Role of apparent diffusion coefficient measurement in differentiating histological subtypes of brain metastasis of lung cancer

SUMMARY OBJECTIVE: The aim of this study was to investigate the role of apparent diffusion coefficient of diffusion-weighted imaging in differentiating histological subtypes of brain metastasis of lung cancer. METHODS: Diffusion-weighted imaging of 158 patients (mean age: 61.2±10.68 years) with brain metastasis of lung cancer (36 small cell lung cancer and 122 non-small cell lung cancer) were retrospectively evaluated. The minimum and mean apparent diffusion coefficient values of the metastasis, apparent diffusion coefficient of edema around the metastasis, and apparent diffusion coefficient of contralateral brain parenchyma were measured. Normalized apparent diffusion coefficient was calculated by proportioning the mean apparent diffusion coefficient of the metastasis to the apparent diffusion coefficient of the contralateral brain parenchyma. Minimum and mean apparent diffusion coefficient of the metastasis, apparent diffusion coefficient of edema around metastasis, and normalized apparent diffusion coefficient were compared between small cell lung cancer and non-small cell lung cancer metastases. RESULTS: Minimum apparent diffusion coefficient, mean apparent diffusion coefficient, and normalized apparent diffusion coefficient values of small cell lung cancer metastases (0.43±0.19×10−3mm2/s, 0.63±0.20×10−3mm2/s, and 0.81 [0.55-1.44], respectively) were significantly lower than those of non-small cell lung cancer metastases (0.71±0.26×10−3mm2/s, 0.93±0.29×10−3mm2/s, and 1.30 [0.60-3.20], respectively; p<0.001). Mean apparent diffusion coefficient of edema of small cell lung cancer metastases (1.21±0.28×10−3mm2/s) was significantly lower than that of non-small cell lung cancer metastases (1.39±0.26×10−3mm2/s, p=0.020). The best cutoff values of minimum apparent diffusion coefficient, mean apparent diffusion coefficient, normalized apparent diffusion coefficient, and apparent diffusion coefficient of edema for the differentiation of small cell lung cancer and non-small cell lung cancer were found to be 0.56×10−3mm2/s, 0.82×10−3mm2/s, 1.085, and 1.21×10−3mm2/s, respectively. The area under the receiver operating characteristic curve, sensitivity, and specificity values were, respectively, 0.812, 80.6, and 73.8% for minimum apparent diffusion coefficient; 0.825, 91.7, and 61.5% for mean apparent diffusion coefficient; 0.845, 80.6, and 73.8% for normalized apparent diffusion coefficient; and 0.698, 75.0, and 67.7% for apparent diffusion coefficient of edema. CONCLUSIONS: Minimum apparent diffusion coefficient, mean apparent diffusion coefficient, normalized apparent diffusion coefficient, and apparent diffusion coefficient of edema around metastasis can differentiate histological subtypes of brain metastasis of lung cancer.

Estado actual del condrosarcoma en un centro de referencia / Current status of chondrosarcoma in a reference center

Resumen: Introducción: El condrosarcoma es el segundo tumor óseo maligno primario más frecuente, se caracteriza por la formación de matriz condroide, es más común en edades avanzadas y su pronóstico guarda relación directa con el subtipo histológico y el grado tumoral. El objetivo de este artículo es presentar el perfil demográfico y de tratamiento en un centro de referencia. Material y métodos: Se realizó un estudio retrospectivo, descriptivo, observacional, analítico de tipo cohorte en un centro de referencia entre el 01 de Enero de 2005 y el 31 de Diciembre de 2019, se analizaron las variables demográficas y se contrastaron con las variables de desenlace que fueron supervivencia global y período libre de enfermedad. Resultados: Se incluyeron 85 pacientes, la media edad de presentación fue 43.3 años, la etapa clínica al momento de la presentación fue mayormente IIa y IIb abarcando 54.1%, 35 pacientes tuvieron metástasis con etapa clínica IV. El principal sitio de metástasis fue el pulmón en 32 pacientes (37.6%). De los pacientes, 36 (42.3%) presentaron mortalidad cáncer específica, 35 (41.2%) fallecieron como consecuencia de la enfermedad metastásica a pulmón u otros órganos y un paciente falleció por extensión directa del tumor en columna cervical. Conclusión: Los factores pronósticos importantes hallados en nuestra serie que influyen en la supervivencia global son: la presencia de metástasis y la localización axial.

Abstract: Introduction: Chondrosarcoma is the second most frequent primary malignant bone tumor, is characterized by the formation of a chondroid matrix, is more frequent in advanced ages and its prognosis is directly related to the histological subtype and tumor grade. The objective of this article is to present the demographic and treatment profile in a reference center. Material and methods: A retrospective, descriptive, observational, analytical cohort-type study was conducted in a reference center between January 1, 2005 and December 31, 2019, the demographic variables were analyzed and contrasted with the outcome variables that were overall survival and disease-free period. Results: 85 patients were included, the mean age of presentation was 43.3 years, the clinical stage at the time of presentation was mostly IIa and IIb covering 54.1%. 35 patients had metastases with clinical stage IV. The main site of metastasis was the lung in 32 patients (37.6%). Thirty-six patients (42.3%) had specific mortality. 35 patients (41.2%) died as a result of metastatic disease to lung or other organs, one patient died from direct extension of the tumor in the cervical spine. Conclusion: The important prognostic factors found in our series that influence global survival are: the presence of metastases and axial localization.

Association between baseline SUVmax and histological subtypes of ≤2 cm early peripheral lung adenocarcinoma / 中国胸心血管外科临床杂志

@#Objective    To investigate the association between the baseline 18F-FDG PET/CT SUVmax and histological subtypes of ≤2 cm early peripheral lung adenocarcinoma (cN0). Methods    We retrospectively reviewed the clinical data of consecutive patients who received baseline 18F-FDG PET/CT and underwent anatomic lung resection for ≤2 cm early peripheral lung adenocarcinoma from 2011 to 2014 in our institute. Results    A total of 195 patients were enrolled in this study, including 86 males and 109 females, with an average age of 59.96±9.19 years. Twenty-two patients were pathologically confirmed with lymph node metastasis. One hundred and fifty-seven patients were in the subtype group 1, which included lepidic, acinar, and papillary predominant tumors. Thirty-eight patients were in the subtype group 2, which included solid and micropapillary predominant tumors. The 5-year survival rate was 79.0% and 58.0% in the subtype group 1 and subtype group 2, respectively (P=0.006). The median SUVmax was 2.00 (0.30-13.10) and 4.15 (1.20-17.90) in the subtype group 1 and subtype group 2, respectively (P=0.000). Logistic regression suggested that baseline SUVmax≥2.5 was an independent risk factor for the subtype group 2 (OR=6.635, 95%CI 2.510-17.545, P=0.000). The receiver operating characteristic curve suggested that the continuous SUVmax had an moderate predictive value for subtypes (area under the curve was 0.792, 95%CI 0.717-0.866). Conclusion    Baseline 18F-FDG PET/CT SUVmax has certain predictive value for histological subtypes of ≤2 cm early peripheral lung adenocarcinoma.

Correlation between histological subtypes of invasive lung adenocarcinoma and epithelial growth factor receptor (EGFR) gene mutation / 中国胸心血管外科临床杂志

@#Objective    To investigate the correlation between histological subtypes of invasive lung adenocarcinoma and epithelial growth factor receptor (EGFR) gene mutation, and to provide a reference for clinical prediction of EGFR gene mutation status. Methods    From October 2017 to May 2019, 102 patients with invasive lung adenocarcinoma were collected, including 58 males and 44 females aged 62 (31-84) years. Invasive lung adenocarcinoma was classified into different histological subtypes. Scorpion probe amplification block mutation system (ARMS) real-time PCR was used to detect the mutation of EGFR gene in adenocarcinoma specimens, and the relationship between invasive lung adenocarcinoma subtypes and EGFR mutation status was analyzed. Results    In 102 patients with invasive lung adenocarcinoma, EGFR gene mutations were detected in 68 patients, and the mutation rate was 66.7% (68/102). The mutation sites were mainly concentrated in the exons 19 and 21; the mutation rate was higher in female patients (34/44, 77.3%) and non-smokers (34/58, 58.6%). EGFR mutation was mostly caused by acinar-like invasive lung adenocarcinoma, and was rare in solid-type lung adenocarcinoma. The EGFR gene mutation rates in different subtypes of adenocarcinoma were statistically different (P<0.05). Conclusion    The EGFR mutation status is related to gender, smoking status and histological subtype of invasive lung adenocarcinoma. EGFR mutation rates are higher in female, non-smoking and acinar-like invasive lung adenocarcinoma patients, and are lower in patients with solid type lung adenocarcinoma.

Clinical Features and Recurrence Rate of Basal Cell Carcinomas Treated with Surgical Excision / 대한피부과학회지

BACKGROUND: Basal cell carcinoma is the most common form of skin cancer. Surgical excision is commonly used as the therapeutic modality. However, there is insufficient data on the prognosis of Korean patients who have undergone surgical excision for basal cell carcinoma. OBJECTIVE: We therefore retrospectively analyzed the effectiveness of surgical excision in patients with basal cell carcinoma and compared it with previous studies. METHODS: From 2009 to 2015, we enrolled 138 patients with primary basal cell carcinoma who underwent surgical excision and analyzed the recurrence rate, clinical features, surgical procedures, and histopathological subtypes. RESULTS: The case series comprised 138 patients (M:F=1:1.51) with a mean age of 68.7 years. Recurrence after surgical excision was diagnosed in 0 of the 138 patients with a mean follow-up period of 47.5 months (12~93 months). The mean tumor diameter and surgical margin were 0.9 cm and 3.1 mm, respectively. Most tumors (85.5%) were of the nodular subtype. Primary closure was used most often to repair the surgical defects (44.9%). CONCLUSION: Surgical excision may be a satisfactory method for the treatment of primary basal cell carcinomas, especially in non-high-risk cases.

Dermatofibrosarcoma Protuberans: A Study of Clinical, Pathologic, Genetic, and Therapeutic Features in Korean Patients

PURPOSE: Dermatofibrosarcoma protuberans (DFSP) carries a translocation resulting in the collagen type I alpha 1 (COL1A1)-platelet-derived growth factor beta (PDGFB) fusion gene, which is responsible for PDGFB activation. The purpose of this study is to evaluate the clinicopathological, genetic, and therapeutic features of DFSP in Korean patients. MATERIALS AND METHODS: Clinicopathological features of 37 patients with DFSP were reviewed. Multiplex reverse transcriptase-polymerase chain reaction (PCR) was carried out in 16 patients using formalin-fixed, paraffin-embedded tissues and specific primers for COL1A1 and PDGFB. RESULTS: The mean age of 37 patients was 37.4 years old. The most common tumor location was the trunk. All patients were treated primarily with surgery: 34 (91.7%) cases with Mohs micrographic surgery (MMS) and 3 (8.3%) cases with wide local excision. The median follow-up time was 33.7 months. Two patients, one in each treatment group, demonstrated local recurrence during the follow-up period. The COL1A1-PDGFB fusion gene was expressed in 14 (87.5%) cases, demonstrated by reverse transcriptase PCR analysis. No association was found among the different COL1A1-PDGFB fusion transcripts, the various histological subtypes and clinical features. CONCLUSION: Our results support the effectiveness of MMS in treating DFSP. The COL1A1-PDGFB fusion transcript was observed in 87.5% of patients. Therefore, COL1A1-PDGFB is a useful and accurate tool in diagnosing DFSP in Koreans.

Dermatofibrosarcoma Protuberans: A Study of Clinical, Pathologic, Genetic, and Therapeutic Features in Korean Patients

PURPOSE: Dermatofibrosarcoma protuberans (DFSP) carries a translocation resulting in the collagen type I alpha 1 (COL1A1)-platelet-derived growth factor beta (PDGFB) fusion gene, which is responsible for PDGFB activation. The purpose of this study is to evaluate the clinicopathological, genetic, and therapeutic features of DFSP in Korean patients. MATERIALS AND METHODS: Clinicopathological features of 37 patients with DFSP were reviewed. Multiplex reverse transcriptase-polymerase chain reaction (PCR) was carried out in 16 patients using formalin-fixed, paraffin-embedded tissues and specific primers for COL1A1 and PDGFB. RESULTS: The mean age of 37 patients was 37.4 years old. The most common tumor location was the trunk. All patients were treated primarily with surgery: 34 (91.7%) cases with Mohs micrographic surgery (MMS) and 3 (8.3%) cases with wide local excision. The median follow-up time was 33.7 months. Two patients, one in each treatment group, demonstrated local recurrence during the follow-up period. The COL1A1-PDGFB fusion gene was expressed in 14 (87.5%) cases, demonstrated by reverse transcriptase PCR analysis. No association was found among the different COL1A1-PDGFB fusion transcripts, the various histological subtypes and clinical features. CONCLUSION: Our results support the effectiveness of MMS in treating DFSP. The COL1A1-PDGFB fusion transcript was observed in 87.5% of patients. Therefore, COL1A1-PDGFB is a useful and accurate tool in diagnosing DFSP in Koreans.

Clinical Features of Basal Cell Carcinoma according to Histological Subtype / 대한피부과학회지

BACKGROUND: Basal cell carcinoma (BCC) is a slow-growing, locally invasive malignant epidermal skin tumor. Several studies of differences in age, site distribution and male to female ratio have been conducted among different histological subtypes of BCC. OBJECTIVE: We analyzed the five major subtypes of BCC with regard to gender, age, and anatomical distribution. METHODS: We retrospectively included 246 cases of BCC diagnosed from January 2000 to March 2011. The diagnoses and classifications of histopathological subtypes (nodular, superficial, micronodular, infiltrative, or morphemic) of BCC were confirmed by three dermatologists. Gender, age at diagnosis, and location were recorded and analyzed by histopathological subtypes. RESULTS: We recorded 246 cases (M : F=11.08) with a mean age of 64.0 years. Of the BCCs, 61.0% were nodular, 15.4% were superficial, 11.4% were micronodular, 10.2% were infiltrative, and 2.0% were morpheic. The nodular subtype was diagnosed at a mean age of 64.9 years, whereas the superficial subtype was diagnosed at an earlier age (60.3 years) and more frequently occurred in women (M : F=1 : 1.5) than the nodular subtype. Compared with the nodular subtype (4%), the superficial subtype (26.3%) occurred more frequently in the trunk (p-value<0.0001). CONCLUSION: The results showed differences in anatomical distribution, gender, and mean age according to histological subtypes. Superficial BCC occurred more commonly on the trunk, more often in women, and was seen in younger patients than that of the nodular subtype.

Prognostic value of WHO histological subtype and Masaoka clinical stage in postoperative radiotherapy for thymoma / 中华放射肿瘤学杂志

ween WHO histological subtype and Masaoka clinical stage, and their combination is valuable for guiding postoperative treatment in thymoma.

Falx Meningiomas: Surgical Results and Lessons Learned from 68 Cases

OBJECTIVE: The purpose of this study was to review the characteristics of falcine meningioma retrospectively and to identify the parameters associated with tumor recurrence. METHODS: The analysis included; age, sex, extent of resection, and radiologic and pathologic findings. Falcine meningiomas were classified by location as anterior, middle, or posterior as described for parasagittal meningiomas. RESULTS: Of the 795 meningioma patients treated between 1990 and 2004 at the authors' institution, 68 patients with meningiomas arising from the falx underwent craniotomies. There were 22 male and 46 female patients (1 : 2.1). Mean age was 55 years and ranged from 14 to 77 years. Locations of falcine meningioma were; the anterior third in 33 cases, middle in 20, and posterior in 15. Mean tumor volume was 42 cc and ranged from 4 to 140 cc. In 58 of the 68 patients tumors were totally removed. Additional surgery for recurrence was performed in 6 patients over 15 years. Of these 6 patients, only two patients underwent gross total tumor resection at first operation; the other four underwent subtotal tumor resection. Based on pathologic reports, the largest tumor subtype was transitional. There were four patients with a high grade tumor-three atypical and one anaplastic meningioma. Of the 68 patients, 59 achieved a good outcome (no neurological deficit or recurrence), six had temporary complications, two suffered new permanent postoperative deficits, and the remaining one died due to severe brain swelling despite postoperative intensive care. Extent of surgical resection was found to be significantly related to tumor recurrence. CONCLUSION: Falcine meningioma accounted for 8.5% of intracranial meningiomas and the transitional meningioma was the most common subtype of falcine meningioma. Gross total resection of tumor was the single most important predictor of an improved surgical outcome.