Spread Through Air Spaces (STAS) Is an Independent Prognostic Factor in Resected Lung Squamous Cell Carcinoma.

Objective: There is no histoprognostic grading for lung squamous cell carcinoma (LUSC). Different prognostic factors have been described in the recent literature and are not always studied in parallel. Our objective was to search for morphological histopathological prognostic factors in LUSC. Materials and Methods: In this single-center retrospective study of 241 patients, all patients with LUSC who underwent surgical excision over a 12-year period were included. The primary endpoint was 5-year overall survival. Results: STAS was present in 86 (35.7%) patients. The presence of Spread Through Air Spaces (STAS) was correlated with tumor location (p < 0.001), pathological stage (p = 0.039), tumor differentiation (p = 0.029), percentage of necrosis (p = 0.004), presence of vascular and/or lymphatic emboli, budding (p = 0.02), single cell invasion (p = 0.002) and tumor nest size (p = 0.005). The percentage of tumor necrosis was correlated with the overall survival at 5 years: 44.6% of patients were alive when the percentage of necrosis was ≥50%, whereas 68.5% were alive at 5 years when the necrosis was <30% (p < 0.001). When vasculolymphatic emboli were present, the percentage of survival at 5 years was 42.5% compared to 65.5% when they were absent (p = 0.002). The presence of isolated cell invasion was correlated with a lower 5-year survival rate: 51.1% in the case of presence, versus 66% in the case of absence (p = 0.02). In univariate analysis, performance status, pathological stage pT or pN, pleural invasion, histopathological subtype, percentage of tumor necrosis, vasculolymphatic invasion, single-cell invasion, budding and tumor nest size correlated with the percentage of survival at 5 years. On multivariate analysis, only STAS > 3 alveoli (HR, 2.74; 95% CI, 1.18−6.33) was related to overall survival. Conclusion: In conclusion, extensive STAS is an independent factor of poor prognosis in LUSC. STAS is correlated with the presence of other poor prognostic factors such as emboli and pleural invasion and would reflect greater tumor aggressiveness.

Nuclear grading, BAP1, mesothelin and PD-L1 expression in malignant pleural mesothelioma: prognostic implications.

For malignant pleural mesothelioma (MPM), histopathological subtype is one of the most important prognostic factors. Several immunohistochemical stains whose expressions have possible therapeutic implications have been identified in MPM such as BAP1, mesothelin and PD-L1. The aim of our work was to evaluate the clinical significance and prognostic implications of BAP1, mesothelin and PD-L1 expression in 117 patients with a diagnosis of MPM who were diagnosed in our institution between 2002 and 2017. We also correlated this immunohistochemical profile to a recently described nuclear grading and to histopathological subtype. Mesothelin expression, BAP1 loss and PD-L1 expression were associated with histopathological subtype (p < 0.0001), BAP1 loss was more frequent in epithelioid subtype whereas PD-L1 expression was more frequent in non-epithelioid subtype. For epithelioid MPM, BAP1 expression was associated with overall survival (p = 0.034), with a longer survival when BAP1 expression is lost. Necrosis and nuclear grading are associated with overall survival (p = 0.0048 and <0.0001, respectively), with longer survival when necrosis was absent and for grade I. For non-epithelioid MPM, overall survival was not related to clinical, histopathological or immunohistochemical expression of BAP1, mesothelin or PD-L1. In multivariate analysis, grade I for nuclear grading was an independent prognostic factor associated with overall survival (p < 0.0001). In epithelioid and non-epithelioid MPM, we analysed overall survival in subgroups with combined mesothelin, BAP1 and PD-L1 expression. In epithelioid MPM, BAP1 retained/mesothelin negativity/PD-L1 > 1%, and BAP1 retained/mesothelin positivity/PD-L1 > 1% profiles, are associated with shorter overall survival. In non-epithelioid MPM, BAP1 loss/mesothelin negativity/PD-L1 > 1% is associated with shorter overall survival. Our work confirms that nuclear grading in epithelioid MPM is a strong and independent prognosis factor. Moreover, this study on several promising immunohistochemical stains whose expressions have possible therapeutic implications identifies subgroups with a poor prognosis.

Mediastinal Mature Teratoma With Malignant Carcinomatous Transformation (Somatic-Type Malignancy) With Metastatic Course.

We report the case of a 76-year-old patient presenting with an anterior mediastinal heterogeneous mass. Surgical biopsy revealed a solid and cystic lesion filled with hair. Pathological examination showed an atypical papillary epithelial lining without other germ cell tumor or immature teratoma associated. The final diagnosis was a mature teratoma of the mediastinum with somatic-type malignancy (carcinomatous transformation). After 8-month follow-up, subcutaneous and lymph node metastatic lesions of the carcinomatous component were identified. Subtyping of the malignant component within germ cell tumors is an important challenge for therapeutic options and prognosis.

Metastatic meningiomas: an unusual clinical and pathological diagnosis with highly variable outcome.

Metastatic meningioma is a rare situation. We conducted a retrospective study from our databases and identified cases of metastatic meningioma. We report three presentations of patients with medical history of surgical removal of meningioma presenting several years later a liver tumor with bone metastasis or multiple lung tumors. These observations highlight the difficulty of the clinical and pathological diagnosis and the absence of consideration of metastatic state for histologically "benign" but clinically aggressive meningiomas in the current WHO 2007 classification of meningiomas. We also reviewed published cases of metastatic meningiomas since they are clearly distinguished from haemangiopericytoma.

Rapid-clearance iron nanoparticles for inflammation imaging of atherosclerotic plaque: initial experience in animal model.

PURPOSE: To evaluate the use of a recently developed fast-clearing ultrasmall superparamagnetic iron oxide (USPIO) for detection of vascular inflammation in atherosclerotic plaque. MATERIALS AND METHODS: The study protocol was approved by the animal experimentation ethics committee. A recently introduced USPIO, P904, and a reference-standard USPIO, ferumoxtran-10, were tested in a rabbit model of induced aortic atherosclerosis. In vivo magnetic resonance (MR) angiography and T2*-weighted plaque MR imaging were performed at baseline and after administration of P904 and ferumoxtran-10 (administered dose for both, 1000 micromol of iron per kilogram of body weight) in 26 hyperlipidemic New Zealand white rabbits. The variation in vessel wall area over time was evaluated with nonparametric testing. Ex vivo MR imaging findings were compared with iron content at linear regression analysis. RESULTS: With in vivo MR imaging, plaque analysis was possible as early as 24 hours after P904 injection. The authors observed a 27.75% increase in vessel wall area due to susceptibility artifacts on day 2 (P = .04) and a 38.81% increase on day 3 (P = .04) after P904 administration compared with a 44.5% increase in vessel wall area on day 7 (P = .04) and a 34.8% increase on day 10 (P = .22) after ferumoxtran-10 administration. These susceptibility artifacts were correlated with intraplaque iron uptake in the corresponding histologic slices. The number of pixels with signal loss on the ex vivo MR images was linearly correlated with the logarithm of the iron concentration (P = .0001; R(2) = 0.93). CONCLUSION: Plaque inflammation in rabbits can be detected earlier with P904 than with ferumoxtran-10 owing to the faster blood pharmacokinetics and the early uptake of P904 in the reticuloendothelial system. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/252/2/401/DC1.

Swyer-James-MacLeod syndrome; repeated chest drainages in a patient misdiagnosed with pneumothorax.

Swyer-James-MacLeod Syndrome (SJMS) occurs as a result of childhood bronchiolitis obliterans. Typically, this disorder is diagnosed in childhood after evaluations for recurrent respiratory infections. One of the reasons to explain the difficulty in diagnosis is that when patients develop little bronchiectasis, and therefore, few symptoms, then this syndrome may not be recognized until adulthood. Here, we are presenting a 22-year-old female patient who was diagnosed with SJMS who was initially misdiagnosed with a pneumothorax and treated by multiple chest tube drainages. This case highlights the significance of taking a careful history, the application of computed tomography and scintigraphy in confirming the diagnosis of SJMS and in eliminating other diseases.

Biomimetic MRI contrast agent for imaging of inflammation in atherosclerotic plaque of ApoE-/- mice: a pilot study.

OBJECTIVE: Atherosclerosis involves an inflammatory process characterized by cellular and molecular responses. A slow-clearance blood-pool paramagnetic agent (CMD-A2-Gd-DOTA: P717) chemically modified to create a functionalized product (F-P717) for targeting inflammation in vessel walls was evaluated in vivo in mice. METHODS AND RESULTS: Carboxylate and sulfate groups were grafted onto the macromolecular paramagnetic Gd-DOTA-dextran backbone. Products were also fluorescently labeled with rhodamine isothiocyanate. Pre- and postcontrast MRI was performed on a 2-Tesla magnet in ApoE-/- and control C57BL/6 mice after P717 or F-P717 injection at a dose of 60 micromol Gd/kg. Axial T1-weighted images of the abdominal aorta were obtained using a 2D multislice spin-echo sequence. F-P717 significantly enhanced the magnetic resonance imaging (MRI) signal in the abdominal aortic wall of ApoE-/- mice (>50% signal-to-noise ratio increase between 10 and 30 minutes), but not of control mice. P717 produced only moderate (<20%) MRI signal enhancement within the same time frame. The MRI data were correlated to histopathology. Immunofluorescence in ApoE-/- mice colocalized F-P717 but not P717 with the inflammatory area revealed by P-selectin labeling. CONCLUSION: This study demonstrates the efficacy of F-P717 as a new molecular imaging agent for noninvasive in vivo MRI location of inflammatory vascular tree lesions in ApoE-/- mice.

In vitro, nonrigid model of aortic arch aneurysm.

PURPOSE: To develop and validate a controlled patient-derived process for producing an in vitro, nonrigid model of aortic arch aneurysm. MATERIALS AND METHODS: A three-dimensional magnetic resonance (MR) angiogram derived from a patient with an aortic arch aneurysm was segmented by using a homemade software package, meshed and converted to Standard Tessellation Language (STL) file format. The authors transferred this format to a stereolithography machine to produce a replica of the entire aorta, including the arch aneurysm and supraaortic arteries, by pouring silicone rubber. RESULTS: A sturdy, life-size, soft, transparent plastic cast, accurately reproducing both the internal and external anatomy of the aortic aneurysm, was produced in less than 1 week. Comparison between the STL file format of MR angiographic images of both the patient's aorta and model enabled validation of the reliability of the manufacturing process. CONCLUSIONS: The combination of easy segmentation and conversion to the STL file format with stereolithography techniques enabled a realistic, life-size, silicone vascular phantom to be created from a live patient imaging dataset.

In vitro non-rigid life-size model of aortic arch aneurysm for endovascular prosthesis assessment.

PURPOSE: It is essential to evaluate new stent designs before in vivo testing. The purpose of this study was to develop and validate a controlled and reproducible patient-derived process to produce a life-size in vitro model of aortic arch aneurysm for endovascular procedure simulation. METHODS: A three-dimensional magnetic resonance angiography (3D MRA) image derived from a 60-year-old patient with aortic arch aneurysm was segmented using a home-made software package which allows one-click automatic segmentation of the aorta, meshing, and conversion to standard tessellation language (STL) format. A rapid prototyping technique established a stereolithographic model to produce a replica of the whole aorta, including the arch aneurysm and supra-aortic arteries. RESULTS: The final model was made by pouring silicone rubber to obtain a sturdy, life-size, soft, transparent, plastic cast, accurately reproducing both the internal and external anatomy of the aortic aneurysm. This model was used under perfusion by an extracorporeal circulation pump, to test ex vivo stent deployment. CONCLUSION: The combination of easy segmentation and conversion to the STL format with industrial stereolithography techniques enabled a realistic silicon vascular phantom to be created for endovascular procedure simulation, image modality calibration, and new stent design.

Cough-induced intercostal lung herniation requiring surgery: Report of a case.

Lung herniation is a rare event defined by protrusion of the lung through an abnormal weakness in the thoracic wall. We report a case of spontaneous intercostal pulmonary herniation, which occurred as a result of vigorous coughing. We repaired the herniation by approximating the ribs with heavy stitches. The mechanism of intercostal muscle disruption, and the etiology and treatment of lung herniations, are discussed.