Single Site Involvement Research Articles

Clinicopathological spectrum of central nervous system germ cell tumors: A single-institution retrospective study.

Central nervous system germ cell tumors (CNSGCTs) though rare is the second most common extragonadal site for GCTs. To determine the clinicopathological features of CNSGCTs diagnosed at our center. A retrospective study of all histologically diagnosed CNSGCTs, during 2006-2019. The patients' data were retrieved from the hospital information systems and analyzed. Data on categorical variables were analyzed as percentages, and data on continuous variables calculated as mean. Chi-square test or Fisher's exact test was used to study association between variables. Of the total 34 cases with CNSGCT, age ranged from 1 to 27 years, majority in the second decade (19/34; 56%). Male: female (M: F) ratio was 1.6:1. Single site involvement was seen in 27 cases (27/34; 79%), whereas seven (7/34; 21%) showed bi/multifocal involvement. Among the unifocal cases, common sites involved were suprasellar (12/27; 44.4%), closely followed by the pineal (10/27; 37%). All multifocal tumors affected suprasellar compartment, being bifocal with pineal in four cases. A male gender predilection was noted among pineal region (9/10;90%) and multifocal tumors (5/7;71%). Germinoma was the commonest subtype (21/34; 61.8%) with male gender predilection (17/21; 81%) (M: F =4.3:1), with female predilection seen among mixed GCTs (MGCTs) (8/10; 80%) (M: F =1:4) and suprasellar location (M: F =1:2). Serum tumor markers (25 cases) and CSF markers (7 cases) were concordant with histology in all, except two cases. Though histology and immunohistochemistry were diagnostic, correlation between serum and/or CSF marker was essential to rule out GCT component(s) that may be missed on biopsy due to sampling error.

1420. 99mTc-Ethambutol scintigraphy with SPECT/CT in skeletal tuberculosis: A Prospective Study

Abstract Background Tuberculosis (TB) is the most common infectious disease in poor and underdeveloped countries, with extra-pulmonary TB (EPTB) infections accounting for 10-15 percent of all cases in developing and underdeveloped countries. Apart from 18F-FDG PET/CT, which cannot discriminate between metastatic and infective lesions, Nuclear Medicine methods do not play a significant role in clinical practice. We have attempted to address this constraint by our study involving radiolabelled Ethambutol. Methods The study was conducted over a period of 20 months at the Department of Nuclear Medicine of our institution and included a prospective cohort of 16 adult patients diagnosed as skeletal TB (clinico-radiologically, histopathologically, or microbiologically) who were treatment naive or within 14 days of treatment initiation. 10-15 mCi of Tracer was administered to the patients. Dynamic phase imaging was performed for 10 minutes, followed by minimum 3 planar anterior and posterior views whole-body scans with over 4 hours. SPECT/CT was performed between 60-120mins after injection. Patients were followed up by a clinical assessment/telephonic review with a follow up period of 2 months to 21 months (mean follow up period of 10.2 months). Results SPECT-CT and 99mTc-Ethambutol scintigraphy were performed on 16 patients at the time of diagnosis or treatment initiation. The average age of individuals with positive scans was 33.75, whereas those with negative scans was 36.25 +/- 19.80. The most common symptom was bone pain (93.75%), followed by fever (81.25%) and weight loss (13 of 16 cases) (81.25 percent ). 3/12 (25%) of the 12 positive patients had multiple site involvement, whereas 8/12 (75%) had single site involvement. We found considerable tracer uptake in 75% of the patients in the trial. When ATT was given to 11/12 (92%) of the people who had a positive scan, the clinical result was decreased discomfort and greater mobility in the affected joints. Conclusion 99mTc-ethambutol scintigraphy with SPECT/CT was accurately able to show bony lesions in 75% of the patients. Also 92% of those with positive scan eventually responded to Anti-Tubercular Treatment thus showing that this rarely used technique may have a role in prognosticating skeletal tuberculosis. Disclosures All Authors: No reported disclosures.

Multiple Extramedullary-Bone Related and/or Extramedullary Extraosseous Are Independent Poor Prognostic Factors in Patients With Newly Diagnosed Multiple Myeloma.

BackgroundExtramedullary (EM) lesions are common in multiple myeloma (MM) and are often related to the poor prognosis of MM but are scarcely understood.MethodsIn this retrospective study, the baseline characteristics of 357 newly diagnosed patients with extramedullary multiple myeloma (EMM) and their impact on the prognosis were analyzed. All patients received first-line treatment with bortezomib-based regimen.ResultsThe overall incidence rate of EM was 22.4%, and the detection rate of PET/CT was significantly higher than other imaging methods (P = 0.015). The cohorts consisted of 10 cases of extramedullary extraosseous (EME) and 70 cases of extramedullary-bone related (EMB), including 53 cases with single site involvement (one case with EME) and 27 cases with multiple sites (>1 site) involvement (nine cases with EME). EMM patients had high levels of hemoglobin (Hgb, ≥10 g/dl) and serum lactate dehydrogenase (LDH, >245u/L) and are inclined to early-stage revised international staging system (R-ISS). Compared to patients without EM, those with EMM had worse progression-free survival (PFS) (P = 0.014) and overall survival (OS) (P = 0.032). In addition, patients without EM and those with a single site of EMB had similar PFS and OS, while patients with multiple sites of EMB or EME and multiple sites of EMB with EME had poor PFS and OS. Multivariate analysis confirmed that multiple sites of EMB and/or EME were independent prognostic predictors affecting PFS and OS in newly diagnosed MM patients.ConclusionsThis study suggested that among patients treated with bortezomib-based regimens, multiple sites of EMB and/or EME are independent poor prognostic factors for newly diagnosed MM patients, while a single site of EMB does not affect the survival of newly diagnosed MM patients. Thus, these findings could be used as a reference for the study of EMM patients in the new drug era, but prospective clinical studies are needed to provide evidence-based data for the diagnosis and treatment of EMM.

651 Inconspicuous Donor Sites- A Patient-Centered Approach to Donor Site Management with Autologous Skin Cell Suspension

Abstract Introduction Donor site morbidity (DSM) is a major patient dissatisfier due to pain and scarring leading to aesthetic and functional limitations acutely and over time. Many of the recent advancements in burn care such as autologous skin cell suspension (ASCS), cultured tissues, and engineered tissues are driven to reduce DSM. One of the most important advancements in reducing DSM has been the approval of ASCS. Our study assesses donor site (DS) location using real-world data after ASCS procedures with an inconspicuous surgical approach for DS. Methods An IRB approved, retrospective chart review of all burn patients undergoing ASCS at an American Burn Center verified burn center between January 2019 and August 2020 was completed. Patients were excluded who received ASCS in combination with widely meshed skin graft or who died during their hospitalization. Demographics were reported including age, gender, % total body surface area (TBSA), length of stay (LOS), ASCS size in cm2 and % TBSA, and location of burn. All DS were harvested at 0.004–0.008 inch after clysis of the prep site with injectable saline and 0.25% Marcaine with a dermatome or Weck knife. Photographs of the DS and burn wounds were uploaded to the EMR by the surgeon of record and assessed by two experienced burn nurses that were blinded to DS location and intraoperative procedures. Results 83 patients underwent ASCS with 25 patients meeting inclusion criteria. The average age was 33 years (range 15 months to 88 years). 68% of patients were male with an average TBSA of 11% (range 2.5–40). The mean LOS was 5.8 days (range 1–16). Burn locations included face/neck (n=9), torso (n=16), extremity (n=20), hand (n=10), and two patients had single site involvement. The adult patient average size of ASCS applied was 1700cm2 (range 250–6200) while pediatric patients had an average size of 13% TBSA (range 6–32). 21 of the 25 patients had DS adjacent to the burn. No significant difference was noted in healing time, infection rate, or hypertrophic scarring. None of the patients complained of DS pain that was distinguishable from the burn wound. Blinded observers were unable to discern the DS in 56% of the patients from the initial burn wound. Conclusions DSM is an iatrogenic insult to non-burn skin and a significant cause of morbidity. ASCS DS may be taken adjacent to the burn wound without risk of delayed re-epithelization, infection, or hypertrophic scarring. Placing ASCS DS adjacent to the burn wound is a more patient-centered approach with indistinguishable pain from the burn wound, a more pleasing cosmetic outcome, and potential greater patient satisfaction.

Initial chest CT imaging features of COVID-19 and their relation to clinical types

Objective: To investigate the initial chest CT imaging features and clinical types of patients with COVID-19. Methods: A total 165 patients with COVID-19 were retrospectively analyzed according to different age groups and different clinical classifications. Results: There were statistically significant differences in involvement sites, involvement range, lesion distribution and largest diameter of the lesions in COVID-19 patients among different age groups. Logistic regression analysis of age between normal type group and severe type group showed statistical significance (P<0.05). The maximum sensitivity and specificity were 64.20% and 69.00%. The corresponding age threshold was 50.5 years old. Conclusion: The main manifestations of initial chest CT in COVID-19 patients were ground-glass opacities, most often involving the posterior basal segment of the lower lung. Single site involvement was more common in 17-35 years patients. Most of the lesions were distributed around the subpleural and bronchovascular bundle in 36-90 years patients, involving both lungs and reaching more than two pulmonary lobes. For the COVID-19 patients with diabetes, hypertension, or older than 50.5 years, early diagnosis, isolation and treatment are necessary, and the changes of their conditions should be closely mornitored. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Histopathological Pattern and Different Stages of Sinonasal Carcinoma Patients: A Study on 40 Cases in Bangladesh

Background: Sino-nasal carcinoma has various histological types presented with different stages.&#x0D; Objectives: The purpose of this present study was to see the histopathological types and stages of sinonasal carcinoma patients in tertiary level hospital.&#x0D; Methodology: This cross-sectional study was conducted in the Department of Otolaryngology- Head &amp; Neck Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2008 to December 2009 for a period of two (02) years.All consecutive cases of sinonasal carcinoma admitted in hospital and outpatient department during the study period. Suspected cases of sinonasal carcinoma was diagnosed from history and clinical examination proved by CT-scan, MRI and histopathological examination.&#x0D; Result: A total number of 40 cases of sino-nasal carcinoma were recruited for this study. Among these single site involvement was reported in 11 cases and the rest 29 cases were involved in multiple sites. Regarding multiple sites involvement maxillary sinus with nasal cavity involvement was reported in 15(51.72%) cases. Maxillary sinus, nasal cavity with ethmoid sinus involvement was found in 10(34.48%) cases. The presentation of the sinonasal carcinoma at stage T4 was 16(40.05) cases followed by T3, T2, and T1 which were 13(32.5%) cases, 7(17.5%) cases and 4(10.0%) cases respectively. Squamous cell carcinoma was found in 25(63%) cases followed by adenocarcinoma andadenoid cyst carcinoma which were 7 cases, 5 cases respectively.&#x0D; Conclusion: In conclusion majority of the sino-nasal carcinoma are squamous cell carcinoma involving the multiple sites in the T4 stage.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 110-113

Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery.

Patients with de novo metastatic breast cancer (MBC) constitute a heterogeneous group with different clinicopathologic characteristics and survival outcomes. Despite controversy regarding its prognostic value, primary tumor surgery may improve survival for selected patients. Patients with de novo MBC were identified using the SEER database and were then divided randomly into training and validation sets. A Fine-Gray competing risks model was developed to identify the variables associated with increased cancer-specific mortality in the training set. The M1 subdivision system was established based on the independent prognostic factors. Cumulative incidence curves were estimated and compared using Gray's test. Involvement of brain or liver and number of metastatic sites were identified as independent prognostic factors in multivariate analysis. The M1 category was subdivided into 3 subcategories: M1a, single site involvement except brain and liver; M1b, liver involvement only, or multiple site involvement except brain and liver; and M1c, brain involvement regardless of number of metastatic sites, or liver and other sites involvement except brain (M1b vs M1a: subdistribution hazard ratio [SHR], 1.48; 95% CI, 1.29-1.68; M1c vs M1a: SHR, 2.45; 95% CI, 2.18-2.75). Patients with the M1a subtype benefited most from primary tumor surgery in the adjusted competing risks model (M1a: SHR, 0.57; 95% CI, 0.48-0.67, M1b: SHR, 0.62; 95% CI, 0.47-0.83, and M1c: SHR, 0.59; 95% CI, 0.44-0.80), whereas benefits conferred by treatment with chemotherapy alone increased with the upstaging of metastatic disease (M1a: SHR, 0.72; 95% CI, 0.62-0.83, M1b: SHR, 0.54; 95% CI, 0.44-0.68, and M1c: SHR, 0.53; 95% CI, 0.45-0.61). Subdivision of M1 stage facilitates prognosis prediction and treatment planning for patients with de novo MBC. Treatment offered should be decided in a coordinated multidisciplinary setting. Primary tumor surgery may play an important role in the management of selected patients.

Abdominal tuberculosis in children: A real-world experience of 218 cases from an endemic region.

Background and AimAbdominal tuberculosis (ATB) in children poses a diagnostic challenge because of its nonspecific clinical features, which often delay the diagnosis. Our aim was to present our real‐world experience and provide an insight into the presentation, pattern of distribution, and diagnosis of the disease.MethodsA retrospective review was conducted of case records of all children ≤12 years of age diagnosed with ATB from January 2007 to January 2018. Clinical details and investigations were recorded and analyzed.ResultsA total of 218 children (110 boys), with a median age of 10 (0.25–12) years, were included. There was a median delay of 4 (0.5–36) months in establishing the diagnosis. Abdominal pain, fever, and loss of weight were the most common presenting features, with the triad of symptoms present in 54%. Multiple intra‐abdominal sites were involved in 118 (54%) patients, with a combination of the gastrointestinal tract (I) and abdominal lymph nodes (L) being the most common (53/118). Among children with single‐site involvement (n = 100), the most commonly involved was L in 39 (39%), followed by I in 35(35%). Loss of weight was more common in children with involvement of multiple sites (85/118 vs 60/100, P = 0.03). Overall, a confirmed diagnosis was possible in 94 participants (43.1%). Suggestive imaging had the highest diagnostic yield of 85%. Nine (4.1%) patients needed surgical management.ConclusionA triad of abdominal pain, fever, and weight loss is suggestive of ATB. Multiple intra‐abdominal sites are frequently involved. Microbiological confirmation is possible in only one‐third of the cases.

Complex regional pain syndrome in children: incidence and clinical characteristics

ObjectiveTo study the clinical and epidemiological characteristics of complex regional pain syndrome (CRPS) in children.Patients and methodsAll children and adolescents under 16 years of age with a new diagnosis of...

Primary and Recurrent Crohnʼs Disease

Between 1970 and 1988, 1379 patients with Crohn's disease were treated at the University of Chicago. Of these, 639 (mean age, 32.5 years; 322 men, 317 women) required at least one surgical procedure. The most common indications for operation were failure of medical treatment (n = 215, 33%), presence of a fistula (n = 154, 24%), and bowel obstruction (n = 141, 22%). A fistula was the most common intraoperative Crohn's-related complication. In 582 patients (92%), a resection was necessary, with primary anastomosis in 416 (65%), a temporary stoma in 124 (20%), and a permanent stoma in 42 (7%). The remaining 57 patients underwent diverse procedures (stricturoplasty, bypass, and so on). Two patients (0.3%) died. Follow-up data was obtained in 95%. One hundred eighteen patients developed recurrence requiring reoperation. The recurrence rate was 20% at 5 years and 34% at 10 years. The recurrence involved a permanent stoma or a previous anastomosis in 62 patients (afferent limb in 46, efferent in 16). In the 391 patients without previous surgery for Crohn's disease, a covariate analysis was performed to determine those variables significantly associated with recurrence. Variables included demographic data, findings at operation, surgical procedures, and histopathologic characteristics. The analysis revealed that the number of sites involved was the only variable that was significantly associated with the intra-abdominal recurrence rate (p less than 0.001). The annualized risk of recurrence was 1.6% for patients with single-site involvement and 4% for those with multiple-site involvement. Perineal disease was associated with a significantly higher risk of local recurrence than any other site (p less than 0.02). A subanalysis of 236 patients with single-site involvement but no previous operation allowed us to study the influence of site on indications for surgery and type of operative procedure. Failure of medical treatment was the most common indication for all sites. In contrast the site involved influenced the procedure: resection and primary anastomosis was feasible in 88% of jejunoileal and terminal ileal cases and a temporary ileostomy was necessary in only 12%. No patients with small bowel localization required a permanent stoma. A resection with primary anastomosis was feasible in only 32% of patients with colonic disease. The remaining two thirds of patients required either a temporary or a permanent stoma. It is concluded that multisite involvement is associated with 2.5 times the rate of recurrence of single-site disease, while the presence of perineal disease has a significantly higher incidence of local recurrence.(ABSTRACT TRUNCATED AT 400 WORDS)