bims-netuvo 2024-09-08 papers

bims-netuvo

Biomed News

on Nerves in tumours of visceral organs

Issue of 2024–09–08
eightteen papers selected by
Maksym V. Kopanitsa, Charles River Laboratories

Neural Circuitries between the Brain and Peripheral Solid Tumors.
Cervical cancer-produced neuromedin-B reprograms Schwann cells to initiate perineural invasion.
Analysis of neuroglia and immune cells in the tumor microenvironment of breast cancer brain metastasis.
Incidence of Central Nervous System Relapse in Primary Mediastinal Large B-Cell Lymphoma: Implications for Central Nervous System Prophylaxis.
Global and single-cell proteomics view of the co-evolution between neural progenitors and breast cancer cells in a co-culture model.
Regulation and Crosstalk of Cells and Factors in the Pancreatic Cancer Microenvironment.
A Case Report and Review of Diagnostic and Therapeutic Challenges of a Malignant Peripheral Nerve Sheath Tumor in the Foot.
Successful Treatment of Peripheral Nerve Sheath Tumor-related Pain with Perineural Steroid Injection: a case report.
The CoREST complex is a therapeutic vulnerability in malignant peripheral nerve sheath tumors.
Rapidly Growing Leiomyoma Mimicking Schwannoma of the Saphenous Nerve in the Lower Extremity: An Unusual Case Report.
Triple therapy boosts survival in NSCLC patients with brain metastases: a retrospective cohort study of chemotherapy, ICIs, and antiangiogenic agents.
A Rare Case of a Gigantic Retroperitoneal Schwannoma.
Energy spectrum computed tomography multi-parameter imaging in preoperative assessment of vascular and neuroinvasive status in gastric cancer.
Cancer survivors and cancer pain.
Neurologic Clinical, Electrophysiologic, and Pathologic Characteristics of Primary vs Secondary Neurolymphomatosis.
Leptomeningeal metastases in prostate cancer: A review of the current literature.
Thoracoscopic resection of a giant esophageal schwannoma: A case report and review of literature.
Effects of exercise in adults with cancer pain: a systematic review and Network meta-analysis.

Cancer Res. 2024 Sep 03.

Neural Circuitries between the Brain and Peripheral Solid Tumors.

Xiang Chen, Yuli Geng, Guanxin Wei, Danzeng He, Jialong Lv, Wenhao Wen, Fan Xiang, Kaixiong Tao, Chuanqing Wu.

The recent discovery of the pivotal role of central nervous system (CNS) in controlling tumor initiation and progression has opened a new field of research. Increasing evidence suggests a bidirectional interaction between the brain and tumors. The brain influences the biological behavior of tumor cells through complex neural networks involving the peripheral nervous system, the endocrine system, and the immune system, while tumors can establish local autonomic and sensory neural networks to transmit signals into the CNS, thereby affecting brain activity. This review aims to summarize the latest research in brain-tumor crosstalk, exploring neural circuitries between the brain and various peripheral solid tumors, analyzing the roles in tumor development and the related molecular mediators and pathological mechanisms, and highlighting the critical impact on the understanding of cancer biology. Enhanced understanding of reciprocal communication between the brain and tumors will establish a solid theoretical basis for further research and could open avenues for repurposing psychiatric interventions in cancer treatment.

DOI: https://doi.org/10.1158/0008-5472.CAN-24-1779
Cell Death Dis. 2024 Aug 30. 15(8): 636

Cervical cancer-produced neuromedin-B reprograms Schwann cells to initiate perineural invasion.

Xiaoyan Gao, Qi Wang, Ting Huang, Chen Xu, Xiaoming Yang, Lin Zhang, Jing Wang, Linlin Yang, Xuan Zheng, Qiong Fan, Dan Cao, Lijuan Li, Ting Ni, Xiao Sun, Jin Hou, Yudong Wang.

Perineural invasion (PNI) is a new approach of cervical cancer invasion and metastasis, involving the cross-talk between tumor and nerve. However, the initiating signals and cellular interaction mechanisms of PNI remain largely elusive. The nerve-sparing radical hysterectomy (NSRH) proposed to improve postoperative quality of life is only applicable to cervical cancer patients without PNI. Therefore, it is important to elucidate the underlying mechanisms initiating PNI, and suggest the effective biomarkers to predict PNI before NSRH surgery. Here, we found that PNI is the characteristic of advanced cervical cancer, and Schwann cells were the antecedent cells that initiating PNI. Further, neuropeptide neuromedin B (NMB) produced by cervical cancer cells was determined to induce PNI by reprogramming Schwann cells, including driving their morphological and transcriptional changes, promoting their proliferation and migration, and initiating PNI by secreting CCL2 and directing axon regeneration. Mechanistically, cervical cancer cells-produced NMB activated its receptor NMBR in Schwann cells, and opened the T-type calcium channels to stimulate Ca2+ influx through PKA signaling, which could be blocked by the inhibitor. Clinically, combined examination of serum NMB and CCL2 levels was suggested to effectively predict PNI in cervical cancer patients. Our data demonstrate that cervical cancer-produced NMB initiates the reprograming of Schwann cells, which then direct axon regeneration, thus causing PNI onset. The elevated serum NMB and CCL2 levels may be useful for the decision-making to nerve sparing during hysterectomy surgery of cervical cancer patients.

DOI: https://doi.org/10.1038/s41419-024-07030-9
Cancer Biol Ther. 2024 Dec 31. 25(1): 2398285

Analysis of neuroglia and immune cells in the tumor microenvironment of breast cancer brain metastasis.

Haixin Mo, Xin Zhang, Liangliang Ren.

  Breast cancer stands as the most prevalent cancer diagnosed worldwide, often leading to brain metastasis, a challenging complication characterized by high mortality rates and a grim prognosis. Understanding the intricate mechanisms governing breast cancer brain metastasis (BCBM) remains an ongoing challenge. The unique microenvironment in the brain fosters an ideal setting for the colonization of breast cancer cells. The tumor microenvironment (TME) in brain metastases plays a pivotal role in the initiation and progression of BCBM, shaping the landscape for targeted therapeutic interventions. Current research primarily concentrates on unraveling the complexities of the TME in BCBM, with a particular emphasis on neuroglia and immune cells, such as microglia, monocyte-derived macrophages (MDMs), astrocytes and T cells. This comprehensive review delves deeply into these elements within the TME of BCBM, shedding light on their interplay, mechanisms, and potential as therapeutic targets to combat BCBM.

Keywords:  Breast cancer; brain metastasis; immune cells; neuroglia; tumor microenvironment

DOI:  https://doi.org/10.1080/15384047.2024.2398285
Clin Lymphoma Myeloma Leuk. 2024 Aug 02. pii: S2152-2650(24)00290-8. [Epub ahead of print]

Incidence of Central Nervous System Relapse in Primary Mediastinal Large B-Cell Lymphoma: Implications for Central Nervous System Prophylaxis.

Izel Okcu, Yucai Wang, Allison M Bock, Jihao Zhou, Muhamad Alhaj Moustafa, Han W Tun, Allison C Rosenthal, Patrick B Johnston, Firas Baidoun, Arushi Khurana, Brian F Kabat, Rebecca L King, Thomas M Habermann, Grzegorz S Nowakowski.

   BACKGROUND: Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon type of aggressive B-cell non-Hodgkin lymphoma. PMBCL shares some clinical and biologic features with nodular sclerosis classic Hodgkin lymphoma (cHL). Central nervous system (CNS) relapse is exceedingly rare in cHL. Therefore, it may be expected that CNS relapse in PMBCL is also uncommon. Herein, we examined the incidence of CNS relapse in patients with PMBCL treated with standard chemoimmunotherapy.
PATIENTS AND METHODS: This retrospective single center analysis included 154 patients with newly diagnosed PMBCL seen at Mayo Clinic. The CNS relapse rate was calculated using a competing risk model, with death considered as a competing risk.
RESULTS: With a median follow-up of 39 months, 3 patients experienced CNS relapse, all associated with systemic relapse. The cumulative incidence of CNS relapse for the entire cohort was 1.43% (95% CI, 0.3%-4.6%) at 1 year and 2.21% (95% CI, 0.6%-5.8%) at both 2 and 5 years. For those who did not receive CNS prophylaxis (n = 131), the incidence was 0.85% (95% CI, 0.1%-4.2%) at 1 year and 1.80% (95% CI, 0.3%-5.8%) at both 2 and 5 years. All 3 patients who experienced CNS relapse had R-CHOP as frontline therapy; 2 patients did not receive any CNS prophylaxis, while 1 patient received intrathecal CNS prophylaxis.
CONCLUSION: The risk of CNS relapse in PMBCL appears to be very low after treatment with standard chemoimmunotherapy, suggesting routine CNS prophylaxis is not necessary.

Keywords:  DA-EPOCH-R; Intrathecal chemotherapy; Methotrexate; Non-Hodgkin's lymphoma; R-CHOP

DOI:  https://doi.org/10.1016/j.clml.2024.07.019
EBioMedicine. 2024 Sep 03. pii: S2352-3964(24)00361-X. [Epub ahead of print]108 105325

Global and single-cell proteomics view of the co-evolution between neural progenitors and breast cancer cells in a co-culture model.

Ole Vidhammer Bjørnstad, Manuel Carrasco, Kenneth Finne, Vandana Ardawatia, Ingeborg Winge, Cecilie Askeland, Jarle B Arnes, Gøril Knutsvik, Dimitrios Kleftogiannis, Joao A Paulo, Lars A Akslen, Heidrun Vethe.

   BACKGROUND: Presence of nerves in tumours, by axonogenesis and neurogenesis, is gaining increased attention for its impact on cancer initiation and development, and the new field of cancer neuroscience is emerging. A recent study in prostate cancer suggested that the tumour microenvironment may influence cancer progression by recruitment of Doublecortin (DCX)-expressing neural progenitor cells (NPCs). However, the presence of such cells in human breast tumours has not been comprehensively explored.
METHODS: Here, we investigate the presence of DCX-expressing cells in breast cancer stromal tissue from patients using Imaging Mass Cytometry. Single-cell analysis of 372,468 cells across histopathological images of 107 breast cancers enabled spatial resolution of neural elements in the stromal compartment in correlation with clinicopathological features of these tumours. In parallel, we established a 3D in vitro model mimicking breast cancer neural progenitor-innervation and examined the two cell types as they co-evolved in co-culture by using mass spectrometry-based global proteomics.
FINDINGS: Stromal presence of DCX + cells is associated with tumours of higher histological grade, a basal-like phenotype, and shorter patient survival in tumour tissue from patients with breast cancer. Global proteomics analysis revealed significant changes in the proteomic landscape of both breast cancer cells and neural progenitors in co-culture.
INTERPRETATION: These results support that neural involvement plays an active role in breast cancer and warrants further studies on the relevance of nerve elements for tumour progression.
FUNDING: This work was supported by the Research Council of Norway through its Centre of Excellence funding scheme, project number 223250 (to L.A.A), the Norwegian Cancer Society (to L.A.A. and H.V.), the Regional Health Trust Western Norway (Helse Vest) (to L.A.A.), the Meltzer Research Fund (to H.V.) and the National Institutes of Health (NIH)/NIGMS grant R01 GM132129 (to J.A.P.).

Keywords:  Breast cancer; Cancer innervation; Co-culture model; Doublecortin (DCX); Imaging mass cytometry; Molecular subtypes; Neural progenitor cells; Proteomics

DOI:  https://doi.org/10.1016/j.ebiom.2024.105325
Curr Cancer Drug Targets. 2024 Sep 02.

Regulation and Crosstalk of Cells and Factors in the Pancreatic Cancer Microenvironment.

Jia Xu, Songmei Lou, Hui Huang, Jian Xu, Feng Luo.

  Pancreatic cancer is a highly malignant form of cancer that distinguishes itself from other gastrointestinal tumors through significant fibrosis and unique perineural invasion. These characteristics underscore the complexity of neural regulation within the pancreatic cancer Tumor Microenvironment (TME). This review aimed to explore the regulatory mechanisms and crosstalk among stromal cells and their factors within the pancreatic cancer microenvironment. We begin by reviewing the major components of the pancreatic cancer microenvironment, analyzing interactions among crucial cell types, such as Cancer-associated Fibroblasts (CAFs) and immune cells, and revealing the dynamic changes between tumor cells and surrounding nerves, immune, and stromal cells. We discuss the role of neural factors, including the Nerve Growth Factor (NGF) and Brain-derived Neurotrophic Factor (BDNF), in the progression of pancreatic cancer and the mechanisms by which the sympathetic and parasympathetic nervous systems regulate tumor cell growth, migration, and invasion. Interactions among stromal cells, cytokines, and neural factors in the pancreatic cancer microenvironment promote fibrosis and perineural invasion. A deeper understanding of the regulation and crosstalk among components in the pancreatic cancer microenvironment offers new perspectives for inhibiting fibrosis and perineural invasion in pancreatic cancer.

Keywords:  Pancreatic cancer; neural factors; stromal components.

DOI:  https://doi.org/10.2174/0115680096317840240723071018
Cureus. 2024 Jul;16(7): e65669

A Case Report and Review of Diagnostic and Therapeutic Challenges of a Malignant Peripheral Nerve Sheath Tumor in the Foot.

Khushbu Vaidya, Raju K Shinde, Somya Goel, Kavisha Shah.

  Malignant peripheral nerve sheath tumors are rare. It is a soft tissue carcinoma with an aggressive nature, and it is usually associated with a poor prognosis. Common clinical presentations may include local pain, weakness, a growing mass, tingling, and numbness due to the compression of adjacent nerves or tissues, as well as weakness in affected nerves. Radiological assessment tools, such as magnetic resonance imaging and histopathological analysis, can confirm the diagnosis of malignant peripheral nerve sheath tumors. A multidisciplinary approach can manage these tumors with a timely follow-up to improve the outcomes. This is the case report of a 56-year-old female with a painless lesion on her left foot for 15 years, which recently started causing pain and a sticky discharge over the past six months. The patient was later diagnosed with a malignant peripheral nerve sheath tumor on histopathological examination, which was managed by forefoot excision without any complications. The patient recovered well at the three-month follow-up with no new complaints.

Keywords:  discoloration of the foot; foot tumors; malignant tumors; nerve sheath tumors; progressive swelling

DOI:  https://doi.org/10.7759/cureus.65669
Interv Pain Med. 2024 Mar;3(1): 100394

Successful Treatment of Peripheral Nerve Sheath Tumor-related Pain with Perineural Steroid Injection: a case report.

David S Jevotovsky, Elizabeth Callahan, Jina Libby, Salvador E Portugal.

  Pain associated with Neurofibromatosis Type 1 (NF1) is poorly understood. To date, no treatment options have been approved for NF1-related pain. We present the case of a young female NF1 patient with intermittent buttock pain radiating down the leg who presented with positive dural tension signs. The patient was diagnosed with neurofibroma sciatic nerve compression, which was successfully managed with ultrasound-guided perineural steroid injection. There is sparse literature regarding the efficacy of ultrasound-guided perineural steroid injection in NF1 patients for treatment of benign peripheral nerve sheath tumor compressions. This case describes the utility of perineural steroid injections for symptomatic relief of NF1 neurofibroma-related pain. Perineural steroid injections should be considered when neurofibroma-related pain fails to respond to other conservative treatment. Steroid injections provide an alternative to oral medicinal management and avoid the often morbid risks of surgical intervention.

Keywords:  Injections; Neurofibromatosis 1; Pain; Ultrasonography

DOI:  https://doi.org/10.1016/j.inpm.2024.100394
bioRxiv. 2024 Aug 19. pii: 2024.08.17.607802. [Epub ahead of print]

The CoREST complex is a therapeutic vulnerability in malignant peripheral nerve sheath tumors.

Imad Soukar, Robert Fisher, Sanjana Bhagavatula, Marianne Collard, Philip A Cole, Rhoda M Alani.

Malignant peripheral nerve sheath tumor (MPNST) is a highly aggressive sarcoma that may be seen in patients with neurofibromatosis type 1 (NF1) or occur sporadically. While surgery is the primary treatment for localized MPNST with a 61.9% overall survival rate, metastatic disease is often fatal due to resistance to systemic therapies which underscores the urgent need for effective treatments. MPNSTs frequently harbor inactivating driver mutations in the PRC2 epigenetic repressor complex suggesting epigenetic therapies may represent a specific vulnerability in these tumors. Here, we investigate the role of the LSD1-HDAC1-CoREST (LHC) repressor complex in mediating MPNST tumor growth and progression. Our findings demonstrate that the LHC small molecule inhibitor, corin, induces apoptosis and significantly inhibits proliferation in MPNST cells. Transcriptomic analysis of corin-treated MPNST cells demonstrates specific increases in genes associated with axonogenesis and neuronal differentiation as well as altered extracellular matrix; additionally, corin treatment is shown to inhibit MPNST invasion in vitro. These results underscore the critical role of the LHC complex in facilitating MPNST growth and progression and suggest that targeting the LHC complex represents a promising therapeutic approach for this aggressive malignancy.

DOI: https://doi.org/10.1101/2024.08.17.607802
J Musculoskelet Neuronal Interact. 2024 Sep 01. 24(3): 325-329

Rapidly Growing Leiomyoma Mimicking Schwannoma of the Saphenous Nerve in the Lower Extremity: An Unusual Case Report.

Şule Göktürk, Yasin Göktürk, Kağan Kamaşak, Fatoş Tekelioğlu.

Leiomyomas and schwannomas are both types of rare benign soft tissue tumours. Leiomyomas are more commonly found in the lower limbs than in the upper extremities, while schwannomas are rare peripheral nerve sheath tumours that can occur in different anatomical regions. However, they rarely occur in the saphenous nerve. This case study presents a 41-year-old female patient with a solitary mass lesion located deep in the soft tissue of the anteromedial lower extremity. The physical examination revealed a palpable, elastic-hard, mobile and non-tender mass. Magnetic resonance imaging (MRI) showed an oval-shaped subcutaneous mass on contrast-enhanced T1-weighted sections. The initial MRI images suggested a schwannoma, but the tumour was later confirmed to be a leiomyoma after total enucleation. An immunohistochemical study was performed for differential diagnosis. Solitary mass lesions in the lower extremities can be mistaken for various types of tumours and misdiagnosed and require histopathological examination and good radiological imaging for differential diagnosis. Complete surgical excision is usually a safe and effective treatment for leiomyomas.

Keywords: Leiomyoma; Lower Extremity Tumour; Neoplasm; Schwannoma; Soft Tissue Tumour
Cancer Immunol Immunother. 2024 Sep 06. 73(11): 226

Triple therapy boosts survival in NSCLC patients with brain metastases: a retrospective cohort study of chemotherapy, ICIs, and antiangiogenic agents.

Dingyi Yang, Erha Munai, Siwei Zeng, Dan Tao, Ze Yuan, Liang Du, Wei Zhou, Yongzhong Wu, Xiao-Dong Zhu.

   BACKGROUND: Treatment of brain metastases (BMs) in non-small cell lung cancer (NSCLC) patients, especially those with non-sensitive genetic mutations, is hindered by limited drug delivery through the blood-brain barrier (BBB). This retrospective study explores the efficacy of systemic treatments during brain metastasis to radiotherapy evaluation window in improving patient survival.
METHODS: In this retrospective cohort study, we evaluated 209 NSCLC patients with non-sensitive mutations and BMs, treated between 2016 and 2023 at two tertiary medical centers (Chongqing University Cancer Hospital and Guangxi Medical University Cancer Hospital). The patients were divided into three groups, namely chemotherapy alone (C; n = 95), chemotherapy plus immune checkpoint inhibitors (ICIs) (C + I; n = 62), and chemotherapy with ICIs and antiangiogenic therapy (A) (C + I + A; n = 52). Statistical analyses were performed using R software, version 4.3.3. Categorical variables were compared using Fisher's exact test, and survival curves were estimated with the Kaplan-Meier method and compared via the log-rank test. Univariate and multivariate Cox regression models were used to assess factors associated with overall survival (OS). Bayesian model averaging (BMA) was employed to address model uncertainty and improve result robustness. Subgroup analyses evaluated treatment-related mortality risk.
RESULTS: From an initial cohort of 658 NSCLC patients with BMs, 209 were analyzed with a median age of 59; the majority were male (80.9%) and diagnosed with adenocarcinoma (78.9%). Univariate analysis identified significant variables influencing outcomes, including BMs radiotherapy EQD2, BMs count, local thoracic treatment, BMs radiotherapy field, intracranial response, and systemic treatment post-BMs diagnosis. The C + I + A regimen significantly improved median OS to 23.6 months compared to 11.4 months with C and 16.2 months with C + I, with a hazard ratio (HR) of 0.60 (95% CI: 0.43-0.82; P < 0.0001). The two-year OS rate was highest in the C + I + A group at 38.5%, versus 10.5% in C and 20.4% in C + I (P < 0.001). Cox regression and BMA analyses confirmed the stability of BMA in providing HR estimates, yielding area under the curve (AUC) values of 0.785 for BMA and 0.793 for the Cox model, with no significant difference in predictive performance. Subgroup analysis revealed a 71% mortality risk reduction with C + I + A (HR: 0.29; 95% CI: 0.18-0.47; P < 0.0001), showing consistent benefits regardless of patient sex, BMs count, extracranial metastases presence, and local thoracic treatments. Treatment sequence analysis indicated a median OS of 33.4 months for patients starting with A, though not statistically significant (HR: 0.59; P = 0.36). The overall incidence of radiation-induced brain injury was low at 3.3%, with rates in the C, C + I, and C + I + A groups being 3.2%, 4.8%, and 1.9%, respectively (P = 0.683).
CONCLUSION: Our study demonstrates the significant benefit of the C + I + A combination therapy in improving OS and reducing mortality risk in NSCLC patients with non-sensitive gene-mutated BMs. The sequential administration of A followed by ICIs shows a promising synergistic effect with cranial radiotherapy, highlighting the potential for optimized treatment sequencing. These findings emphasize the efficacy of tailored combination therapies in complex oncological care and suggest that our approach could lead to meaningful improvements in clinical outcomes for this challenging patient population.

Keywords:  Brain metastasis; Immune-related combination therapy; Non-sensitive genetic mutations; Non-small cell lung cancer; Peri-brain radiotherapy

DOI:  https://doi.org/10.1007/s00262-024-03797-0
Medicina (Kaunas). 2024 Jul 25. pii: 1203. [Epub ahead of print]60(8):

A Rare Case of a Gigantic Retroperitoneal Schwannoma.

Nenad Koruga, Borna Kovačić, Alen Rončević, Branko Dmitrović, Zrinka Požgain, Anamarija Soldo Koruga, Tatjana Rotim, Sonja Škiljić, Hrvoje Vinković, Tajana Turk.

  Introduction: Schwannomas (Schs) are benign tumor masses that rarely occur intra-abdominally and rarely reach larger diameters. When present, they occur as rare solitary nerve sheath tumors of peri-neural Schwann cells. Schwannoma mostly affects the nerves of the extremities, trunk, or the head and neck region. They are more common in female patients, mostly among patients between the third and fifth decade. They occur spontaneously but could also be found in association with a group of genetic autosomal dominant disorders called type 2. When present intra-abdominally, schwannomas grow slowly without significant clinical signs and symptoms. Clinical importance is presented in cases of occupying intra-abdominal space and impingement of surrounding structures, which causes intermittent pain. Only 0.5-5% of all retroperitoneal tumors are schwannomas and their malignant transformation is very rare. Case report: The authors present a case of a large intra-abdominal schwannoma in a 70-year-old female patient. She underwent CT scanning due to refractory left-sided subcostal pain, which revealed a large tumor mass in the left-sided hemiabdomen. Preoperative cytologic biopsy confirmed Sch. The patient underwent an MRI scan upon admission to our department, which revealed the origin of the tumor at the left-sided L3 level and intra-abdominal tumor spreading with the largest diameter of 25 cm. The patient underwent multidisciplinary surgical excision, confirmed by MRI scan in a period of five months postoperatively. Conclusions: Its rare presentation leads to the necessity to adequately evaluate such patients, especially to avoid any hidden diagnosis which might lead to further complications. The goal of a multidisciplinary approach should be emphasized as maintaining a good postsurgical condition without neurological deficits.

Keywords:  abdominal neoplasms; retroperitoneal space; schwannoma; somatosensory evoked potentials

DOI:  https://doi.org/10.3390/medicina60081203
World J Gastrointest Surg. 2024 Aug 27. 16(8): 2511-2520

Energy spectrum computed tomography multi-parameter imaging in preoperative assessment of vascular and neuroinvasive status in gastric cancer.

Jing Wang, Jian-Cheng Liang, Fa-Te Lin, Jun Ma.

   BACKGROUND: Vascular and nerve infiltration are important indicators for the progression and prognosis of gastric cancer (GC), but traditional imaging methods have some limitations in preoperative evaluation. In recent years, energy spectrum computed tomography (CT) multiparameter imaging technology has been gradually applied in clinical practice because of its advantages in tissue contrast and lesion detail display.
AIM: To explore and analyze the value of multiparameter energy spectrum CT imaging in the preoperative assessment of vascular invasion (LVI) and nerve invasion (PNI) in GC patients.
METHODS: Data from 62 patients with GC confirmed by pathology and accompanied by energy spectrum CT scanning at our hospital between September 2022 and September 2023, including 46 males and 16 females aged 36-71 (57.5 ± 9.1) years, were retrospectively collected. The patients were divided into a positive group (42 patients) and a negative group (20 patients) according to the presence of LVI/PNI. The CT values (CT40 keV, CT70 keV), iodine concentration (IC), and normalized IC (NIC) of lesions in the upper energy spectrum CT images of the arterial phase, venous phase, and delayed phase 40 and 70 keV were measured, and the slopes of the energy spectrum curves [K (40-70)] from 40 to 70 keV were calculated. Arterial phase combined parameter, venous phase combined parameters (VP-ALLs), and delayed phase association parameters were calculated for patients with late-stage disease. The differences in the energy spectrum parameters between the positive and negative groups were compared, receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated to measure the diagnostic efficiency of each parameter.
RESULTS: In the delayed phase, the CT40 keV, CT70 keV, K (40-70), IC, NIC, and CT70 keV and the NIC in the upper arterial and venous phases of energy spectrum CT were greater in the LVI/PNI-positive group than in the LVI-negative group. The representative parameters for the arterial phase NIC were 0.14 ± 0.04 in the positive group and 0.12 ± 0.04 in the negative group. The venous phase NIC was 0.5 (0.5, 0.6) in the positive group and 0.4 (0.4, 0.5) in the negative group. Last, for the delayed phase NIC, it was 0.6 ± 0.1 in the positive group and 0.5 ± 0.1 in the negative group (all P values are less than 0.05). ROC curve analysis demonstrated that the diagnostic efficacy of each parameter during the venous stage was superior to that during the arterial and delayed stages. Furthermore, the diagnostic efficacy of the combined parameter throughout all three stages was superior to that of any single parameter. The AUC, sensitivity, and specificity of the optimal parameter, VP-ALL, were 0.931 (95% confidence interval: 0.872-0.990), 80.95%, and 95.00%, respectively.
CONCLUSION: When assessing the condition of LVI and PNI (perineural invasion) in patients with GC prior to surgery, the ability to diagnose these conditions using venous stage parameters was superior to that using arterial stage and delayed stage parameters. Furthermore, the diagnostic accuracy of using a combination of parameters was better than that of using individual parameters alone.

Keywords:  Cross-sectional study; Energy spectrum computed tomography; Gastric cancer; Nerve invasion; Tomography; Vascular invasion; X-ray computer

DOI:  https://doi.org/10.4240/wjgs.v16.i8.2511
BJA Educ. 2024 Sep;24(9): 309-317

Cancer survivors and cancer pain.

T Craig, A Napolitano, M Brown.



Keywords:  cancer pain; cancer treatment protocols; chemotherapy; pain management

DOI:  https://doi.org/10.1016/j.bjae.2024.05.002
Neurology. 2024 Sep 24. 103(6): e209777

Neurologic Clinical, Electrophysiologic, and Pathologic Characteristics of Primary vs Secondary Neurolymphomatosis.

Michael P Skolka, Narupat Suanprasert, Jennifer M Martinez-Thompson, Rebecca L King, William R Macon, Michelle L Mauermann, Christopher J Klein, Thomas M Habermann, Patrick B Johnston, Ivana N Micallef, Arushi Khurana, Kimberly Amrami, Robert J Spinner, Jay Mandrekar, Peter J Dyck, P James B Dyck.

BACKGROUND AND OBJECTIVES: Neurolymphomatosis (NL) is characterized by lymphomatous infiltration of the peripheral nervous system presenting as the initial manifestation of a lymphoma (primary NL [PNL]) or in relapse of a known lymphoma (secondary NL [SNL]). This report details and compares the neurologic clinicopathologic characteristics of these 2 groups.
METHODS: This retrospective study was performed on patients diagnosed with pathologically confirmed NL in nerve between January 1, 1992, and June 31, 2020. Patient clinical characteristics, neurologic examination, imaging studies, EMG, and nerve biopsy data were collected, analyzed, and compared between PNL and SNL.
RESULTS: A total of 58 patients were identified (34 PNL and 24 SNL). Time from neurologic symptom onset to diagnosis was longer in PNL at 18.5 months compared with 5.5 months in SNL (p = 0.01). Neurologic symptoms were similar in both patient groups and included primarily sensory loss (98%), severe pain (76%), and asymmetric weakness (76%). A wide spectrum of EMG-confirmed different neuropathy patterns were observed, but patients with SNL had increased numbers of mononeuropathies (n = 8) compared with PNL (n = 1, p = 0.01). MRI studies detected NL more frequently (86%) compared with fluorodeoxyglucose (FDG)-PET CT imaging studies (60%) (p = 0.007). Nerve biopsies revealed B-cell lymphoma (PNL n = 32, SNL n = 22), followed by T-cell lymphoma (PNL n = 2, SNL n = 2), with increased demyelination in both groups and increased axonal degeneration (p = 0.01) and multifocal myelinated fiber loss (p = 0.04) significant in SNL vs PNL. Identifying SNL resulted in patient treatment modifications but a worse prognosis compared with PNL (p = 0.025).
DISCUSSION: While PNL and SNL are both primarily painful and asymmetric neuropathies with axonal and demyelinating features on EMG and nerve biopsy, SNL presents somewhat differently than PNL with fulminant, asymmetric often mononeuropathies better detected on MRI than FDG-PET/CT. The focal pattern of SNL is likely a result of residual cancer cells that evaded initial chemotherapy, which does not cross the blood-nerve barrier, and these cells can later recur and result in fulminant disease. Although still resulting in a poorer prognosis, identifying SNL is important because this changed treatment and management in every SNL case.

DOI: https://doi.org/10.1212/WNL.0000000000209777
Curr Urol. 2024 Sep;18(3): 159-166

Leptomeningeal metastases in prostate cancer: A review of the current literature.

Umar Durrani, Kasem Rifai, Maha Arshad, Awais Paracha, Ekamjit Deol, Maria Paracha, Fatima Waheed, Zohair Siddiqui, Ali Abid, Esed Mustafic, Wilson Rodriguez, Zachary Hamilton.

  Leptomeningeal metastasis/leptomeningeal carcinomatosis (LMC; terms used interchangeably) is an inflammatory complication of primary tumors that involves the spread of the disease to the meninges (specifically the arachnoid and pia maters) and spinal cord. In the United States, approximately 110,000 new cases are diagnosed each year, and the prognosis is usually poor. Complications of LMC include cognitive impairment, cranial nerve dysfunction, ischemic stroke, and mortality. The survival times of untreated and treated LMC are approximately 4-6 weeks and 2-4 months, respectively. Leptomeningeal carcinomatoses are usually metastatic cancers that spread to the central nervous system. Although lung and breast cancers have a clearly defined relationship with LMC, it remains unclear whether prostate cancer (PC) is also directly associated with LMC. To determine whether such association exists, we conducted a PubMed review of the literature on patients with PC with coexisting LMCs. Our search yielded 23 case reports of patients with preexisting PC who developed LMC. In addition, 2 retrospective cohort studies were examined. Various findings were identified in the revised cases and studies. The first 3 findings were related to the progression of the disease: patients presenting with neurological disease symptoms were in remission from PC for 7 years on average, LMCs tended to occur after other cancer diagnoses, and the disease had already rapidly progressed by the time the symptoms were present. Regarding diagnosis, the major finding was that most LMCs were detected by magnetic resonance imaging (which does not detect early dissemination), and it was suggested that single-photon emission computed tomography or positron emission tomography imaging could be used for earlier detection. Finally, in terms of treatment, the main finding was that treatment was palliative rather than curative and that prognosis remained poor despite treatment. On the basis of these results, we recommend for individuals with risk factors, such as high-grade PC and hormonal PC, to be evaluated on a case-by-case basis for increased surveillance of LMC development.

Keywords:  Leptomeningeal carcinomatosis; Prostate cancer; Prostate cancer metastasis

DOI:  https://doi.org/10.1097/CU9.0000000000000245
Medicine (Baltimore). 2024 Aug 30. 103(35): e39507

Thoracoscopic resection of a giant esophageal schwannoma: A case report and review of literature.

Shu Chen, Yixuan Zhao, Yinghao Zhao.

INTRODUCTION: Benign esophageal tumors are uncommon, accounting for approximately 2% of esophageal tumors. Esophageal schwannoma is a much rarer solid tumor with few cases reported in the literature. Open surgery is the surgical approach of choice for the treatment of esophageal tumors. With the advent of thoracoscopy, more and more countries are adopting a thoracoscopic approach to treat esophageal tumors, but there is still no clear surgical standard or modality for the treatment of esophageal tumors.
PATIENT CONCERNS: A 50-year-old woman was admitted to our hospital. Over the past 2 months, her clinical presentation has included progressively worse swallowing disorder and weight loss. Gastroscopy showed an elevated lesion with a smooth surface visible 18 cm out from the incisors. An electron circumferential ultrasound endoscopy showed a hemispherical bulge with a smooth surface 18 to 23 cm from the incisor; the bulge originated from the intrinsic muscular layer and showed a heterogeneous mixed moderate ultrasound with a little blood flow signal and blue-green elastography in 1 of the sections measuring approximately 4 cm × 3 cm. Chest computed tomography (CT) showed a mass-like soft tissue shadow in the upper esophagus measuring approximately 39 mm × 34 mm, with a CT The lumen was compressed and narrowed, and the lumen of the upper part of the lesion was dilated, and the adjacent trachea was compressed and displaced to the right.
INTERVENTIONS: After completion of the examination, assisted by artificial pneumothorax and thoracoscopic resection of esophageal masses were performed.
DIAGNOSIS AND OUTCOMES: Postoperative pathology report: Mesenchymal-derived tumor (esophagus), combined with immunohistochemical staining results and morphologic features supported schwannoma. The patient's postoperative course was calm. The patient's postoperative dysphagia subsided.
CONCLUSION: We describe a case of successful treatment of a schwannoma of the upper esophagus using artificial pneumothorax-assisted VATS. The combined use of Sox10 and S100 helps to improve the sensitivity and specificity of schwannoma diagnosis. Damage to the esophageal lining was avoided by mixed thoracoscopic and endoscopic exploration. This approach can also be applied to benign esophageal tumors in the thoracic and subthoracic segments, leading to better minimally invasive results.

DOI: https://doi.org/10.1097/MD.0000000000039507
J Pain Symptom Manage. 2024 Aug 30. pii: S0885-3924(24)00990-4. [Epub ahead of print]

Effects of exercise in adults with cancer pain: a systematic review and Network meta-analysis.

Jie Wang, Meiling Lv, Hongpeng Li, Dongqing Guo, Xin Chu.

   CONTEXT: Pain is one of the most common symptoms of cancer patients, affecting the patient's physical, psychological, behavioral, social relations and other aspects. Previous studies have demonstrated that exercise is effective for cancer pain, and the optimal exercise is still unknown.
OBJECTIVES: This study aimed to compare the effects of different exercise interventions on cancer pain in adults.
METHODS: Randomized control trials identified from medical literature databases that reported effects of exercise in adults with cancer pain were included in this study. Literature screening and data extraction were conducted independently by two researchers. Cochrane Bias Assessment 2.0 was used to assess the quality of the literature, and Stata 15.0 software was used for Network meta-analysis.
RESULTS: Forty-one studies were included, involving 3537 patients with cancer pain. The types of exercise involved included aerobic exercise, medium intensity continuous training, high-intensity interval training, resistance exercise, mind-body exercise and comprehensive exercise program (CEP). The results suggested that CEP was more effective than the usual care in relieving pain intensity in cancer patients [SMD=-1.96,95%CI (-3.47, -0.44)] (SUCRA=97.9%). Mind-body exercise outperformed usual care in reducing pain interference in cancer patients [SMD = -0.65, 95% CI (-1.21, -0.09)] (SUCRA=83.8%).
CONCLUSION: Current evidence shows that CEP is the best way to relieve the pain intensity of cancer patients, and mind-body exercise is the best way to reduce pain interference of cancer patients. Due to the limited number and quality of the included studies, the above conclusions need to be further verified by more high-quality studies.

Keywords:  Bayesian network meta-analysis; Exercise Therapy; cancer-related pain

DOI:  https://doi.org/10.1016/j.jpainsymman.2024.08.033