Prieryklinio tarpo navikų diagnostikos ypatybės ir sunkumai

IntroductionParapharyngeal space tumours, most of them benign, account for some 0.5% of head and neck. Since they are rare, most clinicians will only come across a small number of them during their career. Nevertheless, it is important to highlight a few aspects of their diagnostics: symptoms are various and usually nonspecific, and signs manifest when tumour is rather advanced.Materials and methodsThis article summarizes diagnostic aspects of retrospective analysis of 6 parapharyngeal space tumour cases, treated in National Cancer Institute between 2004 and 2016. We revise the scientific literature and analyse the diagnostic sequence, placing special emphasis on describing difficulties and peculiarities of diagnosing parapharyngeal space tumours.Results3 benign and 3 malignant tumours were diagnosed. Patients reported a wide variety of symptoms, most of them being nonspecific. The vast majority of patients underwent preoperative fine needle aspiration biopsy (FNAB), and radiological imaging (computed tomography (CT) and/or magnetic resonance imaging (MRI) was performed for all of them.ConclusionsAll clinicians who come across these cases should take into consideration that symptoms of parapharyngeal space tumours are usually nonspecific, and signs appear after a period of silence. In diagnostic sequence, fine needle aspiration biopsy is mandatory to avoid histological surprises. Radiological imaging, especially MRI, is useful in predicting the origin, side, size and, to some extent, the type of the tumour.ĮžangaPrieryklinio tarpo navikai, dažniausiai nepiktybiniai, sudaro apie 0,5 % galvos ir kaklo srities navikų. Jie yra reti, todėl daugelis gydytojų per savo praktiką su šia patologija susiduria nedažnai. Svarbu išskirti kelis prieryklinio tarpo navikų diagnostikos ypatumus: simptomai yra įvairūs ir nespecifiški, o objektyvūs požymiai pasireiškia, kai navikas yra vėlesnės stadijos.Medžiaga ir metodaiŠiame straipsnyje apibendrinami retrospektyviosios šešių prieryklinio tarpo navikų atvejų analizės diagnostiniai aspektai. Visi aptariami pacientai buvo gydyti Nacionaliniame vėžio institute nuo 2004 iki 2016 metų. Straipsnyje apžvelgiame mokslinę literatūrą ir nagrinėjame diagnostikos seką, atkreipdami dėmesį į prieryklinio tarpo navikų diagnozavimo ypatumus bei sunkumus.RezultataiBuvo diagnozuoti trys gerybiniai ir trys piktybiniai navikai. Pacientai skundėsi įvairiais, daugiausia nespecifiniais, simptomais.Daugumai pacientų buvo atlikta priešoperacinė aspiracinė biopsija plona adata, visiems – priešoperacinis radiologinis tyrimas (kompiuterinė tomografija ir (ar) magnetinio rezonanso tomografija.IšvadosVisi gydytojai, susiduriantys su šia patologija, turėtų atkreipti dėmesį, kad prieryklinio tarpo navikų simptomai dažniausiai būna nespecifiniai, o objektyvūs požymiai pasireiškia navikui jau pažengus. Kalbant apie diagnostikos seką, aspiracinė biopsija plona adata yra būtinas tyrimas, siekiant išvengti histologinių netikėtumų. Radiologinis tyrimas, ypač magnetinio rezonanso tomografija, yra naudingas vertinant naviko kilmę, dydį, iš dalies ir tipą

Defining Melanoma Immune Biomarkers—Desert, Excluded, and Inflamed Subtypes—Using a Gene Expression Classifier Reflecting Intratumoral Immune Response and Stromal Patterns

The spatial distribution of tumor infiltrating lymphocytes (TILs) defines several histologically and clinically distinct immune subtypes—desert (no TILs), excluded (TILs in stroma), and inflamed (TILs in tumor parenchyma). To date, robust classification of immune subtypes still requires deeper experimental evidence across various cancer types. Here, we aimed to investigate, define, and validate the immune subtypes in melanoma by coupling transcriptional and histological assessments of the lymphocyte distribution in tumor parenchyma and stroma. We used the transcriptomic data from The Cancer Genome Atlas melanoma dataset to screen for the desert, excluded, and inflamed immune subtypes. We defined subtype-specific genes and used them to construct a subtype assignment algorithm. We validated the two-step algorithm in the qPCR data of real-world melanoma tumors with histologically defined immune subtypes. The accuracy of a classifier encompassing expression data of seven genes (immune response-related: CD2, CD53, IRF1, and CD8B; and stroma-related: COL5A2, TNFAIP6, and INHBA) in a validation cohort reached 79%. Our findings suggest that melanoma tumors can be classified into transcriptionally and histologically distinct desert, excluded, and inflamed subtypes. Gene expression-based algorithms can assist physicians and pathologists as biomarkers in the rapid assessment of a tumor immune microenvironment while serving as a tool for clinical decision making

The Impact of the COVID-19 pandemic on cancer patient’s management Lithuanian cancer center experience

The pandemic spread of the COVID-19 virus significantly affected daily life, but the highest pressure was piled on the health care system. Our aim was to evaluate an impact of COVID-19 pandemic management measures on cancer services at the National Cancer Institute (NCI) of Lithuania. We assessed the time period from 1 February 2020 to 31 December 2020 and compared it to the same period of 2019. Data for our analysis were extracted from the NCI Hospital Information System (HIS) and the National Health Insurance Fund (NHIF). Contingency table analysis and ANOVA were performed. The COVID-19 pandemic negatively affected the cancer services provided by NCI. Reductions in diagnostic radiology (−16%) and endoscopy (−29%) procedures were accompanied by a decreased number of patients with ongoing medical (−30%), radiation (−6%) or surgical (−10%) treatment. The changes in the number of newly diagnosed cancer patients were dependent on tumor type and disease stage, showing a rise in advanced disease at diagnosis already during the early period of the first lockdown. The extent of out-patient consultations (−14%) and disease follow-up visits (−16%) was also affected by the pandemic, and only referrals to psychological/psychiatric counselling were increased. Additionally, the COVID-19 pandemic had an impact on the structure of cancer services by fostering the application of modified systemic anticancer therapy or hypofractionated radiotherapy. The most dramatic drop occurred in the number of patients participating in cancer prevention programs; the loss was 25% for colon cancer and 62% for breast cancer screening. Marked restriction in access to preventive cancer screening and overall reduction of the whole spectrum of cancer services may negatively affect cancer survival measures in the nearest future. Keywords: COVID-19 pandemic; cancer management; national lockdown