An investigation into tumor regression grade as a parameter for locally advanced rectal cancer and 5-year overall survival rate

Purpose@#The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation (nCRT) followed by surgery. Several parameters are associated with patient survival in LARC. One of these parameters is tumor regression grade (TRG); however, the significance of TRG remains controversial. In this study, we aimed to examine the correlations of TRG with 5-year overall (OS) and relapse-free survival (RFS) and identify other factors that influence the survival rates in LARC after nCRT followed by surgery. @*Methods@#This retrospective study included 104 patients diagnosed with LARC who underwent nCRT followed by surgery at Songklanagarind Hospital from January 2010 to December 2015. All patients received fluoropyrimidine-based chemotherapy at a total dose of 45.0 to 50.4 Gy in 25 daily fractions. Tumor response was evaluated using the 5-tier Mandard TRG classification. TRG was categorized into good (TRG 1–2) and poor (TRG 3–5) responses. @*Results@#TRG (classified by either the 5-tier classification system or the 2-group classification system) was not correlated with 5-year OS or RFS. The 5-year OS rates were 80.0%, 54.5%, 80.8%, and 67.4% in patients with TRG 1, 2, 3, and 4, respectively (P=0.22). Poorly differentiated rectal cancer and systemic metastasis were associated with poor 5-year OS. Intraoperative tumor perforation, poor differentiation, and perineural invasion were correlated with inferior 5-year RFS. @*Conclusion@#TRG was probably not associated with either 5-year OS or RFS; however, poor differentiation and systemic metastasis were strongly associated with poor 5-year OS.

A rare case of primary muscular non-Hodgkin's lymphoma and a review of how imaging can assist in its diagnosis

Primary malignant non-Hodgkin's lymphoma of the muscle is rare. Currently, imaging tools are necessary to enable its diagnosis. Herein, we report the case of a patient who presented with swelling and pain in the right thigh and pelvis. Computed tomography findings revealed isodense masses in the patient's right thigh and left iliacus muscle, leading to the initial diagnosis of either primary muscular lymphoma or soft tissue sarcoma. Further investigation with magnetic resonance imaging was done, and a biopsy was performed. The ensuing histological diagnosis was that of diffuse large B-cell lymphoma.

Sensitivity and specificity of 24-hour-delayed radiographs in demonstrating the transition zone of Hirschsprung disease

AbstractObjective: Our aims were to determine the sensitivity and specificity of the practice of 24-hour-delayed radiographs used to demonstrate the transition zone of Hirschsprung disease.Materials and methods: We collected the cases from all pediatric patients with suspected Hirschsprung disease who were referred for barium enema with a 24-hour-delayed radiographs from January 2000 through October 2006. All pediatricpatients had a final biopsy diagnosis. Both barium enema and 24-hour-delayed radiographs were restudied by an experienced radiologist unaware of the results of the pathology reports. The radiologist used a checklist of radiological criteria including transition zone, rectosigmoid index and mucosal irregularity patterns on barium enema and retention of contrast agent on delayed radiographs. The sensitivity and specificity of the findings were evaluated using 2x2 tables.Results:The study had 46 patients, 27 with and 19 without Hirschsprung disease. The sensitivity and specificity of the 24-hour-delayed radiographs for demonstrating the transition zone of Hirschsprung disease were about 80.8 and 40.0 percent, respectively. The sensitivity andspecificity of barium enema for demonstrating the transition zone of Hirschsprung disease were about 88.9 percent and 36.8 percent, respectively.Conclusion: 24-hour-delayed radiographs had high sensitivity and low specificity for demonstrating the transition zone of Hirschsprung disease, about the same as a barium enema.