Malignant melanoma:An important differential diagnosis for clear cell sarcoma of the gastrointestinal tract

A case report by Liu et al describes the characteristics of metastatic clear cell sarcoma(CCS)of the pancreas and provides valuable therapeutic insights for this rare malignancy.This case is interesting because of its rarity,suggesting that the pancreas may be a potential target organ for CCS,either primary or metastatic.At the same time,the authors also emphasize the importance of regular postoperative follow-up for timely detection of recurrent lesions,as CCS is characterized by a high degree of malignancy and a high rate of recurrent metastases.Considering that CCS of the gastrointestinal tract is easily confused with malignant melanoma(MM)of the gastrointestinal tract,here we compare the clinical features,histopathological and immunohistochemical characteristics,diagnosis,treatment,and prognosis of CCS and MM of the gastrointestinal tract,hoping to provide a reference for clinical work.

Chinese guidelines for diagnosis and treatment of melanoma 2018(English version)

1. Overview2. Screening and diagnosis2.1 Surveillance and screening of high-risk population2.2 Diagnosis of melanoma2.2.1 Clinical symptoms2.2.2 Imaging diagnosis2.2.3 Laboratory tests2.2.4 Focus biopsy2.3 Pathological diagnosis of melanoma2.3.1 Criteria for pathological diagnosis2.3.2 Standard pathological diagnosis of melanoma2.3.3 Pathological report of melanoma2.4 Clinical diagnostic criteria and route map of melanoma3. Staging4. Treatment4.1 Surgical treatment4.1.1 Wide excision4.1.2 Sentinel lymph node biopsy (SLNB).

Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery

BACKGROUND Intracranial infection is a common clinical disease.Computed tomography(CT)and magnetic resonance imaging(MRI)have certain sensitivity and have good diagnostic efficacy.AIM To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.METHODS We selected 82 patients who underwent craniocerebral surgery(including 40 patients with intracranial infection and 42 patients without infection)during the period from April 2016 to June 2019 in our hospital.All 82 patients received CT and MRI examinations,and their clinical data were reviewed.A retrospective analysis was performed,and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods.The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.RESULTS For all types of pathogenic infections(Staphylococcus aureus,Staphylococcus hemolyticus,Staphylococcus epidermidis,and others),MRI scans had higher positive diagnostic coincidence rates than CT scans;the overall diagnostic coincidence rate,sensitivity,specificity,positive predictive value,and negative predictive values were significantly higher with MRI examinations than with CT examinations,and the differences were statistically significant(P<0.05).CONCLUSION MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery.Compared with CT,MRI had higher diagnostic efficiency.The diagnostic sensitivity and specificity,the diagnostic coincidence rate,and the positive and negative predictive values were significantly higher with MRI than with conventional CT,which can be actively promoted.

National guidelines for diagnosis and treatment of melanoma 2022 in China(English version)

Contents1.Overview 2.Screening and diagnosis 2.1 Surveillance and screening of high-risk population 2.2 Diagnosis of melanoma 2.2.1 Clinical symptoms 2.2.2 Imaging diagnosis 2.2.3 Laboratory tests 2.2.4 Focus biopsy 2.3 Pathological diagnosis of melanoma 2.3.1 Criteria for pathological diagnosis 2.3.2 Standard pathological diagnosis of melanoma 2.3.3 Pathological report of melanoma 2.4 Clinical diagnostic criteria and route map of melanoma.

Comments on Chinese guidelines for diagnosis and treatment of melanoma 2018(English version)

Melanoma is a rare malignant tumor in China;however,its mortality rate is high and the incidence rate is also increasing year by year.In order to improve the efficacy of melanoma treatment,the National Health Commission of the People’s Republic of China revised Chinese guidelines for diagnosis and treatment of melanoma in 2018,and meanwhile its modified English version Chinese guidelines for diagnosis and treatment of melanoma 2018(English version)(1)is also published.Based on the most updated research findings for the Chinese ethnicity with emphasis on acral and mucosal melanomas,two most commonly seen subtypes in Asia,as well as treatment for melanoma liver metastases.

Intestinal Behçet's disease: A review of clinical diagnosis and treatment

Behçet's disease(BD)is a chronic inflammatory disorder prone to frequent re-currences,with a high predilection for intestinal involvement.However,the ef-ficacy and long-term effects of surgical treatment for intestinal BD are unknown.In the current issue of World J Gastrointest Surg,Park et al conducted a retrospec-tive analysis of 31 patients with intestinal BD who received surgical treatment.They found that elevated C-reactive protein levels and emergency surgery were poor prognostic factors for postoperative recurrence,emphasizing the adverse impact of severe inflammation on the prognosis of patients with intestinal BD.This work has clinical significance for evaluating the postoperative condition of intestinal BD.The editorial attempts to summarize the clinical diagnosis and treatment of intestinal BD,focusing on the impact of adverse factors on surgical outcomes.We hope this review will facilitate more precise postoperative management of patients with intestinal BD by clinicians.

Anorectal Malignant Melanoma：Diagnosis and Treatment of 42 Cases

Objective：Anorectal malignant melanoma（AMM） is a rare and aggressive malignant tumor,and its treatment still controversial.This study was to investigate and summarize our experience on diagnosis,treatment and misdiagnosis of AMM.Methods：From August 1980 to December 2009,42 patients with AMM were treated in our hospital.The clinical data of those patients were retrospectively analyzed,including the major symptoms,treatment and prognosis.Further immunophenotyping analyses using antibodies to S-100 protein,HMB-45 reactive antigen and vimentin were performed in 22 specimens.Results：The major complaints among the 42 cases were hematochezia（23/42,55.0%）,anal masses（12/42,28.6%）,changes in stool character（4/42,9.5%）,and anal tenesmus or pain（3/42,7.1%）.The misdiagnosis rate was 62%（26/42）,the most common misdiagnosis consisted of hemorrhoid（9/26,34.6%）,polyps（11/26,42.3%） and rectal cancer（6/26,23.1%）.28 cases underwent abdominoperineal resection,10 underwent local wide excision,3 underwent palliative operation,and 1 with no operation.After surgery,15 patients underwent radiotherapy,21 underwent chemotherapy and 8 were treated with both.22 cases deceased within 1 year,11 within 2 years,5 within 3 years and 1 within 4 years.The median survival time was 11 months,with the longest of 45 months.The immunohistochemical findings revealed that the S-100 protein was present in all 22 cases（100%）,HMB-45 was stained in 19 of 22（86.4%） and vimentin in 21 of 22（95.5%）.Conclusion：AMM is a rare disease with a poor prognosis and with an aptitude of being misdiagnosed.Hematochezia is the most common symptom.Immunohistochemical staining is conducive to the diagnosis of AMM.Operation is the major treatment,the operation type should be individualized.

Comments on National guidelines for diagnosis and treatment of melanoma 2022 in China(English version)

Melanoma remains a rare malignant tumor with high mortality and increasing incidence in China. Due to ethnic characteristics, acral and mucosal melanomas are the predominant subtypes in Asia, many research advances have been made in melanoma these years, especially for these two subtypes. In keeping with the development of key research on melanoma.

A robust system for melanoma diagnosis using heterogeneous image databases

Early diagnosis of melanoma is essential for the fight against this skin cancer. Many melanoma detection systems have been developed in recent years. The growth of interest in telemedicine pushes for the development of offsite CADs. These tools might be used by general physicians and dermatologists as a second advice on submission of skin lesion slides via internet. They also can be used for indexation in medical content image base retrieval. A key issue inherent to these CADs is non-heterogeneity of databases obtained with different apparatuses and acquisition techniques and conditions. We hereafter address the problem of training database heterogeneity by developing a robust methodology for analysis and decision that deals with this problem by accurate choice of features according to the relevance of their discriminative attributes for neural network classification. The digitized lesion image is first of all segmented using a hybrid approach based on morphological treatments and active contours. Then, clinical descriptions of malignancy signs are quantified in a set of features that summarize the geometric and photometric features of the lesion. Sequential forward selection (SFS) method is applied to this set to select the most relevant features. A general regression network (GRNN) is then used for the classification of lesions. We tested this approach with color skin lesion images from digitized slides data base selected by expert dermatologists from the hospital “CHU de Rouen-France” and from the hospital “CHU H&#233;di Chaker de Sfax-Tunisia”. The performance of the system is assessed using the index area (Az) of the ROC curve (Receiver Operating Characteristic curve). The classification permitted to have an Az score of 89,10%.

Recent advances in computerized imaging and its vital roles in liverdisease diagnosis, preoperative planning, and interventional liversurgery: A review

The earliest and most accurate detection of the pathological manifestations of hepatic diseases ensures effective treatments and thus positive prognostic outcomes.In clinical settings,screening and determining the extent of a pathology are prominent factors in preparing remedial agents and administering approp-riate therapeutic procedures.Moreover,in a patient undergoing liver resection,a realistic preoperative simulation of the subject-specific anatomy and physiology also plays a vital part in conducting initial assessments,making surgical decisions during the procedure,and anticipating postoperative results.Conventionally,various medical imaging modalities,e.g.,computed tomography,magnetic resonance imaging,and positron emission tomography,have been employed to assist in these tasks.In fact,several standardized procedures,such as lesion detection and liver segmentation,are also incorporated into prominent commercial software packages.Thus far,most integrated software as a medical device typically involves tedious interactions from the physician,such as manual delineation and empirical adjustments,as per a given patient.With the rapid progress in digital health approaches,especially medical image analysis,a wide range of computer algorithms have been proposed to facilitate those procedures.They include pattern recognition of a liver,its periphery,and lesion,as well as pre-and postoperative simulations.Prior to clinical adoption,however,software must conform to regulatory requirements set by the governing agency,for instance,valid clinical association and analytical and clinical validation.Therefore,this paper provides a detailed account and discussion of the state-of-the-art methods for liver image analyses,visualization,and simulation in the literature.Emphasis is placed upon their concepts,algorithmic classifications,merits,limitations,clinical considerations,and future research trends.

Current perspectives on pancreatic serous cystic neoplasms:Diagnosis, management and beyond

Pancreatic cystic neoplasms have been increasingly recognized recently. Comprising about 16% of all resected pancreatic cystic neoplasms, serous cystic neoplasms are uncommon benign lesions that are usually asymptomatic and found incidentally. Despite overall low risk of malignancy, these pancreatic cysts still generate anxiety, leading to intensive medical investigations with considerable financial cost to health care systems. This review discusses the general background of serous cystic neoplasms, including epidemiology and clinical characteristics, and provides an updated overview of diagnostic approaches based on clinical features, relevant imaging studies and new findings that are being discovered pertaining to diagnostic evaluation. We also concisely discuss and propose management strategies for better quality of life.

Diagnosis and surgical treatment of primary hepatic lymphoma

AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnosis. The mean delay time between initial symptoms and final diagnosis was 26.8 d (range:14-47 d). Hepatitis B virus infection was noted in 33.3% of these patients. Most of the lesions were found to be restricted to a solitary hepatic mass. The surgical procedure performed was left hepatectomy in five cases, including left lateral segmentectomy in three. Right hepatectomy was performed in three cases and combined procedures in one. One patient died on the eighth day after surgery,secondary to hepatic insufficiency. The cumulative 6-mo, 1-year, and 2-year survival rates after hepatic surgery were, respectively, 85.7%,71.4%, and 47.6%. One patient survived for>5 years after surgery without any signs of recurrence until latest follow-up, who received routine postoperative chemotherapy every month for 2 years and then regular follow-up. By univariate analysis, postoperative chemotherapy was a significant prognostic factor that influenced survival (P=0.006). CONCLUSION: PHL is a rare entity that is often misdiagnosed, and has a potential association with chronic hepatitis B infection. The prognosis is variable, with good response to early surgery combined with postoperative chemotherapy in strictly selected patients.

Intussusception in adults:Clinical characteristics,diagnosis and operative strategies

AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS： There were 20 rases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine （85%）. There were three （15%） cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION： Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.

Advances in early diagnosis and therapy of pancreatic cancer

BACKGROUND: Pancreatic cancer remains a devastating disease with a 5-year survival rate of less than 5%. Recent advances in diagnostic methods and therapeutic approaches have increased the possibility of improving the existing poor prognosis. DATA SOURCES: English-language articles reporting early diagnosis and therapy of pancreatic cancer were searched from the MEDLINE and PubMed databases, Chinese-language articles were from CHKD (China Hospital Knowledge Database) RESULT: The current literature about pancreatic cancer was reviewed from three aspects: statistics, screening and early detection, and therapy. CONCLUSIONS: Early detection and screening of pancreatic cancer currently should be limited to high risk patients Surgical resection is the only curative approach available, with some recent improvement in outcomes. Gemcitabine has been a standard treatment during the last decade. Gemcitabine based combination treatment, especially combined with newer molecular targeted agents, is promising. The rationale for radiotherapy is controversial, but with the recent development of modern radiation delivery techniques, radiotherapy should be intensified. Patients with borderline pancreatic cancer could benefit from neoadjuvant therapy but more evidence is needed and the best neoadjuvant regimen is still to be determined.

Pulmonary artery sarcoma successfully treated by right pneumonectomy after definitive diagnosis

Pulmonary artery sarcoma(PAS)is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy.Early diagnosis and radical surgical resection offer the only chance for survival.However,making a preoperative histopathological diagnosis is quite difficult.We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism.After confirming a definitive diagnosis using a catheter suction biopsy,we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass.Eighteen months after surgery,no recurrence was observed.

Pancreatic insulinomas: diagnosis and surgical treatment of 74 patients

Objective: To summarize retrospectively the experi- ence in diagnosis and surgical treatment of pancreatic insulinoma. Method: 74 patients who had been operated on and confirmed pathologically from July 1967 to July 2001 were enrolled. They were 37 men and 37 women, aged 41.91 years on average. Results: In all patients with typical Whipple's triad, the ratio of insulin to glucose was measured over 0.3 for at least one time. 52.70 % of the patients were once misdiagnosed, and only 20.27 % of them were correctly diagnosed in a year after onset of symp- toms. Their average course of the disease was 3.36 years. B-ultrasonography and endoscopic ultrasonog- raphy (EUS) showed a low positive rate for localiza- tion of insulinoma. CT and magnetic resonance ima- ging (MRI) could correctly detected 63.41% and 63.64 % of tumors respectively, in sharp contrast to a localization rate of 90 % for arterial stimulation and venous sampling (ASVS). Single insulinoma was ob- served in 66 patients (89.19 %), multiple insulinoma in 2 (2.70 %), hyperplasia in 4 (5.41%), and malig- nant insulinoma in 2 (2. 70%). Most (85. 29%) of the benign insnlinomas were less than 2 cm in diame- ter. Simple enucleation was the major operative pro- cedure for benign tumors. In 88. 52% of the pa- tients, glycemia increased to normal in 30 minutes after tumor excision, and in the remaining patients within 2 hours. 97. 26% of the patients experienced temporary hyperglycemia but recovered in a week. The major complications of insnlinoma included pan- creatic fistulae (27.27 %) and pancreatitis (5. 19 %). Conclusions: Better recognization of insulinoma and its rational examination are essential to early diagno- sis. CT can be first used for localization, otherwise ASVS is used. Surgery is the major choice for the treatment of insulinoma, but cautions should be taken to pancreatic fistulae after operation.

Clinical diagnosis and management of pancreatic mucinous cystadenoma and cystadenocarcinoma:Single-center experience with 82 patients

BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MCN are particularly important.AIM To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTS Of the 82 patients included in this study,70 had MCA and 12 had MCC.Tumor size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,respectively.CONCLUSION Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with MCN.Surgical resection is the primary treatment modality for MCC and MCA.

Update on diagnosis and management of cuboid fractures

Cuboid fractures due to the particular bone anatomy and its protected location in the midfoot are rare, and they are usually associated with complex injuries of the foot. Clinical examination to diagnose these fractures should be detailed and the differential diagnosis, especially in the case of vague symptoms, should include the exclusion of all lateral foot pain causes. Conventional radiographs do not always reveal occult fractures, which can be under diagnosed especially in children. In this case, further investigation including magnetic resonance imaging or scintigraphy may be required. The treatment of these injuries depends on the particular fracture characteristics. Non-displaced isolated fractures of the cuboid bone can be effectively treated conservatively by immobilization and by avoiding weight bearing on the injured leg. In the case of shortening of the lateral column> 3 mm or articular displacement > 1 mm, surgical management of the fracture is mandatory in order to avoid negative biomechanical and functional consequences for the foot and adverse effects such as arthritis and stiffness as well as painful gait. In this review, an update on diagnosis and management of cuboid fractures is presented.

Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China

AIM: To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years (1980-2000). METHODS: The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively. RESULTS: Abdominal pain,jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%).Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures.In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality. CONCLUSION: The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly.CT and ERCP were of great help in the classification of the disease.Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli's disease) with frequently recurrent cholangitis.

Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy:Significance of preoperative diagnosis

We present a female patient with sigmoid colon endometriosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hy- pointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.