Sonologic features of vulvar cancer and lymph node status among patients at a tertiary hospital - A 10‑year review / Philippine Journal of Obstetrics and Gynecology

Context@#Vulvar cancers are rare gynecologic tumors. Ultrasound can characterize primary tumors and guide the biopsy of suspicious nodes. Currently, there are no studies on the sonologic features of different vulvar cancer types.@*Aims@#The aim is to determine the sonologic features of different vulvar malignancies. To compare the accuracy of ultrasound in identifying lymph node status.@*Settings and Design@#This is a retrospective descriptive study.@*Subjects and Methods@#Patient records, ultrasound images, and reports of vulvar cancer with long‑ and short‑axis (L/S) ratio of inguinal nodes were reviewed from the year 2010 to 2019. @*Statistical Analysis Used@#The accuracy of ultrasound to detect lymph nodes and the correlation of L/S ratio to histopathology were done. @*Results@#The study included 49 patients. The most common histopathologies were squamous cell carcinoma (SCCA), vulvar melanoma (VM), and adenocarcinoma (ADCA). Most tumors were > 4 cm, unifocal, and lateral in location. SCCA, verrucous carcinoma, VM, ADCA, adenosquamous carcinoma (ASCA), eccrine carcinoma (ECCA), and carcinosarcoma (CS) were irregular heterogeneous masses. Leiomyosarcoma (LMS) and proximal‑type epithelioid sarcoma (PES) were regular, heterogeneous masses. Paget’s disease of the vulva (PDV) was hypoechogenic with regular borders. Vascularities were absent in PDV and LMS, minimal in ECCA, moderate in ASCA and PES, moderate to abundant in CS, and variable in VM. The accuracy of ultrasound in detecting lymph nodes was 78%; the accuracy of the L/S ratio was 75%. Tumor border and FIGO stage showed significant association with histopathologic type.@*Conclusions@#Sonologic features and accuracy of ultrasound in predicting lymph node status help prognostication in vulvar cancer. Nodal morphometric studies are recommended for future researches.

Evaluation of the histopathologic status of rectal adenocarcinoma and its regional lymph nodes after neoadjuvant therapy, and its relation to the duration of disease-free survival

Introduction: Colorectal cancer is one of the most common malignant tumors and has a relatively poor prognosis. Lymph node involvement is considered the most important prognostic factor. Materials and Methods: During a retrospective cohort study, 132 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2010 to 2015 in Sina hospital were reviewed. Results: Multivariable analysis was performed and shown the clinical stage was not a representative factor for disease-free survival (P = 0.187), but Dworak Tumor Regression Grading were significantly associated with higher disease-free survival (P = 0.000) in stage II and stage III. The total number of retrieved lymph nodes and involved lymph nodes in the same clinical stage were statistically associated with higher mean disease-free survival in patients (P = 0.000 in both conditions). Conclusion: In the same clinical stage, increasing the Dworak Tumor Regression Grading reduced the risk of rectal cancer recurrence. Increasing total number of retrieved lymph nodes and involved lymph nodes, 2.14 times and 3.87 times increased the risk of recurrence, respectively.

Predictive value of postoperative lymph node status for adjuvant therapy in esophageal cancer patients after radical resection / 中国肿瘤临床

Objective: To analyze the predictive value of postoperative lymph node status for adjuvant therapy in esophageal cancer patients after radical resection. Methods: The indexes related to postoperative lymph node of 354 patients with esophageal carcinoma, who underwent radical surgery during a period between January 2007 and December 2010, were retrospectively analyzed. Univariate analysis was performed by Log-rank test and multivariate analysis by a Cox regression model. Results: The 1-, 3- and 5-year overall survival (OS) rates were 84.46%, 64.12% and 54.06%, respectively, and the median survival time was 86.49 months. The 5-year OS rate of N0, N1, N2 and N3 stage patients were 93.13%, 55.50%, 19.80% and 3.45%, respectively. And it is obviously different from each other in PN stage (χ2=225.161, P8.51% were 81.63% and 23.40%, respectively. There were significant differences between the two groups (χ2=143.504, P8.51% groups with adjuvant therapy showed a significantly better survival than those with surgery alone and without adjuvant therapy (χ2=12.609, P8.51% who had undergone adjuvant therapy showed a significantly better survival than those with simple surgery and without adjuvant therapy (χ2=12.609, P<0.001). Conclusions: The combination of PN stage and LNR as a better factor for predicting the prognosis of patients with esophageal cancer after radical resection can predict the value of adjuvant therapy. The patients with PN2 stage and higher LNR should choose postoperative adjuvant therapy.

Expression of clusterin in colorectal carcinoma in relation to clinicopathological criteria

Background/Aim: Colorectal carcinoma (CRC) carries a high incidence of morbidity and mortality.Prognosis is related to nodal metastasis and stage. Clusterin is a widely distributed glycoproteinwith not yet fully understood functions. Clusterin may be overexpressed in some tumours or underexpressed in other tumours. The aim behind this study is to examine the relation of clusterincytoplasmic immunostaining to tumour characteristics, disease relapse, and survival in CRC. Materialsand Methods: Paraffin blocks of 133 CRCs were retrieved from the Department of Pathology,King Abdulaziz University, Jeddah, Saudi Arabia. Immunostaining was done using antibody toclusterin. Staining expression in 10% of malignant cells was used as a cut-off to determine lowimmunostaining and high immunostaining. Statistical tests were used to evaluate the association ofclusterin immunostaining with clinicopathological parameters. Results: Immunohistochemical resultsshowed clusterin low immunostaining in CRC and nodal metastases. No association was foundbetween clusterin immunostaining and tumour grade, age, tumour invasiveness, distant metastases,vascular invasion, nodal metastases, relapse, and survival. Conclusion: Our study showed low clusterinimmunostaining in CRC with lack of association with prognostic indicators in CRC. These resultsraise the controversy of understanding the role of clusterin in CRC. Further molecular studies arerequired to explore more about possible mechanisms of clusterin association with tumorigenicity,apoptosis, tumour growth progression, local and vascular invasion, and metastasis of CRC.

Expression of vimentin in breast carcinoma, its correlation with Ki67 and other histopathological parameters.

CONTEXT: Vimentin is a mesenchymal marker, known to express in some epithelial carcinomas. AIMS: 1. To find out the expression of vimentin in infiltrating ductal carcinoma of breast (not otherwise specified), 2. To find out the correlation between expression of vimentin and prognostic markers such as tumor size, tumor grade, lymph node status, proliferation index (measured by Ki 67), and Nottingham prognostic index (NPI). MATERIALS AND METHODS: Study was done at Department of Pathology; 50 cases of infiltrating ductal carcinoma (NOS) were studied for tumor grade; immunohistochemistry was done using antibodies against vimentin and Ki 67. Percentages of positive cells were documented. An immunoscore was also calculated for vimentin. Vimentin expression was correlated with tumor size, lymph node status, Nottingham prognostic index, and Ki 67. Statistical analysis used: statistical correlation was done using Pearson’s chi-square test. A P value less than 0.01 was considered significant. RESULTS: Vimentin expression was seen in 18% of cases. Its expression correlated with high tumor grade and high growth fraction (P value < 0.01). It did not correlate with lymph node status, tumor size, and NPI. CONCLUSIONS: Increased vimentin expression is associated with bad prognostic factors. Immunohistochemistry with vimentin may be helpful in knowing the prognosis in cases of infiltrating ductal carcinoma of breast (NOS).

Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens.

Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise. Objective: The aim of this study was to acquire information about the extent and spread of breast carcinoma in our patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. Materials and Methods: One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases. Results: Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20%) were grade 3. Also, 9 cases (7.5%) were T1 (4 were T1b, and 5 were T1c); 53 (44.16%) were T2; 50 (41.66%) were T3; and 8 (6.66%) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23%) lymph nodes were negative for metastases pN0; 29 (27.10%) cases were pN1; 26 (24.30) were pN2; and 25 cases (23.36%) were pN3. Extranodal spread was present in 56 (70%) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33%). Vascular invasion was present in 43 out of 120 cases (35.83%). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1%) indicating poor prognosis. Conclusion: The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). The findings show extensive and advanced disease trends in our patients.

Recurrencia de cáncer de mama en mujeres del Noroeste de México / Recurrence of breast cancer in women residing in northwestern Mexico

Introducción: La recurrencia del cáncer de mama se ha definido como la presencia de un nuevo tumor local o distante después de un año del tratamiento inicial. El objetivo de este estudio fue evaluar la prevalencia y características de la recurrencia de cáncer de mama en mujeres con diagnóstico de cáncer de mama en el noroeste de México. Material y métodos: Estudio transversal en una cohorte de seguimiento de mujeres con cáncer de mama, para conocer la prevalencia de la recurrencia de la enfermedad. Se analizó edad, etapa del tumor, estado ganglionar axilar, tipo de tumor, grado histológico, receptores de estrógenos, progesterona y proteína HER2, tratamiento y muerte. Resultados: Se incluyeron 397 mujeres, observándose 23 % de recurrencia en un seguimiento a cinco años, con mayor frecuencia en los casos en que al diagnóstico estaban en etapa III de la enfermedad (48 %; OR = 3.54, p = 0.0001), ante metástasis a ganglios linfáticos axilares (21 %; OR = 1.12, p = 0.05) y positividad a receptores de estrógenos (19 %; OR = 0.64, p = 0.07) y proteína HER2 (28 %; OR = 1.53, p = 0.08). Treinta y cinco de 121 mujeres que recibieron terapia endocrina presentaron recurrencia (29 %; OR = 1.63, p = 0.04) y 15 de 30 que recibieron trastuzumab (50 %; OR = 3.89, p = 0.01). La muerte ocurrió en 77 % de los casos de recurrencia de la enfermedad (OR = 12.66, p = 0.001). Conclusiones: En el cáncer de mama en etapa tardía, la expresión positiva del HER2 en mujeres con receptores de estrógenos positivos y metástasis a ganglios axilares se asocia con mayor frecuencia de recurrencia y muerte.

BACKGROUND: Recurrence of breast cancer has been defined as the presence of a new local or distant tumor after a year of initial treatment. The aim of this study was to assess the prevalence and characteristics of breast cancer recurrence in women diagnosed with breast cancer in northwestern Mexico. METHODS: We designed a cross-sectional study in a cohort of women with breast cancer to determine the prevalence of disease recurrence. We analyzed age, tumor stage, axillary lymph node status, type of tumor, histological grade, estrogen receptor (ER), progesterone receptor (PR) and protein HER2, treatment used and death. RESULTS: We included 397 women with 23% recurrence of the total number who were followed for up to 5 years. There was a higher frequency of recurrence in those cases where diagnosis was stage III of the disease (48%; OR = 3.54; p = 0.0001), axillary lymph node metastases (21%; OR = 1.12; p = 0.05), ER positive (19%; OR = 0.64; p = 0.07) and HER2 protein (28%; OR = 1.53; p = 0.08). Of 121 women who received endocrine therapy, 35 had recurrence (29%; OR = 1.63; p = 0.04) and 15/30 women who received trastuzumab presented recurrence (50%; OR = 3.89; p = 0.01). Death was reported in 77% of cases of disease recurrence (OR = 12.66; p = 0.001). CONCLUSIONS: In the late stage of breast cancer, HER2-positive expression in women with ER positive, axillary node involvement and metastases is associated with a higher frequency of recurrence and death.

Recurrencia y supervivencia en cáncer mamario temprano con inmunofenotipo triple-negativo / Recurrence and survival rates among early breast cancer cases with triple negative immunophenotype

Antecedentes: El estado ganglionar axilar, la expresión de los receptores hormonales y del HER2 son importantes factores pronóstico en cáncer de mama temprano. El inmunofenotipo triple negativo (HER2 y receptores hormonales negativos) se ha asociado con mayor frecuencia de recurrencia y menor tiempo de supervivencia. El objetivo de esta investigación fue evaluar el comportamiento clínico, recurrencia y supervivencia en mujeres con cáncer de mama temprano-triple negativo y otros inmunofenotipos. Material y métodos: Estudio retrospectivo de mujeres en etapas IIIB, mayores de 18 años, en quienes se determinó la expresión de la proteína HER2, receptores de estrógeno y de progesterona a través de inmunohistoquímica. Se identificaron cinco grupos: triple negativo, triple positivo, HER2 negativo y receptores hormonales positivos, HER2 positivo y receptores hormonales negativos, HER2 negativo y un receptor hormonal positivo. En cada caso se analizó la edad, fecha del diagnóstico, etapa clínica, tamaño tumoral, estado ganglionar axilar, receptores de estrógenos, progesterona, HER2, p53, angiogénesis, Ki67, tipo de cirugía realizada, tratamiento adyuvante, tiempo a la recurrencia, número y sitios de la recurrencia, así como el tiempo de sobrevida global. Resultados: 17 pacientes (15.4%) manifestaron el fenotipo triple negativo; 14 (12.7%), triple positivo; 52 (47.3%) en el grupo 3, 11 (10%) en el 4 y 16 (14.5%) en el grupo 5. El fenotipo triple negativo se asoció con proliferación celular aumentada (p<0.000), menor edad (mediana 43 años), mayor tamaño tumoral (mediana 2.5 cm) y menor proporción de pacientes en etapa I, así como mayor frecuencia de expresión positiva de la proteína p53 (78.5%). Observamos mayor frecuencia de recurrencia y de muerte en el grupo triple negativo y en HER2 positivo con receptores hormonales negativos. Conclusiones: El cáncer de mama triple negativo se presenta en mujeres jóvenes y se asocia con proliferación celular aumentada, induce mayor incidencia de recurrencia y de mortalidad. El comportamiento biológico del cáncer de mama con fenotipo triple negativo es agresivo y similar al observado en pacientes con HER2 positivo y receptores hormonales negativos.

BACKGROUND: Axillary lymph node status, hormonal receptors (HR) and HER2 expression are significant prognostic factors for early breast cancer. Triple negative immunophenotype (HER2 and HR negative) is associated with a high frequency of recurrence and lower overall survival. The objective was assess clinical behavior, recurrence and survival of patients with triple negative early breast cancer and patients with other immunophenotypes. MATERIAL AND METHODS: We carried out a retrospective study among women with stages I-IIB over 18 years with determination of HR and HER2 expression by immunohistochemical assay. We identified 5 groups: triple negative, triple positive, HER2 negative & HR positive, HER2 positive & HR negative, HER2 negative & 1 HR positive. We recorded age, date of diagnosis, clinical stage, tumor size, axillary lymph node status, ER, PR, HER2, p53, angiogenesis, Ki67, type of surgery, adjuvant treatment, time to recurrence, number and recurrence site and overall survival. RESULTS: 17 patients (15.4%) had triple negative phenotype, 14 (12.7%) triple positive, 52 (47.3%) were localized in group 3, 11 (10%) in 4 and 16 (14.5%) in group 5. Triple negative phenotype was associated with increased cellular proliferation (p < 0.000); being young (median 43 years), large tumor size (median size 2.5 cm) lower proportion of patients in stage I and high frequency of p53 positive (78.5%). We observed a high frequency of recurrence and death among the triple negative group and among the HER2 positive and HR negative cases. CONCLUSIONS: Triple negative breast cancer is more common among young women and is associated with a high frequency of recurrence and mortality. Clinical behavior among triple negative breast cancer cases is aggressive and displays a similar clinical profile that observed among HER2 positive and HR negative patients.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

Analysis of Postoperative Survival and Prognostic Factors in Breast Cancer

We reviewed 723 breast cancer patients treated between Jan. 1981 and Dec. 1991 at the Department of Surgery, Seoul National University Hospital. Survival curves were constructed using the life table method. The significance of the differences in the survival patterns was determined by the log-rank test in univariate analysis, by the Cox proportional hazards regression test in multivariate analysis. Distribution of the patients and the survival rate between this patients and 802 breast cancer patients from Jan. 1970 to Dec. 1988 were compared using paired sample t-test. The mean age of the patients was 46.9 years, and the most prevalent age group was the 5th decade. The distribution of patients according to the tumor stage showed no meaningful change from our previous study. The overall 5-year and 10-year survival rate were 80.1%, 68.4% respectively. On univariate analysis, tumor size, lymph node status, number of lymph node metastasis and stage were found to influence survival significantly. On multivariate analysis, tumor size(p=0.0004), lymph node status (p=0.0231) were found to be significant prognostic factors. In conclusion, the increased proportion of early stage breast cancer patients, although not statistically significant, seems to account for the slight improvement of the overall survival compared to that of our previous study. The tumor size and the lymph node status were potential prognostic factors on survival, a result which is as that of our previous study.

p53 Protein Expression in Infiltrating Ductal Carcinoma of the Breast

Overexpression of the nuclear phosphoprotein p53 is the most common genetic anomaly found in primary human cancer and mutation of the tumor suppressor gene p53 has been identified in breast cancer cell lines. In this study, we evaluated the prognostic significance of p53 protein expression in patients with mammary infiltrating ductal carcinoma and its correlation with histopathologic grade, lymph node status, tumor size, p53 protein expression and survival. Among 53 cases, p53 protein expression was detected in 26(49.1%) cases by immunohistochemistry. There was no correlation between p53 protein overexpression and histopathologic grade(p=0.09) or lymph node status(p=0.38) and between survival and histopathologic grade (p=0.68) or lymph node status(p=0.52). However, p53 protein expression was significantly correlated with survival(p=0.01) and patients with p53 protein-positive tumors showed poorer survival times. But Cox multivariate analysis showed the lymph node status is significant(p=0.01). The authors conclude that the presence of mutant p53 protein and lymph node status may serve a prognostic role, in a subset of mammary infiltrating ductal carcinoma cases.