Sultan et al retrospectively searched the surveillance
Sultan et al retrospectively searched the surveillance, epidemiology, and end results (SEER) database for patients who were diagnosed with NPC from 1988 to 2006. They compared the clinical features and outcomes of 129 children and adolescents (<20 years of age) and 5885 adults. Younger patients had distinct features with advanced stages more frequently observed (of the combined children and adolescents, 31% and 46% had stages III and IV, respectively) and 87% had WHO type III histology. Since there is a strong association between the histology of undifferentiated carcinoma, Epstein-Barr virus infection, and the high rate of advanced disease status, nasopharyngeal carcinoma in children is distinguishable from the adult form by its close association with Epstein-Barr virus (EBV) infection, a higher rate of undifferentiated histology, and a greater incidence of advanced locoregional disease. Despite an elevated incidence of advanced loco-regional disease in children and young adults compared with older adults with nasopharyngeal carcinoma, the overall survival rates are not significantly different between these order A-769662 groups. Several studies have found that children and adolescent NPC patients have superior results compared with adult NPC patients, with 5-year overall survival (OS) rate 71% v 58%, respectively (p = 0.03).
Standard therapy for NPC in children has generally followed the guidelines established for adults. Since undifferentiated NPC is very sensitive to radiation, high dose radiation to the nasopharynx and involved cervical nodal regions is the mainstay of treatment of locoregional NPC. However, this treatment appears to control the primary tumor, but shows no benefit for preventing the appearance of distant metastasis. The prognosis of children with advanced NPC (Stages III and IV) treated with radiation therapy alone is poor, with a 5-year survival rate between 20 and 40%. High dose radiotherapy-related morbidities in children are also a great concern among long-term survivors, including xerostomia, hearing loss, neck fibrosis, hypothyroidism, and the most troubling, second primary malignancy in the radiation field. The poor overall survival and high incidence of systemic failure in patients with locally advanced NPC has led to the investigation of early combined therapy (chemotherapy before, concurrently with, or after radiotherapy) to improve survival in childhood NPC. Single-agent studies have shown that adriamycin, epirubicin, cisplatin, and bleomycin are the most active agents for treatment of NPC. Unfortunately, due to the small sample sizes of childhood nasopharyngeal carcinoma, the standard chemotherapy combinations or treatment schedules are not available. Platinum-based chemotherapy has gained popularity, however, including BEP (Bleomycin, Epirubicin, Cisplatin), PF (Cisplatin, Fluorouracil), MPF (Methotrexate, Cisplatin, Fluorouracil), and PMB (Cisplatin, Methotrexate, Bleomycin). According to data from different studies, the survival rate was around 40–90% when a combination of different chemotherapy regimens and radiotherapy are utilized.
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Introduction The most common type of human papillomavirus (HPV) reportedly associated with large cell and small cell neuroendocrine carcinoma of the cervix are type 16 and 18. HPV has rarely been found in small cell lung cancer or neuroendocrine carcinoma of the lung. We present a case of a female patient with cervical mixed adenoneuroendocrine carcinoma who underwent radical resection, whereafter lung nodules and multiple metastases later developed after 6 years. The pathologic features of lung and brain lesions were similar to previous cervical carcinoma. Moreover, the HPV type 18 was identified in these three specimens.
Case report A 59-year-old woman was diagnosed with stage IA1 adenocarcinoma of the uterine cervix in 2007. Following initial conization, she underwent radical hysterectomy after which there was no gross residual cancer. The pathologic finding from her conization specimen revealed adenocarcinoma with infiltrative acinar pattern (Fig. 1A). Immunohistochemical study displayed focal cytoplasmic staining for synaptophysin (Fig. 1B), CD56 (Fig. 1C) and thyroid transcription factor-1 (TTF-1) (Fig. 1D), which confirmed the neuroendocrine differentiation. The patient did not receive any adjuvant treatment following the surgery, and annual follow-up examinations with Pap smear showed no evidence of recurrence. Until our recent medical intervention, the patient had remained in her customary health status, with medically-controlled hypertension.