Comment on ‘Histological Subtypes of Lung Cancer in Chinese Males from 2000 to 2012'

Mortality from lung cancer has dramatically increased in China over the past 4 decades and investigations into its attributing factors should be designated as one of the highest priorities for its prevention and control. It has been shown that different environmental carcinogens have different particular carcinogenesis pathways in humans, resulting in different kinds of cancer or its histological subtypes in various target organs. Although the distribution of lung cancer is changing in many countries, no papers on its epidemiology in China are available. In the present study, 15 427 male lung cancer patients were identified in Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medial Colleg （CHCAMS-PUMC）. The number of lung cancer patients increased between 2000 and 2012 （Zou et al., Table I）, while the relative frequency of squamous cell carcinoma, a pathological sub-type of lung cancer, consistently decreased, especially in those born after 1961 （Zou et al, Figure 2）. On the other hand, the relative frequency of adenocarcinoma, a pathological sub-type of lung cancer, dramatically increased （Zou et al., Figure 2）. Adenocarcinoma has become the major histological sub-type of lung cancer in the 2011-2012 period （Zou et al., Table 3）. These findings provide important information and clues for the etiology of lung cancer and this specific field needs to be further studied.

Rare histological subtype of invasive micropapillary carcinoma in the ampulla of Vater: A case report

BACKGROUND Carcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm,and the most common histological type is adenocarcinoma with a tubular growth pattern.Invasive micropapillary carcinoma(IMPC)is an aggressive variant of adenocarcinoma in several organs that is associated with lymph node metastasis and poor prognosis.IMPC was first described as a histological subtype of breast cancer;however,IMPC of the ampulla of Vater is extremely rare,with only three articles reported in the English literature.CASE SUMMARY We have reported a case of IMPC of the ampulla of Vater in an 80-year-old man.Microscopically,the surface area of the carcinoma was composed of tubulopapillary structures mimicking intra-ampullary papillary-tubular neoplasm,and the deep invasive front area exhibited a pattern of IMPC.The carcinoma showed lymphatic invasion and extensive lymph node metastasis.The immunohistochemical study revealed mixed intestinal and gastric/pancreatobiliary phenotypes.CONCLUSION This rare subtype tumor in the ampulla of Vater showed a histologically mixed phenotype and exhibited aggressive behavior.

Relationship between molecular changes in epidermal growth factor receptor(EGFR)and anaplastic lymphoma kinase(ALK)mutations in lung adenocarcinoma

Objective This study aimed to analyze the relationship between the mutations in epidermal growth factor receptor(EGFR)and anaplastic lymphoma kinase(ALK)and their impact on the prognosis and treatment of lung adenocarcinoma.Methods A total of 158 cases of lung adenocarcinoma reported between January 2007 and January 2014 were retrospectively analyzed.These tumors were resected using radical pneumonectomy and underwent pathology-based diagnosis at our institution(Inner Mongolia People’s Hospital,Hohhot,China).The tissue sections were evaluated using the updated World Health Organization classification of lung adenocarcinomas(2015 version),with each histological component recorded in 5%increments.The histological subtypes were classified,and any surviving cases were followed up.The reverse transcription-polymerase chain reaction(RT-PCR)and direct DNA sequencing were used to evaluate mutations in exons 18,19,20,and 21 in the EGFR gene,and the echinoderm microtubule-associated protein-like 4 gene-ALK variant(EML4-ALK)fusions were detected using sequencing.Results Our cohort included 25 patients with pre-invasive adenocarcinoma,13 patients with lepidic,66 patients with acinar,13 patients with papillary,and 25 patients with solid infiltrative adenocarcinoma with the remaining cases presenting with a variety of pathological subtypes.The prognosis of each histological subtype was different with the 5-year disease-free survival and 5-year overall survival(OS)of pre-invasion adenocarcinoma at 100%;the 5-year OS of lepidic,acinar,and papillary adenocarcinoma patients was only 84.6%,72.7%,and 76.9%,respectively.The 5-year OS of solid and mucinous adenocarcinomas were 32.0%and 36.4%,respectively.EGFR mutation was detected in 69 cases with a mutation rate of 43.7%and majority of these mutations were found in exons 19(50.6%)and 21(37.9%),with women and non-smokers shown to experience a higher mutation rate(P<0.05).However,histological subtype analysis showed that EGFR mutations were primarily found in adenocarcinomas.Most of these mutations were found in lepidic(53.8%)or acinar adenocarcinomas(50.0%),whereas these mutations were rare in both solid(28.0%)and mucinous adenocarcinoma(27.2%).The fusion mutation rate in the EML4-ALK gene was 5.69%,and was most common in young,nonsmoking patients(P<0.05).Conclusion The prognosis of patients in each lung adenocarcinoma subtype is different,and these outcomes are likely related to mutations in the EGFR and EML4-ALK genes.EGFR mutation rates are higher in lepidic and acinar adenocarcinomas,whereas EML4-ALK gene fusion mutations are more common in solid and mucinous adenocarcinoma.EGFR mutations are more common in female and non-smoking patients,whereas EML4-ALK fusions are more common in young,non-smoking patients.

Infra-tentorial brain tumor subtypes in children and adults--surgical outcome in an ethnic population with a single regional tertiary center

Background:To analyze clinically and radiologically the surgical outcome like residual disease,progression of disease,recurrence,disabilities,event-free survival(EFS),and mortality of different infra-tentorial tumor subtypes in children and adults of a strictly non-migratory and ethnic population.Methods:The 410 histologically proved,out of 589,infra-tentorial brain tumor patients were analyzed clinically and by the imaging post-surgically in a single tertiary center for an ethnic region.In this analytico-observational study,retrospectively postoperative records of 589 infra-tentorial brain tumors from November 1998 to December 2018(20 years)were retrieved,scrutinized,and compiled.The post-operative clinic-radiological records of 410 patients with proved histopathological examination results were included.Statistical law of variance was applied where-ever necessary.Results:The 63.2%of the all 410 operated infra-tentorial brain tumors were males while females predominated in meningiomas and pineoblastomas.About 31.7%infra-tentorial tumors were children(below 18 years).About 54.1%cases were histologically malignant.The residual tumors comprised 40.2%and symptoms of disease-progression occurred in 10.9%.The tumor recurrence occurred in 14.3%while 6.0%patients developed severe disability.The overall mortality was 11.4%but 18.9%in malignant tumors.The event-free survival(EFS)for all the patients was 66.0%,patients with malignancies had 47.7%and benign group had 87.7%.Conclusion:The study,surgical outcome of infra-tentorial brain tumor subtypes in children and adults(approx.1/3rd of patients being children),conducted in a tertiary center at a remote land-locked location with non-migratory ethnic population as its catchment area,has a significant epidemiological value for the community and the region.