Prognostic significance of SOX2 and GPC3 in Ameloblastoma and its malignant counterpart (Ameloblastic Carcinoma)

Background: Ameloblastoma is a common benign aggressive odontogenic tumor with a tendency for high recurrence rate. Ameloblastic Carcinoma is the malignant counterpart of Ameloblastoma. However, they are usually difficult to be distinguished from one another. Therefore, using Immunohistochemical markers might be beneficial for diagnosing them accurately.Objective: Evaluation of SOX2 and GPC3 expressions as well as evaluating their roles in the tumorigenesis and the biological behavior of Ameloblastoma and Ameloblastic Carcinoma.Methods: Tissue samples are composed of 34 archived histopathologically confirmed cases of (19 Conventional Ameloblastomas, and 15 Ameloblatic Carcinomas). Sections were subjected to Immunohistochemical staining according to a standard protocol by applying antibodies to SOX2, and GPC3.Results: SOX2 and GPC3 expressions in recurrent Ameloblastoma were significantly higher than non- recurrent cases. Ameloblastic Carcinoma showed the highest immune-reactivity to SOX2 and GPC3 compared to the Conventional Ameloblastoma. Desmoplastic Ameloblastoma showed the highest scores of SOX2 and GPC3 compared to the other subtypes.Conclusions: SOX2 and GPC3 can be used as a panel for diagnosing the aggressive and the malignant odontogenic tumors accurately. Desmoplastic Ameloblastoma behaves more aggressively than other Conventional Ameloblastoma subtypes.

Tumor stroma ratio as a parameter for prognosis and clinicopathological behavior of oral squamous cell carcinoma: A retrospective cohort study

Background and aim: Tumor-stroma ratio (TSR) is the proportion of tumor cells to surrounding stroma. TSR was reported in many carcinomas as an independent strong, prognostic parameter, and could be applied routinely in diagnostic pathology. This study aimed to clarify the association between prognosis and TSR of oral squamous cell carcinoma (OSCC) and to evaluate its correlations with the clinical stages and histological grades of the studied cases.Materials and Methods: One hundred thirty-nine anti-vimentin stained slides were digitized and analyzed for TSR scoring. TSR was classified as stroma rich (< 50%) and stroma poor (≥ 50%). Correlations between clinicopathological variables and TSR were assessed.Results: Microscopical examination of the studied cases revealed that 67 (48.2%) were stroma-rich and 72 (51.8%) were stroma-poor. Overall findings explained that stroma rich group had larger size, higher clinical stage, higher recurrence rate with a low disease free survival (DFS) and worse overall survival (OS) than the stroma poor.Conclusion: The clinical outcomes of stroma rich OSCC is poor as it is associated with decreased OS and DFS of patients. Hence, TSR may be used as a prognostic independent factor for OSCC and thus, TSR can be considered as an important, low cost and valuable parameter that could be used in addition to the TNM status. Moreover, TSR might be helpful for the judgment of prognosis and for the determination of OSCC high-risk patients to treat them individually.

A pilot study to evaluate the efficacy of PEC blocks in minimising chronic post-mastectomy pain

This small prospective pilot study of 17 patients evaluated the efficacy of PECS block in preventing both immediate and long term post-operative pain after mastectomy. It describes the technique for performing a PECS blockade and demonstrated very low pain scores in both the peri-operative period and at 6 months.

Androgen receptor expression in the urinary bladder urothelial carcinoma and its relation to known prognostic factors

Objective: The current study was carried out to assess the prognostic value of androgen receptor expression in urothelial carcinoma of the bladder and correlate it to the disease outcome.Methods: Histologically confirmed cases of bladder urothelial carcinoma were studied. Clinical, pathological, and radiological data were collected. Paraffin embedded tissue sections were submitted for hematoxylin and eosin staining, as well as immunohistochemical staining for androgen receptor in tumor cells.Results: Nuclear androgen receptor expression was positive in 75% of the studied histopathological specimens. Additionally, a significant positive association between androgen receptor expression and tumor grade, muscle invasion & tumor size were noticed.Conclusions: There is a significant association between large tumor size, high grade, deep invasion, and expression of Androgen receptor in urothelial bladder carcinoma. Antiandrogen could be an effective chemo preventive or therapeutic approach in treatment of urothelial bladder carcinoma.

Facial Plexiform Neurofibroma excision with sequential muti-layer hemostatic sutures, the novel technique to reduce blood loss

Plexiform neurofibromatosis is an autosomal dominant and is frequently seen at birth. Surgical excision is asociate to facial nerve damage and profussal bleeding. Sequential multi-layered hemostatic sutures is a technique frequently used in our practice for Arterio-veous malfromations (AVM). 15 patiets with facial plexiform neurofibroma were treated from 2004 to 2020 with surgical excision, in all patients the hemifacial area was affected. Although preoperative embolization is well known as a safe technique to reduce intraoperative bleeding, low rates of serious complications were reported as stroke, ischemic attack and necrosis. The multi-layered hemostatic sutures permit to remove piecewise the tumor avoiding dramatically bleeding in all our procedures, and is based on vessel collapse after mechanical ligation. The sequential multi-layer suture and the retrograde disection of the facial nerve in our practice has decresed the average of iatrogenic damage of nerve, and massive bleeding during the excision of the plexiform neurofibroma.

Prognostic significance of annexin II , human epididymis protein (HE-4) and claudin in endometrial carcinoma

Introduction: Endometrial cancer (EC) is one of the most prevalent malignant tumors of the female reproductive system worldwide. Annexins are membrane binding proteins with important role in tumor development and progression. Human Epididymis Protein (HE-4) is a novel marker for gynecolgical tumors. Claudins are proteins of tight junction category playing an important role in cell adhesion and tumor spread.Material and methods: Seventy blocks of paraffin-embedded tissues of endometrial carcinoma cases. Immunohistochemical evaluation of Annexin II , HE- 4 and Claudin-7 staining was performed. Clinical follow-up to all cases was done every three months.Results: Positive Annexin II,HE-4 expression were observed in 88.6% and 77.1% of EC respectively. Significant correlation was found between expression of both Annexin II and HE-4 and FIGO stage, decreased both overall and disease free survival rates. Positive Claudin-7 expression was observed in 40% of EC, with significant correlation with high grade only, however, no correlation with other clinical parameters or survival analysis was detected.Conclusion: Annexin II, HE-4 and Claudin-7 are prognostic factors for endometrial carcinoma and could be used in molecular targeted therapy.

A health disparities study of MicroRNA-146a expression in prostate cancer samples derived from African American and European American patients

Considering the prevalence of prostate cancer all over the world, it is desired to have tools, technologies, and biomarkers which help in early detection of the disease and discriminate different races and ethnic groups. Genetic information from the single gene analysis and genome-wide association studies have identified few biomarkers, however, the drivers of prostate cancer remain unknown in the majority of prostate cancer patients. In those cases where genetic association has been identified, the genes confer only a modest risk of this cancer, hence, making them less relevant for risk counseling and disease management. There is a need for additional biomarkers for diagnosis and prognosis of prostate cancer. MicroRNAs are a class of non-protein coding RNA molecules that are frequently dysregulated in different cancers including prostate cancer and show promise as diagnostic biomarkers and targets for therapy. Here we describe the role of micro RNA 146a (miR-146a) which may serve as a diagnostic and prognostic marker for prostate cancer, as indicated from the data presented in this report. Also, a pilot study indicated differential expression of miR-146a in prostate cancer cell lines and tissues from different racial groups. Reduced expression of miR-146a was observed in African American tumor tissues compared to those from European Whites This report provides a novel insight into understanding the prostate carcinogenesis.

Detecting EGFR mutations (L858R, T790M) using allele specific multiplex sequencing: A comparison with Pyrosequencing and TruSeq

We are presenting an evaluation of Allele Specific Multiplex Sequencing (ASMS) to detect two EGFR somatic mutations (L858R, T790M). Late stage lung cancer samples were tested for both EGFR mutations and were compared to either pyrosequencing or TruSeq. The analytical lower limit of detection (LLOD) for the ASMS-L858R assay was found to be 36 copies, and 72 copies for the ASMS-T790M assay. The forty-one FFPE samples that were tested for T790M showed 100% concordance with the respective comparative method. The forty-five FFPE samples tested previously by Truseq for L858R showed 100% concordance with ASMS. Out of the twenty L858R samples previously tested by pyrosequencing, there was 95% concordance with ASMS. Additionally, twenty-one normal blood samples were tested by ASMS were found to be negative for L858R and T790M. In conclusion, the detection of L858R and T790M by ASMS are in acceptable concordance with both pyrosequencing and TruSeq in detecting EGFR mutations from late stage lung cancer. Further, ASMS was able to detect EGFR (L858R) with 10 picograms (3 copies gDNA) of FFPE extracted DNA, and hence could be used to detect mutations from samples carrying low copy numbers.

Advanced and metastatic renal cell carcinoma – Ain Shams Clinical Oncology Department Experience

Background: Renal cell carcinoma is a rare tumor and till recently few treatment options were available. It is poorly understood why people develop RCC since only a few etiologic factors have been clinically identified as risk factors for RCC.Purpose: To analyze our experience at Ain Shams University Clinical Oncology department in Egypt with patients presenting with advanced renal cell carcinoma to provide a correlations between clinic-pathological factors, treatment and survival outcomes.Methodology: Retrospective review of the data of 54 patients who were diagnosed as RCC and presented to Ain Shams University Clinical Oncology department in Egypt from 1 May 2013 till 1 May 2015. Descriptive and clinic-pathological data were described using simple and relative frequencies. Survival outcome for the patients will be described using Kaplan Meier curves stratified according to morphology, age group and treatment received.Results: The sample included 54 patients (53.7% were males) of whom 14.3% were less than 40 years and 3.7% were elderly (≥ 70 years old). The median age was 55.5 years (SD ± 13.6 , range 19-71). Median PFS was 6.5 months (SD ± 12.3846 Range 43) while the median OS was 13 months (SD ± 12.161 Range 46). PFS in patients aged below 55.5 years was 9 months (95% CI=6.509-11.491) compared to 4 months (95% CI=2.704-5.296) in older patients (p = .004). PFS in patients who achieved PR after sunitinb was 17 months (95% CI=6.916-27.084) compared to 5 months (95% CI=3.699-6.301) in patients who didn’t achieved PR (p < .001). OS in patients aged below 55.5 years was 15 months (95% CI=9.131-20.869) compared to 11 months (95% CI=8.947-13.053) in older patients (p = .012). Favorable pathology status was associated with prolonged OS of 14 months (95% CI= 9.403-18.597) versus 11 months (95% CI=8.363-13.637) for unfavourable pathology status (p = .11). Low grades histopathogy was associated with prolonged OS of 44 months (95% CI= 38.456-49.544) versus 12 months (95% CI=10.077-13.923) for higher grades (p = < .001).Conclusion: Multivariate analyses supported a conclusion that younger age was an independent prognostic factor for survival along with other known risk factors such as tumor grade and pathology status.

Surgical resection of pancreatic tumors: review of 70 cases

Background: Endoscopic ultrasound (EUS) has gradually become the main stream method of the diagnosis and local treatment of pancreatic tumors. Endoscopic ultrasound (EUS) is frequently used in making the cytological diagnosis of pancreatic cancer and its great role in the pre-operative staging of pancreatic tumors.Objective: To evaluate the role of EUS in diagnosis and treatment of pancreatic tumors prospectively for 2 years study 2014-2015.Patients and methods: Prospective study including 70 patients who presented with pancreatic tumors underwent EUS at the endoscopy unit at Faculty of Medicine Cairo University and National Cancer Institute, Cairo University.Results: Out of 70 patients; median age was 55 years (range 32_73 years). Males were 32 (46%) and females were 38 (54%). Jaundice was the main symptom 47 (67%), clay colored stool 46 (65.7%), dark urine 47 (67%) and abdominal pain 50 (71%). There were 20 patients with benign disease and 50 patients with malignant disease. The following results showing the accuracy of the EUS in detecting malignant pancreatic tumors; Sensitivity: 96.0%, specificity: 75%, PPV: 90.6%, NPV: 88.2%, accuracy: 90.0%.Conclusion: EUS can clarify locoregional spread when CT/MR are equivocal. EUS Elastography is a new application in the field of the endosonography and seems to be able to differentiate fibrous and benign tissue from malignant lesions. The combination of superior detection, good staging, tissue diagnosis and potential therapy makes EUS guided FNA a cost-effective modality.