Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer

BACKGROUND Patients with clinical T4 colorectal cancer(CRC)have a poor prognosis because of compromised surgical margins.Neoadjuvant therapy may be effective in downstaging tumors,thereby rendering possible radical resection with clear margins.AIM To evaluate tumor downsizing and resection with clear margins in T4 CRC patients undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery.METHODS This study retrospectively included 86 eligible patients with clinical T4 CRC who underwent neoadjuvant concurrent chemoradiotherapy followed by radical resection.Neoadjuvant therapy consisted of radiation therapy at a dose of 45-50.4 Gy and chemotherapy agents,either FOLFOX or capecitabine.A circumferential resection margin(CRM)of<1 mm was considered to be a positive margin.We defined pathological complete response(p CR)as the absence of any malignant cells in a specimen,including the primary tumor and lymph nodes.A multivariate logistic regression model was used to identify independent predictive factors for p CR.RESULTS For 86 patients who underwent neoadjuvant chemoradiotherapy and surgery,the rate of p CR was 14%,and the R0 resection rate was 91.9%.Of the 61 patients with rectal cancer,7(11.5%)achieved p CR and 5(8.2%)had positive CRMs.Of the 25 patients with colon cancer,5(20%)achieved p CR and 2(8%)had positive CRMs.We observed that the FOLFOX regimen was an independent predictor of p CR(P=0.046).After a median follow-up of 47 mo,the estimated 5-year overall survival(OS)and disease-free survival(DFS)rates were 70.8%and 61.4%,respectively.Multivariate analysis revealed that a tumor with a negative resection margin was associated with improved DFS(P=0.014)and OS(P=0.001).Patients who achieved p CR exhibited longer DFS(P=0.042)and OS(P=0.003)than those who did not.CONCLUSION Neoadjuvant concurrent chemoradiotherapy engenders favorable p CR and R0 resection rates among patients with T4 CRC.The R0 resection rate and p CR are independent prognostic factors for patients with T4 CRC.

Sclerosing polycystic adenosis of the submandibular gland: Two case reports

BACKGROUND Sclerosing polycystic adenosis(SPA)is a rare disease of salivary glands,similar to fibrocystic disease of the breast.It occurs over a wide age range and exhibits a slight female preference.Most SPA cases have occurred in the parotid gland.The exact nature of SPA is unclear,but its tumor nature has recently been proposed.Although SPA has a good prognosis after adequate surgery,atypical lesions might occur,ranging from mild dysplasia to carcinoma in situ in some cases.To the best of our knowledge,only five cases of SPA in the submandibular gland have been reported to date.Here,we present two new cases of SPA involving the submandibular gland.CASE SUMMARY A 50-year-old woman and a 52-year-old woman were referred to Tongji Hospital in Wuhan,China,with complaints of moderate pain,recurrent swelling,and a mass in the submandibular area.After admission,the two cases of the submandibular mass were examined physically.The boundary of the submandibular tumor was clear,and the range of motion was good.After preoperative examinations,surgery was performed on a selective basis.Postoperative histopathological examination revealed a well-defined mass with acinar structures,ducts,or cystic dilated glands of various sizes scattered in a large number of proliferative sclerosing stroma.There were flat and cuboidal cells,and eosinophils in the duct epithelium.There was also a eosinophilic substance in the lumen of dilated cysts.No atypical epithelial hyperplasia,invasive growth,or carcinoma in situ was found.Based on the above findings,the mass was diagnosed as SPA.Both patients have remained asymptomatic and no recurrence or distant metastasis had occurred by the 7-mo and 5-year follow-up,respectively.CONCLUSIONSPA is a rare disease of the salivary gland. Even though it has a good prognosisafter adequate surgery, atypical lesions may occur from mild dysplasia tocarcinoma in situ. However, no recurrence, distant metastasis, or mortality hasbeen reported for submandibular gland SPA. Clinicians and pathologists shouldbe familiar with the characteristics of SPA in the submandibular gland to avoidmisdiagnosis and overtreatment.

Reduced delay in diagnosis of odontogenic keratocysts with malignant transformation:A case report

BACKGROUND In rare cases,odontogenic keratocysts(ODs)transform into squamous cell carcinoma.Intervals between the first attendance of a patient and the diagnosis of OD with malignant transformation vary from weeks to years.In this article,we report a case of malignancy derived from OD with a five-day delay in diagnosis.CASE SUMMARY A 54-year-old woman was referred to Tongji Hospital in Wuhan,China with complaints of moderate pain,recurrent swelling,and pus discharge around her left maxillary lateral incisor for over 10 years.Physical examination revealed a fistula at the palatine-side mucoperiosteum of the left maxillary lateral incisor and enlarged lymph node in the left neck.Cone beam computed tomography revealed a cystic lesion with massive bone destruction from the left maxillary central incisor to the left secondary maxillary premolar and local bony destruction in the left first mandibular molar.The patient was clinically diagnosed with OD.Enucleation rather than marsupialization was performed given the risk factors of long history,recent aggravated pain,and massive bony destruction.Malignant transformation of OD was confirmed by pathologists 3 d after the operation.Radical surgery was performed,and lymph node metastasis was observed.The patient was subjected to postoperative radiotherapy and synchronous chemotherapy,and no local recurrence or distant metastasis was noted at one-year follow-up.CONCLUSION Our case suggests that clinicians should be aware of the malignant transformation of OD,especially when patients present with a long history,massive cyst,chronic inflammation,recent persistent infections,aggravated pain,numbness around the cystic lesion,and lymph node enlargement.