bluuebunny/crossref_metadata_2025 huggingface dataset:
Basal Cytokeratin Expression in Relation to Immunohistochemical and Clinical Characterization in Breast Cancer Patients with Triple Negative Phenotype
Authors: Liu Zhe-Bin , Wu Jiong , Ping Bo , Feng Li-Qing , Di Gen-Hong , Lu Jin-Song , Shen Kun-Wei , Shen Zhen-Zhou , Shao Zhi-Min
Published: February 2018

Aims and background

To evaluate the immunohistochemical characterization of CK5/6 and CK17 and whether the expression level of the two markers was correlated with clinical outcome or pathological feature in triple negative (ER-, PR-, HER-2-) patients with breast cancer.

Methods and study design

We carried out an immunohistochemical assay for CK5/6 and CK17 markers on formalin-fixed invasive carcinoma samples from 112 patients who were diagnosed between 2000 and 2002. All of them had an immunohistochemical triple negative status and follow-up information available.

Results

Of the 112 patients characterized by triple negative immunohistochemical status, 82 (73.2%) were disease free with no relapse or metastasis. In total, CK5/6 and CK17 were both determined positive in 33.9% (38/112) of the 112 tumor samples, and 46.4% (52/112) were regarded as positive for CK5/6 or CK17. The Kaplan-Meier curve showed that positive staining for CK5/6, CK17, or CK which means CK5/6 positive or CK17 positive, was associated with worse disease-free survival (P = 0.020, P = 0.032, P = 0.003), and positive staining for CK5/6 or CK was associated with worse overall survival (P = 0.027, P = 0.015). When we considered 91 patients whose pathological type was invasive ductal carcinoma, we found that there was also an association between CK5/6 or CK17 immunostaining and high grade (P = 0.030). In addition, these two markers were also associated with axillary lymph node status (P = 0.044). The Cox regression multiple-factor analysis showed that pathological stage, grade and expression of CK were the factors affecting both disease-free and overall survival, whereas age and menopausal status were independent factors affecting disease-free and overall survival, respectively.

Conclusions

Positive staining for CK5/6 or CK17 was associated with a worse prognosis, high tumor grade and positive axillary lymph nodes.
Expression of Ezrin and Metastatic Tumor Antigen in Osteosarcomas of the Jaw
Authors: Park Hye-Rim , Cabrini Romulo Luis , Araujo Eduardo Santini , Paparella Maria Luisa , Brandizzi Daniel , Park Yong-Koo
Published: February 2018

Aims and background

Ezrin is a membrane-cytoskeleton linker protein involved in regulation of the growth and metastatic behavior of cancer cells. Metastatic tumor antigen (MTA) is a potential metastasis-associated protein. The objective of this study was to evaluate the expression of ezrin and MTA and their correlation with clinico-pathological features in osteosarcomas of the jaw.

Methods

We analyzed ezrin and MTA protein levels by immunohistochemistry in 31 osteosarcomas of the jaw.

Results

The mean age at diagnosis was 39 years and half of the patients were male. The mandible (n = 19) was more frequently involved than the maxilla (n = 12). The predominant histological type was chondroblastic (58.1%) and 24 patients (77.4%) were classified as having a high grade of malignancy. Immunoreactivity for ezrin was identified in 6 of 31 cases (19.4%), while 77.4% displayed expression of MTA. All ezrin-positive patients had high-grade tumors. The high-grade tumors (n = 24) had a higher rate of MTA expression (42.9% vs 87.5%). Expression of ezrin and MTA was not significantly different according to age, sex, tumor site, histological type, and tumor ploidy. Follow-up information was available for 13 patients, with a mean follow-up time of 26.7 months (range, 6–48 months). At the time of last follow-up, 5 (38.5%) patients had died of disease and 8 patients (61.5%) were alive with no evidence of disease. Expression of ezrin and MTA was not significantly different according to the follow-up data.

Conclusions

In our study, high-grade tumors had a higher rate of ezrin and MTA expression. This expression pattern indicates that ezrin and MTA positivity can be additional prognostic markers in osteosarcoma of the jaw.
Protective Effect of Vitamin A on ARA-C Induced Intestinal Damage in Mice
Authors: Elli Murat , Aydin Oguz , Bilge Sirri , Bozkurt Ayhan , Dagdemir Ayhan , Pinarli Faruk Guclu , Acar Sabri
Published: February 2018

Background

Cytarabine (ARA-C) has been used for many years in the treatment of patients with leukemia and lymphoma. Gastrointestinal ulceration and mucositis are two of the well-known side effects of ARA-C. We set out to investigate whether vitamin A (VA) can help prevent ARA-C-induced mucosal lesions in mice.

Materials and methods

Mice were divided into 5 groups. Group I (control group) received only saline; group II received ARA-C plus saline; group III received ARA-C plus VA; group IV received ARA-C plus a lipid solution, and group V received VA alone. VA (5000 IU/kg) was administered orally to the mice once daily for 7 days. ARA-C (3.6 mg) was administered intraperitoneally for 5 days to groups II, III and IV, starting on the third day of VA treatment. Intestinal segments from the proximal end of the jejunum of treated mice were isolated.

Results

There was improved mucosal integrity, less necrosis and increased villus length with advanced mucosal proliferation in crypts in the VA plus ARA-C group when compared to the ARA-C groups without VA.

Conclusion

We conclude that VA has a protective effect against ARA-C-induced mucosal damage in mice.
Thyroid as a Target of Metastases: A Case of Metastatic Seminoma in a Patient who Died of a Second Cancer
Authors: Mattavelli Franco , Collini Paola , Pizzi Natalia , Nicolai Nicola , Pennacchioli Elisabetta , Group Roberto Salvioni for the Thyroid Study
Published: February 2018

Background

The typical route of metastatic spread of testicular seminoma is through lymphatic pathways, whereas hematogenous dissemination is less frequent. The thyroid is a rare site of metastases from any cancer, but any patient with a previous oncologic disease should inquire about a thyroid nodule.

Case report

We present a case of a 37-years-old man with a testicular seminoma with a peculiar metastatic spread behavior, with previously unreported histological findings. The initial clinical appearance was of a stage I testicular tumor with normal tumor markers. Nevertheless, the tumor appeared to have spread directly to the thyroid gland and subsequently to latero-cervical nodes, about 3 years after the first diagnosis. Perhaps the patient could have been treated with chemotherapy alone, as he developed a second cancer 6 years after the diagnosis, and that event could have been related to delivered therapies, mainly radiotherapy.

Conclusion

This type of seminoma spread has previously been described only once, and it is not a typical route for metastasis by seminoma. In view of this unusual finding, we reinforce the need for accurate diagnostic planning of any thyroid nodule occurring in a patient with a previous cancer history. Accurate staging is crucial in planning the treatment and follow-up of seminoma. Currently, greater attention is due to management of the disease at diagnosis, as emerging data support a risk of a second cancer among patients treated with radiotherapy and chemotherapy for a testicular cancer.
Successful Treatment of Placental Site Trophoblastic Tumor in Twin Pregnancy without Hysterectomy
Authors: Liszka Lukasz , Wilk Mariusz , Wodolazski Anatol , Palen Piotr , Sikora Jerzy
Published: February 2018

To the best of the authors’ knowledge, no case of placental site trophoblastic tumor (PSTT) pertinent to twin pregnancy has yet been published. There are only few case reports concerning patients with PSTT who were successfully treated by fertility-sparing methods. A 29-year-old nulliparous woman was admitted to hospital in the 36th week of a twin pregnancy due to symptoms of preterm labor. She underwent a cesarean section, during which a 4-cm uterine mass was found and resected. Histopathology revealed PSTT. Eighteen weeks after the delivery an ultrasound scan displayed another intrauterine mass, 2 cm in size. In the material resected in hysteroscopy there was necrotic decidual tissue. Another 30 months of observation revealed no abnormalities. Even though PSTT is rarely diagnosed, it may cause significant diagnostic and therapeutic problems.
Treatment of Multiple Relapsing Non-Melanoma Skin Cancers in a Patient with Severe Hemophilia A
Authors: Salek Silva Zupancic , Radman Ivo , Pulanic Drazen , Pasic Aida , Nola Marin , Labar Boris
Published: February 2018

Although non-melanoma skin cancers are the most predominant malignancies in the Caucasian population and hemophilia A is one of the most frequent hereditary bleeding disorders, medical literature data about the management of non-melanoma skin cancers in patients with hemophilia are surprisingly scarce. In this case report we describe the treatment of a patient with multiple recurrent non-melanoma skin cancers and severe hemophilia A. The management of such patients could be very challenging, with possible significant bleeding complications, and requires a multidisciplinary approach.
Cytomegalovirus Infection of Endocrine System in a Patient with Diffuse Large B-cell Lymphoma. Report of a Case
Authors: Stathis Anastasios , La Rosa Stefano , Proserpio Ilaria , Micello Donata , Chini Claudio , Pinotti Graziella
Published: February 2018

Cytomegalovirus (CMV) is an opportunistic pathogen causing different diseases in immunocompromised patients and leading to death in a high percentage of cases. CMV infection is also relatively frequent among patients with hematological malignancies, especially when treated with immunosuppressive agents. We describe the clinical history of a patient with stage IV diffuse large B-cell lymphoma (DLBCL) treated with eight courses of R-CHOP every two weeks, who presented clinical remission of the disease at the end of therapy. However, two months later he developed neurological symptoms due to cerebellar involvement and a subcutaneous dorsal lymphomatous infiltration. He had a partial response after chemotherapy and brain radiotherapy, but his clinical course was complicated by fever and hypotension. Although the fever resolved with broad-spectrum antibiotics, he presented progressive endocrine failure and died three weeks later. Autopsy confirmed disseminated multiorgan involvement by DLBCL associated with an unexpected CMV infection of the lungs and several endocrine organs including the pituitary gland, pancreatic islets and adrenals, a clinical association not previously reported in the English literature.
Acute Abdomen as an Unusual Presentation of Hepatic PEComa. A Case Report
Authors: Priola Adriano Massimiliano , Priola Sandro Massimo , Cataldi Aldo , Marci Valerio , Fava Cesare
Published: February 2018

Perivascular epithelioid cell (PEC) tumors (or PEComas) are myomelanocytic lesions defined by coexpression of melanocytic and muscle markers, suggesting dual differentiation. They are rare mesenchymal tumors and include subtypes with distinct clinical features: angiomyolipoma, lymphangioleiomyomatosis, and clear cell “sugar” tumors of the lung, pancreas and uterus. Consequent upon the World Health Organization's recognition of PEC-derived tumors as a distinct entity, an increasing number of reports has documented PEComas arising at various anatomical locations. Clear cell myomelanocytic tumors of the falciform ligament/ligamentum teres (CCMTs) represent a rare variant of the PEComas. These hepatic PEComas, different from angiomyolipoma of the liver, pose a clinical, radiological and morphological diagnostic challenge. Because of their rarity, the clinical features and biological behavior of these tumors have yet to be established.

We experienced our first case of CCMT in a 36-year-old woman who presented to our emergency department with a 3-day history of abdominal discomfort and progressive growth of an epigastric bulk. Intralesional hemorrhage was causing abdominal distension, which progressed to acute abdomen soon after. The hemoglobin concentration was 9.9 g/dL. Liver laboratory tests showed slight elevation of AST, ALT and gamma-GT. The alpha-fetoprotein level was not elevated. The radiological images showed a hemorrhagic mass with some bizarre features in left hepatic lobe, immediately adjacent to the ligamentum teres and falciform ligament. The patient underwent a left hepatic lobectomy. The diagnosis of CCMT was based on histological and immunohistochemical staining. The postoperative course was uneventful. The patient received no adjuvant treatment and is currently, 34 months after surgery, alive and disease free. In this report we describe a peculiar and hitherto undescribed clinical presentation of this tumor and its further course. Moreover, we discuss previously undescribed diagnostic imaging. We recommend that all unusual carcinomas and mesenchymal tumors of the liver should be tested for HMB-45: when positive, there is a high likelihood of PEComa.
Squamous Cell Carcinoma Metastatic to Cervical Lymph Nodes from an Unknown Primary Site: The Impact of Radiotherapy
Authors: Lu Xueguan , Hu Chaosu , Ji Qinghai , Shen Chunying , Feng Yan
Published: February 2018

Aims and background

Cervical lymph node metastases of squamous cell carcinoma from an unknown primary site constitute about 5% of the total head and neck cancer cases. The management of these patients is still a therapeutic challenge. The aim of the present study was to analyze the prognosis in a series of patients and, in particular, the impact of different radiotherapy techniques on the prognosis.

Methods and study design

Data from 60 patients with cervical lymph node metastases of squamous cell carcinoma from an unknown primary site were reviewed. Nine of 60 patients (15.0%) received excisional biopsy. Radiotherapy was delivered to the bilateral neck and pharyngeal mucosa (extensive field) in 11 patients (18.3%), to the bilateral neck in 24 patients (40.0%), and to the ipsilateral neck in 25 patients (41.7%). Fourteen patients (23.3%) also received chemotherapy.

Results

The 5-year overall survival rate of all patients was 68.5%. The overall survival of patients with N1, N2, and N3 stage was 100%, 68.0%, and 40.9%, respectively (P = 0.026). The overall survial of patients irradiated by ipsilateral neck, bilateral neck, and extensive field was 66.5%, 74.5%, and 54.6%, respectively (P = 0.5). At multivariate analysis, only N stage significantly affected overall survival (P = 0.032). The 5-year neck control rate of all patients was 65.6%. The neck control rate of patients with N1, N2, and N3 stage was 100%, 63.2%, and 34.6%, respectively (P = 0.064). The neck control rate of patients irradiated by ipsilateral neck, bilateral neck, and extensive field was 87.6%, 51.1%, and 72.7%, respectively (P = 0.279). Emergence of the occult primary was observed in 21.2% patients, and all of these occurred within the head and neck region. The primary tumor emerged in 23.3% of patients treated with ipsilateral and bilateral neck irradiation and in 12.5% of patients irradiated by extensive field (P = 0.469).

Conclusions

Patients with cervical lymph node metastases of squamous cell carcinoma from an unknown primary site have clinical features and a prognosis similar to those of other head and neck malignancies. Extensive irradiation results in a lower trend of emergence of the primary tumor than when patients are treated with ipsilateral and bilateral irradiation, but there is no significant difference in overall survival.
Factors Related to Recurrence after Pathological Complete Response to Postoperative Chemotherapy in Patients with Epithelial Ovarian Cancer
Authors: Karagol Hakan , Saip Pinar , Eralp Yesim , Topuz Samet , Berkman Sinan , Ilhan Ridvan , Topuz Erkan
Published: February 2018

Aims and background

It has been appreciated for some time that the lack of detection of ovarian cancer at clinical and pathological (second-look laparotomy) evaluation is not synonymous with cure. The goal of this study was to define clinical risk factors for recurrence after complete pathological response to postoperative chemotherapy in patients with epithelial ovarian cancer.

Methods

Fifty-seven patients who met the inclusion criteria of our study were evaluated. The characteristics (age, menopausal status, histological subtype, tumor grade, presence of ascites at diagnosis, type of omentectomy, FIGO stage, and residual tumor volume after primary surgery) of patients with and those without tumor recurrence were compared.

Results

The median follow-up was 52 months (range, 15–142 months). The overall survival rates of the patients were 100%, 96%, and 87% at 1, 3 and 5 years, respectively. At the time of the study analysis, 21 of 57 (37%) patients had recurrent disease. The median time to recurrence was 16 months. Recurrences were most frequent in the pelvis and abdominal cavity (38%). Age, menopausal status, stage at diagnosis, and residual tumor volume after initial surgery were significantly related to the risk of recurrence in univariate analysis (P = 0.039, 0.038, 0.004, and 0.000, respectively). Residual tumor volume after initial surgery was found to be the only significant independent prognostic factor (P = 0.049, HR: 0.16, 95% CI: 0.02–0.99).

Conclusion

We believe it is necessary to conduct randomized studies on this issue because insight into predictors of recurrence after pathological complete response to postoperative chemotherapy could be used to select patients for trials of consolidation therapy.
Association of Gastrointestinal Stromal Tumor and Acute Myeloid Leukemia Preceded by Myelodysplastic Syndrome with Refractory Anemia
Authors: Sonmez Mehmet , Arslan Mehmet , Cobanoglu Umit , Kavgaci Halil , Ozbas Hasan Mucahit , Aydin Fazil , Ovali Ercument , Omay Serdar Bedii
Published: February 2018

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs are believed to be related to mutational activation of receptor tyrosine kinases, KIT, or platelet-derived growth factor receptor-alpha. The coexistence of GISTs with other neoplams has been extensively addressed in the literature. The most common second neoplasms are colorectal cancer, prostate cancer, and neoplasms derived from lymphoid tissue. In this case report, we describe a patient affected by GIST and acute myeloid leukemia preceded by myelodysplastic syndrome with refractory anemia. The clinicopathological characteristics of the patient are discussed and the literature is reviewed.
Tobacco Sales to Minors in Italy
Authors: Gallus Silvano , Tramacere Irene , Zuccaro Piergiorgio , Colombo Paolo , La Vecchia Carlo
Published: February 2018

Aims and background

One of the strategies to control tobacco is to limit purchase of cigarettes to minors. To understand the attitudes of Italian adults towards regulations to prevent minors from purchasing tobacco products, we added specific questions to the annual survey on smoking in Italy.

Methods

During March-April 2007, we conducted a survey on smoking on 3,057 subjects representative of the Italian population aged ≥15 years. Two specific questions were included, one investigating the attitudes towards the proposed legislation prohibiting purchase of tobacco to individuals under 18 years of age (instead of 16 years) as a policy to reduce smoking prevalence and consumption. The second question asked whether the current tobacco sales-to-minors law was observed.

Results

Overall, 78% of Italians believed that a restriction of the current tobacco sales-to-minors law could be moderately to extremely effective as a strategy to decrease smoking prevalence and consumption. More than 90% of Italians reported that they had never seen in their lifetime a retailer refusing to sell cigarettes to an adolescent or requesting the minor's identification or age.

Conclusions

A restriction of the legislation, increasing to 18 years the minimum age for purchasing tobacco, would limit access to tobacco products by minors, only if adopted together with systematic and effective enforcement measures.
Prognosis of Acute Myeloid Leukemia in the General Population: Data from Southern Switzerland
Authors: Lerch Erika , Espeli Vittoria , Zucca Emanuele , Leoncini Leda , Scali Giancarlo , Mora Oreste , Bordoni Andrea , Cavalli Franco , Ghielmini Michele
Published: February 2018

Aims and background

To evaluate the outcome of adult patients with de novo acute myeloid leukemia in the Italian-speaking part of Switzerland and to identify prognostic factors, time to progression and overall survival.

Methods and study design

Data of all adult patients diagnosed with acute myeloid leukemia from January 1984 to December 2003 were collected retrospectively. Univariate and multivariate analysis for time to progression and overall survival were performed.

Results

The incidence of acute myeloid leukemia in the adult population in southern Switzerland is 2.6/100,000 per year. Complete clinical and pathological data and follow-up information were available for 128 patients. The median age was 67 years (range, 18 to 94). The median follow-up was 97 months. Median overall survival was 6 months, with a 2-year overall survival of 16%. Median time to progression was 3 months. Thirty-five patients (median age, 80 years) were given best supportive care and/or palliative chemotherapy. The median survival in this subset was 2 months. Of the 93 patients treated with a curative intent, 48 were older than 60 years. The complete remission rate after induction chemotherapy was 80% for patients younger than 60 years and 31% for those older than 60 years (P <0.0001). Overall survival at 2 years was 40% and 12%, respectively (P <0.0005). The relapse rate was 61%, and only 28% of the patients who were given reinduction chemotherapy reached a second complete remission. Of the patients treated with curative intent, 52% were treated in a clinical trial. Their median age was significantly lower than those not included in a trial: 57 vs 66 years (P <00001). Patients treated in a trial had a significantly better prognosis than those not so treated (median survival, 12 vs 6 months). Patients treated with high-dose cytarabine as first-line therapy (given to 25 of 93 patients treated with a curative intent) had a better survival than those given standard cytarabine doses (P <0.0005). The outcome of the patients treated after 1993 was significantly better (P = 0.026) than that of the previously treated cohort. In multivariate analysis (not including cytogenetic data), only age (P = 0.005), performance status >1 (P = 0.001) and treatment given before/after 1993 (P = 0.044) were found to be independent prognostic factors for both overall survival and time to progression.

Conclusions

Most patients with acute myeloid leukemia are older than 60 years, and their outcome is still disappointing. For younger patients, the prognosis is better if they receive high-dose cytarabine as post-remission therapy and if they are treated in the setting of a clinical trial.
The Challenge of Culturing Human Colorectal Tumor Cells: Establishment of a Cell Culture Model by the Comparison of Different Methodological Approaches
Authors: Failli Alessandra , Consolini Rita , Legitimo Annalisa , Spisni Roberto , Castagna Maura , Romanini Antonella , Crimaldi Gaetano , Miccoli Paolo
Published: February 2018

Background

Because colorectal cancer is a significant cause of morbidity and mortality in the Western population, knowledge of the molecular and biological alterations associated with its development is important. Since primary human colon cancer cultures from fresh tumor tissue are technically difficult to obtain, experiments in most laboratories are performed on colon epithelial cell lines, but these represent just one stage of tumor progression. Only primary cultures of neoplastic colonocytes may reflect the actual responsiveness of tumors at certain developmental stages to antitumor agents.

Methods

This paper analyzes several critical points concerning primary cultures, ranging from cell isolation to culture conditions, and compares different methodological approaches to isolate and cultivate a pure fraction of viable tumor cells. Samples of resected colorectal cancers were collected from 20 patients (stage T3 or T4). We compared in vitro several approaches of tissue disaggregation including mechanical disaggregation and enzymatic dissociation with trypsin or collagenase. Isolated cells were maintained in a short-term serum-free culture system. Evaluation of the purity and tumoral nature of isolated cells was performed by immunochemistry.

Results

We established the antibiotic concentration necessary during transport and washing of the specimens to prevent microbial overgrowth. We demonstrated that the number of viable cells was dependent on the dissociation method used. Mechanical disaggregation is not a valid dissociation method because of the high mortality of cells and might be used only in samples for molecular analysis. Comparison of the enzymatic digestion procedures showed that digestion with trypsin allowed the highest recovery of viable cells.

Conclusion

In this paper we analyzed several critical aspects of cell culture procedures and designed a methodological approach suitable for functional studies of colorectal cancer.
11C-Acetate PET for Early Prediction of Sunitinib Response in Metastatic Renal Cell Carcinoma
Authors: Maleddu Alessandra , Pantaleo Maria A , Castellucci Paolo , Astorino Maria , Nanni Cristina , Nannini Margherita , Busato Fiorenza , Di Battista Monica , Farsad Mohsen , Lodi Filippo , Boschi Stefano , Fanti Stefano , Biasco Guido
Published: February 2018

Sunitinib is an oral multitargeted tyrosine kinase inhibitor with antiangiogenic properties used for treatment of renal cell carcinoma and gastrointestinal stromal tumors at a dose of 50 mg/day consecutively for 4 weeks followed by 2 weeks off per cycle. At present, no data are available on the early prediction of sunitinib response in renal cell carcinoma. We report a clinical case of a patient with metastatic renal cell carcinoma diagnosed with 11C-acetate PET and conventional CT and treated with sunitinib. Partial and complete remission documented by CT was preceded by early functional tumor inhibition shown by 11C-acetate-PET after only 14 days of therapy. This case report highlights some interesting points related to the potential role of a novel non-FDG PET tracer, 11C-acetate, in the early prediction of the response to targeted therapies in metastatic renal cell carcinoma.
Eyelid Localization in Mantle Cell Lymphoma: Long-Lasting Complete Remission after Surface Brachytherapy
Authors: Franco Pierfrancesco , Filippi Andrea Riccardo , Ricca Irene , Raucci Carlo , Ricardi Umberto
Published: February 2018

Ocular adnexal lymphoma is the most frequent malignancy occurring in the eye region. With regard to the histology of these lesions, 2% to 7% of non-Hodgkin's lymphomas located in the periocular region are mantle cell lymphomas. A few cases of mantle cell lymphoma characterized by a fairly indolent course and prolonged survival have been described in the medical literature. We here report on a patient with indolent mantle cell lymphoma presenting at relapse with an isolated eyelid mass that was treated with lens-sparing surface brachytherapy resulting in durable locoregional complete remission.
Prone Breast Radiotherapy in a Patient with Early Stage Breast Cancer and a Large Pendulous Breast
Authors: Ferrari Annamaria , Ivaldi Giovanni , Leonardi Maria Cristina , Rondi Elena , Orecchia Roberto
Published: February 2018

In women with large and pendulous breasts postoperative radiotherapy in the supine position could represent a technical challenge because of the resulting dose inhomogeneity and the large amount of lung and heart receiving a high percentage of the prescribed dose. Breast-conserving surgery is therefore relatively contraindicated in these patients. Alternative positions for radiation therapy treatment have been proposed, and prone breast irradiation in particular has been recognized as a useful alternative to conventional treatment in the supine position. We report the case of a large-breasted patient treated in prone position in our radiation therapy division.
Surgery and Radiotherapy in the Treatment of Malignant Parotid Tumors: A Retrospective Multicenter Study
Authors: Nagliati Michele , Bolner Andrea , Vanoni Valentina , Tomio Luigi , Lay Giancarlo , Murtas Rita , Deidda Maria Assunta , Madeddu Angela , Delmastro Elena , Verna Roberta , Gabriele Pietro , Amichetti Maurizio
Published: February 2018

Aims and background

Major salivary gland cancers are rare, with many histologic types and subtypes. The low incidence and heterogeneity of primary parotid carcinomas makes their outcome difficult to evaluate. Treatment remains primarily surgical, but optimal therapeutic regimens have yet to be fully realized. The present study reviews the experience of three Italian institutions in the treatment of primary parotid carcinomas in order to describe the clinicopathological presentation and treatment options with emphasis on radiotherapy and to analyze the factors influencing survival.

Methods and study design

The records of 110 patients with primary parotid neoplastic lesions treated at three Italian institutions from 1993 to 2004 were retrospectively reviewed. Six patients were excluded from the study: 3 received surgery alone and 3 were not assessable, for a total of 104 assessable patients. Acute and late toxicity of radiotherapy was quantified following the recommendations of the RTOG/EORTC. Survival was analyzed by the actuarial Kaplan-Meier product-limit method. The influence of selected factors on 10-year disease-specific survival was analyzed.

Results

The 104 assessable patients were treated as follows: 11 patients received radiotherapy as their only treatment (3 with a palliative purpose) and 93 had postoperative radiotherapy. Thirty-two patients underwent neck dissection: neck lymph node metastases were found in all them. Their mean age was 60 years (range, 14–92). According to the UICC/2002 TNM Classification, 8 patients were stage I, 19 stage II, 34 stage III, 25 stage IVA, 5 stage IVB, 3 recurrent and 10 not assessable (Tx). The most frequent histologies were adenoid cystic carcinoma (n = 16), mucoepidermoid carcinoma (n = 15), and acinic cell carcinoma (n = 15). Twenty-three patients had recurrences: 10 had local recurrences, 3 neck recurrences, 9 distant metastases, and 1 patient had both local recurrence and distant metastases. No factors were observed that would negatively influence the prognosis. Actuarial 10-year disease-specific survival was 71% and actuarial 10-year local control 82%.

Conclusions

The treatment of salivary gland malignancies remains primarily surgical. Our study confirms the results of the literature with surgery and adjunctive radiotherapy in patients with advanced-stage disease. No variables were observed to influence the prognosis.
Three-Fraction Stereotactic Body Radiation Therapy for Isolated Liver Recurrence from Colorectal Cancer
Authors: Kim Mi-Sook , Kang Jin-Kyu , Cho Chul Koo , Choi Chul Won , Seo Young Seok , Hwang Dae Yong , Moon Sun Mi , Kang Hae Jin , Kim Young Han , Kim Min Suk , Oh Nahmgun
Published: February 2018

Aims

To determine the feasibility and efficacy of 3-fraction stereotactic body radiation therapy for isolated colorectal cancer liver metastases.

Materials and methods

Ten patients with isolated inoperable liver metastasis from colorectal cancer with progression after salvage chemotherapy underwent stereotactic body radiation therapy. Follow-up was 7–49 months (median, 12). Six patients had a solitary lesion and 4 patients had 2 lesions. Internal target volumes of metastatic liver tumors ranged from 3.4 to 271 ml. Stereotactic body radiation therapy doses ranged from 36 to 51 Gy and were administered in three fractions. All patients demonstrated disease progression despite chemotherapy prior to stereotactic body radiation therapy.

Results

Three-year overall survival and local control rates were 40% and 60%, respectively. Tumors with an internal target volume <100 ml showed better local control rate than larger tumors. No severe complication was attributed to the therapy.

Conclusion

Our study suggests the potential feasibility of stereotactic body radiation therapy for selected patients with colorectal cancer liver metastasis and no treatment option. The study showed that excellent local control was achieved in patients with a total tumor volume of <100 ml but failed to clarify the role of stereotactic body radiation therapy for larger tumors. Further large scale studies are needed to define the indications of such therapy.
Serotonin Transporter 5-HTTLPR Polymorphism and Response to Citalopram in Terminally ill Cancer Patients: Report of Twenty-One Cases
Authors: Capozzo Maria Anna , Schillani Giulia , Aguglia Eugenio , De Vanna Maurizio , Grassi Luigi , Conte Maria Anna , Giraldi Tullio
Published: February 2018

The aim of this study was to examine the effects of the SSRI antidepressant drug citalopram on anxiety, depression and mental adjustment to cancer in terminally ill cancer patients, considering also the 5-HTTLPR genetic polymorphism.

A group of twenty-one consecutive patients admitted to the hospice of the Casa di Cura Pineta del Carso (Trieste, Italy) with different types of advanced cancer, who were clinically judged to require treatment with an antidepressive drug, was treated with citalopram for two weeks. The response was determined and related to 5-HTTLPR.

Citalopram significantly reduced the scores on the depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS). When the effects of citalopram were analyzed in relation to the 5-HTTLPR polymorphism, the HADS depression score was significantly decreased only in patients with the “l/l” allelic variant of the serotonin transporter conferring high functional activity, while the score of the Mini-MAC fatalism scale was significantly increased in patients carrying at least one “s” allele. These preliminary findings seem to indicate that two weeks of treatment with citalopram are effective in reducing depressive symptoms in terminally ill cancer patients. Moreover, the effects of citalopram on fatalism as a strategy of mental adaptation to cancer, and on depressive symptoms depend on the allelic variants of the 5-HTTLPR genotype of the patients. These results seem to encourage the examination of a larger patient sample and of different treatment schedules, as well as a more thorough characterization of fatalism as a coping strategy in cancer patients.
Loss of Heterozygosity Combined with Promoter Hypermethylation, the Main Mechanism of Human MutL Homolog (hMLH1) Gene Inactivation in Non-Small Cell Lung Cancer in a Chinese Population
Authors: Geng Xin , Wang Fei , Zhang Liang , Zhang Wei Ming
Published: February 2018

Aims and background

The mechanism of human MutL Homolog (hMLH1) gene transcriptional inactivation in non-small cell lung cancer (NSCLC) is still unclear. The aim of this study is to further investigate the main mechanism of hMLH1 gene inactivation in NSCLC samples of Chinese patients.

Methods and study design

This study was performed in surgically resected primary tumor and matched normal tissues from 116 NSCLC cases. The hMLH1 gene alterations examined included loss of heterozygosity (LOH) by D3S1612 locus PCR-electrophoresis-silver staining and promoter methylation by HpaII/ MspI-based PCR analysis. Loss of hMLH1 mRNA expression was analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and loss of hMLH1 protein expression was studied by immunohistochemistry and Western blot.

Results

The frequencies of LOH and promoter hypermethylation of the hMLH1 gene were 68.1% (79/116) and 72.4% (84/116), respectively. Among the 79 hMLH1 LOH (+) cases, 68 (86.1%) showed hypermethylation, which was significantly higher than in the LOH (–) group. The frequencies of loss of hMLH1 mRNA expression and protein expression in NSCLC were 79.3% (92/116) and 76.7% (89/116), respectively. The frequency of 2-hit inactivation of hMLH1, 75.3% (67/89), by LOH combined with promoter hypermethylation was related to the loss of protein expression.

Conclusions

Biallelic inactivation of the hMLH1 gene by LOH combined with promoter hypermethylation is likely to cause inactivation of hMLH1 protein and to play an important role in the development of NSCLC in the Chinese population.
Pitfalls in the Diagnosis of Neuroendocrine Tumors: Atypical Clinical and Radiological Findings as Cause of Medical Mistakes
Authors: Bajetta Emilio , Catena Laura , Ducceschi Monika , Pusceddu Sara , Milione Massimo , Maccauro Marco , Bajetta Roberto , Procopio Giuseppe , Buzzoni Roberto , Formisano Barbara , Di Guardo Lorenza , Platania Marco
Published: February 2018

Aims and background

Carcinoids are infrequent neoplasms arising from neuroendocrine cells. Due to blurred symptoms and the presence of equivocal diagnostic findings, these tumors are sometimes misdiagnosed. Therefore, increased rates of false neuroendocrine tumors represent an emerging problem in clinical practice. Our aim is to alert clinicians on this matter by supplying them with useful warnings.

Methods

In the specialized neuroendocrine tumor study Center Centro di Riferimento per lo Studio e la Cura dei Carcinoidi e dei Tumori Neuroendocrini (Ce.Ri.Ca), some patients highly suspected to have a neuroendocrine tumor have been recognized as having false neuroendocrine tumors. The related clinical and instrumental findings leading to a previous wrong neuroendocrine tumor diagnosis are reported.

Results

From July 2006 to December 2008, 88 consecutive cases of neuroendocrine tumors (Nets) were referred at Ce.Ri.Ca. In the former group, 8 cases of false Nets were discovered while in the remaining 80 cases a correct Net diagnosis was carried out. Watchful differential diagnoses and skill appraisal of laboratory investigations resulted in: chronic atrophic gastritis with enterochromaffin-like cell hyperplasia (4 cases), estrogen-deprivation syndrome (1), hypochondriac disorder (1), metabolic syndrome (1), and sarcoidosis (1).

Conclusions

Neuroendocrine tumors are still relatively known clinical entities. To discriminate false neuroendocrine tumors from neuroendocrine tumors requires a good expertise and a large daily practice with the disease. Good knowledge and skillfulness in identifying biochemical alterations and false radiological positive results could avoid both patient inconvenience and very expensive workup. The importance of a multidisciplinary approach in specialized centers is emphasized.
3p Abnormalities in Peripheral Lymphocytes in Small Cell Lung Cancer
Authors: Tarkan-Argüden Yelda , Hacihanefioglu Seniha , Öngen Gül , Erk Müzeyyen , Cenani Asim
Published: February 2018

3p abnormalities are the most frequent chromosome abnormalities in small cell lung cancer (SCLC). To date these abnormalities have only been observed in cells derived from tumor tissues. It is thought that cancer-related chromosome abnormalities in peripheral lymphocytes could help to predict cancer development, prognosis, and future metastasis. We report clonal and nonclonal 3p abnormalities in the peripheral lymphocytes of two patients with SCLC. A standard T-lymphocyte culture method and GTL banding technique were applied to the samples, and various clonal and nonclonal chromosome 3 abnormalities, i.e., −3, del(3)(p24), del(3)(p21), del(3)(p11), del(3)(q22), inv(3)(p14q29), and inv(3)(q21q29) were observed. Efforts have been made to understand if there are cancer-related chromosome abnormalities in lymphocytes and the suitability of these abnormalities to predict cancer development or metastases. As far as we know, this is the first report on chromosome 3 abnormalities in lymphocytes. Since 3p abnormalities are specific for SCLC, it is important to show that these cancer-related abnormalities can be found in blood cells.
Perianal Granular Cell Tumor: Report of a Case and Review of the Literature
Authors: Mistrangelo Massimiliano , Cassoni Paola , Scozzari Gitana , Castellano Isabella , Gavello Giorgia , Corno Franco , Morino Mario
Published: February 2018

Introduction

Granular cell tumor was first described by Abrikossoff in 1926. Over the years several cases of this neoplasm have been reported, with a variety of localizations. We here report a case of perianal granular cell tumor and discuss its histogenesis and its relevance to clinical practice.

Methods

The clinical course and histopathology of the case are reviewed, and a literature search for other reported cases has been performed.

Results

A 46-year-old woman presented with a perianal nodular lesion. Pathological examination revealed a granular cell tumor. A literature search produced only 25 other cases of anal and perianal granular cell tumors.

Conclusions

Granular cell tumors are rarely observed in the perianal region. Their existence must always be borne in mind in the differential diagnosis of perianal neoplasms. In most cases surgical excision is curative, but potential malignant transformation must be considered during therapeutic procedures and follow-up.
Adaptive Radiation Therapy in a Patient with a Massive Nodal Breast Cancer Recurrence
Authors: Trovò Marco , Drigo Annalisa , Dassie Andrea , Rumeileh Imad Abu
Published: February 2018

Adaptive radiation therapy (ART) is the next improvement in image-guided radiation therapy (IGRT). ART consists in changing treatment delivery to compensate for changes in patient anatomy or tumor volume. The treatment planning is therefore adapted to the new target volume. By daily imaging, the tumor volume can be assessed and compared with the initial volume. In case of tumor progression or tumor response, a new plan can be obtained to adequately treat the new volume.

We report the use of ART with the Plan Adaptive software of TomoTherapy Inc. in a patient with massive breast cancer recurrence in the axilla. Between the CT simulation and the first day of radiotherapy the axillary lesion progressed. Megavolt CT performed to image-guide the treatment showed impressive growth of the lesion, which went out of the treatment field. By studying the dose distribution on the new anatomy, we found that the planning target volume was substantially undercovered by the prescription dose. Adaptive planning was performed using the anatomical information acquired by the megavolt CT.
International collaborations in cancer control and the Third International Cancer Control Congress
Authors: Micheli Andrea , Sanz Natalia , Mwangi-Powell Faith , Coleman Michel P , Neal Claire , Ullrich Andreas , Travado Luzia , Santini Luiz Antonio , Grassi Luigi , De Lorenzo Francesco , Costa Alberto , Dangou Jean-Marie , Bisanti Luigi , Costantini Adele Seniori , Abu-Rmeileh Niveen , Kamal Mostafa , Federico Massimo , Saracci Rodolfo , Rennert Gad , Stefanini Angelo , Cavalli Franco , Cazap Eduardo , Redmond Kathy , O?Reilly Susan , Muti Paola , Casali Paolo , Gatta Gemma , Ferrari Andrea , Koifman Sergio , Bah Ebrima , Pastore Guido , Barr Ronald , Lombardo Claudio , Frazzingaro Cristina , Ciampichini Roberta , Baili Paolo ,   ICCC-3 Session B group
Published: February 2018

Over the past few decades, there has been growing support for the idea that cancer needs an interdisciplinary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health Assembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treatment, and palliative care. This paper highlights experiences/ideas in cancer control for international collaborations between low, middle, and high income countries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the Eastern Mediterranean countries. These proposals are presented within the context of the global vision on cancer control set forth by WHO in partnership with the International Union Against Cancer (UICC), in addition to issues that should be considered for collaborations at the global level: cancer survival (similar to the project CONCORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is given lower priority on the health agenda of low and middle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focusing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Control Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new international collaborations to promote cancer control actions in low and middle income countries. The development of supranational collaborations has been hindered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MGGs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.
Cancer prevention and population-based screening
Authors: Luciani Silvana , Vardy Lianne , Paci Eugenio , Adewole Isaac , Sasco Annie , Calvacante Tania ,   ICCC-3 Session C Group
Published: February 2018

Cancer prevention, screening and early detection can provide some of the greatest public health benefits for cancer control. In low resource settings, where cancer control is challenged by limited human, financial and technical resources, cancer prevention and screening are of utmost importance and can provide significant impacts on the cancer burden. Public policies, social, environmental and individual level interventions which promote and support healthy eating and physical activity can lower cancer risks. Tobacco use, a significant cancer risk factor, can be reduced through the application of key mandates of the World Health Organization Framework Convention on Tobacco Control. In addition, cancer screening programs, namely for cervical and breast cancers, can have a significant impact on reducing cancer mortality, including in low resource settings. Comprehensive cancer control programs require interventions for cancer prevention, screening and early detection, and involve sectors outside of health to create supportive environments for healthy ways of life. Sharing experiences in implementing cancer control programs in different settings can create opportunities for interchanging ideas and forming international alliances.