Research progress on the malignant transformation of oral submucosal fibrosis / 国际肿瘤学杂志

Oral submucous fibrosis (OSF) can cause various oral dysfunctions in patients and can turn into oral cancer. The causes and processes of OSF malignant transformation involve betel nut chewing, vascular atrophy, tissue hypoxia, cell cycle changes, aging, autophagy, and changes in cancer/cancer suppressor genes and microRNAs. It is of great significance to study the causes and process of OSF malignant transformation for the treatment and prevention of OSF malignant transformation.

Malignant peripheral nerve sheath tumors arising from schwannomas: case series and literature review.

A malignant peripheral nerve sheath tumor (MPNST) arising from a schwannoma is extremely rare, with limited literature on its clinicopathologic features. Here, we present a case series and literature review on patients with MPNSTs arising from schwannomas. We performed a retrospective review of patients from our institution's records to identify those with MPNSTs arising from schwannomas. We conducted a search for additional cases from the literature utilizing PubMed. 20 patients (including 2 at our institution and 18 from 16 prior publications) were identified. The patients aged 22-93 (mean 52) years, and 63% were females. Histologically, while most MPNSTs arising from schwannomas were of epithelioid-type, 7 tumors (including 2 at our institution) were of conventional spindle-cell type. All 20 patients underwent surgical excision, while a subset received additional radiotherapy and/or chemotherapy. In 17 patients with available follow-up, the overall survival was 2-72 (median 12) months. MPNSTs rarely arise from schwannomas and should be considered in patients with a clinical diagnosis of schwannoma, however, with atypical radiologic or clinical features. MPNSTs arising from schwannomas can show epithelioid or spindle-cell histology and harbor an aggressive course, even with surgical excision and adjuvant treatment.

Molecular expression characteristics confirm the malignancy concealed by morphological alterations in endometrial cancer after fertility-preserving treatment.

PURPOSE: Fertility-preserving treatment (FPT) has been widely used for young patients with early stage endometrial cancer (EC). However, the literature on the effectiveness and safety of FPT remains controversial. The aim of this study was to investigate malignant transformation in EC after FPT by immunohistochemistry (IHC). METHODS: A retrospective analysis of pre- and post-treatment biopsy specimens from 24 patients with grade 1 endometrioid adenocarcinoma (EAC) or complex atypical hyperplasia (CAH) was performed. The expression levels of ARID1A, PTEN, and ß-catenin were assessed by IHC. RESULTS: The protein expression levels of ARID1A, PTEN, and ß-catenin were not significantly different between pre- and post-treatment specimens. However, there was a significant difference between pre-treatment and normal specimens as well as between post-treatment and normal specimens. The protein expression of ß-catenin was significantly increased in patients with progression compared with those without progression after FPT. CONCLUSION: The morphologic normalization of patients with EC after FPT may not be accompanied by the absence of tumor malignancy, and ß-catenin may serve as a biomarker for the response to FPT. These results may contribute to a better understanding of the malignant transformation of EC after FPT and the optimization of treatment strategies for young patients with birth plans.

Neuroendocrine Tumor Arising in a Tailgut Cyst: A Rare Presacral Tumor.

A tailgut cyst (retrorectal cystic hamartoma) is an uncommon lesion that develops in the presacral (retrorectal) space. Malignant change in a tailgut cyst is extremely rare and presents as a soft tissue (presacral) or bone (sacral) neoplasm. We report a case of tailgut cyst in which a neuroendocrine tumor developed in a 25-year-old female. Computed tomography and magnetic resonance imaging scans revealed a sacrococcygeal malformation with absent left S4 and S5 and a partly cystic lesion within the right presacral space. Histologically, the lesion contained cystic and solid elements. The cysts were lined by columnar and stratified squamous epithelial cells with underlying patchy smooth muscle. The solid element was a partly necrotic neuroendocrine tumor composed mainly of ribbons of tumor cells, which showed mitotic activity and expressed cytokeratin, chromogranin, and synaptophysin. Histologically, tailgut cysts are lined by epithelium and contain scattered smooth muscle bundles in the cyst wall. Although rare, the possibility of tailgut cyst with neuroendocrine tumor should be included in the differential diagnosis of an enlarging presacral tumor.

Clinicopathological features and post-resection outcomes of biliary cystadenoma and cystadenocarcinoma of the liver.

BACKGROUNDS/AIMS: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) account for 5%-10% of liver cystic diseases. In this study, we analysed the clinical presentation and surgical management of patients with BCA and BCAC. METHODS: We retrospectively analysed the medical records of 23 BCA and 7 BCAC cases diagnosed between January 2007 and December 2013. RESULTS: There was a statistically significant difference in age (p=0.044) and sex (p=0.048) between BCA and BCAC groups. In the BCA group, 17 patients showed no symptoms (74%), 5 had abdominal pain (22%) and 1 showed abdominal distension (4%). In the BCAC group, two patients were without any symptoms (29%), three had abdominal pain (43%), one showed abdominal distension (14%) and one had fever and chills (14%). The cystic lesion size was widely variable; thus, there was no statistical difference (p=0.84). Complete resection was performed in all patients with BCA and BCAC. No tumour recurrence developed in patients with BCA. In patients with BCAC, 1-, 3- and 5-year disease-free survival rates were 100%, 85.7% and 57.1%, respectively, and 1-, 3- and 5-year overall patient survival rates were 100%, 100% and 75.0%, respectively. CONCLUSIONS: It is difficult to distinguish between BCA and BCAC via clinical manifestations and diagnostic imaging findings. Surgical resection is the treatment of choice for BCA and BCAC, and patient prognosis after complete resection was very favourable.

Multiple Sebaceous Horn on the Penis-an Interesting Case Report.

Sebaceous horns (de la Pena Zarzuelo et al., Arch Esp Urol 54:367-368, 2001; Vera-Donoso, Scand J Urol Nephrol 43:92-93, 2009) are rare on the penis, as they are commonly seen only on sun-exposed areas. A 45-year-old male presenting with multiple sebaceous horns of the penis is reported here. Excision of the horn with a rim of normal tissue in the base was done. Histopathological examination revealed no malignant change.

Malignant fibrous histiocytoma-case report.

Fibrous histiocytoma is a tumor composed of a mixture of fibroblastic and histiocytic cells. These lesions most often arise on the skin, but may rarely occur in soft deep tissues. The diagnosis of FH may be clinically difficult when the lesion is located in the deep tissues, and is frequently confirmed after local excision. The most important diagnostic necessity is the separation of this tumor from aggressive forms of fibrohistiocytic neoplasms. We present a unique case of malignant fibrous histiocytoma developing in left buccal mucosa very near to the surgical margin from which a benign fibrous histiocytoma of the mandible was excised 3 years earlier in a 31 year old female. Clinical and histopathological evidence were not sufficient to establish link between these two processes. This article aims to describe the case and discuss the findings.

Expression of Cyclooxygenase-2 and p53 Protein in Colonic Adenoma with Malignant Change / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the value of expression of COX-2 and p53 protein in colonic adenoma with or without malignant change. METHODS: We studied twenty-five cases of colonic adenoma with malignant change and twenty-five cases of colonic adenoma without malignant change treated by colonoscopic polypectomy in Chungnam National University Hospital from January, 1999 to July, 2002. We compared the expression of COX-2 and p53 protein by immunohistochemical stain in both group. RESULTS: In immunohistochemical staining, the expression of COX-2 was demonstrated 68.0% (17 of 25) of colonic adenoma with malignant change and not different with that of colonic adenoma without malignant change. The overexpression of p53 protein was detected immunohistochemically in 88.0% (22 of 25) of colonic adenoma with malignant change and 32% (8 of 25) of colonic adenoma only (p <0.05). CONCLUSIONS: The degree of COX-2 expression was similar in colonic adenoma and colonic adenoma with malignant change, but the expression of p53 in colonic adenoma with malignant change was significantly higher (p <0.05). These results suggest COX-2 might operate on early step of adenoma-carcinoma sequence. Also these results remind us that mutation of p53 gene operates on the late step of adenoma-carcinoma sequence.

Clinicopathological Study on Laterally Spreading Tumor (LST) / 대한소화기내시경학회지

BACKGROUND/AIMS: Laterally spreading tumors (LST) were growthed along the colonic wall. These tumors were high malignant potential compared to colon polyp. We analyzed clinicopathological characteristics of these tumors. METHODS: From June 1996 to June 2001, twenty nine patients were diagnosed by colonoscopy. These lesions were classificated macroscopic (granular type and nongranular type) and microscopic findings. RESULTS: 20 male and 9 female were enrolled (mean age, 68.1). Among the LST, 41.4% were 20~30 mm in diameter, and 7% were larger than 30 mm. According to macroscopic findings granular types were 72.4% (21/29) and nongranular types were 27.6% (8/29). In macroscopic findings, tubular types were 48.4% (14/29), malignant changes were 31.3% (9/29). Tumor size was only significant factor in malignant potential of LST (p=0.004). Endoscopic mucosal resection was performed in 72.4% (21/29), operation in 8 (27.6%). Rate of submucosal invasion in LST was 3.4% (1/29, sm1). Recurrent rate of endoscopic treatment group was 9.5% (2/21). CONCLUSIONS: Most of LST were good indication for endoscopic treatment, but larger tumor size and irregular surface of tumor were suspected to be submucosal invasion. Therefore these lesions were performed other procedures as endoscopic ultrasound or computerized tomography for invasion depth.

A Case of a Solid and Papillary Epithelial Neoplasm of the Pancreas Associated with Malignant Change / 대한소화기내시경학회지

The solid and papillary epithelial neoplasm of the pancreas is a relatively uncommon disease. It accounts for approximately 1 to 2 percent of all exocrine pancreatic tumors. This benign or low grade malignant tumor is reported to occur predominantly in young women and rarely in men. Recurrence and development of metastasis after resection are found only in a small fraction of the general population. A case is herein reported involving a solid and papillary epithelial neoplasm of the pancreas which extensively spread to nearby organs, in a 34 year-old man. Chief complaints were black stool. Physical examination revealed tenderness on the left upper quadrant of the abdomen. Esophagogastroduodenoscopy revealed multiple cardiac variceal bleeding. Abdominal sonography and CAT scan findings showed a huge lobulated mass on the left upper quadrant area with an internal necrotic portion. Surgical findings showed determined a splenic vein tumor thromboembolus, portal vein involvement, distal stomach involvement, and multiple colonic invasion. Therefore, distal pancreatectomy, wedge resection of the stomach, splenetomy, segmental resection of the transverse colon, and excision of the mass were all performed. Pathologic examination revealed a solid and papillary epithelial neoplasm in the pancreatic tail with a marked dilated splenic vein filled with tumor thromboembolus. The patient has been under chemotherapy since then, and is being closely observed.

Clinical Observation in Endoscopic Treatment of Colonic Polyps / 대한소화기내시경학회지

BACKGROUND AND AIMS: Colonic polyps are premalignant lesion, whose removal is important for the prevention of colon cancer. METHODS: A series of 116 patients (195 polyps) who undergone colonoscopic polypectomy at Chung Nam National University Hospital from March 1994 to Feb.1997 were analyzed. RESULTS: 1) The ratio of males and females was 81:35, with the average age being in the 60's. 2) Colorectal polyps were found at the rectum (39.5%), sigmoid colon (35.9%). The size of the polyps was less than 0.6 cm in diameter (44.6%), between 0.6 and 1.0 cm (27.7%), between 1.1 and 2.0 cm (22.6%). The number of polyp was single polyp (59.5%). According to the Yamada classification, type III was the most common (43.1%). 3) Histopathologic findings were as follows. Tubular adenomas (58.6%), LSPs was in 3 cases, and malignant changed polyps in 14 case. 4) The malignantly changed polyps peaked in those in their 70's, had sizes ranging between 1.1 and 2.0 cm. Histopathologic finding were villous adenomas (50.0%), tubular adenomas (13.2%), LSPs (33.3%) in orders. CONCLUSION: Although the prevalence of cancer of villous adenomas and LSP was higher than other polyps, the size of the adenomas, their numbers do not seem to influence the malignancy rate in this report.

Malignant changes in bile duct cysts in adults: a report of 24 cases / 中华肝胆外科杂志

Objective To investigate the surgical measures for relieving biliary malignancies that occur in bile duct cysts (BDCs). Methods Twenty four cases of biliary carcinoma occurring in BDCs treated in our Department from October 1965 to June 1999 were reviewed. Results Of the patients, 5 were male and 19 female. The average age at the time of being diagnosed was 38. Nine patients had undergone cystoenterostomy before. The mean duration between operation of drainage and detection of carcinoma was 10 years. Operations included excision of the extrahepatic bile duct plus pancreatoduodenectomy in 5, excision of extrahepatic bile duct in 6, and various palliative procedures because of extensive spread of tumor in 13. Follow up data were obtained in all but 2 patients who died in hospital. The mean survival time for the 16 death cases after discharge was 11 months. Four patients have been alive and free from disease for 12, 7, 6.5 and 0.5 years, respectively. Conclusions 1) Early diagnosis and curative resection for the biliary carcinoma in BDCs are the key points to achieve better outcomes. 2) Prophylactic excision of cyst in adults with BDCs, especially those previously treated with cystoenterostomy, can effectively reduce the risk of malignant changes.

CLINICAL ANALYSIS FOR 148 CASES OF COLORECTAL ADENOMA WITH MALIGNANT CHANGE / 中国癌症杂志

PURPOSE In order to correct the wrong point of view which considered the colorectal adenoma with malignant change as early stage of carcinoma or as carcinoma with low grade malignancy and to avoid performing simple operation unreasonably. METHODS 148 cases of colorectal adenoma with malignant change which were treated in our department in 1995-1997 were submitted to a retrospective study. RESULTS We find only 27 cases (18. 8%) whose malignant changes were localized in the layers of mucosa.mucosalmuscle and submucosa,72 cases (50. 0 % , whose malignant changes had penetrated to the layer of serosa, and 43 cases (30. 7 % ) had lymph nodes metastases,18 cases (12. 5%) had blood metastases or implantations. We also find 51 cases (35. 5%) that couldn't get a definite diagnoses of malignant changes although 1-3 times of biopsies had been made before operation. and of them in fact 39 cases (74. 3%)had malignant changes that had penetrated to the layers muscle and serosa ,10 cases (19.6%) had metastases of lymph nodes and 7 cases (13. 7%) and blood metastases or implantations. CONCLUSION The adenoma with malignant change can not be considered as the early stage of carcinoma. We can not say the adenoma whose diagnosis was made by 1 - 3 times of biopsies is a real adenoma and certainly has no malignant change. We can not say the tumor whose original diagnosis was adenoma still belongs to the early stage of carcinoma either. So we suggest to treat the adenoma with malignant change correctly,aviod performing simple operation unreasonably.

A Case Report of Peutz - Jeghers Syndrome with an Adenomatous Malignant Change in a 44 Year Old Male Patient / 대한소화기내시경학회지

Peutz-Jeghers Syndrome, characterized by autosomal inheritance, skin pigmentation, and hamartomatous polyps, had long been considered a benign polyposis until recent studies suggested an association with increased risk of malignant neoplasia in patients who had been followed-up for long periods. The authors present a case of Peutz-Jeghers syndrome in a 44 year old man with an adenomatous malignant change in his small bowel. The patient underwent surgery following a diagnosis of intestinal intussuception. Observing the polyps resected, all the polyps had characteristics of hamartoma, excluding one which showed a malignant transformation. Although it has not been fully determined with certainty whether the adenocarcinoma developed from hamartoma, histologic examination of an excised specimen suggested, thht potency of hamartoma to undergo malignant transformation. All the members of the family were confirmed to have no evidence of Peutz-Jeghers syndrome. Our clinical experience determines the malignant potency in Peutz-Jeghers and recommends that intensive follow-up of gastrointestinal and extragastrointestinal sites is needed in patients with this syndrome.

Surgical Experience of Multiple Recurrent Astrocytoma: Case Report

The treatment of recurrent supratentorial glioma is one of the most challenging and at the same time one of the oldest problem in neurosurgery, especially in case of multiple recurrence. We have experienced 15-year-old male, multiple recurrent supratentorial glioma patient who was subjected to 6 times of operation, radiation therapy and chemotherapy druing 5 year follow-up period. We reveiewed the literature and discussed about recurrent rate, malignant change, method of management and indication of reoperation in low grade glioma.