Type Of Primary Lesion Research Articles

P-234 Association between tumor differentiation grade and TNM staging in colorectal cancer

The tumor differentiation grade has been shown by several studies to be a stage-independent prognostic factor in colorectal cancer (CRC) 1. It is a factor that accounts for the tumor biology and is considered as an indicator of potential tumor growth and spread. The aim of this study was to analyze the importance of differentiation grade and how it relates to TNM staging system. 1. Mori T, Hirota T, Ohashi Y, Kodaira S. Significance of histologic type of primary lesion and metastatic lymph nodes as a prognostic factor in stage III colon cancer. Dis Colon Rectum 2006;49:982–92. The study was a retrospective single-centre analysis conducted at the University Clinic of Gastroenterology, University Hospital Center Mother Teresa, Tirana, Albania during the period 2014-2017. The clinical parameters and pathology data of cancer stage and differentiation grade were included. Tumor staging was done according to TNM system, AJCC (American Joint Committee on Cancer) 7th edition. The differentiation grade was correlated with demography, tumor location and overall TNM stage. They were further divided into low tumor grade (G1+G2) and high tumor grade (G3+G4) according to tumor differentiation. Data analysis was performed using the SPSS statistical package version 23.0. A total number of 237 patients were included in the study, mean age 62.7 ± 11.0 years, 133 (56.1%) male and 104 (43.9%) female. The tumor differentiation grade correlated significantly with the overall TNM stage (p = 0.001). A higher grade was more likely to correspond with a worse overall stage. High tumor grade (G3+G4) was diagnosed more frequently in stage III-IV than in stage I-II (71.6% vs 9.6%). The grade significantly correlated with the risk of having lymph node metastasis where the high grade tumors (G3/4) had a markedly increased risk of having positive nodes (p < 0.001). There were found no correlations between the differentiation grade and age or gender. Tumor differentiation grade is an important prognostic component, which correlates strongly with TNM classification system of CRC. Higher grade may have a higher malignant potential and be associated with worse clinical outcomes.

Clinical information and management status of de novo stage IV breast cancer patients: a Chinese multicenter investigation (CSBrS-002).

Background:Although de novo stage IV breast cancer is so far incurable, it has entered an era of individualized treatment and chronic disease management. Based on systemic treatment, whether the surgical resection of primary or metastatic foci of de novo stage IV breast cancer can bring survival benefits is currently controversial. We aimed to explore the clinicopathological factors and current status of the management of de novo stage IV breast cancer in China to provide a reference for clinical decisions.Methods:Based on the assistance of Chinese Society of Breast Surgery, a retrospective study was conducted to analyze the clinical data of patients with de novo stage IV breast cancer in 33 centers from January 2017 to December 2018. The relationship between basic characteristic (age, menstrual status, family history, reproductive history, pathological type, estrogen receptor [ER] status, progesterone receptor [PR] status, human epidermal growth factor receptor 2 [HER2] status, Ki-67 percentage, and molecular subtype), and metastasis sites (lung metastasis, liver metastasis, and bone metastasis) was examined by Pearson Chi-square tests.Results:A total of 468 patients with de novo stage IV breast cancer were enrolled. The median age of the enrolled patients was 51.5 years. The most common pathological type of primary lesion was invasive carcinoma (97.1%). Luminal A, luminal B, HER2 overexpressing, and triple-negative subtypes accounted for 14.3%, 51.8%, 22.1%, and 11.8% of all cases, respectively. Age, PR status, and HER2 status were correlated with lung metastasis (χ2 = 6.576, 4.117, and 8.643 and P = 0.037, 0.043, and 0.003, respectively). Pathological type, ER status, PR status, and molecular subtype were correlated with bone metastasis (χ2 = 5.117, 37.511, 5.224, and 11.603 and P = 0.024, <0.001, 0.022, and 0.009, respectively). Age, PR status, HER2 status, Ki-67 percentage, and molecular subtype were correlated with liver metastasis (χ2 = 11.153, 13.378, 10.692, 21.206, and 17.684 and P = 0.004, <0.001, 0.001, <0.001, and 0.001, respectively). Combined treatment with paclitaxel and anthracycline was the most common first-line chemotherapy regimen for patients with de novo stage IV breast cancer (51.7%). Overall, 91.5% of patients used paclitaxel-containing regimens. Moreover, 59.3% of hormone receptor-positive patients underwent endocrine therapy.Conclusions:In 2018, 1.07% of patients from all studied centers were diagnosed with de novo stage IV breast cancer. This study indicated that 95.1% of patients received systemic therapy and 54.2% of patients underwent surgical removal of the primary lesion in China.

Middle-retroauricular Island Flap: A New Axial Flap for Reconstruction of Non-helical Ear Defects.

Background:Surgical treatment of ear carcinomas needs the selection of the appropriate reconstructive techniques, which depends on the location and the dimensions of the defect after excision of the cancer and the quality of blood supply to the peri-lesional skin.The aim of this study was to evaluate the efficacy and reliability of a new axial island retroauricular flap (middle-retroauricular island flap M-RIF) for coverage of non-helical ear defects with direct donor site closure.Methods:All patients, from January 2013 to January 2020, with skin tumors of the non-helix region and undergoing a combined skin-cartilage excision with M-RIF local flap reconstruction under local anesthesia, were enrolled in the study.Results:18 patients (14 men and 4 women) underwent auricle skin-cartilage excision and M-RIF flap reconstruction. The mean age was 65 years (range, 60–85); the type of primary lesions were 12 BCC and 6 SCC. One flap wound dehiscence and one donor site infection and partial necrosis of the posterior auricular skin occurred; no other complications were recorded.Conclusions:The M-RIF flap is a valid surgical option when dealing with non-helical defects of the anterior pinna. It allows the reconstruction of the defect of the entire anterior surface of the auricle apart from the helix and the lobe and primary donor site closure.

Status of pleural lavage cytology in cases of pulmonary metastasis: a single-institution retrospective study.

In primary lung cancer surgery, intraoperative pleural lavage cytology (PLC) has been identified as a prognostic marker. However, there have been no reports on PLC for pulmonary metastasectomies. Therefore, the impact of PLC status for patients undergoing pulmonary metastasectomy remains unknown. We aimed to know the incidence and prognostic impact of positive PLC findings in pulmonary metastasectomies. We retrospectively reviewed patients undergoing pulmonary metastasectomies between January 2013 and December 2018. One hundred and eighty-nine PLC procedures in 159 patients undergoing pulmonary metastasectomy were analyzed. Follow-up information was available in 107 patients who underwent 132 procedure, and they were investigated for pleural recurrence-free probability (PRFP) and overall survival (OS) after pulmonary metastasectomy. The type of primary lesion was colorectal cancer (101/189, 53%), urothelial/kidney cancer (17/189, 9%), skeletal/soft tissue tumor (18/189, 10%), hepatobiliary/pancreatic cancer (19/189, 10%), uterine/ovarian cancer (14/189, 7%), otorhinolaryngological cancer (11/189, 6%), and other minor lesions (9/189, 5%). Nine PLC-positive metastasectomies were revealed (9/189, 4.8%). They consisted of six metastasectomies from pancreatic cancer, two from osteosarcoma, and one from tongue cancer. Significant predictors for PLC status was type of primary tumor (P < 0.001). PRFP and OS rate of PLC-positive group were significantly lower than PLC-negative (P < 0.001, respectively). PLC-positive results were rarely seen in pulmonary metastasectomies. PLC status was associated with the incidence of ipsilateral pleural recurrence and survival after metastasectomy. Cytologic examination of PLC should be considered in patients undergoing pulmonary metastasectomy.

Perineal ulcerations revealing Crohn's disease

The whole of the lesions associated with Crohn's disease affecting the anal canal, the skin of the perineum, the bottom-rectum and the recto vaginal septum are referred to as anoperineal lesions of Crohn's disease. The main types of primary lesions include ulcerations, suppurations and stenoses. Crohn's disease-like anoperineal lesions are often suspected in patients with severe inflammatory process, peri-anal skin thickening, œdematous marisques, multiple lesions and lesions extending above pectineal line. Fistulas usually originate from an ulceration or a scar rather than the crypts of the anal canal. Elementary lesions of Crohn's disease are rarely isolated and they are, in most cases, combined lesions. The presence of a stenosis of the anal canal or of the rectum is very often associated with an inflammatory and suppurative process. Anal ulcerations are complicated with suppuration in half of the cases. We report the case of 45-year old woman treated for autoimmune thyroiditis and vitiligo who presented with knife-cut painful perineal ulcerations. The patient reported episodes of diarrhea during interview. Histological examination of skin lesions showed epitheliogigantocellular granuloma without caseous necrosis and digestive exploration suggested Crohn's disease which was confirmed with histology.

Significance of hypoxia inducible factor-1 expression in liver metastasis of colorectal cancer.

464 Background: In colorectal liver metastasis (CRLM), the difference of tumor malignancy between primary and metastatic lesion has been elucidated. Hypoxia inducible factor-1 (HIF-1) represent tumor malignancy including angiogenesis, tumor growth and epithelial mesenchymal transition (EMT). The aim of this study was to investigate the difference of tumor malignancy between metastatic and primary lesion of CRLM and its impact for patient’s prognosis. Methods: In an initial curative hepatectomy of 75 cases in CRLM, HIF-1 expression in primary and metastatic lesion was evaluated by immunostaining method (Sigma-Aldrich, HPA 001275). Staining score was classified as follows, staining intensity (0: negative, 1: low, 2: medium, 3: high) and staining area (0: 0%, 1: -25%, 2: 26-50%, 3: ≥ 51%), and defined more than 4 points as positive expression. We evaluated the clinicopathological features according to HIF-1 expression. Results: Regarding HIF-1 expression of metastatic site, we divided into the positive group (n = 54) and the negative group (n = 21). There was no difference between metastatic HIF-1 expression and clinicopathological factors. Nevertheless, in overall survival, multivariate analysis revealed that HIF-1 positive in metastasis (HR: 2.850, p = 0.042) and poor differentiation type of primary lesion (HR: 20.873, p = 0.001) were independent prognostic factors. HIF-1 positive and negative patients were 3 year survival of 95.2% and 58.6%, respectively. Also, in disease free survival, HIF-1 positive in metastasis (HR: 2.608, p = 0.004), Synchronous (HR: 1.794, p = 0.049), Grade BC (HR: 2.145, p = 0.008), and lymph node metastasis in primary lesion (HR: 2.070, p = 0.016) was identified. Regarding HIF-1 expression of primary site, we divided into 51 cases of positive group and 24 cases of negative group. There was no relationship to clinicopathological factors as well as HIF-1 expression in metastasis, besides HIF-1 expression of prognosis was not associated. Conclusions: In CRLM, HIF-1 expression in the metastatic lesion is not associated with the primary lesion and may be useful as prognostic marker.

The impact of pre-resection endoscopic examination time on the rate of synchronous gastric neoplasms missed during endoscopic treatment.

Synchronous multiple gastric cancers have been reported in up to 14% of patients, but few efforts have been made to optimize techniques for detection of multiple neoplasms. We sought to evaluate whether the length of endoscopic examination before endoscopic resection affected the detection rates of synchronous gastric neoplasms. Among patients referred for endoscopic treatment of gastric neoplasms (n = 1,017), we enrolled those in whom at least one other synchronous neoplasm was found during pre-resection endoscopy or during the 1-year follow-up examination. Pre-resection endoscopic examination time was compared between those in whom multiple neoplasms were completely diagnosed before resection (complete examination group) and those in whom multiple neoplasms were not fully diagnosed prior to resection but were found during follow-up evaluation (incomplete examination group). Eighty-three patients were included in the study. We found no significant difference in any of the multiplicity, location, gross appearance, size, or resection type of primary lesion between the complete (n = 46) and incomplete examination (n = 37) groups. The complete examination group had a significantly longer examination time compared to the incomplete examination group (6.5 ± 2.4min vs. 3.8 ± 1.8min, respectively; P < 0.001). The synchronous lesions most commonly presented as the flat type (42/94 lesions, 45%) and were smaller than the primary lesions (10.0 ± 7.4mm vs. 14.3 ± 9.1mm, respectively; P = 0.002). Endoscopists should consider the possibility of synchronous gastric neoplasms and examine the whole stomach, thus allowing adequate time to reduce the risk of missed lesions.

Long-Term Survival after Radiofrequency Ablation of Lung Oligometastases from Five Types of Primary Lesions: A Retrospective Evaluation

PurposeTo conduct a retrospective evaluation of long-term survival after radiofrequency (RF) ablation for lung oligometastases from 5 types of primary lesions. Materials and MethodsThe study population consisted of 123 patients with lung oligometastases from colorectal cancer (CRC), non–small-cell lung cancer, hepatocellular carcinoma, esophageal cancer, and renal-cell carcinoma treated with RF ablation. Lung oligometastases were defined as 1–5 metastases confined to the lung while the primary cancer and other metastases were eradicated. Overall survival (OS) and recurrence-free survival (RFS) were estimated for the overall study population and for patients with each type of primary lesion. The OS and RFS rates were compared with those of the patients with any of the other four primary lesion types. Finally, various variables were analyzed to determine what factors influenced OS and RFS. ResultsThe median follow-up was 45.7 months, and the 5-year OS and RFS rates for all 123 patients were 62% and 25%, respectively. The OS time for patients with metastases from CRC was significantly longer (P = .042); it was significantly shorter (P = .022) in patients with metastases from esophageal cancer. Longer disease-free interval was significantly (P = .015) associated with better OS. There was no variable significantly associated with OS and RFS on multivariate analyses. ConclusionsData from this single-center study appear promising in terms of long-term survival after RF ablation of lung oligometastases from 5 primary lesions.

Proposal to Develop a Clinical Index for Classification of Skull Fractures (CISFRAC): Proposal for Personalized Management Score

Traumatic brain injury is a public health problem. There are several clinical classification systems for traumatic brain lesion. Skull fractures are a type of primary lesion of the cranial vault, whose classification system is simple but is not homogeneous. We propose an innovative index of severity of head injuries. This index will be especially important for neurosurgeons and researchers to plan management and compare the results.

Significance of Histologic Type of Primary Lesion and Metastatic Lymph Nodes as a Prognostic Factor in Stage III Colon Cancer

This study was designed to investigate whether the histologic types of the primary lesion and of metastatic lymph nodes in Stage III colon cancer are useful as prognostic factors. The usefulness of adjuvant chemotherapy in a randomized, controlled trial by using these prognostic factors as stratification criteria was also investigated. Stage III colon cancer patients were enrolled and were divided into two groups: Group W, in which the histologic type of both primary tumors and metastatic lymph nodes was well-differentiated adenocarcinoma; and Group U, in which the primary tumors and the metastatic lymph nodes were of any type other than well-differentiated. Group W patients were assigned to Treatment Arm A (surgery alone) or Arm B (surgery, then 1-hexylcarbamoyl-5-fluorouracil); and Group U patients, to Treatment Arm C (same as B), and Arm D (surgery + 1-hexylcarbamoyl-5-fluorouracil + mitomycin C). The Group W five-year survival rate was significantly superior to that in Group U (P = 0.0035). There was a better survival rate in Treatment Arm A than Arm B (P = 0.0321), but no difference between Treatment Arms C and D. In Stage III colon cancer, the prognosis of cases whose primary lesion and lymph node tissues are both well differentiated is extremely good. In such cases, it is possible for adjuvant chemotherapy to have a deleterious effect, and therefore, it is not recommended.

深頸部感染症６９例の臨床的検討

Deep neck infection (DNI) remains an emergent and life-threatening otolaryngologic disease. We examined 69 patients, 52 men and 17 women, with DNI, who were treated in our hospital between January 1995 and December 2004. The mean age of the patients with DNI was 50.0 years and the peak incidence was in the sixth decade. Twenty patients suffered from diabetes mellitus (DM). The primary DNI lesion was found in the tonsils in 34 cases, the oral cavity in 16 cases, and the pharynx in 12 cases, respectivelys. Among the 69 patients with DNI, the infection remained in the suprahyoid region in 31 cases, but it extended to the infrahyoid region in 33 cases and to the mediastinum in 5 cases. The titer of C-reacting protein (CRP) and the duration of admission were considered as parameters of the severity of DNI. CRP was significantly higher in elderly patients, in patients with DM, and in patients whose infection extended to the infrahyoid region and to the mediastinum, however, significant difference was not found between men and women, or among the types of primary DNI lesions. Moreover, the duration of admission was significantly longer in elderly patients, in patients with DM, and in patients with infrahyoid and mediastinal DNI, whereas no significant differences were found between men and women or among the types of primary lesions. Therefore, age, DM, and the extension of DNI are considered to be important factors which determining the severity of DNI.

Clinicopathologic and immunohistochemical studies of papillary thyroid microcarcinoma presenting with cervical lymphadenopathy.

Although most papillary thyroid microcarcinomas (PMCs) are of little clinical significance, patients with PMCs occasionally have an unfavorable outcome, especially when they present with bulky nodal metastasis or distant metastasis. We have attempted to identify "high-risk" PMCs by evaluating clinical, pathologic, and immunohistochemical prognostic factors. Among 190 patients with a PMC, 156 without clinically apparent nodal metastasis had a benign course. The remaining 34 patients, who presented with cervical lymphadenopathy of at least 1 cm, were studied. Three of the four patients who developed distant metastasis died of the disease, and the other died of local recurrence. All patients who developed distant metastasis or died of the disease had both nodal metastasis of at least 3 cm and a nonencapsulated type of primary lesion. All patients who developed distant metastasis showed both extracapsular extension of the metastatic lesions in lymph nodes and positive staining for transforming growth factor-beta3 (TGFbeta3) (a potent growth inhibitor) in the primary lesion. The Ki-67 (an indicator of cell proliferation) labeling indices in the primary and metastatic nodal lesions of patients who died of cancer were significantly higher than those of the others with nonfatal disease. None of the patients showed P53 (nuclear tumor-suppressor phosphoprotein) overexpression. In conclusion, patients with PMC who have both 3 cm or larger lymphadenopathy and a nonencapsulated type of primary lesion may be regarded as high-risk patients. Immunohistologic positivity for Ki-67 and TGFbeta3 in cancer cells is a potential indicator of aggressively malignant PMC.

DIAGNOSING ABILITY OF CT ON PERIAORTIC LYMPH NODE METASTASIS OF GASTRIC CANCER

One-hundred and two resected cases of advanced gastric cancer were subjected to a study of investigating whether preoperative CT could identify the presence of periaortic lymph node metastasis of gastric cancer. According to our diagnosis criteria, the correct diagnosing rate was 88.2%, specificity was 97.4%, and sensitivity was 60.0%. These figures allowed to consider that the diagnosing ability of CT was high. However, false-negative cases amounted to 10, or 11.8%. When the false-negative cases were reviewed by macroscopic and histological types of primary lesions, no significant difference in macroscopic type was found, but an increasing tendency in falsenegative results was observed in poorly differentiated type. From these findings preoperative CT was considered useful to know the presence of periaortic lymph node metastasis of gastric cancer. For probable false-negative result, our efforts to minimize it would mandatory by diagnosing based on histological type of the primary lesion.

T1 squamous cell carcinoma of the arytenoid.

Twenty-two cases of early squamous cell carcinoma of the arytenoid cartilage staged as T1 according to the 1983 American Joint Committee for Cancer Staging Classification system were reviewed. Eighteen percent of the patients showed no symptoms. In the remaining 82%, the main presenting symptom was pain in the form of sore throat, odynophagia, or otalgia. Radiotherapy and partial laryngeal surgery were the options retained for the treatment of the larynx. A "watch and wait" policy or preventive treatment of the ipsilateral jugulocarotid lymph nodes were the treatment options retained for the neck. Significant differences were noted in terms of local and nodal recurrence between the two programs. Results indicate that partial laryngeal surgery with total arytenoidectomy and preventive treatment of the neck appear to be advisable for this particular type of primary lesion.

An analysis of twenty years' experience with operations for carcinoma of the stomach.

We analyzed the records of 242 consecutive patients with adenocarcinoma of the stomach operated on for cure. We correlated survival with several factors, including the type of primary lesion, the operation performed, operative mortality, state of regional lymph nodes, margins of the resected specimens, and duration of preoperative symptoms. Overall survival at 5 years was only 18.6% and at 10 years was 7.1%. Patients with small malignant gastric ulcers, however, enjoyed increased survival at 5 years (53.8%) and at 10 years (15.0%). Overall operative mortality was 7.1%, but was 0% for patients with small malignant gastric ulcers. Even with large or high-lying lesions, radical operation can be accomplished with acceptable mortality and definite chance for cure. Thirteen of 45 five-year survivors had positive lymph nodes, and 7 of the 45 had positive margins of resection. Longer symptomatic preoperative periods, correlated positively with increased survival. Thirty patients with preoperative symptomatic periods exceeding 24 months had a 30.0% 5-year survival. Perhaps some of these lesions underwent malignant change in areas of symptomatic benign disease. We advocate early operation for gastric ulcers which do not heal promptly and stay healed.

Bone metastases from thyroid carcinoma.

Metastasis to bone from carcinoma of the thyroid was noted in 33 (12.7%) of 259 patients referred to the Nuclear Medicine Section of the University of California Medical Center, San Francisco from 1945 through 1964. Data are presented on these 33 patients in regard to (a) sex, (b) histologic type of primary lesion, (c) age of patient, (d) time between diagnosis and known bone metastasis, (e) bone sites involved and (f) survival from the time that metastasis was diagnosed.