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1.
Am J Case Rep ; 24: e939183, 2023 Apr 15.
Article in English | MEDLINE | ID: mdl-37060172

ABSTRACT

BACKGROUND Merkel cell carcinoma (MCC) is an aggressive neuroendocrine malignancy that has increased in incidence in recent decades. The management of MCC should involve multidisciplinary experts to achieve optimal patient outcomes. Radiotherapy is commonly used as adjuvant therapy. Our literature review of MCC indicates that aggressive adjuvant radiotherapy might have a positive impact on overall local control and survival. CASE REPORT The first case is a 75-year-old male patient who discovered a right preauricular mass 2 weeks prior. He underwent right parotidectomy with tumor removal on 2012/07/09, and pathology revealed MCC in 3 lymph nodes. The patient received postoperative adjuvant radiotherapy (61.2 Gy) to the remaining right parotid tumor bed and right neck lymph nodes. The patient refused adjuvant chemotherapy. During long-term follow-up, the patient remained disease free for 10 years. The other case is a 73-year-old female patient with metastatic MCC in a left parotid lymph node. She also underwent left parotidectomy with tumor removal, and pathological staging performed according to the 8th edition of the AJCC staging system showed pTxN1aMx, stage IIIA. After the operation, she received postoperative adjuvant radiotherapy (56 Gy) to the remaining left parotid and left neck lymph nodes. The patient remained disease free for 14 months. CONCLUSIONS Metastatic MCC of the parotid lymph nodes without a detectable primary skin tumor is very rare. Adjuvant radiotherapy to the tumor bed and regional nodal basin might be beneficial for preventing disease recurrence despite the absence of systemic medical therapy.


Subject(s)
Carcinoma, Merkel Cell , Neoplasms, Unknown Primary , Skin Neoplasms , Male , Female , Humans , Aged , Carcinoma, Merkel Cell/radiotherapy , Carcinoma, Merkel Cell/surgery , Carcinoma, Merkel Cell/pathology , Radiotherapy, Adjuvant , Neoplasms, Unknown Primary/radiotherapy , Neoplasm Recurrence, Local/pathology , Skin Neoplasms/radiotherapy , Skin Neoplasms/pathology , Lymph Nodes/pathology
2.
Mol Clin Oncol ; 14(4): 84, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33758665

ABSTRACT

Chordomas are slow-growing aggressive tumors that account for 1-4% of all bone tumors. The anatomical distribution of chordomas includes 50-60% in the sacrococcygeal region, 25-30% in the skull base and 15% in the mobile spine. Virchow was the first to describe and term these tumors as 'ecchordosis physaliphora' in 1857, and Muller established their notochordal origin in 1895. Extraosseous chordomas of the nasopharynx are very rare, and they exhibit similarities with other lesions of the nasopharynx, presenting as a soft tissue mass. Gross total resection combined with postoperative radiotherapy offers the best chance of long-term control. We herein present the case of a 63-year-old female patient with complaints of left temporal headaches, dizziness, left nasal obstruction, left maxillary area numbness, left ear hearing loss and swallowing difficulty. Computed tomography imaging examination revealed an 8.2x3.2x5.7-cm space-occupying lesion with central necrosis in the nasopharynx and oropharynx, partially occluding the pharyngeal lumen; the mass had infiltrated the left parapharyngeal space, the left medial and lateral pterygoid muscle and the left parotid gland, with bone erosion of the left mandible. The patient was diagnosed with extraosseous chordoma of the nasopharynx, conventional type, stage IIB. The patient underwent surgery and high-dose radiotherapy and local control of the chordoma was achieved. However, the patient succumbed to a lung metastasis. The details of the case are discussed, and a review of the current medical literature is presented to provide an updated discussion on the current status of nasopharyngeal chordoma research.

3.
IEEE Trans Neural Netw ; 22(12): 2296-309, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22010148

ABSTRACT

We propose a novel approach for building a type-2 neural-fuzzy system from a given set of input-output training data. A self-constructing fuzzy clustering method is used to partition the training dataset into clusters through input-similarity and output-similarity tests. The membership function associated with each cluster is defined with the mean and deviation of the data points included in the cluster. Then a type-2 fuzzy Takagi-Sugeno-Kang IF-THEN rule is derived from each cluster to form a fuzzy rule base. A fuzzy neural network is constructed accordingly and the associated parameters are refined by a hybrid learning algorithm which incorporates particle swarm optimization and a least squares estimation. For a new input, a corresponding crisp output of the system is obtained by combining the inferred results of all the rules into a type-2 fuzzy set, which is then defuzzified by applying a refined type reduction algorithm. Experimental results are presented to demonstrate the effectiveness of our proposed approach.


Subject(s)
Data Mining/methods , Databases, Factual , Feedback , Fuzzy Logic , Models, Theoretical , Neural Networks, Computer
4.
Med Dosim ; 35(4): 304-11, 2010.
Article in English | MEDLINE | ID: mdl-20627683

ABSTRACT

During radiotherapy treatments, quality assurance/control is essential, particularly dose delivery to patients. This study was designed to verify midline doses with diode in vivo dosimetry. Dosimetry was studied for 6-MV bilateral fields in head and neck cancer treatments and 10-MV bilateral and anteroposterior/posteroanterior (AP/PA) fields in pelvic cancer treatments. Calibrations with corrections of diodes were performed using plastic water phantoms; 190 and 100 portals were studied for head and neck and pelvis treatments, respectively. Calculations of midline doses were made using the midline transmission, arithmetic mean, and geometric mean algorithms. These midline doses were compared with the treatment planning system target doses for lateral or AP (PA) portals and paired opposed portals. For head and neck treatments, all 3 algorithms were satisfactory, although the geometric mean algorithm was less accurate and more uncertain. For pelvis treatments, the arithmetic mean algorithm seemed unacceptable, whereas the other algorithms were satisfactory. The random error was reduced by using averaged midline doses of paired opposed portals because the asymmetric effect was averaged out. Considering the simplicity of in vivo dosimetry, the arithmetic mean and geometric mean algorithm should be adopted for head/neck and pelvis treatments, respectively.


Subject(s)
Head and Neck Neoplasms/radiotherapy , Pelvic Neoplasms/radiotherapy , Radiometry/instrumentation , Radiotherapy, Conformal/methods , Female , Humans , Male , Radiotherapy Dosage , Reproducibility of Results , Semiconductors , Sensitivity and Specificity
5.
Am J Pathol ; 176(4): 1619-28, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20150437

ABSTRACT

Colorectal cancer has high rates of recurrence and metastasis. Many patients with similar histopathological features show significantly different clinical outcomes, and these differences are primarily related to metastases undetected by current diagnostic methods. There is no useful serological marker for metastatic disease. We investigated the cellular apoptosis susceptibility (CSE1L/CAS) protein in comparison with carcinoembryonic antigen (CEA) as a marker for metastatic colorectal cancer. Using serum from 103 patients with stage I, II, III, and IV disease, CSE1L was detected in 36.0% (9 of 25), 57.7% (15 of 26), 71.4% (30 of 42), and 88.9% (8 of 9) of patients, respectively; a pathological CEA level was found in 16.0% (4 of 25), 42.3% (11 of 26), 47.6% (20 of 42), and 77.8% (7 of 9) of patients, respectively; a combined CSE1L/CEA assay was detected in 48.0% (12 of 25), 65.4% (17 of 26), 88.1% (37 of 42), and 100% (9 of 9) of patients, respectively. Lymphatic metastasis is an important predictor of poor prognosis and crucial for determination of therapeutic strategy. Serum CSE1L was detected in 74.5% (38 of 51) of patients with lymph node metastasis, whereas a pathological CEA level was found in only 52.9% (27 of 51) of the same patients (P < 0.001); the combined CSE1L/CEA assay increased sensitivity to 90.2% (46 of 51). Animal experiments showed CSE1L reduction in B16-F10 melanoma cells correlated with decreased metastasis to the colorectal tract in C57BL/6 mice. These results indicate that assay of serum CSE1L may facilitate diagnosis of colorectal cancer lymphatic metastases; furthermore, CSE1L is a possible therapeutic target.


Subject(s)
Apoptosis , Cellular Apoptosis Susceptibility Protein/blood , Colorectal Neoplasms/pathology , Gene Expression Regulation, Neoplastic , Adult , Aged , Aged, 80 and over , Animals , Biomarkers, Tumor/metabolism , Female , Humans , Lymphatic Metastasis , Male , Melanoma, Experimental , Mice , Mice, Inbred C57BL , Middle Aged , Neoplasm Metastasis
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