Appendiceal tumors

BACKGROUND: Appendiceal tumors are rare and often unexpectedly discovered in an acute situation, in which decision-making is difficult. To help define the most appropriate management, a retrospective analysis was undertaken to describe the clinicopathologic behavior of appendiceal tumors, and the literature was reviewed of the management of the different types of appendiceal tumors. METHOD: From a single center, a histopathologic database of 7,970 appendectomies, all appendiceal tumors, were identified and case notes reviewed. Analysis of clinical presentation, histopathology, operation, and outcome is presented. RESULTS: During a 16-year period (7,970 appendectomies), 74 patients (0.9 percent) with appendiceal tumors were identified: 42 carcinoid, 12 benign, and 20 malignant. Acute appendicitis was the most common presentation (49 percent), and 9.5 percent were incidental findings. Primary malignant tumors of the appendix were found in 0.1 percent of all appendectomies. Secondary malignant disease was identified in the appendix of 11 patients, most commonly (55 percent) from patients with primary colorectal disease. There was a high incidence of synchronous and metachronous colorectal cancer in all appendiceal tumors: carcinoids, 10 percent; benign tumors, 33 percent; secondary malignancies, 55 percent; primary malignancies, 89 percent. CONCLUSION: Appendiceal tumors are uncommon and most often present as appendicitis. Most are benign and can be managed by appendectomy, except adenocarcinomas and carcinoids larger than 2 cm, which are most appropriately managed by right hemicolectomy. A suggested management algorithm is provided. Controversy exists over the management of carcinoids 1 to 2 cm in size and adenocarcinoids. All types of appendiceal tumors have a high incidence of synchronous and metachronous colorectal cancer.Read at the meeting of the Royal Australasian College of Surgeons, Brisbane, Australia, May 11 to 15, 1997.     

Chemoradiation for resected pancreatic adenocarcinoma with or without intraoperative radiation therapy boost: Long-term outcomes

Background/objectivesTo analyze prognostic factors associated with long-term outcomes in patients with pancreatic cancer treated with chemoradiation therapy (CRT) and surgery with or without intraoperative electron beam radiotherapy (IOERT).Patients and methodsFrom January 1995 to December 2012, 60 patients with adenocarcinoma of the pancreas and locoregional disease (clinical stage IB [n = 13; 22%], IIA [n = 16; 27%], IIB [n = 22; 36%], IIIC [n = 9; 15%]) were treated with CRT (45–50.4 Gy before surgery [n = 19; 32%] and after surgery [n = 41; 68%]) and curative resection (R0 [n = 34; 57%], R1 [n = 26, 43%]). Twenty-nine patients (48%) also received a pre-anastomosis IOERT boost (applicator diameter size, 7–10 cm; dose, 10–15 Gy; beam energy, 9–18 MeV).ResultsWith a median follow-up of 15.9 months (range, 1–182), 5-year overall survival (OS), disease-free survival (DFS), and locoregional control were 20%, 13%, and 58%, respectively. Univariate analyses showed that R1 margin resection status (HR, 3.17; p = 0.04), not receiving IOERT (HR, 7.33; p = 0.01), and postoperative CRT (HR, 5.12; p = 0.04) were associated with a higher risk of locoregional recurrence. In the multivariate analysis, only margin resection status (HR, 3.0; p = 0.05) and not receiving IOERT (HR, 6.75; p = 0.01) retained significance with regard to locoregional recurrence. Postoperative mortality and perioperative complications were 3% (n = 2) and 43% (n = 26).ConclusionsAlthough local control is good in the radiation-boosted area, OS remains modest owing to high risk of distant metastases. Intensified locoregional treatment needs to be tested in the context of more efficient systemic therapy.     

Prognostic value of surgical intervention in advanced lung adenocarcinoma: a population-based study

BackgroundSurgical intervention is generally not considered as a treatment option in patients with advanced non-small cell lung cancer (NSCLC). Accumulating data suggest that surgery may have beneficial effects for these advanced patients. However, no evidence supports the significance of primary tumor resection (PTR) and metastatic tumor resection (MTR) in patients with stage IV lung adenocarcinoma (LUAD).MethodsA total of 32,497 patients diagnosed with primary stage IV LUAD were selected through the Surveillance, Epidemiology, and End Results (SEER) database. Possible confounders were eliminated by propensity score matching (PSM). The overall survival (OS) and lung cancer-specific survival (LCSS) were estimated as the primary endpoints. Furthermore, the independent prognostic factors of patients with the surgical intervention were retrospectively analyzed.ResultsPatients underwent surgical intervention had better OS and LCSS than those who did not (P=0.001 for OS; P<0.001 for LCSS). Meanwhile, patients who underwent surgery combined with lymph node dissection had better survival outcomes (P<0.001 for OS and LCSS) in the K-M analysis. For different metastatic sites, PTR was beneficial to the survival of patients with isolated lung metastases (LUM) and multiple organ metastases (MOM) (LUM: P=0.041; MOM: P=0.003). As for metastatic surgery, no patients were found to benefit from resection of metastatic tumor [bone metastasis (BOM): P=0.696; brain metastasis (BRM): P=0.951; LUM: P=0.402; MOM: P=0.365].ConclusionsSurgical intervention strategies can prolong survival to some extent, depending on different sites of metastasis and highly selected patients.     

阑尾血吸虫病伴阑尾低级别黏液性肿瘤2例

本文报道2例阑尾血吸虫病伴阑尾低级别黏液性肿瘤病例。     

Clinical characteristics of initial recurrence in lung after surgical resection for pancreatic ductal adenocarcinoma

BackgroundThe clinical characteristic differences at the initial recurrence site after resection for pancreatic ductal adenocarcinoma (PDAC) remain unknown. We investigated the clinical characteristics in patients with lung recurrence after surgical resection and evaluated the outcome of resection for isolated lung recurrence.MethodsOf 442 consecutive PDAC patients who underwent surgical resection between 2002 and 2018, 229 had recurrence on imaging. Initial recurrence sites were the liver, lung, local, peritoneal, multiple organs, and others. We analyzed the clinicopathologic factors and outcomes, comparing by initial recurrence site, and investigated the outcomes of resection for isolated lung recurrence.ResultsLiver recurrences were the most frequent (n = 60, 26%), followed by lung recurrence (n = 48, 21%). The interval from surgery to recurrence was significantly longer in lung recurrence (P = 0.0001). Patients with lung recurrence had significantly longer overall survival after diagnosis (P < 0.0001). Patients who underwent surgical resection of lung recurrence had a significantly prolonged overall survival rate after recurrence diagnosis (P = 0.004).ConclusionsPatients with lung recurrence had significantly prolonged survival than those with other recurrence patterns. Resection for isolated lung recurrence represented relatively good prognosis, and possibly may be beneficial in highly-selected patients.     

Metachronous small bowel adenocarcinoma after rectal adenocarcinoma: A case report

Rationale:Small bowel adenocarcinoma (SBA), an uncommon gastrointestinal malignant tumor, is difficult to diagnose at an early stage because of its non-specific disease presentation. Metachronous SBA is a special type of SBA that is rarely reported. We herein report a case of metachronous primary SBA following resection of rectal adenocarcinoma.Patient concerns:A 65-year-old man presented to our hospital after having experienced recurrent bowel obstruction for 6 months. He had undergone a Dixon operation 30 months previously followed by adjuvant chemotherapy with capecitabine plus oxaliplatin.Diagnosis:Abdominal computed tomography showed thickened bowel walls in the right lower abdomen, and the patient was initially misdiagnosed with intestinal adhesion. After the operation, he was diagnosed with primary SBA (T3N0M0, stage IIA).Interventions:Treatment with a transnasal ileus tube was ineffective. Therefore, we performed small intestinal segmental resection and side-to-side anastomosis through open surgery.Outcomes:The patient completed all postoperative adjuvant chemotherapy, and posttreatment surveillance revealed no further abnormalities.Lessons:This case suggests that patients with colorectal adenocarcinoma may have an increased risk of metachronous SBA. Corresponding symptoms in high-risk patients should raise clinicians’ suspicion for SBA, and further detailed examinations are imperative. Early screening for SBA may help to improve the patients’ prognosis.     

Long-term effects of proglumide on resection of cardiac adenocarcinoma

AIM: Patients with advanced stage cardiac adenocarcinoma have a very poor prognosis. Surgery is the first choice of treatment for this kind of patients. Peptide hormone gastrin is a recognized growth factor for gastric cancer, and gastrin receptor antagonist proglumide can block the effects of gastrin. The aim of this study was to investigate the actions of proglumide as an adjuvant treatment to improve the postoperative long-term survival rate of patients with cardiac adenocarcinoma. METHODS: We performed a randomized, controlled study of gastrin receptor antagonist proglumide in 301 patients with cardiac adenocarcinoma after proximal subtotal gastrectomy. The oral dose of 0.4 g proglumide thrice daily preprandially was maintained for more than 5 years in 153 cases (proglumide treatment group). In the control group, 148 patients underwent operation only. In clinicopathologic features, there was no significant difference between the two groups (P>0.05). All patients were followed up during their lifetime, and the survival rates were analyzed combined with clinicopathologic factors by SPSS 11.5 statistical software. RESULTS: The 1,3,5 and 10-year survival rate of the patients was 88.4%, 48.8%, 22.6% and 13.4%, respectively. The 1,3,5 and 10-year survival rate of the proglumide treatment group was 90.2%, 49.7%, 26.8% and 17.6% compared to 86.5%, 48.0%, 18.2% and 8.9% of the control group. There was a significant difference between the two groups (P= 0.0460). The patients in proglumide treatment group had no obvious side effects after administration of the drug, and no definite hepatic and renal function damage was found. According to single factor log-rank analysis, the long-term survival rate was correlated with the primary tumor position (P= 0.0205), length of the tumor (P= 0.0000), property of the operation (P= 0.0000), histopathologic grading (P = 0.0003), infiltrating degree of the tumor (/>= 0.0000), influence of lymph node metastasis (P = 0.0000), clinicopathologic staging (P= 0.0000) and administration of proglumide (P = 0.0460). Cox regression analysis demonstrated the infiltrating degree of tumor (P= 0.000), influence of lymph node metastasis (P= 0.039) and the clinicopathologic staging (P = 0.003) were independent prognostic factors. Administration of proglumide (P= 0.081), length of the tumor (P = 0.304), radical status of the resection (P= 0.224) and histopathologic types (P= 0.072) were not the independent prognostic factors. CONCLUSION: Proglumide is convenient to use with no obvious toxic side effects, and prolonged postoperative administration of proglumide as a postoperative adjuvant treatment can increase the survival rate of patients after resection of cardiac adenocarcinoma. Proglumide may provide a new effective approach of endocrinotherapy for patients with gastric cardiac cancer.     

Long-term survival in a patient with advanced non-smoking lung adenocarcinoma and no EGFR mutation after comprehensive therapy with EGFR-TKI-based therapy: A case report

Rationale:This is the first known report to describe a case of advanced non-smoking lung adenocarcinoma with no epidermal growth factor receptor mutation after comprehensive epidermal growth factor receptor-tyrosine kinase inhibitor-based therapy that survived for nearly 12 years.Patient concerns:A 48-year-old Chinese woman that came to our hospital with a left supraclavicular mass.Diagnosis:The final diagnosis was left lung adenocarcinoma with left supraclavicular lymph node metastasis, cT1N3M0 IIIB (International association for the Study of lung cancer 6th version).Interventions:After 4 months of 4 cycles of chemotherapy, gefitinib was administered alone for 5.5 years. Local radiotherapy (40GY/20F) was administered for 1 month, and osimertinib alone was followed for 4.5 years. A combination of pemetrexed with oxaliplatin and hyperthermia at the same time was administered for 4 cycles. Toripalimab and anlotinib were administered for 3 months. Since then, the patient had been taking a double dose of icotinib herself.Outcomes:The patient has survived for nearly 12 years since diagnosis of lung cancer.Lessons:Our case is of significant importance to clinicians involved in the treatment of patients with advanced nonsmoking lung adenocarcinoma and no epidermal growth factor receptor mutations.     

Small-cell lung cancer transformation from EGFR-mutant adenocarcinoma after EGFR-TKIs resistance: A case report

Rationale:With the recent advancements in molecular biology research, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have emerged as excellent therapies for patients with EGFR-mutant cancers. However, these patients inevitably develop cross-acquired resistance to EGFR-TKIs. Transformation to small-cell lung cancer (SCLC) is considered a rare resistance mechanism against EGFR-TKI therapy. Here, we report a case of TKI resistance due to SCLC transformation and demonstrate its mechanisms and clinical features.Patient concerns:A 54-year-old Chinese man with a history of smoking for 40 years complained of an intermittent cough in March 2019.Diagnosis:Transbronchial lung biopsy was performed on the basal segment of the left lower lobe, which confirmed lung adenocarcinoma. In January 2020, repeat biopsy was performed, and the results of immunohistochemistry (IHC) staining showed TTF-1 (+), CK7 (+), napsin A (+), syn (+), and CD56 (+), with a Ki-67 (+) index 80% of small cell carcinomas. Infiltrating adenocarcinomas and small cell carcinomas were observed.Interventions:Icotinib (125 mg thrice daily) was administered as a first-line treatment from June 2019. We subsequently administered a chemotherapy regimen consisting of etoposide (180 mg, days 1–3) plus cisplatin (45 mg, days 1–3) every 3 weeks for 1 cycle after recurrence. As the patient could not tolerate further chemotherapy, he continued taking icotinib orally and received whole-brain radiotherapy 10 times to a total dose of 30 Gy after brain metastases.Outcomes:The patient relapsed after successful treatment with icotinib for 9 months. A partial response was achieved after 4 cycles of chemotherapy, and despite the brief success of chemotherapy, our patient exhibited brain metastasis and metastases of the eleventh thoracic spine and the second lumbar vertebra with pathological fracture. The patient eventually died of aggressive cancer progression.Lessons:Our case highlights the possibility of SCLC transformation from EGFR-mutant adenocarcinoma and the importance of repeat biopsy for drug resistance. Serum neuron-specific enolase levels may also be useful for detecting early SCLC transformation.     

Metachronous adenocarcinoma occurring at a colostomy site after abdominoperineal resection for rectal carcinoma

Received: October 31, 2000 / Accepted: March 30, 2001     

Hepatoid adenocarcinoma of the gallbladder

We describe here a rare case of hepatoid adenocarcinoma (HAC) of the gallbladder without the production of alpha‐fetoprotein (AFP). A 77‐year‐old man was referred to our division with complaints of general fatigue, loss of appetite, and loss of body weight. A preoperative diagnosis of advanced gallbladder cancer was made, and cholecystectomy with combined resection of two liver subsegments (S4a + S5) and lymph node dissection were performed. Microscopically, the tumor was mainly composed of characteristic cells featuring eosinophilic cytoplasm, enlarged nuclei, and prominent nucleoi, arranged in nests or proliferated in a trabecular pattern. These features were highly suggestive of HAC of the gallbladder, and the tumor cells were negative for AFP immunohistochemical staining. The patient is doing well and has survived for 15 months postoperatively without any recurrence.     

Construction and validation of a robust ferroptosis-associated gene signature predictive of prognosis in lung adenocarcinoma

To construct and validate a ferroptosis-associated signature predictive of prognosis in lung adenocarcinoma (LUAD), and systematically evaluate the underlying molecular connections in cancer biology.We retrieved mRNAs sequencing profiles of LUAD from the cancer genome atlas (TCGA) data portal and clinical information from the cBio Cancer Genomics Portal. The differentially expressed ferroptosis-associated genes (DEFAGs) were screened between normal samples and LUAD by packages “limma” in R. Then the total TCGA cohort was randomly divided into training set and testing set. Based on the training set, a DEFAG signature was built and further validated in the test set, the total TCGA cohort and other independent cohorts from the gene expression omnibus data portal. A nomogram was constructed and validated, and the correlation between high-risk group and cancer biology was further evaluated.We initially identified 68 DEFAGs from TCGA cohort. A 6 DEFAG signature was built and further validated in the test set, the total TCGA cohort and other 2 independent cohorts including {"type":"entrez-geo","attrs":{"text":"GSE31210","term_id":"31210"}}GSE31210 and {"type":"entrez-geo","attrs":{"text":"GSE72094","term_id":"72094"}}GSE72094 from gene expression omnibus data portal. Further exploration indicated that high-risk group combined with TP53 mutation harbored the most unfavorable prognosis while low-risk group with TP53 wild-type status had the most favorable survival advantage over other groups. Moreover, high-risk group was associated with higher cancer stemness, tumor mutation burden, and CD274 (programmed cell death 1 ligand 1) expression.We constructed a robust ferroptosis-associated gene signature and a nomogram predictive of prognosis in LUAD, and provided a new perspective on associations between ferroptosis and cancer.     

Long-term outcomes of autoimmune pancreatitis

Autoimmune pancreatitis(AIP) has been considered a favorable-prognosis disease; however,currently,there is limited information on natural course of AIP during long-term follow-up. Recently published studies regarding the long-term outcomes of AIP has demonstrated the developments of pancreatic stone formation,exocrine insufficiency,and endocrine insufficiency are observed in 5%-41%,34%-82%,and 38%-57% of patients having the disease. Furthermore,the incidence rate of developing pancreatic cancer ranges from 0% to 4.8% during the long-term followup. The event of death from AIP-related complications other than accompanying cancer is likely to be rare. During follow-up of AIP patients,careful surveillance for not only relapse of the disease but also development of complications at regular intervals is needed.     

Clinical outcomes of small cell neuroendocrine carcinoma and adenocarcinoma of the gallbladder

AIM: To compare the demographics and survival rates between gallbladder adenocarcinoma(GB-adenocarcinoma) and small cell neuroendocrine carcinoma of the gallbladder(GB-NEC-SCC).METHODS: From March 2007 to September 2012,patients who underwent resection of tumor stage T2/T3 GB cancer were enrolled for this study.Fortytwo patients were included in this study,including 38 diagnosed with GB-adenocarcinoma and four diagnosed with GB-NEC-SCC.In the GB-adenocarcinoma group,a radical operation was performed in 28 patients,and ten patients underwent simple cholecystectomy.In the GB-NEC-SCC group,a radical operation was performed in three patients,and one patient underwent simple cholecystectomy.Comparative analysis of the two groups was performed,including clinicopathologic features and survival rates.RESULTS: The median age of the patients was 68 y(range: 35-83 years) and females comprised 26/42 of the patients.GB-adenocarcinoma patients were significantly older than GB-NEC-SCC patients(67.89 ± 11.15 vs 55.75 ± 10.31 years; P = 0.029).The median tumor size in GB-adenocarcinoma patients was 2.56 ± 1.75 cm and 3.98 ± 3.74 cm in GB-NEC-SCC patients; however,there was no significant difference between the two groups.For tumors 2 cm,T stage(T2 vs T3),lymphovascular invasion,perineural invasion,lymph node metastasis and lymph node ratio showed no significant differences between the two groups.The overall survival rate of the 42 patients at five years was 77.0%.In the GB-adenocarcinoma group,the overall five-year survival rate was 74.8%,and survival in the GB-NEC-SCC group was 100%,which was not significantly different between the two groups.CONCLUSION: The strategy for treating patients with GB-NEC-SCC should be similar to that used for treating GB-adenocarcinoma,including radical cholecystectomy and liver resection.     

GASC1在肺腺癌组织中表达的临床意义及预后价值

目的 探讨GASC1在肺腺癌组织中表达的临床意义及预后价值.方法 采用Q-PCR、免疫组织化学、Western blot技术检测100例肺腺癌组织中GASC1蛋白的表达,并分析GASC1蛋白表达与肺腺癌临床病理特征及预后的相关性.结果 GASC1高表达与肺腺癌分化程度、淋巴结转移、临床分期显著相关(P<0.05).GA...     

Impact of postoperative TNM stages after neoadjuvant therapy on prognosis of adenocarcinoma of the gastro-oesophageal junction tumours

AIM To compare prognostic relevance of postoperative tumour/node/metastasis(TMN) stages between patients with and without neoadjuvant treatment. METHODS Data from patients with adenocarcinoma of the gastrooesophageal junction(AEG) who had undergone surgical resection at a single German university centre were retrospectively analysed. Patients with or without neoadjuvant preoperative treatment were selected by exact matching based on preoperative staging. Standard assessment of preoperative(c)TNM stage was based on endoscopic ultrasound and computed tomography of the thorax and abdomen, according to the American Joint Committee on Cancer/Union for International Cancer Control classification system. Patients with cT1cN0cM0 and cT2cN0cM0 stages were excluded from the study, as these patients are generally not recommended for pretreatment. Longterm survival among the various postoperative TNM stages was compared between the groups of patients with or without neoadjuvant treatment. For statistical assessments, a P-value of ≤ 0.05 was considered significant.RESULTS The study included a total of 174 patients. The group of patients who had received preoperative neoadjuvant treatment included more cases of AEG(Siewert) type 1 carcinoma(P 0.001), and consequently oesophagectomy was performed more frequently among these patients(P 0.001). The two groups(with or without preoperative neoadjuvant treatment) had comparable preoperative T stages, but the group of patients with preoperative neoadjuvant treatment presented a higher rate of preoperative N-positive disease(P = 0.020). Overall long-term survival was not different between the two groups of patients according to tumours of different AEG classifications, receipt of oesophagectomy or gastrectomy, nor between patients with similar postoperative TNM stage, resection margin and grading. However, an improvement of long-term survival was found for patients with nodal down-staging after neoadjuvant therapy(P = 0.053).CONCLUSION The prognostic relevance of postoperative TNM stages is similar for AEG in patients with or without neoadjuvant preoperative treatment, but treatment-related nodal down-staging prognosticates longer-term survival.