Gangliocytic paraganglioma (GP) has been regarded as a rare benign tumor that commonly arises from the second part of the duodenum. As GP does not exhibit either prominent mitotic activity or Ki-67 immunoreactivity, it is often misdiagnosed as neuroendocrine tumor (NET) G1. However, the prognosis might be better in patients with GP than in those with NET G1. Therefore, it is important to differentiate GP from NET G1. Moreover, our previous study indicated that GP accounts for a substantial, constant percentage of duodenal NETs. In the present article, we describe up-to-date data on the clinicopathological characteristics of GP and on the immunohistochemical findings that can help differentiate GP from NET G1, as largely revealed in our new and larger literature survey and recent multi-institutional retrospective study. Furthermore, we would like to refer to differential diagnosis and clinical management of this tumor and provide intriguing information about the risk factors for lymph node metastasis on GP.

BackgroundAs the World Health Organization grading system for gastroenteropancreatic-neuroendocrine tumors (GEP-NETs) may not always correlate with tumor progression, it is imperative that other independent predictors of tumor progression be established. To identify such predictors, we conducted a retrospective histopathological study of hindgut NETs, obtained from endoscopic procedures, and used statistical analyses to evaluate predictive factors.MethodsWe first obtained clinicopathological data of cases of hindgut NETs. Tissue sections from tumor samples were prepared and subjected to pathological examination. In particular, we calculated the microvessel density (MVD) and lymphatic microvessel density (LMVD) values, and performed appropriate statistical analyses.ResultsA total of 42 cases of hindgut NETs were selected for the study, 41 from the rectum and 1 from the sigmoid colon. Based on the Ki-67 labeling index, 34 cases were classified as NET G1 tumors and 8 as NET G2 tumors. MVD values ranged from 1.4/mm2 to 73.9/mm2 and LMVD values from 0/mm2 to 22.9/mm2. MVD and LMVD were identified as risk factors for venous and lymphatic invasion of hindgut NETs. Moreover, MVD positively correlated with the maximum diameter of the tumor.ConclusionsTumor progression of NETs may cause angiogenesis and lymphangiogenesis, via an unknown mechanism, as well as lymphovascular invasion. Angiogenesis likely plays an important role in occurrence and progression in the initial phase of hindgut NETs.

Pathological stage is the most important prognostic factor in patients with lung cancer, and is defined according to the tumor node metastasis classification system. The present study aimed to investigate the clinicopathological significance of lymphatic invasion in 103 patients who underwent surgical resection of lung squamous cell carcinoma (SqCC). The patients were divided into two groups, according to the degree of lymphatic invasion: Those with no or mild lymphatic invasion (ly0-1) and those with moderate or severe lymphatic invasion (ly2-3). Ly2-3 was associated with tumor size (P=0.028), lymph node metastasis (P<0.001), venous invasion (P=0.001) and histological differentiation (P=0.047). Statistical analysis using the Kaplan-Meier method and the log-rank test indicated that overall survival was significantly reduced in patients with ly2-3 compared with those with ly0-1 (P<0.001). Multivariate analysis identified ly2-3 as an independent predictor of mortality (hazard ratio, 2.580; 95% confidence interval, 1.376–4.839). In conclusion, moderate or severe lymphatic invasion (ly2-3) indicated a high malignant potential and may be considered an independent predictor of poor prognosis in patients with SqCC of the lung.

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Background: Chemo-radiation is considered to be the standard treatment for the management of limited disease of small cell lung cancer (SCLC). Even in this early stage, the role of surgery in SCLC is still controversial. We sought to examine the role of surgery; complete resection in terms of survival in SCLC. Method: A retrospective review was undertaken of patients who underwent surgery for SCLC between 2001 and 2015. Patients were staged according to the 7th edition of the Tumor, Node, Metastasis classification of lung cancer. Actuarial survival estimated with Kaplan Meier method and comparisons were undertaken using Cox regression hazard model. Clinicopathological factors and predictors of survival were analyzed. Result: We identified 49 patients who underwent complete resection. The mean follow up period was 1343 days. The mean age was 70.7 years. 40 patients were men and 9 were women. The number of patients of clinical stage was stage IA :21, IB: 15, IIA: 4, IIB: 6, IIIA:3. Operative procedure was lobectomy in 43, segmentectomy in 1, wedge resection in 5. The number of patients of pathological stage was stage IA :15, IB: 11, IIA: 14, IIB: 7, IIIA:2. Adjuvant chemotherapy was performed in 26 patients (53.1%). The 5-year overall survival (OS) rate in all patients was 58.8%. The 5-year OS was 61.3% in c-stage I, 54.5% in c-stage II, and 50% in c-stage III. The 5-year OS were 66.2% in p-stage I, 55.4% in p-stage II, and 50% in p-stage III. The 5-year OS of patients with adjuvant chemotherapy was significantly better than that of patients without adjuvant chemotherapy (77.8% vs. 39.8%, p¼0.005). Multivariable Cox regression hazard model demonstrated that adjuvant chemotherapy was prognostic factor of overall survival (OS) (hazard ratio 0.255 (.095-.688), p¼0.007) Conclusion: Surgical outcome for early stage SCLC was satisfied one. The role of surgery for this group seemed to be important. Adjuvant chemotherapy may improve prognosis and long-term survival will be expected.