Preliminary assessing no-surgical treatment response in bronchogenic carcinoma with double-phase contrast material-enhanced computed tomography

Objective： To evaluate the efficacy of double-phase contrast material-enhanced computed tomography （CT） in assessing no-surgical treatment response in bronchogenic carcinoma preliminarily. Methods： 52 patients with bronchogenic carcinoma after no-surgical treatment underwent double-phase contrast material-enhanced computed tomography. Two spiral CT scans were obtained at 25 and 90 seconds respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 4 mUs by using an autoinjector. Precontrast and postcontrast attenuation on every scan was recorded and peak height was calculated. Enhancement pattern was evaluated on the images obtained at 25 and 90 seconds after injection of contrast medium. Results： Precontrast attenuation, postcontrast attenuation at 25 and 90 seconds were 42.20 ± 7.43 Hu, 57.35 ± 10.09 Hu and 71.85 ±12.45 Hu, respectively. No statistically significant difference in precontrast attenuation was found between our results in the study and the results in our old study （mean precontrast attenuation 40.70 Hu） which was obtained in cases before therapy （t = 1.455, P = 0.152 〉 0.05）. Peak height of bronchogenic carcinoma after no-surgical treatment （29.46 ±10.85 Hu） were significantly lower than that of bronchogenic carcinoma before therapy obtained in our old study （mean peak height 35.79 Hu; t = 4.206, P = 0.001 〈 0.05）. 32 of 52 cases showed homogeneous enhancement at 90 seconds. Of the 32 cases, there were 21 with inhomogeneous enhancement, 7 with inhomogeneous enhancement, 2 with central enhancement and 2 with peripheral enhancement at 25 seconds. Conclusion： Bronchogenic carcinoma after no-surgical treatment shows a gradual increase to the peak height after administration of contrast material. Peak heights can reflect the blood supply of bronchogenic carcinoma and might be index for evaluation of no-surgical treatment response in bronchogenic carcinoma.

Increasing secondary bacterial infections with Enterobacteriaceae harboring bla_(CTX-M-15) and bla_(CMY-6) in patients with bronchogenic carcinoma:an emerging point of concern

Objective:To look for secondary bacterial infections in bronchogenic carcinoma（BCA） with resistant organisms harboring bla genes considering the paucity of relevant studies.Methods: A total of 137 confirmed cases of BCA and 34 healthy volunteers were studied for the occurrence and prevalence of blaCTX-M and and blaAmpC harboring-enterobacteriaceae.A subset of these patients（n=69） was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages（BAL） were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of blaCTX-M and blaAmpC.The isolates were also screened for the association of insertion sequence（IS26） by PCR and characterized by RAPD for any clonal relatedness.Results:A total of 143 bacterial isolates were obtained from 137 BAL specimens of BC,patients.The Enterobacteriaceae-isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides.Both blaCTX-M and blaAmpC of CIT family were detected in 77.4%and 27.4%isolates,respectively.Sequencing revealed the presence of blaCTX-M-15 and blaCMY-6.Twenty one percent of the isolates were simultaneously harboring blaampC and blaCTX-M-15.IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified.The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier.Conclusions:We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections,along with secondary fungal infections,so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.

Correlation of the quantifiable parameters of blood flow pattern derived with dynamic CT in solitary bronchogenic adenocarcinoma

Objective:To evaluate the correlation of the quantifiable parameters of blood flow pattern derived with dynamic CT in solitary bronchogenic adenocarcinoma(SBA).Methods:46 patients with solitary bronchogenic adenocarcinomas (SBA)(diameter≤4 cm)underwent multi-location dynamic contrast material-enhanced(nonionic contrast material was administrated via the antecubital vein at a rate of 4 mL/s by using an autoinjector 90 mL,4×5 mm or 4×2.5 mm scanning mode with stable table were performed)serial CT.Precontrast and postcontrast attenuation on every scan was recorded.Perfusion (PBA),peak height(PHBA),ratio of peak height of the SPN to that of the aorta(BA-to-A ratio)and mean transit time(MTT)were calculated.The correlation between peak height of the aorta(PHA)and parameters of the SBA(PHBA,BA-to-A ratio,PBA,and MTT)and those among parameters of the SBA were assessed by means of linear regression analysis.Regression equation among parameters of the SBA were obtain by means of stepwise regression.Results:The correlation between the SBA peak height(PHBA,36.78 HU±12.02)and the aortic peak height(PHA)was significant(r=0.506,P<0.0001).No significant cor- relation was found between the BA-to-Apeak height ratio(15.33%±4.55)and the aortic peak height(r=0.130,P=0.388> 0.05)as it was between the SBA perfusion(PBA,31.86 mL/min/100 g±9.74)and the aortic peak height(r=0.049,P=0.749 >0.05).The SBA perfusion correlated with the PHBA and the BA-to-A peak height ratio(r=0.394,P=0.007<0.05;r=0.407, P=0.005<0.05).The PHBA correlated positively with the BA-to-A peak height ratio(r=0.781,P<0.0001).Mean transit time was 14.84 s±5.52.PBA=18.500+0.872×BA-to-A ratio.BA-to-A ratio=4.467+0.295×PHBA.Conclusion:The linear correlation between the SBA perfusion and BA-to-Aratio and that between BA-to-Aratio and PHBA can be expressed by equation. It is possible to design a simpler scanning procedure of investigation of bronchogenic adenocarcinoma angiogenesis.

Study of serum level of sex hormones and expression of their receptors in patients with bronchogenic carcinoma

Objective: To study the serum level of estradiol, progesterone and testosterone (SEL, SPL and STL) and the expression of the receptors of estradiol and progesterone (ER and PR) in 53 cases of bronchogenic carcinoma. Methods: ER and PR in the tissue of the carcinoma were determined with enzyme-linked affinity histochemical method. SEL, SPL and STL were measured with double antibody radioimmunoassay. Results: Most of ER and PR were present in the cytoplasm of the malignant cells (58.2%) and the positive rates of ER and PR were 49.1% and 54.7% respectively. SEL and SPL were significantly higher in the patients with lung cancer than in the subjects of the control groups (P<0.05), no matter whether ER and PR were positive or negative. SEL and SPL were lower in the ER positive, PR positive and both ER and PR positive groups than in the ER negative, PR negative and both ER and PR negative groups. Conclusion: The existence of ER and PR in the patients with bronchogenic carcinoma indicates that the pathogenesis of bronchogenic carcinoma is sex hormone dependent to some extent. ER and SEL are negatively correlated with a correlative coefficient of -1.

Bronchogenic Carcinoma in a Scleroderma Patient with Multiple Metastases： One Case Report

IntroductionThe association between pulmonary interstitial fibrosis and the development of bronchogenic carcinoma in a patient with scleroderma has been reported rarely. It is hypothesized that intense epithelial proliferation that is accompanied by the .brotic process increases the occurrence of carcinomatous changes. We report the case of a pa-tient who presented with 3-year history of Raynaud＇s phenomenon, gradual tightening of the skin which was ignored by the patient and her family members, and a 2-week history of severe respiratory dis-tress with left shoulder and upper back pain followed by the develop-ment of paraparesis. After a series of examinations, the patient was diagnosed with scleroderma and simultaneously with bronchogenic carcinoma and multiple distant metastases.

Preliminary assessing no-surgical treatment response in bronchogenic carcinoma with three-phase contrast material-enhanced MRI

Objective:The aim of this study was to evaluate the efficacy of three-phase contrast material-enhanced MRI in assessing no-surgical treatment response in peripheral bronchogenic carcinoma preliminarily.Methods:Twenty-two patients with bronchogenic carcinoma after no-surgical treatment underwent three-phase contrast material-enhanced MRI.Three scans were obtained at 25 s,120 s and 180 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 2 mL/s by using an autoinjector.Precontrast and postcontrast signal intensity on every scan was recorded.Peak Height(PH) and Maximum Enhancement(Emax) were calculated.Enhancement pattern was evaluated on the images obtained at 120 s and 180 s after injection of contrast medium.Results:Precontrast signal intensity,postcontrast signal intensity at 120 s and 180 s were 478 ± 108,926 ± 209 and 1050 ± 252.PH(571 ± 225) and Emax(119 ± 49) of bronchogenic carcinoma after no-surgical treatment were significantly lower than those of bronchogenic carcinoma without any therapy(mean PH 655,mean Emax 150)(t = 2.178,P = 0.005 < 0.05,t = 4.196,P = 0.001 < 0.05).Six cases among 22 appeared homogeneous enhancement at 180 s.At 120 s,there were 4 cases with inhomogeneous enhancement,1 case with homogeneous enhancement,1 case with peripheral enhancement among the 6 cases.Conclusion:Bronchogenic carcinoma after no-surgical treatment shows a gradual increase to the PH after administration of contrast material.Three-phase contrast material-enhanced MRI can reflect the blood supply of bronchogenic carcinoma and might be effective approach for evaluation of no-surgical treatment response in bronchogenic carcinoma.

Assessing no-surgical treatment response in bronchogenic carcinoma with contrast material-enhanced computed tomography

Objective:The aim of the study was to evaluate the efficacy of contrast material-enhanced computed tomography(CT) in assessing no-surgical treatment response in bronchogenic carcinoma.Methods:The 67 patients with bronchogenic carcinoma after no-surgical treatment underwent two-phase contrast material-enhanced computed tomography.Two spiral CT scans were obtained at 25 and 90 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 4 mL/s by using an autoinjector.Precontrast and postcontrast attenuation values on every scan were recorded and peak height was calculated.Enhancement pattern was evaluated on the image obtained at 25 and 90 s after injection of contrast medium.Results:Precontrast attenuation value,postcontrast attenuation values at 25 and 90 s were(41.26 ± 7.77) Hu,(56.45 ± 10.48) Hu,(70.82 ± 11.99) Hu,respectively.No statistically significant difference in precontrast attenuation was found between our results in this study and the results in our old study(mean precontrast attenuation 40.70 Hu) which was obtained in cases without any therapy(t = 0.593,P = 0.555﹥0.05).Peak height of bronchogenic carcinoma after no-surgical treatment [(29.40 ± 10.73) Hu] were significantly lower than that of bronchogenic carcinoma without any therapy obtained in our old study(mean peak height 35.79 Hu)(t =-4.874,P = 0.001 < 0.05).The 39 among 67 cases appeared homogeneous enhancement at 90 s.At 25 s,there were 26 cases with inhomogeneous enhancement,9 cases with homogeneous enhancement,2 cases with central enhancement,and 2 cases with peripheral enhancement among the 39 cases.Conclusion:Peak heights can reflect the blood supply of bronchogenic carcinoma and might be an index for evaluation of no-surgical treatment response in bronchogenic carcinoma.

Imaging diagnosis of bronchogenic carcinoma(the forgotten disease)during times of COVID-19 pandemic:Current and future perspectives

Patients with bronchogenic carcinoma comprise a high-risk group for coronavirus disease 2019(COVID-19),pneumonia and related complications.Symptoms of COVID-19 related pulmonary syndrome may be similar to deteriorating symptoms encountered during bronchogenic carcinoma progression.These resemblances add further complexity for imaging assessment of bronchogenic carcinoma.Similarities between clinical and imaging findings can pose a major challenge to clinicians in distinguishing COVID-19 super-infection from evolving bronchogenic carcinoma,as the above-mentioned entities require very different therapeutic approaches.However,the goal of bronchogenic carcinoma management during the pandemic is to minimize the risk of exposing patients to COVID-19,whilst still managing all life-threatening events related to bronchogenic carcinoma.The current pandemic has forced all healthcare stakeholders to prioritize per value resources and reorganize therapeutic strategies for timely management of patients with COVID-19 related pulmonary syndrome.Processing of radiographic and computed tomography images by means of artificial intelligence techniques can facilitate triage of patients.Modified and newer therapeutic strategies for patients with bronchogenic carcinoma have been adopted by oncologists around the world for providing uncompromised care within the accepted standards and new guidelines.

Peripheral bronchogenic carcinoma: Enhancement pattern evaluation on PACS and CT workstations

Objective: The aim of the study was to determine the efficiency and effectiveness of picture archiving and communication system(PACS) workstation in detecting enhancement pattern of peripheral bronchogenic carcinoma. Methods: The 62 patients with peripheral bronchogenic carcinoma underwent two-phase contrast material-enhanced multislices computed tomography(MSCT) of the chest in a single-breath-hold technique. Two spiral CT scans were obtained at 25 s and 90 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 4 m L/s by using an autoinjector. Precontrast and postcontrast attenuation on every scan were measured on PACS and CT workstations respectively and peak height was calculated. Enhancement pattern was evaluated on the image obtained at 90 s after injection of contrast medium on PACS and CT workstations respectively. Results: No statistically significant difference in precontrast attenuation, postcontrast attenuation at 25 s and 90 s was found between these measured on a PACS workstation [(40.21 ± 7.03) HU;(55.53 ± 11.09) HU;(75.95 ± 13.45) HU] and those [(39.01 ± 8.95) HU;(56.01 ± 10.91) HU;(76.03 ± 11.95) HU] on a CT workstation(t = 1.140, P = 0.256 > 0.05; t = 1.580, P = 0.149 > 0.05; t = 1.505, P = 0.150﹥0.05). The peak height that calculated on a PACS workstation was 35.74 HU(20 HU). There was not statistically significant difference in peak height between that calculated on a PACS workstation and that on a CT workstation [(37.02 ± 12.05) HU; t = 2.001, P = 0.099 > 0.05]. The tumors showed same enhancement pattern on PACS workstation and CT workstation. Of the 62 cases, 38 showed homogeneous enhancement, 17 showed heterogeneous enhancement, five showed peripheral enhancement, two showed central enhancement, at 90 s. The enhancement pattern revealed on PACS workstation was consistent with feature of peripheral bronchogenic carcinoma. Conclusion: The efficiency and effectiveness of PACS workstation is as same as those of CT workstation in detecting enhancement pattern of peripheral bronchogenic carcinoma.

INVESTIGATION OF BLOOD SUPPLY OF BRONCHOGENIC CARCINOMA DERIVING FROM PULMONARY ARTERY

Microfil perfusion technique was used to investigate the blood supply of bronchogenic carcinoma deriving from pulmonary artery on 20 fresh specimens of lung cancer, including 11 squamous carcinoma, 6adenocarcinoma, 1 alveolar cell carcinoma and 2undifferentiated carcinoma cases. The results showed that the appearance and quantity of pulmonary blood supply of bronchogenic carcinoma depended on and changed with the site, activity,growth mode as well as the local condition of tumor nodules; pulmonary artery supplied blood to the Periphery of the tumor and its iunermost part as well; vessels from pulmonary artery in tumor nodules were generally less in number than those in the surrounding normal lung tissues around. The results suggested that the tumor blood supply from pulmonary artery should he evaluated comprehensively and dynamically; during interventional chemotherapy via pulmonary artery, patients should bc selected carefully and the catheter for infusion placed in suitable position so as to gain the best therapeutic effect.

Preliminary investigation of tumor angiogenesis and blood flow pattern in solitary bronchogenic adenocarcinoma: radiologic-pathologic correlation

Objective: To investigate the correlations of vascular endothelial growth factor (VEGF)-positive tumor angiogenesis and the quantifiable parameters of blood flow pattern derived with dynamic CT in solitary bronchogenic adenocarcinoma. Methods: 30 patients with VEGF-positive bronchogenic adenocarcinomas (diameter ≤ 4 cm) underwent multi-location dynamic contrast material-enhanced (nonionic contrast material was administrated via the antecubital vein at a rate of 4 mL/sec by using an autoinjector) serial CT. The quantifiable parameters (Perfusion, peak height, ratio of peak height of the bronchogenic adenocarcinoma to that of the aorta and mean transit time) of blood flow pattern derived with dynamic CT in solitary bronchogenic adenocarcinoma were compared with microvessel densities (MVDs) and VEGF expression by immunohistochemistry. Results: Peak height of VEGF-positive bronchogenic adenocarcinoma was 36.06 HU ± 13.57 HU, bronchogenic adenocarcinoma-to-aorta ratio 14.25% ± 4.92, and perfusion value 29.66 ± 5.60 mL/min/100 g , mean transit time 14.86 s ± 5.84 s, and MVD 70.15 ± 20.03. Each of peak height, ratio of peak height of the bronchogenic adenocarcinoma to that of the aorta and perfusion correlated positively with MVD (r = 0.781, P < 0.0001; r = 0.688, P < 0.0001; r = 0.716, P < 0.0001; respectively). No significant correlation was found between mean transit time and MVD (r = 0.260, P = 0.200 > 0.05). Conclusion: Perfusion, peak height and ratio of peak height of the bronchogenic adenocarcinoma to that of the aorta reflect MVD in VEGF-positive bronchogenic adenocarcinoma. Perfusion, peak height and ratio of peak height of the bronchogenic adenocarcinoma to that of the aorta derived with dynamic CT might be index for VEGF-related tumor angiogenesis in bronchogenic adenocarcinoma.

Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 30 years

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients. Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic

Irreversible electroporation for metastatic pancreatic carcinoma with liver metastasis:What does the evidence say

Irreversible electroporation is a promising non-thermal ablation method that has been shown to increase overall survival in locally advanced pancreatic cancer in some studies.However,higher quality studies with proper controls and randomization are required to establish its superiority when added with neoadjuvant chemotherapy over the current management of choice,which is chemotherapy alone.Further studies are required before establishment of any survival benefit in metastatic pancreatic carcinoma,and such evidence is lacking at present.

Cetuximab combined with chemotherapy for simultaneous esophageal squamous cell carcinoma and colon adenocarcinoma:A case report

BACKGROUND Multiple primary carcinomas(MPCs)are defined as two or more independent primary cancers that occur simultaneously or sequentially in the same individual.Synchronous MPCs are rarer than solitary cancers or metachronous MPCs.Accurate diagnoses of synchronous MPCs and the choice of treatment are critical for successful outcomes in these cases.CASE SUMMARY A 64-year-old patient presented with dysphagia,without obvious cause.A diagnosis of synchronous esophageal squamous cell carcinoma and colon adenocarcinoma with liver metastasis was confirmed based on examination and laboratory results.After multi-disciplinary consultations,combination chemotherapy(a 3-wk cycle with oxaliplatin 212 mg administered on day 1 and capecitabine 1.5 g twice daily on days 1-14)and esophageal cancer radiotherapy were initiated.Based on the results of genetic testing,we switched to a regimen of leucovorin+fluorouracil+oxaliplatin and cetuximab regimen for 8 cycles.Subsequently,capecitabine and bevacizumab were administered until the most recent follow-up,at which the tumor remained stable.CONCLUSION Successful cetuximab chemotherapy treatment provides a reference for the nonoperative and homogeneous treatment of different pathological types of synchronous MCPs.

Combined hepatocellular cholangiocarcinoma: A clinicopathological update

Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a rare primary liver cancer associated with an appalling prognosis.The diagnosis and manage-ment of this entity have been challenging to physicians,radiologists,surgeons,pathologists,and oncologists alike.The diagnostic and prognostic value of biomarkers such as the immunohistochemical expression of nestin,a progenitor cell marker,have been explored recently.With a better understanding of biology and the clinical course of cHCC-CCA,newer treatment modalities like immune checkpoint inhibitors are being tried to improve the survival of patients with this rare disease.In this review,we give an account of the recent developments in the pathology,diagnostic approach,and management of cHCC-CCA.

Vaginal clear cell adenocarcinoma in Herlyn-Werner-Wunderlich syndrome:A case report

BACKGROUND Herlyn-Werner-Wunderlich(HWW)syndrome is a rare Müllerian duct anomaly,characterized by a combination of urogenital abnormalities.The occurrence of primary cervico-vaginal carcinomas in patients with HWW syndrome is excep-tionally rare,posing significant challenges for screening,early diagnosis,and effective management.CASE SUMMARY We report a rare case of primary clear cell carcinoma of the vagina complicated in a 40-year-old woman with HWW syndrome.The patient presented with irregular vaginal bleeding for 4 years.On gynecological examination,an oblique vaginal septum was suspected.Surgical resection of the vaginal septum revealed a com-municating fistula and a tumor on the left vagina and the left side of the septum,which was confirmed as clear cell carcinoma.One month later,she underwent a radical hysterectomy,vaginectomy,bilateral salpingo-oophorectomy,and pelvic lymph node dissection.Due to significant side effects,she completed only one course of chemotherapy.A year later,lung metastasis was detected and continued to grow.A thoracoscopic wedge resection of the right upper lobe was performed 4 years after the initial surgery.We also conducted a systemic review of the lite-rature on primary cervical or vaginal carcinoma in HWW syndrome to explore this rare entity.CONCLUSION Cervico-vaginal adenocarcinomas in patients with HWW syndrome are occult,and require early surgical intervention and regular imaging surveillance.

New trends in diagnosis and management of gallbladder carcinoma

Gallbladder(GB)carcinoma,although relatively rare,is the most common biliary tree cholangiocarcinoma with aggressiveness and poor prognosis.It is closely associated with cholelithiasis and long-standing large(>3 cm)gallstones in up to 90%of cases.The other main predisposing factors for GB carcinoma include molecular factors such as mutated genes,GB wall calcification(porcelain)or mainly mucosal microcalcifications,and GB polyps≥1 cm in size.Diagnosis is made by ultrasound,computed tomography(CT),and,more precisely,magnetic resonance imaging(MRI).Preoperative staging is of great importance in decisionmaking regarding therapeutic management.Preoperative staging is based on MRI findings,the leading technique for liver metastasis imaging,enhanced three-phase CT angiography,or magnetic resonance angiography for major vessel assessment.It is also necessary to use positron emission tomography(PET)-CT or ^(18)F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic uptake.Staging laparoscopy may detect dissemination not otherwise found in 20%-28.6%of cases.Multimodality treatment is needed,including surgical resection,targeted therapy by biological agents according to molecular testing gene mapping,chemotherapy,radiation therapy,and immunotherapy.It is of great importance to understand the updated guidelines and current treatment options.The extent of surgical intervention depends on the disease stage,ranging from simple cholecystectomy(T1a)to extended resections and including extended cholecystectomy(T1b),with wide lymph node resection in every case or IV-V segmentectomy(T2),hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y,and adjacent organ resection if necessary(T3).Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery,but much attention must be paid to avoiding injuries.In addition to surgery,novel targeted treatment along with immunotherapy and recent improvements in radiotherapy and chemotherapy(neoadjuvant-adjuvant capecitabine,cisplatin,gemcitabine)have yielded promising results even in inoperable cases calling for palliation(T4).Thus,individualized treatment must be applied.

Early adenocarcinoma mixed with a neuroendocrine carcinoma component arising in the gastroesophageal junction: A case report

BACKGROUND Early adenocarcinoma mixed with a neuroendocrine carcinoma(NEC)component arising in the gastroesophageal junctional(GEJ)region is rare and even rarer in young patients.Here,we report such a case in a 29-year-old Chinese man.CASE SUMMARY This patient presented to our hospital with a 3-mo history of dysphagia and regurgitation.Upper endoscopy revealed an elevated nodule in the distal esophagus 1.6 cm above the GEJ line,without Barrett’s esophagus or involvement of the gastric cardia.The nodule was completely resected by endoscopic submu-cosal dissection(ESD).Pathological examination confirmed diagnosis of intra-mucosal adenocarcinoma mixed with an NEC component,measuring 1.5 cm.Immunohistochemically,both adenocarcinoma and NEC components were positive for P53 with a Ki67 index of 90%;NEC was positive for synaptophysin and chromogranin.Next-generation sequencing of 196 genes demonstrated a novel germline mutation of the ERCC3 gene in the DNA repair pathway and a germline mutation of the RNF43 gene,a common gastric cancer driver gene,in addition to pathogenic somatic mutations in P53 and CHEK2 genes.The patient was alive without evidence of the disease 36 mo after ESD.CONCLUSION Early adenocarcinoma with an NEC component arising in the distal esophageal side of the GEJ region showed evidence of gastric origin.

Advanced Lung Adenocarcinoma with EGFR 19-del Mutation Transformed into SCC after EGFR-tyrosine Kinase inhibitors Treatment:A Case report

BACKGROUND Epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)significantly improve the survival of patients with Epidermal growth factor receptor(EGFR)sensitive mutations in non-small cell lung cancer(NSCLC).CASE SUMMARY A 67-year-old female patient in advanced lung adenocarcinoma suffered from drug resistance after EGFR-TKIs treatment.Secondary pathological tissue biopsy confirmed squamous cell carcinoma(SCC)transformation.Patients inevitably encountered drug resistance issues after receiving EGFR-TKIs treatment for a certain period of time,while EGFR-TKIs can significantly improve the survival of patients with EGFR-sensitive mutations in NSCLC.Notably,EGFR-TKIs resistance includes primary and acquired.Pathological transformation is one of the mechanisms of acquired resistance in EGFR-TKIs,with SCC transformation being relatively rare.Our results provide more detailed results of the patient’s diagnosis and treatment process on SCC transformation after EGFR-TKIs treatment for lung adenocarcinoma.CONCLUSION Squamous cell carcinoma transformation is one of the acquired resistance mechanisms of EGFR-TKIs in advanced lung adenocarcinoma with EGFR mutations.

Downstaging strategies for unresectable hepatocellular carcinoma

A significant number of patients with hepatocellular carcinoma(HCC)are usually diagnosed in advanced stages,that leads to inability to achieve cure.Palliative options are focusing on downstaging a locally advanced disease.It is wellsupported in the literature that patients with HCC who undergo successful conversion therapy followed by curative-intent surgery may achieve a significant survival benefit compared to those who receive chemotherapy alone or those who are successfully downstaged with conversion therapy but not treated with surgery.Hepatic artery infusion chemotherapy can be a potential downstaging strategy,since recent studies have demonstrated excellent outcomes in patients with colorectal liver metastatic disease as well as primary liver malignancies.