The value of gastroenterultrasound developer in diagnosis of the stomach tumor

Objective: To study the value of gastroenterultrasound developer in diagnosis of the stomach tumor. Methods: 38 patients who diagnosed as stomach tumor by gastroscopy were chosen, and their images before and after by using gastroenterultrasound developer were compared. Results: The difference between the detectable rate of stomach tumor before and after by using gastroenterultrasound developer was significant (P < 0.01). Conclusion: Gastroenterultrasound developer has a high diagnostic value in diagnosis of the stomach tumor.

Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach

AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS: The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC=0.795, 95%CI: 0.751-0.839, P=0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size<4.8 cm). Tumor size was significantly correlated with histological type (P=0.039), Borrmann type (P=0.000), depth of tumor invasion (P=0.000), lymph node metastasis (P=0.000), tumor-nodes metastasis stage (P=0.000), mean number of metastatic lymph nodes (P=0.000) and metastatic lymph node ratio (P=0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P=0.000). Univariate analysis showed that depth of tumor invasion (c 2=69.581, P=0.000), lymph node metastasis (c 2=138.815, P=0.000), tumor size (c 2=78.184, P=0.000) and metastatic lymph node ratio (c 2=139.034, P=0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P=0.000), lymph node metastasis (P=0.019) and tumor size (P=0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P<0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors (P > 0.05). CONCLUSION: Using a tumor size cutoff value of 4.8cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.

Plexiform angiomyxoid myofi broblastic tumor of the stomach

Plexiform angiomyxoid myofibroblastic tumor of the stomach is a unique mesenchymal tumor that we first described in 2007.The tumor is very rare,and to date,only 18 cases confirmed by immunohistochemistry have been reported in the literature.The patients' ages ranged from 7 to 75 years(mean,43 years),and the male-to-female ratio was approximately 1:1.Representative clinical symptoms are ulceration,associated upper gastrointestinal bleeding(hematemesis),and anemia.The tumors are located at the antrum in all cases,and grossly,the tumor is whitish to brownish or reddish,and forms a lobulated submucosal or transmural mass.Microscopically,the tumor is characterized by a plexiform growth pattern,the proliferation of cytologically bland spindle cells,and a myxoid stroma that is rich in small vessels and positive for Alcian blue stain.Immunohistochemically,the tumor cells are positive for α-smooth muscle actin and negative for KIT and CD34.Differential diagnoses include gastrointestinal stromal tumor and other mesenchymal tumors of the gastrointestinal tract.Some authors proposed that this tumor should be designated as "plexiform fibromyxoma",but this designation might cause confusion.The tumor is probably benign and thus far,neither recurrence nor metastasis has been reported.

Glomus tumor in the stomach:Computed tomography and endoscopic ultrasound findings

A 57-year-old man presented with intermittent dull abdominal pain after a period of 1 year.Abdominal computed tomography(CT) was performed.Except for the endoscopy,the work-up for possible medical causes remained inconclusive.An open-abdomen,partial surgical excision of the stomach was performed after the unsuccessful endoscopic resection.The pathology report revealed a glomus tumor of the stomach.Importantly,glomus tumors of the stomach are rare and are almost always benign.Therefore,the most important current role of imaging associated with the diagnostic approach and therapeutic plan for a glomus tumor is to differentiate it from other gastric submucosal tumors(SMTs).We report this case with representative radiologic findings,including CT and endoscopic ultrasound(EUS) reports,and also correlate them with clinical and pathologic presentations that can help in the early detection and differentiation of gastric SMTs from other SMTs.As such,the purpose of this report is to provide a better understanding of relevant CT and EUS features.Alternative treatments should be considered carefully according to the imaging results.

A perivascular epithelioid cell tumor of the stomach:An unsuspected diagnosis

Perivascular epithelioid cell tumor(PEComa) is a rare mesenchymal neoplasia and currently well recognized as a distinct entity with characteristic morphological,immunohistochemical and molecular findings.We report a case of PEComa arising in the antrum of a 71-year-old female with melena.The tumor,located predominantly in the submucosa as a well delimited nodule,measured 3.0 cm in diameter and was completely resected,with no evidence of the disease elsewhere.Histologically,it was composed predominantly of eosinophilic epithelioid cells arranged in small nests commonly related to variably sized vessels,with abundant extracellular material,moderate nuclear variation and discrete mitotic activity.No necrosis,angiolymphatic invasion or perineural infil-tration was seen.Tumor cells were uniformly positive for vimentin,smooth muscle actin,desmin and melan A.Although unusual,PEComa should be considered in the differential diagnosis of gastric neoplasia with characteristic epithelioid and oncocytic features and prominent vasculature.

Plexiform Angiomyxoid Myofibroblastic Tumor of the Stomach

Plexiform angiomyxoid myofibroblastic tumor (PAMT) is a recently described gastric tumor with a peculiar plexiform pattern, bland spindle cells and a myxoid stroma rich in arborizing blood vessels. PAMT of the stomach is a very rare tumor without distinctive clinical manifestations. In this study, we report a new case of PAMT which is the first Chinese case in English literature. A 47-year-old Chinese woman was admitted with a 6-month history of intermittent epigastric discomfort, and abdominal pain for 2 months. Gastroscopy showed an elevated mass in the anterior wall of the gastric antrum. Endoscopic ultrasound revealed a focal hypoechoic lesion protruding into the lumen. A laparoscopic distal gastrectomy was performed, and the patient made an uneventful recovery and remains well 1.5 years later. A diagnosis of PAMT was made by histopathology and immunochemistry.

Diagnostic utility of endoscopic ultrasound-guided fineneedle aspiration biopsy for glomus tumor of the stomach

A 52-year-old man was referred for further investigation of a gastric submucosal tumor on the greater curvature of the antrum. Endoscopic ultrasonography demonstrated a hypoechoic solid mass, which was primarily connected to the muscular layer of the stomach. We performed endoscopic ultrasoundguided fine-needle aspiration biopsy. The pathological examination showed proliferation of oval-shaped cells with nest formation, which stained strongly positive for muscle actin, and negative for c-kit, CD34, CD56,desmin, S-100, chromogranin, and neuron-specific enolase. Therefore, we performed laparoscopy and endoscopy cooperative surgery based on the preoperative diagnosis of glomus tumor of the stomach. The final histological diagnosis confirmed the preoperative diagnosis. Although preoperative diagnosis of glomus tumor of the stomach is difficult with conventional images and endoscopic biopsy, endoscopic ultrasoundguided fine-needle aspiration biopsy is an essential tool to gain histological evidence of glomus tumor of the stomach for early diagnosis.

Bioinformatics Analysis Revealed Potential Tumor Suppressors (KLF4/CGN), Oncogenes (SHH/LIF) and Biomarkers of Asian Stomach Adenocarcinoma

Stomach adenocarcinoma (STAD) is the fifth most prevalent cancer and the third leading cause of cancer-related death in the world and is more common in Asia than in most Western countries. There is an urgent need to identify potential novel oncogenes and tumor suppressor genes, and biomarkers for STAD. 6652 differentially expressed genes were identified between STAD and normal samples based on the transcriptome data analysis of the TCGA and GEO databases. 13 key modules were identified in STAD by WGCNA analysis. 293 potential STAD associated genes were identified from intersection by Venn Diagram. The 293 intersected genes were enriched in cell cortex and infection by GO and KEGG analysis. 10 hub genes were identified from PPI and Cytoscape analyses of the intersected genes. KLF4/CGN low and SHH/LIF high expression were associated with short overall survival of Asian STAD patients. Bioinformatics analysis revealed potential novel tumor suppressors (KLF4/CGN), oncogenes (SHH/LIF) and biomarkers for diagnosis, therapy and prognosis of STAD, specifically for Asian patients.

单孔腹腔镜联合内镜治疗胃血管球1例及国内外文献复习

分析川北医学院附属医院胃肠外科2023年4月收治的1例罕见疾病[胃血管球瘤(GGT)]患者。该例患者术前临床诊断为胃间质瘤,术后通过免疫组织化学确诊为GGT,经单孔腹腔镜联合内镜治疗后痊愈出院。GGT术前难以确诊,且易误诊为胃间质瘤,手术切除肿瘤是其唯一治疗方法。该文深入探讨GGT的临床表现、影像及病理特征、临床诊断、鉴别诊断及治疗方法,并复习国内外相关文献,以便为今后临床工作提供参考信息。

健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响研究

目的 探究健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响。方法 收集我院2019年6月—2022年6月肿瘤科收治的晚期胃癌患者95例,随机分为对照组(47例)与试验组(48例)。对照组予以FOLFOX4方案进行化疗,试验组在对照组的基础上予以健脾养胃法。两组均治疗9周,治疗结束后比较2组中医症状积分、血清肿瘤标志物、免疫功能指标、治疗期间胃肠道反应、远期生存率。结果 治疗后与对照组相比,试验组临床有效率较高(P<0.05)。治疗后与治疗前相比2组脘腹痞闷、胸胁胀痛、食欲缺乏、便溏及神疲乏力等中医症状积分降低;与对照组相比,试验组所有中医症状积分均较低(P<0.05)。治疗后与治疗前相比2组CEA、CA12-5、CA19-9及CA72-4降低;与对照组相比,试验组CEA、CA12-5、CA19-9及CA72-4较低(P<0.05)。治疗后与治疗前相比2组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)升高,IgG、IgM降低(P<0.05);与对照组相比,试验组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)较高,IgG、IgM较低(P<0.05)。2组6个月及1年生存率相比无统计学意义(P>0.05);试验组3年内生存率高于对照组(P<0.05)。结论 健脾养胃法应用于老年胃癌晚期胃癌患者的治疗中近远期治疗效果显著,能提高免疫功能,下调肿瘤标志物水平,适宜临床应用。

消食药在肿瘤治疗中的运用规律

中医认为脏腑气血亏虚、痰瘀毒邪互结是肿瘤发病中的重要因素。消食药健运中焦、疏肝理气、祛痰逐瘀等功效与肿瘤正虚邪实的核心病机高度契合,在肿瘤治疗中发挥着独特作用,现代药理学研究表明此类药物可以通过调节肠道菌群、抑制炎症介质表达、抑制血管生成、诱导细胞凋亡等抗肿瘤。临证时应谨守病机、随证加减、合理配伍、巧妙化裁、注意禁忌。

一种罕见的胃癌-胃肝样腺癌

胃肝样腺癌(hepatoid adenocarcinoma of the stomach,HAS)是一种表现在肝脏外的罕见的特殊胃恶性肿瘤,与一般的胃癌不同,HAS的恶性程度高、侵袭性高,容易出现肝转移、淋巴转移、预后差,但是HAS的诊断、临床病理特征和预后仍有较大的争论.为了帮助临床医生更了解这种胃癌,本文从甲胎蛋白的起源开始对HAS的诊断、临床病理特征及其预后等进行系统综述,从而为这种特殊胃癌的临床诊治提供建设性的意见及帮助.

核纤层蛋白B2在胃癌中高表达并调节胃癌的免疫微环境

目的:研究核纤层蛋白B2(LMNB2)在胃癌患者中的表达特征及其与临床预后、临床病理特征相关性,并探讨LMNB2表达对胃癌免疫微环境的影响。方法:下载UCSC数据库中经统一标准化的泛癌数据集,对其中19131例癌旁正常组织及60499例肿瘤组织中LMNB2的表达情况进行分析。收集自2014年至2016年间在温州医科大学附属第一医院行胃癌根治性切除术的142例胃癌组织及28例配对癌旁正常组织,免疫组化技术检测127例胃癌组织及28对配对癌旁组织中LMNB2的差异表达情况,并结合临床信息,对LMNB2表达情况与患者预后、临床病理特征之间的关系进行分析。采用ESTIMATE等算法分析LMNB2表达水平对胃癌组织中的基质、免疫细胞浸润等的影响;分析胃癌组织中不同免疫细胞的浸润情况及肿瘤突变负荷(TMB)、微卫星不稳定性(MSI)、细胞程序性死亡-配体1(PD-L1)与LMNB2表达水平之间的相关性,并通过基于免疫组化技术进行的评分,对临床组织样本进一步验证分析。结果:LMNB2在胃癌组织中表达上调,与患者的不良预后、更差的TNM分期等临床病理特征相关性。ESTIMATE分析显示,LMNB2的表达与免疫评分(r=-0.202,P<0.001)、基质评分(r=-0.272,P<0.001)、ESTIMATE评分(r=-0.251,P<0.001)呈负相关。免疫细胞的浸润情况分析发现,LMNB2表达与M1型巨噬细胞(r=0.322,P<0.001)、NK细胞(r=0.423,P<0.001)、中性粒细胞(r=0.307,P<0.001)浸润呈正相关。免疫组化对组织芯片进一步分析显示LMNB2高表达组拥有更高的CD4、CD56评分(均P<0.05),而其CD8、CD163评分则更低(均P<0.05)。LMNB2的表达水平与胃癌中TMB评分(r=0.343,P<0.001)及MSI评分(r=0.221,P<0.001)呈正相关,且LMNB2高表达组的PD-L1表达水平上调(P<0.05)。结论:LMNB2在胃癌中的表达上调,调节胃癌中的免疫微环境,可能是潜在的胃癌诊断标志物及评价胃癌病人免疫检查点抑制剂疗效的指标。

自身免疫性胃炎与胃肿瘤的研究进展

自身免疫性胃炎(AIG)是一种由自身免疫功能异常所致的胃炎,临床常表现为恶性贫血或神经系统症状,内镜下通常可见胃体黏膜萎缩,可伴有血清抗壁细胞抗体和(或)抗内因子抗体阳性。有研究表明,AIG是胃神经内分泌瘤和胃癌的危险因素,因此内镜下诊断并随访监测AIG至关重要。本文就AIG与胃肿瘤的研究进展作一综述。

胃腺癌中抗原处理相关转运蛋白1的表达和临床意义

目的探讨胃腺癌(stomach adenocarcinoma,STAD)中抗原处理相关转运蛋白1(transporter associated with antigen processing 1,TAP1)表达与临床病理特征的关系及其预后意义。方法通过癌症基因组图谱(The Cancer Genome Atlas,TCGA)数据库收集TAP1在STAD组织中的mRNA表达水平和患者临床资料。采用GraphPad Prism软件分析TAP1表达与临床病理特征的关系,采用Kaplan-Meier曲线分析其与患者总生存期的关系。采用蛋白质印迹法检测STAD细胞株MKN45和AGS以及人正常胃黏膜上皮细胞株GES-1中TAP1的蛋白表达。收集2020年1月1日至12月31日武汉大学中南医院病理科的STAD组织标本122例和2020年10月1日至12月31日武汉大学中南医院病理科的正常胃切除标本24例,采用免疫组织化学法检测组织中的TAP1表达,分析其与患者临床病理特征的关系。结果TCGA数据库分析和组织标本的免疫组织化学分析均显示,TAP1在STAD组织中较正常胃组织高表达(均P<0.05)。TAP1在STAD细胞株MKN45中的表达较正常胃黏膜上皮细胞株GES-1高(P<0.01),而人STAD细胞株AGS与GES-1中TAP1水平比较,差异无统计学意义(P>0.05)。在STAD组织中,TAP1蛋白表达水平在STAD的Laurén分型方面比较,差异具有统计学意义(P<0.05)。TCGA数据库分析发现,TAP1表达水平随肿瘤组织分级的增加而升高(P<0.05)。TCGA数据库中STAD患者按TAP1表达中位数6.82分为TAP1高表达组和低表达组。TAP1高表达组中位总生存期更长(57.1个月vs 25.1个月,P<0.05)。结论TAP1在STAD组织中高表达,且与Laurén分型和组织分级相关,为预后保护因素,可作为STAD预后的潜在标志物。

上皮细胞黏附分子与肺癌、乳腺癌及部分消化系统肿瘤关系的研究进展

上皮细胞黏附分子(EpCAM)最早在结肠癌细胞中被发现,其可参与调节细胞的黏附、增殖、分化、迁移及信号转导等过程。正常情况下,EpCAM仅表达于正常上皮细胞,然而研究发现,其在人类上皮细胞源性恶性肿瘤中存在且高表达。EpCAM参与肿瘤进展的多个环节,其在肿瘤中独特的表达模式也使其成为最重要的肿瘤生物标志物之一。本文综述了近年来EpCAM作为肿瘤生物标志物的研究进展,以及其在肺癌、乳腺癌和部分消化系统肿瘤治疗中的潜在应用,揭示了EpCAM在肿瘤发展中的重要作用,为其作为治疗靶点提供了科学依据。

45例肝胃间隙占位性病变分析

目的探讨肝胃间隙占位性病变的临床特点。方法对2016年7月至2023年2月于武汉大学人民医院及华中科技大学同济医学院附属同济医院进行诊治的45例肝胃间隙占位性病变患者的临床资料进行回顾性分析。结果肝胃间隙恶性肿瘤占57.78%,良性肿瘤占42.22%。其中胃肠道间质瘤占肝胃间隙占位性病变的31.11%,各种转移癌占33.33%。胃肠道间质瘤的大小以及特殊的EUS特征与其危险度有关(P<0.05)。EUS下病变回声是否均匀以及病变分界是否清晰在占位性病变的良恶性中差异无统计学意义(P>0.05),而病变回声(如低回声、高回声等)在良恶性占位性病变中差异有统计学意义(P<0.05)。结论肝胃间隙恶性占位性病变种类较多,恶性病变多于良性病变,可行EUS-FNA明确病理性质,从而对临床治疗提供指导。

胃肠道钙化性纤维性肿瘤17例临床病理分析

目的探讨胃肠道钙化性纤维性肿瘤(CFT)的临床病理学特征、免疫表型、诊断及鉴别诊断。方法收集17例胃肠道CFT的病例资料,分析其临床及病理学特征,并复习相关文献。结果女性13例,男性4例;年龄16~67岁;15例位于胃,2例位于直肠;镜下特征为大量玻璃样变胶原纤维组织,夹杂散在分布形态温和的梭形细胞,伴淋巴细胞、浆细胞浸润,多少不等的营养不良性钙化及砂砾体形成。免疫组化:部分病例瘤细胞表达CD34(3/15),1例部分表达SMA(1/16),DOG1、CD117、Desmin、S-100、ALK等均阴性。结论胃肠道CFT是一种罕见的良性纤维性肿瘤,容易误诊为消化道来源的其他间叶源性肿瘤,诊断需要结合病理学形态及免疫组化表型进行综合分析。

Clinicopathological features of gastric glomus tumor

AIM:To study the clinicopathological features of gastric glomus tumor and review the related Chinese literature published in 1990-2010.METHODS:A case of gastric glomus tumor was re-ported.Clinicopathological findings in 56 cases of gastric glomus tumor were analyzed.RESULTS:Gastric glomus tumor was far more common in women than in men with a female to male ratio of 1.6:1.The median age of the patients was 45 years(range 28-79 years).The patients often complained of epigastric pain and bloody stool.The tumor was located in antrum of the stomach.The greatest diameter of the tumor was 0.8-11cm.Histologically,the tumor was comprised of nests of glomus cells surrounding the capillaries.Glomus cells were small,uniform and round.Vimentin,smooth muscle actin and actin were expressed in the tumor.Other markers,including S-100 protein,CD34,CD117,desmin,CD56,synaptophysin,chromo-granin A,neuron specific enolase and cytokeratin were all negative.CONCLUSION:Gastric glomus tumor is a rare benign mesenchymal neoplasm.Its diagnosis depends on pathologic examination.Differential diagnosis includes gastrointestinal stromal tumor,paraganglioma and carcinoid tumor.