Solitary Tumor Research Articles

Atypical Presentation of Traumatic Ulceration Granuloma with Stromal Eosinophilia (TUGSE) of the Tongue: A Case Report

Introduction: This article aims to report a rare case of traumatic ulceration granuloma with stromal eosinophilia (TUGSE) in young children. Contrary to the reported cases in the literature, this article describes an atypical case of TUGSE presented as a solitary tumour on the tongue. Case Report: A 4 years old boy with Down syndrome was referred to the Paediatric Dentistry Department for management of swelling of the tongue, which gradually increased in size. Clinical examination demonstrated a well-defined firm, pedunculated swelling over the left dorsum of the tongue measuring 15 mm x 12 mm. A provisional diagnosis of fibroma was made. Excisional biopsy was performed under general anaesthesia (GA). Recurrence of the lesion was observed and a subsequent surgical excision with the extractions of left primary molars were conducted under GA. The histopathological examination (HPE) reports interpreted the lesion as TUGSE. Conclusion: It is difficult to clinically diagnose TUGSA hence histological findings are paramount to establish the diagnosis. Awareness of TUGSE is crucial to emphasise the correct diagnosis and to deliver appropriate and effective treatment.

Breast myofibroblastoma in a woman: a case report

Breast myofibroblastoma is a rare benign neoplasm of mesenchymal origin with fibroblastic and myofibroblastic characterizations. Myofibroblastoma has a higher incidence in men between the ages of 50 and 70 years and is less common in women. It is described as a solitary, unilateral, painless and mobile tumor, with a firm consistency and slow growth. Microscopically, it is a non-encapsulated tumor, with lobular growth, consisting of spindle cells organized in short, intersecting fascicles and interrupted by bundles of hyalinized collagen. On ultrasound, it can manifest as a hypoechoic solid mass, well circumscribed, homogeneous and similar to fibroadenoma; whereas, on mammography, a single, well-defined, rounded or discretely lobulated lesion can be observed, without calcifications. We report here the case of a 58-year-old patient with no previous breast complaints, who presented with changes in ultrasound and mammography examinations performed for breast cancer screening. The examinations revealed a suspicious lump in the left breast, classified as BIRADS 4C. Core biopsy described a low-grade spindle cell neoplasm, showing no signs of invasion, with immunohistochemistry results suggesting myofibroblastoma. As treatment, a sectorectomy was performed, and the reevaluated material confirmed the diagnosis of myofibroblastoma due to the positive expression of the markers calponin, CD34, BCL2 and CD99.

A Rare Occurrence of Enchondroma in the Head of Femur in an Adult Male: A Case Report

Introduction: Enchondroma is a solitary, benign, and intramedullary cartilaginous tumor occurring most commonly in small bones of hands and feet contributing to 3–10% of all bone tumors. They originate from the growth plate cartilage which later on proliferates to form enchondroma. Lesions are central or eccentric and metaphyseal involvement is most common for long bones. We report a case of atypical occurrence of enchondroma in the head of femur in a young male. Case Report: A 20-year-old male patient presented with a history of pain in the left groin for 5 months. Radiological examination showed a lytic lesion in the head of femur. The patient was managed by safe surgical dislocation of the hip, curettage with autogenous iliac crest bone graft with countersunk screw fixation. Histopathology confirmed the lesion to be enchondroma. At the latest follow-up after 6 months, the patient was symptom-free and there was no evidence of any recurrence. Conclusion: Lytic lesions in the neck femur can have a good prognosis provided timely diagnosis and interventions are done. The present case of enchondroma in the head of femur represents a very rare differential diagnosis for the same and this must be kept in mind. So far, no such case has been reported in the literature. Magnetic resonance imaging and histopathology are of the essence to confirm this entity. Keywords: Enchondroma, atypical presentation, safe surgical dislocation of hip.

Piddling and Moderate-Primary Cutaneous CD4+ Small/Medium T Cell Lymphoproliferative Disorder

Initially contemplated as a provisional subtype of cutaneous T cell lymphoma (CTCL), primary cutaneous CD4+ small / medium T cell lymphoproliferative disorder manifests as an indolent, solitary cutaneous lesion in the absence of accompanying cutaneous lymphoma as mycosis fungoides. Preponderantly, infiltration of upper dermis with miniature to intermediate, pleomorphic CD4+ T cells in the absence of preceding or concurrent patches and plaques with focal epidermotropism is encountered. Primary cutaneous CD4+ small/medium T cell lymphoproliferative disorder commonly appears in adults as a solitary plaque, tumour or nodule situated upon face, neck, upper trunk or thoracic region. Upon cytology, pleomorphic, miniature, intermediate or occasionally enlarged T lymphoid cells with irregular nuclear contours are variably intermixed with miniature, reactive CD8+ T cells, B cells, plasma cells, histiocytes and monotypic plasma cells. Morphologically, an intense dermal infiltrate of atypical lymphoid cells or small / medium pleomorphic CD4+ T cells extending into subcutaneous tissue appears to configure a diffuse or nodular configuration wherein the enlarged, pleomorphic cells articulate < 30% of neoplastic cellular infiltrate. Neoplastic lymphocytes appear immune reactive to T cell markers as CD3, CD4, CD5 along with T follicular helper markers as CD279 (PD-1), ICOS and CXCL13. Primary cutaneous CD4+ small/medium T cell lymphoproliferative disorder necessitates segregation from mycosis fungoides, cutaneous involvement with systemic T cell lymphoma of T follicular helper immuno-phenotype, benign inflammatory infiltrate, extra-nodal marginal zone (MALT) lymphoma or adult T cell leukaemia /lymphoma. The disorder can be therapeutically managed with intralesional steroids, radiotherapy or surgical extermination of lesion.

Combination Therapy of Submandibular Keloids Electrosection and Cryotherapy

Introduction: Keloid is an excessive formation of scar tissue (proliferative growth) that appears on the skin that has been traumatized or over a surgical wound and is not in accordance with the severity of the trauma, cannot heal spontaneously, and can recur after excision. Treatment of keloids on the face is difficult and challenging and has consequences for aesthetics. Various types of combination therapy, such as electrosurgery (radiofrequency) followed by frozen surgery (cryotherapy) are recommended to reduce the risk of keloid recurrence. Case Illustration: A 15-year-old male came with the chief complaint of a lump on his face. at the location of the submandibular region found a solitary tumor, with firm boundaries, oval shape, skin color, a diameter of 1 cm, and a smooth and shiny surface. On palpation, the consistency is firm and immobile. On dermoscopy examination, a purple vascular structure was obtained, and arborizing vascular structures were seen. A clinical diagnosis of keloid was given. The treatment was given by radiofrequency electrosection and was followed by cryotherapy for lesions in the submandibular region. Discussion: The combination of radiofrequency and cryotherapy was considered in this case because the location of the keloid lesion was located on the facial area which could reduce the risk of bleeding and also from a cosmetic point of view of the patient. The combination of the 2 therapies also functions to reduce the possibility of recurrence in patients. Conclusion: Radiofrequency and cryotherapy measures show significant clinical improvement; the lesions shrink and soften.

The Compact Bleb-Eosinophilic Solid and Cystic Renal Cell Carcinoma

The contemporary, indolent, Eosinophilic solid and cystic renal cell carcinoma configures as a predominantly solitary neoplasm delineating solid and cystic pattern of tumour evolution. Neoplastic cells are incorporated with abundant Eosinophilic cytoplasm and intracytoplasmic inclusions or basophilic stippling. Tumour cells display frequent somatic loss of function genetic mutations confined to TSC1 (9q34.13) gene or TSC2 (16p13) gene. Eosinophilic tumour cell clusters appear admixed with macroscopic cysts or microscopic tubules and cystic structures coated with singular layer of hobnail cells. Neoplastic cells are permeated with abundant, granular, eosinophilic cytoplasm. Tumour cells appear immune reactive to PAX8, CK20, AMACR, CD10, SDHB, fumarate hydratase, vimentin, cathepsin K and Melan A.

Eccrine poroma over the scalp: an atypical presentation

<p class="abstract">An eccrine poroma is a solitary tumor arising from the eccrine duct epithelium in the epidermis. The lesions commonly occur on palm and soles, and occasionally on the nose, eyelids, neck, and chest. We report a patient who presented with a slow-growing nodular lesion over his scalp, dermoscopic examination showed lobular appearance composed a structureless white areas and pigmentation at periphery with erosion in centre, vascular pattern with interlacing white cords separating structure-less islands with central ulceration. Histopathology examination showed a nodular infiltrate composed of poroid cells extending from epidermis to dermis and finding suggestive of an eccrine poroma. We are presenting this case for its unusual site and early onset of presentation.</p><p> </p>

Characteristics and treatment strategies for hepatocellular carcinoma caused by nonalcoholic fatty liver disease

In recent years, nonalcoholic fatty liver disease (NAFLD) incidence has rapidly increased, and it is gradually becoming a major contributor to liver cirrhosis and hepatocellular cancer (HCC). The degree of liver fibrosis, diabetes mellitus (DM), obesity, age, and gender are the main risk factors for nonalcoholic steatohepatitis (NASH) progression to HCC. Patients with NASH-related HCC are predominantly male, and almost all of them have at least one metabolic disorder (obesity, DM, dyslipidemia, hypertension, etc.). Most HCCs manifest as solitary tumor nodules and a significant number of NASH-related HCCs are non- cirrhotic. Case fatality rates are similar across patients with cirrhotic and noncirrhotic HCC, despite the fact that patients with noncirrhotic HCC tend to be older, have a single macronodular tumor, and have lower incidence of type 2 diabetes and liver transplantation. Controlling the risk factors for NASH might thereby minimize the likelihood of developing HCC. The BCLC staging system should be used as a guide to treat patients with NASH-related HCC. The long-term outcomes of NAFLD-related HCC treatment are similar to those for other HCCs of different etiologies. However, patients combined with metabolic syndrome are at high perioperative risk, so apporpriate preoperative preparation, especially cardiac examination, is essential to avoid this risk.

Oncology

The December 2022 Oncology Roundup360 looks at: Is high-dose radiation therapy associated with early revision with a cemented endoprosthesis?; Neoadjuvant chemotherapy and endoprosthetic reconstruction for lower extremity sarcomas: does timing impact complication rates?; Late amputation after treatment for lower extremity sarcoma; Osteosarcoma prediagnosed as another tumour: a report from the Cooperative Osteosarcoma Study Group; The influence of site on the incidence and diagnosis of solitary central cartilage tumours of the femur: a 21st century perspective.

Predicting short- and long-term renal function following partial and radical nephrectomy

ObjectivesTo externally validate the previously published Mayo clinic model for the prediction of early (<30 days) postoperative renal failure, which relies solely on preoperative estimated glomerular filtration rate (eGFR) and develop a novel model for the prediction of long-term (>30 days) renal function after partial nephrectomy (PN) and radical nephrectomy (RN), including patient factors and nephrometry scores. Patients and methodsRetrospective, single-center cohort study on patients who underwent PN or RN for a unilateral renal tumor between 2003 and 2019 with a preoperative eGFR of at least 15 ml/min/1.73m2. Early postoperative renal failure was defined as eGFR <15 ml/min/1.73 m2 or receipt of dialysis within 30 days. We determined the area under the receiver operating characteristics curve (AUC) to assess the Mayo clinic model's discriminative power. We used hierarchical linear mixed models with backward selection of candidate variables to develop a prediction model for long-term eGFR following PN and RN, separately. Their predictive ability was quantified using the marginal and conditional R2GLMM and an internal validation. ResultsWe included 421 patients (7,548 eGFR observations) who underwent PN and 271 patients (6,530 eGFR observations) who underwent RN. The Mayo clinic model for prediction of early postoperative renal failure following PN and RN showed an AUC of 0.816 (95% CI 0.718–0.920) and 0.825 (95% CI 0.688–0.962), respectively.In multivariable models, long-term eGFR following PN was associated with age, diabetes, the presence of a solitary kidney, tumor diameter and preoperative eGFR, while long-term eGFR following RN was associated with age, body mass index, RENAL nephrometry score and preoperative eGFR. Marginal and conditional R2GLMM were 0.591 and 0.855 for the PN model, and 0.363 and 0.849 for the RN model, respectively. ConclusionsThe Mayo clinic model for short-term renal failure prediction showed good accuracy on external validation. Our long-term eGFR prediction models depend mostly on host factors as opposed to tumor complexity and can aid in decision-making when considering PN vs. RN.

PSUN27 Largest Cohort of Cervical Spine Metastases of Pheochromocytoma/Paraganglioma in the Setting of SDHB Mutation

Abstract Background Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors arising from chromaffin cells in adrenal or extra-adrenal locations, respectively. Overall, 10 to 20% of PPGLs are metastatic, with higher metastatic potential observed in succinate dehydrogenase subunit B (SDHB)-related tumors (up to 90%). Metastatic PPGLs are diagnosed based on the presence of tumor cells of chromaffin origin in a location outside the site of normal development (adrenal medulla and the sympathetic chain) in the bones and lymphatic nodes per 2017 WHO guidelines. Studies evaluating both metastatic pheochromocytomas and extra-adrenal PGLs have reported bone to be the most common site of metastasis. Clinical Case We reviewed the metastatic patients in our PPGL cohort and found 40 (29.85%) out of 134 patients with SDHB-related metastatic PPGLs developing metastatic lesions in the cervical spine. The related descriptive analyses were as follows: 25 (62.5%) were males, 15 (37.5%) females. Fourteen patients (35%) have died due to metastatic PPGL complications. The average age of patients at the time of the primary tumor diagnosis was 30.3 ± 35 years and the age at the initial metastatic tumor diagnosis was 34 ± 33 years. The average time interval to metastatic disease was 7.4 ± 38 years. At their initial presentation, there were 25 (62.5%) patients with solitary tumors; 1 (2.5%) with multiple primary tumors; and 14 (35%) with metastatic tumors. All the patients either developed or had metastatic lesions in the cervical vertebrae. Nine (22.5%) patients required surgical fusions of the vertebrae to manage their pathological fractures and another 9 (22.5%) patients received radiation therapy. Conclusion Genetic testing is recommended for all patients with PPGLs. Genetic analysis, especially finding a SDHB mutation may be helpful in determining metastatic potential. Most patients with spinal metastatic lesions are asymptomatic, but when clinical symptoms arise, the most common clinical symptom involves pain and neurological deficit. Metastasis to the spine is an important complication that can lead to significant pain and disability and requires surgical interventions or radiotherapy. Awareness for such spinal tumors is essential for offering the correct treatment to the patients. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Survival benefit of adequate lymphadenectomy in patients undergoing liver resection for clinically node-negative intrahepatic cholangiocarcinoma

Lymph-nodal status is an important predictor of survival in intrahepatic cholangiocarcinoma (iCCA), but the need to perform lymphadenectomy in patients with clinically node-negative (cN0) iCCA is still under debate. The aim of this study was to determine whether adequate lymphadenectomy improves long-term outcomes in patients undergoing liver resection for cN0 iCCA. We performed a retrospective cohort study on consecutive patients who underwent radical liver resection for cN0 iCCA at five tertiary referral centers. A propensity score based on preoperative data was calculated and used to generate stabilized inverse probability of treatment weight (IPTW). Overall and recurrence-free survival of patients undergoing adequate (≥6 retrieved lymph nodes) vs. inadequate lymphadenectomy were compared. Interactions between adequacy of lymphadenectomy and clinical variables of interest were explored through Cox IPTW regression. The study includes 706 patients who underwent curative surgery for cN0 iCCA. Four-hundred and seventeen (59.1%) received adequate lymphadenectomy. After a median follow-up of 33 months (IQR 18-77), median overall survival was 39 months (IQR 23-109) and median recurrence-free survival was 23 months (IQR 8-74). After stratification according to nodal status at final pathology, node-positive patients had longer overall survival (28 vs. 23 months; hazard ratio 1.82; 95% CI 1.14-2.90; p= 0.023) and disease-free survival (13 vs. 9 months; hazard ratio 1.35; 95% CI 1.14-1.59; p= 0.008) after adequate lymphadenectomy. Adequate lymphadenectomy significantly improved survival outcomes in patients without chronic liver disease, and in patients with less-advanced tumors (solitary tumors, tumor size <5cm, carbohydrate antigen 19-9 <200 U/ml). Adequate lymphadenectomy provided better survival outcomes for patients with cN0 iCCA who were found to be node-positive at pathology, supporting the routine use of adequate lymphadenectomy for cN0 iCCA. Lymphadenectomy is essential for the surgical staging of intrahepatic cholangiocarcinoma (iCCA). While its role in patients with preoperative suspicion of nodal metastases is implicit, the impact of lymphadenectomy on survival of patients with clinically node-negative (cN0) disease is still under debate. In this large retrospective study on patients who underwent surgical resection for cN0 iCCA, we show that adequate lymphadenectomy (i.e. retrieving ≥6 lymph nodes) significantly improves survival and lowers the risk of tumor recurrence. Lymphadenectomy during surgical resection of iCCA is actually underperformed by the surgical community, resulting in inadequate staging and possibly worse long-term outcomes. The results of this study should empower surgeons and clinicians to push for adequate lymphadenectomy even for cN0 iCCA. Since patients with no chronic liver disease and with less-advanced tumors receive a significant benefit from lymphadenectomy, our results might guide decision making in patients at high-risk of postoperative complications.

Features of lymph node metastasis depending on intratumoral heterogeneity of non-small cell lung cancer in patients with different morphological changes in the bronchial epithelium

The aim of the study: to examine the relationship between the morphological diversity of non-small cell lung cancer and the frequency of lymph node metastasis in groups of patients with different epithelial conditions in the bronchi adjacent to the tumor. Material and methods. Surgical specimens from 90 patients with non-small cell lung cancer, who were treated in the Thoracoabdominal Department Of The Research Institute Of Oncology Of The Tomsk National Research Medical Center in the period from 2009 to 2017 were studied. The histological type of cancer was determined according to the who classification (2020). Lepidic, acinar, papillary, micropapillary, solid and solitary tumor cells were isolated in the parenchymal component of adenocarcinoma. In the parenchymal component of squamous cell carcinoma, 5 types of structures were distinguished: with keratinization, consisting of atypical cells of the prickly type without keratinization, consisting of atypical cells of the basaloid type, built of atypical cells with pronounced polymorphism, single tumor cells. Results. In patients with isolated basal cell hyperplasia, acinar (37 %), papillary (29 %) and solid (27 %) patterns were found less frequently in cases with metastatic regional lymph nodes compared to those without metastatic lymph nodes (63 %; p=0.05; 71 %; p=0.05; 73 %; p=0.01, respectively). In patients with isolated basal cell hyperplasia of the bronchial epithelium, in cases with the presence of lymph node metastasis in the parenchymal component of squamous cell carcinoma, structures 1 (with keratinization) (17 %), 2 (spiky pattern) (33 %) and 4 (polymorphic pattern) (29 %) were less frequently detected compared to those without metastases in regional lymph nodes (83 %; p=0.01; 67 %; p=0.02 and 71 %; p=0.01, respectively). In patients with a combination of basal cell hyperplasia and squamous metaplasia, a spiny pattern (65 %), a basaloid pattern (100 %), a polymorphic pattern (82 %) and single tumor cells (89 %) were more frequently detected in cases with metastatic lymph nodes than in cases without metastatic lymph nodes (35 %; р=0.04; 0 %; р=0.01; 18 %; р=0.01; 11 %; р=0.01, respectively). Conclusion. The data obtained clarify the available information on the significance of the morphological heterogeneity of the tumor for predicting the course of adenocarcinoma and squamous cell carcinoma of the lung.

Counterclockwise modular laparoscopic anatomical mesohepatectomy using combined glissonean pedicle (Takasaki approach) and hepatic vein-guided approaches.

Although laparoscopic anatomical hepatectomy (LAH) is widely adopted today, laparoscopic anatomic mesohepatectomy (LAMH) for patients with hepatocellular carcinoma (HCC) remains technically challenging. In this study, 6 patients suffering from solitary liver tumors located in the middle lobe of the liver underwent counterclockwise modular LAMH using combined Glissonean pedicle (Takasaki approach) and hepatic vein-guided approaches. In this process, the Glissonean pedicle approach (Takasaki approach) was first used to transect the liver pedicles of segment right anterior (G58) and segment 4 (G4). Second, the hepatic vein-guided approach was performed along the umbilical fissure vein (UFV) to sever the liver parenchyma from the caudal to cranial direction, and the middle hepatic vein (MHV) and anterior fissure vein (AFV) were then disconnected at the root. Last, the hepatic vein-guided approach was once more performed along the ventral side of the right hepatic vein (RHV) to transect the liver parenchyma from the cranial to anterior direction, and the middle lobe of the liver, including the tumor, was removed completely. The entire process was applied in a counterclockwise fashion, and the exposure or transection sequence was G58, and G4, followed by UFV, MHV, AFV, and finally, the liver parenchyma along the ventral side of RHV. The counterclockwise modular LAMH using combined Glissonean pedicle (Takasaki approach) and hepatic vein-guided approaches was feasible in all 6 cases. The median duration of the operation was 275 ± 35.07 min, and the mean estimated blood loss was 283.33 ml. All of the 6 patients recovered smoothly. The Clavien-Dindo Grade I-II complications rate was up to 33.33%, mainly characterized by postoperative pain and a small amount of ascites. No Clavien-Dindo Grade III-V complications occurred, and the mean postoperative hospital stay was 6.83 ± 1.47 days. Follow-up results showed that the average disease-free survival (DFS) was 12.17 months, and the 21-months OS rate, DFS rate and tumor recurrent rate were 100%, 83.33% and 16.67% respectively. Counterclockwise modular LAMH using combined Glissonean pedicle (Takasaki approach) and hepatic vein-guided approaches takes the advantages of the two approaches, is a novel protocol for LAMH. It is thought to be technically feasible for patients with a centrally located solitary HCC. The oncologic feasibility of this technique needs to be investigated based on long-term follow-up. A multicenter, large-scale, more careful study is necessary.

Multi-Institutional Matched Comparison of Radical Cystectomy to Trimodality Therapy for Muscle Invasive Bladder Cancer (MIBC)

<h3>Purpose/Objective(s)</h3> Prior randomized controlled trials (RCT) comparing bladder preservation to radical cystectomy (RC) for muscle invasive bladder cancer (MIBC) closed early due to lack of accrual. Given that no future RCTs are foreseen, and in the absence of level 1 data, we aimed to provide the best evidence possible on outcomes of matched cohorts comparing trimodality therapy (TMT, maximal transurethral resection of bladder tumor followed by concurrent chemoradiation) to RC in order to guide management. <h3>Materials/Methods</h3> This retrospective analysis included 703 patients with MIBC clinical stage T2-T3/4aN0M0 MIBC urothelial carcinoma of the bladder, 421 RC and 282 TMT who would have been eligible for both TMT or RC, treated at three tertiary referral academic institutions between 2005-2017. To compare homogeneous cohorts, all patients included in this analysis had solitary tumors <7 cm, no or unilateral hydronephrosis, and no extensive carcinoma in situ. Treatment propensity scores were estimated using logistic regression, and patients were matched 3:1 with replacement. Covariates included age, sex, clinical T stage, hydronephrosis, (neo)adjuvant chemotherapy, body mass index, smoking history, and ECOG status. Overall survival (OS) was estimated with adjusted Cox models; cancer-specific survival (CSS), distant failure-free survival, pelvic nodal failure-free survival and metastasis-free survival (combined distant and pelvic nodal failure) were estimated with adjusted competing risk models. Our primary endpoint of interest was metastasis-free survival. The analysis was performed as intent-to-treat. <h3>Results</h3> The 3:1 matched cohort comprised of 1,116 patients (834 RC vs 282 TMT). After matching, age (71.3 vs 71.6), cT2 clinical stage (88 vs 90%), presence of hydronephrosis (12 vs 10%), and use of (neo)adjuvant chemotherapy (60 vs 65%) was similar between RC and TMT cohorts. Salvage cystectomy was performed in 38 patients (13%) treated by TMT. At 5 years, metastasis-free (73 vs 78%, p=0.07), distant failure-free (78 vs 82%, p=0.14), and pelvic nodal failure-free (96 vs 94%, p=0.33) survival were not statistically different between RC and TMT, whereas CSS and OS favored TMT (78 vs 85%, p=0.02; 66 vs 78%, p<0.001). Outcomes for RC and TMT were not different among centers. Final pT stage in the RC patients was: pT0 14%, pT1 7%, pT2 29%, pT3/4 42% and N+ 24%. Peri RC mortality was 2.1% and median number of nodes removed was 40. NMIBC recurrence occurred in 57/282 (20.2%) TMT patients. <h3>Conclusion</h3> This large multi-institutional contemporary study provides the best evidence to date, in the absence of randomized trials, supporting TMT for select patients with MIBC. Oncologic outcomes seem to be equivalent between TMT and RC, affirming the position that TMT should be offered as an effective alternative.

Transarterial chemoembolisation for very early and early stage hepatocellular carcinoma: single-centre experience

To evaluate the safety and efficacy of transarterial chemoembolisation (TACE) in patients with very early and early stage hepatocellular carcinoma (VES-HCC). A retrospective analysis was performed for all TACE procedures done at King's College Hospital, a tertiary liver centre, for VES-HCC during a 5-year period (January 2014-December 2018). Patients with solitary tumours ≤5 cm and patients with 2-3 tumours (each ≤3 cm) were included. Two hundred and thirty-seven eligible patients were included. Technical success was achieved in 233 (98.3%) procedures. TACE using drug-eluting beads (DEB-TACE) was performed in 192 (82.4%) procedures. A complete response was achieved in 109 (45.9%) patients. The recurrence rate was 44% (48 cases), during a median imaging follow-up of 31.9 months (IQR 15.9-44.7). Median overall survival was 71.1 months (95% confidence interval [CI]: 62.9-79.3). Median recurrence-free survival was 58.9 months (95% CI: 47.1-70.7). Sixty-six (27.8%) patients eventually underwent transplantation, and six (2.5%) patients underwent surgical resection. Mild, moderate, and severe adverse events were encountered in 2.9%, 5.4%, and 0.8% of cases, respectively. No 30-day mortality was encountered. DEB-TACE is safe and effective for treating VES-HCC patients, who are unsuitable for thermal ablation or surgery, and may offer comparable survival benefit. It can also be used as a bridge to transplantation for these patients.

Clinical and Pathological Diagnosis of Hereditary Gastrointestinal Polyposis in Jack Russell Terriers.

Simple SummaryIn dogs, hundreds of hereditary diseases are currently known, representing a major health problem in small animal clinical practice. Hereditary gastrointestinal (GI) polyposis in Jack Russell Terriers (JRTs) is a hereditary disease recently discovered in Japan. This is an autosomal dominant disease caused by a germline variant in the adenomatous polyposis coli (APC) gene. Dogs with hereditary GI polyposis develop solitary and multiple tumors predominantly in the stomach and/or colorectum but have a much better prognosis than sporadic cases of GI tumors. Since the discovery of this disease, the number of newly diagnosed cases in Japan has increased, allowing the update of the disease’s clinical and pathological features. In the present study, some patients exhibited more severe condition than previously reported, including cases harboring tumors in the small intestine besides the stomach and colorectum. In addition, the rare cases died from systemic metastasis of GI tumors. Our study would facilitate the accurate diagnosis of hereditary GI polyposis in JRTs and raise global awareness of this novel hereditary disease.Hereditary GI polyposis in JRTs is a novel hereditary disease characterized by the development of solitary and multiple polypoid tumors, predominantly in the stomach and/or colorectum. Our recent study indicated that JRTs with GI neoplastic polyps harbor an identical germline variant in the APC gene, c.[462_463delinsTT], in a heterozygous state. Unlike sporadic cases, dogs afflicted with hereditary GI polyposis can be expected to have a prolonged survival time, as hereditary tumors are noninvasive. Since the discovery of this disease, the number of newly diagnosed cases in Japan has increased, allowing us to update the clinical and pathological features and provide a large number of diagnostic images. The present clinical case series study employing various diagnostic imaging techniques revealed that some of the cases harbored tumors in the small intestine in addition to the stomach and colorectum. Moreover, although rare, hereditary GI cancers can progress to the advanced stage and develop systemic metastasis, similar to sporadic GI tumors. These findings indicate that there is a wider range of variation in disease severity than was initially recognized. Our results can contribute to the accurate diagnosis of hereditary GI polyposis in clinical practice, pathological examinations, and future research.

Expression Patterns of Tumor Markers in Liver Transplant Recipients Showing Complete Pathological Response of Hepatocellular Carcinoma.

Complete pathological response (CPR) is achieved with various pretransplant locoregional treatments for hepatocellular carcinoma (HCC). This study aimed to investigate pretransplant expression of HCC tumor markers in liver transplantation (LT) recipients showing CPR. For the CPR group, 166 patients were selected from a single-institution LT database. Two control groups of 332 patients without HCC and 184 patients with partial pathological response (PPR) were also selected. The model for end-stage liver disease score in the CPR group was 11.5 ± 7.7. The number of transcatheter arterial chemoembolization sessions before LT was one in 68 patients (14.0%), two in 38 patients (22.9%), and three or more in 60 patients (36.1%). A solitary non-viable tumor was identified in 120 (86.4%) of the explant livers and the largest tumor size was 2.4 ± 1.3 cm. Living-donor and deceased-donor LTs were performed in 152 (91.6%) and 14 (8.4%) patients, respectively. The median levels of α-fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist-II (PIVKA-II) measured within two weeks before LT were 4.2 ng/mL and 20 mAU/mL, respectively. These tumor marker levels were comparable to those in the no-HCC control group, but much lower than those in the PPR group (p < 0.001). Receiver operating characteristic curve analysis of AFP and PIVKA-II showed no definite cutoff values for CPR in the cohort of CPR and no-HCC patients, but significant cutoffs of 6.5 ng/mL for AFP and 29 mAU/mL for PIVKA-II were obtained in the cohort of CPR and PPR patients. The 1-, 3- and 5-year HCC recurrence and overall patient survival rates of the CPR group were 5.1% and 93.3%, 7.6% and 89.6%, and 7.6% and 89.6%, respectively. These tumor recurrence rates were much lower than those in the PPR group (p < 0.001). In conclusion, the present study results suggest that normalizing AFP and PIVKA-II after locoregional treatment is indicative of CPR. However, some CPR patients showed high expression of tumor markers; thus, pretransplant values of HCC tumor markers should be interpreted with caution.

BENIGN PLEURAL SCHWANNOMA WITH PLEURAL EFFUSIONS AND NECROTIZING PNEUMONIA

BENIGN PLEURAL SCHWANNOMA WITH PLEURAL EFFUSIONS AND NECROTIZING PNEUMONIA

A proposal for T1 subclassification in hepatocellular carcinoma: reappraisal of the AJCC 8th edition

BackgroundIn the 8th edition of American Joint Committee on Cancer (AJCC) staging system for hepatocellular carcinoma (HCC), tumor size is not considered in T1 stage. The present study aimed to find out the optimal cutoff for tumor size to further stratify patients with T1 HCC.MethodsOperated HCC patients were identified from the Chang Gung Research Database (CGRD), and the patients with T1bN0M0 tumors were further divided into two groups based on the tumor size. The resulting subgroups were denoted as T1b (≤ cutoff) and T1c (> cutoff). The survivals were compared between T1a/b and T1c as well as T1c and T2.ResultsFrom 2002 to 2018, a total of 2893 patients who underwent surgery for T1N0M0 HCC were identified from the CGRD. After excluding cases who died within 30 days of surgery, Kaplan–Meier survival analysis discovered that T1 tumors > 65 mm (T1c) had survivals similar to those of T2N0M0 tumors. Cox regression multivariate analysis further demonstrated that tumor size > 6.5 cm was an independent poor prognostic indicator for T1 HCC. Sensitivity tests also confirmed that tumors lager than 6.5 cm were significantly more likely to develop both tumor recurrence and liver-specific death after surgery.ConclusionsOur study demonstrated that tumor size would significantly impact the survival outcome of T1 HCC after surgery. Due to significantly worse survival, we proposed a subclassification within T1 HCC, T1c: solitary tumor > 6.5 cm without vascular invasion, to further stratify those patients at risk. Further studies are mandatory to validate our findings.