Classification,clinicopathologic features and treatment of gastric neuroendocrine tumors

Gastric neuroendocrine tumors (GNETs) are rare lesions characterized by hypergastrinemia that arise from enterochromaffin-like cells of the stomach. GNETs consist of a heterogeneous group of neoplasms comprising tumor types of varying pathogenesis, histomorphologic characteristics, and biological behavior. A classification system has been proposed that distinguishes four types of GNETs; the clinicopathological features of the tumor, its prognosis, and the patient’s survival strictly depend on this classification. Thus, correct management of patients with GNETs can only be proposed when the tumor has been classified by an accurate pathological and clinical evaluation of the patient. Recently developed cancer therapies such as inhibition of angiogenesis or molecular targeting of growth factor receptors have been used to treat GNETs, but the only definitive therapy is the complete resection of the tumor. Here we review the literature on GNETs, and summarize the classification, clinicopathological features (especially prognosis), clinical presentations and current practice of management of GNETs. We also present the latest findings on new gene markers for GNETs, and discuss the effective drugs developed for the diagnosis, prognosis and treatment of GNETs.

Clinical evaluation of endoscopic resection for treatment of large gastric stromal tumors

BACKGROUND Gastric stromal tumor is a digestive tract mesenchymal tumor with malignant potential, and endoscopic techniques have been widely used in the treatment of gastric stromal tumors, but there is still controversy over their use for large gastric stromal tumors(≥ 3 cm).AIM To evaluate the clinical long-term efficacy and safety of endoscopic resection for large(≥ 3 cm) gastric stromal tumors.METHODS All patients who underwent endoscopic resection or surgery at our hospital from 2012 to 2017 for pathologically confirmed gastric stromal tumor with a maximum diameter of ≥ 3 cm were collected. The clinical data, histopathologic characteristics of the tumors, and long-term outcomes were recorded.RESULTS A total of 261 patients were included, including 37 patients in the endoscopy group and 224 patients in the surgical group. In the endoscopy group, the maximum tumor diameter was 3-8 cm; the male: Female ratio was 21/16; 34 cases had low-risk tumors, 3 had intermediate-risk, and 0 had high-risk; the mean follow-up time was 30.29 ± 19.67 mo, no patient was lost to follow-up, and no patient received chemotherapy after operation; two patients with recurrence had low-risk stromal tumors, and neither had complete resection under endoscopy. In the surgical group, the maximum tumor diameter was 3-22 cm; the male: Female ratio was 121/103; 103 cases had low-risk tumors, 75 had intermediate-risk, and 46 had high-risk; the average follow-up time was 38.83 ± 21.50 mo, 53 patients were lost to follow-up, and 8 patients had recurrence after operation(6 cases had high-risk tumors, 1 had intermediate-risk, and 1 had low-risk). The average tumor volume of the endoscopy group was 26.67 ± 26.22 cm^3(3.75-120), all of which were less than 125 cm^3. The average volume of the surgical group was 273.03 ± 609.74 cm^3(7-4114). Among all patients with a tumor volume < 125 cm^3,7 with high-risk stromal tumors in the surgical group(37.625 cm^3 to 115.2 cm^3)accounted for 3.8%(7/183); of those with a tumor volume < 125 cm^3, high-risk patients accounted for 50%(39/78). We found that 57.1%(12/22) of patients with high-risk stromal tumors also had endoscopic surface ulcer bleeding and tumor liquefaction on ultrasound or abdominal computed tomography; the ratio of tumors positive for both in high-risk stromal tumors with a volume < 125 cm^3 was 60%(3/5).CONCLUSION Endoscopic treatment is safe for 95.5% of patients with gastric stromal tumors with a tumor diameter ≥ 3 cm and a volume of < 125 cm^3 without endoscopic surface ulcer bleeding or CT liquefaction.

Clinical application of multidisciplinary teams in tumor therapy

Multidisciplinary team （MDT） model is a diagnostic and treatment model characterized by interdisciplinarity, integration, centralism, individualization, and precision and is becoming more common in the management of complex malignancies. MDT emphasizes team spirit and a personalized treatment strategy according to the actual condition of each patient. A cooperative and effective multidisciplinary team is an important guarantee for delivering high-quality services to patients. Under the guidance of a medical humanistic concept, MDT provides reasonable, effective, convenient, and a full range of excellent quality medical service to patients. The MDT maximizes patient benefits, and it is the developmental direction for large-scale general hospitals. At the same time, the MDT is also an important measure to strengthen the core competitiveness of hospitals. Here, we introduce the clinical application of the model in tumor therapy as well as the current state and development in our hospital.

Osteoclastic and pleomorphic giant cell tumors of the pancreas:A review of clinical,endoscopic,and pathologic features

Giant cell tumors of the pancreas come in three varieties-osteoclastic,pleomorphic,and mixed histology.These tumors have distinctive endoscopic,clinical,and cytological features.Giant cell tumors have a controversial histogenesis,with some authors favoring an epithelial origin and others favoring a mesenchymal origin.The true origin of these lesions remains unclear at this time.These are also very rare tumors but proper identification and differentiation from more common pancreatic adenocarcinoma is important.The risk factors of these tumors and the prognosis may be different from those associated with standard pancreatic adenocarcinoma.Recognition of these differences can significantly affect patient care.These lesions have a unique appearance when imaged with endoscopic ultrasound(EUS),and these lesions can be diagnosed via EUS guided Fine Needle Aspiration(FNA).This manuscript will review the endoscopic,clinical,and pathologic features of these tumors.

Clinical Analysis of 73 Cases of Intraspinal Nerve Sheath Tumor

Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.0 months. Out of the 73 cases enrolled, 69 had gradual recovery of sensation, motor and sphincter functions 1 week to 3 months after operation. Forty-six cases had incomplete paralysis, whose American Spinal Injury Association （ASIA） grades, however, were gradually increased during the follow-up period, 4 cases had no significant improvement of the clinical symptoms and no change in ASIA grades during the follow-up period. Two cases had postoperative recurrence of the tumor. There were no deaths, no spinal instability, and no kyphotic malformations fotmd in any cases. Our study indicated that complete removal of the tumor is important for good recovery, and an ideal surgical method may reduce the recurrence of the tumor or the occurrence of complications.

Clinical Presentation of Ovarian Tumors

Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed although presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory.

Clinical-Pathological Features and Treatment Modalities of Primary Brain Tumors in Tanzania—4 Years of Institutional Experience

Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X2 test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.

Clinical application of several tumor imaging agents

Neoplasms is one of the main diseases for harming health. It is difficult to prevent the neoplasms because the factors of bringing out them are complex. To raise survival rate the early diagnosis of tumors is very important. Radionuclide imaging is useful to detect recurrent or residual disease and to identify benign or malignant tumor. Several tumor imaging agents as following have clinical significance in diagnosing tumors.

Study on Circulating Tumor Cells and Various Clinical Features and Blood-Related Indexes in Patients with Renal Cancer

Objective: To investigate the value of CTC clinical features and blood-related test indicators in renal cancer patients by detecting the number of circulating tumor cells (CTC) in patients with renal cancer. Methods: To analyze 59 patients with renal cell carcinoma (RCC) admitted to the Department of Urology, Affiliated Hospital of Chengde Medical College from May 2018 to October 2019. According to the CTC count (5 pcs/3.5 ml), they were divided into CTC positive group and CTC negative group. The age, gender, tumor location, tumor size, hematuria, CEC (circulating endothelial cells), CTC Cluster (aggregate), gene mutation, platelet (PLT), albumin (ALB), hemoglobin (HB), alkaline phosphatase (AKP), lactate dehydrogenase (LDH) were compared between the two groups of patients and the correlation of the number of CTCs. Results: There were significant differences in tumor size, CEC, and gene mutations between the two groups (P < 0.05). The number of CTC in patients was correlated with the levels of HB, PLT and LDH (P < 0.05). Conclusion: The number of CTC in RCC patients is correlated with some clinical features (tumor size, CEC, gene mutation) and some related test indicators (HB, PLT, LDH), and can be combined with the above related indicators to predict the occurrence, metastasis and prognosis of renal cancer.

A CLINICAL ANALYSIS OF 7878 PATIENTS WITH TUMORS IN THE HEAD AND NECK

7878 patients with tumors in the head and neck were analyzed in a period of twenty years. All the diagnosis were confirmed by pathologic examination. There were 5485 cases (69.62%) of malignant tumors. Nearly an half of malignant tumors were in the nasopharynx (49.32%). Among the malignant tumors of the nasopharynx, 2698 were carcinoma (99.34%) and only 18 (0.66%) sarcoma. Nine of them were under 10 years of age, the youngest patient was 3 years old, and this is rare in our county. The incidence of head and neck tumors was 37.66% and that of the head and neck malignancies was 26.22% of tumors in the whole body. This study indicates that incidence of malignant tumor in head and neck was rather higher, it is worth to improve ths procedure of treatment and prevention.

Gastrointestinal Stromal Tumors (GISTs), Surgical Management and Clinical Outcome

Introduction: This study investigated the incidence, surgical management and outcome of Gastrointestinal Stromal Tumors (GIST) in Upper Egypt. Methods: A retrospective review of all GIST patients admitted a South Egypt Cancer Institute between Jan. 2010 and Dec. 2015 was conducted. Patients’ demographics, clinical presentation, tumor characteristics, radiological, pathological and immunohistochemical findings, surgical procedures, recurrence and mortality were recorded. Results: A total of 36 GIST patients were identified, stomach was the most common site (27.8%) followed by the small intestine (19.4%) and the large intestine (16.7%). The mean age at time of diagnosis as 52.8 ± 14.4 (ranged from 17 to 76 years). Of these 36 cases, 20 (55.6%) cases were males and 16 (44.4%) cases were females with a ratio of 1.2:1. About 22 cases (61.1%) presented with primary tumors, eight cases (22.2%) had primary tumors and metastases, three cases (8.35) presented with recurrent mass, whereas one case (2.2%) presented either with recurrent mass and metastases or metastases only. The majority of cases (22) had tumorsize >5 cm. Patients were stratified as high, intermediate, low and very low risk (50.6%, 30.6%, 11.1% and 2.8%, respectively). Almost all the cases were surgically managed and 75% were completely resectable. During follow up (average 26.5 months), 22 patients showed complete recovery, 7 had recurrent or metastatic disease and 2 died due to liver metastasis. Conclusion: The incidence of GIST in Upper Egypt is apparently low. Surgical resection is the preferred choice of treatment. The demographic data of GIST patients in South Egypt Cancer institute were similar to those published in the literature. Other prospective studies are required to assess the prognosis and the effect of treatment.

Clinical analysis of malignant pancreatic endocrine tumors:reports of 27 cases

To investigate clinicopathological features,diagnosis and treatment of malignant pancreatic tumors.Methods A retrospective clinical analysis was made in 27 cases of malignant pancreatic tumors admitted from 1989 to 2003.Results Tumors were surgically resected in 22 patients.Tumor infiltration into surrounding organs was found in 13 cases.Four patients had lymph nodes metastasis and 5 had liver metastasis.Two cases were found tumor embolus in vascular or lymph tube.Neural invasion was found in 3.Conclusion Malignant pancreatic tumors has good prognosis.Aggressive attempts of surgical management should be performed.6 refs,1 tab.

Clinical pathologic analysis of urologic primary primitive neuroectodermal tumor

Objective To explore clinico-pathological features,immunophenotype,treatment and prognosis of urologic primary primitive neuroectodermal tumor ( PNET) . Methods The clinical data of 3 patients with urologic PNET were analyzed retrospectively. All patients were male,aged 29,32 and 75 years respectively.

Characteristics and long-term prognosis of patients with rectal neuroendocrine tumors

AIM: To analyze the clinicopathologic characteristics and prognostic factors of rectal neuroendocrine tumors.

Bioreductive prodrugs as cancer therapeutics:targeting tumor hypoxia

Hypoxia, a state of low oxygen, is a common feature of solid tumors and is associated with disease progression as well as resistance to radiotherapy and certain chemotherapeutic drugs. Hypoxic regions in tumors, therefore, represent attractive targets for cancer therapy. To date, five distinct classes of bioreactive prodrugs have been developed to target hypoxic cells in solid tumors. These hypoxia-activated prodrugs, including nitro compounds, N-oxides, quinones, and metal complexes, generally share a common mechanism of activation whereby they are reduced by intracellular oxidoreductases in an oxygensensitive manner to form cytotoxins. Several examples including PR-104, TH-302, and EO9 are currently undergoing phase II and phase III clinical evaluation. In this review, we discuss the nature of tumor hypoxia as a therapeutic target, focusing on the development of bioreductive prodrugs. We also describe the current knowledge of how each prodrug class is activated and detail the clinical progress of leading examples.

Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma

AIM:To explore the relationship between α-fetoprotein(AFP) and various clinicopathological variables and different staging system of hepatocellular carcinoma(HCC) thoroughly.METHODS:A retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and December 2009 in West China Hospital was enrolled in our study.The association of serum AFP values with the HCC clinicopathological features was analysed by univariate and multivariate analysis,such as status of hepatitis B virus(HBV) infection,tumor size,tumor number,vascular invasion and degree of tumor differentiation.Also,patients were divided into four groups at the time of enrollment according to different cutoff values for serum value of AFP(≤ 20 μg/L,21-400 μg/L,401-800 μg/L,and ≥ 801 μg/L),to compare the positive rate of patient among four groups stratified by various clinicopathological variables.And the correlation of different kinds of tumor staging systems,such as TNM,Barcelona Clinic Liver Cancer(BCLC) staging classification and China staging,were compared with the serum concentration of AFP.RESULTS:A total of 2304 HCC patients were enrolled in this study totally;the mean serum level of AFP was 555.3 ± 546.6 μg/L.AFP levels were within the normal range(< 20 μg/L) in 27.4%(n = 631) of all the cases.81.4%(n = 1875) patients were infected with HBV,and those patients had much higher serum AFP level compared with non-HBV infection ones(573.9 ± 547.7 μg/L vs 398.4 ± 522.3 μg/L,P < 0.001).The AFP level in tumors ≥ 10 cm(808.4 ± 529.2 μg/L) was significantly higher(P < 0.001) than those with tumor size 5-10 cm(499.5 ± 536.4 μg/L) and with tumor size ≤ 5 cm(444.9 ± 514.2 μg/L).AFP levels increased significantly in patients with vascular invasion(694.1 ± 546.9 μg/L vs 502.1 ± 543.1 μg/L,P < 0.001).Patients with low tumor cell differentiation(559.2 ± 545.7 μg/L) had the significantly(P = 0.007) highest AFP level compared with high differentiation(207.3 ± 420.8 μg/L) and intermediate differentiation(527.9 ± 538.4 μg/L).In the multiple variables analysis,low tumor cell differentiation [OR 6.362,95%CI:2.891-15.382,P = 0.006] and tumor size(≥ 10 cm)(OR 5.215,95%CI:1.426-13.151,P = 0.012) were independent predictors of elevated AFP concentrations(AFP > 400 μg/L).Serum AFP levels differed significantly(P < 0.001) in the D stage of BCLC(625.7 ± 529.8 μg/L) compared with stage A(506.2 ± 537.4 μg/L) and B(590.1 ± 551.1 μg/L).CONCLUSION:HCC differentiation,size and vascular invasion have strong relationships with AFP,poor differentiation and HCC size ≥ 10 cm are independent predictors of elevated AFP.BCLC shows better relationship with

Diagnosis and management of pancreatic neuroendocrine tumor in von Hippel-Lindau disease

The pancreatic manifestations seen in patients with von Hippel-Lindau(VHL) disease are subdivided into 2 categories:pancreatic neuroendocrine tumors(NET),and cystic lesions,including simple cyst and serous cystadenoma.The VHL-associated cystic lesions are generally asymptomatic and do not require any treatment,unless they are indistinguishable from other cystic tumor types with malignant potential.Because pancreatic NET in VHL disease are non-functioning and have malignant potential,it is of clinical importance to find and diagnose these as early as possible.It will be recommended that comprehensive surveillance using dynamic computed tomography for abdominal manifestations,including pancreatic NET,should start from the age of 15 years in VHL patients.Unlike sporadic non-functioning NET without VHL disease,in which surgical resection is generally recommended,VHL patients at lower metastatic risk of pancreatic NET should be spared the risks of operative resection.

Clinical significance of microRNA-130b in osteosarcoma and its role in cell growth and invasion

Objective: To investigate clinical signii cance of microRNA-130b(mi R-130b) in osteosarcoma and its role in cell growth and invasion. Methods: miR-130b expression was detected in 68 samples of surgically resected osteosarcoma and matched normal tumor-adjacent tissues by q RT-PCR. The expression of miR-130b was altered by corresponding vectors in osteosarcoma cells, and then Western blot was used to detect the expression of PPAR毭. Brd U cell proliferation and Transwell assays were performed to determine cell proliferation and invasion. Results: The expression of miR-130b in osteosarcoma tissues was signii cantly higher than that in normal tumor-adjacent tissues. Its expression in patients with metastasis was signii cantly higher than that in those without metastases. miR-130b expression in tumor tissues was signii cantly associated with tumor size, clinical stage and distant metastasis. And its expression was signii cantly correlated with overall survival and disease free survival. miR-130b overexpression obviously repressed the expression of PPAR毭, and resulted in signii cant increase of Saos-2 cell proliferation and invasion. On the contrast, repressing miR-130b expression with its inhibitor signii cantly increased PPAR毭 expression, and inhibited MG-63 cell proliferation and invasion. Conclusions: The high-expression of miR-130b is correlated with the adverse clinicopathological features and poor prognosis in osteosarcoma. miR-130b may regulate proliferation and invasion of osteosarcoma cells by targeting PPAR毭, suggesting miR-130b may play a key role in the progression of osteosarcoma.

Comparison between laparoscopic and open surgery for large gastrointestinal stromal tumors:A meta-analysis

AIM To investigate whether laparoscopic surgery is as safe and feasible as open resection for patients with larger gastrointestinal stromal tumors(GISTs)(≥ 5 cm).METHODS A systematic search of Pub Med, EMBASE, Web of Science and the Cochrane Library database was performed. Relevant studies of laparoscopic and open surgery for GISTs of > 5 cm published before December 2016 were identified from these databases. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. The tumor size, operation time, blood loss, postoperative hospital stay, complication rate, and disease-free survival rate were assessed. The software Stata(version 12.0) was used for the meta-analysis.RESULTS Five clinical trials comprising 209 patients with GISTs of similar larger sizes were evaluated. The pooled analysis of 100 patients in the laparoscopic resection group and 109 patients in the open resection group demonstrated that laparoscopic surgery was significantly associated with a shorter postoperative hospital stay(P < 0.001)and less blood loss(P = 0.002). Moreover, there were no statistically significant differences in the operation time(P = 0.38), postoperative complication rate(P = 0.88), or disease-free survival rate(P = 0.20) between two groups. CONCLUSION Our findings revealed that for patients with large GISTs of comparable sizes, laparoscopic surgery did not significantly influence the operation factors or clinical outcomes compared with open surgery. This suggests that laparoscopic resection is as acceptable as open surgery for treatment of large gastric GISTs.