Collision tumor of primary malignant lymphoma and adenocarcinoma in the colon diagnosed by molecular pathology:A case report and literature review

BACKGROUND Collision tumors of primary malignant lymphoma and adenocarcinoma in the colon are rare.Primary diffuse large B-cell lymphoma(DLBCL)–adenocarcinoma collision tumors are especially rare.CASE SUMMARY A 74-year-old woman presented with abdominal pain of 1 mo duration.Biopsy under colonoscopy revealed adenocarcinoma of the ascending colon.Subsequently,the patient underwent laparoscopic radical resection of right colon cancer with lymph node dissection.A collision tumor was found incidentally through postoperative pathological sampling.Genetic analysis showed a collision tumor of DLBCL with germinal center B-cell subtype and TP53 mutation,and adenocarcinoma arising in a tubulovillous adenoma in the colon,with BRAF mutation and mutL homolog 1 promoter methylation.The patient died 3 mo after surgery.To our knowledge,this is the 23rd reported case of collision tumor of colorectal adenocarcinoma and lymphoma.The mean age of the 23 patients was 73 years.The most common site was the cecum.There were 15 cases with followup data including 11 living and four dead with a 3-year overall survival rate of 71.5%.CONCLUSION Based on pathological and genetic analysis,surgery combined with chemotherapy or chemoradiotherapy may have good therapeutic effects for collision tumor.

Detecting circulating tumor material and digital pathology imaging during pancreatic cancer progression

Pancreatic cancer(PC) is a leading cause of cancerrelated death worldwide. Clinical symptoms typically present late when treatment options are limited and survival expectancy is very short. Metastatic mutations are heterogeneous and can accumulate up to twenty years before PC diagnosis. Given such genetic diversity, detecting and managing the complex states of disease progression may be limited to imaging modalities and markers present in circulation. Recent developments in digital pathology imaging show potential for early PC detection, making a differential diagnosis, and predicting treatment sensitivity leading to long-term survival in advanced stage patients. Despite large research efforts, the only serum marker currently approved for clinical use is CA 19-9. Utility of CA 19-9 has been shown to improve when it is used in combination with PC-specific markers. Efforts are being made to develop early-screening assays that can detect tumor-derived material, present in circulation, before metastasis takes a significant course. Detection of markers that identify circulating tumor cells and tumor-derived extracellular vesicles(EVs) in biofluid samples offers a promising non-invasive method for this purpose. Circulating tumor cells exhibit varying expression of epithelial and mesenchymal markers depending on the state of tumor differentiation. This offers a possibility for monitoring disease progression using minimally invasive procedures. EVs also offer the benefit of detecting molecular cargo of tumor origin and add the potential to detect circulating vesicle markers from tumors that lack invasive properties. This review integrates recent genetic insights of PC progression with developments in digitalpathology and early detection of tumor-derived circulating material.

Comparative Study of Images with Pathology:Superparamagnetic Iron Oxide-enhanced Magnetic Resonance Image(MRI)of Splenic VX2 Tumor in Rats

Objective： To establish a rodent model of VX2 tumor of the spleen, to analyze relationship between the change of the signal intensity on superparamagnetic iron oxide enhanced magnetic resonance image （MRI） and pathologic change to evaluate the ability of superparamagnetic iron oxide enhanced MRI for detection of splenic metastases. Methods： 8 rodent models of VX2 tumor of spleen were established successfully. The images were obtained before and after administration of superparamagnetic iron oxide. T1-weighted spin-echo （SE） pulse sequence with a repetition time （TR） of 450 msec, and echo time （TE） of 12 msec （TR/TE=450/12） was used. The imaging parameters of T2-weighted SE pulse sequence were as follows： TR/TE=4000/128. Results： On plain MR scanning T1-weighted splenic VX2 tumor showed hypointensity or isointensity which approximated to the SI of splenic parenchyma. Therefore all lesions were not displayed clearly. On superparamagnetic iron oxide enhancement T2WI sequence the SI of splenic parenchyma decreased obviously with percentage of signal intensity loss （PSIL） of 55.04%, But the SI of tumor was not evidently changed with PSIL of 0.87%. Nevertheless the SNR of normal splenic parenchyma around the lesions had obvious difference （P〈0.001） comparatively. Therefore the contrast between tumor and spleen increased, and tumor displayed more clearly. Moreover the contrast-to-noise （CNR） between VX2 tumor and splenic parenchyma had an evident difference before and after admininstration of superparamagnetic iron oxide （P〈0.001）. Conclusion： On superparamagnetic iron oxide enhancement T1WI sequence the contrast of tumor-to-spleen is poor. Therefore it is not sensitive to characterize the lesions in spleen. On superparamagnetic iron oxide enhanced T2WI the contrast degree of lesions increases obviously. Consequently, superparamagnetic iron oxide -enhanced T2WI MRI scanning can improve the rate of detection and characterization for lesions of spleen.

Long-Term Follow-Up of Microsurgical Reconstruction for Pelvic Tumor Focusing on Spinal Deformity and Quality of Life

Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1;simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2;and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.

Analysis of results of two kinds of hemi-pelvic arthroplasty after wide resection of pelvic tumors

Objective The Patients with pelvic tumors were treated with tumor resection,hemi-pelvic allografting or artificial hemi-pelvic replacement for the improvement of their life quality.Methods Seven cases of pelvic tumor were treated with wide resection and hemi-pelvic allografting,and 35 cases with resection of pelvic tumors and artificial hemi-pelvic replacement.Results These 42 cases were all successfully operated upon without operative mortality.The results of long term following-up of 2.5 to 12 years(mean 5.4 years)showed that the increased and satisfactory functional recovery(50.0%).Conclusion Hemi-pelvic allografting or artificial hemi-pelvic replacement after wide resection of pelvic tumors can improve the survival rate of patients,as well as reconstruction of the pelvis and the hip joint with satisfactory function.

Anesthetic Treatment in Operations of Small Pelvic Organs Pathology

The article presents data on the surgical treatment of 405 patients with pelvic organ surgical and gynecological diseases. When using regional anesthesia during operations in the lower abdominal cavity of patients with pelvic pathology, a smoother operation course and early postoperative period were observed compared with general anesthesia use. In this work, 405 patients with surgical and gynecological diseases of pelvic organs, operated in the surgical and gynecological departments were analyzed. When using regional anesthesia, it was observed that intraoperative blood loss in patients and consumption of narcotic analgesics in the postoperative period decreases.

molecular pathology of intraductal papillary mucinous neoplasms of the pancreas

Since the first description of intraductal papillary mucinous neoplasms(IPMNs)of the pancreas in the eighties,their identification has dramatically increased in the last decades,hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases.However,the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions.The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed.We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms,identifying some genes,molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy.The knowledge of molecular biology of IPMNs has impressively developed over the last few years.A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified,in pancreatic juice or in blood or in the samples from the pancreatic resections,but further researches are required to use these informations for clinical intent,in order to better define the natural history of these diseases and to improve their management.

The Magnetic Resonance Image and Pathology of Spinal Cord Cavernous Hemangioma

Objective To investigate the characteristics of magnetic resonance image (MRI) of spinal cord cavernous hemangioma. Methods Six cases of spinal cord cavernous heman-gioma diagnosed by MRI and confirmed by pathology were reviewed. The characteristics of MRI were analyzed and correlated with pathological characteristics of spinal cord cavernous hemangioma. Results In 4 cases, the tumors were located in thoracic segment of the spinal cord and 2 in cervical cord. All lesions were solitary and the spinal cords were normal or a little thicker. The MRI showed that the images of focus were ball-like popcorn or mulberry with mixed signal,with short T2 signal around the focus. Under microscope, the hemangioma was composed of highly expanded blood sinusoids and its wall was thin and consisted of flat epithelial cells. There were some red blood cells in the cavity of the sinusoid and a little fibrous tissue in the diazoma between blood sinusoids. And also some fresh and old hemorrhages could be seen in the specimen. Conclusion MRI has high sensitivity and specificity in the diagnosis of spinal cavernous hemangioma.

The Anatomic Pathology Evaluation of Liver with Diethylinitrosamine Treated via Intraperitoneal Injection Singly and Peros for 90 Days Carcinogenicity Study in F344 Rats

Objective：To establish the integrity experiment method of short（ medium）- term carcinogenicity test pursuant to GLP, make into relative SOP and improve the safeguard in the center. Methods：Diethylinitrosamine（DEN） is known as carcinogenic agent, whose target organ is liver. Using the two-stage carcinogenesis test method, DEN was treated to F344 rats via intraperitoneal injection singly（200 mg/kg） , and peros administrated for 90 days（10 ppm）. The liver in any group rat will be examined by light microscopy. Results：In pathologic examination, no liver cell tumor was shown in the livers of the rats that were singly treated with a carcinogenic chemical-DEN. Foci of cellular alteration were observed in the livers of these rats. The proliferation lesions of liver from slight to seveity （foci of cellular aherationepatocelluar adenoma-hepatocellular carcinoma） were observed in the livers of the rats which exposed peros to a low dose of DEN for 90 days after initiation by a single intraperitoneal injection. The incidence of hepatocelluar tumor was 35% in male animal ,which was not shown in the liver of female rat. Conclusion：For current results, it may be possible that low-dose DEN acts as a promotor of hepatocelluar tumor if it was exposed in a population for a long time. It is considered that male hormone has a synergistic effect on hepatocelluar tumor development of DEN. This two-stage carcinogenesis test might be a new model for the study of drug induced and promoted carcinogenesis, which could be used to evaluate the carcinogenesis of chemical compound fast.

Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors

BACKGROUND The incidence of gastric cancer remains high,and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide.Oral contrastenhanced ultrasonography is a simple,non-invasive,and painless method for the diagnosis of gastric tumors.AIM To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors.METHODS The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination.RESULTS Among 42 patients with gastric tumors enrolled in the study,the diagnostic accordance rate was 95.2%for oral contrast-enhanced ultrasonography(n=40)and 90.5%for electronic gastroscopy(n=38)compared with postoperative pathological examination.The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy,and there was no significant difference between them(P=0.397).For the TNM staging of gastric tumors,the accuracy rate of oral contrast enhanced ultrasonography was 81.9%for the overall T staging and 50%,77.8%,100%,and 100%for T1,T2,T3,and T4 staging,respectively.The sensitivity and specificity were both 100%for stages T3 and T4.The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%,80%,100%,and 100%for stages N0,N1-N3,M0,and M1,respectively.CONCLUSION The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy,and it could be used as the preferred method for the early screening of gastric tumors.

Combining prognostic value of serum carbohydrate antigen 19-9 and tumor size reduction ratio in pancreatic ductal adenocarcinoma

BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a common cancer with increasing morbidity and mortality due to changes of social environment.AIM To evaluate the significance of serum carbohydrate antigen 19-9(CA19-9)and tumor size changes pre-and post-neoadjuvant therapy(NAT).METHODS This retrospective study was conducted at the Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment,Chongqing University Cancer Hospital.This study specifically assessed CA19-9 levels and tumor size before and after NAT.RESULTS A total of 156 patients who completed NAT and subsequently underwent tumor resection were included in this study.The average age was 65.4±10.6 years and 72(46.2%)patients were female.Before survival analysis,we defined the post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level as the CA19-9 ratio(CR).The patients were divided into three groups:CR<0.5,CR>0.5 and<1 and CR>1.With regard to tumor size measured by both computed tomography and magnetic resonance imaging,we defined the post-NAT tumor size/pre-NAT tumor size as the tumor size ratio(TR).The patients were then divided into three groups:TR<0.5,TR>0.5 and<1 and TR>1.Based on these groups divided according to CR and TR,we performed both overall survival(OS)and disease-free survival(DFS)analyses.Log-rank tests showed that both OS and DFS were significantly different among the groups according to CR and TR(P<0.05).CR and TR after NAT were associated with increased odds of achieving a complete or near-complete pathologic response.Moreover,CR(hazard ratio:1.721,95%CI:1.373-3.762;P=0.006),and TR(hazard ratio:1.435,95%CI:1.275-4.363;P=0.014)were identified as independent factors associated with OS.CONCLUSION This study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.

The Role of MSCT in Evaluating Tumor Size,Density,Immunohistochemical Classification,and Pathological Risk in GIST Patients

Objective:To investigate the role of multilayer spiral CT(MSCT)in evaluating patients with gastrointestinal stromal tumors(GIST),particularly its utility in determining tumor size,immunohistochemical classification,and pathological risk.Methods:A retrospective analysis was conducted on 22 GIST patients,confirmed by surgical pathology between January 2019 and December 2023.All patients underwent MSCT examination prior to surgery.Tumor size,density,and immunohistochemical classification from the MSCT results were compared with the postoperative pathological findings.Additionally,the ability of MSCT to predict GIST risk grade was evaluated in combination with immunohistochemical analysis results.Results:No significant differences were found between the preoperative MSCT findings and postoperative pathological results in terms of tumor size,density,or immunohistochemical classification in GIST patients.MSCT also enhanced the ability to predict GIST risk grades.Conclusion:MSCT demonstrates significant clinical value in the diagnosis and risk assessment of GIST,aiding in the prediction of the tumor’s biological behavior and patients’treatment responses.

Image Registration Technique for Assessing the Accuracy of Intraoperative Osteotomy for Pelvic Tumors by 3D-Printed Patient-Specific Templates

The study aimed to explore the feasibility of an image registration technique for assessing the accuracy of intraoperative osteotomy of pelvic tumors by 3-dimensional(3D)-printed patient-specific templates.Patients with malignant pelvic tumors who were admitted to our hospital between March 2014 and December 2020 were retrospectively enrolled.Patients underwent hemi-pelvic resection and reconstruction by 3D-printed individualized prostheses.The registration between the designed model and the postoperative segmented model of the prosthesis was used to obtain the intraoperative osteotomy plane and reduce metal artifacts in postoperative computed tomography(CT)images.The distance and angle between the planned and actual osteotomy planes were then used to assess the accuracy of the intraoperative osteotomy.Eight patients with 13 osteotomy planes were enrolled,including four males and four females.The median age at the time of imaging examination was 44 years(range,33–54 years).All intraoperative osteotomy planes were assessed successfully.The mean distance between the planned and true intraoperative osteotomy planes was−0.69 cm(−7.5–7.35 cm),and the mean angle was 6.57°±3.36°(1.05°–11.88°).This new assessment method of registering the designed model and the postoperative CT segmented model of the prosthesis may be used to assess the accuracy of intraoperative osteotomy for pelvic tumors,using 3D printed patient-specific templates.

Esophageal mesenchymal tumors:Endoscopy,pathology and immunohistochemistry

AIM： To study the endoscopic, pathological and immunoo histochemical features of esophageal mesenchymal tumors. METHODS： Twenty-nine patients diagnosed as esophageal rnysenchymal tumors by electronic endoscopy and endoscopic ultrasound （EUS） were observed under light microscopes, and all tissues were stained by the immunohistochemical method. The expression of CD117, CD34, SMA and desmin were measured by staining intensity of cells and positive cell ratios. RESULTS： Endoscopically, esophageal gastrointestinal stromal tumors （GISTs） and leiomyomas （LMs） had similar appearances, showing submucosal protuberant lesions. They all showed low echo images originated from the muscularis propria or muscularis mucosa on EUS. Endoscopy and EUS could not exactly differentiate esophageal GISTs from LMs. Microscopically, there were two kinds of cells： spindle cell type and epitheloid cell type in esophageal GISTs. Leiomyomas and leiomyosarcornas were only of spindle cell type. One malignancy was found in five cases of esophageal GISTs, and one malignancy in 24 cases of leiomyomas and leiomyosarcomas. Using Fisher＇s exact method, the differences of malignant lesion proportion were not significant between esophageal LMs and GISTs, 1/5 vs 1/24 （P 〉 0.05）. All cases of esophageal GISTs were positive for CD117, and 3 cases were also positive for CD34. The 24 cases of leiomyomas and leiomyosarcomas were all negative for CD117 and CD34. The differences of positive rates of CD117 and CD34 were significant between esophageal GISTs and LMs, 5/5 vs 0/24, 3/5 vs 0/24 （P 〈 0.005）. All leiomyomas and leiomyosarcomas were positive for SMA, and desmin. Among 5 cases of esophageal GISTs, 2 cases were SMA positive, and 1 case was desmin positive. The differences in positive rates and expression intensity of SMA and desmin were significant between esophageal LMs and GISTs, 24/24 vs 2/5, 24/24 vs 115 （P 〈 0.005）. CONCLUSION： The most common esophageal mesenchymal tumors are leiomyomas, and esophageal GISTs are less common. Most of esophageal LMs and GISTs are benign. Endoscopy and EUS are the effective methods to diagnose esophageal mesenchymal tumors and they can provide useful information for the treatment of these tumors. However, they cannot exactly differentiate esophageal GISTs from LMs. Pathological, especially immunohistochemical features are useful to differentiate GISTs from leiomyomas.

Emerging role of deep learning-based artificial intelligence in tumor pathology

The development of digital pathology and progression of state-of-the-art algorithms for computer vision have led to increasing interest in the use of artificial intelligence(AI),especially deep learning(DL)-based AI,in tumor pathology.The DL-based algorithms have been developed to conduct all kinds of work involved in tumor pathology,including tumor diagnosis,subtyping,grading,staging,and prognostic prediction,as well as the identification of pathological features,biomarkers and genetic changes.The applications of AI in pathology not only contribute to improve diagnostic accuracy and objectivity but also reduce the workload of pathologists and subsequently enable them to spend additional time on high-level decision-making tasks.In addition,AI is useful for pathologists to meet the requirements of precision oncology.However,there are still some challenges relating to the implementation of AI,including the issues of algorithm validation and interpretability,computing systems,the unbelieving attitude of pathologists,clinicians and patients,as well as regulators and reimbursements.Herein,we present an overview on how AI-based approaches could be integrated into the workflow of pathologists and discuss the challenges and perspectives of the implementation of AI in tumor pathology.

Clinical and computed tomography features of adult abdominopelvic desmoplastic small round cell tumor

To investigate the clinical and computed tomography(CT)features of desmoplastic small round cell tumor(DSRCT),we retrospectively analyzed the clinical presentations,treatment and outcome,as well as CT manifestations of four cases of DSRCT confirmed by surgery and pathology.The CT manifestations of DSRCT were as follows:(1)multiple soft-tissue masses or diffuse peritoneal thickening in the abdomen and pelvis,with the dominant mass usually located in the pelvic cavity;(2)masses without an apparent organbased primary site;(3)mild to moderate homogeneous or heterogeneous enhancement in solid area on enhanced CT;and(4)secondary manifestations,such as ascites,hepatic metastases,lymphadenopathy,hydronephrosis and hydroureter.The prognosis and overall survival rates were generally poor.Commonly used treatment strategies including aggressive tumor resection,polychemotherapy,and radiotherapy,showed various therapeutic effects.CT of DSRCT shows characteristic features that are helpful in diagnosis.Early discovery and complete resection,coupled with postoperative adjuvant chemotherapy,are important for prognosis of DSRCT.Whole abdominopelvic rather than locoregional radiotherapy is more effective for unresectable DSRCT.

Total pelvic exenteration and a new model of diversion for giant primitive neuroectodermal tumor of prostate: A case report and review of the literature

The present study reports a rare primitive neuroectodermal tumor (PNET) of prostate.A 27-year-old male was admitted to Harbin Medical University Cancer Hospital (Harbin,China) for dysuria and dyschezia. Magnetic resonance imaging (MRI) revealed a large mass thatmay involve the bladder and rectum next to the prostate. Histopathological analysis of biopsyof prostate indicated mesenchymal origin tumor, and immunohistochemistric stainingconfirmed diagnosis of PNET of prostate. En bloc total pelvic exenteration and double barrelsigmoidostomy were performed. Double stomas in the skin incision were used for fecal andurinary diversion, respectively. Short-term outcome is satisfactory, while long-term efficacyremains to be poor. Clinical features of PNET of prostate should be paid much more attentionand radical surgery and adjuvant chemotherapy should be recommended.

Perivascular epithelioid cell tumor of male pelvic cavity:a case report and literature review

Perivascular epithelioid cell tumors （PEComas） are a family of rare mesenchymal neoplasms. The PEComas, composed of epithelioid and spindle cells, have the same cellular and immtmohistocherrtical features but are found in different visceral and soft tissue sites. Here, we report the histological and immunohistochemical features of one case of PEComa restricted in the pelvic visceral peritoneum of a male patient. The patient was treated with radical surgery, and was well and on follow-up visits without tumor recurrence.

Development and validation of an online calculator to predict the pathological nature of colorectal tumors

BACKGROUND No single endoscopic feature can reliably predict the pathological nature of colorectal tumors(CRTs).AIM To establish and validate a simple online calculator to predict the pathological nature of CRTs based on white-light endoscopy.METHODS This was a single-center study.During the identification stage,530 consecutive patients with CRTs were enrolled from January 2015 to December 2021 as the derivation group.Logistic regression analysis was performed.A novel online calculator to predict the pathological nature of CRTs based on white-light images was established and verified internally.During the validation stage,two series of 110 images obtained using white-light endoscopy were distributed to 10 endoscopists[five highly experienced endoscopists and five less experienced endoscopists(LEEs)]for external validation before and after systematic training.RESULTS A total of 750 patients were included,with an average age of 63.6±10.4 years.Early colorectal cancer(ECRC)was detected in 351(46.8%)patients.Tumor size,left semicolon site,rectal site,acanthosis,depression and an uneven surface were independent risk factors for ECRC.The C-index of the ECRC calculator prediction model was 0.906(P=0.225,Hosmer-Lemeshow test).For the LEEs,significant improvement was made in the sensitivity,specificity and accuracy(57.6%vs 75.5%;72.3%vs 82.4%;64.2%vs 80.2%;P<0.05),respectively,after training with the ECRC online calculator prediction model.CONCLUSION A novel online calculator including tumor size,location,acanthosis,depression,and uneven surface can accurately predict the pathological nature of ECRC.

Factors associated with gastrointestinal stromal tumor rupture and pathological risk:A single-center retrospective study

BACKGROUND Gastrointestinal stromal tumor(GIST)is a rare gastrointestinal mesenchymal tumor with potential malignancy.Once the tumor ruptures,regardless of tumor size and mitotic number,it can be identified into a high-risk group.It is of great significance for the diagnosis,treatment,and prognosis of GIST if non-invasive examination can be performed before surgery to accurately assess the risk of tumor.AIM To identify the factors associated with GIST rupture and pathological risk.METHODS A cohort of 50 patients with GISTs,as confirmed by postoperative pathology,was selected from our hospital.Clinicopathological and computed tomography data of the patients were collected.Logistic regression analysis was used to evaluate factors associated with GIST rupture and pathological risk grade.RESULTS Pathological risk grade,tumor diameter,tumor morphology,internal necrosis,gas-liquid interface,and Ki-67 index exhibited significant associations with GIST rupture(P<0.05).Gender,tumor diameter,tumor rupture,and Ki-67 index were found to be correlated with pathological risk grade of GIST(P<0.05).Multifactorial logistic regression analysis revealed that male gender and tumor diameter≥10 cm were independent predictors of a high pathological risk grade of GIST[odds ratio(OR)=11.12,95%confidence interval(95%CI):1.81-68.52,P=0.01;OR=22.96,95%CI:2.19-240.93,P=0.01].Tumor diameter≥10 cm,irregular shape,internal necrosis,gas-liquid interface,and Ki-67 index≥10 were identified as independent predictors of a high risk of GIST rupture(OR=9.67,95%CI:2.15-43.56,P=0.01;OR=35.44,95%CI:4.01-313.38,P<0.01;OR=18.75,95%CI:3.40-103.34,P<0.01;OR=27.00,95%CI:3.10-235.02,P<0.01;OR=4.43,95%CI:1.10-17.92,P=0.04).CONCLUSION Tumor diameter,tumor morphology,internal necrosis,gas-liquid,and Ki-67 index are associated with GIST rupture,while gender and tumor diameter are linked to the pathological risk of GIST.These findings contribute to our understanding of GIST and may inform non-invasive examination strategies and risk assessment for this condition.