Itzhak Nir

Pediatric melanoma in New Mexico American Indians, Hispanics, and non-Hispanic whites, 1981–2009

BACKGROUND Pediatric melanoma rates are increasing nationally. Our purpose was to determine the incidence of melanoma in New Mexicos (NMs) American Indian, Hispanic, and non-Hispanic white children. METHODS A retrospective review (1981 to 2009) of the NM Tumor Registry was conducted. Melanomas diagnosed in children <19 years of age were identified. Average annual age-adjusted incidence rates per million were calculated. RESULTS Sixty-four cases were identified. Rates per million were 7.4 for non-Hispanic whites, 2.1 for Hispanics, and 3.3 for American Indians. Fifty-nine percent were women. Fifty-five (86%) cases were localized, 6 (9%) were regional, and 1 (3%) case was metastatic. Majority of cases (49/64; 77%) occurred in children >14 years of age. American Indians presented with thicker melanomas as compared to whites and Hispanics. CONCLUSIONS Incidence rates for pediatric melanoma in NM are highest for non-Hispanic whites. Distant metastasis is uncommon. Melanoma in children is rare, but practitioners must be aware of its occurrence for prompt diagnosis and treatment.

Viral hepatitis status does not affect survival in patients with hepatocellular carcinoma

Background There have been few studies on the impact of viral etiology on the prognosis in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the clinical characteristics and survival of patients with viral hepatitis-associated HCC (V-HCC), compared to patients with HCC of non-hepatitis B, non-hepatitis C (NBNC-HCC) etiology. Methods We performed a retrospective analysis of all patients with HCC treated at our comprehensive cancer center from 2000 through 2014. Patients were divided into two groups according to their viral hepatitis status. Presentation patterns, treatments, and survival data were analyzed. Results We evaluated 366 patients: 233 patients (63.7%) had V-HCC while 133 (36.3%) patients had NBNC-HCC. V-HCC patients were younger (P<0.0001) and more likely to be male (P=0.001). Decompensated cirrhosis was more prevalent in V-HCC patients (P=0.01). There was no difference in the resectability rate or disease stage. In patients with resectable disease, those with V-HCC were less likely to undergo hepatectomy (23.7% vs. 38%; P=0.04) for more advanced liver disease. The estimated median survival for V-HCC was 13 months compared to 16 months in NBNC-HCC patients (P=0.57). On multivariate analysis, disease stage (P<0.0001) and Child-Pugh class (P<0.0001) were independent factors affecting survival, but viral status was not (P=0.75). Conclusion Despite presenting with more advanced cirrhosis and being less likely to undergo surgery, V-HCC patients had similar survival to patients with NBNC-HCC.

Diversification and trends in biliary tree cancer among the three major ethnic groups in the state of New Mexico

BACKGROUND New Mexicos population is composed of 45% non-Hispanic whites, 42% Hispanics, 10% American Indians, and 3% other minorities. The purpose of this study was to compare the trends of biliary tract cancer among these groups over the past 3 decades. METHODS The states tumor registry was used to ascertain the incidence of gallbladder cancer, extrahepatic bile duct cancer, and intrahepatic bile duct cancer. RESULTS A total of 1,449 new biliary cancers were diagnosed between 1981 and 2008. The contemporary incidence of gallbladder cancer remains several times higher among American Indians than in other ethnicities: for men, 4.1%, 1.1%, and .8% for American Indians, Hispanics, and non-Hispanic whites, respectively, and for women, 8.1%, 2.1%, and 1.0%, respectively. CONCLUSIONS Biliary malignancies are more prevalent among American Indians. Despite a decline in the incidence of gallbladder cancer among American Indians and Hispanics, it remains higher compared with the states non-Hispanic white population.

A 50-Year-Old Man with Postprandial Epigastric Pain

A 50-year-old otherwise healthy man, with moderate hypertension, had suffered from intermittent postprandial epigastric pain and bloating for over 3 years. The pain was moderate in intensity, lasted for about 1 h, did not radiate, and had no obvious other precipitating or relieving factors. Although occasional belching was noted, the pain was not accompanied by nausea, vomiting, weight loss, or disturbance of bowel habits. Physical examination revealed an obese man with normal vital signs. His abdomen was soft, non-tender, and non-distended, and bowel sounds were normal. There were no masses palpable in the abdomen. Results of routine blood tests, including serum liver enzymes, bilirubin, amylase, and lipase, carcinoembryonic antigen and CA19-9, were all normal. Solid gastric emptying, delayed 36 % at 2 h, was initially treated empirically with domperidone 10 mg postoperatively three times a day, with partial relief of symptoms. A 0.5-cm duodenal bulb carcinoid was removed via endoscopic mucosal resection, with considerable improvement in his symptoms. Nevertheless, 2 years later during routine follow-up, an elevated serum concentration of chromogranin A, without elevation of concentration of any other gut hormone, was noted as part of an investigation for symptomatic relapse. A computerized tomographic (CT) scan of his abdomen and pelvis was unremarkable. He was then referred to an endoscopic ultrasound examination to evaluate the possibility of having residual or recurrent carcinoid tumor. Radial endosonography (EUS), although revealing no evidence of residual tumor, identified circumferential pancreatic tissue around the second portion of the duodenum, immediately distal to the duodenal sweep, with associated luminal narrowing (Figs. 1, 2). A magnetic resonance imaging (MRI) scan, with MR cholangiopancreatography (MRCP), confirmed the existence of an annular pancreas (Fig. 3a, b). A subsequent upper gastrointestinal barium study displayed narrowing of the second portion of the duodenum, but failed to reveal the presence of a dilated duodenal bulb, characteristic of the condition.

Gallbladder cancer: review of a rare orphan gastrointestinal cancer with a focus on populations of New Mexico

Gallbladder cancer is a rare malignancy of the biliary tract with a poor prognosis, frequently presenting at an advanced stage. While rare in the United States overall, gallbladder cancer has an elevated incidence in geographically distinct locations of the globe including Chile, North India, Korea, Japan and the state of New Mexico in the United States. People with Native American ancestry have a much elevated incidence of gallbladder cancer compared to Hispanic and non-Hispanic white populations of New Mexico. Gallbladder cancer is also one of the few bi-gendered cancers with an elevated female incidence compared to men. Similar to other gastrointestinal cancers, gallbladder cancer etiology is likely multi-factorial involving a combination of genomic, immunological, and environmental factors. Understanding the interplay of these unique epidemiological factors is crucial in improving the prevention, early detection, and treatment of this lethal disease. Previous studies have failed to identify a distinct genomic mutational profile in gallbladder cancers, however, work to identify promising clinically actionable targets is this form of cancer is ongoing. Examples include, interest in the HER2/Neu signaling pathway and the recognition that chronic inflammation plays a crucial role in gallbladder cancer pathogenesis. In this review, we provide a comprehensive overview of gallbladder cancer epidemiology, risk factors, pathogenesis, and treatment with a specific focus on the rural and Native American populations of New Mexico. We conclude this review by discussing future research directions with the goal of improving clinical outcomes for patients of this lethal malignancy.

Clinicopathologic correlations of gallbladder cancer by ethnicity in New Mexico, 1980-2009.

160 Background: Gallbladder cancer (GBCA) is a rare malignancy; however, within the U.S. incidence varies geographically. GBCA has a higher occurrence in the American Indian (AI) population versus non-Hispanic whites (NHW) and Hispanics (H). The goal of the study is to determine if clinicopathologic features correlate with ethnicity. Methods: Incident GBCA diagnosed in New Mexico from 1980-2009 were identified from the population-based New Mexico Tumor Registry. Average age-adjusted incidence rates were calculated by direct method using the United States 2000 standard population. Chi-squared statistic was used to assess ethnicity differences in case distribution at diagnosis by sex, age, stage and grade. Cause-specific survival was calculated by the Kaplan-Meier method and assessed with log-rank statistic. Results: GBCA incidence rates in New Mexico are highest for AI (7.6 per 100,000–95% confidence interval (CI)=6.5-8.9), followed by H (2.8 per 100,000 – 95% CI=2.5-3.2) and NHW (1.0 per 100,000 – 95% CI=...