Malignant Histotypes Research Articles

Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy: The value of a multidisciplinary team

ObjectiveTo report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma (RCC) treated at a referral academic centre, focusing on technical nuances and on the value of a multidisciplinary team. MethodsWe queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced (cT3-T4 N0-1 M0) renal masses suspected of RCC at our centre between January 2017 and December 2020. ResultsOverall, 32 patients were included in the analytic cohort. Of these, 12 (37.5%) tumours were staged as cT3a, 8 (25.0%) as cT3b, 5 (15.6%) as cT3c, and 7 (21.9%) as cT4; 6 (18.8%) patients had preoperative evidence of lymph node involvement. Nine (28.1%) patients underwent nephron-sparing surgery while 23 (71.9%) received radical nephrectomy. A template-based lymphadenectomy was performed in 12 cases, with evidence of disease in 3 (25.0%) at definitive histopathological analysis. Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation. While intraoperative complications were recorded in 3 (9.4%) patients, no postoperative major complications (Clavien-Dindo ≥3) were observed. At histopathological analysis, 2 (6.2%) patients who underwent partial nephrectomy harboured oncocytoma, while the most common malignant histotype was clear cell RCC (62.5%), with a median Leibovich score of 6 (interquartile range 5–7). ConclusionLocally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams. Our experience confirms that provided careful patient selection, surgery in experienced hands can achieve favourable perioperative, oncological, and functional outcomes.

Expression of PLAG1, HMGA1 and HMGA2 in minor salivary glands tumours.

Diagnosis of minor salivary gland (MSG) tumours is often difficult, due to the scarce tissue obtained from bioptic excision and complex histopathological differential diagnosis. In our study we performed an immunohistochemical analysis of PLAG1, HMGA1 and HMGA2 on a series of MSG tumours, in order to develop a new helpful diagnostic panel. A retrospective series of 17 surgical specimens of MSG tumours were analysed for the expression of PLAG1, HMGA1 and HMGA2. Three control cases were enrolled and analysed. An intensity and percentage-based approach was performed, creating a combined score panel. PLAG1 facilitate the diagnosis of benign tumours, discriminating it from malignant histotypes, with a defined cut-off value. Similarly, HMGA1 is significantly higher in benign histotypes than in malignant ones. HMGA2 in our series, did not reveal any association in identifying benign from malignant histotypes. In this study we assessed the diagnostic role of PLAG1, HMGA1 and HMGA2 immunohistochemical analysis. The score panel facilitate histopathological diagnosis of these rare tumours, helping to distinguish benign tumours from malignant ones and ameliorating the differential diagnosis of specific histotypes.

Management of phyllodes tumour of breast: 5 year experience at Madina Teaching Hospital, Faisalabad.

Objectives: To determine the oncological outcome of different types of phyllodes tumour (PT) and to analyze the impact of radiotherapy on outcome. Study Design: Experimental study. Setting: Madina Teaching Hospital, Faisalabad, Pakistan. Period: April 2015 to April 2020. Material & Methods: Female patients diagnosed as phyllodes tumour of breast were included and classified into benign, borderline and malignant PT according to WHO criteria. Borderline and malignant PT were further divided into 2 groups; Group A (Surgery alone) and Group B (Surgery + Radiotherapy). Oncological outcome based on local recurrence, distant metastasis and overall survival rate among different types of phyllodes tumour and those patients who received or not received radiotherapy was assessed. Results: In 5 years, 29 patients of phyllodes tumour were studied. 15 (51.7%) patients had benign, 8 (27.6%) malignant and 6 (20.7%) borderline tumour. Mean age of our patients was 39.5 years (range: 25-55 years).The disease free survival rate was 82.8% (100% for benign, 83.4% for borderline and 50% for malignant PT). Malignant histotype and tumour size >6cm were significantly associated with recurrence (p<0.05). In Group A, 4 patients developed local recurrence and 2 of them developed distant metastasis; while in group B only 1 patients developed local recurrence (p=0.2, OR=0.147). Overall survival rate was 93.1%. It was 100% for radiotherapy group compared to 88% for non irradiated patients. Conclusion: Malignant phyllodes tumour and large tumour size is associated with worse prognosis. Post operative radiotherapy is associated with improved local recurrence, distant metastasis and overall survival.

Major and minor salivary gland tumours.

Salivary glands carcinomas are very rare epithelial malignant tumors. In 2013 in Europe, 7800 new diagnoses were estimated, 8.5 % of all head and neck cancer. The last WHO classification (2017) counts more than 20 malignant histotypes, this variety as well as the rarity of some of them needs a skilled pathologist for diagnosis. Surgery remains the mainstay of management followed by radiation in high-grade and high-risk pathological features cases. The intensity modulated radiotherapy (IMRT) should be preferred over conformational radiotherapy techniques as adjuvant and exclusive treatment in advanced cases. Particle radiotherapy (i.e. protons, carbon ions) can have a role in advanced/unresectable disease since it was proved to have better results over photons in loco-regional control both in adenoid cystic carcinoma and in other histotypes. Although chemotherapy is still the most frequent treatment for metastatic patients, several new compounds (i.e. anti-angiogenic agents, tailored agents, checkpoint inhibitors) are under investigation.

Diffusion-Weighted Imaging in Oncology: An Update.

To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the “functional” information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.

Genetic aberrations and molecular biology of cardiac sarcoma.

Cardiac tumors are rare and complex entities. Early assessment and differentiation between non-neoplastic and neoplastic masses, be they benign or malignant, is essential for guiding diagnosis, determining prognosis, and planning therapy. Cardiac sarcomas represent the most frequent primary malignant histotype. They could have manifold presentations so that the diagnosis is often belated. Moreover, considering their rarity and the limitation due to the cardiac location itself, the optimal multimodal management of patients affected by primary cardiac sarcomas still remains highly difficult and outcome dismal. Therefore, there is an urgent need to improve these results mainly focusing on more adequate tools for prompt diagnosis and exploring new and more effective therapies. Knowledge about the molecular landscape and pathogenesis of cardiac sarcoma is even more limited due to the rarity of this disease. In this sense, the molecular characterization of heart tumors could unfold potentially novel, druggable targets. In this review, we focused on genetic aberrations and molecular biology of cardiac sarcomas, collecting the scarce information available and resuming all the molecular findings discovered in each tumor subtype, with the aim to get further insights on mechanisms involved in tumor growth and to possibly highlight specific molecular profiles that can be used as diagnostic tests and unveil new clinically actionable targets in this tricky and challenging disease.

Robot-assisted Partial Nephrectomy for Complex (PADUA Score ≥10) Tumors: Techniques and Results from a Multicenter Experience at Four High-volume Centers

BackgroundRobot-assisted partial nephrectomy (RAPN) represents a widely accepted minimally invasive alternative to open and laparoscopic surgery for the treatment of clinically localized renal tumors. ObjectiveTo assess the feasibility of RAPN in a contemporary series of patients with highly complex tumors (PADUA score ≥10) treated at four high-volume robotic surgery institutions. Design, setting, and participantsData from a prospectively maintained multi-institutional database on patients subjected to RAPN between 2010 and 2017 were reviewed. For the scope of this analysis, only patients with highly complex renal tumors, defined as a PADUA score between 10 and 14, were included. Surgical procedureRAPN was performed with the da Vinci Si or Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) using novel technologies such as TilePro and near-infrared fluorescence imaging. MeasurementsIntraoperative, postoperative, surgical, and oncological outcomes were collected. Predictors of optimal surgical outcomes defined according to the Margin Ischemia and Complications binary system (absence of Clavien-Dindo >2 complications, warm ischemia time [WIT] <20min, and absence of positive surgical margins) were determined using logistic regression models (LRMs). Results and limitationsOverall, 255 patients with complex renal tumors were included. The mean operative time was 165min and mean WIT was 18.6min. Overall, WIT was longer than 20min in 86 (33.7%) individuals, while a Clavien-Dindo >2 complication and positive surgical margins were observed in 13 (5.1%) and four (out of 211 patients with malignant histotypes; 1.9%) individuals, respectively. Optimal surgical outcomes were achieved in 158 (62.0%) patients. At a median follow-up of 28mo, one (0.4%) local and two (0.8%) distant recurrences of the disease were observed. In multivariable LRMs, extremely complex tumors (PADUA score 12–13) were associated with an increased likelihood of not achieving optimal outcomes (odds ratio: 2.31; p=0.024). Besides tumor complexity, male gender was also associated with a two-fold higher risk of not achieving optimal surgical outcomes (p=0.029). ConclusionsIn experienced hands, RAPN can be considered as an effective treatment option even in cases of complex renal lesions. However, increasing tumor complexity may affect the surgical outcomes in this highly selected patient population. Patient summaryWe reported our multicentric experience with robot-assisted partial nephrectomy (RAPN) in patients with complex renal tumors. We demonstrated that, in experienced hands, RAPN is a feasible and safe treatment option even in such patients. Novel technologies applied to RAPN may further extend the indications without compromising the outcomes.

Correlation between Serum Cytokeratin 19 Fragment and the Clinicopathological Features and Prognosis of Thymic Epithelial Tumors

背景与目的胸腺肿瘤中尚无肿瘤标志物的应用，本研究旨在评估血清细胞角蛋白19片段（cytokeratin 19 fragment, Cyfra 21-1）与胸腺肿瘤临床病理特征和预后的相关性。方法回顾性分析上海市胸科医院2012年11月-2016年9月收治的159例胸腺肿瘤病例的临床资料。比较术前血清Cyfra 21-1水平在不同分期及组织学类型间的差异，研究术前及术后血清Cyfra 21-1水平与复发的关系。结果在局部晚期（T4期）（P < 0.001）、胸腺癌（P < 0.001）患者中，术前血清Cyfra 21-1水平显著升高，且当术前Cyfra 21-1≥1.66 ng/mL时，其对术后复发有提示意义。分析患者随访的血清Cyfra 21-1，将2.66 ng/mL作为cut-off值时，提示胸腺肿瘤复发的敏感度为0.667，特异度为0.925，阳性预测值为0.462，阴性预测值为0.966。结论术前患者血清Cyfra 21-1水平较高，有助于提示肿瘤分期较晚、肿瘤恶性程度较高，或可提示术后复发的风险升高。在随访时结合血清Cyfra 21-1检测，将可能有助于提高复发患者的检出率，改善预后。

Abstract 2936: Molecular profiling of primary malignant pleuralmesothelioma histotypes cell lines reveals relationship between GDF15overexpression and cisplatin resistance both in in vitro and in vivo models

Abstract Malignant pleural mesothelioma (MPM) development is mainly correlated with exposure to asbestos and appears to be a trend toward an increase in its incidence in the years to come. Although novel therapeutic strategies are under investigation, alone or in combination with conventional therapy, MPM remains a cancer with high medical need. With the aim to identify putative novel therapeutic targets/biomarkers expressed in specific MPM histotypes we investigated 9 different primary MPM cell lines at molecular, biochemical and pharmacological levels. A transcriptomic analysis has been conducted comparing the gene expression in epitheliod (E-MM473), sarcomatoid (S-MM432) and biphasic (B-MM487) primary cell lines. We found more than 1000 genes differentially regulated and statistically validated (p&amp;lt; = 0.05). The hierarchical clustering of the top 100 expressed genes revealed an histotype specific expression while few of them have a similar expression among the histotypes. 14 out of 100 genes were chosen based on their role in cell survival (hk1; gdf15; ifnar1/2; bmpr1/2; tgfrb; cdca8; birc5; plk1; srsf6; pin1; nox1; wt1). Their expression was confirmed via RT-PCR in all the 9 MPM cell lines (E-MM473, E-MM288, E-MM317, E-MM404, E-MM481; S-MM432, S-MM472; B-MM487, B-MM491) vs normal mesothelium cells (MET5A). Among the validated genes, gdf15 and hk1 expression strongly correlated with the epithelioid and bifasic histotype, respectively. The tumor relevance of these genes has been confirmed by siRNA interference in which hk1 and gdf15 transcript reduction significantly affected S-MM432 (&amp;gt;90%) and E-MM473/B-MM487 cell survival (&amp;gt;50%). GDF15 belongs to the TGF-β superfamily and its role in different pathologies including cancer is controversial (Breit et al., 2011). Its overexpression has been associated to tumor chemoresistance (Chung-Ying et al.,2007) including Cisplatin (Cis) (Li et al., 2015; Yang et al. 2014). To this end, we investigated if GDF15 protein levels in MPM cells exposed to Cis correlate with its citotoxicity. Interestingly GDF15 protein level, which is high in E-MM473, medium in B-M M432 and low in S-MM487, is inversely correlated with the cells sensitivity to the treatment (i.e. E-MM473 are 2-5 times more resistant) and GDF15 silencing increases Cis-induced cytotoxicity. To assess the relationship between GDF15 levels/ Cis resistance, efficacy of Cis (4mg/kg; q7dx3w;i.v.) on stably expressing luciferase E-MM473(highGDF15) and B-MM487 (lowGDF15), orthotopically xenografted in nude mice, were investigated. While, E-MM473 showed a poor response to the Cis (TGI 58%), an impressive tumor response (TGI 95%) was observed in treated B-MM487. Our results suggest and support the need of further clinical investigation to correlate GDF15 plasma level to the chemotherapy response in MPM patients. Citation Format: Claudio Pisano, Gianluca Carletta, Fulvio D’Angelo, Antonietta Esposito, Erminia Bianchino, Assunta Riccio, Michela Festa, Francesco Cardile, Emanuele Carchia, Walter D’Acunto, Giacomo Signorino, Mario B. Guglielmi, Pasquale De Luca. Molecular profiling of primary malignant pleuralmesothelioma histotypes cell lines reveals relationship between GDF15overexpression and cisplatin resistance both in in vitro and in vivo models. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2936.

Abstract 590: Identification and validation of novel candidate circulating biomarkers in high-grade soft tissue sarcoma

Abstract Soft Tissue Sarcoma (STS) are rare mesenchymal tumors, accounting for less than 1% of adult and 7-10% of pediatric cancers respectively. They are very complex and approximately include 50 different benign and malignant histotypes. Identification of circulating cancer biomarkers improves early detection and is important in determining patient risk stratification, in monitoring tumor progression and therapy response, and in planning new treatment. However, at present there are no laboratory tests that allow reliable early STS diagnosis and consequent prognosis. Discovery of new serum protein biomarkers is especially needed for patients with advanced/metastatic STS for whom the outcome remains strongly unfavorable. Proteomic technologies are used for global profiling and identification of disease-associated markers in biological fluids, such as serum. The low-molecular-weight (LMW) proteome (&amp;lt;30 kDa) is considered a rich source of new potential biomarkers, that are often masked by the presence of abundant proteins in serum. In order to determine whether low-abundant serum proteins/peptides can be indicative of advanced disease, we analyzed 53 high-grade STS sera divided in discovery (34 sera) and validation (19 sera) subsets by using poly(N-isopropylacrylamide-co-vinylsulfonic acid) hydrogel core-shell nanoparticles with incorporated Cibacron Blue F3G-A. These nanoparticles selectively entrap LMW proteins/peptides on the bases of size exclusion and affinity chromatography. These nanoparticles protect the analytes from enzymatic degradation and amplify the concentration for mass spectrometry detection. 13 benign STS and 20 healthy sera were used as control. The most significant protein, IGFBP7, was then validated in a wider series of cases including 59 high-grade STS sera by ELISA assay and 86 paraffin-embedded high-grade primary STS by immunohistochemistry. Mass spectrometry data revealed 17 proteins/peptides common to discovery and validation subsets with significance differences in abundance when compared to benign and/or normal sera. The function of selected biomarkers was predominantly related to calcium-binding proteins (MGP), immune response (Ceruloplasmin, Lactotransferrin), coagulation process (Serpin C1) and metabolism (TGFBI). Moreover, as confirmed by ELISA assay, expression of insulin-like growth factor binding protein 7 (IGFBP7) involved in cell signaling pathway progressively increased in healthy, benign and malignant tumors. With immunohistochemistry, tissue IGFBP7 had a significantly higher expression in metastatic than in non metastatic STS. Our data suggest that proteomic technology is able to identify circulating biomarkers associated to STS malignant phenotype and IGFBP7 in paired primary specimens may discriminate STS patients with increased risk of metastatic progression. Citation Format: Amalia Conti, Claudia Fredolini, Davide Tamburro, Giovanna Magagnoli, Weidong Zhou, Lance A. Liotta, Piero Picci, Alessandra Luchini, Maria Serena Benassi. Identification and validation of novel candidate circulating biomarkers in high-grade soft tissue sarcoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 590. doi:10.1158/1538-7445.AM2015-590

Nuclear survivin expression as a potentially useful tool for the diagnosis of canine cutaneous sebaceous lesions

Sebaceous glands are specialized cutaneous adnexal glands, which work under constant hormonal control to produce sebum. They can give rise to several proliferative lesions, such as hamartoma, hyperplasia and neoplasms (adenoma, epithelioma and carcinoma). Their nomenclature is currently confusing, both in veterinary and in human medicine, owing to the difficulty of differentiating between some of these lesions. The present study used immunohistochemistry to determine the expression levels and patterns of survivin and Ki67 in five samples of normal canine skin and 44 cases of canine cutaneous lesions with sebaceous differentiation (10 hamartomas, nine hyperplasia, eight adenomas, eight epitheliomas and nine carcinomas). In normal glands, survivin, as well as Ki67, was expressed in scattered reserve cells. In hamartomas, survivin was more highly expressed than in normal skin, indicating a possible role of this molecule in the pathogenesis of these congenital lesions. In tumours, a moderate or high level of survivin and Ki67 expression (more than two and four and more than two positive cells, respectively) were significantly correlated with a malignant histotype, infiltrative growth and a moderate or high number of mitoses (more than two). The level of survivin expression increased with increasing malignancy, designating survivin as a new diagnostic marker in the assessment of malignancy of sebaceous tumours.

HGF/C-MET system pathways in benign and malignant histotypes of thyroid nodules: an immunohistochemical characterization.

Upon binding with HGF, the thyrosine-kinase receptor c-met induces cell growth, scattering and morphogenic effects via the trasducers STAT3 and phosphorylated-STAT3, PI3K/Akt, Rho. HGF, c-met and STAT3 are expressed with very high frequency in papillary thyroid carcinomas (PTC), suggesting a role in PTC. Herein we first investigate the simultaneous expression of HGF, c-met, STAT3, phosphor-STAT3, PI3K, Akt and Rho in thyroid nodules. Using immunohistochemistry, we studied: 30 colloid nodules (CN), 18 hyperplastic nodules (HN), 20 follicular adenomas (FA), 15 oncocytic adenomas (OA), 20 PTC, 16 follicular carcinomas (FTC) and 6 anaplastic carcinomas (ATC). All 7 proteins were expressed in 15% of FA (with HGF, PI3K and Rho stromal reactivity) and 25% of PTC, and the combination HGF/c-met/STAT3/ pSTAT3/PI3K was expressed by all PTC, each protein being expressed by tumor cells. In contrast, 13/16 FTC (81%) exhibited immunoreactivity for PI3K (both epithelial and stromal), and 100% of ATC was PI3K+ (both epithelial and stromal) and Rho+ (epithelial). Epithelial expression of PI3K correlated with the clinical behavior of histotypes and, within FTC, the proportion of PI3K+ cells correlated with both the clinical and pathological stage (r=0.95; p<0.001). As for the shared epithelial expression of PI3K, this concerned approximately one-fourth of tumor cells in FTC and ATC vs one-thirtieth in PTC. Our data may have practical implications for the targeted medical therapy of thyroid cancer arising from the follicular epithelium.

Is there a role for myeloablative chemotherapy with autologous hematopoietic cell rescue in the management of childhood high‐grade astrocytomas?

High-grade or malignant glioma represent 10% of pediatric brain tumors and are, taken as a whole, the second more frequent malignant histotype after medulloblastoma. Apart from a complete excision followed by full dose local radiotherapy, chemotherapy seems to give some beneficial to final outcome. Different trials have explored the role of high-dose chemotherapy that theoretically could give an advantage to these patients by overcoming blood-brain barrier, tumor cell chemo-resistance and inducing a wider number of responses. It is, however, still doubtful if better responses translate into improved outcome and which patients can have a true beneficial from this treatment strategy.

Peptide receptor radionuclide therapy with 90Y-DOTATOC in recurrent meningioma

Meningiomas are generally benign and in most cases surgery is curative. However, for high-grade histotypes or partially resected tumours, recurrence is fairly common. External beam radiation therapy (EBRT) is usually given in such cases but is not always effective. We assessed peptide receptor radionuclide therapy (PRRT) using (90)Y-DOTATOC in a group of patients with meningioma recurring after standard treatments in all of whom somatostatin receptors were strongly expressed on meningioma cell surfaces. Twenty-nine patients with scintigraphically proven somatostatin subtype 2 receptor-positive meningiomas were enrolled: 14 had benign (grade I), 9 had atypical (grade II) and 6 had malignant (grade III) disease. Patients received intravenous (90)Y-DOTATOC for 2-6 cycles for a cumulative dose in the range of 5-15 GBq. Clinical and neuroradiological evaluations were performed at baseline, during and after PRRT. The treatment was well tolerated in all patients. MRI 3 months after treatment completion showed disease stabilization in 19 of 29 patients (66%) and progressive disease in the remaining 10 (34%). Better results were obtained in patients with grade I meningioma than in those with grade II-III, with median time to progression (from beginning PRRT) of 61 months in the low-grade group and 13 months in the high-grade group. PRRT with (90)Y-DOTATOC can interfere with the growth of meningiomas. The adjuvant role of this treatment, soon after surgery, especially in atypical and malignant histotypes, deserves further investigation.

Accuracy of CT-guided transthoracic needle biopsy of lung lesions: Results of 612 consecutive procedures

18022 Background: CT-guided transthoracic needle biopsy (TNB) is commonly used in diagnostic work-up of lung lesions. The availability of a on-site pathologist at the time of the procedure ameliorate its sensitivity, reduce the number of biopsies and false negatives. Methods: 612 procedures (608 patients with a CT-documented central or peripheral pulmonary lesion) performed at S. Luigi Hospital between November 2002 and August 2005 were prospectively analyzed; 66% males, median age was 66 years (range 29–87). Ineligibility criteria for the procedure included severe coagulopathy, previous contralateral pneumonectomy, lesions with a maximum diameter less than 5 mm or the impossibility to understand the procedure or to maintain the clinostatism for the time of the procedure. The on-site pathologist assigned to each specimen a semiquantitative score: 0 for bloody sample without other cells, 1 for aspecific benign or inflammatory cells, 2 for malignant cells without histotype characterization and 3 for well established benign or malignant histotype. Results: Most of the procedures was performed by fine needle aspiration biopsy, while in a minority of cases a tru-cut biopsy was requested. In 57.2% of the cases a single transthoracic access (range 1–4) was used and in 31% the procedure was repeated on the basis of the radiologist/pathologist judgment. In 154 patients a surgical resection was subsequently performed, while 454 were patients non-surgical. A score of 3 was obtained in 71% of cases (88% malignancies), 2 in 12.5%, 1 in 7.5% and 0 in 9%. A definitive diagnosis was made in 83.5% of procedures, while a score of 0–1 was assigned in 101 cases. Among 458 malignancies there were 411 lung cancer, 7 non-epithelial cancers and 40 metastases with only 1 false positive. The diagnostic accuracy for benign and malignant lesions was 67% and 92%, respectively (Pearson’s test p&lt;0.005) with overall diagnostic accuracy of 83.3%. The variables affecting diagnostic accuracy were final diagnosis (benign 67%, malignant 92%, p&lt;0.001) and lesion size (lesion 5 cm 78%, p&lt;0.05). The presence of cavitation or necrotic areas and location of the lesion didn’t affect the diagnostic accuracy. Conclusion: In consecutive cases of CT-guided TNB final diagnosis and lesion size affect diagnostic accuracy. No significant financial relationships to disclose.

Use of high-dose chemotherapy in front-line therapy of childhood malignant glioma

Brain tumors are the second most common cancer in pediatric patients and the main cause from death of malignant tumors in this age group. High-grade or malignant glioma, among which anaplastic astrocytomas and glioblastoma are the most prevalent histotypes, represent 10% of pediatric brain tumors and, taken as a whole, are the second most frequent malignant histotype after medulloblastoma. Apart from complete excision followed by full-dose local radiotherapy, chemotherapy appears to provide some benefit to the final outcome. Different trials have explored the role of high-dose chemotherapy that, theoretically, could give an advantage to these patients by overcoming the blood–brain barrier, cell chemoresistance and inducing a wider number of responses. However, it is still doubtful if more responses translate into better outcome and it is not fully understood which patients can experience a true benefit from this treatment strategy. New protocols under evaluation include new agents with specific biological targets, multiple cycles of high-dose chemotherapy, and vaccination, as an immunotherapeutic approach.

Sacrococcygeal teratoma. Outcome and management. An analysis of 17 cases.

The authors compare their experience of 17 cases of sacrococcygeal teratoma (SCT) with the literature in an attempt to clarify the natural history of this tumor and to identify factors related to its prognosis and management. The obstetrical, neonatal and surgical data were analyzed for 17 cases of SCT observed between July 1985 and December 1998. Three fetuses died in utero or shortly after birth. In the remaining 14, the tumors were removed. Twelve of the infants are currently tumor-free, with good sphincter control and lower-limb function. The remaining two died: one had a malignant tumor, and the other had a recurrence of an embryonal carcinoma. Recurrent tumors (mature histotypes) were also removed from two of the 12 patients who survived. Benign SCTs generally have favorable prognosis. Negative prognostic factors for SCT include solid tumors, those detected early in pregnancy, malignant histotypes, polyhydramnios, placentomegaly, and fetal hydrops.

Descriptive Epidemiology of Malignant Brain Tumors in the Swiss Canton of Vaud

Incidence registration and survival data from brain neoplasms have been analyzed from the population-based system of the Cancer Registry of the Swiss Canton of Vaud, which has been operating in a particularly favorable environment for surveillance and using an integrated and homogeneous system of cancer registration. Between 1974 and 1987, a total of 401 cases was registered, corresponding to an age-adjusted rate for all malignant histotypes of 5.3/100,000 (world standard) for the period 1975-1980 and 5.0 for 1981-1987 in males, and of 3.9 and 3.7, respectively, in females. Thus, no increase in brain neoplasm incidence has taken place in this population, and indeed some decline has been observed in males, particularly for gliomas (from 2.7 to 2.0). During the most recent calendar period, incidence rates were 2.0 in males and 1.5 in females for gliomas, 0.9 in both sexes for astrocytomas, 0.4 in males and 0.1 in females for oligodendrogliomas, and 1.7 in males and 1.2 in females for other or unspecified histotypes. For both gliomas, astrocytomas and total brain neoplasms, the peak rate was observed in the age group 55-74, and some flattening of rates was registered above age 75. Overall 5-year survival was 16%. While there was no difference between sexes, survival rates were substantially lower at older (greater than or equal to 60 years, 3%) than at younger (less than 60 years, 26%) age, and for gliomas (7% at 5 years) than for other histological types. However, the histotype distribution could not explain the major difference in survival by age, since similar differences were observed for various histotypes.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic factors in non-Hodgkin's lymphomas.

Prognostic factors were investigated in 67 patients with non-Hodgkin's lymphomas, homogeneously staged and treated (COP or CHOP according to low or high malignant histotype). A large number of parameters were scrutinized in order to recognize those exhibiting a prognostic value regarding length of survival. All the parameters that singly appeared to influence survival were entered into a multiple regression factor analysis. The erythrocyte sedimentation rate (ESR), higher or lower than 35 mm at the 1st h, better discriminated the groups of patients surviving or not at a given time. The histologic type, according to the Kiel classification of malignancy, was the second best prognosticator when a short-term prediction was requested (survival or death after no more than 2.5 years), but showed insufficient statistical weight for predicting longer survivals (greater than 4 years). Stage seemed to be the third best prognosticator for the first years of survival, but only the second best for longer survivals. Other parameters had very low prognostic importance when compared with those above. The results were substantially confirmed by 28 other patients, taken as controls. The importance that such a simple and easy test as ESR may be adequate with regard to prognosis is emphasized.