Purpose: Colorectal cancer is one of the most common forms of cancer in developed nations and the incidence of this disease is increasing. There is a need to further stratify prognostically distinct groups of colorectal cancer, and the purpose of this study was to identify prognostically significant immunohistochemical marker profiles in colorectal cancer. Experimental Design: In this study, a range (n = 23) of markers [pRb, p16, p21, p27, p53, proliferating cell nuclear antigen, cyclin D1, bcl-2, epidermal growth factor receptor, C-erb-B2, topoisomerase-I, liver fatty acid^binding protein, matrix metalloproteinases (MMP) 1-3, 7, 9, and 13, MT1-MMP, MT2-MMP, and tissue inhibitors of MMP 1-3] of putative prognostic significance have been investigated by immunohistochemistry on formalin-fixed, wax-embedded sections in a series (n = 90) of stage III (Dukes C) colorectal cancers. An immunohistochemical score based on the intensity of immunoreactivity and, where relevant, the proportion of immunoreactive cells was established for each marker. Results: Unsupervised two-dimensional hierarchical cluster analysis identified three distinct cluster groups (designated groups 1-3) with different marker profiles. There were significant survival differences between groups 1and 2 (log rank = 11.48; P = 0.0007) and between groups 1and 3 (log rank = 8.32; P = 0.0039). Multivariate analysis showed that the complete marker profile was independently the most significant prognostic factor (hazard ratio, 2.27; 95 % confidence interval, 1.15-4.48; P = 0.004). Conclusions: This study has identified an immunohistochemical marker profile of colorectal cancer and showed that it is an independent indicator of prognosis in this type of cancer.

cm posterior mediastinal mas. With these findings, the patient was admitted for surgery. Physical examination, laboratory work-ups, and pulmonary function tests revealed normal results. The patient underwent thoracotomy of the right hemithorax. Intraoperatively, an elongated, pulsatile, fixed mass measuring 10 x 12 x 12 cm occupying the middle and posterior mediastinum extending from the azygous vein down to the diaphragm was noted. Microscopic examination of the resected tissues showed fibrocollagenous and adipose tissue fragments with several variably sized vascular channels with no evidence of malignancy. Large caliber arteries and veins were encountered and there was excessive bleeding hence, total excision of the mass was aborted. Results: Histopathologic examination revealed fibrocollagenous and adipose tissue with several irregular thick-walled vascular channels, nerve bundles, lymphocytic infiltrates, and hemorrhagic areas. The final anatomic diagnosis was: Fibrocollagenous tissue with proliferating blood vessels. A hemangioma and/or arteriovenous malformation is considered. Elastic stain and immunohistochemical staining were done. Thick-walled blood vessels were highlighted by elastic stain. The endothelial cells were immunoreactive to Factor VIII. S100 stained a nerve bundle and isolated neural cells. Positivity to CD31 was also observed on the cells lining the vessels. The immunohistochemical staining result supported the diagnosis of arteriovenous malformation. Conclusion:We report a rare case of posterior mediastinal arteriovenous malformation in a 27-year-old male. This is a case of an uncommon tumor in a very unusual location. The advent of immunohistochemistry has aided in classifying proliferating vascular tumors. The need to identify markers for the prognostic significance was emphasized, providing the opportunity to better inform our clinical colleagues. Due to the rarity of the disease, it posed a great dilemma which required a multidisciplinary approach. It provided a diagnostic and surgical challenge to our clinicians, radiologists, pathologists, and thoracovascular surgeons as well.

Background Intravenous methylprednisolone (IVMP), repository corticotropin injection (RCI), plasmapheresis (PMP), and intravenous immunoglobulin (IVIG) are used in the treatment of acute multiple sclerosis (MS) relapse. A systematic literature review (SLR) of randomized controlled trials (RCTs) was conducted to examine the highest quality evidence available for these therapies. Methods English-language articles were searched in MEDLINE, Embase, and Cochrane Library through May 2016 per Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. MS conferences, SLRs, and bibliographies of included studies were also searched. Eligible studies included adults treated with ≥1 aforementioned therapy. Results Twenty-three RCTs were identified: 22 on efficacy, 11 on safety, and 3 on QOL (ie 18 IVMP, 2 RCI, 2 PMP, and 2 IVIG). IVMP and RCI improved relapse-related disability; however, IVIG and PMP showed inconsistent efficacy. QOL data were only ascertained for IVMP. Conclusions RCTs indicate IVMP and RCI are efficacious and well tolerated treatments for MS relapse. Overall, many RCTs were dated, with sample sizes of fewer than 30 patients and no definitions for relapse nor clinically significant change. Contemporary evidence generation for all relapse treatments of interest, across efficacy, safety, and QOL outcomes, is still needed.

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BackgroundCongenitally transmitted cytomegalovirus (CMV) is the leading infectious cause of deafness and intellectual impairment among infants. Due to lack of effective preventive and curative treatments, routine CMV screening of pregnant women is generally not recommended by clinical guidelines or public health authorities, but is conducted on an opportunistic basis by specific healthcare systems and providers. This targeted review describes the rate of reported maternal screening for CMV infection and subsequent pregnancy outcomes.MethodsPubMed and Embase were searched to identify English-language articles reporting the rate of screening for CMV maternal infection (Objective 1), the acceptance rate for diagnostic amniocentesis (Objective 2), and the elective termination rates due to CMV infection (Objective 3) in Europe and Israel. No date limit was applied.ResultsSeventeen articles published between 2000 and 2018 were included. Routine CMV screening of pregnant women in the absence of country-level guidelines appears to be common in France and Israel (table). Conversely, in Portugal, where country-level guidelines exist for preconception screening, a high proportion of women are not screened (table). Acceptance rates of diagnostic amniocentesis among women with CMV infection vary considerably across countries, with the highest rates reported in Israel (73%) and the lowest in Italy (16%). Elective termination rates were higher among women who underwent amniocentesis vs. those who did not and those with primary CMV infection vs. those with nonprimary infection. Conversely, one study in Israel showed higher termination rates among patients who did not undergo amniocentesis vs. those who did (35.5% vs. 7.3%).ConclusionThe available data indicate that routine screening is carried out in some countries to a variable degree. There is an unmet need for effective prevention and management options to help prevent unnecessary termination of pregnancy. Disclosures All authors: No reported disclosures.