Primary prostate Burkitt's lymphoma resected with holmium laser enucleation of the prostate:A rare case report

BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.

Comprehensive review of diagnostic modalities for early chronic pancreatitis

Chronic pancreatitis(CP)is a progressive condition caused by several factors and characterised by pancreatic fibrosis and dysfunction.However,CP is difficult to diagnose at an early stage.Various advanced methods including endoscopic ultrasound based elastography and confocal laser endomicroscopy have been used to diagnose early CP,although no unified diagnostic standards have been established.In the past,the diagnosis was mainly based on imaging,and no comprehensive evaluations were performed.This review describes and compares the advantages and limitations of the traditional and latest diagnostic modalities and suggests guidelines for the standardisation of the methods used to diagnose early CP.

Endoscopic full-thickness resection using an over-the-scope device:A prospective study

BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative(R0)resection.Endoscopic full-thickness resection(EFTR)has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection techniques.AIM To evaluate the efficacy and safety of EFTR using an over-the-scope clip(OTSC).METHODS This prospective,single-center,non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical University.The study included patients aged 18-70 years who had gastric or colorectal submucosal tumors(SMTs)(≤20 mm in diameter)originating from the muscularis propria based on endoscopic ultrasound(EUS)and patients who had early-stage gastric or colorectal cancer(≤20 mm in diameter)based on EUS and computed tomography.All lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October 2016.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.RESULTS A total of 68 patients(17 men and 51 women)with an average age of 52.0±10.5 years(32-71 years)were enrolled in this study,which included 66 gastric or colorectal SMTs and 2 early-stage colorectal cancers.The mean tumor diameter was 12.6±4.3 mm.The EFTR procedure was successful in all cases.The mean EFTR procedure time was 39.6±38.0 min.The mean OTSC defect closure time was 5.0±3.8 min,and the success rate of closure for defects was 100%.Histologically complete resection(R0)was achieved in 67(98.5%)patients.Procedure-related adverse events were observed in 11(16.2%)patients.The average post-procedure length of follow-up was 48.2±15.7 mo.There was no recurrence during follow-up.CONCLUSION EFTR combined with an OTSC is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional endoscopic resection techniques.

Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors

BACKGROUND Gastrointestinal stromal tumors(GISTs)with a diameter of<2 cm are called small GISTs.Currently,endoscopic ultrasound(EUS)is widely used as a regular followup method for GISTs,which can also provide a preliminary basis for judging the malignancy potential of lesions.However,there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.AIM To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.METHODS We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019.The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery.Preoperative EUS features(marginal irregularity,cystic changes,homogeneity,ulceration,and strong echogenic foci)were retrospectively analyzed.The assessment results based on EUS features were compared with the pathological features.RESULTS A total of 256 patients(69 men and 187 women)were enrolled.Pathological results included 232,16,7,and 1 very low-,low-,intermediate-,and high-risk cases,respectively.The most frequent tumor location was the gastric fundus(78.1%),and mitoses were calculated as>5/50 high power field in 8(3.1%)patients.Marginal irregularity,ulceration,strong echo foci,and heterogeneity were detected in 1(0.4%),2(0.8%),22(8.6%),and 67(65.1%)patients,respectively.However,cystic changes were not detected.Tumor size was positively correlated with the mitotic index(P<0.001).Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential(95%confidence interval:0.824–0.956).EUS heterogeneity with tumor diameters>1.48 cm was associated with higher risk classification(P<0.05).CONCLUSION Small GISTs(diameters>1.48 cm)with positive EUS features should receive intensive surveillance or undergo endoscopic surgery.EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.

Endoscopic ultrasound-measured muscular thickness of the lower esophageal sphincter and long-term prognosis after peroral endoscopic myotomy for achalasia

BACKGROUND People with achalasia typically have a thick lower esophageal muscularis propria(LEMP),and peroral endoscopic myotomy(POEM)has been effective in treating most patients.LEMP thickness may be associated with the outcomes and prognosis after POEM.However,more evidence is needed regarding the relationship between LEMP thickness and patient prognosis after POEM.AIM To assess the association between LEMP thickness,measured using endoscopic ultrasound(EUS),and long-term prognosis,especially relapse,after POEM for achalasia.METHODS All medical records,including EUS data,of patients who underwent POEM to treat achalasia at Shengjing Hospital of China Medical University from January 2012 to September 2018 were retrospectively reviewed.LEMP thickness was measured by EUS,and a thickness of≥3 mm was defined as thickened.The severity of patient symptoms was evaluated using the Eckardt score.Relapse was defined as a 3-point rise in the Eckardt score after a period of clinical remission.The relationship between patient characteristics,muscle thickness,and recurrence was analyzed.RESULTS Eighty-two patients(32 males and 50 females,aged 17-78 years)and 85 POEM procedures were included.In total,76.8%(63/82 patients)of patients had a thickened muscularis propria.Older age and longer disease course were associated with muscularis propria thickening(P<0.05).The mean postoperative follow-up time was 35.4±17.2 mo(range,8-87.5 mo)in 60 patients.Five patients with Eckardt scores>3 refused further management after their symptoms were relieved.The relapse rate was 12.73%(7/55 cases).Five patients,four of whom had muscularis propria thickening,had disease recurrence within 12 mo after the procedure.Achalasia relapsed in one patient who had a thickened muscularis propria after 24 mo and in another patient who did not have a thickened muscularis propria after 30 mo.Patients with recurrence were typically younger and had a shorter disease course(P<0.05).The relapse rate in patients with a non-thickened muscularis propria tended to be higher(18.2%,2/11 patients)than that in patients with a thickened muscularis propria(11.4%,5/44 patients),although no significant difference was found.Age(hazard ratio=0.92;95%confidence interval:0.865-0.979;P<0.05)and being male(hazard ratio=7.173;95%confidence interval:1.277-40.286;P<0.05)were identified as risk factors for symptomatic recurrence by multivariable analysis using the Cox model.CONCLUSION Patients with a thickened muscularis are typically older and have a longer disease course.Younger age and the male sex are associated with increased recurrence.Patients with a thin muscularis propria may be prone to relapse,although further validation is needed.

Endoscopic fenestration in the diagnosis and treatment of delayed anastomotic submucosal abscess:A case report and review of literature

BACKGROUND Abscess formation is one of the complications after radical resection of rectal cancer;cases with delayed postoperative anastomotic abscess are rare.Here,we report a rare case of postoperative anastomotic abscess with a submucosal neoplasm appearing after rectal surgery.Ultimately,the patient was diagnosed and treated by endoscopic fenestration.In addition,we review the literature on the appearance of an abscess as a complication after rectal cancer surgery.CASE SUMMARY A 57-year-old man with a history of rectal malignancy resection complained of a smooth protuberance near the anastomotic stoma.Endoscopic ultrasonography revealed a hypoechoic structure originating from the muscularis propria,and a submucosal tumor was suspected.The patient was subsequently referred to our hospital and underwent pelvic contrast-enhanced computed tomography,which revealed no thickening or strengthening of the anastomotic wall.In order to clarify the origin of the lesion and obtain the pathology,endoscopic fenestration was performed.After endoscopic procedure,a definitive diagnosis of delayed anastomotic submucosal abscess was established.The patient achieved good recovery and prognosis after the complete clearance of abscess.CONCLUSION Endoscopic fenestration may be safe and effective for the diagnosis/treatment of delayed intestinal smooth protuberance after rectal cancer surgery.

The molecular control of meiotic double-strand break (DSB) formation and its significance in human infertility

Meiosis is an essential step in gametogenesis which is the key process in sexually reproducing organisms as meiotic aberrations may result in infertility. In meiosis, programmed DNA double-strand break (DSB) formation is one of the fundamental processes that are essential for maintaining homolog interactions and correcting segregation of chromosomes. Although the number and distribution of meiotic DSBs are tightly regulated, still abnormalities in DSB formation are known to cause meiotic arrest and infertility. This review is a detailed account of molecular bases of meiotic DSB formation, its evolutionary conservation, and variations in different species. We further reviewed the mutations of DSB formation genes in association with human infertility and also proposed the future directions and strategies about the study of meiotic DSB formation.