Clinical status and research progress of adenosquamous carcinoma of the lung / 中国综合临床

Adenosquamous carcinoma of the lung (ASC), a relatively rare subtype of non-small-cell lung cancer, is defined as a malignancy containing components of both lung adenocarcinoma (ADC) and lung squamous cell carcinoma (SCC), with each comprising at least 10% of the tumor. Comparing to pure ADC or SCC, ASC has stronger aggressiveness and poorer prognosis. Surgery and chemotherapy are the mainstay treatments for ASC currently. The great progress of targeted therapy and immunotherapy in non-small cell lung cancer (NSCLC) has given ASC patients new hope. The EGFR mutation frequency and PD-L1 expression rate are similar comparing ASC to ADC and SCC, which means the targeted therapy and immunotherapy could make promising benefits to ASC patients. How to make personal treatment strategy and conduct whole course management is the emphasis of future studies.

Interpretation of CT images of lung adenosquamous carcinoma / 中国综合临床

Lung adenosquamous carcinoma (ASC) is a rare histological subtype of lung cancer, which has a worse prognosis than simple lung adenocarcinoma and lung squamous cell carcinoma. ASC was predominantly located in the peripheral field of the lung with heterogeneous attenuation and the most common features included lobulation, spiculation, pleural tail sign, necrosis and cavitation on chest CT images. However, the imaging features of ASC are not specific. Therefore, acquring accurate pathological diagnosis and adequate treatment as soon as possible are very important.

Medical treatment of lung adenosquamous carcinoma / 中国综合临床

Adenosquamous carcinoma of the lung is a rare pathological type of non-small cell lung cancer. Adenosquamous carcinoma of the lung has a high degree of malignancy and poor clinical prognosis. Medical treatment plays an important role in patients who have lost the opportunity of operation or have recurrence and metastasis after operation. Platinum based chemotherapy is still the cornerstone of medical treatment. It is recommended that routine driver gene testing should be performed for patients with advanced lung adenosquamous carcinoma. For patients with sensitive driver genes, targeted therapy has a definite effect in some patients. Studies on markers related to immune checkpoint inhibitors suggest that patients with lung adenocarcinoma may benefit from immunotherapy, but there is still a lack of clinical practice data.

Update of adenosquamous carcinoma of the lung: pathological diagnosis and pathogenesis / 中国综合临床

Adenosquamous carcinoma (ASC) of the lung is a unique type of lung cancer. The pathological definition is a carcinoma showing components of both squamous cell carcinoma (SCC) and adenocarcinoma, with each accounting for ≥10% of the tumor. Definitive diagnosis requires a resection specimen sampled appropriately. Biopsy and cytology can not make the diagnosis of adenosquamous carcinoma. The research by applying microdissection and next-generation sequencing showed that the genotype of adenocarcinoma component and SCC component in ASC are similar, which is very close to the pure adenocarcinoma and significantly different from the pure SCC. So far, the theory of common precursor stem cell differentiating to adenocarcinoma and SCC is the most accepted among the hypotheses about adenocarcinoma origin.

Mistaking a Tumour for an Infection - Acrometastasis of the Finger from Endocervical Adenosquamous Carcinoma: A Case Report

@#Acrometastasis is rare with a very low incidence of all bone metastasis. It can present with swelling, pain and warmth with erythema that may mimic an infection especially in the distal phalanx. Due to its rarity and subtle clinical presentation, it can be misdiagnosed as an infection causing the treatment to be delayed. We report a 42-year-old female with an acrometastasis to the distal phalanx of the left middle finger which we mistook as an infection thus delaying her treatment. It was a terminal presentation of her endocervical adenosquamous carcinoma. We would like to highlight that acrometastasis has an indistinct presentation and in cases where the lesion does not respond to treatment, acrometastasis should be included as one of the differential diagnoses. Thus, physicians need to have a high level of suspicion in patients with a primary malignant tumour.

Coughing up: “Adenosquamous carcinoma lung with unusual initial presentation as an ulceroproliferative growth” - case report and review of literature

Lung carcinoma is the most common carcinoma seen in males with the skin being a rare metastatic site. Adenosquamous carcinoma as a rare histologic subtype, showing cutaneous metastasis is an unusual event with no reports in the literature till date. Skin metastasis is an alarming sign, carries poor prognosis, and is associated with shortened survival. Herein, we report a case of 60-year-old male who presented with isolated cutaneous metastasis as a chronic nonhealing ulcer over the sternal region for 3 years (unusual) in the first place, without any other associated symptoms and clinical evidence of the primary. Wide local excision of the lesion was performed after proper workup which revealed metastatic adenosquamous carcinoma. The patient was advised systemic chemotherapy. A high index of suspicion along with clinico-radio-pathological correlation in these cases is of utmost importance and forms the basis of accurate diagnosis

Clinical characteristics of adenosquamous carcinoma of the pancreas: A case-control study / 中国肿瘤临床

Objective: To analyze the clinical characteristics of adenosquamous carcinoma of the pancreas (ACP) and pancreatic ductal adenocarcinoma (PDA), and to explore the differences in prognosis between the two types. Methods: The clinical and pathological characteristics of 26 cases with ACP (Group A) and another 26 with PDA (Group B), both of whom underwent radical surgery at Tianjin Medical University Cancer Hospital from August 2014 to April 2019, were retrospectively analyzed, and were matched according to the ratio of one to one. In our study, the characteristics of each pair included preoperative ECOG score, age, gender, the location and size of the tumors, TNM staging, CA19-9, CEA. The prognostic differences between the two groups were compared and analyzed. Results: There were 7 females and 19 males in both groups, among which 12 had lesions in the head of the pancreas and 14 in the tail of the pancreas; TNM staging: 13 in stageb, 6 in stage Ⅱa, 6 in stage Ⅱb, and 1 in stage III. The average tumor size was 3.9 cm in the Group B, and 4.4 cm in the Group A. Radical surgery was performed in the patients of both groups, and among them 7 patients in Group A received combined organ resections. Survival analysis showed that the median survival time was 8.5 months in Group A and 19 moths in Group B (HR: 0.442; 95% CI: 0.224-0.872; P=0.019). Conclusions: ACP is more common in the males and its The prognosis is worse compared with PDA, but it has no specific clinical manifestations.

Hypoxia-inducible factor 1 alpha expression is an indicator of invasiveness in uterine cervical tumors

Background: Hypoxia is a common feature of cancers. Hypoxia-inducible factor 1A (HIF1A) is a causative agent that changes the transcriptional response of tumors under hypoxia. Some alterations lead to an increase in HIF1A activity and this supports other critical pathways leading to angiogenesis, metabolic adaptation and tumor progression. This retrospective study was designed to evaluate the differences of tissue expressions of HIF1A in a spectrum of cervical neoplasms.Methods: Tissue expression of HIF1A was studied in a total of 107 formalin-fixed, paraffin-embedded uterine cervical tumors specimens and its association with different clinicopathologic parameters was evaluated.Results: In this series, there were 30 low and 29 high grade cervical intraepithelial neoplasms (CINs), 27 squamous cell carcinomas, 15 adenosquamous carcinomas and 6 adenocarcinomas. Strong and diffuse nuclear staining was evaluated as positive HIF1A expression. Positive HIF-1 alpha expression was detected in 7 (25.9%) of squamous cell carcinomas, 1 of adenocarcinomas (16.7%) and only 1 of HGSILs (3.4%). Statistically it was determined that the positivity rate of strong nuclear HIF1A expression was significantly higher in invasive carcinomas when compared with in non-invasive squamous cell carcinomas (p=0.07). Contrary, there was no statistically significant difference according to the subtypes of carcinomas due to scarce number of cases with adenocarcinoma (p=0.188).Conclusions: Our findings were demonstrated to link of nuclear HIF1A expression and the invasive characters of uterine neoplasms. As a result, HIF-1 alpha expression may be important in foreseeing of the invasion and tumor progression.

Clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic analysis / 中华消化外科杂志

Objective@#To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors.@*Methods@#The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model.@*Results@#(1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level, tumor diameter, pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.451, 4.900, 8.256, 4.419, 5.858, P<0.05), and pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ2=5.828, 6.968, 4.077, P<0.05). Multivariate analysis showed that preoperative ALP level, tumor diameter, and lymph node metastasis were independent factors influencing the postoperative 2-year overall survival rate of patients [hazard ratio (HR)=2.539, 2.619, 2.201, 95% confidence interval (CI) : 1.174-5.491, 1.209-5.673, 1.104-4.391, P<0.05)]; pathological type of tumor and lymph node metastasis were independent factors influencing the postoperative 2-year disease-free survival rate of patients (HR=2.254, 2.296, 95%CI: 1.170-4.344, 1.206-4.374, P<0.05). ③ Survival analysis: pathological type of tumor was an associated factor for the postoperative 2-year overall survival rate and 2-year disease-free survival rate of patients. Of the 87 patients with T3 gallbladder cancer, there was no significant difference in the postoperative 2-year overall survival rate between the 64 patients with gallbladder adenocarcinoma and 23 with gallbladder adenosquamous carcinoma (68.8% vs. 34.8%, χ2=8.256, P>0.05), but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3% vs. 30.4%, χ2=5.828, P<0.05). (3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis. ① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months, with a range from 3.2 to 82.7 months. The postoperative 2-year overall survival rate was 68.8%, and the postoperative 2-year disease-free survival rate was 56.3%. ② For the 64 patients with T3 stage gallbladder adenocarcinoma, univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (χ2=4.012, 8.837, P<0.05). The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (χ2=6.361, P<0.05). Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.244, 0.382, 95%CI: 0.088-0.674, 0.176-0.831, P<0.05). ③ Survival analysis: range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 64 patients with T3 stage gallbladder adenocarcinoma, the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8% and 69.7%, versus 51.6% and 41.9% of the patients undergoing standard lymph node dissection (χ2=8.837, 6.361, P<0.05). (4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. ① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months, with a range from 1.1 to 70.3 months. The postoperative 2-year overall survival rate was 34.8%, and the postoperative 2-year disease-free survival rate was 30.4%. ② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma, univariate analysis showed that preoperative ALP level, lymph node metastasis, range of hepatectomy, and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.288, 4.574, 12.960, 4.106, P<0.05). The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ2=7.364, 10.582, P<0.05). Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102, 0.153, 95%CI: 0.012-0.880, 0.033-0.718, P<0.05). ③ Survival analysis: range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma, the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5% and 75.0%, versus 6.7% and 6.7% of the patients undergoing hepatic wedge resection (χ2=12.960, 10.528, P<0.05).@*Conclusions@#Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer. The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma. Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma. Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection, and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy.

Clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic analysis / 中华消化外科杂志

Objective To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected.There were 44 males and 43 females,aged 29-79 years,with a median age of 61 years.According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer,corresponding surgeries were performed.Observation indicators:(1) surgical and postoperative conditions;(2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis;(3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis;(4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis.Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018.Measurement data with skewed distribution were represented as M (range),and count data were described as absolute numbers.Survival curve,survival time and survival rate were drawn and calculated by the Kaplan-Meier method.Survival analysis was performed by the Log-rank test.Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model.Results (1) Surgical and postoperative conditions:all the 87 patients underwent radical resection of gallbladder cancer,including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy.Of the 87 patients,42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection.There were 27 cases receiving extrahepatic bile duct reconstruction.The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma.There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion.The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases.The degree of tumor differentiation:there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor.Of the 87 patients,43 received postoperative adjuvant therapy and 44 didn't receive adjuvant therapy.(2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis.① All the 87 patients were followed up for 1.8-128.0 months,with a median follow-up time of 26.3 months.All the 87 patients had survived for 1.1 -82.7 months,with a median time of 20.1 months.The 2-year overall survival rate of patients was 59.8％,and the 2-year disease-free survival rate was 49.4％.② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level,tumor diameter,pathological type of tumor,lymph node metastasis,and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (x2 =5.451,4.900,8.256,4.419,5.858,P ＜ 0.05),and pathological type of tumor,lymph node metastasis,and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (x2 =5.828,6.968,4.077,P＜ 0.05).Multivariate analysis showed that preoperative ALP level,tumor diameter,and lymph node metastasis were independent factors influencing the postoperative 2-year overall survival rate of patients [hazard ratio (HR) =2.539,2.619,2.201,95％ confidence interval (CI):1.174-5.491,1.209-5.673,1.104-4.391,P＜ 0.05)];pathological type of tumor and lymph node metastasis were independent factors influencing the postoperative 2-year disease-free survival rate of patients (HR =2.254,2.296,95％CI:1.170-4.344,1.206-4.374,P＜0.05).③ Survival analysis:pathological type of tumor was an associated factor for the postoperative 2-year overall survival rate and 2-year disease-free survival rate of patients.Of the 87 patients with T3 gallbladder cancer,there was no significant difference in the postoperative 2-year overall survival rate between the 64 patients with gallbladder adenocarcinoma and 23 with gallbladder adenosquamous carcinoma (68.8％ vs.34.8％,x2 =8.256,P＞0.05),but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3％ vs.30.4％,x2=5.828,P＜0.05).(3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis.① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months,with a range from 3.2 to 82.7 months.The postoperative 2-year overall survival rate was 68.8％,and the postoperative 2-year disease-free survival rate was 56.3％.② For the 64 patients with T3 stage gallbladder adenocarcinoma,univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (x2=4.012,8.837,P＜0.05).The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (x2 =6.361,P＜0.05).Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR =0.244,0.382,95％CI:0.088-0.674,0.176-0.831,P＜0.05).③ Survival analysis:range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients.Of the 64 patients with T3 stage gallbladder adenocarcinoma,the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8％ and 69.7％,versus 51.6％ and 41.9％ of the patients undergoing standard lymph node dissection (x2 =8.837,6.361,P＜0.05).(4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis.① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months,with a range from 1.1 to 70.3 months.The postoperative 2-year overall survival rate was 34.8％,and the postoperative 2-year disease-free survival rate was 30.4％.② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma,univariate analysis showed that preoperative ALP level,lymph node metastasis,range of bepatectomy,and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (x2 =5.288,4.574,12.960,4.106,P＜0.05).The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (x2 =7.364,10.582,P＜0.05).Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102,0.153,95％CI:0.012-0.880,0.033-0.718,P＜0.05).③ Survival analysis:range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients.Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma,the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5％ and 75.0％,versus 6.7％ and 6.7％ of the patients undergoing hepatic wedge resection (x2 =12.960,10.528,P＜0.05).Conclusions Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer.The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma.Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma.Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection,and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy.

The clinical and pathological features, biomarker characteristics and prognosis analysis of lung adenosquamous carcinoma / 中华肿瘤杂志

Objective@#Adenosquamous carcinoma of lung is an uncommon subtype with more aggressive behavior and poor prognosis than adenocarcinoma and squamous cell carcinoma. This study was aimed to investigate the clinicopathological characteristics and prognostic factors of lung adenosquamous carcinoma.@*Methods@#The pathological features and follow-up data of 133 patients were collected and the prognostic factors of these patients were retrospectively analyzed.@*Results@#Among the 133 patients, 81 cases (60.9%) smoked. Among the 62 patients whose percentage of histological components were identified, 45 cases had >50% adenocarcinoma components, and 17 cases had >50% squamous cell carcinoma components. 55 patients had lymph node metastasis at the first visit. All patients accepted at least one test of tumor driven gene mutation, and the results showed that the mutation rate of EGFR was 50.8% (67/132), the mutation rate of K-ras was 8.6% (11/128), the ALK-positive rate was 4.2% (2/48). The gender, smoking status, and the proportion of pathological components were the main influence factors of EGFR mutation status. The median overall survival was 28 months, the rates of 1-year, 3-year, and 5-year survival were 72.9%, 23.3%, and 9.0%, respectively. EGFR tyrosine kinase inhibitors (TKIs) treatment was an independent risk factor for prognose of these patients (P=0.024).@*Conclusions@#Lung adenosquamous carcinoma is a rare subtype with high malignancy and poor prognosis. Early diagnosis and driven-mutation-based individualized therapy may improve the survival of patients with lung adenosquamous carcinoma.

A Case of Adenosquamous Carcinoma Arising from the Tonsil / 대한이비인후과학회지

Adenosquamous cell carcinoma of tonsil is a rare lesion of head and neck and is often misdiagnosed as squamous cell carcinoma. It has a very aggressive clinical pattern. We encountered a patient with an adenosquamous cell carcinoma of tonsil and performed various treatment modalities including surgical resection, radiation therapy, chemotherapy but the patient expired two years after the first diagnosis. Such case has never been reported earlier in Korea. Herein, we present this rare case with a review of related literature.

Colonic adenosquamous carcinoma and mucinous adenocarcinoma with microsatellite instability

@#A 43-year-old man presented with two-month history of fatigue, weakness, paleness, rectal bleeding, sweating, and weight loss of 10 kg in the past one month. A complete blood count revealed anaemia. The patient underwent a right hemicolectomy. The microscopic examination revealed an adenosquamous carcinoma associated with a mucinous adenocarcinoma in a patient with microsatellite instability due to loss of MLH1 and PMS2 expression and retention of MSH2 and MSH6 expression in both the squamous and glandular components. We also observed an atypical immunohistochemical phenotype in the adenocarcinoma component showing CK7 expression and reduced CK20 and CDX2 expression.

Clinical Characteristics and Prognostic Factors of Lung Adenosquamous Carcinoma in SEER Database between 2010 and 2015 / 中国肺癌杂志

BACKGROUND@#The incidence and the mortality of lung cancer rank first among all malignant tumors and it seriously affects human health. The common types of non-small cell lung cancer (NSCLC) are adenocarcinoma and squamous carcinoma with clinical research and more attention, while adenosquamous carcinoma is a rare pathological subtype of lung cancer, which clinical features and prognostic factors are not yet fully understood. The purpose of this study is to analyze the clinical features and prognosis of lung adenosquamous carcinoma, and construct a nomogram to predict the patients' prognosis.@*METHODS@#We obtained the data of adenosquamous carcinoma patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database of the United States, and compared their clinical features and prognosis with those of lung adenocarcinoma and lung squamous cell carcinoma patients in the same period. Then we used univariate and multivariate analyses to explore the independent prognostic factors of adenosquamous carcinoma. Finally, we constructed and validated a nomogram to visually predict the outcomes of lung adenosquamous carcinoma.@*RESULTS@#1,453 patients with lung adenosquamous carcinoma were finally included. Compared with patients with lung adenocarcinoma and lung squamous cell carcinoma, the distributions of lung adenocarcinoma patients in most of the variables were medium between lung adenocarcinoma and squamous cell carcinoma. The prognosis of adenosquamous carcinoma was better than that of lung squamous cell carcinoma, but worse than that of lung adenocarcinoma. Multivariate analysis showed that age, differentiation, tumor-node-metastasis (TNM), surgery, and chemotherapy were independent prognostic factors (all P were less than 0.001). We constructed a nomogram with a C-index of 0.783 (0.767-0.799). The distinction test and consistency test showed that the nomogram could predict the patient's prognosis effectively.@*CONCLUSIONS@#Lung adenosquamous carcinoma has unique clinical, pathological, and prognostic characteristics. Age, differentiation, T, N, M, surgery, and chemotherapy status are independent predictors of prognosis in patients with adenosquamous carcinoma. Our nomogram can efficiently predict the prognosis of patients.

The efficacy and influence factors analysis of EGFR TKIs on patients with lung adenosquamous carcinoma / 中华肿瘤杂志

Objective@#To investigate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) on patients with lung adenosquamous carcinoma, and to analyze relative factors.@*Methods@#From August 2007 to July 2017, 40 patients who were pathologically diagnosed as lung adenosquamous carcinoma in our hospital and received EGFR TKIs treatment were retrospectively analyzed. All patients underwent EGFR mutation detection, resulted in 11 wild type, 13 19Del, 13 21L858R mutations, and 3 uncommon EGFR mutations in 20 exon and 19/21 complex mutation. A higher frequency of EGFR mutation was found in non-smokers and patients with adenocarcinoma components over 50.0%.@*Results@#Twenty-six (65.0%) patients had disease progression after EGFR TKIs treatment, with a median progression-free survival (PFS) of 5.5 months (95% CI 0.52-10.49 months). A total of 20 (50.0%) patients died with an median overall survival (OS) of 15 months (95% CI 11.03-18.97 months). Multivariate analysis showed that gender, age, smoking, histopathological subtypes, EGFR mutations, and brain metastasis had no influence on PFS (all P>0.05). Gender, age, smoking, histopathological subtypes, and the presence of brain metastasis during TKI treatment had no influence on OS (P>0.05), while EGFR mutation is the only influencing factor of OS (P<0.05) in the current study.@*Conclusions@#EGFR TKIs had modest efficacy in lung adenosquamous carcinoma, especially in patients with EGFR mutation. Based on the pathological features, EGFR mutation and EGFR TKIs treatment should be introduced into the routine clinical practice to improve the survival of patients with lung adenosquamous carcinoma.

Pancreatic adenosquamous carcinoma, a rare entity: report of four cases / Carcinoma adenoescamoso do pâncreas, uma entidade rara: relato de quatro casos

ABSTRACT Adenosquamous carcinoma of the pancreas (ASCP) is a rare variant of the pancreatic ductal adenocarcinoma (PDAC). Between 2004 and 2016, four cases of ASCP were resected at our institution; clinicopathological data were collected. All of our patients were males, aged 55-80 years. Three cases were cephalic tumors; and one, pancreatic tail tumor, measuring between 2.3 and 5.5 cm. All had neurovascular invasion and lymphatic metastasis. Two had retroperitoneal positive margins. The overall survival (OS) after surgery was three weeks-42 months. Prognosis of ASCP is dark and OS appears to be more closely related to surgical margins status than to other clinicopathological factors.

RESUMO O carcinoma adenoescamoso pancreático (ASCP) é uma variante rara do adenocarcinoma ductal (PDAC). Entre 2004 e 2016, foram ressecados quatro casos de ASCP em nossa instituição, com registro dos dados clínicos e patológicos. Os pacientes eram homens entre 55 e 80 anos. Três tumores eram cefálicos; e um, caudal, com dimensões variáveis entre 2,3 e 5,5 cm. Todos tinham invasão neurovascular e metástases linfáticas; dois, margens cirúrgicas retroperitoneais positivas. A sobrevida global (SG) pós-cirurgia foi de três semanas a 42 meses. O prognóstico do ASCP é sombrio, com SG aparentemente mais relacionada com o status das margens cirúrgicas do que com outro fator clinicopatológico.

Clinical outcomes of epidermal growth factor receptor tyrosine kinase inhibitors in re-current adenosquamous carcinoma of the lung after resection / 中国肿瘤临床

Objective:To investigate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in adenosqua-mous carcinoma (ASC) of the lung after resection. Methods:Clinical data of patients suffering from ASC and receiving EGFR-TKI treat-ment at one institution between January 2006 and December 2014 were retrospectively reviewed. Results:A total of 27 EGFR muta-tion-positive patients with ASC subjected to EGFR-TKI therapy were enrolled in this study. EGFR mutations included deletion in exon 19 in 15 cases and point mutation at codon 858 in exon 21 in 12 cases. Of the 27 ASC patients who received EGFR-TKI treatment, 9 exhibit-ed a partial response and 11 manifested a stable disease, and these patients accounted for a disease control rate of 74.1%(20/27). The median overall survival (OS), median progression-free survival, and median relapse OS of the EGFR mutation-positive patients who underwent TKI therapy were 39 months [95%confidence interval (CI)=25.6-52.4], 15 months (95%CI=12.9-17.1), and 19 months (95%CI=0.9-37.1), respectively. The 3-and 5-year survival rates of these patients after operation were 51.9%and 15.3%, respectively. Con-clusion:The survival of EGFR mutation-positive ASC patients treated with EGFR-TKIs was satisfactory. EGFR testing was recommended for ASCs and EGFR-TKI treatment was suitable for ASCs with EGFR-sensitizing mutation.

Clinicopathological observation of 5 cases of primary liver adenosquamous carcinoma / 上海交通大学学报（医学版）

Primary liver adenosquamous carcinoma is a rare kind of liver malignant tumor with very poor prognosis. Clinical data of 5 cases were analyzed retrospectively, four male and one female, whose average age was 60.2 years (50-67 years) old. Adenosquamous carcinoma contains both adenocarcinoma and squamous carcinoma histologically, and squamous carcinoma cells are dominant (>80%). Four cases underwent surgical resection and one received liver transplantation. The postoperative follow-up period ranged from 6 to 35 months and the mean survival time of these cases was about 15 months. Three patients died during the follow-up period. The survival rates 1 and 2 years after operation were 60% and 20%, respectively.

Oral Adenosquamous Carcinoma Mimicking a Pyogenic Granuloma: a Challenging Diagnosis

Abstract Adenosquamous carcinoma is an aggressive variant of squamous cell carcinoma. This report describes a case of adenosquamous carcinoma with clinical features of a benign lesion and discusses the differential diagnoses, especially regarding histopathological and immunohistochemical analyses. A 45-year-old male was referred to our outpatient clinic complaining about a rapid-growing enlargement in hard palate. Clinical examination revealed an erythematous and pedunculated nodule with lobulated non-ulcerated surface. Excisional biopsy was performed following clinical diagnosis of pyogenic granuloma. Histologically, the specimen consisted of areas characterizing both well-differentiated squamous cell carcinoma and true adenocarcinoma. After a broad list of immunohistochemical markers was evaluated (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 and Ki67), the diagnosis of adenosquamous carcinoma was rendered and the patient referred to complementary surgery. Adenosquamous carcinoma represents a challenge in diagnostic routine due to its rarity, diverse range of clinical presentations and histological features. Furthermore, classical clinical benign features may be present in malignant lesions; hence the submission of every surgical specimen to histological analysis is mandatory to provide the patient the adequate treatment.

Resumo O carcinoma adenoescamoso é uma variante agressiva do carcinoma de células escamosas. Este relato descreve um caso de carcinoma adenoescamoso que apresenta características clínicas de uma lesão benigna e discute o diagnóstico diferencial, especialmente em relação à análise histopatológica e imuno-histoquímica. Um homem de 45 anos foi encaminhado ao nosso serviço queixando-se um aumento de volume de rápido crescimento no palato duro. O exame clínico revelou um nódulo eritematoso e pedunculado com superfície lobulada não ulcerada. Foi realizada biópsia excisional seguindo a hipótese clínica de granuloma piogênico. Histologicamente o fragmento consistia em áreas de carcinoma de células escamosas bem diferenciado e áreas de adenocarcinoma verdadeiro. Após a avaliação de uma ampla lista de marcadores imuno-histoquímicos (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 e Ki67), o diagnóstico de carcinoma adenoescamoso foi atribuído e o paciente foi encaminhado à cirurgia complementar. O carcinoma adenoescamoso representa um desafio na rotina de diagnóstico, devido à sua raridade, diversificada gama de apresentações clínicas e características histológicas. Além disso, características clínicas benignas podem estar presentes em lesões malignas, por isto a submissão de todas as peças cirúrgicas à análise histológica é obrigatória para fornecer ao paciente o tratamento adequado.

Primary adenosquamous carcinoma of liver: a clinical study of 2 patients / 中华肝胆外科杂志

Objective To study the diagnosis and treatment of primary adenosquamous carcinoma (ASC) of liver.Methods The clinical and histopathological data of 2 patients with ASC were analyzed retrospectively.The cases were confirmed by surgery and histopathological examination.Results The tumors were located in the left liver in these 2 patients.Both patients presented with abdominal pain and they underwent surgical resection.On gross pathological examination,the tumors were irregular in shape with unclear boundaries.Microscopically,the tumor cells were arranged in a nesting pattern with a tubular structure,which was an adenosquamous carcinoma structure.One patient survived 4 months after surgery and the other patient died of intrahepatic tumour recurrence 7 months after surgery.Conclusions The diagnosis of primary hepatic ASC relied on histopathological examination.Surgical resection was safe and feasible.