Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Absence of enhancement in a lesion does not preclude primary central nervous system T-cell lymphoma:A case report

BACKGROUND Primary central nervous system lymphoma(PCNSL)is a non-Hodgkin lymphoma that originates in the central nervous system(CNS)and is exclusively limited to the CNS.Although most PCNSLs are diffuse large B-cell lymphomas,primary CNS T-cell lymphomas(PCNSTLs)are rare.PCNSTLs typically demonstrate some degree of enhancement on contrast-enhanced magnetic resonance imaging(MRI).To the best of our knowledge,non-enhancing PCNSTL has not been reported previously.CASE SUMMARY A 69-year-old male presented to the neurology department with complaints of mild cognitive impairment and gradual onset of left lower leg weakness over a span of two weeks.Initial MRI showed asymmetric T2-hyperintense lesions within the brain.No enhancement was observed on the contrast-enhanced T1 image.The initial diagnosis was neuro-Behçet’s disease.Despite high-dose steroid therapy,no alterations in the lesions were identified on initial MRI.The patient’s symptoms deteriorated further.An MRI performed one month after the initial scan revealed an increased lesion extent.Subsequently,brain biopsy confirmed the diagnosis of PCNSTL.The patient underwent definitive combined chemoradiotherapy.However,the patient developed bacteremia and died of septic shock approximately three months after diagnosis.CONCLUSION The absence of enhancement in the lesion did not rule out PCNSTL.A biopsy approach is advisable for pathological confirmation.

Synchronous primary duodenal papillary adenocarcinoma and gallbladder carcinoma:A case report and review of literature

BACKGROUND Synchronous primary cancers(SPCs) have become increasingly frequent over the past decade.However,the coexistence of duodenal papillary and gallbladder cancers is rare,and such cases have not been previously reported in the English literature.Here,we describe an SPC case with duodenal papilla and gallbladder cancers and its diagnosis and successful management.CASE SUMMARY A 68-year-old Chinese man was admitted to our hospital with the chief complaint of dyspepsia for the past month.Contrast-enhanced computed tomography of the abdomen performed at the local hospital revealed dilatation of the bile and pancreatic ducts and a space-occupying lesion in the duodenal papilla.Endoscopy revealed a tumor protruding from the duodenal papilla.Pathological findings for the biopsied tissue revealed tubular villous growth with moderate heterogeneous hyperplasia.Surgical treatment was selected.Macroscopic examination of this surgical specimen revealed a 2-cm papillary tumor and another tumor protruding by 0.5 cm in the gallbladder neck duct.Intraoperative rapid pathology identified adenocarcinoma in the gallbladder neck duct and tubular villous adenoma with high-grade intraepithelial neoplasia and local canceration in the duodenal papilla.After an uneventful postoperative recovery,the patient was discharged without complications.CONCLUSION It is essential for clinicians and pathologists to maintain a high degree of suspicion while evaluating such synchronous cancers.

Proteomic identification of tumor biomarkers associated with primary gallbladder cancer

AIM:To identify potential biomarkers of primary gallbladder cancer(PGC).METHODS:Fresh PGC,cholecystitis and normal gallbladder tissue specimens collected from 10 patients,respectively,were subjected to comparative proteomic analysis.The proteomic patterns of PGC were compared with those of cholecystitis and normal gallbladder tissues using two-dimensional gel electrophoresis(2-DE).The differentially expressed proteins were then identified using a MALDI-TOF mass spectrometer(MS)and database searches.To further validate these proteins,20 samples of PGC tissues and normal tumoradjacent tissues were collected for Western blot,quantitative real-time PCR,and immunohistochemical staining assay.RESULTS:Seven differentially expressed protein spots were detected by 2-ED analysis by comparing the average maps of PGC,cholecystitis and normal gallbladder tissues.Six of the seven differentially expressed proteins were identified using MALDI-TOF MS,with three overexpressed and three underexpressed in PGC tissue.Protein levels of annexin A4(ANXA4)were significantly elevated,and heat shock protein90-beta(Hsp90β)and dynein cytoplasmic 1 heavy chain 1(Dync1h1)were decreased in PGC tissues relative to the normal tumor-adjacent tissues as shown by Western blot analysis.However,levels of actin,aortic smooth muscle and gamma-actin were unchanged.In addition,the mRNA levels of all 5 proteins showed similar changes to those of the protein levels(P<0.01).Further validation by immunohistochemical analysis showed the upregulated expression of ANXA4 and decreased expression of Hsp90βand Dync1h1 in the cytoplasm of PGC tissues relative to the normal tumoradjacent tissues.CONCLUSION:Three proteins are identified as potential biomarkers of PGC using proteomic analysis.The functions of these proteins in the carcinogenesis of PGC remain to be studied.

Early diagnosis of primary gallbladder carcinoma

Objective: To improve early diagnosis of primary gallbladder carcinoma (PGC) and the understanding of its pathogenesis, pathological stages and progno- sis. Methods: The data from 679 patients with PGC trea- ted in our hospital from 1956 to 1998 were analyzed retrospectively. Results: The incidence of PGC has been increasing in recent years, and the treatment is not satisfactory. Upon diagnosis, most patients with PGC were at ad- vanced stage. PGC was usually found in elderly women. The ratio of man to woman was 1:3. The gallstone, closely related to PGC, was found in 60% of the patients with PGC. The diagnostic accordance rate before and after operation was Iow. In most pa- tients, PGC was found unexpectedly during opera- tion for gallstone or acute cholecystitis. Many pa- tients with PGC missed the opportunity of diagnosis and therapy because doctor only noticed the diagnosis of gallstone. Pathological classification revealed that PGC in most patients (84.4%) were adenocarcino- ma. Imaging helped to find early-stage cases and im- prove prognosis. Conclusions: Understanding of pathogenesis, patho- logical stages and prognosis of PGC and proper use of various examinations are essential to the early di- agnosis and treatment of the disease.

A new blood supply for human primary gallbladder carcinomas:vasculogenic mimicry,and its correlation with VEGF and significance

Objective To explore if vasculogenic mimicry (VM) exists in human primary gallbladder carcinomas and evaluate the correlation between the VM and expression of vascular epithelial growth factor (VEGF) in gallbladder carcinomas and its significance. MethodsSeventy-four carcinomas, 10 adenomas and 10 chronic inflammatory lesions of the gallbladder underwent operation and confirmed histopathologically were studied. Clinical-pathological data and survival of each patient with gallbladder carcinoma were recorded and followed-up. VM in human gallbladder carcinomas was observed under light microscope by HE staining, CD31 and PAS staining; the expression of VEGF proteins in each paraffin section of each patient in vivo was determined by Envision method of immunohistochemistry; the correlation among the VM, VEGF expression and their clinical significance in the patients with gallbladder carcinomas were analyzed and compared by Kaplan-Meier actuarial survival curves and Cox multiple factors. Results①13.5% (10/74) of human gallbladder carcinomas were found to contain VM, namely intratumoral, tumor cell-lined extracellular matrix (ECM)-rich, PAS-positive and vasculogenic-like network patterns. VM was associated with histological type (χ2=10.241,P=0.017), hepatic metastasis (χ2=4.238,P=0.042) and poor overall survival (χ2=5.722 1,P=0.016). ②Expression of VEGF was increased significantly in carcinomas with or without VM than adenomas and inflammatory lesions of the gallbladder (P<0.000 1) in vivo; VEGF expression in the gallbladder carcinomas without VM was increased significantly than that with VM (P=0.018 2). ③There is positive correlation between expression of VEGF and the gallbladder carcinomas without VM in the cases of Nevin stage (P=0.003 5), invasion depth (P=0.005 9), liver metastases (P=0.037 3) and lymph node metastases (P=0.000 1), the same correlation was only observed between expression of VEGF and the gallbladder carcinomas with VM in the cases of liver metastases (P=0.032 3). When being compared the non-VM gallbladder carcinomas with the VM gallbladder carcinomas, expression of VEGF in the same conditions of Nevin stage (S3～S5, P=0.049 0) was higher significantly in the gallbladder carcinomas without VM than those with VM. ④The non-VM group underwent operation with positive expression of VEGF had longer 5-year survival than the VM group (P=0.007 2), furthermore, the non-VM group underwent operation with negative expression of VEGF had longer 5-year survival than the positive expression group (P=0.031). Also, VM, as invasive depth, lymph node metastasis, hepatic metastasis and operational method, is an independent, risk prognostic factor for patients with gallbladder carcinoma by Cox multiple factor analysis. ConclusionsVM, as a new blood supply for the growth of gallbladder carcinomas, is found to exist in the patients with gallbladder carcinomas. Increased expression of VEGF and its negative correlation with VM were observed in the gallbladder carcinomas. It is showed that VM is an independent risk prognostic factor in patients with gallbladder carcinoma, and VEGF is an important clinical marker for evaluation of Nevin stage, invasion depth, lymph node or liver metastases and prognosis in patients with gallbladder carcinoma; VM and VEGF are especially of important markers for estimating of prognosis in the gallbladder carcinoma patients.

Heterochronic triple primary malignancies with Epstein-Barr virus infection and tumor protein 53 gene mutation:A case report and review of literature

BACKGROUND The diagnosis and etiology of multiple primary malignant neoplasms(MPMNs)are difficult to establish.Here,we report a case of heterochronic triple primary malignancies with gastric cancer,nasopharyngeal squamous cell cancer,and then rectal cancer.CASE SUMMARY The patient was first diagnosed with gastric cancer at the age of 33 in 2014 and underwent distal gastrectomy and gastrojejunostomy and six cycles of adjuvant chemotherapy.Three years later,he was diagnosed with nasopharyngeal cancer and treated with radical chemoradiotherapy in 2017.Recently,a mass in the middle of the rectum was resected and reported as ulcerative,moderately to poorly differentiated adenocarcinoma.Research on the etiology of MPMNs showed that Epstein-Barr virus(EBV)infection may be the cause of gastric cancer and nasopharyngeal squamous cell cancer since these two primary lesions were positive for transcripts of EBV-encoded ribonucleic acid using an in situ hybridization EBV-encoded ribonucleic acid probe in formalin-fixed,paraffinembedded tissue.The cause of rectal cancer may be due to a somatic mutation of tumor protein 53 gene in exon 8(c.844C>T,p.Arg282Trp)through highthroughput sequencing for the rectal cancer.Appropriate standard therapy for each primary cancer was administered,and the patient has no evidence of cancer disease to date.CONCLUSION To our knowledge,this is the first report on heterochronic triple primary malignancies whose cause may be associated with EBV infection and tumor protein 53 genetic mutations.The etiological research may not only elucidate the cause of MPMN but also has implications in clinical management.

Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature

BACKGROUND Spinal metastases are common in patients with malignancies,but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis.Knowledge of surgical complications,particularly perioperative mortality,in patients with spinal metastases from unidentified sources is still insufficient.CASE SUMMARY A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra(T7).Radiographic examinations,as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion,resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion.Therefore,spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis.Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma.As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery,the origin of this metastasis was undetermined.We discuss this case with respect to reported perioperative mortality in similar cases.CONCLUSION A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.

Genetic characteristics of a patient with multiple primary cancers:A case report

BACKGROUND Two or multiple primary malignant neoplasms(MPMNs)rarely occur in the same patient.It has been reported that MPMNs are easily misdiagnosed as the recurrence or metastasis of malignancies in clinical practice,affecting the choice of treatment for the patients,thereby resulting in the delay of optimal diagnosis.Next generation sequencing(NGS)can be used to distinguish between multiple primary lung cancers and intrapulmonary metastasis,and may distinguish the origin of tumours in different sites of the body.CASE SUMMARY We report the case of 66-year-old woman who suffered from different malignant neoplasms in the rectum and esophageal and gastrointestinal tract.The first neoplasm rectal adenocarcinoma was diagnosed and removed in 2016.The second and third lesions were diagnosed with esophageal squamous-cell carcinoma(ESCC)and gastrointestinal stromal tumour(GIST),respectively,in 2019.Nextgeneration whole exome sequencing was performed on the tissue specimens of rectal carcinoma,esophageal cancer,GIST,and white blood cells to investigate the relationship between malignancies at different timeframe and determine whether the ESCC and GIST evolved from the rectal adenocarcinoma.Mutations including v-Ki-ras2-Kirsten rat sarcoma viral oncogene homolog,adenomatosis polyposis coli,and mothers against decapentaplegic homolog 4 were detected in rectal adenocarcinoma sample,mast/stem cell growth factor receptor was detected in GIST tissue,and lysine methyltransferase 2D was detected in ESCC specimen.Overall,ESCC and GIST were not genetically evolved from rectal adenocarcinoma,and this patient did not have a trunk driven clone.CONCLUSION NGS is an effective tool to study clonal evolution of tumours and distinguish between MPMNs and intrapulmonary metastasis.

Radiotherapy of double primary esophageal carcinoma

INTRODUCTIONDouble primary esophageal carcinoma is defined ashaving two loci of squamous cell cancersimultaneously or consecutively developing indifferent sites of esophagus.This rare diseaseappears mostly in the literature as case reports,reports about its treatment are even moreinfrequent.Here we present our experiences

Synchronous quintuple primary gastrointestinal tract malignancies: Case report

Multiple primary malignancy is defined as two or more malignancies detected in an individual person. In particular, synchronous quintuple primary malignancy is extremely rare. A 52-year-old male with anal pain and intermittent blood-tinged stool was diagnosed with malignancies in the stomach, jejunum, ascending colon, transverse colon and rectum. He underwent a subtotal gastrectomy, segmental resection of the jejunum and total protocolectomy with end ileostomy. The postoperative pathologic findings were moderate differentiated gastric adenocarcinoma(pT1b N0M0, p StageⅠA), combined adenocarcinoma and neuroendocrine carcinoma of the jejunum(pT3N0M0, p StageⅡA), three mucinous adenocarcinoma of the ascending colon(pT3N0M0, pStageⅡA), transverse colon(pT1N0M0, p StageⅠ) and rectum(pT3N1 a M0, p StageⅢB). The tumors did not lack MLH-1 and MSH-2 expression, as the markers(bat26, D5S346, bat25, D2S123) suggest MSI-H presence. Adjuvant chemoradiotherapy was started according to regimen, FOLFOX 4 for advanced rectal cancer. Six years post-operation, the patient is currently attending regular follow-ups without recurrence or metastasis.

DIAGNOSTIC VALUE OF WHOLE BODY DIFFUSION WEIGHTED IMAGING FOR SCREENING PRIMARY TUMORS OF PATIENTS WITH METASTASES

Objective To evaluate the values of whole body diffusion weighted imaging (DWI) in screening primary unknown tumor in patients with metastases. Methods Totally, 34 patients with metastases of primary unknown tumors were scanned with whole body DWI, and conventional magnetic resonance (MR) imaging was performed if suspected lesions were detected. All the metastases including 27 cases of osseous metastases, 2 brain metastases, 2 liver metastases, 1 pulmonary multiple metastasis, 1 neck metastasis and 1 malignant ascites, were diagnosed by computed tomography, single photon emission computed tomography, or MR imaging. For the proven primary tumors diagnosed by biopsy or pathology of surgical specimens, apparent diffusion coefficient (ADC) values of the primary and metastatic lesions were measured respectively. The sensitivity and specificity of this technique for screening primary tumors were evaluated. Results We found 24 cases with suspected primary lesions, in which 23 lesions were proved to be primary tumors, and 1 was proved to be benign lesion. And no definite primary lesion was found in 10 cases on whole body DWI, but in which 1 case was diagnosed with primary tumor by biopsy later, and the other 9 cases remained unknown within follow-up of over half a year. The difference was not significant in ADC values between primary and metastatic lesions (P>0.05). The sensitivity and specificity of whole body DWI for searching primary tumors was 95.8% and 90.0%, respectively. Conclusion Combined with conventional MR scanning, whole body DWI can help to search primary lesions of patients with metastases.

Pathogenesis and clinical spectrum of primary sclerosing cholangitis

Primary sclerosing cholangitis(PSC) is a disease of the biliary tract, which has been documented in the literature since 1867. This disease has a strong predilection for affecting men and can be seen in individuals as young as 2 years of age. PSC has a strong associated with inflammatory bowel disease, more commonly with ulcerative colitis, and is also part of the clinical spectrum of Ig G4-related diseases. Smallduct PSC, a variant of PSC, also has an association with inflammatory bowel disease. The exact pathogenesis of PSC is not well understood at present, however, is likely a combination of a genetic predisposition with alteration of the molecular structure of the gut. Abnormal serum liver chemistry and presence of certain autoimmune markers are usually the first indicators leading to a diagnosis of PCS, however, these may often be normal in early stages of this disease. The diagnosis is made by cholangiography, which is now considered the gold standard. PSC is a known pre-malignant condition. Such patients have an increased risk of developing cholangiocarcinoma, gallbladder neoplasia, and colon cancer. Many new treatment modalities have emerged in the recent past, including anti-tumor necrosis factor-α and anti-integrins; however, liver transplantation is the only known cure for PSC. Despite past and present research, PSC remains an enigmatic biliary disease with few viable treatment options.

Synchronous primary cancers of the endometrium and ovary： review of 43 cases

目的将调查子宫内膜和卵巢的同步原发癌的临床、病理学的特征，治疗方法，和预后。有子宫内膜和卵巢的同步原发癌的 43 个病人的临床的数据回顾地被考察的方法。幸存被 Kaplan-Meier 方法计算并且比较了使用木头等级测试。结果在诊断的病人的中部的年龄是 49 年(范围， 28 73 年) 。最普通的症状是反常阴道流血(69.8%) 并且腹或骨盆的疼痛(44.2%) 。骨盆的群众在 39.5% 病人被发现并且在药品检查在 27.9% 扩大了宫体，当骨盆的群众在 43 个病人(29 个案例) 中的 67.4% 个被发现并且变厚时或在 23.3% 的反常子宫内膜(10 个案例) 在超声检查期间。CT/MRI 检查的 25 个病人，骨盆的群众在 13 种情况中被发现并且在 11 种情况中扩大了子宫。经历了子宫内膜的活体检视的所有 15 个病人被证明有子宫内膜样癌。浆液 CA125 水平被发现与中部的价值在 34 个检验盒子(64.7%) 中的 22 个中被提高 500 U/mL (范围， 39 3439 U/mL ) 。子宫内膜的癌的 FIGO 阶段：IA 18 盒子， IB 20 盒子， IC 2 盒子，和 IIA 3 盒子；卵巢的癌的阶段：IA 19 大小写， IB 4 盒子， IC 7 盒子， II 4 盒子，和 IIIC 9 盒子。24 个病人(55.8%) 在舞台我子宫内膜、卵巢的癌。同时， 31 个病人与网膜切除术和阑尾切除术加双边的输卵管卵巢切除术经历了全部的子宫切除 12 个病人有骨盆的淋巴节点解剖。43 个病人(88.4%) 中的 38 个有一病理地证明的子宫内膜的腺癌。占优势的卵巢的组织学与子宫内膜样部件是子宫内膜样或混合瘤(30/43， 69.8%) 。手术后地， 26 个病人(60.5%) 独自收到了辅助化疗，加放射疗法的 12 有的化疗，仅仅一个病人有独自一个的放射并且留下 4 个盒子没收到辅佐疗法。这个组的 3 年、 5 年的幸存率分别地是 87.4% 和 71.1% 。有子宫内膜样癌在的病人的 3 年、 5 年的幸存率子宫内膜、卵巢比有 non-endometrioid 的那些的高或混合了 histologic 子类型(93.8% ， 82% 对 79.7% ， 69%) 。有早阶段疾病的病人的 3 年、 5 年的幸存率比另外的病人的那些好(93.3% ， 93.3% 对 69.7% ， 36.7%) 。复发在 15 个病人(34.9%) 发展了。它被降低加放射疗法的化疗显著地并且断然影响了的 CA125 水平，早 FIGO 阶段，和助手的 univariate 分析显示出 5 年的幸存评价，当加放射疗法的仅仅早的 FIGO 舞台和化疗被揭示由时多变量分析同样独立的预示的因素。子宫内膜和卵巢的结论同步原发癌与也不同主要子宫内膜或卵巢的癌症，当通常它能与好预后在早舞台被检测时。进一步的预后需要上的 CA125 水平的影响学习了。外科治疗可能独自为早阶段病人是足够的。化疗正放射疗法可能为先进病人是必要的。

An atypical primary malignant melanoma arising from the cervical nerve root: A case report and review of literture

BACKGROUND Primary melanomas affecting the central nervous system are very rare,and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer.As a consequence,not much is known about this.CASE SUMMARY Here we report a case of primary malignant melanoma originating in the cervical spinal cord nerve root.A 64-year-old woman presented with symptoms of numbness in the right side of the neck,pain,and hypoesthesia in the right upper limb which persisted for 1 year.Neurological examination showed that the superficial sensation in the right upper limb had decreased with muscle strength of grade 4.Magnetic resonance imaging examination revealed a mass(approximately 2.5 cm×1.4 cm×1 cm)in the right side of the spinal canal in the C-2 plane.Based on findings obtained during operation,perioperative examination,pathological diagnosis,and the diagnostic criteria of primary central melanoma proposed by Hayward,the mass was confirmed to be a melanoma of intraspinal nerve root origin.CONCLUSION This is the first case of primary malignant melanoma originating from cervical spinal cord nerve roots and spread along the inside and outside of the spinal canal.The clinical relevance of this case is discussed to provide new insights into the differential diagnosis of intraspinal tumours.Further studies are needed to better understand the mechanisms driving the growth pattern and development of this type of tumour.

Advances in the Study of High-Risk Gene Mutations for Primary Myelofibrosis

Primary myelofibrosis is a kind of MPNs due to clonal appreciation of hematopoietic stem cells. With the development of second-generation sequencing, high-risk mutation (HMR) genes such as ASXL1, EZH2, SRSF2, and IDH1/2 have been shown to be associated with disease prognosis and progression, and although allo-HSCT remains the only possible treatment for PMF, with the development of JAK inhibitors, there is an increasing interest in the study of inhibitors of these mutant loci.

Intraductal papillary neoplasm of the bile duct developing in a patient with primary sclerosing cholangitis: A case report

We report a case of intraductal papillary neoplasm of the bile duct(IPNB) that developed in a patient with primary sclerosing cholangitis. A 46-year-old woman was admitted to our hospital with obstructive jaundice. The liver function tests demonstrated increased serum liver enzyme levels. Computed tomography showed dilatation of the intrahepatic bile ducts. Abdominal ultrasonography revealed a highly echoic protruding lesion in the posterior bile duct near the right lobe of the liver. The lesion was suspected to be IPNB, but we were unable to confirm whether it was a carcinoma. A right hepatectomy was performed, and this showed that the dilated bile duct was filled with mucin and contained several yellowish papillary tumors. Histologically, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. The tumor was diagnosed as IPNB, high-grade intraepithelial neoplasia secreting abundant mucin. No recurrence has been detected 3 years after surgery.

Microsatellite instable double primary cancers of the colorectum and stomach exhibit less favorable outcome

AIM: To ascertain the adequacy of the microsatellite instability (MSI) as a prognostic indicator by assessing MSI status of patients with double primary gastric and colorectal cancer (DPGCC).METHODS: Sixteen patients were studied, all of whom exhibited sporadic DPGCC, and had no family history of hereditary non-polyposis colorectal cancer, according to the Amsterdam criteria. A total of 32 cancers from 16DPGCC patients, and 216 single primary CRC, were assessed for MSI in 5 microsatellite loci, BAT25, BAT26,D2S123, D5S346, and D17S250.RESULTS: MSI was observed in 6 (37.5%) of 16 GC and 4 (25.0%) of 16 CRC. Thirty tumors (13.9%) out of 216single primary CRC and one tumor (16.7%) out of 6 double primary CRC were found to be microsatellite unstable. Of the 6 GC with MSI in DPGCC, 5 (31.3%) were MSI-high and one (6.3%) was MSI-low. In 5 of 16 DPGCC patients,the cancer recurred in or adjacent to the anastomosis or metastasized to the kidney or lung. The MSI-high DPGCC cases were associated with a younger age of onset (47.5 years vs 62.5 years), higher frequency of lymph node metastasis (100% vs 25%), and advanced Dukes stage (C, 100% vs 41.7%), as well as a higher frequency of recurrence or metastasis (100% vs 8.3%). Only recurrence or metastasis showed statistical significance by Fisher's exact test.CONCLUSION: Our data suggest that MSI may play an important role in the development of DPGCC, and that it may be used clinically as a molecular predictive marker for recurrence or late metastasis of DPGCC.

Detection of Unknown Primary Tumors Using Whole Body FDG PET

Objective: To assess the usefulness of 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in locating occult primary lesions. Methods: 50 patients with varying hetero-geneous metastases of unknown primary origin were referred for FDG PET. The locations of the known metastatic tumor manifestations were distributed as follows: cervical lymph nodes metastases (n=18),skeletal metastases (n=15), cerebral metastases (n=12), others (n=5). All patients underwent whole body ^18F-FDG PET imaging. The images were interpreted by visual inspection and semi-quantitative analysis(standardized uptake value, SUV). The patients had undergone conventional imaging within 2 weeks of FDG PET. Surgical, clinical and histopathologic findings were used to assess the performance of FDG PET.Results: FDG PET was able to detect the location of the primary tumor in 32/50 patients (64%). The primary tumors were proved by histopathologic results, and located in the lungs (n=17), the nasopharynx(n=9), the breast (n=2), the ovary (n=l), the colon(n=l), the prostate(n=l),the thyroid (n=l). FDG PET were proved false positive in 2 patients (4%), and the suspicious primary tumors were in uterus and colon respectively. During the clinical follow-up of 2 to 26 months, the primary tumor was found in only 2 patients ( prostate cancer, gastric cancer). Conclusion: PET imaging allows identification of the primary site and metastatic lesions(including bone and soft tissue metastases) at a single examination.Whole body lSF-FDG PET allows effective localization of the unknown primary site of origin and can contribute substantially to patient care.

Laparoscopic cholecystectomy based on Laennec approach via the cystic plate with lymphadenectomy in Calot's triangle for gallbladder neoplasms:Initial experience and technical details

Background:It is still challenging to define the exact stage of early gallbladder carcinoma with preoperative imaging.Generally,subserous gallbladder is dissected for the potential early gallbladder carcinoma,which may cause incomplete tumor resection or tumor spread especially for the patients with T2 stage.Here,we reported our experience and safety of Laennec approach via the cystic plate to dissect the whole gallbladder with lymphadenectomy in Calot's triangle for accurate diagnosis and stage in gallbladder neoplasms.Methods:The anatomical gap between Laennec capsule and the cystic plate serves as the landmark to dissect the whole gallbladder through Laennec approach.Laparoscopic cholecystectomy based on Laennec approach via the cystic plate,together with lymphadenectomy in Calot's triangle,was performed in 17 patients with gallbladder neoplasms.Results:All patients had less intraoperative bleeding,no gallbladder breakage,no bile leakage,and accurate intraoperative rapid pathological staging under the corresponding strategies.The duration of surgery was comparable to that of traditional laparoscopic cholecystectomy.Conclusion:Laparoscopic cholecystectomy based on Laennec approach via the cystic plate,together with lymphadenectomy in Calot's triangular is safe for gallbladder neoplasms.In the future,the prospective clinical trial is going on to confirm the feasibility and effectiveness of this approach.