Safety and efficacy of nivolumab therapy in patients with metastatic renal cell carcinoma and impaired kidney function.

INTRODUCTION: Patients with renal insufficiency, usually defined as those with creatinine clearance < 40 mL/min, were excluded from pivotal clinical trials, especially in studies involving nivolumab therapy in patients with renal cell carcinoma (RCC). The aim of the study is to evaluate the efficacy and safety of nivolumab in patients with metastatic RCC (mRCC) stratified according to creatinine clearance. MATERIAL AND METHODS: Data from mRCC patients treated with nivolumab were retrospectively analyzed. Patients were classified into two categories according to their estimated glomerular filtration rate (eGFR); the first category (C1) included patients with eGFR < 40 mL/min/1.73 m2 and the second category (C2) included those with eGFR ≥ 40 mL/min/1.73 m2. RESULTS: Of the 95 patients enrolled, 1. group included 26 patients (27.4%) and 2. group included 69 patients (72.6%). None of the pts in category 1 were on hemodialysis. Overall incidence of adverse events was not statistically different between the two groups (P = .469). The overall response rate ORR was 50% in the first group and 42.0% in the second group (P = .486). Median overall survival (OS) was longer with 23.3 months in the 2. group versus 11 months in the 1. group (P = .415). CONCLUSION: Renal insufficiency is a common problem in patients with advanced renal cancer since they often undergo nephrectomy and their renal function may also worsen while receiving tyrosine kinase inhibitor therapy. We found that there is no significant difference in the safety and efficacy of nivolumab treatment between two groups. Nivolumab appears to be a safe and effective agent in patients with renal impairment.

Imprint cytology in the endoscopic diagnosis of gastrointestinal malignancies.

BACKGROUND/AIMS: To compare imprint cytology with histopathology regarding diagnostic accuracies and quickness in the diagnosis of gastrointestinal malignancies. METHODOLOGY: Multiple endoscopic biopsies were taken from 146 patients having various lesions without a prior histopathological diagnosis. Imprint smears were prepared, using all biopsied tissues, on 3-5 slides. Tissues were fixed in 10% formalin. Time from the materials were received at the pathology laboratory to when the results were available was recorded. Cytopathologists and histopathologists, blinded to each other's diagnosis, examined the imprint smears and tissues. RESULTS: Average time to get imprint cytology results was shorter than that of histopathology (55 minutes vs. 8 days). Fifty-eight patients had a final diagnosis of malignancy. Histopathology and imprint were positive in 56 and 54, respectively. Eighty-eight patients had benign histopathology, all of these had negative imprint results. False-negative and false-positive rates for imprint were 6.8%, 0% and for histopathology were 3.4%, 0%, respectively. CONCLUSIONS: Imprint cytology is an easy, reliable method that can be used as an adjunctive measure with histopathology. It gives the earliest information about the nature of the lesion with a minimum misdiagnosis risk. Imprint cytology lets the surgeon plan a therapeutic strategy approximately 1 week earlier.

Comparison of five detection methods for Helicobacter pylori.

OBJECTIVE: To evaluate which diagnostic test is preferable for the diagnosis of Helicobacter pylori in patients with gastroduodenal disease. STUDY DESIGN: H pylori infection was diagnosed prospectively in 101 patients. Diagnosis of H pylori was made by tests based on five different principles: (1) culture, (2) direct histologic demonstration, (3) imprint cytology, (4) brushing cytology, and (5) gram staining of H pylori. Efficacy of each test was compared. RESULTS: All the tests were reliable for diagnosing H pylori infection; 73.3% of patients showed concordance in at least two tests. All the tests were positive in > 50% of patients. Significant concordance between brushing and imprint cytology was also determined. These two tests have almost similar specificity when compared to other tests. CONCLUSION: When patients undergo upper endoscopy, we recommend taking biopsy specimens for culture and histology. H pylori can be assessed equally well with all the tests, but imprint and brushing cytology have the advantage of rapid response, specificity, much lower cost and reproducibility.

Adenoid cystic carcinoma of the tongue.

Malignant tumours of the salivary glands in children are extremely rare. We present here a 12-year-old girl initially diagnosed as pleomorphic adenoma on fine needle aspiration biopsy, and adenoid cystic carcinoma (ACC) after the lesion was excised and examined by histopathology. A wide resection of the lesion and bilateral supraomyohyoid neck dissection was performed. To our knowledge this is one of the youngest patients with ACC of the minor salivary glands. Due to its benign histological appearance, the biological agressiveness of ACC is usually underestimated. Although fine needle aspiration cytology (FNAC) is very valuable in diagnosis, cytological variations of pleomorphic adenoma must be considered. ACC of the tongue in a young age group should be treated with wide resection and selective neck dissection if the tumour is localized in places where the risk of metastasis is increased and if there is a clinically palpable lymph node. In such cases the clinician should not avoid radical operations even in a young patient.

Imprint cytology in the diagnosis of Helicobacter pylori. Does imprinting damage the biopsy specimen?

OBJECTIVE: To investigate the efficacy of imprint cytology in the diagnosis of Helicobacter pylori infection and whether it damages the biopsy specimen for subsequent histologic examination. STUDY DESIGN: Two antral biopsies were taken from 76 patients with dyspeptic symptoms undergoing upper gastrointestinal endoscopy. Imprint cytology was made from the first specimen. This specimen was fixed in 10% formalin and sent for histopathologic examination. The second specimen was directly fixed in 10% formalin for routine histopathologic examination without being used for an imprint. The imprint smears were examined by cytopathologists. The biopsy specimens were examined by pathologists who did not know which specimens were used for the imprints. RESULTS: H pylori was seen in smears from 55 (72%) patients and in both biopsy specimens from the same patients. The pathologists could not recognize the biopsy specimens from which the imprints were made. Concordance between imprint cytology and histopathology was 100%. CONCLUSION: Imprint cytology is a suitable test for H pylori diagnosis, and imprints do not adversely affect the quality of the biopsy specimen.

Idiopathic granulomatous mastitis. Report of a case diagnosed with fine needle aspiration cytology.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign, inflammatory breast disease of unknown etiology. Although it is rare, it frequently presents in a manner similar to that of breast carcinoma. CASE: A 41-year-old female developed unilateral idiopathic granulomatous mastitis, diagnosed by fine needle aspiration cytology. The clinical presentation and mammographic findings were suspicious for carcinoma. Fine needle aspiration cytology showed granulomatous inflammation. Histopathologic examination revealed a noncaseating, granulomatous lesion. Further clinical, radiologic and laboratory investigations disclosed no etiology. Therefore, we considered the case to be idiopathic granulomatous mastitis. CONCLUSION: Cytologically it may be difficult to distinguish IGM from carcinoma of the breast. Typical cytologic findings of the lesion are helpful to rule out cancer. In the differential diagnosis, all known causes of granulomatous changes have to be excluded before a diagnosis of idiopathic granulomatous mastitis is made.

Congenital cystic adenomatoid malformation. Report of two cases and review of the literature.

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare pulmonary lesion, characterized by an excessive overgrowth of the terminal respiratory bronchioles. The lesion is almost always unilateral and may occur in any lobe. We present two children with CCAM. The first case was a one-day-old female infant admitted with respiratory distress and cyanosis. The second case was a 19-month-old girl with a nine-month history of recurrent respiratory infections. Preoperative diagnosis of both cases was intrapulmonary mass. The histopathological examinations revealed CCAM.

Sustained ventricular tachycardia in cardiac hemochromatosis treated with amiodarone.

Cardiac hemochromatosis can cause heart failure and cardiac arrhythmias. Among these arrhythmias, ventricular tachycardia may be resistant to treatment. A case of cardiac hemochromatosis complicated with ventricular tachycardia that did not respond to intravenous lidocaine, procainamide or propafenone, nor to DC cardioversion, was successfully treated with amiodarone. Amiodarone, a class III antiarrhythmic drug, may be highly effective in similar cases.

Cystic chondroma arising from the falx cerebri: a case study with review of literature.

A 28-year-old woman was presented with an 1-year history of headache, double vision and left hand and foot paresthesia. Clinical and CT findings were evaluated malignant. During the operation a solid mass attached to the falx cerebri was found. Pathological examination showed a chondroma with large central cystic degeneration. Our review of the literature revealed only 9 cases of falcine chondroma up to now, excluding ours.

A case of intrapulmonary teratoma presenting with hair expectoration.

Benign cystic teratomas of the lung are extremely rare. Up to the present time, around 30 cases have been reported in the literature. We report an additional case, a 28-year-old woman, admitted with the complaint of expectoration of hair. Histopathological, clinical, and Ct features are presented.

Large cell carcinoma of the lung with unilateral hamartoma.

A 54-year-old Turkish male was admitted with a history of nonproductive cough and left chest pain. Chest roentgenogram demonstrated two masses located on different lobes of the left lung. One was a chondromatous hamartoma, the other was a large cell carcinoma.

Ki-67 index in fine needle aspiration cytology specimens from primary and recurrent rectal cancer.

A Ki-67 index was determined in 63 fine needle aspiration cytology (FNAC) specimens from patients with rectal cancer, 21 with primary cancers and 42 with local recurrences. Seventeen of the patients had received external irradiation before the examination. In primary cancers, in recurrences as well as in the post-irradiation cases, the mean percentage of Ki-67 positive cells was about 55% with a wide variation. The percentage of Ki-67 positive cells was independent of the length of the recurrence-free period. In conclusion, the Ki-67 antigen may well be studied in FNAC specimens. The presence of antigen did not correlate with development of recurrence, length of recurrence-free period or irradiation prior to the analysis.

Bronchioloalveolar carcinoma in progressive systemic sclerosis. Report of a case diagnosed by fine needle aspiration cytology.

BACKGROUND: Progressive systemic sclerosis (PSS) is a systemic disorder involving many internal organs, including the lungs. The occurrence of a pulmonary tumor has occasionally been reported, especially in long-standing cases. Bronchioloalveolar carcinoma is the most prevalent histologic type. CASE: A 35-year-old male with a 12-year history of PSS presented with exertional dyspnea and pain in the left side of the chest. Fine needle aspiration cytology (FNAC) showed abundant cellular material with large, monolayered sheets and papillary structures. The neoplastic cells had uniform round to oval nuclei and spacious cytoplasm. Some had intranuclear vacuoles. Phosphotungstic acid-hematoxylin (PTAH) stain revealed structures in the form of prominent cell membranes rimming the free surfaces of the tumor cells. The overall cytologic picture was interpreted as consistent with bronchioloalveolar carcinoma. The patient's condition did not permit surgery. CONCLUSION: In this case the development of bronchioloalveolar carcinoma occurred over a 12-year period following the diagnosis of PSS. This case emphasizes diagnosis of the tumor solely by FNAC. PTAH stain was also helpful in the cytologic diagnosis.

Assessment of fine needle aspiration cytology and histopathology for diagnosing male breast masses.

OBJECTIVE: To investigate the diagnostic accuracy of fine needle aspiration cytology (FNAC) from breast lesions in males and to determine the frequency of benign versus malignant histopathologic diagnoses in surgical biopsies from male breast lesions. STUDY DESIGN: FNAC specimens from breast lesions taken from 241 males over 8.5 years were divided into four subgroups according to the original cytologic diagnoses. Diagnostic accuracy was verified with the Norwegian Cancer Registry. Ten years' worth of material from 809 surgical biopsies from male breast lesions was subgrouped according to the original histopathologic diagnoses. RESULTS: Of the 809 surgical biopsies, 779 (96.3%) were benign lesions. Of the 241 fine needle aspirates, 27 (11.2%) were unsatisfactory for cytologic diagnosis. Of the remaining 214 cases, 200 benign cytologic diagnoses were confirmed at follow-up. Thus, there were no false negative cytologic diagnoses; eight malignant diagnoses were confirmed by later histopathologic examination of the surgical biopsy. CONCLUSION: To reduce the high rate of surgical biopsies of benign male breast masses, we conclude that FNAC should be performed as a standard procedure in the clinical evaluation of male breast lesions.

Occult papillary carcinoma of the thyroid presenting as an intratracheal tumour.

A case of occult papillary carcinoma of the thyroid presenting as an intratracheal tumor in a 64-year-old woman is reported. No lymph node metastases were observed. The patient had an 11-year history of hoarseness, dyspnea and productive cough, and was found at bronchoscopy to have a large intratracheal tumor occupying half of the lumen. It was histologically a papillary carcinoma with immunoreactivity of thyroglobulin. No primary tumor was found in the thyroid gland. By reviewing the English literature, no similar case was encountered.