Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy

© 2008 Libertas Academica Ltd. All rights reserved.Purpose: The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT).Methods and Materials: Seventeen patients with high rectal, rectosigmoid or distal sigmoid tumours above the peritoneal reflection received neoadjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy.Results: Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA).Conclusions: Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins

Small bowel gastrointestinal stromal tumours and ampullary cancer in Type 1 neurofibromatosis

BACKGROUND: Type 1 neurofibromatosis (NF-1) is an autosomal dominant disorder with variable penetrance; approximately 50% of cases present as new mutations CASE REPORT: We report a case of a 56 year-old man with Von Recklinghausen's disease, carcinoma of the ampulla of Vater and incidental benign gastrointestinal stromal tumours of the jejunum. CONCLUSIONS: Coexistence between ampullary carcinoid, ectopic pancreatic tissue in the jejunum and neurofibroma of the jejunum in NF-1 has been previously described however; the association of synchronous carcinoma of the ampulla of Vater and gastrointestinal stromal tumour of the jejunum in NF-1 has not been previously reported

Assessing the viability of estimating baleen whale abundance from tourist vessels

Many populations of southern hemisphere baleen whales are recovering and are again becoming dominant consumers in the Southern Ocean. Key to understanding the present and future role of baleen whales in Southern Ocean ecosystems is determining their abundance on foraging grounds. Distance sampling is the standard method for estimating baleen whale abundance but requires specific logistic requirements which are rarely achieved in the remote Southern Ocean. We explore the potential use of tourist vessel-based sampling as a cost-effective solution for conducting distance sampling surveys for baleen whales in the Southern Ocean. We used a dataset of tourist vessel locations from the southwest Atlantic sector of the Southern Ocean and published knowledge from Southern Ocean sighting surveys to determine the number of tourist vessel voyages required for robust abundance estimates. Second, we simulated the abundance and distributions of four baleen whale species for the study area and sampled them with both standardized line transect surveys and non-standardized tourist vessel-based surveys, then compared modeled abundance and distributions from each survey to the original simulation. For the southwest Atlantic, we show that 12-22 tourist vessel voyages are likely required to estimate abundance for humpback and fin whales, with relative estimates for blue, sei, Antarctic minke, and southern right whales. Second, we show tourist vessel-based surveys outperformed standardized line transect surveys at reproducing simulated baleen whale abundances and distribution. These analyses suggest tourist vessel-based surveys are a viable method for estimating baleen whale abundance in remote regions. For the southwest Atlantic, the relatively cost-effective nature of tourist vessel-based survey and regularity of tourist vessel voyages could allow for annual and intra-annual estimates of abundance, a fundamental improvement on current methods, which may capture spatiotemporal trends in baleen whale movements on forging grounds. Comparative modeling of sampling methods provided insights into the behavior of general additive model-based abundance modeling, contributing to the development of detailed guidelines of best practices for these approaches. Through successful engagement with tourist company partners, this method has the potential to characterize abundance across a variety of marine species and spaces globally, and deliver high-quality scientific outcomes relevant to management organizations.publishedVersio

Carbon sequestration potential of a 27-year-old tree-based intercropping system in southwestern Ontario

Paper presented at the 13th North American Agroforesty Conference, which was held June 19-21, 2013 in Charlottetown, Prince Edward Island, Canada.In Poppy, L., Kort, J., Schroeder, B., Pollock, T., and Soolanayakanahally, R., eds. Agroforestry: Innovations in Agriculture. Proceedings, 13th North American Agroforestry Conference, Charlottetown, Prince Edward Island, Canada, June 19-21, 2013.This study aimed to quantify carbon (C) pools and fluxes in a 27-year-old tree-based intercropping (TBI) system as compared to a conventional agricultural system at the University of Guelph�s Agroforestry Research Station (43o 16�N 89o 26�W) (established 1987). Tree species quantified during this study include poplar hybrid (Populus spp.), Norway spruce (Picea abies), red oak (Quercus rubra), black walnut (Juglans nigra), and white cedar (Thuja occidentalis). In the TBI system, above- and belowground biomass, along with soil organic carbon (SOC) concentrations, litterfall, litter decomposition and soil respiration were quantified. In the conventional agricultural field, SOC, litter decomposition and soil respiration were quantified. Preliminary results indicated higher C sequestration potential rate with faster growing species such as poplar, and slower potential rate for slower growing species such as spruce and cedar. SOC accumulation was highest in the predominant wind direction (east), closest to the tree rows (0.5 m), and at shallower depths (10-20 cm) for all species. SOC accumulation was highest under poplar tree, followed by spruce, oak and walnut. Quantities of litterfall followed similar pattern and decomposition rates are still being analyzed. Soil respiration rates were higher in TBI systems and at distances closer to the tree row. Further results will be presented on the total measured C pools and fluxes and the importance of C sequestration potential of a 27-year-old TBI system to sequester atmospheric C and mitigate climate change. Accumulation of SOC can also have implications on crop yields and long term stability of TBI soils.Amy Wotherspoon (1), Idris Mohammed (1), Naresh V. Thevathasan (1), Andrew M. Gordon (1), and R. Paul Voroney (1) ; 1. School of Environmental Sciences, University of Guelph, Guelph, ON, Canada, N1G 2W1.Includes bibliographical references

Dynamic Site Characterisation of the Waikato Basin using Passive and Active surface Wave Methods

Despite the relatively low seismicity, a large earthquake in the Waikato region is expected to have a high impact, when the fourth-largest regional population and economy and the high density critical infrastructure systems in this region are considered. Furthermore, Waikato has a deep soft sedimentary basin, which increases the regional seismic hazard due to trapping and amplification of seismic waves and generation of localized surface waves within the basin. This phenomenon is known as the “Basin Effect”, and has been attributed to the increased damage in several historic earthquakes, including the 2010-2011 Canterbury earthquakes. In order to quantitatively model the basin response and improve the understanding of regional seismic hazard, geophysical methods will be used to develop shear wave velocity profiles across the Waikato basin. Active surface wave methods involve the deployment of linear arrays of geophones to record the surface waves generated by a sledge hammer. Passive surface wave methods involve the deployment of two-dimensional seismometer arrays to record ambient vibrations. At each site, the planned testing includes one active test and two to four passive arrays. The obtained data are processed to develop dispersion curves, which describe surface wave propagation velocity as a function of frequency (or wavelength). Dispersion curves are then inverted using the Geopsy software package to develop a suite of shear wave velocity profiles. Currently, more than ten sites in Waikato are under consideration for this project. This poster presents the preliminary results from the two sites that have been tested. The shear wave velocity profiles from all sites will be used to produce a 3D velocity model for the Waikato basin, a part of QuakeCoRE flagship programme 1

A comparison of immunohistochemical assays and FISH in detecting the ALK translocation in diagnostic histological and cytological lung tumor material.

Introduction:Detection of the ALK rearrangement in a solid tumor gives these patients the option of crizotinib as an oral form of anticancer treatment. The current test of choice is fluorescence in situ hybridization (FISH), but various cheaper and more convenient immunohistochemical (IHC) assays have been proposed as alternatives.Methods:Fifteen FISH-positive cases from patients, seven with data on crizotinib therapy and clinical response, were evaluated for the presence of ALK protein using three different commercially available antibodies: D5F3, using the proprietary automated system (Ventana), ALK1 (Dako), and 5A4 (Abcam). A further 14 FISH-negative and three uncertain (<15% rearrangement detected) cases were also retrieved. Of the total 32 specimens, 17 were excisions and 15 were computed tomography-guided biopsies or cytological specimens. All three antibodies were applied to all cases. Antibodies were semiquantitatively scored on intensity, and the proportion of malignant cells stained was documented. Cutoffs were set by receiver operating curve analysis for positivity to optimize correct classification.Results:All three IHC assays were 100% specific but sensitivity did vary: D5F3 86%, ALK 79%, 5A4 71%. Intensity was the most discriminating measure overall, with a combination of proportion and intensity not improving the test. No FISH-negative IHC-positive cases were seen. Two FISH-positive cases were negative with all three IHC assays. One of these had been treated with crizotinib and had failed to show clinical response. The other harbored a second driving mutation in the EGFR gene.Conclusions:IHC with all three antibodies is especially highly specific (100%) although variably sensitive (71%-86%), specifically in cases with scanty material. D5F3 assay was most sensitive in these latter cases. Occasional cases are IHC-positive but FISH-negative, suggesting either inaccuracy of one assay or occasional tumors with ALK rearrangement that do not express high levels of ALK protein

CCR6 activation links innate immune responses to mucosa-associated lymphoid tissue lymphoma development

The genesis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is driven by oncogenic co-operation among immunological stimulations and acquired genetic changes. We previously identified recurrent CCR6 mutations in MALT lymphoma, with majority predicted to result in truncated proteins lacking the phosphorylation motif important for receptor desensitization. Functional consequences of these mutational changes, the molecular mechanisms of CCR6 activation and how this receptor signaling contributes to MALT lymphoma development remain to be investigated. In the present study, we demonstrated that these mutations impaired CCR6 receptor internalization and were activating changes, being more potent in apoptosis resistance, malignant transformation, migration and intracellular signaling, particularly in the presence of the ligands CCL20, HBD2 (human beta defensin 2) and HD5 (human alpha defensin 5). CCR6 was highly expressed in malignant B cells irrespective of the lymphoma sites. HBD2 and CCL20 were constitutively expressed by the duct epithelial cells of salivary glands, and also those involved in lymphoepithelial lesions (LEL) in salivary gland MALT lymphoma. While in the gastric setting, HBD2, and HD5, to a less extent CCL20, were highly expressed in epithelial cells of pyloric and intestinal metaplasia respectively including those involved in LEL, which are adaptive responses to chronic Helicobacter pylori infection. These findings suggest that CCR6 signaling is most likely active in MALT lymphoma, independent of its mutation status. The observations explain why the emergence of malignant B cells and their clonal expansion in MALT lymphoma are typically around LEL, linking the innate immune responses to lymphoma genesis

B-cell lymphomas with discordance between pathological features and clinical behavior

B-cell lymphomas encompass a large number of disease entities clinically ranging from indolent to aggressive. The defining pathological features usually predict clinical course, with small and large B-cell lymphomas correlating to low-grade vs high-grade features, but discordant situations may be encountered. Two sessions of the workshop of the XVIII meeting of the European Association for Haematopathology (EAHP) held in Basel in 2016 addressed this topic. One session illustrated various facets of "aggressiveness" in indolent lymphomas, either peculiar clinical manifestations, cytological variants, or unusual genetic features, as well as several examples of progression or transformation to a more aggressive disease. Another session exemplified large B-cell lymphomas with unexpected indolent behavior including cases arising in well-defined body compartments or in sanctuary sites. This paper describes the features of the cases presented in both groups, highlights the most salient points of discussion raised by the submitters and the panel, and summarizes current knowledge and recommendations relevant to diagnostic pathology practice

Unusual presentation of metastatic adenocarcinoma

<p>Abstract</p> <p>Background</p> <p>The most common tumours of the adrenal gland are adenoma, pheochromocytoma, adrenocortical carcinoma, and metastases. Although the imaging features of these tumours are established, the imaging characteristics of uncommon adrenal masses are less well known. In patients with extradrenal tumour, incidental discovery of an adrenal mass necessitates excluding the possibility of metastatic malignancy.</p> <p>Case presentation</p> <p>A 52 year-old female was diagnosed with oesophageal adenocarcinoma and treated with oesophagectomy and adjuvant chemotherapy. Sixteen months later on staging CT scan a 2 × 2 cm adrenal mass was detected, which increased in size over a period of time to 3 × 3 cm in size. Adrenalectomy was performed and histological examination revealed metastatic adenocarcinoma within an adrenal adenoma.</p> <p>Conclusion</p> <p>The present case highlights the unusual behaviour of an oesophageal adenocarcinoma causing metastasis to an adrenocortical adenoma.</p