Spindle-cell carcinoma of the hypopharynx presenting with a pedunculated appearance: CT and MR features

Spindle-cell carcinoma (SPCC) is a rare tumor that presents biphasic components: squamous-cell carcinoma and sarcomatous features without any differentiation. We present a case of SPCC of the hypopharynx in a 60-year-old man. A well-demarcated mass occupying the hypomesopharynx and presenting a pedunculated appearance was observed originating from the lateral wall of left piriform sinus. High signal intensity on T2-weighted magnetic resonance (MR) images corresponded to the myxoid matrix of the tumor on MR pathologic correlation.     

Cisplatin- vs. oxaliplatin-based radiosensitizing chemotherapy for squamous cell carcinoma of the esophagus

Purpose

To compare the outcomes of two neoadjuvant radiochemotherapy (N-RCT) regimens for squamous cell carcinoma of the esophagus (ESCC).

Methods

The standard N-RCT regimen for ESCC at our institution between 2002 and 2011 was a total dose of 45 Gy (1.8-Gy fractions) with concomitant cisplatin (20 mg/m², days 1–5 and 29–33) and 5-fluorouracil (5-FU; 225 mg/m², 24 h continuous infusion on days 1–33). During the same period, a phase I/II study comparing the standard ESCC N-RCT protocol with a regimen identical except for the replacement of cisplatin with weekly oxaliplatin (40–50 mg/m²) was performed at our center. The standard regimen was used to treat 40 patients; 37 received the oxaliplatin regimen. All patients subsequently underwent radical resection with reconstruction according to tumor location and two-field lymph node dissection.

Results

Median follow-up time from the start of N-RCT was 74 months (range 3–116 months). The two patient groups were comparable in terms of demographic and baseline tumor characteristics. R0 resection was achieved in 37/39 patients (95?%) in the cisplatin-based N-RCT group, compared to 24/37 (65?%) in the oxaliplatin-based group (p?=?0.002). A pathological complete response (pCR) was seen in the resection specimens from 18/39 patients (46?%) in the cisplatin-based N-RCT group and in 8/37 (22?%) oxaliplatin-group patients. In the cisplatin group, 2- and 5-year overall survival (OS) rates were 67?±?8?% and 60?±?8?%, respectively (median OS 103 months), compared to 38?±?8?% and 32?±?8?%, respectively, for the oxaliplatin group (median OS 17 months; hazard ratio, HR 0.452; 95?% confidence interval, CI 0.244–0.839; p?=?0.012).

Conclusion

Oxaliplatin-based N-RCT resulted in poorer outcomes in ESCC patients and should not routinely replace cisplatin-based N-RCT.     

食管炎性肌纤维母细胞瘤一例

患者 男，37岁。进行性吞咽困难伴咳嗽、咯痰2个月余，加重1周。体检：上纵隔处可闻及响亮的哮鸣音。     

Mimicry of physiological urinary FDG excretion: squamous cell carcinoma of esophagus metastasizing to psoas muscle

Skeletal muscle metastases are rare and usually occur with various malignancies at more advanced stages. FDG PET/CT has been known as a useful tool to detect these lesions because of the character of whole-body scanning and superior contrast between malignant and normal tissues, except in areas with abundant physiological FDG radioactivity, such as the urinary system. We present a patient with esophageal squamous cell carcinoma and an incidental, rare finding of psoas muscle metastasis that was initially omitted because of the similarity of its distribution to physiological urinary FDG excretion in the ureter.     

血清miR-21在食管鳞癌中的表达及临床意义

目的 检测血清miR-21在食管鳞癌患者中的表达及临床意义。方法 收集2016年10月—2017年6月汕头大学医学院附属肿瘤医院食管鳞癌患者50例和健康体检者50例血清标本,提取miRNAs,通过实时荧光定量PCR检测miR-21表达水平,结合食管鳞癌患者临床资料进行统计分析。结果 在食管鳞癌患者血清样本中,miR-21的表达水平明显高于健康对照组,差异比较具有统计学意义（P<0.001）;miR-21的高表达与肿瘤远处器官转移及淋巴结转移呈正相关（P<0.001）;临床分期为Ⅲ、Ⅳ期的患者血清miR-21表达水平明显高于Ⅰ、Ⅱ期患者（P<0.05）;miR-21在胸中、下段食管鳞癌患者中的表达水平与胸上段食管鳞癌患者相比显著上调（P<0.05）。结论 血清miR-21表达水平与食管鳞癌的发生、转移及临床分期密切相关,有望成为新的肿瘤标志物。     

Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection

PURPOSE: To compare the effectiveness of biphasic computed tomography (CT) and magnetic resonance (MR) imaging in the detection of pancreatic islet cell tumors. MATERIALS AND METHODS: Retrospective quantitative, qualitative, and receiver operating characteristic analyses of biphasic CT and MR imaging were performed in 19 patients with 26 histopathologically proved islet cell tumors. Delayed arterial dominant-phase (AP) and portal venous-phase (PVP) biphasic CT was performed after the administration of contrast material. MR imaging included T1-weighted spin-echo (SE) and T2-weighted SE or fast SE imaging, fat-saturated T1-weighted SE imaging, dynamic contrast material-enhanced T1-weighted gradient-echo imaging, and delayed enhanced T1-weighted SE imaging with or without fat saturation. RESULTS: PVP CT and delayed enhanced T1-weighted MR imaging had the highest A(z) values (0.98 and 0.97, respectively; P <.05). Delayed enhanced T1-weighted MR imaging had the highest relative sensitivity (14-15 [74%-79%] of 19 lesions), followed by PVP CT (18-19 [69%-73%] of 26 lesions), AP CT (17-19 [65%-73%] of 26 lesions), fat-saturated T1-weighted MR imaging (eight to 10 [57%-71%] of 14 lesions), T2-weighted (16-17 [62%-65%] of 26 lesions), T1-weighted (15-18 [58%-69%] of 26 lesions) MR imaging, and dynamic MR imaging (nine [56%] of 16 lesions). CONCLUSION: Biphasic (especially PVP) CT and MR imaging have similar effectiveness in the detection of islet cell tumors if fat-saturated T1-weighted and delayed enhanced T1-weighted MR imaging are included.     

胸上段食管鳞癌根治术后辅助放化疗的疗效分析

目的 比较单纯手术与术后放化疗对胸上段食管鳞癌根治术后患者预后的影响。方法 回顾性分析2007年1月至2011年12月在河北医科大学第四医院接受治疗的168例胸上段食管癌患者,根据治疗方法不同分为单纯手术组（86例）和术后放化疗组（82例）。采用SPSS 19.0统计软件进行数据分析,组间资料构成比应用χ²检验,应用Log-rank法检验和单因素预后分析,Cox回归模型行多因素预后分析。结果 全组患者1、3、5年生存率、复发率和远处转移率分别为83.9%、52.4%、43.5%,26.5%、40.8%、43.4%和5.3%、11.4%、16.9%。多因素分析结果显示,患者性别、T分期、N分期和治疗方式为患者独立性预后影响因素（P=0.020、0.008、0.005、0.000）;N分期和治疗方式为局部/区域复发的独立性预后影响因素（P=0.001、0.003）;分化程度和T分期为远处转移的独立性预后影响因素（P=0.045、0.020）。单纯手术组和术后放化疗（POCRT）组患者胸腔内-区域复发率分别为44.2%（38/86）和29.3%（24/82）,差异有统计学意义（χ²=7.110,P<0.05）;远处转移率分别为19.8%（17/86）和13.4%（11/82）,差异无统计学意义（P>0.05）。结论 胸上段食管鳞癌根治术后患者仍有较高的复发率,术后放化疗可以提高患者的总生存率,并降低患者的复发率,但能否降低患者的远处转移率有待进一步研究。