P14.32 Patterns of invasion in Glioblastoma have unique radiological features, varied response to radiotherapy and long term outcomes

BACKGROUND To assess the correlation of the three patterns of invasion of Glioblastoma (GB) with the respective MRI features, response to radiotherapy and disease free survival MATERIAL AND METHODS Histopathology of 62 patients with Glioblastoma who had undergone maximal safe resection (MSR)/ stereotactic biopsy (STB) & referred for adjuvant therapy was reviewed to assess the pattern of invasion. Three patterns were observed- single cell infiltration (pattern 1), perineuronal satellitosis (pattern 2) and vessel cooption (or perivascular spread, pattern 3), majority also had diffuse infiltration pattern in the background. The pre and post operative MRI scans were utilized for RT planning of 3DCRT/ IMRT/ VMAT, the modality decided by the treating oncologist. RT volumes were as per ESTRO-ACROP guidelines. Duration of radiotherapy- the Stupp regimen or a short course of hypofractionated radiotherapy (HFRT) (35Gy/10Fr- planned gap- completion of total dose) was based on the extent of resection (EOR) and KPS at the time of RT. Correlation of the pattern of invasion, MRI characteristics of each on the response to radiotherapy as assessed by RANO criteria and survival was analysed with the help of SPSS V21. RESULTS MRI findings after stratification of 62 patients, median age 43 years(18–70), M:F::42:20) into type 1:17, type 2:21 and type 3:24- patterns of invasion, were cortical tumours (subtle enhancement) close to SVZ, solid (+/- cystic) lesion in the eloquent cortex or large mass effect crossing the barriers respectively. OS of entire cohort at 1 year was 75%, with significant differences among groups (82% vs. 85% vs. 50%). Among pattern 1, those patients with IDH mutant (20%) & mean dose to C/L SVZ of 30Gy or more had longer DFS at 1 year (89% Vs. 38% & 85% vs. 0%, p<0.05). In pattern 2, EOR (gross total or near total resection Vs. only STB) showed a better DFS at 1 year (90% vs. 40%, p=0.095). In patients with pattern 3, 40% had post op KPS of <80 and 20% of them underwent HFRT who showed higher CR/PR rates compared to the conventional RT. HFRT in low KPS with m-MGMT showed higher local control at 6 months (100% Vs. 66%, p= 0.02). CONCLUSION Glioblastoma has three patterns of invasion with unique MRI features and aggressiveness for each. Identification of this may guide choice of adjuvant therapy, patterns of failure and therapy resistance

Updated Review on Pathology of Endocervical Adenocarcinoma with Emphasis on Clinically Relevant Findings

<p>In the present review, we summarize and critically appraise recent advances in the pathology of endocervical adenocarcinoma. In recent years, the diagnosis of endocervical adenocarcinoma has shifted from morphologic criteria classification in 2014 World Health Organization (WHO) to etiology- based classification of International endocervical adenocarcinoma criteria and classification (IECC). IECC recommends classifying endocervical adenocarcinoma into Human Papillomavirus (HPV)- associated and non-HPV-associated. Ultimately, this approach may lead to different treatment options based on molecular pathways rather than purely based on the tumor’s grade and stage. Recently, the College of American Pathologists (CAP) has incorporated stromal invasion patterns as an optional data set in the synoptic report. The pattern of invasion classification is a valuable prognostic tool in excision specimens. Conclusion: IECC is a simple classification system that recognizes and classifies endocervical tumors based on pathogenesis and association to HPV. The pathologists should also be familiar with the pattern-based classification of endocervical adenocarcinoma.</p>

Deciphering the Genetic Alterations in SPARC Gene Family and Its Association with HNSCC

The aim of this study is to identify the genetic alteration in SPARC gene family and its association with head and neck squamous cell carcinoma (HNSCC). Head and neck cancer is a set of cancerous lesions arising from the squamous cell of the mucous membrane of the oral cavity, nose throat, larynx and pharynx. SPARC gene encodes for cysteine rich acid matrix metalloprotein, osteonectin whose expression in metastatic OSCC (Oral squamous cell carcinoma) was found to be higher. This expression pattern also correlated with the worst pattern of invasion and differentiation of OSCC tumors. In line with the above facts, the present study was carried out to ascertain the gene alterations and their consequences. Also the putative association of gene alterations with HNSCC was analyzed using computational tools. The Cancer Gene Atlas (TCGA, Firehose Legacy) dataset hosted by the cBioportal server was used in the present study. The non-synonymous variants identified were further assessed for protein stability and pathogenicity employing IMutant and PROVEAN tools. Gene amplification was observed in the FSTL1 gene, which was also shown to present with the highest frequency of gene alterations (5%) among eight genes. Furthermore, the expression of the FSTL1 gene was found to differ significantly among different grades of HNSCC. In conclusion, the study throws light on the possible association of the FSTL1 gene of the SPARC family with HNSCC.