Subtype Of Adenocarcinoma Research Articles

Prostate Pathology: What is New in the 2022 WHO Classification of Urinary and Male Genital Tumors?

In 2022, after a six-year interval, the International Agency for Research on Cancer (IARC) has published the 5th edition of the WHO Classification of Urinary and Male Genital Tumors, which provides a comprehensive update on tumor classification of the genitourinary system. This review article focuses on prostate carcinoma and underscores changes in the prostate chapter as well as those made across the entire series of the 5th edition of WHO Blue Books. Although no major alterations were made to this chapter, some of the most notable updates include restructure of contents and introduction of a new format; standardization of mitotic counts, genomic nomenclatures, and units of length; refined definition for the terms "variant", "subtype", and "histologic pattern"; reclassification of prostatic intraepithelial neoplasia (PIN)-like adenocarcinoma as a subtype of prostatic acinar adenocarcinoma; and recognition of treatment-related neuroendocrine prostatic carcinoma as a distinct tumor type. Evolving and unsettled issues related to grading of intraductal carcinoma of the prostate and reporting of tertiary Gleason pattern, the definition and prognostic significance of cribriform growth pattern, and molecular pathology of prostate cancer will also be covered in this review.

The prognostic role of epidermal growth factor receptor mutation in completely resected ampullary adenocarcinoma.

Theaim ofthis study is to make adifferential diagnosis and prognosis oftheampullary adenocarcinoma subtypes. We also investigated therole ofprognostic markers PD-1 and PD-L1, and epidermal growth factor receptor (EGFR). Local or locally advanced stage ampullary adenocarcinoma patients who had undergone pancreaticoduodenectomy at thetime ofdiagnosis were included. MUC1, MUC2, MUC5AC, CDX2, CK7, CK20, PD-1, and PDL-1 were analysed immunohistochemically, and EGFR was analysed by real-time polymerase chain reaction. According to histopathological and immunohistochemical evaluation, we found 27 patients as pancreatobiliary type and 56 patients as intestinal type adenocarcinoma. Themedian survival ofpatients with intestinal and pancreatobiliary type adenocarcinoma was 23 months and 76 months ( p = 0.201), respectively. When thesurvival ofPD1-positive ( n = 23) and PD-L1-positive ( n = 18) patients were compared with thepatients with negative staining ( n = 60, n = 65), no significant difference was found. Epidermal growth factor receptor mutation was detected in atotal of6 patients, and 5 ofthese 6 mutations were shown in intestinal type tumours and one in apancreatobiliary type tumour. Asignificant difference was determined in terms ofoverall survival for thepatients with EGFR mutations compared to those without ( p = 0.008). In conclusion, we could reveal theprognostic significance ofEGFR mutation, which is also atarget molecule.

COMPARISON OF HUMAN PAPILLOMAVIRUS 16 EXPRESSION BY IMMUNOHISTOCHEMISTRY IN CERVICAL CARCINOMAS AND NON-NEOPLASTIC CERVICAL MUCOSA Arti

Objective: To compare the prevalence of Human Papillomavirus 16 in cervical carcinoma and non-neoplastic cervical mucosa by immunohistochemistry. Methodology: From September 2020 to November 2021, this retrospective cross-sectional study was conducted at the Department of Pathology, Peshawar Medical College, Riphah International University Islamabad, Pakistan. On FFPE blocks of 38 cervical carcinoma cases and 38 non-neoplastic cervical mucosa by immunohistochemistry using a monoclonal antibody against HPV 16 by Bio-SB. SPSS 20 was used for the analysis of data. Results: The mean age of cervical carcinoma patients was 55.18 ± 11.536. The majority of the Cervical carcinoma cases were more than 50 years of age (n= 28, 73.6%). HPV16 positivity was observed in 44.7 % cases of cervical carcinoma and 5.35 % of normal cervical mucosa. The p-value was < 0.00007 and hence statistically significant. HPV 16 expression was higher in the patients with cervical carcinoma in the fourth and fifth decade of life. Among the subtypes of cervical carcinoma, 60.5 % (n=23/38) were Squamous cell carcinoma out of which 43.5% (n=10/23) were positive for HPV 16 expression, Adenocarcinoma subtype was 34.2% (n=13/38) out of which 46.2% (n=6/13) were positive and the Adenosquamous subtype was 5.3% (n=2/38) out of these 1 was positive for HPV 16 expression. High grade tumors (n=18) showed higher HPV 16 expression (61.1%) as compared to low grade lesions (30.0%).Conclusion: HPV 16 expression is higher in cervical carcinoma cases as compared to normal cervical mucosa. Although not statistically significant high-grade tumors showed higher expression of HPV 16.

The use of histopathological subtyping in patients with ampullary cancer: a nationwide analysis

BackgroundRecent guidelines advise to subtype adenocarcinoma at the ampulla and papilla of Vater (here: ampullary cancer) as intestinal, pancreatobiliary, and mixed, because this has consequences for both prognosis and treatment. This nationwide study aimed to investigate how often histopathological subtyping is performed in daily clinical practice in patients with ampullary cancer.MethodsPathology reports of all patients with ampullary cancer were retrieved from the Dutch nationwide pathology database (PALGA, 1991-2020). Reports were assessed for the presence and methods used for the classification of these tumors into intestinal, pancreatobiliary, and mixed subtypes. The use of immunohistochemical markers was recorded.ResultsOverall, 5246 patients with ampullary cancer were included. In 1030 (19.6%) patients, a distinction between intestinal, pancreatobiliary, and mixed subtypes was made. Use of subtyping increased from 3% in 1991–1993 to 37% in 2018–2020. In 274 of the 1030 (26.6%) patients, immunohistochemistry was used to make this distinction. A gradual increase in the use of various immunohistochemical markers was seen over time since 2008, with cytokeratin 7, cytokeratin 20, and CDX2 being the most common. Staining of DPC4/SMAD4 was increasingly used since 2012.ConclusionDespite recent improvements in the use of subtyping in ampullary cancer, the distinction between intestinal, pancreatobiliary, and mixed subtypes is only made in a minority of patients. Nationwide efforts are required to standardize the pathological distinction of the various subtypes of ampullary cancer.

Similar Survival Among All Subtypes of Mucinous Appendiceal Adenocarcinoma Except the Intermediate Subtype, Which Shows an Improved Survival.

Limited success in the management of mucinous appendiceal adenocarcinoma (MACA) has been reported. Cytoreductive surgery with perioperative intraperitoneal chemotherapy was used to treat a cohort of patients with peritoneal dissemination of MACA. The clinical and histopathologic variables were assessed for their impact on overall survival. The study analyzed 196 patients during a median follow-up period of 8 years. The patients had a median age was 46 years, a median survival of 12 years, and a mean survival of 12.4 years. Preoperative systemic chemotherapy and a high prior surgical score had a negative impact on prognosis. Survival was better for 37 patients (18.9%) with mucinous appendiceal adenocarcinoma-Intermediate (MACA-Int) histology than for 159 patients (81.1%) with MACA grade 1, 2, or 3, or signet ring cells (S) (p = 0.0004). Although MACA-1 and MACA-2 versus MACA-3 and MACA-S had a difference in survival of 63.9 versus 43.2 years at 5 years, with long-term follow-up evaluation, the differences in survival became insignificant (p = 0.5841). The histologic subtype of MACA-Int had a 10-year survival of 81.1%, which was markedly superior to that of MACA-1, -2, -3, or -S (32.7%). With long-term follow-up evaluation, MACA-1, -2, -3, and -S did not differ significantly in survival.

Invasive mucinous adenocarcinoma of the lung: clinicopathological features, 18F-FDG PET/CT findings, and survival outcomes.

Invasive mucinous adenocarcinoma (IMA) is a rare subtype of lung adenocarcinoma. This study aimed to retrospectively evaluate the clinicopathological features, 18F-FDG PET/CT findings, and prognosis of IMA of the lung, as well as to investigate the associations among these variables, to improve the management of such patients. Clinicopathological and 18F-FDG PET/CT characteristics of 72 patients with pathologically confirmed IMA of the lung were retrospectively collected and investigated, and their predictive efficacy on progression-free survival (PFS) was evaluated. The median age of the enrolled 72 patients was 61years (range, 26-79years), and the male-to-female ratio was 1:1.25. According to the radiological morphology of IMA, solidary nodule/mass type (n = 59, 81.9%) was the most common, followed by GGO type (n = 8, 11.1%) and pneumonia type (n = 5, 6.9%). Lobulated or spiculated margin and pleural traction were the most common radiological signs. The median SUVmax of IMA lesions was 3.0, ranging from 0.5 to 23.1. Higher SUVmax was observed in IMA with non-GGO type, clinical symptom, advanced stage, lobulated margin, pleural traction or spread through air spaces (STAS) (P < 0.05). Moreover, higher SUVmax was related to larger tumor size in non-pneumonia-type IMA (r = 0.708, P < 0.001). The median PFS was 21.3months, and the 12-, 24- and 36-month PFS rates were 89.8%, 83.3% and 75.5%, respectively. A poorer PFS was significantly associated with SUVmax ≥ 3, advanced stage and STAS. 18F-FDG PET/CT combined with clinicopathological characteristics can aid the diagnosis and prognostic evaluation of lung IMA, which could provide guidance for the appropriate management of such patients.

Whole exome sequencing in Chinese mucinous pulmonary adenocarcinoma uncovers specific genetic variations different from lung adenocarcinoma.

As a rare subtype of primary lung adenocarcinoma (LUAD), mucinous pulmonary adenocarcinoma (MPA) was considered a distinctive entity with unfavorable outcomes. Therefore, there is a great need for a better understanding of the genomic and immunological landscape of this rare tumor type, which would inform improved therapeutic strategies. A total of 96 patients histologically confirmed with MPA were recruited from Shandong Cancer Hospital and Institute (SCH). Single nucleotide variation (SNV), copy number variation (CNV), genomic instability, and immunological landscape insights into 96 MPA patients were identified using WES. We demonstrated that MPAs had marked different genomic alterations and were more complex in genomic profiles than LUADs. Mutations in Tumor Protein 53 (TP53) and CYP7A Promoter-Binding Factor (CPF) pathways significantly shortened survival whereas mutations in Notch and Wnt pathways significantly prolonged survival in MPA. Besides, we demonstrated that mutations in immune-related genes influenced outcomes, with mutations in TP53, Ataxia Telangiectasia Mutated (ATM), Polymerase (DNA) Delta 1 (POLD1), and Epidermal Growth Factor Receptor (EGFR) correlated with worsened survival. We not only depicted the genetic and immunologic landscape of Chinese MPA but also reveal its distinction from LUAD in genomic and immune context. Our findings may provide opportunities for therapeutic susceptibility among Chinese MPA patients.

Introducing in vivo pancreatic cancer models for the study of new therapeutic regimens

Introduction: Pancreatic cancer is a severe oncological disease with an ever-increasing incidence and a high rate of morbidity and mortality. Therapeutic options are limited and the five-year overall survival rate is 7–20%, depending on the possibility of surgical resection and the earliness of detection. Most patients with this diagnosis die due to the resistance of tumour cells and their microenvironment to the used treatment regimes. Methods: In our study, we focused on the implementation of two in vivo models, which are the cell-line derived xenograft (CDX) and the patient-derived xenograft (PDX). These two models differ significantly from each other methodologically, technically, financially, but also in their achieved results. Results: In a pilot study, we managed to successfully implement the CDX model with a very aggressive and resistant PaCa-44 line of pancreatic cancer in a total of 30 NU/NU strain mice. Furthermore, we created three PDX models with various subtypes of pancreatic cancer from patients operated at the University Hospital Kralovske Vinohrady, Department of General Surgery. These tumours were re-transplanted into subsequent generations of 23 individuals of NOD/SCID strain and 47 NU/NU strain mice. The established CDX and PDX models are then used to compare conventional and experimental chemotherapy regimens. Conclusion: The next steps will be to evaluate the effects of treatment regimens by using imaging and molecular genetic methods and to optimise the entire process for further use in precise personalised medicine for patients with pancreatic cancer. The upcoming goal is to create a library of PDX models of the most common pancreatic ductal adenocarcinoma and other rare subtypes of pancreatic cancer.

Bioinformatics analyses for the identification of tumor antigens and immune subtypes of gastric adenocarcinoma.

Background: Although mRNA vaccines have been effective against multiple cancers, their efficacy against stomach adenocarcinoma (STAD) remains undefined. Immunotyping can indicate the comprehensive immune status in tumors and their immune microenvironment, which is closely associated with therapeutic response and vaccination potential. The aim of this study was to identify potential antigens in STAD for mRNA vaccine development, and further distinguish immune subtypes of STAD to construct an immune landscape for selecting suitable patients for vaccination. Methods: The gene expression and clinicopathological features of patients with gastric cancer were downloaded from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression Program (GTEx). 729 samples from GSE66229 and GSE84437 were downloaded through GEO and were used as the validation cohorts. Differential gene expression, genetic alterations and prognosis were analyzed using the R package, cBioPortal program and Kaplan-Meier. The relationship between tumor antigens and immune cells was evaluated and plotted by TIMER. ConsensusClusterPlus was used for consistency matrix construction and data clustering, and graph learning-based dimensional reduction was used to depict immune landscape. WGCNA was used to estimate the relationship between the color modules and immune subtypes. Results: Two overexpressed and mutated tumor antigens associated with poor prognosis and infiltration of antigen presenting cells were identified in STAD, including RAI14 and NREP. The immune subtypes showed distinct molecular, cellular and clinical characteristics. IS1 and IS2 exhibited immune-activated phenotypes and correlated to better survival compared to IS3, while IS3 tumors was immunologically cold. Immunogenic cell death modulators, immune checkpoints, and CA125, and CEA were also differentially expressed among the three immune subtypes. Finally, the immune landscape of STAD showed a high degree of heterogeneity between individual patients. Conclusion: RAI14 and NREP are potential antigens for developing anti-STAD mRNA vaccine, and patients with IS1 and IS3 tumors may be suitable for vaccination.

Deep-Learning Algorithm and Concomitant Biomarker Identification for NSCLC Prediction Using Multi-Omics Data Integration.

Early diagnosis of lung cancer to increase the survival rate, which is currently at a low range of mid-30%, remains a critical need. Despite this, multi-omics data have rarely been applied to non-small-cell lung cancer (NSCLC) diagnosis. We developed a multi-omics data-affinitive artificial intelligence algorithm based on the graph convolutional network that integrates mRNA expression, DNA methylation, and DNA sequencing data. This NSCLC prediction model achieved a 93.7% macro F1-score, indicating that values for false positives and negatives were substantially low, which is desirable for accurate classification. Gene ontology enrichment and pathway analysis of features revealed that two major subtypes of NSCLC, lung adenocarcinoma and lung squamous cell carcinoma, have both specific and common GO biological processes. Numerous biomarkers (i.e., microRNA, long non-coding RNA, differentially methylated regions) were newly identified, whereas some biomarkers were consistent with previous findings in NSCLC (e.g., SPRR1B). Thus, using multi-omics data integration, we developed a promising cancer prediction algorithm.

ASO Author Reflections: Similar Survival of All Subtypes of Mucinous Appendiceal Adenocarcinoma Except the Intermediate Subtype Which Shows an Improved Survival.

ASO Author Reflections: Similar Survival of All Subtypes of Mucinous Appendiceal Adenocarcinoma Except the Intermediate Subtype Which Shows an Improved Survival.

Identification of characteristic markers correlated with Th2 cell infiltration and metabolism molecular subtype in pancreatic adenocarcinoma

Pancreatic adenocarcinoma, the deadliest malignant cancer, has gradually become the third leading cause of cancer-related death. Multidisciplinary therapy has been difficult to implement because of the particularity of pancreatic adenocarcinoma. Research has increasingly indicated the significance of metabolic adaption in pancreatic adenocarcinoma. The difference in metabolism may influence immune cell infiltration in pancreatic adenocarcinoma. Novel immune-related metabolism biomarkers are needed to improve the therapeutic outcomes of existing targeted therapies. We enrolled whole-genome sequencing data and clinical information about 168 pancreatic adenocarcinoma samples from The Cancer Genome Atlas (TCGA) database, other pancreatic adenocarcinoma samples, and clinical information from other cohorts. We used the gene set variation analysis (GSVA) package to calculate feature score, the weighted gene co-expression network analysis (WGCNA) and randomSurvivalForest package to screen hub genes, the ConsenClusterPlus package to classify subtypes, the pRRopthetic package to evaluate drug sensibility, the maftools package to analyze mutation information and the Seurat package to analyze single cell sequencing data. We revealed the prognosis significance of Th2 cell infiltration, classified two subtypes based on hub genes, compared immune cell infiltration, substance metabolism, cellular processes, gene mutation, and copy number variation (CNV) between subtypes and explored the clinical and biological features of Th2 cell infiltration. We displayed the poor prognosis significance of Th2 cell infiltration and the significant difference of simple nucleotide polymorphism, CNV, natural killer (NK) CD56 bright cell infiltration, substance metabolism, autophagy and necroptosis between subtypes. Additionally, we discovered the sensitivity difference of chemotherapy drug and the Th2 cell infiltration changes after chimeric antigen receptor T cells (CAR-T) cell therapy and radiotherapy and explored the differences between normal liver and metastatic liver tissues of pancreatic adenocarcinoma patients.

Prognosis of the second predominant subtype in lung adenocarcinoma: a retrospective single-center cohort study.

The histologic classification of lung adenocarcinoma (LUAD) was mainly divided into three pathological subtype groups: the low-grade predominant subtype group (lepidic), the intermediate-grade predominant subtype group (papillary and acinar), and the high-grade predominant subtype group (micropapillary and solid). Previous studies have focused on the prognostic impact of predominant subtypes of lung adenocarcinoma. In this investigation, we investigated the effect of the second predominant subtype on prognosis. The data of LUAD postoperative patients were retrospectively collected. Exclusion criteria included cases in which the pathologic results revealed a single characteristic, the presence ofinvasive mucinous LUAD, or if the first predominant and the second predominant groups could not be distinguished. Categorical variables were compared with the two-tailed Pearson χ2 test and continuous variables with the Student's t-test. Follow-up was conducted by telephone and other methods. Independent prognostic factors of the second major subtype were determined by the Kaplan-Meier method and log-rank test. The Cox proportional risk regression model was used to analyze the possible prognostic factors. Among 293 patients, the meanage was 61.9 years and 47.1% were male. The results revealed that when the predominant group was the low-grade group, the second predominant groups had no significant influence on overall survival (OS) (P=0.15) but significantly influenced disease free survival (DFS) (P=0.037). Subsequently, when the predominant group was the intermediate-grade group, the second predominant groups significantly influenced OS (P=0.024) but had no significant influence on DFS (P=0.3). Moreover, when the predominant group was the high-grade group, the second predominant groups significantly influenced OS (P=0.033) but had no significant influence on DFS (P=0.31). The independent prognostic effect of the second predominant group was not identified for OS and DFS of lung adenocarcinoma. The effects of the second predominant subtype groups on OS and DFS were not evenly distributed among different predominant subtype groups, and the low-grade second predominant subtype exhibited some protective effects on the middle-grade predominant subtypes.

A retrospective diagnostic test study on circulating tumor cells and artificial intelligence imaging in patients with lung adenocarcinoma.

Either tumor volume or folate-receptor-positive circulating tumor cells (FR+CTC) has been proven effective in predicting tumor cell invasion. However, it has yet to be documented to use FR+CTC along with artificial intelligence (AI) tumor volume to differentiate between pathological subtypes of lung adenocarcinoma (LUAD). Therefore, this study is aimed to evaluate the accuracy of FR+CTC and AI tumor volume for classifying the invasiveness of LUAD. A total of 226 patients who were diagnosed with LUAD were enrolled. The inclusion criteria were: (I) FR+CTC detection and AI imaging before anticancer therapy, and (II) definite histopathologic diagnosis, which is the gold diagnosis of LUAD and its subtypes. Use the CytoploRare® Detection Kit to quantify FR+CTC and the AI-assisted diagnosis system, ScrynPro, to measure tumor volume. The clinical data were used to construct univariate and multivariate logistic regression models. A nomogram was drawn based on the multivariate logistic regression model. The validity is evaluated by the calibration curve and Hosmer-Lemeshow goodness-of-fit test. The mean age of 146 patients (96 males, 49 females and 1 gender missing) retrospectively enrolled was 56.6. In the cohort, 41 and 105 patients were assigned to adenocarcinoma in situ (AIS) + minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA), respectively. There was no significant difference between the sex distribution and smoking history of the two groups (P=0.155 and P=0.442, respectively). In univariate analysis, the nodules type, maximum density, tumor volume and FR+CTC level were statistically significant with the invasiveness of LUAD (P<0.05). The multivariate analysis showed significant differences in FR+CTC and AI tumor volume (P<0.001). The area under the curves (AUCs) of FR+CTC and AI tumor volume in diagnosing tumor invasiveness were 0.659 and 0.698, respectively. A predictive model combining FR+CTC with AI tumor volume showed a sensitivity of 86.89% and a specificity of 70.94%, and the AUC was 0.841. The nomogram had good agreement with actual observation, and the Hosmer-Lemeshow test yielded non-significant goodness-of-fit. FR+CTC and/or AI tumor volume are independent indicators of the invasiveness of LUAD, and the nomogram based on them can be used for the preoperative screening of patients.

Specifics of Young Gastric Cancer Patients: A Population-Based Analysis of 46,110 Patients with Gastric Cancer from the German Clinical Cancer Registry Group.

Introduction: 2−8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000−2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.

A novel transfer-learning based physician-level general and subtype classifier for non-small cell lung cancer

Confirming histological patterns of lung carcinoma is important for determining the prognosis and the next steps of treatment for a patient. Confirming the histologic patterns (subtype) of lung adenocarcinoma is important for determining the prognosis and treatment options for a patient. The task is challenging, and often requires the input of experienced pathologists, who by themselves lack interobserver concordance. A computer-aided diagnosis holds the potential to accelerate the time to diagnosis. As many adenocarcinoma tissue samples contain multiple histologic patterns, accurate computer-aided diagnosis requires annotations manually labeled by pathologists. We propose a method that merges weak supervised learning and Integrated Learning using Transfer Learning using two datasets: The Cancer Genome Atlas (TCGA), and the Clinical Proteomic Tumor Analysis Consortium (CPTAC) to reduce the need for manual annotation by a pathologist while maintaining accuracy. Whole-slide images (WSI) are first determined to be either adenocarcinoma or squamous cell carcinoma, then further identify the subtypes by generating weak classifiers for each subtype, then using integrated learning to create a strong classifier.Our model was evaluated with independent datasets from the CPTAC dataset and a dataset from a private hospital. It can achieve AUC values of 0.86, 0.91, 0.82, 0.77, 0.96, 0.98 in Acinar, LPA, Micropapillary, Papillary, Solid, and Normal, respectively.

Development and validation of a radiomic nomogram based on pretherapy dual-energy CT for distinguishing adenocarcinoma from squamous cell carcinoma of the lung.

Based on pretherapy dual-energy computed tomography (DECT) images, we developed and validated a nomogram combined with clinical parameters and radiomic features to predict the pathologic subtypes of non-small cell lung cancer (NSCLC) - adenocarcinoma (ADC) and squamous cell carcinoma (SCC). A total of 129 pathologically confirmed NSCLC patients treated at the Second Affiliated Hospital of Nanchang University from October 2017 to October 2021 were retrospectively analyzed. Patients were randomly divided in a ratio of 7:3 (n=90) into training and validation cohorts (n=39). Patients' pretherapy clinical parameters were recorded. Radiomics features of the primary lesion were extracted from two sets of monoenergetic images (40 keV and 100 keV) in arterial phases (AP) and venous phases (VP). Features were selected successively through the intra-class correlation coefficient (ICC) and the least absolute shrinkage and selection operator (LASSO). Multivariate logistic regression analysis was then performed to establish predictive models. The prediction performance between models was evaluated and compared using the receiver operating characteristic (ROC) curve, DeLong test, and Akaike information criterion (AIC). A nomogram was developed based on the model with the best predictive performance to evaluate its calibration and clinical utility. A total of 87 ADC and 42 SCC patients were enrolled in this study. Among the five constructed models, the integrative model (AUC: Model 4 = 0.92, Model 5 = 0.93) combining clinical parameters and radiomic features had a higher AUC than the individual clinical models or radiomic models (AUC: Model 1 = 0.84, Model 2 = 0.79, Model 3 = 0.84). The combined clinical-venous phase radiomics model had the best predictive performance, goodness of fit, and parsimony; the area under the ROC curve (AUC) of the training and validation cohorts was 0.93 and 0.90, respectively, and the AIC value was 60.16. Then, this model was visualized as a nomogram. The calibration curves demonstrated it's good calibration, and decision curve analysis (DCA) proved its clinical utility. The combined clinical-radiomics model based on pretherapy DECT showed good performance in distinguishing ADC and SCC of the lung. The nomogram constructed based on the best-performing combined clinical-venous phase radiomics model provides a relatively accurate, convenient and noninvasive method for predicting the pathological subtypes of ADC and SCC in NSCLC.

Kristen Rat Sarcoma Viral Oncogene Mutations in Colorectal Carcinomas at the University Teaching Hospital in Lusaka, Zambia

Background: The second leading cause of cancer-related deaths worldwide is colorectal cancer. With an incidence rate of 4.8 per 100,000, this is Zambia’s sixth most prevalent cancer;&#x0D; &#x0D; Methods: This laboratory-based, cross-sectional study examined the frequency of Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation and its association with prognostic factors in colorectal carcinoma cases from the University Teaching Hospital-Adult Hospital (UTHs), Lusaka, Zambia;&#x0D; &#x0D; Results: Thirty (30) formalin-fixed paraffin-embedded (FFPE) samples collected between June 2017 and June 2018 were sent to the Lancet laboratories and analyzed for KRAS mutations (codons 12 and 13). One FFPE block did not meet the inclusion criteria and was excluded. The demographic and clinicopathological data were analyzed using STATA 12. Males outnumber females by 20 to nine. The average age of the patient was 45 ± 16 years. The rectum was the location of 44.8% of the tumors, with the majority being conventional adenocarcinoma (CAC) (65.6 %). All cases (100%) had advanced-stage (stages 3 and 4) disease; however, only 27.6% of patient tumors exhibited lymphovascular invasion. KRAS mutation was detected in 11 (37.9%) cases and mainly in left-sided tumors (62.5%). KRAS mutations were only detected in CAC and serrated adenocarcinoma subtypes. No significant associations were observed between the KRAS mutation status and tumor or patient’s clinical and sociodemographic factors;&#x0D; &#x0D; Conclusion: We advocate for incorporating KRAS mutation testing into the standard of care for treating colorectal cancer.

Kristen Rat Sarcoma Viral Oncogene Mutations in Colorectal Carcinomas at the University Teaching Hospital in Lusaka, Zambia

Background: The second leading cause of cancer-related deaths worldwide is colorectal cancer. With an incidence rate of 4.8 per 100,000, this is Zambia’s sixth most prevalent cancer;&#x0D; Methods: This laboratory-based, cross-sectional study examined the frequency of Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation and its association with prognostic factors in colorectal carcinoma cases from the University Teaching Hospital-Adult Hospital (UTHs), Lusaka, Zambia;&#x0D; Results: Thirty (30) formalin-fixed paraffin-embedded (FFPE) samples collected between June 2017 and June 2018 were sent to the Lancet laboratories and analyzed for KRAS mutations (codons 12 and 13). One FFPE block did not meet the inclusion criteria and was excluded. The demographic and clinicopathological data were analyzed using STATA 12. Males outnumber females by 20 to nine. The average age of the patient was 45 ± 16 years. The rectum was the location of 44.8% of the tumors, with the majority being conventional adenocarcinoma (CAC) (65.6 %). All cases (100%) had advanced-stage (stages 3 and 4) disease; however, only 27.6% of patient tumors exhibited lymphovascular invasion. KRAS mutation was detected in 11 (37.9%) cases and mainly in left-sided tumors (62.5%). KRAS mutations were only detected in CAC and serrated adenocarcinoma subtypes. No significant associations were observed between the KRAS mutation status and tumor or patient’s clinical and sociodemographic factors; &#x0D; Conclusion: We advocate for incorporating KRAS mutation testing into the standard of care for treating colorectal cancer.

High-Grade Desmoplastic Foamy Gland Prostatic Adenocarcinoma.

It is important to recognize high-grade foamy gland prostatic adenocarcinoma with desmoplastic stroma given its aggressive clinical course with frequent metastases and death. To review the morphology, immunohistochemistry, and prognosis for this rare subtype of prostate adenocarcinoma. Twenty-four cases received for consultation from 2010 to 2021 were analyzed including needle biopsy (n = 21), transurethral resection (n = 2), and a cystoprostatectomy (n = 1). Patients ranged in age from 40 to 89 years (mean, 67 years). On average, 8 cores per case were involved (mean 67% core involvement). Extraprostatic extension and seminal vesicle invasion were observed in 6 of 21 (29%) and 3 of 21 (14%) needle biopsy cases, respectively. Twenty of the 24 cases (83%) were Grade Group (GG) 5 with 4 of 24 (17%) being GG4. Tumor necrosis as a component of Gleason pattern 5 was observed in 21 of 24 cases (88%). Associated intraductal adenocarcinoma (IDC) was observed in 22 of 24 cases (92%), with 4 of 24 cases (17%) demonstrating extensive IDC. Diagnostic challenges were as follows: (1) sparse isolated cancer glands embedded in the dense desmoplastic stroma; (2) fragmented glands; and (3) aberrant staining for high-molecular-weight cytokeratin in a nonbasal cell pattern in all cases. PTEN loss was observed in 9 cases, and p53 nuclear accumulation was observed in 8 cases. Three patients were lost to follow-up. Overall, of the 16 patients with meaningful follow-up, 12 (75%) either had metastases or died from prostate cancer. High-grade desmoplastic foamy gland adenocarcinoma is difficult to diagnose and grade and has a poor prognosis.