Peri-treatment adverse events of primary mediastinal non-seminomatous germ cell tumors.

Primary mediastinal non-seminomatous germ cell tumors (PMNSGCT) are rare but life-threatening thoracic cancers. We report our experience from eight patients with peri-treatment adverse events. By analyzing changes in tumor extent, serum tumor markers, and pathologies between diagnosis and transfer, those events could be attributed to postbiopsy respiratory insufficiency, growing teratoma syndrome, secondary histiocytic malignancy, and PMNSGCT progression. Subjecting patients to respiratory therapy, conventional or high-dose chemotherapy, and surgery controlled the disease, with five of the eight patients surviving disease free. These outcomes indicate that integrated appropriate and timely approaches are important in tackling peri-treatment adverse events.

Validation of the 18-gene classifier as a prognostic biomarker of distant metastasis in breast cancer.

We validated an 18-gene classifier (GC) initially developed to predict local/regional recurrence after mastectomy in estimating distant metastasis risk. The 18-gene scoring algorithm defines scores as: <21, low risk; ≥21, high risk. Six hundred eighty-three patients with primary operable breast cancer and fresh frozen tumor tissues available were included. The primary outcome was the 5-year probability of freedom from distant metastasis (DMFP). Two external datasets were used to test the predictive accuracy of 18-GC. The 5-year rates of DMFP for patients classified as low-risk (n = 146, 21.7%) and high-risk (n = 537, 78.6%) were 96.2% (95% CI, 91.1%-98.8%) and 80.9% (74.6%-81.9%), respectively (median follow-up interval, 71.8 months). The 5-year rates of DMFP of the low-risk group in stage I (n = 62, 35.6%), stage II (n = 66, 20.1%), and stage III (n = 18, 10.3%) were 100%, 94.2% (78.5%-98.5%), and 90.9% (50.8%-98.7%), respectively. Multivariate analysis revealed that 18-GC is an independent prognostic factor of distant metastasis (adjusted hazard ratio, 5.1; 95% CI, 1.8-14.1; p = 0.0017) for scores of ≥21. External validation showed that the 5-year rate of DMFP in the low- and high-risk patients was 94.1% (82.9%-100%) and 80.3% (70.7%-89.9%, p = 0.06) in a Singapore dataset, and 89.5% (81.9%-94.1%) and 73.6% (67.2%-79.0%, p = 0.0039) in the GEO-GSE20685 dataset, respectively. In conclusion, 18-GC is a viable prognostic biomarker for breast cancer to estimate distant metastasis risk.

Mediastinal Germ Cell Tumor-associated Histiocytic Proliferations Treated With Thalidomide Plus Chemotherapy Followed by Alemtuzumab-containing Reduced Intensity Allogeneic Peripheral Blood Stem Cell Transplantation: A Case Report.

Mediastinal nonseminomatous germ cell tumor (MNSGCT)-associated histiocytic proliferations are rare and rapidly fatal disorders. Standard treatment modalities have yet to be established.We report a case of MNSGCT-associated hemophagocytic syndrome that evolved into malignant histiocytosis/disseminated histiocytic sarcoma (MH/HS), which was initially treated with intravenous immunoglobulin, corticosteroids, and cyclosporine. Then, thalidomide plus cyclophosphamide, adriamycin, oncovin, prednisolone chemotherapy followed by alemtuzumab-containing reduced-intensity allogeneic peripheral blood stem cell transplantation (PBSCT) was used as salvage therapy.The severe constitutional symptoms and pancytopenia resolved shortly after thalidomide with cyclophosphamide, adriamycin, oncovin, prednisolone. After PBSCT, the patient developed steroid-dependent skin graft-versus-host disease, but maintained a functional life for 1.5 years. Rapid resolution of chronic graft-versus-host disease preceded the fulminant recurrence of hemophagocytic syndrome and MH/HS.Thalidomide plus chemotherapy followed by alemtuzumab-containing reduced intensity allogeneic PBSCT is effective in allaying MNSGCT-associated histiocytic disorders, but does not prevent eventual relapse. However, further posttransplant immune modulation should be developed to completely eradicate the residual MH/HS cells.

Second primary lung cancers among breast cancer patients treated with anti-estrogens have a longer cancer-specific survival.

BACKGROUND/AIM: Estrogen is thought to play an important role in lung cancer carcinogenesis and progression. The incidence and survival of second primary lung cancer among breast cancer patients with and without anti-estrogen therapy were evaluated. PATIENTS AND METHODS: All women diagnosed with breast cancer and treated at the Sun Yat-Sen Cancer Center between January 2000 and December 2009 were included and followed-up for occurrence and/or death from lung cancer until December 2011. RESULTS: Twenty-six women developed second primary lung cancer among 6,361 breast cancer patients. All but one were adenocarcinoma and none had a smoking habit. Seventeen (65.4%) patients had previously received anti-estrogen treatment. The relative risk of developing second primary lung cancer among those who have received anti-estrogens for breast cancer and those who have not was 1.01 (95% confidence interval (CI)=0.45~2.28; p=0.970). Second primary lung cancer patients who have received anti-estrogens had a longer cancer-specific survival (p=0.007). The multivariate Cox proportional hazards analysis showed that anti-estrogen therapy remained an independent prognostic factor with a hazard ratio of 0.11 (95% CI=0.01~0.97, p=0.002) for second primary lung cancer patients. CONCLUSION: The results of this study further support the fact that estrogen adversely affects the prognosis of patients with lung cancer. However, the role of estrogen in lung cancer carcinogenesis remains to be determined.

Differentiation of soft tissue benign and malignant peripheral nerve sheath tumors with magnetic resonance imaging.

PURPOSE: The objective of this study was to differentiate the magnetic resonance (MR) imaging appearance of benign peripheral nerve sheath tumors (PNSTs) from that of malignant PNSTs. MATERIALS AND METHODS: Twenty-six patients who underwent MR imaging and had a histologic diagnosis of benign (schwannoma, n=16; neurofibroma, n=1) or malignant (n=9) PNST were retrospectively reviewed. The size, location, shape, margin, and signal intensities of the tumors on precontrast and gadolinium-enhanced MR imaging were analyzed. In each patient, the presence or absence of split fat, target, and fascicular signs was determined. RESULTS: The mean size of the benign PNSTs (3.4 cm, S.D.=2.5 cm) was significantly smaller than that of the malignant tumors (8.2 cm, S.D.=3.1 cm) (P<.001). Seventeen (65.4%) of the 26 tumors were spindle shaped or ovoid (12 benign and 5 malignant tumors). Contiguity with specific nerves was identified in 15 (88.2%) of the 17 benign PNSTs but in none of the malignant tumors (P<.05). Well-defined margins were noted in all 17 benign PNSTs but in only 3 (33.3%) of the 9 malignant tumors (P<.001). Five (55.6%) of the 9 malignant PNSTs but none of the benign tumors showed signal intensity change in adjacent soft tissue (P<.05). There was no significant difference in signal intensity between the benign and malignant tumors on T(1)-weighted, T(2)-weighted, and contrast-enhanced MR images. The split fat and target signs were present more frequently in the benign PNSTs than in the malignant PNSTs (P<.05). CONCLUSIONS: Benign and malignant PNSTs are often spindle shaped. Recognition of contiguity with adjacent nerves, a well-defined margin, and the presence of the split fat sign may suggest benignity. Imaging features suggestive of malignancy can be a larger size and an infiltrative margin.

Magnetic resonance imaging appearance of well-differentiated hepatocellular carcinoma.

OBJECTIVE: To investigate the magnetic resonance imaging (MRI) features of well-differentiated hepatocellular carcinoma (HCC). METHODS: We reviewed the MRI of 32 patients with 33 pathologically confirmed well-differentiated HCC. The MRI protocol included T2-weighted imaging with and without fat saturation, dual-phase T1-weighted imaging, and gadolinium-enhanced dynamic study. The signal intensity of each lesion was categorized as hyperintense, isointense, and hypointense with reference to the surrounding liver parenchyma. RESULTS: Thirty-one (93.9%) of 33 well-differentiated HCC were demonstrated on the MRI. The remaining 2 were isointense in all magnetic resonance sequences and, therefore, could not be identified. Most of them were hyperintense (n = 15 [45.4%]) or isointense (n = 16 [48.5%]) on T1-weighted imaging, and hyperintense (n = 12 [36.4%]) or isointense (n = 17 [51.5%]) on T2-weighted imaging. On the dynamic study, 17 lesions (51.5%) were enhanced. CONCLUSIONS: MRI may identify most well-differentiated HCC; however, the imaging appearance is diverse. Biopsy should be performed if magnetic resonance study is inconclusive.

MRI of angiomatoid fibrous histiocytoma.

Angiomatoid fibrous histiocytoma is a rare soft tissue tumor of low-grade malignancy. We present the case of a 32-year-old man who complained of soreness and numbness over his left arm and hand over the previous 2 months and of having a palpable mass over his left upper back for 4 years. Magnetic resonance imaging (MRI) showed an intramuscular soft tissue mass in the left scapular region. The tumor mass was seen to have multiple cystic components with fluid-fluid levels. Histological examination showed multiple cystic spaces filled with blood lakes and hemosiderin deposits in the solid part of the tumor. After the initial surgery, the patient had local recurrences over 2.5 years. The immunohistochemical study at the second surgery showed that the recurrent tumor was strongly positive for the histiocytic marker CD68, and the myoid trait desmin. Histological diagnosis was compatible with angiomatoid fibrous histiocytoma.

Spontaneous regression of hepatocellular carcinoma: a case report and literature review.

A case of spontaneous regression of hepatocellular carcinoma is reported and compared with the reports published in the English literature. Spontaneous regression of a histologically proven hepatocellular carcinoma was observed in a 42-year-old male patient with chronic hepatitis B. The patient refused to receive any medical therapy. The tumor subsequently regressed without specific treatment, as demonstrated radiologically by computed tomography 22 months and ultrasonography 24 months after initial diagnosis. We review 27 case reports of apparently spontaneous regression of hepatocellular carcinoma that have been published in the English literature from 1982 to 2002. In this report, we present our unusual case and discuss possible causes of spontaneous total necrosis or regression of hepatocellular carcinoma.

Complementary role of 18F-fluorodeoxyglucose positron emission tomography and 131I scan in the follow-up of post-therapy differentiated thyroid cancer.

BACKGROUND AND PURPOSE: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a relatively new modality in the follow-up of patients with differentiated thyroid cancer (DTC) who have undergone total thyroidectomy and postoperative radioiodine therapy. The aim of this study was to assess the diagnostic value of FDG-PET, comparing it with 131I whole-body scan (WBS) and 201Tl WBS. METHODS: Fifteen selected patients with local invasive and/or aggressive DTC were included in this study. The follow-up period ranged from 1 to 12 years, with a mean +/- standard error of 6 +/- 3 years. FDG-PET was performed when patients were still receiving thyroxin therapy. RESULTS: In the cervical region, residual cancer in two patients was demonstrated by FDG-PET, but could not be detected using 131I WBS or 201Tl WBS. Pathology of the surgical specimen showed dedifferentiation of thyroid cancer in one of these patients. Metastatic cervical lymph nodes were detected using FDG-PET in three patients, but in only one patient using 131I WBS and in another one patient using 201Tl WBS. Mediastinal metastases were detected using FDG-PET in three patients, 131I WBS in two patients, and 201Tl WBS in one patient. Diffuse lung metastasis was detected only by 131I WBS in two patients. The use of FDG-PET in conjunction with computerized tomography provided useful diagnostic information about small nodular lesions of the lung which could not be localized by 131I WBS or 201Tl WBS in three patients. In skeletal metastases, 131I WBS detected more metastatic lesions than FDG-PET or 201Tl WBS, especially when the lesions were located in the pelvis. CONCLUSIONS: In the follow-up evaluation of patients with post-therapy DTC, FDG-PET was useful for detecting dedifferentiated lesions and was superior to 131I WBS in detecting residual cervical or mediastinal lesions and suspected small metastatic foci in the lung. FDG-PET was inferior to 131I WBS in detecting diffuse lung metastases and distant bone metastases.