Differentiation between dysplastic nodule and early-stage hepatocellular carcinoma: The utility of conventional MR imaging

AIM:To elucidate the variety of ways early-stage hepatocellular carcinoma(HCC)can appear on magnetic resonance(MR)imaging by analyzing T1-weighted,T2-weighted,and gadolinium-enhanced dynamic studies.METHODS:Seventy-three patients with well-differentiated HCC(wHCC)or dysplastic nodules were retrospectively identified from medical records,and new histological sections were prepared and reviewed.The tumor nodules were categorized into three groups:dysplastic nodule(DN),wHCC compatible with Edmondson-Steiner grade I HCC(w1-HCC),and wHCC compatible with Edmondson-Steiner gradeⅡHCC(w2-HCC).The signal intensity on pre-contrast MR imaging and the enhancing pattern for each tumor were recorded and compared between the three tumor groups.RESULTS:Among the 73 patients,14 were diagnosed as having DN,40 were diagnosed as having w1-HCC,and 19 were diagnosed as having w2-HCC.Hyperintensity measurements on T2-weighted axial images(T2WI)were statistically significant between DNs and wHCC(P=0.006)and between DN and w1-HCC(P=0.02).The other imaging features revealed no significant differences between DN and wHCC or between DN and w1-HCC.Hyperintensity on both T1W out-phase imaging(P=0.007)and arterial enhancement on dynamic study(P=0.005)showed statistically significant differences between w1-HCC and w2-HCC.The other imaging features revealed no significant differences between w1-HCC and w2-HCC.CONCLUSION:In the follow-up for a cirrhotic nodule,increased signal intensity on T2WI may be a sign of malignant transformation.Furthermore,a noted loss of hyperintensity on T1WI and the detection of arterial enhancement might indicate further progression of the histological grade.

CHARACTERISTICS OF MUCINS AND CEA IN GLOBOID DYSPLASTIC CELLS OF HUMAN STOMACH AND ITS RELATIONSHIP WITH SIGNET RING CELL CARCINOMA

Fourty-three cases of globoid dysplasia and signet ring cell carcinoma were stained by mucin and CEA (ABC method). It was found that there were three kinds of mucins (neutral, sialo and sulphomucin in both globoid dysplastic cells and signet ring cells. The percentages of the three kinds of mucins seen in the two kinds of cells were not much different. It was indicated that the altered mucins in the gastric epithelial cells must be a sign of dedifferentiation of the cells and the results of malfunction. The globoid dysplasia type I mainly contained neutral mucin, whereas type II, the acid mucin was predominant, especially the sulphomucin. The CEA positive reaction became stronger as the atypia being remarkable, and the characteristics of distribution of CEA positive particles were similar in the two kinds of cells namely, randomly or disorderly in the cells. Based on the analysis of the results, a conclusion can be made that the variety of mucins in globoid dysplastic cells can be used as a reference point in classification and is not much significant in grading, but the amount of CEA positive matter can be a reference point in grading. The globoid dysplasia is such a lesion with special features in morphology and function manifested in the process of de-differentiation towards signet ring cell carcinoma following the successive action of carcinogens upon the cells of gastric epithelium.

Dysplastic Gangliocytoma: A Rare Example of Cerebellar Tumor with An Evident Genetic Profile (Cowden Syndrome)

Objective: To describe the histological and immunohistochemical findings observed when studying a dysplastic cerebellar gangliocytoma observed in a 33-year-old man with a history of Thyroid Cancer. Material and Methods: Radiological images (MRI) and histological and immunohistochemical preparations obtained from the cerebellar tissue were received in our laboratory. Results: A neoplasm constituted by aberrant-looking mature neurons was observed that showed negativity for the immunohistochemical markers of the PTEN protein, expression of the activity of the PTEN gene. Conclusions: Verify the diagnosis of a rare entity, clearly related in scientific publications with Cowden’s Syndrome.

Acute Hydrocephalus Revealing Unusual Cerebellar Mass: Dysplastic Cerebellar Gangliocytoma or Lhermitte-Duclos Disease (LDD)

Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the cerebellum is a rare benign lesion of uncertain pathogenesis characterized by overgrowth of cerebellar ganglion cells which replace granular cells and Purkinje cells;this results in gross thickening of the cerebellar folia. It is revealed by symptoms of raised intracranial pressure, cerebellar impairment and obstructive hydrocephalus. We reported the case of a 41-year-old male who presented with symptoms of acute raised intracranial pressure. Brain computed tomography (CT) scan revealed hydrocephalus due to compression of the 4th ventricle by a large non-enhancing left cerebellar mass. Magnetic resonance imaging (MRI) showed a space-occupying lesion within the left cerebellar hemisphere with unusual striation. Radical surgery was retained though the margins with normal cerebellar tissue were not distinct. Clinical complications after gross total or partial removal of Lhermitte-Duclos lesions have been rarely reported in the literature;herein we stress the importance of extreme caution in removing these lesions in cerebellar areas that have no distinct margins between the lesion and normal tissue.

Cotyloidplasty in acetabular reconstruction for dysplastic hips

To introduce the osteotomy of acetabular medial wall as a technique to facilitate anatomical implantation and secure fit of acetabular cups for dysplastic hips.Methods Eighteen hip replacements were performed with use of an osteotomy of acetabular medial wall to stabilize the cups in 17 dysplastic patients.The patients were aged from 35～70 years,with an average of 51.4 year.Among all the dysplastic hips,4 were of type Ⅰ,7 of type Ⅱ,4 of type Ⅲ,and 3 of type Ⅳ according to the Crowe criteria.A Ranawat triangle was drawn on the X-ray film,and a supposed optimal rotating center was located.Both of the horizontal and vertical distances between femoral head and supposed rotating center was decreased significantly after operation.Results With medial wall osteotomy,all the acetabular components were placed in the true acetabulum.The diameters of the implanted cups were 44～56 mm with an average of 50.78 mm.Medial bony wall was preserved with an average thickness of 9.5 mm.The horizontal distance was 21.09 mm(12～40 mm) preoperatively and 3.73 mm(-3～10.1 mm)postoperatively,there was statistical difference (t=7.95,P<0.01);whereas the vertical distance was 15.39 mm(5～32 mm)preoperatively and 4.98 mm(-18～26.3 mm)postoperatively,there was also statistical difference (t=3.42,P<0.01).13 acetabular cups were implanted with the medial aspect of their dome beyond the Kohler line.In the cases followed-up more than 3 months,the osteomized site all achieved bony union.Conclusion The medial wall osteotomy technique is a predictable,reproducible procedure for optimal rotating center reconstruction and it may obtain fixation of an uncemented hemispheric acetabular component in a dysplastic hip.11 refs,3 figs.

Somatic mutations predict prognosis in myelodysplastic syndrome patients with normal karyotypes

Dear Editor,Myelodysplastic syndromes(MDSs)are a group of clonal myeloid stem cell disorders characterized by varying degrees of cytopenias,cytogenetic and molecular genetic abnormalities,and a predisposition to acute myeloid leukemia(AML).The treatments for MDS mainly consist of cytoreductive treatment,such as traditional AML-like chemotherapy,hypomethylating agents(HMAs),allogeneic hematopoietic stem cell transplantation(alio-HSCT)and immunoregulation according to risk stratification.

GDF11 level in patients with myelodysplastic syndrome and is clinical significance

Objective To detect the expression level of growth differentiation factor 11(GDF11)in patients with myelodysplastic syndrome(MDS),and to evaluate the relationship between GDF11 level and erythropoiesis functions.Methods A total of 44 MDS patients(18 low-risk group patients and 26 high-risk group patients)in the Department of Hematology in Tianjin Medical

Identifying sex-specific injury predictors as a key factor in maintaining optimal physical activity levels

BACKGROUND Optimal physical activity is known to reduce cardiovascular,respiratory and endocrine system diseases and,as a consequence,improve quality of life.An important risk factor for reinjuries during normal exercise is the initial connective tissue pathology.The variety of clinical dysplastic manifestations significantly complicate the timely diagnosis of this comorbidity.AIM To establish pathognomonic sex-specific dysplasia phenotypes that indicate a particular sensitivity to physical exertion.METHODS The study involved 117 participants with recurrent musculoskeletal injuries that occurred during normal exercise.There were 67 women(57.26%)and 50 men(42.74%),which made it possible to compare the presence of the identified signs between sexes.A validated questionnaire was used to screen their connective tissue status.RESULTS Ranking the most commonly revealed dysplasia signs depending on their clinical significance made it possible to establish pathognomonic sex-specific phenotypes that indicated a particular susceptibility to injuries.Individualized programs of optimal physical activity are necessary for men with chest deformities,flat-valgus feet,dolichostenomelia,arachnodactylia,hemorrhoids,abdominal muscle diastasis and recurrent hernias.In women,special sensitivity to physical exertion was associated with a combination of signs such as asthenic body,joint hypermobility,overly soft auricles,thin hyperelastic skin,atrophic striae,telangiectasias and varicose veins.Of particular importance were universal signs such as gothic palate,scoliosis,kyphosis,leg deformities,temporomandibular joint crunching,and moderate to high myopia.CONCLUSION Participants’connective tissue condition should be considered when designing optimal physical activity programs.Identifying the established sex-specific dysplasia phenotypes will allow timely optimization of training loads,thus reducing the risk of injury.

小脑发育不良性神经节细胞瘤合并脑积水1例并文献复习

小脑发育不良性神经节细胞瘤（dysplastic cerebellar gangliocytoma）又称Lhermitte-Duclos病（Lhermitte-Duclos disease,LDD）是一种罕见的小脑占位性病变,国内外报道均较少。在神经影像学发展之前,LDD很难被正确的诊断并进行及时的治疗,

假性Kaposi肉瘤

假性Kaposi肉瘤(Pseudo-Kaposi’s Sarcoma以下简称PKS)是1974年Earhari等命名的,具有与Kaposi肉瘤相似皮损的动静脉瘘的一种疾病。本病在60～70年代的皮肤科文献上曾应用过多种病名,如皮肤及其下组织的先天性发育不良性血管病(Congenital dysplastic angiopathy of the skin and underlying tissue);足部肢端血管性皮炎(Acroangiodermatitis of the foot);

简介肝癌的综合防治

肝脏是人体最大的实质性器官,行使着消化、代谢、储存、贮血、解毒等重要的生理功能,并直接参与调节物质代谢、人体免疫、防卫、凝血等机制。随着环境等因素的改变,肝脏肿瘤的发病率呈上升趋势,其中,原发性肝癌已超过62.6万/年,居于恶性肿瘤的第五位,死亡接近60万/年,位居肿瘤相关死亡的第三位。目前,我国原发性肝癌患者数约占全球的55%,在肿瘤相关死亡中仅次于肺癌,位居第二。以往,人们认为肝癌难以早期发现,治疗效果又不佳,影视作品中对肝癌患者疼痛难忍的痛苦演绎更是让人谈癌色变。

Latest developments in precancerous lesions of hepatocellular carcinoma

Hepatocarcinogenesis in human chronic liver diseases is a multi-step process in which hepatic precancerous lesions progress into early hepatocellular carcinoma(HCC) and progressed HCC, and the close surveillance and treatment of these lesions will help improve the survival rates of patients with HCC. The rapid development and extensive application of imaging technology have facilitated the discovery of nodular lesions of ambiguous significance, such as dysplastic nodules. Further investigations showed that these nodules may be hepatic precancerous lesions, and they often appear in patients with liver cirrhosis. Although the morphology of these nodules is not sufficient to support a diagnosis of malignant tumor, these nodules are closely correlated with the occurrence of HCC, as indicated by long-term follow-up studies. In recent years, the rapid development and wide application of pathology, molecular genetics and imaging technology have elucidated the characteristics of precancerous lesions. Based on our extensive review of the relevant literature, this article focuses on evidence indicating that high-grade dysplastic nodules are more likely to transform into HCC than low-grade dysplastic nodules based on clinical, pathological, molecular genetic and radiological assessments. In addition, evidence supporting the precancerous nature of large cell change in hepatitis B virus-related HCC is discussed.

Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.

Magnetic resonance imaging of the cirrhotic liver: An update

Noninvasive imaging has become the standard for hepatocellular carcinoma(HCC) diagnosis in cirrhotic livers. In this review paper, we go over the basics of MR imaging in cirrhotic livers and describe the imaging appearance of a spectrum of hepatic nodules marking the progression from regenerative nodules to low- and high-grade dysplastic nodules, and ultimately to HCCs. We detail and illustrate the typical imaging appearancesof different types of HCC including focal, multifocal, massive, diffuse/infiltrative, and intra-hepatic metastases; with emphasis on the diagnostic value of MR in imaging these lesions. We also shed some light on liver imaging reporting and data system, and the role of different magnetic resonance imaging(MRI) contrast agents and future MRI techniques including the use of advanced MR pulse sequences and utilization of hepatocyte-specific MRI contrast agents, and how they might contribute to improving the diagnostic performance of MRI in early stage HCC diagnosis.

Awareness, knowledge, and attitudes towards sun protection among patients with melanoma and atypical mole syndrome

BACKGROUND Patients with atypical mole syndrome(AMS)have a 3-to 20-fold higher risk of developing malignant melanoma(MM)than individuals without.The most modifiable risk factor for developing MM is the ongoing ultraviolet exposure.AIM To assess awareness,knowledge,and attitudes towards sun protection among patients with MM and AMS.METHODS From January 2020 till December 2021,a written survey was administered to patients with MM and AMS and a control group who attended a specialist mole clinic at the Dermatology Department of the University Hospital of Heraklion in Heraklion,Crete,Greece.Demographic data and photoprotective practices,knowledge,and perceived barriers were collected.Relevant statistical analyses were performed using SPSS IBM 25.RESULTS In total,121 subjects consented and participated in the survey.Their mean age was 43.92±12.55 years.There were 66(54.4%)females and 55(45.4%)males.Forty-seven(38.8%)patients had AMS,26(21.5%)had a past medical history of MM,and 48(39.7%)attended the clinic for a full skin checkup for their naevi without having AMS or MM.Although 104(86%)participants reported using sunscreen with the majority of them(59/121=48.8%)wearing sunscreen with a sun protection factor of>50,only 22(18.2%)patients did so every day and only 20(16.5%)all year round.Approximately 74.4%of patients recalled having received advice on how to protect their skin from sunlight,and 73%were interested in receiving education about sun protection.The most mentioned barriers in photoprotection were concerns over adequate vitamin D and lack of time.CONCLUSION Despite mentioning having received adequate education in photoprotection,adherence to photoprotection practices is suboptimal in patients with MM and AMS.

Postnatal management of antenatally detected hydronephrosis

With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.

Other hemopoitic disorders

920729 DNA repair in patients with myelo-dysplastic syndrome. CHENG Yuandong(程远东), XI Yuren(席雨人). Hematol ResDiv, Henan Med Univ, Zhengzhou. Chin J He-matol 1992; 13(8): 393-394. VNA repair was studied in peripheral

Liver carcinogenesis: diagnostic and clinical aspects of preneoplastic nodules

In multistep hepatocarcinogenesis,sizable lesions can precede the development of hepatocellular carcinoma(HCC).These lesions are currently classified as low grade(LG)-and high grade(HG)-dysplastic nodules.Following international guidelines recommending the surveillance of cirrhotic patients,a growing number of 1-2 cm hepatocellular nodules are recognized including early hepatocellular carcinoma(eHCC)and DN the latter accounting for as many as 70%of nodules<1 cm.HG-DN are currently considered the most advanced HCC precursors.The histological diagnosis of low-grade dysplastic nodule(LG-DN),high-grade dysplastic nodule(HG-DN)and eHCC in small liver biopsies requires a comprehensive stepwise morphological and immunocytochemical approach.By imaging the differential diagnosis among these lesions is a challenge.According to vascular enhancement at dynamic computed tomography(CT)or magnetic resonance imaging(MRI)these precursors are classified as hypo-vascular/indeterminate nodules even though distinction between LG-DN and HG-DN is almost impossible.The introduction of gadoexetic acid-enhanced MRI has represented an extremely important advance in this field allowing a better differentiation of dysplastic lesions from eHCC and progressed HCC.Additional MRI features as diffusion-weighted imaging further improved diagnostic accuracy of imaging.According to Liver Imaging Reporting and Data System(LI-RADS),either CT/MRI or Contrast-Enhanced Ultrasound LI-RADS,the dysplastic lesions should be categorized as LR-3 or LR-4.Natural history of these lesions confirmed that HCC can develop from HG-DN but which nodule and when it will undergo malignant transformation is not predictable.The search and validation of radiological and tissue markers able to select lesions more prone to HCC development,is currently underway.Whether and how HG-DN should be ablated or closely followed up is currently debated.

Magnetic resonance imaging findings in Lhermitte-Duclos disease:reports of three cases

Lhermitte-Duclos disease （LDD）, or dysplastic gangliocytoma of the cerebellum, is a rarehamartomatous lesion characterized by a slowly enlarging mass within the cerebellar cortex. The disease reveals unique appearance on magnetic resonance imaging （MRI）. Recognition of the imaging features makes the correct diagnosis possible even without a pathological examination. Three cases are presented and analyzed in this report.

飞行员多囊肾、多囊肝一例

一、临床资料 患者,男,35岁,米-17飞行员,飞行时间4000 h.于2012年4月5日因右侧间断性腰痛1周,加重1d入院.患者曾于2006年因胆囊结石住院期间体检发现多囊肾、多囊肝;其祖父患有多囊肾病史.并于2011年12月2日因体检发现双肾结石2周,入解放军第四五二医院治疗.患者入院查体:腹平,全腹柔软,无压痛及肌紧张,双侧肾区稍叩击痛,输尿管走行区无压痛,膀胱区无膨隆,无压痛.B超检查示:右肾积液,右输尿管上段扩张,双肾结石.中下腹CT示:右肾小结石,右输尿管上段小结石,多囊肝、多囊肾.静脉肾盂造影结果示:双肾功能良好,肝、肾功能正常.诊断:右输尿管结石,双肾结石,多囊肾,多囊肝.治疗上给予多饮水,适当活动,联合给予抗感染、解痉、利尿等对症治疗,于2012年4月19日经尿道排出结石1枚,长径约0.5 cm.