Endoscopic and pathological features of neoplastic transformation of gastric hyperplastic polyps:Retrospective study of 4010 cases

BACKGROUND Hyperplastic polyps,which represent 30%-93%of all gastric epithelial polyps,are the second most common type of gastric polyps after fundic gland polyps.They were previously considered to have no risk of neoplastic transformation.Recently,an increasing number of cases of gastric hyperplastic polyps(GHPs)combined with neoplastic changes have been reported;however,the specific mechanism underlying their transformation has not been thoroughly explored.AIM To investigate the clinical,endoscopic,and pathological characteristics of the neoplastic transformation of GHPs and explore the risk factors.METHODS A retrospective analysis was performed on 4010 cases of GHPs diagnosed by gastroscopy and pathological examination at the hospital from 2005 to 2021.In total,3874,119,and 17 cases were in the group without intraepithelial neoplasia(IN),with low-grade IN,and with high-grade IN,respectively.The data analysis examined the association of endoscopic and pathological features with risk factors for neoplastic transformation.Factors with significant differences were entered into univariate logistic regression,followed by multivariate logistic regression analysis.RESULTS Univariate analysis revealed diameter,multiple polyp presence,redness,rough surface,lobulation,erosion,Yamada classification,location,and gastric mucosa were risk factors for neoplastic transformation.Multivariate analysis showed that age>65 years[odds ratio(OR)=1.789;95%confidence interval(CI):1.227-2.609;P=0.003],male sex(OR=1.680;95%CI:1.158-2.438;P=0.006),multiple polyps(OR=1.851;95%CI:1.230-2.784;P=0.003),pedunculated or semi-pedunculated shape(OR=2.722;95%CI:1.689-4.388;P<0.001),and polyp diameter were significantly associated with GHPs that demonstrated neoplastic transformation.Compared with chronic superficial gastritis,autoimmune gastritis,atrophic gastritis,and gastritis with IN were independent risk factors for neoplastic transformation[(OR=2.672;95%CI:1.559-4.579;P<0.001),(OR=1.876;95%CI:1.134-3.103;P=0.014),and(OR=5.299;95%CI:3.173–8.849;P<0.001),respectively].CONCLUSION Male sex,age>65 years,multiple polyps,pedunculated or semi-pedunculated shape,polyp size>1 cm,and specific background gastric mucosa are key indicators for predicting neoplastic transformation of GHPs.

No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature

BACKGROUND Emergency pancreaticoduodenectomy(EPD)is a rare event for complex periam-pullary etiology.Increased intraoperative blood loss is correlated with poor post-operative outcomes.CASE SUMMARY Two patients underwent EPD using a no-touch isolation technique,in which all arteries supplying the pancreatic head region were ligated and divided before manipulation of the pancreatic head and duodenum.The operative times were 220 and 239 min,and the blood loss was 70 and 270 g,respectively.The patients were discharged on the 14^(th) and 10^(th) postoperative day,respectively.Thirty-two patients underwent EPD for the treatment of neoplastic bleeding.The mean operative time was 361.6 min,and the mean blood loss was 747.3 g.The comp-lication rate was 37.5%.The in-hospital mortality rate was 9.38%.CONCLUSION The no-touch isolation technique is feasible,safe,and effective for reducing intraoperative blood loss in EPD.

Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder

AIM:To investigate the preoperative factors that can predict neoplastic polypoid lesions of the gallbladder(PLGs) as well as malignant PLGs.METHODS:A retrospective analysis was conducted on the 210 consecutively enrolled patients who underwent cholecystectomy due to a PLG larger than 10 mm,as was determined by preoperative trans-abdominal ultrasonography or endoscopic ultrasonography.We ana-lyzed the medical,laboratory,radiologic data and the pathologic results.RESULTS:In 210 cases,146 had non-neoplastic polyps(69.5%) and 64 cases were neoplastic polyps(30.5%).An older age(≥ 65 years),the presence of diabetes mellitus(DM) and the size of polyp(≥ 15 mm) were revealed to be independent predictive variables for neoplastic polyps with odd ratios(OR) of 2.27(P = 0.044),2.64(P = 0.021) and 4.94(P < 0.01),respectively.Among the neoplastic PLGs,an older age(≥ 65 years),the presence of DM and polyp size(≥ 15 mm) were associated with malignancy with ORs of 4.97(P = 0.005),6.13(P = 0.001) and 20.55(P < 0.001),respectively.CONCLUSION:Among patients with PLGs larger than 10 mm in size,higher risk groups such as elderly patients more than 65 years old,those with DM or a large polyp size(≥ 15 mm) should be managed by cholecystectomy.

Risk factors for neoplastic progression in Barrett's esophagus

Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (MDC) sequence. Many of the genetic insults driving this MDC sequence have recently been characterized, providing targets for candidate biomarkers with potential clinical utility to stratify risk in individual patients. Many clinical risk factors have been investigated, and associations with a variety of genetic, specific gastrointestinal and other modifiable factors have been proposed in the literature. This review summarizes the current understanding of the mechanisms involved in neoplastic progression of BE to EAC and critically appraises the relative roles and contributions of these putative risk factors from the published evidence currently available.

Neoplastic pericardial disease: Old and current strategies for diagnosis and management

The prevalence of neoplastic pericardial diseases has changed over time and varies according to diagnostic methods. The diagnostic factor is usually the detection of neoplastic cells within the pericardial fluid or in specimens of pericardium, but the diagnosis may be difficult. Accurate sampling and cytopreparatory techniques, together with ancillary studies, including immunohistochemical tests and neoplastic marker dosage, are essential to obtain a reliable diagnosis. The goals of treatment may be simply to relieve symptoms (cardiac tamponade or dyspnea), to prevent recurrent effusion for a long-term symptomatic benefit, or to treat the local neoplastic disease with the aim of prolonging survival. Immediate relief of symptoms may be obtained with percutaneous drainage or with a surgical approach. For long term prevention of recurrences, various approaches have been proposed: extended drainage, pericardial window (surgical or percutaneous balloon pericardiostomy), sclerosing local therapy, local and/or systemic chemotherapy or radiation therapy (RT) (external or with intrapericardial radionuclides). The outcomes of various therapeutic approaches vary for different tumor types. Lymphoma and leukemias can be successfully treated with systemic chemotherapy; for solid tumors, percutaneous drainage and the use of systemic and/or localsclerosing and antineoplastic therapy seems to offer the best chance of success. The use of "pure" sclerosing agents has been replaced by agents with both sclerosing and antineoplastic activity (bleomycin or thiotepa), which seems to be quite effective in breast cancer, at least when associated with systemic chemotherapy. Local chemotherapy with platinum, mitoxantrone and other agents may lead to good local control of the disease, but the addition of systemic chemotherapy is probably relevant in order to prolong survival. The surgical approach (creation of a pericardial window, even with the mini-invasive method of balloon pericardiostomy) and RT may be useful in recurring effusions or in cases that are refractory to other therapeutic approaches.

Comparative study of mutations in SNP loci of K-RAS, hMLH1 and h MSH2 genes in neoplastic intestinal polyps and colorectal cancer

AIM: To clarify the molecular mechanism involved in pathogenesis of colorectal cancer as well as clinical significance of genetic analysis of histological samples.

NEOPLASTIC TRANSFORMATION OF HUMAN EMBRYONIC NASOPHARYNGEAL EPITHELIAL CELLS INDUCED BY N,N'-DINITROSOPIPERAZINE (DNP) IN VITRO

This experiment is the first report on N, N'-dini-trosopiperazine (DNF)-induced neoplastic transformation of human embryonic nasopharyngeal (HENPE) cells. The transformed cells showed a prolonged life span, anchorage independent growth, chromosome aberration, tumorigenicity and an altered cell morphological appearance. The results demonstrated that DNP was able to induce not only nasopharyngeal carcinoma (NPC) of rats in vivo, but also neoplastic transformation of HENPE cells in vitro.

THE ROLE OF PSYCHOSOCIAL STRESSORS,PERSONALITY AND COPING IN THE MULTIFACTORIAL ORIGIN,INITIATION AND CLINICAL COURSE OF NEOPLASTIC DISEASE AND IN HOST-DEFENSE

Summary: Retrospective and prospective bio-behavioral cancer studies have revealed that psycho social stressors may play a pivotal role in the initiation and progression of malignant neoplasia. In recent research, a pattern has emerged, which in analogy to the coronary prone pattern (type A) has been labelled type C, encompassing suppression of emotional responses, such as anger and hostility, rationality and antiemotionality, as well as high social conformity and a lack of self-assertiveness. There is growing evidence in both infrahuman and human research that specific coping styles (repressive coping) with stress may be associated with specific biologic responses, including neuroendocrine, immunologic and other bodily functions. The application of this model appears to be of importance for further research, as well as for the detection of high risk individuals, but also in regard to therapy, rehabilitation, early detection and possibly also prevention of malignant disease. This concept suggests also new directions and modifications of stress research, as stressors are to be viewed not necessarily as pathological, but in some instances as quite possibly salutary, depending on the nature of the stres-sor, the psychophysiologic state of the individual and his or her ability to cope with adverse life situations. Quite naturally, the development of this concept is still in its initial stages, there remain anumber of open questions, and it needs hardly to be pointed out in this connection that further and painstaking clinical and laboratory work is warranted in order to clarify the role of stressors, life and coping styles and its biological concomitants in neo-plastic disease.

Genomic profile concordance between pancreatic cyst fluid and neoplastic tissue

BACKGROUND DNA mutational analysis of pancreatic cystic fluid (CF) is a useful adjunct to the evaluation of pancreatic cysts. KRAS/GNAS or RAF/PTPRD/CTNNB1/RNF43 mutations are highly specific to precancerous or advanced neoplasia. Several studies recently demonstrated the ability of next-generation sequencing (NGS)analysis to detect DNA mutations in pancreatic CF, but few studies have performed a systematic comparative analysis between pancreatic CF and neoplastic surgical tissue (NT). The value of CF-NGS analysis indicators for determining surgical resection necessitates evaluation. AIM To confirm whether CF genomic profiles are a reliable malignancy predictor by comparing NGS mutational analyses of CF and NT. METHODS Patients requiring surgery for high-risk pancreatic cysts were included in a multicenter prospective pilot study. DNA from CF (collected by endoscopic ultrasound-guided fine needle aspiration (known as EUS-FNA)) and NT (collected by surgery) were analyzed by NGS. The primary objective was to compare the mutation profiles of paired DNA samples. The secondary objective was to correlate the presence of specific mutations (KRAS/GNAS, RAF/ PTPRD/CTNNB1/RNF43/POLD1/TP53) with a final cancer diagnosis. Sensitivity and specificity were also evaluated. RESULTS Between December 2016 and October 2017, 20 patients were included in this pilot study. Surgery was delayed for 3 patients. Concordant CF-NT genotypes were found in 15/17 paired DNA, with a higher proportion of mutated alleles in CF than in NT. NGS was possible for all pancreatic CF collected by EUS-FNA. In 2 cases, the presence of a KRAS/GNAS mutation was discordant between CF and NT. No mutations were found in 3 patients with NT or pancreatic cysts with high-grade dysplasia. The sensitivity and specificity of KRAS/GNAS mutations in CF to predict an appropriate indication for surgical resection were 0.78 and 0.62, respectively. The sensitivity and specificity of RAF/PTPRD/CTNNB1 /RNF43/POLD1/TP53 mutations in CF were 0.55 and 1.0, respectively. CONCLUSION Mutational analyses of CF and NT were highly concordant, confirming the value of NGS analysis of CF in the preoperative malignancy assessment. However, these results need to be confirmed on a larger scale.

THE STUDY ON RELATED GENES IN THE NEOPLASTIC TRANSFORMATION OF IMMORTALIZED HUMAN FETAL TRACHEAL FIBROBLAST CELLS INDUCED BY IRRADIATION

In this study, we investigated the genes related to the transformation of immortalized human fetal tracheal fibroblast cell line induced by alpha particles by means of differential display mRNA method. The result revealed that there were 23 DNA fragments that were expressed intensively in alphaSHTF cells (SHTF cells forming clone on agar after irradiated by alpha particles emitted by 238Pu) only and not in SHTF (SV40-immortalized human fetal tracheal fibroblast) cells. Northern dot confirmed two fragments, C17-5, C23-1 which showed intensive mRNA expression in alphaSHTF cells, but not in SHTF cells. The length of the C17-5 fragment was 310bp. Searching in BLAST database revealed that the C17-5 fragment might be an unknown sequence.

Fruquintinib beneficial in elderly patient with neoplastic pericardial effusion from rectal cancer:A case report

BACKGROUND Neoplastic pericardial effusion(NPE)is a rare consequence of rectal cancer and carries a poor prognosis.Optimal management has yet to be determined.Fruquintinib is an oral anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor approved by the China Food and Drug Administration in September 2018 as third-line treatment of metastatic colorectal cancer.CASE SUMMARY Herein,we report an elderly patient with NPE from rectal cancer who responded to the use of fruquintinib.In March 2015,a 65-year-old Chinese woman diagnosed with KRAS-mutated adenocarcinoma of the rectum was subjected to proctectomy,adjuvant concurrent chemoradiotherapy,and adjuvant chemotherapy.By October 2018,a mediastinal mass was detected via computed tomography.The growth had invaded parietal pericardium and left hilum,displaying features of rectal adenocarcinoma in a bronchial biopsy.FOLFIRI and FOLFOX chemotherapeutic regimens were administered as first-and second-line treatments.After two cycles of second-line agents,a sizeable pericardial effusion resulting in tamponade was drained by pericardial puncture.Fluid cytology showed cells consistent with rectal adenocarcinoma.Single-agent fruquintinib was initiated on January 3,2019,as a third-line therapeutic.Ten cycles were delivered before the NPE recurred and other lesions progressed.The recurrence-free interval for NPE was 9.2 mo,attesting to the efficacy of fruquintinib.Ultimately,the patient entered a palliative care unit for best supportive care.CONCLUSION Fruquintinib may confer good survival benefit in elderly patients with NPEs due to rectal cancer.

Study on medication regularity of traditional Chinese medicine cases in treatment of neoplastic fever based on data mining

Objective:To analyze the medication regularity of traditional Chinese medicine cases in treatment of neoplastic fever in order to guide clinical medication.Methods:The database of China National Knowledge Infrastructure,Vip database and WanFang medical network were searched.The cases involving traditional Chinese medicine prescription in the treatment of neoplastic fever were screened.After extracting the prescriptions and Chinese medicines,make statistics according to frequency analysis,cluster analysis and association analysis.Results:79 literatures were included which involving 123 decoctions.221 traditionalChinese medicines were included in the statistics,the most frequently used traditional Chinese medicines were Gancao,Chaihu,Huangqi and Shengdihuang.The proportion of heat-clearing drugs in Chinese medicines was the largest(23.98%).The most common property of the Chinese medicines is cold property,accounting for 51.13%.The higher frequencies of flavors of the Chinese medicines are bitter,sweet and acrid,the sum of which is 84.66%.The most common meridian of Chinese medicines is liver meridian,accounting for 19.82%.The cluster analysis and association analysis of high frequency Chinese medicines showed that high frequency Chinese medicines could form three clustering formulas,and could get 18 pairs of high frequency drug combinations.Conclusion:Traditional Chinese medicines for heat-clearing,deficiencytonifying,phlegm-resolving,blood stasis-dispeling are mostly used to the treatment of neoplastic fever.The results of cluster analysis and association analysis of high frequency traditional Chinese medicines can provide certain reference and guidance for clinical medication.

Clinical Observation on the Treatment of Male Neoplastic Anemia with Yixuesheng Capsule(益血生胶囊) Combined with Recombination Human Erythropoietin

Objective:To explore the efficacy and mechanism of Yixuesheng capsule(益血生胶囊,YXS) combined with recombination human erythropoietin(RHE) in treating male neoplastic anemia(NA).Methods: Sixty-five patients were randomized into two groups,the 33 patients in the treated group treated with a combined therapy of YXS and RHE,and the 32 in the control group treated with RHE alone,all for 12 weeks.Related clinical indexes,including hemoglobin(Hgb),red blood cell(RBC),hematocrit(HMC),testosterone(T),estradiol (E_2) an...

A Nomogram-based Model to Predict Neoplastic Risk for Patients with Gallbladder Polyps

Background and Aims:Gallbladder polyp(GBP)assessment aims to identify the early stages of gallbladder carcinoma.Many studies have analyzed the risk factors for malignant GBPs.In this retrospective study,we aimed to establish a more accurate predictive model for potential neoplastic polyps in patients with GBPs.Methods:We devel-oped a nomogram-based model in a training cohort of 233 GBP patients.Clinical information,ultrasonographic find-ings,and blood test findings were analyzed.Mann-Whitney U test and multivariate logistic regression analyses were used to identify independent predictors and establish the nomogram model.An internal validation was conducted in 225 consecutive patients.Performance and clinical bene-fit of the model were evaluated using receiver operating characteristic curves and decision curve analysis(DCA),re-spectively.Results:Age,cholelithiasis,carcinoembryonic antigen,polyp size,and sessile shape were confirmed as independent predictors of GBP neoplastic potential in the training group.Compared with five other proposed predic-tion methods,the established nomogram model presented better discrimination of neoplastic GBPs in the training co-hort(area under the curve[AUC]:0.846)and the validation cohort(AUC:0.835).DCA demonstrated that the greatest clinical benefit was provided by the nomogram compared with the other five methods.Conclusions:Our developed preoperative nomogram model can successfully be used to evaluate the neoplastic potential of GBPs based on simple clinical variables that maybe useful for clinical decision-making.

Early and long-term results of combined cardiac surgery and neoplastic resection in patients with concomitant severe heart disease and neoplasms

Background It is a surgical dilemma when patients present with both severe heart disease and neoplasms. The best surgical treatment remains controversial. This study aimed to analyze the early and long-term results of simultaneous surgical treatment of severe heart disease and neoplasms. Methods We reviewed the clinical records of 15 patients who underwent simultaneous neoplastic resection and cardiac surgery between September 2006 and January 2011. There were 5 male and 10 female patients. The mean age was （59.2±12.5） years and the mean left ventricular ejection fraction was （57.4±11.0）%. All patients were followed up completely for a period of 12 to 51 months （mean, （33.1±11.2） months）. Results Fifteen patients underwent simultaneous cardiac surgery and neoplastic resection. Cardiac procedures consisted of off pump coronary artery bypass grafting （n=7）, aortic valve replacement （n=3）, mitral valve replacement （n=3）, mitral valve replacement with coronary artery bypass grafting （n=1） and left atrial myxoma resection （n=1）. Neoplastic resection consisted of lung cancer resection （n=5）, colonic cancer resection （n=3）, gallbladder resection （n=1）, colonic cancer resection with gallbladder resection （n=1）, hysterectomy （n=2）, hysterectomy with bilateral salpingo-oophorectomy （n=2） and left ovariectomy （n=1）. Pathological examination confirmed malignant disease in 10 patients and benign disease in 5 patients. There were no perioperative myocardial infarctions, stroke, pericardial tamponade, renal failure or hospital deaths. The most frequent complications were atrial fibrillation （33.3%）, pneumonia （26.7%）, low cardiac output syndrome （6.7%） and delayed healing of surgical wounds （6.7%）. There was 1 late death 42 months after surgery for recurrent malignant disease. At 1 and 3 years, survival rates were 100% （Kaplan-Meier method）. Conclusions Simultaneous cardiac surgery and neoplastic resection was not associated with increased early or late morbidity or mortality. Cardiopulmonary bypass does not appear to adversely affect survival in patients with malignant disease. The long-term survival was determined by tumor stage.

Clinical features of neoplastic pathological fracture in long bones

Background Pathological fractures signify a potentially more aggressive subset of the original disease with higher misdiagnosis rates and inferior oncologic results. The purpose of the present study was to explore the clinical features of neoplastic pathological fracture in extremities. Methods From August 2002 to December 2010, a consecutive series of 139 patients suffering neoplastic pathological fracture were recruited, including 79 males and 60 females with a mean age of 31.3 years. Fractures were classified into five groups： tumor-like lesions （55）, benign bone tumors （13）, giant cell tumors （7）, primary malignant bone tumors （28）, and metastatic bone tumors （36）. Based on their inducing forces, pathologic fractures were classified into four grades： spontaneous fracture, functional fracture, minor injury, and traumatic injury. Patients＇ age, fracture site, histological diagnoses, fracture forces, prodromes, and misdiagnosis were well reviewed. Kruskal-Wallis and X2 tests were used to compare forces and prodromes within different types of bone tumors. Results The highest pathologic fracture morbidity was 32.3% （45/139）, which lay in the 11-20 year group, and 86.1% of metastatic tumors occurred in the 50-80 year group. The common sites of fractures were femur, humerus, and tibia. The fracture forces in benign bone tumors and tumor-like lesions are the strongest, followed by metastatic tumors and primary malignant bone tumors （Hc=80.980, P=0.000）. Sixty-seven patients （48.2%） had local prodromes before pathologic fracture. The incidence rates of prodromes between primary malignant tumors and metastatic bone tumors had no significant difference （P=0.146）, but they were all obviously higher than that of benign bone tumors and tumor-like lesions. Twenty patients experienced misdiagnosis. Conclusion Minor injury forces and local prodromes are clinical features of neoplastic pathologic fractures and they are also the critical factor avoiding misdiagnoses.

Paraneoplastic cerebellar degeneration:initial presentation of mucosa-associated lymphoid tissue lymphoma in a patient with primary Sjogren’s syndrome

A 29-year-old Chinese woman complained of recurring dizziness for 5 months and gait disturbance for 2 months.On admission(April 2016),she was found to have a widebased gait,horizontal nystagmus and positive heel-kneeshin test.Initial hematological,biochemical,microbiological,hormonal investigations and tumor serum markers were unremarkable.Oligoclonal bands were observed in cerebrospinal fluid(CSF)without other pathological changes,while magnetic resonance imaging(MRI)of cervical spine and brain were normal.An anterior mediastinal mass was noted by computed tomography(CT)[Figure 1A].Despite a lack of paraneoplastic antibodies in CSF or serum,such as anti-neuronal nuclear autoantibody type 1(ANNA-1,also known as"anti-Hu"),ANNA-2(also known as"anti-Ri"),Purkinje cell antibody type 1(PCA-1,also known as"anti-Yo"),anti-CV2(also known as"collapsin response mediator protein 5[CRMP5]"),anti-Ma,anti-Amphiphysin,anti-Tr(also known as"delta/notch-like epidermal growth factorrelated receptor[DNER]")and anti-glutamic acid decarboxylase(GAD),her neurological manifestation still pointed toward one of the paraneoplastic neurological syndromes(PNSs).

STUDY OF NEOPLASTIC TRANSFORMATION OF HUMAN FETAL KIDNEY EPITHELIAL CELLS INDUCED BY DIETHYL-NITROSAMINE in vitro

About 90 percent of human malignant tumors result from the neoplastic transformation of epithelial cells. As the conclusions obtained from animal cells cannot be extrapolated to humans directly, and the humans are not allowed to be used for carcinogen-esis experiments, establishment of a transformation system of human epithelial

STUDY OF NEOPLASTIC TRANSFORMATION OF HUMAN FETAL LUNG CELLS INDUCED BY A NEW NITROSAMINE COMPOUND (MAMBNA) in vitro

The model system of neoplastic transformation of human cells in vitro, as a desirable way for screening potential carcinogens and studying the mechanisms of carcinogenesis, has aroused great interest in a lot of laboratories. But till now,

Higher risk of neoplastic progression of Barrett’s esophagus in patients with systemic sclerosis

Systemic sclerosis(SSc)is a multisystem connective-tissue disorder of unknown etiology affecting various internal organs and skin.Esophageal involvement is present in≤70%–90%of the patients and is manifested by severe gastroesophageal-reflux disease and dysmotility.Although Barrett’s esophagus(BE)has been reported in patients with SSc[1,2],the risk of neoplastic progression has not been reported before in the USA.Therefore,we aimed to study the prevalence of BE in SSc and incidence of neoplastic progression.