Pub Date : 2020-04-01DOI: 10.1177/0300891619868019
I. Ardoino, S. Signoroni, Enzo Malvicini, M. T. Ricci, E. Biganzoli, L. Bertario, S. Occhionorelli, M. Vitellaro
Background: The best surgical choice for patients with familial adenomatous polyposis (FAP) is still debated. No prospective trials have been carried out to evaluate the pros and cons of the recommended procedures: total colectomy (ileorectal anastomosis [IRA]) vs restorative proctocolectomy (ileal pouch–anal anastomosis [IPAA]). The aim of this study was to provide a basis for tailored precision surgery in patients with FAP. Methods: We conducted a retrospective review of patients with FAP who underwent surgery and were registered in a dedicated database in Milan, Italy. Twenty-year survival related to surgical approach and prognostic factors were investigated using a Cox regression model. Results: A total of 925 patients underwent surgery between 1947 and 2015: 340 (36.8%) IPAA and 585 (63.2%) IRA. Colorectal cancer (CRC) at surgery was diagnosed in 28.6% of patients and a pathogenic APC variant was identified in 88%. During a median follow-up of 129 months, 150 patients died. The survival probability was significantly higher in the IRA than the IPAA group: 0.82 vs 0.75 (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.42–0.84). Multivariable regression modeling adjusted for propensity scores showed a similar difference, although no longer significant. Multivariable analysis indicated as independent risk factors CRC (HR 4.68, 95% CI 3.04–7.20) and age at surgery (HR 1.03, 95% CI 1.02–1.06). Among patients without cancer, the main risk factor for shorter survival was older age (HR 1.06, 95% CI 1.04–1.09). Conclusion: The study confirms excellent long-term results of surgical approaches with IRA and IPAA, suggesting that the best surgical choice may be an individually and clinically tailored approach, preferably at a young age.
背景:家族性腺瘤性息肉病(FAP)患者的最佳手术选择仍有争议。目前还没有前瞻性试验来评估推荐手术的利弊:全结肠切除术(回直肠吻合术[IRA])和恢复性直结肠切除术(回肠袋-肛门吻合术[IPAA])。本研究的目的是为FAP患者的精准手术提供依据。方法:我们对在意大利米兰的一个专用数据库中登记的接受手术的FAP患者进行了回顾性研究。采用Cox回归模型研究与手术入路相关的20年生存率和预后因素。结果:1947年至2015年间共有925例患者接受了手术:340例(36.8%)IPAA, 585例(63.2%)IRA。28.6%的患者在手术中被诊断出结直肠癌(CRC), 88%的患者被鉴定出致病性APC变异。在平均129个月的随访期间,150名患者死亡。IRA组的生存率显著高于IPAA组:0.82 vs 0.75(风险比[HR] 0.6, 95%可信区间[CI] 0.42-0.84)。多变量回归模型调整倾向得分显示类似的差异,虽然不再显著。多变量分析显示,结直肠癌(HR 4.68, 95% CI 3.04-7.20)和手术年龄(HR 1.03, 95% CI 1.02-1.06)是独立危险因素。在没有癌症的患者中,缩短生存期的主要危险因素是年龄较大(HR 1.06, 95% CI 1.04-1.09)。结论:该研究证实了IRA和IPAA手术入路的良好长期效果,表明最佳手术选择可能是个体化和临床定制的入路,最好是在年轻时。
{"title":"Long-term survival between total colectomy versus proctocolectomy in patients with FAP: a registry-based, observational cohort study","authors":"I. Ardoino, S. Signoroni, Enzo Malvicini, M. T. Ricci, E. Biganzoli, L. Bertario, S. Occhionorelli, M. Vitellaro","doi":"10.1177/0300891619868019","DOIUrl":"https://doi.org/10.1177/0300891619868019","url":null,"abstract":"Background: The best surgical choice for patients with familial adenomatous polyposis (FAP) is still debated. No prospective trials have been carried out to evaluate the pros and cons of the recommended procedures: total colectomy (ileorectal anastomosis [IRA]) vs restorative proctocolectomy (ileal pouch–anal anastomosis [IPAA]). The aim of this study was to provide a basis for tailored precision surgery in patients with FAP. Methods: We conducted a retrospective review of patients with FAP who underwent surgery and were registered in a dedicated database in Milan, Italy. Twenty-year survival related to surgical approach and prognostic factors were investigated using a Cox regression model. Results: A total of 925 patients underwent surgery between 1947 and 2015: 340 (36.8%) IPAA and 585 (63.2%) IRA. Colorectal cancer (CRC) at surgery was diagnosed in 28.6% of patients and a pathogenic APC variant was identified in 88%. During a median follow-up of 129 months, 150 patients died. The survival probability was significantly higher in the IRA than the IPAA group: 0.82 vs 0.75 (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.42–0.84). Multivariable regression modeling adjusted for propensity scores showed a similar difference, although no longer significant. Multivariable analysis indicated as independent risk factors CRC (HR 4.68, 95% CI 3.04–7.20) and age at surgery (HR 1.03, 95% CI 1.02–1.06). Among patients without cancer, the main risk factor for shorter survival was older age (HR 1.06, 95% CI 1.04–1.09). Conclusion: The study confirms excellent long-term results of surgical approaches with IRA and IPAA, suggesting that the best surgical choice may be an individually and clinically tailored approach, preferably at a young age.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"410 1","pages":"139 - 148"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77229250","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 : 2020-04-01DOI: 10.1177/0300891620914118
A. Zayane, M. Elanigri, H. Abourrazek, Y. Bouchabaka, Issam Lalya, A. Elomrani, M. Khouchani
Objective: To retrospectively report the results in terms of local control and toxicities, of the 2 x 9 Gy fractionation used in our service, in high dose rate brachytherapy, during the treatment of locally advanced cervical cancer, preceded by a concomitant chemotherapy radiotherapy association. Material and method: Report and analyze data from 106 patients treated in our center between 2015 and 2018, for cervical cancer stage IIB and IIIB according to the FIGO classification. Results: The median follow-up was 29 months. Among the 106 patients analyzed, 75.5% had good local control at 3 years against 7.5% who had local progression, while 9.5% had local relapse and 7.5% had metastatic relapse. The average time for the occurrence of an event (progression, local or remote relapse) was 8 months. Most patients (90.6%) did not have acute toxicity. As for chronic toxicities, 66% had good long-term tolerance, while 27.4% had synechiae or even vaginal stenosis. The other toxicities were in the minority. Conclusion: Despite the considerable advantage of 2 x 9 Gy fractionation in uterovaginal brachytherapy in terms of reduction in treatment time, it is not the ideal choice in terms of local control and toxicity and the 3 x 8 Gy scheme seems a good alternative.
{"title":"Retrospective Evaluation of the Bifractionated Scheme in Utero-Vaginal Brachytherapy in the Treatment of Cervical Cancer : Experience of the Radiotherapy Oncology Service at Marrakech University Hospital","authors":"A. Zayane, M. Elanigri, H. Abourrazek, Y. Bouchabaka, Issam Lalya, A. Elomrani, M. Khouchani","doi":"10.1177/0300891620914118","DOIUrl":"https://doi.org/10.1177/0300891620914118","url":null,"abstract":"Objective: To retrospectively report the results in terms of local control and toxicities, of the 2 x 9 Gy fractionation used in our service, in high dose rate brachytherapy, during the treatment of locally advanced cervical cancer, preceded by a concomitant chemotherapy radiotherapy association. Material and method: Report and analyze data from 106 patients treated in our center between 2015 and 2018, for cervical cancer stage IIB and IIIB according to the FIGO classification. Results: The median follow-up was 29 months. Among the 106 patients analyzed, 75.5% had good local control at 3 years against 7.5% who had local progression, while 9.5% had local relapse and 7.5% had metastatic relapse. The average time for the occurrence of an event (progression, local or remote relapse) was 8 months. Most patients (90.6%) did not have acute toxicity. As for chronic toxicities, 66% had good long-term tolerance, while 27.4% had synechiae or even vaginal stenosis. The other toxicities were in the minority. Conclusion: Despite the considerable advantage of 2 x 9 Gy fractionation in uterovaginal brachytherapy in terms of reduction in treatment time, it is not the ideal choice in terms of local control and toxicity and the 3 x 8 Gy scheme seems a good alternative.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"119 1","pages":"2 - 2"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73142143","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 : 2020-04-01DOI: 10.1177/0300891619869518
Yasushi Domeki, M. Nakajima, Masakazu Takahashi, M. Kikuchi, Haruka Yokoyama, Hideo Ogata, Kentaro Okamoto, S. Yamaguchi, K. Sasaki, T. Tsuchioka, H. Kato
Background: This study aimed to examine the treatment outcomes of patients with brain metastases from esophageal cancer. Brain metastases from esophageal cancer are rare and have a poorer prognosis than brain metastases from lung and breast cancer. Methods: This study included patients who were diagnosed with and treated for esophageal cancer in our department and subsequently developed brain metastases between April 2010 and December 2014. We examined the differences in survival in patients based on receiving chemotherapy. Results: In total, 8 patients (7 men and 1 woman) with a mean age of 65 years (range 51–73) were included. Seven presented with neurologic symptoms. Two were diagnosed via computed tomography (CT), 5 via magnetic resonance imaging, and 1 via positron emission tomography/CT. They were treated using whole-brain irradiation or with a gamma knife. In 5 patients, chemotherapy was administered after treatment of the brain metastases. The mean survival from the start of treatment was 358 days (range 31–1196). Conclusion: The relatively successful local control of brain metastases in these patients indicates that long-term survival may be attainable via concomitant chemotherapy.
{"title":"Treatment strategy for brain metastases from esophageal cancer","authors":"Yasushi Domeki, M. Nakajima, Masakazu Takahashi, M. Kikuchi, Haruka Yokoyama, Hideo Ogata, Kentaro Okamoto, S. Yamaguchi, K. Sasaki, T. Tsuchioka, H. Kato","doi":"10.1177/0300891619869518","DOIUrl":"https://doi.org/10.1177/0300891619869518","url":null,"abstract":"Background: This study aimed to examine the treatment outcomes of patients with brain metastases from esophageal cancer. Brain metastases from esophageal cancer are rare and have a poorer prognosis than brain metastases from lung and breast cancer. Methods: This study included patients who were diagnosed with and treated for esophageal cancer in our department and subsequently developed brain metastases between April 2010 and December 2014. We examined the differences in survival in patients based on receiving chemotherapy. Results: In total, 8 patients (7 men and 1 woman) with a mean age of 65 years (range 51–73) were included. Seven presented with neurologic symptoms. Two were diagnosed via computed tomography (CT), 5 via magnetic resonance imaging, and 1 via positron emission tomography/CT. They were treated using whole-brain irradiation or with a gamma knife. In 5 patients, chemotherapy was administered after treatment of the brain metastases. The mean survival from the start of treatment was 358 days (range 31–1196). Conclusion: The relatively successful local control of brain metastases in these patients indicates that long-term survival may be attainable via concomitant chemotherapy.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"63 1","pages":"109 - 114"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76841331","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 : 2020-04-01DOI: 10.1177/0300891620914124
S. A. Ali, A. El-daly, A. El-Sayed, H.G El-Shredy, G. Fadaly
Introduction: The associations between programmed cell death ligand 1 (PD-L1) and the prognosis of various cancers have always been a research topic of considerable interest.However, the prognostic value of PD-L1 in breast cancer patients remains a controversial subject. We aimed to evaluate the role of programmed death-1 receptor and programmed death ligand-1 (PD-1/PD-L1) expressing lymphocytes, monocytes and granulocytes, as potential mechanism of immune escape in breast cancer patients. Also, serum levels of Bcl-2 were analyzed among patients with different stages of breast cancer. Material and Methods: The study was conducted on a total of seventy-five females; fifty-five of them represented the breast cancer females at early (24 females) and advanced (31 females) stages and 20 ages matched female donors represented the control group. Patients were recruited from the Cancer Research and Management Department, Medical Research Institute, Alexandria University. Venous blood samples obtained from all females under study were used for determination of PD-1/PD-L1 expression using flowcytometry technique and measurement of Bcl-2 serum levels using ELISA technique. Results: Significantly higher expression levels of PD-L1 were found in patients with positive lymph node, advanced tumor stage, histological grade II, tumor size T2, ER, PR, Her-2 negativity and TNBC subtype. Whilst a general increase in PD-1 positive expression between the breast cancer patients and control group regarding percentage and MFI of positive PD-1 expressing monocytes and granulocytes. Also, the results showed a highly significant association between PD-1+ and PD-L1+ expression in early and advanced breast cancer patients (p<0.0001). There was a significant increase in the mean of Bcl-2 serum concentration in patients compared to healthy individuals. Finally, the results showed that Bcl-2 serum concentration correlated positively with positive PD-L1+ expressing granulocytes. While the correlation between serum Bcl-2 and PD-1+ expressing lymphocytes, monocytes and granulocytes did not show any statistical significance. Conclusions: Our study suggested that PD-L1 could serve as an important target for antibody based immunotherapies, especially in the TNBC, where treatment options are limited. The direct correlation between PD-L1+ expression and serum Bcl-2 concentration may explore a role of apoptotic machinery in the pathogenesis of breast cancer.
{"title":"The Study of Programmed Death-1 Receptor, Programmed Death-1 Ligand (Pd-1/Pd-L1) and Apoptosis in Breast Cancer Patients: A Potential Mechanism of Immune Escape","authors":"S. A. Ali, A. El-daly, A. El-Sayed, H.G El-Shredy, G. Fadaly","doi":"10.1177/0300891620914124","DOIUrl":"https://doi.org/10.1177/0300891620914124","url":null,"abstract":"Introduction: The associations between programmed cell death ligand 1 (PD-L1) and the prognosis of various cancers have always been a research topic of considerable interest.However, the prognostic value of PD-L1 in breast cancer patients remains a controversial subject. We aimed to evaluate the role of programmed death-1 receptor and programmed death ligand-1 (PD-1/PD-L1) expressing lymphocytes, monocytes and granulocytes, as potential mechanism of immune escape in breast cancer patients. Also, serum levels of Bcl-2 were analyzed among patients with different stages of breast cancer. Material and Methods: The study was conducted on a total of seventy-five females; fifty-five of them represented the breast cancer females at early (24 females) and advanced (31 females) stages and 20 ages matched female donors represented the control group. Patients were recruited from the Cancer Research and Management Department, Medical Research Institute, Alexandria University. Venous blood samples obtained from all females under study were used for determination of PD-1/PD-L1 expression using flowcytometry technique and measurement of Bcl-2 serum levels using ELISA technique. Results: Significantly higher expression levels of PD-L1 were found in patients with positive lymph node, advanced tumor stage, histological grade II, tumor size T2, ER, PR, Her-2 negativity and TNBC subtype. Whilst a general increase in PD-1 positive expression between the breast cancer patients and control group regarding percentage and MFI of positive PD-1 expressing monocytes and granulocytes. Also, the results showed a highly significant association between PD-1+ and PD-L1+ expression in early and advanced breast cancer patients (p<0.0001). There was a significant increase in the mean of Bcl-2 serum concentration in patients compared to healthy individuals. Finally, the results showed that Bcl-2 serum concentration correlated positively with positive PD-L1+ expressing granulocytes. While the correlation between serum Bcl-2 and PD-1+ expressing lymphocytes, monocytes and granulocytes did not show any statistical significance. Conclusions: Our study suggested that PD-L1 could serve as an important target for antibody based immunotherapies, especially in the TNBC, where treatment options are limited. The direct correlation between PD-L1+ expression and serum Bcl-2 concentration may explore a role of apoptotic machinery in the pathogenesis of breast cancer.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"47 1","pages":"5 - 5"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90533118","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 : 2020-04-01DOI: 10.1177/0300891620914129
R. Samaka, A. Abu-Zeid
Objectives: Fibromatosis is a rare breast lesion that is considered locally aggressive tumor without metastasis. It doesn't need more than surgical excision with clean margins as a treatment but the recurrence is very common. Breast fibromatosis clinically mimics other lesions as fibromatosis like metaplastic tumor of breast. Therefore, recognition of breast fibromatosis is important for surgeons and histopathologists, in order to set a proper plan for management and avoid unnecessary extensive surgery. Comprehensive search revealed only 33 case reports as it's compromising less than 0.2% of all primary breast tumor. Case summary Methods and Materials: A 35 years old female patient complained of palpable left breast mass for four months. Her imaging belonged to BI-RAD (4) assessment category. The pathological examination of the core biopsy showed B3; spindle cell lesion. The patient underwent surgical excision of the mass and the histopathologic assessment revealed an infiltrative uncapsulated lesion composed of proliferated spindle shaped cells (mixed fibroblasts and myofibroblast like cells) arranged in sweeping fascicles with occasional extravasated RBCs. There was no mitosis, necrosis or atypia. There was no associated hyperplasia, atypical hyperplasia, insitu or invasive components. Results: Immunohistochemical studies showed positivity for SMA and B- Catenine and negativity for Pan CK and P63 that confirm our diagnosis. Conclusion: The conclusion of this case report is to stress upon keeping breast fibromatosis in mind as a potential differential diagnosis for fibromatosis like metaplastic carcinoma and other mimics of spindle cell lesions in breast.
{"title":"Breast Fibromatosis, A Rare Benign Tumor Mimicking Breast Carcinoma: A Case Report","authors":"R. Samaka, A. Abu-Zeid","doi":"10.1177/0300891620914129","DOIUrl":"https://doi.org/10.1177/0300891620914129","url":null,"abstract":"Objectives: Fibromatosis is a rare breast lesion that is considered locally aggressive tumor without metastasis. It doesn't need more than surgical excision with clean margins as a treatment but the recurrence is very common. Breast fibromatosis clinically mimics other lesions as fibromatosis like metaplastic tumor of breast. Therefore, recognition of breast fibromatosis is important for surgeons and histopathologists, in order to set a proper plan for management and avoid unnecessary extensive surgery. Comprehensive search revealed only 33 case reports as it's compromising less than 0.2% of all primary breast tumor. Case summary Methods and Materials: A 35 years old female patient complained of palpable left breast mass for four months. Her imaging belonged to BI-RAD (4) assessment category. The pathological examination of the core biopsy showed B3; spindle cell lesion. The patient underwent surgical excision of the mass and the histopathologic assessment revealed an infiltrative uncapsulated lesion composed of proliferated spindle shaped cells (mixed fibroblasts and myofibroblast like cells) arranged in sweeping fascicles with occasional extravasated RBCs. There was no mitosis, necrosis or atypia. There was no associated hyperplasia, atypical hyperplasia, insitu or invasive components. Results: Immunohistochemical studies showed positivity for SMA and B- Catenine and negativity for Pan CK and P63 that confirm our diagnosis. Conclusion: The conclusion of this case report is to stress upon keeping breast fibromatosis in mind as a potential differential diagnosis for fibromatosis like metaplastic carcinoma and other mimics of spindle cell lesions in breast.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"64 1","pages":"9 - 9"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82967439","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 : 2020-04-01DOI: 10.1177/0300891620914167
Z. Ali, M. Abdullah, M. Houseni, D. Hashem
Introduction: Breast cancer is the most common cancer type in women and the leading cause of cancer-related deaths in women worldwide. F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) is widely used in the initial staging, evaluation of the therapeutic response, and detection of recurrent disease. However, with the increasing use of FDG PET/CT, sites of increased activity have been occasionally discovered in unexpected locations which may not correlate with the patient’s clinical history or the expected spread of the primary malignancy. The aim of this study is to detect the diagnostic value of PET/CT in breast cancer patients; comparing PET/CT performance with that of contrast enhanced CT in diagnosis of breast cancer and distant metastasis. Material and Methods: A prospective study carried out at National liver institute –Menoufia University from January 2016 to December 2017. It included 30 female patients. All patients had pathologically confirmed breast cancer. All patients underwent 18F-FDG PET/CT examination. Patients fasting for about 6 hours before study, then 370–550 MBq of 18F-FDG was injected. Approximately after 60 min from injection, PET/CT scans were performed. Following PET imaging, volumetric contrast enhanced CT scanning was performed from skull base to mid-thigh on the same PET/CT machine. Images were reconstructed and viewed on workstation. Results: The study included 30 female patients with breast cancer, mean age: 53.56 years ±10.64 (SD), age range: 33-73years. Detection of contralateral breast affection in 2 patients (6.7%) and distant metastasis were seen on PET/CT. Sites of distant metastasis included: bone (n=12), axillary lymph nodes (n=11), cervical lymph nodes (n=6), mediastinal lymph nodes (n=12), abdominal lymph nodes (n=8), liver (n=5), lung (n=11) and other visceral sites metastasis (n=9).PET/CT detected breast lesions with a sensitivity of 100% and specificity of 95.4%. In contrast, the sensitivity and specificity of CT alone were 81.2% and 90.4% respectively. Conclusion: PET/CT has superiority over CT alone in detecting breast lesions and distant metastases.
{"title":"Role of PET/CT in Breast Cancer","authors":"Z. Ali, M. Abdullah, M. Houseni, D. Hashem","doi":"10.1177/0300891620914167","DOIUrl":"https://doi.org/10.1177/0300891620914167","url":null,"abstract":"Introduction: Breast cancer is the most common cancer type in women and the leading cause of cancer-related deaths in women worldwide. F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) is widely used in the initial staging, evaluation of the therapeutic response, and detection of recurrent disease. However, with the increasing use of FDG PET/CT, sites of increased activity have been occasionally discovered in unexpected locations which may not correlate with the patient’s clinical history or the expected spread of the primary malignancy. The aim of this study is to detect the diagnostic value of PET/CT in breast cancer patients; comparing PET/CT performance with that of contrast enhanced CT in diagnosis of breast cancer and distant metastasis. Material and Methods: A prospective study carried out at National liver institute –Menoufia University from January 2016 to December 2017. It included 30 female patients. All patients had pathologically confirmed breast cancer. All patients underwent 18F-FDG PET/CT examination. Patients fasting for about 6 hours before study, then 370–550 MBq of 18F-FDG was injected. Approximately after 60 min from injection, PET/CT scans were performed. Following PET imaging, volumetric contrast enhanced CT scanning was performed from skull base to mid-thigh on the same PET/CT machine. Images were reconstructed and viewed on workstation. Results: The study included 30 female patients with breast cancer, mean age: 53.56 years ±10.64 (SD), age range: 33-73years. Detection of contralateral breast affection in 2 patients (6.7%) and distant metastasis were seen on PET/CT. Sites of distant metastasis included: bone (n=12), axillary lymph nodes (n=11), cervical lymph nodes (n=6), mediastinal lymph nodes (n=12), abdominal lymph nodes (n=8), liver (n=5), lung (n=11) and other visceral sites metastasis (n=9).PET/CT detected breast lesions with a sensitivity of 100% and specificity of 95.4%. In contrast, the sensitivity and specificity of CT alone were 81.2% and 90.4% respectively. Conclusion: PET/CT has superiority over CT alone in detecting breast lesions and distant metastases.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"31 1","pages":"35 - 35"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88543116","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 : 2020-04-01DOI: 10.1177/0300891620914122
L. Rashed, S. Faiz, Magdy M. Hassan, M. Elsebaie, AE Saad
Background: Recent studies have reported the involvement of micro RNA 181a in diverse cellular functions. Though some studies have shown that miR-181a expression is downregulated in several human solid tumors, others have demonstrated that upregulation of miR-181a may promote metastasis and invasion of human cancers. Aim of the Study: The aim of this work is to detect the level of circulating miRNA-181a in breast cancer cases at different stages and to study its role in metastasis & epithelial mesenchymal transformation (EMT) through the possible association between miRNA 181a and transforming growth factor beta (TGFβ) signaling pathway. Subjects and Methods: The present work included 70 female patients, with breast cancer at different stages 30 patients with metastatic disease and 40 patients with non-metastatic disease 20 healthy subjects were taken as a control group. We detected miRNA-181a expression in peripheral blood with qRT PCR, and TGF-beta, SMAD-4, SNAIL-1 and Bim expression by quantitative PCR. Results: miRNA-181a, TGF-beta, SNAIL-1 and SMAD-4 were significantly upregulated in patients with metastatic breast cancer compared to patients with non-metastatic disease while Bim is significantly downregulated in metastatic versus non-metastatic group. Also, miRNA-181a was a prognostic marker for disease progression and overall survival. Conclusion: signaling pathway of TGFβ-SMAD, regulate miRNA-181a which in turn play role in stabilizing SNAIL transcription factor that promote tumor aggressiveness and metastasis through epithelial mesenchymal transition, as well as down-regulation of Bim.
{"title":"Circulating Micro RNA 181A as Biomarker in Breast Cancer, Its Possible Association with Metastasis & Epithelial Mesenchymal Transformation","authors":"L. Rashed, S. Faiz, Magdy M. Hassan, M. Elsebaie, AE Saad","doi":"10.1177/0300891620914122","DOIUrl":"https://doi.org/10.1177/0300891620914122","url":null,"abstract":"Background: Recent studies have reported the involvement of micro RNA 181a in diverse cellular functions. Though some studies have shown that miR-181a expression is downregulated in several human solid tumors, others have demonstrated that upregulation of miR-181a may promote metastasis and invasion of human cancers. Aim of the Study: The aim of this work is to detect the level of circulating miRNA-181a in breast cancer cases at different stages and to study its role in metastasis & epithelial mesenchymal transformation (EMT) through the possible association between miRNA 181a and transforming growth factor beta (TGFβ) signaling pathway. Subjects and Methods: The present work included 70 female patients, with breast cancer at different stages 30 patients with metastatic disease and 40 patients with non-metastatic disease 20 healthy subjects were taken as a control group. We detected miRNA-181a expression in peripheral blood with qRT PCR, and TGF-beta, SMAD-4, SNAIL-1 and Bim expression by quantitative PCR. Results: miRNA-181a, TGF-beta, SNAIL-1 and SMAD-4 were significantly upregulated in patients with metastatic breast cancer compared to patients with non-metastatic disease while Bim is significantly downregulated in metastatic versus non-metastatic group. Also, miRNA-181a was a prognostic marker for disease progression and overall survival. Conclusion: signaling pathway of TGFβ-SMAD, regulate miRNA-181a which in turn play role in stabilizing SNAIL transcription factor that promote tumor aggressiveness and metastasis through epithelial mesenchymal transition, as well as down-regulation of Bim.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"8 1","pages":"3 - 3"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87753554","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 : 2020-04-01DOI: 10.1177/0300891620914132
S. Touimi, D. N’chiepo, I. Mbarki, H. Elkacemi, S. ElMajjaoui, T. Kebdani, N. Benjaafar, C. Neftah, A. Saoud, J. Boulaarab, H. Jerguigue, Y. Omor, R. Latib, H. El Agouri, B. El khannoussi
Introduction: Apocrine carcinoma of breast is a rare type of malignant tumor, the incidence of which varies between 0.3 - 0.4 % of all female breast cancers.Apocrine carcinoma is exceptional in male patients and very few cases have been described in literature. This tumor shows distinct microscopic and immunohistological features. We report an exceptional observation of apocrine carcinoma of breast in a man. Patient and observation: He’s a 54 years old man who had for 2months a painless nodule at the left axillary..The patient had family history of breast and prostate cancers. Physical examination revealed a left axilary lymphadenopathy movable relative to superficial and deep plans with no evidence mass of breasts. MRI of the breast was performed and revealed a mass that was 38 x 10 mm in size.A biopsy of the lymphadenopathy was performed. It objectified a carcinomatous proliferation. An immunohistochemical study showed that tumor cells express Her 2, but do not express estrogenic and progesterone receptors. A tumorectomy of the left breast was performed and didn’t show any malignant lesion of the breast. The axiler dissection of 13 lymphnodes showed 11 metastatics ones with 3 breaking capsular. The diagnosis of apocrine carcinoma of the breast was made in despite of the result of the tumorectomy. The CT did not indicate metastasis. The patient was administered adjuvant chemotherapy then he received radiation therapy on left susclavicular, axila and breast with a total dose of 42Gy,15 fractions of 2.8 Gy on 21 days with no late effects. 1 year of trastuzumab was administrated. There was no recurrence or metastasis approximately 2 years after radiation therapy. Then the patient presented a susclavicular lymphnode that was comfirmed on the pet-scanner with multiple mediastinal lymphnodes. A biopsy of the susclavicular lymphnode comfirmed the progression of the disease. The patient started chemotherapy in association with pertuzumab and trastuzumab. Discussion: Apocrine carcinoma of the breast is a rare malignant tumor whose incidence varies between 0.3% and 4% of all female’s breast cancer and represents 0.5 % of all invasive breast cancers. This tumor is exceptional in men. Indeed, only a dozen cases have been described in the literature . Most neoplasms are slowly progressive, small in size, and are most frequently seen in the axilla. They can be recurrent and metastasize to the lymph node, lung, and bone. Male patients have been advanced disease at presentation compared to women which may be due to lack of public awareness of breast cancer in male. Histologically, it has glandular structures with apocrine features and decapitation secretions. There is cytoplasmic PAS positivity of the tumor cells. The presence of neoplastic glands high in the dermis and immediate subepidermis favors the primary origin of tumor cells from apocrine sweat glands. Apocrine adenocarcinomas are positive for cytokeratins, carcinoembryogenic antigen (CEA) and epithelia
简介:乳腺大汗腺癌是一种罕见的恶性肿瘤,其发病率在所有女性乳腺癌的0.3 - 0.4%之间。大汗腺癌在男性患者中是罕见的,文献中很少有病例描述。该肿瘤表现出明显的显微镜和免疫组织学特征。我们报告一个特殊的观察大汗腺癌的乳房在一个男人。患者与观察:54岁男性,左腋窝无痛性结节2个月,有乳腺癌、前列腺癌家族史。体格检查显示左侧腋窝淋巴结病变,相对于浅表和深部计划可移动,没有乳房肿块的证据。乳房MRI显示肿块大小为38 x 10mm。对淋巴结病变进行活检。这是一种癌性增生。一项免疫组织化学研究表明,肿瘤细胞表达Her 2,但不表达雌激素受体和孕激素受体。左乳房肿瘤切除后未发现任何恶性病变。13个淋巴结腋部解剖显示11个淋巴结转移,3个被囊破裂。乳腺大汗腺癌的诊断是尽管肿瘤切除术的结果。CT未见转移。患者给予辅助化疗后,行左锁骨、腋窝、乳房放射治疗,总剂量42Gy,15次2.8 Gy,持续21天,无迟发效应。给予曲妥珠单抗治疗1年。放疗后约2年无复发或转移。然后患者表现为锁骨淋巴结,pet扫描证实为多发纵隔淋巴结。锁骨淋巴结活检证实了病情的进展。患者开始化疗与帕妥珠单抗和曲妥珠单抗相关。讨论:乳腺大汗腺癌是一种罕见的恶性肿瘤,其发病率在所有女性乳腺癌的0.3%至4%之间,占所有浸润性乳腺癌的0.5%。这种肿瘤在男性中很少见。事实上,文献中只描述了十几个病例。大多数肿瘤进展缓慢,体积小,最常见于腋窝。它们可以复发并转移到淋巴结、肺和骨。与女性患者相比,男性患者在发病时已处于疾病晚期,这可能是由于公众对男性乳腺癌缺乏认识。组织学上,它具有腺状结构,具有大汗腺特征和头颅分泌物。肿瘤细胞胞质PAS阳性。肿瘤腺体位于真皮和直接表皮下,有利于肿瘤细胞主要来自大汗腺。大汗腺癌细胞角蛋白、癌胚性抗原(CEA)和上皮膜抗原(EMA)呈阳性。通常,这些肿瘤不表达雌激素受体- α、孕激素受体和bcl-2。大汗腺癌预后较差,其预后因素包括大小、组织学类型、淋巴结累及及远处转移。无淋巴结转移的10年无病生存率为56%。大汗腺癌的治疗方案与乳腺非大汗腺癌相似。然而,有关使用抗雄激素的研究正在进行中。治疗的选择是广泛的局部切除,边界清晰,有或没有区域淋巴结清扫。在缺乏临床试验的情况下,放射治疗的作用仍然不确定。大汗腺癌的治疗方式与复发无明显的相关性,大汗腺癌的生存率与其他乳腺癌无明显差异。结论:男性大汗腺癌是一种非常罕见、独特、形态独特的浸润性导管癌。虽然免疫组化染色可能在男性中显示差异,但预后与其他乳腺癌没有区别。它具有不同的激素谱,雄激素受体阳性使大汗腺癌患者适合靶向治疗。
{"title":"Apocrine Carcinoma of Breast in a Male Patient: Case Report","authors":"S. Touimi, D. N’chiepo, I. Mbarki, H. Elkacemi, S. ElMajjaoui, T. Kebdani, N. Benjaafar, C. Neftah, A. Saoud, J. Boulaarab, H. Jerguigue, Y. Omor, R. Latib, H. El Agouri, B. El khannoussi","doi":"10.1177/0300891620914132","DOIUrl":"https://doi.org/10.1177/0300891620914132","url":null,"abstract":"Introduction: Apocrine carcinoma of breast is a rare type of malignant tumor, the incidence of which varies between 0.3 - 0.4 % of all female breast cancers.Apocrine carcinoma is exceptional in male patients and very few cases have been described in literature. This tumor shows distinct microscopic and immunohistological features. We report an exceptional observation of apocrine carcinoma of breast in a man. Patient and observation: He’s a 54 years old man who had for 2months a painless nodule at the left axillary..The patient had family history of breast and prostate cancers. Physical examination revealed a left axilary lymphadenopathy movable relative to superficial and deep plans with no evidence mass of breasts. MRI of the breast was performed and revealed a mass that was 38 x 10 mm in size.A biopsy of the lymphadenopathy was performed. It objectified a carcinomatous proliferation. An immunohistochemical study showed that tumor cells express Her 2, but do not express estrogenic and progesterone receptors. A tumorectomy of the left breast was performed and didn’t show any malignant lesion of the breast. The axiler dissection of 13 lymphnodes showed 11 metastatics ones with 3 breaking capsular. The diagnosis of apocrine carcinoma of the breast was made in despite of the result of the tumorectomy. The CT did not indicate metastasis. The patient was administered adjuvant chemotherapy then he received radiation therapy on left susclavicular, axila and breast with a total dose of 42Gy,15 fractions of 2.8 Gy on 21 days with no late effects. 1 year of trastuzumab was administrated. There was no recurrence or metastasis approximately 2 years after radiation therapy. Then the patient presented a susclavicular lymphnode that was comfirmed on the pet-scanner with multiple mediastinal lymphnodes. A biopsy of the susclavicular lymphnode comfirmed the progression of the disease. The patient started chemotherapy in association with pertuzumab and trastuzumab. Discussion: Apocrine carcinoma of the breast is a rare malignant tumor whose incidence varies between 0.3% and 4% of all female’s breast cancer and represents 0.5 % of all invasive breast cancers. This tumor is exceptional in men. Indeed, only a dozen cases have been described in the literature . Most neoplasms are slowly progressive, small in size, and are most frequently seen in the axilla. They can be recurrent and metastasize to the lymph node, lung, and bone. Male patients have been advanced disease at presentation compared to women which may be due to lack of public awareness of breast cancer in male. Histologically, it has glandular structures with apocrine features and decapitation secretions. There is cytoplasmic PAS positivity of the tumor cells. The presence of neoplastic glands high in the dermis and immediate subepidermis favors the primary origin of tumor cells from apocrine sweat glands. Apocrine adenocarcinomas are positive for cytokeratins, carcinoembryogenic antigen (CEA) and epithelia","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"92 1","pages":"12 - 13"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76843104","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 : 2020-04-01DOI: 10.1177/0300891620914162
L. Mohamed, A. Elsaka, Y. Zamzam
Local inflammatory markers have been defined as prognostic and predictive markers in triple negative markers as proved by many studies. The prognostic and predictive value of systemic inflammatory markers such as neutrophil lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) remain to be elucidated. Aim of study: To evaluate pathological complete response (PCR) to neoadjuvant chemotherapy in locally advanced cancer breast in relation to tumor infiltrating lymphocytes(TILs), neutrophil lymphocyte ratio and lymphocyte monocyte ratio as well as overall survival and disease free survival. Patients and methods: In Tanta university Hospital, oncology department form January 2012 to December 2013, 67 patients with locally advanced TNBC stage IIB, IIIB 0r IIIC using TNM 8t h edition . All patients received neoadjuvant chemotherapy in the form of dose dense AC followed by paclitaxel (adriamycin & cyclophosphamide 60 mgm/m2 & 600 mgm/m2 respectively the cycle is repeated every 2 weeks for 4 cycles followed by paclitaxel 175mgm/m2 every 2 weeks for 4 cycles). All cycles with G-CSF support. Pre treatment TILs, NLR and LMR were evaluated with PCR and as prognostic factor of survival. Results: Low NLR has been detected in 74.6% of cases and has been associated with high TILs and this was statistically significant (p value=0.03). High LMR was observed in 80.6% of cases and correlated significantly with TILs (p value =0.003). Pathological CR was found to be associated with high TILs, low NLR and high LMR. In our study we evaluated the pre neoadjuvant systemic and local inflammatory markers as prognostic marker we found that in multivariate analysis, the lymphocyte monocyte ratio maintained their statistical significance with overall survival. While tumor infiltrating lymphocyte maintained their statistical significance as prognostic factors with overall survival and disease free survival. Conclusion: Systemic inflammatory markers can be used as marker of pathological complete response in locally advanced triple negative breast6 cancer with neoadjuvant chemotherapy.
{"title":"Local and Systemic Inflammatory Markers as Prognostic and Predictive Markers In Locally Advanced Triple Negative Breast Cancer","authors":"L. Mohamed, A. Elsaka, Y. Zamzam","doi":"10.1177/0300891620914162","DOIUrl":"https://doi.org/10.1177/0300891620914162","url":null,"abstract":"Local inflammatory markers have been defined as prognostic and predictive markers in triple negative markers as proved by many studies. The prognostic and predictive value of systemic inflammatory markers such as neutrophil lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) remain to be elucidated. Aim of study: To evaluate pathological complete response (PCR) to neoadjuvant chemotherapy in locally advanced cancer breast in relation to tumor infiltrating lymphocytes(TILs), neutrophil lymphocyte ratio and lymphocyte monocyte ratio as well as overall survival and disease free survival. Patients and methods: In Tanta university Hospital, oncology department form January 2012 to December 2013, 67 patients with locally advanced TNBC stage IIB, IIIB 0r IIIC using TNM 8t h edition . All patients received neoadjuvant chemotherapy in the form of dose dense AC followed by paclitaxel (adriamycin & cyclophosphamide 60 mgm/m2 & 600 mgm/m2 respectively the cycle is repeated every 2 weeks for 4 cycles followed by paclitaxel 175mgm/m2 every 2 weeks for 4 cycles). All cycles with G-CSF support. Pre treatment TILs, NLR and LMR were evaluated with PCR and as prognostic factor of survival. Results: Low NLR has been detected in 74.6% of cases and has been associated with high TILs and this was statistically significant (p value=0.03). High LMR was observed in 80.6% of cases and correlated significantly with TILs (p value =0.003). Pathological CR was found to be associated with high TILs, low NLR and high LMR. In our study we evaluated the pre neoadjuvant systemic and local inflammatory markers as prognostic marker we found that in multivariate analysis, the lymphocyte monocyte ratio maintained their statistical significance with overall survival. While tumor infiltrating lymphocyte maintained their statistical significance as prognostic factors with overall survival and disease free survival. Conclusion: Systemic inflammatory markers can be used as marker of pathological complete response in locally advanced triple negative breast6 cancer with neoadjuvant chemotherapy.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"8 1","pages":"30 - 30"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83200426","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 : 2020-04-01DOI: 10.1177/0300891620914149
O. Harb, M. Elfeky, Basant Sh Elshafaay, A. Obaya, Amr A. Awd, Mohamed M. Alkilany, L. Gertallah
Background: It is important to identify of novel therapeutic targets for cervical carcinoma. Nucleolar and spindle associated protein 1 (NUSAP1) could be able to bind microtubules, and has important role in spindle formation and mitotic progression. Maternal embryonic leucine zipper kinase (MELK) is a cell cycle related conserved protein kinase that is involved in control and regulation of the cell cycle, apoptosis, and carcinogenesis. The L1 cell adhesion molecule (L1-CAM) was discovered as a protein which has an essential role in cell migration and axon guidance in the nervous system. The Aim of This Study Is to investigate the tissue protein expression of NUSAP1, MELK and L1CAM in tissues of cervical carcinoma and to detect their prognostic roles. Methods: Expression of NUSAP1, MELK and L1CAM was evaluated in sections from 62 cases of cervical carcinoma using immunohistochemistry we followed our patients for 3 years correlate their expression with clinicopathological parameters and patients outcome. Results: High levels of NUSAP1, MELK and L1CAM expression was positively related to older age of the patients, high grade of the tumor, lympho-vascular invasion, advanced FIGO stage, poor survival rates and higher recurrence rate after successful therapy (p<0.001). L.N metastases (p=0.002), distant metastases (p=0.003). There are statistically significant positive association between NUSAP1, MELK and L1CAM Phi correlation coefficient= + 0.87 and + 0.721 respectively (p<0.001). Conclusion: NUSAP1, MELK and L1CAM are considered markers of poor prognosis in cervical carcinoma cells.
{"title":"Nusap1, Melk and L1cam Expression in Cervical Cancer Tissues; Prognostic and Clinicopathological Implications","authors":"O. Harb, M. Elfeky, Basant Sh Elshafaay, A. Obaya, Amr A. Awd, Mohamed M. Alkilany, L. Gertallah","doi":"10.1177/0300891620914149","DOIUrl":"https://doi.org/10.1177/0300891620914149","url":null,"abstract":"Background: It is important to identify of novel therapeutic targets for cervical carcinoma. Nucleolar and spindle associated protein 1 (NUSAP1) could be able to bind microtubules, and has important role in spindle formation and mitotic progression. Maternal embryonic leucine zipper kinase (MELK) is a cell cycle related conserved protein kinase that is involved in control and regulation of the cell cycle, apoptosis, and carcinogenesis. The L1 cell adhesion molecule (L1-CAM) was discovered as a protein which has an essential role in cell migration and axon guidance in the nervous system. The Aim of This Study Is to investigate the tissue protein expression of NUSAP1, MELK and L1CAM in tissues of cervical carcinoma and to detect their prognostic roles. Methods: Expression of NUSAP1, MELK and L1CAM was evaluated in sections from 62 cases of cervical carcinoma using immunohistochemistry we followed our patients for 3 years correlate their expression with clinicopathological parameters and patients outcome. Results: High levels of NUSAP1, MELK and L1CAM expression was positively related to older age of the patients, high grade of the tumor, lympho-vascular invasion, advanced FIGO stage, poor survival rates and higher recurrence rate after successful therapy (p<0.001). L.N metastases (p=0.002), distant metastases (p=0.003). There are statistically significant positive association between NUSAP1, MELK and L1CAM Phi correlation coefficient= + 0.87 and + 0.721 respectively (p<0.001). Conclusion: NUSAP1, MELK and L1CAM are considered markers of poor prognosis in cervical carcinoma cells.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"219 1","pages":"19 - 19"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77748748","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}