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Introduction Lung cancer is the most common cause of cancer deaths worldwide, accounting for 1.8 million deaths each year. Only 20% of lung cancer cases are reported to occur in low- and middle-income countries. An estimated 1.5% of all Ethiopian cancers involved the lung; however, no nationwide cancer registry exists in Ethiopia. Thus, accurate data on clinical history, histopathology, molecular characteristics, and risk factors for lung cancer are not available. The aim of this study was to describe the clinical, radiologic, and pathologic characteristics, including available molecular profiles, for lung cancer at Tikur Anbessa Specialized Hospital (TASH), the main tertiary referral center in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted at TASH among 146 patients with pathologically confirmed primary lung cancer, diagnosed from 2015 to 2019 and recorded in the Addis Ababa Cancer Registry at TASH. Clinical data were extracted from patient medical records, entered into a Research Electronic Data Capture database, and analyzed using Statistical Package for the Social Sciences statistical software. Variables collected included sociodemographics, personal exposures, comorbidities, clinical manifestations at presentation, chest imaging results, diagnostic procedures performed, histopathological classification, cancer staging, and type of treatment (if any). A subset of lung biopsies fixed in formalin for 2 to 7 days, which could be retrieved from the files of the Pathology Department of TASH, were reviewed, and molecular analysis was performed using next-generation sequencing to identify the tumor-oncogenic drivers. Results Among the 146 patients studied, the mean (SD) age was 54 plus or minus 13 years; 61.6% (n = 90) were male and 25.3% (n = 37) had a history of tobacco use. The most common clinical manifestations included cough (88.4%, n = 129), chest pain (60.3%, n = 88), and dyspnea (53.4%, n = 78). The median duration of any symptoms was 6 months (interquartile range: 3–12 mo). The most common radiologic features were lung mass (84.9%, n = 129) and pleural effusion (52.7%, n = 77). Adenocarcinoma accounted for 35.7% of lung cancers (n = 52) and squamous cell carcinoma 19.2% (n = 28) from those specimens was reported. Among patients on whom staging of lung cancer was documented, 92.2% (n = 95) of the subjects presented at advanced stages (stages III and IV). EGFR mutation, exons 19 and 20, was found in 7 of 14 tissue blocks analyzed. No specific risk factors were identified, possibly reflecting the relatively small sample size and limited exposures. Conclusions There are marked differences in the presentation, risk factors, and molecular characteristics of lung cancer in Ethiopia as compared with other African and non-African countries. Adenocarcinoma was the most common histologic type of lung cancer detected in our study, similar to findings from other international studies. Nevertheless, compared with high-income countries, lung cancer in Ethiopia presents at a younger age, a later stage, and without considerable personal tobacco use. The relatively higher prevalence of EGFR mutation, from the limited molecular analyses, suggests that factors other than smoking history, such as exposure to biomass fuel, may be a more important risk factor. Country-specific screening guidelines and treatment protocols, in addition to a national tumor registry and greater molecular mutation analyses, are needed to improve prevention and management of lung cancer in Ethiopia.

PurposeAdding pelvic lymph node dissection (PLND) to cystectomy offers significant survival benefit. However, it remains unclear whether this benefit persists in all histologic types. The aim of the study was to examine the impact of PLND on overall survival (OS) after cystectomy in bladder carcinoma patients with histological variants.MethodsWithin the Surveillance, Epidemiology and End Results database, we identified 16,880 bladder carcinoma patients receiving cystectomy between 2004 and 2015. Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology. Cox regression models were used to evaluate the effect of PLND on OS stratified by histologic type.ResultsHistologic types were significantly associated with the presence of lymph node metastasis in patients with bladder carcinoma (P < 0.001). In multivariable Cox regression analyses, PLND compared with non-PLND was associated with OS benefit in patients with transitional cell carcinoma (hazard ratio [HR], 0.595; 95% confidence interval [95% CI], 0.557–0.634 [P < 0.001]), squamous cell carcinoma (HR, 0.646; 95% CI, 0.494–0.846 [P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107–0.504 [P < 0.001]), whereas no significant differences in OS were observed in other histological subsets.DiscussionOur analyses revealed a significant OS benefit from PLND in patients with transitional cell carcinoma, squamous cell carcinoma, and signet ring cell carcinoma. However, a survival benefit of PLND in patients with other histologic types was not demonstrated.

We aimed to investigate potential causal associations between serum 25-hydroxyvitamin D [25(OH)D] levels and incidence of lung cancer overall and histologic types. We performed a Mendelian randomization (MR) analysis using a prospective cohort study in Norway, including 54580 individuals and 676 incident lung cancer cases. A 25(OH)D allele score was generated based on vitamin D-increasing alleles of rs2282679, rs12785878 and rs10741657. Hazard ratios (HRs) with 95% confidence intervals (CIs) for incidence of lung cancer and histologic types were estimated in relation to the allele score. Inverse-variance weighted method using summarized data of individual single-nucleotide polymorphisms was applied to calculate the MR estimates. The allele score accounted for 3.4% of the variation in serum 25(OH)D levels. There was no association between the allele score and lung cancer incidence overall, with HR being 0.99 (95% CI 0.93 to 1.06) per allele score. A 25 nmol/L increase in genetically determined 25(OH)D level was not associated with the incidence of lung cancer overall (MR estimate HR 0.96, 95% CI 0.54 to 1.69) or any histologic type. MR analysis did not suggest causal association between 25(OH)D levels and risk of lung cancer overall or histologic types in this population-based cohort study. © 2018. This is the authors' accepted and refereed manuscript to the article. The final authenticated version is available online at: 10.1183/13993003.00329-2018

Background: Previous prospective studies have shown inconsistent associations between serum 25-hydroxyvitamin D [25(OH)D] level and lung cancer incidence. The aim of the present study was to explore the associations of serum 25(OH)D levels with incidence of lung cancer overall and different histologic types. Methods: We performed a population-based prospective case-cohort study including 696 incident lung cancer cases and 5804 individuals in a subcohort who participated in the second survey of the Nord-Trøndelag Health Study in Norway. Cox proportional hazards regression models counting for the case-cohort design were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for lung cancer overall or histologic types in relation to serum 25(OH)D levels. Results: Compared with the 4th season-specific quartile of 25(OH)D (median 68.0 nmol/L), lower 25(OH)D levels were not associated with the incidence of overall, small or squamous cell lung cancer. However, the risk of adenocarcinoma was lower in the 2nd and 3rd quartiles (median 39.9 and 51.5 nmol/L) compared with the 4th quartile, with HRs of 0.63 (95% CI 0.41 to 0.98) and 0.58 (0.38 to 0.88), respectively. The associations of lower levels of 25(OH)D with a reduced risk of adenocarcinoma were only observed in the overweight/obese subjects [HRs for 2nd and 3rd quartiles: 0.40 (0.22 to 0.72) and 0.50 (0.27 to 0.92)] but not in the normal weight subjects [HRs: 0.95 (0.52 to 1.75) and 0.60 (0.32 to 1.10)]. Conclusions: Serum 25(OH)D levels were not associated with the risk of lung cancer in general. The observation that lower 25(OH)D levels were associated with a lower risk of adenocarcinoma should be interpreted with caution. This is a pre-print of an article published in [European Journal of Epidemiology]. The final authenticated version is available online at: https://doi.org/10.1007/s10654-017-0324-1

Tumors of the small bowel account for 5% of all tumors of the gastrointestinal tract. Although important progress has been made from a radiological and endoscopic point of view, they have a poor prognosis due to delayed diagnosis. This occurs because of the absence of clinical manifestations and of the difficulties of exploration. This study aimed to highlight the endoscopic and histologic features of tumors of the small bowel. We conducted a retrospective descriptive study in the Department of Hepato-Gastroenterology at the University hospital Hassan II, Fez, over a period of 11 years (2002-2012). We analyzed the epidemiological, clinical, endoscopic and histologic features of tumors of the small bowel. Data were collected from the medical records of 27 patients. The average age was 48 years [21-80 years] with a male predominance (H/F:2.4). Melenas led to the discovery of tumor in 55% of cases, abdominal mass in 15% of cases and Koenig syndrome or occlusive syndrome in 11% of cases. One patient had a history of celiac disease. CT enteroclysis showed the seat of the tumor in 18 cases. Push enteroscopy for detection of proximal tumors and double-balloon enteroscopy for detection of distal tumor were performed in 8 patients (30%). Endoscopy showed ulcerated lesion in 37.5% of cases, ulcerated stenotic lesion in 50% of cases and ulcerobudding stenotic lesion in 25% of cases. Surgery with anatomopathological examination of the surgical specimen allowed the diagnosis in 18 cases. The histologic type was dominated by stromal tumors in 14 cases (51%), followed by adenocarcinomas in 5 cases (18.5%), B-cell non-Hodgkin lymphoma in 4 cases (15%), neuroendocrine carcinoma of the jejunum in 1 case. Tumors of the small bowel are rare but they are characterized by a poor prognosis. Current imaging techniques (CT enteroclysis and MR enterography) coupled with endoscopic examinations, in particular double-balloon enteroscopy, allow earlier diagnosis and mortality reduction.

Papillary thyroid carcinoma (PTC) is a disease with an indolent course, excellent overall prognosis, and a long-term survival rate close to that of the general population;1 however, some variants of PTC have been associated with an increased risk of recurrent disease and aggressive behavior.2 The tall cell variant of PTC (TCVPTC) is the most common aggressive variant of PTC.2,3,4 The incidence of TCVPTC ranges from 4% to 17% of all PTCs, and its disease-free 10-year survival rate is believed to be 10% to 15% lower than that of classic PTC.5,6 The incidence of this disease in Korea has been reported to be up to 5%, although there are limited existing data.7,8 Some studies suggest that TCV PTC is still under-diagnosed worldwide.3,4,5,9,10 In fact, 1% to 13% of tumors originally diagnosed as classic PTC can be reclassified as TCV by thyroid expertise.11,12 TCVPTC was originally described by Hawk and Hazard9 in 1976 as a distinctive subtype of PTC. Tall tumor cells are at least three times as tall as they are wide and have moderate to abundant eosinophilic cytoplasm, basally oriented nuclei and nuclear features typical of classic PTC.2,10 TCVPTCs present later in life and have more aggressive pathologic features such as a larger size and higher frequency of extrathyroidal extension, lymph node metastasis, vascular invasion, and distant metastasis, when compared to classic PTC.5,9,11,13,14 However, some studies have shown that the worse prognosis of TCVPTC is related to prognostic factors such as old age, tumor size, and extrathyroidal extension rather than the histologic type itself.4 There is still controversy with regard to what percentage of tall cells defines a TCVPTC.2,9,15 Thresholds ranging from 10 to 75% have been suggested by various studies.2,5,15,16,17,18 PTCs harboring fewer tall cells than the required cutoff percentage are diagnosed as classic PTC with tall cell features (TCF). Therefore, the incidence and clinical results of TCVPTC may vary according to different diagnostic criteria and the pathologist's level of experience.15,19 The goal of this study was to investigate the prevalence of TCVPTC in Korea and possible differences in clinicopathologic features between TCVPTCs and classic PTCs with TCF according to the percentage of tall cells.