Value of 18F-FDG PET/CT for Assessment of Advanced Lacrimal Sac Non-Keratinizing Squamous Cell Carcinoma Successfully Treated with Concurrent Chemoradiotherapy

Non-keratinizing squamous cell carcinoma (NKSCC) of the lacrimal apparatus is extremely rare. It is usually very aggressive in destroying local tissue and has a grave prognosis for relentless recurrence and distant failures. Though the current evidence cannot make confident recommendations regarding the best management, curative surgical excision with adjuvant radiotherapy remains the most commonly used strategy. Here, we report a 71-year-old woman presented with progressive right medial canthal swellings for six months. A transnasal endoscopic biopsy revealed NKSCC of the lacrimal sac. She then underwent a combination of magnetic resonance images (MRI) and 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging purposes. Following cisplatin-based concurrent chemo-radiotherapy (CCRT), the post-treatment PET/CT illustrated the absence of an abnormal metabolic accumulation over the suspicious region as observed in post-treatment CT. A further trans-ostia re-biopsy confirmed complete tumor remission. This case demonstrates the remarkable ability of 18F-FDG PET/CT to differentiate between a persistent malignancy and post-treatment changes. Furthermore, a definite CCRT might provide comparable outcomes to traditional surgery.

HISTOPATHOLOGICAL EVALUATION OF CERVICAL LESIONS IN TERTIARY BASED HOSPITAL - KUTCH REGION

Aim:To find out various cervical lesions with histopathological correlation and age. Method: This was a prospective study conducted in pathology department of a tertiary care teaching hospital over a period of two years. A total of 255 women were included in this study. All cases of gynecological lesions at Histopathology department of Gujarat adani institute of medical science,Bhuj for 2 years starting from May 2019 to May 2021 were retrieved.The demographic information such as nature of specimen which include Punch biopsy(21 cases) and total abdominal hysterectomy(234 cases) were extracted. Results: The most common finding was Nonspecific chronic cervicitis in 159 patients(62.35%) followed by normal stratified squamous epithelium was found in 42 patients(16.47%) and Papillary endocervicitis were 14 patients(5.49%).In benign tumor or tumor-like lesion,Cervical metaplasia were 12 cases(4.70%),Nabothian cyst were 6 cases(2.35%) and Endocervical polyp were 2 cases(0.78%). The premalignant cervical lesions were only 4 cases(1.56%). The malignant cervical lesions were Large cell non-keratinizing squamous cell carcinoma were 7 cases(2.74%), Large cell keratinizing squamous cell carcinoma were 4 cases(1.56%),Squamous cell carcinoma NOS were 3 cases(1.17%) ,Poorly differentiated carcinoma was only one case(0.39%),Basaloid squamous cell carcinoma was only one case(0.39%). Conclusion: Cancer cervix is an ideal malignancy for screening,can be detected early and the premalignant lesion can be treated to prevent the progress to invasive disease. Hence all women with unhealthy cervix should be subjected to punch biopsy to detect early cases of cancer & carcinoma in situ. Most common cervical lesion is Squamous Cell carcinoma and most common age group is 40-49 years.

Immunohistochemical expression of P16 and Ki-67 in uterine cervical neoplasms

To study the expression of Ki-67 and p16 in neoplastic lesions of uterine cervix and to evaluate the prognostic significance of tumour differentiation, histological type, stage and grade, depth of tumour invasion and lymphovascular invasion in women with neoplasia of uterine cervix. This study was performed on 50 biopsies and surgically resected specimens of uterine cervix, which were fixed in 10% formalin, processed, paraffin embedded and cut into 3-5 microns thickness, stained with hematoxylin and eosin stains and immunohistochemical staining by p16 and Ki-67 antibodies was performed and studied. Majority of cases of invasive carcinoma cervix were large cell non-keratinizing squamous cell carcinoma, 58 cases (48.2%). Majority of cases of invasive carcinoma cervix were seen in stage 2B, 40 (40.8%) cases followed by stage 3B, 24 (24.4%) cases. Out of 18 cases of large cell non-keratinizing squamous cell carcinoma, 12 (66.7%) showed 3+ positivity for Ki-67. 7 (53.8%) cases of stage 2A showed 3+ positivity, 3 (23.1%) cases each showed 2+ positivity for p16. 7 (36.8%) cases of moderately differentiated SCC showed 3+ positivity, 4 (21.1%) showed 2+ positivity and 5 (26.3%) showed 1+ positivity of Ki-67. Out of 10 stable patients, 4 (40.0%) showed negative p16 immunoexpression and all the 3 cases (100%) with recurrence showed 2+ positivity and 2 (100%) patients with metastasis showed 3+ positivity. Out of 10 stable patients, 6 (60%) showed negative Ki-67 immunoexpression and all the 3 (100%) cases with recurrence showed 3+ positivity and one each (50.0%) patient with metastasis showed 2+ positivity and 3+ positivity. p16 and Ki-67 immunomarkers are useful as a diagnostic and prognostic tool in cases with recurrence and metastasis, helping in early detection of disease progression.

Descriptive epidemiology of nasopharyngeal carcinoma at Tikur Anbessa Hospital, Ethiopia

Background Nasopharyngeal cancer is distinguished from other cancers of the head and neck in its epidemiology, histopathology, clinical characteristics, and therapeutic outcome. Its unique clinico-epidemiologic pattern of the disease is an area focus for this investigation. Accordingly, the study investigated the demographic and histologic characteristics, as well as the clinical stage at presentation of nasopharyngeal carcinoma patients at Tikur Anbessa Specialized hospital. Methods Hospital based retrospective descriptive study was conducted from September 2017 – October 2020. All biopsy proven incidental cases during the study period are included. SPSS version 26 is used for data entry and analysis. Result A total of 318 patients with histologically confirmed nasopharyngeal carcinoma cases during the study period were included. There were 218 males and 90 females, with a male: female ratio of 2.5:1. The age of patients ranges from 13 to 81 years with a mean age of 37.8 ± 15 years. The median age at diagnosis was 38 years. Age distribution has two peaks for males, first between 30 to 39 and second 50 to 59 years of age. While the peak age of occurrence for females is in the 20–39 age range. Juvenile cases constituted 34% of the study group. The study revealed, nonkeratinizing carcinoma as the most prevalent histology at 94.3% (undifferentiated type 85.9% and differentiated keratinizing squamous cell carcinoma 8.4%) and 5.7% of the cases showed keratinizing squamous cell carcinoma. Majority of the patients, 86%, presented late with stage III and IV disease. Conclusion Nasopharyngeal cancer is commonly found among the young and productive age group, under the age 30. Nonkeratinizing carcinoma is the predominant histopathologic variant resembling that seen in endemic areas of the world. Thus, genetic and early life environmental exposures should be well studied to identify possible risk factors in the region. Late-stage presentation at diagnosis impacts the treatment outcome of patients, thereby indicating the need for a raised index of suspicion among health professionals for early diagnosis and better prognosis of patients.

Keratinizing Squamous Cell Carcinoma of the Palate in Clinically Negative Neck: Case Report and Review

Background: The Squamous cell carcinoma of the palate is rare; women are more affected than men. This study aimed to discuss the etiology, diagnostic modalities, prognosis factors, and treatment strategies. Case: A 49-year-old woman was admitted to our department in 2019 with a chief complaint of a hard and painful mass on the right palate. The Clinical assessment revealed a palatal tumor extended to 3/4 of hard palate and part of the soft palate, with hard consistency, no mobility, cauliflower-like surface partly covered by a white pseudo-membrane, dark red-colored, and clinically negative neck. 3D CT scan of palate and maxilla revealed malignant lesion features, Cervical MRI and Chest CT revealed enlarged lymph nodes. The histopathological assessment diagnosed keratinizing squamous cell carcinoma of the right palate. Resection of the tumor and Reconstructive surgery were performed. The postoperative outcomes were simple. Conclusion: Hepatitis B virus, local chronic inflammation were the risk factors incriminated in this case. The prognosis factors such as patient age, tumor size, lymph node involvement, bone invasion, and pathological grade influence the treatment and survival. Selective neck dissection, Ablative surgery, and Reconstruction with Submental island flap represented our management strategy for keratinizing squamous cell carcinoma of the palate.

Comprehensive Molecular Characterizations of Chinese Patients With Different Subtypes of Lung Squamous Cell Carcinoma

BackgroundThis study aims to profile integrative genomic spectra of Chinese patients with different subtypes of lung squamous cell carcinoma (LUSC) and explore potential molecular prognosis factors.MethodsWe retrospectively identified 204 surgically resected LUSC patients in Shanghai Chest Hospital who underwent capture-based targeted next-generation sequencing (NGS) with a panel of 68 lung cancer‐related genes from September 2017 to January 2019. NGS was used to profile comprehensive molecular characterizations.ResultsOf 204 cases, 114 (55.9%) were keratinizing squamous cell carcinoma (KSCC), 77 (37.7%) were non-keratinizing squamous cell carcinoma (NKSCC), 13 (6.4%) were basaloid squamous cell carcinoma (BSCC), respectively. All subtypes presented similarly high proportions of mutations, including TP53, CDKN2A, and NOTCH1. A comparable prevalence of FGFR1 amplifications was identified between KSCC and NKSCC (11.4 versus 26.9%, p = 0.007). Compared with NKSCC, IGF1R amplifications were more frequent in BSCC (0 versus 15.4%, p = 0.019). We found cases with TP53 alterations had less EGFR alterations in KSCC (P = 0.013, OR = 0.158). Compared with TCGA cohorts, our Chinese cohorts exhibited statistic differences in both somatic mutations and signaling pathways. We found that STK 11 alterations and TOP2A alterations were significantly associated with higher risk of recurrence in patients with LUSC.ConclusionsSignificant differences exist among three subtypes of LUSC in molecular characterizations.