Spindle-cell squamous carcinoma of the esophagus: a tumor with biphasic morphology

Spindle-cell squamous carcinoma of the esophagus is a rare malignant tumor. It is characterized by a large bulky mass in the middle third of the esophagus with a lobulated surface and local expansion of the esophagus. This lesion may be pedunculated and cause relatively little obstruction despite its bulk. The current view, based on ultrastructure and immunohistochemical evidence, has confirmed that the sarcomatous component of the squamous cell carcinoma originates from mesenchymal metaplasia of squamous cells. On the basis of this evidence and clinical behavior, it seems appropriate to consider carcinosarcoma and pseudosarcoma as equivalents and as variants of squamous cell carcinoma. Four patients with spindle-cell squamous carcinoma, an unusual subset of squamous carcinoma, are described, and the salient radiographic and pathologic features of this disorder's distinctive biphasic morphology are discussed.     

CT demonstration of calcification in carcinoma of the lung

Radiologic visualization of calcification within lung cancer is uncommon and may cause confusion and misdiagnosis. For this reason, we reviewed CT records of 353 patients undergoing initial evaluation of lung cancer for the presence of calcification within the tumor, both to document this finding and to estimate its prevalence. Twenty patients (6%) whose records indicated that CT showed calcification were identified, and their chest radiographs and CT scans were analyzed. Patients were included in the study if calcium was seen within the tumor on noncontrast pretreatment CT scans and if pathologic data were available. There were 15 lung and five mediastinal tumors. Fourteen were 5 cm or greater in diameter; three were between 3 and 5 cm, and three were 2 cm or smaller. Cell types of the tumors included small-cell carcinoma (eight patients), squamous cell carcinoma (seven patients), adenocarcinoma (four patients), and undifferentiated carcinoma (one patient). Patterns of calcification were amorphous (eight patients), punctate (10 patients), and reticular (two patients). Extent of tumor calcification and distribution (central, peripheral, or diffuse) did not correlate with cell type or size of the lesion. The visualization of calcium on chest radiographs and CT scans does not alone exclude the diagnosis of bronchogenic carcinoma.     

Primary tumors and mediastinal lymph nodes after neoadjuvant concurrent chemoradiotherapy of lung cancer: serial CT findings with pathologic correlation

PURPOSE: The purpose of this work was to describe the changes of primary tumor and mediastinal lymph nodes on CT after neoadjuvant concurrent chemoradiotherapy and to correlate the CT findings with pathology. METHOD: Twenty-one consecutive patients [N2 disease (n = 19) or resectable T4 and N2 disease (n = 2)] with non-small cell lung cancer underwent neoadjuvant concurrent chemoradiotherapy. Changes of primary tumor and mediastinal nodes before and after the therapy were assessed using CT. The CT findings were correlated with pathologic findings. RESULTS: With neoadjuvant therapy, decrease in T stage was achieved in 9 of 21 (43%) patients on CT. On pathology, the remaining tumor consisted mostly of fibrosis and necrosis with little proportion of viable tumor cells (mean volume 17%, range 0-55%). Decrease in nodal stage was achieved in 14 of 21 (67%) patients on pathologic examination. Seven patients had cancer cells in mediastinal lymph nodes: in 6 of 9 (67%) patients with adenocarcinoma and 1 of 12 (8%) patients with squamous cell carcinoma (p = 0.016). CONCLUSION: With neoadjuvant concurrent chemoradiotherapy, the remaining tumor consists mostly of fibrosis or necrosis. Decreased nodal stage on pathology is achieved especially in patients with N2 disease of squamous cell carcinoma. The CT findings of the tumor and mediastinal nodes are not helpful in predicting the pathology after the therapy.     

影像学检查和血清肿瘤标志物检测对肺癌诊断及病理分型的价值

目的 探讨几种常用肿瘤标记物CEA、NSE、LTA检测与影像学诊断对肺癌的检查及病理分型相关研究。资料与方法 选择190例肺部病变的患者，均摄胸部X线平片和CT扫描及肿瘤标记物CEA、NSE、LTA外周血清检测。结果 (1)CT诊断鳞癌50例、腺癌46例、小细胞性未分化癌14例、良性病变20例、未定型60例。(2)三项肿瘤标记物检测水平及敏感性鳞癌LTA为85．3％，腺癌CEA为86．9％，小细胞未分化癌NSE为93．3％。(3)影像学诊断与肿瘤标记物相结合，定性诊断及病理分型上升率鳞癌为14．7％，腺癌11．5％，小细胞未分化癌为46．7％。结论 影像学检查与几种常见肿瘤标记物检测结合在肺癌的诊断、病理分型及良恶性病变的鉴别起着重要的作用，为临床诊断及治疗提供更可靠的依据。     

Technetium-99m glucoheptonate imaging in lung cancer and benign lung disease: concise communication

We prospectively studied technetium-99m glucoheptonate (Tc-GHA) uptake in 58 patients with newly diagnosed lung cancer and in 20 patients with pulmonary inflammatory disease or metastatic carcinoma. Fifty-three (91%) primary tumors accumulated Tc-GHA: squamous cell 20/22, adenocarcinoma 7/7, large cell 10/11, and small cell 16/18. Intensity of tumor uptake was greatest in small-cell cancer. Supraclavicular metastases were detected in two patients. Fourteen patients with mediastinal evaluation by Tc-GHA imaging and trispiral tomography underwent mediastinoscopy or thoracotomy. Five of ten patients with negative mediastinum by tomography and Tc-GHA imaging showed metastases by biopsy (false-negative Tc-GHA). Less intense accumulation of Tc-GHA was observed in 18/20 cases of pulmonary inflammatory disease or pulmonary metastases. Although Tc-GHA accumulates by an unknown mechanism in primary lung cancer, we cannot recommend its use in detecting mediastinal spread of lung cancer due to its unacceptably high false-negative rate.     

Oral cavity and oropharynx tumors

Cancers of the oral cavity and pharynx are the most common head and neck cancers in the United States, and squamous cell carcinoma is the most frequent histologic type. The clinical behavior and outcome of tumors in the oral cavity is distinct from those of the oropharynx. As a general rule, surgical resection is the primary treatment for oral cavity squamous cell carcinoma, whereas oropharyngeal squamous cell carcinomas are treated with radiation with or without chemotherapy. A clear understanding of the anatomy and knowledge of clinical behavior and spread patterns of oral cavity and oropharyngeal squamous cell carcinoma are essential for radiologists to make a meaningful contribution to the treatment of these patients.     

18F-FDG PET in patients with esophageal squamous cell carcinoma undergoing curative surgery: prognostic implications.

We investigated whether the standardized uptake value (SUV) of the primary tumor, the tumor length measured on a PET image, the number of (18)F-FDG PET-positive nodes, and the PET stage were independent prognostic predictors over other clinical variables in patients with esophageal squamous cell carcinoma who were undergoing curative surgery. METHODS: Sixty-nine patients with newly diagnosed esophageal squamous cell carcinoma who underwent preoperative (18)F-FDG PET and curative esophagectomy were included. The events for survival analysis were defined as recurrence or metastasis and cancer-related death. The disease-free and overall survival rates of each variable were estimated by the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate independent prognostic variables for multivariate survival analysis. RESULTS: Using univariate survival analysis, the presence of adjuvant therapy, pathologic stage, number of CT-positive nodes (0, 1, > or =2), tumor length on PET (cutoff: 3 cm, 5 cm), number of PET-positive nodes (0, 1, 2, > or =3), and PET stage (N0 M0, N1 M0, M1) were significant prognostic predictors for disease-free survival. However, only the number of PET-positive nodes was an independent significant prognostic predictor for disease-free survival in multivariate analysis (hazard ratio = 1.87, P < 0.001). In univariate survival analysis, the sex, presence of adjuvant therapy, clinical and pathologic stages, number of CT-positive nodes, maximum SUV of the primary tumor (cutoff: 6.3, 13.7), tumor length on PET, number of PET-positive nodes, and PET stage were significant prognostic predictors for overall survival. In contrast, the clinical stage (hazard ratio = 0.53, P < 0.05), pathologic stage (hazard ratio = 3.14, P < 0.005), tumor length by PET (hazard ratio = 2.74, P = 0.01), and number of PET-positive nodes (hazard ratio = 1.71, P < 0.05) were independent significant prognostic predictors for overall survival in multivariate analysis. CONCLUSION: In addition to the pathologic stage, (18)F-FDG PET provides noninvasively independent prognostic information using the number of positive lymph nodes and the tumor length on the PET image in preoperative esophageal squamous cell carcinoma. A revised TNM classification system for esophageal carcinoma may consider tumor length and the number of positive lymph nodes as important prognostic factors.     

Neuroendocrine carcinomas of the lung: clinical, radiologic, and pathologic correlation

Neuroendocrine carcinomas of the lung are characterized by differentiation toward Kulchitsky cells and are classified as Kulchitsky-cell carcinoma (KCC) I (classic carcinoid), KCC II (atypical carcinoid), and KCC III (small-cell carcinoma). The clinical, computed tomographic (CT), and pathologic findings in 31 patients with KCC were reviewed. KCC I lesions generally occurred in younger (56 years +/- 18) nonsmoking women, were small (1.8 cm +/- 0.7 in diameter on CT scans), and were associated with lymphadenopathy in one of ten patients. KCC II tumors were found predominantly in older (66 years +/- 12) smoking men and were larger (3.9 cm +/- 1.3 in diameter, P less than .001); four of ten patients had CT evidence of lymphadenopathy. KCC III tumors occurred in older (66 years +/- 8) smoking men and were large (4.2 cm +/- 1.0); 11 of 11 patients had massive lymphadenopathy. Clinical, radiologic, or pathologic overlap was noted in three patients. Sputum cytologic and fine-needle and bronchoscopic biopsy findings were often nondiagnostic or misleading, particularly for KCC II lesions. CT of the chest provides additional discriminating information in the preoperative diagnosis of neuroendocrine lung carcinomas.     

不同组织学类型肺癌患者大脑静息葡萄糖代谢改变研究

目的 探讨不同组织学类型肺癌患者大脑静息葡萄糖代谢改变特点.方法 回顾性分析100例未经治疗的原发性肺癌患者全身18F-FDG PET/CT检查资料.肺癌组织学类型均经穿刺或手术病理明确,根据不同组织学类型将患者分为腺癌（42例）、鳞癌（37例）、小细胞肺癌（21例）3组.将50名健康体检者作为对照,采用统计参数地形图分析软件分析每组患者PET脑代谢显像资料,采用两样本t检验比较3组患者脑代谢改变的差异.结果 3组患者脑PET显像均表现为区域性大脑静息葡萄糖代谢降低,主要分布在左侧额叶上中回及双侧颞叶上、中、下回,小细胞肺癌组还可见右侧顶下小叶及海马区受累.小细胞肺癌组低代谢脑区面积（体素数3848）大于腺癌组（体素数1436）（t=14.33,P＜0.05）和鳞癌组（体素数1397）（t=10.07,P＜0.05）,腺癌组与鳞癌组之间差异无统计学意义（t=0.764,P＞0.05）.结论 肺癌患者大脑静息葡萄糖代谢改变与其组织学类型有一定相关性.脑代谢降低区多涉及精神情感功能区,PET脑显像有望为肺癌患者出现的精神情感障碍症状提供客观的分子影像学依据和可能的评价指标.     

Quantitative gallium-67 scanning for predictive value in primary lung carcinoma

Gallium-67 scintigraphy was performed on 87 patients with a variety of histological types of untreated primary lung carcinoma. Gallium-67 uptake was determined, allowing for differences in tumor size. Differential uptakes were found for the various tumor types, with anaplastic small-cell carcinoma having the greatest average uptake, and adenocarcinoma and anaplastic large-cell carcinoma the smallest. Gallium-67 uptake was compared with response to radiation therapy, incidence of metastasis, and host survival in 58 of the patients. From these results it is suggested that the greater the Ga-67 accumulation in the tumor, the more effective is radiation therapy in reducing tumor size. Gallium-67 scintigraphy appears to be a valuable tool in estimating the sensitivity of the tumor before radiation therapy and in indicating the prognosis following radiation therapy in patients with primary lung carcinoma.     

肝转移性肿瘤DSA表现分析

目的 探讨肝转移瘤血供特点与原发性肝癌的鉴别以及和原发肿瘤的相关性。材料与方法 搜集５１例肝转移瘤ＤＳＡ影像,根据肿瘤血管的多少和肿瘤染色深浅分为多血供、中血供和少血供,原发肿瘤包括腺癌３８例,鳞癌８例,其他类型５例。结果 肝转移瘤血供来源主要为肝动脉,门静脉参与供血,多血供肝转移１２例,中血供７例,少血供３２例。累及肝右叶少血供转移２７例,腺癌转移多于动脉晚期及以后显示多或单发环状染色;鳞癌转移     

18F-FDG PET/CT检测淋巴结转移性鳞癌原发灶的价值

目的 探讨18F-氟脱氧葡萄糖（FDG） PET/CT在淋巴结转移性鳞癌原发灶检测中的临床应用价值。 方法 选取2018年3月至2020年11月于广东省佛山市禅城区中心医院因发现淋巴结转移性鳞癌而原发灶不明行全身18F-FDG PET/CT检查的56例患者进行回顾性研究,其中男性44例、女性12例,年龄19~81岁,中位年龄51岁。所有患者的淋巴结转移性鳞癌均于18F-FDG PET/CT显像前经组织病理学检查确诊,原发灶经组织病理学检查或临床随访确诊。分析并计算18F-FDG PET/CT检测原发灶的检出率;原发灶与淋巴结转移部位、最大标准化摄取值（SUV_max）的关系。采用双变量相关分析法分析原发灶与淋巴结转移灶的SUV_max的相关性。 结果 56例患者中,18F-FDG PET/CT检测原发灶阳性44例（真阳性42例、假阳性2例）,检出率为75.0%;假阴性1例（鼻咽癌）;11例患者18F-FDG PET/CT未发现原发灶。双变量相关分析结果显示,原发灶与淋巴结转移灶的SUV_max在一定程度上具有一致性（r=0.320,P<0.05）。 结论 18F-FDG PET/CT显像对淋巴结转移性鳞癌的不明原发灶检测具有较好的临床应用价值,淋巴结转移灶与原发灶的18F-FDG代谢强度存在良好的相关性。     

Lung cancer detection with low-dose spiral computed tomography in chronic obstructive pulmonary disease patients

Purpose: To determine whether low-dose spiral computed tomography (LDCT) can improve the lung cancer detection rate in chronic obstructive pulmonary disease (COPD) subjects.

Material and Methods: From October 1999 to December 2003, 374 COPD patients underwent LDCT for lung carcinoma screening. All subjects with an abnormal baseline CT scan were followed with serial CT scans as part of our protocol. Follow-up was continued until the demonstration of no change over a minimum of 24 months, or resolution. Sputum samples were also obtained for cytological analysis.

Results: On the baseline spiral CT scan, 132 of 374 patients (35.2%) had at least one non-calcified nodule that required periodic follow-up with CT scans. The median follow-up time was 21 months (range 2-48 months). Of the 374 COPD subjects, nine patients with primary lung cancer (2.4%) were detected: six were squamous cell carcinomas, two were small-cell lung carcinomas (SCLC), and one was adenosquamous carcinoma. Three of the nine tumors were in stage IA, two in stage IIB, two in stage IIIA, and two were limited SCLC. Potentially curative pulmonary resection was performed in four patients, pulmonary lobectomy in three, and wedge excision in one. One subject with stage IA squamous cell carcinoma received radiotherapy, as pulmonary function was severely impaired. In addition, four patients underwent removal of benign lesions. Sputum was collected in 205 (54.8%) of 374 patients. There were 154 (75 %) metaplasia, 14 (6%) moderate dysplasia, and one (0.4%) malignant case.

Conclusion: LDCT increases early lung carcinoma detection rate in COPD patients, but pulmonary function impairment may reduce its benefit.     

宫颈腺癌及其血管内介入治疗

与鳞癌比较,年轻患者中宫颈腺癌发病呈上升趋势,预后亦较差。传统的放疗和静脉途径化疗在肿瘤的治疗中均难以取得好的疗效。宫颈腺癌的分子生物学行为有别于鳞癌。其原发灶与局部浸润灶均较长时间局限于盆腔内,这为宫颈腺癌的血管内介入治疗提供了可靠的临床病理学基础。本文就宫颈腺癌的临床病理特点、分子生物学研究及血管内介入治疗作一综述。     

Evaluation of primary lung carcinoma using technetium 99m-hexamethylpropylene amine oxime: preliminary clinical experience

99mTc-labelled hexamethylpropylene amine oxime (HMPAO) is a lipophilic compound with a neutral charge which reflects tumor blood flow and has been previously investigated to estimate brain blood flow. In this study, we attempted to use 99mTc-HMPAO for the evaluation of 18 patients with histologically proven primary lung carcinoma. The eight surgical specimens revealed that viable carcinoma cells were present when the 99mTc-HMPAO accumulated in the tumor, however, extensive tumor necrosis was observed when defective or ring like uptake was seen in the tumor. Qualitative study revealed that when perfusion defects were observed corresponding to the tumor, the possibility of squamous cell carcinoma or large cell carcinoma was high instead of adenocarcinoma. Quantitative analysis revealed that the uptake ratio was statistically different between adenocarcinoma (1.6 +/- 0.1) and squamous cell carcinoma (1.2 +/- 0.4) (P less than 0.05), between squamous cell carcinoma and large cell carcinoma (0.9 +/- 0.1) (P less than 0.05), and also between adenocarcinoma and large cell carcinoma (P less than 0.01). In conclusion, 99mTc-HMPAO may be useful for the evaluation of patients with primary lung carcinoma.     

Treatment recommendations in patients diagnosed with high-risk cutaneous squamous cell carcinoma

Non-melanoma cutaneous cancers occur at an epidemic rate in Australia. With an ageing population, more Australians will develop these cancers and at an increasing rate. In the majority of cases local treatment is highly curative. However, a subset of the population will be diagnosed with a high-risk cutaneous squamous cell carcinoma. These can be defined as patients at risk of having subclinical metastases to regional lymph nodes based on unfavourable primary lesion features (including inadequately excised and recurrent lesions), patients with metastatic squamous cell carcinoma to regional lymph nodes, and squamous cell carcinoma in immunosuppressed patients. The mortality and morbidity associated with high-risk cutaneous squamous cell carcinoma is usually as a consequence of uncontrolled metastatic nodal disease and, to a lesser extent, distant metastases. Radiotherapy has an essential role in treating these patients and in many cases the addition of adjuvant radiotherapy may be life saving. It is therefore important that all clinicians treating skin cancers have an understanding and awareness of the optimal approach to these patients. The aim of this article is to present treatment recommendations based on an overview of the current published literature.     

Radiotherapy of bronchial cancer

Current radiotherapy is effective both in treating the non-small cell bronchial carcinoma and the small-cell anaplastic carcinoma. The spectrum of radio-oncologic methods requires on-target determination of indication. Curative treatment of non-small cell bronchial carcinoma may yield 5-year survival rates of 11% in case of radiotherapy; if onset of treatment is early, this rate may increase to 20%. Even in elderly patients (70-75%) the results are by no means inferior compared to younger patients. Adjuvant postoperative radiotherapy is indicated in N2 cases. Palliative radiotherapy is of undisputed value in non-small cell bronchial carcinomas. For treating the non-small cell anaplastic bronchial carcinoma, radiotherapy is an essential part of a multimodal interdisciplinary therapeutic concept. In combination therapy it ensures complete remission, reduces the relapse rate and results in remarkable long-term remissions because of its essential target areas in the region of the primary tumour and the cerebrum together with chemotherapy and surgery, and hence in an improvement of the survival time.     

Primary squamous cell carcinoma of the thyroid gland

A case of primary squamous cell carcinoma of the thyroid is presented. Squamous epithelium is normally not present in the thyroid gland, and this tumor is exceedingly rare. Proper workup is described, including the differentiation from metastatic disease. The case reported is of a 64-year-old woman who presented with an asymptomatic nodule and underwent thyroidectomy. The final pathologic diagnosis, confirmed using immunohistochemistry for cytokeratin and transmission electron microscopy, revealed the unusual tumor. Squamous cell carcinoma of the thyroid is highly aggressive and behaves clinically like anaplastic thyroid carcinoma; the prognosis is poor. The patient described developed local recurrence and expired 7 months after resection from local invasion and airway obstruction. Unfortunately, this is the typical outcome. Chemoradiotherapy is generally not helpful, and complete resection remains the best chance for cure.     

原发性胸腺癌的CT表现及鉴别诊断

目的分析原发性胸腺癌的影像表现,以期进一步提高对该肿瘤的认识及诊断水平。方法回顾性分析19例经病理证实的原发性胸腺癌的影像表现,17例行CT平扫及增强检查,2例仅行CT平扫检查。结果19例胸腺癌中,鳞状细胞癌16例,未分化癌、粘液表皮样癌及淋巴上皮样癌各1例;CT表现为前中上纵隔较大分叶状软组织肿块,最大径约为3.5~12.8cm(平均为6.6cm),肿块密度不均匀,均有坏死,其中3例鳞状细胞癌有钙化;19例肿瘤中,侵犯大血管10例,心包侵犯9例,胸内转移(纵隔淋巴结转移11例,胸膜转移7例,肺内转移4例),胸外转移(腹膜后淋巴结及骨骼各2例,肝脏3例)。结论原发性胸腺癌是一种罕见的纵隔肿瘤,CT表现具有一定的特征,结合病变的临床及CT表现,可提高病变的诊断率。     

Synchronous primary adenocarcinoma and adenosquamous carcinoma of the esophagus

Multiple malignant esophageal tumors of the same cell type are described. In the esophageal mucosa, widespread carcinomatous transformation may be observed and multicentric invasive squamous cell carcinomas may develop. The concomitance of two independent esophageal malignant neoplasms of different epithelial histogenesis is uncommon. Synchronous adenocarcinoma and squamous cell carcinoma of the esophagus is reported. Adenosquamous carcinoma of the esophagus is a rare tumor. Adenocarcinoma of the esophagus represents 10% of esophageal cancer. We report a case of a synchronous primary invasive adenosquamous carcinoma and adenocarcinoma of the esophagus. Both tumors were demonstrated radiographically. The peculiarity of this neoplastic association and the importance of complete radiographic esophageal evaluation in patients with one obvious obstructing tumor of the esophagus are emphasized. Electronic Publication