Recurrence in node-negative advanced gastric cancer:Novel findings from an in-depth pathological analysis of prognostic factors from a multicentric series

AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up. METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1). We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2). We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis) of 41 cases matched with Group 1 according to demographic and pathological characteristics. RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients. In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns: lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.

CLINICOPATHOLOGICAL ANALYSIS OF 5785 CASES WITH RESPIRATORY SYSTEM TUMORS

Objective; To study the characteristics and tendency of incidence of patients with respiratory system tumors during the past 23 y in Tianjin. Methods： All data in our research was obtained from the surgical pathology files of Department of Pathology of the general and the Second Hospitals of Tianjin Medical University between 1981 and 2003. All data was analyzed by Spss 11.5 statistics program. The comparisons were made by u-test, P〈0.05 was considered as significant. Results： 1. The detection rate of malignant tumors is significantly higher than that of benign tumors （U=52.68, p=0.000） in respiratory system. 2. The common sites of benign tumors are nose and pharynx, but the common sites of malignant tumors are lung and larynx. 3. The incidence of benign tumors generally peaks between the ages of 40 and 50, but the incidence of malignant tumor generally peaks between the ages of 50 and 60. 4. The commonest histological type of malignant tumors is squamous cell carcinoma, but the commonest histological type of benign tumors is papilloma. 5. The detection rate of malignant lung tumors steadily increased between 1981 and 1999 and increased sharply from 1999 to 2003, but the detection rate of malignant Nasopharyngeal tumors steadily decreased from 1981 to 2003. Between 1981 and 1997, the detection rate of malignant laryngeal tumors steadily increased, followed by a decrease between 1997 and 2003. Conclusion： The detection rate of malignant respiratory system tumors especially lung cancer is gradually increasing. Therefore early prevention and treatment are critical to patients＇ prognosis.

Retrospective Analysis of Diagnosis by Intraoperative Frozen Section and Routine Paraffin Embedded Tissue in 638 Thyroid Disease Patients

OBJECTIVE To summarize a common pathogenefic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different common thyroid diseases （TD）. diagnostic methods in cases of METHODS Data from 638 cases with frozen sections from thyroid tissue were retrospectively analyzed. The intraoperative frozen sections of the patients and postoperative diagnostic results of routine paraffin sections were compared. RESULTS In the 683 patients, the gender ratio of females to males was 2.64 ： 1, and the ratio between the patients with nodular goiter （NG） and the patients with thyroid adenoma was 1.5 ： 1. The oldest age group of patients with thyroid cancer （TC） ranged from 40 to 49 years. Frozen section pathologic examination has been employed more and more in the diagnosis of thyroid diseases, and the detection rate of TC has increased year by year, i.e., the rate increased to 6.45%, 7.58%, 14.55% and 16.57%, respectively, in 2005, 2006, 2007 and 2008. Thyroid papillary carcinoma （TPC） was the most commonly seen malignant tumor of the thyroid （MTT）, which accounted for approximately 94.8% of MTTs and 11.44% of the total TDs. Micropapillary carcinoma accounted for 27.4% of TPC, and multifocal carcinomas accounted for 15.58% of TCs. Many of the TCs （19.48%） were complicated by benign diseases such as adenoma, NG and thyroiditis. The coincidence rate of diagnoses made by frozen section and paraffin embedding for thyroid disease was 98.59%. Calcification was rather common in NG and TPC, and there were significant differences in psammoma bodies （PMB） between the calcifications of TPC and NG （P 〈 0.01）. CONCLUSION TPC ranks first in the incidence of MTTs and accounts for 94.8% of all MTTs. About 1/4 of TPCs are micropapillary carcinoma, while 1/5 are accompanied by benign disease, such as adenorna, NG and thyroiditis. PMB are of importance and of significance in the diagnosis of TPC.

Clinical pathologic analysis of urologic primary primitive neuroectodermal tumor

Objective To explore clinico-pathological features,immunophenotype,treatment and prognosis of urologic primary primitive neuroectodermal tumor ( PNET) . Methods The clinical data of 3 patients with urologic PNET were analyzed retrospectively. All patients were male,aged 29,32 and 75 years respectively.

Pathologic analysis of donor grafts in 482 cases of renal transplantation recipients

Objective To evaluate the correlation between the pathologic findings of donor renal grafts and the post-transplantative diseases throuth the biopsies of donor grafts in 482 cases. Methods The renal structures of biopsies of the donor grafts in 482 cases were observed under microscope, and the pathologic findings combined with the post-transplantative conditions were analysed. Results After transplantation, acute rejection occurred in 71 cases,of when 16(22.5%) had adverse changes in donor grafts; chronic allograft nephropahty developed in 17 cases, of whom 7 (41.2% ) had adverse changes in donor grafts; elevated sera creatinine levels with unknown causes occurred in 39 cases, of whon 7(18.0% ) had adverse changes in donor grafts. The lesion of donor renal grafts had nothing to do with the acute rejection or other abnormalities after operation ( r≤ 0.3) but some kind of lesion had certain correlation with chronic allograft nephropathy(CAN, r 】0.3). Conclusion Routine biopsy of donor renal graft is

Collision tumor of primary malignant lymphoma and adenocarcinoma in the colon diagnosed by molecular pathology:A case report and literature review

BACKGROUND Collision tumors of primary malignant lymphoma and adenocarcinoma in the colon are rare.Primary diffuse large B-cell lymphoma(DLBCL)–adenocarcinoma collision tumors are especially rare.CASE SUMMARY A 74-year-old woman presented with abdominal pain of 1 mo duration.Biopsy under colonoscopy revealed adenocarcinoma of the ascending colon.Subsequently,the patient underwent laparoscopic radical resection of right colon cancer with lymph node dissection.A collision tumor was found incidentally through postoperative pathological sampling.Genetic analysis showed a collision tumor of DLBCL with germinal center B-cell subtype and TP53 mutation,and adenocarcinoma arising in a tubulovillous adenoma in the colon,with BRAF mutation and mutL homolog 1 promoter methylation.The patient died 3 mo after surgery.To our knowledge,this is the 23rd reported case of collision tumor of colorectal adenocarcinoma and lymphoma.The mean age of the 23 patients was 73 years.The most common site was the cecum.There were 15 cases with followup data including 11 living and four dead with a 3-year overall survival rate of 71.5%.CONCLUSION Based on pathological and genetic analysis,surgery combined with chemotherapy or chemoradiotherapy may have good therapeutic effects for collision tumor.

Multilevel analysis of the central-peripheral-target organ pathway:contributing to recovery after peripheral nerve injury

Peripheral nerve injury is a common neurological condition that often leads to severe functional limitations and disabilities.Research on the pathogenesis of peripheral nerve injury has focused on pathological changes at individual injury sites,neglecting multilevel pathological analysis of the overall nervous system and target organs.This has led to restrictions on current therapeutic approaches.In this paper,we first summarize the potential mechanisms of peripheral nerve injury from a holistic perspective,covering the central nervous system,peripheral nervous system,and target organs.After peripheral nerve injury,the cortical plasticity of the brain is altered due to damage to and regeneration of peripheral nerves;changes such as neuronal apoptosis and axonal demyelination occur in the spinal cord.The nerve will undergo axonal regeneration,activation of Schwann cells,inflammatory response,and vascular system regeneration at the injury site.Corresponding damage to target organs can occur,including skeletal muscle atrophy and sensory receptor disruption.We then provide a brief review of the research advances in therapeutic approaches to peripheral nerve injury.The main current treatments are conducted passively and include physical factor rehabilitation,pharmacological treatments,cell-based therapies,and physical exercise.However,most treatments only partially address the problem and cannot complete the systematic recovery of the entire central nervous system-peripheral nervous system-target organ pathway.Therefore,we should further explore multilevel treatment options that produce effective,long-lasting results,perhaps requiring a combination of passive(traditional)and active(novel)treatment methods to stimulate rehabilitation at the central-peripheral-target organ levels to achieve better functional recovery.

Correlation between Central and Lateral Neck Dissection in Differentiated Thyroid Carcinoma

Objective: To determine the histopathological correlation between central and lateral neck metastasis in differentiated thyroid carcinoma, and its potential therapeutic impact. Although the central neck dissection (CND) is recommended in differentiated thyroid carcinoma, the indication for lateral neck dissection (LND) remains controversial. Design: Retrospective study. Methods and Main Outcome Measures: Pathological analysis of systematic ipsilateral central neck dissection (CND) and LND performed with total thyroidectomy in differentiated thyroid carcinoma was retrospectively reviewed according to “side” and to “patient”. Results: A total of 56 sides (46 patients) were suitable for analysis. Analysis by “side” revealed that CND and LND dissection samples were both negative in 15 cases, both positive in 32, CND was positive and LND was negative for 8 cases and CND was negative and LND was positive in 1 case. The combined presence of positive LND and positive CND was therefore observed in 32/40 “sides” and 26/46 “patients”. Analysis by “side” of the impact of the treatment decision to perform ipsilateral LND only in patients with positive CND and vice versa demonstrated a sensitivity, specificity, and accuracy of 97%, 65%, and 84%, respectively. Conclusions: In most cases, the presence of positive LND was associated with positive ipsilateral CND. The very low prevalence of positive LND in patients with negative CND may justify LND as a second step procedure only in patients with positive CND, except in the case of documented lateral neck metastasis.

Analysis of sensitivity and specificity:precise recognition of neutrophils during regeneration of contused skeletal muscle in rats

In this report,we applied the TissueFAXS 200 digital pathological analysis system to rapidly and accurately identify neutrophils during regeneration of contused skeletal muscle,and to provide information for follow-up studies on neutrophils to estimate wound age.Rat injury model was established,and skeletal muscle samples were obtained from the control group and contusion groups at 1,1.5,2,3,4,and 6 h,as well as at 1,3,5,and 15 d post-injury(n紏5 per group).The expression of nuclei and neutrophils was detected by hematoxylin and eosin(HE)staining and immunohistochemical(IHC)staining.A total of 20 injury site areas of 0.25mm^(2)(0.5mm0.5mm)were then randomly selected at all time points.A TissueFAXS 200 digital pathological analysis system was used to identify the positive and negative numbers.Knowledge of five professional medical workers were considered the gold standard to measure the false positive rate(FPR),false negative rate(FNR),sensitivity,specificity,and area under the curve(AUC)of receiver operating characteristic(ROC)curves.As a result,with a staining area of neutrophils from 8 μm^(2) to 15 μm^(2),the FPR was 4.28%–12.14%,the FNR was 12.42%–64.08%,the sensitivity was 35.92%–87.58%,the specificity was 87.86%–95.72%,the Youden index was 0.316–0.754,the accuracy was 82.80%–88.30%,and the AUC was 0.771–0.826.The AUC was largest when the cut-off value of the staining area was 12 mm^(2).Our results show that this software-based method is more accurate than the human eye in evaluating neutrophil infiltration.Based on the sensitivity and specificity,neutrophils can be accurately identified during regeneration of contused skeletal muscle.The TissueFAXS 200 digital pathological analysis system can also be used to optimize conditions for different cell types under various injury conditions to determine the optimal cut-off value of the staining area and provide optimal conditions for further study.Furthermore,it will provide evidence for forensic pathology cases.

Pathological demography of native patients in a nephrology center in China

Objective To analysis the pathological demography in Chinese patients undergoing renal biopsy from our niphrology center.Methods Between January 1979 and October 2000 in Jinling Hospital, Nanjing, China, 10 002 attempts of percutaneous renal were performed in patients with renal disease from 33 provinces of China. The pathological classifications were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995 by a panel of pathologists and nephrologists during routine clinical-pathological rounds. The pathological demography between those specimens collected from 1979 -1989 and those from 1990 -1999 was compared.Results The mean age of the 10002 subjects undergoing renal biopsy was 31.4 ?3.0 years (ranging from 1 to 78 years), with a male to female ratio of 1. 3: 1; for the 592 renal transplant recipients, the mean age was 37. 5 ±9. 1 years (ranging from 16 to 66 years), with a male to female ratio of 2.36: 1. Primary glomerular diseases (PGD) accounted for 71% of the total patients undergoing renal biopsies, secondary glomerular nephritis (SGN) 23%, tubular-interstitial diseases 3. 2% , unclassified renal diseases 1. 3% , hereditary and congenital renal diseases 1. 0% , end stage renal diseases 0. 96% , and recently realized or rare renal diseases 0. 15%. IgA nephropathy (IgAN) was the most frequent pathological pattern (40%) of PGD, followed by mesangial proliferative lesion (MsPL) (30%), membranous nephropathy (MN) (10%), and focal segmental glomerulosclerosis ( FSGS) (6%). Lupus nephritis (LN) was the most pathology common seen (74%) in SGN. During the 22 years of the study period, there was a steady increase in patients with SGN discovered during pathological evaluation of renal disorders. A rise in prevalence was found in IgA nephropathy, MN (both P<0.001), crescentic glomerulonephritis (P<0. 0001), anti-GBM disease, and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura related renal damages ( both P < 0. 001 ). There was a decrease in endocapillary proliferative glomerulonephritis ( P < 0. 001 ) and IgM nephropathy (IgMN) ( P < 0. 01) from 1990 - 1999 as compared to 1979 - 1989. Infrequent renal pathological entities were also diagnosed in this group, including Niemann Pick disease, Fabry' s disease, POEMS syndrome, and lipoprotein glomerulonephropathy.Conclusions This is the largest series of renal biopsy data in China, and therefore may reflect the demographic picture of renal diseases in this country. Changes in prevalence of renal pathological entities were reflected in this group of patients over the last 22 years. In primary glomerular diseases, IgA nephropathy is still the most frequently observed pathological pattern. In SGN, LN appeared the most often. Increased prevalence was found in anti-GBM nephritis and HUS/TTP.

Auxiliary Diagnosis of Papillary Thyroid Carcinoma Based on Spectral Phenotype

Thyroid cancer,a common endocrine malignancy,is one of the leading death causes among endocrine tumors.The diagnosis of pathological section analysis suffers from diagnostic delay and cumbersome operating procedures.Therefore,we intend to construct the models based on spectral data that can be potentially used for rapid intraoperative papillary thyroid carcinoma(PTC)diagnosis and characterize PTC characteristics.To alleviate any concerns pathologists may have about using the model,we conducted an analysis of the used bands that can be interpreted pathologically.A spectra acquisition system was first built to acquire spectra of pathological section images from 91 patients.The obtained spectral dataset contains 217 spectra of normal thyroid tissue and 217 spectra of PTC tissue.Clinical data of the corresponding patients were collected for subsequent model interpretability analysis.The experiment has been approved by the Ethics Review Committee of the Wuhu Hospital of East China Normal University.The spectral preprocessing method was used to process the spectra,and the preprocessed signal respectively optimized by the first and secondary informative wavelengths selection was used to develop the PTC detection models.The PTC detection model using mean centering(MC)and multiple scattering correction(MSC)has optimal performance,and the reasons for the good performance were analyzed in combination with the spectral acquisition process and composition of the test slide.For model interpretable analysis,the near-ultraviolet band selected for modeling corresponds to the location of amino acid absorption peak,and this is consistent with the clinical phenomenon of significantly lower amino acid concentrations in PTC patients.Moreover,the absorption peak of hemoglobin selected for modeling is consistent with the low hemoglobin index in PTC patients.In addition,the correlation analysis was performed between the selected wavelengths and the clinical data,and the results show:the reflection intensity of selected wavelengths in normal cells has a moderate correlation with cell arrangement structure,nucleus size and free thyroxine(FT4),and has a strong correlation with triiodothyronine(T3);the reflection intensity of selected bands in PTC cells has a moderate correlation with free triiodothyronine(FT3).