Patients Underwent Tumor Resection Research Articles

Salivary Duct Carcinoma of the Submandibular Gland: A Case Report and Review of the Literature

We report a patient who presented with swelling to the left submandibular region. Imaging studies revealed an expansive heterogeneous process. The patient underwent tumor resection and a biopsy confirmed the presence of a salivary duct carcinoma. Additional treatment included chemotherapy and the patient is currently receiving palliative and supportive care for advanced metastatic disease. J Med Cases. 2019;10(12):354-358 doi: https://doi.org/10.14740/jmc3396

Surgical treatment of primary solitary fibrous tumors involving the pelvic ring.

The surgical treatment of primary solitary fibrous tumors (SFT) involving the pelvic ring has not been reported previously. In this study, we aimed to evaluate the efficacy of surgical treatment for this disease. From 2009 to 2015, 13 patients underwent tumor resection at our hospital, with an average age of 49.5 years (27–68 years). Four patients underwent en bloc resection, and 9 patients underwent piecemeal resections. A Chi-square test was used to compare the postoperative recurrence rates between the en bloc resection and the piecemeal resection groups (p = 0.68), and no significant difference was found between the benign and malignant solitary fibrous tumor groups (p = 0.44). The 5-year survival rate of the patients in this study was 83.3%, and the 5-year progression-free survival rate was 63.5%. The progression-free survival rate was not significantly different between the en bloc resection and piecemeal resection groups (p = 0.97). Piecemeal resection can also achieve acceptable local control, particularly for patients with sacral tumors, as they may achieve even better postoperative function with sacral nerve preservation. Recurrence and metastasis occur relatively late in the course of this disease. Therefore, long-term follow-up is required.

Effects of general anesthesia with combined epidural anesthesia on inflammatory response in patients with early-stage gastric cancer undergoing tumor resection.

The present study aimed to investigate the effects of combined epidural and general anesthesia on gastric cancer patients undergoing tumor resection. A total of 107 patients with early-stage gastric cancer who underwent surgery between January 2014 and January 2017 were enrolled in the present study. All patients in the control group (n=54) were treated with general anesthesia, while patients in the observation group (n=53) were treated with combined epidural and general anesthesia. The percentages of viable T lymphocyte subsets and the levels of carcinoembryonic antigen in the serum were measured. Furthermore, the pro-inflammatory cytokines interleukin (IL)-1, IL-8, high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor (TNF)-α were measured. Compared with those in the control group, the percentages of CD3+ and CD4+ T lymphocytes and the CD4+/CD8+ ratio in the observation group were increased, while the population of CD8+ cells was decreased. Furthermore, the serum levels of the pro-inflammatory cytokines IL-1, IL-8, hs-CRP and TNF-α in the observation group were reduced compared with those in the control group. In addition, the incidence of nausea and vomiting, as well as post-operative agitation were lower in the observation group compared with those in the control group. In conclusion, compared with general anesthesia, combined anesthesia inhibits the inflammatory response and improves immune function in early-stage gastric cancer patients undergoing tumor resection.

Intraoperative Cerebrospinal Fluid Leak in Extradural Spinal Tumor Surgery.

ObjectivePatients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population.MethodsWe reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications. ResultsA total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098). ConclusionSurgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

P1.14-08 The Usefulness of the Hemiclamshell Thoracotomy in Thoracic Surgery

The antero-lateral approach provides good exposure of the cervicothoracic region and enables removal of lesions that develop in this complex anatomic area. We retrospectively evaluated the indications and outcomes of the hemiclamshell approach in patients undergoing tumor resection in thoracic surgery. Eleven lung cancer patients and one non seminomotous germ cell tumor of the mediastinum who underwent tumor resection via hemiclamshell approach in our department, between 2007 and 2018 were studied retrospectively, analyzing the indications, morbidity and outcome. The indications were apical tumors with vascular invasion in four, giant mass (10, 17, 21cm in tumor diameter) with superior or inferior vena cava invasion in three, aortic arch invasion in one, sternal invasion in one, mediastinal lymph node metastasis in the left upper lung cancer in one, and pulmonary artery aneurysm after left upper lobectomy in one. In eleven lung cancer patients, combined resection of the neighboring organ was performed in nine organs among eight patients: subclavian artery in two, carotid artery in one, aorta in one, superior vena cava in one, chest wall in two, phrenic nerve in one, and pericardium in one. One-month mortality was 0%. Operative morbidity was observed in four patients (33%): two patients suffered from deep wound infection, one from a chylothorax, and one from pleural effusion. R0 resection was achieved in eleven patients. The hemiclamshell approach was associated with relative high morbidity rate but no mortality. Hemiclamshell is suitable for tumours of the cervicothoracic junction with vascular invasion and giant tumors, providing good access for control of the large vessels including pulmonary artery and vein.

Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study.

Postoperative delirium is a common and important complication in cancer patients. We need to identify patients at high risk of postoperative delirium such that it can be prevented preoperatively or in early postoperative phase. The aim of this study was to investigate whether preoperative anxiety predicted onset of postoperative delirium in cancer patients, not only in order to identify high-risk groups but also to help develop new preventive approaches. This was a prospective observational cohort study of cancer patients undergoing tumor resections. Postoperative delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Preoperative anxiety was evaluated with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and we defined HADS-A > 7 as clinical anxiety. We conducted multivariate logistic regression to determine which factors were predictors of delirium. The final analysis included 91 patients, 29 of whom met the criteria for postoperative delirium. In multivariable logistic regression, age (5-year increments; odds ratio (OR) = 1.565, 95% confidence interval (CI) = 1.057-2.317, p = 0.025) and HADS-A > 7 (OR = 4.370, 95% CI = 1.051-18.178, p = 0.043) predicted delirium onset. These variables explained 74.2% of the variance. Preoperative anxiety strongly predicted postoperative delirium in cancer patients. Our findings suggest that preoperative anxiety may be a new target for prevention of postoperative delirium. Trial registration number This study was registered at UMIN000018980.

Application of the Eighth Edition of the American Joint Committee on Cancer Staging for Pancreatic Adenocarcinoma.

Notable modifications have been made in the American Joint Committee on Cancer (AJCC) Staging eighth edition staging for pancreatic cancer for the consideration of the irreproducible and inapplicable of the AJCC seventh edition staging. However, the new staging classification has not been systemically verified. A comparison was performed to evaluate the application of the AJCC seventh and eighth staging classifications using the Surveillance, Epidemiology, and End Results registry (18,450 patients) and an institutional series (2040 patients). For the eighth staging classification, patients with tumor diameter of greater than 4 cm (T3N0M0, IIA) had similar prognosis to patients with 1 to 3 positive nodes (T1-3N1M0, IIB). For patients who underwent tumor resection and without lymph node involvement, survival curves of T1 (≤2 cm), T2 (2-4 cm), and T3 (>4 cm) were well separated. Statistical difference in survival analyses was demonstrated in N0 (0 positive node), N1 (1-3 positive nodes), and N2 (≥4 positive nodes) patients underwent tumor resection. The AJCC eighth edition had better stage distribution than the AJCC seventh edition for pancreatic cancer. The eighth edition of AJCC staging is more applicable and accurate than the seventh edition for pancreatic adenocarcinoma.

Abstract 5601: Single-cell molecular profiling of circulating tumor cells (CTCs) within the TRACERx study reveals heterogeneous patterns in early non-small cell lung cancer (NSCLC)

Abstract Introduction: For early stage NSCLC, surgery with curative intent is the most common therapeutic option; however, tumour recurrence occurs in approximately 50% of cases and most commonly at distant sites. Analysis of CTCs represents a potential means of tracking cancer cells from the primary tumour and has the potential to provide insights into the metastatic process and mechanisms of resistance to therapy linking cell phenotype and genotype. Within the TRACERx study, we are carrying out whole genome analysis of single CTCs obtained from NSCLC patients undergoing surgery in order to examine the relationship between CTCs, the primary tumour and metastatic relapse. Methods: Blood from 163 patients was collected at surgery from the tumour draining pulmonary vein and from peripheral vein in longitudinal samples. CTCs were enriched based on their EpCAM expression using CellSearch® and then enumerated according to their positivity for epithelial markers (Cytokeratins) and lack of detectable blood markers (CD45). Samples containing at least five CellSearch® CTCs (CS-CTCs) were processed through DEPArray™ for single cell isolation followed by whole genome amplification (WGA) using the Ampli1™ WGA kit. Genome wide copy number alterations (CNA) were detected through low-depth whole genome sequencing (WGS) and mutational analysis of individual CTCs was carried out using whole exome sequencing (WES). CTC genomic profiles were compared to the corresponding spatially separated tumour sections obtained at surgery. Results: In a pilot study of 30 patients undergoing tumour resection, the presence of pulmonary vein CS-CTCs has been linked to poor clinical outcome (Crosbie et al, J Thorac Oncol, 2016). Here we extended the evaluation of pulmonary vein CS-CTCs to a further 122 patients and confirmed the initial observation that the presence of pulmonary vein CS-CTCs is a poor prognostic indicator. CNA analysis of 100 single CTCs from the first 12 patients revealed heterogeneous patterns between patients and within individual patients. Three types of pulmonary CS-CTC candidates were observed: Type 1, which share clear copy number changes with both tumour and other CS-CTCs; Type 2, where copy number changes were detected but were not shared with the tumour; Type 3, where no copy number changes were detected. Using WES of both CTCs and matching excised tumour regions, we identified common genetic alterations shared by CTCs and the tumour, as well as private genetic changes detected only in CTCs. We are currently evaluating metastatic biopsies from relapsing patients and comparing their molecular profiles to those seen in CS-CTCs obtained at surgery. Conclusion: The combined tumour and CTC data show that single CTC analysis provides an additional layer of complexity with a valuable new perspective on tumour heterogeneity and early dissemination in NSCLC. Citation Format: Francesca Chemi, Sakshi Gulati, Dominic G. Rothwell, Debbie Burt, Daniel Slan-Tan, Barbara Mesquita, Chris Wirth, Gareth Wilson, Jackie Pierce, Ged Brady, Charles Swanton, Caroline Dive. Single-cell molecular profiling of circulating tumor cells (CTCs) within the TRACERx study reveals heterogeneous patterns in early non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5601.

Skeletal Muscle Fibrosis in Pancreatic Cancer Patients with Respect to Survival.

BackgroundCancer cachexia is a catabolic condition characterized by skeletal muscle wasting, consequent to tumor burden, which negatively impacts tolerance to cancer therapies and contributes to increased mortality. Partly because of the limited knowledge of the underlying mechanisms of cancer cachexia derived from human studies, however, the ability to therapeutically intervene remains elusive. The purpose of the current study was therefore to better define the phenotype of skeletal muscle obtained from patients with pancreatic ductal adenocarcinoma (PDAC), which has one of the highest rates of cachexia.MethodsMorphological analyses were performed on rectus abdominis muscle biopsies obtained from resectable PDAC patients undergoing tumor resection surgery (N = 20) and from weight-stable non-cancer control subjects undergoing benign abdominal surgery (N = 16). PDAC patients with a body weight loss of greater than 5% during the previous 6 months were considered cachectic (N = 15). Statistical tests were two sided. ResultsSkeletal muscle from cachectic PDAC patients had increased collagen content compared with non-cancer control subjects (1.43% vs 9.66%, P = .0004, Dunn test). Across all PDAC patients, collagen content positively correlated with body weight loss (P = .0016, r = 0.672), was increased in patients with lymph node metastasis (P = .007, Mann-Whitney U test), and was associated with survival on univariate (HR = 1.08, 95% confidence interval [CI] = 1.02 to 1.04, P = .008) and multivariable analyses (HR = 1.08, 95% CI = 1.00 to 1.17, P = .038). Cachectic PDAC patients also displayed increased lipid deposition (2.63% vs 5.72%, P = .042), infiltration of CD68+ macrophages (63.6 cells/mm2 vs 233.8 cells/mm2, P = .0238), calcium deposition (0.21% vs 2.51%, P = .030), and evidence of deficient cellular quality control mechanisms (Mann-Whitney U test). Transcriptional profiling of all patients supported these findings by identifying gene clusters related to wounding, inflammation, and cellular response to TGF-β upregulated in cachectic PDAC patients compared with non-cancer control subjects.ConclusionsTo our knowledge, this work is the first to demonstrate increased collagen content in cachectic PDAC patients that is associated with poor survival.

Solitary metastasis to a superior mediastinal lymph node after distal gastrectomy for gastric cancer: a case report

BackgroundMediastinal lymph node metastases occasionally occur in patients of advanced gastric cancer of the cardia with esophageal invasion, but they rarely occur in patients with gastric cancer of other sites. This report describes a case of a solitary metastasis to t a superior mediastinal lymph node after distal gastrectomy for gastric cancer of the antrum.Case presentationA 70-year-old man underwent curative distal gastrectomy for advanced gastric cancer of the antrum (pT2pN2M0, stage IIB). Postoperatively, he underwent adjuvant chemotherapy with S-1 (100 mg/day). Although the serum levels of his tumor markers increased after surgery, computed tomography scans did not detect evidence of early recurrence in the superior mediastinum. However, a 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan showed accumulation of fluorodeoxyglucose in the upper mediastinum with no evidence of recurrence elsewhere. Therefore, a solitary superior mediastinal lymph node was suspected to have a metastatic lesion derived from the gastric cancer. The patient underwent tumor resection right mini-thoracotomy two years and three months following gastrectomy. A pathological examination demonstrated moderately differentiated adenocarcinoma, confirming that it was a metastatic adenocarcinoma from the gastric cancer. The patient developed recurrences in the superior mediastinum and several right costa six months following the second surgery. He was treated with chemotherapy, but he died 18 months after the second operation.ConclusionWe present a rare case of a solitary metastasis to a superior mediastinal lymph node after distal gastrectomy for gastric cancer. An FDG-PET scan is useful for the diagnosis of mediastinal lymph node metastasis in gastric cancer. Metastasis to the superior mediastinal lymph nodes from gastric cancer in sites other than the cardia suggests systemic expansion of gastric cancer, and therefore, even a solitary metastasis may be related to a poor prognosis.

Infrahyoid Flap, a Convenient Alternative for Reconstruction of Tongue and Floor of Mouth Defects: Case Series.

The aim of this study was to share our clinical experience with the neurovascular myofasiocutan infrahyoid flap (NMIHF), which was used for the reconstruction of the defects after oral cavity cancer surgery. Records of five patients who were diagnosed with oral cavity cancer and underwent tumor resection, neck dissection, and defect reconstruction with NMIHF between 2012 and 2017 were analyzed retrospectively. The infrahyoid flap was used in five patients: four males and one female. The mean age of patients was 61.8 years. Four patients underwent tumor resection and bilateral level I-III neck dissection, whereas one patient underwent tumor resection and unilateral level I-III neck dissection. NMIHF was used for the reconstruction of the defects during the same procedure in all the patients. Mean post-operative follow-up was 30.6 months. Partial skin necrosis was observed in two patients, but none of the patients showed total necrosis of the flap. Postoperatively, oral intake was initiated after an average of 12 days in all patients. For two patients who required post-operative radiotherapy (RT), the treatment was started after an average of 50 days. NMIHF does not prolong operation time and does not cause additional scar in the neck, and the defect in the donor field can be closed without the use of a graft or flap. This is considered to be a reliable and successful alternative to free flaps for the reconstruction of oral cavity defects.

Clinicopathological characteristics and outcome of 31 patients with ETV6-NTRK3 fusion gene confirmed (mammary analogue) secretory carcinoma of salivary glands

ObjectivesIn 2010, a new subtype of salivary gland cancer (SGC), (mammary analogue) secretory carcinoma (SC), was defined, characterized by the ETV6-NTRK3 fusion gene. As clinical behavior and outcome data of this histological subtype tumor are still sparse, we aimed to describe the clinicopathological course and outcome of a series of translocation positive SC patients. Patient and methodsWe re-evaluated the pathological diagnosis of a subset of SGCs, diagnosed in 4 of 8 Dutch head and neck centers. Subsequently, tumors with a morphological resemblance to SC were tested for the ETV6-NTRK3 fusion gene using RT-PCR. Furthermore, patients prospectively diagnosed with SC were included. The clinical characteristics and outcomes were retrieved from the patient files. ResultsThirty-one patients with ETV6-NTRK3 fusion gene positive SC were included. The median age was 49 years, 17 patients (55%) were male. Eighteen tumors (58%) arose in the parotid gland. One patient presented with lymph node metastasis. All patients underwent tumor resection and 4 patients had a neck dissection. Four patients had re-resection and 15 patients (48%) received postoperative radiotherapy. One patient developed a local recurrence, no regional recurrences or distant metastases were observed. After a median follow-up of 49 months the 5- and 10-year overall survival were 95%, the 5- and 10-year disease free survival were 89%. ConclusionThe clinical course of SC is favorable with a low rate of locoregional recurrence and excellent survival. Given the low incidence of nodal metastases, elective neck treatment, i.e. surgery and/or radiotherapy, does not seem to be indicated.

F117. Efficacy of intraoperative electrocorticography: Long-term results of surgical treatment of symptomatic epilepsy

Electrocorticography (ECoG) is a standard procedure for the localization of the epileptogenic zone during the surgical treatment of symptomatic epilepsy. The purpose of this study was to evaluate the diagnostic efficacy of intraoperative pre- and post-resective ECoG for the localization of the epileptogenic zone in patients with symptomatic epilepsy associated with supratentorial brain tumors. Twenty-four patients (11 men) with tumor-related epilepsy and various localizations of tumors (8 persons – frontal lobe, 10 patients – temporal lobe, 2 patients – parietal lobe, 4 patients – other localization) entered this study. Patients underwent surgical treatment at the Polenov Russian Scientific Research Institute of Neurosurgery in 2013–2016. The age of the patients ranged from 22 to 66 years. Patients underwent tumor resection accompanied by neurophysiological monitoring. The ECoG was recorded intra-operatively with 2 × 4 cortical grids (Ad-Tech, USA) via the Mitsar-EEG-201 complex (Mitsar Co. Ltd., Russia). Prior to resection, registration was performed over the tumor site and adjoining cortical areas. Post-resective ECOG was performed after the removal of the tumor to assess the completeness of resection of the epileptogenic zone. In the postoperative period, the patients completed a questionnaire aimed to report the presence and severity of the postoperative seizures over a period of one to three years after the operation. The patients underwent surgical treatment with varying resection rates: gross total resection was achieved in 54% (13) patients, subtotal – in 13% (3) patients, partial – in 19% (7) patients. During the surgical treatment ECoG was performed in 62.5% (15) of the patients. In 9 out of 15 patients (60%) epileptiform activity was detected. In the long-term period, 9 patients noted the persistence of epileptic syndrome. In these 9 cases, only in 5 patients epileptic activity was registered on pre-resective ECoG, in 2 patients – on post-resective. The ECoG procedure was not performed in 9 patients due to technical challenges. In this group of patients 8 out of 9 patients reported ongoing epileptic seizures in the late postoperative period. Statistical analysis of these data shows that EcoG lacks diagnostic efficacy (χ2 = 2,27, p = 0.13). The sensitivity in this study is 50% for pre-operative ECoG and 25% for post-operative ECoG. Specificity reaches 75% for post-operative ECoG. 1. In the surgical treatment of symptomatic epilepsy associated with intracerebral neoplasm, intraoperative ECG remains a relatively effective method. 2. The effectiveness of intraoperative pre- and post-resection ECoG is affected by factors associated with the performance of neurosurgical surgery (the influence of general anesthetics, mechanical effects on the brain, repeated electrocoagulation), which significantly alter the index of epileptiform activity.

Diets That Promote Colon Inflammation Associate With Risk of Colorectal Carcinomas That Contain Fusobacterium nucleatum

Specific nutritional components are likely to induce intestinal inflammation, which is characterized by increased levels of interleukin 6 (IL6), C-reactive protein (CRP), and tumor necrosis factor-receptor superfamily member 1B (TNFRSF1B) in the circulation and promotes colorectal carcinogenesis. The inflammatory effects of a diet can be estimated based on an empiric dietary inflammatory pattern (EDIP) score, calculated based on intake of 18 foods associated with plasma levels of IL6, CRP, and TNFRSF1B. An inflammatory environment in the colon (based on increased levels of IL6, CRP, and TNFRSF1B in peripheral blood) contributes to impairment of the mucosal barrier and altered immune cell responses, affecting the composition of the intestinal microbiota. Colonization by Fusobacterium nucleatum has been associated with the presence and features of colorectal adenocarcinoma. We investigated the association between diets that promote inflammation (based on EDIP score) and colorectal cancer subtypes classified by level of F nucleatum in the tumor microenvironment. We calculated EDIP scores based on answers to food frequency questionnaires collected from participants in the Nurses' Health Study (through June 1, 2012) and the Health Professionals Follow-up Study (through January 31, 2012). Participants in both cohorts reported diagnoses of rectal or colon cancer in biennial questionnaires; deaths from unreported colorectal cancer cases were identified through the National Death Index and next of kin. Colorectal tumor tissues were collected from hospitals where the patients underwent tumor resection and F nucleatum DNA was quantified by a polymerase chain reaction assay. We used multivariable duplication-method Cox proportional hazard regression to assess the associations of EDIP scores with risks of colorectal cancer subclassified by F nucleatum status. During 28 years of follow-up evaluation of 124,433 participants, we documented 951 incident cases of colorectal carcinoma with tissue F nucleatum data. Higher EDIP scores were associated with increased risk of F nucleatum-positive colorectal tumors (Ptrend= .03); for subjects in the highest vs lowest EDIP score tertiles, the hazard ratio for F nucleatum-positive colorectal tumors was 1.63 (95% CI, 1.03-2.58). EDIP scores did not associate with F nucleatum-negative tumors (Ptrend= .44). High EDIP scores associated with proximal F nucleatum-positive colorectal tumorsbut not with proximal F nucleatum-negative colorectal tumors (Pheterogeneity= .003). Diets that may promote intestinal inflammation, based on EDIP score, are associated with increased risk of F nucleatum-positive colorectal carcinomas, but not carcinomas that do not contain these bacteria. These findings indicate that diet-induced intestinal inflammation alters the gut microbiome to contribute to colorectal carcinogenesis; nutritional interventions might be used in precision medicine and cancer prevention.

Surgical effect analysis of hepatocellular carcinoma with different lymphovascular invasion

Objective To compare the clinical features and surgical outcomes of hepatocellular carcinoma (HCC) combined with portal venous tumor thrombus (PVTT) and hepatic venous tumor thrombus (HVTT) or bile duct tumor thrombi (BDTT), and analyze the effects of different tumor thrombus (TT) types and different surgical methods for TT on prognosis. Methods The retrospective cross-sectional study was conducted. The clinical data of 220 HCC patients with lymphovascular invasion (LVI) who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University between January 2004 and December 2014 were collected. Of 220 patients, 140 were combined with PVTT, 36 with HVTT and 44 with BDTT. According to patients′ conditions, they underwent tumor and TT resection, and tumor resection + TT removal or single TT removal. Observation indicators: (1) comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT; (2) surgical and postoperative situations; (3) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 2015. Measurement data with normal distribution were represented as ±s. Comparisons among 3 indicators were analyzed using the one-way ANOVA, and comparisons between 2 indicators were analyzed using the t test. Comparisons of count data were analyzed using the chi-square test. The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method, and the Log-rank test was used for survival analysis. Results (1) Comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT: number of patients with Child-pugh A, Child-pugh B and peritoneal effusion, tumor diameter and cases with tumor capsule were respectively detected in 133, 7, 23, (10±4)cm, 91 in HCC patients with PVTT and 35, 1, 4, (9±4)cm, 27 in HCC patients with HVTT and 35, 9, 16, (6±4)cm, 15 in HCC patients with BDTT, with statistically significant differences (χ2=12.693, 10.408, F=11.300, χ2=17.188, P 0.05). ④ Of 44 HCC patients with BDTT, 24, 6 and 14 were respectively detected in type Ⅰ, Ⅱ and Ⅲ BDTTs, and median survival time, 1-, 3- and 5-year survival rates were respectively 38 months, 87.5%, 60.4%, 34.9% in type Ⅰ BDTT patients and 26 months, 83.3%, 16.7%, 0 in type Ⅱ BDTT patients and 35 months, 78.6%, 50.0%, 21.4% in type Ⅲ BDTT patients, showing no statistically significant difference in survival (χ2=5.312, P>0.05). Of 44 patients, median survival time, 1-, 3- and 5-year survival rates were respectively 38 months, 91.3%, 59.5%, 34.3% in 23 patients undergoing tumor and TT resection and 26 months, 85.7%, 35.7%, 15.3% in 21 patients undergoing tumor resection + TT removal through incising common bile duct, showing no statistically significant difference in survival (χ2=2.071, P>0.05). Conclusions HCC patients with PVTT have larger tumor diameter and worse liver dysfunction, and are prone to peritoneal effusion. HCC patients with different LVI undergo surgery. There is better prognosis in HCC patients with BDTT, and good prognosis in patients with HVTT, while poorer prognosis in patients with PVTT. The postoperative survival of HCC patients with PVTT is associated with TT type, and patients will have better prognosis after tumor resection + TT removal if TT type is confirmed earlier. The postoperative survival of HCC patients with BDTT is not associated with TT type, tumor resection + TT removal maybe prolong postoperative survival time. Key words: Carcinoma, hepatocellular; Portal venous tumor thrombus; Hepatic venous tumor thrombus; Bile duct tumor thrombus; Surgical procedures, operative; Prognosis; Overall survival rate

Ossified extradural en-plaque meningioma of the cervical spine

A 57-year-old woman sustained gradually progressive sensorimotor disturbance in the left upper extremity for one year. Neurological examination found a diminished sensation below the left C7 dermatome and reduced strength in the left interosseous muscles. Computed tomography of the cervical spine revealed a high density mass at C7, in the left dorsal part of the spinal canal. Magnetic resonance imaging found an enhancing, en-plaque tumor at C6-T1, involving a non-enhancing part, and considerable compression of the spinal cord. The patient underwent tumor resection through hemilaminectomy of C5-C7. The tumor was located epidurally, highly fibrous including bony-hard parts, and severely adhered to the dura mater that necessitated drilling for debulking. A subtotal resection was achieved and histological diagnosis was a fibrous meningioma with metaplastic ossification. Ossification may be a pathognomonic appearance of spinal extradural meningiomas that makes resection maneuvers difficult.

Somatotrophic Adenoma in Children Younger than 14 Years: Clinical Features and Treatment of 22 Cases at a Large Pituitary Center.

To investigate the clinical features of somatotrophic adenoma in children younger than 14 years and to evaluate the short-term and long-term outcomes of transsphenoidal surgery. This single-center retrospective study included 22 patients with somatotrophic adenoma who were admitted to our institution between January 1997 and January 2017. The patients' demographics, hormone levels, imaging characteristics, surgical outcomes, and follow-up data were summarized. The average age of patients at diagnosis was 10.3 years, and the average disease duration was 42.5 months. Growth acceleration was observed in 90.9% of patients. Mixed somatolactotrophic adenoma was identified in 36.4% of patients. In total, 77.3% of tumors on imaging were macroadenomas or giant adenoma, and 50% were invasive. Twenty-one patients underwent tumor resection, and the remission rate after a single transsphenoidal surgery was 45%. Preoperative growth hormone levels (P= 0.017), growth hormone nadir (P= 0.003), and tumor size (P= 0.026) were the most likely influencing factors associated with the surgical remission rate. Postoperative cerebral spinal fluid leakage (15%) was the main complication of transsphenoidal surgery. During a median follow-up period of 42.5 months, 72.7% of the patients obtained remission after monotherapy or combined treatment, and no recurrence was observed. Somatotrophic adenomas in children younger than 14 years tend to be macroadenomas with a shorter disease duration than that observed in adults. Transsphenoidal surgery is safe and effective and could represent a preferred treatment option. The combination of surgery, medication, and radiation is recommended to achieve optimal long-term outcomes.

Oncological and functional results after surgical treatment of bone metastases at the proximal femur

BackgroundMetastatic lesions to the proximal femur occur frequently (about 10% of patients with cancer) and require surgical treatment. There are many surgical methods of treatment, however, use of the tumor modular endoprostheses seems to be particularly promising. The aim of study was to evaluate oncological and functional results of treatment in patients with proximal femur metastases. Oncological results were evaluated considering the survival of patients and the number of local recurrences. Functional results were assessed as pain intensity in VAS score and performance in Karnofsky and MSTS score.MethodsBetween 2010 and 2016, 122 patients with metastatic tumour to the proximal femur were treated in our hospital. Majority of the patients were women − 77 patients. The mean age was 67 years for women and 72 years for men. Pathological fracture was diagnosed in 98 cases. Metastatic bone tumors commonly develop from breast cancer – 48 and myeloma – 24. One hundred one patients underwent tumor resection and in 21 cases metastatic tumors was not resected. In 75 patients wide tumour resection and modular endoprosthetic replacement were prefomed. Twenty-one patients underwent standard or long stem hip endoprosthetic replacement. Intramedullary gamma nails were implanted in 20 cases and DHS plate in 6 cases. In 92 cases 3-4 weeks after surgery patients undergo external beam radiotherapy (8Gy).Functional results were assessed as pain intensity in VAS score and performance in Karnofsky and MSTS score. Oncological results were evaluated considering the survival of patients and the number of local recurrences.ResultsThe mean follow-up of patients was 27 months (min 4, max 51). Forty-five patients died before last visit in hospital. The mean survival after modular endoprosthetic replacement was 860 days and after bone fixations 360 days. We noticed 9 cases of local recurrences or progressions, 6 in patients who had no radiotherapy. Three patients after modular endoprosthesis replacement and 6 after bone fixations.After surgery, all patients experienced improvement in the comfort of life resulting from reduction in pain. Mean VAS score before modular endoprosthetic replacement was 6.8 and after 3.4; before standard prothesoplasty 4.9 and after 2.8; and before and after bone fixation 6.9 -5.1. Mean MSTS score was respectively 6.4-19.8; 8.8-22.4 and 10.8-18.2.In 6 patients after modular endoprosthesis replacement, delayed wound healing were observed. Infectious complications were not observed after fixation with nails and plates. In 3 cases, the fixation was failed. The systemic complications affected 12 patients.ConclusionsResults of surgical treatment for metastases to the proximal femur are particularly good in patients after standard or modular endoprostheses replacement. The author considers this treatment method to be optimal in patients with good prognosis.

Value of Fluorine-18-fluorodeoxyglucose PET/CT examination to predict microvascular invasion of hepatocellular carcinoma

Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18F-FDG) positron-emission temography/computed tomography (PET/CT) examination to predict microvascular invasion(MVI) of hepatocellular carcinoma (HCC). Methods The retrospective cohort study was conducted. The clinicopathological data of 51 HCC patients who were admitted to Changhai Hospital of the Second Military Medical University (32 patients) and Universal Medical Imaging Diagnostic Center (19 patients) from January 2013 to October 2017 were collected. Of 51 patients receiving postoperative pathological examination, 21 diagnosed with positive MVI and 30 diagnosed with negative MVI were respectively allocated into the positive and negative MVI groups. All the patients received preoperative 18F-FDG PET/CT examination and underwent surgery after related examinations. Two imaging doctors independently read films and made a semi-quantitative analysis. Observation indicators: (1) results of 18F-FDG PET/CT examination; (2) multivariate analysis and diagnostic value affecting MVI of HCC; (3) treatment and follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative patients′ survival up to November 2017. Measurement data with normal distribution were represented as ±s, and comparisons between groups were evaluated with the independent-sample t test. Measurement data with skewed distribution were described as M(Qn), and comparisons between groups were analyzed using the independent-sample rank sum test. Comparisons of count data were analyzed using the chi-square test. Logistic regression analysis was performed in variables with statistical significance. The inclusion criteria was 0.05 and exclusion criteria was 0.10 according to Backward (LR) method for screening variables. Receiver Operating Characeristic (ROC) curve analysis was used to evaluate the diagnostic value using MVI as a diagnostic standard. Results (1) Results of 18F-FDG PET/CT examination: of 51 HCC patients, tumors located in the right lobe, left lobe and caudate lobe of the liver were respectively detected in 37, 12 and 2 patients. CT examinations of 51 HCC patients: HCCs showed the hypodense shadow or slightly hypodense shadow in liver and were round-like, and some of the larger lesions were irregularly conglomerate, with a relatively clear tumor-liver boundary; tumor necrosis area showed patchy and irregular lower density, with small lesions around the port of tumors. Of 51 patients, 34 were positive on PET and 17 were negative on PET, and some necrotic areas showed no uptake and located in the center of tumors. There was no abnormal 18F-FDG uptake in other parts of the whole body. The maximum diameter of tumor was (6±3)cm. The maximum standardized uptake value (SUVmax), and ratio of SUVmax of tumor to SUVmax of liver (SUVmax T/L) in all the lesions were 6.38±4.91 and 2.42±1.93, respectively. The mean standardized uptake value (SUVmean), metabolism of volume (MTV), total lesion of glycolysis (TLG) of 40 patients were 4.30±2.46, 43.82 cm3 (8.97 cm3, 219.13 cm3) and 165.73 (28.26, 794.50), respectively, and software could not automatically delineate lesions in other 11 patients due to low metabolism. Delayed imaging was found in 21 patients, and the delayed SUVmax and retention index (RI) were 7.22±6.26, 19.66% (-7.10%, 50.84%), respectively. The cases with positive and negative on PET were 18, 3 in the positive MVI group and 16, 14 in the negative MVI group, respectively, with a statistically significant difference between groups (χ2=5.829, P<0.05). The maximum diameter of tumor in the positive MVI group and negative MVI group was respectively (7.7±2.9)cm and (5.2±3.1)cm, with a statistically significant difference between groups (t=-2.930, P<0.05). (2) Multivariate analysis and diagnostic value affecting MVI of HCC: the results of multivariate analysis showed that maximum diameter of tumor was an independent factor affecting MVI of HCC (OR=1.276, 95% confidence interval: 1.028-1.585, P<0.05). The area under the ROC curve of the maximum diameter of tumor was 0.723 using MVI as a diagnostic standard. The sensitivity, specificity and Youden index were respectively 90.5%, 50.0% and 0.405, with 4.55 cm as the critical value. (3) Treatment and follow-up: all 51 patients underwent tumor resection. Twenty-two patients were followed up for 25 months (range, 12-46 months). The 1- and 2-year overall survival rates were 81.8%(18/22) and 63.6%(14/22), respectively. The 1- and 2-year tumor-free survival rates were 59.1%(13/22) and 45.5%(10/22), respectively. Conclusion The positive rate on PET of 18F-FDG PET/CT examination in HCC patients with positive MVI is higher than that in HCC patients with negative MVI, and the maximum diameter of tumor is an independent factor predicting MVI of HCC, with a certainly reference value. Key words: Liver neoplasms; Carcinoma, hepatocellular; Microvascular invasion; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Sustained Delivery of Doxorubicin via Acetalated Dextran Scaffold Prevents Glioblastoma Recurrence after Surgical Resection.

The primary cause of mortality for glioblastoma (GBM) is local tumor recurrence following standard-of-care therapies, including surgical resection. With most tumors recurring near the site of surgical resection, local delivery of chemotherapy at the time of surgery is a promising strategy. Herein drug-loaded polymer scaffolds with two distinct degradation profiles were fabricated to investigate the effect of local drug delivery rate on GBM recurrence following surgical resection. The novel biopolymer, acetalated dextran (Ace-DEX), was compared with commercially available polyester, poly(l-lactide) (PLA). Steady-state doxorubicin (DXR) release from Ace-DEX scaffolds was found to be faster when compared with scaffolds composed of PLA, in vitro. This increased drug release rate translated to improved therapeutic outcomes in a novel surgical model of orthotopic glioblastoma resection and recurrence. Mice treated with DXR-loaded Ace-DEX scaffolds (Ace-DEX/10DXR) resulted in 57% long-term survival out to study completion at 120 days compared with 20% survival following treatment with DXR-loaded PLA scaffolds (PLA/10DXR). Additionally, all mice treated with PLA/10DXR scaffolds exhibited disease progression by day 38, as defined by a 5-fold growth in tumor bioluminescent signal. In contrast, 57% of mice treated with Ace-DEX/10DXR scaffolds displayed a reduction in tumor burden, with 43% exhibiting complete remission. These results underscore the importance of polymer choice and drug release rate when evaluating local drug delivery strategies to improve prognosis for GBM patients undergoing tumor resection.