ПЛОСКОКЛЕТОЧНАЯ КАРЦИНОМА ПОЛОСТИ РТА У КОШЕК

This study describes the clinical and pathological characteristics of cutaneous spindle cell squamous cell carcinoma (SCSCC) in 18 cats. The average age of the cats was 11.8 ± 2.7 years, and all tumors were located in the facial skin, mainly affecting the pinna (13/18, 72%), followed by the periorbital area (4/18, 22%) and the dorsal muzzle (1/18, 6%). Tumors were composed of fusiform neoplastic cells with moderate atypia arranged in solid sheets or fascicles with foci of squamous differentiation. A panel of antibodies against cytokeratins, vimentin, S-100 protein, NSE, GFAP, Melan A, SMA, desmin, CD18, CD31, and p63 was used to help differentiate SCSCC from other spindle cell malignancies. SCSCCs expressed CK5/6 (17/18, 94%), AE1/AE3 (15/18, 83%), and p63 protein (18/18, 100%), but there was no immunolabeling for CK8/18. A role for sunlight exposure in the pathogenesis of the tumors was suggested by changes indicative of actinic keratosis, the location of the tumors in dorsal areas, and the absence of histomorphologic features of papillomavirus infection. Recurrence was not recorded in 14/18 cases (78%) during a follow-up period of 7 to 25 months. Three of 18 (17%) tumors recurred or led to humane euthanasia due to local progression, and one case (5%) had regional lymph node metastasis. Clinical outcome varied with cutaneous location, mitotic count, and invasion of surgical margins; thus, SCSCCs with a more aggressive behavior were located in the periorbital area (4/4 cases), had ≥14 mitoses in 10 high-power fields (2.37 mm2) (4/4 cases), and showed invasion of surgical margins (3/4 cases).

O carcinoma de células escamosas é uma neoplasia cutânea de grande relevância em países de clima tropical como o Brasil, uma vez que a exposição crônica à radiação ultravioleta é um dos fatores importantes para o desenvolvimento da doença. Esta revisão tem por objetivo discorrer sobre alternativas de tratamento do carcinoma de células escamosas em gatos, com ênfase à terapia fotodinâmica. A escolha da modalidade terapêutica deve ser estabelecida de acordo com o estadiamento do tumor, o estado geral do paciente, a colaboração do proprietário e a disponibilidade de equipamentos e fármacos. A precocidade no diagnóstico tem efeito fundamental no prognóstico.

Oral Squamous Cell Carcinoma in Cats

Preview this chapter: Strontium 90 plesiotherapy in the treatment of eyelid squamous cell carcinoma in cats, Page 1 of 1 < Previous page | Next page > /docserver/preview/fulltext/10.22233/9781910443699/9781910443699.67.5-1.gif

Over the last hundred years, there has been great debate among surgeons regarding the management of clinically negative regional lymph nodes in patients with cutaneous melanoma. The debate is based on the concept that if melanoma metastasizes, it spreads first to the regional lymph nodes and then to distant sites. Intuitive thinking suggests that the lymphatic pathways represent a clear and defined connection from the primary to the regional lymph nodes, and that physical soiling of the regional lymph nodes with tumor metastases likely occurs before any spread to distant sites. This theory is based on clinical observation of the natural history and progression of metastatic melanoma. If melanoma uniformly metastasizes first to the regional lymph nodes, then removal of these nodes early in the course of the disease should halt the metastatic progression and improve prognosis. Both single- and multiple-institutional retrospective studies have identified subgroups of patients who achieve a survival benefit from early elective lymph node dissection (ELND). However, the four randomized prospective studies1– 4 have failed to demonstrate any conclusive evidence that routine ELND in all melanoma patients is therapeutic, in part because a majority of patients do not have nodal metastases. Cost, potential morbidity, and lack of therapeutic value have made ELND impractical for the routine care of patients with clinically localized primary melanoma. However, if we can identify the subgroup of patients who have subclinical metastases limited to the regional lymph nodes, can we improve their survival by complete lymphadenectomy? With the development of the technique of intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) more than 10 years ago, 5 surgeons have renewed their interest in evaluation of the tumor status of regional lymph nodes. 6 Unlike staging based on clinical exam or conventional ELND, LM/SL allows pathologists to focus on a single lymph node. Very small volumes of tumor can be identified (by immunohistochemistry and RT-PCR to melanoma-specific genes) in this sentinel lymph node. But what if the sentinel node is free of tumor? Does the absence of nodal involvement improve survival? The study reported in this issue of Annals of Surgical Oncology by Dessureault et al. 7 from the American Joint

In patients with rectal cancer, the status of regional or mesorectal lymph nodes is central to both tumor staging and predicting local and distant recurrence. The importance of mesorectal lymph nodes in rectal cancer should inform treatment decisions around pre-operative diagnostic imaging, surgical techniques, pathologic assessment, and the use of radiation therapy.

There have been recent attempts to transfer well-established principles of rectal cancer management to colonic cancer, thereby offering neoadjuvant chemotherapy to high-risk patients at least in the trial settings. Traditionally, postoperative chemotherapy is offered to patients with colonic tumors that metastasize into regional lymph nodes and have features of extramural vascular invasion (EMVI). If the same criteria are used for the selection of patients with colonic cancer for neoadjuvant chemotherapy, then their accurate preoperative detection becomes of paramount importance. The aim of the study was to establish the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the computerized tomographic (CT) assessment of lymph node involvement and EMVI in colonic cancer. This retrospective study included 53 consecutive adult patients (35 males and 18 females; median age, 72 years) who had complete preoperative CT staging of colonic cancer followed by its surgical resection during a 12-month period from January 1, 2012, to December 31, 2012. Patients with rectal and colonic tumors presenting as an emergency who did not have complete preoperative CT imaging were excluded. Preoperative CT findings on regional lymph node status and EMVI were compared with the final histopathological staging of resected specimens calculating sensitivity, specificity, PPV, and NPV of the test. In predicting regional lymph node metastases, CT scan had a sensitivity of 85% and a specificity of 24%. PPV was calculated as 63% and NPV as 50%. In predicting EMVI, it had a sensitivity of 69% and a specificity of 49%. PPV was 37% and NPV was 78%. Preoperative CT scan does not allow an accurate detection of regional lymph node metastases and EMVI and has a tendency to overstage colonic cancer.

This study explores the relationships between tumor size and regional lymph node involvement in patients with Dukes' B and C colorectal cancer in the randomized prospective clinical trials of the NSABP. Six-hundred and seventy patients with colon cancer and 236 patients with carcinoma of the rectum were available for analysis. Utilizing cumulative frequency distributions of tumor diameter and tumor volume, comparisons were carried out between Dukes' B and C lesions. The results indicate that there was no correlation between the longest diameter of the primary tumor and the status of regional lymph nodes for either colon or rectal cancer. Moreover, this lack of association was evident throughout the distribution. When tumor volume was analyzed, Dukes' B tumors proved to be consistently larger than Dukes' C lesions. This inverse relationship was statistically significant for carcinoma of the rectum. These findings underscore the unique biological behavior of colorectal cancer and emphasize the function of the current generation of randomized prospective trials in providing natural history information.

Tumor stage, histologic grade, and regional lymph node status are currently used to obtain prognostic information about bladder cancers. However, additional prognostic indicators are needed to aid clinicians in selecting patients who would benefit most from specific therapies. A majority of studies assessing the prognostic value of measuring tumor angiogenesis (i.e., measurement of tumor microvessel densities) have found a positive association between increasing microvessel densities and worsening prognosis. We explored the relationship between established prognostic indicators and the extent of tumor-associated angiogenesis in patients with invasive transitional cell carcinoma (TCC) of the bladder, and we determined whether tumor microvessel density measurement could be used independently to predict bladder tumor behavior. Tumor tissue was obtained from 164 patients with invasive primary TCC of the bladder. The extent of tumor-associated angiogenesis in this tissue was evaluated by immunohistochemical methods using HPCA-1, a mouse monoclonal antibody directed against the endothelial cell antigen, CD34. The number of microvessels in a 200x microscopic high-power field (hpf) containing the area of greatest neovascularization within or immediately adjacent to each tumor was determined. The patient population was then divided into three equivalently sized groups, with tumors containing low (< or = 64), intermediate (65-99), or high (> or = 100) numbers of microvessels per hpf. Kaplan-Meier product limit estimates of overall survival and the complement of cumulative incidence curves for recurrence-free survival were plotted. When analyzing survival or recurrence, the logrank test was used to compare groups of patients with and without stratification according to tumor stage. Analysis of variance was used to test for an association between microvessel density and established prognostic variables. Reported P values are from two-sided tests. Microvessel density was significantly associated with disease-free (P < .0001) and overall (P = .0007) survival. The estimated probabilities of recurrence at 5 years were 19% (95% confidence interval [CI] = 8-29), 56% (95% CI = 43-69), and 68% (95% CI = 55-81) for patients with lowest, intermediate, and highest microvessel counts, respectively. Overall survival at 5 years was estimated to be 68% (95% CI = 56-81), 44% (95% CI = 30-57), and 34% (95% CI = 21-47) for the same three patient groups. Microvessel density was associated with disease progression in patients with organ-confined tumors, tumors extending through the bladder wall, and tumors that had spread to regional lymph nodes. Tumor angiogenesis was found to be an independent prognostic indicator when evaluated in the presence of histologic grade, pathologic stage, and regional lymph node status. Tumor angiogenesis, as determined by microvessel density measurement, is an independent prognostic indicator for patients with invasive TCC of the bladder.

Isolated tumor cells (ITCs) are the histopathological finding of small clusters of cancer cells no greater than 0.2 mm in diameter in the regional lymph nodes. For endometrial cancer, the prognostic significance of ITCs is uncertain. To assess clinico-pathological characteristics and oncologic outcomes associated with ITCs in endometrial cancer. This retrospective cohort study using the National Cancer Database included patients with endometrial cancer who had primary hysterectomy and nodal evaluation from 2018 to 2020. Patients with microscopic and macroscopic nodal metastases and distant metastases were excluded. Data were analyzed from June to September 2023. Regional nodal status with ITCs (N0[i+] classification) or no nodal metastasis (N0 classification). (1) Clinical and tumor characteristics associated with ITCs, assessed with multivariable binary logistic regression model, and (2) overall survival (OS) associated with ITCs, evaluated by nonproportional hazard analysis with restricted mean survival time at 36 months. A total of 56 527 patients were included, with a median (IQR) age of 64 (57-70) years. The majority had T1a lesion (37 836 [66.9%]) and grade 1 or 2 endometrioid tumors (40 589 [71.8%]). ITCs were seen in 1462 cases (2.6%). In a multivariable analysis, ITCs were associated with higher T classification, larger tumor size, lymphovascular space invasion (LVSI), and malignant peritoneal cytology. Of those tumor factors, LVSI had the largest association with ITCs (7.9% vs 1.4%; adjusted odds ratio [aOR], 4.37; 95% CI, 3.87-4.93), followed by T1b classification (5.3% vs 1.3%; aOR, 2.62; 95% CI, 2.30-2.99). At the cohort level, 24-month OS rates were 94.3% (95% CI, 92.4%-95.7%) for the ITC group and 96.1% (95% CI, 95.9%-96.3%) for the node-negative group, and the between-group difference in expected mean OS time at 36 months was 0.35 (SE, 0.19) months, but it was not statistically significant (P = .06). There was a statistically significant difference in OS when the low-risk group (stage IA, grade 1-2 endometrioid tumors with no LVSI) was assessed per nodal status and adjuvant therapy use (P < .001): (1) among the cases treated with surgical therapy alone, 24-month OS rates were 95.9% (95% CI, 89.5%-98.5%) for the ITC group and 98.8% (95% CI, 98.6%-99.0%) for the node-negative group, and the between-group mean OS time difference at 36 months was 0.61 (SE, 0.43) months (P = .16); and (2) among the cases with ITCs, adjuvant therapy (radiotherapy alone, systemic chemotherapy alone, or both) was associated with improved survival compared with no adjuvant therapy (24-month OS rates, 100% vs 95.9%; between-group mean OS time difference at 36 months, 0.95 [SE, 0.43] months; P = .03). In this cohort study of patients with surgically staged endometrial cancer, the results of exploratory analysis suggested that presence of ITCs in the regional lymph node may be associated with OS in the low-risk group. While adjuvant therapy was associated with improved OS in the low-risk group with ITCs, careful interpretation is necessary given the favorable outcomes regardless of adjuvant therapy use. This hypothesis-generating observation in patients with low-risk endometrial cancer warrants further investigation, especially with prospective setting.

Current issues in the staging of esophageal cancer

This study aimed to define patients with renal cell cancer and coexisting tumor thrombus in order to address concerns regarding survival and prognostic factors after radical surgery. Several prognostic factors for overall survival (OS) were assessed in patients treated surgically at five institutions from 2012 to 2018. Univariate and multivariate analyses were used to determine the independent risk factors of OS. A total of 142 patients were eligible for further analysis (mean age of 64.75 years, 56% males). Most patients presented with clear cell carcinoma (95%). The Mayo stage was predominantly 0–1 (88%). Distant visceral metastases at the time of diagnosis were present in 36 patients (25%), whereas nodal metastases were present in 24 patients (16.9%). During the follow-up period (mean of 32.5 months), the 3-year OS rate reached 68.2%. The majority of patients received no adjuvant treatment (n = 107). In a multivariable model predicting OS, regional lymph node status (p < 0.001), distant metastases (p = 0.009), tumor grade (p = 0.002), duration of hospitalization (p = 0.016), and Clavien–Dindo grade (p = 0.047) were identified as independent prognostic factors. A subgroup of patients with specific clinicopathological factors may benefit most from the radical surgery, including patients without regional lymph node or distant metastases and with low tumor grades, whereas short hospitalization and low Clavien–Dindo grades represent additional independent prognostic factors.

Tumors acquire nutrients that are essential for continued growth and an avenue for dissemination to the rest of the body by inducing angiogenesis (i.e., the formation of new blood vessels). Preliminary studies involving a number of different kinds of cancer have indicated that an assessment of tumor angiogenesis may be useful in predicting disease outcome. In a prospective study, we evaluated the relationship between tumor angiogenesis and survival for 407 patients with non-small-cell lung carcinoma who were treated with potentially curative surgery. The study population consisted of 360 male and 47 female patients who underwent surgery consecutively at the Department of Surgery, University of Pisa, Italy, from March 1991 through December 1994. Follow-up lasted through February 1996, with a median follow-up for living patients of 29 months (range, 15-60 months). An anti-CD34 monoclonal antibody, which is specific for endothelial cells, and standard immunohistochemical techniques were used to measure angiogenesis in tumor samples. Angiogenesis was quantified in terms of microvessel counts; the counts for single, high-power microscopic fields (magnification x250) in the three most intense areas of blood vessel growth for each sample were averaged. The median microvessel count in this series was 20, and the counts were categorized as follows: 1) low versus high (< or =20 versus >20 microvessels) or 2) in five categories (1-10, 11-20, 21-30, 31-40, and > or =41 microvessels). Disease-free and overall survival during follow-up were assessed. Kaplan-Meier survival curves were modeled in a univariate analysis of patient and tumor characteristics; the Cox proportional hazards model was used in multivariate analysis. Reported P values are two-sided. In the univariate analysis, patients with larger tumors (P for trend <.00001), a more advanced tumor stage (P for trend <.00001), a greater degree of regional lymph node involvement (P for trend <.00001), or more vascularized tumors (high versus low microvessel count, P<.00001) experienced significantly reduced overall survival. When microvessel counts were analyzed in five categories, a highly significant trend (P<.00001) toward worse prognosis was observed with increasing tumor vascularity. In multivariate analysis, tumor microvessel count (P<.00001), tumor size (P = .0006), and regional lymph node status (P<.00001) retained independent prognostic value with respect to overall survival; among these variables, tumor microvessel count, considered as a continuous variable, was the most important, with a relative hazard of death of 8.38 (95% confidence interval = 4.19-16.78) associated with the highest microvessel counts. An evaluation of tumor angiogenesis may be useful in the postsurgical staging of patients with non-small-cell lung carcinoma and in identifying subsets of patients who may benefit from different postsurgical treatments.

The status of regional lymph nodes (LNs) is one of the most consistent predictors of survival in Merkel cell carcinoma (MCC). In cases of clinically localized disease, current practice involves sentinel lymph node (SLN) assessment. To propose ultrasonography (US) followed by fine needle aspiration cytology (FNAC) and immunohistochemistry as a useful diagnostic tool in the pre-surgical management of patients with MCC. US of LNs was performed in 75 patients with MCC (22 with stage III tumours; 53 with stage I-II). In patients with US suspected disease, US coupled with FNAC of the LN was performed. Smears were examined by routine cytological staining supplemented with immunohistochemical staining for cytokeratin 20. All patients underwent surgical removal of regional LNs. In all 22 patients with stage III tumours, US was indicative of tumour deposits and FNAC confirmed metastases to LNs. In 11 of 53 patients with localized MCC without clinical evidence of nodal disease, US revealed enlarged, equivocal nodes where FNAC was performed. Ten LNs were cytologically positive for metastases, and one was negative. Upon histological examination, the FNAC-negative case showed a metastasis 5 mm in diameter. In all the other 42 cases with no clinical or US evidence of LN involvement, only SLN biopsy was performed and in six cases small metastatic foci were detected. Ultimately, of the 53 stage I-II MCC, 17 had positive LN involvement. In 10 cases (59%) metastases were detected by FNAC, and in seven cases, were detected by SLN biopsy. In a selected subset (∼20%) of patients with MCC with clinically localized disease, US followed by FNAC in the suspect LN is a valid alternative to the classical protocol of SLN histological examination.

Neuroendocrine Tumors in Meckel’s Diverticulum: Recommendation for Lymphadenectomy Regardless of Tumor Size Based on the NCDB Experience