Familial glioblastoma: A case report of glioblastoma in two brothers and review of literature.

BACKGROUND: Gliomas that aggregate in families with history of malignancy may have an inheritable genetic basis. Gliomas can occur in several well known tumor syndromes. However, their occurrence in the absence of these syndromes is quite rare. High-grade gliomas, such as glioblastoma multiforme (GBM), are the most common and most lethal primary cancers of the central nervous system (CNS). CASE DESCRIPTION: We present a case of two brothers both diagnosed with GBM. Both siblings underwent biopsy with debulking of the tumors by different surgeons. Only one sibling elected to undergo chemotherapy and radiation. Cytogenetic studies were possible only on one sibling and the tumor specimen revealed multiple chromosomal abnormalities, including triploidies 4, 8, 12, 22 and loss of heterozygosity of 1p, 9p, and 10. Histological samples for both tumors were similar, both revealing increased cellularity consisting of gemistocytic astrocytes, central necrosis, and microvascularization. CONCLUSION: We present two brothers who display a rare familial relationship in the development of their GBMs. Supplementary and improved genetic studies may allow for specific treatment modalities as certain genetic abnormalities have better response to tailored treatments and carry better prognoses.

Ultrastaging of sentinel lymph nodes (SLNs) vs. non-SLNs in colorectal cancer--do we need both?

BACKGROUND: The aim of this study to analyze whether ultrastaging of initially negative nonsentinel lymph nodes (non-SLNs) would increase nodal positivity in colon cancer and rectal cancer. METHODS: After SLN mapping (SLNM), SLNs were ultrastaged by 4 hematoxylin and eosin and 1 immunohistochemistry sections. A blinded pathologist reexamined initially negative non-SLNs by 3 additional hematoxylin and eosin and 1 immunohistochemistry sections. RESULTS: In 156 colon cancer and 44 rectal cancer patients, 2,755 nodes were identified (494 SLNs and 2,261 non-SLNs). Metastases were detected in 20.9% of SLNs and 8.6% of non-SLNs (P<.0001). After ultrastaging non-SLNs, only .58% became positive for metastases in 12 patients. Of these, 10 already had positive lymph nodes, hence no change of staging occurred. Ultrastaging upstaged only 2 of 200 patients (1%). CONCLUSIONS: The chance of finding additional metastases by ultrastaging of all non-SLNs is extremely low (<1%) and of little benefit.

Utility of a liquid-based, monolayer preparation in the evaluation of thyroid lesions by fine needle aspiration biopsy: comparison with the conventional smear method.

OBJECTIVE: To retrospectively compare the diagnostic accuracy and cytomorphologic features of thyroid lesions on ThinPrep (TP) (Cytyc Corporation, Boxborough, Massachusetts, U.S.A.) monolayer preparations with those of the conventional smear (CS) method on fine needle aspiration biopsy (FNAB). STUDY DESIGN: Slides of 145 TP and 145 CS consecutive cases of thyroid FNAB were retrospectively reviewed for the following features: amount and architecture of follicular cells, nuclear and cytoplasmic details, amount and quality of colloid, background blood, cyst fluid and macrophages, and lymphocytes and plasma cells. These were semiquantitatively scored 0-4 for each parameter. RESULTS: The TP slides more often had higher cellularity with flat clusters, while CS slides more often had 3-dimentional clusters. The CS slides displayed better morphology and more preserved follicular cells with intact cytoplasm and crisper nuclei, while TP slides revealed shrunken cells with fragmented cytoplasm and dark, often-naked nuclei. The amount of colloid was generally more abundant on the CS slides, while it appeared as small, dense droplets (thick colloid) or as folded tissue paper-like material (thin, watery colloid) on the TP slides. The CS more often had a bloody background obscuring the cells, while the TP slides had a clear background. Simple thyroid cysts were more often detected on TP than CS slides by the presence of cyst fluid and macrophages. The 2 methods had almost similar diagnostic rates for chronic thyroiditis (11% TP vs. 12% CS) and atypical/neoplastic lesions (3.4% each). The 2 methods had similar diagnostic correlation for colloid nodules (49% TP vs. 45.5% CS), but the nondiagnostic rate was lower in TP (24%) than CS slides (31%). CONCLUSION: Although there are cytomorphologic differences between the TP and CS methods, including better cellular preservation and details on CS, the TP method shows a lower nondiagnostic rate, similar diagnostic rate for chronic thyroiditis and atypical/neoplastic lesions, and slightly better diagnostic rate for colloid nodules. The 2 methods complement each other, and we strongly recommend that they both be performed on all thyroid FNAB cases.

A multicenter trial of sentinel lymph node mapping in colorectal cancer: prognostic implications for nodal staging and recurrence.

BACKGROUND: Sentinel lymph node (SLN) mapping (M) for staging in colorectal cancer (CRCa) remains controversial and needs to be validated. This study analyzes results of SLNM at a multi-institutional level for CRCa. METHODS: Group A patients underwent SLNM with 1 to 3 mL of 1% lymphazurin. First 1 to 4 blue lymph nodes were designated as SLNs and had focused analysis. Group B had standard resection and nodal staging. Patients with a minimum of 2 years of follow-up were analyzed for recurrence. RESULTS: Overall nodal metastasis were 50% for 500 group A patients versus 35% for 368 group B patients. In SLNM patients success, accuracy, sensitivity, and negative predictability values were 98%, 96%, 90%, and 93%, respectively. With a 2-year minimum follow-up, 153 group A patients had 7% recurrences compared with 25% in 162 group B patients. CONCLUSION: SLNM is highly feasible and accurate for staging CRCa with higher detection of nodal metastasis and lower recurrences.

Sentinel lymph node mapping technique in colon cancer.

Current conventional surgical and pathological techniques substantially understage colon cancer. This is evidenced by the fact that a significant subset of patients who are stage I and II at the time of colectomy return with distant metastases and ultimately succumb to the disease within the next 5 years. The identification of more nodes within a specimen and the detailed analysis of lymph nodes with advanced pathological techniques such as immunohistochemistry and reverse-transcriptase polymerase chain reaction (RT-PCR) can improve the staging of colon cancer, but are also associated with tremendous financial, time, and labor constraints. Sentinel lymph node (SLN) mapping has provided an avenue of staging colon cancer with high success rates and accuracy rates, while maintaining cost- and time-effectiveness. The ability to reproduce these results is dependent on adherence to the technical details of the procedure, and thereby providing the pathologist with the true SLNs, upon which the advanced pathological studies can be applied. We report our experience of SLN mapping for colon tumors in 209 patients, elaborating on the materials used, technical details, pitfalls, and results of the procedure. Our results show a success rate of 100% (209/209) and an overall accuracy rate for predicting positive or negative metastatic disease of 96.2% (201/209). Nodal metastases were identified in 46.2% (85/184) of patients with invasive disease (stage T1 to T4). The SLN was the exclusive site of metastases in 38.8% (33/85) of these patients, and the nodal disease was detected only as micrometastases in 22.4% (19/85). The skip metastases rate (false negatives) was 9.4% (8/85). SLN mapping is a powerful tool for accurate staging of colon cancer with a high success rate. The upstaging associated with this procedure may reveal disease that might otherwise go undetected by conventional surgical and pathological methods. Those patients who are upstaged can then benefit from adjuvant chemotherapy, which has been shown to improve survival of colon cancer patients with nodal disease by at least 33%.