text stringlengths 0 5.79k |
|---|
LICENSE: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
ABSTRACT: AbstractMeningiomas arise from arachnoid cap cells and are the most common heavily researched intracranial tumors. Most of these neoplasms are benign and are classified as World Health Organization (WHO) grade I. They are often found in parasagittal and falx regions, over cerebral convexities, and in the sphe... |
## Introduction |
Meningiomas are the most common primary brain tumors accounting for 24%-37.9% of intracranial neoplasms [1,2]. According to the WHO, the majority of meningiomas are benign and are categorized as grade I [2]. Some of these benign subtypes include meningothelial, fibrous, transitional, and psammomatous meningiomas, and t... |
Meningiomas arise from arachnoid cap cells of the meninges and occur predominantly in middle-aged and elderly patients, peaking in the sixth and seventh decades of life [2]. Childhood tumors are less common but tend to be more aggressive. Some risk factors for meningiomas include genetic predispositions, radiation expo... |
There is a marked female bias for intracranial meningiomas in middle-aged patients with a female to male ratio of 1.7:1. Approximately 90% of spinal meningiomas occur in females [2]. There is evidence that suggests a role for sex hormones in meningioma growth. Many of these tumors display a combination of estrogen, pro... |
The majority of meningiomas arise in intracranial, intraspinal, or orbital locations [2]. Intracranially, the most common sites include cerebral convexities, olfactory grooves, sphenoid ridges, para/suprasellar regions, optic nerve sheath, petrous ridges, tentorium, and posterior fossa [2]. It has been reported that on... |
Because of the rarity of spheno-orbital meningiomas (SOMs), it is necessary that additional research on these tumors be conducted and reported. The current case describes a remarkably large SOM occurring in a 93-year-old cadaver who likely spread from the middle cranial fossa anteriorly through the superior orbital fis... |
## Case presentation |
This report describes an unusual case of a 93-year-old female cadaver with a large SOM occupying the left middle cranial fossa and invading the left orbit. Her cause of death was listed as blunt force trauma of which we found no evidence. |
Routine dissection of the cadaver indicated unilateral proptosis of the left eyeball (Figure 1). To investigate the cause of the structural deformity, the scalp was reflected, and evidence of a previous craniotomy was found in the left temporal and parietal bones (Figure 2). Upon removal of the calvaria, the brain pare... |
Examination of the skull base revealed a large cauliflower-like mass extended along the sphenoid wing, nearly filling the left middle cranial fossa. The lobulated tumor appeared brownish-white, had a firm to hard consistency, and had an estimated size of 4.5 cm anterior to posterior and 5 cm in width (Figure 5). The tu... |
Histopathological examination of a section taken from the skull-base tumor revealed a sparse distribution of the whorled cellular pattern that is typical of meningiomas, thin collagenous septae separating tumor cell lobules, and lymphoplasmocytes (Figure 7). No psammoma bodies were found. These features led to the clas... |
## Discussion |
The meningioma presented in this case study occupied both the left cranium and orbit, compressing the temporal and frontal lobes, thickening the optic nerve sheath, and diminishing axons in the optic nerve (Figures 1, 3, 6, 8). Without a medical history containing CT or MRI images for this cadaver, we are unable to det... |
Although the underlying cause of meningiomas remains unclear, certain genetic factors result in increased susceptibility to develop meningiomas. There was no evidence that suggested that the individual presented in this case suffered from NF2; however, it could be possible that the meningioma resulted from a sporatic m... |
Histological examination and the dural confinement of the neoplasm presented in this case report support its classification as a meningioma. Macroscopically, most meningiomas are well-demarcated, rounded masses that have a characteristic broad dural attachment. In 25%-50% of cases, these tumors will invade through the ... |
Microscopic examination of the tumor cells confirms it as a grade I meningioma, specifically, the common variant, meningothelial meningioma. Cells forming lobules that are demarcated by thin collagenous septae and oval nuclei with delicate chromatin are characteristics of this subtype (Figure 7C) [2]. While the whorls ... |
Grade I meningiomas are typically slow growing and initially asymptomatic. As they grow, they produce varying symptoms depending on compression of adjacent structures through mass effect. Therefore, specific symptoms are subject to the location and size of the tumor. Moreover, headache and seizures are extremely common... |
This particular tumor is of interest because of its location and remarkable size. The estimated size of this SOM is 9.5 cm anterior to posterior and 5 cm in width (Figure 6). Magill et al. studied 1,113 patients with meningiomas to examine relationships between location, size, and WHO grade of these neoplasms. The majo... |
Based on the remaining evidence of a craniotomy, it is evident that an attempt to debulk the tumor had been made (Figure 2). However, with the lack of a medical history, it cannot be determined whether any of the tumor was indeed resected. Surgery is the standard therapeutic treatment of meningiomas, and excision alone... |
Resection of orbit-invading meningiomas is not as straightforward as intracranial meningiomas and depends largely on the patient’s symptoms, degree of cranial nerve involvement, and original diagnosis. One study investigated a group of 47 patients with intracranial meningiomas that spread to the orbit and found that on... |
Cannon et al. examined 12 patients who underwent multidisciplinary surgical resection of SOMs. They determined that the indicating factor for surgery was deterioration in visual function. After surgery, 75% of the patients either had a reduction or stabilization of their proptosis, but visual acuity results were mixed.... |
Additionally, Leroy et al. studied 70 patients with SOMs. The complete resection rate was only 31%, owing to the difficulty of resecting orbit-invading tumors. Preoperatively, 56 patients had proptosis and 86% exhibited significant improvement after surgery. Of the 52 patients who presented with decreased visual acuity... |
## Conclusions |
This case report describes a 93-year-old female cadaver presenting with a SOM occupying the middle cranial fossa, extending anteriorly through the superior orbital fissure, and invading the orbital cavity. Such tumors are accompanied by symptoms such as proptosis, decreased visual acuity, diplopia, and orbital pain. Hi... |
## Acknowledgments |
We would like to thank the following LECOM Bradenton medical students for their input on this project: R. Resnick, M. Caldera, N. Bellacicco, B. Ilechukwu, S. Lohbauer, B. Godfrey, C. LaFerla, and K. Coutinho. |
The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research a... |
## Human Ethics |
## References |
c8dea3c9a6cee43a83ab45101a4544e76b397e3e6467f8d87402c5167c336ef0 pmc7536112.txt |
https://creativecommons.org/licenses/by/4.0/ Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/ ). |
01754d2ec3191dcfd81ebb47f86916d816d87135b73f271488773b74effcd9f0 pmc7698816-licence-evidence.txt |
PMCID: PMC7698816 |
TITLE: New International Association for the Study of Lung Cancer (IASLC) Pathology Committee Grading System for the Prognostic Outcome of Advanced Lung Adenocarcinoma |
LICENSE: https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
ABSTRACT: Simple SummaryThis study investigated the association between survival outcome and the new grading system among advanced stage lung adenocarcinoma (LADC) (stages IIIA, IIIB and IV) patients who were diagnosed as LADC with a pathologic report according to a new grading system by the International Association f... |
## 1. Introduction |
Lung cancer is a leading cause of life-threatening malignancy worldwide. According to the revised classification criteria released by the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS) in 2011, lung adenocarcinoma (LADC) ca... |
To date, several studies have investigated the impact of the IASLC/ATS/ERS classification system introduced in 2011 to predict the prognosis in patients with advanced LADC, although tumor heterogeneity in late-stage LADC is widely known to be complex [9,10,11,12]. Campos-Parra et al. reported that high-grade LADC (micr... |
To evaluate the prognostic relevance of the new grading system [8], we aimed to apply this system to patients with advanced LADC harboring (or not) driver gene mutations and analyze the potential prognostic differences. In this study, we examined the clinical relevance for Asian patients with late-stage disease using s... |
## 2. Results |
### 2.1. Clinicopathological Factors |
As classified by the IASLC pathology committee’s new grading system, 136 LADC cases out of a total of 1317 met the inclusion criteria and were analyzed (Figure 1). Of the 136 patients, 7 (5.1%) had well differentiated adenocarcinoma, 74 (54.4%) had moderately differentiated adenocarcinoma, and 55 (40.4%) had poorly dif... |
### 2.2. EGFR Wild-Type and EGFR Mutations and First-Line Treatment |
EGFR mutations were also independent of grade (p > 0.05, chi-square test). There were 58 wild-type EGFR patients (42.6%), and 78 (57.4%) had EGFR mutations. Among those with EGFR mutations, there were 7 exon 18 mutations (5.1%), 33 exon 19 deletions (24.3%), 2 exon 20 insertions (1.5%), and 34 exon 21 point mutations (... |
### 2.3. Survival Analysis |
The survival outcomes of the poorly differentiated, moderately differentiated, and well differentiated groups diagnosed between January 2007 and December 2018 were analyzed. Each group had a statistically significant difference in PFS (p = 0.013) but not in OS (p = 0.154) (Figure 3A,B). Those without systemic treatment... |
We found no differences in the prognostic outcomes with regards to age, sex, or smoking status. Poorer overall survival was detected in the patients with a BMI ≤ 25 kg/m2 and age >70 years in late-stage disease (Figure S4A,B). In the univariate analysis, those aged >70 years, those with a BMI ≤ 25, and wild-type EGFR p... |
In brief, poorly differentiated patients had the worst PFS in this study. In the subgroup analysis, the poorly differentiated group with wild-type EGFR also had a worse PFS when treated with chemotherapy. |
## 3. Discussion |
The classification of patients with LADC has been addressed in previous studies, and valuable prognostic features have been identified according to the revised IASLC/ATS/ERS system released in 2011. The importance in early stage is well-documented [1,2,4,6,23,24,25,26]. The predominant type of LADC can be used to predi... |
The previous limited resected sample of LADC was able to predict poor prognostic outcomes in early-stage disease. The new grade system proposed by Moreira et al. provided a more complete scale for redefining the predominant subtyping into different categories for predicting the prognosis [8]. Although the clinical rele... |
The previous limited resected sample sizes of LADC were able to predict poor prognostic outcomes in early-stage disease, but the role of each subtype in predicting the prognosis during the late stage remains unclear [2,9,14,15,29]. In the current study, we showed that the use of the new grading system in patients with ... |
Another important issue is that driver gene mutations are highly expressed in certain subtypes [33,34,35]. In patients with advanced-stage LADC harboring EGFR mutations, TKIs are efficient and widely used as the first-line therapeutic choice. Nevertheless, the duration of PFS and OS ranges widely according to the indiv... |
In this study, the poorly differentiated group had the worst PFS, and this result was also seen in the subgroup analysis of those with the wild-type EGFR receiving chemotherapy. There were no significant differences in sex and smoking status. Those aged >70 years and those with a BMI ≤ 25 kg/m2 had a worse OS. This hig... |
There are several limitations to the current study. First, the relatively small sample size may have affected the interpretation of the results of the survey. This could also have generated selection bias when performing the statistical analysis, so the results must be validated in a larger cohort in the future. Second... |
## 4. Materials and Methods |
### 4.1. Participants |
From January 2007 to December 2018, patients with late-stage (stage IIIA, IIIB and IV) LADC who received treatment at Cathay General Hospital (CGH), Taipei, Taiwan were identified. The inclusion criteria for the current study were as follows: (i) patients who received a lung tumor biopsy at CGH (FFPE: formalin-fixed pa... |
All biopsy specimen interpretations under the new grading system based on the IASLC pathology committee classified the adenocarcinomas as being well differentiated, moderately differentiated, or poorly differentiated. The grading scheme in this model comprised lepidic predominant patterns with a 20% or lower cutoff of ... |
We also evaluated other parameters including sex, age at diagnosis, smoking history, body mass index (BMI), gene mutation status, and staging according to the eighth edition of the lung cancer staging system [41]. The first-line treatment regimen used, progression-free survival (PFS), and overall survival (OS) were rec... |
### 4.2. Mutational Analysis |
In total, 137 FFPE lung malignant tissue samples were collected by CT-guided or echo-guided biopsy from the Department of Pathology, CGH. Mutations of EGFR, KRAS, and BRAF were determined following standard protocols (EGFR Mutation Test V2, KRAS Mutation Test V2, and BRAF/ NRAS Mutation Test (LSR); Roche, Mannheim, Ger... |
### 4.3. Statistical Analysis |
The statistical analysis was performed using SPSS version 20.0 (IBM Corp, Armonk, NY, USA). Correlations between two categorical variables were examined using Pearson’s chi-squared test. PFS and OS were calculated at 12 and 36 months after the initial diagnosis, respectively. The Kaplan–Meier method was used to analyze... |
## 5. Conclusions |
In conclusion, this is the first study to apply the new grading system of the IASLC for predicting the survival prognosis of Asian patients with advanced LADC. Negative impacts were shown on PFS and OS in certain patient subgroups, including poorly differentiated patients, those with a lower BMI, and the elderly. Despi... |
37a8c2e5952f11ec325e9a034eb4d77018b1807885bf500ecf1be6f44a1872f3 pmc7698816.txt |
PMCID: PMC8155169 |
TITLE: High-risk lesions of the breast: concurrent diagnostic tools and management recommendations |
LICENSE: Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Comm... |
ABSTRACT: AbstractBreast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favor... |
## Key points |
## Background |
Breast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. In the past several decades, the diagnosis of B3 lesions has significantly increased with the widespread implementation of screening programs a... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.