The relative risk of noncervical high-risk human papillomavirus-related (pre)malignancies after recurrent cervical intraepithelial neoplasia grade 3: A population-based study

Women with cervical intraepithelial neoplasia grade 3 (CIN3) have a long-lasting increased risk for noncervical high-risk human papillomavirus (hrHPV)-related (pre)malignancies. The aim of our study was to estimate this risk in women with recurrent CIN3 compared to women without a history of CIN3 and women with a single episode of CIN3. Women with a CIN3 diagnosis between 1990 and 2010 were obtained from the Dutch Pathology Registry (PALGA) and matched with a control group of women without CIN3. Analysis has been conducted in a subset of women with recurrent CIN3, defined as reoccurrence minimally 2 years post-treatment. Cases of noncervical hrHPV-related (pre)malignancies of the anus, vulva, vagina and oropharynx were identified until 2015 and incidence rate ratios (IRRs) were estimated. Then, 1,797 women with recurrent CIN3 were included with a median age of 34 years (range 18–76) and 31,594 person-years of follow-up. Women with recurrent CIN3 had an increased risk of developing noncervical hrHPV-related (pre)malignancies compared to women without CIN3 with an IRR of 25.96 (95%CI 6.32–106.58). The IRR was 2.48 (95% CI 1.87–3.30) compared to women with a single episode of CIN3. Studies on posttreatment follow-up and prophylactic hrHPV vaccination are warranted.     

Non-squamous cell carcinoma diseases of the larynx: clinical and imaging findings

IntroductionSquamous cell carcinoma is the most common laryngeal neoplasm and accounts for approximately 95% of all malignant neoplams of the larynx. However, various benign and malignant tumors and inflammatory diseases may affect the larynx.ObjectiveThe purpose of this study is to analyze the clinical and imaging findings of non-squamous cell neoplasms and inflammatory diseases of the larynx.MethodsThis retrospective study was conducted in 18 patients who were diagnosed with non-squamous cell carcinoma lesions of larynx at our institution between 2007-2017. Clinical symptoms, examination findings, imaging characteristics, histopathologic diagnosis and treatment modalities were analyzed.ResultsThere were 9 malignant lesions (2 chondrosarcoma, 1 neuroendocrine tumor-atipical carcinoid, 1 Natural Killer/T-cell lymphoma, 1 diffuse large B-cell lymphoma, 3 plasmocytoma-multiple myeloma involvement, 1 adenocarcinoma metastasis), 3 benign neoplasms (chondroma, paraganglioma, lipoma), 2 tumor-like lesions (Brown tumor and inflammatory myofibroblastic tumor), 3 inflammatory lesions (Wegener granulomatosis, Behçet's disease and tuberculosis involvements), and 1 vascular malformation. The most common presenting symptom was hoarseness (66.6%). Paraganglioma was seen as hypervascular lesion on computed tomography and magnetic resonance imaging and showed intense tracer uptake on 68Gallium-DOTA-peptide PET/CT. Chondroid matrix calcifications were detected in chondroma and chondrosarcoma-grade 1. In patients with vascular malformation and lipoma, the typical imaging findings made it possible to diagnose.ConclusionImaging studies may provide clues for diagnosis of non-squamous cell laryngeal lesions. Clinical and imaging findings and previous clinical history should be evaluated together in clinical management of laryngeal lesions.     

Bullous Melanoma: should the thickness of the bullous lesion be included in Breslow depth measurement?

Bullous melanoma represents a rare variant of melanoma, especially in patients without underlying bullous cutaneous disease. Few cases have been described in the literature, including cases of melanoma in patients with bullous epidermolysis or Hailey-Hailey disease. The histopathological diagnosis of bullous melanoma does not show any difficulties, except for the measurement of the Breslow index. The rarity of this case, the dilemma of how to measure the Breslow index and the importance of an early diagnosis motivated this report.     

Il mixoma odontogeno: revisione della letteratura e presentazione di un caso clinico

Objectives

The aim of this work was perform a literature review concerning the treatment of odontogenic myxoma with a view to identifying potential guidelines for its treatment. A clinical case of myxoma and its surgical treatment was also described.

Materials and methods

The research was made through medical databases (PubMed from 1994 until 2013), by selecting articles in English, including at least 10 patients.

Results

The initial research provided 307 clinical publications, but only 21 of them matched the review's specific inclusion criteria. Overall, 724 patients who had been treated with a surgical approach were taken into account. Few data concerning the used surgical techniques, the incidence of recurrences and the followup were available; this made it difficult to obtain pertinent information and well defined guidelines for the appropriate treatment modalities.

Conclusions

The few available data were not sufficient to identify standardized protocols for the treatment of odontogenic myxomas. However, due to the significant incidence of recurrences after conservative surgical treatment, the most reliable therapy seems to be an “en bloc” resection which includes the tumor and healthy surrounding soft and hard tissues to provide reliable safety margins, thus reducing the likelihood of recurrences, as shown in the described clinical case.     

Infrared Coagulator™: A Useful Tool for Treating Anal Squamous Intraepithelial Lesions

PURPOSE The incidence of invasive anal squamous carcinoma in men who have sex with men is rising, particularly in those with human immunodeficiency virus. As in the cervix the high-grade squamous intraepithelial lesion is thought to be an invasive squamous cell carcinoma precursor. Cervical high-grade squamous intraepithelial lesions are treated by removing the squamocolumnar transition zone. This is not possible in the anus, where treatment is often surgical and is accompanied by significant pain and morbidity. Better office-based techniques to treat anal high-grade squamous intraepithelial lesions are needed. We employed the infrared coagulator in an office setting to ablate high-grade squamous intraepithelial lesions.METHODS A retrospective review of medical records was performed on 68 human immunodeficiency virus-positive men who have sex with men who underwent infrared coagulator ablation of biopsy-proven high-grade dysplasia from the time we began using the procedure in 1999. All patients have had at least six months of follow-up. Procedures were performed with local anesthesia on patients with discrete high-grade squamous intraepithelial lesions. Follow-up consisted of anal cytology with high-resolution anoscopy and biopsy of suspicious areas every three to six months. New or recurrent high-grade dysplasia was retreated. Patients with circumferential or bulky disease were treated in the operating room and were excluded from the study.RESULTS Altogether, 68 patients met the enrollment criteria. The median patient age was 41 years (range 29–62 years). A total of 165 lesions were treated (mean 1.6 lesions, range 1–5) and only 46 (28 percent) persisted. However, 44 patients (65 percent) developed a new or persistent high-grade squamous intraepithelial lesion within a median time of 217 days (range 27–566 days) after infrared coagulation. The remaining 24 patients (35 percent) were free of high-grade dysplasia for a median of 413 days (range 162–1313 days) after infrared coagulation. When patients were treated a second or third time, the incidence of new or persistent high-grade dysplasia dropped to 58 percent and 40 percent, respectively. The probability of curing a retreated lesion was 72 percent. Using generalized estimating equations, the incidence of high-grade dysplasia decreased with repeated infrared coagulator treatments. No patient developed squamous-cell carcinoma, had a serious adverse event, or developed anal stenosis.CONCLUSIONS The infrared coagulator is a safe, office-based modality for treating anal high-grade squamous intraepithelial lesion in human immunodeficiency virus-positive men who have sex with men. Successive treatments led to decreased recurrence rates.This retrospective chart review was performed on patients treated at the first authors surgical practice in New York City. It was supported in part by supply of the infrared coagulator furnished by Redfield Corporation, Rochelle Park, New Jersey. Adam Kawaleks participation was partially funded through the Mount Sinai School of Medicine Alumni Summer Research Fellowship.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004     

Higher prevalence of proximal colon polyps and villous histology in African-Americans undergoing colonoscopy at a single equal access center

Background

In the United States, African Americans (AA) have the highest incidence and mortality from colorectal cancer (CRC) of any racial group. Few studies have evaluated if AA who undergo colonoscopy are more likely to have aggressive neoplasia (polyp) tumor biology compared to Caucasians (C). The primary aim of the study was to compare polyp characteristics between AA and C undergoing outpatient colonoscopy.

Methods

A single center retrospective cohort study was performed at a single Veteran Administration (VA) health care system. The charts of 4,038 veterans undergoing colonoscopy from 2005 to 2008 were reviewed. After applying exclusion criteria, data was analyzed for 1,388 persons. Categorical variables were compared using the chi-square test and data were expressed as percentages. Continuous variables were compared using student’s t-test and the data were expressed as mean with standard deviation.

Results

A total of 37% of AA had proximal polyps compared to 21% of C (P<0.0001). Twenty-four percent of AA had polyps with villous histology compared to 16% of C (P=0.01). Twelve percent of AA had hyperplastic polyps compared to 20% of C (P=0.02). There was no difference in the overall prevalence of tubular adenomas, adenomatous polyps with high-grade dysplasia, number, size or polyp morphology between groups.

Conclusions

In an equal access healthcare system and under varying indications, AA have more proximal polyps and polyps with more aggressive histology compared to C. This could partially explain the higher incidence of CRC in AA, and the increased likelihood for AA to develop advanced proximal neoplasia.     

DNA甲基转移酶1和组蛋白脱乙酰基酶1在胰腺组织中的表达及其临床意义

背景：近年针对DNA甲基化和组蛋白乙酰化修饰的表观遗传学研究是探索胰腺癌发生机制的新热点。目的：研究DNA甲基转移酶1（DNMT1）和组蛋白脱乙酰基酶1（HDAC1）在胰腺上皮内瘤变（PanIN）和胰腺癌组织中的表达．探讨其可能的临床意义。方法：以免疫组化SP法检测DNMT1、HDAC1在10例正常胰腺组织、39例证实含有PanIN的胰腺癌旁组织和54例胰腺导管腺癌（PDAC）组织中的表达。结果：DNMT1和HDAC1在胰腺组织中的阳性表达率均随组织异型程度的增加而逐渐增高，即正常胰腺导管（0％）〈PanIN—IA（7．2％±1．2％，10．7％±5．0％）〈PanIN-1B（24．5％±9．6％，40．1％±8．0％）〈PanIN-2（30．0％±11．9％，51．2％±13．4％）〈PanIN-3（46．7％±11．2％，73．1％±11.3％）〈PDAC（56．7％±27．5％，82．5％±19.4％），差异均有统计学意义（P〈0．05）。结论：DNMT1和HDAC1表达增强是胰腺癌发生的早期事件．两者共同促进了胰腺癌的进展，可能成为胰腺癌早期诊疗的新靶点。