Histological Risk Factors for Lymph Node Metastasis in pT1 Colorectal Cancer:Does Submucosal Invasion Depth Really Matter?

Objective After endoscopic resection of colorectal cancer with submucosal invasion(pT1 CRC),additional surgical treatment is recommended if deep submucosal invasion(DSI)is present.This study aimed to further elucidate the risk factors for lymph node metastasis(LNM)in patients with pT1 CRC,especially the effect of DSI on LNM.Methods Patients with pT1 CRC who underwent lymph node dissection were selected.The Chi-square test and multivariate logistic regression were used to analyze the relationship between clinicopathological characteristics and LNM.The submucosal invasion depth(SID)was measured via 4 methods and analyzed with 3 cut-off values.Results Twenty-eight of the 239 patients presented with LNM(11.7%),and the independent risk factors for LNM included high histological grade(P=0.003),lymphovascular invasion(LVI)(P=0.004),intermediate to high budding(Bd 2/3)(P=0.008),and cancer gland rupture(CGR)(P=0.008).Moreover,the SID,width of submucosal invasion(WSI),and area of submucosal invasion(ASI)were not significantly different.When one,two,three or more risk factors were identified,the LNM rates were 1.1%(1/95),12.5%(7/56),and 48.8%(20/41),respectively.Conclusion Indicators such as the SID,WSI,and ASI are not risk factors for LNM and are subjective in their measurement,which renders them relatively inconvenient to apply in clinical practice.In contrast,histological grade,LVI,tumor budding and CGR are relatively straightforward to identify and have been demonstrated to be statistically significant.It would be prudent to focus on these histological factors rather than subjective measurements.

Blood Oxygenation Level-dependent Magnetic Resonance Imaging of Breast Cancer： Correlation with Carbonic Anhydrase IX and Vascular Endothelial Growth Factor

Background： Blood oxygenation level-dependent magnetic resonance imaging （BOLD-MRI） is a functional MRI technique which involves using the paramagnetic properties of deoxyhemoglobin to image the local tissue oxygen concentration. The purpose of this study was to investigate whether BOLD-MRI could evaluate hypoxia and angiogenesis of breast invasive ductal carcinoma （IDC）. Methods： Ninety-eight female patients with IDC were retrospectively included in this research. All patients underwent breast BOLD-MRI at 3.0 T before surgery. R2＊ values of BOLD-MR1 were measured. The expression of carbonic anhydrase IX （CA IX） and vascular endothelial growth factor （VEGF） was analyzed by immunohistochemistry. Spearman＇s correlation analysis was used to correlate R2＊ value with CA IX and VEGF levels. Results： Heterogeneous intensity on BOLD-MRI images was the main finding of IDCs. The mean R2＊ value was 52.8 ± 18.6 Hz. The R2＊ values in patients with axillary lymph node metastasis were significantly higher than the R2＊ values in patients without axillary lymph node metastasis （t = 2.882, P = 0.005）. R2＊ values increased with CA IX level and positively correlated with the level of CA 1X （r = 0.616, P 〈 0.001）; however, R2＊ value had no significantly correlation with the level of VEGF （r = 0.110, P = 0.281）. Conclusion： B OLD-MRI could noninvasively evaluate chronic hypoxia of IDC, but not angiogenesis.

Pulmonary Capillary Hemangiomatosis Associated with CREST Syndrome： A Challenge of Diagnosis and Treatment

To the Editor： A 65-year-old woman with calcinosis, Raynaud＆#39;s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia （CREST） syndrome was admitted to hospital because of progressive dyspnea on exertion for about 1 year. In the past, she had been diagnosed as gastroesophageal reflux disease and scleroderma for 10 years. Physical examination showed masked face, Raynaud＇s phenomenon, finger sclerodactyly, and skin telangiectasia on her neck and back [Figure 1a and 1b]. The titer of anticentromere antibody in serum increased to 1： 1000. Analysis of arterial gas on room air revealed the partial pressure of arterial oxygen （PaO2） was 54 mmHg （1 mmHg = 0.133 kPa） and carbon dioxide （PaCO2） was 32 mmHg. Echocardiogram showed severe tricuspid regurgitation and elevated pulmonary arterial pressure of 78 mmHg.

Xanthogranulomatous Cholecystitis and Misdiagnosis Analysis

INTRODUCTION Gastric sub-epithelial masses （SEMs） are relatively common findings when receiving gastric endoscopy. It is a mass, bulge, or impression visible. Computed tomography （CT） and magnetic resonance imaging can assist in making a diagnosis,