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Salivary gland lesions are routinely evaluated by fine-needle aspiration cytology (FNAC) preoperatively. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has standardized salivary gland FNAC reporting. Its application in major salivary glands (MSGs) has been well-established; however, its utility in minor salivary glands (MiSGs) is not well-known. We studied the utility of MSRSGC in MiSG FNAC. A retrospective search of MiSG FNACs from 2 academic institutions (2006-2023) was performed. FNACs were classified using the MSRSGC. Histologic data were reviewed and recorded. The risk of malignancy (ROM), risk of neoplasia (RON), diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The series included 43 MiSG FNAC (24 males and 18 females), with a mean age of 55 years (range 10-92). Aspirated sites included the following: palate, buccal space, floor of mouth, lip, tongue, and maxillary sinus. FNACs were classified as nondiagnostic (1), nonneoplastic (3), atypia of undetermined significance (6), benign neoplasm (9), salivary gland neoplasm of uncertain malignant potential (15), suspicious for malignancy, (2) and malignant (7). The risk of neoplasia and risk of malignancy were 87% and 39%. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, respectively. Milan System for Reporting Salivary Gland Cytopathology offers valuable information for stratifying MiSG lesions. However, the distribution and the range of diagnostic entities encountered differ somewhat from those in MSGs. For instance, mucinous cyst contents may warrant unique consideration in MiSG; while an atypical classification is recommended in MSGs, the high prevalence of mucoceles in MiSG may tilt this group toward benignity. • The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides valuable data for categorizing minor salivary gland lesions. • The distribution of malignant versus benign lesions and diagnostic entities encountered differ from those found in the major salivary glands. • Mucinous cyst contents may warrant special consideration, given the high prevalence of mucoceles in minor salivary glands. [ABSTRACT FROM AUTHOR]

To investigate if there were changes in mortality knowing that industrialization was a slow and late process in Portugal. The biographic information (1) of the individuals buried at the Coimbra Municipal Cemetery, considering three quinquennia: 1861–1865 (n = 1111, 18.3%), 1870–1974 (n = 2602, 42.7%), 1910–1914 (n = 2374, 39.0%), related to the periods before, during and at the end of the second industrialization and (2) of the Coimbra identified osteological collections (CIOC, N = 1796) composed of individuals who were born and died in the city. Excel databases with the biographic information were analyzed with SPSS. Data from the cemetery show statistically significant differences between sexes and age-at-death mortalities. Non-adult mortality (higher in the age range from 1 to 7 years) has decreased over time which has increased mean age-at-death. The main adult occupations are domestic work (females) and craft activities (males). Child labor is common after the age of 14. The main causes of death (in both cemetery and CIOC records) were infections, respiratory diseases, heart disease, and malignant neoplasm. Among the communicable diseases, tuberculosis accounted for the highest number of deaths. The identified individuals have lesions compatible with tuberculosis and sinusitis while malignant neoplasms are more difficult to identify. The high prevalence of heart disease can overshadow other causes of death. In the absence of industrialization, tuberculosis, heart disease, and malignant neoplasms increased over time, while respiratory diseases decreased. Mortality profile changed between 1861–1864 and 1910–1914 in Coimbra. The causes of death were studied, but not all diseases. Study of other cemetery records for further comparison. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) patients with comorbid cancers are increasing in aging populations. However, little is known about the impact of PD on the outcomes of surgeries to resect these cancers. We sought to clarify the association between PD and discharge status of patients who underwent surgery for gastrointestinal cancers, as the most prevalent malignant neoplasms worldwide.Methods: We identified patients who underwent surgery for gastric and colorectal cancers between April 01, 2014 and March 31, 2018 using the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan. We then collected data on their sex, age, smoking status, body mass index, activities of daily living, cancer stage, and comorbidities. Multivariable Cox regression analyses were conducted to determine factors that influenced discharge to home.Results: Compared with non-PD patients (n = 272,668), PD patients (n = 1341) were significantly older and less likely to receive laparoscopic surgery, and had lower body mass index, more advanced cancer stage, and lower activities of daily living. The proportions of PD and non-PD patients discharged to home were 80.3% and 96.2%, respectively. The adjusted hazard ratio for discharge to home for PD patients was 0.68 (95% confidence interval, 0.64-0.73; P < 0.001).Conclusions: Compared with non-PD patients, PD patients were less likely to be discharged to home after surgery for gastrointestinal cancers. The present results may indicate a necessity to improve perioperative care for patients with PD. [ABSTRACT FROM AUTHOR]

The development of malignant neoplasms over the site of pacemaker implantation is a rare event, with a limited number of published case reports. We report the case of a 78-year-old male who presented with discomfort and pocket mass expansion, reportedly following trauma. Due to initial presumption of a simple hematoma, dissection and drainage were performed without tissue collection for histology. Later presentation with an exophytic ulcerated mass led to biopsy and identification of a lymphoplasmacytic lymphoma. To the best of our knowledge this is the first reported case of a cutaneous lymphoplasmacytic lymphoma presenting as a pacemaker pocket mass, and underlines the importance of systematic pacemaker inspection, of adequate histological characterization and of a high degree of clinical suspicion for the identification malignancy in this context. < Learning objective: We report the first case of a lymphoplasmacytic lymphoma presenting primarily as a pacemaker pocket mass. Lymphoplasmacytic lymphoma is a rare and indolent subtype of Non-Hodgkin lymphoma that may present with cutaneous manifestations. Due to the extreme rarity of malignant neoplasms presenting as pacemaker pocket masses, a high degree is clinical suspicion is required, and tissue histology plays a key role in the diagnosis.> [ABSTRACT FROM AUTHOR]

Many controversies exist in the diagnosis and management of this aggressively malignant condition, mainly because of limited literature and lack of randomized control trials, resulting in nonstandardized treatment methods. We performed a comprehensive review of the literature to identify management approach and treatment options for esthesioneuroblastoma. An extensive review of the published literature was conducted in PubMed, OVID Medline, and EMBASE journals for studies of esthesioneuroblastoma. Terms for search included esthesioneuroblastoma (ENB) and olfactory neuroblastoma (ONB). No date restrictions were used. The search yielded 3876 related articles. Cross-checking of articles led to exclusion of duplicate articles. The remaining 1170 articles were screened for their full text and English language availability. Of 609 full-text articles available, animal studies, irrelevant articles, and studies with mixed/confusing data were excluded. We finalized 149 articles pertaining to the topic, including 119 original research articles, 3 book chapters, 11 reviews, 9 case reports, and 7 case series. Surgical resection followed by radiotherapy is the standard for treatment for higher-grade lesions. The endoscopic endonasal approach is gaining further recognition with more favorable outcomes and better survival than for open surgery. Postoperative radiotherapy is associated with the highest overall survival and shows benefit for patients with higher-stage disease and those who receive chemotherapy. Recurrence rates after treatment vary drastically in the literature and, therefore, prolonged follow-up with repeated imaging is recommended. Lifelong surveillance is recommended because of late recurrences associated with this tumor. [ABSTRACT FROM AUTHOR]

Targeted application of next-generation sequencing (NGS) technology allows detection of specific mutations that can provide treatment opportunities for cancer patients. We evaluated the applicability of the Ion AmpliSeq Cancer Hotspot Panel V2 (CHV2) using formalin-fixed, paraffin-embedded (FFPE) tissue of clinical specimens. Thirty-five FFPE tumour samples with known mutational status were collected from four different hospitals and sequenced with CHV2 using an Ion Chef System and Ion S5 XL system. Out of 35 cases, seven were sequenced with Oncomine focus Assay Panel for comparison. For the limit of detection test, we used an FFPE reference standard, a cell line that included an engineered 50% EGFR T790 M in an RKO cell line background. Coverage analysis results including number of mapped reads, on target percent, mean depth, and uniformity were not different according to hospitals. Sensitivity for mutation detection down to 3% was demonstrated. NGS results showed 100% concordance with the results from single molecular pathology tests Assay in 30 cases with 24 known positive mutations and 14 known negative mutations, and another NGS panel of the Oncomine focus in seven cases. The CHV2 NGS test for solid tumours using Ion chef system and S5 XL system in clinical molecular pathology laboratories for analysis of solid tumours could be routinely used and could replace some single molecular pathology tests after a stringent and thorough validation process. [ABSTRACT FROM AUTHOR]

Malignant melanoma of the gastrointestinal tract is an extremely rare event of which 50 % occurs in anorectal region. The lesion can easily be misdiagnosed as rectal-carcinoma, which comprises >90 % of rectal tumors and has a different treatment. The behavior of the anorectal melanoma is very aggressive and has very poor prognosis with fatal outcome. A 48-year-old man presented complaining of rectal bleeding of two months' duration, without any other significant history. Colonoscopy showed a polypoidal mass in the rectum that was in favor of adenocarcinoma. The microscope examination of biopsy tissue showed sheets of poorly differentiated malignant neoplasm. Immuno-histochemical (IHC) staining showed negativity of pan Cytokeratin and CD31. IHC for HMB45 showed diffuse and strong positivity in neoplastic cells, confirming the diagnosis of malignant melanoma. According to a report by the National Cancer Database of the United States, primary rectal melanoma is very rare. Mucosal surface of the body is third most common site for primary melanoma after skin and eye. The first case of anorectal melanoma was reported in 1857. Histopathological examinations are gold standard for diagnosis, but histopathology examination without immunohistochemistry will misdiagnose some cases as poorly differentiated adenocarcinoma which has completely different treatment. Surgical resection has been reported as the most useful treatment option. Malignant melanoma of the rectum is extremely rare and difficult to diagnose in low resources settings. Histopathologic examination with IHC stains can differentiate poorly differentiated adenocarcinoma from melanoma and other rare tumors of anorectal region. • Rectal melanoma is a rare occurrence with aggressive behavior. • Exact diagnosis of rectal melanoma is very important because it has different treatment plan. • Conventional histopathology without immunohistochemical stains may misdiagnose it as poorly differentiated carcinoma. • In addition, exact clinical evaluation and past history of skin tumors/surgical removal are mandatory to rule out the possibility of metastatic melanoma. [ABSTRACT FROM AUTHOR]

Background: Previous research suggests a possible link between sleep-medication use and mortality, especially cancer deaths, but findings are mixed, and large population-based studies are lacking.Methods: Data from the Finnish Public Sector study were linked to the Finnish Cancer Register and the Drug Prescription Register of Finland. A total of 5053 cancer cases (mean age of 57.4 years) diagnosed in 2002-2011, and their 24,388 controls free of cancer and matched for sex, age, socioeconomic status, employer, and geographical area, were identified. The use of sleep medications was defined as purchases of prescribed sleep medications.Results: Both quantity and duration of prior sleep-medication use during the seven years studied were associated with increased odds of having cancer. Compared with participants not using sleep medications, the odds ratio was 1.18-fold (95% confidence interval (CI): 1.01-1.39) for those who used >100 defined daily doses per year and 1.16-fold (95% CI: 1.01-1.34) for those who had such a medication for >3 years. Site-specific analyses showed a more pronounced association of quantity and duration of sleep-medication use with subsequent cancer of the respiratory system (odds ratio for >100 defined daily doses per year vs. no use: 3.47; 95% CI: 1.97-6.11). No associations were found with other cancer sites.Conclusion: In this register-based study, sleep-medication use was associated with an increased cancer incidence of the respiratory system. Further studies are needed to examine potential carcinogenic mechanisms associated with hypnotic medications. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To investigate the feasibility of dual-energy computed tomography (DECT) in differentiating malignant from benign mediastinal tumors. Materials and methods: We prospectively enrolled 25 patients (14 males; mean age: 56.7 years) who had suspected mediastinal tumors on chest radiography or non-contrast chest computed tomography (CT). All patients underwent a two-phase DECT using gemstone spectral imaging (GSI) mode (GE HD750). For the quantitative analysis, two investigators measured the following parameters of the tumors in the early and the delayed phases: CT attenuation value in Hounsfield units (HU) and iodine concentration (mg/ml). Pathological results were used for a final diagnosis. Statistical analyses were performed using the Fisher's exact test and the Mann–Whitney t-test. Results: 10 patients (40%) had benign pathology, while 15 (60%) had malignant pathology. The iodine concentration measurements were significantly different between benign and malignant tumors both in the early phase (1.38mg/ml vs. 2.41mg/ml, p =0.001) and in the delayed phase (1.52mg/ml vs. 2.84mg/ml, p =0.001), while mean attenuation values were not significantly different in both phases (57.8HU vs. 69.1HU, p =0.067 and 67.4HU vs. 78.4HU, p =0.086, respectively). Conclusions: Dual-energy CT using a quantitative analytic methodology can be used to differentiate between benign and malignant mediastinal tumors [Copyright &y& Elsevier]

Abstract: Synovial sarcoma, although commonly found in the lower extremities, is considered a rare neoplasm. One of the distinguishing features of a synovial sarcoma is its initial benign features that can later turn into a more aggressive lesion. Because of the subtle early features, synovial sarcoma can be mistaken for other pathologic entities that present with clinical signs of erythema, warmth, edema, and pain. We present a patient who was originally diagnosed with complex regional pain syndrome. That diagnosis and subsequent treatment of complex regional pain syndrome likely delayed the appropriate evaluation, which led to a 9-month lag in the proper diagnosis. After magnetic resonance imaging and biopsy were performed, synovial sarcoma was diagnosed. The patient was referred to an orthopedic oncologist, who performed a transtibial amputation and chemotherapy. Although rare, neoplasm should always be considered in the differential diagnosis of a clinical presentation of a painful erythematous and edematous mass. [Copyright &y& Elsevier]

Abstract: Background: Complex hepatobiliary surgical procedures for benign and malignant conditions are regularly performed at tertiary academic referral centers with excellent outcomes, but whether similar surgical outcomes are achievable in community hospitals is not well documented. Methods: Eighty-four patients underwent complex hepatobiliary surgery between December 2004 and December 2008. Data were prospectively analyzed, including patient demographics, operative procedures, perioperative parameters, pathology, complications up to 30 days postoperatively, and long-term outcomes. Results: The most frequent procedures performed were isolated segmentectomy or segmentectomies (n = 41 [49%]). Major hepatic resections (n = 32 [38%]) included 25 lobectomies (30%) and 7 trisegmentectomies (8%). Nine patients (11%) had surgical complications, and the most common indications for surgery was metastatic carcinoma (n = 42 [50%]). Conclusions: Complex hepatobiliary surgery can be performed safely at a community-based teaching hospital with excellent outcomes. In the ongoing debate centering on mandatory referral and centralization of complex surgical procedures, tertiary community hospitals with well-determined outcomes should be included. [Copyright &y& Elsevier]

Background & Aims: It is not clear how cirrhosis affects the risks for hepatocellular carcinoma (HCC) and non-HCC cancers, which are rare among these patients. We assessed the risk for malignant neoplasms in patients with cirrhosis. Methods: Patients diagnosed with cirrhosis in Gothenburg, Sweden, from 1994 to 2005 were identified and linked to the National Cancer and Death registers. We studied data from 1019 patients with cirrhosis: 68% men, 48% with alcoholic liver disease (ALD), 10% with hepatitis C virus (HCV), and 12% with HCV + ALD. Standardized incidence ratios for malignant neoplasms were calculated (corrected for sex, age, and calendar year according to data from the general Swedish population). The follow-up period was 3290 person-years. Results: Overall, 114 (11%) patients developed HCC; HCC occurred more frequently among patients with HCV than other diseases (P < .05). HCC risk did not differ among patients with HCV, with or without ALD (P > .05). Compared with the general population, cirrhotic patients had increased risk for HCC (26-fold); cholangiocarcinoma (13-fold); and esophageal (8-fold), pancreatic (5-fold), and colorectal and lung cancers (each 4-fold). The risk for cholangiocarcinoma increased mainly among patients with non-ALD cirrhosis, whereas the risk for extrahepatic malignancies increased mainly among patients with ALD and cirrhosis. Conclusions: The overall risk for non-HCC malignancies is more than 2-fold greater for patients with cirrhosis (mostly in biliary and gastrointestinal malignancies) than of the general population. The risk for non-HCC cancers differs between patients with ALD and non-ALD cirrhosis. The increased risk for HCC among patients with cirrhosis is associated with HCV; it is the same among patients with HCV, with or without ALD. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this article was to review the spectrum of common and rare malignant neoplasms arising in the epigastric region in children and to illustrate their characteristic computed tomography (CT) imaging features. Understanding the characteristic CT appearance of various malignant neoplasms, which can occur in the epigastric region in children, aids in accurate diagnosis and optimizes pediatric patient care. [ABSTRACT FROM AUTHOR]

Summary: Primary cardiac sarcomas are exceptionally rare. We present a 10-year, single-institution experience with 24 primary adult cardiac sarcomas. These cases were retrieved from the Department of Pathology data file of the Methodist Hospital at Houston, TX. Clinical presentation and pathologic features were analyzed. Histologic classification was followed according to the criteria set by the World Health Organization, and grading according to the system proposed by the Federation Nationale des Centres de Lutte Contrele Cancer. There were 14 men and 10 women (male/female, 1.4:1) with a mean age of 42.2 years (range 20-68 years). The tumors involved the right atrium in 14 cases, left atrium in 6 cases, right ventricle in 2 cases, and left ventricle in 2 cases. The tumor size ranged from 2.0 to 17.0 cm (mean 7.2 cm), and, histologically, there were 10 angiosarcomas, 9 unclassified sarcomas, 3 synovial sarcomas, and 2 leiomyosarcomas. All 10 angiosarcomas originated from the right atrium, whereas 5 of the unclassified sarcomas were from the left atrium. Although cases were limited, no predilection site was found for the other histologic types. All tumors were graded as 2 (5 cases) or 3 (19 cases) in differentiation. The prognosis was poor with a median survival time of 25 months after diagnosis. The grade was not statistically significant on survival (P = .14). In conclusion, angiosarcoma and unclassified sarcomas are the most common sarcomas of the heart accounting for 76%, but rare tumors such as synovial sarcoma and leiomyosarcoma may also occur in this organ. The survival of cardiac sarcomas is poor. [Copyright &y& Elsevier]

Abstract: Malignant tumors at the site of implantation of a pacemaker generator, although rare, have been reported in the literature. We present a case of an 89-year-old man with atypical fibroxanthoma in a pacemaker pocket. The device had been implanted for more than 4 years. An exophytic tumor had developed in this place and was clinically interpreted as a pyogenic granuloma. An excisional biopsy revealed the nature of the tumor. To our knowledge, the association of atypical fibroxanthoma arising from a pacemaker pocket has not been previously reported. A review of the literature has revealed four malignant soft tissue tumors previously reported at the pacemaker site. Routine examination in all patients with implanted pacemaker generators should be practiced at follow-up visits. This would allow an early diagnosis of a malignant associated neoplasm. Pathologists should become familiar with this type of devices and their potential neoplastic complications. [Copyright &y& Elsevier]

Abstract: Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumour of childhood and has two main subtypes: embryonal and alveolar. The embryonal subtype accounts for most cases in the genitourinary tract and head and neck. Oral presentations are rare, and mainly in the tongue, palate, or cheek. Cytogenetically, alveolar RMS is characterised by the translocation t(2;13)(q35;q14), which plays an important part in diagnosis, but no consistent and unique genetic alterations have been identified in embryonal RMS. It is currently not known whether oral embryonal RMS is similar to those that arise from other sites, as only one cytogenetic report has been published to date. We present the case of a 9-year-old boy with embryonal RMS of the cheek, and discuss the cytogenetic alterations in his case. [Copyright &y& Elsevier]

Transfusion strategies are involving the survival and prognosis of patients with malignant neoplasm and the rational utilization of medical resources, but there are still controversy between different transfusion strategies. The aim of this article is to compare the benefit and harm of restrictive and liberal red blood cell(RBC) transfusion strategies in patients with malignant tumors. We searched articles in the databases of PubMed, Cochrane Library, Web of Science, Embase and major conference proceedings, identified all randomized controlled trials (RCTs) and compared restrictive transfusion strategies with those that are liberal until MARCH 18, 2019. We used risk ratio (RR) and and 95 % confidence interval (95 %CI) to calculate the results of dichotomous variables, and the study heterogeneity was assessed by using the I 2 statistics. Also, we did sensitivity analysis and quality assessment. Restrictive transfusion policies appear to have no effect on all-cause mortality (RR 1.33; 95 % CI 0.74–2.38; P = 0.34), compared with liberal policies. 2 trials including 498 patients were included of renal replacement therapy (RR 1.38; 95 % CI, 0.73–2.59; P = 0.32 ; I2 = 0%). Myocardial infarction (RR 1.17; 95 % CI, 0.33–4.1; P = 0.81 ; I2 = 0%) and ICU readmission were also mentioned in these articles (RR 1.19; 95 % CI, 0.7–2.04; P = 0.52 ; I2 = 0%). However, the RR of hospital length can't be evaluated. Restrictive transfusion strategies were not associated with all-cause mortality and other clinical outcomes in malignant tumors, and may be more suitable for patients' quality of life and medical economy than liberal. [ABSTRACT FROM AUTHOR]

Summary: Malignant tumors of the nasal cavity and paranasal sinuses are rare, with poorly differentiated squamous cell carcinoma of the maxillary sinus being the most common. The aim of this study is to report a carcinoma affecting the maxillary sinus of a young adult, with diagnosis only being achieved with an intra-oral biopsy, after the lesion had perforated the palate bone. This case stresses the importance of early diagnosis of maxillary sinus carcinoma, in order to increase chances of survival. [Copyright &y& Elsevier]

Background ICIs with a programmed death protein 1 (PD-1) or programmed death protein ligand 1 (PD-L1) antibodies have shown survival benefits for various metastatic cancer patients. However, some patients treated with ICIs may suffer from AEs. We investigated the association between AEs and survival in metastatic cancer patients treated with PD-1/PD-L1 inhibitors. Methods We retrospectively reviewed medical records of metastatic cancer patients treated with pembrolizumab, nivolumab or atezolizumab from April 2016 to June 2019 for AEs, progression-free survival (PFS), and overall survival (OS). Kaplan-Meier curve was used to estimate survival probability and the Cox proportional hazard model was used to estimate hazard ratio (HR) and 95% confidence interval (CI) between each interesting group. Results We enrolled 101 patients. Primary cancers were urothelial carcinoma (n = 52), lung cancer (n = 42), hepatocellular carcinoma (n = 5), and cholangiocarcinoma (n = 2). Atezolizumab was the most common prescribed agents (n = 69), followed by pembrolizumab (n = 29) and nivolumab (n = 3). The AEs happened more frequently were associated with lung (n = 25), skin (n = 24), endocrine (n = 17), and liver (n = 11). Median time for these AEs happened was 1.4 months. Median OS (mOS) for these patients was 16.9 months and median PFS (mPFS) was 9.1 months. Among various AEs, patients with skin AE had significantly longer PFS and OS compared to those without skin AE (mPFS: 11.9 months vs. 4.9 months, p = 0.0016 ; mOS: 16.4 months vs. 10.3 months, p = 0.0022). In comparison with those without endocrine AE, the occurrence of endocrine AE was associated with an improved PFS (mPFS: 19.2 months vs. 6.0 months, p = 0.0476) and a trend toward to OS (mOS: 19.4 months vs. 10.9 months, p = 0.1731). There were no survival difference between patients who experienced lung or liver AEs. Conclusions In metastatic cancer patients treated with anti-PD-1/PD-L1 ICIs, development of skin or endocrine AEs may indicate improved survival time. The patients with AEs involved visceral organ, like lung or liver, have no better survival time. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]