Analysis of risk factors of radiation-induced toxicity in limited-stage small cell lung cancer treated with hypofractionated intensity-modulated radiotherapy / 中华肿瘤杂志

Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.

Primary Ovarian Small Cell Carcinoma of Pulmonary Type: Analysis of 6 Cases and Review of 31 Cases in the Literatures / 中国医学科学杂志(英文版)

Objective Primary ovarian small cell carcinoma of pulmonary type (SCCOPT) is a rare ovarian tumor with a poor prognosis. The platinum-based chemotherapy is the standard treatment. However, there is little research on the clinical characteristics of SCCOPT and the potential benefits of other treatments due to its low incidence. The study aims to investigate clinicopathological characteristics and treatment of SCCOPT.Methods We summarized the clinical, imaging, laboratorical and pathological characteristics of 37 SCCOPT cases, in which 6 cases were admitted to the Gansu Provincial Hospital from the year of 2008 to 2022 and 31 cases reported in 17 English and 3 Chinese literatures.Results The median age of the studied SCCOPT cases (n=37) was 56.00 (range, 22-80) years. Almost 80% of them had a stage Ⅲ or Ⅳ tumor. All patients underwent an operation and postoperative chemotherapy. Nevertheless, all cases had a poor prognosis, with a median overall survival time of 12 months. Immunohistochemically, the SCCOPT of all patients showed positive expressions of epithelial markers, such as CD56 and sex-determining region of Y chromosome-related high-mobility-group box 2 (SOX-2), and negative expressions of estrogen receptor, progesterone receptor, vimentin, Leu-7, and somatostatin receptor 2. The tumor of above 80% cases expressed synaptophysin. Only a few cases expressed neuron-specific enolase, chromogranin A, and thyroid transcription factor-1. Conclusions SCCOPT had a poor prognosis. SOX-2 could be a biomarker to be used to diagnose SCCOPT.

Clinical and pathological characteristics of small cell carcinoma of bladder and the efficacy of neoadjuvant therapy / 现代泌尿外科杂志

【Objective】 To investigate the clinical characteristics and prognostic factors of small cell carcinoma of bladder (SCCB), and to explore the efficacy of neoadjuvant therapy. 【Methods】 Clinical information of 47 SCCB patients were retrospectively collected, and the clinical and pathological features were compared with those of urothelial carcinoma (UBC). The prognostic factors and efficacy of neoadjuvant therapy were also investigated. 【Results】 SCCB had higher baseline tumor staging, and was more likely to invade the muscle (100%) and metastasize distantly (21.3%). The overall survival was poor (median: 13.1 months, 1-year survival rate: 53.7%, 5-year overall survival rate: 15.4%). Tumor T staging was a risk factor for SCCB, while neoadjuvant therapy was an independent protective factor that significantly reduced the risk of recurrence and metastasis (HR: 0.189, 95%CI: 0.051-0.697, P=0.012) and death (HR: 0.177, 95%CI: 0.045-0.698, P=0.013), and significantly improved disease-free survival and overall survival. In addition, compared with neoadjuvant chemotherapy alone, neoadjuvant chemotherapy combined with immunotherapy could improve the pathological complete response rate. 【Conclusion】 SCCB is highly malignant and prone to metastasis, and has a poor prognosis. Neoadjuvant therapy combined with radical cystectomy is recommended as the first-line treatment.

Carcinoma de células pequeñas extrapulmonar de mama. Comunicación de caso / Extrapulmonary small cell carcinoma of the breast. Case report

RESUMEN El carcinoma de células pequeñas representa 20% de los cánceres de pulmón; raramente ocurre en otros sitios. El carcinoma de células pequeñas extrapulmonar es agresivo, con propensión a la diseminación regional y a distancia. Este tipo de carcinoma es una neoplasia poco frecuente en mama. Aunque la apariencia clínica es inespecífica, a menudo responde bien a la terapia y tiene buen pronóstico de supervivencia. Se presenta el caso de mujer de 50 años con carcinoma de células pequeñas extrapulmonar de mama. El examen físico mostró lesión de 4 x 3 x 3 centímetros confirmada por resonancia magnética de la mama izquierda. El diagnóstico se realizó mediante biopsia que mostró las características células pequeñas, redondas, similares a linfocitos con núcleos hipercromáticos y escaso citoplasma, compatible con carcinoma de células pequeñas de mama. La paciente fue tratada con quimioterapia antes de ser sometida a mastectomía total y resección de los ganglios linfáticos.

ABSTRACT Small cell carcinoma accounts for 20% of lung cancers; it rarely occurs at other sites. Extrapulmonary small cell carcinoma is aggressive, with a propensity for regional and distant spread. This type of carcinoma is a rare breast neoplasm. Although the clinical appearance is nonspecific, it often responds well to therapy and has a good prognosis of survival. We present the case of a 50-year-old woman with extrapulmonary small cell carcinoma of the breast. Physical examination showed a 4 x 3 x 3 centimeters lesion confirmed by magnetic resonance imaging of the left breast. The diagnosis was made by biopsy showing characteristic small, round, lymphocyte-like cells with hyperchromatic nuclei and scant cytoplasm, compatible with small cell carcinoma of the breast. The patient was treated with chemotherapy before undergoing total mastectomy and lymph node resection.

Analysis of clinicopathological features of seven patients with lung adenocarcinoma translating to small cell lung cancer / 中国肿瘤临床

Objective: To analyze the clinicopathological features of small cell lung cancer transformed from lung adenocarcinoma. Methods: We retrospectively analyzed the clinical and pathological characteristics and follow-up data of seven patients who had been diagnosed with small cell lung cancer transformed from lung adenocarcinoma following treatment from January 2014 to December 2018 at the Fourth Hospital of Hebei Medical University. Results: The latest follow-up had been performed on June 1, 2020. The median time of small cell lung cancer transformation from lung adenocarcinoma following treatment was 31 months; the median time of tyrosine kinase inhibitor (TKI) application before transformation is 14 months. Three patients had transformation at the same site as the original. Seven patients had higher levels of neuron-specific enolase (NSE) before transformation. Before the transformation, disease progression mostly occurred at multiple sites, and the lung, bone, brain, pleura, and lymph nodes were commonly affected. In all cases, immunohistochemical indicators after transformation showed that thyriod transcription factor-1 (TTF-1) was positive; Napsin A was negative; Syn, CD56, and AE1/AE3 were positive; Ki67 expression was high; and PD-L1 expression was negative. Genetic testing after transformation showed that six patients had maintained the original mutant EGFR gene. Treatments after transformation were mainly comprehensive, based on chemotherapy. The median progression-free survival time after transformation was 6 months, and median survival time after transformation for five patients who died was 10 months. Conclusions: Once lung adenocarcinoma undergoes transformation to small cell lung cancer, the disease progresses rapidly, and survival time is short. Patients with lung adenocarcinoma due to EGFR E19 mutation who undergo EGFR-TKI therapy are more prone to small cell lung cancer transformation, and the time to transformation generally exceeds 2 years. The sites of disease progression before transformation are often multiple, and NSE is increased. After transformation, patients generally maintain the original EGFR mutation.

Hepatoid adenocarcinoma of the lung mimicking metastatic hepatocellular carcinoma

Hepatoid adenocarcinoma of the lung is a rare subtype of lung cancer. We report a case of a metastatic hepatoid adenocarcinoma of the lung with aggressive behavior, including biopsy and autopsy findings. The pulmonary tumors showed features indistinguishable from hepatocellular carcinoma and were diffusely positive for Hepatocyte Paraffin 1.

Bronchoscopic Evaluation in Clinically and Radiologically Suspected Lung Carcinoma.

Lung cancer is generally diagnosed during late stage of the disease; so, early diagnosis of lung cancer is very important to reduce lung cancer death rate. Flexible fibreoptic bronchoscopy (FOB) is an important diagnostic technique performed in patients with suspected malignant lung lesion as it provides sufficient cytologic and histologic specimens in the form of bronchial washing, bronchial brushing and bronchial forceps biopsy.METHODSThe present descriptive study analysed cytology of bronchial washing, bronchial brushing and histology of bronchial biopsy in 100 patients with suspected lung cancer. Patients in whom clinical and radiological findings suggested lung carcinoma, were included in the study. Patients with coagulopathy, refractory hypoxemia, cardiac instability, poor ability to cooperate with the procedure were excluded from this study. Age, gender, smoking habits, clinical and radiological findings, various histological types of malignancies, and yield of various bronchoscopic diagnostic techniques in the diagnosis of lung cancer were evaluated.RESULTSOf the 100 cases, 86 (86%) were males and 14 (14%) were females with male to female ratio of 6.14:1. The mean age in this study group was 58 years. Overall diagnostic yield by means of all techniques during bronchoscopy was 90% (90/100 patients). Squamous cell carcinoma was the most common primary bronchogenic tumour 36.67% (33/90 patients) followed by Adenocarcinoma 25.56% (23/90 patients), small cell carcinoma 24.44% (22/90 patients), Undifferentiated Non-Small Cell Carcinoma (NSCLC) 12.22% (11/90 patients), poorly differentiated carcinoma 1 patient. No evidence of malignancy was found in 10 patients by all techniques during bronchoscopy.CONCLUSIONSLung cancer is a common malignancy with male preponderance. Bronchial washing and brushing cytology in combination with bronchial biopsy has a very high diagnostic yield. Therefore, all these techniques may be used concurrently to diagnose lung malignancy.

Computed Tomography Guided Fine Needle Aspiration of Lung Lesions Suspected to be Bronchogenic Carcinoma: Experience of a Tertiary Care Hospital

CT guided FNAC is a simple and safe procedure of diagnostic value in patients with lung lesionssuspected to have lung malignancy. We undertook a study on 41 patients and were able to diagnose/rule out malignancy in 85.37% of these patients, while in 14.63 % of patients the smears were nondiagnostic. Once malignancy was diagnosed in these patients, then the next most important step wasto categorize the lesions. 44% of patients had squamous cell carcinoma, 12.12 % had adenocarcinoma,9.75% had small cell carcinoma, 7.31 % had poorly differentiated carcinoma, 4.87% each hadmetastasis & tuberculosis and 2.43% had aspergillosis. Squamous cell carcinoma was the commonestsubtype in our study, which is contrary to changing trends in incidence of lung carcinoma whereadenocarcinoma has replaced squamous cell carcinoma as the commonest lung malignancy. Threeof our patients had minor complication in the form of mild pneumothorax, and it resolved in all patientswithin 24 hours.

Computed Topographic-Guided Core Needle Biopsy of Lung Masses: Our Experience at a Diagnostic Center in Western India

Introduction: Lung carcinomas are one of the most common malignancies and major cause of cancer-related deaths worldwide. India also shares a great burden of this disease. Computed topography (CT)-guided fine-needle aspiration cytology of lung masses is a widely used and simple diagnostic tool which is being replaced increasingly by CT-guided core biopsies. This study shows our experience at a diagnostic center.Materials and Methods: This was a prospective study conducted over a period of 1 year from April 2018 to April 2019 and consisted of 107 cases. After taking detailed history, CT-guided core biopsies were obtained using coaxial needles of 17–19 gauge and biopsy needles of 18–20 gauge. The tissues were then examined histopathologically and the results were noted.Results: Out of the 107 patients, 81.3% were male and 18.7% were female. The age range of patients was from 33 to 92 years, with mean age being 63.7 years. Majority of the lesions were located in the right lung (57.9%). The most common histopathological diagnosis was squamous cell carcinoma 74.7%, followed by small cell carcinoma (12.1%) and adenocarcinoma (9.3%), Hodgkin lymphoma (1.8%), malignant mesothelioma (0.9%), and angiosarcoma (0.9%).Conclusions: This study shows our experience regarding lung malignancies in a diagnostic center in Western India. The epidemiology of lung malignancies seen across the Indian subcontinent reflects in our study. CT-guided core needle biopsies though less invasive may cause complications in some patients. Hence, utmost care should be taken during the procedure to ensure patient safety.

A case of small cell neuroendocrine carcinoma of ovary / 中国综合临床

Objective@#Small cell neuroendocrine carcinoma of the ovary is a kind of ovarian cancer with a very low incidence.Its clinical manifestations are not obvious.The diagnosis should be based on the pathology and neuroendocrine indicators, and its primary nature should be determined.The main treatment is operation combined with platinum based chemotherapy.The survival period is related to clinical stage and treatment plan.The patient was hospitalized for 2 days because of the aggravation of abdominal distention and pain for half a year.The diagnosis of adnexal mass was confirmed by pathology.After three cycles of neoadjuvant chemotherapy (etoposide+ cisplatin), the patients underwent abdominal " total hysterectomy+ greater omentum resection+ appendectomy+ right pelvic wall peritoneal biopsy+ mesenteric biopsy" . After the operation, the patients received three cycles of EP chemotherapy, and they have been followed up for 15 months.

Treatment and prognostic analysis of patients with primary esophageal small-cell carcinoma / 中华肿瘤杂志

The study aimed to analyze the clinicopathological features, treatment, and prognosis factors of primary esophageal small-cell carcinoma (PESC). The clinical records and follow-up data of 100 patients with PESC were collected, and the clinicopathological features and treatments were examined. Log-rank test and Cox regression model were performed to identify the independent prognostic factors. Progressive dysphagia, weight loss, and abdominal pain were the most common initial symptoms in the 100 patients with PESC. The primary tumor site mainly occurred in the middle of the chest (51%, 51/100), and the ulcer type was the most common under gastroscope (31%, 31/100). One or more positive markers of epithelial origin were present in all of the enrolled patients. At the time of diagnosis, 80 cases had limited disease (LD) and 20 cases had extensive disease (ED). The 1-, 3-, and 5-year survival rates of PESC patients were 57.0%, 18.0%, and 11.0%, respectively, with a median survival time (MST) of 13.8 months. In all PESC patients, multivariate Cox regression analysis indicated that the significant prognostic factors included the lesion length (=2.661, <0.001), TNM staging (=1.464, =0.016), and treatment methods (=0.333, <0.001). Besides, in patients with LD, the lesion length (=2.638, =0.001) and treatment methods (=0.285, <0.001) were independent prognostic factors. The MST of patients in surgery + chemotherapy group (21.6 months) was longer than that of the surgery only group (8.3 months, =0.021), while patients in surgery+ chemotherapy+ radiotherapy group were also associated with a longer MST than the chemotherapy + radiotherapy group (31.0 months, 9.8 months, respectively; <0.001). PESC is a rare esophageal malignant tumor with poor prognosis. Our findings reveal that the lesion length, TNM staging, and treatment method are independent prognostic factors for PESC patients. Moreover, surgery-based comprehensive treatments may prolong the survival of patients with LD.

Clinicopathologic features, treatment, prognosis and prognostic factors of neuroendocrine carcinoma of the endometrium: a retrospective analysis of 42 cases from the Kansai Clinical Oncology Group/Intergroup study in Japan / 부인종양

OBJECTIVE: We conducted a retrospective, multi-institutional, collaborative study to accumulate cases of neuroendocrine carcinoma of the endometrium, to clarify its clinicopathologic features, treatment, prognosis and prognostic factors to collate findings to establish future individualized treatment regimens. To our knowledge, this is the largest case study and the first study to statistically analyze the prognosis of this disease. METHODS: At medical institutions participating in the Kansai Clinical Oncology Group/Intergroup, cases diagnosed at a central pathologic review as neuroendocrine carcinoma of the endometrium between 1995 and 2014 were enrolled. We retrospectively analyzed the clinicopathologic features, treatment, prognosis and prognostic factors of this disease. RESULTS: A total of 65 cases were registered from 18 medical institutions in Japan. Of these, 42 (64.6%) cases were diagnosed as neuroendocrine carcinoma of the endometrium based on the central pathological review and thus included in the study. Advanced International Federation of Gynecology and Obstetrics stages (stage III and IV) and pure type small cell neuroendocrine carcinoma cases had a significantly worse prognosis. Upon multivariate analysis, only histologic subtypes and surgery were significant prognostic factors. Pure type cases had a significantly worse prognosis compared to mixed type cases and complete surgery cases had a significantly better prognosis compared to cases with no or incomplete surgery. CONCLUSION: Our findings suggest that complete surgery improves the prognosis of neuroendocrine carcinoma of the endometrium. Even among cases with advanced disease stages, if complete surgery is expected to be achieved, clinicians should consider curative surgery to improve the prognosis of neuroendocrine carcinoma of the endometrium.

Primary Gastric Small Cell Carcinoma (Presenting as Linitis Plastica) Diagnosed Using Endoscopic Ultrasound-Guided Biopsy: A Case Report

Small cell carcinomas are the most aggressive, highly malignant neuroendocrine tumors; among these, gastric small cell carcinoma (GSCC) is extremely rare. Here we report a case of a patient with primary GSCC, presenting as linitis plastic, who was diagnosed using endoscopic ultrasound (EUS)-guided biopsy. With undiagnosed linitis plastica, an 80-year-old woman was referred to our institution. Abdominal computed tomography revealed irregular wall thickening extending from the gastric body to the antrum. Endoscopy suspected to have Borrmann type IV advanced gastric cancer. EUS of the stomach showed diffuse submucosal thickening of the gastric wall, mainly the antrum. EUS-guided bite-on-bite biopsy confirmed the diagnosis of GSCC. In general, GSCC is difficult to diagnose and careful examination is necessary to determine the therapeutic strategy; however, EUS is particularly helpful in the differential diagnosis of a lesion presenting as linitis plastica.

Neuroendocrine cells of prostate cancer: Biologic functions and molecular mechanisms / 亚洲男科学杂志(英文版)

Prostate cancer (PCa) is a major health risk for older men worldwide. Existing systemic therapies mostly target androgen receptor (AR). Although treatments are initially effective, the disease always recurs. A potential mechanism for the treatment failure is that PCa contains, in addition to the AR-positive luminal type tumor cells, a small component of neuroendocrine (NE) cells. The function of NE cells in PCa remains poorly understood, and one important characteristic of these cells is their lack of expression of AR and resistance to hormonal therapy. In addition, many patients develop the more aggressive small-cell neuroendocrine carcinoma (SCNC) after hormonal therapy. Although this clinical phenomenon of disease transformation from adenocarcinoma to SCNC is well established, the cell of origin for SCNC remains unclear. Recently, loss of function of Rb and TP53 and amplification and overexpression of MYCN and Aurora A kinase have been identified as important biomarkers and potential disease drivers. In this article, we systematically review the histology of normal prostate and prostate cancer including the main histologic types: adenocarcinoma and SCNC. We also review the findings from many studies using cellular and animal models as well as human specimens that attempt to understand the molecular mechanisms of treatment failure, disease progression, and tumor transformation from adenocarcinoma to SCNC.

Small-cell carcinoma of the prostate: A report of 2 cases and review of the literature / 中华男科学杂志

Objective@#To investigate the clinicopathological characteristics and improve the clinical treatment of prostatic small-cell carcinoma (PSCC).@*METHODS@#We reported 2 cases of PSCC derived from prostate cancer after treated by androgen blockade and prostate electrotomy and reviewed the relevant literature.@*RESULTS@#Two patients with PSA elevation were diagnosed with prostate cancer by prostatic puncture biopsy and treated by maximum androgen blockade, which reduced their total PSA to the normal level. Later, due to difficult urination, they both underwent prostate electrotomy, followed by chemotherapy or radiotherapy for PSCC confirmed by postoperative pathology. Nevertheless, they died at 8 to 9 months after the discovery of PSCC.@*CONCLUSIONS@#PSCC can derive from prostate cancer after treatment, which may be attributed to the pathological mutation induced by long-term endocrine therapy. PSCC is more malignant than prostate cancer, and its prognosis is poor.

Curative effect analysis of different clinical characteristics and treatment modalities for primary esophageal small cell carcinoma / 国际肿瘤学杂志

Objective To analyze the efficacy of different clinical characteristics and treatment modalities for patients with primary esophageal small cell carcinoma (PESC),and to find out the prognostic factors,and provide reference for clinical treatment decision.Methods Patients with PESC who were treated at Shandong Cancer Hospital Affiliated to Shandong University from January 2008 to May 2017 were retrospectively enrolled.The clinical features were collected.Their disease progression time and survival status were determined by follow-up,and the follow-up ended in October 2017.Data analysis was performed using SPSS 25.0 software,and GraphPad Prism 7.0 was used for mapping.Survival analysis was performed by Kaplan-Meier method,and log-rank test was used to compare the differences in survival curves of each group.Factors with significant differences in univariate analysis were included in the Cox multivariate survival analysis.ROC curve was used to verify the sensitivity and specificity of the model.Results A total of 83 PESC patients with a complete follow-up were included in the study,including 68 males and 15 females.The average age was 61.93 years old (41-82 years old).The median progression-free survival (PFS) was 9.1 months (1.0-60.0 months) and the median overall survival (OS) was 26.1 months (1.8-60.0 months).Cox multivariate survival analysis showed radiotherapy or not (HR=0.321,95％ C I:0.184-0.559,P ＜0.001) and chemotherapy cycles (HR =0.841,95％CI:0.737-0.960,P =0.010) were independent prognostic factors for PFS.The Veterans Administration Lung Study Group (VALSG) staging (HR =3.050,95 ％ CI:1.606-5.794,P =0.001),radiotherapy or not (HR =0.312,95％CI:0.174-0.560,P ＜0.001),and chemotherapy cycle (HR =0.711,95％ CI:0.601-0.842,P ＜0.001) were independent predictors of OS.The ROC curve showed that the sensitivity and specificity of the PFS prediction model were 78.26％ and 73.33％,and the sensitivity and the specificity of the OS prediction model were 80.00％ and 58.49％.Conclusion VALSG staging is an independent predictor of PESC survival.Comprehensive therapy based on radiotherapy and chemotherapy can improve disease control,reduce metastasis,and improve survival.

Clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection. Methods    A retrospective study of patients with resectable esophageal small cell carcinoma undergoing surgical resection from January 2009 to June 2015 in the Department of Thoracic Surgery, Sichuan Provincial Fourth People's Hospital and Department of Thoracic Surgery, West China Hospital of Sichuan University was performed. Survival analysis was conducted by Kaplan-Meier analysis and log-rank test. Cox regression model was used for identifying independent prognostic factors. Results    A total of 53 patients with resectable esophageal small cell carcinoma were included for analysis. The mean age was 58.4 ± 8.3 years and there were 42 male patients and 11 female patients. Forty-two patients were diagnosed as pure esophageal small cell carcinoma while 11 patients were diagnosed with mixed esophageal small cell carcinoma, who were all mixed with squamous cell carcinoma. Most of the esophageal small   cell carcinomas were located in the middle (58.5%) and lower (32.1%) segments of the esophagus. Thirty patients (56.6%) were found to have lymph node metastasis, and 7 patients (13.2%) were found to have lymphovascular invasion. According to the 2009 TNM staging criteria for esophageal squamous cell carcinoma, there were 12 patients with stage Ⅰ disease, 19 patients with stage Ⅱ disease, and 22 patients with stage Ⅲ disease. Most of the patients underwent left thoracotomy with two-field lymphadenectomy. Postoperatively, only twenty-two patients (41.5%) received adjuvant chemoradiotherapy. The median survival time of these patients was 20.1 months, and the 1- and 3-year survival rate was 75.5% and 33.1%, respectively. For prognosis, age, gender, pathological type, tumor location, and lymphovascular invasion had no significant impact on long-term survival of these patients. However, TNM stage (1 year survival rate: stage Ⅰ: 91.7%; stage Ⅱ: 78.9%; stage Ⅲ: 63.6%; P=0.004) and postoperative adjuvant therapy (1 year survival rate: 81.8% vs. 71.0%; P=0.005) had significant impact on the survival of patients with esophageal small cell carcinoma. In multivariate analysis, TNM stage and postoperative adjuvant therapy were independent prognostic factors for long-term prognosis of patients with esophageal small cell carcinoma. Conclusion    Esophageal small cell carcinoma is very rare, with high malignancy and poor prognosis. For patients with resectable esophageal small cell carcinoma, the TNM staging system of esophageal squamous cell carcinoma can be used to direct the choice of treatment options. For early stage esophageal small cell carcinoma (stage Ⅰ/Ⅱ), surgery plus postoperative adjuvant chemoradiotherapy can be the prior therapeutic choice, while for locally advanced esophageal small cell carcinoma (stage Ⅲ), chemoradiotherapy should be the preferred treatment.

Carcinoma neuroendocrino primario de vagina. Revisión de literatura a propósito de un caso / Primary neuroendocrine carcinoma of the vagina. Literature review on the subject of a case

RESUMEN El carcinoma primario de vagina representa 1 a 2% de los cánceres ginecológicos, siendo la diferenciación histológica neuroendocrina de células pequeñas extremadamente infrecuente, sólo se han reportado 28 casos en la literatura, describiéndose en orden de frecuencia en cérvix, endometrio, ovario, vagina y vulva. Se observa con más frecuencia en mujeres postmenopáusicas. Se presenta el caso de paciente femenino, de 39 años de edad, quien acude a la consulta por presentar secreción genital serohemática, fétida, de 1 mes de evolución, evidenciándose al examen físico lesión exofítica, friable, renitente, de aproximadamente 4 cm de diámetro, en tercio superior y cara posterolateral izquierda de vagina, por lo que se realiza biopsia excisional de dicha lesión, siendo el diagnóstico anatomopatológico carcinoma neuroendocrino de células pequeñas, grado histológico: 3. A propósito de este caso, se realiza una revisión del tema, haciendo hincapié en la importancia de la exploración ginecológica exhaustiva que incluya tomas de citologías y colposcopias periódicas, tomando en cuenta la vagina y así, realizar diagnóstico precoz en vista que el riesgo de carcinoma en dicha zona es infrecuente, mejorando el pronóstico y sobrevida de las pacientes.

ABSTRACT The primary carcinoma of the vagina represents 1 to 2 % of gynecologic cancers, being the histological differentiation neuroendocrine of small cells extremely infrequent, only 28 cases have been reported in the literature, describing in order of frequency: in the cervix, endometrium, ovary, vagina and vulva. It is most commonly seen in postmenopausal women. We present the case of a female patient, 39 years old, who comes to medical consult due to serohematic, fetid, genital discharge of 1 month of evolution, evidencing at physical examination an exophytic lesion, friable, renitent, with a diameter of approximately 4 cm, in the upper third and posterolateral left side of the vagina, for which an excisional biopsy of said lesion is performed, being the anatomopathological diagnosis neuroendocrine carcinoma of small cells, histological grade: 3. A bibliography reviewed was made, emphasizing the importance of exhaustive gynecological exploration with periodic cytology and colposcopy examinations, including the vagina for early diagnosis in view of carcinoma risk in this area is uncommon, improving the prognosis and survival of patients.

Poorly Differentiated Neuroendocrine Carcinoma of the Eyelid

PURPOSE: To report a case of poorly differentiated neuroendocrine carcinoma of the eyelid. CASE SUMMARY: A 70-year-old male presented with a 5-month history of a right upper eyelid mass. The mass appeared as 1.2 × 1.2 cm on the right upper eyelid. A mass excision was performed under frozen section control. The tumor was completely excised with a safety margin clearance and an upper eyelid reconstruction was performed. Histopathological examination revealed a tumor composed of small atypical cells which showed a high nuclear/cytoplasm ratio, nuclear molding, and increased mitotic activity. Immunohistochemical examination revealed positive reactivity for Ki-67, synaptophysin, CD56, and negative reactivity for chromogranin, cytokeratin 20, and thyroid transcription factor-1. CONCLUSIONS: Primary neuroendocrine carcinoma of the eyelid is extremely rare, but the tumor has high malignancy and readily metastasizes. Poorly differentiated neuroendocrine carcinoma should be considered in the differential diagnosis of a rapidly growing eyelid mass.

Expression of tissue neuronal cell adhesion molecule 56, chromogranin A, and synapto-physin and its relationship with clinicopathological features and prognosis in 92 Chi-nese patients with primary esophageal small cell carcinoma / 中国肿瘤临床

Objective:To investigate the expression level of synaptophysin (Syn), tissue neuronal cell adhesion molecule 56 (CD56) and chromogranin A (CgA) in 92 primary esophageal small cell carcinoma (PESC) and to explore its repationship with clinicopathological features and clinical outcome. Methods:Immunohistochemical studies of CD56, CgA, and Syn were performed in 92 paraffin-embed-ded tissues with clinical-related information obtained from 500,000 esophageal and gastric cardia carcinoma databases established by Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University in Henan, China. Binary logistic regression was used to analyze the correlations of CgA, Syn, and CD56 expression with clinicopathological features. Kaplan-Mei-er survival analysis and Cox proportional hazards regression models were performed for univariate and multivariate survival analyses. Log-rank test was used to compare the difference in survival rates. Results:The CgA-positive expression rate in PESC at lower segment of esophagus (72.2%) was higher than those at the middle and lower segments (41.1%, 10.0%) (P=0.001). The expression level of CD56, CgA, and Syn was not correlated with gender (P=0.262, 0.998, 0.931), age (P=0.250, 0.998, 0.703), tumor invasion (P=0.253, 0.997, 0.061), and lymph node metastasis (P=0.767, 0.998, 0.613). Univariate analysis showed no survival influence in patients with and without lymph node metastasis (P=0.563). Multivariate survival analysis showed that patients with PESC mixed squamous cell car-cinoma (HR=2.58;95%Cl, 1.11-5.98) and higher CgA protein expression (HR=1.87;95%Cl, 1.02-3.43) exhibited a longer survival time than those with pure PESC and without CgA expression. Conclusion:Tissue CgA level was associated with tumor location in PESC. His-tological type and tissue CgA expression were independent important prognostic factors, and lymph node metastasis exerted no influ-ence on survival in PESC.