Browsing by Author "Saeed, Omer"

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    Clinicopathological and Treatment Patterns of Combined Small-Cell Lung Carcinoma with Future Insight to Treatment: A Population-Based Study
    (MDPI, 2023-01-28) Ullah, Asad; Saeed, Omer; Karki, Nabin Raj; Goodbee, Mya; Yasinzai, Abdul Qahar Khan; Waheed, Abdul; Heneidi, Saleh; Thomas, Anish; Karim, Nagla Abdel; Johnson, Joyce; Del Rivero, Jaydira; Khan, Jaffar; Pathology and Laboratory Medicine, School of Medicine
    Background: Primary lung cancer is the most common cause of cancer-related mortality in the United States (US). Approximately 90% of lung cancers are associated with smoking and the use of other tobacco products. Based on histology, lung cancers are divided into small-cell lung carcinomas (SCLCs) and non-small-cell lung carcinomas (NSCLCs). Most SCLCs are of the pure subtype, while the rare combined SCLCs contain elements of both small-cell and non-small-cell morphologies. This study sought to evaluate the demographics, clinical factors, molecular abnormalities, treatment approaches, and survival outcomes with combined SCLC and NSCLCs. Materials and methods: Data on 2126 combined SCLC patients was extracted from the Surveillance Epidemiology and End Result (SEER) database from 2000 to 2018. Data extracted for analyses included age, sex, race, tumor size, tumor location, metastasis status, stage at diagnosis, treatment received, and treatment outcomes. Multivariate analysis was performed using Statistical Product and Service Solutions (SPSS) software. Results: The patients had a median age of 68 years; 43.9% of the patients were female and 56.1% were male; 84.5% were White and 11.7% were African Americans. The majority of patients had a poorly differentiated disease at 29.6%; 17% were undifferentiated, 3.2% were moderately differentiated, and 0.8% were well differentiated. Chemotherapy was the most common treatment modality (45.3%); 17% underwent surgery only, 10.3% underwent surgery followed by adjuvant chemotherapy, and 10% underwent radiation after surgery. Five-year cancer-specific survival was 15.2% with surgery alone, and combined surgery and chemotherapy provided the highest percentages (38.3% and 34.7%, respectively). Females had significantly higher 1- and 5-year cancer-specific survival rates compared to males (59.3% and 29.9% vs. 48.0% and 23.7, respectively; p < 0.001). Well-differentiated tumors had significantly higher survival compared to other gradings (p < 0.001). Survival decreased as tumor staging moved distally from localized to regional to distant (p < 0.001). Metastasis to bone, liver, brain, and lung significantly decreased survival in comparison to patients who did not have any metastasis (p < 0.001). Females had significantly shorter survival compared to their counterparts when metastasis was to the bone, brain, or liver (p < 0.001). Multivariate analysis identified male sex (Hazard Ratio (HR) = 1.2), undifferentiated grade (HR = 1.9), regional extent of disease (HR = 1.7), distant extent of disease (HR = 3.7), and metastasis to liver (HR = 3.5) as variables associated with worse survival. Conclusion: Combined SCLC is overall very rare. However, the frequency of presentation with combined SCLC is on the rise, in part due to improvements in diagnostic techniques. Despite advances in therapies, treating combined SCLC is challenging, and novel therapies are not utilized, owing to low rates of targetable mutations. Combined SCLC has higher survival rates if well differentiated.
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    Comparative Survival Benefits of Surgery and Adjuvant Chemotherapy in Neuroendocrine Carcinoma of the Gallbladder: A Population-Based Study with Insight into Future Personalized Therapeutic Approach
    (MDPI, 2023-06-18) Khan, Jaffar; Ullah, Asad; Yasinzai, Abdul Qahar Khan; Waheed, Abdul; Ballur, Kalyani; Dickerson, Thomas E.; Ullah, Kaleem; Mejias, Christopher D.; Saeed, Omer; Pathology and Laboratory Medicine, School of Medicine
    Background: Neuroendocrine carcinomas of the gallbladder (NECs-GB) are rare tumors, accounting for <0.2% of all neuroendocrine carcinomas of the gastrointestinal tract. They originate from the neuroendocrine cells of the gallbladder epithelium with associated intestinal or gastric metaplasia. The current study is the largest study from the SEER database on NECs-GB that aims to elucidate the demographic, clinical, and pathologic factors influencing the prognosis and comparative survival analysis of different treatment modalities. Methods: The data from 176 patients with NECs-GB was abstracted from the Surveillance Epidemiology and End Result (SEER) database (2000–2018). Multivariate analysis, non-parametric survival analysis, and a chi-square test were used to analyze the data. Results: NECs-GB had a higher incidence amongst females (72.7%) and Caucasians (72.7%). Most patients had surgery only (N = 52, 29.5%), (N = 40) 22.7% had chemotherapy only, and (N = 23) 13.1% had chemotherapy with surgery. Only (N = 17) 9.7% had trimodaltiy (surgery, chemotherapy, and radiation therapy), and for (N = 41) 23.3% the status of chemotherapy was unknown, and these cases had neither radiation nor surgery. Conclusion: NECs-GB more frequently affects Caucasian females after the 6th decade of life. The combination of surgery, radiation, and adjuvant chemotherapy was associated with better long-term (5 years) outcomes, while surgery alone was associated with better short-term (<2 years) outcome survival.
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    Isolated Kaposi sarcoma of the upper aerodigestive tract in immunocompetent individuals, an underrecognized entity with favorable prognosis
    (Sage, 2022-09-15) Shabaan, Abdelrahman; Alkashash, Ahmad; Hou, Tieying; Saeed, Omer; Yesensky, Jessica; Roshal, Anna; Mesa, Hector; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Kaposi sarcoma (KS) is a rare vascular neoplasm that most commonly arises in the setting of immunosuppression, in areas with high prevalence of Human Herpesvirus-8 infection, and when both situations coexist. Most cases affect the skin, isolated involvement of the upper respiratory tract without skin involvement is extremely rare with only a few cases reported in the literature. We present a case of isolated nasopharyngeal KS in an immunocompetent patient who achieved remission after multimodality therapy. Recent advances in KS-therapy are discussed.
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    Metastatic Liver Tumors in Surgical Pathology: Impact of Contemporary Diagnostic and Therapeutic Paradigms in a Tertiary Care Center
    (Sage, 2021) Armutlu, Ayşe; Saeed, Omer; Saxena, Romil; Pathology and Laboratory Medicine, School of Medicine
    We analyzed metastatic liver tumors received in the department of pathology in a tertiary care center over a 3-year period. There were 509 metastatic liver tumors; counterintuitively, there were as many resections (235 cases) as biopsies (274 cases). This unexpected finding reflects contemporaneous organ-specific paradigms for diagnosis and management of metastatic liver disease in oncologic practice, and the association of our practice with a National Cancer Institute-designated comprehensive cancer center with expertise and specialization in liver surgery. We receive a large number of resections for metastatic liver tumors because metastasectomy from a variety of primary tumors is associated with improved overall, and in many instances, disease-free, long-term survival. Metastatic colorectal carcinomas, metastatic neuroendocrine tumors, and metastatic gastrointestinal stromal tumors constituted 78% of resections because the largest body of literature and cumulative experience exists for these lesions. In contrast, breast carcinomas and pancreatic carcinomas, which are the next common metastatic liver tumors were biopsied but rarely resected, because metastasectomy is not the standard of care for these tumors. Immunohistochemistry was performed in less than a quarter of the total number of cases (23%), because the primary tumor site was known in the vast majority of cases. Of the 42 cases with unknown primary tumor, it was elucidated in 50% of the cases by immunohistochemical and clinical work-up. Of the cases with known primary tumor, immunohistochemistry was performed mostly in metastatic breast, colon, and lung carcinomas. In these cases, biomarker analyses provided additional information relevant to clinical management.
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    Mucinous cystic neoplasms of the liver: presence of biliary communication
    (Oxford University Press, 2019-12) Rodriguez, Robert M.; Barrio, Martin; Parker, Mitch L.; Saeed, Omer; Sherman, Stuart; Ceppa, Eugene P.; Surgery, School of Medicine
    A 35-year-old woman was referred for a symptomatic liver mass. Diagnostic workup detected a septated cyst located centrally in the liver measuring 10 × 7 cm. The cyst had gradually increased in size from previous studies with new intrahepatic biliary dilation. Due to concern for malignancy and symptomatic presentation of the patient, a partial central hepatectomy was performed. Pathology revealed a smooth-walled, multiloculated cyst lined with mucinous epithelium and ovarian-type stroma. The diagnosis of low-grade mucinous cystic neoplasm of the liver (MCN-L) was made. Characteristics of MCN-L have not been elucidated due to its rarity.
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    Mucinous intrahepatic cholangiocarcinoma: a distinct variant
    (Elsevier, 2018) Chi, Zhikai; Bhalla, Amarpreet; Saeed, Omer; Cheng, Liang; Curless, Kendra; Wang, Hanlin L.; Patil, Deepa T.; Lin, Jingmei; Pathology and Laboratory Medicine, School of Medicine
    Mucinous variant of intrahepatic cholangiocarcinoma (iCC) is rare, and its clinicopathological features and prognosis are far less clear. Six patients who had iCCs with more than 50% of mucinous component and 79 conventional iCCs were included in the study. The mean size of mucinous and conventional iCCs was 6.2 cm and 6.0 cm, respectively. The majority of patients (83%) with mucinous iCC presented at T3 stage or above, compared to 28% of the conventional group (p < 0.01). Three patients with mucinous iCC (50%) died within 1 year. The average survival time of patients with mucinous iCCs was significantly reduced compared to that of conventional group (9 months vs 2 years; P < .001). Immunohistochemistry was performed on 6 mucinous and 12 conventional iCCs with matched age, sex and stage, which revealed positive immunoreactivity in MUC1 (83% vs 58%), MUC2 (33% vs 17%), MUC5AC (100% vs 42%), MUC6 (50% vs 0), CK7 (83% vs 83%), CK20 (0 vs 17%), and CDX2 (17% vs 0) in mucinous and conventional iCCs, respectively. Molecular studies showed one mucinous iCC with KRAS G12C mutation and no BRAF or IDH1/2 mutations. Mucinous iCC is a unique variant that constitutes 7.2% of iCCs. It is more immunoreactive for MUC1, MUC2, MUC5AC and MUC6. Unlike adenocarcinomas of colorectal primary, mucinous iCCs are often CK7+/CK20-/CDX2- and microsatellite stable. Patients with mucinous iCC likely present at advanced stage upon diagnosis with shorter survival time compared to the conventional counterparts.
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    Pathologic Risk Factors for Higher Clinical Stage in Testicular Seminomas
    (Wiley, 2018) Trevino, Karen; Esmaeili-Shandiz, Alaleh; Saeed, Omer; Xu, Huiping; Ulbright, Thomas M.; Idrees, Muhammed; Pathology and Laboratory Medicine, School of Medicine
    Introduction Testicular seminomas require accurate staging for effective management. 20% are metastatic at presentation while 80% are clinical stage I, requiring only orchiectomy and surveillance. Tumor size, rete testis invasion, hilar soft tissue invasion, and lymphovascular invasion have been shown to incur a higher risk of metastasis and recurrence in clinical stage I seminomas, with little congruence between studies. Materials and Methods We reviewed 211 cases of testicular seminomas and recorded patient age, tumor size, lymphovascular invasion and rete testis, hilar soft tissue, epididymis, spermatic cord, tunica albuginea, and tunica vaginalis involvement. A univariate and multivariate analysis was performed comparing clinical stage I to advanced clinical stage patients (stages II and III) in reference to these factors. Results We found that tumor size (p=0.02), vascular invasion (p=0.02), and invasion of rete testis stroma (p=0.01), epididymis (p=0.02), spermatic cord (p=0.047), and hilar soft tissue (p=0.04) were predictors of higher clinical stage at the univariate level. However, multivariate analysis showed that only tumor size and vascular invasion remained significant (p=0.008 and 0.032, respectively). A tumor size of 4 cm was the size cutoff found to be significant. Discussion Tumor size and vascular invasion are the strongest predictors of higher clinical stage in testicular seminomas. Our univariate data suggests that rete testis and hilar soft tissue invasion relate to higher clinical stage. However, neither of these factors were found to be independent risk factors at multivariate analysis. Therefore, this study supports tumor upstaging based only upon size and vascular invasion.
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    Successful Sequential Liver and Isolated Intestine Transplantation for Mitochondrial Neurogastrointestinal Encephalopathy Syndrome: A Case Report
    (International Scientific Information, 2024-02-27) Kubal, Chandrashekhar A.; Mihaylov, Plamen; Snook, Riley; Soma, Daiki; Saeed, Omer; Rokop, Zachary; Lacerda, Marco; Graham, Brett H.; Mangus, Richard S.; Surgery, School of Medicine
    Background: Mitochondrial neurogastrointestinal encephalopathy syndrome (MNGIE) is an autosomal recessive disease caused by thymidine phosphorylase deficiency leading to progressive gastrointestinal dysmotility, cachexia, ptosis, ophthalmoparesis, peripheral neuropathy and leukoencephalopathy. Although liver transplantation corrects thymidine phosphorylase deficiency, intestinal deficiency of the enzyme persists. Retrospective chart review was carried out to obtain clinical, biochemical, and pathological details. Case Report: We present a case of liver and subsequent intestine transplant in a 28-year-old man with MNGIE syndrome with gastrointestinal dysmotility, inability to walk, leukoencephalopathy, ptosis, cachexia, and elevated serum thymidine. To halt progression of neurologic deficit, he first received a left-lobe partial liver transplantation. Although his motor deficit improved, gastrointestinal dysmotility persisted, requiring total parenteral nutrition. After exhaustive intestinal rehabilitation, he was listed for intestine transplantation. Two-and-half years after liver transplantation, he received an intestine transplant. At 4 years after LT and 20 months after the intestine transplant, he remains off parenteral nutrition and is slowly gaining weight. Conclusions: This is the first reported case of mitochondrial neurogastrointestinal encephalomyopathy to undergo successful sequential liver and intestine transplantation.