The role of sentinel node tumor burden in modeling the prognosis of melanoma patients with positive sentinel node biopsy: an Italian melanoma intergroup study (N = 2,086)

Background The management of melanoma patients with metastatic melanoma in the sentinel nodes (SN) is evolving based on the results of trials questioning the impact of completion lymph node dissection (CLND) and demonstrating the efficacy of new adjuvant treatments. In this landscape, new prognostic tools for fine risk stratification are eagerly sought to optimize the therapeutic path of these patients. Methods A retrospective cohort of 2,086 patients treated with CLND after a positive SN biopsy in thirteen Italian Melanoma Centers was reviewed. Overall survival (OS) was the outcome of interest; included independent variables were the following: age, gender, primary melanoma site, Breslow thickness, ulceration, sentinel node tumor burden (SNTB), number of positive SN, non-sentinel lymph nodes (NSN) status. Univariate and multivariate survival analyses were performed using the Cox proportional hazard regression model. Results The 3-year, 5-year and 10-year OS rates were 79%, 70% and 54%, respectively. At univariate analysis, all variables, except for primary melanoma body site, were found to be statistically significant prognostic factors. Multivariate Cox regression analysis indicated that older age (P < 0.0001), male gender (P = 0.04), increasing Breslow thickness (P < 0.0001), presence of ulceration (P = 0.004), SNTB size (P < 0.0001) and metastatic NSN (P < 0.0001) were independent negative predictors of OS. Conclusion The above results were utilized to build a nomogram in order to ease the practical implementation of our prognostic model, which might improve treatment personalization

An AI-Based Algorithm for the Automatic Classification of Thoracic Radiographs in Cats

An artificial intelligence (AI)-based computer-aided detection (CAD) algorithm to detect some of the most common radiographic findings in the feline thorax was developed and tested. The database used for training comprised radiographs acquired at two different institutions. Only correctly exposed and positioned radiographs were included in the database used for training. The presence of several radiographic findings was recorded. Consequenly, the radiographic findings included for training were: no findings, bronchial pattern, pleural effusion, mass, alveolar pattern, pneumothorax, cardiomegaly. Multi-label convolutional neural networks (CNNs) were used to develop the CAD algorithm, and the performance of two different CNN architectures, ResNet 50 and Inception V3, was compared. Both architectures had an area under the receiver operating characteristic curve (AUC) above 0.9 for alveolar pattern, bronchial pattern and pleural effusion, an AUC above 0.8 for no findings and pneumothorax, and an AUC above 0.7 for cardiomegaly. The AUC for mass was low (above 0.5) for both architectures. No significant differences were evident in the diagnostic accuracy of either architecture

Surgery and adjuvant therapies in the treatmentof stage IV melanoma: our experience in 84 patients

Background and aims Survival rates of patients with stage IV melanoma are poor: Median survival is 7\u20138 months and 5-year survival rates about 5%. There is no agreement on the role of surgery at this stage. Most patients with metastatic melanoma are not able to undergo resection and usually are sent to systemic chemo- and immunotherapy. Patients and methods Eighty-four patients operated on for stage IV melanoma were evaluated. Of them, 61.9% were submitted to reiterative surgery with 168 operations and 182 surgical procedures overall. A total of 90.5% was submitted to adjuvant therapies according to aggressive and reiterated schedules: chemotherapy, immunotherapy, dendritic cells vaccine, infusion of tumor infiltrating lymphocytes, local therapies as electrochemotherapy. Results The mean overall survival (Kaplan\u2013Meier) was 56.7 months (1 year: 72.1%, 3 years: 46.5%, 5 years: 23.16%). The survival of reiterative surgery was significatively longer than single surgery (62.7 vs 42.4 months

Un caso di sarcoma fibromixoide a basso grado con rara localizzazione retroperitoneale sconfinata all’inguine

Introduzione: Il sarcoma fibromixoide a basso grado (LGFMS) è una rara neoplasia che di solito colpisce giovani adulti ma riportata anche in bambini e di solito a partenza dai tessuti molli delle estremità prossimali. Riportiamo un caso di LGFMS con eccezionale localizzazione retroperitoneale e sconfinante all’inguine. Caso clinico: Un uomo di 40 anni dopo una storia di dolori addominali ingravescenti e sintomi sub-occlusivi, veniva sottoposto prima ad ecografia addominale e poi a TC con mdc per una massa retroperitoneale di 11x10x10 cm adesa al muscolo ileo-psoas dx che dislocava medialmente anse ileali,cieco e vescica. Per l’aggravamento rapido della sintomatologia è stato sottoposto direttamente a chirurgia senza previa biopsia. Si è proceduto ad exeresi radicale previa biopsia intraoperatoria (sarcoma a basso grado) della massa, che dislocava senza comprimere i vasi spermatici ed iliaci, e che sconfinava con una propaggine di 4 cm in regione inguinale attraverso la lacuna vasorum. L’istologia della massa di 480 g ha posto diagnosi di LGFMS nella variante “a rosette giganti”. Non è stata eseguita nessuna terapia adiuvante. Dopo uno stretto follow-up basato su TC toraco-addominale e risonanza magnetica (RMN), il paziente dopo 18 mesi è vivo e libero da malattia. Conclusioni: Il LGFMS è un tumore con basso grado istologico ma con alto rischio di recidiva locale e rischio significativo di metastatizzazione anche tardiva. Bisogna sempre sospettare questo raro tumore ed inviare i tessuti per esami di citogenetica o genetica molecolare se presenti dubbi. Precauzioni speciali vanno poste nell’interpretazione di biopsie con blanda cellularità fusiforme in bambini. Un accurato follow-up è richiesto dopo chirurgia radicale

Emergencies in colorectal carcinoma: negative prognostic factor

The authors analyze a consecutive series of 219 patients affected by complicated colorectal cancer who underwent surgery in emergency. In hospital mortality, 5-year survival and recurrence\u2019s incidence in 104 of these patients who underwent curative treatment are calculated and compared with a series of 701 patients who underwent elective surgical treatment. There was no significative statistical difference between emergency and elective group. At the multivariate analysis only the stage of the tumour was an independent prognostic factor

A rare case of giant malignant eccrine spiradenoma

A 45-year-old man from Nigeria in generally good health presented with a giant occipital neoformation approximately 8 7 8 cm. The lesion, exophytic, ulcerated, bleeding, and foul-smelling, had first appeared 4 months earlier and had grown rapidly. There was another similar, smaller lesion near the original one, which was presumed to be an intransit metastasis. Contrast-enhanced computed tomography and positron emission tomography scans confirmed that the patient had already developed lung, bone, and kidney metastases

Chirurgia per carcinoma gastrico in area ad elevata incidenza: studio retrospettivo

Background and aims: Gastric cancer (GC) remains one of most worldwide frequent cancers. In Eastern Tuscany (Italy), the areas close to mountains are high-risk areas, with GC incidence and mortality significantly higher than in rest of Italy and Western European Countries. The experience in gastric surgery from a little-sized hospital located in high-risk area is reported. Methods: From 2000 to 2008, 206 patients (mean age 74.3 yrs) were diagnosed for GC. 35% of them were already in far-advanced and metastatic stage and not operated on. Surgery, post-operative mortality and morbidity, clinico-pathologic features and actuarial cumulative survival (Kaplan-Meier) were retrospectively analyzed; uni- (log rank) and multi-variated analysis (Cox’s regression) were performed. Results: In 78.8% of patients submitted to operation, radical surgery was achieved. The mean excised nodes were 31.8; only in 11% of cases less than 15 nodes were excised. Median overall survival (OS) was 51.2 mos for radical surgery vs 4.2 of palliative surgery and 5.5 of no surgery. The lympho-nodal status, the T-status, the N ratio, hystology according Lauren’s, UICC stage were all correlated with survival at univariated analysis. N ratio, N status and T status were independent prognostic factors also at Cox’s multivariated analysis. Conclusion: Endoscopic screening is desiderable in high-risk areas for GC. In the treatment of gastric cancer, radical surgery plays a lead role, but the recurrence rate is high even after curative surgery combined with extended nodal dissection. Multimodal treatments should be considered in the treatment of these patients