Diagnosis and treatment of biliary mucinous cystic neoplasms: A single-center experience

Background: Biliary mucinous cystic neoplasms(BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. Methods: We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Afflliated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. Results: Among the 49 patients, 37 were female(75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients(44.9%) had no symptoms. Serum carbohydrate antigen(CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34(70.8%) had low-grade intraepithelial neoplasms(LGINs), and 14(29.2%) had high-grade intraepithelial neoplasms(HGINs). The potential immunohistochemical markers of BMCNs were cytokeratin(CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival(OS) of BMCNs was not reached. The longest survival time was 137 months.The 5-and 10-year OS rates were 100% and 85.4%, respectively. The 5-and 10-year recurrence-free survival(RFS) rates were 93.9% and 80.2%, respectively. Conclusions: BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.

Experimental investigation of hydrate formation in water-dominated pipeline and its influential factors

Blockage in water-dominated flow pipelines due to hydrate reformation has been suggested as a potential safety issue during the hydrate production.In this work,flow velocity-dependent hydrate formation features are investigated in a fluid circulation system with a total length of 39 m.A 9-m section pipe is transparent consisted of two complete rectangular loops.By means of pressurization with gas-saturated water,the system can gradually reach the equilibrium conditions.The result shows that the hydrates are delayed to appear as floccules or thin films covering the methane bubbles.When the circulation velocity is below 750 rpm,hydrate is finally deposited as a“hydrate bed”at upmost of inner wall,narrowing the flow channel of the pipeline.Nevertheless,no plugging is observed during all the experimental runs.The five stages of hydrate deposition are proposed based on the experimental results.It is also revealed that a higher driving pressure is needed at a lower flow rate.The driving force of hydrate formation from gas and water obtained by melting hydrate is higher than that from fresh water with no previous hydrate history.The authors hope that this work will be beneficial for the flow assurance of the following oceanic field hydrate recovery trials.

Ectopic Thyroid Masquerading as Pituitary Adenoma

To the Editor： We reported 2 cases ofectopic thyroid gland （ETG） masquerading as pituitary adenoma （PA）. The first case was a 15-year-old boy with growth, and mental retardation whose height was 121 cm and weight was 44 kg on admission. Bone age development index was 40, while bone age showed 6-10 years old.