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Olivares-Antúnez Y, Dávila-Zablah YJ, Vázquez-Ávila JR, Gómez-Macías GS, Mireles-Aguilar MT, Garza-Montemayor ML. Ductal carcinoma in situ within a fibroadenoma: A case report and review of literature. World J Radiol 2024; 16:58-68. [PMID: 38596169 PMCID: PMC10999957 DOI: 10.4329/wjr.v16.i3.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/20/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Fibroadenoma (FA) is the most common tumor found in young women, although it can occur in any age group. Ductal carcinoma in situ (DCIS) that is confined in a FA is rare; it is most frequently reported as an incidental finding. CASE SUMMARY We report a case of DCIS within a FA in a 46-year-old female without cancer-related personal and family histories. The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year. In the current control image study, we found suspicious microcalcification, as a new finding, within one of the nodules. Consequently, a core biopsy of the tumor, which appeared hypoechoic, oval, and circumscribed, was performed. The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion. The patient underwent breast-conserving surgery and received radiotherapy as well as endocrine therapy (tamoxifen). CONCLUSION We recommend a multidisciplinary approach for adequate treatment and follow-up.
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Affiliation(s)
- Yazmin Olivares-Antúnez
- Department of Diagnostic Breast Imaging Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
| | - Yesika Janett Dávila-Zablah
- Department of Diagnostic Breast Imaging Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
| | - José Raúl Vázquez-Ávila
- Department of Patology Service, Hospital San José, Tecnológico de Monterrey, Nuevo León 64710, Mexico
| | - Gabriela Sofía Gómez-Macías
- Department of Patology Service, Hospital San José, Tecnológico de Monterrey, Nuevo León 64710, Mexico
- Department of Faculty of Medicine, Hospital Universitario de la UANL, Nuevo León 64710, Mexico
| | - María Teresa Mireles-Aguilar
- Department of Breast Surgery Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
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Furuya N, Yamaguchi A, Kato N, Sugata S, Hamada T, Mizumoto T, Tamaru Y, Kusunoki R, Kuwai T, Kouno H, Kuraoka K, Shibata Y, Tazuma S, Sudo T, Kohno H, Oka S. High-grade pancreatic intraepithelial neoplasia diagnosed based on changes in magnetic resonance cholangiopancreatography findings: A case report. World J Clin Cases 2024; 12:1487-1496. [PMID: 38576815 PMCID: PMC10989451 DOI: 10.12998/wjcc.v12.i8.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND High-grade pancreatic intraepithelial neoplasia (PanIN) exhibits no mass and is not detected by any examination modalities. However, it can be diagnosed by pancreatic juice cytology from indirect findings. Most previous cases were diagnosed based on findings of a focal stricture of the main pancreatic duct (MPD) and caudal MPD dilatation and subsequent pancreatic juice cytology using endoscopic retrograde cholangiopancreatography (ERCP). We experienced a case of high-grade PanIN with an unclear MPD over a 20-mm range, but without caudal MPD dilatation on magnetic resonance cholangiopancreatography (MRCP). CASE SUMMARY A 60-year-old female patient underwent computed tomography for a follow-up of uterine cancer post-excision, which revealed pancreatic cysts. MRCP revealed an unclear MPD of the pancreatic body at a 20-mm length without caudal MPD dilatation. Thus, course observation was performed. After 24 mo, MRCP revealed an increased caudal MPD caliber and a larger pancreatic cyst. We performed ERCP and detected atypical cells suspected of adenocarcinoma by serial pancreatic juice aspiration cytology examination. We performed a distal pancreatectomy and obtained a histopathological diagnosis of high-grade PanIN. Pancreatic parenchyma invasion was not observed, and curative resection was achieved. CONCLUSION High-grade Pan-IN may cause MPD narrowing in a long range without caudal MPD dilatation.
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Affiliation(s)
- Nao Furuya
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima 734-8551, Hiroshima, Japan
| | - Atsushi Yamaguchi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Naohiro Kato
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Syuhei Sugata
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Takuro Hamada
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima 734-8551, Hiroshima, Japan
| | - Takeshi Mizumoto
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Yuzuru Tamaru
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Ryusaku Kusunoki
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Hirotaka Kouno
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Kazuya Kuraoka
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Yoshiyuki Shibata
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Sho Tazuma
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Takeshi Sudo
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Hiroshi Kohno
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima 734-8551, Hiroshima, Japan
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Sagami R, Yamao K, Minami R, Nakahodo J, Akiyama H, Nishikiori H, Mizukami K, Yamao K, Bhatia V, Amano Y, Murakami K. Endoscopic Ultrasound Can Differentiate High-Grade Pancreatic Intraepithelial Neoplasia, Small Pancreatic Ductal Adenocarcinoma, and Benign Stenosis. Gut Liver 2024; 18:338-347. [PMID: 37165770 PMCID: PMC10938144 DOI: 10.5009/gnl220521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 05/12/2023] Open
Abstract
Background/Aims High-grade pancreatic intraepithelial neoplasia and invasive pancreatic ductal adenocarcinoma ≤10 mm are targets for early detection of pancreatic cancer. However, their imaging characteristics are unknown. We aimed to identify endoscopic ultrasound findings for the detection of these lesions. Methods Patients diagnosed with high-grade pancreatic intraepithelial neoplasia (n=29), pancreatic ductal adenocarcinoma ≤10 mm (n=11) (who underwent surgical resection), or benign main pancreatic duct stenosis (n=20) between January 2014 and January 2021 were retrospectively included. Six features differentiating these lesions were examined by endoscopic ultrasonography: main pancreatic duct stenosis, upstream main pancreatic duct dilation, hypoechoic areas surrounding the main pancreatic duct irregularities (mottled areas without demarcation or round areas with demarcation), branch duct dilation, prominent lobular segmentation, and atrophy. Interobserver agreement was assessed by two independent observers. Results Hypoechoic areas surrounding the main pancreatic duct irregularities were observed more frequently in high-grade pancreatic intraepithelial neoplasia (82.8%) and pancreatic ductal adenocarcinoma ≤10 mm (90.9%) than in benign stenosis (15.0%) (p<0.001). High-grade pancreatic intraepithelial neoplasia exhibited mottled hypoechoic areas more frequently (79.3% vs 18.9%, p<0.001), and round hypoechoic areas less frequently (3.4% vs 72.7%, p<0.001), than pancreatic ductal adenocarcinoma ≤10 mm. The sensitivity and specificity of hypoechoic areas for differentiating high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis were both 85.0%, with moderate interobserver agreement. Conclusions The hypoechoic areas surrounding main pancreatic duct irregularities on endoscopic ultrasound may differentiate between high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis (Trial Registration: UMIN Clinical Trials Registry (UMIN000044789).
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan
- Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Osaka-Sayama, Japan
| | - Kentaro Yamao
- Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Osaka-Sayama, Japan
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Ryuki Minami
- Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Osaka-Sayama, Japan
- Department of Gastroenterology, Tenri Hospital, Nara, Japan
| | - Jun Nakahodo
- Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Osaka-Sayama, Japan
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Hidetoshi Akiyama
- Department of Gastroenterology, Oita Red Cross Hospital, Oita, Japan
| | | | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kenji Yamao
- Department of Gastroenterology, Narita Memorial Hospital, Aichi, Japan
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yuji Amano
- Department of Endoscopy, Urawa Kyosai Hospital, Saitama, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
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Llano A, Chan A, Kuk C, Kassouf W, Zlotta AR. Carcinoma In Situ (CIS): Is There a Difference in Efficacy between Various BCG Strains? A Comprehensive Review of the Literature. Cancers (Basel) 2024; 16:245. [PMID: 38254736 PMCID: PMC10813486 DOI: 10.3390/cancers16020245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Introduction: Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is the standard of care for high-risk and intermediate-risk non-muscle-invasive bladder cancer (NMIBC) as well as for Carcinoma in situ (CIS). Evidence supports that the different BCG strains, despite genetic variability, are equally effective clinically for preventing the recurrence and progression of papillary NMIBC. The available evidence regarding possible differences in clinical efficacy between various BCG strains in CIS is lacking. Methods: We reviewed the literature on the efficacy of different BCG strains in patients with CIS (whether primary, secondary, concomitant, or unifocal/multifocal), including randomized clinical trials (RCTs), phase II/prospective trials, and retrospective studies with complete response rates (CRR), recurrence-free survival (RFS), or progression-free survival (PFS) as endpoints. Results: In most studies, being RCTs, phase II prospective trials, or retrospective studies, genetic differences between BCG strains did not translate into meaningful differences in clinical efficacy against CIS, regardless of the CIS subset (primary, secondary, or concurrent) or CIS focality (unifocal or multifocal). CRR, RFS, and PFS were not statistically different between various BCG strains. None of these trials were designed as head-to-head comparisons between BCG strains focusing specifically on CIS. Limitations include the small sample size of many studies and most comparisons between strains being indirect rather than head-to-head. Conclusions: This review suggests that the clinical efficacy of the various BCG strains appears similar, irrespective of CIS characteristics. However, based on the weak level of evidence available and underpowered studies, randomized studies in this space should be encouraged as no definitive conclusion can be drawn at this stage.
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Affiliation(s)
- Andres Llano
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
| | - Amy Chan
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
| | - Cynthia Kuk
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
| | - Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, QU H4A 3J1, Canada;
| | - Alexandre R. Zlotta
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Heath Network, University of Toronto, Toronto, ON M5G 2C4, Canada
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Yip HM, Cameron A, Sheppard K, Fasanmade A, Garg M. Oral mucosal melanoma in situ: a case report and review of the literature. Int J Oral Maxillofac Surg 2023; 52:1230-1234. [PMID: 37179134 DOI: 10.1016/j.ijom.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Oral mucosal melanoma is a rare presentation of malignant melanoma with a 5-year survival rate of only 15%. Oral mucosal melanoma in situ (OMMIS) is its assumed precursor. This report describes one of only 20 documented cases of OMMIS and outlines how early clinical recognition resulted in prompt histopathological diagnosis and subsequent complete surgical excision. A literature review of existing reported cases, their management, and latest outcomes was also performed, highlighting this rare condition for consideration in the differential diagnosis of pigmented oral pathologies.
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Affiliation(s)
- H M Yip
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Headington, Oxford, UK.
| | - A Cameron
- Department of Oral Surgery, Great Western Hospital, Swindon, UK
| | - K Sheppard
- Department of Pathology, John Radcliffe Hospital, Headington, Oxford, UK
| | - A Fasanmade
- Department of Oral and Maxillofacial Surgery, Churchill Hospital, Headington, Oxford, UK
| | - M Garg
- Department of Oral and Maxillofacial Surgery, Churchill Hospital, Headington, Oxford, UK
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Huh G, Lee GY, Chung Y, Chae SW, Choi YJ. Pathologically Confirmed Subcutaneous Fat and Lymphovascular Invasion of a Hypopigmented Area in Extramammary Paget Disease. Ann Dermatol 2023; 35:S229-S233. [PMID: 38061710 PMCID: PMC10727877 DOI: 10.5021/ad.21.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/23/2022] [Accepted: 02/20/2022] [Indexed: 12/20/2023] Open
Abstract
Extramammary Paget disease (EMPD) is a rare adenocarcinoma that usually occurs in areas of the body that are rich in apocrine sweat glands. Great depth of tumor invasion is a well-known risk factor for worse prognosis. Paget cells usually are limited to the epidermis, whereas invasive EMPD, which infiltrates the dermis, is relatively rare. It is even rarer for the tumor to spread beyond the dermis. Only 3.1% of patients with EMPD of the penis and scrotum have exhibited infiltration of the subcutaneous fat layer. We report a case of a 62-year-old male with EMPD that invaded the subcutaneous fat layer. He presented with a several-year history of a slowly expanding erythematous plaque with the hypopigmented area on the left penoscrotum. One month before presentation, the patient had undergone punch biopsy at another hospital and diagnosed with EMPD. He had no personal history of urogenital cancers. The patient was treated with Mohs micrographic surgery, and negative margins were achieved after four stages. The histopathologic findings revealed Paget cells scattered throughout the epidermis. At the hypopigmented area, Paget cells extended to the subcutaneous fat layer with lymphovascular invasion. There was no evidence of recurrence at seven months postoperatively. Herein, we describe a case of hypopigmented EMPD that infiltrated the subcutaneous layer, which rarely has been reported in Korea.
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Affiliation(s)
- Gyoo Huh
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga-Young Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yumin Chung
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Jun Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Plambeck BD, Tazegul TE, McElree IM, Steinberg RL, Packiam VT, O'Donnell MA. Neoadjuvant systemic and intravesical chemotherapy with partial cystectomy for muscle invasive bladder cancer with concomitant CIS. Urol Case Rep 2023; 50:102516. [PMID: 37645679 PMCID: PMC10461041 DOI: 10.1016/j.eucr.2023.102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023] Open
Abstract
The presence of carcinoma in situ (CIS) is traditionally a contraindication to bladder-sparing approaches for muscle invasive bladder cancer (MIBC). Strategies that might aid in bladder preservation for this population require further investigation. We report a case of MIBC with CIS treated with both neoadjuvant systemic and intravesical chemotherapy prior to partial cystectomy.
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Affiliation(s)
- Benjamin D. Plambeck
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Tutku E. Tazegul
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Ian M. McElree
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Ryan L. Steinberg
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Vignesh T. Packiam
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Michael A. O'Donnell
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Younes B, Zakaria B, Meriem N, Benhessou M, Ennachit S, El Karroumi M. Extensive Paget's disease of the nipple: Case report. Int J Surg Case Rep 2023; 109:108586. [PMID: 37531879 PMCID: PMC10400464 DOI: 10.1016/j.ijscr.2023.108586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Paget's disease of the nipple is a rare form of ductal carcinoma in situ. It is often associated with an underlying breast cancer or, more rarely, may be isolated with no associated breast neoplasm. PRESENTATION OF CASE We report the case of a patient with extensive Paget's disease of the nipple without associated breast lesions, treated by mastectomy with coverage by a dorsalis major flap. CLINICAL DISCUSSION The association of Paget's disease of the nipple with breast cancer is the most frequent situation, requiring a complete radiological work-up of the breast. The diagnosis is confirmed by anatomopathological examination combined with immunohistochemistry, the treatment of Paget's disease of the nipple remains controversial, with conservative or radical treatment depending on the extent of the disease and the presence or absence of associated breast cancer. CONCLUSION Paget's disease of the nipple is a rare form of breast cancer. Treatment relies mainly on surgery, which can be either conservative or radical.
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Affiliation(s)
- Bencherifi Younes
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco.
| | - Bousada Zakaria
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Nouri Meriem
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Mustapha Benhessou
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Simohamed Ennachit
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Mohammed El Karroumi
- Onco-gynecological Surgery Center, University Hospital Center Ibn Rochd Casablanca, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
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Yamaguchi R, Watanabe H, Mihara Y, Yamaguchi M, Tanaka M. Histopathology of non-mass-like breast lesions on ultrasound. J Med Ultrason (2001) 2023; 50:375-380. [PMID: 36773105 PMCID: PMC10354136 DOI: 10.1007/s10396-023-01286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/30/2022] [Indexed: 02/12/2023]
Abstract
There have been several investigations of non-mass-like (NML) lesions on ultrasound (US) since Uematsu first described this approach, and it is a relatively new concept for breast examination. However, the results have varied, and there have been only a few studies related to the detailed histopathology of NML lesions on US. Here, we review the histopathology of NML lesions. NML lesions are pathologically benign, atypical, or malignant. There are two major findings of NML lesions on US: architectural distortion and calcifications. Architectural distortion pathologically indicates a fibrous change with ductal proliferation, invasive breast carcinoma, and carcinoma in situ. Histopathologically, microcalcifications are seen in both benign and malignant lesions, and it is important to distinguish between these lesions among NML lesions, particularly fibrocystic changes including adenosis and hyperplasia in the case of benign lesions and carcinoma in situ (ductal and lobular) in the case of malignant lesions. The differential major points may be whether NML lesions are associated with abundant hyperechoic foci, which indicate comedo necrosis on histology. They are usually high-grade carcinoma in situ that may be positive for HER2 or triple negativity. A recent report indicated that low-grade carcinoma in situ showed better survival than higher-grade carcinoma in situ, which is often accompanied by comedo necrosis on histology, reflecting visible microcalcification on US. NML lesions are considered to include a certain rate of low-grade carcinoma in situ. Therefore, more caution may be needed when detecting and managing NML lesions to avoid overdiagnosis and overtreatment as a result of this recent "low-risk ductal carcinoma in situ" concept.
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Affiliation(s)
- Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, 155-1 Kokubu, Kurume, Fukuoka, 839-0863, Japan.
| | - Hidetaka Watanabe
- Department of Surgery, Japan Community Healthcare Organization Kurume General Hospital, Kurume, Fukuoka, Japan
| | - Yutaro Mihara
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Miki Yamaguchi
- Department of Surgery, Japan Community Healthcare Organization Kurume General Hospital, Kurume, Fukuoka, Japan
| | - Maki Tanaka
- Department of Surgery, Japan Community Healthcare Organization Kurume General Hospital, Kurume, Fukuoka, Japan
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Inman BA, Hahn NM, Stratton K, Kopp R, Sankin A, Skinner E, Pohar K, Gartrell BA, Pham S, Rishipathak D, Mariathasan S, Davarpanah N, Carter C, Steinberg GD. A Phase 1b/2 Study of Atezolizumab with or Without Bacille Calmette-Guérin in Patients with High-risk Non-muscle-invasive Bladder Cancer. Eur Urol Oncol 2023; 6:313-320. [PMID: 36803840 DOI: 10.1016/j.euo.2023.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/02/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG) is the standard therapy after transurethral resection of bladder tumour for high-risk non-muscle-invasive bladder cancer (NMIBC). However, post-BCG recurrence/progression occurs frequently, and noncystectomy options are limited. OBJECTIVE To evaluate the safety and clinical activity of atezolizumab ± BCG in high-risk BCG-unresponsive NMIBC. DESIGN, SETTING, AND PARTICIPANTS This phase 1b/2 GU-123 study (NCT02792192) treated patients with BCG-unresponsive NMIBC who had carcinoma in situ with atezolizumab ± BCG. INTERVENTION Patients in cohorts 1A and 1B received atezolizumab 1200 mg IV q3w for ≤96 wk. Those in cohort 1B also received standard BCG induction (six weekly doses) and maintenance courses (three doses weekly starting at month 3) with optional maintenance at 6, 12, 18, 24, and 30 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Coprimary endpoints were safety and 6-mo complete response (CR) rate. Secondary endpoints included 3-mo CR rate and duration of CR; 95% confidence intervals were calculated using the Clopper-Pearson method. RESULTS AND LIMITATIONS At data cut-off (September 29, 2020), 24 patients were enrolled (cohort 1A, n = 12; cohort 1B, n = 12), and the recommended BCG dose was 50 mg in cohort 1B. Four patients (33%) had adverse events (AEs) leading to BCG dose modification/interruption. Three patients (25%) in cohort 1A reported atezolizumab-related grade 3 AEs; cohort 1B had no atezolizumab- or BCG-related grade ≥3 AEs. No grade 4/5 AEs were reported. The 6-mo CR rate was 33% in cohort 1A (median duration of CR, 6.8 mo) and 42% in cohort 1B (median duration of CR, not reached [≥12 mo]). These results are limited by the small sample size of GU-123. CONCLUSIONS In this first report of the atezolizumab-BCG combination in NMIBC, atezolizumab ± BCG was well tolerated, with no new safety signals or treatment-related deaths. Preliminary results suggested clinically meaningful activity; the combination favoured a longer duration of response. PATIENT SUMMARY We studied atezolizumab with and without bacille Calmette-Guérin (BCG) to determine whether this combination was safe and had clinical activity in patients with high-risk noninvasive bladder cancer (high-grade bladder tumours that affect the outermost lining of the bladder wall) that has previously been treated with BCG and is still present or occurred again. Our results suggest that atezolizumab with or without BCG was generally safe and could be used to treat patients unresponsive to BCG.
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Affiliation(s)
- Brant A Inman
- Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Noah M Hahn
- Department of Oncology, Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Stratton
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ryan Kopp
- Department of Urology, Oregon Health & Science University, Portland, OR, USA; VA Portland Healthcare System, Portland, OR, USA
| | - Alex Sankin
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Eila Skinner
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH, USA
| | | | - Song Pham
- Genentech Inc, South San Francisco, CA, USA
| | | | | | | | | | - Gary D Steinberg
- Goldstein Bladder Cancer Program, NYU Langone Health, New York, NY, USA; Department of Urology, New York University School of Medicine, New York, NY, USA
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11
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Kikuyama M, Nakahodo J, Honda G, Suzuki M, Horiguchi SI, Chiba K, Tabata H, Ome Y, Uemura SI, Kawamoto Y, Kamisawa T. Pancreatic duct epithelial malignancy suggested by large focal pancreatic parenchymal atrophy in cystic diseases of the pancreas. Pancreatology 2023:S1424-3903(23)00066-2. [PMID: 37003856 DOI: 10.1016/j.pan.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND /Objectives: A cystic lesion is common in the pancreas. Focal pancreatic parenchymal atrophy (FPPA) has been reported as a sign of high-grade pancreatic intraepithelial neoplasia/carcinoma in situ (HGP/CIS). Some cystic lesions accompany FPPA. However, the relationship between a cystic lesion, FPPA, and the histopathological background of the pancreatic duct is unknown. METHODS We retrospectively evaluated the data of 98 patients with a cystic lesion who underwent serial pancreatic juice aspiration cytologic examination (SPACE) because of accompanying FPPA, increased size of the cystic lesion, and pancreatic duct stricture at the base. RESULTS The clinical diagnosis of a cystic lesion was intraductal papillary mucinous neoplasia (IPMN) and cysts in 72 (73.5%) and 26 (26.5%) patients, respectively. Ninety of the 98 patients (91.8%) had FPPA. Positive results (adenocarcinoma and suspicion) on SPACE were observed in 56 of all cases (57.1%), 48 of IPMN (66.7%), 8 of cysts (30.8%), and 54 of FPPA (59.3%), and were significantly associated with IPMN (p = 0.002) and the large FPPA (>269.79 mm2,p = 0.0001); moreover, these disorders are considerably related (p = 0.0003). Fifty patients (51.0%) with positive results on SPACE underwent surgery, with the histopathological diagnosis of epithelial malignancy in 42 patients (42.9%, 42/50, 84%). Many cystic lesions clinically diagnosed as IPMN were dilated branches covered by pancreatic intraepithelial neoplasia. CONCLUSIONS Positive results on SPACE were significantly associated with the clinical diagnosis of IPMN and the large FPPA. Moreover, these disorders are significantly related. Surgery owing to positive results could lead to the histopathological diagnosis of HGP/CIS.
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Tokyo Women's Medical Hospital, Tokyo, Japan; Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
| | - Jun Nakahodo
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Women's Medical Hospital, Tokyo, Japan
| | - Mizuka Suzuki
- Department of Radiology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | | | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Hiroki Tabata
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Yusuke Ome
- Department of Surgery, Tokyo Women's Medical Hospital, Tokyo, Japan
| | | | - Yusuke Kawamoto
- Department of Surgery, Tokyo Women's Medical Hospital, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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12
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Gaisa NT, Hartmann A, Knüchel-Clarke R. [New WHO classification 2022: urinary bladder cancer]. Pathologie (Heidelb) 2023; 44:139-148. [PMID: 36826493 DOI: 10.1007/s00292-023-01183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 02/25/2023]
Abstract
The new World Health Organization (WHO) classification of urogenital tumors is still primarily based on anatomic location, but is also a hierarchical taxonomic classification without separate chapters for tumors of the upper urinary tract and the urethra. It clarifies aspects regarding grading and noninvasive entities. It consolidates the use of the Paris system for urinary cytology as well as various subtypes/special types of neoplasms, and incorporates general concepts of the 5th edition of the WHO blue book. In addition to mesenchymal tumors, well-differentiated neuroendocrine tumors and neuroendocrine carcinomas are addressed in separate chapters. Papillary non-invasive low- and high-grade carcinomas and carcinoma in situ remain, while dysplasia and urothelial proliferation of unknown malignant potential (UPUMP) are no longer treated as separate entities. Former variants of urothelial carcinoma are now called subtypes and aberrant differentiation and special types are more precisely defined.
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Affiliation(s)
- Nadine Therese Gaisa
- Institut für Pathologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - Arndt Hartmann
- Institut für Pathologie, Uniklinikum Erlangen, Erlangen, Deutschland
| | - Ruth Knüchel-Clarke
- Institut für Pathologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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13
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Tachibana T, Ikeda M, Shimura S, Amano N, Murakami Y, Yamada Y, Koguchi D, Maeyama R, Kawamura M, Sakata Y, Hagiwara M, Matsumoto K, Iwamura M. Efficacy of Intravesical Instillation Therapy with Low-Dose Tokyo-172 Bacillus Calmette-Guérin to Prevent Recurrence of Non-Muscle-Invasive Bladder Cancer and Treat Carcinoma in situ: A Multi-Institutional Retrospective Study. Urol Int 2023; 107:230-238. [PMID: 36646046 PMCID: PMC10064385 DOI: 10.1159/000527718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION There are various doses, durations, and strains of bacillus Calmette-Guérin (BCG) intravesical instillation therapy, but optimal treatment has not yet been established. We retrospectively investigated the efficacy and safety of low-dose BCG therapy for non-muscle-invasive bladder cancer (NMIBC) and carcinoma in situ (CIS) in a multicenter study. METHODS From 1991 to 2019, 323 patients who received BCG therapy to prevent recurrence of NMIBC were analyzed as group A. Similarly, 147 patients who received BCG therapy for the treatment of CIS were analyzed as group B. Patients received low- or full-dose Tokyo-172 strain or full-dose Connaught strain, and the three strains were compared. Survival curves were estimated by the Kaplan-Meier method, and independent risk factors for intravesical recurrence were examined by multivariate logistic regression. RESULTS Recurrence-free survival (RFS) in group A was significantly better for the Connaught strain than the low-dose Tokyo-172 strain (p = 0.026), but not between the low- and full-dose Tokyo-172 strains (p = 0.443). RFS of group B, cancer-specific survival, and progression-free survival in both groups did not show statistically significant differences. Logistic analysis of group A showed that for intravesical recurrence, only pT1 was a significant risk factor, and there were no differences between the BCG strain and dose and no significant factors in group B. There were also no differences in the completion rate in both groups, but adverse events such as urinary frequency and feeling of residual urine were significantly lower with the low-dose Tokyo-172 strain. CONCLUSION There was no difference in efficacy between the low- and full-dose Tokyo-172 strains, but to minimize adverse events, the low-dose Tokyo-172 strain may be worth considering.
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Affiliation(s)
- Takashi Tachibana
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
- Department of Urology, Kitasato University Medical Center, Saitama, Japan
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Soichiro Shimura
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Noriyuki Amano
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasukiyo Murakami
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasufumi Yamada
- Department of Urology, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
- Department of Urology, Yokosuka City Uwamachi Hospital, Kanagawa, Japan
| | - Ryota Maeyama
- Department of Urology, Higashiyamato Hospital, Tokyo, Japan
| | | | - Yusuke Sakata
- Department of Urology, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Masahiro Hagiwara
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
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14
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Fernández-Nestosa MJ, Clavero O, Sánchez DF, Giannico GA, Lobatti A, Cañete-Portillo S, Velázquez EF, Alemany L, Muñoz N, de San José S, Bosch FX, Cubilla AL. Penile intraepithelial neoplasia: Distribution of subtypes, HPV genotypes and p16(INK4a) in 84 international cases. Hum Pathol 2023; 131:1-8. [PMID: 36427594 DOI: 10.1016/j.humpath.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
There are few pathologic or molecular studies of penile precancerous lesions, and the majority refers to lesions associated with invasive carcinomas. Penile Intraepithelial Neoplasia (PeIN) is classified in two morphologically and distinctive molecular groups, non-HPV and HPV-related with special subtypes. The primary purpose of this international series was to classify PeIN morphologically, detect HPV genotypes and determine their distribution according to PeIN subtypes. A secondary aim was to evaluate the p16INK4a immunostaining as a possible HPV surrogate for high-risk HPV infection in penile precancerous lesions. Samples consisted of 84 PeIN cases, part of a retrospective cross-sectional analysis of 1095 penile carcinomas designed to estimate the HPV DNA prevalence in penile cancers using PCR and p16INK4a immunostaining. Penile Intraepithelial Neoplasia (PeIN) was classified in HPV-related (basaloid, warty-basaloid, warty, hybrid, and mixed subtypes) and non-HPV-related (differentiated), the former being the most frequent. PeIN subtypes were differentiated (non-HPV-related) and basaloid, warty-basaloid, warty, hybrid and mixed (HPV-related). Basaloid PeIN was the most commonly diagnosed subtype, and HPV16 was the most frequent HPV genotype detected. Warty-basaloid and warty PeIN showed a more heterogeneous genotypic composition. Most HPV genotypes were high-risk but low-risk HPV genotypes were also present in a few cases (4%). A single HPV genotype was detected in 82% of HPV positive cases. In contrast, multiple genotypes were detected in the remaining 18% of cases. The findings in this study support the paradigm that penile in situ neoplasia, like its invasive counterparts, is HPV dependent or independent and has distinctive morphological subtypes readily identified in routine practice. Considering that HPV16 is clearly the predominant type, and that the three available vaccines have HPV16, all of them will be suitable for vaccination programs; the price of the vaccines will be probably the main determinant to choose the vaccine.
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15
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Yoon SB, Jung MK, Lee YS, Park JK, Jang DK, Lee JM, Lee HS, Shin DW, Lee JC, Hwang JH. Long-term outcomes of endoscopic papillectomy for ampullary adenoma with high-grade dysplasia or adenocarcinoma: a propensity score-matched analysis. Surg Endosc 2022; 37:3522-3530. [PMID: 36587061 DOI: 10.1007/s00464-022-09856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Evidence of endoscopic papillectomy (EP) for ampullar adenoma with high-grade dysplasia (HGD) or adenocarcinoma is insufficient. Here we investigated the long-term outcomes of the advanced ampullary tumors treated by EP with careful surveillance comparing to subsequent surgery after EP. METHODS Patients treated with EP for ampullary adenoma with HGD or adenocarcinoma from the multi-center retrospective Korean cohort of ampulla of Vater tumor were categorized into EP alone versus EP with subsequent surgery groups. The overall survival (OS) and recurrence-free survival (RFS) were analyzed for unmatched and matched cohorts using propensity score with nearest neighbor method. RESULTS During a median 43.3 months of follow-up, 5-year OS was not significantly different between the EP alone and EP surgery groups (91.9% vs. 82.3%, P = 0.443 for unmatched cohort; 89.2% vs. 82.3%, P = 0.861 for matched cohort, respectively). Furthermore, 5-year RFS was not significantly different between the two groups (82.1% vs. 86.7%, P = 0.520 for unmatched cohort; 66.1% vs. 86.7%, P = 0.052 for matched cohort, respectively). However, the patients with positive both (lateral and deep) margins showed significantly poorer survival outcomes than those with negative margins within the EP alone group (P = 0.007). CONCLUSION EP alone with careful surveillance showed comparable survival outcomes to those of EP with subsequent surgery for ampullar HGD or adenocarcinoma. Resection margin status could be a parameter to determine whether to perform subsequent radical surgery after EP.
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Affiliation(s)
- Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Kyu Jung
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea. .,Division of Gastroenterology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsan Seogu, Goyang, 10380, South Korea.
| | - Joo Kyung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Woo Shin
- Department of Internal Medicine, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jin-Hyeok Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Mathieu R, Amanda W, Eric B, Gang W, Black PC. Detection and resection of carcinoma in situ of the bladder: Implications for clinical trial design. Urol Oncol 2022; 41:254.e9-254.e15. [PMID: 36566105 DOI: 10.1016/j.urolonc.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The path to approval of novel therapeutics for patients with BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) requires demonstration of efficacy in eradicating carcinoma in situ (CIS), as determined by cytology, white light cystoscopy and only sometimes mandatory re-biopsy. This paradigm is based on the premise that CIS, in contrast to papillary tumors, cannot be completely resected. We aimed to determine the accuracy of CIS by standard means and the rate at which CIS may be eradicated by transurethral bladder tumor resection (TURBT). METHODS We performed a retrospective analysis of consecutive patients who underwent radical cystectomy (RC) for high risk NMIBC or muscle invasive bladder cancer (MIBC) between 2005 and 2019 in a tertiary academic center. The concordance in the presence of CIS in matched TURBT and RC samples was calculated. RESULTS Complete pathologic information was available for 816 patients with urothelial carcinoma. CIS was detected at TURBT in 354 (43.4%) patients (64.0% NMIBC, 32.3% MIBC) and at RC in 436 (53.4%) patients (64.7% NMIBC, 47.4% MIBC). CIS was missed by TURBT in 199 (45.6%) of those cases (NMIBC 25.4%, MIBC 60.6%). CIS detected on TURBT was not found in the RC specimen in 33.1% (117/354) of cases. Lack of prospective bladder mapping and central pathology review are limitations. CONCLUSION Our results suggest that TURBT is inaccurate in detecting CIS. The absence of CIS in the RC specimen after detection in the matched TURBT specimen suggests that CIS may be completely resected by TURBT in a proportion of patients. These factors need to be considered in the design of clinical trials in patients with NMIBC. The use of random biopsies or enhanced cystoscopy could improve the accuracy of CIS detection, but the former is associated with patient morbidity and randomization would alleviate concern about these variables impacting clinical trial outcomes.
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Affiliation(s)
- Roumiguié Mathieu
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Department of Urology, Toulouse University Hospital, Toulouse, France
| | - Wong Amanda
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Belanger Eric
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Wang Gang
- Department of Pathology, British Columbia Cancer Vancouver Centre, Vancouver, Canada
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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17
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Sargunaraj JJE, Mathews SS, Paul RR, Michael RC, Thomas M, Gowri M, Albert RRA. Role of Narrow Band Imaging in Laryngeal Lesions: A Prospective Study from Southern India. Indian J Otolaryngol Head Neck Surg 2022; 74:5127-5133. [PMID: 36742616 PMCID: PMC9895569 DOI: 10.1007/s12070-021-02945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
To assess the utility of Narrow Band Imaging (NBI) as a diagnostic tool in evaluating laryngeal pathology in patients presenting with hoarseness. Study design: Prospective cross sectional diagnostic study. Methods: 200 patients with voice change were recruited and laryngeal findings documented with high definition flexible endoscopy with both white light and narrow band light and the representative still images recorded for analysis. The NBI intraepithelial papillary capillary loop (IPCL) patterns was compared with the histopathology report. Of the 200 patients evaluated, 84 lesions were biopsied which included both benign and malignant lesions. The sensitivity obtained was 73.3% [54.1-87.7% with 95% CI] and the specificity was 87% [75.1-94.6% with 95% CI] for detecting malignant lesions. NBI can be considered as a useful diagnostic tool in evaluating laryngeal pathology and can be used to detect early premalignant and malignant lesions.
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Affiliation(s)
| | - Suma Susan Mathews
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Roshna Rose Paul
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Rajiv C. Michael
- Department of Head and Neck Surgery, Christian Medical College, Vellore, 632004 India
| | - Meera Thomas
- Department of General Pathology, Christian Medical College, Vellore, 632004 India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, 632004 India
| | - Rita Ruby A. Albert
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
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18
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Mathonnet A, Dabakuyo S, Philip CA, Jankowski C, Cortet M. [How is our practice of mastectomy? Analysis based on population data in a French department]. Gynecol Obstet Fertil Senol 2022; 50:770-776. [PMID: 36183985 DOI: 10.1016/j.gofs.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this research was to study the evolution of the mastectomy rate in patients with breast cancer between 1998 and 2015, based on population data from the Côte d'Or breast cancer registry of the FRANCIM network ("France cancer incidence and mortality"). METHODS In this study on population register we included patients who had presented a primary breast cancer (invasive cancer and/or carcinoma in situ [CIS]) between 1998 and 2015 in the Côte d'Or department. We estimated the annual proportions of mastectomies, then calculated their evolution trends over this period. RESULTS Between 1998 and 2015, 7093 patients were included. The overall proportion of mastectomies was stable at 28% and did not respond to a time trend (Sen's slope of 0.2% per year; P=0.289). There was an increase in the proportion of lobular carcinomas (slope at 0.3% per year; P <0.05), with a rising proportion of mastectomy for lobular carcinomas (slope at 0.6% per year; P<0.05) but decreasing for ductal (slope at -0.8% per year; P<0.05). The proportion of mastectomy was stable for plurifocal cancers but the proportion of plurifocal cancers increased over time (slope at 0.8% per year; P<0.05). CONCLUSION Therefore, mastectomy remained a stable practice over the 18 years of analysis in the Côte d'Or region. However, this overall stability is the result of variations in the profiles of diagnosed cancers and surgical practices.
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Affiliation(s)
- A Mathonnet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France.
| | - S Dabakuyo
- Registre des cancers du sein et des cancers gynécologiques de Côte d'Or, unité de recherche en epidémiologie et qualité de vie, Inserm U1231, Georges François Leclerc Centre-UNICANCER, Dijon, France
| | - C-A Philip
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
| | - C Jankowski
- Service de chirurgie oncologique, centre de lutte contre le cancer Georges-François Leclerc, Dijon, France
| | - M Cortet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
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Territo A, Fontanet S, Meneghetti I, Gallioli A, Sanguedolce F, Rodriguez-Faba Ó, Gaya JM, Palou J, Huguet J, Breda A. Management of primary upper urinary tract carcinoma in situ diagnosed by ureteroscopic biopsy: Is bacillus Calmette-Guerin an alternative to nephroureterectomy? Actas Urol Esp 2022; 47:221-228. [PMID: 36379260 DOI: 10.1016/j.acuroe.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Radical nephroureterectomy (RNU) represents the gold standard treatment for upper tract urothelial carcinoma (UTUC); however, attempts have been made to treat upper urinary tract CIS (UT-CIS) conservatively. The aim of this study was to compare the outcome of patients with primary UT-CIS treated in our center by means of RNU vs. bacillus Calmette-Guérin (BCG) instillations. METHODS This retrospective study included patients with diagnosis of primary UT-CIS between 1990 and 2018. All patients had histological confirmation of UT-CIS in the absence of other concomitant UTUC. Histological confirmation was obtained by ureteroscopy with multiple biopsies. Patients were treated with BCG instillations, RNU or distal ureterectomy. Clinicopathological features and outcomes were compared between RNU and BCG groups. RESULTS A total of 28 patients and 29 renal units (RUs) were included. Sixteen (57.1%) patients (17 RUs) received BCG. BCG was administered via nephrostomy tube in 4 patients, with a single-J ureteral stent in 5, and using a Double-J stent in 7. Complete response and persistence or recurrence were detected in ten (58.8%) and seven (41.2%) RUs treated with BCG, respectively. Eight (27.6%) RUs underwent RNU, and 4 (13.8%) Rus distal ureterectomy. No differences were found in recurrence-free survival (p=0.841) and cancer-specific survival (p=0.77) between the RNU and BCG groups. CONCLUSIONS Although RNU remains the gold standard treatment for UT-CIS, our results confirm that BCG instillations are also effective. Histological confirmation of UT-CIS is mandatory before any treatment.
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Affiliation(s)
- A Territo
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - S Fontanet
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - I Meneghetti
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Gallioli
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - F Sanguedolce
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ó Rodriguez-Faba
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Gaya
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Palou
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Huguet
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Breda
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
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Straccia P, Fiorentino V, Martini M, Pierconti F. A systematic review and meta-analysis of CK20, CD44, Ki67 and p53 as immunohistochemical markers in bladder carcinoma in situ. Actas Urol Esp 2022; 46:521-30. [PMID: 36216762 DOI: 10.1016/j.acuroe.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/18/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Urothelial dysplasia and carcinoma in situ (CIS) are related to recurrence and progression of urothelial carcinoma. Differentiating CIS and dysplasia from reactive atypia is often difficult based only on histological features. The integration of histological findings with immunohistochemistry is used in routine practice to make a diagnosis of CIS and, for this purpose, the immunohistochemical markers CK20, CD44, Ki67 and p53 are used to supplement histology. In this work, we aimed to assess CK20, CD44, Ki67 and p53 as immunohistochemical markers in patients with CIS through a systematic review and meta-analysis. MATERIALS AND METHODS A systematic review was performed by searching electronic databases for English-language studies published from January 2010 to April 2021. Studies were considered eligible if they evaluated the CK20, CD44, Ki67 and p53 expression in CIS. RESULTS In total, 15 references were suitable for quantitative review. The overall rate of CK20, CD44, Ki67 and p53 expression in CIS was 43%, 31%, 44%, 38%, respectively. CONCLUSIONS Our study supports the 2014 International Society of Urologic Pathology consensus that histological assessment remains the gold standard to diagnose urothelial CIS and suggests that a very close correlation between morphological, immunohistochemical and clinical data is essential to provide the best management for patients with bladder carcinoma.
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21
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Subiela JD, Rodríguez Faba Ó, Aumatell J, Gonzalez-Padilla DA, Rosales Bordes A, Huguet J, Krajewski W, Algaba F, López Curtis D, Brasero Burgos J, Sánchez González Á, Jiménez Cidre MÁ, Burgos Revilla FJ, Breda A, Palou J. Long-term Recurrence and Progression Patterns in a Contemporary Series of Patients with Carcinoma In Situ of the Bladder With or Without Associated Ta/T1 Disease Treated with Bacillus Calmette-Guérin: Implications for Risk-adapted Follow-up. Eur Urol Focus 2022; 9:325-332. [PMID: 36163105 DOI: 10.1016/j.euf.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited data are available on patients with carcinoma in situ (CIS) of the bladder managed according to current clinical practice guidelines. OBJECTIVE To assess the patterns of recurrence, progression to muscle-invasive bladder cancer (MIBC), and upper tract urothelial carcinoma (UTUC) in patients with CIS, and to compare the effectiveness of adequate versus inadequate bacillus Calmette-Guérin (BCG) immunotherapy. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 386 patients with CIS of the bladder with or without associated pTa/pT1 disease treated with BCG between 2008 and 2015. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier estimations and an inverse probability of treatment weighting (IPTW)-Cox regression were performed to compare recurrence-free survival (RFS) and progression-free survival (PFS) and UTUC incidence over time for patients who received adequate versus inadequate BCG treatment. RESULTS AND LIMITATIONS The median follow-up was 70.5 mo. At 5 and 10 yr, RFS was 82% and 52%, PFS was 93.6% and 75.8%, and UTUC incidence was 1.7% and 2.9%, respectively. Most recurrence (73.6%) and progression (69.1%) events occurred in the first 3 yr of follow-up, while 38.7% of UTUC incident events were recorded after 5 yr of follow-up. IPTW-Cox regression revealed that patients who received BCG treatment had a lower risk of recurrence (hazard ratio [HR] 0.21, 95% confidence interval [CI] 0.13-0.34), progression (HR 0.46, 95% CI 0.25-0.87), and UTUC incidence (HR 0.24, 95% CI 0.09-0.64). Limitations include the retrospective design and potential selection bias. CONCLUSIONS Patients with CIS of the bladder show a high risk of recurrence, progression, and UTUC incidence. Most of these outcomes occur during the first 3 yr of follow-up, but a significant proportion of the events occur at long-term follow-up. Although receipt of adequate BCG treatment improves outcomes, intensive and long-term surveillance may be warranted. PATIENT SUMMARY We investigated the long-term cancer control outcomes for patients with carcinoma in situ (CIS; cancerous cells that have not spread from where they first formed) of the bladder. Patients with CIS have a high risk of cancer recurrence and progression. Treatment with bacillus Calmette-Guérin (BCG) improves outcomes.
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Affiliation(s)
- José Daniel Subiela
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain.
| | - Óscar Rodríguez Faba
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - Júlia Aumatell
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | | | - Antonio Rosales Bordes
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - Jorge Huguet
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Department of Public Health, Wrocław Medical University, Wrocław, Poland
| | - Ferran Algaba
- Department of Pathology, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain; Department of Morphological Sciences, Barcelona, Spain
| | - David López Curtis
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Jennifer Brasero Burgos
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Álvaro Sánchez González
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Miguel Ángel Jiménez Cidre
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | | | - Alberto Breda
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - Joan Palou
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
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Lewis JS Jr, Smith MH, Wang X, Tong F, Mehrad M, Lang-Kuhs KA. Human Papillomavirus-Associated Oral Cavity Squamous Cell Carcinoma: An Entity with Distinct Morphologic and Clinical Features. Head Neck Pathol 2022; 16:1073-81. [PMID: 35802245 DOI: 10.1007/s12105-022-01467-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND HPV-associated oral cavity squamous cell carcinoma (SCC) is not well-characterized in the literature, and also has a clinical significance that is poorly understood. METHODS We gathered a cohort of oral cavity (OC) SCC with nonkeratinizing morphology, either in the invasive or in situ carcinoma (or both), tested for p16 by immunohistochemistry and high risk HPV E6/E7 mRNA by RTPCR (reference standard for transcriptionally-active high risk HPV) and gathered detailed morphologic and clinicopathologic data. RESULTS Thirteen patients from two institutions were proven to be HPV-associated by combined p16 and high risk HPV mRNA positivity. All 13 patients (100%) were males, all were heavy smokers (average 57 pack/year), and most were active drinkers (9/11 or 81.8%). All 13 (100%) involved the tongue and/or floor of mouth. All had nonkeratinizing features, but maturing squamous differentiation varied widely (0-90%; mean 37.3%). Nonkeratinizing areas had high N:C ratios and larger nests, frequently with pushing borders, and minimal (or no) stromal desmoplasia. The carcinoma in situ, when present, was Bowenoid/nonkeratinizing with cells with high N:C ratios, full thickness loss of maturation, and abundant apoptosis and mitosis. HPV was type 16 in 11 patients (84.6%) and type 33 in two (15.4%). Nine patients had treatment data available. These underwent primary surgical resection with tumors ranging from 1.6 to 5.2 cm. Most had bone invasion (6/9-66.7% were T4a tumors), and most (6/9-66.7%) had extensive SCC in situ with all 6 of these patients having final margins positive for in situ carcinoma. CONCLUSIONS HPV-associated OCSCC is an uncommon entity that shows certain distinct clinical and pathologic features. Recognition of these features may help pathologic diagnosis and could potentially help guide clinical management.
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23
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Chen W, Kang L, Huang Y, Ding Z. Rectal intramucosal carcinoma with lymph node metastasis and tumor deposit. Asian J Surg 2022; 45:1719-1720. [PMID: 35181213 DOI: 10.1016/j.asjsur.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wenhao Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Liang Kang
- Department of Colorectal and Anal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yan Huang
- Department of Pathology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhao Ding
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
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24
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Tomida R, Miyake M, Minato R, Sawada Y, Matsumura M, Iida K, Hori S, Fukui S, Ohyama C, Miyake H, Hongo F, Taoka R, Kobayashi T, Kojima T, Matsui Y, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K, Hashine K. Impact of carcinoma in situ on the outcome of intravesical Bacillus Calmette-Guérin therapy for non-muscle-invasive bladder cancer: a comparative analysis of large real-world data. Int J Clin Oncol 2022; 27:958-968. [PMID: 35142962 DOI: 10.1007/s10147-022-02127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study investigated the clinical impact of carcinoma in situ (CIS) in intravesical Bacillus Calmette-Guérin (BCG) therapy for patients with non-muscle-invasive bladder cancer (NMIBC). METHODS This study retrospectively evaluated 3035 patients who were diagnosed with NMIBC and treated by intravesical BCG therapy between 2000 and 2019 at 31 institutions. Patients were divided into six groups according to the presence of CIS as follows: low-grade Ta without concomitant CIS, high-grade Ta without concomitant CIS, high-grade Ta with concomitant CIS, high-grade T1 without concomitant CIS, high-grade T1 with concomitant CIS, and pure CIS (without any papillary lesion). The endpoints were recurrence- and progression-free survival after the initiation of BCG therapy. We analyzed to identify factors associated with recurrence and progression. RESULTS At a median follow-up of 44.4 months, recurrence and progression were observed in 955 (31.5%) and 316 (10.4%) patients, respectively. Comparison of six groups using univariate and multivariate analysis showed no significant association of CIS. However, CIS in the prostatic urethra was an independent factors associated with progression. CONCLUSION Concomitant CIS did not show a significant impact in the analysis of Ta and T1 tumors which were treated using intravesical BCG. Concomitant CIS in the prostatic urethra was associated with high risk of progression. Alternative treatment approaches such as radical cystectomy should be considered for patients with NMIBC who have a risk of progression.
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Affiliation(s)
- Ryotaro Tomida
- Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Metsuyama, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Ryoei Minato
- Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Metsuyama, Japan
| | - Yuichiro Sawada
- Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Metsuyama, Japan
| | - Masafumi Matsumura
- Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Metsuyama, Japan
| | - Kota Iida
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shinji Fukui
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Kojima
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Naotaka Nishiyama
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Katsuyoshi Hashine
- Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Metsuyama, Japan
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Abstract
In the fifth edition of the World Health Organization (WHO) classification of tumors of the breast, the histological features of the lesions continue to form the basis of the classification; however, molecular pathology nowadays provides approaches for improved diagnostics and prediction of prognosis and treatment response, which have been incorporated into the update of the classification. The most important changes are presented, which include changes in the histological classification of invasive carcinomas, the subtyping of lobular carcinoma in situ (LCIS) and the dignity criteria of phyllodes tumors.
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Affiliation(s)
- Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Gemeinschaftspraxis für Pathologie, Lübeck, Deutschland.
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26
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de Maria Serra F, Parizi JLS, Odorizzi GASDM, Sato GMRH, Patrão IB, Chagas PHN, de Azevedo Mello F, Nai GA. Subchronic exposure to a glyphosate-based herbicide causes dysplasia in the digestive tract of Wistar rats. Environ Sci Pollut Res Int 2021; 28:61477-61496. [PMID: 34173954 DOI: 10.1007/s11356-021-15051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Glyphosate-based herbicides (GBH) are the most widely used herbicide for treatment of crops in the world. The digestive tract is one of the first systems exposed to pesticides, and damage to this system can affect the general health of individuals. The aim of this study was to evaluate the effects of subchronic inhalation and oral exposure to GBH on the digestive tract in rats. Six groups of Wistar rats (male and female) were exposed to nebulization with three concentrations of GBH [3.71 × 10-3 grams of active ingredient per hectare (g.a.i./ha), 6.19 × 10-3 g.a.i./ha and 9.28 × 10-3 g.a.i./ha] administered orally or by inhalation for 75 days. Bone marrow cells, smears of the tongue and fragments of the tongue, oesophagus, stomach and intestine were collected for histopathological analysis. Congestion, inflammation, an increase in the number of mast cells and nucleoli-organizing regions were detected in the tongue in the groups exposed to GBH. Females had a higher number of mast cells in the tongue than males. Animals in the groups exposed to higher concentrations of GBH showed dysplasia in the oesophagus and small and large intestine regardless of sex. Gastric changes were not observed. Animals exposed to GBH showed increased micronucleus formation. Our data indicate that GBH causes oral allergies and dysplastic lesions in the oesophagus and small and large intestine and has genotoxic potential.
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Affiliation(s)
- Fernanda de Maria Serra
- Graduate Program in Animal Science, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
| | - José Luiz Santos Parizi
- Department of Pathology, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
- Faculty of Medicine of Presidente Prudente (FAMEPP), Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
| | | | - Grace Mitiko Rosati Hori Sato
- Faculty of Dentistry of Presidente Prudente (FOPP), Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
| | - Isabela Bocardi Patrão
- Faculty of Dentistry of Presidente Prudente (FOPP), Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
| | - Pedro Henrique Nahas Chagas
- Faculty of Medicine of Presidente Prudente (FAMEPP), Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
| | - Fabíola de Azevedo Mello
- Graduate Program in Animal Science, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
| | - Gisele Alborghetti Nai
- Graduate Program in Animal Science, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil.
- Department of Pathology, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil.
- Faculty of Medicine of Presidente Prudente (FAMEPP), Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil.
- Faculty of Dentistry of Presidente Prudente (FOPP), Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil.
- Laboratório de Anatomia Patológica e Citopatologia, Universidade do Oeste Paulista (UNOESTE), Rua José Bongiovani, 700, Presidente Prudente, SP, 19050-680, Brazil.
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27
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Soorojebally Y, Surlemont L, Neuzillet Y, Lebret T. Impact of carcinoma in situ on survival of patients treated by adjuvant chemotherapy after cystectomy. Prog Urol 2021:S1166-7087(21)00474-7. [PMID: 34756696 DOI: 10.1016/j.purol.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Factors predicting response to adjuvant chemotherapy (AC) are required to identify patients who will most benefit from it. The aim of this study was to evaluate the impact of carcinoma in situ (CIS) at radical cystectomy (RC) on recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS) of patients treated by AC. MATERIALS AND METHODS A single-center retrospective study was performed on patients who received AC after RC without pre-RC chemotherapy or trimodal therapy. RESULTS Among the 150 patients analyzed, 52,7% had CIS on the RC specimens. Baseline characteristics were not significantly different between the CIS negative and positive groups. Most patients received a cisplatin-based AC (74%). The median follow-up of the cohort was 36,4 months. The presence of CIS was not significantly associated to disease-recurrence (OR=0.67; 95%CI=0.35-1.29; P=0.23), cancer related death (OR=0.70; 95%CI=0.36-1.33; P=0.27) or death by any cause (OR=0.80; 95%CI=0.42-1.52; P=0.50). The presence of CIS had no significant impact on RFS (HR=0.86; 95%CI=0.56-1.33; P=0.49), CSS (HR=0.85; 95%CI=0.53-1.36; P=0.50) or OS (HR=0.93; 95%CI=0.60-1.45; P=0.74). CONCLUSION The presence of CIS on RC specimens did not have an impact on survival of patients treated by AC. CIS could be evaluated as a prognostic factor of response to novel adjuvant regimens such as immunotherapy.
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Hurle R, Guazzoni G, Colombo P, Santoro A, De Cobelli O, Trapani ED, Nohales G, Carlos L, Duran-Merino R, Lazzeri M. Oncofid-P-B: a novel treatment for BCG unresponsive carcinoma in situ (CIS) of the bladder: Results of a prospective European Multicentre study at 15 months from treatment start. Urol Oncol 2021; 40:11.e9-11.e15. [PMID: 34649772 DOI: 10.1016/j.urolonc.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/06/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study reports the safety and efficacy of Oncofid-P-B, a novel compound under development by Fidia Farmaceutici S.p.A. with specific binding to CD44 receptor, in patients with CIS unresponsive or intolerant to BCG. MATERIALS AND METHODS This is a phase 1 open-label, single arm, multicenter European study to assess safety, tolerability and efficacy of Oncofid-P-B administered in 20 patients with CIS ± Ta-T1, unresponsive or intolerant to BCG, unwilling or unfit for cystectomy. Oncofid-P-B was administered by intravesical instillation for 12 consecutive weeks (intensive phase) followed, in CR patients, by 12 monthly instillations (maintenance phase). The primary objective was the overall safety profile. Secondary objectives included: i) any evidence of antitumor activity, ii) patient's compliance, iii) systemic absorption. The CR was defined as a negative cystoscopy, negative biopsy of the urothelium and negative cytology. RESULTS At the end of the intensive phase, 15 of the 20 enrolled patients (75%), achieved the CR. Patients still in CR after 3, 6, 9 and 12 months of maintenance phase were 13 (65%), 12 (60%), 9 (45%) and 8 (40%), respectively. Only seven (5 mild and 2 moderate) drug-related AEs were reported in three patients. No drug related serious AEs and no drug related withdrawals have been reported. In all plasma samples, the drug concentratiosn was below the LLOQ (1ng/ml). CONCLUSIONS Oncofid-P-B is very safe, well tolerated and highly effective (75% CR) when administered weekly for up to 12 consecutive weeks (75% CR), with 40% CR still after 15 months from treatment start.
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Affiliation(s)
- Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | | | - Armando Santoro
- Department of Oncology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gloria Nohales
- Department of Urology, Hospital del Mar, Barcelona, Spain
| | - Llorente Carlos
- Department of Urology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | | | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Italy
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Slaager C, Hofhuis W, Hoogduin K, Ewing-Graham P, van Beekhuizen H. Serous endometrial intraepithelial carcinoma (SEIC): Current clinical practice in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2021; 265:25-29. [PMID: 34416579 DOI: 10.1016/j.ejogrb.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Serous endometrial intraepithelial carcinoma (SEIC) is a rare diagnosis, defined as an intraepithelial lesion with cells identical to serous type endometrial carcinoma. SEIC is considered to be potentially metastatic, however clear and robust data on prognosis are lacking, potentially leading to variability in clinical management. OBJECTIVE The aim is to establish the opinion of gynecologists on the optimal management of patients with SEIC. METHODS An online questionnaire with 15 multiple choice questions was sent to all gynecologists with expertise in gynecological oncology in 19 expert centers in The Netherlands. RESULTS A total of 24 gynecologists participated. The majority of respondents (n = 18/24, 75%) do not consult a guideline regarding the treatment of SEIC. In current practice, 14 of the 24 respondents perform surgical staging in women with SEIC (58.3%) while seven choose hysterectomy with bilateral salpingo-oophorectomy (29.2%), and three (12.5%) have no firm preference. Eleven of the 14 respondents who perform a surgical staging procedure believe that this is certainly the optimal treatment. The majority of respondents have no firm opinion on whether lymph node sampling or lymph node dissection is preferable during surgical staging (n = 15/23, 65.2%). Most respondents do not give adjuvant therapy (n = 15/24, 62.5%), 25.0% recommend brachytherapy (n = 6/24). Follow-up is for 5 years in almost all cases (n = 23/24). CONCLUSION There is no consensus on the optimal surgical treatment and the use of adjuvant therapy for patients with SEIC. Our research team is therefore conducting a nationwide cohort study in which treatment modality, morbidity and survival will be evaluated.
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Affiliation(s)
- Ciska Slaager
- Franciscus Gasthuis en Vlietland, Department of Obstetrics and Gynecology. Kleiweg 400, Rotterdam, The Netherlands.
| | - Ward Hofhuis
- Franciscus Gasthuis en Vlietland, Department of Obstetrics and Gynecology. Kleiweg 400, Rotterdam, The Netherlands.
| | | | - Patricia Ewing-Graham
- Erasmus Medical Center, Department of Pathology. Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Heleen van Beekhuizen
- Erasmus MC Cancer Institute, Department of Gynecological Oncology. Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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Dasgupta S, de Jonge E, Van Bockstal MR, Wong-Alcala LSM, Wilhelmus S, Makkus LACF, Schelfout K, Van de Vijver KK, Smits S, Marbaix E, Koljenović S, van Kemenade FJ, Ewing-Graham PC. Histological interpretation of differentiated vulvar intraepithelial neoplasia (dVIN) remains challenging-observations from a bi-national ring-study. Virchows Arch 2021; 479:305-315. [PMID: 33682013 PMCID: PMC8364542 DOI: 10.1007/s00428-021-03070-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/29/2022]
Abstract
Differentiated vulvar intraepithelial neoplasia (dVIN) is a premalignant lesion that is known to progress rapidly to invasive carcinoma. Accurate histological diagnosis is therefore crucial to allow appropriate treatment. To identify reliable diagnostic features, we evaluated the inter-observer agreement in the histological assessment of dVIN, among a bi-national, multi-institutional group of pathologists. Two investigators from Erasmus MC selected 36 hematoxylin-eosin-stained glass slides of dVIN and no-dysplasia, and prepared a list of 15 histological features of dVIN. Nine participating pathologists (i) diagnosed each slide as dVIN or no-dysplasia, (ii) indicated which features they used for the diagnosis, and (iii) rated these features in terms of their diagnostic usefulness. Diagnoses rendered by > 50% participants were taken as the consensus (gold standard). p53-immunohistochemistry (IHC) was performed for all cases, and the expression patterns were correlated with the consensus diagnoses. Kappa (ĸ)-statistics were computed to measure inter-observer agreements, and concordance of the p53-IHC patterns with the consensus diagnoses. For the diagnosis of dVIN, overall agreement was moderate (ĸ = 0.42), and pair-wise agreements ranged from slight (ĸ = 0.10) to substantial (ĸ = 0.73). Based on the levels of agreement and ratings of usefulness, the most helpful diagnostic features were parakeratosis, cobblestone appearance, chromatin abnormality, angulated nuclei, atypia discernable under × 100, and altered cellular alignment. p53-IHC patterns showed substantial concordance (ĸ = 0.67) with the consensus diagnoses. Histological interpretation of dVIN remains challenging with suboptimal inter-observer agreement. We identified the histological features that may facilitate the diagnosis of dVIN. For cases with a histological suspicion of dVIN, consensus-based pathological evaluation may improve the reliability of the diagnosis.
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Affiliation(s)
- Shatavisha Dasgupta
- Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands
| | - Elf de Jonge
- Department of Pathology, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - Mieke R. Van Bockstal
- Department of Pathology, Cliniques Universitaires Saint-Luc Bruxelles, Brussels, Belgium
| | | | - Suzanne Wilhelmus
- Department of Pathology, Pathan B.V., Laboratory for Pathology, Rotterdam, The Netherlands
| | | | - Katrien Schelfout
- Department of Pathology, Bravis Ziekenhuis, Bergen op Zoom, The Netherlands
- Department of Pathology, Ziekenhuis Geel, Geel, Belgium
| | - Koen K. Van de Vijver
- Department of Pathology, Cancer Research Institute Ghent, Ghent University Hospital, Ghent, Belgium
- Department of Pathology, Antwerp University, Antwerp, Belgium
| | - Sander Smits
- Department of Pathology, Pathan B.V., Laboratory for Pathology, Rotterdam, The Netherlands
| | - Etienne Marbaix
- Department of Pathology, Cliniques Universitaires Saint-Luc Bruxelles, Brussels, Belgium
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands
| | - Folkert J. van Kemenade
- Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands
| | - Patricia C. Ewing-Graham
- Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands
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Naspro R, La Croce G, Finati M, Roscigno M, Pellucchi F, Sodano M, Manica M, Gianatti A, Da Pozzo LF. Oncological outcomes of concomitant carcinoma in situ at radical cystectomy in pure urothelial bladder cancer and in histological variants. Urol Oncol 2021; 40:61.e9-61.e19. [PMID: 34334293 DOI: 10.1016/j.urolonc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/14/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The presence of carcinoma in situ at transurethral resection is known to increase the risk of recurrence and progression to invasive disease. However, the evidence regarding the prognostic role of concomitant carcinoma in situ after radical cystectomy due to bladder cancer is controversial. Moreover, concomitant carcinoma in situ was found to be significantly associated with bladder histological variants. The aim of our study is to evaluate whether the presence of concomitant carcinoma in situ at radical cystectomy, impacts on recurrence and survival outcomes in pure urothelial bladder cancer, compared to histological variants. METHODS We evaluated 410 consecutive patients diagnosed with non-metastatic bladder cancer and treated with radical cystectomy at a single tertiary referral centre between January 2009 and May 2019. Patients were stratified according to the presence of carcinoma in situ. The Kaplan-Meier method was used to compare recurrence free, cancer specific and overall survival in pure urothelial and histological variants. Cox proportional hazards regression analyses model was used to predict recurrence, cancer specific and overall mortality in pure urothelial and histological variants bladder cancer, according to pathological stage. RESULTS Median age was 71 years. 340 patients (82%) were male. At a median follow-up of 32 months, disease recurrence, cancer specific mortality and overall mortality were, 37% (155 patients), 32.9% (135 patients) and 46.6% (191 patients), respectively. Concomitant and pure carcinoma in situ were found in 39% and 19% of radical cystectomy specimens, respectively. Concomitant carcinoma in situ was more frequent in patients with histological variants (50.9%) compared to pure urothelial bladder cancer (35.4%) (P-value <.001) and was associated with worst pathological features (lymphovascular invasion, lymph node involvement and non-organ confined disease). Recurrence free survival at Kaplan-Meyer analyses was significantly higher in patients with pure carcinoma in situ compared to those with concomitant or no carcinoma in situ (all P <.001), similarly for patients without carcinoma in situ compared with those with concomitant Cis (P =.02) at radical cystectomy. Cancer specific and overall survival were significantly higher in patients with pure carcinoma in situ compared to those with concomitant or no carcinoma in situ (all P <.001). Conversely no significant difference was found between patients without carcinoma in situ and with concomitant carcinoma in situ (P>0.1) at radical cystectomy Moreover, concomitant carcinoma in situ at radical cystectomy in histological variants is associated with higher free recurrence rate compared to the other groups. At multivariate Cox proportional hazards regression analyses the presence of carcinoma in situ at radical cystectomy was not associated with any survival effect or recurrence (all P > .05) in the overall population and when patients are stratified according to histology. However, concomitant carcinoma in situ represents an independent predictor of recurrence in the subgroup of patients with organ confined disease in case of urothelial bladder cancer and histological variants. CONCLUSION Concomitant carcinoma in situ should be considered a proxy of aggressiveness in bladder cancer after radical cystectomy. Based on its prognostic implications, concomitant carcinoma in situ should be considered for strict follow-up in patients with organ confined disease which may deserve adjuvant treatment both in pure urothelial bladder cancer and histological variants.
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Affiliation(s)
- Richard Naspro
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy.
| | | | | | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Sodano
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Manica
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Gianatti
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luigi F Da Pozzo
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Milano-Bicocca, Milan, Italy
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Erbersdobler A, Dräger D. [Non-invasive precursor lesions of penile carcinoma : Differential diagnosis and treatment]. Urologe A 2021; 60:895-900. [PMID: 34142169 DOI: 10.1007/s00120-021-01562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 12/01/2022]
Abstract
Clinical diagnosis of preinvasive malignant lesions of the penis is difficult and there are numerous differential diagnoses. Recent decades have been witness to several changes in the terminology of histopathological diagnoses. In the current World Health Organization classification, penile intraepithelial neoplasia (PeIN) is defined, of which several subtypes exist. Just like in invasive carcinoma, the principal classification of PeIN subtypes corresponds with pathogenesis and includes human papilloma virus (HPV)-related and non-HPV-related forms. Subdivision is important for prognosis. Several therapeutic options exist, including surgical and nonsurgical procedures.
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Affiliation(s)
- A Erbersdobler
- Institut für Pathologie, Universitätsmedizin Rostock, Strempelstr. 14, 18057, Rostock, Deutschland.
| | - D Dräger
- Urologische Klinik, Universitätsmedizin Rostock, Rostock, Deutschland
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Subiela JD, Faba ÓR, Aumatell J, Krajewski W, Calderón J, Parada R, Huguet J, Algaba F, Breda A, Palou J. Impact of clinical and pathological subtypes of carcinoma in situ (CIS) of the bladder: Lessons learned from long-term follow-up of a series of CIS patients treated with BCG. Urol Oncol 2021; 40:9.e9-9.e17. [PMID: 34140244 DOI: 10.1016/j.urolonc.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Some attempts have previously been made to stratify patients with CIS for the purpose of risk-adapted clinical management and clinical trial design. In particular, two classification systems have been proposed: clinical classification, comprising primary (P-CIS), concomitant (C-CIS), and secondary (S-CIS) disease, and pathological classification, comprising P-CIS, cTa-CIS, and cT1-CIS. The aim of the present study was to assess the impact of both classifications on BCG response, recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS). PATIENTS AND METHODS We performed a retrospective analysis of 386 patients with bladder CIS, with or without associated cTa/cT1 disease, treated with BCG instillations between 2008 and 2015. Patients were stratified according to the two classification systems. Cox multivariate regression models were used to assess the impact of these subtypes on BCG response, RFS, PFS, OS, and CSS. We also performed a cumulative meta-analysis according to PRISMA guidelines. RESULTS The median follow-up was 70.5 months. According to the clinical classification, 34 (8.8%) patients had P-CIS, 81 (21%) S-CIS, and 271 (70.2%) C-CIS. The pathological classification showed 34 (8.8%) patients to have P-CIS, 190 (49.2%) cTa-CIS, and 162 (42%) cT1-CIS. In the overall cohort, BCG response was reported in 296 (76.7%); 159 (41.2%) had recurrence, 55 (14.2%) had progression, and 67 (17.4%) underwent radical cystectomy. Death from any cause was recorded in 135 (35%) and death from urothelial carcinoma in 38 (9.9%). Cox multivariate regression analysis showed that neither clinical classification nor pathological classification is an independent predictive factor for BCG response, RFS, PFS, OS, or CSS after adjusting for confounders. In the pooled meta-analysis, two studies and the present series were included for evidence synthesis, recruiting a total of 941 patients. We found no statistically significant difference across the groups for both classifications with respect to BCG response, RFS, PFS, and CSS. CONCLUSIONS Currently, the supporting evidence for an impact of clinical classification and pathological classification on oncological outcomes of CIS of the bladder is insufficient to justify their use to guide clinical management or follow-up.
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Affiliation(s)
- José Daniel Subiela
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain.
| | - Óscar Rodríguez Faba
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain
| | - Julia Aumatell
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain
| | - Wojciech Krajewski
- Department of Pathology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Morphological Sciences, Barcelona, Spain
| | - Julio Calderón
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain
| | - Rubén Parada
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain
| | - Jorge Huguet
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain
| | - Ferran Algaba
- Department of Urology and Oncological Urology, Department of Public Health, Wrocław Medical University, Wrocław, Poland
| | - Alberto Breda
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain
| | - Joan Palou
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Department of Surgery, Barcelona, Spain
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Talcott WJ, Miccio JA, Park HS, White AA, Kozono DE, Singer L, Sands JM, Sholl LM, Detterbeck FC, Mak RH, Decker RH, Kann BH. Rates of invasive disease and outcomes in NSCLC patients with biopsy suggestive of carcinoma in situ. Lung Cancer 2021; 157:17-20. [PMID: 34052704 DOI: 10.1016/j.lungcan.2021.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Carcinoma in situ is a rare non-invasive histology of non-small cell lung cancer (NSCLC) with excellent survival outcomes with resection. However, management of lung biopsy suggestive of in situ disease remains unclear. To inform decision-making in this scenario, we determined the rate of invasive disease presence upon resection of lesions with an initial biopsy suggestive of purely in situ disease. METHODS The study included 960 patients diagnosed with NSCLC from 2003 to 2017 in the National Cancer Database whose workup included a lung biopsy suggestive of in situ disease. Among the cohort who proceeded to resection, we identified the rate of invasive disease discovered on surgical pathology along with significant demographic and clinical contributors to invasion risk. Survival outcomes were measured for the observed cohort that did not receive local therapy after biopsy. RESULTS Invasive disease was identified at resection in 49.3 % of patients. Lesion size was associated with risk of invasive disease: 35.7 % for ≤1 cm, 45.2 % for 1-2 cm, 55.7 % for 2-3 cm, and 87.5 % for 3-5 cm (p < 0.001). Of patients with squamous histology, 61.5 % had invasive disease versus 46.5 % with adenocarcinoma histology (p = 0.026). On multivariable logistic regression, invasive disease remained associated with tumor size (OR 1.9 per cm, 95 % CI 1.5-2.4, p < 0.001), and squamous histology (OR 1.8, 95 % CI 1.1-3.2, p = 0.028). Overall survival at 3 years was 51.5 % in the observed cohort. CONCLUSION Nearly half of patients with biopsy suggestive of in situ disease had invasive disease at resection. Tumor size and histology are strong predictors of invasive disease and may be used for risk stratification. However, the findings support the practice of definitive therapy whenever feasible.
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Affiliation(s)
- Wesley J Talcott
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
| | - Joseph A Miccio
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Abby A White
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - David E Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa Singer
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacob M Sands
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank C Detterbeck
- Department of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Benjamin H Kann
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Fasina O. Ocular surface squamous neoplasia at a tertiary eye facility, Southwestern Nigeria: a 10-year review. Int Ophthalmol 2021; 41:3325-3331. [PMID: 34014459 DOI: 10.1007/s10792-021-01894-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is a low-grade malignancy arising from the squamous epithelium of the ocular surface AIM: To describe the clinical presentation, histological diagnoses, treatment, and outcome of treatment in patients with OSSN managed at a tertiary health facility. METHODS Medical records of all patients with OSSN managed using a standardized treatment protocol over a 10-year period were reviewed. RESULTS Eighty-six patients comprising 44 (51.2%) males and mean age of 48.2 ± 15.8 years were studied. The most common presentation was a fleshy growth in the eye in all patients, and 43 (50.0%) patients tested positive to human immunodeficiency virus. The right eye was affected in 44 (51.2%) patients with no bilateral tumors, and the medial limbus was involved in 28 (32.6%) patients. Morphologically, 40 (46.5%) patients had gelatinous growth, 24 (27.9%) patients were in Tis category while 30 (34.9%) patients were in T4 category. Twenty-eight (32.6%) patients received complete course of adjuvant topical mitomycin C (0.04%) while nine (10.5%) patients completed adjuvant systemic chemotherapy and external beam radiation. Overall, 61 (70.9%) patients had no tumor recurrence, seven (8.1%) patients had recurrent tumor, while the status of 18 (20.9%) patients was not known. CONCLUSION OSSN occurs more commonly in younger age group in our studied population and is strongly associated with HIV seropositivity. Intraoperative cryotherapy in patients with carcinoma in situ and intraoperative cryotherapy with adjuvant topical mitomycin C in those with invasive SCC that is limited to the ocular surface are associated with low tumor recurrence.
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Affiliation(s)
- Oluyemi Fasina
- Department of Ophthalmology, University College Hospital/University of Ibadan, Ibadan, Nigeria.
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Şengün DN, Karaca İR, Saraç N, Uğur A, Fırat A, Kaymaz FF, Öztürk HS. Evaluation of the chemopreventive effects of Hypericum perforatum L on DMBA-applied rat oral mucosa. Arch Oral Biol 2021; 127:105139. [PMID: 33964648 DOI: 10.1016/j.archoralbio.2021.105139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Hypericum perforatum L also known as St. John's wort is known to have many beneficial properties for the organism including its antioxidant and anticancer activities. It is also known to have shown antiproliferative and cytotoxic effects against various cancer cell lines. The purpose of this study was to investigate the effects of Hypericum perforatum L on 7,12-dimethylbenz(a)anthracene-induced rat oral squamous cell carcinoma model. DESIGN The in vitro antioxidant properties of Hypericum perforatum L was determined and an extract was prepared. Thirty Wistar male rats were divided randomly into 4 groups (Control group, DMBA group, HP + DMBA group, HP group). The antioxidant defense mechanisms in tissue and blood samples were evaluated biochemically and immunohistochemically, the carcinomatous changes in connective tissue were investigated immunohistochemically and epithelial changes in the tissue samples were evaluated histopathologically. RESULTS The extract revealed inhibitory effects on some antioxidant enzymes (catalase, glutathione peroxidase). Immunohistochemical evaluations revealed no invasive changes in the connective tissue. Hypericum perforatum L demonstrated chemopreventive effects although it did not prevent carcinomatous changes altogether. CONCLUSIONS Hypericum perforatum L is a promising chemopreventive agent and further studies are needed in order to evaluate the full potential of this plant.
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Affiliation(s)
- Dilara Nur Şengün
- Gazi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey.
| | - İnci Rana Karaca
- Gazi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey.
| | - Nurdan Saraç
- Mugla Sitki Kocman University, Faculty of Science, Department of Biology, Mugla, Turkey.
| | - Aysel Uğur
- Gazi University, Faculty of Dentistry, Department of Basic Sciences, Section of Medical Microbiology, Ankara, Turkey.
| | - Ayşegül Fırat
- Hacettepe University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey.
| | - Fevziye Figen Kaymaz
- Hacettepe University, Faculty of Medicine, Department of Histology and Embryology, Ankara, Turkey.
| | - Hasan Serdar Öztürk
- Ankara University, Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
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Garczyk S, Bischoff F, Schneider U, Golz R, von Rundstedt FC, Knüchel R, Degener S. Intratumoral heterogeneity of surrogate molecular subtypes in urothelial carcinoma in situ of the urinary bladder: implications for prognostic stratification of high-risk non-muscle-invasive bladder cancer. Virchows Arch 2021; 479:325-335. [PMID: 33650041 PMCID: PMC8364543 DOI: 10.1007/s00428-021-03054-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022]
Abstract
Reliable factors predicting the disease course of non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) are unavailable. Molecular subtypes have potential for prognostic stratification of muscle-invasive bladder cancer, while their value for CIS patients is unknown. Here, the prognostic impact of both clinico-pathological parameters, including CIS focality, and immunohistochemistry-based surrogate subtypes was analyzed in a cohort of high-risk NMIBC patients with CIS. In 128 high-risk NMIBC patients with CIS, luminal (KRT20, GATA3, ERBB2) and basal (KRT5/6, KRT14) surrogate markers as well as p53 were analyzed in 213–231 biopsies. To study inter-lesional heterogeneity of CIS, marker expression in independent CIS biopsies from different bladder localizations was analyzed. Clinico-pathological parameters and surrogate subtypes were correlated with recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Forty-six and 30% of CIS patients exhibited a luminal-like (KRT20-positive, KRT5/6-negative) and a null phenotype (KRT20-negative, KRT5/6-negative), respectively. A basal-like subtype (KRT20-negative, KRT5/6-positive) was not observed. A significant degree of inter-lesional CIS heterogeneity was noted, reflected by 23% of patients showing a mixed subtype. Neither CIS surrogate subtype nor CIS focality was associated with patient outcome. Patient age and smoking status were the only potentially independent prognostic factors predicting RFS, PFS, OS, and PFS, respectively. In conclusion, further clarification of heterogeneity of surrogate subtypes in HR NMIBC and their prognostic value is of importance with regard to potential implementation of molecular subtyping into clinical routine. The potential prognostic usefulness of patient age and smoking status for high-risk NMIBC patients with CIS needs further validation.
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Affiliation(s)
- Stefan Garczyk
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Felix Bischoff
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ursula Schneider
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Reinhard Golz
- Institute of Pathology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Ruth Knüchel
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Stephan Degener
- Department of Urology, Helios University Hospital Wuppertal, Wuppertal, Germany
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Eckel HE, Simo R, Quer M, Odell E, Paleri V, Klussmann JP, Remacle M, Sjögren E, Piazza C. European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up. Eur Arch Otorhinolaryngol 2020; 278:1723-1732. [PMID: 33058010 PMCID: PMC8131286 DOI: 10.1007/s00405-020-06406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/16/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the current knowledge regarding the diagnosis, treatment, and follow-up of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. The diagnosis of LD largely relies on endoscopic procedures and on histopathology. Diagnostic efficiency of endoscopy may be improved using videolaryngostroboscopy (VLS) and bioendoscopic tools such as Narrow Band Imaging (NBI) or Storz Professional Image Enhancement System (SPIES). Current histological classifications are not powerful enough to clearly predict the risk to carcinoma evolution and technical issues such as sampling error, variation in epithelial thickness and inflammation hamper pathological examination. Almost all dysplasia grading systems are effective in different ways. The 2017 World Health Organization (WHO) system should prove to be an improvement as it is slightly more reproducible and easier for the non-specialist pathologist to apply. To optimize treatment decisions, surgeons should know how their pathologist grades samples and preferably audit their transformation rates locally. Whether carcinoma in situ should be used as part of such classification remains contentious and pathologists should agree with their clinicians whether they find this additional grade useful in treatment decisions. Recently, different studies have defined the possible utility of different biomarkers in risk classification. The main treatment modality for LD is represented by transoral laser microsurgery. Radiotherapy may be indicated in specific circumstances such as multiple recurrence or wide-field lesions. Medical treatment currently does not have a significant role in the management of LD. Follow-up for patients treated with LD is a fundamental part of their care and investigations may be supported by the same techniques used during diagnosis (VLS and NBI/SPIES).
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Affiliation(s)
- Hans Edmund Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt am Wörthersee, Austria
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edward Odell
- Department of Head and Neck Pathology, King's College London Guy's Hospital, London, UK
| | - Vinidh Paleri
- Department of Otorhinolaryngology Head and Neck Surgery, Royal Marsden Hospital, London, UK
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Marc Remacle
- Department of Otorhinolaryngology, Head and Neck Surgery, CH Luxembourg, Luxembourg, Belgium
| | - Elisabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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Odell E, Eckel HE, Simo R, Quer M, Paleri V, Klussmann JP, Remacle M, Sjögren E, Piazza C. European Laryngological Society position paper on laryngeal dysplasia Part I: aetiology and pathological classification. Eur Arch Otorhinolaryngol 2020; 278:1717-1722. [PMID: 33051798 PMCID: PMC8131293 DOI: 10.1007/s00405-020-06403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
Purpose of review To give an overview of the current knowledge regarding the aetiology, epidemiology, and classification of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. As most cases of dysplasia occur at the glottic level and data on diagnosis and management are almost exclusively from this location, laryngeal dysplasia in this position paper is taken to be synonymous with dysplasia of the vocal folds. Summary LD has long been recognized as a precursor lesion to laryngeal squamous cell carcinoma (SCC). Tobacco and alcohol consumption are the two single most important etiological factors for the development of LD. There is currently insufficient evidence to support a role of reflux. Although varying levels of human papillomavirus have been identified in LD, its causal role is still uncertain, and there are data suggesting that it may be limited. Dysplasia has a varying presentation including leukoplakia, erythroleukoplakia, mucosal reddening or thickening with exophytic, “tumor-like” alterations. About 50% of leukoplakic lesions will contain some form of dysplasia. It has become clear that the traditionally accepted molecular pathways to cancer, involving accumulated mutations in a specific order, do not apply to LD. Although the molecular nature of the progression of LD to SCC is still unclear, it can be concluded that the risk of malignant transformation does rise with increasing grade of dysplasia, but not predictably so. Consequently, grading systems are inherently troubled by the weak correlation between the degree of the dysplasia and the risk of malignant transformation. The best data on LD grading and outcomes come from the Ljubljana group, forming the basis for the World Health Organization classification published in 2017.
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Affiliation(s)
- Edward Odell
- Head and Neck Pathology, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - Hans Edmund Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Feschnigstr. 11, Klagenfurt, Austria
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Cologne, Germany
| | - Marc Remacle
- Department of Otorhinolaryngology, Head and Neck Surgery, CH Luxembourg, Luxembourg, Belgium
| | - Elisabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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Takamatsu K, Matsumoto K, Kikuchi E, Ogihara K, Hayakawa N, Tanaka N, Takeda T, Morita S, Kosaka T, Mizuno R, Asanuma H, Mikami S, Oyama M, Oya M. Can random bladder biopsies be eliminated after bacillus Calmette-Guérin therapy against carcinoma in situ? Int Urol Nephrol 2021; 53:465-9. [PMID: 33025406 DOI: 10.1007/s11255-020-02667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Intravesical bacillus Calmette-Guérin (BCG) is the standard of care for bladder carcinoma in situ (CIS). The response to BCG therapy against CIS is generally assessed by random bladder biopsy (RBB). In this study, we examined the necessity of routine RBB after BCG therapy. METHODS We retrospectively identified 102 patients who were initially diagnosed with CIS with or without papillary tumor and received subsequent 6-8-week BCG therapy. Thereafter, all patients underwent voiding cytology analysis, cystoscopy, and RBB to evaluate the effects of BCG therapy. We evaluated the association between clinical parameters (voiding cytology and cystoscopy findings) and the final pathological results by RBB specimens. RESULTS According to the pathological results of RBB, 30 (29%) patients had BCG-unresponsive disease (remaining urothelial carcinoma was confirmed pathologically) and 20 were diagnosed with CIS. Positive/suspicious voiding cytology and positive cystoscopy findings were well observed in patients who had BCG-unresponsive disease compared with their counterparts (p = 0.116, and p < 0.001, respectively). The sensitivity (Sen.), specificity (Spe.), positive predictive value (PPV), and negative predictive value (NPV) of voiding cytology were 50%, 68%, 39%, and 77%, respectively. The values for cystoscopy findings were as follows: Sen.: 87%, Spe.: 57%, PPV: 46%, and NPV: 91%. The values for their combination (having either of them) were as follows: Sen.: 100%, Spe.: 44%, PPV: 43%, and NPV: 100%. CONCLUSION RBB after BCG therapy for patients with negative voiding cytology and negative cystoscopy may be omitted because their risk of BCG-unresponsive disease is significantly low (NPV: 100%).
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Olivera P, Cernadas G, Fanjul I, Peralta D, Zubiaurre I, Lasa J, Moore R. Effect of successive endoscopic procedures in polyp and adenoma detection rates: Too early is not always too good. Indian J Gastroenterol 2020; 39:450-456. [PMID: 33150568 DOI: 10.1007/s12664-020-01060-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/21/2020] [Indexed: 02/04/2023]
Abstract
UNLABELLED BACKGROUND AND AIMS: There is conflicting evidence regarding the impact of hypothetical cumulative fatigue after performing too many endoscopic procedures on both polyp and adenoma detection rates (PDR, and ADR, respectively). The aim of this study is to evaluate the effect of successive endoscopic procedures on PDR and ADR. METHODS A retrospective cross-sectional study was undertaken among consecutive patients on whom colonoscopy and/or esophagogastroduodenoscopy were performed between January 2012 and August 2014. Data regarding polyp and adenoma detection, cecal intubation, and bowel cleansing quality as well as demographical data of subjects were extracted. Endoscopic procedures were classified according to the time slots of the procedures throughout the endoscopy session in three groups: from the 1st to 4th endoscopy study (round 1), from the 5th to the 8th study (round 2), above the 9th study (round 3). We compared PDR and ADR among rounds. RESULTS Overall, 3388 patients were enrolled. Median age was 50 years (range 18-95) and 52.39% were female. There was a significant difference in terms of PDR among rounds (36.83%, 41.24%, and 43.38%, respectively, p = 0.007) and a non-significant numerical difference when ADR was compared (23.2%, 25.71%, and 26.78%, p = 0.07). On multivariate analysis, ADR was significantly associated with age (odds ratio [OR] 1.02 [1.01-1.03]), and male sex (OR 1.64 [1.38-1.94]). CONCLUSION Theoretical endoscopist's fatigue due to cumulative performance of endoscopies does not diminish colonoscopy quality. Both PDR and ADR seem to improve after endoscopist's cumulative rounds of performed endoscopies. This could be due to a "warm-up" effect.
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Affiliation(s)
- P Olivera
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - G Cernadas
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina.
| | - I Fanjul
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - D Peralta
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - I Zubiaurre
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - J Lasa
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - R Moore
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
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Izutani-Kitano A, Okada Y, Ichikawa K, Reinach PS, Saika S. Alteration of expression pattern of transient receptor potential vanilloid 2 and transient receptor potential vanilloid 3 in ocular surface neoplasm. Taiwan J Ophthalmol 2020; 10:106-110. [PMID: 32874838 PMCID: PMC7442101 DOI: 10.4103/tjo.tjo_12_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/14/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE We determined if the immunohistochemical expression pattern of transient receptor potential vanilloid (TRPV) family members and TRP ankyrin 1 (TRPA1) differs among a healthy conjunctival epithelium and diseased epithelia. MATERIALS AND METHODS Subjects include a normal conjunctival epithelium, pterygium epithelium, epithelial dysplasia or carcinoma in situ. RESULTS TRPV1, TRPV4 or TRPA1 was detected in both the cytoplasm and nuclei, or in either the nuclei or cytoplasm, of these different epithelial layers, respectively. There was no difference in the expression pattern of these three TRP isoforms. On the other hand, the expression patterns of TRPV2 and TRPV3 differed dramatically among these different subjects. TRPV2 was observed in the basal layer epithelium of a normal conjunctiva and pterygium. Its pattern was scattered in this region, although TRPV2 was absent throughout most of the dysplastic epithelium. TRPV2 was detected only in some of the suprabasal epithelial cells of a carcinoma in situ. TRPV3 was faintly detected in the cytoplasm of all the cell layers and also in the nuclei of some of the basal cells in a normal conjunctiva and in the pterygia epithelium, while in situ it was uniformly expressed in all of the dysplasia and carcinoma nuclei in all epithelial cell layers. CONCLUSION These results suggest that TRPV2 and TRPV3 expression pattern analysis might be potential diagnostic markers of ocular surface epithelial disorders.
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Affiliation(s)
- Ai Izutani-Kitano
- Department of Ophthalmology, Kihoku Hospital, Wakayama Medical University, Wakayama, Japan
| | - Yuka Okada
- Department of Ophthalmology, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kana Ichikawa
- Department of Ophthalmology, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Peter Sol Reinach
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Shizuya Saika
- Department of Ophthalmology, School of Medicine, Wakayama Medical University, Wakayama, Japan
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Wicker CA, Takiar V, Suganya R, Arnold SM, Brill YM, Chen L, Horbinski CM, Napier D, Valentino J, Kudrimoti MR, Yu G, Izumi T. Evaluation of antioxidant network proteins as novel prognostic biomarkers for head and neck cancer patients. Oral Oncol 2020; 111:104949. [PMID: 32801084 DOI: 10.1016/j.oraloncology.2020.104949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Recurrence rates for head and neck squamous cell carcinoma (HNSCC) approach 50% at 5 years. Current staging fails to identify patients with a worse prognosis who might benefit from intensified treatment, which warrants improved prognostic biomarkers. The purpose of this retrospective case study is to identify potential prognostic biomarkers in patients with HNSCC including APE1 (DNA repair/redox gene regulator), NRF2 and PPARGC1A (redox gene regulators), SOD3 and DCN (antioxidant proteins). MATERIALS AND METHODS Differential protein expression between benign, carcinoma in situ (CIS), and invasive HNSCC tissue specimens from 77 patients was assessed using immunohistochemistry. Protein expression was analyzed with multivariate, pair-wise, and Kaplan-Meier survival analyses to identify potential prognostic biomarkers. Utilizing The Cancer Genome Atlas's transcriptome database, pair-wise and survival analysis was performed to identify potential prognostic biomarkers. RESULTS APE1, NRF2, PPARGC1A, SOD3, and DCN expression in HNSCC in relation to, lymph node invasion, and patient survival were examined. Elevated APE1 protein expression in CIS corresponded with reduced survival (p = 0.0243). Increased APE1 gene expression in stage T4a HNSCC was associated with reduced patient survival (p < 0.015). Increased PPARGC1A in invasive tumor correlated with reduced survival (p = 0.0281). Patients with lymph node invasion at diagnosis had significantly increased APE1 protein in the primary sites (p < 0.05). Patients with poorly differentiated invasive tumors had reduced PPARGC1A in CIS proximal to the invasive tumor and had elevated DCN and SOD3 in proximal benign tissue (p < 0.05). CONCLUSIONS The expression of APE1, DCN, and SOD3 is a potential prognostic signature that identifies patients with worsened survival.
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Affiliation(s)
- Christina A Wicker
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Rangaswamy Suganya
- Houston Eye Associates, Clinical Research Department, Houston, TX, United States
| | - Susanne M Arnold
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States; Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Yolanda M Brill
- Department of Pathology, University of Kentucky, Lexington, KY, United States
| | - Li Chen
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States; Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Craig M Horbinski
- Department of Pathology, Northwestern University, Chicago, IL, United States
| | - Dana Napier
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Joseph Valentino
- Department of Otolaryngology, University of Kentucky, Lexington, KY, United States
| | - Mahesh R Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Lexington, KY, United States
| | - Guoqiang Yu
- F. Joseph Halcomb III M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States
| | - Tadahide Izumi
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, United States.
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Tachibana I, Bandali E, Calaway AC, Krishnan N, Cheng L, Adra N, Kaimakliotis HZ. Urothelial carcinoma in situ response to cisplatin-based neoadjuvant chemotherapy, or lack thereof: Impact on patient selection for organ preservation in muscle-invasive disease? Urol Oncol 2020; 38:850.e1-850.e7. [PMID: 32693973 DOI: 10.1016/j.urolonc.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/03/2020] [Accepted: 06/13/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Neoadjuvant cisplatin-based chemotherapy (NACT) followed by radical cystectomy improves urothelial bladder cancer survival [1]. Complete pathological response on cystectomy pathology (pT0N0) is associated with the best survival outcomes [2]. Rates of complete response have increased with improved adoption of NACT calling into question the need for radical cystectomy or perhaps use of organ preservation protocols. In patients with papillary bladder tumors, carcinoma in situ (CIS) has been shown to influence progression and develop into invasive urothelial carcinoma [3]. Furthermore, in patients with invasive urothelial carcinoma, concurrent CIS has been reported in roughly 45% to 65% of cases [4]. Thus, we sought to determine the response rate of CIS to NACT to determine if the presence of CIS should factor into excluding patients from organ preservation. METHODS A review of our prospectively maintained bladder cancer database was performed among patients undergoing preoperative cisplatin-based chemotherapy followed by cystectomy between 2007 and 2017. Presence of CIS before and after radical cystectomy was assessed. Random bladder biopsies or transurethral resection (TUR) with enhanced imaging for CIS (Cysview) were not routinely utilized in the preoperative setting. RESULTS One-hundred eighty-three patients were identified that underwent preoperative cisplatin chemotherapy. A total of 96 (52.4%) unique patients had documented CIS in the entire cohort. Forty-eight (50%) patients were noted to have CIS on TUR. Of these 48 patients, 26 (54.1%) were noted to have residual CIS on final pathology. An additional 48 patients were found to have CIS on final pathology that was not diagnosed on TUR, making a total of 74 (77.1%) patients with CIS refractory to NACT on cystectomy pathology. CONCLUSIONS CIS seems to respond poorly to cisplatin-based neoadjuvant chemotherapy. If organ preservation protocols are considered, a thorough assessment for CIS with enhanced photodynamic detection cystoscopy or random bladder biopsies should be considered. Residual cisplatin-refractory disease, even if noninvasive CIS, may lead to poor outcomes. Future molecular classifiers may assist in disease signatures to help guide treatment protocols.
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Affiliation(s)
- Isamu Tachibana
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Elhaam Bandali
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Adam C Calaway
- Departent of Urology, University Hospitals/Case Western Reserve University School of Medicine, Cleveland, OH
| | - Naveen Krishnan
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Liang Cheng
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Department of Hematology and Medical Oncology, Indiana University School of Medicine, Indianapolis, IN
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Robertson AG, Groeneveld CS, Jordan B, Lin X, McLaughlin KA, Das A, Fall LA, Fantini D, Taxter TJ, Mogil LS, Lindskrog SV, Dyrskjøt L, McConkey DJ, Svatek RS, de Reyniès A, Castro MAA, Meeks JJ. Identification of Differential Tumor Subtypes of T1 Bladder Cancer. Eur Urol 2020; 78:533-7. [PMID: 32684305 DOI: 10.1016/j.eururo.2020.06.048] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/22/2020] [Indexed: 11/24/2022]
Abstract
Stage T1 bladder cancers have the highest progression and recurrence rates of all non-muscle-invasive bladder cancers (NMIBCs). Most T1 cancers are treated with bacillus Calmette-Guérin (BCG), but many will progress or recur, and some T1 patients will die from bladder cancer. Particularly aggressive tumors could be treated with early cystectomy. To better understand the molecular heterogeneity of T1 cancers, we performed transcriptome profiling and unsupervised clustering, and identified five consensus subtypes of T1 tumors treated with repeat transurethral resection (reTUR) and induction and maintenance BCG. The T1-LumGU subtype was associated with carcinoma in situ (CIS; six/13, 46% of all CIS), had high E2F1 and EZH2 expression, and was enriched in E2F target and G2M checkpoint hallmarks. The T1-Inflam subtype was inflamed and infiltrated with immune cells. While most T1 tumors were classified as luminal papillary, the T1-TLum subtype had the highest median luminal papillary score and FGFR3 expression, no recurrence events, and the fewest copy number gains. T1-Myc and T1-Early subtypes had the most recurrences (14/30 within 24 mo), the highest median MYC expression, and, when combined, had significantly worse recurrence-free survival than the other three subtypes. T1-Early had five (38%) recurrences within the first 6 mo of BCG, and repressed IFN-α and IFN-γ hallmarks and inflammation. We developed a single-patient T1 classifier and validated our subtype biology in a second cohort of T1 tumors. Future research will be necessary to validate the proposed T1 subtypes and to determine if therapies can be individualized for each subtype. PATIENT SUMMARY: We identified and characterized expression subtypes of high-grade stage T1 bladder cancer that are biologically heterogeneous and have variable responses to bacillus Calmette-Guérin treatment. We validated the subtypes and describe a single-patient classifier.
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Abstract
The most common forms of nonmelanocytic skin cancer (NMSC) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The growing incidence of skin cancer in the Republic of Korea has sparked increasing scientific interest in these types of tumors. In the case described herein, multiple NMSCs occurred asynchronously in various areas of the body in a single patient. A 67-year-old man presented with an ulcerative lesion on the right retro-auricle and multiple keratinized masses on the back and face. The right retro-auricular lesion was diagnosed as BCC, and the keratinized masses on the patient’s back and face were diagnosed as SCC. He subsequently presented with numerous pigmented skin lesions on the forehead, temple, pre-auricle, neck, right forearm, right hand, and both thighs. One lesion on the neck was diagnosed as BCC, and five lesions on the right hand and forearm were diagnosed as SCC. The patient was also diagnosed with supraglottic SCC and external auditory canal SCC. An otolaryngologist performed radical excision of the primary SCC. Suspected skin cancer lesions observed on the face and both ears were diagnosed as SCC. Patients with multiple NMSCs are at an elevated risk for additional skin cancers, making periodic follow-up important; furthermore, all suspicious lesions should be biopsied.
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Affiliation(s)
- Song Hyun Han
- Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Soon Heum Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Cheol Keun Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Dong In Jo
- Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
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Williams C, Lamar M, Delgado P. Urethral carcinoma: A compilation of case studies and research findings. Urol Case Rep 2020; 31:101169. [PMID: 32309144 PMCID: PMC7154991 DOI: 10.1016/j.eucr.2020.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
There are three major recognized histological types for primary urethral carcinoma (PUC). These include transitional cell carcinoma (55%), squamous cell carcinoma (21.5%), and adenocarcinoma (16.4%). However, primary urethral carcinoma still only accounts for approximately less than 1% of all bladder cancers. Current management includes surgery alone or surgery with adjunctive radiotherapy and chemotherapy. Current research suggests that in those cases managed with only surgery, the five-year disease-free survival is only 20-30%; as additional treatment with radiotherapy and chemotherapy is new recommendation, there is no published statistical data to suggest outcomes, only current clinical observation.
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Affiliation(s)
- Cheau Williams
- Colquitt Regional Medical Center, Philadelphia College of Osteopathic Medicine, Medical College of Georgia, Moultrie, GA, USA.,2nd Year Resident at Colquitt Regional Medical Center, Georgia South Family Medicine Residency, Moultrie, GA, USA.,Medical College of Georgia, USA
| | - Madison Lamar
- 2nd Year Resident at Colquitt Regional Medical Center, Georgia South Family Medicine Residency, Moultrie, GA, USA
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Gao X, Ma Y, Chen G, Chen J, Li H, Li H, Wei X, Wang K. Concomitant carcinoma in situ as a prognostic factor in the upper tract urothelial carcinoma after radical nephroureterectomy: A systematic review and meta-analysis. Urol Oncol 2020; 38:574-581. [PMID: 32273049 DOI: 10.1016/j.urolonc.2020.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/01/2020] [Accepted: 02/17/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Some excised specimens of upper tract urothelial carcinoma (UTUC) are concomitant carcinoma in situ (CIS). However, whether concomitant CIS affects the prognosis of UTUC is controversial. The objective of this study was to provide a comprehensive association between CIS and the prognosis of UTUC. MATERIALS AND METHODS Web of Science, PubMed, and Embase were searched to identify clinical studies about CIS and UTUC before July 2019. Newcastle Ottawa Scale was used to evaluate the quality of the literature. We calculated hazard ratios (HRs) and 95% CIs to evaluate the relationship between concomitant CIS and survival outcomes. Z test was used to pooled HRs, if P < 0.05, the difference was considered statistically significant. RESULTS Total of 7,852 patients with UTUC were included, of which 1,004 (12.79%) concomitant CIS. In univariate analysis, our meta-analysis shows that concomitant CIS is associated with worse cancer-specific survival (HR: 1.54; P < 0.00001), worse recurrence-free survival (RFS) (HR: 1.42; P < 0.00001) and worse overall survival (OS; HR: 1.41; P = 0.04). In multivariate analysis, concomitant CIS is associated with worse cancer-specific survival (HR: 1.25; P = 0.004), worse recurrence-free survival (HR: 1.24; P = 0.006), and worse OS (HR: 1.12; P = 0.25), however, there was no statistical difference in the effect of CIS on OS (P > 0.05). CONCLUSIONS Our meta-analysis shows that concomitant CIS is associated with worse survival outcomes in UTUC after radical nephroureterectomy. CIS is an independent prognostic risk factor in UTUC.
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Affiliation(s)
- Xiaoshuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Guo Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jixiang Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hao Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xin Wei
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Ohno K, Okada T, Nakamura T, Koyama H. Sebaceous carcinoma of the breast predominantly characterized by intraductal growth: a case report. Surg Case Rep 2020; 6:41. [PMID: 32095941 PMCID: PMC7040145 DOI: 10.1186/s40792-020-0799-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Sebaceous carcinoma (SC) is frequently classified as periocular or extraocular. Extraocular SC is rare and mainly occurs in the head and neck, the major salivary glands, or oral mucosa. SC of the breast, lung, and ovary is particularly rare, and the few cases of SC of the breast predominantly exhibit intraductal growth. Case presentation A 47-year-old Japanese woman was referred to our hospital with accumulated polymorphic calcification in the left breast which was detected using mammography. Ultrasonography revealed an irregular 13-mm mass in the left breast, and analysis of a core needle biopsy revealed noninvasive ductal carcinoma. Total mastectomy and sentinel lymph node biopsy were performed. Histopathology demonstrated that carcinoma in situ (CIS) represented a significant lesion, and the cytoplasm of tumor cells was clear with numerous minute vacuoles. Immunohistochemical analysis demonstrated that most tumor cells expressed adipophilin. Together, these findings led to a diagnosis of SC, mainly comprising CIS. Conclusions We encountered a rare case of SC of the breast with predominant CIS.
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Affiliation(s)
- Koichi Ohno
- Department of Breast and Endocrine Surgery, Suwa Red Cross Hospital, 5-11-50, Kogan-douri, Suwa, Nagano, 392-8510, Japan.
| | - Toshihiro Okada
- Department of Breast and Endocrine Surgery, Suwa Red Cross Hospital, 5-11-50, Kogan-douri, Suwa, Nagano, 392-8510, Japan
| | - Toshitsugu Nakamura
- Department of Diagnostic Pathology, Suwa Red Cross Hospital, 5-11-50, Kogan-douri, Suwa, Nagano, 392-8510, Japan
| | - Hiroshi Koyama
- Koyama Clinic, 1-2557-1, Jonan, Suwa, Nagano, 392-0017, Japan
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50
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Xu H, Wang YM, Zhang J. [Clinicopathological features of stratified mucin-producing neoplastic lesions of the cervix]. Zhonghua Bing Li Xue Za Zhi 2020; 49:28-33. [PMID: 31914531 DOI: 10.3760/cma.j.issn.0529-5807.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigatethe clinicopathological features of stratified mucin-producing intraepithelial lesion (SMILE) and invasive stratified mucin-producing carcinoma (ISMC) of the cervix with review of the literature. Methods: Sixteen patients with SMILE/ISMC components of the cervix were collected from files in the Department of Pathology at Xijing Hospital from January 2007 to March 2019. Clinicopathological data included age at diagnosis, clinical presentation, histological type, depth of invasion measurement, the status of lymphovascular space invasion (LVSI) and lymph node metastasis, FIGO staging and follow-up. Histochemistry AB and PAS-D staining and immunostaining for cytokeratin (CK) 7, p16, p63, p40, PAX8, MUC6, p53 were performed simultaneously. In addition, twelve cases with invasive endocervical adenocarcinoma were evaluated using three-tiered pattern-based system (also called Pattern Classification). Results: The average age at diagnosis for patients was 49.7 years (range, 33 to 65 years), and vaginal bleeding occurred in the majority of cases (13/16). The characteristic morphology of SMILE and ISMC was present as non-invasive and invasive stratified epithelium that the full-thickness cells contained different amount of cytoplasmic mucin, respectively. Five cases of SMILE coexisted with adenocarcinoma in situ (1 case), high-grade squamous intraepithelial lesion (1 case), and invasive adenocarcinoma (3 cases). Thirteen cases with ISMC components included pure ISMC (3 cases), mixed with usual-type endocervical adenocarcinoma (8 cases) or squamous cell carcinoma (2 cases). All pure ISMC had lymph vascular space invasion and depth of invasion exceeded 10 mm. All eleven cases of invasive adenocarcinoma with ISMC components belonged to Pattern C tumors, which typically showed diffusely destructive stromal invasion, solid or poorly differentiated components. The results of histochemical staining confirmed that SMILE/ISMC cells were rich in acidic and neutral mucin. The immunohistochemical staining for CK7 and p16 was diffusely strong positive in SMILE (4/4) and ISMC (8/8) components. The positive expressions of p63 and p40 was located in peripheral cells of stratified epithelial nests or merely in a few cells of SMILE (1/3) and ISMC (2/8) components. In ISMC tissues, there were partial expression of MUC6 (5/7), focal expression of PAX8 (2/8), and wild-type expression pattern (4/10) or completely negative expression (6/10) of p53 protein. All thirteen patients with follow-up data were alive (mean 50.5 months, range 4 to 140). Conclusions: As new tumor entities, SMILE is a rare and unique endocervical intraepithelial lesion, while ISMC belongs to an invasive leison. Given that the tumors with ISMC components may have aggressive behavior, it is important for clinicians and pathologists to fully understand the clinicopathological features of SMILE and ISMC.
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Affiliation(s)
- H Xu
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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