Clinicopathological and Perioperative Outcome of Appendiceal Tumors: Case Review of 31 Patients.

INTRODUCTION: Neoplasms of the appendix are quite rare and found in approximately 1% of appendectomy specimens. These neoplasms have been pathologically categorized into various subgroups depending on cell of origin, and surgical treatment varies according to histological subtype and disease stage. PURPOSE: The purpose of this case series review was to evaluate the clinicopathological presentation and survival outcome of a sample of patients with appendiceal tumors. METHODS: Before data collection, this project design was approved by the authors' institutional review board. Pathology records at our institution were reviewed for cases of appendiceal tumors from January 2007 to December 2016. A total of 31 patients were identified over this 10-year period. Retrospective data collection included patient demographics, presenting symptoms, tumor size, histologic diagnosis, initial and secondary management, perioperative and postoperative outcome, and survival benefits. RESULTS: Thirty one patients with four different appendiceal tumor subtypes were included in the study: Mucinous Cystadenoma, Mucinous Adenocarcinoma, Goblet Cell, and Carcinoid. The sample was comprised of 17 women (54.8%) and 14 men (45.2%) with an overall mean age of 50.1 (SD = 22.3). Subgroups of 13 (42%) patients had Carcinoid tumor, 12 (39%) had Mucinous Cystadenoma, four (13%) had Goblet cell tumor, and two (6%) had Mucinous Adenocarcinoma. The stage at presentation and tumor size also varied by histologic subtype. The most common presenting symptom was abdominal pain (64.5%), followed by a radiological identified mass (12.9%). Overall, 27 (87.1%) patients survived, and four (12.9%) were deceased. CONCLUSIONS: The findings from this case series review provides a retrospective analysis of appendiceal tumor characteristics, follow up, and survival. Based on these results, the prognosis and management of patients with these tumors should be based on the histologic subtype and the extent of their disease.

Long-term results of conservative surgery and radiotherapy for ductal carcinoma in situ using lung density correction: the University of Michigan experience.

The purpose of the study was to review the treatment outcomes of 198 patients treated with breast-conserving surgery (BCS) and whole breast radiation therapy using lung density correction for ductal carcinoma in situ (DCIS). Between April 1985 and December 2002, 198 patients with 200 lesions diagnosed as DCIS (AJCC stage 0) were treated at the University of Michigan. All underwent BCS and whole breast radiotherapy. Median total follow-up was 6.2 years (range: 0.8-18.2). The 5- and 10-year cumulative rates of in-breast only failure were 5.9% (95% CI: 2.6-9.3%) and 9.8% (95% CI: 5.2-14.4%), respectively. Factors that significantly predicted for an increased risk of local failure were family history of breast cancer, positive or close surgical margins and age

Pathologic features of breast cancer associated with complete response to neoadjuvant chemotherapy: importance of tumor necrosis.

Breast cancer patients with a complete pathologic response after neoadjuvant chemotherapy have a better prognosis than incomplete responders. The predictive value of the histologic characteristics of the tumor prior to neoadjuvant treatment has not been well defined, and there are no guidelines for reporting tumor characteristics in the core biopsy report. Histologic and nuclear grades, presence of tumor necrosis and angiolymphatic invasion (ALI), and estrogen receptor (ER), progesterone receptor (PR), and HER-2/neu expression were assessed in core biopsies of 55 patients with invasive carcinomas. Patients were then uniformly treated with four cycles of doxorubicin/docetaxel followed by excisions and lymph node dissections. Complete pathologic response (pCR) was defined as having no invasive carcinoma at excision. Noncomplete pathologic response was defined as having invasive carcinoma at excision. Five of the 55 patients (9%) achieved pCR. Of the 5 complete responders, 4 (80%) had tumor necrosis in the core biopsy specimens, while only 8 of the 46 (17%) noncomplete responders (pNR) had this feature (P = 0.0086). Higher histologic and nuclear grades, ER, PR status, and HER-2/neu overexpression were not associated with pCR. The presence of ALI in the core biopsy, post-therapy excision, or both was associated with axillary lymph node metastases (P = 0.0062, P = 0.0249, and P = 0.0021, respectively). Although preliminary, our study suggests that the presence of tumor necrosis and ALI in the core biopsy may be important features to be included in the standard report.

Giant folliculosebaceous cystic hamartoma of the upper extremity.

BACKGROUND: Folliculosebaceous cystic hamartoma (FSCH) is a rare cutaneous hamartoma consisting of dilated folliculosebaceous units invested in mesenchymal elements. These lesions have a striking predilection for the central face and scalp of adults. The vast majority of lesions present as 0.5-1.5-cm papules or exophytic nodules. A single case of giant FSCH has been reported on the upper back. METHODS: A 32-year-old woman presented with a (15 cm in greatest dimension) plaque-like, multinodular lesion on her left upper arm for several years. The lesion was clinically suspected to be a nevus sebaceus. RESULTS: The skin excision showed numerous dermal and subcutaneous dilated follicular structures with peripherally radiating sebaceous lobules, hair follicles, and surrounding mesenchymal elements consistent with FSCH. CONCLUSION: To our knowledge, this is the second case of giant FSCH. Our case is unique for its larger size, more plaque-like growth, and location on an extremity when compared to the seminal case of giant FSCH.