Papillary craniopharyngioma: a type of tumor primarily impairing the hypothalamus. A comprehensive anatomo-clinical characterization of 350 well-described cases

Objective: Papillary craniopharyngiomas (PCPs) represent a rare histological variant of craniopharyngiomas (CPs) usually involving the hypothalamus. This study systematically analyzes the clinical-anatomical correlation between tumor topography and symptoms related to hypothalamic dysfunction in the largest series of PCPs ever gathered. Methods: From 5,346 CP reports published from 1856 to 2021, we selected 350 well-described cases of the squamous-papillary type. Clinical presentation, tumor topography, severity of hypothalamic adhesion, patient outcome and tumor recurrence were thoroughly analyzed. Results: PCPs predominantly occur in adult (96.3%), male (61.7%) patients presenting with headache (63.4%), visual alterations (56.2%) and psychiatric disturbances (50.4%). Most PCPs are solid (50%), round (50%) lesions that occupy the third ventricle (3V, 94.8%) and show low-risk severity adhesions to the hypothalamus (66.8%). Two major topographical categories can be found: strictly 3V (57.5%), growing above an intact 3V floor (3VF) and not-strictly or infundibulo-tuberal (32.9%), expanding at the infundibulum and/or tuber cinereum. The hypothalamic syndrome predominated among strictly 3V PCPs (p<0.001). Psychiatric symptoms (p<0.001) and high-risk hypothalamic attachments (p=0.031) related to unfavorable postoperative outcomes among patients treated from 2006 onwards. The not-strictly 3V topography was identified as the major predictor of high-risk hypothalamic attachments (71.2% correctly predicted), which, along with incomplete tumor removal (p=0.018), underlies the higher tumor recurrence of this topography (p=0.001). Conclusions: This systematic review evidences that PCP topography is a major determinant of hypothalamic-related symptoms, type of hypothalamic attachments and tumor recurrence rate. Accurate preoperative definition of PCP-hypothalamus relationships is essential for the judicious, safe management of these complex lesions.

The Role p53 Protein Expression in Urothelial Neoplasm

The urinary bladder had a line with transitional epithelium. Urothelial neoplasms are the majority among the bladder neoplasms. Urothelial neoplasms were more common in males than in females. Urothelial neoplasms usually occur in the elderly age group. The majority of the tumor size was more significant than 3 cm, and papillary type is majorly found among the tumors. The present study aimed to identify the grade and staging of the p53 in urothelial neoplasms. The bladder carcinoma (54) cases from Department of Pathology, Sree Balaji Medical College and hospital (during September 2015 to September 2017) were analysed. The median age for bladder carcinoma in the present study was 66 years. The clinical parameter studied was the size of the lesion based on the cytoscopic or radiological findings (31- 33). Based on tumor size, lesions were classified into two groups, less than equal to 3cm and greater than 3cm, which was found to be 42% and 58%, respectively This study concludes that p53 is useful in differentiating benign and malignant neoplasms in morphologically difficult cases. Immunohistochemistry for p53 is useful adjunct to histomorphology.

Collision kidney tumor with clear cell renal cell carcinoma and papillary type 1 renal cell carcinoma. A case report and review of the literature

Introduction: The most common renal neoplasms include clear cell, papillary, and chromophobe renal cell carcinomas. The simultaneous occurrence of different histological types of adjacent neoplasms in the same organ is known as a collision tumor. Collision kidney tumors have already been described but only in rare cases. Case description: In this case report we present a 68-year-old man with chronic kidney insufficiency under dialysis who underwent an open right nephrectomy in our department with the histological diagnosis of a collision kidney tumor consisting of clear cell and papillary type 1 renal cell carcinoma. Conclusion: To the best of our knowledge, our case of a collision kidney tumor consisting of clear cell RCC and papillary type 1 RCC, is unique in literature.

UNISON - nivolumab then ipilimumab + nivolumab in advanced non-clear cell renal cell carcinoma (ANZUP 1602): Part 1—Nivolumab monotherapy.

325 Background: Immune checkpoint inhibitors (ICI) are active in many cancers, but people with rare variant, non clear-cell renal cell carcinoma (nccRCC) have been excluded from most clinical trials in RCC. UNISON (NCT03177239) aimed to test 2 hypotheses; the activity of nivolumab in nccRCC (Part 1), and the benefit of adding ipilimumab to nivolumab, in people whose cancers progress on nivolumab (Part 2). Methods: 83 participants (pts) with advanced nccRCC with good (ECOG0/1) performance status, were enrolled including papillary type 1 (17%), papillary type 2 (28%), chromophobe (18%), Xp11 translocation (6%), hereditary leiomyomatosis renal cell carcinoma syndrome-associated renal cell carcinoma (6%), RCC unclassified (10%) and other (15%) histological subtypes. Participants took nivolumab (N) 240mg every two weeks in Part 1 in total. If they experienced progression and remained eligible they could take N (3mg/kg) plus ipilimumab (I; 1mg/kg) every 3 weeks for up to 4 doses (Part 2). Pts with disease control after N or N + I could continue N for up to 1 year. UNISON was powered to distinguish a clinically-relevant improvement in objective tumor response rate (OTRR) from 15% to 30% in people taking N+I in Part 2 in pts whose cancers were refractory to single-agent first-line N. Here we report results of Part 1. Results: Pts experience of N appeared similar to previous reports, with most experiencing mild adverse events. 12 treatment related SAE occurred in 11 patients (13%). 14 pts (17%) experienced treatment delays, or permanent treatment discontinuation (10%). The median time on treatment was 5.1 months. The OTRR was 17% with 3 complete responses and 11 partial responses. The median duration of response was 21 months. Stable disease occurred in 49% of pts and disease progression in 34%. The disease control rate at 6 months was 45% (95% CI: 34%, 56%). The median PFS was 4.0 months (95% CI: 3.6, 7.4). The 6 month progression-free survival (PFS) was 45% (95% CI: 34-55) and the 12 months PFS was 30% (95% CI: 21%, 40%). Conclusions: Pts with nccRCC treated with N experience similar adverse events compared to pts with other cancers. A substantial minority of people with nccRCC derive benefit, but many pts have cancers refractory to anti-PD1, similar to other reports. The activity of I and N in this PD1-refractory population is of considerable interest and will be reported at a later date. Clinical trial information: NCT03177239 .

Prevalence of type of maxillary labial frenal attachment among 18-30 years: A retrospective study

The frenum has its origin from the remnant of central cells of vestibular lamina which predominantly has connective tissue and least amount of muscle fibers. Labial frenum is a vertical band of oral mucosa that attaches the cheeks and lips to the alveolar mucosa of the mandibular and maxillary arches, limiting the movement of the lips and cheeks. The aim of the study was to find out the prevalence of the type of maxillary labial frenal attachment among 18-30 years. The present retrospective study was conducted among 100 outpatients who reported to a private institution in Chennai from June 2019 to March 2020. Data regarding the type of frenal attachment was collected and analysed. From our current study, it was found out that out of 100 patients, 41% had a gingival type, 27% had a mucosal and papillary type, 5% had the papillary penetrating type of maxillary labial frenal attachment and there was no significant association between gender and type of frenal attachment (Pearson Chi-Square test - 1.105, df-3, p value - 0.776(>0.05); statistically not significant). Within the limitations of the present study, the most prevalent type of maxillary frenal attachment in the given population was a gingival type. Least prevalent type was papillary penetrating and there was no significant association between gender and type of frenal attachment.

Craniopharyngioma and arteriovenous malformation operated using the same craniotomy

Craniopharyngiomas (CPs) are rare benign epithelial tumours. Brain arteriovenous malformations (AVMs) are also rare lesions occurring in young adults. The appearance of both these lesions in the same patient is rare. A 42-year-old patient presented with headaches for 3 months and a progressive decrease in his visual acuity. Bitemporal hemianopsia was detected in the visual field. Magnetic resonance imaging (MRI) revealed a tumour with cystic and solid components located in the suprasellar region and AVM in the right temporal lobe. AVM (Martin–Spetzler grade III) was visualised using digital subtract angiography (DSA), which was fed from the right middle cerebral artery and drained through the sigmoid sinus via the inferior petrosal sinus. The patient was operated with enlarged right frontotemporal craniotomy. AVM nidus was totally removed at the first operation. Embolisation was not preferred before the AVM surgery. After 3 days, sylvian dissection was performed using the same craniotomy. The tumour was completely removed via the carotid cistern by making sharp dissection from the infundibulum. Post-operatively, the patient showed normal neurological examination and significant improvement in his visual field examination. There was no residual/recurrent tumour or AVM on contrast-enhanced MRI and DSA at post-operative 6 months. Histopathological examination revealed AVM in the first operative material and papillary-type CP in the second. The coexistence of these two rare pathologies has previously been reported in only one patient. This is the first case of surgical resection of CP and AVM using the same craniotomy.

Is the consumption of sweets a risk factor for thyroid cancer?

Background Several studies have investigated the role of diet as a risk and/or protective factor on the development of the thyroid cancer but the results are unclear. The aim of this study was to investigate the role of eating habits on the risk of thyroid cancer. Methods We carried out a hospital-based case-control study. The eating habits of the participants were investigated through a validated Lifestyles Questionnaire. The frequency of consumption of the different types of food was reported on a 4-level scale (never, 1 time per week, 2-3 times a week, 6 times a week). Logistic regression models were used to estimate the ORs and their 95% confidence intervals adjusted for age, gender and BMI. Statistical data analysis was conducted using the IBM SPSS Statistics 21.0 program. Results One hundred and six cases (91.2% CA papillary type) and 217 controls were recruited. A positive association was observed for BMI (OR: 1.085; IC95% = 1.022-1.152), consumption of complex carbohydrates (OR: 2,324; IC95%: 1,364-3,960) and a low consumption of legumes, cereals, potatoes, fruit and vegetables (OR: 2.285, 95% CI: 1.330-3.926). The consumption of sweets decreased with age (Rho: -0.445, N = 318, p = 0.000), but at the same age the cases had a higher consumption than controls. In particular, the consumption of sweets was higher in the age group between 39 and 52 years old. Conclusions Our study adds new and relevant information to support the hypothesis that a sugar rich diet may increase the risk of developing thyroid cancer. Funding This research was funded by Intradepartmental Research Plan 2016/2018 of Department of Medical, Surgical and Advanced Technologies, University of Catania, grant number: 5C722012104. Key messages Future studies need to clarify the mechanisms that associate the diet with the risk of thyroid cancer. More research is also needed to explain the differences in thyroid cancer among women and men.

A Case of Heterotopic Ossification in Papillary Renal Cell Carcinoma Type 2

Renal cell carcinoma (RCC) is associated with a variety of different histopathologic subtypes in which each subtype may be further subclassified. These entities carry with them unique prognoses and necessitate treatment with specific immunotherapy agents should advanced disease be uncovered. Meanwhile, aberrant physiologic processes may lead to unique histologic findings within these subtypes, further complicating management and prognostication. Heterotopic ossification within RCC is one of these rare occurrences and was once thought to have favorable prognostic implications. We report a case of a young female with papillary type 2 RCC with heterotopic ossification.