Appendiceal intussusception complicated by adenocarcinoma of the cecum:A case report

BACKGROUND Appendiceal intussusception is a pathological condition in which the appendix is inverted into the cecum,which may cause symptoms that resemble those of other gastrointestinal disorders and may induce intestinal obstruction.The rarity of this case presentation is the co-occurrence of appendiceal intussusception and cecal adenocarcinoma,a combination that to our knowledge has not previously been reported in the medical literature.This case provides new insights into the complexities of diagnosing and managing overlapping pathologies.CASE SUMMARY A 25-year-old woman presented with persistent periumbilical pain and bloody stools.An initial biopsy showed cecal cancer;however,subsequent colonoscopy and computed tomography findings raised the suspicion of appendiceal intussus-ception,which was later confirmed postoperatively.This unique case was charac-terized by a combination of intussusception and adenocarcinoma of the cecum.The intervention included a laparoscopic right hemicolectomy,which led to the histopathological diagnosis of mucinous adenocarcinoma with appendiceal intussusception.The patient recovered well postoperatively and was advised to initiate adjuvant chemotherapy.This case highlights not only the importance of considering appendiceal intussusception in the differential diagnosis,but also the possibility of appendicitis and the atypical presentation of neoplastic lesions.CONCLUSIONS Physicians should consider the possibility of appendiceal intussusception in cases of atypical appendicitis,particularly when associated with neoplastic presentation.

Plexiform fibromyxoma of the small bowel: A case report

BACKGROUND Plexiform fibromyxoma is a rare, special type of mesenchymal tumor. The most common presenting symptoms are anemia, hematemesis, and hematochezia, without sex or age predilection. The reported cases have mainly occurred in the gastric antrum and pylorus region, with some cases in the duodenum. CASE SUMMARY We report here a case of plexiform fibromyxoma in the upper segment of the jejunum, which was continuously followed up for 3 years after surgical removal. Plexiform fibromyxoma showed multinodular or plexiform growth. The cells in the tumor node were spindle-shaped but few in number and mitotic figures. Small blood vessels and mucous matrix were found among the tumor cells. Immunohistochemistry revealed that the plexiform fibromyxoma cells were positive for smooth muscle actin, focally positive for CD10, and negative for cytokeratin, CD117, DOG-1(discovered on GIST-1) desmin, S-100, epithelial membrane antigen, and CD34. Ki-67 labeling index was < 5%. Plexiform fibromyxoma showed benign biological behavior. After 3 years of consecutive postoperative follow-up, no obvious signs of metastasis or recurrence were found by imaging examination. CONCLUSION Plexiform fibromyxoma is a rare type of mesenchymal tumor. The diagnosis mainly depends on pathological examination, and it should be distinguished from other gastrointestinal mesenchymal tumors.

Dickkopf-related protein 1/cytoskeleton-associated protein 4 signaling activation by Helicobacter pylori-induced activator protein-1 promotes gastric tumorigenesis via the PI3K/AKT/mTOR pathway

BACKGROUND Gastric cancer(GC)is a common malignant tumor with high incidence and mortality rates globally,especially in East Asian countries.Helicobacter pylori(H.pylori)infection is a significant and independent risk factor for GC.However,its underlying mechanism of action is not fully understood.Dickkopf-related protein(DKK)1 is a Wnt signaling antagonist,and cytoskeleton-associated protein(CKAP)4 is a newly identified DKK1 receptor.Recent studies found that the binding of DKK1 to CAKP4 mediated the procancer signaling of DKK1 independent of Wnt signaling.We hypothesize that H.pylori-induced activation of DKK1/CKAP4 signaling contributes to the initiation and progression of GC.AIM To investigate the interaction of H.pylori infection,DKK1 and CAKP4 in GC,as well as the underlying molecular mechanisms.METHODS RNA sequencing was used to identify differentially expressed genes(DEGs)between H.pylori-infected and uninfected primary GC cells.Gain-and loss-offunction experiments were performed to verify the H.pylori-induced upregulation of activator protein-1(AP-1)in GC cells.A dual-luciferase reporter assay and co-immunoprecipitation were used to determine the binding of AP-1 to the DKK1 promoter and DKK1 to CKAP4.Western blotting and immunohistochemistry detected the expression of DKK1,CKAP4,and phosphatidylinositol 3-kinase(PI3K)pathway-related proteins in GC cells and tissues.Functional experiments and tumorigenicity in nude mice detected malignant behavior of GC cells in vitro and in vivo.RESULTS We identified 32 DEGs between primary GC cells with and without H.pylori infection,including JUN,fos-like antigen-1(FOSL1),and DKK1,and confirmed that the three proteins and CKAP4 were highly expressed in H.pylori-infected GC cells,H.pylori-infected gerbil gastric tissues,and human GC tissues.JUN and FOSL1 form AP-1 to transcriptionally activate DKK1 expression by binding to the DKK1 promoter.Activated DKK1 bound to CKAP4,but not the most common Wnt coreceptor low-density lipoprotein receptor-related protein 5/6,to promote GC cell growth,colony formation,migration,invasion,and xenograft tumor growth in nude mice.All these effects were driven by activation of the PI3K/AKT/mammalian target of rapamycin(mTOR)pathway.Targeting the PI3K signaling pathway by LY294002 inhibited DKK1-mediated CKAP4/PI3K signaling activity and the malignant behavior of GC cells.CONCLUSION H.pylori induces JUN and FOSL1 expression to form AP-1,which transcriptionally activates DKK1.Binding of DKK1 to KAKP4 contributes to gastric tumorigenesis via the PI3K/AKT/mTOR pathway.