Misdiagnosis of left supraclavicular lymph node metastasis of hepatocellular carcinoma:A case report

Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC).This phenomenon is easily neglected in the clinic.A 56-yearold man presented with HCC.On examination,a 1cm long left supraclavicular lymph node was palpated.Auxiliary examination indicated a lesion located in the right lobe of the liver.Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed;however,only necrosis was found.Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining.However,14 d after surgery,significantly enlarged left supraclavicular lymph nodes,a new intrahepatic lesion,and pulmonary and mediastinal metastasis appeared.An excisional biopsy of the left supraclavicular lymph node was performed,and its findings confirmed metastatic HCC.The patient's HCC rapidly progressed and he died one month later.It is possible for HCC tometastasize to the left supraclavicular lymph node.Surgeons should always consider an overall physical examination.When left supraclavicular lymphadenopathy of unknown origin is encountered,FNAC should be performed initially.If the results are negative,an excisional biopsy and subsequent Positron emission tomography computed tomography scanning should be performed.These are very important for making the correct diagnosis and for selecting reasonable therapies.

Molecular Analysis-Based Genetic Characterization of a Cohort of Patients with Duchenne and Becker Muscular Dystrophy in Eastern China

Background： Duchenne muscular dystrophy （DMD） and Becker muscular dystrophy （BMD） are common X-linked recessive neuromuscular disorders caused by mutations in dystrophin gene. Multiplex polymerase chain reaction （multiplex PCR） and multiplex ligation-dependent probe amplification （MLPA） are the most common methods for detecting dystrophin gene mutations, This study aimed to contrast the two methods and discern the genetic characterization of patients with DMD/BMD in Eastern China. Methods： We collected 121 probands, 64 mothers ofprobands, and 15 fetuses in our study. The dystrophin gene was detected by multiplex PCR primarily in 28 probands, and MLPA was used in multiplex PCR-negative cases subsequently. The dystrophin gene of the remaining 93 probands and 62 female potential carriers was tested by MLPA directly. In fetuses, multiplex PCR and MLPA were performed on 4 fetuses and 10 fetuses, respectively. In addition, sequencing was also performed in 4 probands with negative MLPA. Results： We found that 61.98% of the subjects had genetic mutations including deletions （50.41%） and duplications （11.57%）. There were 43.75% of mothers as carriers of the mutation. In 15 fetuses, 2 out of 7 male fetuses were found to be unhealthy and 2 out of 8 female fetuses were found to be carriers. Exons 3-26 and 45-52 have the maximum frequency in mutation regions. In the frequency ofexons individually, exon 47 and exon 50 were the most common in deleted regions and exons 5, 6, and 7 were found most frequently in duplicated regions. Conclusions： MLPA has better productivity and sensitivity than multiplex PCR. Prenatal diagnosis should be applied in DM D high-risk fetuses to reduce the disease incidence. Furthermore, it is the responsibility of physicians to inform female carriers the importance of prenatal diagnosis.

Predictive Value of Inflammation Biomarkers in Patients with Portal Vein Thrombosis

Background and Aims:To investigate the usefulness of inflammation biomarkers to serve as a predictors of portal vein thrombosis(PVT)postoperatively(post)in patients with portal hypertension after splenectomy and periesophagogastric devascularization.Methods:A total of 177 liver cirrhosis patients were recruited from January 2013 to December 2017.They were divided into a PVT group(n=71)and a non-PVT group(n=106),according to ultrasound examination findings at 7-day post.Inflammation biomarkers involving platelet-to-lymphocyte ratio(PLR),neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),red blood cell distribution width-to-platelet ratio(RPR),mean platelet volume-to-platelet ratio(MPR)preoperatively(pre)and at 1,3,7-days post were recorded.Results:The univariate logistic regression analysis indicated that PLR(pre)(odds ratio(OR)=3.963,95%confidence interval(CI)=2.070–7.587,p<0.000),MLR(pre)(OR=2.760,95%CI=1.386–5.497,p=0.004),PLR(postday 7)(OR=3.345,95%CI=1.767–6.332,p=0.000)were significantly associated with the presence of PVT.The multivariate logistic regression analysis results indicated that PLR(pre)(OR=3.037,95%CI=1.463–6.305,p=0.003),MLR(pre)(OR=2.188,95%CI=1.003–4.772,p=0.049),PLR(post-day 7)(OR=2.166,95%CI=1.053–4.454,p=0.036)were independent factors for predicting PVT.Conclusions:The PLR(pre),MLR(pre),and PLR(post-day 7)are predictors of portal vein thrombosis post in patients with portal hypertension after splenectomy and periesophagogastric devascularization.