- Clinicopathologic features of Anaplastic Myxopapillary Ependymomas. [Journal Article]
- BPBrain Pathol 2018 Nov 12
- Myxopapillary ependymomas (MPE) are considered benign (WHO grade I) neoplasms with favorable prognosis. However, malignant behavior occurs in a small subset. To our knowledge, only five anaplastic MP...
Myxopapillary ependymomas (MPE) are considered benign (WHO grade I) neoplasms with favorable prognosis. However, malignant behavior occurs in a small subset. To our knowledge, only five anaplastic MPEs have been reported without consensus on diagnostic criteria. We retrieved fourteen anaplastic MPEs from the pathology archives of six institutions. Each tumor included at least two of the following features: > 5 mitoses per 10 high power fields, Ki-67 labeling index (LI) > 10%, microvascular proliferation (MVP), and spontaneous necrosis. These features were typically encountered in foci of hypercellularity and reduced mucin. There were 8 male and 6 female patients (age range 6-57 years, median=16.5). Ten tumors displayed anaplasia at initial resection, and four were anaplastic at a second surgery for recurrence (ranging from 9 months to 14 years following initial resection). The Ki-67 LI ranged between 8 and 40% in anaplastic foci and <3% in foci of classic MPE. There was documented CSF dissemination in seven cases, recurrence following an anaplastic diagnosis in three cases, and bone or soft tissue invasion in two cases. One patient suffered lung metastases. Two cases evaluated by targeted next-generation sequencing and one evaluated by FISH showed nonspecific chromosomal gains. We conclude that although rare, anaplastic MPE occurs in both pediatric and adult patients, similar to other ependymomas. At a minimum, closer follow-up is recommended, given the concern for aggressive biologic potential. Further study is needed to determine WHO grading criteria and genetic indicators of tumor progression. This article is protected by copyright. All rights reserved.
- Suturing of the laser resection area is recommended over a depth of 2 cm in an experimental porcine lung model. [Journal Article]
- JTJ Thorac Dis 2018; 10(9):5339-5345
- CONCLUSIONS: In non-ventilated porcine lungs, Nd:YAG laser resection surfaces up to a resection depth of 1.5 cm are airtight after ventilation onset. From a depth of 1.5 cm, closure of resection surfaces by an additional suture is needed. Airtightness of resection surfaces was not increased by additional coagulation.
- Pulmonary and mediastinal paragangliomas: rare endothoracic malignancies with challenging diagnosis and treatment. [Journal Article]
- JTJ Thorac Dis 2018; 10(9):5318-5327
- CONCLUSIONS: Endothoracic paragangliomas, rare and often asymptomatic tumors, are of difficult diagnosis and should be considered malignant tumors, due to the potential aggressive behaviour of cases with high mitotic index and the frequent possibility of recurrence and metastases. Surgical resection is the treatment of choice and careful intraoperative manipulation is recommended, due to the high vascularity of these tumors, to prevent complications. After complete excision, long-term prognosis is generally good. However, even after surgical removal, a close, periodical and life-long follow-up is mandatory.
- Brain metastases in ALK-positive NSCLC - time to adjust current treatment algorithms. [Review]
- OOncotarget 2018 Oct 12; 9(80):35181-35194
- The progress in molecular biology has revolutionized systemic treatment of advanced non-small-cell lung cancer (NSCLC) from conventional chemotherapy to a treatment stratified by histology and geneti...
The progress in molecular biology has revolutionized systemic treatment of advanced non-small-cell lung cancer (NSCLC) from conventional chemotherapy to a treatment stratified by histology and genetic aberrations. Tumors harboring a translocation of the anaplastic-lymphoma-kinase (ALK) gene constitute a distinct genetic and clinico-pathologic NSCLC subtype with patients with ALK-positive disease being at a higher risk for developing brain metastases. Due to the introduction of effective targeted therapy with ALK-inhibitors, today, patients with advanced ALK-positive NSCLC achieve high overall response rates and remain progression-free for long time intervals. Moreover, ALK-inhibitors seem to exhibit efficacy in the treatment of brain metastases. In the light of this, it needs to be discussed how treatment algorithms for managing patients with brain metastases should be modified. By integrating systemic ALK-inhibitor therapy, radiotherapy, in particular whole brain radiotherapy might be postponed deferring potential long-term impairment by neurocognitive deficits to a later time point in the course of the disease. An early treatment of asymptomatic brain metastases might offer patients a longer time without impairment of cerebral symptoms or radiotherapeutic interventions. Based on an updated extensive review of the literature this article provides an overview on the epidemiology and the treatment of patients' brain metastases. It describes the specifics of ALK-positive disease and proposes an algorithm for the treatment of patients with advanced ALK-positive NSCLC and brain metastases.
- Stereotactic radiosurgery practice patterns for brain metastases in the United States: a national survey. [Journal Article]
- JRJ Radiat Oncol 2018; 7(3):241-246
- CONCLUSIONS: This is one of the first national surveys assessing the use of SRS for brain metastases in clinical practice. These data highlight some clinical considerations for physicians treating brain metastases with SRS.
- Differential diagnosis of pulmonary enteric adenocarcinoma and metastatic colorectal carcinoma with the assistance of next-generation sequencing and immunohistochemistry. [Journal Article]
- JCJ Cancer Res Clin Oncol 2018 Nov 10
- CONCLUSIONS: Collectively, our study showed that PEAC, exhibiting a similar mutational profile with NSCLC, showed a distinctive signature from CRC and MCC. Furthermore, we derived a classification model, intergrading both IHC markers and genetic signature, to accurately diagnose PEAC.
- Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lung adenocarcinoma and brain metastases. [Journal Article]
- EJEur J Nucl Med Mol Imaging 2018 Nov 10
- CONCLUSIONS: When staging is performed with whole-body PET/CT plus brain PET/MR, our new prognostic index may be helpful to stratify the outcomes of patients with lung adenocarcinoma and brain metastases. The superior prognostic power of this index for nTTP might be used to select appropriate patients for intracranial control and thereby achieve better quality of life.
- Predictive factors for survival of oligometastatic colorectal cancer treated with Stereotactic body radiation therapy. [Journal Article]
- RORadiother Oncol 2018 Nov 07
- CONCLUSIONS: Stereotactic body radiation therapy represents an effective approach in the management of oligometastatic CRC. Control of treated oligometastases seems to be a strong positive predictive factor for both PFS and OS.
- The influence of histology on the response of brain metastases to gamma knife radiosurgery: a propensity score-matched study. [Journal Article]
- ANActa Neurochir (Wien) 2018 Nov 09
- CONCLUSIONS: Histological differences had no effect on local control in the single high-dose range used for radiosurgery. However, changes in tumor volume during progression varied across tumor histology.
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- Bronchoalveolar carcinoma as an unsuspected cause for worsening shortness of breath in a patient with metastatic breast cancer. [Journal Article]
- BCBMJ Case Rep 2018 Nov 08; 2018
- A 70-year-old woman with lung metastases from a breast cancer presented with worsening cough and dyspnoea. She recently had a pleurodesis for a malignant pleural effusion. Chest CT scans demonstrated...
A 70-year-old woman with lung metastases from a breast cancer presented with worsening cough and dyspnoea. She recently had a pleurodesis for a malignant pleural effusion. Chest CT scans demonstrated various radiological changes leading to diagnostic challenges. Differential diagnoses included empyema, pleural disease progression, pulmonary oedema, pneumonitis, lymphangitis and atypical infections. She deteriorated despite a multimodality treatment strategy. Postmortem examination confirmed that lung changes were consistent with a bronchoalveolar carcinoma unrelated to the known metastatic breast cancer. The eventual knowledge of this diagnosis was reassuring to the treating medical team and a comfort to the relatives who witnessed the lack of response to standard treatment.