Day 3 :
University of California, USA
Carina Mari Aparici, MD is a Professor in Clinical Radiology at UCSF. She is a Nuclear Physician with residencies in both Europe (Barcelona) and US (Stanford), and with Molecular imaging fellowships from Stanford University. She is a physician-scientist in the development of Molecular Imaging. She has about 20 years of clinical and research experience in the field, and 10 years of a leadership position as Chief Nuclear Medicine at the San Francisco VAMC as part of her faculty position at UCSF. She has published more than 100 papers in reputed journals and has been serving as an editorial board member of repute.
The clinical management of lesions suspicious for malignancy relies not only on diagnosis of benign versus malignant potential but also tumor grading, immunohistochemical and genetic information. Pathological analysis remains the gold standard for definite diagnosis. Hence, a carefully performed biopsy with low risk of complication is crucial. Compared to open biopsy, image-guided biopsies are minimally invasive and confer several advantages including low morbidity, low complication rate and cost savings. FDG-PET/CT has shown higher diagnostic accuracy than conventional imaging CT in characterizing tumor in initial staging, treatment response evaluation and follow-up. PET/CT guided biopsies may allow early histologic diagnosis and staging before morphologic changes are evident. PET/CT biopsy can therefore rule out/in malignancy in early stage of disease and re-stage different types of cancer. Non-real-time PET/CT biopsies have used the image co-registration of a prior PET with a intraprocedural CT. However, this method is inaccurate in time and space, takes long time and requires special software. The aim of this study is to report the initial experience of utilizing the real-time intraprocedural PET/CT guided biopsies, including feasibility and technical requirements.
University Clinical Center of Kosovo, Pristina
Time : 10:15-11:00
Rufadie Maxhuni is working as a pediatrician in Pediatric Clinic in Prishtina, Hematology and Oncology. She is specialist in Hematology Oncology department of Pediatric Clinic in Prishtina with 12 years experience. She has published papers in reputed journals and attended may of the national and international educational programs.
Introduction: Germ cell tumor (GCT) is a tumor that stems from embryonic stem cells. Embryonic cells are commonly found within the gonads (ovaries and testis). Embryonic stem cell tumors that originate outside the gonads may be birth defects, resulting from errors during the embryo development.
The purpose of the paper: It is to present three of several cases with germinating tumor in our experience during the treatment of different malignancies.
Materials and Methods: Three cases of different ages that are presented in our ward are included in the work. Case I: female, 13 years old weight–45 kg, height–130 cm, S–1.2 m2 Biopsy: mixed germ cell tumor of the ovary to the right. Case II: male 2 years old, weight–11.6 kg, height–91cm, S–0.5 m2. Biopsy: yolk sac tumor Rasti. Case III: male 15 years old weight–69 kg, height–179cm, S–1.7 m2. Biopsy: mixed germ cell tumor of the right testis. Clinical, laboratory, imaging, and surgical intervention and biopsy were performed. The EPI (cisplatin, etopusid, cyclophosphamid) protocol was applied in six cycles. Case II was applied to the EP protocol (etopusid, cisplatin) in six cycles. Case III was applied to PEB protocol (cisplatin, etopusid, bleomycin) in six cycles and because of metastases, VeIP (vinbllastin, ifosfamide, cisplatin) has been applied. After the therapy, the condition of the children was observed to be good and the control imaging and laboratory tests are performed according to the protocol.
Conclusion: A good examination, early diagnosis and adequate surgical and chemotherapy treatment, today these children are among us going to school and living normal lives.
American University of Beirut Medical Center, Lebanon
Keynote: Monitoring immune response in tumors
Time : 12:50-13:30
Ibrahim Khalifeh, after earning his MD from Damascus University’s Medical School in 1999, completed a Surgery Internship (2000–2001) and Pathology Residency (2001–2002) at the American University of Beirut Medical Center. In 2002, he left for the USA where he did four years of training in Pathology and Laboratory Medicine at Wayne State University in Detroit (2002–2006), Oncologic Pathology and Cytopathology Fellowships at MD Anderson Cancer Center (2006–2008), and then he joined the University of Alabama where he completed one year of Fellowship in Dermatopathology (2008–2009). He is a diplomat of the American Board of Anatomic and Clinical Pathology, Cytopathology and Dermatopathology. He joined the Department of Pathology and Laboratory Medicine at AUBMC in 2009 as an Assistant Professor. He has been involved in multiple projects related to cutaneous Leishmania, melanoma, dysplastic nevi and BRAF.
There is growing awareness and importance of the input and insights of different specialties to understand and monitor tumor microenvironment and consequently understand the mechanisms of response and resistance to various cancer treatments. Although current immune monitoring strategies pose clinical challenges, advances in approaches and techniques are improving our ability to better understand immune responses in the tumor microenvironment. In addition to this, improvements in genomic profiling have allowed for a deeper understanding of the influence of mutational burden and other genomic factors on anti-tumor immunity. Continued progress in immune monitoring strategies will help us better understand who will benefit from therapy and will help guide rational choice of treatment as well as proper timing, sequence, and combinations of therapeutic regimens. With the increasing use of immunomodulatory agents in clinical practice, there is a growing interest in assessing anti-tumor immune responses via tissue-based and blood- based assays. However, complexities exist in this analysis, particularly when considering use of archival versus fresh tissue cryopreservation has been shown to alter certain immune cell subsets and cytokine profiles as well as gene expression profiles formalin fixed paraffin embedded (FFPE): mutational burden and neoantigen prediction, genomic variants are lost by using FFPE dynamic properties of the immune system and that archival tissue is often collected in advance of treatment of interest may make data obtained from archival tissue less relevant. This is particularly pertinent with the use of immune checkpoint inhibitors in clinical trials and in standard of care treatment, where assessment of programmed death receptor-1 ligand to determine treatment This may in part explain why clinical studies have produced varying results regarding utility of PD-L1 as a predictive biomarker for selection of patients in which archival tissue was often used for PD-L1 determination. Another rapidly emerging area of investigation that must be considered in the context of anti-tumor immune responses is the microbiome. The microbiome refers to the entire community of bacteria (and their genomes) within an organism, and the number of bacteria within a human outnumbers the number of human cells by at least 10:1. There is a growing role of the microbiome in health and disease, and evidence that the gut microbiome may shape anti-tumor immune responses as well as responses to immune checkpoint blockade and other immunotherapies. Tumor-microenvironment interactions require longitudinal assessment throughout the course of therapy. Optimize concordance between tissue-based and blood-based techniques to assess immune responses will offer better assessment and monitoring.