Primary acinic cell carcinoma of the breast: A case report and review of literature

BACKGROUND In the current World Health Organization classification,acinic cell carcinoma(AcCC)of the breast is considered a rare histological subtype of triple-negative breast cancer.Because of the few reports in the literature,data concerning clinical outcomes are limited.Here,we report a case of AcCC of the breast in a 48-year-old woman.A 48-year-old woman with a mass in her right breast came to our hospital for further diagnosis.Mammography and an ultrasound(US)scan showed a mass in the upper inner side of the right breast.She then underwent surgery to resect the mass in her right breast.Postoperative pathological examination revealed that the tumor had abundant acinar-like structures formed by tumor cells with prominent eosinophilic granules in the cytoplasm,consistent with acinar cell carcinoma.The results of immunohistochemical analysis supported the diagnosis of breast acinar cell carcinoma.Two months later,she underwent breast-conserving surgery and sentinel lymph node biopsy.The pTNM stage was T2N0M0.After surgery,the patient received 30 radiotherapy sessions.The patient was followed up for a period of one year,and no recurrence was found.AcCC of the breast is a rare type of malignant tumor.Because it is usually asym-ptomatic and can be detected by imaging studies,routine breast US or mamm-ograms are important.However,there are no characteristic diagnostic imaging findings or clinical manifestations,so immunohistochemical examination is critical for an accurate diagnosis of AcCC of the breast.

Squamous Cell Carcinoma of the Middle Ear: Case Report and Literature Review

Malignant tumors originating from the middle ear are rare. The literature identifies chronic inflammation and Human Papillomavirus (HPV) infection as the most common risk factors. A CT scan to assess bony invasion and an MRI to evaluate soft tissue involvement, depth of invasion, and perineural invasion, followed by a biopsy, are indispensable for diagnosis and treatment. There is no standard treatment for squamous cell carcinoma of the middle ear, however, most reported cases are treated with surgical resection followed by postoperative radiotherapy. Given the challenges of achieving complete surgical excision, radiotherapy plays a crucial role in controlling middle ear cancers, as demonstrated in our case. We present a case of squamous cell carcinoma of the middle ear in a 63-year-old female with a history of chronic suppurative otitis media. The patient underwent a right subtotal petrosectomy without lymph node dissection followed by concurrent chemoradiotherapy. At the one-year follow visit, no recurrence or metastasis was detected.

Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

BACKGROUND The therapeutic approach of metastatic renal cell carcinoma(RCC)represents a real challenge for clinicians,because of the variable clinical course;the recent availability of numerous targeted therapies that have significantly improved overall oncological results,but still with a low percentage of complete responses;and the increasing role of metastasectomy(MSX)as an effective strategy to achieve a durable cure,or at least defer initiation of systemic therapies,in selected patients and in the context of multimodality treatment strategies.CA^E SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC;he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy,with subsequent systemic therapy with Fluorouracil,Interferon-alpha and Interleukin 2.The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences,successfully treated with multiple systemic treatments,repeated local treatments,including two pancreatic resections,conservative resection and ablation of multiple bilobar liver metastases,resection and stereotactic body radiotherapy of multiple lung metastases.He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites,including resection of more than 38 metastases,and 5 years after his last MSX.CONCLUSION This case highlights that effective multimodality therapeutic strategies,including multiple systemic treatments and iterative aggressive surgical resection,can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.

Primary rectal squamous cell carcinoma treated with surgery and radiotherapy

Primary squamous cell carcinoma of the rectum is a rare malignancy,and the discrete dual lesions of rectum are even rarer.There is currently no effective and satisfactory treatment for this disease.Here we report a case of an elderly female with bi-primary squamous cell carcinoma of the rectum treated with radical resection and radiotherapy.The patient is still alive 43mo after the initial curative resection of the tumor.We suggest that surgery as the primary treatment followed by concomitant radiotherapy may be an effective protocol for elderly patients with rectal squamous cell carcinoma.

Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy:The value of a multidisciplinary team

Objective:To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma(RCC)treated at a referral academic centre,focusing on technical nuances and on the value of a multidisciplinary team.Methods:We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced(cT3-T4 N0-1 M0)renal masses suspected of RCC at our centre between January 2017 and December 2020.Results:Overall,32 patients were included in the analytic cohort.Of these,12(37.5%)tumours were staged as cT3a,8(25.0%)as cT3b,5(15.6%)as cT3c,and 7(21.9%)as cT4;6(18.8%)patients had preoperative evidence of lymph node involvement.Nine(28.1%)patients underwent nephron-sparing surgery while 23(71.9%)received radical nephrectomy.A template-based lymphadenectomy was performed in 12 cases,with evidence of disease in 3(25.0%)at definitive histopathological analysis.Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation.While intraoperative complications were recorded in 3(9.4%)patients,no postoperative major complications(Clavien-Dindo3)were observed.At histopathological analysis,2(6.2%)patients who underwent partial nephrectomy harboured oncocytoma,while the most common malignant histotype was clear cell RCC(62.5%),with a median Leibovich score of 6(interquartile range 5e7).Conclusion:Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams.Our experience confirms that provided careful patient selection,surgery in experienced hands can achieve favourable perioperative,oncological,and functional outcomes.

Clinical Outcome of Definitive Radiotherapy and/or Surgery in T1-2N0M0 Glottic Squamous Cell Carcinoma: A Single Institution Retrospective Report

Background: The current treatment options of early glottic carcinoma are radiotherapy;trans laser microsurgery, and open surgery. However, the best treatment is still controversial due to lack of randomized controlled trials. We aimed to evaluate the treatment results and the prognostic factors of local control of early glottic squamous cell carcinoma patients (GSCC) T1-2N0M0 treated at our institution. Material and Methods: We retrospectively studied the charts of 52 patients with early GSCC T1-T2N0M0 from 2010-2015 at the Clinical Oncology Department, Ain-Shams University. 24 patients had T1 and 28 had T2 early glottic carcinoma. The overall survival OS, local control rate, and laryngeal preservation rate were evaluated. Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. Results: Median duration of follow-up was 13 months. Thirty-eight patients received radiation treatment alone (73.1%), 7.7% of the patients underwent surgery alone, and 19.2% of the patients had surgery combined with radiotherapy. Local recurrence after radiation failure developed in 6/52 patients, all had T2 disease and were salvaged by total laryngectomy. The ultimate local control rate was 88.5%, and the ultimate laryngeal preservation rate was 77.2% (40/52 patients). The median OS of the 52 patients was 13 months (range 2 - 46 months). Univariate analysis of factors associated with poor local control showed that age > 60 years was the only significant factor (P = 0.048). Conclusion: Radiotherapy achieves high local control and laryngeal preservation rates for patients with early glottic carcinoma, and is associated with a low rate of severe complications compared to surgery. Salvage surgery is feasible after radiotherapy failure.

Nephron-sparing surgery for small renal cell carcinoma

Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results：There were no local tumor recurrences and/or tumor metastasis at a mean followup of 60 months. Conclusion： Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.

Optimal margin in nephnm-sparing surgery for renal cell carcinoma 4 cm or less in diameter.

Objective To investigate the optimal margin in nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) 4 cm or less in diameter. Methods Eighty-two kidneys with RCC 4 cm or less in diameter resected by radical nephrectomy were prospectively studied. The kidney samples were sectioned at 3 mm interval and examined for multicentricity. On each layer of tissue sectioned, parenchyma margin of 15 mm beyond pseudocapsule was continuously sectioned and examined for completeness of pseudocapsule and extra-pseudocapsule cancer lesion. The farthest distance between extra-pseudocapsule lesion and primary tumor was measured. PCNA expression was detected in 41 patients by using standard SP immunohistochemistry technique. Results The diameter of 82 primary tumors was 3. 4 ± 0. 8 cm (range 1.5-4.0 cm).Of these,31.7% (26/82) were found without intact pseudocapsules and 17.1% (14/82) with positive cancer lesions beyond pseudocapsule. The average distance between extra-pseudocapsule cancer lesion and primary tumor

Finding the seed of recurrence:Hepatocellular carcinoma circulating tumor cells and their potential to drive the surgical treatment

The treatment for hepatocellular carcinoma(HCC)relies on liver resection,which is,however,burdened by a high rate of recurrence after surgery,up to 60%at 5 years.No pre-operative tools are currently available to assess the recurrence risk tailored to every single patient.Recently liquid biopsy has shown interesting results in diagnosis,prognosis and treatment allocation strategies in other types of cancers,since its ability to identify circulating tumor cells(CTCs)derived from the primary tumor.Those cells were advocated to be responsible for the majority of cases of recurrence and cancer-related deaths for HCC.In fact,after being modified by the epithelial-mesenchymal transition,CTCs circulate as“seeds”in peripheral blood,then reach the target organ as dormant cells which could be subsequently“awakened”and activated,and then initiate metastasis.Their presence may justify the disagreement registered in terms of efficacy of anatomic vs non-anatomic resections,particularly in the case of microvascular invasion,which has been recently pointed as a histological sign of the spread of those cells.Thus,their presence,also in the early stages,may justify the recurrence event also in the contest of liver transplant.Understanding the mechanism behind the tumor progression may allow improving the treatment selection according to the biological patient-based characteristics.Moreover,it may drive the development of novel biological tailored tests which could address a specific patient to neoadjuvant or adjuvant strategies,and in perspective,it could also become a new method to allocate organs for transplantation,according to the risk of relapse after liver transplant.The present paper will describe the most recent evidence on the role of CTCs in determining the relapse of HCC,highlighting their potential clinical implication as novel tumor behavior biomarkers able to influence the surgical choice.

Evaluation of the 7^(th) edition of the TNM classification in patients with resected esophageal squamous cell carcinoma

AIM:To evaluate the prognostic factors and tumor stages of the 7th edition TNM classification for esophageal cancer.METHODS:In total,1033 patients with esophageal squamous cell carcinoma(ESCC)who underwent surgical resection with or without(neo)adjuvant therapy between January 2003 and June 2012 at the Thoracic Surgery DepartmentⅡof the Beijing Cancer Hospital,Beijing,China were included in this study.The following eligibility criteria were applied:(1)squamous cell carcinoma of the esophagus or gastroesophageal junction identified by histopathological examination;(2)treatment with esophagectomy plus lymphadenectomy with curative intent;and(3)complete pathologic reports and follow-up data.Patients who underwent non-curative(R1)resection and patients who died in hospital were excluded.Patients who received(neo)adjuvant therapy were also included in thisanalysis.All patients were restaged using the 7th edition of the Union for International Cancer Control and the American Joint Committee on Cancer TNM staging systems.Univariate and multivariate analyses were performed to identify the prognostic factors for survival.Survival curves were plotted using the Kaplan-Meier method,and the log-rank test was used to evaluate differences between the subgroups.RESULTS:Of the 1033 patients,273 patients received(neo)adjuvant therapy,and 760 patients were treated with surgery alone.The median follow-up time was 51.6mo(range:5-112 mo)and the overall 5-year survival rate was 36.4%.Gender,"p T"and"p N"descriptors,(neo)adjuvant therapy,and the 7th edition TNM stage grouping were independent prognostic factors in the univariate and multivariate analyses.However,neither histologic grade nor cancer location were independent prognostic factors in the univariate and multivariate analyses.The 5-year stage-based survival rates were as follows:ⅠA,84.9%;ⅠB,70.9%;ⅡA,56.2%;ⅡB,43.3%;ⅢA,37.9%;ⅢB,23.3%;ⅢC,12.9%andⅣ,3.4%.There were significant differences between each adjacent staging classification.Moreover,there were significant differences between each adjacent p N and p M subgroup.According to the p T descriptor,there were significant differences between each adjacent subgroup except between p T3 and p T4(P=0.405).However,there was no significant difference between each adjacent histologic grade subgroup and between each adjacent cancer location subgroup.CONCLUSION:The 7th edition is considered to be valid for patients with resected ESCC.However,the histologic grade and cancer location were not prognostic factors for ESCC.

Primary squamous cell carcinoma of the liver associated with hepatolithiasis:A case report

Primary squamous cell carcinoma(SCC) of the liver is rare and reported sporadically.Up to date,only 24 such cases have been reported in the literature.It is associated with hepatic teratoma,congenital cysts,solitary benign non-parasitic hepatic cysts,hepatolithiasis/Caroli's disease or cirrhosis.We reported a case of primary SCC of the liver associated with multiple intrahepatic cholesterol gallstones.The patient underwent hepatectomy followed by radiotherapy,and has survived for over 19 mo without recurrence.

Primary squamous cell carcinoma of the rectum: An update and implications for treatment

AIM: To provide an update on the aetiology, pathogenesis, diagnosis, staging and management of rectal squamous cell carcinoma(SCC).METHODS: A systematic review was conducted according to the preferred reporting items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE was performed with the reference list of selected articles reviewed to ensure all relevant publications were captured. The search strategy was limited to the English language, spanning from 1946 to 2015. A qualitative analysis was undertaken examining patient demographics, clinical presentation, diagnosis, staging, treatment and outcome. The quantitaive analysis was limited to data extracted on treatment and outcomes including radiological, clinical and pathological complete response where available. The narrative and quantitative review were synthesised in concert.RESULTS: The search identified 487 articles in total with 79 included in the qualitative review. The quantitative analysis involved 63 articles, consisting of 43 case reports and 20 case series with a total of 142 individual cases. The underlying pathogenesis of rectal SCC while unclear, continues to be defined, with increasing evidence of a metaplasia-dysplasia-carcinoma sequence and a possible role for human papilloma virus in this progression. The presentation is similar to rectal adenocarcinoma, with a diagnosis confirmed by endoscopic biopsy. Many presumed rectal SCC's are in fact an extension of an anal SCC, and cytokeratin markers are a useful adjunct in this distinction. Staging is most accurately reflected by the tumour-nodemetastasis classification for rectal adenocarcinoma. It involves examining locoregional disease by way of magnetic resonance imaging and/or endorectal ultrasound, with systemic spread excluded by way of computed tomography. Positron emission tomography is integral in the workup to exclude an external siteof primary SCC with metastasis to the rectum. While the optimal treatment remains as yet undefined, recent studies have demonstrated a global shift away from surgery towards definitive chemoradiotherapy as primary treatment. Pooled overall survival was calculated to be 86% in patients managed with chemoradiation compared with 48% for those treated traditionally with surgery. Furthermore, local recurrence and metastatic rates were 25% vs 10% and 30% vs 13% for the chemoradiation vs conventional treatment cohorts.CONCLUSION: The changing paradigm in the treatment of rectal SCC holds great promise for improved outcomes in this rare disease.

Pancreatic metastasis of renal cell carcinoma

BACKGROUND： Renal cell carcinoma （RCC） is a common cancer, but pancreatic metastasis of RCC is unusual. Because of the rarity and peculiarity, pancreatic lesions from RCC metastasis were described mostly in case reports which highlight the importance of a systematic analysis of this clinical condition. DATA SOURCES： Data of 7 patients with pancreatic metastasis of RCC treated in the Peking Union Medical College Hospital were extracted and 193 similar patients reported in the past 10 years from the literature were analyzed. Epidemiological, pathological and follow-up information were investigated. Po- tential prognostic factors were compared with corresponding data reported 10 years ago. RESULTS： Multivariate Cox regression showed that asymp- tomatic metastasis and surgical procedure were independent factors associated with better survival. Compared with the data reported 10 years ago, follow-up of RCC patients has been emphasized in recent years, and atypical surgery is frequently used since it has similar effect as typical surgery on tumor resection while it is able to preserve more pancreatic function. CONCLUSION： Surgical treatment should be an option as long as the pancreatic metastasis of RCC is resectable.

Primary squamous cell carcinoma of the liver:A successful surgically treated case

Primary squamous cell carcinoma (SCC) of the liveris rare. Totally nine such cases have been reportedin the literature. Primary SCC of the liver has beenreported to be associated with hepatic teratoma,hepatic cyst, or hepatolithiasis. Complete remission ofpoorly differentiated SCC of the liver could be achievedby systemic chemotherapy followed by surgery orremarkably respond to hepatic arterial injection of lowdose chemotherapeutic drugs. Here we report the fi rstcase of primary SCC of the liver presenting as a solidtumor and receiving successful hepatic resection with9-mo disease free survival.

Clival metastasis of renal clear cell carcinoma: Case report and literature review

The clivus is an atypical metastatic site for renal clear cell carcinoma(RCCC). Here we report a 54 year old man with acute cavernous sinus syndrome. Brain magnetic resonance imaging identified a clival-based lesion with associated bony erosion. The patient underwent endoscopic endonasal biopsy and partial resection of the clival mass. Because histologic examination of the resected specimen resulted in a diagnosis of RCCC, contrast-enhanced computed tomography scan of the abdomen was performed and showed an enhanced left renal mass. The patient subsequently underwent laparoscopic left radical nephrectomy and gamma knife was planned for the residual clival lesion. We also retrospectively reviewed available published reports on clival metastases, specifically those from RCCC, since 1990.

Pancreatic acinar cell carcinoma:A comprehensive review

Acinar cell carcinoma(ACC)is a rare pancreatic malignancy with distinctive clinical,molecular,and morphological features.The long-term survival of ACC patients is substantially superior to that of pancreatic adenocarcinoma patients.As there are no significant patient series about ACCs,our understanding of this illness is mainly based on case reports and limited patient series.Surgical resection is the treatment of choice for patients with the disease restricted to one organ;however,with recent breakthroughs in precision medicine,medicines targeting the one-of-a-kind molecular profile of ACC are on the horizon.There are no standard treatment protocols available for people in which a total surgical resection to cure the condition is not possible.As a result of shared genetic alterations,ACCs are chemosensitive to agents with activity against pancreatic adenocarcinomas and colorectal carcinomas.The role of neoadjuvant or adjuvant chemoradiotherapy has not been established.This article aims to do a comprehensive literature study and present the most recent information on acinar cell cancer.

Pancreatic metastases from renal cell carcinoma:The state of the art

Pancreatic metastases are rare,with a reported incidence varying from 1.6%to 11%in autopsy studies of patients with advanced malignancy.In clinical series,the frequency of pancreatic metastases ranges from 2%to 5%of all pancreatic malignant tumors.However,the pancreas is an elective site for metastases from carcinoma of the kidney and this peculiarity has been reported by several studies.The epidemiology,clinical presentation,and treatment of pancreatic metastases from renal cell carcinoma are known from singleinstitution case reports and literature reviews.Thereis currently very limited experience with the surgical resection of isolated pancreatic metastasis,and the role of surgery in the management of these patients has not been clearly defined.In fact,for many years pancreatic resections were associated with high rates of morbidity and mortality,and metastatic disease to the pancreas was considered to be a terminal-stage condition.More recently,a significant reduction in the operative risk following major pancreatic surgery has been demonstrated,thus extending the indication for these operations to patients with metastatic disease.

Surgical management of hepato-pancreatic metastasis from renal cell carcinoma

AIM To investigate the outcomes of liver and pancreatic resections for renal cell carcinoma(RCC) metastatic disease. METHODS This is a retrospective, single centre review of liver and/or pancreatic resections for RCC metastases between January 2003 and December 2015. Descriptive statistical analysis and survival analysis using the Kaplan-Meier estimation were performed.RESULTS Thirteen patients h ad 7 pancreatic and 7 liver resections, with median follow-up 33 mo(range: 3-98). Postoperative complications were recorded in 5 cases, with no postoperative mortality. Three patients after hepatic and 5 after pancreatic resection developed recurrent disease. Median overall survival was 94 mo(range: 23-94) after liver and 98 mo(range: 3-98) after pancreatic resection. Disease-free survival was 10 mo(range 3-55) after liver and 28 mo(range 3-53) after pancreatic resection. CONCLUSION Our study shows that despite the high incidence of recurrence, long term survival can be achieved with resection of hepatic and pancreatic RCC metastases in selected cases and should be considered as a management option in patients with oligometastatic disease.

Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma?

Metastatic renal cell carcinoma(m RCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival(ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with m RCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it's based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with longterm survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.

Signet ring cell carcinoma hidden beneath large pedunculated colorectal polyp:A case report

BACKGROUND Large pedunculated colorectal polyps are not frequent among colonic polyps.We present a clinical case of a large pedunculated colorectal polyp with signet ring cell cancer infiltrating the submucosa and lymph node invasion in a patient who ultimately underwent additional surgery.Clinicians should attach importance to pedunculated colorectal polyps and choose the most appropriate therapy.CASE SUMMARY A 52-year-old female farmer underwent routine screening colonoscopy and denied constipation,diarrhea,hematochezia,or other gastrointestinal symptoms.Her past medical history and general biochemical examination results were unremarkable.During the colonoscopy,a 25-mm pedunculated polyp in the sigmoid colon was identified.The superficial epithelium was macroscopically congestive,rough,and granular,showing characteristic features of adenoma.We first ligated the root of the pedunculated polyp using nylon loops as well as a titanium clip.Histopathological examination revealed high-grade intraepithelial neoplasia of the tumor surface and a negative margin with signet ring cell adenocarcinoma infiltrating the submucosal layer.The deepest infiltration was approximately 0.9 cm from the tumor surface and 0.55 cm from the stratum basale.We performed radical resection of the left colon with lymph node dissection after two weeks.The lesion was completely resected,and pathological assessment revealed signet ring cell adenocarcinoma infiltrating the submucosal layer as well as lymph node invasion(stage PT1N1M0 and grade IIIA in pathological grading,NRAS-,BRAF V600E-,KRAS-).CONCLUSION This case highlights the importance of paying attention to the malignancy of large pedunculated polyps.Polyps or adenomas removed via endoscopy must be evaluated histologically.Even if adenomas may be fragile,endoscopy doctors should still remove polyps as completely as possible and choose perpendicular sections through the stalk and base to fix by formaldehyde solution.