Abstract Whether cancer cells metastasize from the primary site to the distant sites via the lymphatic vessels or the blood vessels directly into the circulation is still under intense study. In this review article, we follow the journey of cancer cells metastasizing to the sentinel lymph nodes and beyond to the distant sites. We emphasize cancer heterogeneity and microenvironment as major determinants of cancer metastasis. Multiple molecules have been found to be associated with the complicated process of metastasis. Based on the large sentinel lymph node data, it is reasonable to conclude that cancer cells may metastasize through the blood vessels in some cases but in most cases, they use the sentinel lymph nodes as the major gateway to enter the circulation to distant sites. 

Cancer metastasis through the lymphatic versus blood vessels

Familiar controversies in the management of head and neck melanomas are more remarkable in locally advanced cases, and they represent a treatment challenge both surgically and oncologically. In our retrospective study, patients with surgically treated primary malignant melanoma of the head and neck region larger than 3 cm in diameter were included. Five patients met our inclusion criteria. In all cases, wide excision and immediate reconstruction were performed without sentinel lymph node biopsy. The defect on the scalp was covered by a split skin graft, with local flaps chosen for reconstruction on the face on an individual basis. After a 2–6 year follow-up, a good oncological, functional, and esthetic result was achieved. Our results show that in the case of large, locally advanced melanomas, surgical treatment still plays a crucial role that can provide long-term local control and support the effect of systemic treatment.

/pdf/challenges-in-the-complex-management-of-neglected-cutaneous-5imv9lto.pdf

Challenges in the Complex Management of Neglected Cutaneous Melanomas in the Head and Neck Area: A Single Center Experience

BACKGROUND:Regional lymph nodes are a common first site of metastasis in patients diagnosed with invasive melanoma. Knowledge of sentinel lymph node status provides strong prognostic information in melanoma and is important for staging and treatment decisions. The National Comprehensive Cancer Network® (NCCN) recommends performance of sentinel lymph node biopsy (SLNB) for melanoma patients with a T category of ≥T2a. This study aims to assess our academic institution's guideline adherence to improve quality of care. METHODS:Retrospective review of medical records from 2017 to 2023 identified 628 patients referred to our institution for invasive melanoma treatment. Adherence to guidelines was assessed using Chi-square analyses and Fisher's exact tests. RESULTS:In total, 8.2% of cases did not follow the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for SLNB. When justification provided within the medical record was considered adherent to guidelines, our rate of discordance was 1.6%. Head and neck melanomas were more likely to have guideline-discordant SLNB management, regardless of whether or not a justification was provided. CONCLUSION:Greater than 98% of melanoma cases at our institution aligned with the SLNB NCCN Guidelines®. We outlined the complex justifications physicians and patients may use to pursue care that is nonadherent to guidelines. Employment of SLNB may be limited by medical comorbidities, surgical risks, and when the management would not change based on the result. Our study provides a blueprint for institutional assessment of guideline adherence and highlights the importance of documentation and guideline dissemination.

An Evaluation of Sentinel Lymph Node Biopsy Guideline Adherence in Melanoma Patients

The aim of this study was to evaluate independent predictors of prognosis in patients with mixed medullary and follicular cell carcinoma (MMFCC) and to establish the novel prognostic nomograms in the academic community for 3-, 5-, and 10 year CSS and OS in patients with MMFCC.Demographic information, clinicopathological characteristics, treatment information, and survival status information of 200 patients with MMFCC and 6615 patients with medullary thyroid carcinoma (MTC) from 2000 to 2020 in the SEER database were retrospectively analyzed. Independent predictors of prognosis in MMFCC patients were derived using univariate and multivariate Cox regression analyses after relevant comparisons based on pathologic typing. On this basis, we developed and validated clinical prognostic nomograms and risk-stratified the patient population.In this study, the clinical information of 200 patients with MMFCC was compared with that of 5947 patients with MTC (NOS) and 668 patients with MTC with amyloid stroma, and there was a significant difference in the relevant variables among the three, with the CSS being 88.5%, 87.5%, and 90.9%, and the OS being 76.5%, 75.4%, and 83.8%. Univariate and multivariate Cox regression analyses yielded that age at diagnosis, presence of distant metastases, thyroidectomy scope, and lymph node dissection status were significantly correlated with the prognosis of patients (P < 0.05), and were independent predictors of CSS and OS for patients with MMFCC, and the Kaplan-Meier survival curves plotted by these factors demonstrated their predictive power for the prognosis of patients with MMFCC. The concordance index of the prognostic nomograms of CSS and OS established on this basis was 0.838 and 0.794, respectively, and the time-dependent area under curve, calibration curve, and decision curve analysis curve showed that the model had good discriminative ability, accuracy, and clinical applicability.In this study, we concluded that there are large differences between MMFCC and MTC in terms of demographic information, clinicopathological characteristics, treatment information, and survival status information, and we constructed the novel prognostic nomograms for 3-, 5-, and 10 year CSS and OS for patients with MMFCC with risk stratification, which will help clinicians to develop individualized protocols for their postoperative treatments and follow-ups. 

The novel prognostic nomograms for predicting cancer-specific survival and overall survival in mixed medullary and follicular cell carcinoma: A SEER-based study.

Thyroid malignancies are considered rare but it is the most common type of endocrine malignancy that increase rapidly over the past decades. Specifically, papillary thyroid carcinoma (PTC) in the pyramidal lobe is extremely rare. Herein, we described a case of recurrence case of PTC in the pyramidal lobe post total thyroidectomy with category VI T2N1M1 (Bethesda classification) with right neck lymph nodes metastasis at once and attempt to determine both clinical presentation and therapeutical strategies to overcome this case to diminish the possibility of tumor recurrence and optimize therapeutic outcomes for PTC recurrence. It was reported a 28 yo female with a diagnosis of PTC from the pyramidal lobe post-total thyroidectomy procedure. A definite diagnosis of PTC is important to understand the patient's condition and as a consideration to decide the appropriate procedure to cure it. The management of PTC with total thyroidectomy followed by removing the possible root source of recurrent PTC, such as the pyramidal lobe, is mandatory to minimize the residual thyroid tissue that dan influenced PTC recurrent. Even though almost all PTC has an excellent prognosis, periodic follow-up after surgery, and patients’ adherence to their medication are still required. 
 

Papillary thyroid carcinoma post total thyroidectomy: a case report

/pdf/sentinel-lymph-node-biopsy-in-cutaneous-melanoma-a-clinical-3er72nv1.pdf

Sentinel Lymph Node Biopsy in Cutaneous Melanoma, a Clinical Point of View

Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease; non-invasive biomarkers that accurately reflect the endoscopic and histological activity of UC require validation. Therefore, our study focused on exploring the potential of serum oncostatin M (OSM) as a biomarker for evaluating UC severity. A total of UC 89 eligible participants (≥18 years) underwent extensive clinical and paraclinical evaluation. Clinical, endoscopic, and histological activity were assessed using the partial Mayo score (pMS), the Mayo endoscopic score (MES), and the Nancy Histological Index (NHI), respectively. Serum OSM levels were determined by ELISA test and measured in pg/mL; fecal calprotectin (FC) was measured in µ/g. In our study, serum OSM was significantly associated with all four outcome measures: higher OSM levels predicted higher pMS (β = 0.471, p < 0.001, R2 = 0.222), MES (β = 0.422, p < 0.001, R2 = 0.178), NHI (β = 0.422, p < 0.001, R2 = 0.256), and FC (β = 0.431, p < 0.001, R2 = 0.186). Furthermore, ROC curve analyses demonstrated that OSM had excellent diagnostic accuracy for active disease, particularly in relation to histological inflammation (AUC = 0.967). In comparison, FC showed good but slightly lower accuracy (AUC = 0.875). Notably, OSM also outperformed FC in discriminating histological remission. Pairwise ROC curve analyses using DeLong’s test further confirmed the diagnostic accuracy of OSM, FC, and combined biomarker scores (OSM+FC) across clinical, endoscopic, and histological endpoints. The combined score PRE1 (OSM + FC based on NHI) achieved perfect discrimination (AUC = 1.000, p < 0.001). Composite models PRE2 and PRE3 (OSM+FC based on MES and pMS) improved diagnostic accuracy relative to OSM, confirming the value of combining OSM with FC. Although both outperformed OSM (p < 0.05), neither achieved a superior advantage over FC. Serum OSM is strongly associated with histological activity in UC and demonstrates superior performance compared with FC in assessing histological remission.

Serum Oncostatin M in Ulcerative Colitis Patients and Its Relation to Disease Activity

Thyroid collision tumors (TCTs) are rare pathological findings, representing <1% of thyroid cancers. This study aimed to compare the main pathological features of TCTs containing medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) components with MTC-only tumors and PTC-only tumors. Methods: The retrospective study included 69 cases diagnosed with TCTs (with simultaneous MTC and PTC components), MTC and PTC. All tumors were comparatively assessed for the classical histopathological prognostic features, including a new grading system for MTC. Results: The main component of TCTs had more frequent microscopic extrathyroidal extension (mETE) (p = 0.000), lymphovascular invasion (LVI) (p = 0.000), perineural invasion (PNI) (p = 0.044), and lymph node metastasis (p = 0.042). Additionally, the TCTs’ MTC component presented with more frequent LVI (p = 0.010). Comparing TCTs’ MTC and PTC components with MTC-only tumors and PTC-only tumors revealed that only the TCTs’ MTC components had statistically significant more frequent mETE (p = 0.010) than MTC-only tumors. When applied to the MTC component of TCTs, the pathological parameters of the new grading system of MTC showed no correlations with other microscopic or clinical aspects. Conclusion: Using classical pathological prognostic features, the comparative analysis revealed that the main TCTs’ component was more aggressive than the minor one. Contrary to PTCs, in TCTs, the medullary component was more aggressive than the papillary one, but also more aggressive than MTC-only tumors.

https://www.mdpi.com/2075-4418/13/2/285/pdf?version=1673949928

Thyroid Collision Tumors: The Presence of the Medullary Thyroid Carcinoma Component Negatively Influences the Prognosis

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Sentinel Lymph Node Biopsy in Cutaneous Melanoma, a Clinical Point of View

Serum Oncostatin M in Ulcerative Colitis Patients and Its Relation to Disease Activity

Thyroid Collision Tumors: The Presence of the Medullary Thyroid Carcinoma Component Negatively Influences the Prognosis