Implantation Metastasis Research Articles

S2346 Metastatic Implantation of Esophageal Adenocarcinoma to PEG Tube Site: A Case Report

Introduction: Patients with esophageal cancer often need a Percutaneous Endoscopic Gastrostomy (PEG) tube to provide nutrition. However, metastasis of the original tumor to the gastrostomy site may occur as a rare, but noteworthy complication. Case Description/Methods: A 64-year-old male had a PEG tube placed after he was diagnosed with Stage 2 esophageal adenocarcinoma with extension into the proximal stomach in Sep 2018. Following this, he received chemo and radiation therapy and did well. A follow up EGD demonstrated no evidence of malignancy, but a non-malignant duodenal narrowing / stenosis was noted. Subsequently, the patient suffered persistent leakage around his PEG tube; due to this and duodenal stenosis, his gastrostomy tube (G-tube) was removed and a jejunostomy tube (J-tube) was placed with surgical closure of the gastrostomy site (Figure). A few months later, when the patient was admitted with melena and severe anemia, an upper endoscopy performed revealed a hard, 3-4 cm malignant appearing mass with recent evidence of bleeding noted on the greater curvature of the stomach at the previous PEG tube site. Biopsies from this area showed invasive moderately differentiated adenocarcinoma with histological features similar to the previous adenocarcinoma. Though re-initiation of chemotherapy and radiation did result in improvement of the patient’s stomach neoplasm, his wound healing complications at the J-tube site persisted, resulting in delay of his treatment. In October 2021, there was recurrence of his stomach cancer. Due to persistent difficulties with wound healing and recurrent illnesses, the patient elected to forgo further treatment in favor of comfort care. He subsequently passed away peacefully. Discussion: Our experience with this case and review of the literature indicate that, in patients with esophageal cancer, usage of the “pull-string” technique as well as length of time of PEG tube placement are associated with a significantly higher risk of metastatic implantation. To avoid this rare complication, potential alternative techniques such as the “push” technique for PEG tube placement or radiologically / surgically placed G-tubes or J-tubes should be considered in patients with oropharyngeal or esophageal cancer for nutrition.Figure 1.: Endoscopic image revealing a malignant-appearing mass on the greater curvature of the stomach at initial PEG tube site.

Endometrioid Carcinomas of the Ovaries and Endometrium Involving Endocervical Polyps: Comprehensive Clinicopathological Analyses.

While synchronous ovarian and endometrial endometrioid carcinomas (ECs) have long been described in the literature, ovarian or endometrial EC involving concomitant endocervical polyp (ECP) has not yet been reported. This study aimed to investigate the histological types and prevalence of gynecological tumors co-existing with ECP and to comprehensively analyze the clinicopathological characteristics of ovarian and endometrial ECs involving ECPs. We searched for ECP cases associated with premalignant lesions or malignancies of the female genital tract occurring between March 2019 and February 2022. We then investigated the histological types and prevalence of gynecological tumors co-existing with ECP. In addition, we reviewed electronic medical records and pathology slides to collect the clinicopathological features of four patients with ovarian or endometrial EC involving ECP. We found 429 ECPs over the three-year study period. Of these, 68 (15.9%) were associated with premalignant or malignant lesions occurring in the uterine cervix, endometrium, and ovaries. Four of these cases, including two (0.5%) ovarian grade 3 ECs and two (0.5%) endometrial grade 1 ECs, involved ECPs. In the former cases (cases 1 and 2), ECs involving ECPs exhibited similar morphology and immunohistochemical staining results to those of advanced-stage ovarian EC. In the latter cases (cases 3 and 4), the histological and immunophenotypical features of EC involving ECP were identical to those of primary endometrial EC, despite the lack of tumor involvement in the myometrium, lower uterine segment, and cervical stroma as well as the absence of lymphovascular invasion and lymph node metastasis. In all cases, no evidence of benign endometriosis, endometrial hyperplasia without atypia, or atypical hyperplasia/endometrial intraepithelial neoplasm within ECP or the adjacent endocervical tissue was noted. Considering our results, the involvement of ECP by EC may have been caused by an implantation metastasis from the ovarian (cases 1 and 2) or endometrial (cases 3 and 4) EC. To the best of our knowledge, this is the first exploration of the synchronous occurrence of endometrial or ovarian EC and ECP involvement. Implantation metastasis via transtubal and trans-endometrial cavity migration may have been the pathogenic mechanism of ECP involvement.

Multiple subcutaneous metastasis from gastric cancer: A rare clinical presentation

Introduction: The aim of this report is to describe a rare clinical situation in oncology, a gastric tumor with metastatic implants in subcutaneous tissue. This case demonstrates a rare scenario of gastric adenocarcinoma, with very few cases described in the literature, which evolved with subcutaneous metastases and whereby the role of systemic and even surgical treatment remains unclear. Case Report: The case reported refers to a patient with an advanced gastric adenocarcinoma that evolved with multiple metastases implanted in the subcutaneous tissue, in addition to peritoneal, non-regional lymph nodes, and bone involvement, requiring first-line chemotherapy treatment. Conclusion: This case manifests a rare presentation of advanced gastric neoplasm. The subcutaneous metastasis of internal malignancies is unusual, corresponding to less than 10% of neoplasms. The occurrence of skin or subcutaneous metastasis is still less usual in solid neoplasms, including gastric cancer, with a few cases reported in the literature. In this context, the role of diagnostic medicine is fundamental.

IGF1R acts as a cancer-promoting factor in the tumor microenvironment facilitating lung metastasis implantation and progression

Given the long-term ineffectiveness of current therapies and late-stage diagnoses, lung cancer is a leading cause of malignant diseases. Tumor progression is influenced by cancer cell interactions with the tumor microenvironment (TME). Insulin-like growth factor 1 receptor (IGF1R) was reported to affect the TME; however, the role of IGF1R in lung TME has not been investigated. First, we assessed IGF1R genomic alterations and expression in NSCLC patient tissue samples, as well as IGF1R serum levels. Next, we performed tumor heterotopic transplantation and pulmonary metastases in IGF1R-deficient mice using melanoma and Lewis lung carcinoma (LLC) cells. Herein we report increased amplification and mRNA expression, as well as increased protein expression (IGF1R/p-IGF1R) and IGF1R levels in tumor samples and serum from NSCLC patients, respectively. Moreover, IGF1R deficiency in mice reduced tumor growth, proliferation, inflammation and vascularization, and increased apoptosis after tumor heterotopic transplantation. Following induction of lung metastasis, IGF1R-deficient lungs also demonstrated a reduced tumor burden, and decreased expression of tumor progression markers, p-IGF1R and p-ERK1/2. Additionally, IGF1R-deficient lungs showed increased apoptosis and diminished proliferation, vascularization, EMT and fibrosis, along with attenuated inflammation and immunosuppression. Accordingly, IGF1R deficiency decreased expression of p-IGF1R in blood vessels, fibroblasts, tumor-associated macrophages and FOXP3+ tumor-infiltrating lymphocytes. Our results demonstrate that IGF1R promotes metastatic tumor initiation and progression in lung TME. Furthermore, our research indicates that IGF1R could be a potential biomarker for early prediction of drug response and clinical evolution in NSCLC patients.

Non-iatrogenic implantation of cutaneous metastasis from hepatocellular carcinoma.

Cutaneous metastases as an extrahepatic metastasis from hepatomas (HCC) is extremely rare and always carry a poor prognosis and less survival time. Previously, there has been a limited number of literature that reported skin metastasis in a large number of cases, which has rarely been discussed in the empirical treatment and therapy of cutaneous metastasis, especially for non-iatrogenic implantation. It is necessary to discuss this kind of metastasis. We summarize cases from our medical center from 2013 to 2021, there are 12 patients diagnosed with non-iatrogenic implantation of cutaneous metastasis after HCC. We conducted the investigation of the clinical prognosis, pathological characteristics, and treatment of those patients. All patients were male, the age ranged from 21 to 71years old, the average size of primary HCC was over 5cm, there was four patient's cutaneous metastasis from the skin of head (including scalp and occipital region), followed by right abdominal (2 patients), right chest wall (2 patients), back (2 patients), umbilical (1 patient), gluteal region (1 patient). The cutaneous metastases presented as solitary or multiple nodules, papules, and erythema without ulcers with sizes between 0.5cm and 5cm. 7 patients died after being diagnosed with cutaneous metastasis within 2-19months. The rate of non-iatrogenic implantation cutaneous metastasis is low, but the prognosis is poor, combining with histopathological analysis and history of diseases can be helpful in diagnosis. For large HCC (> 5cm), systematic treatment is recommended to prevent the occurrence of cutaneous metastasis and improve the prognosis after hepatectomy.

Retrospective analysis of 9 cases of appendiceal mucocele in 3,071 cases of appendicitis

Appendiceal mucocele is a rare disease. Due to the lack of specific clinical symptoms, and the high misdiagnosis rate before operation, in the present study, the clinical data were assessed to determine a potential basis for the diagnosis and treatment of appendiceal mucocele. The clinical data of 3,071 patients with appendicitis admitted between January 2014 and July 2021, including 9 patients with appendiceal mucoceles were retrospectively analyzed. The data were retrieved from the hospital records and included the patients' age, sex, leukocyte counts (measured in the peripheral venous blood sample), the surgical methods, the pathological results and the postoperative follow-up information. Among the 3,071 patients with appendicitis, 9 cases were appendiceal mucocele. These 9 were treated by laparoscopic surgery in 6 cases (2 laparoscopic appendectomy, 2 laparoscopic partial cecectomy plus appendectomy, and 2 laparoscopic right hemicolectomy) and laparotomy in 3 cases (partial cecectomy plus appendectomy). Pathological examination was performed on the surgically resected specimens of all patients. The results showed that 7 cases were appendiceal mucoceles, and 2 cases were low-grade appendiceal mucoceles. During the follow-up after surgery, one patient with exploratory laparotomy plus partial cecectomy and appendectomy was pathologically diagnosed with low-grade appendiceal myxoma. The patient developed peritoneal implants appeared 2 years later, and the remaining patients are still alive, without any postoperative complications or obvious signs of recurrence. Appendiceal mucocele is a disease that usually causes clinical manifestations of acute appendicitis. Ultrasound and CT scans can be used for preoperative diagnosis. The surgical treatment options for mucoceles are open or laparoscopic appendectomy, cecectomy, and right hemicolectomy. Although the incidence of appendiceal mucocele is low, special attention should be paid to surgery due to its predisposition to peritoneal implantation and metastasis. Laparoscopic appendectomy with partial cecectomy is not a difficult procedure and is not likely to cause abdominal implantation metastasis, thus it should be the preferred surgical method. When conditions permit, intraoperative rapid cryotherapy can quickly identify the occurrence of malignant tumors.

A Preliminary Exploration Using Imaging Methods to Predict the Possibility of the Recurrence of Serous Ovarian Cancer in Patients Undergoing Total Resection.

BackgroundThe purpose of our research was to explore the value of preoperative CT and MRI examinations and clinical indicators in the prediction of recurrence of ovarian serous carcinoma in patients who underwent satisfactory staging surgery.ProcedureDetailed inclusion and exclusion criteria were installed to screen all patients collected and the eligible patients were divided into two groups. The CT and MRI features and some clinical characteristics of two groups were analyzed, in addition, the apparent diffusion coefficient (ADC) value in tumor solid region was measured. Univariate analysis was used in this study.ResultsThere were 78 patients with histologically proven ovarian serous carcinoma. According to the strict inclusion and exclusion criteria, we retained 29 patients (recurrence group: 11 patients, no recurrence group: 18 patients). For the peritoneal implantation metastasis in CT or MRI images and Ki67 proliferation index (Ki67 PI), the differences between two cohorts were statistically significant (P < 0.05). The rate of peritoneal metastasis in the recurrence cohort (10/11, 91%) was higher than that in the no recurrence cohort (7/18, 39%). Patients with high Ki67 PI expression had lower recurrence risk than those with low Ki67 PI expression, HR=0.172 (95%CI: 0.050-0.589, P=0.005), and patients without peritoneal planting had lower recurrence risk than those with it, HR=9.373 (95%CI: 1.194-73.551, P=0.033). For FIGO III patients, ipsilateral fallopian tube involvement was statistically significant between the two groups (P < 0.05). The differences in the other preoperative imaging characteristics of ovarian serous cancer, including the volume; capsule of the mass; main components; ADC value; cystic change; bleeding; degree of enhancement of the mainly solid region in 3 periods; and range of tumor involvement in the ovary, uterus, bladder, bowel, and pelvic wall, were not statistically significant. In addition, the differences in the other clinical indicators (i.e., age, FIGO stage) between the two cohorts were not statistically significant.ConclusionsIn CT and MRI examinations before surgery, peritoneal implantation metastasis was suggestive of the possibility of the recurrence of serous ovarian carcinoma in the near future. In addition to that, ipsilateral fallopian tube involvement and Ki67 PI may also indicate the possibility of recurrence (the former was only applicable to FIGO III patients).

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

BackgroundAnal metastasis of colorectal cancer is very rare and may present synchronously or metachronously, regardless of pre-existing anal diseases. We report a case of anal fistula metastasis after completion of neoadjuvant therapy for rectal cancer, followed by surgical resection of the primary tumor and metastatic lesion.Case presentationA 50-year-old man was diagnosed with rectal cancer located 5 cm from the anal verge, with a clinical stage of cT3N0M0. He denied any medical or surgical history, and physical examination revealed no perianal disease. He underwent preoperative chemoradiation therapy (CRT) consisting of a tegafur/gimeracil/oteracil potassium (S-1)-based regimen with 45 Gy of radiation. After completion of CRT, computed tomography (CT) revealed the primary tumor’s partial response, but a liver mass highly suggestive of metastasis was detected. This mass was later diagnosed as cavernous hemangioma 3 months after CRT initiation. He then underwent and completed six cycles of consolidation chemotherapy with a capecitabine-based regimen. Subsequent colonoscopy revealed the complete response of the primary tumor, but CT showed thickening of the edematous rectal wall. Therefore, we planned to perform low anterior resection as a radical surgery. However, he presented with persistent anal pain after the last chemotherapy, and magnetic resonance imaging revealed a high-intensity mass behind the anus, suggestive of an anal fistula. We considered the differential diagnosis of a benign anal fistula or implantation metastasis into the anal fistula. Fistulectomy was performed, and a pathological diagnosis of tubular adenocarcinoma, suggestive of implantation metastasis, was made. Thereafter, we performed laparoscopic abdominoperineal resection. Histopathological examination revealed well-differentiated adenocarcinoma, ypT2N0, with a grade 2 therapeutic effect. Subsequent immunohistochemistry of the resected anal fistula showed a CDX-2-positive, CK20-positive, CK7-negative, and GCDFP-15 negative tumor, with implantation metastasis. There was no cancer recurrence 21 months after the radical surgery.ConclusionsThis is the first report of anal fistula metastasis after neoadjuvant therapy for rectal cancer in a patient without a previous history of anal disease. If an anal fistula is suspected during or after neoadjuvant therapy, physical and radiological assessment, differential diagnosis, and surgical intervention timing for fistula must be carefully discussed.

Local recurrence at the site of the Lone Star device through implantation of exfoliated cells during local excision for early rectal cancer: A case report.

IntroductionInvasive procedures for colorectal cancer can cause iatrogenic tumor cell seeding. Implantation of these exfoliated cells in the surrounding tissue can result in locoregional cancer recurrence. This has been described in endoscopic procedures and major surgical resections, however recurrence in iatrogenic lesions of the anal canal during minimal invasive rectal surgery has not been shown in literature yet. This is the first reported case of recurrent rectal cancer that developed into an anal metastasis at the site where hooks of the Lone Star Retractor disrupted the epithelial lining of the anal canal during a local excision of early rectal cancer using TAMIS.Presentation of caseA 57 year old male was diagnosed with a high risk early stage rectal adenocarcinoma. He was treated with transanal minimally invasive surgery (TAMIS) with the use of a Lone Star retractor and he received subsequent chemo-radiotherapy. 23 months later the patient developed a bleeding mass bulging out of the anus. A true cut and incision biopsy was performed and the pathology report revealed localization of adenocarcinoma at the anal canal which was similar to the earlier diagnosed rectal carcinoma. The patient underwent an abdominal perineal resection and left-sided lymph node dissection.Discussion and conclusionThis shows that local recurrence through implantation of exfoliated tumor cells can occur in iatrogenic lesions of the anal canal not only in major but also in minimal invasive rectal surgery. Careful tissue handling and rectal washout may reduce the chance of this implantation metastasis.

Carrier-free multifunctional nanomedicine for intraperitoneal disseminated ovarian cancer therapy

BackgroundOvarian cancer is the most lethal gynecological cancer which is characterized by extensive peritoneal implantation metastasis and malignant ascites. Despite advances in diagnosis and treatment in recent years, the five-year survival rate is only 25–30%. Therefore, developing multifunctional nanomedicine with abilities of promoting apoptosis and inhibiting migration on tumor cells would be a promising strategy to improve the antitumor effect.Methods and resultsIn this study, we developed a novel ACaT nanomedicine composed of alendronate, calcium ions and cyclin-dependent kinase 7 (CDK7) inhibitor THZ1. With the average size of 164 nm and zeta potential of 12.4 mV, the spherical ACaT nanoparticles were selectively internalized by tumor cells and effectively accumulated in the tumor site. Results of RNA-sequencing and in vitro experiments showed that ACaT promoted tumor cell apoptosis and inhibited tumor cell migration by arresting the cell cycle, increasing ROS and affecting calcium homeostasis. Weekly intraperitoneally administered of ACaT for 8 cycles significantly inhibited the growth of tumor and prolonged the survival of intraperitoneal xenograft mice.ConclusionIn summary, this study presents a new self-assembly nanomedicine with favorable tumor targeting, antitumor activity and good biocompatibility, providing a novel therapeutic strategy for advanced ovarian cancer.Graphical

Analysis for the short-term efficacy and long-term prognosis of laparoscopic and laparotomy radical resection for gallbladder cancer

Objective: To compare the short-term efficacy and long-term prognosis of laparoscopic and laparotomy radical resection for gallbladder cancer(GBC). Methods: From January 2010 to December 2020,the clinical data and survival information for 133 patients who underwent radical resection of GBC at the Department of Hepatopancreatobiliary Surgery,Zhejiang Provincial People's Hospital,were retrospectively collected. Eighty patients(23 males and 57 females) underwent laparoscopic radical resection and had a median age(M(IQR)) of 66.0(12.8)years(range:28.0 to 82.0 years). Fifty-three patients(45 males and 8 females) who received laparotomy were 63.0(6.0)years old(range:45.0 to 80.0 years old). There were no significant differences in age,gender,body mass index,preoperative albumin,preoperative total bilirubin,N stages,vascular invasion,peri-neural invasion or tumor differentiation between the laparoscopic and laparotomy group(all P>0.05). But there were significant differences in preoperative CA19-9(Z=-2.955, P=0.003), preoperative ALT level(Z=-2.801,P=0.031) and T stage (χ2=19.110,P=0.007) between the two groups. A non-parametric test was used for quantitative data. χ2 test or Fisher exact probability method was used for count data. Results: Patients in the laparoscopic group did not differ from those in the laparotomy group in terms of length of operation,number of lymph node yield,number of positive lymph nodes,the incidence of intraoperative gallbladder rupture,incidence of postoperative bile leakage,abdominal bleeding or abdominal infection,30-day mortality,90-day mortality, the incidence of incision implantation or peritoneal cavity metastasis(all P>0.05). Patients in the laparoscopic group showed less intraoperative bleeding(100.0(200.0)ml vs. 400.0(250.0)ml)(Z=-5.260,P<0.01),fewer days with drainage tube indwelling(6.0(3.8)days vs. 7.0(4.0)days)(Z=-3.351, P=0.001), and fewer postoperative days in hospital(8.0(5.0)days vs. 14.0(7.5)days)(Z=-6.079,P<0.01) than those in the laparotomy group. Patients in the laparoscopic group displayed better overall survival (P<0.01) and progression-free survival (P<0.01). Subgroup analysis for GBC of T1b-T2 and T3 stages revealed comparable overall survival and progression-free survival between the laparoscopic and laparotomy groups (P>0.05). Conclusions: Laparoscopic radical resection can achieve long-term survival for GBC comparable to that with open surgery. Laparoscopic radical resection has advantages over open surgery regarding surgical trauma and postoperative recovery.

Gastric Cancer with Bone Marrow Invasion and Disseminated Intravascular Coagulation: A Case Report

Gastric cancer is the fifth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide in 2020. Gastric cancer usually undergoes lymph node metastasis and implantation metastasis, but bone metastasis and bone marrow invasion are rare. However, gastric cancer patients with bone marrow invasion usually have cancer emergency, so special attention should be paid in clinical practice. Herein, we analyzed the clinical characteristics of an asian gastric cancer patient with bone marrow invasion and disseminated intravascular coagulation (DIC) in our hospital and summarized the diagnosis and treatment experience to provide a reference for such diseases.

Фенотипическое разнообразие макрофагов при раке яичников

Фенотипическое разнообразие макрофагов при раке яичников

Local-Regional Recurrence of Pheochromocytoma/Paraganglioma: Characteristics, Risk Factors and Outcomes.

ObjectiveTo study the characteristics, risk factors, and outcomes of local-regional recurrence of pheochromocytoma and paraganglioma (PPGL).MethodsClinical data of 96 PPGL patients with local-regional recurrence and 112 patients without recurrence were retrospectively analyzed.ResultsRecurrent patients exhibited a median recurrence time of 6.0 (4.0, 9.0) years after resection of the primary tumor. SDHB mutation [HR 4.1 (1.7, 9.5), p=0.001), primary tumor size ≥5cm [HR 2.3 (1.1, 4.7), p=0.028], and average Ki-67 count ≥3% in the primary tumor [HR 2.6 (1.4, 4.9), p=0.003] were independent predictors for recurrence of PPGL. Primary tumor sizes ≥5cm [HR 5.1 (1.7, 15.3), p=0.003] and average Ki-67 counts ≥3% of the primary tumor [HR 2.4 (1.1, 5.2), p=0.035] were independent predictors for recurrence of pheochromocytoma, while SDHB mutation [HR 4.6 (1.5, 13.9), p=0.007] was a predictor for paraganglioma recurrence. Among recurrent patients, 47% (45/96) had multiple nodules in recurrent sites, and 58% (56/96) had metastases, with 20% (19/96) being implantation metastases. The risk of metastases (42% vs. 25%, p=0.030) and death (15% vs. 8%, p=0.003) was significantly increased in untreated patients after recurrence compared with treated patients.ConclusionLong-term follow-up is necessary for all PPGL patients. Risk factors for recurrence of pheochromocytoma and paraganglioma differ, with primary tumor size and average Ki-67 count representing independent predictors for pheochromocytoma patients and SDHB mutations predicting paraganglioma recurrence. Although the treatment of recurrence can be difficult, patients should be treated once recurrence is detected as it decreases the risk of metastases and death.

A SHEEP IN WOLF'S CLOTHING: BENIGN TERATOMA MASQUERADING AS MALIGNANT THYMOMA

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Metastatic parietal pleural implants can be seen in patients with thymoma. Benign teratomas are not associated with parietal pleural implants. We describe resection of a benign teratoma, appearing as a locally advanced thymoma with parietal pleural implants. CASE PRESENTATION: A 37-year-old healthy female was found to have an incidental large pericardial mass on screening breast MRI. A CT Chest showed a 9.4 cm well-defined hypoattenuating calcified cystic lesion with mass effect on the right atrium (Figure 1). Her preliminary diagnosis was thymoma. In the operating room, thoracoscopy demonstrated a large mass with involvement of the pulmonary parenchyma, pericardium, parietal pleural implants, and visceral pleural implants. (Figure 2A, B, C). Robotic en bloc resection was performed. The mass was mobilized with the resection of portions of the upper and middle lobes, pericardium and away from the remaining thoracic structures including the phrenic nerves (Figure 2C, D). Intra-operative frozen section of the mass revealed benign teratoma. Frozen section of the parietal pleural implants revealed fibrosis with teratomatous elements on final pathology (Figure 3). A single chest drain was placed. The patient did well postoperatively and was discharged on postoperative day four. DISCUSSION: To our knowledge, this is the first report of a benign mature teratoma masquerading as a metastatic thymoma. Approximately half of all mediastinal masses in adults are in the anterior mediastinum. The most common mediastinal tumor in adults is thymoma. Thymoma, although considered a low-grade neoplasm, has a propensity for locally invasiveness and recurrence. For these reasons, all thymomas should be approached as aggressive(1). In contrast, benign mature teratomas are well-circumscribed and indolent. Although there is potential for malignant transformation, complete resection results in cure(2). The current recommendation for diagnosis of anterior mediastinal mass is up front resection unless neoadjuvant or medical therapy is being pursued as treatment(1). Preoperative imaging, while helpful, cannot reliably delineate between thymoma and teratoma(3). The higher incidence of thymoma in adults makes the preoperative diagnosis of thymoma more likely. CONCLUSIONS: This case highlights the importance of performing an R0 resection given the known aggressiveness of thymomas as well as highlighting that things are not always as they seem. REFERENCE #1: Detterbeck FC ed. Pathology of the Mediastinum. New York: Cambridge University Press, 2014 REFERENCE #2: Lewis BD, Hurt RD, Payne WS et al Benign Teratomas of the Mediastinum J Thorac Cardiovasc Surg 1983; 86 (5): 727-731. REFERENCE #3: Tomiyana N, Honda O, Tsubamoto M et al Anterior Mediastinal Tumors: Diagnostic Accuracy of CT and MRI. Eur J Radiol. 2009; 69 (2): 280-288. DISCLOSURES: No relevant relationships by Mia DeBarros, source=Web Response No relevant relationships by Grant Fischer, source=Web Response No relevant relationships by M. Blair Marshall, source=Web Response No relevant relationships by Sue Wang, source=Web Response

Embedding similarities between embryos and circulating tumor cells: fundamentals of abortifacients used for cancer metastasis chemoprevention

BackgroundThe global epidemiological studies reported lower cancer risk after long-term use of contraceptives. Our systematic studies demonstrated that abortifacients are effective in preventing cancer metastases induced by circulating tumor cells (CTCs). However, the molecular and cellular mechanisms by which abortifacients prevent CTC-based cancer metastases are almost unknown. The present studies were designed to interdisciplinarily explore similarities and differences between embryo implantation and cancer cell adhesion/invasion.MethodsBiomarker expressions on the seeding embryo JEG-3 and cancer MCF-7 cells, as well as embedding uterine endometrial RL95-2 and vascular endothelial HUVECs cells were examined and compared before and after treatments with 17β-estradiol plus progesterone and abortifacients. Effects of oral metapristone and mifepristone on embryo implantation in normal female mice and adhesion/invasion of circulating tumor cells (CTCs) in BALB/C female mice were examined.ResultsBoth embryo JEG-3 and cancer MCF-7 cells expressed high sLex, CD47, CAMs, while both endometrial RL95-2 and endothelial HUVECs exhibited high integrins and ICAM-1. Near physiological concentrations of 17β-estradiol plus progesterone promoted migration and invasion of JEG-3 and MCF-7 cells via upregulating integrins and MMPs. Whereas, mifepristone and metapristone significantly inhibited migration and invasion of JEG-3 and MCF-7 cells, and inhibited JEG-3 and MCF-7 adhesion to matrigel, RL95-2 cells and HUVECs, respectively. The inhibitions were realized by downregulating sLex, MMPs in JEG-3 and MCF-7 cells, and downregulating integrins in RL95-2 cells and HUVECs, respectively. Mifepristone and metapristone significantly inhibited both embryo implantation and cancer cell metastasis in mice.ConclusionsThe similarities between the two systems provide fundamentals for abortifacients to intervene CTC adhesion/invasion to the distant metastatic organs. The present studies offer the rationale to repurpose abortifacients for safe and effective cancer metastasis chemoprevention.

CHARACTERIZATION OF CCL5/CCR5 AXIS AND ASSOCIATED CHEMOKINE RECEPTORS IN ORAL SQUAMOUS CELL CARCINOMA CELL LINES

<h3>Background</h3> The communication between cancer cells and lymphatic fibroblasts is important for the implantation of lymph node metastasis and chemokines play a fundamental role. CCR5 is one of the main chemokine receptors associated to regional lymph node metastasis; however, the mechanisms of the CCL5/CCR5 axis in oral squamous cell carcinoma (OSCC) are poorly understood. <h3>Objective</h3> We studied the expression of CCL5 and CCR5 and ligands (CCL3) and receptors (CCR1, CCR3, and CCR4) that have been involved with the CCL5/CCR5 axis. <h3>Methods</h3> Cell lines from primary tongue cancer (SCC9, SCC15, SCC25, Cal27), 1 cell line from lymph node metastasis (HSC3), and 1 primary cell line from normal oral keratinocytes were studied. The expression of ligands was measured by enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction, and the expression of receptors was measured by whole blood and quantitative real-time polymerase chain reaction. Thirty-six primary tumors and 15 lymph node metastases were analyzed by immunohistochemistry for the chemokine receptors. <h3>Results</h3> The expression of CCL5 was significantly higher than that of CCL3. SSC25 was the cell line with the higher expression of CCL5, significantly different to normal oral keratinocyte. CCR4 and CCR5 were expressed by all cell lines, with a higher expression in SCC9 and Cal27 in comparison with the control. The expression of CCR1 and CCR3 was significantly lower. These results were correlated with the immunohistochemical expression in paraffin-embedded samples. <h3>Conclusions</h3> These findings suggest that CCL5, CCR5, and CCR4 are the molecules involved in the CCL5/CCR5 axis, with higher expression in OSCC. More studies are needed to understand the mechanisms involved in the CCL5/CCR5 axis in OSCC.

Establishment of a modified percutaneous CT-guided paraspinal intramuscular VX-2 squamous cell carcinoma dual tumor model in rabbits.

BackgroundThe rabbit VX-2 tumor model is a commonly used transplanted tumor model and is widely used in surgical, radiological, and interventional studies. Most of the known tumor models for each site are single solid tumors. This study aimed to establish an accurate and stable intramuscular dual tumor model guided by computed tomography (CT).MethodsIn this study, we compared three different inoculation methods to select the most appropriate dual tumor model. Six New Zealand White rabbits were used as tumor-carrying rabbits for tumor harvesting. Thirty rabbits were divided into three groups as experimental rabbits. Group A applied the tumor cell suspension method, in which the suspension was injected into the designated location with a syringe under CT guidance. Groups B and C used tumor tissue strips obtained in vivo or under direct in vitro vision. The tumor tissue strips were implanted into the designated locations using a guide needle under CT guidance. The differences in tumorigenic rate, the size difference between bilateral tumors, and metastasis between the three methods were compared.ResultsIt was found that group A obtained a 100% tumor survival rate, but the size of the tumor was more variable, and needle tract implantation metastasis occurred in 5 cases. In group B, tumor tissue strips were taken in vivo for implantation, in which one case failed to survive. Tumor tissue strips in group C were obtained in vitro under direct vision. The tumor tissue strips obtained in vitro by puncture using a biopsy needle in group C had a 100% tumorigenicity rate and stable tumor size. No significant needle tract implantation metastases were found in either group B or C. The variance of tumor size obtained in group A was significantly higher than in groups B and C. The variance of tumor size in group C was the smallest. Group C had high tumorigenicity and a more stable size and morphology of the formed tumors.ConclusionThe results showed that the method of obtaining tumor tissue strips using in vitro direct vision puncture and implanting them into the muscle with CT guidance and guide needles can establish an accurate and stable dual tumor model. This dual tumor model can provide substantial support for relevant preclinical studies.

A 61-year-old woman with jejunal lymphatic malformation visualized on computed tomography: a case report

BackgroundJejunal lymphatic malformations are congenital lesions that are seldom diagnosed in adults and rarely seen on imaging.Case presentationA 61-year-old Caucasian woman was initially diagnosed and treated for mucinous ovarian carcinoma. After an exploratory laparotomy with left salpingo-oophorectomy, a computed tomography scan of the abdomen and pelvis demonstrated suspicious fluid-containing lesions involving a segment of jejunum and adjacent mesentery. Resection of the lesion during subsequent debulking surgery revealed that the lesion seen on imaging was a jejunal lymphatic malformation and not a cancerous implant.ConclusionsAbdominal lymphatic malformations are difficult to diagnose solely on imaging but should remain on the differential in adult cancer patients with persistent cystic abdominal lesions despite chemotherapy and must be differentiated from metastatic implants.

Metástasis de carcinoma de células transicionales de vejiga a estoma del conducto ileal. Reporte de caso y revisión de la literatura

Clinical case presentation: An 80-year-old man was admitted to our emergency department due to fever and progressively growing mass in the urinary diversion stoma four months after a radical cystectomy for muscle invasive bladder cancer.&#x0D; Surgical resection was done, and histo-pathological examination revealed metastases of high-grade urothelial carcinoma. After almost three years of follow-up any sign of recurrence did not seen. &#x0D; Relevance: Urothelial cancer at all stages can metastasize to other organs.&#x0D; Metastasis occurs hematogenously to all organs, most frequently the lungs, liver, bone, or lymphatically to regional lymph nodes in the pelvis, or further to retroperitoneal lymph nodes. Metastasis of bladder cancer in the ileal conduit stoma is unusual. Cancer recurrence after radical cystectomy has-been reported in ureteroileal anastomosis.&#x0D; Clinical implications: Surgical treatment is an option in these patients. Adjuvant radiotherapy and / or chemotherapy would be possible alternatives in more than one site of metastasis. There are no clinical guidelines establishing their correct management.&#x0D; Conclusion: The urinary diversion stoma metastases secondary to a urothelial carcinoma is a rare entity. Direct implantation during the surgical act, hematogenous, lymphatic or mixed dissemination, could justify metastatic implantation.&#x0D;