WHO Histological Classification Research Articles

Unusual Histology in Mesothelioma: A Report of Two Cases with a Brief Review.

Mesothelioma is often difficult to diagnose due to its rarity and its unusual histopathological features that could lend to diagnostic pitfalls and misdiagnosis. The WHO histological classification of pleural tumors in 2021 recommended a pathologic grading system for malignant pleural mesothelioma. Architectural aspects and cytological features, with nuclear grading, bent on a neoplastic score with fundamental prognostic and diagnostic value. Unusual features must be correctly assigned in the grading system to avoid misdiagnosis, especially toward metastatic lesions or reactive pleural processes. In this paper, we present two cases as examples of unusual morphological and architectural features with a brief literature review.

Thymectomy with angioplasty through a thoracoscopic subxiphoid approach with double elevation of the sternum in Masaoka stage III thymoma.

Thymectomy with angioplasty through a thoracoscopic subxiphoid approach with double elevation of the sternum in Masaoka stage III thymoma.

Significance of stratifin in early progression of lung adenocarcinoma and its potential therapeutic relevance.

Lung cancer is the most common cause of global cancer-related mortality, and the main histological type is adenocarcinoma, accounting for 50% of non-small cell lung cancer. In 2015, the World Health Organization (WHO) histological classification defined the concepts of "adenocarcinoma in situ" (AIS) and "minimally invasive adenocarcinoma" (MIA), which are considered to be adenocarcinomas at a very early stage. Although AIS and MIA have a very favorable outcome, once they progress to early but invasive adenocarcinoma (eIA), they can sometimes have a fatal outcome. We previously compared the expression profiles of eIA and AIS, and identified stratifin (SFN; 14-3-3 sigma) as a protein showing significantly higher expression in eIA than in AIS. Expression of SFN is controlled epigenetically by DNA demethylation, and its overexpression is significantly correlated with poorer outcome. In vitro and in vivo analyses have shown that SFN facilitates early progression of adenocarcinoma by enhancing cell proliferation. This review summarizes genetic and epigenetic abnormalities that can occur in early-stage lung adenocarcinoma and introduces recent findings regarding the biological significance of SFN overexpression during the course of lung adenocarcinoma progression. Therapeutic strategies for targeting SFN are also discussed.

Clinicogenomic characterization of metastatic thymic epithelial tumors.

8579 Background: Thymic epithelial tumors (TET) are one of the rarest adult malignancies. Overall, patients have favorable survival outcomes, however a small subset develop metastatic disease. Genomic characterization of this very rare, clinically aggressive TET subset is lacking. Herein, we evaluated the clinical and genomic characteristics of metastatic TET (mTET) compared to a large cohort (n = 117) of primary TET (pTET) from The Cancer Genome Atlas (TCGA). Methods: From 2015 to 2020, 52 pts with mTET underwent clinical CLIA-based sequencing using either whole-exome (n = 35), panel-based testing (n = 13) and/or liquid biopsy (n = 22). The specimen was taken from a metastatic organ (n = 34) or relapsed primary mediastinal mass (n = 14); 4 pts had liquid bx only. Data on pTET was derived from the TCGA. Kaplan-Meier and log-rank test was used for assessment of PFS, OS. Results: The median age was 56 yrs in mTET (range 32-74) vs. 60 yrs (range 17-84) in TCGA data. The M/F (%) was 40/60 in mTET and 48/52 in TCGA, respectively. Of note, 13 mTET pts had other types of cancer prior or concurrent with TET diagnosis (4-breast, 2-bladder, 5-other) in which radiotherapy (n = 4) and/or chemotherapy (n = 3) was administered prior to TET diagnosis. In our cohort, 19 pts had stage IVA and 33 pts had stage IVB (most common metastatic site was liver in 17 pts). WHO histologic classification was: A = 1, A/B = 3, B1 = 4, B2 = 10, B3 = 12, TC = 18, TC with neuroendocrine feature = 3, and lymphoepithelial carcinoma = 1. WHO B3 and TC histologies were more common in our cohort of mTET than in the TCGA cohort (63% (33/52) vs. 17% (20/117), respectively). Pts with TC had worse mOS compare to thymoma (109m vs. 163m, HR = 2.78, P = 0.04). The most common genomic alteration in mTET was TP53 (n = 17, 33%) compared to 3% in TCGA. This was followed by CDKN2A (n = 5, 10%), PIK3CA (n = 4, 8%), CDKN2B (n = 3, 6%) and NF1 (n = 3, 6%). All TP53 missense mut functionality was analyzed with polyphen-2 software and 91.6% (22/24) had 98-100% damaging probability. 70% of pts that harbored TP53 muts were TC (41%) or B3 (29%) histology. Clinically actionable genomic alterations targetable with available or investigational agents (e.g. high TMB; gain-of-function mutations in PIK3CA, CDK4, and mTOR; loss-of-function mutations in NF1) were seen in 23% (12/52) of pts. Conclusions: Patients with mTET are associated with more aggressive WHO histology (B3 and TC). Greater frequency of TP53 mutations are observed in mTET compared to pTET. Clinically actionable genomic alterations are frequently seen in mTET suggesting value in the routine sequencing of these patients.

Competing-risks nomograms for predicting cause-specific mortality in parotid-gland carcinoma: A population-based analysis.

IntroductionParotid‐gland carcinoma (PGC) is a relatively rare tumor that comprises a group of heterogeneous histologic subtypes. We used the Surveillance, Epidemiology, and End Results (SEER) program database to apply a competing‐risks analysis to PGC patients, and then established and validated predictive nomograms for PGC.MethodsSpecific screening criteria were applied to identify PGC patients and extract their clinical and other characteristics from the SEER database. We used the cumulative incidence function to estimate the cumulative incidence rates of PGC‐specific death (GCD) and other cause‐specific death (OCD), and tested for differences between groups using Gray's test. We then identified independent prognostic factors by applying the Fine–Gray proportional subdistribution hazard approach, and constructed predictive nomograms based on the results. Calibration curves and the concordance index (C‐index) were employed to validate the nomograms.ResultsWe finally identified 4,075 eligible PGC patients who had been added to the SEER database from 2004 to 2015. Their 1‐, 3‐, and 5‐year cumulative incidence rates of GCD were 10.1%, 21.6%, and 25.7%, respectively, while those of OCD were 2.9%, 6.6%, and 9.0%. Age, race, World Health Organization histologic risk classification, differentiation grade, American Joint Committee on Cancer (AJCC) T stage, AJCC N stage, AJCC M stage, and RS (radiotherapy and surgery status) were independent predictors of GCD, while those of OCD were age, sex, marital status, AJCC T stage, AJCC M stage, and RS. These factors were integrated for constructing predictive nomograms. The results for calibration curves and the C‐index suggested that the nomograms were well calibrated and had good discrimination ability.ConclusionWe have used the SEER database to establish—to the best of our knowledge—the first competing‐risks nomograms for predicting the 1‐, 3‐, and 5‐year cause‐specific mortality in PGC. The nomograms showed relatively good performance and can be used in clinical practice to assist clinicians in individualized treatment decision‐making.

A dense connection encoding–decoding convolutional neural network structure for semantic segmentation of thymoma

Accurately positioning and segmenting thymoma from computed tomography (CT) images is of great importance for an image-driven thymoma analysis. In clinical practice, the diagnosis and segmentation of thymomas for radiologists are time-consuming and inefficient tasks. Thus, it is necessary to develop a method to accurately and efficiently realize automatic segmentation of thymoma. Here, a dense skip connection encoding–decoding model (DSC-Net), which is a deep convolutional neural network, was proposed to perform automatic segmentation of thymoma with the ability to fuse feature maps under receptive fields of different scales. An image preprocessing method was also proposed to provide much more texture information and enhance the contrast between thymoma and its surrounding tissues. A total of 310 subjects who underwent contrast-enhanced CT scanning were included in this ethically-approved retrospective study. All of the CT slices were manually labeled by four experienced radiologists, and 80% of images were included in the training set and the rest were included in the testing set. The performance of segmentation was evaluated by calculating the accuracy, intersection over union (IoU), and Boundary F1 contour matching score (BFScore) between the predicted segmentation and the manual labels. For segmentation of thymoma in the testing set, the accuracy, IoU and BFScore were 92.96%, 87.86% and 0.9087 respectively. Compared to the U-Net method, the DSC-Net model improved IoU by 3.94%. In addition, the efficacy and robustness of DSC-Net in segmentation of different patients and different types of thymoma classified by the WHO histological classification criteria were verified. The proposed preprocessing method and DSC-Net demonstrated improved performance in segmentation of thymomas, suggesting the ability to provide consistent delineation and assist radiologists in their clinical applications.

Breast cancer detection by dedicated breast positron emission tomography according to the World Health Organization classification of breast tumors

ObjectiveConsidering the difficulty in detecting primary breast cancers using whole-body positron emission tomography (WBPET) owing to its limited spatial resolution, we aimed to evaluate the detectability of breast cancer by ring-type dedicated breast PET (DbPET) on the World Health Organization (WHO) histological classification in comparison with WBPET. MethodsA total of 938 patients with breast cancer underwent WBPET and ring-type DbPET, and 1021 lesions were histologically assessed based on the WHO classification of tumors of the breast. The findings of WBPET and DbPET were retrospectively evaluated and compared. ResultsThe size-related sensitivity of DbPET was superior to that of WBPET for subcentimetric tumors (81.9% vs. 52.4%, P < 0.001). The histological distribution was as follows: 11 lobular carcinoma in situ, 158 ductal carcinoma in situ, 738 infiltrating duct carcinoma not otherwise specified (NOS), 12 lobular carcinoma NOS, 40 mucinous adenocarcinoma, 13 tubular carcinoma, 36 invasive breast carcinoma others, and 13 papillary neoplasms. WBPET had low sensitivity for lobular carcinoma in situ, ductal carcinoma in situ, lobular carcinoma NOS, mucinous adenocarcinoma, and tubular carcinoma. DbPET showed improved sensitivity for all the above except lobular and tubular carcinoma. The maximum standardized uptake values (SUVmax) of DbPET were significantly higher than those of WBPET for histological types, excluding lobular carcinoma in situ. The SUVmax of papillary neoplasms was high regardless of low-grade histology and Ki-67 labeling index. ConclusionsDBPET was found to have high sensitivity and SUVmax values for all histologic types that showed low sensitivity of detection on WBPET, except lobular carcinoma in situ.

Risk factors for developing post-thymectomy myasthenia gravis in patients with thymoma.

Thymectomy is required for the treatment of thymoma-associated myasthenia gravis (MG). However, MG may develop only after thymectomy, a condition known as post-thymectomy MG. This study aimed to investigate the risk factors for post-thymectomy MG in patients with thymoma. We retrospectively identified 235 patients with thymoma who underwent thymectomy at a single hospital from January 2008 to December 2017: 44 with preoperatively diagnosed MG were excluded, leaving 191 patients in the final analysis. Univariable survival analyses using Cox proportional hazards regression model and Kaplan-Meier estimate were conducted to identify risk factors for post-thymectomy MG. Post-thymectomy MG developed in 4.2% (8/191) of the patients with thymoma between 18 days and 108 mo after surgery. Hazard ratios (HRs) of pre- and postoperative anti-acetylcholine receptor antibody (AChR-Ab) titers were 2.267 (P = .002) and 1.506 (P < .001), respectively. Patients with extended thymectomy had a low chance of post-thymectomy MG (HR 0.035, P = .007). Larger thymoma (HR, 1.359; P = .005) and type A or AB thymoma according to World Health Organization histological classification (HR, 11.92; P = .021) were associated with higher chances of post-thymectomy MG. Within the subgroup of preoperatively AChR-Ab seropositive patients, post-thymectomy MG developed in 22.2% (6/27). Pre- and postoperative AChR-Ab levels should be measured in patients with thymoma. A large thymoma and partial thymectomy appear to be associated with a higher probability of post-thymectomy MG.

Introduction of histological classification and cytology reporting format of the Japanese General Rules for the Description of Thyroid Cancer with a special focus on the differences of the WHO Histological Classification and The Bethesda System of Thyroid Cytology.

Histological classification and cytology reporting format described in General Rules for the Description of Thyroid Cancer, the 8th edition (2019) (the Japanese General Rules) were briefly introduced. Moreover, the differences between "the Japanese General Rules", and WHO Histological Classification, the 4th edition (2017) and The Bethesda System for Reporting Thyroid Cytopathology, the 2nd edition (2018) were also explained. The Japanese General Rules did not accept the borderline lesions of thyroid tumor which were newly shown in WHO Histological Classification. We believe it is not necessary to introduce these borderline lesions in daily practice in Japan. Borderline lesions were proposed for avoiding over-surgery for thyroid cancer patients. In the United States, when the patient is diagnosed as malignant on cytology, total thyroidectomy is generally recommended. However, there is no over-surgery in Japan, because surgeons have several choices of treatment for thyroid cancer patients. This article is the first that the Japanese General Rules was shown by foreign language. Therefore, this will be advantageous to us when we present our opinion concerning histology and cytology of thyroid tumor to the world.

Postresection prognosis of combined hepatocellular carcinoma-cholangiocarcinoma according to the 2010 World Health Organization classification: single-center experience of 168 patients.

PurposeCombined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) has wide histologic diversity. This study investigated the effects of cHCC-CC histology, according to the 2010 World Health Organization (WHO) classification, on patient prognosis.MethodsThe medical records of patients who underwent surgical resection for cHCC-CC at our institution between July 2012 and June 2019 were retrospectively evaluated.ResultsDuring the study period, 168 patients, 122 males (72.6%) and 46 females (27.4%), underwent surgical resection for cHCC-CC, including 159 patients (94.6%) who underwent R0 resection. Mean tumor diameter was 4.4 ± 2.8 cm, and 161 patients (95.8%) had solitary tumors. Histologically, 86 patients (51.2%) had classical type, and 82 (48.8%) had tumors with stem cell (SC) features, including 33 (19.6%) with intermediate-cell and 23 (13.7%) each with typical SC and cholangiolocellular features; 3 tumors (1.8%) were unclassifiable. At 1, 3, and 5 years, tumor recurrence rates were 31.9%, 49.6%, and 58.1%, respectively, and patient survival rates were 91.0%, 70.2%, and 60.3%, respectively. Univariate analysis showed that tumor size of >5 cm, microscopic and macroscopic vascular invasion, lymph node metastasis, 8th edition of the American Joint Committee on Cancer (AJCC) tumor stage, and 2010 WHO classification were significantly prognostic. Multivariate analysis showed that the 8th AJCC tumor stage and 2010 WHO histologic classification were independently prognostic for tumor recurrence and patient survival. There were no significant prognostic differences among the 3 SC subtypes.ConclusionPostresection outcomes are better in patients with SC-type than with classical-type cHCC-CC.

Correlation of Computed Tomography Parameters with Histology, Stage and Prognosis in Surgically Treated Thymomas.

Background and objectives: The histological classification and staging of thymic tumors remains a matter of debate. The correlation of computed tomography (CT) parameters with tumor histology and stage also still has to be completely assessed. The aim of this study was therefore to analyze the correlation of radiological parameters with histological and staging classifications of thymomas evaluating their prognostic role. Materials and Methods: Data of 50 patients with thymoma submitted to a complete surgical treatment between 2005 and 2015 were retrospectively analyzed. Tumors were classified according to the WHO and Suster and Moran (S&M) histological classifications and to the Masaoka–Koga and tumor, node and metastases (TNM) staging systems. The correlation of CT features with histology and stage and the prognostic role of histopathological and radiological features were assessed. Results: Five-year overall (OS) and disease-free survival (DFS) were 90.3% and 81.1%, respectively. A significant correlation of DFS with the Masaoka–Koga (p = 0.001) and TNM staging systems (p = 0.002) and with the S&M (p = 0.02) and WHO histological classifications (p = 0.04) was observed. CT scan features correlated with tumor stage, histology and prognosis. Moderately differentiated tumors (WHO B3) had a significantly higher incidence of irregular shape and contours (p = 0.002 and p = 0.001, respectively) and pericardial contact (p = 0.036). A larger tumor volume (p = 0.03) and a greater length of pleural contact (p = 0.04) adversely influenced DFS. The presence of pleural (p < 0.001) or lung invasion (p = 0.02) and of pleural effusion (p = 0.004) was associated with a significantly worse OS. Conclusions: Pre-operative CT scan parameters correlate with stage and histology, and have a prognostic role in surgically treated thymomas.

Epidemiology of thymic epithelial tumors: 22-years experience from a single-institution.

BackgroundTo assess the correlation of WHO histological classification and Masaoka–Koga staging system of thymic epithelial tumors (TETs) with prognosis.MethodsWe retrospectively analyzed 83 patients with TETs in the Instituto Nacional de Enfermedades Neoplasicas between 1996 to 2018. We analyzed the clinical stages, histological types and treatment modalities and attempted to determine the impact on overall survival. The data was retrieved from clinical files and reviewed by a pathologist who reclassificated according to the 2004 WHO classification system. The staging was performed with the Masaoka–Koga staging system. Survival curves were constructed with Kaplan‐Meir method.ResultsThere was a total of 83 patients with a median age of 55 years old included in the study. The histological type corresponded to thymoma (T) in 63.8% (n = 53) and to thymic carcinoma (TC) in 36.1%. T were type A, AB, B1, B2 and B3 in 14.4%, 18%, 12%, 3.6%, 7.4% of cases, respectively. The proportion of advanced disease (Masaoka stage III–IV) was high (65%). With a median follow‐up of 88.4 months, median overall survival (OS) was 81.6 months for T and 12.3 months for TC (P = 0.01). Univariate analysis showed that sex, histological type, clinical stage and surgery (P = 0.01) were significant independent prognostic factors. On multivariate analysis, histology type and Masaoka–Koga staging had an effect on survival.ConclusionsThe results indicates a clear association between the WHO histological classification and Masaoka–Koga staging system with survival. We found a higher proportion of TETs with advanced disease at diagnosis. Further research are required and collaboration is important to foster knowledge focused on classification and treatment.Key pointsSignificant findings of the studyThe WHO histological classification, the Masaoka–Koga system and surgery treatment were associated with overall survival.What this study addsTo determine prognosis factors in TETs.

Volume and Mass Doubling Time of Lung Adenocarcinoma according to WHO Histologic Classification.

ObjectiveThis study aimed to evaluate the tumor doubling time of invasive lung adenocarcinoma according to the International Association of the Study for Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) histologic classification.Materials and MethodsAmong the 2905 patients with surgically resected lung adenocarcinoma, we retrospectively included 172 patients (mean age, 65.6 ± 9.0 years) who had paired thin-section non-contrast chest computed tomography (CT) scans at least 84 days apart with the same CT parameters, along with 10 patients with squamous cell carcinoma (mean age, 70.9 ± 7.4 years) for comparison. Three-dimensional semiautomatic segmentation of nodules was performed to calculate the volume doubling time (VDT), mass doubling time (MDT), and specific growth rate (SGR) of volume and mass. Multivariate linear regression, one-way analysis of variance, and receiver operating characteristic curve analyses were performed.ResultsThe median VDT and MDT of lung cancers were as follows: acinar, 603.2 and 639.5 days; lepidic, 1140.6 and 970.1 days; solid/micropapillary, 232.7 and 221.8 days; papillary, 599.0 and 624.3 days; invasive mucinous, 440.7 and 438.2 days; and squamous cell carcinoma, 149.1 and 146.1 days, respectively. The adjusted SGR of volume and mass of the solid-/micropapillary-predominant subtypes were significantly shorter than those of the acinar-, lepidic-, and papillary-predominant subtypes. The histologic subtype was independently associated with tumor doubling time. A VDT of 465.2 days and an MDT of 437.5 days yielded areas under the curve of 0.791 and 0.795, respectively, for distinguishing solid-/micropapillary-predominant subtypes from other subtypes of lung adenocarcinoma.ConclusionThe tumor doubling time of invasive lung adenocarcinoma differed according to the IASCL/ATS/ERS histologic classification.

Extracellular volume fraction measurement correlates with lymphocyte abundance in thymic epithelial tumors

BackgroundRecent advance in tissue characterization with parametric mapping imaging has the potential to be a novel biomarker for histopathologic correlation with thymic epithelial tumors (TETs). The purpose of our study is to evaluate MRI T1 mapping with the calculation of extracellular volume (ECV) fraction for histologic correlation with thymic epithelial tumor based on lymphocyte abundance.MethodsA retrospective study including 31 consecutive patients (14 men and 17 women, median age, 56 years; interquartile range, 12 years) with TETs was performed. The T1 values and ECV were assessed by using quantitative MRI mapping techniques. Mann-Whitney U test, Kruskal-Wallis H test, and receiver operating characteristic curve analyses were used to assess discrimination between different types of TETs based on lymphocyte abundance.ResultsExtracellular volume was significantly higher in TETs with sparse lymphocyte, including type A, type B3, and thymic carcinoma, compared with those with abundant lymphocyte, including type B1, B2, and AB thymomas (42.5% vs 26.9%, respectively; p < 0.001). Extracellular volume was significantly higher in thymic carcinoma compared with low grade and high grade thymomas (48.6% vs 31.1% vs 27.6%, respectively; p = 0.002).ConclusionsT1 mapping with the calculation of extracellular volume (ECV) fraction correlate with the WHO histologic classification of thymic epithelial tumor based on lymphocyte abundance.

EXTREMELY RARE CASE OF SCLEROSING THYMOMA TYPE A WITH NEUROENDOCRINE/PARANEOPLASTIC FEATURES OF ISAAC MERTEN SYNDROME

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sclerosing thymoma is an extremely rare neoplasm with only 16 reported [documented] cases worldwide in literature till date. The patient in our case presented with Sclerosing thymoma WHO Type A as well as clinical findings suggestive of Isaac’s-Merten’s syndrome (Neuromyotonia). CASE PRESENTATION: The Patient is a 53-year-old Caucasian male former smoker who presented with worsening dyspnea on exertion, and productive cough onset two weeks prior to presentation. He also complained of unintentional weight loss, generalized weakness, and progressively worsening bilateral hand contractures over the last year. On physical examination, the patient was noted to have contracted fingers on both hands with impaired flexion and extension. CXR and CT chest findings were consistent with pneumonia and an incidental large anterior 11.1 cm and 8.4 cm necrotic mediastinal mass that enveloped the main pulmonary artery. CT guided biopsy was performed and the mass was found to be of thymic origin. Neoadjuvant chemotherapy and radiation therapy were administered outpatient for tumor shrinkage prior to resection. The patient later underwent complete thymectomy and wedge resection of the left lung upper lobe. Pathology and immunohistochemistry results confirmed definitive diagnosis of sclerosing thymoma WHO Type A pattern. DISCUSSION: Sclerosing thymoma is an extremely rare type of thymoma accounting for <1% of all thymomas with preoperative clinical presentations that are widely varied. Kuo reported the first two cases of sclerosing thymoma in 1994. The WHO histologic classification of thymomas in 2004 entails 5 subtypes A, A1, B1, B2 and B3. These main subtypes are distinguished from the other rare variants of thymoma (sclerosing, micronodular, metaplastic, microscopic and lipofibroadenoma). Till date, only 16 cases of this sclerosing variant have been reported in literature worldwide. Although previously considered benign, even low-grade thymomas with type A pattern are considered malignant per International Thymic Malignancy Interest Group (ITMIG) guidelines. Certain paraneoplastic syndromes including the Isaac’s-Merten’s syndrome (Neuromyotonia) have been reported in association with thymomas on literature review. Neuromyotonia also known as peripheral nerve hyperexcitability is characterized by muscle stiffness as evidenced by bilateral hand contractures in our patient. CONCLUSIONS: Thymomas are rare mediastinal tumors. Sclerosing thymoma WHO type A is a very rare variant with few cases reported. Careful follow up of patients with thymic tumors is recommended to detect any local recurrence or distant metastasis. Reference #1: Travis WD, Brambilla E, Müller-Hermelink HK. Thymomas. WHO Classification of Tumours: Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Lyon, France: IARC Press; 2004;146–71. Reference #2: Kuo T. Sclerosing thymoma—a possible phenomenon of regression. Histopathology 1994;25:289–91. DISCLOSURES: No relevant relationships by Sherif Badra, source=Web Response No relevant relationships by john Brock, source=Web Response No relevant relationships by Vivian Chukwurah, source=Web Response Stock Holder relationship with Sarepta Therapeutics Inc Please note: $20001 - $100000 Added 03/26/2020 by Manjesh Lingamurthy, source=Web Response, value=Stock Holder Stock Holder relationship with Sarepta Therapeutics Inc Please note: $20001 - $100000 Added 03/26/2020 by Manjesh Lingamurthy, source=Web Response, value=Stock Holder Removed 03/26/2020 by Manjesh Lingamurthy, source=Web Response No relevant relationships by Comfort Takang, source=Web Response No relevant relationships by Silvio Tanev, source=Web Response

A single-center experience: management of patients with thymic epithelial tumors

BackgroundThymic epithelial tumors are rare neoplasias. There are no internationally accepted standards to treat this complex oncological disease. The studies on which our knowledge is based frequently have methodological weaknesses. If the tumor is resectable, complete surgical excision is currently the first-line therapy. Thymic epithelial tumors respond to radiation. The therapeutic benefit of adjuvant radiotherapy depends on tumor stage. To validate and improve treatment, we share our current experiences with clinical management and surgical intervention.MethodsThis single-center retrospective study included 40 patients with primarily resectable thymic epithelial tumors who underwent resection with curative intent. The survival data was collected and presented according to Kaplan-Meier. Single- and multiple predictor survival analyses were carried out using the log-rank test and Cox proportional hazards model.ResultsSingle-predictor survival analysis showed survival to be dependent on the Masaoka-Koga classification, WHO histological classification, resection status, surgical technique, and Clavien-Dindo grade for postoperative complications. Multiple predictor analysis confirms that the Masaoka-Koga stage (HR = 4.876, P = 0.032) and Clavien-Dindo grade (HR = 4.904, P = 0.011) are independent prognostic factors for survival.ConclusionIn addition to the Masaoka stage, the occurrence of severe postoperative complications represents an independent prognostic factor. Given the tumor’s sensitivity to radiation, the use of neoadjuvant radiotherapy can be considered to downstage Masaoka-Koga stages III and higher, thus reducing surgical risks. Further prospective multicenter studies are urgently needed.

18F-FDG-PET/CT predicts grade of malignancy and invasive potential of thymic epithelial tumors.

The aim of this study was to evaluate the ability of fluorine-18-fluorodeoxyglucose positron emission tomography coupled with computed tomography (18F-FDG-PET/CT) to predict the WHO malignancy grade, initial staging, and invasive potential of thymic epithelial tumors. We retrospectively reviewed the medical records of 56 patients with thymic epithelial tumors who were evaluated by PET/CT before surgery and underwent surgical resection. We analyzed the relationship of the maximum standardized uptake value (SUVmax) with the WHO histological classification, tumor invasion, TNM classification, and the Masaoka-Koga classification. There were differences of SUVmax of the FDG-PET between thymic carcinoma (9.09 ± 3.34) and thymoma (4.86 ± 2.45; p < 0.01), thymic carcinoma (9.09 ± 3.34) and high-grade thymoma (6.01 ± 2.78; p < 0.01), and high-grade thymoma (6.01 ± 2.78) and low-grade thymoma (4.06 ± 1.86; p < 0.01). The cut-off value for the SUVmax was 7.40 and 5.40, and the sensitivity/specificity for predicting the histologic subtype of each group was 0.72/0.79 and 0.61/0.85, respectively. According to T classification, SUVmax was significantly higher in T3 (8.31 ± 2.57) than in T1a (4.45 ± 2.06; p < 0.01). Regarding Masaoka-Koga classification and WHO histological classification, a significantly higher SUVmax was detected in patients with stage III and IV disease than in those with stage I and II diseases (p < 0.01). The cut-off value for SUVmax was 5.40 in Masaoka-Koga stage and 5.60 in the WHO classification; the sensitivity/specificity for predicting the histologic subtype was 0.85/0.80 and 0.89/0.78, respectively. FDG-PET is a useful tool to predict aggressiveness of thymic epithelial tumors.

Adult ovarian granulosa cell tumor: Role of systemic chemotherapy and surgical treatment.

e18083 Background: Granulosa cell tumor (GCT) are rare sex cord-stromal tumours. Their frequency is approximately 3% - 5% of all malignant ovarian tumors, and the incidence is from 0.6 to 2.1 cases per 100 000 women per year. According to the histological features, GCT are divided into two types: adult and juvenile. In the 2014 WHO histological classification, GCT were divided into borderline, which included the GCT of the juvenile type, and the malignant GCT of the adult type (AGCT). Despite the definition of AGCT not as borderline, but as low-grade malignant tumors, there are no specific recommendations for the surgical and drug treatment in such patients. Main method of treatment is surgical. Role of systemic treatment due to rarity of AGCT and late recurrence still has not determined. Methods: Data of 93 patients in our institution who were diagnosed with AGCT I-IV stage of the disease between 1980 and 2017 were evaluated. The data were obtained from the files of the patients, electronic database of the gynecologic oncology clinic, operation notes, and pathology records. Results: Stage of the disease, the spread of the tumor beyond the capsule and the number of mitoses of more than 10 significantly influenced the OS rates (p &lt; 0.05). The average time before the onset of the first relapse in IA, IB stage was 134.5 months, in IC stage - 67.4 months, in II-IV stage - 34.3 months. Stage of the disease is an independent prognostic factor for the occurrence of a relapse of the disease. In stage I disease there was no influence of the volume of surgical treatment and adjuvant chemotherapy on DFS and the duration of disease-free period (p &gt; 0.05). The duration of the non-progressive period was some, but not significantly more when performing optimal cytoreduction for the recurrence of the disease, and did not depend on the implementation regimen and adjuvant chemotherapy. Conclusions: There were not found significant difference in the overall and relapse-free survival of patients with ovarian AGCT, depending on the options of surgical and drug treatment they underwent. Studies showed that hormones play a critical role in the pathogenesis and treatment of GCT, especially in some ineffective cases for radiotherapy and chemotherapy. Additional multicenter randomized trials are needed to clarify the effectiveness of the various options for surgical and drug treatment of adult GCT patients.

Histopathological study of thyroidectomy specimens

Diseases of thyroid gland are common and have wide spectrum of entities ranging from functional, immune mediated to neoplastic lesions. The aim of this study is to describe the different pattern of lesions in thyroidectomy specimens. To study occurrence of various lesions of thyroidectomy specimens.This study was done in Dept. of pathology, Mysore Medical College over a period of 2 years from Feb 2017 to Feb 2019. The thyroid diseases were classified on histological grounds into congenital, non- neoplastic and neoplastic lesions that were further sub classified as benign and malignant as per WHO histological classification of thyroid tumors. A total of 104 thyroidectomy specimens were received during this study period. 91 cases (87.5%) were females and 13 cases (12.5%) were males with F: M ratio of 7:1. Non neoplastic lesions accounted for 72% and includes colloid goiter, multinodular goiter, nodular hyperplasia, hashimoto’s thyroiditis, thyroglossal cyst and lymphocytic thyroiditis. Neoplastic lesions accounted for 30% and consists of follicular adenoma as benign neoplasm, 17 malignant cases, 13 cases were of papillary thyroid carcinoma classic type, two cases of follicular carcinoma, one case of well differentiated follicular carcinoma of undetermined malignant potential and one case of non invasive follicular tumor with papillary like nuclear features. Thyroid lesions predominantly affects females. Most commonly seen during 3decade of life. Colloid goiter is the commonest non-neoplastic followed by multinodular goiter. Follicular adenoma was the most common benign neoplasm, papillary carcinoma of thyroid was the common thyroid malignancy seen.

Treatment Outcome and Prognostic Factors of Malignant Thymoma - A Single Institution Experience.

Objective:Our objectives are to investigate the clinicopathological features, treatment modalities, and prognostic and prognostic factors in order to estimate long-term outcomes for patients with thymoma and thymic carcinoma at our institution. Methods:We reviewed all patients diagnosed with thymic malignancies malignancies over a period of 38 years (from 1976 to 2014). Patients were identified using a single institution database at King Faisal Specialist Hospital and Research Center (KFSH and RC), Riyadh. Demographic data, clinical staging, histopathology classification, treatment approaches, and survival data were collected. Data Analysis was performed using both the Kaplan–Meier method and Cox proportional hazards modeling. Results:The fifty-six identified patients consists of 30 females (53.6%) and 26 males (46.4%). The median age at diagnosis was 39 years. About 37% of the patients were diagnosed with myasthenia gravis (MG). There was a significant association between the WHO histologic classification and the Masaoka stage (p= 0.018). The estimated 5-year overall survival rate was 88.6% for patients with thymic malignancies. The median survival time of thymoma and thymic carcinoma was 61 and 14 months, respectively. The univariate analysis suggested that histology (thymoma versus thymic carcinoma, p= 0.044) and Masaoka stage (II-III versus IV, p= 0.048) were independent prognostic factors affecting overall survival. Histology (p = 0.044) was found to be an independent predictor of overall survival. Conclusion:The findings of this study indicates that late Masaoka-Koga staging and histology types are significantly associated with extended overall survival. Similarly, surgical resection and multimodality treatments play a significant role in thymic malignancies neoplasms therapy strategies to prolong survival rates.