基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用

目的探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件肿瘤进行分类,以病理组织学作为金标准,计算出O-RADS、ADNEX模型及两者联合的诊断效能,绘制受试者工作特征(ROC)曲线。结果95例患者中,病理结果恶性46例、良性49例。O-RADS 4、5类诊断附件恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、69.39%(95%CI:0.544,0.813)、74.14%、91.89%,ADNEX模型诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为89.13%(95%CI:0.756,0.959)、79.59%(95%CI:0.652,0.893)、80.39%、88.63%,两者联合诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、83.67%(95%CI:0.698,0.922)、84.31%和93.18%。O-RADS、ADNEX模型及其联合诊断附件肿瘤良恶性的曲线下面积分别0.814、0.844、0.871。由2位超声医师运用O-RADS分类诊断的一致性好(κ=0.847,P=0.000),运用O-RADS简化流程图者较颜色编码计分表格者用时更短,分别为42 min 39 s和51 min 3 s。结论O-RADS联合ADNEX模型诊断中老年女性附件肿瘤良恶性的价值较单独使用O-RADS高,不同超声医师使用O-RADS有较高的一致性,且使用简化流程图者可更快速进行分类,值得推广。

Guiding function of positron emission tomographycomputed tomography examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma

AIM:To explore the role of positron emission tomographycomputed tomography(PET-CT)examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma(OAML).METHODS:The general clinical data,postoperative PET-CT results,treatment regimens,and the prognosis of 21 histopathologically confirmed OAML patients between October 2017 and September 2021 were collected.Among the 21 patients,five patients underwent surgical treatment alone,13 patients underwent surgical treatment combined with radiotherapy,and three patients underwent surgical treatment combined with chemotherapy.RESULTS:The follow-up period ranged from 8 to 79mo,with four cases of recurrence and no deaths.Through PETCT examination,two patients exhibited both local ocular metabolic elevation and systemic metastasis,and one of these patients had cervical lymph node metastasis,while the other had submandibular and parotid gland metastasis.Nine patients showed only local ocular metabolic elevation,while 10 patients had no abnormal metabolic activity locally.CONCLUSION:PET-CT examination plays a crucial role in detecting residual lesions and recurrence following tumor resection,aiding in precise disease staging,and facilitating the development of personalized treatment plans,ultimately improving patient prognosis.

O-RADS、GI-RADS、ADNEX模型诊断附件肿瘤良恶性的价值及一致性分析

目的分析O-RADS、GI-RADS、ADNEX模型超声诊断分类系统鉴别附件肿瘤良恶性的价值及一致性。方法回顾性分析2017年1月—2020年12月在常州市第二人民医院行手术治疗的299例患者的324个附件肿瘤,由3位经验丰富的超声医师分别根据O-RADS、GI-RADS、ADNEX模型进行分类,绘制受试者工作特征曲线,获得最佳分界值,以病理检查结果为金标准,分析3种超声分类系统诊断附件肿瘤的有效性。使用κ值评估各超声医师分类的一致性。结果当取O-RADS>3类的cut-off值时,其诊断附件肿瘤良恶性的曲线下面积(AUC)为0.981,大于GI-RADS(0.934)和ADNEX模型(0.907)(P<0.05);而GI-RADS与ADNEX模型的AUC比较,差异无统计学意义(P>0.05)。O-RADS诊断附件肿瘤良恶性的敏感性为96.0%,高于GI-RADS(90.0%)和ADNEX模型(88.0%)(P<0.05);GI-RADS与ADNEX模型的敏感性比较,差异无统计学意义(P>0.05)。O-RADS、GI-RADS、ADNEX模型诊断附件肿瘤良恶性的特异性分别为92.9%、88.4%和93.3%,差异无统计学意义(P>0.05)。3位超声医师采用O-RADS、GI-RADS、ADNEX模型诊断附件肿瘤良恶性的一致性均较好,κ值为0.857~0.937。结论O-RADS、GI-RADS、ADNEX模型均有较高的诊断价值,且一致性较好,但O-RADS的诊断效能优于GI-RADS和ADNEX模型。

对比观察ADNEX模型、简单规则风险估计模型及恶性风险指数诊断卵巢良恶性肿瘤

目的比较ADNEX模型、简单规则风险估计模型及恶性风险指数(RMI)对卵巢良恶性肿瘤的诊断价值。方法回顾性分析286例卵巢肿瘤患者的术前超声检查图像,分别以ADNEX模型、简单规则风险估计模型及RMI评估卵巢肿瘤的良恶性。以病理结果为金标准,计算并比较3种方法的敏感度、特异度,绘制ROC曲线,获得曲线下面积。结果286例卵巢肿瘤患者中,良性肿瘤142例,恶性肿瘤144例。ADNEX模型、简单规则风险估计模型、RMI诊断卵巢良恶性肿瘤的敏感度分别为83.33%(120/144)、80.56%(116/144)、65.97%(95/144),特异度分别为89.44%(127/142)、92.96%(132/142)、90.14%(128/142)。ADNEX模型与简单规则风险估计模型间敏感度及特异度差异均无统计学意义(χ~2=0.352、1.784,P=0.554、0.182),ADNEX模型及简单规则风险估计模型的敏感度均高于RMI(χ~2=16.691、7.533,P均<0.001),而特异度与RMI间差异均无统计学意义(χ~2=0、0.561,P=1.000、0.454)。ADNEX模型、简单规则风险估计模型及RMI鉴别卵巢肿瘤良恶性的AUC分别为0.864、0.868和0.788(P均<0.001)。结论 ADNEX模型及简单规则风险估计模型鉴别卵巢肿瘤良恶性的效能在一定程度上优于RMI。

ADNEX模型对早期鉴别卵巢肿瘤良恶性及分期的临床价值分析

目的探讨ADNEX模型在早期鉴别卵巢肿瘤良恶性及分期的临床价值。方法对2011年1月至2015年10月长江大学附属第一医院收治的223例卵巢肿瘤患者进行回顾性研究,从中选取满足ADNEX模型各项超声指标要求并术前行盆腔核磁共振(MRI)检查的患者136例作为研究对象,使用ADNEX模型和MRI资料进行回顾性分析,ADNEX模型用于对卵巢肿瘤进行良恶性定性和分期,以病理检查结果为金标准,对比分析两种诊断方式的准确度、灵敏度、特异度及诊断值等。结果在卵巢肿瘤定性方面,ADNEX模型的准确度为78. 70%,灵敏度为93%; MRI检查的准确度为80. 1%,灵敏度为90. 7%;两种检查方法各项诊断值对比,差异均无统计学意义。在卵巢肿瘤分期方面,ADNEX模型对交界性肿瘤分期的准确度和特异度较MRI检查低,灵敏度较MRI检查高,三项差异均有统计学意义,两种检查方法对其他各分期各项诊断值差异均无统计学意义。结论ADNEX模型对鉴别卵巢肿瘤良恶性及预测分期具有一定临床价值,对卵巢肿瘤的检出和排除有较大帮助,但早期鉴别仍有欠缺,需进一步研究验证。

WJBC 5^(th) Anniversary Special Issues(2): Proteomics In 2014, can we do better than CA125 in the early detection of ovarian cancer?

Ovarian cancer is a lethal gynecologic malignancy with greater than 70% of women presenting with advanced stage disease. Despite new treatments, long term outcomes have not significantly changed in the past 30 years with the five-year overall survival remaining between 20% and 40% for stage Ⅲ and Ⅳ disease. In contrast patients with stage Ⅰ disease have a greater than 90% five-year overall survival. Detection of ovarian cancer at an early stage would likely have significant impact on mortality rate. Screening biomarkers discovered at the bench have not translated to success in clinical trials. Existing screening modalities have not demonstrated survival benefit in completed prospective trials. Advances in high throughput screening are making it possible to evaluate the development of ovarian cancer in ways never before imagined. Data in the form of human "-omes" including the proteome, genome, metabolome, and transcriptome are now available in various packaged forms. With the correct pooling of resources including prospective collection of patient specimens, integration of high throughput screening, and use of molecular heterogeneity in biomarker discovery, we are poised to make progress in ovarian cancer screening. This review will summarize current biomarkers, imaging, and multimodality screening strategies in the context of emerging technologies.

Role of ultrasonography and contrast-enhanced ultrasonography in a case of Krukenberg tumor

We report a case of Krukenberg tumor of gastric origin with adnexal metastasis,in which ultrasonography(US) and contrast-enhanced US(CEUS) played a key diagnostic role.An 64-year-old female patient was referred to our department for abdominal pain,nausea and ascites.US examination was performed as first line diagnostic imaging approach,confirming the presence of ascites and detecting marked thickness of the gastric wall and a right adnexal mass.CEUS was immediately performed and showed arterial enhancement followed by wash-out in the venous phase of both the gastric wall and the adnexal mass,suggesting the diagnosis of gastric cancer with right adnexal metastasis(Krukenberg syndrome).The patient underwent USguided paracentesis and esophagogastroduodenoscopy that showed linitis plastica.Cytologic examination of the peritoneal fluid revealed the presence of signetring cells,and histologic examination of the specimen obtained by endoscopic biopsy showed primary gastric mucus-producing adenocarcinoma with signetring cells.Although transvaginal US is undoubtedly the method of choice to evaluate ovarian tumors,abdominal US and CEUS can provide key diagnostic elements,supporting clinicians in the first steps of the diagnostic work-up of abdominal and pelvic masses.

Clinical features and treatment outcomes of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma: a single center retrospective analysis of 64 patients in China

AIM: To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma(POAML).METHODS: A retrospective analysis was performed on 64 patients with POAML who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2018.RESULTS: With a median follow-up of 61 mo(range, 2-156 mo), estimated overall survival(OS) rate and progressionfree survival(PFS) rate at 10 y reached 94.5% and 61.5%, respectively. Median OS time and PFS time were not reached. During this period, only 3 patients died, but none of them died directly due to disease progression. One patient(1.6%) developed transformation to diffuse large B-cell lymphoma(DLBCL). Of the 56 patients achieved complete remission after first-line treatment, 5(8.9%) developed local and/or systemic relapse eventually. Patients ≥60 y had significantly shorter PFS than younger patients(P=0.01). For patients with early stages(Ann Arbor stage I and stage II), univariate analysis confirmed that radiotherapydose lower than 32 Gy were independently associated with shorter PFS(P=0.04). Other factors including gender, bone marrow involvement, the initial location of the disease, and the laterality were not associated with PFS.CONCLUSION: The data from our center indicate that POAML has a slow clinical progression and has an excellent clinical outcome. Patients with POAML harbor a continual risk of relaps and transformation to aggressive subtype of lymphoma.

Facial microcystic adnexal carcinoma-treatment with a “jigsaw puzzle” advancement flap and immediate esthetic reconstruction: A case report

BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histological invasiveness,clinical inexperience and inadequate procedure design,immediate or permanent facial deformity may occur after surgical operations.CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip.She declined the recommended treatment plan,which included two-stage reconstruction,skin grafting,or surgery that could have resulted in obvious facial dysfunction or esthetic deformity.We accurately designed a personalized procedure involving a“jigsaw puzzle advancement flap”for the patient based on the lesion location and the estimated area of skin loss.The procedure was successful;both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.CONCLUSION This study suggests that when treating facial MAC or other skin malignancies,a surgical team should have sufficient plastic surgery-related knowledge and skills.An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.

The expressions of metadherin and LEF-1 in mucosa-associated lymphoid tissue lymphoma of ocular adnexal

AIM：To investigate the expressions of metadherin（astrocyte elevated gene-1, AEG-1） and lymphoid enhancerbinding factor-1（LEF-1） in ocular adnexal mucosaassociated lymphoid tissue（MALT） lymphoma.METHODS：The expressions of AEG-1 and LEF-1 were detected on specimens harvested from patients suffering from MALT lymphoma and lymphadenosis of ocular adnexal in Ophthalmology Department, Affiliated Hospital of Qingdao University from 2000 to 2015 by immunohistochemical and polymerase chain reaction（PCR） analysis.RESULTS：AEG-1 and LEF-1 expressions in MALT lymphoma was respectively higher than that in lymphadenosis, both by immunohistochemical and PCR analysis（P〈0.05）. Diversity of AEG-1 and LEF-1 expressions in different Ann Arbor clinical stages showed a statistically significant result（P〈0.05）. A positive relevance between AEG-1 and LEF-1 was observed in MALT ocular adnexal lymphoma（r=0.435, P=0.016）.CONCLUSION：The over expressions of AEG-1 and LEF-1 at the level of protein and mR NA participates in the tumorigenesis of ocular adnexal MALT lymphoma. They should act as a new biological marker for pathological diagnosis in the future.

Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature

BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively,despite the use of advanced diagnostic methods by experienced clinicians.CASE SUMMARY A 59-year-old G2P2 woman,with chronic pelvic pain,underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm×34 mm×36 mm,with irregular borders,heterogeneous echogenicity,no color Doppler vascularization and without acoustic shadowing.Normal ovarian tissue was visualized in contact with the lesion,and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe.Ascites,peritoneal metastases or other alterations were not observed.With the international ovarian tumor analysis ADNEX model,the lesion was classified as a malignant tumor(the risk of malignancy was 27.1%,corresponding to Ovarian-Adnexal Reporting Data System category 4).Magnetic resonance imaging confirmed the presence of a right adnexal mass,apparently an ovarian tumor measuring 65 mm×35 mm,without signs of invasive or metastatic disease.During explorative laparotomy,normal morphology of the internal reproductive organs was noted.A solid mobile lesion involved the entire appendix.Appendectomy was performed.Inspection of the abdominal cavity revealed no signs of malignant dissemination.Histopathologically,the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm(LAMN).CONCLUSION The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature(benign vs malignant)and origin(gynecological vs nongynecological)of the lesion.Radiologists,gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific.The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.

CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease: multi-institutional case series

AIM:To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease(IgG4-MALT lymphoma),a rare but clinically important complication of ocular adnexal IgG4-related disease.METHODS:We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three ter tiary and one secondary referral centers,between February 2003 and December 2016.Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified.CT and MR images were analyzed by consensus of two experienced head and neck radiologists.RESULTS:Lacrimal glands were the main site of involvement in all seven patients.The lesions typically showed well-demarcated margins,iso-to hyperattenuation on precontrast CT,T2 hypo-to isointensity,T1 isointensity,and homogenous internal architecture with homogenous enhancement pattern.Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images,respectively.CONCLUSION:Unlike in typical ocular adnexal IgG4-related disease,T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases.Although the findings may be nonspecific,the possibility of accompanying MALT lymphoma may need to be considered,when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients.However,this is a case series of a very rare complication of ocular adnexal IgG4-related disease,and thus caution is warranted to generalize the conclusion.

Role of minimally invasive surgery in complex adnexal tumours and ovarian cancer

Ovarian cancer is one of the most common causes of cancerrelated death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing with a complex adnexal mass should be defned prior to surgery and several scoring systems may be useful for this purpose. Laparoscopic management of ovarian tumours allows a minimally invasive approach with respect to several oncological assumptions. In the last decade concerns have been raised regarding the risk of cyst rupture and tumour spillage as a con-sequence of the laparoscopic technique itself both in early and advanced stages of ovarian cancer. Although limited data have been reported in the literature on the use of minimally invasive techniques in ovarian cancer, the clear benefits of this approach must be balanced with the potential hazards in different clinical situations. Laparoscopic staging in borderline tumours and presumed early-stage ovarian cancer performed by a laparoscopic oncologist seems to be safe and effec-tive when compared to laparotomy. The precise role of laparoscopy in patients with more advanced cancer is still to be defned, and the risk of suboptimal surgery should never outweigh the potential benefits of mini-mally invasive surgery. Thus, a tailored prediction of optimal laparoscopic debulking is mandatory in these patients.

Dermoid Ovarian Cyst Complicated with Torsion in a Girl of 11 Years Old at the Teaching Hospital Sanou Souro of Bobo-Dioulasso (Burkina Faso): About an Observation and Review of the Literature

The dermoid ovarian is an organic mild tumor. It can be revealed by an adnexal torsion which constitutes a gynecological emergency that can bring into play in a short term after the functional prognosis. We are reporting an observed case in an 11-year-old teenager who is in times peri-pubertal. The patient was presenting a painful abdomino-pelvic syndrome and a pelvic mass at the physical examination. The ultrasound was showing a right cyst mass with a right moderated hydronephrosis. A right adnexectomy was realized. The histological test after excision of the adnexal was showing a mature cystic teratoma of the right ovary with a congestive and edematous tubal fragment.

MRI is a state of art imaging modality in characterization of indeterminate adnexal masses

Aims and Objectives: The aim of this diagnostic observational study was to find an association of final diagnosis of adnexal masses suggested by MRI and compare it as an imaging modality in determining the origin, nature (benign/malignant) & characteristics of adnexal masses by calculating sensitivity, specificity, and diagnostic accuracy. Materials and Methods: The present study was carried out in 90 patients in the department of radio diagnosis and imaging, institute of medical sciences, Banaras Hindu University (BHU). The patients were referred from department of obstetrics & gynecology, institute of medical sciences. Majority of the referred cases were those who had clinical features of abdominal pain, abdominal lump, menstrual irregularity, ascites, and anorexia or weight loss & in whom adnexal mass was suspected clinically. Magnetic resonance imaging was performed using 1.5 Tesla MR Scanner, Magnetom Avanto (Siemens Healthcare). Results: Out of 114 masses, 17 (14.9%) were malignant. The benign adnexal masses were maximum in the age group 20 - 39 years (56/97, 57.7%), while malignant masses were mainly found in women ≥60 years of age (11/17, 64.7%). CA-125 level was grossly elevated in association with 35.3% of the malignant masses. On MRI, the sensitivity for the mass of ovarian origin was (97.7%) and specificity was (73.1%). The diagnostic accuracy was (92.1%). The mass of uterine origin had a sensitivity of (73.1%) and diagnostic accuracy (99.1%). Conclusion: MRI, because of its accuracy in identifying the origin of adnexal mass and characterizing the solid, hemorrhagic, fatty and fibrous content, may obviate surgery or significantly contribute to preoperative planning for a sonographically indeterminate mass. MRI is the state of the art imaging modality for evaluation of adnexal masses with an overall high diagnostic accuracy.

超声IOTA ADNEX模型对卵巢附件肿块诊断准确性的系统评价和Meta分析

目的通过系统回顾和Meta分析评估IOTA ADNEX模型对卵巢附件肿块的诊断准确性。方法使用Pubmed、Embase、Web of Science、Clinical Trials、中国知网和万方数据库进行文献检索,相关文献截止至2021年8月15日。根据纳入和排除标准筛选文献,并运用STATA16.0及RevMan5.4对最终纳入的文献进行Meta分析。结果基于IOTA ADNEX的14项纳入研究,最终联合敏感性、特异性、PLR、NLR、曲线下面积和诊断优势比分别为0.95(95%CI:0.93~0.96)、0.78(95%CI:0.71~0.84)、4.3(95%CI:3.2~5.8)、0.06(95%CI:0.05~0.09)、67.0(95%CI:44~101)和0.96(95%CI:0.94~0.97)。结论IOTA ADNEX模型在识别卵巢附件肿块的风险方面具有重要的诊断价值。

Conservative laparoscopic surgery of adnex torsion for fertility preservation

Objectives:To evaluate the safety and efficacy of conservative laparoscopic surgery for adnexal torsion and the feasibility of secondary operation.Methods:This is a retrospective study that consists of 17 patients with clinically diagnosed adnexal torsion who have a desire for pregnancy in the future.We performed conservative laparoscopic adnexal detorsion operations from January 2014 to June 2016 in Sir Run Run Shaw Hospital.The collected data,including age,onset time,maximum diameter of adnexal lesion,local blood flow signal,torsion degree,and recovery of local blood supply after detorsions,were analyzed.The blood flow of the lesion side,the antral follicles development,the basal endocrine hormone levels and the menstrual cycle were examined one-month and three-month post operation.Future fertility was investigated postoperatively.Results:All cases had no obvious clinical postoperative complications.There were no significant changes on menstrual cycle and ovarian function during the follow-up period.Conclusions:Adnexal torsion in young patients should be carefully treated and fertility reservation should be thoroughly considered.The decision to remove adnexa needs careful consideration.Conservative laparoscopic surgery is safe and does not increase the occurrence of serious complications.There is a higher possibility of a long delay between surgery and onset necrosis,but this is not always the case.Even if there is adnex thromboembolic infarction it does not result in serious complications such as pulmonary infarction.Conservative laparoscopic surgery can be performed first unless the clinician is certain it is already necrotic.We should do our best to reserve patients’fertility as much as possible.If necessary,a secondary surgery can be performed.

Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis?

Objective： The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. Methods： Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index （PDI）, risk of malignancy index （RMI） and body mass index （BMI） were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. Results： The study included 689 women （112 malignant, 544 benignant, and 33 borderline tumors）. Malignant and borderline tumors were more frequent in postmenopausal women （P=0.000）. Women who had benignant tumors had the lowest BMI （P=0.000）. There were significant （P〈0.05） differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen （CEA） levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors （P=0.000）. Women with malignant tumors had highest values of RMI and PDI （P=0.000）. Conclusions： Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.

Microcystic adnexal carcinoma misdiagnosed as a“recurrent epidermal cyst”:A case report

BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant cutaneous adnexal neoplasm,often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region.Its characteristic indolent presentation usually leads to initial misdiagnosis,resulting in tumor mismanagement and added morbidity due to increased propensity for local invasion.CASE SUMMARY A 63-year-old Chinese male patient with a long-term history of excessive ultraviolet irradiation had received two surgeries for an“epidermal cyst”on his glabella and was presented to our hospital’s Dermatology Department for further diagnosis and therapy of the lesion on his glabella.One month ago,his two 7 mm×7 mm subcutaneous nodules were diagnosed as"recurrent epidermal cysts",and he underwent local excision surgery.Additionally,he has post medical history of surgery for right clear cell renal carcinoma.According to his biopsy,the patient was diagnosed as MAC in our hospital,and a tumor remnant was found on his wound.He then underwent wide local excision to achieve negative margins and reconstruction of full-thickness flap transplantation for tissue coverage.He remained tumor-free after six months of follow-up.CONCLUSION This case highlights the importance of MAC’s possible pathogenic factor of excessive ultraviolet exposure,its differential diagnosis to avoid misdiagnosis and mismanagement to adverse prognosis,the patient’s particular medical history of clear cell renal carcinoma,the alert for any tumor recurrence in older patients,and his uncommon multiple nodules mess consisting of two 7 mm×7 mm subcutaneous nodules,that will enrich the existing knowledge of MAC’s clinical features.

An Iranian male with syringoid eccrine carcinoma misdiagnosed as basal cell carcinoma:a case report

Syringoid carcinoma (syringoid eccrine carcinoma,or eccrine epithelioma) is a rare cutaneous tumor with some controversy regarding its correct definition.This tumor shows a slow growth and has often been for many years,some decades before diagnosis.It may also be difficult to differentiate from its benign counterpart (syringoma) or other adnexal carcinoma and cutaneous metastasis.There have been limited case reports of syringoid carcinoma in foreign literatures but none from Iran.Here we report a case of syringoid carcinoma in a 52 year-old Iranian man.Syringoid eccrine carcinoma is a very rare and uncommon diagnosed tumor thought to be derived from eccrine sweat apparatus.It locally invasive,destructive and often shows recurrence.It may also be difficult to differentiate from metastatic adenocarcinoma.