Poorly differentiated neuroendocrine carcinoma originating in the subglottic larynx: A case report with imm unohistochemical study

Key Clinical Message

Laryngeal neuroendocrine carcinomas are the most common non-squamous neoplasm of the larynx. Due to the rarity of the tumor, pathological diagnosis should be confirmed by immunohistochemistry.

Abstract

Laryngeal neuroendocrine carcinomas (LNECs) are a rare cancer of the head and neck. Few case reports of poorly differentiated neuroendocrine carcinoma originating in the subglottic larynx exist within the literature. In this case, we discuss a 57-year-old patient with a history of four-month hoarseness with a newly diagnosed of poorly differentiated neuroendocrine carcinoma in the subglottic larynx. Treatment and prognosis of the various NEC groups differ, so precise identification requires consideration of the microscopic findings and immunostaining analysis. immunohistochemistry staining demonstrated positive result for cytokeratin 7, synaptophysin, chromogranin, CD 56, with the Ki-67 index of45%. Although surgery is usually the treatment for all tumor types, chemo radiotherapy is recommended for poorly differentiated NECs because surgery is ineffective.

Collision tumor of squamous cell carcinoma of the scalp and meningioma: A case report

Finding 2 different histological tumor types at the same site is extremely unusual, especially in patients with no history of radiation exposure or a family history of cancer. We describe a rare case of co-occurrence of meningioma and squamous cell carcinoma at the same site. A 67-year-old woman with a 6-month headache and a verrucous ulcerative mass on her frontoparietal region is the subject of this case study. Her medical history and her family's medical history are both blank. Her bilateral frontoparietal regions were found to have large heterogeneous lesions with areas of necrosis and superficial ulceration on radiological examination. An extensive heterogeneous extra-axial lesion was discovered during further radiological analysis in the left parasagittal region. Histopathologic examination revealed an impinging tumor consisting of a meningioma and squamous cell carcinoma at the same site. It is extremely uncommon to have multiple primary scalp cancers of different cell types present at the same time. To identify these cancers and choose the best treatments, clinicians will benefit from the information in our case reports.

POS1018 IMPORTANCE OF LATERAL SPINE VIEW IN DXA BONE DENSITOMETRY IN PATIENTS WITH SPONDYLOARTHRITIS

Background:

Osteoporosis is an increasingly important health problem among patients with spondyloarthritis (SPA). The Measure of Bone Mineral Density BMD is routinely carried out in an anteroposterior (AP) view of the spine. However, the syndesmophytes, ligaments calcifications, and the posterior part of vertebrae affect AP scanning. A lateral spine view is a more sensitive tool in assessing bone loss in trabecular bone.

Objectives:

We aimed to evaluate the association between lateral lumbar DXA and syndesmophyte grading in patients with SPA.

Methods:

We conducted a retrospective study including 75 patients with SPA. Bone density of the hip and lumbar spine was measured with a GE Lunar Prodigy Advance Bone Densitometer equipment. All patients had lumbar lateral, AP, and proximal femur DXA scans. The T-score, which measures the difference between a patient’s BMD and young-normal subjects, was computed and age-matched.

Results:

The mean age of the patients was 36±11 years. Male predominance was noted with a sex ratio of 4.76. The mean BMI was 25±5 kg/m2. Eight percent were obese. Fifty-two percent had Vitamin D deficiency.

Forty-eight percent of the patients had axial SPA, while 52% had axial and peripheral symptoms.

The mean age of onset was 27±7 years. Fifty-two percent of the patients had high inflammatory biomarkers. The BASDAI, ASDAS-VS, and ASDAS-CRP mean levels were respectively: 3.5±2.4, 3.1±0.9, and 3±0.8. The mean BASRI and mass were respectively 8 + 4.8 and 16.4 + 19.4. Analyses of T-score values obtained over the femoral neck revealed osteoporosis in 18.7% of the cases and osteopenia in 32% of the cases. On the other hand, analyses of AP, spine views revealed osteoporosis in 25.3% and osteopenia in 45.3% of patients (p=0.028, r=0.254). We detected the highest percentage of osteoporosis in lateral lumbar view and T-scores matched more closely with femoral neck values; osteoporosis in 29.3%, and osteopenia in 22.7% of the patients (p<10-3, r=0.562). BMD measured in AP, and lateral views were in good agreement (p<10-3, p=0.592). Age was inversely but not significantly associated with BMD in lateral (p=0.442, r=-0.09), AP (p=0.319, r=-0.117) and femoral neck projections (p=0.179, r=-0.157). Femoral neck BMD was associated with the activity of SPA (ASDAS vs (p=0.027, r= -0.295), and the mobility limitation BASMI (p=0.032, r= -0.247). Coxitis, BASRI, or mSASS were independent of BMD.

Conclusion:

We conclude that spine lateral view in DXA accurately measures BMD exceeding the AP spine views and femoral neck values. Therefore, structural changes do not affect this measurement

Disclosure of Interests:

None declared.

POS1013 LET’S TAKE A LOOK AT THE SYMPHYSIS PUBIC AREA IN SPONDYLARTHRITIS

Background:

Symphysis pubic (SP) is the frequent site of enthesitis in spondylarthritis (SpA). Radiological changes in SP appear later in the course of the disease. Underdiagnosed, its prevalence varies from 4% to 47% (1), depending on imaging modalities.

Objectives:

This study aimed to evaluate the prevalence of SP involvement in patients with spondyloarthritis (SpA). We also focused on the relation between radiographical changes and clinical findings.

Methods:

It was a cross-sectional study, including patients with SpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. We collected the following data: age, gender, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), and Bath Ankylosing Spondylitis Functional Index (BASFI).

Pelvic radiographs were examined by 2 experimented rheumatologists. Grading symphysial involvement was made as follow: scores ranged from 0-4 per reading: grade 0 = normal; grade 1 = subtle irregularity and/or subchondral sclerosis, grade 2 = clear erosions, 3 = marked sclerosis, grade 4 = ankylosis.

We divided our patients into two groups: G0 patients without SP changes and G1 patients with SP changes.

Results:

One hundred and thirty-one patients were included, 84 were male, and 48 were female. The sex ratio M/F was 1.72. The mean age was 41.32±12.42 years. The mean disease duration was 12.65 ± 9.49 years. The clinical presentation of SpA was peripheral in 61 cases and axial in 118 cases. The mean disease scores activity was: BASDAI: 3.94±2.046 and ASDASCRP: 2.75±1.05. The mean BASFI was 4.17±2.7

SP changes were observed in 31 patients: score 1 (n=14), score 2 (n=8), score 3 (n=8) and score 4 (n=4). Sex ratios M/F were 2.1 and 1.65 in G1 and G0, respectively (p=0.23). No statistically significant differences were reported between the two groups G0 and G1: mean age (40.48 vs. 43.45, p=0.324), mean disease duration (11.19 vs. 14.45, p=0.218), mean BASDAI (3.8 versus 3.9, p=0.850), mean ASDAS-ESR (3.09 vs. 2.55, p=0.113) and mean BASFI (3.76 versus 4.96, p=0.06) respectively. In G1, nine patients had hip involvement (p=0.203). Enthesitis was more common in patients with SP changes (p=0.02).

Conclusion:

In our study, the presence of enthesitis was associated with SP changes. Surprisingly, age and disease duration did not influence SP changes (1).

References:

[1]Kang Y, Ahn JM, Lee E, Lee JW, Kang HS. Active inflammatory changes around the pubic symphysis in patients with axial spondyloarthritis: Magnetic resonance imaging characteristics and association with clinical factors. Eur J Radiol. mars 2020;124:108802.

Disclosure of Interests:

None declared.

AB0187 PREVALENCE, RISK FACTORS, AND TREATMENT MODALITIES OF ATLANTOAXIAL DISLOCATION IN RHEUMATOID ARTHRITIS

Background:

Cervical spine involvement is common in patients with rheumatoid arthritis (RA). The most common abnormality is atlantoaxial dislocation (AAD). It may lead to severe neurological symptoms and even death. Currently, there is a lack of consensus on the best approach to treatment.

Objectives:

We investigated the prevalence of and risk factors for AAD in patients with RA, as well as its relationship to treatment modalities.

Methods:

We conducted a cross-sectional study including 224 patients with RA. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck, anteroposterior and odontoid projection view. Patients were divided into two groups: (G1) a group with AAD and (G2) without ADD. We compared clinical, radiological, and laboratory findings between the two groups, as well as the treatments used: Steroid therapy, classic and biologic disease-modifying anti-rheumatic drugs (DMARDs). Structural joint damage was assessed with the Sharp/van der Heijde radiographic method. Functional impairment was assessed using the Health Assessment Questionnaire (HAQ). We used Statistical Package for Social Sciences (SPSS) 22.0 to analyze the results. The level of statistical significance was set at 0.05.

Results:

ADD was present in 16% of the cases (n=36). Female predominance was noted, with a sex ratio of 0.25 (p=0.530). The mean age was 58±12 years, with no significant difference between groups (p=0.146). The mean disease duration was significantly higher in G1 (11.5 ± 10.5 years versus 5.9 ± 6.3, p=0.004). A noticeable relationship between AAD and immunopositivity was found: rheumatoid factor (RF) was present in 86.1% of the cases in G1 versus 67.5% in G2 (p=0.025). Anti-citrullinated protein antibodies (ACPA) were present in 86.1% of the cases in G1 versus 64.8% in G2 (p=0.012). We found a significant difference between AAD and disease activity assessed by DAS28-VS (5.8±1.3 in G1 versus 5.3±1.6 in G2,p=0.027). AAD was significantly associated with more structural joint damage: erosions (121.1±60.9 in G1 versus 61.8±56.5 in G2,p<10-3), joints space narrowing (77.4±47.4 in G1 versus 38.7±40 in G2, p<10-3), Sharp/van der Heijde radiographic score (190.2±103.1 in G1 versus 100.1±90.6 in G2, p<10-3). Hip involvement was more frequent in G1 (22.2% versus 9.4% in G2, p=0.038).

HAQ score was higher in G1 (1.8±0.7 versus 1.2±1, p=0.002).

Seventy-five percent of patients in G1 had received methotrexate versus 82.3% in G2 (p=0.301). The mean duration of methotrexate therapy was longer in G1 (24.6±23.5 versus

18±24 months, p=0.015). G1 patients received a higher mean dose and cumulative dose of methotrexate: 13.2±3.5 g/week versus 11.8±4.4 g/week (p=0.048), and 6.5±6.8 versus 4.8±8.5 (p=0.025), respectively.

Thirty-five percent of patients in G1 had received corticosteroids versus 25% in G2 (p=0.217). Patients in G1 had a significantly longer duration of steroid therapy: 17.8 + 20.2 versus 13.3 + 24.3 months (p=0.22). The mean dose of corticosteroids was similar between the two groups: 6.9±4.3 mg/day versus 5.7±4.6 mg/day (p=0.132). The total cumulative dose was significantly higher in G1: 6.5±6.8 mg/day versus 4.8±8.5 mg/day (p=0.025).There was no significant difference in using other DMARDs: Sulfasalazine (p=0.182) and leflunomide (p=0.276).

No significant difference was observed with patients under biologic DMARDs: 24.1% in G1 versus 17% in G2 (p=0.725).

Conclusion:

Cervical spine involvement is common in RA and may be asymptomatic. Immunopositive patients seem to have more frequently ADD, as well as those with high disease activity and severe structural joint damage. The treatment modalities do not appear to be affected by AAD; however, patients with ADD seem to have higher cumulative doses of corticosteroids and methotrexate. Given the cross-sectional nature of our study, it is difficult to confirm the connection between the two. Further studies are needed.

Disclosure of Interests:

None declared

AB0519 PHYSICAL ACTIVITY AND OBESITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Ankylosing Spondylitis (AS) is associated with an increased cardiovascular risk. Obesity and limited activity in patients with AS may contribute to this cardiovascular risk.

Objectives:

We aimed to evaluate physical Activity and obesity in patients with AS.

Methods:

We conducted a cross-sectional observational study of 40 patients with AS, over a period of 3 months. We evaluated the level of physical activity using the IPAQ (International Physical Activity Questionnaire). We also measured body mass index (BMI), body fat percentage, waist circumference, hip circumference and their ratio in all patients.

Results:

The mean age of our population was 44±10 years. A male predominance was noted with a sex ratio =11.1. The mean ASDAS-CRP and BASDAI levels were 2.1±0.95 and 2.25±1.33. The mean of IPAQ was 3900 MET minutes per week, with a median of 3069 and extremes of 339 and 11000. 45.5% of patients had moderate physical activity and 20% had low activity.The mean BMI was 26.5 + 4.7 kg/m2. Twenty percent of patients were obese. The mean body fat percentage was 25% with a median of 23.7% and extremes of 8-46%. Forty-five percent of the patients had a high fat mass. The mean waist circumference was 95±13 cm, hip circumference 104±9.5 cm. The mean waist to hip ratio was 0.9±0.07. Thirty-seven percent of patients had a high waist to hip ratio. BMI and body fat percentage were negatively correlated with HDL level; (r=-0.365,p=0.024)and(r=-0.393,p=0.015) respectively.

Conclusion:

The majority of our patients have moderate or low levels of physical activity. The increase in BMI and fat mass appear to be associated with disturbance of the lipid balance, with low HDL values.

Disclosure of Interests:

None declared.

AB0518 ATHEROSCLEROTIC RISK IN PATIENTS WITH ANKYLOSING SPONDYLITIS: BIOMARKERS VERSUS SCORE

Background:

Chronic inflammatory rheumatic diseases are associated with a high cardiovascular risk. However, data in ankylosing spondylitis (AS) are still limited.

Objectives:

The aim of our study was to assess the atherosclerotic risk in patients with AS, by comparing the Systematic coronary risk evaluation: SCORE, with biomarkers of atherosclerosis: High sensitivity C-reactive protein (Hs-CRP), LDL/HDL ratio and apoliprotein A1 (Apo A) /apolipoprotein B (Apo B) ratio.

Methods:

We conducted a cross-sectional observational study of 40 patients with AS, over a period of 3 months. Socio-demographic data, clinical characteristics of the disease, as well as biological, radiological and therapeutic data were collected for each patient. Coagulated blood samples were collected following a 12-hour fast. Cardiovascular risk was considered high for Hs-CRP>3.0 mg/L [1], LDL/HDL> 3.5 in men and 3.0 in women [2], and ApoB/ApoA level>0.9 [3,4]. SCORE was calculated for all patients.

Results:

The mean age of our population was 44±10 years. Male predominance was noted with a sex ratio =11.1. The mean ASDAS-CRP and BASDAI levels were 2.1±0.95 and 2.25±1.33. Thirty-two percent of the patients had a high risk of cardiovascular diseases according to Hs-CRP level, with an average of 10.7 mg/L. The mean LDL/HDL ratio was high in twenty-two percent of the patients. The mean value of ApoA1 and ApoB was respectively 1.3 g/l. and 0.9 g/l. Low values of Apo A1 were determined in 12.5% of the subjects, and high values of ApoB were found in 15% of subjects. The mean value of ApoA/ApoB ratio was 0.7. Ten percent of the studied subjects had an unfavourable ApoB/ApoA1. The predicted 10-year risk of CV mortality according to SCORE was high in 5% of the patients, very high in 2.5% and moderate in 35% of them. Over 17 patients with moderate, high and very high risk according to SCORE: Four patients (23.5%) had high LDL/HDL ratio, 8 (47%) had high waist/hip ratio, 5 (29.4%) had high Hs-CRP level, and 2 (11.7%) had high ApoB/ApoA ratio.

We found ApoB/ApoA to be positively correlated with Hs-CRP (r=0.31, p=0.05). The SCORE was correlated to the age at the onset of the disease (r=0.78, p<10-3).

Conclusion:

The atherosclerotic risk in our population ranged from 10 to 43%. SCORE presented with the highest percentage, making it more suitable for mass screening. Biomarkers on the other hand are more precise. Hs-CRP is biomarker to be included in daily practice, even when AS is in remission. Accuracy of the apoB/apoA ratio is significantly great and appears to be associated with inflammation.

References:

[1]Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, Biasucci LM, et al. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Report From the Laboratory Science Discussion Group. Circulation [Internet]. 2004 Dec 21 [cited 2020 Oct 20];110(25).

[2]Munoz. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. VHRM. 2009 Sep;757.

[3]Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. The Lancet. 2001 Dec;358(9298):2026–33.

Disclosure of Interests:

None declared.

AB0512 CLINICAL AND RADIOLOGICAL FEATURES OF SHOULDER INVOLVEMENT IN SPONDYLARTHRITIS

Background:

Peripheral joint involvement is frequent among patients with peripheral spondylarthritis (SA). However, the root joint involvement, such as hip involvement, has been described as being associated with axial spondylarthritis, while data for shoulder involvement are scarce. Cuff tendonitis and enthesitis are common features in the shoulder in patients with SA.

Objectives:

This study aimed to identify the prevalence of shoulder involvement in SA patients and describe its clinical and radiological features.

Methods:

We conducted a retrospective study including SA patients, all fulfilling the assessment of Spondyloarthritis International Society (ASAS) criteria.

For all patients, we collected the following data: Age, the clinical presentation of SA, the inflammatory biomarkers C-reactive protein (CRP), and the disease activity assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).

Regarding shoulder involvement, we assessed the following items: tenderness, mobility, rotator cuff tests, as well as the results of X-ray and Ultrasound examination (US).

Results:

We included one hundred and thirty-one SA patients (mean age 39,77 years). Among them, sixty-two percent were male. Ten percent of patients were smokers, 46,6% had the peripheral beginning of the disease. Fourteen patients complained of shoulder pain. The majority of them were male.

X-rays showed no abnormalities (n=2), while a destructive form was noted in (n=7).

Rotator cuff rupture or enthesopathy was also revealed by the reduction of subacromial space (n=5), condensation of the greater tuberosity (n=3), crooked aspect of the acromion (n=2), and Moloney’s line disruption(n=1).

US showed no abnormalities (n=1), supraspinatus tendinopathy (n=5), supraspinatus transfixing tear (n=1), infraspinatus tendinopathy (n=2), supraspinatus enthesopathy (n=2), infraspinatus enthesopathy (n=1), moderate synovitis (n=1), subacromiodeltoid bursitis (n=1).

Shoulder involvement was correlated significantly with the peripheral beginning of SA (P < 0.05). There were no significant differences in gender, tobacco use, CRP value, and the disease activity between the two groups (P > 0.05).

Conclusion:

The shoulder involvement was rare in our study. It is characterized by cuff tendonitis and enthesitis, especially in supraspinatus insertion. However, the glenohumeral synovitis was uncommon in our series, even in the peripheral form of the disease.

References:

[1]Hip and Shoulder Involvement and Their Management in Axial Spondyloarthritis: a Current Review Clementina López-Medina1,2,3,4 & M. Carmen Castro-Villegas1,2,3 & Eduardo Collantes-Estévez1,2,3, 23 July 2020.

Acknowledgements:

I would like to thank all the authors listed above, for they helped me make writing my first abstract less harder.

Disclosure of Interests:

None declared.

AB0150 ACPA-STATUS AND RHEUMATOID ARTHRITIS: MUCH MORE TO BE REVEALED!

Background:

Anti-citrullinated protein antibodies (ACPA) are commonly associated with Rheumatoid arthritis (RA). RA is, therefore, classified as immunopositive or immunonegative, with disparate mechanisms in predisposition.

Objectives:

Our study aimed to determine the baseline characteristics and differences of ACPA-positive and ACPA-negative RA.

Methods:

We conducted a cross-sectional study including 224 patients with RA. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. The patients were divided according to their ACPA status into two groups: ACPA-positive group (G1) and ACPA-negative group (G2). We compared clinical, radiological, and laboratory findings between the two groups, as well as extra-articular manifestations, comorbidities including fractures and osteoporosis. The Fracture Risk Assessment Tool (FRAX) was used to estimate the 10-year probability of major osteoporotic fracture (MOF) and also hip fracture (FH).

Results:

Of the 224 patients, 31.6% were negative for ACPA (n=71). Female predominance was found in both groups with a sex ratio of 0.25 (p=0.203). ACPA-negative subjects were younger (57±11 versus 59±12 years) (p= 0.305).

The initial presentation of RA was different between the two groups without reaching statistical significance. In the ACPA-negative group, alteration of general condition was more frequent (16.9% in G2 versus 13.7% in G1) (p=0.533), with a tendency to oligo-articular onset (18.5% in G2 versus 6.7% in G1) (p=0.737). ACPA-positivity was more associated with an acute start of symptoms (10.4% in G1 versus 8.4% in G2) (p=0.639)

There was no significant difference in the mean DAS28-VS (5.2±1.1 in G2 versus 5.5±1.3 in G1) and DAS28-CRP levels (5±1 in G2 versus 5.3±1.2 in G1) (p=0.069 and p=0.098 respectively).

ACPA-positive RA was, however, significantly associated with more structural joint damage: erosions (55.9±53 in G1 versus 78±36 in G2, p=0.01), joint space narrowing (50.4±45.5 in G1 versus 33.1±36.6 in G2, p=0.003), Sharp/van der Heijde radiographic score (126.6 ±103.2 in G1 versus 88.8±81.5 in G2, p=0.004). ACPA-positive RA patients had more atlantoaxial dislocation: 20.2% in G1 versus 7% in G2 (p=0.012). There was no significant difference in hip involvement (9.8% in G1 versus 14% G2) (p=0.344).

There were no significant differences in extra-articular manifestations between the two groups: Rheumatoid nodules (10.4% in G1 versus 18.3% in G2) (p=0.891), Sjögren’s syndrome (16.3% in G1 versus 16.9% in G2)(p=0.715), amyloidosis (0.6% in G1) (p=1), pulmonary fibrosis (5.8% in G1 versus 4.2% in G2) (p=0.757), neurological signs (4.5% in in G1 versus 5.6% in G2) (p=0.733), anaemia (5.8% in G1 versus 1.4% in G2) (p=0.175).

When analyzing comorbidities, no significant differences were found: diabetes (10.4% in G1 versus 18.3% in G2) (p=0.103), cardiovascular diseases (19.6% in G1) (p=1), neurological diseases (0.06% in G1 versus 1.4% in G2) (p=0.534), dysthyroidism (2.6% in G1 versus 5.6% in G2) (p=0.267), dyslipidemia (3.2% in G1 versus 4.2% in G2) (p=0.711), cancer (1.3% in G1) (p=1). There were neither significant differences in the prevalence of fracture (21.5% in G1 versus 18.3% in G2) (p=0.574), and osteoporosis (23.6% in G1 versus 29.5% in G2) (p=0.347), between the two groups. However, ACPA-positive patients presented with a significantly higher FRAX score of MOF (2±2.8 in G1 versus 1.2±1 in G2) (p=0.006), and FRAX score of FH (0,9±1.8 in G1 versus 0.3±0.5 in G2) (p=0.003).

Conclusion:

ACPA status appears to influence both the clinical presentation and radiological progression of RA patients. ACPA-positive patients present with an acute start of symptoms, with more structural damages and atlantoaxial dislocation. Comorbidities, including osteoporosis, does not seem affected by ACPA status. However, regardless of osteoporosis, ACPA-positivity is associated with a higher probability of major osteoporotic and hip fractures. Further research is needed to clarify this relationship.

Disclosure of Interests:

None declared