Synchronous Adenocarcinoma Research Articles

Goblet Cell Carcinoma of the Appendix with Synchronous Adenocarcinoma of the Cecum: Distinct or Related Entities?

Goblet cell carcinoma (GCC) is a rare primary tumor of the appendix characterized by both epithelial and neuroendocrine components containing goblet cells. While in the past, the GCC has been associated with neuroendocrine tumors, recent studies consider that GCC is closer to adenocarcinoma than a neuroendocrine component. The association between gastro-intestinal (GI) carcinoids and second primary malignancies (SPMs) is widely described in the literature, but there is no reported case of GCC and synchronous adjacent adenocarcinoma of the colon. We describe the first case in the literature, to our knowledge, of synchronous colorectal adenocarcinoma of the cecum and GCC of the appendix that are incidentally discovered in the resected primary cancer specimen. The association between the two neoplasms seems to be not causal and maybe the “paracrine-effect theory” may explain the development of a second tumor close to the primary.

S1639 Metastatic Gastric Cancer to the Rectum: A Systematic Review

Introduction: Rectal metastasis (RM) from gastric cancer (GC) is an extremely rare entity. Herein, we review trends to promote detection and strategies for management. Methods: PubMed search for "gastric cancer" and "rectal metastasis," from database inception through April 30, 2022; pooled with a case from our institution. Results: We included 25 cases with a female:male ratio of 1.77:1 (Table). Mean age (±SD) at RM was 57.5 (±12.1) years. Cases were metachronous in 68.2%, with a median time to RM of 45 (range 12-120) months. Histologically, 80% had diffuse-type adenocarcinoma (AC), 13.3% had intestinal-type AC, and 6.7% had gastroesophageal junction AC originating from the stomach. Regarding initial GC diagnosis (iGCd) AJCC stage and TNM classification, 28.6% were stage (St IIA, T3N0M0), the rest were evenly split at 14.3% for each of St IA (T1N0M0), St IB (T2N0M0), St IIIA (T3N2M0), St IIIB, and St IV (T3N0M1). Treatment included surgery alone (45.5%), chemotherapy (27.3%), surgery with chemotherapy (18.2%), and surgery with chemoradiation (9.1%). Rectal stenosis from Schnitzler's metastasis described in 68% of cases. The most common symptoms at RM were mechanical bowel obstruction—including abdominal mass, distension, discomfort, and/or pain (28.6%); constipation (24.5%); ascites (10.2%); and nausea, dyspepsia, or vomiting (8.2%), weight loss (8.2%), tenesmus (6.1%), rectal discharge or hematochezia (6.1%), and anemia (4.1%). RM median duration of symptoms was 60 (range 1-180) days with a median distance from dentate line of 5 (range 4-10) cm and a median rectal wall thickness of 11.5 (range 8-20) mm. All patients underwent lower endoscopy—sigmoidoscopy in 59.1%, and colonoscopy in 27.3%. EUS in 41.7%, CT abdomen/pelvis in 54.1%, EGD in 18.2%—75% were synchronous AC. Pelvic MRI was utilized in 12.5%. PET scan was utilized in 16.7%—all had established GC diagnosis, 75% presented with rectal stenosis, and 75% failed to detect RM on endoscopic mucosal biopsy requiring further surgical sampling. Regarding outcomes, 46.7% were alive and 53.0% succumbed to disease with a median follow-up of 6 (range 0.5-35.5) months after RM. Conclusion: In our cohort, over 2-thirds of patients had a metachronous disease. Surgical sampling should be performed to detect RM when evaluating patients with mechanical bowel obstruction, even when the endoscopic mucosal biopsy is negative. Our findings would enhance accurate evaluation, and promote multidisciplinary management strategies that will eventually reshape outcomes. Table 1. - Characteristics of patients with RM from GC Characteristics of Patients with RM from GC Female:Male 1.77:1 Mean age, (±SD) 57.5, (±12.1) years Metachronous 68.2% - Median time to RM in metachronous setting, (range) 45, (12-120) months Histological subtype - Diffuse type AC 80% - Intestinal type AC 13.3% - Gastroesophageal junction originating from the stomach 6.7% AJCC stage groups at the time of GC diagnosis, (TNM) - St IA (T1N0M0) 14.3% - St IB (T2N0M0) 14.3% - St IIA (T3N0M0) 28.6% - St IIIA (T3N2M0) 14.3% - St IIIB (NM) 14.3% - St IV (T3N0M1) 14.3% Rectal stenosis from Schnitzler's metastasis 68% Most common symptoms at time of RM - Abdominal mass, distension, discomfort, and/or pain 28.6% - Constipation 24.5% - Ascites 10.2% - Nausea, dyspepsia, or vomiting 8.2% - Weight loss 8.2% - Tenesmus 6.1% - Rectal discharge or hematochezia 6.1% - Anemia 4.1% Median duration of symptoms at the time of RM diagnosis, (range) 60, (1-180) days Median distance of RM from the dentate line, (range) 5, (4-10) cm Median rectal wall thickness, (range) 11.5 (8-20) mm Workup - Lower GI Endoscopy - Sigmoidoscopy 59.1% - Colonoscopy 27.3% - EGD 18.2% - EUS 41.7% - CT abdomen and pelvis 54.1% - PET scan 16.7% - Pelvic MRI 12.5% Median duration of follow-up, (range) 6 (0.5-35.5) months Treatment modalities - S alone 45.5% - C alone 27.3% - S+C 18.2% - S+CRT 9.1% Survival Outcomes - Alive 46.7% - Died of disease 53.0% RM: rectal metastasis; GC: gastric cancer; AC: adenocarcinoma; AJCC: American Joint Committee on Cancer; St: stage; TNM: TNM classification of malignant tumors; NM: not mentioned; S: surgery; C: chemotherapy; CRT: chemoradiation; GI: gastrointestinal; EGD: esophagogastroduodenoscopy; EUS: endoscopic ultrasound; CT: computed tomography; PET: positron emission tomography; MRI: magnetic resonance imaging.

S2078 Multicentric, Synchronous Colon Cancer in the Rectum, Sigmoid and Cecum in an Elderly Female

Introduction: Multicentric tumors are more common in genetically-linked cancers. In most instances, tumor occurrence in a different location is due to recurrence of the malignancy. Our case illustrates a rare endoscopic finding of 3 distinct and synchronous adenocarcinomas of the rectum, sigmoid colon, and cecum in an otherwise healthy elderly female at an average risk for colorectal cancer. Case Description/Methods: An 81-year-old female with no medical history presented to the hospital with constipation and diffuse intermittent abdominal pain for 4 months. She had been self-medicating at home with over-the-counter laxatives but recently reported that she was not experiencing relief. She denied any prior endoscopy or family history of colorectal cancer. On admission, her vital signs were normal and her physical exam was significant for diffuse abdominal tenderness to palpation. Digital rectal examination revealed a non-tender, hard mass in the left lateral wall of the rectum. Her complete blood count and comprehensive metabolic panels were normal. Iron studies were also unremarkable. A computed tomography (CT) scan of the abdomen and pelvis showed thickening in the sigmoid colon and the rectum with scattered subcentimeter lymph nodes. On colonoscopy, she was found to have 3 partially-obstructing, malignant-appearing lesions located in the rectum, proximal sigmoid, and cecum. Biopsies of all 3 sites revealed adenocarcinoma. Immunohistochemistry for DNA mismatch repair proteins (MMR) showed intact MLH1, MSH2, MSH6, PMS2 genes. She underwent a laparoscopic total colectomy with end ileostomy, with pathological staging revealing pT3 N0 for the sigmoid tumor and pT4a N2b for the cecal tumor. She was planned for neoadjuvant chemoradiation therapy in anticipation for future robotic proctectomy for treatment of the rectal tumor (Figure 1). Discussion: Synchronous colorectal cancers pose a distinct challenge in terms of management and treatment. The extent of surgical resection and the use of chemoradiation depends on the location, number of lesions, and lymph node involvement. Our patient was an interesting case as she presented later in life and her only symptom was constipation. She was an average risk patient, had otherwise normal labs, and HNPCC/lynch syndrome-related cancers were excluded on the basis of normal immunohistochemistry testing.Figure 1.: Partially-obstructing malignant lesions in the (A) rectum, (B) proximal sigmoid, and (C) cecum.

Laparoscopic distal gastrectomy for synchronous adenocarcinoma, diffuse large B cell lymphoma and gastrointestinal stromal tumor in the stomach: a case report

BackgroundSynchronous lymphoma and adenocarcinoma are occasionally detected in the stomach. Gastrointestinal stromal tumor (GIST) and adenocarcinoma are sometimes seen simultaneously in the stomach. However, we rarely observe synchronous adenocarcinoma, lymphoma, and GIST in the stomach, and there are few reports on cases with these three lesions.Case presentationThis is a case report of a 71-year-old man who had a laparoscopic distal gastrectomy and lymphadenectomy for three gastric tumors. Preoperative diagnoses were early adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma in the stomach, but final diagnosis was synchronous adenocarcinoma, diffuse large B cell lymphoma (DLBCL), and GIST. Helicobacter pylori (H. pylori) is highly involved in the development of DLBCL and MALT lymphoma in the stomach. Gastric adenocarcinoma is partially involved in chronic gastritis with atrophy and intestinal metaplasia caused by H. pylori infection. Indeed, a rapid urease test was found positive in this case. Therefore, we prescribed medicine to eliminate H. pylori after gastrectomy.ConclusionThis is the first case report where a patient underwent minimally invasive laparoscopic gastrectomy for synchronous adenocarcinoma, DLBCL and GIST in the stomach, although one patient who underwent open gastrectomy for synchronous adenocarcinoma, MALT lymphoma and GIST was previously reported.

Intrapericardial Thymoma Presented as Pericardial Tamponade with Post-Operative Myasthenia Gravis

Background: Thymoma is an epithelial mass arising from the thymus. Most thymomas are located in the anterior mediastinum. Ectopic intrapericardial thymoma is very unusual; to date, only eight cases of pericardial thymoma have been reported. Among thymoma patients, 20% to 25% are associated with myasthenia gravis. However, postoperative myasthenia gravis occurs in less than 1% of cases. Here, we share a rare case of ectopic intrapericardial thymoma that developed postoperative myasthenia gravis six months after surgery. Case presentation: A 66-year-old woman visited the outpatient department due to productive cough and chest pain. Chest radiography showed increased soft tissue opacity over the mediastinum. A soft tissue mass in the pericardium and a ground glass nodule in right upper lung were noted using chest computed tomography. The diagnosis of thymoma, type B2, pT3N0M0, and stage IIIA and synchronous adenocarcinoma in situ of the right upper lung was confirmed after surgical removal. Six months later, the patient developed postoperative myasthenia gravis. Conclusions: Thymoma is rarely considered a differential diagnosis in pericardial tumors. Surgical removal with adjuvant radiation therapy should be performed considering the malignancy potential of thymomas and cardiac complications. In patients without myasthenia gravis, a small chance of postoperative myasthenia gravis remains. Patients should be carefully monitored for myasthenia gravis after surgery.

Collision of germline POLE and PMS2 variants in a young patient treated with immune checkpoint inhibitors

The onset of multiple and metachronous tumors in young patients induces to suspect the presence of genetic variants in genes associated with tumorigenesis. We describe here the unusual case of a 16-year-old patient who developed a synchronous bifocal colorectal adenocarcinoma with distant metastases. We provide high throughput molecular characterization with whole-exome sequencing (WES) and DNA targeted sequencing of different tumoral lesions and normal tissue samples that led to unveil a germline POLE mutation (p.Ser297Cys) coexisting with the PMS2 c.2174 + 1 G > A splicing mutation. This clinical scenario defines a “POLE-LYNCH” collision syndrome, which explains the ultra-mutator phenotype observed in the tumor lesions, and the presence of MMR deficiency-associated unusual signatures. The patient was successfully treated with immune checkpoint inhibitors but subsequently developed a high-grade urothelial carcinoma cured by surgery. We complement this analysis with a transcriptomic characterization of tumoral lesions with a panel targeting 770 genes related to the tumor microenvironment and immune evasion thus getting insight on cancer progression and response to immunotherapy.

An Interesting Case of Synchronous Low-Grade Peritoneal Mesothelioma and Ovarian Endometrioid Adenocarcinoma

Synchronous mesothelioma with other primary malignancies has previously been reported. However, the finding of a low-grade peritoneal mesothelioma with a synchronous ovarian endometrioid adenocarcinoma remains unreported. We report a case of a 57-year-old woman presenting with distended abdomen. CT abdomen and pelvis and subsequent MRI revealed a large pelvic mass. On pathology of the exploratory laparotomy specimen, stage IIIB FIGO grade 3 right ovarian endometrioid adenocarcinoma, as well as stage 1A left ovarian endometrioid borderline tumor, were discovered. Incidentally, a low-grade mesothelioma, epithelioid type, was discovered spanning omentum, right upper paracolic gutter left upper paracolic gutter, and umbilicus. Post-surgery, chemotherapy was initiated primarily to treat the ovarian adenocarcinoma.

High-dose planned adaptive intensity-modulated radiation therapy with simultaneous integrated boost for synchronous oligometastatic pancreatic cancer.

The purpose of this study was to investigate the efficacy and feasibility of high-dose (72.6 Gy) planned adaptive intensity modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) for 9 consecutive patients with synchronous oligometastatic pancreatic ductal adenocarcinoma (PDAC). The estimated 2-year overall survival rate was 66.7%, and the local progression-free survival at 2 years was 83.3%. No severe adverse events were observed. Planned adaptive dose-escalated IMRT-SIB has the potential to improve local control rate and prolong overall survival in patients with synchronous oligometastatic PDAC.

Clinical Features and Surgical Treatment of Synchronous Multiple Primary Lung Adenocarcinomas With Different EGFR Mutations.

BackgroundWith the popularity of lung cancer screening and advances in imaging technology, more and more synchronous multiple primary lung adenocarcinomas (SMPLA) are being diagnosed clinically, however, the clinical characteristics and prognosis of SMPLA with different EGFR mutations remains unclear. We aimed to explore clinical features and surgical outcomes of these patients to aid in the diagnosis and treatment of SMPLA.MethodsMedical records of patients with different EGFR mutations who have been diagnosed as SMPLA and underwent surgical resection from March 2015 to December 2019 were retrospectively analyzed. Clinical characteristics, surgical outcomes, recurrence-free survival (RFS) and overall survival (OS) were investigated.ResultsA total of 70 patients (68.6% female and 77.1% non-somkers) were included. Total of 161 lesions in all patients, 84.4% were ground-glass opacity (GGO) lesions. EGFR mutations were detected in 108 lesions, most of which were L858R (35.4%) and 19Del (20.5%). The mutation rate of mixed GGO is significantly higher than that of pure GGO and solid nodules (SN); the mutation rate of invasive adenocarcinoma is significantly higher than that of other histology subtypes; the mutation rate of lesions >20 mm was significantly higher than that of ≤20 mm. However, there is no significant difference in the mutation rate of specific driver gene between different radiological features, pathological characteristics and sizes. After a median follow-up time of 29 months, the 3-year OS and RFS were 94.4% and 86.0%, respectively.ConclusionsA high discordance of EGFR mutations were identified between tumors in patients with SMPLA. Synchronous multiple lung adenocarcinomas with predominantly multiple GGO should be considered as SMPLA, and surgery may be aggressively performed for these patients due to a good prognosis.

Phase II Prospective, Open-Label Randomized Controlled Trial Comparing Standard of Care Chemotherapy With and Without Sequential Cytoreductive Interventions for Patients with Oligometastatic Foregut Adenocarcinoma and Undetectable Circulating Tumor Deoxyribose Nucleic Acid (ctDNA) Levels.

BackgroundMetastatic adenocarcinomas of foregut origin are aggressive and have limited treatment options, poor quality of life, and a dismal prognosis. A subset of such patients with limited metastatic disease might have favorable outcomes with locoregional metastasis-directed therapies. This study investigates the role of sequential cytoreductive interventions in addition to the standard of care chemotherapy in patients with oligometastatic foregut adenocarcinoma.MethodsThis is a single-center, phase II, open-label randomized clinical trial. Eligible patients include adults with synchronous or metachronous oligometastatic (metastasis limited to two sites and amenable for curative/ablative treatment) adenocarcinoma of the foregut without progression after induction chemotherapy and having undetectable ctDNA. These patients will undergo induction chemotherapy and will then be randomized (1:1) to either sequential curative intervention followed by maintenance chemotherapy versus routine continued chemotherapy. The primary endpoint is progression-free survival (PFS), and a total of 48 patients will be enrolled to detect an improvement in the median PFS in the intervention arm with a hazard ratio (HR) of 0.5 with 80% power and a one-sided alpha of 0.1. Secondary endpoints include disease-free survival (DFS) in the intervention arm, overall survival (OS), ctDNA conversion rate pre/post-induction chemotherapy, ctDNA PFS, PFS2, adverse events, quality of life, and financial toxicity.DiscussionThis is the first randomized study that aims to prospectively evaluate the efficacy and safety of surgical/ablative interventions in patients with ctDNA-negative oligometastatic adenocarcinoma of foregut origin post-induction chemotherapy. The results from this study will likely develop pertinent, timely, and relevant knowledge in oncology.Supplementary InformationThe online version contains supplementary material available at 10.1245/s10434-021-11249-7.

A population-based study in synchronous versus metachronous metastatic esophagogastric adenocarcinoma.

Background:Real-world data on treatment and outcomes in patients with synchronous metastatic disease compared with patients with metachronous metastatic disease in esophagogastric cancer have not been published before. The aim of our study was to explore treatment, overall survival (OS), and time to treatment fialure (TTF) in patients with synchronous and metachronous metastatic esophagogastric adenocarcinoma.Methods:Patients with synchronous metastatic disease (2015–2017) and patients with metachronous metastatic disease initially treated with curative intent for nonmetastatic disease (2015–2016) were selected from the Netherlands Cancer Registry. OS and TTF were assessed from metastatic diagnosis for patients with synchronous, early metachronous (⩽6 months) or late metachronous (>6 months) metastatic disease using Kaplan–Meier curves with two-sided log-rank test.Results:Median OS was 4.2, 2.1, and 4.4 months in patients with synchronous, early metachronous, and late metachronous metastatic disease, respectively (p < 0.001). The proportion of patients receiving systemic treatment was 41.3%, 21.5%, and 32.5% for synchronous, early metachronous, and late metachronous metastatic disease, respectively (p = 0.001). Among patients receiving systemic treatment, median OS was 8.8, 4.5, and 9.1 months (p < 0.001) and median TTF was 6.1, 3.8, and 5.7 months (p < 0.001) in synchronous, early metachronous, and late metachronous metastatic disease, respectively.Conclusion:Patients with early metachronous metastatic disease have a worse survival compared with patients with synchronous or late metachronous metastatic disease. These patients less often receive systemic treatment, and even when treated, survival is worse compared with patients with synchronous or late metachronous metastatic disease, suggesting a more aggressive tumor behavior.

Complete remission of an early-stage laryngeal cancer under combined pembrolizumab and chemotherapy treatment of a synchronous lung adenocarcinoma

BackgroundAnti-PD1-Checkpoint inhibition (CI) is an established treatment of recurrent and/or metastatic head and neck cancer. A potential benefit from CI in early-stage disease that is usually treated by radiation or surgery has not been investigated so far and is currently not addressed in clinical trials.Case presentationA 58-year-old man was diagnosed with a cT2 supraglottic laryngeal cancer and a synchronous metastasized adenocarcinoma of the lung. As the patient refused any treatment of his laryngeal cancer, he received combined immune-chemotherapy according to the KEYNOTE-189 protocol. After 4 cycles of pembrolizumab/carboplatin/pemetrexed, the patient showed a complete remission of his laryngeal cancer with a clear shrinkage of the mediastinal and hilar lung cancer metastases. After 21 cycles of maintenance therapy, the lung adenocarcinoma shows a stable disease status with no signs of any residual or recurrent laryngeal cancer.ConclusionsAnti-PD1-CI may be a treatment option also for early-stage HNSCC with excellent functional outcome when established therapies are not available.Graphical

The survival impact of palliative radiotherapy on synchronous metastatic pancreatic ductal adenocarcinoma: metastatic site can serve for radiotherapy-decision.

Background: The metastatic site seems to represent a malignancy with a different biological characteristic and is an important prognostic factor in metastatic pancreatic ductal adenocarcinoma (mPDAC). Palliative radiotherapy is a therapeutic option, and usually used for pain management in the treatment of mPDAC. The real-world effect of radiotherapy on the survival outcomes of mPDAC patients might do exist and is worth exploring.Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) was extracted to identify mPDAC diagnosed in the periods of 2010-2016. The statistical methods included Pearson's chi-square test, Log-rank test, Cox regression model and propensity score matching (PSM).Results: Radiotherapy was able to improve the overall survival of PDAC with liver metastasis (p<0.001), but not for PDAC patients with lung (p=0.130), bone (p=0.451) and brain metastasis (p=0.226) before PSM. Radiotherapy can only a prognostic factor for PDAC liver metastasis (p=0.001) in the cox regression analysis. The survival curves provided consistent results with cox regression analysis (PDAC with liver metastasis: p=0.023, PDAC with lung metastasis: p=0.528, PDAC with bone metastasis: p=0.210, PDAC with brain metastasis: p=0.106) after PSM. We continue to divided PDAC liver patients into PDAC-liver-metastasis with and without lung, bone, and/or brain (LBB) metastasis. Finally, radiotherapy can be used as a feasible treatment to prolong the overall survival of patients with PDAC liver metastasis without LBB metastasis.Conclusions: Radiotherapy can be used as a feasible treatment to prolong the overall survival of patients with PDAC liver metastasis without LBB metastasis.

Intertumoural Heterogeneity and Branch Evolution of Synchronous Multiple Primary Lung Adenocarcinomas by Next-Generation Sequencing Analysis.

ObjectivesMultiple primary lung cancers (MPLCs) are an increasingly well-known clinical phenomenon, but there is a lack of high-level evidence for their optimal clinical diagnosis and therapeutic approaches. Thus, we analysed genetic variation to determine the intertumoural heterogeneity and branch evolution of synchronous multiple primary lung adenocarcinomas.MethodsWe performed multiplex mutational sequencing on 93 synchronous multiple primary lung adenocarcinoma lesions from 42 patients who underwent surgical resection.ResultsThe high discordance rate of mutation was 92.9% (n=39) between tumours in individual patients. EGFR, TP53 and KRAS mutations were detected in 57 (61.3%), 19 (20.4%) and 11 (11.8%) of the 93 tumours, respectively. 16 cases of multiple primary lung adenocarcinomas simultaneously harboured EGFR mutations and TP53 mutations. Matching mutations between paired tumours were observed in 1 (2.4%) patient for P20. The genotypes were all EGFR L858R mutations, but the pathological type of P20T1 was lepidic predominant, and P20T2 was adenocarcinoma in situ. In the phylogenetic tree, genetic variations were divided into trunk, shared and branch subtypes. Branch mutations accounted for 91.09% of variations in sMPLA, while the ratio of trunk (4.95%) and shared (3.96%) variations was significantly lower.ConclusionsRemarkable intertumoural heterogeneity and frequent branch mutations were found in synchronous multiple primary lung adenocarcinomas.

S1972 Synchronous Rectal Adenocarcinoma and Anal Squamous Cell Carcinoma in an Elderly Woman

S1972 Synchronous Rectal Adenocarcinoma and Anal Squamous Cell Carcinoma in an Elderly Woman

Investigation of miRNA dysregulation and association with immune cell profile during malignant transformation of colorectal cells

BackgroundColorectal cancer (CRC) is one of the most prevalent and life-threatening cancer among the world. Accumulated somatic mutations during malignant transformation process endow cancer cells with increased growth, invasiveness and immunogenicity. These highly immunogenic cancer cells develop multiple strategies to evade immune attack. Through post-transcriptional regulation, microRNAs (miRNAs) not only participate in cancer development and progression but also manipulate anti-cancer immune response. This study aims to identify miRNAs associated with the colorectal cell malignant transformation process and their association with immune cell population using synchronous adjacent normal, polyp and CRC specimens. MethodsWe conducted a Low Density Array to compare the miRNA expression profile of synchronous colorectal adenoma, adenocarcinoma and adjacent normal colon mucosa collected from 8 patients, in order to identify candidate miRNAs involved in CRC progression. These findings were further validated in 14 additional patients and GEO dataset GSE41655. The relative abundance of dendritic cells, natural killer cells, neutrophil and macrophage was determined and correlated with dysregulated miRNA levels. ResultsMicroRNA microarray identified 39 miRNAs aberrantly expressed during the colorectal cell transformation process. Seven novel miRNAs were shortlisted, and dysregulation of miR-149-3p, miR-192-3p, miR-335-5p and miR-425 were further validated by the qPCR validation experiment and data retrieved from the GEO dataset. Furthermore, these miRNAs demonstrated certain associations with level of dendritic cells, natural killer cells, neutrophil and macrophage within the polyp or CRC specimens. ConclusionThis study revealed miRNA dysregulated during stepwise malignant transformation of colorectal mucosal cells and their association with immune cell population.

Adénocarcinomes pulmonaires multifocaux synchrones : intérêt de la biologie moléculaire pour la stadification

The presence of multiple synchronous lung tumors is not a rare event. Distinguishing intra-pulmonary metastases from multiple synchronous lung adenocarcinoma is a challenge for pathologists and physicians. We present observation of a patient with three lung tumors corresponding to three adenocarcinomas for which molecular analysis had a significant impact on tumor staging. Three suspect lesions were discovered in a 61-year-old patient, a smoker, in each lobe of the right lung. Right pneumonectomy with lymph node dissection was performed. Pathological examination showed that each tumor was in fact an adenocarcinoma. In order to more precisely indicate tumor staging, molecular analysis was performed with next generation sequencing showing a different point mutation in a driver gene on each tumor. The final diagnosis is that the three tumors are distinct synchronous tumors, which must be staged separately. In modern-day practice of thoracic oncology and of surgical pathology, molecular biology represents a complement for tumor staging in the event of multiple lung tumors.

Surgical outcomes of one-stage resection for synchronous multiple primary lung adenocarcinomas with no less than three lesions

BackgroundMore and more synchronous multiple primary lung adenocarcinomas (SMPLA) have been diagnosed and surgical treatment has become the mainstay of treatment for them, but there are few reports on the surgical outcome of patients with ≥ 3 lesions who underwent surgical resection. Therefore, we summarized and analyzed the clinical characteristics and surgical outcomes of these patients, hoping to provide some experience in the diagnosis and treatment.MethodsClinical characteristics and treatment outcomes of patients with ≥ 3 lesions who have been diagnosed as SMPLA and underwent surgical resection in our hospital from March 2015 to July 2019 were retrospectively reviewed.ResultsTwenty-eight patients, 20 females and 8 males, with a mean age of 57.7 ± 5.69 (45–76) years, were finally included. A total of 95 lesions, 86.4% were ground-glass opacity (GGO) lesions (pure-GGO,45.3%; mixed-GGO,41.1%); 51 lesions had EGFR mutations and the mutation rate of invasive adenocarcinoma was significantly higher than that of other pathological subtypes (P < 0.001); the mutation rate of mGGO was also significantly higher than that of pGGO and solid nodule (SN) (P < 0.05). Four and 24 patients respectively underwent bilateral and unilateral surgical resection. The surgical procedure was mainly sublobar resection, and no severe postoperative complications or deaths occurred. After a median follow-up time of 32.2 months, the rates of overall survival and disease-free survival at 3 years were 94.7% and 88.9%, respectively.ConclusionsFor SMPLA with ≥ 3 lesions, one-stage resection may be safe and feasible, and surgical procedure was mainly sublobar resection as far as possible, which can yield satisfactory prognosis. EGFR mutation testing should be used routinely in the diagnosis and treatment of patients with SMPLA, especially in the presence of mGGO and invasive adenocarcinoma.

80 THE PROGNOSTIC FACTORS ASSOCIATED WITH LONG-TERM SURVIVAL IN THE PATIENTS WITH SYNCHRONOUS OLIGOMETASTATIC ESOPHAGEAL ADENOCARCINOMA

Abstract Patients with gastrointestinal cancer are increasingly being diagnosed with oligometastatic disease due to the development of sensitive imaging. Oligometastases (OLM) represent a clinical and anatomical manifestation of resistant localized cancer and/or metastases. However, oligometastatic disease is complicated by the lack of uniformity due to the heterogeneity of cancer, therefore, differing prognoses. The aim of this study is to identify the factors associated with long-term survival in the patients with synchronous oligometastatic esophageal adenocarcinoma (EAC). Methods Between 2002 and 2016, of 1400 patients with EAC (esophagus and Siewert types I and II) treated at our institute, 233 patients initially diagnosed with stage IVB were enrolled. OLM was defined as only metastasized to one organ and less than 5 metastases. We retrospectively analyzed the association between clinicopathological factors and prognosis, especially focused on the pattern of metastases. Results Eighty-five patients (36.5%) had OLM, and 148 (63.5%) had non-oligometastais (Non-OLM). The patients in OLM had significantly better overall survival (OS) than the patients in Non-OLM (p = 0.0001). Univariate analysis showed pattern of metastases (lymphatic OLM) and treatment method (consolidative local radiotherapy: CLT) were significantly associated with prognosis (p = 0.04 and 0.01). Multivariate analysis revealed that lymph node metastases (cN0-N1), number of metastasis (solitary) and treatment (CLT) were independent predictors for OS of patients with OLM. (p = 0.03, 0.01 and 0.001). In OLM patients, the patients with lymphatic OLM who received CLT had more favorable prognosis (5-years survival rate 25%). Conclusion This study suggests that CLT is one of the promising modalities for oligometastatic patients with EAC, especially the patients with lymphatic OLM.

Colorectal Cancer Surveillance after Resection

Background: Multiple guidelines have recommended performing surveillance colonoscopies after resection of colorectal cancer. However, there has been debate about the optimal frequency of endoscopic surveillance and its yield. Objective: The objective of this study was to explore the adherence and the yield of surveillance colonoscopy in our population. Design: This was a retrospective cohort study. Setting: This study was carried out in two tertiary care centers in Riyadh of all patients who were found to have colon cancer on colonoscopy. Patients and Methods: All patients who were found to have colon cancer on colonoscopy at one center from January 2016 to July 2019 and the second center from April 2012 to April 2019 were included in the study. The main outcome measures were as follows: rate of adherence to surveillance colonoscopies as well as the rate of synchronous and metachronous tumors identified. The sample size was not calculated. Results: A total of 280 patients were identified with a mean age of 64.5 years (standard deviation: 13.1), 61.4% were male, and the majority (72%) of the original cancers were left sided (rectum – 25.45%, rectosigmoid – 13.45%, sigmoid – 25.82%, and descending colon – 7.27%). Surveillance was performed in 55.7%, 17.9% did not attend their scheduled procedures, 2.1% refused, while there was no clear reason in 8.9%. Surveillance was not applicable to 15.3% of the study population. Over the course of three rounds of surveillance, the timing of the procedures was in line with recommendations in 66.8% in the first round while it was 20% in the second and third rounds. The procedures were normal in 69%, 71.9%, and 90% of the first, second, and third rounds, respectively. Metachronous adenocarcinoma was seen in 2.6% and synchronous adenocarcinoma in 0.6% during the first round. Adenocarcinoma was found in 5 out of 75 patients in the second round and 1 out of 10 in the third round. Conclusion: The attrition rate and deviation from timing suggested by guidelines are high. Furthermore, the yield of surveillance colonoscopies for important findings is clinically relevant. The limitations of this study were as follows: retrospective, probability of unmeasured confounders, as well possibility of attrition bias.