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Objective:To develop and validate the models based on mixed enhanced computed tomography (CT) radiomics and deep learning features, and evaluate the efficacy for differentiating pancreatic adenosquamous carcinoma (PASC) from pancreatic ductal adenocarcinoma (PDAC) before surgery.Methods:The clinical data of 201 patients with surgically resected and histopathologically confirmed PASC (PASC group) and 332 patients with surgically resected histopathologically confirmed PDAC (PDAC group) who underwent enhanced CT within 1 month before surgery in the First Affiliated Hospital of Naval Medical University from January 2011 to December 2020 were retrospectively collected. The patients were chronologically divided into a training set (treated between January 2011 and January 2018, 156 patients with PASC and 241 patients with PDAC) and a validation set (treated between February 2018 and December 2020, 45 patients with PASC and 91 patients with PDAC) according to the international consensus on the predictive model. The nnU-Net model was used for pancreatic tumor automatic segmentation, the clinical and CT images were evaluated, and radiomics features and deep learning features during portal vein phase were extracted; then the features were dimensionally reduced and screened. Binary logistic analysis was performed to develop the clinical, radiomics and deep learning models in the training set. The models' performances were determined by area under the ROC curve (AUC), sensitivity, specificity, accuracy, and decision curve analysis (DCA).Results:Significant differences were observed in tumor size, ring-enhancement, upstream pancreatic parenchymal atrophy and cystic degeneration of tumor both in PASC and PDAC group in the training and validation set (all P value <0.05). The multivariable logistic regression analysis showed the tumor size, ring-enhancement, dilation of the common bile duct and upstream pancreatic parenchymal atrophy were associated with PASC significantly in the clinical model. The ring-enhancement, dilation of the common bile duct, upstream pancreatic parenchymal atrophy and radiomics score were associated with PASC significantly in the radiomics model. The ring-enhancement, upstream pancreatic parenchymal atrophy and deep learning score were associated with PASC significantly in the deep learning model. The diagnostic efficacy of the deep learning model was highest, and the AUC, sensitivity, specificity, and accuracy of the deep learning model was 0.86 (95% CI 0.82-0.90), 75.00%, 84.23%, and 80.60% and those of clinical and radiomics models were 0.81 (95% CI 0.76-0.85), 62.18%, 85.89%, 76.57% and 0.84 (95% CI 0.80-0.88), 73.08%, 82.16%, 78.59% in the training set. In the validation set, the area AUC, sensitivity, specificity, and accuracy of deep learning model were 0.78 (95% CI 0.67-0.84), 68.89%, 78.02% and 75.00%, those of clinical and radiomics were 0.72 (95% CI 0.63-0.81), 77.78%, 59.34%, 65.44% and 0.75 (95% CI 0.66-0.84), 86.67%, 56.04%, 66.18%. The DCA in the training and validation sets showed that if the threshold probabilities were >0.05 and >0.1, respectively, using the deep learning model to distinguish PASC from PDAC was more beneficial for the patients than the treat-all-patients as having PDAC scheme or the treat-all-patients as having PASC scheme. Conclusions:The deep learning model based on CT automatic image segmentation of pancreatic neoplasm could effectively differentiate PASC from PDAC, and provide a new non-invasive method for confirming PASC before surgery.
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RESUMEN El cáncer colorectal es el tercer tipo de neoplasia maligna más frecuentemente diagnosticada para ambos sexos. El adenocarcinoma es el tipo histológico que constituye el 86% de todos los casos de carcinoma colónico; sin embargo, existen otros subtipos menos frecuentes, como el carcinoma adenoescamoso, una neoplasia sumamente rara, pero con peor pronóstico y menor sobrevida. Presentamos el caso de una paciente mujer de 68 años con un tiempo de enfermedad de 2 años, caracterizado por anemia, hematoquezia y dolor abdominal. El estudio colonoscópico reveló la presencia de tumoración a nivel de colon ascendente, el cual luego de la resección quirúrgica y estudios anatomopatológicos, resultó corresponder a un carcinoma adenoescamoso primario colónico.
ABSTRACT Colorectal cancer is the third most frequently diagnosed cancer in both men and women. Adenocarcinoma is the most common pathologic subtype of colon cancer and constitutes 86% of all colon cancers. Nontheless, there are other less frequent sybtyes of colorectal carcinomas, such as adenosquamous carcinoma, an extremely rare form of colon cancer, but with worse prognosis and greater potential of metástasis. We present the case of a 68-year-old female presented with a two-month history of anemia, hematochezia and abdominal pain. The colonoscopic study presented a tumor in the ascending colon, which after surgical resection and pathological studies, turned out to be a primary colonoc adenosquamous carcinoma.
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Objective:To explore the differences in clinical and imaging features between pancreatic adenosquamous carcinoma (PASC) and pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data, imaging and pathological data of 171 patients pathologically diagnosed with PASC after surgical resection (PASC group) (from February 2011 to October 2020, 148 patients from the First Affiliated Hospital of Naval Medical University and 23 patients from the Second Affiliated Hospital of Zhejiang University School of Medicine) and 100 patients pathologically diagnosed with PDAC after surgical resection (PDAC group) (from January to June, 2018, at the First Affiliated Hospital of Naval Medical University) were retrospectively analyzed. Computed tomography and magnetic resonance imaging features were analyzed by two associate chief physician of department of radiology. Independent sample t test, rank sum test, chi-square test or Fisher exact probability test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze independent predictors of PASC. Results:The longest diameter of tumor of PASC group was larger than that of PDAC group (35.0 mm (28.0 mm to 45.0 mm) vs. 29.5 mm (23.0 mm to 36.0 mm)), and the rates of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma of PASC group were higher than those of PDAC group (62.0%, 106/171 vs. 12.0%, 12/100; 66.1%, 113/171 vs. 25.0%, 25/100; 52.0%, 89/171 vs. 12.0%, 12/100; 70.2%, 120/171 vs. 29.0%, 29/100, respectively); and the differences were statistically significant ( Z=-4.001, χ2=72.183, 42.612, 43.284 and 43.221, all P<0.01). The results of multivariate logistic regression analysis showed that the cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma were indenpendent predictors of PASC (odds ratio=10.083, 2.361, 3.086 and 2.632, 95% confidence interval 8.736 to 11.639, 2.096 to 2.660, 2.605 to 3.656 and 2.267 to 3.057, all P<0.01); and the sensitivity for PASC diagnosis was 62.0%, 66.1%, 51.7% and 70.3%, respectively; the specificity was 88.0%, 75.0%, 88.0% and 71.0%, respectively; the positive predictive value was 89.3%, 81.9%, 88.1% and 80.5%, respectively. Conclusions:PASC and PDAC have similar clinical features. The imaging features of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma are independent predictive factors of PASC.
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Objective To analyze magnetic resonance imaging (MRI) features of adenosquamous carcinoma of the pancreas and to summarize MRI signs with diagnostic value.Methods From August 2010 to June 2017,at Zhongshan Hospital Affiliated to Fudan University,the MRI data of 20 patients with pathologically diagnosed adenosquamous carcinoma of pancreas were retrospectively analyzed.The image analysis included tumor location,size,morphology,lesion borders,signal intensity,enhancement pattern,bile duct and main pancreatic duct dilatation,pancreatic atrophy,extrapancreatic invasion,lymph node metastasis and liver metastasis.Results The lesions of all the 20 patients with pancreatic adenosquamous carcinoma were single,and the diameter was (3.39 ± 1.17) cm (1.37 to 5.87 cm).The lesions of 12 patients were located in the head of pancreas,and eight cases were located in body and (or)tail.Eleven lesions were round and nine lesions were irregular.Eight lesions had clear lesion boundaries,and 12 lesions had blurred lesion boundaries.The imagines of 20 lesions showed slightly lower or hypointensity signal on T1 weighted imaging (T1WI),and equal or slightly higher signal on T2 weighted imaging (T2WI).There were different sizes of necrosis or cystic areas in 18 lesions,and two lesions were complete solid masses.The imagines of 19 lesions showed uneven enhancement during dynamic enhanced scan,which were ring-shaped or separated.The enhancement started from the periphery of tumors,and the signal intensity of the enhanced areas within the lesions approached or exceeded the signal intensity of the normal pancreatic tissue.Conclusion Pancreatic adenosquamous carcinoma is prone to cystic necrosis,and its enhanced MRI imaging has certain characteristics.
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Large cell neuroendocrine carcinoma (LCNEC) of the gallbladder is extremely rare and usually combined with other type of malignancy, mostly adenocarcinoma. We report an unusual case of combined adenosquamous carcinoma and LCNEC of the gallbladder in a 54-year-old woman. A radical cholecystectomy specimen revealed a 4.3×4.0 cm polypoid mass in the fundus with infiltration of adjacent liver parenchyma. Microscopically, the tumor consisted of two distinct components. Adenosquamous carcinoma was predominant and abrupt transition from adenocarcinoma to squamous cell carcinoma was observed. LCNEC showed round cells with large, vesicular nuclei, abundant mitotic figures, and occasional pseudorosette formation. The patient received adjuvant chemotherapy. However, multiple liver metastases were identified at 3-month follow-up. Metastatic nodules were composed of LCNEC and squamous cell carcinoma components. Detecting LCNEC component is important in gallbladder cancer, because the tumor may require a different chemotherapy regimen and show early metastasis and poor prognosis.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Carcinoma, Adenosquamous , Carcinoma, Neuroendocrine , Carcinoma, Squamous Cell , Chemotherapy, Adjuvant , Cholecystectomy , Drug Therapy , Follow-Up Studies , Gallbladder Neoplasms , Gallbladder , Liver , Neoplasm Metastasis , PrognosisABSTRACT
OBJECTIVE: To compare the survival outcomes of patients with cervical squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC) among patients with locally advanced cervical cancer that were treated with definitive radiotherapy. METHODS: The baseline characteristics and outcome data of patients with locally advanced cervical cancer who were treated with definitive radiotherapy between November 1993 and February 2014 were collected and retrospectively reviewed. A Cox proportional hazards regression model was used to investigate the prognostic significance of AC/ASC histology. RESULTS: The patients with AC/ASC of the cervix exhibited significantly shorter overall survival (OS) (p=0.004) and progression-free survival (PFS) (p=0.002) than the patients with SCC of the cervix. Multivariate analysis showed that AC/ASC histology was an independent negative prognostic factor for PFS. Among the patients who displayed AC/ASC histology, larger tumor size, older age, and incomplete response to radiotherapy were found to be independent prognostic factors. PFS was inversely associated with the number of poor prognostic factors the patients exhibited (the estimated 1-year PFS rates; 100.0%, 77.8%, 42.8%, 0.0% for 0, 1, 2, 3 factors, respectively). CONCLUSION: Locally advanced cervical cancer patients with AC/ASC histology experience significantly worse survival outcomes than those with SCC. Further clinical studies are warranted to develop a concurrent chemoradiotherapy (CCRT) protocol that is specifically tailored to locally advanced cervical AC/ASC.
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Female , Humans , Adenocarcinoma , Carcinoma, Adenosquamous , Carcinoma, Squamous Cell , Cervix Uteri , Chemoradiotherapy , Disease-Free Survival , Epithelial Cells , Multivariate Analysis , Radiotherapy , Retrospective Studies , Uterine Cervical NeoplasmsABSTRACT
Objective To explore the pathological features affecting the prognosis by observing lung adenosquamous carcinoma overall survival after surgical treatment.Methods Totally 59 cases of lung ASC from 2531 surgically treated lung cancer patients in the First Hospital of Jilin University,from January 2000 to June 2012,were retrospectively analyzed to study their clinical characteristics,survival condition and the related factors influencing the prognosis.Using log-rank test and Cox multiple factors analysis for statistical analysis.Results (1) The 59 patients with ASC were mostly the male patients (62.7％).The median age was 57.2 years.Median survival time was 409 days(13.6 months).1-,3-,5-year survival rates were 59.9 ％,36.4％ and 31.2 ％.(2) Among the 59 patients (52 cases of pathological specimens),11 cases were EGFR mutation positive,positive rate was 21.2％,2 cases of patients were KRAS mutations positive,positive rate was 3.8％ ;(3) Single factor and multiple factors analysis showed that the pathological subtype,adjuvant treatment,pleural invasion and tumor stage were associated with prognosis as independent factors (P ＜ 0.05).Conclusion Compared with the simplex lung squamous carcinoma and lung adenocarcinoma,lung adenosquamous carcinoma has poorer prognosis.Early diagnosis and given comprehensive treatment were the keys to prolong its survival.
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This paper reports a case of low-grade adenosquamous carcinoma (LGASC) arising in a 69-year-old woman, who presented with a 1-cm palpable mass on her right breast. Core needle biopsy diagnosed the mass as a fibroadenoma. After six months, the mass increased in size, and the patient received subsequent mammotome excision. On microscopic examination, bland-looking small glands were infiltrating into the fibrotic stroma with lymphocytic infiltrates at the periphery. Hematoxylin and eosin staining revealed relatively easily detectable myoepithelial cells along the outside in each of the glandular structures with variable degrees of squamous metaplasia. Based on histologic features, the patient was diagnosed with LGASC. LGASC is a rare variant of metaplastic carcinoma, which is characterized by a favorable prognosis. Due to the bland cytology and presence of myoepithelial cells, LGASC can be misdiagnosed as benign lesion. Additionally, inconsistent expression of myoepithelial markers could aid the diagnosis of LGASC.
Subject(s)
Aged , Female , Humans , Biopsy, Large-Core Needle , Breast , Carcinoma, Adenosquamous , Diagnosis , Eosine Yellowish-(YS) , Fibroadenoma , Hematoxylin , Immunohistochemistry , Metaplasia , PrognosisABSTRACT
Objective To investigate characteristics of cervical cytology and management in pregnant women. Methods From Aug. 2006 to Jan. 2010, 5152 pregnant women who received antenatal and postpartum examination underwent cervical cytological screening by liquid-based cytological test (LCT)in China-Japan Friendship Hospital. The cytological diagnosis was in accordance with the Bethesda system (TBS) 2001 diagnosis and classification system.The abnormal LCT results were followed up at 3 months after postpartum. The diagnosis of high-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) were based on colposcopic examination and biopsy during pregnant. The diagnosis of atypical glandular cells(AGC) was based on curettage and biopsy at postpartum 6 weeks. The histopathology of biopsy were compared and analyzed. Results ( 1 ) Cervical cytological changes related with pregnancy:among 5152 cases, it was found navicular cells in 3215 cases (62. 40% ), decidual cells in 783 cases ( 15.20% ), reactive glandular cells in 369 cases (7. 16% ), and trophoblastic cells in 55 cases (1.07%). (2) LCT results: among 5152 cases, the normal samples were 4125 cases (80.07%), the inflammatory samples were 542 cases (10.52%), and the samples of abnormal epithelial cells were 485cases (9.41%). Among those abnormal cases, 291 cases (5.65%) were in atypical squamous cells (ASC), 153 cases (2. 97%) were in low-grade squamous intraepithelial lesions (LSIL), 33 cases (0. 64%) were in HSIL, 1 case ( 0. 02% ) were in SCC and 7 cases (0. 14% ) were in AGC. (3)Histological pathology results: all women with HSIL and SCC underwent colposcopic examination and biopsy,it was found 28 cases in cervical intraepithelial neoplasia (CIN) Ⅱ - Ⅲ, 1 cases in adenosquamous carcinoma. 7 women underwent curettage and biopsy at postpartum 6 weeks which were diagnosed by AGC,the histopathological diagnosis was all negative. The concordance rate of cytopathologic and histopathologic diagnosis was 71%(29/41). (4) Follow-up: 485 women with abnormal LCT results were all followed up to 3 months at postpartum. Women with HSIL, SCC and AGC undergoing biopsy showed normal LCT results during follow-up. Those women with ASC and LSIL did not undergo colposcopic examination and biopsy. The regression rate was 72.3% (321/444) at postpartum 3 months. Conclusions The navicular cells were primarily morphological characteristics of cytology during pregnant and postpartum women. Some changes were easily confused with malignant lesions. It should be careful discrimination, and avoid excessively diagnosis and misdiagnosis. It suggested that we should follow up those women closely and expand the indication of colposcopic biopsy.
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The most common pancreatic cancer is adenocarcinoma. Primary adenosquamous cell carcinoma of the pancreas is very rare and aggressive. A 46-year-old man presented with a 3-month history of dyspepsia and a 7-kg weight loss. The physical examination showed tenderness of the right upper quadrant of the abdomen. There was no jaundice. Amylase and lipase were elevated. CA 19-9 was elevated to 566.7 U/mL. Gastroduodenoscopy showed a hard ulceroinfiltrative mass with a yellowish exudate that bled readily on touch in the second portion of the duodenum. Abdominal computed tomography showed a 7.1 x 6.3-cm heterogeneously enhancing mass in the pancreatic head. The pancreatic mass had invaded the duodenum wall, gastric antrum, and gastroduodenal artery sheath. Fine-needle aspiration biopsy of the pancreatic mass revealed adenosquamous cell carcinoma, anaplastic type. We concluded that an adenosquamous cell carcinoma of pancreas had invaded the duodenal mucosa causing ulceration.
Subject(s)
Humans , Male , Middle Aged , Amylases/blood , Biopsy, Fine-Needle , CA-19-9 Antigen/blood , Carcinoma, Adenosquamous/blood , Duodenoscopy , Duodenum/pathology , Intestinal Mucosa/pathology , Lipase/blood , Neoplasm Invasiveness , Pancreatic Neoplasms/blood , Tomography, X-Ray ComputedABSTRACT
Objective To explore the clinical diagnostic and therapeutic characteristics，prognostic factors of pailents with primary clear cell carcinoma of the cervix.Methods The clinical,pathologic and follow-up data of patients with primary clear cell carcinoma of the cervix treated in our hospital from Jan 2003 to Dec 2006 were collected and analyzed retrospectively.The relative literature was reviewed.ResultsFive patients with primary clear cell carcinoma of the cervix were treated(1 case stage Ⅰ b1，2 of stage Ⅰ b2，1of stage Ⅱ a，1 of stage Ⅳa).The mean age was 40.2 years(32 to 50 years).The primary symptom was mostly irregularly vaginal bleeding(3/5)and clinical type was predominantly(4/5)endophytie growth.The positive rate of cervical cytologic examination was 2/4,the negative rate of cervical human papillomavirus(HPV)DNA examination was 4/4.Serum CA125 level was abnormal(62.5 to 592.1 kU/L)before operation and when relapse occurred,and returned to normal after operation.All of five patients underwent operation,pathologic examination showed that three patients with infihration in deep 1/2 myomctrium of cervix,and two patients with infiltration in cervix-corpus juncture.Four patients underwent radical abdominal hysterectomy with systematic pelvic lymphadenectomy.All of four patients underwent four courses of chemotherapy with fluorouracil(5-FU)and carboplatin，one patient(stage Ⅱ a)was added with intracavitary brachytherapy.None of the four patients had relapse or metastasis after a follow-up of 10 to 44 months.The patient with stage Ⅳ a underwent firstly hysterectomy and prerectum mass removal.Pelvic relapse occurred three months after operation and the patient then underwent the second operation，external beam radiotherapy and intracavitary brachytherapy and 8 courses of chemotherapy with paclitaxel(taxol) and carboplatin.There was no relapse or metastasis after a follow-up of 26 months.Conclusions Primary clear cell carcinoma of the cervix may be unrelated to HPV infection.It shows predominantly endophytic growth and tends toward deep infiltration in cervix and extending to uterine corpus.Operation combined with chemotherapy with carboplatin and 5-FU or taxol may lead to relatively perfect short-term therapeutical effect.Serum CA125 can help to monitor prognosis.Objective To study the clinical characteristics，treatment modalities.and prognosis of cervical adenosquamous carcinoma.Methods The data of 21 patients with adenosquamous cervical cancer who were admitted into Zhongnan Hospital，Wuhan University from Jan 2001 to Dec 2005 were analyzed retrospectively.Six patients received Surgical therapy only and 15 patients received combined therapy.ResultsSeven cases were with positive pelvic lymph node metastases and 3 cases were with ovarian metastases.The median survival time of the combined therapy group and surgical therapy group was 54 and 20 months，respectively.In stage Ⅰ and stage Ⅱ patients，the median survival time of the combined therapy group and surgical therapy group was 66 and 20 months,respectively.The difference was significant between the two groups(P＜0.05).ConclusionsCombined therapy should be given to patients with adenosquamous carcinoma of the cervix.Surgical therapy and chemotherapy play an important role in the management and prognosis of adenoquamous carcinoma of cervix.Preserve of ovary for patients with adenosquamous carcinoma of the cervix should only be done when the ovary is confirmed free from any malignant involvement by pathology.
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Adenosquamous carcinoma of the papilla of Vater is a rare tumor and only a few cases have been reported so far. Here, we report a case of adenosquamous carcinoma in a 76-year-old male who presented with jaundice and right upper quadrant abdominal pain. Ultrasonography and enhanced abdominal CT scans showed dilated common bile duct (CBD) and intrahepatic bile duct (IHD) with a suspicious obstructing mass in distal CBD. On endoscopy, obstructing and ulcerated mass was noted on the papilla of Vater. Histopathological inspection of the biopsied specimens from mass showed adenosquamous cell carcinoma of the papilla of Vater. Since the patient refused operation, we inserted a self-expandable metallic stent in distal CBD. This is the first case report on adenosquamous carcinoma of the papilla of Vater in Korea.
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Aged , Humans , Male , Ampulla of Vater/pathology , Carcinoma, Adenosquamous/diagnosis , Cell Differentiation , Immunohistochemistry , Tomography, X-Ray ComputedABSTRACT
Objective To investigate the biological features and treatment of pancreatic adenosquamous carcinoma. Methods A retrospective clinical analysis was conducted in 6 cases of pancreatic adenosquamous carcinoma treated in our hospital from 1995 to 2005. The clinical features, imaging findings, therapy and pathology were analyzed. Results Pancreatic adenosquamous carcinoma was found in 3 men and 3 women with a mean age of 51. 8?10. 8 years. Tumor was located in the head of the pancreas in 4 patients, body in 1 and tail in 1. Three cases received pancreaticoduodenectomy, two did distal pancreatectomy and splenectomy, one underwent palliative operation. The mean size of the tumor was 5. 2 cm ? 4. 1 cm ? 3. 0 cm, pathologically primary tumor and the liver metastasis were mixture of adenocarcinoma and squamous cell carcinoma. Tumor invaded the duodenal wall and common bile duct in 3 cases, portal vein was invaded in 1 case. Neural invasion was present in 4 cases. Lymphatic invasion was found in 3 cases. Postoperative mean survival time was 6. 7 months after the operation with patients finally dying of tumor recurrence and liver metastasis. Conclusions Pancreatic adenosquamous carcinoma is characterized by the mixture of adenomatous and squamous cell element with aggressive biological behavior. The prognosis of this tumor is poor demanding early diagnosis and proper surgical treatment.