Plexiform angiomyxoid myofibroblastic tumor treated by endoscopic submucosal dissection:A case report and review of the literature

BACKGROUND Plexiform angiomyxoid myofibroblastic tumor(PAMT)is a rare mesenchymal tumor characterized by multiple nodular plexiform growth patterns and an immunophenotype with myofibroblasts.The pathological characteristics,immunohistochemistry,diagnostic criteria,differential diagnosis,and gene-level changes of PAMT have been reported in many studies.At present,the main treatment for PAMT in the reported cases is surgery;only eight cases were treated via endoscopy(excluding 1 thoracoscopic resection),and the lesions were all smaller than 5 cm.There are no reports on the prognosis and follow-up of young patients with lesion sizes reaching 5 cm who undergo endoscopic submucosal dissection(ESD).Herein,we present the first case of a young patient with a lesion size reaching 5 cm who was diagnosed with PAMT via endoscopic submucosal dissection.CASE SUMMARY A 15-year-old young man with upper abdominal pain for 2 years presented to the Gastroenterology Department of our hospital.Painless gastroscopy showed a semicircular bulge approximately 5 cm in size in the lesser curvature near the cardia of the fundus;the surface was eroded,and shallow ulcers had formed.The pathological manifestations of the biopsy were spindle cell proliferative lesions with interstitial mucinous changes,and the surface mucosa showed chronic inflammatory changes with active lesions;immunohistochemistry showed smooth muscle actin(SMA)(+),CD117(-),CD34(-),DOG-1(-),S-100(-),and Ki67(LI:<1%).We performed ESD on the patient.The lesion that we removed was 5 cm×4 cm×2 cm in size.Pathologically,the resected tissue displayed typical manifestations,such as fat spindle-shaped fibroblasts and myofibroblast-like cells showing irregular nodular hyperplasia.Immunohistochemistry staining of the tumor cells revealed the following:CD34(partially+),SMA(weakly+),CD117(-),DOG-1(-),S-100(-),SDHB(+),PCK(-),and Ki67(labelling index:2%).There was no recurrence or metastasis during the 3-mo follow-up after the operation,and the treatment effect was good.We also performed a review of the literature on the clinical manifestations,pathological features,immunohistochemistry,and differential diagnosis of PAMT.CONCLUSION At present,the diagnostic criteria for PAMT are relatively clear,but the pathogenesis and genetic changes require further study.PAMT is benign in nature,and these patients are less likely to experience local or metastatic recurrence.The main treatment is still surgery if the lesion is in the stomach.Partial gastrectomy and distal gastrectomy are the most frequently performed surgical treatments for PAMT,followed by local resection,subtotal gastrectomy,and wedge resection.But for comprehensive evaluation of the disease,ESD can be considered a suitable method to avoid excessive treatment.

Alcohol and tea consumption in relation to the risk ofnasopharyngeal carcinoma in Guangdong, China

To investigate whether alcohol and tea con-sumption has an etiological association with nasophar-yngeal carcinoma(NPC)in a high-incident population,a large scale case-control study was conducted.The study included 2846 individuals in Guangdong Province,China,with 1387 newly diagnosed cases of NPC and 1459 frequency-matched controls.Exposure histories of alcohol and tea consumption were obtained via personal inter-views.Information regarding socio-demographic charac-teristics(age,sex,education,dialect and household type),family history of NPC,Epstein-Barr virus(EBV)infection,dietary habits and other potential confounding factors was also studied.An analysis was performed using uncondi-tional logistic regression to calculate odds ratios(OR)and 95%confidence intervals(CI).The risk of NPC was found to be associated with habitual alcohol consumption and tea consumption.Tea consumption has been associated with a decreased occurrence of NPC(OR=0.62),while con-sumption of alcohol was associated with a complex effect.Specifically,moderate consumption of alcohol was associated with decreased risk of NPC,while overuse,especially strong distillate spirits,appeared to be a risk factor.