Mesenchymal-epithelial transition factor amplification correlates with adverse pathological features and poor clinical outcome in colorectal cancer

BACKGROUND Colorectal cancer(CRC)is the third most common cancer and the second most common cause of cancer-related mortality worldwide.Mesenchymal-epithelial transition factor(MET)gene participates in multiple tumor biology and shows clinical potential for pharmacological manipulation in tumor treatment.MET amplification has been reported in CRC,but data are very limited.Investigating pathological values of MET in CRC may provide new therapeutic and genetic screening options in future clinical practice.AIM To determine the pathological significance of MET amplification in CRC and to propose a feasible screening strategy.METHODS A number of 205 newly diagnosed CRC patients undergoing surgical resection without any preoperative therapy at Shenzhen Cancer Hospital of Chinese Academy of Medical Sciences were recruited.All patients were without RAS/RAF mutation or microsatellite instability-high.MET amplification and c-MET protein expression were analyzed using fluorescence in situ hybridization(FISH)and immunohistochemistry(IHC),respectively.Correlations between MET aberration and pathological features were detected using the chi-squared test.Progression free survival(PFS)during the two-year follow-up was detected using the Kaplan-Meier method and log rank test.The results of MET FISH and IHC were com pared using one-way ANOVA.RESULTS Polysomy-induced MET amplification was observed in 14.4%of cases,and focal MET amplification was not detected.Polysomy-induced MET amplification was associated with a higher frequency of lymph node metastasis(LNM)(P<0.001)and higher tumor budding grade(P=0.02).In the survival analysis,significant difference was detected between patients with amplified-and non-amplified MET in a two-year follow-up after the first diagnosis(P=0.001).C-MET scores of 0,1+,2+,and 3+were observed in 1.4%,24.9%,54.7%,and 19.0%of tumors,respectively.C-MET overexpression correlated with higher frequency of LNM(P=0.002),but no significant difference of PFS was detected between patients with different protein levels.In terms of concordance between MET FISH and IHC results,MET copy number showed no difference in c-MET IHC 0/1+(3.35±0.18),2+(3.29±0.11)and 3+(3.58±0.22)cohorts,and the MET-to-CEP7 ratio showed no difference in three groups(1.09±0.02,1.10±0.01,and 1.09±0.03).CONCLUSION In CRC,focal MET amplification was a rare event.Polysomy-induced MET amplification correlated with adverse pathological characteristics and poor prognosis.IHC was a poor screening tool for MET amplification.

Clinical features and prognostic factors of duodenal neuroendocrine tumours:A comparative study of ampullary and nonampullary regions

BACKGROUND Duodenal neuroendocrine tumours(DNETs)are rare neoplasms.However,the incidence of DNETs has been increasing in recent years,especially as an incidental finding during endoscopic studies.Regrettably,there is no consensus regarding the ideal treatment of DNETs.Even there are few studies on the clinical features and survival analysis of DNETs.AIM To analyze the clinical characteristics and prognostic factors of patients with duodenal neuroendocrine tumours.METHODS The clinical data of DNETs diagnosed in the First Affiliated Hospital of Air Force Military Medical University from June 2011 to July 2022 were collected.Neuroen-docrine tumours located in the ampulla area of the duodenum were divided into the ampullary region group;neuroendocrine tumours in any part of the duo-denum outside the ampullary area were divided into the nonampullary region group.Using a retrospective study,the clinical characteristics of the two groups and risk factors affecting the survival of DNET patients were analysed.RESULTS Twenty-nine DNET patients were screened.The male to female ratio was 1:1.9,and females comprised the majority.The ampullary region group accounted for 24.1%(7/29),while the nonampullary region group accounted for 75.9%(22/29).When diagnosed,the clinical symptoms of the ampullary region group were mainly abdominal pain(85.7%),while those of the nonampullary region groups were mainly abdominal distension(59.1%).There were differences in the composition of staging of tumours between the two groups(Fisher's exact probability method,P=0.001),with nonampullary stage II tumours(68.2%)being the main stage(P<0.05).After the diagnosis of DNETs,the survival rate of the ampullary region group was 14.3%(1/7),which was lower than that of 72.7%(16/22)in the nonampullary region group(Fisher's exact probability method,P=0.011).The survival time of the ampullary region group was shorter than that of the nonampullary region group(P<0.000).The median survival time of the ampullary region group was 10.0 months and that of the nonampullary region group was 451.0 months.Multivariate analysis showed that tumours in the ampulla region and no surgical treatment after diagnosis were independent risk factors for the survival of DNET patients(HR=0.029,95%CI 0.004-0.199,P<0.000;HR=12.609,95%CI:2.889-55.037,P=0.001).Further analysis of nonampullary DNET patients showed that the survival time of patients with a tumour diameter<2 cm was longer than that of patients with a tumour diameter≥2 cm(t=7.243,P=0.048).As of follow-up,6 patients who died of nonampullary DNETs had a tumour diameter that was≥2 cm,and 3 patients in stage IV had liver metastasis.Patients with a tumour diameter<2 cm underwent surgical treatment,and all survived after surgery.CONCLUSION Surgical treatment is a protective factor for prolonging the survival of DNET patients.Compared to DNETs in the ampullary region,patients in the nonampullary region group had a longer survival period.The liver is the organ most susceptible to distant metastasis of nonampullary DNETs.

Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

Epidemiology, Clinical Features and Antifungal Resistance Profile of Candida auris in Africa: Systematic Review

Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.

Research Progress on the Relationship between Magnetic Resonance Imaging and Clinical Pathological Characteristics of Liver Cancer

Liver cancer is one of the main malignant tumors in the digestive system.Early detection and treatment have positive significance in improving patient prognosis and reducing mortality.MRI is the main method for liver cancer examination,which mainly uses computers to compare imaging of different energy regions of tumors,observe the density and signal changes of liver cancer,and the degree of tumor enhancement.In particular,various new MRI functional imaging technologies,such as diffusion-weighted imaging,perfusion weighted imaging,delayed imaging,liver cell specific contrast agent enhanced imaging,etc.,can be used at the molecular level Multiple aspects such as cell function provide clinicians with richer diagnostic information.Therefore,further comparative analysis of MRI manifestations and pathological results of liver cancer can help to gain a deeper understanding of the biological behavior of tumors and provide a basis for treatment decision-making and prognosis evaluation.

Osteoclastic and pleomorphic giant cell tumors of the pancreas:A review of clinical,endoscopic,and pathologic features

Giant cell tumors of the pancreas come in three varieties-osteoclastic,pleomorphic,and mixed histology.These tumors have distinctive endoscopic,clinical,and cytological features.Giant cell tumors have a controversial histogenesis,with some authors favoring an epithelial origin and others favoring a mesenchymal origin.The true origin of these lesions remains unclear at this time.These are also very rare tumors but proper identification and differentiation from more common pancreatic adenocarcinoma is important.The risk factors of these tumors and the prognosis may be different from those associated with standard pancreatic adenocarcinoma.Recognition of these differences can significantly affect patient care.These lesions have a unique appearance when imaged with endoscopic ultrasound(EUS),and these lesions can be diagnosed via EUS guided Fine Needle Aspiration(FNA).This manuscript will review the endoscopic,clinical,and pathologic features of these tumors.

Clinical and pathological features and risk factors for primary breast cancer patients

BACKGROUND Breast cancer is the most common malignancy in women all around the world.According to the latest statistics in 2018,there were more than 2.08 million new breast cancer cases all around the world and more than 620000 deaths;the proportion of breast cancer deaths in women with cancer is 15%.By studying age,clinicopathological characteristics and molecular classification,age at menarche,age at birth,number of births,number of miscarriages,lactation time,surgical history of benign breast lesions,history of gynecological diseases,and other factors,we retrospectively summarized and compared the disease history of patients with primary breast cancer and patients with benign thyroid tumors admitted to our hospital in the past 10 years to explore the clinicopathological characteristics and risk factors for primary breast cancer.AIM To investigate the clinical and pathological features and risk factors for primary breast cancer treated at our center in order to provide a reference for the prevention and treatment of breast cancer in the Zhuhai-Macao region.METHODS Through a retrospective case-control study,149 patients with primary breast cancer diagnosed and treated at Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2013 to March 2020 were included as a case group,and 165 patients with benign breast tumors diagnosed and treated from January 2019 to March 2020 were included as a control group.The data collected included age,age at menarche,age at first birth,number of births,number of miscarriages,lactation time,history of surgery for benign breast lesions,history of familial malignant tumors,history of gynecological diseases,history of thyroid diseases,and the tumor characteristics of the patients in the case group including pathological diagnosis,pathological type,tumor size,lymph node metastasis,distant metastasis,stage,and molecular classification,among others.In the case group,the chi-square test was used to analyze the clinical and pathological features of patients in three age groups(<40,40-59,and≥60 years).A multifactor logistic regression analysis was used to analyze correlations between the two groups.RESULTS Among 149 patients with primary breast cancer,the average age was 48.20±12.06 years,and the proportion of patients at 40-59 years old was the highest,accounting for 61.8%of cases.The molecular type was mainly luminal B type,accounting for 69.2%of cases,and at the time of diagnosis,the tumor stage was mainly stage I/II,accounting for 62.4%of cases.There were no statistically significant differences in the distributions of tumor location,pathological type,tumor size,lymph node metastasis,stage,or molecular classification among the three age groups(<40,40-59,and≥60 years)(P≥0.05).The differences in the distribution of distant metastasis among the three age groups(<40,40-59,and≥60 years)were statistically significant(P<0.01).The differences in lactation time,history of familial malignant tumors,history of gynecological diseases,and history of thyroid diseases between the two groups were not statistically significant(P≥0.05).The differences in age at disease diagnosis,age at menarche,and history of surgery for benign breast lesions were statistically significant(P<0.01).The difference in age at first birth was also statistically significant(P<0.05).CONCLUSION The highest incidence of breast cancer in the Zhuhai-Macao region is present among women aged 40-59 years.There is a larger proportion of stage I/II patients,and the luminal B type is the most common molecular subtype.Distant metastasis occurs mainly in the≥60-year-old group at the first diagnosis;increased age,late age at menarche,and late age at first birth may be risk factors for primary breast cancer,and a history of surgery for benign breast lesions may be a protective factor for primary breast cancer.

Assessment of clinical and pathological features of patients who underwent thyroid surgery: A retrospective clinical study

AIM To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery. METHODS We retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinicalparameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric MannWhitney U test was used to compare quantitative data that were not normally distributed, and Pearson's chisquared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method.RESULTS This study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy(P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively.CONCLUSION This study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.

Clinical and Pathological Features of Riedel's Thyroiditis

Objective To evaluate the clinical and pathological features of Riedel's thyroiditis(RT),and current diagnostic and treatment methods for that disease.Methods Five RT cases identified by surgery and pathological examinations at Peking Union Medical College Hospital from 1985 to 2009 were analyzed and compared with the cases reported in the literature in terms of clinical and pathological features.Immunohistochemical staining of kappa and lambda light chains was carried out for RT tissues from all the five patients.Results All the five cases were females,aged 45-55 years.Elevation of serum thyroid autoantibodies was found in only one patient,who had longer disease duration than the others.Pathological examination revealed invasive fibrosclerosis of the thyroid follicles,thyroid capsule,and the surrounding tissues.In RT tissues,the number of cells containing lambda chains was a little higher than those containing kappa chains.Conclusions RT is a rare disease which might be more common in middle-aged females than in other populations.Pathological features include the destruction of thyroid follicle,extension into surrounding tissues by inflammatory cells and fibrous tissues.Immunohistochemical staining of kappa and lambda chains could help diagnose RT.

Clinical and pathological features of Devic’s neuromyelitis optica and multiple sclerosis in Chinese patients

BACKGROUND：Devic＇s neuromyelitis optica （DNMO） and multiple sclerosis in Asian populations have been considered to be the same disease. However, there is an increasing number of studies suggesting that DNMO and multiple sclerosis are different diseases.OBJECTIVE：Little information is available regarding comparisons of DNMO patients between China and other countries, as well as clinical manifestations of Chinese patients with DNMO and multiple sclerosis. The present study performed a multi-center, pathological, retrospective analysis.DESIGN, TIME AND SETTING：A retrospective analysis of clinical data from seven patients with DNMO diagnosed between 1957 and 1998.PARTICIPANTS：Data from Chinese DNMO patients was provided by the Shanghai Second Medical University, Sun Yat-sen University of Medical Sciences and the First Affiliated Hospital of Harbin Medical University in China.METHODS：Clinical and pathological data from Chinese patients with DNMO were retrospectively analyzed. The clinical characteristics of DNMO were compared between Chinese and Caucasian patients. In addition, clinical and pathological differences between DNMO and multiple sclerosis Chinese patients were compared.MAIN OUTCOME MEASURES：Clinical and pathological features of Chinese patients with DNMO.RESULTS：All seven Chinese patients with DNMO exhibited abrupt onset of vision disturbance, with a disease course of 3 clays to 9 years. DNMO recurred in two of the patients. Demyelinating lesions were observed in all patients, with necrotic lesions and gitter cells in five patients, collagenous hyperplasia in one patient, and perivascular inflammatory cell infiltration in six patients. Comparison between Chinese and Caucasian DNMO patients revealed no significant differences in age at onset, clinical onset, duration, or interval between optic neuritis and myelitis. Compared with Chinese multiple sclerosis patients, Chinese DNMO patients presented with fewer recurrences, higher occurrence of necrosis, perivascular inflammatory cell infiltration and gitter cells, and a lower occurrence of collagenous hyperplasia.CONCLUSION：There was no difference in DNMO clinical features between Chinese and Caucasian patients. However, the clinical and pathological features of DNMO were different compared with multiple sclerosis in Chinese patients. Results suggested that the characteristics of DNMO in Chinese patients were significantly different than multiple sclerosis.

Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments

The coronavirus disease 2019(COVID-19)pandemic has been a serious threat to global health for nearly 3 years.In addition to pulmonary complications,liver injury is not uncommon in patients with novel COVID-19.Although the prevalence of liver injury varies widely among COVID-19 patients,its incidence is significantly increased in severe cases.Hence,there is an urgent need to understand liver injury caused by COVID-19.Clinical features of liver injury include detectable liver function abnormalities and liver imaging changes.Liver function tests,computed tomography scans,and ultrasound can help evaluate liver injury.Risk factors for liver injury in patients with COVID-19 include male sex,preexisting liver disease including liver transplantation and chronic liver disease,diabetes,obesity,and hypertension.To date,the mechanism of COVID-19-related liver injury is not fully understood.Its pathophysiological basis can generally be explained by systemic inflammatory response,hypoxic damage,ischemia-reperfusion injury,and drug side effects.In this review,we systematically summarize the existing literature on liver injury caused by COVID-19,including clinical features,underlying mechanisms,and potential risk factors.Finally,we discuss clinical management and provide recommendations for the care of patients with liver injury.

Clinical features and prognostic factors in 49 patients with follicular lymphoma at a single center:A retrospective analysis

BACKGROUND Follicular lymphoma(FL)is a type of B-cell lymphoma that originates at the germinal center and has a low malignancy rate.FL has become the most common inert lymphoma in Europe and America but has a relatively low incidence in Asia.AIM To explore the clinical features,curative effects,and prognostic factors of FL.METHODS Completed medical records of 49 patients with FL who were admitted to the Ningbo First Hospital from June 2010 to June 2021 were examined.These patients were definitively diagnosed by pathological biopsy or immunohistochemical staining.The diagnostic criteria were based on the 2008 World Health Organization classification of lymphomas.Ann Arbor staging was performed according to the imaging and bone marrow examination results.Risk stratification of all patients was performed based on the International Prognostic Index(IPI),age-adjusted IPI,Follicular Lymphoma International Prognosis Index(FLIPI),and FLIPI2 to compare the efficacy of different treatment regimens and analyze the related prognostic factors.RESULTS The age of onset in patients ranged from 24 to 76 years,with a median age of 51 years.Most patients developed the disease at 40–59 years of age,and the male:female ratio was 1.6:1.No significant difference was noted in the curative effect between the non-chemotherapy,combined chemotherapy,and other chemotherapy regimens(P>0.05).Hemoglobin(Hb)level<120 g/L,Ki-67 value>50%,bone marrow involvement,and clinical stagesⅢ–IV were associated with a poor prognosis of FL(P<0.05).However,the influence of other indicators was not statistically significant.Risk grouping was performed using the FLIPI,and the results showed that 24.5%,40.8%,and 34.7%of patients were in the low-,moderate-,and high-risk groups,respectively.According to the survival analysis results,the survival rate of patients was lower in the high-risk group than in the other low-risk and moderate-risk groups(P<0.05).CONCLUSION FL mainly occurs in middle-aged and elderly men,primarily affecting lymph nodes and bone marrow.Hb level,Ki-67 value,bone marrow involvement,and clinical staging were used to evaluate prognosis.

Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma

AIM:To explore the relationship between α-fetoprotein(AFP) and various clinicopathological variables and different staging system of hepatocellular carcinoma(HCC) thoroughly.METHODS:A retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and December 2009 in West China Hospital was enrolled in our study.The association of serum AFP values with the HCC clinicopathological features was analysed by univariate and multivariate analysis,such as status of hepatitis B virus(HBV) infection,tumor size,tumor number,vascular invasion and degree of tumor differentiation.Also,patients were divided into four groups at the time of enrollment according to different cutoff values for serum value of AFP(≤ 20 μg/L,21-400 μg/L,401-800 μg/L,and ≥ 801 μg/L),to compare the positive rate of patient among four groups stratified by various clinicopathological variables.And the correlation of different kinds of tumor staging systems,such as TNM,Barcelona Clinic Liver Cancer(BCLC) staging classification and China staging,were compared with the serum concentration of AFP.RESULTS:A total of 2304 HCC patients were enrolled in this study totally;the mean serum level of AFP was 555.3 ± 546.6 μg/L.AFP levels were within the normal range(< 20 μg/L) in 27.4%(n = 631) of all the cases.81.4%(n = 1875) patients were infected with HBV,and those patients had much higher serum AFP level compared with non-HBV infection ones(573.9 ± 547.7 μg/L vs 398.4 ± 522.3 μg/L,P < 0.001).The AFP level in tumors ≥ 10 cm(808.4 ± 529.2 μg/L) was significantly higher(P < 0.001) than those with tumor size 5-10 cm(499.5 ± 536.4 μg/L) and with tumor size ≤ 5 cm(444.9 ± 514.2 μg/L).AFP levels increased significantly in patients with vascular invasion(694.1 ± 546.9 μg/L vs 502.1 ± 543.1 μg/L,P < 0.001).Patients with low tumor cell differentiation(559.2 ± 545.7 μg/L) had the significantly(P = 0.007) highest AFP level compared with high differentiation(207.3 ± 420.8 μg/L) and intermediate differentiation(527.9 ± 538.4 μg/L).In the multiple variables analysis,low tumor cell differentiation [OR 6.362,95%CI:2.891-15.382,P = 0.006] and tumor size(≥ 10 cm)(OR 5.215,95%CI:1.426-13.151,P = 0.012) were independent predictors of elevated AFP concentrations(AFP > 400 μg/L).Serum AFP levels differed significantly(P < 0.001) in the D stage of BCLC(625.7 ± 529.8 μg/L) compared with stage A(506.2 ± 537.4 μg/L) and B(590.1 ± 551.1 μg/L).CONCLUSION:HCC differentiation,size and vascular invasion have strong relationships with AFP,poor differentiation and HCC size ≥ 10 cm are independent predictors of elevated AFP.BCLC shows better relationship with

Relationship between autophagy and perineural invasion, clinicopathological features, and prognosis in pancreatic cancer

AIM To investigate the relationship between autophagy and perineural invasion(PNI), clinical features, and prognosis in patients with pancreatic cancer. METHODS Clinical and pathological data were retrospectively collected from 109 patients with pancreatic ductal adenocarcinoma who underwent radical resection at the First Affiliated Hospital of Zhengzhou University from January 2011 to August 2016. Expression levels of the autophagy-related protein microtubuleassociated protein 1 A/1 B-light chain 3(LC3) and PNI marker ubiquitin carboxy-terminal hydrolase(UCH) in pancreatic cancer tissues were detected by immunohistochemistry. The correlations among LC3 expression, PNI, and clinical pathological features in pancreatic cancer were analyzed. The patients were followed for further survival analysis. RESULTS In 109 cases of pancreatic cancer, 68.8%(75/109) had evidence of PNI and 61.5%(67/109) had high LC3 expression. PNI was associated with lymph node metastasis, pancreatitis, and CA19-9 levels(P < 0.05). LC3 expression was related to lymph node metastasis(P < 0.05) and was positively correlated with neural invasion(P < 0.05, r = 0.227). Multivariate logistic regression analysis indicated that LC3 expression, lymph node metastasis, pancreatitis, and CA19-9 level were factors that influenced neural invasion, whereas only neural invasion itself was an independent factor for high LC3 expression. Univariate analysis showed that LC3 expression, neural invasion, and CA19-9 level were related to the overall survival of pancreatic cancer patients(P < 0.05). Multivariate COX regression analysis indicated that PNI and LC3 expression were independent risk factors for poor prognosis in pancreatic cancer(P < 0.05). CONCLUSION PNI in patients with pancreatic cancer is positively related to autophagy. Neural invasion and LC3 expression are independent risk factors for pancreatic cancer with a poor prognosis.

Clinicopathologic features of remnant gastric cancer over time following distal gastrectomy

AIM: To investigate remnant gastric cancer(RGC) at various times after gastrectomy, and lay a foundation for the management of RGC.METHODS: Sixty-five patients with RGC > 2 years and< 10 years after gastrectomy(RGC Ⅰ) and forty-nine with RGC > 10 years after gastrectomy(RGC Ⅱ) who underwent curative surgery were enrolled in the study.The clinicopathologic factors, surgical outcomes, and prognosis were compared between RGC Ⅰ and RGC Ⅱ.RESULTS: There was no significant difference in surgical outcomes between RGC Ⅰ and RGC Ⅱ. For patients reconstructed with Billroth Ⅱ, significantly more patients were RGC Ⅱ compared with RGC(71.9%vs 21.2%, P < 0.001), and more RGC Ⅱ patients had anastomotic site locations compared to RGC Ⅰ(31.0%vs 56.3%, P = 0.038). The five-year survival rates for the patients with RGC Ⅰ and RGC Ⅱ were 37.6%and 47.9%, respectively, but no significant difference was observed. Borrmann type and tumor stage were confirmed to be independent prognostic factors in both groups.CONCLUSION: RGC Ⅱ is located on the anastomotic site in higher frequency and more cases develop after Billroth Ⅱ reconstruction than RGC Ⅰ.

Clinicopathological Features of Renal Amyloidosis: A Single-center Study on 47 Cases

The correlations between the clinicopathological features and the long-term outcomes of renal amyloidosis（RA） were analyzed with a view to develop strategies for improving diagnosis and prognosis of RA. We retrospectively reviewed the clinicopathological characteristics of 47 patients diagnosed with RA between 2004 and 2014 at the Wuhan Union Hospital. The data on the renal histology, clinical manifestations, and prognosis of RA patients were retrieved from the hospital records and characteristic patterns were identified. The histological changes in the kidneys were correlated with the clinical manifestations of RA. Additionally, most RA patients in this study had decreased serum levels of κ light chain and increased urine levels of κ and λ light chains as well as presence of M-protein in the urine and serum. Patients with early RA showed no specific pathognomonic symptoms. Bleeding associated with diagnostic renal biopsy was rare. We recommend that the routine work-up of patients aged over 40 years and presenting with non-diabetic nephropathy includes the non-invasive tests for the measurement of serum and urine levels of κ and λ light chains as well as protein electrophoresis tests for the presence of urinary and serum M-protein. Additionally, such patients should undergo renal biopsy screening with Cong-red staining to ensure early diagnosis of RA and improve their survival, since the risk of hemorrhage related to renal biopsy screening is low at early stages of RA.

Clinicopathological Features of Non-familial Colorectal Cancer with High-frequency Microsatellite Instability

Objective To explore the clinicopathological features of non-familial colorectal cancer with high-frequency microsatellite instability (MSI-H). Methods One hundred and fifty patients with colorectal cancer who had no family history were enrolled in this study from June 2006 to June 2008. Five standard microsatellite loci including BAT25, BAT26, D2S123, D5S346, and D17S250 were amplified with immunofluorescent polymerase chain reaction. The patient information including age, sex, and tumor location was recorded. Pathological features including differentiation, mucinous differentiation, histological heterogeneity, and Crohn's-like reaction were observed under light microscope. The presence of tumor-infiltrating lymphocytes (TLs, CD4+ and CD8+) was detected by means of immunohistochemistry. A regression equation was obtained by stepwise logistic regression analysis to evaluate the relationship between MSI-H phenotype in colorectal cancer ands pathological features. Results MSI-H phenotype occurred in 13.33% of the 150 patients with non-familial colorectal cancer. Poor differentiation, histological heterogeneity, Crohn's-like reaction, and presence of TLs were found to be independent factors to identify MSI-H non-familial colorectal cancer. Logistic regression equation showed an overall sensitivity of 70.0%, specificity of 99.2%, and accuracy of 95.3% in identifying MSI-H non-familial colorectal cancer. Conclusion MSI-H non-familial colorectal cancer manifests specific pathological features, which may be relied upon for effective identification of that disease.

Clinic pathological features and prognosis of metaplastic breast carcinoma

Objective:To investigate clinic pathological peculiarities and evaluate the prognosis of metaplastic breast carcinoma.Methods:Patients with metaplastic breast carcinoma at the First Affiliated Hospital of Zhejiang University and Guangxing Hospital Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from 2008 to 2013 were retrospectively selected.Results:A total of 73 female patients were reviewed,including 41 cases of purely epithelial type and 32 cases of mixed epithelial and mesenchymal type.Median tumor size was 4.6cm.Forty-three patients(58.8%)presented with lymph node metastasis,84.9%of cases were in advanced TNM stage,and 60.2%of cases were overexpressed by Ki-67.At a median follow-up of 59 months,median overall survival and disease-free survival were 59.7 and 43.9 months,respectively.Five-year overall survival rate was 45.2%and disease-free survival rate was 30.1%,and 76.7%of patients had recurrence or metastasis.Univariate analysis showed that tumor size,lymph node,and radiotherapy were associated with overall survival and disease-free survival(P<0.05),while Ki-67 over-expression was correlated with overall survival(P<0.05).With multivariate analysis,tumor size,lymph node,and radiotherapy affected prognosis(P<0.05);however,pathological typing was not an independent prognostic factor(P>0.05).Conclusion:Metaplastic breast carcinoma is a rare malignant tumor with large tumor,high lymph node metastasis rate,staging relatively late,high local recurrence and distant metastasis rate.The treatment follows the principle of comprehensive treatment based on surgery,but the prognosis is poor.Tumor size,lymph node,and radiotherapy treatment affect the prognosis.Overexpression of Ki-67 can be used as a potential diagnostic,therapeutic and prognostic indicator for metaplastic breast cancer.

Analysis of the Clinicopathologic Features and Prognosis in Triple-Negative Breast Cancer

OBJECTIVE To investigate the clinical and pathological features,as well as prognosis in triple-negative breast cancer patients.METHODS A total of 509 cases of operable breast cancer from January,2002 to June,2002 treated in the Cancer Hospital of Tianjin Medical University were analyzed.The Her-2,ER and PR status was determined using immunohistochemistry.Of the total cases,one group was identifi ed as triple negative breast cancer,ie defi ned as ER,PR and Her-2 negative.The other group was non-triple-negative breast cancer.Clinicopathologic features of the groups were compared and 5-year disease-free survival(DFS) analyzed by the Kaplan-Meier method.RESULTS Of the total cases,21.4%(109/509) of cases were found to be triple-negative while 78.6%(400/509) were non-triple-negative.The triple negative group had higher incidence rates than the non-triple-negative group of the medullary type and Grade Ⅲ tumors(P < 0.05).There was no other difference in the clinicopathologic features between the 2 groups.From follow-up to June,2007,21.1%(23/109) of the triple-negative group and 12.7%(51/400) of the non-triple negative group had a local recurrence or distant metastasis,resulting in a signifi cant difference(P < 0.05).In the triple-negative group and non-triple-negative group,5-year DFS were 78.9% and 87.3% respectively.There was a statistically signifi cant difference between the 2 groups(P = 0.031).CONCLUSION Compared with non-triple-negative breast cancer,triple-negative breast cancer patients have an increased likehood of a local recurrence or distant metastasis and a poorer prognosis.

Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.