Brown Tumor of the Thoracic Spine : First Manifestation of Primary Hyperparathyroidism

Sonmez, Erkin,Tezcaner, Tugan,Coven, Ilker,Terzi, Aysen The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.58 No.4

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.

Who should be offered non-radical surgery for early-stage cervical cancer?

Geneviève Bouchard-Fortier,Allan Covens 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4

Simple hysterectomy SHAPE-ing up to be the treatment of choice for early cervical cancer under 2 cm

Anouk Benseler,Allan Covens 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2

Cer vical cancer is the fourth most common cancer in women [1]. While we hope globalhuman papillomavirus vaccination efforts will change this reality, as a result of screeningprograms 42% of women in North America present with localized disease [2]. Radicalhysterectomy has been recommended for most patients, presenting with stage IA2 to 4 cmIB3 cancers [3]. Overall sur vival is excellent, however there are significant adverse effectsassociated with parametrial and vaginal resection [4]. We congratulate Plante et al. on completing this randomized non-inferiority trial of 700patients with stage 1A2 and 1B1 cer vical cancer comparing simple hysterectomy and pelvicnode dissection to radical hysterectomy and pelvic node dissection (recently published inthe New England Journal of Medicine) [5]. The primar y endpoint was designed to detect non-inferiority of pelvic-relapse free sur vival at 3 years, with secondar y outcomes including overallsur vival, parametrial involvement, quality of life and treatment-related toxicity. The 3-yearpelvic-recurrence rate was 2.5% in the simple hysterectomy group and 2.2% in the radicalhysterectomy group per intention to treat analysis (2.8% and 2.3% per protocol analysis) andthe upper 95% confidence limit did not meet the pre-defined threshold of inferiority. The3-year extra pelvic relapse-free sur vival and overall sur vival were 98.1% vs. 99.7% and 99.1%vs. 99.4%, respectively. Surgical margins were similar (2.4% SH vs. 2.7% RH). Patient reported outcomes of sexual health were measured by the Female Sexual FunctionIndex and the Female Sexual Distress Scale-Revised, and bowel, bladder and non-sexualvaginal symptoms were measured by EORTC QLQ-C30 with QLQ-CX24. Simple hysterectomywas associated with decreased pain experience and favorable sexual health. Patients whounder went simple hysterectomy reported less sexual worr ying and increased sexual enjoymentat 3 months, less sexual pain and improved sexual lubrication for the first 12 months, andimproved sexual vaginal functioning for the first 24 months. Overall better body image andincreased sexual activity was reported for up to 36 months. Decreased urinar y retentionand incontinence also favored simple hysterectomy (0.6% vs. 9.9% and 4.7% vs. 11%,respectively). These findings of decreased sexual health and increased bladder symptoms inpatients undergoing radical hysterectomy are consistent with the literature [6-9]. The ConCer v trial prospectively evaluated patients with cer vical cancer up to 2 cm, treatedwith conization or simple hysterectomy, and concluded conser vative surger y may be offeredbased on a cumulative recurrence of 3.5% over a median follow up of 36.3 months [10].A systematic review of the literature including 2,662 women demonstrated no significantassociation between mortality and simple vs. radical hysterectomy in patients withmicroscopic disease, and the recent SCCAN retrospective trial of 1,257 patients comparingtype B, C1 and C2 radical hysterectomy techniques found no sur vival difference for tumors upto 2 cm with increased radicality of surger y [11,12]. What can we conclude from all this? The evidence from these studies is congruent; nonradical surger y for small cer vical cancers is safe, not associated with increased relapse rates,and improves quality of life, measured through patient reported outcomes. Rarely do wefind a therapy, that relative to standard of care, is as effective yet less complex, less costly andbetter tolerated by patients. While it is unlikely this study will be replicated, these findingsstimulate additional questions. With no reason to suspect other wise, will the 5-year overallsur vival be consistent with these 3-year findings? Given that the majority of patients inthe ConCer v trial (96%) and the SHAPE trial (75%) under went minimally invasive surger yfor their hysterectomy, what is the optimal surgical approach for these patients [10,13]?Can sentinel node biopsy replace full pelvic lymphad...

Evaluation of P57, P53 and Ki67 Expression in Meningiomas

Kucukosmanoglu, Ilknur,Karanis, Meryem Ilkay Eren,Unlu, Yasar,Coven, Ilker The Korean Neurosurgical Society 2022 Journal of Korean neurosurgical society Vol.65 No.4

Objective : We conducted this study with the aim of predicting the biological behavior of meningiomas, and determining the benefits of associating histological subtype and grade with the expression of proliferative markers and tumor suppressor proteins. Methods : The study included 29 patients with primary intracranial and intraspinal meningioma diagnosed in the pathology laboratory of Konya City Hospital between January 2014 and December 2020. Clinicopathological characteristics of the patients including parameters such as age and gender were obtained from the hospital records. Histopathological findings were obtained by re-evaluating the preparations stained with Hematoxylin-Eosin, which were extracted from the archive, and by evaluating new sections obtained from paraffin blocks of patients stained with Ki67, p53, and p57 immunohistochemical stains. Results : A moderate correlation was found between tumor size and Ki67 proliferation index (PI) (p=0.003, r=0.530). There was no significant difference between grade I and grade II tumors in terms of p53 (p=0.184) and p57 (p=0.487) expressions. There were higher levels of Ki67 PI in grade II tumors. The histological subtypes of the tumor had no significant difference with Ki67 PI (p=0.018), p53 (p=0.662), and p57 (p=0.368) expressions. Conclusion : In order to obtain more definitive results, there is a need for studies, which are conducted with a greater number of patients and in multiple centers, and in which a long prospective follow-up is planned. The combination of histological, surgical, and imaging markers could make a more sensitive tool for predicting recurrence, and this could also be tested in future studies.

Effects of Rearing Systems on Performance, Egg Characteristics and Immune Response in Two Layer Hen Genotype

Kucukyilmaz, Kamil,Bozkurt, Mehmet,Herken, Emine Nur,Cinar, Mustafa,Catli, Abdullah Ugur,Bintas, Erol,Coven, Fethiye Asian Australasian Association of Animal Productio 2012 Animal Bioscience Vol.25 No.4

White (Lohmann LSL) and Brown (ATAK-S) laying hens, were reared under organic and conventional cage rearing systems, and the effects of the rearing system on performance parameters, egg production, egg characteristics, and immune response were investigated. For this purpose, a total of 832 laying hens of two commercial hybrids, i.e., 416 white (Lohmann LSL) and 416 Brown (ATAK-S) layers, were used. The experiment lasted between 23 and 70 wk of age. In this study, the white layers yielded more eggs as compared to the brown layers in both organic and conventional production systems. Egg weight exhibited a similar pattern to that of laying performance. However, the total hen-housed egg number for the white birds in the organic system was fewer than that of white birds in the conventional cage facility; conversely, a contradictory tendency was observed for the brown birds. Livability of the white layers in the organic system was remarkably lower (14%) than that of the brown line, whereas the white line survived better (3.42%) than their brown counterparts in conventional cages. The feed conversion ratio of the white hens was markedly inferior in the organic system as compared to that of the white hens in the conventional system, whereas relatively lower deterioration was reported in brown layers when reared in an organic system. The organic production system increased egg albumen height and the Haugh unit in eggs of the brown layers. The yolk color score of organic eggs was lower than that of conventional eggs for both brown and white hens. The egg yolk ratio of eggs from white layers was found to be higher in organic eggs as compared to those obtained in the conventional system. All organic eggs had heavier shells than those produced in the conventional system. Eggs from brown layers had more protein content than eggs from white layers. Neither housing systems nor genotype influenced egg yolk cholesterol concentration. When compared to conventional eggs, n-3 fatty acid content was lower in organic eggs, and the n-6:n-3 ratio was higher in organic eggs. In conclusion, two hen genotypes showed different responses in terms of performance and egg quality to two different rearing systems. A commercial white strain produced more eggs with higher egg quality as compared to a native brown strain. The brown strain was found to have adapted well to organic production conditions when survival and total egg number was taken into consideration.

Trebananib or placebo plus carboplatin and paclitaxel as first-line treatment for advanced ovarian cancer (TRINOVA-3/ENGOT-ov2/GOG-3001): a randomised, double-blind, phase 3 trial

Vergote, Ignace,Scambia, Giovanni,O'Malley, David M,Van Calster, Ben,Park, Sang-Yoon,del Campo, Josep M,Meier, Werner,Bamias, Aristotelis,Colombo, Nicoletta,Wenham, Robert M,Covens, Al,Marth, Christia Elsevier 2019 LANCET ONCOLOGY Vol.20 No.6

<P><B>Summary</B></P> <P><B>Background</B></P> <P>Angiopoietin 1 and 2 regulate angiogenesis and vascular remodelling by interacting with the tyrosine kinase receptor Tie2, and inhibition of angiogenesis has shown promise in the treatment of ovarian cancer. We aimed to assess whether trebananib, a peptibody that inhibits binding of angiopoietin 1 and 2 to Tie2, improved progression-free survival when added to carboplatin and paclitaxel as first-line therapy in advanced epithelial ovarian, primary fallopian tube, or peritoneal cancer in a phase 3 clinical trial.</P> <P><B>Methods</B></P> <P>TRINOVA-3, a multicentre, multinational, phase 3, double-blind study, was done at 206 investigational sites (hospitals and cancer centres) in 14 countries. Eligible patients were aged 18 years or older with biopsy-confirmed International Federation of Gynecology and Obstetrics (FIGO) stage III to IV epithelial ovarian, primary peritoneal, or fallopian tube cancers, and an ECOG performance status of 0 or 1. Eligible patients were randomly assigned (2:1) using a permuted block method (block size of six patients) to receive six cycles of paclitaxel (175 mg/m<SUP>2</SUP>) and carboplatin (area under the serum concentration-time curve 5 or 6) every 3 weeks, plus weekly intravenous trebananib 15 mg/kg or placebo. Maintenance therapy with trebananib or placebo continued for up to 18 additional months. The primary endpoint was progression-free survival, as assessed by the investigators, in the intention-to-treat population. Safety analyses included patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT01493505, and is complete.</P> <P><B>Findings</B></P> <P>Between Jan 30, 2012, and Feb 25, 2014, 1164 patients were screened and 1015 eligible patients were randomly allocated to treatment (678 to trebananib and 337 to placebo). After a median follow-up of 27·4 months (IQR 17·7–34·2), 626 patients had progression-free survival events (405 [60%] of 678 in the trebananib group and 221 [66%] of 337 in the placebo group). Median progression-free survival did not differ between the trebananib group (15·9 months [15·0–17·6]) and the placebo group (15·0 months [12·6–16·1]) groups (hazard ratio 0·93 [95% CI 0·79–1·09]; p=0·36). 512 (76%) of 675 patients in the trebananib group and 237 (71%) of 336 in the placebo group had grade 3 or worse treatment-emergent adverse events; of which the most common events were neutropenia (trebananib 238 [35%] <I>vs</I> placebo 126 [38%]) anaemia (76 [11%] <I>vs</I> 40 [12%]), and leucopenia (81 [12%] <I>vs</I> 35 [10%]). 269 (40%) patients in the trebananib group and 104 (31%) in the placebo group had serious adverse events. Two fatal adverse events in the trebananib group were considered related to trebananib, paclitaxel, and carboplatin (lung infection and neutropenic colitis); two were considered to be related to paclitaxel and carboplatin (general physical health deterioration and platelet count decreased). No treatment-related fatal adverse events occurred in the placebo group.</P> <P><B>Interpretation</B></P> <P>Trebananib plus carboplatin and paclitaxel did not improve progression-free survival as first-line treatment for advanced ovarian cancer. The combination of trebananib plus carboplatin and paclitaxel did not produce new safety signals. These results show that trebananib in combination with carboplatin and paclitaxel is minimally effective in this patient population.</P> <P><B>Funding</B></P> <P>Amgen.</P>