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.

Cancer incidence in Western Samoa.

This report presents the first data on cancer incidence in Western Samoa, which has one of the largest Polynesian communities in the world. Incidence estimates are based on a systematic retrospective survey of cancer cases identified in the laboratory of pathology, and from hospital records, for the period January 1980 to June 1988. The overall incidence rates are low in both sexes (age-standardized incidence rates are 93.7 for males and 95.7 per 100,000 for females). Although cases may have been missed, it seems likely that incidence rates among Samoans are substantially lower than those recorded in Polynesian populations elsewhere. It is notable that cancers related to tobacco are responsible for less than 17% of all cancers in males, compared to more than 30% in other Polynesians. Stomach cancer remains the most common cancer in males. In females, breast and cervix are equally common and make up almost 40% of all cancers. Liver cancer occurs more commonly in males, and the rates are slightly lower than those of other Polynesians. The high incidence of thyroid cancer seen in some Pacific Island populations is not seen among Samoans.

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.

Incidental lung adenocarcinoma in a 20-year-old woman with bronchiectasis.

A case of lung adenocarcinoma in a 20-year-old woman with bronchiectasis is presented. The patient showed no clinical and radiological findings in regard to the carcinoma. The tumor was discovered incidentally in the parenchyma of the lung specimen resected due to chronic bronchiectasis.

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.

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 Tc-99m HIG and Ga-67 citrate in the evaluation of bacterial abscess in a rat model.

Tc-99m labeled polyclonal human immunoglobulin (HIG) has been shown to be able to localize an inflammatory site. There are several possible explanations for HIG accumulation at focal infection sites such as increased vascular permeability, binding of the Fc part of Ig to Fc receptors of leucocytes and binding directly to bacteria. In this study, we compared Tc-99m HIG and Ga-67 citrate scintigraphy in localizing acute bacterial abscesses induced by E. coli and S. aureus. Serial scintigrams were performed at 1, 4, 24 hr after injection. Tc-99m HIG showed greater accumulation at all times with both infections agents than Ga-67 citrate (p < 0.05). While Tc-99m HIG showed greater accumulation in S. aureus than E. coli (p < 0.05), there was no statistically significant difference between E. coli and S. aureus (p > 0.05) by Ga-67 citrate. Our study suggests that Tc-99m HIG is a superior agent to Ga-67 and bacterial affinity can be a factor responsible for HIG accumulation at focal sites of inflammation.

Diagnostic accuracy of fine needle aspiration cytology in pancreatic lesions. A review of 77 cases.

Fine needle aspiration cytologic specimens from pancreatic lesions in 77 patients were blindly reviewed. The patients were divided into two subgroups: group A included 19 patients without malignancy of the pancreas, and group B included 58 patients with confirmed malignancy (primary or secondary) of the pancreas. The original cytologic diagnoses in both groups were plotted against the respective reevaluated cytologic diagnoses. In group A there were no false-positive cytologic diagnoses, neither originally nor on reevaluation. In group B, among nine cases originally diagnosed as "benign cells," there were two cases diagnosed as malignant on reevaluation, while in the remaining seven cases malignant cells could not be found on reevaluation. In 11 cases in group B the cell material was considered insufficient for cytologic diagnosis, both originally and on reevaluation. In 34 of the 58 cases (58.6%) in group B a conclusive cytologic diagnosis of malignancy was made both in the original cytologic reports and on reevaluation. In this series, sampling errors accounted for most false-negative cytologic diagnoses. The specificity in our series was 100%. The demonstrated sensitivity was 59% initially and 62% on reevaluation.

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.

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.

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.

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.

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.

Preliminary assessment of multidrug therapy in leprosy patients in Western Samoa.

Western Samoa is an island state in the Polynesian part of the South Pacific Ocean with a total population of around 160,000. In 5 July 1985 multidrug therapy (MDT) as advised by the WHO was started in leprosy patients there. One hundred and eighteen cases (99 males, 19 females) on the active list were included in the MDT programme. Sixty-three (53.3%) were paucibacillary and 55 (46.6%) were multibacillary. Eighteen patients (15.26%, 15 paucibacillary, 3 multibacillary) were below 15 years of age. In this paper we present a preliminary evaluation of WHO/MDT, in leprosy patients in Western Samoa as of 31 December 1987. Assessment was done on clinical, bacteriological and histopathological grounds. During the evaluation period the acceptance of MDT by Samoan patients was found adequate, even though surveillance is still continuing. As of 31 December 1987 there were 40 patients (34 male, 6 female) on the active list. Thirty-five (87.5%) were on multibacillary and 5 (12.5%) on paucibacillary regimen. Only 2 patients (both paucibacillary) were below 15 years of age. The prevalence rate was now estimated to be 0.25/1000. Leprosy cannot be considered to be a serious public health problem in the country. However there is still need for improvement in case-finding, recording and follow up matters.

The occurrence of trophoblastic disease in Western Samoa.

In order to study the occurrence of hydatidiform mole and choriocarcinoma in the island of Western Samoa in the South Pacific, a delivery based study was carried out. All deliveries, both livebirths and stillbirths at the main referral centre (National Hospital), all livebirths at the district hospitals/health centres and all live home deliveries 1980-87 were included. Thirty-two hydatidiform mole cases were recorded on pathological and clinical grounds. No case of choriocarcinoma was encountered. The incidence rate of hydatidiform mole was estimated to be 0.90 per 1000 deliveries, the estimated frequency rate being 1:1109 deliveries. The mean age of cases was 31 years, ranging from 19 to 48. It is suggested that the incidence of trophoblastic disease is not significant in Western Samoa in terms of geographical variations. The importance of methodology in estimating the incidence was also discussed.

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.

Indeterminate leprosy: a clinical and histopathological evaluation.

27 histologically confirmed indeterminate leprosy cases were evaluated clinically and histopathologically at the SLR & TC, Karigiri, South India in 1985. The main clinical finding was a single or multiple (up to 3) patches. This was found in 25 (92%) of 27 cases. 2 cases only showed an area of anaesthesia without any skin lesion. Loss of sensation was present in 22 cases (81%). Histologically all cases (100%) showed lymphohistiocytic infiltration around the dermal structures and around/in the dermal nerves. AF bacilli were found in 17 cases (63%). They were detected most commonly in cellular infiltrate in the dermis (7 cases, 26%) and secondly in the dermal nerves (5 cases, 14%). Careful search and deeper sections increased the chance of detecting bacilli. Criteria for histological diagnosis were also discussed.