Did the 2004 World Health Organization (WHO) histologic classification result in better prognostic categories for resected thymomas as compared to 1999 WHO classification scheme?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18552-e18552
Author(s):  
Yousif Yonan ◽  
Dani Zander ◽  
John M. Varlotto ◽  
Jennifer Toth ◽  
Michael Reed ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Who Classification ◽  
Proportional Hazards ◽  
Wide Spectrum ◽  
World Health ◽  
Rank Tests ◽  
Histologic Classification ◽  
Time Periods ◽  
Log Rank Tests

e18552 Background: The classification of thymic epithelial neoplasms is subject of controversy. The purpose of our investigation is to see whether the 2004 histologic classification results in better prognostic categories than that of the 1999 classification. Methods: The SEER 18 database was used to investigate incidence and overall survival/cause-specific survival (OS/CSS) of resected thymomas during 2000-2009. Incidence was examined by frequency and trend analyses. Patients diagnosed with first primary localized thymoma/thymic carcinoma were selected in two time periods (2000-2003: N=201; 2005-2009: N = 497). The median follow up is 79 months and 27 months respectively. OS/CSS in two patients group were analyzed by Kaplan-Meier estimation, log-rank tests, and multivariate proportional hazards modeling. Results: The proportion of six histology categories (A, AB, B1-B3,C) did not change significantly during the two time periods. Compared to patients diagnosed in 2000-2003, OS was not significantly different in patients diagnosed in 2005-2009 in the log rank tests or multivariate analysis after accounting for treatment, tumor factors, and patient characteristics (OS, HR=0.737, p=0.1580; CSS, HR=0.731, p=0.3711). Histology as 6 categories is a significant predictor for OS in the multivariate analysis in 2005-2009, but not in 2000-2003. However, the predictive role of histology is similar in both time periods in the multivariate analysis of CSS. Complete resection, classification C, and tumor stage are significantly linked to OS and CSS. Conclusions: Patients diagnosed after 2004 did not have better survival outcomes than earlier patients. The WHO classification of 2004 may be a better predictor of OS than that of 1999 as shown by the wide-spectrum of pathologists reporting to SEER.

A unified approach to power and sample size determination for log-rank tests under proportional and nonproportional hazards

2021 ◽  
pp. 096228022098857
Author(s):  
Yongqiang Tang
Keyword(s):  
Sample Size ◽  
Proportional Hazards ◽  
Sample Size Calculation ◽  
Unified Approach ◽  
Rank Tests ◽  
Trial Duration ◽  
Nonproportional Hazards ◽  
Equivalence Trials ◽  
Superiority Trials ◽  
Log Rank Tests

Log-rank tests have been widely used to compare two survival curves in biomedical research. We describe a unified approach to power and sample size calculation for the unweighted and weighted log-rank tests in superiority, noninferiority and equivalence trials. It is suitable for both time-driven and event-driven trials. A numerical algorithm is suggested. It allows flexible specification of the patient accrual distribution, baseline hazards, and proportional or nonproportional hazards patterns, and enables efficient sample size calculation when there are a range of choices for the patient accrual pattern and trial duration. A confidence interval method is proposed for the trial duration of an event-driven trial. We point out potential issues with several popular sample size formulae. Under proportional hazards, the power of a survival trial is commonly believed to be determined by the number of observed events. The belief is roughly valid for noninferiority and equivalence trials with similar survival and censoring distributions between two groups, and for superiority trials with balanced group sizes. In unbalanced superiority trials, the power depends also on other factors such as data maturity. Surprisingly, the log-rank test usually yields slightly higher power than the Wald test from the Cox model under proportional hazards in simulations. We consider various nonproportional hazards patterns induced by delayed effects, cure fractions, and/or treatment switching. Explicit power formulae are derived for the combination test that takes the maximum of two or more weighted log-rank tests to handle uncertain nonproportional hazards patterns. Numerical examples are presented for illustration.

Hemorrhagic Suprasellar Central Nervous System Embryonal Tumor in an Adult: Uncommon Features of an Extremely Rare Neoplasm

2021 ◽  
Author(s):  
Martina Piloni ◽  
Filippo Gagliardi ◽  
Michele Bailo ◽  
Lina Raffaella Barzaghi ◽  
Marcella Callea ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Who Classification ◽  
Optic Chiasm ◽  
World Health ◽  
Embryonal Tumors ◽  
Embryonal Tumor ◽  
First Case ◽  
Diffusion Pattern

Abstract Background Occurrences of suprasellar central nervous system (CNS) embryonal tumors in adults are extremely rare. Hemorrhagic onset is further uncommon, with only anecdotic cases reported in the literature. The authors describe the case of a 57-year-old man affected by a suprasellar CNS embryonal tumor, with hemorrhagic onset and a unique diffusion pattern along the optic pathways. Material and Methods A 57-year-old man presenting with acute visual acuity worsening and left homonymous hemianopia was referred to our hospital. Neuroradiologic studies demonstrated an infiltrating, high-grade lesion involving the optic chiasm and right retrochiasmatic pathways with a hemorrhagic area in the ipsilateral pulvinar. Results The patient underwent microsurgical biopsy. Pathologic assessment confirmed the diagnosis of CNS embryonal tumor, not otherwise specified (NOS) according to the 2016 World Health Organization (WHO) classification of CNS tumors. The patient was referred to a multimodal adjuvant treatment; he eventually died 4 months after surgery. Competent literature has been systematically reviewed in the light of the relevant changes made in the last version of the WHO classification. Conclusion Embryonal tumors should be considered in the differential diagnosis for sellar and suprasellar space-occupying lesions, despite the rarity of the disease and the uncommon features at time of presentation. As per our knowledge, this is the first case ever described of hemorrhagic suprasellar embryonal tumor with a diffusion pattern along white matter fibers. Histogenesis, biomolecular and neuroradiologic features, and classification of embryonal tumors are an open field of research, with considerable implications for the definition of better diagnostic pitfalls and therapeutic regimens.

Acute Leukemia

2016 ◽  
Author(s):  
Richard A. Larson ◽  
Roland B Walter
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Who Classification ◽  
Lymphoblastic Leukemia ◽  
World Health ◽  
Acute Leukemias ◽  
Acute Myeloid

The acute leukemias are malignant clonal disorders characterized by aberrant differentiation and proliferation of transformed hematopoietic progenitor cells. These cells accumulate within the bone marrow and lead to suppression of the production of normal blood cells, with resulting symptoms from varying degrees of anemia, neutropenia, and thrombocytopenia or from infiltration into tissues. They are currently classified by their presumed cell of origin, although the field is moving rapidly to genetic subclassification. This review covers epidemiology; etiology; classification of leukemia by morphology, immunophenotyping, and cytogenetic/molecular abnormalities; cytogenetics of acute leukemia; general principles of therapy; acute myeloid leukemia; acute lymphoblastic leukemia; and future possibilities. The figure shows the incidence of acute leukemias in the United States. Tables list World Health Organization (WHO) classification of acute myeloid leukemia and related neoplasms, expression of cell surface and cytoplasmic markers for the diagnosis of acute myeloid leukemia and mixed-phenotype acute leukemia, WHO classification of acute lymphoblastic leukemia, WHO classification of acute leukemias of ambiguous lineage, WHO classification of myelodysplastic syndromes, European LeukemiaNet cytogenetic and molecular genetic subsets in acute myeloid leukemia with prognostic importance, cytogenetic and molecular subtypes of acute lymphoblastic leukemia, terminology used in leukemia treatment, and treatment outcome for adults with acute leukemia. This review contains 1 highly rendered figure, 9 tables, and 117 references.

Haematopathology of classic myeloproliferative neoplasms

2020 ◽  
pp. 45-62
Author(s):  
Hans Michael Kvasnicka ◽  
Jürgen Thiele
Keyword(s):  
Continuous Improvement ◽  
Who Classification ◽  
Myeloproliferative Neoplasms ◽  
Primary Myelofibrosis ◽  
World Health ◽  
Polycythaemia Vera ◽  
The World ◽  
Health Organization ◽  
Diagnostic Importance

The classification of the World Health Organization (WHO) continues to advocate the diagnostic importance of bone marrow (BM) morphology in the diagnostic workup of myeloproliferative neoplasms (MPN). In this regard, distinctive histological BM patterns characterize specific subtypes of MPN and are the key to a meaningful clinical and molecular-defined risk stratification of patients. In this regard, the morphological denominator includes a characteristic megakaryocytic proliferation along with variable changes in the granulopoiesis and erythropoiesis. Importantly, diagnosis of MPN requires absence of relevant dysgranulopoiesis or dyserythropoiesis. In terms of clinical practice, the concept of precursor stages provides the possibility of an early intervention by appropriate therapeutic regimens that might prevent fatal complications like thrombosis and haemorrhage, especially in early stages of polycythaemia vera or in primary myelofibrosis. However, the WHO classification is not aimed to capture all biological true cases of MPN or guarantee a complete diagnostic specificity and thus might be in need of continuous improvement following clinical experience.

scholarly journals Congenital eruption cyst: a case report

2010 ◽  
Vol 21 (3) ◽  
pp. 259-262 ◽  
Author(s):  
Ramón Manuel Alemán Navas ◽  
María Guadalupe Martínez Mendoza ◽  
Mário Roberto Leonardo ◽  
Raquel Assed Bezerra da Silva ◽  
Henry W. Herrera ◽  
...  
Keyword(s):  
Case Report ◽  
Tooth Extraction ◽  
Who Classification ◽  
World Health ◽  
Close Monitoring ◽  
Cystic Lesions ◽  
Separate Entity ◽  
Epithelial Cysts ◽  
Health Organization

Congenital pathologies are those existing at or dating from birth. Occurrence of congenital cystic lesions in the oral cavity is uncommon in neonates. Eruption cyst (EC) is listed among these unusual lesions. It occurs within the mucosa overlying teeth that are about to erupt and, according to the current World Health Organization (WHO) classification of epithelial cysts of the jaws, EC is a separate entity. This paper presents a case of congenital EC successfully managed by close monitoring of the lesion, without any surgical procedure or tooth extraction. Eruption of the teeth involved, primary central incisors, occurred at the fourth month of age. During this time neither the child nor mother had any complication such as pain on sucking, refusal to feed, airway obstruction, or aspiration of fluids or teeth.

scholarly journals The ISUP system of staging, grading and classification of renal cell neoplasia

2014 ◽  
Vol 1 (3) ◽  
pp. 26-39 ◽  
Author(s):  
Hemamali Samaratunga ◽  
Troy Gianduzzo ◽  
Brett Delahunt
Keyword(s):  
Renal Cell ◽  
Who Classification ◽  
Majority Vote ◽  
Cell Cancer ◽  
Consensus Conference ◽  
World Health ◽  
Renal Tumors ◽  
International Consensus ◽  
Staging Classification

There have been significant changes in the staging, classification and grading of renal cell neoplasia in recent times. Major changes have occurred in our understanding of extra-renal extension by renal cell cancer and how gross specimens must be handled to optimally display extra-renal spread. Since the 1981 World Health Organization (WHO) classification of renal tumors, in which only a handful of different entities were reported, many new morphological types have been described in the literature, resulting in 50 different entities reported in the 2004 WHO classification. Since 2004, further new entities have been recognized and reported necessitating an update of the renal tumor classification. There have also been numerous grading systems for renal cell carcinoma with Fuhrman grading, the most widely used system. In recent times, the prognostic value and the applicability of the Fuhrman grading system in practice has been shown to be, at best, suboptimal. To address these issues and to recommend reporting guidelines, the International Society of Urological Pathology (ISUP) undertook a review of adult renal neoplasia through an international consensus conference in Vancouver in 2012. The conduct of the conference was based upon evidence from the literature and the current practice amongst recognized experts in the field. Working groups selected to deal with key topics evaluated current data and identified points of controversy. A pre-meeting survey of the ISUP membership was followed by the consensus conference at which a formal ballot was taken on each key issue. A 65% majority vote was taken as consensus. This review summarizes the outcome and recommendations of this conference with regards to staging, classification and grading of renal cell neoplasia.

scholarly journals Grey Zone Lymphomas: Lymphomas with Intermediate Features

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sylvia Hoeller ◽  
Christiane Copie-Bergman
Keyword(s):  
B Cell ◽  
Who Classification ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
World Health ◽  
Grey Zone ◽  
B Cell Lymphomas ◽  
Large B Cell Lymphoma ◽  
Large B Cell

The current classification of lymphoid neoplasms is based on clinical information, morphology, immunophenotype, and molecular genetic characteristics. Despite technical and scientific progress, some aggressive B-cell lymphomas with features overlapping between two different types of lymphomas remain difficult to classify. The updated 2008 World Health Organization (WHO) classification of Tumours of the Hematopoietic and Lymphoid Tissues has addressed this problem by creation of two new provisional categories of B-cell lymphomas, unclassifiable; one with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma and the second with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. We review here the diagnostic criteria of these two provisional entities and discuss new scientific findings in light of the 2008 WHO classification.

Marrow Fibrosis in Myelodysplastic Syndromes - Its Significance in the Context of the WHO Classification of Disease and the International Prognostic Scoring System.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1446-1446
Author(s):  
Guntram Buesche ◽  
Arnold Ganser ◽  
Ludwig Wilkens ◽  
Brigitte Schlegelberger ◽  
Hartmut Hecker ◽  
...  
Keyword(s):  
Survival Time ◽  
Myelodysplastic Syndromes ◽  
Scoring System ◽  
Who Classification ◽  
World Health ◽  
International Prognostic Scoring System ◽  
Bone Marrow Biopsies ◽  
Health Organization ◽  
Marrow Fibrosis

Abstract Marrow fibrosis (MF) is rarely considered in myelodysplastic syndromes (MDS) although the frequency of this complication ranges from 10 to 50 % in the few reports on this issue, and there are no data on occurrence and significance of this complication in the context of the International Prognostic Scoring System (IPSS) and the World Health Organization (WHO) classification of disease. In a retrospective study, diagnostic bone marrow biopsies from a total of 936 patients with MDS were examined for MF and its relevance to the course of disease. Frequency of MF varied markedly between different types of MDS ranging from 3 % (RARS) to 37 % (MDS, therapy-related; WHO classification, P < 0.000005). Risk of MF furthermore correlated with multilineage dysplasia (P < 0.000005). However, there was no obvious correlation to the IPSS or to karyotype abnormalities. The survival time of patients was significantly reduced by about 50 % from 11 (RAEB-1/-2) - 55 (RARS, RCMD-RS) down to 6 (RAEB-1/-2) - 33 months (RARS, RCMD-RS) in median when MF was detected independently of the IPSS and the classification of disease (FAB, WHO; P = 0.0001). We conclude that MF is an unfavorable complication of MDS significantly shortening the survival time of patients independently of the IPSS and the classification of disease.

Expert Second Opinion Pathology Review of Lymphoma in the Era of the World Health Organization Classification.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3317-3317
Author(s):  
Matthew J. Matasar ◽  
Weiji Shi ◽  
Jonathan Silberstien ◽  
Julie T. Feldstein ◽  
Daniel Filippa ◽  
...  
Keyword(s):  
World Health Organization ◽  
Who Classification ◽  
Second Opinion ◽  
World Health ◽  
Cancer Center ◽  
Major Revision ◽  
The World ◽  
Health Organization ◽  
Pathology Review

Abstract Background: The effective management of lymphoma depends upon an accurate and precise pathologic diagnosis. However, the classification of lymphoma continues to evolve. Reports addressing the role of second opinion expert pathology review have found varying impact, and little is known regarding the predictors of a change in diagnosis. Furthermore, the impact of the World Health Organization (WHO) classification of lymphomas over the 5 years following their formal publication has not been formally assessed. Methods: All outside pathology is reviewed at Memorial Sloan-Kettering Cancer Center (MSKCC) before a clinical opinion is finalized. We performed a chart review of all externally referred lymphoma cases from 1/1/01 to 6/30/01 and from 1/1/06 to 6/30/06 with second opinions from MSKCC hematopathology. Statistical analysis was performed using Chi-square or Fisher’s exact test for univariate analysis and logistic regression for multivariate analysis. Results: 719 patients (365 in 2001, 354 in 2006) met inclusion criteria. Diagnostic revisions were classified as major or minor; major changes were those that would lead to management changes as per National Comprehensive Cancer Network guidelines. 122 patients (18% in 2001, 16% in 2006) had a major diagnostic revision and an additional 22 (4% in 2001, 2% in 2006) had confirmation of major revisions rendered previously at second opinion from another National Cancer Institute Comprehensive Cancer Center (CCC). This did not change significantly by era, with 79 major revisions (22%) in 2001 and 65 (18%) in 2006 (P=NS). An additional 55 patients [24 (7%) in 2001, 31 (9%) in 2006] received minor revisions. Common categories of major revision included changing from nondiagnostic/ambiguous to definitive [6 in 2001, 8 in 2006], definitive to nondiagnostic [9 in 2001, 9 in 2006], malignant to benign [1 in 2001, 6 in 2006], indolent B-cell lymphoma (BCL) to aggressive BCL [15 in 2001, 8 in 2006], and aggressive BCL to indolent BCL [4 in 2001, 1 in 2006]. Major diagnostic revision was significantly associated with additional immunohistochemistry (IHC) testing in 2001 (OR=2.3; 95%CI 1.3, 4). In 2006, additional IHC (OR=1.8; 95%CI 1, 3.4), repeat biopsy (OR=3.1; 95%CI 1.2, 8.0), and skin biopsy (versus lymph node biopsy; OR 3.3; 95%CI 1.6, 7.0) were significantly associated with major revision. Two of the 7 patients reclassified as benign received revisions based on additional IHC, whereas 7 of the 14 patients reclassified as malignant were revised due to either additional IHC (4) or repeat biopsy (3). No effect was seen by biopsy type, nor were patient gender, age, race or ethnicity associated with odds of major revision. Of cases seen first at another CCC, 12% in 2001 and 16% in 2006 received major revisions, compared to 19% (2001) and 16% (2006) of other cases; these differences were not statistically significant. Conclusion: The rate of clinically meaningful diagnostic revisions at second opinion expert pathology review was high for patients seen at MSKCC, and remained so despite five years of increased familiarity with the WHO classification schema. These data confirm the fact that an appropriate evaluation, including detailed IHC and an adequate biopsy specimen, plays a central role in the accurate diagnosis of lymphoma. The high rates of diagnostic revision reported here lend support to the routine application of expert second opinion hematopathology review.

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