Radiographic assessment of pulmonary metastatic lesions in superficial cutaneous and mammary neoplasms in dogs.

The present study was carried out to assess the pulmonary metastatic lesions in cases of canine superficial and mammary neoplasms presented to the University Veterinary Hospitals, Mannuthy and Kokkalai, Kerala Veterinary and Animal Sciences University during a twelve month period from February 2019 to February 2020. Twenty-four cases of neoplasms in dogs consisting of 12 cases of superficial neoplasms and 12 cases of mammary neoplasms were subjected to fine needle aspiration cytology (FNAC) for the confirmation of malignancy of neoplasm and three view thoracic radiographs were taken to assess the pulmonary metastatic pattern. The results were correlated with the malignancy detected in histopathological analysis after excisional biopsy. The most commonly observed pulmonary metastatic lesions were pulmonary nodules followed by pulmonary micronodules, miliary nodules, and pulmonary mass. These lesions were more evident in malignant mammary neoplasms especially in tubulopapillary carcinoma, ductal carcinoma, and medullary mammary carcinoma with spatial arrangements more in the perihilar region followed by caudodorsal, midventral, and cranioventral area of lung parenchyma. In case of superficial neoplasms miliary patterns and pulmonary microndules were mostly detected as pulmonary metastatic pattern in soft tissue sarcoma, round cell tumour, and malignant fibrohistiocytoma.

Metastatic Pattern of Truncal and Extremity Leiomyosarcoma: Retrospective Analysis of Predictors, Outcomes, and Detection

BackgroundLeiomyosarcomas (LMS) are a heterogenous group of malignant mesenchymal neoplasms with smooth muscle origin and are classified as either non-uterine (NULMS) or uterine (ULMS). Metastatic pattern, prognostic factors, and ideal staging/surveillance studies for truncal and extremity LMS have not been defined.MethodsA retrospective analysis of patients diagnosed with histopathology-confirmed truncal or extremity LMS between 2009-2019 was conducted. Data collected included demographics, tumor characteristics, staging, surveillance, and survival endpoints. Primary site was defined as either 1. Extremity, 2. Flank/Pelvis, or 3. Chest wall/Spine.ResultsWe identified 73 patients, 23.3% of which had metastatic LMS at primary diagnosis, while 68.5% developed metastatic disease at any point. The mean metastatic-free survival from primary diagnosis of localized LMS was 3.0±2.8 years. Analysis of prognostic factors revealed that greater age (≥50 years) at initial diagnosis (OR=3.74, p=0.0003) and higher tumor grades II (OR=16, p=0.019) and III (OR=13, p=0.025) were significantly associated with metastases.ConclusionsTruncal and peripheral extremity LMS is an aggressive tumor with high metastatic potential. While there is a significant risk of metastases to lungs, extra-pulmonary tumors are relatively frequent. Older patients and patients with higher-grade (II/III) tumors carry an increased risk of developing metastatic disease.

Beta-2-microglobulin Mutations Are Linked to a Distinct Metastatic Pattern and a Favorable Outcome in Microsatellite-Unstable Stage IV Gastrointestinal Cancers

Immune checkpoint blockade (ICB) shows remarkable clinical effects in patients with metastatic microsatellite-unstable (MSI) cancer. However, markers identifying potential non-responders are missing. We examined the prevalence of Beta-2-microglobulin (B2M) mutations, a common immune evasion mechanism, in stage IV MSI gastrointestinal cancer and its influence on metastatic pattern and patients’ survival under ICB. Twenty-five patients with metastatic, MSI gastrointestinal adenocarcinoma were included. Eighteen patients received ICB with pembrolizumab and one patient with nivolumab/ipilimumab. Sequencing was performed to determine B2M mutation status. B2M mutations and loss of B2M expression were detected in 6 out of 25 stage IV MSI cancers. B2M mutations were strongly associated with exclusively peritoneal/peritoneal and lymph node metastases (p=0.0055). However, no significant differences in therapy response (25% vs. 46.6%, p>0.99) and survival (median PFS: 19.5 vs 33.0 months, p=0.74; median OS 39 months vs. not reached, p>0.99) were observed between B2M-mutant and B2M-wild type tumor patients. Among metastatic MSI GI cancers, B2M-mutant tumors represent a biologically distinct disease with distinct metastatic patterns. To assess ICB response in B2M-mutant MSI cancer patients, future studies need to account for the fact that baseline survival of patients with B2M-mutant MSI cancer may be longer than of patients with B2M-wild type MSI cancer.

Frequency and Clinicopathological Features of Distant Metastasis of Bladder Cancer: A SEER-Based Study

Background: bladder cancer (BCa) is a common malignancy in the urinary system. But the hematogenous metastatic pattern of it was poorly explored. The aim of this study was to provide a better understanding of the prognosis of the different distant metastatic pattern from stage IV BCa patients and support for making a suitable clinical decision.Methods: The Surveillance, Epidemiology and End Result database (SEER) provided data for this study include BCa from 2010 to 2015. Kaplan–Meier method was used to evaluate the survival prognosis of patients of metastatic BCa. Cox proportional hazards regression model was utilized to analyzed risk factors. All statistical tests were two-sided.Results: At the time of diagnosis, a total of 6808 eligible patients at stage IV were extracted from SEER database. Patients who suffered metastasis to either one of the four sites occupied 25.31% (1723/6808) of BCa. Bone was the most common distant metastatic site of BCa (1225 cases), and brain metastases had the worst prognosis whose mean survival was 6.282 months. The results of univariate survival analysis presented that diagnostic age, race, gender, primary site surgery, tumor size, T stage, N stage, primary tumor site, histology, marital status and metastatic number were independent prognostic factors affecting overall survival (OS) (P<0.05). On multivariable Cox regression, squamous cell carcinoma was an independent risk factor affecting the overall survival (P < 0.05). The nomogram model was constructed to show the 1-, 3- and 5-year survival rates of patients.Conclusion: In analysis of single metastatic sites, patients with brain metastasis had the worst overall survival and lung metastasis had the best outcomes than other three distant metastases. Knowledge of these differences in metastatic patterns is helpful for clinicians to make better pre-treatment evaluation and clinical decisions.

Breast cancer metastasis to the colon and rectum: Review of current status on diagnosis and management, Murad Bani Hani M.D., Bashir Attuwaybi, MD, Bryan Butler, MD

Approximately 5-10% of patients will harbor distant metastasis at the time of breast cancer diagnosis with about a third of these patients developing distant recurrence after optimal therapy. Breast cancer has an unusual metastatic pattern to the colon and rectum with incidence that may be underappreciated. Lobular breast cancer has a higher preponderance to this unusual metastatic pattern. Clinical manifestation is nonspecific with a long latency period and diagnosis requires a high index of suspicion. The management is not clearly defined. However, medical management with chemo and hormonal therapy seem to be favored likely because of overall metastatic burden at time of diagnosis. Radical colonic resection in selected patients with isolated colorectal metastasis has been well tolerated and may influence survival. A regimented screening colonoscopy in breast cancer patients with high-risk features may offer early diagnosis and