Cytoreductive Surgery of the Primary Tumor in Metastatic Adrenocortical Carcinoma: Impact on Patients’ Survival

Context The role of cytoreduction of adrenocortical carcinoma (ACC) remains poorly understood. Objective To analyze the impact of cytoreductive surgery of the primary tumor in patients with metastatic ACC. Design and Setting We performed a multicentric, retrospective paired cohort study comparing the overall survival (OS) in patients with metastatic ACC who were treated either with cytoreductive surgery (CR group) or without cytoreductive surgery (no-CR group) of the primary tumor. Data were retrieved from 9 referral centers in the American-Australian-Asian Adrenal Alliance (A5) collaborative research group. Patients Patients aged ≥18 years with metastatic ACC at initial presentation who were treated between January 1, 1995, and May 31, 2019. Intervention Performance (or not) of cytoreductive surgery of the primary tumor. Main outcome and measures A propensity score match was done using age and the number of organs with metastasis (≤2 or >2). The main outcome was OS, determined from the date of diagnosis until death or until last follow-up for living patients. Results Of 339 patients pooled, 239 were paired and included: 128 in the CR group and 111 in the no-CR group. The mean follow-up was 67 months. Patients in the no-CR group had greater risk of death than did patients in the CR group (HR, 3.18; 95% CI, 2.34-4.32). Independent predictors of survival included age (HR, 1.02; 95% CI, 1.00-1.03), hormone excess (HR, 2.56; 95% CI, 1.66-3.92), and local metastasis therapy (HR, 0.41; 95% CI, 0.47-0.65). Conclusion Cytoreductive surgery of the primary tumor in patients with metastatic ACC is associated with prolonged survival.

Identification of TRPV4 as a novel target in invasiveness of colorectal cancer

Background Emerging evidence has indicated the critical role of TRPV4 in diverse human cancers. However, the underlying molecular mechanism of TRPV4 in colon cancer invasiveness is still unknown. Methods Immunohistochemistry staining was used to analyze the expression of TRPV4 and ZEB1 in clinical tissues; Wound healing and transwell assays were applied to determine the cell invasiveness; Western blot was used to explore the relation between TRPV4 and ZEB1. Results Colon cancer cells were transfected with siRNA against TRPV4 or HC067047 (a selective TRPV4 antagonist), TRPV4 full-length plasmid or siRNA against ZEB1, or both, in order to measure cell migration and invasion. And we found that TRPV4 silencing or inhibition exhibited an inhibitory role in colon cancer cell migration and invasion, coupled with compromised EMT process, and suppressed AKT activity. TRPV4 stimulated expression of ZEB1 and consequently contributed to EMT process and invasiveness. It was also revealed that overexpression of TRPV4 and ZEB1 in clinical patients with local metastasis, and positive correlation between TRPV4 and ZEB1. Conclusions Our results uncovered the role of TRPV4 in tumor metastasis and highlighted the potential mechanism of TRPV4-ZEB1 axis in indicating EMT.

Outcome of Breast Cancer Patients with COVID-19 Infection: A Report from a Tertiary Cancer Center in India

Background: Nowadays breast cancer (BC) is the most common cancer in women. More than 1.5 million cases are detected yearly. Survival of patients is dependent on several factors. Metastasis and cancer recurrence of different types and in different locations have various outcome. Methods: This is a retrospective cohort study to describe survival of patients after diagnosis of breast cancer based on receptor subtypes and sites of metastasis among Iranian population. A total number of 2051 females with breast cancer were evaluated and among these, 138 patients with recurrent BC were investigated. Results: The 1-year survival of local, bone, visceral and brain metastasis were 64.99%, 63%, 32.83%, and 21.57%, respectively. Based on sites of metastasis, bone and local metastasis showed the best survival while brain and visceral metastasis had the worst survival and prognosis. Conclusion: Our study showed that Her2 enriched positive BCs had the worst survival, this may be due to Trastuzumab uncovered insurance till 10 years ago in our country. Also, drugs related to luminal A and B which are used to improve their survival and hormonal therapy could be associated with their better prognosis in comparison to triple negative receptor subtype. But this study showed that triple negative BC had better survival.

The lifetime cost estimation of human papillomavirus-related diseases in China: a modeling study

Objectives To estimate the lifetime treatment costs of patients with human papillomavirus (HPV) infection-related diseases in China and to provide cost estimates for the economic evaluation of HPV intervention strategies. Methods We extracted real-world hospital data from 2012 to 2019 and screened for subjects who met the criteria of clinical diagnosis of HPV-related diseases to obtain country-specific inputs into a Markov decision model. The model simulated lifetime treatment costs for HPV from the perspective of a national payer. A 5% discount rate was applied. Costs were converted and inflated to 2020 US dollars (USD) Results Using 2021 as the base year, the lifetime costs per patient for carcinoma in situ, local metastasis, and distant metastasis cervical cancer are $24,208 (95%CI: 18,793–30,897), $19,562 (95%CI: 14,456–25,567), and $17,599 (95%CI: 10,604–25,807), respectively. For carcinoma in situ, local metastasis, and distant metastasis vaginal cancer, the lifetime costs are $17,593 (95%CI: 14,962–23,596), $17,120 (95%CI: 13,215–22,417), and $22,411 (95%CI: 12,172–22,249), respectively. The base-case lifetime cost per patient for different stages of vulvar cancer/penile cancer/anal cancer/oral cancer/oropharyngeal cancer/laryngeal cancer falls within $17,120–$58,236. Conclusions Using real-world data, we calculated lifetime treatment costs of HPV-related cancer in China and found that the lifetime cost for patients exceeded $17,000 for various stages of disease. The national burden of HPV-related disease could be significantly reduced by eliminating HPV infection.

Papillary carcinoma arising from thyroglossal duct cyst with cervical lymph node metastasis

Thyroglossal duct cyst carcinoma is uncommon. Its prevalence is less than one percent. Papillary carcinoma is the most common pathologic finding of the thyroglossal duct cyst carcinoma. Metastasis of the cervical lymph node is less common. Its prevalence is less than 8%. A 38-year-old woman presented with a complaint of painless mass in the midline of the neck. Ultrasonography of the neck revealed a solid cystic mass, measuring 5.5 × 2.5 cm in the submental area. Ultrasonography of the neck additionally revealed suspicion lymph node at bilateral level Ib. A preoperative Computed Tomography (CT) showed a 4 cm size MIX heterogeneous lesion in the anterior left-sided hyoid bone. The patient underwent sistrunk surgery, which was the result of the patient’s frozen section papillary carcinoma arising from the thyroglossal duct cyst. The patient had local metastasis to the neck, so she underwent total thyroidectomy and central N-D surgery and bilateral modified radical N-D. Diagnosis of thyroglossal duct cyst carcinoma before surgery is unusual. The definitive diagnosis is often after surgery and is based on the patient’s histopathological findings. The best surgical procedure is sistrunk. But if the patient has local metastasis to the neck, total thyroidectomy and modified radical N-D are performed.

CLINICAL AND MORPHOLOGICAL FEATURES OF MERKEL’S CARCINOMA IN ELDERLY PATIENTS (LITERATURE REVIEW)

Карцинома Меркеля (КМ) - редкая агрессивная нейроэндокринная опухоль кожи с высокой частотой рецидивирования и местного метастазирования. Средний возраст, при котором диагностируют КМ, составляет 75 лет. Выявление роли соматических мутаций и репараций ДНК в механизмах старения ставит вопрос об их непосредственной связи с процессами дифференцировки, возрастных особенностей иммунитета, программированной клеточной гибели и злокачественного роста. В этой связи сохраняется необходимость в проведении исследований, направленных на усовершенствование ранней диагностики и патогенетического лечения пожилых пациентов с КМ. Merkels cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin tumor with a high rate of recurrence and local metastasis. The average age at which MCC is diagnosed is 75 years. The identification of the role of somatic mutations and DNA repair in aging mechanisms raises the question of their direct connection with the processes of differentiation, age-related characteristics of the immune system, programmed cell death and malignant growth. In this regard, there remains a need for research aimed at improving the early diagnosis and pathogenetic treatment of elderly patients.

Reemplazo articular de cadera en paciente con tumor de células gigantes

El tumor óseo de células gigantes (TCG) representa el 5 % de los tumores óseos primarios. Por lo general son benignos, pero de comportamiento impredecible debido a su potencial biológico de malignidad, caracterizado por agresividad y recurrencia local, metástasis y transformación maligna. Se presenta caso de una paciente mujer de 44 años que acude con una fractura patológica transcervical izquierda por tumor de células gigantes, diagnosticada por biopsia; se descarta metástasis y se trató con resección femoral proximal y artroplastia de cadera izquierda, resultando en una evolución favorable.

Conjunctival Melanoma Angiotropic Microsatellitosis: A Mechanism of Local Extravascular Migratory Metastasis

Purpose: To report a case of local metastasis of conjunctival melanoma, which may occur via extravascular migratory metastasis (EVMM), and discuss its clinical relevance in conjunctival melanoma tumor staging and possible management implications. Methods: Retrospective chart review of a single clinical case with clinicopathologic correlation. Results: A 65-year-old male referred due to local recurrence of conjunctival melanoma at the caruncle was successfully treated after two excisional procedures with negative sentinel lymph node biopsies. Forty-eight months after initial presentation, the patient developed a nodular lesion representing local recurrence in the ipsilateral upper tarsal conjunctiva, distant from the primary tumor site. Histopathology showed nodules in the substantia propria in the absence of primary acquired melanosis. The tumor cells were found along the extravascular surface without intralymphatic or intravascular tumor cells consistent with local metastasis. One possible mechanism is angiotropic microsatellitosis leading to local EVMM. Additional neck CT imaging showed no lymphadenopathy. Conclusion: EVMM via angiotropic microsatellitosis is another possible mechanism of noncontiguous local recurrence of conjunctival melanoma. Angiotropic microsatellitosis may represent a high-risk finding possibly related to increased melanoma-related mortality.

Chest wall metastasis in postoperative thyroid cancer: a case report

Thyroid cancer is common in China. Thyroid adenocarcinoma metastases can be local or distal metastasis. Local metastasis presents as a hard and fixed lymph node in the neck, while distant metastases are found in the lung, skull, vertebrae, and pelvis. However, thyroid follicular carcinomas are mostly observed in hematogenous metastases. The thyroid adenocarcinoma and follicular carcinoma of the thyroid gland are often misdiagnosed. Here, we report the case of a 53-year-old female patient. More than 2 years after her initial diagnosis, her left chest wall was physically examined. The results revealed a progressive enlargement that had a hard quality, poor activity, unclear boundary, pressure pain, and percussion pain. Thyroid follicular cell carcinoma was subsequently diagnosed and treated surgically. The thyroid carcinoma had multiple bone metastases, and the thyroid follicular carcinoma had spread to the chest wall through the blood vessels. Thus, preoperative procedures and follow-up should be strengthened because early pathological thyroid follicular carcinoma and thyroid adenoma can easily be misdiagnosed. Pathologic consultation and follow-ups should be strengthened to prevent misdiagnosis.