Mortality Risk factors and SOX2 and mTOR expression in Patients with Esophageal Cancer

Causes of mortality in EC patients are not confined to cancer-specific mortality but include various protein expressions of SOX2 and mTOR in Esophageal Cancer patients and their correlation with the clinical stage. Data about the risk factors and involvement of cancer-specific protein are still lacking. This study aimed to define the risk factors and association of SOX2 and mTOR expression in mortality in patients with EC. We conducted a retrospective cohort study to assess the risk factors for cancer-specific mortality and cardiovascular mortality in patients with esophageal cancer (EC). The expression rates of SOX2, as well as MTO, were checked in patients. The multivariate analysis revealed a high-risk EC mortality with age ≥ 65 years, black race, grade, stage, and sequence of treatment; radiation after surgery; radiation before and after surgery; Surgery both before and after radiation. While the cardiovascular mortality increased with age ≥ 65 years, adenocarcinoma type, grade, stage, and sequence of treatment. The expression rates of SOX2, as well as mTOR, were 75.5 percent and 86.8 percent in Esophageal Cancer, while were 10.7 percent and 7.5 percent in osteochondroma, respectively, which was statistically significant (P<0.05). Risk factors for cancer-specific mortality and cardiovascular mortality in EC patients include older age at diagnosis, male sex, non-married status, grade III of the tumor, the regional or distant spread of the tumor, no cancer-directed therapy. The expression levels of SOX2, mTOR, and the total survival time were related to the different stages. It shows an upward trend for the expression levels of mTOR and SOX2 in Esophageal Cancer tissues. The expression levels of SOX2 and mTOR are related to the clinical stage, metastasis, and prognosis.

P-OGC59 Pattern of recurrence following neoadjuvant treatment and two-stage oesophagectomy for oesophageal/junctional adenocarcinoma: 10-year results from a high-volume centre

Background Disease recurrence remains high following oesophagectomy for oesophageal and junctional adenocarcinoma in spite of the incremental gains from improved neoadjuvant treatment (NAT). Follow-up remains important for the detection and treatment of recurrence, although the optimum surveillance strategy remains undefined. Recurrence after treatment can occur locoregionally, distantly, or a combination of both. This retrospective review of a single, high-volume centre’s 10-year experience has sought to determine the pattern of recurrence in those who have received curative NAT followed by two-stage subtotal oesophagectomy (2S-STO) for oesophageal and junctional adenocarcinoma. Methods A retrospective analysis was performed on a cohort of patients from a high-volume, single centre between January 2009 and January 2019 who had confirmed disease recurrence after receiving NAT and 2S-STO for either oesophageal or junctional (Siewert I/II) adenocarcinoma. The Unit’s prospectively collected cancer database was utilised as well as patients’ notes to determine the pattern of recurrence seen in this cohort. Patients receiving a three-stage or transhiatal oesophagectomy for any cause, or those diagnosed with squamous cell carcinoma were excluded. Results 215 patients were identified with recurrence following NAT and 2S-STO for oesophageal/junctional adenocarcinoma within the 10-year period. The median age was 69 (range 23-85) with 67% being male and 33% female. The median time to diagnosis of recurrence was 13 months following surgery. 87 (40%) patients were diagnosed with locoregional recurrence, with the commonest pattern being in mediastinal or abdominal lymph nodes, followed by peritoneal disease. 62 (29%) patients were diagnosed with distant recurrence, with the vast majority being in the liver or lungs. 66 (31%) patients had evidence of both locoregional and distant spread at diagnosis of recurrence. Conclusions The incidence of recurrence following curative treatment for oesophageal and junctional adenocarcinoma remains high. Locoregional disease appears to be the commonest pattern of recurrence as identified in this study, which would confirm spread predominates via the lymphatic and transcoelomic routes. Liver and lung remain the commonest sites for haematogenous spread, although other sites include adrenal, brain and bone. Although the optimum follow-up strategy remains undefined in such patients, timely investigation of symptoms is required for early diagnosis so as to optimise the benefits of palliative treatment.

Pattern of colorectal cancers at tertiary rural hospital in Central India

Background: In India the incidence of colorectal cancers is moderate to low but the five year survival of colorectal cancers in India is one of the lowest in the world. The poor survival rate warrants the assessment of reasons. Population based data is available only from few regions in India. Hospital based data may give a crude idea regarding the cancer distribution in the respective areas.Methods: The present study was carried out at a tertiary rural hospital in central India. A total of 216 cases of primary malignant tumors of colon and rectum presenting over a period of 10 year interval from 1994 to 2004 were analyzed for demographic and clinical presentation.ResultsThe peak incidence of cancer of colon and rectum was in 7th and 6th decade respectively. The M: F ratio was found to be 1.6: 1 for colorectal cancers combined. The mean age of presentation was 50.6 years. 25% patients with colorectal cancers were below age of 40 years. 48.3% patients with cancer of colon and 79.5% with cancer of rectum had locoregional disease, while 38.2% and 15.7% had distant spread respectively.Conclusions: Rectal cancer was found to be much commoner than colonic cancer supporting the case of independent etiologies. The incidence of colorectal cancer in young patients was high. Disease confined to the primary organ when the patient is first treated was very low.

A Locally Advanced Endometrioid Adenocarcinoma Arising from Vaginal Endometriosis: Management and Review of the Literature

Endometrioid adenocarcinoma associated with endometriosis at extrauterine or extraovarian localization is a rare entity. Often presenting with local spread without nodal and distant metastasis, this entity has no specific staging system nor treatment guidelines. In the case of nodal and distant spread, the treatment decision requires personalization. In this article, we present the diagnosis and surgical and systemic treatment of a 56-year-old woman diagnosed with an endometriosis-associated advanced endometrioid adenocarcinoma of the vagina with nodal involvement. Following an extensive review of the scarce data reported to guide the treatment choices in this rare setting, we proposed a multidisciplinary treatment with laparoscopic surgical cytoreduction, four cycles of adjuvant chemotherapy with carboplatin and paclitaxel, and radiotherapy with brachytherapy. Due to an anaphylactic reaction on the first administration, paclitaxel was replaced with nab-paclitaxel. Despite many negative prognostic factors, the patient is free from relapse after 48 months. We report the case of a locally advanced endometrioid adenocarcinoma associated with endometriosis of the vagina, with pelvic nodal spread, and the relevant literature review of similar cases.

Primary MALT lymphoma of the colon - Pathohistological and immunohistochemical analysis, prognosis and complex treatment

Colonic MALT lymphoma is a rare disease. Due to rare diagnosis, randomized studies are missing to determine the optimal therapeutic approach. We present a 77-year-old patient with Mucosa-Associated Lymphoid Tissue (MALT) lymphoma of the colon, which is diagnosed after colonoscopy with biopsy and precise pathohistological and immunohistochemical analysis. Treatment includes surgery /hemicolonectomy, followed by 6 cycles of chemotherapy- R-COPP regimen. Two years after diagnosis, the patient is in good condition with normal quality of life without recurrence and distant spread of the disease. Through this article, our goal is to support medical literature with another clinical case that demonstrate the need for thorough and precise diagnosis by immunohistichemic analysis and an assessment of optimal complex treatment. Keywords: MALT lymphoma; non-Hodgkin's lymphoma; pathohistological analysis; immunohistochemical analysis; chemotherapy; Complex treatment.

Měkkýši Přírodní rezervace Prokopské údolí v Praze [Molluscs of the Prokopské údolí Nature Reserve in Prague]

Mollusc fauna of the Prokopské údolí Nature Reserve in Prague (Czech Republic) has been revised. The current research follows up on the monitoring that took place there at five-year intervals in the years 1984–2009. In the 1980s, 43 land snail and seven aquatic species were recorded, while in 2020 the list included 56 land snail and three aquatic species. Although the reserve is considered to be one of the best examined areas in the capital city, remarkable findings are presented, such as a viable population of the critically endangered Helicopsis striata, a new locality of the internationally protected Vertigo angustior, and a recent distant spread of the rare snail Zebrina detrita. Notable trends in the development of local malacofauna in the last four decades are discussed.

Test, Track and Treat the Devil in the Paranasal Sinuses

Introduction Complications of rhinosinusitis result from progression of acute fungal or bacterial rhinosinusitis beyond the paranasal sinuses, potentially causing significant morbidity from either local or distant spread. Case Report A 45year old male patient presented with left sided headache since 8 days, left sided facial pain and swelling since 4 days which rapidly progressed to have pre-maxillay pus pointing and cellulitis. Functional endoscopic sinus surgery (FESS) was planned and intraoperatively inferior turbinectomy and maxillary clearance through the necrosed inferior turbinate was performed. Discussion The management of acute fungal rhinosinusitis is surgical debridement by doing FESS. This case report highlights that it may not be the case always. The treatment in the form of maxillary clearance and debridement of necrosed area need to be tailor made according to the disease and involvement as suggested on radiological imaging.

Predicting biomarkers of hepatic metastasis in Chinese colorectal cancer patients.

e15545 Background: Hepatic metastasis is the most common site of distant spread from colorectal cancer. About 15-25% patients with colorectal cancer harbors hepatic metastasis. The molecular mechanism and predicting biomarkers in colorectal cancer are still not fully understood. Methods: 57 Chinese colorectal cancer patients were enrolled in a cohort study. Samples of primary tumor were collected in these patients and underwent whole exome sequencing. Mutation profiles of primary tumors between the patients with metastasis and those without metastasis were analyzed and compared. Results: In the cohort, 54.4% (31/57) patients presented hepatic metastasis at the time of diagnosis, while 45.6% (26/57) did not. The patients were divided into 2 groups—with hepatic metastasis and without hepatic metastasis. The mutation landscape of primary tumor indicated that the Top 3 most frequently mutated genes of both groups were the same and presented mutated TP53, APC, and KRAS. 2. Interestingly, compared with the patients without hepatic metastasis, the patients with hepatic metastasis presented a higher frequency of mutated TCF7L2 (35.5% vs 3.85%) and TRIM77 (16.1% vs 0%). Moreover, in the patients with hepatic metastasis, the patients with TRIM77 mutation in primary tumor showed a worse overall survival (p < 0.0001). Conclusions: TCF7L2 and TRIM77 may be identified as potential candidate predicting biomarkers for hepatic metastasis in colorectal patients. In addition, mutated TRIM 77 predicted a poor overall survival in hepatic metastasis from colorectal cancer.

Advanced lung cancer in combination with liver echinococcosis

Presented clinical case is a rare case of poorly differentiated squamous cell non-keratinizing cancer of the right lung with ingrowth into the diaphragm and liver, metastatic liver damage in combination with recurrent echinococcosis of the liver. Taking into account the epidemiological history, the surgery, the features of radiation imaging and the results of serology in the preoperative period, the diagnosis of “echinococcosis of the liver with spread to the lungs” was made, which turned out to be incorrect. The diagnosis during the surgical operation was changed, but also turned out to be incorrect. The final diagnosis was made only on the basis of histological and immunohistochemical studies.The reasons of diagnostic errors are analyzed, the emphasis is made on the criteria of differential diagnosis. Typical features of visualization of liver echinococcosis, lung cancer with local and distant spread are presented.

A “Terrible” Headache in a HIV Patient

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.