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Background: Cancer is a major public health challenge in West Africa, with a significant proportion of cancer-related deaths attributed to distant metastasis. De novo metastatic cancer (DnMC), where metastasis is detected at diagnosis, presents considerable therapeutic challenges, particularly in limited-resource settings where novel treatments are often unavailable and/or unaffordable.

Aim: To determine the prevalence, incidence and clinicopathological characteristics of patients diagnosed with DnMC at a major radiotherapy center in West Africa.

Methods: This was a single-institution-based quantitative cross-sectional study. Data on the prevalence and incidence of DnMC were retrieved from a hospital-based cancer registry whereas patients' demographic and clinicopathologic data were extracted from patients' medical records and analysed with STATA software (version 16). Descriptive statistics were used to summarise patient- and tumour-related characteristics.

Results: The prevalence and incidence of DnMC were 15.2% and 5.3%, respectively, with a 36% overall incidence rate of metastatic cancer. The mean age was 50.9 years (SD 15.2), ranging from 15 to 90 years, with a male-to-female ratio of 1:1.6. Also, 28.8% had a history of alcohol intake whereas 13.7% were (tobacco) smokers. Additionally, 10.3% of the patients had a positive family history of cancer. Pain (28.2%) was the most common presenting symptom, followed by bleeding (16.5%). In all, 34.9% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 whereas 33.3% were ECOG 1. The gastrointestinal tract (25.8%) and breasts (17.6%) were the most frequent primary cancer sites, whereas 4.4% had metastatic cancers of unknown primary origin. The most frequent sites of distant metastasis were the lungs (34.6%), liver (28.9%) and bone (13.8%). Adenocarcinoma was the most prevalent histological type (35.2%).

Conclusion: There was a relatively high rate of DnMC compared with high-income countries, emphasising the need for early detection and expanded access to comprehensive cancer care in limited-resource settings.

Plasmacytoid blast dendritic cell neoplasm is a rare subtype of acute leukaemia that represents less than 1% of haematologic neoplasms. It is characterised by skin involvement and leukaemic dissemination in the rest of the body. The immunophenotype is represented by the expression of CD4, CD56 and CD123. Due to its low incidence, there is no standardised treatment. For most authors, acute lymphoblastic leukaemia) regimens with or without consolidation with allogeneic transplantation seem to be the most appropriate. We present the case of a 31-year-old male with a history of von Willebrand's disease, who was diagnosed with plasmacytoid blast dendritic cell neoplasm with central nervous system involvement. After receiving first-line immunopolychemotherapy with rituximab, the patient achieved complete haematologic remission with the high-dose ara-C regimen. Subsequently, he consolidated with allogeneic haploidentical transplantation.

Introduction: The role of stereotactic radiosurgery (SRS) in pituitary adenomas (PAs) is evolving especially considering its safety. Existing literature is hampered by limited sample sizes and short-term follow-ups, impeding its preeminence in the clinical and radiological outcomes. We propose a comprehensive, single-centred study to evaluate the outcomes following CyberKnife stereotactic radiosurgery (CK SRS) for PAs in a larger patient population, incorporating meticulous clinical and radiological follow-up.

Methods: This is a retrospective cohort study of 278 cases of PAs that underwent CK SRS from 2013 to 2021. Based on their endocrinology profile, they were classified as functional adenomas (FA) and non-functional adenomas (NFA). We assessed pre and post-CK SRS clinical, visual, hormonal and radiological parameters and the associated toxicity. Where applicable, data were compared using the Independent t-test, chi-square test, Fisher Exact and Mann-Whitney U test. A p-value <0.05 was considered significant.

Results: The median age of the patients was 40.13 ± 12.61 years (111 female and 167 male patients). The median prescribed radiosurgery dose was 25.0 ± 5.0 Gy into 3 or 5 fractions. The median follow-up time was 12 months (IQR 20). Data were grouped into NFA (169, 60.8%) and FA (109, 39.2%). After adjusting for patients lost to follow-up, post-CK SRS visual perimetry improved in 80.4% of patients and tumour size reduced in 78.6% of the study population. Seventeen patients with NFA and nine with FA manifested new-onset hormonal deficiencies. No statistically significant differences were seen in post-CK SRS visual outcomes and hormone deficiency groups.

Conclusion: CK SRS is effective and safe for managing PAs, achieving tumour control and preserving visual function with minimal toxicity. Extended follow-up is needed to evaluate post-SRS toxicity and hypopituitarism.

Background: Metastatic breast cancer (MBC) patients have numerous options for treatment. However, it is essential to consider treatments with favorable toxicity profiles and convenient modes of administration. Eribulin has shown effectiveness in aggressive MBC, but there is a lack of sufficient real-world data specific to Indian patients.

Patients and methods: We conducted a retrospective audit of patients with MBC who received intravenous Eribulin between 2019 and 2023 at a dosage of 1.4 mg/m² on days 1 and 8 every 3 weeks. The median Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.

Results: During the specified time, 107 consecutive patients with MBC received Eribulin treatment. The median age was 52 years (range, 28-75 years) with 3 patients with male breast cancer. The median number of prior chemotherapy lines and involved sites were 3 (range, 2-5) and 3 (range, 1-6), respectively. Visceral involvement was present in 84 (78.5%) patients. A median of 3 cycles of Eribulin (range, 1-11) was administered. Eribulin resulted in partial responses in 49 (45.8%) patients, stable disease in 11 (10.3%) patients and progressive disease in 47 (43.9%) patients. The median PFS was 4.0 months (95% CI: 3.4-4.6), and the median OS was 10.0 months (95% CI: 8.3-11.7). For patients with triple-negative breast cancer (TNBC), the median OS was 8 months (95% CI: 5.6-10.4), whereas non-TNBC patients had a median OS of 11 months (95% CI: 9.1-12.8) (hazard ratio, 1.9, 95% CI: 1.2-3.1, p = 0.002). Eribulin was well-tolerated, with dose reduction was needed in 9 (8.4%) of the patients in the overall cohort.

Conclusion: Eribulin is a viable and safe option for treating heavily pre-treated MBC in real-world settings. The study found comparable efficacy in both TNBC and non-TNBC patients.

Squamous cell carcinoma is the most common malignancy of the head and neck. Pseudovascular squamous cell carcinoma (PSCC) is a rare variant that occurs commonly in the skin of the head and neck. However, oral cavity involvement is extremely rare, with only a few cases reported to date. This variant is associated with an adverse prognosis. Morphologically, the tumour shows marked acantholysis and anastomosing channels mimicking vascular neoplasms. This rare variant poses a diagnostic challenge for pathologists and the accurate diagnosis can be made with the help of immunohistochemical (IHC) studies. A 72-year-old male patient was referred to our hospital with a fast-growing left-sided oral ulcer for more than 1 month. Wide local excision with segmental mandibulectomy was performed and the specimen was sent to our department. On gross examination, a large, soft, lobulated mass was identified in the lower alveolus and the buccal mucosa. On microscopic examination, the tumour was composed of malignant epithelial cells arranged in nests, trabeculae and irregular anastomosing channels. Marked acantholysis and pseudo vascular spaces lined by atypical cells were seen. IHC examination revealed tumour cells positive for CK, P40, P63 and Vimentin and negative for CD31, CD34, S100 and HMB45. The pathological diagnosis was confirmed as PSCC. A short history of the case and a review of literature is discussed here.

Objective: Upper gastrointestinal (UGI) cancers, including esophageal (EC) and gastric (GC) cancers, pose a significant global health challenge. Previous studies have indicated a fundamental correlation between basophil count and the risk of UGI cancer. However, confirming a causal relationship demands further investigation. Mendelian randomization (MR) provides a critical method for evaluating the possible causal connections between peripheral circulating blood cells (PCBCs) and UGI cancer.

Method: Our study comprehensively employed a two-sample MR analysis. We used publicly available genetic data to survey the causal association between PCBC and UGI cancer. We used inverse variance weighting and weighted median for MR analyses and sensitivity analyses to assess heterogeneity and pleiotropy.

Results: In terms of the association between PCBCs and UGI cancer, we found that basophils count (EC: OR = 1.416, 95% CI = 1.125-1.783, p = 0.003; GC: OR = 1.623, 95% CI = 1.052-2.505, p = 0.029) were all strongly correlated with both EC and GC. Interestingly, Basophil count was a risk factor for both EC and GC. However, no significant correlations were seen between eosinophil, monocyte, lymphocyte or white blood cell count and UGI cancer.

Conclusion: The findings of this research corroborate the idea that basophils might serve as a fundamental risk factor for UGI cancer. Further exploration of the underlying mechanisms driving this relationship could provide crucial understanding helpful in creating prospective preventive and treatment methods for UGI cancer.

Background: There is limited data from India on Ewing sarcoma (ES) patients. We analysed the demographic and clinical profile of ES patients, the systemic chemotherapy, local treatment and outcomes in patients with localised, metastatic and recurrent disease.

Methods: Data of ES patients reporting from 2010 to 2019 to a tertiary care referral centre in north India was evaluated. A total of 81 patients were retrieved of whom 76 were assessed for treatment and outcomes. Patients were stratified as per localised (LD) or metastatic disease (MD). Outcomes were evaluated in terms of 3-year and 5-year disease-free survival (DFS) and overall survival (OS). Prognostic factors influencing OS for patients with LD were assessed.

Results: The majority (68%, n = 55) of patients presented from rural areas with 30% (n = 24) presenting 6 months after the onset of symptoms, 63% (n = 51) had primary tumours more than 8 cm and 7% (n = 6) had a pathological fracture at presentation, 78% (n = 63) patients had LD while 22% (n = 18) patients had MD. Local treatment consisted of surgery in 56% (n = 28) patients and definitive radiotherapy in 44% (n = 22) patients. Compliance with chemotherapy was poor with patients receiving a median of five and seven cycles of chemotherapy as neoadjuvant and consolidation chemotherapy, respectively. Three-year OS for LD, MD and overall cohort was 41%, 6% and 32%, respectively. Size of the primary tumour > 8 cm, completion of less than 15 cycles of chemotherapy and presence of MD was associated with inferior survival on multivariate analysis.

Conclusion: Poor outcomes were reported in this cohort of ES patients from a resource-limited setting where patients have a delayed diagnosis, advanced disease and poor compliance to adjuvant consolidation chemotherapy secondary to geographical, social and financial barriers. There is an urgent need to address these barriers for low middle-income countries to improve outcomes.

Optic nerve gliomas (ONG) are benign central nervous system tumours and the most common tumours of the optic nerve in children, often occurring before age 20. These tumours are slow-growing and can be treated with surgery and/or radiation therapy. Surgical resection is, however, associated with significant morbidity and loss of vision in the affected eye. The successful management of ONG requires a multidisciplinary, individualised approach aimed at preserving vision. This case report discusses an 11-year-old Ghanaian male diagnosed with left ONG in July 2023. He presented with blurred vision in the left eye, mild proptosis and poor vision, but no pain, headaches or neurological deficits. A contrast-enhanced magnetic resonance imaging of the orbit showed diffuse fusiform enlargement of the left optic nerve (35 × 12 × 11 mm). The successful management of ONG, in this case, using intensity-modulated radiotherapy demonstrates the potential of advanced radiotherapy techniques in preserving vision and achieving tumour control in pediatric patients, even in resource-limited settings. Continuous follow-up and a multidisciplinary approach are essential for managing the long-term outcomes and ensuring the best possible quality of life for these patients.

Statement of the problem: Oral squamous cell carcinoma (OSCC) is the most common type of oral cancer. During the invasion, tumour cells break through the basement membrane and penetrate the connective tissue to interact with the extracellular matrix. An attempt was made to evaluate the connective tissue changes in different grades of OSCCs, oral submucous fibrosis (OSMF) and Oral Epithelial Dysplasias. Literature related to the evaluation of malignant epithelial cells is vast but very sparse knowledge is available on the role of extracellular stromal fibres on tumour invasion in oral cancer and precancer especially on elastic fibres using Shikata's Modified Orcein Stain.

Purpose: To analyse the changes in elastic fibres in varying grades of OSCC, OSMF and Oral Epithelial Dysplasias using a special stain, Shikata's modified orcein stain.

Materials and method: A total of 100 cases were selected as the study group in this retrospective observational study. One section each was cut from 50 samples of varying grades of OSCC and 50 samples of varying grades of OSMF and oral leukoplakia. Ten samples of the control group were taken from the archives of the Department of Oral Pathology. Qualitative and quantitative analysis of elastic fibres was accomplished using set criteria. Spearman's test was done to evaluate the elastic fibres. Statistically insignificant results were obtained for quantitative and qualitative analysis of elastic fibres.

Results: A change in density in elastic fibres was observed in progression from early to advanced grades of OSCC, OSMF and oral epithelial dysplasia cases. A low expression of elastic fibres in tumour stoma indicates that the protective barrier against tumour progression is deficient, allowing the tumour to progress more easily and resulting in a poorer prognosis.

Conclusion: The elastic fibres undergo a change in density, orientation and packing in the stroma of varying grades of OSCC, OSMF and oral epithelial dysplasia cases. The unique feature of this study lies in the exploration of elastic fibres in OSCC which has not been done so far.

Colorectal cancer (CRC) is the third most commonly occurring cancer in men and the second most commonly occurring cancer in women. The epidermal growth factor receptor (EGFR) is relevant in the development and progression of CRC, because it is part of multiple signaling pathways involved in processes of the cell cycle, their malfunction causes dysregulation and subsequently carcinogenesis. Consequently, therapies were developed with anti-EGFR monoclonal antibodies (MAbs) that improve the survival of patients with CRC. However, mutations in the oncogenes Kirsten rat sarcoma (KRAS) and Neuroblastoma RAS (NRAS), modulators of the EGFR signaling pathway (downstream) activate a pathway independent in which such drugs have no effect. Patients with these mutations have a low response to MAb therapies. In this research, the SNaPshot sequencing method was used for the first time in Venezuela for the diagnosis of mutations in exon 2 of the KRAS and NRAS genes, from DNA extracted from tumor tissue samples fixed with formalin and included in paraffin (FFPE) and was compared with Sanger's method to determine the specificity and sensitivity, in the detection of mutations in the KRAS and NRAS genes. Of the 33 samples analysed, 27.3% presented mutations in KRAS and 15.1% in NRAS. With the obtained, it was carried out for the first time in the country the assignment of the geographical distribution of the polymorphisms found in these genes. The mutational status of the KRAS and NRAS genes showed no relationship statistically significant with clinical-histopathological variables. For this study, the SNaPshot method showed greater accuracy, sensitivity and specificity in the detection of single nucleotide polymorphisms than the Sanger method.