A case of mediastinal lymph node carcinoma of unknown primary site treated with docetaxel and cisplatin with concurrent thoracic radiation therapy

Mediastinal lymph node carcinoma of unknown primary site is rare and may have a better prognosis if extensive treatment is performed. Case, A 69-year-old-male presented with a persistent cough. Chest computed tomography (CT) demonstrated a large tumor 9.5 × 8.2 cm, in the mediastinum, compressing the right main bronchus, the right pulmonary artery, and the superior vena cava. Because fiberoptic bronchoscopy was insufficient for diagnosis, mediastinoscopic tumor biopsy under general anesthesia was undertaken. Histological examination revealed adenocarcinoma. Extensive examinations revealed no other neoplastic lesion except in the mediastinum. Mediastinal lymph node carcinoma of unknown primary site was diagnosed. The patient was treated with docetaxel and cisplatin with concurrent thoracic radiation therapy. A month after the start of chemoradiotherapy, the mediastinal tumor regressed markedly. The patient remained free of symptoms without regrowth of the primary site. Exploration of the body showed no further abnormalities 20 months after disease onset.     

Cancer of the gallbladder: a review of forty-three cases

This study presents the clinicopathologic findings 43 cases of cancer of the gallbladder. Particular attention was paid to the classification of various histologic types along with their distribution by age, sex, race, the presenting symptoms, the presence of gallstones, the occupational history, and the sites of metastases. The most common type was found to be differentiated adenocarcinoma, and the bulk of the cases occurred in elderly white females. Of note was the fact that in 79 per cent of the cases it was possible to identify underlying predisposing circumstances, either cholelithiasis or a positive occupational history. In light of the dismal prognosis associated with this malignant tumor, the identification of such predisposing factors provides an important avenue for the future investigation and prevention of this disease. In addition, in this series, a high rate of multiple primary malignant tumors of different tissues was note. This was attributable to the age and sex distribution of the cases, that is, their being primarily elderly and female. However, this subpopulation of multiple cancers was significantly different with regard to etiologic factors, and this may provide further clues for future preventive measures for this cancer.     

Gastrointestinal stromal tumor of the digestive organs: a histopathologic study of 31 cases in a single Japanese institute

The author herein reports histopathologic features of 31 surgical cases of gastrointestinal stromal tumor (GIST) of the digestive organs. The 31 cases of GIST were diagnosed in our pathology laboratory. They consisted of 24 cases of gastric GIST, 1 case of hepatic GIST, 1 case of small intestinal GIST, 4 cases of colon GIST, and 1 case of rectal GIST. The age of the patients ranged from 56 year to 84 years with a mean of 71 years. Male to female ratio was 21:10. The presenting symptoms were gastrointestinal bleeding in 13 cases, abdominal pain and discomfort in 13 cases, and asymptomatic in 5 cases. Endoscopy and imaging modalities including US, CT and MRI were useful to detect the tumors in all cases, and biopsies confirmed the GIST diagnosis in 21 cases. The size of GIST ranged from 1 cm to 12 cm with a mean of 4.3 cm. Grossly, 23 cases were submucosal tumors, 6 serosa-side tumors, 1 solid tumor in the liver, and 1 rectal polyp. Histologically, 28 cases were of spindle cell type and 3 of epithelioid type. According to mitotic counts and tumor size, the malignant risk was very low in 4 cases, low in 14 cases, intermediate in 9 cases, and high in 4 cases. Immunohistochemically, all cases were positive for KIT and vimentin, 30 cases for CD34, and 4 cases for α-smooth muscle actin. None were positive for desmin and S100 protein. Ki-67 labeling ranged from 2% to 18%. P53 protein was negative in all cases. PDGFRA was positive in 20 cases among 24 cases examined. Genetic analysis using PCR-direct sequencing method was performed in 5 GISTs; all the 5 GISTs showed point mutations or deletions in KIT gene, but did not in PDGFRA gene. The 5 cases of GIST were positive for PDGFRA protein, suggesting that PDGFRA overexpression is not associated with PDGFRA gene mutations. Four of the 31 cases showed metastases. The chemotherapy was imatinib mesylate in 6 cases, and none in 25 cases. Four cases of high risk died of GIST, and 27 cases are alive now without tumors.     

Metastatic adenocarcinoma of unknown primary site: diagnostic electron microscopy to determine the site of tumor origin

Poorly differentiated malignant tumors and metastatic adenocarcinomas have been studied by electron microscopy. Rapid ultrastructural analysis allows the accurate diagnosis of the cell of tumor origin to be reported in conjunction with the routine surgical signout of paraffin sections. The identification of specialized intracellular structures is useful for determining the site of origin of metastatic tumors. Particularly useful in this material was the presence of lamellar (surfactant) bodies, typical of alveolar cell carcinoma of the lung, as well as the presence of apical terminal webs, diagnostic of gut epithelial cells.     

Incidence of pulmonary non-epithelial tumors: 18 years’ experience at a single institute

Primary and metastatic non-epithelial tumors of the lung and pleura (NETs-LP) are presumed to represent a small proportion of pulmonary neoplasm, and their epidemiologic characterization is lacking. Moreover, classification of pulmonary mesenchymal tumor according to ‘WHO Classification of Tumors of Lung and Pleura’ (2004) is simple and necessary to give a supplementation like new ‘WHO Classification of Tumors of Soft Tissue and Bone’ (2013).     

The efficacy of personal construct therapy: a comprehensive review

Prior narrative and quantitative reviews have suggested that personal construct therapy (PCT) is an efficacious and viable form of treatment. However, these reviews failed to include all published, controlled PCT outcome studies and did not account for all measures of outcome. The present quantitative review, therefore, offers a comprehensive integration of the 22 published studies that compare PCT to a control group, examining its overall efficacy at posttest and follow-up as well as its effects for different types of outcome measures. Overall, the efficacy of PCT was found to be somewhat weaker than that reported in previous reviews. It was also found that traditional self-report and behavioral observation measures tended to yield larger effects compared to measures that focused on personal meanings and scored content supplied by the client.     

Prevalence and biological behaviour of variants of papillary thyroid carcinoma: experience at a single institute

Aims: There are many variants of papillary carcinoma, and some of these variants have been reported to show biological behaviours differing from that of conventional papillary carcinoma. In this study, we present our experience regarding the prevalence and prognoses of these variants of papillary carcinoma. Methods: H&E sections from 1521 patients who underwent initial surgery for papillary carcinoma in Kuma Hospital between 1987 and 1995 were re-reviewed and classified into conventional papillary carcinoma and various histological variants. We investigated the biological behaviours of these lesions, including prognoses. Results: Follicular, tall cell and oncocytic variants were observed in comparably high incidences: 6.6%, 3.9%, and 1.9%, respectively. Patients with tall cell variant showed significantly worse disease-free survival (DFS) and cause-specific survival (CSS) rates than those with conventional papillary carcinoma. The prognoses of patients with follicular variant did not differ from those of patients with conventional papillary carcinoma. Patients with oncocytic variant have not shown carcinoma recurrence. Among the rare variants, which accounted for less than 1%, columnar cell carcinoma showed a worse prognosis. Conclusions: Since patients with some variants show different clinical outcomes from those with conventional papillary carcinoma, classification of variants might be helpful to predict patient prognosis.     

多西他赛联合顺铂及氟尿嘧啶(DCF)改良方案治疗晚期胃癌疗效观察

目的 研究多西他赛联合顺铂及氟尿嘧啶改良方案(mDCF)治疗晚期胃癌的疗效及安全性.方法 2006年1月起,采用改良DCF方案治疗45例晚期胃癌患者.化疗方案:多西他赛60 mg/m2,d1;顺铂12 mg/m2,d1 ～5;氟尿嘧啶2500 mg/m2,持续输注(civ) 120 h;每21天一个周期.主要研究终点:无进展生存期(PFS).次要研究终点:总生存期(OS),总缓解率(ORR)及不良反应.结果 接受一线解救化疗患者40例,完全缓解0例(0％),部分缓解7例(17.5％),疾病稳定19例(47.5％),疾病进展14例(35.0％),总缓解率17.5％(95％ CI 7.5％ ～30.0％),疾病控制率65.0％ (95％ CI 50.0％ ～77.5％).中位PFS 5.2个月(95％ CI 3.6～6.8月),中位OS 11.0个月(95％CI6.9～15.1月).接受二线解救化疗患者5例,疾病稳定3例,疾病进展2例,中位PFS 5.3个月(95％ CI 0 ～11.3月),中位OS 8.5个月(95％ CI0～17.1月).主要不良反应为血液学毒性,Ⅲ～Ⅳ度粒细胞减少及粒细胞减少伴发热发生率分别为26.7％及11.1％,Ⅲ～Ⅳ度恶心、呕吐及腹泻发生率分别为8.9％、8.9％及11.1％.结论 改良DCF方案有效,不良反应可耐受.     

Non-Hodgkin's lymphoma of the breast: a review of 18 primary and secondary cases

We evaluated the clinical features, morphology, and incidence of 18 cases of breast lymphoma over 10 years at the University of Alabama at Birmingham. Fine needle aspiration was performed in 7 of 18 patients, and tissue biopsy/resection was available for all 18 cases. Patients were 33 to 91 years old (median, 61); 17 were women and 1 was a man. Fine needle aspiration was consistent with the tissue diagnosis in 6 of the 7 cases (86%). One case was diagnosed by fine needle aspiration as atypical cells, favor benign; the biopsy revealed diffuse large B-cell lymphoma. Tissue diagnoses revealed that 11 cases (61%) represented diffuse large B-cell lymphoma and 3 (17%) were follicular lymphomas. The remaining 4 cases (22%) were plasma cell neoplasm, T-cell neoplasm, Burkitt's lymphoma, and precursor B-cell lymphoblastic lymphoma. Flow cytometry and/or gene rearrangement supported the diagnosis of lymphoma in 8 cases. Although rare, lymphoma should be considered in the differential diagnosis of a breast mass. Fine needle aspiration can facilitate appropriate triage of patients for further management.     

Phage therapy efficacy: a review of the last 10 years of preclinical studies

Abstract

Due to the rise of multidrug-resistant infections in humans, phage therapy is gaining renewed attention in Western medicine. Despite the increasing number of publications focussed on the isolation, characterization and in vitro performance of different phages, there is still a lack of concise pre-clinical information to guide the application of phage therapy in clinical practice. Nevertheless, over the last decade, efforts have been made to conduct more detailed studies of the in vivo efficacy of phages. Here, we review the most relevant in vivo studies performed in the last decade covering phage efficacy in both preclinical and clinical trials. We compare different routes of administration, dosage effect and different animal models of distinct types of infections. Moreover, insights into case studies and results from clinical trials are presented. Challenges and limitations of phage use as evidenced by the current state of research are also discussed in order to improve both the trustworthiness and success of the implementation of phage therapy.     

Brain tumor in the first year of life: a single institute study.

Brain tumors in infants present special diagnostic and therapeutic challenges. To figure out the clinical features, pathological classification of the tumors and the treatment outcome of infantile brain tumors, 458 children (age<16) with brain tumors were reviewed retrospectively. Among them 21 cases (4.6%) were diagnosed during the first 12 months of life. Two tumors were definitely of congenital origin. The majority of infants with brain tumors presented with increased intracranial pressure. Fourteen tumors were located at the supratentorial area. Sixteen cases had neuroepithelial tumors; astrocytoma (optic pathway), supratentorial primitive neuroectodermal tumor (PNET) and medulloblastoma were found in three cases each. There were two treatment-related mortalities. Compared with the outcomes in older children, the treatment outcome was poorer in medulloblastoma and the optic pathway glioma which showed a higher growth potential. Because of the limited application of postoperative adjuvant therapy, radical surgical removal played a more important role in this age group. The prognosis of patients in whom the tumors could not be totally removed, largely depended on the pathological malignancy of the tumors. Though the treatment outcome was not always dismal, immaturity of the brain, higher growth potential, perioperative risks, limitations in adjuvant therapy, and pessimistic attitude on the part of parents made management more challenging.     

Postoperative radiotherapy in the treatment of male breast carcinoma: a single institute experience

BACKGROUND: To evaluate the outcomes of radiation therapy treatment of male patients with breast cancer in our single institutional cohort and discover possible adverse prognostic factors. METHODS: We retrospectively evaluated 42 male patients (median age 55; range 33-77 years) with breast cancer. Patients were irradiated postoperatively in 2 Gy/fraction/day to chest wall +/- lymphatics. RESULTS: Median follow-up was 29 months. Eleven patients had neoadjuvant and 36 patients had adjuvant Adriamycin-based chemotherapy. Nine patients (21%) had local or regional, two (5%) had distant, and one (2.5%) had both local and distant disease at the time of analysis. The actuarial five-year Overall Survival (OS) was 77%, whereas the actuarial five-year Disease-Free (DFS), Locoregional Recurrence-free (LRRFS), and Distant Metastases-Free (DMFS) survival rates were 45%, 69% and 66%, respectively. Univariate analysis of variables, including patient characteristics, treatment modalities and factors, and tumor characteristics, failed to show an association with LRRFS and DFS except percent positive nodal involvement > or = 30% and 50%. CONCLUSION: Though radiotherapy seems quite effective in reducing local recurrence, we have revealed that male breast cancer patients in our cohort with extensive nodal involvement (PPNI >30% and 50%) appeared not to have had a significant benefit from postmastectomy irradiation and adjuvant CMF-based chemotherapy.     

Androgen receptors: a marker to increase sensitivity for identifying breast cancer in skin metastasis of unknown primary site.

Metastatic lesions to the skin may present a dilemma in the identification of the primary site. Breast carcinoma, metastatic to the skin, that is negative for estrogen receptors (ERs) and/or progesterone receptors (PRs) may be mimicked by a number of other metastatic lesions. In the present study, 16 formalin-fixed and paraffin-embedded infiltrating ductal carcinomas metastatic to the skin, which were ER-/PR-, ER-/PR+, or ER+/PR-; 5 metastatic lesions to the skin from primary lesions other than breast cancer; and 5 eccrine tumors were examined for immunoreactivity to the androgen receptor. The majority of the metastatic breast lesions (82%) exhibited immunopositivity for androgen receptor, whereas the metastatic skin lesions from primary lesions other than breast cancer and the eccrine tumors were immunonegative. Thus, androgen receptor immunohistochemistry could serve as a marker to increase sensitivity for identifying breast cancer in skin metastasis of unknown primary sites.     

Primary orbital meningioma: a study of six cases at a single institution

Primary orbital meningioma is a rare tumor of the anterior visual pathway and constitutes approximately 2% of all orbital tumors and 1-2% of all meningiomas. The differentiation from secondary orbital meningioma of intracranial origin is sometimes difficult on image. As the tumor often leads to visual loss if left untreated and surgical intervention inevitably causes morbidity, the timing and modality of treatment are very important. We carried out the study involving six cases (mean age: 42.7 years, male to female ratio: 1:5) of primary orbital meningioma to further elucidate its behavior. The clinical signs and symptoms, diagnosis, treatment strategies, and follow-up information are recorded for all cases. The most frequent initial symptoms were visual complaints (100%) and proptosis (67%). In five cases, the diagnosis was based on pathologic findings and the tumors were all grade I meningiomas. In one case, however, the diagnosis was based on radiographic and clinical findings, lacking histologic confirmation. Five patients were operated on, four underwent tumor removal, and one received eyeball exenteration. One patient was treated with Novalis radiotherapy. The mean follow-up period was 8.8 years (range from 9 months to 15 years). All patients experienced loss of vision during the course without exception. No recurrent tumor was found in five cases during follow-up. In case 5, whose eyeball was exenterated, developed recurrent meningioma 7 years later. She received radiotherapy but the tumor was out of control. She expired 8 years after eyeball exenteration. The primary orbital meningioma is aggressive in behavior despite its benign histopathologic features. Loss of vision is frequently seen even after treatment. The tumor could be fatal if surgery and radiotherapy fail to control its intracranial extension.     

A case of lung and mediastinal and hilar lymph node metastasis in a patient with cancer of unknown primary site

Clinical & Experimental Metastasis -     

Siblings with ETV6/RUNX1-positive B-lymphoblastic leukemia: A single site experience and review of the literature

Siblings diagnosed with B-lymphoblastic leukemia (B-ALL) that share the same driver abnormality have been rarely described in the literature. Herein, we report three pairs of siblings (one non-identical pair, one maternal half-sibling pair, and one identical pair) all diagnosed with ETV6/RUNX1-positive B-ALL. Considering that ETV6/RUNX1 fusion is thought to represent a prenatal event and necessitates additional genomic alterations to result in leukemia, siblings of patient's with known ETV6/RUNX1-positive B-ALL may be at increased risk of ETV6/RUNX1-positive B-ALL due to common exposures (environmental or infectious) or shared germline polymorphisms.