Adenomyoepithelioma of the breast with malignant transformation and repeated local recurrence:A case report

BACKGROUND Adenomyoepithelioma(AME)of the breast is a rare type of benign breast tumor.Many AMEs show benign behavior,but reports of the malignant type are rare.We present the case of a patient with AME with repeated local recurrences and further malignant transformation.CASE SUMMARY A 53-year-old woman visited our hospital with a 16-mm palpable mass in the right breast.A core needle biopsy was performed.The pathological diagnosis was AME.Lumpectomy with a safety margin was performed without axillary lymph node dissection(ALND).Two years later,local recurrence developed,and the patient again underwent lumpectomy with a safety margin.The pathology showed malignant AME,and the margin was negative.Eight months later,local recurrence developed again in the same location,and a total mastectomy was performed without ALND.The pathological diagnosis was malignant AME.The patient was disease-free for three years posttreatment.CONCLUSION The treatment of AME requires caution,as it may exhibit repeated recurrences after local excision as well as malignant transformation.

Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching

BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation.Some clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so far.There were few reports that observed the course over long periods of time after CP in clinical practice.AIM To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score matching.METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy subsequently.We divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was performed.Using propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.RESULTS After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the groups.The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the groups.Adverse events did not occur in either group.CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice.CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.

Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy

Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the current strategies and further perspectives on this patient setting.Methods:A non-systematic review of the literature was completed.The research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific tools.No clear evidence is reported about these methods.Regarding PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery.Regarding local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN.In this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive alternative.Salvage surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach.Overall,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ablation.Conclusion:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN.Active surveillance is likely to be the optimal first-line management option for most patients with PSMs.Ablation and salvage surgery both represent valid options in patients with local recurrence after PN.Conversely,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA.In this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.

TREATMENT OF LOCAL RECURRENCE OF NASOPHARYN-GEAL CARCINOMA WITH REIRRADIATION

From 1975 to 1987, 112 patients with loco-regional recurrence of nasopharyngeal carcinoma (N P C) were treated again with radiation at our hospital. All cases were proven histologically by biopsy. Of these patients, 92 had their recurrence in the nasopharynx only, 13 had additional involvement of the base of the skull, and 7 had tumor recurrences simultaneously in the nasopharynx as well as the cervical lymph nodes. Radiotherapy adopted in this series was 60Co external irradiation (X R Te) and/ or betatron in 96 patients, X R Te plus intracavitary 60Co irradiation (X R Ti) in 12 patients and X R Ti alone in the other 4 patients. The 1-, 3-, and 5-year survival rates were 86.3%, 45.8% and 30.2% respectively after the start of recurrence retreatment. The 63 patients who survived for 5 years or more were analyzed. The prognosis of the patient was related to the histological type, clinical stage, modality of treatment, and disease interval to recurrence and site of recurrence. No serious complications occurred. It is suggested that re-irradiation is appropriate in the treatment of loco-regional recurrent N P C.

THE FACTORS AND TREATMENT OF LOCAL RECURRENCE AFTER RADICAL RESECTION RESERVING THE ANUS IN THE PATIENTS WITH RECTAL CANCER

Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.

Morphology of the anterior mesorectum:a new predictor for local recurrence in patients with rectal cancer

Background:Pre-operative assessment with high-resolution magnetic resonance imaging(MRI)is useful for assessing the risk of local recurrence(LR)and survival in rectal cancer.However,few studies have explored the clinical importance of the morphology of the anterior mesorectum,especially in patients with anterior cancer.Hence,the study aimed to investigate the impact of the morphology of the anterior mesorectum on LR in patients with primary rectal cancer.Methods:A retrospective study was performed on 176 patients who underwent neoadjuvant treatment and curative-intent surgery.Patients were divided into two groups according to the morphology of the anterior mesorectum on sagittal MRI:(1)linear type:the anterior mesorectum was thin and linear;and(2)triangular type:the anterior mesorectum was thick and had a unique triangular shape.Clinicopathological and LR data were compared between patients with linear type anterior mesorectal morphology and patients with triangular type anterior mesorectal morphology.Results:Morphometric analysis showed that 90(51.1%)patients had linear type anterior mesorectal morphology,while 86(48.9%)had triangular type anterior mesorectal morphology.Compared to triangular type anterior mesorectal morphology,linear type anterior mesorectal morphology was more common in females and was associated with a higher risk of circumferential resection margin involvement measured by MRI(35.6%[32/90]vs.16.3%[14/86],P=0.004)and a higher 5-year LR rate(12.2%vs.3.5%,P=0.030).In addition,the combination of linear type anterior mesorectal morphology and anterior tumors was confirmed as an independent risk factor for LR(odds ratio=4.283,P=0.014).Conclusions:The classification established in this study was a simple way to describe morphological characteristics of the anterior mesorectum.The combination of linear type anterior mesorectal morphology and anterior tumors was an independent risk factor for LR and may act as a tool to assist with LR risk stratification and treatment selection.

Classification of rectal cancer according to recurrence types-comparison of Japanese guidelines and Western guidelines

BACKGROUND Rectal cancer is characterized by more local recurrence(LR)and lung metastasis than colon cancer.However,the diagnosis of rectal cancer is not standardized as there is no global consensus on its definition and classification.The classification of rectal cancer differs between Japanese and Western guidelines.AIM To clarify the characteristics of rectal cancer by comparing the tumor location and characteristics of rectal cancer with those of colon cancer according to each set of guidelines.METHODS A total of 958 patients with Stage II and III colorectal cancer were included in the analysis:607 with colon cancer and 351 with rectal cancer.Localization of rectal cancers was assessed by enema examination and rigid endoscopy.According to Japan guidelines,rectal cancer is classified as Rb(below the peritoneal inversion),Ra(between the inferior margin of second sacral vertebrae and Rb)or RS(between Ra and sacral promontory).RESULTS There were no significant differences between RS rectal cancer and colon cancer in the rates of liver and lung metastasis or LR.Lung metastasis and LR were significantly more common among Rb rectal cancer(in Japan)than in colon cancer(P=0.0043 and P=0.0002,respectively).Lung metastases and LR occurred at significantly higher rates in rectal cancer measuring≤12 cm and≤10 cm than in colon cancers(P=0.0117,P=0.0467,P=0.0036,P=0.0010).Finally,the rates of liver metastasis,lung metastasis,and LR in rectal cancers measuring 11 cm to 15 cm were 6.9%,2.8%,and 5.7%,respectively.These were equivalent to the rates in colon cancer.CONCLUSION High rectal cancer may be treated with the same treatment strategies as colon cancer.There was no difference in the classification of colorectal cancer between Japan and Western countries.

Boron neutron capture therapy: moving towards targeted therapy for locally recurrent head and neck squamous cell carcinoma

Locally recurrent head and neck squamous cell carcinoma(HNSCC)is often unresectable,and a repeat course of radiotherapy is associated with incremental toxicities.Boron neutron capture therapy(BNCT)is a novel targeted radiotherapy modality that can achieve a high dose gradient between cancerous and adjacent normal tissues.However,the relationships among the dose resulting from BNCT,tumor response to BNCT,and survival are not completely understood.Recently,a study published in Radiotherapy and Oncology investigated the efficacy of BNCT in the treatment of patients with locally recurrent HNSCC and the factors associated with favorable treatment response and survival.In this article,the findings,strengths and limitations of this study are discussed in depth,and the significance of the study and motivations for future research are highlighted.

Clinicopathologic risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

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上颌窦癌术后复发

1 临床资料 患者，女，49岁，因“左上颌窦癌术后4年半，左面部胂块伴麻木3个月”于2009—5—22入院。患者于4年半前于外地医院因左上颌窦癌行鼻内镜联合柯陆径路上颌窦肿块切除术，病理类型不详，并于术后20天于当地医院行放射治疗（总量65Gy，50次），恢复好。3个月前左面部出现肿块且生长迅速并伴左面部麻木，3个月来出现复视、张口受限，不伴眼球运动障碍及左眼视力下降，自行口服中药（具体不详）无改善。以上颔窦癌术后复发收入我科进一步治疗。

Prevention of Local Liver Cancer Recurrence after Surgery Using Multilayered Cisplatin-loaded Polylactide Electrospun Nanofibers

In this study a cisplatin-loaded, multilayered polylactide （PLA） electrospun nanofibers, with the structure of two layers of drug-loaded mat being sandwiched by three layers of blank mat, were designed for prolonged cisplatin release at surgical margin to prevent local cancer recurrence following surgical resection in a murine model. In vivo drug release and biodistribution study suggested that the multilayered fibrous mat displayed a slower cisplatin release behavior and a more stable drug rentention in the local tissue within 24 h than that of single-layered fibrous mat. By covering the surgical site with the multilayered fibrous mat following resection of subcutaneous liver cancer in mice, retarded tumor recurrence, prolonged survival time and less systemic toxicity were observed compared with other treatment groups.

Simple instruments facilitating achievement of transanal total mesorectal excision in male patients

AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.

Review of incomplete macroscopic resections(R2)in rectal cancer:Treatment,prognosis and future perspectives

Colorectal cancer is one of the most prevalent tumours,but with improved treatment and early detection,its prognosis has greatly improved in recent years.However,when the tumour is locally advanced at diagnosis or if there is local recurrence,it is more difficult to perform a complete tumour resection,and there may be a residual macroscopic tumour.In this paper,we review the literature on residual macroscopic tumour resections,concerning both locally advanced primary tumours and recurrences,evaluating the main problems encountered,the treatments applied,the prognosis and future perspectives in this field.

喉癌术后复发

1临床资料患者,男,75岁,因喉癌术后10个月,发现颈部肿块2个月为主诉入院。患者10个月前因喉癌（声门型,T2NOMO）全麻支撑喉镜下取活检、气管切开、喉额侧垂直部分切除术、会厌下拉修补术。术后病理为溃疡型中分化鳞状细胞癌,术后未行放化疗。2个月前复诊时发现颈部肿块,

Multimodal therapy in the management of primary orbital mesenchymal chondrosarcoma

AIM:To evaluate the ophthalmic manifestations,radiographic features,and prognosis of Chinese patients with primary orbital mesenchymal chondrosarcoma(MCS).METHODS:The study included 6 cases with primary orbital MCS treated at Tianjin Eye Hospital from January 2009 to December 2019.Patitent ophthalmic manifestations,radiographic features,diagnosis,pathology,therapeutic regimens,and prognosis were retrospectively reviewed.RESULTS:Six patitents with primary orbital MCS were identified.The mean age at the first visit was 33y(range,25-42y).All six patients displayed manifestations of exophthalmos,diplopia,limitation of eye displacement,upper eyelid oedema,decreased visual acuity and ptosis.The mean disease history and range were 5 and 2-8mo,respectively.The tumors were located in the superonasal extraconal compartment(2/6,33.3%),intraconal compartment(2/6,33.3%),and bitemporal extraconal compartment(2/6,33.3%),respectively.Radiographic features were a well-defined,orbital mass with calcification and ossification on computed tomography(CT),and marked heterogenous enhancement on dynamic magnetic resonance imaging(MRI).Five patients were treated with tumor resection and one patient received orbital exenteration.Five patients in the cohort received postoperative radiation therapy,two patients received chemotherapy,and one patient did not receive postoperative adjuvant therapy because he refused.The histopathologic classification revealed a tumour composed of a mixture of mature chondroid tissue surrounded by small,round,and undifferentiated mesenchymal cells.Immunohistochemistry revealed Bcl-2,vimetin,CD99,and S-100 were expressed were expressed.After surgeries,two patients have developed a local recurrence.The median recurrence time of 58 mo(52-64 mo).One patient had distant recurrence included the lungs occurred 52mo after the initial surgery.CONCLUSION:The possibilty of orbital MCS need to be considered when a painless,slowly growing orbital mass with calcification and ossification.From our experience,trimodality treatment of radiation therapy,chemotherapy and surgery maybe the best option.Orbital MCS has a high tendency for late recurrence,regular long-term follow-up after complete excision is mandatory.

Long-term follow-up of HER2 overexpression in patients with rectal cancer after preoperative radiotherapy:A prospective cohort study

BACKGROUND The role of HER2 overexpression in rectal cancer is controversial.AIM To assess the role of HER2 overexpression in the long-term prognosis of rectal cancer.METHODS Data from patients with locally advanced rectal cancer who underwent total mesorectal excision after short-course radiotherapy at Beijing Cancer Hospital between May 2002 and October 2005 were collected.A total of 151 tissue samples of rectal cancer were obtained using rigid proctoscopy before neoadjuvant radiotherapy,followed by immunohistochemistry and fluorescence in situ hybridisation to determine the patients’HER2 expression status.Univariate and multivariate analyses of the associations between the clinicopathological factors and HER2 status were performed.Survival was estimated and compared using the Kaplan-Meier method based on HER2 expression status,and the differences between groups were verified using the log-rank test.RESULTS A total of 151 patients were enrolled in this study.A total of 27(17.9%)patients were ultimately confirmed to be HER2-positive.The follow-up duration ranged from 9 mo to 210 mo,with a median of 134 mo.Distant metastasis and local recurrence occurred in 60(39.7%)and 24(15.9%)patients,respectively.HER2 positivity was significantly associated with the pre-treatment lymph node stage(pre-N)(P=0.040),while there were no differences between HER2 status and age,sex,preoperative CEA levels(pre-CEA),T stage,and lympho-vascular invasion.In terms of prognosis,HER2 overexpression was correlated with distant meta stasis(P=0.002)rather than local recurrence(P>0.05).The multivariate analysis demonstrated that elevated pre-CEA[P=0.002,odds ratio(OR)=3.277,97.5%confidence interval(CI):1.543-7.163],post N(+)(P=0.022,OR=2.437,97.5%CI:1.143-5.308)and HER2(+)(P=0.003,OR=4.222,97.5%CI:1.667-11.409)were risk factors for distant metastasis.The survival analysis showed that there were significant differences between rectal cancer patients in terms of disease-free survival(DFS)[hazard ratio:1.69(95%CI:0.91-3.14);P=0.048]and overall survival(OS)[1.95(1.05-3.63);P=0.0077].CONCLUSION HER2 overexpression is a potential biomarker for predicting lymph node metastasis and distant metastasis,which are associated with worse long-term DFS and OS in rectal cancer patients with locally advanced disease.

Hussein Hassan Okasha,Mahmoud Wahba,Eva Fontagnier,Abeer Abdellatef,Hani Haggag,Sameh

BACKGROUND Almost half of the patients with colorectal cancer(CRC)will experience localregional recurrence after standard surgical excision.Many local recurrences of colorectal cancer(LRCC)do not grow intraluminally,and some may be covered by a normal mucosa so that they could be missed by colonoscopy.Early detection is crucial as it offers a chance to achieve curative reoperation.Endoscopic ultrasound(EUS)is mainly used in CRC staging combined with cross-section imaging study.EUS can provide an accurate assessment of sub-mucosal lesions by demarcating the originating wall layer and evaluating its echostructure.EUS fineneedle aspiration(FNA)provides the required tissue examination and confirms the diagnosis.CASE SUMMARY We report a series of five cases referred to surveillance for LRCC with negative colonoscopy and/or negative endoscopic biopsies.EUS-FNA confirmed LRCC implanted deep into the third and fourth wall layer with normal first and second layer.CONCLUSION Assessment for LCRR is still problematic and may be very tricky.EUS and EUSFNA may be useful tools to exclude local recurrence.

The Place of Nipple-Sparing Mastectomy in the Treatment of Breast Cancer: Review of the Literature

Introduction: Mastectomy with conservation of the nipple-areola complex (NAC) in breast cancer care has been controversial with regards to the oncological safety of this procedure and the risk of complications including NAC necrosis. Aim: The objective of this study is to assess, through a literature review, the safety and reliability of a conservative NAC mastectomy in breast cancer treatment, paying attention to the rate of local recurrence and complications. Methods: A review of the literature was conducted from PubMed data, and articles published between January 2007 and December 2017, using the terms “nipple-sparing mastectomy”, “breast cancer”, “local recurrence”, “necrosis of the nipple”, “global complications”. The articles were analyzed with regards to the following parameters of evaluation: local recurrence, recurrence rate at NAC level, global complication rates and nipple necrosis rates. Results: In the 36 studies we selected, the average rate of local recurrence was 3.23%. The average rate of recurrence at the NAC was 0.81%. The average rate of complications was 20%. The average rate of necrosis of the NAC was 5.9%. The main factors of these recurrences were the tumor size > 5 cm and tumor stage > stage II. Conclusion: Conservative mastectomy of the nipple-areola complex offers an aesthetic advantage and oncological safety in carefully selected patients with breast cancer.

Clinical Features of Giant Cell Tumor of Bone in Elderly Patients

Background: Giant cell tumor of the bone (GCTB) occurs most often in younger individuals aged between 20 and 40 years. However, it also occurs in a small proportion of elderly people. Therefore, it is necessary to determine the clinical characteristics of GCTB in elderly people, as only few reports have completely examined the characteristics of GCTB in elderly patients. Methods: This retrospective study enrolled 69 patients with benign GCTB. Patients’ information on age, sex, anatomical location and size, Campanacci grade, pathological fracture, treatment for primary tumors, local and distant relapse, and outcome was collected. We compared these clinical courses between the younger and older groups. We divided the age groups into three subgroups: ≤54 years and ≥55 years, ≤59 years and ≥60 years, and ≤64 years and ≥65 years. We compared the two groups in each subgroup. In addition, we examined factors affecting local recurrence and distant metastasis. Results: Tumor size was significantly larger in the older group between the two subgroups of 55 and 60 years. Kaplan-Meier curves for local recurrence-free survival and distant metastasis-free survival between the two subgroups of 65 years showed significant differences (p = 0.0183 and p = 0.0014). In the multivariate logistic regression analyses, female sex, curettage-only surgical procedure, and denosumab usage before surgery affected local recurrence. Conclusion: Age is unlikely to affect local recurrence and distant metastases in GCTB patients, but local recurrence and distant metastases may be noted in elderly patients aged ≥65 years with GCTB.

Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum

Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the high incidence of recurrence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the pectinate line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients – 400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radiotherapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducing the number of undifferentiated cells and in diminishing the tumor volume and the carcinomatous infiltration of the rectal wall.