Gynecologic organ involvement and incidental gynecologic organ neoplasms in female patients with urothelial carcinoma of the bladder undergoing anterior pelvic exenteration in Rajavithi Hospital

Objective: To evaluate the pathological data of the bladder and gynecologic organs obtained from anterior pelvic exenteration and review the incidence of gynecologic organ involvement and primary gynecologic tumor. Materials and Methods: The clinicopathological data of 70 patients who were diagnosed with bladder transitional cell carcinoma and underwent anterior pelvic exenteration in Rajavithi Hospital between January 2008 and October 2020 were analyzed to examine and determine any correlations. Results: Thirteen (18.5%) patients had gynecologic organ involvement. This consisted of 4 cases (5.7%) involving the uterus, 7 (10%) involving the vagina, 2 (2.8%) involving the ovaries, and 10 (14.2%) involving the cervix. Female patients with gynecologic organ invasion were more likely to have a high pathological T stage (p < 0.001), and have pre-operative hydronephrosis (p = 0.002). From multivariate logistic regression, pre-operative hydronephrosis was associated with increased risk of gynecologic organ invasion (odds ratio 9.57; 95% confidence interval, 1.86 - 49.18; p = 0.007). There were 23 (32%) female patients incidentally diagnosed with benign gynecologic tumors, specifically 16 (22%) cases of myoma uteri, 7 (10%) of adenomyosis and 4 (2.8%) with ovarian cysts. No patient was diagnosed as having primary gynecologic malignancy. Conclusions: The incidence of gynecologic organ involvement in female patients who had undergone anterior pelvic exenteration for urothelial carcinoma of the bladder was 18.5%. Pre-operative hydronephrosis was a risk factor associated with increased risk of gynecologic organ involvement. Information from this study may allow better identification of candidates for gynecologic organ sparing surgery.

Sarcopenia Increases the Risk of Major Organ Invasion in Patients with Papillary Thyroid Cancer

While sarcopenia is associated with poor overall survival and cancer-specific survival in solid cancer patients, the impact of sarcopenia on clinicopathologic features that can influence conventional papillary thyroid cancer (PTC) prognosis remains unclear. To investigate the impact of sarcopenia on aggressive clinicopathologic features in PTC patients, prospectively collected data on 305 patients who underwent surgery for PTC with preoperative staging ultrasonography and bioelectrical impedance analysis were retrospectively analyzed. Nine sarcopenia patients showed more patients aged 55 or older (p = 0.022), higher male proportion (p < 0.001), lower body-mass index (p = 0.015), higher incidence of major organ invasion (p = 0.001), higher T (p = 0.002) stage, higher TNM (p = 0.007) stage, and more tumor recurrence (p = 0.023) compared to the non-sarcopenia patients. Unadjusted and adjusted logistic regression analyses showed that sarcopenia (odds ratio (OR) 9.936, 95% confidence interval (CI) 2.052–48.111, p = 0.004), tumor size (OR 1.048, 95% CI 1.005–1.093, p = 0.027), and tumor multiplicity (OR 3.323, 95% CI 1.048–10.534, p = 0.041) significantly increased the risk of major organ invasion. Therefore, sarcopenia in PTC patients should raise suspicion for a more locally advanced disease and direct appropriate management.

Differentiation Between the Aalignant Mesothelioma of Pleura and Pleural Metastasis with Contrast Enhanced CT, Is It Possible?

Objective: To compare CT findings between malignant pleural mesothelioma (MPM) and metastatic pleuraldisease (MPD).Materials and Methods: CT chest images of 157 cases of pathologically-proven malignant pleural disease(21 MPM, 136 MPD) were retrospectively reviewed by two radiologists who were blinded to the diagnosis. Findingsof interest included pleural effusion, pleural thickening, organ invasion, lymphadenopathy, dominant lung nodule,pulmonary or extra-thoracic organ metastasis, and asbestos-related disease.Results: Findings commonly found in MPM compared with MPD are circumferential pleural thickening (52.4%vs 14.0%, p<0.001), pleural mass (33.3% vs 7.4%, p<0.001), organs invasion (57.1% vs 9.6%, p<0.001), and asbestosrelated disease (19% vs 0%, p<0.001).Conclusions: Circumferential pleural thickening, pleural mass, presence of organ invasion, and CT finding ofasbestos-related pleural disease were the CT findings that raise the possibility of MPM.

Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study

BackgroundThe safety and benefit of sentinel lymph node biopsy (SLNB) compared with regional lymph node dissection (RLND) and no lymph nodes removed (NA) in patients with vulvar squamous cell cancer (VSCC) was not well studied.MethodsA retrospective analysis on VSCC patients without distant metastasis and adjacent organ invasion from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2016 was carried out. Within subgroups stratified by negative (LN−) or positive (LN+) regional lymph node findings, inverse probability weighting (IPW) adjusted multivariate Fine-Gray compete risk (CR) model and accelerated failure time (AFT) model was used to investigate the factors associated with and cancer-specific survival (CSS) and overall survival (OS).ResultsOf the 3,161 VSCC patients treated with surgery, 287 (9.1%) underwent SLNB, 1,716 (54.3%) underwent RLND, and 1,158 (36.6%) had no regional lymph nodes removed. As illustrated by IPW adjusted multivariate regressions, SLNB was significantly associated with prolonged CSS (LN−, adjusted sub-proportional hazard ratio [sHR] = 0.42; 95% confidence interval [CI], 0.19–0.93; P=0.032; LN+, adjusted sHR = 0.29; 95% CI, 0.16–0.54, P&lt;0.001) and OS (LN−, adjusted time ratio [TR] = 1.38; 95% CI, 0.82–2.32; P=0.226; LN+, adjusted TR = 2.68; 95% CI, 1.73–4.14; P&lt;0.001), although the effect of SLNB on OS was not significant within the LN− cohort. Moreover, SLNB led to improved CSS (adjusted sHR = 0.40; 95% CI, 0.23–0.70; P = 0.001) and OS (adjusted TR=1.15, 95% CI 0.76-1.73, P=0.279) compared with NA. Age was a significant prognostic factor of CSS and OS, whereas tumor size, surgery type, and invasion depth were not.ConclusionsSLNB leads to significantly prolonged CSS and OS in VSCC surgery patients without distant metastasis and adjacent organ invasion than RLND, except for the similar OS in the LN− cohort. SLNB could be carried out preferentially for VSCC surgery patients without distant metastasis and adjacent organ invasion, irrespective of tumor size, surgery type, invasion depth, and regional lymph nodes metastasis. Further prospective clinical trials are warranted to confirm the findings of this study.

Correlation of clinical staging and MRI staging for cervical cancer

Background Cervical cancer is a major public health problem for women. Accurate staging may lead to proper management of cervical cancer. We retrospectively reviewed all patients with cervical cancer who underwent pre-treatment MRI between January 2009 and December 2018 and analyzed the correlation between the clinical staging and MRI staging. Results Correlation of overall clinical and MRI staging by percent agreement is moderate (73.9%), but the kappa coefficient showed a slight correlation. The correlation of clinical and MRI findings in the vaginal invasion, pelvic sidewall invasion, adjacent pelvic organ invasion, and spreading to distant organ also showed moderate-to-strong correlation by percent agreement (ranging from 67.6 to 91.9%) but slight correlation between clinical and MRI examinations by kappa or weighted kappa coefficient (K = 0.000–0.128w). Conclusion In patients with cervical cancer, pretreatment MRI provides higher spatial soft tissue resolution which can define pelvic tumor extent, including a more accurate assessment of tumor size (due to multiplanar evaluation), parametrial invasion, pelvic sidewall invasion, and adjacent pelvic organ invasion. This could potentially lead to a reduction in staging morbidity by invasive investigation such as cystoscopy and proctoscopy.

Genetic fate-mapping reveals surface accumulation but not deep organ invasion of pleural and peritoneal cavity macrophages following injury

During injury, monocytes are recruited from the circulation to inflamed tissues and differentiate locally into mature macrophages, with prior reports showing that cavity macrophages of the peritoneum and pericardium invade deeply into the respective organs to promote repair. Here we report a dual recombinase-mediated genetic system designed to trace cavity macrophages in vivo by intersectional detection of two characteristic markers. Lineage tracing with this method shows accumulation of cavity macrophages during lung and liver injury on the surface of visceral organs without penetration into the parenchyma. Additional data suggest that these peritoneal or pleural cavity macrophages do not contribute to tissue repair and regeneration. Our in vivo genetic targeting approach thus provides a reliable method to identify and characterize cavity macrophages during their development and in tissue repair and regeneration, and distinguishes these cells from other lineages.

Microscopic Invasion of Nerve Is Associated With Aggressive Behaviors in Pancreatic Neuroendocrine Tumors

ObjectivesThe role of neural invasion has been reported in cancers. Few studies also showed that neural invasion was related to survival rate in patients with pancreatic neuroendocrine tumor (PNET). The aim of this study is to explore the association between neural invasion and aggressive behaviors in PNET.MethodsAfter excluding those patients with biopsy and with missing histological data, a total 197 patients with PNET who underwent surgery were retrospectively analyzed. The demographic data and histological data were obtained. Aggressive behavior was defined based on extra-pancreatic extension including vascular invasion, organ invasion and lymph node metastases. Logistic regression analyses were used to identify risk factor for aggressive behavior. Receiver operating characteristic (ROC) curves were performed to show the performance of nomograms in evaluating aggressive behavior of PNET.ResultsThe prevalence of neural invasion in the cohort was 10.1% (n = 20). The prevalence of lymph node metastasis, organ invasion, and vascular invasion in PNET patients with neural invasion was higher than those in patients without neural invasion (p &lt; 0.05). Neural invasion was more common in grade 3 (G3) tumors than G1/G2 (p &lt; 0.01). Tumor size, tumor grade, and neural invasion were independent associated factors of aggressive behavior (p &lt; 0.05) after adjusting for possible cofounders in total tumors and G1/G2 tumors. Two nomograms were developed to predict the aggressive behavior. The area under the ROC curve was 0.84 (95% confidence interval (CI): 0.77–0.90) for total population and was 0.84 (95% CI: 0.78–0.89) for patients with G1/G2 PNET respectively.ConclusionsNeural invasion is associated with aggressive behavior in PNET. Nomograms based on tumor size, grade and neural invasion show acceptable performances in predicting aggressive behavior in PNET.

Laboratory testing for COVID-19 in suspected human cases and the impact of corona virus pandemic on the global health system

COVID-19, coronavirus (SARS-CoV-2) infection has become pandemic after first appearing in Wuhan, China in December 2019. It destroyed the life of millions of people throughout the different parts of Europe, America, Asia and others in the world. Various groups of scientists throughout the globe have claimed on trialing for the corona vaccine and for finding out suitable medication for the treatment of COVID-19. No vaccine or medicines are successfully reported to short out the issue for saving the valuable life of human beings, till date. The mechanism of SARS-CoV-2 infection and organ invasion are not understood and it creates difficulty in clinical diagnosis and treatment of corona patients. The pathogenic mechanism of SARS-CoV-2 infection is not very much clear and it may invade multiple organ systems of respiratory, digestive and hematological in a confirmed case. The impact of corona virus outbreak on the global and Indian health systems is also reviewed herewith.

SARS-CoV-2, ACE2 expression, and systemic organ invasion

A novel coronavirus disease, COVID-19, has created a global pandemic in 2020, posing an enormous challenge to healthcare systems and affected communities. COVID-19 is caused by Severe Acute Respiratory Syndrome (SARS)-CoronaVirus-2 (CoV-2) that manifests as bronchitis, pneumonia, or a severe respiratory illness. SARS-CoV-2 infects human cells via binding a "spike" protein on its surface to angiotensin-converting enzyme 2 (ACE2) within the host. ACE2 is crucial for maintaining tissue homeostasis and negatively regulates the renin-angiotensin-aldosterone system (RAAS) in the humans. The RAAS is paramount for normal function in multiple organ systems including the lungs, heart, kidney, and vasculature. Given that SARS-CoV-2 internalizes via ACE2, the resultant disruption in ACE2 expression can lead to altered tissue function and exacerbate chronic diseases. The widespread distribution and expression of ACE2 across multiple organs is critical to our understanding of the varied clinical outcomes of COVID-19. This perspective review based on the current literature was prompted to show how disruption of ACE2 by SARS-CoV-2 can affect different organ systems.