High-dose, pulsed-dose BRT feasible palliative options in laryngeal cancer

High-dose and pulsed-dose brachytherapy are feasible options for laryngeal cancer patients with recurrent or residual stomal tumor after total laryngectomy, report Polish researchers.

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The ABC of terminal hemorrhage management

To best cope with terminal hemorrhage, at-risk patients should be identified by healthcare professionals while their families and caregivers are prepared, supported, and instructed to assure, be there for, and calm and comfort the patient as the event occurs, say researchers.

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V-shaped lymph node dissection in laparoscopic distal gastrectomy; new technique of intra-abdominal dissection and surgical outcomes

Background: Recently, laparoscopic-assisted distal gastrectomy (LADG) has become popular for the treatment of early gastric cancer. Furthermore, the use of totally laparoscopic gastrectomy (TLG), a more difficult procedure than LADG, has been increasing in Japan. Laparoscopic-assisted distal gastrectomy is currently performed more frequently than laparoscopic distal gastrectomy (LDG) in hospitals in Japan.MethodReconstruction after LDG is commonly performed extra-abdominally and lymph node dissection of the lesser curvature is performed at the same time. We have developed a new method of intra-abdominal lymph node dissection for the lesser curvature. Results: Our technique showed positive results, is easy to perform, and is reasonable in terms of general oncology theory. Conclusion: In oncological therapy, this technique could be a valuable surgical option for totally laparoscopic surgery.

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Granular cell tumors: a report of six cases

Granular cell tumor is a soft tissue neoplasm that originates in the nervous system and arises at virtually any body site, but is mainly found in the skin, oral cavity or digestive tract. Most are benign and reportedly malignant cases are rare, occurring in only 1% or 2% of cases. We report on our findings in six patients who developed granular cell tumor in the mammary gland, esophagus, subcutaneous tissue and muscle. Of six patients, two had granular cell tumor located in the breast, two in the submucosa of the esophagus, and the other two under the skin of the left axillary cavity and in the right latissimus dorsi muscle, respectively. One of the two patients with tumor in the submucosa of the esophagus also had esophageal cancer. Patients' age ranged from 41 to 70 years (average, 59.1 years). Two patients with tumor in the submucosa of the esophagus were men, and the others were women. All of them were given a diagnosis of granular cell tumor by tissue biopsy and examination of excised specimens, but no evidence of malignancy was found. No recurrence has been noted in the patients who underwent surgical tumor removal.

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Predicting necrosis in residual mass analysis after retroperitoneal lymph node dissection: a retrospective study

Background: Recent studies have demonstrated that pathological analysis of retroperitoneal residual masses of patients with testicular germ cell tumors revealed findings of necrotic debris or fibrosis in up to 50% of patients. We aimed at pursuing a clinical and pathological review of patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in order to identify variables that may help predict necrosis in the retroperitoneum. Methods: We performed a retrospective analysis of all patients who underwent PC-RPLND at the University Hospital of the University of Sao Paulo and Cancer Institute of Sao Paulo between January 2005 and September 2011. Clinical and pathological data were obtained and consisted basically of: measures of retroperitoneal masses, histology of the orchiectomy specimen, serum tumor marker and retroperitoneal nodal size before and after chemotherapy. Results: We gathered a total of 32 patients with a mean age of 29.7; pathological analysis in our series demonstrated that 15 (47%) had necrosis in residual retroperitoneal masses, 15 had teratoma (47%) and 2 (6.4%) had viable germ cell tumors (GCT). The mean size of the retroperitoneal mass was 4.94 cm in our sample, without a difference between the groups (P = 0.176). From all studied variables, relative changes in retroperitoneal lymph node size (P = 0.04), the absence of teratoma in the orchiectomy specimen (P = 0.03) and the presence of choriocarcinoma in the testicular analysis after orchiectomy (P = 0.03) were statistically significant predictors of the presence of necrosis. A reduction level of 35% was therefore suggested to be the best cutoff for predicting the absence of tumor in the retroperitoneum with a sensitivity of 73.3% and specificity of 82.4%. Conclusions: Even though retroperitoneal lymph node dissection remains the gold standard for patients with residual masses, those without teratoma in the primary tumor and a shrinkage of 35% or more in retroperitoneal mass have a considerably smaller chance of having viable GCT or teratoma in the retroperitoneum and a surveillance program could be considered.

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Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

Background: Currently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO2) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system. Methods: A total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO2), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO2 insufflation, and 30 min after desufflation. Results: CO2 insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients' safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO2 insufflation pressure caused increases in PaCO2 and decreases in arterial pH. However, vital signs were stable and pH and PaCO2 were within the physiologic range during the surgery in the 6- and 9-mmHg groups. Conclusions: We propose that a CO2 insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.

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The utility of hyperthermia for local recurrence of breast cancer

Background: Hyperthermia has long been used in combination with chemotherapy or radiation therapy for the treatment of superficial malignancies, in part due to its sensitizing capabilities. Patients who suffer from superficial recurrences of breast cancer have poor clinical outcomes. Skin metastases may particularly impair the quality of life due to the physical appearance, odor and bleeding.Case presentationA 66-year-old woman underwent mastectomy and axillary lymph node dissection for breast cancer. Nine years post-operatively, local metastases developed in the left axillary area (measuring 5 cm in diameter). Initially the tumor did not respond to radiation therapy and chemotherapy. Therefore, we added hyperthermia combined with them. Eight weeks later, the tumor became nearly flat and the patient noted improved activity in her daily life. Conclusion: Hyperthermia may accelerate the antitumor effects of radiation therapy and chemotherapy. This treatment provides an alternative for unresectable breast cancer skin metastases.

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Cyclooxygenase/lipoxygenase shunting lowers the anti-cancer effect of cyclooxygenase-2 inhibition in colorectal cancer cells

Background: Arachidonic acid metabolite, generated by cyclooxygenase (COX), is implicated in the colorectal cancer (CRC) pathogenesis. Inhibiting COX may therefore have anti-carcinogenic effects. Results from use of non-steroidal anti-inflammatory drugs inhibiting only COX have been conflicting. It has been postulated that this might result from the shunting of arachidonic acid metabolism to the 5-lipoxygenase (5-LOX) pathway. Cancer cell viability is promoted by 5-LOX through several mechanisms that are similar to those of cyclooxygenase-2 (COX-2). Expression of 5-LOX is upregulated in colorectal adenoma and cancer. The aim of this study was to investigate the shunting of arachidonic acid metabolism to the 5-LOX pathway by cyclooxygenase inhibition and to determine if this process antagonizes the anti-cancer effect in colorectal cancer cells. Methods: Three colorectal cancer cell lines (HCA7, HT-29 & LoVo) expressing 5-LOX and different levels of COX-2 expression were used. The effects of aspirin (a non-selective COX inhibitor) and rofecoxib (COX-2 selective) on prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) secretion were quantified by ELISA. Proliferation and viability were studied by quantifying double-stranded DNA (dsDNA) content and metabolic activity. Apoptosis was determined by annexin V and propidium iodide staining using confocal microscopy, and caspase-3/7 activity by fluorescent substrate assay. Results: COX inhibitors suppressed PGE2 production but enhanced LTB4 secretion in COX-2 expressing cell lines (P <0.001). The level of COX-2 expression in colorectal cancer cells did not significantly influence the anti-proliferative and pro-apoptotic effects of COX inhibitors due to the shunting mechanism. Conclusions: This study provides evidence of shunting between COX and 5-LOX pathways in the presence of unilateral inhibition, and may explain the conflicting anti-carcinogenic effects reported with use of COX inhibitors.

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A case of wedge resection of duodenum for massive gastrointestinal bleeding due to duodenal metastasis by renal cell carcinoma

Background: Gastrointestinal bleeding due to duodenal metastasis from renal cell carcinoma is extremely rare. Several previous reports have shown that embolic therapy or pancreatoduodenectomy (radical surgical resection) could be effective in controlling this type of clinical complication. Management is entirely dependent on the general condition and concurrent metastases at other sites. Optimizing the therapeutic strategies thus deserves further discussion and exploration. Methods: In this report, we describe a patient with severe co-morbidities who underwent successful palliative wedge resection of duodenum and direct duodenal wall defect repair without reconstruction of duodeno-jejunostomy for acute upper digestive tract hemorrhage caused by duodenal metastasis from renal clear cell carcinoma. Results: The patient recovered uneventfully and did not experience rebleeding and frequent vomiting after surgery. Since then (1.5 years) he has had no evidence of rebleeding. Conclusions: Gastrointestinal bleeding due to duodenal metastasis of RCC may benefit from emergent resection even in the presence of severe co-morbidities, and for palliative treatment.

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Chromosomal structural analysis in carcinoma of the gallbladder

Background: The etiopathogenesis of gallbladder cancer is still unknown. Both environmental and patient factors have been incriminated in its cause. That it is found in pockets of epidemiological distribution raises an issue of genetic changes associated with it. The aim of this study was to find out the chromosomal changes in gallbladder cancer. Methods: Lymphocyte cell culture was carried out on blood of gallbladder cancer patients to determine chromosomal banding abnormalities. Native PAGE was also evaluated to analyze lactate degydrogenase (LDH), superoxide dismutase (SOD) and catalase enzyme activity from the same blood of gallbladder cancer patients. Results: Out of 30 gallbladder cancer patients, 4 male showed breakage on the long arm of chromosome 1 while only one male patient showed the translocation from the long arm of chromosome 4 to the long arm of chromosome 6 in a male patient. Conclusion: The aberrations found in our study may suggest underlying genetic predisposition for the development of gallbladder cancer. They can act as a marker for gallbladder cancer, which needs further study.

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Preoperative multidetector-row computed tomography scan staging for lymphatic gastric cancer spread

Background: Multidetector-row computed tomography (MDCT) is commonly used to stage patients with gastric cancer, even though the technique often shows low specificity for lymph-node involvement. Methods: In this study, 111 patients with gastric cancer who consecutively underwent MDCT scan followed by radical surgical treatment at our hospital were retrospectively evaluated. Results: In total, 3632 lymph nodes from 643 lymphatic stations were studied and then correlated with radiological features. Lymph-node size was not always associated with infiltration. Of the 261 lymph-node stations that were not radiologically detected, 60 (22.9%) were infiltrated. There were 108 stations with lymph nodes larger than 10 mm seen on MDCT, of which 67 (62%) had lymphatic invasion. The sensitivity was 32.6%, specificity 90.6%, positive predictive value 62.0%, negative predictive value 74.2%, and accuracy 72.1%. When three lymph nodes, at least one of which was larger than 10 mm, were detected in the same station, infiltration was confirmed with 99% specificity in 93.8% of patients. Moreover, all of the 13 patients in whom three lymph nodes larger than 10 mm were detected in different neighboring stations had lymphatic invasion. Conclusions: Although presence of lymph nodes greater than 10 mm in size is not, in itself, sufficient to confirm lymphatic invasion, nodal involvement can be hypothesized when associated images are detected by MDCT.

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Routine tests flag up cancer danger in cryptogenic stroke

Blood tests and imaging findings could point to hidden malignancies in patients with cryptogenic stroke, say researchers.

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Cancer fears allayed for shingles patients

Herpes zoster infection, or shingles, is not associated with cancer, show results from a study published in the Canadian Journal of Medicine

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Recurrent glioblastoma: consider after effects before choosing palliative surgery

Before suggesting surgery as palliative therapy for patients with recurrent glioblastoma, physicians should consider the impact of morbidities on quality of life, suggest researchers from Italy.

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Reduced-intensity benefits confirmed for AML cell transplantation

Reduced-intensity conditioning reduces toxicity associated with allogeneic hematopoietic cell transplantation for acute myeloid leukemia without affecting long-term outcomes, show results from the first randomized trial of this treatment.

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MRD monitoring falls short in childhood AML assessment

Measuring treatment response by minimal residual disease monitoring offers no more prognostic value than morphologic analysis in children with acute myeloid leukemia (AML), show study findings.

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Cancer stem cells from a rare form of glioblastoma multiforme involving the neurogenic ventricular wall

Background: The cancer stem cell (CSC) hypothesis posits that deregulated neural stem cells (NSCs) form the basis of brain tumors such as glioblastoma multiforme (GBM). GBM, however, usually forms in the cerebral white matter while normal NSCs reside in subventricular and hippocampal regions. We attempted to characterize CSCs from a rare form of glioblastoma multiforme involving the neurogenic ventricular wall. Methods: We described isolating CSCs from a GBM involving the lateral ventricles and characterized these cells with in vitro molecular biomarker profiling, cellular behavior, ex vivo and in vivo techniques. Results: The patient's MRI revealed a heterogeneous mass with associated edema, involving the left subventricular zone. Histological examination of the tumor established it as being a high-grade glial neoplasm, characterized by polygonal and fusiform cells with marked nuclear atypia, amphophilic cytoplasm, prominent nucleoli, frequent mitotic figures, irregular zones of necrosis and vascular hyperplasia. Recurrence of the tumor occurred shortly after the surgical resection. CD133-positive cells, isolated from the tumor, expressed stem cell markers including nestin, CD133, Ki67, Sox2, EFNB1, EFNB2, EFNB3, Cav-1, Musashi, Nucleostemin, Notch 2, Notch 4, and Pax6. Biomarkers expressed in differentiated cells included Cathepsin L, Cathepsin B, Mucin18, Mucin24, c-Myc, NSE, and TIMP1. Expression of unique cancer-related transcripts in these CD133-positive cells, such as caveolin-1 and -2, do not appear to have been previously reported in the literature. Ex vivo organotypic brain slice co-culture showed that the CD133+ cells behaved like tumor cells. The CD133-positive cells also induced tumor formation when they were stereotactically transplanted into the brains of the immune-deficient NOD/SCID mice. Conclusions: This brain tumor involving the neurogenic lateral ventricular wall was comprised of tumor-forming, CD133-positive cancer stem cells, which are likely the driving force for the rapid recurrence of the tumor in the patient.

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Retraction: colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial

The authors have retracted this article (Scabini et al) because it contains large portions of text that have been duplicated from another article previously published in Annals of Surgery (Zmora et al). The authors apologise to the Editors and readers as well as the authors of the original article.

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Expression of miR-34 is lost in colon cancer which can be re-expressed by a novel agent CDF

Background: Colorectal Cancer (CRC) is one of the leading causes of death worldwide. Numerous cellularevents, including deregulated expression of microRNAs (miRNAs), specifically the family ofmiR-34 consisting of miR-34a, b and c, which is known to regulate the processes of growthand metastasis. Methods: We evaluated the expression of miR-34 in formalin-fixed paraffin-embedded (FFPE) humancolon cancer tissue specimens compared to normal colonic mucosa. Moreover, we alsoassessed the expression of miR-34 in colon cancer cell lines treated with our newly developedsynthetic analogue of curcumin referred as diflurinated curcumin (CDF) compared to wellknown inhibitor of methyl transferase. Results: We found that the expression of miR-34a and miR-34c was down-regulated in colon cancerspecimens compared to normal colonic mucosa and the loss of expression was also consistentwith data from colon cancer cell lines. This down-regulation was attributed to promoterhypermethylation, because we found that the treatment of colon cancer cells with 5-aza-2'-deoxycytidine, a methyltransferase inhibitor, markedly induced the levels of miR-34a andmiR-34c expression. Likewise, CDF was very effective in the re-expression of miR-34a andmiR-34c, which was consistent with inhibition of cell growth of both chemo-sensitive andchemo-resistant colon cancer cells. The re-expression of miR-34 led to a marked reduction inthe expression of its target gene, Notch-1. Conclusion: The loss of expression of miR-34 in colon cancer is in part due to promoter hypermethylationof miR-34, which can be re-expressed with our novel agent CDF, suggesting that CDF couldbe a novel demethylating agent for restoring the expression of miR-34 family, and thus CDFcould become a newer therapeutic agent for the treatment of colon cancer.

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Safety and preliminary results of perioperative chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) for high-risk gastric cancer patients

IIntroduction: Gastric cancer relapse occurs in about 30% of the patients treated with gastrectomy and D2-lymphadenectomy, mainly as distant or peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with an improvement in survival and lower peritoneal recurrence, albeit with increased morbidity. The aim of this study is to report the preliminary results of the association of perioperative chemotherapy, radical surgery and HIPEC in high-risk gastric patients in a single institution. Methods: Treatment protocol was started in 2007 and included patients younger than 65 years old, with good performance status and gastric adenocarcinoma with serosa involvement and lymph node metastases, located in the body or antrum. Patients should receive three preoperative cycles of DCF (Docetaxel 75mg/m2, Cisplatin 75mg/m2 and continuous intravenous infusion of 5-Fluorouracil 750mg/m2 for 5 days), followed by gastric resection with D2-lymphadenectomy, hyperthermic intraperitoneal chemotherapy with Mytomicin C 34mg/m2 and three more postoperative cycles of DCF. Results: Ten patients were included between 2007 and 2011. Their median age was 47 years old and six were male. Nine were staged with cT4 cN+ tumors and one as cT3 cN+. Nine patients completed all three preoperative chemotherapy cycles. Eight individuals were treated with a total gastrectomy and the other two had a distal gastrectomy, all having HIPEC. Postoperative morbidity was 50%, with no deaths. Regarding postoperative chemotherapy, only 5 patients completed three cycles. With a median follow-up of 25 months, three relapses were identified and 7 patients remain disease-free, two with more than 4 years of follow-up. Conclusion: The association of perioperative systemic and intraperitoneal chemotherapy plus radical surgery is a feasible multimodality treatment, with acceptable morbidity. With a longer follow-up and a larger group of patients, we hope to be able to determine if it also influences survival outcomes and patterns of recurrence.

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HDM2 antagonist MI-219 (spiro-oxindole), but not Nutlin-3 (cis-imidazoline), regulates p53 through enhanced HDM2 autoubiquitination and degradation in human malignant B-cell lymphomas

Background: Lymphomas frequently retain wild-type (wt) p53 function but overexpress HDM2, therebycompromising p53 activity. Therefore, lymphoma is a suitable model for studying thetherapeutic value of disrupting the HDM2-p53 interaction by small-molecule inhibitors(SMIs). HDM2 have been developed and are under various stages of preclinical and clinicalinvestigation. Previously, we examined the anti-lymphoma activity of MI-319, the laboratorygrade of a new class of HDM2 SMI, the spiro-oxindole, in follicular lymphoma. Since then,MI-219, the clinical grade has become readily available. This study further examines thepreclinical effects and mechanisms of MI-219 in a panel of human lymphoma cell lines aswell as a cohort of patient-derived B-lymphcytes for its potential clinical use. Results: Preclinical assessment of MI-219 was evaluated by means of an in vitro and ex vivo approachand compared to Nutlin-3, the gold standard. Characterization of p53 activity and stabilitywere assessed by quantitative PCR, Western blot, and immunoprecipitation. Biologicaloutcome was measured using Trypan blue exclusion assay, Annexin V/PI, PARP andcaspase-3 cleavage. Surprisingly, the overall biological effects of Nutlin-3 were more delayed(48 h) while MI-219 triggered an earlier response (12-24 h), predominantly in the form ofapoptotic cell death. Using a cell free autoubiquitination assay, neither agent interfered withHDM2 E3 ligase function. MI-219 was more effective in upregulating wt-p53 stabilizationcompared to Nutlin-3. MI-219, but not Nutlin-3, enhanced the autoubiquitination anddegradation of HDM2. Conclusions: Our data reveals unexpected differences between MI-219 and the well-studied Nutlin-3 inlymphoma cell lines and patient samples. We suggest a novel mechanism for MI-219 thatalters the functional activity of HDM2 through enhanced autoubiquitination and degradation.Additionally, this mechanism appears to correspond to biological outcome. Our resultsprovide evidence that different classes of HDM2 SMIs elicit molecular events that extendbeyond HDM2-p53 dissociation which may be of biological and potentially therapeuticimportance.

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Conjunctival lymphoma arising from reactive lymphoid hyperplasia

Extra nodal marginal zone B-cell lymphoma (EMZL) of the conjunctiva typically arises in the marginal zone of mucosa-associated lymphoid tissue. The pathogenesis of conjunctival EMZL remains unknown. We describe an unusual case of EMZL arising from reactive lymphoid hyperplasia (RLH) of the conjunctiva. A 35-year-old woman had fleshy salmon-pink conjunctival tumors in both eyes, oculus uterque (OU). Specimens from conjunctival tumors in the right eye, oculus dexter (OD), revealed a collection of small lymphoid cells in the stroma. Immunohistochemically, immunoglobulin (Ig) light chain restriction was not detected. In contrast, diffuse atypical lymphoid cell infiltration was noted in the left eye, oculus sinister (OS), and positive for CD20, a marker for B cells OS. The tumors were histologically diagnosed as RLH OD, and EMZL OS. PCR analysis detected IgH gene rearrangement in the joining region (JH) region OU. After 11 months, a re-biopsy specimen demonstrated EMZL based on compatible pathological and genetic findings OD, arising from RLH. This case suggests that even if the diagnosis of the conjunctival lymphoproliferative lesions is histologically benign, confirmation of the B-cell clonality by checking IgH gene rearrangement should be useful to predict the incidence of malignancy.

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Expression and significance of the TLR4/MyD88 signaling pathway in ovarian epithelial cancers

Background: Toll-like receptors (TLR) are a family of pattern recognition receptors that constitutes a major part of the innate immune system. The TLR4/(Myeloid differentiation factor 88 (MyD88) signaling pathway has been shown to have oncogenic effects. Methods: To demonstrate the role of TLR4/MyD88 signaling in ovarian epithelial cancers (OECs), we examined the expression of TLR4, MyD88 and nuclear factor- kappaB (NF-kappaB) in OECs. The expression of TLR4, MyD88, and NF-kappaB was detected by immunohistochemistry, and the relationships between these and clinicopathologic features in 123 cases of OECs were also analyzed. Results: The expression of TLR4, MyD88, and NF-kappaB in OECs was observed in 46.3% (57/123), 36.6% (45/123) and 65% (80/123) of OEC cases, respectively. The TLR4, MyD88, and NF-kappaB expressions were associated with the histologic type of OECs, particularly with the clear cell type of OEC. There was no significant correlation between TLR4 or NF-kappaB expression and histologic grade, tumor size, mitotic count, FIGO (International Federation of Gynecology and Obstetrics) stage, disease recurrence. However, there was a significant correlation between MyD88 expression and FIGO stage, disease recurrence as well as histologic type. In univariate analysis, the expression of TLR4 and MyD88, and the coexpression of TLR4/MyD88 and TLR4/MyD88/NF-kappaB had a significant impact on the survival of patients with OECs. Only MyD88 expression had an independent prognostic significance in multivariate analysis. Conclusions: Our findings suggest that the TLR4/MyD88 signaling pathway is associated with the survival of patients with OECs, and that MyD88 is an independent prognostic predictor in patients with OECs. The TLR4/MyD88 signaling pathway may be a mechanism responsible for poor prognosis in patients with clear cell type of OEC.

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Fluorodeoxyglucose-positron emission tomography scan-positive recurrent papillary thyroid cancer and the prognosis and implications for surgical management

Background: To compare outcomes for patients with recurrent or persistent papillary thyroid cancer (PTC) who had metastatic tumors that were fluorodeoxyglucose-positron emission tomography (FDG-PET) positive or negative, and to determine whether the FDG-PET scan findings changed the outcome of medical and surgical management. Methods: From a prospective thyroid cancer database, we retrospectively identified patients with recurrent or persistent PTC and reviewed data on demographics, initial stage, location and extent of persistent or recurrent disease, clinical management, disease-free survival and outcome. We further identified subsets of patients who had an FDG-PET scan or an FDG-PET/CT scan and whole-body radioactive iodine scans and categorized them by whether they had one or more FDG-PET-avid (PET-positive) lesions or PET-negative lesions. The medical and surgical treatments and outcome of these patients were compared. Results: Between 1984 and 2008, 41 of 141 patients who had recurrent or persistent PTC underwent FDG-PET (n = 11) or FDG-PET/CT scans (n = 30); 22 patients (54%) had one or more PET-positive lesion(s), 17 (41%) had PET-negative lesions, and two had indeterminate lesions. Most PET-positive lesions were located in the neck (55%). Patients who had a PET-positive lesion had a significantly higher TNM stage (P = 0.01), higher age (P = 0.03), and higher thyroglobulin (P = 0.024). Only patients who had PET-positive lesions died (5/22 vs. 0/17 for PET-negative lesions; P = 0.04). In two of the seven patients who underwent surgical resection of their PET-positive lesions, loco-regional control was obtained without evidence of residual disease. Conclusion: Patients with recurrent or persistent PTC and FDG-PET-positive lesions have a worse prognosis. In some patients loco-regional control can be obtained without evidence of residual disease by reoperation if the lesion is localized in the neck or mediastinum.

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SPECT/CT detects metastatic nodes in melanoma

The preoperative use of single-photon emission CT plus CT imaging improves the detection of metastatic lymph nodes over standard lymphoscintigraphy, research shows.

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Suboptimal chemotherapy is an adverse prognostic factor in osteosarcoma

Background: We sought to determine whether suboptimal chemotherapy compromised the prognosis ofosteosarcoma patients. Methods: A total of 132 eligible patients who underwent chemotherapy between 1998 and 2008 wereidentified in our database. Information regarding patient demographics, clinicalcharacteristics, and survival status were extracted for analysis. Optimal chemotherapy wasdefined as receipt of [greater than or equal to]80% of the planned dose intensity of prescribed agents within theplanned durations Results: The use of optimal chemotherapy resulted in an overall survival benefit with P = 0.006.Patients who failed to complete the optimal chemotherapy protocol had a dismal prognosis of30.8% overall survival over five years, whereas those who completed the optimalchemotherapy had an overall survival rate over five years of 65.3%. Based on multivariateanalysis, patients who were treated with a suboptimal protocol had a higher risk of relapse,metastasis and mortality. The hazard ratio (HR) of recurrence or death for the suboptimalchemotherapy group was as high as 2.512 over that of the optimal chemotherapy group (HR= 2.512, 95% confidence interval = 1.242 to 3.729). Conclusions: Chemotherapy is a significant independent prognostic variable, and suboptimal chemotherapywas found to have a detrimental effect on the outcome of patients with osteosarcoma.

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Serum VEGF levels as predictive marker of bisphosphonate-related osteonecrosis of the jaw

Recent studies have been reported that angiogenesis suppression may play a role indeveloping bisphosphonate-related osteonecrosis of the jaw (B-ONJ). According to theseevidence we evaluated the role of VEGF as predictive marker of B-ONJ onset. Of the 81patients, 6 developed B-ONJ following bisphosphonate treatment. These patients showed astrongest decrease in VEGF circulating levels at day 7 and at day 21 after the firstadministration. These data demonstrated for the first time that the anti-angiogenic propertiesof bisphosphonates are directly linked to B-ONJ pathogenesis and serum VEGF levels couldrepresent an effective early predictive marker.

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Objective response rate promising after crizotinib for NSCLC

More than half of the latest evaluated participants from the ongoing phase II PROFILE 1005 trial of crizotinib against ALK-positive advanced non-small-cell lung cancer, achieved an objective tumor response, report researchers.

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Think ‘glass half full’ to reduce pain after breast surgery

Women who undergo surgery for breast cancer are less likely to experience postoperative pain if they have an optimistic personality, but are more likely to experience it if they already had preoperative pain, shows an analysis of the Study of Recovery after Breast Surgery.

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Optimal approach for esophageal cancer surgery varies

Accurate preoperative staging of junctional adenocarcinoma of the esophagus can impact the surgical approach used, and postoperative outcomes vary according to the patients’ stage of disease, report German researchers.

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Blood pressure, oxygen saturation predict death in terminally ill

The most reliable events that predict impending death in terminally ill cancer patients being treated palliatively are decreased blood pressure and low oxygen saturation, show study results.

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Colon cancer lymph node target ‘overambitious’ for rectal disease

The lymph node yield needed during rectal cancer surgery following long-course radiotherapy may be considerably less than that recommended for colon cancer, say the authors of a systematic review.

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Therapeutic advancement of chronic lymphocytic leukemia

Despite the combinations of chemotherapy with monoclonal antibodies have furtherimproved response rates, chronic lymphocytic leukemia (CLL) remains an incurable diseasewith an extremely variable course. This article reviews the ongoing clinical advances in thetreatment of CLL in both previously untreated and relapsed disease and focuses on the benefitof different therapeutic strategies, the most effective therapy combinations and the potentialactivity of novel agents. Novel agents and combination therapies have been investigated byseveral studies in both the upfront and relapsed setting, particularly for patients with 17pdeletion, TP53 mutation and fludarabine-refractory CLL. While these agents and combinationtherapies have improved initial response rates, ongoing studies are continued to determineand improve the efficacy and safety. Despite advancements in the treatment of CLL have ledto high response rates, allogeneic hematopoietic stem cell transplantation (allo-HSCT)remains the only curative option and reduced-intensity conditioning (RIC) allo-HSCT mustbe strongly considered whenever feasible. As such, ongoing studies of these agents and othernovel approaches in clinical development are needed to expand and improve treatmentoptions for CLL patients.

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Low accuracy of endoscopic ultrasonography for detailed T staging in gastric cancer

Background: The accuracy of endoscopic ultrasonography (EUS) for preoperative staging of gastric cancer varies. The aim of this study was to investigate the accuracy of EUS tumor (T) and node (N) staging, and to identify the histopathological factors influencing accuracy based on the detailed tumor depth of gastric cancer. Methods: In total, 309 patients with gastric cancer with confirmed pathological staging underwent EUS examination for preoperative staging at Seoul St. Mary's Hospital, Korea, between January and December 2009.The T and N staging of EUS and the pathologic report were compared. Results: The overall accuracies of EUS for T stage and the detailed T stages were 70.2% and 43.0%, respectively. In detailed stage, tumors greater than 50 mm in diameter were significantly associated with T overstaging (odds ratio (OR) = 2.094).The overall accuracy of EUS for N staging was 71.2%. Tumor size (20 mm = size <50 mm, OR = 4.389; and 50 mm = size, OR = 8.170), cross-sectional tumor location (circumferential, OR = 4.381) and tumor depth (submucosa, OR = 3.324; muscular propria, OR = 6.923; sub-serosa, OR = 4.517; and serosa-exposed, OR = 6.495) were significant factors affecting incorrect nodal detection. Conclusions: Careful attention is required during EUS examination of large-sized gastric cancers to increase accuracy, especially for T staging.

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Primary yolk sac tumor of seminal vesicle: a case report and literature review

Background: Yolk sac tumor (endodermal sinus tumor) is a rare malignant germ cell tumor arising in the testis or ovary. Extragonadal yolk sac tumor is even rarer and has only been described in case reports. Due to the rarity of the tumors, the appropriately optimal treatment remains unclear. We report a case of yolk sac tumor in the seminal vesicle.CaseA 38-year-old Asian male presented with gross hematuria and hemospermia. Transrectal ultrasound scan showed a solid mass in the left seminal vesicle and the scrotal sonography showed no abnormalities. Bilateral seminal vesicles were resected, and histopathological examination showed a typical pattern of yolk sac tumor (YST). The patient responded poorly to comprehensive treatment of radiotherapy, chemotherapy and surgeries, developed systemic multiple metastases, and died of cachexia one and half years after diagnosis.

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Managing soft tissue sarcomas in a developing country: are prognostic factors similar to those of developed world?

Background: Managing soft tissue sarcomas (STS) in a developing country with limited financial resources and a poor health referral system is a challenge. Presenting late, these extremity STS are prone to recurrence despite apparently complete resection. This study aimed to explore and compare the impact of clinico-pathological factors on recurrence and survival in Pakistan with the corresponding figures quoted from the developed world. Methods: An institutional review was performed on all patients with primary STS of the extremities operated on between 1994 and 2008. The prognostic influence of clinical, pathologic, and treatment variables on local recurrence free survival (LRFS), metastasis free survival (MFS) and overall survival (OS) were analyzed by univariate and multivariate Cox regression analysis and Kaplan Meier survival curves. Results: A total of 84 patients with a mean age of 41.8 +/- 21.9 years were included in the study. The local recurrence rate was 14.3% after a median of 6 (mean 7.4) months. Metastases occurred in 7 patients (8.3%) and 65 patients were alive without evidence of disease after a mean follow-up of 52.6 +/- 39.8 months. Tumor size > 5 cm, grade 3 tumors and margin < 10 mm significantly increased local recurrence rates. A margin >= 10 mm and age < 45 years significantly enhanced cumulative survival. Significant multivariate risk factors for metastases were margin < 10 mm and tumor grade G3. Conclusions: Despite a poor health referral system in our country, our results are no different from those reported from the developed world. Surgical margins and tumor grade prognostically influenced LRFS, MFS and OS.

via World Journal of Surgical Oncology

A Lonely Voice Asking Tough Questions on Cancer Cost-Effectiveness | Xconomy

Last week, the Fred Hutchinson Cancer Research Center announced that it is investing some of its own funds to start an institute ICORE with a stated goal to “improve the efficiency and effectiveness of cancer prevention, early detection and treatment to reduce the economic and human burdens of cancer.”

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Personality of outpatients with malignant tumors: a cross-sectional study

Background: There have been scarce large-scale studies investigating the personality of patients with malignant tumors. The purpose of this study is to determine the characteristic personality in malignant tumors outpatients. Methods: Three thousand and three among 5013 consecutive outpatients who consented to answer the Japanese Maudsley Personality Inventory questionnaires were divided into two groups. 603 outpatients diagnosed with malignant tumors (M group) and the other 2400 outpatients (non-M group) were enrolled in this study. We determined three scores such as introversion/extroversion (E-score), neuroticism (N-score), and lie detection (L-score). All data were used to compare the two groups. Results: Average E-score was slightly higher, and average N-score was slightly lower in M group than that in non-M group, and no significant differences between the two groups. However, the average L-score in M group was significant higher than that in non-M group (p < 0.01). Conclusion: Outpatients with malignant tumors showed a significantly higher L-score on MPI when compared with patients with non-malignant tumors. These results stress the importance of taking the mentality of patients with cancer into consideration when conducting treatment and care.

via World Journal of Surgical Oncology

Genomic profiling using array comparative genomic hybridization define distinct subtypes of diffuse large b-cell lymphoma: a review of the literature

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-HodgkinLymphoma comprising of greater than 30 % of adult non-Hodgkin Lymphomas. DLBCLrepresents a diverse set of lymphomas, defined as diffuse proliferation of large B lymphoidcells. Numerous cytogenetic studies including karyotypes and fluorescent in situhybridization (FISH), as well as morphological, biological, clinical, microarray andsequencing technologies have attempted to categorize DLBCL into morphological variants,molecular and immunophenotypic subgroups, as well as distinct disease entities. Despite suchefforts, most lymphoma remains undistinguishable and falls into DLBCL, not otherwisespecified (DLBCL-NOS). The advent of microarray-based studies (chromosome, RNA, geneexpression, etc) has provided a plethora of high-resolution data that could potentiallyfacilitate the finer classification of DLBCL. This review covers the microarray data currentlypublished for DLBCL. We will focus on these types of data; 1) array based CGH; 2) classicalCGH; and 3) gene expression profiling studies. The aims of this review were three-fold: (1)to catalog chromosome loci that are present in at least 20 % or more of distinct DLBCLsubtypes; a detailed list of gains and losses for different subtypes was generated in a tableform to illustrate specific chromosome loci affected in selected subtypes; (2) to determinecommon and distinct copy number alterations among the different subtypes and based on thisinformation, characteristic and similar chromosome loci for the different subtypes weredepicted in two separate chromosome ideograms; and, (3) to list re-classified subtypes andthose that remained indistinguishable after review of the microarray data. To the best of ourknowledge, this is the first effort to compile and review available literatures on microarrayanalysis data and their practical utility in classifying DLBCL subtypes.Although conventional cytogenetic methods such as Karyotypes and FISH have played amajor role in classification schemes of lymphomas, better classification models are clearlyneeded to further understanding the biology, disease outcome and therapeutic management ofDLBCL. In summary, microarray data reviewed here can provide better subtype specificclassifications models for DLBCL.

via Journal of Hematology & Oncology

An unusual case of retrovesical ectopic prostate tissue accompanied by primary prostate cancer

We report an unusual case of retrovesical ectopic prostate tissue in a 73-year-old man withprimary prostate cancer. The man's prostate-specific antigen was 24.66 ng/ml.Transabdominal ultrasonography, pelvic computed tomography and pelvic magneticresonance imaging demonstrated a heterogeneous 8.5 x 8.0 x 7.0 cm mass in contact with theposterior wall of the urinary bladder. The patient underwent a retropubic radicalprostatectomy and resection of the tumor. Pathological examination of the prostate revealed aprostatic adenocarcinoma, Gleason score of 4 + 5 = 9, and the retrovesical tumor wasconfirmed to be a benign prostate tissue.

via World Journal of Surgical Oncology

Presentation of two patients with malignant granulosa cell tumors, with a review of the literature

Granulosa cell tumors (GCTs) of the ovary account for 2 to 5 of ovarian malignancies. We present two patients with malignant ovarian adult GCT. In one patient, a combination of bleomycin, etoposide, and cisplatin was effective after initial surgery for malignant GCT. In the other, an aromatase inhibitor was effective for recurrent malignant GCT. We also review the literature for further management of this tumor. Because GCT of the ovary is rare, it will be necessary to elucidate the clinical phenotype and establish treatment protocols by accumulating and analyzing more patients.

via World Journal of Surgical Oncology

'No malignancy risk' with biologic response modifiers

Rheumatoid arthritis patients treated with biologic response modifiers for at least 6 months do not have a greater risk for malignancy than those given other disease-modifying drugs or placebo, conclude US and Spanish researchers.

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Intermittent hormone therapy effective for prostate cancer patients

Intermittent androgen deprivation is as effective as continuous therapy for men with rising prostate-specific antigen levels after primary or salvage radiotherapy, say researchers who believe the break from treatment improves quality of life.

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Biomarker predicts temsirolimus benefit in renal cancer

In patients with metastatic renal cell carcinoma, the biomarker serum lactate dehydrogenase is both prognostic for survival and predictive for the survival benefit conferred by the TORC1 inhibitor temsirolimus, research shows.

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CAD risk no higher in head and neck cancer

Researchers have shown that people with head or neck cancer are not necessarily at any greater risk for developing coronary artery disease than the general population.

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Arsenic trioxide and ascorbic acid interfere with the BCL2 family genes in patients with myelodysplastic syndromes: an ex-vivo study

Background: Arsenic Trioxide (ATO) is effective in about 20% of patients with myelodysplasia (MDS); itsmechanisms of action have already been evaluated in vitro, but the in vivo activity is still notfully understood. Since ATO induces apoptosis in in vitro models, we compared theexpression of 93 apoptotic genes in patients' bone marrow before and after ATO treatment.For this analysis, we selected 12 patients affected by MDS who received ATO incombination with Ascorbic Acid in the context of the Italian clinical trial NCT00803530,EudracT Number 2005-001321-28. Methods: Real-time PCR quantitative assays for genes involved in apoptosis were performed usingTaqMan(R) Assays in 384-Well Microfluidic Cards "TaqMan(R) Human Apoptosis Array".Quantitative RT-PCR for expression of EVI1 and WT1 genes was also performed. Geneexpression values (Ct) were normalized to the median expression of 3 housekeeping genespresent in the card (18S, ACTB and GAPDH). Results: ATO treatment induced up-regulation of some pro-apoptotic genes, such as HRK, BAK1,CASPASE-5, BAD, TNFRSF1A, and BCL2L14 and down-regulation of ICEBERG. In themajority of cases with stable disease, apoptotic gene expression profile did not change,whereas in cases with advanced MDS more frequently pro-apoptotic genes were upregulated.Two patients achieved a major response: in the patient with refractory anemia thetreatment down-regulated 69% of the pro-apoptotic genes, whereas 91% of the pro-apoptoticgenes were up-regulated in the patient affected by refractory anemia with excess of blasts-1.Responsive patients showed a higher induction of BAD than those with stable disease.Finally, WT1 gene expression was down-regulated by the treatment in responsive cases. Conclusions: These results represent the basis for a possible association of ATO with other biologicalcompounds able to modify the apoptotic pathways, such as inhibitors of the BCL2 family.

via Journal of Hematology & Oncology

A significant proportion of breast cancer survivors have chronic fatigue

UK study results show that over a third of breast cancer survivors have cancer-related fatigue syndrome and that these women have significantly lower subjective quality of life and mood than their nonfatigued peers.

via Med Wire News

Reduced NF-κB expression linκed to postradiation oral mucosa vulnerability

The fragility of oral mucosa after radiotherapy for oral squamous cell carcinoma may be due to the inhibition of the DNA transcriptor protein nuclear factor κappa-light-chain-enhancer of activated B cells, show study findings.

via Med Wire News

More focus required on hospice care for heart failure patients

End-stage heart failure patients enter hospice care closer to the time of their death, are more often referred from acute care facilities, and are more likely to die in acute care settings compared with cancer patients, show study results.

via Med Wire News

Arsenic induces acute promyelocytic leukemia remission

Elderly patients with acute promyelocytic leukemia have a high rate of response to arsenic trioxide, say researchers who believe the drug should be a first-line treatment in this population.

via Med Wire News

Predictors for pain after breast cancer surgery unveiled

Researchers have identified that chronic preoperative pain, axillary surgery, and psychologic robustness significantly predict acute pain outcomes after breast cancer surgery.

via Med Wire News

Pediatric central line infections reduced by ‘best practice’ guidelines

The number of central line-associated bloodstream infections sustained by hospitalized children with cancer can be substantially reduced by encouraging staff to follow simple “best practice” regulations, say researchers.

via Med Wire News

Mammographic density 'unrelated to breast cancer death risk'

Although high-density breast cancer high breast density on mammography is an established risk factor for developing breast cancer, it is not associated with an increased risk for death, say US investigators who suggest different factors may affect risk at different times.

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Anastomotic leakage does not increase rectal cancer recurrence risk

Incidence of clinical anastomotic leak after anterior resection for patients with rectal adenocarcinoma does not increase the risk for local disease recurrence, despite previous studies indicating the opposite, report US researchers.

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Oral lesion progression markers validated, discovered

Loss of heterozygosity can reliably differentiate between individuals with premalignant oral lesions who are likely to progress to oral carcinoma, and those who are not, show study results.

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Recurrence and prognostic factors in patients with aggressive fibromatosis. The role of radical surgery and its limitations

Background: Surgery is still the standard treatment for aggressive fibromatosis (AF); however, localcontrol remains a significant problem and the impact of R0 surgery on cumulative recurrence(CR) is objective of contradictory reports. Methods: This is a single-institution study of 62 consecutive patients affected by extra-abdominal andintra-abdominal AF who received macroscopically radical surgery within a time period of 15years. Results: Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13patients. Five-year CR for patients who underwent R0 vs R1 surgery was 7.1% vs 46.4%(P = 0.04) and for limbs vs other localizations 33.3% vs 9.9% (P = 0.02) respectively. In 17patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was morecommon (17 of 17 vs 32 of 45, P = 0.01) and CR lower (five-year CR 0% vs 19.1%,respectively, P = 0.04). However, in multivariate analysis only limb localization showed anegative impact on CR (HR: 1.708, 95% CI 1.03 to 2.84, P = 0.04). Conclusions: IFS evaluation could help the surgeon to achieve R0 surgery in AF. Non-surgical treatment,including watchful follow-up, could be indicated for patients with limb AF localization,because of their high risk of recurrence even after R0 surgery.

via World Journal of Surgical Oncology

Analyzing the gene expression profile of pediatric acute myeloid leukemia with real-time PCR arrays

Background: The Real-time PCR Array System is the ideal tool for analyzing the expression of a focused panel of genes. In this study, we will analyze the gene expression profile of pediatric acute myeloid leukemia with real-time PCR arrays. Methods: Real-time PCR array was designed and tested firstly. Then gene expression profile of 11 pediatric AML and 10 normal controls was analyzed with real-time PCR arrays. We analyzed the expression data with MEV (Multi Experiment View) cluster software. Datasets representing genes with altered expression profile derived from cluster analyses were imported into the Ingenuity Pathway Analysis Tool. Results: We designed and tested 88 real-time PCR primer pairs for a quantitative gene expression analysis of key genes involved in pediatric AML. The gene expression profile of pediatric AML is significantly different from normal control; there are 19 genes up-regulated and 25 genes down-regulated in pediatric AML. To investigate possible biological interactions of differently regulated genes, datasets representing genes with altered expression profile were imported into the Ingenuity Pathway Analysis Tool. The results revealed 12 significant networks. Of these networks, Cellular Development, Cellular Growth and Proliferation, Tumor Morphology was the highest rated network with 36 focus molecules and the significance score of 41. The IPA analysis also groups the differentially expressed genes into biological mechanisms that are related to hematological disease, cell death, cell growth and hematological system development. In the top canonical pathways, p53 and Huntington's disease signaling came out to be the top two most significant pathways with a p value of 1.5E-8 and2.95E-7, respectively. Conclusions: The present study demonstrates the gene expression profile of pediatric AML is significantly different from normal control; there are 19 genes up-regulated and 25 genes down-regulated in pediatric AML. We found some genes dyes-regulated in pediatric AML for the first time as FASLG, HDAC4, HDAC7 and some HOX family genes. IPA analysis showed the top important pathways for pediatric AML are p53 and Huntington's disease signaling. This work may provide new clues of molecular mechanism in pediatric AML.

via Cancer Cell International

A significant proportion of breast cancer survivors have chronic fatigue

UK study results show that over a third of breast cancer survivors have cancer-related fatigue syndrome and that these women have significantly lower subjective quality of life and mood than their nonfatigued peers.

via Med Wire News

Reduced NF-κB expression linκed to postradiation oral mucosa vulnerability

The fragility of oral mucosa after radiotherapy for oral squamous cell carcinoma may be due to the inhibition of the DNA transcriptor protein nuclear factor κappa-light-chain-enhancer of activated B cells, show study findings.

via Med Wire News

Gene expression profiling of the synergy of 5-aza-2'-deoxycytidine and paclitaxel against renal cell carcinoma

We previously demonstrated that 5-Aza-2'-deoxycytidine (DAC) could significantly increase the susceptibility of renal cell carcinoma (RCC) cells to Paclitaxel (PTX) treatment in vitro, and showed the synergy of DAC and PTX against RCC. However, the gene expression profiling and the pathways involved in the synergy of these two agents remain unknown. In this study, we performed cDNA microarray, which was coupled with real-time PCR, to identify critical genes in the synergistic mechanism of the both agents against RCC cells. Various patterns of gene expression were observed by cluster analysis, and results indicated that lymphoid enhancer-binding factor 1 (LEF1), transforming growth factor beta-induced (TGFBI), C-X-C motif ligand 5 (CXCL5) and myelocytomatosis viral related oncogene (c-myc) may play a pivotal role in the synergy of DAC and PTX. In addition, network analysis using IPA software, suggested that the PI3K/Akt pathway and some other pathways associated with cyclins, DNA replication and cell cycle/mitotic regulation were also associated with the synergy of DAC and PTX against RCC.

via World Journal of Surgical Oncology

More focus required on hospice care for heart failure patients

End-stage heart failure patients enter hospice care closer to the time of their death, are more often referred from acute care facilities, and are more likely to die in acute care settings compared with cancer patients, show study results.

via Med Wire News

Arsenic induces acute promyelocytic leukemia remission

Elderly patients with acute promyelocytic leukemia have a high rate of response to arsenic trioxide, say researchers who believe the drug should be a first-line treatment in this population.

via Med Wire News

Predictors for pain after breast cancer surgery unveiled

Researchers have identified that chronic preoperative pain, axillary surgery, and psychologic robustness significantly predict acute pain outcomes after breast cancer surgery.

via Med Wire News

Pediatric central line infections reduced by ‘best practice’ guidelines

The number of central line-associated bloodstream infections sustained by hospitalized children with cancer can be substantially reduced by encouraging staff to follow simple “best practice” regulations, say researchers.

via Med Wire News

Pulmonary sclerosing hemangioma: report of two cases

Pulmonary sclerosing hemangioma (PSH) is a rare benign tumor of the lungs. These tumors are composed of cuboidal surface cells and polygonal stromal cells and show four histological manifestations: hemorrhagic, papillary, solid, and sclerotic. PSH predominantly affects asymptomatic middle-aged women. The tumor often occurs at the intralobar site, and less commonly in the bronchus and mediastinum. PSH is easy to be misdiagnosed preoperatively. In this study, we present in detail the treatment procedures followed for two atypical cases of PSH. Case 1 was a 62-year-old woman bearing a tumor for 15 years. The tumor lesion was found to be located in the oblique fissure of the left lung. PSH was confirmed by surgical resection and postoperative pathological diagnosis. There was no sign of recurrence and metastasis 1.5 years after surgery. Case 2 was a 54-year-old woman diagnosed with bilateral multiple nodules by physical examination. This patient was diagnosed with definite PSH through computed tomography-guided percutaneous lung biopsy. Surgical resection was not performed. The patient also showed no sign of enlarged tumor and metastasis after 2 years of follow-up. Although PSH can be cured by surgical resection, the findings in our cases indicate that surgical resection need not be considered the preferred course of treatment. If PSH is diagnosed before surgery, the patients may survive while bearing the tumor.

via World Journal of Surgical Oncology

Successful treatment with the mTOR inhibitor everolimus in a patient with Perivascular epithelioid cell tumor

Perivascular epithelioid cell tumor (PEComa) is an extremely rare neoplasm that appears toarise most commonly at visceral (especially gastrointestinal and uterine), retroperitoneal, andabdominopelvic sites. Malignant PEComas exist but are very rare. These tumors represent afamily of mesenchymal neoplasms, mechanistically linked through activation of the mTORsignaling pathway. Metastatic PEComa is a rare form of sarcoma for which no effectivetherapy has been described previously and that has a uniformly fatal outcome. Although thereis no known effective therapy, the molecular pathophysiology of aberrant mTOR signalingprovides a scientific rationale to target this pathway therapeutically. The difficulty indetermining optimal therapy, owing to the sparse literature available, led us to present thiscase. On this basis, we report a case of metastatic retroperitoneal PEComa treated with anoral mTOR inhibitor, with everolimus achieving significant clinical response.

via World Journal of Surgical Oncology