Endoscopic ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms

This research aimed to examine the diagnostic accuracy and clinical significance of endoscopic ultrasonography(EUS)in the context of small rectal neuroendocrine neoplasms(NENs).A total of 108 patients with rectal subepithelial lesions(SELs)with a diameter of<20 mm were included in the analysis.The diagnosis and depth assessment of EUS was compared to the histology findings.The prevalence of NENs in rectal SELs was 78.7%(85/108).The sensitivity of EUS in detecting rectal NENs was 98.9%(84/85),while the specificity was 52.2%(12/23).Overall,the diagnostic accuracy of EUS in identifying rectal NENs was 88.9%(96/108).The overall accuracy rate for EUS in assessing the depth of invasion in rectal NENs was 92.9%(78/84).Therefore,EUS demonstrates reasonable diagnostic accuracy in detecting small rectal NENs,with good sensitivity but inferior specificity.EUS may also assist physicians in assessing the depth of invasion in small rectal NENs before endoscopic excision.

Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms

AIM:To investigate the diagnostic accuracy of endoscopic ultrasonography(EUS)for rectal neuroendocrine neoplasms(NENs)and the differential diagnosis of rectal NENs from other subepithelial lesions(SELs).METHODS:The study group consisted of 36 consecutive patients with rectal NENs histopathologically diagnosed using biopsy and/or resected specimens.The control group consisted of 31 patients with homochronous rectal non-NEN SELs confirmed by pathology.Epithelial lesions such as cancer and adenoma were excluded from this study.One EUS expert blinded to the histological results reviewed the ultrasonic images.The size,original layer,echoic intensity and homogeneity of the lesions and the perifocal structures were investigated.The single EUS diagnosis recorded by the EUS expert was compared with the histological results.RESULTS:All NENs were located at the rectum 2-10 cm from the anus and appeared as nodular(n=12),round(n=19)or egg-shaped(n=5)lesions with a hypoechoic(n=7)or intermediate(n=29)echo pattern and a distinct border.Tumors ranged in size from 2.3 to 13.7 mm,with an average size of 6.8 mm.Homogeneous echogenicity was seen in all tumors except three.Apart from three patients(stage T2 in two and stage T3 in one),the tumors were located in the second and/or third wall layer without involvement of the fourth and fifth layers.In the patients with stage T1 disease,the tumors were located in the second wall layer only in seven cases,the third wall layer only in two cases,and both the second and third wall layers in27 cases.Approximately 94.4%(34/36)of rectal NENs were diagnosed correctly by EUS,and 74.2%(23/31)of other rectal SELs were classified correctly as nonNENs.Eight cases of other SELs were misdiagnosed as NENs,including two cases of inflammatory lesions and one case each of gastrointestinal tumor,endometriosis,metastatic tumor,lymphoma,neurilemmoma,and hemangioma.The positive predictive value of EUS for rectal NENs was 80.9%(34/42),the negative predictive value was 92.0%(23/25),and the diagnostic accuracy was85.1%.CONCLUSION:EUS has satisfactory diagnostic accuracy for rectal NENs with good sensitivity,but unfavorable specificity,making the differential diagnosis of NENs from other SELs challenging.

Underwater endoscopic mucosal resection for neoplasms in the pyloric ring of the stomach: Four case reports

BACKGROUND Tumors located in the pylorus are technically more complex to resect by endoscopic resection,as the anatomical characteristics of this region can affect the adequate assessment of margins and performance of the procedure.We reported the results of underwater endoscopic mucosal resection(UEMR)of benign mucosal neoplasms located in the pyloric ring.CASE SUMMARY This case series describes 4 patients with 4 mucosal neoplasms located in the pyloric ring.The diameter of each neoplasm was less than 15 mm.We performed UEMR for the lesions.Water immersion enabled slight floating of the lesions,resulting in easy identification.We achieved en bloc resection with a snare and electrosurgical unit.All procedure were performed within 3 min without adverse events.Pathologic examination showed low-grade dysplasia with clear resection margins in one case and hyperplastic polyps in three cases.CONCLUSION UEMR can be an effective and safe treatment method for neoplasms in the gastric pyloric ring.

Metastatic stomach lymphoepithelioma-like carcinoma and immune checkpoint inhibitor therapy:A case report

BACKGROUND Pulmonary lymphoepithelioma-like carcinoma(PLELC)is a rare type of nonsmall-cell lung cancer.Stomach lymphoepithelioma-like carcinoma(LELC)metastasis secondary to PLELC has not been reported recently.CASE SUMMARY A 64-year-old female was admitted to our hospital for a regular gastroscopy examination with a 6-year history of surgical resection for left PLELC.Positron emission tomography/computed tomography suggested high accumulation of 18F-fludeoxyglucose in the gastric cardia region.Upper gastrointestinal endoscopy confirmed a large mass at the stomach fundus.Immunohistochemistry(IHC)of the biopsy suggested metastatic stomach LELC.Proximal gastrectomy showed that this 6.5 cm×5.0 cm mass was located in the stomach fundus near the cardia.Histopathological examination showed a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltration.IHC demonstrated that the tumor was positive for CK(AE1/AE3),p63,p40,p53,Ki-67(70%),and EGFR(3+)and negative for CK7,CK20,Her2,and CD10.In situ hybridization analysis showed positive staining Epstein-Barr virus-encoded RNA.Tumor programmed cell death ligand 1(PD-L1)expression score was 98%,and the combined positive score was 100,with no evidence of microsatellite instability.Thus,the patient was unequivocally diagnosed with metastatic stomach LELC secondary to pulmonary LELC.After discharge,this patient underwent PD-1 inhibitor treatment(toripalimab,240 mg)every 3 wk for ten cycles,and she has had no tumor recurrence.CONCLUSION For gastric LELC metastasis,PD-1 inhibitor therapy could become a new therapeutic approach,though there is still no evidence from large data sets to support this.

Experimental study on effect of recombinant human growth hormone combined with chemotherapy on stomach neoplasms implanted in nude mice

Objective: To investigate the effect of different doses of recombined growth hormone (rhGH) on stomach neo- plasms implanted in nude mice, and its efficacy in combining with chemotherapy (flurouracil, 5-FU). Methods: Human stom- ach neoplasms model was established in nude mice. The nude mice were divided into control group, moderate-dose of rhGH group, low-dose rhGH group, 5-FU group, moderate-dose rhGH/5-FU group, and low-dose rhGH/5-FU group. The results of each group were observed after ten days. Results: After therapy, the body mass of rhGH groups was significantly increased compared with control group (P<0.05), the body mass of rhGH/5-FU groups was significantly increased compared with 5-FU group (P<0.05), but it was no significant difference between rhGH/5-FU groups and control group (P>0.05). The average tumor mass and volume of rhGH groups were not significantly increased compared with control group (P>0.05), but they were significantly reduced in 5-FU group and rhGH/5-FU groups (P<0.05). They were no significant difference between rhGH/5- FU groups and 5-FU group (P>0.05). After treatment, the percentages of S, G0/G1 and G2/M phases and proliferation index (PI) were not significantly changed in rhGH groups compared with control group (P>0.05), and the same with rhGH/5-FU groups compared with 5-FU group (P>0.05). The difference caused by dose of rhGH was not significant. Conclusion: rhGH enhances body mass, does not stimulate tumor growth, and has no adverse effects on tumor bearing nude mice. Combined with flurouracil, rhGH does not influence the efficacy of chemotherapy, and has no effect on tumor cell cycle kinetics.

Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver?

Hepatocellular adenoma(HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography(CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A(SAA), focal positive for glutaminesynthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.

Systematic review of ablative therapy for the treatment of renal allograft neoplasms

BACKGROUND To date,there are no guidelines on the treatment of solid neoplasms in the transplanted kidney.Historically,allograft nephrectomy has been considered the only reasonable option.More recently,nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected cases.AIM To review outcomes of AT for the treatment of renal allograft tumours.METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist.PubMed was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA),cryoablation (CA),microwave ablation (MWA),high-intensity focused ultrasound (HIFU),and irreversible electroporation (IRE) of solid tumours of the kidney allograft.Only original manuscripts describing actual cases and edited in English were considered.All relevant articles were accessed in full text.Additional searches included all pertinent references.Selected studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa scale.Data on recipient characteristics,transplant characteristics,disease characteristics,treatment protocols,and treatment outcomes were extracted and analysed.Given the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series),a descriptive summary was provided.RESULTS Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 patients.Recipient age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 mo.Most of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical reasons.Preferred diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan,and magnetic resonance imaging.Main tumour types were: papillary renal cell carcinoma (RCC) and clear cell RCC.Maximal tumour diameter ranged from 5 to 55 mm.The vast majority of neoplasms were T1a N0 M0 with only 2 lesions staged T1b N0 M0.Neoplasms were managed by RFA (n = 78),CA (n = 15),MWA (n = 3),HIFU (n = 3),and IRE (n = 1).Overall,3 episodes of primary treatment failure were reported.A single case of recurrence was identified.Follow-up ranged from 1 to 81 mo.No cancer-related deaths were observed.Complication rate was extremely low (mostly < 10%).Graft function remained stable in the majority of recipients.Due to the limited sample size,no clear benefit of a single procedure over the other ones could be demonstrated.CONCLUSION AT for renal allograft neoplasms represents a promising alternative to radical nephrectomy and NSS in carefully selected patients.Properly designed clinical trials are needed to validate this therapeutic approach.

Localized type 1 autoimmune pancreatitis superimposed upon preexisting intraductal papillary mucinous neoplasms

A 70-year-old woman was found to have 2 cystic lesions in the head of the pancreas on abdominal ultrasonography during a routine medical examination.Endoscopic ultrasonography(EUS)and magnetic resonance cholangiopancreatography showed multilocular cysts in the head of the pancreas without dilation of the main pancreatic duct.The patient was followed-up semiannually with imaging studies for suspected branch duct-type intraductal papillary mucinous neoplasm(IPMN).At 3 years after initial presentation,hypoechoic lesions were observed around each pancreatic cyst by EUS.Diffusion-weighted imaging showed high-intensity regions corresponding to these lesions.Therefore,a diagnosis of invasive carcinoma derived from IPMN could not be excluded,and subtotal stomach-preserving pancreaticoduodenectomy was performed.The macroscopic examination of the surgical specimen showed whitish solid masses in the head of the pancreas,with multilocular cysts within each mass.Microscopically,each solid mass consisted of inflammatory cells such as lymphocytes and plasma cells.Furthermore,immunochemical staining revealed immunoglobulin G4-positive cells,and many obliterating phlebitides were observed.The cysts consisted of mucus-producing epithelial cells and showed a papillary growth pattern.Based on these findings,we diagnosed multiple localized type 1 autoimmune pancreatitis occurring only in the vicinity of the branch ducttype IPMN.

Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrastenhanced endoscopic ultrasonography

AIM: To elucidate the role of contrast-enhanced endoscopic ultrasonography(CE-EUS) in the diagnosis of branch duct intraductal papillary mucinous neoplasm(BD-IPMN).METHODS: A total of 50 patients diagnosed with BDIPMN by computed tomography(CT) and endoscopic ultrasonography(EUS) at our institute were included in this study. CE-EUS was performed when mural lesions were detected by EUS. The diagnostic accuracy for identifying mural nodules(MNs) was evaluated by CT, EUS, and EUS combined with CE-EUS. In the patients who underwent resection, the accuracy of measuring MN height with each imaging modality was compared. The cut-off values to diagnose malignant BD-IPMNs based on MN height for each imaging modality were determined using receiver operating characteristic curve analysis.RESULTS: Fifteen patients were diagnosed with BD-IPMN with MNs and underwent resection. The remaining 35 patients were diagnosed with BD-IPMN without MNs and underwent follow-up monitoring. The pathological findings revealed 14 cases with MNs and one case without. The accuracy for diagnosing MNs was 92% using CT and 72% using EUS; the diagnostic accuracy increased to 98% when EUS and CE-EUS were combined. The accuracy for measuring MN height significantly improved when using CE-EUS compared with using CT or EUS(median measurement error value, CT: 3.3 mm vs CE-EUS: 0.6 mm, P < 0.05; EUS: 2.1 mm vs CE-EUS: 0.6 mm, P < 0.01). A cut-off value of 8.8 mm for MN height as measured by CE-EUS improved the accuracy of diagnosing malignant BDIPMN to 93%. CONCLUSION: Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.

Long-term growth of intrahepatic papillary neoplasms: A case report

BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade;thus, we report the case of a patient with an IPNB that grew for over 13 years. CASE SUMMARY A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient’s wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB.CONCLUSION The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.

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.

Proton pump inhibitors and stomach neoplasm

This study aimed to explore the relationship between proton pump inhibitors(PPIs)and gastric tumors and determine the reasons behind these connections.We reviewed studies on PPIs and stomach tumors.We explored the relationship between PPIs and different types of gastric neoplasms according to the classification of gastric neoplasms.Long-term use of PPIs is associated with stomach infection,high gastrin levels,and rebound acid hypersecretion,which are directly or indirectly related to the development of gastric neoplasms.PPIs can increase the risk of gastric fundal polyps.Further evidence is needed to prove that it can increase the risk of gastric cancer.

Ultrasonographic Characteristics of Intraductal Papillary Mucinous Neoplasm of the Pancreas

Objective To analyze the clinical and ultrasonographic imaging features of intraductal papillary mucinous neoplasm(IPMN) of the pancreas.Methods Twelve patients with IPMN underwent surgery between May 2005 and December 2008,including 4(33.3%) with adenoma and 8(66.7%) with adenocarcinoma.IPMN was classified preoperatively into 3 types based on sonographic findings of different sites:main duct,branch duct,and combined type.All clinical presentations and ultrasonographic findings of those patients were reviewed and the correlation between ultrasonographic findings and histopathological results was analyzed.Results There were 9 men and 3 women with a mean age of 60.1±9.6 years(range,32-73).Of all the 12 patients with IPMN,9(75.0%) had experienced some symptoms of epigastric discomfort and/or pain as well as backache;7 cases were with medical history of acute pancreatitis,5 cases with diabetes,4 cases with elevated CA19-9,and 2 cases with steatorrhea.All lesions of IPMN have been revealed by transabdominal ultrasonography.The mean diameters of the lesions were 1.4±0.8 cm(range,0.5-2.0) and 6.3±6.0 cm(range,2.0-20.0) in adenomas and adenocarcinomas,respectively.And the mean diameters of the main duct in adenomas and adenocarcinomas were 1.0±0.8 cm and 1.6±1.0 cm,respectively.Among the 4 adnomas,3(75.0%) cases were classified as branch type based on sonographic findings,and 2 were demonstrated as mural nodules in which no color signals was detected.Among the 8 adenocarcinomas,5(62.5%) cases were classified as main duct type,and 3(37.5%) as combined type.In 7 of the 8 adenocarcinomas,mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected.Conclusions Transabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic ducts.Some characteristics should be noticed as suggesting the possibility of malignancy:clinical symptoms of pancreatic insufficiency,large tumor size,and mural nodules with color Doppler flow signals.Transabdominal ultrasonography could be a useful tool to help diagnose and make appropriate management of IPMN.

Extraskeletal Ewing sarcoma of the stomach:A rare case report

BACKGROUND Extraskeletal Ewing sarcoma(EES)is a rare and highly malignant small round cell tumor associated with a poor clinical outcome.Ewing sarcoma(ES)involving the stomach is an uncommon presentation and can be easily confused with other small round cell tumors.We herein present a rare case of ES involving the gastric area.CASE SUMMARY We report a case of gastric ES in a 19-year-old female patient who initially presented with a complaint of a tender epigastric mass for 5 d.Contrast-enhanced abdominal computed tomography revealed a soft-tissue-density mass with a diameter of 8.5 cm between the liver and stomach;the mass was connected to the gastric antrum.Then,the mass was surgically excised completely.Upon histopathological,immunophenotype and molecular analysis,the mass was identified to be a primary gastric ES.CONCLUSION EES is an aggressive tumor with poor prognosis.Therefore,early diagnosis and timely intervention are essential for a good prognosis.It is imperative for us to raise awareness about this rare tumor.Surgical resection is still the best treatment option.

经腹超声引导下经皮穿刺活检对内镜超声引导下穿刺活检诊断胰腺肿瘤的补充价值

目的 观察经腹超声引导下经皮穿刺活检对内镜超声(EUS)引导下穿刺活检诊断胰腺肿瘤的补充价值。方法 回顾性分析30例因EUS引导下穿刺活检诊断结果不满意(未见肿瘤细胞20例、可见异常细胞但无法明确诊断10例)而接受经腹超声引导下经皮穿刺活检的胰腺肿瘤患者,评价后者的补充诊断价值。结果 20例EUS引导下穿刺活检未见肿瘤细胞患者中,经腹超声引导下穿刺活检明确诊断11例肿瘤及其病理类型,7例可见异常细胞但未能明确诊断,2例仍未见肿瘤细胞;10例EUS引导下穿刺结果无法明确诊断患者中,经腹超声引导下穿刺活检明确诊断9例肿瘤及其病理类型,1例为非典型细胞。结论 经腹超声引导下经皮穿刺活检对EUS引导下穿刺活检诊断胰腺肿瘤具有较高补充价值。

超声人工智能辅助诊断系统用于甲状腺髓样癌

目的 以甲状腺乳头状癌(PTC)为对照,对比超声甲状腺人工智能(AI)辅助诊断系统(AI辅助诊断系统)与不同年资超声医师诊断甲状腺髓样癌(MTC)的效果。方法 纳入经病理证实的63枚MTC、70枚PTC和62枚良性结节。以AI辅助诊断系统分析并识别结节,将恶性概率值≥0.40者诊断为恶性结节;由高、中及初级职称医师各1名利用我国甲状腺影像报告和数据系统(C-TIRADS)对甲状腺结节进行分类;对比两种方法诊断MTC及PTC的效能。结果 AI辅助诊断系统诊断MTC和PTC的敏感度、特异度、阳性预测值、阴性预测值、准确率及曲线下面积(AUC)均低于3名医师;高、中级职称医师与AI辅助诊断系统诊断MTC和PTC的AUC差异均有统计学意义(P均<0.01),初级职称医师与AI辅助诊断系统AUC差异均无统计学意义(P均>0.05)。AI辅助诊断系统诊断MTC的敏感度、特异度、阳性预测值、阴性预测值、准确率及AUC均低于其诊断PTC,但AUC差异无统计学意义(P>0.05)。结论 超声甲状腺AI辅助诊断系统诊断MTC效能较高。

超声乳腺影像报告和数据系统联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤

目的观察超声乳腺影像报告和数据系统(BI-RADS)联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤(PTB)的价值。方法回顾性分析74例经乳腺超声检查及术后病理证实的PTB女性患者共76个病灶,包括良性57个、交界性14个及恶性5个,比较3种病变患者年龄及其超声BI-RADS分类,观察以单一年龄、超声BI-RADS及其联合鉴别诊断价值。结果良性、交界性及恶性PTB之间,患者年龄及超声BI-RADS分类差异均有统计学意义(P=0.026、0.015)。以44.5岁、超声BI-RADS 4B类及其联合鉴别良性与交界性/恶性PTB的敏感度分别为94.74%、36.84%及73.68%,特异度分别为56.36%、87.27%及72.73%,曲线下面积分别为0.769、0.649及0.780。结论超声BI-RADS分类联合患者年龄有助于鉴别良性与交界性/恶性PTB。

基于倾向性评分匹配的T_(4a)期胃癌腔镜辅助与开腹手术近期疗效的对比分析

目的:探讨T_(4a)期胃癌行腹腔镜辅助D2根治术的近期疗效。方法:采用倾向性评分匹配,分析2014年1月至2020年12月为T_(4a)期胃腺癌患者行D2淋巴结清扫的临床资料。将患者分为开腹组(n=362)与腹腔镜组(n=134),通过倾向性评分匹配对数据进行1∶1匹配,匹配容差设为0.03。最终获得两组病例各134例。比较两组手术情况、术后并发症、术后炎性指标变化及2年总生存率。结果:倾向性匹配后,两组基线资料具有可比性(P>0.05)。两组术后首次进食时间、住院时间、并发症情况差异均无统计学意义(P>0.05);腹腔镜组与开腹组手术时间[240(203.75,256.25)min vs.140(120,190)min,P<0.05]、术中出血量[200(100,300)mL vs.200(200,300)mL,P<0.05]、淋巴结清扫数量[20.5(17,27.25)vs.16(10,23),P<0.05]、切口长度[5(5,6)cm vs.12(10,15)cm,P<0.05]、术后排气时间[4(3,6)d vs.5(3,6)d,P<0.05]、术后下床活动时间[2(2,3)d vs.3(2,3)d,P<0.05]差异均有统计学意义。两组术前中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值、淋巴细胞-单核细胞比值差异无统计学意义(P>0.05),术后血小板-淋巴细胞比值差异无统计学意义,腹腔镜组中性粒细胞-淋巴细胞比值低于开腹组,淋巴细胞-单核细胞比值高于开腹组,差异有统计学意义。开腹组与腹腔镜组术后2年总生存率为53.3%与48.3%,差异无统计学意义(P=0.211)。结论:对于T_(4a)期胃癌,腹腔镜手术后并发症发生率、2年生存率与开腹手术相当,但腹腔镜手术具有创伤小、美观、术后康复快的优势。

1例初始表现为急性弥散性血管内凝血的胃低分化腺癌伴多发转移:^(18)F-FDG PET/CT显像所见

患者女,20岁,无明显诱因阵发性下腹部疼痛伴牙龈出血、皮肤散在瘀斑及肛门坠胀感9天;既往体健。查体:贫血貌,全身皮肤散在片状瘀斑,四肢皮肤干燥;腹部柔软,无压痛及反跳痛。实验室检查:红细胞2.49×10^(12)/L,血小板36×10^(9)/L,血红蛋白70 g/L,血浆鱼精蛋白副凝固实验(+),D-二聚体>20 mg/L,纤维蛋白原降解产物>150.00 mg/L,糖类抗原12573.40 U/ml。

血清miR-345、miR-138及miR-22与晚期胃癌患者化疗敏感性的相关性分析

【目的】探讨血清微小RNA-345(miR-345)、miR-138及miR-22与晚期胃癌患者化疗敏感性的相关性。【方法】100例均接受同一化疗方案治疗的晚期胃癌患者,依据疗效分为有效组(n=69)及无效组(n=31),比较两组临床病理特征及血清相关指标,绘制受试者工作特征(ROC)曲线分析血清miR-345、miR-138及miR-22预测晚期胃癌化疗效果的价值,采用多因素Logistic回归分析影响患者化疗效果的因素。【结果】Ⅲ期患者的血清miR-345相对表达量低于Ⅳ期患者,miR-138及miR-22相对表达量高于Ⅳ期患者(P<0.05);有效组miR-345低于无效组,miR-138、miR-22高于无效组(P<0.05)。经ROC曲线分析证实,血清miR-345、miR-138及miR-22能用于预测晚期胃癌的化疗效果,其敏感度与特异性分别为0.855、0.935、0.971、0.839和0.884、0.903(均P<0.05)。多因素Logistic回归分析显示,病理分期为Ⅳ期、miR-345≥14.5、miR-138≤2及miR-22≤3.12为晚期胃癌患者化疗效果不佳的危险因素(P<0.05)。【结论】血清miR-345≥14.5、miR-138≤2、miR-22≤3.12均为导致化疗效果不佳的危险因素,其可作为评估患者化疗效果的生物学标志物。