Is endoscopic submucosal dissection safe for papillary adenocarcinoma of the stomach?

AIM: To identify the clinicopathological predictors of lymph node(LN) metastasis and evaluate the outcomes of endoscopic submucosal dissection(ESD) in papillary adenocarcinoma-type early gastric cancers(EGCs).METHODS: From January 2005 to May 2013, 49 patients who underwent surgical operation and 24 patients who underwent ESD for papillary adenocarcinomatype EGC were enrolled to identify clinicopathological characteristics and predictive factors of LN metastasis and to evaluate the outcomes of ESD for papillary adenocarcinoma-type EGC.RESULTS: Most papillary adenocarcinoma-type EGCs were located in the lower third of the stomach and had an elevated macroscopic shape. The overall prevalence of LN metastasis was 18.3%(9/49). The presence of lymphovascular invasion was found to be a predictor of LN metastasis(P = 0.016). According to current indication criteria of ESD, 6 and 11 of the 49 patients had absolute and expanded indications for ESD, respectively. Two patients(11.8%) with expanded indication for ESD had LN metastasis. Of the 24 patients who underwent ESD, 13(54%) achieved out-of-ESD indication, with 9 of those 13 patients undergoing surgical operation due to non-curative resection. CONCLUSION: The use of ESD should be carefully considered for papillary adenocarcinoma-type EGC with suspected ESD indication after pre-treatment work-up because of the higher frequency of LN metastasis and additional surgeries.

Concomitant pancreatic adenocarcinoma in a patient with branch-duct intraductal papillary mucinous neoplasm

Branch duct intraductal papillary mucinous neoplasms(BD-IPMN) are pre-malignant pancreatic cystic lesions which carry a small risk of malignant transformation within the cyst. Guidelines exist with respect to surveillance of the cysts using computed tomography, magnetic resonance imaging, and/or endoscopic ultrasound(EUS). There are reports that patients with IPMNs are at increased risk of developing pancreatic adenocarcinoma, which arises in an area separate to the IPMNs. We present two cases of pancreatic adenocarcinoma arising within the parenchyma, distinct from the IPMN-associated cyst, identified with EUS. This case report highlights that patients with BD-IPMN are at increased risk for pancreatic adenocarcinoma separate from the cyst and also the importance for endosonographers to carefully survey the rest of the pancreatic parenchyma separate from the cyst in order to identify small pancreatic adenocarcinomas.

Malignant transformation of pulmonary bronchiolar adenoma into mucinous adenocarcinoma:A case report

BACKGROUND Bronchiolar adenoma(BA)and ciliated muconodular papillary tumor are rare tumors that have bilayered cell proliferation and continuous expression of p40 and CK5/6 in the basal cell layer.Diagnosis is difficult because of the limited knowledge of these tumors and their morphological similarities to malignant tumors,including invasive mucinous adenocarcinoma,especially based on the histopathology of intraoperative frozen sections.These tumors are now considered to be benign neoplasms,with malignant transformation reported in only a few cases.CASE SUMMARY A 57-year-old woman presented with a 17.0 mm×7.0 mm nodule in the lower lobe of the left lung.Hematoxylin-eosin staining and immunohistochemistry of a surgical specimen were performed.The tumor consisted of a BA area and a mucinous adenocarcinoma(MA)area.In the BA area,the tumor had a bilayered structure of luminal cells and basal cells.The basal cells were positive for CK5/6 and p40,but the MA area was negative for these biomarkers.The Ki-67 proliferation index was low(1%-2%).The patient was diagnosed with BA accompanied by MA,and had a favorable outcome.CONCLUSION The present study indicated that BA may be carcinogenic,and suggests that clinicians should be aware of its potential for malignant transformation.

Unusual Cystic and Papillary Appearance of Brain Metastasis from Papillary Lung Adenocarcinoma on MRI. Radiologic-Pathologic Correlations in Two Similar Cases

We report two cases of brain metastasis from a lung adenocarcinoma. Magnetic Resonance Imaging (MRI) appearance was closely correlated with the macroscopic and microscopic findings that showed multiples nodules of a well-differentiated papillary adenocarcinoma with secreting tubules, surrounded by mucoid fluid.

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.

鼻咽部乳头状腺癌4例临床分析及文献复习

目的 探讨鼻咽部乳头状腺癌的临床特征和预后,以期为该疾病的诊断和治疗提供参考。方法 回顾性分析2020年12月~2022年2月青岛大学附属医院耳鼻咽喉头颈外科收治的4例经鼻内镜手术完全切除鼻咽部乳头状腺癌患者的临床资料,4例均为男性,年龄45~67岁,平均年龄55岁,分析总结鼻咽部乳头状腺癌患者的临床特征、治疗方式及预后。结果 4例鼻咽部乳头状腺癌患者中2例主要症状为后吸涕中带血,1例为单侧鼻塞,1例为双侧流涕,患者经组织活检病理明确诊断后均接受了鼻内镜手术,术中将肿瘤完全切除,术后随访16~30个月,复查内镜及MRI未见肿瘤复发。结论 鼻咽部乳头状腺癌临床上极为少见,经鼻内镜手术完全切除是治疗鼻咽部乳头状腺癌的有效方式,患者预后较好。

Breast Cancer in a Supernumerary Breast at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital: About a Case

Accessory or ectopic breast tissue is an anomaly in the development of the breast. It is a rare condition that occurs along the embryological mammary line. In less than 1% of all breast cancers, supernumerary breast cancer is reported, with the axillary location being the most common in 60% to 90% of cases. Cancerous degeneration of this supernumerary breast tissue can pose a dual diagnostic and therapeutic problem. We report the case of locally advanced adenocarcinoma in a right supernumerary breast. This is a 75-year-old, grand-multiparous, postmenopausal, and known hypertensive patient on treatment. Family history was remarkable for brain cancer in her sister and oesophageal cancer in her mother. She consulted for a mass in the right axillary cavity on supernumerary breast evolving for a year. Clinical examination revealed a large, fixed, budding and haemorrhagic-ulcerated mass of the right axilla, with long axis measuring about 15 cm. There was as wella supernumerary breast on the left, but without particularity. A soft tissue ultrasound showed a large hypoechoicmass in the right axillary region of 116 mm with areas of central necrobiosis. Morphologically, the breasts were normal. A breast MRI revealed a subcutaneous mass in the right axillary cavity with skin ulceration and satellite lymphadenopathy. The extension assessment revealed liver metastases, and a biopsy of the mass revealed a breast adenocarcinoma. The case was the subject of a multidisciplinary consultation meeting following which a wide excision of the mass was indicated. The histo-pathology analysis results of the surgical specimen were in favour of a triple negative papillary adenocarcinoma. After a post-operative multidisciplinary consultation meeting, adjuvant chemotherapy was indicated. The development of supernumerary breasts depends on hormones, just like normal breasts. Breast cancer in accessory breast tissue is quite rare with the incidence being 6%. The most common pathology is invasive carcinoma (50% - 75%). It is usually located in the armpit (60% - 70%) although it can be present in other less common locations such as the inframammary region (5% - 10%) and rarely the thighs, perineum, groin and the vulva. Since accessory axillary breast tissue is not considered during breast screening examination, it is necessary for clinicians to be aware of this entity and associated pathologies. Their preventive excision in women at high risk can also be considered.

Mucinous neoplasm of the appendix:A case report and review of literature

BACKGROUND Appendiceal mucinous neoplasms(AMNs),although not classified as rare,are relatively uncommon tumors most often discovered incidentally during colorectal surgery.Accurate identification of AMNs is difficult due to non-specific sym-ptoms,overlapping tumor markers with other conditions,and the potential for misdiagnosis.This underscores the urgent need for precision in diagnosis to pre-vent severe complications.CASE SUMMARY This case report describes the unexpected discovery and treatment of a low-grade AMN(LAMN)in a 74-year-old man undergoing laparoscopic hemicolectomy for transverse colon adenocarcinoma(AC).Preoperatively,non-specific gastroin-testinal symptoms and elevated tumor markers masked the presence of AMN.The tumor,presumed to be an AMN peritoneal cyst intraoperatively,was con-firmed as LAMN through histopathological examination.The neoplasm exhibited mucin accumulation and a distinct immunohistochemical profile:Positive for Ho-meobox protein CDX-2,Cytokeratin 20,special AT-rich sequence-binding protein 2,and Mucin 2 but negative for cytokeratin 7 and Paired box gene 8.This profile aids in distinguishing appendiceal and ovarian mucinous tumors.Postoperative recovery was uncomplicated,and the patient initiated adjuvant chemotherapy for the colon AC.CONCLUSION This case highlights the diagnostic complexity of AMNs,emphasizing the need for vigilant identification to avert potential complications,such as pseudomyxoma peritonei.

Prognosis of invasive intraductal papillary mucinous neoplasms of the pancreas

Intraductal papillary mucinous neoplasms(IPMN) are mucin producing cystic neoplasms of the pancreas histologically classified as having non-invasive and invasive components.The five-year survival rates for non-invasive and associated invasive carcinoma are 90% and 40%,respectively in resected IPMN lesions.Invasive carcinoma within IPMN lesions can be further classified by histological subtype into colloid carcinoma and tubular carcinoma.Estimated five-year survival rates following resection of colloid carcinoma range from 57%-83% and estimated five-year survival following resection of tubular carcinoma range from 24%-55%.The difference in survival outcome between invasive colloid and tubular IPMN appears to be a function of disease biology,as patients with the tubular subtype tend to have larger tumors with a propensity for metastasis to regional lymph nodes.When matched to resected conventional pancreatic adenocarcinoma lesions by the Memorial Sloan Kettering Cancer Center pancreatic adenocarcinoma nomogram,the colloid carcinoma histological subtype has an improved estimated five-year survival outcome compared to conventional pancreatic adenocarcinoma,87% and 23%(P = 0.0001),respectively.Resected lesions with the tubular carcinoma subtype overall have a similar five-year survival outcome compared to conventional pancreatic adenocarcinoma.However,when these groups were stratified by regional lymph node status patients with negative regional lymph nodes and the tubular subtype experienced significantly better survival than patients with a similar nodal status and ductal adenocarcinoma with estimated five-year survival rates of 73% and 27%(P = 0.01),respectively.

Differential gene expression profiling of gastric intraepithelial neoplasia and early-stage adenocarcinoma

AIM: To investigate the differentiated whole genome expression profiling of gastric high- and low-grade intraepithelial neoplasia and early-stage adenocarcinoma.

Pancreatic cancer screening in patients with presumed branch-duct intraductal papillary mucinous neoplasms

Because delayed diagnosis is one of the causes of poor prognosis in pancreatic ductal adenocarcinoma(PDAC), early detection is a key for overall improvement of prognosis. Towards this end, periodic screening is recommended for individuals considered high-risk for PDAC. Advances in diagnostic imaging modalities have increased the frequency of incidental findings of pancreatic cysts,including the intraductal papillary mucinous neoplasm(IPMN)-a major risk factor of PDAC, having 1% annual prevalence of concomitance with IPMN.Proper retainment of patients with IPMN and regular follow-up by routine imaging examination will likely improve early detection and better prognosis of PDAC. Unfortunately, current guidelines only address management of PDAC derived from IPMN and overlook PDAC concomitant with IPMN. Screening of patients with IPMN, by endoscopic ultrasonography(currently the most reliable modality for detecting small PDAC), may facilitate early detection of both IPMNderived and-concomitant PDAC. Prospective studies to evaluate the usefulness of endoscopic ultrasonography in screening of IPMN-concomitant PDAC will also help in determining the optimal surveillance strategy for more widespread applications.

Histo-molecular oncogenesis of pancreatic cancer:From precancerous lesions to invasive ductal adenocarcinoma

Pancreatic cancer is a lethal malignancy,whose precursor lesions are pancreatic intraepithelial neoplasm,intraductal papillary mucinous neoplasm,intraductal tubulopapillary neoplasm,and mucinous cystic neoplasm.To better understand the biology of pancreatic cancer,it is fundamental to know its precursors and to study the mechanisms of carcinogenesis.Each of these precursors displays peculiar histological features,as well as specific molecular alterations.Starting from such pre-invasive lesions,this review aims at summarizing the most important aspects of carcinogenesis of pancreatic cancer,with a specific focus on the recent advances and the future perspectives of the research on this lethal tumor type.

Adenocarcinoma of the nonpigmented ciliary epithelium manifested as an anterior chamber mass

Dear Editor,Adenocarcinoma of the nonpigmented ciliary epithelium（NPCE）is a rare malignant tumor which is not easy to be found in the early stage（[1]）.Herein,we report a case of adenocarcinoma of the NPCE in a Chinese boy and discuss its.

MRI在十二指肠乳头腺癌术前TNM分期中的价值

目的 探讨MRI对十二指肠乳头腺癌患者术前TNM分期的临床应用价值。方法 选取本院经手术病理证实为十二指肠乳头腺癌的48例患者术前进行TNM分期,并与术后病理结果相对照。结果 48例十二指肠乳头腺癌患者,MRI对肿瘤浸润深度T分期的总体诊断准确率为83.3%;对淋巴结转移情况N分期的总体诊断准确率为81.3%;对远处转移M分期的总体诊断准确率为95.8%。MRI对十二指肠乳头腺癌术前T、N分期与术后病理分期一致性较好(K=0.731,K=0.650),MRI对M分期与术后病理分期一致性很好(K=0.850)。结论 MRI检查可以较准确的判断肿瘤的浸润深度、淋巴结转移及远处转移情况,对于十二指肠乳头腺癌术前TNM分期具有一定优势。

侵袭性胰腺导管内乳头状黏液性肿瘤与胰腺导管腺癌的生存差异分析

目的分析侵袭性胰腺导管内乳头状黏液性肿瘤(IPMN)与胰腺导管腺癌(PDAC)的生存差异。方法研究对象为2012年1月—2022年6月在复旦大学附属中山医院普外科行手术治疗且临床资料完整的侵袭性IPMN患者91例和PDAC患者893例,术后病理明确诊断为侵袭性IPMN或PDAC,PDAC患者均行化学治疗(简称化疗)。收集所有患者的基线特征(性别、年龄、首发症状或疾病、糖尿病史、ASA分级、术前CA19-9水平),手术情况(手术时长、术中失血量、手术方式、动脉和静脉侵犯),术后并发症(胰漏、胃瘫、肺栓塞、出血),再手术率,术后拔除引流管、胃管的时间,住院时长,术后病理特征(肿瘤直径、TNM分期、周围脂肪浸润、脉管浸润),术后肿瘤复发或转移,以及辅助治疗情况。应用Rstudio 4.22的survminer包绘制生存曲线,两组生存曲线分析采用Kaplan-Meier法比较,采用Log-Rank检验。采用Cox风险回归模型进行多因素logistic回归分析侵袭性IPMN患者中位生存时间的影响因素。结果两组间年龄、各首发症状或疾病患者占比、术前CA19-9水平比较,差异均有统计学意义(P<0.05或0.01)。两组间患者各手术方式及肿瘤有无静脉侵犯患者占比比较,差异均有统计学意义(P值均<0.01);两组间手术时长、术中失血量、肿瘤有无动脉侵犯患者占比比较,差异均无统计学意义(P值均>0.05)。两组间术后各级胰瘘、胃瘫发生率比较,差异均有统计学意义(P<0.01或0.05);两组间术后肺栓塞和术后出血发生率、再手术率、术后拔除引流管、胃管时间和术后住院时长比较,差异均无统计学意义(P值均>0.05)。两组间肿瘤各T分期、N分期患者占比及肿瘤伴周围脂肪浸润率比较,差异均有统计学意义(P值均<0.01);两组间肿瘤直径、肿瘤各M分期患者占比及肿瘤伴脉管浸润率比较,差异均无统计学意义(P值均>0.05)。截至2022年10月30日,侵袭性IPMN组中,术后复发或转移23例;接受术后辅助治疗48例,均接受化疗,其中有9例接受了放射治疗,6例接受了阿帕替尼、尼妥珠单抗等靶向治疗或替雷丽珠单抗等程序性死亡受体1(PD-1)抑制剂治疗。侵袭性IPMN组中位生存时间为1034(819,1106)d,PDAC组为919(876,980)d,两组间中位生存时间的差异无统计学意义(P=0.82)。多因素logistic回归分析结果显示,年龄为侵袭性IPMN患者生存时间的影响因素(P=0.003)。结论侵袭性IPMN患者的肿瘤分期较PDAC患者更早,但侵袭性IPMN与PDAC患者间无明显生存差异。

胆囊癌误漏诊14例临床分析

目的 分析胆囊癌术前误漏诊的原因及防范措施。方法 回顾性分析2020年1月—2022年8月收治的误漏诊胆囊癌14例的临床资料。结果 14例中4例有多年胆囊结石史;均有右上腹疼痛不适,恶心呕吐6例,食欲缺乏、消瘦11例,乏力5例,发热2例,皮肤、巩膜黄染8例。14例均行超声检查,3例示胆囊单个隆起性圆形或椭圆形强光团且不随体位改变;11例囊腔体部见多个强回声光团,后方伴有尾影,体位变化时强回声光团会出现相应的位置改变。初步诊断为胆囊结石11例,胆囊息肉3例,均行腹腔镜胆囊切除术;11例胆囊结石者于胆囊体部发现结节状肿物。术后病理检查均提示胆囊乳头状腺癌。误诊时间3~5 d。8例Ⅱ期及3例Ⅲ期者术后辅以化疗。术后随访2年,4例失访,4例死亡,6例尚存活。结论 胆囊癌早期症状多样,易合并胆囊良性病变,早期行超声检查特异度不高,导致术前误漏诊率较高。加强对胆囊癌高危因素的认识,熟知其易与其他胆道疾病共存的特点,合理选用检查方法,必要时行病理检查,可降低术前误漏诊率。

cN0甲状腺乳头状癌手术方案选择临床分析

目的:探讨甲状腺乳头状癌(PTC)临床淋巴结阴性(cN)0患者手术方案选择。方法:分析2007年1月-2010年1月127例cN0PTC患者临床资料,根据术前临床分期及术中冰冻病理分期,113例行选择性颈部淋巴结清扫术:中央区淋巴结清扫术44例,扩大中央区淋巴结清扫术13例,功能性颈部淋巴结清扫术56例。分析比较淋巴结转移情况和各组淋巴结转移间的关系。结果:清扫淋巴结病理检查示隐性转移率30.1%(34/113);不同肿瘤侵犯范围和年龄的Ⅵ区淋巴结转移率差异有统计学意义(均P<0.05);不同性别及体质量指数的Ⅵ区淋巴结转移率间差异无统计学意义(P>0.05);Ⅱ～Ⅳ区淋巴结转移与Ⅵ区淋巴结转移情况存在相关性(r=0.610,P<0.01)。结论:cN0PTC患者应行中央区淋巴结清扫术,对高危转移患者可考虑扩大中央区行淋巴结清扫术。

鼻咽部原发性甲状腺样低级别乳头状腺癌临床病理学特征

目的探讨鼻咽部甲状腺样低级别乳头状腺癌(TL-LGNPPA)的临床病理学特点、诊断与鉴别诊断要点。方法报道1例鼻咽部甲状腺样低级别乳头状腺癌的临床及影像学资料,行HE染色、免疫组化标记及分子病理检测,分析其临床病理特征并随访患者预后,以及复习相关文献。结果患者女性,47岁。镜下肿瘤主要由具有纤维血管轴心的树枝状乳头、管状腺体和梭形细胞区构成。腺体不规则,呈囊状或管状,乳头和管腔表面被覆单层或假复层柱状上皮。瘤细胞圆形或卵圆形,核仁不明显,未见核分裂。免疫组化:肿瘤细胞CK7、CK19和TTF-1(+),TG、CD15和CK5/6(-)。原位杂交检测示EBER(-),BRAF基因1799位点15外显子(BRAFV600E)无突变。随访3年,无复发。结论原发性鼻咽部甲状腺样低级别乳头状腺癌是一种非常罕见的低度恶性肿瘤,明确诊断需结合病理组织学形态和免疫表型。

分化型甲状腺癌的手术范围探讨

目的探讨分化型甲状腺癌中央区肿大淋巴结快速冷冻病理检查对手术方案的指导意义。方法回顾性分析206例分化型甲状腺癌患者的临床资料,根据对中央区淋巴结快速冷冻病理的检查结果,分别对甲状腺癌患者行一侧全切+峡部切除或患侧功能性颈淋巴结清扫术。结果全组均行手术治疗,其中甲状腺乳头状癌198例(96.1%),直径<1 cm的微小乳头状癌87例(43.9%),甲状腺滤泡状癌8例(3.9%)。术后随访5年,随访率100.0%,1例在术后3年、2例在术后5年复发而再次手术,其他患者无复发。结论在分化型甲状腺癌患者的手术中,对中央区淋巴结的术中快速冷冻病理检查,可指导对甲状腺癌患者手术方式的选择,减少术后复发。

NF-κB p65、CyclinD1在甲状腺乳头状癌组织中的表达及意义

目的探讨NF-κBp65、CyclinD1在甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)在甲状腺乳头状癌组织中的表达及意义。方法采用免疫组化EnVision两步法检测257例PTC及癌旁甲状腺组织中的NF-κBp65、CyclinD1表达水平,并分析二者表达水平的变化与临床病理参数的关系。结果 (1)NF-κBp65、CyclinD1在PTC组织中的阳性率分别为58.8%(151/257)及89.9%(231/257),均显著高于癌旁正常甲状腺组织(P<0.01);(2)NF-κBp65、CyclinD1的表达水平与肿瘤大小、病灶数目、淋巴结转移及临床分期有关,与性别及年龄无关;(3)NF-κBp65与CyclinD1的表达呈正相关关系(P<0.01)。结论 NF-κBp65、CyclinD1的异常表达与甲状腺乳头状癌的发生发展、转移及预后有密切联系,联合检测二者表达水平可作为判断PTC生物学行为及预后指标,并为其新靶点治疗提供依据。