scholarly journals Effect of changes in Breslow thickness between the initial punch biopsy results and final pathology reports in acral lentiginous melanoma patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tae Hyung Kim ◽  
Jin Cheol Kim ◽  
Ji Eun Kwon ◽  
You Chan Kim ◽  
Jee Woong Choi
Keyword(s):  
Cox Regression ◽  
Excisional Biopsy ◽  
Punch Biopsy ◽  
Nodal Metastasis ◽  
Breslow Thickness ◽  
Wide Excision ◽  
Acral Lentiginous Melanoma ◽  
Final Pathology ◽  
Pathology Reports ◽  
Pathologic Parameters

AbstractAcral lentiginous melanoma (ALM) is the most common subtype of cutaneous melanoma among Asians; punch biopsy is widely performed for its diagnosis. However, the pathologic parameters evaluated via punch biopsy may not be sufficient for predicting disease prognosis compared to the parameters evaluated via excisional biopsy. We investigated whether changes in Breslow thickness (BT) between initial punch biopsy results and final pathology reports can affect the prognosis of ALM. Pathologic parameters were recorded from specimens acquired through the initial punch biopsy and wide excision. Patients were classified into two groups based on a change in Breslow depth: the BT increased or decreased on comparing the samples from the initial punch biopsy and final wide excision. We compared clinical characteristics, and a Cox regression model was used to identify independent prognostic factors influencing melanoma-specific death (MSD). Changes in BT did not affect MSD (hazard ratio [HR]: 0.55, P = 0.447). In multivariate analysis, a higher BT (> 2 mm) (HR: 9.93, P = 0.046) and nodal metastasis (HR: 5.66, P = 0.041) were significantly associated with an increased MSD risk. The use of punch biopsy did not affect MSD despite the inaccuracy of BT measurement as long as ALM was accurately diagnosed.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

scholarly journals Melanoma: clinical-pathological and molecular analysis in patients of Ibague city, Colombia

Duazary ◽  
2020 ◽  
Vol 17 (1) ◽  
pp. 5-18 ◽  
Author(s):  
Carlos Puentes ◽  
Ana Estrada ◽  
Mabel Bohórquez ◽  
Anggi Vélez ◽  
Carlos Giraldo ◽  
...  
Keyword(s):  
Gene Mutations ◽  
Mitotic Rate ◽  
Clinicopathological Characteristics ◽  
Lower Limbs ◽  
Braf Gene ◽  
Acral Lentiginous Melanoma ◽  
Kaplan Meier ◽  
Age Of Diagnosis ◽  
Pathology Reports ◽  
Clinicopathological Variables

This study aimed to establish the clinicopathological characteristics of patients with melanoma and its association with BRAF gene mutations. The pathology reports and paraffin-embedded tumor samples from 47 women and 30 men with melanoma, with an average age of diagnosis of 60 years, were reviewed at the Hospital Federico Lleras Acosta of Ibague, between 2010 and 2016. The presence of V600E mutation at the exon 15 of BRAF gene, was analyzed in these tumoral samples by Sanger sequencing and visual inspection of the electropherograms. We also studied the clinicopathological variables with X2, t-Student and the Kaplan Meier index. Most of the lesions were located in the lower limbs (46.6%). The most frequent subtype was Acral Lentiginous Melanoma (41.8%). Most lesions were of poor prognosis: Breslow depth greater than 4.1 mm (52.7%), ulceration (61.4%) and medium or high mitotic rate (> 30 %). The V600E mutation was identified in five patients with large, deep and ulcerated tumors, four of them had less than four years of survival. In conclusion, there was a higher frequency of melanoma in women, V600E BRAF mutation was present in patients with advanced disease (high Breslow index) and, the probability of five-year survival was less than 40%.

856 NODAL METASTASES AFTER NEOADJUVANT CHEMORADIATION AND R0 RESECTION IN ESOPHAGEAL ADENOCARCINOMA: PATTERNS AND PROGNOSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Caitlin Harrington ◽  
Rebecca Carr ◽  
Smita Sihag ◽  
Prasad Adusumilli ◽  
Manjit Bains ◽  
...  
Keyword(s):  
Lymph Node ◽  
Esophageal Adenocarcinoma ◽  
Lymph Node Metastases ◽  
Cox Regression ◽  
Neoadjuvant Chemoradiation ◽  
Nodal Metastasis ◽  
Nodal Metastases ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Node Metastases

Abstract   Although the pattern of nodal metastasis and the prognosis of number and location of positive nodes have been well described with esophageal cancer undergoing upfront surgery, little is known about nodal metastasis after neoadjuvant treatment. The aim of this study is to assess the pattern of nodal metastases in esophageal adenocarcinoma treated with neoadjuvant chemoradiation and surgery and evaluate its effect on prognosis. Methods All patients with esophageal adenocarcinoma who had undergone neoadjuvant chemoradiation and an R0 esophagectomy between 2010 and 2018 at our institution were included (n = 577). Pathology reports were reviewed for sites of lymph node metastases. Patients were excluded if nodal stations were not listed separately (n = 40). Age, sex, race, tumor location, TRG, pT stage, number of positive lymph nodes, number of positive nodal stations, and specific nodal stations were analyzed for risk of recurrence using univariable Cox regression, and significant covariates were included in multivariable Cox regression model. Results Of 537 patients, 193(36%) had pathologic nodal metastases. 153 patients(28%) had single-station disease: 135(88%) at the paraesophageal station, 16(10%) at the left gastric, 1 at the subcarinal and 1 at the paratracheal station(0.65% each). 32 patients(6.0%) had two-station and 8(1.5%) had three-station disease. The majority of patients with multiple positive nodal stations had positive nodes in the paraesophageal(90%) and/or left gastric artery stations(60%). On multivariable analysis, the number of positive nodal stations (HR 1.59, CI 1.35–1.84, p < 0.001), subcarinal (HR 2.78, CI 1.54–5.03, p < 0.001), and paraesophageal stations (HR 2.0, CI 1.58–2.54, p < 0.001) were associated with increased risk of recurrence. Conclusion Patients who have undergone neoadjuvant and R0 esophagectomy for adenocarcinoma often have lymph node metastases at time of surgery, most commonly at the paraesophageal station. The number of nodal stations, along with subcarinal and paraesophageal metastases, were associated with increased risk of recurrence.

Prognostic Factors Associated with Outcomes in Small Bowel Neuroendocrine Tumors

2017 ◽  
Vol 83 (10) ◽  
pp. 1174-1178 ◽  
Author(s):  
Nicholas Manguso ◽  
Jeffrey Johnson ◽  
Attiya Harit ◽  
Nicholas Nissen ◽  
James Mirocha ◽  
...  
Keyword(s):  
Small Bowel ◽  
Neuroendocrine Tumors ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Nodal Metastasis ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Open Operation ◽  
Recurrence Group

Small bowel neuroendocrine tumors (SBNET) account for most gastrointestinal neuroendocrine tumors. Patients often present with late-stage disease; however, there is little information regarding factors that contribute to recurrence. Database review identified 301 patients diagnosed with SBNET between 1990 and 2013. Univariate analysis included patients who underwent complete resection. Survival was estimated by the Kaplan–Meier method. A total of 147 patients met study criteria. Average age was 60 years (range 21–91); 49 per cent were male. Thirty-seven (25.3%) patients had laparoscopic resection, and 29 (19.9%) patients had only small bowel disease, whereas 108 (72.6%) had nodal metastasis. Five-year overall and disease-free survival were 97.5 and 73.5 per cent. Forty-seven (32%) patients had recurrence. The recurrence group was more likely to have an open operation (59.6 vs 32%, P < 0.01), mesenteric invasion, or lymphatic metastasis (87.2 vs 67%, P < 0.01) compared with the no-recurrence group. Cox regression analysis showed that variables associated with recurrence included nodal disease (HR 9.06, P = 0.03), lymphovascular invasion (LVI) (3.95, P < 0.01), perineural invasion (PNI) (3.48, P < 0.01), and mesenteric involvement (3.77, P = 0.03). Patients with SBNET presenting with nodal metastasis, mesenteric involvement, LVI, or PNI have a higher risk of recurrence. Closer surveillance should be considered after operative resection.

Regression Does Not Predict Nodal Metastasis or Survival in Patients with Cutaneous Melanoma

2011 ◽  
Vol 77 (8) ◽  
pp. 1009-1013 ◽  
Author(s):  
Alison L. Burton ◽  
Juliana Gilbert ◽  
Russell W. Farmer ◽  
Arnold J. Stromberg ◽  
Lee Hagendoorn ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cutaneous Melanoma ◽  
Clinical Decision Making ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Nodal Metastasis ◽  
Breslow Thickness ◽  
Significant Prognostic Factor ◽  
Superficial Spreading ◽  
Histologic Subtype

Controversy exists regarding the prognostic implications of regression in patients with cutaneous melanoma. Some consider regression to be an indication for sentinel lymph node (SLN) biopsy because regression may result in underestimation of the true Breslow thickness. Other data support regression as a favorable prognostic indicator, representing immune system recognition of the primary tumor. This analysis was performed to determine whether regression predicts nodal metastasis, disease-free survival (DFS), or overall survival (OS). Post hoc analysis was performed of a multicenter prospective randomized trial that included patients aged 18 to 70 years with cutaneous melanomas 1 mm or greater Breslow thickness. All patients underwent SLN biopsy; those with tumor-positive SLN underwent completion lymphadenectomy. Kaplan-Meier analysis of survival, univariate analysis, and multivariate analysis were performed. A total of 2220 patients (261 with regression; 1959 without regression) were included in this analysis with a median follow-up of 68 months. Patients with regression were more likely to be male, older than 50 years old, and have lower median Breslow thickness, superficial spreading histologic subtype, and a non-extremity anatomic location ( P < 0.05 in all cases). Regression was not significantly associated with Clark level, ulceration, lymphovascular invasion, number of SLNs removed, or SLN metastasis. On multivariate analysis, factors independently predictive of DFS included Breslow thickness, ulceration, and SLN status ( P < 0.05 in all cases); the same factors along with age, gender, and anatomic tumor location were significantly associated with OS ( P < 0.05 in all cases). Regression was not significantly associated with DFS (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.67-1.27; P = 0.68) or OS (RR, 1.01; 95% CI, 0.76-1.32; P = 0.93). These data suggest that regression is not a significant prognostic factor for patients with cutaneous melanoma and should not be used to guide clinical decision-making for such patients.

Is Excisional Biopsy and Chemoprevention Warranted in Patients with Atypical Lobular Hyperplasia on Core Biopsy?

2015 ◽  
Vol 81 (9) ◽  
pp. 876-878 ◽  
Author(s):  
Shelby Allen ◽  
Edward A. Levine ◽  
Nadja Lesko ◽  
Marissa Howard-Mcnatt
Keyword(s):  
Breast Cancer ◽  
Core Biopsy ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Patient Characteristics ◽  
Current Treatment ◽  
Final Pathology ◽  
Atypical Lobular Hyperplasia

The management of atypical lobular hyperplasia (ALH) on core biopsy remains controversial. The upstaging rates after surgical excision vary. We reviewed our upgrade rates and use of chemoprevention for ALH. Patients were identified through our pathology database for ALH from 2006 to 2013. Patients were included in the study that had a diagnosis only of ALH on core needle biopsy. Tumor and patient characteristics and final pathology were analyzed. ALH was identified in 56 patients since 2006. Sixteen patients met the inclusion criteria. All the patients underwent surgical excision. Final pathology of the excised specimens confirmed ALH in 62 per cent (n = 11). Two cases contained lobular carcinoma in situ. The upgrade rate on excisional biopsy was 18.75 per cent (n = 3) to invasive cancer. Chemopreventative treatment was taken by 44 per cent of the patients. After a mean follow-up of three years, none of the patients who received chemoprevention developed breast cancer. One patient who refused tamoxifen developed breast cancer. This is one of the few studies to examine the current treatment of ALH. We noted a significant upstaging rate after excision. We recommend women to undergo surgical excision. Patients should also consider chemoprevention to reduce their risk for developing breast cancer.

Relationship between Initial Margin Status for Invasive Breast Cancer and Residual Carcinoma after Re-Excision

2007 ◽  
Vol 73 (4) ◽  
pp. 337-343 ◽  
Author(s):  
Cyrus Kotwall ◽  
Mark Ranson ◽  
Anquonette Stiles ◽  
Mary Sue Hamann
Keyword(s):  
Invasive Carcinoma ◽  
Early Stage ◽  
Excisional Biopsy ◽  
Margin Status ◽  
Invasive Cancer ◽  
Positive Margins ◽  
Residual Carcinoma ◽  
Pathology Reports ◽  
Second Procedure ◽  
The Relationship

Little data exists addressing the relationship between initial margin status in a specimen from an excisional biopsy and the presence of residual carcinoma in a subsequent specimen from lumpectomy or mastectomy. We sought to determine the relationship between initial margin status and the presence of residual invasive cancer, and to identify any relationship to other variables. This study was a retrospective review of pathology reports of 582 early-stage invasive duct carcinomas with open excisional biopsies. The initial specimen was classified into one of six margin categories: multiply focally positive (n = 174), focally positive (n = 132), margins <1 mm (n = 98), margins 1 to 2 mm (n = 20), margins >2 mm (n = 46), and margins undetermined (n = 90). All patients had a subsequent definitive second procedure. Pathology reports from the second procedure revealed the presence of residual invasive cancer by initial margin status as follows: in 30 per cent of the initial procedures with multiply focally positive margins, in 22 per cent with focally positive margins, in 8 per cent, 15 per cent, and 4 per cent with margins of <1 mm, 1 to 2 mm, and >2 mm, respectively, and in 28 per cent with undetermined margins. Women with palpable tumors, larger tumor size, and positive axillary nodes were more likely to have multiply focal and focally positive margins. Multiply focally positive and focally positive margins had similar residual invasive carcinoma rates and should be re-excised. All clear margins were equivalent; thus, re-excision was not necessary.

scholarly journals Increasing the Efficacy of SLNB in Cases of Malignant Melanoma Located in Close Proximity to the Lymphatic Basin

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Alexander Bogdanov-Berezovsky ◽  
Vasileios A. Pagkalos ◽  
Eldad Silberstein ◽  
Yaron Shoham ◽  
Arsinoi A. Xanthinaki ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Medical Center ◽  
Radioactive Tracer ◽  
Lymph Node Biopsy ◽  
Wide Excision ◽  
Node Biopsy ◽  
Close Proximity ◽  
Blue Stain ◽  
Pathology Reports

Background. Being predictive of the entire nodal bed, sentinel lymph node biopsy (SLNB) is invaluable in the surgical management of melanoma. Although the concept is simple, sentinel lymph node (SLN) identification and removal can be technically challenging. Methods. A total of 102 consecutive patients have undergone SLNB in the Division of Plastic and Reconstructive Surgery of Soroka University Medical Center from 2009 to 2012. Patients have undergone SLNB using a radioactive tracer and blue stain in order to identify the SLN. Although SLNB usually precedes the wide excision of melanoma, primary lesions in close proximity (<10 cm) to the lymph basin require wide excision before beginning the SLN quest. Results. All pathology reports confirmed the excision of lymph nodes. Conclusions. When treating MM in close proximity to the lymph basin, changing the sequence of the SLNB procedure seems to increase the efficacy of the method.

scholarly journals Salvage surgery for a giant melanoma on the back

Rare Tumors ◽  
2011 ◽  
Vol 3 (3) ◽  
pp. 90-91 ◽  
Author(s):  
Schelto Kruijff ◽  
Robert Vink ◽  
Joost Klaase
Keyword(s):  
Salvage Surgery ◽  
Palliative Therapy ◽  
Breslow Thickness ◽  
Wide Excision ◽  
Tumor Control ◽  
Axillary Lymph ◽  
Left Axilla ◽  
The Right ◽  
In Transit

We report a case of a giant melanoma on the back with a very extreme Breslow thickness. On physical examination a large odorous and ulcerating tumour was seen adjacent to two large crusted lesions, probably in transit metastases. In the right and left axilla enlarged lymph nodes were palpated. The patient underwent salvage surgery consisting of a complete wide excision of the tumors on the back as well as axillary lymph node dissection on both sides. Histopathology showed a malignant melanoma with a Breslow thickness of 48 mm. Four of fifteen nodes in the right axilla and one of nine nodes in the left axilla, were positive for metastatic disease. Also various in transit and subcutaneous metastases were found in the wide excision specimen. The interest of our observation relies in the rarity of a melanoma with such an extreme Breslow thickness and the difficulty in performing adequate palliative therapy that offers quality of life by means of tumor control.

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