Altered splicing machinery in lung carcinoids unveils NOVA1, PRPF8 and SRSF10 as novel candidates to understand tumor biology and expand biomarker discovery.

BACKGROUND: Lung neuroendocrine neoplasms (LungNENs) comprise a heterogeneous group of tumors ranging from indolent lesions with good prognosis to highly aggressive cancers. Carcinoids are the rarest LungNENs, display low to intermediate malignancy and may be surgically managed, but show resistance to radiotherapy/chemotherapy in case of metastasis. Molecular profiling is providing new information to understand lung carcinoids, but its clinical value is still limited. Altered alternative splicing is emerging as a novel cancer hallmark unveiling a highly informative layer. METHODS: We primarily examined the status of the splicing machinery in lung carcinoids, by assessing the expression profile of the core spliceosome components and selected splicing factors in a cohort of 25 carcinoids using a microfluidic array. Results were validated in an external set of 51 samples. Dysregulation of splicing variants was further explored in silico in a separate set of 18 atypical carcinoids. Selected altered factors were tested by immunohistochemistry, their associations with clinical features were assessed and their putative functional roles were evaluated in vitro in two lung carcinoid-derived cell lines. RESULTS: The expression profile of the splicing machinery was profoundly dysregulated. Clustering and classification analyses highlighted five splicing factors: NOVA1, SRSF1, SRSF10, SRSF9 and PRPF8. Anatomopathological analysis showed protein differences in the presence of NOVA1, PRPF8 and SRSF10 in tumor versus non-tumor tissue. Expression levels of each of these factors were differentially related to distinct number and profiles of splicing events, and were associated to both common and disparate functional pathways. Accordingly, modulating the expression of NOVA1, PRPF8 and SRSF10 in vitro predictably influenced cell proliferation and colony formation, supporting their functional relevance and potential as actionable targets. CONCLUSIONS: These results provide primary evidence for dysregulation of the splicing machinery in lung carcinoids and suggest a plausible functional role and therapeutic targetability of NOVA1, PRPF8 and SRSF10.

The Role of Intraperitoneal Intraoperative Chemotherapy with Paclitaxel in the Surgical Treatment of Peritoneal Carcinomatosis from Ovarian Cancer-Hyperthermia versus Normothermia: A Randomized Controlled Trial.

BACKGROUND: The treatment of ovarian carcinomatosis with cytoreductive surgery and HIPEC is still controversial. The effect and pharmacokinetics of the chemotherapeutics used (especially taxanes) are currently under consideration. METHODS: A phase II, simple blind and randomized controlled trial (NTC02739698) was performed. The trial included 32 patients with primary or recurrent ovarian carcinomatosis undergoing cytoreductive surgery (CRS) and intraoperative intraperitoneal chemotherapy with paclitaxel (PTX): 16 in hyperthermic (42-43 °C) and 16 in normothermic (37 °C) conditions. Tissue, serum and plasma samples were taken in every patient before and after intraperitoneal chemotherapy to measure the concentration of PTX. To analyze the immunohistochemical profile of p53, p27, p21, ki67, PCNA and caspase-3 and the pathological response, a scale of intensity and percentage of expression and a grouped Miller and Payne system were used, respectively. Perioperative characteristics and morbi-mortality were also analyzed. RESULTS: The main characteristics of patients, surgical morbidity, hemotoxicity and nephrotoxicity were similar in both groups. The concentration of paclitaxel in the tissue was higher than that observed in plasma and serum, although no statistically significant differences were found between the two groups. No statistically significant association regarding pathological response and apoptosis (caspase-3) between both groups was proved. There were no statistically significant differences between the normothermic and the hyperthermic group for pathological response and apoptosis. CONCLUSIONS: The use of intraperitoneal PTX has proven adequate pharmacokinetics with reduction of cell cycle and proliferation markers globally without finding statistically significant differences between its administration under hyperthermia versus normothermia conditions.

Prognosis and survival of patients diagnosed with well-differentiated and dedifferentiated retroperitoneal liposarcoma.

OBJECTIVES: The main objective is to establish the overall survival and disease-free survival profiles regarding the patients with retroperitoneal liposarcoma, making a comparison based on the well-differentiated and dedifferentiated histological subtypes. The secondary objectives are to descriptively analyze the clinical characteristics of said patients and to identify and analyze other independent variables that might modify these survival profiles significantly. METHODS: An observational and analytical study was performed using a retrospective historical cohort that was followed prospectively. The inclusion criteria consisted of: the procedure of liposarcoma located in the retroperitoneum, the well-differentiated and dedifferentiated histological subtypes, between January of 2002 and May of 2019. As a result, 32 patients took part in this study's sample. Kaplan-Meier estimator was used to summarise the results and log-rank test was used in the comparative analysis. RESULTS: The overall survival at 5 years was around 59%. No differences were found between the patients with a well-differentiated subtype compared to the dedifferentiated ones (p = 0.834). The disease-free survival at 2 years was 59% regarding the well-differentiated and 26% regarding the dedifferentiated, with these differences being statistically significant (p = 0.005). None of the other studied variables modified these survival profiles significantly. CONCLUSIONS: Dedifferentiated retroperitoneal liposarcomas show less disease-free survival than well-differentiated liposarcomas. However, regarding overall survival no differences can be claimed.

Surgical treatment of vena cava leiomyosarcomas: Series of cases in a referral center and literature review.

BACKGROUND: Primary tumors of the inferior vena cava are rare tumors of mesenchymal origin. They arise from the smooth muscles of the vena cava wall. Due to its low prevalence, there are few definitive data on its treatment and prognosis. Its treatment is based on general oncological principles. METHODS: A series of 6 cases operated from 2010 to 2020 were analyzed. Different parameters related to the demographic characteristics, the tumor, the treatment received, and the results obtained in survival and morbidity were analyzed. In addition, a bibliographical review of the currently available evidence was carried out. RESULTS: Optimal surgical resection was accomplished in all patients with R0 in 4/6 and R1 in 2/6. The greatest morbidity occurred in a patient who died in the intraoperative period. Cavorraphy was performed in one patient and cavoplasty in 5/6 using cryopreserved graft in 3/6 and prothesis in 2/6. The 50% were still alive at the end of the follow-up (with a mean follow-up of 10.7 months). The mean survival was 11.3 ± 9.07 months. 3/6 patients presented hematogenous recurrences with a disease-free interval of 9 ± 2 months. CONCLUSION: The diagnosis and treatment of inferior vena cava leiomyosarcoma is still a challenge. Due to its low prevalence, it will be difficult to establish a totally standardized treatment and its approach is recommended in specialized centers. On the other hand, a multicentric study should be made to collect the most cases as possible in order to advance in the understanding of the approach to this disease.

Prognosis and survival of patients diagnosed with well-differentiated and dedifferentiated retroperitoneal liposarcoma. / Pronóstico y supervivencia de pacientes diagnosticados de liposarcoma retroperitoneal bien diferenciado y desdiferenciado.

OBJECTIVES: The main objective is to establish the overall survival and disease-free survival profiles regarding the patients with retroperitoneal liposarcoma, making a comparison based on the well-differentiated and dedifferentiated histological subtypes. The secondary objectives are to descriptively analyze the clinical characteristics of said patients and to identify and analyze other independent variables that might modify these survival profiles significantly. METHODS: An observational and analytical study was performed using a retrospective historical cohort that was followed prospectively. The inclusion criteria consisted of: the procedure of liposarcoma located in the retroperitoneum, the well-differentiated and dedifferentiated histological subtypes, between January 2002 and May 2019. As a result, 32 patients took part in this study's sample. Kaplan-Meier estimator was used to summarize the results and log-rank test was used in the comparative analysis. RESULTS: The overall survival at 5 years was around 59%. No differences were found between the patients with a well-differentiated subtype compared to the dedifferentiated ones (p=0.834). The disease-free survival at 2 years was 59% regarding the well-differentiated and 26% regarding the dedifferentiated, with these differences being statistically significant (p=0.005). None of the other studied variables modified these survival profiles significantly. CONCLUSIONS: Dedifferentiated retroperitoneal liposarcomas show less disease-free survival than well-differentiated liposarcomas. However, regarding overall survival no differences can be claimed.

Surgical treatment of vena cava leiomyosarcomas: Series of cases in a referral center and literature review. / Tratamiento quirúrgico de los leiomiosarcomas de vena cava. Serie de casos en un hospital de tercer nivel y revisión de la literatura.

INTRODUCTION: Primary tumors of the inferior vena cava are rare tumors of mesenchymal origin. They arise from the smooth muscles of the vena cava wall. Due to its low prevalence, there are few definitive data on its treatment and prognosis. Its treatment is based on general oncological principles. METHODS: A series of six cases operated from 2010 to 2020 were analyzed. Different parameters related to the demographic characteristics, the tumor, the treatment received, and the results obtained in survival and morbidity were analyzed. In addition, a bibliographical review of the currently available evidence was carried out. RESULTS: Optimal surgical resection was accomplished in all patients with R0 in 4/6 and R1 in 2/6. The greatest morbidity occurred in a patient who died in the intraoperative period. Cavography was performed in one patient and cavoplasty in 5/6 using cryopreserved graft in 3/6 and prothesis in 2/6. The 50% were still alive at the end of the follow-up (with a mean follow-up of 10.7 months). The mean survival was 11.3±9.07 months. 3/6 patients presented hematogenous recurrences with a disease-free interval of 9±2 months. CONCLUSION: The diagnosis and treatment of inferior vena cava leiomyosarcoma is still a challenge. Due to its low prevalence, it will be difficult to establish a totally standardized treatment and its approach is recommended in specialized centers. On the other hand, a multicentric study should be made to collect the most cases as possible in order to advance in the understanding of the approach to this disease.

Epithelioid angiomyolipoma presenting as an urothelial.

OBJECTIVE: Renal angiomyolipoma is a mesenchymal neoplasm composed of dysmorphic blood vessels, smooth muscle, and adipose tissue. Epithelioidangiomyolipoma is an uncommon variant considered potentially malignant. We report a case of renal epithelioid angiomyolipoma suspicious for urothelialcarcinoma of renal pelvis. METHODS: A 50-year-old woman with a 3-day history of macroscopic hematuria and CT-scan showing a tumor arising from the left renal pelvis suspicious for urothelialcarcinoma. Nephrectomy was analysed in multiple slides of hematoxilin-eosin and immunohistochemistry. RESULTS: Left nephrectomy was performed. Tumor sized 8 cm and showed pathologic findings of epithelioid angiomyolipoma with a little component of classic angiomyolipoma. We studied differential diagnosis and pathologic characteristics for the prognosis. CONCLUSIONS: Pathologic study in detail is fundamental for differential diagnosis and prognosis of this tumor. Our patient's pathology showed good prognosis, however follow-up is important due the malignant potential of the neoplasm.

Angiomiolipoma epitelioide presentado como un carcinoma urotelial de pelvis renal / Epithelioid angiomyolipoma presenting as an urothelial Carcinoma of renal pelvis

OBJETIVO: El angiomiolipoma renal es una neoplasia compuesta de vasos sanguíneos dismórficos, músculo liso y tejido adiposo. El angiomiolipoma epitelioide es una variante rara potencialmente maligna. Aportamos un caso de angiomiolipoma epitelioide renal sospechoso de carcinoma urotelial de pelvis. MÉTODO: Mujer de 50 años con hematuria y masa, en la tomografía axial computerizada, sospechosa de carcinoma urotelial de pelvis renal. Se analiza patológicamente la pieza de nefrectomía, con múltiples cortes histológicos de hematoxilina-eosina y técnicas inmunohistoquímicas. RESULTADOS: Se realiza nefrectomía izquierda. El riñón muestra tumor de 8cm con rasgos morfoinmunohistoquímicos de angiomiolipoma epitelioide, con escaso componente de angiomiolipoma clásico. Planteamos diagnóstico diferencial y analizamos los datos patológicos de pronóstico. CONCLUSIONES: El estudio patológico detallado del tumor es fundamental para el diagnóstico diferencial y su pronóstico. En este caso la paciente no presentaba rasgos indicativos de mal pronóstico, aunque el seguimiento es fundamental dado el potencial maligno de la neoplasia (AU)

OBJECTIVE: Renal angiomyolipoma is a mesenchymal neoplasm composed ofdysmorphic blood vessels, smooth muscle, and adipose tissue. Epithelioidangiomyolipoma is an uncommon variant considered potentially malignant. Wereport a case of renal epithelioid angiomyolipoma suspicious for urothelialcarcinoma of renal pelvis. METHODS: A 50-year-old woman with a 3-day history of macroscopic hematuria and CT-scan showing a tumor arising from the left renal pelvis suspicious for urothelialcarcinoma. Nephrectomy was analysed in multiple slides of hematoxilin-eosinand immunohistochemistry. RESULTS: Left nephrectomy was performed. Tumor sized 8cm and showed pathologic findings of epithelioid angiomyolipoma with a little component of classic angiomyolipoma. We studied differential diagnosis and pathologic characteristics for the prognosis. CONCLUSIONS: Pathologic study in detail is fundamental for differential diagnosisand prognosis of this tumor. Our patient`spathology showed good prognosis, however follow-up is important due the malignant potential of the neoplasm (AU)