CASE REPORT: Herein, we describe and compare three cases of CASTLE, including a case with distant metastasis despite administering postoperative chemotherapy. Thus, the mechanisms underlying metastasis of CASTLE are unclear. This case study helps to elucidate the histopathological risk factors of metastasis in CASTLE.
DISCUSSION: We found that prominent lymphovascular invasion and higher proliferative activities might be risk factors of metastasis in CASTLE. In addition, we have summarised the cytological, morphological, and immunohistochemical features of CASTLE for an accurate diagnosis.
MATERIALS AND METHODS: This study included 50 cases of thyroid lesions (20 cases of colloid goitre, 15 of follicular adenoma, 5 of follicular carcinoma and 10 papillary carcinomas). Digital images of cytologic smears of these cases were captured using a dedicated photomicrography system and nuclear profiles traced manually. With self-designed image analysis software, nuclear morphometric measurements, including texture analysis, were performed. Discriminant analysis was performed including the morphometric parameters and percentage of correctly classified nuclei noted.
RESULTS: Nuclear morphometry parameters showed that papillary thyroid carcinoma had the highest perimeter, area, radius and elongation factor compared to other thyroid lesions. Discriminant analysis revealed that altogether 77.9% of cells could be correctly classified to their lesion category based on the nuclear morphometric and textural parameters. Of the neoplastic cases, 84.5% of cells of follicular neoplasms and 72.5% of papillary carcinoma were classified to the respective category.
CONCLUSION: Nuclear morphometry, including texture analysis, can assist in the cytologic diagnosis of thyroid lesions, considering the high degree of accuracy of classification. Further studies and methodological refinements can achieve higher accuracy.
CASE REPORT: The patient was a 47-year-old woman with no familial history of FAP. A 3.0-cm unifocal mass was identified in the left thyroidal lobe. Fine-needle aspiration cytology revealed papillary clusters of atypical cells with nuclear grooves, which was suspected to be conventional papillary thyroid carcinoma. Histologically, the tumour comprised a papillary and cribriform growth of atypical cells with cytoplasmic accumulation and nuclear translocation of b-catenin. In addition, frequent morule formation was identified.
DISCUSSION: In this case, we performed morule analysis through correlative light and electron microscopy (CLEM), and revealed its ultrastructure. Although CMV is a rare form of thyroid carcinoma, it should be considered along with its distinct clinicopathological characteristics.
METHODS: The records of one hundred and thirty-four NPC cases confirmed by histopathology in Hospital Universiti Sains Malaysia (USM) between 1st January 1998 and 31st December 2007 that fulfilled the inclusion and exclusion criteria were retrospectively reviewed. Simple and multiple Cox proportional hazard regression analyses were performed to determine the significant prognostic factors affect the survival of NPC patients.
RESULTS: The mean (SD) age of patients diagnosed with NPC was 48.12 (15.88) years with Malay was the largest ethnic group compared to other ethnicities. Most of patients had locally advanced stage IV (40.6%) and stage III (39.1%) of NPC. The overall median survival time of NPC patients was 31.30 months (95% CI 23.76, 38.84). The significant prognostic factors that influenced the survival of NPC patients were older age (HR 1.03, 95% CI 1.01, 1.04), metastases (HR 2.52, 95% CI 1.01, 6.28) and stage IV disease (HR 4.50, 95% CI 1.66, 9.88).
CONCLUSION: Older age, the presence of metastases and late stage are significant prognostic factors that influence the survival of NPC. Therefore, it is important to provide education to public and to raise awareness to diagnose NPC at an earlier stage and before the presence of metastases.
METHODS: This study enrolled 100 patients in a single-center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano's classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly.
RESULTS: The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver-operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non-disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P
METHODS: Colonic EMRs performed for polypoid and nonpolypoid lesions at a tertiary institution were prospectively collected and analyzed for efficacy, and short and long-term complications.
RESULTS: 224 colonic neoplasms (143 flat, 65 sessile and 16 subpedunculated) were excised by the standard inject-and-cut method, with standard accessories. The median size of all lesions was 10 mm (range 2-50 mm) and 110 (49.2%) lesions were located in the proximal colon. Histological completeness of resection was achieved in 87% of cases. Of the lesions 77.2% were dysplastic, with 5 cases of carcinoma in situ and 18 severely dysplastic adenomas. Complications included bleeding in five cases (2.2 %) and a single case of perforation (0.4%). All complications were managed endoscopically. Median follow up at 24 +/- 16 months (range 12-84 months) revealed a 7.2% local recurrence rate, all of which were subsequently eradicated by repeat EMR.
CONCLUSIONS: Standard inject-and-cut colonic EMR is practical and effective in the eradication of superficial colonic neoplasia.
MATERIALS AND METHODS: The cancer registry from 1986 to 2014 maintained by the State Laboratory was retrospectively reviewed. The age standardized rates (ASR) and the age specific incidence rates (ASIR) were calculated. Non NPC tumors were excluded from the study.
RESULTS: Altogether, there were a total of 450 NPC cases diagnosed accounting for 4.4% of all total cancer cases over the study period, declining from 10.3% in 1986-1990 to 2.3% in 2011-2014. The most common tumor type was the undifferentiated carcinoma (96.4%). The case characteristics were mean age 50.4 ± 14.4 years old, male 69%, and predominately Malays 74.4%, followed by Chinese 16.7%. The mean age of diagnosis increased over the study period from 45.6 ± 17.1 years (1986-1989) to 54.1 ± 12.5 years (ANOVA, p<0.01 for trend). There were no differences in the mean age of diagnosis between the ethnic groups or genders. The ASR showed a declining trend from 11.1 per 100,000 in 1986-1990 to 5.95 per 100,000 in 2011-2014, similar trends been observedfor both genders. Among the age groups, declining trends were seen in all the other age groups apart from the >70 years group. The overall ASRs for the Malays and Chinese were 7.92/100,000 and 8.83/100,000 respectively, both showing declining trends.
CONCLUSIONS: The incidence of NPC in Brunei Darussalam is comparable to rates reported from Singapore and Malaysia, but higher than rates reported from the other Southeast Asian nations. Unlike higher rates reported for Chinese compared to the Malays in other countries, the rates between the Malays and Chinese in our study was comparable. Importantly, the ASR is declining overall and for both genders and ethnic groups.