Search

Objective: To correlate the epidemiological and histological data of breast le-sions ACR 3, ACR 4 and ACR 5 biopsied on ultrasound in the city of Ouaga-dougou. Materials and methods: This was a retrospective study of data for 02 years (2015-2017) in the city of Ouagadougou. With the approval of the Ethics Committee for Health Research, the study focused on the histological results and radiological reports of biopsied lesions. Results: A total of 150 patients files had been collected. Breast lesions classified as ACR 4 were 50%, ACR 3 40% and ACR 5 10%. The risk factors were related to the ACR class. Ultra-sound was performed in all patients. The masses were the most common ele-mentary lesions found in breast imaging. On histology 98 lesions were benign, 16 intermediate lesions and 36 malignant lesions. Fibroids were the most common benign lesions of the ACR 3 and ACR 4 classes. Invasive ductal car-cinoma was the most common histologic type among malignant lesions in all ACR classes. Conclusion: Cancerous lesions are discovered late in our context. The ACR classification must always take into account discriminative ele-ments.

Highlights • 0.5 % of appendectomy specimens show neuroendocrine and 0.5 % show epithelial malignancy. • In 2 patients these two malignancies were in the same appendectomy specimen. • Patients peritoneal metastases occurred from the mucinous epithelial malignancy only. • Rather than routine right hemicolectomy, radical appendectomy is suggested., Background Although uncommon, neoplasms of the appendix do exist. The two most common types are neuroendocrine tumors and mucinous appendiceal neoplasms. Methods In two patients unusual gross and microscopic findings in an appendectomy specimen were recorded. Special immunocytochemistry studies were used to determine the histologic type of the tumors in the appendix. Results The clinical features and histopathology of two patients who had both a neuroendocrine tumor and a low grade appendiceal mucinous neoplasm in the same appendectomy specimen were described. Possibilities for the causation and treatment of this unusual condition were discussed. The incidence of this double malignancy was estimated at 2.5 in 1000 appendectomy specimens. Conclusion Although extremely unusual, a neuroendocrine tumor and a mucinous appendiceal neoplasm can exist in the same appendix. This condition is reported in two young patients.

Purpose Claudin-low molecular subtypes have been identified in breast and bladder cancers and are characterized by low expression of claudins, enrichment for epithelial-to-mesenchymal transition (EMT), and tumor-initiating cell (TIC) features. We evaluated whether the claudin-low subtype also exists in gastric cancer. Materials and Methods Four hundred fifteen tumors from The Cancer Genome Atlas (TCGA) gastric cancer mRNA data set were clustered on the claudin, EMT, and TIC gene sets to identify claudin-low tumors. We derived a 24-gene predictor that classifies gastric cancer into claudin-low and non–claudin-low subtypes. This predictor was validated with the Asian Cancer Research Group (ACRG) data set. We characterized molecular and clinical features of claudin-low tumors. Results We identified 46 tumors that had consensus enrichment for claudin-low features in TCGA data set. Claudin-low tumors were most commonly diffuse histologic type (82%) and originally classified as TCGA genomically stable (GS) subtype (78%). Compared with GS subtype, claudin-low subtype had significant activation in Rho family of GTPases signaling, which appears to play a key role in its EMT and TIC properties. In the ACRG data set, 28 of 300 samples were classified as claudin-low tumors by the 24-gene predictor and were phenotypically similar to the initially derived claudin-low tumors. Clinically, claudin-low subtype had the worst overall survival. Of note, the hazard ratios that compared claudin-low versus GS subtype were 2.10 (95% CI, 1.07 to 4.11) in TCGA and 2.32 (95% CI, 1.18 to 4.55) in the ACRG cohorts, with adjustment for age and pathologic stage. Conclusion We identified a gastric claudin-low subtype that carries a poor prognosis likely related to therapeutic resistance as a result of its EMT and TIC phenotypes.

Perineural tumor spread (PNTS) is one of the important methods of tumoral spread in head and neck cancers. It consists of a complex process that entails the production of certain chemicals or the production of certain cell receptors. Histologic type and primary tumor site play an important role in PNTS. Any nerve could be affected; however, the trigeminal and facial nerves are the most involved nerves. Magnetic resonance imaging and computed tomography detect the primary and secondary signs of PNTS. Functional imaging such as diffusion-weighted imaging and hybrid imaging act as problem-solving techniques.

BACKGROUND: Pure and mixed desmoplastic melanomas may have different natural histories and behavior. METHODS: We conducted a retrospective review of patients diagnosed with desmoplastic melanoma at our institution between January 1997 and April 2019. A total of 33 unique desmoplastic melanomas were identified and subsequently analyzed based on histologic type (pure versus mixed). RESULTS: The majority (57.6%) of our cases were classified as pure histology. Patients with pure desmoplastic melanomas were more likely to be male (p=0.035) and be over the age of 65 (p=0.019) compared to patients with mixed desmoplastic melanoma. Patients with mixed desmoplastic melanoma were more likely to have mitoses present (p=0.001) compared to patients with pure desmoplastic melanoma. There were no differences in ulceration, perineural invasion, vascular invasion, or survival between patients with pure and mixed histologic subtypes. Additionally, no differences in sentinel lymph node biopsy, radiation or chemotherapy were noted between the two histologic subtypes. Immunohistochemistry showed 27.3% of the pure desmoplastic melanomas stained with Melan-A and HMB45 were positive for these immunomarkers. CONCLUSIONS: Pure and mixed variants of desmoplastic melanoma were found to have similar clinicopathologic characteristics. Patients with the mixed histologic subtype were more likely to have mitoses, but no difference in the therapeutic management or patient survival was seen between the two subtypes.

Background Esophageal involvement length (EIL) is a promising indicator of metastasis or recurrence in mediastinal lymph nodes (MLNs) in adenocarcinoma of the esophagogastric junction (EGJ). This study aimed to elucidate the accuracy of the preoperative endoscopic evaluations of EIL and its clinical significance in this disease. Materials and methods In total, 75 patients with Siewert type II (N = 53) or III (N = 22) adenocarcinoma of the EGJ, who underwent surgical resection without preoperative therapy between 1995 and 2016 were enrolled. We retrospectively examined the accuracy of the preoperative endoscopic evaluations of EIL (preoperative EIL), compared to the pathologically evaluated EIL. Finally, we investigated the association between preoperative EIL and metastasis or recurrence in MLNs. Results The accuracy of the preoperative EIL within a 1-cm interval was only 53.3%. Among patients with discordance between the pre- and postoperative evaluations, 68.6 % had the underestimation in the preoperative EIL. pN1–3 (OR = 5.85, 95% CI: 1.03–33.17) and undifferentiated histologic type (OR = 2.52, 95% CI: 0.89–7.14) were potential risk factors for the discordance. Regarding metastasis or recurrence in MLNs, preoperative EIL of 2–3 cm (OR = 10.41, 95% CI: 1.35–80.11) and >3 cm (OR = 8.33, 95% CI: 1.09–63.96) were independent predictors. Conclusion Although the accuracy of the endoscopic evaluations of EIL is insufficient with many underestimations, EIL should be assessed in preoperative staging because of significant predictive power for metastasis or recurrence in MLNs.

There are few data on the long-term outcomes of patients with phyllodes tumors following breast-conserving surgery with or without radiation therapy (RT). We reviewed 69 patients diagnosed from 2000 to 2015 with surgical specimens available for central pathology assessment for outcome in relation to histopathologic subtype, margin width, and utilization of RT. Median follow-up was 63 months (interquartile range, 35-131 months). Forty-eight patients had benign, 13 borderline, and eight malignant phyllodes tumors, with local recurrence rates of 4%, 0%, and 38%, respectively (P ≤ .04 comparing malignant lesions to both benign and borderline lesions). None of the eight patients who received RT suffered a local recurrence. Two of the 26 (8%) patients with benign phyllodes tumors who did not receive RT with margins that were positive or

Thymic carcinomas (TCs) and thymic neuroendocrine tumors (TNETs) are aggressive cancers with poor survival outcome and limited investigation. This study is to investigate clinicopathologic features on TC and TNET patients' prognosis of a large cohort.The Surveillance, Epidemiology, and End Results database were used to identify a total of 362 TC and TNET patients with documented clinicopathologic features we investigated. The characteristics and overall survival of the TC and TNET patients were studied.Two hundred and forty TC and 122 TNET patients were identified. For the entire cohort of TC and TNET, histologic type (P0.001), tumor size (P = 0.015), Masaoka-Koga stage (P = 0.008), regional node positive (P = 0.004), surgery of primary site (P0.001), lymph node surgery (P = 0.013), and chemotherapy (P = 0.001) were considered as significant clinicopathologic features that could affect prognosis of TC and TNET patients in univariate analysis. More importantly, histologic type (P0.001), regional nodes positive (P = 0.03) and surgery of primary site (P0.001) were able to independently predict overall survival of those patients. In addition, for the cohort of TC, we found that regional nodes positive (P = 0.034) and surgery of primary site (P = 0.001) could be independent predictors of TC patients' survival.Regional nodes detection is essential for TC and TNET patients. Surgery of primary site is the preferred primary treatment for those patients.

Pancreatic cystic neoplasms are becoming increasingly frequent, presenting a number of challenges in clinical practice. While several guidelines have been published to address these, they are largely composed of expert opinions based on relatively low-level evidence. Their recommendations are similar in general, but there are many differences in detail. Pancreatic neoplasms have differing malignant potential, based on the histologic type and clinical and radiological features of the cysts. It is necessary to stratify the malignancy risk of each cyst, using proper evaluation methods, and to manage it appropriately, with surgical resection or surveillance. In addition, risks associated with surgical resection, costs associated with long-term follow-up, and patient discomfort and anxiety must be considered in the proper management of pancreatic cystic neoplasms. In this review, we introduce four recently published guidelines. (Korean J Med 2019;94:322-329)

OBJECTIVE. FDG PET/CT affects the management of patients with breast cancer in multiple settings, including initial staging, treatment response assessment, and evaluation of suspected recurrence. This article reviews the strengths and weaknesses of FDG PET/CT for the staging of the primary breast lesion, axillary and extraaxillary nodal metastases, and distant metastases. The utility of FDG PET/CT for measuring breast cancer treatment response is appraised and compared with other imaging modalities. The role that tumor histologic type may have on PET/CT interpretation is also discussed. CONCLUSION. Although FDG PET/CT is currently the PET modality with the greatest effect on clinical management of patients with breast cancer, novel radiotracers and imaging systems continue to broaden the application of PET for patients with breast cancer. National Comprehensive Cancer Network guidelines for FDG PET/CT for patients with breast cancer are reviewed. Emphasis is given where FDG PET/CT has shown clinical effect.

Ovarian cancer is one of the most malignant gynaecological cancer for women. Women with ovarian cancer generally have a poor prognosis with short survival. In our study, an exploratory analysis was carried out using the data routinely collected on patients with ovarian cancer, who were diagnosed and treated in a large hospital in Sydney. Survival following the diagnosis of ovarian cancer was examined in relation to several important prognostic factors, including FIGO stage, age, residual disease and histologic type, aiming to evaluate the effect size of each factor and build up a predictive model for survival. The predicted survival provides valuable information for patients and their families, and is particularly important in helping clinician and hospital with the management of each patient with ovarian cancer.

// Michele M. Gage 1 , Neeraja Nagarajan 1 , Jessica M. Ruck 1 , Joseph K. Canner 1 , Salma Khan 2 , Katherine Giuliano 1 , Faiz Gani 1 , Christopher Wolfgang 1 , Fabian M. Johnston 1 , and Nita Ahuja 1, 3 1 Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA 2 Rehman Medical Institute, Hayatabad, Pakistan 3 Department of Surgery, Yale University, New Haven, Connecticut, USA Correspondence to: Nita Ahuja, email: nita.ahuja@yale.edu Keywords: sarcoma; mesenchymal tumors; connective tissue tumors; SEER; trends of sarcoma Received: November 06, 2018 Accepted: February 19, 2019 Published: March 29, 2019 ABSTRACT Background and objectives: Sarcomas represent a heterogeneous group of tumors, and there is lack of data describing contemporary changes in patterns of care. We evaluated the epidemiology of sarcomas over 12 recent years Methods: The Surveillance, Epidemiology and End Results (SEER) database was queried for sarcoma cases from 2002-2014. Patient, tumor and treatment factors, and trends over time were studied overall and by subtype. Univariable and multivariable logistic regression models and 5-year survival and cause-specific mortality (CSM) were summarized. Results: There were 78,527 cases of sarcomas with an overall incidence of 7.1 cases per 100,000 people, increasing from 6.8 in 2002 to 7.7 in 2014. Sarcoma NOS(14.8%) and soft tissue(43.4%) were the most common histology and primary site, respectively. A majority of tumors were high-grade(33.6%) and >5 cm(51.3%). CSM was 28.6% and 5-year survival was 71.4%. Many patients had unknown-grade(42.2%), which associated with 2.6 times increased odds of no surgical intervention. Conclusions: This comprehensive national study highlights important trends including increasing incidence, changing histologic types, and underestimation of true incidence. A large proportion of sarcomas are inadequately staged (unknown-grade 42.2%) with lack of appropriate surgical treatment. Our study highlights need for standardization of care for sarcomas.

Tumor budding has been associated with poor prognosis in several cancer types, but its significance in gastric cancer is unknown. The aim of this study was to assess the prognostic significance of tumor budding in gastric adenocarcinoma, and its main histologic types. Some 583 gastric adenocarcinoma patients who underwent surgery in Oulu University Hospital during the years 1983-2016 were included in this retrospective cohort study. Tumor budding was counted per 0.785 mm fields from the slides originally used for diagnostic purposes. Patients were divided into low-budding (10 buds) and high-budding (≥10 buds) groups. Tumor budding was analyzed in relation to 5-year survival and overall survival. Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI), adjusted for confounders. Determining tumor budding was difficult in diffuse-type cancer due to the uncohesive growth pattern of these tumors. Patients with high tumor budding had worse 5-year survival compared with patients with low tumor budding (adjusted HR, 1.55; 95% CI, 1.20-2.01). In intestinal-type adenocarcinomas, the high-budding group had significantly poorer 5-year survival compared with the low-budding group (adjusted HR, 1.57; 95% CI, 1.14-2.15). There were no differences in 5-year survival between the budding groups in the diffuse type adenocarcinoma. In conclusion, high tumor budding is an independent prognostic factor in gastric adenocarcinoma, but its value is limited to the intestinal type of gastric adenocarcinoma. In diffuse type gastric adenocarcinoma, the assessment of tumor budding is hardly feasible, and it does not have prognostic relevance.

Head and neck squamous cell carcinoma (HNSCC) is highly variable by tumor site, histologic type, molecular characteristics, and clinical outcome. During recent years, emerging targeted therapies have been focused on driver genes. HNSCC involves several genetic alterations, such as co-occurrence, multiple feedback loops, and cross-talk communications. These different kinds of genetic alterations interact with each other and mediate targeted therapy response. In the current review, it is emphasized that future treatment strategy in HNSCC will not solely be based on "synthetic lethality" approaches directed against overactivated genes. More importantly, biologic, genetic, and epigenetic alterations of HNSCC will be taken into consideration to guide the therapy. The emerging genetic alterations in HNSCC and its effect on targeted therapy response are discussed in detail. Hopefully, novel combination regimens for the treatment of HNSCC can be developed.

Aim We aim to assess prognostic significance of immunohistochemistry represented in Napsin A and CK 5/6 in NSCLC, Moreover we aim to correlate histologic patterns of adenocarcinoma with Napsin A expression and identify its prognostic significance. Patients and methods The study was conducted on 130 cases diagnosed pathologically as NSCLC, and then we used Napsin A and CK 5/6 for subtyping them into actual histologic types (108 cases were diagnosed as adenocarcinoma and 22 cases as squamous cell carcinoma, we correlated expression levels of Napsin A and CK 5/6 to different clinicopathological variants. Results Napsin A score 2 was high in age more than or equal 60 years while Napsin A score 3 was high in age less than 50 years also Napsin A score 3 was high in cases with lymph node metastasis, while CK 5/6 was associated with cases without distant metastasis. Conclusion Both Napsin A and CK 5/6 could be used as prognostic and diagnostic markers in NSCLC.

Hybrid ameloblastoma has a variable clinical, radiological, and histopathological presentation. They contain two or more different histologic types and their biologic comportment is still arguable. We herein present a case of a hybrid variant of desmoplastic ameloblastoma which is the first of its kind to have ever been reported due to its unusual location in the maxillary anterior region, along with systematic review of clinicopathologic features of reported cases immunohistochemical markers may act as an adjunct in the accurate diagnosis of these lesions.

Background Standard treatments have not been established in metastatic papillary renal-cell carcinoma (PRCC). We aimed to investigate treatment outcomes in patients with mPRCC. Patients and Methods This study included 51 patients who were diagnosed with PRCC at 14 institutions. Pathologic slides were reviewed by pathologists. The associations between clinical factors and overall survival (OS) were analyzed. Results Final pathologic diagnoses could be determined in 50 patients. Thirty-five tumors were diagnosed as PRCC (type 2 PRCC, 91.4%), and 15 were diagnosed as other histologic types. Targeted therapies (TTs) were provided to 25 mPRCC patients. Patients treated with TT survived significantly longer than those treated before the era of TT (median OS, 22.5 vs. 6.3 months; P = .0035). Median OS of patients who experienced stable disease for ≥ 9 months using single TT was 43.1 months. Patients treated with a tyrosine kinase inhibitor (TKI) as first-line TT survived longer after TT initiation than those treated with an mTOR inhibitor (median, 22.4 vs. 11.7 months; P = .2684). Patients treated with TKIs in both first- and second-line settings had significantly better survival after TT initiation than those treated with a TKI in one therapy line and an mTOR inhibitor in the other (31.4 vs. 12.9 months, P = .0172). Patients treated with a TKI as second-line TT survived significantly longer after second-line TT initiation than did those treated with an mTOR inhibitor (16.2 vs. 7.4 months, P = .0016). Conclusion Prognoses of patients with mPRCC were improved by TT, and TKIs appeared to be the treatment of choice in both the first- and second-line settings.

The mucinous histologic subtype accounts for 5% to 20% of colorectal cancer (CRC) cases but remains poorly characterized. The present study characterized the baseline characteristics, mutational profile, and clinical outcomes of patients diagnosed with mucinous CRC.We identified 1877 patients with metastatic CRC with available histologic findings and molecular profiling and summarized the baseline clinical and pathologic characteristics and overall survival (OS) stratified by the histologic type. The data from separate cohorts with consensus molecular subtype (CMS) and CpG island methylator information were also summarized.The mucinous histologic type was found in 277 of the 1877 patients (14.8%) and was associated with an increased prevalence of microsatellite instability (P .001) and a right-sided primary (P .001). An increased frequency of CMS1 (microsatellite instability immune) and lower rates of CMS2 (canonical) were identified, with mucinous compared with nonmucinous adenocarcinoma (P .0001). Mutations in SMAD4 (P .001), GNAS (P .001), ERBB2 (P = .02), BRAF (P .001), and KRAS (P .001) occurred at greater frequencies in the mucinous CRC cases, and TP53 (P .001), APC (P .001), and NRAS mutations (P = .03) were less common. Univariate (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; P .001) and multivariate analysis (HR, 1.36; 95% CI, 1.12-1.64; P = .002) demonstrated that the mucinous histologic type is associated with worse OS. The features associated with the mucinous histologic subtype were independent predictors for shorter OS, including BRAF (HR, 1.74; 95% CI, 1.35-2.25; P .001) and KRAS (HR, 1.42; 95% CI, 1.22-1.65; P .001) mutations, right-sided location (HR, 1.20; 95% CI, 1.04-1.39; P = .01), and synchronous metastases (HR, 2.92; 95% CI, 2.49-3.42; P .001).Compared with nonmucinous adenocarcinoma, the mucinous histologic type is associated with a worse prognosis, even when controlling for known prognostic features. This unique biologic behavior should be considered in the treatment and prognostic assessment of patients with CRC.

Background: Thyroid cancer is currently the third fastest rising cancer diagnosis in the United States and represents 80.3% of endocrine neoplasms and 2.6% of total malignancies in Egypt with male to female ratio is 1:2. Papillary thyroid carcinoma (PTC) represents the most common histologic type of thyroid carcinoma in Egypt representing 83.3%. Diagnosis of papillary thyroid carcinoma is not always straight forward because some lesions exhibit equivocal nuclear features making the distinction of benign from malignant lesions is difficult. So it is necessary to use ancillary diagnostic tools to reach accurate diagnosis. TROP-2 is a trans-membranous glycoprotein, was originally identified in human trophoblast and choriocarcinoma cell lines and was subsequently reported to be over-expressed in a variety of human carcinomas. Few studies have verified the diagnostic power of TROP2 in PTC suggesting that it could be a potential novel immunohisto-chemical marker for identification of both classic and follicular variants of PTCAim of Study: The aim of this study is to review the diagnostic value of TROP-2 in papillary thyroid carcinoma (PTC) in English literature.Material and Methods: From Medline databases (PubMed, Medscape and Google scholar) and also materials available on the Internet from 2014 to 2017.The initial search presented 5 articles that studied the diagnostic role of TROP-2 in differentiating PTC from non malignant thyroid lesions and were performed on histological specimens only (cytological specimens were excluded).If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.A structured systematic review was performed with the results tabulated.Results: TROP-2 sensitivity in total papillary thyroid carcinoma cases ranged from 50% to 86.8% passing through 58.3% to 81.5% and 81.6%. Regarding TROP-2 specificity it was 100% in 4 out of 5 articles and 89.3% in the remaining one. Four articles showed 100% of positive predictive value (PPV) and one article demonstrated 84.6%. The negative predicitive value (NPV) ranged from 74.1% to 92.4% and the diagnostic accuracy ranged from 79.4% to 94.3%. As regard non follicular variant PTC (non FVPTC) TROP-2 sensitivities ranged between 81.5% and 98.7%. The NPV ranged between 84% and 99.6%, while diagnostic accuracy ranged between 88.6% and 99.7%. The PPV was 100% in four articles and 82.4% in one article.Conclusion: TROP-2 could be considered as a reliable immunostaining marker in diagnosing papillary thyroid car-cinoma especially non follicular variant owing to its high specificity and sensitivity. TROP-2 is a specific rather than sensitive as its specificities in 4 studies revealed 100%. Ther-efor it is expected to be negative in benign and non-neoplastic thyroid lesions reducing the overdiagnosis of PTC and dis-criminating it from many mimickers.

BACKGROUND/OBJECTIVES: Rhabdomyosarcoma (RMS) is characterized by the expression of the myogenic regulatory protein MYOD1. Histologic types include alveolar, embryonal (ERMS), and spindle cell sclerosing RMS (SRMS). SRMS harbors MYOD1 mutations in a subset of adult cases in association with poor prognosis. DESIGN/METHODS: To study the level of MYOD1 protein expression and its clinical significance, we have analyzed variable numbers of pediatric (

OBJECTIVE: To characterize and compare the molecular subtypes and profiles of prospectively-accrued newly-diagnosed early- and advanced-stage endometrial cancers (ECs). METHODS: EC patients consented to an IRB-approved protocol of massively parallel sequencing of 410–468 cancer-related genes; 175 ECs of 7 histologic types (n=135 FIGO stages I/II, n=40 FIGO stages III/IV) were included. Previously reported sequencing data from 99 additional advanced-stage ECs were retrieved for comparisons. RESULTS: Irrespective of histologic type, all 175 ECs could be stratified into the molecular subtypes, with 75 (43%) being of p53 wild-type, 49 (28%) MMR-deficient, 39 (22%) p53 abnormal and 12 (7%) of POLE molecular subtypes. Subtype distribution, mutational and copy number profiles varied according to histologic type. In endometrioid ECs, genetic alterations varied according to histologic grade. Potential therapeutic targets, including high tumor mutational burden, ERBB2 amplification and PIK3CA hotspot mutations, were found across histologic types in 63% (n=110) of all ECs. Compared to their early-stage counterparts, advanced-stage endometrioid ECs had a significantly higher fraction of genome altered (median 0.1% vs 12%, p0.05) and PIK3CA mutations (46% vs 27%, p>0.05). Whole-genome doubling was found in advanced- but not early-stage carcinosarcomas and clear cell carcinomas. CONCLUSIONS: Our findings demonstrate the molecular heterogeneity within and across histologic types of EC and the increased genomic complexity of advanced-stage ECs. Molecular subtypes are present across EC histologic types and may help stratify EC patients for prognostic and therapeutic purposes.

Papillary thyroid carcinoma (PTC) is the most common histologic type of thyroid carcinoma worldwide. Lymph node (LN) metastases are common, and microscopic LN metastases occur in the majority of patients who have PTC. 1 LN metastases are associated with an increased risk of local or regional recurrence of cancer, and they can be a negative prognostic indicator with respect to survival. 2 , 3 , 4 LN metastases may necessitate more extensive surgery, with increased risks, and a longer period of recovery, as well as an increased use of postoperative radioactive iodine. To facilitate development of an appropriate presurgical plan to clear all macroscopic disease during the initial surgery, a thorough examination of LNs with preoperative radiographic mapping is essential.

Primary salivary gland–type tumors of the lung are rare neoplasms that arise from the submucosal glands of central airways. Four histologic types are identified (two of which are extremely rare).

Introduction Integrating additional factors into the International Federation of Gynaecology and Obstetrics (FIGO) staging system is needed for accurate patient classification and survival prediction. In this study, we tested machine learning as a novel tool for incorporating additional prognostic parameters into the conventional FIGO staging system for stratifying patients with epithelial ovarian carcinomas and evaluating their survival. Material and methods Cancer-specific survival data for epithelial ovarian carcinomas were extracted from the Surveillance, Epidemiology, and End Results (SEER) program. Two datasets were constructed based upon the year of diagnosis. Dataset 1 (39 514 cases) was limited to primary tumor (T), regional lymph nodes (N) and distant metastasis (M). Dataset 2 (25 291 cases) included additional parameters of age at diagnosis (A) and histologic type and grade (H). The Ensemble Algorithm for Clustering Cancer Data (EACCD) was applied to generate prognostic groups with depiction in dendrograms. C-indices provided dendrogram cutoffs and comparisons of prediction accuracy. Results Dataset 1 was stratified into nine epithelial ovarian carcinoma prognostic groups, contrasting with 10 groups from FIGO methodology. The EACCD grouping had a slightly higher accuracy in survival prediction than FIGO staging (C-index = 0.7391 vs. 0.7371, increase in C-index = 0.0020, 95% confidence interval [CI] 0.0012-0.0027, p = 1.8 × 10-7 ). Nevertheless, there remained a strong inter-system association between EACCD and FIGO (rank correlation = 0.9480, p = 6.1 × 10-15 ). Analysis of Dataset 2 demonstrated that A and H could be smoothly integrated with the T, N and M criteria. Survival data were stratified into nine prognostic groups with an even higher prediction accuracy (C-index = 0.7605) than when using only T, N and M. Conclusions EACCD was successfully applied to integrate A and H with T, N and M for stratification and survival prediction of epithelial ovarian carcinoma patients. Additional factors could be advantageously incorporated to test the prognostic impact of emerging diagnostic or therapeutic advances.

Objectives: Although the incidence of ovarian cancer has decreased over the past several years, it is unclear if this finding is represented in the uncommon histologic types. As such, we investigated the incidence and trends of granulosa cell tumors of the ovary in the United States. Methods: Data were extracted from the United States Cancer Statistics, 2001-2016. Trends in the incidence was analyzed by SEER*Stat 8.3.8. Chi-square tests were used for statistical analysis. Results: Of 5,531 patients with granulosa cell tumors, 60.7% were White, 23.9% Black, 11.2% Hispanic, and 2.6% Asian. Local, regional, and distant, and unknown stages represented 52.7%, 26.5%, 13.1%, and 7.7% of the study population. The annual percent change in incidence (APC) of White individuals was 2.15% (p Conclusions: Despite the overall decrease in the incidence of epithelial ovarian cancer in the US, the new cases of granulosa cell tumors have been increasing. Black patients and White patients aged 50-59 years residing in the Central US are at higher risk. Factors such as genetics and social determinants of health may further explain these findings.

Background and objectives: Our aim is to explore the relationship between the levels of protein encoded by Ki67 and the histopathological aspects regarding the overall survival and progression-free survival in a single university center. A secondary objective was to examine other factors that can influence these endpoints. New approaches to the prognostic assessment of breast cancer have come from molecular profiling studies. Ki67 is a nuclear protein associated with cell proliferation. Together with the histological type and tumor grade, it is used to appreciate the aggressiveness of the breast tumors. Materials and Methods: We conducted a retrospective single-institution study, at Elias University Emergency Hospital, Bucharest, Romania, in which we enrolled women with stage I to III breast cancer. The protocol was amended to include the immunohistochemistry determination of Ki67 and the histological aspects. The methodology consisted in using a Kaplan&ndash, Meier analysis for the entire sample and restricted mean survival time up to 36 months. Results: Both lower Ki67 and low tumor grade are associated with better prognosis in terms of overall survival (OS) and progression-free survival (PFS) for our patients&rsquo, cohort. In our group, the histological type did not impact the time to progression or survival. Conclusions: Both overall survival and progression-free survival may be influenced by the higher value of Ki67 and less differentiated tumors. Further studies are needed in order to establish if the histologic type may impact breast cancer prognostic, probably together with other histologic and molecular markers.

Although it is known that lung cancer is prevalent in Kentucky, the exact scope and nature of the problem was unknown. We report extraordinarily high lung cancer incidences, shifted subtype distributions, late disease presentation, and poor survival in Kentucky and Appalachian Kentucky. Our findings indicate that Kentucky lung cancer patients may benefit from expanded efforts in prevention, drug discovery, and health care delivery, especially in the rural and Appalachian regions. INTRODUCTION: Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood. PATIENTS AND METHODS: We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions. RESULTS: We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky. CONCLUSION: Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.

Background A combined transcranial and transfacial approach has long been the gold standard for surgical management of large tumors with sinonasal and skull base involvement. The extended endoscopic endonasal approach for such pathologies has its advantages, but it has flaws as well, such as anatomic limitations and more ponderous skull base reconstruction and thus higher risk of postoperative complications. Our primary technique for surgical treatment of these pathologies has been a combination of transfacial and minimally invasive transciliary supraorbital keyhole approaches. With the aim to further minimize invasiveness, potential complications, and unsatisfactory aesthetic outcomes during surgical treatment of large tumors invading both the sinonasal area and the skull base, we abandoned the transfacial approach and simultaneously combined the transciliary supraorbital keyhole approach with the endoscopic endonasal approach. Methods The well-known microscope-assisted minimally invasive approach via a transciliary supraorbital keyhole craniotomy was combined with the endoscopic endonasal approach. Results Six patients with different histologic types of tumors affecting the sinonasal area and the skull base were operated on. The mean operative time was 3 hours, there were no unexpected intraoperative or postoperative complications, and total tumor removal was achieved in each patient. None of the patients experienced complications associated with the surgery during follow-up. Conclusions Our combined simultaneous multiportal approach enables total tumor eradication with reduced operative time and is associated with minimal intraoperative and postoperative complications, low mortality rate, and excellent cosmetic results.

Purpose of review Optic nerve sheath meningiomas (ONSMs) are rare benign tumors of the anterior visual pathway which present with slowly progressive and painless vision loss and account for approximately 2% of all orbital tumors. This article provides an overview as well as an update on the ONSMs with regards to cause, epidemiology, clinical presentation, diagnosis, and management in adults and pediatric population. Recent findings The clinical presentation and prognosis of ONSMs can vary and largely depend on the location of tumor as well as the histologic type. Overall, the diagnosis is based on clinical presentation, examination, and neuroimaging findings. Nevertheless, delays in diagnosis or misdiagnosis are not uncommon and can result in higher morbidity rates. Recent advances in diagnostic as well as more effective and less-invasive treatment options are discussed in this review. Summary ONSMs are a rare cause of slowly progressive and inexorable visual loss. Although ONSM diagnosis depends on the characteristic clinical and radiologic findings, prompt diagnosis, and appropriate management is critical for favorable visual outcomes. Thus, current focus is optimizing diagnostic as well-treatment methods for patients with ONSMs.

Abastract Background The American Joint Committee on Cancer (AJCC) staging system is the reference standard for describing the extent of neoplastic disease on the basis of the size of primary tumor (T), and the presence of regional lymph node (N) involvement and distant metastasis (M). Multiple foci of invasive breast carcinoma may pose staging challenges to the reporting pathologist. We set out to evaluate the practice of local breast pathologists with regard to staging of multiple foci of invasive carcinoma. Patients and Methods Breast pathologists were surveyed at a Community of Interest in Breast Pathology meeting. The live voting survey contained 6 case-based scenarios of multiple foci of invasive mammary carcinoma of the same or different histologic type and with unilateral or bilateral involvement. A supporting illustration was provided for each case. Results There was poor interobserver agreement with no consensus reached among the respondents in any of the cases. Staging choices varied from staging tumors together irrespective of histology or procedure type to staging tumors of the same histologic type together, or staging each tumor focus separately. Confusion was particularly evident when tumor foci with different histologic types were present. Conclusion Inconsistencies exist in the reporting of AJCC pathologic TNM stage for multiple foci of invasive carcinoma. The results serve as a reminder that education and strict adherence to the AJCC guidelines is essential for establishing standard practice in order to provide accurate cancer staging and ensure optimal clinical management.

Introduction Malignant nonendodontic periapical lesions represent a rare diagnosis, in which few case have been reported about this condition. Due to the low occurrence and little exploration of this subject, serious errors of diagnosis are observed in the oral medicine services. In this sense, the purpose of the present review was to integrate the information on the record published on malignant lesions that mimic endodontic pathoses into a comprehensive analysis of their clinical, radiologic, and histopathologic features. Methods An online search was made in March 2020 in the following databases: Pubmed, Web of Science, and Scopus. Eligibility criteria included publications having enough clinical, radiologic, and histopathologic information to confirm the diagnosis. Data were assessed descriptively. Results Forty-nine publications from 16 countries comprising 60 cases were included. There is a nearly equal occurrence rate between males and females (male/female ratio is 49.15%/50.84%) with a mean age of 46.56 years. The lesions were more prevalent in the posterior mandibles (40.69%), and, radiographically, they were unilocular radiolucent. Histopathologic analysis showed metastasis (26.67%) as the most prevalent lesion followed by salivary gland malignant disease (25%). Conclusions The present systematic review revealed several histologic types of malignant periapical lesions that could be mimicking endodontic pathoses. Because these lesions usually do not show clinical or radiologic features of malignant alteration, clinicians should consider these hypotheses in their routine.

Papillary thyroid carcinoma (PTC) is the most common histologic type of differentiated thyroid cancer and is considered to be a relatively indolent tumor from which death is rare. Recent advances i...

Background/Aim: This study characterized lung cancer (LC) in Portugal, to capture sex differences, regional variation, and spatial distribution. Patients and Methods: Variables: age, sex, vital status, region of residence, degree of urbanization, histologic types and stage at diagnosis. Spatial analyses conducted to identify high (HIC) and low incidence (LIC) clusters. Results: In total, 11,642 cases were diagnosed (76.6% male, 23.4% female), with a similar mean age at diagnosis. There were 23,6% locally advanced and 58.4% metastatic disease cases, with 13.4% alive five years after diagnosis. Non-small-cell LC accounted for 77.3% of which 40.8% was adenocarcinoma and 22.7% was squamous cell carcinoma. Standardized incident rate (IR) was 37.5/10(5), 65.2/10(5) in males, and 15.7/10(5) in females, with four HIC (urban) clusters and four LIC (non-urban). Conclusion: This study highlighted the sex differences in incidence, mortality, histology, and geographic distribution of LC in Portugal. Considering the advanced stages and the poor overall survival, understanding sex and geographic differences is important for public health interventions.

The roots of precision cancer therapy began at the Mayo Clinic in 1914 when surgical pathologist Albert C. Broders began collecting data showing that cancers of the same histologic type behaved differently. In March 1920, based upon 6 years of clinical follow‐up, Broders published his first paper, utilizing data from over 500 cases of squamous cell carcinoma of the lip that he had blindly divided into four histologic grades based upon degree of differentiation, showing that numerical tumor "grading" allowed him to predict patient prognosis. Before this, surgeons had no scientific way to evaluate prognosis. Broders then replicated his work using other types of tumors at other body sites, as did several Mayo Fellows and pathologists at other institutions. Cuthbert Dukes in London, England not only replicated Broders’ findings with rectal adenocarcinomas, he also used the same data to develop the first tumor “staging” methodology by focusing upon depth of local invasion and presence or absence of lymph node metastases. Soon, tumor grading, tumor staging, or the combination of both represented state‐of‐the‐art prognostic techniques for scientific cancer care. This brief historical vignette celebrates the 100th anniversary of Broders’ first paper, which is the starting point for the long road to personalized cancer care., The roots of precision cancer therapy began 100 years ago when surgical pathologist Albert C. Broders began collecting data showing for the first time that cancers of the same histologic type and anatomical site behaved differently. He had blindly divided squamous cell carcinoma of the lip into four histologic grades based upon degree of differentiation, showing that numerical tumor "grading" allowed him to predict patient prognosis. This quickly led to "staging" of cancers.

Purpose: Invasive lobular carcinoma (ILC) accounts for approximately 5%–15% of all invasive breast cancer cases. Most of the correlations between multigene assays and patient outcome were derived from studies based on patients with invasive ductal carcinoma (IDC) or without distinction between the subtypes. Here, we investigate the prognostic value of EndoPredict (EPclin) in a large cohort of ILCs pooled from three phase III randomized trials (ABCSG-6, ABCSG-8, TransATAC). Experimental Design: The primary objective of this analysis was to determine the prognostic value of EPclin for distant recurrence (DR) in years 0–10 in postmenopausal women with ILC. The primary outcome was DR. Results: 470 women (17.9%) presented with ILC, 1,944 (73.9%) with IDC, and 216 (8.2%) with other histologic types. EPclin was highly prognostic in women with ILC [HR = 3.32 (2.54–4.34)] and provided more prognostic value than the Clinical Treatment Score [CTS; HR = 2.17 (1.73–2.72)]. 63.4% of women were categorized into the low EPclin risk group and they had a 10-year DR of 4.8% (2.7–8.4) compared with 36.6% of women in the high-risk group with a 10-year DR risk of 26.6% (20.0–35.0). EPclin also provided highly prognostic information in women with node-negative disease [HR = 2.56 (1.63–4.02)] and node-positive disease [HR = 3.70 (2.49–5.50)]. Conclusions: EPclin provided highly significant prognostic value and significant risk stratification for women with ILC. Ten-year DR risk in the EPclin low-risk groups were similar between ILC and IDC. Our results show that EPclin is informative in women with ILC and suggest that it is equally valid in both histologic subtypes.

The frequency and prognostic significance of the histologic type in early-stage ovarian cancer (OC) is not as well established as in advanced stages. In addition, histologic typing based only on morphologic features may be difficult, especially in high-grade tumors. In this study, we have analyzed a prospective cohort of 502 early-stage OCs to investigate their frequency, immunohistochemical characteristics, and survival of the 5 main histologic types. Histotype was assigned according to not only the morphologic features but also according to the expression pattern of WT1, p53, Napsin A, and progesterone receptors. In addition, an extended panel including p16, -catenin, HER2, Arid1A, HINF1B, CK7, CDX2, and CK20 was used to refine the diagnosis in difficult cases. In this series, the frequency of the 5 major histologic types was as follows: endometrioid carcinoma, 32.7%; clear cell carcinoma, 25.1%; high-grade serous carcinoma (HGSC), 24.7%; mucinous carcinoma, 10.2%; low-grade serous carcinoma, 4.6%; and others, 2.8%. The combination of morphology and immunohistochemistry allowed the reclassification of 23% of OCs. The lowest concordance was found between samples initially diagnosed as endometrioid, but finally classified as high-grade serous tumors (22% error rate). Endometrioid carcinoma was the most favorable histologic type, whereas HGSC and low-grade serous carcinoma had the worst prognosis. Clear cell carcinoma with abnormal p53 immunostaining pattern also had poor prognosis. Although histologic grade was not a prognostic factor among early-stage endometrioid OCs, distinction between grade 3 endometrioid OC and HGSC is recommended, taking into account differences in prognosis and molecular alterations that can guide different treatments.

Gastrointestinal (GI) cancers altogether represent the most common cancer type. HER2 is found to be present in nearly all histologic types of GI cancers in variable degrees of expression. Over the last decade, substantial advances have been made in targeting HER2-positive cancers. Areas covered: The present review summarizes the current progress and future directions for HER2 targeted therapies in GI cancers, including esophagogastric, pancreaticobiliary, and colon cancers. To date trastuzumab is the only anti-HER2 therapy approved for metastatic esophagogastric adenocarcinoma. Efforts are ongoing to expand the therapeutic role of HER2 to other GI cancers and overcome mechanisms of drug resistance. Novel agents and combinations are being tested in most HER2 positive GI cancers including early stage disease. These are of recent interest in colorectal cancer with studies indicating that HER2 overexpression might increase resistance to anti-EGFR therapy and may be potentially targeted. Expert commentary: With the current ability to sequence tumors and detect genetic alterations, emphasis should be put on genomically-selected pan-tumor targeted therapies. HER2 is a perfect example of a promising drug target in GI cancers.