Site Of Primary Lesion Research Articles

Can we apply the concept of sentinel lymph node in rectal cancer surgery?

Introduction Colorectal cancer remains one of the most common causes of cancer-related mortality worldwide, and lymph node staging is crucial in the diagnostic and therapeutic process. Sentinel lymph nodes are the first involved in this process, but their validity in colorectal surgery has not yet been established. Following the emergence of new imaging instrumentation, some authors have attempted to propose different techniques for lymph node identification. However, a clear pattern of mesorectal lymph node distribution relative to the primary lesion site has yet to be defined. Material and methods Our analysis retrospectively reviewed suspicious mesorectal pathological lymph nodes on pre-operative magnetic resonance imaging (MRI) of rectal cancer patients, in order to assess the distribution patterns of possible tumour-related rectal lymph nodes. Mesorectal space was subdivided into quadrants and levels, and morphological features and distances from the lymph node to the primary rectal tumour were recorded. Results Two hundred and fifty-five mesorectal lymph nodes distributed among 60 patients were collected. Results show that in 92.1% of cases, nodes were distributed in the same mesorectal quadrant as the rectal primary tumour, and in 88.5% of cases, they were found at the same level as the rectal primary tumour. Conclusions Although a clear node distribution pattern was not established, these results may suggest at least a lymphatic drainage preference lane, worthy of further investigation.

Decreased SREBP2 of the striatal cell relates to disrupted protein degradation in Huntington’s disease

This study delineated the intricate relation between cholesterol metabolism, protein degradation mechanisms, and the pathogenesis of Huntington’s disease (HD). Through investigations using both animal models and cellular systems, we have observed significant alterations in cholesterol levels, particularly in the striatum, which is the primary lesion site in HD. Our findings indicate the dysregulation of cholesterol metabolism-related factors, such as LDLR and SREBP2, in HD, which may contribute to disease progression. Additionally, we uncovered disruptions in protein degradation pathways, including decreased neddylated proteins and dysregulated autophagy, which further exacerbated HD pathology. Moreover, our study highlighted the potential therapeutic implications of targeting these pathways. By restoring cholesterol levels and modulating protein degradation mechanisms, particularly through interventions, such as MLN4924, we observed potential improvements in cellular function, as indicated by the increased BDNF levels. These insights underscore the importance of simultaneously addressing cholesterol metabolism and protein degradation to alleviate HD pathology. Collectively, this study provides a basic understanding of the interplay between the decrease of SREBP2 and the dysfunctional protein degradation system derived from disrupted cholesterol metabolism in HD and HD cells.

PG I and PG II show unique value in diagnosing postoperative biochemical recurrence in patients with gastric cancer after total gastrectomy

ObjectiveTo investigate the potential of group I pepsinogen (PG I) and group II pepsinogen (PG II) as diagnostic markers for recurrence in gastric cancer (GC) patients post-total gastrectomy.MethodsNinety-six patients who underwent total gastrectomy for GC between June 2022 and June 2023 were included in this study. Clinical data, serum samples, and ascites samples were collected. Patients were categorized based on recurrence status at the time of sample collection and the primary tumor site. PG I and PG II levels were determined using a chemiluminescent immunoassay, and their clinical utility following total gastrectomy for GC was evaluated via receiver operating characteristic (ROC) curve analysis.ResultsThis study included 96 GC patients who underwent total gastrectomy, 55 of whom experienced postoperative recurrence (57.29%). The levels of serum PG I (27.86 (27.04, 30.97) vs. 26.05 (24.16, 27.09) ng/mL; P < 0.0001) and PG II (1.95 (1.23, 3.05) vs. 0.63 (0.47, 0.90) ng/mL; P < 0.0001) were significantly greater in the recurrent group compared to the non-recurrent group. The secretion of PG I and/or PG II by metastatic cancer cells correlated with the primary lesion site. When the cut-off value for serum PG I was 26.93 ng/mL, the area under the curve (AUC) for PG I was 0.77. When the cut-off value for serum PG II was 0.96 ng/mL, the AUC reached 0.90. The combined AUC was 0.97.ConclusionThese findings suggest that serum PG I and PG II are valuable biomarkers for identifying GC patients with biochemical recurrence post-total gastrectomy.

A modified supraclavicular artery island flap for reconstruction of oral and maxillofacial defects

ObjectiveTo overcome the limitation of the supraclavicular artery island flap (SCAIF), we describe a modified SCAIF which incorporates a portion of the upper trapezius and the superficial branch of the transverse cervical artery (TCA) for the reconstruction of oral and maxillofacial defects. Study designThe modified SCAIF was used on 20 patients at our hospital between April 2013 to August 2022. All patients underwent resection of the primary lesion site and immediate reconstruction with the modified SCAIF. Demographic data and flap details were recorded. Complications were assessed for at least a 6-month follow-up period. ResultsThis study included 20 patients. The mean flap harvest time was 50 minutes. The mean flap length was 6.0 cm, and the mean flap width was 5.0 cm. All flaps of 20 cases survived with good appearance, and no shoulder morbidity was found during a follow-up period of at least 6 months. ConclusionThe modified SCAIF is a versatile and reliable local flap option for moderate to large reconstruction in this special region after resection of the primary lesions. We found this simple flap design has overcome the limitations of the traditional one with a reliable blood supply and adequate tissue for larger defects.

IJCM_151A: Proportion of primary oesophageal cancer in persons with previous head and neck cancer in upper Assam

Background: Head and neck cancer highest amongst Indian states reported from Assam and is the leading cancer in men and third leading cancer in women. Due to advanced disease at the time of diagnosis prognosis of oesophageal cancer is poor. As mass screening for oesophageal cancer is neither feasible nor reasonable, high-risk groups should be identified and surveilled. Objective: To estimate the proportion of primary oesophageal cancer in persons with previous head and neck cancer in upper Assam. Methodology: A match case-control design with equal allocation was conducted in Assam Medical College in 2017. A total of, 232 patients with head and neck squamous cell carcinoma (HNSCC) with age and gender matched controls were evaluated with chromoendoscopy for possible second malignancy in oesophagus. Structured questioning using predesigned pretested schedule was done. Data analysis was done by using rates, ratio and proportion. Results: Men women ratio of the study participants was 79.3%:20.7%(184:48). According to site of primary lesion, majority having hypo-pharyngeal lesions (33%), followed by oral cavity(25%), oropharynx(18%) and nasopharynx(4%), respectively. Out of 232 patients, 64(27.59%) showed presence of varieties of oesophageal abnormalities Conclusion: Counselling all patients and screening of high- risk group specially those with previous head and neck cancer along with health awareness creation and timely intervention may be effective in risk reduction.

Pre-treatment Evaluation of Patients Eligible for Whole Brain Radiation Therapy: The Risk of Hippocampal Metastases in a Retrospective Study of 248 Cases at a Single Institution.

Whole brain radiation therapy (WBRT) is effective for multiple brain metastases (BMs) but may impair neurocognitive function (NCF). The incidence of hippocampal metastasis (HM) is low, and the factors associated with the occurrence of HM remain unclear. This study aimed to assess the occurrence of limbic system metastasis (LSM), including HM, and to analyze the risk of HM. We retrospectively analyzed 248 patients who underwent three-dimensional conformal radiation therapy for BMs between May 2008 and October 2015. Gadolinium-enhanced brain MRI or CT scans were used for diagnosis. Statistical analysis involved assessing clinical factors, including age, gender, primary tumor, number of BMs, and maximum metastasis diameter, in relation to the presence of HMs using logistic regression and receiver operating characteristic (ROC) curve analysis. The median age at treatment was 62 years (range: 11-83 years). Primary lesion sites included the lung (n = 150; 60.5%), breast (n = 45; 18.1%), gastrointestinal tract (n = 18; 7.3%), and bone and soft tissue (n = 2; 0.8%). Histological cancer types included adenocarcinoma (n = 113; 45.6%), squamous cell carcinoma (n = 26; 10.5%), small cell carcinoma (n = 28; 11.3%), invasive ductal carcinoma (n = 35; 14.1%), sarcoma (n = 3; 1.2%), and others (n = 43; 17.3%). MRI or CT scans of the 248 patients were analyzed, indicating a total count of 2,163 brain metastases (median: five metastases per patient). HMs were identified in 18 (7.3%) patients. The most common location for LSMswas the cingulum/cingulate gyrus in 26 (10.5%) patients. In univariate and multivariate analyses, patients with 15 or fewer BMs had a significantly lower incidence of HMs (odds ratio (OR), 0.018 (95% confidence interval (CI), 0.030-0.24)) (p < 0.0001). A maximal tumor size of less than 2cm significantly increased the incidence of HMs (OR, 13.8 (95%CI, 1.80-105.3)) (p = 0.0003). The presence of cingulum/cingulate gyrus metastases also demonstrated a significant increase in the incidence of HMs (OR, 9.42 (95%CI, 3.30-26.84)) (p < 0.0001). The present study has uncovered a novel association between a high number of metastases in the cingulate gyrus and the development of HMs. Patients with BMs eligible for WBRT with metastases in the cingulate gyrus may be at risk of developing HM.

Comparative Evaluation of Surgical Operability with and without Induction Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma.

To compare and evaluation of surgical operability with and without induction chemotherapy in locally advanced head and neck squamous cell carcinoma. Head and neck malignancy grossly refers to squamous cell carcinomas of head and neck (HNSCC) have multiple treatment modalities and strategies, when opted in an appropriate manner renders tumours curable. The aim of this study is to compare and evaluation of surgical operability with and without induction chemotherapy in locally advanced head and neck squamous cell carcinoma. A prospective observational study involving 50 patients of histologically proven squamous cell carcinoma of head and neck region. Patients were categorized into two major groups, group-1 patients included resectable tumour stage and group-2 included unresectable tumour stage. Both groups were compared after appropriate chemotherapy and surgical intervention. There were a total of 78% males and 22% females with majority of patients in age group of 41-60years. 54% patients had ulcerative type of growth pattern and most patients had primary site of lesion in oral cavity. 50% patients had moderately differentiated squamous cell carcinoma. Induction chemotherapy was considered in 70% of patients, whilemajority of patients were belonging to T4N2M0 stage. In this study, we recommend that the borderline category of patients who are initially in an unresectable tumour stage can undergo induction chemotherapy to downstage and shrink the tumour to a resectable stage following which the appropriate surgical intervention should be done with a close monitoring and sustained follow up to prevent recurrence.

Induction immunochemotherapy conversion rate and survival outcomes versus chemotherapy in initially unresectable esophageal squamous cell carcinoma.

e16077 Background: Currently, no comparative study has been reported to elucidate whether the addition of immunotherapy in the induction setting could improve treatment efficacy and prolong the overall survival of initially-unresectable locally advanced esophageal squamous cell carcinoma (iuESCC). This study aimed to compare surgical conversion rate and short-term overall survival in induction chemotherapy (iC) and induction immunochemotherapy (iIC) for patients with iuESCC. Methods: In this multicenter retrospective cohort study, patients with the guideline-defined unresectable disease were included at four high-volume institutions. The primary endpoints were conversion surgical rate and overall survival (OS). Pathological complete response (pCR) was defined as the disappearance of tumor cells in the primary lesion site. Multivariate cox regression analysis was used to identify the independent significant prognostic factors associated with OS. The stabilized inverse probability of treatment weighting (IPTW) was applied to confirm the survival comparison between iIC and iC cohorts. Results: A total of 309 patients (150 in iIC and 159 in iC cohort) were included. A significantly higher conversion surgical rate was observed in iIC cohort (iIC vs. iC: 127/150, 84.7% vs. 79/159, 49.7%, P &lt; 0.001). In terms of pathological response, the rates of pCR were 22.0% and 5.1% in the iIC and the iC cohort, respectively (P = 0.001). A significant difference in OS was observed between iIC (not reached) and iC cohorts (median [95% CI]: 36.3 [27.2 – 45.5] months). The stabilized IPTW yielded similar results. Regimen (iIC vs. iC, HR 0.215, 95% CI: 0.102 - 0.454, P &lt; 0.001) and operation (Yes vs. No, HR 0.262, 95% CI: 0.161 - 0.427, P &lt; 0.001) were the significant prognostic factors for OS. Further, subgroup analysis revealed that significantly higher OS was seen in iIC cohort than that in the iC cohort (P = 0.003) in patients who had non-pCR disease. Conclusions: Immunochemotherapy plus conversion surgery in the induction setting had higher pathological response rate and better OS in iuESCC patients. Moreover, this combined modality also contributed to improving OS in patients with residual tumor burden. This study provided evidence for future randomized control trial designs.

Surveillance of Mpox Cases Attending Sexual Health Services in England (SOMASS): design, implementation and initial findings from the SOMASS data collection tool, 2022

ObjectivesWe aimed to design and implement a data collection tool to support the 2022 mpox (monkeypox) outbreak, and to describe clinical and epidemiological data from individuals with mpox attending sexual...

Evaluation of the Autologous Genetically Enriched Leucoconcentrate on the Lumbar Spinal Cord Morpho-Functional Recovery in a Mini Pig with Thoracic Spine Contusion Injury.

Pathological changes associated with spinal cord injury (SCI) can be observed distant, rostral, or caudal to the epicenter of injury. These remote areas represent important therapeutic targets for post-traumatic spinal cord repair. The present study aimed to investigate the following in relation to SCI: distant changes in the spinal cord, peripheral nerve, and muscles. The changes in the spinal cord, the tibial nerve, and the hind limb muscles were evaluated in control SCI animals and after intravenous infusion of autologous leucoconcentrate enriched with genes encoding neuroprotective factors (VEGF, GDNF, and NCAM), which previously demonstrated a positive effect on post-traumatic restoration. Two months after thoracic contusion in the treated mini pigs, a positive remodeling of the macro- and microglial cells, expression of PSD95 and Chat in the lumbar spinal cord, and preservation of the number and morphological characteristics of the myelinated fibers in the tibial nerve were observed and were aligned with hind limb motor recovery and reduced soleus muscle atrophy. Here, we show the positive effect of autologous genetically enriched leucoconcentrate-producing recombinant neuroprotective factors on targets distant to the primary lesion site in mini pigs with SCI. These findings open new perspectives for the therapy of SCI.

Epidemiological, Clinical, and Histopathological Characteristics of Patients with Sporotrichoid Lymphocutaneous Infection in Southern Thailand: A 10-Year Retrospective Study.

Sporotrichoid lymphocutaneous infection is caused by a variety of pathogens. However, in most cases, the causative pathogen cannot be identified on the basis of clinical and histopathological features. We examined the clinical manifestations, histopathologic findings, causative pathogens, treatment, and prognostic factors of sporotrichoid lymphocutaneous infection, specifically in the context of Thailand. The electronic medical records of patients with sporotrichoid lymphocutaneous infection who visited Songklanagarind Hospital from January 2000 to December 2010 were reviewed. A total of 53 patients were included; 41 (77.4%) were female, 12 (22.6%) were male, and the mean (SD) age was 52.9 (± 15.9) years. Nodules, plaques, and papules were the most commonly observed morphologies. Upper extremities were the most commonly infected sites. Mammal-caused injuries were associated with fungal infection but not at a statistically significant level. The most common histopathologic finding was suppurative granuloma. The identified causative pathogens were mainly dematiaceous fungus and occasionally nontuberculous Mycobacterium. Itraconazole was the medication of choice for empiric and specific treatment of the patients with confirmed fungal infection. Dematiaceous fungi were the most common identified pathogens causing sporotrichoid lymphocutaneous infection in southern Thailand. Empirical itraconazole is useful, especially in patients who report contact injury caused by pets at the primary lesion site. Skin biopsy for tissue histopathology and culture is essential.

MP64-20 UNDERSTANDING CLINICAL OUTCOMES IN PATIENTS RENDERED NO EVIDENCE OF DISEASE IN METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP64-20 UNDERSTANDING CLINICAL OUTCOMES IN PATIENTS RENDERED NO EVIDENCE OF DISEASE IN METASTATIC RENAL CELL CARCINOMA Arnold Oparanozie, Stephen W. Reese, Lennert Eismann, Katiana Vasquez-Rivera, Robert Motzer, Martin H. Voss, Chung-Han Lee, Maria Carlo, Ritesh R. Kotecha, Jonathan Coleman, Paul Russo, and A. Ari Hakimi Arnold OparanozieArnold Oparanozie More articles by this author , Stephen W. ReeseStephen W. Reese More articles by this author , Lennert EismannLennert Eismann More articles by this author , Katiana Vasquez-RiveraKatiana Vasquez-Rivera More articles by this author , Robert MotzerRobert Motzer More articles by this author , Martin H. VossMartin H. Voss More articles by this author , Chung-Han LeeChung-Han Lee More articles by this author , Maria CarloMaria Carlo More articles by this author , Ritesh R. KotechaRitesh R. Kotecha More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Paul RussoPaul Russo More articles by this author , and A. Ari HakimiA. Ari Hakimi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In renal cell carcinoma (RCC), patients with metastatic disease who have achieved no evidence of disease after treatment of primary lesion and metastatic sites (M1NED) remain a poorly characterized cohort. Clinical management strategies are diverse, as they may be candidates for adjuvant immunotherapy or may be candidates for a strategy of surveillance to minimize treatment-related toxicities and optimize quality of life. Given the poorly characterized nature of this disease state and the uncertain utility of rendering a patient NED with metastatic disease, we sought to better characterize the clinical outcomes of this patient population. METHODS: In this retrospective single-institution study at a large academic institution, we identified a cohort of patients with metastatic RCC who achieved M1NED status. Inclusion in our cohort required that the patient be rendered free of disease within 30 days of surgery from the index operation. Patients could be rendered free of metastatic sites of disease via metastasectomy, thermal ablation, or radiation. Using the Kaplan-Meier method, overall survival (OS), cancer-specific survival (CSS), systemic-therapy-free survival (ST-FS), and progression-free survival (PFS) were calculated. Additionally, we modeled the risk of progression using a Cox Proportional Hazard model. RESULTS: The study included 84 patients who achieved M1NED status from 1989 to 2020. In the cohort, the median age was 56.3 years, patients had good performance (KPS: 85.6), 62 (73.8%) had clear cell histology, 1 site of metastatic organ involvement [67, 79.8%] and 63 (75%) had clinical T-stage T3. The most common metastatic site after being rendered NED was bone 23 (27.4%) and lung 21(25%). Median follow-up for the cohort was 86.2 mo. (95% CI: 49.2 199.9). Median OS for the cohort was 56 mo. (95% CI: 40.6 79.3), CSS was 78.4 mo. (95%CI: 40.6-79.3), ST-FS 46.5 mo. (95% CI: 27.2 NR) and PFS 13.8 mo. (95% CI: 10.0-16.5). On a Cox Proportional-Hazard model, only sarcomatoid histology was associated with an increased risk of progression [HR: 3.28 (95% CI:3.94-2.62), p<0.01]. CONCLUSIONS: Patients with RCC who are rendered M1NED are associated with favorable outcomes and may achieve a long interval of systemic therapy-free survival. This patient population demonstrates significant competing risks and many patients did well on surveillance before initiating systemic therapy. This study offers a unique insight into a classically hard-to-define population and a detailed study of this population may be helpful in clinical decision-making. Source of Funding: MSK P30 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e889 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arnold Oparanozie More articles by this author Stephen W. Reese More articles by this author Lennert Eismann More articles by this author Katiana Vasquez-Rivera More articles by this author Robert Motzer More articles by this author Martin H. Voss More articles by this author Chung-Han Lee More articles by this author Maria Carlo More articles by this author Ritesh R. Kotecha More articles by this author Jonathan Coleman More articles by this author Paul Russo More articles by this author A. Ari Hakimi More articles by this author Expand All Advertisement PDF downloadLoading ...

The lymphatic system of the uterine cervix: towards a more precise definition of the drainage routes

Lymph node involvement in cancer of the uterine cervix is a major independent prognostic factor for overall survival. The aim of our study was to examine the lymphatic drainage regions of the different parts of the uterine cervix. An anatomical study of fresh cadavers was conducted by injecting patent blue in the anterior or posterior lip of the uterine cervix and dissecting drainage regions. Furthermore, a retrospective radiological and pathological studies were conducted on patients who were treated for early-stage cancer of the uterine cervix with lymph node involvement. Radiological analysis of pre-therapeutic MRIs and/or pathological analysis of surgical specimens showed the precise location of the tumour. A correlation between the anatomy of the primary lesion site and the lymphatic area involved was established. We administered 15 cadaveric injections: 8 in the anterior lip of the uterine cervix and 7 in the posterior one. For 100% of the anterior lip injections, lymphatic drainage was bilateral ileo-obturator (n = 8/8) combined with bilateral parametrial drainage. For the posterior injections, there was never any ileo-obturator drainage, and 6 of the 7 (75%) posterior injections drained in the posterior uterine serosa. Concerning the clinical study, we included 21 patients. We observed a non-significant tendency towards bilateral lymph node involvement when the tumour of the anterior lip. Physiological lymphatic drainage of the uterine cervix presents anatomical specificities, depending on the structure studied, anterior or posterior lip of the cervix. Better knowledge of these specificities should allow personalized surgery for each patient.

Immunization with Tp0954, an adhesin of Treponema pallidum, provides protective efficacy in the rabbit model of experimental syphilis.

Syphilis, a chronic multisystemic disease caused by spirochete Treponema pallidum subspecies pallidum infection, continues to be a serious global health problem and congenital syphilis remains a major cause of adverse outcomes in pregnancy in developing countries. The development of an effective vaccine is the most cost-effective way to eliminate syphilis, but so far has been elusive. Here, we evaluated the immunogenicity and protective efficacy of Tp0954, a T. pallidum placental adhesin, as a potential vaccine candidate in a New Zealand White rabbit model of experimental syphilis. Animals immunized with recombinant Tp0954 (rTp0954) produced high titers of Tp0954-specific serum IgG, high levels of IFN-γ from splenocytes and specific splenocyte proliferation response when compared to control animals immunized with PBS and Freund's adjuvant (FA). Furthermore, rTp0954 immunization significantly delayed the development of cutaneous lesions, promoted inflammatory cellular infiltration at the primary lesion sites, as well as inhibited T. pallidum dissemination to distal tissues or organs when compared with that of the control animals. In addition, the naïve rabbits receiving popliteal lymph nodes from Tp0954-immunized, T. pallidum-challenged animals were not infected by T. pallidum, confirming sterile immunity. These findings suggest that Tp0954 is a potential vaccine candidate against syphilis.

Role of Denosumab in the Management of Giant Cell Tumor, a Cross Sectional Study

ABSTRACT Background: Giant cell tumor (GCT) of bone is a benign lesion which is characterized by presence of multinucleated osteoclasts type giant cells. Nuclear factor kappa B (RANKL) serves as the trigger factor for osteoclasts cells formation. Although surgery is the primary treatment for GCT of bone but recurrence remains the concern. Therefore, the development of denosumab, a monoclonal antibody for treating GCT for both primary and recurrent disease cases. The present study aims to show the role of denosumab along with surgery when given as neo-adjuvant drug to patients of GCT for their treatment. Methodology: A total of 23 patients diagnosed with GCT were included in this study from January 2016–December 2019 and all of these patients had received neo adjuvant denosumab dose of 120 mg SC on day 0, 15, 30 &amp; 45. All patients were treated at the section of Orthopedics, department of surgery, Aga Khan University hospital, Karachi. Other benign lesions were excluded from the study. Results: Out of 23 patients we had 12 (52.2%) males and 11 (47.8%) females. The mean age of our patients was 34±13.8 years and mean follow up duration of all patients was 20.5 ± 10.7 months. There were 15 (65.2%) primary cases of GCT while 8 (34.8%) were recurrent cases. In 8 (34.8%) of the cases primary site of lesion was distal femur followed by 7(30.4%) proximal tibia cases and 3(13%) distal radius cases. In surgical procedure 20 (87%) patients underwent wide margin excision and only 3 (13%) had intralesional curettage. Reconstruction was performed in 21 patients which consist of bone grafting in 9 patients and mega prosthesis insertion in 12 patients. Only two patients had no reconstruction. On final histopathology, there was no residual GCT and we observed no denosumab induced adverse effects. Post-operative complications included wound infection and peri prosthetic infection in 3 patients. On follow-up we had 4(17.4%) cases of recurrence that were offered revision surgery while 19 (82.6%) were disease free. Conclusion: Denosumab has shown successful results in treating patients with GCT along with surgical intervention and it can be a best option for treating recurrent disease as well. Highlights Research registration no: researchregistry4695

33755 Patterns and prognosis of distant metastases of melanoma subtypes in the Surveillance, Epidemiology, and End Results database

Background: Metastatic melanoma has poor prognosis with patterns of distant metastases that are incompletely explored. We aim to describe the distribution and prognosis of melanoma subtypes using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Patients with metastatic melanoma were identified in SEER diagnosed from 2010 to 2016. Melanoma subtypes encompassed malignant melanoma, NOS (MM), nodular melanoma (NM), superficial spreading melanoma (SSM), acral lentiginous melanoma (ALL), and lentigo maligna melanoma (LMM). ANOVA and Fisher exact tests assessed for differences in clinical characteristics by melanoma subtype and primary site of lesion. Fine-Grey competing risk regression was performed on MM, SSM, and NM subtypes to assess for prognosticators of cancer-specific mortality. Results: We identified 2492 patients with metastatic melanoma (63.5% MM, 24.4% NM, 12.2% SSM, 2.2% ALM, and 1.9% LMM). MM and NM had a higher propensity for brain metastases, liver metastases, and lung metastases than other subtypes. Patients with ALM had a predilection for bone and lung metastases compared with other sites of metastasis. When stratified by site, head and neck and trunk lesions for all subtypes (except ALM) had a greater propensity for lung metastases compared with lesions on the extremities. Furthermore, lesions on the trunk had a higher proportion of liver metastases than lesions on other primary sites. On regression analysis, lung and liver metastases had poorer prognosis in MM, SSM, and NM. Conclusions: Our analysis demonstrates that melanoma subtypes have a differential preference for sites of distant metastases.

Growing Teratoma Syndrome-A Clinicoradiological Series.

Context Growing teratoma syndrome (GTS) is a rare entity seen following chemotherapy for metastatic nonseminomatous germ cell tumors, characterized by increase in size of the metastatic deposits, with normal serum tumor markers. Aims In this article, we aim to describe the various clinicoradiological presentations of GTS treated at our center. Design All patients who satisfied the GTS criteria from 2001 to 2019 were included. Characteristic imaging appearances along with sites of primary lesion and metastatic disease, stage and risk stratification at diagnosis, details of chemotherapy, details of surgical treatment and histopathology, levels of tumor markers, serum β-human chorionic gonadotropin, lactate dehydrogenase, and alpha fetoprotein levels at baseline and at the end of all chemotherapy were analyzed. Results The significant radiological findings observed were an increase in the fat and cystic components and appearance of coarse calcifications within the lesions. Majority of the cases were male patients (87.5%) with testicular primaries and GTS transformation in nodal metastases being the most common occurrence (75%). All eight cases (100%) showed an increase in size and cystic component, whereas four out of eight cases (50%) had presence of internal septations and internal calcification. Conclusion Early recognition of this entity and clinical decision making through serial radiological imaging are of utmost importance as these growing deposits are resistant to chemotherapy and radiotherapy, with complete surgical excision being the only curative and definitive treatment option.

More Attention on Segments Remote from the Primary Spinal Cord Lesion Site.

Recent findings from multimodal imaging studies point to macrostructural pathological changes in areas significantly distant from the epicenter of spinal cord injury, both in the spinal cord and in the brain. Studies are being performed to determine cellular and molecular mechanisms of these shifts, which are currently poorly understood. Research has demonstrated that the pathological process in the remote area is multifaceted. This process involves astrocytes and microglia, which contribute to the degeneration of nerve fibers passing from and through the immediate impact area, as well as participate in reciprocal activation. As a result, there is accompanying synaptic loss in areas remote to the spinal cord injury location. Reactive astrocytes produce chondroitin sulfate proteoglycans that inhibit axon growth and damage cells. However, neuronal death in the remote area remains controversial. The area of primary injury is the source of numerous neurotoxic molecules that release into the cerebrospinal fluid. It is assumed that these molecules, primarily matrix metalloproteinases, disrupt the blood-spinal cord barrier, which leads to tissue infiltration by macrophage precursors in the remote area. Activated macrophages secrete pro-inflammatory cytokines and matrix metalloproteinases, which, in turn, induce astrocytes and microglia towards a pro-inflammatory phenotype. In addition, reactive microglia, together with astrocytes, secrete numerous pro-inflammatory and neurotoxic molecules that activate inflammatory signaling pathways, consequently exacerbating synaptic depletion and neurological deterioration. It appears likely that the interplay between chronic inflammation and neurodegeneration is a pivotal characteristic of the pathological process in the spinal cord areas distant from the epicenter of the lesion. Pathological changes in the distant areas should be the object of research as potential therapeutic targets.

To CT or not to CT: Questioning the Cost-Effectiveness of CT Thorax in Head and Neck Cancers

Computed tomography (CT) scan has been an integral part of the diagnostic workup for patients with head and neck squamous cell carcinoma. Our study was designed to find out the incidence of distant metastasis and second primary tumor and to correlate the cost-effectiveness of CT thorax in detecting the same. This study was conducted among 326 cancer patients who visited our center with curative intent in the year 2021, with lesions in various head and neck subsites. Data were collected based on their pathological TNM staging and the presence of distant metastasis as evident on their CT thorax imaging with various variables related to the disease. Incremental cost-effectiveness ratio (ICER) was calculated for detecting a single metastatic deposit and second primary tumor in terms of Indian currency and was correlated to each subsite and stage of disease at presentation. Out of these 326 patients, 281 patients were included in our study after considering the inclusion criteria, and among these 281 patients, 235 of them underwent CT thorax for metastatic workup. No patient was found to have a second primary. Metastases were found in 12 patients. The site of primary lesion and clinical tumor (cT) staging were found to be significantly influencing the incidence of metastasis on CT thorax. ICER was least for larynx, pharynx, and paranasal sinuses and was highest for oral cavity primaries and early-stage disease. As per our observations and results of ICER, CT thorax is indeed a valuable modality but should be used judiciously when it comes to initial diagnostic workup.

Females Have Worse Overall and Disease-Specific Survival in Human Papillomavirus–Negative Oropharyngeal Squamous Cell Carcinoma

Although sex (male vs female) has been identified as an independent prognostic factor in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), the role of sex in HPV-negative OPSCC is less understood. The purpose of this study is to measure the association between sex and HPV-negative OPSCC disease-specific survival (DSS) and overall survival (OS). This longitudinal, retrospective study examined cases of HPV-negative OPSCC diagnosed in the United States between 2013 and 2016 from the Surveillance, Epidemiology, and End Results database. Patients with primary OPSCC and known HPV-negative status were included. Those with HPV-positive or unknown status and primary lesions located outside the oropharynx were excluded. The primary predictor variable was patient sex (male vs female). Primary outcome variables of interest included DSS and OS. The following patient-level covariates were also assessed: age, race, insurance status, primary anatomical site and histological type of lesion, histologic grade and stage, and disease outcome. A survival analysis was conducted using univariate and multivariate analyses via a cox proportional hazard regression model. An α value less than 0.05 was considered statistically significant. The study sample consisted of 2,565 cases (25.1% female) of HPV-negative OPSCC. Females presented with lower histologic grade (P=.015) and earlier stage (P=.003). Females demonstrated worse DSS (P<.001) and OS (P<.001). After multivariate adjustment, female sex (hazard ratio [HR]= 1.38; 95% confidence interval [CI], 1.13 to 1.67; P=.002), advanced age (HR= 1.672; 95% CI, 1.07 to 2.60; P=.023), advanced overall stage (HR= 4.69; 95% CI, 1.54 to 14.267; P=.006), TNM stage (T4: HR= 5.74; 95% CI, 3.86 to 8.55, P<.001, N3: HR= 3.48; 95% CI, 2.17 to 5.58; P<.001, and M1: HR= 2.80; 95% CI, 2.09 to 3.74; P<.001), subjects residing in counties with the highest rates of smoking (HR= 1.29; 95% CI, 1.01 to 1.65; P=.044), and the lack of surgical treatment in patients treated with radiation and/or chemotherapy (HR= 1.44; 95% CI, 1.08 to 1.91; P=.012) were correlated with poorer DSS and OS. Females with HPV-negative OPSCC demonstrated worse DSS and OS despite better typical prognostic signs such as histologic grade and clinical stage.