BACKGROUND Mucosal adenocarcinoma of the descending duodenum is a very rare gastroin-testinal tumor.Due to its low incidence,it has rarely been the focus of clinical and pathological studies.The clinical manifestation...BACKGROUND Mucosal adenocarcinoma of the descending duodenum is a very rare gastroin-testinal tumor.Due to its low incidence,it has rarely been the focus of clinical and pathological studies.The clinical manifestations of these tumors are usually nonspecific,and they are easily misdiagnosed or missed.Pathological diagnosis is the gold standard for diagnosis,but due to the small number of cases,the relevant pathological characteristics and diagnostic criteria are not completely clear.The purpose of this study was to deepen the understanding of the diagnosis and treatment of this disease and to provide a clinical guidance.CASE SUMMARY A 61-year-old woman who was hospitalized with recurrent abdominal pain for more than 20 days.The patient developed epigastric pain with no obvious cause more than 20 days prior,mainly left epigastric pain and middle epigastric pain,and presented persistent dull pain without nausea or vomiting,fever or chills.The patient was treated at a local hospital,gastroscopy revealed a new lesion in the circum-intestinal cavity in the descending part of the duodenum,and pathological biopsy revealed mucous adenocarcinoma in the descending part of the duode-num.Currently,for further diagnosis and treatment,the patient is admitted to our hospital for surgical treatment for“malignant tumor of the duodenum”in the outpatient department.CONCLUSION Mucosal adenocarcinoma of the descending duodenum has a high misdiagnosis rate and missed diagnosis rate,clinical manifestations lack specificity,and pathological diagnosis is the main basis for diagnosis.展开更多
BACKGROUND Gallbladder neuroendocrine carcinoma(GB-NEC)has a low incidence rate;therefore,its clinical characteristics,diagnosis,treatment and prognosis are not well explored.AIM To review recent research and analyze ...BACKGROUND Gallbladder neuroendocrine carcinoma(GB-NEC)has a low incidence rate;therefore,its clinical characteristics,diagnosis,treatment and prognosis are not well explored.AIM To review recent research and analyze corresponding data in the Surveillance Epidemiology and End Results(SEER)database.METHODS Data of GB-NEC(n=287)and gallbladder adenocarcinoma(GB-ADC)(n=19484)patients from 1975 to 2016 were extracted from the SEER database.Survival analysis was performed using Kaplan–Meier and Cox proportional hazards regression.P<0.05 was considered statistically significant.We also reviewed 108 studies retrieved from PubMed and Reference Citation Analysis(https://www.referencecitationanalysis.com/).The keywords used for the search were:"(Carcinoma,Neuroendocrine)AND(Gallbladder Neoplasms)".RESULTS The GB-NEC incidence rate was 1.6%(of all gallbladder carcinomas),male to female ratio was 1:2 and the median survival time was 7 mo.The 1-,2-,3-and 5-year overall survival(OS)was 36.6%,17.8%,13.2%and 7.3%respectively.Serum chromogranin A levels may be a specific tumor marker for the diagnosis of GBNEC.Elevated carcinoembryonic antigen,carbohydrate antigen(CA)-19-9 and CA-125 levels were associated with poor prognosis.Age[hazard ratio(HR)=1.027,95%confidence interval(CI):1.006–1.047,P=0.01]and liver metastasis(HR=3.055,95%CI:1.839–5.075,P<0.001)are independent prognostic risk factors for OS.Patients with advanced GB-NEC treated with surgical resection combined with radiotherapy and/or chemotherapy may have a better prognosis than those treated with surgical resection alone.There was no significant difference in OS between GB-NEC and GB-ADC.CONCLUSION The clinical manifestations and prognosis of GB-NEC are similar to GB-ADC,but the treatment is completely different.Early diagnosis and treatment are the top priorities.展开更多
Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a unique type of liver tumor that contains both hepatocellular carcinoma and cholangiocarcinoma components within a single tumor.The fifth edition of the World He...Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a unique type of liver tumor that contains both hepatocellular carcinoma and cholangiocarcinoma components within a single tumor.The fifth edition of the World Health Organization classification provides a definition and diagnostic criteria for cHCC-CCA.However,the heterogeneous histomorphology and presentation resulting from variation of the proportion of each component poses challenges for clinical diagnosis and treatment.A diagnosis of cHCC-CCA may be suggested by the synchronous elevation of serum tumor markers for hepatocellular carcinoma and cholangiocarcinoma,a mixed enhancement pattern on imaging,and a discrepancy between the elevation of tumor marker and the imaging enhancement pattern.Histopathological examination using hematoxylin and eosin staining is considered the gold standard for diagnosing cHCC-CCA,and comprehensive examination of resection or biopsy specimens is crucial for an accurate diagnosis.Currently,there is no standard treatment for cHCC-CCA,and surgery is the mainstay.Anatomic hepatectomy with lymphadenectomy is among the recommended surgical procedures.The role of liver transplantation in the management of cHCC-CCA is still uncertain.Transarterial chemoembolization may be effective for unresectable cHCC-CCA,particularly for hypervascular tumors.However,the available evidence does not support systemic therapy for advanced cHCC-CCA.The prognosis of cHCC-CCA is generally poor,and there is no established staging system.Further research is needed to better understand the histogenesis and clinical management of cHCC-CCA.This review provides an overview of the current literature on cHCC-CCA with a focus on its clinical characteristics,pathological diagnosis,and management.展开更多
Post-traumatic osteomyelitis(PTO)is a worldwide problem in the field of orthopaedic trauma.So far,there is no ideal treatment or consensus-based gold standard for its management.This paper reviews the representative l...Post-traumatic osteomyelitis(PTO)is a worldwide problem in the field of orthopaedic trauma.So far,there is no ideal treatment or consensus-based gold standard for its management.This paper reviews the representative literature focusing on PTO,mainly from the following four aspects:(1)the pathophysiological mechanism of PTO and the interaction mechanism between bacteria and the body,including fracture stress,different components of internal fixation devices,immune response,occurrence and development mechanisms of inflammation in PTO,as well as the occurrence and development mechanisms of PTO in skeletal system;(2)clinical classification,mainly the etiological classification,histological classification,anatomical classification and the newly proposed new classifications(a brief analysis of their scope and limitations);(3)imaging diagnosis,including non-invasive examination and invasive examination(this paper discusses their advantages and disadvantages respectively,and briefly compares the sensitivity and effectiveness of the current examinations);and(4)strategies,including antibiotic administration,surgical choices and other treatment programs.Based on the above-mentioned four aspects,we try to put forward some noteworthy sections,in order to make the existing opinions more specific.展开更多
BACKGROUND Pediatric-type follicular lymphoma(PTFL)is a unique pathological type in the 4th edition of hematopoiesis and lymphoid tissue tumor classification revised by World Health Organization.It is unique in clinic...BACKGROUND Pediatric-type follicular lymphoma(PTFL)is a unique pathological type in the 4th edition of hematopoiesis and lymphoid tissue tumor classification revised by World Health Organization.It is unique in clinical practice and seldom seen in adult.PTFL mainly occurs in the head and neck lymph nodes.Most of the cases are short of fever,night sweat,weight loss,and other B symptoms which substitute for lymphadenopathy as the main symptom.PTFL can be disposed of surgical resection and it can achieve long-term tumor-free survival,and it has an excellent outcome.CASE SUMMARY Two cases of PTFL were reported and their clinicopathological features,differential diagnosis,therapy and prognosis were discussed.PTFL showed graybrown tough texture in general performance.The histological manifestations of PTFL were similar to that of adult-follicular lymphoma(FL).Under low power microscope,the structure of lymph nodes was destroyed in different degree,the follicles were closely arranged,expanded and irregular,and the mantle zone became thin or disappeared.In addition,the“starry sky phenomenon”could be seen.At high magnification,the follicles were mainly composed of single medium-sized central cells,and some of them mainly consisted of centroblastic cells to characterize scattered chromatin and inconspicuous nucleoli.Immunohistochemical showed the tumor cells expressed CD20,PAX5,CD79a and CD10,BCL6,FOXP-1,which were limited in germinal center;Ki-67 was highly expressed in germinal center.CD21 and CD23 showed nodular and expanded follicular dendritic cells.Immunoglobulin gene rearrangement was positive for IGH and IGK.The two patients underwent surgical resection with no complications.After discharge,the two patients with a close review for 18 mo and 5 mo respectively and showed no evidence of recurrence.CONCLUSION PTFL in adult is generally supposed to be extremely rare.PTFL displayed characteristic morphological,immunophenotypic,and molecular biological changes which are a kind of neoplasm with satisfactory prognosis after surgical excision.展开更多
OBJECTIVE To investigate the clinical diagnosis and differential diagno- sis of synovial sarcoma (SS). METHODS A total of 41 paraffin-embedded synovial sarcoma samples were examined by H&E staining, immunohistoche...OBJECTIVE To investigate the clinical diagnosis and differential diagno- sis of synovial sarcoma (SS). METHODS A total of 41 paraffin-embedded synovial sarcoma samples were examined by H&E staining, immunohistochemistry staining and the re- verse transcriptase polymerase chain reaction (RT-PCR), in order to provide a scientific bases for diagnosis and differential diagnosis. RESULTS Twelve cases were a biphasic type, 22 cases were a mono- phasic fibrous type, and 7 cases were a poorly differentiated type. Thirty-six cases were both CK (and/or EMA) and Vim positive. Five cases were only Vim positive. A SYT-SSX fusion gene was detected in 18 cases by RT-PCR. CONCLUSION By observation of the histomorphology, immunohisto- chemistry markers and detection of a SYT-SSX fusion gene, we can make a clinical pathological diagnosis of synovial sarcoma.展开更多
目的观察卵巢-附件报告和数据系统超声2022版(O-RADS US v2022)及其联合恶性风险指数4(RMI4)鉴别附件良、恶性肿瘤的价值。方法回顾性分析126例手术病理诊断为附件肿瘤患者,根据O-RADS US v2022将1~3类归为良性病变、4~5类归为恶性病变,...目的观察卵巢-附件报告和数据系统超声2022版(O-RADS US v2022)及其联合恶性风险指数4(RMI4)鉴别附件良、恶性肿瘤的价值。方法回顾性分析126例手术病理诊断为附件肿瘤患者,根据O-RADS US v2022将1~3类归为良性病变、4~5类归为恶性病变,以450为RMI4分类的临界值,基于二者进行联合分类。以病理结果为金标准,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估单一O-RADS US v2022、RMI4及其联合鉴别附件良、恶性肿瘤的效能。结果126例附件肿瘤中,良性94例、恶性32例。O-RADS US v2022鉴别附件良、恶性肿瘤的敏感度、特异度、准确率及AUC分别为78.13%、80.85%和80.16%、0.795,RMI4分别为71.88%、84.04%和80.95%、0.780;二者联合的特异度及准确率(93.62%、92.06%)均高于单一O-RADS US v2022(χ^(2)=7.322、5.967,P=0.007、0.015)或RMI4(χ^(2)=4.625、5.331,P=0.032、0.021),而敏感度及AUC(87.50%、0.906)差异均无统计学意义(P均>0.05)。结论O-RADS US v2022能有效鉴别附件良、恶性肿瘤,联合RMI4可提高鉴别特异度及准确率。展开更多
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...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.展开更多
基金Supported by China Scholarship Council,No.202406210298the Scientific Research Project of the Education Department of Anhui Province,No.YJS20210324+1 种基金the Research and Development of Intelligent Surgical Navigation and Operating System for Precise Liver Resection,No.2022ZLA006the National Natural Science Foundation of China,No.81972829.
文摘BACKGROUND Mucosal adenocarcinoma of the descending duodenum is a very rare gastroin-testinal tumor.Due to its low incidence,it has rarely been the focus of clinical and pathological studies.The clinical manifestations of these tumors are usually nonspecific,and they are easily misdiagnosed or missed.Pathological diagnosis is the gold standard for diagnosis,but due to the small number of cases,the relevant pathological characteristics and diagnostic criteria are not completely clear.The purpose of this study was to deepen the understanding of the diagnosis and treatment of this disease and to provide a clinical guidance.CASE SUMMARY A 61-year-old woman who was hospitalized with recurrent abdominal pain for more than 20 days.The patient developed epigastric pain with no obvious cause more than 20 days prior,mainly left epigastric pain and middle epigastric pain,and presented persistent dull pain without nausea or vomiting,fever or chills.The patient was treated at a local hospital,gastroscopy revealed a new lesion in the circum-intestinal cavity in the descending part of the duodenum,and pathological biopsy revealed mucous adenocarcinoma in the descending part of the duode-num.Currently,for further diagnosis and treatment,the patient is admitted to our hospital for surgical treatment for“malignant tumor of the duodenum”in the outpatient department.CONCLUSION Mucosal adenocarcinoma of the descending duodenum has a high misdiagnosis rate and missed diagnosis rate,clinical manifestations lack specificity,and pathological diagnosis is the main basis for diagnosis.
文摘BACKGROUND Gallbladder neuroendocrine carcinoma(GB-NEC)has a low incidence rate;therefore,its clinical characteristics,diagnosis,treatment and prognosis are not well explored.AIM To review recent research and analyze corresponding data in the Surveillance Epidemiology and End Results(SEER)database.METHODS Data of GB-NEC(n=287)and gallbladder adenocarcinoma(GB-ADC)(n=19484)patients from 1975 to 2016 were extracted from the SEER database.Survival analysis was performed using Kaplan–Meier and Cox proportional hazards regression.P<0.05 was considered statistically significant.We also reviewed 108 studies retrieved from PubMed and Reference Citation Analysis(https://www.referencecitationanalysis.com/).The keywords used for the search were:"(Carcinoma,Neuroendocrine)AND(Gallbladder Neoplasms)".RESULTS The GB-NEC incidence rate was 1.6%(of all gallbladder carcinomas),male to female ratio was 1:2 and the median survival time was 7 mo.The 1-,2-,3-and 5-year overall survival(OS)was 36.6%,17.8%,13.2%and 7.3%respectively.Serum chromogranin A levels may be a specific tumor marker for the diagnosis of GBNEC.Elevated carcinoembryonic antigen,carbohydrate antigen(CA)-19-9 and CA-125 levels were associated with poor prognosis.Age[hazard ratio(HR)=1.027,95%confidence interval(CI):1.006–1.047,P=0.01]and liver metastasis(HR=3.055,95%CI:1.839–5.075,P<0.001)are independent prognostic risk factors for OS.Patients with advanced GB-NEC treated with surgical resection combined with radiotherapy and/or chemotherapy may have a better prognosis than those treated with surgical resection alone.There was no significant difference in OS between GB-NEC and GB-ADC.CONCLUSION The clinical manifestations and prognosis of GB-NEC are similar to GB-ADC,but the treatment is completely different.Early diagnosis and treatment are the top priorities.
文摘Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a unique type of liver tumor that contains both hepatocellular carcinoma and cholangiocarcinoma components within a single tumor.The fifth edition of the World Health Organization classification provides a definition and diagnostic criteria for cHCC-CCA.However,the heterogeneous histomorphology and presentation resulting from variation of the proportion of each component poses challenges for clinical diagnosis and treatment.A diagnosis of cHCC-CCA may be suggested by the synchronous elevation of serum tumor markers for hepatocellular carcinoma and cholangiocarcinoma,a mixed enhancement pattern on imaging,and a discrepancy between the elevation of tumor marker and the imaging enhancement pattern.Histopathological examination using hematoxylin and eosin staining is considered the gold standard for diagnosing cHCC-CCA,and comprehensive examination of resection or biopsy specimens is crucial for an accurate diagnosis.Currently,there is no standard treatment for cHCC-CCA,and surgery is the mainstay.Anatomic hepatectomy with lymphadenectomy is among the recommended surgical procedures.The role of liver transplantation in the management of cHCC-CCA is still uncertain.Transarterial chemoembolization may be effective for unresectable cHCC-CCA,particularly for hypervascular tumors.However,the available evidence does not support systemic therapy for advanced cHCC-CCA.The prognosis of cHCC-CCA is generally poor,and there is no established staging system.Further research is needed to better understand the histogenesis and clinical management of cHCC-CCA.This review provides an overview of the current literature on cHCC-CCA with a focus on its clinical characteristics,pathological diagnosis,and management.
基金supported by the National Natural Science Foundation of China(NSFC No.82060347)Innovative Research Projects for Postgraduates in Higher Education Institutions in Hainan Province(Hys2020-342)Youth Incubation Fund of the First Affiliated Hospital of Hainan Medical University(HYYFYPY202005)。
文摘Post-traumatic osteomyelitis(PTO)is a worldwide problem in the field of orthopaedic trauma.So far,there is no ideal treatment or consensus-based gold standard for its management.This paper reviews the representative literature focusing on PTO,mainly from the following four aspects:(1)the pathophysiological mechanism of PTO and the interaction mechanism between bacteria and the body,including fracture stress,different components of internal fixation devices,immune response,occurrence and development mechanisms of inflammation in PTO,as well as the occurrence and development mechanisms of PTO in skeletal system;(2)clinical classification,mainly the etiological classification,histological classification,anatomical classification and the newly proposed new classifications(a brief analysis of their scope and limitations);(3)imaging diagnosis,including non-invasive examination and invasive examination(this paper discusses their advantages and disadvantages respectively,and briefly compares the sensitivity and effectiveness of the current examinations);and(4)strategies,including antibiotic administration,surgical choices and other treatment programs.Based on the above-mentioned four aspects,we try to put forward some noteworthy sections,in order to make the existing opinions more specific.
基金Supported by the Special Fund of Hebei Provincial Finance Department,No.2016034942。
文摘BACKGROUND Pediatric-type follicular lymphoma(PTFL)is a unique pathological type in the 4th edition of hematopoiesis and lymphoid tissue tumor classification revised by World Health Organization.It is unique in clinical practice and seldom seen in adult.PTFL mainly occurs in the head and neck lymph nodes.Most of the cases are short of fever,night sweat,weight loss,and other B symptoms which substitute for lymphadenopathy as the main symptom.PTFL can be disposed of surgical resection and it can achieve long-term tumor-free survival,and it has an excellent outcome.CASE SUMMARY Two cases of PTFL were reported and their clinicopathological features,differential diagnosis,therapy and prognosis were discussed.PTFL showed graybrown tough texture in general performance.The histological manifestations of PTFL were similar to that of adult-follicular lymphoma(FL).Under low power microscope,the structure of lymph nodes was destroyed in different degree,the follicles were closely arranged,expanded and irregular,and the mantle zone became thin or disappeared.In addition,the“starry sky phenomenon”could be seen.At high magnification,the follicles were mainly composed of single medium-sized central cells,and some of them mainly consisted of centroblastic cells to characterize scattered chromatin and inconspicuous nucleoli.Immunohistochemical showed the tumor cells expressed CD20,PAX5,CD79a and CD10,BCL6,FOXP-1,which were limited in germinal center;Ki-67 was highly expressed in germinal center.CD21 and CD23 showed nodular and expanded follicular dendritic cells.Immunoglobulin gene rearrangement was positive for IGH and IGK.The two patients underwent surgical resection with no complications.After discharge,the two patients with a close review for 18 mo and 5 mo respectively and showed no evidence of recurrence.CONCLUSION PTFL in adult is generally supposed to be extremely rare.PTFL displayed characteristic morphological,immunophenotypic,and molecular biological changes which are a kind of neoplasm with satisfactory prognosis after surgical excision.
文摘OBJECTIVE To investigate the clinical diagnosis and differential diagno- sis of synovial sarcoma (SS). METHODS A total of 41 paraffin-embedded synovial sarcoma samples were examined by H&E staining, immunohistochemistry staining and the re- verse transcriptase polymerase chain reaction (RT-PCR), in order to provide a scientific bases for diagnosis and differential diagnosis. RESULTS Twelve cases were a biphasic type, 22 cases were a mono- phasic fibrous type, and 7 cases were a poorly differentiated type. Thirty-six cases were both CK (and/or EMA) and Vim positive. Five cases were only Vim positive. A SYT-SSX fusion gene was detected in 18 cases by RT-PCR. CONCLUSION By observation of the histomorphology, immunohisto- chemistry markers and detection of a SYT-SSX fusion gene, we can make a clinical pathological diagnosis of synovial sarcoma.
文摘目的观察卵巢-附件报告和数据系统超声2022版(O-RADS US v2022)及其联合恶性风险指数4(RMI4)鉴别附件良、恶性肿瘤的价值。方法回顾性分析126例手术病理诊断为附件肿瘤患者,根据O-RADS US v2022将1~3类归为良性病变、4~5类归为恶性病变,以450为RMI4分类的临界值,基于二者进行联合分类。以病理结果为金标准,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估单一O-RADS US v2022、RMI4及其联合鉴别附件良、恶性肿瘤的效能。结果126例附件肿瘤中,良性94例、恶性32例。O-RADS US v2022鉴别附件良、恶性肿瘤的敏感度、特异度、准确率及AUC分别为78.13%、80.85%和80.16%、0.795,RMI4分别为71.88%、84.04%和80.95%、0.780;二者联合的特异度及准确率(93.62%、92.06%)均高于单一O-RADS US v2022(χ^(2)=7.322、5.967,P=0.007、0.015)或RMI4(χ^(2)=4.625、5.331,P=0.032、0.021),而敏感度及AUC(87.50%、0.906)差异均无统计学意义(P均>0.05)。结论O-RADS US v2022能有效鉴别附件良、恶性肿瘤,联合RMI4可提高鉴别特异度及准确率。
文摘胃肝样腺癌(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.
