bluuebunny/crossref_metadata_2025 huggingface dataset:
Epithelioid angiosarcoma of bone and soft tissue: A report of seven cases with emphasis on morphologic diversity, immunohistochemical features and clinical outcome
Authors: Chen Yunxin , Shen Danhua , Sun Kunkun , Bao Dongmei , Song Qiujing , Wang Gongwei , Chen Dingbao , Yan Taiqiang , Guo Wei
Published: February 2018

Aims and background

Epithelioid angiosarcoma is a rare histopathologic variant of angiosarcoma characterized by an epithelioid morphology. This subset can histologically mimic non-vascular neoplasms and impose serious challenges in reaching a correct diagnosis, especially in the context of limited tissue sampling (e.g., needle core biopsy). To improve recognition of epithelioid angiosarcoma – and the spectrum of morphologic diversity associated with this rare variant – and to avoid a misdiagnosis, we describe the clinical, histopathologic, and immunohistochemical findings of cases of epithelioid angiosarcoma diagnosed at our institution.

Methods and study design

Seven cases of epithelioid angiosarcoma with appropriate pathologic material were identified from our archives. Immunohistochemistry was used to detect the expression of CD31, CD34, Factor VIII, cytokeratin, epithelial membrane antigen, vimentin, HMB45, CD1a, CD68, lysozyme, CD45, desmin, and smooth muscle actin in all cases. Follow-up information was obtained by reviewing medical records or by direct communication with family members.

Results

The lesions involved the bone (n = 4) and soft tissues (n = 3). Microscopically, all tumors had a predominantly diffuse growth pattern, with a focal nested architecture in 6 cases, which closely mimicked metastatic carcinoma. The initial biopsy was performed in 2 of 6 patients and revealed the presence of a malignant neoplasm suggestive of metastatic carcinoma. Immunohistochemically, the epithelioid endothelial cells usually showed strong reactivity for CD31 (7/7), variable or focal positive staining for CD34 (5/7), Factor VIII (4/7), cytokeratin (6/7), epithelial membrane antigen (2/7), vimentin (7/7), and CD68 (3/7). In contrast, they were negative for CD1a, HMB45, lysozyme, CD45, desmin, and smooth muscle actin. Three patients died of disease within one year of the diagnosis, 2 patients developed local recurrence or metastases, and another 2 were disease-free at this writing.

Conclusions

With any unusual epithelioid neoplasm displaying some or all of the morphologic features described above, epithelioid angiosarcoma should be included in the differential diagnosis. In such an instance, endothelial markers should be incorporated in the immunohistochemical analysis to avoid misdiagnosis, particularly with limited sampling.
Immunohistochemical expression of Mum-1, Oct-2 and Bcl-6 in systemic anaplastic large cell lymphomas
Authors: Saglam Arzu , Uner Aysegul H
Published: February 2018

Aims and backround

Several transcription factors predominantly used for B-cell lineage identification are also expressed in a small percentage of T cells within germinal centers and interfollicular areas. The aim of the study was to evaluate the expression of Mum-1, Oct-2 and Bcl-6 in systemic anaplastic large cell lymphoma.

Methods

Thirty cases of anaplastic large cell lymphoma were retrieved from our archives and tissue microarray constructed. Immunohistochemistry was carried out using an avidin-biotin peroxidase complex method.

Results

A predominance of nuclear staining was observed for all transcription factors. Mum-1 was positive in all but one case (96.7%). Half of the cases displayed Oct-2 expression (15/30 cases). A considerable number of cases also had Bcl-6 expression (9/30). Bcl-6 staining was noted to be more common in ALK positive cases.

Conclusion

Our findings emphasize that these markers are not restricted to B-cell lineage and that extensive expression can be observed in anaplastic large cell lymphoma of T/null cell phenotype.
A case of thyroid metastasis of nasopharyngeal cancer
Authors: Chiumento Costanza , Fiorentino Alba , Castaldo Giovanni , Fusco Vincenzo
Published: February 2018

Aims and background

Thyroid metastasis from nasopharyngeal carcinoma is a rare occurrence. We report a case of thyroid metastases from nasopharyngeal carcinoma with a review of the literature.

Methods

In April 2007 a 59-year-old man was diagnosed with nasopharyngeal carcinoma; in October 2009 he underwent a thyroid biopsy that revealed G2 infiltrating spinocellular carcinoma with lymph node involvement. He was treated with chemotherapy and radiotherapy at our institute.

Results

Currently, after 6 cycles of adjuvant chemotherapy with taxotere and gemcitabine, the patient is asymptomatic with stable disease and improved quality of life.

Conclusion

According to the literature, the treatment choice depends on clinical disease extent. Surgery and/or chemo-radiation therapy must therefore be tailored to the individual patient in order to improve clinical outcome and quality of life.
High-Dose Radiotherapy with Intensity-Modulated Radiation Therapy for Advanced Hepatocellular Carcinoma
Authors: Kang Min Kyu , Kim Myung Se , Kim Sung Kyu , Ye Gi Won , Lee Heon Ju , Kim Tae Nyeun , Eun Jong Ryul
Published: February 2018

Aims and Background

We report the results of intensity-modulated radiotherapy for patients with advanced hepatocellular carcinoma who were not candidate for local ablative therapies, transarterial chemoembolization or hepatic arterial infusion chemotherapy.

Methods and Study Design

Between 2003 and 2008, 27 patients were treated with high-dose radiotherapy (median dose, 50.4 Gy). The equivalent sphere size of tumors was 11.4 ± 2.6 cm. Nineteen and 8 patients were Child-Pugh class A and B, respectively. Eighteen patients had thromboses in large veins. Six patients were treated with radiotherapy as the initial treatment modality, and 21 patients received other treatments before radiotherapy.

Results

The overall response rate was 44.4% (1 pathologic complete response and 11 partial responses). The primary failure pattern was intrahepatic disease progression. Until the last follow-up, the primary liver masses and vein thromboses did not progress in 63.6% and 60.0% of the patients, respectively. The median progression-free survival and overall survival after radiotherapy rate were 3 and 5 months, respectively. Based on univariate analyses, response, Child-Pugh classification, and vein thrombosis were significant factors for overall survival, and tumor response, tumor size, vein thrombosis, and multiplicity were significant factors for progression-free survival. Tumor response was the only significant prognostic factor for overall survival and progression-free survival based on multivariate analyses.

Conclusions

Radiotherapy with intensity-modulated radiotherapy achieved a good response rate in patients with advanced hepatocellular carcinoma, and patients who had a good response lived longer than patients who did not have a good response.
Prognostic Value of Plasma D-Dimer Levels in Lung Carcinoma
Authors: Komurcuoglu Berna , Ulusoy Sadik , Gayaf Mine , Guler Arzu , Ozden Emel
Published: February 2018

Aims and Backgrounds

Plasma concentrations of several proteases of the coagulation system have been shown to predict prognosis in malignancy. The study was aimed to investigate the prognostic value of plasma D-dimer concentrations and some other coagulation factors in lung cancer.

Methods

Between 2004 and 2008, 100 newly diagnosed lung cancer patients and 25 healthy individuals serving as the control group were evaluated. The patients had no history of coagulation system disorders or anticoagulant therapy. Plasma D-dimer concentrations, prothrombin time, activated partial thromboplastin time, international normalized ratio and blood counts of the patients were obtained. Patient age, lung cancer stage, tumor histology, therapy modalities (surgery, chemotherapy and radiotherapy), therapy outcomes and survival durations of the patients were determined.

Results

The median age of the patients (86 males/14 females) was 67 years, and 15% had stage 2, 26% had stage 3A, 24% had stage 3B, and 35% had stage 4 disease. Histologic subtypes were non-small cell carcinoma (87%) and small cell carcinoma (13%). The median D-dimer level of the patients was 1250 ng/dl, which was significantly higher than that of the control group. Survival duration was significantly higher in patients with low D-dimer levels (P <0.05). D-dimer plasma levels predicted survival independently of the clinical stage of disease, histologic tumor type and performance status of the patient (HR = 5.1; 95% confidence interval, 1.015–1.19, P = 0.013). Plasma D-dimer level was significantly higher in metastatic disease (P <0.01).

Conclusions

The results suggest that D-dimer plasma levels might be useful to predict the clinical outcome and survival of patients with lung cancer.
Simultaneously Targeting Bcl-2 and Akt Pathways Reverses Resistance of Nasopharyngeal Carcinoma to TRAIL Synergistically
Authors: Li Shi-Sheng , Tang Qing-Lai , Wang Shu-hui , Chen Yue-Hong , Liu Jia-Jia , Yang Xin-Ming
Published: February 2018

Aims and Background

Despite progress in treatment techniques, the five-year survival rate of nasopharyngeal carcinoma (NPC) is disappointing. Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) can selectively induce apoptosis in most tumor cells while sparing normal cells. Given the antiapoptotic functions of Bcl-2 and Akt, we examined the effects of targeting these pathways alone or simultaneously on TRAIL apoptosis in NPC cell lines.

Methods and Study Design

We first tested the cytotoxic effect of TRAIL and the expression of death receptors, Bcl-2, Akt, and p-Akt on four NPC cell lines by MTT and Western blotting, respectively. Small interfering RNAs (siRNAs) targeting Bcl-2 and PI3–K inhibitor (LY294002) were used alone or combined with TRAIL in the cell lines and cytotoxicity was examined by MTT. Apoptosis rates, mitochondrial transmembrane potential, and apoptotic pathway signals were detected by flow cytometric analysis, DiOC6(3) assays, and Western blotting after the various combination treatments on CNE-2, the cell line that was most resistant to TRAIL.

Results

Although no direct correlation between the sensitivity to TRAIL and the relative expression levels of Bcl-2 and activated Akt was found in the NPC cell lines examined, siRNA mediated the downregulation of Bcl-2 and LY294002-induced inactivation of Akt, increasing the sensitivity of all examined NPC cell lines to TRAIL. Synergistic enhancement of TRAIL-mediated cytotoxicity was observed in combination treatment of Bcl-2 siRNA and LY294002 compared to cells treated with each treatment alone. The synergistic effects were mediated through increased apoptotic signaling of the mitochondrial pathway, as was evident from the more increased mitochondrial depolarization, activation of caspase-9 and caspase-3, and suppression of XIAP.

Conclusions

This study provides proof of principle that TRAIL combined with simultaneously targeting the Bcl-2 and Akt signaling pathways may have potential as a novel future treatment strategy for NPC.
Bone Marrow Metastases from Anaplastic Oligodendroglioma Presenting with Pancytopenia and Hypogammaglobulinemia: A Case Report
Authors: Cordiano Vincenzo , Miserocchi Fabio , Storti Matteo
Published: February 2018

We report the case of a 40-year-old man whose bone marrow metastases occurred 57 months after the initial diagnosis and 9 months after completing radiotherapy for an anaplastic oligodendroglioma. Four months before the demonstration of visceral metastases was obtained by bone marrow biopsy, the patient developed diffuse bone pain, pancytopenia, hypercalcemia, and panhypogammaglobulinemia. These abnormalities and other clinical signs of extracranial dissemination of the primary brain tumor were initially unrecognized until the patient was admitted with the suspicion of a nonsecretory multiple myeloma. We also briefly review the factors predisposing these tumors to spread outside the CNS, albeit rarely, and discuss the clinical implications of a misdiagnosis of extracranial invasion by anaplastic oligodendroglioma, whose chemosensitivity has been definitively demonstrated.
Accessory Spleen Mimicking a Pancreatic Neuroendocrine Tumor
Authors: Suriano Sergio , Ceriani Luca , Gertsch Philippe , Crippa Stefano , Giovanella Luca
Published: February 2018

A 60-year-old man underwent computed tomography as part of colorectal cancer follow-up. A hypervascular nodule was found within the pancreatic tail and subsequently proved to be positive on [111In] DTPA-octreotide scan. A neuroendocrine tumor of the pancreas was supposed and a distal pancreatectomy performed. Heterotopic splenic tissue was finally proved by pathological examination. The present case suggests that intrapancreatic accessory spleen be considered in the differential diagnosis of pancreatic lesions positive on [111In] DTPA-octreotide scan.
Radiotherapy in Italy for Non-Small Cell Lung Cancer: Patterns of Care Survey
Authors: Ramella Sara , Maranzano Ernesto , Frata Paolo , Mantovani Cristina , Lazzari Grazia , Menichelli Claudia , Navarria Piera , Pergolizzi Stefano , Salvi Fabrizio
Published: February 2018

Aims and Background

Surveys in clinical practice are useful to find how current clinical approaches follow recommendations from evidence-based medicine, to stimulate discussion in a multidisciplinary team, and to hypothesize collaborative multi-centric trials. To assess management strategies for the use of radiotherapy in the treatment of lung cancer in Italy, in 2009, the Italian Society of Radiation Oncology Lung Cancer Study Group proposed the survey to all Italian radiation oncology institutions. Results were compared with literature data and international reports.

Study Design

Questionnaires on patterns of care of non-small cell lung cancer were sent to radiation oncology centers active at June 2009 and evaluated data recorded in 2008.

Results

A total of 65 of 143 Italian centers responded to the questionnaire. The responding centers reflect the distribution of radiotherapy centers throughout the country. Of the treated patients, 55.2% were stage III, and most cases had a good performance status. FDG-PET was routinely used by 51% of centers for diagnostic and contouring phases. Postoperative radiotherapy was prescribed to pN1 and pN2 patients in 42.2% and 98.5%, respectively. The possible use of neo-adjuvant concomitant chemoradiation was declared by 70% of responders. A sequential chemoradiation approach was actually used in 43.6% of cases, induction chemotherapy followed by concomitant radiochemotherapy in 42.4%, and upfront concomitant radiochemotherapy in only 14%. In 53% of the institutions, patients have a clinical examination by a radiation oncologist only after the beginning of chemotherapy and in 82.4% of cases they have already received 2–4 cycles of chemotherapy. Most of the institutions exclude elective nodal irradiation from routine application. Total dose and fractionation in adjuvant, neoadjuvant, curative and palliative settings confirm literature data. There were significant differences in treatment planning constraints applied for lung, esophageal and cardiac tissues. Of the responding centers, 41% had stereotactic therapy for primary inoperable lung cancer and for metastatic lesions.

Conclusions

In Italy, daily practice differs in some ways from the evidence supported by the results of meta-analyses/clinical trials as regards concurrent chemoradiation approaches. It could be postulated that there is an urgent need for groups that collaborate with the other societies involved in the treatment of non-small cell lung cancer in order to offer the best therapy to our patients.
A Feasibility Study of Neo-Adjuvant Low-Dose Fractionated Radiotherapy with Two Different Concurrent Anthracycline-Docetaxel Schedules in Stage IIA/B-IIIA Breast Cancer
Authors: Nardone Luigia , Valentini Vincenzo , Marino Lorenza , De Santis Maria Carmen , Terribile Daniela , Franceschini Gianluca , Balducci Mario , Mantini Giovanna , Mattiucci Giancarlo , Mulè Antonino , Belli Paolo , Masetti Riccardo
Published: February 2018

Aims and Background

The aim of the study was to evaluate the feasibility of neoadjuvant low-dose fractionated radiotherapy, in combination with two anthracycline-docetaxel regimens, in breast cancer treatment.

Materials and Methods

Women with stage IIA/B-IIIA breast cancer were assigned to receive the treatment of low-dose fractionated radiotherapy (0.4 Gy/per fraction, 2 fractions per day, for 2 days, every 21 days for 8–6 cycles) with concomitant neoadjuvant chemotherapy with non-pegylated liposomal doxorubicin and docetaxel. Two chemotherapy schedules were planned to be combined with low-dose fractionated radiotherapy. The first schedule consisted of four cycles of non-pegylated liposomal doxorubicin sequentially followed by four cycles of docetaxel, and the second schedule consisted of six cycles of non-pegylated liposomal doxorubicin plus concomitant docetaxel. Acute toxicity was evaluated according to the Radiation Therapy Oncology Group score system. Pathological response was evaluated by the Mandard score and expressed as tumor regression grade.

Results

Between March 2008 and February 2009, 10 patients underwent low-dose fractionated radiotherapy and concomitant chemotherapy. No grade 3–4 breast toxicity was observed. Five patients had a clinical complete response. Seven patients underwent conservative surgery. Overall, tumor regression grade 1 (absence of residual cancer) was achieved in one patient (10%) and grade 2 (residual isolated cells scattered through the fibrosis) in 4 patients (40%). The pathologic major response rate (tumor regression grade 1 + 2) was 20% in patients receiving low-dose fractionated radiotherapy and sequential non-pegylated liposomal doxorubicin and docetaxel and 80% in the group receiving low-dose fractionated radiotherapy and concurrent non-pegylated liposomal doxorubicin and docetaxel treatment.

Conclusions

Concomitant low-dose fractionated radiotherapy combined with anthracycline and docetaxel is feasible. The toxicity profile of radio-chemotherapy was similar to that of chemotherapy alone: there was no acute skin or cardiac toxicity. The concurrent application of liposomal doxorubicin and docetaxel with low-dose fractionated radiation led to higher histological response rates compared to the sequential application of the same two drugs.
Morbidity of Selective Lymph Node Biopsy for Melanoma: Meta-Analysis of Complications
Authors: Cigna Emanuele , Gradilone Angela , Ribuffo Diego , Gazzaniga Paola , Fino Pasquale , Sorvillo Valentina , Scuderi Nicolò
Published: February 2018

Background and Aim

Intraoperative lymphatic mapping and selective lymph node biopsy is accepted worldwide as the standard procedure for staging regional lymph nodes of 1–4 mm thick melanomas, as well as for other neoplasms. Although it is often stated that selective lymph node biopsy is a minimally invasive procedure associated with few complications, few data exist concerning the morbidity associated with the procedure. The present analysis was performed to evaluate the morbidity associated with selective lymph node biopsy in a long-term follow-up.

Materials and Methods

The study provides a review of 437 selective lymph node biopsies on 269 patients, operated on between the 1994 and the 2009, for the lymph node biopsy of head and neck, groin, axilla, upper and lower limbs and nodal basins. Patients’ history and follow-up were reviewed for 2 weeks after surgery, every 3 months for the first 2 years, every 4 months during the third year, and every 6 months subsequently, and postoperative morbidity was evaluated.

Results

After sentinel node biopsy, 14 patients developed one of the following complications: hematoma, 1 case (0.30%); lymphedema, 1 case (0.30%); seroma, 2 cases (0.61%); wound infection, 6 cases (1.83%); keloid scar, 2 cases (0.61%); and postoperative pain, 2 cases (0.61%). The total complication rate was 4.26%.

Conclusions

Selective lymph node biopsy for melanoma, as for other tumors, in respect to radical lymphadenectomy, is not a complications-free procedure but is usually not severe.
On the Diagnostic Accuracy of Stereotactic Vacuum-Assisted Biopsy of Nonpalpable Breast Abnormalities. Results in a Consecutive Series of 769 Procedures Performed at the Trento Department of Breast Diagnosis
Authors: Bernardi Daniela , Borsato Giuliana , Pellegrini Marco , Tuttobene Paolina , Fanto’ Carmine , Valentini Marvi , Aldovini Daniela , Ciatto Stefano
Published: February 2018

Aims and Background

To assess the diagnostic accuracy of stereotactic vacuum-assisted biopsy of nonpalpable breast lesions.

Methods and Study Design

769 consecutive vacuum-assisted biopsy procedures were retrospectively reviewed. Positive predictive value for carcinoma (B5) at vacuum-assisted biopsy was assessed on the overall series and by age, lesion morphology and size, degree of suspicion and calendar period. The accuracy of vacuum-assisted biopsy was based on surgical histology or follow-up (no change at 12 months was assumed as negative).

Results

Lesions were depicted as isolated microcalcifications, opacity + microcalcifications, or opacity in 716 (93.1%), 28 (3.6%), or 25 (3.2%) cases, respectively. Vacuum-assisted biopsy was negative (B1 = 63; B2 = 319) in 382 (49.7%), borderline (B3) in 142 (18.5%), suspicious (B4) in 2 (0.3%), and positive (B5) in 243 (31.6%) cases (in situ = 185, 24.1%), invasive = 58 (7.5%)), respectively. Age (χ2df3 = 19.50; P <0.002), size (χ2df4 = 51.02; P = 10-6) and degree of suspicion (χ2df2 = 146.68; P = 10-6) were associated with a B5 outcome, no significant association was evident for morphology (χ2df2 = 0,47; P <0.78), whereas calendar period had a moderate but significant inverse association (χ2df2 = 6.12; P <0.04). The positive predictive value for surgically confirmed carcinoma (in situ or invasive) was 0% for B1, 0.7% for B2, 12.3% for B3, 100% for B4, 92.7% for in situ B5, and 94.6% for invasive B5. Conversion from in situ B5 to invasive was 12.3% and was insignificantly associated with size (χ2df2 = 0.95; P = 0.62) and histology grade (χ2df2 = 3.64; P = 0.16). Down-grading of vacuum-assisted biopsy lesions to a less severe histology occurred in 13 (7.2%) in situ and in 16 (28.6%) invasive carcinomas. B3 cases upgrading to more severe lesions was 0%, 4.5% or 16.0% in the presence of no, mild, or severe atypia.

Conclusions

The study confirmed a good performance of vacuum-assisted biopsy, possibly influenced by the local scenario (e.g., radiologist's and pathologist's interobserver variability and sampling modality). Conflicting results with the literature may have local explanations rather than being due to inadequate performance.
High Lapatinib Plasma Levels in Breast Cancer Patients: Risk or Benefit?
Authors: Cizkova Magdalena , Bouchalova Katerina , Friedecky David , Polynkova Adriana , Janostakova Anna , Radova Lenka , Cwiertka Karel , Trojanec Radek , Zezulova Michaela , Zlevorova Miloslava , Hajduch Marian , Melichar Bohuslav
Published: February 2018

Aims and Background

Lapatinib is a tyrosine kinase inhibitor targeting epidermal growth factor receptors 1 (EGFR/HER1) and 2 (HER2) used in the treatment of patients with HER2-positive breast cancer. The aim of the present study was to determine lapatinib plasma levels in breast cancer patients treated with lapatinib plus capecitabine.

Patients and Methods

We assessed lapatinib plasma levels in blood samples from 21 breast cancer patients treated with lapatinib plus capecitabine using the standard regimen in an expanded access program. Liquid chromatography tandem mass spectrometry was used for measuring lapatinib plasma concentrations. The validated method was applied for measurement of 55 plasma samples.

Results

The median lapatinib plasma level was 5.09 μg/mL, with large interindividual differences. Patients of lower weight tended to have higher lapatinib plasma levels (Spearman correlation coefficient R = −0.435, P = 0.055). One patient's lapatinib plasma levels were markedly higher than those of the others, with a median level of 11.25 μg/mL and repeatedly exceeding 7.80 μg/mL. The treatment was terminated after 8 months when hyperbilirubinemia occurred.

Conclusions

The lapatinib plasma levels reported here are twice as high as the clinically effective steady-state geometric mean maximum concentration. We conclude that increased lapatinib body levels occur when patients are in a nonfasting state at the time of drug intake and when lapatinib doses are not adjusted to low body weight or weight loss during treatment. In Europe, dose adjustments are not recommended in the case of hepatic function impairment. Thus, attention should be paid to changes in liver function test results in clinical practice, especially in patients of small stature and weight, given the risk of high plasma concentrations. Prospective lapatinib plasma level assessment in treated patients might be useful to confirm or refute the possible correlation of high lapatinib plasma levels with hepatic and/or other toxicities.
Radiation Therapy for Pituitary Metastasis: Report of Four Cases
Authors: Turaka Aruna , Parsons Rosaleen B , Buyyounouski Mark K
Published: February 2018

Aims and Background

To report the clinical outcomes of four patients with pituitary metastases treated with radiotherapy.

Methods

Retrospective chart review of four cases.

Results

The mean age of the patients was 66 years; two were women and two were men. The mean duration of symptoms at initial presentation of the primary tumor was 2.25 months. The location of the primary tumor was the breast in one case and the lung in three. Magnetic resonance imaging of the brain revealed sellar masses in all cases. The mean interval between the primary tumor diagnosis and the development of pituitary metastases was 22.5 months. The metastases were treated with radiation therapy (palliative/stereotactic/intensity modulated) at a mean dose of 3219 cGy. At the last follow-up, three patients were dead and one was alive.

Conclusions

Treatment with three-dimensional conformal radiotherapy or stereotactic radiotherapy is a suitable non-surgical option for patients with pituitary metastases.
Pericardial Breast Cancer Metastasis 25 Years after Mastectomy
Authors: Rovere Rodrigo Kraft , De Araujo Daniel Brito , Ribeiro Daniel Rios Pinto , Marques Rogério Torres
Published: February 2018

Pericardial effusion in a patient with a history of cancer should always prompt a hypothesis of malignant involvement. We report the case of a 66-year-old white woman presenting with pericardial effusion 25 years after a mastectomy for ductal breast carcinoma. This is one of the cases with the latest recurrence ever reported.
Ileal Vanek's Tumor Mimicking Cecal Carcinoma
Authors: Piñero Antonio , García-Muñoz Pedro A , López María J , Ruiz-Maciá Jose A , Sola Joaquín , Pons Jose A
Published: February 2018

Inflammatory fibroid polyps or Vanek's tumors are rare benign pseudotumoral lesions with morphological characteristics similar to those of submucosal mesenchymal tumors. They have been described in the gastrointestinal tract, most frequently in the gastric antrum. We present a case of ileal Vanek's tumor associated with a raised carcinoembryonic antigen level and with radiological and endoscopic features mimicking cecal carcinoma.
Esophageal Cancer: Associated Factors with Special Reference to the Kashmir Valley
Authors: Rasool Sabha , Ganai Bashir A , Sameer A Syed , Masood Akbar
Published: February 2018

Esophageal cancer is one of the most common cancers worldwide. It is a multifactorial disease, and no single agent has been identified so far as the sole cause of the cancer. Many factors like smoking, the consumption of alcohol, fungal-contaminated, spicy and various nitrosamine-containing food stuffs and hot beverages, nutritional deficiency of some vitamins like β-carotene, vitamin A, C and E and minerals like zinc, selenium and molybdenum, the use of opium, HPV infection and various genetic factors have been found associated with the occurrence of the disease worldwide. Wide geographic differences and substantial changes in the incidence of esophageal cancer occurring over time have been suggested. Among the risk factors in India, betel quid chewing carries a relatively high risk. High incidences in Kashmir have been associated with the consumption of hot salted tea, sun-dried, smoked foods, tobacco in the form of hukka and various genetic factors. The exact cause of esophageal squamous cell carcinoma is unknown. Much work has been carried out on the role of various environmental factors, gene mutations, and polymorphisms worldwide, including Kashmir. Although the Kashmir valley is present on the border of the ‘high risk esophageal cancer belt’ and esophageal squamous cell carcinoma represents the most commonly occurring malignancy in Kashmir, the amount of information available on various associated factors is still very little as there is a paucity of various epidemiological and molecular studies being carried out in this field.
Asbestos and SV40 in Malignant Pleural Mesothelioma from a Hyperendemic Area of North-Eastern Italy
Authors: Comar Manola , Zanotta Nunzia , Pesel Giuliano , Visconti Patrizia , Maestri Iva , Rinaldi Rosa , Crovella Sergio , Cortale Maurizio , De Zotti Renata , Bovenzi Massimo
Published: February 2018

Aims and background

Malignant mesothelioma is a fatal cancer of increasing incidence in north-eastern Italy. Together with asbestos, the polyomavirus SV40 was hypothesized to contribute to the onset of malignant mesothelioma. To investigate the putative role of SV40 in the individual susceptibility to asbestos-induced malignant mesothelioma, we conducted a molecular epidemiological study on a series of malignant mesothelioma patients from an area in north-eastern Italy hyperendemic for malignant pleural mesothelioma.

Methods and study design

We collected 63 mesothelioma samples from incidence cases of patients diagnosed with malignant pleural mesothelioma in the period 2009–2010. DNA was extracted from patients’ tissue biopsies using the BioRobot EZ1 Qiagen workstation. SV40 sequence detection and quantification was performed by specific real time PCR. The 74.6% of the 63 enrolled patients had a history of asbestos exposure. The epithelioid histotype was more prevalent in males (64.0%) and the mixed in females (61.5%) who showed significantly higher cancer co-morbidity (46.1% vs 12%, P = 0.005). SV40 was detected in 22% of MM tumors, with a low viral load. In SV40-positive patients, a threefold increased risk of asbestos exposure was observed, more evident in females (OR 4.32) than in males (OR 1.20).

Conclusions

Our findings indicate that a high prevalence of SV40 was present in malignant mesothelioma incident cases from an area hyperendemic for malignant mesothelioma in north-eastern Italy. Although asbestos is considered the main risk factor in malignant mesothelioma onset, a role for SV40 could be hypothesized.
Response to Concurrent Chemoradiotherapy as a Prognostic Marker in Elderly Patients with Locally Advanced Esophageal Cancer
Authors: Go Se-Il , Lee Won Sup , Kang Myung Hee , Song Haa-Na , Kim Moon Jin , Lee Min Jeong , Kim Hoon-Gu , Lee Gyeong Won , Kang Jung Hun , Lee Jeong-Hee , Kang Ki Mun , Jeon Kyung-Nyeo , Cho Jae Min , Jung Woon Tae , Ko Gyung Hyuck
Published: February 2018

Aims and background

Little is known about chemoradiotherapy in elderly patients with locally advanced esophageal cancer. We compared the efficacy and toxicity of chemoradiotherapy in elderly and non-elderly patients with locally advanced esophageal cancer and determined the variables affecting the treatment outcome in the elderly patients with locally advanced esophageal cancer who had received chemoradiotherapy.

Methods

Fifty-seven elderly patients (age ≥65 years) and 30 non-elderly patients (age <65 years) were reviewed retrospectively.

Results

The median age of the elderly group was 69 years and in the non-elderly group, 56.5 years. Although treatment compliance appeared to be poor, the response rate and median survival were similar in both the groups (elderly versus non-elderly; 84.4% vs 87.5%, and 11.2 months vs11.3 months) and so were G3/4 hematologic and non-hematologic toxicities. The treatment-related mortality of the elderly patients appeared to be higher than that of the non-elderly group (7.0% vs 3.3%), but did not reach statistical significance. In prognostic factor analysis, a major response to chemoradiotherapy was a good prognostic indicator in the elderly group (response versus non-response; median overall survival times of 19.5 vs 5.4 months, respectively, P <0.001).

Conclusions

The study suggests that chemoradiotherapy for locally advanced esophageal cancer in elderly patients, even though treatment compliance appears to be poor, is as safe and effective as in non-elderly patients and that the response to chemoradiotherapy is related to prognosis in elderly patients.
Rare Tumors of the Testis and Mesothelial Proliferation in the Tunica Vaginalis
Authors: Colecchia Maurizio , Mikuz Gregor , Algaba Ferran
Published: February 2018

An increasing number of rare testicular tumors have been recognized in the recent years with a wide and heterogeneous spectrum of morphologies. The utility of ancillary studies, including immunohistochemistry, is often limited and is important for the pathologists to be aware of these entities, because they require a comprehensive pathological and clinical approach for an appropriate treatment.
Mediastinal Small-Cell Lung Carcinoma after Right Lung Transplant for Pulmonary Interstitial Fibrosis
Authors: Miao Jinbai , Li Hui , You Bin , Hou Shengcai , Hu Bin
Published: February 2018

Pulmonary carcinoma is uncommon after lung transplant, but doubtlessly affects recipient survival independently of other complications. Small cell lung cancer is much rarer after transplant than non-small cell lung cancer. We report a case of mediastinal small cell lung carcinoma confirmed by endobronchial ultrasound biopsy that occurred 18 months after a single lung transplant for interstitial pulmonary fibrosis in a 58-year-old male non-smoker. The patient died shortly after of distant metastasis. Our report confirms the usefulness of tumor markers and positron-emission tomography-computed tomography as routine tests for earlier detection of malignant disease after lung transplant.
Symptomatic Pericardial Effusion in Hodgkin's Lymphoma: A Rare Occurrence. Case Report and Review of the Literature
Authors: Adler Adam C , Cestero Cesar
Published: February 2018

Pericardial effusion is observed in approximately 5% of patients with Hodgkin's lymphoma but is rarely symptomatic. We report a case in which a 21-year-old woman with newly diagnosed Hodgkin's lymphoma was found to have symptoms and radiographic evidence of pericardial effusion. Symptomatic pericardial effusion in patients with Hodgkin's lymphoma is extremely rare, with few reports in the literature. The mechanism for the heart and pericardial involvement is reviewed along with a description of the presenting symptoms and differential diagnosis.
Clinical Response after Sorafenib for Hepatocellular Carcinoma in Elderly Patients: A Report of Two Cases
Authors: Spada Francesca , Squadroni Michela , Lorizzo Katia , Farris Antonio , Fazio Nicola
Published: February 2018

Among primary liver cancers occurring worldwide, hepatocellular carcinoma (HCC) is the major histological type accounting for 70–85% of all cases. Phase III trials in patients with advanced HCC treated with sorafenib (SO), a multitargeted tyrosine kinase inhibitor, showed significant improvements in both overall and progression-free survival. We report the cases of two elderly patients with advanced HCC who had prolonged stable disease following treatment with SO (400 mg bid). Patient 1 was treated with SO for a period of 16 months until evidence of right sacral metastases was noted. Patient 2 received SO 400 mg bid from January 2009 to October 2009 until radiological evidence of disease progression was noted. Both patients experienced minimal toxicity, suggesting that SO can be safely administered to elderly patients.
Aggressive Clinical Course of Primary Invasive Vaginal Carcinoma Associated with Type 61 HPV: A Case Report
Authors: Zanfagnin Valentina , Tripodi Elisa , Perotto Stefania , Ravarino Nicoletta , Zola Paolo
Published: February 2018

Primary invasive vaginal cancer is one of the rarest malignant processes in the female genital tract. The etiology has not been identified, but the strongest association is with HPV infection and subtypes 16 and 18 have the highest oncogenic potential. We present the case of a young woman diagnosed with metastatic squamous cell carcinoma of the vagina associated with HPV type 61, a non-oncogenic HPV type. We report the propensity of a primary vaginal neoplasm to spread to lymphatic vessels early and the unresponsive aggressive behavior to multimodal therapy.
Palonosetron: An Evidence-Based Choice in Prevention of Nausea and Vomiting Induced by Moderately Emetogenic Chemotherapy
Authors: Celio Luigi , Agustoni Francesco , Testa Isabella , Dotti Katia , de Braud Filippo
Published: February 2018

Aims and background

In 2003, the second-generation, 5-HT3 receptor antagonist (5-HT3 RA) palonosetron was approved by the FDA for the prevention of nausea and vomiting associated with highly and moderately emetogenic chemotherapy. We reviewed the current knowledge on the role of palonosetron against acute and delayed emesis in patients with solid tumors undergoing single-day moderately emetogenic chemotherapy regimens.

Methods

A literature review in PubMed was performed to update currently available preclinical and clinical evidence on palonosetron, prioritizing randomized clinical trials.

Results

The distinct pharmacology of palonosetron provides a rationale behind the improved efficacy observed with the drug in prevention of delayed symptoms. This may be explained by allosteric binding properties and by palonosetron-triggered receptor internalization, which result in prolonged inhibition of the 5-HT3 receptor function. Very recent pharmacology experiments have also suggested that palonosetron would be able to differentially inhibit 5-HT3/neurokinin 1 (NK-1) receptor signaling cross-talk. In two recent meta-analyses, palonosetron was shown to be more effective than other available 5-HT3 RAs in preventing acute and delayed nausea and vomiting for both HEC and MEC. Recent findings also suggest that a single-day regimen of palonosetron plus dexamethasone (both drugs administered intravenously) may provide a reasonable therapeutic alternative to reduce the total dexamethasone dose administered in patients undergoing moderately emetogenic chemotherapy.

Conclusions

On the basis of accumulating data, the evidence-based international guidelines devised from the major organizations have been recently updated to recommend the use of palonosetron plus 3-day dexamethasone for the optimal prevention of nausea and vomiting due to moderately emetogenic chemotherapy. There is still a need to investigate the efficacy of palonosetron in combination with an NK-1 receptor antagonist and dexamethasone in well-designed randomized trials.
A Case-Control Study of the Risk of Cutaneous Melanoma Associated with Three Selenium Exposure Indicators
Authors: Vinceti Marco , Crespi Catherine M , Malagoli Carlotta , Bottecchi Ilaria , Ferrari Angela , Sieri Sabina , Krogh Vittorio , Alber Dorothea , Bergomi Margherita , Seidenari Stefania , Pellacani Giovanni
Published: February 2018

Aims and background

A direct association between exposure to the metalloid selenium and risk of cutaneous melanoma has been suggested by some observational and experimental cohort studies, whereas other studies have yielded inconsistent results. Since some of the inconsistencies may be due to exposure misclassification arising from the use of exposure indicators that do not adequately reflect body tissue selenium content or the levels of the biologically relevant species of this metalloid, we examined this issue using multiple indicators of exposure.

Methods

We analyzed the relation of selenium exposure with risk of cutaneous melanoma using two different biomarkers, plasma and toenail selenium concentration, and estimated dietary selenium intake in a population-based case-control series (54 cases, 56 controls) from an Italian community.

Results

In unmatched and matched logistic regression models as well as nonparametric generalized additive models, higher plasma selenium levels were strongly associated with excess disease risk. In contrast, toenail and dietary selenium exhibited little relation with melanoma risk. The pattern of correlation among indicators of exposure differed by disease status, with dietary intake associated with plasma selenium levels in patients but not in controls.

Conclusions

Our data showed that different selenium exposure indicators can yield different inferences about melanoma risk. Although the series was small, our results are consistent with a positive association between circulating levels of selenium and melanoma risk. Further investigation of the exposure classification performance of various selenium biomarkers and of metabolic patterns of the metalloid and of its speciation are needed to help elucidate the relation between selenium exposure and human health.
Capecitabine in Elderly Patients with Metastatic Breast Cancer
Authors: De Sanctis Rita , Quadrini Silvia , Longo Flavia , Lapadula Vittoria , Restuccia Rossella , Del Signore Ester , De Filippis Lucilla , Stumbo Luciano , Gori Bruno , Bianco Vincenzo , Speranza Iolanda , Basile Maria Luisa , Di Seri Marisa
Published: February 2018

Aims and background

Capecitabine is the reference treatment for anthracycline-and/or taxane-pretreated metastatic breast cancer (MBC). This study examined its efficacy, tolerability and impact on the quality of life of elderly patients with MBC.

Materials and methods

Between January 2002 and December 2009, 75 consecutive elderly patients with MBC received first-line chemotherapy with capecitabine 1000 mg/m2 twice daily for 14 days every 3 weeks. Endpoints were efficacy, tolerability and clinical-benefit response measured every 3 cycles.

Results

Median age was 76 years (range 65–88); median ECOG performance status was 1 (range 0–2); 51 patients (68%) had received adjuvant chemotherapy and all patients had received hormonal therapy. Median exposure was 6 cycles. After 3 cycles, 11 patients (14.7%) had a partial response, one patient experienced a complete response, and 49 patients (65.3%) had stable disease, amounting to a disease control rate of 81.3%. Stable disease was maintained in 45 patients (60%) after 6 cycles, in 21 patients (28%) after 9 cycles, and in 13 patients (17.3%) after 12 cycles. A clinical-benefit response was experienced by 42 patients (56%), indicating a positive impact on quality of life. Treatment was well tolerated, the most common grade 3 events being diarrhea (12%) hand-foot syndrome (8%), and mucositis (8%). Adverse events were managed with dose adjustments and supportive therapy when required.

Conclusions

Our results indicate that capecitabine is active and well tolerated in elderly patients with MBC. This dosing regimen warrants further study in the first-line setting for patients with less aggressive MBC who are not candidates for combination therapy.
High-Dose 3D-CRT in the Radical and Postoperative Setting for Prostate Cancer. Analysis of Survival and Late Rectal and Urinary Toxicity
Authors: Tramacere Francesco , Gianicolo Emilio Antonio Luca , Pignatelli Antonietta , Portaluri Maurizio
Published: February 2018

Purpose

The aim of the study was to retrospectively compare outcome and complications of prostate cancer patients treated with a curative and postoperative intent using a pretreatment defined NCCN classification.

Material and methods

A total of 103 patients was treated curatively (RAD) and 94 postoperatively (POST-OP). The mean age was higher in the RAD group (72.6 years; range, 56.4–85.1) than in the POST-OP group (65.4 years; range, 43.9–77) (P <0.0001). According to the NCCN prognostic classification, 13 (12%) patients were at low risk, 48 (47%) at intermediate risk and 42 (41%) at high risk in the RAD group. In the POST-OP group, 13 (14%) patients were low risk, 37 (40%) at intermediate risk and 44 (46%) at high risk. Hormone therapy was used in 98 patients (95%) in the RAD group and 45 patients (47.8%) in the POST-OP group. Patients were treated with three-dimensional conformal radiotherapy. The prescription dose was 80 Gy in 2-Gy fractions in the RAD group and 70 Gy in 2-Gy fractions in the POST-OP.

Results

No biochemical, clinical relapse was found in low-risk patients in the RAD group and 1 relapse was found in the POST-OP group. The largest number of relapses occurred (39%) and (33%) in intermediate-high risk in RAD and POST-OP groups, respectively. In the cause-specific survival analysis, no significant differences were found in the high-risk group between RAD and POST-OP groups (P = 0.9). In the analysis of 5-year biochemical relapse-free survival, no significant differences were found in the high-risk group between RAD and POST-OP groups (P = 0.1020).

Conclusions

Radiotherapy in the RAD low-risk group was an excellent treatment. RAD and POST-OP radiotherapy were well tolerated with very low toxicity. The cause-specific survival at 5 years was 95% and 97% for the two treatment groups, RAD and POST-OP, respectively (logrank test, P = 0.2908).
Hope Herth Index (HHI): A Validation Study in Italian Patients with Solid and Hematological Malignancies on Active Cancer Treatment
Authors: Ripamonti Carla Ida , Buonaccorso Loredana , Maruelli Alice , Bandieri Elena , Boldini Stefania , Pessi Maria Adelaide , Chiesi Francesca , Miccinesi Guido
Published: February 2018

Aims and background

Although hope is a widely used term, the experience of hope in patients with chronic or even life-threatening diseases is often disregarded due to the scarcity of carefully designed and validated assessment tools. The aim of this study was to validate the Hope Herth Index (HHI) questionnaire in the Italian population of patients with solid or hematological malignancies during active cancer treatment.

Methods

After the translation procedures, the psychometric properties of the Italian version of HHI were evaluated in 266 patients with non-advanced cancer cared for in four different settings. Summative scores ranged from 12–48, with a higher score denoting greater hope. Confirmative factorial analysis was performed to assess dimensionality. The test-retest reliability was assessed by means of the Lin concordance coefficient (two weeks' interval, 80 patients). Concurrent validity was assessed through the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), Edmonton Symptom Assessment Scale (ESAS), and System Belief Inventory (SBI-15R).

Results

A total of 266 patients were enrolled. Confirmative factor analysis did not confirm the original three-factor solution, whereas a one-factor solution did perform well. Cronbach's alpha was 0.84 and the test-retest reliability was 0.64 (95% CI 0.51; 0.76). Large convergence was found with spiritual well-being as measured by the FACIT-Sp (0.69) and with anxiety-depression as measured by the HADS (inverse correlation: –0.51). Physical symptoms and religiousness were only slightly correlated, as expected.

Conclusions

The Italian version of HHI is a valid and reliable assessment tool – useful to initiate conversation with someone who is troubled but finds it difficult to talk – in patients with either solid or hematological malignancies on active cancer treatment during the non-advanced stages of the disease.