Tumor Pathological Features Research Articles

Minimally invasive versus open resection of distal pancreatic neuroendocrine neoplasms: an NCDB analysis

Presenter: Courtney Chen MD | Cedars-Sinai Medical Center Background: Pancreatic neuroendocrine neoplasms (PNENs) are a heterogenous group of pancreatic neoplasms and comprise 1-2% of pancreatic malignancies in the US. Resection of PNENs without extrapancreatic extension confers a survival benefit, particularly in tumors ≤2cm, with well-differentiated pancreatic neuroendocrine tumors (WDPNETs) having better prognosis compared to pancreatic neuroendocrine carcinomas (PNECs). Optimal resection strategies using minimally invasive (MIS) approaches versus open resection remain controversial despite increasing use of MIS. This study aims to identify predictors for overall survival (OS) after MIS versus open distal pancreatectomy (DP) for PNENs. Methods: The NCDB was queried from 2010-2016 for pancreatic tail PNEN patients who underwent robotic, laparoscopic, or open DP (n=2252; WDPNET n = 1373; PNEC n = 879). Exclusion criteria included extrapancreatic extension and distant metastases. Patients were grouped based on histology (WDPNET vs PNEC). Patient demographics, pathologic tumor characteristics, and surgical outcomes were compared. Mann-Whitney U and Pearson’s Chi-squared tests were used for nonparametric continuous and categorical variables, respectively. Kaplan Meier estimate was used to assess mean OS between groups, with the log rank test to test for significance. Cox proportional hazard analysis were performed and included age, Charlson/Deyo comorbidity (CDC) score, tumor grade, pathologic tumor and nodal stages, surgical approaches, R1 resection, and lymphovascular invasion. Results: A total of 2252 PNEN patients who underwent DP (robotic DP = 313; laparoscopic DP = 991; open DP = 948) were included. MIS approaches resulted in significantly lower 90-day mortality and length of stay (LOS) (p=0.03, p<0.01 respectively), although PNENs resected with MIS DP (robotic median size = 22mm, laparoscopic median size = 20mm) had smaller tumors compared to open DP (open median size = 25mm) (robotic vs laparoscopic p=0.81; robotic vs open p=0.04; laparoscopic vs open p<0.01; p=0.01 overall). Robotic DP had a significantly higher rate of R1 resection compared to laparoscopic DP (p=0.03). R1 resection had no impact on OS for WDPNETs (HR=0.88, 95% CI 0.24-3.23) or PNECs (HR=1.08, 95% CI 0.32-3.56) on cox regression analysis. Laparoscopic DP had significantly better OS only with PNECs (HR 0.49, 95% CI 0.26-0.92). Pathologic N1 status in WDPNETs was associated with significantly worse survival (HR 2.31, 95% CI 1.05-5.09) but was not significant for PNECs. Higher grade tumors (Grade 3) had worse prognosis as expected (HR 5.73, 95% CI 2.63-12.47). Conclusion: Patients who undergo MIS DP for PNENs likely benefit from short-term decreases in morbidity and mortality with non-inferior oncologic outcomes compared to open DP, even with R1 resection. Consideration of MIS DP for pancreatic tail PNENs of all histologic types is warranted, and future studies are needed to identify potential benefits beyond short-term decreases in morbidity, mortality, and hospital LOS.

LAR vs VLAR in Low Rectal Cancer - Postoperative Results - A Single-Center Experience.

Background: The management of rectal cancer recognizes surgical resection as the most important step towards a permanent cure. Respecting the oncological principles, functional preservation represents a priority in achieving an acceptable quality of life for the patient. This study aimed to compare the results after low anterior resection (LAR) versus very low anterior resection (VLAR), in terms of postoperative outcome. Methods: We conducted a retrospective, observational study on a group of 147 patients with LAR or VLAR done for low rectal cancer in the 1st Department of General Surgery of the Emergency County Hospital of Targu Mures, between January 2015 and December 2019. We considered as low rectal cancer tumors located between 5-10 cm from the anal verge and very low those situated less than 5 cm from it. Patients were divided in two groups according to the type of operation. The postoperative evolution was followed. Results: The two groups, LAR with 81 and VLAR with 66 cases, had homogenous distribution regarding patients demographic and biological parameters and tumor pathological features. A significantly (p=0.0223) longer surgical intervention time was reported in VLAR than in LAR procedures. We found no statistically significant differences between LAR and VLAR in terms of associated postoperative morbidity or mortality, neither in hospitalization time. Conclusions: There was no statistical difference in terms of early postoperative outcomes among LAR and VLAR. The most important factor in achieving good oncologic and functional results in low rectal cancer is choosing the adequate, tailored to the case surgical management.

Repeat hepatectomy outcomes for colorectal liver metastases from an international multicenter collaborative

Presenter: Cristian D Valenzuela MD | Wake Forest University Background: Resection of colorectal metastases to the liver has become the standard of care when feasible, prolonging survival. However, despite improved surgical approaches, subsequent isolated hepatic recurrences are not unusual. Repeat hepatectomy for Colorectal Liver Metastases (CLM) appears to be safe and effective for recurrent disease, but there is paucity of data with few reports from large studies. We report an experience in over one thousand surgical CLM cases in a multicenter database from five hepatobiliary institutions. Methods: An international collaborative of five institutions (Wake Forest, Mayo Clinic Jacksonville, University of California San Francisco, Yale, and University of Hong Kong) was formed to collect CLM cases performed at these locations from 2000-2018. Institutional review committees approved this project at all locations. A total of 1004 CLM hepatectomy cases were identified. Compiled data included: patient demographics, comorbidities, primary tumor and metastasis characteristics, pre-operative labs and imaging, operative characteristics including hepatectomy type, transfusions, tumor pathology features, complications, neoadjuvant and adjuvant therapies, surveillance strategies, recurrence characteristics, and survival. Kaplan-Meier analysis was performed with the Log Rank test to determine differences between subgroups. Complications were considered major if the Clavien-Dindo score was three or greater, and the Chi-Square test was used to compare subgroups. Results: For all cases, median overall survival after hepatectomy for CLM was 47.2 months, and disease-free survival was 19.0 months with a median follow-up of 32.0 months. Repeat hepatectomy was performed in 78 patients (7.9%): 51 (65%) were minor and 27 (35%) were major hepatectomies, similar to first-hepatectomies, in which 551 (61%) were minor and 358 (39%) were major. Ablations were performed as part of first-hepatectomy in 121 (13.3%) patients, and as part of second-hepatectomy in 6 patients (7.6%). From time of surgery, there was no significant difference in median overall survival (49.1 vs 47.2 months, p=0.830) or disease-free survival (19.6 vs. 19.3 months, p=0.288) after second hepatectomy compared to first hepatectomy. Patients who underwent repeat hepatectomy had improved median overall survival from time of cancer diagnosis compared to patients undergoing only one hepatectomy (87.5 vs 65.0 months, Log Rank χ2 =3.926, p= 0.048). Microscopic margin status was associated with outcomes after hepatectomy for CLM: median overall survival for R1 liver resections was 35.5 months versus 48.7 months for R0 resections (Log Rank χ2 = 11.06, p=0.001). Similarly, median disease-free survival was significantly worse for R1 resections compared to R0 resections (15.1 vs. 19.6 months; Log Rank χ2 = 5.074; p=0.024). Whether the hepatectomy was minor or major had no significant effect on median overall survival (49.7 vs. 43.6 months, Log Rank χ2 = 1.681; p=0.195). However, major hepatectomy was associated with a significantly higher number of major complications compared to minor hepatectomy (17.9% vs. 12.1%; p=0.0004). Conclusion: A second hepatectomy for recurrence was beneficial for patients with CLM, yielding improved survival compared to those only undergoing one hepatectomy. Generally, obtaining R0 margins during hepatectomy for CLM was important for overall survival. Major hepatectomy was associated with higher risk of severe complications, but was associated with similar survival compared to minor hepatectomy for CLM.

Kliničko-patološke karakteristike tumora kostiju karlice

Introduction: Bone tumors are rare neoplasms whose therapy depends on the location. Pelvic bones represent a special anatomical entity diagnosis and therapy of pelvic tumors in addition to the pathohistological type largely depends on the anatomical specifics of that region. Aim: The aim of this study was to show the frequency, as well as clinical and pathological characteristics of primary and secondary tumors of the pelvic bones. Material and methods: The research as a descriptive study in the period from January 1, to December 31, 2019 at the Institute of Pathology of the Medical Faculty of the University of Belgrade and includes 33 patients. Demographic, clinical and radiological data were obtained from the Bone Tumor Registry. Statistical processing and analysis were done in the Statistical Package for Social Science SPSS Windows version 22 (IBM Chicago, Ilinois, USA). Results: Out of 33 patients, 55% had secondary pelvic tumors, primarily cancer metastases (37%). In 21% of cases, primary malignant bone tumor as diagnosed, and in 12%, primary benign bone tumor. Hematopoietic neoplasms were verified in 12%. Conclusion: Pelvic bone tumors are not common, but these neoplasms, in orthopedic oncology, represents their malignant biological behavior are of great importance. The most common primary malignant tumor in adults is chondrosarcoma, and in children Ewing sarcoma. Highest frequency for pelvic bone metastases has lung cancer. Plasmacytoma in adults, Langerhans cellular histiocytosis in children are hematological neoplasms seen at this site.

An Online Calculator to Predict Recurrence after Hepatectomy for Colorectal Liver Metastasis: Reflecting the New Era of Genetic and Biological Features

Introduction: The risk of recurrence after hepatectomy for colorectal liver metastasis (CRLM) remains high. The objective of the current study was to develop a novel online calculator to estimate the risk of CRLM recurrence using pathological, genetic, and morphologic tumor characteristics.

Association of Human Parvovirus B19 with Papillary Thyroid Carcinoma and its Relationship with Tumor Staging and Pathologic Features

Background: Papillary thyroid carcinoma (PTC) is the most prevalent form of thyroid cancer. In some studies, parvovirus B19 (PVB19) infection was involved in the pathogenesis of thyroid diseases such as Graves’ disease, Hashimoto thyroiditis, and thyroid cancer. PVB19 induces chronic inflammation in thyroid, which can lead to carcinogenesis through the effect of inflammatory mediators. The association of PVB19 with PTC tumorigenesis is still a matter of controversy. We evaluated the correlation of PVB19 with PTC and, for the first time, pathologic features. Method: This cross-sectional retrospective study focused on the thyroid specimens of 82 patients with PTC and 77 patients with benign thyroid nodules. We conducted the present study from March 2014 to November 2017 in the hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. We evaluated the presence of PVB19 DNA by nested polymerase chain reaction method in PTC, adjacent non-malignant tissues, and benign thyroid nodules. PVB19 positivity was also compared between PTC and two other groups. We further investigated the association of pathologic features and tumor staging with PVB19 positivity. Results: Of the patients, 81% were female. We detected PVB19 positivity in 9.8% of PTC specimens and 0.01 of adjacent non-malignant tissues (P=0.016). None of the benign thyroid nodule specimens had PVB19 DNA, and they were significantly different from PTC specimens (P=0.007). There was no significant correlation between PVB19 positivity and tumor stages (P=0.988) and histologic types (P=0.560). Conclusion: This research, similar to some other studies, showed a significant association between PTC and PVB19 positivity. For the first time, we showed that no significant relationship existed between PVB19 positivity and tumor stages and histologic types. Further investigations are needed to evaluate the relationship between this virus and PTC.

Expression of tumor-associated vascular insulin receptor in colorectal cancer and its relationship with tumor pathological features

To study the expression of tumor associated vascular insulin receptor (TVIR) in colorectal cancer with or without metabolic syndrome (MS) and its relationship with the pathological features of colorectal cancer. The expression of TVIR in 220 colorectal cancer specimens was detected by tissue microarray and immunohistochemistry. The relationships between the expression of TVIR and the pathological features (pathological subtypes, histological grade, invasion depth, lymph node metastasis and TNM stage) of colorectal cancer with/without MS were analyzed. The insulin receptor expression was observed in colorectal cancer tissue or border area between cancer and normal tissue, but not in normal intestinal tissue. The high-expression rates of TVIR in MS group was remarkably lower than that of non-MS group (21.6%vs. 41.0%, P< 0.05). TVIR high expression was significantly associated with tumor deep invasion, lymph node metastasis and high TNM stage (P<0.05 or P<0.01). Univariate logistic regression analysis showed high-expression of TVIR to be significantly associated with risk of deep invasion (OR=2.21, 95% CI: 1.10-4.44, P<0.05), lymph node metastasis (OR=2.21, 95% CI: 1.26-3.86, P<0.01) and high TNM stage (OR=2.08, 95% CI: 1.19-3.63, P<0.05). Such associations can be observed in patients without MS, but not in patients with MS. s: High-expression of TVIR is associated with aggressive pathological features such as invasion, lymph node metastasis and high TNM stage of colorectal cancer, especially for those patients without MS. TVIR could be a useful biological marker for prognosis of colorectal cancer.

Preservation of Endopelvic Fascia: Effects on Postoperative Incontinence and Sexual Function – A Randomized Clinical Trial

BackgroundUrinary incontinence and sexual dysfunction are common after robot-assisted radical prostatectomy (RALP). New surgical techniques to improve these functions after the operation are under evaluation for example, preservation of endopelvic fascia during RALP. However, the benefits of this technique have not been critically scrutinized in a randomized setting. AimIn this study, we compared endopelvic fascia preserving operation with the standard surgical procedure in a randomized trial at the Tampere University Hospital, Finland. MethodsA total of 158 men with localized prostate cancer and scheduled for RALP were randomized 1:1 into endopelvic fascia–preserving RALP or a control group that is, standard operation. All operations were performed by a single surgeon. OutcomesUrinary and sexual function were evaluated by the Expanded Prostate Cancer Index Composite-26 questionnaire at baseline and 3, 6, and 12 months after the surgery. ResultsThere was no difference in urinary incontinence or sexual function between the groups at any time point (urinary incontinence domain at 12 months after RALP for fascia preserving and control group 73.6 ± 3 vs 78.9 ± 2.5 and sexual domain 43 ± 3.2 vs 40.3 ± 3, respectively). Clinical and pathologic tumor characteristics, duration of surgery, blood loss, rate of complications, and time to hospital discharge were similar between the study arms. Compliance of filling out the Expanded Prostate Cancer Index Composite-26 questionnaire varied from 91% to 98%, with no difference between study arms. Clinical ImplicationsBased on our results, endopelvic fascia preservation alone during RALP is not recommended over the standard surgical method. Strengths & LimitationsThis is a randomized clinical study with sufficient statistical power. As a limitation, only a minority of participants underwent magnetic resonance imaging before the operation, thus we could not evaluate the role of urethral length or shape of the prostate. Urinary and sexual function results are based on questionnaires filled out by the patients, however, participants completed the surveys independently unassisted by health care personnel. ConclusionEndopelvic fascia–preserving RALP does not improve urinary continence or sexual function as compared with the standard surgical technique. Future studies aiming to improve functional outcomes after RALP should focus on evaluating other technique modifications.Siltari A, Riikonen J, Murtola TJ. Preservation of Endopelvic Fascia: Effects on Postoperative Incontinence and Sexual Function – A Randomized Clinical Trial. J Sex Med 2021;18:327–338.

Clinicopathological characterization of primary pulmonary and tracheal glomus tumors

Objective: To investigate the clinical pathological features of primary pulmonary and tracheal glomus tumors. Methods: The clinical and pathological features of 11 cases (4 cases from Shanghai Pulmonary Hospital, Tongji University School of Medicine, China and 7 cases from Fudan University Shanghai Cancer Center, China) of respiratory glomus tumor diagnosed from 2010 to 2019 were analyzed, and reviewed in light of the relevant literature. Results: In the 11 cases, there were 5 males and 6 females, with the onset ages of 29‒66 years (median age of 43). Six tumors were located in the lung, and 5 in the trachea. The tumor diameters ranged 1.0‒7.5 cm, with the average diameter of 2.6 cm. At low magnification, the tumors were diffuse or lobulated in shape. The tumor cells composed of sheets of oval to short spindle cells, with sharply defined cell border and prominent branching thin-walled vessels. Among the 4 benign glomus tumors, one was classified as benign symplastic glomus tumor owing to the hyperchromatic or degeneration nuclei. Two cases were classified as glomus tumors of uncertain malignant potential, on the account of cellular atypia and rare atypical mitotic figures. Five cases were classified as malignant glomus tumors, owing to the tumor necrosis, vascular invasion, marked nuclear atypia, prominent nucleoli and brisk mitoses (2-20/10HPF) including pathological mitotic figures. The tumor cells showed strong immunostaining for SMA, vimentin, type Ⅳ collagen and caldesmon to different extents, while CD34, cytokeratin and S-100 stains were negative. One of the cases was positive for desmin, and one case positive for synaptophysin. Follow-up information was available in 8 patients with the duration ranging from 6 to 95 months. At the end of the follow-up, 6 patients were alive without recurrence or metastasis, and two of the patients with malignant glomus tumors died. Conclusions: Primary pulmonary and tracheal glomus tumors is rare. Among the reported cases, malignant glomus tumor is the most frequent, followed by benign glomus tumors and uncertain malignant potential glomus tumors. Glomus tumors show sheet-like growth pattern and clusters of round epithelioid cells with numerous vascular spaces. They can be easily misdiagnosed as carcinoid tumor. The final diagnosis should be combined with immunohistochemical staining, such as SMA, caldesmon and vimentin.

Detection and assessment of capsular invasion, vascular invasion and lymph node metastasis volume in thyroid carcinoma using microCT scanning of paraffin tissue blocks (3D whole block imaging): a proof of concept

In the modern era, detailed pathologic characteristics of a thyroid tumor are crucial to achieve accurate diagnosis and guide treatment. The presence of capsular invasion (CI) is diagnostic for carcinoma, whereas vascular invasion (VI) and nodal metastasis (NM) are included in risk stratification. However, the very definition of CI and VI is surrounded by controversies and an accurate assessment of NM is lacking. Whole Block Imaging (WBI) by microCT is a new imaging modality to create 3D reconstruction of whole tissue block with microscopic level resolution without the need for tissue sectioning. In this study, we aimed to define CI, VI, and NM volume using WBI by microCT. Twenty-eight paraffin blocks (PBs) from 26 thyroid tumors were scanned. Ten PBs contained CI, whereas 7 had VI. 3D microCT images were compared with whole slide images (WSI) of corresponding H&E slides. In 2 cases with VI and/or CI, WSI of serial H&E slides were obtained and underwent 3D-reconstruction to be compared with the WBI. Satellite tumor nodules beyond tumor capsule were shown to be CI by demonstrating the point of penetration using microCT and 3D reconstruction. Additional foci of CI were detected using microCT. VI was seen using microCT. Fibrin associated with tumor thrombus was not always present on serially sectioned H&E slides. WBI by microCT scanner was able to assess the volume of NM. In conclusion, WBI is able to detect CI, VI, and assess the volume of NM in thyroid carcinoma without tissue sectioning. It is the ultimate method for the complete sampling of the tumor capsule. It has the potential to increase the detection rate of CI, better define criteria for CI and VI, and provide an accurate assessment of the volume of nodal disease. This technology may impact the future practice of surgical pathology.

Prognostic role of microRNA 182 and microRNA 18a in locally advanced triple negative breast cancer.

BackgroundThe study assessed the epigenetic regulation and the role of microRNA (miR) expression in locally advanced triple negative breast cancers (TNBC) and comparison with the clinico-pathological variables and survival.MethodsFifty patients of locally advanced TNBC during the period 2011–2013 were included. Expression level of test microRNA (miR-182 and miR-18a) was determined using Taqman quantitative Real time polymerase chain reaction (qRT-PCR) from formalin fixed paraffin embedded biopsy blocks. Clinical and demographic information and survival data was retrieved from the Hospital medical records.ResultsAn improved clinical complete response (cCR) was observed in patients with age ≥ 45 years (80%), premenopausal status (70%), tumor size < 6 cms (80%), nodal status N0-N1 (95%) and grade II-III tumor (80%). A statistically significant correlation was observed on comparison of cCR with menopausal status (p-value 0.020), T category (p-value 0.018) and the clinical nodal status (p-value 0.003). pCR also correlated with clinical nodal status (p-value 0.008). Epigenetically, miR-18a under expression (< 8.84) was most commonly associated with tumor size < 6 cms (76.7%), clinical nodal status N0-N1 (90%), cCR (60%) and pCR (53.3%). A similar trend was observed with miR-182. Statistical significance was observed with T category (p-values 0.003 and 0.004), clinical nodal status (p-values 0.001 and 0.001), clinical response (p-values 0.002 and 0.002) and pathological response (p-values 0.007 and 0.006) with respect to miR-18a and miR-182, respectively. Also, the menopausal status significantly correlated with the miR-182 expression (p-value 0.009). miR-182 overexpression (≥ 6.32) was not observed in any of the postmenopausal patients. A univariate cox proportional hazard regression model also showed statistical interactions (p-values <0.004).ConclusionmiR-182 and miR-18a overexpression correlates with worse clinical and pathological tumor characteristics in locally advanced TNBC and hence could be used to predict the outcomes and prognosis in these patients.

Recurrence and Disease-Free Survival in Head and Neck Squamous Cell Carcinoma After Margin-Free Resection on Frozen Section: An Institutional Perspective.

IntroductionThe most important factor determining survival in patients with head and neck squamous cell carcinoma (HNSCC) is a disease recurrence. A high rate of recurrence was noted in previous studies conducted in Pakistan; however, these studies did not consider margin status as inadequate margin clearance leads to disease recurrence. In this study, we determined cancer recurrence in patients with HNSCC after nullifying this factor.MethodsThis cross-sectional observational study was conducted in Liaquat National Hospital (LNH) for a duration of three years. Data collection period was from January 2015 to December 2017. A total of 150 patients that underwent surgery at LNH for HNSCC with margin-free frozen sections were included in the study. Pathological tumor characteristics such as tumor type, size, depth of invasion and nodal status were determined.ResultsThe mean age of the patients was 50.31±12.90 with mean tumor size of 3.38±1.76. Nodal metastases were present in 45.3% cases with 17.3% showing extranodal extension. Recurrence was observed in 66% of cases with median disease-free survival of 12 months and perineural invasion was noted in 12% cases. We found a significant association of disease recurrence with larger tumor size, depth of invasion and extranodal extension. Moreover, younger age (<30 years) and older age (>50 years) groups showed higher rates of recurrence than the middle age group (30-50 years). Similarly, univariate and multivariate analyses revealed that tumors with ≥1 cm depth of invasion and the presence of extranodal extension were more likely to have disease recurrence than tumors with <1 cm depth of invasion and without extranodal extension. Survival analysis using the Kaplan-Meier method for HNSCC revealed a significant difference in disease-free survival in patients with more than 2 cm tumor size and ≥1 cm depth of invasion than cases with ≤ 2cm tumor size and <1 cm depth of invasion.ConclusionA high rate of disease recurrence for HNSSC was noted in our study, despite margin-free primary tumor resection. Apart from tumor size and depth of invasion, extranodal extension was significantly associated with disease recurrence in HNSCC. This signifies a need for margin evaluation of neck dissection specimen in cases with extranodal extension.

Targeted Next-Generation Sequencing Identifies Molecular and Genetic Events in Dedifferentiated Chondrosarcoma.

Dedifferentiated chondrosarcoma is a rare adult bone tumor with a dismal prognosis and is composed of a conventional chondrosarcoma juxtaposed to high-grade nonchondrogenic sarcoma. Dedifferentiated chondrosarcomas may represent tumor progression from a differentiated to a primitive histotype. To determine the genetic and molecular events that drive progression from a conventional chondrosarcoma to high grade nonchondrogenic sarcoma. We analyzed the genomic landscape of paired conventional and dedifferentiated components of 11 dedifferentiated chondrosarcoma using targeted next-generation DNA sequencing with immunohistochemical validation. Clinical, radiographic, and pathologic features of tumors were reviewed. Capture-based DNA sequencing targeting the coding regions of 479 cancer genes and select introns was performed. The tumors arose in the femur (n = 4; 36%), scapula (n = 3; 27%), pelvis (n = 3; 27%), and humerus (n = 1; 9%) of 7 men (64%) and 4 women (36%; median age, 61 years). DNA was adequate for sequencing from all 11 dedifferentiated components (100%) and 9 paired conventional chondrosarcoma components (82%). All tumors (100%) harbored either IDH1 p.R132 or IDH2 p.R172S hotspot mutations. Seven tumors (64%) displayed COL2A1 alterations. TERT promoter mutations were present in 5 of 9 pairs (56%) and 2 (22%) additional unpaired dedifferentiated components. IDH1/2, COL2A1, and TERT mutations were identical in both components of the paired samples. Pathogenic missense or truncating mutations in TP53 and large-scale copy number alterations were more common in dedifferentiated components than in those of matched conventional components. The results support IDH1/2, COL2A1, and TERT promoter mutations being common in dedifferentiated chondrosarcoma and as likely early events in progression, whereas inactivating mutation of TP53 and high-level copy number alterations may be later events in the dedifferentiated phenotype.

Multimodal imaging of a retinal cavernous hemangioma.

We describe the characteristics of an isolated retinal cavernous hemangioma in a young female patient using multimodal imaging. Fundus examination of the right eye showed a large vascular mass, composed by clusters of dark red and dilated saccular angiomatous formations with superficial whitish fibroglial tissue and hemorrhages, located in the inferonasal peripheral retina, along the vascular arcade. On green-light fundus autofluorescence the lesion appeared hypoautofluorescent, with moderately hyperautofluorescent areas. On multiColor imaging it showed mainly a green pseudocolor, with knobby surface and well-defined irregular margins. Fundus fluorescein angiography showed early hypofluorescence within the tumor mass and late incomplete staining, without leakage. Ocular ultrasonography documented an elevated well-defined hyperechogenic lesion, with high internal reflectivity, without choroidal excavation, retinal detachment, or acoustic shadowing. Swept source optical coherence tomography showed multilobulated cavernous formations, varying in size, containing for the greatest part hyperreflective material, within an interconnecting fibrous scaffold and with an overlying partially adherent epiretinal membrane. Optical coherence tomography angiography documented a few highly reflective, tortuous and abnormal branching veins extending into the tumor mass, with a root-like appearance, and surrounding nodular changes, corresponding to the angiomatous formations. Different imaging modalities can be used in combination for a better evaluation of the pathological features of this rare vascular tumor.

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

BackgroundTo explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS.MethodsStudies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model.ResultsA total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR = 0.58, 95% CI 0.48, 0.71, P < 0.00001), lymphovascular invasion (RR = 0.68, 95% CI 0.47, 0.99, P = 0.004) and vascular invasion (RR = 0.66, 95% CI 0.45, 0.99, P = 0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR = 0.92, 95% CI 0.77, 1.09, P = 0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD = − 3.18, 95% CI − 4.47, − 1.90, P < 0.00001). While no significant difference was found in the number of positive lymph nodes (MD = − 0.11, 95% CI − 0.63, 0.42, P = 0.69) and N stage [N0 (RR = 1.03, 95% CI 0.92, 1.15, P = 0.60), N1 (RR = 0.99, 95% CI 0.87, 1.14, P = 0.91), N2 (RR = 0.94, 95% CI 0.77, 1.15, P = 0.53)].ConclusionsSEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

The effect of sex on disease stage and survival after radical cystectomy: a population-based analysis

BackgroundThe increased awareness regarding the sex gap in bladder cancer (BCa) care over the last decade may have resulted in more timely-wise referral patterns and treatment of female patients with BCa. Thus, we tested the association of sex with disease stage at presentation, as well as with cancer-specific mortality (CSM) after radical cystectomy (RC) in a contemporary cohort of patients with nonmetastatic urothelial bladder cancer (UCUB). MethodsWithin the Surveillance, Epidemiology, and End Results database (2004–2016), we identified 14,086 patients (10,879 men and 3,207 women) treated with RC for non-metastatic UCUB. Temporal trend, interaction analyses, logistic regression, cumulative incidence, and competing-risks regression analyses were used. ResultsOverall, 10,879 (77.2%) men and 3,207 (22.8%) women underwent RC between 2004 and 2016. Female gender was an independent predictor of non-organ-confined (NOC) UCUB at RC in multivariable analyses (odds ratio: 1.23; 95% confidence intervals [CI] 1.10–1.38; P < 0.001). While NOC rates in men decreased over time (from 54.8% to 45.7%; P < 0.01), NOC rates in women remained stationary (from 60.6% to 57.3%; P = 0.15) and the excess NOC rate between men and women increased from + 5.8% in 2004 to +11.6% in 2016. Moreover, in multivariable analyses adjusted for other covariates, female gender was an independent predictor of higher CSM after RC in NOC UCUB (HR: 1.14; 95%CI 1.04–1.24; P < 0.01), but not in localized UCUB (P = 0.06). ConclusionIt is worrisome that, while in men the rate of NOC is decreasing, NOC rates in females have not improved over time. Moreover, it is also worrisome that, despite adjustment for both pathological tumor and patient characteristics, female sex remains an adverse prognostic factor for CSM. Reassessment of referral, diagnostic, and treatment patterns aimed at eliminating these sex discrepancies appears warranted.

Evaluation of the Learning Curve in Robotic Nipple-sparing Mastectomy for Breast Cancer

BackgroundThis study discusses the preliminary results of robotic nipple sparing mastectomy (R-NSM) in patients with breast cancer and analyzes the learning curve of the same surgeon in a single medical center. Patients and MethodPatients with breast cancer from a single center who received R-NSM between 2018 to 2020 were recruited for clinical and pathologic tumor characteristics including family history, grade, type of tumor, treatment, and outcome. The learning curve for R-NSM was analyzed by using cumulative sum (CUSUM). ResultsA total of 85 R-NSM procedures from 78 patients were evaluated. In the CUSUM plot analysis of the learning curve, a significant decrease in time for mastectomy, reconstruction, and total operation appeared in the 22nd, 23rd, and 26th procedures, respectively. Patients’ body weight, gel implant size, and specimen weight had significant correlations with the time for mastectomy. Four (5.6%) patients had nipple partial ischemia, and 1 (1.4%) had total nipple necrosis. The mean follow-up was 11.4 ± 6.2 months; only 1 patient showed recurrence. ConclusionRobotic breast surgery is a feasible method with good cosmetic outcome under suitable patient selection. Oncologic safety is not a reason to stop its development.

Prognostic impact of paraneoplastic syndromes on patients with non-metastatic renal cell carcinoma undergoing surgery: Results from Canadian Kidney Cancer information system.

The impact of paraneoplastic syndromes (PNS) on survival in patients with renal cell carcinoma (RCC) is uncertain. This study was conducted to analyze the association of PNS with recurrence and survival of patients with non-metastatic RCC undergoing nephrectomy. The Canadian Kidney Cancer information system is a multi-institutional cohort of patients started in January 2011. Patients with nephrectomy for non-metastatic RCC were identified. PNS included anemia, polycythemia, hypercalcemia, and weight loss. Associations between PNS and recurrence or death were assessed using Kaplan-Meier curves and multivariable analysis. Of 4337 patients, 1314 (30.3%) had evidence of one or more PNS. Patients with PNS were older, had higher comorbidity, and had more advanced clinical and pathological tumor characteristics as compared to patients without PNS (all p<0.05). Kaplan-Meier five-year estimated recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were significantly worse in patients with PNS (63.7%, 84.3%, and 79.6%, respectively, for patients with PNS vs. 73.9%, 90.8%, and 90.1%, respectively, for patients without PNS, all p<0.005). On univariable analysis, presence of PNS increased risk of recurrence (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.48-1.90, p<0.0001) and cancer-related death (HR 1.85, 95% CI 1.34-2.54, p=0.0002). Adjusting for known prognostic factors, PNS was not associated with recurrence or survival. In non-metastatic RCC patients undergoing surgery, presence of PNS is associated with older age, higher Charlson comorbidity index score, advanced tumor stage, and aggressive tumor histology. Following surgery, baseline PNS is not strongly independently associated with recurrence or death.

Intracranial kaposiform hemangioendothelioma presenting as epistaxis: a rare case report with review of literature

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of intermediate malignancy with tendency for local invasion and recurrence. The tumor almost exclusively occurs in children, especially in infants. Intracranial KHE are extremely rare with only two cases reported in the literature. We report the clinical and pathological features of this rare tumor arising from basitemporal region in a 21-month child. Our case did not present with Kasabach-Merritt phenomenon. Histopathological examination confirmed the diagnosis of KHE. KHE should be considered in the differential diagnosis of intracranial extra-axial neoplasm in children, and histopathological examination plays an important role in distinguishing KHE from its morphologic mimics. It is essential to diagnose KHE due to its locally aggressive nature.

Spread through air spaces (STAS) in invasive mucinous adenocarcinoma of the lung: Incidence, prognostic impact, and prediction based on clinicoradiologic factors.

BackgroundSpread through air spaces (STAS) has recently been demonstrated to exhibit a negative impact on lung adenocarcinoma prognosis. However, most of these studies investigated STAS in nonmucinous adenocarcinoma. Here, we investigated the incidence of STAS in invasive mucinous adenocarcinoma (IMA) of the lung and evaluated whether tumor STAS was a risk factor of disease recurrence in IMA. We also examined clinicoradiologic factors in patients with IMA harboring STAS.MethodsWe reviewed pathologic specimens and imaging characteristics of primary tumors from 132 consecutive patients who underwent surgical resection for IMA to evaluate STAS. Patients with and without STAS were compared with respect to clinical characteristics as well as computed tomography (CT) imaging using logistic regression. The relationships between all variables including STAS and survival were analyzed.ResultsAmong a total of 132 patients, full pathologic specimens were available for 119 patients, and STAS was observed in 86 (72.3%). IMA patients with STAS were significantly associated with older age, presence of lobulated and spiculated margins on CT scan (P = 0.009, P = 0.006, and P = 0.027). In multivariate analysis for overall survival (OS), STAS was a borderline independent poor prognostic predictor (P = 0.028). Older age, history of smoking, higher T stage, presence of lymph node metastasis, and consolidative morphologic type remained independent predictors for OS.ConclusionsSTAS was associated with reduced OS and was a borderline independent poor prognostic factor in IMA. IMA with STAS was associated with older age and presence of lobulated and spiculated margins on CT scan.Key pointsSignificant findings of the studyCompared with other subtypes, IMA shows a higher incidence of STAS, which is an independent poor prognostic predictor even in IMA. Lobulated and spiculated margins on CT are associated with STAS.What this study addsConsidering that STAS can carry the potential for aerogenous metastasis, predicting STAS using preoperative surrogate CT imaging is desirable to avoid limited resection.