Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix implant and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm: A preliminary result

AIM： To present our trial using a combination of the human acellular dermal matrix （HADM） implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS： Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADN and omentum flap. Postoperative morbidities and signs of herniation were monitored. RESULTS： The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period. CONCLUSION： The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.

Abdominal wall actinomycosis simulating a malignant neoplasm:Case report and review of the literature

Abdominal wall actinomycosis is a rare disease frequently associated with the presence of an intra uterine device.We report on a case of a 47-year-old woman who had used an intrauterine device for many years and had removed it about a month prior to the identif ication of an abdominal wall abscess caused by Actinomyces israelii.The abscess mimicked a malignancy and the patient underwent a demolitive surgical treatment.The diagnosis was obtained only after histopathological examination.Postoperatively,the patient developed an infection of the wound which was treated with daily medication.The combination of long-term high dose antibiotic therapy with surgery led to successful treatment.

Diagnostic Value of Mini-laparoscopy in Patients with Abdominal Neoplasm

Objective：Blood biochemistry,ascites tests,and imaging examinations have low sensitivities in abdominal neoplasm diagnoses.In addition,exploratory laparotomy is not suitable for final stage patients.Mini-laparoscopy has recently emerged as a new diagnostic technology for abdominal disease.The aim of this research was to evaluate the value of mini-laparoscopy in diagnosing abdominal neoplasms.Methods：Clinical and operational data were retrospectively analyzed in 20 cases with pathologically confirmed abdominal malignancies.Of these,10 cases were each diagnosed by mini-laparoscopy and exploratory laparotomy.The surgical and anesthesia expenses,perioperative nursing,monitoring and treating charges,postoperative hospital stay and complications were compared between groups.Results：The surgical and anesthesia costs were statistically lower in patients who received a mini-laparoscopy （P0.01）.Perioperative drug expenses and nursing and monitoring charges were also significantly decreased （P0.05 and P0.01,respectively）.Further,the gastrointestinal function recovery time and postoperative hospital stay were significantly reduced in the mini-laparoscopy group.There was no significant difference between the two groups regarding the preoperative hospital stay and postoperative complications.Conclusion：Mini-laparoscopy effectively reduces surgical injury and treatment costs,and is capable of safely diagnosing abdominal tumors.Moreover,the procedure is also easy to perform.

Intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm harboring a GNAS mutation: A case report

BACKGROUND Bronchogenic cysts are congenital cysts caused by abnormal sprouting from the ventral foregut during fetal life.They usually occur in the mediastinum or lung,but there are very rare cases of ectopic bronchogenic cysts that develop in the abdominal cavity.A unique intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm that was producing carcinoembryonic antigen(CEA),harboring a GNAS mutation,is reported.The present case may contribute to clarifying the mechanism of tumorigenesis and malignant transformation of ectopic bronchogenic cysts.CASE SUMMARY In 2007,a man in his 50s was incidentally found to have an intra-abdominal cystic mass,8 cm in diameter.Surgical resection was recommended,but he preferred to remain under observation.In 2020,his serum CEA level increased to 26.7 ng/mL,and abdominal computed tomography showed a 15 cm×12 cm,multifocal,cystic mass located predominantly on the lesser curvature of the stomach.Since malignancy could not be ruled out,he finally underwent surgical resection.Histologically,the cystic wall was lined by ciliated columnar epithelium,accompanied by bronchial gland-like tissue,bronchial cartilage,and smooth muscle.Part of the cyst consisted of atypical columnar epithelium with an MIB-1 index of 5%and positive for CEA.Moreover,a GNAS mutation(p.R201C)was detected in the atypical epithelium,leading to a diagnosis of an ectopic bronchogenic cyst with a low-grade mucinous neoplasm.The patient is currently undergoing outpatient follow-up without recurrence.CONCLUSION An extremely rare case of an abdominal bronchogenic cyst with a low-grade mucinous neoplasm harboring a GNAS mutation was reported.

Diffusion-weighted MRI in abdominal oncology:Clinical applications

Diffusion-weighted magnetic resonance imaging(DWI) provides image contrast that is different from that obtained by conventional magnetic resonance techniques.Although previously,DWI has been used to evaluate various diseases of the central nervous system,several technical advances have expanded the clinical applications of DWI beyond the central nervous system.As a result,many reports have been published on the use of DWI in abdominal diseases.Particularly,abdominal DWI has now being focused on evaluation of patients with abdominal cancer.DWI can be used for pretreatment tumor detection,characterization including predicting tumor response to therapy,monitoring tumor response during therapy,and follow-up study after treatment to detect possible tumor recurrence.

Malignant neoplasms of the uterus following radiation therapy for cervical carcinoma: a clinical study of 47 cases

Objective： To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods： Clinical data of 47 cases of uterine neoplasms occurred following radiation therapy for cervical carcinoma were retrospectively reviewed. Results： The median age at uterine neoplasms diagnosis was 62 years （range： 38-77 years）, and the median latency period from initial therapy to development of uterine neoplasms was 14 years （range： 5-35 years）. Thirty of 47 cases were endometrial carcinoma, of which 3 were uterine papillary serous carcinoma （UPSC）. Seventeen of 47 patients were uterine sarcoma, all of those were carcinosarcoma. The distribution by stage, grade, and histology of 30 cases of endometrial carcinoma was as follows： stage Ⅰb, 1 case; stage Ⅰc, 2 cases; stage Ⅱ, 6; stage Ⅲa, 4; stage Ⅲb, 2; stage Ⅲc, 11; stage Ⅳ, 4 cases; grade 1, two cases; grade 2, nine; grade 3 （include 3 UPSC patients）, seventeen; unknown grade, two; endometriod, 27; UPSC, 3 cases; 7 of 30 cases of endometrial carcinoma had recurrences （23.3%）, at median time to recurrence was 24 months, and their median survival time was 26 months. The overall 3- and 5-year survival rates were 60% and 38%, respectively. Of the 17 cases of uterine sarcoma, the median survival was 10 months, 6 patients occurred recurrence （35.9%）, at a median time to recurrence was 9 months, and their median survival was 6 months. The overall 3- and 5-year survival rates were 12% and 0, respectively. Conclusion： The main uterine neoplasms development after radiation therapy for cervical carcinoma is endometrial carcinomas, of which there is a preponderance of high-risk histological subtypes and a poor prognosis. Most of the uterine sarcomas occurred following radiation therapy for cervical carcinoma are carcinosarcomas and the prognosis is very poor.

Primitive Neuroectodermal Tumor as the Second Malignant Neoplasm in a Long-Term Survivor Child of Acute Lymphoblastic Leukemia: A Case Report

Acute lymphoblastic leukemia(ALL)is a common pediatric cancer.The second malignant neoplasms(SMNs)in long-term survivors of pediatric ALL are relatively rare.Herein we report a 10-year-old girl who was diagnosed as primitive neuroectodermal tumor(PNET)5 years after the initial diagnosis of ALL with radiotherapy・free treatment.PNET is an exceedingly rare neoplasm in SMNs of survivors of childhood ALL.It is predisposed to be misdiagnosed and the pathogenesis is unclear.The outcome is poor.Long-term follow-up is necessary for the survival children of ALL.

Clinical Course Of Patients with Small Cell Lung Cancer As Second Primary Malignancy

Objective： To evaluate the clinical course of patients with small cell lung cancer （SCLC） as second primary malignancy. Methods： Among the 355 patients diagnosed with SCLC at Helen and Harry Gray Cancer Center of Hartford Hospital Connecticut USA between 1988 and 1998, the records of 48 patients, which had been diagnosed with other malignancies before their diagnosis of SCLC, were retro- spectively reviewed. Results： Forty-eight patients （13.5%） were diagnosed with other malignancies prior to their SCLC among which 43 had documented smoking history and 93% of them （40/43） were current/former smokers. Of the 28-second primary SCLC patients who were treated with standard method, 11 （39.3%） achieved CR. 12 （42.8%） achieved PR, and the RR was 82.1%. The median survival of the 28 treated with standard method was 11.3 months （5.1-77.7 months）, while that of the rest 19 untreated patients （1 of 20 was lost to follow-up） was only 2.0 months （0.5 34.0 months）. There was no significant difference in the median survival and RR between 165 treated first primary SCLC （13.5 months and 77.6% respectively） and 28 treated secondary primary SCLC （11.3 months and 82.1% respectively） （P〉0.05）. The patients who had prostate cancer were older and subjected to less treatments than those with skin cancer, so their survival was shorter than the latter （3.5 months vs. 15 months, P〈0.05）. Conclusion： The response and survival of the treated patients with SCLC as a second malignancy showed no difference as compared to the treated ones with SCLC only. Therefore, an active medical treatment is important to relieve symptom and prolong survival of the second primary SCLC patients.

Incidence rate and risk factors of second primary neoplasms among older patients with hematological malignancies:Insights from a Chinese single-center experience(1997-2021)

Background:Patients with hematological malignancies face an increased risk of developing second primary neoplasms due to various factors,including immune system compromise and chemotherapy-related effects.However,the incidence and associated risk factors in older patients remain poorly understood.This study aimed to assess the incidence,identify risk factors,and evaluate their impact on survival outcomes among older patients with hematological malignancies.Methods:This retrospective single-center study analyzed data from 163 patients,focusing on the occurrence of second primary neoplasms.Cumulative incidence rates were calculated,and risk factor analysis was conducted using a competing risk model.Results:Among 124 eligible patients with a total follow-up duration of 572.57 person-years,the incidence rate of second primary neoplasms was 15.72/1000 person-years.The standardized incidence ratio(SIR)was 0.81(95%confidence interval[CI][0.39–1.48],P=0.518).History of radiotherapy emerged as a significant risk factor(subdistribution hazard ratio[SHR]=21.61[2.81–166.14],P=0.003),whereas regular natural killer(NK)cell infusion was associated with reduced risk(SHR=3.25 e8[9.81 e9–1.08 e7],P<0.001).Conclusions:These findings underscore the importance of informing older patients with hematological malignancies about the long-term risks of second primary neoplasms.Healthcare providers should carefully weigh risk factors when formulating treatment strategies.The results are valuable for investigating the fundamental principles underlying the occurrence and progression of second primary neoplasms.

Risk of second primary cancers after testicular cancer in East and West Germany： a focus on contralateral testicular cancers

Testicular cancer survival rates improved dramatically after cisplatin-based therapy was introduced in the 1970s. However, chemotherapy and radiation therapy are potentially carcinogenic. The purpose of this study was to estimate the risk of developing second primary cancers including the risk associated with primary histologic type （seminoma and non-seminoma） among testicular cancer survivors in Germany. We identified 16 990 and 1401 cases of testicular cancer in population-based cancer registries of East Germany （1961-1989 and 1996-2008） and Saarland （a federal state in West Germany; 1970-2008）, respectively. We estimated the risk of a second primary cancer using standardized incidence ratios （SIRs） with 95% confidence intervals （95% Cls）. To determine trends, we plotted model-based estimated annual SIRs. In East Germany, a total of 301 second primary cancers of any location were observed between 1961 and 1989 （SIR： 1.9; 95% Ch 1.7-2.1）, and 159 cancers （any location） were observed between 1996 and 2008 （SIR： 1.7; 95% Ch 1.4-2.0）. The SIRs for contralateral testicular cancer were increased in the registries with a range from 6.0 in Saarland to 13.9 in East Germany. The SIR for seminoma, in particular, was higher in East Germany compared to the other registries. We observed constant trends in the model-based SIRs for contralateral testicular cancers. The majority of reported SIRs of other cancer sites including histology-specific risks showed low precisions of estimated effects, likely due to small sample sizes. Testicular cancer patients are at increased risk especially for cancers of the contralateral testis and should receive intensive follow-ups.

Nude mice multi-drug resistance model of orthotopic transplantation of liver neoplasm and Tc-99m MIBI SPECT on p-glycoprotein

AIM: To establish a model of drug-resistant neoplasms using a nude mice model, orthotopic transplantation of liver neoplasm and sporadic abdominal chemotherapy. METHODS: Hepatocellular carcinoma cells HepG2 were cultured and injected subdermally to form the tumor-supplying mice. The orthotopic drug-resistant tumors were formed by implanting the tumor bits under the envelope of the mice liver and induced by abdominal chemotherapy with Pharmorubicin. Physical examination, ultrasonography, spiral CT and visual inspection were used to examine tumor progression. RT-PCR and immunohistochemistry were used to detect expression of mdr1 mRNA and its encoded protein p-glycoprotein (p-gp). Tc-99m sestamibi scintigraphy was performed by obtaining planar abdominal images at 20 min after injection, and the liver/heart ratios were calculated. RESULTS: Post-implantation mortality was 0% (0/25), tumor implantation success was 90% (22/25), and the rate of implanting successfully for the second time was 100% (3/3). Tumor induction using Pharmorubicin was 80% (16/20). The mdrl mRNA expression of the induced group was 23 times higher than that of the control group, and p-gp protein expression was 13-fold higher compared to the control group. The liver/heart ratio (as assessed in vivo, using Tc-99m radiography) was decreased significantly in the induced group as compared to the control group. CONCLUSION: We have established an in vivo model of mdrl in nude mice by orthotopic transplantation of liver neoplasm coupled to chemotherapy. We propose that identification of drug resistance as characterized by decreased 99mTc-ppm radiography due to enhanced clearance by p-gp may be useful in detecting in vivo drug resistance, as well as a useful tool in designing more effective therapies.

妊娠中期单孔腹腔镜剔除多发子宫肌瘤术后足月妊娠一例

子宫肌瘤在妊娠期间出现蒂扭转或红色变性可引起腹痛并诱发流产,药物保守治疗被认为是金标准,若腹痛不能缓解,必要时于妊娠期行手术治疗。手术可根据子宫肌瘤类型、大小、位置、孕周及医生经验选择开腹或腹腔镜剔除肌瘤,但是单孔腹腔镜剔除妊娠中期子宫肌瘤少有报道。报道1例妊娠中期多发子宫肌瘤变性导致先兆流产的病例,患者经磁共振成像评估为Ⅵ型子宫肌瘤,保守治疗失败后行单孔腹腔镜子宫肌瘤剔除术。术后继续妊娠,并成功足月分娩。报道此案例,为单孔腹腔镜在妊娠期子宫肌瘤剔除中的应用提供一定参考。

Second malignant neoplasms in childhood cancer survivors in a tertiary paediatric oncology centre in Hong Kong, China

Background Childhood cancer survivors were at risk of development of second malignant neoplasms. The aim of this study is to evaluate the incidence, risk factors and outcome of second malignant neoplasms in childhood cancer survivors in a tertiary paediatric oncology centre in Hong Kong, China. Methods We performed a retrospective review of patients with childhood cancer treated in Children＇s Cancer Centre in Prince of Wales Hospital, Hong Kong, China between May 1984 and June 2009. Case records of patients who developed second malignant neoplasms were reviewed. Results Totally 1374 new cases aged less than 21-year old were treated in our centre in this 25-year study period. Twelve cases developed second malignant neoplasms with 10-year and 20-year cumulative incidence of 1.3% （95% confidence interval 0.3%-2.3%） and 2.9% （95% confidence interval 1.1%-4.7%） respectively. Another 4 cases were referred to us from other centres for the management of second malignant neoplasms. In this cohort of 16 children with second malignant neoplasms, the most frequent second malignant neoplasms were acute leukemia or myelodysplastic syndrome （n--6） and central nervous system tumor （n=4）. Median interval between diagnosis of primary and second malignant neoplasms was 7.4 years （range 2.1-13.3 years）. Eight patients developed second solid tumor within the previous irradiated field. Radiotherapy significantly increased the risk of development of second solid tumor in patients with acute lymphoblastic leukemia （P=0.027）. Seven out of 16 patients who developed second malignant neoplasms had a family histo＇ry of cancer among the first or second-degree relatives. Nine patients died of progression of second malignant neoplasms, mainly resulted from second central nervous system tumor and osteosarcoma. Conclusions Cumulative incidence of second cancer in our centre was comparable to western countries. Radiotherapy was associated with second solid tumour among patients with acute lymphoblastic leukemia. Patients who developed second brain tumor and osteosarcoma had a poor outcome.

Malignant myopericytoma originating from the colon: A case report

BACKGROUND Myopericytoma is a benign tumor that typically occurs within subcutaneous tissue and most often involves the distal extremities,followed by the proximal extremities,neck,thoracic vertebrae and oral cavity.Complete resection is often curative.Malignant myopericytoma is extremely rare and has a poor prognosis.Here,we report for the first time a case of malignant myopericytoma originating from the colon.CASE SUMMARY A 69-year-old male was admitted to our hospital with right upper quadrant pain for five days.Imaging suggested a liver mass with hemorrhage.A malignant hepatic tumor was the initial diagnosis.Surgical resection was performed after a complete preoperative work up.Initial postoperative pathology suggested that the mass was a malignant myoblastoma unrelated to the liver.Four months after the first surgery,an enhanced computed tomography(CT)scan revealed a recurrence of the tumor.The diagnosis of malignant myopericytoma derived from the colon was confirmed on histopathological examination of the specimen from the second surgery.The patient did not return to the hospital regularly for surveillance.The first postoperative abdominal CT examination six months after the second surgery demonstrated multiple liver metastases.Survival time between the diagnosis of the tumor to death was approximately one year.CONCLUSION Malignant myopericytoma is a rare cancer.Preoperative diagnosis may be difficult.Due to a lack of treatment options,prognosis is poor.

基于造口APP的模块化管理在膀胱癌尿流改道腹壁造口患者中的应用

目的探讨基于造口APP的模块化管理在膀胱癌尿流改道腹壁造口患者中的临床应用效果。方法采用便利抽样法,选取2022年8月-2023年8月我院收治的膀胱癌尿流改道腹壁造口患者85例为研究对象,采用随机数字表法分为观察组43例和对照组42例。对照组实施常规护理,观察组在对照组的基础上实施基于造口APP的模块化管理干预。比较两组干预前后造口自护能力、造口相关并发症及生活质量。结果观察组干预后造口自护能力量表及中文版造口患者生活质量量表(COH-QOL-OQ)评分高于对照组(P<0.05),观察组造口并发症发生率低于对照组(P<0.05)。结论基于造口APP的模块化管理能有效提高膀胱癌尿流改道腹壁造口患者自护能力,降低造口相关并发症,提升患者生活质量。

动态增强CT与多层螺旋CT血管成像技术联合诊断盆腹部起源不明巨大肿瘤的价值

目的研究动态增强CT与多层螺旋CT血管成像技术(MSCTA)联合用于盆腹部起源不明的巨大肿瘤的诊断价值。方法收集广东省人民医院南海医院2018年1月至2023年7月收治的96例盆腹部肿瘤患者临床资料,开展回顾性对比研究。以病理结果为金标准,分析动态增强CT与MSCTA在诊断盆腹部起源不明巨大肿瘤病变性质和病变类型中的临床价值。结果手术病理结果证实,恶性肿瘤病变66例,良性肿瘤病变30例。动态增强CT与MSCTA联合诊断盆腹部不明原因巨大肿瘤性质和病变类型的结果与手术病理结果一致性满意(Kappa值=0.832,0.911;P<0.001)。动态增强CT与MSCTA联合诊断病变性质的灵敏度为93.9%,特异度为90.0%,准确度为92.7%,阳性预测值为95.4%,阴性预测值为87.1%。手术病理结果证实,胃间质瘤23例,小肠间质瘤17例,子宫肌瘤12例,囊腺瘤22例,畸胎瘤14例,肝癌8例。MSCTA诊断病变类型的准确度为92.7%。结论动态增强CT与MSCTA联合用于盆腹部起源不明的巨大肿瘤性质和病变类型的诊断,具有较高准确性。

Diagnostic significance of ultrasonography and CT for large upper abdominal mass

OBJECTIVE: To assess the effect of ultrasonography and computerized tomography (CT) in the diagnosis of large upper abdominal mass. METHODS: Data from 43 cases that were clinically and pathologically confirmed were retrospectively analyzed and the effect of their preoperative ultrasonography and CT was compared. RESULTS: Four of 10 (40 percent) cases of liver mass were diagnosed correctly using ultrasonic device, nineteen of 25 (76 percent) cases of adrenal gland mass and 2 of 4 cases of kidney mass. Two of 10 (20 percent) cases of liver mass were correctly diagnosed by CT, and so were 6 of 22 (27.2 percent) cases of adrenal gland mass. In 4 patients with spleen mass, neither ultrasonography nor CT diagnosis was correct. CONCLUSION: Because upper abdomen organs are closely connected with each other, correct imaging localization of a large mass in this region is not easy. In this study, we compared the accuracy of ultrasonography and CT in diagnosing large upper abdominal masses, and found that ultrasonography works better for adrenal rather than liver or kidney. Neither ultrasonography or CT could accurately diagnose a large mass in the spleen.

胃癌腹腔微转移的研究及其临床意义

目的运用细胞学及RT-PCR方法检测胃癌患者术中腹腔冲洗液和腹膜组织,以探讨这些方法对预测胃癌腹腔微转移的意义。方法收集3 8例胃癌和5例胃良性病变患者的术中腹腔冲洗液,并同时切除少量大网膜、腹膜作为对照。用RT-PCR方法测定冲洗液中游离细胞的CEAmRNA表达,同时作冲洗液细胞学检查(PLC)。结果腹腔冲洗液和腹膜组织中的CEA mRNA的阳性率分别为3 6.8%(1 4/3 8)和3 9.5%(1 5/3 8),皆高于腹腔冲洗液PLC的2 6.3%(1 0/3 8)。CEA mRNA的阳性率与肿瘤的分化程度、浸润深度、淋巴结转移、浆膜侵犯深度有关。结论CEART-PCR方法对于检测腹腔微量游离癌细胞较PLC有更高的灵敏度和特异性,是一种检测胃癌腹腔微转移的有效方法。

超声引导射频消融术应用于治疗肝转移癌

目的 :探讨超声引导射频消融对肝转移癌的治疗效果及临床应用价值。方法 :对不宜手术、放疗、化疗或不愿接受手术治疗的肝转移癌患者 48例 (91个灶 )行超声引导下射频治疗。原发灶来自消化道肿瘤 33例(6 8.7% ) ,乳腺癌 7例 (14.5 % ) ,其他肿瘤 8例 (16 .8% )。本组肿瘤最大直径范围为 1.5～ 7.2cm (中位数 2 .3cm) ,2 6例为单发灶 ,余 2 2例为 2～ 5个病灶。采用螺旋CT增强扫描为主结合彩超、穿刺活检、肿瘤标记物等检查方法综合评价疗效。结果 :1个月后螺旋CT增强扫描显示 87个病灶完全失去活性 ,近期有效率达 95 .6 %。有 4例局部复发 ,14例肝内其他部位再发 ,而行第 2～ 4次治疗。全部病例经 3～ 18个月随访 ,目前 46例存活 ,2例射频后肿瘤缩小者行手术治疗 ,因手术并发症死亡。较重并发症 1例 (2 .1% )为肝被膜损伤出血 ,经射频消融凝固止血成功。结论 :超声引导射频消融术可作为肝转移癌的一种微创局部治疗方法 ,其并发症少 ,缓解率高 ,是治疗肝转移癌安全。