scholarly journals Prognostic Implication of Preoperative Behavior Changes in Patients with Primary High-Grade Meningiomas

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Andrej Vranic ◽  
Frederic Gilbert
Keyword(s):  
Brain Edema ◽  
Tumor Size ◽  
Tumor Grade ◽  
Tumor Location ◽  
Proliferation Index ◽  
Behavior Changes ◽  
High Grade ◽  
Duration Of Symptoms ◽  
Brain Invasion ◽  
Male Patients

High-grade meningiomas are rare extra-axial tumors, frequently causing brain invasion and prominent brain edema. Patients harboring high-grade meningiomas occasionally present with behavior changes. Data about frequency and prognostic importance of preoperative behavior changes in patients with high-grade meningiomas is missing. 86 patients with primary high-grade meningiomas were analyzed. Statistical analysis was performed to determine correlation of preoperative behavior changes with tumor location, preoperative brain edema, tumor cleavability, tumor grade, Ki67 proliferation index, and microscopic brain invasion. Survival analysis was performed. 30 (34.9%) patients presented with preoperative behavior changes. These changes were more frequent with male patients (P=0.066) and patients older than 55 years (P=0.018). They correlated with frontal location (P=0.013), tumor size (P=0.023), microscopic brain invasion (P=0.015), and brain edema (P=0.006). Preoperative behavior changes did not correlate with duration of symptoms, tumor cleavability, tumor malignancy grade, and Ki67 proliferation index. They were not significantly related to overall survival or recurrence-free survival of patients with primary high-grade meningiomas. Preoperative behavior changes are frequent in patients harboring primary high-grade meningiomas. They correlate with tumor size, microscopic brain invasion, and brain edema. Preoperative behavior changes do not predict prognosis in patients with primary high-grade meningiomas.

scholarly journals 5-Aminolevulinic Acid Fluorescence in High Grade Glioma Surgery: Surgical Outcome, Intraoperative Findings, and Fluorescence Patterns

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Pietro Ciccarino ◽  
Giuseppe Lombardi ◽  
Giuseppe Rolma ◽  
Diego Cecchin ◽  
...  
Keyword(s):  
Tumor Size ◽  
Surgical Outcome ◽  
Aminolevulinic Acid ◽  
High Grade Glioma ◽  
Tumor Grade ◽  
Tumor Location ◽  
Consecutive Series ◽  
High Grade ◽  
Glioma Surgery ◽  
Surgical Data

Background. 5-Aminolevulinic acid (5-ALA) fluorescence is a validated technique for resection of high grade gliomas (HGG); the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients.Methods. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection(GTR)>98% andGTR>90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO).Results. 94 patients were finally enrolled. OverallGTR>98% andGTR>90% was achieved in 93% and 100% of patients. Extent of resection(GTR>98%)was dependent on tumor location, tumor grade(P<0.05), and tumor size(P<0.05). In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57%)(P<0.01)and recurrent (60%) tumors.Conclusions. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.

scholarly journals Non-muscle invasive high grade urothelial carcinoma of the bladder. Which factors can influence understaging at the time of radical cystectomy?

2016 ◽  
Vol 88 (1) ◽  
pp. 13 ◽  
Author(s):  
Daniele Minardi ◽  
Giulio Milanese ◽  
Gianni Parri ◽  
Vito Lacetera ◽  
Giovanni Muzzonigro
Keyword(s):  
Risk Factors ◽  
Radical Cystectomy ◽  
Lamina Propria ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Residual Tumor ◽  
Tumor Location ◽  
High Grade ◽  
Microscopic Vascular Invasion ◽  
Muscle Invasive

Objective: To evaluate the main factors which influence understaging in patients with T1G3 non-muscle invasive bladder cancer (NMIBC). Materials and methods: 109 patients with T1/G3 underwent transurethral resection of bladder tumor (TURBT) and then radical cystectomy (RC) with pelvic lymph nodes dissection. A number of variables were considered when evaluating the detection of understaging. We considered the patients age and gender, as well as the size, number, location and morphology of their tumor. We also considered coexistence of bladder carcinoma in situ (CIS), microscopic vascular invasion and deep lamina propria invasion. The level of experience of the surgeon was also analyzed. Results: in RC samples muscle invasion, that is understaging, was detected in 74 (67.9%) patients, while 35 (32.1%) patients were appropriately staged. In these cohort of patients with high grade tumors, understaging was associated with deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size &gt; 6 cm, tumor location (trigone and dome), presence of residual tumor; age, gender, tumor morphology, CIS associated, and experience of urological surgeon were not associated with clinical understaging. Conclusions: in our study, evaluating patients with high grade NMIBC at first TURBT, we identified some risk factors that need to be considered and that are able to increase the risk of understaging: deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size &gt; 6 cm, tumor location (trigone and dome), presence of residual tumor. When these risk factors are present, performing an early cystectomy, and not a re-TURBT, could lower the risk of worse pathological finding due to rapid disease progression of the high grade tumors, and can prolong survival.

Clinical characteristics of nonosteogenic, non-Ewing’s sarcoma of the bone: Experience at the Toronto Sarcoma Program.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11029-11029
Author(s):  
Zachary William Neil Veitch ◽  
Peter Charles Ferguson ◽  
Anthony Griffin ◽  
Kanan Alshammari ◽  
Esmail Mutahar Al-Ezzi ◽  
...  
Keyword(s):  
Tumor Size ◽  
Clinical Characteristics ◽  
Malignant Tumors ◽  
Osteogenic Sarcoma ◽  
Tumor Location ◽  
R0 Resection ◽  
Data Series ◽  
High Grade ◽  
Term Survival

11029 Background: Non-osteogenic sarcoma of the bone is a rare entity comprising a heterogenous group of malignant tumors. Clinical characteristics and outcome data are sparse in the literature. We evaluated the characteristics and long-term outcomes of patients (pts) with this disease. Methods: Pts with non-osteogenic sarcoma of the bone treated at the Toronto Sarcoma Program from 1987-2017 were identified from our institutional sarcoma database. Patient characteristics (ie: age, gender, tumor size, histology, grade, necrosis, tumor location), treatment modality (ie: surgical management, chemotherapy, radiotherapy), and survival information were collected. Survival was estimated by Kaplan-Meier (log-rank). Multi-variate analysis (MVA) was used to evaluate characteristics for sarcoma specific survival. Results: Of 130 pts identified, 106 had non-metastatic disease with a median age of 46 (range 18-89). Male-to-female predominance was 1.5:1. Common histologies were undifferentiated pleomorphic sarcoma (UPS; 42%), leiomyosarcoma (21%), and fibrosarcoma (11%). Tumors were generally high grade (59%) and > 5 cm in size (73%). The majority of pts received chemotherapy (68%), with Cisplatin/Doxorubicin based regimens (95%). R0 resection was achieved in 85% of cases. Survival for the entire cohort, showed a median (m)DFS of 8.13 years (95%CI:2.52-18.02), and a mOS of 11.72 (95%CI:7.00-not reached [NR]). Median sarcoma specific survival was NR, however 15- and 25-year survivals were 60.4% and 52.6% respectively. MVA demonstrated axial tumor location (HR = 13.03; p = 0.005), no chemotherapy (HR = 4.50; p = 0.017) and tumor grade (G2: HR = 36.21; p = 0.012; G3: HR = 20.30; p = 0.015) as risk factors for sarcoma specific death. Tumor size > 10cm (p = 0.085) and necrosis > 90% (p = 0.082) trended towards significance. Conclusions: Non-osteogenic sarcoma of the bone is a rare tumor entity, with a predominant UPS histology. Patient outcomes are reasonable, with measurable long-term survival. Axial tumor location, absence of chemotherapy, and high-grade disease predict for worse survival outcome. Further evaluation with larger data series is warranted to more fully understand this disease.

scholarly journals Predicting the probability of meningioma recurrence based on the quantity of peritumoral brain edema on computerized tomography scanning

1999 ◽  
Vol 7 (1) ◽  
pp. E2 ◽  
Author(s):  
Ross E. Mantle ◽  
Boleslaw Lach ◽  
Mauricio R. Delgado ◽  
Salleh Baeesa ◽  
Gerard Bélanger
Keyword(s):  
Brain Edema ◽  
Computerized Tomography ◽  
Statistical Significance ◽  
Ct Scanning ◽  
Tumor Location ◽  
Complete Resection ◽  
Brain Invasion ◽  
Ottawa Civic Hospital ◽  
Peritumoral Brain Edema ◽  
The Mean

Object The goal of this study was to determine whether the quantity of peritumoral brain edema displayed on computerized tomography (CT) scanning could be correlated with brain invasion and subsequent recurrence of meningiomas. Methods One hundred thirty-five patients who underwent resection of intracranial meningiomas at the Ottawa Civic Hospital were followed during the period 1980 to 1998. A complete resection was defined as one in which tumor, invaded bone, and involved dura were removed. Tumors were examined microscopically for evidence of brain invasion. The mean follow-up period was 9 years (± 4 years, standard deviation [SD]) and the mean time to recurrence was 5 years (± 4 years, SD). The authors used a simple grading system based on the average thickness (in centimeters) of edema seen on an axial CT slice showing the most tumor. Edema grade was linearly related to edema volume determined by digitizing the scans (r = 0.96; 29 cases). The chance of brain invasion increased by 20% for each centimeter of edema (rs = 1, p < 0.0001; 124 cases). The presence of brain invasion was predictive of recurrence after complete resection with an accuracy of 83%, a sensitivity of 89%, and a specificity of 82%. The chance of recurrence within 10 years after complete resection was given by the equation: percentage chance of recurrence = (centimeter of edema)3 X 0.7, which can be used to predict the chance of recurrence based on findings on CT scans (rs = 1.00, p < 0.0001; 86 patients). Statistical significance was confirmed using Kaplan-Meier and univariate and multivariate analyses. Completeness of resection was the most powerful predictor of recurrence (p < 0.00001, r = 0.6), followed by edema grade and brain invasion (both p = 0.02, r = 0.1). Patient age and gender and tumor location, size, and histological subtype were nonsignificant factors. Conclusions Brain invasion causes peritumoral edema. Invaded brain tissue is also the source of residual cells in cases of tumor recurrence after gross-total resection.

scholarly journals Oncotype DX RS Correlation with Clinicopathologic Risk Factors and Chemotherapy: Follow up Based on TAILORx Study

2021 ◽  
Author(s):  
Faroug Ali ◽  
Nabil Omar ◽  
Francois Calaud ◽  
Mufid Elmistiri ◽  
Hafedh Ghazouani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Adjuvant Chemotherapy ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Cancer Recurrence ◽  
Tumor Grade ◽  
Oncotype Dx ◽  
Proliferation Index ◽  
Chemotherapy Treatment

Abstract Background: Oncotype DX risk score is a clinically validated prognostic and predictive molecular test. It estimates the recurrence and predicts the likelihood of benefit from adjuvant chemotherapy in early ER\PR positive, node-negative breast cancer. Patients are categorized into one of three tiers based on a calculated recurrence score (RS); low (<18), intermediate (18-30), and high (≥31-100) reflecting 10 years distant recurrence likelihood. 2008 NCCN guidelines recommended adjuvant endocrine therapy for low RS and adjuvant chemoendocrine therapy for high RS, but there was no clear recommendation of chemotherapy for intermediate RS (18-30). In 2018 the TAILORx re-established RS categories; a score of less than 11 is low, 11-25 is intermediate and 26-100 is high, and provided evidence to treat patients in intermediate RS category. Reviewing of Oncotype DX RS previous data in reference to TAILORx might support the optimal utility of this test which was suggested by the study. The Aim of the Study: Look for Oncotype Dx RS correlation, with clinical and pathological risk factors (age, tumor size, tumor grade, ER/PR status, tumor proliferation index) and chemotherapy based on TAILORx RS tier. Study the characteristics of patients who had cancer recurrence. Method: Retrospective data review of 54 patients who had Oncotype DX test during 2012-2017 at National Cancer Center-Qatar. Result: Of 54 patients studied 16(29.63%) had low RS, 32(59.26%) had intermediate RS, and 6(11.1%) had high RS. Univariate analysis showed that age (p<0.014), tumor grade (p<0.034), and Ki67% (cut-off 20%; p<0.013) were significantly different among Oncotype DX RS categories. There was no significant difference among Oncotype DX RS categories for tumor size (p<0.288) or PR status (cut-off 1%, p<0.3). Multivariate analysis showed that none of the clinical/pathological factors significantly predict the Oncotype DX RS. Chemotherapy was given to 1/16 (6.25%) patients with low, 7/32(21.9%) patients with intermediate, and 4/6 (66.7%) patients with high Oncotype DX RS (univariate analysis p<0.01). Although Oncotype DX RS had significant association with chemotherapy in univariate analysis, tumor size was the only predictor of adjuvant chemotherapy treatment from all factors including Oncotype DX RS (OR 2.33 CI 0.33 - 3.86, p<0.020). The majority (75%) of patients who had disease recurrence belonged to the high intermediate (16-25) Oncotype DX tier, and all were less than 50 years old in age. Conclusion: Oncotype RS correlates significantly with individual clinical risk factors including age, tumor grade, Ki67%, chemotherapy treatment. Tumor size significantly predicts adjuvant chemotherapy. Breast cancer recurrence was noticed in younger patients with high intermediate RS (16-25), and adjuvant chemotherapy may be a reasonable option for these patients.

scholarly journals Clinical Features Associated with the Efficacy of Chemotherapy in Patients with Glioblastoma (GBM): A Population-based Study

2020 ◽  
Author(s):  
Jieqiong Wen ◽  
Wanbin Chen ◽  
Yayun Zhu ◽  
Pengbo Zhang
Keyword(s):  
Overall Survival ◽  
Tumor Size ◽  
Tumor Grade ◽  
Tumor Location ◽  
Population Based ◽  
Rank Test ◽  
Chi Squared ◽  
Multivariable Analyses ◽  
Well Differentiated ◽  
Student’S T

Abstract BackgroundGlioblastoma (GBM) is a highly malignant brain tumor with poor survival and prognosis. Randomized trials have demonstrated that chemotherapy improves survival in patients with GBM. This study aims to examine the clinical characteristics that are potentially associated with the efficacy of chemotherapy and the risk factors of GBM.MethodsA total of 25,698 patients diagnosed with GBM were identified between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER). The clinical and demographic variables between groups were examined by Student's t-test and Pearson's chi-squared test. GBM-specific survival (GBMSS) and overall survival (OS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors.ResultsPatients who received chemotherapy had better overall survival (median OS 13 vs. 3 months, HR=1.9224, 95%CI 1.8571-1.9900, p<0.0001) and better GBMSS (median GBMSS of 12 vs. 3 months, HR=1.9379, 95%CI 1.8632-2.0156, p<0.0001) compared with patients who did not. Further subgroup analysis revealed that among patients who underwent chemotherapy, those who were younger, with the well-differentiated tumor, with a supratentorial tumor, received surgery or radiotherapy had both improved OS and GBMSS. Age, race, tumor grade, tumor location, tumor size, and treatments were identified as independent prognostic factors by multivariable analyses for patients with glioblastoma. ConclusionPatients with GBM who were younger (<65 years), with the well-differentiated tumor, underwent surgery or radiotherapy can benefit more from chemotherapeutic regimens. Age, race, tumor size, tumor location, tumor grade, surgery, radiotherapy, and chemotherapy were factors associated with the prognosis of patients with GBM.

scholarly journals Ultrasound Imaging Morphology is Associated with Biological Behavior in Invasive Ductal Carcinoma of the Breast

2021 ◽  
Vol 11 ◽  
pp. 48
Author(s):  
Gopal R. Vijayaraghavan ◽  
Matthew Kona ◽  
Abiramy Maheswaran ◽  
Dina H. Kandil ◽  
Madhavi K. Toke ◽  
...  
Keyword(s):  
Invasive Ductal Carcinoma ◽  
Tumor Size ◽  
Ductal Carcinoma ◽  
Germ Line ◽  
Brca Mutation ◽  
Tumor Grade ◽  
Biological Behavior ◽  
High Grade ◽  
Receptor Status ◽  
Acoustic Shadowing

Objectives: Ultrasound (US) is commonly used for diagnostic evaluation of breast lesions. The objective of this study was to investigate the association between US imaging morphology from routine radiologists’ interpretation and biological behavior such as receptor status and tumor grade determined from histopathology in invasive ductal carcinoma (IDC). Material and Methods: This retrospective study included 453 patients with pathology-verified diagnosis of IDC who had undergone US imaging and had surgery over a 5-year period. US and surgical pathology reports were reviewed and compiled. Correlation analyses and age-adjusted multivariable models were used to determine the association between US imaging morphology and receptor status, tumor grade, and germ line mutation of the breast cancer genes (BRCA1 and BRCA2). The odds ratio (OR), area under receiver operating characteristic curve (AUC), and 95% confidence intervals (CI) were obtained. Results: The likelihood for high-grade cancer increased with size (OR: 1.066; CI: 1.042–1.091) and hypo-echogenicity (OR: 2.044; CI: 1.337–3.126), and decreased with angular or spiculated margins (OR: 0.605; CI: 0.393–0.931) and posterior acoustic shadowing (OR: 0.352; CI: 0.238–0.523). These features achieved an AUC of 0.799 (CI: 0.752–0.845) for predicting high-grade tumors. The likelihood for Estrogen Receptor-positive tumors increased with posterior acoustic shadowing (OR: 3.818; CI: 2.206–6.607), angulated or spiculated margins (OR: 2.596; CI: 1.159–5.815) and decreased with US measured tumor size (OR: 0.959; CI: 0.933–0.986) and hypoechoic features (OR: 0.399; CI: 0.198– 0.801), and achieved an AUC of 0.787 (CI: 0.733–0.841). The likelihood for Progesterone Receptor-positive tumors increased with posterior acoustic shadowing (OR: 2.732; CI: 1.744–4.28) and angulated or spiculated margins (OR: 2.618; CI: 1.412–4.852), and decreased with US measured tumor size (OR: 0.961; CI: 0.937–0.985) and hypoechoic features (OR: 0.571; CI: 0.335–0.975), and achieved an AUC of 0.739 (CI: 0.689–0.790). The likelihood for Human epidermal growth factor receptor 2-positive tumors increased with heterogeneous echo texture (OR: 2.141; CI: 1.17– 3.919) and decreased with angulated or spiculated margins (OR: 0.408; CI: 0.177–0.944), and was marginally associated with hypoechoic features (OR: 2.101; CI: 0.98–4.505) and circumscribed margins (OR: 4.225; CI: 0.919–19.4). The model with the aforementioned four US morphological features and achieved an AUC of 0.686 (CI: 0.614–0.758). The likelihood for triple-negative breast cancers increased with hypo-echogenicity (OR: 2.671; CI: 1.249–5.712) and decreased with posterior acoustic shadowing (OR: 0.287; CI: 0.161–0.513), and achieved an AUC of 0.739 (CI: 0.671– 0.806). No statistical association was observed between US imaging morphology and BRCA mutation. Conclusion: In this study of over 450 IDCs, significant statistical associations between tumor grade and receptor status with US imaging morphology were observed and could serve as a surrogate imaging marker for the biological behavior of the tumor.

scholarly journals Relationship between tumor location, size, and WHO grade in meningioma

2018 ◽  
Vol 44 (4) ◽  
pp. E4 ◽  
Author(s):  
Stephen T. Magill ◽  
Jacob S. Young ◽  
Ricky Chae ◽  
Manish K. Aghi ◽  
Philip V. Theodosopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tumor Size ◽  
Recursive Partitioning ◽  
Tumor Grade ◽  
Tumor Location ◽  
Who Grade ◽  
Grade Ii ◽  
Male Sex ◽  
Who Grade Ii Meningioma ◽  
The Relationship

OBJECTIVEPrior studies have investigated preoperative risk factors for meningioma; however, no association has been shown between meningioma tumor size and tumor grade. The objective of this study was to investigate the relationship between tumor size and grade in a large single-center study of patients undergoing meningioma resection.METHODSA retrospective chart review of patients undergoing meningioma resection at the University of California, San Francisco, between 1985 and 2015 was performed. Patients with incomplete information, spinal meningiomas, multiple meningiomas, or WHO grade III meningiomas were excluded. The largest tumor dimension was used as a surrogate for tumor size. Univariate and multivariate logistic regression models were used to investigate the relationship between tumor grade and tumor size. A recursive partitioning analysis was performed to identify groups at higher risk for atypical (WHO grade II) meningioma.RESULTSOf the 1113 patients identified, 905 (81%) had a WHO grade I tumor and in 208 (19%) the tumors were WHO grade II. The median largest tumor dimension was 3.6 cm (range 0.2–13 cm). Tumors were distributed as follows: skull base (n = 573, 51%), convexity/falx/parasagittal (n = 431, 39%), and other (n = 109, 10%). On univariate regression, larger tumor size (p < 0.001), convexity/falx/parasagittal location (p < 0.001), and male sex (p < 0.001) were significant predictors of WHO grade II pathology. After controlling for interactions, multivariate regression found male sex (OR 1.74, 95% CI 1.25–2.43), size 3–6 cm (OR 1.69, 95% CI 1.08–2.66), size > 6 cm (OR 3.01, 95% CI 1.53–5.94), and convexity/falx/parasagittal location (OR 1.83, 95% CI 1.19–2.82) to be significantly associated with WHO grade II. Recursive partitioning analysis identified male patients with tumors > 3 cm as a high-risk group (32%) for WHO grade II meningioma.CONCLUSIONSLarger tumor size is associated with a greater likelihood of a meningioma being WHO grade II, independent of tumor location and male sex, which are known risk factors.

High-grade endometrial cancer: Revisiting tumor size and the lower uterine segment.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5589-5589 ◽  
Author(s):  
Kemi M. Doll ◽  
Sheri Denslow ◽  
Jill Tseng ◽  
Paola A. Gehrig ◽  
Amanda Nickles Fader
Keyword(s):  
Endometrial Cancer ◽  
Tumor Size ◽  
Early Stage ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Lower Uterine Segment ◽  
High Grade ◽  
Nodal Disease ◽  
Recurrence Rates ◽  
Poor Prognostic Factor

5589 Background: Tumor size is an independent poor prognostic factor in endometrial cancer, while tumor location has shown mixed results, with few studies addressing high-grade disease. We aim to determine if tumor size (TS) or lower uterine segment involvement (LUS) is associated with nodal disease and recurrence in high-grade endometrial cancer. Methods: In an IRB-approved, multi-institutional cohort study of patients with clinically early-stage, high-grade endometrial cancer (grade 3 and all non-endometrioid histologies), records were reviewed for demographic, pathologic, and treatment data. Recurrence as a function of tumor size and location were analyzed using logistic regression and exact tests for significance. Hazard ratios were calculated. Results: 208 patients with high-grade histology were identified from Jan 2005 to Jan 2012 with 188 patients having tumor location identified and 183 having tumor size reported. Both pelvic and para-aortic lymphadenectomy were completed in 100% of patients. There were 75 endometrioid (36.1%), 35 papillary serous (16.8%), 12 clear cell (5.8%), 26 carcinosarcoma (12.5%), and 60 (28.8%) with undifferentiated or mixed histology. Median follow up time was 17.2 months (0.2 – 67.6 mo) with 55 recurrences. LUS tumors were more likely to have pelvic and para-aortic nodal disease (OR 3.83, 95%CI 1.70 – 8.60, OR 5.13, 95% CI 1.96 – 13.45) and increased recurrence rates (HR 2.21, 95% CI 1.16-4.20) on univariate analysis. Tumors size ≥2cm was associated with pelvic nodal disease (27.4% vs. 0%, p = 0.01; OR 10.00, p = 0.01). TS was not independently associated with recurrence and patterns of failure did not significantly differ with LUS involvement. Conclusions: In patients with clinically early stage, high-grade endometrial cancers, TS and LUS tumor location are significantly associated with lymph node metastasis and advanced stage disease at the time of comprehensive surgical staging. Tumor location in particular is strongly associated with distant nodal disease and is a poor prognostic indicator for recurrence. Studies evaluating the role of adjuvant therapy based on tumor size and tumor location would be helpful in improving patient related outcomes.

A Challenging Case of A Myeloid Sarcoma Misdiagnosed as High Grade B-Cell Lymphoma

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
A Herrmann ◽  
B Mai ◽  
S Elzamly ◽  
A Wahed ◽  
A Nguyen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Myeloid Sarcoma ◽  
Proliferation Index ◽  
High Grade ◽  
Cell Markers ◽  
Thoracolumbar Region ◽  
The Right

Abstract Introduction/Objective A 46-year-old female presented with severe back pain associated with progressive bilateral lower extremity weakness and paresthesia, urinary retention, and constipation. Computed tomography revealed a retroperitoneal mass encasing the right psoas muscle, obstructing the right kidney, and extending to the thoracolumbar region resulting in severe spinal compression. An epidural tumor resection was subsequently performed at an outside hospital. Methods Histological sections showed sheets of blastoid neoplastic cells with intermediate to large nuclei, irregular membranes, fine chromatin, and prominent nucleoli. Immunohistochemical stains showed that these cells were positive for CD43, CD79a (weak, focal), BCL2, C-MYC, and PAX5 (weak, focal) and negative for CD10, CD20, CD30, ALK1, BCL6, MUM1, and Tdt. The Ki-67 proliferation index was 75-80%. With this immunophenotype, this patient was diagnosed with a high grade B-cell lymphoma and transferred to our institution for further work-up. On review of the slides, further immunohistochemical testing was requested which revealed positivity for CD117 and myeloperoxidase (MPO). Results The overall morphological and immunophenotypical features are most compatible with myeloid sarcoma (MS) with aberrant expression of B-cell markers and this patient’s diagnosis was amended. Interestingly, the patient’s bone marrow examination only showed 2% myeloblasts with left shifted granulocytosis and concurrent fluorescence in situ hybridization (FISH) studies were negative. Conclusion A literature review showed that 40-50% of MS are misdiagnosed as lymphoma. MS can frequently stain with B-cell or T-cell markers, as seen in this case, which makes it challenging for an accurate diagnosis and sub- classification. In addition, our case is interesting in that there was only extramedullary presentation without bone marrow involvement. Typically, MS develops after the diagnosis of acute myeloid leukemia (AML) with an incidence of 3–5% after AML. It can also manifest de novo in healthy patients, who then go on to develop AML months to years later. Therefore, this patient will require close follow-up.

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