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Experimental and Therapeutic Medicine Aug 2024Mixed epithelial and stromal tumors (MESTs) of the kidney are rare renal neoplasms, primarily affecting middle-aged women. These tumors are characterized by a mix of...
Mixed epithelial and stromal tumors (MESTs) of the kidney are rare renal neoplasms, primarily affecting middle-aged women. These tumors are characterized by a mix of epithelial and stromal components. While generally benign, MESTs require accurate diagnosis and appropriate management due to the potential for malignant transformation. The present study reports the case of a 75-year-old male patient who underwent a partial nephrectomy following the incidental discovery of a kidney tumor. Histopathological examination revealed a partially cystic tumor with solid areas, measuring 26 mm in diameter. The tumor had cysts lined with cuboidal cells and an ovarian-like stroma. The solid component consisted of elongated cells with eosinophilic cytoplasm and oval nuclei, showing angiocentric growth around small blood vessels without nuclear atypia or mitoses. Since the morphology of the solid component could not reveal the differentiation of those cells, immunohistochemical staining was performed and a myopericytoma/myofibroma component was established, mostly based on the positivity of smooth muscle actin, muscle-specific actin, h-caldesmon, estrogen receptor, progesterone receptor, solute carrier family 2 facilitated glucose transporter member 1 and collagen IV, along with a lack of staining for desmin, CD34, CD31 and CD99. Thus, to the best of our knowledge, for the first time in the literature, MEST with myopericytoma/myofibroma stromal component in a male patient was reported.
PubMed: 38939172
DOI: 10.3892/etm.2024.12610 -
Scientific Reports Jun 2024We developed a composite symptom score (CSS) representing disease-related symptom burden over time in patients with malignant pleural mesothelioma (MPM). Longitudinal...
We developed a composite symptom score (CSS) representing disease-related symptom burden over time in patients with malignant pleural mesothelioma (MPM). Longitudinal data were collected from an open-label Phase IIB study in which 239 patients completed the validated MD Anderson Symptom Inventory for MPM (MDASI-MPM). A blinded, independent review committee of external patient-reported outcomes experts advised on MDASI-MPM symptoms to include in the CSS. Through iterative analyses of potential symptom-item combinations, 5 MPM symptoms (pain, fatigue, shortness of breath, muscle weakness, coughing) were selected. The CSS correlated strongly with the full MDASI-MPM symptom set (0.92-0.94) and the Lung Cancer Symptom Scale-Mesothelioma (0.79-0.87) at each co-administration of the scales. The CSS also had good sensitivity to worsening disease and global quality-of-life ratings. The MDASI-MPM CSS can be used as an outcome in MPM clinical trials, including in responder analyses and at the individual patient level. It is brief enough to administer frequently, including electronically, to better capture symptom trajectories during and after a trial and in clinical practice. As a single score, the CSS addresses multiplicity issues that can arise when several symptoms increase due to worsening disease. Our process can be adapted to produce a CSS for other advanced-cancer trials.
Topics: Humans; Mesothelioma, Malignant; Male; Female; Pleural Neoplasms; Aged; Middle Aged; Quality of Life; Lung Neoplasms; Mesothelioma; Patient Reported Outcome Measures; Fatigue; Symptom Assessment; Longitudinal Studies; Severity of Illness Index; Symptom Burden
PubMed: 38937473
DOI: 10.1038/s41598-024-62307-5 -
Abdominal Radiology (New York) Jun 2024The purpose of this study was to investigate the impact of different low-energy virtual monochromatic images (VMIs) in dual-energy CT on the performance of radiomics...
OBJECTIVE
The purpose of this study was to investigate the impact of different low-energy virtual monochromatic images (VMIs) in dual-energy CT on the performance of radiomics models for predicting muscle invasive status in bladder cancer (BCa).
MATERIALS AND METHODS
A total of 127 patients with pathologically proven muscle-invasive BCa (n = 49) and non-muscle-invasive BCa (n = 78) were randomly allocated into the training and test cohorts at a ratio of 7:3. Feature extraction was performed on the venous phase images reconstructed at 40, 50, 60 and 70-keV (single-energy analysis) or in combination (multi-energy analysis). Recursive feature elimination (RFE) and the least absolute shrinkage and selection operator (LASSO) were employed to select the most relevant features associated with BCa. Models were built using a support vector machine (SVM) classifier. Diagnostic performance was assessed through receiver operating characteristic curves, evaluating sensitivity, specificity, accuracy, precision, and the area-under-the curve (AUC) values.
RESULTS
In the test cohort, the multi-energy model achieved the best diagnostic performance with AUC, sensitivity, specificity, accuracy, and precision of 0.917, 0.800, 0.833, 0.821, and 0.750, respectively. Conversely, the single-energy model exhibited lower AUC and sensitivity in predicting the muscle invasion status.
CONCLUSIONS
By combining information from VMIs of various energies, the multi-energy model displays superior performance in preoperatively predicting the muscle invasion status of bladder cancer.
PubMed: 38937340
DOI: 10.1007/s00261-024-04459-6 -
Abdominal Radiology (New York) Jun 2024A wide spectrum of benign and malignant primary mesenchymal tumors and tumor-like lesions of the spleen has been recently included under the umbrella term... (Review)
Review
A wide spectrum of benign and malignant primary mesenchymal tumors and tumor-like lesions of the spleen has been recently included under the umbrella term 'stroma-derived' neoplasms and tumor-like lesions. These include dendritic cell neoplasms such as follicular dendritic cell sarcoma, EBV-positive inflammatory follicular dendritic cell sarcoma, and fibroblastic reticular cell tumor; smooth muscle and myofibroblastic lesions such as inflammatory pseudotumor, EBV-associated smooth muscle tumor and undifferentiated pleomorphic sarcoma as well as a diverse spectrum of vascular and vascular-stromal tumors and tumor-like lesions. While some tumor and tumor-like lesions are unique to the spleen, others may also occur in diverse extra-splenic viscera. These tumors and tumor-like lesions demonstrate characteristic histopathology, immunocytochemistry and biological behavior. While cross-sectional imaging studies allow detection, staging and limited characterization of these splenic lesions, histopathological confirmation permits optimal management and surveillance strategies.
PubMed: 38937338
DOI: 10.1007/s00261-024-04461-y -
Frontiers in Oncology 2024Thyroid-like follicular renal cell carcinoma (TLFRCC), also known as thyroid-like follicular carcinoma of the kidney or thyroid follicular carcinoma like renal tumor, is...
Thyroid-like follicular renal cell carcinoma (TLFRCC), also known as thyroid-like follicular carcinoma of the kidney or thyroid follicular carcinoma like renal tumor, is an exceedingly rare variant of renal cell carcinoma that has only recently been acknowledged. This neoplasm exhibits a distinct follicular morphology resembling that of the thyroid gland. Immunohistochemical analysis reveals positive expression of PAX8, Vimentin, and EMA, while thyroid-specific markers TG and TTF1 are consistently absent. Furthermore, there is a notable absence of any concurrent thyroid pathology on clinical evaluation. Previous reports have suggested that TLFRCC is an indolent, slow-growing malignancy with infrequent metastatic potential. In this report, we present a case of TLFRCC characterized by remarkable ossification and widespread metastasis, including multifocal pulmonary lesions, involvement of the abdominal wall, and infiltration into the psoas muscle. To our knowledge, this represents only the third documented instance of distant metastasis in thyroid follicular renal carcinoma. The current case demonstrates a therapeutic approach that combines radiotherapy with the utilization of toripalimab, a programmed cell death 1 (PD-1) receptor inhibitor, and pazopanib. This treatment regimen was tailored based on comprehensive genomic profiling, which identified mutations in the POLE (catalytic subunit of DNA polymerase epsilon) and ATM (ataxia-telangiectasia mutated) genes, both of which have been implicated in the pathogenesis of various malignant tumors. These findings represent a novel discovery, as such mutations have never been reported in association with TLFRCC. Thus far, this therapeutic approach has proven to be the most efficacious option for treating metastatic TLFRCC among previously reported, and it also marks the first mention of the potential benefits of radiotherapy in managing this particular subtype of renal cell carcinoma.
PubMed: 38933440
DOI: 10.3389/fonc.2024.1352865 -
Nutrients Jun 2024(1) Background: The assessment of muscle mass is crucial in the nutritional evaluation of patients with colorectal cancer (CRC), as decreased muscle mass is linked to... (Observational Study)
Observational Study
(1) Background: The assessment of muscle mass is crucial in the nutritional evaluation of patients with colorectal cancer (CRC), as decreased muscle mass is linked to increased complications and poorer prognosis. This study aims to evaluate the utility of AI-assisted L3 CT for assessing body composition and determining low muscle mass using both the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for sarcopenia in CRC patients prior to surgery. Additionally, we aim to establish cutoff points for muscle mass in men and women and propose their application in these diagnostic frameworks. (2) Methods: This retrospective observational study included CRC patients assessed by the Endocrinology and Nutrition services of the Regional University Hospitals of Malaga, Virgen de la Victoria of Malaga, and Vall d'Hebrón of Barcelona from October 2018 to July 2023. A morphofunctional assessment, including anthropometry, bioimpedance analysis (BIA), and handgrip strength, was conducted to apply the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia. Body composition evaluation was performed through AI-assisted analysis of CT images at the L3 level. ROC analysis was used to determine the predictive capacity of variables derived from the CT analysis regarding the diagnosis of low muscle mass and to describe cutoff points. (3) Results: A total of 586 patients were enrolled, with a mean age of 68.4 ± 10.2 years. Using the GLIM criteria, 245 patients (41.8%) were diagnosed with malnutrition. Applying the EWGSOP2 criteria, 56 patients (9.6%) were diagnosed with sarcopenia. ROC curve analysis for the skeletal muscle index (SMI) showed a strong discriminative capacity of muscle area to detect low fat-free mass index (FFMI) (AUC = 0.82, 95% CI 0.77-0.87, < 0.001). The identified SMI cutoff for diagnosing low FFMI was 32.75 cm/m (Sn 77%, Sp 64.3%; AUC = 0.79, 95% CI 0.70-0.87, < 0.001) in women, and 39.9 cm/m (Sn 77%, Sp 72.7%; AUC = 0.85, 95% CI 0.80-0.90, < 0.001) in men. Additionally, skeletal muscle area (SMA) showed good discriminative capacity for detecting low appendicular skeletal muscle mass (ASMM) (AUC = 0.71, 95% CI 0.65-0.76, < 0.001). The identified SMA cutoff points for diagnosing low ASMM were 83.2 cm (Sn 76.7%, Sp 55.3%; AUC = 0.77, 95% CI 0.69-0.84, < 0.001) in women and 112.6 cm (Sn 82.3%, Sp 58.6%; AUC = 0.79, 95% CI 0.74-0.85, < 0.001) in men. (4) Conclusions: AI-assisted body composition assessment using CT is a valuable tool in the morphofunctional evaluation of patients with colorectal cancer prior to surgery. CT provides quantitative data on muscle mass for the application of the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia, with specific cutoff points established for diagnostic use.
Topics: Humans; Sarcopenia; Male; Female; Body Composition; Colorectal Neoplasms; Aged; Malnutrition; Tomography, X-Ray Computed; Retrospective Studies; Middle Aged; Electric Impedance; Nutrition Assessment; Aged, 80 and over; Predictive Value of Tests; Muscle, Skeletal; Hand Strength
PubMed: 38931224
DOI: 10.3390/nu16121869 -
Nutrients Jun 2024This study investigates the role of body composition parameters in patients with pancreatic cancer undergoing surgical treatment. The research involved 88 patients...
This study investigates the role of body composition parameters in patients with pancreatic cancer undergoing surgical treatment. The research involved 88 patients diagnosed with pancreatic cancer who underwent surgery at the Modena Cancer Center between June 2015 and October 2023. Body composition parameters were obtained from CT scans performed before and after surgery. The percentage of sarcopenic patients at the time of diagnosis of pancreatic cancer is 56.82%. Of the patients who died between the first and second CT evaluated, 58% were sarcopenic, thus confirming the role of sarcopenia on outcome. The study found that all body composition parameters (TAMA, SMI, VFI, and SFI) demonstrated a trend towards reduction between two examinations, indicating an overall depletion in muscle and adipose tissue. We then evaluated the relationships between fat-related parameters (VFI, SFI and VSR) and survival outcomes: overall survival and progression-free survival. Cox univariate regression model show significant parameter related to outcomes was adipose tissue, specifically VFI. The study found that higher VFI levels were associated with greater survival rates. This research holds promise for advancing our understanding of the link between body composition and the prognosis of pancreatic cancer patients.
Topics: Humans; Pancreatic Neoplasms; Body Composition; Male; Female; Aged; Sarcopenia; Middle Aged; Adipose Tissue; Tomography, X-Ray Computed; Prognosis
PubMed: 38931189
DOI: 10.3390/nu16121834 -
Nutrients Jun 2024Reduced muscle strength (dynapenia) and mass (atrophy) are prognostic factors in oncology. Measuring maximal handgrip strength with dynamometers is feasible but limited... (Comparative Study)
Comparative Study
A Cross-Sectional Validation Study of Camry EH101 versus JAMAR Plus Handheld Dynamometers in Colorectal Cancer Patients and Their Correlations with Bioelectrical Impedance and Nutritional Status.
BACKGROUND
Reduced muscle strength (dynapenia) and mass (atrophy) are prognostic factors in oncology. Measuring maximal handgrip strength with dynamometers is feasible but limited by the cost of the reference device (JAMAR).
METHODS
A cross-sectional study was conducted on colorectal cancer outpatients treated with chemotherapy or under active surveillance in our center from September 2022 to July 2023. Accuracy, reliability, and concordance were compared for two handheld dynamometers: the JAMAR Plus (the gold-standard device) and the Camry EH101 (a low-cost index device). A simultaneous nutritional diagnosis with GLIM criteria and bioelectrical impedance analysis (BIA) was carried out.
RESULTS
A total of 134 participants were included. The median of maximal strength for the JAMAR Plus had a non-significant difference of 1.4 kg from the Camry EH101. The accuracy and reliability of the devices were high. Bland-Altman analysis showed a 0.8 kg bias and -4.1 to 5.6 kg limits of agreement (LoA); a 0.1 kg bias and -5.3 to 5.4 kg LoA in men; a 1.5 kg bias and -2.2 to 5.3 kg LoA in women. In total, 29.85% of the participants were malnourished. Prevalence of dynapenia increased from 3.67% with the JAMAR Plus to 5.14% with the Camry EH101. Both devices had a moderate and significant correlation with BIA-estimated muscle mass.
CONCLUSIONS
The Camry EH101 was a cost-effective alternative to JAMAR Plus in our sample.
Topics: Humans; Colorectal Neoplasms; Male; Female; Cross-Sectional Studies; Electric Impedance; Middle Aged; Nutritional Status; Aged; Reproducibility of Results; Hand Strength; Muscle Strength Dynamometer; Nutrition Assessment; Adult
PubMed: 38931179
DOI: 10.3390/nu16121824 -
Journal of Clinical Medicine Jun 2024: Leiomyosarcoma (LMS) originating from the adrenal gland is exceedingly rare, constituting a minute fraction of soft tissue sarcomas. Due to its rarity, with less than... (Review)
Review
: Leiomyosarcoma (LMS) originating from the adrenal gland is exceedingly rare, constituting a minute fraction of soft tissue sarcomas. Due to its rarity, with less than 50 documented cases in English medical literature, the diagnosis and management of adrenal LMS remain challenging. The aim of this study was to perform a review of the literature, in order to evaluate the prognosis of these rare cancers and report our specific case. : A systematic review of the literature was conducted using PubMed, Web of Science, Google Scholar, and Scopus databases, up to December 2020. The search utilized MeSH terms such as "Adrenal Gland Neoplasms," "Leiomyosarcoma," "Adrenalectomy," and "Smooth Muscle Tumor." The inclusion criteria focused on studies reporting patients with a histopathological diagnosis of adrenal leiomyosarcoma. The PRISMA guidelines were followed to ensure a comprehensive analysis. : Out of 63 identified studies, 43 met the inclusion criteria and were reviewed. These studies highlighted the rarity and aggressive behavior of adrenal leiomyosarcoma. Surgical excision remains the cornerstone of treatment, often complemented by adjuvant therapies. The reviewed case involved a 52-year-old woman who underwent a right laparoscopic adrenalectomy for a 9 × 7 × 6 cm grade 3 leiomyosarcoma. Despite subsequent adjuvant chemotherapy, hepatic metastases were detected, illustrating the aggressive nature of the disease. The literature underscores the importance of histopathological analysis and long-term surveillance for managing disease progression. : Optimal management of adrenal leiomyosarcoma requires a multidisciplinary approach and meticulous follow-up. The rarity of the disease poses challenges for standardizing treatment, but surgical excision and tailored adjuvant therapies show promise. Further research is essential to refine treatment strategies and improve prognosis for this rare malignancy.
PubMed: 38930027
DOI: 10.3390/jcm13123499 -
Serum Endocan Is a Risk Factor for Aortic Stiffness in Patients Undergoing Maintenance Hemodialysis.Medicina (Kaunas, Lithuania) Jun 2024: Endocan, secreted from the activated endothelium, is a key player in inflammation, endothelial dysfunction, proliferation of vascular smooth muscle cells, and...
: Endocan, secreted from the activated endothelium, is a key player in inflammation, endothelial dysfunction, proliferation of vascular smooth muscle cells, and angiogenesis. We aimed to investigate the link between endocan and aortic stiffness in maintenance hemodialysis (HD) patients. : After recruiting HD patients from a medical center, their baseline characteristics, blood sample, and anthropometry were assessed and recorded. The serum endocan level was determined using an enzyme immunoassay kit, and carotid-femoral pulse wave velocity (cfPWV) measurement was used to evaluate aortic stiffness. : A total of 122 HD patients were enrolled. Aortic stiffness was diagnosed in 53 patients (43.4%), who were found to be older ( = 0.007) and have a higher prevalence of diabetes ( < 0.001) and hypertension ( = 0.030), higher systolic blood pressure ( = 0.011), and higher endocan levels ( < 0.001), when compared with their counterparts. On the multivariate logistic regression model, the development of aortic stiffness in patients on chronic HD was found to be associated with endocan [odds ratio (OR): 1.566, 95% confidence interval (CI): 1.224-2.002, < 0.001], age (OR: 1.040, 95% CI: 1.001-1.080, = 0.045), and diabetes (OR: 4.067, 95% CI: 1.532-10.798, = 0.005), after proper adjustment for confounders (adopting diabetes, hypertension, age, systolic blood pressure, and endocan). The area under the receiver operating characteristic curve was 0.713 (95% CI: 0.620-0.806, < 0.001) for predicting aortic stiffness by the serum endocan level, at an optimal cutoff value of 2.68 ng/mL (64.15% sensitivity, 69.57% specificity). Upon multivariate linear regression analysis, logarithmically transformed endocan was proven as an independent predictor of cfPWV (β = 0.405, adjusted R change = 0.152; < 0.001). : The serum endocan level positively correlated with cfPWV and was an independent predictor of aortic stiffness in chronic HD patients.
Topics: Humans; Vascular Stiffness; Male; Proteoglycans; Female; Middle Aged; Renal Dialysis; Risk Factors; Neoplasm Proteins; Aged; Adult; Pulse Wave Analysis; ROC Curve; Biomarkers; Logistic Models; Cross-Sectional Studies
PubMed: 38929601
DOI: 10.3390/medicina60060984