Metachronous Development Research Articles

Modified Endoscopic Medial Maxillectomy for Zygomatic Implant Salvage

Objectives:Odontogenic chronic rhinosinusitis (CRS) is an epidemiologically important disease process due, in part, to the increasingly commonplace use of dental restorative procedures such as zygomatic implantation. Traditional management of this clinical entity typically entails extraction of the infected hardware via an open or endoscopic approach. We describe a novel management strategy of odontogenic CRS following bilateral zygomatic implantation for oral rehabilitation that we surgically salvaged via a modified endoscopic medial maxillectomy.Methods:We describe the presentation and management of a case of metachronous development of bilateral CRS subsequent to zygomatic implantation.Results:The patient's postoperative course was characterized by marked endoscopic, radiologic, and symptomatic improvement as measured by the 22-item Sino-Nasal Outcome Test.Conclusion:We describe a novel treatment strategy for the management of odontogenic sinusitis resulting from erroneous zygomatic implant placement. Modified endoscopic medial maxillectomy in this clinical context facilitates mucosal normalization of the affected sinus, while permitting preservation of oral function through salvage of the displaced implant.

Regional specificity of the climatic evolution of soils in the southern part of eastern Europe in the second half of the Holocene

The analysis of characteristic features of chernozems and chestnut soils of different ages that have been formed in the south of the East European Plain in the past 5000 years attests to the spatial and temporal heterogeneity of the rate and direction of pedogenetic processes, i.e., to the metachronous development of the soil cover. A linear zone of the retarded (before 3600–3200 years ago) and, then, enhanced development of the humus profiles of chernozems was found along the Voeikov climatic axis corresponding to the contact zone between cyclonic and anticyclonic weather conditions. It was concluded about the significant rise in the degree of atmospheric moistening of the territory took place at the end of the Subboreal–the beginning of the Subatlantic periods of the Holocene. This factor favored the more active growth of the humus profiles of chernozems in this zone in comparison with chernozems on adjacent territories.

Phases of alluvial fan development in a loess area, Lublin Upland, E Poland

Holocene alluvial fans are a record of the evolution of the environment and human impact over the last 10 000 years. The study presents the structure of fans at the mouth of gullies as well as their development in the loess areas of the Lublin Upland. Sediment-soil sequences of seven alluvial fans and the adjoining flood sediments and dry valley bottom sediments were studied in detail. The development of fans occurred in three phases: i) the Eneolithic; ii) the middle and late Bronze Age and the Hallstatt period and iii) the Middle Ages and the modern times. The middle phase consists of two sub-phases while last phase consists of three sub-phases: the early Middle Ages; the Little Ice Age; the 19th and first half of the 20th century. These phases were interspersed with longer or shorter periods of stabilization of the alluvial fan surface. The different course of land use changes in the catchments was the reason for this metachronous development of the alluvial fans. Our studies indicate that heavy and catastrophic rainfall and rapid thaw had a considerable role in the development of the alluvial fans. The establishment of roads along the axes of valleys and across the slopes had a key impact on alluvial fan development. The deforestation of the catchment was not an essential condition for the formation of gullies and alluvial fans.

Total proctocolectomy for rectal cancer in Lynch syndrome: indications and considerations

SUMMARY Patients with Lynch syndrome and rectal cancer present a unique clinical challenge. Management of the primary rectal cancer and prophylactic removal of the colon should be considered. In patients requiring a mesorectal excision, a combined prophylactic colon removal can be considered. Although surveillance of the colon with frequent colonoscopies is an alternative, concerns of metachronous colon cancer development support prophylactic removal of the colon as an alternative. Since data are not available to confirm superiority of either approach, the final decision is greatly dependent upon a patient's wishes and preferences. Patients interested in pursuing simultaneous prophylactic colon removal can be offered total proctocolectomy with either ileal pouch anal-anastomosis as a sphincter-preserving alternative or a total proctocolectomy with end ileostomy.

Mo1077 Extensive Mucosal Atrophy Quantified by Serum Pepsinogen Levels Can Predict Metachronous Gastric Cancer Development After Endoscopic Resection Regardless of Helicobacter pylori Eradication

INTRODUCTION: Quality in endoscopy is critical to ensure improved patient outcomes in colorectal cancer screening. The Global Rating Scale (GRS) was developed in the UK to provide metrics for quality in endoscopy and, although never formally validated, has been associated with improved patient outcomes nationally. AIMS &METHODS: To psychometrically test the adapted Canadian version of the Global Rating scale (GRS-C), in view of its deployment by the Canadian Association of Gastroenterology throughout the country to participating endoscopy units. The GRS-C was assessed at 3 separate institutions by endoscopy unit physicians, endoscopy nurses, and administrative personnel. The psychometric properties evaluated included validity, reliability, and responsiveness to change. For face validity, a group comprising staff not familiar with the GRS was assembled. Each of the groups then responded to the questions of the GRS-C that span 12 items. Content validity was assessed by comparing GRS-C questions to national quality indicators in endoscopy, while construct validity was determined by associating questions of the GRS-C with those of its original UK GRS counterpart. The GRS-C was completed at the 3 sites both at time 0 and 2 weeks later, with no intervening change to processes, as well as 6 months later after practice changes had been implemented as a result of patient satisfaction questionnaire responses, to respectively assess test-retest reliability and responsiveness to change. Descriptive and inferential data analyses were completed, including kappa values for agreement and paired assessments when comparing question responses. RESULTS: Face validity was demonstrated as the majority of participants were able to accurately identify the overarching theme each item was intended to measure. For content validity, 18 of 23 key quality indicators (78%, 95% CI: 56-93%) determined by an expert consensus group were addressed in the GRS-C. Statements not included related to educational programs and monitoring of competency. When comparing GRS-C and GRS-UK ratings for all 3 sites, concordance ranged from 75-100% across all three sites, while Kappa agreement levels on test-retest reliability ranged from 0.65 to 0.83. Following a series of process change initiatives, responsiveness to change in 6-month post-implementation scores were statistically higher (P<.001) in two endoscopy units. CONCLUSION: The GRS-C appears to exhibit satisfactory psychometric properties that can be used as part of a national quality initiative aimed at improving processes in endoscopy units. Linking GRS scores to actual patient outcomes is required to ensure that GRS-C implementation helps to achieve improved patient care.

Metachronous cancer after endoscopic submucosal dissection of gastric neoplasia.

559 Background: Metachronous recurrence after endoscopic resection (ER) of gastric cancer is known to be high. However, recurrence rate of metachrous lesions after ER of gastric adenoma has not been studied well. The aim of the study was to compare the metachronous recurrence between gastric carcinoma and adenoma patients. Methods: Four hundred eight carcinoma and 539 adenoma patients were enrolled in this study, and median follow-up period was 27 months (IQR: 16-45 months). Clinicopathological characteristics were assessed. At the follow-up endoscopy, the whole gastric mucosa was examined thoroughly to detect any gastric neoplasia. All suspicious lesions were evaluated histologically on endoscopic biopsies. Surveillance endoscopic schedule was as follows: every 3–6 months within 1 year, then once every year. Results: Forty three metachronous recurrence was diagnosed in in carcinoma patients and 45 in adenoma patients. There was no significant difference in the incidence of recurrent metachronous neoplasm between carcinoma and adenoma patients (p=0.728, log-rank test). After excluding metachronous adenoma, cancer recurrence was not different either between two groups (p=0.943). After adjusting for age, sex, multiplicity, and Helicobacter pylori status, the risk of the metachronous development of gastric cancer in adenoma patients was similar with that in carcinoma patients (HR, 0.96; 95% CI, 0.63-1.45). Conclusions: Metachronous gastric cancer after ER of gastric adenoma was as high as that of gastric carcinoma. Similar endoscopic surveillance program should be applied for both gastric carcinoma and adenoma patients after ER.

The incidence and clinicopathologic features of metachronous gastric tumors after endoscopic submucosal dissection.

37 Background: Endoscopic submucosal dissection (ESD) has become a standard method of treatment for gastric tumors. The synchronous and metachronous development of two or more primary adenocarcinomas occurs in 10 to 20% of all cases of stomach cancer. Therefore, metachronous recurrence should be a consideration after ESD has been performed. The aim of this study was to review our experiences in the management of patients with synchronous and metachronous lesions, and to evaluate their incidence and clinicopathologic features. Methods: We reviewed 194 patients who underwent ESD for gastric tumors between January 2007 and December 2011. Synchronous lesions were defined as secondary gastric tumors detected within 6 months after the initial ESD. Metachronous tumors were defined as those detected more than 6 months after the initial ESD. We investigated the incidence and clinicopathologic features of synchronous and metachronous tumors after ESD. Results: In total, 20 patients (10.3%) had synchronous lesions and 19 patients (9.8%) had metachronous lesions. The annual incidence of metachronous tumors after ESD was 2.93%. The median period until discovery after initial ESD was 40.1 months. Female patients developed synchronous and metachronous tumors more frequently than male patients (p = 0.037). Patients with H. pyloriinfections developed tumors more frequently than those without (p = 0.04). There were no significant differences with respect to the type and differentiation of tumors. Conclusions: Synchronous and metachronous lesions of gastric tumors were considerably prevalent after ESD. Considering the results of this study, careful endoscopic investigation should be performed after ESD for female patients and those with H. pylori infections. However, further large-scale and longer prospective studies are needed.

Detection of BCL2 Gene Rearrangements in the Reed-Sternberg Cells of Composite Lymphomas or Newly Diagnosed Hodgkin Lymphoma in Patients with a Previous Diagnosis of Follicular Lymphoma

Introduction:Composite lymphomas involving Hodgkin lymphoma (HL) and non-Hodgkin lymphomas (CLL, DLBCL, FL, MZL, MCL, T-NHL) are relatively rare but are increasingly frequently diagnosed. This may be a function of the change in diagnostic practice, the more varied and increased treatment of the presenting disease or simply reflect better monitoring post treatment with re-biopsy of lymph nodes. Composite lymphoma is defined as the synchronous and metachronous development of two or more lymphomas in the same patient. The mechanism of pathogenesis underlying its occurrence is not clearly established and in particular the relationship between entities when HL is diagnosed a number of years following successful treatment for follicular lymphoma (FL).Methods:We identified 48 patients with a diagnosis of Hodgkin lymphoma at our centre between January 2005 and June 2014 who had a previous or concurrent diagnosis of another lymphoproliferative disorder. Diagnoses included CLL = 14; follicular lymphoma = 13; DLBCL = 8; mantle cell lymphoma = 1; marginal zone lymphoma = 5; T-cell lymphoma = 3; not specified = 3 and a single patient had CLL, MZL and most recently MCL. The diagnosis of Hodgkin lymphoma was confirmed on the tissue biopsy by using a standard panel of immunohistochemistry markers (CD3, CD20, CD30, IRF4, TARC, CD79, LMP1, BCL6, BOB1, OCT2). This study is focussed on the 13 cases with follicular lymphoma. The aim of the study was to identify a relationship between the Hodgkin lymphoma and the follicular lymphoma using interphase FISH studies to look for identical chromosomal translocations.Results:8/13 patients had follicular lymphoma diagnosed on an earlier tissue biopsy, range 1-9 years prior to the diagnosis of Hodgkin lymphoma; 7/8 of these FL cases had bone marrow staging carried out at presentation and 5/7 had involvement by FL. 5/13 were newly presenting patients with composite lymphoma; 3/5 had a staging marrow which in each case showed evidence of follicular lymphoma alone with no evidence of Hodgkin lymphoma. In total, 7/13 patients fit the criteria for composite lymphoma with Hodgkin lymphoma and follicular lymphoma occupying distinct zones within the same tissue biopsy. The remaining 6/13 patients show no evidence of follicular lymphoma in the current biopsy and are indistinguishable from de novo presentation of Hodgkin lymphoma. Interphase FISH was used to assess for a genetic relationship between the disease entities. 3µ sections were cut from formalin fixed paraffin processed tissue, using the same block where possible as the H&E and immunohistochemistry. All cases were independently assessed by two experienced scientists with knowledge of histology and FISH reporting on thin sections. 8/13 cases had suitable samples for FISH, the remaining 5 cases had insufficient material remaining in the block. Commercial probes for BCL2 'Split-Signal’ (Abbott/Vysis or Dako) were used and FISH results were examined using a Zeiss microscope with MetaSystem image capture. All 8 cases showed BCL2 gene rearrangement in the Reed-Sternberg (RS) cells (5/8 cases were de novo group of Hodgkin lymphoma with no morphological or phenotypic evidence of FL in the tissue and 3/8 were composite lymphoma with distinct zoning). One rare case contained RS cells in a dab/imprint preparation made from the fresh tissue, FICTION technique was carried out on this case combining CD30 immunofluorescent staining with FISH for BCL2 gene rearrangement confirming RS cell type with BCL2 gene rearrangement.CONCLUSIONSThe identification of BCL2 gene rearrangement in RS cells, the hallmark cell of Hodgkin lymphoma, in this series of composite lymphomas suggests a relationship between the B cells of follicular lymphoma and the RS cells of HL. The presence of the same chromosomal abnormalities identified in more than one lymphoma cell type indicates the same clonal cell of origin. DisclosuresJack:Roche: Research Funding; Genentech: Collaboration, Collaboration Other.

Colorectal Adenoma Stem-like Cell Populations: Associations with Adenoma Characteristics and Metachronous Colorectal Neoplasia

Cancer stem cells have tumor-initiation and tumor-maintenance capabilities. Stem-like cells are present in colorectal adenomas, but their relationship to adenoma pathology and patient characteristics, including metachronous development of an additional adenoma ("recurrence"), has not been studied extensively. We evaluated the expression of aldehyde dehydrogenase isoform 1A1 (ALDH1A1), a putative stem cell marker, in baseline adenomas from the placebo arm of chemoprevention trial participants with colonoscopic follow-up. An exploratory set of 20 baseline adenomas was analyzed by ALDH1A1 immunohistochemistry with morphometry, and a replication set of 89 adenomas from 76 high-risk participants was evaluated by computerized image analysis. ALDH1A1-labeling indices (ALI) were similar across patient characteristics and in advanced and nonadvanced adenomas. There was a trend toward higher ALIs in adenomas occurring in the right than left colon (P = 0.09). ALIs of synchronous adenomas were correlated (intraclass correlation coefficient 0.67). Participants in both sample sets who developed a metachronous adenoma had significantly higher ALIs in their baseline adenoma than participants who remained adenoma free. In the replication set, the adjusted odds for metachronous adenoma increased 1.46 for each 10% increase in ALIs (P = 0.03). A best-fit algorithm-based cutoff point of 22.4% had specificity of 75.0% and positive predictive value of 70.0% for metachronous adenoma development. A larger population of ALDH1A1-expressing cells in an adenoma is associated with a higher risk for metachronous adenoma, independent of adenoma size or histopathology. If confirmed, ALDH1A1 has potential as a novel biomarker in risk assessment and as a potential stem cell target for chemoprevention.

Primary cutaneous marginal zone lymphoma with sequential development of nodal marginal zone lymphoma in a patient with selective immunoglobulin A deficiency

Multiple lymphoma subtypes occurring within one patient is rare in the context of B-cell lymphoma, and only few such cases have been reported in association with primary cutaneous marginal zone lymphoma (PCMZL). We herein describe the case of a 43-year-old patient who was diagnosed with PCMZL and subsequently developed a clonally unrelated nodal marginal zone lymphoma (MZL). At the time of diagnosis of PCMZL, multiple skin lesions were present. The atypical lymphoid infiltrate showed monotypic expression of immunoglobulin light chain lambda and heavy chain (IgM) on immunohistochemistry and an identical B-cell clone. No sign of systemic lymphoma was present in staging examinations. Complete remission was achieved utilizing rituximab. After a 3-year clinical course of repetitive cutaneous relapses and remissions, the patient additionally developed nodal lymphoma involvement by MZL which, however, harbored an immunophenotype and a genetic clone distinct from the cutaneous lymphoma counterpart. Therefore, the rare occurrence of two different types of MZL with sequential evolution was diagnosed. In this uncommon case, we hypothesize that selective immunoglobulin A deficiency may play a promoting role for the metachronous development of the two MZL that occurred in our patient.

Elimination of esophageal multiple precancerous lesions by chemotherapy: potential chemoprevention of metachronous multiple cancer development after curative treatment

Background Dysplastic squamous epithelium is a precancerous lesion for squamous cell carcinoma. It is often present in the esophagus and head and neck region, and can be visualized as a Lugol-voiding lesion (LVL) by iodine chromoendoscopy. However, effective treatment for such dysplastic epithelia has not yet been developed.

Bilateral testicular germ cell tumors (TGCT) prevalence: The 24-year-long single-center experience.

e15031 Background: Theetiology andreliable biomarkers for the risk of bilateral TGCT are still under investigation. Long-term relapse risks of up to 20 years after the therapy in contralateral testes demand a specific model of surveillance. Due to the rarity of the tumor type, reports of national experiences of bilateral TGCT are of a crucial significance for a future global database. Methods: The study was conducted during the treatment of 1 823 patients with TGCT in a single center from 1987-2011. Their mean age was 24 years at the time of diagnosis. Results: Out of 1 823 patients diagnosed with TGCT, 33 developed the bilateral disease (1.81%), 11 of them had synchronous tumors (33%). In the rest of patients the second testicular tumor was diagnosed 1 to 17 years after the initial diagnosis. The mean age of patients with bilateral TGCT was 28. According to the histological type: 11 were seminoma, 14 non-seminoma and 8 mixed seminoma and non-seminoma. Seven patients with bilateral tumor had a seminoma component at initial diagnosis. Compared to 5 patients out of 11 with synchronous tumor, the yolk sac component was detected only in 2 out of 22 metachronous patients. Conclusions: The presented findings of bilateral TGCT prevalence (1.8%) are in concordance with similar previous studies. As this type of tumor may be effectively treated, the risk assessment of metachronous tumor development should in future be facilitated by new biomarkers based on omics techniques. Thus, the investigation of karyotyping, c-KIT and transcriptome specificities will contribute to elucidation which pathways contribute to germ cell neoplasms. The stem cell markers for pluripotency maintenance may in future become potential diagnostic markers used as predictors for metastatic germ cell tumors. The development of a global database on these rare tumors will be of a crucial importance.

Pathomorphological Analysis of Internal Endometriosis

We performed clinical and morphological examination of 59 women with internal endometriosis (adenomyosis). Women were found to develop adenomyosis more frequently in the perimenopausal period (in their 40s) after repeated abortions and diagnostic surgical procedures. In 90% patients, adenomyosis was associated with the formation of multiple leyomyomatous nodules; glandular hyperplasia of the endometrium and fibrocystic transformation or fibrous degeneration of the ovaries were found in 60 and 100% cases. Two morphological variants of adenomyosis were identified: invasion of cytogenic stroma into the underlying myometrium with the formation of endometrial glands and invasion of cytogenic stroma via connective tissue interlayers without formation of endometrial glands and with pronounced neoangiogenesis. Foci of active adenomyosis in the uterus with predominance of cytogenic stroma were most prevalent in the late reproductive period. Endometrioid heterotopias were accompanied by considerable structural and functional reorganization of the myometrium with the formation of multiple leyomyomatous nodules. The presence of active and inactive adenomyosis foci and leyomyomatous nodules in uterus specimens reflects their metachronous development.

Von Hippel-Lindau病全国疫学調査における腎癌の臨床的解析

To understand the current clinical features of kidney cancers in patients with von Hippel-Lindau (VHL) disease in Japan. We performed a nationwide epidemiological survey of patients with VHL disease using the epidemiology program for incurable disease by the Ministry of Health, Labour and Welfare. The content of the survey included age of onset of VHL disease, sex, residential area, treatment modalities, kidney function, ECOG performance status, and prognosis. Here, we report the results of kidney cancer. The incidence rate of kidney cancer in VHL disease in Japan is 50.3% (206/409). Males and females are equally affected. The mean age of onset is 37.8 + 0.92 years. The median age of onset is 35 years. The ages of onset are distributed between 15 and 75 years. The mostly affected age of onset is between 20 and 50 years. The incidence rate of patients with metastasis is 11.1% (23/206). The most common site for metastasis is the lung (60%, 14/23). Due to multiple numbers of tumors at initial diagnosis and the metachronous development of tumors, patients received treatment on multiple occasions (mean 1.6 times), including partial nephrectomy (46%), total nephrectomy (31%) or radiofrequency ablation (14%) up to 6 times. The multiple treatments resulted in deterioration of the kidney function, causing chronic dialyses in 7 cases (3%). The ECOG performance status was scored as more than 1 in 42% of patients. The ten-year survival rate in VHL patients with kidney cancer was 94%, which is relatively high compared with that survival rates in sporadic kidney cancers. The current study indicates that the age of onset of kidney cancers in VHL disease is relatively young, and kidney cancers have features of metachronous development. The clinical features of kidney cancer developed in VHL disease among Japanese population are very similar with those in European countries. Multiple treatments result in deterioration of the kidney function.

M1584: Risk Factors of Synchronous or Metachronous Tumor Development in Early Gastric Cancer and Precancerous Lesion: A Review of 1005 Endoscopic Resections of Early Gastric Cancer and Gastric Adenoma

M1584: Risk Factors of Synchronous or Metachronous Tumor Development in Early Gastric Cancer and Precancerous Lesion: A Review of 1005 Endoscopic Resections of Early Gastric Cancer and Gastric Adenoma

Circulating tumour tissue fragments in patients with pulmonary metastasis of clear cell renal cell carcinoma

Tumour metastasis is the result of a complex sequence of events, including migration of tumour cells through stroma, proteolytic degradation of stromal and vessel wall elements, intravasation, transport through the circulation, extravasation and outgrowth at compatible sites in the body (the 'seed and soil' hypothesis). However, the high incidence of metastasis from various tumour types in liver and lung may be explained by a stochastic process as well, based on the anatomical relationship of the primary tumour with the circulation and mechanical entrapment of metastatic tumour cells in capillary beds. We previously reported that constitutive VEGF-A expression in tumour xenografts facilitates this type of metastatic seeding by promoting shedding of multicellular tumour tissue fragments, surrounded by vessel wall elements, into the circulation. After transport through the vena cava, such fragments may be trapped in pulmonary arteries, allowing them to expand to symptomatic lesions. Here we tested whether this process has clinical relevance for clear cell renal cell carcinoma (ccRCC), a prototype tumour in the sense of high constitutive VEGF-A expression. To this end we collected and analysed outflow samples from the renal vein, directly after tumour nephrectomy, in 42 patients diagnosed with ccRCC. Tumour fragments in venous outflow were observed in 33% of ccRCC patients and correlated with the synchronous presence or metachronous development of pulmonary metastases (p < 0.001, Fisher's exact test). In patients with tumours that, in retrospect, were not of the VEGF-A-expressing clear cell type, tumour fragments were never observed in the renal outflow. These data suggest that, in ccRCC, a VEGF-A-induced phenotype promotes a release of tumour cell clusters into the circulation that may contribute to pulmonary metastasis.

Male breast cancer: follow-up recommendations after surgery.

Abstract Abstract #4130 Introduction: National Comprehensive Cancer Network (NCCN) guidelines for female breast cancer treatment and surveillance are well established, but data on male breast cancers are not collected. As an NCCN institution, our objective was to examine practice patterns and follow-up for male breast cancer.&amp;#x2028; Methods: After IRB approval, a prospective breast database from 1990-2008 was queried for male patients. Medical records were examined for traditional factors (TNM, receptor status, treatment, gynecomastia) and follow-up practices such as mammogram use. Survival analysis was performed using the Kaplan-Meier method with 95% confidence intervals (CI) generated for 5-yr estimates. The logrank test was used to compare node positive/negative cohorts.&amp;#x2028; Results: Of the 19,132 patients in the database, 71 (0.4%) were male; 64 had complete data. The median age for the 64 patients was 68.8yrs (range 29-85yrs). 89.1% presented with a palpable mass. 12.5% had gynecomastia in the cancer breast and 9.4% had contralateral gynecomastia. 18/64 (28.1%) had a familial history of breast, ovarian or colon cancer. One patient had bilateral synchronous breast cancer. Seven (10.9%) had previous prostate cancer and 4 (6.25%) had other synchronous cancers (2 papillary thyroid, 2 lung). Genetic testing was offered to all 64; 3 accepted. Two men had contralateral prophylactic mastectomy years later. The mean/median invasive tumor size was 2.0/1.6cm (range 0.0-10.0cm) and all but 2 tumors were ductal. 63 had a mastectomy (65.1% with axillary node dissection; 34.9% with sentinel lymph node biopsy). Lymph node involvement occurred in 25/64 (39.1%). Under NCCN guidelines, 49/64 (76.6%) should receive chemotherapy and chest wall radiation should be given to 27/64 (42.2%) based on tumor size and nodal status. Chemotherapy was offered to 50.0%; 35.9% received chemotherapy. Chest wall radiation was given in 59.3%. 63/64 were ER positive; 49 (77.8%) received hormone therapy. Follow-up annual mammograms were obtained in 27/64 (42.2%)[all BIRADs 1 or 2], not obtained in 28/64 (43.8%), and unknown in 9/64 (14.0%). Median follow-up was 26.1mos (range: 0.26-377.8mos). The 5-yr survival estimates and 95% CI for node positive and negative diseases were 75% (95% CI=46-90%) and 93% (95% CI=74-98%) respectively. For comparison, 5-yr survival rates from the NSABP B-04 trial were 60% in node-positive and 75% in node-negative disease. Four patients (6.3%) died of disease; 10 (15.6%) are alive with distant disease; 47 (73.4%) have no evidence of disease; and 3 (4.7%) are unknown or dead of other causes. There were 2 local recurrences (3.1%) [1 chest wall, 1 in-breast] and no metachronous contralateral breast cancer development. Conclusions: Male breast cancer is uncommon, as is contralateral breast cancer. Men were less likely to receive/accept chemotherapy/hormone therapy/genetic testing/annual mammograms and more likely to receive radiation based on NCCN guidelines, but survival compared to historic females was no worse. Creation of follow-up guidelines for males may be different than females. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4130.

Hereditary Cancer Syndromes

Persons carrying mutations for hereditary cancer syndromes are at high risk for the development of tumors at an early age, as well as the synchronous or metachronous development of multiple tumors of the corresponding tumor spectrum. The genetic causes of many hereditary cancer syndromes have already been identified. About 5% of all cancers are part of a hereditary cancer syndrome. Selective literature review, including evidence-based guidelines and recommendations. Clinical criteria are currently available according to which many hereditary cancer syndromes can be diagnosed or suspected and which point the way to further molecular genetic analysis. A physician can easily determine whether these criteria are met by directed questioning about the patient's personal and family medical history. The identification of the causative germ line mutation in the family allows confirmation of the diagnosis in the affected individual and opens up the option of predictive testing in healthy relatives. Mutation carriers for hereditary cancer syndromes need long-term medical surveillance in a specialized center. It is important that these persons should be identified in the primary care setting and then referred for genetic counseling if molecular genetic testing is to be performed in a targeted, rational manner.

Identification of Immunohistochemical Factors That Predict the Synchronous or Metachronous Development of Bladder Tumors in Patients with Upper Urinary Tract Tumors

Objective: To identify markers that predict the synchronous or metachronous development of bladder cancer in patients with upper urinary tract (UUT) tumors. Materials and Methods: Between March 2001 and December 2005, we identified 38 consecutive patients who had been histologically diagnosed as having transitional cell carcinoma in the renal pelvis and ureter. These patients were divided into 2 groups (n = 19 per group): group 1 patients with metachronous or synchronous bladder cancer, and group 2 patients with UUT tumors only. We analyzed the differences between the 2 groups with respect to the expression of various biomarkers (p53, Rb, Ki-67, PTEN, and bcl-2) and in terms of clinical parameters. Results: The 2 groups differed significantly in terms of multiplicity (p = 0.029), papillary configuration (p = 0.001), the presence of lymphovascular emboli (p = 0.019), and Ki-67 overexpression (p = 0.029) in UUT tumors. Multivariate analysis revealed that Ki-67 overexpression in UUT tumor tissues significantly predicts bladder cancer development (HR 6.440; 95% CI 1.121–37.014; log rank p = 0.037). Conclusion: Ki-67 overexpression in UUT tumor tissues was found to be an independent predictor of the development of bladder cancer in UUT tumor patients.

Intracranial metastasis from synovial sarcoma

Synovial sarcomas comprise between 5% to 10% of all soft tissue sarcomas in adults. It has a predilection for young adults and is one of the more frequently misdiagnosed soft tissue sarcomas. It is not unusual for synovial sarcoma to present initially after a traumatic event. It most commonly occurs in close proximity to a large joint. The most common site for metastasis is the lung, followed by lymph node involvement. Synovial sarcoma rarely metastasizes to the skeleton and when it occurs, it most commonly involves the long bones. Cranial metastasis is rare and has only been described in 2 previously reported cases. Reports of other sarcomas having intracranial metastasis include rhabdomyosarcoma, angiosarcoma, fibrosarcoma, liposarcoma, Ewing's sarcoma, and clear cell sarcoma from the kidney. The synchronous or metachronous development of >or=2 primary soft tissue sarcomas has been reported. These are primary soft tissue sarcomas occurring at multiple soft tissue sites without pulmonary or lymphatic involvement. It is often difficult to distinguish between the synchronous or metachronous appearance of a second primary and soft tissue sarcoma metastasis. This article presents a case of a 17-year-old adolescent boy who presented with simultaneous enlarging masses involving the skull and thigh. Open biopsies confirmed synovial sarcoma in both regions. Staging studies, including computed tomography (CT) of his chest, abdomen/pelvis and bone scan were otherwise negative for metastasis.