O-positive blood type is associated with prolonged recurrence-free survival following curative resection of pancreatic neuroendocrine tumors

BACKGROUND

The ABO blood group may influence the development and progression of cancer. In particular, the prognosis of patients with blood type O is better for pancreatic adenocarcinoma, although this has not been extensively explored in pancreatic neuroendocrine tumors (PanNET).

OBJECTIVE

To assess the influence of the ABO and Rhesus blood types on the risk of recurrence in patients who underwent curative intent PanNET surgical resection.

METHODS

All consecutive patients operated on for well-differentiated panNET in an expert center from 2003 to 2018 were retrospectively included. Blood group, Rhesus system, demographic and clinical data were collected. The primary endpoint was recurrence free survival (RFS). Factors associated with RFS were explored using Cox proportional hazard models.

RESULTS

Overall, 300 patients (male 43%) were included, median age 54 years old (IQR 45-64). The ABO blood group distribution was similar to that of the French population. There was no association between blood group and tumor features. The median postoperative follow-up was 43.9 months (17.0-77.8). The 5- and 10-year RFS rates were 85 ± 4% and 71 ± 13% in O RhD + patients, versus 72 ± 4% and 63 ± 6% otherwise, respectively (p = 0.035). The O RhD + blood group was associated with a decreased risk of recurrence (HR 0.34, 95% CI [0.15-0.75]), p = 0.007 in multivariable analysis adjusted for age, ki67, functioning syndrome, resection margins, tumor size, lymph node status, oncogenetic syndrome.

CONCLUSIONS

After curative-intent surgical resection for PanNET, patients with a non-O RhD + blood group may have an increased risk of recurrence and could benefit from closer follow-up.

[Immunohistological studies on growth potential of head and neck carcinomas]

In order to evaluate the growth potential of head and neck carcinomas, the S-phase cell labeling index (SLI) of biopsied specimens from 106 patients was determined immunohistological examination using anti-BrdU monoclonal antibody. Expression of epidermal growth factor receptor (EGFR) was also investigated in these specimens. The results were statistically compared with clinical findings, and the conclusions were as follows: SLI was higher in advanced cases than in early cases, and it was higher in patients with lymph node metastasis than in those without metastasis. The survival rate showed a strong tendency to be lower for patients with higher SLI. No relationship was found between SLI and origin of head and neck carcinomas. No relationship was found between SLI and differentiation of carcinomas. Expression of EGFR showed no relationship with T classification, but the incidence of positive expression of EGFR was higher in patients with lymph node metastasis than in those without metastasis. Patients positive for EGFR tended to have lower survival rates than EGFR-negative patients. The incidence of positive expression of EGFR was statistically higher in patients with hypopharyngeal carcinoma than in those with other head and neck carcinomas. No relationship was found between the expression of EGFR and differentiation of carcinomas. Patients with positive expression of EGFR showed a strong tendency to have a higher SLI. SLI and the expression of EGFR may well reflect the growth potential of head and neck carcinomas, and it seems very likely that they are can be used to evaluate the oncological characteristics to predict the out come of each case.

Identification of intracellular stages of Cyclospora species by light microscopy of thick sections using hematoxylin

Cyclospora sp is a recently identified coccidia responsible for enteric infection in humans. Most reports have failed to detect this parasite in intestinal biopsies by light microscopy, although the different stages have been ultrastructurally described in jejunum enterocytes. Very recently, some investigators have reported the detection by light microscopy of parasitophorous vacuoles in intestinal biopsies; however, only transmission electron microscopy (TEM) could clearly identify the parasitic stages. To improve the histological diagnosis without using TEM, we have tested different staining methods in biopsies obtained from a patient infected by the human immunodeficiency virus who was shedding Cyclospora oocysts. Hematoxylin stain alone for 15 minutes on 5 micrometer-thick sections of duodenal biopsies was found to be the most efficient method for observing different stages of the parasite. In particular, the banana-shaped merozoites were visualized and appeared very similar to the human coccidia Isopora belli. This simple technique may be useful in diagnosing Cyclospora infection.

[Immunohistological investigation of the histological origin and differentiation of pleomorphic adenoma of the parotid gland]

Immunohistological expressions of the cytokeratin (CK) subclass, vimentin, glial fibral antigen protein (GFAP), alpha-smooth muscle actin, and S-100 protein were investigated in pleomorphic adenoma of the parotid gland. In addition, the correlation between immunohistological findings in the normal parotid gland and those in pleomorphic adenoma was examined. Vimentin, S-100 protein, and GFAP, which were not detected in the normal parotid gland, were observed in pleomorphic adenoma. Only CK-1, which was not detected in the normal parotid gland, was expressed intensely in squamous metaplastic lesions of pleomorphic adenoma. All other CK detected in pleomorphic adenoma were also expressed in the normal parotid gland. Therefore, the expression of vimentin, S-100 protein, GFAP, and CK-1 in pleomorphic adenoma is related to oncogenesis. Since most types of CK expression were observed in solid pleomorphic adenoma lesions and all types of CK expression detected in other lesions were included, cellular differentiation between solid and nonsolid lesions was elucidated. According to the pattern of CK subclass expression, the following sequence of differentiation was suggested; solid lesion-->myxoid lesion-->chondroid lesion, solid lesion-->tubular lesion, solid lesion-->myoepithelioid lesion, and solid lesion-->squamous metaplastic lesion. In normal parotid glands, satellite cells around the ductal cells showed all types of CK subclass expression detected in myoepithelial cells, acinus cells, and ductal cells. Since the types and patterns of CK expression in solid lesions of pleomorphic adenoma are the same as those in satellite cells in the normal parotid gland, pleomorphic adenoma seems to originate from satellite cells. If satellite cells in the normal parotid gland are considered to be so-called reserve cells in the bicellular theory, the origin and cellular differentiation of pleomorphic adenoma can be explained in relation to CK subclass expression.

Ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator: case reports

Two cases of ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator are described. Results were very good, with short periods of occupational disability. These cases support primary stable osteosynthesis of these simultaneous fractures and the value of dynamic axial external fixation as a definitive treatment of open fractures of the femur and tibia shaft, either isolated or simultaneous.

[Correlation of proliferation index with submucosal invasion of hypopharyngeal cancer]

Proliferation index of biopsied specimens from 11 cases of hypopharyngeal carcinoma was studied immunohistochemically using anti-BrDU monoclonal antibody. S-phase cell labelling index (SLI) was measured and compared with the extent of submucosal invasion that was evaluated histologically in each extirpated specimen by means of continuous large section technique. Conclusions were as follows: 1. The largest SLI was obtained in a moderately differentiated carcinoma, and calculated up to 56, while the smallest was encountered in a well differentiated carcinoma as 18. Mean value in these 11 cases was 35. 2. It seemed likely that moderately or poorly differentiated carcinomas show larger SLI, but its statistical significance could not be delineated in these materials. 3. Submucosal invasion was much longer in the oral direction than in the anal. The longest invasion was observed in a case that showed the largest SLI, and measured up to 22 mm. The shortest invasion, on the contrary, was seen in a case with the smallest SLI, and was only 9 mm. Mean value in these 11 cases was 14.4 mm. 4. SLI correlates well in every case to the extent of submucosal invasion toward the oropharynx. 5. SLI evaluated preoperatively in biopsied specimen may help to indicate an ample safety margin at the surgery.