Outcome and molecular characteristics of non-invasive encapsulated follicular variant of papillary thyroid carcinoma with oncocytic features

Abstract

Purpose

In 2016, non-invasive encapsulated follicular variant of papillary thyroid carcinoma (NI-EFVPTC) was renamed as noninvasive thyroid follicular neoplasm with papillary-like nuclear features (NIFTP). However, as the study cohort did not mention tumors with oncocytic features, such lesions are still labeled by some as FVPTC. It is therefore crucial to evaluate the outcome and molecular profile of oncocytic NI-EFVPTC.

Methods

A multi-institutional clinico-pathologic review was conducted to select 61 patients having oncocytic NI-EFVPTC. A detailed molecular profile was carried out in 15 patients.

Results

Oncocytic NI-EFVPTCs predominantly affected women in their 50s. There was no distant metastasis, lymph node metastases, or structural recurrence in the entire cohort. Among patients with ≥5 years of FU, all 33 individuals did not recur with a median FU of 10.2 years. Oncocytic NI-EFVPTC commonly had RAS (33%) mutations, a high frequency of mitochondrial DNA mutations (67%) and multiple chromosomal gains/losses (53%). No fusion genes were detected.

Conclusions

Oncocytic NI-EFVPTC, when stringently selected for, lacks metastasis at presentation and follows an extremely indolent clinical course, even when treated conservatively with lobectomy alone without RAI therapy. These tumors share a similar mutational profile as NIFTP, FVPTC, and follicular neoplasm and are predominantly RAS-related. Like Hurthle cell neoplasms, they harbor a high frequency of mitochondrial DNA mutations, which contribute to the oncocytic cytomorphology. However, they lack the widespread chromosomal alterations observed in Hurthle cell carcinoma. Consideration should be given to include oncocytic NI-EFVPTCs as NIFTP in order to avoid overtreatment of these highly indolent tumors.

http://bit.ly/2B6RLLY

Primäre und adjuvante Radio(chemo)therapie bei Kopf-Hals-Tumoren

Zusammenfassung

Hintergrund

Die perkutane definitive bzw. adjuvante Radiotherapie oder Radio(chemo)therapie bildet eine der kurativen Behandlungsoptionen beim Plattenepithelkarzinom der Kopf-Hals-Region.

Ziel

Der Beitrag soll eine Übersicht zu aktuell gültigen Behandlungsansätzen und Ergebnissen der Radio(chemo)therapie im Rahmen der definitiven und postoperativen Therapie sein.

Material und Methoden

Es erfolgte eine Sichtung der aktuellen Leitlinien und Literaturrecherche via PubMed-Datenbank.

Ergebnisse

Plattenepithelkarzinom der Kopf-Hals-Region werden stadienadaptiert behandelt. Frühstadien (cT1–2, cN0–1) mit alleiniger Radiotherapie (RT), lokal fortgeschrittenen Stadien mit Radiochemotherapie (RCT). Intensitätsmodulierte RT (IMRT) führt zu vergleichbaren Ergebnissen bei weniger Nebenwirkungen. Partikeltherapie kann Vorteile haben. Die definitive RCT ist der Goldstandard. Adjuvante RT ist bei ≥pT3, pN+, adjuvante RCT bei positivem Resektionsrand oder extranodulärer Ausbreitung (ENE) indiziert. HPV-positive Oropharynxkarzinome haben die beste Prognose. Klinische Studien zur Deintensivierung und Kombination mit Checkpointinhibitoren laufen.

Schlussfolgerung

Moderne perkutane Radiotherapie ist integraler Bestandteil der Therapie, kann Nebenwirkungen reduzieren und wird stadienabhängig alleine oder in Kombination mit Systemtherapie und/oder Operation angewandt. Die Therapie des HPV-assoziierten Oropharynxkarzinoms und HPV-negativen Kopf-Hals-Tumor unterscheidet sich derzeit nicht. Goldstandard im lokal-fortgeschrittenen Stadium ist die simultane Radiochemotherapie mit Cisplatin.

http://bit.ly/2DBpkr2

The Methodology and Electro-physiological Classification of Pre-operative Trans-tympanic Electrically-Evoked Auditory Brainstem Response (TT-EABR)

http://bit.ly/2B5NZlY

Influence of the Maillard Reaction on the Allergenicity of Food Proteins and the Development of Allergic Inflammation

Abstract

Purpose of Review

The Maillard reaction (MR) is a non-enzymatic reaction between reducing sugars and compounds with free amino groups such as proteins and takes place during thermal processing and storage of foods. This review aims to discuss potential effects of dietary MR products on the pathological mechanisms of allergic diseases.

Recent Findings

Since the MR leads to modification of proteins with various types of glycation structures, the impact of the MR on the immunogenicity and potential allergenicity of food proteins in many allergenic foods has been assessed. In addition, recent studies have suggested that the MR products, in particular "advanced glycation end products (AGEs)," contained in the diet may be involved in the development of chronic inflammation by acting as inflammatory components and affecting the gut microbiome.

Summary

This review found that the biological, immunological, and allergic properties of dietary MR products are diverse due to the complexity of the MR.

http://bit.ly/2B7oCAp

Next-Generation Approaches for the Treatment of Food Allergy

Abstract

Purpose of Review

IgE-mediated food allergies are an increasing health concern, and current management includes food avoidance and use of emergency medications. Effective treatment of food allergy is highly desirable. Next generation approaches for the treatment of food allergy aim to improve both safety and efficacy, potentially including long-term tolerance.

Recent Findings

Oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) will likely be integrated into clinical practice as part of food allergy management in the near future. Newer approaches, such as sublingual immunotherapy (SLIT), modified proteins, lysosomal-associated membrane protein DNA (LAMP DNA) vaccines, and the use of immunomodulatory agents, are early in development and depending on results, could also become important treatment options.

Summary

This is a review of novel approaches to the treatment of food allergy that are currently under investigation, including the use of SLIT, modified proteins, probiotics, Chinese herbal supplements, biologic therapies, and DNA vaccines, as well as a summary of the current status of OIT and EPIT.

http://bit.ly/2Tgz53j

Interobserver agreement of skeletal muscle mass measurement on head and neck CT imaging at the level of the third cervical vertebra

Abstract

Objectives

Skeletal muscle mass (SMM) is most often assessed in cancer patients on abdominal computed tomography (CT) imaging at the level of the third lumbar vertebra (L3). Abdominal CT imaging is not routinely performed in head and neck cancer (HNC) patients. Recently, a novel method to assess SMM on a single transversal CT slice at the level of the third cervical vertebra (C3) was published. The objective of this study was to assess the robustness of this novel C3 measurement method in terms of interobserver agreement.

Patients and methods

Patients diagnosed with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) at our center between 2007 and 2011 were evaluated. Fifty-four patients with were randomly selected for analysis. Six observers independently measured the cross-sectional muscle area (CSMA) at the level of C3 using a predefined, written protocol as instruction. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs), a Bland–Altman plot and Fleiss' kappa (κ).

Results

The agreement in vertebra selection between all observers was excellent (Fleiss' κ: 0.96). There was a substantial agreement between all observers in single slice selection (Fleiss' κ: 0.61). For all CSMA measurements, ICCs were excellent (0.763–0.969; all p < 0.001). The Bland–Altman plot showed good agreement between measurements, with narrow limits of agreement.

Conclusion

Interobserver agreement for SMM measurement at the level of C3 was excellent. Assessment of SMM at the level of C3 is easy and robust and can performed on routinely available imaging in HNC patients.

http://bit.ly/2ThF6gp

The Methodology and Electro-physiological Classification of Pre-operative Trans-tympanic Electrically-Evoked Auditory Brainstem Response (TT-EABR)

http://bit.ly/2B5NZlY