Papillary Tumors Research Articles

MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA Michael Rezaee, Maximilian Pallauf, Roy Elias, Sean Fletcher, Christian Pavlovich, Ezra Baraban, Yasser Ged, and Nirmish Singla Michael RezaeeMichael Rezaee More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Roy EliasRoy Elias More articles by this author , Sean FletcherSean Fletcher More articles by this author , Christian PavlovichChristian Pavlovich More articles by this author , Ezra BarabanEzra Baraban More articles by this author , Yasser GedYasser Ged More articles by this author , and Nirmish SinglaNirmish Singla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003279.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies in clear cell renal cell carcinoma (RCC) have suggested that the pT3a staging subclassification based on perinephric fat, renal sinus fat, and renal vein invasion may represent an overly heterogenous group of patients with varying survival trajectories. A similar evaluation has not yet been performed in patients with non-clear cell pathology. Therefore, we examined the prognostic significance of perinephric fat, renal sinus fat, and renal vein invasion in pT3a non-clear cell RCC (nccRCC) patients. METHODS: A population-based retrospective cohort study of patients with pT3aN0M0 nccRCC was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2010 through 2019. Patients were grouped by pT3a subclassification: perinephric fat, renal sinus fat, and segmental or renal vein invasion. Cox proportional hazards models were used to examine the relationship between pT3a subclassification groups and cancer-specific survival, overall and by histological subtype (papillary, chromophobe, and other nccRCC tumors). RESULTS: The final analysis sample consisted of 1,640 pT3aN0M0 nccRCC patients with a median follow up of 4 years. Compared to perinephric fat invasion, segmental or renal vein invasion was associated with significantly worse cancer-specific survival (hazard ratio [HR] 3.0, 95% CI: 2.1 – 4.3, Figure 1) overall. Of these patients, 51.1%, 38.4%, and 10.5% had papillary, chromophobe, and other nccRRC tumors, respectively. Among patients with papillary (HR 4.8, 95% CI: 2.8 – 8.3) and chromophobe (HR 2.9, 95% CI: 1.1 – 7.9) pT3a tumors, segmental or renal vein invasion was associated with significantly worse cancer-specific survival compared to perinephric fat invasion. No difference was observed in cancer-specific survival by pT3a subgroups for other nccRCC tumors. Patients with two pT3a characteristics had significantly worse cancer-specific survival compared to those with only one (HR 2.1, 95% CI: 1.5 to 3.1). CONCLUSIONS: Cancer-specific survival is significantly worse in pT3a nccRCC patients with segmental or renal involvement, particularly in those with papillary and chromophobe tumors. Current RCC staging guidelines may underestimate the prognostic value of segmental or renal vein involvement relative to other pT3a criteria. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e557 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rezaee More articles by this author Maximilian Pallauf More articles by this author Roy Elias More articles by this author Sean Fletcher More articles by this author Christian Pavlovich More articles by this author Ezra Baraban More articles by this author Yasser Ged More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA03-08 PEMBROLIZUMAB (PEMBRO) FOR PATIENTS (PTS) WITH HIGH-RISK NON-MUSCLE-INVASIVE BLADDER CANCER (HR NMIBC) UNRESPONSIVE TO BACILLUS CALMETTE-GUERIN (BCG): EFFICACY AND EVALUATION OF SUBSEQUENT CYSTECTOMY FROM COHORT B OF THE PHASE 2 KEYNOTE-057 STUDY

LBA03-08 PEMBROLIZUMAB (PEMBRO) FOR PATIENTS (PTS) WITH HIGH-RISK NON-MUSCLE-INVASIVE BLADDER CANCER (HR NMIBC) UNRESPONSIVE TO BACILLUS CALMETTE-GUERIN (BCG): EFFICACY AND EVALUATION OF SUBSEQUENT CYSTECTOMY FROM COHORT B OF THE PHASE 2 KEYNOTE-057 STUDY

PD13-08 CORE1: PHASE 2 SINGLE ARM STUDY OF CG0070 COMBINED WITH PEMBROLIZUMAB IN PATIENTS WITH NON MUSCLE INVASIVE BLADDER CANCER UNRESPONSIVE TO BACILLUS CALMETTE-GUERIN (BCG)

You have accessJournal of UrologyCME1 Apr 2023PD13-08 CORE1: PHASE 2 SINGLE ARM STUDY OF CG0070 COMBINED WITH PEMBROLIZUMAB IN PATIENTS WITH NON MUSCLE INVASIVE BLADDER CANCER UNRESPONSIVE TO BACILLUS CALMETTE-GUERIN (BCG) Roger Li, Gary Steinberg, Edward M. Uchio, Donald Lamm, Paras Shah, Ashish M. Kamat, Trinity J Bivalacqua, Vignesh Packiam, Michael J. Chisamore, John Mcadory, Paola Grandi, Nataliya Hnat, and James Burke Roger LiRoger Li More articles by this author , Gary SteinbergGary Steinberg More articles by this author , Edward M. UchioEdward M. Uchio More articles by this author , Donald LammDonald Lamm More articles by this author , Paras ShahParas Shah More articles by this author , Ashish M. KamatAshish M. Kamat More articles by this author , Trinity J BivalacquaTrinity J Bivalacqua More articles by this author , Vignesh PackiamVignesh Packiam More articles by this author , Michael J. ChisamoreMichael J. Chisamore More articles by this author , John McadoryJohn Mcadory More articles by this author , Paola GrandiPaola Grandi More articles by this author , Nataliya HnatNataliya Hnat More articles by this author , and James BurkeJames Burke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: CG0070, is an Ad5-based oncolytic vaccine engineered to express GM-CSF and replicate selectively in tumor cells with mutated or deficient RB. The CG0070 mechanism of action includes cell lysis and immunogenic cell death which is enhanced in the presence of GM-CSF. In an open label ph. 2 study, an overall CR rate of 62% and a CR at 12 months (m) of 29% have been observed in patients with high risk NMIBC previously treated with BCG. IV pembrolizumab, was recently approved by the FDA for patients with BCG- unresponsive CIS (with or without papillary tumors) with an overall complete RR of 41% and a 12 m CR rate of ∼20%. This ph. 2 study will assess the potential synergy of the two agents in the treatment of BCG-unresponsive NMIBC. METHODS: 35 pts with BCG-unresponsive CIS with or without concurrent Ta or T1 disease will be treated with intravescical CG0070 (1x1012 vp) in combination with pembrolizumab at a dose of 400 mg IV q6 weeks. CG0070 will be administered weekly x 6 as induction followed by weekly x 3 maintenance instillations at months 3, 6, 9, 12, and 18. Patients with persistent CIS or HG Ta at 3 m may receive re-induction with weekly x 6 of CG0070. Pembrolizumab will be administered up to 24m. Assessment of response will include q3 m cystoscopy with biopsy of areas suspicious for disease, urine cytology, CTU/MRU, and mandatory bladder mapping biopsies at 12 m. Recurrence of HG disease will be enumerated as disease recurrence. The primary endpoint of the study is CR at 12m. Secondary endpoints will include CR at any time, progression free survival, duration of response, cystectomy free survival and the safety. Correlate assessments includes changes in the TME, systemic immune induction, viral replication. RESULTS: Enrollment has been completed. Based on follow up thus far, CR rate of 92% (22/24) at 3 m has been observed. All patients in CR at 3 m remain in CR at downstream timepoints including: 14/16 at 6m, 9/11 at 9m, and 6/8 at 12 m. Treatment related AE are consistent with those observed in studies of each agent alone. CONCLUSIONS: This initial data on the efficacy and safety of CG0070 plus pembrolizumab for the treatment of BCG unresponsive NMIBC is encouraging. Data on efficacy and safety for all enrolled patients, N=35, as well as biomarker (CAR, E2F, and PDL1) assessment will be presented at the time of the conference. Source of Funding: CG Oncology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e408 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roger Li More articles by this author Gary Steinberg More articles by this author Edward M. Uchio More articles by this author Donald Lamm More articles by this author Paras Shah More articles by this author Ashish M. Kamat More articles by this author Trinity J Bivalacqua More articles by this author Vignesh Packiam More articles by this author Michael J. Chisamore More articles by this author John Mcadory More articles by this author Paola Grandi More articles by this author Nataliya Hnat More articles by this author James Burke More articles by this author Expand All Advertisement PDF downloadLoading ...

MP64-08 99m TC- SESTAMIBI SPECT/CT FOR THE CHARACTERIZATION OF SMALL RENAL MASSES: INITIAL EXPERIENCE FROM a TERTIARY REFERRAL CENTER

MP64-08 ^99m TC- SESTAMIBI SPECT/CT FOR THE CHARACTERIZATION OF SMALL RENAL MASSES: INITIAL EXPERIENCE FROM a TERTIARY REFERRAL CENTER

PD13-05 LONG-TERM ONCOLOGICAL OUTCOMES OF OFFICE-BASED FULGURATION OF TA LOW-GRADE NON MUSCLE INVASIVE BLADDER CANCER: A LARGE SINGLE CENTER SERIES

You have accessJournal of UrologyCME1 Apr 2023PD13-05 LONG-TERM ONCOLOGICAL OUTCOMES OF OFFICE-BASED FULGURATION OF TA LOW-GRADE NON MUSCLE INVASIVE BLADDER CANCER: A LARGE SINGLE CENTER SERIES Christian Vitug, Katherine Lajkosz, Julian Chavarriaga, Andres Llano, Shayan Din, Eunice Villegas, Cynthia Kuk, Bruce Gao, Otto Hemminiki, Dhiral Kot, Jimmy Misurka, Theodorus Van Der Kwast, Christopher Wallis, Michael Jewett, Mark Soloway Aventura, Fl, Neil Fleshner, Girish Kulkarni, and Alexandre Zlotta Christian VitugChristian Vitug More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Julian ChavarriagaJulian Chavarriaga More articles by this author , Andres LlanoAndres Llano More articles by this author , Shayan DinShayan Din More articles by this author , Eunice VillegasEunice Villegas More articles by this author , Cynthia KukCynthia Kuk More articles by this author , Bruce GaoBruce Gao More articles by this author , Otto HemminikiOtto Hemminiki More articles by this author , Dhiral KotDhiral Kot More articles by this author , Jimmy MisurkaJimmy Misurka More articles by this author , Theodorus Van Der KwastTheodorus Van Der Kwast More articles by this author , Christopher WallisChristopher Wallis More articles by this author , Michael JewettMichael Jewett More articles by this author , Mark Soloway Aventura, FlMark Soloway Aventura, Fl More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Alexandre ZlottaAlexandre Zlotta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sixty percent of non-muscle-invasive bladder tumors initially present as low grade (LG), which have a high recurrence rate but low risk of progression. Transurethral resection of bladder tumor (TURBT) is standard for the diagnosis, staging, and treatment of bladder cancer (BC). Office-based fulguration under local anesthesia for small, recurrent, apparent Ta LG tumors is an alternative to TURBT. It is convenient for both patients and physicians, avoiding the costs and risks of a hospital-based procedure requiring general or spinal anesthesia. However, despite being part of some guidelines, it has not become the primary management approach in part due to the paucity of large studies with long term follow-up. METHODS: We retrospectively reviewed our experience with 270 patients with a history of Ta LG BC who underwent office-based fulguration for subsequent small recurrent papillary bladder tumors between 1991 and 2021 at the Toronto General Hospital/Princess Margaret Cancer Center, University Health Network, Toronto, Canada. We report the cancer specific survival (CSS) and progression free survival (PFS, defined as muscle invasive disease or metastases). RESULTS: 270 patients with recurrent Ta LG NMIBC treated with office fulguration were included. Mean age was 64.9 (SD 13.3) years, 70.8% were men and 60.3% had single tumors. The mean number of fulgurations per patient was 3.1 (SD 3.2) with a range from 1 to 22. Median follow up was 10.1 years (IQR 5.8−16.2). Patients also underwent a mean of 3.6 (SD 3.0) TURBTs during follow-up. 44.4% of patients never received intravesical therapy during follow-up. At 10 years, the CSS was 100% and PFS was 97.3 (93.8-98.8)%, respectively. CONCLUSIONS: Our results are based on a large patient experience with long follow-up (10 years) and demonstrate that select patients with recurrent apparent Ta LG BC can be safely managed with office-based fulguration under local anesthesia, without compromising long-term oncological outcomes. This approach reduces surgical and anesthetic associated morbidity and may generate cost-savings to healthcare systems. Office-based fulguration for recurrent small tumors after Ta LG NMIBC should be more widely used. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e407 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Vitug More articles by this author Katherine Lajkosz More articles by this author Julian Chavarriaga More articles by this author Andres Llano More articles by this author Shayan Din More articles by this author Eunice Villegas More articles by this author Cynthia Kuk More articles by this author Bruce Gao More articles by this author Otto Hemminiki More articles by this author Dhiral Kot More articles by this author Jimmy Misurka More articles by this author Theodorus Van Der Kwast More articles by this author Christopher Wallis More articles by this author Michael Jewett More articles by this author Mark Soloway Aventura, Fl More articles by this author Neil Fleshner More articles by this author Girish Kulkarni More articles by this author Alexandre Zlotta More articles by this author Expand All Advertisement PDF downloadLoading ...

Successful Development of a Natural Language Processing Algorithm for Pancreatic Neoplasms and Associated Histologic Features.

Natural language processing (NLP) algorithms can interpret unstructured text for commonly used terms and phrases. Pancreatic pathologies are diverse and include benign and malignant entities with associated histologic features. Creating a pancreas NLP algorithm can aid in electronic health record coding as well as large database creation and curation. Text-based pancreatic anatomic and cytopathologic reports for pancreatic cancer, pancreatic ductal adenocarcinoma, neuroendocrine tumor, intraductal papillary neoplasm, tumor dysplasia, and suspicious findings were collected. This dataset was split 80/20 for model training and development. A separate set was held out for testing purposes. We trained using convolutional neural network to predict each heading. Over 14,000 reports were obtained from the Mass General Brigham Healthcare System electronic record. Of these, 1252 reports were used for algorithm development. Final accuracy and F1 scores relative to the test set ranged from 95% and 98% for each queried pathology. To understand the dependence of our results to training set size, we also generated learning curves. Scoring metrics improved as more reports were submitted for training; however, some queries had high index performance. Natural language processing algorithms can be used for pancreatic pathologies. Increased training volume, nonoverlapping terminology, and conserved text structure improve NLP algorithm performance.

TSC/MTOR Mutated Renal Cell Carcinoma with Leiomyomatous Stroma is a Distinct Entity: A Comprehensive Study of 12 Cases.

The 2016 World Health Organization (WHO) Classification of Tumors of the Urinary System includes renal cell carcinoma (RCC) with leiomyomatous stroma (RCC-LS) as a provisional category. Recent studies have shown that this category includes at least 4 subtypes: clear cell (CCRCC), clear cell papillary renal cell tumor (CCPRCT), ELOC (TCEB1) mutated, and a subtype of RCC with TSC/MTOR mutations. The most recent 2022 World Health Organization (WHO) Classification of Tumors of the Urinary System includes ELOC mutated RCC-LS as a distinct entity but does not address any other renal tumors with smooth muscle stroma. We reviewed >500 cases of RCC with clear cell phenotype and identified 12 cases that exhibited prominent smooth muscle stroma, of which 4 of the cases had been previously reported. Review of the H&E revealed that all of the tumors were circumscribed with nested, solid, tubular, and tubulopapillary architecture. The epithelium was intimately embedded in the rich smooth muscle stroma. WHO/ISUP grade corresponded to grade 3 and 4. Nuclei were randomly distributed and the cytoplasm had predominantly clear and occasionally flocculent appearance. Immunohistochemically, all the cases showed membranous CAIX staining, although the pattern was combined cup and box-shaped. CK7 was positive in all cases ranging from 25% to 100% of cells. Membranous and apical staining of CD10 was present in all cases. Next generation sequencing (NGS) of these cases identified mutations in TSC1 (n=4), TSC2 (n=3), and MTOR (n=4) with one case exhibiting loss of TSC1. This descriptive study, although small, demonstrates the difficulty in applying the current WHO provisional criteria at a single institution. Given the heterogeneity seen with these cases, we suggest following up an immunohistochemical panel of CAIX, CK7, and CD10 with molecular diagnostic studies to assist in the diagnosis of TSC/MTOR associated RCC-LS, which we believe is a distinct entity.

Clinical Features and Prognostic Factors of Metastatic Non-Clear Cell Renal Cell Carcinoma: A Multicenter Study from the Turkish Oncology Group Kidney Cancer Consortium

Introduction: We aimed to evaluate clinical features, prognostic factors, and treatment preferences in patients with non-clear cell renal cell carcinoma (nccRCC). Methods: Patients with metastatic nccRCC were selected from the Turkish Oncology Group Kidney Cancer Consortium (TKCC) database. Clinical features, prognostic factors, and overall survival (OS) outcomes were investigated. Results: A total of 118 patients diagnosed with nccRCC were included in this study. The median age at diagnosis was 62 years (interquartile range: 56–69). Papillary (57.6%) and chromophobe tumors (12.7%) are common histologic subtypes. Sarcomatoid differentiation was present in 19.5% of all patients. When the patients were categorized according to the International Metastatic RCC Database Consortium (IMDC) risk scores, 66.9% of the patients were found to be in the intermediate or poor risk group. Approximately half of the patients (55.9%) received interferon in the first line. At the median follow-up of 53.2 months (95% confidence interval [CI]: 34.7–71.8), the median OS was 19.3 months (95% CI: 14.1–24.5). In multivariate analysis, lung metastasis (hazard ratio [HR]:2.22, 95% CI: 1.23–3.99) and IMDC risk score (HR: 2.35, 95% CI: 1.01–5.44 for intermediate risk; HR: 8.86, 95% CI: 3.47–22.61 for poor risk) were found to be independent prognostic factors. Conclusion: In this study, survival outcomes are consistent with previous studies. The IMDC risk score and lung metastasis are the independent prognostic factors for OS. This is an area that needs research to better treat this group of patients and create new treatment options.

A surgical case of ciliated muconodular papillary tumor of the lung

Ciliated muconodular papillary tumor (CMPT) is a rare type of tumor with both benign and malignant characteristics. Herein, we report the surgical case of a 65-year-old man with CMPT. Chest computed tomography revealed a solitary cavitary lesion with a maximum diameter of 11-mm in S10b of the right lower lung. A thoracoscopic lung wedge resection was subsequently performed. On microscopic examination, the tumor was composed of highly columnar cells with tubular-to-papillary and cystic growth patterns. On immunostaining, it was positive for the epidermal growth factor receptor. The tumor was diagnosed as a CMPT, exhibiting no recurrence after two years of follow-up.

Clinical features and Surgical Outcome of Clear Cell Papillary Renal Cell Tumor: result from a prospective cohort

BackgroundClear cell papillary renal cell tumor (CCPRCT) was first reported in 2006 a patient with end stage renal disease. After that it was discovered in the kidney without end stage renal disease in the 2010s and started to be mentioned in pathology and urology. The incidence of CCPRCT is low and most of it is discovered incidentally, so there is a lack of reports on clinical characteristics and surgical outcome.MethodsThis study used clinical data from the Seoul National University Prospectively Enrolled Registry for Renal Cell Carcinoma-Nephrectomy (SUPER-RCC-Nx). Between August 2016 and July 2022, patients who underwent radical or partial nephrectomy with clear cell papillary RCC with pathological finding were included in this study. All patients’ pathologic reports were reviewed by 1 pathologist. Clinical characteristics and surgical outcomes were presented through descriptive statistics, and Kaplan-Meier curve used for survival analysis.ResultsOf the 2057 patients, CCPRCT was reported in 36 patients (1.8%). The median follow up period was 26.8 months. The median age was 67 years, and there were 10 females and 26 males. The median tumor size was 1.2 cm. Twenty-nine patients underwent partial nephrectomy. Seven patients with end-stage renal disease underwent radical nephrectomy. The median operative time for patients who underwent partial nephrectomy was 97.5 min and the estimated blood loss was 100 cc. The median hospital days was 4 and 30-day complications were 2 cases with clavien-dindo classification III or higher. During the follow-up period, there was no recurrence and cancer specific mortality.ConclusionsThe size of CCPRCT was small and there was no advanced stage at that time of diagnosis. There was no recurrence or cancer specific mortality during the follow-up period. A multi-center study with a large scale is needed in the future.Trial registrationSeoul National University Hospital (SNUH) Institutional Review Board (IRB) (approval number: 2210-126-1371).

Papillary Tumor of the Pineal Region: A Case Report and Literature Review

Pineal tumors of the pineal region (PTPR) are rare neuroepithelial tumors of the central nervous system, and their clinical features often lack specificity, so it is always difficult to make a definite diagnosis before surgery, and the treatment is mainly based on complete surgical resection. We report the case of a 21-year-old male who presented with intermittent dizziness and headache with vomiting for more than 2 months. The imaging revealed a mass in the region of the pineal region with obstructive hydrocephalus. After the hospitalization, the patient underwent a microscopic excision of the pineal mass, and the tissue was sent for histopathological examination and available immunohistochemical tests, which resulted in a definitive diagnosis of a papillary tumor of the pineal region. He had undergone several radiation treatments during his hospitalization and remained recurrence-free until the latest follow-up visit. This article highlights the similarities between this case and the PTPR described in WHO 2021 in terms of clinical presentation, imaging, and histopathological features. Therefore, this case report completes the sample database of PTPRs. By reviewing the literature related to PTPRs, we hope that this report will be helpful to improve the understanding of clinicians and pathologists about this rare tumor. However, more relevant studies are needed to clarify the pathogenesis, prognosis, and optimal treatment options to achieve early diagnosis, early treatment, and improved prognosis.

Limitations and Success Ratio of ERCP in the Treatment of Obstructive Jaundice

Background: Obstructive jaundice can be instigated by benign or malignant lesions. These problems are treated with biliary decompression, which can be done either endoscopically or surgically. Aim: The aim of the study is to assess the advantages and limitations as well as the therapeutic and diagnostic benefits of ERCP in the treatment of obstructive jaundice. Methods: This cross-sectional study was held in the Departments of General Surgery, Liaquat University of Medical and Health Science, Jamshoro for one-year duration from January 2022 to December 2022. A total of 70 consecutive patients were included with purposive sampling and with the diagnosis of obstructive jaundice done with ERCP. Patients with prior diagnostic or therapeutic endoscopic intervention or gastric outlet obstruction or prior gastric surgery were excluded from this study. The results are summarized in a table and conclusions are made. Results: The study included 70 patients (45 males and 25 females) with mean age of 45 years (21-70 years). The most common malignant causes of obstructive jaundice are papillary carcinoma (8.6%), cholangiocarcinoma (17.1%) and pancreatic Carcinoma (27.1%). The most common benign cause was bile duct stone (30%), followed by round warm biliary tree (5.8%) and papillary stenosis (11.4%). 30(93.8%) of patients done with stenting with 92% of success rate. Biopsies were performed to diagnose 8.6% of papillary tumors. 45.7% of patients done with stenting with 93.8% of success rate. In the remaining cases, the success rate was 100%. the most common reason for not performing ERCP; duodenal stenosis in 2.9%, abnormal papillary position in 4.3%, complete papillary obstruction in 4.3% and ampulla was not found endoscopically in 7.1% of subjects. Acute pancreatitis was the most communal complication occurred in 5.7% of cases. Bleeding occurs in 4.3% of cases; 4.3% have acute cholangitis and perforation in 2.9%. Conclusions: In spite of its complications and limitations, ERCP is a reliable stenting procedure as a palliative and tissue diagnostic tool for blockage due to malignant tumor and in the treatment of obstructive jaundice and most benign diseases. In this study, the effectiveness of ERCP in the treatment of obstructive jaundice is satisfactory. Keywords: Cholangiocarcinoma, pancreatic carcinoma, ERCP, Obstructive jaundice, and Stenting.

Curative en bloc resection of a laterally spreading mixed-nodular papillary tumor with endoscopic submucosal dissection: a case report.

A 56-year-old man was referred to our hospital with epigastric pain for 3 months. A white light image revealed a laterally spreading mixed-nodular tumor at the duodenal major papilla ([Fig. 1]), diagnosed as a tubular adenoma by biopsy. Narrow-band imaging with magnifying endoscopy demonstrated distinct demarcation, irregular micro-vessel plus surface pattern, and positive white opaque substance (WOS). After signed informed consent, we performed endoscopic submucosal dissection (ESD) using dental floss traction with a supine position ([Video 1]) and captured a resection specimen of 30 × 35 mm ([Fig. 2]).

In Brief: Adstiladrin – A Gene Therapy for Bladder Cancer

Nadofaragene firadenovec-vncg (Adstiladrin – Ferring), an adenoviral vector-based gene therapy, has been approved by the FDA for treatment of adults with high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ with or without papillary tumors. It is the first adenoviral vector-based gene therapy to be approved in the US for this indication. The immune checkpoint inhibitor pembrolizumab (Keytruda) was approved for the same indication in 2021.

Mesothelioma In Situ Mimicking Well-differentiated Papillary Mesothelial Tumor.

We have previously hypothesized that well-differentiated papillary mesothelial tumor (WDPMT) consists of 2 morphologically identical lesions, one of which is true WDPMT, while the other is a form of mesothelioma in situ. Here, we report 8 examples of the latter phenomenon, 3 with pleural disease (2 men/1 woman, ages 66 to 78y); and 5 with peritoneal disease (all women, ages 31 to 81y). At presentation the pleural cases all had effusions but no evidence of pleural tumor on imaging. Four of the 5 peritoneal cases had ascites as the initial finding and all 4 had nodular lesions that by imaging and/or direct inspection were thought to represent a diffuse peritoneal malignancy. The fifth peritoneal case presented with an umbilical mass. Microscopically, the pleural and peritoneal lesions looked like diffuse WDPMT, but all had lost BAP1. Occasional microscopic foci of superficial invasion were present in 3/3 pleural cases, while single nodules of invasive mesothelioma and/or occasional foci of superficial microscopic invasion were found in all of the peritoneal cases. The pleural tumor patients developed what clinically appeared to be invasive mesothelioma at 45, 69, and 94 months. Four/five peritoneal tumor patients underwent cytoreductive surgery and heated intraperitoneal chemotherapy. Three with follow-up data are alive without recurrence at 6, 24, and 36 months; 1 patient refused treatment but is alive at 24 months. We conclude that mesothelioma in situ morphologically mimicking WDPMT is strongly associated with the synchronous or metachronous development of invasive mesothelioma, but that these lesions appear to progress very slowly.

Diagnostic usefulness of SpyGlass in intracholecystic papillary neoplasm with pancreaticobiliary maljunction: a case report and comparison with conventional gallbladder cancer with pancreaticobiliary maljunction.

Intracholecystic papillary neoplasm (ICPN) is one of the precursors of gallbladder cancer defined in the 2010 World Health Organization classification of tumors. We herein report ICPN with pancreaticobiliary maljunction (PBM), which is a high-risk factor for biliary cancer. A 57-year-old female presented with abdominal pain. Computed tomography showed a swollen appendix and gallbladder nodules with bile duct dilatation. Endoscopic ultrasonography revealed a gallbladder tumor spreading into the cystic duct confluence accompanying PBM. Based on papillary tumors around the cystic duct detected using the SpyGlass DS II Direct Visualization System (SpyGlass DS), ICPN was suspected. We performed extended cholecystectomy, extrahepatic bile duct resection, and appendectomy with a diagnosis of ICPN and PBM. The pathological diagnosis was ICPN (90 × 50mm) with high-grade dysplasia spreading into the common bile duct. The absence of residual cancer in the resected specimen was pathologically confirmed. P53 staining was totally negative in both the tumor and normal epithelium. The overexpression of CTNNB1 was not observed. We encountered a patient with a very rare gallbladder tumor, ICPN with PBM. SpyGlass DS contributed to a precise assessment of the extent of the tumor as well as a qualitative diagnosis.

Nadofaragene Firadenovec: First Approval.

Nadofaragene firadenovec (nadofaragene firadenovec-vncg; Adstiladrin®) is a non-replicating adenoviral vector-based gene therapy developed by Ferring Pharmaceuticals for the treatment of high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC). Nadofaragene firadenovec constitutes vector DNA that encodes for interferon (IFN)-α2b and is the first approved gene therapy in bladder cancer. The production of IFN-α2b by transfected urothelial cells is associated with anticancer activity, including immunostimulatory, antiangiogenic and apoptotic effects. In December 2022, nadofaragene firadenovec received its first global approval in the USA for the treatment of high-risk BCG-unresponsive NMIBC with carcinoma in situ (CIS) with or without papillary tumours in adults. This article summarizes the milestones in the development of nadofaragene firadenovec leading to this first approval for this indication.

Conventionally fully fractionated Gamma Knife Icon re-irradiation of primary recurrent intracranial tumors: the first report indicating feasibility and safety.

With the incorporation of real-time image guidance on the Gamma Knife system allowing for mask-based immobilization (Gamma Knife Icon [GKI]), conventionally fully fractionated (1.8-3.0 Gy/day) GKI radiation can now be delivered to take advantage of an inherently minimal margin for delivery uncertainty, sharp dose falloff, and inhomogeneous dose distribution. This case series details the authors' preliminary experience in re-irradiating 7 complex primary intracranial tumors, which were considered to have been previously maximally radiated and situated adjacent to critical organs at risk. The authors retrospectively reviewed all patients who received fractionated re-irradiation using GKI at the Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada, between 2016 and 2021. Patients with brain metastases, and those who received radiotherapy courses in 5 or fewer fractions, were excluded. All radiotherapy doses were converted to the equivalent total dose in 2-Gy fractions (EQD2), with the assumption of an α/β ratio of 2 for late normal tissue toxicity and 10 for the tumor. A total of 7 patients were included in this case series. Three patients had recurrent meningiomas, as well as 1 patient each with ependymoma, intracranial sarcoma, pituitary macroadenoma, and papillary pineal tumor. Six patients had undergone prior linear accelerator-based conventional fractionated radiotherapy and 1 patient had undergone prior proton therapy. Patients were re-irradiated with a median (range) total dose of 50.4 (30-63.4) Gy delivered in a median (range) of 28 (10-38) fractions with GKI. The median (range) target volume was 6.58 (0.2-46.3) cm3. The median (range) cumulative mean EQD2 administered to the tumor was 121.1 (107.9-181.3) Gy, and the median (range) maximum point EQD2 administered to the brainstem, optic nerves, and optic chiasm were 91.6 (74.0-111.5) Gy, 58.9 (6.3-102.9) Gy, and 59.9 (36.7-127.3) Gy, respectively. At a median (range) follow-up of 15 (6-42) months, 6 of 7 patients were alive with 4 having locally controlled disease. Only 3 patients experienced treatment-related toxicities, which were self-limited. Fractionated radiotherapy using GKI may be a safe and effective method for the re-irradiation of complex progressive primary intracranial tumors, where the aim is to minimize the potential for serious late effects.

Cytomorphology of renal angiomyolipoma: performance and accuracy of touch preparation of core needle biopsy.

The recognition of renal angiomyolipoma (AML) can be challenging based on cytology preparations such as touch preparation (TP) of core needle biopsy (CNB) and fine needle aspiration. This study evaluated the cytologic features and performance of TP of CNB during rapid onsite evaluation (ROSE) of renal AML. A pathology database search was performed between 2000 and 2021 for renal CNB specimens with ROSE using TP that were primarily favored AML on preliminary impression and/or confirmed AML on CNB or subsequent resection. Twenty confirmed AML were identified (90% female, median age 65.5 years). Sixteen (80%) were deemed adequate for diagnosis at the time of ROSE, and 9 of 16 (56%) had available onsite impression: AML was favored in 4 of 9 cases (44%). Examination of TP slides revealed spindle/epithelioid cells in 20 (100%), adipose tissue in 14 (70%), and blood vessels in 3 (15%). All AML cases were subsequently confirmed by immunohistochemistry. Additionally, 3 other cases with ROSE favoring AML revealed to be "renal parenchyma with fibrosis," clear cell papillary renal cell tumor and clear cell renal cell carcinoma. Onsite evaluation of TP ensures adequate material for diagnosis in most renal AML. Spindle/epithelioid cells were the most common component seen on TP, followed by adipose tissue. Blood vessels were rarely seen. While the recognition of AML at ROSE can be challenging, proper evaluation is important in obtaining adequate diagnostic tissue. Correlation with CNB and utilization of immunohistochemistry are crucial for arriving at the diagnosis.

Mesotheliomas and Benign Mesothelial Tumors: Update on Pathologic and Imaging Findings

A diverse spectrum of benign entities and malignant neoplasms originate from the monotonous mesothelium that lines the serosal membranes of the pleural, pericardial, and peritoneal cavities. The mesothelium of myriad sites shows a common origin from the lateral plate mesoderm; primary mesothelial tumors thus demonstrate similar pathogenesis, imaging findings, and treatment options. Significant changes have been made in the 2021 World Health Organization (WHO) classification schemata of the pleural and pericardial tumors on the basis of recent advances in pathology and genetics. While malignant mesotheliomas are biologically aggressive malignancies that occur primarily in patients exposed to asbestos with attendant poor survival rates, well-differentiated papillary mesothelial tumors and adenomatoid tumors charter a benign clinical course with an excellent prognosis. Mesothelioma in situ is a newly characterized entity represented by recurrent unexplained pleural effusions without any identifiable mass at imaging or thoracoscopy. Immunohistochemical markers based on BAP1, MTAP, CDKN2A, and TRAF7 gene mutations help differentiate diffuse mesotheliomas from benign mesothelial proliferations and localized mesotheliomas. Cross-sectional imaging modalities, including US, CT, MRI, and fluorine 18-fluorodeoxyglucose (FDG) PET/CT, permit diagnosis and play a major role in staging and assessing surgical resectability. Imaging studies are invaluable in providing noninvasive and quantitative assessment of tumor response in patients with unresectable disease. Owing to significant overlap in patient characteristics and pathomorphology, accurate diagnosis based on advanced histopathology techniques and genetic abnormalities is imperative for optimal management and prognostication. While patients with nonepithelioid pleural mesotheliomas benefit from immunotherapy, novel targeted therapies for CDKN2A-, NF2-, and BAP1-altered mesotheliomas are under consideration. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.