Going straight for the gut:gut-brain axis pathology and treatment of Parkinson's disease

This perspective focuses on the recent literature regarding the role of the gut-brain axis(GBA) in fecal microbiota transplantation(FMT) and stem cell therapy(SCT) in Parkinson's disease(PD).PD is the second most common neurodegenerative disease in the United States,yet therapies remain limited.Current research suggests that the GBA may play a role in the pathogenesis of PD.GBAbased FMT as well as SCT offer promising new avenues for PD treatment.Pro bing the interactions between FMT and SCT with the GBA may reveal novel therapeutics for PD.

Using MsfNet to Predict the ISUP Grade of Renal Clear Cell Carcinoma in Digital Pathology Images

Clear cell renal cell carcinoma(ccRCC)represents the most frequent form of renal cell carcinoma(RCC),and accurate International Society of Urological Pathology(ISUP)grading is crucial for prognosis and treatment selection.This study presents a new deep network called Multi-scale Fusion Network(MsfNet),which aims to enhance the automatic ISUP grade of ccRCC with digital histopathology pathology images.The MsfNet overcomes the limitations of traditional ResNet50 by multi-scale information fusion and dynamic allocation of channel quantity.The model was trained and tested using 90 Hematoxylin and Eosin(H&E)stained whole slide images(WSIs),which were all cropped into 320×320-pixel patches at 40×magnification.MsfNet achieved a micro-averaged area under the curve(AUC)of 0.9807,a macro-averaged AUC of 0.9778 on the test dataset.The Gradient-weighted Class Activation Mapping(Grad-CAM)visually demonstrated MsfNet’s ability to distinguish and highlight abnormal areas more effectively than ResNet50.The t-Distributed Stochastic Neighbor Embedding(t-SNE)plot indicates our model can efficiently extract critical features from images,reducing the impact of noise and redundant information.The results suggest that MsfNet offers an accurate ISUP grade of ccRCC in digital images,emphasizing the potential of AI-assisted histopathological systems in clinical practice.

A Multi-Task Deep Learning Framework for Simultaneous Detection of Thoracic Pathology through Image Classification

Thoracic diseases pose significant risks to an individual's chest health and are among the most perilous medical diseases. They can impact either one or both lungs, which leads to a severe impairment of a person’s ability to breathe normally. Some notable examples of such diseases encompass pneumonia, lung cancer, coronavirus disease 2019 (COVID-19), tuberculosis, and chronic obstructive pulmonary disease (COPD). Consequently, early and precise detection of these diseases is paramount during the diagnostic process. Traditionally, the primary methods employed for the detection involve the use of X-ray imaging or computed tomography (CT) scans. Nevertheless, due to the scarcity of proficient radiologists and the inherent similarities between these diseases, the accuracy of detection can be compromised, leading to imprecise or erroneous results. To address this challenge, scientists have turned to computer-based solutions, aiming for swift and accurate diagnoses. The primary objective of this study is to develop two machine learning models, utilizing single-task and multi-task learning frameworks, to enhance classification accuracy. Within the multi-task learning architecture, two principal approaches exist soft parameter sharing and hard parameter sharing. Consequently, this research adopts a multi-task deep learning approach that leverages CNNs to achieve improved classification performance for the specified tasks. These tasks, focusing on pneumonia and COVID-19, are processed and learned simultaneously within a multi-task model. To assess the effectiveness of the trained model, it is rigorously validated using three different real-world datasets for training and testing.

miR-200c/ZEB1/E-cadherin轴在胆管癌转移侵袭中的作用及对胆管癌预后评估的价值

目的:探讨微小RNA-200c(miR-200c)/锌指转录因子(ZEB1)/E-钙黏蛋白(E-cadherin)在胆管癌(HCCA)转移、侵袭中的作用及对HCCA预后评估的临床价值。方法:选取2020年08月至2022年12月间我院收治的胆管癌患者36例为研究对象,同时选取胆管良性疾病患者(胆总管结石或胆管良性狭窄)20例作为对照。采用原位杂交、实时荧光定量PCR检测miR-200c在HCCA患者组织及血清中的表达;生存曲线分析miR-200c表达与总生存期的相关性;Transwell实验检测细胞的迁移及侵袭能力;免疫印迹检测ZEB1及E-cadherin蛋白的表达。体内研究构建裸鼠成瘤实验,采用免疫组化检测ZEB1及E-cadherin蛋白的表达;Tunel技术检测组织中的凋亡情况。受试者工作特征(ROC)曲线评估生物标志物对胆管癌预后的诊断效能。结果:miR-200c低表达于HCCA组织及血清中;生存曲线分析显示,miR-200c表达与患者的总生存期呈正相关性,TNM分期与患者的总生存期呈负相关性;miR-200c mimics抑制了胆管癌细胞的迁移和侵袭能力,并降低ZEB1表达而诱导E-cadherin表达;转染ZEB1逆转miR-200c的作用效应,促进胆管癌细胞的迁移和侵袭特性,抑制胆管癌细胞的凋亡。CA199、CEA和miR-200c联合检测诊断胆管癌预后的ROC曲线下面积为0.892,灵敏度0.8611,特异度0.8000。结论:miR-200c/ZEB1/Ecadherin轴参与胆管癌的转移侵袭;CA199、CEA和miR-200c联合检测对胆管癌预后的诊断效能良好,对临床胆管癌的治疗策略具有重要指导价值。

芪贞归脾汤辅助治疗对食管癌伴锁骨上淋巴结转移患者细胞E-cadherin表达的影响

目的探讨芪贞归脾汤辅助治疗对食管癌伴锁骨上淋巴结转移患者细胞钙黏素(E-cadherin)表达的影响。方法选取2016年1月—2021年1月食管癌伴锁骨上淋巴结转移病例96例,随机编号方法分两组,各48例,对照组采用常规放疗;在此基础上,观察组采用芪贞归脾汤辅助治疗,持续治疗8周。治疗前后评价中医证候积分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、免疫功能、细胞角蛋白19片段(cytokeratin 19 fragment,CYFRA21-1)、癌胚抗原(carcinoembryonic antigen,CEA)、癌抗原(cancer antigen 125,CA125)、E-cadherin和不良反应情况。结果观察组治疗后咽下困难、胸闷不舒、形体消瘦、气短乏力等积分低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍等评分低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)高于对照组,CD^(+)_(8)低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后血清CYFRA21-1、CEA、CA125低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后E-cadherin阳性率72.92%高于对照组54.17%,差异有统计学意义(P<0.05)。两组放射性皮炎、恶心呕吐、白细胞减少、肝功能异常、神经毒性等不良反应比较,差异无统计学意义(均P>0.05)。结论芪贞归脾汤辅助治疗可以提高食管癌伴锁骨上淋巴结转移患者的免疫功能和睡眠质量,降低肿瘤标志物及E-cadherin的表达,安全性高。

Axial length,vitreoretinal pathology,and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

Aquaporin 5 in Alzheimer’s disease:a link between oral and brain pathology?

The involvement of aquaporins(AQPs)in the development of diseases has been widely described(Azad et al.,2021).AQP5 has been described in astrocytes changing after traumatic brain injuries(Chai et al.,2013),but the precise role of AQP5 in Alzheimer’s disease(AD)pathology is yet to be understood.We have recently reported that AQP5 expression changes during the development of AD(Antequera et al.,2022).The AQP5 expression in salivary glands is decreased in 6-month-old APP/PS1 mice and AD patients.This decrease in AQP5 expression could be involved in the mechanism of salivary gland dysfunction described in a previous study(Antequera et al.,2021).Now,we propose a new indirect role of AQP5 in the connection between infection-induced oral dysbiosis and AD(Sureda et al.,2020).Here,we suggest that the proinflammatory response induced by oral pathogen infection results in the downregulation of AQP5 contributing to the salivary gland secretory dysfunction.All these alterations destabilize the peripheral immune-inflammatory balance and exacerbate neuroinflammation and neurodegeneration leading to AD pathology.

卵巢浆液性癌中miR-182和E-cadherin的表达及意义

目的检测卵巢浆液性癌中微小RNA-182(microRNA-182,miR-182)和上皮型粘附素(E-cadherin)的表达,探讨其相关性及临床意义。方法选择行卵巢浆液性癌根治性手术的患者59例作为研究组,选择行手术治疗的卵巢浆液性囊腺瘤患者59例作为对照组,应用实时荧光定量PCR法检测组织中miR-182的表达,应用免疫组化法检测组织E-cadherin的表达。结果研究组中miR-182的表达量(1.83±0.32)明显高于对照组(1.31±0.31)(t=4.59,P=0.012),研究组中E-cadherin表达阳性率(47.46%)明显低于对照组(84.75%)(X~2=18.31,P=0.000)。miR-182和E-cadherin在卵巢浆液性癌不同级别(2.01±0.29 vs.1.66±0.22)(27.59%vs.66.67%)、不同肿瘤最大径(1.93±0.22 vs.1.64±0.39)(28.21%vs.85.00%)及有无脉管癌栓(1.80±0.15 vs.2.03±0.20)(20.00%vs.53.06%)的比较中差异有统计学意义(P<0.05),而在不同年龄、有无淋巴结转移分组的比较中差别无统计学意义(P>0.05)。线性相关分析显示研究组中miR-182与E-cadherin呈负相关性(r=-0.57,P=0.008)。生存分析显示miR-182的表达与患者生存时间有关(P<0.05)。结论miR-182和E-cadherin在卵巢浆液性癌中异常表达且具有相关性,组织中miR-182高表达提示不良预后。

Effects of alendronate on bone mass and organ pathology in ovariectomized mice

Objective:To investigate the effect of alendronate on bone mass and organ pathology of ovariectomized mice.Methods:Thirty SPF grade C57 female mice were randomly divided into three groups(n=10):Sham operation group(Sham),ovariectomized group(OVX)and ovariectomized+alendronate group(ALN).The sodium alendronate was injected subcutaneously at 400μg/kg twice a week in the ALN group.The equal volume of normal saline was injected subcutaneously twice a week in the SHAM group and OVX group.After 12 weeks of drug administration,the samples were taken.The organ coefficients,main organ pathological sections,and bone histopathological sections were observed,and the micro CT,L4 biomechanics and serum biochemical indicators were analyzed.Results:The uterine coefficient of Sham group was(0.0054±0.0007)significantly higher than that of OVX group(0.0026±0.0009)and ALN group(0.0025±0.0007),and the difference was statistically significant(P<0.05).No obvious lesions or toxic or side effects were observed in the main organs.Compared with the OVX group,the ALN group with decalcified sections of bone tissue had compact trabecular structure and fewer adipocytes.Micro-CT results showed that the Tb.BMD,Tb.N,Tb.Th and Tb.BV/TV values of the ALN group were significantly increased compared with those of the OVX group,but the Tb.Sp value was significantly decreased,and the difference was statistically significant(P<0.05).In L4 vertebral body biomechanics,the elastic modulus(50.29±13.43)and maximum load number(29.83±4.92)of ALN group were significantly higher than those of OVX group(14.77±3.12)and maximum load number(11.57±3.18),and the difference was statistically significant(P<0.05).Compared with the OVX group,the serum OCN and PINP indicators of bone formation in the ALN group were increased,while the bone resorption indicators TRACP-5b and CTX-I were decreased,with statistical significance(P<0.05).Conclusion:Alendronate sodium improves bone quality by increasing bone density,improving bone microstructure,increasing bone strength,promoting bone formation and inhibiting bone resorption,without obvious toxic and side effects on organs.

卵巢肿瘤患者血清E-cadherin、CK19表达与病理特征的相关性

目的探讨卵巢肿瘤患者血清E-cadherin、CK19表达与病理特征的相关性。方法将88例接受根治性手术治疗的卵巢肿瘤患者设为卵巢肿瘤组,选择同期在本院体检的88名健康人群为正常组。检测卵巢肿瘤组与对照组的E-cadherin、CK19表达表达水平,调查卵巢肿瘤患者的病理特征、预后并进行相关性分析。结果卵巢肿瘤组的血清E-cadherin、CK19含量均显著高于对照组,差异有统计学意义(P<0.05)。卵巢肿瘤患者中,淋巴结转移19例、鳞癌48例、腺癌40例;Ⅰ期50例、Ⅱ期38例;高分化38例、中分化28例,低分化22例。Spearsman相关分析显示,患者的临床分期、组织学分化、淋巴结转移、肿瘤最大直径与血清E-cadherin、CK19含量均存在相关性,差异有统计学意义(P<0.05)。多因素Cox比例风险模型分析显示,血清E-cadherin、CK19含量都为影响患者预后中位生存时间的重要因素,差异有统计学意义(P<0.05)。结论卵巢肿瘤患者多伴随有血清E-cadherin、CK19的高表达,血清E-cadherin、CK19表达水平与病理特征存在相关性,也是影响患者预后的重要危险因素。

Evolution of human kidney allograft pathology diagnostics through 30 years of the Banff classification process

The second half of the previous century witnessed a tremendous rise in the number of clinical kidney transplants worldwide.This activity was,however,accompanied by many issues and challenges.An accurate diagnosis and appropriate management of causes of graft dysfunction were and still are,a big challenge.Kidney allograft biopsy played a vital role in addressing the above challenge.However,its interpretation was not standardized for many years until,in 1991,the Banff process was started to fill this void.Thereafter,regular Banff meetings took place every 2 years for the past 30 years.Marked changes have taken place in the interpretation of kidney allograft biopsies,diagnosis,and classification of rejection and other non-rejection pathologies from the original Banff 93 classification.This review attempts to summarize those changes for increasing the awareness and understanding of kidney allograft pathology through the eyes of the Banff process.It will interest the transplant surgeons,physicians,pathologists,and allied professionals associated with the care of kidney transplant patients.

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.

Transitioning of renal transplant pathology from allograft to xenograft and tissue engineering pathology:Are we prepared?

Currently,the most feasible and widely practiced option for patients with endstage organ failure is the transplantation of part of or whole organs,either from deceased or living donors.However,organ shortage has posed and is still posing a big challenge in this field.Newer options being explored are xenografts and engineered/bioengineered tissues/organs.Already small steps have been taken in this direction and sooner or later,these will become a norm in this field.However,these developments will pose different challenges for the diagnosis and management of problems as compared with traditional allografts.The approach to pathologic diagnosis of dysfunction in these settings will likely be significantly different.Thus,there is a need to increase awareness and prepare transplant diagnosticians to meet this future challenge in the field of xenotransplantation/regenerative medicine.This review will focus on the current status of transplant pathology and how it will be changed in the future with the emerging scenario of routine xenotransplantation.

Preliminary Exploration of All-English Teaching in Pathology for International Students

With the development of medical education in China, the education of international students has gradually become an important part of China’s higher education. Pathology is a bridge course connecting basic medicine and clinical medicine, and is a compulsory course for international medical students. In order to improve the quality of all-English teaching in pathology, according to the characteristics of international students and the discipline characteristics of pathology, this paper discussed the problems existing in the pathology teaching of international students, such as language communication, teacher training, textbook selection, teaching content arrangement, etc., aiming at exploring ways to solve these problems and improve the learning effect of international students from teaching practice.

Self-assembly of tau fragments as a key pathologic event in tauopathies

Tau protein is encoded by the microtubuleassociated protein tau(MAPT)gene and stabilizes microtubules in the neurons.Tau has unique biophysical properties that make it both highly water-soluble and positively charged.Although tau is an intrinsically disordered protein lacking defined secondary structures,it can acquire highly organized-sheet structures and stack into a filamentous inclusion such as a paired helical filament(PHF).

Soluble alpha-synuclein post-translational modifications:unexpected regulators of pathological alpha-synuclein amplification

The build-up of misfoldedα-synuclein(α-syn)in the central nervous system is the pathological hallmark of a number of neurodegenerative diseases that are known asα-synucleinopathies.These include Parkinson’s disease(PD),Parkinson’s disease with dementia(PDD),dementia with Lewy body(LB),multiple system atrophy(MSA),and a subset of Alzheimer’s disease.Growing evidence underscores that the intercellular transmission and amplification of pathologicalα-syn are critical processes underlying the progression ofα-synucleinopathies(Peng et al.,2020),and as such,the study of these processes could lead to the identification of promising therapeutics to mitigate disease progression.Most previous studies have focused solely on pathological seeds in relation to disease progression.

Anal Pathologies: What Management at the Reference Health Center of Bamako’s Commune V?

Anal pathologies are conditions affecting the anal margin and the anal canal. The aim of our study was to update data on anal diseases. Non-specific, it can reveal an emergency, a serious illness, a chronic disease or a benign condition. It was a prospective, descriptive and analytical study from April 2022 to March 2023, carried out in the hepato-gastroenterology unit of the Centre de Santé de Référence de la commune V du District de Bamako in Mali. Out of seven hundred and forty-nine (749) patients seen in consultation, 98 had anal pathology, i.e. a prevalence of 13.08%. The mean age was 40 ± 15.15 years and the sex ratio was 1.5. Hemorrhoidal disease and anal fissure were the most frequent pathologies in 66.4% and 24.4% of cases respectively. Medical treatment was initiated in 91.9% of patients with hemorrhoidal disease and 91.7% with anal fissure. Anal pathologies are common in young male patients. In our context, they are dominated by benign conditions.

Prevalence of retinal pathologies in people over 60 years:the Tehran Geriatrics Eye Study

AIM:To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors.METHODS:A cross-sectional study was conducted in Tehran using multistage cluster sampling.After selecting subjects aged 60 and over,optometric,and ophthalmic examinations were done.For retinal examination,a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops.Biometry was done using the IOL Master for all participants.RESULTS:Of 3791 people that were invited through cluster sampling,3310 participated in the study(response rate=82%).The prevalence of retinal pigmented epithelium(RPE)change,drusen,geographic atrophy(GA),hypertensive retinopathy(HTR),nonproliferative diabetic retinopathy(NPDR),proliferative diabetic retinopathy(PDR),choroidal neovascularization(CNV),central retinal artery occlusion(CRAO),myopic retinopathy(MR),branch retinal vein occlusion(BRVO),and central retinal vein occlusion(CRVO)was 27.42%,11.08%,4.52%,3.03%,4.05%,0.54%,0.82%,0.39%,0.20%,0.49%,and 0.19%,respectively.After removing the effect of age,the odds of NPDR were 1.68 times higher in women compared to men(P=0.014).After removing the effect of sex,the odds of drusen,RPE change,GA,CNV,BRVO,and CRVO increased with age.CONCLUSION:There is a higher prevalence of RPE change,drusen,GA,CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values.Considering the correlation of most of the diseases with age and their effects on vision,attention should be paid to these diseases and the related screening programs to prevent vision impairment.

Pathological diagnosis and immunohistochemical analysis of giant retrosternal goiter in the elderly: A case report

BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges.This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis,providing clinicians with more precise diagnostic and treatment strategies.A 77-year-old male,was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination,accompanied by dyspnea.Locally protruding into the superior mediastinum,the adjacent structure was compressed,the trachea was compressed to the right,and the local lumen was slightly narrowed.The patient was diagnosed with giant retrosternal goiter.Considering dyspnea caused by trachea compression,our department planned to perform giant retrosternal thyroidectomy.Immunohistochemical results:Tg(+),TTF-1(+),Calcitonin(CT)(I),Ki-67(+,about 20%),CD34(-).Retrosternal goiter means that more than 50%of the volume of the thyroid gland is below the upper margin of the sternum.As retrosternal goiter disease is a relatively rare disease,once the disease is diagnosed,it should be timely surgical treatment,and the treatment is more difficult,the need for professional medical team for comprehensive treatment.CONCLUSION The imaging manifestations of giant retrosternal goiter are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of giant retrosternal goiter immunohisto-chemistry and shows that giant retrosternal goiter is positive for Tg,TTF-1,and Ki-67.

Clinical pathological characteristics of“crawling-type”gastric adenocarcinoma cancer:A case report

BACKGROUND Gastric cancer(GC)is a significant health problem worldwide,and early detection and accurate diagnosis are crucial for improving patient outcomes.Crawling-type gastric adenocarcinoma is a rare subtype of GC that has unique histopathological and clinical characteristics,and its diagnosis and management can be challenging.This pathological type of GC is also rare.CASE SUMMARY Here,we report the case of a patient who underwent ordinary endoscopy,na-rrow-band imaging,and endoscopic ultrasonography intending to determine the extent of tumor invasion and upper abdominal enhanced computed tomography and whether there was tumor metastasis.Then,endoscopic submucosal dissection was performed.After pathological and immunohistochemical examination,the pathological diagnosis was crawling-type gastric adenocarcinoma.This is a very rare and special pathological type of tumor.This case highlights the importance of using advanced endoscopic techniques and pathological examination in diagnosing and managing gastric crawling-type adenocarcinoma.Moreover,the findings underscore the need for continued research and clinical experience in this rare subtype of GC to improve patient outcomes.CONCLUSION The“crawling-type”GC is a rare and specific tumor pathology.It is difficult to identify and diagnose gliomas via endoscopy.The tumor is ill-defined,with a flat appearance and indistinct borders due to the lack of contrast against the background mucosa.Pathology revealed that the tumor cells were hand-like,so the patient has diagnosed with“crawling-type”gastric adenocarcinoma.