scholarly journals Is There a Need for New Classifications to Predict Prognosis in Gastroenteropancreatic Neuroendocrine Carcinomas?

2021 ◽  
Author(s):  
Emel Tekin ◽  
Arzu Avcı ◽  
Neşe Ekinci
Keyword(s):  
Survival Rates ◽  
Case Series ◽  
Threshold Value ◽  
World Health ◽  
Proliferation Index ◽  
Neuroendocrine Neoplasms ◽  
Ki 67 ◽  
Significant Difference ◽  
Who 2010 Classification ◽  
Health Organization

Objective: Neuroendocrine neoplasms (NEN) are frequently located in the lung and gastroenteropancreatic (GEP) system organs. Neuroendocrine carcinoma (NEC) constitutes 5% of GEP NENs and has a very high malignancy potential. In this study, it is aimed to determine a new threshold value in addition to the 20% Ki-67 proliferation index that was specified as a threshold value for predicting survival in patients with grade (G) 3 tumors according to World Health Organization (WHO) 2010 classification. Method: Demographic, clinicopathologic features and survival rates of 34 patients diagnosed with GEP NEC between 2008-2015 in İzmir Katip Celebi University Atatürk Training and Research Hospital Medical Pathology Clinic were evaluated retrospectively. Results: Most of the 34 (76.5%) cases were male and the average age was 63.9 years. Median survival rates were 15, and 7 months in patients with Ki-67 indexes of ≤65% and >65%, respectively (p=0.232). Conclusion: Recent studies have shown heterogeneity of high-grade NENs, identified as NEC and foreseen their subdivision into biological subgroups. The researchers suggest that the NECs should be divided into two categories as patients with Ki-67 indexes of 20-55% and >55%. In our study, the most significant difference in survival rates was observed when 65% was selected as threshold value for Ki-67 index which supports the results of other studies in the literature. Since the number of our cases is limited and it is a single-center study, the findings obtained needs to be further investigated in studies with greater number of case series.

scholarly journals Oncology Referral Concerning Paediatric Neurosurgery? Analysis of the Situation between 2008-2013 in the North of Portugal

2016 ◽  
Vol 29 (1) ◽  
pp. 15
Author(s):  
Ana Batista ◽  
Luís Nogueira-Silva ◽  
Rui Vaz ◽  
Joana Oliveira
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Survival Rates ◽  
Population Based ◽  
World Health ◽  
The North ◽  
Central Nervous System Tumours ◽  
Significant Difference ◽  
Health Organization ◽  
Tumour Characteristics

<p><strong>Introduction:</strong> Primary central nervous system tumours represent the second most frequent neoplasm and are the leading cause of death from solid tumours in children. Our study aimed to provide the most up-to-date epidemiological analysis of primary central nervous system tumours in children living in the north of Portugal and to explore a possible effect of the centralisation of care on outcomes.<br /><strong>Material and Methods:</strong> This population-based study included all newly diagnosed and histologically confirmed primary central nervous system tumours in people below 18 years old, living in the north of Portugal, from January 2008 to December 2013. Data were collected through access to clinical files. We described children and tumour characteristics, and analysed patient: paediatric neurosurgeon and histological tumour type: paediatric neurosurgeon ratios.<br /><strong>Results:</strong> A total of 147 cases was recorded. Mean age at diagnosis of primary central nervous system tumours was 8.0 ± 5.2 years. Astrocytomas were the most common histological type (34%). We found that World Health Organization Tumour Grade was the only variable of statistically significant influence in mortality (p = 0.001). 1-, 3- and 5-year survivals related to 2008-2013 period were statistically higher than 2005 - 2007. Astrocytomas have the highest survival rate, with statistically significant difference from other tumours (p = 0.015). We estimated a mean of 12.25 treated cases per year by each paediatric neurosurgeon at our institution.<br /><strong>Discussion:</strong> Our results are globally consistent with those published all over the world, but we reported the highest survival rates. The number of cases treated per year by each neurosurgeon is accordant to the recommended.<br /><strong>Conclusion:</strong> We showed an improvement when comparing to data previous to 2008 and better results than those from previous studies, namely higher survival at 1-, 3- and 5-years from the diagnosis, with low complication and relapsing rates. Therefore, the referral of primary central nervous system tumours cases to centres with larger experience can be invaluable for the achievement of the best outcomes.</p>

scholarly journals Oncology Referral Concerning Paediatric Neurosurgery? Analysis of the Situation between 2008-2013 in the North of Portugal

2016 ◽  
Vol 29 (1) ◽  
pp. 15
Author(s):  
Ana Batista ◽  
Luís Nogueira-Silva ◽  
Rui Vaz ◽  
Joana Oliveira
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Survival Rates ◽  
Population Based ◽  
World Health ◽  
The North ◽  
Central Nervous System Tumours ◽  
Significant Difference ◽  
Health Organization ◽  
Tumour Characteristics

<p><strong>Introduction:</strong> Primary central nervous system tumours represent the second most frequent neoplasm and are the leading cause of death from solid tumours in children. Our study aimed to provide the most up-to-date epidemiological analysis of primary central nervous system tumours in children living in the north of Portugal and to explore a possible effect of the centralisation of care on outcomes.<br /><strong>Material and Methods:</strong> This population-based study included all newly diagnosed and histologically confirmed primary central nervous system tumours in people below 18 years old, living in the north of Portugal, from January 2008 to December 2013. Data were collected through access to clinical files. We described children and tumour characteristics, and analysed patient: paediatric neurosurgeon and histological tumour type: paediatric neurosurgeon ratios.<br /><strong>Results:</strong> A total of 147 cases was recorded. Mean age at diagnosis of primary central nervous system tumours was 8.0 ± 5.2 years. Astrocytomas were the most common histological type (34%). We found that World Health Organization Tumour Grade was the only variable of statistically significant influence in mortality (p = 0.001). 1-, 3- and 5-year survivals related to 2008-2013 period were statistically higher than 2005 - 2007. Astrocytomas have the highest survival rate, with statistically significant difference from other tumours (p = 0.015). We estimated a mean of 12.25 treated cases per year by each paediatric neurosurgeon at our institution.<br /><strong>Discussion:</strong> Our results are globally consistent with those published all over the world, but we reported the highest survival rates. The number of cases treated per year by each neurosurgeon is accordant to the recommended.<br /><strong>Conclusion:</strong> We showed an improvement when comparing to data previous to 2008 and better results than those from previous studies, namely higher survival at 1-, 3- and 5-years from the diagnosis, with low complication and relapsing rates. Therefore, the referral of primary central nervous system tumours cases to centres with larger experience can be invaluable for the achievement of the best outcomes.</p>

An Unusual Intracranial Collision Tumor of Anaplastic Ependymoma and Atypical Meningioma

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S53-S53
Author(s):  
Zainab Harb ◽  
Luis Moral
Keyword(s):  
World Health Organization ◽  
Collision Tumor ◽  
Atypical Meningioma ◽  
World Health ◽  
Proliferation Index ◽  
Anaplastic Ependymoma ◽  
Ki 67 ◽  
Collision Tumors ◽  
Microvascular Proliferation ◽  
Health Organization

Abstract The close geographic association of two or more synchronous primary brain tumors is an unusual occurrence. There are around 50 case reports of these intracranial collision tumors, mostly consisting of malignant astrocytoma (mainly glioblastoma) and meningioma. We present a rare intracranial collision tumor consisting of anaplastic ependymoma and atypical meningioma. To our knowledge, this is the first reported case of intracranial collision tumor with this combination. The patient is a 33-year-old gentleman who presented 2 years ago with new-onset intermittent headaches with increasing severity and associated blurry vision and vomiting. On imaging, he was found to have a 4.2 × 4.1 × 4.1-cm cystic-solid and heterogeneously enhancing extra-axial mass lesion in the left frontal lobe, with an enhancing dural tail. Histologic examination of the surgically excised lesion showed two geographically distinct areas of an extra-axial atypical meningioma (World Health Organization grade II) and an intra-axial anaplastic ependymoma (World Health Organization grade III). The anaplastic ependymoma component showed increased cellularity, pseudorosettes, microvascular proliferation, necrosis, and increased mitoses. It was diffusely positive for GFAP and had a Ki-67 proliferation index of 40%. The atypical meningioma showed 5 mitoses per 10 high-power fields. It had a membranous EMA immunoreaction and a Ki-67 proliferation index of approximately 20%. Recently, the patient had a recurrence of the anaplastic ependymoma component only. So far, no clear explanation has been found in the literature to understand the mechanisms leading to collision tumors. Since our patient does not appear to have any syndrome, it may represent a sporadic phenomenon; however, the sharing of a common oncogenic insult or any underlying molecular/genetic mechanism leading to synchronous tumorigenesis remains to be elucidated in this case.

Malignant transformation of grade II ganglioglioma to glioblastoma: A case report

2012 ◽  
Vol 3 (2) ◽  
Author(s):  
Hrvoje Čupić ◽  
Tomislav Sajko ◽  
Nikolina Sesar ◽  
Mihovil Ivica ◽  
Leo Pažanin
Keyword(s):  
Malignant Transformation ◽  
Ganglion Cells ◽  
Histopathological Examination ◽  
World Health ◽  
Proliferation Index ◽  
Surgical Removal ◽  
Ki 67 ◽  
Grade Ii ◽  
Health Organization ◽  
P53 Immunoreactivity

AbstractGangliogliomas are well differentiated and slowly growing neuroepithelial tumors composed of neoplastic ganglion cells and neoplastic glial cells corresponding mostly to the World Health Organization grade I tumors. However, some of these tumors disclose histologically more malignant glial component and correspond to grade II or grade III tumors. We report a case of left temporal lobe tumor in a 42-year-old woman fulfilling the diagnostic criteria for atypical (grade II) ganglioglioma with high Ki-67 proliferation index and p53 immunoreactive tumor cells. In spite of gross total removal of the tumor, it recurred eight months after surgery. Histopathological examination of the recurrent tumor revealed that it had undergone malignant transformation into a glioblastoma. This case indicates that gangliogliomas with high Ki-67 proliferating index and p53 immunoreactivity should be carefully monitored for recurrence and malignant progression regardless of their morphological grading and seemingly total surgical removal.

scholarly journals Are Blood Transfusions Useful for Non-Specific Symptoms of Anemia in the Elderly?

2014 ◽  
Vol 1 (1) ◽  
pp. 36-49
Author(s):  
Sakeena Raza ◽  
Jeanne Wei ◽  
Syed Ashad Abid ◽  
Gohar Azhar
Keyword(s):  
Functional Status ◽  
Case Series ◽  
The Elderly ◽  
Adverse Outcomes ◽  
World Health ◽  
Health Clinic ◽  
Blood Transfusions ◽  
Significant Difference ◽  
Life Threatening ◽  
Health Organization

Background: Over 10% of adults older than 65 years have World Health Organization defined anemia (Hemoglobin lower than13 g/dl in men and 12 g/dl in women). It is more prevalent with increasing age, exceeding 20% in the very elderly (85 years and older). Typical symptoms of anemia are nonspecific and often attributed to aging or to an exacerbation of another illness in the elderly. Methods: We present a case series of patients between ages 65-99 years who were followed at the Senior Health clinic and presented with nonspecific symptoms. All these patients were found to have life-threatening anemia requiring blood transfusions. Design: Case series. Results: All our elderly patients experienced good outcomes in terms of resolution of their symptoms and improvement in functional status. There was a significant difference in the total number of symptoms pre-transfusion compared with symptoms post-transfusion (p < 0.01). There were no adverse outcomes. Conclusion: Our case series suggests that symptoms of anemia in the elderly are often attributed to aging or other disease co-morbidities. Nonspecific symptoms like dyspnea, fatigue and confusion should not be ignored. Management decisions regarding anemia should involve functional assessment of the elderly subject. Immediate arrangements for transfusion must be made if the elderly patient is symptomatic regardless of the hemoglobin level. If monitored appropriately, blood transfusions can prolong survival, improve quality of life and functional status of the older individual.

scholarly journals Pancreatic Neuroendocrine Neoplasms: Basic Biology, Current Treatment Strategies and Prospects for the Future

2016 ◽  
Author(s):  
Akihiro Ohmoto ◽  
Hirofumi Rokutan ◽  
Shinichi Yachida
Keyword(s):  
Treatment Strategies ◽  
Genomic Analysis ◽  
Genetic Alterations ◽  
Current Treatment ◽  
Pancreatic Tumors ◽  
Proliferation Index ◽  
Neuroendocrine Neoplasms ◽  
Ki 67 ◽  
Pancreatic Neuroendocrine Neoplasms ◽  
Who 2010 Classification

Pancreatic neuroendocrine neoplasms (pNENs) are rare tumors accounting for only 1-2% of all pancreatic tumors. pNENs are pathologically heterogeneous and are categorized into three groups (neuroendocrine tumor: NET G1, NET G2 and neuroendocrine carcinoma: NEC) on the basis of Ki-67 proliferation index and mitotic count according to the 2010 WHO classification of gastroenteropancreatic NENs. NEC in this classification includes both histologically well-differentiated and poorly differentiated subtypes, and modification of the WHO 2010 classification is under discussion based on genetic and clinical data. Genomic analysis has revealed NETs G1/G2 have genetic alterations in chromatin remodeling genes such as MEN1, DAXX and ATRX, whereas NECs have an inactivation of TP53 and RB1, and these data suggest that different treatment approaches would be required for NET G1/G2 and NEC. While there are promising molecular targeted drugs, such as everolimus or sunitinib, for advanced NET G1/G2, treatment stratification based on appropriate predictive and prognostic biomarkers is becoming an important issue. The clinical outcome of NEC is still dismal, and a more detailed understanding of the genetic backround together with preclinical studies to develop new agents, including those already under investigation for SCLC, will be needed to improve the prognosis.

Immunoexpression of Ki-67 Labelling Proliferation Index in Phyllodes Tumour of Breast by Polymer-based Detection Method

2019 ◽  
Vol 31 (3) ◽  
pp. 245-250
Keyword(s):  
Detection Method ◽  
World Health ◽  
Proliferation Index ◽  
Ki 67 ◽  
Clear Cut ◽  
Tumour Margin ◽  
Phyllodes Tumour ◽  
Proliferative Markers ◽  
Health Organization

Phylloides tumours (PTs) are rare breast neoplasms with a variable clinical course depending on the tumour category. The classification of PTs proposed by the World Health Organization (WHO) into benign, borderline and malignant is based on a combination of several histologic features, including Stromal cellularity, nuclear atypia, mitotic activity, stromal overgrowth and tumour margin appearance. However, there are no defined criteria or clear cut-offs for individual histologic parameters. Thus, the diagnosis of PTs based on the integration of morphology remains challenging. Along with the grade, additional study of proliferative markers such as Ki-67 are essential to identify those with potential for aggressive behaviour. This study was undertaken to assess the histopathological characters and correlate Ki-67 expression in different subtypes of PTs. In this study, 30 cases of PTs were studied. Regarding histologic features, routine H&E stains were taken into consideration for diagnosis and classification of tumours. Immunostaining for Ki-67 was also performed by polymer-based detection method. Ki-67 labelling index (LI) was categorized as 0-10, 11-30, 31-50, 51 and above depending on the percentage of positive tumor cells and was correlated with histologic grade and clinical features in each case. Twenty cases (66.7%) of benign phyllodes tumour (BPT), 3 cases (10%) of borderline PT, and 7 cases (23.3%) cases of malignant phylloides tumour (MPT) were examined in this study. Among 20 cases of BPT, 3 cases (15%) were recurrent tumours. Average Ki-67 LI in BPT was 5% (range 1-10%) and borderline PT was 17.5% (range 15-20%). MPT exhibited Ki-67 LI range of 15-35% with average LI of 25%. A significant association was seen between expression of Ki-67 in different grades of PT(p=0.01). So, Ki-67 LI should be performed in routine histopathology reporting of phylloides for sub-categorisation of phylloides.

scholarly journals HIGH-GRADE GASTROENTEROPANCREATIC NEUROENDOCRINE NEOPLASMS. MODERN CLASSIFICATION, DIAGNOSTICS AND TREATMENT

2018 ◽  
Vol 8 (3) ◽  
pp. 13-20
Author(s):  
A. A. Kolomeytseva ◽  
V. A. Gorbunova ◽  
N. F. Orel ◽  
G. S. Emelianova ◽  
A. M. Ivanov ◽  
...  
Keyword(s):  
World Health ◽  
Neuroendocrine Neoplasms ◽  
Ki 67 ◽  
First Line Therapy ◽  
Gastroenteropancreatic Neuroendocrine Neoplasms ◽  
Platinum Based Chemotherapy ◽  
Poorly Differentiated ◽  
Net G3 ◽  
Well Differentiated ◽  
Health Organization

Poorly differentiated gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) are rare malignancies, most of which are characterized by aggressiveness, a tendency to rapid metastasis and an unfavorable prognosis even when localized. In 2017 World Health Organization (WHO) updated classification of GEP NENs and recognized the category of well-differentiated pancreatic NET G3, associated with Ki‑67 index usually over 20%. The upper level of Ki‑67 is not defined. Usually it is 55%. Highgrade poorly differentiated pancreatic NENs are defined as pancreatic neuroendocrine carcinomas (panNECs). Although the NET G3 category is recognized for pancreatic neuroendocrine neoplasms only, many specialists consider it reasonable to apply this term to all well-differentiated GEP NETs with Ki‑67 index in the 20 to 55 percent range. Clinical behavior and therapeutic approaches for advanced GEP NECs and NETs G3 are different. Standard palliative chemotherapy for GEP NECs consists of cisplatin or carboplatin combined with etoposide. The second-line regimens include irinotecan-, oxaliplatin, fluoropyrimidine- and temozolomide-based regimens. Temozolomide-based chemotherapy regimens, as well as targeted therapy are more preferable as first line therapy for patients with NETs G3. The platinum-based chemotherapy regimens are considered at the time of disease progression. Further clinical studies with the inclusion of much more patients will determine the optimal treatment strategy for this category of patients.

Household and Population-Level Behavioural Changes Due to COVID-19 Pandemic: A Smart Thermostat Based Comparative Data Analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 1-6
Author(s):  
Kirti Sundar Sahu ◽  
Arlene Oetomo ◽  
Niloofar Jalali ◽  
Plinio P. Morita
Keyword(s):  
Data Analysis ◽  
Population Level ◽  
World Health ◽  
Motion Sensors ◽  
Household Level ◽  
Work From Home ◽  
Significant Difference ◽  
Health Organization ◽  
Smart Thermostat ◽  
The Impact

The World Health Organization declared the coronavirus outbreak as a pandemic on March 11, 2020. To inhibit the spread of COVID-19, governments around the globe, including Canada, have implemented physical distancing and lockdown measures, including a work-from-home policy. Canada in 2020 has developed a 24-Hour Movement Guideline for all ages laying guidance on the ideal amount of physical activity, sedentary behaviour, and sleep (PASS) for an individual in a day. The purpose of this study was to investigate changes on the household and population-level in lifestyle behaviours (PASS) and time spent indoors at the household level, following the implementation of physical distancing protocols and stay-at-home guidelines. For this study, we used 2019 and 2020 data from ecobee, a Canadian smart Wi-Fi thermostat company, through the Donate Your Data (DYD) program. Using motion sensors data, we quantified the amount of sleep by using the absence of movement, and similarly, increased sensor activation to show a longer duration of household occupancy. The key findings of this study were; during the COVID-19 pandemic, overall household-level activity increased significantly compared to pre-pandemic times, there was no significant difference between household-level behaviours between weekdays and weekends during the pandemic, average sleep duration has not changed, but the pattern of sleep behaviour significantly changed, specifically, bedtime and wake up time delayed, indoor time spent has been increased and outdoor time significantly reduced. Our data analysis shows the feasibility of using big data to monitor the impact of the COVID-19 pandemic on the household and population-level behaviours and patterns of change.

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