Pediatric Non Metastatic Non Rhabdomyosarcoma Soft Tissue Sarcomas (NRSTSS): Five Years Experience from NCI-Egypt.

PURPOSE: Evaluation of demographic, pathological, and clinical patterns in addition to treatment outcome of pediatric NRSTS patients treated at the NCI, Egypt. PROCEDURE: 21 pediatric patients of NRSTS between 2001 and 2006 were included. Clinical and pathological diagnosis and subtyping verification were done. Patients' cohort formed of 3 treatment groups. (1) Patients who underwent complete surgical resection with no adjuvant therapies. (2) Patients who received chemotherapy and complete surgical resection, and group (3) Patients with localized unrersectable tumors for whom systemic chemotherapy only was given. Demographic, clinicopathological variables, and treatment modalities were statistically evaluated and compared with the outcome. RESULTS: Tumors of unknown histiogenesis followed by MPNST and myxofibrosarcoma were the most frequent tumor subtypes. Low tumor grade was in favor of better outcome. With a median follow up of 2-years; respectively 100% and 81.1% of patients who had complete surgical resection of a localized disease with or without chemotherapy entered in CR (p=0.01). Local failure rate was 27.2% among CR patients (n=17). Two patients suffered local recurrance and one had distant disease metastasis. CONCLUSIONS: Complete surgical resection with or without chemotherapy is the mainstay of therapy for localized NRSTS. Tumor grade and surgical resection of NRSTS are 2 important predictors of prognosis. KEY WORDS: Nonrhabdomyosarcoma - Soft tissue sarcoma - Pediatric.

Evaluation of MIB-1 and p53 overexpression as risk factors in large cell non-Hodgkin lymphoma in adults.

BACKGROUND: Improvement of current results of therapy for large cell non-Hodgkin lymphoma patients can be achieved by optimization of initial treatment or application of risk-adapted therapy. The international prognostic index ( IPI), introduced to identify high-risk patients, was recently criticized because it was based on clinical risk factors only, ignoring important tumor molecular risk factors and it fails to identify a sector of high-risk patients, who ultimately relapse. OBJECTIVE: The aim of this study is to evaluate the value of two tumor biomarkers:MIB-1 and p53 as potential risk factors in diffuse large cell lymphoma. MIB-1 measures tumor cell proliferation, whereas p53 is related to tumor progression and response to chemotherapy. PATIENTS AND METHODS: The study was done on 69 adult patients with diffuse large cell NHL ( 58 B-phenotype and 11 T-phenotype). Clinical risk assessment was determined by the IPI and patients with a score of 3 or more were considered high-risk. Expression of MIB-1 and p53 was determined by immunohistochemistry and nuclear staining was quantitated by image analysis. Immunoexpression was considered high for MIB-1 nuclear count 50% and p53 counts 20%. Evaluation included both response to chemotherapy ( mostly CHOP), as well as 2- year overall survival analysis. RESULTS: The IPI was the only clinical variable which had a significant impact on survival. Overexpression of both MIB-1 and p53 was associated with poor response to treatment, as well as unfavorable survival. Combined risk factor analysis revealed that only MIB-1 was an independent variable. MIB-1 could also identify some high-risk patients previously categorized in the IPI lowrisk group. CONCLUSIONS: MIB-1 is an independent biologic risk factor for large cell NHL. In order to optimize risk assessment of these patients, it is recommended to construct a new prognostic index by adding MIB-1 overexpression to the other clinical factors of standard IPI. This may allow better identification of high-risk patients and help to guide planning of effective initial treatment. Key Words:NHL - MIB-1 - p53 - CHOP - Risk factors.

A comparative study of rectal and colonic carcinoma: demographic, pathologic and TNM staging analysis.

OBJECTIVE: The aim is to determine the relative frequency of rectal carcinoma in a large recent surgical series. In addition, rectal carcinoma is compared with colonic carcinoma with regard to demographic data, histological types and TNM stages. PATIENTS AND METHODS: A retrospective pathologic study was conducted on 215 patients with colorectal carcinomas, all treated by radical surgery during the years 2003-2005. Tumors of unfavorable histology included: Mucinous carcinoma, signet-ring carcinoma and undifferentiated carcinoma. For tumor staging, the international TNM staging system was adopted. RESULTS: The mean age was 51 years and male to female ratio was 1.1. Rectal tumors contributed only 27% of cases, contrary to much higher previous reports from Egypt. Tumors of unfavorable histology constituted 24.2% of cases. Patients presented at advanced stages (78.6% stages II and III) with 46.5% lymph node metastases. Patients with rectal carcinomas were younger, with more risk of suboptimal distal surgical margins. CONCLUSIONS: Egyptian patients with rectal carcinoma are younger than those with colonic carcinoma. Otherwise, patients with rectal carcinoma are similar to colonic carcinoma with regard to sex distribution, histological types and TNM stages.