A 73-year-old female presenting with haemoptysis and dyspnoea was found to have a locally advanced left thyroid mass and vocal cord palsy. A CT scan of the neck and thorax and endoscopy demonstrated invasion into the tracheal lumen. Histopathology of the intraluminal tracheal mass confirmed a papillary thyroid cancer (PTC). The tumour was deemed unresectable due to local extent and patient comorbidities. TKI therapy with lenvatinib was used for 14 months. On serial scanning, a marked reduction in tumour volume from 31 × 59 × 32 mm to 17 × 28 × 22 mm was noted. This subsequently allowed a successful surgical resection with a total thyroidectomy and central neck dissection with no evidence of residual macroscopic disease. Histopathology confirmed a well-differentiated PTC with features of tumour regression. In this case, TKI therapy in a locally advanced unresectable DTC reduced tumour size and infiltration to a degree that surgical resection of macroscopic disease was possible, without requiring airway resection. This raises the possibility that TKIs may have a neoadjuvant role in selected cases of locally advanced DTC to reduce tumour volume and therefore morbidity of subsequent surgical resection.
Objectives To assess whether application of the risk model originally proposed by Brandwein-Gensler, influences survival and disease progression in patients treated for oral squamous cell carcinoma (OSCCs) Materials and Methods Tumours from 134 T1 and T2 OSCC resections (7th edition) were scored independently by 3 histopathologists according to worst pattern of invasion (WPOI), lymphocytic host response (LHR) and perineural invasion (PNI) and categorised according to risk score. Local recurrence, locoregional recurrence, disease progression and overall survival were study endpoints. Interobserver variability of pathologist scoring was also assessed. Results Seventy-two patients (54%) were classified with low or intermediate risk and 62 (46%) patients were ‘high risk’. The inter-observer agreement was in moderate to strong agreement with the consensus scores (k range = 0.45–0.82). There was statistical significance between distant metastasis and ‘high risk’ tumours. Thirty tumours were upstaged to T3 in the 8th edition TNM staging, of which 83% had high risk scores. Overall risk score and TNM8 T stage has significant correlation with overall survival in comparison to the TNM 7 T stage. Conclusion ‘High risk’ tumours were significantly associated with distant metastasis possibly due to the greater likelihood of aggressive features such as WPOI and PNI. Primary tumours are more likely to express high risk features with increasing T stage. None of the patients classified as ‘low risk’ died perhaps suggesting these tumours represent a rare variant of OSCC with excellent prognosis.
AimsTo compare the predictive values of axillary ultrasound (US) combined with fine needle aspiration (FNA) cytology with tumour size (T stage) and grade in the preoperative staging of breast cancer. More precise definition of axillary FNA reporting nomenclature is also presented. Patients and Methods 314 patients: 119 patients had suspicious US investigated by FNA, 195 patients had normal US not investigated further preoperatively. This study examined the node-positive and node-negative cases in these two groups, calculating predictive values for cytology, US, T stage and tumour grade, and tested comparisons for significance.Results Axillary FNA has a positive predictive value of 84.8% compared with US (66.7%). The difference is significant (p¼0.008). Negative US has a negative predictive value of 81.0% compared with a negative predictive value for cytology of 66.7%, but the difference is not significant (p¼0.08). 43% of patients with unsatisfactory cytology were node positive. Of 195 patients with negative axillary US, 37 (19%) had metastatic nodal disease. Fewer than 20% of these patients had micrometastases alone. Tumour size and grade influenced node status in US-suspicious cases only. Conclusion Axillary FNA adds significantly to the positive predictive value provided by US. US gives falsenegative results in 19% of cases and only a small proportion of these can be explained by micrometastases. Unsatisfactory cytology needs to be repeated because of a high rate of positive nodes in this group.
Salivary gland tumours constitute approximately 1-5% of all human neoplasms. Pleomorphic adenoma (PA) is the commonest benign neoplasm affecting the parotid gland most often (> 75%), followed by the submandibular gland (13%), then the palate (9%). Metastasising pleomorphic adenoma (MPA) is extremely rare. The effects can be severe and a reported 40% of MPA patients die with disease. This case represents the first known case in English literature of an untreated minor salivary gland PSA of the palate metastasising to an ipsilateral cervical node. We report a 61 year old female who presented with a large tumour occupying the palatal vault, and cervical neck mass. The oral tumour was believed to have been growing over four decades. The patient died eight months following surgical resection. Of known cases, male: female ratio is 35:51 and the mean age at diagnosis is 49.2. Most commonly, MPA is detected in bone 33.3% (n = 29), lung 31% (n = 27) and cervical lymph nodes 20.7% (n = 18). Thorough reporting is deemed essential to further understand the biological differences of non metastasising and metastasising PAs, treatment outcomes, prognosis and survival rates.
Objective Primary surgical resection remains the mainstay of management in locally advanced differentiated thyroid cancer. Tyrosine kinase inhibitors have recently shown promising results in patients with recurrent locally advanced differentiated thyroid cancer. This study discussed four patients with locally advanced differentiated thyroid cancer managed with tyrosine kinase inhibitors used prior to surgery in the ‘neoadjuvant’ setting. Method Prospective data collection through a local thyroid database from February 2016 identified four patients with locally advanced differentiated thyroid cancer unsuitable for primary surgical resection commenced on neoadjuvant tyrosine kinase inhibitor therapy. Results All cases had T4a disease at presentation. Three cases tolerated tyrosine kinase inhibitor therapy for more than 14 months while the last case failed to tolerate treatment at 1 month. All patients subsequently underwent total thyroidectomy to facilitate adjuvant radioactive iodine treatment. Disease-specific survival remains at 100 per cent currently (range, 29–75 months). Conclusion Neoadjuvant tyrosine kinase inhibitors in locally advanced differentiated thyroid cancer can be effective in reducing primary tumour extent to potentially facilitate a more limited surgical resection for local disease control.
IntroductionCollagenous colitis (CC) is a syndrome of chronic, watery, non-bloody diarrhoea.1 Its worldwide incidence is increasing; emerging evidence suggests a possible association between CC and malignancy.2 However, studies thus far have been inconclusive and data on the incidence of metachronous extra-colonic malignancy (MEcM) in CC is scarce.3 This study aimed to determine the occurrence of MEcM in patients with CC.MethodsRetrospective study; data on MEcM in patients previously diagnosed with CC was collected within NHS Lothian (Scotland) over a 14 year period (Jan 2000 – Nov 2013). Person-years at risk were calculated according to age-specific categories. The standard error (Se) was calculated using the Poisson approximation. Relative risk (RR) and confidence interval (CI) of the age-standardised rate (ASR) were compared to publicly available population data for Lothian, Scotland.4 Results are reported as average ± standard deviation or RR with confidence interval (CI). P values <0.05 were considered statistically significant.ResultsIn the aforementioned period, 394 patients were diagnosed with CC and included for analysis. Thirty-three (21 F/12 M) developed MEcM, Table 1. The average age of the group with MEcM was 71.6 ±7.4 years compared to 65.9 ±13.6 years for the remainder of the patients (P < 0.05). The average duration of follow-up from CC diagnosis to MEcM was 2 ±2.23 years and for the group as a whole was 4 ±3.45 years. The RR for lung cancer (4.63, 1.30;16.49) and total cancers (2.34, 1.38;3.95) in patients with CC was higher compared to population data from Lothian (P < 0.05 for both).Abstract PTU-053 Table 1ConclusionThe RR of MEcM, including lung cancer, is higher in patients with CC.The increased RR for lung cancer may be explained by the association between CC and smoking.5Further collective data will be useful to clarify other associations.References1 Münch A, et al. Microscopic colitis: current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohn’s Colitis 2012;6:932–945.2 Freeman HJ. Complications of collagenous colitis. World J gastroenterol 2008;14:1643.3 Chan JL, et al. Cancer risk in collagenous colitis. Inflamm Bowel Dis 1999;5:40–43.4 5 Vigren L, et al. Is smoking a risk factor for collagenous colitis? Scand J Gastroenterol 2011;46:1334–1339.Disclosure of InterestNone Declared
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