas checkpoint inhibitor use and parietal lobe tumors appeared to be associated with seizures at 6 months postoperatively. Future research should focus on the effect of metastatic lesion-targeting therapeutic interventions on seizure control in these patients.

Effects of acute ischemic stroke on binaural perception.

Stroke-induced lesions at different locations in the brain can affect various aspects of binaural hearing, including spatial perception. Previous studies found impairments in binaural hearing, especially in patients with temporal lobe tumors or lesions, but also resulting from lesions all along the auditory pathway from brainstem nuclei up to the auditory cortex. Currently, structural magnetic resonance imaging (MRI) is used in the clinical treatment routine of stroke patients. In combination with structural imaging, an analysis of binaural hearing enables a better understanding of hearing-related signaling pathways and of clinical disorders of binaural processing after a stroke. However, little data are currently available on binaural hearing in stroke patients, particularly for the acute phase of stroke. Here, we sought to address this gap in an exploratory study of patients in the acute phase of ischemic stroke. We conducted psychoacoustic measurements using two tasks of binaural hearing: binaural tone-in-noise detection, and lateralization of stimuli with interaural time- or level differences. The location of the stroke lesion was established by previously acquired MRI data. An additional general assessment included three-frequency audiometry, cognitive assessments, and depression screening. Fifty-five patients participated in the experiments, on average 5 days after their stroke onset. Patients whose lesions were in different locations were tested, including lesions in brainstem areas, basal ganglia, thalamus, temporal lobe, and other cortical and subcortical areas. Lateralization impairments were found in most patients with lesions within the auditory pathway. Lesioned areas at brainstem levels led to distortions of lateralization in both hemifields, thalamus lesions were correlated with a shift of the whole auditory space, whereas some cortical lesions predominantly affected the lateralization of stimuli contralateral to the lesion and resulted in more variable responses. Lateralization performance was also found to be affected by lesions of the right, but not the left, basal ganglia, as well as by lesions in non-auditory cortical areas. In general, altered lateralization was common in the stroke group. In contrast, deficits in tone-in-noise detection were relatively scarce in our sample of lesion patients, although a significant number of patients with multiple lesion sites were not able to complete the task.

A pediatric case of anaplastic pleomorphic xanthoastrocytoma (Grade 3)

Pleomorphic xanthoastrocytoma (PXA) is a glial tumor which accounts for less than 1% of astrocytomas. PXA most commonly occurs in the temporal lobe in the outer cortex of brain and usually seen in young adults and children. As per 2020 WHO classification of CNS tumors, PXA with a mitotic activity ≥5 mitoses/10 HPF is defined as anaplastic pleomorphic xanthoastrocytoma (APXA), WHO grade 3. Here we present a rare case of Anaplastic Pleomorphic Xanthoastrocytoma developing in a female child of 11 years of age.A 11 years old female child presented with symptoms of continuous headache, giddiness, fever and vomiting since last 15 days. Computed Tomography of her brain revealed a soft tissue density mass lesion in right temporal lobe involving the insular cortex and capsuloganglionic region. The radiological differential diagnosis was a neoplastic lesion, most likely glioma. The patient underwent surgery for removal of temporal lobe tumor and the resected tumor bits were sent for histopathological assessment. Microscopically, many multinucleated lipidized giant cells were seen having eccentrically pushed nuclei, conspicuous nucleoli and abundant eosinophilic granular cytoplasm. A second population of few spindled cells with less amount of cytoplasm was also noted in the intervening parenchyma. Immunohistochemical workup showed the tumor to be positive for GFAP, S-100, Synaptophysin, p53 and CD-68. The tumor was negative for CD34. Ki-67 index was 15-20%. A final diagnosis of Anaplastic Pleomorphic Xanthoastrocytoma (grade 3) was made.APXA is a rare astrocytic tumor and has relatively more aggressive radiological and histomorphological features than pleomorphic xanthoastrocytomas and therefore it needs to be identified and treated separately.

Diagnostic value of dual-layer spectral detector CT in differentiating lung adenocarcinoma from squamous cell carcinoma.

The pathological type of non-small cell lung cancer is considered to be an important factor affecting the treatment and prognosis. The purpose of this study was to investigate the diagnostic value of spectral parameters of dual-layer spectral detector computed tomography (DLCT) in determining efficacy to distinguish adenocarcinoma (AC) and squamous cell carcinoma (SC), and their combined diagnostic efficacy was also analyzed. This is a single-center prospective study, and we collected 70 patients with lung SC and 127 patients with lung AC confirmed by histopathological examination. Morphological parameters, plain scan CT value, biphasic enhanced CT value, and spectral parameters were calculated. The diagnostic efficiency of morphological parameters, spectral parameters, and spectral parameters combined with morphological parameters was obtained by statistical analysis. In univariate analysis, seven morphological CT features differed significantly between SC and AC: tumor location (distribution), lobulation, spicule, air bronchogram, vacuole sign, lung atelectasis and/or obstructive pneumonia, and vascular involvement (all p < 0.05). In the arterial phase and the venous phase, the spectral parameters of AC were higher than those of SC (AP-Zeff: 8.07 ± 0.23 vs. 7.85 ± 0.16; AP-ID: 1.41 ± 0.47 vs. 0.94 ± 0.28; AP-NID: 0.13 ± 0.04 vs. 0.09 ± 0.03; AP-λ: 3.42 ± 1.10 vs. 2.33 ± 0.96; VP-Zeff: 8.26 ± 0.23 vs. 7.96 ± 0.16; VP-ID: 1.18 ± 0.51 vs. 1.16 ± 0.30; VP-NID: 0.39 ± 0.13 vs. 0.29 ± 0.08; VP-λ: 4.42 ± 1.28 vs. 2.85 ± 0.72; p < 0.001). When conducting multivariate analysis combining CT features and DLCT parameters with the best diagnostic efficacy, the independent predictors of AC were distribution on peripheral (OR, 4.370; 95% CI, 1.485-12.859; p = 0.007), presence of air bronchogram (OR, 5.339; 95% CI, 1.729-16.484; p = 0.004), and presence of vacuole sign ( OR, 7.330; 95% CI, 1.030-52.184; p = 0.047). Receiver operating characteristic curves of the SC and AC showed that VP-λ had the best diagnostic performance, with an area under the curve (AUC) of 0.864 and sensitivity and specificity rates of 85.8% and 74.3%, respectively; the AUC was increased to 0.946 when morphological parameters were combined, and sensitivity and specificity rates were 89.8% and 87.1%, respectively. The quantitative parameters of the DLCT spectrum are of great value in the diagnosis of SC and AC, and the combination of morphological parameters and spectral parameters is helpful to distinguish SC from AC.

Comparison of oncological outcomes between trisegmentectomy and lobectomy for non-small cell lung cancer in the left upper division.

The left upper lobe is one of the largest lobes in the lungs and is divided into two anatomical units: the upper division (segments 1+2 and segment 3) and lingula (segments 4 and 5). This anatomical classification is similar to that used for the right upper and middle lobes. Although bilobectomy is not recommended for right upper or middle lobe tumors close to the interlobar plane, lobectomy is often performed for tumors located close to the intersegmental plane in the left upper division. To aid in establishing trisegmentectomy as a standard treatment for clinical N0 non-small cell lung cancer (NSCLC) in the left upper lobe, we aimed to re-assess its feasibility based on oncological outcomes according to tumor location. We retrospectively analyzed the data of patients with clinical N0 NSCLC in the left upper division who underwent left upper lobectomy or trisegmentectomy between April 2006 and December 2020. After propensity score matching, oncological outcomes were compared between the trisegmentectomy and lobectomy groups. To verify whether trisegmentectomy was indicated regardless of tumor distance from the intersegmental plane, we compared the recurrence-free survival (RFS) rates following trisegmentectomy between patients with tumors ≤20 and >20 mm from the intersegmental plane. After propensity score matching, 46 patients were included in each group. There was no significant difference in the 5-year RFS rate between the lobectomy and trisegmentectomy groups (75.5% vs. 84.0%, P=0.41). In the trisegmentectomy cohort, the 5-year RFS rate did not significantly differ according to tumor distance from the intersegmental plane (≤20 or >20 mm) measured using three-dimensional computed tomography (79.4% vs. 81.2%, P=0.69). Multivariate analysis indicated that tumor distance from the intersegmental plane was not a significant predictor of RFS (hazard ratio: 1.75, 95% confidence interval: 0.52-5.91, P=0.37). Our analysis suggests that oncological outcomes (i.e., RFS rates) following trisegmentectomy for clinical N0 NSCLC in the left upper division are not significantly inferior to those following lobectomy, even if the tumor is located close to the intersegmental plane.

Long-term outcomes of endoscopic ultrasound-guided laser ablation for liver tumors in the caudate lobe: 5 years of experience

Objectives Liver tumor in the caudate lobe is challenging to treat, partly due to its deep location. Endoscopic ultrasound-guided laser ablation (EUS-LA) is a new attractive option for tumors in high-risk or difficult-to-reach locations. This prospective study investigated the long-term efficacy of EUS-LA for tumors in the caudate lobe, and factors that predict outcomes. Methods From June 2016 to July 2021, twenty consecutive patients (aged 56.95 ± 10.06 years) with 25 caudate lobe tumors (15.64 ± 6.37 mm) underwent EUS-LA. Treatment outcomes were assessed and predictive factors were calculated via univariate and multivariate analyses. Results Twenty-five tumors achieved complete ablation after the first or second session of EUS-LA. The treatment effectiveness was 100%. During a median follow up of 27 months (3–60), four tumors (16%) developed local tumor progression and 15 patients (75%) experienced intrahepatic distant recurrence. According to univariate and multivariate analyses, the significant prognostic factor of local tumor progression was tumor size >2 cm (p = 0.047). Significant prognostic factors of intrahepatic distant recurrence were: tumor number, alpha-fetoprotein level, and total bilirubin level (p = 0.020, 0.019, 0.010, respectively). No adverse events related to EUS-LA were observed. Conclusion EUS-LA is a viable, safe, and effective treatment option for patients with liver tumor in the caudate lobe. Tumor size >2 cm increases the risk of post-procedural local tumor progression. Intrahepatic tumor number, and pretreatment alpha-fetoprotein level and total bilirubin level are associated with intrahepatic distant recurrence. Registration Clinicaltrials.gov, ID: NCT02816944(June 29, 2016)

Misdiagnosis of Tuberculosis

Introduction: High incidence of tubercular cases in developingcountries, similar clinical presentation of tuberculosis andmalignancy, lack of adequate infrastructure, and lack ofproper follow up are the most common factors associated withmisdiagnosis.Case Summary: A 72 years old male CAME with complainsof cough with expectoration for 2 month, intermittent feverassociated with chills and rigors for 1 month, loss of appetiteand weight, intermittent pain in right side of the chest for1 month. Patient was a known smoker and alcoholic. Onauscultation bilateral air entry was decreased with occasionalrhonchi. Patient’s chest x-ray was suggestive of consolidationin right upper zone of chest. His sputum was negative forAFB from outside, patient started on ATT, 2 months prior todate of admission from private clinic on empirical basis thatwas continued till the date of admission. Patient showed noimprovement, even after 2 months of ATT. His chest X-Ray wassuggestive of right upper zone consolidation, patient had noprior radiography for comparison. He was continued on ATTas he had already taken treatment for 2 months from outside.Patient was tested negative for sputum AFB 1 and 2, CBNAATand culture.Patient presented to emergency after a gap of two monthsin state of drowsiness with complains of breathlessness andsevere right side chest pain. He was intubated in emergencyand managed on ventilator support. Patient recovered and aCECT thorax was done suggestive of likely possibility of rightlung upper lobe neoplasm with metastatic lymphadenopathywith possibility of multiple liver and bilateral adrenal metastasisand changes of chronic airways disease with fibro bullouschanges in bilateral upper lobe apical segments. The FNACwas positive for malignant cells with features suggestive of nonsmallcell carcinoma – (possibly adenocarcinoma). Patient wasfurther managed in the department of Radiation Oncology bychemotherapy. We discuss the radiographical progression andsubsequent investigations required to make a proper diagnosis.Conclusion: It is imperative to form a conclusive diagnosisusing available diagnostic modalities in smear negativetubercular cases to avoid delay in management of otherpossible life-threatening diseases like lung carcinomas.

Endobronchial Implanted Real-Time Radiofrequency (RF) Transponder Beacon Guided, Respiratory-Gated, Stereotactic Body Radiotherapy for Moving Lung Tumors: Interim Analysis of a Prospective Phase I/II Cohort Study

<h3>Purpose/Objective(s)</h3> Endobronchially implanted real-time tracking system (technology company) radiofrequency (RF) transponder beacons provide real-time, high precision, positional data of moving lung tumors. We report interim results of a Phase I/II prospective single arm prospective cohort study evaluating feasibility and dosimetric impact of real-time tracking system beacons for patients undergoing SBRT for moving lung tumors. <h3>Materials/Methods</h3> Eligible patients were adults, ECOG 0-2, with T1-T2N0 Non-small cell lung cancer (NSCLC) or pulmonary metastasis ≤4cm of the right middle/lower lobe, or lingula. Upper lobe tumors were eligible if they moved ≥5mm. Three real-time tracking system beacons were endobronchially implanted at prespecified peritumoral locations using SuperDimension™ navigational bronchoscopy (Medtronic, USA). Four-dimensional free-breathing CT simulation scans were obtained and end-exhalation phases were selected to define a gating window (GW). A 3mm expansion of the ITV_GW defined the PTV. Real-time tracking system-guided, respiratory phase-gated, SBRT (GW-SBRT) was delivered using 10MV VMAT photon arcs at 2400MU/min to total doses of 54Gy/3# or 48Gy/4#. For each GW-SBRT plan, a corresponding 10-phase plan was generated for comparison to standard image-guided (IG)SBRT. PTV, and OAR metrics were tabulated and differences between GW-SBRT and IG-SBRT plans analyzed using non-parametric Wilcoxon Signed-Rank pair test. Treatment related toxicity was graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. <h3>Results</h3> From November 2017 to December 2021, 41 patients were screened and 17 patients consented to participate. Two patients did not undergo beacon implant: one had tumor progression; another withdrew consent. Of the 15 patients with beacon implants, median age was 73, with 7 females. 47% were T1 NSCLC, 40% were M1 and remaining 13% were T2 NSCLC. Median tumor dimension was 1.9cm. 73% of targets were located peripherally, and 27% centrally with a median respiratory tumor motion of 1.25 cm (range 0.53 cm to 4.04 cm). No beacon migration was observed between CT simulation scan and the completion of SBRT treatments. Of the N=12 tumor targets were treated with GW-SBRT, 47% of patients received 48Gy/4# and 53% received 54Gy/3#. GW-SBRT yielded an average relative reduction of PTV of 46.9% (p<0.005) compared with IG-SBRT. Lung V5, V10, V20 and D2 had mean relative reductions of 11.3%, 20.3%, 31.1% and 15.5% respectively (p<0.005). Dose to OARs was significantly reduced (p<0.05) except for spinal cord. At 6 months follow-up, mean radiographic tumor volume reduction was 53.5% (p<0.005); No treatment related grade 3 toxicity was observed. <h3>Conclusion</h3> Endobronchial RF beacons are safe and effective at reducing SBRT treatment volumes for patients with moving lung tumors and can be considered for tumors with large motion amplitude or those located in close proximity to organs at risk. This study has the ClinicalTrials.gov identifier NCT03322072.

Descriptive Statistics for Patients with Glioblastoma Associated with Germline Mismatch Repair Gene Mutation

<h3>Purpose/Objective(s)</h3> Hereditary Nonpolyposis Colorectal Cancer (HNPCC), also known as Lynch Syndrome, is a genetic mismatch repair mutation associated with increased risk for development of glioblastoma (GBM). There is a paucity of data describing the clinical outcomes of GBM patients with HNPCC. We aim to describe tumor characteristics, treatment patterns, and outcomes. <h3>Materials/Methods</h3> IRB approved retrospective review of consecutive patients with a diagnosis of both HNPCC and GBM at a single institution. <h3>Results</h3> Nine patients with a diagnosis of HNPCC and GBM were treated at a single institution from 2001-2022. Six patients were male. Median age at GBM diagnosis was 61 (range 21-84). Median follow up from the time of GBM diagnosis was 7.83 months. Eight patients had prior malignancies: n=7 with colon adenocarcinoma, n=1 with Burkitt lymphoma. Two patients had active synchronous cancers with GBM. The most common presenting symptoms were facial droop (n=3) and cognitive changes (n=2). Others include headache, gait change, visual field defect, and seizures with n=1 each. All patients underwent surgery: n=2 gross total resection, n=4 subtotal resection, and n=3 biopsy alone. There were 3 temporal lobe, 3 parietal lobe, 2 frontal lobe, and 1 frontoparietal lobe tumors. Two patients had multifocal disease at diagnosis. One patient had a giant cell variant GBM. Seven patients had MSH6 mutations and 2 had MSH2 mutations. Two patients progressed rapidly after surgery and were unable to receive RT. Seven patients received adjuvant radiation therapy (RT): n=5 received concurrent TMZ- 1 with concurrent bevacizumab, 5-fluorouracil, and leucovorin due to synchronous metastatic colon cancer, 1 received no chemotherapy. The most common dose and fractionation schedules were 60 Gy in 30 fractions (fx) (n=3), 40.05 Gy in 15 fx (n=3), and n=1 received 30 Gy in 10 fx due to poor performance status and large tumor volume. One patient received proton therapy for active MS, n=8 received IMRT. Two patients initiated tumor treating fields following RT completion. The median time to progression after RT was 3.35 months, and all progressed within the radiation field. Median survival from diagnosis was 6.5 months (range 1.2-15.5). No patients received immune checkpoint inhibitors. One patient was alive at the time of data collection. Seven died due to GBM progression, and n=1 died from progression of a synchronous malignancy. <h3>Conclusion</h3> In this small series, patients with mismatch repair mutation associated glioblastoma had especially poor outcomes and a rapidly progressive disease course.

Adjuvant Chemoradiation Therapy Versus Chemotherapy Alone for Resected Oligodendroglioma: A Surveillance, Epidemiology and End Results (SEER) Analysis

The benefit of postoperative adjuvant therapy for survival of oligodendrocyte glioma remains unclear. In this study, we compared the effect of chemoradiation therapy (CRT) and chemotherapy (CT) alone in patients who underwent resection. We aim to identify which adjuvant therapy provides more survival benefits. We identified patients who underwent oligodendroglioma resection in the Surveillance, Epidemiology and End Results (SEER) database. A multivariate Cox regression analysis was used to evaluate the factors affecting survival rates. We used a propensity matching analysis to minimize selection bias in each group. We performed subgroup analyses based on patients' clinical characteristics. This study identified 1826 patients who received adjuvant CT (n= 503) or adjuvant CRT (n= 1323). On multivariate analysis, elderly, white and other race, and temporal lobe and parietal lobe tumor site were independent risk factors for improved overall survival (OS). After 1:1 propensity match, we included 501 patients who received CT and 501 with CRT. Patients in the CT group showed improved overall survival rate compared with those who received CRT (median OS: 146 months vs. 111 months). Subgroup analysis showed that improved overall survival in CT group was more significant in patients who were younger or older, male or female, white race, frontal lobe and parietal lobe tumor site, smaller tumor size (≤4 cm), and with gross total resection (GTR) (P < 0.05). In patients with resected oligodendroglioma, adjuvant CT is associated with better survival compared to adjuvant CRT. The benefit was more significant in patients who were younger and older, male and female, white race, frontal lobe and parietal lobe tumor site, smaller tumor size (≤4 cm), and with GTR.

Surgical management of T1/T2 node-negative papillary thyroid cancer with tall cell histology: Is lobectomy enough?

BackgroundThe tall cell variant of papillary thyroid carcinoma has traditionally been treated more aggressively than classic papillary thyroid carcinoma. However, this may not be justified in patients with T1/T2 tall cell variant node-negative tumors. MethodsWe evaluated well-differentiated thyroid cancers treated surgically between 1985 and 2015 at our institution. We compared patients undergoing lobectomy for node-negative T1/T2 tall cell variant tumors with the same cohort with classic papillary thyroid carcinoma. Patients who underwent early planned completion thyroidectomy were excluded. Tall cell variant tumors were defined as those with ≥30% tall cells. Survival and recurrence outcomes were determined by the Kaplan-Meier method and groups compared using the log-rank test. ResultsThyroid lobectomy was performed for T1/T2 N0X disease in 70 (15%) tall cell cases and 429 (23%) classic papillary thyroid carcinoma cases. There was no significant difference in 10-year overall survival (P = .56) or locoregional recurrence-free probability (P = .52). Disease-specific survival and local or central nodal recurrence-free probability were 100% in both groups. In 9 papillary thyroid carcinoma cases, subsequent contralateral lobe tumors developed, and in 5, lateral neck metastases developed. No recurrences were seen in the tall cell group. ConclusionT1 node-negative tumors with tall cell histology can be satisfactorily managed with thyroid lobectomy, with equivalent oncological outcomes to classic papillary thyroid carcinoma.

Trichoblastoma of the Lower Eyelid

Purpose: We report an unusual trichoblastoma of the lower eyelid.Case summary: A 74-year-old male presented with an asymptomatic 0.6 × 0.4-cm left lower eyelid tumor that had developed 3 years prior. On histological examination, a 0.3 × 0.3-cm intradermal tumor that was not connected to the epidermis was observed. The tumor was multilobular, and was surrounded by fibrous stroma and connective tissue. The tumor lobules consisted of basaloid cells, and a few keratinizing cysts were evident. These features are consistent with a trichoblastoma. We observed no recurrence at 1 year after complete resection.Conclusions: Trichoblastoma (a rare, benign skin tumor) is histologically similar to basal cell carcinoma but the prognosis is excellent after complete resection. Trichoblastoma should be considered during the differential diagnosis of basal cell carcinoma of the eyelids.

S2429 A Rare Case of Esophageal Adenocarcinoma Presenting as an Isolated Brain Lesion 6 Years After Treatment

Introduction: Esophageal adenocarcinomas account for ∼1% of all cancers in the U.S. The prevalence of central nervous system (CNS) metastases associated with these cancers is around 1.8%. Response rates to standard of care are poor and prognosis is dismal. Often CNS involvement is associated with widely metastatic disease, herein, we present a case of a solitary brain lesion from esophageal adenocarcinoma at first recurrence. Case Description/Methods: A 72-year-old-male with a 40 pack-year smoking presented with progressive dysphagia in March 2015. Contrast enhanced CT of the chest, abdomen and pelvis revealed a constricting mass at the esophagogastric junction that led to endoscopy guided biopsy revealing esophageal adenocarcinoma. He underwent neoadjuvant chemotherapy (cisplatin/5-fluorouracil) and radiation therapy followed by esophagogastrectomy in July of 2015 where diagnosis of stage IIIBT3N2cM0 esophageal adenocarcinoma was confirmed. Clinical and imaging surveillance for 6 years had not shown any progression of cancer. However, in June of 2021, he presented with altered mental status that led to contrast enhanced brain MRI showing a T2 hyperintense left parietal lobe mass with an 8 mm midline shift and surrounding vasogenic edema (Figure). FDG PET-CT head to toes did not show extracranial recurrence. He underwent left posterior temporal craniotomy for resection of tumor confirming the diagnosis of metastatic esophageal adenocarcinoma. IHC showed positivity of cytokeratin7, CDX2 and SATB2. Whole exome sequencing revealed mutations in ARID1A, FH, and TP53 with variants of unknown significance of ATM and CDH. Tumor displayed proficient mismatch repair protein, a combined positive score of 15 for PD-L1, and negative Her2/Neu. Further sequencing showed tumor mutational burden of 4, no genomic loss of heterozygosity, and stable microsatellite repeats. He received gamma-knife radiation to the solitary left temporal lobe lesion. Patient continues to maintain his quality of life with no evidence of clinical and radiographic recurrence. Discussion: Isolated brain metastasis from esophageal adenocarcinoma is a very rare phenomenon. Limited data suggests that the survival of patients with isolated CNS lesions is < 1 year, however, achieving pathologic complete response after neoadjuvant chemo-radiation therapy has shown to improve survival. These esophageal cancers with isolated CNS metastases may share a unique genomic profile and more research is required to understand their alterations.Figure 1.: MRI of the brain. 1A- Pre-op axial OLEA of L. temporal lobe tumor (06/2021), 1B- Pre-op axial coronal T1 (06/2021), 1C- Follow-up T2 MRI.

Use of Cytokeratin 17 in the Differentiation Between Desmoplastic Trichilemmoma and Cutaneous Basal Cell Carcinoma.

Desmoplastic trichilemmoma (DTL) is a variant of trichilemmoma characterized by a prominent desmoplastic stroma that may mimic invasive carcinoma. These lesions typically show features of a conventional trichilemmoma at the periphery, surrounding dense hyalinized stroma with entrapped cords of tumor cells. On a small or superficial biopsy, DTL may pose a diagnostic challenge in distinguishing this benign adnexal neoplasm from invasive carcinoma, particularly basal cell carcinoma (BCC). We aimed to investigate whether the immunohistochemical expression of cytokeratin 17 (CK17) would be useful in the differentiation between DTL and BCC. CK17 is expressed in normal adnexal structures and has been shown to demonstrate strong staining in BCCs. Expression of CK17 was examined in 23 cases of DTL and 23 BCCs. An immunoreactivity score was assigned using the percentage of tumor cells staining with scoring as follows: 0, complete negativity; 1, < 15% tumor cells staining; 2, 15%-84% tumor cells staining; and 3, >85% staining. All cases of BCC scored as 3, whereas 18% of DTL scored as 3. The mean percent staining for CK17 was significantly higher for BCCs (97% of tumor cells) than DTLs (57% of tumor cells); P < 0.001 in the unpaired t test. The pattern of CK17 staining may also help differentiate between cases scoring 3. All BCCs showed strong diffuse staining throughout, whereas for those cases of DTL with a score of 3, the peripheral basaloid rim in the tumor lobules did not stain. CK17 is a useful adjunct in distinguishing DTL from BCC in small or superficial biopsy specimens.

Results of 301 Parotidectomies: A Twenty-Year Experience of One Single Institution.

To evaluate demographic, clinical, surgical and histopathological results and complications of 301 parotidectomies performed in southern part of Turkey. The results of 297 patients undergoing 301 parotidectomies between 2000 and 2019 were retrospectively reviewed. Four patients underwent bilateral parotidectomy. Age, gender, side and size of lesion, postoperative facial nerve function (FNF) for benign tumors and types of surgery were evaluated. There were 172 male and 125 female patients. The mean age was 52.53 ± 16.67years (range 11-90years). Patients with malignant tumor had higher mean age than the patients with benign diseases (p < 0.001) and the mean age of Warthin tumor (WT) patients was significantly higher than pleomorphic adenoma (PA) (p < 0.001). There was a significant male dominancy in WTs than the PAs (p < 0.001). The mean size of the malignant tumors was significantly higher than the benign tumors (p = 0.012). The mean of cigarette smoking value (pack/year) was higher in WTs than the PAs (p < 0.001). WT incidence was slightly higher than PA in between years 2010 and 2019 (p = 0.272) compared to between years 2000 and 2009. Fine needle aspiration biopsy had asensitivity of 96% and specificity of 78% for the benign tumors. Tumor location (p < 0.001) and tumor size (p = 0.034) had negative effect on the postoperative FNF. The incidence of WT had a significant rise in the last decade. Deep lobe tumors and increased tumor size had effect postoperative FNF. Experience of surgeon ismore important than nerve monitoring to prevent facial paralysis. Partial superficial parotidectomy was available methods for small benign tumors in tail of the parotid gland.

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique.

Background: The role played by the non-dominant parietal lobe in motor cognition, attention and spatial awareness networks has potentiated the use of awake surgery. When this is not feasible, asleep monitoring and mapping techniques should be used to achieve an onco-functional balance. Objective: This study aims to assess the feasibility of a dual-strip method to obtain direct cortical stimulation for continuous real-time cortical monitoring and subcortical mapping of motor and visual pathways simultaneously in parietal lobe tumour surgery. Methods: Single-centre prospective study between 19 May–20 November of patients with intrinsic non-dominant parietal-lobe tumours. Two subdural strips were used to simultaneously map and monitor motor and visual pathways. Results: Fifteen patients were included. With regards to motor function, a large proportion of patients had abnormal interhemispheric resting motor threshold ratio (iRMTr) (71.4%), abnormal Cortical Excitability Score (CES) (85.7%), close distance to the corticospinal tract—Lesion-To-Tract Distance (LTD)—4.2 mm, Cavity-To-Tract Distance (CTD)—7 mm and intraoperative subcortical distance—6.4 mm. Concerning visual function, the LTD and CTD for optic radiations (OR) were 0.5 mm and 3.4 mm, respectively; the mean intensity for positive subcortical stimulation of OR was 12 mA ± 2.3 mA and 5/6 patients with deterioration of VEPs > 50% had persistent hemianopia and transgression of ORs. Twelve patients remained stable, one patient had a de-novo transitory hemiparesis, and two showed improvements in motor symptoms. A higher iRMTr for lower limbs was related with a worse motor outcome (p = 0.013) and a longer CTD to OR was directly related with a better visual outcome (p = 0.041). At 2 weeks after hospital discharge, all patients were ambulatory at home, and all proceeded to have oncological treatment. Conclusion: We propose motor and visual function boundaries for asleep surgery of intrinsic non-dominant parietal tumours. Pre-operative abnormal cortical excitability of the motor cortex, deterioration of the VEP recordings and CTD < 2 mm from the OR were related to poorer outcomes.

P16.03.A Epithelioid gliobastoma requires rapid treatment and BRAF inhibitors should be made readily available for their treatment

Abstract Background Epithelioid glioblastoma is a rare subtype of Glioblastoma. We examine two cases who presented acutely with symptoms of headache, neck stiffness and an eye squint. The purpose of this case review is to look at their management, the spread of the disease and propose the availability of BRAF inhibiting agents be made readily available for this subtype. Material and Methods The clinical records including pathology and surgical reports, multi-disciplinary team meeting documents, oncology plans and inpatient notes have all been reviewed alongside the literature on epithelioid GBM and BRAF V600e mutations and inhibitors. Results Patients were females aged 25 and 32 presenting with acute onset headache and neck stiffness to emergency Department. The 25 year old had developed a right eye squint within seven days of the other symptoms, her tumour was right frontal with midline shift. The 32 year old had symptoms for 10 days prior to presentation, the tumour was right temporal. They both underwent craniotomies. The frontal tumour was totally resected, while the temporal lobe tumour was haemorrhagic in nature and minimally de-bulked. Pre-operative stealth imaging showed that there had been an increase in the size of the temporal lesion in the fourteen days since presentation. Histology proved these to be epithelioid GBM’s with BRAF V600e mutations, IDH wild-type and TERT promoter mutant. Full pathology reports with molecular markers were available within ten days. The frontal lobe patient began chemo-radiation sixteen days from her surgical date. On day two she was admitted with severe headache and nausea. She became agitated, confused, and transferred back to the neurosurgery unit for management of hydrocephalus. She was diagnosed with PRES and simultaneously treated for this and hydrocephalus. Clinically she suffered storming, passing away exactly eight weeks from presentation. Seven days after surgery the temporal lobe tumour patient suffered a seizure and admitted for symptom management and expedite oncology treatment. She passed away six days later suffering continual neurological deterioration and the tumour progression with leptomeningeal spread. This was exactly four weeks from initial presentation. Conclusion The prognosis for epithelioid Glioblastoma is limited to weeks to short months. Extent of resection in these case studies demonstrates benefit in delaying progression though it is clear that time is of the essence from presentation, to surgery, to adjuvant treatment. Neither of these tumours were methylated meaning the standard treatment for glioblastoma is likely to lack efficacy. BRAF inhibitors should be made readily available for this rare sub-type to commence treatment expediently. Both patients suffered distressing neurological symptoms in their final days which require expert management and are best managed in a neurosurgical centre.

Studies of Cognitive Functions and the Organization of Brain Bioelectrical Activity during Waking and Sleep in Patients with Frontal Lobe Tumors

Studies of Cognitive Functions and the Organization of Brain Bioelectrical Activity during Waking and Sleep in Patients with Frontal Lobe Tumors