Clinical characteristics of 272 437 patients with different histopathological subtypes of primary esophageal malignant tumors / 中华内科杂志

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Metaplastic breast carcinoma: series of cases and literature review

Introduction: Metaplastic breast carcinoma is a heterogeneous group of infrequent invasive carcinomas with aggressive behavior. It presents differentiation from the neoplastic ductal epithelium to squamous and/or sarcomatous mesenchymal component, through the epithelial-mesenchymal transition process, and may present morphology of epithelioid and fusiform cells, with possible cartilage, bone, lipomatous, fibromatous, smooth muscle or skeletal muscle differentiation, among others. Most of the cases present the triple-negative immunohistochemical profile. Objective: To report three cases of metaplastic carcinomas, with an emphasis on clinical and pathological aspects, in addition to conducting a literature review on this topic. Methods: The three cases were registered in the internal search system for reference services in breast pathology in São Paulo, between 2012 and 2019. For literature review, the keywords metaplastic carcinoma, breast, cancer, review, breast cancer subtype and pathological and clinical outcomes were used in PubMed. We found 154 articles, of which 42 were selected for full reading, based on the abstract and established inclusion criteria. After this initial selection, these articles were read and reviewed; nine articles that did not meet the inclusion criteria were excluded. Discussion: Three cases of metaplastic carcinoma with similar immunohistochemical characteristics have been reported. The first case is that of a 40-year-old patient with the diagnosis of metaplastic carcinoma producing a chondroid matrix with liposarcomatous and osteosarcomatous differentiation. The second case is that of a 50-year-old patient who presented with the final diagnosis for a fusocellular metaplastic carcinoma with lymph node metastasis. Finally, the third case described is that of a 59-year-old patient, who presented metaplastic carcinoma with chondroid differentiation. Conclusion: Metaplastic carcinoma is a rare and aggressive type of breast cancer, in which most of the patients have shorter survival and worse prognosis in relation to the other subtypes. More studies are needed in order to determine a gold standard treatment for this disease.

Clinicopathological features and prognosis of patients with triple-negative special types of breast cancer / 肿瘤

Objective: To examine the clinicopathological features and prognosis of triple-negative special types of breast cancer (SBC). Methods: The clinical data of 240 patients with triple-negative SBC who were treated in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2014 were collected. The clinicopathological features and survival time of patients were retrospectively analyzed. The univariate analysis of survival factors was performed by log-rank test, and the multivariate analysis of survival factors was performed by COX proportional hazard model. Results: Among the 240 patients, there were 38 cases of medullary carcinoma, 84 cases of metaplastic carcinoma, 19 cases of adenoid cystic carcinoma, 31 cases of invasive lobular carcinoma, 30 cases of apocrine carcinoma, and 38 cases of mixed lobular-ductal carcinoma. The histological grade, tumor T stage, lymph node metastasis, Ki-67 expression, chemotherapy or not and chemotherapy regimens had statistically significant differences among the different histological types of triple-negative SBC patients (all P < 0.05). The 5-year disease-free survival (DFS) and 5-year overall survival (OS) rates in patients with mixed lobular-ductal carcinoma, metaplastic carcinoma or invasive lobular carcinoma were lower than those in patients with adenoid cystic carcinoma, medullary carcinoma or apocrine carcinoma (all P < 0.01). The 5-year DFS and OS rates of patients with triple-negative SBC were correlated with histological grade, tumor T stage, lymph node metastasis, chemotherapy and histological type (all P < 0.05). Tumor T stage, lymph node metastasis, chemotherapy and histological type were independent prognostic factors on the 5-year DFS and OS in the triple-negative SBC patients (all P < 0.05). The metaplastic carcinoma patients after platinumbased chemotherapy (P = 0.044) and the mixed lobular-ductal carcinoma patients after anthracycline combined with taxane-based chemotherapy (P = 0.008) obtained longer DFS time. Conclusion: Triple-negative SBC patients with different histological types have different clinicopathological features and prognosis. The patients with adenoid cystic carcinoma, medullary carcinoma and apocrine carcinoma have a better prognosis, while the patients with metaplastic carcinoma, invasive lobular carcinoma and mixed lobular-ductal carcinoma have a poor prognosis. Platinum-based chemotherapy can be used in the treatment of patients with triple-negative metaplastic carcinoma.

Prevalence and attribution of high-risk HPV in different histological types of cervical cancer / 中华妇产科杂志

Objective To investigate the prevalence of high-risk HPV subtypes in different pathological types of cervical cancer, and analyze the attribution of carcinogenic HPV subtypes in different pathological types. Methods A total of 1 541 patients with cervical cancer were treated between February 2009 and October 2016 in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The median age at diagnosis was 49 years (ranged 20-82 years old). The numbers of patients with cervical cancer from North China, Northeast China, East China, Central China and other regions (including Northwest, Southwest and South China) were 961, 244, 175, 87 and 74 cases, respectively. Pathological types: 1 337 cases of squamous cell carcinoma (SCC), 87 usual adenocarcinoma (ADC), 23 adenosquamous carcinoma (ASC), 20 mucinous carcinoma (MC), 19 clear cell carcinoma (CCC), 12 endometrioid carcinoma (EC), 25 neuroendocrine carcinoma (NEC), 9 serous carcinoma (SC), 5 villous adenocarcinoma (VADC) and 4 minimal deviation adenocarcinoma (MDAC). The prevalence of high-risk HPV in different regions, age groups at diagnosis and pathological types in cervical cancer were analyzed. The attribution of 13 high-risk HPV subtypes in different pathological types of cervical cancer based on proportional attribution method, and the attribution of high-risk HPV subtypes prevented by 9-valent HPV vaccine in SCC and ADC were calculated. Results (1) The prevalence of high-risk HPV in 1 541 patients with cervical cancer was 86.6% (1 335/1 541). The multiple high-risk HPV infection rate in patients with SCC ≥60 years old (23.0%, 37/161) was significantly higher than those in patients aged 45-59 years old and≤44 years old [11.4% (85/747) vs 11.7% (50/429), P<0.01], and the high-risk HPV infection rates of patients with cervical cancer in North China, Northeast China, East China, Central China and other regions were respectively 86.8% (834/961), 87.7% (214/244), 83.4% (146/175), 83.9% (73/87) and 91.9% (68/74). SCC (86.8%, 1 337/1 541) and ADC (5.6%, 87/1 541) were the most common pathological types in cervical cancer. The high-risk HPV prevalence of SCC, ADC, ASC, MC, NEC and VADC were 90.1% (1 205/1 337), 74.7% (65/87), 87.0% (20/23), 65.0% (13/20), 72.0% (18/25) and 5/5 respectively. The high-risk HPV infection rates of SC, EC, CCC and MDAC were 4/9, 3/12, 2/19 and 0/4 respectively. (2) According to proportional attribution, HPV 16 (69.5%), HPV 18 (5.6%), HPV 58 (2.2%), HPV 31 (1.9%), HPV 52 (1.4%) and HPV 33 (1.3%) were the six common high-risk HPV subtypes in SCC. While, HPV 18 (44.1%), HPV 16 (20.5%), HPV 52 (2.3%), HPV 58 (1.2%) and HPV 51 (1.2%) were the main carcinogenic subtypes in ADC. The main carcinogenic high-risk HPV subtypes of ASC, NEC and MC were HPV 18 and HPV 16. The total attribution of HPV 16, 18, 31, 33, 45, 52 and 58 prevented by 9-valent HPV vaccine in SCC and ADC were 82.6% and 68.1% respectively; the attribution of HPV 45 in SCC and ADC were only 0.8% and 0. Conclusions SCC and ADC are the main pathological types in cervical cancer. SCC, ADC, ASC, MC, NEC and VADC are closely related to high-risk HPV infection. HPV 16 is the main carcinogenic genotypes of SCC. HPV 18 maybe play an important role in the pathogenesis of ADC.

Evaluation of the accuracy of frozen section in different anatomical sites / Avaliação da acurácia diagnóstica do exame intraoperatório por congelação em diferentes sítios anatômicos

ABSTRACT INTRODUCTION: Frozen section is recommended in several situations to: establish the nature of a lesion; establish the presence of a lesion; confirm the presence of a benign lesion; confirm that sufficient tissue is present for diagnosis; establish the grade of the lesion; determine the organ of origin and determine the adequacy of margins. OBJECTIVES: To evaluate the accuracy of frozen section biopsy in multiple organs and analyze possible factors in discrepancy. METHODS: A retrospective study was carried out during a five-year period at a teaching hospital of Recife, Pernambuco, Brazil. The diagnoses of frozen section were compared with results obtained in the permanent section and classified as concordant or discordant. The discordant cases were reviewed by a pathologist and subdivided into false positives and false negatives. Possible reasons for discrepancy were indicated. RESULTS: A total of 1.226 specimens were analyzed, of which 1.181 (96.33%) were concordant and 45 (3.67%) were discordant. After the review of the discordant cases, 39 remained, six (15.4%) were false positives and 33 (84.6%) were false negatives. The tissue that had most false-positive results was mammary sentinel lymph node (3/1.2%), whereas ovarian showed most false negative outcomes with 17 specimens (51.51% of all false negatives). The possible reasons for discrepancy were sampling error, misunderstanding and complexity of the diagnosis. CONCLUSION: The frozen section accuracy of 96.3% found in our study is similar to specialized literature and does not seem to depend on the tissue analyzed.

RESUMO INTRODUÇÃO: O exame intraoperatório por congelação (EIC) visa avaliar histológica e intraoperatoriamente um pequeno fragmento de tecido ou órgão lesado no qual haja dúvida diagnóstica. Entre as indicações do EIC estão a determinação da natureza e a extensão da lesão, com consequente diferenciação entre lesões benignas e malignas, além da análise das margens cirúrgicas. OBJETIVOS: Avaliar a acurácia do EIC em múltiplos órgãos e analisar possíveis fatores de interferência. MÉTODOS: Foi realizado um estudo retrospectivo em um período de cinco anos (entre janeiro de 2011 e março de 2016) em um hospital de ensino da cidade do Recife, Pernambuco, Brasil. Os resultados dos EICs foram comparados com os laudos finais após o processamento histopatológico e classificados como concordantes ou discordantes. Os casos discordantes foram revistos por patologista e subdivididos em falso-positivos e falso-negativos. Possíveis causas para a discordância dos exames foram levantadas. RESULTADOS: Foram analisadas 1.226 peças cirúrgicas, das quais 1.181 (96, 33%) foram concordantes e 45 (3, 67%), discordantes. Após reavaliação dos casos discordantes, 39 permaneceram, sendo seis (15, 4%) falso-positivos e 33 (84, 6%) falso-negativos. A estrutura que mais apresentou resultado falso-positivo foi o linfonodo sentinela mamário (3/1, 2%), enquanto o ovário foi o órgão com mais resultados falso-negativos, com 17 amostras, 51, 51% de todos os casos negativos. As possíveis causas para a discordância foram tamanho da amostra, limitação do método e complexidade do diagnóstico. CONCLUSÃO: A acurácia do EIC encontrada neste estudo foi de 96, 3% e é semelhante à literatura especializada.

A Review Of Relationship Between Presenting Symptoms And Tumour Location In Colorectal Carcinoma In Tertiary Centre Hospital

@#Colorectal cancer is ranked as the most common cancer for men and the second most common cancer for women according to the Malaysian National Cancer Registry Report (MNCR) 2007-2011. However, delay in the diagnosis of colorectal cancer is still common partly attributable due to late presentation and incorrect diagnosis by the general practitioners. The aim of this study is to determine the relationship between presenting symptoms of colorectal cancer to the location of the tumour in order to prevent delay in diagnosis of colorectal cancer. Between 1996 until 2009, a total of 212 patient data from Hospital Universiti Sains Malaysia were retrospectively analyzed. The demographic and surgical data were obtained. We studied the relationship of the presenting symptoms of colorectal cancer to the location of the tumour. The age of candidate included in this study range from 16 to 93 years old with mean age was 56 and male predominance. In this study, there is a strong relationship between presenting symptoms and the location of the colorectal cancer but no significant relationship between age and sex to the anatomical location of the tumour. The study showed the presenting symptoms of rectal bleeding, change in bowel habit and tenesmus were significantly associated with rectal tumor, intestinal obstruction with left sided tumors and anemia and abdominal mass with right sided tumors (p-value <0.05). However abdominal pain does not follow this role as it is mostly associated with other presenting symptoms and it has no significant relation to the anatomical location of the tumor.

Clinicopathologic features of gastric adenocarcinoma based on the revised Lauren′s classification / 中华病理学杂志

Objective@#To compare the clinicopathologic features and prognosis of the subtypes in a consecutive series of gastric cancers (GC) patients basing on the revised Lauren′s classification so as to better understand the biological behavior of GC.@*Methods@#The surgically resected GC from Peking Union Medical College Hospital during 2003-2005 were reviewed for patients′ age, gender, tumor size, location, Borrman classification, depth of invasion, lymph node metastasis, vascular invasion, and tumor growth pattern (Ming classification).@*Results@#One hundred and sixty-six GC cases were enrolled and classified into four groups: intestinal GC (30, 18.1%), diffuse GC (56, 33.7%), solid GC (9, 5.4%), and mixed GC (71, 42.8%). Intestinal GC patients were older[ (63.2±11.3) years], with a male predominance, and were more frequently found in the antrum. Intestinal GC was the most common subtype for early GC, and tend to develop liver metastases. Diffuse GC patients were youngest [(52.2±12.7) years], with no gender difference, and were usually found in the antrum. Microscopically, diffuse GC were more likely infiltrative (51/56, 91.1%), and tended to metastasize by lymphatic pathway. Solid GC were usually large[ (6.4±2.2) cm], with a male predominance, and the most frequent site was the body/fundus. Solid GC were more likely to show expansile growth pattern with greater depth of invasion (8 of 9 cases were T3/4), but lower rate of lymphatic metastasis. Mixed GC also showed a male predominance, usually found in the antrum, and showed an infiltrative growth pattern (49/71, 69.0%). Though there was fewer T3/4 than solid and diffuse GC, mixed GC were more likely to show lymph nodes, vascular metastases and liver metastases (13/71, 18.3%). TNM staging, lymph nodes metastasis, lymphovascular invasion and revised Lauren′s classification were four independent prognostic factors on multivariate analysis(P<0.05). The survival of patients with mixed GC were significantly worse than patients with other histological types.@*Conclusion@#Revised Lauren′s classification for GC has four distinct subgroups and can be used as independent prognostic factors.

Research of ultrasound vascular effects and drug delivery to tumor / 中华医学超声杂志（电子版）

Objective To improve the chemotherapy drug delivery to tumor by enhancing the tumor vascular perfusion induced by diagnostic ultrasound combined with microbubbles.Methods Ten healthy male sprague-dawley(SD)rats with total twenty walker-256 tumors implanted in the two back legs were randomized to the two paired groups: controlled group(C,n=10)and treatment group(T,n=10).Tumors in the controlled group were ultrasonic sham operated,while in the treatment group were treated by diagnostic ultrasound combined with microbubbles.The treatment group were taken contrast-enhanced ultrasound(CEUS)before and after treatment and analyzed the quantitative parameters.The microbubbles used in the treatment and CEUS was a kind of self-made lipid microbubbles called Zhifuxian.The 0.02 ml microbubbles were bolus injected at CEUS,while during treatment,0.04 ml microbubbles diluted into 1 ml saline solution were injected slowly at constant speed.Flushed by saline solution after treatment,the rats' tumors were harvested into three parts: one for chemotherapy drug concentration detected by high performance liquid chromatography(HPLC),one for HE detection,and one for Dox fluorescence intensity detected by confocal laser scanning microscopy(CLSM).The peak intensity(PI)values,the area under curve(AUC)values and the Dox concentration of each group were analyzed by pared-samples t test.Results(1)The contrast enhanced ultrasound quantitative analysis of the T group: PI value of the tumors before and after treatment were 66.22±16.25 and 75.74±17.67.The AUC values were 2937.52±677.51 and 3354.91±796.15.There was significant statistical difference between them(t=-5.212,-5.259,all P ＜ 0.05).(2)The Dox concentration of the T and C groups were(1.15±0.25)ug/g and(0.96±0.21)ug/g.There was significant statistical difference between them(t=2.403,P＜0.05).The Dox concentration of the treatment group was 1.2 times of the controlled group.(3)The pathology results of T and C groups: the tumor cells were arranged in cords,with big round deep-stained nucleus.No pathological changes were observed in the controlled group,and there was no significant difference between the two groups.But in the treatment group,tumor vascular congestion and inflammatory cell infiltration could be observed.(4)The confocal laser scanning microscopy(CLSM)detection of the T and C groups: the Dox red fluorescence was distributed in the tumor tissue interstitial,and the fluorescence intensity and distribution area of the treatment group were significant higher than the controlled group.Conclusions Diagnostic ultrasound combined with microbubbles treatment could significantly increase the blood perfusion in the walker-256 tumors of SD rats.Taking advantage of this vascular effect,the chemotherapy drug Dox could be delivered much more to the tumor tissue along with circulating bloodstream.With the addition of the sonoporation effect induced by the cavitation of the microbubbles,the chemotherapy drugs could be released much more to the tumor interstitial tissue.

Características de los pacientes con tumor cardíaco primario en un hospital general / Clinical features of patients with primary heart tumors

Los tumores cardíacos primarios son una afección rara, con incidencias menores al 0.3% en series de necropsias. Objetivos: Determinar las características demográficas, clínicas, terapéuticas y evolución de los pacientes con tumor cardíaco atendidos en un hospital general. Material y métodos: Estudio retrospectivo y descriptivo, tipo serie de casos. Se revisó la base de datos del Servicio para identificar los pacientes con diagnóstico final de tumor cardíaco, desde enero de 2008 a septiembre de 2015. Se revisaron las historias clínicas disponibles y se obtuvo el reporte de patología de los pacientes. Se determinaron las características clínicas de la población. Resultados: Se encontraron 10 pacientes que contaban con datos clínicos y de patología completos. La localización más común fue la aurícula izquierda. Los síntomas iniciales principales fueron disnea y síndrome de falla cardíaca congestiva. Las causas de muerte no pudieron ser identificadas. Conclusiones: La población de pacientes analizada tiene una distribución comparable con los reportes a nivel mundial. La neoplasia cardíaca más común fue el mixoma localizado en la aurícula izquierda. (AU)

Primary heart tumors are rare conditions with an incidence of less than 0.3% in necropsy studies. Objectives: To determine demographic, clinical and therapeutic features of primary heart tumors in a general hospital. Methods: A retrospective and descriptive study was carried out from January 2008 to September 2015. A hospital data base was reviewed to identify patients with the diagnosis of primary heart tumors, clinical charts and pathology reports were reviewed. Results: 10 patients with complete information were found. The most common location was the left atrium. Dyspnea and congestive heart failure were the main clinical onset manifestations. Causes of death could not be determined. Conclusions: The most common heart tumor was left atrial myxoma which correlates with what is reported worldwide. (AU)

Research progress of tumor markers in pancreatic cancer tissue / 国际外科学杂志

Pancreatic cancer is a hidden disease,rapid progress,treatment and poor prognosis of the digestive tract malignant tumor,in recent years,the incidence rate has increased significantly.At present,surgical resection is the only effective way to long-term survival of pancreatic cancer patients,however,once the clinical diagnosis of the disease patients mostly in late or distant metastases occur,often lost the best chance of operation.The development of modem biomedical science and technology provides a new technique for the study of high sensitivity pancreatic cancer markers,which can improve the early diagnosis rate of pancreatic cancer,thus improving the surgical resection rate and improving the prognosis of patients.The study of tumor markers in pancreatic cancer tissues has always been a hot topic in the early diagnosis of pancreatic cancer.This paper reviews the progress of pancreatic cancer tumor markers in pancreatic cancer tissues.

Características clínicas, anatomopatológicas y moleculares en casos de cáncer colorrectal según localización tumoral y grado de diferenciación / Clinical, anatomopathological and molecular characteristics of colorectal cancer by tumor location and degree of differentiation

Objetivos: El cáncer colorrectal (CCR) presenta elevada incidencia y mortalidad con diferentes tendencias según localización anatómica y otras características anatomopatológicas que parecen vinculadas a cambios tanto a la exposición a factores de riesgo como al diagnóstico siendo esencial una adecuada filiación tumoral para valorar el efecto de dichos factores en la aparición, diagnóstico y progresión de la enfermedad. El objetivo fue describir las características clínicas y anatomopatológicas de pacientes diagnosticados de CCR en el Área de Salud de León en función de la localización tumoral y del grado de diferenciación. Métodos: Se estudió una serie de 408 casos de entre 25 y 85 años con diagnóstico confirmado de CCR, recogiéndose información de características clínicas y anatomopatológicas y de los biomarcadores analizados en la rutina clínica. Se realizó análisis univariable y bivariable según el grado de diferenciación y la localización tumoral. Resultados: El tamano tumoral disminuye desde colon proximal a recto (Colon Proximal = 5,13 cm: Colon Distal = 4,09cm: Recto = 3,17cm; p< 0,001) siendo el TNM también mayor en zonas proximales. Los adenocarcinomas mucinosos son más frecuentes en tumores pobremente diferenciados que en bien diferenciados (23,1% vs 5,5%). Las invasiones linfática, venosa y peritumoral son más frecuentes con menor grado de diferenciación. Conclusiones: La distribución del estadio tumoral en función de la localización tiene estadios TNM más avanzados en zonas proximales, lo que podría asociarse a una menor detección precoz en dichos casos. La asociación entre invasión venosa y linfática con el grado de diferenciación es poco conocida requiriéndose estudios que aclaren su posible interés pronóstico.

Aims: Colorectal cancer (CRC) has a high incidence and mortality, with different patterns depending on anatomical location and other pathological characteristics that appear linked to changes in exposure risk factors exposure as well as the diagnosis. All these make it essential to determine the source of the tumour to properly assess the effect of these factors in the development, diagnosis and progression of the disease. The aim was to describe the clinical and anatomical-pathological characteristics of patients diagnosed with CRC in the Health Area of Leon (ASL) based on their location and degree of tumour differentiation. Methods: Information was collected on the clinical and pathological characteristics, including biological markers analysed in clinical routine of 408 patients between 25 and 85 years with a confirmed diagnosis of CRC, and residents in ASL at least six months before diagnosis. Univariate and bivariate analyses were performed according to the degree of differentiation and tumour location. Results: Tumour size decreases from the colon to the rectum from location decline proximal colon to the rectum (Proximal Colon = 5.13cm; Distal Colon = 4.09cm; Rectum = 3.17cm, P< 0.001), with the TNM stage also being higher in proximal areas. Mucinous adenocarcinomas are more frequent in poorly differentiated than in well differentiated tumours (23.1% vs 5.5%). Lymphatic, venous and peri-tumour invasions are more common in poorly differentiated tumours. Conclusions: The distribution in accordance with the location has more advanced TNM stages in the proximal areas, which could be related to the poorer early diagnosis in proximal areas. The association between venous and lymphatic invasion with the degree of differentiation is poorly understood, and requires studies to clarify their possible prognostic interest.

Localización y clínica asociada al cáncer de colon: Hospital Nacional Arzobispo Loayza: 2009 - 2013 / Location and associated clinical characteristics of colon cancer: Hospital Nacional Arzobispo Loayza: 2009 - 2013

OBJETIVO: Determinar la clínica asociada a la localización del cáncer de colon en pacientes del Hospital Nacional Arzobispo Loayza durante el periodo mayo 2009 - setiembre 2013. MATERIAL Y MÉTODOS: estudio transversal que analizó información de 114 pacientes con neoplasia maligna primaria de colon, de los cuales 42 cumplieron los criterios de inclusión; internados en el Servicio 6-II del Departamento de Cirugía General del Hospital Nacional Arzobispo Loayza entre mayo 2009 y setiembre 2013. RESULTADOS: La media de edad fue de 60.5 años, y predominó el género femenino con 66.7%. El 100% de los tipos histológicos fue adenocarcinoma. El colon derecho resultó afectado en 61.9%, el izquierdo en 33,3% y un 4,8% presentó localización mixta. En la topografía, se halló 33,3% en colon ascendente y 21,4% en colon sigmoides. Los síntomas más frecuentes fueron dolor abdominal (76,2%), pérdida de peso (69%) y anemia (64%). Para el colon derecho, hubo 13 veces más riesgo de presentar astenia, y 4.44 veces más riesgo de presentar anemia (p<0,05). CONCLUSIÓN: La localización de cáncer de colon más frecuente fue en el colon derecho, el cual se asoció significativamente a la presencia de astenia y anemia en el cuadro clínico. Los síntomas más presentados fueron el dolor abdominal y la pérdida de peso, en cualquiera de sus localizaciones. Todos los casos fueron de adenocarcinoma. (Horiz Med 2015; 15(2): 49-55)

OBJECTIVE: To determine the association between the clinical characteristics and the location of colon cancer in patients hospitalized at "Hospital Nacional Arzobispo Loayza", during May 2009 - September 2013. MATERIAL AND METHODS: transversal study of 144 patients with primary colon cancer, of which 42 patients met the inclusion criteria; hospitalized in the 6-II Wing of the Department of General Surgery at "Hospital Nacional Arzobispo Loayza", between May 2009 and September 2013. RESULTS: the mean age was 60.5 years, and 66.7% of the cases were women. 100% of histologic types were adenocarcinoma. The right colon was affected in 61.9% of the cases; the left colon in 33.3%, and a mixed location in 4,8%. Regarding the topography, 33,3% of the cases were found in the ascending colon and 21,4% in the sigmoid colon. The most frequent symptoms were abdominal pain (76.2%), weight loss (69%) and anemia (64%). For right colon cancer, fatigue was 13 times more likely to appear, and anemia was 4.44 times more likely (p< 0.05). CONCLUSION: the most common location for cancer was in the right colon, and it was associated significantly with the presence of fatigue and anemia among the clinical characteristics. The most frequent symptoms were abdominal pain and weight loss, in any location. All cases were adenocarcinoma. (Horiz Med 2015; 15(2): 49-55)

Epidemiological characterization of oral cancer: literature review / Caracterización epidemiológica del cáncer oral: revisión de la literatura

Oral cancer is a disease of high impact globally. It ranks as the sixth more frequent one among all types of cancer. In spite of being a widely known pathology and easy access to the diagnosis, the lack of epidemiological data reported in the last 10 years in Chile called attention to. At the global level, the World Health Organization (WHO) has developed a project called “GLOBOCAN” in order to collect epidemiological data of the global cancer, between its data, highlights the high incidence and high rate of mortality in the male sex, parameter that shows tendency to replicate in both America and Chile. In consequence to these data, a narrative review of the literature concerning the epidemiological profile of the different forms of oral cancer in the past 15 years was done. The diagnosis of oral cancer crosses transversely the Dental Science, forcing us to establish triads of work between oral and maxillofacial surgeons, pathologists and dentists of the various specialties, so as to allow a timely research, appropriate biopsies and histopathological studies finishes with the purpose of, on the one hand, obtain timely and accurate diagnostics, in addition, maintaining the epidemiological indicators...

El cáncer oral es una patología de alto impacto a nivel mundial, ocupando el sexto lugar más frecuente entre todos los tipos de cáncer. A pesar de unapatología ampliamente conocida y de fácil acceso al diagnóstico, llama la atención la falta de datos epidemiológicos reportados en los últimos 10 años en Chile. A nivelmundial, la Organización Mundial de Salud (OMS) ha desarrollado un proyecto denominado “GLOBOCAN”con el fin de recolectar datos epidemiológicos mundiales del cáncer, entre sus datos, destaca la gran incidencia y elevada tasa de mortalidad en el sexo masculino, parámetro que muestra tendencia a replicarse en tanto América como en Chile. En consecuencia a estos datos, se realizóuna revisión narrativa de la literatura, referente al perfil epidemiológico de las diferentes formas de cáncer oral enlos últimos 15 años. El diagnóstico del cáncer oral cruza de manera transversal a la Odontología, obligándonos a establecer triadas de trabajo entre cirujanos orales y maxilofaciales,patólogos y odontólogos de las diversas especialidades, para permitir así una oportuna pesquisa, biopsias adecuadas y estudios histopatológicos acabados con la finalidad de, por una parte, obtener diagnósticos oportunos y certeros, además, mantener actualizados los indicadores epidemiológicos...

Role of Diffusion Weighted Magnetic Resonance Imaging at 3-T in Staging of Endometrial Cancer and Correlation to Histopathology.

Aim: To investigate the value of diffusion weighted imaging (DWI) at 3-T MR in staging of endometrial cancer and the correlation to histopathology. Study Design: A retrospective study. Place and Duration of Study: CT-MR Division, Qianfoshan Hospital Affiliated to Shandong University. Department of Radiology, Affiliated Hospital of Jining Medical College. From June 2013 to June 2014 Methodology: 30 patients with histologically proved endometrial cancers were analyzed retrospectively. The staging diagnosis of DWI was compared with pathologic results. The ADC values in different histologic types and different differentiated of endometrial cancers were also compared. P<0.05 was considered statistically significant. Results: The staging accuracy of DWI was 83.3%. The ADC value in 30 patients of endometrial cancer was (0.856±0.080) ×10-3 mm2/s. There was no statistically significant difference in different histologic types (t=1.093，P=0.284). In different differentiated endometrial cancers, there was significant difference (F=97.246，P=0.000). Conclusion: DWI has considerable value in staging of endometrial cancer. The ADC values can demonstrate the grade malignancy of tumors initially. So diffusion weighted sequences can be included in routine MR protocols for tumor assessment.

Outcome analysis in patients with uterine sarcoma

PURPOSE: To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. MATERIALS AND METHODS: We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). RESULTS: The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. CONCLUSION: The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.

Lung cancer stem cells and lung cancer / 中国组织工程研究

BACKGROUND:Lung cancers are highly heterogeneous and resistant to available therapeutic agents, with a five year survival rate of less than 15%. It has been difficult to determine the basis of lung cancer heterogeneity and drug resistance. Cancer stem cellmodel has attracted a significant amount of attention in recent years as a viable explanation for the heterogeneity, drug resistance, dormancy and recurrence and metastasis of various tumors. OBJECTIVE:To summarize the current understanding of lung cancer stem cells, including their histological types and tumor growth areas, and to discusses the prognosis of lung cancer and its relationship with lung cancer stem cells, in an effort to eradicate these cells to combat lung cancer. METHODS:In order to search relevant articles about the lung cancer stem celland its relationship with lung cancer from PubMed and Sciencedirect databases (from 1990 to 2014), a computer-based search was performed, using the key words of“lung cancer, cancer stem cell, lung cancer stem cell, lung cancer occur, tumor heterogeneity, drug resistance, gene mutation, signal pathways”in English. After eliminating literatures which were irrelevant to research purpose or containing a similar content, 48 articles were chosen for further analysis. RESULTS AND CONCLUSION:The cancer stem cellmodel has gained considerable support recently in context of lung cancers and stem-like cells that are associated with aggressive cancer behavior, metastatic progression, resistance to therapy and relapse. Since lung cancer stem cells are thought to consist of a heterogeneous population depending on the histology and site of tumors, and multiple signaling pathways might have to be targeted to effectively eliminate lung cancer stem cells for therapeutic benefit. It can be imagined that the multidisciplinary efforts currently under way to characterize and target stem-like cells in lung cancer wil reap significant therapeutic benefits in the future.

Fluorouracil sustained release agent in the treatment of advanced gastric cancer / 中国组织工程研究

BACKGROUND:Fluorouracil sustained-release agent is a commonly used anti-cancer sustained-release drug, which has a good anti-tumor effect. OBJECTIVE:To explore the effect of fluorouracil sustained-release agent in the treatment of gastric cancer. METHODS:Literatures concerning the effect of fluorouracil sustained-release agent in the treatment of gastric cancer were retrieved and analyzed. In the paper, we investigated the preventive effect of fluorouracil sustained-release agent against tumor recurrence and metastasis after radical resection, and fol owed up the patients who underwent clinical peritoneal implantation of fluorouracil sustained-release agent. We could determine the effect of fluorouracil sustained-release agent in the treatment of advanced gastric cancer by observing the patient’s symptoms and signs, expression of tumor markers, tumor size and survival rate. RESULTS AND CONCLUSION:After combination therapy of fluorouracil sustained-release agent and arterial infusion chemotherapy adjuvant therapy, the patient’s symptoms and tumor resection rate were significantly improved. The levels of CEA, CA19-9, CA72-4 in the serum of patients significantly reduced, while the apoptosis and necrosis of tumor cells significantly increased. Fluorouracil sustained-release agent could also reduce tumor metastasis and local recurrence, and improve patient survival.

Carcinoma de ovário seroso e não seroso: tipo histológico em relação ao grau de diferenciação e prognóstico / Serous and non-serous ovarian carcinoma: histological tumor type as related to the grade of differentiation and disease prognosis

OBJETIVO: Comparar as características clinicopatológicas de mulheres com carcinoma seroso e não seroso de ovário e identificar os fatores associados à sobrevida. MÉTODOS: Foram incluídas, neste estudo de coorte reconstituída, 152 mulheres com carcinoma de ovário, atendidas entre 1993 e 2008 e seguidas até 2010, nas quais o tipo histológico foi claramente estabelecido: 81 pacientes com carcinoma seroso e 71 pacientes com tumores não serosos (17 com carcinoma endometrioide, 44 com carcinoma mucinoso e 10 com carcinoma de células claras). Foram calculados os odds ratios (OR) brutos e os OR ajustados com os respectivos intervalos de confiança (IC95%) para as características clínicas e patológicas, comparando tumores serosos e não serosos. Foram calculados os Hazard Ratios (HR) com os respectivos IC95% em relação à sobrevida geral, para as variáveis clínicas e patológicas. RESULTADOS: Comparando os tipos seroso e não seroso, na análise univariada, os tumores serosos foram mais frequentes na pós-menopausa e eram preponderantemente carcinomas de alto grau histológico (G2 e G3), em estádios avançados, com CA125>250 U/mL e citologia peritoneal positiva. Após regressão múltipla, apenas o alto grau histológico se manteve associado com tumores serosos (OR ajustado 15,1; IC95% 2,9-77,9). Observamos 58 óbitos pela doença. O tipo histológico (seroso ou não seroso) não esteve associado com a sobrevida (HR 0,4; IC95% 0,1-1,1). Mulheres com idade de 50 anos ou menos (HR 0,4; IC95% 0,1-0,9) e aquelas que estavam em menacme (HR 0,3; IC95% 0,1-0,9) tiveram maior sobrevida quando comparadas, respectivamente, àquelas com idade acima de 50 anos e na menopausa. Carcinomas de alto grau histológico (G2 e G3) (p<0,01), estádio II a IV (p<0,008) e citologia peritoneal positiva (p<0,001) estiveram significativamente relacionados com pior prognóstico. O nível sérico de CA125 e a presença de ascite não se relacionaram com a sobrevida. A sobrevida foi menor quando a doença foi diagnosticada em estágios II a IV em comparação àquela das mulheres diagnosticadas no estádio I (log-rank p<0,01) independentemente do tipo histológico (seroso ou não seroso). CONCLUSÕES: A proporção de carcinomas de alto grau histológico (G2 ou G3) foi significativamente maior entre os carcinomas serosos comparados com não serosos. O tipo histológico seroso ou não seroso não esteve associado à sobrevida total.

PURPOSE: To compare the clinical-pathological features of women with serous and non-serous ovarian tumors and to identify the factors associated with survival. METHODS: In this reconstructed cohort study, 152 women with ovarian carcinoma, who attended medical consultations between 1993 and 2008 and who were followed-up until 2010 were included. The histological type was clearly established for all women: 81 serous carcinomas and 71 non-serous tumors (17 endometrioid, 44 mucinous and 10 clear cell carcinomas). The crude and adjusted odds ratios (OR), with the respective 95% confidence intervals (95%CI), were calculated for the clinical and pathological features, comparing serous and non-serous histological types. The Hazard Ratios (HR) with 95%CI was calculated for overall survival, considering the clinical and pathological features. RESULTS: Comparison of serous to non-serous tumor types by univariate analysis revealed that serous tumors were more frequently found in postmenopausal women, and were predominantly high histological grade (G2 and G3), advanced stage, with CA125>250 U/mL, and with positive peritoneal cytology. After multivariate regression, the only association remaining was that of high histological grade with serous tumors (adjusted OR 15.1; 95%CI 2.9-77.9). We observed 58 deaths from the disease. There was no difference in overall survival between women with serous carcinoma and women with non-serous carcinoma (HR 0.4; 95%CI 0.1 - 1.1). It was observed that women aged 50 years or less (HR 0.4; 95%CI 0.1-0.9) and those who were in menacne (HR 0.3; 95%CI 0.1-0.9) had a longer survival compared respectively to those above 50 years of age and menopaused. High histological grade (G2 and G3) (p<0.01), stages II-IV (p<0.008) and positive cytology (p<0.001) were significantly associated with worse prognosis. CA125 and the presence of ascites did not correlate with survival. Survival was poor when the disease was diagnosed in stages II to IV and compared to stage I (log-rank p<0.01) regardless of histological type (serous and non-serous). CONCLUSIONS: The proportion of high histological grade (G2 and G3) was significantly higher among serous than non-serous carcinomas. Serous and non-serous histological types were not related to overall survival.

Correlation of tumor size and histopathological characteristics for presumed renal cell carcinoma / 中华泌尿外科杂志

ObjectiveTo analyze the incidence of benign lesions in patients undergoing surgery for presumed renal cell carcinoma (RCC) and investigate the correlation of tumor size and histopathological characteristics.MethodsFrom Jan 2003 to Sep 2010,1531 patients (1042 males,489 females with average age of 55.1 years (15 -89 years) underwent nephrectomy.There were 1123 radical nephrectomies and 408 partial nephrectomies for solitary renal cortical neoplasms presumed to be RCC in preoperative imaging study.The pathological tumor size,the percentage of benign lesions and histologic subtypes were analyzed retrospectively.The correlation of Fuhrman grading and tumor size in clear cell type RCC and papillary RCC was investigated as well.Results Pathological examinations revealed that there were 81 (5.3％)benign lesions of 1531 patients.The incidence of benign lesions was 7.8％ in renal masses smaller than 4.0cm,3.8％ in masses with 4.1 - 7.0 cm,and 1.1％ in masses larger than 7.0 cm ( P ＜ 0.01 ).Angiomyolipoma was the most predominant histologic subtype in benign renal lesions with a frequency of 69.5％,52.6％ and 33.3％ in ≤4.0 cm,4.1 - 7.0 cm and ＞ 7.0 cm subgroups,respectively.Oncocytoma was present in 13.6％,15.8％ and 33.3％ of the benign lesions in the above 3 subgroups (P =0.47).One thousand four hundred and fifty cases of malignancies (94.7％) were identified.The frequency of clear cell type RCC was 91.7％ in malignant tumors smaller than 4.0 cm,88.1％ in 4.1 - 7.0 cm malignancies,and 77.6％ in tumors ＞7.0 cm； the frequency of papillary RCC was 4.0％,4.2％ and 7.7％ in the above 3 subgroups,and the frequency of chromophobe cell RCC was 3.6％,5.2％ and 6.3％ accordingly ( P ＜0.01 ).One thousand three hundred and seventeen cases of clear cell type RCC and papillary RCC with definite Fuhrman grading were identified.The probability of high grade tumors increased with size,while the probability of low-grade lesions decreased (r =0.94,P ＜ 0.01 ),especially for tumors smaller than 11.0cm.ConclusionsPatients in the present study population show a low incidence of benign renal lesions.Benign lesions are less common in larger tumors than in smaller ones.The proportion of clear cell type RCC decreases in larger tumors,however papillary RCC and chromophobe cell RCC are increasing.The probability of high-grade tumors increases with size.The correlation between tumor size and histopathological characteristics may be helpful in patients counseling and decision-making.