Imaging Evaluation of Thymoma and Thymic Carcinoma

Imaging is integral in the management of patients with thymoma and thymic carcinoma. At initial diagnosis and staging, imaging provides the clinical extent of local invasion as well as distant metastases to stratify patients for therapy and to determine prognosis. Following various modalities of therapy, imaging serves to assess treatment response and detect recurrent disease. While imaging findings overlap, a variety of CT, MRI, and PET/CT characteristics can help differentiate thymoma and thymic carcinoma, with new CT and MRI techniques currently under evaluation showing potential.

Data from small cell neuroendocrine carcinoma of the cervix: FIGO 2018 staging is more accurate than FIGO 2009

Objective To compare the prognostic value of International Federation of Gynecology and Obstetrics (FIGO) 2009 and 2018 staging systems in surgical patients with small cell neuroendocrine carcinoma of the cervix (SCNEC). Methods We re-staged 64 surgical IB–IIA (FIGO 2009) SCNEC patients according to the FIGO 2018 system and refined stage IIIC of FIGO 2018 based on tumor local invasion. The prognostic factors were analyzed, and the advantages of FIGO 2018 were compared with 2009. Results The 5-year overall survival rate (OS) was 78.5% for stage I and 22.2% for stage II (FIGO 2009). In FIGO 2018, there was no difference between stage I and II, and the 5-year OS was 74.1%, 60.2%, and 0% for stage I/II, IIIC1, and IIIC2. After combining stage IIIC with the local invasion stage (T1 was limited to the cervix and vagina; T2 involved the parametrium; T3 involved the pelvic or abdominal cavity), the 5-year OS for stage IIICT1, IIICT2, and IIICT3 was 83.3%, 30.0%, and 0%, respectively. Conclusions For stage II SCNEC patients, FIGO 2009 underestimated the prognosis, while FIGO 2018 was more accurate. For stage IIIC, FIGO 2018 might be more individualized and accurate after combining stage IIIC with tumor local invasion.

Rectal Gastrointestinal Stromal Tumor (GIST): About a Rare and Unusual Case

Rectal gastrointestinal stromal tumors (GIST) are extremely rare, accounting for approximately 0.1% of all rectal tumors. Diagnosis is based on histological and immunohistochemical confirmation. We report the case of a 38-year-old patient with a rectal GIST revealed by chronic rectal bleeding associated with rectal tenesmus, abdominal pain with painful contractions and frequent evacuations evolving in a context of altered general state. Rectoscopy was used to visualize the tumor mass and to take biopsies; their histological and immunohistochemical study revealed a rectal location of a gastrointestinal stromal tumor. The extension assessment was negative. After discussion of the case in a multidisciplinary consultation meeting, management consisted of initially putting the patient on Imatinib given the large tumor size, the degree of local invasion and the location of the mass (lower rectum), with regular follow-up in order to schedule a less invasive surgical resection later. Despite the rarity of rectal GIST, early diagnosis is necessary to avoid progression to locoregional invasion complicating some surgical resections given the anatomical constraints of the pelvic region. Hence the interest of neoadjuvant therapy with tyrosine kinase inhibitors allowing in some cases a decrease in tumor volume, a regression of the degree of local invasion and a decrease in the morbidity of the surgery in order to improve the patient's quality of life.

The invasive herb Lupinus polyphyllus can reduce plant species richness independently of local invasion age

The ecological impacts of invasive species may change or accumulate with time since local invasion, potentially inducing further changes in communities and the abiotic environment. Yet, time since invasion is rarely considered when investigating the ecological impacts of invasive non-native species. To examine the effect of time since invasion on the ecological impacts of Lupinus polyphyllus, a perennial nitrogen-fixing herb, we surveyed vascular plant communities in the presence and absence of L. polyphyllus in young, intermediate, and old semi-natural grassland sites (ca. 5, 10, 15 years representing both time since lupine invasion and plant community age). We analyzed vascular plant community composition, vascular plant species richness, and the cover of various ecological plant groups and L. polyphyllus. In contrast to our hypotheses, we found no change in the mean cover of L. polyphyllus (about 35%) with time since local invasion, and an ordination did not suggest marked changes in plant community composition. L. polyphyllus was associated with lower species richness in invaded plant communities but this effect did not change with time since invasion. Invaded plant communities were also associated with lower occurrence of generalist, oligotrophic (low-nutrient-adapted) and copiotrophic (nutrient-demanding) species but no temporal dynamics were detected. We conclude that even the intermediate cover of L. polyphyllus can reduce plant species richness, but the ecological impact caused by this invader might not dramatically change or accumulate with time since invasion.

EP.WE.412An unusual case of a 13.8cm Gastric Schwannoma invading into Transverse Mesocolon: A case report and literature review

Gastric Schwannomas (GS) are benign, slow-growing, Sub-mucosal tumours (SMT’s) that constitute 0.2% of all gastric tumours. They usually have a homogenous appearance on contrast enhanced computed tomography of the abdomen (CECT Abdomen) and rarely show malignant features such as irregular borders, calcification, local invasion and mucosal ulceration. Due to lack of mucosal changes and poor yield during Oesophago-Gastro-Duodenoscopy (OGD) and biopsy, they are often misdiagnosed as Gastro-Intestinal Stromal tumours (GISTs), a malignant SMT. Treatment options range from conservative management to major open resections and are dependent on the size and clinical presentation. Histologically, GS are spindle cells tumours with lymphoid cuffing. On Immunohistochemistry, they test positive for S100 but negative for DOG1, Smooth muscle actin and Desmin which are markers of GISTs. Here we present the case of a 61-year-old female with a 15-year history of epigastric fullness that turned out to be a 13.8cm GS originating from the greater curvature of the stomach. On CECT Abdomen, the tumour appeared heterogeneous, with multiple calcium deposits and local invasion into the transverse mesocolon. The patient underwent a Sub-total gastrectomy with en-bloc transverse colectomy. Symptoms from GS can be vague and can pose a significant diagnostic and investigative dilemma. Physicians and Surgeons should have a low threshold to investigate prolonged symptoms with CECT Abdomen. Despite their benign nature, if left undiagnosed, GS can grow to significant sizes and mimic malignant gastric tumours on conventional imaging resulting in unconventionally major resections.

Monocarboxylate Transporter-2 Expression Restricts Tumor Growth in a Murine Model of Lung Cancer: A Multi-Omic Analysis

Monocarboxylate transporter 2 (MCT2) is a major high-affinity pyruvate transporter encoded by the SLC16A7 gene, and is associated with glucose metabolism and cancer. Changes in the gut microbiota and host immune system are associated with many diseases, including cancer. Using conditionally expressed MCT2 in mice and the TC1 lung carcinoma model, we examined the effects of MCT2 on lung cancer tumor growth and local invasion, while also evaluating potential effects on fecal microbiome, plasma metabolome, and bulk RNA-sequencing of tumor macrophages. Conditional MCT2 mice were generated in our laboratory using MCT2loxP mouse intercrossed with mCre-Tg mouse to generate MCT2loxP/loxP; Cre+ mouse (MCT2 KO). Male MCT2 KO mice (8 weeks old) were treated with tamoxifen (0.18 mg/g BW) KO or vehicle (CO), and then injected with mouse lung carcinoma TC1 cells (10 × 105/mouse) in the left flank. Body weight, tumor size and weight, and local tumor invasion were assessed. Fecal DNA samples were extracted using PowerFecal kits and bacterial 16S rRNA amplicons were also performed. Fecal and plasma samples were used for GC−MS Polar, as well as non-targeted UHPLC-MS/MS, and tumor-associated macrophages (TAMs) were subjected to bulk RNAseq. Tamoxifen-treated MCT2 KO mice showed significantly higher tumor weight and size, as well as evidence of local invasion beyond the capsule compared with the controls. PCoA and hierarchical clustering analyses of the fecal and plasma metabolomics, as well as microbiota, revealed a distinct separation between the two groups. KO TAMs showed distinct metabolic pathways including the Acetyl-coA metabolic process, activation of immune response, b-cell activation and differentiation, cAMP-mediated signaling, glucose and glutamate processes, and T-cell differentiation and response to oxidative stress. Multi-Omic approaches reveal a substantial role for MCT2 in the host response to TC1 lung carcinoma that may involve alterations in the gut and systemic metabolome, along with TAM-related metabolic pathway. These findings provide initial opportunities for potential delineation of oncometabolic immunomodulatory therapeutic approaches.

Huge Trichilemmal Carcinoma With Metastasis Presenting With Two Distinct Histological Morphologies: A Case Report

BackgroundTrichilemmal carcinoma (TC) is a rare malignancy of cutaneous adnexal carcinoma, with only 136 cases reported in the literature to date. It usually has an indolent course and benign clinical evolution, and only four cases with regional and distant metastasis have been reported. Tumor cells present with the characteristics of trichilemmal differentiation on both histological and immunohistological examination.Case PresentationWe report a case of TC on the scalp with an aggressive course and metastasis to the ipsilateral neck. Moreover, the lesions presented with two distinct histological morphologies.ConclusionDespite an indolent course and benign clinical evolution, TC has the potential for local invasion and recurrence, which implies that accurate early diagnosis and careful follow-up are very important for these patients. More than one specimen should be obtained for histopathological examinations when the lesion is very large and characterized by different morphologies.

Nefroma mesoblastico congénito: reporte de un caso

El nefroma mesoblastico congénito es un tumor renal infrecuente, pero común en el periodo neonatal. De comportamiento benigno y pronóstico excelente en su variedad clásica pero en el subtipo celular puede presentar recurrencia local, invasión retroperitoneal y metástasis pulmonares y cerebrales. El tratamiento es la nefrectomía radical. Los factores pronósticos son la edad menor a tres meses y la resección quirúrgica completa. Paciente de 17 días nacida a las 35 semanas por polihidramnios, con diagnóstico prenatal de masa abdominal. Al examen físico masa en flanco derecho e hipertensión arterial (121/79 mm Hg, TAM 77mm Hg). Ecografía abdominal con riñón derecho aumentado de tamaño y voluminosa formación sólida, de 4,4 x 4,3 x 4,8 cm, heterogénea y vascularizada al Doppler en polo inferior. Tomografía de abdomen con formación nodular heterogénea de 5,0 x 4,1 x 5,1 cm en polo inferior del riñón derecho. Se realizó nefrectomía radical derecha sin complicaciones. Evolución en los últimos 20 meses satisfactoria y libre de enfermedad.