Risk for Pelvic Metastasis and Role of Pelvic Lymphadenectomy in Node-Positive Vulvar Cancer-Results from the AGO-VOP.2 QS Vulva Study

The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.

ROLE OF MAGNETIC RESONANCE IMAGING IN NODAL AND METASTATIC STAGING OF PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To evaluate the usage of MRI in prostate cancer staging, especially in nodal involvement (N-staging) and metastasis (M-staging) of prostate cancer. Methods: This is a systematic review and meta-analysis assessing role of MRI in nodal and metastasis staging of prostate cancer. Search of studies were done through search engine using Pubmed, Cochrane, and EBSCO Host and manual searching. Quality of eligible studies were assessed using a revised version of Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and analyzed in pooled analysis according to nodal involvement or metastasis staging, modality of diagnosis used as the index test and gold standard used using STATA version 13. Results: Total 26 studies corresponding with study’s eligibility criteria were found. Overall, usage of MRI has a sensitivity of 47% (95% CI 35% - 60%; I2 83.08%) and a specificity of 93% (95% CI 89% - 96%, I2 82.21%) in nodal involvement staging of prostate cancer, while using of MRI in M-staging of prostate cancer shows a sensitivity of 94% (95% CI 86% - 97%) and a specificity of 99% (95% CI 97% - 99%). Using lymphotrophic superparamagnetic nanoparticle (LSN) - enhanced MRI gives higher sensitivity than using MRI without LSN for N-staging of prostate cancer. Conclusion: The usage of MRI in prostate cancer staging has a moderate sensitivity and relatively high specificity in detecting lymph node. Moreover, it plays an important role and even can be used as a modality of choice in assisting bone metastatic prostate cancer detection.

A RARE CASE OF ROSAI-DORFMAN DISEASE IN HYPOTHYROIDISM PATIENT A DIAGNOSTIC COEXISTENCE

Rosai-Dorfman disease (RDD) is a rare, benign, and predominantly nodal disease that most commonly presents as bilateral, painless cervical lymphadenopathy; although inguinal, axillary, mediastinal, and hilar lymphadenopathy has also been reported. Apart from nodal involvement, RDD has extra nodal manifestations involving bone, soft tissue, and liver as well as constitutional symptoms of fever, night sweats, and weight loss, which make it reasonable to rule out the infectious, autoimmune, and malignant conditions as the differential diagnosis.

Does failed mapping predict sentinel lymph node metastasis in cN0 breast cancer?

Aims: The clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) is unknown. The authors sought to determine the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Patients & methods: A total of 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively studied. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Results: Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Conclusion: Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.

Gastrointestinal Manifestations of Mature B Cell Neoplasms: Single Center Experiences from the Collective Perspective of Hematology and Pathology

Introduction: Hematological malignancies are frequently affecting the gastrointestinal (GI) tract, either by secondary extra nodal or extramedullary extension to the GI tract, or as a primary process arising in the GI tract. Gastrointestinal non-Hodgkin lymphomas (gNHL) appear less than other solid organ tumours in the GI tract. Therefore, in the absence of nodal or extra nodal involvement in imaging methods, there may be difficulties in diagnosis. Haematologists provide more important support by pathologists in terms of diagnosis than imaging methods.Methods: We retrospectively investigated all B-cell lymphoma patients diagnosed in our clinic between 01.01.2015- 01.01.2021. After that, patients not diagnosed by gastrointestinal system sampling were excluded from the study. Demographic data of these patients were obtained from the hospital information system and outpatient clinic files. Slides of these patients were obtained from pathology archive and re-evaluated under light microscope by two pathologists. All cases were diagnosed according to revised World Health Organization (WHO) 2017 classification.Results: 55 patients were diagnosed with B-cell lymphoma by sampling by endoscopy or colonoscopy. 40 of the patients were diagnosed with Diffuse Large B Cell Lymphoma (DLBCL), 10 with Marginal Zone Lymphoma (MZL), 2 with Mantle Cell Lymphoma (MCL), 2 patients with Burkitt Lymphoma (BL) and 1 patient with Lymphoplasmacytic Lymphoma (LPL).Conclusion: Like the literature, the frequency of DLBCL was the highest in patients diagnosed with GI tract in our study. The second most common B-cell lymphoma was MALToma. Although MCL is with a high frequency of GI involvement, there were few patients diagnosed with GI involvement. The reason for this was that the patients were diagnosed with nodal involvement rather than GI sampling.

Validation of FLIPI1, FLIPI2, PRIMA and POD24 in Patients with Extranodal Follicular Lymphoma: A Cohort from Two Cancer Centers in Peru

Background Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma subtype, being nodal involvement its main characteristic. However, data about Extranodal (EN) involvement is not reported in Latin American patients. Our aim was to evaluate the clinical features, treatment patterns outcomes of Peruvian patients with ENFL from two cancer centers and validate FLIPI1, FLIPI2, PRIMA and POD-24 prognostic index in our cohort. Methods: This is a retrospective study, including all patients with a pathological diagnosis of FL grade 1 to 3A treated at the National Institute of Neoplastic Diseases and Oncosalud, both in Lima, Peru from 2010 to 2019. All cases were reviewed by specialized pathologists. Baseline clinical and pathological data were collected. Responses were assessed based on the Lugano criteria. Overall survival (OS) was estimated using the Kaplan-Meier method. Differences were compared with the log-rank test. Results A total of 86 patients were evaluated. The median age was 61 years (30-91), 43% were male, 20% had bulky disease (≥6 cm in diameter), 51% had stage III/IV disease, 31% had hemoglobin &lt;12 g/dl, 11% had serum albumin &lt;3 g/dl, 25% had elevated serum LDH, 31% had B2-microglobulin ≥3,5 mg/l, 27% had bone marrow involvement and 19% had lymph node sites &gt;4. The most frequent EN sites were gastrointestinal, bone marrow, cutaneous and breast with 22%, 21% and 9%, and 6%% respectively. Low, intermediate and high-risk FLIPI1 was seen in 56%, 23% and 21% of patients, respectively. Low, intermediate and high-risk FLIPI2 was seen in 28%, 58% and 14% of patients, respectively. Low, intermediate, and high PRIMA was seen in 57%, 10% and 33%, respectively. 55 patients (64%) received any treatment, 47% received CHOP ± rituximab (R), 16% CVP ± R, 22% radiotherapy alone, 9% CHOP, 15% other treatments. Response data were available in 44 patients with complete response in 45%, partial response in 43% and no response in 12%, for an overall response rate of 88%. From patients who received CHOP/CVP ± R, 13% patients had disease progression within 24 months of first treatment initiation (POD24). For the entire cohort (N=88) the median follow-up time was 2.1 years (interquartile range [IQR] 0.08-11.3), median overall survival was 8.25 years (IQR 4.4-not reached [NR]). 5y OS was71.7% (95% CI 55.3-82.9), figure 1. For the FLIPI group 5y OS for low, intermediate and high FLIPI were 86.9% (95% CI 64.7-95.6), 60.1% (95% CI 24.4-83.2) and 75.7% (95% CI 30.4-93.7), respectively (p=0.07; Figure 2). For the FLIPI2 group (N=58) 5y OS for low, intermediate and high FLIPI2 were 79.5% (95% CI 39.3-94.5), 77% (95% CI 55.3-89.2) and 86% (95% CI 33.4-97.8), respectively (p=0.86). For the PRIMA group (N=38) 5y OS for low, intermediate and high PRIMA was 86% (95%55.6-96.6), 100% (95% CI 100), and 80% (95% CI 42-95), respectively (p=0.80). Patients who had and did not have POD24 had median OS of NR (IQR 0.6-NR) and NR (IQR 2.69-NR), respectively. 5y OS for patients who had and did not have POD24 was 71.2 % (95% CI 48-85) and 75% (12.7-96), respectively (p&lt;0.87). Conclusion: Peruvian patients with ENFL showed a higher rate of female patients. Gastrointestinal involvement was the most common primary site. The OS rates is similar to our nodal involvement cohort. Chemoimmunotherapy is the standard approach to FL patients, which is associated with high rates of overall response. In our study FLIPI, FLIPI2, PRIMA and POD24 were not predictors for OS, but larger cohorts and longer follow-up are needed to find more accurate predictors of survival in these patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Dedifferentiated Liposarcoma of the Transverse Colon

While liposarcoma is one of the most common soft tissue sarcomas, it is rarely seen within the gastrointestinal tract, and even less frequently seen within the colon. Dedifferentiated liposarcoma is a subtype of liposarcoma, which along with the pleomorphic subtype is considered a high-grade, aggressive tumor; both possess the ability to metastasize and are associated with decreased survival. Despite complete resection, recurrence is common. While surgical excision is the cornerstone of treatment for liposarcoma of the colon, there is no consensus on adjuvant therapies. We present the case of a 66-year-old woman who presented with abdominal pain with rectal bleeding and was found on colonoscopy to have a high-grade dedifferentiated liposarcoma of the transverse colon. She underwent robotic segmental colectomy. Due to absence of nodal involvement or distal metastasis, adjuvant therapy was not administered. On 1-year follow-up, the patient remains disease free.

A PROSPECTIVE STUDY ON CLINICAL PRESENTATION AND MANAGEMENT PROTOCOLS OF CARCINOMA PENIS IN TERTIARY CARE CENTRE

INTRODUCTION:Carcinoma of the penis is a malignancy with a wide range of clinical and pathological presentations. It constitutes a major substantial health concern in many developing countries including India. Proper evaluation of both the primary lesion and lymph nodes is critical because nodal involvement is the most important factor for survival. This study was undertaken to [1,2,3] determine incidence with age, religion, and socioeconomic status and to study risk factors and its management . METHODS:A descriptive study was conducted among 30 patients with proven carcinoma penis for a period of 2 years. RESULTS: In my study the maximum incidence was found to be in the age group of 50 to 70. All cases were Hindus and Muslims were free of disease may be due to early circumcision. In my study 86.6% of the patients associated with carcinoma penis were smokers. The commonest symptom at presentation was proliferative growth (76%). The most common site of origin was the Glans penis. The average time interval between onset of symptoms and seeking medical advice is 7 Months. The most common surgery performed was partial penectomy (73.3%) and a majority of the biopsy report showed SCC. Moderately and poorly differentiated tumors had a very strong association with nodal involvement. CONCLUSION: Carcinoma penis can be avoided by better penile hygiene and circumcision. It is a curable disease, if detected early and treated properly. The surgery is the mainstay of treatment. Creating awareness in public is the only way to reduce mortality and morbidity due to the carcinoma of the penis.