bluuebunny/crossref_metadata_2025 huggingface dataset:
Dose-Finding Study of Weekly Docetaxel plus Estramustine in Patients with Hormone-Refractory Metastatic Prostate Cancer
Authors: Coccaro Mariarosa , Tartarone Alfredo , Romano Gianpiero , Ardito Raffaele , Di Renzo Nicola
Published: July 2019

Objective

The aim of this phase I study was to find the maximum tolerated dose of weekly docetaxel in association with estramustine in hormone-refractory prostate cancer.

Methods

Eleven patients with hormone-refractory prostate cancer were treated with escalating weekly doses of docetaxel (level I, 3 patients, 30 mg/m2; level II, 3 patients, 35 mg/m2, level III, 3 patients, 40 mg/m2; level IV, 2 patients, 45 mg/m2) associated with fixed dosage of estramuscine (840 mg/day).

Results

In level I, there was only one episode of grade 3 neutropenia; grade 1 nausea and vomiting were registered in 1 patient; in 1 patient mild edema of the lower limbs was noted. In level II, grade 2 stomatitis and grade 1 sensory symptoms occurred in 1 patient, and grade 1 edema in 1 case. In level III, grade 2 edema was noted in 2 patients, damage to nails in 1 patient, asthenia in 1 patient, grade 1 neuropathy in 2 patients, and grade 1 nausea in 1 patient. In level IV, grade 2 edema was present in 1 patient, grade 3 edema in 1 patient, changes with fall of nails and grade 2 erythema of face in 2 patients, asthenia in 2 patients, grade 1 neuropathy in both patients. Nine patients had a more than a 50% decrease in PSA after 2 cycles of therapy.

Conclusions

The results of the study suggest a good tolerability of weekly 35 mg/m2 docetaxel in hormone-refractory prostate cancer in association with estramustine.
Re-Irradiation of Brain Metastases and Metastatic Spinal Cord Compression: Clinical Practice Suggestions
Authors: Maranzano Ernesto , Trippa Fabio , Pacchiarini Diamante , Chirico Luigia , Basagni Maria Luisa , Rossi Romina , Bellavita Rita , Schiavone Concetta , Italiani Marco , Muti Marco
Published: July 2019

The recent improvements of therapeutic approaches in oncology have allowed a certain number of patients with advanced disease to survive much longer than in the past. So, the number of cases with brain metastases and metastatic spinal cord compression has increased, as has the possibility of developing a recurrence in areas of the central nervous system already treated with radiotherapy.

Clinicians are reluctant to perform re-irradiation of the brain, because of the risk of severe side effects. The tolerance dose for the brain to a single course of radiotherapy is 50–60 Gy in 2 Gy daily fractions. New metastases appear in 22–73% of the cases after whole brain radiotherapy, but the percentage of re-irradiated patients is 3–10%. An accurate selection must be made before giving an indication to re-irradiation. Patients with Karnofsky performance status >70, age <65 years, controlled primary and no extracranial metastases are those with the best prognosis. The absence of extracranial disease was the most significant factor in conditioning survival, and maximum tumor diameter was the only variable associated with an increased risk of unacceptable acute and/or chronic neurotoxicity. Re-treatment of brain metastases can be done with whole brain radiotherapy, stereotactic radiosurgery or fractionated stereotactic radiotherapy. Most patients had no relevant radiation-induced toxicity after a second course of whole brain radiotherapy or stereotactic radiosurgery. There are few data on fractionated stereotactic radiotherapy in the re-irradiation of brain metastases.

In general, the incidence of an “in-field” recurrence of spinal metastasis varies from 2.5–11% of cases and can occur 2–40 months after the first radiotherapy cycle. Radiation-induced myelopathy can occur months or years (6 months-7 years) after radiotherapy, and the pathogenesis remains obscure. Higher radiotherapy doses, larger doses per fraction, and previous exposure to radiation could be associated with a higher probability of developing radiation-induced myelopathy. Experimental data indicate that also the total dose of the first and second radiotherapy, interval to re-treatment, length of the irradiated spinal cord, and age of the treated animals influence the risk of radiation-induced myelopathy. An α/β ratio of 1.9–3 Gy could be generally the reference value for fractionated radiotherapy. However, when fraction sizes are up to 5 Gy, the linear-quadratic equation become a less valid model. The early diagnosis of relapse is crucial in conditioning response to re-treatment.
Perioperative Hyperfractionated High-Dose Rate Brachytherapy Combined with External Beam Radiotherapy in the Treatment of Soft Tissue Sarcomas
Authors: Petera Jiri , Neumanová Renata , Odrazka Karel , Ondrak Martin , Prochazka Egon
Published: July 2019

Aims and background

Low-dose rate brachytherapy alone or in combination with external beam radiotherapy represents a well-established adjuvant treatment in soft tissue sarcomas following surgical resection. The experience with high-dose radiotherapy in this indication is limited. The purpose of our study was an evaluation of the viability of perioperative hyperfractionated high-dose rate brachytherapy in combination with external beam radiotherapy for primary and recurrent soft tissue sarcomas.

Patients and methods

From February 1998 through June 2002, 10 adult patients with soft tissue sarcomas were treated by interstitial perioperative high-dose rate brachytherapy and external beam radiotherapy. TNM classification was pT2bpN0pM0 in 9 patients and pT1bpN0pM0 in 1 patient. Grade of differentiation was G1 (2 patients), G2 (n = 1), G3 (n = 5), G4 (n = 2). Surgical margins were negative in 7 cases, close in 2 cases and positive in 1 case. The tumor was localized in an extremity in all cases. Hyperfractionation 3 Gy twice daily at 10 mm from the plane of sources was used for brachytherapy, with total doses 18–30 Gy. The patients received external beam radiotheapy with doses 40–50 Gy after brachytherhapy. Follow-up periods were between 24–71 months (median, 46).

Results

Local control of the disease was achieved in all 10 patients. Distant metastases occurred in 2 cases. One patient was disease free after salvage surgery and chemotherapy, and one patient died of lung disease progression 14 months after brachytherapy. In one case, subcutaneous fistula occurred after radiotherapy and was cured by an excision. Six patients experienced grade 1 or 2 fibrosis and 1 case a mild peripheral neuropathy was recorded.

Conclusions

Our study on a small number of patients suggests that perioperative hyperfractionated high-dose rate brachytherapy with doses 8 × 3 Gy in combination with external beam radiotherapy 40–50 Gy is a promising method to achieve high biological doses in the postoperative radiotherapy of soft tissue sarcomas without severe late morbidity and warrants further research.
Prostate Brachytherapy with Iodine-125 Seeds: Radiation Protection Issues
Authors: Anglesio Silvia , Calamia Elisa , Fiandra Christian , Giglioli Francesca Romana , Ragona Riccardo , Ricardi Umberto , Ropolo Roberto
Published: July 2019

Aims and background

Brachytherapy for prostate cancer by means of permanently implanted 125 I sources is a well established procedure. An increasing number of patients all over the world are treated with this modality. When the technique was introduced at our institution, radiation protection issues relative to this technique were investigated in order to comply with international recommendations and national regulations. Particular attention was paid to the need for patient shielding after discharge from hospital.

Methods

The effective and equivalent doses to personnel related to implantation, the effective dose to patient relatives as computed by a developed algorithm, the air kerma strength values for the radioactive sources certified by the manufacturer compared with those measured by a well chamber, and the effectiveness of lead gloves in shielding the hands were evaluated.

Results

The effective dose to the bodies of personnel protected by a lead apron proved to be negligible. The mean equivalent doses to the physician's hands was 420 μSv for one implant; the technician's hands received 65 μSv. The mean air kerma rate measured at the anterior skin surface of the patient who had received an implant was 55 μGy/h (range, 10–115) and was negligible with lead protection. The measured and certified air kerma strength for 125I seeds in RAPID Strand corresponded within a margin of ± 5%. The measured attenuation by lead gloves in operative conditions was about 80%. We also defined the recommendations to be given to the patient at discharge.

Conclusions

The exposure risks related to brachytherapy with 125I to operators and public are limited. However, alternation of operators should be considered to minimize exposure. Patient-related measurements should verify the dose rate around the patient to evaluate the need for shielding and to define appropriate radiation protection recommendations.
P53 Alteration in Oral Tongue Cancer is Not Significantly Associated with Age at Diagnosis or Tobacco Exposure
Authors: Siegelmann-Danieli Nava , Ben-lzhack Ofer , Hanlon Alexandra , Ridge John A , Stein Moshe E , Khandelwal Vivek , Langer Corey J
Published: July 2019

Aims and background

The tumor suppressor gene P53 is mutated in almost half of head and neck cancers. The current work assessed the prognostic significance of P53 alteration in patients with squamous cell carcinoma of the oral tongue treated with a curative intent, its association with age at diagnosis (using 45 years as a cut point), and risk exposure as defined by tobacco and/or alcohol consumption.

Methods

P53 alteration was determined immunohistochemically in 45 patients with tongue cancer treated with a curative intent.

Results

P53 alteration occurred in 20 of 45 tumors (44%) and was more common among younger patients (58% versus 36% for younger versus older patients, respectively) and those lacking tobacco/alcohol exposure (53% versus 40% for “no-risk” and “risk” groups, respectively), but the differences were not statistically significant. With a median follow-up of 56 months, 5-year progression-free survival rates were 48% and 66% in patients with and without P53 detection, respectively (P = 0.22).

Conclusions

Despite a trend of a younger age at diagnosis in P53-altered tumors, results did not reach statistically significant differences. A trend of a worse clinical outcome with P53 alteration was noted.
Posterior Mediastinal Hyperfunctioning Insular Thyroid Carcinoma
Authors: Bellantone Rocco , Lombardi Celestino Pio , Bossola Maurizio , Fadda Guido , Salvatori Massimo , Princi Pietro
Published: July 2019

A case is presented of a posterior mediastinal mass arising in a 57-year-old woman with severe compressive cervical symptoms and hyperthyroidism. Computed tomography showed intrathoracic thyroid tissue that displaced the trachea towards the front and the right and invaded the posterior mediastinum. Pathological examination showed features of a poorly differentiated (insular) thyroid carcinoma. To the best of our knowledge, this is the first reported case of a posterior mediastinal insular thyroid carcinoma with thyroid hyperfunction.
Breast Vasculitis Presenting as a Tumor-Like Lesion. A Case Report
Authors: Famà Fausto , Piquard Arnaud , Fedele Francesco , Florio Maria Antonietta Gioffrè
Published: July 2019

Breast vasculitis presenting as a tumor-like lesion is rare. The differential diagnosis in these cases can be extremely difficult but is very important for treatment and follow-up. We report the case of a 80-year-old woman who was admitted to our service with a lesion resembling an inflammatory carcinoma of the breast. We discuss the pathological and clinical characteristics, the presentation, assessment and treatment of this case and its resolution. Few reports in the literature have addressed the possible occurrence of systemic vasculitis mimicking cancerous lesions. The most common location of such lesions was shown to be the breast in one review. Although rare, such manifestations can be effectively recognized and treated.
Cost of Insurance Policies for Investigator-Initiated Cancer Clinical Trials in Italy
Authors: Perrone Francesco , Marangolo Maurizio , Di Costanzo Francesco , Colucci Giuseppe , Repetto Lazzaro , Merlano Marco , De Placido Sabino , Torri Valter , Cornelia Giuseppe , Labianca Roberto , Parisi Valerio , Gallo Ciro
Published: July 2019

Background

Clinical trials with non-profit promoters are frequently performed in oncology and represent a highly valuable source of information.

Methods

To describe the costs of insurance policies and their determinants, data were collected from 12 Italian non-profit promoters of cancer trials. The cost of policies was expressed as per-patient premium.

Results

Sixty-two quotations issued by only two companies were collected, relative to 44 trials proposed for quotation between December 1998 and February 2003. Only the date of quotation was significantly associated with the cost (P = 0.0003) of quotations by Company A for policies with a deductible, with cost increasing over time. Date of quotation (P = 0.0002), sample size (P = 0.008) and number of study arms (P = 0.02) were independently associated with the cost of no-deductible policies quoted by Company A. Only the number of study arms was significantly associated with cost (P = 0.0001) in no-deductible policies quoted by Company B.

Conclusion

There is insufficient competition among companies for insurance of cancer trials with non-profit promoters. Many variables that affect the trial risk profile from a clinical perspective are not associated with insurance cost. Date of quotation is among the strongest determinants of the cost, which has sharply increased over time. This trend may become a serious problem for non-profit promoters of cancer clinical trials.
Proteomic Strategies and their Application in Cancer Research
Authors: Alessandro Riccardo , Fontana Simona , Kohn Elise , De Leo Giacomo
Published: July 2019

The understanding of carcinogenesis and tumor progression on a molecular basis needs a detailed study of proteins as effector molecules and as critical components of the multiple interconnected signaling pathways that drive the neoplastic phenotype. Thus, the proteomic approach represents a powerful tool for the challenge of the post-genomic era. The term “cancer proteome” refers to the collection of proteins expressed by a given cancer cell and should be considered as a highly dynamic entity within the cell, which affects a variety of cellular activities. The emerging proteomic analysis platforms including 2D-PAGE, mass spectrometry technologies, and protein microarrays represent powerful tools to study and understand cancer. These systems aim to not only identify, catalogue, and characterize cancer proteins, but also to unveil how they interact to affect overall tumor progression. Moreover, recent studies on various cancers have reported promising results concerning the detection of novel molecular biomarkers useful in the early diagnosis of cancer and in drug discovery. Thus, a new subdiscipline named clinical proteomics, concomitant with new molecular technologies that are developed, demonstrates promise to discover new cancer biomarkers. The early diagnosis of cancer, even in a premalignant state, is crucial for the successful treatment of this disease. For these reasons, it is clear that the identification of biomarkers for the early diagnosis of cancer should represent one of the main goals of this emerging field of study.
Elderly Patients with Advanced Colorectal Cancer: Tolerability and Activity of Chemotherapy
Authors: Berardi Rossana , Saladino Tiziana , Mari Davide , Silva Rosa Rita , Scartozzi Mario , Verdecchia Lorena , Onofri Azzurra , Cascini Stefano
Published: July 2019

Aims and Background

Colorectal cancer is the most common gastrointestinal tumor in Western countries and is increasing in elderly patients. In recent years, new treatments based on the use of 5-fluorouracil associated with oxaliplatin or CPT-11 have shown promising activity. The aim of the present study was to analyze the tolerability and activity of chemotherapy with 5-fluorouracil plus oxaliplatin or CPT-11 in elderly patients with advanced colorectal cancer.

Methods

Patients aged 70 years or older with advanced colorectal cancer were treated with 5-fluorouracil (400 mg/m2 in bolus and 600 mg/m2 in a 22-hr continuous infusion on days 1-2) plus folinic acid (100 mg/m2) associated to oxaliplatin (85 mg/m2 on day 1, FOLFOX regimen) or CPT-11 (180 mg/m2 on day 1, FOLFIRI regimen), every 14 days.

Results

Twenty-nine patients with a median age of 76 years (range, 70-82) were treated with FOLFOX or FOLFIRI as first-line chemotherapy for metastatic disease. We observed a partial response in 8/29 (27.6%), stable disease in 11/29 (37.9%) and progressive disease in 10/29 (34.5%). Median survival was 21 months; 1-year survival probability was 89.8%. Grade III leukopenia was observed in 2/29 (7%) patients and grade III diarrhea in 1/29 patients. No other grade III-IV toxicity was observed.

Conclusions

FOLFOX and FOLFIRI appear to be active and well tolerated regimens for elderly patients with advanced colorectal cancer.
Low-Molecular-Weight Heparin and Calcium Heparin in Thrombosis Prophylaxis in Patients with Percutaneous Arterial and Venous Ports for Colorectal Liver Metastases
Authors: Zanon Claudio , Bortolini Massimiliano , Chiappino Isabella
Published: July 2019

Study Objective

The evaluation of low-molecular-weight heparin use to prevent arterial and venous thrombosis in patients with indwelling arterial Port-a-Cath implants.

Methods

From 1996 to March 2003 we placed 370 indwelling hepatic arterial catheters with a minimally invasive approach. The left distal subclavian artery was approached from beneath the left clavicle, then an angiographic study of the tumoral vascular district was performed and the gastroduodenal artery was occluded by an embolus. A polyurethane catheter was introduced distally into the hepatic artery and connected to a reservoir through a 3-4 cm long subcutaneous tunnel. In 90 patients a venous Port-a-Cath was placed for concurrent systemic chemotherapy. All 370 patients received regional chemotherapy and were treated with calcium heparin at a dose of 5000 IU twice a day and with low-molecular-weight heparin at prophylactic doses (dalteparin 2500 IU or nadroparin 3000 IU) during catheter permanence to prevent hepatic artery thrombosis. Intra-arterial trans-port radionuclide scans using technetium-99m-labeled micro-aggregated albumin were performed monthly to check the infusion distribution and hepatic artery patency. In the presence of anomalous patterns, thrombosis, pulmonary embolism or other complications, angiography and/or other diagnostic studies were performed to determine the cause of the vascular event and the local or systemic symptoms. The mean arterial and venous Port-a-Cath permanence times were 6 and 8 months, respectively.

Results

We observed episodes of hepatic artery thrombosis in 4.3% of patients. Three of these 17 patients were successfully treated by intra-arterial thrombolysis using urokinase. No venous thrombosis occurred as a consequence of regional and/or systemic chemotherapy, no episodes of arterial thrombosis were registered during arterial catheter permanence, nor did any hemorrhagic complications related to anti-coagulant therapy occur. Five patients treated with low-molecular-weight heparin required treatment suspension due to a platelet count of <40,000/dL.

Conclusion

Our experience suggests that low-molecular-weight heparin and/or calcium heparin at prophylactic doses could be useful in the prevention of arterial and venous thrombosis in patients with indwelling arterial catheters or venous Port-a-Cath treated with regional or systemic chemotherapy for hepatic metastases from colorectal cancer. The homogeneity of the patient group and the use of analogous chemotherapeutic drugs (fluoropyrimidines) avoided statistical contamination related to differences between kinds of cancer and between the chemotherapeutic agents used.
Liver Resection for Intrahepatic Cholangiocarcinoma
Authors: Giuliante Felice , Gauzolino Riccardo , Vellone Maria , Ardito Francesco , Murazio Marino , Nuzzo Gennaro
Published: July 2019

Aims and Background

Intrahepatic cholangiocarcinoma (IHCC) is the second most common primary liver cancer, representing 10% of all primary liver malignancies. Despite the increase in its incidence, this tumor remains extremely rare in Western countries and few reports detailing experience with surgical resection have been published. The aim of this study was to analyze the experience with resection of IHCC in our center.

Methods

From 1987 to 2003 we observed 35 patients with IHCC; 15 of them (42.8%) were submitted to hepatic resection. IHCCs accounted for 13% of all liver resections for primary liver tumors carried out at our center during this period. According to the classification of the Liver Cancer Study Group of Japan, the tumors were classified as “mass-forming” in 14 cases and as “periductal” in one case. Major resections were performed in ten cases and minor resections in five cases. In the patient with a periductal tumor a major resection was performed along with excision of the main biliary confluence. In 14 cases (93.3%) tumor-free resection margins were obtained.

Results

The intraoperative mortality was nil and the postoperative mortality 6.6%. The postoperative morbidity rate was 21.4%. The mean overall survival was 38.4 months, with 86% and 49% one- and three-year survival rates, respectively. Patients with mass-forming tumors and curative resections (R0) (mean survival 40.8 months; one- and three-year survival rates 92.3% and 52.7%), and those with TNM stage I-II tumors (mean survival 43.7 months; one- and three-year survival rates 100% and 66.7%) had a longer survival. The patient with the periductal tumor and R1 resection died after seven months.

Conclusions

These results support a surgical approach based on accurate selection of patients with IHCC and aimed at radical resection whenever possible. The good survival rates observed in R0 resections emphasize the role of radical surgery as the only chance of cure for patients with this tumor.
Fusion Hybrid of Dendritic Cells and Engineered Tumor Cells Expressing Interleukin-12 Induces Type 1 Immune Responses against Tumor
Authors: Shi Meiqing , Su Liping , Hao Sigou , Guo Xulin , Xiang Jim
Published: July 2019

Aims and Background

Dendritic cell (DC)-tumor fusion hybrid vaccinees that facilitate antigen presentation represent a novel powerful strategy in cancer immunotherapy. Preclinical studies have demonstrated that IL-12 promotes specific antitumor immunity mediated by T cells in several types of tumors. In the present study, we investigated the antitumor immunity derived from vaccination of fusion hybrids between DCs and engineered J558/IL-12 myeloma cells secreting Th1 cytokine IL-12.

Methods

The expression vector pcDNA-IL-12 was generated and transfected into J558 myeloma cells and then bone marrow-derived DCs were fused with engineered J558/IL-12 cells. The antitumor immunity derived from vaccination of the fusion hybrid DC/J558/IL-12 was evaluated in vitro and in vivo.

Results

DC/J558/IL-12 cells secreted recombinant IL-12 (1.6 ng/mL), and inoculation of BALB/c mice with DC/J558/IL-12 hybrid induced a Th1 dominant immune response and resulted in tumor regression. Immunization of mice with engineered DC/J558/IL-12 hybrid elicited stronger J558 tumor-specific cytotoxic T lymphocyte (CTL) responses in vitro as well as more potent protective immunity against J558 tumor challenge in vivo than immunization with the mixture of DCs and J558/IL-12, J558/IL-12 and J558, respectively. Furthermore, the antitumor immunity mediated by DC/J558/1L-12 tumor cell vaccination in vivo appeared to be dependent on CD8+ CTL.

Conclusions

These results demonstrate that the engineered fusion hybrid vaccines that combine Th1 cytokine gene-modified tumor cells with DCs may be an attractive strategy for cancer immunotherapy.
Upregulation and Overexpression of DVL1, the Human Counterpart of the Drosophila Dishevelled Gene, in Prostate Cancer
Authors: Mizutani Kazunori , Miyamoto Shizuyo , Nagahata Takemitsu , Konishi Noboru , Emi Mitsuru , Onda Masamitsu
Published: July 2019

Aims and Background

The Wnt/beta-catenin signaling pathway is one of the main carcinogenic mechanisms in human malignancies including prostate cancer. Recently, the DVL1 gene was identified as a middle molecule of the Wnt/beta-catenin signaling pathway. In addition, alterations of the DVL1 gene have been reported in breast and cervical cancer. The abnormality of beta-catenin in prostate cancer has been well studied, so the examination of the DVL1 gene in prostate cancer is appealing.

Methods

We investigated DVL1 messenger RNA alterations by semiquantitative PCR (SQ-PCR) in 20 primary prostate cancers and assessed the protein expression by immunohistochemical analysis in the same samples. In addition, DVL1 and beta-catenin protein expression was evaluated with a new validated set of 20 prostate cancers.

Results

SQ-PCR revealed significant overexpression of DVL1 in prostate cancer (65%). Upregulation of the DVL1 gene product in prostate cancer was confirmed by immunostaining. With SQ-PCR and immunostaining, none of the cases showed underexpression or downregulation of DVL1. In addition, the data showed correlations between DVL1 mRNA and protein expression. Interestingly, the expression level of DVL1 increased with worsening histological grade. In addition, a correlation between DVL1 expression and beta-catenin expression was confirmed.

Conclusions

DVL1 was overexpressed in prostate cancer and its overexpression might be related to prostate cancer progression through the Wnt/beta-catenin pathway.
Mesenteric Fibromatosis in a Patient with Camurati-Engelmann Disease. A Case Report and Literature Review
Authors: Ballardini Pierluigi , Gulmini Loretta , Margutti Guido , Lelli Giorgio
Published: July 2019

Mesenteric fibromatosis is a rare type of desmoid tumor characterized by local aggressiveness and a tendency to relapse. In view of these characteristics it may be considered a low-grade fibrosarcoma. Camurati-Engelmann disease is a very rare form of bone dysplasia characterized by osteosclerosis of the diaphyses of the long bones. Here we describe the case of a male patient affected by these two rare diseases in association with chronic inflammatory intestinal disease.
Adolescent Renomedullary Interstitial Cell Tumor: A Case Report
Authors: Agras Koray , Tuncel Altug , Asian Yilmaz , Kulacoglu Sezer , Atan Ali
Published: July 2019

A 14-year-old boy presented with painless gross hematuria after a blunt trauma to his right lumbar region. Abdominal ultrasonography and abdominal computerized tomography revealed that the right kidney was hydronephrotic; contrast material delineated a hematoma inside the kidney. The patient underwent a right simple nephrectomy and after histopathological examination was found to have a renomedullary interstitial cell tumor of the right kidney. This tumor is common in patients older than 50 years, whereas our patient was very young. The diagnosis of this small tumor is not possible by conventional radiological techniques and histopathological examination is mandatory for its diagnosis.
Parathyroid Carcinoma in a Chronic Hemodialysis Patient: Case Report and Review of the Literature
Authors: Bossola Maurizio , Tazza Luigi , Ferrante Angela , Giungi Stefania , Carbone Arnaldo , Gui Daniele , Luciani Giovanna
Published: July 2019

Parathyroid carcinoma is a rare disease in normal population as well as in patients with end-stage renal disease. Approximately 700 cases have been reported and, of these, 20 occurred in patients receiving chronic hemodialysis. We describe a case of parathyroid carcinoma in a 59-year-old female patient with end-stage renal disease secondary to membranous glomerulonephritis treated by hemodialysis since 1995. In September 1998, the calcium level was 12.4 mg/dl and intact parathyroid hormone serum levels were 1366 pg/ml (normal range, 25-65). A routine ultrasonographic examination of the neck revealed enlargement of two parathyroid glands, the left inferior gland being the largest and measuring 2×3×2 cm. In October 1998, resection of two parathyroid glands was performed. On the basis of histology, which documented the presence of proliferating cells arranged in sheets or in a trabecular pattern, numerous mitosis and vascular invasion, a diagnosis of parathyroid carcinoma was made.
Endodermal Sinus Tumor of the Omentum: Case Report
Authors: Geminiani Maria Luisa , Panetta Achille , Pajetta Vida , Bacci Francesco , Negri Lamberto , Maccaferri Roberto , Virzì Salvatore , Ventrucci Maurizio
Published: July 2019

We report a case of primary endodermal sinus tumor of the omentum in a 46-year-old woman. The patient had been referred to our hospital for pain in the right abdomen. CT scan revealed a right-sided abdominal mass. At laparotomy, a large omental tumor extending to the bowel, uterus, ovaries and peritoneum was found, and it was totally resected. The tumor displayed the typical histological patterns observed in endodermal sinus tumor, and the immunohistochemical findings confirmed the diagnosis. Serum AFP level was 21.550 ng/ml prior to laparotomy, and decreased to 13.845 ng/mL after surgery, whereas the level of serum beta human chorionic gonadotropin was normal. Post-surgery, the patient received combination chemotherapy consisting of cisplatin, etoposide and bleomycin every 3 weeks for a total of 6 cycles. At the end of the treatment, all the findings, including AFP level, were normal.
Splenic Metastases from Mucinous Neoplasms of the Appendix and Colon
Authors: Cabanas Jacobo , da Silva Rodrigo Gomes , Zappa Luis , Esquivel Jesus , Cerruto Carlos , Goldstein Paulo , Sugarbaker Paul H
Published: July 2019

Aims and Background

Splenic metastases associated with mucinous intraabdominal tumors have been an enigma in the radiologic and oncology literature. These focal parenchymal defects from a non-metastasizing malignancy within an organ that rarely develops metastatic foci, even with high-grade cancer, were studied.

Methods

Information on 9 patients who underwent splenectomy with intraparenchymal splenic masses associated with appendiceal or colorectal mucinous tumors with peritoneal dissemination was collected. The CT scan, the histopathology and the clinical parameters of these patients were studied. A literature review searching for prior reports of this subject was performed.

Results

Eight of these patients had mucinous appendiceal tumors and 1 a mucinous sigmoid colon cancer. All patients had mucinous carcinomatosis at some time in their clinical course. These splenic tumor masses had a CT image compatible with metastases and not compatible with mucinous tumor layered out of the splenic capsule. None of the patients had evidence of metastases to other sites such as liver or lymph nodes. All patients had a mucinous histopathology. Splenectomy may be associated with prolonged survival.

Conclusions

From our review of the clinical information available on these 9 patients, these splenic lesions were thought to be an entrapment of mucinous tumor within splenic surface trabeculae, which expand into the splenic parenchyma resembling metastatic disease. These CT findings may be more accurately referred to as splenic pseudometastases.
Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Management of Primary Cutaneous Melanoma: Report of a Single-centre Experience
Authors: Cecchi Roberto , De Gaudio Cataldo , Buralli Lauro , Innocenti Stefania
Published: July 2019

Aims and Background

Lymphatic mapping and sentinel lymph node biopsy provide important prognostic data in patients with early stage melanoma and are crucial in guiding the management of the tumor. We report our experience with lymphatic mapping and sentinel lymph node biopsy in a group of patients with primary cutaneous melanoma and discuss recent concepts and controversies on its use.

Patients and Methods

A total of 111 patients with stage I-II AJCC primary cutaneous melanoma underwent lymphatic mapping and sentinel lymph node biopsy from December 1999 through December 2004 using a standardized technique of preoperative lymphoscintigraphy and biopsy guided by blue dye injection in addition to a hand-held gamma probe. After removal, sentinel lymph nodes were submitted to serial sectioning and permanent preparations for histological and immunohistochemical examination. Complete lymph node dissection was performed only in patients with tumor-positive sentinel lymph nodes.

Results

Sentinel lymph nodes were identified and removed in all patients (detection rate of 100%), and metastases were found in 17 cases (15.3%). The incidence of metastasis in sentinel lymph nodes was 2.1%, 15.9%, 35.2%, and 41.6% for melanomas < or 1.0, 1.01-2.0, 2.01-4.0, and > 4.0 mm in thickness, respectively. Complete lymph node dissection was performed in 15 of 17 patients with positive sentinel lymph nodes, and metastases in non-sentinel lymph nodes were detected in only 2 cases (11.7%). Recurrences were more frequently observed in patients with a positive than in those with negative sentinel lymph node (41.1% vs 5.3% at a median follow-up of 31.5 months, P<0.001). The false-negative rate was 2.1%.

Conclusions

Our study confirms that lymphatic mapping and sentinel lymph node biopsy allow accurate staging and yield relevant prognostic information in patients with early stage melanoma.
Ct Image Fusion as a Tool for Measuring in 3D the Setup Errors during Conformal Radiotherapy for Prostate Cancer
Authors: Cambria Raffaella , Cattani Federica , Ciocca Mario , Garibaldi Cristina , Tosi Giampiero , Orecchia Roberto
Published: July 2019

Aims and Background

The importance of optimal daily patient positioning has been stressed in order to ensure treatment reproducibility and gain in accuracy and precision. We report our data on the 3D setup uncertainty during radiation therapy for prostate cancer using the CT image fusion technique.

Methods

Ten consecutive patients scheduled for radiation therapy for prostate cancer underwent 5 prone position CT scans using an individualized immobilization cast. These different setups were analyzed using the image fusion module of the ERGO 3D-Line Medical System (Milan, Italy) treatment planning system. The isocenter and the body marker displacements were measured.

Results

The 3D isocenter dislocations were quantified: systematic error was Σ3D = 3.9 mm, whereas random error was σ3D = 1 mm. The mean of the minimum displacements was 0.2 ± 1 mm showing that the immobilization device used allows an accurate setup to be obtained. Single direction errors were also measured showing systematic errors, ΣAP = 2.6 mm, ΣLL = 0.6 mm, ΣSI = 3 mm in the anterior-posterior, latero-lateral, superior-inferior direction, respectively. Related random errors were σAP = 1 mm, σLL = 0.6 mm, σSI = 1.2 mm. In terms of accuracy, our uncertainties are similar to those reported in the literature.

Conclusions

By applying the CT image fusion technique, a 3D study on setup accuracy was performed. We demonstrated that the use of an individualized immobilization system for prostate treatment is adequate to obtain good setup accuracy, as long as a high-quality positioning control method, such as the stereoscopic X-ray-based positioning system, is used.
Association of Cyclooxygenase-2 Immunoreactivity with Tumor Recurrence and Disease Progression in Superficial Urothelial Bladder Cancer
Authors: Mokos Ivica , Jakić-Razumović Jasminka , Mareković Zvonimir , Pasini Josip
Published: July 2019

Aims and Background

The main characteristic of urothelial bladder cancer is a clear predisposition to recurrence and disease progression. The aim of this study was to assess the possible relationship between cyclooxygenase-2 (COX-2) immunoreactivity in superficial urothelial bladder carcinoma and tumor grade, stage, number of recurrences and clinical disease progression.

Methods

In this prospective study 70 consecutive patients who underwent transurethral resection for superficial urothelial bladder cancer were included. Tumor slides were immuno-histochemically stained for COX-2, and COX-2 immunoreactivity in tumor and inflammatory stromal cells was categorized as negative or mildly, moderately or strongly positive. Patients were followed up for 2 years, and during this period the possible association of COX-2 immunoreactivity with tumor stage and grade, number of recurrences and progression of disease was evaluated.

Results

COX-2 immunoreactivity in tumor cells was found in 57 (81.4%) patients and did not correlate with tumor grade, stage of disease, number of recurrences, and progression of disease. COX-2 immunoreactivity in inflammatory cells was found in 16 of the 57 patients with COX-2 positive tumors, and was significantly related to the number of recurrences, time to appearance of the first recurrence, and disease progression.

Conclusions

COX-2 immunoreactivity in inflammatory stromal cells adjacent to the COX-2-positive tumor might be useful in clinical practice for selection of patients with a high risk of tumor recurrence and disease progression.
Clinical Significance of Serum p53 Antibodies in Oral Cancer
Authors: Sainger Rachana Narendra Singh , Shah Manisha Hasmukhray , Desai Amisha Anil , Shukla Shilin Nandubhai , Shah Pankaj Manubhai , Telang Shaila Dattatraya , Patel Prabhudas Shankerbhai
Published: July 2019

Aim and Background

The incidence and mortality due to oral cancer have increased worldwide. In India, the use of tobacco has been found to be the major etiological factor for the development of oral cancers. Various studies on serum p53 antibodies have suggested their clinical importance as prognostic markers in cancer. However, there is a dearth of data on serum p53 antibodies in oral cancer patients in India. The present study was carried to evaluate the clinical significance of serum p53 antibodies in oral cancer.

Materials and Methods

The serum p53 antibody status was analyzed by means of ELISA in 55 healthy individuals, 60 patients with oral precancerous conditions, 75 untreated oral cancer patients, and 86 follow-up blood samples of the oral cancer patients.

Results

We found serum p53 antibodies in 23% of cancer patients. The frequency of p53 antibody positivity was higher in patients with lymph node metastasis, advanced disease and well-differentiated tumors. Furthermore, p53 antibody positivity strongly correlated with poor treatment outcome in cancer patients. Kaplan-Meier survival analysis showed significantly poorer disease-free survival in patients with serum p53 antibodies.

Conclusion

The results of this study suggest the usefulness of serum p53 antibodies in the prognostication of oral cancer patients.
Matrix Metalloproteinase-9 (MMP-9) Elevated in Serum but not in Bronchial Lavage Fluid in Patients with Lung Cancer
Authors: Koç Melike , Ediger Dane , Budak Ferah , Karadağ Mehmet , Oral Haluk Barbaros , Uzaslan Esra , Ege Ercüment , Gözü Ramazan Oktay
Published: July 2019

Aims and Background

Matrix metalloproteinase (MMP) family member MMP-9 degrades type IV collagen, which is one of the main constituents of the basement membrane. MMP-9 is closely associated with the invasive and metastatic potential of most types of lung cancer. In this study we investigated the levels of MMP-9 in serum and bronchial lavage fluid from lung cancer patients and compared them with the levels in patients with nonmalignant lung disease. We also attempted to clarify the possible relationship between serum and bronchial lavage fluid MMP-9 levels and histopathology, staging and metastasis of lung cancer.

Study Design

The study group consisted of 34 patients with lung cancer. The control group comprised 21 patients with nonmalignant lung disease. MMP-9 levels in serum and bronchial lavage fluid were evaluated by ELISA.

Results

MMP-9 levels in serum samples from the group with malignant disease were significantly higher than those from the control group (P <0.05). Bronchial lavage MMP-9 levels did not differ significantly between the two groups (P >0.05). Serum MMP-9 levels were two-fold higher than those in bronchial lavage, but there was no correlation between bronchial lavage and serum levels in both groups (r = 0.18, P >0.05). In the group with malignant disease, MMP-9 levels in serum and bronchial lavage fluid did not show any relationship with histopathological type and tumor stage. There was a statistically significant correlation between serum MMP-9 levels and local tumor stage in smoking nonsmall cell lung cancer (NSCLC) patients (r = 0.33, P <0.05). Karnofsky scores of lung cancer patients were inversely correlated with MMP-9 levels of serum (r = -0.39, P <0.05) but not of bronchial lavage fluid.

Conclusion

From our data it can be concluded that MMP-9 levels of serum but not of bronchial lavage fluid can be helpful in differentiating between malignant and benign lung diseases, and are related to the local stage in NSCLC patients and general clinical status of lung cancer patients.
Early Gallbladder Carcinoma: A Single-Center Experience
Authors: Cangemi Vincenzo , Fiori Enrico , Picchi Cristina , De Cesare Alessandro , Cangemi Roberto , Galati Gaspare , Volpino Patrizia
Published: July 2019

Aims and background

Controversy continues regarding the best surgical treatment for early gallbladder carcinoma defined as a tumor confined to the mucosa (pT1a) or to the muscularis propria (pT1 b) according to the TNM classification. This study evaluates the effectiveness of different surgical approaches in patients with early gallbladder carcinoma in terms of long-term survival.

Materials and methods

From 1980 to 2001, 175 patients with gallbladder carcinoma were admitted to our department. Fifteen of them underwent resections for early gallbladder carcinoma: 4 patients for pT1a tumors and 11 patients for pT1b tumors. All patients with pT1a tumors and 8 patients with pT1b tumors underwent simple cholecystectomy. The remaining 3 patients with pT1 b tumors underwent extended cholecystectomy.

Results

The 5-10 year cumulative survival rate was 100% for patients with pT1a tumors, 37.5% for patients with pT1b tumors who underwent simple cholecystectomy, and 100% for patients with pT1b tumors who underwent extended cholecystectomy.

Conclusions

Simple cholecystectomy is the appropriate treatment for patients with pT1a tumors, whereas patients with pT1b tumors require an extended cholecystectomy.
Gene Expression of E-Selectin in Tissue and its Protein Level in Serum of Breast Cancer Patients
Authors: Shaker Olfat G , El-Deen Mohamed A Ay , El-Rahim Mohamed T Abd , Talaat Randa M
Published: July 2019

Aims and background

This study aims to detect the expression of E-selectin in tissue and the serum level of its soluble form in patients with primary breast cancer and benign breast tumors and to correlate the results with the clinicopathological data of the subjects.

Methods

Fifty participants were included in the study and stratified into 3 subgroups. Group A comprised 30 patients with primary breast cancer, group B 9 patients with benign breast tumors, and group C 11 healthy control women undergoing reduction mammoplasty. E-selectin gene expression was investigated in breast tissues by PCR techniques and soluble E-selectin was measured in sera by ELISA.

Results

The E-selectin gene was expressed in 73.3% of group A, 44.4% of group B and 9.1% of group C. It was expressed in 61.5% of patients with grade 2 breast cancer and in 82.4% of patients with grade 3 breast cancer. E-selectin gene expression was detected in 60%, 73.3% and 100% of patients with stage II, III and IV tumors, respectively. It was detected in 81.8% of patients with node-positive primary breast cancer and in 50% of patients with node-negative cancer. PCR in situ hybridization was done to locate the site of E-selectin expression. E-selectin was found on the membranes of peritumoral endothelial cells while it was not found on breast epithelial cells. Serum levels of soluble E-selectin were significantly elevated in group A compared to groups B and C ( P <0.001). They increased significantly with increasing breast cancer stage ( P <0.001) and were significantly higher in patients with lymph node involvement than in patients without node involvement ( P <0.001).

Conclusions

The studied marker showed associations with established prognostic parameters such as lymph node involvement and histological tumor grade. Further studies are needed to evaluate E-selectin as a possible target for antimetastat-ic therapy through modulation of the expression of the cell adhesion molecule. E-selectin can be regarded as a promising strategy in improving tumor therapy.
Kit Protein (CD 117) and Proliferation Index (Ki-67) Evaluation in Well and Poorly Differentiated Neuroendocrine Tumors
Authors: Ferrari Leonardo , Torre Silvia Della , Collini Paola , Martinetti Antonia , Procopio Giuseppe , De Dosso Sara , Bajetta Roberto , Catena Laura
Published: July 2019

Aims and background

Kit protein expression seems to be associated with a poor outcome in cancer patients and may be an important target for new anticancer drugs. We examined by immunohistochemistry the presence of Kit protein in neuroendocrine tumors (NETs) to explore its relationship with histological grade and proliferation index.

Patients and methods

Thirty-five tumor specimens from patients with 24 well differentiated and 11 poorly differentiated NETs were examined for the presence of Kit protein and the proliferation index marker Ki-67.

Results

Eleven specimens were positive for Kit protein expression, 8 of which had poorly-differentiated histology and only 3 had well-differentiated histology. Most of the tumors showing immunopositivity for Kit protein were also characterized by a high proliferation index.

Conclusions

Immunohistochemical positivity for Kit protein is mainly related to poorly differentiated NETs. In our study, the percentage of tumors with immunopositivity for Kit protein was lower than that observed by other authors. This difference could be attributable to the different immunohistochemistry procedures used and to the biological heterogeneity of NETs. The number of Kit protein-positive NETs may justify targeted therapy with a tyrosine kinase receptor-associated inhibitor only in a selected subset of patients, whenever no other therapy is available and an autocrine loop sustained by the Kit receptor and its specific ligand has been demonstrated.
Fatal Interstitial Pneumonitis Associated with Docetaxel Administration in a Patient with Hormone-Refractory Prostate Cancer
Authors: Leimgruber Karl , Negro Rosa , Baier Susanne , Moser Bernadetta , Resch Gerhard , Sansone Stefano , Adami Michele , Zanon Peter , Graiff Claudio , Egarter-Vigl Eduard , Wiedermann Christian J
Published: July 2019

Taxanes are widely used chemotherapeutic agents with the potential to induce pulmonary injury through a variety of mechanisms. Patients receiving these agents are at risk of acute or subacute pulmonary damage. The case is presented of a 72-year-old man with hormone-refractory prostate cancer and weekly administration of 30 mg/m2 docetaxel who developed subacute interstitial pneumonitis-related pulmonary fibrosis after seven doses and died despite mechanical ventilation and high-dose corticosteroid treatment. Even though only a few cases of this adverse event have been reported in the literature, severe docetaxel-induced pulmonary toxicity needs to be considered in the differential diagnosis when such patients present with respiratory symptoms.