Search

Intraoral and oropharyngeal (including tongue base) adenocarcinomas are rare neoplasms, constituting less than 1% of all head and neck tumors. (1) Three main types of adenocarcinomas exist in oral and [...], * Context.--Nonsalivary primary adenocarcinomas of the base of the tongue (PABOTs) are extremely rare and worth reporting. Objective.--To study the detailed clinicopathologic features of PABOT. Design.--Cases of PABOT diagnosed on pathology material were retrieved from the archived electronic surgical pathology records. Results.--Six cases in 4 men and 2 women (M:F ratio, 2:1), with an age range of 31 to 76 years, satisfied the criteria. The tumor epicenter was the base of the tongue in all (6 of 6; 100%), with extension to the epiglottis in 50% (3 of 6), nodal metastasis in 66.7% (4 of 6), and distant metastasis in 33.3% (2 of 6). On histology, all but one were pure adenocarcinoma. Five of 6 cases (83.3%) had a gastrointestinal (GI) phenotype, of which 2 (40%) had a colonic/lower-GI-type (small groups of cells floating in mucin, CK20+, SATB2+, and CDX2+) and 3 (60%) had an upper-GI-like adenocarcinoma (UGI-LA; malignant glands with intracellular mucin, CK7+) histology. Cystic structure suggestive of teratomatous origin was identified in 2 of 5 cases (40%), both with UGI-LA phenotype. The non-GI-type case had a unique histology with squamous differentiation in addition to adenocarcinoma areas, diffuse nuclear [beta]-catenin on immunohistochemistry, and a corresponding exon 3 CTNNB1 mutation. One patient succumbed to disease, and 4 are alive with disease (follow-up of 1-9 months after completion of therapy). Conclusions.--We suggest using the broad term primary adenocarcinomas of the base of tongue (PABOTs), which can be further subdivided into colonic-type adenocarcinoma of the tongue and oral cavity, UGI-LA, and not otherwise specified categories, and reiterate a need for recognition and distinction of PABOT from salivary gland tumors. A subset originates from teratoid/duplication cysts, necessitating extensive sampling. Multicentric studies are essential to clinically and biologically prognosticate each of these categories. doi: 10.5858/arpa.2021-0468-OA

Purpose: Extranodal extension (ENE) increases the risk of recurrence and death in head and neck squamous cell carcinoma (HNSCC) patients and is an indication for treatment escalation. Histopathology forms the mainstay of diagnosing ENE. There is substantial variation in the diagnosis of ENE and related terminology. Harmonising the diagnostic criteria for ENE was identified as a priority by the Head and Neck Consensus Language for Ease of Reproducibility (HN CLEAR) Steering Committee and its global stakeholders. Methods: An international working group including 16 head and neck pathologists from eight countries across five continents evaluated whole slide images of haematoxylin and eosin-stained sections depicting potential diagnostic problems through nine virtual meetings to develop consensus guidelines. Results: ENE should be diagnosed only when viable carcinoma extends through the primary lymph node (LN) capsule and directly interacts with the extranodal host environment with or without desmoplastic stromal response. Identifying the original LN capsule and reconstruction of its contour can assist in the detection and assessment of ENE. The term matting is recommended for confluence of two or more nodes due to histologically identifiable tumour extending from one LN to another. Matting constitutes major form of ENE. On the other hand, the terms fusion/adhesion/confluence/conglomeration and other synonyms of adhesion should be limited to confluence due to fibrosis or inflammation without histologically identifiable tumour between involved lymph nodes. Tumour extension along narrow needle tracks or spillage of cyst contents following an FNA do not constitute ENE. Conclusions: The consensus recommendations encompassing the definition of ENE, macroscopic and histologic examination of lymph nodes (LN) and practical guidelines for handling challenging cases are provided. [ABSTRACT FROM AUTHOR]

The incidence of paraganglioma (PGL) is rising due to better imaging modalities employed for evaluating incidentaloma and surveillance of the asymptomatic carriers. Benign and malignant PGLs often cannot be reliably diagnosed on histology alone, and the documentation of metastases is important in the diagnosis of malignancy. Advancement in genomics has improved our understanding of PGL.68 Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) scan shows a significant superior detection rate compared with other conventional functional and anatomical imaging modalities, can detect rare sites of primary disease in PGL, and also aids in patient selection for peptide receptor radionuclide therapy (PRRT). PRRT is increasingly used in metastatic setting with good symptomatic and biochemical response and disease stabilization in metastatic PGL patients. We present a series of three patients with PGLs located in rare primary sites (sigmoid colon, urinary bladder, and carotid body space), which showed recurrence of disease on conventional treatments and developed metastatic disease in the lymph nodes, liver, skeleton, and lungs. PRRT with177 Lu-DOTATATE achieved symptom control, favorable biochemical and imaging responses, and increased progression-free and overall survival rate in the described patients. [ABSTRACT FROM AUTHOR]

Background and objective: Extrathyroidal extension (ETE) is the term used to describe the growth of the primary thyroid tumor beyond the thyroid capsule. ETE is a critical prognostic marker for thyroid tumors, necessitating accurate preoperative assessment. This study aims to evaluate the diagnostic performance of computed tomography (CT)-based grading for ETE and tracheal invasion (TI) for preoperative prediction in patients with differentiated papillary thyroid carcinoma (PTC) and compare the diagnostic accuracy with ultrasound (US). Materials and methods: This retrospective study was approved by our institutional review board. Preoperative US and CT were performed for 83 patients who underwent surgery for PTC between 1 January 2010 and 31 December 2020. The US and CT features of ETE and TI of each case were retrospectively and independently investigated by two radiologists. The diagnostic performances of US and CT, including their specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for ETE, and their accuracy in predicting ETE and TI were analyzed. As per the grading for ETE on USG and CT, lesions were graded into three grades and Mahajan grading was also devised on CT to predict the TI and graded into four grades. Results: The accuracy and specificity of CT are relatively good for identifying tumor infiltration into the adjacent structures and range from 82% to 87% and 95% to 98%, respectively. It, however, has a low sensitivity, between 14.3% and 77.78%, when compared to US, which suggests that in case of any doubt regarding CT evidence of tumor infiltration into surrounding structures, additional clinical examination must be performed. CT showed better sensitivity (78%) and specificity (75%) in detecting TI compared to previous studies. The diagnostic accuracy of CT Mahajan grading was 91.5% with p <0.005 in the prediction of TI. Conclusion: Preoperative US should be regarded as a first-line imaging modality for predicting minimal ETE, and CT should be additionally performed for the evaluation of maximal ETE. The specificity and PPV of CT are higher than those of US in detecting overall ETE and TI of PTC. The US- and CT-based grading systems have the potential to optimize preoperative surgical planning. [ABSTRACT FROM AUTHOR]

Background The evolution and outcomes of extended pancreatectomies at a single institute over 15 years are presented in this study. Methods A retrospective analysis of the institutional database was performed from 2015 to 2022 (period B). Patients undergoing extended pancreatic resections, as defined by the International Study Group for Pancreatic Surgery, were included. Perioperative and survival outcomes were compared with data from 2007–2015 (period A). Regression analyses were used to identify factors affecting postoperative and long-term survival outcomes. Results A total of 197 (16.1%) patients underwent an extended resection in period B compared to 63 (9.2%) in period A. Higher proportions of borderline resectable (5 (18.5%) versus 51 (47.7%), P = 0.011) and locally advanced tumours (1 (3.7%) versus 24 (22.4%), P < 0.001) were resected in period B with more frequent use of neoadjuvant therapy (6 (22.2%) versus 79 (73.8%), P < 0.001). Perioperative mortality (4 (6.0%) versus 12 (6.1%), P = 0.81) and morbidity (23 (36.5%) versus 83 (42.1%), P = 0.57) rates were comparable. The overall survival for patients with pancreatic adenocarcinoma was similar in both periods (17.5 (95% c.i. 6.77 to 28.22) versus 18.3 (95% c.i. 7.91 to 28.68) months, P = 0.958). Resectable, node-positive tumours had a longer disease-free survival (DFS) in period B (5.81 (95% c.i. 1.73 to 9.89) versus 14.03 (95% c.i. 5.7 to 22.35) months, P = 0.018). Conclusion Increasingly complex pancreatic resections were performed with consistent perioperative outcomes and improved DFS compared to the earlier period. A graduated approach to escalating surgical complexity, multimodality treatment, and judicious patient selection enables the resection of advanced pancreatic tumours. [ABSTRACT FROM AUTHOR]

The article discusses the first reported case of SMARCA4-deficient carcinoma ex-pleomorphic adenoma in salivary glands, a rare and aggressive malignancy. The case study involves a 60-year-old man with a parotid mass and metastatic lymph nodes, revealing a tumor with rhabdoid/plasmacytoid cells and high-grade nuclear atypia. Immunohistochemistry confirmed the loss of SMARCA4 expression, leading to the diagnosis of SMARCA4-deficient carcinoma ex-PA. This case highlights the importance of including SMARCA4 in the immunohistochemistry panel for tumors with rhabdoid morphology and underscores the aggressive nature of SMARCA4-deficient neoplasms. [Extracted from the article]