High Incidence of Distant Metastasis Is Associated With Histopathological Subtype of Pediatric Papillary Thyroid Cancer - a Retrospective Analysis Based on SEER

ObjectiveChildren with papillary thyroid cancer (PTC) have a higher invasive rate and distant metastasis rate, but the mortality rate is lower with unknown reasons. The majority of PTC cases comprise classical papillary thyroid carcinoma (CPTC) and follicular variant papillary thyroid carcinoma (FVPTC). This study aimed to determine the relationship between histopathological subtype and rate of distant metastasis and investigate factors influencing distant metastasis in pediatric PTC.MethodsA total of 102,981 PTC patients were recruited from SEER registry, 2004-2015. Proportion of distant metastasis between children (≤18 years) and adults with different histopathological subtypes was compared by propensity score matching. The cut-off age for distant metastasis in children was calculated by receiver operating characteristic (ROC) curve, and the risk factors for distant metastasis in pediatric patients were analyzed by logistic regression models.ResultsAmong the 1,484 children and 101,497 adults included in the study, the incidence of CPTC patients with distant metastasis in children was higher than that in adults (p<0.001). The ROC curve was calculated, which yielded a cut-off age for distant metastasis in CPTC children as 16 years old. In CPTC, the proportion of young children (2-16 years) with distant metastasis was higher than that of adolescents (17-18 years) and adults (>18 years) (both p<0.001). While there was no such trend in FVPTC. In young children (2-16 years), the incidence of CPTC with distant metastasis was higher than FVPTC (p=0.006). There was no difference between the proportion of CPTC and FVPTC with distant metastasis in adolescents (17-18 years) and adults. Logistic regression models revealed that extrathyroidal extension, lymph node metastasis and CPTC histopathological subtype were risk factors for distant metastasis in young children aged 2 -16 years.ConclusionsIn CPTC, the incidence of distant metastasis in young children (2-16 years) was significantly higher than that in adolescents (17-18 years) and adults (>18 years). In patients with distant metastasis aged 2-16 years, the proportion of CPTC was higer than that of FVPTC. Extrathyroidal extension, lymph node metastasis, and CPTC histopathological subtype were risk factors for distant metastasis in young children aged 2-16 years.

Adenosquamous Carcinoma of Gallbladder – A Case Report

Gallbladder cancer is an uncommon malignancy and majority of these carcinomas are adenocarcinomas. Adenosquamous carcinoma of gallbladder is a rare histopathological subtype of gallbladder carcinoma. It usually presents with symptoms of cholelithiasis like epigastric pain, nausea and bloating. On clinical examination, tenderness is usually present. Radiologically in most of the cases, gallstones are found leading to the diagnosis of cholelithiasis for which cholecystectomy is done. Gallbladder carcinomas are found mostly as an incidental finding on microscopic examination of cholecystectomy specimen. This disease is curable if diagnosed earlier but in most of the cases they present at advanced stages when resection is not possible and prognosis is poor. As this disease is extremely rare so published information is largely based on the case reports and case series. This is a case of 60 years old female patient who underwent cholecystectomy for cholelithiasis with incidental finding of Adenosquamous carcinoma on histopathology report.

P04.11 10-Year Institutional Retrospective Case Series of WHO Grade II Gliomas and Correlation of Seizures, Lobar Location, Histopathological Subtype and IDH-1 Mutation (2010–2020)

BACKGROUND A 10-year retrospective case series was undertaken of all patients who had a tissue diagnosis of a World Health Organisation (WHO) Grade II glioma, i.e. low grade glioma (LGGM), at the Institute of Neurological Sciences (INS) between January 2010 and January 2020 (NB: pre-2016 World Health Organisation classification). The objective was to assess the correlation of World Health Organisation (WHO) Grade II gliomas to seizure symptomology, intracerebral tumour location, histopathological glioma sub-type and molecular markers including isocitrate dehydrogenase-1 (IDH-1) mutation. MATERIAL AND METHODS We extracted data regarding clinical, radiological, histological, molecular discriminators and functional outcomes in patients. The pre-operative symptomology was restricted to seizures, headache and focal neurological deficits. RESULTS 84 patients underwent resection and had a mean age of 42rs (range: 21-77yrs]). Seizures (NB: pre-2017 International League against Epilepsy classification [ILAE]) occurred in 71% and of these 52% were generalised, 37% partial and 11% mixed. 31% had ongoing seizures postoperatively. Headache occurred in 38% (of these 50% had headache and seizures). Focal neurological deficits (FNDs) occurred in 21% (of these 61% had FNDs and seizures). Seizure, as an isolated pre-operative symptom occurred in 48% patients compared to isolated headache in 10% and isolated FNDs in 4%. Anatomically, 58% of lesions were frontal. The seizure spatial frequency was 60% frontal. Histologically, 60% were diffuse astrocytomas and 40% oligodendrogliomas. Furthermore, 71% of oligodendrogliomas and 49% of diffuse astrocytomas had a frontal location. IDH-1 mutation occurred in 80% patients (75% of these had seizures) and of these 66% were frontal. CONCLUSIONS Our analysis confirms a correlation between incidence of seizures, frontal lobar location, histopathological subtype and IDH-1 mutations (p = <0.05

What We Need to Learn When Exploring the Mixed Basal Cell Carcinoma of Head and Neck

Coexistence of different histopathological types of basal cell carcinomas (BCC) in the same anatomical localisation is rare, and, therefore, is engaging for histopathologists and clinicians. In many cases, the determination of a neoplasm type remains difficult, since BCC may consist of more than one histopathological subtype. Mixed BCCs often present with an aggressive course and recurrence when compared to other subtypes of a tumour. Furthermore, tumours of this type are associated with time-consuming treatment and not a very satisfactory cosmetic result, thus worsening the quality of the patient’s life. Several clinical studies have been published regarding the histopathologically diverse tumours developed in the same anatomical region; however, largely peculiarities of mixed BCCs are not explored sufficiently. The purpose of this study was to substantiate the use of dermoscopy and morphology, assessing mixed type BCC of the head and neck. The tumours were removed with a surgical excision of 1 cm margins, and the tumour sites were assessed in a 24-month-long follow-up period. The dermoscopic characteristics of mixed and aggressive BCC are analysed in this study. Finally, to better estimate the invading cone of the tumour, a complex morphology, which included collagen type IV and podoplanin immunohistochemistry, and electron microscopy were used.

Clinicopathologic Characteristics and Chemotherapy Response of Classic Hodgkin Lymphoma: A Study in Tertiary Teaching Hospital

Background and Objective: Hodgkin Lymphoma (HL) is known as a malignancy of the lymphatic system and 90% of the HL is Classic Hodgkin Lymphoma (CHL). Prognostic factors that identify the patient's response to therapy are useful for optimizing the therapy. This study aims to assess the clinicopathological characteristics and chemotherapy response associated with CHL patients. Materials and Methods: This is a retrospective study of 40 patients diagnosed as CHL and treated with ABVD chemotherapy at Hasan Sadikin General Hospital/Padjadjaran University, Bandung, Indonesia during the period of January 2014 to December 2019. The clinicopathological characteristics data consisting of age, sex, histopathology subtype, tumor location and clinical stage were assessed. Their responses to chemotherapy were also analyzed. Result and Discussion: A total of 40 patient data were included in this study, 21 CHL patients responded to ABVD chemotherapy (52.5%) while 19 patients not responded (47.5%). There were no significant association between age, sex, histopathological subtype, tumour location and clinical stage with chemotherapy response. Conclusion: In this study, 47.5% of CHL patients did not respond to ABVD chemotherapy. The response of ABVD chemotherapy was not associated with age, sex, histopathological subtype, tumor location or clinical stage. Keywords: Classic Hodgkin Lymphoma, chemotherapy response, clinicopathological characteristics.

Don’t Judge a Tumor by Its Biopsy!

Trichoblastomas (TBs) are extremely rare, benign hair germ tumors that can mimic basal cell carcinoma (BCC). They usually arise on the head or neck and have a potential for malignant transformation, albeit it is rare. We report a case of giant TB on the forehead of a 75-year-old otherwise healthy woman. Since the age of 20 she reported a bulge on her forehead, in which a superficial-looking wound had now developed. Initially a dermatologist biopsied the tumor suspecting a BCC, which the histological analyses confirmed. The patient was then referred to the Department of Plastic Surgery for complete excision of the carcinoma, including the large frontal bulge. Surprisingly, the concluding pathology report changed the diagnosis from a BCC to a TB. Current management of most skin lesions relies on the histopathological subtype of a single punch biopsy. Many benign and malignant dermatological entities may mimic BCC, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. Mimics may include various types of nonneoplastic processes, benign adnexal tumors, including TB, or cutaneous carcinomas with basaloid features. A single punch biopsy is not always adequate in making the correct diagnosis. Although it is considered the gold standard, the clinical assessment is just as important. Due to its potential for malignant transformation, it is recommended to excise TB with negative margins.

Primary Heterotopic Meningioma of Nasal Cavity: Case Report and Literature Review

Primary heterotopic meningiomas are lesions that are not associated with a cranial nerve foramen, vertebral canal, or intracranial structure. The most common histopathological subtype is meningeal epithelioma. In clinical practice, primary heterotopic nasal meningioma occurs relatively rarely, and its most common pathological type is psammomatous meningioma, whereas nasal fibrous meningioma is infrequent. In our case, a 31-year-old male patient was admitted to the hospital with “progressive nasal obstruction on the right side for half a year.” Computed tomography examination of the paranasal sinuses revealed a polyploid mass in the right nasal cavity. The patient underwent surgical resection of the mass under nasal endoscopy. Histopathological examination confirmed that the mass was an ectopic meningioma of the nasal cavity. The patient was regularly followed up for 2 years without recurrence of the tumor. Primary heterotopic fibrous meningioma of the nasal cavity is clinically rare but should be considered as a differential diagnosis for hemangioma of the nasal cavity, inverted papilloma, and nasal polyp. The final diagnosis is based on pathology and immunohistochemistry analysis results.

Detailed analysis of 5-aminolevulinic acid induced fluorescence in different brain metastases at two specialized neurosurgical centers: experience in 157 cases

OBJECTIVEIncomplete neurosurgical resection of brain metastases (BM) due to insufficient intraoperative visualization of tumor tissue is a major clinical challenge and might result in local recurrence. Recently, visible 5-aminolevulinic acid (5-ALA) induced fluorescence was first reported in patients with BM. The aim of this study was thus to investigate, for the first time systematically, the value of 5-ALA fluorescence for intraoperative visualization of BM in a large patient cohort.METHODSAdult patients (≥ 18 years) with resection of suspected BM after preoperative 5-ALA administration were prospectively recruited at two specialized neurosurgical centers. During surgery, the fluorescence status (visible or no fluorescence); fluorescence quality (strong, vague, or none); and fluorescence homogeneity (homogeneous or heterogeneous) of each BM was investigated. Additionally, these specific fluorescence characteristics of BM were correlated with the primary tumor type and the histopathological subtype. Tumor diagnosis was established according to the current WHO 2016 criteria.RESULTSAltogether, 157 BM were surgically treated in 154 patients. Visible fluorescence was observed in 104 BM (66%), whereas fluorescence was absent in the remaining 53 cases (34%). In detail, 53 tumors (34%) showed strong fluorescence, 51 tumors (32%) showed vague fluorescence, and 53 tumors (34%) had no fluorescence. The majority of BM (84% of cases) demonstrated a heterogeneous fluorescence pattern. According to primary tumor, visible fluorescence was less frequent in BM of melanomas compared to all other tumors (p = 0.037). According to histopathological subtype, visible fluorescence was more common in BM of ductal breast cancer than all other subtypes (p = 0.008). It is of note that visible fluorescence was observed in the surrounding brain tissue after the resection of BM in 74 (67%) of 111 investigated cases as well.CONCLUSIONSIn this largest series to date, visible 5-ALA fluorescence was detected in two-thirds of BM. However, the characteristic heterogeneous fluorescence pattern and frequent lack of strong fluorescence limits the use of 5-ALA in BM and thus this technique needs further improvements.