Prognostic Parameters Research Articles

Assessment of right ventricular ejection fraction cut-point for predicting mortality and heart failure hospitalization in asian patients with heart failure and reduced ejection fraction (HFrEF)

Abstract Background Left ventricular ejection fraction (LVEF) has been well established as a predictor of morbidity and mortality in heart failure patients (HF). Meta-analyses have confirmed that right ventricular systolic dysfunction (RVSD) identified by cardiac MR predicts adverse outcomes in HF patients. However, the cut-point and predictive value of right ventricular ejection fraction (RVEF) in Asian patients remain unknown. Objectives To evaluate the RVEF cut-point for RVSD and demonstrate the association between RVSD by cardiac MR and a composite endpoint consisting of HF hospitalisation and/or all-cause mortality in HFrEF patients (LVEF ≤40%). Materials & Methods A retrospective chart review of 370 consecutive HFrEF patients who underwent cardiac MR between 01 June 2009 and 31 December 2013 was done. The primary outcome was defined as all-cause mortality and/or HF hospitalisation. Receiver Operating Characteristic (ROC) analysis was done to explore the most accurate RVEF as a cut-point for RVSD. Multivariate Cox regression analysis was calculated. Results Patients were followed for a total of 1,989 patient-years with an average of 5.4 ± 2.9 years. The primary outcome occurred in 112 patients (30.3%). ROC analysis demonstrated that RVEF <48% provided the most accurate prognostic value (specificity 52%, sensitivity 70%) with an area under the curve of 0.62 (95% CI 0.55 – 0.69). Multivariate Cox analysis showed that RVSD was a significant independent risk factor (hazard ratio 1.71; 95% CI 1.10 – 2.66; p=0.018) for the primary outcome, in addition to age (p<0.001), New York Heart Association functional class (p<0.001), and diabetes mellitus (p=0.014), regardless of LVEF. Conclusions In Asian HFrEF patients, RVSD defined by RVEF <48% by cardiac MR can predict adverse events and provide a prognostic parameter for risk stratification.

What is the true normal: comparison of different equations for estimating peak oxygen uptake for outcome prediction in heart failure

Abstract Background and Objectives One of the strongest prognostic parameters obtained during Cardiopulmonary exercise testing (CPET) in patients with heart failure (HF) is the peak oxygen uptake (pVO2), as a standalone or as a percentage of the predicted peak oxygen uptake (ppVO2) reached. However, traditional standards by which ppVO2 is calculated have limitations, having been derived from small cohorts, lacking portability and poorly represented by women. Thus, we aim to compare the FRIEND Registry equation to previously used methods of calculating ppVO2 as it relates to prognostic value imparted by the percentage of ppVO2 (%ppVO2) reached during CPET and portability to the Portuguese HF population. Methods Single centre retrospective study of patients with HF with LVEF < 50% who underwent CPET between 2015-2021. Patients who did not reach RER≥ 1.05 were excluded from our analysis. All tests were evaluated and ventilatory thresholds determined by 3 independent, experienced operators. ppVO2 was calculated according to 1) the Wasserman equation; 2) the Wasserman equation using ideal body weight; 3) the Neder equation, 4) the SHIP equation and 5) the FRIEND equation. Our primary endpoint was a composite of CV death, urgent transplant or left ventricular assist device implantation and HF hospitalization. Results We included 238 patients (mean age 59 ± 11 years, 83% males). The HF aetiology was mostly ischemic in nature (68%), with LVEF of 34 ± 9% and median NTproBNP of 776 (2566 – 2342) pg/mL. Most patients (67%) were in class NYHA I-II and with high prevalence of GDMT (93% ACEi/ARB; 97% beta-blockers and 64% on MRA). Mean BMI in this group was 27.3 ± 4.7 kg/min. Patients performed CPET on a treadmill with a protocol adjusted to their predicted exercise capacity. Mean pVO2 was 18.1 ± 6.2mL/kg/min, corresponding to a median %ppVO2 that ranges from 51 ± 16% to 71 ± 22%, depending on the equation that is used. Mean VE/VCO2 Slope was 42 ± 13 and 48 % (n = 98) of patients showed exercise oscillatory ventilation (EOV). Mean ppVO2 as per the FRIEND and Wasserman equations was 18.9 ± 6.6 and 21.2 ± 4.5 mL/kg/min, with no statistically significant difference between both. %ppVO2 as calculated through all equations was an independent predictor of prognosis on multivariate analysis adjusted for LVEF, NTproBNP and VE/VCO2 Slope (p < 0.001 for values derived from all equations). However, the FRIEND and Wasserman equations showed a slight advantage over the remaining 2 equations, with higher AUC on ROC curve analysis (see figure). Conclusions In our population of Portuguese patients with HF, both the FRIEND registry and Wasserman equations for predicting pVO2 yielded strong prognostic power. However, these equations provide different absolute predicted VO2 values for the same patients and thus should not be used interchangeably. Standardisation of the type ppVO2 equation used should be recommended by local scientific societies.

Expression of CD44 in Triple Negative Breast Cancer and its Correlation with Prognostic Parameters

Background: The study aims to evaluate CD44 expression as a cancer stem cell marker in Triple-negative breast cancer (TNBC) and its correlation with prognostic parameters. Evaluation of CD44 immunoexpression in TNBC is vital for understanding tumour aggressiveness and determining its prognostic value. Methods: A hospital based cross sectional study of 50 cases of primary triple negative breast cancer patients. The tissue sections were subjected to immunohistochemical examination using CD44 antigen marker. The proportion and intensity of CD44 immunostaining was assessed and correlation with prognostic markers such as histological grade, tumor size and nodal status. Results: CD44 expression was observed in 40% of the total cases with a statistically significant association with histological grade (p-value= 0.002). Higher CD44 expression was noticed with increasing tumour grade. However, no statistical significance was observed with respect to tumour size and nodal status. Conclusion: The study suggests that CD44 immunoexpression may serve as a surrogate marker of BCSCs and may hold prognostic value in TNBC patients. However, further studies on larger samples are required to fully understand its role.

The combination of CDX2 expression status and tumor-infiltrating lymphocyte density as a prognostic factor in adjuvant FOLFOX-treated patients with stage III colorectal cancers.

Colorectal carcinomas (CRCs) with caudal-type homeobox 2 (CDX2) loss are recognized to pursue an aggressive behavior but tend to be accompanied by a high density of tumor-infiltrating lymphocytes (TILs). However, little is known about whether there is an interplay between CDX2 loss and TIL density in the survival of patients with CRC. Stage III CRC tissues were assessed for CDX2 loss using immunohistochemistry and analyzed for their densities of CD8 TILs in both intraepithelial (iTILs) and stromal areas using a machine learning-based analytic method. CDX2 loss was significantly associated with a higher density of CD8 TILs in both intraepithelial and stromal areas. Both CDX2 loss and a high CD8 iTIL density were found to be prognostic parameters and showed hazard ratios of 2.314 (1.050-5.100) and 0.378 (0.175-0.817), respectively, for cancer-specific survival. A subset of CRCs with retained CDX2 expression and a high density of CD8 iTILs showed the best clinical outcome (hazard ratio of 0.138 [0.023-0.826]), whereas a subset with CDX2 loss and a high density of CD8 iTILs exhibited the worst clinical outcome (15.781 [3.939-63.230]). Altogether, a high density of CD8 iTILs did not make a difference in the survival of patients with CRC with CDX2 loss. The combination of CDX2 expression and intraepithelial CD8 TIL density was an independent prognostic marker in adjuvant chemotherapy-treated patients with stage III CRC.

Prognostic Value of Separate Extramural Vascular Invasion Reporting in Operative Samples of Rectal Cancer: Single-Institutional Experience.

Vascular invasion, especially extramural vascular invasion (EMVI), has emerged as a prognostic parameter for rectal cancer (RC) in recent years. Prediction of recurrence and metastasis development poses a significant challenge for oncologists, who need markers for prediction of adverse outcome. The aim of this study was to examine the prognostic significance of pathohistologically detected EMVI in untreated rectal cancer and its implications in separate reporting. We examined 100 untreated RC patients who underwent curative resection from January 2016 to June 2018 with a follow-up of 5 years. Patients were divided into equal EMVI- and EMVI+ groups based on histological re-examination of H&E-stained postoperative surgical samples. The presence of EMVI within the selected cohort was significantly associated with female gender, T3/T4 and N1/N2 post-operative stages, positive lymph nodes, lymph node ratio LNR2 and LNR3 groups, abundant tumor-infiltrating lymphocytes, positive lympho-vascular invasion (LVI), perineural (PNI), and circumferential resection margin (CRM) (p < 0.05 in all tests). Within EMVI+ patients, local recurrences and/or metastases and death outcomes were more frequent events (p = 0.029 and p = 0.035, respectively), while survival analyses revealed that EMVI+ patients had significantly shorter overall survival (OS, p = 0.040) and disease-free survival (DFS, p = 0.028). Concerning LVI, differences in OS between LVI+ and LVI- patients were not statistically significant (p = 0.068), while LVI+ patients had significantly shorter DFS (p = 0.024). Moreover, univariate COX regression analysis demonstrated the negative impact of EMVI on OS (HR: 2.053, 95% CI: 1.015-4.152; p = 0.045) and DFS (HR: 2.106, 95% CI: 1.066-4.870; p = 0.038), which was not the case for LVI + RC patients. The obtained results strongly suggest the significance of separate reporting of EMVI from lympho-vascular invasion, as it is potentially a surrogate marker for adverse prognosis and outcome.

Correlation of tumor budding with a novel and other established prognostic parameters in patients with invasive breast carcinoma.

Breast cancer is the most common malignancy among women. Established prognostic markers in breast carcinomas include tumor size, histologic grade, nodal status, lymphovascular invasion, perineural invasion, hormone receptor status, HER-2 status, and age. To correlate peripheral tumor budding (pTB) with stromal tumor-infiltrating lymphocytes (sTILs) and established prognostic factors in invasive breast carcinoma. It is a retrospective study conducted at multiple centers including a tertiary care center. 100 cases were included over a period of 2.5 years. All cases of invasive breast carcinoma (IBC) in which excision specimens with lymph node dissection were available were studied. Slides were reviewed for pTB and sTILs. Tumor budding of ≤20/10 hpf was considered low tumor budding, and >20 buds/10 hpf was considered high tumor budding. Tumor budding was correlated with age, tumor size, lymphovascular invasion, perineural invasion, tumor stage (pT, pN), stromal tumor-infiltrating lymphocytes, tumor grade, ductal carcinoma in situ, hormonal receptors, and HER2neu. Fisher exact test and Chi-square test were used. We found that high tumor budding was seen in 34 cases and low tumor budding in 66 cases. There was a statistically significant association between high tumor budding and tumor size (P = 0.007), lymphovascular invasion (P < 0.001), perineural invasion (P = 0.004), tumor staging/pT (P = 0.006), nodal staging/pN (P = 0.001), and low sTILs (P < 0.001). However, the association of high tumor budding with parameters like age (P = 0.979), histological type (P = 0.243), tumor grade (P = 0.052), DCIS (P = 0.478), and ER (P = 0.633), and PR (P = 0.544), HER2Neu status (P = 0.171) was not significant. This study suggests tumor budding score can be used as a prognostic indicator for breast cancer.

Outcome of autologous bone marrow transplant in patients with relapsed and refractory diffuse large B-cell lymphoma in relation with prognostic factor: A single-center experience

Abstract: BACKGROUND Currently, about 50% of diffuse large B-cell lymphoma patients are relapsed following their complete response to first-line therapy. The treatment strategy for fit patients with relapsed refractory diffuse large B-cell lymphoma (R/R DLBCL) has been done with salvage therapy with non-cross resistant combination chemo-immunotherapy regimens followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT). OBJECTIVES: The aim of study was to evaluate the outcome of ASCT for R/R DLBCL in relation to certain prognostic parameters. PATIENTS, MATERIALS AND METHODS: This is retrospective study, conducted from May 2014 to December 2022, at Hematology and BMT Center of Medical City Complex in Baghdad. Thirty-six patients with R/R DLBCL were investigated pre- and post-ASCT; the recorded data included patient disease status pre-transplant, early mortality rate, and type of response at day 100 post-transplant and, survival rate, relapsed rate, and mortality at the end of the study were documented accordingly. RESULTS: The mean age of DLBCL patients in this study was 41.3 (14–65) years, post-ASCT at day 100; there were 33 (91.6%), 2 (5.5%), and 1 (2.7%) patients in complete remission, relapsed progressive disease, and death, respectively, At 3-year posttransplant, the overall survival (OS) was 71%, whereas the event-free survival (EFS) was 59%. According to disease status pre-ASCT, the OS was 62%, 80%, and 66% with P = 0.7, whereas the EFS was 66%, 60%, and 50% with P = 0.5 for CR, UCR, and PR, respectively. CONCLUSION: Iraqi bone marrow transplant center data showed acceptable OS and EFS results in the treatment of R/R DLBCL patients in areas where there is no more option in terms of better OS and EFS but with insignificant relation to the available prognostic factor.

Immunohistochemical Expression of Cyclin D1 in Invasive Breast Carcinoma

Objective: This study was conducted to determine the immunohistochemical expression of cyclin D1 in invasive breast carcinoma and its association with already established prognostic parameters like estrogen receptor (ER), progesterone receptor (PR), HER2/Neu, and Ki67 status. Study Design &amp; Setting: Cross sectional Observational. Department of Pathology, Armed Forces Institute of Pathology, Rawalpindi Methodology: The study included 350 cases of invasive breast cancer diagnosed between January 2023 and December 2023. Data collected included patient age, histological subtype, molecular subtypes, tumor size, and the presence of estrogen (ER) and progesterone (PR) receptors, as well as HER2/Neu and Ki67 status. Patients who had undergone chemotherapy, received radiation to the breasts, or experienced relapse were excluded from the study. Immunohistochemistry was conducted using a Cyclin D1 antibody to assess Cyclin D1 expression in tissue samples. The expression levels were categorized as negative, weak, moderate, strong staining in tumor cells. Data analysis was performed using SPSS 29.0, and statistical comparisons were made between Cyclin D1 staining and ER, PR, HER2/Neu, and Ki67 status. Results: Cyclin D1 moderate to strong staining was seen in 173/352 (49.14%) cases of invasive BC. Cyclin D1 expression was slightly statistically significantly associated with ER (x2 = 7.78, P value &lt;0.051) and Ki67 positivity (÷2 = 7.27, P value &lt;0.064). Conclusion: Cyclin D1 has the potential to serve as a prognostic marker. Incorporating it into the routine IHC workup for breast cancer could enhance patient management, especially with the development of new targeted therapies that inhibit the Cyclin D-CDK4/6 axis.

Clinical cases of verruciform epidermodysplasia of Lewandovski—Luts

Data from the medical literature and own observations of veruciform epidermodysplasia of Lewandovski — Luts (VEDLL) indicate that there are many issues that need to be resolved or clarified. They relate, in particular, to carrying out genetic research — in order to prove the phenomenon and regularities of heredity of dermatosis. The detection of a benign neoplastic formation in one of our patients — esophageal leiomyoma — obliges doctors to carefully examine patients with VEDLL, even without complaints about disorders of one or another body system. Does such a case not suggest the possibility of neoplastic transformation of a benign nature and not only from the side of the skin (papillomas and warts)? Can HPV for VEDLL cause, in addition to skin carcinoma, the occurrence of internal organ tumors? An important task of dermatologists is the early detection of patients among children, who often have common forms of wart-like efflorescences. It can be assumed that in some patients, the disease is latent for some time and manifests itself only under the influence of adverse factors (inadequate insolation, stress, etc.). The issues of VEDLL require practicing dermatovenereologists not only to conduct clinical and differential diagnosis of wart-like dermatoses but also to carry out laboratory tests to identify dermatosis (biopsy, cytology, PCR), which will allow for more frequent detection of VDLL. Since the rarity of VEDLL does not contribute to the accumulation of a sufficient amount of results on the detection of pathogenetic factors of dermatosis, particularly immunological ones, the treatment problem remains relevant. It is necessary to conduct permanent monitoring of the development of VEDLL to identify early signs of neoplastic transformation and determine predictors, that is, prognostic parameters, and introduce methods for their determination.

Evaluation of Multiple Tissue Levels Frequently Upstages Patients With Clinically Localized Thin Primary Cutaneous Melanoma.

Breslow thickness (BT), ulceration, and microsatellitosis are critical prognostic parameters for cutaneous melanoma staging. These parameters can vary depending on the number of tissue levels examined from individual paraffin blocks. We sought to evaluate all prognostic histopathologic parameters in melanoma for their variations between levels, taken at regular intervals, in a single study. We analyzed 40 consecutive cases of primary cutaneous (nonacral) melanoma through five hematoxylin and eosin sections, taken at 100 μm intervals, for staging and prognostic parameters. Examination of additional levels resulted in (a) an increase in BT in 47.5% (19 out of 40) of cases and (b) detection of ulceration in a further 5% (2/40). This resulted in upstaging for 20% (8 out of 40) of patients (15% because of BT, 2.5% because of ulceration, and 2.5% because of BT and ulceration). The upstaging effect was incremental, with approximately 5% of patients upstaged with each additional 100 μm interval (up to 400 μm). Incipient ulceration and epidermal consumption were infrequent (10% of cases); however, when present, ulceration was subsequently observed in half of cases. We encountered no cases where microsatellitosis was detected at deeper levels. The performance of additional tissue levels is a simple and inexpensive procedure that can improve the accuracy of staging for patients with thin (pT1) primary cutaneous melanomas. It may be pertinent for pathologists to consider additional levels for thin melanomas when a BT measurement is close to a staging threshold (e.g., within 0.1-0.3 mm for pT1a vs. pT1b, or pT1b vs. pT2a), or when incipient ulceration is encountered.

Fetal Fraction of Cell-Free DNA in the Prediction of Adverse Pregnancy Outcomes: A Nationwide Retrospective Cohort Study.

To assess the added value of fetal fraction of cell-free DNA in the maternal circulation in the prediction of adverse pregnancy outcomes. Retrospective cohort study. Nationwide implementation study on non-invasive prenatal testing (NIPT; TRIDENT-2 study). Pregnant women in the Netherlands opting for NIPT between June 2018 and June 2019. Two logistic regression prediction models were constructed for each adverse pregnancy outcome. The first model (base model) included prognostic clinical parameters that were selected from existing first-trimester prediction models for adverse pregnancy outcomes. The second model (fetal fraction model) included fetal fraction as a predictor on top of the prognostic clinical parameters included in the base model. The added prognostic value of fetal fraction was assessed by comparing the base and fetal fraction models in terms of goodness of fit and predictive performance. Likelihood ratio test (LRT), area under the curve (AUC) and Integrated Discrimination Improvement (IDI) index. The study cohort consisted of 56 110 pregnancies. The incidence of adverse pregnancy outcomes was 5.7% for hypertensive disorders of pregnancy (HDP; n = 3207), 10.2% for birthweight < p10 (n = 5726), 3.2% for birthweight < p2.3 (n = 1796), 3.4% for spontaneous preterm birth (sPTB; n = 1891), 3.4% for diabetes (n = 1902) and 1.3% for congenital anomalies (n = 741). Adding fetal fraction to the base model improved model fit for HDP, birthweight < p10, birthweight < p2.3, all sPTB, and diabetes, but not for congenital anomalies (LRT p < 0.05). For HDP, the AUC improved from 0.67 to 0.68 by adding fetal fraction to the base model (p = 0.14) with an IDI of 0.0018 (p < 0.0001). For birthweight < p10, the AUC improved from 0.65 to 0.66 (p < 0.0001) with an IDI of 0.0023 (p < 0.0001). For birthweight < p2.3, the AUC improved from 0.67 to 0.69 (p < 0.0001) with an IDI of 0.0011 (p < 0.0001). For all sPTB, the AUC was similar for both models (AUC 0.63, p = 0.021) with an IDI of 0.00028 (p = 0.0023). For diabetes, the AUC was similar (AUC 0.72, p = 0.35) with an IDI of 0.00055 (p = 0.00015). Fetal fraction has statistically significant but limited prognostic value in the prediction of adverse pregnancy outcomes in addition to known prognostic clinical parameters.

Maximum standardized uptake value-to-tumor size ratio in fluorodeoxyglucose F18 positron emission tomography/computed tomography: a simple prognostic parameter for non-small cell lung cancer.

By correcting the effect of tumor size on metabolic activity, the maximum standardized uptake value-to-tumor size (SUVmax:tumor size) ratio on fluorodeoxyglucose F18 positron emission tomography (18F-FDG PET)/computed tomography (CT) scans can be a prognostic parameter of non-small cell lung cancer (NSCLC). The current study evaluates the prognostic value of SUVmax:tumor size ratio on pretreatment 18F-FDG PET/CT scans in patients with NSCLC. Furthermore, the SUVmax:tumor size ratio is compared with other established PET parameters. This study included 108 patients with NSCLC who underwent pretreatment 18F-FDG PET/CT scans and curative lung surgery. The associations between the SUVmax:tumor size ratio and other conventional PET parameters were investigated. The recurrence-free survival according to the SUVmax:tumor size ratio was also analyzed. In addition, the SUVmax:tumor size ratio was compared according to postoperative pathologic findings. In total, 72 (66.7%) of the 108 participants presented with adenocarcinoma (ADC). Nineteen (17.6%) patients experienced recurrence during a median follow-up period of 32.3 months. The median SUV max:tumor size ratio was 2.37 (1.23 for ADCs and 3.90 for other histologic types). The SUVmax:tumor size ratio was associated with SUVmax and mean SUV, as well as metabolic tumor volume and total lesion glycolysis. Patients with an SUVmax:tumor size ratio higher than the median had a worse recurrence outcome than those with an SUVmax:tumor size ratio lower than the median. Participants with ADC who presented with lymphovascular invasion had a higher SUVmax:tumor size ratio than those without. The presence of lymph node metastasis and advanced histologic grade were associated with a high SUVmax:tumor size ratio in patients with ADC. The SUVmax:tumor size ratio on pretreatment 18F-FDG PET/CT scans was associated with aggressive tumor behavior and poor outcome in NSCLCs, particularly ADC. The SUVmax:tumor size ratio on pretreatment 18F-FDG PET/CT scans has a prognostic value in patients with NSCLCs, especially ADC.

Evaluation of Tumour-Associated Macrophages and Colony-Stimulating Factor-1 Expression in Invasive Breast Carcinoma and Their Association with Prognostic Parameters

INTRODUCTION: Recent breast cancer research has focused on tumour microenvironment (TME). Tumour-associated macrophages (TAMs) are the key players in TME as they provide pro-tumorigenic milieu for tumour progression and metastasis. These macrophages are primarily regulated by colony-stimulating factor-1 (CSF-1) secreted by breast cancer cells. This study investigated the association of localization of TAMs infiltration within breast carcinoma and CSF-1 expression by cancer cells with the pathological prognostic parameters. MATERIALS AND METHODS: TAMs were assessed in 128 cases of invasive breast carcinoma by CD163 immunohistochemical expression. The median TAM density in both the tumour nest and tumour stroma was utilized to classify TAMs into categories of low and high infiltration. The cancer cells were immunostained with anti-CSF-1 antibody and the staining intensity was evaluated as low or high expression. RESULTS: High nest and stromal TAMs were associated with higher tumour grades (p=0.005 and p=0.0001, respectively) whereas only high stromal TAMs showed significant association with negative oestrogen and progesterone receptors status (p=0.001 and 0.001, respectively); and triple-negative subtype (p=0.002). High CSF-1 expression was significantly associated with high stromal TAMs (p=0.031). High CSF-1 expression was associated with tumour grade and positive HER2 status (p=0.008 and 0.007, respectively). CONCLUSION: TAMs in tumour nest and stroma showed varying degrees of association with the clinicopathological parameters. High CSF-1 expression was associated with unfavourable prognostic parameters. Therefore, the evaluation of TAMs and CSF-1 expressions could potentially serve as prognostic markers and cellular targets for novel treatment modality in invasive breast cancers.

Prospective selective embedding of radical prostatectomy specimens is not inferior to full embedding regarding established and new prognostic parameters.

The histopathological examination of radical prostatectomy specimens is essential for assessing critical tumor characteristics, including stage, grade, and margins, all of which impact patient prognosis. However, the extent of embedding the prostate has long been a subject of debate, with some advocating partial/selective embedding and others favoring complete embedding. This study establishes a standardized and time-efficient protocol for processing radical prostatectomy specimens with limited embedding while maintaining diagnostic accuracy. Two hundred twenty-six prostatectomy specimens were analyzed, and the results of a highly standardized selective embedding protocol, systematically embedding the apex, the base, the transition to the seminal vesicles, and selected horizontal sections, were compared with full embedding as the gold standard. Non-inferiority testing was conducted by one-sided binomial tests and Pearson-Clopper confidence intervals. Selective embedding provided consistent and accurate diagnostic information with up to 90-98% concordance in pT, margins, ISUP-grade groups, and presence of IDC-P and cribriform tumor growth. In summary, this study establishes an economical standardized protocol for selective embedding of radical prostatectomy specimens with only minimal loss of information.

The value and significance of nucleolar organizer region proteins as markers of malignancy in breast cancer patients.

To assess argyrophilic nucleolar organizer regions (AgNORs) in 60 patients with primary breast carcinoma and evaluated their association with clinical prognostic parameters of breast cancer. Argyrophilic nucleolar organizer regions were stained in paraffin sections of the tissues using Ploton's silver method. For each sample, the number of AgNORs within the nuclei of 100 tumor cells was counted. The average number of AgNORs per nucleus was calculated, and the results were expressed as mean. The number of AgNORs was significantly higher in breast invasive ductal carcinoma (6.6) compared to benign breast tumors (fewer than 2.0). However, differences in AgNOR counts across different age groups were not statistically significant. This study suggests that AgNOR counts could be used as a potential procedure for estimating proliferation characteristics in histopathological sections of benign and malignant breast lesions. Argyrophilic nucleolar organizer region counts may also be valuable for identifying high-risk patients and indicating tumor aggressiveness. A larger study with an increased sample size that incorporates both AgNOR numbers and Ki67 scores for assessing cell kinetics is needed to confirm our findings.

Association of Hashimoto thyroiditis with papillary thyroid carcinoma and its clinical features – A retrospective study in a tertiary care hospital

Background: Papillary thyroid carcinoma (PTC) is the most widespread endocrine malignancy. Among the several risk factors, Hashimoto thyroiditis (HT) is one of the factors associated with increased incidence of PTC. Both HT and PTC share several epidemiologic features including high prevalence, female predominance, and increased incidence in iodine-sufficient areas. Aims and Objectives: The aim of the study was to assess the incidence of HT and PTC coexistent in endemic population. The study also aimed to determine the association of various prognostic parameters of PTC in patients with coexistent HT. Materials and Methods: This was a retrospective study done from May 2019 to May 2024 over a period of 5 years in a tertiary care hospital of West Bengal. A total of 54 patients with primary PTC who underwent total thyroidectomy with cervical lymph node dissection (LND) were studied. Patients with primary PTC with neck LND and complete medical history were included in this study. Patients with previous thyroidectomy surgery or patients with incidental PTC diagnosed in thyroidectomy specimens done for a benign neoplasm (without LND) were excluded from the study. Results: A total of 54 cases of PTC were studied out of which 23 cases were PTC associated with HT and 31 cases were PTC without HT constituting 42.59% and 57.4%, respectively. PTC associated with HT had a greater incidence in females. In this study, our results showed that PTC with HT had a greater tendency of tumor multifocality, greater mean lymph node size, and increase rate of extranodal tumor extension. At the same time, patients of PTC associated with HT had smaller tumor size and low clinical stage. Conclusion: PTC associated with HT had a female preponderance, larger metastatic lymph node, a tendency for multifocality, and extranodal extension. At the same, they also had smaller tumor size and low clinical stage indicating a complex and controversial effect of HT on PTC.

Cerebellar glioblastoma in adults: a comparative single-center matched pair analysis and systematic review of the literature

PurposeThe rarity of cerebellar glioblastoma presents a significant challenge in clinical practice due to the lack of extensive prognostic data on long-term survival rates, rendering it an underrepresented entity compared to its supratentorial counterpart. This study aims to analyze potential differences in survival outcome between patients with cerebellar and supratentorial glioblastomas.MethodsFrom 2009 to 2020, 8 patients underwent surgical treatment for cerebellar glioblastoma at the authors’ institution. These patients were individually matched with a cohort of 205 consecutive patients from our institutional database with supratentorial glioblastoma, taking into account key prognostic parameters. Progression-free survival (PFS) and overall survival (OS) rates were compared. Additionally, we performed a systematic literature review to compile further survival data on cerebellar glioblastoma patients.ResultsThe median OS for cerebellar glioblastoma patients was 18 months (95% CI 11–25). The balanced matched-pair analysis showed no significant difference in survival when compared to patients with supratentorial glioblastoma, exhibiting a median OS of 23 months (95% CI 0–62) (p = 0.63). Respective values for PFS were 8 months (95% CI 4–12) for cerebellar and 7 months (95% CI 0–16) for supratentorial glioblastoma (p = 0.2). The systematic review revealed that median OS for cerebellar glioblastoma in current literature ranges from 7 to 21 months.ConclusionsThe present findings indicate that patients with supra- and infratentorial glioblastoma do not significantly differ in regard to survival outcome parameters. This similarity in prognosis might encourage clinicians to consider surgical interventions for both supra- and infratentorial glioblastoma in a similar manner.

The Prevalence of Cytogenetic Abnormalities Detected by Interphase FISH Method in Chronic Lymphocytic Leukemia

Abstract Background Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia. Identification of genomic aberration provides prognostic/predictive information that is helpful in the precision medicine management of these patients. The aim of this study was to determine prevalence of the most common cytogenetic abnormalities of CLL patients in the southwest region (Shiraz) of Iran and correlate with clinical prognostic parameters to clarify their prognostic value. Materials and Methods In this cross-sectional study, 100 patients with CLL were recruited from April 2019 to October 2021. Four milliliters of anticoagulated peripheral blood was collected from each participant. The sample was used for complete blood count (CBC) test and fluorescence in situ hybridization (FISH) test. Interphase FISH (I-FISH) was performed for most common cytogenetic abnormalities, including trisomy 12, 13q14 deletion, 11q deletion, and 17p deletion on interphasic cell nuclei. Results Among 100 patients with CLL, 33 (33%) were females and 67 (67%) were males. The mean age (mean ± standard error [SE]) of the patients was 59.00 ± 1.14 years, with a ranged of 25 to 79 years. Our analysis demonstrated that 86 (86%) patients had at least one chromosomal aberration. The most commonly detected abnormality was 13q deletion (61, 61%), followed by 17q deletion (50 cases, 50%). Trisomy 12 was detected in 14 (14%) cases and 10 cases (10%) had 11q deletion. Conclusion The higher frequency of 13q14 and 17p anomalies in our study may be attributed to delayed medical consultations, leading to the emergence of secondary abnormalities. More studies are recommended for verifying the results.

EXPRESSION OF VITAMIN D3 RECEPTOR IN TUMOR TISSUE AND RELATIONSHIP BETWEEN CLINICAL FEATURES, PROGNOSTIC INDICATORS AND EXPRESSION OF VITAMIN D3 RECEPTOR IN HODGKIN LYMPHOMA

&lt;p&gt;&lt;strong&gt;Background and objectives:&lt;/strong&gt; In our study, we aimed to investigate the expression of vitamin D receptor and the relationship between clinical features, prognostic indicators, and expression of vitamin D receptor in Hodgkin lymphoma. &lt;strong&gt;Materials and Methods:&lt;/strong&gt; Pathology records and medical files of patients with Hodgkin lymphoma were evaluated. Forty-two tissue samples were analyzed retrospectively. Vitamin D receptor staining was performed with immunohistochemistry. The patients were divided into low, medium, and intense staining subgroups. The demographic data, clinical and biochemical values of patients were reviewed retrospectively, and the relationship between clinical features, prognostic indicators, and vitamin D receptor expressions were examined. &lt;strong&gt;Results:&lt;/strong&gt; VDR staining was positive in Reed-Sternberg cells of all Hodgkin lymphoma patients. The cases were divided into three groups according to VDR staining intensity as low, medium and intense staining and compared with known clinical prognostic parameters. Only the presence of symptom B was statistically significantly different. Gender, bone marrow involvement, extralymphatic involvement, mediastinal mass, bulky mass, mean leukocyte count, and treatment response were associated with vitamin D receptor staining intensity, but they were statistically insignificant. &lt;strong&gt;Conclusion: &lt;/strong&gt;Our study is the second study showing VDR in tumor Hodgkin lymphoma tumor tissues and is meant to be the first to evaluate its association with clinical and biochemical prognostic laboratory tests. Vitamin D receptor staining in all Hodgkin lymphoma patients led to the conclusion that VDR can be used in the histopathological differential diagnosis of HL. More studies are needed to assess and demonstrate the relationship between prognostic and diagnostic indicators and vitamin D receptor intensity of immunohistochemically detected VDR in tumor tissues of Hodgkin lymphoma. Also, further studies with serum vitamin D levels and other histologic subtypes can provide more reliable results.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0715/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

The Pulmonary Artery Pulsatility Index Provides No Additional Prognostic Information in Pediatric Pulmonary Arterial Hypertension.

The pulmonary artery pulsatility index (PAPi, calculated as (SPAP - DPAP)/mRAP) has been suggested as a measure of right ventricular-vascular coupling (RVVC) and as a prognostic parameter in cardiovascular conditions, particularly right ventricular failure. This retrospective study investigated the relationship between the PAPi and its components with disease severity parameters, the RVVC, and clinical outcomes in children with pulmonary arterial hypertension (PAH). We analyzed data from 111 children from the Dutch National Registry with PAH. The PAPi (median 6.0 [3.9-8.3]) was calculated from heart catheterization data and the RVVC was determined as the TAPSE/sPAP ratio via echocardiography (0.25 ± 0.12 mm/mmHg). Disease severity was characterized by clinical, hemodynamic, and laboratory data. Cox proportional hazard modeling assessed the PAPi's predictive value for transplant-free survival. There was no correlation between the RVVC and PAPi (R = -0.208, p = 0.111, n = 60). The PAPi correlated negatively with uric acid (R = -0.387, p < 0.001) but not with other disease severity parameters. Mean right atrial pressure correlated with multiple disease severity indicators. Transplant-free survival rates at 1, 3, and 5 years were 87%, 79%, and 73%, respectively. Neither the PAPi nor its components correlated with transplant-free survival. In conclusion, the PAPi does not correlate with the RVVC and this study could not demonstrate any prognostic value of the PAPi regarding disease severity or outcomes in children with PAH, challenging its utility in this population.