Tumour Node Metastasis (tumour + node_metastasis)

Distribution by Scientific Domains

Selected Abstracts

Pathology of conjunctival melanocytic neoplasms

Purpose To describe the classification, grading and staging of conjunctival melanocytic proliferation. Methods We have audited our experience with conjunctival melanomas, using a novel mapping system and have found shortcomings in the current Tumour Node Metastasis (TNM) staging system. We have also reviewed our cases of intra-epithelial melanocytic neoplasia and confirmed other authors' impressions that conjunctival ,primary acquired melanosis with atypia' is histologically similar to cutaneous in situ melanoma. To improve objectivity in the reporting of conjunctival intra-epithelial melanocytic neoplasia, we propose a scoring system based on pattern of melanocytic infiltration, density of melanocytes & degree of cellular atypia. Results The term ,conjunctival melanosis' should be used only to describe the slit-lamp appearance of hyperpigmentation. Histologically, this abnormality should be categorized as ,hypermelanosis' or ,melanocytosis'. Hypermelanosis can either be primary or secondary to ocular or systemic disease. Benign melanocytosis comprises conjunctival melanocytic hyperplasia and naevi. Malignant melanocytosis is essentially melanoma, which is primary (in situ or invasive) or secondary (i.e., spreading to conjunctiva from adjacent tissues) or rarely metastatic. We suggest that the TNM staging system for conjunctival melanoma should be revised to: (1) include a Tis stage; (2) take account of superficial extent, invasion of adjacent tissues and caruncular involvement, in stages TI to TIII; and (3) to sub-categorize TIV disease so that there is better correlation with likely mortality. Conclusion We have revised the classification of conjunctival melanocytic proliferations & improved the grading and staging of melanoma. These developments should be useful in treatment & research. [source]

Importance of tumour size in papillary and follicular thyroid cancer,

C. Passler
Background: The most controversial change in the new pathological tumour node metastasis (pTNM) classification of thyroid tumours is the extension of the pT1 classification to include tumours up to 20 mm. Methods: Four hundred and three patients with pT1 or pT2 differentiated thyroid carcinomas were divided into three groups according to tumour diameter (group 1, 10 mm or less; group 2, 11,20 mm; group 3, 21,40 mm). They were analysed retrospectively with respect to carcinoma-specific and disease-free survival. Results: No patient in group 1 died from papillary thyroid carcinoma, compared with three patients in group 2 and six in group 3. There was a statistically significant difference in carcinoma-specific survival between groups 1 and 2 (P = 0033). Two patients in group 1, six in group 2 and eight in group 3 developed recurrence. The difference in disease-free survival between groups 1 and 2 was significant (P = 0025). One patient in group 1, three in group 2 and four in group 3 died from follicular thyroid carcinoma, but there were no significant differences in survival between the three groups. Conclusion: Extension of the pT1 classification to cover all tumours up to 20 mm does not appear to be justified for papillary thyroid carcinoma. Copyright 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Pathological determinants of survival in node-negative oesophageal cancer,

O. A. Khan
Background: Many studies have analysed prognostic factors following oesophagectomy, but few have examined survival determinants in node-negative (N0) oesophageal cancer. The prognostic significance of a number of histological variables following surgical resection of N0 oesophageal cancer was studied. Methods: The case notes of 219 patients undergoing potentially curative oesophagectomy for N0 squamous cell carcinoma or adenocarcinoma of the oesophagus were reviewed. Details of the patient's sex, age at operation, histological type, longitudinal tumour length, tumour (T) stage, circumferential resection margin involvement, tumour grade, presence of vascular invasion, perineural invasion, Barrett's metaplasia, and survival were noted. Univariate and multivariate analyses were performed to identify prognostic factors. Results: Univariate analysis revealed three factors that correlated with poor prognosis: T stage (P = 0024), adenocarcinoma (P = 0033) and degree of differentiation (P = 0001). Multivariate analysis revealed that all three were significant independent adverse prognostic indicators. Conclusion: Surgical resection of node-negative oesophageal cancer is associated with diverse long-term outcomes. This diversity of outcome is not reflected in the tumour node metastasis (TNM)-based staging system. The utility of the TNM system in predicting prognosis after surgical resection is open to question. Copyright 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma

R. Yamaguchi
Background: The clinical significance of perineural invasion of gallbladder carcinoma remains unclear. The aim of this study was to elucidate the incidence and mode of perineural invasion of gallbladder carcinoma and clarify its prognostic significance. Methods: A clinicopathological study was conducted on 68 patients who underwent attempted curative resection for gallbladder carcinoma. According to the pathological tumour node metastasis (pTNM) classification of the Union Internacional Contra la Cancrum, there were five (7 per cent), nine (13 per cent), 20 (29 per cent) and 34 (50 per cent) patients with pT1, pT2, pT3 and pT4 disease respectively. Twenty patients (29 per cent) had pM1 disease, including involved para-aortic nodes, liver metastases and localized dissemination. Results: The overall incidence of perineural invasion was 71 per cent (48 of 68 patients). Forty-four (96 per cent) of 46 patients with extrahepatic bile duct invasion had perineural invasion. Although several histological factors were associated with perineural invasion, multivariate analysis demonstrated that extrahepatic bile duct invasion was the only significant factor correlated with perineural invasion (odds ratio 990, P < 0001). The perineural invasion index, defined as the ratio of the number of involved nerves to the total number of nerves examined, was significantly higher at the centre than in the proximal and distal parts of the tumour in the 46 patients with extrahepatic bile duct invasion (P < 0001). The 5-year survival rate for patients with perineural invasion was significantly lower than that for patients with no invasion (7 versus 72 per cent; P < 0001). Cox proportional hazard analysis identified perineural invasion (relative risk (RR) 53, P < 0001) and lymph node metastasis (RR 25, P = 0008) as significant independent prognostic factors. Conclusion: Perineural invasion is common in advanced gallbladder carcinoma and has a significant negative impact on patient survival. 2002 British Journal of Surgery Society Ltd [source]

Criteria for extramural perineural invasion as a prognostic factor in rectal cancer

Dr H. Ueno
Background: An abundant extramural autonomic nerve network is an anatomical feature of the rectum. Extramural perineural invasion (PNI) may influence the prognosis after resection of rectal cancer, however, few assessment criteria exist. Methods: PNI was investigated in 364 patients who underwent curative surgery for rectal cancer penetrating the muscular layer. A grading system was established based on the ,intensity' (number of PNI foci in a 20-power field) and ,depth' (distance from the muscularis propria) of PNI. PNI-0 was defined as without PNI, PNI-1 as ,intensity' of less than five foci and ,depth' less than 10 mm, and PNI-2 as five or more foci or 10 mm or greater ,depth' of invasion. Results: PNI was observed in 52 patients (14 per cent) and strongly correlated with pathological tumour node metastasis (pTNM) stage. Five-year survival was related to PNI grade (74 per cent in PNI-0, 50 per cent in PNI-1 and 22 per cent in PNI-2). The rate of local recurrence was also related to PNI stage: 43 per cent in PNI-2 and 9 per cent in both PNI-0 and PNI-1. Multivariate analyses showed that graded PNI was associated both with local recurrence and long-term survival, independent of tumour depth (pTNM T) and nodal involvement (pTNM N). Conclusion: The PNI grading system may be useful in prognosis and allow case selection for intensive postoperative adjuvant therapy. 2001 British Journal of Surgery Society Ltd [source]

Multicentre study comparing aggressive behaviour of familial non-medullary thyroid carcinoma and sporadic thyroid cancer

O. Alsanea
Background Familial non-medullary thyroid cancer represents about 5 per cent of all thyroid cancers of follicular cell origin. Whether familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer is controversial. Methods Each patient with familial non-medullary thyroid cancer was matched with three controls for age, sex and tumour node metastasis (TNM) stage of disease. Possible prognostic factors were compared in relation to recurrence, metastases and mortality rate in both groups. Univariate analysis was performed using contingency table analysis and McNemar's ,2 test for paired measurements. Multivariate analysis was used to evaluate factors significant in univariate analysis. Results Forty-eight cases (ten men) and 144 matched controls (30 men) were analysed with a mean follow-up of 102 and 94 months respectively. The mean age was 39 years for cases and 46 years for controls. Some 29 per cent of the cases and 12 per cent of the controls had history of prior or coexistent benign thyroid disease (P < 005). Ninety-four per cent of cases and 90 per cent of controls had papillary cancers; the remainder were Hurthle cell cancers. Based on TNM staging, there were 66 per cent stage I, 21 per cent stage II and 13 per cent stage III tumours in the familial non-medullary thyroid cancer group; the distribution was similar in the control group. Modified radical neck dissection was performed in 42 per cent of cases and 22 per cent of controls. Multifocal or bilateral disease was seen in 75 per cent of cases and 41 per cent of controls (P < 005); 35 per cent of cases and 16 per cent of controls had at least one recurrence (P < 005). Ten per cent of cases and 2 per cent of controls developed distant metastases (P < 005). Six per cent of cases but no controls died from thyroid cancer (P < 005). In patients with familial non-medullary thyroid cancer aged over 45 years (n = 14), distant metastases affected four, of whom three died. In multivariate analysis, age was the only significant variable that affected the disease outcome (P < 001). Conclusion Familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer and is associated with increased recurrence, metastasis and death, especially in patients over 45 years of age. 2000 British Journal of Surgery Society Ltd [source]