Small Cell Undifferentiated Carcinoma Research Articles

Detailed report on the clinicopathological factors of patients with endometrial cancer in Japan: a JSOG gynecologic tumor registry-based study.

In this study, we collected data over 8 years (2012-2019) from the Japan Society of Obstetrics and Gynecology (JSOG) tumor registry to determine the status of endometrial cancer in Japan, and analyzed detailed clinicopathological factors. The JSOG maintains a tumor registry that gathers information on endometrial cancer treated at the JSOG-registered institutions. Data from the patients whose endometrial cancer treatment was initiated from 2012 to 2019 were analyzed retrospectively. A total of 82,969 patients with endometrial cancer underwent treatment from 2012 to 2019. Chemotherapy alone or in combination with hormonal therapy is more common among endometrial cancer patients under 40 years compared with those over 40 years. The number of patients with endometrial cancer, treated with laparoscopic or robot-assisted surgery was observed to have increased yearly. Small cell carcinomas and undifferentiated carcinomas were more likely to be diagnosed at an advanced stage. Lymphadenectomy was most commonly performed for stage IIIC2 disease, whereas positive peritoneal washing cytology was most common for stage IVB and serous carcinoma. Multi-year summary reports provided detailed clinicopathological information regarding endometrial cancer that could not be obtained in a single year. These reports were useful in understanding treatment strategies and trends over time based on age, histology, and stage.

Study on the relationship between the pathological type of lung cancer caused by coke oven discharge and the contact type and exposure time

Objective: To study the pathological types of lung cancer caused by coke oven emissions and analyze the correlation between different exposure levels. Methods: In October 2020, the relevant data of 86 confirmed cases of lung cancer caused by coke oven emissions (including basic information of patients, relevant occupational exposure and clinical data) were collected, The workers were grouped according to the different COEs concentrations in their posts: workers in auxiliary posts were taken as the low exposure group (11 persons) , The workers at coke side and furnace bottom are the medium exposure group (14 persons) , and the workers at furnace top are the high exposure group (61 persons) , and the correlation between pathological types of lung cancer and different exposure levels was analyzed. Results: There was no significant difference in age and length of service among the groups (P>0.05) ; The number of lung cancer cases and pathological types among workers in each group were statistically significant (P=0.044) . After adjusting for interference factors, the number of undifferentiated cancers (mainly small cell lung cancer) increased with the increase of exposure level, with a statistically significant difference (P=0.001) . The incidence of lung cancer increased gradually with the length of service, and the incidence rate of lung cancer among workers of different working ages was statistically significant (P<0.05) . Conclusion: Undifferentiated small cell carcinoma is the most common pathological type of lung cancer caused by coke oven emissions, and the incidence of lung cancer tends to increase with the length of service.

CT-Guided FNAC of Lung Lesions and Cytological Sub-Classification of Bronchogenic Carcinoma of 246 cases at a Tertiary Care Hospital

Background: CT-guided fine needle aspiration cytology (FNAC) is a useful tool for evaluating lung nodules or masses. In view of the relative paucity of published studies regionally, this study was undertaken in the Department of Pathology, Enam Medical College &amp; Hospital to see the use of the technique. Materials and Methods: Two forty six CT guided lung FNACs were performed during January 2017 to December 2018 and cytological diagnoses were made. Reported results and relevant data were recorded in the data sheet and then analyzed by standard statistical method. Results: Total number of cases were 246. Adequate samples were obtained in 228 (92.68%) cases, among the adequate samples 135 (59.41%) were malignant, and 93 (40.49%) were benign or nonmalignant lesions. Among the benign lesions, lung abscess (36;38.70%) was the most common followed by pulmonary TB (27;29.03%). Adenocarcinoma (54;40%) was the most common type of bronchogenic carcinoma followed by squamous cell carcinoma (51;37.78%), small cell carcinoma (21;15.56%), NHL (6;4.44%) and large cell undifferentiated carcinoma (3;2.22%). In male persons, squamous cell carcinoma (42.85%) was the most common type of bronchogenic carcinoma, followed by adenocarcinoma (34.29%). In female, adenocarcinoma was the most common type (18;60%) of bronchogenic carcinoma, followed by squamous cell carcinoma (6;20%). Conclusion: FNAC is a safe method for the evaluation of lung nodules and it enables sub-classification of bronchogenic carcinoma in the vast majority of cases. It is also useful for the diagnosis of tuberculous pulmonary nodules. J Enam Med Col 2020; 10(3): 169-173

Myeloid sarcoma: an uncommon presentation of myeloid neoplasms; a case series of 4 rare cases reported in a tertiary care institute.

ABSTRACTMyeloid sarcoma (MS) is a rare extramedullary neoplasm of myeloid cells, which can arise before, concurrently with, or following hematolymphoid malignancies. We report 04 such cases of MS, diagnosed in this institute over a period of 6 years, during various phases of their respective myeloid neoplasms/leukemias. These cases include MS occurring as a relapse of AML (Case 1), MS occurring as an initial presentation of CML (Case 2), MS occurring during ongoing chemotherapy in APML (Case 3), and MS presenting as a progression of MDS to AML (Case 4). In the absence of relevant clinical history and unemployment of appropriate immunohistochemical (IHC) studies, these cases have a high risk of being frequently misdiagnosed either as Non-Hodgkin’s Lymphoma (NHL) or small round cell tumors or undifferentiated carcinomas, which may further delay their management, making an already bad prognosis worse. This case series has been designed to throw light on the varied presentation of MS and the lineage differentiation of its neoplastic cells through the application of relevant IHC markers along with their clinical correlation.

Prognostic Factors and Survival of Patients with Primitive Lung Cancer in Douala and Yaounde

Background: Primary lung cancer (PLC) represents a real public health problem. It is one of the main types of cancer in the world in terms of incidence and also the main cause of death from cancer. In Africa primary bronchial cancer appears to be a rare entity. Objective: To study the prognostic factors and survival of patients with PLC in Douala and Yaounde. Patients and method: We performed an analytical, longitudinal (retrospective) study over a period from January 2010 to December 2019 including all records of patients in whom the diagnosis of PBC was histologically proven. The data collected were recorded and analyzed by SPSS version 25. Survival was determined by the Kaplan Meier method and the search for prognostic factors was carried out using the Cox proportional hazards model. A value less than 0.05 were considered significant. Results: A total of 94 patients were included in the study. The sex ratio was 1.24. The median age at cancer diagnosis was 62 years old. More than half of the population (61 cases; 64.9%) resided in urban areas; 51 (54.3%) were exposed to tobacco, 14 (14.9%) had occupational exposure and 88.1% of women were exposed to biomass smoke. The average smoking index was 29.24 ± 26.27 pack-years and the average duration of exposure was 30.17 ± 4.36 years. The histological types encountered were in order of decreasing frequency: adenocarcinoma (48 cases; 51.1%), squamous cell carcinoma (33 cases; 35.1%), small cell lung cancer (8 cases; 8.5 %) and undifferentiated large cell carcinoma (5 cases 5.3%); in the majority of cases the cancer was diagnosed at stage IV for non-small cell lung cancer (62 out of 86 cases) and at the localized stage for small cell lung cancer (6 out of 8). Of the 94 cases collected, 56 (59.6%) had adhered to anti-tumor treatment. The median overall survival was 4 months with 95% CI [1.52-6.79]. The overall survival rates at 6 months, 12 months, 24 months and 36 months were 50%, 17.4%; 12% and 8.7% respectively. The poor prognostic factor found was: The presence of brain metastases (HR: 80.01; p-value: 0.004). Conclusions: Survival was very low with a median overall survival of 4 months. The overall survival rates at 6 months, 12 months, 24 months and 36 months were 50%, 17.4%, 12% and 8.7% respectively. The poor prognostic factor found was: the presence of brain metastases.

Abstract 2337: Pan-cancer analysis of sex differences and their associations with ancestry and genomic biomarkers in a large comprehensive genomic profiling dataset

Abstract Background: Sex differences in the prevalence of cancer subtypes can inform patient screening, diagnosis, and treatment, but for many disease ontologies (DO), sex disparities have not been fully explored, especially with regards to ancestral and genomic subsets. Furthermore, existing data and reports may lack centralized expert pathology review or comprehensive genomic profiling (CGP) that can enable better characterization of biological and environmental etiologies. Design: The cohort consisted of 276,696 de-identified patient cancers, 45.7% male and 54.3% female, submitted to Foundation Medicine for CGP. Each patient was assigned an ancestry of either African, admixed American, East Asian, European, or South Asian, using a SNP-based machine learning methodology (J. Newberg et al., AACR 2019). Within the dataset 321 DOs originate at a known tissue site of origin common to both sexes. Binomial testing for significance of expected (50%) versus observed ratio of the sexes was performed for each DO, with correction for multiple hypothesis testing. For each DO, Fisher's exact tests were used to identify associations between ancestry and sex and associations between sex and gene-level genomic biomarkers (including the detection of a viral-derived gene) with ≥ 1% prevalence within the DO. Results: Of the 321 DOs, significant sex differences (corrected p-value ≤ 0.05) were seen in 106 DOs, of which 84 were significantly skewed towards males and 22 towards females. Among all DO and ancestry combinations, 14 DO-ancestry pairings showed a statistically significant (corrected p-value ≤ 0.05) skew towards one sex when compared to all other patients in the disease group. Notably, there was an enrichment of lung small cell undifferentiated carcinoma in East Asian men (OR = 2.75, corrected p-value = 0.027) and esophagus squamous cell carcinoma in East Asian men (OR = 2.55, corrected p-value = 0.028). 33 DOs exhibited sex biases in gene alterations (OR ≥ 2 and corrected p ≤ 0.05). Of particular note are a few genes that were highly enriched in a single sex across multiple distinct disease groups: CDKN2A/CDKN2B (bladder, anus, CNS non-glioma, and kidney diseases), TERT (hepato-biliary, kidney, and anus diseases), and ASXL1 (myelomas and plasma neoplasms) for males; ATRX in both lung small cell undifferentiated carcinoma and colon adenocarcinoma for females. Conclusions: Using FMI's large cancer cohort, significant differences in the occurrences of the sexes were observed in various DOs and have the potential to inform our understanding of different disease etiologies and possible courses of therapy. Further analyses incorporating covariates may help to explain the source of these imbalances. Citation Format: Benjamin G. Kaplan, Peter Halmos, Justin Y. Newberg, Ethan S. Sokol, Meagan Montesion, Lee A. Albacker, Vincent Miller, Jeff S. Ross, Garrett M. Frampton, Jonathon K. Killian. Pan-cancer analysis of sex differences and their associations with ancestry and genomic biomarkers in a large comprehensive genomic profiling dataset [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2337.

Polymetastatic highly aggressive Small Cell Undifferentiated Neuroendocrine Carcinoma of Ascending Colon

Polymetastatic highly aggressive Small Cell Undifferentiated Neuroendocrine Carcinoma of Ascending Colon

Correlation analysis of expression and prognosis of TTF-1 and CD44v6 in undifferentiated lung carcinoma.

The correlation between expression and prognosis of thyroid transcription factor-1 (TTF-1) and CD44v6 in undifferentiated lung carcinoma was investigated. There were 116 cases with large cell undifferentiated carcinoma in group A, 120 cases with small cell undifferentiated carcinoma in group B and 80 normal individuals from the same period in group C. The expression levels of TTF-1 and CD44v6 in the serum of group A, B and C and the cancer tissues and adjacent tissues of group A, B and C were detected using enzyme-linked immunosorbent assay (ELISA), and the levels in each group were compared. Pearsons test was used to analyze the correlation between TTF-1 and CD44v6 expression in serum of group A and group B and cancer tissues. Patients were divided into the survival group and the deceased group according to their 5-year survival. Multivariate logistic regression was applied to analyze the risk factors of mortality, and receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of TTF-1 and CD44v6. The best cut-off values of TTF-1 and CD44v6 were divided into the high and low expression groups to observe the 5-year mortality of patients and the Kaplan-Meier (K-M) survival curve was drawn. Multivariate logistic regression was used to analyze the risk factors of mortality. The expression of CD44v6 in the serum of group A and group B was higher than that in group C, and that of group B was higher than that in group A (P<0.05). The expression of TTF-1 in serum of group A and group B was higher than that of group C, and the expression of TTF-1 in group A was higher than that in group B (P<0.05). The expression of TTF-1 and CD44v6 in group A and group B were significantly higher than those in adjacent tissues (P<0.05). The expression of TTF-1 in group A was higher than that in group B (P<0.05), and that of CD44v6 was lower than that in group B (P<0.05). The 5-year survival of patients showed that 209 patients died and 27 survived at 5 years; the survival rate was 11.44%. The course of disease, TNM stage, TTF-1 and CD44v6 were independent mortality factors for undifferentiated lung cancer.

ACQUIRED ICHTHYOSIS: A RARE PRESENTATION OF LUNG CANCER

SESSION TITLE: Lung Cancer 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Acquired ichthyosis (AI) is a skin condition characterized by dry, rough and scaling skin, often described as “fish scale skin”. AI can be either congenital or acquired and can be associated with malignancies, lupus, chronic liver disease, kidney disease, malnutrition, AIDS and certain medications. Cancers associated with AI include but are not limited to: Hodgkin's lymphoma, lung and breast adenocarcinoma. Although AI is associated with underlying malignancy, this skin finding is not always recognized and is often treated independently and thus, a diagnostic evaluation for an underlying malignancy is not always performed. CASE PRESENTATION: A 54-year-old Caucasian male, who is an 80 pack year smoker and type 2 diabetic, presented to the ER with dizziness and syncope. He reported shoulder pain from falling, anorexia and unintentional weight loss. He had no shortness of breath, cough, hemoptysis, night sweats or fatigue. On exam, he was cachectic with severe dry, rough scaling skin especially to the palms and plantar surfaces (Figure1&2). He reported that this skin finding had been present for 2 months. CT of the head showed: a right frontal mass and a second heterogeneous mass within the cerebellum. So, a chest x-ray was obtained to evaluate for a possible primary neoplasm and showed a left peri-hilar mass. CT chest was subsequently completed and showed a left lower lobe mass with mediastinal lymphadenopathy, which CT guided biopsy later confirmed as small cell undifferentiated carcinoma. Podiatry was consulted for his skin findings which were believed to be paraneoplastic acquired ichthyosis and keratolytic therapy with 40% urea cream was ordered. Oncology was consulted and palliative radiation for brain metastasis and chemotherapy were started. Unfortunately, the patient died 4 months after his diagnosis was made. DISCUSSION: Lung cancer is associated with multiple paraneoplastic phenomena, including AI. Early recognition of cancer is very important especially in fast growing small cell lung cancers. As shown in this case, AI presented 2 months before the diagnosis of cancer was confirmed. This diagnosis could have been made earlier if a thorough evaluation by a dermatologist or a podiatrist was obtained. Furthermore review of the current literature and case reports on AI are very limited. Therefore, a high index of suspicion in the appropriate clinical scenario is warranted and can make a difference in the early diagnosis and treatment of associated malignancy. Unfortunately, for our patient his diagnosis of AI was made simultaneously with his diagnosis of metastatic lung cancer and so he lost an opportunity for earlier diagnosis. CONCLUSIONS: Paraneoplastic syndromes might be the first red flag observed with the presentation of cancer. Therefore, it is crucial that rare manifestation such as AI be recognized and investigated to rule underlying malignancy. Reference #1: Okulicz JF, Schwartz RA. Hereditary and acquired ichthyosis vulgaris. Int J Dermatol 2003; 42:95–8. Reference #2: Penven K, Verneuil L, Dompmartin A, Louvet S, Leroy D. An association of paraneoplastic syndromes in a patient. Ann Dermatol Venereol. 2002; 129(8-9):1042-5. Reference #3: Patel N, Spencer LA, English JC, Zirwas MJ. Acquired ichthyosis. J Am Acad Dermatol 2006; 55:647. DISCLOSURES: No relevant relationships by Haytham Adada, source=Web Response No relevant relationships by Mahmoud Amarna, source=Web Response No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by AHMAD HAMMAD, source=Web Response No relevant relationships by Leisa Walker, source=Web Response

Laryngeal sarcomas: A case series of 5 cases

Primary sarcomas of the larynx are rare and miscellaneous. The most common is chondrosarcoma. Other sarcomas are very rare. Sarcomas can have heterogeneous morphologic features of spindle, small round, epithelioid, pleomorphic and giant cells. Laryngeal sarcomas may mimic carcinomas, lymphomas, small cell carcinoma, mesothelioma and melanoma. This imposes diagnostic challenges for unfamiliar pathologists particularly in small laryngeal biopsies. Our aim was to study the different types of sarcomas that can involve the larynx in our institution, to investigate their diagnostic challenges and potential pitfalls and to find helpful histologic clues to avoid misinterpretation and missed diagnosis. We performed a retrospective review study over 13 years. We retrieved 5 cases of laryngeal sarcomas. They included Kaposi sarcoma, low-grade chondrosarcoma, epithelioid angiosarcoma, polypoid leiomyosarcoma and small cell osteosarcoma. The age range was between 32 and 74 years with an average age of 52 years. The male to female ratio was 3:2. The Kaposi sarcoma and chondrosarcoma were correctly diagnosed. The angiosarcoma was initially missed as recurrent carcinoma. The leiomyosarcoma was initially inferred as polypoid sarcomatoid squamous cell carcinoma. The small cell osteosarcoma initiated the differential diagnosis of high-grade lymphoma, small cell carcinoma, undifferentiated carcinoma, Ewing sarcoma and rhabdomyosarcoma. An implementation of a panel of immunohistochemical markers guided by certain histomorphologic clues was helpful to make the correct diagnosis. Pathologists should be aware of the morphologic spectrum and different growth patterns of laryngeal sarcomas. Immunohistochemistry studies are essential. Correct diagnosis, classification and grading of laryngeal sarcomas are clinically important for the prognosis and appropriate management of patients.

Temporal bone histopathology of furosemide ototoxicity.

ObjectivesTo describe the human temporal bone pathology in two patients who incurred furosemide induced ototoxicity.Patients1) A 46‐year‐old woman in acute liver and renal failure treated with high doses of furosemide for anasarca who developed a rapidly progressive severe‐to‐profound asymmetric sensorineural hearing loss. 2) A 65‐year‐old woman with undifferentiated small cell carcinoma of the lung who received intravenous furosemide 1 day prior to death for pulmonary edema.InterventionsRemoval of temporal bones, histologic processing, and light microscopy of temporal bones.Main Outcome MeasuresTemporal bone histopathology and correlation with clinical and audiometric data.ResultsAll three temporal bones demonstrated edema and cystic changes in the stria vascularis. In the first case the furosemide exposure was associated with hearing loss and the pathological changes were more extensive including cystic changes in the Hensen's cells, collapse of Reissner's membrane and the tectorial membrane and diffuse loss of inner and outer hair cells with only modest reduction in the spiral ganglion cell population. In the second case, without attributable hearing loss, there was only modest reduction in hair cell and spiral ganglion cell counts. Pathological changes were not observed in the ampullae of the semicircular canals or epithelium of the saccular or utricular maculae in either case.ConclusionsThe temporal bone pathologic correlate for furosemide‐induced ototoxicity is edema and cystic degeneration of the stria vascularis. The degree of degenerative change appears dose‐dependent. We infer that pathological changes may occur in the absence of a measurable immediate clinical effect.Level of EvidenceNA.

Analysis of survival-and prognosis-related factors of brain metastasis from esophageal cancer

Objective To explore the incidence of brain metastases from esophageal cancer, survival-related factors after brain metastases, and the result of different treatment methods. Methods From January 2000 to October 2016 treated 11 338 cases of esophageal cancer patients, 84 cases of brain metastases, were collected with complete clinical data. Results Eighty four cases of patients with brain metastases included esophageal squamous carcinoma in 74 cases, adenocarcinoma in 6 cases, and small cell undifferentiated carcinoma 4 cases; single brain metastases in 19 cases, 65 cases of multiple brain metastases included 59 cases with brain metastasis symptoms, 58 with extracranial metastases, primary tumors and brain metastases interval time less than 6 months in 31 cases, 24 cases of 6-12, 16 cases for 12-24 months. Prognostic logrank univariate analysis of survival rate found 24-36 months survival for 13 patients. All patients were followed for a median of 19.31 months after brain metastases, the median survival time was 5.43 months. Conclusions About 0.7% of brain metastases from esophageal cancer occurs. Esophageal carcinoma metastatic to the brain: There was no extracranial metastasis, recursive partitioning analysis classification (RPA), Karnofsky (KPS) score, brain metastases different treatment methods is a poor prognostic factor for esophageal cancer brain metastasis. Key words: Stomach neoplasms/ME/DI; Brain neoplasms/SC/EP; Survival rate; Prognosis

Small Cell Prostate Cancer: A Potential Prophylactic Treatment for a Rare and Aggressive Tumor

Small cell prostate cancer (SCPC) is a rare pathology, with aggressive behaviour and a high tendency to metastasize. We present a case report of a 62-year-old male who underwent prostatectomy due to a rising prostate specific antigen (PSA) value and a positive biopsy for prostate cancer. Pathology results revealed a poorly differentiated adenocarcinoma of the prostate gland, Gleason score of 4+5=9, with extensive areas of undifferentiated small cell carcinoma. Despite aggressive adjuvant chemotherapy, hormone deprivation treatment and radiotherapy, the patient developed a castration-resistant prostate cancer with oligometastatic disease, diagnosed by choline positron emission tomography - computerized tomography (PET-CT). We discuss the clinical aspects correlated with this unusual subgroup of prostate cancer, adding a literature review to talk over potential prophylactic treatments in order to prevent central nervous system lesions, or potential discontinuation of hormone deprivation treatment if poor response is achieved.

High Secretion of Beta-HCG by Squamous Cell Carcinoma of the Lung in a Postmenopausal Female

With the development of research in tumor, some of them have been found to secrete beta-human chorionic gonadotropin (β-HCG) ectopically and lung cancer is one of them. Generally, lung cancer secreting β-HCG is mostly undifferentiated small cell carcinoma. Here, we report a rare case of squamous cell lung cancer secreting high level of β-HCG in a postmenopausal female. The tumor secreted β-HCG, measuring 16,500 mIU/ml. The patient presented with hemoptysis and postmenopausal bleeding. Pathological examination of CT-guided biopsy and investigations could not tell whether it was primary squamous cell lung cancer or choriocarcinoma with lung metastasis, to be responsible for the high level of β-HCG. The chemotherapy in the early stage seemed to be effective, but not good in the late stage. Then she underwent a right pulmonary middle lobectomy and the pathological examination finally confirmed the diagnosis of poorly differentiated squamous cell carcinoma. The auxiliary chemotherapy made a decreased β-HCG. Only a few reports of squamous cell lung cancer secreting that high level of β-HCG can be found in the literature.

Diagnostic value of bronchoalveolar lavage fluid and serum tumor markers for lung cancer.

To analyze the changes of bronchoalveolar lavage fluid (BALF) and serum tumor markers in lung cancer. Fifty patients with lung cancer (study group) and 50 cases with benign lung lesions (control group) were selected from May, 2010 to May, 2013. The observation group included squamous cell carcinoma subgroup (n = 25), adenocarcinoma subgroup (n = 19), and small cell undifferentiated carcinoma subgroup (n = 6). The carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and cytokeratin 19 fragment (CYFRA21-1) concentration were compared; and the comparisons among subgroups were also performed. Three kinds of tumor markers in BALF and serum of the observation group were higher than that of the control group. NSE concentration of small.cell lung cancer was the highest, CYFRA21.1 concentration was highest in the squamous cell carcinoma, and CEA concentration was highest in the adenocarcinoma group; the former increased more significantly. BALF and serum NSE, CEA, and CYFRA21.1 elevated in lung cancer, which had prompt value for pathology, especially significant for BALF.

The Association Between Alcohol Consumption and Lung Carcinoma by Histological Subtype.

Alcohol is a carcinogen suspected of increasing lung cancer risk. Therefore, we prospectively evaluated the relationship between alcohol consumption and lung carcinoma in 492,902 persons from the National Institutes of Health-AARP Diet and Health Study. We used Cox models to calculate hazard ratios and 95% confidence intervals, adjusting for tobacco smoking and other potential confounders. Between 1995/1996 and December 31, 2006, there were 10,227 incident cases of lung carcinoma, classified as adenocarcinoma (n = 4,036), squamous cell carcinoma (n = 1,998), small cell carcinoma (n = 1,524), undifferentiated carcinoma (n = 559), and other (n = 2,110). Compared with nondrinking, alcohol consumption was associated with a modest nonlinear reduction in total lung carcinoma risk at lower levels of consumption (for 0.5-<1 drink/day, HR = 0.89, 95% confidence interval: 0.82, 0.96) but a modest increase in risk in the highest category (for ≥7 drinks/day, HR = 1.11, 95% confidence interval: 1.00, 1.24). Regarding histological type, alcohol was associated with a nonlinear reduction in squamous cell carcinoma that became attenuated as consumption increased and a modest increase in adenocarcinoma among heavier drinkers. Cubic spline models confirmed these findings. Our data suggest that the relationship between alcohol consumption and lung carcinoma differs by histological subtype.

Surgical Resection of Rare Esophageal Cancers

Although surgical resection of adenocarcinoma or squamous cell carcinoma of the esophagus is standard practice, the treatment strategy for other malignant rare esophageal cancers is still under debate. The aim of this study was to examine the treatment of rare malignant esophageal cancers and to evaluate the survival of these patients. A retrospective review of all esophagectomies performed at Mayo Clinic from 1980 to 2014 (approximately 4,000 cases) identified 24 patients with histologic features other than adenocarcinoma or squamous cell carcinoma. Their medical records were reviewed for demographics, presenting symptoms, evaluation, surgical management, pathologic features, and short-term and long-term outcome. Pathologic identifications included small cell carcinoma, lymphoma, and undifferentiated carcinoma in 4 (16.7%) patients each and neuroendocrine, melanoma, leiomyosarcoma, sarcomatoid, sarcoma, and gastrointestinal stromal tumor in 2 (8.3%) patients each. The most common presenting symptoms included dysphasia in 91.7% patients (22/24), pain in 75.0% (18/24), and weight loss in 62.5% (15/24). Preoperative evaluation included barium swallow in 91.7% (22/24), computed tomography in 91.7% (22/24), positron emission tomography in 54.2% (13/24), esophagogastroduodenoscopy in 100% (24/24), and endoscopic ultrasonography in 29.2% (7/24) patients. The location of the tumor was at the gastroesophageal junction in 41.7% (10/24). There was no operative mortality, and 13 patients (54.16%) had at least one postoperative adverse event. The 1-year survival after esophagectomy was 69.7%, the 5-year survival was 42.7%, and the 10-year survival was 37.4%. Esophageal cancer with pathologic features other than squamous cell carcinoma or adenocarcinoma is rare. Esophagectomy for rare types of malignant esophageal cancers should be considered part of the effective treatment paradigm.

Histological features of tumor-bearing tissues formed by human fibroblasts after reprograming by Piwil2

To observe the histological features of tumor-bearing tissues formed by human fibroblasts after reprograming by spermatogonial stem cell self-renewal key regulating gene Piwil2 (Piwil2-iCSC). Piwil2-iCSC tumor spheroids-like colonies were selected for tumor formation assay in four nude mice. Pathological features of Piwil2-iCSC tumors were observed by histology. Stem cell markers and common triploblastic markers were detected by reverse transcriptase-polymerase chain reaction (RT-PCR) assay and immunohistochemistry. Germ cell tumor markers were detected by immunohistochemical examination. Two weeks after inoculation, subcutaneous tumors were formed in all the four nude mice with a tumor formation rate of 100%. In the Piwil2-iCSC tumor tissues, Piwil2-GFP(+) cells showed high-density nuclear expression and were widely observed in DAPI-stained sections. Numerous mitotic figure of the neoplastic cells were seen (>10 cells/field of vision under high magnification) in HE-stained sections. Enlarged abnormal cell nuclei were observed. RT-PCR assay showed that Piwil2-iCSC tumors still expressed Piwil2 and some self-renewal and pluripotent markers of stem cells and some markers of triploblastic differentiation. Immunohistochemical staining showed that the tumors expressed stem cell markers, triploblastic markers and germ cell tumor markers AFP and HCG. Piwil2-iCSC tumors are probably undifferentiated embryonic small cell carcinoma, most likely to be immature teratoma, mixed with yolk sac tumor and choriocarcinoma components. It can be used as a useful model for the research of origin or genesis mechanism of cancer stem cells and the treatment of relevant tumors.

Observer variability in the histopathologic diagnosis of lung cancer.

The occurrence of intraobserver and interobserver variability in classifying the cellular types of lung cancer was studied in five experienced pathologists, each of whom gave two independent readings of 50 different specimens. Arbitrary rating scales were established to grade the types of discrepancy and other disagreements. With 15 different cellular names available for citation, only one of the 50 slides received readings that were in total agreement for all aspects of the ten interpretations. With the variety of designations reduced to five major histologic groups, the percentages of disagreements of the observers from the consensus reading were 2 per cent to 5 per cent for well differentiated adenocarcinomas and epidermoid carcinomas, 23 per cent to 25 per cent for undifferentiated large cell and small cell carcinomas, and 40 per cent to 42 per cent for poorly differentiated epidermoid and adenocarcinomas. Significant disagreements between the first and second readings of the same slide by the same pa...

Ovarian cancer transformation from adenocarcinoma to undifferentiated small cell carcinoma: A case report

The ovaries contain cells that have the capacity for regeneration and cancer stem cells (CSC) that are capable of differentiating aberrantly from the homeostatic controls. The histology of ovarian cancer does not usually change in a patient. However, CSCs are the origin of a number of tumors. CSCs are known to exist in ovarian carcinomas and the expression of CD44, c-Kit and CD133 has been identified in such carcinomas. This study presents the case of a patient diagnosed with ovarian cancer with an abdominal mass who underwent surgery, eight cycles of gemcitabine-paclitaxel chemotherapy and irradiation. Pathological examination indicated a transformation from adenocarcinoma to undifferentiated small cell carcinoma. The expression of CD133 changed from negative to positive in ovarian carcinomas. The present case indicates that any histological changes observed in ovarian neoplasms originate from neoplastic stem cells. In addition, this case demonstrates the importance of repeatedly assessing therapy by tumor biopsy throughout the course of ovarian cancer treatment.