A rare presentation of an ACTH-producing high-grade large cell neuroendocrine carcinoma with Cushing's syndrome

High-grade neuroendocrine tumors (HGNET) are rare neoplasms composed of neural and hormonal with only around 42 cases reported in the last 20 years1. Herein, we describe a rare case of pancreatic HGNET, large cell type, associated with a Cushing's syndrome presentation.

Prognostic significance of poorly differentiated histology and impact of adjuvant chemotherapy in early squamous cell carcinoma of cervix uteri

Objective

This study is to determine whether the addition of cisplatin‐based chemotherapy after radical hysterectomy will improve the survival of low‐risk squamous cervical carcinoma with poor differentiation.

Methods

Patients with low‐risk squamous cervical cancer (FIGO IA2–IIA, absent high‐ and intermediate‐risk factors after pathological evaluation) were eligible for this study. As first, the prognostic relevance of G3 versus G1/G2 among patients with low‐risk squamous cervical cancer was analyzed, then, the oncological results of postoperative chemotherapy among low‐risk squamous cervical cancer with poor differentiation was explored.

Results

Totally, there were 367 low‐risk squamous cervical cancer patients, of whom 161 were poor‐differentiated (47 in the chemotherapy group and 114 in the nonchemotherapy group), with a median follow‐up time of 56 months. Patients with G3 displayed a significantly worse overall survival (p = 0.035), and a higher recurrence rate (p = 0.014) than patients with G1/G2. Compared with the nonchemotherapy group, the hazard ratios (95%CI) for recurrence‐free survival in the chemotherapy group was 0.24 (0.06–0.93), (p = 0.038). No difference in overall survival was observed between the chemotherapy group and the nonchemotherapy group.

Conclusions

The addition of cisplatin‐based chemotherapy following surgery significantly improved recurrence‐free survival for low‐risk, poor differentiation, and early stage squamous cervical cancer patients.

The prognostic value of major facilitator superfamily domain-containing protein 2A in patients with hepatocellular carcinoma

INTRODUCTION

We aimed to characterize the expression of major facilitator superfamily domain-containing protein 2A (MFSD2A) in hepatocellular carcinoma (HCC) patients and analyze its prognostic value.

RESULTS

Immunohistochemistry revealed that low expression of MFSD2A was present in 37 of 79 cases (46.84%), which was significantly correlated with poor histological differentiation (P = 0.012). The plasma MFSD2A level in HCC patients was significantly lower than in healthy controls (P = 0.0079) and controls with chronic hepatitis B virus (HBV) infection (P = 0.0430). Moreover, patients with lower MFSD2A expression had shorter survival than higher expression (P = 0.021). Multivariate analysis revealed that MFSD2A was an independent prognostic predictor for HCC patients (P = 0.027).

CONCLUSION

The current study indicate MFSD2A may be an optimal diagnostic and prognostic biomarker for HCC.

METHODS

First, we examined MFSD2A expression in 24 paired HCC and nontumorous tissues by real-time quantitative PCR (RT-qPCR). Second, the protein levels of MFSD2A in 11 paired HCC and nontumorous tissues were investigated by western blotting (WB). Moreover, MFSD2A protein expression was evaluated by immunohistochemistry in 79 HCC patients. In addition, we detected the plasma level of MFSD2A in HCC patients and healthy individuals and investigated the relationship between MFSD2A expression and clinicopathological parameters or prognosis of HCC patients.

Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation

The aim of the present study was to explore the pattern of lymph node metastasis (LNM) in poorly-differentiated esophageal squamous cell carcinoma (pdESCC) and the implication of postoperative irradiation. A total of 690 patients with pdESCC were retrospectively investigated. The rates of intro-thoracic and extra-thoracic LNM in pdESCC were investigated and compared to previous research on ESCC en bloc. The comparison of the rates between pdESCC and ESCC were performed using the Cochran-Mantel-Haenszel test. The clinicopathological factors associated with LNM in pdESCC were analyzed by Chi-squared tests, and Fisher's exact test was used to assess the rate difference of extra-thoracic LNM. Logistic-regression analysis was used to explore risk factors associated with lymph node (LN) station. Results demonstrated that the distribution pattern of LNM in pdESCC was significantly different compared with that of ESCC (P<0.05). Univariate and multivariate analysis indicated that risk factors associated with LNM were depth and length (P<0.001 and P<0.001) and multivariate analysis also indicated that the location of the tumor (P=0.042) was a risk factor associated with LNM in pdESCC. Metastasis in the abdominal cavity was significantly higher than in the neck in the middle and lower thoracic pdESCC (both P<0.01). LN station 102 and 7 for upper thoracic ESCC, 101 and 105 for middle thoracic ESCC, and 100 for lower thoracic ESCC were identified as high-risk stations for metastases in pdESCC compared to ESCC. Several parameters, including location and neck metastasis, were identified as risk factors of metastasis for the above sites, respectively. In conclusion, postoperative therapy should include more LN stations in pdESCC depending on risk factors of tumor metastasis individually.

Pyrimidine metabolic rate limiting enzymes in poorly-differentiated hepatocellular carcinoma are signature genes of cancer stemness and associated with poor prognosis

Cellular metabolism of cancer cell is generally recognized to provide energy for facilitating tumor growth, but little is known about the aberrant metabolism in tumor progression and its prognostic value. Here, we applied integrated genomic approach to uncover the aberrant expression of metabolic enzymes in poorly-differentiated human hepatocellular carcinoma (HCC) for revealing targets against HCC malignancy. A total of 135 upregulated (22 are rate-limiting enzymes (RLEs)) and 362 down-regulated (77 are RLEs) metabolic genes were identified and associated with poor patient survival in large-cohorts of HCC patients in TCGA-LIHC and two other independent transcriptomic studies. Ten out of 22 upregulated RLEs in poorly-differentiated HCC are critical enzymes in pyrimidine metabolism pathways in association with stemness features by gene enrichment analysis and upregulated in ALDH1⁺ stem-like HCC subpopulations. By focusing on three RLEs including TK1, TYMS and DTYMK of dTTP biosynthesis pathway, expression of 3 RLEs in well-differentiated HCC cells increased ALDH1⁺ and spheroid stemness population but reversed by knockdown in poorly-differentiated HCC cells. Up-regulated 3 RLEs in HCC were associated with poor patient survival in multiple cohorts. Together, we identified aberrant pyrimidine pathway in poorly-differentiated HCC promotes cancer stemness served as potential theranostic target for battling HCC tumor progression.