-
Human Reproduction Update 2014Time-lapse monitoring (TLM) has emerged as a novel technology to perform semi-quantitative evaluation of embryo morphology and developmental kinetics in assisted... (Review)
Review
BACKGROUND
Time-lapse monitoring (TLM) has emerged as a novel technology to perform semi-quantitative evaluation of embryo morphology and developmental kinetics in assisted reproduction. While this method has already been introduced into clinical practice in many laboratories, it is unclear whether it adds value to conventional morphology. Most studies only report blastocyst formation as the primary end-point. The aim of this systematic review is to provide a critical evaluation of the available studies that report clinical outcomes following embryo selection with TLM.
METHODS
A literature search in MEDLINE, Cochrane CENTRAL and ISI Web of Knowledge Science Citation Index was performed to identify studies that assess the clinical utility of kinetic markers for non-invasive selection of human embryos with high implantation potential. Only studies published before 31 December 2013 in the English language that report rates of implantation, clinical pregnancy or live birth were included.
RESULTS
Two hundred and fifty-one studies were identified by database search and reference list review; only 13 met eligibility criteria and were included in this analysis. The following morphokinetic parameters were assessed: pronuclear dynamics and morphology (n = 3), duration of first cytokinesis and reappearance of nuclei after cleavage (n = 3), time to various cleavage stages (n = 5), duration of various cleavage stages (n = 6), duration of cleavage cycles and mitotic synchronicity (n = 6), and time to morula, blastocyst and hatching (n = 4). Five studies used combined parameter grading to generate a cumulative score, and two studies retrospectively compared implantation rates following embryo selection by conventional morphology alone or with the addition of a hierarchal time-lapse classification. While several studies suggest higher implantation rates for fast-cleaving embryos and those with a timely duration (i.e. all time points within the defined ranges) of the 2-cell and 3-cell stages, no single morphokinetic parameter has been consistently shown to predict implantation potential. Furthermore, there was considerable disagreement regarding not only which parameters are useful, but also what constitutes normal and abnormal intervals for these measurements.
CONCLUSIONS
While TLM has the potential to revolutionize clinical embryology, there are currently no high-quality data to support the clinical use of this technology for selection of human preimplantation embryos. Our recommendations for the adoption of this technique are thus limited by the available literature and the lack of robust prospective studies reporting clinical outcomes. Sparse, often incomplete and largely heterogeneous data suggest that TLM may be able to distinguish between high and low-implantation potential embryos. Only one study demonstrated significantly improved clinical pregnancy rates when embryos were selected by TLM in addition to conventional morphology. Prospective studies are currently underway and hopefully will clarify the role of TLM. As more data become available, it is of the utmost importance that groups using TLM share a common nomenclature for measured time points; herein, we have proposed a standardized system for describing any milestone along the preimplantation developmental timeline. Furthermore, future studies must publish complete datasets in an effort to define patient-specific algorithms with the clinically meaningful end-point of implantation, prior to routine adoption in the assisted reproduction technology laboratory. Until such evidence accumulates, selection of embryos by TLM should remain an experimental strategy subject to institutional review and approval.
Topics: Blastocyst; Embryo Implantation; Embryo Transfer; Embryonic Development; Female; Humans; Live Birth; Pregnancy; Pregnancy Rate; Time-Lapse Imaging
PubMed: 24890606
DOI: 10.1093/humupd/dmu023 -
Annals of Diagnostic Pathology Oct 2022To describe the clinicopathological features and differential diagnoses of 15 cases of superficial myofibroblastoma, a rare mesenchymal tumor involving the lower female...
OBJECTIVE
To describe the clinicopathological features and differential diagnoses of 15 cases of superficial myofibroblastoma, a rare mesenchymal tumor involving the lower female genital tract.
METHODS
The clinicopathological data and immunohistochemical findings were retrospectively analyzed in 15 cases of superficial myofibroblastoma. Meanwhile, a systematic literature review was conducted.
RESULTS
The age of patients ranged from 34 to 73 years (median, 49 years). Most patients presented with nodular or polypoid masses ranging in size from 0.4 cm to 6.5 cm. Twelve tumors were located in the vagina, two in the vulva, and one in the cervix. Microscopically, the tumor was located in the subepithelial tissue, with a clear boundary and without capsule on the surface. The tumor cells were spindle, oval, stellate or wavy, and arranged in various architectural patterns of reticular, fascicular, wavy and disorderly patterns. There were no obvious cellular atypia and mitotic figures. Thin collagen fibers and thin-walled vessels could be observed in all cases. Most cases were diffusely and strongly reactive to Vimentin (12/12), Desmin (14/15), ER (15/15) and PR (13/14). Variable immunoreactivity for CD34 (8/15), Caldesmon (2/8), SMA (4/14) and CD99 (4/5) were observed. The tumors showed a low Ki67 proliferative index (≤5 %). Follow-up information was available in 10 patients and there was no evidence of recurrence or metastasis.
CONCLUSIONS
Superficial myofibroblastoma is a rare benign tumor that originates from the hormone-sensitive, subepithelial mesenchymal tissue of the lower female genital tract, and should be differentiated from other mesenchymal tumors.
Topics: Adult; Aged; Biomarkers, Tumor; Calmodulin-Binding Proteins; Collagen; Desmin; Female; Hormones; Humans; Ki-67 Antigen; Middle Aged; Neoplasms, Muscle Tissue; Retrospective Studies; Vagina; Vimentin
PubMed: 35907316
DOI: 10.1016/j.anndiagpath.2022.152010 -
Clinical Neurology and Neurosurgery Sep 2020Primary intracranial Rhabdoid meningioma (PIRM) is an uncommon subtype of WHO grade III meningioma. Given its rarity, its risk factors and management strategies are...
Primary intracranial Rhabdoid meningioma (PIRM) is an uncommon subtype of WHO grade III meningioma. Given its rarity, its risk factors and management strategies are still unclear. Therefore, we aimed to assess the risk factors and outcomes for patients with PIRM and proposed an appropriate treatment. Ovid, Medline, Embase, Pubmed, Web of Science and Cochrane database were used to search for articles published between January 1998 and October 2019. Search terms combined "intracranial", "brain", and "cerebral" with "rhabdoid meningioma" or "WHO grade III meningioma". The entire cohort included 27 males (51.9 %) and 25 females (48.1 %) with an age ranging from 2 to 77 years (median 44 years). The size of tumor ranged from 1.3 to 7.4 cm (mean 4.3 cm). The Ki-67 proliferation index ranged from 1 % to 90 % (mean 15 %). In the whole cohort, gross total resection (GTR) and non-GTR were achieved in 63.5 % (33 cases) and 36.5 % (19 cases) patients, respectively. Twenty-five patients (48.1 %) had the postoperative radiotherapy, and 5 patients (9.6 %) had postoperative chemotherapy. Nineteen patients (39.6 %) developed recurrences, 4 patients (7.7 %) developed distant metastasizes, and 13 patients (25.0 %) died. GTR was associated with favorable overall survival (p = 0.008). The 1-, 3-, and 5-year progression-free survival rates were 84.6 %, 59.4 %, and 49.6 %, respectively; and the 1-, 3- and 5- year overall survival rates in the entire group were 91.4 %, 83.5 % and 68.9 %, respectively. GTR is recommend as the initial treatment option for PIRMs, contributing to acute histological diagnosis and prolonging long-term survival.
Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Kaplan-Meier Estimate; Ki-67 Antigen; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Mitotic Index; Neoplasm Grading; Neurosurgical Procedures; Prognosis; Progression-Free Survival; Proportional Hazards Models; Retrospective Studies; Treatment Outcome; Tumor Burden; Young Adult
PubMed: 32516684
DOI: 10.1016/j.clineuro.2020.105971 -
The Oncologist Jul 2020Sertoli cell tumors (SCTs) of the testes are rare, and the literature provides only weak evidence concerning their clinical course and management. The objective of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sertoli cell tumors (SCTs) of the testes are rare, and the literature provides only weak evidence concerning their clinical course and management. The objective of this study was to summarize evidence on SCTs' clinical presentation, clinicopathological risk factors for malignancy, treatment options, and oncological outcomes.
MATERIALS AND METHODS
Data sources included Medline, Embase, Scopus, the Cochrane Database of Systematic Reviews, and Web of Science. Published case reports, case series, and cohorts were included. Data on clinicopathological variables, treatment of local or metastatic disease, site of metastasis, or survival were extracted from each study considered in this paper, and associations between clinicopathological variables and metastatic disease were analyzed. Whenever feasible, data on individual patients were collected.
RESULTS
Of the 435 patients included, only one (<1%) showed local recurrence after testis-sparing surgery (TSS). Three patients underwent adjuvant retroperitoneal lymphadenectomy. Fifty patients presented with metastases, located in the retroperitoneal lymph nodes (76%), lungs (36%), and bones (16%); median time to recurrence was 12 months. Risk factors for metastatic disease included age, tumor size, necrosis, tumor extension to the spermatic cord, angiolymphatic invasion, and mitotic index. Patients with metastases had a median life expectancy of 20 months. In six patients, metastasectomy resulted in complete remission.
CONCLUSION
Our findings suggest that few local recurrences result after TSS, and no adjuvant therapy can be regarded as a standard of care. Several risk factors are predictive of metastatic disease. Surgery leads to remission in metastatic disease, whereas systemic treatment alone does not result in long-term remission.
IMPLICATIONS FOR PRACTICE
Testicular Sertoli cell tumors usually present without metastatic disease and show low local recurrence rates after testis-sparing surgery; no adjuvant therapy option can be regarded as a standard of care. Patients with risk factors should undergo staging investigations. Those with metastatic disease have poor prognoses, and metastasectomy may be offered in selected cases.
Topics: Humans; Lymph Node Excision; Male; Neoplasm Recurrence, Local; Neoplasm Staging; Sertoli Cell Tumor; Systematic Reviews as Topic; Testicular Neoplasms
PubMed: 32043680
DOI: 10.1634/theoncologist.2019-0692 -
Journal of Gastrointestinal Cancer Jun 2024GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon,... (Review)
Review
PURPOSE
GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon, omentum, retroperitoneum, abdominal wall, liver and pancreas with pancreas comprising less than 5% of it. Due to limited data, it is unknown if the results of GIST can be generalised for EGISTs. We thereby present the largest single-centre case series of primary pancreatic GIST so far with review of existing literature.
METHODS
A total of 9 patients of primary pancreatic GIST were treated at our institute from September 2016 to February 2023. After literature search for all studies published before February 2023, 51 articles including 57 patients were identified. Their clinicopathological data and survival analysis were assessed.
RESULTS
The median age of patients treated at our centre was 53 years with a female predominance. The most common epicentre was pancreatic head with abdominal pain as the most common presenting symptom. All 57 patients documented in literature belonged to a similar age group with similar gender predilection. The factors impacting DFS were histologic type, mitotic index, NIH risk category and adjuvant therapy. The median DFS was 74 months with a 5-year DFS being 71.9%, while the 5-year OS was 90.4%.
CONCLUSION
Pancreatic GIST is a rare entity. Due to limited evidence and evolving literature, results cannot be generalised to a larger population. Larger case series with longer follow-up data are required to further understand the disease biology and long-term outcomes of pancreatic GIST.
Topics: Humans; Gastrointestinal Stromal Tumors; Middle Aged; Pancreatic Neoplasms; Female; Male; Aged; Adult
PubMed: 38324136
DOI: 10.1007/s12029-024-01024-8 -
Pathology, Research and Practice Apr 2020Granular cell tumor (GCT) remains a diagnostic clinicopathologic problem because the exact frequency of its detailed morphological and clinical characteristics is...
BACKGROUND
Granular cell tumor (GCT) remains a diagnostic clinicopathologic problem because the exact frequency of its detailed morphological and clinical characteristics is unknown as most observations are collected from small series or isolated cases. Herein, our aim is to highlight the frequency of all clinicopathological characteristics of this rare tumor based in our series and the available medical (PubMed) literature.
MATERIAL AND METHODS
42 cases were evaluated for: tissue layers involved by the tumor (in skin and mucosae), growth pattern, nuclear pleomorphism, mitotic index, necrosis, spindling, calcification, hyalinization, and pustule-ovoid bodies of Milian, as well as perineural and vascular invasion, and the presence of adjacent epithelium changes, and lymphocytes and eosinophils infiltration., Follow-up was analyzed. The tumors were subclassified into benign, atypical and malignant according to Fanburg-Smith criteria and into benign or GCT of uncertain malignant potential according to Nasser criteria. The same characteristics were analyzed for 1499 cases reviewed according to PRISMA guidelines.
RESULTS
In the current series, the mean age at diagnosis was 45.8 years (range 6-69 years). Most patients were females (60 %) and the involved organs were by descending frequency: skin and subcutaneous tissue, bronchus, esophagus, breast, tongue, larynx, pharynx, gingiva, trachea, right colon, vulva, and hypopharynx. No recurrence or progression was seen, despite 32 cases were incompletely excised, with the exception of one malignant tumor. The growth pattern was either infiltrative (85.71 %) or well limited (7.14 %). Sixteen tumors had vesicular nuclei. Mitotic activity was found in two tumors. Lymphocytic infiltration was found in 14 tumors. Eosinophils were present in 6 cases. One GCT of the right colon showed extensive calcification and hyalinization. Perineural invasion was noted in 6 lesions. No vascular invasion was found. One tumor was clinically malignant and the patient died 2 years after diagnosis. Medical literature review showed similar results in terms of frequency of the reported clinical and morphological features. Among cases with available follow up, almost 20 % showed positive margins and of those 20 % developed local recurrence. According to the Fanburg-Smith criteria, 72 % would be benign, 17 % atypical and 11 % malignant tumors, while according to those of Nasser, 93 % would be benign and 7% of uncertain malignant potential. However, true malignancy, as affirmed by metastasis of GCT is found in almost 2.5 % of the cases.
CONCLUSION
GCT is a usually benign tumor, affecting any anatomic location. Necrosis and mitotic activity seem to be the most effective histologic criteria for detecting aggressive tumors, but the presence of metastasis (2.5 % of the cases) remains the most accepted definitive criterion for diagnosis of malignant GCT.
Topics: Adolescent; Adult; Aged; Child; Female; Granular Cell Tumor; Humans; Male; Middle Aged; Young Adult
PubMed: 32089415
DOI: 10.1016/j.prp.2020.152865 -
Neurosurgery Feb 2018Adults diagnosed with vestibular schwannomas.
TARGET POPULATION
Adults diagnosed with vestibular schwannomas.
QUESTION 1
What is the prognostic significance of Antoni A vs B histologic patterns in vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 2
What is the prognostic significance of mitotic figures seen in vestibular schwannoma specimens?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 3
Are there other light microscopic features that predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 4
Does the KI-67 labeling index predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 5
Does the proliferating cell nuclear antigen labeling index predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 6
Does degree of vascular endothelial growth factor expression predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_6.
Topics: Adult; Humans; Neuroma, Acoustic; Prognosis
PubMed: 29309662
DOI: 10.1093/neuros/nyx514 -
Frontiers in Surgery 2024Solitary fibrous tumor (SFT) is a rare soft tissue tumor found at any site of the body. The treatment of choice is surgical resection, though 10%-30% of patients... (Review)
Review
INTRODUCTION
Solitary fibrous tumor (SFT) is a rare soft tissue tumor found at any site of the body. The treatment of choice is surgical resection, though 10%-30% of patients experience recurrent disease. Multiple risk factors and risk stratification systems have been investigated to predict which patients are at risk of recurrence. The main goal of this systematic review is to create an up-to-date systematic overview of risk factors and risk stratification systems predicting recurrence for patients with surgically resected SFT within torso and extremities.
METHOD
We prepared the review following the updated Prisma guidelines for systematic reviews (PRISMA-P). Pubmed, Embase, Cochrane Library, WHO international trial registry platform and ClinicalTrials.gov were systematically searched up to December 2022. All English studies describing risk factors for recurrence after resected SFT were included. We excluded SFT in the central nervous system and the oto-rhino-laryngology region.
RESULTS
Eighty-one retrospective studies were identified. Different risk factors including age, symptoms, sex, resection margins, anatomic location, mitotic index, pleomorphism, hypercellularity, necrosis, size, dedifferentiation, CD-34 expression, Ki67 index and -expression, APAF1-inactivation, TERT promoter mutation and fusion variants were investigated in a narrative manner. We found that high mitotic index, Ki67 index and presence of necrosis increased the risk of recurrence after surgically resected SFT, whereas other factors had more varying prognostic value. We also summarized the currently available different risk stratification systems, and found eight different systems with a varying degree of ability to stratify patients into low, intermediate or high recurrence risk.
CONCLUSION
Mitotic index, necrosis and Ki67 index are the most solid risk factors for recurrence. TERT promoter mutation seems a promising component in future risk stratification models. The Demicco risk stratification system is the most validated and widely used, however the G-score model may appear to be superior due to longer follow-up time.
SYSTEMATIC REVIEW REGISTRATION
CRD42023421358.
PubMed: 38357190
DOI: 10.3389/fsurg.2024.1332421 -
Pancreatology : Official Journal of the... Jul 2019The clinicopathological features and biological behaviors of cystic pancreatic neuroendocrine tumors (pNETs) are unclear and controversial. Here we performed a... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
The clinicopathological features and biological behaviors of cystic pancreatic neuroendocrine tumors (pNETs) are unclear and controversial. Here we performed a systematic review and meta-analysis to investigate the unique characteristics of cystic pNETs, to determine whether they represent a distinct clinical entity.
METHODS
We selected comparative studies published since January 2000 that explore the differences between clinicopathological features of cystic and solid pNETs. Demographic information, pathological characteristics, and survival information were analyzed.
RESULT
The 12 selected studies comprised 355 and 1530 patients diagnosed with cystic and solid pNETs, respectively. Compared with solid pNETs, cystic pNETs were less likely to be functional (odds ratio, OR = 0.31, 95% confidence interval (CI) 0.19-0.50, p < 0.00001), more likely to affect males (OR = 1.56, 95% CI 1.22-2.00, p = 0.0005), and significantly associated with multiple endocrine neoplasia type 1 (OR = 2.71). Cystic pNETs were more likely to present with G1 and G2 rather than G3 (OR = 1.66). Cystic pNETs were associated with less frequent distant organs and lymph node metastasis, microvascular invasion, perineural invasion, and a low Ki-67 index and mitotic count. There were no significant differences between 5- and 10-year overall survival. However, the 5-year disease-free survival (DFS) and 10-year DFS rate of patients with cystic pNETs was significantly higher compared with those with solid pNETs (94.6% vs 83.5%, OR = 3.00; 92.7% vs 63.6%, OR = 5.92, respectively).
CONCLUSIONS
Cystic pNETs represent a distinct subgroup of pNETs that present with an indolent biological behavior, and patients experience better DFS. Observation and surveillance should be considered in some selected cases.
Topics: Humans; Neuroendocrine Tumors; Pancreatic Neoplasms; Prognosis
PubMed: 31160191
DOI: 10.1016/j.pan.2019.05.462 -
Journal of Gynecology Obstetrics and... Jun 2021Primary ovarian leiomyosarcomas (POLMs) comprise <0.1 % of all ovarian malignancies. Here we aimed to define the clinical, surgical, and pathological features, as well...
Primary ovarian leiomyosarcomas (POLMs) comprise <0.1 % of all ovarian malignancies. Here we aimed to define the clinical, surgical, and pathological features, as well as the oncologic outcome, of POLM. A systematic review of the medical literature was performed to identify articles about POLMs. An electronic literature search was conducted for English language abstracts of articles published between 1975 and December 2018.51 articles were included in the study. The primary endpoint of the study was disease-free survival (DFS) and overall survival (OS), whereas the secondary endpoint was clinicopathological features. Five-year DFS and OS for the entire cohort was 15 % and 26 %, respectively. The DFS and OS were significantly related to paraaortic lymphadenectomy, a mitotic index>10/high power field, and advanced cancer stages. Eventually, we were unable to obtain clear results, this might be due to the limited number of cases at the literature.With more authors presenting their own cases, it will be possible to have clearer results.
Topics: Adult; Aged; Chemotherapy, Adjuvant; Female; Humans; Hysterectomy; Leiomyosarcoma; Middle Aged; Ovarian Neoplasms; Ovariectomy; Salpingectomy
PubMed: 32497729
DOI: 10.1016/j.jogoh.2020.101825