Conventional peritoneal cytology lacks the prognostic significance of detecting local or peritoneal recurrence in colorectal cancer: An Egyptian experience.

BACKGROUND AND AIM: Colorectal cancer (CRC) accounts for over 8% of all deaths each year, with 1.2 million new cases diagnosed annually worldwide. It represents the seventh most common cancer in Egypt. Early detection of peritoneal metastasis is a major challenge in such cases. It helps with the decision of the immediate application of intraperitoneal chemotherapy after resection. Meta-analysis studies reported contrast evidence for a possible prognostic role of intraperitoneal free cancer cells (IPCCs) in peritoneal recurrence and survival after curative resection. In this work, we aim to evaluate the prevalence and impact of detecting free malignant cells in peritoneal fluid on survival and local recurrence and to estimate the incidence of peritoneal carcinomatosis (PC) during follow up. METHODS: Design: This was a prospective cohort study. Settings: From June 2016 to December 2018, samples were collected from 104 patients who underwent abdominal surgery for colorectal cancer in the Egyptian National Cancer Institute. A total of 96 Egyptian CRC patients who underwent curative resection were enrolled. Intraoperative peritoneal lavage was performed to detect IPCC by conventional cytology. Patients with no residual tumor after surgery and no evidence of PC were followed up for a median 14 months. The cumulative 12-month overall survival rate for patients with IPCC was 100% versus 86% for patients with negative cytology. RESULTS: Our results demonstrated that the prevalence of IPCC in the peritoneal lavage was 11.5%. Peritoneal and local recurrence occurred at a higher rate in patients with cytology positive lavage (9.1% vs 6.3% and 9.1% vs 3.8%, respectively), although this was statistically insignificant. Distant metastasis occurred significantly in patients with positive cytology (45.5% vs 8.9%) with P-value <0.001.The conventional cytology technique has a high specificity but less sensitivity. CONCLUSIONS: The presence of IPCC using conventional cytology was not an independent prognostic factor for the development of PC or survival.

Association of Osteopontin Gene Polymorphisms with Colorectal Cancer.

We investigated the association of the Osteopontin (OPN) (rs9138 and rs1126616) polymorphisms with colorectal cancer (CRC). One hundred CRC patients and 112 healthy individuals were subjected to OPN (rs9138 and rs1126616) genotyping and measurement of OPN protein plasma level. The C allele of OPN rs1126616 and the CC haplotype were significantly higher in CRC patient (p = 0.036, 0.003, respectively). In females, the C allele of OPN rs9318 (A/C) polymorphism was significantly associated with increased CRC risk (p = 0.036). The plasma OPN level >104.35 ng/mL was significantly associated with CRC. Our findings suggest a significant role played by OPN (rs9138 and rs1126616) in colorectal carcinogenesis.

The role of surgical management in pediatric germ cell tumors (GCTs), NCI case series.

PURPOSE: To review the experience of a tertiary referral center in pediatric germ cell tumors (GCTs) in the last 8 years and to investigate the impact of surgery and site of disease on prognosis. PATIENTS AND METHODS: We retrospectively analyzed the cases of pediatric germ cell tumors at National Cancer Institute over an 8 years period. Data concerning diagnosis, surgery and medical decisions were reviewed and analyzed for all patients. A total of 34 children with (GCTS) were found, with a mean age, at presentation, of 6.7 years and a follow-up period ranging from 3-52 months. One patient with benign GCT was excluded during analysis of the results. RESULTS: Among the 34 patients, there were 14 males and 20 females with mean age of 6.7 years (range: 9 months-15 years), with male to female ratio 1:1.4. All patients were symptomatic at presentation, most commonly with abdominal swelling (18 patients; 52.9%). Anatomic distribution of GCTs according to sex organ involvement was either gonadal in 21 patients (61.8%) or extragonadal in 13 patients (38.2%). All patients had surgery either in the form of curative resection or biopsy after formal exploration and evidence of irresectability. No significant surgical morbidity or mortality were encountered in our patients. Yolk sac tumor and malignant teratoma were the commonest histologic subtypes in our series. Metastatic disease was encountered in nine out of 33 patients (27.2%). Adjuvant chemotherapy was administered in 28 out of 33 patients (84.8%), following surgery, including all patients with extragonadal disease. Our patients were followed-up to 52 months. Twenty-two patients (66.7%) had no recurrence while two patients (6.1%) died from disease. Pelvic extragonadal site was the worst site regarding resectability. Complete surgical resection showed better disease free survival, while those with irresectable disease had comparable overall survival while none could be rendered disease free with chemotherapy. CONCLUSION: The initial surgical approach to malignant GCTs at all sites should be complete resection when possible; the morbidity of extensive surgical resection should be weighed carefully against the good tumor control with chemotherapy. Surgical staging does not preclude preservation of fertility, which should always be considered in this young age. The site of primary disease plays a role in the prognosis of pediatric germ cell tumors with the extragonadal pelvic tumors being the worst regarding resectability. Good tumor response can be achieved with surgery and chemotherapy even for advanced stage and metastatic disease.

Medullary thyroid cancer.

Medullary thyroid cancer is a rare neoplasm that arises from the parafollicular C cells. It occurs in a sporadic form, or less commonly as a hereditary form, as part of multiple endocrine neoplasia syndromes types 2A and 2B. The RET proto-oncogene is currently the primary factor that is implicated in the hereditary forms of this neoplasm. The knowledge about the genetic makeup of the neoplasm impacts upon management as it allows for screening, early detection, and prophylactic treatment. Surgery is the main modality that offers a cure. This entails a total thyroidectomy and vigilant management and surveillance of the neck. Prognosis of patients with MTC is variable, but the more constant factors that affect it are the stage of disease and the age of the patient. The emerging molecular genetic understanding of this malignancy will provide the foundation for prognostic and therapeutic decision-making in the future. Interdisciplinary management by surgeons, endocrinologists, pathologists, radiotherapists, radiologists, and medical oncologists should be sought.