Radical Surgical Therapy Research Articles

Metastatic Adenoid Cystic Carcinoma at the Base of the Tongue and Duplicate Breast Cancer Diagnosed During Restaging.

Adenoid cystic carcinoma (AdCC) is a rare malignant tumor that primarily affects the salivary glands but can also occur in other organs. Low incidence and unpredictable clinical behavior make AdCC one of the most difficult head and neck tumors to treat. We present the case of a 54-year-old woman with AdCC localized at the base of the tongue, following radical surgical and oncological therapy. Due to advances in palliative oncological treatment, there is a more than five-year survival period before the progression of metastatic disease. Considering the rare occurrence of this disease, a literature search was also conducted, and therapy options are discussed. Ensuring a sufficient extent of the surgical procedure is still a challenge, and most specialists agree that subsequent postoperative radiotherapy reduces the risk of local recurrence. The effective dose of radiotherapy to the area of the primary tumor and lymph nodes is not clearly defined. The distinct biological behavior of AdCC results in varying sensitivity to chemotherapy or radiotherapy compared to treatments commonly used for head and neck squamous cell carcinomas. Treatment recommendations for these rarer tumors are based mainly on case reports and small clinical trials. The acquired therapeutic experience can contribute to prolonging the survival period of patients and improving their prognosis and quality of life.

The Current and Prospective Adjuvant Therapies for Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) stands as the most prevalent form of primary liver cancer and is highly invasive and easily recurs. For HCC, chemotherapy shows limited effect. The gold standard for HCC treatment includes curative surgical resection or liver transplantation. However, the recurrence rate at 5 years after liver resection is estimated at approximately 70% and even at 5 years after liver transplantation, it is 20%. Therefore, improving survival outcomes after curative surgical resection of liver cancer is crucial. This review highlights the importance of identifying risk factors for HCC recurrence following radical surgical resection and adjuvant therapy options that may reduce the recurrence risk and improve overall survival, including local adjuvant therapy (e.g., transcatheter arterial chemoembolization and radiotherapy), adjuvant systemic therapy (e.g., small molecule targeted therapy and immunotherapy), and other adjuvant therapies (e.g., chemotherapy). However, further research is needed to refine the use of these therapies and optimize their effectiveness in preventing HCC recurrence.

Primary adenocarcinoma of the seminal vesicles in Port Harcourt, Nigeria; Our experiences: Review of current diagnosis, treatment methods and outcome

Introduction: Primary tumors of the seminal vesicles are rare. The aims of this study are to present the case of a 32-year old man with advanced primary adenocarcinoma of the left seminal vesicle (PSVCA) that simulated features of prostatic neoplasm. Challenges encountered in its diagnosis are highlighted, and the literature reviewed to compare our experiences with current views of others on precise diagnosis of the tumor, its treatment methods and outcome. Materials and Methods: Consecutive male urology patients seen at UPTH, Port Harcourt, Nigeria were evaluated clinically and with relevant investigations. Two patients who had provisional diagnosis of PSVCA had operations/ post-operative specimen histology. One had confirmed diagnosis of PSVCA, was further treated, followed up and reported. Data were collected simultaneously with patients’ services. The PubMed/Medline and PubMed Central databases were searched for articles on clinical, immune histochemical features, treatment and outcome of PSVCA. Data on these features were presented in tables. Results: Of two presumptively diagnosed patients, one (32-year-old) had histological confirmation of primary adenocarcinoma of the left seminal vesicle. Radical surgery with urinary diversion, and either neoadjuvant or adjuvant androgen deprivation therapy, or cytotoxic chemotherapy, or adjuvant radiotherapy were the common treatment options found on literature review. Conclusion: The reported patient in this study had good post-operative performance but follow-up period was short. Currently, histopathologic and radiologic diagnostic methods are reinforced with immune histochemical techniques for precise diagnosis of PSVCA. Radical surgical therapy with neoadjuvant or adjuvant therapy are currently favored. Immune histochemical facilities should be provided at our center.

LBA75 RACE IT: A prospective, single arm, multicenter, phase II-trial to assess safety and efficacy of preoperative RAdiation therapy before radical CystEctomy combined with ImmunoTherapy in locally advanced urothelial carcinoma of the bladder (AB 65/18) – first results

Patients (Pts) with locally advanced bladder cancer (BC) have a poor prognosis despite radical surgical therapy. Early data on neoadjuvant immunotherapy in muscle invasive BC is promising, while there are indications of synergistic effects of radiation and immunotherapy. This trial evaluates the feasibility, safety and efficacy of neoadjuvant radio-immunotherapy (RIT) following radical cystectomy (RCX) in patients with locally advanced, muscle invasive BC. Patients with locally advanced urothelial BC (cT3/4 cN0/N+ cM0, eligible for RCX, unfit for or refusing neoadjuvant chemotherapy) were included in this prospective, single arm, phase II-trial. Pts were treated with Nivolumab 240mg intravenously every two weeks for 4 cycles, starting one week before radiotherapy of the bladder/pelvis with 50.4 Gy, followed by RCX with standardized pelvic lymphadenectomy. Primary endpoint is the rate of Pts with completed treatment (RIT and RCX) at the end of week 15. Secondary endpoints include overall response rate (ORR), pathological response rates, disease free survival (DFS) and toxicity. Of 33 treated Pts, 32 (97%) were ≥cT3/4 and 10 (30.3%) were lymph node positive (cN+). For primary endpoint and efficacy analysis, 31 Pts were eligible. Primary endpoint of completed treatment (RIT and RCX) in time at the end of week 15 was reached in 27/31 (87.1%) Pts. Median number of nivolumab cycles was 4. The radiological ORR was 70.9% (CR 16.1%, PR 54.8%, SD 25.8% and PD 3.2%). Pathological response rate was ypT0 38.7% and ≤ ypT1 58.1%. While survival data is immature, DFS rate at 12 months was 90.6%. Any-grade treatment-related AEs (TRAEs) occurred in 54.5 % of all 33 patients. TRAEs were mostly grade 1-2. Most common TRAEs were thyroid and gastrointestinal disorders (each 15.2%) and skin reactions (33.3%). TRAEs led to Nivolumab discontinuation in 8 (25.8%) Pts. The trial met its primary endpoint. Neoadjuvant radio-immunotherapy followed by radical cystectomy in locally advanced bladder cancer patients is feasible and safe.

Treatment of Metastatic Spinal Disease; what the Radiologist needs to know.

Advancements in technology and multidisciplinary management have revolutionized the treatment of spinal metastases. Imaging plays a pivotal role in determining the treatment course for spinal metastases. This article aims to review the relevant imaging findings in spinal metastases from the perspective of the treating clinician, describe the various treatment options, and discuss factors influencing choice for each available treatment option. Cases that once required radical surgical resection or low-dose conventional external beam radiation therapy, or both, are now being managed with separation surgery, spine stereotactic radiosurgery/stereotactic body radiation therapy, or both, with decreased morbidity, improved local control, and more durable pain control. The primary focus in determining treatment choice is now on tumor control outcomes, treatment-related morbidity, and quality of life.

Better Therapy for Pancreatic Cancer through More Radical Surgery?

Despite advances in the treatment of pancreatic cancer, the survival of affected patients remains limited. A more radical surgical therapy could help to improve the prognosis, in particular by reducing the local recurrence rate, which is around 45% in patients with resected pancreatic cancer. In addition, patients with oligometastatic pancreatic cancer could also benefit from a more radical indication for surgery.Based on an analysis of the literature, important principles of pancreatic cancer surgery were examined.Even if even more radical surgical approaches such as an "extended" lymphadenectomy or a standard complete pancreatectomy do not bring any survival advantage, complete resection of the tumour (R0), a thorough locoregional lymphadenectomy and an adequate radical dissection in the area of the peripancreatic vessels including periarterial nerve plexuses should be the standard of pancreatic carcinoma resections. Whenever necessary to achieve an R0 resection, resections of the pancreas have to be extended, as well as additional venous vascular resections and multivisceral resections had to be performed. Simultaneous arterial vascular resections as part of pancreatic resections as well as surgical resections in oligometastatic patients should, however, be reserved for selected patients. These aspects of the surgical technique in pancreatic carcinoma mentioned above must not be neglected from the point of view of an "existing limited prognosis". On the contrary, they form the absolutely necessary basis in order to achieve good survival results in combination with system therapy. However, it may always be necessary to adapt these standards according to the age, comorbidities and wishes of the patient.

An Update on Emerging Therapeutic Options for Malignant Pleural Mesothelioma.

The treatment paradigm for malignant pleural mesothelioma (MPM) has changed little in the last 18 years. Radical intent treatment, consisting of surgical resection, radiotherapy and chemotherapy, has been offered to a highly select few; however, there is little randomised evidence to validate this approach. Prior to 2020 chemotherapy with platinum and an anti-folate was the only intervention with randomised evidence to demonstrate improved overall survival (OS) in MPM. No systemic therapy had been demonstrated to improve OS in the second line setting until 2020. The publication of the Checkmate 743 trial in 2021 demonstrated a survival benefit of combination immunotherapy over standard chemotherapy in newly diagnosed patients with MPM. This finding was shortly followed by the CONFIRM trial which demonstrates a modest but significant survival benefit of second line nivolumab versus placebo in patients having previously received standard chemotherapy. The results of these trials, recent biomarker directed therapy and chemotherapy adjuncts are discussed within this review. The integration of immunotherapy for the few patients in whom radical surgical therapy is intended is currently the subject of clinical trials and offers the prospect of improving outcomes in this rare but devastating disease.

Giant cystic hygroma of the neck in a 3-year-old child: Clinical case and literature review

Giant cystic hygroma of the neck often represents a pathology in children with severe potential complications and considerable technical difficulties in surgical therapy, which often makes it necessary because the alternative therapies provided are not available. A case of a cystic hygroma with a maximum diameter of 10 cm, located in the neck of a 3-year-old girl, with sudden rapid growth and an underlying inclusion cyst compressing the internal jugular vein, is described. The case was resolved with radical surgical therapy, without complications, without recurrence, and with acceptable aesthetic results.

Fungal brain infection\u2014no longer a death sentence

The aim of this case series was to provide a modern cohort of patients with cerebral aspergillosis and show the effectiveness of modern treatment concepts. In a 10-year period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients’ and disease characteristics were recorded. The median age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 3.1 surgeries per patient followed by antifungal treatment for 6 months (= median) according to the microbiological findings. Regarding comorbidities, the mean Charlson comorbidity index (CCI) at the time of admission was 5, representing an estimated 10-year survival of 21%. Six (60%) of 10 patients showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. Four patients showed associated frontobasal bone destruction, mycotic aneurysms, or thromboses. The mean duration of hospital stay was 37 days. Mortality was much lower than in literature. Sixty percent of the patients died during the follow-up period. The outcome of the two immunocompetent patients was more favorable. Cerebral aspergillosis is a rare, but still life-threatening, condition, which predominantly occurs in immunosuppressive conditions. Due to radical surgical and antifungal therapy for several months, mortality can be reduced dramatically.

Radiation therapy before radical cystectomy combined with immunotherapy in locally advanced bladder cancer \u2013 study protocol of a prospective, single arm, multicenter phase II trial (RACE IT)

BackgroundPatients with locally advanced bladder cancer (cT3/4 cN0/N+ cM0) have a poor prognosis despite radical surgical therapy and perioperative chemotherapy. Preliminary data suggest that the combination of radiation and immunotherapy does not lead to excess toxicity and may have synergistic (abscopal) anti-tumor effects. We hypothesize that the combined preoperative application of the PD-1 checkpoint-inhibitor Nivolumab with concomitant radiation therapy of the bladder and pelvic region followed by radical cystectomy with standardized lymphadenectomy is safe and feasible and might improve outcome for patients with locally advanced bladder cancer.MethodsStudy design: “RACE IT” (AUO AB 65/18) is an investigator initiated, prospective, multicenter, open, single arm phase II trial sponsored by Technical University Munich. Study drug and funding are provided by the company Bristol-Myers Squibb.Study treatment: Patients will receive Nivolumab 240 mg i.v. every 2 weeks for 4 cycles preoperatively with concomitant radiation therapy of bladder and pelvic region (max. 50.4 Gy). Radical cystectomy with standardized bilateral pelvic lymphadenectomy will be performed between week 11–15.Primary endpoint: Rate of patients with completed treatment consisting of radio-immunotherapy and radical cystectomy at the end of week 15.Secondary endpoints: Acute and late toxicity, therapy response and survival (1 year follow up).Main inclusion criteria: Patients with histologically confirmed, locally advanced bladder cancer (cT3/4, cN0/N+), who are ineligible for neoadjuvant, cisplatin-based chemotherapy or who refuse neoadjuvant chemotherapy.Main exclusion criteria: Patients with metastatic disease (lymph node metastasis outside pelvis or distant metastasis) or previous chemo-, immune- or radiation therapy.Planned sample size: 33 patients, interim analysis after 11 patients.DiscussionThis trial aims to evaluate the safety and feasibility of the combined approach of preoperative PD-1 checkpoint-inhibitor therapy with concomitant radiation of bladder and pelvic region followed by radical cystectomy. The secondary objectives of therapy response and survival are thought to provide preliminary data for further clinical evaluation after successful completion of this trial. Recruitment has started in February 2019.Trial registrationProtocol Code RACE IT: AB 65/18; EudraCT: 2018–001823-38; Clinicaltrials.gov: NCT03529890; Date of registration: 27 June 2018.

The recurrence of colonic volvulus due to nonrotation after intestinal resection in adulthood: a case report

BackgroundIntestinal nonrotation is a rare congenital condition that causes fatal colonic volvulus at any age. Once volvulus attack occurs, radical surgical therapy is required for treatment and the prevention of recurrence. This report describes the case of an adult female patient with a recurrence of cecum volvulus due to intestinal nonrotation after transverse colon resection for colonic volvulus.Case presentationA 27-year-old female visited our emergency room (ER) with intermittent abdominal pain and nausea. Enhanced computed tomography (CT) showed enlargement of the level of the ascending and transverse colon and an obstruction with a whirlpool sign at the transverse colon. The small intestine was distributed on the right side of the abdominal cavity, and the large intestine occupied the left side. She was diagnosed with volvulus with intestinal nonrotation, and emergency surgery was performed. Surgical examination indicated that the ascending colon to the transverse colon was not fixed to the retroperitoneum, and the transverse colon was rotated 180° clockwise. The axis of the volvulus was a mesenteric adhesion of the transverse colon. The involved transverse colon was resected, and the intestine was reconstructed by functional end-to-end anastomosis (FEEA). Six years after the initial surgery, the patient presented to the ER with abdominal fullness and lower abdominal pain. Enhanced CT revealed that the cecum, ascending colon, and remaining transverse colon were dilated with an obstruction. The appendix was located in the left upper abdominal cavity. The clinical diagnosis was cecal volvulus with intestinal nonrotation. An emergency laparotomy revealed that the cecum was rotated 180° clockwise. The terminal ileum to the remaining transverse colon was resected, and FEEA was performed. Seven months later, she suffered obstruction of the intestine caused by an operative adhesion, and conservative treatment was successful. The patient has had no abdominal symptoms for one and a half years so far.ConclusionsSurgeons should realize that nonrotation of the intestines induces volvulus in adulthood and should familiarize themselves with its clinical findings, appropriate treatment, and prognosis. Even after surgical treatment, awareness of the recurrence of volvulus should be maintained to avoid a late diagnosis.

Comparison of genomic profiles to reveal heterogenous patterns of tumor evolution in primary and recurrent diffuse gliomas.

e14060Background: Diffuse gliomas represent heterogeneous group of tumors with highly variable biological behavior. Despite of radical surgical resection and intensive therapy, recurrent lesions wi...

Awareness of hepatic arterial variants is required in surgical oncology decision making strategy: Case report and review of literature.

Surgery for the treatment of pancreatic cancer remains the gold standard, however, the identification of the vascular supply of the pancreas and the nearby organs remains a crucial difficulties in a curative resection. During pancreatic head resection for carcinoma dissection of regional arterial vasculature is mandatory. Normal coeliac and hepatic arterial anatomy occurs in ~50–70% of patients and multiple variations have been described. Knowledge of multiple arterial anomalies is essential in hepato-pancreatico-billary surgery to avoid unnecessary complications. The present study presents coeliac trunk and common hepatic artery (CHA) anomalies along with their clinical importance, as reviewed according to the available literature. Patients diagnosed with cancer of the pancreatic head were hospitalized for staging and planning of radical surgical therapy. Computed tomography (CT) revealed a large tumour mass in the head of the pancreas and CHA, which branched directly from the superior mesenteric artery. A three-dimensional CT reconstruction revealed a demonstrative vascular anomaly, which was confirmed during an operation. Despite the anomalous origin of the CHA, pylorus preserving pancreatoduodenectomy and regional lymph node dissection without intraoperative complications was performed in each case. The patient's postoperative clinical course was uneventful and adjuvant chemotherapy could be administered without delay. In the multidisciplinary treatment of pancreatic carcinoma the surgeon and radiologist must be aware of the aberrant anatomy in order to avoid potential complications. As CT scans used for the preoperative staging are of diagnostic value for vascular anomaly, it is required for appropriate surgical decision making.

Effect and safety of proton beam therapy for locally recurrent rectal cancer.

743 Background: The first choice of treatment for locally recurrent rectal cancer is surgical resection. However, the operation is often difficult with high perioperative risk. For surgically unfit cases, proton beam therapy (PBT) is proposed as the treatment option. However, its efficacy for locally recurrent rectal cancer remains unclear. Therefore, this study aimed to evaluate the efficacy and safety of PBT for locally recurrent rectal cancer. Methods: A total of 23 patients with locally recurrent rectal cancer who received PBT were retrospectively evaluated, from November 2005 to July 2014. Patients with single lesion, who refuse the radical surgical therapy, or who were considered unfit for the operation were included in this study. All patients were treated with 2.8Gy relative biological effectiveness (RBE)/fraction. Twenty-five irradiations were performed, with a total irradiation of 70Gy RBE. Unfit for operation criteria include invasion to the vertebra higher than the third sacrum or lateral lymph node recurrence after a lateral lymph node dissection. To assess the safety of PBT, adverse events were evaluated by using the Common Terminology Criteria for Adverse Effects (CTCAE version4.0). To assess the efficacy, the overall and relapse-free survival rates and local control rate were evaluated. Results: Sixteen patients were unfit for operation, and seven refused surgery. Three patients experienced Grade 3 late adverse events in the CTCAE (two ileum fistula and one urinary tract obstruction). The median follow-up time was 28.9 months. The 5-year overall and relapse-free survival rates were 47.6% and 20.2%, respectively. Fifteen patients (65.2%) showed distant metastasis or regrowth at the locally recurrent site. The 5-year local control rate was 39.0%. Ten patients (43.4%) showed regrowth at the proton beam irradiation site. Conclusions: PBT was relatively effective for locally recurrent rectal cancer with manageable adverse effects. Therefore, PBT may be considered as the therapeutic option for selected locally recurrent rectal cancer patients.

Zoonotic necrotizing myositis caused by Streptococcus equi subsp. zooepidemicus in a farmer

BackgroundStreptococcus equi subsp. zooepidemicus is a beta-hemolytic group C streptococcus mainly causing infections in domesticated animals. Here we describe the first case of zoonotic necrotizing myositis caused by this bacterium.Case presentationThe patient was a 73-year-old, previously healthy farmer with two asymptomatic Shetland ponies in his stable. After close contact with the ponies while feeding them, he rapidly developed erythema of his left thigh and sepsis with multiple organ failure. The clinical course was severe and complicated, requiring repetitive surgical excision of necrotic muscle, treatment with vasopressors, mechanical ventilation and continuous venovenous hemofiltration, along with adjunctive hyperbaric oxygen therapy. The patient was discharged from hospital at day 30, without obvious sequelae.The streptococcal isolate was identified as Streptococcus equi by MALDI-ToF MS, and was later assigned subspecies identification as S. equi subsp. zooepidemicus. Multilocus sequence typing identified the strain as a novel sequence type (ST 364), closely related to types previously identified in horses and cattle. A focused proteomic analysis revealed that the ST 364 expressed putative virulence factors similar to that of Streptococcus pyogenes, including homologues of the M protein, streptodornases, interleukin 8-protease and proteins involved in the biosynthesis of streptolysin S.ConclusionThis case illustrates the zoonotic potential of S. equi subsp. zooepidemicus and the importance of early clinical recognition, rapid and radical surgical therapy, appropriate antibiotics and adequate supportive measures when necrotizing soft tissue infection is suspected. The expression of Streptococcus pyogenes-like putative virulence determinants in ST 364 might partially explain the fulminant clinical picture.

Association of Comorbidity, Age, and Radical Surgical Therapy for Prostate Cancer, Bladder Cancer, and Renal Cell Carcinoma

To assess trends and factors driving aggressive surgery for patients >75 years diagnosed with prostate cancer (PCa), bladder cancer (BCa), and renal cell carcinoma (RCC). We identified all patients >75 years diagnosed with PCa, BCa, and RCC from the Surveillance, Epidemiology and End Results-Medicare registry during 1992-2009. We analyzed the comorbidity and trends in radical cystectomy (RC), nephrectomy, and radical prostatectomy (RP) for these cohorts. Predictive factors for receiving aggressive surgery were assessed using logistic regression analysis. We identified cohorts of 85,073 PCa, 44,801 BCa, and 10,737 RCC patients. Among the BCa patients, 5.75% underwent RC and 78.2% had a Charlson comorbidity score (CCS) of ≤1. The trend of RC did not change significantly. There was a significant change in receipt of RP (P = .01). There were 85.8% of PCa patients who had a CCS ≤1 and 2.67% underwent RP. Approximately 65.2% of RCC patients had nephrectomy whereas 76.2% had CCS of ≤1. There was a decline in receipt of nephrectomies (P < .0001). Younger age, high stage or grade disease, and lower comorbidity were associated with higher odds of receiving RC, RP, and nephrectomy. In addition to stage and grade, age remains an important factor influencing the decision to undergo curative surgical therapy for PCa, BCa, and RCC patients >75 years. Comorbidity is also predictive, but to a lesser extent.

Descending necrotizing mediastinitis : Treatment concept with focus on thoracic surgery

Descending necrotizing mediastinitis (DNM) originates from odontogenic or oropharyngeal infections which spread along preformed cervicothoracic spaces into the mediastinum and requires emergency multidisciplinary treatment. A total of seven patients were diagnosed with DNM based on typical radiological features in a cervicothoracic computed tomography (CT) scan and subsequently underwent standardized transcervical and open transthoracic radical debridement. The initially detected polymicrobial spectrum of pathogens was dominated by streptococci followed by enterobacteriae. After calculated antibiotic treatment a shift in the spectrum of pathogens was noted and in particular a mycotic superinfection occurred in 43 % of the cases. Anterolateral thoracotomy was performed for radical removal of tissue necrosis and mediastinothoracic drainage extending to the posterior mediastinum was placed. In selected cases, cervico-mediastino-thoracic tubes were transmediastinally placed by the rendevouz technique either in the previsceral or retrovisceral mediastinal space. Despite predominantly advanced mediastinitis (Endo classification type II B) in this patient cohort, the mortality only reached 14 %. Rapid diagnosis, anatomical knowledge, understanding of the progression of infections as well as critical care, antimicrobial treatment and multidisciplinary radical surgical therapy are paramount for successful treatment of DNM. We favor anterolateral thoracotomy as the standard open transthoracic approach to the mediastinum. Placement of cervico-mediastino-thoracic irrigation drains can help to limit DNM.

193. The correlation between breast cancer stage and anticancer therapy and the risk of lymphoedema

Background: Radical surgical therapy of breast cancer associated with removal of axillary lymph nodes, combined with irradiation, may cause development of severe early and delayed complications, including lymphoedema of the upper limb. The therapy of lymphatic edema is life-long and of limited efficacy. Therefore it is highly important to select the group of patients, in whom development of lymphoedema is expected.

Pancreatic neuroendocrine tumors: an analysis of 88 patients

Objective To analyze the clinicopathological characteristics,diagnosis,treatment outcomes and prognosis of patients with pancreatic neuroendocrine tumors (PanNETs).Methods The clinicopathological characteristcs and prognostic factors of 88 patients who were diagnosed with pancreatic neuroendocrine tumors by postoperative pathology were analyzed retrospectively.The data included age,sex,symptoms,tumor size,pathological grades,TNM staging,treatment and follow up.Results There were 28 males and 60 females.The ratio of male to female was 1 ∶ 2.1,with a mean age of 42 (range 8～75) years.Of the 88 PanNETs,74(84.1％) were nonfunctional tumors.Using the WHO 2000 pathological classification system,there were 35 well differentiated endocrine tumors (WDET),29 well differentiated endocrine carcinomas (WDEC),and 24 poorly differentiated endocrine carcinomas (PDEC).Using the 7th AJCC TNM staging system,23(26.1％),46(52.3％),13(14.8％) and 6 patients (6.8％) were diagnosed to have stage Ⅰ,Ⅱ,Ⅲ and Ⅳ,respectively.The overall 5-year survival rate was 72.0 ％.Univariable analysis revealed tumor size,histopathological grades,TNM staging and radical surgery were associated with prognosis.Multivariate analysis showed histopathological grades,TNM staging and radical surgery were independent risk factors of survival.Conclusions PanNETs are rare pancreatic neoplasms with high heterogeneity and low malignant potential.PanNETs have various clinical manifestations and the preoperative misdiagnosis rate is high.A definitive diagnosis depends on pathological examination.The new TNM and pathological classification systems have good predictive abilities on survival.The majority of patients who received radical surgery or surgical comprehensive therapy have good prognosis. Key words: Pancreatic neoplasms; Diagnosis; Therapy; Prognosis

Incidence of Synchronous Bilateral Tonsillar Carcinoma in a Cohort of T1/T2 Primary Tonsil Cancer

Objectives: The most recent review of bilateral synchronous tonsillar carcinoma published in 2012 identified 12 previously described cases in the literature. It has been estimated that there is a 10% incidence of contralateral nodal metastasis from tonsillar carcinoma. However, the true incidence of bilateral synchronous occult disease is unknown. This study aims to describe the incidence of bilateral tonsillar carcinoma in early stage disease. Methods: The study design consisted of a retrospective cohort study of 120 patients with T1 or T2 primary tonsillar squamous cell carcinoma treated between 1995 to 2012. All patients were treated with primary radical surgical therapy and had the contralateral tonsil removed at the time of surgery. Data was extracted from an institutional review board approved department database. All cases were reviewed for evidence of an occult tumor in the contralateral tonsil. Results: Out of 120 patients, 3 patients were identified to have an occult primary cancer in the contralateral tonsil. This resulted in a 2.5% incidence of disease in this cohort of patients. Compared to the incidence of tonsillar carcinoma in the general population 2.1 x 10-5, (95% CI: 2 x 10-5, 2.2 x 10-5) this is significantly elevated. Conclusions: This is the first study attempting to establish the incidence of bilateral tonsillar carcinoma in a large cohort of early stage tonsillar carcinoma patients. Given the increasing use of transoral robotic surgery to treat these patients, it is important to be aware that there is likely a small but slightly elevated risk of contralateral occult disease.