Recent Publications by CFE Educators

Hepatic resection for colorectal hepatic metastatic disease has been demonstrated to have a significant outcome benefit for selected patients. Advances in anesthetic and surgical technique have resulted in a significantly reduced morbidity and mortality for this procedure, and this management approach has become widely practiced. This hepatic resection paradigm is also being applied to hepatic metastatic disease of noncolorectal origin. The purpose of this report is to review and summarize the reported literature in order to define if the current data support an indication for hepatic metastasectomy. The specific cancer primaries that this analysis evaluated include breast, melanoma, gynecologic, neuroendocrine, sarcoma, and gastric cancer. Based on the data examined, we propose that although hepatic metastasectomy for noncolorectal cancer may be a promising component of overall oncologic treatment, the role of surgical resection cannot be generalized and at present should be individualized based on the patient's clinical course and by the biologic behaviors of specific malignancies.

PURPOSE OF REVIEW

Adrenocortical carcinoma is a rare malignancy, accounting for 0.02% of all annual cancers reported. Given the generally advanced stage at diagnosis, the overall 5-year survival remains poor, varying between 20 and 45%. While older studies purported an improved outcome for functional tumors in adult patients, this has not been borne out in more recent studies. In the pediatric population, though, virilizing tumors carry a better survival than non-functional or cortisol-secreting tumors.

RECENT FINDINGS

Recent studies focusing on the tumorigenesis of adrenocortical carcinoma have focused on onco-developmental genes present in the fetal adrenal cortex, as well as local adrenal paracrine and autocrine effects of cellular peptides.

SUMMARY

Pre-operative diagnostic advances in positron emission scanning are emerging as promising modalities for confirmation of malignancy of indeterminate adrenal masses. No significant advances in the treatment of adrenocortical carcinoma have been developed. Surgery remains the mainstay for primary and recurrent disease, including select patients with isolated liver metastases. Mitotane has remained the preferred adjuvant treatment agent, showing modest effect in patients with unresectable, residual or metastatic disease. Multi-institutional registries and trials need to be established, with multidisciplinary efforts focused on the development of new therapeutic strategies.

PURPOSE

Cardiovascular magnetic resonance (CMR) can characterize carotid atherosclerosis. The purpose of this study is to evaluate reader agreement of carotid atherosclerotic lesion types by CMR.

METHODS

Carotid arteries of 34 patients (29 men, 5 women; mean age, 53 years) were imaged on a 1.5-T scanner. Images with 4 contrast weightings (T1, T2, proton density, and 3-dimensional time-of-flight) were acquired on each axial slice of the carotid arteries. Modified AHA criteria were used for lesion type assessment on the 4 selected axial slices (1 from the common carotid artery, 1 from the carotid bifurcation, and 2 from the internal carotid artery). The modified AHA criteria are as follows: type I-II, near-normal wall thickness without calcification; type III, diffuse wall thickening or small eccentric plaque without calcification; type IV-V, plaque with a lipid rich necrotic core surrounded by fibrous tissue with possible calcification; type VI, complex plaque with a possible surface defect, hemorrhage, or thrombus; type VII, calcified plaque; and type VIII, fibrotic plaque without a lipid core and with possible small calcifications.

RESULTS

Of the 272 possible axial slices (34 patients x 2 arteries per patient x 4 slices per artery), 256 slices were available for lesion type assessment. The majority (94%) of the lesions were of type I-II and III. kappa was 0.80 and 0.60 for intra-reader and inter-reader agreement of lesion types, respectively. Inter-reader disagreement for type I-II and type III occurred in 82% of lesions. Weighted kappa was 0.92 and 0.83 for intra-reader and inter-reader agreement of lesion types, respectively.

CONCLUSION

The difference between type I-II and III lesions lies in the definition of the vessel wall. The moderate inter-reader agreement suggests further efforts such as establishment of normal carotid artery wall thickness by a quantitative measure are needed for carotid atherosclerotic lesion characterization.

Human endogenous retrovirus K (HERV-K) is distinctive among the retroviruses that comprise about 8% of the human genome in that multiple HERV-K proviruses encode full-length viral proteins, and many HERV-K proviruses formed during recent human evolution. HERV-K gag proteins are found in the cytoplasm of primary tumor cells of patients with seminoma. We identified HERV-K-specific T cells in patients with a past history of seminoma using the interferon-gamma ELISPOT assay and an MHC-HERV-K peptide-specific tetramer. A minority of apparently healthy subjects without evident germ cell tumors also made HERV-K-specific T cell responses. In summary, we detected T cell reactivity to HERV-K peptides in both past seminoma patients and a minority of apparently healthy controls.