Staging Of Malignant Tumors Research Articles

Correction: Aryl hydrocarbon receptor regulates histone deacetylase 8 expression to repress tumor suppressive activity in hepatocellular carcinoma

[This corrects the article DOI: 10.18632/oncotarget.9841.].

Malignant perineal tumors in dogs: the contribution of computed tomography for staging and surgical planning

ABSTRACT: The contribution of computed tomography for staging and surgical planning of malignant perineal tumors in dogs is discussed. Five dogs diagnosed with malignant perineal neoplasms underwent to computed tomography (CT) examination. The CT image enabled investigation of cleavage planes between neoplastic lesions and adjacent structures such as the rectum, anus, vagina, urethra and perineal muscles. Accurate assessment regional lymph nodes and adjacent bone structures was also possible. All tumors evaluated in this region presented heterogeneous appearance in pre and postcontrast CT images, but only the anal sac adenocarcinomas presented lymphadenopathy. Computed tomography proved to be a valuable tool for tumor staging and determination of lesion extension and invasion of adjacent tissues, providing significant contributions to clinical and surgical therapeutic planning.

Reduced area of the normal lung on high-resolution computed tomography predicts poor survival in patients with lung cancer and combined pulmonary fibrosis and emphysema.

This study aimed to determine the radiologic predictors and clarify the clinical features related to survival in patients with combined pulmonary fibrosis and emphysema (CPFE) and lung cancer. We retrospectively reviewed the medical chart data and high-resolution computed tomography (HRCT) findings for 81 consecutive patients with CPFE and 92 primary lung cancers (70 men, 11 women; mean age, 70.9 years). We selected 8 axial HRCT images per patient, and visually determined the normal lung, modified Goddard, and fibrosis scores. Multivariate analysis was performed using the Cox proportional hazards regression model. The major clinical features were a high smoking index of 54.8 pack-years and idiopathic pulmonary fibrosis (n = 44). The major lung cancer profile was a peripherally located squamous cell carcinoma (n = 40) or adenocarcinoma (n = 31) adjacent to emphysema in the upper/middle lobe (n = 27) or fibrosis in the lower lobe (n = 26). The median total normal lung, modified Goddard, and fibrosis scores were 10, 8, and 8, respectively. TNM Classification of malignant tumors (TNM) stage I, II, III, and IV was noted in 37, 7, 26, and 22 patients, respectively. Acute exacerbation occurred in 20 patients. Multivariate analysis showed that a higher normal lung score and TNM stage were independent radiologic and clinical predictors of poor survival at the time of diagnosis of lung cancer. A markedly reduced area of normal lung on HRCT was a relevant radiologic predictor of survival.

A graph-based approach to automated EUS image layer segmentation and abnormal region detection

Endoscopic ultrasonography (EUS) has shown great advantages in the diagnosis and staging of gastrointestinal malignant tumors. However, EUS based diagnosis is limited by variability in the examiner’s subjective interpretation to differentiate between normal and early esophageal carcinoma. In this paper, we propose a novel approach aiming at automatic abnormal region detection from the esophageal EUS images; the contribution is three-fold: first, we present a series of preprocessing strategies developed specifically for the enhancement of EUS images to aid the estimation in the subsequent works. Second, we provide an automatic layer segmentation method based on the multiple surface graph searching approach with incorporation of geometric constraints, which is applied to segment the EUS images into five discernible layers. Third, we introduce the novel feature extraction strategy by utilizing the features from each column in the segmented layers. The SVM classifier is then applied to fulfill the normal and early esophageal carcinoma classification. Subsequently, a clustering method is used to assemble the abnormal columns together so as to detect the abnormal region. Experimental results show that our method has demonstrated its robustness even facing noisy EUS images, and has achieved high accuracy in detecting abnormal region.

Primary tumors of the hand: Functional and restorative management.

Primary malignant tumors of the hand are rare. Most cases present to clinics unaffiliated with cancer centers, making it incumbent on all hand surgeons to understand the pathology indicative of malignancy and the proper course of treatment of hand neoplasms. In this review, we report, based on tumor type, the anatomical considerations, proper management, staging, surgical approaches, reconstructive considerations, and long-term surveillance of primary malignant tumors of the hand.

HER2 Overexpression in Borderline and Malignant Ovarian Tumors: A Cross-sectional Study in an Iranian Population and Literature Review

Background: Different studies have investigated the overexpression of human epidermal growth factor receptor 2 in ovarian cancers, in addition to the association between the level of its overexpression and tumor characteristics (tumor grade, subtype, stage, and prognosis). However, the prognostic significance of human epidermal growth factor receptor 2/neu dysregulation in epithelial ovarian tumors is controversial. The current study aims to assess human epidermal growth factor receptor 2 overexpression in different types and stages of epithelial borderline and malignant ovarian tumors in a population of Iranian patients.Methods: We conducted this cross-sectional study on 100 patients diagnosed with epithelial borderline and malignant ovarian tumors who referred to the Cancer Institute of Imam Khomeini Hospital at Tehran between 2012 and 2014. After selection of the appropriate tissue block, we prepared slides for immunohistochemical staining with the human epidermal growth factor receptor 2 marker. Human epidermal growth factor receptor 2 positivity was evaluated and scored according to Ellis and Wolff recommendations. Cases with equivocal immunohistochemical results (score 2) also underwent chromogenic in situ hybridization.Results: The most prevalent tumor in our study was serous carcinoma (54%). Human epidermal growth factor receptor 2 scores were: 0 in 69%, 1+ in 26%, 2+ in 4%, and 3+ in 1% of tumors. Chromogenic in situ hybridization examination of cases with human epidermal growth factor receptor 2 score of 2 showed negative results for human epidermal growth factor receptor 2 gene amplification. We observed no association between human epidermal growth factor receptor 2 and the level of tumor differentiation, histologic subtype, clinical stage, tumor size, and patient’s age.Conclusion: Controversial results and wide range of prevalence in human epidermal growth factor receptor 2 overexpression in different studies could be due to several causes. Technical considerations, tumor heterogeneity, and lack of standard guidelines for interpretation could influence the results. We did not find any relationship between human epidermal growth factor receptor 2 overexpression and prognostic indices of grade, clinical stage or histologic subtype as many other reports. Future studies should be conducted on larger numbers of patients with different disease stages and adequate numbers of different histologic subtypes.

Investigation of the utility of lymph node fine-needle aspiration cytology for the staging of malignant solid tumors in dogs.

Fine-needle aspiration cytology (FNAC) of lymph nodes (LNs) is routinely used for staging canine malignant solid tumors, but studies evaluating its efficacy are limited. The primary objectives of this study were to evaluate the sensitivity/specificity of FNAC and the significance of nondiagnostic FNAC when staging canine malignant tumors. A secondary objective was to determine the prevalence of multiple nodal metastases. Lymph nodes draining malignant solid tumors assessed with FNAC and histopathology were included. The sensitivity/specificity of FNAC was determined for LNs with diagnostic FNAC, using histopathology as the gold standard. The proportion of nondiagnostic FNAC and associated histopathologic prevalence of metastasis were determined. Among the tumors with multiple LNs assessed, the prevalence of multiple nodal metastases was determined. The sensitivity of FNAC (194 LNs) was 67% for sarcomas, 100% for carcinomas, 63% for melanomas, 75% for mast cell tumors, and 100% for other round cell tumors. The specificity varied between 83% and 96%. Nondiagnostic FNAC was reported in 25% of LNs sampled (65/259), most of which were nonenlarged and/or difficult to access, and 20% of which were metastatic on histopathology. When several LNs were assessed (88/189 tumors), the prevalence of multiple nodal metastases was 24%. Histopathologic LN evaluation cannot be robustly substituted with FNAC when staging selected canine solid tumors. When a diagnostic FNAC is elusive, the histopathologic assessment remains ideal. Finally, staging should not always be limited to the assessment of a single LN.

68Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients.

The present study analyzed the impact of Gallium-68 (68Ga)-labeled prostate-specific membrane antigen-HBED-CC (68Ga-PSMA-11) positron-emission tomography (PET)/computed tomography (CT) on radiotherapeutic management in a large cohort of men with primary or recurrent disease. Methods: This study investigated 121 men with carcinoma of the prostate who underwent 68Ga-PSMA-11 PET/CT as well as conventional imaging. 50 patients were treatment naive, 11 had persistent prostate-specific antigen (PSA) soon after surgery and 60 presented with recurrent PSA following definitive therapy. Changes in TNM classification of malignant tumors (TNM) stage and radiotherapeutic management after 68Ga-PSMA-11 imaging were compared to results achieved with conventional imaging. Results: In total, a change in TNM stage and radiotherapeutic management was observed for 49 patients (40.5%) and 62 patients (51.2%), respectively. In treatment naïve patients, a change in TNM stage and radiotheraeutic plan occurred in 26.0% and 44.0% of the cohort respectively. For patients with PSA persistence or recurrence, TNM and radiotherapeutic management changed in 50.7% and 56.3% respectively. Conclusion:68Ga-PSMA-11 PET/CT may shortly become an indispensable tool for detecting prostate cancer lesions in treatment-naïve patients as well as in men with recurrent disease or persistent PSA and seems to be very helpful in personalizing radiotherapeutic management to the individual patients' distribution of disease.

The risk of thyroid carcinoma in multinodular goiter compared to solitary thyroid nodules: A retrospective analysis of 600 patients

BackgroundIt is generally believed that multinodular goiter (MNG) is associated with a lower risk of malignancy compared to solitary thyroid nodules (STN). This will be the null hypothesis in this retrospective study and we aim to prove or reject it. MethodsMedical files and histopathology reports of 600 patients who underwent thyroidectomy over 4-year period were reviewed. Data including patient’ age, gender, presentation, ultrasonography, FNAC, surgical procedures, final histopathologic diagnosis and stage of malignant tumors were collected and analyzed. The primary end point was assessment of risk of thyroid carcinoma in patients with MNG compared to those with STN. Secondary endpoints included demographic differences and prognosis. ResultsThere were 459 females (76.5%). Mean age was 44.3±14.5 years (range 14–85). After exclusion of 33 patients, 224 (39.5%) had STN and 343 (60.5%) had MNG. The prevalence of thyroid cancer was 41.1% (92/224) in STN compared to 29.2% (100/343) in MNG (Chi-Square=8.593, p<0.01). However, on multiple logistic regression analysis this correlation was found insignificant (p=0.640). Only male gender (p=<0.000005) and preoperative impression of malignancy (p=0.000082) were significantly associated with thyroid carcinoma. ConclusionThe risk of thyroid carcinoma in STN and MNG was similar. Male gender was identified as a risk factor for thyroid cancer while age, number and size of nodules were not.

Reconstruction of Skull and Skull Base Defects Using Titanium, Collagen, Polyesterurethane and Other Alloplastic, Allogeneic, Xenogeneic and Autogenic Materials

We present our experience in the reconstruction of 12 defects of the skull and lateral skull base following the resection of advanced stage malignant tumors. The reconstruction was performed using three pectoralis major flaps and six temporalis muscle flaps, local skin flaps in two cases and one skin graft. For three dural defects, the plasty was performed using synthetic substitutes. In two cases titanium mesh was utilized for protection of the soft tissues. In one patient a gold plate was used to counteract the effects of facial nerve paralysis on eyelid closure. The advantages and disadvantages of the reconstructive methods are discussed, together with a literature review listing frequently used methods of skull base defect restoration, including autogenous tissues in the form of local, regional or distant flaps, as well as allogeneic, xenogeneic and alloplastic materials.

Minimally Invasive Staging of Apparent Stage I Malignant Ovarian Germ Cell Tumors: Prevalence and Outcomes

Study ObjectiveEvaluate the prevalence, trends, and outcomes of minimally invasive surgical (MIS) staging of malignant ovarian germ cell tumors (MOGCTs) apparently confined to the ovary. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingParticipating hospitals in the National Cancer Data Base. PatientsWomen diagnosed between 2010 and 2014 with a MOGCT apparently confined to the ovary with information on the planned surgical approach. InterventionsStaging with MIS or laparotomy. Measurement and Main ResultsA total of 918 patients were identified. MIS was planned for 294 patients (32%): a laparoscopic approach for 237 patients and a robotic-assisted approach for 57 patients. Rate of conversion to laparotomy was 11% (46 cases), 1.7% and 15.6% in the robotic and laparoscopy groups, respectively (p = .003). No difference in the use of MIS was noted based on year of diagnosis (p = .38). By multivariate analysis white race, higher level of education, and smaller tumor size were associated with the receipt of MIS. Patients in the MIS group were less likely to undergo lymph node dissection (39.6% vs 51.3%, p = .001) and omentectomy (18.7% vs 28.5%, p = .002). Hospital stay after surgery was shorter for patients who had MIS (median, 2 vs 3 days; p <.001). Unplanned 30-day readmission rate was also lower in the MIS group (1.4% vs 3.9%, p = .043). No difference in overall survival was noted between the 2 groups (p = .81). ConclusionMIS for apparent early-stage MOGCTs was less comprehensive but associated with a decreased hospital stay and unplanned readmission rate.

Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

Objective To investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors. Methods The National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann–Whitney U test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan–Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders. Results A total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46). Conclusions Macroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.

State-of-the-Art Imaging of Salivary Gland Tumors.

MR imaging is the modality of choice in evaluation of salivary gland tumors. Postcontrast MR imaging is adequate for exact localization and extension of salivary gland tumors and multiparametric of diffusion-weighted and dynamic contrast-enhanced MR imaging helps in characterization of benign and malignant salivary gland tumors. Imaging is important for preoperative localization, characterization of salivary gland tumors and locoregional extension, perineural spread, and nodal and distant staging of malignant salivary gland tumors. Imaging has a role in detection of tumor recurrence, monitoring patients after therapy, prediction of malignant transformation of benign tumors, and differentiation of salivary gland tumors from simulating inflammatory and autoimmune disorders.

The clinical value of comprehensive surgical staging in malignant ovariangerm cell tumors

Malignant ovariangerm cell tumors (MOGCTs) is second only to epithelial tumor which often occur in young women and young women, with high malignancy and high mortality.Effective treatment is particularly important in clinical practice. The prognosis is improved for valid chemotherapy scheme founded in recent years. Surgery still play a crucial role in the therapy of MOGCTs no matter for the primary operation or re-operation. Since the 70s, the comprehensive surgical staging (CSS) has improved the prognosis in patients with malignant ovarian cell tumors. Retroperitoneal lymphadenectomy is an integral part of the complete staging in MOGCT. The paper discusses various aspects of the clinical value of comprehensive surgical staging in MOGCTs. Key words: Ovarian neoplasms/SU; Germinoma/SU; Hysterectomy; Lymph node excision; Review

On staging of urologic cancers in accordance with the updated 8th edition of the TNM Classification

On January 1, 2018, an updated 8 th edition of the international TNM Classification of Malignant Tumors comes into effect. The classification was developed by 2 leading organizations: the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). Based on consensus conferences of the International Society for Urological Pathology (ISUP) which reconsidered the current approaches to pathomorphology and staging of malignant tumors of the prostate (2009), kidneys (2012), testicles and penis (2015), the World Health Organization approved the new morphological classification of tumors of the urinary and male reproductive systems. At the first time, the TNM Classification indicates evidence level.

Validation of the latest WHO histological classification and the 8th TNM staging system for thymic epithelial tumors

Histological classification and staging systems are indispensable for performing accurate management and research in patients with malignant tumors. The World Health Organization (WHO) classification and the Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification are the international standards for the histological classification and staging of malignant tumors. However, for thymic epithelial tumors (TETs), these systems were not available until 1999 (1) and 2017 (2), respectively, perhaps because of the rarity and unique biological behavior of these tumors.

Targeting PSMA by radioligands in non-prostate disease-current status and future perspectives.

Prostate-specific membrane antigen (PSMA) is the up-and-coming target for molecular imaging of prostate cancer. Despite its name, non-prostate-related PSMA expression in physiologic tissue as well as in benign and malignant disease has been reported in various publications. Unlike in prostate cancer, PSMA expression is only rarely observed in non-prostate tumor cells. Instead, expression occurs in endothelial cells of tumor-associated neovasculature, although no endothelial expression is observed under physiologic conditions. The resulting potential for tumor staging in non-prostate malignant tumors has been demonstrated in first patient studies. This review summarizes the first clinical studies and deduces future perspectives in staging, molecular characterization, and PSMA-targeted radionuclide therapy based on histopathologic examinations of PSMA expression. The non-exclusivity of PSMA in prostate cancer opens a window to utilize the spectrum of available radioactive PSMA ligands for imaging and molecular characterization and maybe even therapy of non-prostate disease.

Limitations of dual time point FDG-PET imaging in the evaluation of focal abdominal lesions.

For the evaluation of the diagnostic potential of dual time point FDG positron emission tomography (PET) in patients with suspicious focal abdominal uptake, dual time point PET imaging was compared with clinical findings. In a prospective study, 56 patients exhibiting a solitary suspicious, intense abdominal FDG uptake, underwent dual time point PET imaging for staging or restaging of different malignant tumors, maximal standardized uptake value (SUVmax) measurements included. The first acquisition was started 64.8 +/- 19.5, the second 211.3 +/- 52.5 min after FDG injection. The final diagnosis based on CT or MRT imaging and a follow-up period of 12.6 +/- 2.8 months. Additionally, colonoscopy was done in 6 patients. In another 6 patients histopathology was obtained from CT guided biopsy. Malignant focal abdominal lesions with a SUVmax <2.5 (n = 4) showed an uptake increase of > or =30%. In the remaining malignant cases with an uptake of > or =2.5 (n = 11), uptake increased in 64% and decreased in 36%. Malignant lesions showing FDG uptake decrease (n = 4) had an initial SUVmax value > or =2.5 and remained with a SUVmax > or =2.5 in the second imaging. In benign lesions with an initial SUVmax > or =2.5 (n = 31), the uptake increased in 17 patients (55%) and decreased in 14 patients (45%). All lesions which changed configuration (33%) were confirmed as benign (n = 5). Using dual time point PET abdominal lesions show a very hetergenous uptake pattern regardless of their dignity. Malignancy can only be reliably excluded in lesions which change their configuration and in lesions with an initial SUVmax value <2.5 combined with an SUV decrease in the delayed imaging. Particularly abdominal lesions which show an initial SUVmax > or =2.5 combined with a SUV increase in the delayed imaging are suspicious for malignancy and need further clarification.

Free Radical Activity as Diagnostic and Prognostic Criteria in Solid Tumors and Their Therapy

Blood plasma of 39 cancer patients who had not previously undergone anti-tumor treatment, and 21 patients with recurrent epithelial tissues cancer before treatment and after the first course of chemotherapy were investigated. The treatment effectiveness of patients with relapse was evaluated throughout the year. The control group was the blood plasma of 14 healthy people. Free radical activity and oxidative modification of proteins were assessed in blood plasma. In malignant neoplasms of epithelial tissues, free radical activity and oxidative modification of plasma proteins are significantly higher. At the initial stages of carcinogenesis, the oxidative modification level of plasma proteins increases both due to aldehyde and ketone carbonyl derivatives. In the terminal stage of malignant tumors, an increase in the oxidative modification of proteins occurs due to aliphatic ketone dinitrophenyl hydrazones, which are the markers of protein aggregation characteristic of the late stages of oxidative stress. In case of an objective response to polychemotherapy, there is a significant decrease in free radical plasma activity after the first course of therapy and a significant increase in carbonyl derivatives recorded at a wavelength of 230 nm, which can serve as a marker of its effectiveness.

Fertility-sparing surgery in advanced stage malignant ovarian germ cell tumor: a case report

BackgroundMalignant ovarian germ cell tumor is a rare type of disease, which generally has a good prognosis due to the high chemosensitivity of this type of tumor.Fertility preservation is an important issue because malignant ovarian germ cell tumor commonly affects young women. Although conservation is the standard for early stage, it becomes more debatable as the disease progresses to more advanced stages.Aim: Report the case of a patient with an International Federation of Gynecology and Obstetrics Stage IIIc malignant ovarian germ cell tumor, who had conservative surgery and chemotherapy with a good fertility outcome.Case presentationA 23-year-old North African woman with a left malignant ovarian germ cell tumor stage IIIc was treated by left adnexectomy and omentectomy followed by chemotherapy. A 15-year follow-up showed no signs of relapse, and she completed three full-term natural pregnancies.ConclusionsMalignant ovarian germ cell tumor is a rare ovarian tumor with a good prognosis. It is usually associated with a good fertility outcome in early stages. However, due to the rarity of the disease in advanced stages, the fertility outcome for this group of patients is not clear. This lack of data surrounding advanced stages points to the need for a meta-analysis of all published cases.