Maximum Tumor Dimension Research Articles

Clinicopathological Profile of Renal Cancer in a Caribbean Hospital: Analysis of a Surgical Case Series.

ObjectiveTo document the demographic and pathological profile of renal cancer at San Fernando General Hospital (SFGH), Trinidad and Tobago over a five-year period (2015-2019).MethodsThis is a retrospective study that was conducted on all patients who had a histological diagnosis of renal cancer with surgical treatment from 2015-2019 at SFGH. Data were collected on patient demographics, clinical presentation, and pathological characteristics such as cancer size, location, and grade. Data were tabulated on Microsoft Excel and results were summarized using descriptive statistics.ResultsOver a 5-year period, there were 42 patients diagnosed with kidney cancer who had surgical intervention. The age ranged from 18 to 81 years with a mean age of 61 years and 67% of patients were over the age of 60. Males consisted of 57% of all patients. Most patients presented with pain, hematuria, or both. The majority (93%) of the patients had radical surgical treatment with equal distribution of right and left tumors. Clear cell carcinoma is the most common renal cell carcinoma (RCC), accounting for 80.5% followed by papillary with 16.7%. The majority of renal cell tumors were Fuhrman grade 2 with negative surgical margins and no lymphovascular invasion. The average maximum tumor dimension was 4.2 cm.ConclusionsThis study shows that in our hospital renal cancer affects primarily older patients, mostly men with the common presentation of pain and hematuria. The tumors are commonly clear cell RCC, grade 2 with negative margins, no lymphovascular invasion, and an average maximum dimension of 4.2 cm.

112. Surgical treatment of primary mobile spine chordomas

<h3>BACKGROUND CONTEXT</h3> Chordoma of the mobile spine (C1-L5) is a rare, locally aggressive tumor with the ability to metastasize. Data examining outcomes of primary surgical resection with or without adjuvant treatment of mobile spine chordomas are currently scarce. <h3>PURPOSE</h3> The purpose of this study was to review the overall survival, local recurrence, and distant metastasis of all patients receiving surgical treatment of a primary mobile spine chordoma. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series. <h3>PATIENT SAMPLE</h3> All patients (34) undergoing surgical excision of a primary mobile spine chordoma. <h3>OUTCOME MEASURES</h3> Patient and oncologic outcomes including, patient survival, disease specific survival, local and distant recurrence, complications, and need for revision surgery. <h3>METHODS</h3> Over a 29-year period (1990-2019), 34 primary mobile spine chordomas were treated with surgical resection at our institution. Of those, 21 (60%) were males, at a mean age of 57±18 years, and mean BMI of 29±7.1 kg/m². Tumor location included cervical (n=16, 47%), thoracic (n=3, 9%) and lumbar (n=15, 44%) spine. Eighteen (53%) patients presented with a pathological fracture. The mean maximal tumor dimension was 5±3 cm, with a mean tumor volume of 140±424 cm³. The final resection margin was considered positive in 15 (44%) patients. Radiotherapy was used in 23 (68%) patients to assist with margin control. Mean follow-up was 7 years (up to 22 years). <h3>RESULTS</h3> Following surgical resection, the mean 2-, 5- and 10-year survival was 86%, 60% and 46% respectively. There was no difference (p=0.96) in the 5-year overall survival between patients with cervical (61%), thoracic (66%) and lumbar (58%) spine tumors. Local tumor recurrence was associated with death due to disease (HR 3.39, 95% CI 1.16-9.87, p=0.02). Tumor recurrence occurred in 17 (50%) patients and defined as local only (n=8, 24%), distant only (n=4, 12%) and local and distant (n=5, 15%). The 2-, 5- and 10-year local recurrence free survival was 78%, 59% and 46%. Local recurrence free survival was improved in patients receiving en bloc resection with negative margins (83% vs 35%, p=0.02) and similar in patients receiving adjuvant radiation therapy (43% vs 45%, p=0.30) at 10 years. A positive surgical margin (HR 16.17, 95% CI 2.05-127.53, p<0.008) was associated with local tumor recurrence. The 2-, 5- and 10-year distant disease recurrence free survival was 85%, 73% and 66%. Larger tumor size (>140 cm³) was associated with metastatic disease (HR 9.20, 95% CI 1.53-55.21, p=0.01). Following resection, complications occurred in 30 (88%) patients, leading to a reoperation in 13 (38%) patients. The most common indication for reoperation was for failure of surgical hardware (n=5, 15%). <h3>CONCLUSIONS</h3> Surgical resection of mobile spine chordomas is associated with a high rate of complications; however, en bloc resection can provide a hope for cure and appears to confer better oncologic outcomes for these tumors without an increase in complications compared to lesser resections. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The incidence and relevance of non-fatty components in trunk and extremity lipomatous soft tissue masses.

To determine the incidence and diagnostic relevance of non-fatty 'solid appearing' components within lipomatous tumours of the trunk and extremity. Retrospective review of patients referred to a specialist musculoskeletal oncology service over a 12-month period with a lipomatous trunk or extremity soft tissue tumour. The presence and morphology (solitary/multifocal; homogeneous/heterogeneous; well-defined/poorly defined) of non-fatty components was recorded based on MRI and compared with the final histological diagnosis. 213 patients with 217 lipomatous tumours were included, 119 (55.9%) males and 94 (44.1%) females with mean age of 54.6 years (range 7-93 years). Seventy-seven (35.5%) lesions arose superficial to the fascia and 139 (64.1%) deep, while a single case involved both compartments. Mean maximal tumour dimension was 94.9 mm (range 12-288 mm). Non-fatty 'solid appearing' components were identified in 28 (12.9%) cases, of which eight were solitary and 20 were multifocal, six had homogeneous SI and 22 had heterogeneous SI, and eight had well-defined margins, while 20 had poorly defined margins. Histological diagnosis was available in 20 of the tumours containing non-fatty components, 16 of which were benign, two intermediate grade and two malignant (a dedifferentiated liposarcoma and a myxoid liposarcoma). The commonest diagnosis was spindle cell lipoma, which accounted for 10 of 20 (50%) cases with confirmed histology. Non-fatty components are identified in ~13% of trunk and extremity lipomatous tumours. The majority of such lesions are benign lipoma variants, most commonly spindle cell lipoma. Solid non-fatty components are identified in approximately 13% of lipomatous tumours referred to a specialist sarcoma service. Despite the concern that these may represent dedifferentiated liposarcomas, high-grade tumours were seen in only two cases, the commonest diagnosis being a spindle cell lipoma.

Imaging criteria to predict Shamblin group in carotid body tumors - revisited.

This study aims to compare the imaging findings of carotid body tumors on contrast-enhanced computed tomography (CT) with the intraoperative Shamblin grade and to evolve an imaging-based scoring system that can accurately predict the Shamblin grade. Preoperative contrast-enhanced CT scans of 40 patients who underwent surgical excision of carotid body tumors in our institution between 2004 and 2017 were retrospectively reviewed. The angle of contact with the internal carotid artery (ICA), tumor volume, presence of peritumoral tuft of veins, loss of tumor adventitia interface and distance from the skull base were assessed and compared with the intraoperative Shamblin grades of the tumor. Ordinal logistic regression was used to determine which parameters could be predictors of the Shamblin grades. Receiver operator characteristic (ROC) curves were used to score the tumor volumes. Among the 42 tumors evaluated, 6 (14.3%) were surgically classified as Shamblin I, 15 (35.7%) as Shamblin II, and 21 (50%) as Shamblin III tumors. Pairwise comparison between the three Shamblin groups showed a statistically significant difference for angle of contact with ICA, maximum tumor dimension, presence of peritumoral tuft of veins and loss of tumor adventitia interface (p = 0.001, p = 0.001, p = 0.038 and p = 0.003, respectively). However, tumor volumes and distance from skull base were not significantly different between the Shamblin groups (p = 0.136 and p = 0.682). A scoring system, including four of the above mentioned parameters (angle of contact with ICA, tumor volume, presence of peritumoral tuft of veins, and loss of tumor adventitia interface) was developed with a maximum score of 8 and a minimum of 2. A statistically significant difference was found between the final scores among the three Shamblin groups (p < 0.001). Using ROC curves, a final score of ≥6 was found to separate Shamblin grade III tumors from grade I and II tumors (sensitivity, 95.24%; specificity, 71.43%). All patients with documented intraoperative estimated blood loss of >1000 mL had Shamblin grade III tumors. Postoperative complications like stroke, ICA thrombosis and lower cranial nerve palsies were seen only with Shamblin grade II and III tumors. The simple scoring system we have proposed correlates well with the Shamblin grade and helps in identifying patients who have a higher risk of developing complications.

Giant Prolactinomas: An Experience From South India

Giant prolactinomas are large lactotroph adenomas, defined as those with maximum dimension of >4cm. They constitute <5% of all prolactin secreting tumors, and are more frequently seen in men. They present with features of hyperprolactinemia and hypopitutarism and are responsive to dopamine agonist therapies. In the current study we have shared our experience on management of giant prolactinomas over the last 15 years. We collected clinical data retrospectively from medical records of patients with giant prolactinoma managed at our institute over the last 15 years. This study describes the symptomatology, tumor characteristics and response to therapy. Our study included 21 patients with 15 males and 6 females. The mean age of presentation was 32 ± 10.3 years, ranging between 10 to 53 years. Vision defect was the predominant complaint (57%, 12 patients), followed by headache (52%, 11 patients). Erectile dysfunction was a presenting feature in 13% of men (2 patients) and amenorrhea/galactorrhea in 33% of women (2 patients). Seizure was seen in 10% of the patients (2 patients) and 10% (2 patients) were diagnosed with giant prolactinoma on evaluation for primary infertility. Tumor associated pituitary dysfunction manifested as hypogonadism in 67%, 14 patients, central hypothyroidism in 38%, 8 patients, and hypocortisolism in 1 patient. The median maximum tumor dimension was 4.4 cm with median basal PRL of 7168 ng/ml. Five patients underwent debulking surgery (24% of the patients) prior to endocrinology referral for indications such as apoplexy/raised intracranial tension. All patients received cabergoline and a mean dose of 2.1 ± 1.7 mg/week (range, 1-7 mg/week) was prescribed to attain a median nadir prolactin level of 48 ng/ml over a median period of 4 months (range, 1-40 months). The follow-up MRI data was analysed for 13 patients. Tumor shrinkage of >50% from the baseline was seen in all but 1 patient (92%) and 2 patients had disappearance of radiologically detectable tumor. Although giant prolactinomas have a greater tumor burden than the more common macroprolactinomas, the responsiveness to dopamine agonist therapy is excellent and surgical therapy is reserved for any exceedingly large tumors to relieve compression on vital structures.

Abstract No. 22 Predictors of intrahepatic recurrence of hepatocellular carcinoma following percutaneous microwave ablation of tumors larger than 3 cm

To identify the predictors of local recurrence and distant intrahepatic recurrence following microwave ablation of hepatocellular cancer larger than 3 cm 74 cases of microwave ablations for HCC >3 cm in size were included from a single institution. Data was collected from EMR and PACS. Mean age was 66 (SD 4.2) and the mean maximal tumor dimension was 4.2 cm (SD 1.2 cm). The mean distance of the tumors from diaphragm and the capsule were 2.5 (SD 2.6) and 0.5 (SD 0.9) cm, respectively. In 25 cases (33.7%), the tumor was < 1cm from diaphragm. In 45 cases (60.8%) a large vessel was located within 1 cm from the tumor margin. The mean AFP was 155.5 (224). Mean red cell distribution width was 14.9%. The mean platelet/albumin ratio was 2.8 (1.48). There were 44 (59.4%) cases of total recurrences of which 30 (40.5%) were local recurrences over a mean follow up period of 20 months. Tumors over 3.5 cm had a significantly higher proportion of recurrence (40.7 vs 73.3%, P = 0.03). Both maximal tumor dimension (P = 0.04) and the least distance from diaphragm (0.03) were independent predictors of recurrence on multivariate regression analysis. In HCC over 3 cm, the maximal tumor dimension and the proximity of the tumor to the diaphragm are predictors of recurrence following microwave ablation. Tumors over the size of 3.5 cm have significantly higher rates of recurrence.

Abstract No. 466 Quantitative assessment of the effect of intra-arterial nitroglycerin on hepatocellular carcinoma perfusion using two-dimensional digital subtraction angiography

To evaluate the effects of intra-arterial nitroglycerin on hepatocellular carcinoma perfusion using 2-D perfusion angiography Two-dimensional (2D) perfusion angiograms obtained during planning arteriography for radioembolization of HCCs from September 2019 to February 2020 were retrospectively reviewed. Inclusion criteria included LIRADS-5 lesions and angiographically identifiable tumor and background parenchyma. Exclusion criteria included treated lesions and motion-degraded studies. Tumor and background liver parenchyma 2D perfusion data before and after the administration of intra-arterial nitroglycerin were processed and the area under the curve (AUC) of the time-density curve was calculated. Relative perfusion of HCC to background liver was compared at the 2 time points using a 2-tailed unpaired t-test. Twenty-four arteriograms were reviewed. Twelve were excluded from the analysis due to prior treatment (n = 5), motion degradation (n = 2), and no identifiable background liver (n = 5). Twelve HCCs in 12 patients were included in the final analysis. Mean patient age was 71.7 ± 9.7 years. Ten patients had cirrhosis. Mean maximum tumor dimension was 4.9 ± 2.0 cm. Seven tumors were in the right lobe and 5 in the left lobe. Contrast injection duration was 5 seconds. Mean intra-arterial nitroglycerin dose was 279 ± 69 micrograms. The arteriograms were then analyzed using 2D perfusion software. The ratio of the AUC of HCC to background liver was 2.18 ± 1.11 before intra-arterial nitroglycerin and 3.14 ±1.70 after nitroglycerin administration (P < 0.05). Intra-arterial nitroglycerin significantly increases perfusion to hepatocellular carcinoma when compared to background liver. Further research is needed to determine if nitroglycerin increases the permeability of HCC tumors and thereby increases intra-tumoral dose delivery.

Radionecrosis (RN) in patients with brain metastases treated with stereotactic radiosurgery (SRS) and immunotherapy

Objectives Limited data exist regarding radionecrosis (RN) rates when patients receive immunotherapy (IT) and SRS for brain metastases. This study assesses the influence of such treatments on the rate of RN. Methods We retrospectively reviewed 352 lesions from 105 patients with metastatic melanoma or NSCLC treated with SRS and IT from 2012 to 2018. Lesions were excluded from analysis if patients had received WBRT or prior GK to the same lesion, if RN occurred before IT, or if IT had been discontinued >6 months pre-SRS or initiated >1 year post-SRS. IT was delivered concurrently (±30 days of SRS) or sequentially. Overall survival and RN rates were assessed with Kaplan-Meier analysis. Univariate analysis and multivariate analysis were performed to identify characteristics predicting RN. Results Of 195 lesions from 63 patients included in analysis, the median prescription dose, IDL, lesion volume, and maximum tumor dimension (MTD) were 19 Gy, 50%, 0.15 cc and 0.8 cm, respectively. RN rates at 1, 2, and 3 years were 7.3%, 10.4% and 10.4%. On UVA, RN risk increased with, isodose volume (IDV), MTD, and tumor volume (TV) whereas conformity index was associated with a trend toward decreased RN risk. Two-year RN rates increased with TV ≥ 0.3 cc (16% vs 1.1% p = 0.001), MTD ≥ 1.3 cm (19.1% vs 1.8% p < 0.003), and IDV ≥ 1.5 cc (19.6% vs 1.7% p = 0.001). Concurrent vs sequential timing of IT did not predict for RN. Conclusions Patients who received IT and SRS had acceptably low rates of RN. Timing of IT did not predict for RN. Further investigation is warranted to define RN risk with combined SRS and IT.

The differential diagnosis of trunk and extremity dermal and sub-dermal lesions referred to a musculoskeletal oncology service

ObjectivesTo determine the differential diagnosis of dermal and sub-dermal soft tissue masses which do not extend to the deep fascia that are referred to a specialist musculoskeletal oncology service. Materials and methodsReview of all patients referred to a specialist musculoskeletal oncology service over a 13-month period with a dermal or sub-dermal soft tissue mass which did not extend to the deep fascia based on MRI appearances. Data collected included age, gender, site and maximal lesion size, and final histological diagnosis for biopsied and/or excised lesions. Results56 patients were included, 21 (37.5%) males and 35 (62.5%) females with mean age 49.75 years (range 5–86 years). 3 patients had 2 lesions making a total of 59 lesions, 11 (18.6%) dermal and 48 (81.4%) sub-dermal. Histological diagnosis was available in 44 (74.6%) cases, of which 11 (25%) were non-neoplastic, 23 (52.3%) were benign neoplasms, and 10 (22.7%) were malignant neoplasms. Although older age at presentation and greater mean maximal tumour dimension were seen with malignant lesions, these did not reach statistical significance (p = 0.154 and 0.102 respectively). There was also no relationship between skin involvement from sub-dermal lesions and malignancy, but 5 of 6 dermal lesions which showed an exophytic growth pattern were malignant. ConclusionsThe differential diagnosis of dermal and sub-dermal lesions which do not reach the deep fascia is wide with a malignant lesion being the cause in almost one-quarter of cases.

Suspected intra-articular soft-tissue tumours and tumour-like lesions: Performance of image-guided core needle biopsy

PurposeTo determine the efficacy of image-guided core needle biopsy (IGCNB) in patients presenting with suspected intra-articular soft tissue tumours or tumour-like lesions. MethodsRetrospective study of patients referred to a musculoskeletal oncology service between January 2019 and May 2020 with a suspected intra-articular soft tissue tumour over a 16-month period. Data collected included patient age, gender, joint involved and maximal lesion size. Type of image-guidance (ultrasound or computed tomography), type of needle and type of anaesthesia, general anaesthetic (GA) or local anaesthetic (LA), were recorded, as was the histological diagnosis. For patients who proceeded to surgical excision, the IGCNB histology result was correlated with resection histology. Descriptive statistics were used and complications were also noted. ResultsBy the termination of data collection 91 patients underwent IGCNB, 32 (35.2 %) males and 59 (64.8 %) females with a mean age of 41.4 years (age range 3–86 years). The joints involved were the knee (n = 73; 80.2 %), ankle (n = 12; 13.2 %), hip (n = 3; 3.3 %), shoulder (n = 1; 1.1 %), elbow (n = 1; 1.1 %) and wrist (n = 1; 1.1 %). Biopsy types were as follows: US-guided GA (n = 29; 31.9 %), US-guided LA (n = 37; 40.7 %), CT-guided GA, (n = 23; 25.3 %), CT-guided LA (n = 2; 2.2 %). Mean maximal tumour dimension for 76 focal lesions was 36.5 mm (range 18−113 mm). IGCNB yielded a definitive histological result in 85 of 91 cases (93.4 %), 44 of whom went on to surgical resection. Concordance between IGCNB and resection histology was achieved in 42 of 44 cases (95.5 %). The commonest diagnosis was tenosynovial giant cell tumour, with only a single malignant lesion identified. There were no recorded immediate or delayed complications. ConclusionsIGCNB of suspected intra-articular tumours or tumour-like lesions is a highly effective and safe technique.

Quantitative Assessment of the Hemodynamic Effects of Intra-Arterial Nitroglycerin on Hepatocellular Carcinoma using Two-Dimensional Perfusion Angiography

PurposeTo determine the hemodynamic effects of intra-arterial nitroglycerin on hepatocellular carcinoma (HCC) using 2-dimensional (2D) perfusion angiography. Materials and MethodsTwo-dimensional perfusion angiograms obtained prior to radioembolization from September 2019 to February 2020 were retrospectively reviewed. The inclusion criteria were the presence of Liver Imaging Reporting and Data System-5 tumors and angiographically distinguishable tumor and background liver. The exclusion criteria were previously treated tumors and motion-degraded studies. Thirteen patients with 2D perfusion angiograms obtained before and 2 minutes ± 1 after the administration of intra-arterial nitroglycerin were analyzed. The mean patient age was 72 years ± 9 and 11 of 13 (85%) had cirrhosis. The mean maximum tumor dimension was 4.6 cm ± 2.1. Eight tumors were in the right lobe and 5 were in the left lobe. The tumor and background liver 2D perfusion data were processed and the areas under the time-density curves were calculated. The relative perfusion of HCC to background liver was compared before and after nitroglycerin administration using a 2-tailed paired t-test. ResultsThe mean rate of contrast administration was 1.4 mL/s ± 0.7 and the mean volume administered was 7.1 mL ± 3.3. The mean nitroglycerin dose was 281 μg ± 69. Ten of 13 patients (77%) demonstrated a relative increase in tumor perfusion. The mean HCC to background liver area under the curve ratio was 1.94 ± 0.76 before and 2.40 ± 0.89 after nitroglycerin administration (P < .05). ConclusionsIntra-arterial nitroglycerin increases previously untreated HCC perfusion relative to background liver as measured by 2D perfusion angiography, but this effect is variable among patients and should be validated with 3-dimensional imaging techniques.

Management and Long-Term Outcomes of Patients with Refractory Solitary Plasmacytoma after Treatment with Definitive Radiation Therapy

Definitive radiation therapy (RT) is the current standard of care for the treatment of solitary plasmacytoma (SP), as RT typically affords excellent local control with possible long-term remission or even cure. Given the low rates of local failure after RT, the optimal management of RT-refractory SPs is unknown. With IRB approval, we reviewed our institutional records of all SP patients (pts) treated with RT and evaluated at our institution from Jan 2000-Sept 2019. All pts met criteria for SP or SP with minimal marrow involvement. Refractory disease was defined as persistent disease on post-RT biopsy/surgery or persistent, residual avid disease on PET-CT. Of 102 total pts, 17 (17%) were considered refractory to RT and included in the study. Median age at diagnosis was 54 (range 33-75). Sixteen of 17 pts had solitary bone plasmacytoma (vs extramedullary). At diagnosis, the median maximal tumor dimension was 6.2 cm (range 2.1-11.9), 11 pts had positive blood paraprotein (median 0.8 gm/dL) and 5 pts had positive Bence Jones proteinuria (median 152 mg/24hrs). On SP biopsy, four pts had associated amorphous material or amyloid; 1 pt had amyloid on fat pad biopsy. Median RT dose was 45 Gy (range 39.6-56 Gy). Most pts underwent PET-CT pre- (15 pts, median maximum standardized uptake value [SUVmax] 9.3, range 2.3-32) and post- (15 pts, median SUVmax 9.3, range 2.9-23) RT; SUVs decreased for 35% of pts (n = 6) after RT. For eleven pts with positive proteins and data available, ten had persistent blood/urine protein levels after RT until next intervention. Ten pts had pathologic confirmation of residual plasmacytoma at median 7 months (range 1.5-32) post-RT. Median follow-up was 27 months. Thirteen pts had at least one additional treatment for refractory disease; the median time to next treatment was 9 months. Pts had the following interventions: surgical resection (n = 4), additional RT (n = 2), systemic therapy without evidence of MM (n = 4), systemic therapy for progression to MM (n = 3) and observation (n = 4, median observation follow-up 7.5 months). Of the 2 pts treated with additional RT (cumulative doses of 110 Gy and 70 Gy), neither responded to RT and both had pathologic confirmation of residual disease after the second course. All pts with follow up after systemic therapy or surgery had an imaging-based response at the SP site. Two pts died: 1 cause unknown, 1 from osteosarcoma developed at the site of the twice-radiated sacral plasmacytoma. Patients with RT-refractory SPs can achieve good outcomes with alternative therapies such as surgery or systemic therapy. Additional RT does not seem to be effective. Given the known high rates of progression from SP to multiple myeloma, treatment of SP should not cause significant morbidity and close observation of asymptomatic persistent disease after RT for a limited time is reasonable.

Small and Thin Oral Squamous Cell Carcinomas may Exhibit Adverse Pathologic Prognostic Features.

We set out to record the frequency of recognised adverse pathologic features in early oral squamous cell carcinoma (OSCC) and correlate with neck disease, in particular in small and thin carcinomas, a group that might be assumed to behave less aggressively. We also examined the possibility of a biopsy site interfering with assessment of WPOI5 in small tumors. We reviewed all OSCCs ≤ 20mm size and ≤ 10mm depth reported at our institution over a 5-year period. Tumor maximum dimension, depth, perineural invasion (PNI), lymphovascular invasion (LVI), worst pattern of invasion (WPOI), and nodal status were recorded. Out of 95 cases, there were 44 (46.3%) small and 78 (82.1%) thin OSCCs. Depth and WPOI were significant factors in predicting nodal disease. There were 41 (43.2%) OSCC that were small and thin, of which 9.8% had PNI, none had LVI, and 61% had WPOI 4 or 5. Their rate of PNI and of nodal disease was similar to the other early OSCC. Assessment of WPOI5 at a biopsy site was only a problem in 2/38 cases. In early OSCC, depth and WPOI are important factors in predicting nodal disease. The very earliest OSCC (small and thin) have a similar rate of PNI and of nodal disease to other early OSCC, suggesting that while there may be a tendency to de-escalate treatment, these small tumours should be managed in the same way as for all early OSCC. In addition, the presence of scarring due to a biopsy in very small carcinomas rarely affects assessment of WPOI5.

Interleukin-6 in Patients with Cardiac Myxoma.

The relationships between interleukin (IL)-6 and cardiac myxoma remain to be clarified. This article systematically reviewed the IL-6 properties in cardiac myxoma patients based on retrieval of pertinent literature published between 1998 and 2018. Significant differences were found in circulating IL-6 values between preoperation and 1 and 6 months after operation. Preoperative circulating IL-6 correlated significantly with tumour volume (r=0.8552, p=0.003), while there were no significant correlations with maximal tumour dimension (r=0.2443, p=0.190). No correlation was found between circulating IL-6 at 1 and 6 months after tumour resection with either tumour volume or with maximal tumour dimension. The positive rate of immunostaining of IL-6 in cardiac myxoma tissues was 93.3%. Overproduction of IL-6 is responsible for the inflammatory presentations, constitutional symptoms, and recurrence and distal embolisation of cardiac myxoma. Cardiac myxoma could be a cellular source of IL-6 release. Cardiac myxoma resection is an absolute choice of eliminating IL-6 production in these patients. Key Words: Cardiac surgical procedures, Cytokines; Inflammation, Interleukin-6, Neoplasms.

Appendiceal neoplasms and histological involvement of the mesoappendix: A case series

IntroductionAcute appendicitis is a common presentation to surgical departments, typically resulting in appendicectomy. Appendiceal tumours may not be visible intraoperatively, and are present in roughly 0.5–1% of specimens. Routine resection of the mesoappendix is not universally practiced, despite the mesoappendix being commonly involved in appendiceal tumours.This is a case series of the histological findings of 21 patients with appendiceal tumours, with consideration to tumour within the resected mesoappendix. MethodsWe reviewed the histology of 1344 patients undergoing laparoscopic appendicectomy over a 6-year period assessing for the presence of appendiceal tumours and resected mesoappendix. ResultsTwenty-one patients were found to have appendiceal tumours, with a mean maximum tumour dimension of 7.2 mm. Sixteen of these patients had simultaneous mesoappendix resection, of whom six (38%) were found to have direct or indirect tumour tissue within the mesoappendix. ConclusionFurther evidence for routine removal of the mesoappendix, and the need for larger prospective studies to investigate for any survival benefit. We note the worrying trend of conservative management of acute appendicitis.

Maximum tumor dimension and tumor volume as prognostic factors in patients with newly diagnosed localized Ewing sarcoma (ES)- a report from the Children’s Oncology Group (COG).

11529 Background: Maximum tumor dimension &gt; 8 cm. and large tumor volume have been reported to be adverse prognostic factors in patients with ES but have not been prospectively evaluated in the context of a phase 3 clinical trial with interval compressed chemotherapy. Methods: COG AEWS1031 (NCT01231906) was a randomized phase 3 clinical trial comparing interval compressed chemotherapy regimens in patients with newly diagnosed localized ES of bone and soft tissue. A correlative objective of AEWS1031 was to evaluate tumor size and volume as prognostic factors. Institution-reported dimensions of the primary tumor from baseline imaging were prospectively collected. For inclusion in this analysis, patients had to have at least 1 tumor dimension reported for tumor size analyses and dimensions in 3 axes for tumor volume analyses. Maximum dimension was dichotomized as less than vs. &gt; / = 8cm. Tumor volume was dichotomized as less than vs. &gt; / = 200 mL. Event-free (EFS) and overall survival (OS) from enrollment were calculated using Kaplan-Meier methods and compared between groups using a two-sided log-rank test. Hazard ratios (HR) and confidence intervals (CI) were calculated using the Cox model. Results: The 5-year EFS and OS of the 629 eligible patients was 78% (95% CI: 75-81%) and 87% (95% CI: 84-90%) respectively and there was no significant difference in both EFS and OS between the randomized interval compressed chemotherapy arms of AEWS1031. 590 of 629 (94%) patients were evaluable for maximum tumor dimension and 307 (52%) had tumors &gt; / = 8 cm. Patients with tumors &gt; / = 8 cm were at significantly increased risk for EFS events (p = 0.016) with estimated 5-year EFS of 73.7% (95% CI: 68.1 vs.78.4%) vs. 82.9% (95% CI 77.7-87.1%) for patients with tumors &lt; 8 cm [HR: 1.53 (1.08-2.17)]. For tumor volume, 586 of 629 patients (93%) were evaluable and 180 (31%) had tumors &gt; / = 200 mL. Patients with tumor volume &gt; / = 200 mL were at significantly increased risk for EFS events (p = 0.003) with estimated 5-year EFS of 70% (95% CI: 62.3-76.4%) vs. 81.6% (95% CI: 77.2-85.2%) for patients with tumors &lt; 200 mL [HR: 1.69 (1.2-2.39)]. Conclusions: Maximum tumor dimension and tumor volume as defined are both prognostic in patients with newly diagnosed localized ES treated with interval compressed chemotherapy. Clinical trial information: NCT01231906 .

Outcomes of Transzygomatic Middle Cranial Fossa Approach for Skull Base Tumors—A Single Institutional Experience

Objective This study aimed to evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting This study was done at the tertiary skull base center. Design This is a retrospective case series. Main Outcome Measures The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications. Results Sixteen patients were identified with a median age of 45 years (range: 20-72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1-7.3) and the mean tumor volume was 28.5 cm 3 (SD: 18.8, range: 2.9-63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma ( n = 7) followed by chondrosarcoma ( n = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V ( n = 1), CN III ( n = 2), CN VI ( n = 1), and CN X ( n = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House-Brackmann grade 2). Conclusion Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity.

A nomogram to predict invasiveness in lung adenocarcinoma presenting as ground glass nodule.

BackgroundAdenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive adenocarcinoma (IA) can all appear as a ground glass opacity (GGO) on chest computed tomography (CT). However, their respective prognoses are considerably different. This study aimed to predict IA in radiological examinations of patients with GGO lesions.MethodsWe retrieved the clinical records and high-resolution CT (HRCT) images of 124 patients with GGO lesions, who underwent various lung resections between 2016 and 2017. Correlations between the imaging features of preoperative HRCT and the postoperative pathology were analyzed. Receiver-operating characteristic (ROC) curve analysis, chi-square test, and one-way analysis of variance and multiple logistic regression were performed. A nomogram was developed and analyzed using a multiple logistic model.ResultsThe maximum sensitivity and specificity were obtained at a cutoff value of −410 Hounsfield units (HU) for the mean CT value (m-CT), 10 mm for the maximum tumor dimension (MTD), and 0.25 for the consolidation tumor ratio (CTR). Further, there were significant differences in MTD, CTR, margin characteristics, air bronchogram, pleural indentation, and multiple GGOs (P<0.05). The independent predictive factors of IA included MTD [risk ratio (RR), 5.047; P=0.018], air bronchogram or vacuole sign (RR, 4.054; P=0.025), pleural retraction (RR, 4.742; P=0.008), and m-CT value (RR, 5.874; P =0.005). The scoring nomogram model was as follows: −3.50744 + 1.26374 × (MTD>10 mm=1) + 2.41978 × (m-CT value≥−410 HU=1) + 1.77779 × (with air bronchogram or vacuole sign=1) + 1.60913 × (with pleural retraction=1). The area under the ROC curve was 0.9. The cutoff score was −0.5502 with a sensitivity of 86.8% and a specificity of 78.9%.ConclusionsIA in patients with GGO lesions can be predicted by evaluating the MTD, m-CT value, air bronchogram, and pleural retraction on HRCT by using a nomogram model.

Implications of Tumor Size, Subsite, and Adjuvant Therapy on Outcomes in pT4aN0 Oral Cavity Carcinoma.

To determine if tumor size, subsite, and adjuvant radiation therapy (AXRT) are associated with overall survival (OS) in patients with pT4aN0 oral cavity squamous cell carcinoma (OSCC) who underwent mandibulectomy with negative surgical margins (NSMs). Retrospective cohort study. National Cancer Database (NCDB). Retrospective analysis of the NCDB that included patients diagnosed with pT4aN0 OSCC who underwent mandibulectomy with NSMs between 2004 and 2015. The association of age, Charlson-Deyo score (CDS), tumor size, subsite, and AXRT with OS was analyzed. The cases were divided into 3 subgroups based on maximal tumor dimension for subgroup analysis; tumors ≤2.0 cm, tumors 2.1 to 4.0 cm, and tumors >4.0 cm. For the entire cohort; age (P < .001; hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02-1.03), CDS (P = .013; HR, 0.57; 95% CI, 0.37-0.89), tongue subsite (P = .003; HR, 2.01; 95% CI, 1.27-3.40), floor of mouth subsite (P = .001; HR, 1.76; 95% CI, 1.28-2.42), tumor size (P < .001; HR, 0.57; 95% CI, 0.45-0.72), and AXRT (P < .001; HR, 1.46; 95% CI, 1.24-1.72) were associated with OS on multivariate analysis. On subgroup analysis, AXRT not significantly associated with OS in patients with gingival, hard palate, retromolar trigone, and not specified tumors ≤2.0 cm (P = .323; HR, 1.29; 95% CI, 0.78-2.15). In patients with pT4aN0 OSCC who underwent mandibulectomy with NSMs, age, CDS, tongue subsite, floor of mouth subsite, tumor size, and AXRT are associated with OS. AXRT was not significantly associated with overall survival in patients with gingival, hard palate, retromolar trigone, and not specified tumors ≤2.0 cm.

Primary appendicular soft-tissue sarcoma resection: What tumour parameters affect wound closure planning?

Wound closure after wide, local excision of an appendicular soft-tissue sarcoma (STS) can be challenging. This study evaluates the value of magnetic resonance imaging (MRI)-based tumour parameters in planning wound closure. A total of 71 patients with a primary limb-based STS, excluding vascular or osseous involvement, excluding the shoulder or hand and hip or foot were included. Axial MRI images were used to measure the circumferences and cross-sectional areas of the limb, bone, and tumour. The tumour diameter, length, and depth at the level of maximal tumour dimension were measured to identify the tumour's relative contribution to the planning of optimal wound closure management through primary closure (PC) or reconstructive surgery (RS). Eighteen patients required planned wound RS. Wound complications occurred in 14% overall. Tumours, which were closed by PC, were of significantly greater depth, shorter radial diameter, and shorter tumour circumference relative to those closed by RS. On multivariate analysis, tumour depth was the greatest contributory factor in predicting type of wound closure. A quantitative analysis of MRI-based tumour parameters demonstrates tumour depth as the most predictive factor in planning for the type of wound closure and may prove beneficial in providing greater insight into planned wound management of sarcoma resection.