Lymph Node Tumor Research Articles

Expression and Clinical Significance of <i>PIK3CA</i>, <i>c-MET</i> and <i>c-KIT</i> Mutations in Saudi Breast Cancer Patients

Objective: PIK3CA is the most common pathway affected by mutations in breast cancer. PIK3CA/PTEN pathway is under intense investigation as a possible target for molecular therapy. Dysregulation PIK3CA/PTEN pathway is a substantial mechanism for the development of resistance to anti-HER2 therapy. Therefore, we aimed to study the PIK3CA/PTEN in breast cancer patients in Saudi population. Methods: We applied PTEN immunohistochemistry on 98 patients. Then, we applied next-generation sequencing to determine the genetic variations associated with the development of breast cancer and their correlations with clinicopathological variables. Results: PTEN expression was significantly correlated with lymph node metastasis (LNM), tumor stage, lymphovascular invasion (LVI) and triple negative breast cancer (TNBC). The prevalence of the PIK3CA mutation was 33.3% of cases and it was significantly associated with LNM, tumor stage, and with PTEN expression. c-MET mutation was identified in 41.7% of cases and it was associated with tumor stage and with TNBC, while c-KIT mutation was detected in 20.8% of cases, and it was significantly associated with TNBC only. Patients with positive PTEN expression had a significantly better overall survival (OS); on the contrary, patients with PIK3CA and c-MET had a significantly worse OS. Conclusion: Our study confirms the importance of PIK3CA/PTEN pathway in breast cancer patients. A high frequency of PIK3CA and c-MET mutations was detected and was associated with poor prognosis. Both c-MET and c-KIT genes have significant roles in developing TNBC. These findings should be expanded to a larger group study to improve the clinical outcomes and individualizing treatment.

A review of prognostic factors in squamous cell carcinoma of the vulva: Evidence from the last decade.

Squamous cell carcinoma of the vulva is a rare gynecologic cancer that is associated with significant patient morbidity and mortality, particularly for recurrent disease. This review summarizes the evidence and continued challenges, regarding the traditional clinicopathologic factors used to prognosticate vulvar squamous cell carcinoma. Articles published within the last 10 years (2010-2020) were identified. Relevant articles concerning the following fifteen prognostic factors were reviewed: HPV/p16 status, vulvar intraepithelial neoplasia, patient age, tumor stage, tumor grade, tumor size, depth of invasion, stromal changes, histologic patterns of invasion, lymphovascular space invasion (LVSI), perineural invasion, lymph node metastases, tumour focality, margin status and lichen sclerosus (LS). The relationship between each prognostic factor and progression-free survival (PFS) and overall survival (OS), including hazard ratios, 95% confidence intervals and p-values, were extracted.

CircRASSF2 acts as a prognostic factor and promotes breast cancer progression by modulating miR-1205/HOXA1 axis

ABSTRACT Circular RNA (circRNA), a recently identified endogenous non-coding RNA molecule, regulates gene expression in mammals. At the current stage, the expression and function of circRASSF2 in breast cancer (BC) have not been clarified. According to our study, it is found that circRASSF2 sequences contain miR-1205 binding sites, and Homeobox gene A1 (HOXA1) is the target gene of miR-1205. Besides, the clinical observations and histopathologic study reveal that the expression of circRASSF2 increased to a significant extent in BC tissues and serum. Additionally, it is found that circRASSF2 expression had a positive correlation with distant metastasis, lymph node metastasis, TNM stage, differentiation and tumor size, and that overall survival (OS) and progression-free survival (PFS) of circRASSF2 high expression BC patients were inferior to those with low circRASSF2 expression. In vitro study, an overt decrease was detected in the proliferation, clone formation ability, migration and invasion of breast cancer cells in cells when circRASSF2 was knocked down. We confirmed the direct interaction between circRASSF2, miR-1205 and HOXA1 by a dual luciferase reporter system. Additionally, our study revealed that over-expression of miR-1205 decreased HOXA1 protein expression, and HOXA1 protein expression decreased when circRASSF2 were knocked down, and when miR-1205 expression was inhibited, HOXA1 expression was significantly increased. In conclusion, our study suggests that circRASSF2 regulates BC progression through the miR-1205/HOXA1 pathway. Our findings suggest the prospect of circRASSF2 serving as therapeutic target as such to cure BC patients.

Comparison RNA Expression Level of HER2 (By QRT-PCR) With Protein Expression Level (Immunohistochemistry) and Investigation HER 2 Expression Level with Clinicopathological Features

Background: Evaluation HER2 (human epidermal growth factor receptor 2) status is considered as a standard practice in breast cancer clinical management. There are different methods for evaluation HER2 status, but currently the routine method for assessment of HER2 status is Immunohistochemistry (IHC) .The aim of the this study was to compare the results obtained by IHC and Quantitative Real Time PCR methods in determination of HER2 status to specify whether QRT- PCR can use as supplementary method in breast cancer or not. Methods: In this regard, 48 fresh tissues from patients with breast tumor were studied. IHC, qRT- PCR technique was done in every speciman. IHC was done with DAKO HercepTest and QRT- PCR method was performed with TaqMan probes and primers in lightcyclerTMsystem (Corbett Real Time Thermal cycler). Results: No Correlations was seen between relative HER2 mRNA expression and IHC HER2 status. Furthermore, the relation between HER2 expression level and patient's age, tumor size, lymph node involvement and tumor grade was not significant. Conclusion: The present results show that the relative mRNA levels of HER2 by using q RT-PCR cannot discriminate between HER2 IHC positive from negative

The clinical characteristics and prognostic factors of combined Hepatocellular Carcinoma and Cholangiocarcinoma, Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma after Surgical Resection: A propensity score matching analysis.

Background: Clinical characteristics and prognosis among combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (cHCC-CC) with HCC and intrahepatic cholangiocarcinoma (ICC) were inconsistent in previous studies. The aim of this study was to compare postoperative prognosis among cHCC-CC, HCC and ICC, and investigated the prognostic risk factor of cHCC-CC after surgical resection.Methods: A total of 1041 eligible patients with pathological diagnosis of cHCC-CC (n=135), HCC (n=698) and ICC (n=208) were enrolled in this study. Univariate and multivariate Cox analysis were applied for assessing important risk factors. cHCC-CC were further 1:1 matched with HCC and ICC on important clinical risk factors. Survival curves of matched and unmatched cohorts were depicted by Kaplan-Meier method with log-rank test.Results: Patients with cHCC-CC had similar rate of sex, age and cirrhosis with HCC (p<0.05) and comparable incidence of hepatitis B or C with ICC (p=0.197). Patients of cHCC-CC had intermediate prognosis between HCC and ICC, with median overall survival (OS) time of cHCC-CC, HCC and ICC of 20.5 months, 35.7 months and 11.6 months (p<0.001). In matched cohorts, the OS of cHCC-CC were worse than HCC (p<0.001) but comparable with ICC (p=0.06), while the disease-free survival (DFS) of cHCC-CC was worse than HCC but better than ICC (p<0.05). And lymph node infiltration and postoperative transarterial chemoembolization (TACE) were independent risk factors of cHCC-CC associated with prognosis.Conclusion: The long term survival of cHCC-CC was worse than HCC but comparable with ICC when matched on albumin level, tumor size, lymph node infiltration, tumor stage and margin. Presence of lymph node infiltration and no postoperative TACE were associated with poor prognosis of cHCC-CC.

Development and Validation of Nomograms Predicting the Overall and the Cancer-Specific Survival in Endometrial Cancer Patients.

Background: The present study was aimed at developing nomograms estimating the overall survival (OS) and cancer-specific survival (CSS) of endometrial cancer (EC)-affected patients.Patients and Methods: We retrospectively collected 145,445 EC patients between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were identified via univariate and multivariate Cox analyses. These risk factors were used to establish nomograms to predict 3- and 5-year OS and CSS rates. Internal and external data were used for validation. The predictive accuracy and discriminative ability were measured by using concordance index (C-index) and risk group stratification.Results: A total of 63,510 patients were collected and randomly assigned into the training cohort (n = 42,340) and the validation cohort (n = 21,170). Age at diagnosis, marital status, tumor size, histologic type, lymph node metastasis, tumor grade, and clinical stage were identified as independent prognostic factors for OS and CSS (p < 0.05 according to multivariate Cox analysis) and were further used to construct the nomograms. The area under the receiver operating characteristics (ROC) curve was greater than that of International Federation of Gynecology and Obstetrics (FIGO) staging system for predicting OS (0.83 vs. 0.73, p < 0.01) and CSS (0.87 vs. 0.79, p < 0.01) in the training cohort. The stratification into different risk groups ensured a significant distinction between survival curves within different FIGO staging categories.Conclusion: We constructed and validated nomograms that accurately predicting OS and CSS in EC patients. The nomograms can be used for estimating OS and CSS of individual patients and establishing their risk stratification.

Immune responses against autologous tumor and human papilloma virus in lymph nodes from patients with penile cancer.

PurposeNearly half of penile cancers are related to human papillomavirus (HPV) infection. Investigations of tumor- and HPV-specific T cell reactivity in regional lymph nodes (LNs) from patients with penile cancer are warranted.Materials and MethodsIn this study, single-cell suspensions from LNs and peripheral blood from 11 patients with penile cancer were stained with antibodies for lymphocyte markers and analyzed by fluorescence-activated cell sorting (FACS). DNA was extracted from the tumor tissue and HPV status was investigated by PCR.ResultsT-cell reactivity against autologous tumor-extract and against the HPV-vaccine Gardasil® was tested by flow-cytometric assay of specific cell-mediated immune response in activated whole blood (FASCIA). CD4+/CD8+ ratios were significantly lower in HPV positive LNs (p<0.05). Immune responses to tumor extract assessed by blast transformation and expansion in vitro, of either CD4+ or CD8+ T-cells, were found in 9 of 13 LNs (69%). 5 of 6 tested patients demonstrated T cell recognition of tumor-associated antigen(s). In HPV-positive patients, dose-dependent T cell responses against L1 (late) HPV proteins (Gardasil vaccine) were demonstrated.ConclusionsLN-derived T cells from patients with penile cancer recognize tumor antigen(s) and in HPV-positive cases, there is a response against L1 (late) HPV proteins, being constituents of the Gardasil vaccine.

Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer.

BackgroundWomen with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC.MethodsData from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC.ResultsOf the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients.ConclusionThis study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.

Penile sparing therapy for penile cancer.

Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.

Peri-tumoral Lymphovascular density by antipodoplanin antibody D2-40, as a predictor of nodal metastasis in oral squamous cell carcinoma

BACKGROUND:&#x0D; The involvement of regional lymph nodes by cancer is a major determinant of prognosis in oral squamous cell carcinoma (OSCC) and is a significant predictor of patient survival. Peri-tumoral lymphangiogenesis is being studied as an important tool in predicting neck lymph node metastasis. Podoplanin, a transmembrane glycoprotein is expressed on lymphatic vessel endothelium and considered as a marker of lymphangiogenesis. The high podoplanin expression has been associated with invasion, progression, and metastasis of oral cancer. D2-40, an anti-podoplanin monoclonal antibody, is a specific marker of lymphatic endothelial cells. The present study was designed to investigate the peritumoral lymphovascular density (PT-LVD) by evaluating D2-40 expression and its potential utility in predicting lymph node metastasis in OSCC.&#x0D; METHODS: Seventy-two patients with OSCC were enrolled (36 with early and 36 with advanced-stage tumors). Differential expression of peritumoral lymphovascular density (PT-LVD) was evaluated using D2-40 expression by immunohistochemistry (IHC). Expression was categorized as low and high, derived from the mean of a number of vessels per 10 high power fields in hot-spots. Statistical methods were employed to correlate expression with age, gender, tumor site, stage, and neck lymph node involvement. &#x0D; RESULTS: We observed a significant association between peritumoral lymphovascular density (PT-LVD) with clinical neck lymph node status (p=0.001) and tumor stage (p=0.033). There was no significant correlation of D2-40 expression with age, gender, tumor site, T stage, and tumor differentiation.&#x0D; CONCLUSION: PT-LVD is a positive predictor of neck lymph node metastasis. It has translational potential, along with other clinical parameters for decision making in the treatment of the neck in oral cancer.

FOXK1 plays an oncogenic role in theprogression of hilar cholangiocarcinoma.

Hilar cholangiocarcinoma (HC) has a poor outcome in terms of survival. Forkhead box K1 (FOXK1) dysregulation is critical in solid tumors, which serves a pivotal role in the biological characteristics, such as invasion and migration, but its expression and functions in HC are unclear. The present study investigated the clinical significance and biological functions of FOXK1 in HC. Tumor microarrays and immunohistochemistry were used to evaluate FOXK1 in HC and its expression was modulated to determine its effects on chemoresistance and tumorigenesis. FOXK1 was highly expressed in HC and cell lines, which was associated with tumor invasion, regional lymph node metastasis, tumor recurrence and poor prognosis. Silencing FOXK1 in HC cells inhibited invasion and migration, upregulated E-cadherin, and downregulated vimentin, matrix metallopeptidase 9 and Twist in HC cells. Sensitivity to 5-fluorouracil and cisplatin was increased, and glutathione S-transferase π, multidrug resistance mutation 1 and P-glycoprotein expression levels were downregulated in RBE cells in vitro following FOXK1 knockdown. These results indicated that FOXK1 plays an oncogenic role in HC progression and can serve as a novel therapeutic target for HC.

Adjuvant chemotherapy of resistant high risk choriocarcinoma

Choriocarcinoma is a subtype of gestational trophoblastic disease. It is a very rare neoplasm, with incidence of about 1 case in 40.000 pregnancies. Gestational form of choriocarcinoma arises most commonly after abortion, while nongestational form develops from pluripotent germ cells. Choricarcinoma is highly malignant and highly chemosensitive type of tumor. A 43-year-old patient diagnosed with extra uterine pregnancy in September 2017 was treated with methotrexate with no response and had surgical removal of right Fallopian tube. Choriocarcinoma was diagnosed one and a half year after extra uterine pregnancy. Radiological imaging before treatment showed pulmonary and inguinal lymph node metastases and tumor invasion of the anterior uterine wall. Surgery was performed due to heavy bleeding and uterine wall invasion. As high risk patient she received chemotherapy. She was followed radiologically and her serum ?-HCG was monitored. Refractivity to the chemotherapy protocol during treatment was observed. Therapy response was achieved after administration of EMA-EP protocol modification i.e. three consecutive negative follow-up values of ?-HCG were obtained and radiological findings were disease free. One month after treatment patient had no signs of disease and ?-HCG level was normal.

Value of spectral detector CT for pretherapeutic, locoregional assessment of esophageal cancer

PurposeTo investigate the diagnostic value of spectral detector dual-energy CT-derived low-keV virtual monoenergetic images (VMI) and iodine overlays (IO) for locoregional, pretherapeutic assessment of esophageal cancer. Method74 patients with biopsy-proven esophageal cancer who underwent pre-therapeutic, portal-venous-phase staging examinations of the chest and abdomen were retrospectively included. Quantitative image analysis was performed ROI-based within the tumor, healthy esophageal wall, peri-esophageal lymph nodes, azygos vein, aorta, liver, diaphragm, and mediastinal fat. Two radiologists evaluated delineation of the primary tumor and locoregional lymph nodes, assessment of the celiac trunk and diagnostic certainty regarding tumor infiltration in conventional images (CI), VMI from 40 to 70 keV and IO. Moreover, presence/absence of advanced tumor infiltration (T3/T4) was determined binary using all available images. ResultsVMI40−60keV showed significantly higher attenuation and signal-to-noise ratio compared to CI for all assessed ROIs, peaking at VMI40keV (p < 0.05). Contrast-to-noise ratio of tumor/esophagus (VMI40keV/CI: 7.7 ± 4.7 vs. 2.3 ± 1.5), tumor/diaphragm (VMI40keV/CI: 9.0 ± 5.5 vs. 2.2 ± 1.7) and tumor/liver (4.3 ± 5.5 vs. 1.9 ± 2.1) were all significantly higher compared to CI (p < 0.05). Qualitatively, lymph node delineation and diagnostic certainty regarding tumor infiltration received highest ratings both in IO and VMI40keV, whereas vascular assessment was rated highest in VMI40keV and primary tumor delineation in IO. Sensitivity/Specificity/Accuracy for detecting advanced tumor infiltration using the combination of CI, VMI40−70keV and IO was 42.4 %/82.0 %/56.3 %. ConclusionsIO and VMI40−60keV improve qualitative assessment of the primary tumor and depiction of lymph nodes and vessels at pretherapeutic SDCT of esophageal cancer patients yet do not mitigate the limitations of CT in determining tumor infiltration.

Minimally Invasive Approaches in Locally Advanced Cervical Cancer Patients Undergoing Radical Surgery After Chemoradiotherapy: A Propensity Score Analysis

PurposeChemoradiation (CT/RT) followed by radical surgery (RS) may play a role in locally advanced cervical cancer (LACC) patients with suboptimal response to CT/RT or in low-income countries with limited access to radiotherapy. Our aim is to evaluate oncological and surgical outcomes of minimally invasive radical surgery (MI-RS) compared with open radical surgery (O-RS).Patients and MethodsData for stage IB2–IVA cervical cancer patients managed by CT/RT and RS were retrospectively analyzed.ResultsBeginning with 686 patients, propensity score matching resulted in 462 cases (231 per group), balanced for FIGO stage, lymph node status, histotype, tumor grade, and clinical response to CT/RT. The 5-year disease-free survival (DFS) was 73.7% in the O-RS patients and 73.0% in the MI-RS patients (HR 1.034, 95% CI 0.708–1.512, p = 0.861). The 5-year locoregional recurrence rate was 12.5% (O-RS) versus 15.2% (MI-RS) (HR 1.174, 95% CI 0.656–2.104, p = 0.588). The 5-year disease-specific survival (DSS) was 80.4% in O-RS patients and 85.3% in the MI-RS group (HR 0.731, 95% CI 0.438–1.220, p = 0.228). Estimated blood loss was lower in the MI-RS group (p < 0.001), as was length of hospital stay (p < 0.001). Early postoperative complications occurred in 77 patients (33.3%) in the O-RS group versus 88 patients (38.1%) in the MI-RS group (p = 0.331). Fifty-six (24.2%) patients experienced late postoperative complications in the O-RS group, versus 61 patients (26.4%) in the MI-RS group (p = 0.668).ConclusionMI-RS and O-RS are associated with similar rates of recurrence and death in LACC patients managed by surgery after CT/RT. No difference in early or late complications was reported.

Indeterminate Dendritic Cell Tumor (IDCT) of GI Tract, Lymph Node and Spleen Masquerading as Refractory Inflammatory Bowel Disease

Abstract Introduction/Objective Indeterminate dendritic cell tumor (IDCT) is an extremely rare neoplasm, most frequently presenting in skin with cells resembling precursors to Langerhans cells. We report an exceptional case of IDCT occurring in GI tract, spleen, and lymph nodes of a 66-year-old lady, mimicking inflammatory bowel disease (IBD). Methods Four years prior to the diagnosis of IDCT, she was diagnosed with ulcerative colitis (UC) based on bloody diarrhea and pan-colitis. Her colitis became refractory to medical treatments and she developed pancytopenia, splenomegaly and abdominal lymphadenopathy. A FNA of abdominal lymph node and a colonoscopic biopsy both showed non-necrotizing granulomas, which along with her multiple oral ulcers suggested Crohn’s disease. Due to failure to medical treatments, she underwent proctocolectomy and ileostomy, followed later by subtotal colectomy with excision of a splenule and lymph nodes. Results All specimens from the final operation showed involvement by IDCT characterized by polygonal cells with abundant eosinophilic cytoplasm, oval nuclei with occasional nuclear grooves, open chromatin and eosinophilic nucleoli. By immunohistochemistry, the tumor cells expressed S100, CD1a, cyclin D1, BRAFV600E. Langerin staining was observed in &amp;lt;5% of cells, suggesting partial differentiation of tumor cells (frequently seen in IDCT) vs. reactive Langerhans cells. No overt cytological atypia and no necrosis were observed. Eosinophils, neutrophils, lymphocytes and plasma cells were sparse. There was no emperioloperesis. The colon showed multifocal active and chronic inflammation and ulcerations associated with the IDCT infiltrate. These specimens were diagnostic of IDCT. Conclusion Absence Langerin in the majority of cells excluded the possibility of Langerhans cell histiocytosis. The presence of CD1a and absence of bone involvement excluded the possibility of Erdheim-Chester disease. Retrospectively, it appears that the patient’s symptoms were due to IDCT rather than IBD. The clinical course of IDCT is highly variable, but the BRAF mutation offers a promising new therapeutic target for this patient.

SETD8 promotes stemness characteristics and is a potential prognostic biomarker of gastric adenocarcinoma

SETD8 is a lysine methyltransferase containing an SET domain, which is involved in the carcinogenesis of many cancer types through monomethylation of the histone H4 lysine 20. However, its prognostic value and underlying mechanisms in gastric adenocarcinoma (GA) have not been extensively studied. Here, we assessed SETD8 expression and its relationship with clinicopathological parameters, cancer stemness-related proteins, cell cycle-related proteins, and PI3K/Akt pathway proteins in GA. SETD8 expression in GA tissues was correlated with the primary tumor stage, lymph node metastasis, tumor size, gross type, and clinical stage. SETD8 was an independent predictor of poor overall survival of patients with GA. Cox regression analysis showed that SETD8 is a potential biomarker of unfavorable clinical outcomes in patients with GA. Moreover, SETD8 overexpression was associated with cancer stemness-related genes, cell cycle-related genes, and PI3K/Akt/NF-κB pathway genes in clinical GA tissue samples. SETD8 silencing downregulated the expression of cancer stemness-associated genes (LSD1 and SOX2) and inhibited GA cell proliferation, spheroid formation, invasion, and migration. Additionally, LY294002 significantly reduced the expression of SETD8, pAkt-Ser473, pPI3K-p85, and NFκB-p65 in MKN74 and MKN28 cells. SETD8 may be a novel cancer stemness-associated protein and potential prognostic biomarker in GA.

Primary Nodal Lymphangioma: A Rare Case Report and Literature Review

Abstract Introduction/Objective Lymphangiomas are benign nodal vascular tumors commonly seen in the skin, mucosa, and soft tissue; however, its occurrence in lymph nodes is extremely rare, with only a few cases reported in English literature. Methods We report a case of a 20-year-old female who presented with a 6 cm right upper thigh mass below the inguinal region that has been gradually increasing in size over the past three months. Ultrasound showed a cystic appearance. An excisional biopsy was performed to yield a thin-walled cystic mass filled with clear fluid. The mass appeared to be connected to a regional lymph node. Histologic examination revealed a multiloculated thin-wall cyst involving the hilum of the lymph node. The cyst is lined by flat lymphatic endothelial cells with focally disorganized smooth muscle at the wall of large channels and peripheral lymphoid aggregates. The rest of the lymph node shows reactive change with vascular proliferation and congestion. Results Lymphangiomas are soft, relatively well-circumscribed hamartomatous malformations due to the failure of the lymphatic system to communicate with the venous system. This leads to abnormal rests of lymphatic tissue that proliferate and accumulate fluid, causing their cystic morphology. Lymphangiomas are classified as capillary, cavernous, and cystic forms. Imaging techniques such as ultrasonography, mammography, and magnetic resonance imaging may aid in clinical diagnosis and follow-up. Histologically, cavernous lymphangiomas show numerous narrow cavernous spaces lined by a single layer of attenuated endothelial cells, and containing amorphous eosinophilic fluid with few lymphocytes. These spaces may contain blood resulting in misdiagnosis of this lesion as cavernous hemangioma; however, increased lymphoid cells in the stroma, more irregular cavernous spaces, support the diagnosis of lymphangioma. Conclusion Lymphangiomas are slowly progressive painless lesions that frequently recur in cases of incomplete excision. It is important to identify this primary nodal lymphangioma to avoid misdiagnosis of benign vascular proliferation, benign vascular tumor, or malignant vascular tumor.

Clinicopathological characteristics of gastric cancer in adolescents aged 10-24 years: 17-year experience of 17 years in a single institute

Objective: Gastric cancer in adolescents is rare, with only a few cases reported in the literature. The purpose of this study is to investigate the clinicopathological features and prognostic factors of gastric cancer in adolescents aged 10-24 years. Methods: A case-controlled study was performed. The clinicopathological data of gastric cancer patients aged 10-24 years who were treated at the First Medical Center of Chinese PLA General Hospital from February 2000 to February 2017 were retrospectively collected and compared with those patients over 40 years old at the same period, which were randomly selected in a ratio of 1:2. All the patients were followed up until June 2019 and Cox proportional hazard model was used to analyze prognostic factors in the adolescent patients. Results: A total of 63 adolescent gastric cancer patients (0.4% of all 14 794 gastric cancer patients) were enrolled, including 31 males (49.2%) and 32 females (50.8%), with a mean body mass index of (19.5±4.3) kg/m(2). Before diagnosis, Only 35 cases (55.6%) had warning symptoms such as weight loss, ascites, obstruction, hematemesis, black stool, etc.; 5 cases (7.9%) had a family history of gastrointestinal tumor. The median duration of symptoms before diagnosis was 3 months. At diagnosis, 58 cases (92.1%) were poorly differentiated, 57 cases (90.5%) were T3-4 stage, 19 cases (30.2%) were signet ring cell cancer or mucous adenocarcinoma, 57 cases (90.5%) had lymph node metastasis, and 36 cases (57.1%) had distant metastasis. Twenty-nine patients (46.0%) underwent radical surgery, 12 patients underwent palliative surgery, 5 patients underwent exploratory laparotomy, 17 patients were unable to operate due to late stage. Of 56 cases (88.9%) with TNM stage Ⅲ-Ⅳ, 51 patients (81.0%) received chemotherapy. Of the 126 patients over 40 years old, 98 cases (77.8%) were male and 28 cases (22.2%) were female, and the mean body mass index was (23.8±3.2) kg/m(2). There were 60 cases (47.6%) with low differentiation, 90 cases (71.4%) with T3-4, 16 cases (12.7%) with signet ring cell cancer and mucous cell cancer, 79 cases (62.7%) with lymph node metastasis, and 12 cases (9.5%) with distant metastasis. A total of 115 cases (91.3%) underwent radical surgery. Of 74 cases (58.7%) with TNM stage Ⅲ-Ⅳ, 67 cases received (53.2%) chemotherapy. The 63 adolescent gastric cancer patients had lower body mass index, and higher proportion in female, poorly differentiation, signet ring cell cancer and mucous cell cancer, T3-4 stage, lymph node metastasis, distant metastasis, TNM stage Ⅲ-Ⅳ and receiving chemotherapy compared with 126 gastric cancer patients over 40 years old (all P<0.05). Among the 63 adolescent gastric cancer patients, 52 cases (82.5%) were followed up with median follow-up time of 72.1 (36.1, 100.8) months, and the median survival time was 10.4 months (95% CI: 6.5-15.1). The 1-year, 3-year and 5-year survival rates were 44.2%, 25.0% and 18.0%, respectively. Univariate analysis showed that the depth of tumor invasion (HR=7.15, 95% CI:1.71-29.89, P=0.007), lymph node metastasis (HR=6.00, 95% CI:1.42 - 25.42, P=0.015), distant metastasis (HR=7.25, 95% CI: 3.25 - 16.18, P<0.001), TNM stage (HR=5.49, 95% CI: 1.67-18.12, P=0.005) and tumor resection (HR=0.18, 95% CI: 0.09-0.37, P<0.001) were the risk factors affecting the prognosis of adolescent gastric cancer patients. Multivariate survival analysis showed that distant metastasis was an independent factor for gastric cancer survival in adolescents (HR=3.67, 95% CI: 1.32-10.19, P=0.012). Conclusions: Gastric cancer in adolescents is insidious and progresses rapidly. Most of them are in the advanced stage at diagnosis and have low rate of radical excision.

Extricating the Association Between the Prognostic Factors of Colorectal Cancer.

Colorectal cancer (CRC) is one of the recurring and lethal gastrointestinal tract disease rankings as the primary cause of worldwide morbidity and mortality. In general, the tumour node metastasis (TNM) and Dukes classification assist in diagnosis, prognosis and treatments of CRC along with haematological examinations and tumour demographic characterisations in patients. The present investigation is carried out on clinically acknowledged sixty-five CRC patients based on haematological findings and are sorted into stages using TNM and Dukes. The present study is to find the association between haematological findings, demographic characters, differentiation position, lymph node invasion and tumour node metastasis in CRC patients in accordance with their age. We observed significant (p < 0.05) nexus between lymph node metastasis and tumour node metastasis on the basis of tumour's differentiation demographic positioning and age of the individuals. Earlier location tracing and medicinal treatment or surgery lessen the chance of CRC morbidity and mortality along with prolonging survival rate via prognostic factors and disease position determination.

Increased expression of ALDH-1 is associated with clinical parameters of salivary glands neoplasms

The enzyme aldehyde dehydrogenase-1 (ALDH-1) is a known putative tumour stem cells (TSC) marker, and these cells are implicated in carcinogenesis and progression of human neoplasms. We aimed to evaluate ALDH-1 expression in benign and malignant salivary gland neoplasms and its clinicopathological and prognostic significance. Expression of ALDH-1 was investigated by immunohistochemistry and confirmed by Western Blot analysis in 154 salivary gland neoplasms (103 malignant and 51 benign neoplasms). The expression was identified in the parenchyma of malignant (n = 88; 85.6%) and benign (100%) neoplasms. Overall, expression in the parenchyma varied considerably and was not associated with clinical parameters in most malignant neoplasms, however, a high expression in mucoepidermoid carcinomas (MEC) was associated with advanced pathological TNM stage (p = 0.047). The presence of ALDH-1 in stromal cells of malignant neoplasms (n = 67; 65.0%) was associated with lymph node metastasis (p = 0.032), tumour recurrence (p = 0.006) and death (p = 0.013). Overall and disease-free survival in 5 and 10 years was lower in patients with diagnosis of adenoid cystic carcinoma, tumour recurrence, advanced staging, and presence of ALDH-1 in the stroma. When adjusted by multivariate analysis, advanced staging and stromal expression were independent prognostic factors affecting disease-free survival. Our findings provide evidence that cells characterized as TSC in the parenchyma and stroma are differentially present among the different types of neoplasms studied and may be related to tumourigenesis, biological behaviour and persistence capacity of malignant tumours of the salivary gland.