Pub Date : 2021-06-01DOI: 10.1177/03008916211012337
DP Agbanglanon, S. Jaba, GG Kietga, I. M’barki, H. Elkacemi, T. Kebdani, S. Elmajjaoui, N. Benjaafar
Introduction: Vulvar verrucous carcinoma (VC) is extremely rare, accounting for less than 1% of vulvar cancer cases. Effectively, it is characterization by a slow growing, no metastasis or lymph node involvement. The aim of this study was to report our experience with this disease Material and Methods: This is a retrospective study of patients with vulvar VC who were treated at National Institute of Oncology between 2013 and 2018. Clinicopathological characteristics, treatment and follow-up were extracted from the medical records. Results: Three cases were identified in the National Institut of Oncology. The average age at diagnosis was 66 years (± 10.02). The average time from the onset of symptoms to diagnosis was 17 months (± 12,7). All patients complained of a vulvar mass or nodule, accompanied by vulvar pruritus and/or pain, which was the reason for consultation. A preliminary pathological diagnosis of squamous cell carcinoma was made in two cases. Surgical treatment included wide local excision, radical vulvectomy with lymph node dissection in the groin. Tumor size and invasion depth ranged from 50 to 105 mm and 17 to 35 mm respectively. In the final histology, VC of the vulva staged IB (2 cases) and staged III (1 case) with marginal limits in two cases. The concurrent radiochemotherapy was performed in one case, exclusive radiotherapy in one case and only surgery in one case. Regarding toxicity after concurrent radiochemotherapy and exclusive radiotherapy we had observed respectely grade 2 proctitis with renal toxicity and grade 2 radiodermatitis. The mean follow-up was 43 months with no recurrence in all cases. The prognosis is good, with low recurrent rate if wide local excision is performed. Conclusions: Vulvar VC is a distinct type of slow-growing, tumor with unclear etiology. Surgery is the most effective treatment. Concurrent radiochemotherapy indicated depending on disease stage and risk factors.
{"title":"Verrucous Carcinoma of the Vulva","authors":"DP Agbanglanon, S. Jaba, GG Kietga, I. M’barki, H. Elkacemi, T. Kebdani, S. Elmajjaoui, N. Benjaafar","doi":"10.1177/03008916211012337","DOIUrl":"https://doi.org/10.1177/03008916211012337","url":null,"abstract":"Introduction: Vulvar verrucous carcinoma (VC) is extremely rare, accounting for less than 1% of vulvar cancer cases. Effectively, it is characterization by a slow growing, no metastasis or lymph node involvement. The aim of this study was to report our experience with this disease Material and Methods: This is a retrospective study of patients with vulvar VC who were treated at National Institute of Oncology between 2013 and 2018. Clinicopathological characteristics, treatment and follow-up were extracted from the medical records. Results: Three cases were identified in the National Institut of Oncology. The average age at diagnosis was 66 years (± 10.02). The average time from the onset of symptoms to diagnosis was 17 months (± 12,7). All patients complained of a vulvar mass or nodule, accompanied by vulvar pruritus and/or pain, which was the reason for consultation. A preliminary pathological diagnosis of squamous cell carcinoma was made in two cases. Surgical treatment included wide local excision, radical vulvectomy with lymph node dissection in the groin. Tumor size and invasion depth ranged from 50 to 105 mm and 17 to 35 mm respectively. In the final histology, VC of the vulva staged IB (2 cases) and staged III (1 case) with marginal limits in two cases. The concurrent radiochemotherapy was performed in one case, exclusive radiotherapy in one case and only surgery in one case. Regarding toxicity after concurrent radiochemotherapy and exclusive radiotherapy we had observed respectely grade 2 proctitis with renal toxicity and grade 2 radiodermatitis. The mean follow-up was 43 months with no recurrence in all cases. The prognosis is good, with low recurrent rate if wide local excision is performed. Conclusions: Vulvar VC is a distinct type of slow-growing, tumor with unclear etiology. Surgery is the most effective treatment. Concurrent radiochemotherapy indicated depending on disease stage and risk factors.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"24 1","pages":"8 - 8"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74090791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012332
R. Samaka, A. Mohamed, A. Abu-Zeid
Introduction: Tuberculosis (TB) of the upper genital tract is a rare disease worldwide. TB should be always considered in the differential diagnosis of a pelvic or adnexal mass as it may diagnosed as ovarian carcinoma but both have completely different treatment. Therefore, recognition of TB is important for surgeons and histopathologists, in order to set a proper plan for management and avoid unnecessary extensive therapy. Granulosa cell tumor of the ovary is a rare type of ovarian cancer that accounts for approximately 2% of all ovarian tumors. This type of tumor is known as a sex cord-stromal tumor and usually occurs in adults. Thorough search in English literature revealed only 2 case reports showed combination between genital TB and granulosa cell tumor. Case summary: A 68 years old female patient complained of vaginal bleeding for four months. She had no personal or family history of TB. An ultrasound study showed a 2x1.5 cm mixed echogenic mass in the right adnexa. Based on her clinical and imaging findings which suggestive of ovarian cancer, the patient underwent panhystrectomy and bilateral salpingoophrectomy. The gross examination of the specimen revealed distended and coiled tubes with right adnexal mass measured 2x1.5 cm and dissection of the uterus revealed erythematous endometrium with yellowish secretions. The histopathologic assessment of right adnexal mass revealed malignant neoplasm *Granulosa cell tumor* formed of short polygonal cells arranged in diffuse sheets with patternless pattern. The malignant cells showed nuclear grooving. There was no necrosis or other ovarian neoplastic element. The histopathologic assessment of both tubes and endometrium revealed infiltration by multiple nodular granulomas. Each granuloma was formed of multinucleated giant cells and epithelioid cells rimmed by lymphocytes with occasional central caseation *genital tuberculosis*. Conclusion: The conclusion of this case report is to stress upon keeping genital TB in mind as a potential differential diagnosis for ovarian carcinoma.
{"title":"Female Genital Tuberculosis, a Rare Lesion Mimicking Ovarian Carcinoma, with Granulosa Cell Tumor: A Case Report","authors":"R. Samaka, A. Mohamed, A. Abu-Zeid","doi":"10.1177/03008916211012332","DOIUrl":"https://doi.org/10.1177/03008916211012332","url":null,"abstract":"Introduction: Tuberculosis (TB) of the upper genital tract is a rare disease worldwide. TB should be always considered in the differential diagnosis of a pelvic or adnexal mass as it may diagnosed as ovarian carcinoma but both have completely different treatment. Therefore, recognition of TB is important for surgeons and histopathologists, in order to set a proper plan for management and avoid unnecessary extensive therapy. Granulosa cell tumor of the ovary is a rare type of ovarian cancer that accounts for approximately 2% of all ovarian tumors. This type of tumor is known as a sex cord-stromal tumor and usually occurs in adults. Thorough search in English literature revealed only 2 case reports showed combination between genital TB and granulosa cell tumor. Case summary: A 68 years old female patient complained of vaginal bleeding for four months. She had no personal or family history of TB. An ultrasound study showed a 2x1.5 cm mixed echogenic mass in the right adnexa. Based on her clinical and imaging findings which suggestive of ovarian cancer, the patient underwent panhystrectomy and bilateral salpingoophrectomy. The gross examination of the specimen revealed distended and coiled tubes with right adnexal mass measured 2x1.5 cm and dissection of the uterus revealed erythematous endometrium with yellowish secretions. The histopathologic assessment of right adnexal mass revealed malignant neoplasm *Granulosa cell tumor* formed of short polygonal cells arranged in diffuse sheets with patternless pattern. The malignant cells showed nuclear grooving. There was no necrosis or other ovarian neoplastic element. The histopathologic assessment of both tubes and endometrium revealed infiltration by multiple nodular granulomas. Each granuloma was formed of multinucleated giant cells and epithelioid cells rimmed by lymphocytes with occasional central caseation *genital tuberculosis*. Conclusion: The conclusion of this case report is to stress upon keeping genital TB in mind as a potential differential diagnosis for ovarian carcinoma.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"38 1","pages":"3 - 3"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82193351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012334
E. Aboelkheir*, A. Ashour, S. Fadel, W. Arafat
Introduction: The standard treatment of hormone receptor positive Her2 negative metastatic breast cancer is endocrine therapy with or without targeted therapy (e.g.CDK4/6inhibitors and mTOR inhibitors). Chemotherapy is indicated only in visceral crisis and the presence of visceral metastases is not indication for chemotherapy Aim of study The retrospective study aimed to characterize treatment and outcomes for patients with hormone receptor positive metastatic breast cancer in Alexandria clinical oncology department to review change in treatment trend during the last 10 years. Physician questionnaire to determine their preferences in choosing treatment. Methods Retrospective study using patient files of adult female diagnosed and treated at Clinical Oncology and Nuclear Medicine Department, Alexandria Main University Hospitals during the period from January 2010 to December 2019. Physician questionnaire was done by physician recruitment via online survey & scientific meetings. Results: The study identified 611 women with hormone receptor positive metastatic breast cancer, median age was 50years, 48.9% were postmenopausal, 56.7% of hormone receptor positive, Her2 negative patients received chemotherapy as first line systemic treatment, 69.5% of these patients received chemotherapy as first line treatment in the first 5years. But, 48.8% of these patients received chemotherapy as first line in the last 5years and the study showed that median overall survival for all studied patients was 34 months. In contrast, the physician questionnaire showed that 75% of physicians prefer endocrinal therapy as first line treatment for hormone receptor positive, Her2 negative metastatic breast cancer. Conclusion: There is significant change in practice pattern in choosing the first line treatment between the first and last 5 years. Also, there is a discrepancy between practice pattern and physician preferences in choosing the first line systemic treatment for hormone receptor positive, Her2 negative metastatic breast cancer. The reason is the unavailability of most targeted agents (e.g; CDK4/6 inhibitors and mTOR inhibitors) and some hormonal agents such as fulvestrant.
{"title":"Endocrine Therapy Versus Chemotherapy as First Line Treatment in Metastatic Hormone Receptor Positive Breast Cancer","authors":"E. Aboelkheir*, A. Ashour, S. Fadel, W. Arafat","doi":"10.1177/03008916211012334","DOIUrl":"https://doi.org/10.1177/03008916211012334","url":null,"abstract":"Introduction: The standard treatment of hormone receptor positive Her2 negative metastatic breast cancer is endocrine therapy with or without targeted therapy (e.g.CDK4/6inhibitors and mTOR inhibitors). Chemotherapy is indicated only in visceral crisis and the presence of visceral metastases is not indication for chemotherapy Aim of study The retrospective study aimed to characterize treatment and outcomes for patients with hormone receptor positive metastatic breast cancer in Alexandria clinical oncology department to review change in treatment trend during the last 10 years. Physician questionnaire to determine their preferences in choosing treatment. Methods Retrospective study using patient files of adult female diagnosed and treated at Clinical Oncology and Nuclear Medicine Department, Alexandria Main University Hospitals during the period from January 2010 to December 2019. Physician questionnaire was done by physician recruitment via online survey & scientific meetings. Results: The study identified 611 women with hormone receptor positive metastatic breast cancer, median age was 50years, 48.9% were postmenopausal, 56.7% of hormone receptor positive, Her2 negative patients received chemotherapy as first line systemic treatment, 69.5% of these patients received chemotherapy as first line treatment in the first 5years. But, 48.8% of these patients received chemotherapy as first line in the last 5years and the study showed that median overall survival for all studied patients was 34 months. In contrast, the physician questionnaire showed that 75% of physicians prefer endocrinal therapy as first line treatment for hormone receptor positive, Her2 negative metastatic breast cancer. Conclusion: There is significant change in practice pattern in choosing the first line treatment between the first and last 5 years. Also, there is a discrepancy between practice pattern and physician preferences in choosing the first line systemic treatment for hormone receptor positive, Her2 negative metastatic breast cancer. The reason is the unavailability of most targeted agents (e.g; CDK4/6 inhibitors and mTOR inhibitors) and some hormonal agents such as fulvestrant.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"24 1","pages":"5 - 5"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78569948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012338
E. Qasem, Y. Dorgham, Seham Mohammed Elhagrasy, Nashwa Nawar, Ahmed Z. Al Attar
Background: Bone metastatic disease affect a patient’s quality of life. Aim: Evaluating possible stratification factors affecting the efficacy of different schedules of zoledronic acid on SREs. Patients and Methods: A randomized, clinical trial at Zagazig university hospitals. 108 Patients were enrolled to receive zoledronic acid 4 mg (A and B groups=12 and 4 weeks, respectively) for 2 years. Results: Regarding age, tumour type, types of bone metastasis and number of bone metastasis, there was an insignificant difference between both groups. However, 3 monthly regimen of zoledronic acid gave better results in solitary than multiple bone metastases. Regarding pretreatment ECOG, there was an insignificant difference between between both groups. However, 3 monthly regimen of zoledronic acid gave better results in pre-treatment ECOG 1and ECOG 2 than ECOG 3. Conclusion: A 3-monthly regimen of zoledronic acid is more effective in management of solitary or few sites of bone metastasis, osteoblastic bony lesions and patients with good performance status. Recommendations: We recommend a larger sample size and the study should include a homogenous groups of patients so we can judge well on different stratifications factors that can affect efficacy of 3- monthly regimen of zoledronic acid.
{"title":"Efficacy of 3 Monthly versus Monthly Zoledronic Acid on Bone Metastasis","authors":"E. Qasem, Y. Dorgham, Seham Mohammed Elhagrasy, Nashwa Nawar, Ahmed Z. Al Attar","doi":"10.1177/03008916211012338","DOIUrl":"https://doi.org/10.1177/03008916211012338","url":null,"abstract":"Background: Bone metastatic disease affect a patient’s quality of life. Aim: Evaluating possible stratification factors affecting the efficacy of different schedules of zoledronic acid on SREs. Patients and Methods: A randomized, clinical trial at Zagazig university hospitals. 108 Patients were enrolled to receive zoledronic acid 4 mg (A and B groups=12 and 4 weeks, respectively) for 2 years. Results: Regarding age, tumour type, types of bone metastasis and number of bone metastasis, there was an insignificant difference between both groups. However, 3 monthly regimen of zoledronic acid gave better results in solitary than multiple bone metastases. Regarding pretreatment ECOG, there was an insignificant difference between between both groups. However, 3 monthly regimen of zoledronic acid gave better results in pre-treatment ECOG 1and ECOG 2 than ECOG 3. Conclusion: A 3-monthly regimen of zoledronic acid is more effective in management of solitary or few sites of bone metastasis, osteoblastic bony lesions and patients with good performance status. Recommendations: We recommend a larger sample size and the study should include a homogenous groups of patients so we can judge well on different stratifications factors that can affect efficacy of 3- monthly regimen of zoledronic acid.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"3 1","pages":"9 - 9"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87956390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012320
H. Gadelrab, M. Mokhtar, H. Morsy, M. Elnaggar
Introduction: Breast cancer is the most frequently occurring cancer among females and the second most common cancer overall. Programmed Cell Death Ligand 1 (PD-L1) plays an important role in blocking ‘cancer-immunity cycle’ and is considered as a major inhibitory pathway. The aim of the present study was to clarify the alterations of expression of PD-L1 in peripheral blood mononuclear cytes (PBMCs) of female breast cancer patients and analyze its association with clinico-pathological criteria as well as therapeutic response. Materials and Methods: The study was conducted on 45 female breast cancer patients and 45 female controls. Blood samples were collected followed by PBMCs isolation, total RNA extraction, reverse transcription and finally, quantitative polymerase chain reaction (qPCR) using SYBR Green DNA binding dye. Expression levels of PD-L1 were calculated and then compared with clinicopathological parameters of the patients in addition to initial therapeutic response. Results: A significant difference was detected for PD-L1 expression levels in breast cancer patients compared to controls. A significant association with age, metastatic breast cancer, estrogen receptor (ER) negative status as well as high concentrations of cancer antigen 15-3 (CA15-3) was detected. On the other hand, no significant association was recognized with tumor size, lymph nodal status, histopathological type, grade, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, triple negative, among de novo and recurrent metastatic patients and for the number of metastatic sites as well as the therapeutic response. Conclusions: This study paves the way of the use of PD-L1 as a noninvasive prognostic and diagnostic biomarker for poor prognosis of breast cancer.
简介:乳腺癌是女性中最常见的癌症，也是第二常见的癌症。程序性细胞死亡配体1 (Programmed Cell Death Ligand 1, PD-L1)在阻断“癌症-免疫周期”中起着重要作用，被认为是一个主要的抑制途径。本研究旨在阐明女性乳腺癌患者外周血单个核细胞(PBMCs)中PD-L1表达的改变，并分析其与临床病理标准和治疗反应的关系。材料与方法:选取45例女性乳腺癌患者和45例女性对照进行研究。采集血样，分离PBMCs，提取总RNA，进行逆转录，最后用SYBR Green DNA结合染料进行定量聚合酶链反应(qPCR)。计算PD-L1的表达水平，并与患者的临床病理参数及初始治疗反应进行比较。结果:与对照组相比，乳腺癌患者的PD-L1表达水平有显著差异。发现年龄、转移性乳腺癌、雌激素受体(ER)阴性状态以及高浓度癌症抗原15-3 (CA15-3)与乳腺癌有显著相关性。另一方面，在新发和复发转移患者中，肿瘤大小、淋巴结状态、组织病理类型、分级、孕激素受体(PR)状态、人表皮生长因子受体2 (HER-2)状态、三阴性、转移部位数量和治疗反应之间没有明显的关联。结论:本研究为将PD-L1作为乳腺癌预后不良的无创预后和诊断性生物标志物铺平了道路。
{"title":"Study of Gene Expression of Programmed Cell Death Ligand 1 (PD-L1) in Breast Cancer Patients","authors":"H. Gadelrab, M. Mokhtar, H. Morsy, M. Elnaggar","doi":"10.1177/03008916211012320","DOIUrl":"https://doi.org/10.1177/03008916211012320","url":null,"abstract":"Introduction: Breast cancer is the most frequently occurring cancer among females and the second most common cancer overall. Programmed Cell Death Ligand 1 (PD-L1) plays an important role in blocking ‘cancer-immunity cycle’ and is considered as a major inhibitory pathway. The aim of the present study was to clarify the alterations of expression of PD-L1 in peripheral blood mononuclear cytes (PBMCs) of female breast cancer patients and analyze its association with clinico-pathological criteria as well as therapeutic response. Materials and Methods: The study was conducted on 45 female breast cancer patients and 45 female controls. Blood samples were collected followed by PBMCs isolation, total RNA extraction, reverse transcription and finally, quantitative polymerase chain reaction (qPCR) using SYBR Green DNA binding dye. Expression levels of PD-L1 were calculated and then compared with clinicopathological parameters of the patients in addition to initial therapeutic response. Results: A significant difference was detected for PD-L1 expression levels in breast cancer patients compared to controls. A significant association with age, metastatic breast cancer, estrogen receptor (ER) negative status as well as high concentrations of cancer antigen 15-3 (CA15-3) was detected. On the other hand, no significant association was recognized with tumor size, lymph nodal status, histopathological type, grade, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, triple negative, among de novo and recurrent metastatic patients and for the number of metastatic sites as well as the therapeutic response. Conclusions: This study paves the way of the use of PD-L1 as a noninvasive prognostic and diagnostic biomarker for poor prognosis of breast cancer.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"19 1","pages":"2 - 2"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87234896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012335
A. Khalaf, GA Fadaly, AI El-Sarha, AF El-Karmouty
Introduction: Triple negative breast cancer (TNBC) is an aggressive form of breast cancer associated with a poor prognosis. No targeted treatment is available for this subtype. Tumor microenvironment (TME) has been increasingly considered a diagnostic and a prognostic biomarker and a therapeutic target for breast cancer. Tumor associated macrophages (TAM) are a pivotal member of TME and have been proposed as potential targets of therapy. Material and Methods: The immunohistochemical expression of CD68+ve TAM was studied in both tumor stroma (TS) and tumor nest (TN) in 50 cases of triple negative invasive ductal carcinoma as well as in 10 control cases of benign breast lesions. Results: The cases were divided into high or low density groups according to the median. The median in CD68+ve TAM in TS was (61.88), while in CD68+ve TAM in TN was (49.88). The expression of CD68+ve TAM in TS was low in 22 cases and high in 28 cases, while its expression in TN was low in 35 cases and high in 15 cases. There was no statistical association between high CD68+ve TAM in TN and different clinicopathological parameters, meanwhile a statistically significant association was found between high CD68 +ve TAM in TS and tumor grade, lymph/vascular invasion and lymph node metastasis. Conclusions: High expression of TAM in TS, but not in TN, is of clinical significance in patients with TNBC and highlights the importance of analyzing the localization rather than merely the presence of TAM as a marker for prognosis and a potential target for future treatment of triple negative breast cancer.
{"title":"Immunohistochemical Expression of CD68 in Triple Negative Invasive Ductal Carcinoma of the Breast and its Correlation with Clinicopathological Parameters","authors":"A. Khalaf, GA Fadaly, AI El-Sarha, AF El-Karmouty","doi":"10.1177/03008916211012335","DOIUrl":"https://doi.org/10.1177/03008916211012335","url":null,"abstract":"Introduction: Triple negative breast cancer (TNBC) is an aggressive form of breast cancer associated with a poor prognosis. No targeted treatment is available for this subtype. Tumor microenvironment (TME) has been increasingly considered a diagnostic and a prognostic biomarker and a therapeutic target for breast cancer. Tumor associated macrophages (TAM) are a pivotal member of TME and have been proposed as potential targets of therapy. Material and Methods: The immunohistochemical expression of CD68+ve TAM was studied in both tumor stroma (TS) and tumor nest (TN) in 50 cases of triple negative invasive ductal carcinoma as well as in 10 control cases of benign breast lesions. Results: The cases were divided into high or low density groups according to the median. The median in CD68+ve TAM in TS was (61.88), while in CD68+ve TAM in TN was (49.88). The expression of CD68+ve TAM in TS was low in 22 cases and high in 28 cases, while its expression in TN was low in 35 cases and high in 15 cases. There was no statistical association between high CD68+ve TAM in TN and different clinicopathological parameters, meanwhile a statistically significant association was found between high CD68 +ve TAM in TS and tumor grade, lymph/vascular invasion and lymph node metastasis. Conclusions: High expression of TAM in TS, but not in TN, is of clinical significance in patients with TNBC and highlights the importance of analyzing the localization rather than merely the presence of TAM as a marker for prognosis and a potential target for future treatment of triple negative breast cancer.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"23 1","pages":"6 - 6"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84413475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012342
R. Maher, A. Osman, K. Fahmy, S. M, Osama Al Atarash
Introduction: Idiopathic granulomatous mastitis is a rare benign breast disease. Initial reports from hospitals in Egypt from Departments of Pathology at Cancer Institutes of Cairo, Tanta and Mansoura Universities; indicate that the disease is not as rare as that in the developed countries. It often mimics breast carcinoma both clinically and radiologically. Histological examination is the gold standard for diagnosis. Management of Idiopathic granulomatous mastitis is still debatable. In our study, we aimed to evaluate the addition of corticosteroid therapy to surgical excision in management of idiopathic granulomatous mastitis. Patients and Methods: This is a comparative study was conducted at Ain-Shams University Hospital’s breast clinic on patients with idiopathic granulomatous mastitis from to August 2015 till September 2018. Thirty patients were divided into 2 groups. Group (A) includes patients who underwent surgical management only. Group (B) includes patients who received corticosteroid therapy according to the severity of the cases then surgical Excision was done for the residual lesion. Follow up of all cases up to 1-2 years was done to document the recurrence rate and compare the cosmetic outcome of both groups. Informed consent was obtained from all patients included in the study. Results: The mean age of the affected women was 38.80 and 33.13 in group (A) and group (B), respectively and it wasn’t statistically different (p value = 0.099). The most common presenting symptom was a palpable mass in the breast (66.7% and 93.3%) in group (A) and group (B) respectively. Recurrence rate was higher in group (A) (40%) with no recurrence documented in group (B) however 2 cases were omitted from the study due to steroid noncompliance and complications. Cosmetic outcome was excellent in 76.9% of group (B) and good in 53.3% of group (A). Conclusion: Systemic steroid therapy with surgical resection is the recommended as first-line treatment strategy for IGM as it shows less recurrence rate and surgical scarring. Increased awareness of IGM will increase their understanding and improve their management.
{"title":"Out Come of Wide Local Excision with and without Corticosteroid Therapy in Management of Idiopathic Granulomatous Mastitis","authors":"R. Maher, A. Osman, K. Fahmy, S. M, Osama Al Atarash","doi":"10.1177/03008916211012342","DOIUrl":"https://doi.org/10.1177/03008916211012342","url":null,"abstract":"Introduction: Idiopathic granulomatous mastitis is a rare benign breast disease. Initial reports from hospitals in Egypt from Departments of Pathology at Cancer Institutes of Cairo, Tanta and Mansoura Universities; indicate that the disease is not as rare as that in the developed countries. It often mimics breast carcinoma both clinically and radiologically. Histological examination is the gold standard for diagnosis. Management of Idiopathic granulomatous mastitis is still debatable. In our study, we aimed to evaluate the addition of corticosteroid therapy to surgical excision in management of idiopathic granulomatous mastitis. Patients and Methods: This is a comparative study was conducted at Ain-Shams University Hospital’s breast clinic on patients with idiopathic granulomatous mastitis from to August 2015 till September 2018. Thirty patients were divided into 2 groups. Group (A) includes patients who underwent surgical management only. Group (B) includes patients who received corticosteroid therapy according to the severity of the cases then surgical Excision was done for the residual lesion. Follow up of all cases up to 1-2 years was done to document the recurrence rate and compare the cosmetic outcome of both groups. Informed consent was obtained from all patients included in the study. Results: The mean age of the affected women was 38.80 and 33.13 in group (A) and group (B), respectively and it wasn’t statistically different (p value = 0.099). The most common presenting symptom was a palpable mass in the breast (66.7% and 93.3%) in group (A) and group (B) respectively. Recurrence rate was higher in group (A) (40%) with no recurrence documented in group (B) however 2 cases were omitted from the study due to steroid noncompliance and complications. Cosmetic outcome was excellent in 76.9% of group (B) and good in 53.3% of group (A). Conclusion: Systemic steroid therapy with surgical resection is the recommended as first-line treatment strategy for IGM as it shows less recurrence rate and surgical scarring. Increased awareness of IGM will increase their understanding and improve their management.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"19 1","pages":"13 - 13"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87189649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012340
A. Mohamed, A. Zaher, M. Khalifa, MM AbdElhakem, L. Eloteify
Introduction: The aim of this prospective study was to evaluate the correlation of primary (1ry)tumor metabolic activity parameters maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) in initial staging 18F-fluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan with clinical, histopathological and molecular characteristics of breast cancer (BC) patients. Material and Methods: Initial staging PET/CT was performed in 40 cases with different stages of BC in the supine position. Tumor FDG uptake was qualitatively evaluated and quantitatively assessed using SUVmax and TLR. Results: Forty female patients with newly diagnosed BC were enrolled in our study, age range from 31-78 (mean 50.5 +/- SD11.7). All the 1ry tumors were detected with mean SUVmax 10.8(+/-SD 7.9). The mean /median SUVmax values of 1ry tumor was higher in premenopausal, stage III& IV, Estrogen Receptors negative(ER-), Progesteron Receptors negative(PR-), Her2neu positive patients, high nuclear grade (GIII), in triple negative molecular subgroup (TN), positive axillary nodal (ALNs)metastases, and (P value = 0.003, 0.017, 0.113, 0.089 0.01,0.002, 0.007 & 0.016 respectively). The mean/median TLR values was higher in premenopausal and Her2neu positive, GIII, TN molecular subtype patients, stage III& IV and in patients with positive ALNs, ER- &PR - patients (P value = 0.002, 0.0476, 0.005, 0.018, 0.039 and 0.022, 0.095 & 0.129 respectively). SUVmax of the 1ry lesion and TLR were moderately negatively correlated with the age of the patients (P value = 0.005 and 0.008 respectively), also they were moderately positively correlated with the size of the1ry tumor (P value = 0.019 and 0.036 respectively). Conclusion: The SUVmax of the 1ry tumor and TLR values had similar significant associations with different prognostic factors in BC
{"title":"Correlation of Primary Tumor Metabolic Parameters with Clinical, Histopathological and Molecular Characteristics in Breast Cancer Patients at Preoperative Staging FDG-PET/CT Study","authors":"A. Mohamed, A. Zaher, M. Khalifa, MM AbdElhakem, L. Eloteify","doi":"10.1177/03008916211012340","DOIUrl":"https://doi.org/10.1177/03008916211012340","url":null,"abstract":"Introduction: The aim of this prospective study was to evaluate the correlation of primary (1ry)tumor metabolic activity parameters maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) in initial staging 18F-fluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan with clinical, histopathological and molecular characteristics of breast cancer (BC) patients. Material and Methods: Initial staging PET/CT was performed in 40 cases with different stages of BC in the supine position. Tumor FDG uptake was qualitatively evaluated and quantitatively assessed using SUVmax and TLR. Results: Forty female patients with newly diagnosed BC were enrolled in our study, age range from 31-78 (mean 50.5 +/- SD11.7). All the 1ry tumors were detected with mean SUVmax 10.8(+/-SD 7.9). The mean /median SUVmax values of 1ry tumor was higher in premenopausal, stage III& IV, Estrogen Receptors negative(ER-), Progesteron Receptors negative(PR-), Her2neu positive patients, high nuclear grade (GIII), in triple negative molecular subgroup (TN), positive axillary nodal (ALNs)metastases, and (P value = 0.003, 0.017, 0.113, 0.089 0.01,0.002, 0.007 & 0.016 respectively). The mean/median TLR values was higher in premenopausal and Her2neu positive, GIII, TN molecular subtype patients, stage III& IV and in patients with positive ALNs, ER- &PR - patients (P value = 0.002, 0.0476, 0.005, 0.018, 0.039 and 0.022, 0.095 & 0.129 respectively). SUVmax of the 1ry lesion and TLR were moderately negatively correlated with the age of the patients (P value = 0.005 and 0.008 respectively), also they were moderately positively correlated with the size of the1ry tumor (P value = 0.019 and 0.036 respectively). Conclusion: The SUVmax of the 1ry tumor and TLR values had similar significant associations with different prognostic factors in BC","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"74 1","pages":"11 - 11"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85189867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211016798
S. S. Ismail, A. Farag, D. E. D. Sherif, Ibrahim S. Alhussini
Background: Breast cancer is a disease which have a variety of important features whose different phenotype only partially summarize the underlying biological complexity. Treatment choices in routine management principally rely on the clinical and pathological characteristics of the disease, although molecular classification currently offers information alongside that provided by clinical and pathological examination. The decision to offer adjuvant chemotherapy to patients is not easy and the knowledge of prognostic factors is mandatory. Ki 67 plays an important role in this context, especially in patients who do not have access to genetic signatures. Aim of the work: This study aims to evaluate the value of Ki67 as a prognostic factor in relation to disease free survival and other clinico-pathological factors in Egyptian females with early stage breast cancer. Patients and Methods: Type of study: This is a retrospective cohort study. Study population: It consisted of 124 patients diagnosed with early stage breast cancer. Study Period: They were diagnosed between January 2011 and December 2015. Study setting: The patients were following up in Ain Shams University Hospital clinical oncology department. Information were manually retrieved from the records of the clinical oncology department at Ain Shams university hospitals. Clinical and pathological tumor characteristics were collected using patient charts and pathology reports. Results: Our study showed a significant relation between Ki67 index and estrogen receptors, progesterone receptors and Her2 neu status. Ki67 was found to be statistically significantly correlated to intrinsic subtypes. Our study was unable to find out the effect of Ki67 on disease free survival. Cox regression analysis revealed a statistical significant influence of estrogen receptors status on disease free survival. It also revealed statistical prognostic effect of progesterone receptors and Her2 status on disease free survival. Covariate analysis of results in our study showed that tumor with T4 stage has a significant prognostic effect on disease free survival. Conclusion: ki67 index may have a prognostic role in management of early stage breast cancer in relation to other prognostic markers like hormone receptor status and HER2neu expression. Moreover, immunohisto-chemistry-based subtyping is extremely important to classify breast carcinoma into molecular subtypes that vary in clinic-pathological features and would lead to different prognosis. Thus, molecular subtyping is essential for breast carcinoma management.
{"title":"Evaluation of the Prognostic Value of Ki-67 in Early Stage Breast Cancer","authors":"S. S. Ismail, A. Farag, D. E. D. Sherif, Ibrahim S. Alhussini","doi":"10.1177/03008916211016798","DOIUrl":"https://doi.org/10.1177/03008916211016798","url":null,"abstract":"Background: Breast cancer is a disease which have a variety of important features whose different phenotype only partially summarize the underlying biological complexity. Treatment choices in routine management principally rely on the clinical and pathological characteristics of the disease, although molecular classification currently offers information alongside that provided by clinical and pathological examination. The decision to offer adjuvant chemotherapy to patients is not easy and the knowledge of prognostic factors is mandatory. Ki 67 plays an important role in this context, especially in patients who do not have access to genetic signatures. Aim of the work: This study aims to evaluate the value of Ki67 as a prognostic factor in relation to disease free survival and other clinico-pathological factors in Egyptian females with early stage breast cancer. Patients and Methods: Type of study: This is a retrospective cohort study. Study population: It consisted of 124 patients diagnosed with early stage breast cancer. Study Period: They were diagnosed between January 2011 and December 2015. Study setting: The patients were following up in Ain Shams University Hospital clinical oncology department. Information were manually retrieved from the records of the clinical oncology department at Ain Shams university hospitals. Clinical and pathological tumor characteristics were collected using patient charts and pathology reports. Results: Our study showed a significant relation between Ki67 index and estrogen receptors, progesterone receptors and Her2 neu status. Ki67 was found to be statistically significantly correlated to intrinsic subtypes. Our study was unable to find out the effect of Ki67 on disease free survival. Cox regression analysis revealed a statistical significant influence of estrogen receptors status on disease free survival. It also revealed statistical prognostic effect of progesterone receptors and Her2 status on disease free survival. Covariate analysis of results in our study showed that tumor with T4 stage has a significant prognostic effect on disease free survival. Conclusion: ki67 index may have a prognostic role in management of early stage breast cancer in relation to other prognostic markers like hormone receptor status and HER2neu expression. Moreover, immunohisto-chemistry-based subtyping is extremely important to classify breast carcinoma into molecular subtypes that vary in clinic-pathological features and would lead to different prognosis. Thus, molecular subtyping is essential for breast carcinoma management.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"22 1","pages":"15 - 15"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73126974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1177/03008916211012336
W. Abozeed, M. Zahi, S. Attia
Introduction: The efficacy and safety of the lapatinib based treatment remain challenging in elderly patients with her2neu positive metastatic breast cancer (MBC). Lapatinib exhibits a good overall tolerance, but no study has yet been dedicated to elderly women. The present study is a real-world study that aimed to determine the efficacy and tolerability of the lapatinib-based treatment in the first line setting in Egyptian patients with HER2neu positive MBC who cannot get access to trastuzumab. Patients and Methods: In this retrospective study, 60 elderly patients (⩾ 65 years) with her2neu positive MBC and treatment naïve were included. All patients were treated with the combination of lapatinib (1,250 mg/day, continuously) and chemotherapy (either capecitabine 2,000 mg/m2 on days 1–14 of a 21-day cycle or weekly taxol 80 mg/m2), or lapatinib (1,250 mg/day, continuously) and hormonal treatment. Data on demographics, clinical outcome, and toxicity were collected form the patients’ medical records for descriptive analyses. Results: The median follow-up was 23.5 months (range 11–36 months). Most of the patients were hormone receptor positive (70%). About 28% of the patients had multiple sites of metastasis while 16 patients (26.7%) had bone only metastasis and 11 patients (18.3%) had lung only metastasis. Most of our patients (63.3%) had no associated comorbidities. An overall response rate of 61.7% was achieved, including 2 complete responses (3.3%), and 13 partial responses (21.7%). Median progression-free survival was 15.9 months (95% confidence interval (CI) 13.56- 18.33), and the median overall survival was 19.9 months (95% CI 17.8-21.9). Most common grade 1-2 side effects were diarrhea (43.3%), followed by hand-foot syndrome (35%), and skin rash (13.3%). Grade 3–4 toxicities were identified as hand-foot syndrome (10%), diarrhea (6.6%).There were no symptomatic cardiac events. Tolerability data show that 45% of patients needed a lapatinib dose reduction, and 30% a treatment interruption due to toxicity, while treatment discontinuation occurred in 18.3% of the cases. Conclusion: Lapatinib based therapy in elderly patients with her2neu positive MBC was effective. However, it was not well tolerated especially when combined with chemotherapy.
基于拉帕替尼的治疗在老年her2neu阳性转移性乳腺癌(MBC)患者中的有效性和安全性仍然具有挑战性。拉帕替尼显示出良好的总体耐受性，但尚未有专门针对老年妇女的研究。目前的研究是一项真实世界的研究，旨在确定以拉帕替尼为基础的治疗在一线环境中对无法获得曲妥珠单抗的HER2neu阳性MBC患者的疗效和耐受性。患者和方法:在这项回顾性研究中，包括60名患有her2neu阳性MBC并接受naïve治疗的老年患者(小于或等于65岁)。所有患者均联合使用拉帕替尼(1250 mg/天，连续)和化疗(卡培他滨2000 mg/m2, 21天周期，第1-14天或每周紫杉醇80 mg/m2)，或拉帕替尼(1250 mg/天，连续)和激素治疗。从患者的医疗记录中收集有关人口统计学、临床结果和毒性的数据，用于描述性分析。结果:中位随访时间为23.5个月(11-36个月)。大多数患者激素受体阳性(70%)。多部位转移约占28%，仅骨转移16例(26.7%)，仅肺转移11例(18.3%)。大多数患者(63.3%)无相关合并症。总有效率为61.7%，其中完全缓解2例(3.3%)，部分缓解13例(21.7%)。中位无进展生存期为15.9个月(95%可信区间(CI) 13.56- 18.33)，中位总生存期为19.9个月(95% CI 17.8-21.9)。最常见的1-2级副作用是腹泻(43.3%)，其次是手足综合征(35%)和皮疹(13.3%)。3-4级毒副反应为手足综合征(10%)、腹泻(6.6%)。无症状性心脏事件。耐受性数据显示，45%的患者需要减少拉帕替尼剂量，30%的患者因毒性而中断治疗，而18.3%的患者需要停止治疗。结论:拉帕替尼为主治疗老年her2neu阳性MBC患者疗效确切。然而，它的耐受性不是很好，尤其是与化疗联合使用时。
{"title":"Efficacy and Safety of Lapatinib in Elderly Egyptian Patients with Her2 neu Positive Metastatic Breast Cancer","authors":"W. Abozeed, M. Zahi, S. Attia","doi":"10.1177/03008916211012336","DOIUrl":"https://doi.org/10.1177/03008916211012336","url":null,"abstract":"Introduction: The efficacy and safety of the lapatinib based treatment remain challenging in elderly patients with her2neu positive metastatic breast cancer (MBC). Lapatinib exhibits a good overall tolerance, but no study has yet been dedicated to elderly women. The present study is a real-world study that aimed to determine the efficacy and tolerability of the lapatinib-based treatment in the first line setting in Egyptian patients with HER2neu positive MBC who cannot get access to trastuzumab. Patients and Methods: In this retrospective study, 60 elderly patients (⩾ 65 years) with her2neu positive MBC and treatment naïve were included. All patients were treated with the combination of lapatinib (1,250 mg/day, continuously) and chemotherapy (either capecitabine 2,000 mg/m2 on days 1–14 of a 21-day cycle or weekly taxol 80 mg/m2), or lapatinib (1,250 mg/day, continuously) and hormonal treatment. Data on demographics, clinical outcome, and toxicity were collected form the patients’ medical records for descriptive analyses. Results: The median follow-up was 23.5 months (range 11–36 months). Most of the patients were hormone receptor positive (70%). About 28% of the patients had multiple sites of metastasis while 16 patients (26.7%) had bone only metastasis and 11 patients (18.3%) had lung only metastasis. Most of our patients (63.3%) had no associated comorbidities. An overall response rate of 61.7% was achieved, including 2 complete responses (3.3%), and 13 partial responses (21.7%). Median progression-free survival was 15.9 months (95% confidence interval (CI) 13.56- 18.33), and the median overall survival was 19.9 months (95% CI 17.8-21.9). Most common grade 1-2 side effects were diarrhea (43.3%), followed by hand-foot syndrome (35%), and skin rash (13.3%). Grade 3–4 toxicities were identified as hand-foot syndrome (10%), diarrhea (6.6%).There were no symptomatic cardiac events. Tolerability data show that 45% of patients needed a lapatinib dose reduction, and 30% a treatment interruption due to toxicity, while treatment discontinuation occurred in 18.3% of the cases. Conclusion: Lapatinib based therapy in elderly patients with her2neu positive MBC was effective. However, it was not well tolerated especially when combined with chemotherapy.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"20 3 1","pages":"7 - 7"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74514270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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