Metastatic Liver Lesions Research Articles

S1676 Things Are Not Always What They Seem: A Rare Case of Pancreatic Carcinoma Manifesting Through Cutaneous Metastasis

Introduction: Pancreatic cancer is an aggressive disease that commonly metastasizes to the liver, lung, and peritoneum. Cutaneous metastasis is a rare occurrence with an incidence of only 2.0%. We present a case of metastatic pancreatic adenocarcinoma primarily presenting as a cutaneous nodule. Case Description/Methods: A 50-year-old male was undergoing outpatient evaluation for a raised, left scalp lesion along with neck nodules. Associated symptoms included an unintentional 30lb weight loss. Outpatient CT soft tissue neck revealed numerous necrotic lateral neck lymph nodes, lytic lesion with epidural soft tissue extension at C2-4, and occlusion/thrombosis of the left subclavian, brachiocephalic, and left internal jugular veins (Figure). Given these findings, the patient was referred to the Emergency Department (ED). At time of ED arrival, vital signs were stable along with initial laboratory values. CTA PE study showed no pulmonary embolism but revealed numerous pulmonary and bilateral adrenal nodules, multifocal liver and osseous lesions, and widespread lymphadenopathy. Additionally, CT head demonstrated a left scalp soft tissue lesion. Follow up CT abdomen/pelvis revealed a 2.8 x 2.2 x 1.8 cm ill-defined pancreatic lesion and confirmed widespread metastasis including to the muscles. Additional testing revealed elevated cancer markers with Cancer antigen 19-9 (CA 19-9) of 5418 U/mL and carcinoembryonic antigen (CEA) of 63.8 ng/mL. Pathology from initial scalp lesion biopsy showed fragments of necrotic dermis with small foci of poorly differentiated carcinoma. Biopsies of the right and left neck masses revealed poorly differentiated adenocarcinoma of uncertain primary. Therefore, liver biopsy was performed and confirmed non-small cell carcinoma of pancreatobiliary origin. Further imaging to determine treatment course discovered intracranial metastasis and cervical spine disease resulting in cord compression. Ultimately, the patient underwent 4 out of 10 fractions of palliative radiation to the cervical spine but passed away after transitioning to comfort care one month after diagnosis. Discussion: There are less than 25 documented cases of pancreatic cancer with cutaneous involvement; however, it is even more rare that cutaneous involvement prompts initial diagnosis. The umbilicus is the most common site of cutaneous involvement and is referred to as the Sister Mary Joseph Nodule. Involvement of the soft tissue of the scalp and neck is much less common and poorly documented making this case extremely unique.Figure 1.: Axial contrast enhanced CT of the abdomen shows a 2.8 cm ill-defined hypoattenuating mass in the pancreatic tail (A) with multifocal metastatic liver lesions and bilateral adrenal metastasis (B). Axial CT image of the pelvis shows a metastatic lesion in the right rectus femoris muscle (C). On liver biopsy, H&E, 40X,(S21-41666) revealed high grade carcinoma with vesiculated nuclei, prominent nucleoli (D), CA 19-9 IHC 20X diffuse positivity in tumor cells (E) and CK AE1/3 IHC, 20X, diffusely positivee for pancytokeratin in tumor cells confirming carcinoma (F). Axial CT of the head shows a 2.4 cm nodular left parietal scalp soft tissue lesion (G) which was also seen on clinical examination (H). Biopsy of the scalp lesion (H&E, 40X) demonstrated high grade carcinoma with vesiculated nuclei, prominent nucleoli and mitoses (I), histologically similar to liver biopsy findings.

Patient-Derived Organoids from Colorectal Cancer with Paired Liver Metastasis Reveal Tumor Heterogeneity and Predict Response to Chemotherapy.

There is no effective method to predict chemotherapy response and postoperative prognosis of colorectal cancer liver metastasis (CRLM) patients. Patient-derived organoid (PDO) has become an important preclinical model. Herein, a living biobank with 50 CRLM organoids derived from primary tumors and paired liver metastatic lesions is successfully constructed. CRLM PDOs from the multiomics levels (histopathology, genome, transcriptome and single-cell sequencing) are comprehensively analyzed and confirmed that this organoid platform for CRLM could capture intra- and interpatient heterogeneity. The chemosensitivity data in vitro reveal the potential value of clinical application for PDOs to predict chemotherapy response (FOLFOX or FOLFIRI) and clinical prognosis of CRLM patients. Taken together, CRLM PDOs can be utilized to deliver a potential application for personalized medicine.

Pathological complete response with immunotherapy and brachytherapy to 15 metastatic liver lesions in a single patient.

Materials & methods:High dose rate interstitial brachytherapy (HDR-IBT) treatment plan for 15 metastatic liver lesions in a patient with pancreatic cancer was retrieved and analyzed for liver dose parameters and diaphragm dose. Serial 18F-FDG PET-CT scans were reviewed for disease response assessment and left liver lobe volume. Serial laboratory records were analyzed for liver parameters.Results:Left liver lobe volume increased from 241 cm3 pre-HDR-IBT to estimated 600 cm3 after seven sessions of HDR-IBT. Metabolic complete response (CR) and subsequently pathological CR was confirmed in the right hepatotectomy specimen for all the 15 PET-CT avid lesions treated with HDR-IBT. Maximum diaphragm dose in a single fraction was 82 Gy. The liver parameters were stable and patient did not develop radiation induced liver disease.Discussion:This is the largest reported series of HDR-IBT to liver lesions in a single patient. This first ever reported combined treatment of immunotherapy (IT) and HDR-IBT had likely rendered this patient disease free both at local the liver and systemically. Metabolic CR by PET-CT can be seen as early as 46 days after HDR-IBT. Diaphragm can tolerate very high doses of radiation and repeated treatment.Conclusion:In this patient HDR-IBT for multiple liver lesions with IT is well tolerated. PET-CT can be used for response assessment of HDR-IBT liver. Synergistic effect of IT with HDR-IBT and it’s role as bridging for liver resection has clinical potential and should be further studied in prospective trials.

Is liver resection justified for ovarian sarcoma liver metastases?

Ovarian sarcoma represents an aggressive subtype of ovarian malignancies which is characterized by poor outcomes. However, it seems that applying the principles of radical surgery might increase the long-term outcomes especially if no residual disease is achievable. Even though, most cases will experience a recurrent disease. As expected a significant number of cases will present disseminated lesions and will be therefore submitted to palliative treatment. The aim of the current paper is to present two such cases, the first one being diagnosed with a metachronous metastatic liver lesion while the second one being diagnosed with synchronous liver metastases.

Protocol of Kupffer phase whole liver scan for metastases: A single-center prospective study.

IntroductionAs the presence of hepatic metastases is very important to cancer patients' clinical stage which would directly affect the selection and application of anti-cancer treatments. Although conventional ultrasound is commonly performed as a screening tool, most of the examinations have relatively poor sensitivity and specificity for detecting liver metastases. Contrast-enhanced ultrasound (CEUS) with Sonazoid has been reported to have the advantage of the diagnosis and therapeutic support of focal hepatic lesions and its specific Kupffer phase whole liver scan (KPWLS) is believed to be sensitive to detect liver metastases. And the purpose of this study is to determine the number, size, location and diagnosis of metastatic lesions, and to compare the results with conventional ultrasound and contrast-enhanced computed tomography (CECT), thus to clarify the application value, indications of Sonazoid-CEUS in screening liver metastasis.Methods and analysisKupffer phase whole liver scan for metastases (KPWLSM) is a self-control, blind map-reading, single-center, prospective superiority trial. Approved by the institutional review committee, the study period is planned to be from 1 January 2022 to 31 December 2025. Our study will include 330 patients with history of malignant tumors that cling to metastasize to liver. All patients will undergo the examinations of conventional ultrasound, Sonazoid-CEUS, and contrast-enhanced magnetic resonance imaging (CEMRI), and 65 of them should have additional CECT scans. The primary endpoint is the comparative analysis of the numbers of detected liver metastatic lesions among Sonazoid-CEUS, conventional ultrasound and CECT in screening liver metastases. Subjective conditions of patient after injection of Sonazoid will be followed up 3 and 30 days after KPWLSM, and any short-term and long-term adverse events are to be recorded with telephone interviews.Ethics and disseminationThis study has been granted by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Approval No: 2021-197). When the KPWLSM is completed, we will publish it in an appropriate journal to promote further widespread use.RegistrationTrial Registration Number and Date of Registration: Chinese Clinical Trial Registry, ChiCTR2100054385, December 16, 2021.

Interventional oncology: new techniques and new devices.

Interventional oncology is a rapidly emerging field in the treatment of cancer. Minimally invasive techniques such as transarterial embolization with chemotherapeutic and radioactive agents are established therapies and are found in multiple guidelines for the management of primary and metastatic liver lesions. Percutaneous ablation is also an alternative to surgery for small liver, renal, and pancreatic tumors. Recent research in the niche of interventional oncology has focused on improving outcomes of established techniques in addition to the development of novel therapies. In this review, we address the recent and current advancements in devices, technologies, and techniques of chemoembolization and ablation: thermal ablation, histotripsy, high-intensity focused ultrasound, embolization strategies, liquid embolic agents, and local immunotherapy/antiviral therapies.

Primary squamous cell carcinoma of the colon: A rare case report.

Introduction and importanceSquamous cell carcinoma (SCC) of the colon is an extremely rare pathologic entity, accounting for less than 1 % of all colorectal cancer cases. They tend to be very aggressive with poor outcomes and treatment strategies are still controversial due to the paucity of data available to guide management.Case presentationA case of a cecal mass with metastatic liver lesions. Initially diagnosed as an adenocarcinoma, the patient underwent resection with metastasectomy. Despite achieving negative surgical margins and undergoing adjuvant chemotherapy, the patient relapsed and presented with a new mass in the descending colon. The patient underwent resection with subsequent follow-up revealing distant metastasis. The patient passed away soon after.Clinical discussionPrimary colorectal SCC has similar presentation to adenocarcinoma of the colon. Unfortunately, it usually presents at a late stage. Diagnosis of colorectal SCC requires histologic confirmation of SCC plus exclusion of possible causes. Management is predominantly definitive radical resection followed by adjuvant chemotherapy and radiotherapy. Surgical margins should be at least 5 cm, preferably 10 cm. Lymph node yield greater than 20 was associated with improved survival. Studies assessing the prognosis of primary colorectal SCC following chemo-radiotherapy have not been done.ConclusionSurgery remains the most vital important step in the management of colonic SCC. The role of chemotherapy and/or radiation remains questionable. Depending on the aggressiveness of this disease the need for further frequent.

Intrahepatic CD69+Vδ1 T cells re-circulate in the blood of patients with metastatic colorectal cancer and limit tumor progression

BackgroundMore than 50% of all patients with colorectal cancer (CRC) develop liver metastases (CLM), a clinical condition characterized by poor prognosis and lack of reliable prognostic markers. Vδ1 cells are...

The quorum sensing peptide EntF* promotes colorectal cancer metastasis in mice: a new factor in the host-microbiome interaction

BackgroundColorectal cancer, one of the most common malignancies worldwide, is associated with a high mortality rate, mainly caused by metastasis. Comparative metagenome-wide association analyses of healthy individuals and cancer patients suggest a role for the human intestinal microbiota in tumor progression. However, the microbial molecules involved in host-microbe communication are largely unknown, with current studies mainly focusing on short-chain fatty acids and amino acid metabolites as potential mediators. Quorum sensing peptides are not yet considered in this context since their presence in vivo and their ability to affect host cells have not been reported so far.ResultsHere, we show that EntF*, a metabolite of the quorum sensing peptide EntF produced by Enterococcus faecium, is naturally present in mice bloodstream. Moreover, by using an orthotopic mouse model, we show that EntF* promotes colorectal cancer metastasis in vivo, with metastatic lesions in liver and lung tissues. In vitro tests suggest that EntF* regulates E-cadherin expression and consequently the epithelial-mesenchymal transition, via the CXCR4 receptor. In addition, alanine-scanning analysis indicates that the first, second, sixth, and tenth amino acid of EntF* are critical for epithelial-mesenchymal transition and tumor metastasis.ConclusionOur work identifies a new class of molecules, quorum sensing peptides, as potential regulators of host-microbe interactions. We prove, for the first time, the presence of a selected quorum sensing peptide metabolite in a mouse model, and we demonstrate its effects on colorectal cancer metastasis. We believe that our work represents a starting point for future investigations on the role of microbiome in colorectal cancer metastasis and for the development of novel bio-therapeutics in other disease areas.

Multifactorial Analysis of Clinical Prognosis of Liver Metastasis and Vascular Intervention Combined with Ablation in Colorectal Cancer.

Colorectal cancer is one of the leading causes of deaths in China. The initial stages of colorectal cancer can be treated by surgery, radiation, and chemotherapy. However, in the advanced stages, it warrants an application of multimodality treatment. With advances in the medical field, there are applications of new modality of treatment that could possibly provide the appropriate treatment for the advanced stage tumours. The first site of metastasis after colorectal cancer is the liver and the conventional treatment to cure the metastatic lesion involves the administration of chemotherapy. With further advancement, chemotherapy has been directly administered at the thorough transarterial chemoembolization (TACE) which is a vascular intervention. With further advancement, the nonvascular intervention, such as radiofrequency ablations (RFAs), has been administered to the patients. A large amount of data support the use of vascular intervention (TACE) with ablation for hepatic carcinoma; there is no sufficient literature to support the application of the modality in the metastatic liver lesion. In this prospective observational study, we have enrolled 80 patients with metastatic liver lesion from the adenocarcinoma of colon or rectum, treated the patients with a combination of the TACE and ablation therapy, and followed up the patients for a period of 3 years. A multivariate analysis of the various factors that influence the prognosis and outcome has been studied and it has been concluded that the combination therapy is medically beneficial for individuals with aggressive liver lesions, improving overall as well as progression-free life span.

Despite the increase of serum CA 19-9, complete metabolic response and tumoral calcifications in PET/CT: Could it be a tumor stunning after chemotherapy?

A 74-year-old male patient with a history of nausea, vomiting, and loss of appetite revealed thickening of the antrum and pylorus in gastroscopy and non-mucinous adenocarcinoma was diagnosed in the biopsy. The patient underwent 18F-FDG PET/CT for staging. PET/CT showed intense FDG uptakes in the primary lesion, locoregional lymph nodes and liver metastases. After 5-fluorouracil based chemotherapy, a complete metabolic response in metastatic liver lesions, lymph nodes, and the primary tumor was detected. Furthermore, tumor calcifications were observed in the liver and locoregional lymph node metastases. Although a complete response, there was a 40 percent serum CA 19-9 level increase. During the follow-up, intense FDG uptake was observed in the calcified metastatic liver lesions and some lymph nodes, similar to the continuous increase in serum CA 19-9 levels. Ascites, multiple metastatic lung nodules and metabolic progression in liver lesions were observed on PET/CT in the patient who continued to receive chemotherapy.

A phase Ib study of the combination of alisertib (Aurora A kinase inhibitor) and MLN0128 (dual TORC1/2 Inhibitor) in patients with advanced solid tumors, final expansion cohort data.

3112 Background: In prior work, senescence and up-regulation of genes in the PI3K/AKT/mTor pathway were observed in patient-derived xenograft models treated with alisertib to resistance, and tumor growth inhibition was observed when MLN0128 (sapanisertib) was added to alisertib. In a previously reported dose escalation cohort of patients with advanced solid tumors treated with the combination of alisertib and MLN0128, the maximum tolerated dose (MTD) was alisertib 30mg BID days 1-7 of a 21-day cycle and MLN0128 2mg daily on a continuous schedule. Presented here are final results from the dose expansion portion of this clinical trial. Methods: Three cohorts of patients were treated with the combination at the MTD. Patients with advanced solid tumors, refractory to standard therapy, were assigned to either single-agent treatment with alisertib (Group 1) or MLN0128 (Group 2) on days 1-7 of Cycle 1. For the remainder of the study, patients received combination treatment. Group 3 enrolled patients with refractory pancreatic adenocarcinoma who were treated with standard dosing of the combination. Biopsies were performed in Groups 1 and 2 prior to treatment initiation and after both the single-agent lead-in and 7 days of combination treatment, with assessment of pharmacodynamic markers. Functional imaging was performed pre-treatment and after Cycle 1. Results: A total of 31 patients with refractory cancers were treated. Group 1 included patients with breast (5), colorectal (2), ovarian (2), and pancreatic (1) cancers. Group 2 included patients with breast (4), colorectal (2), pancreatic (2), uterine (1), and kidney (1) cancers. Eleven patients with refractory pancreatic cancer were treated in Group 3. Median time on study was 11.6 weeks in Group 1, 6 weeks in Group 2, and 9 weeks in Group 3. One partial response was documented in Group 1. One patient with pancreatic cancer in Group 1 continued on study for 47 weeks, and another pancreatic cancer patient in Group 3 continued on study for 28 weeks. Toxicity was similar across cohorts, with mucositis, fatigue, hyperglycemia and neutropenia reported as most common. Biopsy results were significant for increased apoptosis and tumor-infiltrating immune cells noted in tissues from 4 patients treated with the MLN0128 lead-in. Decreased F18-FDG uptake on PET/CT, often with increased ADC values in diffusion MRI, was observed in metastatic liver lesions in 4 patients after Cycle 1. Conclusions: In an expansion cohort of 31 patients treated with the combination of MLN0128 and alisertib at the previously defined MTD, treatment was tolerable with an expected toxicity profile. Prolonged stable disease was observed in 2 patients with pancreatic cancer. Increased apoptosis and tumor-infiltrating immune cells were noted in tissues from patients treated with a lead-in of MLN0128. Clinical trial information: NCT02719691.

Lesion-specific radiomics analysis shows promising results for early-stage efficacy assessment of IOA-244 in uveal melanoma.

3068 Background: Radiomics is an image based approach that allows for characterization and quantification of tumor lesions in cancer patients. Radiomics has been proven capable of potentially adding value in the diagnostic and prognostic patient managment. In this study we evaluated the potential of Radiomics to bring additional insight also in early drug development. Methods: All the visible malignant lung and liver metastasis lesions of 7 uveal melanoma patients (86% of women, 60±11y) treated with IOA-244 (EudraCT 2019-000686-20) were manually segmented and analyzed in their size and shape via a radiomics approach. The CT scans at baseline and first follow-up (8 weeks) were included in the study and compared. Descriptive statistics and linear mixed effect (LME) models were used to quantify volumetric lesion-specific response to treatment. Response has been defined both as continuous variable and in three discrete categories (lesion shrinkage, stable and progressive disease for a volume change of [-100%;-0%];[0%-+25%] and > 25%, respectively). The influence of lesion shape at baseline (e.g. compactness, elongation or surface roughness among others) on the treatment response has been explore through LME models as well. Results: We identified and segmented 126 metastatic lesions (70 lung and 56 liver) from baseline scans and 122 lesions (71 lung and 51 liver) from post treatment scans. Of those, 64% could be consistently mapped between visits, resulting in a total of 147 matching lesions on which the radiomics analysis was performed. We found 19% of complete response and 16% of new lesions appearing. 8 weeks after treatment start, we observed non progressive disease in 61% of all lesions, of which 42% was shrinking. LME did not show a significant change in lesion volume between visits, but the mean difference between visits was negative. LME did show that lesion shape is significantly different between progressors and non-progressors at baseline for lung lesions (compact and irregular lesions are more likely to respond), and that there are moderate correlations (0.4-0.7) between tumor shape and volume change for liver lesions (compact lesions have a larger volume drop). Conclusions: This work demonstrates both the clinical potential of IOA-244 for treatment of Uveal Melanoma patients with lesions in the lung and in the liver and the potential of radiomics individual lesion analysis for clinical research in the very early stages of drug development. Lesion evolution volumetric assessment has allowed a more accurate and sensitive understanding of IOA-244 efficacy and impact across different lesions, in both lung and liver. Radiomics showed a promising response of selected population to IOA-244 over the first time point (W0-W8). A further radiomics analysis on next follow-up scans would allow a radiological proof of treatment-induced changes and long-term patient outcome prediction.

Prognostic role of myeloid-derived tumor-associated macrophages at the tumor invasive margin in gastric cancer with liver metastasis (GCLM): a single-center retrospective study.

Liver metastasis is one of the important factors leading to poor prognosis of gastric cancer. According to the classic "seed soil theory", it is speculated that the liver microenvironment at the invasion margin of gastric cancer liver metastases (GCLM) may have a crucial impact on tumor progression. However, few studies had stated the correlation between the patients' prognosis and the densities of stromal cells infiltrating into the invasive margin, where our retrospective study designed to identify the role of infiltrating macrophages on the prognosis of GCLM as a reliable supplement of predictive tumor markers. The material consisted of a group of 72 gastric cancer (GC) patients with liver metastasis diagnosed from February 2015 and December 2020. The CD68+, CD206+, and Clec4f+ macrophages in their specimens were counted by immunohistochemistry (IHC), and the analysis area was the invasive margin of metastatic lesions. Clinical data were collected retrospectively. Overall survival (OS) was calculated from the date of initial diagnosis to the date of last follow-up or death. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate Cox regression was performed to asses impact of macrophages on OS. The expression of CD206 could indicate the prognosis of patients with GCLM, and patients with high expression of CD206 had worse prognoses (P=0.0002). Univariate and multivariate analyses showed that CD206 was an independent risk factor for prognosis (HR 5.276, 95% CI: 1.730-16.089, P=0.003). The CD206+ myeloid-derived tumor associated macrophages (TAMs) may predict whether patients could benefit from R1 resection of liver-metastatic lesions, which has important theoretical significance and practical value for accurately evaluating the clinical prognosis of patients with GCLM and guiding clinical treatment.

Half-dose versus full-dose 18 F-FDG total-body PET/CT in patients with colorectal cancer.

The purpose of this study was to investigate image quality and lesion detectability of half-dose (1.85 MBq/kg) 18 F-fluorodeoxyglucose (FDG) total-body positron emission tomography/computed tomography (PET/CT) for colorectal cancer, full-dose (3.7 MBq/kg) 18 F-FDG serving as a reference. Fifty patients confirmed to have colorectal cancer who underwent total-body PET/CT with half-dose 18 F-FDG were included. Another 50 colorectal cancer patients with 3.70 MBq/kg 18 F-FDG activity were selected for the full-dose group. PET images in the half-dose group were scanned for 15 min and split into 1-, 2-, 3-, 4- and 10-min duration groups, denoted G1, G2, G3, G4 and G10, respectively. In the full-dose group, PET scanning was performed for 5 min, reconstructed with the first 0.5, 1, 2 and 5 min intervals, defined as G0.5', G1', G2' and G5', respectively. Subjective image quality was assessed with 5-point Likert scales. Objective image quality parameters included maximum standardized uptake values (SUV max) , mean standardized uptake values (SUV mean )and signal-to-noise ratio (SNR) of the liver, blood pool and muscle and SUV max and tumor-to-background ratio (TBR) of lesions. In the two groups, the G3 and G2' images met clinical diagnosis requirements in terms of subjective image quality, with scores ≥3. There were no differences in terms of subjective and objective image quality between the groups (G1 and G0.5', G2 and G1', G4 and G2' and G10 and G5'). In the half-dose group, 56 colorectal lesions in 50 patients confirmed by surgical pathology were clearly visible in all groups. The number of FDG-avid lymph nodes was 37 in G1, 38 in G2 and 39 in the remaining half-dose groups. The number of missed metastatic liver lesions was 1 both in G1 and G2. Total-body PET/CT with half-dose was feasible for diagnosing and staging colorectal cancer compared with full-dose 18 F-FDG PET/CT. Moreover, for half-dose total-body PET/CT, a 3-min scan duration could maintain image quality and lesion detectability.

Successful conversion surgery for stage IV gastric cancer with liver metastases after second-line chemotherapy with ramucirumab and paclitaxel: a case report

BackgroundIn recent years, conversion surgery after chemotherapy has been considered a promising strategy for improving the prognosis of patients with stage IV gastric cancer. However, there are few reports on conversion gastrectomy after second-line chemotherapy. Here, we report a case of long-term survival of a patient with liver metastases from gastric cancer who underwent conversion surgery after second-line chemotherapy with ramucirumab and paclitaxel.Case presentationA 77-year-old man complaining of weight loss was diagnosed with human epidermal growth factor receptor 2-positive gastric cancer with multiple liver metastases. Although the patient initially received trastuzumab-based chemotherapy, it was discontinued, because he experienced trastuzumab-induced infusion reactions. Thereafter, he was treated with six courses of S-1 plus cisplatin and six courses of ramucirumab plus paclitaxel as the first- and second-line regimens, respectively. The primary tumor and liver metastases remarkably shrank, and the reduction rate of the measurable metastatic liver lesions was 81.1%. According to the Response Evaluation Criteria in Solid Tumors, the patient responded partially. Therefore, he underwent total gastrectomy with D2 lymphadenectomy and partial hepatectomy of segments 3 and 4. Pathological examination revealed tumor invasion into the muscularis propria, a grade 1a histological response, and no lymph node metastases. No viable cancer cells were identified in the specimens resected from liver segments 3 and 4. Accordingly, the patient was pathologically diagnosed with stage IB (ypT2N0M0). Postoperatively, the patient received adjuvant chemotherapy with S-1 for 6 months, and he survived without recurrence for 42 months after conversion surgery.ConclusionsConversion surgery might be clinically useful for improving survival in certain patients with gastric cancer, including those who previously received second-line chemotherapy.

The prognosis of different distant metastases pattern in malignant tumors of the adrenal glands: A population-based retrospective study

The present existing data on the association of metastatic sites and prognosis of patients with metastatic adrenal malignancy are limited. This study aims to investigate the impact of different distant metastases pattern on the survival of patients with adrenal malignancy. A dataset from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 Registries (2000-2017) was selected for a retrospective metastatic adrenal malignancy cohort study. There was information on distribution of metastatic lesions in bone, brain, liver, and lung in the SEER database. Kaplan-Meier analysis and nomogram analyses were applied to compare the survival distribution of cases. Univariate and multivariate cox regression models were used to analyze survival outcomes. From the SEER database, a total of 980 patients with primary metastatic adrenal malignancy from 2010 to 2017 were enrolled in this cohort study. Based on the initial metastatic sites, 42.3%, 38.4%, 30.5%, and 4.9% of patients were found bone, liver, lung, and brain metastasis, respectively. Patients who had a single site of distant metastases accounted for 52.6% (515/980) and had a better overall survival (OS) and cancer-specific survival (CSS) (both P < 0.001). In contrast with the tumor arising from the cortex, the tumor from the medulla showed better survival outcomes in both OS and CSS (P < 0.001). Different histological types possess various metastatic features and prognostic values. Understanding these differences may contribute to designing targeted pre-treatment assessment of primary metastatic adrenal malignancy and creating a personalized curative intervention.

Preliminary Clinical Application of RGD-Containing Peptides as PET Radiotracers for Imaging Tumors.

Angiogenesis is a common feature of many physiological processes and pathological conditions. RGD-containing peptides can strongly bind to integrin αvβ3 expressed on endothelial cells in neovessels and several tumor cells with high specificity, making them promising molecular agents for imaging angiogenesis. Although studies of RGD-containing peptides combined with radionuclides, namely, 18F, 64Cu, and 68Ga for positron emission tomography (PET) imaging have shown high spatial resolution and accurate quantification of tracer uptake, only a few of these radiotracers have been successfully translated into clinical use. This review summarizes the RGD-based tracers in terms of accumulation in tumors and adjacent tissues, and comparison with traditional 18F-fluorodeoxyglucose (FDG) imaging. The value of RGD-based tracers for diagnosis, differential diagnosis, tumor subvolume delineation, and therapeutic response prediction is mainly discussed. Very low RGD accumulation, in contrast to high FDG metabolism, was found in normal brain tissue, indicating that RGD-based imaging provides an excellent tumor-to-background ratio for improved brain tumor imaging. However, the intensity of the RGD-based tracers is much higher than FDG in normal liver tissue, which could lead to underestimation of primary or metastatic lesions in liver. In multiple studies, RGD-based imaging successfully realized the diagnosis and differential diagnosis of solid tumors and also the prediction of chemoradiotherapy response, providing complementary rather than similar information relative to FDG imaging. Of most interest, baseline RGD uptake values can not only be used to predict the tumor efficacy of antiangiogenic therapy, but also to monitor the occurrence of adverse events in normal organs. This unique dual predictive value in antiangiogenic therapy may be better than that of FDG-based imaging.

Incidental liver lesions on baseline breast MRI: Outcomes on subsequent abdominal imaging

PurposeTo examine outcomes of incidental liver lesions on baseline breast magnetic resonance imaging (MRI) that were further evaluated with dedicated abdominal imaging. MethodsConsecutive breast MRI reports from 2011 to 2016 were retrospectively reviewed to identify incidental liver lesions. Only patients without prior breast MRI, without prior abdominal imaging, and with subsequent abdominal imaging were included. Patient demographics, breast MRI indication, and final liver lesion diagnosis were recorded. ResultsOf 131 women (mean age 53.8 years), 94/131 (71.8%) underwent breast MRI for extent of disease evaluation, 25/131 (19.1%) for high-risk screening, 11/131 (8.4%) for implant evaluation, and 1/131 (0.8%) for problem-solving. Of 131 liver lesions (6–80 mm), 117/131 (89.3%) were deemed benign on subsequent abdominal imaging; 10/131 (7.6%) probably benign; and 4/131 lesions (3.1%) were confirmed breast cancer metastases. Metastatic liver lesions identified on breast MRI were more likely for women with a current diagnosis of breast cancer than for women without a current diagnosis of breast cancer: 4.3% vs 0%. Similarly, metastatic liver lesions identified on breast MRI were more likely for those with a higher prognostic stage (2 or 3) vs a lower prognostic stage (0 or 1) or no current breast cancer: 11.1% vs 0%. ConclusionBaseline breast MRIs showing incidental liver lesions showed unsuspected liver metastases only in women with a current diagnosis of clinical stage 2 or 3 breast cancer. This suggests breast MRI indication and clinical staging of current breast cancer, if present, can help plan management and decisions to obtain follow-up of liver lesions.

Resection of Gastric Cancer Liver Metastases: Literature Review and Case Report

Introduction: The treatment of gastric cancer has undergone changes in recent years, significantly impacting the morbidity and mortality caused by the disease. However, the treatment of metastatic disease remains a challenge. Whether in the intestinal or Lauren's diffuse tumor, the presence of liver metastases in gastric cancer is considered to be an unfavorable prognosis, given the possibility of the existence of other occult metastases at the time of this diagnosis. Given the changes in the panorama of this disease, it is necessary to review the proposed treatment, considering the possibility of oncological benefit from liver metastasectomy and which patients would benefit from this therapy. Clinical case: FAM, female, 65 years old, diagnosed with Lauren's intestinal-type gastric adenocarcinoma submitted to subtotal gastrectomy with D2 lymphadenectomy. Clinical staging IIIB (T4N2M0), referred for adjuvant chemotherapy protocol. At the time no synchronous distant metastases was identified. One year later PET-CT showed a liver nodule at the right lobe and peri-portal nodule. Submitted to right hepatectomy + peri-portal lymphadenectomy. Anatomopathological exame confirmed gastric adenocarcinoma. Conclusion: Review of published studies in the literature showed that patients who would benefit from this therapy would be those with 1-3 metastatic liver lesions, up to 5 cm in length in the largest one, without serosa invasion in the primary lesion and whose lymph node involvement was ≤ N1 . Overall patient survival was increased from 9.5-14.1 months to 31.1-40.8 months in these groups. We therefore conclude that there is benefit in resection of liver metastases in selected cases of gastric cancer.