Mucinous Adenocarcinoma Research Articles

Rare histological prostate cancer subtypes: Cancer-specific and other-cause mortality.

To assess cancer-specific mortality (CSM) and other-cause mortality (OCM) rates in patients with rare histological prostate cancer subtypes. Using the Surveillance, Epidemiology, and End Results database (2004-2020), we applied smoothed cumulative incidence plots and competing risks regression (CRR) models. Of 827,549 patients, 1510 (0.18%) harbored ductal, 952 (0.12%) neuroendocrine, 462 (0.06%) mucinous, and 95 (0.01%) signet ring cell carcinoma. In the localized stage, five-year CSM vs. OCM rates ranged from 2 vs. 10% in acinar and 3 vs. 8% in mucinous, to 55 vs. 19% in neuroendocrine carcinoma patients. In the locally advanced stage, five-year CSM vs. OCM rates ranged from 5 vs. 6% in acinar, to 14 vs. 16% in ductal, and to 71 vs. 15% in neuroendocrine carcinoma patients. In the metastatic stage, five-year CSM vs. OCM rates ranged from 49 vs. 15% in signet ring cell and 56 vs. 16% in mucinous, to 63 vs. 9% in ductal and 85 vs. 12% in neuroendocrine carcinoma. In multivariable CRR, localized neuroendocrine (HR 3.09), locally advanced neuroendocrine (HR 9.66), locally advanced ductal (HR 2.26), and finally metastatic neuroendocrine carcinoma patients (HR 3.57; all p < 0.001) exhibited higher CSM rates relative to acinar adenocarcinoma patients. Compared to acinar adenocarcinoma, patients with neuroendocrine carcinoma of all stages and locally advanced ductal carcinoma exhibit higher CSM rates. Conversely, CSM rates of mucinous and signet ring cell adenocarcinoma do not differ from those of acinar adenocarcinoma.

18F-FDG PET/CT Radiomics-Based Multimodality Fusion Model for Preoperative Individualized Noninvasive Prediction of Peritoneal Metastasis in Advanced Gastric Cancer.

This study was designed to develop and validate a machine learning-based, multimodality fusion (MMF) model using 18F-fluorodeoxyglucose (FDG) PET/CT radiomics and kernelled support tensor machine (KSTM), integrated with clinical factors and nuclear medicine experts' diagnoses to individually predict peritoneal metastasis (PM) in advanced gastric cancer (AGC). A total of 167 patients receiving preoperative PET/CT and subsequent surgery were included between November 2006 and September 2020 and were divided into a training and testing cohort. The PM status was confirmed via laparoscopic exploration and postoperative pathology. The PET/CT signatures were constructed by classic radiomic, handcrafted-feature-based model and KSTM self-learning-based model. The clinical nomogram was constructed by independent risk factors for PM. Lastly, the PET/CT signatures, clinical nomogram, and experts' diagnoses were fused using evidential reasoning to establish the MMF model. The MMF model showed excellent performance in both cohorts (area under the curve [AUC] 94.16% and 90.84% in training and testing), and demonstrated better prediction accuracy than clinical nomogram or experts' diagnoses (net reclassification improvement p < 0.05). The MMF model also had satisfactory generalization ability, even in mucinous adenocarcinoma and signet ring cell carcinoma which have poor uptake of 18F-FDG (AUC 97.98% and 89.71% in training and testing). The 18F-FDG PET/CT radiomics-based MMF model may have significant clinical implications in predicting PM in AGC, revealing that it is necessary to combine the information from different modalities for comprehensive prediction of PM.

Rare Case of Mucinous Adenocarcinoma of Stomach with Calcified Metastasis in Liver

Rare Case of Mucinous Adenocarcinoma of Stomach with Calcified Metastasis in Liver

Analysis of clinical characteristics of mismatch repair status in colorectal cancer: a multicenter retrospective study

BackgroundMicrosatellite instability (MSI) caused by DNA mismatch repair (MMR) deficiency is of great significance in the occurrence, diagnosis and treatment of colorectal cancer (CRC).AimThis study aimed to analyze the relationship between mismatch repair status and clinical characteristics of CRC.MethodsThe histopathological results and clinical characteristics of 2029 patients who suffered from CRC and underwent surgery at two centers from 2018 to 2020 were determined. After screening the importance of clinical characteristics through machine learning algorithms, the patients were divided into deficient mismatch repair (dMMR) and proficient mismatch repair (pMMR) groups based on the immunohistochemistry results and the clinical feature data between the two groups were observed by statistical methods.ResultsThe dMMR and pMMR groups had significant differences in histologic type, TNM stage, maximum tumor diameter, lymph node metastasis, differentiation grade, gross appearance, and vascular invasion. There were significant differences between the MLH1 groups in age, histologic type, TNM stage, lymph node metastasis, tumor location, and depth of invasion. The MSH2 groups were significantly different in age. The MSH6 groups had significant differences in age, histologic type, and TNM stage. There were significant differences between the PMS2 groups in lymph node metastasis and tumor location. CRC was dominated by MLH1 and PMS2 combined expression loss (41.77%). There was a positive correlation between MLH1 and MSH2 and between MSH6 and PMS2 as well.ConclusionsThe proportion of mucinous adenocarcinoma, protruding type, and poor differentiation is relatively high in dMMR CRCs, but lymph node metastasis is rare. It is worth noting that the expression of MMR protein has different prognostic significance in different stages of CRC disease.

Primary urethral carcinoma in female: An extremely rare case series at a single tertiary referral hospital and literature review

Introduction and importancePrimary urethral carcinoma (PUC) is exceedingly uncommon and accounts for 0.02 % of all female cancers and <1 % of female genitourinary tract malignancy. PUC in female usually presents late with a higher disease stage and, hence, has higher cancer-specific mortality. Due to its rarity, the current recommendation for the management of PUC is still unclear. Case presentationThis study reports two rare cases of 59-year-old and 65-year-old women with PUC, presenting with chief complaint of hematuria. Urethrocystoscopy and biopsy were performed. Pathology results revealed mucinous adenocarcinoma (AC) and urothelial carcinoma (UC) of the urethra, respectively. Radiological imaging was conducted for staging. Both were diagnosed with cT4N2M0. The first patient underwent anterior pelvic exenteration with bilateral ureterocutaneoustomy (UCS), while the second patient received cisplatin-based chemotherapy before the surgery. Radiological follow-up was planned 3 months after the surgery. Clinical discussionBoth mucinous AC and UC are considered incredibly unusual subtypes, with no defined treatment guidelines. Anterior exenteration with or without neoadjuvant chemotherapy may be opted for advanced PUC affecting the proximal urethra and adjacent organs. Following the previous studies, in this case series, both patients (locally advanced) underwent anterior exenteration. Additionally, the UC subtype received multimodal treatment with neoadjuvant chemotherapy which was shown to improve overall survival. ConclusionIn conclusion, PUC is extremely rare, and the choice of management remained various. Long-term follow-up for these patients is mandatory to improve understanding of this incredibly uncommon disease.

Retrospective Study of Clinicopathologic Features and Outcome of Colonic Cancer in Relation to Primary Tumor Location

Abstract Background Colon cancer is one of the most common cancers worldwide and outcomes of colon cancer are different according to the primary tumor location and could be considered as distinct disease entities of the same organ. Objectives Analyzing and comparing clinical, epidemiological, pathologic features and outcome of colon cancer according to primary location whether the patients are right sided colon cancer (RSCC) and left sided colon cancer (LSCC) patients in different situations. Patients and Methods This is a retrospective, descriptive and analytical study conducted between January 1st, 2013 and January 1st 2019. One hundred and fifty patients diagnosed with colon cancer were enrolled in GIT unit, Department of Clinical Oncology, Ain Shams University Hospital. Results In our study right sided colon cancer patients were more females and clinically presented with higher frequency of anaemia (P value = 0.001) and perforation (P value = 0.02). Left sided colon cancer on the other side were more males (P value = 0.032) and was associated with more constipation (P value &amp;lt;0.001) and intestinal obstruction (P value = 0.085). RSCC was more associated mucinous adenocarcinoma, more advanced T stage (T4), lymphovascular invasion, larger tumor sizes and more poorly differentiated tumor. LSCC was associated with more advanced stage and lymph node positivity. Right side tumor has highest disease-free survival period which is 34.63 months (95% confidence interval [CI] 28.39-40.86) comparing with the left side tumor which was 24.94 months (95% confidence interval [CI] 19.61-30.27). left side tumor has highest progressive free survival period which is 4.77 months (95% confidence interval [CI] 3.33-8.22) comparing with the right-side tumor which was 2.21 months (95% confidence interval [CI] 0.63-3.79). Conclusion RSCCs and LSCCs show different characteristics in clinical presentation and prognostic features, so we can consider the side of tumor is helpful in determining the behavior and the outcome of the disease. We can consider RSCC and LSCC as two separate disease entities.

Correlation of Ki-67 Proliferating Index with Histological Types and Characterization of Mucin in Colorectal Carcinoma

Background: Colorectal carcinoma is a major cause of cancer associated with a high rate of morbidity and mortality in the western world. One of the pathologic features considered to be important for prognosis is mucin production. Many authors confirmed that colon carcinomas with high mucin content tend to recur locally and carry a poor prognosis. Aim: Correlation of Ki-67 proliferating index with different type of colorectal carcinoma as well as characterization of mucin. Method: This cross sectional study was conducted at Sir Salimullah Medical College, Department of pathology from July 2014 to June 2016. Ninety eight patients with colorectal carcinoma was enrolled in this study who underwent surgical resection of colon, adenocarcinomas. For histological classification we used the WHO recommendation (2000) and to be more accurate we sub-classified mucinous adenocarcinomas by morphometrical analysis in three categories: pure mucinous, with extracellular mucin more than 80% of the tumoral volume; mixed type, with 50–80% extracellular mucin; and mixed type with less than 50% extracellular mucin and their correlation with Ki-67 proliferating index . For histochemical investigation, we used stains such as: D- PAS and Alcian Blue. A technique of manual tissue array was employed to see Ki-67 expression by IHC method. Ki-67 is a proliferation associated nuclear antigen which can be recognized by MIB-1 monoclonal antibody. Result: It was observed that Ki-67 labeling index was high in nonmucinous tumor compared to mucinous adenocarcinoma and signet ring cell carcinoma which is statistically significant (P&lt;0.05). Histochemical stain of mucin where both D-PAS and Alcian Blue positive cases(mixed type) are more than the Only D-PAS positive cases(pure type). Ki-67 proliferating index was also high in mixed type mucinous adenocarcinoma (&lt;50%) compared to pure (&gt;80%) and mixed type (50-80%). The result was statistically significant (p&lt;0.05). Correlation of Ki-67 proliferating index with histologic type as well as mucin characterization and thereby provide information to clinician to better understanding of the treatment as well as prognosis.

Molecular characteristics of patients with colorectal signet-ring cell carcinoma with different ABO blood groups

BackgroundColorectal signet-ring cell carcinoma (SRCC) is a rare subtype of malignant adenocarcinoma, accounting for approximately 1 % of colorectal cancer (CRC) cases. Its biomarkers and molecular characteristics remain controversial, and there are no specific therapeutic targets or strategies for its clinical treatment. MethodsA retrospective study was conducted between January 2010 and December 2021. 1058 colorectal cancer cases from the Sun Yat-sen University Cancer Center and 489 cases from the Tumor Genome Atlas Project were included in the analysis, of which 64 were SRCC. Data extraction included patient demographics, blood types and risk factors, including clinical variables and genomics (either a 19-gene panel NGS or 1021-gene panel NGS). Univariate analyses were performed to identify factors significantly associated with overall survival. ResultsThe blood groups of 27 (42.2 %), 18 (28.1 %), 12 (18.8 %), and seven (10.9 %) patients were classified as O, A, B, and AB, respectively. We found that O was a unique blood group characterized by a low frequency of KRAS mutations, a high frequency of heterozygosity at each HLA class I locus, and a high tumor mutational burden (TMB). Patients in blood group A with high-frequency KRAS mutations and those in blood group B with anemia and metabolic abnormalities required targeted treatment. Furthermore, genetic alterations in SRCC differed from those in adenocarcinoma and mucinous adenocarcinoma. ConclusionsOur study revealed genomic changes in SRCC patients across different blood groups, which could advance the understanding and precise treatment of colorectal SRCC.

Predictive value of circulating lymphocyte subsets and inflammatory indexes for neoadjuvant chemoradiotherapy response in rectal mucinous adenocarcinoma patients: A machine learning approach.

In this study, we aimed to evaluate the predictive value of circulating lymphocyte subsets and inflammatory indexes in response to neoadjuvant chemoradiotherapy (NCRT) in patients with rectal mucinous adenocarcinomas (MACs). Rectal MAC patients who underwent NCRT and curative resection at Fujian Medical University Union Hospital's Department of Colorectal Surgery between 2016 and 2020 were included in the study. Patients were categorized into good and poor response groups based on their pathological response to NCRT. An independent risk factor-based nomogram model was constructed by utilizing multivariate logistic regression analysis. Additionally, the extreme gradient boosting (XGB) algorithm was applied to build a machine learning (ML)-based predictive model. Feature importance was quantified using the Shapley additive explanations method. Out of the 283 participants involved in this research, 190 (67.1%) experienced an unfavorable outcome. To identify the independent risk factors, logistic regression analysis was performed, considering variables such as tumor length, pretreatment clinical T stage, PNI, and Th/Tc ratio. Subsequently, a nomogram model was constructed, achieving a C-index of 0.756. The ML model exhibited higher prediction accuracy than the nomogram model, achieving an AUROC of 0.824 in the training set and 0.762 in the tuning set. The top five important parameters of the ML model were identified as the Th/Tc ratio, neutrophil to lymphocyte, Th lymphocytes, Gross type, and T lymphocytes. Radiochemotherapy sensitivity is markedly influenced by systemic inflammation and lymphocyte-mediated immune responses in rectal MAC patients. Our ML model integrating clinical characteristics, circulating lymphocyte subsets, and inflammatory indexes is a potential assessment tool that can provide a reference for individualized treatment for rectal MAC patients.

Comparative efficacy of lobar resection and sublobar resection in patients with stage IA lung invasive mucinous adenocarcinoma: insights from the SEER database with propensity score matching

Comparative efficacy of lobar resection and sublobar resection in patients with stage IA lung invasive mucinous adenocarcinoma: insights from the SEER database with propensity score matching

Morphological and Clinical Analysis of Colorectal Cancer: Findings from a Cross-Sectional Study

Background: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide, with increasing incidence in developing countries like Pakistan. This study aims to evaluate the distribution patterns of colorectal cancer morphologies among patients treated at Liaquat University of Medical &amp; Health Sciences (LUMHS) Jamshoro. Methodology: This descriptive, cross-sectional study was conducted over two years (January 2022 to December 2023) at the Department of Gastroenterology, Asian Institute of Medical Sciences, in collaboration with the Department of Pathology, LUMHS Jamshoro. A total of 150 patients diagnosed with CRC and who underwent surgical resection were included in the study. Data were collected on socio-demographic characteristics, clinical presentations, histopathological types, tumor grading, and staging. Statistical analysis was performed using SPSS version 25, with Fisher’s exact test applied to assess associations between variables. Results: The mean age of the patients was 58.7 years (± 11.2), with the majority being male (60%). Most tumors were classified as non-mucinous adenocarcinomas (56%), followed by mucinous adenocarcinomas (28%) and signet-ring cell carcinomas (16%). A strong positive correlation was found between tumor size and Dukes' staging (ρ = 0.42, p &lt; 0.001), as well as between Dukes' staging and tumor grading (ρ=0.46, p&lt;0.001). Rectal bleeding was significantly associated with advanced Dukes’ stages (ρ=0.44, p &lt;0.001). Conclusion: This study highlights the aggressive nature of colorectal cancer in the studied population, with significant associations between age, tumor size, staging, and grading. The findings underscore the need for early detection strategies and tailored treatment approaches to address CRC in this region. Keywords: Colorectal Cancer, Dukes’ Staging, Histopathology, Tumor Grading.

Pathological and imaging features of pulmonary invasive mucinous adenocarcinoma-a retrospective cohort study.

Pulmonary invasive mucinous adenocarcinoma (IMA) is a rare subtype of lung cancer which is easily misdiagnosed as inflammatory nodules, tuberculosis, pulmonary diffuse lesions, or hamartomas due to the lack of clinical specificity. This study aims to identify the pathological and imaging characteristics of IMA, which will favor to improve the diagnostic and therapeutic efficacy. A retrospective study was conducted by enrolling patients histopathologically diagnosed with pulmonary IMA in the current study between January 2014 and December 2021. The clinical pathological and radiological data were collected for analysis to evaluate the radiological patterns and pathological and molecular characteristics of IMA. A total of 136 patients were included in the study, of whom 58 were male and 78 were female. The patients had an average age of 63.0±9.7 years. The tumors were classified into the following three pathological types: pure mucinous (76 cases) featured by only mucinous cells observed under the microscope; mixed mucinous (23 cases) featured as an attached-wall, papillary, acinar, and solid tumor cells with more than 10% mucinous cells.; and mucinous-absent (29 cases) featured with the absence of mucous cells, but still can detect more than 10% of mucin expresses. In terms of the morphological classification based on the CT scans, 88 (64.7%) cases were identified as the nodular type, 31 (22.8%) as the inflammatory type, 15 (11.1%) as the mass-like type, and two (1.5%) as the diffuse type. For the molecular features, patients afflicted with IMA showed much lower levels of thyroid transcription factor-1 (15%) than those with usual adenocarcinoma (over 80%). However, cytokeratin 20 was more common in IMA (50%) than the usual adenocarcinoma (about 5%). The K-RAS mutation was prevalent in 75% of IMA, which contrasted sharply to its occurrence in a mere 15% of the usual adenocarcinoma. Epidermal growth factor receptor mutations were rarer in IMA (less than 5%) than the usual adenocarcinoma (about 50%). The pathological and imaging features enrich our understanding of the disease's heterogeneity, which will contribute to more personalized diagnostic and therapeutic strategies.

Critical appraisal of total gastrectomy plus total colectomy with hyperthermic intraperitoneal chemotherapy as a treatment for advanced pseudomyxoma peritonei

AbstractBackgroundThe absolute requirement for a long‐term favorable result with cytoreductive surgery for pseudomyxoma peritonei is a complete resection of all visible disease. A combination of parietal peritonectomy procedures and visceral resections is required for this to occur. The cytoreductive surgery is supplemented by hyperthermic intraperitoneal chemotherapy.MethodsWe searched our database and secured files for patients who required a total gastrectomy and a total colectomy to achieve a complete cytoreductive surgery. Survival of low‐grade mucinous neoplasm (LAMN) and mucinous appendiceal adenocarcinoma (MACA) histologies were determined. Clinical and histologic variables were assessed for their impact on survival.ResultsThirteen of 450 patients (2.9%) with LAMN histology and 14 of 186 patients (7.5%) with MACA histology had these visceral resections. Median survival of these 27 patients was 10 years. LAMN and MACA patients showed the same survival. For LAMN histology, this requirement for extensive visceral resection markedly reduced survival (p &lt; 0.0001). For MACA, there was no adverse impact on survival (p = 0.4359). Class 4 adverse events caused reduced survival (p = 0.0014).ConclusionsA 10‐year median survival accompanies total gastrectomy plus total colectomy for advanced pseudomyxoma peritonei. Systemic chemotherapy and class 4 adverse events reduced survival.

A Population-Based and Propensity Score-Matched Investigation of the Occurrence, Management, and Prognosis of Anal Mucinous Adenocarcinoma Patients

Introduction: Anal mucinous adenocarcinoma (AMAC) is an extremely rare form of anal cancer. Our objective was to examine the incidence, management, and prognostic factors of AMAC. Methods: We analyzed age-adjusted incidence (AAI) rates over time and compared the prognosis of AMAC with anal squamous cell carcinoma (ASCC) and adenocarcinoma (AAC) using propensity score matching and Kaplan-Meier analysis. Patients were classified based on summary stage and treatments to determine cancer-specific survival. Results: AAI of AMAC fluctuated within a narrow range (0.082–0.237 per million person-years) from 2000 to 2018. AMAC had a slight non-significant trend of worse prognosis than ASCC (p = 0.348) and a better prognosis than AAC (p < 0.01). Females made up a larger proportion of patients diagnosed with the distant disease (p < 0.05) and unmarried (p < 0.05) and somewhat less probably to need surgical removal (p < 0.01) and radiotherapy (p < 0.01). Elderly patients have lower rates of survival (p < 0.05). Localized stage was associated with better prognosis (p < 0.05). Surgery was associated with a tendency toward better survival (p = 0.095). Conclusions: AMAC exhibits a low incidence yet favorable prognosis compared to typical AAC and slightly worse compared to ASCC. Elderly age is associated with poorer prognosis, while localized stage indicates better prognosis. Surgery demonstrates a trend toward improved survival.

Long-term outcomes of lobectomy vs . sublobectomy for stage I lung invasive mucinous adenocarcinoma.

Long-term outcomes of lobectomy vs . sublobectomy for stage I lung invasive mucinous adenocarcinoma.

GATA4 is diagnostically useful for distinguishing primary ovarian mucinous carcinomas from metastatic colorectal adenocarcinomas to the ovary.

Determining the primary origin of an ovarian mucin-producing carcinoma can be challenging at times because some metastases of primary colorectal origin may exhibit gross, microscopic, and/or immunohistochemical features that overlap with those of primary ovarian mucinous carcinomas (OMCs). We hypothesized that GATA binding protein 4 (GATA4) might be a novel, useful marker for differentiating primary OMCs from metastatic colorectal adenocarcinomas to the ovary. For comparison with the usefulness of other markers (special AT-rich sequence-binding protein 2 (SATB2) and caudal type homeobox 2 (CDX2)), we elucidated the expression profiles of GATA4 in OMCs, colorectal non-mucinous adenocarcinomas (CNMACs), and colorectal mucinous adenocarcinomas (CMACs) using immunohistochemistry. We confirmed GATA4 expression (H-score ≥50 points) in 93%, SATB2 in 0%, and CDX2 in 64% of 14 OMCs. GATA4 was expressed in 13%, SATB2 in 90%, and CDX2 in 93% of 30 CNMACs. GATA4 was expressed in 20%, SATB2 in 73%, and CDX2 in 100% of 30 CMACs. The expression of GATA4 in a mucus-producing ovarian tumor strongly supports it being a primary OMC rather than a metastatic colorectal carcinoma: GATA4 expression indicates OMC and SATB2 expression indicates colorectal adenocarcinoma. However, three cases of colorectal adenocarcinoma were GATA4-positive and SATB2-negative, so the GATA4/SATB2 marker combination is not absolute for determining the primary site. Further research for more markers is necessary to find the ideal combination.

Comprehensive analysis of gene mutations and mismatch repair in Chinese colorectal cancer patients.

RAS, BRAF, and mismatch repair (MMR)/microsatellite instability (MSI) are crucial biomarkers recommended by clinical practice guidelines for colorectal cancer (CRC). However, their characteristics and influencing factors in Chinese patients have not been thoroughly described. To analyze the clinicopathological features of KRAS, NRAS, BRAF, and PIK3CA mutations and the DNA MMR status in CRC. We enrolled 2271 Chinese CRC patients at the China-Japan Friendship Hospital. MMR proteins were tested using immunohistochemical analysis, and the KRAS/NRAS/BRAF/PIK3CA mutations were determined using quantitative polymerase chain reaction. Microsatellite status was determined using an MSI detection kit. Statistical analyses were conducted using SPSS software and logistic regression. The KRAS, NRAS, BRAF, and PIK3CA mutations were detected in 44.6%, 3.4%, 3.7%, and 3.9% of CRC patients, respectively. KRAS mutations were more likely to occur in patients with moderate-to-high differentiation. BRAF mutations were more likely to occur in patients with right-sided CRC, poorly differentiated, or no perineural invasion. Deficient MMR (dMMR) was detected in 7.9% of all patients and 16.8% of those with mucinous adenocarcinomas. KRAS, NRAS, BRAF, and PIK3CA mutations were detected in 29.6%, 1.1%, 8.1%, and 22.3% of patients with dMMR, respectively. The dMMR was more likely to occur in patients with a family history of CRC, aged < 50 years, right-sided CRC, poorly differentiated histology, no perineural invasion, and with carcinoma in situ, stage I, or stage II tumors. This study analyzed the molecular profiles of KRAS, NRAS, BRAF, PIK3CA, and MMR/MSI in CRC, identifying key influencing factors, with implications for clinical management of CRC.

Unveiling the secrets of gastrointestinal mucous adenocarcinoma survival after surgery with artificial intelligence: A population-based study.

Research on gastrointestinal mucosal adenocarcinoma (GMA) is limited and controversial, and there is no reference tool for predicting postoperative survival. To investigate the prognosis of GMA and develop predictive model. From the Surveillance, Epidemiology, and End Results database, we collected clinical information on patients with GMA. After random sampling, the patients were divided into the discovery (70% of the total, for model training), validation (20%, for model evaluation), and completely blind test cohorts (10%, for further model evaluation). The main assessment metric was the area under the receiver operating characteristic curve (AUC). All collected clinical features were used for Cox proportional hazard regression analysis to determine factors influencing GMA's prognosis. This model had an AUC of 0.7433 [95% confidence intervals (95%CI): 0.7424-0.7442] in the discovery cohort, 0.7244 (GMA: 0.7234-0.7254) in the validation cohort, and 0.7388 (95%CI: 0.7378-0.7398) in the test cohort. We packaged it into Windows software for doctors' use and uploaded it. Mucinous gastric adenocarcinoma had the worst prognosis, and these were protective factors of GMA: Regional nodes examined [hazard ratio (HR): 0.98, 95%CI: 0.97-0.98, P < 0.001)] and chemotherapy (HR: 0.62, 95%CI: 0.58-0.66, P < 0.001). The deep learning-based tool developed can accurately predict the overall survival of patients with GMA postoperatively. Combining surgery, chemotherapy, and adequate lymph node dissection during surgery can improve patient outcomes.

Predicting Survival in Mucinous Adenocarcinoma of the Appendix: Demographics, Disease Presentation, and Treatment Methodology

BackgroundMucinous adenocarcinoma of the appendix (MACA) follows a complex disease course with variable survival. Large-scale predictive modeling may determine subtle yet important prognostic factors otherwise unseen in smaller cohort analyses.MethodsPatients with MACA were identified from the Surveillance, Epidemiology, and End Results (SEER) Research Plus database (2005–2019). Primary, secondary, and tertiary outcomes were disease-specific survival (DSS), overall survival (OS), and average annual percent change (AAPC) in incidence.ResultsAmong 4,258 included patients, MACA was most frequently diagnosed at 50 to 69 years (52.0%), with female preponderance (55.9%). MACA incidence AAPC was 3.8 (95% confidence interval [CI] 1.9–5.9). For patients with exclusive, first-diagnosis MACA included in survival analysis (3,222 patients), median DSS and OS were 118 and 88 months, respectively. In DSS-based multivariable analysis, worse prognosis was associated with non-Hispanic Black background (HR 1.36, 95% CI 1.02–1.82; p = 0.036), high grade (grade 3 HR 3.10, 95% CI 2.44–3.92; p < 0.001), lymphatic spread (HR 2.73, 95% CI 2.26–3.30; p < 0.001), and distant metastasis (HR 5.84, 95% CI 3.86–8.83; p < 0.001). In subcohort analysis of patients with rationale for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC, 2,387 patients), CRS-HIPEC was associated with survival benefit compared with surgery alone but only for moderate-grade tumors (median DSS/OS 138/138 vs. 116/87 months; p < 0.001).ConclusionsMucinous adenocarcinoma of the appendix incidence is increasing in the United States. Survival rates are affected by both demographics and classical risk factors, and CRS-HIPEC-associated survival benefit predominantly occurs in moderate-grade tumors. Further exploration of biologic and clinicopathologic features may enhance risk stratification for this disease.

Appendiceal neoplasms derived from appendiceal tip remnants following appendectomy: a report of two cases

BackgroundNeoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal “stump”. Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal “tip” remnants.Case presentationThe first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively.ConclusionsIf appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.