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Wang Y, Qiu H, Lin R, Hong W, Lu J, Ling H, Sun X, Yang C. Advancements in the Understanding of Small-Cell Neuroendocrine Cervical Cancer: Where We Stand and What Lies Ahead. J Pers Med 2024; 14:462. [PMID: 38793044 PMCID: PMC11122604 DOI: 10.3390/jpm14050462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Small-cell neuroendocrine cervical carcinoma (SCNCC) is a rare yet aggressive gynecological malignancy associated with dismal clinical outcomes. Its rarity has led to a limited number of retrospective studies and an absence of prospective research, posing significant challenges for evidence-based treatment approaches. As a result, most gynecologic oncology centers have limited experience with this tumor, emphasizing the urgent need for a comprehensive review and summary. This article systematically reviews the pathogenesis, immunohistochemical and molecular characteristics, prognostic factors, and clinical management of gynecologic SCNCC. We specifically focused on reviewing the distinct genomic characteristics of SCNCC identified via next-generation sequencing technologies, including loss of heterozygosity (LOH), somatic mutations, structural variations (SVs), and microRNA alterations. The identification of these actionable genomic events offers promise for discovering new molecular targets for drug development and enhancing therapeutic outcomes. Additionally, we delve deeper into key clinical challenges, such as determining the optimal treatment modality between chemoradiation and surgery for International Federation of Gynecology and Obstetrics (FIGO) stage I phase patients within a precision stratification framework, as well as the role of targeted therapy within the homologous recombination (HR) pathway, immune checkpoint inhibitors (ICIs), and prophylactic cranial irradiation (PCI) in the management of SCNCC. Finally, we anticipate the utilization of multiple SCNCC models, including cancer tissue-originated spheroid (CTOS) lines and patient-derived xenografts (PDXs), to decipher driver events and develop individualized therapeutic strategies for clinical application.
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Affiliation(s)
- Yan Wang
- Life Sciences Institute, Zhejiang University, Hangzhou 310058, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou First People’s Hospital, Hangzhou 310006, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Hui Qiu
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Rongjie Lin
- Department of Radiotherapy, West China Xiamen Hospital of Sichuan University, Xiamen 361021, China
| | - Weiwei Hong
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jiahao Lu
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Huan Ling
- Department of Ultrasound in Gynecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xiaoge Sun
- Department of Radiation Oncology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 750306, China
| | - Chunxu Yang
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Li YZ, Liu P, Mao BH, Wang LL, Ren JL, Xu YS, Liu GY, Xin ZH, Lei JQ. Development of an improved diagnostic nomogram for preoperative prediction of small cell neuroendocrine cancer of the cervix. Br J Radiol 2022; 95:20220368. [PMID: 36169239 PMCID: PMC9733602 DOI: 10.1259/bjr.20220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Accurate preoperative diagnosis of small cell neuroendocrine cancer of the cervix (SCNECC) is crucial for establishing the best treatment plan. This study aimed to develop an improved, non-invasive method for the preoperative diagnosis of SCNECC by integrating clinical, MR morphological, and apparent diffusion coefficient (ADC) information. METHODS A total of 105 pathologically confirmed cervical cancer patients (35 SCNECC, 70 non-SCNECC) from multiple centres with complete clinical and MR records were included. Whole lesion histogram analysis of the ADC was performed. Multivariate logistic regression analysis was used to develop diagnostic models based on clinical, morphological, and histogram data. The predictive performance in terms of discrimination, calibration, and clinical usefulness of the different models was assessed. A nomogram for preoperatively discriminating SCNECC was developed from the combined model. RESULTS In preoperative SCNECC diagnosis, the combined model, which had a diagnostic AUC (area under the curve) of 0.937 (95% CI: 0.887-0.987), outperformed the clinical-morphological model, which had an AUC of 0.869 (CI: 0.788-0.949), and the histogram model, which had an AUC of 0.872 (CI: 0.792-0.951). The calibration curve and decision curve analyses suggest that the combined model achieved good fitting and clinical utility. CONCLUSIONS Non-invasive preoperative diagnosis of SCNECC can be achieved with high accuracy by integrating clinical, MR morphological, and ADC histogram features. The nomogram derived from the combined model can provide an easy-to-use clinical preoperative diagnostic tool for SCNECC. ADVANCES IN KNOWLEDGE It is clear that the therapeutic strategies for SCNECC are different from those for other pathological types of cervical cancer according to V 1.2021 of the NCCN clinical practice guidelines in oncology for cervical cancer. This research developed an improved, non-invasive method for the preoperative diagnosis of SCNECC by integrating clinical, MR morphological, and apparent diffusion coefficient (ADC) information.
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Affiliation(s)
| | - Peng Liu
- Department of Radiology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, China
| | - Bao-Hong Mao
- Department of Clinical Medical Research Centre, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Li-Li Wang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | | | | | - Guang-Yao Liu
- Department of Magnetic Resonance, the Second Hospital of Lanzhou University, Lanzhou, Gansu, China
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Fan J, Li H, Zhou C, Xiong W, Villamil C, Ionescu D, Oo HZ, Contreras-Sanz A, Black PC, Wang G. Classifying Pulmonary and Urinary High-grade Neuroendocrine Carcinoma by CK7 Immunohistochemistry. Appl Immunohistochem Mol Morphol 2022; 30:459-468. [PMID: 35603802 DOI: 10.1097/pai.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
High-grade neuroendocrine carcinoma (HGNEC) is subclassified into small cell carcinoma (SmCC) and large cell neuroendocrine carcinoma (LCNEC). Although both are clinically aggressive, the SmCC and LCNEC need to have different treatment strategies, and accurate pathologic diagnosis is challenging. We studied a large retrospective cohort (186 cases) of HGNEC of bladder and lung to investigate the abundance of cytokeratin (CK) 7 expression and staining pattern in SmCC and LCNEC. Overall, the pulmonary and urinary HGNEC exhibited several different CK7 staining patterns, including negative staining (n=28), dot-like staining (n=73), partial membranous staining (n=26), and complete membranous staining (n=60). Overall, 88.9% (44/49) of pulmonary SmCC and 88.0% (44/50) of urinary SmCC showed negative or dot-like patterns for CK7, while 90.8% (59/65) of pulmonary LCNEC and 72.7% (16/22) of urinary LCNEC showed partial or complete membranous patterns for CK7 (χ 2 =105.05, P <0.0001). The distinct staining patterns were also present in those mixed SmCC and LCNEC. In addition, the specimen types or fixation did not affect CK7 staining patterns. In conclusion, CK7 has a high differential value for SmCC and LCNEC and could help guide personalized treatment for patients.
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Affiliation(s)
| | | | - Chen Zhou
- University of British Columbia
- Department of Pathology, British Columbia Cancer Vancouver Centre
| | - Wei Xiong
- University of British Columbia
- Department of Pathology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Carlos Villamil
- University of British Columbia
- Department of Pathology, British Columbia Cancer Vancouver Centre
| | - Diana Ionescu
- University of British Columbia
- Department of Pathology, British Columbia Cancer Vancouver Centre
| | - Htoo Z Oo
- Department of Urologic Sciences, University of British Columbia
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia
| | - Gang Wang
- University of British Columbia
- Department of Pathology, British Columbia Cancer Vancouver Centre
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Kitajima K, Kihara T, Kawanaka Y, Kido A, Yoshida K, Mizumoto Y, Tomiyama A, Okuda S, Jinzaki M, Kato F, Takahama J, Takahata A, Fukukura Y, Nakamoto A, Tsujikawa T, Munechika J, Ohgiya Y, Kawai N, Goshima S, Ohya A, Fujinaga Y, Fukunaga T, Fujii S, Tanabe M, Ito K, Tsuboyama T, Kanie Y, Umeoka S, Ichikawa S, Motosugi U, Daido S, Kido A, Tamada T, Matsuki M, Yamashiro T, Yamakado K. Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis - Japan multicenter study. Oncotarget 2020; 11:3675-3686. [PMID: 33088427 PMCID: PMC7546756 DOI: 10.18632/oncotarget.27613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival. Results: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3–151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively. Materials and Methods: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirty-two tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3). Conclusions: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takako Kihara
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yusuke Kawanaka
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Aki Kido
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kotaro Yoshida
- Department of Radiology, Kanazawa University, Graduate School of Medicine Science, Kanazawa, Ichikawa, Japan
| | - Yasunari Mizumoto
- Department of Obstetrics and Gynecology, Kanazawa University, Graduate School of Medicine Science, Kanazawa, Ichikawa, Japan
| | - Akiko Tomiyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Junko Takahama
- Department of Radiology, Nara Medical University, Nara, Japan
| | - Akiko Takahata
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihiko Fukukura
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsushi Nakamoto
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Jiro Munechika
- Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitstu Ohgiya
- Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Satoshi Goshima
- Department of Diagnostic Radiology and Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ayumi Ohya
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takeru Fukunaga
- Division of Radiology, Department of Pathophysiological and Therapeutic Sciences, Tottori University, Tottori, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Sciences, Tottori University, Tottori, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takahiro Tsuboyama
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yuichiro Kanie
- Department of Radiology, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan
| | - Shigeaki Umeoka
- Department of Radiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | | | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Sayaka Daido
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School, Okayama, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Okayama, Japan
| | - Mitsuru Matsuki
- Department of Diagnostic Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Sugimoto M, Koyama K, Ichimura T, Shimono T, Hashiguchi Y, Miki Y. Comparison of MR imaging features of uterine neuroendocrine carcinoma and uterine malignant lymphoma. Abdom Radiol (NY) 2019; 44:3377-3387. [PMID: 31473773 DOI: 10.1007/s00261-019-02201-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE We retrospectively investigated the characteristic magnetic resonance (MR) imaging findings of uterine neuroendocrine carcinoma (UNEC) compared to those of uterine malignant lymphoma (UML). METHODS Nine consecutive female patients with UNEC and 5 female patients with UML participated in this study. MR imaging features were evaluated retrospectively. RESULTS On MR imaging, seven of 9 UNEC lesions and no UML lesions showed an exophytic growth pattern. All 9 UNEC lesions and no UML lesions showed a growth pattern along the surface of the endocervix or endometrium. Only 1 UNEC lesion and all 5 UML lesions showed diffuse enlargement of the uterus. No UNEC lesions and all 5 UML lesions showed a multinodular shape. These findings showed significant differences between lesions. Findings for margin, endophytic growth pattern, signal intensity, and homogeneity on T2-weighted and T1-weighted imaging did not differ significantly between lesion types. Apparent diffusion coefficient was significantly lower for UML lesions than for UNEC lesions, but was quite low for both types. Local invasion to surrounding tissues was more frequent in UML lesions than in UNEC lesions. There was no significant difference in the frequency of lymphadenopathy between two entities. CONCLUSIONS UNEC lesions tended to show an exophytic growth pattern and growth along the surface of the endocervix or endometrium, even when diffuse enlargement of the uterus was present, while all UML lesions showed a multinodular shape and diffuse enlargement of the uterus without thickening of the cervical epithelium and endometrium.
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Affiliation(s)
- Michiko Sugimoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Osaka, 545-8585, Japan.
| | - Koichi Koyama
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Tomoyuki Ichimura
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Yasunori Hashiguchi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Osaka, 545-8585, Japan
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Katabathina VS, Vikram R, Olaoya A, Paspulati RM, Nicolas MM, Rao P, Zaheer A, Prasad SR. Neuroendocrine neoplasms of the genitourinary tract in adults: cross-sectional imaging spectrum. Abdom Radiol (NY) 2017; 42:1472-1484. [PMID: 27942847 DOI: 10.1007/s00261-016-1012-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Neuroendocrine (NE) neoplasms of the genitourinary (GU) tract in adults are rare tumors with distinct histopathology and variable biological behavior and imaging findings. They may be primary or metastatic in origin. The spectrum of primary GU tract NE neoplasms includes carcinoid, small cell carcinoma, large cell NE carcinoma, and paraganglioma. The tumors commonly show positivity to specific immunohistochemical markers and characteristic dense-core granules at the ultra-structural level. Although imaging findings are nonspecific and accurate differentiation from the more common malignancies of the individual organs is not possible, cross-sectional imaging modalities play an important role in the diagnosis, staging, and surveillance of these tumors. Somatostatin receptor scintigraphy (octreotide scan) may be useful in the detection and treatment of metastatic disease in select patients. Knowledge of the various NE tumors of the adult GU tract and familiarity with their pathological and imaging findings permit optimal patient management.
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Harvey H, Orton MR, Morgan VA, Parker C, Dearnaley D, Fisher C, deSouza NM. Volumetry of the dominant intraprostatic tumour lesion: intersequence and interobserver differences on multiparametric MRI. Br J Radiol 2017; 90:20160416. [PMID: 28055249 PMCID: PMC5601508 DOI: 10.1259/bjr.20160416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/10/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To establish the interobserver reproducibility of tumour volumetry on individual multiparametric (mp) prostate MRI sequences, validate measurements with histology and determine whether functional to morphological volume ratios reflect Gleason score. METHODS 41 males with prostate cancer treated with prostatectomy (Cohort 1) or radical radiotherapy (Cohort 2), who had pre-treatment mpMRI [T2 weighted (T2W) MRI, diffusion-weighted (DW)-MRI and dynamic contrast-enhanced (DCE)-MRI], were studied retrospectively. Dominant intraprostatic lesions (DIPLs) were manually delineated on each sequence and volumes were compared between observers (n = 40 analyzable) and with radical prostatectomy (n = 20). Volume ratios of DW-MRI and DCE-MRI to T2W MRI were documented and compared between Gleason grade 3 + 3, 3 + 4 and 4 + 3 or greater categories. RESULTS Limits of agreement of DIPL volumes between observers were: T2W MRI 0.9, -1.1 cm3, DW-MRI 1.3, -1.7 cm3 and DCE-MRI 0.74, -0.89 cm3. In Cohort 1, T2W volumes overestimated fixed specimen histological volumes (+33% Observer 1, +16% Observer 2); DW- and DCE-MRI underestimated histological volume, the latter markedly so (-32% Observer 1, -79% Observer 2). Differences between T2W, DW- and DCE-MRI volumes were significant (p < 10-8). The ratio of DW-MRI volume (73.9 ± 18.1% Observer 1, 72.5 ± 21.9% Observer 2) and DCE-MRI volume (42.6 ± 24.6% Observer 1, 34.3 ± 24.9% Observer 2) to T2W volume was significantly different (p < 10-8), but these volume ratios did not differ between the Gleason grades. CONCLUSION The low variability of the DIPL volume on T2W MRI between Observers and agreement with histology indicates its suitability for delineation of gross tumour volume for radiotherapy planning. The volume of cellular tumour represented by DW-MRI is greater than the vascular (DCE) abnormality; ratios of both to T2W volume are independent of Gleason score. Advances in knowledge: (1) Manual volume measurement of tumour is reproducible within 1 cm3 between observers on all sequences, confirming suitability across observers for radiotherapy planning. (2) Volumes derived on T2W MRI most accurately represent in vivo lesion volumes. (3) The proportion of cellular (DW-MRI) or vascular (DCE-MRI) volume to morphological (T2W MRI) volume is not affected by Gleason score.
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Affiliation(s)
- Hugh Harvey
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R Orton
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Veronica A Morgan
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Chris Parker
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - David Dearnaley
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Cyril Fisher
- Department of Histopathology, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Nandita M deSouza
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
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Duan X, Ban X, Zhang X, Hu H, Li G, Wang D, Wang CQ, Zhang F, Shen J. MR imaging features and staging of neuroendocrine carcinomas of the uterine cervix with pathological correlations. Eur Radiol 2016; 26:4293-4302. [PMID: 26995208 DOI: 10.1007/s00330-016-4327-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/08/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine MR imaging features and staging accuracy of neuroendocrine carcinomas (NECs) of the uterine cervix with pathological correlations. METHODS Twenty-six patients with histologically proven NECs, 60 patients with squamous cell carcinomas (SCCs), and 30 patients with adenocarcinomas of the uterine cervix were included. The clinical data, pathological findings, and MRI findings were reviewed retrospectively. MRI features of cervical NECs, SCCs, and adenocarcinomas were compared, and MRI staging of cervical NECs was compared with the pathological staging. RESULTS Cervical NECs showed a higher tendency toward a homogeneous signal intensity on T2-weighted imaging and a homogeneous enhancement pattern, as well as a lower ADC value of tumour and a higher incidence of lymphadenopathy, compared with SCCs and adenocarcinomas (P < 0.05). An ADC value cutoff of 0.90 × 10-3 mm2/s was robust for differentiation between cervical NECs and other cervical cancers, with a sensitivity of 63.3 % and a specificity of 95 %. In 21 patients who underwent radical hysterectomy and lymphadenectomy, the overall accuracy of tumour staging by MR imaging was 85.7 % with reference to pathology staging. CONCLUSION Homogeneous lesion texture and low ADC value are likely suggestive features of cervical NECs and MR imaging is reliable for the staging of cervical NECs. KEY POINTS • Cervical NECs show a tendency of lesion homogeneity and lymphadenopathy • Low ADC values are found in cervical NECs • MRI is an accurate imaging modality for the cervical NEC staging.
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Affiliation(s)
- Xiaohui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China
| | - Xiaohua Ban
- Medical Imaging and Minimally Invasive Interventional Center & State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China
| | - Huijun Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China
| | - Guozhao Li
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China
| | - Dongye Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China
| | - Charles Qian Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China.,JMO, Westmead Hospital, University of New South Wales, Sydney, Australia
| | - Fang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China.
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Abstract
OBJECTIVE The role of imaging in patients with suspected gynecologic malignancies is to provide an accurate diagnosis to achieve the best and most tailored treatment plan. Uncommon cancers pose a distinct challenge, because current knowledge of these diseases is still limited. Our purpose is to highlight the role of cross-sectional imaging techniques, including ultrasound, CT, MRI, and PET/CT, in the diagnosis and pretreatment stratification of patients with rare gynecologic cancers. CONCLUSION This review shows the relevance of imaging findings for diagnosis, staging, and treatment planning in patients with uncommon uterine, cervical, vaginal, vulvar, and ovarian cancers.
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Chen MY, Chou HH, Liu FY, Chen CY, Lin G, Yang LY, Pan YB, Jung SM, Wu RC, Huang YT, Tsai JCS, Yen TC, Lai CH, Chang TC. 18F-FDG PET in small-cell cervical cancer: a prospective study with long-term follow-up. Eur J Nucl Med Mol Imaging 2015; 43:663-74. [PMID: 26519293 DOI: 10.1007/s00259-015-3229-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/13/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Min-Yu Chen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St. Kueishan, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St. Kueishan, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Feng-Yuan Liu
- Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St. Kueishan, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ting Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jason Chien-Sheng Tsai
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St. Kueishan, Taoyuan, 333, Taiwan.
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Ting-Chang Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St. Kueishan, Taoyuan, 333, Taiwan.
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Leursen G, Gardner CS, Sagebiel T, Patnana M, de CastroFaria S, Devine CE, Bhosale PR. Magnetic Resonance Imaging of Benign and Malignant Uterine Neoplasms. Semin Ultrasound CT MR 2015; 36:348-60. [PMID: 26296485 DOI: 10.1053/j.sult.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Benign and malignant uterine masses can be seen in the women. Some of these are asymptomatic and incidentally discovered, whereas others can be symptomatic. With the soft tissue contrast resolution magnetic resonance imaging can render a definitive diagnosis, which can further help streamline patient management. In this article we show magnetic resonance imaging examples of benign and malignant masses of the uterus and their treatment strategies.
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Affiliation(s)
- Gustavo Leursen
- Department of Abdominal Radiology, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Tara Sagebiel
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | - Madhavi Patnana
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | | | | | - Priya R Bhosale
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX.
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12
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Wan Q, Jiao Q, Li X, Zhou J, Zou Q, Deng Y. Value of (18)F-FDG PET/CT and MRI in diagnosing primary endometrial small cell carcinoma. Chin J Cancer Res 2014; 26:627-31. [PMID: 25400430 DOI: 10.3978/j.issn.1000-9604.2014.10.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/27/2014] [Indexed: 11/14/2022] Open
Abstract
Primary small cell carcinoma (SCC) is a group of aggressive neoplasms that mainly arise from the lung and digestive tract. Endometrial small cell carcinoma (ESCC) is extremely rare. To our knowledge, less than 90 cases have been reported, and most of these reports were dedicated to describing the clinicopathologic or immunochemical features of ESCC. Herein, we present a new case of ESCC involving a 51-year-old woman and mainly focus on the magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) findings. MRI showed that the uterus was significantly enlarged (11.6 cm × 11.1 cm × 14.4 cm), and a giant irregular mass (7.5 cm × 8.4 cm × 8.5 cm) was observed in the uterine cavity. The lesion demonstrated an extremely low apparent diffusion coefficient (ADC) value [(0.553±0.088)×10(-3) mm(2)/s] and a high FDG uptake value (22.7). Multiple metastatic lymph nodes (LNs) were identified at different positions, with diameters ranging from 0.3 to 2.8 cm and a maximum standardized uptake value (SUVmax) ranging from 6.9 to 19.3.
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Affiliation(s)
- Qi Wan
- 1 Department of Radiology, 2 Infection Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qian Jiao
- 1 Department of Radiology, 2 Infection Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xinchun Li
- 1 Department of Radiology, 2 Infection Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jiaxuan Zhou
- 1 Department of Radiology, 2 Infection Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qiao Zou
- 1 Department of Radiology, 2 Infection Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yingshi Deng
- 1 Department of Radiology, 2 Infection Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Joyce EA, Kavanagh J, Sheehy N, Beddy P, O'Keeffe SA. Imaging features of extrapulmonary small cell carcinoma. Clin Radiol 2013; 68:953-61. [PMID: 23790688 DOI: 10.1016/j.crad.2013.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 03/30/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
Small cell carcinoma accounts for approximately 20% of lung cancers; however, it rarely occurs at other sites. Extrapulmonary small cell carcinoma (EPSCC) is notoriously aggressive with a strong propensity for both regional and distant spread. The majority of the literature on these uncommon tumours is from a clinicopathological viewpoint with a relative paucity of detail regarding the radiological findings. This review will focus on the imaging features of EPSCC in its predominant sites of origin: the gastrointestinal tract, genitourinary tract, head, neck, and breast. We will also discuss the role of positron-emission tomography (PET)/computed tomography (CT) in the staging of EPSCC.
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Affiliation(s)
- E A Joyce
- Department of Radiology, St James's Hospital and Trinity College Dublin, Dublin, Ireland.
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Lin Y, Lin WY, Liang JA, Lu YY, Wang HY, Tsai SC, Kao CH. Opportunities for 2-[(18)F] fluoro-2-deoxy-D-glucose PET/CT in cervical-vaginal neuroendocrine carcinoma: case series and literature review. Korean J Radiol 2012; 13:760-70. [PMID: 23118575 PMCID: PMC3484297 DOI: 10.3348/kjr.2012.13.6.760] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/02/2012] [Indexed: 11/15/2022] Open
Abstract
Objective Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan for the detection of this rare malignancy. Materials and Methods Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5). Results Two cases (cases 1 and 4) were restaged after 18F-FDG PET/CT scan in the initial staging process. Post-treatment 18F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years. Conclusion 18F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the 18F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the 18F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation.
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Affiliation(s)
- Yin Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung 404, Taiwan
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Abstract
OBJECTIVE Extrapulmonary small cell carcinoma (EPSCC) is a rare, aggressive neoplasm arising from virtually any organ. Numerous oncologic studies have addressed prognostic indicators and survival rates in EPSCC, however relatively little has been published regarding the imaging features and metastatic patterns of these uncommon tumors. This article provides a pictorial review of EPSCC in multiple organs, emphasizing the imaging appearance at presentation and the radiologic patterns of recurrence/metastasis. CONCLUSION Although the appearance of EPSCC is often nonspecific, the typical presentation is large aggressive tumors that, similar to small cell carcinoma in the lung, often respond well to local therapy but tend to recur relentlessly at distant sites.
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Abstract
A variety of benign and malignant entities affect the uterine cervix. These are discussed and illustrated. Cross-sectional and functional imaging can improve the accuracy of traditional clinical cervical cancer staging. Emphasis is placed on magnetic resonance imaging for initial staging and fused positron emission tomography-computed tomography for restaging and surveillance. The imaging appearance of benign cervical pathology is reviewed with ultrasonography as the first-line imaging modality and magnetic resonance imaging for problem solving in difficult cases.
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Affiliation(s)
- Maryam Rezvani
- Department of Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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Tamai K, Koyama T, Saga T, Mikami Y, Fujii S, Togashi K. Small cell carcinoma of the uterine corpus: MR imaging and pathological correlation. J Comput Assist Tomogr 2007; 31:485-9. [PMID: 17538301 DOI: 10.1097/01.rct.0000243452.33610.d4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Small cell carcinoma of the uterine corpus is a rare but aggressive neoplasm showing neuroendocrine differentiation; its radiological findings are not well described. We report the magnetic resonance features of 3 cases with pathological correlation. Small cell carcinoma is shown as a bulky endometrial tumor of heterogeneous appearance on T2-weighted images, frequently associated with diffuse myometrium invasion and early extrauterine spread. Irregular enhancement with multifocal unenhanced areas of the thickened myometrium on contrast-enhanced T1-weighted images may represent the infiltrative nature of the tumor with extensive necrosis.
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Affiliation(s)
- Ken Tamai
- Department of Diagnostic Imaging and Nuclear, Graduate School of Medicine, Kyoto University, Japan
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