Carcinoma ; classification ; pathology ; Carcinoma, Papillary ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; Thyroid Neoplasms ; classification ; pathology ; Tracheal Neoplasms ; secondary

OBJECTIVETo explore the prognostic factors and their impact on survival of patients with cancer of unknown primary (CUP).

METHODSThe clinical and follow up data of 154 CUP patients referred to the Cancer Hospital & Institute, Chinese Academy of Medical Sciences from January 1, 2003 to December 31, 2007 were analyzed. Multivariate analysis of survival was performed using recursive partitioning referred to as classification and regression tree (CART) analysis.

RESULTSThe median survival for 154 eligible consecutive CUP patients was 18.2 months, and the 5-year survival rate was 1.3%. CART was performed with an initial split on age of 34, and 5 terminal subgroups were formed. The median survival of the 5 subsets ranged from 5.5 months (younger than 34 years old subgroup) to 61.8 months for patients at age of 34 to 60, with one or two organ sites involved, and non-adenocarcinoma histology subsets.

CONCLUSIONSCART can be used to identify previously unappreciated patient subsets and is a useful method for dissecting complex clinical situations and identifying homogeneous patient populations in clinical practice and future clinical trials.

Adenocarcinoma ; pathology ; secondary ; Adult ; Aged ; Bone Neoplasms ; secondary ; Carcinoma, Squamous Cell ; pathology ; secondary ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms, Unknown Primary ; classification ; pathology ; Regression Analysis ; Survival Rate

OBJECTIVETo analyze the clinicopathologic and immunohistochemical features and prognosis of papillary renal cell carcinoma (PRCC) in 19 cases.

METHODSA retrospective study was performed including reviewing the clinical documents and pathological sections of 19 cases of PRCC. Immunohistochemical staining were performed and follow-up was made in 16 cases.

RESULTSThere were 11 men and 8 women included in this study. The mean age was 52 years (range, 33 to 82 years old). Clinically, most tumors were found incidentally by physical examination because the majority of patients were asymptomatic. Histologically, the PRCC were characterized by varying proportions of papillary and tubular architecture covered by single- or multiple-layer of tumor cells with scanty or voluminous basophilic or eosinophilic cytoplasm. Foam cells and psammoma bodies were seen in some papillary cores and stroma, and the cytoplasm of some tumor cells contained hemosiderin. Of these 19 patients, 12 (63.2%) and 7 (36.8%) were diagnosed as type I and type II PRCC, respectively. The Fuhrman nuclear grade in all the type I PRCC was grade 1 - 2, significantly lower than that in the type II PRCC. Immunohistochemically, the PRCC often showed positive immunostaining for vimentin, EMA, CKpan, CK7, CD10 and p504s. Among the 19 patients, 16 were followed-up from 2 to 67 months. The distant metastasis, including lung, liver and bone metastases were detected in 3 patients at 3, 8, and 9 months after surgery, which were all of type II PRCC. Two patients died of other diseases. The other 11 patients were alive without recurrence or metastasis.

CONCLUSIONTwo subtypes of PRCC show different features of morphology, immunohistochemistry and prognosis. The type II PRCC tends to have unfavorable prognosis in comparison with type I PRCC. The presence of higher nuclear grade, sarcomatoid elements or clear cell carcinoma structure may indicate an aggressive behavior and poor prognosis.

Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms ; secondary ; Carcinoma, Renal Cell ; classification ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Keratin-7 ; metabolism ; Kidney Neoplasms ; classification ; metabolism ; pathology ; surgery ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Mucin-1 ; metabolism ; Prognosis ; Racemases and Epimerases ; metabolism ; Retrospective Studies ; Vimentin ; metabolism

BACKGROUND: A few reports of transudative malignant effusion on a small number of patients have suggested the need to perform routine cytologic examination in all cases of transudative pleural effusion, whether encountered for malignancy or not. The purpose of this study was to investigate whether cytologic examination should be performed in all cases of transudative pleural effusion for the diagnosis of malignancy. METHODS: We performed a retrospective study of 229 consecutive patients with malignant pleural effusion, proven either cytologically or with biopsy. In patients with transudative pleural effusion, we reviewed medical records, results of transthoracic echocardiography, fiberoptic bronchoscopy, chest X-ray, chest CT scan, and ultrasonogram of the abdomen. These data were examined with particular attention to identifying whether or not the malignancy was suggested on chest X-ray, examining the involvement of the superior vena cava, great vessels, and lymph nodes, determining the presence of pericardial effusion, and observing the endobronchial obstruction. RESULTS: Transudative malignant pleural effusion was observed in seven (3.1%) of the 229 patients, and was caused either by the malignancy itself (6 patients) or by coexisting cardiac diseases (1 patient). All the patients showed evidence suggesting the presence of malignancy at the time of initial thoracentesis, which facilitated the decision of most clinicians on whether to perform cytologic examination for the diagnosis of malignancy. CONCLUSION: Therefore, in all cases of transudative pleaural effusion, no clinical implications indicating malignancy were found on cytologic examination.
Biopsy ; Carcinoma/classification/*pathology/*secondary ; Exudates and Transudates ; Human ; Lung Neoplasms/*pathology ; Lymphatic Metastasis ; Neoplasm Staging ; Neoplasms, Unknown Primary/*pathology ; Pleural Effusion, Malignant/metabolism/*pathology ; Retrospective Studies ; Support, Non-U.S. Gov't

BACKGROUND AND OBJECTIVEThe brain is one of the most common metastatic sites of breast cancer. Brain metastases develop in 10%-15% of patients with breast cancer and are associated with poor prognosis. The purpose of this retrospective study was to analyze the clinical characteristics and survival of patients with brain metastases due to breast cancer of different subtypes and to identify the prognostic factors that affect clinical outcome.

METHODSA total of 89 patients with breast cancer brain metastases diagnosed between October 1997 and July 2008 at Sun Yat-sen University Cancer Center were included in this study. Among the 89 patients, the number of luminal A, luminal B, human epidermal growth factor receptor 2 (HER-2), and triple-negative (TN) subtypes were 30, 20, 16, and 14, respectively; 9 patients had an unknown subtype. The clinical characteristics, pathologic features, and prognostic factors were analyzed both at the initial diagnosis and at the diagnosis of brain metastases. Endocrine therapy for patients with luminal subtypes was further studied.

RESULTSThe median age of patients was 46 years (range 28-74 years). The median survival time was 8.0 months (range, 0-80 months), the 1-year survival rate was 32% and the 5-year survival rate was 4%. The time to brain metastasis differed according to clinical stage at the initial diagnosis, and the time for patients with the luminal A subtype was the longest (P < 0.001). Multivariate analysis demonstrated that performance status score > 1, multiple brain metastases and without whole brain radiotherapy (WBRT) in combination with chemotherapy were associated with poor prognosis. Compared with the luminal A subtype, features of the HER-2 and TN subtypes included early metastases, rapid progression after first-line treatment (8.0 months vs. 11.0 months), and poor overall survival (25.0 months vs. 63.0 months). The luminal A subtype showed a tendency for good prognosis and slow growth. Tamoxifen could improve the survival of luminal A/B subtypes (median survival 24.0 months vs. 7.0 months, respectively, P = 0.002).

CONCLUSIONSThe prognosis of brain metastases from breast cancer was poor, especially in patients with HER-2 and TN subtypes. Generally, WBRT in combination with chemotherapy was the standard treatment modality. Patients with the luminal subtypes could benefit from tamoxifen.

Adult ; Aged ; Antineoplastic Agents, Hormonal ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Brain Neoplasms ; secondary ; therapy ; Breast Neoplasms ; classification ; pathology ; therapy ; Carcinoma, Ductal, Breast ; classification ; pathology ; secondary ; therapy ; Chemotherapy, Adjuvant ; Cranial Irradiation ; methods ; Female ; Follow-Up Studies ; Humans ; Mastectomy ; methods ; Middle Aged ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Receptor, ErbB-2 ; blood ; Receptors, Estrogen ; blood ; Receptors, Progesterone ; blood ; Retrospective Studies ; Survival Rate ; Tamoxifen ; therapeutic use

OBJECTIVESBasal cell-like breast cancer is one of the subtypes using molecular typing, and this subtype attracted a wide spread attention. Currently, no uniform diagnostic criteria are available. Most studies demonstrated poor outcomes, but contradictory conclusions appeared recently. The prognosis of basal cell-like breast cancer using different immunohistochemical criteria were analyzed.

METHODSTwo hundred and eighty-four invasive breast cancers with a follow-up information over 5 years were evaluated for ER, PR, HER2, CK5/6, CK14, EGFR expression on tissue microarray immunohistochemically. Based on the results, these cases using four different diagnostic criteria were categorized, namely: Nielsen (ER-/HER2-, CK5/6+ and/or EGFR+), Kim (ER-/PR-/HER2-, CK5/6+ and/or CK14+ and/or EGFR+), Triple-negative (ER-/PR-/HER2-), and basal-CK (CK5/6+ and/or CK14+). 5-year survival information was compared between groups.

RESULTSThe prevalence of basal cell-like breast cancer by Nielsen, Kim, Triple-negative and basal-CK were 15.5% (44/284), 14.8% (42/284), 43.3% (123/284) and 21.1% (60/284) respectively; the recurrence rates were 18.2% (8/44), 21.4% (9/42), 10.6% (13/123) and 11.7% (7/60) respectively. These were higher than recurrence rates for other subtypes, but only the differences by Nielsen's and Kim's criteria were significant. Using Nielsen's and Triple-negative's criteria, basal-like tumors showed shorter 5-year disease-free survival (both P < 0. 01) and overall survival (P < 0.05 and 0.01) than luminal A subtype, using Kim's criteria, basal-like tumors showed a lower 5-year disease-free but not overall survival than luminal A subtype (P < 0.01); no significant difference was found on 5-year survival between basal-like and non-basal-like tumors when typed by basal-CK.

CONCLUSIONBasal cell-like breast cancers are more likely to show more recurrence and worse outcome, but different immunohistochemical diagnostic criteria have an influence on their prognostic analysis, so a uniform diagnostic criteria is essential for the further study of basal-like breast cancers.

Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms ; secondary ; Breast Neoplasms ; classification ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; secondary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratin-5 ; metabolism ; Keratin-6 ; metabolism ; Lung Neoplasms ; secondary ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasms, Basal Cell ; metabolism ; pathology ; secondary ; Prognosis ; Receptor, Epidermal Growth Factor ; metabolism ; Receptor, ErbB-2 ; metabolism ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism ; Survival Rate ; Young Adult

OBJECTIVETo study the expression and clinical significance of kidney injury molecule-1 (KIM-1) in primary and metastatic renal epithelial neoplasms.

METHODSA total of 136 cases of kidney neoplasms were retrospectively reviewed including 63 primary clear cell renal cell carcinomas (RCCs), 22 papillary RCCs, 13 chromophobe RCCs, 7 oncocytomas, 7 RCCs associated with Xp11.2 translocation/TFE3 gene fusions and 24 metastatic clear cell RCCs. Immunostaining for KIM-1 and kidney-specific-protein (Ksp)-cadherin were performed and the relationship to tumor stage and grade in clear cell RCCs was investigated.

RESULTSExpression of KIM-1 was detected in 77.8% (49/63) of clear cell RCCs, 90.9% (20/22) of papillary RCCs, 1/13 of chromophobe RCCs, 7/7 of RCCs associated with Xp11.2 translocation/TFE3 gene fusions and 87.5%(21/24) of the metastatic RCCs, but not detected in 7 cases of oncocytomas. A diffuse expression of KIM-1 was more frequently observed in Furhman nuclear grade III/IV clear cell RCCs (P = 0.010). Ksp-cadherin expression was mainly observed in chromophobe RCCs and oncocytomas.

CONCLUSIONSKIM-1 is a specific biomarker for injuried kidney proximal tubules and the corresponding neoplasms, and has a high specificity and sensitivity for primary or metastatic clear cell RCCs, papillary RCCs and RCCs associated with Xp11.2 translocation/TFE3 gene fusions. Combination of KIM-1 and Ksp-cadherin immunostaining can lead to a more precise histological classification of primary kidney epithelial neoplasms and improve the diagnostic accuracy of metastatic RCCs.

Adenoma, Oxyphilic ; metabolism ; pathology ; Basic Helix-Loop-Helix Leucine Zipper Transcription Factors ; genetics ; metabolism ; Bone Neoplasms ; metabolism ; secondary ; Cadherins ; metabolism ; Carcinoma, Papillary ; metabolism ; pathology ; Carcinoma, Renal Cell ; genetics ; metabolism ; pathology ; Chromosomes, Human, X ; Gene Fusion ; Hepatitis A Virus Cellular Receptor 1 ; Humans ; Kidney Neoplasms ; genetics ; metabolism ; pathology ; Lung Neoplasms ; metabolism ; secondary ; Membrane Glycoproteins ; metabolism ; Neoplasms, Glandular and Epithelial ; classification ; genetics ; metabolism ; pathology ; Receptors, Virus ; metabolism ; Retrospective Studies ; Translocation, Genetic