In situ forming injectable MSC-loaded GelMA hydrogels combined with PD for vascularized sweat gland regeneration

Dear Editor,Three dimensional(3D)bioprinted extracellular matrix(ECM)can be used to provide both biochemical and biophysical cues to direct mesenchymal stem cells(MSCs)differentiation,and then differentiated cells were isolated for implantation in vivo using surgical procedures.However,the reduced cell activity after cell isolation from 3D constructs and low cell retention in injured sites limit its application[1].Methacrylated gelatin(GelMA)hydrogel has the advantage of fast crosslinking,which could resemble complex architectures of tissue construct in vivo[2].Here,we adopted a noninvasive bioprinting procedure to imitate the regenerative microenvironment that could simultaneously direct the sweat gland(SG)and vascular differentiation from MSCs and ultimately promote the replacement of glandular tissue in situ(Fig.1a).

Modified endoscopic submucosal tunnel dissection for large esophageal submucosal gland duct adenoma: A case report

BACKGROUND With the recent improvement of endoscopic techniques,endoscopic ultrasoundguided fine needle aspiration and endoscopic submucosal tunnel dissection(ESTD)have been widely used for accurate diagnosis and dissection acceleration of esophageal tumors.CASE SUMMARY We used a modified submucosal tunnel technique during endoscopic en bloc resection in a 58-year-old man with large esophageal submucosal gland duct adenoma(ESGDA).During modified ESTD,the oral end of the involved mucosa was cut transversely,followed by a submucosal tunnel created from the proximal to the distal end,and the anal end of the involved mucosa blocked by the tumor was incised.As a result of retaining submucosal injection solutions using the submucosal tunnel technique,it was possible to reduce the amount of injection required and increase the efficiency and safety of dissection.CONCLUSION Modified ESTD is an effective treatment strategy for large ESGDAs.Single-tunnel ESTD appears to be a time-saving procedure compared with conventional endoscopic submucosal dissection.

Pleomorphic adenoma(mixed tumor)of the upper lip:A case report

BACKGROUND Salivary gland tumors are relatively rare.Most minor salivary gland tumors are malignant with benign tumors accounting for 18%of the tumors.Pleomorphic adenoma(PA)is the most common salivary gland tumor.Lip PA is uncommon with 9.8%occurring in the upper lip.We are adding on the knowledge of the rare upper lip PA(benign mixed tumor).CASE SUMMARY We report an upper lip PA(benign mixed tumor)in a 28-year-old man.His complaint was a painless swelling on the upper lip.A painless,non-tender,well-circumscribed,slightly mobile,sessile,nodular,and rubbery(in consistency)tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip.The overlying skin was not fixed and of normal color.There was no ulceration,and palpation did not elicit pain or bleeding.There was no history of trauma.Blunt dissection was used to completely excise the nodular,whitish,and encapsulated tumor.Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion,with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells,well-formed tubules containing eosinic secretion,and nests of myoepithelial cells.A diagnosis of PA(benign mixed tumor)was confirmed.CONCLUSION Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.

Large Brunner's gland adenoma:Case report and literature review

Brunner＇s gland adenoma （BGA） is a very rare benign tumour of the duodenum, which is usually asymptomatic and discovered incidentally at endoscopy. Occasionally, this lesion may be large, causing upper gastrointestinal haemorrhage or intestinal obstruction. The case had a large Brunner＇s gland adenoma, presenting melena that was managed by endoscopic excision.

Oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor: A case report

Gastric adenocarcinoma is one of the most common malignancies worldwide.Histochemical and immunohistologic analyses classify the phenotypes of gastric adenocarcinoma into several groups based on the variable clinical and pathologic features.A new and rare variant of gastric adenocarcinoma with chief cell differentiation(GA-CCD)has recently been recognized.Studies reporting the distinct clinicopathologic characteristics proposed the term oxyntic gland polyp/adenoma because of the benign nature of the GACCD.Typically,GA-CCD is a solitary mucosal lesion that develops either in the gastric cardia or fundus.Histologically,this lesion is characterized by tightly clustered glands and anastomosing cords of chief cells.Immunohistochemically,GA-CCD is diffusely positive for mucin(MUC)6 and negative for MUC2and MUC5AC.However,other gastric tumors such as a gastric neuroendocrine tumor or fundic gland polyp have been difficult to exclude.Because GA-CCD tends to be endoscopically misdiagnosed as a neuroendocrine tumor or fundic gland polyp,comprehensive assessment and observation by an endoscopist are strongly recommended.Herein,we report a rare case of oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor that was successfully removed by endoscopic mucosal resection.

Expression of Angiotensin Ⅱ Receptors in Aldosterone-producing Adenoma of the Adrenal Gland and Their Clinical Significance

The expression of angiotensin Ⅱ type 1 receptor (AT1R) and angiotensin Ⅱ type 2 receptor (AT2R) in aldosterone-producing adenoma (APA) of the adrenal gland was detected, and their relationship with clinical indexes of APA was analyzed. The mRNA expression of AT1R and AT2R in 50 cases of APA and tissues adjacent to tumors and 12 cases of normal adrenal tissues was detected by using reverse transcriptase polymerase chain reaction (RT-PCR). The expression of AT1R and AT2R proteins in paraffin-embedded slices of tissue was detected by immunohistochemistry. The expression of AT1R in adenoma, tissues adjacent to tumor, and normal tissues of the adrenal gland showed no significant differences. The expression of AT2R in APA tissue was lower than that in normal adrenal gland tissues (P<0.05). Correlation analysis of the mRNA expression level of AT2R and clinical data from patients demonstrated that AT2R expression was negatively related to plasma aldosterone concentration (PAC) (r=-0.467, P<0.05), but positively related with plasma renin activity (PRA) (r=0.604, P<0.05). It is concluded that down-regulation of the AT2R expression is possibly related with the tumorigenesis of APA.

Small molecules facilitate single factor-mediated sweat gland cell reprogramming

Background: Large skin defects severely disrupt the overall skin structure and can irreversibly damage sweat glands(SGs), thus impairing the skin’s physiological function. This study aims to develop a stepwise reprogramming strategy to convert fibroblasts into SG lineages, which may provide a promising method to obtain desirable cell types for the functional repair and regeneration of damaged skin.Methods: The expression of the SG markers cytokeratin 5(CK5), cytokeratin 10(CK10), cytokeratin 18(CK18), carcinoembryonic antigen(CEA), aquaporin 5(AQP5) and α-smooth muscle actin(α-SMA) was assessed with quantitative PCR(qPCR), immunofluorescence and flow cytometry. Calcium activity analysis was conducted to test the function of induced SG-like cells(iSGCs). Mouse xenograft models were also used to evaluate the in vivo regeneration of iSGCs.BALB/c nude mice were randomly divided into normal group, SGM treatment group and iSGC transplantation group.Immunocytochemical analyses and starch-iodine sweat tests were used to confirm the in vivo regeneration of iSGCs.Results: Ectodermal dysplasia antigen(EDA) overexpression drove human dermal fibroblast(HDF) conversion into i SGCs in SG culture medium(SGM). qPCR indicated significantly increased mRNA levels of the SG markers CK5, CK18and CEA in iSGCs, and flow cytometry data demonstrated(4.18±0.04)% of iSGCs were CK5 positive and(4.36±0.25)%of iSGCs were CK18 positive. The addition of chemical cocktails greatly accelerated the SG fate program. qPCR results revealed significantly increased mRNA expression of CK5, CK18 and CEA in iSGCs, as well as activation of the duct marker CK10 and luminal functional marker AQP5. Flow cytometry indicated, after the treatment of chemical cocktails,(23.05±2.49)% of iSGCs expressed CK5^(+) and(55.79±3.18)% of iSGCs expressed CK18^(+), respectively. Calcium activity analysis indicated that the reactivity of iSGCs to acetylcholine was close to that of primary SG cells [(60.79±7.71)% vs.(70.59±0.34)%, ns]. In vivo transplantation experiments showed approximately(5.2±1.1)% of the mice were sweat test positive, and the histological analysis results indicated that regenerated SG structures were present in iSGCs-treated mice.Conclusions: We developed a SG reprogramming strategy to generate functional iSGCs from HDFs by using the single factor EDA in combination with SGM and small molecules. The generation of iSGCs has important implications for future in situ skin regeneration with SG restoration.

Carcinoma ex pleomorphic adenoma of the sublingual gland:a case report

We report a case of carcinoma ex pleomorphic adenoma of a sublingual gland in a 70-year-old man.Under a clinical diagnosis of benign salivary gland tumor,excision of the mass with the sublingual salivary gland in an en bloc fashion via an intraoral approach was performed.Histopathologically,there was a rupture of the fibrous capsule and diffuse cell-rich sheets composed of myoepithelial cells with round nuclei were also seen.Immunohistochemically,the cells that composed of cell rich sheets were positive to smooth muscle actin.Final diagnosis of myoepithelial carcinoma ex pleomorphic adenoma was made.

Clinical analysis of 109 cases of lacrimal gland pleomorphic adenoma

AIM:To monitor the prognosis of patients with lacrimal gland pleomorphic adenoma(LGPA)following surgical resection within the past 10y.The factors affecting patient prognosis are analyzed and the experience of surgical treatment is summarized.METHODS:In this retrospective,comparative case series,clinical records from 109 cases of LGPA treated chiefly at the same institution between November 2009 and May 2019 were reviewed.All 109 patients underwent surgery,histopathological examination,and imaging examination.For patients who underwent surgery for the first time,LGPA could be resected completely,including tumor and capsule tissues,using a surgical approach via the eyebrow arch or double eyelid crease.RESULTS:The ratio of males to females was 1:1.60,the ages ranged from 19 to 74 years old with a mean age of 43.64±13.07 years old,and the ratio of left to right eyes was 1:1.37.A total of 109 patients underwent surgical excision and five of these收稿日期radiotherapy after malignant transformation.Of these patients,15 were lost to follow up within the April 1,2020 deadline and 1 was diagnosed as a recurring pathology.The 5-year recurrence rate for 86 patients who underwent initial surgery was 7.27%.Single factor analysis revealed that the course of disease,bone destruction,invasion of surrounding tissues,tumor size,capsule integrity,and expression of Ki-67 were statistically significant(P<0.05).Binomial Logistic regression analysis showed that capsule integrity was a risk factor influencing recurrence(P=0.008).CONCLUSION:LGPA has a risk of recurrence and potential for malignant transformation.Complete removal of the tumor and capsule in the initial surgery is a key factor in preventing recurrence.

A Case of Pleomorphic Adenoma of the Parotid Gland with Multiple Local Recurrences through Facial to Cervical Regions

Pleomorphic adenoma is the most common benign parotid gland tumor. Although its local recurrence rate is known to be high, the recurrence extending to the cervical region is rare. Here we report a case of a young female (25 years old) with pleomorphic adenoma of the parotid gland which showed multiple recurrences through facial to cervical regions over a span of eight years. We also discuss how this benign tumor with a high recurrence rate has been treated in other cases, and how it should be treated.

Gastric pyloric gland adenoma resembling a submucosal tumor:A case report

BACKGROUND Pyloric gland adenoma(PGA)is a recently described and rare tumor.Submucosal tumor(SMT)-like PGA is more difficult to diagnose and differentiate from other submucosal lesions.CASE SUMMARY We present the case of a 69-year-old man with a 10 mm SMT-like elevated lesion with an opening in the upper part of the gastric body,referred to our hospital for further endoscopic treatment.Magnifying endoscopy with narrow-band imaging,endoscopic ultrasonography,and complete endoscopic submucosal dissection were performed on the patient.Histopathological findings revealed tightly packed tubular glands lined with cuboidal or columnar cells that had round-tooval nuclei containing occasional prominent nucleoli and an eosinophilic cytoplasm similar to that in non-neoplastic gastric pyloric glands.Additionally,immunohistochemical analysis showed positive staining for both mucin 5AC and mucin 6.Therefore,we arrived at the final diagnosis of gastric PGA.Although there was no apparent malignant component in this tumor,PGA has been considered a precancerous disease with a high risk of transformation into adenocarcinoma.CONCLUSION PGA should be considered when detecting gastric SMT-like lesions.Physicians and pathologists should focus on PGA due to its malignant potential.

High-Grade Mucoepidermoid Carcinoma Ex-Pleomorphic Adenoma of the Parotid Gland: Case Report and Review of Literature

Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological diagnosis. Methods: We present a case of a 71-year-old male with an enlarging left neck mass over several months. CT showed both a parapharyngeal space mass and a separate level II neck mass. Results: The patient underwent resection of the left parapharyngeal mass and ipsilateral selective level II-IV lymphadenectomy. The final pathologic diagnosis was metastatic high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma. Conclusions: We describe a novel presentation of high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma as a metastatic parapharyngeal mass.

Pleomorphic Adenoma with Exuberant Squamous Metaplasia and Keratin Cysts Mimicking Squamous Cell Carcinoma in Minor Salivary Gland

Salivary gland tumors, the second most common neoplasm of the mouth after squamous cell carcinoma, account for a significant proportion of tumors of the oral and perioral regions. An unusual case of adenoma presented as a solitary intraoral palatine mass in a 32-year-old woman is reported here. The tumor was interpreted as an unusual pleomorphic adenoma because of the presence of exuberant squamous metaplasia, clinically mimicking squamous cell carcinoma. Moreover, the presence of cystic structures filled with keratinized material was also salient feature. Pleomorphic adenomas may occasionally display focal squamous metaplastic changes;when extensive, it presents the potential for misinterpretation of the histology as indicative of well-differentiated squamous cell carcinoma.

An overall assessment of circumanal gland adenoma in a terrier mix breed dog

In September 2012,a 10-year-old,intact male,terrier mix breed dog was evaluated because ofmultiple,0.5 to 1.2 cm in diameter,round,intradermal nodules around the anus.It had surgery toexcise a firm,painful swelling in the left ventrolateral perianal region and the excision part wasobserved under light microscopy.The mass spreading in to sub acute was of left hind leg out fromthe ventro-lateral of anus,1.2 cm伊1 cm/0 cm伊0.5 cm in size and 125 g in weight.A completeblood cell count,serum biochemistry panel,and urinalysis(cystocentesis sample)were evaluated.Significant laboratory data demonstrated microcytic anemia(hemoglobin of 6.4 mg/dL)and normalcoagulation times.No remarkable abnormalities were found in the complete blood count and anionized calcium of 1.91 mmol/L(reference range,1.1-1.3 mmol/L)was confirmed hypercalcemia.On cytologic and histopathologic examinations,evaluation of the aspirate revealed a prominentpopulation of round-to-polygonal nucleated cells arranged as cohesive groups with isolatedindividual cells.A mild degree of anisocytosis and anisokaryosis was observed.In addition,smaller reserve type cells,with darker cytoplasm and a higher nucleocytoplasmic ratio.Theadenomas generally retain the lobular architecture,but some may contain focal areas of cellularpleomorphism.These changes may suggest malignant transformation and have led to discordantinterpretations,the well-developed stroma surrounding the lobules and hepatoid cells was noted.Ulceration,hemorrhage,necrosis and secondary infection with inflammatory cell infiltrates arecommon.These cytology and histopathology features are consistent with hepatoid gland adenoma.

Effective chemotherapy for submandibular gland carcinoma ex pleomorphic adenoma with lung metastasis after radiotherapy: A case report

BACKGROUND Only a few cases of carcinoma ex pleomorphic adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic adenoma is surgical resection combined with postoperative radiotherapy,but the necessity of chemotherapy as well as the most appropriate treatment regimen for patients with distant metastasis after radiotherapy remains controversial.CASE SUMMARY This report presents the case of a 73-year-old woman who suffered submandibular gland carcinoma ex pleomorphic adenoma. She accepted surgery to remove the mass; she was found to have lung metastasis after radiotherapy.Her condition was controlled by chemotherapy with liposomal doxorubicin plus cisplatin.CONCLUSION The positive clinical outcome in the patient reveals that this chemotherapy regimen may be an alternative treatment for such a condition.

A large basal cell adenoma extending to the ipsilateral skull base and mastoid in the right parotid gland: A case report

BACKGROUND Basal cell adenoma (BCA) is a rare benign tumour that has unique histological characteristics and primarily arises in the parotid glands. According to published reports, nearby tissue destruction by BCA seems impossible. CASE SUMMARY We presented a case of a 54-year-old woman with a mass in the deep lobe of the right parotid gland involving the ipsilateral skull base and mastoid. The patient exhibited gradual right facial swelling but no other obvious symptoms. Combined resection of the total right parotid gland and partial skull base excision were performed. The biopsy conducted before the surgery and sections cut from intraoperatively obtained tissues were not definitive for identifying the character of the neoplasm. A final diagnosis of tubular BCA without malignant elements was established based on postoperative pathology results and immunohistochemical analysis. The tumour did not recur during the 12-mo follow-up period. CONCLUSION A diagnosis of BCA can only be established based on a histopathological examination after an excisional biopsy, and tubular BCA should carefully be considered as a destructive type.

Rare presentation of Brunner's gland adenoma:another differentiation in patients with recurrent "idiopathic" pancreatitis

BACKGROUND:Brunner's gland adenoma (BGA) is an unusual benign neoplasm arising from Brunner's glands in the duodenum.When symptomatic it presents either with duodenal obstruction or bleeding.However,pancreatitis secondary to ampullary obstruction from a BGA is very rare.METHODS:A 23-year-old female presented with recurrent episodes of 'idiopathic' pancreatitis.She was extensively investigated and was found to have a large polypoid BGA,intermittently obstructing the ampulla.This created a ball-valve effect causing secondary intermittent obstruction of the pancreatic duct resulting in pancreatitis.The condition was cured surgically,through transduodenal excision of the BGA.We reviewed the surgical literature pertaining to these unusual and similar causes of obstructive pancreatitis,not related to gallstones.RESULTS:BGA of the duodenum is a rare cause of pancreatitis.Extensive investigations should be carried out in all cases of unexplained pancreatitis before classifying the condition as 'idiopathic'.Discovery of a lesion of this nature gives an opportunity to provide a permanent surgical cure.CONCLUSIONS:BGA adds an unusual etiology for pancreatitis.All patients with pancreatitis should undergo extensive investigations before being termed 'idiopathic'.Surgical excision of the BGA provides a definitive curative treatment for the adenoma and pancreatitis.

Improved sweat gland function during active heating in tennis athletes

Background：Relatively few studies on the peripheral sweating mechanisms of trained tennis athletes have been conducted.The purpose of this study was to compare the sweating capacities of tennis athletes against untrained subjects（controls）.Methods：Thirty-fi e healthy male volunteers participated including 15 untrained subjects and 20 trained tennis athletes（nationally ranked）.Active heat generation was performed for 30 min（running at 60%VO2max） in a climate chamber（temperature,25.0°C ± 0.5°C;relative humidity,60% ± 3%,termed active heating）.Sweating data（local sweat onset time,local sweat volume,activated sweat glands,sweat output per gland,whole body sweat loss volume） were measured by the capacitance hygrometer-ventilated capsule method and starch-iodide paper.Mean body temperature was calculated from tympanic and skin temperatures.Results：Local sweat onset time was shorter for tennis athletes（p〈0.001）.Local sweat volume,activated sweat glands of the torso and limbs,sweat output per gland,and whole body sweat loss volume were significant y higher for tennis athletes than control subjects after active heating（p〈0.001）.Tympanic and mean body temperatures were lower among tennis athletes than controls（p〈0.05）.Conclusion：These results indicate that tennis athletes had increased regulatory capacity of their sweat gland function.

Inverted cystic tubulovillous adenoma involving Brunner’s glands of duodenum

Benign neoplasia of the duodenum are very rare. Moreover, duodenal tubulovillous adenomas are more uncommon lesions. The microscopic structure of tubulovillous adenoma has frond-like projection of mucosa with branching papillary structure and generally upward growth into the lumen. We describe a 72-year-old man who showed aduodenal tubulovillous adenoma with unusual inverted cystic growth pattern. Interestingly, this tubulovillous adenomatous lesion was interrupted by gastric metaplasia in the deep portion of the cyst and was closely surrounded by Brunner’s glands. Although histogenesis of gastric metaplasia of duodenum is not fully understood, Brunner’s glands has been suggested as a precursor for gastric metaplasia. Therefore, these findings argued that this adenoma arises from Brunner’s glands through gastric metaplasia. This is the first case of inverted cystic tubulovillous adenoma involving Brunner’s glands of duodenum with gastric metaplasia.

A Rare Case of Synchronous Bilateral Pleomorphic Adenoma of the Parotid Gland

Multiple parotid gland tumors are unusual. Warthin’s tumor is the most represented neoplasm in this condition. We present a case of bilateral synchronous pleomorphic adenoma affecting the parotid glands in a 28-year-old woman. Clinically, the lesions were similar to solitary pleomorphic adenoma. Both lesions were diagnosed by fine-needle aspiration cytology. A total parotidectomy for left tumor and surgical enucleation for the right tumor, respectively, were performed with no facial nerves injury. A review of the pertinent literature is included.