OBJECTIVEThe aim of this study was to assess the impact of radiotherapy on patients with postoperative residual or recurrent papillary thyroid cancer (PTC).

METHODSWe retrospectively reviewed the medical records of 34 patients with PTC, who underwent surgery and radiotherapy in other hospitals, and treated at the Department of Head and Neck Surgery at Cancer Institute & Hospital CAMS from January 2011 to January 2014. Among the 34 cases, 22 were in stage I, 5 in stage II and 7 in stage IVa. The 34 patients received 1.5 times of surgery before radiotherapy in average. All the cases received radiotherapy (mean, 56 Gy; range, 50-70 Gy). The patients were re-operated in our hospital, and the specimens were examined by pathology. The pre- and post-radiotherapy images (CT and B-ultrasound) were compared, and the changes of tumor volume were examined. The objective effect of treatment on the tumor residual focus was evaluated using RECIST, and analyzed by t-test (SPSS 17.0).

RESULTSAll the re-resected lesions after radiotherapy were proved by pathology to be papillary thyroid cancer (PTC) or metastatic PTC in cervical lymph nodes. Among the 34 patients, 22 cases showed mild or moderate cell degeneration and the other 12 cases showed no obvious degeneration. The largest tumor diameter was 27.18 mm before radiotherapy and 27.76 mm after radiotherapy, with a non-significant difference between them (t=-1.618, P>0.05). Among the 34 patients, only 3 patients received reoperation, all other 31 cases had complete resection, and no severe complications were observed except recurrent laryngeal nerve injury in one case.

CONCLUSIONSRadiotherapy has few therapeutic benefit to PTC patients after surgery with residual tumor or local recurrence. It should be used in the PTC patients, in which the tumor invasion involves important organ tissues and is difficult for a single operation to achieve safe resection margin, or in patients who can't bear a surgery because of severe coronary heart disease or others.

Carcinoma ; pathology ; radiotherapy ; surgery ; Carcinoma, Papillary ; Chronic Disease ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Neck ; Neck Dissection ; Neoplasm Recurrence, Local ; radiotherapy ; Neoplasm, Residual ; Postoperative Period ; Radiotherapy Dosage ; Reoperation ; Retrospective Studies ; Thyroid Neoplasms ; pathology ; radiotherapy ; surgery ; Thyroidectomy ; Tumor Burden

Papillary thyroid microcarcinoma (PTMC) has been increasing, without a consensus for the management of this condition. In the present study, we analyzed the clinicopathological features of patients with PTMC to examine the impact of initial therapy and establish appropriate treatment. A total of 2,018 patients with PTMC were enrolled at a single university hospital. Of them, 1,245 patients (61.8%) underwent total thyroidectomy, and 1,838 patients (91.3%) underwent central lymph node (LN) dissection. Five-and 10-yr recurrence rates were 3.2% and 4.6%, respectively. In univariate analysis, the prognostic factors for recurrence were N stage, the number of LN metastases, and extrathyroidal extension. However, multivariate analysis revealed LN metastases and N stage as the only significant prognostic factors after adjusting for confounding factors (P < 0.001). Additionally, multivariate analysis of a subgroup consisting of PTMC patients without N1b revealed the number of central LN metastases as the only significant factor. Therefore, intraoperative examination for central LN metastasis may discriminate high or low risk group.
Carcinoma, Papillary/*pathology/radiotherapy/surgery ; Female ; Humans ; Iodine Radioisotopes/therapeutic use ; Lymph Node Excision ; Lymph Nodes/*pathology/surgery ; Lymphatic Metastasis/*pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local/surgery ; Prognosis ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms/*pathology/radiotherapy/surgery ; Thyroidectomy

OBJECTIVE: The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent. METHODS: One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service's prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy. RESULTS: The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001). CONCLUSION: Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.
Adenocarcinoma, Clear Cell/pathology/radiotherapy/*secondary/surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Endometrioid/pathology/radiotherapy/*secondary/surgery ; Cystadenocarcinoma, Papillary/pathology/radiotherapy/*secondary/surgery ; Endometrial Neoplasms/pathology/radiotherapy/*surgery ; Female ; Humans ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Radiotherapy, Adjuvant ; Salvage Therapy/methods ; Survival Analysis ; Treatment Failure ; Treatment Outcome

OBJECTIVETo study the clinicopathologic features of uterine papillary serous carcinoma (UPSC) and the roles of adjuvant therapy.

METHODSSixty-one cases of UPSC with operation done and followed up for a period of 4 to 9 years were enrolled into the study. The histology of slides specimens were reviewed and immunohistochemical study was performed. The follow-up and survival data were analyzed.

RESULTSAll of the 61 patients were post-menopausal, with a median age of 68 years. The clinical presentations included abnormal vaginal bleeding, abdominal symptoms and abnormal Pap smears. The median size of the tumors was 7.5 cm (range=1.2 to 14.8 cm). There were 27.9% cases in FIGO stage I (8.2% in stage IA, 14.8% in stage IB and 4.9% in stage IC), 9.8% in stage II, 32.8% in stage III and 29.5% in FIGO stage IV. The histologic features were similar to those of the ovarian counterpart, with tumor cells containing the high-grade nuclei and arranged in complex papillae. Psammoma bodies were identified in 24.6% of the cases. Immunohistochemical study showed that the tumor cells demonstrated diffuse and strong nuclear staining for p53 and Ki-67. They were negative for estrogen receptor and progesterone receptor. Fifteen of the 61 cases (24.6%) showed no evidence of myometrial invasion. However, ten of the 15 cases had extrauterine disease, with peritoneal (6/15) and nodal (9/15) involvement. Tumors with deep myometrial invasion, lymphovascular permeation and nodal metastasis were associated with worse prognosis by univariate analysis. Fifty-six patients received adjuvant therapy. The number of patients receiving adjuvant chemotherapy alone, adjuvant radiotherapy alone and combined adjuvant chemotherapy/radiotherapy were 42, 24 and 10, respectively. The median survivals of the chemotherapy group and non-chemotherapy group (with or without radiotherapy) were 66.4 months and 32.8 months, respectively.

CONCLUSIONSUPSC has distinctive clinical and pathologic features. The tumor stage, lymph node status, lymphovascular permeation and depth of myometrial invasion were important prognostic factors. Adjuvant chemotherapy for stage III/IV tumors or recurrent UPSC may have survival benefit.

Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Papillary ; drug therapy ; pathology ; radiotherapy ; surgery ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Cystadenocarcinoma, Serous ; drug therapy ; pathology ; radiotherapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Menopause ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Radiotherapy, Adjuvant ; Survival Rate ; Uterine Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery

OBJECTIVETo study the clinicopathologic features of papillary tumor of the pineal region (PTPR).

METHODThree hundred and eighty six cases of pineal region and posterior third ventricle tumors, two newborn and two adult pineal glands were analyzed by HE, PAS and immunohistochemistry of 16 antibodies (EnVision method).

RESULTSFive cases of PTPR were diagnosed with mixed papillary features and densely cellular areas, and included one recurrent case. In the papillary areas, the vessels were lined by one or several layers of cuboidal/columnar cells; the vessel wall was hyalinized. In the densely cellular areas, sheets or nests of tumor cells were seen. The tumor cells of these five cases were immunoreactive to CK, CK8/18, synaptophysin, MAP2, nestin, S-100, and vimentin. Four cases were immunoreactive to NSE and CgA; and 2 cases were immunoreactive to NF. All five cases were negative for EMA, CK5/6, CEA, and NeuN. Ki-67 labeling index ranged from 1% to 6%.Three patients were alive, and the recurrent one died.

CONCLUSIONSPTPR occurs in patients with over a wide age range, from children to adults, and is more commonly found in male than female. PTPR is composed of both papillary and solid areas, characterized by epithelial cytology, and needs to be differentiated from ependymoma. PTPR may originate from the specialized ependymocytes of the subcommissural organ. The prognostic factors are early diagnosis, complete surgical resection and radiotherapy.

Adolescent ; Adult ; Brain Neoplasms ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Carcinoma, Papillary ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Child ; Diagnosis, Differential ; Ependymoma ; metabolism ; pathology ; Female ; Humans ; Immunohistochemistry ; Keratin-18 ; metabolism ; Keratin-8 ; metabolism ; Keratins ; metabolism ; Male ; Microtubule-Associated Proteins ; metabolism ; Nestin ; metabolism ; Pineal Gland ; Pinealoma ; metabolism ; pathology ; S100 Proteins ; metabolism ; Synaptophysin ; metabolism ; Tomography, X-Ray Computed ; Vimentin ; metabolism ; Young Adult