Lymphadenectomy in hypopharyngeal cancer % correlation of micrometastatic spread with predictive molecular markers of therapeutic response

Uvod: Skvamocelularni karcinom hipofarinksa (SKH) predstavlja jednu od najagresivnijih neoplazmi glave i vrata. Petogodišnje preţivljavanje kod ovog oboljenja u većini studija je ispod 30%. Zahvaćenost limfnih ţlezda prepoznata je kao nabitniji prognostiĉki faktor za SKH. Hirurško leĉenje SKH stoga treba orijentisati prema odstranjenju primarnog tumora, ali i adekvatnoj limfonodalnoj disekciji, ĉime bi se postigao potencijalni kurativni efekat, ali i odredio taĉan stadijum i prognoza oboljenja. Uniformno radikalno operisana grupa bolesnika i veliki broj odstranjenih limfnih nodusa omogućio nam je adekvatno odreĊivanje distribucije limfonodalnih metastaza, procene N stadijuma bolesti, ali i dodatnu imunohistohemijsku analizu na prisustvo mikrometastaza u odstranjenim limfnim nodusima. Dodatnim ispitivanjem pokušali smo da ustanovimo korelaciju ekspresije molekularnih markera p53 i EGFR sa preţivljavanjem, i stadijumom bolesti odraţenim prevashodno kroz N stadijum bolesti. Metodologija: U studiju je ukljuĉeno ukupno 55 bolesnika kod kojih je naĉinjena faringolaringoezofagektomija sa funkcionalnom disekcijom vrata i rekonstrukcija visceralnim transplantatom. Disekcija obe strane vrata je uĉinjena primenom lateralne selektivne disekcije koja je obuhvatala uklanjanje limfnih nodusa iz nivoa II, III, IV i VI . Prilikom patohistološke obrade preparata posebna paţnja je obraćena na sledeće parametre:1. Primarna lokalizacija tumora (mukozna distribucija i dubina infiltracije, diferencijacija, invazija vaskularnih, limfatiĉnih i neuralnih elemenata), 2. Nodalni status (ukupan broj odstranjenih nodusa, ukupan broj pozitivnih nodusa, prisustvo ektrakapsularnog rasta, veliĉina nodusa). Dodatnom imunohistohemijskom analizom ispitivani su limfni nodusi na prisustvo mikrometastaza i izolovanih tumorskih ćelija, odnosno uĉinjena je semikvantitativna procena ekspresija ispitivanih 6 markera (p53 i EGFR). Statistiĉkim analizama naĉinjena je korelacija gore navedenih parametara sa ukupnim preţivljavanjem i kliniĉkim ishodom pri završetku studije...Introduction: Hypopharyngeal squamocellular carcinoma (HSCC) represents one of the most aggressive neoplastic diseases of head and neck. Most of the studies reports 5 year survival rate to be below 30%. Lymph node involvement in HSCC has been recognized as the most important prognostic factor. Surgical treatment of HSCC therefore should be oriented towards removal of the primary tumor, together with the adequate lymhonodal dissection, by which one accomplishes curative intent, both with the proper definite disease staging and prognosis. Uniformly radically operated group of patients and a large number of dissected lymph nodes provided us with a possibility of accurate estimation of lymph node distribution, accurate N staging and also allowed us additional immunohistochemical analyzes for presence of micrometastases in lymph nodes. With further investigation we will try to estimate the correlation between molecular expression of p53 and EGFR with the overall survival, and the disease stage. Methodology: Overall, in this study we included 55 patients in whom pharyngolaryngoesophagectomy with selective lymph node dissection and reconstruction with the visceral substituent was performed. We performed bilateral selective lymph node dissection, which included levels II, III, IV and VI. During the pathohistologic work up special emphasis was given upon: 1. primary tumor (mucosal distribution and the depth of infiltration, differentiation and invasion of vascular, lymphatic and neural elements), 2. nodal status (overall number of harvested lymh nodes, overall number of positive lymph nodes, size and presence of extracapsular growth). Immunohistochemistry was performed in order to determine presence of micrometastases and isolated tumor cels (ITC) in lymph nodes, and also to determine the expression of p53 and EGFR. Statistical analyzes were performed with the intent to determine the correlation of the aforementioned parameters with the overall survival rate. Results: In this study there was no intrahospital mortality. Overall survival median was 18.00 months (11,89 - 24,11). 42 (76%) patients died and 13 (24%) was alive when we ended the study. Two year survival was marked in 27 patients (46.5%). N0 stage was present in 17 patients, 8 9 patients had N1 stage while N2 stage was present in 30 patients..

Significance of KIT and PDGFRA mutations in gastric gastrointestinal stromal tumor imatinib-naive surgically treated patients

BACKGROUND: /Aim. KIT (KIT proto-oncogene receptor tyrosine kinase) and PDGFRA (platelet-derived growth factor receptor alpha) gene mutations represent major molecular forces inside the gastrointestinal stromal tumors (GIST). Aim of this study was to evaluate these mutations in the patients who underwent surgical resection of gastric GIST, but without imatinib mesylate treatment. Methods. Retrospective clinical study included patients who were operated on due to gastric GIST from November 2000 till November 2016. A molecular analysis of paraffin embedded tumor tissue was performed, and the patients with the presence of KIT and PDGFRA mutations were further evaluated, with regard to the pathological tumor stage, disease recurrence and overall survival. Results. Out of 45 patients in total, 43 patients had KIT and PDGFRA mutations, and 2 patients were classified as the wild type GIST. After curative resection, 11 patients were classified as a low risk GIST, 8 as an intermediate risk and 26 as a high risk GIST. The KIT mutations were present in 37 patients, most commonly as deletion in exon 11. The PDGFRA mutations were present in 6 patients. The presence of KIT mutation had a strong statistical correlation with the mitotic index (p = 0.021). After the ten-year follow-up, all patients with the PDGFRA mutations were alive, while those with the KIT mutations had a survival rate of 71% (p = 0.31). Conclusion. The presence of KIT exon 11 deletion in the patients with primarily resected gastric GIST is associated with the higher mitotic index and worse overall survival than those present with the PDGFRA mutations. This results suggest prognostic significance towards more aggressive behaviors

Lymphadenectomy in hypopharyngeal cancer % correlation of micrometastatic spread with predictive molecular markers of therapeutic response

Uvod: Skvamocelularni karcinom hipofarinksa (SKH) predstavlja jednu od najagresivnijih neoplazmi glave i vrata. Petogodišnje preţivljavanje kod ovog oboljenja u većini studija je ispod 30%. Zahvaćenost limfnih ţlezda prepoznata je kao nabitniji prognostiĉki faktor za SKH. Hirurško leĉenje SKH stoga treba orijentisati prema odstranjenju primarnog tumora, ali i adekvatnoj limfonodalnoj disekciji, ĉime bi se postigao potencijalni kurativni efekat, ali i odredio taĉan stadijum i prognoza oboljenja. Uniformno radikalno operisana grupa bolesnika i veliki broj odstranjenih limfnih nodusa omogućio nam je adekvatno odreĊivanje distribucije limfonodalnih metastaza, procene N stadijuma bolesti, ali i dodatnu imunohistohemijsku analizu na prisustvo mikrometastaza u odstranjenim limfnim nodusima. Dodatnim ispitivanjem pokušali smo da ustanovimo korelaciju ekspresije molekularnih markera p53 i EGFR sa preţivljavanjem, i stadijumom bolesti odraţenim prevashodno kroz N stadijum bolesti. Metodologija: U studiju je ukljuĉeno ukupno 55 bolesnika kod kojih je naĉinjena faringolaringoezofagektomija sa funkcionalnom disekcijom vrata i rekonstrukcija visceralnim transplantatom. Disekcija obe strane vrata je uĉinjena primenom lateralne selektivne disekcije koja je obuhvatala uklanjanje limfnih nodusa iz nivoa II, III, IV i VI . Prilikom patohistološke obrade preparata posebna paţnja je obraćena na sledeće parametre:1. Primarna lokalizacija tumora (mukozna distribucija i dubina infiltracije, diferencijacija, invazija vaskularnih, limfatiĉnih i neuralnih elemenata), 2. Nodalni status (ukupan broj odstranjenih nodusa, ukupan broj pozitivnih nodusa, prisustvo ektrakapsularnog rasta, veliĉina nodusa). Dodatnom imunohistohemijskom analizom ispitivani su limfni nodusi na prisustvo mikrometastaza i izolovanih tumorskih ćelija, odnosno uĉinjena je semikvantitativna procena ekspresija ispitivanih 6 markera (p53 i EGFR). Statistiĉkim analizama naĉinjena je korelacija gore navedenih parametara sa ukupnim preţivljavanjem i kliniĉkim ishodom pri završetku studije...Introduction: Hypopharyngeal squamocellular carcinoma (HSCC) represents one of the most aggressive neoplastic diseases of head and neck. Most of the studies reports 5 year survival rate to be below 30%. Lymph node involvement in HSCC has been recognized as the most important prognostic factor. Surgical treatment of HSCC therefore should be oriented towards removal of the primary tumor, together with the adequate lymhonodal dissection, by which one accomplishes curative intent, both with the proper definite disease staging and prognosis. Uniformly radically operated group of patients and a large number of dissected lymph nodes provided us with a possibility of accurate estimation of lymph node distribution, accurate N staging and also allowed us additional immunohistochemical analyzes for presence of micrometastases in lymph nodes. With further investigation we will try to estimate the correlation between molecular expression of p53 and EGFR with the overall survival, and the disease stage. Methodology: Overall, in this study we included 55 patients in whom pharyngolaryngoesophagectomy with selective lymph node dissection and reconstruction with the visceral substituent was performed. We performed bilateral selective lymph node dissection, which included levels II, III, IV and VI. During the pathohistologic work up special emphasis was given upon: 1. primary tumor (mucosal distribution and the depth of infiltration, differentiation and invasion of vascular, lymphatic and neural elements), 2. nodal status (overall number of harvested lymh nodes, overall number of positive lymph nodes, size and presence of extracapsular growth). Immunohistochemistry was performed in order to determine presence of micrometastases and isolated tumor cels (ITC) in lymph nodes, and also to determine the expression of p53 and EGFR. Statistical analyzes were performed with the intent to determine the correlation of the aforementioned parameters with the overall survival rate. Results: In this study there was no intrahospital mortality. Overall survival median was 18.00 months (11,89 - 24,11). 42 (76%) patients died and 13 (24%) was alive when we ended the study. Two year survival was marked in 27 patients (46.5%). N0 stage was present in 17 patients, 8 9 patients had N1 stage while N2 stage was present in 30 patients..

Aortoesophageal and aortobronchial fistula caused by Candida albicans after thoracic endovascular aortic repair

Introduction. Endovascular stent-graft placement has emerged as a minimally invasive alternative to open surgery for the treatment of aortic aneurysms and dissections. There are few reports of stent graft infections and aortoenteric fistula after endovascular thoracic aortic aneurysm repair, and the first multicentric study (Italian survey) showed the incidence of about 2%. Case report. We presented a 69-year-old male patient admitted to our hospital 9 months after thoracic endovascular aortic repair, due to severe chest pain in the left hemithorax and arm refractory to analgesic therapy. Multislice computed tomography (MSCT) showed a collection between the stent graft and the esophagus with thin layers of gas while gastroendoscopy showed visible blood jet 28 cm from incisive teeth. Surgical treatment was performed in collaboration of two teams (esophageal and vascular surgical team). After explantation of the stent graft and in situ reconstruction by using Dacron graft subsequent esophagectomy and graft omentoplasty were made. After almost four weeks patient developed hemoptisia as a sign of aorto bronchial fistula. Treatment with implantation of another aortic cuff of 26 mm was performed. The patient was discharged to the regional center with negative blood culture, normal inflammatory parameters and respiratory function. Three months later the patient suffered deterioration with the severe weight loss and pneumonia caused by Candida albicans and unfortunately died. The survival time from the surgical treatment of aortoesophageal fistula was 4 months. Conclusion. Even if endovascular repair of thoracic aortic diseases improves early results, risk of infection should not be forgotten. Postoperative respiratory deterioration and finally hemoptisia could be the symptoms of another fistula

Perforated Appendicitis and Bowel Incarceration within Morgagni Hernia: A Case Report

Morgagni hernia (MH) is a result of abdominal organ protrusion through the congenital defect in the anterior retrosternal aspect of the diaphragm. The colon and omentum are the most commonly involved organs, followed by the small intestine, stomach and liver. Symptoms of MH may be absent, although the majority of patients will experience mild dyspnea or abdominal discomfort. We present a case of MH complicated with intrathoracic acute perforated appendicitis and intestinal obstruction

The Utility of Conventional CT, CT Perfusion and Quantitative Diffusion-Weighted Imaging in Predicting the Risk Level of Gastrointestinal Stromal Tumors of the Stomach: A Prospective Comparison of Classical CT Features, CT Perfusion Values, Apparent Diffusion Coefficient and Intravoxel Incoherent Motion-Derived Parameters

Background: The role of advanced functional imaging techniques in prediction of pathological risk categories of gastrointestinal stromal tumors (GIST) is still unknown. The purpose of this study was to evaluate classical CT features, CT-perfusion and magnetic-resonance-diffusion-weighted-imaging (MR-DWI)-related parameters in predicting the metastatic risk of gastric GIST. Patients and methods: Sixty-two patients with histologically proven GIST who underwent CT perfusion and MR-DWI using multiple b-values were prospectively included. Morphological CT characteristics and CT-perfusion parameters of tumor were comparatively analyzed in the high-risk (HR) and low-risk (LR) GIST groups. Apparent diffusion coefficient (ADC) and intravoxel-incoherent-motion (IVIM)-related parameters were also analyzed in 45 and 34 patients, respectively. Results: Binary logistic regression analysis revealed that greater tumor diameter (p < 0.001), cystic structure (p < 0.001), irregular margins (p = 0.007), irregular shape (p < 0.001), disrupted mucosa (p < 0.001) and visible EFDV (p < 0.001), as well as less ADC value (p = 0.001) and shorter time-to-peak (p = 0.006), were significant predictors of HR GIST. Multivariate analysis extracted irregular shape (p = 0.006) and enlarged feeding or draining vessels (EFDV) (p = 0.017) as independent predictors of HR GIST (area under curve (AUC) of predicting model 0.869). Conclusion: Although certain classical CT imaging features remain most valuable, some functional imaging parameters may add the diagnostic value in preoperative prediction of HR gastric GIST