Prognosis of Subcutaneous Mastectomy for Special Types of Breast Cancer

Background and objectives: In the treatment of the special type of breast cancer (STBC), the choice of chemotherapeutic agents is often based on the characteristic features of the histological type. On the other hand, the surgical strategy is usually determined by the tumor size and presence of lymph node metastasis, and the indication for immediate reconstruction is rarely discussed based on the histological type. The prognoses of STBC and invasive ductal carcinoma of the breast (IDC) patients who underwent subcutaneous mastectomy (SCM) with immediate reconstruction at our institution were compared. Materials and Methods: A total of 254 patients with SCM with immediate reconstruction from 1998 to 2018 were included; their tumor diameter or induration was less than 25 mm, and it was not in close proximity to the skin. Preoperative chemotherapy and non-invasive cancer cases were excluded. Results: The number of patients was 166 for skin-sparing mastectomy (SSM) and 88 for nipple-sparing mastectomy (NSM). The reconstructive techniques were deep inferior epigastric artery perforator flap (DIEP) reconstruction in 43 cases, latissimus dorsi flap reconstruction (LDflap) in 63 cases, tissue expander (TE) in 117 cases, and transverse rectus abdominis myocutaneous flap/vertical rectus abdominis myocutaneous flap (TRAM/VRAM) reconstruction in 31 cases. The histological types of breast cancer were 211 IDC and 43 STBC; 17 were mucinous carcinoma (MUC), 17 were invasive lobular carcinoma (ILC), 6 were apocrine carcinoma, 1 was tubular carcinoma, and 2 were invasive micropapillary carcinoma. There was no difference in local recurrence or disease-free survival (LRFS, DFS) between IDC and STBC, and overall survival (OS) was significantly longer in STBC. OS was better in the STBC group because SCM with immediate reconstruction was performed for STBC, which is a histological type with a relatively good prognosis. Highly malignant histological types, such as squamous cell carcinoma or metaplastic carcinoma, were totally absent in this study. Conclusions: The indications for SCM with immediate reconstruction for relatively common STBCs such as MUC and ILC can be the same as for IDC.

An Application of Machine Learning That Uses the Magnetic Resonance Imaging Metric, Mean Apparent Diffusion Coefficient, to Differentiate between the Histological Types of Ovarian Cancer

This retrospective single-center study included patients diagnosed with epithelial ovarian cancer (EOC) using preoperative pelvic magnetic resonance imaging (MRI). The apparent diffusion coefficient (ADC) of the axial MRI maps that included the largest solid portion of the ovarian mass was analysed. The mean ADC values (ADCmean) were derived from the regions of interest (ROIs) of each largest solid portion. Logistic regression and three types of machine learning (ML) applications were used to analyse the ADCs and clinical factors. Of the 200 patients, 103 had high-grade serous ovarian cancer (HGSOC), and 97 had non-HGSOC (endometrioid carcinoma, clear cell carcinoma, mucinous carcinoma, and low-grade serous ovarian cancer). The median ADCmean of patients with HGSOC was significantly lower than that of patients without HGSOCs. Low ADCmean and CA 19-9 levels were independent predictors for HGSOC over non-HGSOC. Compared to stage I disease, stage III disease was associated with HGSOC. Gradient boosting machine and extreme gradient boosting machine showed the highest accuracy in distinguishing between the histological findings of HGSOC versus non-HGSOC and between the five histological types of EOC. In conclusion, ADCmean, disease stage at diagnosis, and CA 19-9 level were significant factors for differentiating between EOC histological types.

Comparison between Histological Features and Strain Elastographic Characteristics in Canine Mammary Carcinomas

Elastography is a sonographic technique that provides a noninvasive evaluation of the stiffness of a lesion. The objective of this work was to evaluate the accuracy of strain elastography, the most accessible modality in clinical practice, to discriminate between different histological types of malignant mammary neoplasms in the canine species, which can provide complementary information in real time to the diagnosis and thus help in the choice of surgical technique. A total of 34 females with 56 mammary carcinomas were selected and classified into three histological groups according to their aggressiveness. The histological and elastographic characteristics of these malignant tumors were analyzed and compared to evaluate the diagnostic accuracy of strain elastography. Visual score presented a sensitivity of 88.0%, specificity of 58.1%, and accuracy of 71.43% in distinguishing the most aggressive group of carcinomas. The strain ratio had a sensitivity of 84.0%, specificity of 61.1%, and accuracy of 69.64%. On the other hand, intratumoral strain ratio obtained a sensitivity of 71.40% and specificity of 61.90% when intratumoral fibrosis was taken as reference, with an accuracy of 66.07%. Similarly, peritumoral strain ratio was also positively related to fibrosis in the periphery of lesions (p ≤ 0.001), with a sensitivity of 93.80%, specificity of 77.50% and an accuracy of 92.87%. In conclusion, accuracy of this elastographic modality can be a useful method to differentiate more aggressive histological types. Therefore, it represents an additional diagnostic technique useful in the daily clinic thanks to the short time required for the examination, which allows real-time visualization and immediate interpretation of the results.

LARYNX MYOFIBROBLASTIC TUMOR, A RARE CASE REPORT

Myofibroblastic tumour is extremely rare in the larynx, with just over 40 published cases. Despite being a benign tumour, they are tumours with a marked inflammatory character, local destruction and the possibility of degeneration to malignant histological types and with metastatic capacity. Anatomopathological differential diagnosis is fundamental in this cases.

Clinicopathologic Characteristics and Outcomes of Simultaneous Multiple Primary Lung Cancer

Background. Simultaneous multiple primary lung cancer has been detected increasingly nowadays with the development of image technology. However, the clinicopathologic characteristics and outcomes are not clear. Methods. All consecutive patients diagnosed as simultaneous multiple primary lung cancer according to Martini–Melamed and American College of Chest Physicians criteria from June 2010 to June 2019 in our center were enrolled. The clinicopathologic characteristics and outcomes were compared between patients with the same histological type and different histological types. Results. A total of 336 patients were enrolled, consisting of 297 (88.4%) patients with the same histological type and 39 (11.6%) patients with different histological types. Compared to patients with the same histological type, patients with different histological types were more commonly males (87.2% vs. 34.0%; p < 0.001 ) with an older age (65 [62–69] vs. 59 [52–65] yrs; p < 0.001 ) at diagnosis. Also, patients with different histological types showed worse respiratory function and more advanced stage according to TNM staging. The 1-, 2-, and 3-year overall survival of overall patients was 97.7%, 96.1%, and 92.2%, and the 1-, 2-, and 3-year recurrence-free survival of overall patients was 96.8%, 92.9% and 85.7%, respectively. Importantly, patients with different histological types showed worse overall survival ( p < 0.001 ) and recurrence-free survival ( p = 0.002 ) than patients with same histological type. The multivariable Cox proportional hazard model revealed that presence of different histological types was significant predictor for worse overall survival (adjusted hazard ratio: 10.00; 95% confidence interval: 2.92–34.48; p < 0.001 ) and recurrence-free survival (adjusted hazard ratio: 2.59; 95% confidence interval: 1.14–5.88; p = 0.023 ). Conclusions. Although relatively less common in simultaneous multiple primary lung cancer, patients with different histological types showed worse clinical characteristics and outcomes.

The Value of CT-based Radiomics Nomogram in Differential Diagnosis of Different Histological Types of Gastric Cancer

Purpose: To establish and verify a nomogram based on computed tomography (CT) radiomics analysis to predict the histological types of gastric cancer preoperatively for patients with surgical indications.Methods: A sum of 143 patients with gastric cancer in Sir Run Run Shaw Hospital from January 2019 to December 2020 (differentiated type: 46 cases; undifferentiated type: 97 cases) were included into this retrospective study, and were randomly divided into training (n=99) and test cohort (n=44). The least absolute shrinkage and selection operator(LASSO) was used for feature selection while the multivariate Logistic regression method was used for radiomics model and nomogram building. The area under curve(AUC) was used for performance evaluation in this study.Results: The radiomics model got AUCs of 0.755 (95%CI, 0.650-0.859) and 0.71 (95%CI,0.543-0.875) for histological prediction in the training and test cohorts, respectively. The radiomics nomogram based on radiomics features and Carbohydrate antigen 125 (CA125) achieved an AUC of 0.777 (95%CI:0.679-0.875) in the training cohort with 0.726 (95%CI:0.559-0.893) in the test cohort. The calibration curve of the radiomics nomogram also showed good results. The decision curve analysis(DCA) shows that the radiomics nomogram is clinically practical.Conclusion: The radiomics nomogram established and verified in this study showed good performance for the preoperative histological prediction of gastric cancer, which might contribute to the formulation of a better clinical treatment plan.

A Review on the Histological Types of Hemangioma

Even after the approved classification of congenital vascular tumours/malformations which was first published by Mulliken and Glowacki, in the year 1982, there is still a significant amount of confusion to categorize hemangiomas and vascular malformations. Hemangiomas are considered to be true, benign neoplasms arising from endothelial cells and must be clearly differentiated from localized defects of vascular morphogenesis, i.e., vascular malformations.

Frequência dos tipos histológicos de tumores no sistema nervoso central em um hospital universitário: levantamento de casos ao longo de quatro anos / Frequency of central nervous tumors histological types in an university hospital: data from a four-year period

Introdução: A realização de um padrão epidemiológico das neoplasias do sistema nervoso central (SNC) é prejudicada pela sua heterogeneidade de apresentações, causando uma falta de dados a respeito da incidência de seus diversos tipos. É necessário, dessa forma, realizar estudos com a adoção de critérios de classificação. Objetivo: Desenvolver um banco de dados das neoplasias do SNC, incluindo além dos cânceres primários do SNC, os tumores benignos primários do SNC e as metástases. Método: Foram acessados 1010 casos de biópsias no sistema eletrônico de arquivos do Serviço de Anatomia Patológica, sendo incluídos 381 diagnósticos no estudo, em concordância com os critérios de inclusão e exclusão (neoplasias benignas e malignas do SNC). Resultado: A análise dos diagnósticos histológicos demonstrou um total de 212 pacientes do gênero feminino (55,64%) e 169 do gênero masculino (44,36%). Do total de neoplasias, 307 foram primárias do SNC (80,58%) e 74metástases (19,42%). A distribuição etária variou de 1 a 85 anos, com uma média de idade de 48,953 e a mediana de 52 anos. Os gliomas foram o grupo histológico mais frequente, correspondendo a 30,45% (116 casos), sendo “gliomas difusos” o subtipo histológico mais frequente (73%). Conclusão: O presente estudo documenta a frequência dos tipos histológicos das neoplasias do SNC no Serviço de Anatomia Patológica em um Hospital Universitário entre os anos de 2015 e 2018.Palavras chave: Neoplasias, Neuropatologia, Patologia cirúrgica, Neoplasias do sistema central nervoso, Neoplasias encefálicas AbstractIntroduction: The achievement of an epidemiological pattern of central nervous system tumors (CNS) is hampered by their heterogeneity of presentations, causing a lack of dataregarding the incidence of their various types. Therefore, it is necessary to carry out studies with the adoption of classification criteria. Objective: Develop a database of CNStumors including primary cancers, primary benign tumors and metastases. Methods: A total of 1010 cases of biopsies were accessed in the Department of Pathological Anatomy’selectronic archive system, 381 of which were included in the study, in accordance with the inclusion and exclusion criteria (benign and malignant CNS neoplasms). Results: The histological diagnoses analysis revealed a total of 212 female patients (55.64%) and 169 male patients (44.36%). Overall, 307 were primary CNS neoplasms (80.58%) and 74 CNS metastases (19.42%). The age distribution span ranged from 1 to 85 years of age, with a mean age of 48.953 and a median of 52 years of age. Gliomas were the most frequenthistological group, corresponding to 30.45% (116 cases), with “diffuse gliomas” being the most frequent histological subtype (73%). Conclusion: The present study documentsthe frequency of histological types of CNS neoplasms in the Pathological Anatomy Service of a University Hospital between 2015 and 2018.Keywords: Neoplasms, Neuropathology, Surgical pathology, Central nervous system neoplasms, Brain tumors