Primary tumor heterogeneity on pretreatment 18F-FDG PET/CT to predict outcome in patients with rectal cancer who underwent surgery after neoadjuvant therapy.

PURPOSE: This retrospective study aimed to investigate the value of texture features of primary tumors in pretreatment 18F-FDG PET/CT in the prediction of response to treatment, progression, and overall survival in patients with rectal cancer who underwent surgery after neoadjuvant therapy(NAT). METHODS: Patients with rectal cancer who had pretreatment 18F-FDG PET/CT, and underwent surgery after NAT were included in this study. Clinicopathologic features, date of last follow-up, progression, and death were recorded. Textural and conventional PET parameters(maximum standardized uptake value-SUVmax, metabolic tumor volume-MTV, total lesion glycolysis-TLG) were obtained from PET/CT images using LifeX program. Parameters were grouped using Youden index in ROC analysis. Factors predicting the pathological response to treatment, progression, and overall survival were determined using logistic regression and Cox regression analyses. RESULTS: Forty-four patients (26(59%) male, 18(41%) female; 60.1±11.4 years) with rectal cancer were included in this study. The numbers of patients with responders and non-responders to NAT were 15(34.9%) and 28(65.1%), respectively. One patient' pathology report did not contain the response status to NAT. The median of follow-up duration was 29.9 months. 9(20.5%) showed disease progression, and 8(18.2%) died during the follow-up period. Difference entropyGLCM and correlationGLCM parameters were found as independent predictors for response to NAT. The positivity of surgical margin, intensity interquartile rangeCONV and AUC-CSHDISC texture parameters were independent predictors of progression, while normalized inverse differenceGLCM and LZLGEGLZLM parameters were independent predictors of mortality. CONCLUSION: The texture parameters obtained from pretreatment 18F-FDG PET/CT have presented a more robust predictive value than conventional parameters in patients with rectal cancer who underwent surgery after NAT.

The role of CSE1L expression in cervical lymph node metastasis of larynx tumors / O papel da expressão de CSE1L na metástase em linfonodos cervicais de tumores laríngeos

Abstract Introduction: According to international reports, 30-40% of all head and neck cancers are larynx cancers, comprising 1-2.5% of all cancer types. Cervical nodal involvement has been reported to be 40% and 65% in T3 and T4 cases, respectively. Five-year survival in patients with cervical lymph node metastasis has been demonstrated to be 50% lower compared to patients with no metastasis. Chromosome segregation like 1 protein; is a DNA fragment isolated by Brinkmann et al. in 1995 that corresponds to yeast chromosome segregation protein. Studies on the effect of chromosome segregation like 1 protein expression in head and neck tumors are rare and it has been shown that nuclear chromosome segregation like 1 protein is over-expressed in these studies where gastrointestinal and breast tumors over-expressed cytoplasmic chromosome segregation like 1 protein. Objective: Chromosome segregation like 1 protein may regulate the proliferation and metastasis of T3-T4 glottic larynx cancer. The aim of this study is to show the relationship between chromosome segregation like 1 protein expression and cervical lymph node metastasis of T3-T4 glottic larynx cancer. Methods: A total of 57 male patients who were operated for T3-T4 glottic cancer in a tertiary referral hospital was included in this study. There were 28 patients with cervical lymph node metastasis and 29 patients without lymph node metastasis. Immunohistochemistry was carried out on formalin-fixed, paraffin-embedded archival glottic larynx tumour tissue. According to the percentage of immunoreactive cells, chromosome segregation like 1 protein status was analyzed. Results: Among the patients, who had no cervical lymph node metastasis, 15 patients showed weak nuclear staining, 12 patients showed moderate nuclear staining and only 2 patients showed high nuclear staining for chromosome segregation like 1 protein. Among the patients who had cervical lymph node metastasis, 18 patients showed high nuclear staining, 9 patients showed moderate staining and only one patient showed weak staining for chromosome segregation like 1 protein. None of the metastatic patients showed cytoplasmic staining and only one patient in the non-metastatic group showed cytoplasmic staining for chromosome segregation like 1 protein. There was a positive correlation between nuclear chromosome segregation like 1 protein expression and cervical lymph node metastasis (r = 0,668) and it was statistically significant (p < 0,001). Conclusion: Chromosome segregation like 1 protein expression is correlated with lymph node metastasis in T3-T4 glottic cancers. This may change the approach to cervical node treatment in patients with glottic cancers in future.

Resumo Introdução: De acordo com relatos internacionais, 30% a 40% de todos os casos de câncer de cabeça e pescoço são na laringe, compreendem 1% a 2,5% de todos os tipos de câncer. O envolvimento linfonodal cervical foi relatado em 40% e 65% nos casos T3 e T4, respectivamente. A sobrevida em cinco anos em pacientes com metástase linfonodal cervical demonstrou ser 50% menor em comparação com os pacientes sem metástase. A proteína chromosome seg-regation like 1 é um fragmento de DNA isolado por Brinkmann et al. em 1995 que corresponde à proteína de segregação cromossômica de levedura. Estudos sobre o efeito da expressão da proteína chromosome segregation like 1 em tumores de cabeça e pescoço são raros e os poucos estudos demonstram que a proteína chromosome segregation like 1 nuclear é superexpressa no núcleo, enquanto tumores gastrointestinais e de mama superexpressam a proteína chromosome segregation like 1 citoplasmática. Objetivo: A proteína chromosome segregation like 1 pode regular a proliferação e metástase do câncer glótico de laringe T3-T4. O objetivo deste estudo é mostrar a relação entre a expressão da proteína chromosome segregation like 1 em metástase de linfonodo cervical no câncer glótico de laringe T3-T4. Método: Foram incluídos neste estudo 57 pacientes do sexo masculino submetidos a cirurgias por câncer glótico T3-T4 em um hospital terciário. Havia 28 pacientes com metástase de linfonodos cervicais e 29 pacientes sem metástase linfonodal. A análise imunohistoquímica foi realizada em tecido de tumor glótico de laringe embebido em parafina e fixado em formol. De acordo com a porcentagem de células imunorreativas, analisou-se a expressão da proteína chromosome segregation like 1. Resultados: Entre os pacientes, que não tinham metástase linfonodal cervical, 15 apresentaram coloração nuclear fraca, 12 apresentaram coloração nuclear moderada e apenas 2 apresentaram coloração nuclear elevada para proteína chromosome segregation like 1. Entre os pacientes que apresentavam metástase linfonodal cervical, 18 pacientes apresentaram coloração nuclear elevada, 9 apresentaram coloração moderada e apenas um paciente apresentou coloração fraca. Nenhum dos pacientes com metástase apresentou coloração citoplasmática e apenas um paciente no grupo não-metastático mostrou coloração citoplasmática para a proteína chromosome segregation like 1. Houve uma correlação positiva entre a expressão nuclear da proteína chromosome segregation like 1 e a metástase de linfonodo cervical (r = 0,668), que foi estatisticamente significante (p < 0,001). Conclusão: A expressão da proteína chromosome segregation like 1 está correlacionada com metástases linfonodais em casos de câncer glótico T3-T4 e isso pode mudar a abordagem do tratamento cervical de câncer glótico no futuro.

The role of CSE1L expression in cervical lymph node metastasis of larynx tumors.

INTRODUCTION: According to international reports, 30-40% of all head and neck cancers are larynx cancers, comprising 1-2.5% of all cancer types. Cervical nodal involvement has been reported to be 40% and 65% in T3 and T4 cases, respectively. Five-year survival in patients with cervical lymph node metastasis has been demonstrated to be 50% lower compared to patients with no metastasis. Chromosome segregation like 1 protein; is a DNA fragment isolated by Brinkmann et al. in 1995 that corresponds to yeast chromosome segregation protein. Studies on the effect of chromosome segregation like 1 protein expression in head and neck tumors are rare and it has been shown that nuclear chromosome segregation like 1 protein is over-expressed in these studies where gastrointestinal and breast tumors over-expressed cytoplasmic chromosome segregation like 1 protein. OBJECTIVE: Chromosome segregation like 1 protein may regulate the proliferation and metastasis of T3-T4 glottic larynx cancer. The aim of this study is to show the relationship between chromosome segregation like 1 protein expression and cervical lymph node metastasis of T3-T4 glottic larynx cancer. METHODS: A total of 57 male patients who were operated for T3-T4 glottic cancer in a tertiary referral hospital was included in this study. There were 28 patients with cervical lymph node metastasis and 29 patients without lymph node metastasis. Immunohistochemistry was carried out on formalin-fixed, paraffin-embedded archival glottic larynx tumour tissue. According to the percentage of immunoreactive cells, chromosome segregation like 1 protein status was analyzed. RESULTS: Among the patients, who had no cervical lymph node metastasis, 15 patients showed weak nuclear staining, 12 patients showed moderate nuclear staining and only 2 patients showed high nuclear staining for chromosome segregation like 1 protein. Among the patients who had cervical lymph node metastasis, 18 patients showed high nuclear staining, 9 patients showed moderate staining and only one patient showed weak staining for chromosome segregation like 1 protein. None of the metastatic patients showed cytoplasmic staining and only one patient in the non-metastatic group showed cytoplasmic staining for chromosome segregation like 1 protein. There was a positive correlation between nuclear chromosome segregation like 1 protein expression and cervical lymph node metastasis (r = 0,668) and it was statistically significant (p < 0,001). CONCLUSION: Chromosome segregation like 1 protein expression is correlated with lymph node metastasis in T3-T4 glottic cancers. This may change the approach to cervical node treatment in patients with glottic cancers in future.

Radiologic Findings of a Rare Subtype of Invasive Breast Cancer with Poor Prognosis: Metaplastic Carcinoma of the Breast.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the mammographic, sonographic and MRI findings of metaplastic breast carcinoma. METHODS: In this retrospective review study, we analyzed the medical files of 9600 patients who were treated for invasive breast cancers. Clinical information, histopathologic and radiologic findings of 65 patients were included in this study. All existing radiologic images and medical reports were reviewed retrospectively. Thirty-three patients had MG, 58 patients had US and 7 patients had MRI imaging results. RESULTS: Mammographically, the most frequent presentations of MPBC were round shape, microlobulated margin and high density masses. Calcifications with or without masses were not a frequent finding. The most common sonographic findings were round shape, partially indistinct angular margin, hypoechoic and heterogeneous echo patterns and no posterior feature masses. All lesions were presented as masses rather than non-mass enhancements on magnetic resonance imaging. Features of masses had more malignant feature on MRI than other modalities in all 7 patients. CONCLUSION: Metaplastic breast carcinoma is one of the rarest poorly differentiated invasive breast carcinomas. Interestingly, these aggressive tumors demonstrate benign or moderately malign features on imaging methods. This appearance of MPBC can cause it to be misdiagnosed as a benign breast lesion especially in young women. MPBC should be kept in mind in the differential diagnosis of large palpable breast masses. Therefore, follow-up at short intervals and/or multimodality imaging studies which include breast MRI are important for the diagnosis of MPBC.

Transducing-Like Enhancer of Split 1: A Potential Immunohistochemical Marker for Glomus Tumor.

Glomus tumors (GTs) are rare, perivascular soft tissue tumors. Although GTs are usually found in the subcutaneous tissue, they may be detected in extracutaneous sites and mucosal areas. Transducing-like enhancer of split 1 (TLE1) is a highly useful immunohistochemical marker, which basically helps in differential diagnosis of synovial sarcoma. Based on a coincidental detection of TLE1 in one GT case, we studied 26 additional GT cases to establish the importance and distribution of TLE1 in GTs. Of 24 subcutaneous GTs, 22 (91.6%) were positive for TLE1 antibody and the remaining 2 mucosal GTs were negative. Of the 22 positive cases, 10 showed strong nuclear positivity. There was no difference between the subtypes of the GTs. Although TLE1 expression is significantly correlated to SS18 (SYT) rearrangements in synovial sarcomas, the fluorescence in situ hybridization analyses of the GTs showed no evidence of translocation involving this locus. TLE1 is a potential immunohistochemical marker for GTs, but further studies are required to confirm this finding.

Extradigital Glomus Tumor of Thigh.

Glomus tumors are benign neoplasms that arise from neuromyoarterial glomus bodies. They represent around 1-5% of all soft-tissue tumors. High temperature, sensitivity, and pain and localized tenderness are the classical triad of symptoms. Most glomus tumors represent in the subungual area of digits. Extradigital glomus tumors are a very rare entity. There are rare cases of these tumors reported to be in shoulder, elbow, knee, wrist, even stomach, colon, and larynx. We are reporting a case of a glomus tumor on thigh and discuss the histological and immunohistochemical features.

Does CSE1L Overexpression Affect Distant Metastasis Development in Breast Cancer?

BACKGROUND: CSE1L (chromosome segregation 1-like) is the human homologue to the yeast gene CSE1, and is related to invasion and metastasis in cancer progression. The aim of this study was to investigate the potential role of CSE1L expression in distant metastasis of breast cancer. PATIENTS AND METHODS: A total of 71 breast cancer patients were included in this study. Clinical characteristics and CSE1L status were evaluated. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded archival breast tumor tissue. The results of CSE1L staining were analyzed according to the percentage of immunoreactive cells. RESULTS: 34 patients had distant metastasis and 37 did not. The mean age of the patients was 50.5 ± 12.1 years. Age, tumor size, and hormone receptor status were similar in patients with distant metastasis and in those without. A statistically significant relationship was found between nuclear CSE1L expression and distant metastasis of breast cancer. Lymph node metastasis and nuclear grade were other factors affecting distant metastasis. CONCLUSION: There is a relationship between nuclear CSE1L overexpression and distant metastasis in breast cancer. CSE1L status may therefore become a valuable prognostic tool in the future.

The relationship between CSE1L expression and axillary lymph node metastasis in breast cancer.

AIM: CSE1L is the human homologue to the yeast gene CSE1 and CSE1L is a gene related to cancer progression. Thus, CSE1L may regulate the invasion and metastasis of breast cancer. The aim of this study is to show the relationship between CSE1L and axillary lymph node metastasis. METHODS: Sixty-six breast cancer patients were evaluated according to patient and tumor characteristics. Immunohistochemistry was carried out on formalin-fixed, paraffin-embedded archival breast tumor tissues. The results of CSE1L staining were analyzed according to the percentage of immunoreactive cells. RESULTS: There were 29 patients without axillary lymph node metastasis and 37 patients with nodal metastasis. The mean age of the patients was 50.6 ± 11.3 years. Age, tumor size, nuclear grade and hormone receptor status were similar in the axillary lymph node positive and negative groups. There was a statistically significant relationship between cytoplasmic CSE1L expression and axillary lymph node metastasis. However, nuclear CSE1L expression did not have any effect on axillary lymph node metastasis. CONCLUSIONS: Cytoplasmic CSE1L overexpression may be a valuable tool for prognosis of breast cancer in future.

Straight versus S-shaped sternotomy: a histologic study in the sheep model.

INTRODUCTION: Straight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the sternal instability and bone healing. MATERIALS AND METHODS: We enrolled 31 sheep, weighing 18-30 kg. For all animals a midline skin incision was made. In group I (n = 16 animals), straight median sternotomy and in group II (n = 15 animals), S-shaped incision was marked on the periosteum of the sternum by new created device for standard S-shaped sternotomy. Sternum biopsies were performed on second surgery month for all survived animals from the sternum and the surrounding soft tissue. RESULTS: No early superficial wound complications were observed. Overall mortality in the initial approach group was 19.3% (6 sheep). In group I; 3 sheep had died on first surgery day, the reason may be hemorrhage and in group II; 3 sheep developed intractable VF during surgery procedure or immediately afterwards so died. There were statistically significant differences in the scores of bone healing between group 1 and group 2 (4.2 vs.7.3, ANOVA, p < 0.001). DISCUSSION: Our work is based on the use of a standard S-shaped sternotomy procedure on sheep sternum. In our experience with the sternal healing in the sheep model, the process of new bone formation was accelerated with S- shaped cut than straight sternotomy procedure.

Fine needle aspiration biopsy: in the diagnosis of salivary gland neoplasms compared with histopathology.

Fine needle aspiration biopsy is commonly used for pre operative evaluations of salivary gland masses. We would like to focus on this diagnostic tool for the salivary gland lesions by reviewing Ankara Oncology Hospital's case lists. Cytological and postoperatively histological reassessment is done for 115 cases. Fine needle aspiration biopsy's sensitivity was 80.8 %, specificity 95.1 %, positive predictive value was 84 % and negative predictive value was 93.9 %. False positive range was 4.9 % and false negative range was 19.2 %. Salivary gland masses can be assessed by cytology preoperatively.

Synchronous primary carcinoma in 5 different organs of a female genital tract: an unusual case and review of the literature.

The occurrence of double simultaneous primary cancers of the female reproductive tract is a common event. However, the occurrence of synchronous primary quadruple gynecologic malignancies is extremely rare. In this report, the clinical and pathological findings of a 35-year-old female patient with synchronous primary gynecologic cancers regarding papillary serous carcinoma of the left ovary, microinvasive carcinoma in situ of the left and right uterine tubes, endometrial intraepithelial carcinoma of the endometrium, and endocervical carcinoma in situ of the uterine cervix were presented. To our knowledge, the patient presented is the first case in aspect of accompanying ovarian papillary serous carcinoma to bilateral tubal microinvasive carcinoma in situ, endometrial intraepithelial carcinoma, and endocervical carcinoma in situ of the uterine cervix.

Preoperative hemoglobin and platelet count and poor prognostic factors in patients with endometrial carcinoma.

OBJECTIVE: The aim of this study was to evaluate the relationship between preoperative hemoglobin and platelet count and prognostic factors in patients with endometrial cancer. METHODS: Sixty-one patients with endometrial carcinoma who underwent surgical treatment consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, pelvic and para-aortic lymph node dissection, and peritoneal cytology were retrospectively analyzed. Preoperative hemoglobin and platelet count, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, lymphovascular invasion (LVSI), adnexal involvement, positive peritoneal cytology, cervical stromal invasion, and tumor size were investigated. Kruskal-Wallis, Mann-Whitney U, Fishers Exact and Chi-square tests were used for univariate analyses. The multivariate analysis was performed with logistic regression analyses. RESULTS: Twenty-six (42.6%) patients had a pre-treatment hemoglobin value of < or =12 g/dL. These 26 patients had significantly higher rates of positive cytology (P = 0.008), advanced FIGO stage (P = 0.03), omental metastases (P = 0.01), cervical involvement (P = 0.02), and thrombocytosis (P = 0.02). The multivariate analysis revealed cervical involvement (P = 0.019, OR = 4.030, 95% CI = 1.255-12.947) and positive peritoneal cytology (P = 0.022, OR = 12.509, 95% CI = 1.43-109.36) to be significantly associated with low hemoglobin level. In the univariate analysis, the presence of cervical involvement and lymphatic metastasis were associated with significantly higher median preoperative platelet counts. CONCLUSION: Low pre-treatment hemoglobin level may reflect poor prognostic factors such as positive cytology and cervical involvement in patients with endometrial cancer that is associated with thrombocytosis.

The role of omentectomy during the surgical staging in patients with clinical stage I endometrioid adenocarcinoma.

OBJECTIVE: The aim of this study was to evaluate whether omentectomy should be a routine part of staging surgery in endometrioid adenocarcinoma. METHODS: A retrospective study was performed on 65 patients who were primarily treated by total abdominal hysterectomy, salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy, infracolic omentectomy and peritoneal cytology for clinical stage I endometrial carcinoma between January 2002 and December 2005. Data on 65 patients who had been diagnosed with clinical stage I endometrial carcinoma were reviewed. Associations in the data obtained, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, vascular invasion, adnexal involvement, positive peritoneal cytology, lymph node metastasis, cervical stromal invasion, and tumor size, were investigated. The Chi-square (chi(2)) test was used for statistical analysis. Multivariate analysis was performed with logistic regression analyses. RESULTS: Four (6.2%) of 65 patients had omental metastasis, which was microscopic in two patients. As for extrauterine spread, the positivity rate of lymph node metastases was 10/65 (15.38%), peritoneal cytology was 7/65 (10.76%), and adnexal metastases was 10/65 (15.38%). Of those patients with omental metastasis, 2/10(20%) had positive nodes, 2/10(20%) had adnexal metastases, and 3/7(42.8%) had positive peritoneal cytologic findings. These four patients with omental metastasis had significantly higher rates of positive cytology (P = 0.003). Multivariate analysis revealed omental metastasis (P = 0.002; OR 46.5, CI 95% 3.899-554.575) to be significantly associated with positive peritoneal cytology CONCLUSIONS: We conclude that despite the presence of normal-appearing omentum, omentectomy should be performed as a component of surgical staging in the presence of positive peritoneal cytology.

Splenic abscesses in therapy-resistant acute myeloblastic leukemia presenting as recurrent febrile neutropenia and unresolved splenomegaly.

A 14 7/12-year-old boy with acute myeloblastic leukemia M3v was admitted with disseminated intravascular coagulation, otitis media, lobar pneumonia, and splenomegaly. After induction therapy, M2 bone marrow was attained but splenomegaly persisted. Abdominal ultrasonography, which revealed diffuse splenomegaly at admission, showed splenic nodular lesions at the end of the induction therapy. The lesions persisted after M1 bone marrow was attained. He developed acute appendicitis and was operated. Ultrasonography-guided aspiration biopsy revealed nonspecific purulent abscess. Gram's stain and aerobic culture revealed no microorganism or fungi. Splenectomy was performed. The pathologic examination confirmed the diagnosis. He did not have an appropriate bone marrow donor, and developed bone marrow relapse and died.