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Anticancer Research Nov 2021Lymph node metastasis is an important prognostic factor in gastric cancer patients. In node-negative (N0) gastric cancer patients, additional prognostic factors are...
BACKGROUND/AIM
Lymph node metastasis is an important prognostic factor in gastric cancer patients. In node-negative (N0) gastric cancer patients, additional prognostic factors are needed to reinforce TNM staging.
PATIENTS AND METHODS
We semi-quantitatively recorded the presence of lymphatic, venous, and perineural invasion and evaluated the possibility that they could be used as upstaging factors in N0 gastric cancer by comparing N0 gastric cancer cases with N1 cases.
RESULTS
Venous (p<0.001) and perineural (p<0.001) invasion were important factors in the relapse-free survival of N0 patients, but lymphatic invasion was not. N0 cases with venous or perineural invasion had survival curves similar to those of N1 patients. In addition, the number of invasive features (lymphatic, venous, or perineural) was an important factor in predicting poor patient survival.
CONCLUSION
Venous and perineural invasion were significant prognostic factors in N0 gastric cancer cases. It is necessary to record lymphatic, venous, and perineural invasion separately in the pathology report, especially in cases of N0 gastric cancer.
Topics: Adult; Aged; Aged, 80 and over; Disease Progression; Female; Gastrectomy; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Peripheral Nerves; Progression-Free Survival; Risk Assessment; Risk Factors; Stomach Neoplasms; Time Factors; Veins
PubMed: 34732454
DOI: 10.21873/anticanres.15397 -
Cancer Apr 2000Perineural spread is a well-documented feature of cutaneous tumors and may portend a more aggressive course. The incidence of perineural invasion in basal cell carcinoma...
BACKGROUND
Perineural spread is a well-documented feature of cutaneous tumors and may portend a more aggressive course. The incidence of perineural invasion in basal cell carcinoma (BCC) is reportedly 1%. The authors sought to determine whether perineural spread occurs more commonly than previously thought.
METHODS
The authors prospectively evaluated 434 patients with BCC treated with Mohs surgery, assessing the presence or absence of perineural inflammation and invasion in tumors requiring more than one stage of surgery. They also documented the demographic features, clinical characteristics, histologic subtype, and operative data in each case.
RESULTS
Seventy-eight BCCs required more than one stage of Mohs surgery. Perineural inflammation, perineural tumor invasion, or both were present in 29 of the 78 tumors (37%), or 6.7% of all 434 prospectively evaluated cases. Twenty-one of the 78 tumors (26.9%) exhibited perineural inflammation, 3 (3.8%) demonstrated perineural invasion, and 5 (6.4%) exhibited both. Tumors with perineural invasion required 5.3 surgical stages on average for clearance, in contrast to tumors without perineural invasion, which required 2.2 stages. Tumors with perineural inflammation, inflammation plus tumor invasion, and invasion alone were, respectively, 138%, 149%, and 194% greater in area preoperatively than tumors without perineural involvement, and their mean defect areas after Mohs surgery were, respectively, 151%, 121%, and 605% larger than those of tumors without perineural involvement.
CONCLUSIONS
The incidence of perineural invasion among cases of BCC appears higher than previously recognized. Tumor aggressiveness appears to correlate with the presence of perineural invasion. Surgery with horizontal frozen-section margin control enables easy detection of perineural involvement and should therefore be strongly considered for the treatment of high risk BCC patients.
Topics: Aged; Carcinoma, Basal Cell; Female; Humans; Inflammation; Male; Middle Aged; Mohs Surgery; Peripheral Nerves; Peripheral Nervous System Neoplasms; Prospective Studies; Skin Neoplasms
PubMed: 10738219
DOI: 10.1002/(sici)1097-0142(20000401)88:7<1605::aid-cncr15>3.0.co;2-y -
Life (Basel, Switzerland) Jun 2023Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the...
Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the gold standard for assessment, having the possibility of addressing multiple high-risk factors such as perineural invasion (PNI). The current study included a number of 244 BCC patients and targeted the identification of positive PNI and its suggestive signs, and whether they correlated or not with other high-risk tumor signs. PNI was found in 20.1% of patients, with 30.7% of patients having perineural chronic inflammation (PCI), which is a suggestive sign of PNI. PNI was also found in larger tumors, with deeper Clark levels, in high-risk BCCs and high-grade tumors. PNI and PCI are both important for pathology reporting, aiding in treatment choice and further patient management, with possibly positive outcomes concerning morbidity and mortality.
PubMed: 37374188
DOI: 10.3390/life13061406 -
Acta Chirurgica Belgica Apr 2022Inguinodynia after inguinal meshplasty is a notable complication with an incidence of 13-37%. We wanted to determine if a perineural infiltration of bupivacaine given... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Inguinodynia after inguinal meshplasty is a notable complication with an incidence of 13-37%. We wanted to determine if a perineural infiltration of bupivacaine given intraoperatively would reduce the incidence of immediate postoperative pain and inguinodynia.
METHODOLOGY
We have conducted a single-blinded randomized controlled trial including 100 patients with inguinal hernia. Patients in the control group received only spinal anaesthesia. The intervention group received perineural bupivacaine infiltration in addition to spinal anaesthesia. Intraoperatively Ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve was identified and 2 mL of 0.5% bupivacaine was given perineurally along these identified nerves. Presence of inguinodynia, immediate post-operative pain scores using the Wong-Baker faces pain scale, duration of analgesics use, use of additional analgesics along with Paracetamol 500 mg tablet, and the length of hospital stay between the groups were recorded.
RESULTS
100 patients were randomized in the study, 49 in control and 51 in the intervention group. Both the group was comparable in terms of demographic characteristics. The intervention group had significantly lower median pain score at 3 h [4 ± 1.662 vs. 6 ± 1.55; = .0001] and 6 h [4 ± 1.33 vs. 6 ± 1.307; = .0001]. The incidence of inguinodynia did not significantly differ between the two groups (-value = .12).
CONCLUSION
Intraoperative Perineural bupivacaine infiltration significantly reduces the immediate postoperative pain. However, there was no significant reduction in the incidence of inguinodynia or additional analgesic requirement.
Topics: Anesthetics, Local; Bupivacaine; Double-Blind Method; Hernia, Inguinal; Humans; Pain, Postoperative
PubMed: 33497295
DOI: 10.1080/00015458.2020.1860401 -
The Australasian Journal of Dermatology Aug 2020Perineural invasion within keratinocyte cancer is a hallmark of tumour aggression, and a definitive treatment paradigm for this condition remains undetermined. Our aim...
BACKGROUND/OBJECTIVES
Perineural invasion within keratinocyte cancer is a hallmark of tumour aggression, and a definitive treatment paradigm for this condition remains undetermined. Our aim was to investigate the treatment and outcomes of keratinocyte cancer with incidental perineural invasion within two skin cancer databases to refine treatment protocols.
METHODS
We retrospectively assessed the Queensland Perineural Invasion Registry for surgery, histopathology, adjuvant radiotherapy and recurrence of keratinocyte cancer five years post-definitive treatment. We also reviewed the Princess Alexandra Hospital Head and Neck clinical perineural invasion database, specifically looking at surgical margins and adjuvant radiotherapy of cutaneous squamous cell carcinoma (cSCC) with incidental perineural invasion in the primary lesion.
RESULTS
There was no recurrence at 5 years in the Perineural Invasion Registry. Basal cell carcinoma (BCC) lesions with nerves <0.1 mm were more commonly treated with surgery alone, compared to lesions with nerves ≥0.1 mm which were offered adjuvant radiotherapy. Of the total BCC lesions with incidental perineural invasion, those with perineural margins ≥5 mm and peripheral tumour margins ≥3 mm were predominantly treated with surgery alone. Eighty-nine per cent of cSCC lesions with incidental perineural invasion were treated with surgery and adjuvant radiotherapy.
CONCLUSION
Surgery alone is suitable for BCC lesions with incidental perineural invasion. The majority of BCC lesions achieved ≥5 mm perineural and ≥3 mm peripheral tumour margins. Future research can guide if adjuvant radiation is required for BCC with perineural invasion. The treatment of cSCC with incidental perineural invasion with surgery alone remains undetermined.
Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Margins of Excision; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Peripheral Nerves; Radiotherapy, Adjuvant; Registries; Retrospective Studies; Skin Neoplasms
PubMed: 32285436
DOI: 10.1111/ajd.13290 -
World Neurosurgery Sep 2020Adenocarcinomas of müllerian origin are malignancies derived from tissues of the proximal third of the vagina, cervix, uterus, and fallopian tubes. These organs develop...
BACKGROUND
Adenocarcinomas of müllerian origin are malignancies derived from tissues of the proximal third of the vagina, cervix, uterus, and fallopian tubes. These organs develop from the embryologic müllerian ducts. While reports of perineural spread of certain uterine and cervical carcinomas exist in the literature, to our knowledge, no reports of clear cell-type müllerian adenocarcinoma presenting with neural invasion of the lumbosacral plexus exist in the literature.
CASE DESCRIPTION
A 77-year-old woman with a remote history of hysterectomy and bilateral salpingo-oopherectomy for benign disease presented for evaluation of foot drop. We present clinical, electromyographic, and imaging findings of her condition, which revealed a diffuse intraneural lesion of the ipsilateral lumbosacral plexus. Percutaneous biopsy of the lesion confirmed nerve infiltrating clear cell adenocarcinoma of müllerian origin.
CONCLUSIONS
We present the first case of adenocarcinoma of müllerian origin with confirmed perineural spread presenting with ipsilateral lower extremity weakness. This case illustrates the importance of recognizing potential perineural spread of gynecologic malignancies to avoid delay in treatment.
Topics: Adenocarcinoma, Clear Cell; Aged; Carcinoma; Female; Humans; Lumbosacral Plexus; Magnetic Resonance Imaging; Peripheral Nervous System Neoplasms; Spine
PubMed: 32592970
DOI: 10.1016/j.wneu.2020.06.121 -
Oncotarget Mar 2021Although tumor-associated lymphangiogenesis correlates with metastasis and poor prognosis in several cancers, it also supports T cell infiltration into the tumor and...
Although tumor-associated lymphangiogenesis correlates with metastasis and poor prognosis in several cancers, it also supports T cell infiltration into the tumor and predicts favorable outcome to immunotherapy. The role of lymphatic vessels in skin squamous-cell carcinoma (sSCC), the second most common form of skin cancer, remains mostly unknown. Although anti-PD-1 therapy is beneficial for some patients with advanced sSCC, a greater understanding of disease mechanisms is still needed to develop better therapies. Using quantitative multiplex immunohistochemistry, we analyzed sSCC sections from 36 patients. CD8+ T cell infiltration showed great differences between patients, whereby these cells were mainly excluded from the tumor mass. Similar to our data in melanoma, sSCC with high density of lymphatic endothelial cells showed increased CD8+ T cell density in tumor areas. An entirely new observation is that sSCC with perineural infiltration but without metastasis was characterized by low lymphatic endothelial cell density. Since both, metastasis and perineural infiltration are known to affect tumor progression and patients' prognosis, it is important to identify the molecular drivers, opening future options for therapeutic targeting. Our data suggest that the mechanisms underlying perineural infiltration may be linked with the biology of lymphatic vessels and thus stroma.
PubMed: 33868585
DOI: 10.18632/oncotarget.27915 -
Child's Nervous System : ChNS :... Sep 2022Optic pathway gliomas are the most common central nervous system neoplasms in patients with neurofibromatosis type 1. Perineural arachnoidal gliomatosis is a rare and...
Optic pathway gliomas are the most common central nervous system neoplasms in patients with neurofibromatosis type 1. Perineural arachnoidal gliomatosis is a rare and distinctive growth pattern of optic nerve glioma, in which the tumor infiltrates through the pia mater and pre-dominantly involves the subarachnoid space around the optic nerve. Here, we report an 8-year-old girl with perineural arachnoidal gliomatosis associated with neurofibromatosis type 1.
Topics: Arachnoid; Child; Female; Humans; Magnetic Resonance Imaging; Neurofibromatosis 1; Optic Nerve; Optic Nerve Glioma
PubMed: 35652934
DOI: 10.1007/s00381-022-05563-y -
Scientific Reports Mar 2023This study aimed to investigate the prognostic impact of lymphovascular and perineural invasions in patients with squamous cell carcinoma of the tongue who received...
This study aimed to investigate the prognostic impact of lymphovascular and perineural invasions in patients with squamous cell carcinoma of the tongue who received surgery-based treatment at our institution between January 2013 and December 2020. Patients were divided into four groups based on the presence of perineural (P-/P +) and lymphovascular invasions (V-/V +): P-V-, P-V + , P + V-, and P + V + . Log-rank and Cox proportional hazard models were used to evaluate the association between perineural /lymphovascular invasion and overall survival (OS). Altogether, 127 patients were included, and 95 (74.8%), 8 (6.3%), 18 (14.2%), and 6 (4.7%) cases were classified as P-V-, P-V + , P + V-, and P + V + , respectively. Pathologic N stage (pN stage), tumor stage, histological grade, lymphovascular invasion, perineural invasion, and postoperative radiotherapy were significantly associated with OS (p < 0.05). OS was significantly different among the four groups (p < 0.05). Significant between-group differences in OS were detected for node-positive (p < 0.05) and stage III-IV (p < 0.05) cases. OS was the worst in the P + V + group. Lymphovascular and perineural invasions are independent negative prognostic factors for squamous cell carcinoma of the tongue. Patients with lymphovascular and/or perineural invasion may have significantly poorer overall survival than those without neurovascular involvement.
Topics: Humans; Prognosis; Carcinoma, Squamous Cell; Tongue; Health Facilities
PubMed: 36882521
DOI: 10.1038/s41598-023-30939-8 -
World Journal of Surgery Nov 2008Perineural invasion is commonly observed in biliary tract cancer and is an independent prognostic factor. Since intrahepatic cholangiocarcinoma (ICC) develops from...
BACKGROUND
Perineural invasion is commonly observed in biliary tract cancer and is an independent prognostic factor. Since intrahepatic cholangiocarcinoma (ICC) develops from biliary epithelia in the liver, ICC may share the same characteristics in terms of the prognostic implications of perineural invasion. The aim of this study was to evaluate the clinical significance of perineural invasion in ICC.
METHODS
A total of 59 patients with ICC who underwent hepatectomy were retrospectively reviewed. The numbers of nerves with and without tumor involvement were counted. The perineural invasion index (PNI) was calculated as the number of involved nerves divided by the total number of nerves examined. Predictors for perineural invasion and prognostic factors were analyzed.
RESULTS
Perineural invasion was observed in 47 of 59 (80%) patients, and the median PNI was 0.082. The macroscopic tumor appearance and tumor location were significantly associated with perineural invasion (p = 0.013 and 0.032, respectively). Univariate and multivariate analyses (excluding seven in-hospital deaths) revealed that histologic grade, the presence of perineural invasion, nodal metastasis, and intrahepatic metastasis were independent prognostic factors. The survival rate of the patients with (n = 42) or without (n = 10) perineural invasion was 17 and 80% at 3 years; and 17 and 70% at 5 years, respectively (p = 0.001).
CONCLUSION
Perineural invasion is frequently found in patients with ICC and is an independent prognostic factor. ICC is an aggressive tumor similar to other biliary tract cancers. Because perineural invasion is a histologic marker of aggressiveness, it potentially has a role as a determinant of patient selection for adjuvant therapy.
Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness; Nerve Fibers; Peripheral Nerves; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome
PubMed: 18795245
DOI: 10.1007/s00268-008-9726-2