Natural history and clinical outcomes of pancreatic neuroendocrine neoplasms based on the WHO 2017 classification; a single-center experience of 30 years.

BACKGROUND/OBJECTIVES: This single-center study aimed to evaluate treatment outcomes and long-term prognosis of patients with pancreatic neuroendocrine neoplasms (PanNENs) based on the World Health Organization (WHO) 2017 classification. METHODS: We enrolled 245 patients with PanNENs treated at Kyushu University Hospital between January 1987 and March 2018. PanNENs were categorized according to the WHO 2017 classification or further subdivisions of Ki-67 index. Clinicopathological features, median survival time (MST), and prognostic factors were retrospectively analyzed. RESULTS: The number of PanNENs, especially non-functioning PanNENs, has increased over the last decade. The mean MST of all patients was 202 months; which was longest in patients with NET G1 (n = 145, MST = 261 months) relative to NET G2 (n = 72, 132 months), NET G3 (n = 3, 34 months) and NEC G3 (n = 17, 9 months). Prognosis in patients with surgery as the first-line treatment was significantly better than in those with drug therapy. However, 26% of patients who underwent curative resection developed recurrence after a median time of 28.7 months. In unresectable PanNENs (n = 97), the MST and 5-year survival rate were 78 months and 55.8%, respectively. Poor differentiation, Ki-67 index of >10% and presence of liver metastasis were significant unfavorable predictors. Response to first-line therapy (stable disease/partial response) and three or more treatment regimens were significant favorable predictors for unresectable PanNENs according to multivariate analyses (p < 0.01). CONCLUSIONS: We demonstrated the utility of the WHO 2017 classification for PanNENs in the real clinical setting. For better prognosis in PanNENs, the use of three or more regimens should be considered.

Sclerosing odontogenic carcinoma misnomering previously as central odontogenic fibroma-A case report with review of literature.

Sclerosing odontogenic carcinoma (SOC) was first described by Koutlas et al. in 2008. Despite its inclusion in the World Health Organization (WHO) as a distinct entity, it is a tumour that remains poorly defined in the literature, with only 10 reported cases to date. The mandibular premolar and molar region is more commonly affected compared to the maxilla. In the maxilla, the anterior and the molar regions are most commonly affected. This article describes a case report of a Sclerosing Odontogenic Carcinoma in a 50 year old male patient in the mandibular region. The radiograph showed a well-defined radiolucency extending from the left ramus of the mandible to the right lower molar region. SOC is low grade with mild atypia and frequent mitosis and diffused infiltrative and perineural spread.

Impact of changing classification systems on prevalence and frequency distribution of odontogenic tumors in tertiary care center of Nagpur.

INTRODUCTION: The classification of odontogenic tumors has been revised from time to time in order to provide unified terminology. This reclassification had considerable impact on their prevalence and frequency distribution. OBJECTIVES: This study was aimed to emphasize impact of changing classification systems on prevalence and relative frequency of odontogenic tumors. The secondary objective was to analyze demographics of various histological types of odontogenic tumors in comparison to published literature. Review of Indian studies (1992-2020) elaborating frequency of odontogenic tumors is summarized in the end. METHODS: This was a hospital-based retrospective study wherein case files of odontogenic tumors diagnosed from 1990 to 2019 period were retrieved. The classification system used originally at the time of diagnosis was retained and prevalence of odontogenic tumors in three different periods (1990-2004, 2005-2016 and 2017-2019) was compared. Further, prevalence, frequency distribution and demographics of all these tumors (1990-2019) were analyzed using latest World Health Organization 2017 classification. RESULTS: A total of 345 odontogenic tumors was diagnosed as per World Health Organization 2017 system of classification from 1990 to 2019. 96.81% tumors were benign and 3.81% constituted malignant odontogenic tumors. However, there was marked increase in prevalence of odontogenic tumors in 2005-2016 (6.2%) period as compared to 1990-2004 (3.87%) and 2017-2019 (3.47%). Ameloblastoma remained the most common tumor in three different periods, whereas keratocystic odontogenic tumor became second commonest tumor in 2005-2016 as compared to odontoma in 1990-2004 and adenomatoid odontogenic tumor in 2017-2019. CONCLUSIONS: The continuous evolving systems of classification may partly be responsible for inconsistency in odontogenic tumors, with inclusion of keratocystic odontogenic tumor,and has marked impact on prevalence and frequency distribution of odontogenic tumors. The geographical variations in demographics of odontogenic tumors might reflect genetic and environment influence; however it requires elucidation by further studies.

Distribution of Lymphoma Subtypes in Bihar-Analysis of 518 Cases Using the WHO Classification of Lymphoid Tumors (2017).

Introduction The prevalent spectrum of the major subtypes of lymphoma varies across geographical regions. Through this study we aim to study the distribution of lymphoma in the state of Bihar by studying the immunophenotypic features and classifying them according to World Health Organization (WHO) 2017. To the best of our knowledge, this is the first study of this type from Bihar Patients and Methods All the cases diagnosed as lymphoma between January 2016 and June 2019 in the Department of Pathology Mahavir Cancer Sansthan were included in the study. The cases were reviewed by two pathologists and diagnostically difficult cases were referred to higher center for opinion. A total of 518 cases were diagnosed as lymphoma. Results B cell lymphomas formed 79.1%, whereas T cell lymphomas formed 16.2% of the total. Hodgkin lymphoma (HL) was seen in 19.6% cases. Among the non-Hodgkin lymphoma (NHL), diffuse large B cell lymphoma was the most common subtype (58% of all NHLs). Follicular center-cell lymphomas, B cell small lymphocytic lymphoma, mantle-cell lymphoma, and marginal zone B cell lymphomas (including mucosa-associated lymphoid tissue lymphomas) amounted to 2.1, 6.9, 4.5, and 0.95%, respectively. Among the T cell lymphomas, T cell lymphoblastic lymphoma, anaplastic large-cell lymphomas of T/null-cell type, and other nodal peripheral T cell lymphomas accounted for 4.7, 8.1 and 6.6% of all cases, respectively. Conclusions The prevalence of lymphoma subtypes in India is different from the rest of the world. We have analyzed the distribution of lymphomas in Bihar and compared it with other studies from India. Follicular lymphoma and mantle-cell lymphoma are less common in India compared with the west. Peripheral T cell lymphomas and T/NK-cell lymphomas of nasal types are less prevalent than some Asian countries but are more prevalent than the west. T cell lymphoblastic lymphoma and anaplastic large T/null cell lymphoma are more common in India.

A 15 year institutional experience of well-differentiated follicular cell-derived thyroid carcinomas; impact of the new 2017 TNM and WHO Classifications of Tumors of Endocrine Organs on the epidemiological trends and pathological characteristics.

PURPOSE: Our study aimed to describe the evolution of the rate of pathological subtypes of well-differentiated follicular-cell derived thyroid carcinomas (DTCs) in the Department of Pathology, Emergency County Hospital Targu-Mures, Romania over a 15 year period and to assess the impact the new 2017 WHO and TNM classifications of thyroid tumors had on our cases. METHODS: The pathological data were retrieved from the original pathological reports. After applying the exclusion criteria the remaining cases were reviewed on a double-headed microscope and reclassified according to the 2017 WHO and TNM staging system. The follow-up data were collected from the Institute of Oncology Cluj-Napoca, Romania. RESULTS: Our study included 396 cases of DTCs (375 papillary, 11 follicular, and 10 Hürthle cell carcinomas). PTCs revealed a significant increasing trend over the study period, whereas follicular and Hurthle cell carcinomas remain rare; 125/131 of noninvasive encapsulated follicular variant PTC (EFVPTC) were reclassified as noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), resulting in a 33.3% reduction in the number of PTCs. According to 2017 TNM stage-grouping 31% of 271 patients with DTC were downstaged. Follow-up data were available for most of the patients (65.7%, mean period 58.1 months). All patients with noninvasive EFVPTC were disease free at the last clinical assessment. CONCLUSIONS: The increasing rate of PTC was maintained even after exclusion of NIFTP. By applying 2017 TNM criteria, a significant number of DTC cases were downstaged into a more favorable group. Follow-up data highlight the indolent behavior of noninvasive EFVPTCs reclassified as NIFTPs.

Clinicopathologic Characteristics and Surgical Treatment of Plurihormonal Pituitary Adenomas.

OBJECTIVE: Plurihormonal pituitary adenomas (PPAs) have recently been divided into 2 subtypes: pituitary specific transcription factor 1-positive plurihormonal pituitary adenomas (PIT-1+ PPAs) and plurihormonal adenomas with unusual immunohistochemical combinations (PAwUIC). The purpose of this study was to review patients with PPAs, elucidate their clinicopathologic characteristics, and present the surgical results. METHODS: Records were analyzed for 665 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas between 2007 and 2018. Data were reviewed for 27 patients who met the definition of PPAs and delineated regarding clinical, radiologic, pathologic features, and surgical outcomes. RESULTS: Of the 27 patients, 18 had PAwUIC, and 9 patients were diagnosed with PIT-1+ PPAs. Twenty-four patients (88.8%) had macroadenomas, including 6 giant adenomas (≥4 cm) (22.2%). Cavernous sinus invasion was found in 12 patients (44.4%). Pathologic examinations showed high aggressivity in nearly half of the patients. Most patients with PAwUIC (77.8%) had features of nonfunctioning pituitary adenomas, and only 4 had features of hormone-secreting pituitary adenomas. Gross total resection rates were 57.1% for PAwUIC and 77.8% for PIT-1+ PPAs. The remission rate for hormone-secreting pituitary adenomas was 100% in this case series. Mean follow-up was 74.4 ± 33 months (range, 6-121 months) for overall groups. CONCLUSIONS: To our knowledge, this is the first study to describe the clinicopathologic features of newly classified PPAs, which are characterized by aggressive behavior with higher values of percentage of cavernous sinus invasion. Relevant pathologic diagnosis of PPAs is crucial for appropriate management and follow-up.

Imaging features of benign mass lesions in the nasal cavity and paranasal sinuses according to the 2017 WHO classification.

The World Health Organization (WHO) 2017 classification of head and neck tumors has been just published and has reorganized tumors of the nasal cavity and paranasal sinuses. In this classification, three new entities (seromucinous hamartoma, NUT carcinoma, and biphenotypic sinonasal sarcoma) were included, while the total number of tumors has been reduced by excluding tumors if they did not occur exclusively or predominantly in this region. Among these entities, benign tumors were classified as sinonasal papillomas, respiratory epithelial lesions, salivary gland tumors, benign soft tissue tumors, or other tumors. In contrast, inflammatory diseases often show tumor-like appearances. The imaging features of these benign tumors and tumor-like inflammatory diseases often resemble malignant tumors, and some benign lesions should be given attention in the follow-up period and before surgery to avoid recurrence, malignant transformation, or massive bleeding. Understanding the CT and MR imaging features of various benign mass lesions is clinically important for appropriate therapy. The purpose of this article is to describe the clinical characteristics and imaging features of each of clinically important nasal and paranasal benign mass lesions, as classified according to the WHO 2017 classification of head and neck tumors, along with some inflammatory diseases.

Impact of changing classification systems on prevalence and frequency distribution of odontogenic tumors in tertiary care center of Nagpur / Impacto da mudança nos sistemas de classificação sobre a prevalência e a distribuição da frequência de tumores odontogênicos em um centro de atenção terciária de Nagpur

Abstract Introduction The classification of odontogenic tumors has been revised from time to time in order to provide unified terminology. This reclassification had considerable impact on their prevalence and frequency distribution. Objectives This study was aimed to emphasize impact of changing classification systems on prevalence and relative frequency of odontogenic tumors. The secondary objective was to analyze demographics of various histological types of odontogenic tumors in comparison to published literature. Review of Indian studies (1992-2020) elaborating frequency of odontogenic tumors is summarized in the end. Methods This was a hospital-based retrospective study wherein case files of odontogenic tumors diagnosed from 1990 to 2019 period were retrieved. The classification system used originally at the time of diagnosis was retained and prevalence of odontogenic tumors in three different periods (1990-2004, 2005-2016 and 2017-2019) was compared. Further, prevalence, frequency distribution and demographics of all these tumors (1990-2019) were analyzed using latest World Health Organization 2017 classification. Results A total of 345 odontogenic tumors was diagnosed as per World Health Organization 2017 system of classification from 1990 to 2019. 96.81% tumors were benign and 3.81% constituted malignant odontogenic tumors. However, there was marked increase in prevalence of odontogenic tumors in 2005-2016 (6.2%) period as compared to 1990-2004 (3.87%) and 2017-2019 (3.47%). Ameloblastoma remained the most common tumor in three different periods, whereas keratocystic odontogenic tumor became second commonest tumor in 2005-2016 as compared to odontoma in 1990-2004 and adenomatoid odontogenic tumor in 2017-2019. Conclusions The continuous evolving systems of classification may partly be responsible for inconsistency in odontogenic tumors, with inclusion of keratocystic odontogenic tumor,and has marked impact on prevalence and frequency distribution of odontogenic tumors. The geographical variations in demographics of odontogenic tumors might reflect genetic and environment influence; however it requires elucidation by further studies.

Resumo Introdução A classificação dos tumores odontogênicos é revisada de tempos em tempos para fornecer uma terminologia unificada. Essas revisões tiveram um impacto considerável na prevalência e distribuição da frequência desses tumores. Objetivo Enfatizar o impacto da mudança dos sistemas de classificação na prevalência e frequência relativa dos tumores odontogênicos. O objetivo secundário foi analisar os dados demográficos de vários tipos histológicos de tumores odontogênicos em comparação com a literatura publicada. A revisão dos estudos indianos (1992-2020) sobre a frequência dos tumores odontogênicos é resumida no fim. Método Este foi um estudo retrospectivo com base em registro hospitalar de casos de tumores odontogênicos diagnosticados de 1990‐2019 que foram revisados. O sistema de classificação usado originalmente no momento do diagnóstico foi mantido e a prevalência de tumores odontogênicos em três períodos (1990-2004, 2005-2016 e 2017-2019) foi comparada. Além disso, a prevalência, a distribuição da frequência e os dados demográficos de todos esses tumores (1990-2019) foram analisados com a classificação mais recente da OMS de 2017. Resultados Foram diagnosticados 345 tumores odontogênicos de acordo com o sistema de classificação da OMS (2017) de 1990-2019. A ocorrência de tumores odontogênicos benignos e malignos foi de 96,81% e 3,81%, respectivamente. Contudo, houve um aumento acentuado na prevalência de tumores odontogênicos de 2005‐2016 (6,2%), comparado aos períodos de 1990‐2004 (3,87%) e 2017‐2019 (3,47%). O ameloblastoma permaneceu como o tumor mais comum em três períodos, enquanto o tumor odontogênico ceratocístico passou a ser o segundo tumor mais comum em 2005‐2016, comparado ao odontoma em 1990‐2004 e ao tumor odontogênico adenomatoide em 2017‐2019. Conclusões Os sistemas de classificação em evolução contínua podem, em parte, atribuir uma inconsistência à classificação dos tumores odontogênicos com a inclusão do tumor odontogênico ceratocístico e causar um impacto marcante na prevalência e distribuição da frequência dos tumores odontogênicos. As variações geográficas na demografia dos tumores odontogênicos podem refletir influências genéticas e ambientais, mas requerem elucidação por estudos futuros.